undertaken by the Regional Office with the assistance of the SEA/ACMR and other scientists as required. The SEAIACMR in future sessions is expected to try to evaluate the impact of the Regional Research Programme, taking into consideration the contributions of the inter-country project as well as of the research promotion and development projects in the countries. he purpose of this evaluation would be to study the impact of the WHO research programme at country level on the generation of further national activities, allocation of greater national resources and attraction of external assistance to Member countries. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Three titles - "A guide to the care of the low birth-weight infant", "Health research - a simplified community-based approach", and "The health care system of Thailand: a case study" - were brought out under the WHO Regional Publications, South-East Asia Series, during the year. In all, 150 assignment reports of short-term consultants and .long-term staff, final reports on projects and reports on meetings and seminars were edited, processed and issued. Reports brought out under printed cover for wider distribution included the following: (a) Prevention and Control of Pulmonary Hypertension - Report of an Inter-country Seminar; (b) Regional Network of Public Health Institutions for South-East Asia - Report of a WHO (SEARO) Expert Group; (c) Meeting of the Bi-regional Research Study Group on Culex-borne Bancroftian Filariasis; (d) Research in Viral Haemor- rhagic Fevers in the Eastern Mediterranean, South-East Asian and Western Pacific Regions - Report of a meeting; (e) Strategies for Health For All by the Year 2000 - Report of a Joint WHO/UNICEF Regional Meeting; (f) Team-work for Primary Health Care - Report of a WHO (SEARO) Expert Group; (g) Malaria Research and Training in Nepal - Report of an AsDBfWHO Mission; (h) Report of a WHO Seminar on "Anti-malaria Operations with Special Reference to Applied Field Research in Malaria"; (i) Maternal and Child Health and Family Planning in the People's Republic of China - Report on a WHO Study Mission; (j) Central and Regional Occupational Health and Industrial Hygiene Laboratories: Project Findings and Recommendations - Report prepared for the Government of the Republic of Indonesia by WHO Acting as Executing Agency for UNDP; (k) Relief Cataract Services in the South-East Asia Region - Report of an Inter-country Workshop (issued also as Eye Health in South-East Asia Series No. 31, and (1) The Development of Research Protocols on Priority Areas in Traditional Medicine - Report on a Regional Meeting. In addition, wide distribution was given to a large number of other documents. The report and minutes of the thirty-third session of the Regional Committee and the report of the technical discussions held during the session on "Health Manpower Planning and Community Participation for Primary Health Care", were, as usual, edited and issued with a printed cover. A "Supplement to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought out, incorporating the resolutions adopted at the thirty-third session. Sales - The total sales of WHO publications during 1980 amounted to ~~$74 758*, of which subscriptions accounted for US$42 620 and other sales ~~$32 138. These included counter sales, single copy orders, receipts on behalf of Headquarters and lorpriced Regional Office publications. The sales for the first five months of 1981 amounted to US$47 000. Exhibitions and displays WHO participated in the Second United Nations Book Exhibition, held in Bangalore (India) from 5 to 12 April 1981, and set up a stall for displaying its publications. A card calendar with information on WHO publications and on their availability through the Regional Office was printed and distributed to the visitors. Selected books were on display in World Health House during important meetings, seminars and courses, such as the ICMRIWHO Scientific Group Meeting on Vaccination Against Tuberculosis, Meeting on the Preparation of Health Education Specialists in Support of Health for All by the Year 2000, Seminar on New Approaches Developed for the Control of Sexually-transmitted Diseases, Meeting on Promotion of Lay Reporting System in Primary Health Care, and Consultation on Regional Training Prograurnes for Health Sciences Librarians. Groups of nursing students and health educators visiting the Regional Office were regularly briefed on WHO publications and their availability at concessional rates. *All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50% discount (40% in respect of subscriptions) and, in some cases, an additional 10% trade discount have been allowed. Therefore, the commercial value of the publi- cations sold should be taken to be approximately double the figures given.
PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services Member States have well recognized the importance of systematic plan- ning, and have been formulating annual, medium-term and long-term plans for overall socio-economic development, of which health is an essential component. Country health programming (CHP), involving not only health but also other sectors in the formulation of health plans, is increasingly being accepted, applied and improved. In fact, some countries in the Region are carrying out the second cycle of CHP. In all these planning exercises, there is concrete evidence of positive policy support and a strong national commitment to the goals of Health for All by the Year 2000 (HFAl2000) and to the health concepts outlined in the Declaration of Alma-Ata. In this context it is most significant that the Charter for Health Development has now been adopted by nearly all the governments of the Region. In view of the fact that health development is planned as a multi- sector activity, and as the contributions of the various sectors must be coordinated, most of the governments have appointed high-level committees to act as coordinating bodies at the national level, to formulate policy and to supervise the planning,monitoring and evalua- tion of health development activities. For this purpose, health information systems are being strengthened, and manpower for health planning is being trained at all levels. Governments have also accepted the primary health care approach as the best way of providing reasonably good health services to all the people,especially the underserved groups,within the next two decades. For achieving this task, it is essential to expand and strengthen the health infrastructure,especially in regard to the training and super- vision of primary health care workers and the provision of logistic support and referral systems. The need for comprehensive and integrated services is also well under- stood by health ministries. In other words, the trend toward develop- ing promotive, preventive, curative and rehabilitative services, not only for rural areas but also for urban slums, and developing them in an integrated manner at the community level, is gaining momentum. 1.1.1 Health Planning, Programme Formulation and Evaluation The mechanics of health planning,as well as those of programme formu- lation and evaluation,together with efforts to improve national capa- bilities in these fields,have thus continued to make steady progress. The planning exercises mentioned above have also been conducted at provincial and district levels, and some countries have even started macro and micro-level evaluation. In BANGLADESH, country health programming (CHP) was carried out for the second time and a comprehensive country health profile prepared. These exercises contributed to the preparation of the Second Five- Year Plan(1980-1985) for the health sector as well as long-term plans up to the year 2000. The Government has set up a multisectoral national council for the promotion of HFA/2000 together with several national committees. In addition, appropriate health legislation is being drafted, and the national health information system (NHIS) strengthened. In collaboration with non-governmental organizations, progress has been made with schemes for integrated rural development with the appropriate health component. Steps have also been taken to reorganize the health services and to adopt a unified approach to the delivery of integrated curative and preventive health and family planning services. WHO has provided technical support for these efforts. In BHUTAN,the existing UNDP/WHO joint health project is being expand- ed to strengthen the national health information system and to help in the further development of a health planning cell at central level. A start has been made with decentralized health planning, implementation and management in Paro District. In BURMA, the "People's Health Programme" has been elaborated on the basis of the country health programming exercise undertaken in 1975. There have been intensive preparatory activities, including steps to set up a national health development council and a committee for intersectoral coordination. Also, the Government is establishing a task force for HFA/2000; the health acts are being amended, and the formulation of new legislation is under way. In the second cycle of CHP, which started in July 1980 and was completed early in 1981, five broad programme areas were identified - community health care, hospi- tal care, disease control, environmental health and support services. Following this planning exercise, a workshop on project formulation and one on monitoring and evaluation were conducted, leading to the modification of the existing monitoring and evaluation system for CHP. People's councils at different levels - state,township and ward/ village - are involved in the planning and implementation of the pro- grammes, for which WHO has provided technical support. The Government of INDIA has committed itself to the provision of health for all its citizens by the year 2000. The health policy for 1980-85 accords very high priority to primary health care, with emphasis on intersectoral coordination. Indicators have been estab- lished to monitor the progress towards HFA/2000, and five working groups, including one on inter-sectoral coordination, have been set up to prepare reports on various components of the national plan, with staff from the Regional Office contributing to these efforts. It is proposed to establish a national coordination committee for HFA consisting of persons drawn from high decision-making levels in the health and related ministries. The phased implementation of integrat- ed rural development programmes, with special stress on tribal and other difficult areas, and of schemes for the integrated development of children received priority support. Reorganization of the central, State and district health administrations, with emphasis on decentra- lizing and restructuring for efficiency, is under way. INDONESIA has made significant headway in reformulating its health system and in preparing long-term plans for HFA/2000. So far, two five-year health development plans have been formulated, adopted and implemented, i.e., Pelita I (1969-1974) and Pelita I11 (1974-1979); Pelita 111, covering the period 1979-1984, is now in operation. The national health information system also is being strengthened. WHO continued to collaborate in these activities: a team of specialists, consisting of health planners, health economists and statisticians, along with several short-term consultants, has assisted the country in its continuing efforts to develop and improve systematic national health planning and management. In MALDIVES, the first country health programming exercise, which took place in 1980, determined priority programmes for health ser- vices and health manpower development. As a result, intensive efforts are being made to carry out appropriate health manpower training so that there will be adequate numbers of health workers at all levels. ~echnical support has been provided by WHO through Regional Office and also inter-country project staff. Intersectoral coordination of health planning and development among the ministries concerned is also being strengthened. In MONGOLIA, the new five-year health plan (1981-1985) has been pre- pared in line with the primary health care concept. Also, the formu- lation of a strategy for health for all has been completed by a special group under the chairmanship of the First Deputy Minister of Health. Along with health, the development of other social sectors such as education and culture is being geared up, with housing and water supply receiving particular attention. The systematic enforce- ment of health and health-related legislation has been started under the State Planning Committee; also, external resources are being co- ordinated to ensure comprehensive socio-economic development, with health as a priority component. A new pilot scheme for comprehensive rural development including health has been drawn up with the help of a WHO consultant. In NEPAL, the Government has made plans for the health sector, with the objective of meeting the basic minimum needs of the people as the first step towards HFAI2000. To facilitate the achievement of this goal, a national development council has been created, with is Majesty the King as chairman. The National Planning Commission is actively working for intersectoral coordination, and the Ministry of Health has been using comprehensive CHP concepts and methods for the planning, monitoring and evaluation of health development activities. The Government has set up a steering committee for HFA/2000 and an HMGIWHO management committee; also, a community health and integrated development board is being formed to facilitate the development of community health services. Health planning is being decentralized to the district level; the national health information system is being strengthened; a scheme for integrated rural development with a health component is being implemented, and indicators have been developed for the monitoring and evaluation of health programmes. Health for all by the year 2000 has been accepted as a national goal by the Government of SRI LANKA. It is also realized that the achievement of this objective calls for concerted and collaborative efforts on the part of the Ministry of Health and related ministries and agencies. A national health development committee has been estab- lished as the technical arm of the National Health Council; this cmittee, on which WHO is represented, with its sub-committees, consisting of members of the Health Ministry and related ministries and institutions, is charged with the responsibility of drawing up appropriate strategies and plans of action for HFAl2000. It is proposed to create similar intersectoral committees at the district level as well. Steps have been taken to decentralize the health administration, and a White Paper on a major reorganization of the Ministry of Health has been cleared by the Cabinet for general dis- cussion and debate. WHO has been supporting some of these efforts both technically and financially. THAILAND has made significant progress in health planning and manage- ment. Several seminarslworkshops were conducted during the period under review, to orient health officials in health planning methods and techniques,to set up targets with indicators, and to evolve stra- tegies and plans of action for health development. WHO not only has supported these activities, but also has assisted in strengthening the planning ~ivision and the national health information system, thereby stimulating efforts to develop health planning not only at central but also at provincial and district levels; the Ministry of Public Health has been working closely with the ~ational Economic and Social Development Board and the Budget Bureau in this regard. A planning committee for social development at macro-level has been established by the Government, with a sub-cornittee on health, which has set up working groups to activate the health planning processes further at all levels. The Ministry of Public Health is using CHP methods and managerial processes for national health development as conceived by WH0,and the Organization has provided financial support for setting up a network for this development. Through WH0,assistance is also being provided by the Government of the Netherlands. 1.1.2 Organization of Health Services Governments' awareness of the role of the health infrastructure in providing supervisory and referral support to help primary health care workers increase the coverage and improve the quality of their services has already been stressed. In view of the limited services available to the people living in rural areas and urban slums, all governments have now accepted the policy of developing integrated primary health care services by augmenting the number of health centres, sub-centres and primary health care workers at the grass- roots level. In BANGLADESH, two divisions, i.e., those of Health and Population Control, have been combined and brought under a single supervisory authority. Likewise, the Directorates of Curative and Preventive Health Services have been amalgamated to form one Directorate General of Health Services. The Government has constituted a national field implementation committee for the primary health care programme which periodically reviews the progress made in the primary health care pilot project and suggests further improvements. The health infrastructure in the country will be further strengthened under the Second Five-Year ~lan(1980-1985),which envisages the opera- tion of thana health complexes, one in each of the 356 rural thanas, as well as 4500 union health centres/family welfare centres. These complexes will support primary health care activities at village level. As against the target of 356 thana health complexes, 290 have become functional; similarly, as against the target of 4500 union health centres/family welfare centres, 1990 have started functioning. In all, 5000 Palli Chikitshaks have been trained so far to work in rural areas, and at village level, approximately 13 500 field workers are providing health care. The specialized medical care services in subdivisional and district hospitals will be further strengthened to form an effective referral chain along with the thana health complexes and union health centres. In order to strengthen the health infrastructure, laboratory services will also be ~rovided so that the quality of diagnosis and other sup- port to public health programmes will be improved at district, thana and union levels. WHO helped to organize a management workshop for senior government officials to orient them in effective health management practices. In BHUTAN, progress continued to be made in converting dispensaries into integrated basic health units. Zonal health supervisory systems have been established, and zonal hospitals are being strengthened to provide technical support and referral services and to help to train various categories of paramedical personnel. Assistance is being given in the training of village health volunteers, who are being used in primary health care. In BURMA, the people's Health Programme assigns first priority to primary heaIth care and basic health services. The coverage has now reached 50% e., 147) of the townships. About 14 000 cornunity health workers have been trained and posted to underserved villages, where they are supported and technically guided by the basic health services staff. Township hospital staff have been trained in hospital administration and management, and a hospital procedure manual has been prepared and distributed. With WHO assistance, special health services are being provided for workers and their families in three industrial areas of eight townships on the west bank of the Irrawaddy River. During the period under review,563 hospitals, 213 dispensaries and 1187 rural health centres became operational, UNICEF and WHO providing the necessary supplies and equipment. In INDIA, the Government accords the highest priority to the inte- grated rural health scheme. India now has 5463 primary health centres (PHcs), 42 032 sub-centres and 340 upgraded PHCs. Under the Sixth ~ive-Year Plan (1980-19851,the target is to establish 600 new primary health centres and 40 000 sub-centres and to upgrade 1000 rural dis- pensaries to become subsidiary health centres. WHO and UNICEF have continued to support the development of primary health care centres in the country. In INDONESIA, the expansion and strengthening of the infrastructure of basic health services in rural areas continued, in line with the needs of Pelita 111, which was started during the 1979-1980 fiscal year. At the end of Pelita 11, there were 4353 health centres, with at least one in each of the 3270 sub-districts in the country. The percentage of health centres staffed by doctors has reached 89.5, and the average number of health centre visits per day has increased from 25 to 75. The strengthened infrastructure of the rural health ser- vices has contributed greatly to the development of primary health care. A WHO team consisting of a public health administrator and a public health nurse is participating in the development of conrmunity health services. In MALDIVES, health care is provided through the Government Hospital in Male and by health centres in various atolls. WHO consultants in a variety of specialties have provided clinical services at the Govern- ment Hospital, Male. MONGOLIA continues to have a very good health service delivery sys- tem, from the central level to the aimak, somon and brigade levels. WHO provided the services of a hospital architect to assist the Government in designing hospital facilities suited to local condi- tions. An innovative scheme for coordinated and comprehensive rural development, including health, is being planned for Hubskul Aimak, with WHO'S technical support. In NEPAL, the Integrated Community Health Project has entered its third phase,bringing the number of integrated districts up to 23. The five core services - maternal and child health and family planning, the control of malaria,leprosy and tuberculosis and the expanded pro- gramme on immunization - are delivered as a package through regular home visits by village health workers in the integrated districts, while the health posts provide basic medical care. Malaria control is, however, being implemented in only six districts. A high-powered rnultisectoral coordination board is being established to develop com- prehensive rural health services. The Project,which WHO is supporting technically through the provision of a public health administrator, has organized annual workshops for district-level health personnel to enhance their management capabilities. SRI LANKA has an extensive network of both traditional and modern systems of health care. The indigenous system, which meets about 22 per cent of the demand, is limited to curative services and operates through a network of dispensaries and eight ayurvedic hospitals. The modern system, meeting some 73 per cent of the requirements for health care, provides both preventive and curative services. The physical infrastructure for health services is comparatively well developed in Sri Lanka, but the problem of brain drain continues to create difficulties in manning the health facilities. In THAILAND, the integrated rural health services continued to be strengthened and upgraded in support of primary health care. At present there is at least one provincial hospital in each province, and there are 305 district hospitals, with a total hospital bed strength of 31 727. The rural areas are served by 3899 health centres and 1613 midwifery centres, covering about 80% of these areas. WHO has continued to assist in the training of supervisory personnel and peripheral health workers at rural level. 1.1.3 Operational Studies Most of the operational studies undertaken or planned during the period were aimed at supporting HFA activities. As the strategies to achieve the objectives of ~FA/2000 evolve and national plans and regional actions in their support crystallize,the priorities in these studies can be more clearly perceived. The studies carried out so far in the countries of the Region have mostly been confined to the central levels of the health services and to the universities. The involvement of the field staff at the peripheral level in operational research has been inadequate, the major constraint continuing to be lack of training for such staff in the necessary investigative metho- dology. In BANGLADESH, the study of the financial aspects of health care delivery which started last year was completed; the data are being analysed, and a preliminary report has been prepared. The results of this study have, to some extent, helped to rationalize the budget allocation among different health subsectors. Another study, on the impact of socio-economic and educational aspects on disease pattern in rural children, is under way. A consultant was assigned to assist in the planning and conduct of a workshop on research planning and methodology. In BURMA, the WHO-sponsored study on the application of the risk approach to the delivery of maternal and child health care, initiated in 1979, continued during the period under review. The results of this study are likely to provide useful information for the develop- ment of national strategies to deliver the right type of MCH and family planning care through the redistribution of available resources based on the measurement of levels of individual and community risks. WHO provided a consultant to assist the Government in developing a research programme in health manpower development. In INDIA, the study on the outcome of pregnancy, including perinatal mortality and low birth weight, was completed, and one on the appli- cation of the risk approach and intervention strategies in MCH care was initiated in Maharashtra. The objectives of these studies are to develop strategies for MCH and family planning care and to build up a satisfactory model within the available resources. Three short-term consultants were assigned - one to assist in developing a progranme of research in health manpower development,the second to help conduct a sample survey to estimate the annual incidence of and mortality due to neonatal tetanus and poliomyelitis,and the third to collaborate in making a sample survey of the incidence of poliomyelitis and neonatal deaths in the States of Punjab and Haryana and the Union Territory of Chandigarh. Assistance was also provided in organizaing a national seminar on appropriate technology for health, which was held at the Indian council of Medical Research in April 1981. In INDONESIA, the studies on the incidence and causes of disability and on rehabilitation services through primary health care were com- pleted, and the data are being processed and analysed. The Centre for Research Development in Health Services in Surabaya continued to function as a WHO Collaborating Centre for Health Service Development and was involved in stimulating, promoting and implementing several research projects. A short-term consultant was assigned to colla- borate in the development of a research programme in health manpower development. Assistance was also provided in organizing national seminars on general research methodology and on an appropriate technology for health. SRI LANKA's study on health sector "commodity requirement and expenditure flows", initiated last year, continued. The results of the study should help to clarify a number of policy issues, such as the impact of the private sector, the pharmaceutical industry, and fiscal policy on the health sector and the choice of technology for future health management. Another study, an analysis of the work of medical officers and assistant medical practitioners, was carried out to facilitate decisions on educational management. A consultant collaborated in a research programme in health manpower development. Assistance was also provided in organizing a national seminar on health services research, held in February 1981; this seminar deli- neated important areas related to primary health care and helped to generate an awareness of the importance of the multidisciplinary approach and of intersectoral coordination. In THAILAND, the study on the application of the risk approach in the delivery of MCH care continued. The research workers evaluated the performance of auxiliaries and village health connnunicators, and an evaluation pre-test was carried out in three sub-districts. Data on the study of the factors responsible for rural low birth weights are being collected and processed. The pilot study on a simplified data collection system, for strengthening the MCH/FP information sub- system to support the monitoring of the programme, has resulted in the development of a simple data collection card, which is being field-tested. The study on the psycho-social aspects of rural health services continued, and two further studies - on strengthening the basic immunization programme in urban communities and on the perform- ance evaluation of village health volunteers and village health communicators in Nakhon Pathom Province - are under way. With WHO support seminars were organized for training national workers in research methodology with special reference to health services research and also in an appropriate technology for health. Consultants were assigned to advise on (a) research design and metho- dology, (b) the coordination of health research activities, (c) the development of a research programme in health manpower development, (d) survey techniques to establish the child mortality rate, (e) the cost analysis of health development programmes, (f) comparison of alternative strategies for health development by using cost effectiveness or other analytical economic methods, and (g) the formulation of long-term health plans. 1.2 Primary Health Care The Organization has begun to reorient its technical cooperation programme with Member States in consonance with national and regional strategies to achieve the goal of ~FA/2000. An HFA orientation has been given to regional group educational activities, and the precise ways in which WHO'S collaboration should now be extended are being evolved in consultation with Member States. There have also been regional and national activities directed toward the development of appropriate technology for health in relation to primary health care. Two workshops - one regional and the other bi- regional - were held in New Delhi in October 1980 and March 1981 respectively, to review the present level of technology in the Region and to seek ways and means of adapting the existing technologies and developing new ones. In BANGLADESH, the work of committees functioning at different levels of the administration for intersectoral coordination and community participation is being oriented towards the promotion of HFA/2000 objectives. In six pilot thanas, work on the formulation of village health committees and on acceptable methodologies for selecting family welfare workers is in progress. Another activity being carried out in the pilot phase is the training of community health workers. In this connexion, the translation of the WHO Manual, "The Primary Health Worker" has been completed. Also, a closer relationship bet- ween health and family planning workers, including community health workers and field personnel of other agencies, is being developed. In BURMA, considerable progress has been made in the implementation of the People's Health Programme. The training of community health workers, basic health workers and other health staff engaged in this programme continues according to plan, with support from WHO. The Organization has also extended assistance in improving the indigenous system of medicine. A study has shown that, as a result of the intro- duction of voluntary health workers, the proportion of the community seeking treatment from basic health workers has decreased consider- ably - an encouraging trend in the development of primary health care. In INDIA,as stated earlier,primary health care is given high priority in the new draft health policy for 1980-1985. The draft plans of ministries other than the Health Ministry have been coordinated to give priority to components related to HFA/2000. The budgetary provision for the health sector has been increased. The community health volunteer scheme now covers 2366 primary health centres, extending services to almost half the population. The number of community health volunteers exceeds 140 000. Steps are under way to strengthen the rural health divisions in the directorates of health of different States. Female health assistants working in the field have been trained in the early detection of complications of pregnancy as a part of improved primary health care of pregnant mothers. In INDONESIA, the Government, with WHO collaboration, initiated a comprehensive and critical review of the national health system in order to restructure it so as to achieve HFA/2000 goals. The Organization also supported a travelling seminar on primary health care and village development (PKMD) for 32 administrative leaders and medical officers from twelve provinces. The Ministry of Health, in collaboration with UNICEF and WHO, completed an assessment of primary health care activities as carried out by traditional birth attendants, village volunteers and school teachers in 52 villages of six provinces. Two national task forces and working groups developed a plan of action to implement the reconnuendations arising out of the assessment and submitted the plan to BAPPENAS, the central planning organization. In order to improve the monitoring and control of field activities, a model reporting and recording system for health centres is being prepared, and the training of 1030 health centre personnel, out of the Pelita 111 target of 5000, was completed. WHO organized a study tour for eight provincial-level supervisors to observe health centre reporting and recording in selected countries of the Region. With WHO collaboration, efforts continued for the production and distribution of a revised and updated version of the Health Centre Reference Manual. The Government of MALDIVES, in support of HFA/2000, has assigned high priority to efforts to overcome the shortage of trained manpower, and a systematic programme for training selected health personnel is in progress. The Government is also making efforts to utilize health auxiliaries to the maximum possible extent in the provision of pri- mary health care services. A health centre is being developed in each atoll as the core of the health services, with referral services pro- vided by the hospital in Male. In MONGOLIA,priority has been given to community-oriented out-patient care; it is planned that 75% of the health workers will be involved in providing out-patient medical care and that one paediatrician will serve about 750 children. The quality of health services is to be raised to a level which will correspond to that attained in other socialist countries. WHO has been supporting the Government in deve- loping these plans. In NEPAL, the "Basic Minimum Needs Steering Committee" established under the National Planning Commission consists of representatives from the five sectors involved in HFA/2000 activities (food and agriculture, primary and non-formal education, water and sanitation, rural communications and health), as well as from other important departments such as the Ministry of Finance. This committee has carried out a series of analyses, viz., population projection and requirements in regard to manpower, supplies and logistics, physical infrastructure, and finance in relation to HFA/2000. Based on these analyses, a preliminary document, "Planning for Provision of Basic Minimum Needs - 1980-2000", which was prepared in November 1979, has been revised and will be the basis for future action to achieve the goal. The Integrated Community Health Project (described in Section 1.1.2) is progressing satisfactorily as planned. During the period under review the ward-level health volunteer scheme was implemented in four panchayats and two districts on a pilot basis. Under the Sixth Plan it is proposed to extend this scheme to 13 districts. A manual for the volunteers has been developed and field-tested. In SRI LANKA, the re-organization of the health delivery system to be in line with the concept of primary health care received considerable emphasis during the year. Various alternative models have been reviewed and analysed,and the one based on the health centre concept, according to which comprehensive basic health services are provided to the population in a defined area,has been finally accepted. A team of paramedical personnel, such as assistant medical practitioners, nurses, public health inspectors and midwives, headed by a medical doctor, will be made respons'ible for the provision of family health, control of diseases, medical care and referral for the whole popula- tion of the area. It is expected that curative and preventive ser- vices, which have remained compartmentalized, will thus be integrated. In THAILAND, the national primary health care programme, which aims at providing at least 50% of the villages in the country with village health volunteers and village health communicators by 1981, is pro- gressing satisfactorily. WHO collaborated in the supervision and training of these categories of personnel. In addition, the popula- tion project, functioning in 20 selected provinces, also supported the primary health care activities in the project area. The develop- ment of appropriate technology for health in relation to primary health care is another area receiving priority. A national conference was held to focus attention on the technology required for different elements of the PHC package. Action directed towards the formation of drug cooperatives in support of primary health care has also increased considerably. A case study on the financing of primary health care at community level and another on technology for PHC which is now in use in rural areas were also undertaken with WHO support. 1.3 Traditional Medicine Burma and Sri Lanka have taken steps towards developing national programmes in traditional medicine. Indonesia and Thailand are study- ing the efficacy of some traditional medicines,and in Nepal the inte- gration of traditional medicine into the basic rural health services at the health-post level is in progress. A UNDP-assisted project on medicinal herbs and ayurvedic drugs for the least developed countries (Bangladesh, Bhutan and ~epal) in the Region,to facilitate the speedy development of their programmes in traditional medicine,became opera- tional during the year. In BANGLADESH, a national workshop on the promotion and development of traditional medicine was held in Dacca in December 1980. A short- term consultant has been provided to assist the Government in deve- loping a systematic programme on the basis of the recommendations of this workshop. In BURMA, a project on traditional medicine is in the offing with financial assistance from UNDP. The main aim of this project will be to strengthen the Institute of Indigenous Medicine in Mandalay and the existing traditional medicine hospitals/dispensaries in the country as well as to establish another 30 dispensaries. In ZNDONESZA,although a national project has not yet been developed, WHO gave financial support for translating into English copies of an Indonesian book on the utilization of medicinal plants. In order to make better use of the existing practitioners of tradi- tional medicine, the Government of MALDIVES has made plans to train them in primary health care. During the year under review, a specialist in traditional medicine advised the Government of NEPAL on the promotion of traditional medicine at the primary health care level. Recommendations were made for the planning and implementation of the programme,including the training of ayurvedic practitioners and the production of ayurvedic medicines at the Royal Drugs, Nepal. In' SRI LANKA, a separate Ministry of ~ndigenous ~edicine has been established. Plans are being formulated for carrying out a survey of the medicinal plants in the country,for training the existing prac- titioners of traditional medicine in primary health care, and for modernizing the production of drugs at the Ayurvedic Drugs Corpora- tion. Financial support was extended to the Government of THAILAND for the conduct of a national seminar on traditional medicine and primary health care. At the regional level, an inter-country meeting for the development of research protocols on priority areas in traditional medicine was organized in Varanasi, India, from 11 to 13 November 1980. Six such protocols were developed and have been sent to all the countries in the Region (except DPRK and ~ongolia) for appropriate action. It is expected that the response to these research protocols will be encouraging. Specialists from South-East Asia participated in three group educa- tional activities held in the People's Republic of China during the year, viz., (i) Raining Course in Acupuncture Treatment (1 September - 30 ~ovember); (ii) Inter-regional Meeting on Standardization and use of Medicinal Plants (3-11 November), and (iii) Training Course on Acupuncture Treatment (1 April - 30 June 1981). 1.4 Family Health The regional programme in maternal and child health, including family planning, continued to place emphasis on activities directed towards the goal of H~A/2000, in line with the regional strategies which were developed for this purpose and which were endorsed by the Regional Committee at its thirty-third session. WHO has supported the develop- ment, strengthening and integration of national maternal and child health and family planning activities as part of the primary health care package. In the field of manpower development for maternal and child health services, WHO assistance has been given in reorienting training programmes, both basic and continuing education, and in promoting the development of additional manpower to improve and extend coverage. The regional teacher education programme in maternal and child health continued to receive attention. School health services were promoted and strengthened to serve as an active focal point for primary health care. A regional meeting held in August 1980 drew up strategy guidelines for school health pro- grammes for the Region and for the development of a handbook for school health services. In the area of research promotion and development, support was given to health services research related to maternal and child health in several countries of the ~egion. In July 1980,WHO convened a regional workshop on the reproductive health of adolescents, where service- oriented research protocols relevant to the countries of the Region were outlined. A WHO consultant visited Bangladesh and Sri Lanka to assist the national scientists in completing the protocols. In accordance with a resolution of the Thirty-third World Health Assembly on infant and young child feeding (WHA33.32), renewed emphasis has been placed on the regional programme for support to Member countries in their attempts to promote breastfeeding, as a means of improving the health of infants and young children. Conse- quently, technical assistance was given to some countries in acti- vities concerned with education, training and information on infant and young child feeding and in formulating national codes for the marketing of breastmilk substitutes. Also, a regional plan of action on infant and young child feeding has been formulated to support national efforts. The activities in maternal and child health in the Region were imple- mented in close collaboration with UNICEF and UNFPA. Various group educational activities in maternal and child health were also carried out. In BURMA,the main thrust in technical support was towards the further development of health manpower for family health activities. Program- mes of in-service training for basic health workers,couuuunity workers (including traditional birth attendants) and workers of some allied sectors were supported and implemented. In order to strengthen refer- ral services for primary health care, fellowships in maternal and child health were awarded for training outside the country. A short- term consultant assisted in organizing suitable training programmes in maternal and child health for health personnel in the context of primary health care. A training workshop on educational technology was organized for the staff of the family health project with support from the Medical Education Unit of Institute of Medicine I, Rangoon. In INDIA, technical advisory support was provided for the UNFPA- funded family health programme. In order to strengthen perinatal and neonatal care at the district level, training courses for paediatri- cians and obstetricians were organized with the help of two WHO temporary advisers. The in-service training programme in maternal and child health for primary health centre doctors, supported by UNICEF,was evaluated by a WHO consultant, whose conclusions and recommendations were submitted to the Government. To help to ensure that details of the remodelled undergraduate paediatric curriculum, and of the curriculum on the teaching of MCH, are known to medical undergraduates and interns, WHO awarded further fellowships within the country. The usefulness of the "Handbook for the Delivery of Care to Mothers and Children in a Community Development Block" as a teachingflearning tool for the new curriculum in MCH and as a service manual for primary health centre physicians was evaluated by a consultant,who found the Handbook to be practical as a guide for medical officers of primary health centres and useful for undergraduates and interns. The preliminary draft "Handbook on Child Health" was completed by the Ad hoc Committee on MCH, coordinated by a WHO consultant. -- In MONGOLIA,the activities were implemented as planned; however,there was some delay in the supply of equipment, and the project activities were rescheduled at the request of UNFPA because of budgetary con- straints. Support was provided for establishing model aimak MCH services and organizing mobile teams for MCH services at aimak centres and in the somons. Intensive care units were set up in the children's and maternity wards of six aimak hospitals. The further development of health manpower in maternal and child health was promoted through the organization of national training programmes and the award of training fellowships. Several booklets related to education in family health as well as a handbook entitled "Healthy Family" were prepared. Six educational programmes in family health for parents were organized as part of the health education activities. The long-term WHO staff member under the maternal and child health project (MOG MCH 002) and the health education specialist working in the project "Epidemiological Studies of Population Growth" (MOG MCH 003) completed their assignments during the year. A national project manager has been assigned under project MOG MCH 003 since June 1980. A WHO consultant assisted in processing the data on research studies under the first phase of the UNFPA-funded project. Another consultant collaborated in designing the protocol of the study on infant and child nutrition, and in training national staff on the research methodology for the study. Research protocols for studies planned under the second phase of the UNFPA-funded project were designed with the assistance of a WHO statistical consultant. In NEPAL, technical support was provided through a new WHO project directed towards the development of the MCH component of the national FPIMCH project. A consultant was assigned to advise on strengthening and improving the existing maternal and child health and family plan- ning services,with special emphasis on health manpower training. Another WHO consultant helped to formulate a training programme on tubectomy (minilap technique) and also assisted in training health personnel in this procedure and in the organization and conduct of "minilap" camps. Assistance was also given to the training of health manpower in maternal and child health, especially at district level and directed toward panchayat-based workers,through national and regional training programmes. Training fellowships were also awarded in paediatrics to strengthen child health services at referral levels. Several UNFPA-funded projects became operational during the year under review. The research study on the growth and development of children using the WHO Growth Chart is continuing. Preliminary action was taken to support a study on maternal mortality and morbidity. In THAILAND, technical advisory services in family health were pro- vided through a long-term staff member assigned to the Regional Family Health Team. Activities under the UNFPA-funded projects, for which WHO is the executing agency, were related to health manpower development in family health through fellowships planned to meet the requirements of the national family planning programme, and through support to the infrastructure of the programme. These activities were implemented as planned, but because of UNFPA's financial constraints, the dates of award of some fellowships and delivery of some supplies and equipment had to be rescheduled. WHO participated in a UNFPA Needs Assessment Mission. A new project in maternal and child health for WHO support was formu- lated. Technical support also was given in organizing two national meetings on breastfeeding. Details of operational studies in this field are given in Section 1.1.3. 1.5 Nursing Since nurses,midwives and auxiliary nurses and midwives provide, and will no doubt continue to provide,the greater part of the primary health care in most countries of this region, their role in the deli- very of health care must be redefined, enlarged and enriched to meet the challenge of health for all. The educational programmes must be carefully planned so as to ensure that all nursing personnel are able to deliver health care services according to national needs and expectations. The development of nursing manpower as an integral part of the total health manpower has, therefore, been emphasized in WHO'S technical collaboration. The effective utilization of nursing person- nel, including traditional birth attendants (TBAs), in delivering health care services has also been encouraged. The collection and compilation of information on the status of nursing manpower were undertaken during the year. The Organization has been working with Member countries in the deve- lopment of nursing education and services. The framework given below is used as a guide in developing and planning activities at national level geared towards the primary health care programmes of the count- ries. Area 1: Development of nursing manpower planning as an integral part of the total health manpower system of the country. Area 2: Promotion of the effective utilization of all existing nursing personnel, including TBAs, in support of primary health care. Area 3: Development, strengthening and modification of nursing, midwifery and auxiliary nursing education programmes based on community health needs and problems, including the development of continuing education programmes for all categories of personnel. Area 4: Strengthening of the nursing service component at all levels of the health care delivery system. Area 5: Development of nursing research. - The progress and accomplishments in these five areas are shown for each country. In BANGLADESH, the Government has decided to establish more nursing schools to attain the goal of producing 10 000 nurses during the Second Five-Year Plan period. Thirty-eight additional senior regis- tered nurse (SRN) schools at the sub-divisional level and 170 junior nursing training centres in selected thana health complexes are envisaged. As of February 1981, 18 new SRN schools have been opened, bringing the total to 38. Four junior nurse training courses were conducted for a total of 78 participants and several handbooks and manuals were prepared. A continuing education programme was develop- ed, and its implementation planned, Three nurse coordinators have been designated to help with this programme. A write-up on the current situation of nursing manpower supply was completed. The introduction of a nursing registry system is envisaged. In BURMA, the training programme for traditional birth attendants is progressing well. The teaching methodology used in this programme has been considered to be most valuable to other countries in the Region. The development of nursing manpower planning, as an integral part of the total health manpower system of the country, was undertaken. In INDIA, the continuing education programme being carried out at the RAK College of Nursing, New Delhi, made good progress. A workshop on curriculum development was organized. A short course on orthopaedic nursing and rehabilitation was also conducted at the Jawaharlal Institute of Medical Education and Research, Pondicherry. The deve- lopment of a centre for specialized training in clinical nursing was discussed and the need for a further detailed plan recognized. In INDONESIA, support continues to be given for the implementation of the health nurse programme. As of January 1981 there were 94 schools officially reported to be in existence. A six-week clinical nursing course in the five major clinical areas was organized, and a one-year course leading to a certificate in special clinical fields for the general nurse has been planned and is expected to start later in 1981. A working group has been formed to review and revise the nurs- ing academy curriculum. A pilot study of graduates of four health nurse schools was undertaken in January 1981. (Above): The training of all categories of nursing personnel continues to receive Increasing attention in the Region. (Above right): Nursing is a vital element in the provision of medical care. ,Right): A group of student nurses receives instructions in midwifery. NURSING Special attention is being paid to the training and utili- zation of nursing personnel to extend health services to the periphery. It is estimated that 60-80 per cent of the deliveries in the Region take place under the supervision of a traditional birth attendant (TEA). To improve their skills an inter-regional workshop on ',Methods and Materials in TBA Training Programmes" was held in SEAR0 from 3-11 March 1981. Photo shows the partici- pants with Dr U KO KO. Regional Director (second from left in front row). who inaugurated the workshop. An operation theatre on whe provides services to ru communiti Health workers address villagers to seek their participation end involve ment in primary health care activities. TAKING HEALTH CARE TO THE PEOPLE A health worker on her daily rounds. _, .- .w . . , Warkersfrom a rural health centre '... . i , ,,a ' , : prepare to leave for home visits. Reorientation of nurses for the effective provision of primary health care is one of the main activities. An analysis of current curricula used for training the health aide and the assistant nurse was com- pleted. Translation of "Management of Obstetrics and Emergencies in a Health Centre", by B. Essex, into Bahasa Indonesia was completed, and the book will be tested for its relevance to local conditions. All training programmes at the Allied Health Services Training Centre, Male, MALDIVES, are progressing according to schedule. The strengthening of field experience for the students is being empha- sized in the training. Preparation of teaching staff in regard to course development, appropriate teaching methodology and evaluation methods constituted a major achievement. Group educational activities organized during the year helped to enhance the knowledge and skills of community health workers and other health personnel. In MONGOLIA, a WHO consultant provided assistance in the training of nurse tutors in aseptic techniques and of head nurses in hospital management, as well as in strengthening the nurse teachers' teaching methodology. In NEPAL, planning for the post-basic courses in community health nursing was undertaken. The criteria for student selection were formulated, and the preparation of field areas for student practice is under way. The curriculum has already been approved by Tribhuvan University, and the Post-basic Community Nursing Course started in March 1981. The Post-basic Midwifery Course is fully developed, and the final examination was held during March 1981. In SRI LANKA,specific aspects of the nursing activities being carried out have required the services of a short-term consultant. Assistance was provided in the development of an evaluation programme and the organization of four workshops to evaluate the teaching staff. In THAILAND, WHO collaborated in planning and organizing a national workshop on the "Role of Nursing Personnel in Supporting Primary Health Care Activities for the Attainment of HFA by the Year 2000". A community-oriented curriculum was developed with the assistance of a consultant. 1.6 Health Education Greater efforts have been made to reorientate health education ser- vices and activities, at both national and regional levels,in support of primary health care and community participation. Emphasis was laid on educational activities and the training of primary health care workers and community leaders. In addition, the Organization has paid greater attention to the socio-cultural determinants of health and health education and has begun to promote research and to utilize the findings in programme development and operation. An important acti- vity in this connexion was the inter-country Consultative Meeting on Research in Health Behaviour, Health Education and Community Partici- pation,convened in New Delhi during the year. Action on the recomen- dations of this meeting has been initiated at both regional and country level. An inter-country workshop on the preparation of health education specialists in support of HFA/2000 was also organized in New Delhi to examine the training programmes for health education specialists in countries of the Region, in order to make them more relevant to the needs of primary health care programmes. The Regional Office has taken health behaviour and health education into account in the implementation of country and inter-country programmes. BANGLADESH undertook a major reorganization and expansion of health education in collaboration with the World Bank and WHO. The Bank has provided funds to supplement the salaries of health educators and to house the reorganized Health Education Bureau, as well as to meet the cost of equipment,audio-visual aids and the production of manuals. WHO has assigned a health education specialist to study the reorga- nization of the services at the Ministry of Health and in the divi- sions, districts and subdivisions; he will also advise on the in- service training of health education specialists, civil surgeons and others, on the establishment of supporting services such as training units, audio-visual aids and mass communication, and on evaluation and research in the reorganized Health Education Bureau. Workshops have been held for the in-service training of health education specialists and civil surgeons. The MPH Degree Programme in Health Education at the National Insti- tute of Social and Preventive Medicine, Dacca, which was established to train health education specialists within the country, is now in its second year, with a WHO health education specialist serving as a part-time faculty member. Two consultants (in audio-visual and health education) were assigned by WHO to provide further assistance to the Institute. Health education activities have been accelerated in BURMA. The Government has established a special committee to formulate a health education project in support of the People's Health Programme, with emphasis on community participation in primary health care. The pro- ject provides for the expansion of health education services, both in the Ministry of Health and in the divisions, the training of health workers for health education, training of health education specia- lists, and production of audio-visual aids and communication media. The Regional Adviser on Health Education visited Burma during the year and assisted the committee in formulating the project. In INDIA, the Central Health Education Bureau and the bureaux in the States and union territories focused their efforts on health educa- tion in primary health care programmes. A number of workshops financed by WHO were held on the topics of school health education, development of national health education services, training of health education specialists in support of primary health care, and health education in the undergraduate medical curriculum. Special emphasis was placed on health education in the undergraduate medical curri- culum, a five-year programme for the purpose being developed with the assistance of a WHO short-term consultant. With WHO assistance, the Central Health Education Bureau completed a study of the functions performed by health educators as compared with those for which they are being trained. In addition, WHO is collabo- rating in the health behaviour and health education aspects of rural water supply projects in Bihar and Uttar Pradesh. Considerable progress was made in the development of health educa- tion services within the Health Department of the Province of Irian Jaya in INDONESIA. WHO awarded fellowships to enable national per- sonnel to obtain professional qualifications in health education, and helped to organize workshops to give in-service training in health education to senior provincial health department officials as well as health education coordinators of the nine regencies in the Province. A WHO health education specialist assisted in these activities and also helped in the planning, implementation and evaluation of health education activities in the Province. WHO also collaborated in the development of behavioural studies and health education as a part of the rural water supply project in the province of Nusa Tenggara Timur. The Directorate of Health Education in Jakarta has selected health education in hospitals for special attention, and a WHO short-term consultant was assigned to assist the Government in this work. During the year MALDIVES took steps to train primary health care workers and other personnel for health education responsibilities. A WHO consultant assisted the Government in developing the health edu- cation component of the curricula for the training of health person- nel as well as the faculty responsible for teaching health education at the Allied Health Services Training Centre. MONGOLIA carried out a survey of health education in selected commu- nity health education programes as well as in primary and secondary schools and teachers' colleges. Based on this survey, health edu- cation has been promoted, particularly in secondary schools and teachers' colleges. A manual on sex and family life education was prepared, and teachers have been trained for health education in teachers' colleges and selected secondary schools. In the light of the experience gained, health education will be extended to community health programmes and primary and secondary schools and teachers' colleges. A WHO health education specialist assisted the Government in these activities. During the year WHO, together with UNICEF, collaborated in a major review of health education services in NEPAL and formulated a plan of work to support primary health care and other health programmes. In addition, workshops for the training of teachers for school health education were held, with WHO support, and fellowships awarded for the training of health educators and media personnel of the Health Education Unit. In WHO'S collaboration with SRI LANKA in health education during the year, attention was directed to the preparation of the faculty res- ponsible for training primary health care workers (midwives) and to health education in the undergraduate medical curriculum: workshops for the faculty were held, and guidelines for training are being prepared. A meeting of the deans and faculties of medical schools was held to discuss the place of health education in the undergraduate curriculum. In addition to providing assistance in these activities, WHO also supported research on the village health volunteer programme. During the year, THAILAND placed greater emphasis on the development of provincial and regional health education services and the coordi- nation of the health education activities of the health services, hospitals, health-related departments and voluntary agencies. A national workshop was held with support from WHO, which also assigned a short-term consultant to review the current status of health educa- tion in the country, develop health education units in the regions and provinces, and establish coordination among the various agencies concerned. Appropriate research was also supported by the Organiza- tion. 1.7 Nutrition The main thrust of the programme in this area during the year was on the integration of nutrition into the primary health care services and the development of a coordinated approach with other disciplines in planning and implementing activities and research in nutrition. National nutrition units have been strengthened through technical cooperation in developing research-cum-action programmes and in establishing collaborating centres. The interaction of operational research with the implementation of activities is producing informa- tion which can readily be used to improve ongoing programmes. A meet- ing of the principal investigators of the project "Situation Analysis of Nutrition Component of Primary Health Care" was convened in the Regional Office in November 1980 to review the protocols and pre- liminary findings and discuss the methodologies adopted by various countries. In group educational activities organized during the year the focus was on the inclusion of the nutrition component of primary health care. WHO collaborated in country health programming and in several activities of other disciplines having a significant effect on child nutrition and growth. Support was given to national seminars and courses aimed at reviewing and replanning nutrition activities within primary health care. The findings of the projects on the evaluation of the efficiency and efficacy of the nutrition component of health services which were supported by WHO have been found useful in re- orienting and improving these activities. An inter-country workshop, supported by WHO, was held in Dacca to discuss the role of nutrition units based on the information obtained from most countries of the Region by means of a questionnaire. Food and nutrition surveillance systems have been emphasized in all countries through technical support, diffusion of information, and group educational activities. An inter-country meeting held in February 1981 brought together different health officers as well as principal investigators of the research project on "Nutrition Sur- veillance and Evaluation". The meeting discussed in detail the need for information, ways and means of collecting and analysing what was found to be needed, and the utilization of the information in decid- ing on appropriate strategies. During the year a WHO Collaborating Centre was established at the Centre for Research and Development of ~utrition, Bogor (Indonesia), for research in vitamin A and iron deficiency anaemia. Two other centres, one to study the interactions of infection and nutrition and the other to determine the intra-family conditions leading to mal- nutrition, are under consideration. A meeting of the Ad hoc Sub-committee on Nutrition Research was con- -- vened in the Regional Office in November 1980 to review the progress and implementation of action-cum-research programmes in nutrition and to develop guidelines for the implementation and monitoring of these projects. The Sub-comittee noted that WHO had succeeded as a cata- lyst in the exchange of information, development of research methodo- logies and approaches and promotion of personal communication among scientists working in similar fields. Assistance was provided to Bangladesh and Nepal in intensifying their goitre control programmes. In other countries, these programmes are being carried out with assistance from other international and bi- lateral agencies. ~ield tests were carried out in Bangladesh, India, Maldives and Thailand on the draft "Guidelines for Nutrition Training of Primary Health Care Workers and Other Community Workers" developed at global level. After evaluation and necessary modification, they will be issued as a WHO publication later in 1981, for wider application in training programmes. A WHO consultant collaborated with the Institute of public Health Nutrition, Dacca,BANGLADESH, in developing a curriculum and syllabus for a three-month certificate/diploma course in public health nutri- tion. The first course started on 1 June 1981, and in the meantime a field practice area for training has been selected and organized. Four orientation courses in nutrition for thana medical officers, for paramedical personnel in the community as well as in thana health complexes and for nurses - a total of 216 persons - were conducted by the Institute. The first phase of the goitre control programme was initiated with financial assistance from WHO. In BURMA,a WHO consultant assisted in analysing the data on protein- energy malnutrition, nutritional anaemia, goitre and other vitamin deficiencies. The Regional Adviser on Nutrition visited Burma during the year to review the nutrition activities, discuss nutrition research pro- grammes and participate in the development of an evaluation system. In INDIA, a WHO guest lecturer delivered lectures as part of the two nutrition courses - the three-month diploma course and the one-year degree courses - held at the ~ational Institute of Nutrition, Hyderabad, and reviewed the contents and syllabi of these courses. He stressed the need for evaluating the courses and for developing them in future according to the changing needs of the health services. A WHO consultant was assigned to INDONESIA to assist the Government in planning a system of recording, reporting and data processing for the national nutrition surveillance system. The consultant recom- mended a three-stage programme: (a) setting up of equipment and appointment of staff, (b) preparation of study forms for data col- lection and their application in a small area, and (c) expansion of the nutrition surveillance activities to cover the whole country. In January 1981 a WHO public health nutritionist joined the project in NEPAL. He is collaborating with the Chief of the Nutrition Cell and other units of the Department of Health Services in the deve- lopment and implementation of nutrition activities in the country. He is also actively involved in a multisectoral approach adopted by the national authorities. The national goitre control progralmne received assistance from WHO for the training of staff in this field. In SRI LANKA,the protocols for the two nutrition research-cum-action programmes were completed. These projects will now be implemented by the Food and Nutrition Policy Planning Division, Colombo. The nutrition surveillance programme in the country was strengthened, and work on the methodology for rapid assessment of the impact of nutrition on development projects was initiated in collaboration with WHO and FAO. The two agencies participated in designing and sampling for an evaluation of the Mahaweli Area Development Pro- gramme carried out by the Food and Nutrition Policy planning Division. On the Government's request, WHO collaborated in the development of a prefeasibility approach for a food distribution programme. In THAILAND, WHO supported a national workshop on nutrition in primary health care. The protocols for the project, "Situation Analysis of Nutrition Component of Primary Health Care", were completed. A consultant visited three countries in the Region to assess the effect of the health care activities and direct nutrition programmes on the growth of children and to review the recommended activities in the light of their role to correct the present conditions. An- other consultant is under recruitment to develop curricula and syllabi for short and long-term nutrition courses designed to give skills, abilities and knowledge related to the nutrition component of primary health care keeping in view the needs of the health services to achieve the goals of HFAl2000. 1.8 Medical Care The major emphasis in WHO'S collaboration with Member States conti- nues to be on the provision of primary health care (Section 1.3). At the same time, the strengthening of medical stores management and facilities for the repair and maintenance of biomedical equipment also received attention. In BANGLADESH, a WHO long-term staff member is helping to develop and strengthen training facilities for the repair and maintenance of electro-medical equipment. The Government has approved plans for a central workshop to be located at Tejgaon, Dacca, and for four regional workshops. Increasing numbers of trainees attend courses given by the WHO electro-medical engineer. During the year, WHO awarded several fellowships to DPRK national workers in the field of medical care, in addition to providing ambulances, mini-buses and equipment. Efforts continued for the assignment of consultants in the fields of radio-immunoassay, cyto- photometry, drug allergy, hormone-enzyme assay and neuro-psychiatry to meet the country's needs. In INDONESIA, further progress was made in the development of the network of health centres and sub-centres. A design for a recording, reporting and surveillance system for health centres has been evolved. In-service training programmes for health centre staff were conducted as planned, but there is a need to review and improve the technical component of the courses. Further assistance was provided to MALDIVES through the assignment of consultants in surgery, gynaecology, ophthalmology, ENT surgery and maternal and child health. These consultants treated patients with special problems and, at the same time, trained available national health personnel. In SRI LANKA,a short-term consultant in the repair and maintenance of electro-medical equipment made valuable recommendations for improving the facilities and administrative procedures in this regard,including the need for decentralization. The Government has started implement- ing these recommendations. Supplies and equipment and fellowships were provided for training in this field and in that of medical stores management. As regards activities at the regional level, a UNDP-funded inter- country project on training in the repair and maintenance of bio- medical equipment for the least developed countries in the Region became operational during the year. Under this project short-term fellowships have been provided for training personnel within the Region. 1.9 Care of the Aged, Disability Prevention and Medical Rehabilitation International and non-governmental agencies including WHO have actively collaborated with Member States in planning and providing resources for the prevention and control of physical, visual and emotional disabilities. The WHO Regional Office provided the services of consultants to assess existing facilities and to advise on and assist in formulating national plans for disability prevention and rehabilitation. Deafness and health care of the elderly have received priority attention for technical collaboration. The WHO Manual, "Raining the Disabled in the Community", was widely distributed for adaptation, and its translation into local languages was supported. The programme for the prevention of accidents was stimulated through an inter-country seminar. WHO promoted action for establishing national committees for observ- ing 1981 as the International Year of Disabled Persons (IYDP). Two consultants visited BANGLADESH and advised on the mobilization of resources, and on the coordination and formulation of a national plan for community-oriented disability prevention and rehabilitation services. The Rehabilitation Institute and Hospital for the Disabled in Dacca was identified for development as a national institute where a programme for the training of rehabilitation manpower can be orga- nized if it expands its orthopaedic services and includes other relevant activities for prevention as well as the rehabilitation of all types of disabled persons. Another consultant visited the country to study the problem of the elderly and advise on the integration of concepts of gerontology in the training curricula of health and allied personnel. In BURMA, a national plan was formulated and a project proposal was prepared for UNDP assistance in community-oriented disability pre- vention and rehabilitation services. Three townships in Rangoon Division will be developed as demonstration centres, where a survey of disabilities will be conducted and community volunteers,community health workers and midwives trained for disability prevention and early detection. A consultant was assigned during the year to advise on the organization of services for the welfare of the elderly and the management of the health problems pertaining to this group. The WHO manual, "Training the Disabled in the Community", was adapted and translated into Burmese for use at the community level. In INDIA, translation of the WHO manual was undertaken in Hindi, Malayalam and Marathi. A consultant from WHO Headquarters assisted in training community workers and health personnel in Trivandrum to carry out a disability survey in the villages. Two consultants assessed existing facilities for education, training and services in selected centres in the country and advised on integrating disability prevention and medical rehabilitation services in primary health care. Another consultant,a specialist in bio-engineering, visited rehabilitation centres as well as the All-India Institute of Physical Medicine and Rehabilitation, Bombay, and the Artificial Limbs Manu- facturing Corporation of India, in Kanpur, to study the relevance of orthotic and prosthetic appliances in the context of the anthropo- logical and social needs of the population. He demonstrated the preparation of simple aids with local materials and advised on the development of appropriate technology in medical rehabilitation. A national plan of action for achieving the objectives of the Inter- national Year of Disabled Persons (IYDP) was formulated and a national committee constituted for its implementation. An inter- ministerial coordination committee has also been set up to identify and to reserve jobs for rehabilitated disabled persons. A national meeting is to be organized later in 1981 to assess the situation and to prepare a plan for the expansion of activities relating to dis- ability prevention and rehabilitation. The health problems of the elderly were studied by a consultant and his recommendations on gerontology and geriatric services are receiving consideration by the Government in the context of the United Nations Year for the Care of the Elderly (1982). l%e prevention of accidents with the emphasis on problems related to traffic received attention at a WHO-sponsored national meeting. The establishment of an accident prevention cell under the Delhi Trans- port Corporation is under consideration. A consultant visited select- ed centres to collect information on the prevalence of deafness and formulate a plan of action for its prevention. Two consultants visited INDONESIA during the year to assess the faci- lities and to make recommendations on the formulation of a national plan for disability prevention, control and rehabilitation. The Reha- bilitation Centre in Solo and the Rehabilitation Unit at Semarang continued to make impressive progress. The WHO-sponsored disability survey in the country was completed, and further financial support was provided to assist in analysing the data. A consultant reviewed existing facilities for health care of the elderly and recommended measures for strengthening national activities. MONGOLIA has formulated a national plan of action for disability pre- vention. The Government issued a special decree requiring the estab- lishment of operative commissions in each aimak to prepare plans of action for disability prevention and rehabilitation. The training of health workers and also community-oriented rehabilitation activities are making progress. In NEPAL, a national survey of the disabled was sponsored, and the data obtained are being analysed. The problem of rehabilitation of the disabled due to leprosy received special attention. Two consul- tants visited the country during the year to assess existing facili- ties and advise on disability prevention and rehabilitation. Another consultant was assigned to assess the magnitude of the problem of preventable deafness and auditory impairment in the community. The planning and organization of community-oriented disability pre- vention and rehabilitation services in SRI LANKA were promoted through group educational activities. Two consultants studied the existing facilities in the country and recommended measures for strengthening the national programme for the prevention of disabili- ties and rehabilitation of the handicapped. The upgrading of the facilities at the Rehabilitation Hospital in Ragama is being consi- dered to enable the Hospital to function as a national institute for rehabilitation. Supplies and equipment are being provided to enhance the country's manufacturing potential in orthotics and prosthetics. Activities for the prevention and control of deafness were promoted through the assignment of a consultant during the period under review. In THAILAND, prevention of traffic accidents and the management of emergencies received special emphasis in national meetings and group educational activities. Three WHO consultants visited the country to assess the problem of the disabled and recommended measures for strengthening the work on prevention and control of disabilities, as an integral part of primary health care at the community level. 1.10 Oral Health Oral health, especially oral health education, has been receiving increasing attention in the countries of the Region. In BANGLADESH,a WHO staff member continued to assist in the develop- ment of Dacca Dental College and to advise the Government on deve- loping a national programme in oral health. A consultant helped in carrying out surveys of the oral health status of the population in three districts of the country and in training dental health person- nel. WHO has supplied literature in the field of preventive den- tistry. A seminar to discuss the further development of the oral health programme is being organized. The Dental Council of INDIA has constituted a sub-cormnittee to pre- pare a comprehensive document outlining the requirements of depart- ments of dentistry in medical colleges. The Council is also consider- ing reforms in post-graduate education in dental health. WHO provided support for a seminar to examine the feasibility of introducing a new category of dental auxiliary(denta1 therapist) to deliver oral health care in the rural areas, held in March 1981. A WHO consultant was assigned to INDONESIA during the year to help in formulating methods of evaluating the dental health components of the Third Five-Year Plan, and in planning for oral health activities under the Fourth Plan. The consultant recommended that a fluoride mouth-rinsing programme be organized in urban areas and a standard set of simple portable dental equipment be developed for health centres. Another consulta.~t, expected to be in position later in 1981, will assist in the integration of the dental health programme with primary health care. Fellowships have been awarded and supplies and equipment made available for strengthening manpower and physical facilities. In NEPAL, fellowships have been awarded to qualified dentists for study abroad. The programme in oral health is making a significant headway in SRI LANKA. Major activities during the year included carrying out an island-wide epidemiological survey of the state of dental health of the population, implementation of a caries prevention "fluoride" dental programme through the school dental health services, and the organization of workshops for dental and medical personnel and pri- mary health care workers in the context of providing primary oral health care. A consultant was assigned to assist in the development of a national plan for preventive dental health, to advise on the strengthening of dental health education and suggest measures for improving school dental health services, as well as to organize and conduct training programmes for dental health personnel. Fellowships were awarded and supplies and equipment provided, in addition to assistance with a seminar on preventive oral health for dental surgeons, dental nurses and medical officers of health. In THAILAND, a centre in oral health has become operational in Chiang Mi. Two short-term consultants visited the centre during the year and provided technical support. An inter-country meeting of senior dental health officers is scheduled to be held at Chiang Mai in November 1981 to discuss the further development of oral health programmes in the countries of the Region. 1.11 Mental Health The need for the prevention and treatment of mental and neurological disorders, including mental retardation and epilepsies, and also for rehabilitation of the mentally ill, is common to all. countries. Some countries face additional problems related to drug abuse as well as the increasing use of alcohol and tranquillizers. WHO actively continues to promote and support efforts for the fomu- lation of national policies on mental health. Most Member countries now have such policies, and some of them have drawn up outlines of national mental health plans, the focus of which is on extending basic mental health care to hitherto under- or un-served areas through the integration of the mental health component into primary health care. The feasibility of also including in the PHC package a component relating to drug abuse and/or abuse of alcohol is being actively considered in some countries. A regional workshop on child mental health and psychosocial develop- ment was conducted in Jakarta in November 1980, and helped to stimu- late national activities in this field; in most instances these are being carried out in cooperation with UNICEF. In BANGLADESH, the series of annual national workshops has continued. A WHO consultant assisted in organizing a workshop on mental health for high-ranking professionals and administrators, which was followed by a teaching seminar for junior professionals. In order to meet the severe shortage of trained manpower,the Ministry of Health has launched a campaign to recruit junior doctors for post- graduate training in psychiatry. WHO has been providing fellowships for this training. The establishment of model projects on community-oriented "outreach" programmes is being pursued with WHO assistance. In BURMA,the thrust of WHO support continues to be delivered through the United Nations Fund for Drug Abuse control(~~F~A~). Under this programme, and technically supported by WHO, an extensive network of treatment facilities for addicted persons has been set up all over the country. With an increased rate of post-graduate training in psychiatry, mental health services in relation to the drug abuse control programme are being decentralized and integrated into the general health care services and are thus now becoming increasingly available in different parts of the country. The establishment of a mental health component,including drug abuse, as part of primary health care is being actively pursued. A number of national workshops and training seminars for non-specia- lized personnel were organized during the period under review with WHO support. INDIA, through its various model projects of integrated mental health care, has continued to serve as an important focus for regional fellowships in the spirit of TCDC. National centres are collaborat- ing in global research efforts in the fields of community mental health services, psychopharmacology, psychosocial aspects of health care, and the neurosciences. Research into different aspects of mental health has been organized through the Indian Council of Medical Research in collaboration with WHO. A series of meetings convened by the Ministry of Health with WHO support resulted in the emergence of a national plan for the inte- gration of mental health care into the general health services in order to increase the mental health care coverage among the rural population. In INDONESIA, the Directorate of Mental Health of the Department of Medical Care in the Ministry of Health has been designated as a WHO Collaborating Centre for Research and Training in Mental Health. This centre will provide an important base for training and research in community mental health and for international collaborative acti- vities within the WHO medium-term programme. With WHO support, research efforts into relevant aspects of traditional medicine are continuing. The implementation of the national mental health plan has made consi- derable progress, as has the programme of extending mental health care into primary health care centres, with provincial mental hospi- tals as referral and training centres. The community mental health project in Jakarta, as a multisectoral activity of the Jakarta Metropolitan Health Department, the Directo- rate of Mental Health, the Department of Psychiatry and the Faculty of Public Health of the University of Jakarta, has continued and has produced encouraging results, which may serve as a model for other multidisciplinary efforts in Indonesia and in other countries of the Region. In MONGOLIA, the implementation of the national plan has continued, with WHO assistance. Several national workshops were organized during the period and fellowships were provided to develop specialized man- power. An epidemiological survey on mental disorders was completed, and the data are being analysed for use in planning. In NEPAL, where the Government has expressed serious concern regard- ing the inadequacy of mental health services, including services for the mentally retarded, different alternatives are being explored for introducing basic mental health care into hitherto unserved areas, through the expanding general health services. WHO has provided fellowships for training medical personnel in mental health. In SRI LAMA, the National Advisory Body on Mental Health has conti- nued to hold regular meetings, with WHO support, and has proved to be a useful instrument in stimulating cooperation between different groups of psychiatrists and health administrators in the country. There are psychiatric units, with a psychiatrist attached,functioning in seven provincial general hospitals; two more such hospitals each have a psychiatrist but no psychiatric units as yet. The establish- ment of two new university departments in Galle and Jaffna is being supported by WHO and is expected to improve the exposure of under- graduates to psychiatry and facilitate the planned post-graduate training of psychiatrists. Mental health has been identified as one of the 17 components of primary health care, and courses for auxiliaries which include child mental health are regularly being held. In THAI~~~~,expansion of mental health care through integration into the general health system is a clearly articulated national policy. Thailand's participation in the WHO 1nter-regional Study on the Monitoring of Mental Health Needs has greatly stimulated the exten- sion of integrated mental health services, apart from yielding valuable data for the evaluation and further improvement of these services. WHO-sponsored research on the psychosocial and cultural aspects of primary health care is beginning to produce data of great importance for the planning and extension of such care. These data will allow a more thorough consideration of the behavioural aspects of the use or non-use of primary health care facilities. An important part of WHO support is in the field of drug abuse, which is a major public health problem in Thailand. The Institute of Health Research, Chulalongkorn University, Bangkok, as a WHO Collaborating Centre for Research and Training in Drug Dependence, has continued to produce research data of importance for many countries with similar problems. Regional fellowships are sponsored for training in this institution, and professionals from l'hailand have continued to parti- cipate in inter-regional training activities. With WHO support, and through the United Nations Fund for Drug Abuse Control, a series of treatment facilities for drug-dependent persons is beginning to evolve. 1.12 Drug Policies and Management The supply of essential drugs of assured quality has always been given high priority by the Member countries in the Region. WHO has been collaborating with governments in strengthening the different components of pharmaceutical supply systems and in evolving national drug policies and management. An inter-country consultative meeting on drug policies and management, held in the Regional Office in October 1980, provided guidelines and made recornendations for deve- loping a special programme on essential drugs in the Region. In BANGLADESH,the Organization assisted in planning and establishing a pharmaceutical production unit at national level. A WHO consultant particiated in an Asian Development Bank (AsDB) mission to define the support needed from the Bank, which is expected to provide finances for the purchase of raw materials and equipment required for the manufacture of essential drugs. WHO will provide technical support through a consultant for training personnel and advising on the management of the production unit. ~ssistance was provided in strengthening the quality assurance pro- gramme of the Drug Control Administration. In BURMA, the Organization has provided further assistance to the Burma Pharmaceutical Industry for strengthening pharmaceutical production units. National personnel were trained in the technology of cinchona cultivation and the extraction of alkaloids. The Food and Drug Control Laboratory in Rangoon is receiving assist- ance through a UNDP project, under which training has been given in different aspects of drug analysis and supplies and equipment have been provided for strengthening the laboratories. WHO, in collabora- tion with FAO, provided consultsncy services for improving drug control administration, updating food and drug rules and regulations and strengthening food analysis laboratories. WHO and UNDP have collaborated with INDONESIA in developing compre- hensive drug policies. A consultant advised on the establishment of adverse drug monitoring and drug information centres. In MONGOLIA, a WHO consultant advised on strengthening the quality control of pharmaceuticals and biologicals. Two other consultants were assigned to advise on a project for the manufacture of blood products. In NEPAL, support was provided by WHO, UNDP and UNIDO, jointly with assistance from the Netherlands Government, for improving the supply system for essential drugs in the primary health care services. A WHO consultant acted as the technical coordinator and prepared a work plan for the implementation of the project. Another consultant assisted in promoting the use of traditional medicines for primary health care. WHO has collaborated with SRI LANKA in the development of training programmes in pharmacy,the strengthening of national quality control and technical courses,and the preparation of a techno-economic feasi- bility report on the establishment of a drug formulation unit. The National Drug Act has been enacted and is being enforced. A diploma in pharmacy will also be started, with WHO collaboration. It is expected that AsDB assistance will be provided in establishing a for- mulation unit for the production of essential drugs. TAMILAND is developing a comprehensive programme on drug policies and management with WHO collaboration. A consultant advised on preparing a comprehensive project on essential drugs, including their storage, d;, tribution and utilization in PHC, and drug legislation. A national c,,iiference on the selection of essential drugs for PHC was organized with WHO support. The Thirty-fourth World Health Assembly was historic in more than one sense. It not only adopted theGlobal Strategy for Health for All; it was also honoured by the presence of Her Excellency Mrs lndira Gandhi. Prime Minister of India. who delivered a keynote address. Seated behind the Prime Minister are (from I to r) : Dr Halfdan Mahler. Director-General, WHO. Dr Meropi Violaki-Paraskeva. President of the Thirty-fourth World Health Assembly and Dr T.A. Lambo Deputy Director-General , WHO. His Excellency Mr Soeharto. President of the Republic of Indonesia. greets a disabled young man after inaugurat- ing the International Year of Disabled Persons. INTERNATIONAL YEAR OF DISABLED PERSONS Of the estimated 450 million disabled persons in the world, a majority live in developing countries, with scarcely any aid facilities. The International Year of Disabled Persons has focussed attention on the spe- cial needs of the disabled and several activities wereini- tiated in the Region to provide them with adequate medical and rehabilitative services. Learning to walk.. . . . Limbs for the limbless. INTERNATIONAL YEAR OF DISABLED PERSONS Helping .s like himself to nand on their feet. Eflorn are being made to provrda water to more rursl communities. WATER AND SANITATION To ensu'e that the wamr is safe healrh labo- ratones play an importan! tale in keeping a check on it5 qualiw. Communities in rural areas of the Regran are beln~ encouraged to take the iniiialive ra provide themselves with basic sanitalion and excreta disp~sa) facililir. Since a large number of people in rural areas in the Region depend on wells for their water supply, governments are making efforts to make the well water safe for drinking. Communitv health workers and volunteers have been trained to chlorinate wells regularly. More and more handpumps are being installed in rural areas to make safe drinking wafer avail able and accessible to communities at all times.
States and should be a manifestation of the total picture obtaining in the countries. On the subject of the periodicity of Health Assemblies, the Committee felt that it would be advantageous to continue the present practice of annual sessions and passed a resolution to this effect. 'Ihe Committee endorsed the work-plan for the study of the Organiza- tion's structures in the light of its functions. It stressed also the importance of strengthening the functioning of WHO at the country level and recommended the redesignation of the WHO Programme Coordi- nators to "WHO Representatives". It appointed a Sub-committee on Programme Budget to review the proposed programme budget for 1982-1983 and later approved the report of the Sub-committee endorsing the budget proposals. Technical discussions were held on the subject of "Health Manpower Planning and Community Participation for Primary Health Care". The Regional Committee accepted the suggestion of the Thirty-third World Health Assembly that the technical discussions to be held during the thirty-fourth session of the Committee should be on "The Role of Ministries of Health as Directing and Coordinating Authorities on National Health Work". It was, however, decided that the scope of the discussions would be limited to intersectoral coordination in national health work. The Regional Committee adopted a total of 14 resolutions. It also accepted an invitation from the Government of the Republic of Indonesia to hold its thirty-fourth session in Indonesia in 1981 and that of the Government of Bangladesh to hold the 1982 session at Dacca. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION The managerial process of WHO's programme development has been further integrated and unified, particular attention being given to responding to the countries' needs and priorities as emerging from their poli- cies, strategies and plans of action to attain health for all. In this regard, the discussions of WHO's governing bodies, particularly those in the Regional Committee, have provided guidance and direction. Having received comments and guidance from the regional consultative group which had reviewed the first draft of the regional contribution to the programme outline and contents of the Seventh General Programme of Work, the Regional Office revised the regional contributions, which have been incorported into the consolidated version of the Seventh General Programme of Work. Under the regional medium-term programme of health planning and management, country health programming has been supported in Member countries leading to the formulation of medium-term health plans and long-term outlines and strategies for health for all (see also Section 1.1). me Regional Office elaborated a detailed plan of action for the 1981- 83 period to implement the strategy for supporting the managerial process of national health development,to help countries to integrate this process further as a continuing effort to improve the entire range of management of health development. The plan of action, inter alia, provides for the orientation and training of national and WHO - programme managers in the concept and practice of an integrated managerial process. Policy and programme reviews by the Regional Programme Committee continued to provide advice to the Regional Director on important issues and questions relating to the formulation, implementation and evaluation of WHO programmes. In its work, the Programme Committee has striven to concentrate upon key policy and programme matters deserving the attention of the Regional Director, and has been guided by the work of the Headquarters Programme Committee and the Global Programme Committee. The work of the Regional Programme Committee has been reviewed, and conclusions were reached on how to improve its work through selective emphasis upon policy and programme matters. While programme budgeting principles continue to be applied both in country and inter-country programmes, the Regional Office has provided support to the detailed formulation of the programme budget for the 1982-1983 biennium in one country, to establish a clear linkage of the WHO programme with the national programme,and to relate programme objectives and activities to the budgetary tables. In the light of past experience with the WHO information system and the review conducted at Headquarters by an Advisory Group responsible to the Director-General, the Regional Office has undertaken a fresh scrutiny of the entire information system programme with a view to making it more relevant, efficient, useful and economical. As a component of the information system, the monitoring of the implementa- tion of the WHO programme through a Programme Delivery Status Report has been streamlined. This procedure is being re-examined within the overall review of the information system. In pursuance of the policy for the increased involvement of national expertise in the work of WHO, and to foster technical cooperation among Member States, a preliminary inventory of resource persons and institutions has been prepared. In the light of the Regional Committee's observations on the progress report on the Seventh General Programme of Work at its 33rd session, a regional document on the Seventh General Programme was drafted, reflecting the objectives and approaches of the regional programme to serve as the basis for elaborating the types of activities in the medium-term programme period, 1984-89, corresponding to the period of the General Programme of Work. 3. ADMINISTRATION 3.1 General The Director-General and the Regional Director visited Mongolia and DPR Korea in July 1980 to participate in the signing ceremonies of
7.8 Regional Office Library During the period 1 July 1980 - 30 June 1981, the Regional Office Library received 7933 books, pamphlets, WHO publications, current periodicals and reports; 2393 persons (1963 WHO staff and 430 others) visited the Library and 5141 books and periodicals were issued on loan to Regional Office and field staff as well as on interlibrary loans. Photocopies of 1125 pages were supplied. For references needed by the Regional Office. field staff and Headquarters, 64 loan requests were sent to local libraries. Reference material was supplied in connexion with various seminars and meetings held in the Regional Office and outside. The Library, which is the UEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, WEDLINE searches requested by Member countries. It scrutinized the requests and obtained print- outs for searchable requests from the National Library of Medicine, Bethesda, Maryland, USA, under a special agreement. Photocopies of references not available in countries were also provided to them, free of cost, from sources in Delhi, in WHO Headquarters and in the United States of America. As part of the development of the Health Literature, Library and Information Services Network in the Region, the Library actively participated in both national and regional group educational activities on the subject. It is proposed to bring out, by the end of 1981, an experimental issue of the Regional Health Literature Index for South-East Asia. Three Student Loan Libraries were established in 1980-81. The Regional ..Office Librarian visited Mongolia in June 1981 to assist the Government in planning a Republican Reference Medical Library and to discuss other related matters. 8. RESEARCH PROMOTION AM) DEVELOPMENT The South-East Asia Advisory Cormittee on Medical Research (SEA/ACMR), established in 1976, has continued to function as an advisory body to the Regional Director on the implementation of the Regional Research Programme. Through various study groups and consultative meetings, detailed plans for research have been developed in the six priority areas identified by the SEA/ACMR at its first session in 1976. The activities are being implemented by the Regional Office, and their current status is as follows: In the field of research on health services delivery, twelve studies are currently in operation, the results of which will be useful in improving the health care programmes in the respective countries as well as in formulating a regional plan which could be adapted to suit varying national conditions and requirements. National and inter- country meetings have been organized to promote the health service research methodology and to bring together multidisciplinary groups of scientists considered essential for the success of primary health care programes. In regard to traditional medicine, a consultative meeting was held in Varanasi (India) in November 1980, where six research protocols on specific priority areas within the traditional medicine programme were developed. Research proposals based on the protocols outlined have been invited from the countries of the Region. As for research on communicable diseases, an inter-country consulta- tive meeting on tuberculosis has worked out the details of the research needs on a priority basis, as well as an outline of a plan for their implementation. A comprehensive regional research programme in dengue haemorrhagic fever has been elaborated and is in operation. Its components include studies on clinical, epidemiological, immunopathological and vector aspects as well as a programme for the development of a dengue vaccine. A meeting to evaluate the progress of the DHF research programme, particularly that of dengue vaccine, was held in March 1981. This meeting considered the progress made in regard to the vaccine and prepared a provisional work-plan for studies for a further period of 18 to 24 months. It is hoped that these studies may lead to the preparation of a vaccine suitable for preliminary human trials. Ten research studies are currently in progress in dengue haemorrhagic fever and one institution in a Member country is being strengthened to undertake research on the arboviruses with particular reference to dengue. A scientific working group on research in diarrhoea1 diseases met in February 1981 to consider the status of the control progrsmmes as well as research required to improve control measures. In addition, 14 research studies were reviewed by the working group for possible SEAR0 support. The Regional Office is currently supporting four such studies in Member countries. In regard to research on liver diseases. the national coordinators appointed by the governments are implementing studies of regional interest as determined by the respective study groups. In addition, the national coordinators have promoted the establishment of national task forces which are formulating research of regional and national interest. An intercountry consultative meeting is scheduled to be held later in 1981 to evaluate the programme, and, as a prelude to this consultation and to serve as a basis for it, national meetings are being promoted in the countries; two such meetings have already been held. Sixteen research projects on liver diseases supported by the Regional Office are in operation. A research study group meeting on leprosy held in June 1980 developed draft protocols for (a) operational studies on methods of improved case-finding and case-holding and release of inactive cases from control, and (b) field trials of multi-drug therapy regimens. These are currently being promoted in countries of the Region. The Regional Collaborative Studies on drug-resistant P.falciparum to 4-aminoquinolines are progressing satisfactorily. A meeting of the principal investigators is proposed to be held later in 1981 in collaboration with the WHO Regional Office for the Western Pacific and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. This meeting is expected to review progress and identify further research requirements. Two research studies are currently in progress in the field of environmental health. These are concerned with the health benefits of water supply and sanitation and the field testing of an integrated water supply and wasterater utilization system for villages. Other studies of relevance to the Water and Sanitation Decade are being planned. The six research areas concerned with nutrition in primary health care are being implemented in most of the countries of the Region. Meetings of the principal investigators of two of the major projects concerned with this subject were held in the Regional Office in November 1980 and February 1981 respectively. In general, most of the research studies promoted by the Regional Office follow the health services research approach, and are concerned with utilizing available knowledge in a form suitable for adaptation to local situations. Basic research is being promoted primarily in the field of DHF, a disease of particular relevance to South-East Asia and its neighbouring regions. Advisory services have been provided as required to scientists to help them develop research designs and also to guide them on specific techniques required for their research programs. The Visiting Scientists and Research Training Grants programme, which originally and hitherto has been more or less open-ended, is now being focused on achieving maximum impact on the research activities promoted by the Regional Office. Towards this end, specific criteria have been formulated based on the recommendations of the SEA/ACHR at its sixth session in 1980. Thus. the grants are now being awarded primarily for training related to projects supported or planned for support under the Regional Research Programme. Pollorup meetings have so far been held in two countries to consider the guidelines developed at the first meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries. held in December 1979. These guidelines cover areas such as the organization of research, its management and coordination, identification of research priorities, development and operation of task forces on priority research subjects, procedures for the formulation and review of research proposals, ethical review procedures and managerial aspects relating to the utilization of research results. A, second meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the relevant ministries is scheduled to be held in the third quarter of 1981. Consideration will be given to the recommendations made at the Seventh Session of the SEA/ACMR that such meetings be held annually, as they are seen as a very useful mechanism to promote research at national level. In order to build up national research capability, courses on research methodology are being further promoted in the countries concerned. A network of institutions is being established in consuItation with governments in order to.promote collaboration between the scientific expertise within the countries and WHO'S activities. Such collaborat- ing centres are being developed in the fields of diarrhoea1 diseases, nutrition, liver diseases, filariasis, mental health, DHF, health services and traditional medicine. At present there are 33 WHO Collaborating Centres in this region. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continued to remain a major source of encouragement to research in the Region. The identification of priori- ties by the Regional Consultative Meeting in 1979 and subsequent promotive and catalytic activities supported by the Regional Office have resulted in the development of several additiopal field research projects in collaboration with the Special Programme. Topics currently being investigated correspond to the broad areas identified by the Consultation. The UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases has continued to promote and support research in the major tropical diseases such as malaria, filariasis and leprosy, as well as activities to strengthen regional capabilities for research on these diseases. With an increased awareness of the aims and objec- tives of this Special Programme, the number of scientiets and institu- tions in the Region who are participating has steadily increased. In the collaborative studies carried out in the Region, the research supported by the Special Programme has so far been mainly in the fields of malaria chemotherapy and leprosy chemotherapy and immuno- logy. The scientists trained vith the support of the Special Programe are returning to their countries and starting to engage in research activities in their specialties. Promotional activities under the Special Programme have continued through visits to the appropriate centres by Regional Office staff. Regional meetings related to research in tropical diseases have promoted greater liaison with the scientists in various institutions. In keeping with the universal goal of health for all, the Regional Research Programme is being oriented towards contributing to this objective, The SEA/ACW., at its sixth session in 1980, recommended that the research priorities be reviewed by a sub-committee in the light of these new trends. Such a sub-committee was convened by the Regional Director and prepared a conceptual framework within vhich the priorities could be identified. The Seventh Session of the SEA/ ACMR, held in April 1981, considered these suggestions and recommended a scheme for selecting priorities within primary health care require- ments. Further action in developing the detailed activities will be undertaken by the Regional Office with the assistance of the SEA/ACMR and other scientists as required. The SEAIACMR in future sessions is expected to try to evaluate the impact of the Regional Research Programme, taking into consideration the contributions of the inter-country project as well as of the research promotion and development projects in the countries. he purpose of this evaluation would be to study the impact of the WHO research programme at country level on the generation of further national activities, allocation of greater national resources and attraction of external assistance to Member countries. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Three titles - "A guide to the care of the low birth-weight infant", "Health research - a simplified community-based approach", and "The health care system of Thailand: a case study" - were brought out under the WHO Regional Publications, South-East Asia Series, during the year. In all, 150 assignment reports of short-term consultants and .long-term staff, final reports on projects and reports on meetings and seminars were edited, processed and issued. Reports brought out under printed cover for wider distribution included the following: (a) Prevention and Control of Pulmonary Hypertension - Report of an Inter-country Seminar; (b) Regional Network of Public Health Institutions for South-East Asia - Report of a WHO (SEARO) Expert Group; (c) Meeting of the Bi-regional Research Study Group on Culex-borne Bancroftian Filariasis; (d) Research in Viral Haemor- rhagic Fevers in the Eastern Mediterranean, South-East Asian and Western Pacific Regions - Report of a meeting; (e) Strategies for Health For All by the Year 2000 - Report of a Joint WHO/UNICEF Regional Meeting; (f) Team-work for Primary Health Care - Report of a WHO (SEARO) Expert Group; (g) Malaria Research and Training in Nepal - Report of an AsDBfWHO Mission; (h) Report of a WHO Seminar on "Anti-malaria Operations with Special Reference to Applied Field Research in Malaria"; (i) Maternal and Child Health and Family Planning in the People's Republic of China - Report on a WHO Study Mission; (j) Central and Regional Occupational Health and Industrial Hygiene Laboratories: Project Findings and Recommendations - Report prepared for the Government of the Republic of Indonesia by WHO Acting as Executing Agency for UNDP; (k) Relief Cataract Services in the South-East Asia Region - Report of an Inter-country Workshop (issued also as Eye Health in South-East Asia Series No. 31, and (1) The Development of Research Protocols on Priority Areas in Traditional Medicine - Report on a Regional Meeting. In addition, wide distribution was given to a large number of other documents. The report and minutes of the thirty-third session of the Regional Committee and the report of the technical discussions held during the session on "Health Manpower Planning and Community Participation for Primary Health Care", were, as usual, edited and issued with a printed cover. A "Supplement to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought out, incorporating the resolutions adopted at the thirty-third session.
PART I1 ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1. REGIONAL COMMITTEE The thirty-third session of the Regional Committee for South-East Asia was held in Male, Republic of Maldives, from 1 to 7 September 1980. It was attended by representatives from all Member countries of the Region, as well as by representatives of the United Nations Development Programme, of the United Nations Children's Fund, and of three non-governmental organizations in official relations with WHO. In the absence of the Chairman and the Vice-Chairman, the session was opened by the Regional Director. Mr Maumoon Abdul Gayoom, President of the Republic of Maldives, inaugurated the meeting. The inaugural session was also addressed by the Minister of Health of Maldives,and the Director-General of WH0,Dr Halfdan Mahler, delivered a keynote address to the Regional Committee in which he referred to the essentials of the strategies of health for all and the need to avoid inflexibility in the approaches adopted. He stressed that proper use of WHO by Member States in accordance with the constitu- tional role of the Organization could greatly contribute to health development throughout the world. The Regional Committee nominated Dr U KO KO (Burma) as the next Regional Director, to succeed to Dr V.T.H. Gunaratne. Recognizing the significant contribution made by Dr Gunaratne to international health work, the Committee adopted a resolution declaring him "Regional Director Emeritus" of the World Health Organization. In his annual report, the Regional Director pointed out that the health status of the people of the Region had distinctly improved over the past decade, with a noticeable increase in life expectancy at birth in most countries. Thus, despite formidable health problems and paucity of resources, Member countries had made commendable progress in health development. Details were given of activities under way,for example, to establish PHC, to control the communicable diseases such as malaria, to implement EPI, carry out water supply and sanitation schemes and conduct medical and health services research. The Regional Director considered that with even more strenuous efforts by governments in the coming years and with will and determination, the objective of health for all would be attainable. Taking note of a resolution of the World Health Assembly on infant and young child feeding, the Regional Committee recommended that WHO should further intensify coordination of its work with that of other international and bilateral agencies in order to mobilize the necessary resources and public opinion for the promotion of activities directed towards the utilization of weaning foods. The Committee noted with satisfaction that the Regional Office had taken the initiative of developing a research-cum-action programme in nutrition, with particular emphasis on primary health care, and underlined the key role of women in ensuring the success of this programme. With regard to drug policies and management, the Committee stressed the need for technical support to promote rational drug policies at the country level as well as to improve pharmaceutical supply systems. It was explained that the Organization was having a dialogue with the drug industry in an attempt to bring down the prices of essential drugs to a level that any developing country could afford. The need for a uniform policy regarding smallpox vaccination was expressed; vaccinations continued to be given to certain groups, such as defence personnel, in some countries. It was considered that priority should be accorded to diarrhoea1 diseases in countries of the Region, and the Committee noted with satisfaction that a Scientific Group set up by the Regional Advisory Committee on Medical Research had been working on the development and implementation of a service-cum-research programme for the control of these diseases. The Committee reviewed the difficulties in the eradication and control of malaria. The lack of coordination between the ministries of health and of agriculture in some instances contributed to the emergence of resistance of vectors to certain insecticides. The rational use of alternative insecticides and the avoidance of in- discriminate spraying could lead to progress in this area. It was affirmed that the declaration of the International Drinking Water Supply and Sanitation Decade (1981-90) was a step in the right direction and that its success was crucial for achieving the goal of health for all for two reasons: safe water and sanitation constituted a vital element in the basic health service package,and the experience gained from the efforts of the IDWSS Decade should provide an impor- tant basis for the strategies for health for all to be formulated. The Committee adopted a resolution urging Member States to develop a plan of action in accordance with accepted national and regional strategies and to commit themselves fully to its implementation. The Committee appreciated the Regional Director's proposal to establish a multisectoral body to support national strategies for securing intersectoral collaboration - a body which would not only serve as a broad-based advisory group to the Regional Director but also help mobilize collective support for the 'health for all" activities. The proposals for the UNDP Regional Programme of Technical Cooperation for the health sector for Asia and the Pacific for the period 1982-86 were endorsed in principle, and Member States were asked to support these proposals through their national coordinating authorities at the appropriate forums. The Committee noted that the structure and contents of the Seventh General Programme of Work (1984-89) would be based on the strategies for health for all by the year 2000, reflecting the principles contained in the Alma-Ata Declaration. It was felt that the Progrannne should lay stress on the comprehensive health development of Member States and should be a manifestation of the total picture obtaining in the countries. On the subject of the periodicity of Health Assemblies, the Committee felt that it would be advantageous to continue the present practice of annual sessions and passed a resolution to this effect. 'Ihe Committee endorsed the work-plan for the study of the Organiza- tion's structures in the light of its functions. It stressed also the importance of strengthening the functioning of WHO at the country level and recommended the redesignation of the WHO Programme Coordi- nators to "WHO Representatives". It appointed a Sub-committee on Programme Budget to review the proposed programme budget for 1982-1983 and later approved the report of the Sub-committee endorsing the budget proposals. Technical discussions were held on the subject of "Health Manpower Planning and Community Participation for Primary Health Care". The Regional Committee accepted the suggestion of the Thirty-third World Health Assembly that the technical discussions to be held during the thirty-fourth session of the Committee should be on "The Role of Ministries of Health as Directing and Coordinating Authorities on National Health Work". It was, however, decided that the scope of the discussions would be limited to intersectoral coordination in national health work. The Regional Committee adopted a total of 14 resolutions. It also accepted an invitation from the Government of the Republic of Indonesia to hold its thirty-fourth session in Indonesia in 1981 and that of the Government of Bangladesh to hold the 1982 session at Dacca. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION The managerial process of WHO's programme development has been further integrated and unified, particular attention being given to responding to the countries' needs and priorities as emerging from their poli- cies, strategies and plans of action to attain health for all. In this regard, the discussions of WHO's governing bodies, particularly those in the Regional Committee, have provided guidance and direction. Having received comments and guidance from the regional consultative group which had reviewed the first draft of the regional contribution to the programme outline and contents of the Seventh General Programme of Work, the Regional Office revised the regional contributions, which have been incorported into the consolidated version of the Seventh General Programme of Work. Under the regional medium-term programme of health planning and management, country health programming has been supported in Member countries leading to the formulation of medium-term health plans and long-term outlines and strategies for health for all (see also Section 1.1).
thirty-third session, and in resolution sEA/RC33/R8 it endorsed the following proposals for financing under the Real Estate Fund: Extension to the building .. $ 435 000 New electric sub-station . . $ 60 000 New air-conditioning plant . . $ 180 000 Based on the recommendation made by the Sixty-seventh session of the Executive Board, the Thirty-fourth World Health Assembly approved the above proposals and allocated a sum of ~~$675 000 for the execution of the above jobs. The construction plans and drawings have been prepared for submission to the local authorities, and the necessary approval for the proposed construction has been sought. The construction is likely to start before the end of 1981 and, subject to availability of construction material such as cement and steel, the work is expected to be completed by the end of 1982. The installation of the electric sub- station and the air-conditioning plant will be taken in hand when the above construction is nearer completion. The Regional Office has installed the WANG word processing system in order to improve the production process and to meet the increasing workload of the reporting and information systems. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 June 1980 - 31 May 1981, procurement action was taken for supplies and equipment amounting to $7 695 784 under all sources of funds. These consisted of hospital supplies, X-ray equipment, drugs, vaccines, biologicals, spraying equipment and pesticides, laboratory equipment, supplies for environmental health programmes and teaching programmes, vehicles, office and administrative supplies and medical literature. The Eollowing categories of procurement need special mention: Emergency supplies Requests to meet emergency conditions caused by floods, an earthquake and epidemics were received, and the following supplies were procured, totalling ~~$169 000. Bangladesh For flood disaster relief: Medicaments, water purifying tablets, bleaching powder, anti-snake venom serum and 4.5 million tablets of Cliquinol (obtained by Headquarters free of cost, the Regional Office meeting the airfreight charges). Burma - For fire disaster relief, Taungdwingyi: Medicaments, consisting of oral rehydration solution, ampicillin and tetracycline capsules and Ringer's lactate with giving sets (procured in India and airfreighted). For fire disaster relief, Uandalay: Medicaments, consisting of oral rehydration solution, ampicillin capsules, metronidazole tablets, furacin ointment and water purifying tablets (procured in India and airfreighted). Maldives For polio and conjunctivitis outbreaks: 15 000 doses of oral polio vaccine and 85 doz. tubes of tetracycline eye ointment Nepal To control an outbreak of gastro-enteritis in hilly areas: Rehydration solution. For relief of earthquake victims: Medicaments, water purification tablets, surgical bandages. Thailand For relief after an outbreak of diphtheria: Diphtheria antitoxin, 300 ampoules. India - For the control of Japanese encephalitis: Freeze-dried vaccine. Purchases - Revolving Fund/reimbursable basis Bangladesh, Burma, India, Nepal and Sri Lanka made use of the Organization's procurement facilities under the Revolving Fund and reimbursable schemes amounting to $274 189. The purchases were for hospital and laboratory equipment, teaching materials, drugs, vaccines, bleaching powder and renewal of sub- scriptions to journals and procurement of medical books. Local procurement Wherever possible, having regard to prices and quality, purchases were made within the Region. The total amount spent on such purchases during the period under review was US$968 975 representing approxi- mately 13.5% of the total purchases made by the Regional Office. A comparative table showing the procurement trend over the last decade is given below: PROCUREMENT FIGURES OF SUPPLIES AND EQUIPMENT AND MEDICAL LITERATURE, BY CALENDAR YEAR 5. COLLABORATION WITH OTHER AGENCIES With the endorsement of the goal of health for all by the United Nations General Assembly as per its resolution A/RES/34/13, collabora- tion among the agencies of the United Nations system has increased not only for the mobilization of extrabudgetary resources to intensify the primary health care programmes but also for the identification of areas of appropriate collaboration in order to avoid duplication of efforts. Follow-up actions continued on the Meeting on Financing of Primary Health Care Programmes in Asia hdd in July 1979. in US Dollars) Local Purchase as a percentage of Total 19.89% 24.04% 9.37% 10.02% from 1977. Year - 1971 1972 1973 1974 1975 1976 1977* 1978 1979 1980 *Local 5.1 United Nations There is continuing close coordination with the Regional Representa- tive for Western South Asia of the United Nations High Commissioner for Refugees stationed in Bangkok in respect of refugees in Indonesia and Thailand. Procedures for the United Nations Interim Fund for Science and Technology for Development (IFSTD) have been finalized by the United Nations Conference on Science and Technology for Develop- ment (UNCSTD) and circulated to the countries in the Region. Earlier, in response to a request from UNDP, several countries in the Region had prepared and submitted project proposals for finances from the Fund. However, these resources being small as compared to the requests, no final decision on these requests has yet been taken by the UNDP Administrator. Total Procurement 763 137 1 424 086 1 807 730 3 415 000 2 782 000 3 124 000 3 801 567 8 926 324 10 749 445 7 682 169 purchase figures (Expressed Local Purchase within the Region 756 243 2 146 229 1 007 565 769 500 are available only
PART 111 ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST This part of the report contains programme summaries in respect of each country, giving a brief account of the major problems of the country and highlighting the government's efforts during the year, with special refer- ence and in relation to WHO collaboration. The information is complemen- tary to that already given in Part I. Each programme summary is followed by a list of the projects in the country for which WHO has given assist- ance during the whole or part of the period under review. Inter-country projects are listed at the end. In the project list, in the first column (under "Project Number and Source of Funds"), ,I 8, R means Regular Budget "UNDP" United Nations Development Programme VI~PM United Nations Fund for Population Activities 8fFTtt Trust Fund "UF" United Nations Children's Fund "VF" Voluntary Fund for Health Promotion - all sub-accounts. The projects are listed in accordance with the programme classification. 1. BANGLADESH The Government has adopted, as one of its national health policies, the provision of primary health care to the people. "Health for All by the Year 2000" is a long-term national objective, and a firm political commit- ment has been made to provide medical care to the entire population. Under the aegis of the Planning Commission and the Yinistry of Health and Population Control, a national workshop on strategies for HFA/?000 was conducted, followed by the preparation of a country paper on national strategies for HFA, in June 1980. The country paper provides the guide- lines and sets the targets in the health and health-related areas to be achieved by the turn of the century. The plan of action for the primary health care project has been finalized by the Government. UNICEF, the World Bank, WFP, UNDP and WHO held regular meetings of the United Nations Inter-agency Working Group on Primary Health Care Activities and reviewed with government representatives the progress achieved. The Ministry of Health and Population Control regularly surveys the status of development of the thana health complex scheme and ensures supervision thrcughout the country A significant development has been the reorganization of the health services in order to establish a unified approach to the delivery of health and family jlanning services. The Uealth and Population Control Divisions of the Ministry cf Health and Population Control are in the process of being integrated. The offices of the nirector of 'Jealth Services (curative) and the Director of Health Services (Preventive) have been combined to form a Directorate General of liealth Services. With the physical integration of the two divisions of the Ministry, the Civil Surgeon will be in charge of both health and population control services at the district level; at the thana and village levels also, a unified administration of both services will be ensured. Field personnel formerly working in health and population control will be renamed as health and family planning field workers respectively. A management workshop was held for senior government officials to give them orientation in management concepts and skiils for the better adminis- tration of health services. Attention is being given to the establishment of a more effective management structure. Development of a comprehensive health information system for the country is a priority need. In order to bring about necessar" changes, the health information system has been reviewed. Wbi1.e the existing systems continue in most parts of the country, steps are being taken to introduce lay reporting in phases for the collection of health information. Lay reporting is being practised on an experimental basis in two thanas. Training courses in the repair and maintenance of hospital equipment have continue6,and eight major teaching and service hospitals and institutions in Dacca and the Medical College at Xynensingh received assistance in the repair and installation of specialized equipment. A plan for the estab- lishment of four regional workshops and one in each medical college was prepared. Programmes for the prevention and control of communicable diseases, which continue to be priority health problems, are based on a pragmatic approach. Activities for the prevention and control of diarrhoea, malaria and immunizable diseases will constitute the entry points for the imple- mentation of primary health care. A national oral rehydration project as part of diarrhoea1 disease control has been initiated. Mortality from these diseases was reduced substan- tially through oral rehydration; ORS packets are produced locally and distributed by village voluntary health workers. Malaria, though still endemic in the country, is under control generally. However, P.falciparum resistance to chloroquine is slowly increasing, even though it occurs mainly in the border areas in the eastern part of the country. A five-year scheme for the expanded programme on immunization was approved by the Planning Commission. Immunization centres have been established in metropolitan areas, in the thana health complexes of primary health care pilot areas and in clinics run by certain voluntary organizations. BCG, tetanus toxoid and DPT are given as a routine, and poliomyelitis and measles vaccines at immunization centres having the necessary cold-chain facilities. Preparations are being made to increase the geographical coverage of EPI. Workshops were conducted on nutrition, the prevention of blindness, mental health, cardiovascular-disease control, cancer and diabetes. The preven- tion and control of noncmunicable diseases is gaining momentum within the general health services. A workshop on the promotion of research methodology, with emphasis on health services research, was conducted. Health education activities are making progress, with the development of the infrastructure within the general health services. Sub-divisional health education officers have been appointed and trained. The Health Education Bureau at central level was organized providing a higher status for the senior staff. A Master of Public Health (Health s ducat ion) course and other post-graduate courses in public health have been started at the National Institute of Preventive and Social Medicine. The major thrust in environmental health is on water supply and sanita- tion, and the programme for the provision of safe water to the rural population and for the introduction of sanitary water-seal latrines continues, being implemented more or less in line with the primary health care programe. Planning for the International Drinking Water Supply and Sanitation Decade is being initiated. International and bilateral agencies such as the World Bank and the Asian Development Bank and the Government of the Netherlands are supporting the development of piped water supplies in district towns. This scheme is in the pre-investment stage. The country paper on strategies for health for all provides broad guide- lines for health manpower production during the Second Five-Year Plan as well as the next three five-year plans up to the end of the century. A steering committee and working group appointed by the Government are now preparing a health manpower situation report, and a national workshop is to be held to formulate the outline of the health manpower plan in the context of the Second Five-Year Plan and the national strategies for HFA. In the field of medical education, changes have been envisaged in teaching methodologies, including curriculum development, as well as in the preparation of non-medical teachers for the basic medical sciences. During 1980-1981, three medical colleges were opened, bringing the total to eleven; however, the intake of students has not been substantially increased. Similarly, eight more medical assistant training schools have been started. There is a great shortage of teachers, particularly in basic science subjects. The Government has formulated a plan to train more nurses to achieve a target of 10 000 during the Second Five-Year Plan period. The Ministry of Health and Population Control has decided to open 38 schools for senior registered nurses (a four-year programe) at the sub-divisional level, and to implement the junior nurse programme in 170 thana health complexes (an 18lwnth programme). The project "Assistance to Medical Education Centre and Development", which covers the development of teaching methodology in the medical colleges and other teaching institutions, along with the formation of teacher training cells in the medical colleges, has been reformulated. In order to provide relief to more than eight million people who were affected by floods during the year the National Oral Rehydtation Pro- gramme arranged for the supply of oral rehydration salt packets; as a result, mortality from diarrhoea was kept to the minimum. Projects in operation Number and Source of Funds Title - BAN CHP 001 Country Health Progradng R BAN RPD 001 Research Promotion and Development R BAN SPM 001 Organization of Health Services Planning and R Administration BAN SPM 002 strengthening of Thana Health Complexes and Development R of Primary Health Care BAN SPM 003 Repair and Maintenance of Electro-medical Equipment R BAN ATH 001 Development of Health Laboratories and Allied Laboratory R Services BAN NUT 002 UNDP BAN HED 002 R BAN MNH 001 R BAN PHB 001 R BAN ESD 001 R/VF BAN ESD 002 UNDP BAN MPD 001 R/VF BAN BVM 001 RVF/TF BAN SME 001 VF BAN EPI 001 R/ BAN PBL 001 R BAN CAN 001 R BAN CVD 001 R BAN ORH 001 R BAN OND 001 R BAN EHP 001 UNDP BAN BSM 001 R BAN PTR 001 R - 133 - Institute of Public Health Nutrition Health Education Mental Health Pharmaceutical and Biological ~uality Control Strengthening of Epidemiological Services Epidemiology and Disease Control Malaria Control Mycobacterial-Disease Control Smallpox Eradication Expanded Programme on Immunization Prevention of Blindness Cancer Prevention and Control Cardiovascular-Disease Control Oral Health Other Noncommunicable Diseases (Diabetes, Endocrinology) Assistance to Water and Sewerage Authority (Dacca and Chittagong) Community Water Supply and Sanitation Training of Mid-level and Peripheral Health Workers BAN PTR 002 Training of Medical Assistants UNDP BAN PTR 003 Strengthening of Health Manpower Development UNDP BAN PTR 005 National Institute of Preventive and Social Medicine UNDP BAN EDS 001 Nursing Advisory Services and Training R 2. BHUTAN* The development of health services in Bhutan is making steady progress. If the existing momentum is maintained, the target of providing basic health care to the people can be attained in the near future. At the end of 1980, there were 44 basic health units and 41 dispensaries providing basic health care to the population, in addition to 16 general hospitals and two leprosy hospitals. The dispensaries and the basic health units are the peripheral health posts responsible for both preven- tive and curative services. Following the decision of the Government, all the existing dispensaries are being converted gradually into basic health units. These are supervised by the zonal medical officers concerned, stationed in the zonal hospitals, which serve as referral points to basic health units. The General Hospital at Thimphu also functions as the national referral hospital. Assistance to health services from the United Nations system was started in 1974, with the operation of the UNDP-funded project "Development of Yealth Services" following visits by UNDP missions in 1972 and 1973. Under the UNDP project, being executed by WHO, technical experts - both long- term and short-term - in different specialties were provided, fellowships were awarded, and equipment was procured for the Thimphu General Hospital and some other zonal hospitals. 'The Fifth Five-Year Plan of the country, covering the period April 1981 - March 1986, has been formulated. However, the beginning of the plan ueriod has been uostponed by one year, the interregnum being treated as the hridging year. It is envisaged that, during the coming plan period, the Government will consolidate the achievements in the health sector and strive for improvement of quality of work, limiting expansion of services to the minimum required. Percentage outlays for the health sector rose from 2.94 in the First Plan period (1961-66) to 6.06 in the fourth plan (1976-81). The UNDP third country programme will also be synchronized with the Fifth Five-Year Plan period, and the total funds available from indicative ?laming figure (IPF) resources for 1981-1985 will be about $26.9 million (the illustrative IPF for 1982-1986 being $36.5 million). Of this amount, the health sector is likely to receive approximately $1.4 million, accounting for five per cent of the total input by UNDP. The concept of primary health care has been accepted: village health ~lorkers - volunteers drawn from the community, including community leaders and Buddhist lamas - are given training in first aid, sanitation, ky~iene and nutrition and sent back to work in their communities. With supervision, they are enabled to become more reliant and confident in the delivery of health care. They are supported by the basic health units. "'Putan is a Member of the United Nations but not of WHO. Though some of the programmes - such as those of the Expanded Programme on Immunization and leprosy control - are run as vertical programmes, they are being implemented at the periphery by basic health workers, who are in fact, multipurpose workers. The malaria workers, in turn, will be trained to carry the message of family welfare to the communities they serve. One of the significant developnents in the health sector is the establish- ment of a nutrition cell in the Department of Health to formulate a national nutrition policy, to implement this policy and to coordinate all the activities in this field. The development of health services is beset by many problems, of which lack of adequately trained manpower is a major one. To help overcome this inadequacy, the Health School attached to the Thimphu General Hospital runs courses for basic health workers (of 12 months' duration), assistant nurses (12 months) and health assistants (24 months). In addition, during 1982-1986 UNDP has earmarked an amount of $898 000 for fellowships in fields such as nursing, laboratory, X-ray and dental techniques and physiotherapy for studies outside the country. A family welfare training centre is being constructed at Geyldgphug with UNFPA funding, When the centre is ready in March 1982, it will provide facilities for training different categories of workers in the concepts of maternal and child health and family welfare. The Royal Government encourages the development of traditional medicine as well, and the School of Traditional Medicine continues to train students in this system. The School is being enlarged to serve the needs of practical training and provide treatment facilities. Following a tripartite review of the two projects being executed by WHO - Development of Health Services, funded by UNDP, and Development and Strengthening of Maternal and Child Health and Family Planning Services, funded by UNFPA - held in June 1981, a plan of action was chalked out for the near future, and it was agreed that a meeting of all the agencies active in the health sector would be called to ensure optimization of inputs from the agencies and to avoid overlapping. During the period under review, WHO provided assistance in tuberculosis and malaria control and in the preparation of curricula for the training courses to be held at the Family Welfare Training Centre. Fellowships were awarded for basic nursing, in public health administration and in health education. Equipment was procured for Thimphu General Hospital and some zonal hospitals and for basic health units. Under the UNFPA-funded project, the Government is proceeding with the construction of the family welfare training centre and three basic health units. Other agencies of the United Nations system that are active in health and related sectors in Bhutan are: UNICEF, UNDP, FA0 and WPF. In addition, a number of voluntary agencies and the Government of India are involved. Number and Source of Funds Projects in Operation Title - BHU SPM 001 Development of Health Services UNDP BHU MCH 001 Development and Strengthening of MCH and FP Services FP 3. BURMA In Burma, the country health programming (CHP) methodology has been used as a mechanism for national health planning. The second CHP cycle was started in July 1980 in preparation for formulat- ing the People's Health Programme for 1982-86. The programming phase ended with the identification of five broad programme areas and areas of health strategy in which cornunity involvement and intersectoral coordination are prominent, and of which health services research and health information services are essential components. This phase was followed by detailed project formulation and the develop- ment of monitoring and evaluation procedures. The current People's Health Programe (1978-82) has been implemented in a phased manner since April 1978 by increasing the number of townships to be covered every year. The country profile and profiles for individual programmes have been prepared and are regularly updated for management purposes. In order to formulate the programme of health information services and systems the existing health statistics activities have been reoriented, in line with the information needs of the People's Health Programme. The Government has devised a built-in monitoring and evaluation system based on the guidelines evolved by WHO for progrannne evaluation. Primary health care and basic health services are at the centre of health develoment efforts, the main emphasis being laid on the extension of coverage by primary health care at the grass-roots level. Important developnents in this regard are the conversion of workers in vertical campaigns into multipurpose basic health staff, and the utilization and deployment of voluntary health workers. The training programme for CHWs was supported by WHO, and received kits from UNICEF and US AID. Traditional systems of medicine are being integrated into the primary health care programme and community health workers are being trained in the use of these systems as part of their basic training. The Institute of Traditional Medicine, Mandalay, conducts a three-year course with 50 new enrolments a year. Two traditional medicine hospitals and 79 traditional medicine dispensaries are expected to be in operation by 1981. In regard to medical care, efforts continued to extend health facilities in order to provide referral services for primary health care. Training courses for specialists and general medical officers in clinical manage- ment skills were conducted. In the field of rehabilitation, a new UNDP-funded project, "Training and Rehabilitation of the Disabled", is being developed for implementation during 1981. The family health care programme, with emphasis on maternal and child health and nutrition, continued to expand, 2880 voluntary auxiliary midwives having been trained and placed in position as of April 1981. A pilot project for training traditional birth attendants has been completed, and plans are being developed to expand it into a national programme. The water supply and sanitation activities of the environmental health programme include a deep tube-ell programme. Out of a target of 3000 tubwells, 1160 were completed as of 1980181. Water supplies to 11 station hospitals and 42 village schools and rural health centres (jointly) have been completed in 1980181, bringing the Third Plan totals to 47 and 94 respectively. Also, 14 000 latrines in rural and 17 000 in urban areas were completed in 1980181, bringing the total for the Third Plan to 92 700 in rural and 100 000 in urban areas. The Department of Health has completed the formulation of an environmental health programme for the next four-year period beginning in 1982183. This progr-e emphasizes the development of traditional village water sources such as wells and ponds and the provision of household latrines, mainly in rural areas. A UNDP/WHO project for a "Programme Identification Study" has been finalized for approval. A proposal for a UNDPIWHO project on low-cost technology and behavioural studies has been prepared. Preliminary activities have started for Water Decade planning as a WHOIGTZ regional project. Control activities against malaria, filariasis, dengue haemorrhagic fever and Japanese encephalitis were continued during 1980-81. Malaria remains the major public health problem, and P.falciparum is the dominant species in the country. Epidemiological surveys in relation to filariasis were extended, and case distribution, treatment and larviciding activities were intensified. Cases of dengue haemorrhagic fever were reported mainly from Rangoon. Focal space spraying and blood sampling were conducted in selected townships of Rangoon and Mandalay. The Expanded Prograame on Immunization (EPI) covered 104 tovnships as of April 1981. During 1980-81, an evaluation was carried out in 53 townships, using the standard cluster survey technique recommended by WHO. In the field of health manpower development, the training of different categories of health workers was reviewed. Manuals were published for all categories of basic health staff, and a task analysis study of health workers at the peripheral level was undertaken. The curriculum for a management training programme is being developed. The project document for a new UNDP project, "Planning and Manpower Development for Primary Health Care", is being finalized, and implementa- tion is to start during 1981. In regard to referral laboratory services, the emphasis is on upgrading and strengthening facilities at the periphery, including the training of personnel at different levels. Facilities for drug abuse control work were strengthened in selected laboratories. Plans are under way to develop food and drug legislation, inspection and infrastructure. UNDP is expected to support these activities, in addition to the ongoing food and drug control laboratory project. Activities in regard to biomedical and health systems research were carried out in support of the people's Health Programme. The research covered leprosy, malaria, DHF, Japanese encephalitis, diarrhoea1 diseases, viral hepatitis, toxaemias, nutrition and various aspects of maternal and child health. More attention is being given to intersectoral coordination and coopera- tion in the implementation of health and health-related programmes. An intersectoral seminar on integrated vector-borne diseases control in connexion with the construction of dams was conducted in April 1981, to highlight the health and environmental aspects of development projects, especially irrigation projects, and to develop guidelines for future coordinated intersectoral action. Projects in Operation Number and Source of Funds Title - BUR CHP 001 Country Health Programming R BUR RPD 001 Health Research in support of the People's Health R Programme BUR SPM 001 Hospital Services Management R BUR PHC 001 primary Health Care and Basic Health Services R BUR WKH 001 Strengthening of Health Services in Newly Industrialized R/UNDP Areas (West Bank of Irrawaddy River) BUR ATH 001 Supply System and Maintenance and Repair Workshop R for Health Equipment BUR ATH 002 Promotion of Health Laboratory Technology R BUR ATH 003 Food and Drug Quality Control Laboratory UNDP BUR MCH 004 Family Health R BUR PHB 001 R BUR ESD 003 UNDP BUR BVM 001 RIVFITF BUR EPI 001 R BUR VBC 001 RIVF BUR EHP 001 R BUR PTR 001 R BUR PTR 002 UNDP BUR HST 001 R Development of Production and Quality Control of Biological and Pharmaceutical Products Expansion of Epidemiological Surveillance in Comunity Health Services Leprosy ControlIResearch Activities Expanded Programme on Immunization Vector-borne Disease Control Environmental Health Planning and Management Development of Procedures and Staff Training Education and Training of Health Manpower Development of Health Information Services The Fourth Session of the Sixth Supreme People's Assembly of the Democratic People's Republic of Korea on 3 April 1980 adopted the Public Health Law enunciating the basic principles of health care, providing for a system of complete and universal free medical care services, the protec- tion of the health of people in accordance with the policy of prophylactic medicine, the development of Juche-based medical science and technology, the guarantee of material resources for public health work, the considera- tion of health workers as the true servants of the people, and the estab- lishment of health agencies, their direction and management. This enact- ment further gave a concrete shape to the concept of health care and paved the way for providing the most advanced system of public health services to every citizen in the country. Thus the promotion of health and the prevention of diseases through the primary health care approach in the context of "Health for All by the Year 2000" were identified as important objectives to be attained, and the health system of the country was geared to respond to this challenge by legislative and executive action. The medical care services have been further strengthened. Integration of traditional medicine with modern medical care, personalized periodic/ annual physical examination, and maintenance of health through an efficient system of medical records and follow-up, through the "section- doctor" method, and by health education and prophylaxis received greater attention in polyclinics. Health centres are being constructed in different parts, the Chang Guang Health Centre, inaugurated in Pyongyang, serving as a national model. An institute for research in indigenous medicine went into operation. A large, modern maternity home for the care of the mother and child was completed in the record time of one year and commissioned; it provides most modern facilities for advanced ante- nstal, obstetrical and gynaecological investigations, and for the treatment and health care of the new-born, including premature babies. Health and allied personnel are being trained to shoulder greater responsibilities in the delivery of primary health care, as well as specialized medical services and biomedical research. In collaboration with WHO, personnel were trained in recent advances in medicine. Emergency health services have been developed, and flying squads and ambulance services bring medical relief to workers in all parts of the country. A new 250-bed Institute for Cancer Research is under construction in Pyongyang. Ontological departments have been established in all eleven provinces, and personnel who have been trained abroad, with WHO colla- boration to manage cancer patients, are actively participating in services at central and intermediate levels. Facilities are being organized to increase the potential of the public health system for the prevention of cancer by health education and by improving the end-results through early detection and diagnosis and standardized treatment procedures. Based on an epidemiological study in Pyongyang, a school health programme has been formulated for the prevention and control of rheumatic fever, including rheumatic heart diseases. The Cardiology Institute has developed facilities for open-heart surgery and has trained cardiac surgeons to facilitate the establishment of six cardiac surgical centres in the country. Treatment of allergy receives greater attention. Specialized services in angiology, haematology, orthopaedics, neurology, ophthalmology and endocrinology were strengthened. Occupational and environmental health aspects received greater attention; the health of industrial workers is being carefully monitored and their welfare promoted through special holiday schemes for rest and recuperation in sanatoria. The development of appropriate technology in the field of pharmaceuticals, drugs and medical instruments made satisfactory progress. Supplies and equipment for physiotherapy, dental health and ophthalmology are being manufactured and made available to district hospitals and polyclinics. Special attention is being paid to the identification and scientific cultivation of oriental plants of medicinal value. Medical research on the prevention and control of public health problems receives priority consideration in the medical faculties and in special research institutes for cardiovascular diseases, cancer and indigenous medicine, and institutional facilities for the promotion of these research activities have been strengthened. In collaboration with WHO, equipment was provided for ultrasonic diagnosis, cardiac catheterization and scanning photocytometry. During 1980-81, in cooperation with WHO, 13 fellowships were awarded to physicians for training in the quality control of drugs, urology and cardiovascular diseases, as well as training in foreign languages for health personnel. Thus, WHO technical collaboration has been intensified for the development and promotion of primary health care in the context of health for all. Projects in Operation Title - KRD SPM 001 Strengthening of Medical Care Services Laboratory Sciences and Techniques KRD PHB 001 Drug Quality Control R KRD CAN 001 Cancer Control R KRD CM 001 Cardiovascular Diseases R KRD RCE 001 Environmental Health R KRD FSP 001 R Food Hygiene KRD MPM 001 Strengthening of Health Manpower Development R 5. INDIA me Government of India's Sixth Five-Year Plan (1980-1985) views health in totality, as part of the strategy of human resources development, recognizing that the problem of diseases can be successfully tackled only when such an effort is accompanied by an attack on poverty itself. The Plan therefore assigns high priority to programmes for the promotion of gainful employment, eradication of poverty and population control, and for meeting the essential basic needs of the people such as water supply, environmental sanitation, education, nutrition and maternal and child welfare. The Plan also gives high priority to primary health care and seeks to coordinate the programmes in other related sectors in its implementation. The increased requirements for financial and material resources in the health sector are proposed to be met through higher budgetary allocations. Indicators have been selected to monitor progress towards health for all. Five working groups have been set up to prepare reports on the various components of the national plan, including one on intersectoral coordi- nation. It is also proposed to set up a National Coordination Committee for "Health for Allq'under the chairmanship of the Prime Minister, with ministers in charge of the economic and social welfare sectors as members. The Minimum Needs Programme is the main instrument through which the health infrastructure in the rural areas has been expanded and further strengthened to ensure primary health care to the rural population. By the end of 1979, 5400 primary health centres and 50 000 sub-centres had been established. This programme is to be accelerated over successive plan periods to achieve by 2000 AD the target of establishing one primary health centre for every 30 000 people (20 000 in tribal and hilly areas) and one subrentre for every 5000. WHO and UNICEF continue to provide support to the rural health programme. According to the latest census figures (year 1981), India has a population of 684 million, recording a growth of 24.75 per cent since the last census in 1971. This large net addition to the population has been the result of a sharp decline in the death rate coupled with a much slower decline in the birth rate. Life expectancy has increased to 54 years for males and 53 years for females and the rate of infant mortality has come down to 127 per 1000 from 135. The crude death rate has decreased from 15.7 to 14.8 per 1000. The Family Planning Programme, which received a serious setback during 1977-78, is picking up again. It has been widely recognized that family planning cannot be the sole responsibility of a single department but of the Government as a whole. Ihe specific activities of each ministry in relation to family planning are to be identified and the responsibilities fixed. Besides assisting in the undergraduate teaching of paediatrics, maternal and child health and nutrition, WHO, through its Special Programme of Research,Development and Research Training in Human Repro- duction, is closely collaborating in the Family Planning Programme by providing support to institution-strengthening and research activities. An evaluation of the in-service training programme in XH/PP for physi- cians working in primary health centres indicated that the programme has been very useful. Four workshops on neonatology were held. Models of the undergraduate MCB/FP curriculum as well as of the remodelled paediatric curriculum for undergraduates and interns are being demons- trated at B.J. Medical College, Ahmedabad, and at the medical colleges in Trivandrum and Jabalpur. The National Institute of Health and Family Welfare received assistance in testing the teaching modules and in conducting a national workshop on health economics and planning. A basic research model for evaluating the work of primary health centres was prepared and some guidance given on the criteria on the basis of vhich research priorities might be determined. The Community Health Volunteer (CHV) Scheme has been extended to 2366 primary health centres, covering almost half the population of the country. The objective of this scheme is being extended, to have one CHV for every 1000 people. The Government has given the highest priority to the HCH component of primary health care in line with its determination to halve the maternal and infant mortality by 2000 AD. It is planned to attain this target through the expansion of service facilities and by the training and deployment of large numbers of auxiliary nurse midwives supported by trained dais at conmunity level. - The National Institute of Prosthetic and Orthotic Training, Cuttack, con- ducted a disability survey during the year. With a grant from WHO, a programme, "Training the Disabled in the Community", is being undertaken by the Kerala State Council for Child Welfare, Trivandrum. An accident analysis centre has been set up at the Lok Nayak Jaya Prakash Narayan Hospital, New Delhi, and the collection of data is in progress. A national seminar on road traffic accidents was held in November 1980 at the Maulana Azad Medical College, New Delhi, to asseas the magnitude of the problem and draw up a proposed national policy in respect of accidents. At the Public Health Laboratory, Trivandrum, vhich also functions as a regional laboratory, training in applied bacteriology techniques, quality control checks and laboratory management was given to the technical staff. Similar training was carried out for the technical staff of the regional and district public health laboratories. On a request from the Government, WHO is procuring reagents and other laboratory media for the reference centre at the All-India Institute of Medical Sciences, New Delhi, to investigate the epidemic of hepatitis in parts of the country. Integration of health education with all the subjects of the undergraduate medical curriculum is proposed. The goal is for all medical colleges to adopt a curriculum which prepares the students in the use of health educa- tion as a therapeutic and preventive technique in their dealings with patients and with the public. During 1980, the total production of iodized salt amounted to 120 000 metric tons. A. part of the reviev of the national goitre control progranme, it vas decided to examine the possibility of setting up one iodization plant each at Kalka and Pathadcot to cater to the requiremnts of the States of Hhachal Radesh, Punjab and Haryana and the Union Territory of Chandigarh. The drug industry in India is fairly well developed, and both bulk drugs and formulations are manufactured. WHO provides aaristance in the training of personnel in drug analysis and control, and supplies and equipment to drug testing laboratories. The country is self-sufficient in the production of a11 vaccine8 except those against DPT, polio and measles. Action has been taken to increase the DPT-production capacity at the Central Research Institute, Kasauli, and the Haffkine Bio-Plu~~~ceutical Corporation Ltd., Bollbay. A new unit for the production of this vaccine is being opened at the Parteur Insti- tute, Coonoor, and polio vaccine is to be produced at Haffkine, and is expected to be available by the end of 1981. The National Inatitute of C-nicable Diseases received assistance in establishing the in vitro culture of human filaria and guidance in formulating epiddological studies on filariasis. A national workshop on filariasis was organized by the Institute to review, among other things, the epidemiology of and recent advances in chmotherapy and vector control related to bancroftian and malayan filariaaia and to identify the gaps in knowledge and relevant areas for future research. A national seminar on dengue haemorrhagic fever and Japanese encephalitis was held at the School of Tropical Medicine, Calcutta. The NICD organized a threemonth training course in the epidemiology of c~unicable diseases and their control for medical officers, district and municipal health officers, etc., and also several workshops on such topics as the epidaiolagical surveillance of roonoses of public health importance and field training in epidemiological research methodology vith special reference to tropical diseases. Under the National Malaria Eradication Programe all the P.falciparum containment programme areas took active steps to increase insecticidal coverage. Areas were selected for such coverage on the basis of a thorough epidemiological analysis of data employing stratification techniques, thus enabling the States to accord prioritiem for spraying and supervision. A draft five-year plan for the Expanded Rogr- on Inmunization was prepared to ensure a balanced expansion of the activities. Folders on "Recognize the Disease" were distributed to State EPI officers to enable them to train peripheral health staff to identify the EPI diseases and report the cases to the centres. In order to collect reliable baseline data on the incidence of poliomyelitis and neonatal tetanus and to chalk out priority areas vith a high incidence of these diseases, guidelines for sample surveys were prepared in consultation with IQIR and WHO, and such surveys have been conducted or are being planned in a number of States and U~liort Territories. Since 1980, the programme of tetanus toxoid vaccination has been extended to children in the 10 to 16-year age-group. A study on the need for measles vaccination and the administrative feasibility of introducing it in the routine imunization services is under progress. A total of 2.7 million cases of leprosy had been recorded and 2.3 million cases brought under treatment as of 31 March 1981. In addition to supply- ing four tons of DDS (100 mg), and 25 motor-cycles and 12 jeeps, WHO has provided two consultants - a reconstructive surgeon and an epidemiologist- cum-leprologist - to make an on-the-spot, in-depth study of the problem of leprosy in various institutions in the country and to make pragmatic suggestions for improving the methodology of leprosy control. A national worksbon on research ?n leprosy, i~cludile immunology, microbiology and vaccine production, was held at the National Institute of Mental Health and Neurosciences, Rangalore. Out of about 600 tr:Derculosis clinics in India, 351 have been upgraded as district tuberculosis centres; 43 300 beds are now available for in- patient treatment and 17 tuberculosis training and demonstration centres provide training to medical personnel in different parts of the country. In order to make the control programme against sexually-transmitted diseases more effective and meaningful, it is proposed to make it an entirely central programme. With WHO assistance, workshops on STD were organized for junior medical officers from a number of States and Union Territories with the aim of improving working knowledge and focusing attention on the various lacunae in the control of STD. Medical officers engaged in STD work in the districts/~HCs/sub-centres/STD clinics, etc., attended these workshops. At its sixth meeting, the Central Coordination Committee of the National Programme for the Preve~tion of Visual Impairment and the Control of ':lindness, decided to review the performance of the existing 40 mobile units in the field before setting up more units. The curriculum and syllabus for the training of ophthalmic assistants were approved. Cancer control programes at rke State level include the organization of centres for early detection, diagnosis and treatment; development of cancer health education activities, including the production of a multilingual film on cancer prevention, detection and control, and the strengthening of facilities for training in and organizing exfoliative cytological services. Standardized treatment schedules, including combi- nation cancer therapy, have been drawn up. Regional cancer centres have been established in six more States; in many States, early detection centres are under development. National and state-level meetings were organized for formulating a national plan for the prevention and control of cardiovascular diseases. Group educational activities at zonal and State levels were organized to promote community-oriented prevention and control activities, including cardiac resuscitation and rehabilitation. WHO assisted the National Environmental Engineering Research Institute in making a critical review and assessment of water treatment plants in the country, including the managerial aspects. A project proposal for WHO support to the field testing of integrated water supply and wastewater utilization systems for villages has been developed and accepted. The project agreement for hydrogeological and artificial recharge studies to augment the water supply in Madras city has been signed by UNDP and the Government of India. The Government of Tamil Nadu has decided to implement the Cauvery Canal Project for meeting the water supply require- ment of the Madras Metropolitan Authority up to the year 2000. The project, "Conjunctive use of surface and ground water, including arti- ficial recharge in the Arni-Korattaliyar Basin", has been approved by the Government of India and will be executed by the United Nations Department of Technical Cooperation for Development. The Central Board for the Prevention and Control of Water Pollution, New Delhi, was advised on the treatment and disposal of distillery spent wash water, including the possible recovery of useful by-products. A national workshop on food control strategy was held early in 1981 with the assistance of WHO and FAO, to consider ways and means of protecting the consumer against health hazards and commercial exploitation, promoting the nutritional status of the population by ensuring the safety and quality of food supplies, improving food exports through more adequate food quality control and inspection procedures prior to shipment, etc. WHO has assisted in strengthening teacher training and developing teaching aids in the National Teacher Training Centre at Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry. A Regional Teacher Training Centre was established at the PGI, Chandigarh, and a workshop on educational technology was organized at this centre. The National Academy of Medical Sciences also held a one-week workshop on objective methods of assessment in higher professional examinations. With a WHO grant, a short course on orthopaedic nursing and rehabilitation was conducted at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry, for staff nurses/nursing sisters engaged in teaching in medical colleges/hospitals at district level. The training programme under the Multipurpose Health Workers Scheme has been completed in 183 districts and is in progress in 142. Under the programme 8539 medical officers attached to PHCs, 3616 extension educa- tors, 25 051 health assistants and 98 888 multipurpose health workers have been given reorientation training. The revised basic training programme for multipurpose health workers (female) was developed and implemented in all basic training schools. A programme of continuing education of community health volunteers (CHV) has been launched. Manuals for CHVs, male and female MPWs and health assistants, as well as guides for the trainers of various categories of health workers, have been prepared. Training material and aids have been developed at the Gandhigram Institute of Rural Health, Madurai, and the National Institute of Health and Family Welfare, New Delhi, and supplied to various centres. The programme for various categories has been reviewed and modified; an integrated programme for medical officers assigned to PHCs also has been drawn up. The Directorate-General of Health Services has developed prototypes of health records and reports, which have been standardized. This will ensure uniformity of the health information system in primary health care throughout the country. Lay reporting classification lists have been tried in selected areas by the Central Bureau of Health Intelligence. The instruction booklet on lay reporting of health information has also been distributed by the Bureau. WHO has provided assistance in training medical records technicians at Safdarjung Hospital, New Delhi. Projects in Operation Number and Source of Funds Title - IND CHP 001 Country Health Programming R IND ISP 001 Building up of National Information System R IND RPD 001 Biomedical Research R ZND SPM 001 Health Economics and Management R IND PHC 001 Strengthening of Health Administration (Rural) including R Planning and Evaluation IND ADR 001 Medical Rehabilitation R IND ADR 002 Prevention of Disability Related to Road Traffic R Accidents IND ATH 001 Development of Medical Uses of Ionizing Radiation and R Protection Programme IND ATH 002 Promotion of Health Laboratory Services and Health R Laboratory Technology IND ATH 003 Laboratory Quality Control and Standardization R IND ATH 004 Virological Techniques R IND ATH 005 Radiation Health Protection R IND MCH 003 Strengthening of Maternal and Child Health Services R IND NUT 005 R IND HED 005 R IND MNH 002 R IND PHB 001 R IND PHB 002 R IND PHB 003 R IND ESD 001 R IND ESD 003 R IND MPD 001 R/VF IND BVM 001 R/VF/TF IND BVM 002 R/VF IND BVM 003 R IND SME 001 VF IND EPI 001 R IND PBL 001 R IND CAN 001 VF IND CAN 006 R IND CM 002 R IND ORH 002 R - 150 - Nutrition Programmes Development of National Health Education Services Mental Health Quality Control of Pharmaceuticals and Biologicals Production of Freeze-dried BCG Vaccine Technology in Vaccine Production Epidemiological Surveillance Port Health Malaria Eradication Leprosy Control Tuberculosis Control Sexually-transmitted Disease Control Programe National Smallpox Eradication Programe Expanded Programe on Immunization Prevention of Blindness Cancer Control Pilot Project, Tamil Nadu Cancer Control and Prevention Cardiovascular Disease Control Oral Health IND OND 001 R IND EHP 001 R IND BSM 005 R IND BSM 006 UNDP IND RCE 001 R IND FSP 002 R IND PTR 001 R IND EDS 001 R IND EDS 002 R IND EDS 003 R IND HST 001 R IND HST 002 R Prevention and Control of Diabetes Assistance to National Environmental Engineering Research Institute, Nagpur Community Water Supply and Sanitation Madras Metropolitan Water Supply and Sewerage Board Environmental Pollution Control Food Standards Programme Training of Basic Health Workers Medical Education and Training National Medical Library Nursing Development Strengthening of Health Statistics Services Development of Medical/Health Records in Hospitals 6. INDONESIA The goal of achieving health for all by the year 2000, to which the Indonesian Goverument is committed, is in line with Article 27 of the 1945 Constitution and the application of the five principles of Pancasila. Intensive and extensive activities were continued throughout the year to evolve strategies and plans of action for achieving the health goal through the primary health care approach and the development of the national health system. The national health system is seen as a dynamic and functional system at all levels of the health administration, and will be restructured so as to respond to community aspirations and demands, and to encourage involvement and participation. Recognizing the importance of manpower resources for achieving health for all, the Committee of Manpower Development continued its efforts to design a system based on a long-term plan, close coordination between manpower producing and consuming institutions, efficient management and a career system for all categories of health manpower. The health planning capa- bilities at the central, provincial and regency levels continued to be strengthened, with emphasis on the monitoring, control and evaluation of plan implementation. Arrangements are being made for a mid-term review of Pelita 111, and, based on the results, the formulation of Pelita IV within the framework and targets of the long-term health plan will be undertaken. The 1981 Census showed that the crude mortality rate had dropped from 18.7% in 1971 to 12.45% in 1980, with a reduction in the infant and child mortality rate and increasing trends in life expectancy. This improvement in the health situation has been the result of major efforts, including the development of a strong infrastructure of health services, implemen- tation of the PKMD operational model of primary health care, involvement of the cornunity organization at the village level and urban kampungs, improvement in social services, and expansion and development of educa- tional and agricultural infrastructures. The Government continued its efforts to strengthen integrated health services in support of primary health care, health manpower development, improvement of environmental sanitation and provision of essential drugs. The budget allocation for the Ministry of Health in Pelita I11 amounts to Rps. 667.6 million, constituting 3.1% of the total government budget as compared to 1.6% in Pelita 11. Efforts to strengthen the health care delivery infrastructure continued through the expansion of the health centre network and promotion of PKMD. The number of functioning health centres increased from 3445 in 197911980 to 3676 in 198011981. Emphasis was placed on the training of health centre staff as a functioning primary health care team; during the year, 6985 health centre staff from 1195 health centres completed their training. The Ministry of Health, in collaboration with UNICEF and WHO, made an assessment of primary health care activities related to traditional birth attendants (TBAs), village volunteers and school-teachers, and a plan of action to implement the recommendations arising out of the assessment has been prepared. To improve the monitoring and control of field activities, a model health centre reporting and recording system was developed, and 1030 health centre personnel out of the Pelita III target of 5000 were trained. A study tour was organized for eight provincial-level supervisors to observe health centre reporting and recording in countries of the Region. With WHO collaboration, work on revising and updating the Health Centre Reference Manual was continued. Emphasis is being laid on the strengthening of MCH activities in primary health care, the tr$ining of TBAs in 13 UNICEF-assisted areas, and the formulation of programmes for the remaining years of Pelita 111. In the third population project assisted by IBRD, a health component is included in order to strengthen MCH and TBA training in six provinces; WHO collabo- rated in this programme. Two surveys were conducted in Jakarta and West Java to estimate the number of handicapped children in elementary schools. Four workshops were held to review the school health programme and to draw up plans for 1980181 - 1982183 for each development region of the country. The development of a nutritional surveillance system continues. Applied nutrition programmes are being expanded, supported by both government and external resources. The integrated health nutrition-family planning pro- gramme aims at covering two thirds of all villages by the end of Pelita 111. Indonesia is participating in the research collaborative studies on nutrition in primary health care, and the Nutrition Research Centre has been designated as a WHO Collaborating Centre. Programmes for the control of protein-energy malnutrition, vitamin A deficiency, endemic goitre and anaemia continued to expand with ,WHO'S technical cooperation and assist- ance from UNICEF, as well as from bilateral and multilateral sources. Pelita 111 aims also at integrating nutritional programmes with PKMD and family planning, developing sound food and nutrition policies, increasing food production and promoting effective intersectoral coordination. The Government continued to strengthen the infrastructure of health laboratory services at the central, regional, provincial and regency levels. Training activities using the educational material developed earlier through WHO assistance are making progress. In regard to health education, which is being implemented as an integral part of health programmes, techniques to achieve community participation in support of primary health care and to strengthen health education units at the central, provincial, regency and sub-district levels are being implemented. WHO continued to assist the Government at both national and provincial levels (Irian ~a~a). The rural water supply project in Nusa Tenggara Timur and South Sulawesi lays emphasis on intensive health educa- tion efforts to achieve community participation for the extension of the programme and the operation and maintenance of water supply and sanita- tion. WHO, UNICEF, the World Bank, WFP and US AID continued to collaborate in this programme. Formulation of a drug policy and attaining self-sufficiency in the produc- tion of essential drugs are priority programmes, to which WHO, UNDP and UNICEF extended technical support. A WHO~UNDP project conducted a compre- hensive feasibility study which is expected to help attract aid from the Asian Development Bank and bilateral agencies for implementation. With WHO assistance, the ASEAN Task Force continued its efforts to implement the recommendations of the ASEAN meeting on drug policy, legislation, evaluation and quality assurance. Malaria control is accorded priority in the national strategy for HFA and in the long-term plan. Malaria operations were continued in Java and Bali, as well as in transmigration and socio-economic development areas. The special thermal fogging measures and intensified case detection and treatment, as well as surveillance activities, have resulted in the containment of malaria in several pockets of high incidence. US AID has finalized an agreement for a malaria control programme in the province of East Timor. WHO continued to play a catalytic role in attracting extra- budgetary resources from bilateral and multilateral agencies. The Expanded Programme on Irnmunization,which covered only 50 sub-districts in 1976,now operates in 1661 sub-districts. Bio Farma's production of vaccines meets the needs of the BCG, DPT and TT programmes, although polio and measles vaccines are being imported. An assessment of the EPI national coverage indicated that the overall coverage was 63% for BCG and DPTl and 55.3% for DPT2. A health information sub-system was designed, to provide basic data on EPI activities and data to monitor the production and distribution of vaccine to the provinces. The training material for the mid-level supervisors' course was translated and material for health education and disease recognition, prepared by WHO, is being printed by WHO Headquarters. A manual on immunization was also printed for distri- bution to health centres. A study on the immunologic response to three doses as compared to two doses of DPT was completed. A case control study of BCG vaccination in childhood is being designed with support from WHO, UNICEF and US AID. The National Leprosy Training Centre in Ujung Pandang continued the train- ing and refresher training of medical officers and other health personnel. About 450 persons have been trained and, in turn, have given training to more than 17 500 health centre personnel. Random surveys in the provinces of Nusa Tenggara Timur and South Sulawesi were completed, showing preva- lence rates of 3.9 and 4.2 per 1000, respectively. Preparatory activities and/or implementation of random surveys in the provinces of North Sumatra, South Kalimantan, South-East Sulawesi and West Nusa Tenggara are in pro- gress. Leprosaria patients in the provinces of North and Central Sulawesi and Maluku have been screened with the aim of integrating the services of these institutions into the community. WHO technical cooperation was provided for strengthening the epidemio- logical surveillance system at all levels and for improving the entomo- logical services for vector-borne diseases. Assistance to the national tuberculosis control programme was also continued. The national diarrhoea1 disease programme, which continued to expand, is based on educational efforts and on making ORS packets available at low cost at the PHC level. WHO and UNICEF provided assistance for increasing the national production of ORS. A proposal for the establishment of a Regional Training Centre in Diarrhoea1 Diseases in Indonesia is being finalized. An M.Sc. course in epidemiology with emphasis on epidemiological field practice is being designed. The M.Sc. course in medical entomology conti- nued to receive WHO support. The national programmes for the control of yaws and STD also received WHO assistance. The Organization provided consultant support in the fields of cancer, the epidemiology of cardiovascular diseases and radiological health to review the national programme. 'Ihe mental health programme aims at integrating mental health services in the health centres and general hospitals and promoting community mental health in its promotive, preventive, curative and rehabilitative aspects. A case study on child mental health was completed. A WHO Collaborating Centre for Training and Research in Mental Health has been established at the Directorate of Mental Health. The national dental health programme continued to receive WHO technical cooperation. The Government accords high priority to water supply and sanitation projects and considers environmental health as a key element for achieving HFA goals. INPRES national funds continued to be made available to expand water supply and sanitation coverage in rural areas. WHO supported the Directorate of Rural Water Supply and Sanitation, Ministry of Health, and CIPTA KARYA in developing plans for HFA, IDWSSD, medium-term (Pelita) and annual plans. Other fields of assistance included the training of environmental health manpower, development of environ- mental pollution control programmes, food sanitation and sanitation of public places, preparation of designs for rural water supply and latrine progranrmes,and the training of national consulting firms in pre-investment planning and feasibility studies to achieve self-reliance. The national programme also continued to receive considerable support from WHO, UNDP, UNICEF, IBRD, AsDB, US AID, GTZ as well as Japanese, Dutch, Swedish, Swiss, French, Belgian and Australian agencies. A long-term plan for health manpower is being formulated to achieve the national strategy for HFA through the national health system. A Minis- terial Decree was issued for the reorganization of the educational aystem for various categories of manpower. A two-year MPH course at the Faculty of Public Health has been formulated and is scheduled to start in July 1981. Recognizing the importance of post-graduate training, the Ministries of Health and Education are proposing the establishment of new faculties of public health, the first in Surabaya, to be followed by two other faculties in Ujung Pandang and Medan. A proposal for establishing a university-level Faculty of Nursing at the University of Indonesia is under consideration. WHO is playing a catalytic role with US AID, the Ford Foundation and GTZ for providing assistance to the Faculty of Public Health. Also, consultants were assigned to revise the curricula in oral health and in environmental health. Technical cooperation with the Consortium of Medical Sciences was continued. Workshops were held on core curriculum development, develop- ment of community-oriented medical education, creation of teacher training centres in medical and dental faculties, and curriculum development in basic medical sciences and clinical specialties. A team of nurses continued to assist the Centre of Education and Training and the province of Irian Jaya in nursing education. The number of health nurse (PK) schools was increased from 66 in 1980 to 94 in 1981 through the conversion of earlier model schools. Consultants on tools for educa- tional evaluation, hospital nursing legislation and registration were assigned. Two newly constructed and properly equipped nursing training centres in Jakarta and Ujung Pandang were completed and funded by JICA. The national project also receives assistance from UNDP, IBRD and the Government of the Netherlands. Pelita 111 gives priority to strengthening the capabilities of the National ~nstitute of Health Research and Development and its six research centres. The Institute received assistance in completing a needs assess- ment study, in evaluating research projects, to develop inventories of research activities and identify areas for collaborative studies in the universities, and in conducting group educational activities on research methodology. The national health information system is being developed in a phased manner. WHO continued its technical cooperation for developing an inte- grated information sub-system within the Directorate General of Medical Care. A hospital record and reporting system integrating laboratory reports and activities is being designed. Projects in Operation Number and Source of Funds Title - IN0 CHP 001 Country Health Programming R IN0 RPD 001 Strengthening of Health Research and Development R Capabilities IN0 SPM 001 Health Services Development R IN0 SPM 002 Health Care Delivery in the Context of Primary Health R Care IN0 SPM 003 Strengthening of Health Services (province of Irian LMDP Jaya) IN0 ATH 001 Laboratory Services Development R IN0 MCH 003 Medical Servicee for Family Health R IN0 NUT 003 Nutrition R IN0 HED 001 Health Education R IN0 MNH 001 strengthening of Mental Health Services R IN0 PHB 001 Quality Control of Food and Drugs R IN0 ESD 003 R Strengthening of Epidemiological Surveillance and Control ? IN0 MPD 001 R Malaria Control Programme IN0 BVM 001 R/TF Control of Bacterial and Intestinal Diseases IN0 BVM 002 VF Leprosy Control IN0 BVM 003 VF Campaign for Control of Yaws in Sub-District of North Morotai IN0 EPI 001 R Expanded Programme on Immunization IN0 ORH 001 R Dental Health Services Development IN0 EHP 001 R Environmental Health Planning and Management IN0 BSM 003 UNDP Rural Water Supply for East Java Province IN0 BSM 004 VF Rural Water Supply for Central Java Province IN0 BSM 005 UNDP Rural Water Supply, Nusa Tenggara Timur (NTT) IN0 FSP 001 R Food Safety IN0 MPM 001 R Education and Training for Manpower Planning and Management IN0 PTR 001 R Post-graduate Medical Education in Public Health IN0 PTR 002 R Nursing Education and Services IN0 PTR 003 UNDP Nursing Manpower Development IN0 PTR 004 UNDP Training in Pre-Investment Planning in Community Water Supply Undergraduate Medical Education IN0 EDS 001 R IN0 HST 001 R Strengthening of Hospital Statistics 7. MALDIVES In the Maldivian context, the social goal of health for all includes, inter alia the provision of drinking water and basic sanitary facilities, - -$ comprehensive mother and child care, basic health education for all the people, immunization, a regular supply of essential drugs and herbs for both modern and traditional systems, a health infrastructure for the delivery of basic health services and the control of endemic diseases. A national health plan to achieve the objectives of health for all has been finalized and approved by the President. The Charter for Health Development,the main concern of which is to enhance the quality of life of people through improvements in health, was signed by the Government of Maldives in September 1980. The Government has allocated six per cent of the national budget for the health sector. In pursuance of the Gpvernment's policy, the Ministry of Health, through the national health services, is extending the basic health services. Minimum curative facilities are provided by the hospitals and health centres. A systematic programme for training health manpower is being implemented through the collaboration of United Nations agencies and with bilateral support. WHO has been assisting in the development of compre- hensive health services, including the training of paramedical and auxiliary health personnel. In addition, WHO teams consisting of specia- lists in general surgery, gynaecology, ENT and anaesthesiology assisted by examining and treating large numbers of patients and by training national staff. The Government is proposing to open four regional hospi- tals - an effort which both UNICEF and the International Human Assistance Programme are expected to support. The Government also plans to upgrade the hospital laboratory in Male to function as a public health laboratory. Case-finding surveys for leprosy and tuberculosis, case-holding and treat- ment, and examination of household contacts during supervisory visits were continued. Community health workers supervised the treatment in the atolls. Immunizations with DPT and BCG vaccines are being carried out. The leprosy and tuberculosis programme is expected to be supported by the Damien Foundation. Under the national health plan the Ministry of Health is taking action to eradicate malaria within two to three years. Additional inputs are expected to be channelled to this programme so as to interrupt malaria transmission completely by 1985. The Allied Health Services Training Centre continues to train middle and peripheral-level health workers. Two United Nations Volunteers - a public health nutritionist and a public health nurse - joined the Centre during the year. WHO supports the Centre through the assignment of a long-term public health nurse educator. Three groups of family health workers have been trained, and ten community health workers are undergoing training at present. A group of ten nurse-aides is also under training and ten foolumas (traditional birth attendants) have completed the training. Four workshops for health personnel were conducted. With WHO support curricula for various courses are being developed to suit the present needs. Needs for manpower for health development have also been investigated and reports prepared with WHO'S assistance. A national plan for water supply and sanitation to cover all the inhabited islands has been prepared. After necessary review and modification, if necessary, the plan will be sent to UNDP for its assistance in approaching donor countries/organizations to assist with implementation. The United Nations Capital Development Fund project providing for the construction of latrines in Male and 30 other selected islands has been taken up for execution, and materials are being procured. Two United Nations Volunteers have been appointed by UNDP to supervise the work. In order to prevent the recurrence of diarrhoea1 diseases, chlorination of all drinking water wells in the country is being continued with bleaching powder supplied by UNICEF. The work on constructing rain-water tanks and community latrines has been completed in two islands, and is in progress in four others. Projects in Operation Number and Source of Funds Title - MAV SPM 001 Public Health Administration R/ VF MAV MPD 001 Malaria Control R MAV BVM 001 Leprosy and Tuberculosis Programme R/VF/TF MAV BSM 001 Water Supply and Sanitation R MAV BSM 002 Water Supply and Sewerage for Male UNDP MAV PTR 001 Training of Auxiliary Health Personnel R/UNDP MAV PTR 002 Fellowships (Medical Education) UNDP MAV PTR 003 Fellowships (Medical Education - Noncommunicable UNDP Diseases Prevention and Control) 8. MONGOLIA The Government of Mongolia, during the year, signed the Charter for Health Development and has formulated HFA strategies. Such a formulation has stimulated greater efforts towards specifying the health objectives and reviewing the existing strategies. The new Five-Year (1981-86) Health Plan reflects the newly formulated strategies. It lays stress on the expansion and strengthening of out- patient primary health care and the accessibility of specialized referral services to the rural population. A mechanism for intersectoral coordina- tion exists. The Planning Unit of the Ministry of Public Health is striving to bring about a better balance between centralized and decentralized planning and programming by transferring to the provincial health directorates more responsibilities in the development of detailed programmes and projects. Two courses and two seminars were attended by 110 public health adminis- trators and health statisticians, and a national workshop on detailed health programming and project formulation is scheduled for the second half of 1981. A plan of work has been formulated for the establishment of a computerized information system, and steps are being taken to utilize the services of a statistical project under UNFPA to establish this system. Efforts to arrive at a clearer determination of the health problems have continued. The national sample survey of morbidity is still going on; similar sample surveys for psychiatric and cardiovascular morbidity have been completed, as have also studies of infant and maternal mortality and morbidity. Standard architectural designs for health institutions, including designs for inter-somon and somon health centres, have been prepared by a group of architects under the guidance of a WHO hospital architect. Family health has,for a number of years, been the largest cooperative programme and has received continuous support from WHO, UNICEF and UNFPA. Apart from the epidemiological studies on population already completed, six new studies have been planned and the respective research protocols prepared with the assistance of a WHO consultant. Two courses on the "Epidemiology of Population Growth" have been held for 85 obstetricians and paediatricians and two on the prevention and diagnosis of respiratory diseases with 26 participants have been conducted. In six aimaks, work has started on the development of MCH centres and the establishment of paediatric intensive care units and mobile MCH teams. The model MCH centres established earlier in Ulan Bator under the same programme have given encouraging results in the areas which they serve; the infant morta- lity rate has dropped by 50% in comparison with the rates of previous years in the same areas. Further in-depth evaluation is, however,necessary before final conclusions can be drawn as to the effectiveness of this part of the programme. Extensive KAP (knowledge, attitude and practices) studies with teachers, parents and school children have been carried out. Based on the results, a new family health education programme has been formulated for experi- mental use. Several booklets have been compiled to guide the teachers in the implementation of the programme, and a draft of the book, "Healthy Family", has been prepared. The programme for the training of health personnel continued to lay emphasis on developing the pedagogical skills of teachers of health professionals. Seminars on the "Organization and Evaluation of Students' Field Practice", and "Education Science for Health Professional Teachers", and two workshops, on "Health Education in Medical Education Curricula" and "Preventive Aspects of Health Care in the Curricula of the Health Professionals' Education Institute" were conducted. A medical teacher has been awarded a one-year fellowship to study educational science for health professionals,and is expected to head this unit on his return to Mongolia. WHO has provided a consultant on the further development of the Central Research Laboratory (which is already reasonably well equipped) , who advised on plans for the library of the Medical Institute to function as a National Health Science Library, with a network of institutions at aimak level, and is collaborating in the implementation of post-basic training programmes for health personnel. The epidemiological surveillance services have been further supported, and a new programme for the control of hepatitis during the period 1981-85 has been formulated. The Expanded Programme on Immunization is continuing successfully. A unit responsible for operating the cold chain system has been established. A national coordinating group for the control of intra-hospital infections has been established, a one-week course on the control of such infections being held during the year. The regular registration of grippe cases continues. A seminar on the prevention of influenza was held in Ulan Bator for 127 participants. A three-day seminar was held on the prevention of intestinal infections, and a coordinating group for the control of intestinal diseases is soon to be organized. The study of environmental health problems and the effectiveness of the existing sewage purification plants continues. A work plan for close co- operation between the Ministries of Public Health and Water Economy in the context of the WHO cooperative programme has been adopted; it includes a proposal for the investigation of tertiary sewage treatment and reuse of the treated water. Assistance was given in experimenting on a new method of fermentation for the bacteriological examination of water in several aimak laboratories and in introducing disinfection methods in the water distribution points. A seminar on sanitary engineering and also a two- month course were given. Aimak laboratories and the laboratory at the Institute of Hygiene have been strengthened with supplies and equipment, enabling them to undertake adequate examinations of water. The programme for the control of noncommunicable diseases made good pro- gress. A WHO consultant's recent finding that there was a high percentage of streptococcal carriers among school children has led to the establish- ment of a coordinating group for the control of rheumatic fever. The screening for heart diseases continues, and guidelines for the treatment of hypertension and ischaemic heart disease have been prepared and distri- buted among physicians. A seminar on the primary prevention of noncommuni- cable diseases was organized. Epidemiological studies of cancer and chronic liver diseases have conti- nued. A national conference on chronic liver diseases was held for 80 physicians. The construction of the Cancer Research Institute is making headway. A five-year programme for the control of noncommunicable diseases with an integrated approach is under preparation. The epidemiological study of mental diseases covering a population of 150 000 has been completed. An advanced course in psychiatry was organized for 13 physicians. The expansion of mental health services continued, with the opening of new inter-aimak dispensaries, an increase in the capacity of rehabilitation centres, and the strengthening of referral services in logopedology, forensic psychiatry and clinical psychiatry. Drug quality control laboratories have been supported in order to be able to introduce several new methods of investigation. A ten-day seminar on the organization and management of drug supply and distribution was held, attended by heads of city and aimak pharmacies. The work on establishing an independent system of drug quality control is continuing. Projects in Operation Number and Source of Funds Title - MOG CHP 001 Country Health Programming R MCG SPM 001 Management of Health Services R MCG MCH 002 Maternal and Child Health R MCG MCH 003 Epidemiological Studies of Population Growth FP Ma: MNH 002 Mental Health Services R ME PHB 001 Pharmaceuticals and Biologicals - Control and Production R MCG PHB 002 Brucella Vaccine Production UNDP - 163 - MOG ESD 002 Communicable Diseases - Prevention and Control R/ VF MOG OND 001 Noncomunicable Diseases - Prevention and Control R MOG EHP 001 Strengthening of Environmental Health Services R MOG PTR 001 Health Manpower Development R/UNDP 9. NEPAL Nepal is now in the first year of the period covered by its Sixth Plan (1980-1985), which was approved at the tenth meeting of the National Development Council, chaired by His Majesty the King. The Sixth Plan was prepared by the National Planning Commission based on the fundamental principles of speeding up production, increasing employment opportunities and meeting the basic minimum needs of the people. The Plan consists of central and district-level development programmes, to be implemented by the newly-formed Ministry for Local Development in coordination with other ministries. The concept of health for all is basically the same as one of the funda- mental principles of Nepal's Sixth Plan, i.e., to meet the basic minimum needs of the people. The Government reaffirmed its adherence to this principle by signing the Charter for Health Development in August 1980. The National Steering Committee for HFA/2000 Basic Minimum Needs met in Kathmandu in March 1981 to revise the HFA document prepared in November 1979. It was proposed to add cottage industry and forests to the original five sectors involved in HFA, namely, health, primary and adult education, food and agriculture,water supply and sanitation and basic communications. A series of studies in relation to HFA is being carried out, on population projection (completed),on manpower requirements, physical infrastructure and logistics support. The HMG/WHO Management Group, created in November 1979, has been promoting activities pertaining to HFA, strengthening the implementation and manage- ment of health programmes and providing special field supervision. A sub- committee appointed by the Group is being formed to coordinate health research activities. The first draft of the country programme for Nepal for the period July 1980 - December 1985, prepared by the Joint Programming of the United Nations Resources (JPR) group, was completed in June 1981. A national workshop on the development of health planning procedures and health information systems at district level revised the format of the district health profile. Steps are being taken towards the further development of the Health Data Bank. Together with the Integrated Community Health Project (ICHP), the Health Planning Unit has developed a study protocol on "lay reporting of morbidity and mortality". A multisectoral community and Integrated Health Services Development Board has been formed to facilitate the integration of health services and the development of primary health care, the immediate priority being given to the 23 integrated districts. The community health leaders scheme, utiliz- ing ward-level health volunteers, will be implemented as planned in 13 districts during the Sixth Plan, and will start later in 1981 as soon as the manual is printed. As for group educational activities, a district management workshop for integrated health services and a workshop on the role of the public health nurse in community and family health were held in Kathmandu. Apart from WHO'S inputs, UNFPA has approved three projects in support of the Integrated Community Health Project. UNICEF and US AID are also continuing their support to the project. The "Primary Health Support Services Programme", with four components - the training of community health volunteers, central and local production of traditional drugs, the logistic system for drugs and supplies, and the increased production of essential drugs at the Royal Drugs Limited - made progress. In relation to the International Year of Disabled Persons (19811, WHO has collaborated with the Government in the Nepal disability survey, in the establishment of a research cell and documentation,and in public education for community awareness. There are 49 fully operational district laboratories in the country, and training programmes for laboratory technicians, laboratory assistants and microscopists are making progress. Nepal will be participating in a field operational study for the establishment of health laboratory technology at the peripheral level, as a supportive service to primary health care. The FP/MCH project is satisfactorily meeting its planned targets for service delivery, and its activities have been integrated into the basic health services in all 23 districts of the Integrated Community Health Project. With the support of UNFPA, a study was carried out on the feasibility of utilizing dhami-jhankris (faith healers) in forming a communication network to reach the rural population with credible and comprehensive messages about health and family planning. Workshops for medical officers and district family planning supervisors were conducted. Apart from WHO'S inputs, UNFPA, UNICEF and US AID are continuing their assistance to the FP/MCH project. In regard to nutrition, activities such as the detailed work plan for the Nutrition Unit during the Sixth Plan period, evaluation of the progress of nutrition promotion using the multisectoral approach in Makwanpur and Newalparasi Districts, and planning for the extension of this approach to Dhankuta and Banke Districts,were undertaken. A workshop on the management of malnourished cases was organized for medical officers. The distribution of iodized salt for the prevention of goitre and cretinism is proceeding according to plan. The programme for the injection of iodized oil, jointly supported by UNICEF and WHO, is now in operation in six districts. WHO is participating in a UNICEF-funded Government project on a xerophthalmia survey for vitamin A deficiency among children in ten districts. The Government and United Nations agencies such as UNDP, FAO, WFP, UNICEF and WHO are developing an intersectoral action programme for rural children and their families. To encourage wider dissemination of health education, the Health Education Section of the Department of Health Services has conducted a series of health education training workshops for educational supervisors and subsequently school teachers, in collaboration with the Curriculum Text- book and Supervision Department Centre of the Ministry of Education. Epidemiological surveillance activities are gaining momentum. WHO colla- borated with the Government in project formulation, in an epidemiological survey of communicable diseases, in the development of a lay reporting system and in the use of epidemiology in primary health care. A surveil- lance system for communicable diseases and virus encephalitis surveillance and control were supported. The level of malaria incidence during 1980 remained about the same as in 1979. Cases imported from abroad accounted for 26.5% of all cases; 19.6% of these were P.falciparum, which constituted 74% of total falciparum infections in the country; a number of the imported Pf. cases were sus- pected to be resistant to 4-aminoquinolines. All three cycles of spraying were carried out in 1980 - some areas of the Western and Central Regions with malathion and the rest with DDT. Surveillance and research activities are being continued, and efforts are being made to secure community involvement through health education activities. About 33% of the total population of the country has so far been covered by the National Leprosy Control Project. Control activities in the Western and FarWestern Regions are carried out by the organization,"International Nepal Fellowship", with the guidance of the central office of the national project, which is directly responsible for the activities in the Eastern and Central Regions. The Netherlands Leprosy Relief Association is also assisting the project in various parts of the country. Plans were drawn up for the intensification of control activities through community parti- cipation and the introduction of the multidrug regimen of treatment in Bara and Parsa Districts. A Leprosy Services Development Board was formed in August 1980 to strengthen the national programme. Under the Tuberculosis Control Project, during the period from mid-July 1980 to mid-January 1981, seven districts were covered by BCG vaccination. The Second National Tuberculosis Seminar was held in Biratnagar in November, and a Regional Workshop on Tuberculosis at Pokhara in November- December, both supported by WHO. The Expanded Programme on Immunization is now operating in 24 districts, and the Integrated Community Health Project in nine districts. The Family Planning and MCH Project and voluntary associations are also giving immu- nizations. DPT and BCG immunizations are given to children and tetanus toxoid to women of child-bearing age; measles and polio vaccines are available at present only in the larger hospitals. In September 1980, an EPI project, to be implemented with UNICEF assistance during the Sixth Plan, was formulated with the help of WHO. The epidemiological survey for blindness is progressing satisfactorily. Eye centres are to be established in Nepalganj and hangarh hi during September 1981, and the existing eye centre in Butwal will be streng- thened. Also, ophthalmic assistants and other ophthalmic personnel receive training mainly through fellowships abroad, and basic health service staff will be given in-service training in the prevention and treatment of eye diseases, in surveillance and in the reporting system. The programme receives funds from the Dutch Government; support from other agencies, such as the Swiss Red Cross, the 'Save the Child' organization of Sweden and NORAD, is also expected. The Zoonotic Diseases Control Section, within the Department of Health, is collaborating with the Epidemiological Division in virus encephalitis surveillance and control. The Mrigendra Medical Trust, in collaboration with the National Council for Science and Technology, is conducting a research programme on cor pulmonale. The Ministry of Local Development and the Department of Water Supply and Sewerage continued to construct rural water supply schemes. Ninety-five surveys and designs have been completed and training programmes for workers such as overseers and water supply technicians have continued. The Decade Plan for 1981-1990 has been revised and approved by the sector agencies. Three project proposals for the construction of water supply schemes in different areas of the country, as well as one proposal for the training of manpower, to be financed through external sources, have been prepared. At the Institute of Medicine, Tribhuvan University, which continued to be the main institution for health manpower training. WHO has collaborated with the Teacher Training Cell in curriculum development, evaluation and improvement of teaching methodology. A number of workshops are being organized for the instructors in the Institute. A survey to assess the needs of the teachers for teacher training is also under way. A post-basic community nursing course was started in March 1981. The teaching of clinical anatomy and clinical pharmacology was strengthened through the provision of learning materials and by revising the curriculum. Projects in Operation Number and Source of Funds Title - NEP CHP 001 Country Health Programing R NEP RPD 001 Research Promotion and Development R NEP SPM 001 Health Planning and Programing R NEP SPM 002 Development of Health Services VF NEP SPM 003 Strengthening of Integrated Connrmnity Health Project in FP the Ministry of Health at the Central Level NEP PHC 001 Community Health Services and Primary Health Care R Development NEP PHC 002 Primary Health Support Services Programme UNDP NEP ATH 001 Development of Laboratory Technology Services R NEP MCH 001 Family Health Aspects of Integrated Health Service FP Siraha and Saptari Districts NEP MCH 003 Development of Maternal and Child Health Services R NEP MCH 004 Assistance to FP/MCH Project FP NEP NUT 003 R/ VF Nutrition NEP HED 001 F NEP ESD 001 R NEP MPD 001 R/ VF NEP BVM 001 R/VF/TF NEP BVM 002 R NEP EPI 001 R NEP PBL 001 R/VF NEP BSM 001 R NEP PTR 001 R NEP PTR 002 UNDP NEP PTR 003 FP NEP PTR 004 FP Health Education Development of Epidemiological Surveillance Malaria Control Leprosy Control Tuberculosis Control Expanded Programme on Immunization Prevention of Blindness Community Water Supply and Sanitation Training of Health Manpower Institute of Medicine (Teaching Hospital) Strengthening of Health Manpower Training of Integrated Community Health Project Family Health and Family Planning Teaching, Services and Research 10. SRI LANKA The infrastructure for national health development consists of the National Health Council, the National Health Development Couunittee and its six standing committees. To support the national health development network further and to ensure overall community participation, the Govern- ment has decided to establish health development committees at district, divisional and village levels. The National Health Council has formulated policies and primary health care strategies as well as health development goals, objectives and plans for intersectoral action for the achievement of HFA. The National Health Development Committee has drawn up a primary health care programme which envisages the reorganization and expansion of the infrastructure of health facilities to make them more accessible to the total population. Health programmes are being restructured to have a greater impact on health problems. WHO has been giving support to these activities of the Conunittee. Preliminary figures from the 1981 Census show a population of 14.9 million and an average annual growth rate of 1.7% during the decade 1971 - 1981. This achievement supplements the health picture of Sri Lanka, which conti- nues to remain impressive. The Government's commitments to health develop- ment are reflected in the increase in the total expenditure estimates of 19.0% from 1980 to 1981. The Health Ministry's per capita expenditure estimates for health were Rs.58 in 1980 and Rs.68 in 1981. The Government has issued a "White Paper on the re-organization of the Ministry of Health" which envisages the establishment of four teaching hospital authorities and nine provincial health authorities with broad powers and functions and a considerable degree of autonomy. A national seminar on health services research was held in February 1981 to identify national priorities in this regard, and the recommendations of the seminar are expected to result in the preparation of a comprehen- sive work-plan. An action-curresearch programme in nutrition has been formulated, and three projects have been started: (1) situation analysis of the current status with regard to the content and implementation of the nutrition component of PHC; (2) identification of practical problems in promoting the acceptability of lorcost weaning foods among poor rural conmunities, and (3) development and evaluation of a single procedure for food and nutritional surveillance for the identification of mothers and children at risk. WHO has provided support to the Food and Nutrition Policy Plan- ning Division of the Ministry of Plan Implementation in undertaking these projects. The Government strongly supports WHO'S proposal on the code of marketing for infant foods. Restrictions have been placed on the advertising of milk for babies. In collaboration with WHO, the Government organized an international seminar to promote breast-feeding. The Ministry of Indigenous Medicine has completed a detailed project for the development of traditional medicine, including the identification, planting and preservation of medicinal trees; training of traditional practitioners, and modernization of the Ayurvedic Drugs Corporation to promote efficient production. A country-wide survey of electro-medical equipment has been undertaken to identify problems of equipment management in the field. A plan for the establishment of four decentralized units in order to make maintenance facilities more accessible at the periphery has been approved. Also, a protocol has been prepared for strengthening laboratory services at peripheral, district and central levels to support primary health care and to ensure necessary reference facilities. A national committee for the observance of the International Year of Dis- abled Persons has been constituted and a survey of disabled persons in the Kurunegala area conducted. WHO has assisted the family health programme by supporting a scheme for the expansion of facilities available for hospital-based family planning services; such facilities are being established at selected district hospitals. At the same time, an intensive training programme in sterili- zation and the delivery of family health services at district hospitals is being run for doctors and para-professional staff. With support from WHO, a manual for use by the family health worker has been published by the Family Health Bureau of the Ministry of Health. In the field of health education, a village health volunteer programme conforming to the indigenous methodology in community programmes has been in operation for about four years and is showing very promising results. The health education activities, which are need-based, are carried out by these village-level volunteers, who are trained and guided by the health workers. A project proposal for the manufacture of essential drugs for primary health care has been submitted to the Asian Development Bank for assist- ance. Other components of the praject, including the development of the necessary cadre of personnel in pharmacy and drug utilization studies, will be supported by WHO. As part of its long-term drug management policies, the Government plans to organize regular diploma courses in pharmacy. Regulations are being drawn up to control the manufacture, distribution and sale of drugs and to ensure safe food handling. WHO is assisting in the revitalization of the quality assessment laboratory established with support from the Government of Japan. In the field of mental health, WHO provided consultants on the organiza- tion and management of the two mental hospitals and the development of ambulatory care, including day care and rehabilitation services for the mentally ill. WHO has also assisted the Medical Research Institute, Colombo, in develop- ing and strengthening its capability for the epidemiological surveillance of comnicable diseases as well as the development of a surveillance programme for arboviruses, especially dengue and Japanese encephalitis. Epidemiological services have been further strengthened by decentralizing the activities and improving service capabilities at both the centre and the periphery. The malaria control programme continued to make progress. Epidemiological and entomological findings have revealed that malathion spraying continues to be effective in controlling the spread of the disease. The WHOIUNDP vector control programme continues to achieve results as planned. A tripartite review meeting was held in November 1980. Under the Expanded Programme on Immunization, which is ~rogressing aatis- factorily, the cold chain at the periphery has been strengthened, and vaccine carriers have been issued. A mobile maintenance unit for servicing and repairing EPI refrigerators/freezers is being established. The pro- gramme has also been started in the estate sector. Estate superintendents and estate medical assistants were given training with assistance from UNICEF. With WHO collaboration, the Government has formulated a rabies control programme aimed at eradicating the disease in five years and is seeking financial assistance from bilateral agencies for this purpose. A diar- rhoeal diseases programme also has been formulated, for which the manu- facture of oral rehydration salts is expected to be funded by UNICEF, with other components being supported through the WHO programme on diarrhoea1 diseases. In regard to the prevention of blindness, two mobile ophthalmic units have been provided, and the mobile ophthalmic camps organized in the rural areas have been carrying out cataract operations. With WHO collaboration, a curriculum for the training of ophthalmic auxiliaries has been developed, planning for the training of health and allied community personnel in community-oriented public health ophthalmology undertaken, and a national plan drawn up. The National Advisory and Coordinating Body for the Control of Cancer has made considerable progress in developing a national strategy and a plan of action. Projects for the establishment of a cancer registry, early detection, diagnosis and treatment, rehabilitation of cancer patients, cancer education and training have been formulated. With WHO support, a national plan for preventive dental health care has been developed. An island-wide epidemiological survey of the state of dental health, a caries prevention fluoride programme in school dental health services, and workshops for dental and medical personnel and primary health care workers were among the major activities organized in the field of dental health. The national plan for the International Drinking Water Supply and Sani- tation Decade was finalized and forwarded to international and bilateral agencies interested in the development of this sector. Institutional support to the National Water Supply and Drainage Board continues to be provided through a UNDP-funded project. Significant progress has been made in providing on-the-job training to junior design engineers and other technical staff, and bringing about improvements in the general capabilities of the Board to design water supply schemes. The public health engineering programmes at the Universities of Peradeniya and Moratuwa received WHO support in developing and teaching core and optional courses, in laboratory development, and in teaching undergraduate students to conduct basic laboratory analyses for water and wastewater. Training programmes have been expanded to increase the output of medical officers, assistant medical practitioners and nurses, and a crash pro- gramme for the training of 2600 family health workers has been introduced. The UNDP-funded United Nations Volunteer Programme is providing medical doctors to Sri Lanka. The Health Planning Unit carried out a study on health manpower, the report of which was discussed at a national workshop in November 1980 at which senior officials of the Ministry of Health made recomendations on staffing norms for the various health institutions. Courses on occupational health and safety were held, and the Ministry of Health, in collaboration with the Ministry of Labour and Colombo Univer- sity, has prepared a plan of action for improving occupational health and safety. Two country-level courses in planning and management were conducted for district-level planning assistants and statistical survey officers. The Education Technology Institute at the University of Peradeniya is being strengthened by WHO so as to be able to function as a national and regional teacher training centre in medical education technology. Assistance has also been given to the new medical faculties of the Universities of Galle and Jaffna, and financial support provided for the improvement of library facilities for post-graduate students in Colombo and Kandy. Development of the National Institute of Health Sciences is progressing well under the collaborative programme of WHO. In addition to regular training for paramedical personnel, a workshop was held on teacher train- ing for primary health care, and the Institute held its first course in community health management for middle-level managers. To strengthen staff teaching capabilities, UNICEF-funded study tours for Institute staff were arranged. In addition to WHO and UNICEF, UNDP and US AID are participating in the project. Steps to promote TCDC have been taken in the fields of virological medical research, indigenous systems of medicine, radiotherapy and radiology. With WHO assistance, a protocol for the development of an improved health information system has been prepared and is being implemented. Health legislation was reviewed, and a draft bill for rabies control, one for the regulation of the medical profession and their professional conduct, and one to replace the 1952 Health Services Act, were prepared with WHO assistance. Projects in Operation Number and Source of Funds SRL CHP 001 R SRL RPD 001 R SRL SPM 001 R SRL SPM 002 R SRL SPM 003 R SRL SPM 004 R SRL PHC 001 R SRL WKH 001 R SRL WKH 002 R SRL ADR 001 R SRL ATH 001 R SRL MCH 001 R~FP SRL MCH 002 FP SRL MCH 003 FP SRL MCH 004 FP SRL MCH 005 FP SRL NUT 001 R Title - Country Health Programming Research Promotion and Development National Health planning Medical Stores Management Strengthening of Electro-Medical Division Development of National Health Information Services Development of Traditional Medicine Occupational Health and Industrial Hygiene Epidemiology of Pesticide Toxicology and Occupational Health (Teaching) Medical Rehabilitation Strengthening of Laboratory Services Family Health Strengthening of Hospital-based Family Planning Services Family Health Teaching, Service and Research in Medical School, Peradeniya Family Health Teaching, Service and Research in Medical School, Galle Family Health Teaching, Service and Research in Medical School, Colombo Public Health Nutrition 11. THAILAND The Ministry of Public Health and the National Economic and Social Development Board (NESDB), to achieve the goal of health for all, have adopted a conceptual framework for long-term social development objectives with special emphasis on intersectoral and interagency collaboration in policy development and political support for structural changes. A "National Social and Health Development Project - NESDB" has been developed, under which various studies related to intersectoral coordina- tion for long-term planning and long-term strategies, social indicators, monitoring and evaluation models, etc., have been proposed. An initial assessment of the planning procedures of various ministries at central and provincial levels has been started. Activities in the areas of health planning, management and information system development were concerned mainly with the formulation of guide- lines for long-term health development and the translation of these policies and strategies into the broad programmes and strategic objectives of the Fifth Five-Year Health Development Plan. In addition to technical collsboration in the above areas, WHO has extended assistance to a variety of activities, including the setting up of an epidemiological surveillance system at PHC level, planning for the production and supply of essential drugs for the PHC programme, planning for baseline and analytical studies of the cost of rural health services, the development of a manual, and staff training for the health information systems. The national PHC programme, to provide 50% of the villages with village health volunteers and comunicators by 1981,is progressing satisfactorily, as are studies on the role of the community, health education through village health volunteers and communicators, use of specially trained volunteers in remote areas, and the role of district and provincial hospitals. The population project in 20 provinces financed by the World Bank and US AID has been contributing to primary health care. UNFPA and UNICEF have supported PHC training programes. Plans were drawn up for the further development of laboratory services through the strengthening of regional laboratories and by bringing laboratory services closer to the peripheral health units. A referral service is being promoted from the peripheral units, through the districts and provinces to the regional laboratories. Formal training for laboratory workers is being expanded in order to provide personnel for small labora- tories in district hospitals. Family planning activities continued satisfactorily. WHO is involved in the execution of two UNFPA projects. Seminars and training programmes on family planning were held, and a national MCH project is being formulated. A proposal for development communication in health education in the context of health for all, has been formulated. The training programme in health education for school-teachers was continued. A consultative meeting on the development of health education services in relation to PHC was held during the year. The nutrition project aims to cover, by 1986, all 25 000 villages targeted in the PHC programe. A village nutrition project, intended to reduce the incidence and prevalence of protein-energy malnutrition among the vulnerable population, including infants and pre-school children, is being implemented. A nutrition workshop was conducted in Ubol Province for all categories of provincial health personnel. The research project on the "Impact of Nutrition Education on the Growth of Pre-school Children in Rural Areas" has been conducted in two provinces, Mahasarakarm and Suphanburi. In this project, which is sponsored by US AID, village health volunteers and village health communicators have been trained in weighing pre-school children, in using the growth chart and in motivating mothers to improve the feeding of their children, using locally available foods. National drug policies in support of HFA strategies are being formulated, and working groups have been set up to deal with the manufacture, consump- tion, utilization, distribution and control of drugs, research as well as manpower development. Among the main concerns in the drug policy is the supply of safe and quality drugs at reasonable prices throughout the country, especially for primary health care. The working of the Government Pharmaceutical Organization, a state-owned pharmaceutical production unit which manufactures and supplies about 15% of the drugs required by public sector hospitals, was reviewed by a WHO consultant,who has made recommen- dations to enable it to play a more meaningful role in the pharmaceutical supply system. He has also made suggestions for the more effective enforcement of quality control measures. In late 1980,the Ministry of Public Health constituted a National Advisory Board with responsibility for promoting, supporting and coordinating technical development for the prevention and control of communicable and nonconrmunicable diseases. Standardization of technical practices, techni- cal information and related research and manpower development have been particularly emphasized. A two-year plan of action dravn up for the ~oard's operation includes survey and identification of national expertise and institutions as technical resources in various fields of disease prevention and control, identification of five high priority problems, organization of seminars and workshops to promote the exchange of relevant technical information, and the ~romotion of research and training. WHO is supporting the activities of the Board. The incidence of malaria increased in 1980, particularly on the Thai- Kampuchean border, and also in the south, where there are major problems, including the prevalence of highly resistant parasite strains. Recent clinical studies show that most of the infections are unresponsive to the combination of pyrimethamine and sulfadoxine as well.WH0 assistance has been provided for monitoring vector susceptibility to insecticides. In November 1980, a National Malaria Conference to exchange information and improve cooperation among malaria field workers, academics working in malaria research and public health administrators was held with support from WHO. A WHO-sponsored national seminar on the prevention of blindness was con- ducted at Ramathibodi Hospital. Eye health care is being extended from the provincial hospitals to the district hospitals and health centres and is being included in the primary health care programme. Mobile eye units were started as pilot projects in the provinces to extend services to the village level. The EPI project in the Five-Year Health Plan (1982-861, which has been finalized, includes extension of target coverage to 80 per cent of infants under one year of age with BCG. DPT and polio vaccines, and to 70 per cent of pregnant women with tetanus toxoid. The immunization targets for 1980 were achieved. A national childhood mortality survey of four specific diseases - neonatal tetanus, diphtheria, measles and acute diarrhoea - was conducted with support from WHO and UNICEF. The epidemiological surveillance system was assessed. A pilot project for cornunity surveillance and a field epidemiology training programme were started. Programmes for the control of leprosy, tuberculosis, sexually-transmitted diseases, dengue haemorrhagic fever and filsriaais continue to be imple- mented. An evaluation of the leprosy control activities was carried out. An international training course was held for programme managers in diarrhoeal-disease control, and plans were made for a training programme on the implementation and management of diarrhoeal-disease contrtol. A national seminar on cancer control, held to consider the national policy and plan of action, stressed the importance of community-based activities for control. A national seminar on cardiovascular diseases was held, to scrutinize national policies and strategies and to promote coordination among various agencies, and an epidemiological study of cardiovascular diseases was formulated and carried out in one province. The National Economic and Social Development Board, which is the focal point of activities for the International Drinking Water Supply and Sanitation Decade, is collaborating in the development of an information system for the Provincial Water Works Authority. UNDP has been convening meetings of United Nations and bilateral agencies to exchange information on Decade activities. The UNDP-funded WHO project on rural environmental health has been concen- trating its efforts on the conversion of open wells into protected wells equipped with locally developed PVC hand pumps. Surveys were carried out in the districts to identify existing sources of drinking water and family excreta disposal methodr. The small diameter tube-well drilling operations are being strengthened, and the training of tube-well drilling operators is in progress. Thailand is participating in the WHO/UNEP/GEMS project to monitor water and air pollution. UNICEF is supporting the construction of village water supply systems. Three divisions in the Ministry of Public Health are involved in the food safety programe, and their work has included the monitoring of pesticide residues in food, analysis of bottled water and examination of food additives. Action is under way to formulate a long-term health manpower development plan. A series of training programmes for middle management personnel has been initiated; among the activities under way are the training of village health volunteers and village health communicators in primary health care, measures for increasing the production of auxiliary health personnel, in- service training for district health officers and other health personnel, and the organization of seminars for health personnel concerned with primary health care. The health information system has been improved, especially at peripheral levels. In the area of primary health care, information is collected and distributed regularly to the agencies concerned. Some vital statistics data have been analysed and processed in collaboration with the National Statistical Office and the results fed back to the institutions concerned. Various training courses were conducted for improving the quality of the health information system, and manuals on the recording and reporting systems have been prepared in order to facilitate the training programme as well as the generation of data at the peripheral level. Projects in Operation Number and Source of Funds Title - THA CHP 001 Country Health Programming R THA RPD 001 Research Studies on Mansonia Mosquitoes TF THA SPM 001 Planning, Management and Information Systems Development R THA SPM 002 National Centre for Development of Health Planning and R Management THA PHC 001 Development of Primary Health Care R/ VF/TF THA WKH 001 Development of Occupational Health R THA ATH 001 Development of Health Laboratories R THA HSR 001 Development of Health Services Research R THA MCH 003 Fellowships in Family Planning and Related Fields FP THA MCH 004 Expansion of Family Planning Services and Support of FP Infrastructure of the National Family Planning Progranme THA MCH 005 FP Field Trials on New Patterns of Family Planning Services THA NUT 003 R THA HED 001 R Nutrition Training and Studies, Food Marketing and Distribution Development of Health Education THA MNH 001 R Mental Health THA PHB 001 R THA ESD 003 R Development of Vaccine Production Development of Epidemiological Surveillance THA MPD 001 R Malaria and Vector Control THA MPD 002 R Filariasis Control THA EPI 001 R Development of Expanded Programme on Immunization THA CAN 001 R Development of Cancer Control Development of Cardiovascular Diseases Control THA CVD 001 R THA ORH 002 R Development of a Training and Demonstration Centre for Oral Health Environmental Health THA EHP 001 R/UNDP THA FSP 001 R THA HPM 001 R Development of Food Control Development of Health Manpower Planning and Management THA PTR 001 R Promotion of Training THA PTR 002 FP Training and Follow-up Support of Peripheral and Primary Health Care Workers THA EDS 001 R Curricula and Faculty Development Development of National Health Information System THA HST 001 R Number and Source of Funds 12. INTER-COUNTRY Projects in Operation Title ICP CHP 001 Improvement of National Health Planning through Country R Health Programing ICP CWO 002 Liaison with ESCAP R ICP CWO 100 Coordination with other Organizations FP ICP RPD 001 Biomedical Research R ICP RPD 002 Collaboration in Biomedical and Health Services R/VF ICP RPD 100 Research Promotion and Development R ICP DGP 001 Regional Director's Development Programme R ICP PPS 100 Health Services Development - Programme Planning R and General Activities ICP SPM 001 Health Research and Development R ICP SPM 002 National Health Information Systems Development R ICP SPM 003 Strengthening of Health Services Administration through UNDP Training in Planning ICP PHC 002 Organization and Administration of Primary Health Care R ICP PHC 004 Traditional Medicine R ICP PHC 005 Medicinal Herbs and Ayumedic Drugs UNDP ICP ADR 001 Care of the Aged, Disability Prevention and Medical R Rehabilitation ICP ATH 001 Standardization of Diagnostic Material and Laboratory R Practices ICP ATH 002 R ICP MCH 003 R ICP MCH 011 FP ICP MCH 013 R ICP MCH 100 R ICP NUT 005 R ICP NUT 100 R ICP HRP 100 VF ICP HED 003 FP ICP HED 005 R ICP HED 100 R ICP MNH 003 R ICP WH 100 R ICP DPM 001 R ICP PPC 100 R ICP ESD 005 R ICP ESD 100 R ICP MPD 001 R ICP MPD 002 VF Development of Appropriate Technology for Health in Relation to Primary Health Care Education and Studies in MCH Regional Team on Family Health Promotion of Family Health (including ~utrition) Maternal and Child Health Nutrition in Primary Health Care Nutrition Regional Research Adviser Development of Health Education in Family Health Workshops and Seminars in Health Education Health Education Regional Meetings on Mental Health Mental Health Development of Drug Policy in Relation to Primary Health Care Communicable Disease Prevention and Control - Programme Planning and General Activities Strengthening of Epidemiological Surveillance System Epidemiological Surveillance Advisory Services in Malaria Control and Coordination of Antiaalaria Activities in the Region External Cross-checking of Blood Films 1CP MPD 004 UNDP ICP MPD 100 R Regional Manpower Development Programme in Malaria Malarla and Other Parasitic Diseases ICP BVM 001 R/ VF Prevention and Control of Diarrhoea1 Disease of Children ICP BVM 002 R Inter-Country Training Activities for Sexually Transmitted Diseases Control ICP BVM 003 W/TF Leprosy Control ILP BVM 004 R/VF/TF Control of Zoonoses and Food-borne Diseases Tuberculosis Control and Research ICP BVM 005 R ICP EPI 001 R/ VF Development of Expanded Programme on Immunization LCP EPI 002 UNDP Strengthening of Expanded Programme on Immunization LCP TDR 100 TF Strengthening of Biomedical Research Capability Prevention of Blindness and Visual Impairment ICP PBL 001 R/ VF ICP PBL 002 W/TF Prevention of Blindness Control and Prevention of Blindness and Visual Impairment ICP PBL 003 UNDP ICP VBC 100 R Vector Biology and Control Nonconaunicable Disease Prevention and Control - Programme Planning and General Activities ICP PPN 100 R LCP ORH 001 R Regional Oral Health Training Programme ICP OND 001 R Other Noncommunicable Diseases ICP IMM 001 R Training in Immunology ICP PPE 100 R Promotion of Environmental Health - Programe Planning and General Activities ICP EHP 001 R ICP EHP 002 VF ICP BSH 001 R ICP BSH 002 UNDP ICP BSM 003 VF ICP RCE 001 R ICP PPM 100 R ICP PTR 001 R ICP PTR 002 R ICP PTR 003 R ICP PTR 004 R ICP PTR 005 UNDP ICP EDS 001 R ICP HST 100 R ICP HLT 001 R Sector Developent in Environmental Health Building up of Information Services in Environmental Health in South-East Asia Cormunity Water Supply and Sanitation Development of Drinking Water Supply and Sanitation Programme GTZ/WHO Cooperation Project for International Drinking Water Supply and Sanitation Decade Environmental Pollution Control Health Manpower Development - Programme Planning and General Activities Education and Training in Comnity Health Developant of National Post-graduate Training Centres Continuing Education for Health Workers Training of Health Personnel (including community health workers) for Primary Health Care Training in Maintenance and Repair of Health Equipment Educational Technology Health Information - Development of Health Statistical Services Health Literature, Library and Information Services Project No ICP MCH 003 IR/ IRP/DGP/105 BAN ORH 001 THA ORH 002 SRL ORH 001 BAN ATH 001 IN0 SPM 002 ICP PHC 002 THA SPM 001 IR/IRP/ER0/018/VN IRIIRP/MNH/030/FD SRL MNH 001 IN0 MNH 001 THA SPM 002 BUR WKH 001 THA WlCH 001 SRL WKH 001 INTER-REGIONAL ACTIVITIES OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION (1 May 1980 - 30 June 1981) Title Number of Participants Seminar on the Organization 2 (1 from Burma and of MCH Services at the Grass- 1 from Sri Lanka) roots Level, Beijing (23 June - 4 July 1981) Course on Oral Public Health 4 (1 from Bangladesh, Services in Rural Areas, 2 from Sri Lanka and Sofia, Bulgaria (15 September - 1 from Thailand) 10 October 1980) Course on Occupational Health 4 (2 from Bangladesh and in Agriculture, with Particular 2 from Indonesia) Fmphasis on the Prevention of Toxicocity by Pesticides, Lods, Poland (8 September - 11 October 1980) Course on Planning, Organization 2 (1 from Indonesia and and Management of Health Care 1 from Thailand) Delivery in Support of Planning Health Care, Sofia (7-28 October 1980) Course on Health Aspects and 4 (1 from Bangladesh, Relief Management in Natural 1 from India and Disasters, Brussels (12-24 2 from Thailand) October 1980) Training Course I1 on Treatment 12 (5 from Burma, and Rehabilitation of Drug- 1 from India, dependent Persons, Hong Kong 1 from Indonesia, (28 October - 17 November 1980) 1 from Sri Lanka and 4 from Thailand) Fourth International Training 1 from Thailand Course in Occupational and Environmental Toxicology, Belgrade (14 May - 19 June 1981) Workshop on Organization of 3 (1 from Burma, Occupational Health Services, 1 from Sri Lanka and Bulgaria (1-19 June 1981) 1 from Thailand) Project No. IRI IRPIMNHI~Z~ Title - WHO/UNFDAC Seminar on Public Health Problems and Psycho- tropic Substances - Development of a Manual, Helsinki, Finland (7-27 June 1981) IK/IRP/MCH/037/FP.80 IR Course in Fertility Manage- ment and MCH Care, Singapore (24 November 1980 - 3 January 1981) ICP PHC 004 Inter-regional Meeting on Standardization and Use of Medicinal Plants, Beijing (17-27 September 1980) IK/IRP/MCH/O~~/FP.~O Follow-up Meeting of Ex- participants of the IR Courses on Fertility Management and MCH Care, Manila (21-26 July 1980) Number of Participants 2 (1 from India and 1 from Thailand) 2 (1 from Burma and 1 from Nepal) 3 (1 from Bangladesh, 1 from India and 1 from Sri Lanka) 6 (1 from Bangladesh, 1 from Burma, 1 from India, 1 from Indonesia, 1 from Nepal and 1 from Railand)
Agency (CIDA), the Japan Shipbuilding Industry Foundation (JSIF), the Norwegian Agency for International Development (NORAD), and the Ministry of Overseas Development of the United Kingdom. Assistance provided by these organizations was in such fields as prevention of blindness, vector-borne disease control, tuberculosis, leprosy, malaria, water supply and cancer. 5.5 Non-governmental Organizations in Official Relations with WHO Cooperation continued with the local and national agencies affiliated to international non-governmental organizations. As mentioned above, representatives of three non-governmental organizations attended the thirty-third session of the Regional Committee for South-East Asia in September 1980. 6. PUBLIC INFORMATION The accent during the year under review was on expanding and broaden- ing the base of activities for the dissemination of information to help motivate the community's interest and involvement in achieving the universal goal of health for all. Consequently, information material was produced and provided to a variety of users and potential users. The experiment of sending information material to the zonal offices of the Indian Railways for use by their sub-units, which was started last year, was extended to cover departments in other ministries such as information and broadcasting, social welfare, food and agriculture and defence health organizations. 'The names of health educators in the Region were added to the mailing list of the newsletter "HFA/2000", and steps were taken to make the newsletter more reflective of WHO activities, particularly in the field of research development. A Regional Directory of Non-Govern- mental Organizations working in the health and related sectors was also prepared and relevant information material sent to them for their use and further dissemination. Regional Committee: The thirty-third session of the Regional Committee held in Male was a unique media experience, with the local radio and television beaming the opening and closing sessions live, and the newspapers giving the event wide coverage. World Health Day: The 1981 World Health Day theme, "Health for All by the Year 2000g', generated a great deal of interest in the media with special radio and television programmes being produced in many count- ries. To cope with the demand for materia1,over 9000 information kits were distributed. These kits consisted of articles, photographs and wall-charts with contributions from the Unit. A limited number of stickers (9000) was also produced to highlight the HFAj2000 theme. These sets were sent to the mass media, health education bureaux, social welfare agencies, educational institutions and community groups in the Region. Government and national leaders throughout the Region participated in programmes organized to observe the event. The Regional Director's World Health Day broadcast in English and Burmese for All India Radio was translated into other languages and relayed in the Overseas Programme for listeners in South-East Asia, Africa and West Asia. The Delhi Television station also telecast a statement by the Regional Director on World Health Day. In addition, health education units and municipal and social welfare agencies organized special programmes to mark World Health Day. Exhibitions, symposia and workshops were held where the salient features of the theme were explained and the need for community participation and involvement was stressed. Group Educational Activities: The media showed keen interest in the educational activities organized by the Regional Office, particularly those related to HFA, prevention of blindness, and traditional birth attendants (TBAs). As in the past, facilities were provided to media representatives to cover subjects of interest to them and to interview participants. World Health: The magazine carried a number of articles related to the Region, with special contributions on HFA, primary health care, blindness, and women and development. The WHO Chronicle also carried write-ups devoted to health development activities in the Region. Cooperation with Information Centres of the United Nations and Other Agencies: Tne Regional Office continued its collaboration with the United Nations Information Centre, New Delhi, in bringing out a weekly newsletter. On an experimental basis, a basic foide; on WHO and its activities was produced in Nepalese, in collaboration with the United Nations Information Centre, Kathmandu. Similarly, colla- boration was extended to UNICEF, New Delhi, in a media workshop held in Lucknow on "children, water and health". The UNDP office in New Delhi was provided with media support services on the launching of the Water Decade. The Information Unit also participated in various seminars and workshops concerned with health and socio-economic development organized by the United Nations or other agencies. Photographs and Films: The Regional Office photo library continued to expand its services within limited resources, with photographs being provided to an ever-increasing number of publications, both within and outside the Organization. The film on primary health care in Thailand was completed and released, and steps were taken to procure the entire set of seven films on PHC to be given on loan in the Region. Similarly, the existing films were lent to educational institututions, national health officials and WHO staff in the field, and efforts made to procure more copies of WHO films for wider coverage. Visitors: An increasing number of people, including medical and nursing students, school and college students and teachers, social welfare workers and others, visited the Regional Office to learn about the Organization's work, aims and objectives, and were provided with information material, which was also sent in response to a large number of requests.
In BURMA, the Bum Pharmaceutical Industry received WHO assistance to help the Government to achieve self-reliance in the production of the pertussis component of DPT vaccine. Facilities for the production of DPT vaccine were further strengthened in INDIA. The Pasteur Institute, Coonoor, was supported in its efforts to initiate the producton of TT, DT and DPT vaccines. The Haffkine Biopharmaceutical Corporation now produces oral polio vaccine Types 1,II and II1,which are being tested with the help of a WHO consultant. 5. PROMOTION OF ENVIRONMENTAL HEALTH An event of significance during the period under review was the official launching of the International Drinking Water Supply and Sanitation Decade. In most countries of the Region, statements on policy, intent, goals and plans for water and sanitation in the Decade were made at high decision-making levels. Wide publicity was given through the public information media, in which the United Nations agencies participated. A number of government representatives from the Region stated their governments' policies and plans at the special one-day session of the United Nations General Assembly on 10 November 1980, when the Decade was launched. The delegate of Burma, speaking on behalf of all Asian countries, made an earnest appeal to "urge the relevant international organizations and developed countries to increase their support and the flow of grant assistance to developing countries in their efforts to fulfil the worthy goals of the Decade". During the year,the Organization cooperated actively with governments in the preparation of first drafts of their national Sector Decade Plans, a number of which are now ready. Rationalization of the training of senior national personnel, ini- tiated last year, has been completed and the training programme is now being implemented and closely monitored with a view to producing the desired results. Group training was organized on the monitoring of pollution of inland and coastal waters; observationlstudy tours were arranged on the planning, programming, construction, operation and maintenance of rural water supply and sanitation programmes. At the request of one country, orientation and practical training in project formulation and appraisal has been arranged at the World Bank, and a special course on programme management conducted at the Asian Institute of Technology, Bangkok. The experience is being monitored so as to improve the delivery and offer viable group training oppottuni- ties to all countries of the Region. Research in environmental health is being focused more directly on meeting immediate needs and on the practical application of the considerable knowledge and knowhow that exist in the Region. In some countries health education is being made a part of water and sanitation projects, in which the Organization is collaborating. An area where no substantial progress has been made is the dovetailing of water and sanitation with primary health care activities. This will be a challenge in the coming years. 5.1 Environmental Health Most of the countries of the Region have established national mecha- nisms to coordinate policy and action for the International Drinking Water Supply and Sanitation Decade. In some countries subsidiary bodies have been established to deal with specific priority areas of action for the Decade such as the development of human resources, the production and logistics of materials and supplies and funding. The committees or other bodies set up have taken stock of the situation to outline the actions needed. The UNDP Resident Representatives in the countries have been designated as the focal points for the United Nations system in the activities related to the International Drinking Water Supply and Sanitation Decade. WHO continues to provide the technical secretariat to the UNDP necessary For discharging this function. The governments which have already prepared national plans for the Decade are likely to face a variety of problems. In regard to the gap between needs and resources, a number of water and sanitation decade plans have been prepared, with a rough forecast of the expected availability of external resources. The countries of the Region have been successfully stimulated to give priority to and accelerate their activities in water supply and sanitation. However, without any addition to the flow of external resources through soft loans and grants from expected funding sources, they are bound to be disenchanted with the so-called "Decade activities". Notwithstanding, many of them have substantially increased their national budget allo- cations for water and sanitation. Under the inter-country Community Water Supply and Sanitation Project, Member States received assistance in their preparatory activities for the Decade through staff sent on missions to countries, who have helped to review specific projects and to initiate baseline surveys as of the beginning of the Decade. This effort was primarily aimed at helping each country generate baseline information to enable it to monitor progress during the Decade. In Bangladesh, under the UNDP-assisted project for the Development of Drinking Water Supplies and Sanitation Programmes, the Government received assistance in establishing an information base of ground water quality so as to enable it to deal with the specific problems of high iron content of ground water in certain areas and to determine the norms required to prevent pollution of shallow tube-well water by on-site disposal of excreta. The Regional Office continued to co- operate with the Government in preparing a national sector develop- ment plan for the Decade. In India,WHO has collaborated with the national authorities in action to generate data for the formulation of annual, five-year and perspec- tive plans for water and sanitation decade activities. It is expected that by the end of 1981 the approved State plans will be compiled into a national plan document. Additional information has been collected for each State for projects which have been given high priority by the governments, to enable them to prepare a feasibility report and project document for investment. In Nepa1,with assistance from this inter-country project, the Govern- ment has prepared a ten-year National Plan for Water and Sanitation and is now in the process of taking up priority projects under the Plan. The first of these relates to manpower development for which the Government is also utilizing inter alia the UNDP's indicative -- planning figure. With financial assistance from the Government of the Federal Republic of Germany (GTZIWHO programme), WHO is collaborating with the Govern- ments of Burma, Indonesia and Thailand in organizing national workshops to review the status of and determine the strategies and actions required for preparing national decade plans and related programmes . Under the WHO/IBRD Co-operative Programme, the activities in sector support programme development for Decade planning efforts were further assisted in Nepal, Thailand, India (Bihar) and Maldives. Sector memo- randa have been completed for all the States and union territories in India. Assistance was given to the Dacca and Chittagong Water and Sanitation Authorities in billing and collection operations, and preliminary discussions were held on Decade plan preparations in the country. The national plan document of the Government of Maldives was reviewed, and, as stated above, assistance was given to Nepal in the preparation of a manpower development project. Under the DANIDA-assisted project on information systems for water supply and sanitation activities, agencies in Indonesia, Sri Lanka and Thailand were determined to be appropriate for providing assist- ance in devel.oping a suitabie management-oriented information system. A subsidy of US $24 566 was given to the Provincial Water Works Authority, Thailand, and the grant of a subsidy of $25 000 to CIPTA KARYA (Directorate Genera? of TJrban Development and Housing, Ministry of Public Works), Indonesia, has been agreed. A workshop on "Manage- ment Information Systems for Water Supply Organizations" has been planned for December 1981 to enable an exchange of experiences among the participating countries. To stimulate activites for the control of environmental pollution, short-term consultants were provided to Indonesia and Thailand for assistance in developing schemes for surface water quality monitoring and control. An inter-country workshop on "Rapid Assessment of Pollu- tants and Impacts" is being planned for late 1981. At the request of UNEP, proposals are under preparation for Indonesia and Thailand along with other ASEAN countries, for research in industrial waste reduction methods for possible funding by the European Economic Community. Fellowships were provided to enable a number of national workers to attend a special course on monitoring the pollution of inland and coastal waters at the Technological Institute, Delft etherla lands). Under the Global Environmental Monitoring Systems (GEMS) Programme, four stations (in India, Indonesia, Sri Lanka and Thailand) continued to operate for air quality monitoring and five stations(in Bangladesh, India,Indonesia,Sri Lanka and Thailand) for water quality monitoring. A bi-regional workshop on the control of emissions from motor vehicles was held at Kuala Lumpur in November 1980 with participants from five countries in the Region. In BANGLADESH,a protocol for a field study of the pollution of ground- water from on-site excreta disposal systems was completed. The guide- lines that will emerge from this field study and the development of appropriate technology and the training of staff now under way should enable the Government to expand the water and sanitation services qualitatively and geographically without risks to public health. A water quality surveillance programme is also to be instituted simul- taneously. Work on updating tariff structures as well as improving collection and distribution systems and maintenance continued in the Dacca and Chittagong Water and Sewerage Authorities, which have been receiving World Bank (IDA) loans. Stream water quality monitoring data from nine stations are being reported on by the ~nvironment Pollution Control Board, under the UNEP/WHO/GEMS programme. Activities are now mainly concerned with preparing a national plan document for the water and sanitation sector for the IDWSS Decade. In BURMA, the main focus in the environmental health programme is on community water supply and sanitation. The progrannne is managed in the field through one long-term sanitary engineer attached to the Environmental Sanitation Division (ESD) of the Ministry of Health and the Ministry of Agriculture and Forests. A 10-to-20-fold growth in the ESD'S programme of work is envisaged, following the second country health programming exercise completed recently. A support activity project to remove a number of constraints identified is under prepara- tion for possible external funding. A status survey of community water supply and sanitation to be undertaken with UNDP/WHO assistance will facilitate programme planning. Burma will also receive technical assistance in Decade planning, under the GTZ/WHO inter-regional project, and the first inter-sectoral meeting is proposed for August 1981. In the urban sector, a project document for feasibility studies for water supplies to ten towns and for related institution building, has been prepared by the Government with WHO assistance, for potential UNDP funding. During the year there was a spate of activities in INDIA in the deve- lopment of plans for water and sanitation to meet IDWSSD goals. Under the UNDP/WHO inter-regional cooperation project, assistance was provided in the collection of detailed information from each State and Union Territory for preparing the annual and five-year plans as well as the perspective master plan for the sector for the Decade. In addition, local consultants were engaged to collect data in each State on which to base feasibility reports for high priority projects identified by the respective State Governments. The Government of India and the Regional Office cooperated with the World Bank in the preparation of a handbook on project preparation. The reorientation of the WHO fellowship programme for India, started last year, was continued. A special orientation programme has been arranged with the World Bank on project preparation and feasibility studies for six senior sanitary engineers. Group training in programme management for senior state engineers was also arranged at the Asian Institute of Technology, Bangkok. In September 1981, twelve engineers will be attending a special course on the monitoring of inland and coastal water quality, to be organized at the International Institute for Hydraulic and Environment Engineering, Delft, Netherlands. The Government of India has enacted a Bill for the Control of Air Pollution. Arrangements are also under way for deputing a number of sanitary engineers to observe the planning, programming, management and operational maintenance of rural water supply programmes in selected countries. In addition, up to ten sanitary engineers will visit Australia to observe water development and management in arid zones. The services of short-term consultants, to furnish know-how on wastes prevention, control and treatment in a number of industries (e.g., electro-plating and distillery spent wash waters), were provided. Support was also given for stack and ambient air quality monitoring and air pollution control. The National Environmental Engineering Research Institute, Nagpur, received assistance in the form of fellowships and short-term consultants in specific areas. The environmental health programme in INDONESIA is made up of several on-going or about-to-start projects, and has five long-term WHO staff members in position, with three more likely to join soon. The major thrust of the programme has been towards assisting the Government in planning and designing water and sanitation schemes, promoting man- power development and using appropriate technology. One WHO sanitary engineer and one sanitarian are attached to the Ministry of Health, and another sanitary engineer works with the CIPTA KARYA. This project also serves as an umbrella for various other related acti- vities with external funding. With UNDP'S financial support, a rural water supply project, including groundwater exploration and health education, is under way in Nussa Tenggara Province; a similar one for South Sulawesi is expected to commence shortly. Another rural water supply project for Central Java, with GTZ funding, is also due to start soon. With assistance from a WHO sanitary engineer, the Government of MALDIVES has prepared a draft document for water and sanitation. During 1981 it is expected that this draft will be edited, updated and enlarged in the form of a national programme plan. Two candidates were trained in water supply and sanitation under WHO fellowships. UNICEF and the United Nations Capital Development Fund (UNCDF) are assisting in the construction of rain-water tanks and cowunal latrines. For Male,a draft plan commissioned by the Federal Republic of Germany was prepared by a consultant firm in the United Kingdom. This was reviewed by the Regional Office at the request of the Government, and comments were furnished. In MONGOLIA, two courses on sanitary engineering, in which the WHO sanitary engineer participated, were conducted. It is proposed to send two Mongolian observers to attend the Workshop on Environmental Health Problems in Arctic and Sub-Arctic Areas, scheduled to be held in Copenhagen in August 1981. This workshop will deal with water and sanitation problems in permafrost conditions. The Government of NEPAL has prepared a "Ten-Year Plan for the Provi- sion of Drinking Water and Sanitation (1981-1990)", and the sector agencies have now approved the document for printing. The shortage of graduate engineers and also of technicians has adversely affected the planning and implementation of the Decade programme. Manpower planning and in-service training are still crucial needs in the country, and proposals for increased UNDPIWHO assistance are now under considera- tion. Assistance was given in planning and implementing 59 rural water supply schemes. Project proposals for the consideration of external funding agencies have also been prepared for rural water supply schemes in the Western and Far-western Regions. Under the WHO fellowships programme, Nepalese engineers have visited India and Bangladesh to study low-cost technology for water and sanitation, particularly in rural areas and on the urban fringe. SRI LANKA's national plan for the IDWSS Decade was finalized, and copies of the plan document were made available to international and bilateral agencies interested in the development of the sector. Data have been compiled for specific projects under the Decade plan. A rural water supply project for Asian Development Bank (AsDB) funding was prepared, and, with UNICEF assistance, projects have been formu- lated for rural water supplies in Kalutara District and the Mahaweli "H" area. Tubewell drilling in hard-rock areas continues to make progress, and the upgrading of cornunity wells is on hand. Progress in the provision of shallow dug wells is yet to be speeded up. A programme for upgrading water treatment plants and for the preventive maintenance of plants and machinery as well as the training of operators has been taken up, and a unit set up for the operation and maintenance of water supplies at the National Water Supply and Drainage Board. Laboratory equipment and supplies for the Universities of Peradeniya and Moratuwa have been ordered, and staff of the universities have been sent abroad for training in the further development of public health engineering faculties in these universities. The Board itself has made substantial progress in strengthening its capacity for the planning and design of water supply schemes. The manpower situation, however, continues to be critial. In the light of the 25% cut in the development budget,the Decade plan activities will have to be focused on high priority projects. Under the UNDP-assisted project in THAILAND, appropriate technologies and approaches have been field-tested and, in collaboration with Chulalongkorn University, light-weight PVC handpumps that are easy to maintain have been developed. Groundwater investigations and staff training also have been undertaken. Research in appropriate technology is going on at two institutions and more sponsored projects are expected to be taken up shortly. 5.2 Occupational Health The programme in occupational health is developing steadily in the Region. Preparatory work for launching a research project on the pulmonary affection of jute mill workers in BANGLADESH has been completed. In BURMA, the project on "Strengthening of Health Services in the Newly Industrialized Areas (West Bank of the Irrawaddy River)" continued. A mid-term review recommended an extension of the project for two to three years, with the additional provision of short-term consultants, fellowships and supplies and equipment. During the year, a consultant advised the Government on the methodology for assessing the environmental sanitation situation,for sample checking and for laboratory testing, as well as on the provision of proper sanitation, water supply, and the disposal of excreta, industrial pollutants and industrial effluents. He also helped to develop guidelines for the training of national health workers in the sanitary aspects of occupa- tional health. A second consultant conducted a training course on occupational hygiene and toxicology and their practice in industry,for physicians and hygienists. He advised on the importance of assessment and control of occupational standards in industry, and demonstrated to national occupational hygienists and toxicologists the maintenance and calibration of field and laboratory equipment and the conduct of air sampling. WHO assistance to INDIA consisted of fellowships for advanced training abroad, to strengthen occupational and industrial health services. The agency terminal report of the UNDP-funded project on "Development of Central and Regional Occupational Health and Industrial Hygiene Laboratories" in INDONESIA was prepared and submitted to the Government. Further extension of industrial hygiene, occupational health and safety laboratories was considered necessary. Specifically the recommendations were: (a) to establish more branch laboratories, (b) to provide more suitable equipment, (c) to increase the number of technical personnel and to develop their skills on a continuing basis, and (d) to expand occupational health and hygiene services, services in ergonomics and services in occupational nutrition. It was recom- mended that further UNDP assistance might be sought, to determine occupational hazards affecting industrial workers in the country and to find ways and means of dealing with the situation resulting from the use of new insecticides and fertilizers and the tendency for infectious diseases to establish themselves among agricultural workers. A consultant in pesticide toxicology was assigned,to collaborate with the Government of SRI LANKA in the training of national personnel in environmental pollution, particularly with regard to chemicals used in agriculture. He also assisted in setting up a laboratory for analysis of pesticides. Fellowships were awarded for the training of national staff in occupational health. A WHO consultant visited THAILAND during the year to help the Govern- ment prepare a plan of vork and a project proposal for the development of the National Institute of Occupational Health. Fellowships,supplies and equipment were provided to strengthen the national occupational public health programe. 5.3 Radiation Medicine Efforts are being made to introduce the Basic Radiology System on a pilot basis in selected countries in the Region. The radiotherapy facilities available are being improved, and documentation on the best use of these facilities was given wide distribution. 'Ihe postal dose intercomparison programme was continued in collaboration with IAEA, and recently linear accelerators were included in this activity. In India and Thailand secondary standard dosimetric laboratories expanded their activities by providing personnel dosimetric services to increasing numbers of health workers exposed to ionizing radiation and by undertaking the monitoring and calibration of equipment. Films were regularly supplied by WHO for the radiation protection services in Bangladesh, Burma, Mongolia and Nepal. In INDIA, under bilateral assistance from the United Kingdom, a linear accelerator was installed at the Gujarat Cancer and Research Institute. There, a repair and maintenance vorkshop and training faci- lities are also available. Some regional cancer centres will soon be having linear accelerators for the treatment of cancer. Facilities for nuclear teaching medicine are being strengthened in several medi- cal colleges. The Radiation Protection Division of the Bhabha Atomic Centre, -ombay, published the proceedings of a national seminar on radiation protection held in Bombay during December 19761, including the development of radiological physics in India, and this document vas widely circulated. A WHO consultant is being assigned to the Radiation Medicine Centre, Bombay. Radiotherapy centres in INDONESIA are being strengthened in the provinces, with the installation of high-energy therapy units. Two consultants visited MALDIVES to repair the X-ray machines at the Government Bospitsl, Male, to assess the safety of the radiological installation and to advise on improving the safety standards of the X-ray unit. In SRI LANKA, plans have been formulated for establishing radio- therapy facilities in Galle and Jaffna. A consultant assigned to THAILAND advised the National Cancer Insti- tute on the treatment of cancer patients with radiotherapy and on the planning of 8uch treatment. He recommended decentralization of treat- ment facilities through the establishment of radiotherapy equipment, computerized treatment planning and joint clinics to take advantage of the multiple treatment modalities. 5.4 Food Safety Programme The systematic development of national food safety programmes appli- cable to countries of the Region received little attention during the year, except for pragmatic programme review and development related to institutional and manpower requirements, provision of short-term consultants and fellowships for some countries. Food safety pro- grammes are in varying degrees of development in Burma, India, Indonesia, Mongolia, Sri Lanka and Thailand. Although the programme has been instrumental in upgrading some of the facilities and technical competence of services and personnel in food control, particularly in Sri Lanka, Zhailand and Indonesia, many aspects still remain to be covered. Zhe Organization continues to assist countries in reviewing food laws and regulations and in initiating training activities, by awarding fellowships. In India, a national workshop on "National Strategy for Food Quality Control" was organized at the National Institute of Nutrition in Hyderabad. Through the provision of short-term consultants, the methodology and instrumentation for the analysis of food contaminants (in Thailand) and the utilization of laboratory services, the training programme and microbiological requirements for food standards (in Indonesia) have been reviewed and strengthened. In most countries of the Region there is a strongly felt need to develop a rational food safety programme, integrating all related aspects of public health such as veterinary public health, laboratory health services, administration, nutrition, communicable disease control, environmental health and health education. Although country reports on the food control situation in respect of most countries are available, there is still a need for more compre- hensive baseline data and information on all related public health aspects. The Regional Office has prepared a comprehensive question- naire that should enable countries to assess the situation in all its aspects. The main problem in launching a food safety programme is the dispersal of the activities of different facets of the programme among different ministries or departments. It is therefore planned that, on the basis of a comprehensive review, a multidisciplinary WHO team should visit countries and discuss the question of food safety with all departments and minis tries concerned and assist them in evolving a rational food safety programme that meets the needs of the country and is feasible to implement. 6. HEALTH INFORMATION AND STATISTICS During the period under review there have been efforts to evolve methods and procedures for collecting, processing and utilizing information which could have general application in the countries of the Region. Probably the most productive work has, however, been direct collaboration with the countries in improving their information systems. A major part of the activities has been concerned with developing methods of monitoring and evaluating primary health care programmes.
INTRODUCTION The year under review has been marked by a number of significant steps taken by individual countries as well as the Region as a whole for translating the universally accepted objective of "Health for Alln (HFA/2000) into a reality. Two specific examples are: first, the elaboration of HFA/2000 strategies at the national level and their synthesis at the regional level and, second, the formulation of the Seventh General Programme of Work, which provides the basic frame for WHO'S programme of action during the period 1984-1989 in line with these strategies. While the strategies for health for all reflect well-articulated and carefully organized thoughts and ideas for action at national and regional levels, the Seventh General Programme provides a completely reoriented plan for WHO'S active collaboration in the balanced development of appropriate health systems and relevant technologies for delivering primary health care to all who need it. It is gratifying that in all the Member States of the South-East Asia Region, there is considerable national commitment to HF~/2000, and that all development sectors clearly recognize their responsibilities for, and role in, helping to attain this goal. To the socio-political and health leaders in our countries HFA/2000 is no longer a theme for theoretical discussion but an accepted term of reference for individual and collective action. The entire range of health development efforts in the Region is therefore geared to attaining it, both in the health sector and in the overall context of socio-economic development. Health Planning and Management Efforts to stimulate scientific health planning in the Member States have yielded considerable dividends. Country health programming (CHP) as a comprehensive management process for national health development is now being practised in more than half the Region, either in the original or in a modified form, to suit the needs of individual countries. Thus, Bangladesh, Burma, Maldives, Nepal, Sri Lanka and Thailand have all completed at least one cycle of CHP. In fact, Bangladesh, Burma and Nepal have already undertaken the second cycle, and Thailand is in the process of carrying it out for the second time. All these exercises were aimed principally at developing a meaningful, medium-term national health plan. What is interesting is the fact that the experiences gained are now being used in some countries to formulate long-term perspective plans up to the end of the century, with the aim of projecting health needs and visualizing the programme perspectives to achieve health for all by the year 2000. There have also been efforts to evaluate on-going activities. One such effort was the mid-term review undertaken in Nepal to evaluate the achievements and failures of the national Five- Year Health Plan; another is the continuous monitoring and systematic assessment of the People's Health Programme in Burma. These encouraging developments have led WHO to intensify its efforts toward stimulating and further improving the managerial process for national health development through the training of national personnel in health planning and management. To this end, steps have been taken to prepare guidelines, teaching modules and training materials based on the latest experiences gained through country health programming. These will be used in providing intensive training to national staff in different aspects of the managerial process for national health development as suited to individual countries. As for the Organization's own planning and management efforts, in addition to developing the Seventh General Programme of Work based on HFA strategies, WHO has evolved a practical method for its detailed biennial programme planning and budgeting in Member countries, by means of meaningful coordination of all inputs - national and external, international and bilateral. In Indonesia, with the active involvement of the Government, a special effort was made in this regard. It is expected that this method will greatly improve the utilization of resources and avoid duplication of effort and waste. Information Systems The countries in the South-East Asia Region have been showing increasing interest in health information systems, particularly for the planning and management of primary health care. It is now agreed that in most countries the most suitable information system would be one based on lay reporting. In several countries - Bangladesh, Burma, Nepal and Thailand - such reporting has been introduced and is being expanded in a phased manner. Simultaneously, in some cases, with the development of the lay reporting system, hospital record systems involving rural health centres and hospitals at all levels are being streamlined and expanded. As for WHO'S inf ormation system, the major component continued to be the periodically updated country and regional programme profiles. In addition, the programme management information system for day-to-day monitoring has been further simplified and refined to provide need-based information for the management of programme delivery at both country and regional levels. Development of Comprehensive Health Services The tremendous enthusiasm in all countries of the Region for attaining the objective of HFA/2000 on the basis of primary health care has manifested itself in a series of activities for formulating national strategies involving all sectors concerned with health development. Also, countries are establishing, strengthening or streamlining national health development councils or similar mechanisms to enhance political commitment, facilitate intersectoral coordination, formulate and update national health policies and strategies, and provide overall policy guidance based on the monitoring and evaluation of HFA activities. Governments have for long recognized the value of primary health care concepts, as defined at the Alma-Ata Conference, and are currtatly developing national programmes based on these concepts within the framework of their national strategies mentioned above. The major thrust of such programmes has been towards providing an integrated package made up of the eight elements considered essential to primary health care, within the available resources. As primary health care services depend on the prevailing socio-economic situation, they are today in different stages of development in different countries, with varying degrees of coverage. It is, however, significant that all countries have now intensified their efforts to promote community participation and involvement through the training of village volunteers, health workers and motivators from within the community. Countries are also developing reasonably effective referral systems and logistic support, recognized as vital to sustain primary health care. Assessments in several countries indicate that there has, in general, been an improvement in coverage. There is, however, still a need for strengthening efforts not only to maintain but also to accelerate the pace of development. WHO, in close collaboration with UNICEF, is actively supporting governments in these efforts. The Organization's collaboration with Member States in the field of traditional medicine continued to receive increasing attention. In a number of countries - notably Bangladesh, Burma, Nepal and Sri Lanka - plans have been made for the wider use of practitioners of traditional medicine in primary health care. National projects on traditional medicine have already been formulated in Burma, Nepal and Sri Lanka with support from WHO/UNDP. In some countries efforts are being made to organize activities for identifying and cultivating medicinal herbs/ plants, and for producing traditional medicines of standard quality on a large scale. The training of practitioners of traditional medicine for participation in primary health care is continuing and will receive increasing attention. In this context, protocols have been developed in selected countries for research into various aspects of traditional medicine. WHO is now encouraging the integration of mental health services into primary health care in some countries, and Bangladesh, India and Indonesia have already developed model projects in this regard. To improve diagnostic facilities for both clinical and epidemiological purposes, efforts to strengthen national health laboratory services and to extend them to the primary health care level have continued. WHO has provided technical support to these efforts as well as to the development of reference laboratories on a regional basis. Family Health Family health is a priority programme in all the countries, and the activities are being supported in collaboration with UNFPA. WHO'S programme in this area is primarily directed towards appropriate and adequate manpower development and reorientation of the training of health personnel, including traditional birth attendants, in the context of primary health care. The family planning programme, based on the maternal and child health activities in most countries, is, however, directed at stimulating contraceptive practices and the small family norm. Of interest in this connexion are the current studies on the "Risk approach to the delivery of maternal and child health", based on the perinatal study which was completed last year. In the field of nutrition, the programmes are now conceived as a collaborative action-cum-research activity, and have been developed following interdisciplinary consultation with governments and in close collaboration with UNICEF. The action is community-oriented, taking into account the available resources and the socio-cultural situation. During the past year, protocols for a number of research projects were reviewed and streamlined at meetings of persons constituting national focal points, at which the technical aspects of nutrition and its linkage with the socio-cultural focus on target groups, namely, mothers and children, were balanced. Some of these research projects are now being implemented. Health education has been accorded increasing priority in Member States in recent years, and WHO has given special attention to the introduction of the health education component in programmes, wherever relevant, in order to ensure community participation. An inter-country seminar sponsored by WHO emphasized and delineated the role of post-graduate teaching and training in health education in strengthening health education programmes in the countries. The Organization continued to support several countries in establishing health education activities as an integral part of the health services at all levels, through the assignment of long-term staff and short-term consultants, the provision of audio-visual equipment and the development of teaching and training materials, in addition to training personnel. Communicable Diseases Communicable diseases continue to remain a major public health problem, accounting for a large proportion of the health budgets in most countries. During the year under review, epidemiological services and the surveillance of communicable diseases were strengthened further. A programme of training in field epidemiology was started in Thailand, and an M.Sc. course in epidemiology is being organized at the University of Indonesia. Among the important communicable diseases, malaria is receiving priority attention in view of the enormity and complexity of the problems - technical, managerial and financial - which hinder control measures and which are yet to be satisfactorily solved. The Organization continued to provide support to the technical aspects related to clinical, epidemiological, entomological and environmental interventions to prevent and control the disease. The emphasis in WHO'S collaborative effort, however, has been on manpower training, to strengthen the service programme, and on research, to improve the strategy, techniques and methods for clinical, epidemiological and bioenvironmental management. It is gratifying to report that, in the Region as a whole, the number of cases of malaria was reduced by 17% in 1980 as compared with the previous year, although in most countries the efforts for control need strengthening immediately for sustained improvement of the situation. Although, in addition to WHO'S technical colla.boration, CIDA, the Netherlands, Sweden (SIDA), US AID and the United Kingdom have substantially assisted the malaria control efforts in the Region, there is a need for further mobilization of resources, particularly in view of the increasing cost of drugs and insecticides. The control of diarrhoea1 diseases (CDD) through a multidisciplinary approach forms an integral part of primary health care services in several countries of the Region. Development of manpower in both the technical and the managerial aspects of the programme, attainment of self-reliance in the production of oral rehydration salts, development of a simple but effective logistic system, and health education of mothers and the community at large are the main components of the programme. Substantial progress has been made in establishing control programmes in Bangladesh, India, Indonesia and Nepal. The activities in Burma, Thailand and Sri Lanka are also gaining momentum. Two regional training centres for diarrhoeal-disease control have been functioning - one in Dacca and the other in Calcutta - and a similar training centre is being planned for Jakarta. In addition to service and training programmes, research activities are simultaneously being organized and supervised through a Regional Scientific Working Group on Diarrhoea1 Diseases, which was established in early 1981. UNDP and UNICEF have been closely collaborating with WHO in developing this programme. The fight against tuberculosis as a public health problem based on conventional identification and treatment strategies, continued. In addition, BCG vaccination continues as usual. The problems still facing national programmes are shortage of appropriate drugs, a weak logistic system and the improper administration of drugs owing to inefficient management and supervision. These weaknesses were clearly revealed last year in an assessment of the programme in Nepal carried out by a WHO consultant. As for research, the Study Group on Tuberculosis, convened in the Regional Office in March 1981, reviewed the priorities and a number of protocols for research on tuberculosis. Despite recent advances in leprosy control, this disease continues to be an important public health problem. WHO has assisted in organizing training activities, provided technical cooperation, and supported research into several aspects of leprosy. The regional research activities are complementary to those supported under the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. With the availability of funds from the Japan Shipbuilding Industry Foundation, leprosy control activities in the countries of the Region have been intensified. A vaccine against leprosy is not yet in sight, though research in this regard continues to be supported by WHO under the TDR programme. Sexually-transmitted diseases (STD) are rapidly emerging as a problem of increasing complexity. An inter-country meeting held in November 1980 formulated guidelines for strengthening national STD control programmes. In addition to under-reporting of these diseases, the rapid emergence of resistance of the gonococcus to penicillin is causing serious concern in some countries. Though governments in the Region are alive to the complications and sequelae of these diseases, not much headway has yet been made in their control because of technical and socio-cultural constraints. WHO continued to collaborate with countries, notably Burma, Indonesia and Thailand, in strengthening national surveillance programmes for dengue haemorrhagic fever and in the development o f epidemiological and entomological surveillance, strengthening of arbovirus laboratories, improvement of diagnosis and clinical management of cases of DHF and dengue shock syndrome, and research. The WHO Collaboratinq Centre for Research on the Immunopathology of DHF in Bangkok has continued its work, including studies on the development of a vaccine against DHF. At a meeting of the Research Study Group on DHF, held in March 1981, the various aspects of DHF and of research activities for a dengue vaccine were reviewed. During the year, immunization programmes were further expanded in all countries of the Region. In many, there was found to be a considerable increase in the reported numbers of children and pregnant women fully immunized against target diseases under the Expanded Programme on Immunization. Also, in these programmes, a statistically valid and objective method of evaluating immunization coverage was more widely used. In 1980, the number of coverage surveys (in six countries of the Region) increased to 28, and in the areas where they were repeated at one-year intervals, e.g., in Sri Lanka and Burma, the results showed that the coverage had significantly increased. At the same time, the logistics, vaccine and cold-chain system saw further improvement in many areas, ensuring the required level of potency of the vaccine used. The epidemiological surveillance of the target diseases was also improved. In 1980, sentinel areas, to report regularly on incidence to the centre, were established in at least one country (Indonesia), which also set up a feed-back system. The available data indicate that in some areas of the Region the Expanded Programme on Immunization has already influenced the epidemiological parameters of some of the target diseases, viz., decrease in the incidence rates of neonatal tetanus and diphtheria. In 1980/81, particular stress was laid on the training of health staff in the immunization programme. WHO-sponsored inter-regional and inter-country courses in both technical and managerial aspects of the programme have been held, and, by May 1981, the number of trainees from the Region completing these courses had gone up to 300. These trainees, in turn, have conducted training courses in their own countries, which are attended by large numbers of national participants. Thus a core of trained personnel at different levels of the programme has been made available. Noncommunicable Diseases With increasing life expectancy at birth, due to the improved health status of the population, a number of diseases such as cancer and the cardiovascular diseases are emerging as public health problems, especially in Burma, DPR Korea, India, Sri Lanka and Thailand. The major thrust of WHO'S collaboration with governments in the control of these diseases is on community-oriented programmes for early detection and treatment, along with health education for preventive action by the individual and the community. To this end, collection of epidemiological information to define the nature and extent of the problem as well as to serve as the basis for prevention and control is being actively pursued in a number of countries. WHO has also supported the training of manpower and the development of institutional facilities for diagnosis and treatment. Preventable and curable blindness and impairment of vision, particularly due to cataract, xerophthalmia, infections and injuries, have become important public health problems. With the active collaboration of international, bilateral and voluntary agencies, it has been possible to start prevention and control programmes in the countries affected. One of the major efforts has been launched, on a countrywide basis, in Nepal, where a national survey of blindness has just been completed and the data are being processed. Extensive programmes to prevent blindness due to vitamin A deficiency are continuing in Bangladesh, India and Indonesia. Control of trachoma and its complications, e.g., entropion, is being managed by specially trained health assistants in Burma, Nepal and Thailand. Sri Lanka and Thailand have also been carrying out national programmes for blindness control. To ensure continuous technical support to national programmes, the Regional Office has established a post of Regional Medical Officer for the Control of Blindness, with funds provided by the International Agency for the Prevention of Blindness. Environmental Health It is well known that one of the basic requirements for raising the status of health and the quality of life is the provision of appropriate water supply and sanitation facilities to the community. In this context the launching of the International Drinking Water Supply and Sanitation Decade, on 10 November 1980, by the United Nations General Assembly was the occasion for practically all Member States in the Region to enunciate their goals and intentions and to give wide publicity to this decade through the mass media. A number of countries have set up appropriate national bodies for development of their plans, coordination and guidance; some have completed their first draft plans and others are expected to do so before the end of 19 81. In this context it is gratifying that governments have realized that the plans to be developed for the Decade must fully incorporate the primary health care approach, and must involve community participation, appropriate technology and service levels and the building up of self-reliance to the maximum extent possible, especially with regard to operation and maintenance. Another welcome feature was the awareness among many funding agencies that health education, personal hygiene and sanitation have to go hand in hand with safe water supply if the full benefit is to be realized. Projects for human resources development, in particular, are being reoriented in line with this concept. The Organization, in close cooperation with the World Bank, UNICEF, US AID and GTZ continued to provide technical support to ember States in the field. In addition, WHO is actively involved in developing an information service in environmental health, in collaboration with DANIDA. Yet another activity to which WHO is providing support, with UNEP, is the Global Environmental Monitoring System (GEMS) programme, directed towards the control of water and air pollution. Another major aspect of WHO'S environmental health programme has been its support to Member States in training manpower at all levels for work on water supply and sanitation as well as for the prevention of environmental pollution. Promotion and Development of Research The activities of the Organization in the field of research promotion and development have been continuing with advice from the South-East Asia Regional Advisory Committee on Medical Research (SEA/ACMR). Although actual research in the priority areas is supported as far as is practicable within the available resources, the major thrust of the programme has been towards the application of existing and emerging results of research to the improvement of health policies and programmes and the attainment of self-reliance in research, not only by individual Member States but by the Region as a whole. WHO has been collaborating with governments in this regard through a network of national medical research councils or similar national bodies which are actively involved in promoting and developing research in their own countries and in exchanging ideas and views through annual meetings of their representatives held under the aegis of the Organization. During the year under review the SEA/ACMR initiated efforts to review the research priorities in the light of HFA/2000 strategies, developed at the national as well as regional level. A sub-committee was entrusted with this task and has already developed a basic policy paper, laying down the criteria for the selection of priorities. Another important activity has been the stimulation of health services research. There is now a clear recognition of the importance of developing research activities to facilitate the application of the results to the improvement of health programmes by incorporating newer technical knowledge, modern management techniques and built-in operational monitoring and evaluation. To this end the SEA/ACMR is reviewing the situation in respect of health services research in order to formulate guidelines for research in this 'important area. In order to create a core group of scientists in each country to generate and sustain appropriate research efforts, the Organization has been providing "visiting scientists grants" and research training grants to selected young research workers who are actively involved in priority research. Courses in research methods have also been supported in order to provide training to promising young scientists with a view to strengthening the manpower for research. Health Manpower Development With national commitments to primary health care as the key approach to the attainment of the goal of health for all, the need for developing adequate and appropriate manpower to support PHC-based health systems has become very critical. In WHO'S collaborative programmes in health manpower development the emphasis is on well-balanced activities in all three main aspects of the health manpower development process - namely, planning, training and management. In addition, as an integral part of the process, research in health manpower development receives due attention. Planning for health manpower within the framework of overall national health development and its implementation through coordination between health care and education, has been continuously emphasized and encouraged; application of scientific planning methodologies has been the basis of health manpower development programmes in many countries of the Region. Also, reorientation of the training programmes for different categories of health workers and the promotion of appropriate training for effective team-work in the delivery of primary health care have been intensified. Attention has been given to identifying the roles and responsibilities of all categories of health personnel working in primary health care, as a prerequisite for the appropriate development of training programmes. The training of conventional health workers at community level and also of new categories, to strengthen their primary health care capabilities has been further developed and evaluated. In addition, some countries have planned, or are already conducting, training in health care management to support the functioning of primary health care at all levels. A regional network of public health training institutions is being established, and the training of trainers for all categories of health personnel as well as the development of health learning materials have made steady progress. Technical Cooperation Among the Countries The Organization continues to promote technical cooperation among the developing countries (TCDC) in the Region. Early in 1980, an inter-country consultation on TCDC in health planning and management identified specific activities for the purpose,to be implemented by governments, WHO and other international and bilateral agencies. This meeting was followed by two more consultations - on appropriate technology for health and on pharmaceuticals - at both of which the various aspects of TCDC in the respective fields were considered. Yet another effort has been the planning meeting for the establishment of a regional network of public health training institutions mentioned above, at which the coordinative action to be taken by countries in establishing the network were outlined. In spite of these efforts, progress appears to be slow because of time-consuming procedures involved in implementing the action to be taken jointly by governments. To overcome these difficulties, consistent and patient pursuit of the objectives of TCDC by governments as well as by WHO and other organizations concerned must continue. Study of WHO'S Structures in the Light of Its Functions This study on WHO'S structure emanating primarily from a number of inter-related resolutions approved by the World Health Assembly and the Executive Board, has been under way for some time. In pursuance of resolution WHA33.17, the Organization has developed a plan of action which was endorsed by the Regional Committee at its thirty-third session. Accordingly, the study has been continued by the Regional Office with a view to analysing and modifying the functions, if required, proposing necessary changes in structure and indicating the nature and extent of staff requirements in the light of the goal of HFA/2000. The interim results of the study indicate that there is considered to be no need for any drastic change in the functions and structure of the Organization; what is needed, however, is a change in the style of functioning and a streamlining of the managerial processes along with minor readjustments of the staffing pattern, to conform to the concepts contained in the Seventh General Programme of Work. Efforts made by governments in which the Organization had the privilege of cooperating and collaborating during the period under review, are thought to have contributed significantly to overall health development in the Region. The central theme as well as the spirit of HFA/2000 seems to have gained rapid and growing recognition and enthusiasm, which has pervaded all these efforts. I should like to express my sincere gratitude to the peoples and the governments of our Member States for their unstinted support to the Organization to enable it to perform its task and to play its due role. Although this is my first annual report since taking over from Dr Gunaratne on 1 March this year, I am confident that, with growing determination and commitment on the part of our Member States, we will continue to draw ever closer to the objective of health for all so as to bring peace and happiness to all our people. Dr U KO KO Regional Director
Centre for Research and Training in Immunology at the Department of Biochemistry, All India Institute of Medical Sciences, New Delhi. In September 1980 an inter-country workshop on the production of immuno- logical reagents was held in Bangkok, in which the participants were trained in the production and standardization of commonly used immuno- logical reagents with a view to helping the country attain national self-reliance. A consultant visited Indonesia to collaborate in setting up immunological methods in public health laboratories. 4. HEALTH LABORATORY SERVICES 4.1 Organization of Laboratory Services WHO has been collaborating with the countries in the Region in developing their health laboratory infrastructures, improving the technical standard of laboratory services and training national staff in health laboratory technologies and management. The Organization assisted in the development of peripheral laboratories and inter- mediate-level laboratories in support of primary health care. Referral laboratories were strengthened in the fields of microbiology,virology and immunology so as to be able to undertake disease surveillance and support diagnosis. WHO has also helped to develop quality control in clinical chemistry, microbiology and haematology. Since the rapid diagnosis of viral diseases for carrying out preventive measures and promoting better treatment is being increasingly recognized as a health priority, WHO organized an inter-country workshop on this subject in Pune (India) in November 1980. Also, a workshop on anti- biotic sensitivity testing was held in New Delhi in MarchJApril 1981, designed to provide bench-level training to national workers to set up standard techniques in antibiotic sensitivity testing and anti- biotic assays. Here, training was given in advanced techniques in bacteriology,viro?ogy and laboratory management, including techniques for respiratory viruses, and following the workshop, the participants were supplied with adequate amounts of reagents for standardization of the techniques to enable them to carry on the tests in their respective countries. In BANGLADESH,the Institute of Public Health was assisted in organiz- ing training for laboratory personnel from peripheral and inter- mediate laboratories,particularly the training of unipurpose personnel to convert them into multipurpose laboratory workers. A WHO con- sultant was assigned to evaluate the public health laboratory programme. The Government has prepared a project for strengthening laboratory services at intermediate and peripheral levels. Another consultant collaborated with the National Institute of Preventive and Social Medicine in strengthening laboratory facilities for occupa- tional health and industrial hygiene. In BURMA, laboratories at the township level were strengthened, and, at the National Health Laboratory, Rangoon, training programmes were organized for laboratory personne1,which included training in quality control techniques and advanced techniques in microbiology. A con- sultant was assigned to develop a programme for monitoring hospital cross infections. WHO participated in formulating the plan for health laboratory services as part of country health programing for 1982- 1986. In INDIA, WHO long-term staff assisted in improving the performance of public health laboratories in Kerala, Tamil Nadu, Pondicherry, Karnataka, Goa and Bihar. Bench training, with emphasis on quality checks, was imparted to laboratory technicians. WHO collaborated with the authorities in the States of Andhra Pradesh and Kerala in plans for the further improvement of laboratory services. Assistance was also given in organizing a national workshop on blood transfusion technology, and WHO took part in another national workshop on micro- biological procedures in studies of antibiotic resistance in bacteria. In INDONESIA,the laboratory services infrastructure was strengthened, particularly at the peripheral level. WHO supported the training programme in laboratory management and immunology. Consultants have been assigned in the specialties of clinical chemistry, virology and innnunology to help strengthen the regional laboratories. Training programmes in MALDIVES and the further development of the hospital laboratory in Male were assisted. A WHO consultant advised MONGOLIA on strengthening the laboratory services, particularly in tuberculosis bacteriology, at referral and aimak levels. The Government of NEPAL, with WHO assistance, further strengthened the laboratory infrastructure in the country. Training programmes for laboratory workers, conducted by long-term staff, included training in laboratory management and advanced techniques in diagnostic technology. In THAILAND, the laboratory programme was evaluated by a WHO consul- tant. The Chief of Laboratories received training in laboratory management. 4.2 Quality Assurance WHO continued to collaborate with countries in the Region in improv- ing the quality of their laboratory services. External quality control programmes initiated some years ago were continued and strengthened. WHO Headquarters provided guidelines for the prepara- tion of reference values and for the evaluation of diagnostic kits, as well as manuals on quality control in clinical chemistry. In BURMA, external quality control in clinical chemistry was under- taken at the ~ational Health Laboratory, Rangoon, and national staff received training in clinical chemistry at WHO Collaborating Centres. The national programme in quality control will be developed further to improve the work in diagnostic laboratories. In INDIA,external quality control in clinical chemistry was continued. In this programme,l8 laboratories are now participating,their perform- ance being monitored by the national laboratory at the Post-graduate Institute of Medical Education and Research, Chandigarh. Analytical sera developed by the Central Council of Industrial Research are being evaluated in the WHO Collaborating Centre. Quality control in clinical chemistry in INDONESIA was strengthened through the provision of sera for use in such control. A consultant visited the country in April 1981 to assist in strengthening the national programme of quality control in clinical chemistry. The International Federation of Clinical Chemistry is developing a quality control project in THAILAND, in collaboration with the WHO Collaborating Centre for Research in Clinical Chemistry at Birmingham, United Kingdom. Quality control in haematology has been supported in India,Nepal, Sri Lanka and Zhailand through the supply of standardized haematological specimens by the WHO Collaborating Centre in Haematology. Assistance is being given to India in the development of national quality control in haematology at the All India Institute of Medical Sciences, New Delhi. 4.3 Quality Control of Pharmaceuticals and Biologicals One of the important components of pharmaceutical supply systems is assurance of the quality of essential drugs used in primary health care. WHO has been collaborating with governments in establishing and strengthening national quality control in pharmaceuticals and biologi- cals. National staff have been trained in the techniques of drug analysis and in the quality control of biologicals. Several countries have developed national quality control laboratories. In BANGLADESH,the Drug Control Administration was further strengthened through the award of fellowships for training in the quality control of drugs. The National Health Laboratory in BURMA received assistance in estsb- lishing a quality control laboratory for food and drug analysis with UNDP support. National workers were trained in pharmaceutical chemistry and food and drug microbiology. WHOIFAO consultants have supported programmes aimed at assuring food and drug quality. In INDIA, the Drug Control Laboratory received further assistance. The programme for testing the oral polio vaccine manufactured by the Haffkine Biopharmaceutical Corporation was continued. A WHO consul- tant collaborated with national workers in conducting neurovirulence tests on lots of working seeds and vaccines of all three types and also helped to establish a national quality control laboratory at the Central Research Institute, Kasauli. 4.4 Vaccine Production WHO has collaborated with governments in increasing the production of biologicals, particularly vaccines, for the Expanded Programme on Immunization. In BANGLADESH, the Public Health Institute established new facilities for the production of tetanus toxoid and DPT. With support from WHO, the new DPT block is now ready to start functioning. A WHO consultant provided technical support in planning for the production of vaccines with a view to attaining self-reliance in the country. In BURMA, the Bum Pharmaceutical Industry received WHO assistance to help the Government to achieve self-reliance in the production of the pertussis component of DPT vaccine. Facilities for the production of DPT vaccine were further strengthened in INDIA. The Pasteur Institute, Coonoor, was supported in its efforts to initiate the producton of TT, DT and DPT vaccines. The Haffkine Biopharmaceutical Corporation now produces oral polio vaccine Types 1,II and II1,which are being tested with the help of a WHO consultant. 5. PROMOTION OF ENVIRONMENTAL HEALTH An event of significance during the period under review was the official launching of the International Drinking Water Supply and Sanitation Decade. In most countries of the Region, statements on policy, intent, goals and plans for water and sanitation in the Decade were made at high decision-making levels. Wide publicity was given through the public information media, in which the United Nations agencies participated. A number of government representatives from the Region stated their governments' policies and plans at the special one-day session of the United Nations General Assembly on 10 November 1980, when the Decade was launched. The delegate of Burma, speaking on behalf of all Asian countries, made an earnest appeal to "urge the relevant international organizations and developed countries to increase their support and the flow of grant assistance to developing countries in their efforts to fulfil the worthy goals of the Decade". During the year,the Organization cooperated actively with governments in the preparation of first drafts of their national Sector Decade Plans, a number of which are now ready. Rationalization of the training of senior national personnel, ini- tiated last year, has been completed and the training programme is now being implemented and closely monitored with a view to producing the desired results. Group training was organized on the monitoring of pollution of inland and coastal waters; observationlstudy tours were arranged on the planning, programming, construction, operation and maintenance of rural water supply and sanitation programmes. At the request of one country, orientation and practical training in project formulation and appraisal has been arranged at the World Bank, and a special course on programme management conducted at the Asian Institute of Technology, Bangkok. The experience is being monitored so as to improve the delivery and offer viable group training oppottuni- ties to all countries of the Region. Research in environmental health is being focused more directly on meeting immediate needs and on the practical application of the considerable knowledge and knowhow that exist in the Region. In some countries health education is being made a part of water and sanitation projects, in which the Organization is collaborating.
5.4 Food Safety Programme The systematic development of national food safety programmes appli- cable to countries of the Region received little attention during the year, except for pragmatic programme review and development related to institutional and manpower requirements, provision of short-term consultants and fellowships for some countries. Food safety pro- grammes are in varying degrees of development in Burma, India, Indonesia, Mongolia, Sri Lanka and Thailand. Although the programme has been instrumental in upgrading some of the facilities and technical competence of services and personnel in food control, particularly in Sri Lanka, Zhailand and Indonesia, many aspects still remain to be covered. Zhe Organization continues to assist countries in reviewing food laws and regulations and in initiating training activities, by awarding fellowships. In India, a national workshop on "National Strategy for Food Quality Control" was organized at the National Institute of Nutrition in Hyderabad. Through the provision of short-term consultants, the methodology and instrumentation for the analysis of food contaminants (in Thailand) and the utilization of laboratory services, the training programme and microbiological requirements for food standards (in Indonesia) have been reviewed and strengthened. In most countries of the Region there is a strongly felt need to develop a rational food safety programme, integrating all related aspects of public health such as veterinary public health, laboratory health services, administration, nutrition, communicable disease control, environmental health and health education. Although country reports on the food control situation in respect of most countries are available, there is still a need for more compre- hensive baseline data and information on all related public health aspects. The Regional Office has prepared a comprehensive question- naire that should enable countries to assess the situation in all its aspects. The main problem in launching a food safety programme is the dispersal of the activities of different facets of the programme among different ministries or departments. It is therefore planned that, on the basis of a comprehensive review, a multidisciplinary WHO team should visit countries and discuss the question of food safety with all departments and minis tries concerned and assist them in evolving a rational food safety programme that meets the needs of the country and is feasible to implement. 6. HEALTH INFORMATION AND STATISTICS During the period under review there have been efforts to evolve methods and procedures for collecting, processing and utilizing information which could have general application in the countries of the Region. Probably the most productive work has, however, been direct collaboration with the countries in improving their information systems. A major part of the activities has been concerned with developing methods of monitoring and evaluating primary health care programmes. The principal site of delivery of PHC in the rural areas and urban slums will be the community itself and health care will mostly be delivered by the primary health care workers selected from and operating within the community. Hence lay reporting has been adopted1 adapted as a major source of data for monitoring PHC in several countries of the Region. It will, however, be obviously very difficult to obtain absolutely reliable data through lay reporting, partly because of the lack of education of PHC workers and partly owing to the problem of supervising any system of data collection at the local level. Primary health care workers will operate closely with the cornunity leaders on the one hand and with the district health officer on the other, but contact with higher levels of management will be infrequent. The flow of information on PHC activities obtained through lay reporting to higher echelons and feedback to the PHC workers, as has been conceived in the national health information system development activities in the countries of the Region, is shown in the diagram below. FLOW OF INFORMATION ON PHC ACTIVITIES DERIVED FROM THE LAY REPORTING SYSTEM Authorities I I National Health I I I I , -15 Information System - #=/- - =#'- * 5- a *I Regional Health # I I Authorities a- -- I I I I I I In order to consider these problems and the best way of solving them, a meeting was held in October 1980 on "Lay Reporting of Health Information for Primary Health Care". Sixteen participants from eight countries presented their experiences on how the lay reporting system operates in their countries. Previously, lay reporting was restricted to the reporting of morbidity and mortality and was based on symptom association. The main outcome of the meeting was the realization that this reporting has to be adapted to cover the reporting of all health activities being undertaken by the PHC worker. A number of suggestions for achieving this objective were made and these suggestions are being followed up by the countries. Infant and childhood mortality and maternal mortality are all important indicators for assessing the progress of primary health care. However, it is extremely difficult to measure these rates because countries do not possess adequate civil registration systems for recording all births and deaths. National and international organizations, including WHO, have given much attention to trying to evolve methods of collecting reliable data on mortality and to develop techniques of analysing these data. A joint meeting sponsored by ESCAP, WHO Headquarters and the Regional Offices for the Western Pacific and South-East Asia was held in Manila in December to discuss ''Mortality in Asia: A Review of Changing Trends and Patterns, 1950- 1975". At this meeting it was possible to assemble together the latest information on mortality trends in Asian countries. Efforts are also being made- to design an information system which can be used for regional monitoring and evaluation of the IDWSS Decade. The system will initially provide baseline data, which will be periodically updated and reviewed. The activities being carried out for developing national health information system in the countries of the Region are given below: In BANGLADESH, s consultant on medical records was assigned to assist with the introduction of simple and feasible medical and health records systems that can be adopted throughout the country for hospital and health centre services. She visited selected hospitals and rural health complexes and made in-depth studies of the hospital reporting system. She also organized a course to provide training in medical records for employees of selected hospitals and thana health complexes. The development of the information system in Bangladesh gained further momentum with the assignment of a systems analyst in 1980. In colla- boration with the national authorities, a WHO consultant organized a programme for training health personnel in health information. Train- ing in the lay reporting techniques was also started. In February 1981, a consultant assisted in evaluating the health information system, in devising mechanisms for the collection, compilation, analysis and reporting of data, and in developing statistical proce- dures and operational research studies. In BURMA, support continued to be provided to the health information and statistics services. A study of the geographical distribution-. and utilization of hospitals having specialist services was conducted and included information pertaining to staffing, financing, disease patterns and catchment area demarcation. Also, training courses on the International Classification of Diseases for morbidity and mortality recording were conducted at central, state and divisional levels. The national health information system infrastructure largely provided the basis for the monitoring and evaluation of all health programmes. Action has been taken to procure data-processing equipment for Burma; this will greatly enhance the data processing capability and streng- then the health information service. Further, fellowships have been provided in the fields of computer science,data processing,demography and public health statistics. In INDIA, the main activities were concerned with health statistics and medical and health records within the context of national health information system development. With WHO support, two national work- shops were organized on (a) medical certification of cause of death, and (b) standardization of medical and health records. Efforts to increaae the capability of medical records training centres continued. A proposal has been made to establish a WHO Collaborating Centre for Medical and Health Records in India. Financial assistance will be provided for a training programme in medical records techni- ques at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry. Further, fellowships were awarded in the fields of advanced health statistics methodology, information systems development,medical demography and population statistics, and medical coding. Short-term consultants were provided by WHO for data processing in regard to the inter-regional project on disabilities as well as for the statistical aspects of the study on the impact of the improved water supply undertaken in Jhansi. INDONESIA launched a nation-wide programme for training health pee- sonnel in the coding of data according to the International Classi- fication of Diseases. A consultant was assigned to assist in the interpretation and translation of the International Classification into the Indonesian language. Another consultant is being assigned to assist in the development of hospital and laboratory information systems. In August 1981 a workshop on hospital information system was organized, with technical support from Wm). A consultant collaborated in reviewing the uses for the computer attached to the Bureau of Health Planning of the Ministry of Health and in assessing the future needs for computer hard and software. A long-term staff member is being assigned to work with the Bureau in developing the capabilities of the Data Processing Unit. Technical support was given to the Perinatal Mortality Study in Bandung, which forms part of the collaborative study being undertaken in five countries of the Region. Technical assietance was also provided to the national disability study and in analysing the results of leprosy surveys, including the preparation of the sample design for the study, to be undertaken in Nusa Tenggara Barat Province. In MALDIVES, WHO has assisted in the field of health information and statistics by the award of fellowships for acquiring knovledge in medical records techniques,and participation in international meetings on the International Classification of Diseases and Lay Reporting techniques. A preliminary study was made by the team leader of the inter-country project, "National Health Information Systems Develop- ment", who visited Hale and examined the existing information infra- structure, with a view to providing long-term assistance. Action is under way to assign a health information specialist to help to develop a suitable system and train national staff. A consultant in medical records is also to be assigned shortly to assist in designing a simple and feasible medical records system for the Hale Government Hospital and to give training. Statistical assistance was provided in preparing the sample design for a survey to establish the prevalence of measles and paralytic polio in the islands. In MONGOLIA, the development of a health information system and statistical services continued to be supported by WHO. The statisti- cal analysis of data on health service activities has been completed; new reporting forms for health institutions have been worked out, and a seminar for hospital statisticians was conducted. In addition, a course was held for health statisticians vith higher education. In regard to collaboration in improving the maternal and child health services, a consultant helped to complete the analysis of data on studies undertaken in the first phase and in planning and designing the research studies under the second phase. In NEPAL, assistance in the development of health information and statistical services has been continuing, with the assignment of a statistician under the project. "Health Planning and Programming". A health planning profile at district level was completed and a work- shop conducted on the development of health planning procedures and health information system at district level. A protocol for the trial of the lay reporting system was prepared and is under consideration by the Government. Effective collaboration is maintained in the opera- tional aspects of a data bank, in terms of indexing, classifying, storing and retrieving health information. In SRI LANKA, the development of health information systems gained further impetus with the arrival of a long-term health information officer. A project proposal for an improved information system was prepared and is being considered by the Government. A consultant from Headquarters was assigned to collaborate in the strengthening of the medical and health records system in selected hospitals of the country. In THAILAND, tvo WHO consultants were assigned to help set up a national focal point for appropriate technology for health information and to assist in the development of a management information system, respectively. A training programme was organized for statistical instructors in health training institutions, in which 40 persons participated. A meeting of high ranking decision-makers was held to discuss the development of a management information system. Another activity was the organization of a consultative meeting of representatives from various health and health-related agencies which use and produce health information. This meeting was convened with the aim of identifying unreliable health statistical data and recommending or designing technology and methodology for improving such information. Financial support for conducting these meetings was provided by WHO. 7. DEVELOPMENT OF HEALTH MANPOWER The WHO health manpower development programme is aimed at: (1) streng- thening the links between manpower planning, training and management in each country of the Region, to enable it to produce the right kind and sufficient numbers of health workers and to use them effectively; (2) ensuring that the basic training programmes for all types of health workers are directly related to the provision of primary health care within the framework of "~ealth for All by the Year 2000"; (3) stimulating the countries to collaborate with and help one another in all areas involving health manpower development, with the overall objectives of fostering technical cooperation and strengthening national self-sufficiency in dealing with their own most pressing problems, and (4) promoting greater awareness and acceptance in high-priority areas such as "team training", "the effective use of traditional health workers", and "fostering research capability in health services and manpower development (HSMD)". The Organization has therefore further strengthened its efforts to assist Member countries in: developing structures so as to bring manpower planning, training and management into alignment with one another; determining the priority needs for primary health care and helping the training institutions to reorient their programmes in these critical directions; developing national and regional teacher training programmes so that teachers will adopt more systematic and relevant approaches in training future health workers, and providing greater support for research and the use of research results in train- ing and in the provision of primary health care. Health Manpower Planning Countries of the Region are evincing increasing interest in under- taking health manpower planning. It is noted that "Health Manpower Planning and Community Participation for Primary Health Care" was the subject for technical discussions at the thirty-third session of the Regional Committee in 1980. BANGLADESH formed a steering committee for health manpower plan formu- lation in 1980. A situation report has already been prepared, and a national health manpower plan formulation exercise was carried out in June 1981. BURMA has undertaken the preparation of a health manpower development project as part of the buch larger task of formulating its country health programme.
indications that this mosquito is becoming tolerant or resistant to the insecticide. Efforts are being made to encourage the people to restock their wells with larvivorous fish for Aedes control. In NEPAL, a WHO consultant reviewed the entomological activities in the malaria programme and advised on the requirements of field opera- tions and research. Guidance was also provided on procedures for the investigation of vectors related to Japanese encephalitis outbreaks in the Terai. A national entomologist was sent to Thailand on a WHO fellowship to study mosquito cytotaxonomy. In SRI LANKA, UNDP assistance to Phase I1 of the vector control projecr continued throughout the year, and a tripartite review meet- ing was held in November 1980. Most of the activities of the project are progressing as planned, monitored by a WHO epidemiologist. A WHO consultant visited the project in July 1980 and made recommendations concerning long-term control measures against Culex quinquefasciatus in Colombo and the endemic belt,the surveillance and control of Aedes mosquitoes in Colombo, and trials with slow release larviciding for the control of C.quinquefasciatus in the coconut husk soak pits in coastal areas. Trials were continued with different insecticides and formulations,including Dursban 10 CR, ECOPRO chips and Altosid insect growth regulator. The consultant made another visit in May/June 1981 to evaluate the effect of these larvicides. In THAILAND, the monitoring of vector susceptibility/resistance to insecticides and the evaluation of vector response to the impact of DDT residual house spraying have been pursued systematically. During 1980, 86 susceptibility tests were undertaken. In Phrae Province, where chlorinated hydrocarbon insecticides are applied extensively in cotton fields, results of six years of study (1975-1980) show that there has been no significant change in the susceptibility level of An.minimus to DDT. In the partial integration areas of North-east Thailand, where there have been increases in the number of malaria outbreaks, WHO assistance is being given to long-term entomological studies designed to identify the responsible vectorls, their seasonal prevalence and their breeding potential. The Organization has extended its recognition of the Division of Medical Entomology, Department of Medical Sciences, Ministry of Public Health, as the "WHO Collaborating Centre for Evaluation of Pesticide and Pesticide Application Equipment in South-East Asia" for three more years from September 1980. In collaboration with UNDP, the Division of Medical Entomology is planning a trial of monomolecular organic surface films as a method for non-toxic control of disease- carrying mosquitoes in stationary waters. WHOITDR is supporting studies on biological control agents of mosquitoes and snails carried out by different groups of scientists in Chulalongkorn, Mahidol and Chiang Mai Universities. 3. DISEASE PREVENTION AND CONTROL - NONCOMMUNICABLE DISEASES In the context of health for all by the year 2000, attention has been focused on promoting national and regional self-reliance in meeting community-oriented service demands for the prevention and control of emerging health problems including those of the noncommunicable diseases. Technical collaboration with governments has been maintain- ed through sustained efforts to create national awareness of the needs and to develop a system for surveillance and the monitoring of trends in changing patterns of morbidity and mortality. Two important areas have been disabilities resulting from chronic degenerative diseases and health problems associated with ageing. The services of consultants were provided to assess these problems, review existing facilities and advise on measures for integrating training and ser- vices into primary health care. Health education and early detection facilities at the peripheral level and the strengthening of facili- ties for diagnosis and treatment at the intermediate and central levels of health care thus have received increasing emphasis. This approach has made it necessary (a) to train community volunteers and peripheral health workers to assume their responsibilities in these aspects and (b) to give professional staff opportunities to enhance their knowledge and skills in order to provide specialized medical care. National training activities were sponsored and overseas fellowships were awarded for the development of health manpower for work on cancer, cardiovascular diseases, diabetes and chronic respi- ratory disorders. The suitability of imported equipment for deliver- ing health care in the field of noncommunicable diseases under the prevailing cultural,social and economic conditions received scrutiny, and the development of appropriate technology was promoted. In addition, research priorities for prevention and control were identi- fied and protocols developed for epidemiological and operational studies on the commonly seen health problems. Regional and national collaboration was promoted by organizing meetings of scientists and by ~roviding research institutions with supplies and equipment. 3.1 Cancer - National programmes for the prevention and control of cancer made further progress in Bangladesh, Burma, DPRK, India, Indonesia, Mongolia, Sri Lanka and Thailand. In BANGLADESH, a consultant reviewed the morbidity and mortality patterns of cancer and recommended an -- ad hoc survey in selected districts. He suggested that public education on the risk factors for oral and lung cancer should be widely disseminated through the mass media. The other recommendations were for considerably strengthening existing facilities for early detection and diagnosis, for standardi- zation of treatment with radiotherapy and chemotherapy and for the improvement of training in oncology, including epidemiology, in undergraduate and post-graduate education. He considered that a referral system for ontological services and improvement of the cancer centre at Dacca Medical College would considerably enhance the quality of health care for cancer patients. In BURMA, the cancer registration system at Rangoon General Hospital is functioning well. Similar hospital-based cancer registries are being established in Mandalay and Taunggyi. The country health programming exercise identified cancer as a priority problem, and a project for technical collaboration in community-oriented prevention and control activities was included in the programme proposals for the next biennium. Increasing attention will be paid to continuing professional education through assigning consultants, awarding fellowships, and strengthening treatment facilities. A team of WHO staff members from the ~egional office and Headquarters visited DPRK in July 1980, reviewed the progress and prepared a plan of action for continued technical collaboration in cancer prevention and control. Establishment of cancer registration, the strengthening of preventive measures through public education, organization of facilities for early detection and diagnosis, and standardization of treatment continued to receive emphasis. The new cancer institute under construction is expected to be completed soon. Ontological units have been established in all provincial hospitals with the necessary facilities for early detection and diagnosis. A team of three consultants is to be assigned later in 1981 to assist in deve- loping services for treatment and cancer immunology. The training of ontological specialists and the improvement of research in cancer were supported through the provision of supplies and equipment. In INDIA, cancer control activities were increased through the estab- lishment of more regional centres in six States. The Arignar Anna Nemorial Cancer Hospital at Kancheepuram, Tamil Nadu, was inaugurated in March 1981, to function as the State's apex referral centre and undertake training and research in addition to providing treatment for complicated cases. Under bilateral assistance from the United Kingdom, a linear accelerator with facilities for training, repair and maintenance services was installed at the Gujarat Cancer and Research Institute, Ahmedabad. Documentation on cancer and health education, including a set of nine films produced by the American Cancer Society, were made available to selected regional cancer centres. Exfoliative cytological services for the early detection of cervical cancer were strengthened in a number of States as an integral part of the family welfare programme. A WHO consultant assigned to INDONESIA visited institutions providing diagnostic and treatment facilities for cancer patients in Yogyakarta, Semarang and Jakarta, reviewed the progress of control activities and assessed the magnitude and pattern of the problem, on the basis of available data. He also discussed strategies for a national cancer prevention and control programme. In accordance with his advice, efforts are being made for the appointment of a Cancer Coordinating Committee and a National Cancer Advisory Board, the establishment of a system of centralized medical records and hospital-based cancer registry, and the development of a national cancer centre. In MONGOLIA, the national cancer control programme has been progres- sing well. As part of this programme, the construction of the cancer hospital at Ulan Bator is nearing completion. The first round of screening for cervical cancer was carried out in all the aimaks. Since the establishment of the ~ational Advisory and Coordinating Board for the Control of Cancer in SRI LANKA, there has been considerable progress in implementing the national strategy and plan for cancer control. Specific priority areas, including further development of the information systems, increasing the capabilities for early detection, diagnosis and treatment, the improvement of the cancer registry and expansion of facilities at the Government Cancer Institute at Maharagama, were identified. The National Board has appointed sub-committees to prepare plans of action for each of the priority areas. A special cell has been set up in the Ministry of Health to carry out the activities; the national cancer control and prevention programme is now headed by a director. A WHO consultant visited Sri Lanka during August-September 1980 and assisted in the conduct of a workshop on a "Standardized Approach to Cancer Treat- ment". He also prepared guidelines for diagnosis, classification and treatment. Another consultant conducted a training course in 1980 for peripheral health workers in the early detection of precancerous and cancerous lesions of the oral cavity. A training manual was prepared in the local language and field-tested for use by these health workers. WHO also provided grants to the National Board for develop- ing research activities and awarded fellowships. In THAILAND, the training and research activities at the National Cancer Institute progressed satisfactorily. A WHO consultant assisted the Institute in matters relating to the planning of cancer treatment with radiotherapy, and reviewed the morbidity patterns of the disease by visiting a number of treatment centres in the country. On the basis of his findings, the Government is now taking steps to extend the radiotherapy services outside Bangkok and to establish cancer clinics based on multiple treatment modalities. 3.2 Cardiovascular Diseases Prevention of cardiovascular diseases continued to receive consider- able attention from government agencies, professional groups and voluntary organizations. ~ational planning for the prevention and control of cardiovascular diseases has been promoted and the import- ance of education, positive life styles and behaviour received emphasis in the context of prevention as an integral part of primary health care. In BANGLADESH, the Institute of Cardiovascular Diseases started functioning early in 1981. The Institute is well equipped, through Japanese assistance, and is adequately manned by personnel trained by means of bilateral support. It will play a vital role in educating the public about the preventive aspects of cardiovascular diseases and will undertake training, services and research. The Institute conducted a survey around Dacca to determine the magnitude of health problems due to hypertension, rheumatic heart disease and ischaemic heart diseases. With WHO support, a national workshop on the preven- tion and management of cardiovascular diseases, in which 56 doctors participated, was conducted. A WHO consultant assisted in developing a national plan for prevention and control, with special reference to hypertension and ischaemic heart diseases and for the training of health and allied personnel in this field. A programme for the prevention and control of cardiovascular diseases in BURMA was formulated as part of the WHO-supported country health programming early in 1981 and was supported by WHO. The Cardiology Unit of Rangoon General Hospital continued to make efforts to expand and extend its activities to the community level. With the recogni- tion of cardiovascular diseases as a growing problem because of the increase in morbidity and mortality, the Government has drawn up a plan for early diagnosis and treatment as well as for educating the people in prevention. A team of WHO consultants visited DPRK in July 1980 and assisted in assessing progress in the implementation of the plan of action for the early diagnosis and treatment of cardiovascular diseases which had been formulated previously. The results of this assessment led to the reformulation of programme proposals, based on which the budget estimates for WHO collaboration during 1982-83 were drawn up. Based on another survey, a school health programme was formulated for the prevention and control of rheumatic heart disease. Similarly, a community-oriented programme for the prevention and control of hypertension is under consideration. WHO technical support provided during the period also included fellowships, supplies and equipment, and consultant services in the use of the ultrasonic diagnostic technique in cardiovascular diseases. In INDIA, activities for the prevention and control of cardiovascular diseases continued to develop in various institutions. A WHO consultant visited selected institutes in the country to assess the existing facilities and advise on the development of community- oriented services for the prevention and control of hypertension. Following his visits, a meeting of a task force was organized by the Indian Council of Medical Research, to identify priority areas for research on this condition and to formulate a plan of action for community-oriented prevention and control. Two consultants are being assigned to advise and assist in developing national and State-level plans for the prevention and control of ischaemic and rheumatic heart disease. The Indian Council of Medical Research has also developed a plan of action for the prevention and control of rheumatic heart disease amongst school children. The Sree Chitra ~hirunal Institute for Medical Sciences and Technology, Trivandrum, is now specially geared to the promotion of indigenous technology for medical applications which will facilitate national cardiovascular disease control activities. The Institute is in the process of being designated as a WHO Collaborating Centre. A WHO consultant visited MONGOLIA in September-October 1980 and assisted in assessing existing facilities for the study of strepto- coccal microbiology, in conducting a pilot study on streptococcal carriers amongst school-children, and in preparing a medium-term programme for the prevention and control of rheumatic fever and rheumatic heart diseases. The service facilities at the cardiac unit in Colombo, SRI LAW, were expanded through the addition of paediatric cardiology and cardiac surgery. Paining activities for health and allied personnel are progressing satisfactorily. The Department of Health collaborates with the Faculty of Medicine, University of Colombo, in implementing the programme of prevention of cardiovascular diseases through the community approach. WHO assistance in epidemiological studies aimed at preventing and controlling these diseases at the community level has continued. In THAILAND, WHO provided support for the collection and analysis of epidemiological data relating to cardiovascular diseases. A consul- tant assisted in developing a plan for the prevention and control of rheumatic fever and rheumatic heart disease, and a national advisory committee has further elaborated this plan for implementation in the field. 3.3 Prevention of Blindness Formulation of national policies and strategies, preparation of plans of action, surveys of the magnitude of the problem, mobilization of national and international assistance for the implementation of activities aimed at prevention and the restoration of sight to the blind, training of health and auxiliary personnel, promotion of appropriate technology for self-reliance in low-vision aids, and evaluation of ongoing activities were the main components of the programme for the prevention and control of blindness in the Region. The Third Meeting of the WHO Programme Advisory Group on the Preven- tion of Blindness was held in the Regional Office in February 1981. Following a review of regional and inter-regional activities and those of WHO Collaborating Centres, the Advisory Group defined the research priorities in eye health problems and developed alternative approaches for the mobilization of resources. The enthusiasm created by this meeting led to two major actions: first, the inauguration of the Asian Foundation for the Blind in Hong Kong with the main objec- tive of bringing welfare and relief to the preventable, curable and incurable blind in the countries of the South-East Asia and Western Pacific Regions; second, the establishment in 1981 of the post of Medical Officer in the SEA Regional Office, with collaborative assistance from the Royal Commonwealth Society for the Blind, for the management of the prevention of blindness programme. An inter-country Seminar on Cataract Relief Services was organized at the National Institute of Nutrition in Hyderabad, India, during September-October 1980. There were eighteen participants, from Bangladesh, India, Indonesia,Maldives, Nepal, Sri Lanka and Thailand, and representatives of voluntary organizations and non-governmental agencies. The Seminar reviewed current activities and formulated specific strategies for dealing with the large number of cataract patients. A consultant visited Bangladesh, Burma, India and Sri Lanka to review the national programmes, to identify institutions with potential for development as regional training and demonstration centres for the prevention and control of major eye diseases (includ- ing rehabilitation) and to prepare a background paper for developing a regional programme on the prevention and control of blindness, which UNDP will also support. (Above): As a result of various preventive and curative programmes, over a million people have had their eyesight restored and thousands more have been saved from blindness or visual impairment during the past five years in the South-East Asia Region. GIVING SIGHTTO THE BLIND Regular eye examinations in schools promote better vision. early detection of eye diseases and prevention of blindness. Committee for South-East Asia was held in Male, Maldives-the first international meeting to be held in that country. The President of the Republic of Maldives, His Excellency Mr Maumoon Abdul Gayoom (centre), inaugurated the meeting. Others in the picture are (from I tor): the Honourable Mr Fathullah Jameel, Minister of External Affairs, the Honourable Mr Mohamed Musthafa Hussain. Minister of Health, Dr Halfdan Mahler. Director-General. WHO. and Dr V.T.H. Gunaratne. the then Regional Director. A delegation from the Democratic People's Republic of Korea, led by the Honourable Dr Kim Yong Ik. Vice-Minister of Public Health (centre). visited the Regional Office. The deletlation is seen here with Dr U KO KO. the Regional Director (third from right). The delegation visited health institutions in India to observe practices in mental health. traditional medicine and manufacture of pharmaceuticals and drugs. and discussed matters relating to collaboration in research and training. RACMR The 7th session of the SEA Regional Advisory Committee on Medical Research (RACMR), which met in SEAR0 in April 1981. underscored research needs for achievement of the HFA goals. It was inaugurated by Dr U KO KO and chaired by Professor A.A. Loedin (right). Professor S. Bergstrom. Chairman of the Global ACMR (second from left), also attended. In BANGLADESH, health personnel working at different levels received training in eye health. A consultant visited health institutions, reviewed developments with the national workers and improved upon the national plan for the prevention and control of blindness. Measures for integrating eye health services in primary health care,establish- ing referral services,expanding eye-camp activities and manufacturing low-vision aids are receiving priority attention by the Government. A second consultant collaborated in the development of curricula for the training of medical assistants in public health ophthalmology and participated in the training courses. Fellowships were awarded for training in public health ophthalmology. Activities for the preven- tion of xerophthalmia, with support from UNICEF, and rural eye camps, assisted by the Royal Cornonwealth Society for the Blind, made satisfactory progress. In BURMA, a strategy was developed for providing eye health services in remote rural areas for the operative treatment of entropion and cataract, and action taken for the mobilization of extrabudgetary resources and the supply of vehicles and equipment. Audio-visual material for training in ophthalmology and health education was provided. A WHO consultant visited the country to assess the progress and to discuss the future development of this programme with the national authorities. The Government of INDIA initiated a series of administrative proce- dures for the decentralization and speedy implementation of the national plan for the prevention of blindness. Forty-five mobile ophthalmic units are in operation. Coordinators were appointed to assist the programme and monitor its development in the States. Training curricula for ophthalmic assistants were formulated and institutions identified for conducting the courses. Assistance to voluntary organizations was increased to enable them to conduct more eye camps in rural areas. The ~ndian Council of Medical Research organized a meeting to review the activities and plan research in ophthalmic sciences. A WHO consultant assisted in the preparation of a research protocol. Bilateral assistance for the programme was received from DANIDA, and several voluntary agencies working in this field received support from non-governmental organizations from outside the Region, i.e., the Royal Commonwealth Society for the Blind, Christoffel Blindenmission, Operation Eyesight Universal and others. The Royal Commonwealth Society for the Blind formulated a country-wide project for the prevention of blindness due to mal- nutrition and has started to train workers at Madurai. "Operation Cataract" in Medak District, Andhra Pradesh,continued its activities. A research project in collaboration with the National Eye Institute, Bethesda, Maryland USA, is in the early phases of development at the National Institute of Nutrition, Hyderabad. Integration of eye services into the school health programme is also receiving attention. In INDONESIA, the programme for the prevention of xerophthalmia continued to make satisfactory progress. vehicles were supplied with resources made available from the Japan Shipbuilding Industry Founda- tion for mobile ophthalmic units, and comunity-oriented eye health services are being organized in rural areas. A WHO consultant worked with national personnel in streamlining the national plan of action for the control of blindness. Supplies and equipment were made available to MALDIVES, where a strategy is being formulated to restore sight to the curable blind and prevent blindness due to malnutrition and eye infections amongst children scattered over the many islands in the country. A consultant advised on improving the ophthalmological services at Male Hospital and operated on a number of patients for cataract and other eye ailments. In NEPAL, a well-planned national programme for the prevention of blindness was started early this year, with assistance from the Netherlands and WHO as the executing agency. A detailed survey had been carried out in 105 communities, and the data are being analysed, the first phase of the plan of action thus being completed. Extra- budgetary resources for this activity were also made available from non-governmental agencies from the USA and Sweden, as well as from the Swiss Red Cross. Preliminary analysis of the data indicates that trachoma is common in mountainous areas owing to the insanitary environment,whereas cataract is much more common in the Terai region. Based on further analysis of the data, a suitable strategy will be developed for implementing subsequent activities under the programme. Some 48 district medical officers will receive training in secondary eye care, and nearly 1500 community health personnel in the treatment of minor eye conditions, in first-aid and in the referral of ophthal- mic cases to eye departments. The construction of the new building for the Nepal Eye Hospital made progress, through resources made available from Operation Eyesight Universal. An ophthalmic unit is being established in Pokhara in a phased manner, in collaboration with the Institute of Ophthalmology, Munich. The problem of iritis and secondary cataract due to leprosy is being investigated. The mobile ophthalmic unit supplied to the Colombo Eye Hospital, SRI LANKA,has extended its activities to remote rural areas. Negotiations with the Royal Commonwealth Society for the Blind and the Christoffel Blindenmission for the establishment of a school for ophthalmic auxi- liaries in Peradeniya are under way. In THAILAND, the expansion of community-oriented eye health services is progressing satisfactorily, through the training of doctors and nurses from the provinces at Buriram Hospital and in Bangkok. A team of ten doctors and five nurses visited ophthalmic centres in India, under the WHO fellowship programme, to observe the large-scale management of eye diseases, including cataract, in institutional and rural settings. A national plan for the prevention of blindness was formulated at a meeting of health professionals, and the constitution of a national advisory committee is under the consideration of the Government. The proposal to establish an institute of community ophthalmology with extrabudgetary assistance is also receiving attention. 3.4 Immunology The importance of immunological factors in the pathogenesis of disease and of immunological techniques in diagnosis is increasingly being recognized. During the year under review, a WHO team of con- sultants evaluated the work and progress of the WHO Collaborating Centre for Research and Training in Immunology at the Department of Biochemistry, All India Institute of Medical Sciences, New Delhi. In September 1980 an inter-country workshop on the production of immuno- logical reagents was held in Bangkok, in which the participants were trained in the production and standardization of commonly used immuno- logical reagents with a view to helping the country attain national self-reliance. A consultant visited Indonesia to collaborate in setting up immunological methods in public health laboratories. 4. HEALTH LABORATORY SERVICES 4.1 Organization of Laboratory Services WHO has been collaborating with the countries in the Region in developing their health laboratory infrastructures, improving the technical standard of laboratory services and training national staff in health laboratory technologies and management. The Organization assisted in the development of peripheral laboratories and inter- mediate-level laboratories in support of primary health care. Referral laboratories were strengthened in the fields of microbiology,virology and immunology so as to be able to undertake disease surveillance and support diagnosis. WHO has also helped to develop quality control in clinical chemistry, microbiology and haematology. Since the rapid diagnosis of viral diseases for carrying out preventive measures and promoting better treatment is being increasingly recognized as a health priority, WHO organized an inter-country workshop on this subject in Pune (India) in November 1980. Also, a workshop on anti- biotic sensitivity testing was held in New Delhi in MarchJApril 1981, designed to provide bench-level training to national workers to set up standard techniques in antibiotic sensitivity testing and anti- biotic assays. Here, training was given in advanced techniques in bacteriology,viro?ogy and laboratory management, including techniques for respiratory viruses, and following the workshop, the participants were supplied with adequate amounts of reagents for standardization of the techniques to enable them to carry on the tests in their respective countries. In BANGLADESH,the Institute of Public Health was assisted in organiz- ing training for laboratory personnel from peripheral and inter- mediate laboratories,particularly the training of unipurpose personnel to convert them into multipurpose laboratory workers. A WHO con- sultant was assigned to evaluate the public health laboratory programme. The Government has prepared a project for strengthening laboratory services at intermediate and peripheral levels. Another consultant collaborated with the National Institute of Preventive and Social Medicine in strengthening laboratory facilities for occupa- tional health and industrial hygiene. In BURMA, laboratories at the township level were strengthened, and, at the National Health Laboratory, Rangoon, training programmes were organized for laboratory personne1,which included training in quality control techniques and advanced techniques in microbiology. A con- sultant was assigned to develop a programme for monitoring hospital cross infections. WHO participated in formulating the plan for health laboratory services as part of country health programing for 1982- 1986.
2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Comunicable diseases continue to be a major public health problem in the Region in spite of persistent efforts by governments, supported by international and bilateral agencies, to control them. Lack of adequate surveillance services, shortage of trained manpower and weak infrastructures constitute the major constraints. The ~riorit~ communicable diseases include malaria, leprosy, dengue haemorrhagic fever (DHF), acute diarrhoeal diseases and diseases preventable by routine immunization, especially of children. Although there are continuing technical and administrative problems, malaria has shown a reduction of around 17% in reported cases in the Region. However,this is due to a noticeable reduction in only some of the countries. The success of the Swedish International Development Authority (S1DA)-assisted Plasmodium falciparum Containment Programme in India is very encouraging. Research on drug resistance in the treatment of malaria continued and was expanded. In addition to SIDA, the programme in the Region received support from the Canadian Inter- national Development Agency (CIDA), the Netherlands, US AID and the United Kingdom. The progress of the leprosy control programme is rather slow. The social stigma attached to the disease continued to prevent its satis- factory integration into the general health services. Field studies to improve identification and treatment are progressing. Research priorities have been identified and protocols developed with emphasis on drug resistance and more effective regimens for treatment. The Japan Shipbuilding Industry Foundation is providing substantial sup- port to the leprosy control programmes in the Region. DHF continues to be confined to three countries, namely, Burma, Indonesia and Thailand. While the emphasis in the programmes is now on early diagnosis and treatment,the production of a vaccine appears to be a distinct possibility, as a result of research undertaken at the WHO Collaborating Centre in Bangkok. The emphasis in the diarrhoeal disease control programme is on the reduction of mortality in children by prompt oral rehydration. This single modality of treatment in diarrhoeas of all etiological origins is the sheet-anchor of the success of the programme. Supply of ade- quate quantities of oral rehydration salts (ORS) through large and small-scale production, delivery of ORS at village level and use of village volunteers and mothers in treating cases are the major ele- ments of the programme. Research into various facets of the problem, especially the operational aspects, is receiving increasing attention. As in previous years, the focus of WHO activities in the expanded programme on immunization (EPI) is on supporting and strengthening national efforts, in collaboration with UNICEF and other agencies, through the provision of training for various levels of EPI manage- ment staff, including technicians,in the maintenance and repair of refrigerators, the cold-chain and logistics. In addition to the provision by WHO of the usual consultant/long-term staff support, Regional Office staff visited the various countries to assist with programme reviews, training, management of EPI, surveys of immuniza- tion coverage, and evaluation. WHO has provided support in collecting baseline data on EPI target diseases, in conducting epidemiological and serological surveys, in solving operational problems, and in carrying out studies on the economics of the programmes. Preparations are in hand for a regional meeting in Ulan Bator in August 1981 on the implementation of EPI through existing health services and on the evaluation of the programme activities. With regard to other diseases,the sexually transmitted diseases,viral hepatitis, Japanese encephalitis, filariasis,leishmaniasis and plague have received greater attention at national and regional levels. With the appointment of a medical officer in veterinary public health at the Regional Office, support is being given to countries in the plan- ning, formulation and evaluation of programmes for the control of the major zoonotic and food-borne diseases. The FAOIWHO Collaborating Centre for Research and Training in Food Hygiene in Berlin will, it is hoped, collaborate in this field with veterinary public health institutes in the Region. Likewise, activities in the field of vector biology and control were carried out in countries of the Region in respect of malaria, fila- riasis, dengue and Japanese encephalitis and, in certain areas, also typhus and plague. An important activity was the WHO Seminar on Integrated Vector-Borne Diseases Control, jointly organized with the Ministry of Health, Burma, and held in Mandalay in April 1981. Filariasis continued to be a major problem in most countries of the Region. Besides WHO support to various countries, assistance was provided for an international symposium on chemotherapy and immunology in the con- trol of malaria,filariasis and leishmaniasis, held in Lucknow (1ndia) in February 1981. In addition, WHO provided research grants for the study of advanced techniques in the vector biology of mosquito popu- lation and research methods in applied helminthology with reference to filariasis. Research studies supported by the WHO Special Pro- gramme for Training and Research in Tropical Diseases (TDR) are being conducted in India. 2.1 Epidemiological Surveillance WHO has continued to cooperate with the countries of the Region in improving their epidemiological surveillance services so as to make them effective tools in controlling the prevalent communicable diseases. The Organization has also collaborated in training pro- grammes in field epidemiology. In BANGLADESH, the Institute of Epidemiology, Disease Control and Research undertook epidemiological, virological, entomological and parasitological studies with WHO collaboration. In August 1980,a con- sultant assisted in the preparation of material for a WHO-supported certificate course in epidemiology designed to provide medical pet- sonnel with field and applied training. He also reviewed the £oms used for the recording and reporting of communicable diseases in Dacca and the districts,and cooperated in the establishment of opera- tional procedures for the recording and reporting of morbidity and mortality from priority diseases. Another WHO consultant helped in (a) further developing the Parasitology Unit at the Institute of Epidemiology, Disease Control and Research (under the National Insti- tute of Preventive and Social Medicine); (b) enhancing the technical capability of national workers in the -- in vitro technique; (c) review- ing the existing laboratory facilities, and (d) establishing immuno- logical techniques for improving the laboratory diagnosis of important parasitological diseases. With regard to the strengthening of district epidemiology units, WHO provided funds for the conduct of a certificate course in epidemio- logy for the staff of those units, held during January-February 1981. District microbiological laboratories, as integral parts of district epidemiology units, received supplies and equipment. In INDIA, the epidemiological surveillance/services have been further strengthened. WHO supported national training activities in disease surveillance, prevention and control as well as in research through the organization of workshops and seminars. These activities were organized at the National Institute of Communicable Diseases, Delhi, at Varanasi and at the School of Tropical Medicine, Calcutta. In connexion with the establishment of a national centre for viral hepatitis at the Department of Gastroenterology, All-India Institute of Medical Sciences, New Delhi, WHO sponsored a study tour to enable the Professor of Medicine to bring himself up to date with recent advances in viral hepatitis at the WHO Collaborating Centre for Viral Hepatitis, in Phoenix, Arizona (USA). A WHO consultant worked with the Filaria ~ivision of the National Institute of Communicable Diseases, Delhi, paying special attention to the in vitro culture of the filaria parasite and field studies -- aimed at improving methods for the control of filariasis. WHO also assisted in conducting a workshop on filariasis at Varanasi. In INDONESIA, the epidemiological surveillance of communicable diseases has shown improvement. WHO provided support for extending the infrastructure of the epidemiological surveillance system from the peripheral to the provincial and central levels and for improving the entomological services in relation to vector-borne diseases. A WHO consultant assessed the situation of dengue and dengue haemor- rhagic fevers and other arthropod-borne viral diseases in the country and advised on the ongoing research in epidemiological studies on DHF. An entomologist from WHO Headquarters helped to assess the vector surveillance and entomological activities, especially in the outer islands. Grants were provided for a national group educational activity on the development of vector biology and control services, held in September 1980. In MONGOLIA, the expansion of epidemiological surveillance services continued. Both bacteriological and virological diagnostic capabili- ties were improved by awarding fellowships for training abroad and providing logistic support to the respective laboratories. In NEPAL, the Epidemiology and Statistics Division in the Department of Health Services was further strengthened in order to contribute to the development of a national health information system through sur- veys of communicable diseases and the introduction of lay reporting. A WHO consultant cooperated in epidemiological surveys of communi- cable diseases through existing health services, as well as in the development of the lay reporting system and in the use of epidemio- logy in primary health care. In SRI LANKA, the Epidemiological Unit is now well established, and adequate information on communicable diseases is available through the periodic issue of bulletins. However, the Unit's capability for speedy investigation to facilitate action for the control of out- breaks needs to be further improved. A WHO consultant assigned to the Medical Research Institute, Colombo, helped devise ways and means for strengthening the virus laboratory and developing more effective arbovirus surveillance along with the improvement of communicable disease surveillance in general. The Organization provided technical support to THAILAND through a WHO consultant, who assessed the country's epidemiological surveillance system and advised on coordinating the activities of the surveillance system and those of the national health information system. Based on an assessment of the problems of data collection, analysis and feed- back mechanisms at all levels, undertaken through WHO support, a plan has been drawn up to train PHC workers and assistant epidemiologists in using data cards. In addition,a chain of supervision and reporting is to be established and the lay reporting system streamlined. WHO has also supported the establishment of a national advisory board for disease prevention and control. 2.2 Diseases Subject to the International Health Regulations For the fifth consecutive year, no case of smallpox was reported in any country of the Region. Cases of cholera, however, continued to be detected in most of the countries. Plague was reported only from Burma (see table on page 35). 2.2.1 Smallpox Eradication As mentioned above, the countries of the Region continued to be free from smallpox during the year. Nevertheless, surveillance continued in all the countries, and all "rumours" were promptly investigated. Work on the establishment of a cold room (temperature: minus 20%) in the Regional Office for storing an emergency stock of one million ampoules of freeze-dried smallpox vaccine was completed during the period under review. 2.2.2 Diarrhoea1 Diseases, including Cholera The main activities in this area were directed towards the service component of diarrhoea1 disease-control (CDD) programmes, the formu- lation of operational plans for national CDD activities, training, the logistics of the manufacture and supply of oral rehydration (Information compiled from data made available to WHO Headquarters by governments) *including one imported case. Country Bangladesh Burma India Indoneaia Maldives Nepal Sri Leda Thailand Year 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 Cases 5 576 2 154 - 3 351 874 1 018 10 585 5 073 5 960 10 693 18 817 5 541 11 336 - - 1 662 2 2 1 48* 46 33 4 183 1 788 4 331 Cholera Deaths 81 2 1 - 372 7 5 50 246 113 145 507 769 150 220 - - 10 - - 2 - 3 123 44 85 Cases - - - 171 7 5 74 - - - - - - - - - - - - - - - - - - Plague Deaths - - - 6 2 4 - - - - - - - - - - - - - - - - - - solution (ORS), and operational research. All countries in the Region have implemented oral rehydration services as the most important measure for reducing mortality due to acute diarrhoea and have applied it in varying degrees in the context of national health care delivery. However, insufficient supplies of oral rehydration salts and inadequate health care systems for their delivery continue to be important problems. During 1980, India reported the highest number of cholera cases, followed by Indonesia, Thailand, Burma, Sri Lanka and Nepal. Data regarding the number of cases from Bangladesh and Maldives were not available this year. The total number of cases reported in six count- ries of the Region in 1980 was 16 884, with a case-fatality rate of 2.57%, as compared to 28 774 cases (from eight countries of the Region), with a case-fatality rate of 3.55%, in 1979. In BANGLADESH, WHO has developed important collaborative activities with the International Centre for Diarrhoea1 Disease Research (ICDDR), which is a WHO Collaborating Centre for Research and Train- ing in CDD. The first inter-regional training course - in the clinical management of acute diarrhoea - was held at the Centre in December 1980 for national trainers, and a second course - on the laboratory aspects of diarrhoeal diseases - was organized in March 1981, to enhance the national capacity for the proper laboratory diagnosis of acute diarrhoeal disease,for surveillance,for organizing national training courses for laboratory workers and for epidemio- logical studies. The Centre also conducted training programmes for the physicians of thana and rural health centres in Bangladesh and hosted a regional conference on diarrhoeal diseases in February 1981 to provide for an exchange of views among scientists from various countries in the Region. WHO has provided technical cooperation for the national oral rehydra- tion project, which has been launched by the Government in all the thanas of Dacca and Comilla Districts. The activities are being extended to other thanas with 6 very high incidence of acute diar- rhoeal diseases. Health workers are being trained with WHO and UNICEF support. In BURMA,WHO is collaborating with the Department of Medical Research in initiating studies on diarrhoeal diseases. A study of the etiology of acute diarrhoeas in children under five years of age and of the feasibility, acceptability and effectiveness of oral fluid therapy at village level is being supported. In INDIA, the ~ational ~nstitute of Cholera and ~nteric ~iseases, Calcutta, has been designated as a WHO Collaborating Centre for Research and Training in CDD. With WHO'S financial support, the Institute conducted 26 seminars for the training of teachers and senior medical officers in India in the clinical aspects so that a large number of trainers would be available for training district medical officers and medical officers of primary health centres. An assessment/evaluation of the national seminars on CDD held so far was carried out in ~pril 1981. The Institute has also been designated as a regional training centre for diarrhoeal diseases with UNDP support. In collaboration with WHO, the Institute organized an inter-country course on the management of the diarrhoeal disease control programme. WHO has also provided technical support for a study on the health benefits of water supply in a rural area of Uttar Pradesh. In INDONESIA, efforts are under way for the establishment of a regional training centre for diarrhoeal diseases, with the involve- ment of the University of Indonesia, the National Institute for Health Research and Development and the Directorate General of Com- municable-Disease Control. This will be the third regional training centre in the Region - the other two being the ICDDR (Bangladesh) and the National Institute of Cholera and Enteric Diseases, Calcutta (India). WHO and UNICEF have assisted Indonesia in increasing the production of ORS. A research study on a simplified oral therapy with salt and sugar solution using standard plastic scoops in the treat- ment of diarrhoeal diseases is being supported by WHO. A consultant was assigned to MALDIVES in June 1980 to assist in con- trolling an epidemic of diarrhoea, WHO and UNICEF providing the necessary supplies in this regard. The Organization also provided support to NEPAL in an operational research project on diarrhoeal-disease control to assess the efficacy of home-made oral rehydration fluid when delivered through primary health care. In SRI LANKA, a WHO consultant collaborated in the development of a national programme for diarrhoeal diseases. He helped in reviewing project documents, devising training curricula, developing teaching and promotional aids and setting up an evaluation mechanism. ltro research studies - one on the incidence of ~ersinia enterocolitica, Vibrio parahaemolyticus, Campylobacter and Rotavirus in childhood diarrhoeal diseases, and the other on the etiology of acute diar- rhoeal diseases in infants - are in progress, with WHO support. In THAILAND, the first inter-regional training course for national programme managers was held in Bangkok from 27 October to 7 November 1980, attended by 40 participants from 27 countries representing all six WHO Regions. The course covered different aspects of the plan- ning, implementation and evaluation of a national programme. WHO support was provided for a national workshop on diarrhoeal diseases held in Bangkok in March 1981, which reviewed the etiology and epi- demiology of diarrhoeal diseases in the country. A medical officer in diarrhoeal diseases has been in position in the Regional Office since November 1980 to promote and coordinate the WHO services-cum-research programme in diarrhoeal diseases in the Region. The Organization is promoting the development of national ORS produc- tion units, wherever feasible, to meet the present and future needs for adequate supply of prepacked ORS for CDD programmes. For this purpose a WHO consultant visited India, Nepal and Sri Lanka during the year to review ORS production in these countries. Following this visit a consultant assigned jointly by UNICEF/WHO assisted the national authorities in India and Nepal in setting up facilities for the production of ORS packets. An inter-country meeting on diarrhoea1 disease control, which review- ed the implementation of the strategies of the CDD programmes in the various countries and formulated indices and a work-plan for the next three years (1981-1983), was held in the Regional Office in November 1980. An SEA/ACMR Regional Scientific Working Group on Diarrhoea1 Diseases has been established to advise on the development of a service-cum- research programme for the control of diarrhoea1 diseases so that the results of research are incorporated into the service programme in order to improve it. This working group held its first meeting in the Regional Office in March 1981 and identified the most relevant re- search priorities for immediate implementation. In all these activities UNICEF and UNDP have been closely collaborat- ing with WHO. 2.2.3 Plague Plague is endemic in parts of BURMA, where 73 cases with 4 deaths were reported in 1980. The WHO Inter-regional Rodent Control and Demonstration Unit in Rangoon continued to carry out studies on various aspects of rodent control. 2.3 Malaria and Other Parasitic Diseases Malaria continued to be a major public health problem in eight count- ries of the Region, namely, Bangladesh, Burma, India, Indonesia, Maldives, Nepal, Sri Lanka and Thailand. It also occurs at the lower altitudes in Bhutan, where, at the request of the Government, a WHO consultant conducted a malaria survey from mid-October to mid- December 1980. Among the other diseases, filariasis, leishmaniasis and schistosomiasis are causing concern in parts of some countries. 2.3.1 Malaria The overall malaria situation in the Region in 1980 showed an improvement over the previous year, with a reduction in the projected malaria positive cases of about 17%. The projected annual parasite incidence for 1980 was 3.11 per thousand (3.83 in 1979). In this connexion, however, there appears to have been a reduction of 11% in the annual number of blood slides examined, films being collected from 7.2% of the population in 1980 (8.3% in 1979). The slide positivity rate fell to 4.33% (4.62% in 19791, but the slide falci- parum rate increased slightly to 1.08% (1.02% in 1979) despite there being a 13% decrease in the absolute number of Plasmodium falciparum infections; the proportion vis-a-vis other species increased to 24.8% in 1980 (22.2% in 1979). Case incidence continued to decrease in India (where there was a re- duction of nearly 18%, as compared with 1979), Maldives (52 cases in 1980, compared with 329 the previous year), and Nepal. In Sri Lanka, Figure 1. SOUTH-EAST ASIA REGION INCIDENCE OF MALARIA AND P.FALCIPARI/M INCIDENCE T".. -.-,:.:.: ?::;;;::;;;: ........ ..... ^::::If:::::.. - Slide Positivity Rate % - Slide falciparm Rate % BANGLADESH BURMA NEPAL MALDIVES Mill. 4 INDIA *Provisional **Projected INDONESIA SRI WJKA THAILAND although there was no increase in case incidence, the blood examina- tion rate dropped from 9.3% in 1979 to 8.1% in 1980, with an increase in the slide positivity rate from 4.3% to 6%. There was an upsurge of cases in Indonesia and Thailand, which registered increases in inci- dence of 60% and 30% respectively. An increase of cases in Bangladesh is associated with an improvement in the blood examination rate of from 1.7% in 1979 to 3% in 1980, but this rate remained low and little changed in Burma, making it difficult to assess the signi- ficance of a reported annual parasite incidence there of 1.2 (0.65 in 1979). Variations occurred in the pattern of P.falciparum incidence in the different countries, there being an increase in the number of cases and proportion of this infection in Bangladesh, Burma and Thailand, where the overall increase in malaria cases was largely attributable to this species. Vector resistance to pesticides in general use continued to be a serious problem in India, Indonesia, Nepal and Sri Lanka. Suscepti- bility testing for such resistance was intensified, to detect and delineate its development and distribution. Testing materials were supplied by WHO to the malaria control programmes on a regular basis, and assistance and training in the use of the test kits were provid- ed, where necessary, by WHO entomologists. The Organization directed its efforts in technical cooperation towards the development of medium-term programmes, the evaluation of pro- grammes,the development and implementation of applied field research, and the organization of and participation in training activities. Attention was also paid to the promotion of intersectoral coordination and cooperation in border areas, to providing assistance in developing national self-sufficiency in the production of insecticides and anti- malarial drugs, and to supporting the procurement of supplies and equipment. WHO provided consultants for the annual assessments of the programmes in India, Nepal and Sri Lanka. These assessments were undertaken jointly with representatives of the governments and the bilateral agencies assisting each programme. The role of WHO in respect of malaria border coordination meetings was maintained, the Regional Office acting as a focal point for the exchange of information arising from these meetings. In 1980, meetings were held between Bangladesh, Burma and India in Calcutta, between India, Maldives and Sri Lanka in Madras, between Indonesia, Malaysia and Singapore in Penang, and between Indonesia and South-West Pacific countries in Port Moresby. The meeting between India and Nepal was postponed to July 1981. Applied field research in malaria was undertaken vigorously through- out the Region during the year under review. A principal aspect of this research, supported by WHO, was the study on sensitivity of P.falciparum to 4-aminoquinolines. Important regional studies are in progress on the Anopheles species complexes, resistance to insecti- cides by vectors, and bio-environmental control agents. Studies were additionally undertaken in the operational, epidemiological and ecological aspects of malaria control work. The Regional Collaborative Studies on Drug Resistant Malaria, with special emphasis on P.falciparum resistance to 4-aminoquinolines, which were started in 1977, continued to make progress in Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. In Thailand, these studies were extended to include the response of P.falciparum to mefloquine in vitro. Base-line data are being collected before introducing this new schizonticidal drug into the Malaria Control Programme. Increases in the proportion of falciparum malaria in most countries of the Region have prompted a demand for WHO guidance in optimal treatment measures. During 1980, the 'Manual on Clinical Management of Acute Malaria" was issued in the WHO South-East Asia Regional Publications Series, 5000 copies being printed and distributed in response to numerous requests. A workshop on the clinical management of acute and severe malaria was held at Cuttack (~ndia) in March 1981 with WHO support. The report of a regional workshop on field research methodology in malaria, held in Bangkok in December 1979, was published in 1980. Progress has continued to be made by the countries in developing research cells within their anti-malaria organizations. External assistance required for some of these activities has been met, partly from regional funds, partly from the UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases (TDR), and, to some extent from bilateral sources. Of particular importance is the progress being made in establishing, in research centres in Burma, India and Thailand, the procedure for continuous in vitro culture of P.falciparum, essential for sero-epidemiological work, vaccine production, and biological and chemotherapeutic studies of strains of the parasite collected from patients. Applied field research into anti-malarial delivery systems at the community and primary health care levels is of particular importance in the context of HFA 2000. The proper utilization of these systems is increasingly essential for the delivery of drugs, and studies have been initiated to determine how to strengthen them so that they may be used in mosquito control activities. Training continues to be a vital aspect of the malaria control pro- grammes of the Region, and has been strongly supported at various levels by WHO. Fellowships were awarded to anti-malaria personnel, wherever possible within the Region, and subsidies have been provided for national training courses. An inter-regional secretariat for the coordination of malaria training programmes in Asian countries, based in Kuala Lumpur, became operational in 1980, and advantage has been taken of its advisory and supportive services by most Member countries. The overall state of antimalaria programmes in the ~egion was as follows : Population in the Region Population in originally malarious areas Population in areas under anti-malaria operations In areas under control programme 898 In areas under eradication programme 35 Population in areas with no specific anti- malaria operations Highlights of anti-malaria activities in individual countries are given below. The most recent statistical information is, in some instances, provisional. In BANGLADESH, the malaria situation continued to cause concern to the national health administration. There was a noticeable improve- ment in the annual blood examination rate, which increased to 3% in 1980. Consequently, there has been an apparent increase of total cases, including P.falciparum infections. However, the reduction in the slide positivity rate to 2.1% in 1980 (3.42% in 1979) is suffi- ciently indicative of an improving situation, though the control programme has continued to face logistic, administrative and finan- cial difficulties: post-monsoon spraying was curtailed because of shortage of DDT supplies; delays in the recruitment of operational and supervisory personnel impaired surveillance activities; thana health institutions have not been sufficiently utilized for passive case detection activities, and coordination at the thana level bet- ween the staff of integrated health services and the malaria staff in high malaria risk areas has been deficient. Malaria outbreaks among the new settlers moving from low risk areas to the Chittagong Hill Tracts emphasized the need for strengthening intersectoral coordi- nation through the recently established National Malaria Coordination Committee. The training of a majority of thana health administrators was carried out, with WHO support. With the transfer of some trained staff to other positions, however, it has become necessary to undertake a training prograrume for nearly 150 such personnel in 1981. In addi- tion, training is being extended to lower-level supervisory staff. A three-day national workshop on malaria was held in February 1981 to review the progress and the problems encountered, and to formulate plans of action for the fiscal year 1981-82. Susceptibility testing of vector species to DDT and OP compounds was confined to A. philippinensis and A. balabacensis, both species remaining susceptible to these insecticides. However, only a few tests have been carried out, and this activity needs to be expanded to more areas and extended to other vector species. The Regional Collaborative Studies on P. falciparum sensitivity to 4-aminoquinolines continued to be carried out by the Malaria Control Programme and the ~nstitute of Epidemiology, Disease Control and Research. The data derived largely by the in vivo method (as most of the in vitro tests have not been successful), point to an increasing frequency and degree of resistance in the north-eastern, eastern and south-eastern border areas. The DDT factory at Barakaunda, after a lapse of several months, began production in August, with the arrival of a shipment of benzene, but since production has not kept to the planned targets, DDT imports may have to be increased. WHO provided three consultants to the Asian Development Bank Mission which visited the country in July 1980, to provide detailed background information and to plan for an appro- priate programme of assistance for malaria control and rehabilitation of the DDT factory. A programme loan agreement was finally signed by the Government of Bangladesh and the Asian Development Bank for assistance from 1981. In BURMA, out of a population of 34.3 million, 31.8 million people live in malarious areas, in 73% of which control activities are in progress. Drug distribution has continued to be the mainstay of the programme, along with intradomiciliary spraying with DDT covering 7.2 million people, although resistance to this insecticide has occurred focally in A.annularis and A. balabacensis. The estimated morbidity due to malaria is about 50 per thousand population. Clinical facili- ties reported that 7.5% their of out-patients and 18.2% of the in- patients had malaria (compared with 6.5% and 16.5% in 19791, the case fatality rate being 2.22 (2.16 in 1979). Consistent with the pattern of epidemiological dynamics in past years, the malaria situation showed no significant change during the period under review. The annual blood examination rate was 1.6, resulting in an extremely low annual parasite incidence of 1.2 per thousand (0.65 in 19791, and the slide positivity rate was 7.6% (5.58 in 1979). The proportion of P.falciparum increased from 76.5% to 81.7% and the slide falciparum rate from 4.27% to 5.26%. Strains of this species resistant to chloroquine at RI and RII levels were widely distributed, with in vivo and in vitro tests conducted by the Programme and by the - Department of Medical Research confirming their presence in the States of Shan, Kachin, Karen, Arakan, Irrawaddy and Rangoon. Assistance extended to the programme by WHO was used largely for fellowships and supplies. Support was also given by UNICEF and CIDA for the supply of DDT, drugs and equipment, and by the Netherlands in respect of two WHO specialists in vector-borne disease control. An important event involving several ministries and departments was the "Inter-sectoral Seminar on Integrated Vector-Borne Disease Control in connexion with Construction of Dams (Sedawgyi)", held in Mandalay in April 1981, supported by WHO (see also Section 2.8). A WHO malariologist was assigned in 1981 for three weeks to visit the FAO/ASDB Forest I1 ~roject in areas of Kachin, Shan and Mandalay and to provide recommendations on general health and antimalarial measures. In INDIA, 664 million people, out of an estimated total population of 700 million, lived in malarious areas, all of which have been under surveillance. A population of about 400 million was protected by anti-vector measures. In 1980/81 a major portion of the central public health budget conti- nued to be spent on the modified malaria control programme, which was first launched in 1977. The modified plan has resulted in an overall decline of malaria incidence in the country. Increased reliance is placed on community participation. Liberal distribution of anti- malarial drugs through community health workers and volunteer drug distributors has been responsible for much of the reduction of morbi- dity and mortality in rural and inaccessible areas. Projected data for 1980 indicate a case incidence of 2.6 million (in 1979, 3.1 million), of which 14.1% are P.falciparum (in 1979, 18.3%); the blood examination rate is around 7.9% (in 1979, 9.7%). The projected API of 3.5 per thousand represents a reduction of nearly 28% over the figure for 1979. A major technical problem continues to.be pesticide resistance. The principal vector in the rural areas, A.culicifacies, is found focally in many districts to have developed double resistance to DDT and HCH; in western India this mosquito in certain foci shows multiple resist- ance to DDT, HCH and malathion. In urban areas A.stephensi shows double resistance to DDT and HCH. In response to the increasing need for a variety of insecticides, national production of DDT, HCH and malathion has been expanded. Strengthening of the National Malaria Eradication Programme in areas where falciparum malaria is prominent has been undertaken through the P.falciparum Containment Programme (PfCP),supported by the Government of Sweden (SIDA) and WHO. Four WHO staff members and one consultant participated in this programme,being involved in its epidemiological, entomological and applied research components. During the year under review, a fourth zone covering parts of western India is being added to the area involved, which includes north- eastern India and the Andaman and Nicobar Islands (Zone I), parts of Bihar, Orissa and West Bengal (Zone 2), and parts of Andhra Pradesh, Madhya Pradesh, Maharashtra and Tamil Nadu (Zone 3). This intensified programme of intradomiciliary spraying, chemotherapy and surveillance resulted in 1980 in the reduction, within the project area, of falci- parum malaria by 12% and of all types of malaria by 13%, as compared with 1979 (slide falciparum rates 4.3 vs 4.9, and slide parasite rates 6.6 vs 7.6). In many parts of north-east India, resistance of P.falciparum to 4-aminoquinolines had already been suspected on clinical grounds; in the last two years in vivo and in vitro tests carried out by the monitoring teams of the ~ndian Council of Medical Research attached to the NMEP regional offices confirmed the focal extension of resistance into Arunachal Pradesh and Mizoram, the Andaman and Nicobar Islands, and westwards into Orissa, Maharashtra and Uttar Pradesh. WHO support was extended to the programme in a number of areas. Fellowships were provided and grants and subsidies arranged for institutional and field training. At the National Institute of Communicable Diseases, Delhi, regular courses on malariology and entomology were held for medical officers and biologists from the NMEP (including PfCP) and from the Defence Department and the Railways, while the NMEP regional health and family welfare offices (formerly regional coordinating organizations) also trained malaria and other health workers (primary health centre personnel). Consul- tants were provided in the areas of epidemiology, bio-environmental sanitation and the engineering aspects of malaria control, and the management of acute malaria was dealt with at a workshop supported by WHO and held in March 1981. The programme also received WHO equipment and supplies. Periodic review meetings of the PfCP were sponsored by WHO. Both NMEP and the PfCP were subjected to an independent assessment by joint Government, SIDA and WHO teams during April 1981. In INDONESIA, there was an increase of 12% in blood examinations in the first half of 1980 - 69 863 cases in 1980 compared with 41 860 in 1979. The increase of cases was predominantly in Central Java with marginal increases in West Java and Bali, but there has been a 30% reduction in East Java. However, there has been no change in the proportion of P.falciparum, which remains at 47%. The malaria control programme continued to face manpower constraints at all levels,parti- cularly in the outer islands. However, it received a special impetus in 1980-81 owing to massive training and refresher courses and workshops organized with significant WHO support to meet critical programme needs. About 500 medical and non-medical supervisors and nearly 500 laboratory staff have benefitted. The central malaria organization has been strengthened with an epidemiologist, a senior laboratory technician and a technical officer. A recent arrangement for the deployment of supervisory personnel among the kabupatens has resulted in a great improvement in the staffing situation. However, financial constraints have prevented wider application of special measures in high case incidence areas of Java and Bali and the launching of problem solving operational studies. Expansion of the programme to other islands has been limited except in respect of Timur, for which US AID assistance is available. The Regional Collaborative Studies on drug resistant malaria gained momentum with the training of additional personnel in in vitro techniques and the availability of test kits. Susceptibility tests of vectors to insecticides have been limited to A.aconitus in West and Central Java provinces. A.aconitus in West Java is susceptible to DDT, whereas in Central Java this vector is highly resistant to DDT but tolerant to dieldrin. An operational study on community participation for case detection and treatment of malaria is under way in one kecamatan under the aegis of the health centre medical officer, with the cooperation of the kecamatan administrative officer and the local women's welfare organization, in which 30 women volunteers are participating. In MALDIVES, all the 202 inhabited islands, with an estimated popula- tion of 152 000, were under the ambit of malaria control operations. During 1980 only 52 cases were detected, giving a case incidence of 0.34 per 1000 population as against 2.3 in 1979; the annual blood examination rate, however, shoved some decline. Nearly 77% of the detected cases were reported from two islands of Shaviyani Atoll and the rest from the other atolls. Since 1975 no P.falci arum cases have been detected. The vectors, A.subpictus and --+- A.tesse atus, are found to be susceptible to DDT. The control messures continued to be indoor residual spraying of DDT in selected islands, and drug administration. Surveillance operations were carried out mostly by community health workers(CWs) and village health workers (VHWs),with the support and participation of community Leaders. Screening for malaria cases at the international airport and Male harbour progressed satisfactorily. Nevertheless, planned acti- vities were hampered owing to communication and transportation difficulties. WHO collaboration continues; in addition to technical support,fellow- ships, local cost subsidies and supplies and equipment, the Organiza- tion, in consultation with the Government, is arranging to provide a seaworthy vessel to facilitate implementation of the activities in different islands. In NEPAL, out of a population of 14.1 million, 8.6 million lived in malarious areas. Of the latter, 8.4 million have been protected through organized malaria control operations - 6.2 million under the Nepal Malaria Eradication Organization (-0) and 2.2 million under the Cormunity Health Integration Project (CHIP). The trend of malaria incidence during 1980 did not show any signifi- cant change; 13 033 cases (with an annual parasite incidence [API] of 1.6 per 1000 population) were detected during the year as against 12,992 cases in 1979. Most of this slight increase in case incidence occurred in the nine Terai districts of the Central and Western Regions, where the proven vector, A.annularis, and the suspected vector, A. culicifacies, have shown resistance to DDT. These areas were scheduled for malathion spraying during 1980 but, on account of the late arrival of the insecticide, this could not be undertaken. The P.falciparum cases declined by 29%. Nearly 24% of all the cases were imported from a neighbouring country. In vitro testing of P. falciparum from a limited number of the imported cases indicated thz the parasites resistant to chloroquine were coming from the north- eastern States of India. In the integrated districts the annual blood examination rate further declined,from 8.3 in 1979 to 6.6 in 1980, while the overall epidemio- logical situation remained unchanged. However, in order to improve coordination between CHIP and NMEO and prepare guidelines for the integration of the malaria control programme into the basic health services, the establishment of a working group has been agreed to. Following an internal situation analysis, an independent assessment of the programme was carried out during March/April 1981 jointly by the Government, WHO, US AID, ODA (UK) and the Netherlands. WHO collaboration continued in the form of technical support, fellow- ships and supplies and equipent. In addition to long-term staff, short-term consultants assisted in the stratification of malarious areas,in preparing a detailed contribution to the Sixth Five-Year plan, and in entomological research. Seminars and workshops were also held with WHO assistance in order to improve operations and formulate applied research projects. Bilateral assistance from US AID and the UK and Netherlands Governments was also provided for the procurement of insecticides and vehicles. In SRI LANKA, nearly 80% of the population of 14.7 million living in malarious areas was covered by the anti-malaria campaign. The current plan of operations covers the period from 1977 to 1981. During 1980, 3.5 million people were protected by malathion spraying. A.culicifa- cies, the proven vector, remained susceptible to malathion but resis- - tant to DDT. In addition to residual spraying, complementary measures of control, such as larviciding, space spraying, water management and drug administration, were applied when necessary. Intensive surveil- lance operations and the monitoring of vector susceptibility to mala- thion were also continued. The epidemiological picture during 1980 showed very little change. During the year 47 915 cases (API 3.3 per 1000 population) were detected, as against 48 004 in 1979. However, unfavourable trends were observed in a few superintendent of health services (SHS) areas owing to persistent transmission of P. vivax in some localities and localized outbreaks of P. falciparum malaria, particularly in areas of chena cultivation and gem mining where spray coverage was not adequate. ?he incidence of P. falciparum cases showed a slight increase as a result of focal outbreaks, but P. vivax remained the predominant species (97% of the cases). Studies using in vitro tests - indicate that the strains of P. falciparum in Sri Lanka contznued to remain highly sensitive to 4-aminoquinolines. WHO continued to collaborate with the programme by providing advisory scaff,fellowships,and supplies and equipment. Also, bilateral assist- ance was received from US AID and the Governments of the Netherlands and the United Kingdom. The prograaoe of applied research and training continued as planned. In THAILAND, there was a substantial increase in malaria cases in 1980, 396 705 having been reported, as compared with 302 658 during the previous year. The reduction in the number of cases seen in 1979, after seven years, seemed to presage an improving malaria situation, but this reduction was deceptive and influenced by unfavourable cli- matic conditions for transmission,l979 being a dry year. The increase of malaria cases in 1980, though common to all regions in Thailand, was most pronounced in the centre and south and consisted exclusively of P.falciparum infections, the proportion of which reached 70% of all types of malaria (56% in 1979). While the increase may be partly attributable to an improved blood examination rate of 11% (10% in 19791, it may also be due to the large number of P.falciparum infec- tions imported along with refugees from Kampuchea. These infections have been multi-drug resistant,in 1980 failures occurring increasing- ly even with the drug combination of sulfadoxine and pyrimethamine, which,with primaquine as sporontocide, has become the standard treat- ment in Thailand for P. falciparum. lhis situation prompted an investigation, jointly supported by WHO and US AID, into five different treatment regimens against infections caused by P.falciparum. Preliminary results point to quinine (seven days) with tetracycline (ten days) as the most effective line of treatment. On the basis of this investigation, regimens of treatment will be developed for different parts of the country, depending on the sensitivity of the parasite to the sulfadoxine/pyrimethamine combination. To prevent the spread of the multi-drug resistant para- rite from the ihai-Kampuchea border, the programme is, in limited areas, introducing fenitrothion, provided under Japanese aid,for spray coverage. A project is being designed whereby the most severely affected area will receive intensive measures, including the provi- sion of the new and highly effective anti-malarial drug, mefloquine. Susceptibility testing of proven and suspected vectors to DDT, malathion and fenitrothion has been carried out in index villages selected for this purpose. The tests have revealed that the vectors are susceptible to these insecticides except in a few locations in northern Thailand, where A.minimus is tolerant to DDT. An inter-country workshop for training personnel in the use of the micro in vitro test for mefloquine sensitivity was held in Phrabudha- bat in March 1981, with 13 participants. WHO supported the first National Malaria Conference, held in Haad Yai in November 1980. mere were nearly 250 participants, from the NMEP, public health services, universities and defence forces,together with WHO and US AID staff. The meeting, which was intended to increase awareness of the malaria situation in Thailand and obtain the co- operation of these various agencies in the Malaria Control Programme, was followed by a two-day training course in epidemiology for zone officers. 2.3.2 Schistosomiasis A small focus of this disease persists in INDONESIA in a limited area of Central Sulawesi. The Government is applying the usual control measures. :. 1.3 Filariasis Filariasis continued to be a major problem in most countries of the Region. In BURMA, WHO collaborated in filariasis control activities through the vector-borne disease control project. In INDIA, WHO extended technical cooperation in connexion with an international symposium on chemotherapy and irmnunology in the control of malaria, filariasis and leishmaniasis, held in Lucknow in February 1981. TDR-supported research studies are being conducted in the country. In INDONESIA, a WHO consultant was assigned for a month in 1980 to collaborate with the Filariasis Section of the National Institute of Health Research and Development in strengthening surveillance activities in Sumatra, and to make recommendations on experimental studies of Malayan filariasis and the teaching of laboratory techniques. 2.3.4 Leishmaniasis Leishmaniasis is an important health problem, particularly in some parts of India. The international symposium held in Lucknow in February 1981 (referred to above) also concentrated on the chemo- therapy of leishmaniasis. A WHO consultant assigned to Bangladesh assisted in establishing technical capability for serological surveys of leishmaniasis and in investigating an outbreak of the disease in Pabna. During 1980, 12 784 cases with 22 deaths were reported in the States of Bihar and West Bengal in India. Control measures were taken by the Government. 2.4 Bacterial Diseases 2.4.1 Tuberculosis Tuberculosis continues to rank high among the major health problems in the countries of the Region. Nearly all have national tuber- culosis control programmes; however, the impact of control measures has been rather marginal, possibly because of shortfalls in each of the three components, namely, immunization with BCG, case-finding and treatment. In BANGLADESH, BCG immunization,which is included in the EPI activi- ties, is in progress throughout the country, utilizing the thana health complex field workers. WHO continued to assist in the development of a national tuberculosis control programme, integrated with health services at all levels, and in the community-oriented training of medical and paramedical staff. In BHUTAN, a WHO consultant assisted in carrying out field surveys to assess the magnitude of the tuberculosis problem and to help to improve the integrated tuberculosis control programme. Tuberculosis control is an on-going national programme in BURMA. The detection of tuberculosis cases outside hospitals is mainly on the basis of laboratory examination of sputum smears. BCG vaccination is given at birth to all babies born in hospitals. WHO is providing technical support for these efforts. In INDIA,where tuberculosis is a major health problem,it is estimated that nearly 1.5% of the population is suffering from radiologically active tuberculosis, and that nearly one fourth of the cases are sputum-positive or infectious. The strategy for BCG vaccination has been changed and it is now integrated with the expanded programme on immunization. In 1980 a WHO consultant was assigned to review the epidemiological studies in tuberculosis at the Tuberculosis Research Centre, Madras, and at the National Tuberculosis Institute at Bangalore. A WHO temporary adviser visited the Tuberculosis Research Centre in November to assist with the planning and evaluation of controlled clinical trials. SIDA is actively assisting the progranme by providing X-ray units, Odelca cameras and other supplies. UNICEF has supplied BCG kits and laboratory equipment, to help improve the case-finding activities at the district tuberculosis centres. In INDONESIA,also, tuberculosis is still regarded as a very important problem, though accurate statistics are not available. At the request of the Government, a WHO consultant was assigned from November 1980 to January 1981 to evaluate the tuberculosis programme and cooperate in a sample survey of tuberculosis prevalence being conducted in Yogyakarta. According to this consultant, the tuberculosis programme other than BCG vaccination needs improvement, i.e., in case-finding, case-holding and follow-up of contacts. In MALDIVES, a survey of 201 islands by a WHO medical officer gave a detection rate of 0.99 per thousand of those examined (positive sputum smear); the positivity rate among suspected persons was 2.6&%. The overall prevalence rate of tuberculosis in the surveyed islands is 3.31 per thousand. KG vaccination continues. WHO maintained its collaboration with the Government of NEPAL in the national tuberculosis control programme. Community participation in the programme is very encouraging, and training activities and ser- vice delivery have continued as planned. The programme is, however, faced with shortage of drugs, transport problems and the continuing large number of defaulters in treatment. The second National Seminar on Tuberculosis, which was jointly sponsored by the Government, WHO and the International Union Against Tuberculosis, was organized in Biratnagar in November 1980, to review the programme activities. Case-finding, case-holding, laboratory diagnosis, treatment and KG vaccination were discussed. At the same time, the Seminar also devoted some attention to the progress of integrated services, operational problems concerning drug distribu- tion, the training of health personnel and the role of voluntary organizations. WHO provided support through a temporary adviser and a consultant. The consultant, besides helping to organize the Seminar, also reviewed the activities of the control programme and advised on the training of health workers involved in tuberculosis control. In SRI LANKA, the anti-tuberculosis campaign is fully integrated with the general health services and is progressing well. In THAILAND, the mortality rate has steadily decreased. The urban population, especially in Bangkok, is however, at higher risk. WHO supported a national seminar on tuberculosis held in Bangkok in November 1980, in which 120 national workers participated. A WHO temporary adviser and a consultant assisted in the organization and conduct of the seminar. In regard to activities at the regional level, the first meeting of the Research Study Group on Tuberculosis was held in the Regional office in March 1981 to review recently-completed and ongoing studies and to reconsider research priorities. Efforts were also made to draw up an outline of pr0tocolS for priority studies. The following priorities were identified: (a) operational studies on case-finding and the chemotherapy and integration of tuberculosis activities into general health services, (b) epidemiological studies on the incidence of infection and its trend, (c) studies on short-course chemotherapy under programme conditions, (dl studies on the diagnosis of tuber- culosis in children, and (e) studies on the efficacy of BCG in the prevention of tuberculosis in children. 2.4.2 Leprosy The South-East Asia Region has approximately half the total number of leprosy patients in the world - a situation which continued to be a cause for concern to governments in the Region. The position of leprosy in 1980 in the countries of South-East Asia is given below: Leprosy Situation: 1980 Estimated Number Prevalence Country number of registered rate/1000 L-Rate% cases Bangladesh Burma India Indonesia Maldives Nepal Sri Lanka Thailand No information: Mongolia, DPR Korea *Total No. of registered cases,including those released from control. In BANGLADESH, case-finding activities for leprosy were intensified in Rangpur and Sylhet Districts, where the disease is endemic. Elsewhere, at the six primary health care pilot thanas, voluntary health workers motivated persons with suspected leprosy to attend the thana health complexes. WHO support continued through a techni- cal officer. A WHO medical officer from the inter-country project "Leprosy Control" visited Bangladesh to assist in preparing a definitive work plan for the intensification of the programme in endemic areas. WHO support was provided for training family welfare workeralhealth assistants and strengthening the leprosy detection campaign throughout the country. Such strengthening is essential since only 15% of the estimated cases have been registered for treatment. In BURMA, the rifampicin trial made progress, with WHO assistance. A WHO statistician continued to provide technical support to the BCG cohort study and assisted in the coding of data. Financial assistance was given for purchasing dapsone tablets,which were urgently required for the national leprosy control programme. A WHO leprologist from the inter-country leprosy control project visited Rangoon in August 1980 and helped to develop the protocol outline for an operational study of release from control of "inactive" cases of leprosy and their follow-up in an area where the leprosy control programme is integrated into the general health services. A WHO consultant assigned in December 1980 collaborated in the research studies on the impact of rifampicin therapy (for lepromatous patients) on the incidence of new cases in the long term, as well as in reviewing the progress made on the THELEP survey for dapsone resistance in Myingyan. In INDIA, leprosy continued to be a major public health problem, with about 3.9 million estimated cases. One epidemiologist-cum-leprologist and one reconstructive surgeon were assigned by WHO to assist the national leprosy control programme. They advised on the methodology of control and on the organization of reconstructive surgery and prosthetics for leprosy patients respectively. WHO had, up to 31 March 1981, supplied four tons of DDS (da~sone) tablets (100 mg) for distribution to various States, in addition to equipment and transport. UNICEF supplied lamprene capsules and five tons of DDS (100 mg) as well as teaching aids for the programme. The Swedish International Development Agency is to contribute 2.9 million lamprene and 2.5 million rifampicin capsules for the intensified crash programme on multi-drug trials in ten districts to be carried out in a phased manner over a three-year period. Seventeen centres throughout the country have been identified for these trials, which form a component of SIDA aid being given to the leprosy control programme in India through WHO. The Organization provided financial subsidies for national workshops and seminars on various aspects of leprosy control. A national workshop on research on leprosy, including immunology,microbiology and vaccine production, was held in Bangalore during October 1980 and was attended by leprologists and scientists engaged in leprosy research in various institutions in the country. WHO is providing both financial and technical support to leprosy research. In INDONESIA, where the Danish Save the Children Organization and other ILEP members are assisting in the leprosy control programme, WHO continued to provide long-term technical consultant support. The training and retraining of all categories of workers proceeded with increasing intensity, especially at the National Leprosy Training Centre in Ujung Pandang. A supplementary random survey carried out in Timur Tenga Utara Regency of E. Nusa Tenggara Province revealed a higher prevalence of leprosy than in other regencies of the Province. WHO provided support for random sample surveys in West Nusa Tenggara and North Sumatra Province, which will be of immense value in asses- sing the magnitude of the leprosy problem. In MALDIVES, the combined leprosy and tuberculosis control programme continued with the collaboration of the Danish Scout's Help Organiza- tion, which withdrew its assistance in January 1981. The Damien Foundation of Belgium has agreed to support the project from January 1981. A WHO leprologist completed a survey, with 97% coverage in 201 islands(exc1uding Male), showing a detection rate of 5.69 per thousand and a prevalence rate of 13.23 per thousand. The total number of identified leprosy cases in the country was 1650 in the year 1980. The maintenance of treatment for leprosy and tuberculosis is carried out by island staff and supervised by community health workers. A complete survey of Male is expected to be taken up in the last quarter of 1981. In NEPAL, the leprosy control project undertook case detection and health education in several districts, bringing up to 26 the number of districts surveyed. A WHO consultant collaborated in planning the strategy of community involvement in leprosy control measures and in defining the role of national and international voluntary organiza- tions in this regard. A subsidy was made available for two districts to intensify their leprosy control work, including active case- detection and case-holding through community participation, and also the introduction of multi-drug regimens. In THAILAND, support was provided for the in-service training of 1348 provincial health workers attached to the basic health services from twelve provinces engaged in integrated leprosy control activities. This training will promote and strengthen the development of control activities at the grass-roots level. Under an inter-country project,a WHO leprologist has been in position in the Regional Office since the beginning of 1981 to promote and coordinate the WHO services-cum-research programme in leprosy in the countries of the Region. An inventory of institutions and scientists working in the field of leprosy was prepared. Research on multi-drug regimens in lepromatous leprosy, immuno- epidemiological studies and prevalence surveys for dapsone resistance is being supported at the Central Leprosy Teaching and Research Institute, Chingleput (~ndia). A WHO consultant participated in the Conference on the classification of Leprosy which had been convened to modify the Indian classification in keeping with recent trends in modern scientific thinking. The proposed classification is now based on the International System of Classification. Research on various aspects of leprosy, supported by the UNDP/World BankfWHO Special Programme for Research and Training in Tropical Diseases, was in progress in Burma, 1ndia and Thailand. The Japan Shipbuilding Industry Foundation (JSIF) continued to collaborate with WHO in leprosy control, training and research activities in the Region. 2.4.3 Sexually-~ransmitted Diseases (STD) The problem of sexually-transmitted diseases (STD) is gradually growing in this region, and there are considerable national inputs in relevant programmes in ~ndia, Indonesia, Sri Lanka and Thailand. The control of STD needs to be considered by the Member States within the framework of general health services, with a multidisciplinary and integrated approach, since the diseases have simultaneously medical, social and economic dimensions. WHO is stimulating this approach through its country and inter-country efforts. An inter-country meeting on sexually-transmitted disease control was held in the Regional Office in November 1980. It was concerned with the identification of the magnitude of the problem in Member count- ries,the bottlenecks and lacunae in the existing control methodology, and the growing prevalence and spread of antibiotic resistance in gonococci in the Region. The meeting formulated guidelines for strengthening national STD control programmes,and its recommendqtions are being studied to ensure better collaboration with the countries in measures for prevention and control. Under-reporting of STDs, rapid emergence of resistance of the gonococcus to penicillin and social implications are some of the problems which call for the immediate attention of governments. 2.4.4 Diphtheria, Pertussis and Tetanus The surveillance, prevention and control of these diseases continued to be covered under the activities of the Expanded Programme on Immunization (see Section 2.6). 2.5 Viral, Chlamydial, Rickettsia1 and Related Diseases 2.5.1 Trachoma Trachoma continued to be a public health problem in the countries of the Region. WHO support consisted of technical cooperation, the award of fellowships, and the provision of supplies and equipment. 2.5.2 Poliomyelitis In the South-East Asia Region, data are available from some countries which participate in the international surveillance of poliomyelitis. The number of cases reported by these countries in 1976, 1977, 1978 and 1979 is given below: Poliomyelitis in the South-East Asia Region Number of cases Country 1976 1977 1978 1979 Bangladesh 9 85 . . . ... Burma 237 176 220 392 India 12 234 10 365 15 492 12 779 Indonesia 127 154 98 84 Nepal 18 35 9 7 Sri Lanka 258 127 153 141 Thailand 800 863 640 1 083 The incidence of poliomyelitis in the countries of the Region is not known precisely, as the surveillance systems are not yet adequately developed. This view is supported by the results of lameness surveys carried out in six countries - Bangladesh, Burma, India, Indonesia, Nepal and Thailand. Three countries, viz., Mongolia, Sri Lanka and Thailand, have included oral polio vaccination in their national immunization programmes. In Mongolia, the programme covers the entire country, and paralytic poliomyelitis has not been reported since 1972. An inter-country seminar was held in the Regional Office during September-October 1980 to review the epidemiological situation of poliomyelitis in the South-East Asia Region and to formulate steps for its control. The meeting recommended inclusion of oral polio vaccine as a component of the EPI programme in a phased manner in all countries of the Region. 2.5.3 Dengue Haemorrhagic Fever Dengue haemorrhagic fever (DHF), with or without dengue shock synd- rome (DsS), continued to be a major public health problem in Burma, Thailand and ~ndonesia. The Organization continued to provide technical cooperation for the development of epidemiological and entomological surveillance, the strengthening of arbovirus laborato- ries, improvement of the diagnosis and of the clinical management of cases of DHF and dengue shock syndrome, and research. WHO collabora- tion in the establishment of national surveillance programmes resulted in the detection of a large number of DHF~DSS cases. WHO has also collaborated in essential training facilities in viro- logical laboratory techniques for national workers, and has assigned consultants to advise on specific aspects of the epidemiological problem (see Section 2.1, "~pidemiological Surveillance"). A number of research studies on DHF continued to be supported. These included: (1) clinical studies: (a) Clinical trial - the role of heparin in dengue shock syndrome at the Children's Hospital, Bangkok, Thailand, and (b) the effectiveness of oral rehydration fluid for early treatment of dengue haemorrhagic fever; and (2) Epidemiological Studies: (a) dengue haemorrhagic fever surveillance in Colombo, Sri Lanka, (b) prospective epidemiological study on DHF in Thailand in Rayong Province,and (c) a prospective epidemiological study on Dengue in DHF "endemic" and "silent" areas in Indonesia's Yogyakarta and Medan provinces, respectively. The WHO Collaborating Centre for Research on the Immunopathology of DHF at the Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, conducted various research studies, including studies on (1) the development of dengue vaccine, (2) the morphology and morphogenesis of the dengue virus in different host systems, (3) immuno-electromicroscopy of dengue virion in different cell systems, and (4) immunopathology of DHF, as well as (5) an inmunochemical study of DHF. The Virus Research Institute, Bangkok, was further strengthened with a view to improving the technical facilities for the characterization of arbovirus infections and to promoting research in DHF. A pilot "Field Study of the Control of Aedes aegypti (L), the Vector 7 for DHF, by Anisopterus Dragonfly Nymphs in a Community in Rangoon" was supported at the Department of Medical Research, Ministry of Health, Rangoon, Burma. (Top): Regular fallow-up and treatment are the mainstay of leprosy control activities. (Top left): Surveillance work in malaria control continues. (Left): Spraying against vector-borne diseases. COMMUNICABLE DISEASES Communicable diseases continue to pose a major problem in the Region. With consistent efforts being made by the countries to control them, progress has been achieved in reducing the morbidity and mortality in some areas. Early detection of tuberculosis by sputum examination helps in treat- ment and recovery. EXPANDED PROGRAMME ON IMMUNIZATION A successful immunization programme is essential for the achievement of Health for All. Particular attention is beina oaid bv the Member cou&es in ;mplemcntlng the Ex~anded Proqramme on lmmunization and its strengthening. Immunization services are being made available at home.. . . . .at a health post.. . .in a clinic. A workshop on rapid techniques in virology was held at Pune (India) in November 1980 to train national workers in rapid techniques in diagnosis and the epidemiological surveillance of viral diseases including DHF. A meeting of the Research Study Group on Dengue Haemorrhagic Fever, particularly with reference to dengue vaccine development, was held in the Regional Office in March 1981. The Study Group reviewed the ongoing research in DHF in all its aspects in the South-East Asia and the Western Pacific Regions,discussed the development of the vaccine, and defined further fields of research in dengue vaccine development and related problems in support of future prevention and control programmes. Dengue fever was observed in some islands in Maldives and was investigated by epidemiological and entomological teams. Serological studies on children in Male and some other islands revealed the recent occurrence of dengue infections in the population. 2.5.4 Viral Hepatitis Viral hepatitis continued to be an important health problem in Mongolia. Gamma globulin prophylaxis is now carried out using disposable syringes. A WHO consultant was assigned to Burma in December 1980 to assist in initiating a study of mother-infant transmission of hepatitis B. virus at Rangoon Maternity Hospital. A grant was also made available for this study. 2.5.5 Japanese Encephalitis Cases of Japanese encephalitis were reported from India in Assam, Uttar Pradesh (north-eastern districts), Andhra Pradesh, Tamil Nadu and West Bengal, and a severe outbreak was reported in the Terai districts of Nepal in September-October 1980. Appropriate control measures were taken by the respective national health authorities. 2.6 Expanded Programme on Immunization (EPI) During the year under review, the Expanded Programme on Immunization was implemented in all countries of the Region, with the full support and cooperation of WHO, UNICEF and other participating agencies. To strengthen the programme further, inter-regional, inter-country and national EPI courses were conducted; services of staff and consul- tants were provided; operational research was supported, and national programmes were reviewed, with WHO participation. Six participants from this region (2 from Bangladesh, 1 from Burma, 2 from Indonesia and 1 from Nepal) attended an inter-regional senior- level training course on EPI planning and management held in Manila, Philippines, in August 1980. An intercountry EPI course for mid-level programe management was held in Kathmandu in September 1980 for 17 national participants. Similar courses were also organized in (a) Colombo for 14 participants in October 1980; (b) Dacca for 18 participants in February 1981, and (c) Rangoon for 27 participants in March 1981. An inter-regional training course for technicians in the maintenance and repair of refrigerators was held in Bangkok in May/June 1981, and was attended by 12 participants from the countries of this region. With WHO support and participation, EPI mid-level management courses were conducted, also at country level. In India, 223 health workers completed these courses, which were given in eight States. A further 130 workers are to be trained in this type of course before the end of 1981. In Bangladesh, EPI mid-level management course modules were included in the training curriculum at the National Institute of Preventive and Social Medicine. Later,in Thailand, these modules were translated into Thai for use in hail and's national EPI mid-level management courses. Plans for similar activities were also made in Indonesia. Twenty-four fellows from five countries of the Region were sent on one to three-month EPI orientation tours of countries in Asia, and two health workers were awarded fellowships for six to twelve-month study tours in the United States of America and the United Kingdom. During the reporting period, Regional Office staff visited almost all the countries of the Region to assist in programme reviews, training, management of the EPI, immunization coverage surveys and evaluation. A total of ten consultants went to six countries, where they assisted in collecting baseline data on target diseases, conducting epidemio- logical and serological surveys, solving operational problems, and carrying out studies on the economic aspects of the programme. A regional meeting on the implementation of the EPI through the existing health services and on the evaluation of the programme activities is being organized, to be held in Ulan Bator in August 1981. During 1980, the programme in BANGLADESH was further expanded, and by year-end, 34 urban and 55 rural immunization centres were providing services to children and women. In addition, 13 non-governmental organizations were engaged in giving immunizations. In many places, the cold chain system for vaccine storage and distribution was improved, and work on the construction of the central EPI cold room in Dacca continued. Fresh supplies of vaccines and of cold-chain and immunization equipment were received and distributed to the field. A cluster sampling immunization coverage survey, the first in the country, was conducted in Dacca in February 1981, and gave the following results: BCG - 17%; smallpox - 41%; three doses of DPT - 13% and three doses of polio - 11%. Four per cent of eligible children and 6% of their mothers were found fully immunized. A WHO consultant has been provided to work with national EPI staff in solving technical and operational problems connected with the programme. In BHUTAN,the immunization programme (BCG,DPT and polio for children) was implemented in selected areas. Vaccines, cold-chain equipment and a vehicle for transporting vaccines and for supervision were supplied, with UNDP cooperation. A feasibility study on measles imunization is under way. Technical backstopping was provided through the inter- country EPI project. The immunization programme in BURMA was implemented in 27 townships of Greater Rangoon and in 26 townships in seven Divisions and seven States during the year. Plans were made for its expansion to an additional 53 townships before the end of 1981. The health staff in EPI operational areas were trained for the programme needs, and all vaccines,supplies and equipment were procured with UNICEF assistance. The immunization coverage increased, and there was a smaller drop-out rate in 1980 as compared to 1979. A polio immunization feasibility study was started in a selected area of Rangoon in October 1980. The cold-chain system for vaccine storage at the central level improved, following the installation of refrigeration equipment supplied by UNICEF. A cluster sampling immunization coverage survey conducted in Rangoon Municipality in March 1981 gave the following results: BCG - 82%; three doses of DPT - 72%, and fully immunized children - 70%. It was found that 74% of the women surveyed were protected with two or more doses of tetanus toxoid. In March 1981, Regional Office staff took part in a review of the programme, and recommendations were made for its further expansion. A WHO consultant is to be assigned during the third quarter of 1981 to conduct an epidemiological survey of the EPI target diseases in the country. In INDIA, twenty national participants attended the inter-country EPI management courses. National mid-level courses on this subject were held with WHO support in Gujarat, Maharashtra, West Bengal, Punjab, Uttar Pradesh, Tamil Nadu, Kerala, and Karnataka States and in New Delhi, 219 health staff completing these courses. Similar courses are to be held in six other States before the end of 1981. In 1980,cluster sampling immunization coverage surveys were conducted in Delhi, Calcutta, Kharar, Lucknow, Ahmedabad, Rajkot, Nagpur, Pune and Bombay. They indicated a high BCG and smallpox immunization coverage. The percentage of young children who received three doses of DPT varied from 22 to 82. The tetanus toxoid immunization coverage of pregnant women ranged from 25 to 72 per cent. Vaccines, the cold chain, immunization, sterilization and other equipment were supplied to the States and Union Territories. Mobile cold-chain equipment repair units started operating in Andhra Pradesh in cooperation with UNICEF. With the participation of two WHO consultants, polio and neonatal tetanus incidence surveys were organized in four States in 1980. It is planned to conduct such surveys in five further States. The measles immunization feasibility study has continued, with the participation of 28 medical colleges in the country. Several State EPI working committee meetings were held. The programme in Andhra Pradesh was reviewed, with WHO participation, in March 1981. By the end of 1980, the EPI in INDONESIA had been implemented in 1125 kecamatans, with a consequent increase in the immunization coverage. A total of 281 health workers received training for the programme at kabupaten level, and 1132 at kecamatan level. Plans were made to translate WHO EPI mid-level management course materials into Indonesian and to use them in national courses. Preparations are in hand for conducting an inter-country mid-level management course in Indonesia later in 1981. The organization and functioning of the Central EPI Unit was strengthened, and the supervision of field work in the provinces increased. In August 1980, the country programme was independently evaluated, with Government/WHO/US AID participation. Recommendations were made regarding the further expansion of the programme. The epidemiological surveillance of EPI target diseases was streng- thened by establishing sentinel reporting units in all provinces. In October 1980, the first monthly EPI surveillance bulletin was issued and distributed to all public health staff in the country. A survey on the measles fatality rate was conducted in Sulawesi. Studies on diphtheria incidence were carried out and plans made for a serologi- cal survey of children immunized against polio in Jakarta before the end of 1981. Also,a field survey on the incidence of neonatal tetanus is being planned. Immunization coverage surveys were conducted in Jakarta, in five areas of Java, and in provinces outside Java. The highest immunization coverage (69% of target children) was found in Central Java. Polio immunization was given in Jakarta and in selected urban areas in ten provinces. Regional annual EPI review meetings were organized in all three regions of the country, with WHO participation. The WHO epidemiologist assigned to Indonesia continued to provide technical support to the programme. WHO assisted specifically in planning and implementing the expanded programme on immunization in Jakarta Municipality. A WHO consultant collaborated in carrying out a cost analysis of the national EPI. In MALDIVES, children in Male were given BCG, DPT and polio immuniza- tion. Vaccines and cold-chain equipment were supplied. A consultant was assigned in March/April 1981 to organize and conduct a serologi- cal survey on polio and measles among the population of the islands. A Regional Office staff member also visited the country in 1981 and made recommendations on the further expansion and improvement of the programme. In ~0~~0~1~,immunization coverage continued to remain high. From 1977 to mid-1980,there were no reported cases of diphtheria; polio,tetanus and pertussis were totally under control. The epidemiological situa- tion of measles,in the course of the on-going immunization programme, was reviewed in mid-1980 with WHO participation. Plans were made for establishing local facilities for the quality control of imported vaccines and vaccine samples collected from the field. Cold chain and immunization equipment was supplied. One national EPI manager attended the WHO inter-country EPI mid-level management course in Colombo. The programme in NEPAL was further expanded in 1981,being implemented in 25 districts. A cluster sample coverage survey was conducted in Kathmandu Valley in October 1980, with the following results: BCG - 76%; three doses of DPT - 35%; three doses of polio - 22%, and measles immunization - 12%. An inter-country EPI mid-level management course was conducted in 1980, and the five-year plan of action for the programme was prepared for the period 1981-1985, with the participation of WHO. In February 1981, a WHO consultant was assigned for two months to assist in epidemiological studies on measles, aimed at assessing the public health importance of this disease. Another consultant was provided in April 1981, for four months, to assist in solving some of the operational problems. All health divisions in SRI LANKA have been covered with EPI activi- ties, and the reported immunization coverage has increased. Vaccines, cold chain, immunization and other equipment were supplied, with UNICEF cooperation. A central cold room for storing vaccines was constructed in the new building of the Family Health Bureau in Colombo. The cluster sampling technique for assessing immunization coverage was successfully introduced in the country for the first time. A survey using this technique conducted in Colombo Municipality during the last quarter of 1980 indicated the following coverage: BCG - 71%; three doses of polio - 432, and three doses of DPT - 43%. The percentage of children found fully immunized was 41. Statistical data collected indicated that the reported annual number of neonatal tetanus cases had dropped from 874 in 1978 to 423 in 1979. This might be partially attributed to the improving coverage of the immunization of pregnant women with tetanus toxoid. Plans were made for developing facilities in Colombo for the quality control of imported viral vaccines,and also for bringing an additional one million people (estate employees and their families) under the irmnunization programme. In THAILAND, the EPI continued to make steady progress, as indicated by a comparison of reported data on immunization coverage for 1979 and 1980. The national coverage of infants with BCG rose from 54% in 1979 to 68% in 1980; DPT (two-dose schedule) increased from 43% to 49%, and the primary immunization of pregnant women with tetanus toxoid rose from 24% to 34% for the first dose, and from 15% to 23% for the second dose. Polio immunization of infants was introduced in 23 provinces in municipal and sanitary areas in 1979, and in the first year,78% of target infants in those areas were fully immunized. In 1980, the polio immunization delivery was expanded to cover all infants in forty provinces, including Bangkok; the reported data indicated that the overall coverage of the total infant population in these forty provinces was 37% for the first dose and 19% for the third dose. These figures are, however, based only on data from reporting government facilities and, in fact, coverage is known to be substantially higher on account of immunization activities in the non-reporting voluntary health service sector. The immunization schedule was recently improved by increasing the DPT schedule from two to three doses, and, as previously noted, polio immunization is being rapidly expanded in the country following an evaluation of the health importance of polio by a WHO consultant in 1978. A particular achievement in Thailand has been the introduction and use of coverage assessment surveys as a means of programme evaluation and problem identification. In addition to being a source of service information, the surveys have also been used to collect information on parents' knowledge, etc., to identify specific reasons for non- participation in the programme. These innovations in Thailand are now being used in other countries. In June 1980, the training of peripheral area workers in the EPI was completed. During a six-month period, over 11 500 field personnel and 123 supervisors were trained. As a part of the global programme, a demonstration-training area is being developed in Thailand. In this area, the major elements to be studied or developed include alternative means of service delivery and their cost effectiveness, expansion of coverage surveys for other information useful for programme evaluation, an extensive programme of training mid-level management personnel for the EPI, development of work-related curricula for personnel visiting the country on fellowships, and the development and testing of target disease surveillance mechanisms. 2.7 Veterinary Public Health (VPH) Several countries of the Region have identified rabies, brucellosis and food-borne diseases as priority public health problems. In order to provide technical support in the planning, implementation and evaluation of activities to control the major zoonotic and food-borne diseases, a medical officer in VPH, based in the Regional Office, was appointed in 1980 with funds provided by the Federal Republic of Germany. He has visited India, Indonesia and Thailand and held discussions with the national authorities for developing and streng- thening VPH activities. Since one of the major zoonotic problems in most of the countries in this region is rabies, the possibility of developing a potent and stable tissue culture vaccine for veterinary use against rabies is being explored at the Department of Virology, Institute of Medical Sciences, Bangkok. WHO provided support to Nepal and Sri Lanka for further strengthening their activities in the control of rabies. Sri Lanka is seeking bila- teral assistance for rabies control, based on the project prepared with the assistance of WHO. 2.8 Vector Biology and Control Various degrees of resistance and refractory behaviour of vectors to commonly used insecticides for residual house spraying continue to be the major technical problems facing many of the vector-borne disease programmes in South-East Asia. The need to change from cheaper and safer insecticides to more expensive and more toxic ones is causing financial constraints on national health budgets and difficulties in field operations. In order to cope with this problem on a long-term basis, WHO is encouraging and supporting studies on the biological control of disease vectors and reservoirs and is stimulating and assisting in the development of environmental methods for vector control through inter-sectoral cooperation. In collaboration with WHO Headquarters, efforts are being made to formulate innovative methodological approaches to the control of vectors as part of integrated disease control at the village level, in keeping with the principles of primary health care. In BANGLADESH, malaria vectors continue to show susceptibility to DDT in spite of the long history of its use in the antimalaria programme. During 1980 outbreaks of kala-azar occurred in some parts of the country. Attempts are being made to identify the responsible vectors and to develop a strategy for their control. In BURMA, although the available staff is limited, the Vector-Borne Disease Control Programme (VBDC) is making efforts to expand its field activities. The programme continues to receive financial assistance from the Canadian and Netherlands Governments. While Canada provides supplies and equipment, the aid from the Netherlands is utilized to finance the technical staff assigned by WHO. A team leader under the WHO regular budget is being recruited. In Rangoon, a new VBDC Headquarters building, with laboratories, lecture hall, dor- mitory and offices for senior staff, has been completed. A highlight of the year was the holding of an inter-sectoral Seminar on Inte- grated Vector-Borne Disease Control in Connexion with Construction of Sedawgyi Dam. This national seminar, organized with support from WHO and held in Mandalay in April 1981, was attended by 30 national participants, representing ten ministries, and by eight WHO staff members from all levels of the Organization. The participants from all sectors unanimously recornended that in every development pro- ject, the prevention and control of possible adverse health factors must be incorporated at the planning and budgeting stage and maintained throughout construction and subsequent operations. Monitoring of the susceptibility/resistance of malaria vectors to insecticides has been intensified. A total of 34 tests was carried out during the reporting period. Results with Anopheles annularis showed that DDT resistance had developed in this mosquito only in certain parts of its range, in the west and south. An.culicifacies showed varying levels of resistance to DDT, the highest being in Central Burma, whereas An.balabacensis and An.minimus, the main malaria vectors, continue to be susceptible to this widely used insecticide. The WHO Rodent Control Demonstration Unit (RCDU) in Rangoon continued its work on serological surveillance, trials with new rodenticides and the monitoring of flea susceptibility to rodenticides. In INDIA, trials with alternative insecticides are in progress for the control of malaria vectors that are resistant to the common insecticides. Because of the increasing problem of vector resistance to insecticides and for ecological reasons, the national authorities are developing methods for the environmental control of mosquitoes. In this connexion a WHO sanitary engineer visited the malaria programme during November 1980 - January 1981 in order to help in the training course on the engineering and water management of vector control and to advise on bio-environmental sanitation and the engineering aspects of mosquito control in urban and rural areas. A filariasis control demonstration project based on integrated pest management for the control of bancroftian filariasis was launched in Pondicherry, South India. In INDONESIA, WHO/TDR has provided financial support for developing the M.Sc. course in medical entomology at the Bogor Agriculture University. A WHO consultant assessed the present vector surveillance activities, with emphasis on malaria, and provided guidance regarding entomological activities. In collaboration with DANIDA, WHO is hold- ing an inter-country course on "Vector and Rodent Biology and Control in relation to Urban and Peri-urban Situations", at the Ciloto Training Centre during June-July 1981. The WHO Inter-regional Vector Biology and Control Research Unit-2 in Jakarta, with its sub-unit in Semarang, operated by six WHO long-term staff members,is assisting the Government in the training of national staff and in the planning,implementation and evaluation of 13 research projects. These projects cover a wide spectrum in VBC including trials with environmentally acceptable alternative insecticides to DDT and studies on the ecology, bionomics and control of vectors of malaria, filariasis, JE, DHF and vectors and reservoirs of plague in Java and the outer islands. In Central Java, where the level of DDT resistance in An.aconitus is very high and residual house s~rsying with this insecticide is producing no apparent impact on malaria transmission, trials with other insecticides such as fenitrothion, pirimi~hos methyle and bendiocarb have continued. In January 1981, a toxicolo- gist from WHO Headquarters visited Indonesia to observe and monitor the toxic effects of bendiocarb on spraymen, villagers and domestic animals. In regard to the two malaria vectors occurring in MALDIVES, - An. tesselatus continues to be susceptible to and is easily controlled by DDT residual spraying, but An.subpictus, although still responding favourably to DDT spraying, may be developing some tolerance to this insecticide. After many years of application of Abate for the control of Culex quinquefasciatus, the vector of filariasis, there are indications that this mosquito is becoming tolerant or resistant to the insecticide. Efforts are being made to encourage the people to restock their wells with larvivorous fish for Aedes control. In NEPAL, a WHO consultant reviewed the entomological activities in the malaria programme and advised on the requirements of field opera- tions and research. Guidance was also provided on procedures for the investigation of vectors related to Japanese encephalitis outbreaks in the Terai. A national entomologist was sent to Thailand on a WHO fellowship to study mosquito cytotaxonomy. In SRI LANKA, UNDP assistance to Phase I1 of the vector control projecr continued throughout the year, and a tripartite review meet- ing was held in November 1980. Most of the activities of the project are progressing as planned, monitored by a WHO epidemiologist. A WHO consultant visited the project in July 1980 and made recommendations concerning long-term control measures against Culex quinquefasciatus in Colombo and the endemic belt,the surveillance and control of Aedes mosquitoes in Colombo, and trials with slow release larviciding for the control of C.quinquefasciatus in the coconut husk soak pits in coastal areas. Trials were continued with different insecticides and formulations,including Dursban 10 CR, ECOPRO chips and Altosid insect growth regulator. The consultant made another visit in May/June 1981 to evaluate the effect of these larvicides. In THAILAND, the monitoring of vector susceptibility/resistance to insecticides and the evaluation of vector response to the impact of DDT residual house spraying have been pursued systematically. During 1980, 86 susceptibility tests were undertaken. In Phrae Province, where chlorinated hydrocarbon insecticides are applied extensively in cotton fields, results of six years of study (1975-1980) show that there has been no significant change in the susceptibility level of An.minimus to DDT. In the partial integration areas of North-east Thailand, where there have been increases in the number of malaria outbreaks, WHO assistance is being given to long-term entomological studies designed to identify the responsible vectorls, their seasonal prevalence and their breeding potential. The Organization has extended its recognition of the Division of Medical Entomology, Department of Medical Sciences, Ministry of Public Health, as the "WHO Collaborating Centre for Evaluation of Pesticide and Pesticide Application Equipment in South-East Asia" for three more years from September 1980. In collaboration with UNDP, the Division of Medical Entomology is planning a trial of monomolecular organic surface films as a method for non-toxic control of disease- carrying mosquitoes in stationary waters. WHOITDR is supporting studies on biological control agents of mosquitoes and snails carried out by different groups of scientists in Chulalongkorn, Mahidol and Chiang Mai Universities. 3. DISEASE PREVENTION AND CONTROL - NONCOMMUNICABLE DISEASES In the context of health for all by the year 2000, attention has been focused on promoting national and regional self-reliance in meeting
A training programme was organized for statistical instructors in health training institutions, in which 40 persons participated. A meeting of high ranking decision-makers was held to discuss the development of a management information system. Another activity was the organization of a consultative meeting of representatives from various health and health-related agencies which use and produce health information. This meeting was convened with the aim of identifying unreliable health statistical data and recommending or designing technology and methodology for improving such information. Financial support for conducting these meetings was provided by WHO. 7. DEVELOPMENT OF HEALTH MANPOWER The WHO health manpower development programme is aimed at: (1) streng- thening the links between manpower planning, training and management in each country of the Region, to enable it to produce the right kind and sufficient numbers of health workers and to use them effectively; (2) ensuring that the basic training programmes for all types of health workers are directly related to the provision of primary health care within the framework of "~ealth for All by the Year 2000"; (3) stimulating the countries to collaborate with and help one another in all areas involving health manpower development, with the overall objectives of fostering technical cooperation and strengthening national self-sufficiency in dealing with their own most pressing problems, and (4) promoting greater awareness and acceptance in high-priority areas such as "team training", "the effective use of traditional health workers", and "fostering research capability in health services and manpower development (HSMD)". The Organization has therefore further strengthened its efforts to assist Member countries in: developing structures so as to bring manpower planning, training and management into alignment with one another; determining the priority needs for primary health care and helping the training institutions to reorient their programmes in these critical directions; developing national and regional teacher training programmes so that teachers will adopt more systematic and relevant approaches in training future health workers, and providing greater support for research and the use of research results in train- ing and in the provision of primary health care. Health Manpower Planning Countries of the Region are evincing increasing interest in under- taking health manpower planning. It is noted that "Health Manpower Planning and Community Participation for Primary Health Care" was the subject for technical discussions at the thirty-third session of the Regional Committee in 1980. BANGLADESH formed a steering committee for health manpower plan formu- lation in 1980. A situation report has already been prepared, and a national health manpower plan formulation exercise was carried out in June 1981. BURMA has undertaken the preparation of a health manpower development project as part of the buch larger task of formulating its country health programme. In INDONESIA, efforts are being made to strengthen the overall health manpower planning capabilities in the Bureau of Health Planning, Ministry of Health. Emphasis is being placed on the development of trends and projections of the required manpower and skills in each province within the framework of the medium-term and long-term development plans. WHO has provided assistance to the Bureau of Health Planning in asses- sing the training as related to utilization, and in analysing policy related to health manpower development. A US AID team is also assist- ing the Bureau in selected aspects of manpower planning, personnel administration,training and the development of a manpower information system. NEPAL conducted a national workshop on the methodology of health manpower planning, followed by an exercise in health manpower formulation. In SRI LANKA, health manpower planning is undertaken as part of health planning and management. The approach is to conduct limited studies directly related to the expressed needs of the decision- makers, such as the recent study on the manpower staffing structure of the health services. In THAILAND, a health services and manpower development centre is being established as part of the health development network of the Ministry of Public Health. Joint meetings on health manpower planning have been held between the Ministries of Public Health and Universi- ties. Health manpower planning and management concepts and skills have been introduced into all programmes at the Faculty of Public Health of Mahidol University in Bangkok. An inter-country workshop on health manpower planning methodology was held in Colombo, Sri Lanka, during December 1980 - January 1981, to train senior administrators and educators from the Region. Bangladesh and Burma are participating in the inter-regional project on the study of the development of simple methodologies for health manpower projects, organized by WHO Headquarters. Coordination between the Health Services and Education Sectors The Regional Office co-sponsored with the World Federation of Medical Education (WFME) a Bi-regional Seminar on Education and Health Care, held in Manila in March 1980. It is also actively involved in the planning and organization of the World Conference on Education and Health Care, also being co-sponsored with the WFME and scheduled to be held in India in 1982. Training in Health Services Mananement The inter-regional activity to develop training programmes in order to improve the management of primary health care personnel is continuing in Burma, India and Sri Lanka. In BURMA, task analyses of some health personnel have been undertaken as a basis for developing the management training programme. In INDONESIA,WHO is assisting the Department of Health in its efforts to develop trained managers in health manpower through fellowships, group educational activities and training courses for physicians and health centre staff, in order to improve management and service delivery. A Consultation on Management Training and Work Studies was organized ac WHO Headquarters in June 1981, to prepare proposals for support to a programme for training in health management, to develop a basis for the organization of an inter-regional network of health management training programmes and to review the methodology of work studies and task analysis. Development of Health Team Training An expert group meeting held in October 1980 in the Regional Office clarified the concept of "team-work" in the context of the South-East Asia Region, defined the essential components constituting team-work, and developed guidelines for such training. With the use of these guidelines, a survey is to be undertaken to determine the status of primary health care teams and their functioning in the countries of the Region. The recommendations of the expert group will be followed up at an inter-country meeting planned in 1981, which, in turn, will be followed by meetings at the national level, where country-specific plans to promote team work in the delivery of primary health care will be developed. In THAILAND,a national meeting for senior nursing staff was conducted on "team work". With consultative help, community-oriented nursing curricula are now being introduced at Chulalongkorn University. Employment and Working Conditions of Health Personnel Contractual agreements were signed in 1980 with Indonesia (Directorate of Hygiene and Sanitation, Ministry of Health) and 'with Thailand (Faculty of Public Health, Mahidol University, Bangkok) for studies on the employment and working conditions of sanitarians and auxiliary sanitarians. The studies are in progress. Research in Health Manpower Development A consultant visited Bangladesh, Burma, Indonesia, Sri Lanka and Thailand to assist national staff in selecting major problems in the area of health manpower development - particularly with respect to the provision of primary health care - that would benefit from well designed research investigations. The principal research problems identified include: (1) factors which motivate health workers to provide care in rural areas; (2) the need to monitor the content of training programmes for auxiliary health workers to ensure that they are relevant to real health needs; (3) case studies of the strategies that might best be used to reorientate the training towards community needs, and (4) choosing effective methods to convert uni-purpose health workers into multi-purpose personnel. Another consultant helped national personnel in Indonesia, Nepal and Thailand to focus attention on specific problems which lend them- selves to research in the area of medical education. The Regional Office participated in a WHO Headquarters Working Group on the "Assessment of Health Workers' Performance". lhese studies, the central concern of which is the evaluation of health workers in the context of primary health care, are being conducted in Nepal and Sri Lanka. 7.1 Medical Education 7.1.1 Undergraduate Medical Education The objective of health for all cannot be attained until and unless training programmes for all health workers are directly related to pressing and urgent health problems and are geared to the effective provision of primary health care. Over the last few years consider- able efforts have been made in the Region to reorientate the contents of medical education programmes, and to revise substantially the methods by which these programmes are planned, implemented and evaluated. In spite of the resources mobilized by Member countries, by the Organization itself and by other agencies, the following major problems and difficulties remain: (a) The contents of the curricula in some countries are still oriented towards the developed countries and do not prepare doctors for primary health care work, thus contri- buting directly to the migration of doctors; (b) Many of the under- graduate programmes are largely theoretical and not tuned to equip students with the necessary practical skills to enable them to work as members of health care teams, or to manage a rural health centre on minimal resources, and (c) Very few countries in the Region possess teachers with the skills to produce locally-relevant and problem-centred teaching and learning materials. These and other problems must be tackled on a country-wide and Regionride basis, in order to keep up the momentum of HFAl2000. During the course of the year, the Organization continued to assist medical colleges in all the countries in reorientating their curricula and making them relevant to the needs of the community. In BANGLADESH,following a review of the project on medical education, the main purpose of which was to reorient and remodel medical educa- tion at both undergraduate and post-graduate level, it was decided that the project should be reformulated with new strategies. In April 1981, a joint UNDP/WHO mission visited Bangladesh to make recommenda- tions regarding the new project on "Assistance to the Centre for Medical Education and Development". 'Ihe Bangladesh Medical Council, together with the Ministry of Health, reviewed the existing undergraduate medical curriculum in March 1981 and formulated reconmendations for redesigning it. During the fiscal year 1980-81, three more medical colleges were opened by the Government, one each at Khulna and Pabna and an under- graduate medical college component at the Institute of Post-graduate Medicine and Research at Dacca. An important part of the WHO fellowships programme is the provision of post-graduate training for teachers in the pre-clinical sciences, in order to meet the acute shortage in the existing and newly opened medical colleges. In BURMA, a consultant assisted the Directorate General of Medical Education in reviewing the need for strengthening communication skills in the English language for medical students, and in developing a plan in this regard. If effective, this project will have implica- tions for other countries in the Region which have the same problem of a low proficiency in English among students of health training institutes. In DPR KOREA, the Organization collaborates in the programme for equipping medical teachers with improved linguistic skills. A long-term staff member has continued to provide consultative assistance to the State Medical Institute, Ulan Bator, MONGOLIA. In NEPAL, long-term consultative assistance to the Institute of Medicine, Tribhuvan University, has been provided. Many training programmes for teachers of all categories of health workers have been held. Short-term consultants have assisted the Institute in revising its training programmes in clinical pharmacology, community medicine and anatomy. A feasibility study was carried out concerning the use of Birgunj and Pokhara zonal hospitals as out-reach teaching hospitals for the Institute. A decision to use the hospitals in this manner could go a long way towards ensuring orientation of all medical training directly to community needs. SRI LANKA has been receiving fellowships in support of the qualitative improvement of undergraduate training programmes, which will be most important in view of the estabIishment of further training institutes at Galle and Jaffna. A short-term consultant assigned to THAILAND has submitted a very wide-ranging report concerning the ways in which medical education might best be reoriented towards community needs; the feasibility of using provincial and district hospitals for teaching medical students and a range of options for solving the problem of over-concentration of physicians in the cities. Recommendations have been made for establishing innovative, community-oriented institutions in rural areas. The universities, together with the Ministry of Public Health, are actively undertaking a reorientation of the training programmes for health personnel, particularly of medical students, to support national health development. 7.1.2 Post-graduate Medical Education The Organization has continued to provide support for the development of post-graduate medical education in the Region. In BANGLADESH, consultative assistance has been provided to the National Institute of Preventive and Social Medicine, Dacca, in developing competency-based courses in biostatistics, and for the creation of a statistical cell within the Institute. In INDONESIA, since 1979 the Consortium of Medical Sciences has been working on programmes for the establishment of post-graduate education in the basic sciences. Long-term consultative support has been provid- ed to the Faculty of Public Health, University of Indonesia. During the period under review the assistance was mainly directed towards improving the training programmes, all of which are learner-centred and competency-based, in the Department of Occupational and Environ- mental Health. In SRI LANKA, with the Government's decision to provide post-graduate education within the country as well as to hold post-graduate examina- tions locally from 1980, the Post-graduate Institute of Medicine was reconstituted by an Act of Parliament in January 1979 to enable it to assume a new role. Nine boards of studies have since been established, i.e.,in surgery, medicine,cammunity medicine, anaesthesia, obstetrics and gynaecology, paediatrics, radiology, pathology and general practice. Local post-graduate examinations have been conducted in MD Community Medicine, US Surgery Part I, MD Medicine Part I and MS Obstetrics and Gynaecology Part I. WHO consultants were provided to act as external examiners for these examinations. WHO also assisted in developing the library facilities for post- graduate students in Colombo and Kandy. In THAILAND, the Organization has been helping the Faculty of Public Health, Mahidol University, to train national teaching staff as well as to develop educational curricula and an evaluation methodology. During 1980, consultants in veterinary public health and nurse practitioner evaluation collaborated with the Faculty of Public Health. As a follow-up of the Consultation meeting held in 1978, which had reconmended that a network of national training institutes be formed to collaborate and share the facilities and expertise in a mutually supportive and complementary manner, an expert group was called together in the Regional Office in October 1980 to consider details of the establishment of such a network. A regional meeting was held in February 1981 at the All-India Institute of Hygiene and Public Health, Calcutta, to discuss the activities of a regional network of public health training institutes. The participants developed the details, prepared a work schedule with time targets and undertook responsibility for the various activities. The Regional Office participated in the Third International Congress of the World Federation of Public Health Associations, held in Calcutta in February 1981. Representatives from the countries of this region as well as Regional Office staff participated in the Ninth Inter-regional Meeting of Directors or Representatives of Schools of Public Health for the African, Eastern Mediterranean, South-East Asia and Western Pacific Regions of WHO, held in Cotonou, Benin, in March 1981. 7.1.3 Continuing Education In order to attain the goal of health for all through the primary health care approach, all categories of health workers are faced with formidable challenges concerning their roles and the various circw stances under which they have to practise their professions. Continu- ing education is regarded as one of the essential means for helping them to keep their knowledge as up to date as possible, and to acquire the skills and attitudes needed to respond to changing health needs. An inter-country project on continuing education for all categories of health workers has provided assistance through the organization of consultative meetings and workshops and the distribution of relevant publications. 7.1.4 Teacher Training Programes The development of teacher training programes continues to play a pivotal role in many support activities. Teacher training, if appro- priately planned and implemented, can be expected to contribute directly to the qualitative improvement of the training programmes for preparing all types of health workers. It would include assistance to teachers (a) in developing curricula which are based on high priority health needs, competency-based and learner- and problem- centred; (b) in evaluating the quality of the health workers that they are producing, using their findings to improve further the quality of their training programes, and (c) in planning, producing, using and evaluating problem-based health learning materials which are relevant to both high priority health needs and the health workers' job descriptions. It would also include assistance to institutions, and to the countries in the ~egion, in developing their own structures so as to encourage the promotion of relevant teacher training programmes. In Sri Lanka and Thailand, the two Regional Teacher Training Centres continued to provide courses in educational science for teachers of health professionals. They organized a wide range of short courses on such topics as construction of self-learning packages, attitudes and their measurement, clinical evaluation techniques and the concept of the health care team. In INDIA, the National Teacher Training Centre at the Jawaharlal Institute for Post-graduate Medical Education and Research, Pondicherry, has conducted two two-week courses in educational planning and evaluation for medical school teachers. A second National Teachers' Training Centre has been established at the Post-graduate Institute in Chandigarh, and it is now developing training programmes for teachers in northern India. INDONESIA, which has been assisted through the provision of short- term consultants, has designated five national teachers' training centres. Every government medical school already possesses an educational unit, and during the past year efforts were made to develop similar units in all the dental schools in the country. 7.2 Education and Training in Maternal and Child Health Development of national self-reliance in education and training in maternal and child health care is a priority concern in WHO activities at country level. Towards this end and in the spirit of TCDC, imple- mentation of a regional teacher education program in maternal and child health, using the existing training facilities in the Region, has been stimulated. The Organization's technical cooperation aims at ensuring that the training content in basic and continuing education programnes in MCH for all levels of health workers is specifically oriented towards the tasks to be performed and geared to the primary health care approach. As a follow-up of the UNICEPIWHO Course for Senior Teachers of Child Health, educational materials were supplied to some former fellows to help them strengthen and support the child health education programmes in their respective national teacher institutions. In BURMA, WHO supported training programmes for lady health visitors, midwives and auxiliary midwives. The role of the traditional birth attendant ("let-the") in primary health care continued to be promoted. A pilot training programme for let-the's was established with emphasis on asepsis and safety during delivery. In INDIA, training under the re-modelled undergraduate paediatric curriculum was started again, based on the findings of an evaluation. The programme on the teaching of MCH as well as paediatrics to medical undergraduates and interns continued to receive support through intra- country fellowships. The usefulness of the "Handbook on Delivery of Care to Mothers and Children in a Community Development Block" as a teachingllearning manual for faculty members, undergraduates and interns was assessed and confirmed by a WHO consultant. The Ad hoc Committee on Paediatric Education reviewed the second draft of the "Handbook on Child Health" and made necessary recommendations. The final draft is now under preparation. The in-service training programme in MCH for primary health centre physicians was evaluated by another WHO consultant. District-level obstetricians and paediatricians were trained in perinatal and neonatal care through national workshops organized with the aid of grants. As a follow-up of the WHO inter-regional course on "Fertility Management and MCH Caret',some of the former fellows were provided with educational materials to help to strengthen national institutions. In MONGOLIA, emphasis was laid on giving training in MCH to health personnel at aimak level, through the organization of national seminars and courses and the award of fellowships for study outside the country. WHO consultants provided technical support for the training of national workers in the methodology for research projects in MCH, including infant and child nutrition. In NEPAL., training in MCH and family planning was integrated with that of peripheral-level workers, including panchayat-based personnel. The training of health manpower to strengthen MCH referral services was supported through fellowships for study outside the country. In SRI W, the training of medical officers in performing steri- lizations continued. Orientation and on-the-job training for family health workers in using the available manuals was also undertaken. It was planned to make an evaluation of the impact on family health programmes of the training of various categories of health workers. In THAILAND, training in MCH and family planning for different levels of health personnel was supported through the organization of appropriate national seminars, workshops and courses. Fellowships, for studies both within and outside the Region, were also awarded. 7.3 Education and Training in Sanitary Engineering As mentioned in the last Annual Report,practical training of environ- mental health personnel to meet the needs of Member countries in the coming decade is being reoriented. To start with, fellowships for senior staff are being recast to make the content of the studies more relevant. During this year, a group of engineers from India were sent to the World Bank on a special orientation mission on project "pre- feasibility" and project preparation, evaluation and appraisal. After being briefed, they accompanied World Bank staff on country missions. By becoming familiar with the criteria used by the World Bank for project formulation and appraisal, the Government of India plans eventually to set up project cells at the central level and urge State governments to do so at State level, to ensure that all projects prepared will be sound,from the social, institutional,economic, public health and financial aspects, to be able to attract both internal and external investment. A short management course is being arranged for senior managers at central or state level. In order to monitor pollution of inland and coastal waters a special three-month course was organized at the International Institute for Hydraulic and Environmental Engineering, Delft, Netherlands, and started in mid-June 1981. As stated earlier, consultative support was provided to INDONESIA for improving the training programe in sanitary engineering at the Department of Occupational and Environmental Health. In the planning,management, implementation, operation and maintenance of small water supplies, difficulties are experienced in arranging group educational and observation tours in selected countries. The necessary mechanism is being evolved to tackle these problems, and it expected that these difficulties will be overcome shortly and regular exchange group visits may be arranged to foster TCDC. 7.4 Training in Epidemiology WHO provided technical cooperation to Thailand in establishing a field-oriented course in epidemiology, for which a WHO epidemiologist vas assigned in May 1980 for a period of two years. The training course started in June 1980 with five trainees. A formal introductory course on general epideniology,biostatistice and selected c-nicable diseases was given during the first month, with emphasis on the epidemiological methods of investigating outbreaks. The participants were assigned to the various divisions of the Ministry of Public Health, where these epidemiologists-in-training were responsible for disease surveillance, outbreak investigations and the development1 execution of epidemiological research studies. A study tour is being arranged for a medical officer to visit the Centre for Disease Control, Atlanta, Georgia, USA, in view of the fact that the field training programme in Thailand is organized in basically the same way as the epidemiological intelligence services course at CDC. The second group of five trainees started the programe on 25 May 1981. This field-oriented course in epidemiology in Thailand stimulated the Indonesian authorities to visit Bangkok to study the various aspects of the course and possibilities of adapting it for use in Indonesian universities. WHO organized and supported the visit of a group of four Indonesian officials to Bangkok in January 1981. It is expected that the recommendations of this group will help to establish a Master's degree course in epidemiology in Indonesia, with emphasis on field training. 7.5 Training of Auxiliaries and Community Health Workers The countries of the Region have continued to train various categories of health manpower, particularly for the rural areas. Programmes have been started for training the trainers, for the preparation of relevant health learning materials and visual aids, and for the continuing education of vorkers. In BANGLADESH, different types of health manpower are being produced and used to expand primary health care activities in rural areas within the context of HFA strategies. Community health workers at the village level will be the focal point for the implementation of primary health care, whereas other categories of health manpower will be involved in the training, supervision and provision of referral services for PHC. The Government continues to train multipurpose field-level workers, namely, the family welfare workers and the family welfare assistants, whose activities are mainly in the fields of family planning and maternal and child health. The Government is now planning to integrate the health and family planning prograllmes so that a package of the combined services will be delivered to the rural population. It has also continued the training of the village doctor or "Palli Chikitshak" with the objective of providing one such worker to each of the 68 000 villages in the country; already 5000 such workers have been trained. Voluntary health workers (male) and traditional birth attendants (female) have been trained in the six primary health care pilot thanas (districts). A long-term WHO staff member is in position at the Paramedical Institute to assist in training for the health services. Another was assigned to help with the training of medical assistants. In BURMA,the basic training of community health workers, basic health staff, and state/divisional and central level staff was supported through WHO subsidies. Comaunity health workers received refresher training during the period under review. The field staff of the special disease control programmes were given training to convert them into multipurpose health workers, to be eventually posted at rural health centres. US AID assistance has enabled the rapid expansion of the training of community health workers. In INDIA, the community health volunteer scheme has continued to be implemented and has so far covered 2366 primary health centres and almost half the population. The training programme under the multipurpose workers' scheme has been completed in 183 districts and is in progress in 142 districts. Under this programme medical officers of primary health centres, extension educators, health assistants and multipurpose health workers have been given reorientation training. The revised basic training programme for multipurpose health workers (female) was developed and implemented in all basic training schools. A programme of continuing education for community health volunteers was launched through a correspondence course on an experimental basis for a limited area. Manuals for community health volunteers, male and female multipurpose health workers and health assistants have been prepared. Training guides for the trainers of various categories of health workers have been prepared and are under print. Training materials and aids were developed and supplied to the training centres. The training programme for various categories was reviewed and modified. An integrated programme for medical officers of primary health centres has also been developed. In INDONESIA, the PKMD (village community development) programme is now operating in 12 out of 27 provinces. It is focusing attention on training at various levels of the administration and ultimately will include the training and utilization of voluntary health workers at village level. More than 1000 voluntary health workers have been trained. The concepts of primary health care are now being incorporated into the curriculum of professional and other health workers. Manuals and guidelines developed for the voluntary health workers are being tested. In MALDIVES, the Allied Health Services Training Centre continued to produce middle-level and peripheral health manpower consisting of cormnunity health workers, family health workers, nurse aides, and cornunity health aides. A regular training course was also organized for traditional birth attendants ("foolumas") and dispensers. The primary health care programme in NEPAL, utilizing ward-level health volunteers, is being initiated. The manual for the volunteers has been developed and field tested. The National Institute of Health Sciences at Kalutara, SRI LANKA, is responsible for the training of paramedical workers. WHO has assisted the Institute by assigning a consultant, and in organicing workshops on teachers training in primary health care and on health management. The Institute is also supported by UNICEF, US AID and UNDP. In THAILAND, WHO, with the collaboration of UNICEF, has continued to assist in the training of village health volunteers and village health communicators. Health Learning Materials In addition to efforts for developing the capabilities of the countries in the production, use and evaluation of locally relevant health learning materials, WHO has distributed sets of health learn- ing materials (REMAHA [Resource educational material for health auxi- liaries], source library and student loan libraries) to institutes in the Region, for different categories of health workers. Health Literature. Library and Information Services (HELLIS) Network The Health Literature, Library and Information Services (HELLIS) Net- work, which was established following the inter-country consultation meeting of librarians and administrators from health science institu- tions in the Region, has started functioning. National networks have been formed and focal points identified in Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand. A consultant was assigned to design and prepare a detailed curriculum for the Regional Training Programme for Health Science Librarians in the HELLIS Network. This curriculum was considered and modified at an inter-country consultation meeting of health science librarians in December 1980, during which a task force was formed to develop recom- mendations for the standardization of procedures for the Network. WHO has assisted India, Indonesia and Thailand in holding national meetings for the Network. The Organization also collaborated with India in strengthening the National Medical Library in New Delhi and in organizing training courses for library staff in the country. 7.6 Group Educational Activities During the period under review, 116 group educational activities were organized, of which 53 were national, 47 were regional and 16 were inter-regional (see Annex 4). These were mainly seminars, workshops, conferences, short courses and consultative meetings and were attended by a total of 530 participants from the countries of the Region. Representatives of other United Nations agencies, staff members from WHO Headquarters and field project staff also participated in some of these activities. Of the 53 national-level meetings, 36 were supported by the respective country WHO budgets and 17 by the inter-country budget. The subjects covered were primary health care,appropriate technologies for health, the Expanded Programme on Imaunieation, nursing, malaria, mental health, maternal and child health, environmental health, sexually-transmitted diseases, nutrition, medical rehabilitation, health economics, planning, traditional medicine and health manpower development. A growing number of activities deal with research in various priority areas such as tuberculosis, health services research, diarrhoea1 diseases, family planning and dengue haemorrhagic fever. Special mention should be made of two important meetings, viz.,inter- country meetings of the SEAJACMR Sub-comaittee on Research Needs for Health for All by the Year 2000, and the Inter-country Meeting on Preparation of Health Education Specialists in support of Health for All by the Year 2000, as both of them are expected to contribute to efforts for achieving HFA goals. The following three tables give details of these educational activi- ties: (a) BREAKDOWN OF INTER-COUNTRY ACTIVITIES (BY TYPE), WITH NUMBER OF PARTICIPANTS, HELD DURING THE PERIOD 1 JULY 1980 - 30 JUNE 1981 Malaria Border Consultative *Sponsored and paid by the host country. (b) NUMBER OF COUNTRIES REPRESENTED AND NUMBER OF PARTICIPANTS IN INTER-COUNTRY ACTIVITIES, 1 JULY 1980 - 30 JUNE 1981 (Total Number of Activities - 40) I Total 505 + 25* *Participants sponsored and paid by the Government to attend the Border Malaria Coordination Meeting - Bangladesh-Burma-India (India being the host country). (c) BREAKDOWN, BY COUNTRY, OF NATIONAL GROUP EDUCATIONAL ACTIVITIES FOR THE PERIOD 1 JULY 1980 - 30 JUNE 1981 7.7 Fellowships During the thirteerrmonth period from 1 by 1980 to 31 by 1981, 1079 fellowships were awarded using various sources of funds: 931 (86.3%) from the Regular Budget, 89 (8.22) from LINDP, 37 (3.4%) from UNFPA and 22 (2.1%) under inter-regional and other projects funded by WHO Headquarters. The WHO fellowships awarded under the Regular Budget consisted of: 87 (9%) against the 1979 budget, 662 (71%) against the 1980 budget, and 182 (20%) against the 1981 budget. 7.7.1 Implementation Under the Regular Budget for the 1980-1981 biennium, a Sum of US$^ 186 500 was ~rovided for fellowships, constituting 22.6% of the total budget. For 1980, against a total of 1061 fellowships available, 824 (77.7%) have been awarded so far, and the balance of 237 (22.3%) is expected to be awarded before the end of 1981. The planned fellow- ships programme for 1980 will thus be implemented fully. UNDP provided ~~$418 087 for fellowships during 1980, forming 8.2% of the total UNDP budget for the Region. The number of fellowships planned during 1980 was 91, of which 45 (49%) had been awarded by the year-end. The balance of 46 (51%) fellowships has been carried over to 1981. Under UNFPA funds, a total of ~~$199 669 vas provided for fellowships during 1980 - 6.9% of the total UNFPA budget for the Region. The number of fellowships planned during 1980 was 56, of which 25 (45%) , had been awarded by year-end; the remaining 31 (55%) fellowships have been carried over to 1981. Table (a) shovs that 53% of all fellowships were avarded for study within South-East Asia; of the other Regions, the European Region received the highest number of fellows, and the Western Pacific also received a large number. Table (b) shovs that about 58% of the fellows were professional health workers such as doctors, nurses and environmental health engineers and that 75% of the awards were for males and 25% for females. The table also shows the distribution of the fellowships among age groups: 43% were avarded to candidate6 between the ages of 35 and 44 years. Of the fellowships avarded, 245 (23%) were of a duration of one month or less, 470 (44%) for up to three months, 151 (14%) for up to six months, 177 (16%) for up to twelve months and 36 (3%) for duration beyond a year. As for placement, 558 (52%) of the fellows were placed for study in one country, 173 (16%) were in two countries, 194 (18%) visited three countries,ll2 (10%),four countries and 42 (4%) five or more countries. Delays in receiving applications continue, however, to hamper imple- mentation. For 1981, even as of the end of the first quarter, only 23% of the applications had been received against the number of fellowships planned. Since the time available for handling placements during the programme year is thus cut short, many of these fellowships may have to be carried over to the next year. Owing to time cons- traints, because of completion of the current biennium, there might be a considerable bottleneck for the 1982 fellowships programme. Long delays in receiving reports for proficiency in English, vhich is essential for placement in certain countries, also create problems. Zhis problem emphasizes the need for giving early training in English to prospective candidates for fellowships, and for governments to make advance planning in this regard. The cost of fellowships has been rapidly increasing, especially in Europe and North America, and in some cases has almost doubled in comparison to the cost in the last biennium. This trend is expected to continue aiid points to the need for careful selection of host countries for fellowships and, again, towards the desirability of using regional training facilities and institutions. The Regional Office has been constantly striving to improve the administrative procedures for the handling of fellowships. It was noted that the gap between the receipt of applications and placement requests sometimes extended up to four months on account of incomplete applications, lack of proper medical certificates, delsys in obtaining English proficiency certificates, and incomplete academic documents. While the Regional Office continues to try to improve the process, governments can certainly help by ensuring that the applications are complete in all respects before being forwarded to the Regional Office. Graph 2 shows the progress of cumulative percentage delivery of fellowships under the Regular Budget. It was noted that 81% of awards were issued within one month after receipt of acceptance, 15% within two months and 4% after three months or more. During the period under review. an average of 69.27% termination reports and 36% of utilization reports were received against those that were due. An analysis of the 237 utilization reports received shows that 97% of the fellows were suitably employed, 52% established new services and 73% were imparting knowledge to others. In accordance with the reconmendations of the Conference on Regional Cooperation in the Implementation of WHO Fellowships Programe, held in 1979, study tours are being organized for national officers handling the fellowships progranme in order to acquaint them with the problems and procedures. The. first group study tour, consisting of five participants, was conducted in May 1981. %o more such study tours will be organized later in 1981. 7.7.2 Regionalization The increasing trend towards regionalization of the fellowships programe has been maintained. The figures for the previous four years are presented in Table (c). 7.7.3 Subjects of Fellowships Table (d) shows the distribution of the fellowships awarded, by country and by subject. 7.7.4 Fellows from Other Regions During the period under review, placements in this region were arrang- ed for 101 fellows from the following 22 countrie8 and territories outside South-East Asia: Afghanistan, Canada, Egypt, Ethiopia, Fiji, Figure 2 WHO FELLOWSHIP PROGRAMME (REGULAR BUDGET) CWLATIVE PERCENTAGE DELIVERY. 1980 (By stages of operation) Status of: 0----o applications received - placements requested - placements accepted - awards issued Iraq, Japan, Republic of Korea, Kuwait, Malaysia, Mauritius, New Zealand, Papua New Guinea, Philippines, Saudi Arabia, Singapore, Somalia, Western Samoa, Sudan, Viet Nam, Yemen and Zambia. The figures for the previous year were: 68 fellows from 18 countries. DISTRIBUTION OF FELLOWSHIPS (1 May 1980 - 31 May 1981) (a) By Budget and by Region - Analysis of 1079 fellowships (b) By Type, Sex, Age and Duration Region where trained South-East Asia Western Pacific Europe USA Africa and Eastern Mediterranean Total - Percent- age 5 3 10 2 7 9 I Source of Funds Type WHO Regular Budget 472 10 2 275 7 5 7 931 5Pe Profes- sional Others . No. (%) 628 (55%) 451 (42%) Sex UNDP 61 1 20 5 - 8 7 Sex Male Female Age No. (%) 806 (75%) 273 (25%) UNFPA 2 1 3 2 13 - 39 Age Under 25 26-34 35-44 45-54 5 5+ Not known Duration No. (4) 14 (1%) 246 (23%) 464 (43%) 302 (28%) 41 (4%) 12 (1%) Duration Under 1 month Up to 3 months Up to 6 months Up to 12 months Above 12 months HQ and others 20 2 - - - 22 No. (%) 245 (23%) 470 (44%) 151 (14%) 177 (16%) 36 (3%) Total 5 74 109 297 9 3 7 1079 - 104 - (c) Regionalization of Fellowships (d) Fellowships Awarded (Under All Budgets), By Subject of Study and Country of Origin of the Fellow (1 May 1980 - 31 May 1981) Calendar year 1977 1978 19 79 1980 Number of fellowships awarded 5 78 676 591 1 005 Number of regional fellowships awarded 196 (34%) 299 (44%) 280 (47%) 544 (57%) Group Subject No. 1. Public Health Administration 2. Environmental Health 3. Nursing 4. Maternal and Child Health 5. Communicable Diseases and Laboratory Services 6. Clinical Medicine 7. Basic Medical Sciences and Education 8 Others Total BHU - - - - - 3 3 BAN 13 15 - 37 13 17 114 BUR 21 3 5--- 8 28 1 14-47 16 81 DPRK 7 3 - - - - 30 IN0 44 3210 522 12 51 1 31 176 IND 17 43 49 15 27 196 MAL 8 2 - - 4 1 1 18 MON 5 - 2 8 3 852413920 7 30 NEP 14 18 8 17 37 12 15 124 SRL 28 2 21 10 27 109 THA 78 714 513 6 14 20 33 198 Total 235 95 58 90 252 86 177 1079 % - 22 9 5.3 8.3 23 8 868 16.4 7.8 Regional Office Library During the period 1 July 1980 - 30 June 1981, the Regional Office Library received 7933 books, pamphlets, WHO publications, current periodicals and reports; 2393 persons (1963 WHO staff and 430 others) visited the Library and 5141 books and periodicals were issued on loan to Regional Office and field staff as well as on interlibrary loans. Photocopies of 1125 pages were supplied. For references needed by the Regional Office. field staff and Headquarters, 64 loan requests were sent to local libraries. Reference material was supplied in connexion with various seminars and meetings held in the Regional Office and outside. The Library, which is the UEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, WEDLINE searches requested by Member countries. It scrutinized the requests and obtained print- outs for searchable requests from the National Library of Medicine, Bethesda, Maryland, USA, under a special agreement. Photocopies of references not available in countries were also provided to them, free of cost, from sources in Delhi, in WHO Headquarters and in the United States of America. As part of the development of the Health Literature, Library and Information Services Network in the Region, the Library actively participated in both national and regional group educational activities on the subject. It is proposed to bring out, by the end of 1981, an experimental issue of the Regional Health Literature Index for South-East Asia. Three Student Loan Libraries were established in 1980-81. The Regional ..Office Librarian visited Mongolia in June 1981 to assist the Government in planning a Republican Reference Medical Library and to discuss other related matters. 8. RESEARCH PROMOTION AM) DEVELOPMENT The South-East Asia Advisory Cormittee on Medical Research (SEA/ACMR), established in 1976, has continued to function as an advisory body to the Regional Director on the implementation of the Regional Research Programme. Through various study groups and consultative meetings, detailed plans for research have been developed in the six priority areas identified by the SEA/ACMR at its first session in 1976. The activities are being implemented by the Regional Office, and their current status is as follows: In the field of research on health services delivery, twelve studies are currently in operation, the results of which will be useful in improving the health care programmes in the respective countries as well as in formulating a regional plan which could be adapted to suit varying national conditions and requirements. National and inter- country meetings have been organized to promote the health service
ANNUAL REPORT OF THE REGIONAL DIRECTOR WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA 'IFIIKTY-TIIIRD ANNUAL REPORT 0 F TIIE REGIONAL IIIRECTOR TO THE IIEGION \L COMMITTEE FOK SOUTH-EriST ASIA 1 JULY 1980-30 JUNE 1!)81 Safe water is vital to achieve health far all. Vigorous efforts are being made in the Region to attain the Water Decade targets by 1990, which is a step towards Health for All by the Year 2000. CONTENTS INTRODUCTION PART I - GENERAL REVIEW OF ACTIVITIES 1 STRENGTHENING OF HEALTH SERVICES planning and Development of Health Services Health planning, programme formulation and evaluation Organization of health services Operational studies Primary Health Care Traditional Medicine Family Health Nursing Health Education Nutrition Medical Care Care of the Aged, Disability Prevention and Medical Rehabilitation Oral Health Mental Health Drug Policies and Management 2 DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Epidemiological Surveillance Diseases Subject to the International Health Regulations Smallpox eradication Diarrhoea1 diseases, including cholera Plague Malaria and Other Parasitic Diseases Malaria Schistosomiasis Filariasis Leishmaniasis Bacterial Diseases Tuberculosis Leprosy Sexually-transmitted diseases (STD) Diphtheria, pertussis and tetanus Viral, Chlamydial, Rickettsia1 and Related Diseases Trachoma Poliomyelitis Dengue haemorrhagic fever Viral hepatitis Japanese encephalitis Expanded Programe on Immunization (EPI) Veterinary Public Health (VPH) 2.8 Vector Biology and Control 3 DISEASE PREVENTION AND CONTROL - NONCOMMUNICABLE DISEASES 3.1 Cancer 3.2 Cardiovascular Diseases 3.3 Prevention of Blindness 3.4 Immunology 4 HEALTH LABORATORY SERVICES 4.1 Organization of Laboratory Services 4.2 Quality Assurance 4.3 Quality Control of Pharmaceuticals and Biologicals 4.4 Vaccine Production 5 PROMOTION OF ENVIRONMENTAL HEALTH 5.1 Environmental Health 5.2 Occupational Health 5.3 Radiation Medicine 5.4 Food Safety Programme 6 HEALTH INFORMATION AND STATISTICS 7 DEVELOPMENT OF HEALTH MANPOWER Medical Education Undergraduate medical education Post-graduate medical education Continuing education Teacher training programmes Education and Training in Maternal and Child Health Education and Training in Sanitary Engineering Training in Epidemiology Training of Auxiliaries and Community Health Workers Group Educational Activities Fellowships Implementation Regionalization Subjects of fellowships Fellows from other Regions Regional Office Library 8 RESEARCH PROMOTION AND DEVELOPMENT 9 TECHNICAL INFORMATION AND REFERENCE SERVICES PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1 REGIONAL COMMITTEE 2 REGIONAL PROGRAMME PLANNING AND DIRECTION 3 ADMINISTRATION General Organizational Structure Personnel Staffing Staff training Employment conditions Budget and Finance Regional Office Building 4 PROCUREMENT OF SUPPLIES AND EQUIPMENT 5 COLLABORATION WITH OTHER AGENCIES United Nations United Nations Development Programme (UNDP) United Nations Children's Fund (UNICEF) United Nations Fund for Population Activities (UNFPA) Economic and Social Commission for Asia and the Pacific (ESCAP) International Atomic Energy Agency (IAEA) Specialized Agencies Food and Agriculture Organization of the hited Nations (FAO) International Labour Organisation ( ILO) United Nations Industrial Development Organization (UNIDO) United Nations Educational, Scientific and Cultural Organization (UNESCO) World Food Programme (WFP) International Bank for Reconstruction and Development (IBRD) Asian Development Bank (AsDB) Bilateral and Other Agencies bn-governmental Organizations in Official Relations with WHO 6 PUBLIC INFORMATION PART I11 - ACTIVITIES UNDERTAKEN BY GOVERNl-ENTS WITH THE HELP OF WHO PROJECT LIST Bangladesh Bhutan Burma Democratic people's Republic of Korea India Indonesia Maldives Mongolia Ne pa 1 Sri Lanka Thailand Inter-Country Inter-Regional Activities Outside the Region with Participants from the South-East Asia Region ANNEXES Organizational Structure Geographical Distribution of International Staff Assigned to the South-East Asia Region as of 31 May 1981 Distribution of Short-Term Consultants by Nationality, 1 June 1980 - 31 May 1981 Meetings and Courses Organized or Assisted by WHO and Held in the South-East Asia Region (1 July 1980 - 30 June 1981) Conferences and Meetings in the South-East Asia Region Called by Governmentsfother Organizations at which WHO was Represented (1 July 1980 - 30 June 1981) List of Technical Reports Issued by the Regional Office (1 June 1980 - 31 May 1981) FIGURES South-East Asia Region - Incidence of Malaria and P. falciparum Incidence WHO Fellowship Programme (Regular ~udget) - Cumulative Percentage Delivery, 1980 (By stages of operation) Obligations Incurred on Field Activities in the South- East Asia Region INTRODUCTION The year under review has been marked by a number of significant steps taken by individual countries as well as the Region as a whole for translating the universally accepted objective of "Health for Alln (HFA/2000) into a reality. Two specific examples are: first, the elaboration of HFA/2000 strategies at the national level and their synthesis at the regional level and, second, the formulation of the Seventh General Programme of Work, which provides the basic frame for WHO'S programme of action during the period 1984-1989 in line with these strategies. While the strategies for health for all reflect well-articulated and carefully organized thoughts and ideas for action at national and regional levels, the Seventh General Programme provides a completely reoriented plan for WHO'S active collaboration in the balanced development of appropriate health systems and relevant technologies for delivering primary health care to all who need it. It is gratifying that in all the Member States of the South-East Asia Region, there is considerable national commitment to HF~/2000, and that all development sectors clearly recognize their responsibilities for, and role in, helping to attain this goal. To the socio-political and health leaders in our countries HFA/2000 is no longer a theme for theoretical discussion but an accepted term of reference for individual and collective action. The entire range of health development efforts in the Region is therefore geared to attaining it, both in the health sector and in the overall context of socio-economic development. Health Planning and Management Efforts to stimulate scientific health planning in the Member States have yielded considerable dividends. Country health programming (CHP) as a comprehensive management process for national health development is now being practised in more than half the Region, either in the original or in a modified form, to suit the needs of individual countries. Thus, Bangladesh, Burma, Maldives, Nepal, Sri Lanka and Thailand have all completed at least one cycle of CHP. In fact, Bangladesh, Burma and Nepal have already undertaken the second cycle, and Thailand is in the process of carrying it out for the second time. All these exercises were aimed principally at developing a meaningful, medium-term national health plan. What is interesting is the fact that the experiences gained are now being used in some countries to formulate long-term perspective plans up to the end of the century, with the aim of projecting health needs and visualizing the programme perspectives to achieve health for all by the year 2000. There have also been efforts to evaluate on-going activities. One such effort was the mid-term review undertaken in Nepal to evaluate the achievements and failures of the national Five- Year Health Plan; another is the continuous monitoring and systematic assessment of the People's Health Programme in Burma. These encouraging developments have led WHO to intensify its efforts toward stimulating and further improving the managerial process for national health development through the training of national personnel in health planning and management. To this end, steps have been taken to prepare guidelines, teaching modules and training materials based on the latest experiences gained through country health programming. These will be used in providing intensive training to national staff in different aspects of the managerial process for national health development as suited to individual countries. As for the Organization's own planning and management efforts, in addition to developing the Seventh General Programme of Work based on HFA strategies, WHO has evolved a practical method for its detailed biennial programme planning and budgeting in Member countries, by means of meaningful coordination of all inputs - national and external, international and bilateral. In Indonesia, with the active involvement of the Government, a special effort was made in this regard. It is expected that this method will greatly improve the utilization of resources and avoid duplication of effort and waste. Information Systems The countries in the South-East Asia Region have been showing increasing interest in health information systems, particularly for the planning and management of primary health care. It is now agreed that in most countries the most suitable information system would be one based on lay reporting. In several countries - Bangladesh, Burma, Nepal and Thailand - such reporting has been introduced and is being expanded in a phased manner. Simultaneously, in some cases, with the development of the lay reporting system, hospital record systems involving rural health centres and hospitals at all levels are being streamlined and expanded. As for WHO'S inf ormation system, the major component continued to be the periodically updated country and regional programme profiles. In addition, the programme management information system for day-to-day monitoring has been further simplified and refined to provide need-based information for the management of programme delivery at both country and regional levels. Development of Comprehensive Health Services The tremendous enthusiasm in all countries of the Region for attaining the objective of HFA/2000 on the basis of primary health care has manifested itself in a series of activities for formulating national strategies involving all sectors concerned with health development. Also, countries are establishing, strengthening or streamlining national health development councils or similar mechanisms to enhance political commitment, facilitate intersectoral coordination, formulate and update national health policies and strategies, and provide overall policy guidance based on the monitoring and evaluation of HFA activities. Governments have for long recognized the value of primary health care concepts, as defined at the Alma-Ata Conference, and are currtatly developing national programmes based on these concepts within the framework of their national strategies mentioned above. The major thrust of such programmes has been towards providing an integrated package made up of the eight elements considered essential to primary health care, within the available resources. As primary health care services depend on the prevailing socio-economic situation, they are today in different stages of development in different countries, with varying degrees of coverage. It is, however, significant that all countries have now intensified their efforts to promote community participation and involvement through the training of village volunteers, health workers and motivators from within the community. Countries are also developing reasonably effective referral systems and logistic support, recognized as vital to sustain primary health care. Assessments in several countries indicate that there has, in general, been an improvement in coverage. There is, however, still a need for strengthening efforts not only to maintain but also to accelerate the pace of development. WHO, in close collaboration with UNICEF, is actively supporting governments in these efforts. The Organization's collaboration with Member States in the field of traditional medicine continued to receive increasing attention. In a number of countries - notably Bangladesh, Burma, Nepal and Sri Lanka - plans have been made for the wider use of practitioners of traditional medicine in primary health care. National projects on traditional medicine have already been formulated in Burma, Nepal and Sri Lanka with support from WHO/UNDP. In some countries efforts are being made to organize activities for identifying and cultivating medicinal herbs/ plants, and for producing traditional medicines of standard quality on a large scale. The training of practitioners of traditional medicine for participation in primary health care is continuing and will receive increasing attention. In this context, protocols have been developed in selected countries for research into various aspects of traditional medicine. WHO is now encouraging the integration of mental health services into primary health care in some countries, and Bangladesh, India and Indonesia have already developed model projects in this regard. To improve diagnostic facilities for both clinical and epidemiological purposes, efforts to strengthen national health laboratory services and to extend them to the primary health care level have continued. WHO has provided technical support to these efforts as well as to the development of reference laboratories on a regional basis. Family Health Family health is a priority programme in all the countries, and the activities are being supported in collaboration with UNFPA. WHO'S programme in this area is primarily directed towards appropriate and adequate manpower development and reorientation of the training of health personnel, including traditional birth attendants, in the context of primary health care. The family planning programme, based on the maternal and child health activities in most countries, is, however, directed at stimulating contraceptive practices and the small family norm. Of interest in this connexion are the current studies on the "Risk approach to the delivery of maternal and child health", based on the perinatal study which was completed last year. In the field of nutrition, the programmes are now conceived as a collaborative action-cum-research activity, and have been developed following interdisciplinary consultation with governments and in close collaboration with UNICEF. The action is community-oriented, taking into account the available resources and the socio-cultural situation. During the past year, protocols for a number of research projects were reviewed and streamlined at meetings of persons constituting national focal points, at which the technical aspects of nutrition and its linkage with the socio-cultural focus on target groups, namely, mothers and children, were balanced. Some of these research projects are now being implemented. Health education has been accorded increasing priority in Member States in recent years, and WHO has given special attention to the introduction of the health education component in programmes, wherever relevant, in order to ensure community participation. An inter-country seminar sponsored by WHO emphasized and delineated the role of post-graduate teaching and training in health education in strengthening health education programmes in the countries. The Organization continued to support several countries in establishing health education activities as an integral part of the health services at all levels, through the assignment of long-term staff and short-term consultants, the provision of audio-visual equipment and the development of teaching and training materials, in addition to training personnel. Communicable Diseases Communicable diseases continue to remain a major public health problem, accounting for a large proportion of the health budgets in most countries. During the year under review, epidemiological services and the surveillance of communicable diseases were strengthened further. A programme of training in field epidemiology was started in Thailand, and an M.Sc. course in epidemiology is being organized at the University of Indonesia. Among the important communicable diseases, malaria is receiving priority attention in view of the enormity and complexity of the problems - technical, managerial and financial - which hinder control measures and which are yet to be satisfactorily solved. The Organization continued to provide support to the technical aspects related to clinical, epidemiological, entomological and environmental interventions to prevent and control the disease. The emphasis in WHO'S collaborative effort, however, has been on manpower training, to strengthen the service programme, and on research, to improve the strategy, techniques and methods for clinical, epidemiological and bioenvironmental management. It is gratifying to report that, in the Region as a whole, the number of cases of malaria was reduced by 17% in 1980 as compared with the previous year, although in most countries the efforts for control need strengthening immediately for sustained improvement of the situation. Although, in addition to WHO'S technical colla.boration, CIDA, the Netherlands, Sweden (SIDA), US AID and the United Kingdom have substantially assisted the malaria control efforts in the Region, there is a need for further mobilization of resources, particularly in view of the increasing cost of drugs and insecticides. The control of diarrhoea1 diseases (CDD) through a multidisciplinary approach forms an integral part of primary health care services in several countries of the Region. Development of manpower in both the technical and the managerial aspects of the programme, attainment of self-reliance in the production of oral rehydration salts, development of a simple but effective logistic system, and health education of mothers and the community at large are the main components of the programme. Substantial progress has been made in establishing control programmes in Bangladesh, India, Indonesia and Nepal. The activities in Burma, Thailand and Sri Lanka are also gaining momentum. Two regional training centres for diarrhoeal-disease control have been functioning - one in Dacca and the other in Calcutta - and a similar training centre is being planned for Jakarta. In addition to service and training programmes, research activities are simultaneously being organized and supervised through a Regional Scientific Working Group on Diarrhoea1 Diseases, which was established in early 1981. UNDP and UNICEF have been closely collaborating with WHO in developing this programme. The fight against tuberculosis as a public health problem based on conventional identification and treatment strategies, continued. In addition, BCG vaccination continues as usual. The problems still facing national programmes are shortage of appropriate drugs, a weak logistic system and the improper administration of drugs owing to inefficient management and supervision. These weaknesses were clearly revealed last year in an assessment of the programme in Nepal carried out by a WHO consultant. As for research, the Study Group on Tuberculosis, convened in the Regional Office in March 1981, reviewed the priorities and a number of protocols for research on tuberculosis. Despite recent advances in leprosy control, this disease continues to be an important public health problem. WHO has assisted in organizing training activities, provided technical cooperation, and supported research into several aspects of leprosy. The regional research activities are complementary to those supported under the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. With the availability of funds from the Japan Shipbuilding Industry Foundation, leprosy control activities in the countries of the Region have been intensified. A vaccine against leprosy is not yet in sight, though research in this regard continues to be supported by WHO under the TDR programme. Sexually-transmitted diseases (STD) are rapidly emerging as a problem of increasing complexity. An inter-country meeting held in November 1980 formulated guidelines for strengthening national STD control programmes. In addition to under-reporting of these diseases, the rapid emergence of resistance of the gonococcus to penicillin is causing serious concern in some countries. Though governments in the Region are alive to the complications and sequelae of these diseases, not much headway has yet been made in their control because of technical and socio-cultural constraints. WHO continued to collaborate with countries, notably Burma, Indonesia and Thailand, in strengthening national surveillance programmes for dengue haemorrhagic fever and in the development o f epidemiological and entomological surveillance, strengthening of arbovirus laboratories, improvement of diagnosis and clinical management of cases of DHF and dengue shock syndrome, and research. The WHO Collaboratinq Centre for Research on the Immunopathology of DHF in Bangkok has continued its work, including studies on the development of a vaccine against DHF. At a meeting of the Research Study Group on DHF, held in March 1981, the various aspects of DHF and of research activities for a dengue vaccine were reviewed. During the year, immunization programmes were further expanded in all countries of the Region. In many, there was found to be a considerable increase in the reported numbers of children and pregnant women fully immunized against target diseases under the Expanded Programme on Immunization. Also, in these programmes, a statistically valid and objective method of evaluating immunization coverage was more widely used. In 1980, the number of coverage surveys (in six countries of the Region) increased to 28, and in the areas where they were repeated at one-year intervals, e.g., in Sri Lanka and Burma, the results showed that the coverage had significantly increased. At the same time, the logistics, vaccine and cold-chain system saw further improvement in many areas, ensuring the required level of potency of the vaccine used. The epidemiological surveillance of the target diseases was also improved. In 1980, sentinel areas, to report regularly on incidence to the centre, were established in at least one country (Indonesia), which also set up a feed-back system. The available data indicate that in some areas of the Region the Expanded Programme on Immunization has already influenced the epidemiological parameters of some of the target diseases, viz., decrease in the incidence rates of neonatal tetanus and diphtheria. In 1980/81, particular stress was laid on the training of health staff in the immunization programme. WHO-sponsored inter-regional and inter-country courses in both technical and managerial aspects of the programme have been held, and, by May 1981, the number of trainees from the Region completing these courses had gone up to 300. These trainees, in turn, have conducted training courses in their own countries, which are attended by large numbers of national participants. Thus a core of trained personnel at different levels of the programme has been made available. Noncommunicable Diseases With increasing life expectancy at birth, due to the improved health status of the population, a number of diseases such as cancer and the cardiovascular diseases are emerging as public health problems, especially in Burma, DPR Korea, India, Sri Lanka and Thailand. The major thrust of WHO'S collaboration with governments in the control of these diseases is on community-oriented programmes for early detection and treatment, along with health education for preventive action by the individual and the community. To this end, collection of epidemiological information to define the nature and extent of the problem as well as to serve as the basis for prevention and control is being actively pursued in a number of countries. WHO has also supported the training of manpower and the development of institutional facilities for diagnosis and treatment. Preventable and curable blindness and impairment of vision, particularly due to cataract, xerophthalmia, infections and injuries, have become important public health problems. With the active collaboration of international, bilateral and voluntary agencies, it has been possible to start prevention and control programmes in the countries affected. One of the major efforts has been launched, on a countrywide basis, in Nepal, where a national survey of blindness has just been completed and the data are being processed. Extensive programmes to prevent blindness due to vitamin A deficiency are continuing in Bangladesh, India and Indonesia. Control of trachoma and its complications, e.g., entropion, is being managed by specially trained health assistants in Burma, Nepal and Thailand. Sri Lanka and Thailand have also been carrying out national programmes for blindness control. To ensure continuous technical support to national programmes, the Regional Office has established a post of Regional Medical Officer for the Control of Blindness, with funds provided by the International Agency for the Prevention of Blindness. Environmental Health It is well known that one of the basic requirements for raising the status of health and the quality of life is the provision of appropriate water supply and sanitation facilities to the community. In this context the launching of the International Drinking Water Supply and Sanitation Decade, on 10 November 1980, by the United Nations General Assembly was the occasion for practically all Member States in the Region to enunciate their goals and intentions and to give wide publicity to this decade through the mass media. A number of countries have set up appropriate national bodies for development of their plans, coordination and guidance; some have completed their first draft plans and others are expected to do so before the end of 19 81. In this context it is gratifying that governments have realized that the plans to be developed for the Decade must fully incorporate the primary health care approach, and must involve community participation, appropriate technology and service levels and the building up of self-reliance to the maximum extent possible, especially with regard to operation and maintenance. Another welcome feature was the awareness among many funding agencies that health education, personal hygiene and sanitation have to go hand in hand with safe water supply if the full benefit is to be realized. Projects for human resources development, in particular, are being reoriented in line with this concept. The Organization, in close cooperation with the World Bank, UNICEF, US AID and GTZ continued to provide technical support to ember States in the field. In addition, WHO is actively involved in developing an information service in environmental health, in collaboration with DANIDA. Yet another activity to which WHO is providing support, with UNEP, is the Global Environmental Monitoring System (GEMS) programme, directed towards the control of water and air pollution. Another major aspect of WHO'S environmental health programme has been its support to Member States in training manpower at all levels for work on water supply and sanitation as well as for the prevention of environmental pollution. Promotion and Development of Research The activities of the Organization in the field of research promotion and development have been continuing with advice from the South-East Asia Regional Advisory Committee on Medical Research (SEA/ACMR). Although actual research in the priority areas is supported as far as is practicable within the available resources, the major thrust of the programme has been towards the application of existing and emerging results of research to the improvement of health policies and programmes and the attainment of self-reliance in research, not only by individual Member States but by the Region as a whole. WHO has been collaborating with governments in this regard through a network of national medical research councils or similar national bodies which are actively involved in promoting and developing research in their own countries and in exchanging ideas and views through annual meetings of their representatives held under the aegis of the Organization. During the year under review the SEA/ACMR initiated efforts to review the research priorities in the light of HFA/2000 strategies, developed at the national as well as regional level. A sub-committee was entrusted with this task and has already developed a basic policy paper, laying down the criteria for the selection of priorities. Another important activity has been the stimulation of health services research. There is now a clear recognition of the importance of developing research activities to facilitate the application of the results to the improvement of health programmes by incorporating newer technical knowledge, modern management techniques and built-in operational monitoring and evaluation. To this end the SEA/ACMR is reviewing the situation in respect of health services research in order to formulate guidelines for research in this 'important area. In order to create a core group of scientists in each country to generate and sustain appropriate research efforts, the Organization has been providing "visiting scientists grants" and research training grants to selected young research workers who are actively involved in priority research. Courses in research methods have also been supported in order to provide training to promising young scientists with a view to strengthening the manpower for research. Health Manpower Development With national commitments to primary health care as the key approach to the attainment of the goal of health for all, the need for developing adequate and appropriate manpower to support PHC-based health systems has become very critical. In WHO'S collaborative programmes in health manpower development the emphasis is on well-balanced activities in all three main aspects of the health manpower development process - namely, planning, training and management. In addition, as an integral part of the process, research in health manpower development receives due attention. Planning for health manpower within the framework of overall national health development and its implementation through coordination between health care and education, has been continuously emphasized and encouraged; application of scientific planning methodologies has been the basis of health manpower development programmes in many countries of the Region. Also, reorientation of the training programmes for different categories of health workers and the promotion of appropriate training for effective team-work in the delivery of primary health care have been intensified. Attention has been given to identifying the roles and responsibilities of all categories of health personnel working in primary health care, as a prerequisite for the appropriate development of training programmes. The training of conventional health workers at community level and also of new categories, to strengthen their primary health care capabilities has been further developed and evaluated. In addition, some countries have planned, or are already conducting, training in health care management to support the functioning of primary health care at all levels. A regional network of public health training institutions is being established, and the training of trainers for all categories of health personnel as well as the development of health learning materials have made steady progress. Technical Cooperation Among the Countries The Organization continues to promote technical cooperation among the developing countries (TCDC) in the Region. Early in 1980, an inter-country consultation on TCDC in health planning and management identified specific activities for the purpose,to be implemented by governments, WHO and other international and bilateral agencies. This meeting was followed by two more consultations - on appropriate technology for health and on pharmaceuticals - at both of which the various aspects of TCDC in the respective fields were considered. Yet another effort has been the planning meeting for the establishment of a regional network of public health training institutions mentioned above, at which the coordinative action to be taken by countries in establishing the network were outlined. In spite of these efforts, progress appears to be slow because of time-consuming procedures involved in implementing the action to be taken jointly by governments. To overcome these difficulties, consistent and patient pursuit of the objectives of TCDC by governments as well as by WHO and other organizations concerned must continue. Study of WHO'S Structures in the Light of Its Functions This study on WHO'S structure emanating primarily from a number of inter-related resolutions approved by the World Health Assembly and the Executive Board, has been under way for some time. In pursuance of resolution WHA33.17, the Organization has developed a plan of action which was endorsed by the Regional Committee at its thirty-third session. Accordingly, the study has been continued by the Regional Office with a view to analysing and modifying the functions, if required, proposing necessary changes in structure and indicating the nature and extent of staff requirements in the light of the goal of HFA/2000. The interim results of the study indicate that there is considered to be no need for any drastic change in the functions and structure of the Organization; what is needed, however, is a change in the style of functioning and a streamlining of the managerial processes along with minor readjustments of the staffing pattern, to conform to the concepts contained in the Seventh General Programme of Work. Efforts made by governments in which the Organization had the privilege of cooperating and collaborating during the period under review, are thought to have contributed significantly to overall health development in the Region. The central theme as well as the spirit of HFA/2000 seems to have gained rapid and growing recognition and enthusiasm, which has pervaded all these efforts. I should like to express my sincere gratitude to the peoples and the governments of our Member States for their unstinted support to the Organization to enable it to perform its task and to play its due role. Although this is my first annual report since taking over from Dr Gunaratne on 1 March this year, I am confident that, with growing determination and commitment on the part of our Member States, we will continue to draw ever closer to the objective of health for all so as to bring peace and happiness to all our people. Dr U KO KO Regional Director PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services Member States have well recognized the importance of systematic plan- ning, and have been formulating annual, medium-term and long-term plans for overall socio-economic development, of which health is an essential component. Country health programming (CHP), involving not only health but also other sectors in the formulation of health plans, is increasingly being accepted, applied and improved. In fact, some countries in the Region are carrying out the second cycle of CHP. In all these planning exercises, there is concrete evidence of positive policy support and a strong national commitment to the goals of Health for All by the Year 2000 (HFAl2000) and to the health concepts outlined in the Declaration of Alma-Ata. In this context it is most significant that the Charter for Health Development has now been adopted by nearly all the governments of the Region. In view of the fact that health development is planned as a multi- sector activity, and as the contributions of the various sectors must be coordinated, most of the governments have appointed high-level committees to act as coordinating bodies at the national level, to formulate policy and to supervise the planning,monitoring and evalua- tion of health development activities. For this purpose, health information systems are being strengthened, and manpower for health planning is being trained at all levels. Governments have also accepted the primary health care approach as the best way of providing reasonably good health services to all the people,especially the underserved groups,within the next two decades. For achieving this task, it is essential to expand and strengthen the health infrastructure,especially in regard to the training and super- vision of primary health care workers and the provision of logistic support and referral systems. The need for comprehensive and integrated services is also well under- stood by health ministries. In other words, the trend toward develop- ing promotive, preventive, curative and rehabilitative services, not only for rural areas but also for urban slums, and developing them in an integrated manner at the community level, is gaining momentum. 1.1.1 Health Planning, Programme Formulation and Evaluation The mechanics of health planning,as well as those of programme formu- lation and evaluation,together with efforts to improve national capa- bilities in these fields,have thus continued to make steady progress. The planning exercises mentioned above have also been conducted at provincial and district levels, and some countries have even started macro and micro-level evaluation. In BANGLADESH, country health programming (CHP) was carried out for the second time and a comprehensive country health profile prepared. These exercises contributed to the preparation of the Second Five- Year Plan(1980-1985) for the health sector as well as long-term plans up to the year 2000. The Government has set up a multisectoral national council for the promotion of HFA/2000 together with several national committees. In addition, appropriate health legislation is being drafted, and the national health information system (NHIS) strengthened. In collaboration with non-governmental organizations, progress has been made with schemes for integrated rural development with the appropriate health component. Steps have also been taken to reorganize the health services and to adopt a unified approach to the delivery of integrated curative and preventive health and family planning services. WHO has provided technical support for these efforts. In BHUTAN,the existing UNDP/WHO joint health project is being expand- ed to strengthen the national health information system and to help in the further development of a health planning cell at central level. A start has been made with decentralized health planning, implementation and management in Paro District. In BURMA, the "People's Health Programme" has been elaborated on the basis of the country health programming exercise undertaken in 1975. There have been intensive preparatory activities, including steps to set up a national health development council and a committee for intersectoral coordination. Also, the Government is establishing a task force for HFA/2000; the health acts are being amended, and the formulation of new legislation is under way. In the second cycle of CHP, which started in July 1980 and was completed early in 1981, five broad programme areas were identified - community health care, hospi- tal care, disease control, environmental health and support services. Following this planning exercise, a workshop on project formulation and one on monitoring and evaluation were conducted, leading to the modification of the existing monitoring and evaluation system for CHP. People's councils at different levels - state,township and ward/ village - are involved in the planning and implementation of the pro- grammes, for which WHO has provided technical support. The Government of INDIA has committed itself to the provision of health for all its citizens by the year 2000. The health policy for 1980-85 accords very high priority to primary health care, with emphasis on intersectoral coordination. Indicators have been estab- lished to monitor the progress towards HFA/2000, and five working groups, including one on inter-sectoral coordination, have been set up to prepare reports on various components of the national plan, with staff from the Regional Office contributing to these efforts. It is proposed to establish a national coordination committee for HFA consisting of persons drawn from high decision-making levels in the health and related ministries. The phased implementation of integrat- ed rural development programmes, with special stress on tribal and other difficult areas, and of schemes for the integrated development of children received priority support. Reorganization of the central, State and district health administrations, with emphasis on decentra- lizing and restructuring for efficiency, is under way. INDONESIA has made significant headway in reformulating its health system and in preparing long-term plans for HFA/2000. So far, two five-year health development plans have been formulated, adopted and implemented, i.e., Pelita I (1969-1974) and Pelita I11 (1974-1979); Pelita 111, covering the period 1979-1984, is now in operation. The national health information system also is being strengthened. WHO continued to collaborate in these activities: a team of specialists, consisting of health planners, health economists and statisticians, along with several short-term consultants, has assisted the country in its continuing efforts to develop and improve systematic national health planning and management. In MALDIVES, the first country health programming exercise, which took place in 1980, determined priority programmes for health ser- vices and health manpower development. As a result, intensive efforts are being made to carry out appropriate health manpower training so that there will be adequate numbers of health workers at all levels. ~echnical support has been provided by WHO through Regional Office and also inter-country project staff. Intersectoral coordination of health planning and development among the ministries concerned is also being strengthened. In MONGOLIA, the new five-year health plan (1981-1985) has been pre- pared in line with the primary health care concept. Also, the formu- lation of a strategy for health for all has been completed by a special group under the chairmanship of the First Deputy Minister of Health. Along with health, the development of other social sectors such as education and culture is being geared up, with housing and water supply receiving particular attention. The systematic enforce- ment of health and health-related legislation has been started under the State Planning Committee; also, external resources are being co- ordinated to ensure comprehensive socio-economic development, with health as a priority component. A new pilot scheme for comprehensive rural development including health has been drawn up with the help of a WHO consultant. In NEPAL, the Government has made plans for the health sector, with the objective of meeting the basic minimum needs of the people as the first step towards HFAI2000. To facilitate the achievement of this goal, a national development council has been created, with is Majesty the King as chairman. The National Planning Commission is actively working for intersectoral coordination, and the Ministry of Health has been using comprehensive CHP concepts and methods for the planning, monitoring and evaluation of health development activities. The Government has set up a steering committee for HFA/2000 and an HMGIWHO management committee; also, a community health and integrated development board is being formed to facilitate the development of community health services. Health planning is being decentralized to the district level; the national health information system is being strengthened; a scheme for integrated rural development with a health component is being implemented, and indicators have been developed for the monitoring and evaluation of health programmes. Health for all by the year 2000 has been accepted as a national goal by the Government of SRI LANKA. It is also realized that the achievement of this objective calls for concerted and collaborative efforts on the part of the Ministry of Health and related ministries and agencies. A national health development committee has been estab- lished as the technical arm of the National Health Council; this cmittee, on which WHO is represented, with its sub-committees, consisting of members of the Health Ministry and related ministries and institutions, is charged with the responsibility of drawing up appropriate strategies and plans of action for HFAl2000. It is proposed to create similar intersectoral committees at the district level as well. Steps have been taken to decentralize the health administration, and a White Paper on a major reorganization of the Ministry of Health has been cleared by the Cabinet for general dis- cussion and debate. WHO has been supporting some of these efforts both technically and financially. THAILAND has made significant progress in health planning and manage- ment. Several seminarslworkshops were conducted during the period under review, to orient health officials in health planning methods and techniques,to set up targets with indicators, and to evolve stra- tegies and plans of action for health development. WHO not only has supported these activities, but also has assisted in strengthening the planning ~ivision and the national health information system, thereby stimulating efforts to develop health planning not only at central but also at provincial and district levels; the Ministry of Public Health has been working closely with the ~ational Economic and Social Development Board and the Budget Bureau in this regard. A planning committee for social development at macro-level has been established by the Government, with a sub-cornittee on health, which has set up working groups to activate the health planning processes further at all levels. The Ministry of Public Health is using CHP methods and managerial processes for national health development as conceived by WH0,and the Organization has provided financial support for setting up a network for this development. Through WH0,assistance is also being provided by the Government of the Netherlands. 1.1.2 Organization of Health Services Governments' awareness of the role of the health infrastructure in providing supervisory and referral support to help primary health care workers increase the coverage and improve the quality of their services has already been stressed. In view of the limited services available to the people living in rural areas and urban slums, all governments have now accepted the policy of developing integrated primary health care services by augmenting the number of health centres, sub-centres and primary health care workers at the grass- roots level. In BANGLADESH, two divisions, i.e., those of Health and Population Control, have been combined and brought under a single supervisory authority. Likewise, the Directorates of Curative and Preventive Health Services have been amalgamated to form one Directorate General of Health Services. The Government has constituted a national field implementation committee for the primary health care programme which periodically reviews the progress made in the primary health care pilot project and suggests further improvements. The health infrastructure in the country will be further strengthened under the Second Five-Year ~lan(1980-1985),which envisages the opera- tion of thana health complexes, one in each of the 356 rural thanas, as well as 4500 union health centres/family welfare centres. These complexes will support primary health care activities at village level. As against the target of 356 thana health complexes, 290 have become functional; similarly, as against the target of 4500 union health centres/family welfare centres, 1990 have started functioning. In all, 5000 Palli Chikitshaks have been trained so far to work in rural areas, and at village level, approximately 13 500 field workers are providing health care. The specialized medical care services in subdivisional and district hospitals will be further strengthened to form an effective referral chain along with the thana health complexes and union health centres. In order to strengthen the health infrastructure, laboratory services will also be ~rovided so that the quality of diagnosis and other sup- port to public health programmes will be improved at district, thana and union levels. WHO helped to organize a management workshop for senior government officials to orient them in effective health management practices. In BHUTAN, progress continued to be made in converting dispensaries into integrated basic health units. Zonal health supervisory systems have been established, and zonal hospitals are being strengthened to provide technical support and referral services and to help to train various categories of paramedical personnel. Assistance is being given in the training of village health volunteers, who are being used in primary health care. In BURMA, the people's Health Programme assigns first priority to primary heaIth care and basic health services. The coverage has now reached 50% e., 147) of the townships. About 14 000 cornunity health workers have been trained and posted to underserved villages, where they are supported and technically guided by the basic health services staff. Township hospital staff have been trained in hospital administration and management, and a hospital procedure manual has been prepared and distributed. With WHO assistance, special health services are being provided for workers and their families in three industrial areas of eight townships on the west bank of the Irrawaddy River. During the period under review,563 hospitals, 213 dispensaries and 1187 rural health centres became operational, UNICEF and WHO providing the necessary supplies and equipment. In INDIA, the Government accords the highest priority to the inte- grated rural health scheme. India now has 5463 primary health centres (PHcs), 42 032 sub-centres and 340 upgraded PHCs. Under the Sixth ~ive-Year Plan (1980-19851,the target is to establish 600 new primary health centres and 40 000 sub-centres and to upgrade 1000 rural dis- pensaries to become subsidiary health centres. WHO and UNICEF have continued to support the development of primary health care centres in the country. In INDONESIA, the expansion and strengthening of the infrastructure of basic health services in rural areas continued, in line with the needs of Pelita 111, which was started during the 1979-1980 fiscal year. At the end of Pelita 11, there were 4353 health centres, with at least one in each of the 3270 sub-districts in the country. The percentage of health centres staffed by doctors has reached 89.5, and the average number of health centre visits per day has increased from 25 to 75. The strengthened infrastructure of the rural health ser- vices has contributed greatly to the development of primary health care. A WHO team consisting of a public health administrator and a public health nurse is participating in the development of conrmunity health services. In MALDIVES, health care is provided through the Government Hospital in Male and by health centres in various atolls. WHO consultants in a variety of specialties have provided clinical services at the Govern- ment Hospital, Male. MONGOLIA continues to have a very good health service delivery sys- tem, from the central level to the aimak, somon and brigade levels. WHO provided the services of a hospital architect to assist the Government in designing hospital facilities suited to local condi- tions. An innovative scheme for coordinated and comprehensive rural development, including health, is being planned for Hubskul Aimak, with WHO'S technical support. In NEPAL, the Integrated Community Health Project has entered its third phase,bringing the number of integrated districts up to 23. The five core services - maternal and child health and family planning, the control of malaria,leprosy and tuberculosis and the expanded pro- gramme on immunization - are delivered as a package through regular home visits by village health workers in the integrated districts, while the health posts provide basic medical care. Malaria control is, however, being implemented in only six districts. A high-powered rnultisectoral coordination board is being established to develop com- prehensive rural health services. The Project,which WHO is supporting technically through the provision of a public health administrator, has organized annual workshops for district-level health personnel to enhance their management capabilities. SRI LANKA has an extensive network of both traditional and modern systems of health care. The indigenous system, which meets about 22 per cent of the demand, is limited to curative services and operates through a network of dispensaries and eight ayurvedic hospitals. The modern system, meeting some 73 per cent of the requirements for health care, provides both preventive and curative services. The physical infrastructure for health services is comparatively well developed in Sri Lanka, but the problem of brain drain continues to create difficulties in manning the health facilities. In THAILAND, the integrated rural health services continued to be strengthened and upgraded in support of primary health care. At present there is at least one provincial hospital in each province, and there are 305 district hospitals, with a total hospital bed strength of 31 727. The rural areas are served by 3899 health centres and 1613 midwifery centres, covering about 80% of these areas. WHO has continued to assist in the training of supervisory personnel and peripheral health workers at rural level. 1.1.3 Operational Studies Most of the operational studies undertaken or planned during the period were aimed at supporting HFA activities. As the strategies to achieve the objectives of ~FA/2000 evolve and national plans and regional actions in their support crystallize,the priorities in these studies can be more clearly perceived. The studies carried out so far in the countries of the Region have mostly been confined to the central levels of the health services and to the universities. The involvement of the field staff at the peripheral level in operational research has been inadequate, the major constraint continuing to be lack of training for such staff in the necessary investigative metho- dology. In BANGLADESH, the study of the financial aspects of health care delivery which started last year was completed; the data are being analysed, and a preliminary report has been prepared. The results of this study have, to some extent, helped to rationalize the budget allocation among different health subsectors. Another study, on the impact of socio-economic and educational aspects on disease pattern in rural children, is under way. A consultant was assigned to assist in the planning and conduct of a workshop on research planning and methodology. In BURMA, the WHO-sponsored study on the application of the risk approach to the delivery of maternal and child health care, initiated in 1979, continued during the period under review. The results of this study are likely to provide useful information for the develop- ment of national strategies to deliver the right type of MCH and family planning care through the redistribution of available resources based on the measurement of levels of individual and community risks. WHO provided a consultant to assist the Government in developing a research programme in health manpower development. In INDIA, the study on the outcome of pregnancy, including perinatal mortality and low birth weight, was completed, and one on the appli- cation of the risk approach and intervention strategies in MCH care was initiated in Maharashtra. The objectives of these studies are to develop strategies for MCH and family planning care and to build up a satisfactory model within the available resources. Three short-term consultants were assigned - one to assist in developing a progranme of research in health manpower development,the second to help conduct a sample survey to estimate the annual incidence of and mortality due to neonatal tetanus and poliomyelitis,and the third to collaborate in making a sample survey of the incidence of poliomyelitis and neonatal deaths in the States of Punjab and Haryana and the Union Territory of Chandigarh. Assistance was also provided in organizaing a national seminar on appropriate technology for health, which was held at the Indian council of Medical Research in April 1981. In INDONESIA, the studies on the incidence and causes of disability and on rehabilitation services through primary health care were com- pleted, and the data are being processed and analysed. The Centre for Research Development in Health Services in Surabaya continued to function as a WHO Collaborating Centre for Health Service Development and was involved in stimulating, promoting and implementing several research projects. A short-term consultant was assigned to colla- borate in the development of a research programme in health manpower development. Assistance was also provided in organizing national seminars on general research methodology and on an appropriate technology for health. SRI LANKA's study on health sector "commodity requirement and expenditure flows", initiated last year, continued. The results of the study should help to clarify a number of policy issues, such as the impact of the private sector, the pharmaceutical industry, and fiscal policy on the health sector and the choice of technology for future health management. Another study, an analysis of the work of medical officers and assistant medical practitioners, was carried out to facilitate decisions on educational management. A consultant collaborated in a research programme in health manpower development. Assistance was also provided in organizing a national seminar on health services research, held in February 1981; this seminar deli- neated important areas related to primary health care and helped to generate an awareness of the importance of the multidisciplinary approach and of intersectoral coordination. In THAILAND, the study on the application of the risk approach in the delivery of MCH care continued. The research workers evaluated the performance of auxiliaries and village health connnunicators, and an evaluation pre-test was carried out in three sub-districts. Data on the study of the factors responsible for rural low birth weights are being collected and processed. The pilot study on a simplified data collection system, for strengthening the MCH/FP information sub- system to support the monitoring of the programme, has resulted in the development of a simple data collection card, which is being field-tested. The study on the psycho-social aspects of rural health services continued, and two further studies - on strengthening the basic immunization programme in urban communities and on the perform- ance evaluation of village health volunteers and village health communicators in Nakhon Pathom Province - are under way. With WHO support seminars were organized for training national workers in research methodology with special reference to health services research and also in an appropriate technology for health. Consultants were assigned to advise on (a) research design and metho- dology, (b) the coordination of health research activities, (c) the development of a research programme in health manpower development, (d) survey techniques to establish the child mortality rate, (e) the cost analysis of health development programmes, (f) comparison of alternative strategies for health development by using cost effectiveness or other analytical economic methods, and (g) the formulation of long-term health plans. 1.2 Primary Health Care The Organization has begun to reorient its technical cooperation programme with Member States in consonance with national and regional strategies to achieve the goal of ~FA/2000. An HFA orientation has been given to regional group educational activities, and the precise ways in which WHO'S collaboration should now be extended are being evolved in consultation with Member States. There have also been regional and national activities directed toward the development of appropriate technology for health in relation to primary health care. Two workshops - one regional and the other bi- regional - were held in New Delhi in October 1980 and March 1981 respectively, to review the present level of technology in the Region and to seek ways and means of adapting the existing technologies and developing new ones. In BANGLADESH, the work of committees functioning at different levels of the administration for intersectoral coordination and community participation is being oriented towards the promotion of HFA/2000 objectives. In six pilot thanas, work on the formulation of village health committees and on acceptable methodologies for selecting family welfare workers is in progress. Another activity being carried out in the pilot phase is the training of community health workers. In this connexion, the translation of the WHO Manual, "The Primary Health Worker" has been completed. Also, a closer relationship bet- ween health and family planning workers, including community health workers and field personnel of other agencies, is being developed. In BURMA, considerable progress has been made in the implementation of the People's Health Programme. The training of community health workers, basic health workers and other health staff engaged in this programme continues according to plan, with support from WHO. The Organization has also extended assistance in improving the indigenous system of medicine. A study has shown that, as a result of the intro- duction of voluntary health workers, the proportion of the community seeking treatment from basic health workers has decreased consider- ably - an encouraging trend in the development of primary health care. In INDIA,as stated earlier,primary health care is given high priority in the new draft health policy for 1980-1985. The draft plans of ministries other than the Health Ministry have been coordinated to give priority to components related to HFA/2000. The budgetary provision for the health sector has been increased. The community health volunteer scheme now covers 2366 primary health centres, extending services to almost half the population. The number of community health volunteers exceeds 140 000. Steps are under way to strengthen the rural health divisions in the directorates of health of different States. Female health assistants working in the field have been trained in the early detection of complications of pregnancy as a part of improved primary health care of pregnant mothers. In INDONESIA, the Government, with WHO collaboration, initiated a comprehensive and critical review of the national health system in order to restructure it so as to achieve HFA/2000 goals. The Organization also supported a travelling seminar on primary health care and village development (PKMD) for 32 administrative leaders and medical officers from twelve provinces. The Ministry of Health, in collaboration with UNICEF and WHO, completed an assessment of primary health care activities as carried out by traditional birth attendants, village volunteers and school teachers in 52 villages of six provinces. Two national task forces and working groups developed a plan of action to implement the reconnuendations arising out of the assessment and submitted the plan to BAPPENAS, the central planning organization. In order to improve the monitoring and control of field activities, a model reporting and recording system for health centres is being prepared, and the training of 1030 health centre personnel, out of the Pelita 111 target of 5000, was completed. WHO organized a study tour for eight provincial-level supervisors to observe health centre reporting and recording in selected countries of the Region. With WHO collaboration, efforts continued for the production and distribution of a revised and updated version of the Health Centre Reference Manual. The Government of MALDIVES, in support of HFA/2000, has assigned high priority to efforts to overcome the shortage of trained manpower, and a systematic programme for training selected health personnel is in progress. The Government is also making efforts to utilize health auxiliaries to the maximum possible extent in the provision of pri- mary health care services. A health centre is being developed in each atoll as the core of the health services, with referral services pro- vided by the hospital in Male. In MONGOLIA,priority has been given to community-oriented out-patient care; it is planned that 75% of the health workers will be involved in providing out-patient medical care and that one paediatrician will serve about 750 children. The quality of health services is to be raised to a level which will correspond to that attained in other socialist countries. WHO has been supporting the Government in deve- loping these plans. In NEPAL, the "Basic Minimum Needs Steering Committee" established under the National Planning Commission consists of representatives from the five sectors involved in HFA/2000 activities (food and agriculture, primary and non-formal education, water and sanitation, rural communications and health), as well as from other important departments such as the Ministry of Finance. This committee has carried out a series of analyses, viz., population projection and requirements in regard to manpower, supplies and logistics, physical infrastructure, and finance in relation to HFA/2000. Based on these analyses, a preliminary document, "Planning for Provision of Basic Minimum Needs - 1980-2000", which was prepared in November 1979, has been revised and will be the basis for future action to achieve the goal. The Integrated Community Health Project (described in Section 1.1.2) is progressing satisfactorily as planned. During the period under review the ward-level health volunteer scheme was implemented in four panchayats and two districts on a pilot basis. Under the Sixth Plan it is proposed to extend this scheme to 13 districts. A manual for the volunteers has been developed and field-tested. In SRI LANKA, the re-organization of the health delivery system to be in line with the concept of primary health care received considerable emphasis during the year. Various alternative models have been reviewed and analysed,and the one based on the health centre concept, according to which comprehensive basic health services are provided to the population in a defined area,has been finally accepted. A team of paramedical personnel, such as assistant medical practitioners, nurses, public health inspectors and midwives, headed by a medical doctor, will be made respons'ible for the provision of family health, control of diseases, medical care and referral for the whole popula- tion of the area. It is expected that curative and preventive ser- vices, which have remained compartmentalized, will thus be integrated. In THAILAND, the national primary health care programme, which aims at providing at least 50% of the villages in the country with village health volunteers and village health communicators by 1981, is pro- gressing satisfactorily. WHO collaborated in the supervision and training of these categories of personnel. In addition, the popula- tion project, functioning in 20 selected provinces, also supported the primary health care activities in the project area. The develop- ment of appropriate technology for health in relation to primary health care is another area receiving priority. A national conference was held to focus attention on the technology required for different elements of the PHC package. Action directed towards the formation of drug cooperatives in support of primary health care has also increased considerably. A case study on the financing of primary health care at community level and another on technology for PHC which is now in use in rural areas were also undertaken with WHO support. 1.3 Traditional Medicine Burma and Sri Lanka have taken steps towards developing national programmes in traditional medicine. Indonesia and Thailand are study- ing the efficacy of some traditional medicines,and in Nepal the inte- gration of traditional medicine into the basic rural health services at the health-post level is in progress. A UNDP-assisted project on medicinal herbs and ayurvedic drugs for the least developed countries (Bangladesh, Bhutan and ~epal) in the Region,to facilitate the speedy development of their programmes in traditional medicine,became opera- tional during the year. In BANGLADESH, a national workshop on the promotion and development of traditional medicine was held in Dacca in December 1980. A short- term consultant has been provided to assist the Government in deve- loping a systematic programme on the basis of the recommendations of this workshop. In BURMA, a project on traditional medicine is in the offing with financial assistance from UNDP. The main aim of this project will be to strengthen the Institute of Indigenous Medicine in Mandalay and the existing traditional medicine hospitals/dispensaries in the country as well as to establish another 30 dispensaries. In ZNDONESZA,although a national project has not yet been developed, WHO gave financial support for translating into English copies of an Indonesian book on the utilization of medicinal plants. In order to make better use of the existing practitioners of tradi- tional medicine, the Government of MALDIVES has made plans to train them in primary health care. During the year under review, a specialist in traditional medicine advised the Government of NEPAL on the promotion of traditional medicine at the primary health care level. Recommendations were made for the planning and implementation of the programme,including the training of ayurvedic practitioners and the production of ayurvedic medicines at the Royal Drugs, Nepal. In' SRI LANKA, a separate Ministry of ~ndigenous ~edicine has been established. Plans are being formulated for carrying out a survey of the medicinal plants in the country,for training the existing prac- titioners of traditional medicine in primary health care, and for modernizing the production of drugs at the Ayurvedic Drugs Corpora- tion. Financial support was extended to the Government of THAILAND for the conduct of a national seminar on traditional medicine and primary health care. At the regional level, an inter-country meeting for the development of research protocols on priority areas in traditional medicine was organized in Varanasi, India, from 11 to 13 November 1980. Six such protocols were developed and have been sent to all the countries in the Region (except DPRK and ~ongolia) for appropriate action. It is expected that the response to these research protocols will be encouraging. Specialists from South-East Asia participated in three group educa- tional activities held in the People's Republic of China during the year, viz., (i) Raining Course in Acupuncture Treatment (1 September - 30 ~ovember); (ii) Inter-regional Meeting on Standardization and use of Medicinal Plants (3-11 November), and (iii) Training Course on Acupuncture Treatment (1 April - 30 June 1981). 1.4 Family Health The regional programme in maternal and child health, including family planning, continued to place emphasis on activities directed towards the goal of H~A/2000, in line with the regional strategies which were developed for this purpose and which were endorsed by the Regional Committee at its thirty-third session. WHO has supported the develop- ment, strengthening and integration of national maternal and child health and family planning activities as part of the primary health care package. In the field of manpower development for maternal and child health services, WHO assistance has been given in reorienting training programmes, both basic and continuing education, and in promoting the development of additional manpower to improve and extend coverage. The regional teacher education programme in maternal and child health continued to receive attention. School health services were promoted and strengthened to serve as an active focal point for primary health care. A regional meeting held in August 1980 drew up strategy guidelines for school health pro- grammes for the Region and for the development of a handbook for school health services. In the area of research promotion and development, support was given to health services research related to maternal and child health in several countries of the ~egion. In July 1980,WHO convened a regional workshop on the reproductive health of adolescents, where service- oriented research protocols relevant to the countries of the Region were outlined. A WHO consultant visited Bangladesh and Sri Lanka to assist the national scientists in completing the protocols. In accordance with a resolution of the Thirty-third World Health Assembly on infant and young child feeding (WHA33.32), renewed emphasis has been placed on the regional programme for support to Member countries in their attempts to promote breastfeeding, as a means of improving the health of infants and young children. Conse- quently, technical assistance was given to some countries in acti- vities concerned with education, training and information on infant and young child feeding and in formulating national codes for the marketing of breastmilk substitutes. Also, a regional plan of action on infant and young child feeding has been formulated to support national efforts. The activities in maternal and child health in the Region were imple- mented in close collaboration with UNICEF and UNFPA. Various group educational activities in maternal and child health were also carried out. In BURMA,the main thrust in technical support was towards the further development of health manpower for family health activities. Program- mes of in-service training for basic health workers,couuuunity workers (including traditional birth attendants) and workers of some allied sectors were supported and implemented. In order to strengthen refer- ral services for primary health care, fellowships in maternal and child health were awarded for training outside the country. A short- term consultant assisted in organizing suitable training programmes in maternal and child health for health personnel in the context of primary health care. A training workshop on educational technology was organized for the staff of the family health project with support from the Medical Education Unit of Institute of Medicine I, Rangoon. In INDIA, technical advisory support was provided for the UNFPA- funded family health programme. In order to strengthen perinatal and neonatal care at the district level, training courses for paediatri- cians and obstetricians were organized with the help of two WHO temporary advisers. The in-service training programme in maternal and child health for primary health centre doctors, supported by UNICEF,was evaluated by a WHO consultant, whose conclusions and recommendations were submitted to the Government. To help to ensure that details of the remodelled undergraduate paediatric curriculum, and of the curriculum on the teaching of MCH, are known to medical undergraduates and interns, WHO awarded further fellowships within the country. The usefulness of the "Handbook for the Delivery of Care to Mothers and Children in a Community Development Block" as a teachingflearning tool for the new curriculum in MCH and as a service manual for primary health centre physicians was evaluated by a consultant,who found the Handbook to be practical as a guide for medical officers of primary health centres and useful for undergraduates and interns. The preliminary draft "Handbook on Child Health" was completed by the Ad hoc Committee on MCH, coordinated by a WHO consultant. -- In MONGOLIA,the activities were implemented as planned; however,there was some delay in the supply of equipment, and the project activities were rescheduled at the request of UNFPA because of budgetary con- straints. Support was provided for establishing model aimak MCH services and organizing mobile teams for MCH services at aimak centres and in the somons. Intensive care units were set up in the children's and maternity wards of six aimak hospitals. The further development of health manpower in maternal and child health was promoted through the organization of national training programmes and the award of training fellowships. Several booklets related to education in family health as well as a handbook entitled "Healthy Family" were prepared. Six educational programmes in family health for parents were organized as part of the health education activities. The long-term WHO staff member under the maternal and child health project (MOG MCH 002) and the health education specialist working in the project "Epidemiological Studies of Population Growth" (MOG MCH 003) completed their assignments during the year. A national project manager has been assigned under project MOG MCH 003 since June 1980. A WHO consultant assisted in processing the data on research studies under the first phase of the UNFPA-funded project. Another consultant collaborated in designing the protocol of the study on infant and child nutrition, and in training national staff on the research methodology for the study. Research protocols for studies planned under the second phase of the UNFPA-funded project were designed with the assistance of a WHO statistical consultant. In NEPAL, technical support was provided through a new WHO project directed towards the development of the MCH component of the national FPIMCH project. A consultant was assigned to advise on strengthening and improving the existing maternal and child health and family plan- ning services,with special emphasis on health manpower training. Another WHO consultant helped to formulate a training programme on tubectomy (minilap technique) and also assisted in training health personnel in this procedure and in the organization and conduct of "minilap" camps. Assistance was also given to the training of health manpower in maternal and child health, especially at district level and directed toward panchayat-based workers,through national and regional training programmes. Training fellowships were also awarded in paediatrics to strengthen child health services at referral levels. Several UNFPA-funded projects became operational during the year under review. The research study on the growth and development of children using the WHO Growth Chart is continuing. Preliminary action was taken to support a study on maternal mortality and morbidity. In THAILAND, technical advisory services in family health were pro- vided through a long-term staff member assigned to the Regional Family Health Team. Activities under the UNFPA-funded projects, for which WHO is the executing agency, were related to health manpower development in family health through fellowships planned to meet the requirements of the national family planning programme, and through support to the infrastructure of the programme. These activities were implemented as planned, but because of UNFPA's financial constraints, the dates of award of some fellowships and delivery of some supplies and equipment had to be rescheduled. WHO participated in a UNFPA Needs Assessment Mission. A new project in maternal and child health for WHO support was formu- lated. Technical support also was given in organizing two national meetings on breastfeeding. Details of operational studies in this field are given in Section 1.1.3. 1.5 Nursing Since nurses,midwives and auxiliary nurses and midwives provide, and will no doubt continue to provide,the greater part of the primary health care in most countries of this region, their role in the deli- very of health care must be redefined, enlarged and enriched to meet the challenge of health for all. The educational programmes must be carefully planned so as to ensure that all nursing personnel are able to deliver health care services according to national needs and expectations. The development of nursing manpower as an integral part of the total health manpower has, therefore, been emphasized in WHO'S technical collaboration. The effective utilization of nursing person- nel, including traditional birth attendants (TBAs), in delivering health care services has also been encouraged. The collection and compilation of information on the status of nursing manpower were undertaken during the year. The Organization has been working with Member countries in the deve- lopment of nursing education and services. The framework given below is used as a guide in developing and planning activities at national level geared towards the primary health care programmes of the count- ries. Area 1: Development of nursing manpower planning as an integral part of the total health manpower system of the country. Area 2: Promotion of the effective utilization of all existing nursing personnel, including TBAs, in support of primary health care. Area 3: Development, strengthening and modification of nursing, midwifery and auxiliary nursing education programmes based on community health needs and problems, including the development of continuing education programmes for all categories of personnel. Area 4: Strengthening of the nursing service component at all levels of the health care delivery system. Area 5: Development of nursing research. - The progress and accomplishments in these five areas are shown for each country. In BANGLADESH, the Government has decided to establish more nursing schools to attain the goal of producing 10 000 nurses during the Second Five-Year Plan period. Thirty-eight additional senior regis- tered nurse (SRN) schools at the sub-divisional level and 170 junior nursing training centres in selected thana health complexes are envisaged. As of February 1981, 18 new SRN schools have been opened, bringing the total to 38. Four junior nurse training courses were conducted for a total of 78 participants and several handbooks and manuals were prepared. A continuing education programme was develop- ed, and its implementation planned, Three nurse coordinators have been designated to help with this programme. A write-up on the current situation of nursing manpower supply was completed. The introduction of a nursing registry system is envisaged. In BURMA, the training programme for traditional birth attendants is progressing well. The teaching methodology used in this programme has been considered to be most valuable to other countries in the Region. The development of nursing manpower planning, as an integral part of the total health manpower system of the country, was undertaken. In INDIA, the continuing education programme being carried out at the RAK College of Nursing, New Delhi, made good progress. A workshop on curriculum development was organized. A short course on orthopaedic nursing and rehabilitation was also conducted at the Jawaharlal Institute of Medical Education and Research, Pondicherry. The deve- lopment of a centre for specialized training in clinical nursing was discussed and the need for a further detailed plan recognized. In INDONESIA, support continues to be given for the implementation of the health nurse programme. As of January 1981 there were 94 schools officially reported to be in existence. A six-week clinical nursing course in the five major clinical areas was organized, and a one-year course leading to a certificate in special clinical fields for the general nurse has been planned and is expected to start later in 1981. A working group has been formed to review and revise the nurs- ing academy curriculum. A pilot study of graduates of four health nurse schools was undertaken in January 1981. (Above): The training of all categories of nursing personnel continues to receive Increasing attention in the Region. (Above right): Nursing is a vital element in the provision of medical care. ,Right): A group of student nurses receives instructions in midwifery. NURSING Special attention is being paid to the training and utili- zation of nursing personnel to extend health services to the periphery. It is estimated that 60-80 per cent of the deliveries in the Region take place under the supervision of a traditional birth attendant (TEA). To improve their skills an inter-regional workshop on ',Methods and Materials in TBA Training Programmes" was held in SEAR0 from 3-11 March 1981. Photo shows the partici- pants with Dr U KO KO. Regional Director (second from left in front row). who inaugurated the workshop. An operation theatre on whe provides services to ru communiti Health workers address villagers to seek their participation end involve ment in primary health care activities. TAKING HEALTH CARE TO THE PEOPLE A health worker on her daily rounds. _, .- .w . . , Warkersfrom a rural health centre '... . i , ,,a ' , : prepare to leave for home visits. Reorientation of nurses for the effective provision of primary health care is one of the main activities. An analysis of current curricula used for training the health aide and the assistant nurse was com- pleted. Translation of "Management of Obstetrics and Emergencies in a Health Centre", by B. Essex, into Bahasa Indonesia was completed, and the book will be tested for its relevance to local conditions. All training programmes at the Allied Health Services Training Centre, Male, MALDIVES, are progressing according to schedule. The strengthening of field experience for the students is being empha- sized in the training. Preparation of teaching staff in regard to course development, appropriate teaching methodology and evaluation methods constituted a major achievement. Group educational activities organized during the year helped to enhance the knowledge and skills of community health workers and other health personnel. In MONGOLIA, a WHO consultant provided assistance in the training of nurse tutors in aseptic techniques and of head nurses in hospital management, as well as in strengthening the nurse teachers' teaching methodology. In NEPAL, planning for the post-basic courses in community health nursing was undertaken. The criteria for student selection were formulated, and the preparation of field areas for student practice is under way. The curriculum has already been approved by Tribhuvan University, and the Post-basic Community Nursing Course started in March 1981. The Post-basic Midwifery Course is fully developed, and the final examination was held during March 1981. In SRI LANKA,specific aspects of the nursing activities being carried out have required the services of a short-term consultant. Assistance was provided in the development of an evaluation programme and the organization of four workshops to evaluate the teaching staff. In THAILAND, WHO collaborated in planning and organizing a national workshop on the "Role of Nursing Personnel in Supporting Primary Health Care Activities for the Attainment of HFA by the Year 2000". A community-oriented curriculum was developed with the assistance of a consultant. 1.6 Health Education Greater efforts have been made to reorientate health education ser- vices and activities, at both national and regional levels,in support of primary health care and community participation. Emphasis was laid on educational activities and the training of primary health care workers and community leaders. In addition, the Organization has paid greater attention to the socio-cultural determinants of health and health education and has begun to promote research and to utilize the findings in programme development and operation. An important acti- vity in this connexion was the inter-country Consultative Meeting on Research in Health Behaviour, Health Education and Community Partici- pation,convened in New Delhi during the year. Action on the recomen- dations of this meeting has been initiated at both regional and country level. An inter-country workshop on the preparation of health education specialists in support of HFA/2000 was also organized in New Delhi to examine the training programmes for health education specialists in countries of the Region, in order to make them more relevant to the needs of primary health care programmes. The Regional Office has taken health behaviour and health education into account in the implementation of country and inter-country programmes. BANGLADESH undertook a major reorganization and expansion of health education in collaboration with the World Bank and WHO. The Bank has provided funds to supplement the salaries of health educators and to house the reorganized Health Education Bureau, as well as to meet the cost of equipment,audio-visual aids and the production of manuals. WHO has assigned a health education specialist to study the reorga- nization of the services at the Ministry of Health and in the divi- sions, districts and subdivisions; he will also advise on the in- service training of health education specialists, civil surgeons and others, on the establishment of supporting services such as training units, audio-visual aids and mass communication, and on evaluation and research in the reorganized Health Education Bureau. Workshops have been held for the in-service training of health education specialists and civil surgeons. The MPH Degree Programme in Health Education at the National Insti- tute of Social and Preventive Medicine, Dacca, which was established to train health education specialists within the country, is now in its second year, with a WHO health education specialist serving as a part-time faculty member. Two consultants (in audio-visual and health education) were assigned by WHO to provide further assistance to the Institute. Health education activities have been accelerated in BURMA. The Government has established a special committee to formulate a health education project in support of the People's Health Programme, with emphasis on community participation in primary health care. The pro- ject provides for the expansion of health education services, both in the Ministry of Health and in the divisions, the training of health workers for health education, training of health education specia- lists, and production of audio-visual aids and communication media. The Regional Adviser on Health Education visited Burma during the year and assisted the committee in formulating the project. In INDIA, the Central Health Education Bureau and the bureaux in the States and union territories focused their efforts on health educa- tion in primary health care programmes. A number of workshops financed by WHO were held on the topics of school health education, development of national health education services, training of health education specialists in support of primary health care, and health education in the undergraduate medical curriculum. Special emphasis was placed on health education in the undergraduate medical curri- culum, a five-year programme for the purpose being developed with the assistance of a WHO short-term consultant. With WHO assistance, the Central Health Education Bureau completed a study of the functions performed by health educators as compared with those for which they are being trained. In addition, WHO is collabo- rating in the health behaviour and health education aspects of rural water supply projects in Bihar and Uttar Pradesh. Considerable progress was made in the development of health educa- tion services within the Health Department of the Province of Irian Jaya in INDONESIA. WHO awarded fellowships to enable national per- sonnel to obtain professional qualifications in health education, and helped to organize workshops to give in-service training in health education to senior provincial health department officials as well as health education coordinators of the nine regencies in the Province. A WHO health education specialist assisted in these activities and also helped in the planning, implementation and evaluation of health education activities in the Province. WHO also collaborated in the development of behavioural studies and health education as a part of the rural water supply project in the province of Nusa Tenggara Timur. The Directorate of Health Education in Jakarta has selected health education in hospitals for special attention, and a WHO short-term consultant was assigned to assist the Government in this work. During the year MALDIVES took steps to train primary health care workers and other personnel for health education responsibilities. A WHO consultant assisted the Government in developing the health edu- cation component of the curricula for the training of health person- nel as well as the faculty responsible for teaching health education at the Allied Health Services Training Centre. MONGOLIA carried out a survey of health education in selected commu- nity health education programes as well as in primary and secondary schools and teachers' colleges. Based on this survey, health edu- cation has been promoted, particularly in secondary schools and teachers' colleges. A manual on sex and family life education was prepared, and teachers have been trained for health education in teachers' colleges and selected secondary schools. In the light of the experience gained, health education will be extended to community health programmes and primary and secondary schools and teachers' colleges. A WHO health education specialist assisted the Government in these activities. During the year WHO, together with UNICEF, collaborated in a major review of health education services in NEPAL and formulated a plan of work to support primary health care and other health programmes. In addition, workshops for the training of teachers for school health education were held, with WHO support, and fellowships awarded for the training of health educators and media personnel of the Health Education Unit. In WHO'S collaboration with SRI LANKA in health education during the year, attention was directed to the preparation of the faculty res- ponsible for training primary health care workers (midwives) and to health education in the undergraduate medical curriculum: workshops for the faculty were held, and guidelines for training are being prepared. A meeting of the deans and faculties of medical schools was held to discuss the place of health education in the undergraduate curriculum. In addition to providing assistance in these activities, WHO also supported research on the village health volunteer programme. During the year, THAILAND placed greater emphasis on the development of provincial and regional health education services and the coordi- nation of the health education activities of the health services, hospitals, health-related departments and voluntary agencies. A national workshop was held with support from WHO, which also assigned a short-term consultant to review the current status of health educa- tion in the country, develop health education units in the regions and provinces, and establish coordination among the various agencies concerned. Appropriate research was also supported by the Organiza- tion. 1.7 Nutrition The main thrust of the programme in this area during the year was on the integration of nutrition into the primary health care services and the development of a coordinated approach with other disciplines in planning and implementing activities and research in nutrition. National nutrition units have been strengthened through technical cooperation in developing research-cum-action programmes and in establishing collaborating centres. The interaction of operational research with the implementation of activities is producing informa- tion which can readily be used to improve ongoing programmes. A meet- ing of the principal investigators of the project "Situation Analysis of Nutrition Component of Primary Health Care" was convened in the Regional Office in November 1980 to review the protocols and pre- liminary findings and discuss the methodologies adopted by various countries. In group educational activities organized during the year the focus was on the inclusion of the nutrition component of primary health care. WHO collaborated in country health programming and in several activities of other disciplines having a significant effect on child nutrition and growth. Support was given to national seminars and courses aimed at reviewing and replanning nutrition activities within primary health care. The findings of the projects on the evaluation of the efficiency and efficacy of the nutrition component of health services which were supported by WHO have been found useful in re- orienting and improving these activities. An inter-country workshop, supported by WHO, was held in Dacca to discuss the role of nutrition units based on the information obtained from most countries of the Region by means of a questionnaire. Food and nutrition surveillance systems have been emphasized in all countries through technical support, diffusion of information, and group educational activities. An inter-country meeting held in February 1981 brought together different health officers as well as principal investigators of the research project on "Nutrition Sur- veillance and Evaluation". The meeting discussed in detail the need for information, ways and means of collecting and analysing what was found to be needed, and the utilization of the information in decid- ing on appropriate strategies. During the year a WHO Collaborating Centre was established at the Centre for Research and Development of ~utrition, Bogor (Indonesia), for research in vitamin A and iron deficiency anaemia. Two other centres, one to study the interactions of infection and nutrition and the other to determine the intra-family conditions leading to mal- nutrition, are under consideration. A meeting of the Ad hoc Sub-committee on Nutrition Research was con- -- vened in the Regional Office in November 1980 to review the progress and implementation of action-cum-research programmes in nutrition and to develop guidelines for the implementation and monitoring of these projects. The Sub-comittee noted that WHO had succeeded as a cata- lyst in the exchange of information, development of research methodo- logies and approaches and promotion of personal communication among scientists working in similar fields. Assistance was provided to Bangladesh and Nepal in intensifying their goitre control programmes. In other countries, these programmes are being carried out with assistance from other international and bi- lateral agencies. ~ield tests were carried out in Bangladesh, India, Maldives and Thailand on the draft "Guidelines for Nutrition Training of Primary Health Care Workers and Other Community Workers" developed at global level. After evaluation and necessary modification, they will be issued as a WHO publication later in 1981, for wider application in training programmes. A WHO consultant collaborated with the Institute of public Health Nutrition, Dacca,BANGLADESH, in developing a curriculum and syllabus for a three-month certificate/diploma course in public health nutri- tion. The first course started on 1 June 1981, and in the meantime a field practice area for training has been selected and organized. Four orientation courses in nutrition for thana medical officers, for paramedical personnel in the community as well as in thana health complexes and for nurses - a total of 216 persons - were conducted by the Institute. The first phase of the goitre control programme was initiated with financial assistance from WHO. In BURMA,a WHO consultant assisted in analysing the data on protein- energy malnutrition, nutritional anaemia, goitre and other vitamin deficiencies. The Regional Adviser on Nutrition visited Burma during the year to review the nutrition activities, discuss nutrition research pro- grammes and participate in the development of an evaluation system. In INDIA, a WHO guest lecturer delivered lectures as part of the two nutrition courses - the three-month diploma course and the one-year degree courses - held at the ~ational Institute of Nutrition, Hyderabad, and reviewed the contents and syllabi of these courses. He stressed the need for evaluating the courses and for developing them in future according to the changing needs of the health services. A WHO consultant was assigned to INDONESIA to assist the Government in planning a system of recording, reporting and data processing for the national nutrition surveillance system. The consultant recom- mended a three-stage programme: (a) setting up of equipment and appointment of staff, (b) preparation of study forms for data col- lection and their application in a small area, and (c) expansion of the nutrition surveillance activities to cover the whole country. In January 1981 a WHO public health nutritionist joined the project in NEPAL. He is collaborating with the Chief of the Nutrition Cell and other units of the Department of Health Services in the deve- lopment and implementation of nutrition activities in the country. He is also actively involved in a multisectoral approach adopted by the national authorities. The national goitre control progralmne received assistance from WHO for the training of staff in this field. In SRI LANKA,the protocols for the two nutrition research-cum-action programmes were completed. These projects will now be implemented by the Food and Nutrition Policy Planning Division, Colombo. The nutrition surveillance programme in the country was strengthened, and work on the methodology for rapid assessment of the impact of nutrition on development projects was initiated in collaboration with WHO and FAO. The two agencies participated in designing and sampling for an evaluation of the Mahaweli Area Development Pro- gramme carried out by the Food and Nutrition Policy planning Division. On the Government's request, WHO collaborated in the development of a prefeasibility approach for a food distribution programme. In THAILAND, WHO supported a national workshop on nutrition in primary health care. The protocols for the project, "Situation Analysis of Nutrition Component of Primary Health Care", were completed. A consultant visited three countries in the Region to assess the effect of the health care activities and direct nutrition programmes on the growth of children and to review the recommended activities in the light of their role to correct the present conditions. An- other consultant is under recruitment to develop curricula and syllabi for short and long-term nutrition courses designed to give skills, abilities and knowledge related to the nutrition component of primary health care keeping in view the needs of the health services to achieve the goals of HFAl2000. 1.8 Medical Care The major emphasis in WHO'S collaboration with Member States conti- nues to be on the provision of primary health care (Section 1.3). At the same time, the strengthening of medical stores management and facilities for the repair and maintenance of biomedical equipment also received attention. In BANGLADESH, a WHO long-term staff member is helping to develop and strengthen training facilities for the repair and maintenance of electro-medical equipment. The Government has approved plans for a central workshop to be located at Tejgaon, Dacca, and for four regional workshops. Increasing numbers of trainees attend courses given by the WHO electro-medical engineer. During the year, WHO awarded several fellowships to DPRK national workers in the field of medical care, in addition to providing ambulances, mini-buses and equipment. Efforts continued for the assignment of consultants in the fields of radio-immunoassay, cyto- photometry, drug allergy, hormone-enzyme assay and neuro-psychiatry to meet the country's needs. In INDONESIA, further progress was made in the development of the network of health centres and sub-centres. A design for a recording, reporting and surveillance system for health centres has been evolved. In-service training programmes for health centre staff were conducted as planned, but there is a need to review and improve the technical component of the courses. Further assistance was provided to MALDIVES through the assignment of consultants in surgery, gynaecology, ophthalmology, ENT surgery and maternal and child health. These consultants treated patients with special problems and, at the same time, trained available national health personnel. In SRI LANKA,a short-term consultant in the repair and maintenance of electro-medical equipment made valuable recommendations for improving the facilities and administrative procedures in this regard,including the need for decentralization. The Government has started implement- ing these recommendations. Supplies and equipment and fellowships were provided for training in this field and in that of medical stores management. As regards activities at the regional level, a UNDP-funded inter- country project on training in the repair and maintenance of bio- medical equipment for the least developed countries in the Region became operational during the year. Under this project short-term fellowships have been provided for training personnel within the Region. 1.9 Care of the Aged, Disability Prevention and Medical Rehabilitation International and non-governmental agencies including WHO have actively collaborated with Member States in planning and providing resources for the prevention and control of physical, visual and emotional disabilities. The WHO Regional Office provided the services of consultants to assess existing facilities and to advise on and assist in formulating national plans for disability prevention and rehabilitation. Deafness and health care of the elderly have received priority attention for technical collaboration. The WHO Manual, "Raining the Disabled in the Community", was widely distributed for adaptation, and its translation into local languages was supported. The programme for the prevention of accidents was stimulated through an inter-country seminar. WHO promoted action for establishing national committees for observ- ing 1981 as the International Year of Disabled Persons (IYDP). Two consultants visited BANGLADESH and advised on the mobilization of resources, and on the coordination and formulation of a national plan for community-oriented disability prevention and rehabilitation services. The Rehabilitation Institute and Hospital for the Disabled in Dacca was identified for development as a national institute where a programme for the training of rehabilitation manpower can be orga- nized if it expands its orthopaedic services and includes other relevant activities for prevention as well as the rehabilitation of all types of disabled persons. Another consultant visited the country to study the problem of the elderly and advise on the integration of concepts of gerontology in the training curricula of health and allied personnel. In BURMA, a national plan was formulated and a project proposal was prepared for UNDP assistance in community-oriented disability pre- vention and rehabilitation services. Three townships in Rangoon Division will be developed as demonstration centres, where a survey of disabilities will be conducted and community volunteers,community health workers and midwives trained for disability prevention and early detection. A consultant was assigned during the year to advise on the organization of services for the welfare of the elderly and the management of the health problems pertaining to this group. The WHO manual, "Training the Disabled in the Community", was adapted and translated into Burmese for use at the community level. In INDIA, translation of the WHO manual was undertaken in Hindi, Malayalam and Marathi. A consultant from WHO Headquarters assisted in training community workers and health personnel in Trivandrum to carry out a disability survey in the villages. Two consultants assessed existing facilities for education, training and services in selected centres in the country and advised on integrating disability prevention and medical rehabilitation services in primary health care. Another consultant,a specialist in bio-engineering, visited rehabilitation centres as well as the All-India Institute of Physical Medicine and Rehabilitation, Bombay, and the Artificial Limbs Manu- facturing Corporation of India, in Kanpur, to study the relevance of orthotic and prosthetic appliances in the context of the anthropo- logical and social needs of the population. He demonstrated the preparation of simple aids with local materials and advised on the development of appropriate technology in medical rehabilitation. A national plan of action for achieving the objectives of the Inter- national Year of Disabled Persons (IYDP) was formulated and a national committee constituted for its implementation. An inter- ministerial coordination committee has also been set up to identify and to reserve jobs for rehabilitated disabled persons. A national meeting is to be organized later in 1981 to assess the situation and to prepare a plan for the expansion of activities relating to dis- ability prevention and rehabilitation. The health problems of the elderly were studied by a consultant and his recommendations on gerontology and geriatric services are receiving consideration by the Government in the context of the United Nations Year for the Care of the Elderly (1982). l%e prevention of accidents with the emphasis on problems related to traffic received attention at a WHO-sponsored national meeting. The establishment of an accident prevention cell under the Delhi Trans- port Corporation is under consideration. A consultant visited select- ed centres to collect information on the prevalence of deafness and formulate a plan of action for its prevention. Two consultants visited INDONESIA during the year to assess the faci- lities and to make recommendations on the formulation of a national plan for disability prevention, control and rehabilitation. The Reha- bilitation Centre in Solo and the Rehabilitation Unit at Semarang continued to make impressive progress. The WHO-sponsored disability survey in the country was completed, and further financial support was provided to assist in analysing the data. A consultant reviewed existing facilities for health care of the elderly and recommended measures for strengthening national activities. MONGOLIA has formulated a national plan of action for disability pre- vention. The Government issued a special decree requiring the estab- lishment of operative commissions in each aimak to prepare plans of action for disability prevention and rehabilitation. The training of health workers and also community-oriented rehabilitation activities are making progress. In NEPAL, a national survey of the disabled was sponsored, and the data obtained are being analysed. The problem of rehabilitation of the disabled due to leprosy received special attention. Two consul- tants visited the country during the year to assess existing facili- ties and advise on disability prevention and rehabilitation. Another consultant was assigned to assess the magnitude of the problem of preventable deafness and auditory impairment in the community. The planning and organization of community-oriented disability pre- vention and rehabilitation services in SRI LANKA were promoted through group educational activities. Two consultants studied the existing facilities in the country and recommended measures for strengthening the national programme for the prevention of disabili- ties and rehabilitation of the handicapped. The upgrading of the facilities at the Rehabilitation Hospital in Ragama is being consi- dered to enable the Hospital to function as a national institute for rehabilitation. Supplies and equipment are being provided to enhance the country's manufacturing potential in orthotics and prosthetics. Activities for the prevention and control of deafness were promoted through the assignment of a consultant during the period under review. In THAILAND, prevention of traffic accidents and the management of emergencies received special emphasis in national meetings and group educational activities. Three WHO consultants visited the country to assess the problem of the disabled and recommended measures for strengthening the work on prevention and control of disabilities, as an integral part of primary health care at the community level. 1.10 Oral Health Oral health, especially oral health education, has been receiving increasing attention in the countries of the Region. In BANGLADESH,a WHO staff member continued to assist in the develop- ment of Dacca Dental College and to advise the Government on deve- loping a national programme in oral health. A consultant helped in carrying out surveys of the oral health status of the population in three districts of the country and in training dental health person- nel. WHO has supplied literature in the field of preventive den- tistry. A seminar to discuss the further development of the oral health programme is being organized. The Dental Council of INDIA has constituted a sub-cormnittee to pre- pare a comprehensive document outlining the requirements of depart- ments of dentistry in medical colleges. The Council is also consider- ing reforms in post-graduate education in dental health. WHO provided support for a seminar to examine the feasibility of introducing a new category of dental auxiliary(denta1 therapist) to deliver oral health care in the rural areas, held in March 1981. A WHO consultant was assigned to INDONESIA during the year to help in formulating methods of evaluating the dental health components of the Third Five-Year Plan, and in planning for oral health activities under the Fourth Plan. The consultant recommended that a fluoride mouth-rinsing programme be organized in urban areas and a standard set of simple portable dental equipment be developed for health centres. Another consulta.~t, expected to be in position later in 1981, will assist in the integration of the dental health programme with primary health care. Fellowships have been awarded and supplies and equipment made available for strengthening manpower and physical facilities. In NEPAL, fellowships have been awarded to qualified dentists for study abroad. The programme in oral health is making a significant headway in SRI LANKA. Major activities during the year included carrying out an island-wide epidemiological survey of the state of dental health of the population, implementation of a caries prevention "fluoride" dental programme through the school dental health services, and the organization of workshops for dental and medical personnel and pri- mary health care workers in the context of providing primary oral health care. A consultant was assigned to assist in the development of a national plan for preventive dental health, to advise on the strengthening of dental health education and suggest measures for improving school dental health services, as well as to organize and conduct training programmes for dental health personnel. Fellowships were awarded and supplies and equipment provided, in addition to assistance with a seminar on preventive oral health for dental surgeons, dental nurses and medical officers of health. In THAILAND, a centre in oral health has become operational in Chiang Mi. Two short-term consultants visited the centre during the year and provided technical support. An inter-country meeting of senior dental health officers is scheduled to be held at Chiang Mai in November 1981 to discuss the further development of oral health programmes in the countries of the Region. 1.11 Mental Health The need for the prevention and treatment of mental and neurological disorders, including mental retardation and epilepsies, and also for rehabilitation of the mentally ill, is common to all. countries. Some countries face additional problems related to drug abuse as well as the increasing use of alcohol and tranquillizers. WHO actively continues to promote and support efforts for the fomu- lation of national policies on mental health. Most Member countries now have such policies, and some of them have drawn up outlines of national mental health plans, the focus of which is on extending basic mental health care to hitherto under- or un-served areas through the integration of the mental health component into primary health care. The feasibility of also including in the PHC package a component relating to drug abuse and/or abuse of alcohol is being actively considered in some countries. A regional workshop on child mental health and psychosocial develop- ment was conducted in Jakarta in November 1980, and helped to stimu- late national activities in this field; in most instances these are being carried out in cooperation with UNICEF. In BANGLADESH, the series of annual national workshops has continued. A WHO consultant assisted in organizing a workshop on mental health for high-ranking professionals and administrators, which was followed by a teaching seminar for junior professionals. In order to meet the severe shortage of trained manpower,the Ministry of Health has launched a campaign to recruit junior doctors for post- graduate training in psychiatry. WHO has been providing fellowships for this training. The establishment of model projects on community-oriented "outreach" programmes is being pursued with WHO assistance. In BURMA,the thrust of WHO support continues to be delivered through the United Nations Fund for Drug Abuse control(~~F~A~). Under this programme, and technically supported by WHO, an extensive network of treatment facilities for addicted persons has been set up all over the country. With an increased rate of post-graduate training in psychiatry, mental health services in relation to the drug abuse control programme are being decentralized and integrated into the general health care services and are thus now becoming increasingly available in different parts of the country. The establishment of a mental health component,including drug abuse, as part of primary health care is being actively pursued. A number of national workshops and training seminars for non-specia- lized personnel were organized during the period under review with WHO support. INDIA, through its various model projects of integrated mental health care, has continued to serve as an important focus for regional fellowships in the spirit of TCDC. National centres are collaborat- ing in global research efforts in the fields of community mental health services, psychopharmacology, psychosocial aspects of health care, and the neurosciences. Research into different aspects of mental health has been organized through the Indian Council of Medical Research in collaboration with WHO. A series of meetings convened by the Ministry of Health with WHO support resulted in the emergence of a national plan for the inte- gration of mental health care into the general health services in order to increase the mental health care coverage among the rural population. In INDONESIA, the Directorate of Mental Health of the Department of Medical Care in the Ministry of Health has been designated as a WHO Collaborating Centre for Research and Training in Mental Health. This centre will provide an important base for training and research in community mental health and for international collaborative acti- vities within the WHO medium-term programme. With WHO support, research efforts into relevant aspects of traditional medicine are continuing. The implementation of the national mental health plan has made consi- derable progress, as has the programme of extending mental health care into primary health care centres, with provincial mental hospi- tals as referral and training centres. The community mental health project in Jakarta, as a multisectoral activity of the Jakarta Metropolitan Health Department, the Directo- rate of Mental Health, the Department of Psychiatry and the Faculty of Public Health of the University of Jakarta, has continued and has produced encouraging results, which may serve as a model for other multidisciplinary efforts in Indonesia and in other countries of the Region. In MONGOLIA, the implementation of the national plan has continued, with WHO assistance. Several national workshops were organized during the period and fellowships were provided to develop specialized man- power. An epidemiological survey on mental disorders was completed, and the data are being analysed for use in planning. In NEPAL, where the Government has expressed serious concern regard- ing the inadequacy of mental health services, including services for the mentally retarded, different alternatives are being explored for introducing basic mental health care into hitherto unserved areas, through the expanding general health services. WHO has provided fellowships for training medical personnel in mental health. In SRI LAMA, the National Advisory Body on Mental Health has conti- nued to hold regular meetings, with WHO support, and has proved to be a useful instrument in stimulating cooperation between different groups of psychiatrists and health administrators in the country. There are psychiatric units, with a psychiatrist attached,functioning in seven provincial general hospitals; two more such hospitals each have a psychiatrist but no psychiatric units as yet. The establish- ment of two new university departments in Galle and Jaffna is being supported by WHO and is expected to improve the exposure of under- graduates to psychiatry and facilitate the planned post-graduate training of psychiatrists. Mental health has been identified as one of the 17 components of primary health care, and courses for auxiliaries which include child mental health are regularly being held. In THAI~~~~,expansion of mental health care through integration into the general health system is a clearly articulated national policy. Thailand's participation in the WHO 1nter-regional Study on the Monitoring of Mental Health Needs has greatly stimulated the exten- sion of integrated mental health services, apart from yielding valuable data for the evaluation and further improvement of these services. WHO-sponsored research on the psychosocial and cultural aspects of primary health care is beginning to produce data of great importance for the planning and extension of such care. These data will allow a more thorough consideration of the behavioural aspects of the use or non-use of primary health care facilities. An important part of WHO support is in the field of drug abuse, which is a major public health problem in Thailand. The Institute of Health Research, Chulalongkorn University, Bangkok, as a WHO Collaborating Centre for Research and Training in Drug Dependence, has continued to produce research data of importance for many countries with similar problems. Regional fellowships are sponsored for training in this institution, and professionals from l'hailand have continued to parti- cipate in inter-regional training activities. With WHO support, and through the United Nations Fund for Drug Abuse Control, a series of treatment facilities for drug-dependent persons is beginning to evolve. 1.12 Drug Policies and Management The supply of essential drugs of assured quality has always been given high priority by the Member countries in the Region. WHO has been collaborating with governments in strengthening the different components of pharmaceutical supply systems and in evolving national drug policies and management. An inter-country consultative meeting on drug policies and management, held in the Regional Office in October 1980, provided guidelines and made recornendations for deve- loping a special programme on essential drugs in the Region. In BANGLADESH,the Organization assisted in planning and establishing a pharmaceutical production unit at national level. A WHO consultant particiated in an Asian Development Bank (AsDB) mission to define the support needed from the Bank, which is expected to provide finances for the purchase of raw materials and equipment required for the manufacture of essential drugs. WHO will provide technical support through a consultant for training personnel and advising on the management of the production unit. ~ssistance was provided in strengthening the quality assurance pro- gramme of the Drug Control Administration. In BURMA, the Organization has provided further assistance to the Burma Pharmaceutical Industry for strengthening pharmaceutical production units. National personnel were trained in the technology of cinchona cultivation and the extraction of alkaloids. The Food and Drug Control Laboratory in Rangoon is receiving assist- ance through a UNDP project, under which training has been given in different aspects of drug analysis and supplies and equipment have been provided for strengthening the laboratories. WHO, in collabora- tion with FAO, provided consultsncy services for improving drug control administration, updating food and drug rules and regulations and strengthening food analysis laboratories. WHO and UNDP have collaborated with INDONESIA in developing compre- hensive drug policies. A consultant advised on the establishment of adverse drug monitoring and drug information centres. In MONGOLIA, a WHO consultant advised on strengthening the quality control of pharmaceuticals and biologicals. Two other consultants were assigned to advise on a project for the manufacture of blood products. In NEPAL, support was provided by WHO, UNDP and UNIDO, jointly with assistance from the Netherlands Government, for improving the supply system for essential drugs in the primary health care services. A WHO consultant acted as the technical coordinator and prepared a work plan for the implementation of the project. Another consultant assisted in promoting the use of traditional medicines for primary health care. WHO has collaborated with SRI LANKA in the development of training programmes in pharmacy,the strengthening of national quality control and technical courses,and the preparation of a techno-economic feasi- bility report on the establishment of a drug formulation unit. The National Drug Act has been enacted and is being enforced. A diploma in pharmacy will also be started, with WHO collaboration. It is expected that AsDB assistance will be provided in establishing a for- mulation unit for the production of essential drugs. TAMILAND is developing a comprehensive programme on drug policies and management with WHO collaboration. A consultant advised on preparing a comprehensive project on essential drugs, including their storage, d;, tribution and utilization in PHC, and drug legislation. A national c,,iiference on the selection of essential drugs for PHC was organized with WHO support. The Thirty-fourth World Health Assembly was historic in more than one sense. It not only adopted theGlobal Strategy for Health for All; it was also honoured by the presence of Her Excellency Mrs lndira Gandhi. Prime Minister of India. who delivered a keynote address. Seated behind the Prime Minister are (from I to r) : Dr Halfdan Mahler. Director-General, WHO. Dr Meropi Violaki-Paraskeva. President of the Thirty-fourth World Health Assembly and Dr T.A. Lambo Deputy Director-General , WHO. His Excellency Mr Soeharto. President of the Republic of Indonesia. greets a disabled young man after inaugurat- ing the International Year of Disabled Persons. INTERNATIONAL YEAR OF DISABLED PERSONS Of the estimated 450 million disabled persons in the world, a majority live in developing countries, with scarcely any aid facilities. The International Year of Disabled Persons has focussed attention on the spe- cial needs of the disabled and several activities wereini- tiated in the Region to provide them with adequate medical and rehabilitative services. Learning to walk.. . . . Limbs for the limbless. INTERNATIONAL YEAR OF DISABLED PERSONS Helping .s like himself to nand on their feet. Eflorn are being made to provrda water to more rursl communities. WATER AND SANITATION To ensu'e that the wamr is safe healrh labo- ratones play an importan! tale in keeping a check on it5 qualiw. Communities in rural areas of the Regran are beln~ encouraged to take the iniiialive ra provide themselves with basic sanitalion and excreta disp~sa) facililir. Since a large number of people in rural areas in the Region depend on wells for their water supply, governments are making efforts to make the well water safe for drinking. Communitv health workers and volunteers have been trained to chlorinate wells regularly. More and more handpumps are being installed in rural areas to make safe drinking wafer avail able and accessible to communities at all times.
2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Comunicable diseases continue to be a major public health problem in the Region in spite of persistent efforts by governments, supported by international and bilateral agencies, to control them. Lack of adequate surveillance services, shortage of trained manpower and weak infrastructures constitute the major constraints. The ~riorit~ communicable diseases include malaria, leprosy, dengue haemorrhagic fever (DHF), acute diarrhoeal diseases and diseases preventable by routine immunization, especially of children. Although there are continuing technical and administrative problems, malaria has shown a reduction of around 17% in reported cases in the Region. However,this is due to a noticeable reduction in only some of the countries. The success of the Swedish International Development Authority (S1DA)-assisted Plasmodium falciparum Containment Programme in India is very encouraging. Research on drug resistance in the treatment of malaria continued and was expanded. In addition to SIDA, the programme in the Region received support from the Canadian Inter- national Development Agency (CIDA), the Netherlands, US AID and the United Kingdom. The progress of the leprosy control programme is rather slow. The social stigma attached to the disease continued to prevent its satis- factory integration into the general health services. Field studies to improve identification and treatment are progressing. Research priorities have been identified and protocols developed with emphasis on drug resistance and more effective regimens for treatment. The Japan Shipbuilding Industry Foundation is providing substantial sup- port to the leprosy control programmes in the Region. DHF continues to be confined to three countries, namely, Burma, Indonesia and Thailand. While the emphasis in the programmes is now on early diagnosis and treatment,the production of a vaccine appears to be a distinct possibility, as a result of research undertaken at the WHO Collaborating Centre in Bangkok. The emphasis in the diarrhoeal disease control programme is on the reduction of mortality in children by prompt oral rehydration. This single modality of treatment in diarrhoeas of all etiological origins is the sheet-anchor of the success of the programme. Supply of ade- quate quantities of oral rehydration salts (ORS) through large and small-scale production, delivery of ORS at village level and use of village volunteers and mothers in treating cases are the major ele- ments of the programme. Research into various facets of the problem, especially the operational aspects, is receiving increasing attention. As in previous years, the focus of WHO activities in the expanded programme on immunization (EPI) is on supporting and strengthening national efforts, in collaboration with UNICEF and other agencies, through the provision of training for various levels of EPI manage- ment staff, including technicians,in the maintenance and repair of refrigerators, the cold-chain and logistics. In addition to the provision by WHO of the usual consultant/long-term staff support, Regional Office staff visited the various countries to assist with programme reviews, training, management of EPI, surveys of immuniza- tion coverage, and evaluation. WHO has provided support in collecting baseline data on EPI target diseases, in conducting epidemiological and serological surveys, in solving operational problems, and in carrying out studies on the economics of the programmes. Preparations are in hand for a regional meeting in Ulan Bator in August 1981 on the implementation of EPI through existing health services and on the evaluation of the programme activities. With regard to other diseases,the sexually transmitted diseases,viral hepatitis, Japanese encephalitis, filariasis,leishmaniasis and plague have received greater attention at national and regional levels. With the appointment of a medical officer in veterinary public health at the Regional Office, support is being given to countries in the plan- ning, formulation and evaluation of programmes for the control of the major zoonotic and food-borne diseases. The FAOIWHO Collaborating Centre for Research and Training in Food Hygiene in Berlin will, it is hoped, collaborate in this field with veterinary public health institutes in the Region. Likewise, activities in the field of vector biology and control were carried out in countries of the Region in respect of malaria, fila- riasis, dengue and Japanese encephalitis and, in certain areas, also typhus and plague. An important activity was the WHO Seminar on Integrated Vector-Borne Diseases Control, jointly organized with the Ministry of Health, Burma, and held in Mandalay in April 1981. Filariasis continued to be a major problem in most countries of the Region. Besides WHO support to various countries, assistance was provided for an international symposium on chemotherapy and immunology in the con- trol of malaria,filariasis and leishmaniasis, held in Lucknow (1ndia) in February 1981. In addition, WHO provided research grants for the study of advanced techniques in the vector biology of mosquito popu- lation and research methods in applied helminthology with reference to filariasis. Research studies supported by the WHO Special Pro- gramme for Training and Research in Tropical Diseases (TDR) are being conducted in India. 2.1 Epidemiological Surveillance WHO has continued to cooperate with the countries of the Region in improving their epidemiological surveillance services so as to make them effective tools in controlling the prevalent communicable diseases. The Organization has also collaborated in training pro- grammes in field epidemiology. In BANGLADESH, the Institute of Epidemiology, Disease Control and Research undertook epidemiological, virological, entomological and parasitological studies with WHO collaboration. In August 1980,a con- sultant assisted in the preparation of material for a WHO-supported certificate course in epidemiology designed to provide medical pet- sonnel with field and applied training. He also reviewed the £oms used for the recording and reporting of communicable diseases in Dacca and the districts,and cooperated in the establishment of opera- tional procedures for the recording and reporting of morbidity and mortality from priority diseases. Another WHO consultant helped in (a) further developing the Parasitology Unit at the Institute of Epidemiology, Disease Control and Research (under the National Insti- tute of Preventive and Social Medicine); (b) enhancing the technical capability of national workers in the -- in vitro technique; (c) review- ing the existing laboratory facilities, and (d) establishing immuno- logical techniques for improving the laboratory diagnosis of important parasitological diseases. With regard to the strengthening of district epidemiology units, WHO provided funds for the conduct of a certificate course in epidemio- logy for the staff of those units, held during January-February 1981. District microbiological laboratories, as integral parts of district epidemiology units, received supplies and equipment. In INDIA, the epidemiological surveillance/services have been further strengthened. WHO supported national training activities in disease surveillance, prevention and control as well as in research through the organization of workshops and seminars. These activities were organized at the National Institute of Communicable Diseases, Delhi, at Varanasi and at the School of Tropical Medicine, Calcutta. In connexion with the establishment of a national centre for viral hepatitis at the Department of Gastroenterology, All-India Institute of Medical Sciences, New Delhi, WHO sponsored a study tour to enable the Professor of Medicine to bring himself up to date with recent advances in viral hepatitis at the WHO Collaborating Centre for Viral Hepatitis, in Phoenix, Arizona (USA). A WHO consultant worked with the Filaria ~ivision of the National Institute of Communicable Diseases, Delhi, paying special attention to the in vitro culture of the filaria parasite and field studies -- aimed at improving methods for the control of filariasis. WHO also assisted in conducting a workshop on filariasis at Varanasi. In INDONESIA, the epidemiological surveillance of communicable diseases has shown improvement. WHO provided support for extending the infrastructure of the epidemiological surveillance system from the peripheral to the provincial and central levels and for improving the entomological services in relation to vector-borne diseases. A WHO consultant assessed the situation of dengue and dengue haemor- rhagic fevers and other arthropod-borne viral diseases in the country and advised on the ongoing research in epidemiological studies on DHF. An entomologist from WHO Headquarters helped to assess the vector surveillance and entomological activities, especially in the outer islands. Grants were provided for a national group educational activity on the development of vector biology and control services, held in September 1980. In MONGOLIA, the expansion of epidemiological surveillance services continued. Both bacteriological and virological diagnostic capabili- ties were improved by awarding fellowships for training abroad and providing logistic support to the respective laboratories. In NEPAL, the Epidemiology and Statistics Division in the Department of Health Services was further strengthened in order to contribute to the development of a national health information system through sur- veys of communicable diseases and the introduction of lay reporting. A WHO consultant cooperated in epidemiological surveys of communi- cable diseases through existing health services, as well as in the development of the lay reporting system and in the use of epidemio- logy in primary health care. In SRI LANKA, the Epidemiological Unit is now well established, and adequate information on communicable diseases is available through the periodic issue of bulletins. However, the Unit's capability for speedy investigation to facilitate action for the control of out- breaks needs to be further improved. A WHO consultant assigned to the Medical Research Institute, Colombo, helped devise ways and means for strengthening the virus laboratory and developing more effective arbovirus surveillance along with the improvement of communicable disease surveillance in general. The Organization provided technical support to THAILAND through a WHO consultant, who assessed the country's epidemiological surveillance system and advised on coordinating the activities of the surveillance system and those of the national health information system. Based on an assessment of the problems of data collection, analysis and feed- back mechanisms at all levels, undertaken through WHO support, a plan has been drawn up to train PHC workers and assistant epidemiologists in using data cards. In addition,a chain of supervision and reporting is to be established and the lay reporting system streamlined. WHO has also supported the establishment of a national advisory board for disease prevention and control. 2.2 Diseases Subject to the International Health Regulations For the fifth consecutive year, no case of smallpox was reported in any country of the Region. Cases of cholera, however, continued to be detected in most of the countries. Plague was reported only from Burma (see table on page 35). 2.2.1 Smallpox Eradication As mentioned above, the countries of the Region continued to be free from smallpox during the year. Nevertheless, surveillance continued in all the countries, and all "rumours" were promptly investigated. Work on the establishment of a cold room (temperature: minus 20%) in the Regional Office for storing an emergency stock of one million ampoules of freeze-dried smallpox vaccine was completed during the period under review. 2.2.2 Diarrhoea1 Diseases, including Cholera The main activities in this area were directed towards the service component of diarrhoea1 disease-control (CDD) programmes, the formu- lation of operational plans for national CDD activities, training, the logistics of the manufacture and supply of oral rehydration (Information compiled from data made available to WHO Headquarters by governments) *including one imported case. Country Bangladesh Burma India Indoneaia Maldives Nepal Sri Leda Thailand Year 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 1978 1979 1980 Cases 5 576 2 154 - 3 351 874 1 018 10 585 5 073 5 960 10 693 18 817 5 541 11 336 - - 1 662 2 2 1 48* 46 33 4 183 1 788 4 331 Cholera Deaths 81 2 1 - 372 7 5 50 246 113 145 507 769 150 220 - - 10 - - 2 - 3 123 44 85 Cases - - - 171 7 5 74 - - - - - - - - - - - - - - - - - - Plague Deaths - - - 6 2 4 - - - - - - - - - - - - - - - - - - solution (ORS), and operational research. All countries in the Region have implemented oral rehydration services as the most important measure for reducing mortality due to acute diarrhoea and have applied it in varying degrees in the context of national health care delivery. However, insufficient supplies of oral rehydration salts and inadequate health care systems for their delivery continue to be important problems. During 1980, India reported the highest number of cholera cases, followed by Indonesia, Thailand, Burma, Sri Lanka and Nepal. Data regarding the number of cases from Bangladesh and Maldives were not available this year. The total number of cases reported in six count- ries of the Region in 1980 was 16 884, with a case-fatality rate of 2.57%, as compared to 28 774 cases (from eight countries of the Region), with a case-fatality rate of 3.55%, in 1979. In BANGLADESH, WHO has developed important collaborative activities with the International Centre for Diarrhoea1 Disease Research (ICDDR), which is a WHO Collaborating Centre for Research and Train- ing in CDD. The first inter-regional training course - in the clinical management of acute diarrhoea - was held at the Centre in December 1980 for national trainers, and a second course - on the laboratory aspects of diarrhoeal diseases - was organized in March 1981, to enhance the national capacity for the proper laboratory diagnosis of acute diarrhoeal disease,for surveillance,for organizing national training courses for laboratory workers and for epidemio- logical studies. The Centre also conducted training programmes for the physicians of thana and rural health centres in Bangladesh and hosted a regional conference on diarrhoeal diseases in February 1981 to provide for an exchange of views among scientists from various countries in the Region. WHO has provided technical cooperation for the national oral rehydra- tion project, which has been launched by the Government in all the thanas of Dacca and Comilla Districts. The activities are being extended to other thanas with 6 very high incidence of acute diar- rhoeal diseases. Health workers are being trained with WHO and UNICEF support. In BURMA,WHO is collaborating with the Department of Medical Research in initiating studies on diarrhoeal diseases. A study of the etiology of acute diarrhoeas in children under five years of age and of the feasibility, acceptability and effectiveness of oral fluid therapy at village level is being supported. In INDIA, the ~ational ~nstitute of Cholera and ~nteric ~iseases, Calcutta, has been designated as a WHO Collaborating Centre for Research and Training in CDD. With WHO'S financial support, the Institute conducted 26 seminars for the training of teachers and senior medical officers in India in the clinical aspects so that a large number of trainers would be available for training district medical officers and medical officers of primary health centres. An assessment/evaluation of the national seminars on CDD held so far was carried out in ~pril 1981. The Institute has also been designated as a regional training centre for diarrhoeal diseases with UNDP support. In collaboration with WHO, the Institute organized an inter-country course on the management of the diarrhoeal disease control programme. WHO has also provided technical support for a study on the health benefits of water supply in a rural area of Uttar Pradesh. In INDONESIA, efforts are under way for the establishment of a regional training centre for diarrhoeal diseases, with the involve- ment of the University of Indonesia, the National Institute for Health Research and Development and the Directorate General of Com- municable-Disease Control. This will be the third regional training centre in the Region - the other two being the ICDDR (Bangladesh) and the National Institute of Cholera and Enteric Diseases, Calcutta (India). WHO and UNICEF have assisted Indonesia in increasing the production of ORS. A research study on a simplified oral therapy with salt and sugar solution using standard plastic scoops in the treat- ment of diarrhoeal diseases is being supported by WHO. A consultant was assigned to MALDIVES in June 1980 to assist in con- trolling an epidemic of diarrhoea, WHO and UNICEF providing the necessary supplies in this regard. The Organization also provided support to NEPAL in an operational research project on diarrhoeal-disease control to assess the efficacy of home-made oral rehydration fluid when delivered through primary health care. In SRI LANKA, a WHO consultant collaborated in the development of a national programme for diarrhoeal diseases. He helped in reviewing project documents, devising training curricula, developing teaching and promotional aids and setting up an evaluation mechanism. ltro research studies - one on the incidence of ~ersinia enterocolitica, Vibrio parahaemolyticus, Campylobacter and Rotavirus in childhood diarrhoeal diseases, and the other on the etiology of acute diar- rhoeal diseases in infants - are in progress, with WHO support. In THAILAND, the first inter-regional training course for national programme managers was held in Bangkok from 27 October to 7 November 1980, attended by 40 participants from 27 countries representing all six WHO Regions. The course covered different aspects of the plan- ning, implementation and evaluation of a national programme. WHO support was provided for a national workshop on diarrhoeal diseases held in Bangkok in March 1981, which reviewed the etiology and epi- demiology of diarrhoeal diseases in the country. A medical officer in diarrhoeal diseases has been in position in the Regional Office since November 1980 to promote and coordinate the WHO services-cum-research programme in diarrhoeal diseases in the Region. The Organization is promoting the development of national ORS produc- tion units, wherever feasible, to meet the present and future needs for adequate supply of prepacked ORS for CDD programmes. For this purpose a WHO consultant visited India, Nepal and Sri Lanka during the year to review ORS production in these countries. Following this visit a consultant assigned jointly by UNICEF/WHO assisted the national authorities in India and Nepal in setting up facilities for the production of ORS packets. An inter-country meeting on diarrhoea1 disease control, which review- ed the implementation of the strategies of the CDD programmes in the various countries and formulated indices and a work-plan for the next three years (1981-1983), was held in the Regional Office in November 1980. An SEA/ACMR Regional Scientific Working Group on Diarrhoea1 Diseases has been established to advise on the development of a service-cum- research programme for the control of diarrhoea1 diseases so that the results of research are incorporated into the service programme in order to improve it. This working group held its first meeting in the Regional Office in March 1981 and identified the most relevant re- search priorities for immediate implementation. In all these activities UNICEF and UNDP have been closely collaborat- ing with WHO. 2.2.3 Plague Plague is endemic in parts of BURMA, where 73 cases with 4 deaths were reported in 1980. The WHO Inter-regional Rodent Control and Demonstration Unit in Rangoon continued to carry out studies on various aspects of rodent control. 2.3 Malaria and Other Parasitic Diseases Malaria continued to be a major public health problem in eight count- ries of the Region, namely, Bangladesh, Burma, India, Indonesia, Maldives, Nepal, Sri Lanka and Thailand. It also occurs at the lower altitudes in Bhutan, where, at the request of the Government, a WHO consultant conducted a malaria survey from mid-October to mid- December 1980. Among the other diseases, filariasis, leishmaniasis and schistosomiasis are causing concern in parts of some countries. 2.3.1 Malaria The overall malaria situation in the Region in 1980 showed an improvement over the previous year, with a reduction in the projected malaria positive cases of about 17%. The projected annual parasite incidence for 1980 was 3.11 per thousand (3.83 in 1979). In this connexion, however, there appears to have been a reduction of 11% in the annual number of blood slides examined, films being collected from 7.2% of the population in 1980 (8.3% in 1979). The slide positivity rate fell to 4.33% (4.62% in 19791, but the slide falci- parum rate increased slightly to 1.08% (1.02% in 1979) despite there being a 13% decrease in the absolute number of Plasmodium falciparum infections; the proportion vis-a-vis other species increased to 24.8% in 1980 (22.2% in 1979). Case incidence continued to decrease in India (where there was a re- duction of nearly 18%, as compared with 1979), Maldives (52 cases in 1980, compared with 329 the previous year), and Nepal. In Sri Lanka, Figure 1. SOUTH-EAST ASIA REGION INCIDENCE OF MALARIA AND P.FALCIPARI/M INCIDENCE T".. -.-,:.:.: ?::;;;::;;;: ........ ..... ^::::If:::::.. - Slide Positivity Rate % - Slide falciparm Rate % BANGLADESH BURMA NEPAL MALDIVES Mill. 4 INDIA *Provisional **Projected INDONESIA SRI WJKA THAILAND although there was no increase in case incidence, the blood examina- tion rate dropped from 9.3% in 1979 to 8.1% in 1980, with an increase in the slide positivity rate from 4.3% to 6%. There was an upsurge of cases in Indonesia and Thailand, which registered increases in inci- dence of 60% and 30% respectively. An increase of cases in Bangladesh is associated with an improvement in the blood examination rate of from 1.7% in 1979 to 3% in 1980, but this rate remained low and little changed in Burma, making it difficult to assess the signi- ficance of a reported annual parasite incidence there of 1.2 (0.65 in 1979). Variations occurred in the pattern of P.falciparum incidence in the different countries, there being an increase in the number of cases and proportion of this infection in Bangladesh, Burma and Thailand, where the overall increase in malaria cases was largely attributable to this species. Vector resistance to pesticides in general use continued to be a serious problem in India, Indonesia, Nepal and Sri Lanka. Suscepti- bility testing for such resistance was intensified, to detect and delineate its development and distribution. Testing materials were supplied by WHO to the malaria control programmes on a regular basis, and assistance and training in the use of the test kits were provid- ed, where necessary, by WHO entomologists. The Organization directed its efforts in technical cooperation towards the development of medium-term programmes, the evaluation of pro- grammes,the development and implementation of applied field research, and the organization of and participation in training activities. Attention was also paid to the promotion of intersectoral coordination and cooperation in border areas, to providing assistance in developing national self-sufficiency in the production of insecticides and anti- malarial drugs, and to supporting the procurement of supplies and equipment. WHO provided consultants for the annual assessments of the programmes in India, Nepal and Sri Lanka. These assessments were undertaken jointly with representatives of the governments and the bilateral agencies assisting each programme. The role of WHO in respect of malaria border coordination meetings was maintained, the Regional Office acting as a focal point for the exchange of information arising from these meetings. In 1980, meetings were held between Bangladesh, Burma and India in Calcutta, between India, Maldives and Sri Lanka in Madras, between Indonesia, Malaysia and Singapore in Penang, and between Indonesia and South-West Pacific countries in Port Moresby. The meeting between India and Nepal was postponed to July 1981. Applied field research in malaria was undertaken vigorously through- out the Region during the year under review. A principal aspect of this research, supported by WHO, was the study on sensitivity of P.falciparum to 4-aminoquinolines. Important regional studies are in progress on the Anopheles species complexes, resistance to insecti- cides by vectors, and bio-environmental control agents. Studies were additionally undertaken in the operational, epidemiological and ecological aspects of malaria control work. The Regional Collaborative Studies on Drug Resistant Malaria, with special emphasis on P.falciparum resistance to 4-aminoquinolines, which were started in 1977, continued to make progress in Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. In Thailand, these studies were extended to include the response of P.falciparum to mefloquine in vitro. Base-line data are being collected before introducing this new schizonticidal drug into the Malaria Control Programme. Increases in the proportion of falciparum malaria in most countries of the Region have prompted a demand for WHO guidance in optimal treatment measures. During 1980, the 'Manual on Clinical Management of Acute Malaria" was issued in the WHO South-East Asia Regional Publications Series, 5000 copies being printed and distributed in response to numerous requests. A workshop on the clinical management of acute and severe malaria was held at Cuttack (~ndia) in March 1981 with WHO support. The report of a regional workshop on field research methodology in malaria, held in Bangkok in December 1979, was published in 1980. Progress has continued to be made by the countries in developing research cells within their anti-malaria organizations. External assistance required for some of these activities has been met, partly from regional funds, partly from the UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases (TDR), and, to some extent from bilateral sources. Of particular importance is the progress being made in establishing, in research centres in Burma, India and Thailand, the procedure for continuous in vitro culture of P.falciparum, essential for sero-epidemiological work, vaccine production, and biological and chemotherapeutic studies of strains of the parasite collected from patients. Applied field research into anti-malarial delivery systems at the community and primary health care levels is of particular importance in the context of HFA 2000. The proper utilization of these systems is increasingly essential for the delivery of drugs, and studies have been initiated to determine how to strengthen them so that they may be used in mosquito control activities. Training continues to be a vital aspect of the malaria control pro- grammes of the Region, and has been strongly supported at various levels by WHO. Fellowships were awarded to anti-malaria personnel, wherever possible within the Region, and subsidies have been provided for national training courses. An inter-regional secretariat for the coordination of malaria training programmes in Asian countries, based in Kuala Lumpur, became operational in 1980, and advantage has been taken of its advisory and supportive services by most Member countries. The overall state of antimalaria programmes in the ~egion was as follows : Population in the Region Population in originally malarious areas Population in areas under anti-malaria operations In areas under control programme 898 In areas under eradication programme 35 Population in areas with no specific anti- malaria operations Highlights of anti-malaria activities in individual countries are given below. The most recent statistical information is, in some instances, provisional. In BANGLADESH, the malaria situation continued to cause concern to the national health administration. There was a noticeable improve- ment in the annual blood examination rate, which increased to 3% in 1980. Consequently, there has been an apparent increase of total cases, including P.falciparum infections. However, the reduction in the slide positivity rate to 2.1% in 1980 (3.42% in 1979) is suffi- ciently indicative of an improving situation, though the control programme has continued to face logistic, administrative and finan- cial difficulties: post-monsoon spraying was curtailed because of shortage of DDT supplies; delays in the recruitment of operational and supervisory personnel impaired surveillance activities; thana health institutions have not been sufficiently utilized for passive case detection activities, and coordination at the thana level bet- ween the staff of integrated health services and the malaria staff in high malaria risk areas has been deficient. Malaria outbreaks among the new settlers moving from low risk areas to the Chittagong Hill Tracts emphasized the need for strengthening intersectoral coordi- nation through the recently established National Malaria Coordination Committee. The training of a majority of thana health administrators was carried out, with WHO support. With the transfer of some trained staff to other positions, however, it has become necessary to undertake a training prograrume for nearly 150 such personnel in 1981. In addi- tion, training is being extended to lower-level supervisory staff. A three-day national workshop on malaria was held in February 1981 to review the progress and the problems encountered, and to formulate plans of action for the fiscal year 1981-82. Susceptibility testing of vector species to DDT and OP compounds was confined to A. philippinensis and A. balabacensis, both species remaining susceptible to these insecticides. However, only a few tests have been carried out, and this activity needs to be expanded to more areas and extended to other vector species. The Regional Collaborative Studies on P. falciparum sensitivity to 4-aminoquinolines continued to be carried out by the Malaria Control Programme and the ~nstitute of Epidemiology, Disease Control and Research. The data derived largely by the in vivo method (as most of the in vitro tests have not been successful), point to an increasing frequency and degree of resistance in the north-eastern, eastern and south-eastern border areas. The DDT factory at Barakaunda, after a lapse of several months, began production in August, with the arrival of a shipment of benzene, but since production has not kept to the planned targets, DDT imports may have to be increased. WHO provided three consultants to the Asian Development Bank Mission which visited the country in July 1980, to provide detailed background information and to plan for an appro- priate programme of assistance for malaria control and rehabilitation of the DDT factory. A programme loan agreement was finally signed by the Government of Bangladesh and the Asian Development Bank for assistance from 1981. In BURMA, out of a population of 34.3 million, 31.8 million people live in malarious areas, in 73% of which control activities are in progress. Drug distribution has continued to be the mainstay of the programme, along with intradomiciliary spraying with DDT covering 7.2 million people, although resistance to this insecticide has occurred focally in A.annularis and A. balabacensis. The estimated morbidity due to malaria is about 50 per thousand population. Clinical facili- ties reported that 7.5% their of out-patients and 18.2% of the in- patients had malaria (compared with 6.5% and 16.5% in 19791, the case fatality rate being 2.22 (2.16 in 1979). Consistent with the pattern of epidemiological dynamics in past years, the malaria situation showed no significant change during the period under review. The annual blood examination rate was 1.6, resulting in an extremely low annual parasite incidence of 1.2 per thousand (0.65 in 19791, and the slide positivity rate was 7.6% (5.58 in 1979). The proportion of P.falciparum increased from 76.5% to 81.7% and the slide falciparum rate from 4.27% to 5.26%. Strains of this species resistant to chloroquine at RI and RII levels were widely distributed, with in vivo and in vitro tests conducted by the Programme and by the - Department of Medical Research confirming their presence in the States of Shan, Kachin, Karen, Arakan, Irrawaddy and Rangoon. Assistance extended to the programme by WHO was used largely for fellowships and supplies. Support was also given by UNICEF and CIDA for the supply of DDT, drugs and equipment, and by the Netherlands in respect of two WHO specialists in vector-borne disease control. An important event involving several ministries and departments was the "Inter-sectoral Seminar on Integrated Vector-Borne Disease Control in connexion with Construction of Dams (Sedawgyi)", held in Mandalay in April 1981, supported by WHO (see also Section 2.8). A WHO malariologist was assigned in 1981 for three weeks to visit the FAO/ASDB Forest I1 ~roject in areas of Kachin, Shan and Mandalay and to provide recommendations on general health and antimalarial measures. In INDIA, 664 million people, out of an estimated total population of 700 million, lived in malarious areas, all of which have been under surveillance. A population of about 400 million was protected by anti-vector measures. In 1980/81 a major portion of the central public health budget conti- nued to be spent on the modified malaria control programme, which was first launched in 1977. The modified plan has resulted in an overall decline of malaria incidence in the country. Increased reliance is placed on community participation. Liberal distribution of anti- malarial drugs through community health workers and volunteer drug distributors has been responsible for much of the reduction of morbi- dity and mortality in rural and inaccessible areas. Projected data for 1980 indicate a case incidence of 2.6 million (in 1979, 3.1 million), of which 14.1% are P.falciparum (in 1979, 18.3%); the blood examination rate is around 7.9% (in 1979, 9.7%). The projected API of 3.5 per thousand represents a reduction of nearly 28% over the figure for 1979. A major technical problem continues to.be pesticide resistance. The principal vector in the rural areas, A.culicifacies, is found focally in many districts to have developed double resistance to DDT and HCH; in western India this mosquito in certain foci shows multiple resist- ance to DDT, HCH and malathion. In urban areas A.stephensi shows double resistance to DDT and HCH. In response to the increasing need for a variety of insecticides, national production of DDT, HCH and malathion has been expanded. Strengthening of the National Malaria Eradication Programme in areas where falciparum malaria is prominent has been undertaken through the P.falciparum Containment Programme (PfCP),supported by the Government of Sweden (SIDA) and WHO. Four WHO staff members and one consultant participated in this programme,being involved in its epidemiological, entomological and applied research components. During the year under review, a fourth zone covering parts of western India is being added to the area involved, which includes north- eastern India and the Andaman and Nicobar Islands (Zone I), parts of Bihar, Orissa and West Bengal (Zone 2), and parts of Andhra Pradesh, Madhya Pradesh, Maharashtra and Tamil Nadu (Zone 3). This intensified programme of intradomiciliary spraying, chemotherapy and surveillance resulted in 1980 in the reduction, within the project area, of falci- parum malaria by 12% and of all types of malaria by 13%, as compared with 1979 (slide falciparum rates 4.3 vs 4.9, and slide parasite rates 6.6 vs 7.6). In many parts of north-east India, resistance of P.falciparum to 4-aminoquinolines had already been suspected on clinical grounds; in the last two years in vivo and in vitro tests carried out by the monitoring teams of the ~ndian Council of Medical Research attached to the NMEP regional offices confirmed the focal extension of resistance into Arunachal Pradesh and Mizoram, the Andaman and Nicobar Islands, and westwards into Orissa, Maharashtra and Uttar Pradesh. WHO support was extended to the programme in a number of areas. Fellowships were provided and grants and subsidies arranged for institutional and field training. At the National Institute of Communicable Diseases, Delhi, regular courses on malariology and entomology were held for medical officers and biologists from the NMEP (including PfCP) and from the Defence Department and the Railways, while the NMEP regional health and family welfare offices (formerly regional coordinating organizations) also trained malaria and other health workers (primary health centre personnel). Consul- tants were provided in the areas of epidemiology, bio-environmental sanitation and the engineering aspects of malaria control, and the management of acute malaria was dealt with at a workshop supported by WHO and held in March 1981. The programme also received WHO equipment and supplies. Periodic review meetings of the PfCP were sponsored by WHO. Both NMEP and the PfCP were subjected to an independent assessment by joint Government, SIDA and WHO teams during April 1981. In INDONESIA, there was an increase of 12% in blood examinations in the first half of 1980 - 69 863 cases in 1980 compared with 41 860 in 1979. The increase of cases was predominantly in Central Java with marginal increases in West Java and Bali, but there has been a 30% reduction in East Java. However, there has been no change in the proportion of P.falciparum, which remains at 47%. The malaria control programme continued to face manpower constraints at all levels,parti- cularly in the outer islands. However, it received a special impetus in 1980-81 owing to massive training and refresher courses and workshops organized with significant WHO support to meet critical programme needs. About 500 medical and non-medical supervisors and nearly 500 laboratory staff have benefitted. The central malaria organization has been strengthened with an epidemiologist, a senior laboratory technician and a technical officer. A recent arrangement for the deployment of supervisory personnel among the kabupatens has resulted in a great improvement in the staffing situation. However, financial constraints have prevented wider application of special measures in high case incidence areas of Java and Bali and the launching of problem solving operational studies. Expansion of the programme to other islands has been limited except in respect of Timur, for which US AID assistance is available. The Regional Collaborative Studies on drug resistant malaria gained momentum with the training of additional personnel in in vitro techniques and the availability of test kits. Susceptibility tests of vectors to insecticides have been limited to A.aconitus in West and Central Java provinces. A.aconitus in West Java is susceptible to DDT, whereas in Central Java this vector is highly resistant to DDT but tolerant to dieldrin. An operational study on community participation for case detection and treatment of malaria is under way in one kecamatan under the aegis of the health centre medical officer, with the cooperation of the kecamatan administrative officer and the local women's welfare organization, in which 30 women volunteers are participating. In MALDIVES, all the 202 inhabited islands, with an estimated popula- tion of 152 000, were under the ambit of malaria control operations. During 1980 only 52 cases were detected, giving a case incidence of 0.34 per 1000 population as against 2.3 in 1979; the annual blood examination rate, however, shoved some decline. Nearly 77% of the detected cases were reported from two islands of Shaviyani Atoll and the rest from the other atolls. Since 1975 no P.falci arum cases have been detected. The vectors, A.subpictus and --+- A.tesse atus, are found to be susceptible to DDT. The control messures continued to be indoor residual spraying of DDT in selected islands, and drug administration. Surveillance operations were carried out mostly by community health workers(CWs) and village health workers (VHWs),with the support and participation of community Leaders. Screening for malaria cases at the international airport and Male harbour progressed satisfactorily. Nevertheless, planned acti- vities were hampered owing to communication and transportation difficulties. WHO collaboration continues; in addition to technical support,fellow- ships, local cost subsidies and supplies and equipment, the Organiza- tion, in consultation with the Government, is arranging to provide a seaworthy vessel to facilitate implementation of the activities in different islands. In NEPAL, out of a population of 14.1 million, 8.6 million lived in malarious areas. Of the latter, 8.4 million have been protected through organized malaria control operations - 6.2 million under the Nepal Malaria Eradication Organization (-0) and 2.2 million under the Cormunity Health Integration Project (CHIP). The trend of malaria incidence during 1980 did not show any signifi- cant change; 13 033 cases (with an annual parasite incidence [API] of 1.6 per 1000 population) were detected during the year as against 12,992 cases in 1979. Most of this slight increase in case incidence occurred in the nine Terai districts of the Central and Western Regions, where the proven vector, A.annularis, and the suspected vector, A. culicifacies, have shown resistance to DDT. These areas were scheduled for malathion spraying during 1980 but, on account of the late arrival of the insecticide, this could not be undertaken. The P.falciparum cases declined by 29%. Nearly 24% of all the cases were imported from a neighbouring country. In vitro testing of P. falciparum from a limited number of the imported cases indicated thz the parasites resistant to chloroquine were coming from the north- eastern States of India. In the integrated districts the annual blood examination rate further declined,from 8.3 in 1979 to 6.6 in 1980, while the overall epidemio- logical situation remained unchanged. However, in order to improve coordination between CHIP and NMEO and prepare guidelines for the integration of the malaria control programme into the basic health services, the establishment of a working group has been agreed to. Following an internal situation analysis, an independent assessment of the programme was carried out during March/April 1981 jointly by the Government, WHO, US AID, ODA (UK) and the Netherlands. WHO collaboration continued in the form of technical support, fellow- ships and supplies and equipent. In addition to long-term staff, short-term consultants assisted in the stratification of malarious areas,in preparing a detailed contribution to the Sixth Five-Year plan, and in entomological research. Seminars and workshops were also held with WHO assistance in order to improve operations and formulate applied research projects. Bilateral assistance from US AID and the UK and Netherlands Governments was also provided for the procurement of insecticides and vehicles. In SRI LANKA, nearly 80% of the population of 14.7 million living in malarious areas was covered by the anti-malaria campaign. The current plan of operations covers the period from 1977 to 1981. During 1980, 3.5 million people were protected by malathion spraying. A.culicifa- cies, the proven vector, remained susceptible to malathion but resis- - tant to DDT. In addition to residual spraying, complementary measures of control, such as larviciding, space spraying, water management and drug administration, were applied when necessary. Intensive surveil- lance operations and the monitoring of vector susceptibility to mala- thion were also continued. The epidemiological picture during 1980 showed very little change. During the year 47 915 cases (API 3.3 per 1000 population) were detected, as against 48 004 in 1979. However, unfavourable trends were observed in a few superintendent of health services (SHS) areas owing to persistent transmission of P. vivax in some localities and localized outbreaks of P. falciparum malaria, particularly in areas of chena cultivation and gem mining where spray coverage was not adequate. ?he incidence of P. falciparum cases showed a slight increase as a result of focal outbreaks, but P. vivax remained the predominant species (97% of the cases). Studies using in vitro tests - indicate that the strains of P. falciparum in Sri Lanka contznued to remain highly sensitive to 4-aminoquinolines. WHO continued to collaborate with the programme by providing advisory scaff,fellowships,and supplies and equipment. Also, bilateral assist- ance was received from US AID and the Governments of the Netherlands and the United Kingdom. The prograaoe of applied research and training continued as planned. In THAILAND, there was a substantial increase in malaria cases in 1980, 396 705 having been reported, as compared with 302 658 during the previous year. The reduction in the number of cases seen in 1979, after seven years, seemed to presage an improving malaria situation, but this reduction was deceptive and influenced by unfavourable cli- matic conditions for transmission,l979 being a dry year. The increase of malaria cases in 1980, though common to all regions in Thailand, was most pronounced in the centre and south and consisted exclusively of P.falciparum infections, the proportion of which reached 70% of all types of malaria (56% in 1979). While the increase may be partly attributable to an improved blood examination rate of 11% (10% in 19791, it may also be due to the large number of P.falciparum infec- tions imported along with refugees from Kampuchea. These infections have been multi-drug resistant,in 1980 failures occurring increasing- ly even with the drug combination of sulfadoxine and pyrimethamine, which,with primaquine as sporontocide, has become the standard treat- ment in Thailand for P. falciparum. lhis situation prompted an investigation, jointly supported by WHO and US AID, into five different treatment regimens against infections caused by P.falciparum. Preliminary results point to quinine (seven days) with tetracycline (ten days) as the most effective line of treatment. On the basis of this investigation, regimens of treatment will be developed for different parts of the country, depending on the sensitivity of the parasite to the sulfadoxine/pyrimethamine combination. To prevent the spread of the multi-drug resistant para- rite from the ihai-Kampuchea border, the programme is, in limited areas, introducing fenitrothion, provided under Japanese aid,for spray coverage. A project is being designed whereby the most severely affected area will receive intensive measures, including the provi- sion of the new and highly effective anti-malarial drug, mefloquine. Susceptibility testing of proven and suspected vectors to DDT, malathion and fenitrothion has been carried out in index villages selected for this purpose. The tests have revealed that the vectors are susceptible to these insecticides except in a few locations in northern Thailand, where A.minimus is tolerant to DDT. An inter-country workshop for training personnel in the use of the micro in vitro test for mefloquine sensitivity was held in Phrabudha- bat in March 1981, with 13 participants. WHO supported the first National Malaria Conference, held in Haad Yai in November 1980. mere were nearly 250 participants, from the NMEP, public health services, universities and defence forces,together with WHO and US AID staff. The meeting, which was intended to increase awareness of the malaria situation in Thailand and obtain the co- operation of these various agencies in the Malaria Control Programme, was followed by a two-day training course in epidemiology for zone officers. 2.3.2 Schistosomiasis A small focus of this disease persists in INDONESIA in a limited area of Central Sulawesi. The Government is applying the usual control measures. :. 1.3 Filariasis Filariasis continued to be a major problem in most countries of the Region. In BURMA, WHO collaborated in filariasis control activities through the vector-borne disease control project. In INDIA, WHO extended technical cooperation in connexion with an international symposium on chemotherapy and irmnunology in the control of malaria, filariasis and leishmaniasis, held in Lucknow in February 1981. TDR-supported research studies are being conducted in the country. In INDONESIA, a WHO consultant was assigned for a month in 1980 to collaborate with the Filariasis Section of the National Institute of Health Research and Development in strengthening surveillance activities in Sumatra, and to make recommendations on experimental studies of Malayan filariasis and the teaching of laboratory techniques. 2.3.4 Leishmaniasis Leishmaniasis is an important health problem, particularly in some parts of India. The international symposium held in Lucknow in February 1981 (referred to above) also concentrated on the chemo- therapy of leishmaniasis. A WHO consultant assigned to Bangladesh assisted in establishing technical capability for serological surveys of leishmaniasis and in investigating an outbreak of the disease in Pabna. During 1980, 12 784 cases with 22 deaths were reported in the States of Bihar and West Bengal in India. Control measures were taken by the Government. 2.4 Bacterial Diseases 2.4.1 Tuberculosis Tuberculosis continues to rank high among the major health problems in the countries of the Region. Nearly all have national tuber- culosis control programmes; however, the impact of control measures has been rather marginal, possibly because of shortfalls in each of the three components, namely, immunization with BCG, case-finding and treatment. In BANGLADESH, BCG immunization,which is included in the EPI activi- ties, is in progress throughout the country, utilizing the thana health complex field workers. WHO continued to assist in the development of a national tuberculosis control programme, integrated with health services at all levels, and in the community-oriented training of medical and paramedical staff. In BHUTAN, a WHO consultant assisted in carrying out field surveys to assess the magnitude of the tuberculosis problem and to help to improve the integrated tuberculosis control programme. Tuberculosis control is an on-going national programme in BURMA. The detection of tuberculosis cases outside hospitals is mainly on the basis of laboratory examination of sputum smears. BCG vaccination is given at birth to all babies born in hospitals. WHO is providing technical support for these efforts. In INDIA,where tuberculosis is a major health problem,it is estimated that nearly 1.5% of the population is suffering from radiologically active tuberculosis, and that nearly one fourth of the cases are sputum-positive or infectious. The strategy for BCG vaccination has been changed and it is now integrated with the expanded programme on immunization. In 1980 a WHO consultant was assigned to review the epidemiological studies in tuberculosis at the Tuberculosis Research Centre, Madras, and at the National Tuberculosis Institute at Bangalore. A WHO temporary adviser visited the Tuberculosis Research Centre in November to assist with the planning and evaluation of controlled clinical trials. SIDA is actively assisting the progranme by providing X-ray units, Odelca cameras and other supplies. UNICEF has supplied BCG kits and laboratory equipment, to help improve the case-finding activities at the district tuberculosis centres. In INDONESIA,also, tuberculosis is still regarded as a very important problem, though accurate statistics are not available. At the request of the Government, a WHO consultant was assigned from November 1980 to January 1981 to evaluate the tuberculosis programme and cooperate in a sample survey of tuberculosis prevalence being conducted in Yogyakarta. According to this consultant, the tuberculosis programme other than BCG vaccination needs improvement, i.e., in case-finding, case-holding and follow-up of contacts. In MALDIVES, a survey of 201 islands by a WHO medical officer gave a detection rate of 0.99 per thousand of those examined (positive sputum smear); the positivity rate among suspected persons was 2.6&%. The overall prevalence rate of tuberculosis in the surveyed islands is 3.31 per thousand. KG vaccination continues. WHO maintained its collaboration with the Government of NEPAL in the national tuberculosis control programme. Community participation in the programme is very encouraging, and training activities and ser- vice delivery have continued as planned. The programme is, however, faced with shortage of drugs, transport problems and the continuing large number of defaulters in treatment. The second National Seminar on Tuberculosis, which was jointly sponsored by the Government, WHO and the International Union Against Tuberculosis, was organized in Biratnagar in November 1980, to review the programme activities. Case-finding, case-holding, laboratory diagnosis, treatment and KG vaccination were discussed. At the same time, the Seminar also devoted some attention to the progress of integrated services, operational problems concerning drug distribu- tion, the training of health personnel and the role of voluntary organizations. WHO provided support through a temporary adviser and a consultant. The consultant, besides helping to organize the Seminar, also reviewed the activities of the control programme and advised on the training of health workers involved in tuberculosis control. In SRI LANKA, the anti-tuberculosis campaign is fully integrated with the general health services and is progressing well. In THAILAND, the mortality rate has steadily decreased. The urban population, especially in Bangkok, is however, at higher risk. WHO supported a national seminar on tuberculosis held in Bangkok in November 1980, in which 120 national workers participated. A WHO temporary adviser and a consultant assisted in the organization and conduct of the seminar. In regard to activities at the regional level, the first meeting of the Research Study Group on Tuberculosis was held in the Regional office in March 1981 to review recently-completed and ongoing studies and to reconsider research priorities. Efforts were also made to draw up an outline of pr0tocolS for priority studies. The following priorities were identified: (a) operational studies on case-finding and the chemotherapy and integration of tuberculosis activities into general health services, (b) epidemiological studies on the incidence of infection and its trend, (c) studies on short-course chemotherapy under programme conditions, (dl studies on the diagnosis of tuber- culosis in children, and (e) studies on the efficacy of BCG in the prevention of tuberculosis in children. 2.4.2 Leprosy The South-East Asia Region has approximately half the total number of leprosy patients in the world - a situation which continued to be a cause for concern to governments in the Region. The position of leprosy in 1980 in the countries of South-East Asia is given below: Leprosy Situation: 1980 Estimated Number Prevalence Country number of registered rate/1000 L-Rate% cases Bangladesh Burma India Indonesia Maldives Nepal Sri Lanka Thailand No information: Mongolia, DPR Korea *Total No. of registered cases,including those released from control. In BANGLADESH, case-finding activities for leprosy were intensified in Rangpur and Sylhet Districts, where the disease is endemic. Elsewhere, at the six primary health care pilot thanas, voluntary health workers motivated persons with suspected leprosy to attend the thana health complexes. WHO support continued through a techni- cal officer. A WHO medical officer from the inter-country project "Leprosy Control" visited Bangladesh to assist in preparing a definitive work plan for the intensification of the programme in endemic areas. WHO support was provided for training family welfare workeralhealth assistants and strengthening the leprosy detection campaign throughout the country. Such strengthening is essential since only 15% of the estimated cases have been registered for treatment. In BURMA, the rifampicin trial made progress, with WHO assistance. A WHO statistician continued to provide technical support to the BCG cohort study and assisted in the coding of data. Financial assistance was given for purchasing dapsone tablets,which were urgently required for the national leprosy control programme. A WHO leprologist from the inter-country leprosy control project visited Rangoon in August 1980 and helped to develop the protocol outline for an operational study of release from control of "inactive" cases of leprosy and their follow-up in an area where the leprosy control programme is integrated into the general health services. A WHO consultant assigned in December 1980 collaborated in the research studies on the impact of rifampicin therapy (for lepromatous patients) on the incidence of new cases in the long term, as well as in reviewing the progress made on the THELEP survey for dapsone resistance in Myingyan. In INDIA, leprosy continued to be a major public health problem, with about 3.9 million estimated cases. One epidemiologist-cum-leprologist and one reconstructive surgeon were assigned by WHO to assist the national leprosy control programme. They advised on the methodology of control and on the organization of reconstructive surgery and prosthetics for leprosy patients respectively. WHO had, up to 31 March 1981, supplied four tons of DDS (da~sone) tablets (100 mg) for distribution to various States, in addition to equipment and transport. UNICEF supplied lamprene capsules and five tons of DDS (100 mg) as well as teaching aids for the programme. The Swedish International Development Agency is to contribute 2.9 million lamprene and 2.5 million rifampicin capsules for the intensified crash programme on multi-drug trials in ten districts to be carried out in a phased manner over a three-year period. Seventeen centres throughout the country have been identified for these trials, which form a component of SIDA aid being given to the leprosy control programme in India through WHO. The Organization provided financial subsidies for national workshops and seminars on various aspects of leprosy control. A national workshop on research on leprosy, including immunology,microbiology and vaccine production, was held in Bangalore during October 1980 and was attended by leprologists and scientists engaged in leprosy research in various institutions in the country. WHO is providing both financial and technical support to leprosy research. In INDONESIA, where the Danish Save the Children Organization and other ILEP members are assisting in the leprosy control programme, WHO continued to provide long-term technical consultant support. The training and retraining of all categories of workers proceeded with increasing intensity, especially at the National Leprosy Training Centre in Ujung Pandang. A supplementary random survey carried out in Timur Tenga Utara Regency of E. Nusa Tenggara Province revealed a higher prevalence of leprosy than in other regencies of the Province. WHO provided support for random sample surveys in West Nusa Tenggara and North Sumatra Province, which will be of immense value in asses- sing the magnitude of the leprosy problem. In MALDIVES, the combined leprosy and tuberculosis control programme continued with the collaboration of the Danish Scout's Help Organiza- tion, which withdrew its assistance in January 1981. The Damien Foundation of Belgium has agreed to support the project from January 1981. A WHO leprologist completed a survey, with 97% coverage in 201 islands(exc1uding Male), showing a detection rate of 5.69 per thousand and a prevalence rate of 13.23 per thousand. The total number of identified leprosy cases in the country was 1650 in the year 1980. The maintenance of treatment for leprosy and tuberculosis is carried out by island staff and supervised by community health workers. A complete survey of Male is expected to be taken up in the last quarter of 1981. In NEPAL, the leprosy control project undertook case detection and health education in several districts, bringing up to 26 the number of districts surveyed. A WHO consultant collaborated in planning the strategy of community involvement in leprosy control measures and in defining the role of national and international voluntary organiza- tions in this regard. A subsidy was made available for two districts to intensify their leprosy control work, including active case- detection and case-holding through community participation, and also the introduction of multi-drug regimens. In THAILAND, support was provided for the in-service training of 1348 provincial health workers attached to the basic health services from twelve provinces engaged in integrated leprosy control activities. This training will promote and strengthen the development of control activities at the grass-roots level. Under an inter-country project,a WHO leprologist has been in position in the Regional Office since the beginning of 1981 to promote and coordinate the WHO services-cum-research programme in leprosy in the countries of the Region. An inventory of institutions and scientists working in the field of leprosy was prepared. Research on multi-drug regimens in lepromatous leprosy, immuno- epidemiological studies and prevalence surveys for dapsone resistance is being supported at the Central Leprosy Teaching and Research Institute, Chingleput (~ndia). A WHO consultant participated in the Conference on the classification of Leprosy which had been convened to modify the Indian classification in keeping with recent trends in modern scientific thinking. The proposed classification is now based on the International System of Classification. Research on various aspects of leprosy, supported by the UNDP/World BankfWHO Special Programme for Research and Training in Tropical Diseases, was in progress in Burma, 1ndia and Thailand. The Japan Shipbuilding Industry Foundation (JSIF) continued to collaborate with WHO in leprosy control, training and research activities in the Region. 2.4.3 Sexually-~ransmitted Diseases (STD) The problem of sexually-transmitted diseases (STD) is gradually growing in this region, and there are considerable national inputs in relevant programmes in ~ndia, Indonesia, Sri Lanka and Thailand. The control of STD needs to be considered by the Member States within the framework of general health services, with a multidisciplinary and integrated approach, since the diseases have simultaneously medical, social and economic dimensions. WHO is stimulating this approach through its country and inter-country efforts. An inter-country meeting on sexually-transmitted disease control was held in the Regional Office in November 1980. It was concerned with the identification of the magnitude of the problem in Member count- ries,the bottlenecks and lacunae in the existing control methodology, and the growing prevalence and spread of antibiotic resistance in gonococci in the Region. The meeting formulated guidelines for strengthening national STD control programmes,and its recommendqtions are being studied to ensure better collaboration with the countries in measures for prevention and control. Under-reporting of STDs, rapid emergence of resistance of the gonococcus to penicillin and social implications are some of the problems which call for the immediate attention of governments. 2.4.4 Diphtheria, Pertussis and Tetanus The surveillance, prevention and control of these diseases continued to be covered under the activities of the Expanded Programme on Immunization (see Section 2.6). 2.5 Viral, Chlamydial, Rickettsia1 and Related Diseases 2.5.1 Trachoma Trachoma continued to be a public health problem in the countries of the Region. WHO support consisted of technical cooperation, the award of fellowships, and the provision of supplies and equipment. 2.5.2 Poliomyelitis In the South-East Asia Region, data are available from some countries which participate in the international surveillance of poliomyelitis. The number of cases reported by these countries in 1976, 1977, 1978 and 1979 is given below: Poliomyelitis in the South-East Asia Region Number of cases Country 1976 1977 1978 1979 Bangladesh 9 85 . . . ... Burma 237 176 220 392 India 12 234 10 365 15 492 12 779 Indonesia 127 154 98 84 Nepal 18 35 9 7 Sri Lanka 258 127 153 141 Thailand 800 863 640 1 083 The incidence of poliomyelitis in the countries of the Region is not known precisely, as the surveillance systems are not yet adequately developed. This view is supported by the results of lameness surveys carried out in six countries - Bangladesh, Burma, India, Indonesia, Nepal and Thailand. Three countries, viz., Mongolia, Sri Lanka and Thailand, have included oral polio vaccination in their national immunization programmes. In Mongolia, the programme covers the entire country, and paralytic poliomyelitis has not been reported since 1972. An inter-country seminar was held in the Regional Office during September-October 1980 to review the epidemiological situation of poliomyelitis in the South-East Asia Region and to formulate steps for its control. The meeting recommended inclusion of oral polio vaccine as a component of the EPI programme in a phased manner in all countries of the Region. 2.5.3 Dengue Haemorrhagic Fever Dengue haemorrhagic fever (DHF), with or without dengue shock synd- rome (DsS), continued to be a major public health problem in Burma, Thailand and ~ndonesia. The Organization continued to provide technical cooperation for the development of epidemiological and entomological surveillance, the strengthening of arbovirus laborato- ries, improvement of the diagnosis and of the clinical management of cases of DHF and dengue shock syndrome, and research. WHO collabora- tion in the establishment of national surveillance programmes resulted in the detection of a large number of DHF~DSS cases. WHO has also collaborated in essential training facilities in viro- logical laboratory techniques for national workers, and has assigned consultants to advise on specific aspects of the epidemiological problem (see Section 2.1, "~pidemiological Surveillance"). A number of research studies on DHF continued to be supported. These included: (1) clinical studies: (a) Clinical trial - the role of heparin in dengue shock syndrome at the Children's Hospital, Bangkok, Thailand, and (b) the effectiveness of oral rehydration fluid for early treatment of dengue haemorrhagic fever; and (2) Epidemiological Studies: (a) dengue haemorrhagic fever surveillance in Colombo, Sri Lanka, (b) prospective epidemiological study on DHF in Thailand in Rayong Province,and (c) a prospective epidemiological study on Dengue in DHF "endemic" and "silent" areas in Indonesia's Yogyakarta and Medan provinces, respectively. The WHO Collaborating Centre for Research on the Immunopathology of DHF at the Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Bangkok, conducted various research studies, including studies on (1) the development of dengue vaccine, (2) the morphology and morphogenesis of the dengue virus in different host systems, (3) immuno-electromicroscopy of dengue virion in different cell systems, and (4) immunopathology of DHF, as well as (5) an inmunochemical study of DHF. The Virus Research Institute, Bangkok, was further strengthened with a view to improving the technical facilities for the characterization of arbovirus infections and to promoting research in DHF. A pilot "Field Study of the Control of Aedes aegypti (L), the Vector 7 for DHF, by Anisopterus Dragonfly Nymphs in a Community in Rangoon" was supported at the Department of Medical Research, Ministry of Health, Rangoon, Burma. (Top): Regular fallow-up and treatment are the mainstay of leprosy control activities. (Top left): Surveillance work in malaria control continues. (Left): Spraying against vector-borne diseases. COMMUNICABLE DISEASES Communicable diseases continue to pose a major problem in the Region. With consistent efforts being made by the countries to control them, progress has been achieved in reducing the morbidity and mortality in some areas. Early detection of tuberculosis by sputum examination helps in treat- ment and recovery. EXPANDED PROGRAMME ON IMMUNIZATION A successful immunization programme is essential for the achievement of Health for All. Particular attention is beina oaid bv the Member cou&es in ;mplemcntlng the Ex~anded Proqramme on lmmunization and its strengthening. Immunization services are being made available at home.. . . . .at a health post.. . .in a clinic. A workshop on rapid techniques in virology was held at Pune (India) in November 1980 to train national workers in rapid techniques in diagnosis and the epidemiological surveillance of viral diseases including DHF. A meeting of the Research Study Group on Dengue Haemorrhagic Fever, particularly with reference to dengue vaccine development, was held in the Regional Office in March 1981. The Study Group reviewed the ongoing research in DHF in all its aspects in the South-East Asia and the Western Pacific Regions,discussed the development of the vaccine, and defined further fields of research in dengue vaccine development and related problems in support of future prevention and control programmes. Dengue fever was observed in some islands in Maldives and was investigated by epidemiological and entomological teams. Serological studies on children in Male and some other islands revealed the recent occurrence of dengue infections in the population. 2.5.4 Viral Hepatitis Viral hepatitis continued to be an important health problem in Mongolia. Gamma globulin prophylaxis is now carried out using disposable syringes. A WHO consultant was assigned to Burma in December 1980 to assist in initiating a study of mother-infant transmission of hepatitis B. virus at Rangoon Maternity Hospital. A grant was also made available for this study. 2.5.5 Japanese Encephalitis Cases of Japanese encephalitis were reported from India in Assam, Uttar Pradesh (north-eastern districts), Andhra Pradesh, Tamil Nadu and West Bengal, and a severe outbreak was reported in the Terai districts of Nepal in September-October 1980. Appropriate control measures were taken by the respective national health authorities. 2.6 Expanded Programme on Immunization (EPI) During the year under review, the Expanded Programme on Immunization was implemented in all countries of the Region, with the full support and cooperation of WHO, UNICEF and other participating agencies. To strengthen the programme further, inter-regional, inter-country and national EPI courses were conducted; services of staff and consul- tants were provided; operational research was supported, and national programmes were reviewed, with WHO participation. Six participants from this region (2 from Bangladesh, 1 from Burma, 2 from Indonesia and 1 from Nepal) attended an inter-regional senior- level training course on EPI planning and management held in Manila, Philippines, in August 1980. An intercountry EPI course for mid-level programe management was held in Kathmandu in September 1980 for 17 national participants. Similar courses were also organized in (a) Colombo for 14 participants in October 1980; (b) Dacca for 18 participants in February 1981, and (c) Rangoon for 27 participants in March 1981. An inter-regional training course for technicians in the maintenance and repair of refrigerators was held in Bangkok in May/June 1981, and was attended by 12 participants from the countries of this region. With WHO support and participation, EPI mid-level management courses were conducted, also at country level. In India, 223 health workers completed these courses, which were given in eight States. A further 130 workers are to be trained in this type of course before the end of 1981. In Bangladesh, EPI mid-level management course modules were included in the training curriculum at the National Institute of Preventive and Social Medicine. Later,in Thailand, these modules were translated into Thai for use in hail and's national EPI mid-level management courses. Plans for similar activities were also made in Indonesia. Twenty-four fellows from five countries of the Region were sent on one to three-month EPI orientation tours of countries in Asia, and two health workers were awarded fellowships for six to twelve-month study tours in the United States of America and the United Kingdom. During the reporting period, Regional Office staff visited almost all the countries of the Region to assist in programme reviews, training, management of the EPI, immunization coverage surveys and evaluation. A total of ten consultants went to six countries, where they assisted in collecting baseline data on target diseases, conducting epidemio- logical and serological surveys, solving operational problems, and carrying out studies on the economic aspects of the programme. A regional meeting on the implementation of the EPI through the existing health services and on the evaluation of the programme activities is being organized, to be held in Ulan Bator in August 1981. During 1980, the programme in BANGLADESH was further expanded, and by year-end, 34 urban and 55 rural immunization centres were providing services to children and women. In addition, 13 non-governmental organizations were engaged in giving immunizations. In many places, the cold chain system for vaccine storage and distribution was improved, and work on the construction of the central EPI cold room in Dacca continued. Fresh supplies of vaccines and of cold-chain and immunization equipment were received and distributed to the field. A cluster sampling immunization coverage survey, the first in the country, was conducted in Dacca in February 1981, and gave the following results: BCG - 17%; smallpox - 41%; three doses of DPT - 13% and three doses of polio - 11%. Four per cent of eligible children and 6% of their mothers were found fully immunized. A WHO consultant has been provided to work with national EPI staff in solving technical and operational problems connected with the programme. In BHUTAN,the immunization programme (BCG,DPT and polio for children) was implemented in selected areas. Vaccines, cold-chain equipment and a vehicle for transporting vaccines and for supervision were supplied, with UNDP cooperation. A feasibility study on measles imunization is under way. Technical backstopping was provided through the inter- country EPI project. The immunization programme in BURMA was implemented in 27 townships of Greater Rangoon and in 26 townships in seven Divisions and seven States during the year. Plans were made for its expansion to an additional 53 townships before the end of 1981. The health staff in EPI operational areas were trained for the programme needs, and all vaccines,supplies and equipment were procured with UNICEF assistance. The immunization coverage increased, and there was a smaller drop-out rate in 1980 as compared to 1979. A polio immunization feasibility study was started in a selected area of Rangoon in October 1980. The cold-chain system for vaccine storage at the central level improved, following the installation of refrigeration equipment supplied by UNICEF. A cluster sampling immunization coverage survey conducted in Rangoon Municipality in March 1981 gave the following results: BCG - 82%; three doses of DPT - 72%, and fully immunized children - 70%. It was found that 74% of the women surveyed were protected with two or more doses of tetanus toxoid. In March 1981, Regional Office staff took part in a review of the programme, and recommendations were made for its further expansion. A WHO consultant is to be assigned during the third quarter of 1981 to conduct an epidemiological survey of the EPI target diseases in the country. In INDIA, twenty national participants attended the inter-country EPI management courses. National mid-level courses on this subject were held with WHO support in Gujarat, Maharashtra, West Bengal, Punjab, Uttar Pradesh, Tamil Nadu, Kerala, and Karnataka States and in New Delhi, 219 health staff completing these courses. Similar courses are to be held in six other States before the end of 1981. In 1980,cluster sampling immunization coverage surveys were conducted in Delhi, Calcutta, Kharar, Lucknow, Ahmedabad, Rajkot, Nagpur, Pune and Bombay. They indicated a high BCG and smallpox immunization coverage. The percentage of young children who received three doses of DPT varied from 22 to 82. The tetanus toxoid immunization coverage of pregnant women ranged from 25 to 72 per cent. Vaccines, the cold chain, immunization, sterilization and other equipment were supplied to the States and Union Territories. Mobile cold-chain equipment repair units started operating in Andhra Pradesh in cooperation with UNICEF. With the participation of two WHO consultants, polio and neonatal tetanus incidence surveys were organized in four States in 1980. It is planned to conduct such surveys in five further States. The measles immunization feasibility study has continued, with the participation of 28 medical colleges in the country. Several State EPI working committee meetings were held. The programme in Andhra Pradesh was reviewed, with WHO participation, in March 1981. By the end of 1980, the EPI in INDONESIA had been implemented in 1125 kecamatans, with a consequent increase in the immunization coverage. A total of 281 health workers received training for the programme at kabupaten level, and 1132 at kecamatan level. Plans were made to translate WHO EPI mid-level management course materials into Indonesian and to use them in national courses. Preparations are in hand for conducting an inter-country mid-level management course in Indonesia later in 1981. The organization and functioning of the Central EPI Unit was strengthened, and the supervision of field work in the provinces increased. In August 1980, the country programme was independently evaluated, with Government/WHO/US AID participation. Recommendations were made regarding the further expansion of the programme. The epidemiological surveillance of EPI target diseases was streng- thened by establishing sentinel reporting units in all provinces. In October 1980, the first monthly EPI surveillance bulletin was issued and distributed to all public health staff in the country. A survey on the measles fatality rate was conducted in Sulawesi. Studies on diphtheria incidence were carried out and plans made for a serologi- cal survey of children immunized against polio in Jakarta before the end of 1981. Also,a field survey on the incidence of neonatal tetanus is being planned. Immunization coverage surveys were conducted in Jakarta, in five areas of Java, and in provinces outside Java. The highest immunization coverage (69% of target children) was found in Central Java. Polio immunization was given in Jakarta and in selected urban areas in ten provinces. Regional annual EPI review meetings were organized in all three regions of the country, with WHO participation. The WHO epidemiologist assigned to Indonesia continued to provide technical support to the programme. WHO assisted specifically in planning and implementing the expanded programme on immunization in Jakarta Municipality. A WHO consultant collaborated in carrying out a cost analysis of the national EPI. In MALDIVES, children in Male were given BCG, DPT and polio immuniza- tion. Vaccines and cold-chain equipment were supplied. A consultant was assigned in March/April 1981 to organize and conduct a serologi- cal survey on polio and measles among the population of the islands. A Regional Office staff member also visited the country in 1981 and made recommendations on the further expansion and improvement of the programme. In ~0~~0~1~,immunization coverage continued to remain high. From 1977 to mid-1980,there were no reported cases of diphtheria; polio,tetanus and pertussis were totally under control. The epidemiological situa- tion of measles,in the course of the on-going immunization programme, was reviewed in mid-1980 with WHO participation. Plans were made for establishing local facilities for the quality control of imported vaccines and vaccine samples collected from the field. Cold chain and immunization equipment was supplied. One national EPI manager attended the WHO inter-country EPI mid-level management course in Colombo. The programme in NEPAL was further expanded in 1981,being implemented in 25 districts. A cluster sample coverage survey was conducted in Kathmandu Valley in October 1980, with the following results: BCG - 76%; three doses of DPT - 35%; three doses of polio - 22%, and measles immunization - 12%. An inter-country EPI mid-level management course was conducted in 1980, and the five-year plan of action for the programme was prepared for the period 1981-1985, with the participation of WHO. In February 1981, a WHO consultant was assigned for two months to assist in epidemiological studies on measles, aimed at assessing the public health importance of this disease. Another consultant was provided in April 1981, for four months, to assist in solving some of the operational problems. All health divisions in SRI LANKA have been covered with EPI activi- ties, and the reported immunization coverage has increased. Vaccines, cold chain, immunization and other equipment were supplied, with UNICEF cooperation. A central cold room for storing vaccines was constructed in the new building of the Family Health Bureau in Colombo. The cluster sampling technique for assessing immunization coverage was successfully introduced in the country for the first time. A survey using this technique conducted in Colombo Municipality during the last quarter of 1980 indicated the following coverage: BCG - 71%; three doses of polio - 432, and three doses of DPT - 43%. The percentage of children found fully immunized was 41. Statistical data collected indicated that the reported annual number of neonatal tetanus cases had dropped from 874 in 1978 to 423 in 1979. This might be partially attributed to the improving coverage of the immunization of pregnant women with tetanus toxoid. Plans were made for developing facilities in Colombo for the quality control of imported viral vaccines,and also for bringing an additional one million people (estate employees and their families) under the irmnunization programme. In THAILAND, the EPI continued to make steady progress, as indicated by a comparison of reported data on immunization coverage for 1979 and 1980. The national coverage of infants with BCG rose from 54% in 1979 to 68% in 1980; DPT (two-dose schedule) increased from 43% to 49%, and the primary immunization of pregnant women with tetanus toxoid rose from 24% to 34% for the first dose, and from 15% to 23% for the second dose. Polio immunization of infants was introduced in 23 provinces in municipal and sanitary areas in 1979, and in the first year,78% of target infants in those areas were fully immunized. In 1980, the polio immunization delivery was expanded to cover all infants in forty provinces, including Bangkok; the reported data indicated that the overall coverage of the total infant population in these forty provinces was 37% for the first dose and 19% for the third dose. These figures are, however, based only on data from reporting government facilities and, in fact, coverage is known to be substantially higher on account of immunization activities in the non-reporting voluntary health service sector. The immunization schedule was recently improved by increasing the DPT schedule from two to three doses, and, as previously noted, polio immunization is being rapidly expanded in the country following an evaluation of the health importance of polio by a WHO consultant in 1978. A particular achievement in Thailand has been the introduction and use of coverage assessment surveys as a means of programme evaluation and problem identification. In addition to being a source of service information, the surveys have also been used to collect information on parents' knowledge, etc., to identify specific reasons for non- participation in the programme. These innovations in Thailand are now being used in other countries. In June 1980, the training of peripheral area workers in the EPI was completed. During a six-month period, over 11 500 field personnel and 123 supervisors were trained. As a part of the global programme, a demonstration-training area is being developed in Thailand. In this area, the major elements to be studied or developed include alternative means of service delivery and their cost effectiveness, expansion of coverage surveys for other information useful for programme evaluation, an extensive programme of training mid-level management personnel for the EPI, development of work-related curricula for personnel visiting the country on fellowships, and the development and testing of target disease surveillance mechanisms. 2.7 Veterinary Public Health (VPH) Several countries of the Region have identified rabies, brucellosis and food-borne diseases as priority public health problems. In order to provide technical support in the planning, implementation and evaluation of activities to control the major zoonotic and food-borne diseases, a medical officer in VPH, based in the Regional Office, was appointed in 1980 with funds provided by the Federal Republic of Germany. He has visited India, Indonesia and Thailand and held discussions with the national authorities for developing and streng- thening VPH activities. Since one of the major zoonotic problems in most of the countries in this region is rabies, the possibility of developing a potent and stable tissue culture vaccine for veterinary use against rabies is being explored at the Department of Virology, Institute of Medical Sciences, Bangkok. WHO provided support to Nepal and Sri Lanka for further strengthening their activities in the control of rabies. Sri Lanka is seeking bila- teral assistance for rabies control, based on the project prepared with the assistance of WHO. 2.8 Vector Biology and Control Various degrees of resistance and refractory behaviour of vectors to commonly used insecticides for residual house spraying continue to be the major technical problems facing many of the vector-borne disease programmes in South-East Asia. The need to change from cheaper and safer insecticides to more expensive and more toxic ones is causing financial constraints on national health budgets and difficulties in field operations. In order to cope with this problem on a long-term basis, WHO is encouraging and supporting studies on the biological control of disease vectors and reservoirs and is stimulating and assisting in the development of environmental methods for vector control through inter-sectoral cooperation. In collaboration with WHO Headquarters, efforts are being made to formulate innovative methodological approaches to the control of vectors as part of integrated disease control at the village level, in keeping with the principles of primary health care. In BANGLADESH, malaria vectors continue to show susceptibility to DDT in spite of the long history of its use in the antimalaria programme. During 1980 outbreaks of kala-azar occurred in some parts of the country. Attempts are being made to identify the responsible vectors and to develop a strategy for their control. In BURMA, although the available staff is limited, the Vector-Borne Disease Control Programme (VBDC) is making efforts to expand its field activities. The programme continues to receive financial assistance from the Canadian and Netherlands Governments. While Canada provides supplies and equipment, the aid from the Netherlands is utilized to finance the technical staff assigned by WHO. A team leader under the WHO regular budget is being recruited. In Rangoon, a new VBDC Headquarters building, with laboratories, lecture hall, dor- mitory and offices for senior staff, has been completed. A highlight of the year was the holding of an inter-sectoral Seminar on Inte- grated Vector-Borne Disease Control in Connexion with Construction of Sedawgyi Dam. This national seminar, organized with support from WHO and held in Mandalay in April 1981, was attended by 30 national participants, representing ten ministries, and by eight WHO staff members from all levels of the Organization. The participants from all sectors unanimously recornended that in every development pro- ject, the prevention and control of possible adverse health factors must be incorporated at the planning and budgeting stage and maintained throughout construction and subsequent operations. Monitoring of the susceptibility/resistance of malaria vectors to insecticides has been intensified. A total of 34 tests was carried out during the reporting period. Results with Anopheles annularis showed that DDT resistance had developed in this mosquito only in certain parts of its range, in the west and south. An.culicifacies showed varying levels of resistance to DDT, the highest being in Central Burma, whereas An.balabacensis and An.minimus, the main malaria vectors, continue to be susceptible to this widely used insecticide. The WHO Rodent Control Demonstration Unit (RCDU) in Rangoon continued its work on serological surveillance, trials with new rodenticides and the monitoring of flea susceptibility to rodenticides. In INDIA, trials with alternative insecticides are in progress for the control of malaria vectors that are resistant to the common insecticides. Because of the increasing problem of vector resistance to insecticides and for ecological reasons, the national authorities are developing methods for the environmental control of mosquitoes. In this connexion a WHO sanitary engineer visited the malaria programme during November 1980 - January 1981 in order to help in the training course on the engineering and water management of vector control and to advise on bio-environmental sanitation and the engineering aspects of mosquito control in urban and rural areas. A filariasis control demonstration project based on integrated pest management for the control of bancroftian filariasis was launched in Pondicherry, South India. In INDONESIA, WHO/TDR has provided financial support for developing the M.Sc. course in medical entomology at the Bogor Agriculture University. A WHO consultant assessed the present vector surveillance activities, with emphasis on malaria, and provided guidance regarding entomological activities. In collaboration with DANIDA, WHO is hold- ing an inter-country course on "Vector and Rodent Biology and Control in relation to Urban and Peri-urban Situations", at the Ciloto Training Centre during June-July 1981. The WHO Inter-regional Vector Biology and Control Research Unit-2 in Jakarta, with its sub-unit in Semarang, operated by six WHO long-term staff members,is assisting the Government in the training of national staff and in the planning,implementation and evaluation of 13 research projects. These projects cover a wide spectrum in VBC including trials with environmentally acceptable alternative insecticides to DDT and studies on the ecology, bionomics and control of vectors of malaria, filariasis, JE, DHF and vectors and reservoirs of plague in Java and the outer islands. In Central Java, where the level of DDT resistance in An.aconitus is very high and residual house s~rsying with this insecticide is producing no apparent impact on malaria transmission, trials with other insecticides such as fenitrothion, pirimi~hos methyle and bendiocarb have continued. In January 1981, a toxicolo- gist from WHO Headquarters visited Indonesia to observe and monitor the toxic effects of bendiocarb on spraymen, villagers and domestic animals. In regard to the two malaria vectors occurring in MALDIVES, - An. tesselatus continues to be susceptible to and is easily controlled by DDT residual spraying, but An.subpictus, although still responding favourably to DDT spraying, may be developing some tolerance to this insecticide. After many years of application of Abate for the control of Culex quinquefasciatus, the vector of filariasis, there are indications that this mosquito is becoming tolerant or resistant to the insecticide. Efforts are being made to encourage the people to restock their wells with larvivorous fish for Aedes control. In NEPAL, a WHO consultant reviewed the entomological activities in the malaria programme and advised on the requirements of field opera- tions and research. Guidance was also provided on procedures for the investigation of vectors related to Japanese encephalitis outbreaks in the Terai. A national entomologist was sent to Thailand on a WHO fellowship to study mosquito cytotaxonomy. In SRI LANKA, UNDP assistance to Phase I1 of the vector control projecr continued throughout the year, and a tripartite review meet- ing was held in November 1980. Most of the activities of the project are progressing as planned, monitored by a WHO epidemiologist. A WHO consultant visited the project in July 1980 and made recommendations concerning long-term control measures against Culex quinquefasciatus in Colombo and the endemic belt,the surveillance and control of Aedes mosquitoes in Colombo, and trials with slow release larviciding for the control of C.quinquefasciatus in the coconut husk soak pits in coastal areas. Trials were continued with different insecticides and formulations,including Dursban 10 CR, ECOPRO chips and Altosid insect growth regulator. The consultant made another visit in May/June 1981 to evaluate the effect of these larvicides. In THAILAND, the monitoring of vector susceptibility/resistance to insecticides and the evaluation of vector response to the impact of DDT residual house spraying have been pursued systematically. During 1980, 86 susceptibility tests were undertaken. In Phrae Province, where chlorinated hydrocarbon insecticides are applied extensively in cotton fields, results of six years of study (1975-1980) show that there has been no significant change in the susceptibility level of An.minimus to DDT. In the partial integration areas of North-east Thailand, where there have been increases in the number of malaria outbreaks, WHO assistance is being given to long-term entomological studies designed to identify the responsible vectorls, their seasonal prevalence and their breeding potential. The Organization has extended its recognition of the Division of Medical Entomology, Department of Medical Sciences, Ministry of Public Health, as the "WHO Collaborating Centre for Evaluation of Pesticide and Pesticide Application Equipment in South-East Asia" for three more years from September 1980. In collaboration with UNDP, the Division of Medical Entomology is planning a trial of monomolecular organic surface films as a method for non-toxic control of disease- carrying mosquitoes in stationary waters. WHOITDR is supporting studies on biological control agents of mosquitoes and snails carried out by different groups of scientists in Chulalongkorn, Mahidol and Chiang Mai Universities. 3. DISEASE PREVENTION AND CONTROL - NONCOMMUNICABLE DISEASES In the context of health for all by the year 2000, attention has been focused on promoting national and regional self-reliance in meeting community-oriented service demands for the prevention and control of emerging health problems including those of the noncommunicable diseases. Technical collaboration with governments has been maintain- ed through sustained efforts to create national awareness of the needs and to develop a system for surveillance and the monitoring of trends in changing patterns of morbidity and mortality. Two important areas have been disabilities resulting from chronic degenerative diseases and health problems associated with ageing. The services of consultants were provided to assess these problems, review existing facilities and advise on measures for integrating training and ser- vices into primary health care. Health education and early detection facilities at the peripheral level and the strengthening of facili- ties for diagnosis and treatment at the intermediate and central levels of health care thus have received increasing emphasis. This approach has made it necessary (a) to train community volunteers and peripheral health workers to assume their responsibilities in these aspects and (b) to give professional staff opportunities to enhance their knowledge and skills in order to provide specialized medical care. National training activities were sponsored and overseas fellowships were awarded for the development of health manpower for work on cancer, cardiovascular diseases, diabetes and chronic respi- ratory disorders. The suitability of imported equipment for deliver- ing health care in the field of noncommunicable diseases under the prevailing cultural,social and economic conditions received scrutiny, and the development of appropriate technology was promoted. In addition, research priorities for prevention and control were identi- fied and protocols developed for epidemiological and operational studies on the commonly seen health problems. Regional and national collaboration was promoted by organizing meetings of scientists and by ~roviding research institutions with supplies and equipment. 3.1 Cancer - National programmes for the prevention and control of cancer made further progress in Bangladesh, Burma, DPRK, India, Indonesia, Mongolia, Sri Lanka and Thailand. In BANGLADESH, a consultant reviewed the morbidity and mortality patterns of cancer and recommended an -- ad hoc survey in selected districts. He suggested that public education on the risk factors for oral and lung cancer should be widely disseminated through the mass media. The other recommendations were for considerably strengthening existing facilities for early detection and diagnosis, for standardi- zation of treatment with radiotherapy and chemotherapy and for the improvement of training in oncology, including epidemiology, in undergraduate and post-graduate education. He considered that a referral system for ontological services and improvement of the cancer centre at Dacca Medical College would considerably enhance the quality of health care for cancer patients. In BURMA, the cancer registration system at Rangoon General Hospital is functioning well. Similar hospital-based cancer registries are being established in Mandalay and Taunggyi. The country health programming exercise identified cancer as a priority problem, and a project for technical collaboration in community-oriented prevention and control activities was included in the programme proposals for the next biennium. Increasing attention will be paid to continuing professional education through assigning consultants, awarding fellowships, and strengthening treatment facilities. A team of WHO staff members from the ~egional office and Headquarters visited DPRK in July 1980, reviewed the progress and prepared a plan of action for continued technical collaboration in cancer prevention and control. Establishment of cancer registration, the strengthening of preventive measures through public education, organization of facilities for early detection and diagnosis, and standardization of treatment continued to receive emphasis. The new cancer institute under construction is expected to be completed soon. Ontological units have been established in all provincial hospitals with the necessary facilities for early detection and diagnosis. A team of three consultants is to be assigned later in 1981 to assist in deve- loping services for treatment and cancer immunology. The training of ontological specialists and the improvement of research in cancer were supported through the provision of supplies and equipment. In INDIA, cancer control activities were increased through the estab- lishment of more regional centres in six States. The Arignar Anna Nemorial Cancer Hospital at Kancheepuram, Tamil Nadu, was inaugurated in March 1981, to function as the State's apex referral centre and undertake training and research in addition to providing treatment for complicated cases. Under bilateral assistance from the United Kingdom, a linear accelerator with facilities for training, repair and maintenance services was installed at the Gujarat Cancer and Research Institute, Ahmedabad. Documentation on cancer and health education, including a set of nine films produced by the American Cancer Society, were made available to selected regional cancer centres. Exfoliative cytological services for the early detection of cervical cancer were strengthened in a number of States as an integral part of the family welfare programme. A WHO consultant assigned to INDONESIA visited institutions providing diagnostic and treatment facilities for cancer patients in Yogyakarta, Semarang and Jakarta, reviewed the progress of control activities and assessed the magnitude and pattern of the problem, on the basis of available data. He also discussed strategies for a national cancer prevention and control programme. In accordance with his advice, efforts are being made for the appointment of a Cancer Coordinating Committee and a National Cancer Advisory Board, the establishment of a system of centralized medical records and hospital-based cancer registry, and the development of a national cancer centre. In MONGOLIA, the national cancer control programme has been progres- sing well. As part of this programme, the construction of the cancer hospital at Ulan Bator is nearing completion. The first round of screening for cervical cancer was carried out in all the aimaks. Since the establishment of the ~ational Advisory and Coordinating Board for the Control of Cancer in SRI LANKA, there has been considerable progress in implementing the national strategy and plan for cancer control. Specific priority areas, including further development of the information systems, increasing the capabilities for early detection, diagnosis and treatment, the improvement of the cancer registry and expansion of facilities at the Government Cancer Institute at Maharagama, were identified. The National Board has appointed sub-committees to prepare plans of action for each of the priority areas. A special cell has been set up in the Ministry of Health to carry out the activities; the national cancer control and prevention programme is now headed by a director. A WHO consultant visited Sri Lanka during August-September 1980 and assisted in the conduct of a workshop on a "Standardized Approach to Cancer Treat- ment". He also prepared guidelines for diagnosis, classification and treatment. Another consultant conducted a training course in 1980 for peripheral health workers in the early detection of precancerous and cancerous lesions of the oral cavity. A training manual was prepared in the local language and field-tested for use by these health workers. WHO also provided grants to the National Board for develop- ing research activities and awarded fellowships. In THAILAND, the training and research activities at the National Cancer Institute progressed satisfactorily. A WHO consultant assisted the Institute in matters relating to the planning of cancer treatment with radiotherapy, and reviewed the morbidity patterns of the disease by visiting a number of treatment centres in the country. On the basis of his findings, the Government is now taking steps to extend the radiotherapy services outside Bangkok and to establish cancer clinics based on multiple treatment modalities. 3.2 Cardiovascular Diseases Prevention of cardiovascular diseases continued to receive consider- able attention from government agencies, professional groups and voluntary organizations. ~ational planning for the prevention and control of cardiovascular diseases has been promoted and the import- ance of education, positive life styles and behaviour received emphasis in the context of prevention as an integral part of primary health care. In BANGLADESH, the Institute of Cardiovascular Diseases started functioning early in 1981. The Institute is well equipped, through Japanese assistance, and is adequately manned by personnel trained by means of bilateral support. It will play a vital role in educating the public about the preventive aspects of cardiovascular diseases and will undertake training, services and research. The Institute conducted a survey around Dacca to determine the magnitude of health problems due to hypertension, rheumatic heart disease and ischaemic heart diseases. With WHO support, a national workshop on the preven- tion and management of cardiovascular diseases, in which 56 doctors participated, was conducted. A WHO consultant assisted in developing a national plan for prevention and control, with special reference to hypertension and ischaemic heart diseases and for the training of health and allied personnel in this field. A programme for the prevention and control of cardiovascular diseases in BURMA was formulated as part of the WHO-supported country health programming early in 1981 and was supported by WHO. The Cardiology Unit of Rangoon General Hospital continued to make efforts to expand and extend its activities to the community level. With the recogni- tion of cardiovascular diseases as a growing problem because of the increase in morbidity and mortality, the Government has drawn up a plan for early diagnosis and treatment as well as for educating the people in prevention. A team of WHO consultants visited DPRK in July 1980 and assisted in assessing progress in the implementation of the plan of action for the early diagnosis and treatment of cardiovascular diseases which had been formulated previously. The results of this assessment led to the reformulation of programme proposals, based on which the budget estimates for WHO collaboration during 1982-83 were drawn up. Based on another survey, a school health programme was formulated for the prevention and control of rheumatic heart disease. Similarly, a community-oriented programme for the prevention and control of hypertension is under consideration. WHO technical support provided during the period also included fellowships, supplies and equipment, and consultant services in the use of the ultrasonic diagnostic technique in cardiovascular diseases. In INDIA, activities for the prevention and control of cardiovascular diseases continued to develop in various institutions. A WHO consultant visited selected institutes in the country to assess the existing facilities and advise on the development of community- oriented services for the prevention and control of hypertension. Following his visits, a meeting of a task force was organized by the Indian Council of Medical Research, to identify priority areas for research on this condition and to formulate a plan of action for community-oriented prevention and control. Two consultants are being assigned to advise and assist in developing national and State-level plans for the prevention and control of ischaemic and rheumatic heart disease. The Indian Council of Medical Research has also developed a plan of action for the prevention and control of rheumatic heart disease amongst school children. The Sree Chitra ~hirunal Institute for Medical Sciences and Technology, Trivandrum, is now specially geared to the promotion of indigenous technology for medical applications which will facilitate national cardiovascular disease control activities. The Institute is in the process of being designated as a WHO Collaborating Centre. A WHO consultant visited MONGOLIA in September-October 1980 and assisted in assessing existing facilities for the study of strepto- coccal microbiology, in conducting a pilot study on streptococcal carriers amongst school-children, and in preparing a medium-term programme for the prevention and control of rheumatic fever and rheumatic heart diseases. The service facilities at the cardiac unit in Colombo, SRI LAW, were expanded through the addition of paediatric cardiology and cardiac surgery. Paining activities for health and allied personnel are progressing satisfactorily. The Department of Health collaborates with the Faculty of Medicine, University of Colombo, in implementing the programme of prevention of cardiovascular diseases through the community approach. WHO assistance in epidemiological studies aimed at preventing and controlling these diseases at the community level has continued. In THAILAND, WHO provided support for the collection and analysis of epidemiological data relating to cardiovascular diseases. A consul- tant assisted in developing a plan for the prevention and control of rheumatic fever and rheumatic heart disease, and a national advisory committee has further elaborated this plan for implementation in the field. 3.3 Prevention of Blindness Formulation of national policies and strategies, preparation of plans of action, surveys of the magnitude of the problem, mobilization of national and international assistance for the implementation of activities aimed at prevention and the restoration of sight to the blind, training of health and auxiliary personnel, promotion of appropriate technology for self-reliance in low-vision aids, and evaluation of ongoing activities were the main components of the programme for the prevention and control of blindness in the Region. The Third Meeting of the WHO Programme Advisory Group on the Preven- tion of Blindness was held in the Regional Office in February 1981. Following a review of regional and inter-regional activities and those of WHO Collaborating Centres, the Advisory Group defined the research priorities in eye health problems and developed alternative approaches for the mobilization of resources. The enthusiasm created by this meeting led to two major actions: first, the inauguration of the Asian Foundation for the Blind in Hong Kong with the main objec- tive of bringing welfare and relief to the preventable, curable and incurable blind in the countries of the South-East Asia and Western Pacific Regions; second, the establishment in 1981 of the post of Medical Officer in the SEA Regional Office, with collaborative assistance from the Royal Commonwealth Society for the Blind, for the management of the prevention of blindness programme. An inter-country Seminar on Cataract Relief Services was organized at the National Institute of Nutrition in Hyderabad, India, during September-October 1980. There were eighteen participants, from Bangladesh, India, Indonesia,Maldives, Nepal, Sri Lanka and Thailand, and representatives of voluntary organizations and non-governmental agencies. The Seminar reviewed current activities and formulated specific strategies for dealing with the large number of cataract patients. A consultant visited Bangladesh, Burma, India and Sri Lanka to review the national programmes, to identify institutions with potential for development as regional training and demonstration centres for the prevention and control of major eye diseases (includ- ing rehabilitation) and to prepare a background paper for developing a regional programme on the prevention and control of blindness, which UNDP will also support. (Above): As a result of various preventive and curative programmes, over a million people have had their eyesight restored and thousands more have been saved from blindness or visual impairment during the past five years in the South-East Asia Region. GIVING SIGHTTO THE BLIND Regular eye examinations in schools promote better vision. early detection of eye diseases and prevention of blindness. Committee for South-East Asia was held in Male, Maldives-the first international meeting to be held in that country. The President of the Republic of Maldives, His Excellency Mr Maumoon Abdul Gayoom (centre), inaugurated the meeting. Others in the picture are (from I tor): the Honourable Mr Fathullah Jameel, Minister of External Affairs, the Honourable Mr Mohamed Musthafa Hussain. Minister of Health, Dr Halfdan Mahler. Director-General. WHO. and Dr V.T.H. Gunaratne. the then Regional Director. A delegation from the Democratic People's Republic of Korea, led by the Honourable Dr Kim Yong Ik. Vice-Minister of Public Health (centre). visited the Regional Office. The deletlation is seen here with Dr U KO KO. the Regional Director (third from right). The delegation visited health institutions in India to observe practices in mental health. traditional medicine and manufacture of pharmaceuticals and drugs. and discussed matters relating to collaboration in research and training. RACMR The 7th session of the SEA Regional Advisory Committee on Medical Research (RACMR), which met in SEAR0 in April 1981. underscored research needs for achievement of the HFA goals. It was inaugurated by Dr U KO KO and chaired by Professor A.A. Loedin (right). Professor S. Bergstrom. Chairman of the Global ACMR (second from left), also attended. In BANGLADESH, health personnel working at different levels received training in eye health. A consultant visited health institutions, reviewed developments with the national workers and improved upon the national plan for the prevention and control of blindness. Measures for integrating eye health services in primary health care,establish- ing referral services,expanding eye-camp activities and manufacturing low-vision aids are receiving priority attention by the Government. A second consultant collaborated in the development of curricula for the training of medical assistants in public health ophthalmology and participated in the training courses. Fellowships were awarded for training in public health ophthalmology. Activities for the preven- tion of xerophthalmia, with support from UNICEF, and rural eye camps, assisted by the Royal Cornonwealth Society for the Blind, made satisfactory progress. In BURMA, a strategy was developed for providing eye health services in remote rural areas for the operative treatment of entropion and cataract, and action taken for the mobilization of extrabudgetary resources and the supply of vehicles and equipment. Audio-visual material for training in ophthalmology and health education was provided. A WHO consultant visited the country to assess the progress and to discuss the future development of this programme with the national authorities. The Government of INDIA initiated a series of administrative proce- dures for the decentralization and speedy implementation of the national plan for the prevention of blindness. Forty-five mobile ophthalmic units are in operation. Coordinators were appointed to assist the programme and monitor its development in the States. Training curricula for ophthalmic assistants were formulated and institutions identified for conducting the courses. Assistance to voluntary organizations was increased to enable them to conduct more eye camps in rural areas. The ~ndian Council of Medical Research organized a meeting to review the activities and plan research in ophthalmic sciences. A WHO consultant assisted in the preparation of a research protocol. Bilateral assistance for the programme was received from DANIDA, and several voluntary agencies working in this field received support from non-governmental organizations from outside the Region, i.e., the Royal Commonwealth Society for the Blind, Christoffel Blindenmission, Operation Eyesight Universal and others. The Royal Commonwealth Society for the Blind formulated a country-wide project for the prevention of blindness due to mal- nutrition and has started to train workers at Madurai. "Operation Cataract" in Medak District, Andhra Pradesh,continued its activities. A research project in collaboration with the National Eye Institute, Bethesda, Maryland USA, is in the early phases of development at the National Institute of Nutrition, Hyderabad. Integration of eye services into the school health programme is also receiving attention. In INDONESIA, the programme for the prevention of xerophthalmia continued to make satisfactory progress. vehicles were supplied with resources made available from the Japan Shipbuilding Industry Founda- tion for mobile ophthalmic units, and comunity-oriented eye health services are being organized in rural areas. A WHO consultant worked with national personnel in streamlining the national plan of action for the control of blindness. Supplies and equipment were made available to MALDIVES, where a strategy is being formulated to restore sight to the curable blind and prevent blindness due to malnutrition and eye infections amongst children scattered over the many islands in the country. A consultant advised on improving the ophthalmological services at Male Hospital and operated on a number of patients for cataract and other eye ailments. In NEPAL, a well-planned national programme for the prevention of blindness was started early this year, with assistance from the Netherlands and WHO as the executing agency. A detailed survey had been carried out in 105 communities, and the data are being analysed, the first phase of the plan of action thus being completed. Extra- budgetary resources for this activity were also made available from non-governmental agencies from the USA and Sweden, as well as from the Swiss Red Cross. Preliminary analysis of the data indicates that trachoma is common in mountainous areas owing to the insanitary environment,whereas cataract is much more common in the Terai region. Based on further analysis of the data, a suitable strategy will be developed for implementing subsequent activities under the programme. Some 48 district medical officers will receive training in secondary eye care, and nearly 1500 community health personnel in the treatment of minor eye conditions, in first-aid and in the referral of ophthal- mic cases to eye departments. The construction of the new building for the Nepal Eye Hospital made progress, through resources made available from Operation Eyesight Universal. An ophthalmic unit is being established in Pokhara in a phased manner, in collaboration with the Institute of Ophthalmology, Munich. The problem of iritis and secondary cataract due to leprosy is being investigated. The mobile ophthalmic unit supplied to the Colombo Eye Hospital, SRI LANKA,has extended its activities to remote rural areas. Negotiations with the Royal Commonwealth Society for the Blind and the Christoffel Blindenmission for the establishment of a school for ophthalmic auxi- liaries in Peradeniya are under way. In THAILAND, the expansion of community-oriented eye health services is progressing satisfactorily, through the training of doctors and nurses from the provinces at Buriram Hospital and in Bangkok. A team of ten doctors and five nurses visited ophthalmic centres in India, under the WHO fellowship programme, to observe the large-scale management of eye diseases, including cataract, in institutional and rural settings. A national plan for the prevention of blindness was formulated at a meeting of health professionals, and the constitution of a national advisory committee is under the consideration of the Government. The proposal to establish an institute of community ophthalmology with extrabudgetary assistance is also receiving attention. 3.4 Immunology The importance of immunological factors in the pathogenesis of disease and of immunological techniques in diagnosis is increasingly being recognized. During the year under review, a WHO team of con- sultants evaluated the work and progress of the WHO Collaborating Centre for Research and Training in Immunology at the Department of Biochemistry, All India Institute of Medical Sciences, New Delhi. In September 1980 an inter-country workshop on the production of immuno- logical reagents was held in Bangkok, in which the participants were trained in the production and standardization of commonly used immuno- logical reagents with a view to helping the country attain national self-reliance. A consultant visited Indonesia to collaborate in setting up immunological methods in public health laboratories. 4. HEALTH LABORATORY SERVICES 4.1 Organization of Laboratory Services WHO has been collaborating with the countries in the Region in developing their health laboratory infrastructures, improving the technical standard of laboratory services and training national staff in health laboratory technologies and management. The Organization assisted in the development of peripheral laboratories and inter- mediate-level laboratories in support of primary health care. Referral laboratories were strengthened in the fields of microbiology,virology and immunology so as to be able to undertake disease surveillance and support diagnosis. WHO has also helped to develop quality control in clinical chemistry, microbiology and haematology. Since the rapid diagnosis of viral diseases for carrying out preventive measures and promoting better treatment is being increasingly recognized as a health priority, WHO organized an inter-country workshop on this subject in Pune (India) in November 1980. Also, a workshop on anti- biotic sensitivity testing was held in New Delhi in MarchJApril 1981, designed to provide bench-level training to national workers to set up standard techniques in antibiotic sensitivity testing and anti- biotic assays. Here, training was given in advanced techniques in bacteriology,viro?ogy and laboratory management, including techniques for respiratory viruses, and following the workshop, the participants were supplied with adequate amounts of reagents for standardization of the techniques to enable them to carry on the tests in their respective countries. In BANGLADESH,the Institute of Public Health was assisted in organiz- ing training for laboratory personnel from peripheral and inter- mediate laboratories,particularly the training of unipurpose personnel to convert them into multipurpose laboratory workers. A WHO con- sultant was assigned to evaluate the public health laboratory programme. The Government has prepared a project for strengthening laboratory services at intermediate and peripheral levels. Another consultant collaborated with the National Institute of Preventive and Social Medicine in strengthening laboratory facilities for occupa- tional health and industrial hygiene. In BURMA, laboratories at the township level were strengthened, and, at the National Health Laboratory, Rangoon, training programmes were organized for laboratory personne1,which included training in quality control techniques and advanced techniques in microbiology. A con- sultant was assigned to develop a programme for monitoring hospital cross infections. WHO participated in formulating the plan for health laboratory services as part of country health programing for 1982- 1986. In INDIA, WHO long-term staff assisted in improving the performance of public health laboratories in Kerala, Tamil Nadu, Pondicherry, Karnataka, Goa and Bihar. Bench training, with emphasis on quality checks, was imparted to laboratory technicians. WHO collaborated with the authorities in the States of Andhra Pradesh and Kerala in plans for the further improvement of laboratory services. Assistance was also given in organizing a national workshop on blood transfusion technology, and WHO took part in another national workshop on micro- biological procedures in studies of antibiotic resistance in bacteria. In INDONESIA,the laboratory services infrastructure was strengthened, particularly at the peripheral level. WHO supported the training programme in laboratory management and immunology. Consultants have been assigned in the specialties of clinical chemistry, virology and innnunology to help strengthen the regional laboratories. Training programmes in MALDIVES and the further development of the hospital laboratory in Male were assisted. A WHO consultant advised MONGOLIA on strengthening the laboratory services, particularly in tuberculosis bacteriology, at referral and aimak levels. The Government of NEPAL, with WHO assistance, further strengthened the laboratory infrastructure in the country. Training programmes for laboratory workers, conducted by long-term staff, included training in laboratory management and advanced techniques in diagnostic technology. In THAILAND, the laboratory programme was evaluated by a WHO consul- tant. The Chief of Laboratories received training in laboratory management. 4.2 Quality Assurance WHO continued to collaborate with countries in the Region in improv- ing the quality of their laboratory services. External quality control programmes initiated some years ago were continued and strengthened. WHO Headquarters provided guidelines for the prepara- tion of reference values and for the evaluation of diagnostic kits, as well as manuals on quality control in clinical chemistry. In BURMA, external quality control in clinical chemistry was under- taken at the ~ational Health Laboratory, Rangoon, and national staff received training in clinical chemistry at WHO Collaborating Centres. The national programme in quality control will be developed further to improve the work in diagnostic laboratories. In INDIA,external quality control in clinical chemistry was continued. In this programme,l8 laboratories are now participating,their perform- ance being monitored by the national laboratory at the Post-graduate Institute of Medical Education and Research, Chandigarh. Analytical sera developed by the Central Council of Industrial Research are being evaluated in the WHO Collaborating Centre. Quality control in clinical chemistry in INDONESIA was strengthened through the provision of sera for use in such control. A consultant visited the country in April 1981 to assist in strengthening the national programme of quality control in clinical chemistry. The International Federation of Clinical Chemistry is developing a quality control project in THAILAND, in collaboration with the WHO Collaborating Centre for Research in Clinical Chemistry at Birmingham, United Kingdom. Quality control in haematology has been supported in India,Nepal, Sri Lanka and Zhailand through the supply of standardized haematological specimens by the WHO Collaborating Centre in Haematology. Assistance is being given to India in the development of national quality control in haematology at the All India Institute of Medical Sciences, New Delhi. 4.3 Quality Control of Pharmaceuticals and Biologicals One of the important components of pharmaceutical supply systems is assurance of the quality of essential drugs used in primary health care. WHO has been collaborating with governments in establishing and strengthening national quality control in pharmaceuticals and biologi- cals. National staff have been trained in the techniques of drug analysis and in the quality control of biologicals. Several countries have developed national quality control laboratories. In BANGLADESH,the Drug Control Administration was further strengthened through the award of fellowships for training in the quality control of drugs. The National Health Laboratory in BURMA received assistance in estsb- lishing a quality control laboratory for food and drug analysis with UNDP support. National workers were trained in pharmaceutical chemistry and food and drug microbiology. WHOIFAO consultants have supported programmes aimed at assuring food and drug quality. In INDIA, the Drug Control Laboratory received further assistance. The programme for testing the oral polio vaccine manufactured by the Haffkine Biopharmaceutical Corporation was continued. A WHO consul- tant collaborated with national workers in conducting neurovirulence tests on lots of working seeds and vaccines of all three types and also helped to establish a national quality control laboratory at the Central Research Institute, Kasauli. 4.4 Vaccine Production WHO has collaborated with governments in increasing the production of biologicals, particularly vaccines, for the Expanded Programme on Immunization. In BANGLADESH, the Public Health Institute established new facilities for the production of tetanus toxoid and DPT. With support from WHO, the new DPT block is now ready to start functioning. A WHO consultant provided technical support in planning for the production of vaccines with a view to attaining self-reliance in the country. In BURMA, the Bum Pharmaceutical Industry received WHO assistance to help the Government to achieve self-reliance in the production of the pertussis component of DPT vaccine. Facilities for the production of DPT vaccine were further strengthened in INDIA. The Pasteur Institute, Coonoor, was supported in its efforts to initiate the producton of TT, DT and DPT vaccines. The Haffkine Biopharmaceutical Corporation now produces oral polio vaccine Types 1,II and II1,which are being tested with the help of a WHO consultant. 5. PROMOTION OF ENVIRONMENTAL HEALTH An event of significance during the period under review was the official launching of the International Drinking Water Supply and Sanitation Decade. In most countries of the Region, statements on policy, intent, goals and plans for water and sanitation in the Decade were made at high decision-making levels. Wide publicity was given through the public information media, in which the United Nations agencies participated. A number of government representatives from the Region stated their governments' policies and plans at the special one-day session of the United Nations General Assembly on 10 November 1980, when the Decade was launched. The delegate of Burma, speaking on behalf of all Asian countries, made an earnest appeal to "urge the relevant international organizations and developed countries to increase their support and the flow of grant assistance to developing countries in their efforts to fulfil the worthy goals of the Decade". During the year,the Organization cooperated actively with governments in the preparation of first drafts of their national Sector Decade Plans, a number of which are now ready. Rationalization of the training of senior national personnel, ini- tiated last year, has been completed and the training programme is now being implemented and closely monitored with a view to producing the desired results. Group training was organized on the monitoring of pollution of inland and coastal waters; observationlstudy tours were arranged on the planning, programming, construction, operation and maintenance of rural water supply and sanitation programmes. At the request of one country, orientation and practical training in project formulation and appraisal has been arranged at the World Bank, and a special course on programme management conducted at the Asian Institute of Technology, Bangkok. The experience is being monitored so as to improve the delivery and offer viable group training oppottuni- ties to all countries of the Region. Research in environmental health is being focused more directly on meeting immediate needs and on the practical application of the considerable knowledge and knowhow that exist in the Region. In some countries health education is being made a part of water and sanitation projects, in which the Organization is collaborating. An area where no substantial progress has been made is the dovetailing of water and sanitation with primary health care activities. This will be a challenge in the coming years. 5.1 Environmental Health Most of the countries of the Region have established national mecha- nisms to coordinate policy and action for the International Drinking Water Supply and Sanitation Decade. In some countries subsidiary bodies have been established to deal with specific priority areas of action for the Decade such as the development of human resources, the production and logistics of materials and supplies and funding. The committees or other bodies set up have taken stock of the situation to outline the actions needed. The UNDP Resident Representatives in the countries have been designated as the focal points for the United Nations system in the activities related to the International Drinking Water Supply and Sanitation Decade. WHO continues to provide the technical secretariat to the UNDP necessary For discharging this function. The governments which have already prepared national plans for the Decade are likely to face a variety of problems. In regard to the gap between needs and resources, a number of water and sanitation decade plans have been prepared, with a rough forecast of the expected availability of external resources. The countries of the Region have been successfully stimulated to give priority to and accelerate their activities in water supply and sanitation. However, without any addition to the flow of external resources through soft loans and grants from expected funding sources, they are bound to be disenchanted with the so-called "Decade activities". Notwithstanding, many of them have substantially increased their national budget allo- cations for water and sanitation. Under the inter-country Community Water Supply and Sanitation Project, Member States received assistance in their preparatory activities for the Decade through staff sent on missions to countries, who have helped to review specific projects and to initiate baseline surveys as of the beginning of the Decade. This effort was primarily aimed at helping each country generate baseline information to enable it to monitor progress during the Decade. In Bangladesh, under the UNDP-assisted project for the Development of Drinking Water Supplies and Sanitation Programmes, the Government received assistance in establishing an information base of ground water quality so as to enable it to deal with the specific problems of high iron content of ground water in certain areas and to determine the norms required to prevent pollution of shallow tube-well water by on-site disposal of excreta. The Regional Office continued to co- operate with the Government in preparing a national sector develop- ment plan for the Decade. In India,WHO has collaborated with the national authorities in action to generate data for the formulation of annual, five-year and perspec- tive plans for water and sanitation decade activities. It is expected that by the end of 1981 the approved State plans will be compiled into a national plan document. Additional information has been collected for each State for projects which have been given high priority by the governments, to enable them to prepare a feasibility report and project document for investment. In Nepa1,with assistance from this inter-country project, the Govern- ment has prepared a ten-year National Plan for Water and Sanitation and is now in the process of taking up priority projects under the Plan. The first of these relates to manpower development for which the Government is also utilizing inter alia the UNDP's indicative -- planning figure. With financial assistance from the Government of the Federal Republic of Germany (GTZIWHO programme), WHO is collaborating with the Govern- ments of Burma, Indonesia and Thailand in organizing national workshops to review the status of and determine the strategies and actions required for preparing national decade plans and related programmes . Under the WHO/IBRD Co-operative Programme, the activities in sector support programme development for Decade planning efforts were further assisted in Nepal, Thailand, India (Bihar) and Maldives. Sector memo- randa have been completed for all the States and union territories in India. Assistance was given to the Dacca and Chittagong Water and Sanitation Authorities in billing and collection operations, and preliminary discussions were held on Decade plan preparations in the country. The national plan document of the Government of Maldives was reviewed, and, as stated above, assistance was given to Nepal in the preparation of a manpower development project. Under the DANIDA-assisted project on information systems for water supply and sanitation activities, agencies in Indonesia, Sri Lanka and Thailand were determined to be appropriate for providing assist- ance in devel.oping a suitabie management-oriented information system. A subsidy of US $24 566 was given to the Provincial Water Works Authority, Thailand, and the grant of a subsidy of $25 000 to CIPTA KARYA (Directorate Genera? of TJrban Development and Housing, Ministry of Public Works), Indonesia, has been agreed. A workshop on "Manage- ment Information Systems for Water Supply Organizations" has been planned for December 1981 to enable an exchange of experiences among the participating countries. To stimulate activites for the control of environmental pollution, short-term consultants were provided to Indonesia and Thailand for assistance in developing schemes for surface water quality monitoring and control. An inter-country workshop on "Rapid Assessment of Pollu- tants and Impacts" is being planned for late 1981. At the request of UNEP, proposals are under preparation for Indonesia and Thailand along with other ASEAN countries, for research in industrial waste reduction methods for possible funding by the European Economic Community. Fellowships were provided to enable a number of national workers to attend a special course on monitoring the pollution of inland and coastal waters at the Technological Institute, Delft etherla lands). Under the Global Environmental Monitoring Systems (GEMS) Programme, four stations (in India, Indonesia, Sri Lanka and Thailand) continued to operate for air quality monitoring and five stations(in Bangladesh, India,Indonesia,Sri Lanka and Thailand) for water quality monitoring. A bi-regional workshop on the control of emissions from motor vehicles was held at Kuala Lumpur in November 1980 with participants from five countries in the Region. In BANGLADESH,a protocol for a field study of the pollution of ground- water from on-site excreta disposal systems was completed. The guide- lines that will emerge from this field study and the development of appropriate technology and the training of staff now under way should enable the Government to expand the water and sanitation services qualitatively and geographically without risks to public health. A water quality surveillance programme is also to be instituted simul- taneously. Work on updating tariff structures as well as improving collection and distribution systems and maintenance continued in the Dacca and Chittagong Water and Sewerage Authorities, which have been receiving World Bank (IDA) loans. Stream water quality monitoring data from nine stations are being reported on by the ~nvironment Pollution Control Board, under the UNEP/WHO/GEMS programme. Activities are now mainly concerned with preparing a national plan document for the water and sanitation sector for the IDWSS Decade. In BURMA, the main focus in the environmental health programme is on community water supply and sanitation. The progrannne is managed in the field through one long-term sanitary engineer attached to the Environmental Sanitation Division (ESD) of the Ministry of Health and the Ministry of Agriculture and Forests. A 10-to-20-fold growth in the ESD'S programme of work is envisaged, following the second country health programming exercise completed recently. A support activity project to remove a number of constraints identified is under prepara- tion for possible external funding. A status survey of community water supply and sanitation to be undertaken with UNDP/WHO assistance will facilitate programme planning. Burma will also receive technical assistance in Decade planning, under the GTZ/WHO inter-regional project, and the first inter-sectoral meeting is proposed for August 1981. In the urban sector, a project document for feasibility studies for water supplies to ten towns and for related institution building, has been prepared by the Government with WHO assistance, for potential UNDP funding. During the year there was a spate of activities in INDIA in the deve- lopment of plans for water and sanitation to meet IDWSSD goals. Under the UNDP/WHO inter-regional cooperation project, assistance was provided in the collection of detailed information from each State and Union Territory for preparing the annual and five-year plans as well as the perspective master plan for the sector for the Decade. In addition, local consultants were engaged to collect data in each State on which to base feasibility reports for high priority projects identified by the respective State Governments. The Government of India and the Regional Office cooperated with the World Bank in the preparation of a handbook on project preparation. The reorientation of the WHO fellowship programme for India, started last year, was continued. A special orientation programme has been arranged with the World Bank on project preparation and feasibility studies for six senior sanitary engineers. Group training in programme management for senior state engineers was also arranged at the Asian Institute of Technology, Bangkok. In September 1981, twelve engineers will be attending a special course on the monitoring of inland and coastal water quality, to be organized at the International Institute for Hydraulic and Environment Engineering, Delft, Netherlands. The Government of India has enacted a Bill for the Control of Air Pollution. Arrangements are also under way for deputing a number of sanitary engineers to observe the planning, programming, management and operational maintenance of rural water supply programmes in selected countries. In addition, up to ten sanitary engineers will visit Australia to observe water development and management in arid zones. The services of short-term consultants, to furnish know-how on wastes prevention, control and treatment in a number of industries (e.g., electro-plating and distillery spent wash waters), were provided. Support was also given for stack and ambient air quality monitoring and air pollution control. The National Environmental Engineering Research Institute, Nagpur, received assistance in the form of fellowships and short-term consultants in specific areas. The environmental health programme in INDONESIA is made up of several on-going or about-to-start projects, and has five long-term WHO staff members in position, with three more likely to join soon. The major thrust of the programme has been towards assisting the Government in planning and designing water and sanitation schemes, promoting man- power development and using appropriate technology. One WHO sanitary engineer and one sanitarian are attached to the Ministry of Health, and another sanitary engineer works with the CIPTA KARYA. This project also serves as an umbrella for various other related acti- vities with external funding. With UNDP'S financial support, a rural water supply project, including groundwater exploration and health education, is under way in Nussa Tenggara Province; a similar one for South Sulawesi is expected to commence shortly. Another rural water supply project for Central Java, with GTZ funding, is also due to start soon. With assistance from a WHO sanitary engineer, the Government of MALDIVES has prepared a draft document for water and sanitation. During 1981 it is expected that this draft will be edited, updated and enlarged in the form of a national programme plan. Two candidates were trained in water supply and sanitation under WHO fellowships. UNICEF and the United Nations Capital Development Fund (UNCDF) are assisting in the construction of rain-water tanks and cowunal latrines. For Male,a draft plan commissioned by the Federal Republic of Germany was prepared by a consultant firm in the United Kingdom. This was reviewed by the Regional Office at the request of the Government, and comments were furnished. In MONGOLIA, two courses on sanitary engineering, in which the WHO sanitary engineer participated, were conducted. It is proposed to send two Mongolian observers to attend the Workshop on Environmental Health Problems in Arctic and Sub-Arctic Areas, scheduled to be held in Copenhagen in August 1981. This workshop will deal with water and sanitation problems in permafrost conditions. The Government of NEPAL has prepared a "Ten-Year Plan for the Provi- sion of Drinking Water and Sanitation (1981-1990)", and the sector agencies have now approved the document for printing. The shortage of graduate engineers and also of technicians has adversely affected the planning and implementation of the Decade programme. Manpower planning and in-service training are still crucial needs in the country, and proposals for increased UNDPIWHO assistance are now under considera- tion. Assistance was given in planning and implementing 59 rural water supply schemes. Project proposals for the consideration of external funding agencies have also been prepared for rural water supply schemes in the Western and Far-western Regions. Under the WHO fellowships programme, Nepalese engineers have visited India and Bangladesh to study low-cost technology for water and sanitation, particularly in rural areas and on the urban fringe. SRI LANKA's national plan for the IDWSS Decade was finalized, and copies of the plan document were made available to international and bilateral agencies interested in the development of the sector. Data have been compiled for specific projects under the Decade plan. A rural water supply project for Asian Development Bank (AsDB) funding was prepared, and, with UNICEF assistance, projects have been formu- lated for rural water supplies in Kalutara District and the Mahaweli "H" area. Tubewell drilling in hard-rock areas continues to make progress, and the upgrading of cornunity wells is on hand. Progress in the provision of shallow dug wells is yet to be speeded up. A programme for upgrading water treatment plants and for the preventive maintenance of plants and machinery as well as the training of operators has been taken up, and a unit set up for the operation and maintenance of water supplies at the National Water Supply and Drainage Board. Laboratory equipment and supplies for the Universities of Peradeniya and Moratuwa have been ordered, and staff of the universities have been sent abroad for training in the further development of public health engineering faculties in these universities. The Board itself has made substantial progress in strengthening its capacity for the planning and design of water supply schemes. The manpower situation, however, continues to be critial. In the light of the 25% cut in the development budget,the Decade plan activities will have to be focused on high priority projects. Under the UNDP-assisted project in THAILAND, appropriate technologies and approaches have been field-tested and, in collaboration with Chulalongkorn University, light-weight PVC handpumps that are easy to maintain have been developed. Groundwater investigations and staff training also have been undertaken. Research in appropriate technology is going on at two institutions and more sponsored projects are expected to be taken up shortly. 5.2 Occupational Health The programme in occupational health is developing steadily in the Region. Preparatory work for launching a research project on the pulmonary affection of jute mill workers in BANGLADESH has been completed. In BURMA, the project on "Strengthening of Health Services in the Newly Industrialized Areas (West Bank of the Irrawaddy River)" continued. A mid-term review recommended an extension of the project for two to three years, with the additional provision of short-term consultants, fellowships and supplies and equipment. During the year, a consultant advised the Government on the methodology for assessing the environmental sanitation situation,for sample checking and for laboratory testing, as well as on the provision of proper sanitation, water supply, and the disposal of excreta, industrial pollutants and industrial effluents. He also helped to develop guidelines for the training of national health workers in the sanitary aspects of occupa- tional health. A second consultant conducted a training course on occupational hygiene and toxicology and their practice in industry,for physicians and hygienists. He advised on the importance of assessment and control of occupational standards in industry, and demonstrated to national occupational hygienists and toxicologists the maintenance and calibration of field and laboratory equipment and the conduct of air sampling. WHO assistance to INDIA consisted of fellowships for advanced training abroad, to strengthen occupational and industrial health services. The agency terminal report of the UNDP-funded project on "Development of Central and Regional Occupational Health and Industrial Hygiene Laboratories" in INDONESIA was prepared and submitted to the Government. Further extension of industrial hygiene, occupational health and safety laboratories was considered necessary. Specifically the recommendations were: (a) to establish more branch laboratories, (b) to provide more suitable equipment, (c) to increase the number of technical personnel and to develop their skills on a continuing basis, and (d) to expand occupational health and hygiene services, services in ergonomics and services in occupational nutrition. It was recom- mended that further UNDP assistance might be sought, to determine occupational hazards affecting industrial workers in the country and to find ways and means of dealing with the situation resulting from the use of new insecticides and fertilizers and the tendency for infectious diseases to establish themselves among agricultural workers. A consultant in pesticide toxicology was assigned,to collaborate with the Government of SRI LANKA in the training of national personnel in environmental pollution, particularly with regard to chemicals used in agriculture. He also assisted in setting up a laboratory for analysis of pesticides. Fellowships were awarded for the training of national staff in occupational health. A WHO consultant visited THAILAND during the year to help the Govern- ment prepare a plan of vork and a project proposal for the development of the National Institute of Occupational Health. Fellowships,supplies and equipment were provided to strengthen the national occupational public health programe. 5.3 Radiation Medicine Efforts are being made to introduce the Basic Radiology System on a pilot basis in selected countries in the Region. The radiotherapy facilities available are being improved, and documentation on the best use of these facilities was given wide distribution. 'Ihe postal dose intercomparison programme was continued in collaboration with IAEA, and recently linear accelerators were included in this activity. In India and Thailand secondary standard dosimetric laboratories expanded their activities by providing personnel dosimetric services to increasing numbers of health workers exposed to ionizing radiation and by undertaking the monitoring and calibration of equipment. Films were regularly supplied by WHO for the radiation protection services in Bangladesh, Burma, Mongolia and Nepal. In INDIA, under bilateral assistance from the United Kingdom, a linear accelerator was installed at the Gujarat Cancer and Research Institute. There, a repair and maintenance vorkshop and training faci- lities are also available. Some regional cancer centres will soon be having linear accelerators for the treatment of cancer. Facilities for nuclear teaching medicine are being strengthened in several medi- cal colleges. The Radiation Protection Division of the Bhabha Atomic Centre, -ombay, published the proceedings of a national seminar on radiation protection held in Bombay during December 19761, including the development of radiological physics in India, and this document vas widely circulated. A WHO consultant is being assigned to the Radiation Medicine Centre, Bombay. Radiotherapy centres in INDONESIA are being strengthened in the provinces, with the installation of high-energy therapy units. Two consultants visited MALDIVES to repair the X-ray machines at the Government Bospitsl, Male, to assess the safety of the radiological installation and to advise on improving the safety standards of the X-ray unit. In SRI LANKA, plans have been formulated for establishing radio- therapy facilities in Galle and Jaffna. A consultant assigned to THAILAND advised the National Cancer Insti- tute on the treatment of cancer patients with radiotherapy and on the planning of 8uch treatment. He recommended decentralization of treat- ment facilities through the establishment of radiotherapy equipment, computerized treatment planning and joint clinics to take advantage of the multiple treatment modalities. 5.4 Food Safety Programme The systematic development of national food safety programmes appli- cable to countries of the Region received little attention during the year, except for pragmatic programme review and development related to institutional and manpower requirements, provision of short-term consultants and fellowships for some countries. Food safety pro- grammes are in varying degrees of development in Burma, India, Indonesia, Mongolia, Sri Lanka and Thailand. Although the programme has been instrumental in upgrading some of the facilities and technical competence of services and personnel in food control, particularly in Sri Lanka, Zhailand and Indonesia, many aspects still remain to be covered. Zhe Organization continues to assist countries in reviewing food laws and regulations and in initiating training activities, by awarding fellowships. In India, a national workshop on "National Strategy for Food Quality Control" was organized at the National Institute of Nutrition in Hyderabad. Through the provision of short-term consultants, the methodology and instrumentation for the analysis of food contaminants (in Thailand) and the utilization of laboratory services, the training programme and microbiological requirements for food standards (in Indonesia) have been reviewed and strengthened. In most countries of the Region there is a strongly felt need to develop a rational food safety programme, integrating all related aspects of public health such as veterinary public health, laboratory health services, administration, nutrition, communicable disease control, environmental health and health education. Although country reports on the food control situation in respect of most countries are available, there is still a need for more compre- hensive baseline data and information on all related public health aspects. The Regional Office has prepared a comprehensive question- naire that should enable countries to assess the situation in all its aspects. The main problem in launching a food safety programme is the dispersal of the activities of different facets of the programme among different ministries or departments. It is therefore planned that, on the basis of a comprehensive review, a multidisciplinary WHO team should visit countries and discuss the question of food safety with all departments and minis tries concerned and assist them in evolving a rational food safety programme that meets the needs of the country and is feasible to implement. 6. HEALTH INFORMATION AND STATISTICS During the period under review there have been efforts to evolve methods and procedures for collecting, processing and utilizing information which could have general application in the countries of the Region. Probably the most productive work has, however, been direct collaboration with the countries in improving their information systems. A major part of the activities has been concerned with developing methods of monitoring and evaluating primary health care programmes. The principal site of delivery of PHC in the rural areas and urban slums will be the community itself and health care will mostly be delivered by the primary health care workers selected from and operating within the community. Hence lay reporting has been adopted1 adapted as a major source of data for monitoring PHC in several countries of the Region. It will, however, be obviously very difficult to obtain absolutely reliable data through lay reporting, partly because of the lack of education of PHC workers and partly owing to the problem of supervising any system of data collection at the local level. Primary health care workers will operate closely with the cornunity leaders on the one hand and with the district health officer on the other, but contact with higher levels of management will be infrequent. The flow of information on PHC activities obtained through lay reporting to higher echelons and feedback to the PHC workers, as has been conceived in the national health information system development activities in the countries of the Region, is shown in the diagram below. FLOW OF INFORMATION ON PHC ACTIVITIES DERIVED FROM THE LAY REPORTING SYSTEM Authorities I I National Health I I I I , -15 Information System - #=/- - =#'- * 5- a *I Regional Health # I I Authorities a- -- I I I I I I In order to consider these problems and the best way of solving them, a meeting was held in October 1980 on "Lay Reporting of Health Information for Primary Health Care". Sixteen participants from eight countries presented their experiences on how the lay reporting system operates in their countries. Previously, lay reporting was restricted to the reporting of morbidity and mortality and was based on symptom association. The main outcome of the meeting was the realization that this reporting has to be adapted to cover the reporting of all health activities being undertaken by the PHC worker. A number of suggestions for achieving this objective were made and these suggestions are being followed up by the countries. Infant and childhood mortality and maternal mortality are all important indicators for assessing the progress of primary health care. However, it is extremely difficult to measure these rates because countries do not possess adequate civil registration systems for recording all births and deaths. National and international organizations, including WHO, have given much attention to trying to evolve methods of collecting reliable data on mortality and to develop techniques of analysing these data. A joint meeting sponsored by ESCAP, WHO Headquarters and the Regional Offices for the Western Pacific and South-East Asia was held in Manila in December to discuss ''Mortality in Asia: A Review of Changing Trends and Patterns, 1950- 1975". At this meeting it was possible to assemble together the latest information on mortality trends in Asian countries. Efforts are also being made- to design an information system which can be used for regional monitoring and evaluation of the IDWSS Decade. The system will initially provide baseline data, which will be periodically updated and reviewed. The activities being carried out for developing national health information system in the countries of the Region are given below: In BANGLADESH, s consultant on medical records was assigned to assist with the introduction of simple and feasible medical and health records systems that can be adopted throughout the country for hospital and health centre services. She visited selected hospitals and rural health complexes and made in-depth studies of the hospital reporting system. She also organized a course to provide training in medical records for employees of selected hospitals and thana health complexes. The development of the information system in Bangladesh gained further momentum with the assignment of a systems analyst in 1980. In colla- boration with the national authorities, a WHO consultant organized a programme for training health personnel in health information. Train- ing in the lay reporting techniques was also started. In February 1981, a consultant assisted in evaluating the health information system, in devising mechanisms for the collection, compilation, analysis and reporting of data, and in developing statistical proce- dures and operational research studies. In BURMA, support continued to be provided to the health information and statistics services. A study of the geographical distribution-. and utilization of hospitals having specialist services was conducted and included information pertaining to staffing, financing, disease patterns and catchment area demarcation. Also, training courses on the International Classification of Diseases for morbidity and mortality recording were conducted at central, state and divisional levels. The national health information system infrastructure largely provided the basis for the monitoring and evaluation of all health programmes. Action has been taken to procure data-processing equipment for Burma; this will greatly enhance the data processing capability and streng- then the health information service. Further, fellowships have been provided in the fields of computer science,data processing,demography and public health statistics. In INDIA, the main activities were concerned with health statistics and medical and health records within the context of national health information system development. With WHO support, two national work- shops were organized on (a) medical certification of cause of death, and (b) standardization of medical and health records. Efforts to increaae the capability of medical records training centres continued. A proposal has been made to establish a WHO Collaborating Centre for Medical and Health Records in India. Financial assistance will be provided for a training programme in medical records techni- ques at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry. Further, fellowships were awarded in the fields of advanced health statistics methodology, information systems development,medical demography and population statistics, and medical coding. Short-term consultants were provided by WHO for data processing in regard to the inter-regional project on disabilities as well as for the statistical aspects of the study on the impact of the improved water supply undertaken in Jhansi. INDONESIA launched a nation-wide programme for training health pee- sonnel in the coding of data according to the International Classi- fication of Diseases. A consultant was assigned to assist in the interpretation and translation of the International Classification into the Indonesian language. Another consultant is being assigned to assist in the development of hospital and laboratory information systems. In August 1981 a workshop on hospital information system was organized, with technical support from Wm). A consultant collaborated in reviewing the uses for the computer attached to the Bureau of Health Planning of the Ministry of Health and in assessing the future needs for computer hard and software. A long-term staff member is being assigned to work with the Bureau in developing the capabilities of the Data Processing Unit. Technical support was given to the Perinatal Mortality Study in Bandung, which forms part of the collaborative study being undertaken in five countries of the Region. Technical assietance was also provided to the national disability study and in analysing the results of leprosy surveys, including the preparation of the sample design for the study, to be undertaken in Nusa Tenggara Barat Province. In MALDIVES, WHO has assisted in the field of health information and statistics by the award of fellowships for acquiring knovledge in medical records techniques,and participation in international meetings on the International Classification of Diseases and Lay Reporting techniques. A preliminary study was made by the team leader of the inter-country project, "National Health Information Systems Develop- ment", who visited Hale and examined the existing information infra- structure, with a view to providing long-term assistance. Action is under way to assign a health information specialist to help to develop a suitable system and train national staff. A consultant in medical records is also to be assigned shortly to assist in designing a simple and feasible medical records system for the Hale Government Hospital and to give training. Statistical assistance was provided in preparing the sample design for a survey to establish the prevalence of measles and paralytic polio in the islands. In MONGOLIA, the development of a health information system and statistical services continued to be supported by WHO. The statisti- cal analysis of data on health service activities has been completed; new reporting forms for health institutions have been worked out, and a seminar for hospital statisticians was conducted. In addition, a course was held for health statisticians vith higher education. In regard to collaboration in improving the maternal and child health services, a consultant helped to complete the analysis of data on studies undertaken in the first phase and in planning and designing the research studies under the second phase. In NEPAL, assistance in the development of health information and statistical services has been continuing, with the assignment of a statistician under the project. "Health Planning and Programming". A health planning profile at district level was completed and a work- shop conducted on the development of health planning procedures and health information system at district level. A protocol for the trial of the lay reporting system was prepared and is under consideration by the Government. Effective collaboration is maintained in the opera- tional aspects of a data bank, in terms of indexing, classifying, storing and retrieving health information. In SRI LANKA, the development of health information systems gained further impetus with the arrival of a long-term health information officer. A project proposal for an improved information system was prepared and is being considered by the Government. A consultant from Headquarters was assigned to collaborate in the strengthening of the medical and health records system in selected hospitals of the country. In THAILAND, tvo WHO consultants were assigned to help set up a national focal point for appropriate technology for health information and to assist in the development of a management information system, respectively. A training programme was organized for statistical instructors in health training institutions, in which 40 persons participated. A meeting of high ranking decision-makers was held to discuss the development of a management information system. Another activity was the organization of a consultative meeting of representatives from various health and health-related agencies which use and produce health information. This meeting was convened with the aim of identifying unreliable health statistical data and recommending or designing technology and methodology for improving such information. Financial support for conducting these meetings was provided by WHO. 7. DEVELOPMENT OF HEALTH MANPOWER The WHO health manpower development programme is aimed at: (1) streng- thening the links between manpower planning, training and management in each country of the Region, to enable it to produce the right kind and sufficient numbers of health workers and to use them effectively; (2) ensuring that the basic training programmes for all types of health workers are directly related to the provision of primary health care within the framework of "~ealth for All by the Year 2000"; (3) stimulating the countries to collaborate with and help one another in all areas involving health manpower development, with the overall objectives of fostering technical cooperation and strengthening national self-sufficiency in dealing with their own most pressing problems, and (4) promoting greater awareness and acceptance in high-priority areas such as "team training", "the effective use of traditional health workers", and "fostering research capability in health services and manpower development (HSMD)". The Organization has therefore further strengthened its efforts to assist Member countries in: developing structures so as to bring manpower planning, training and management into alignment with one another; determining the priority needs for primary health care and helping the training institutions to reorient their programmes in these critical directions; developing national and regional teacher training programmes so that teachers will adopt more systematic and relevant approaches in training future health workers, and providing greater support for research and the use of research results in train- ing and in the provision of primary health care. Health Manpower Planning Countries of the Region are evincing increasing interest in under- taking health manpower planning. It is noted that "Health Manpower Planning and Community Participation for Primary Health Care" was the subject for technical discussions at the thirty-third session of the Regional Committee in 1980. BANGLADESH formed a steering committee for health manpower plan formu- lation in 1980. A situation report has already been prepared, and a national health manpower plan formulation exercise was carried out in June 1981. BURMA has undertaken the preparation of a health manpower development project as part of the buch larger task of formulating its country health programme. In INDONESIA, efforts are being made to strengthen the overall health manpower planning capabilities in the Bureau of Health Planning, Ministry of Health. Emphasis is being placed on the development of trends and projections of the required manpower and skills in each province within the framework of the medium-term and long-term development plans. WHO has provided assistance to the Bureau of Health Planning in asses- sing the training as related to utilization, and in analysing policy related to health manpower development. A US AID team is also assist- ing the Bureau in selected aspects of manpower planning, personnel administration,training and the development of a manpower information system. NEPAL conducted a national workshop on the methodology of health manpower planning, followed by an exercise in health manpower formulation. In SRI LANKA, health manpower planning is undertaken as part of health planning and management. The approach is to conduct limited studies directly related to the expressed needs of the decision- makers, such as the recent study on the manpower staffing structure of the health services. In THAILAND, a health services and manpower development centre is being established as part of the health development network of the Ministry of Public Health. Joint meetings on health manpower planning have been held between the Ministries of Public Health and Universi- ties. Health manpower planning and management concepts and skills have been introduced into all programmes at the Faculty of Public Health of Mahidol University in Bangkok. An inter-country workshop on health manpower planning methodology was held in Colombo, Sri Lanka, during December 1980 - January 1981, to train senior administrators and educators from the Region. Bangladesh and Burma are participating in the inter-regional project on the study of the development of simple methodologies for health manpower projects, organized by WHO Headquarters. Coordination between the Health Services and Education Sectors The Regional Office co-sponsored with the World Federation of Medical Education (WFME) a Bi-regional Seminar on Education and Health Care, held in Manila in March 1980. It is also actively involved in the planning and organization of the World Conference on Education and Health Care, also being co-sponsored with the WFME and scheduled to be held in India in 1982. Training in Health Services Mananement The inter-regional activity to develop training programmes in order to improve the management of primary health care personnel is continuing in Burma, India and Sri Lanka. In BURMA, task analyses of some health personnel have been undertaken as a basis for developing the management training programme. In INDONESIA,WHO is assisting the Department of Health in its efforts to develop trained managers in health manpower through fellowships, group educational activities and training courses for physicians and health centre staff, in order to improve management and service delivery. A Consultation on Management Training and Work Studies was organized ac WHO Headquarters in June 1981, to prepare proposals for support to a programme for training in health management, to develop a basis for the organization of an inter-regional network of health management training programmes and to review the methodology of work studies and task analysis. Development of Health Team Training An expert group meeting held in October 1980 in the Regional Office clarified the concept of "team-work" in the context of the South-East Asia Region, defined the essential components constituting team-work, and developed guidelines for such training. With the use of these guidelines, a survey is to be undertaken to determine the status of primary health care teams and their functioning in the countries of the Region. The recommendations of the expert group will be followed up at an inter-country meeting planned in 1981, which, in turn, will be followed by meetings at the national level, where country-specific plans to promote team work in the delivery of primary health care will be developed. In THAILAND,a national meeting for senior nursing staff was conducted on "team work". With consultative help, community-oriented nursing curricula are now being introduced at Chulalongkorn University. Employment and Working Conditions of Health Personnel Contractual agreements were signed in 1980 with Indonesia (Directorate of Hygiene and Sanitation, Ministry of Health) and 'with Thailand (Faculty of Public Health, Mahidol University, Bangkok) for studies on the employment and working conditions of sanitarians and auxiliary sanitarians. The studies are in progress. Research in Health Manpower Development A consultant visited Bangladesh, Burma, Indonesia, Sri Lanka and Thailand to assist national staff in selecting major problems in the area of health manpower development - particularly with respect to the provision of primary health care - that would benefit from well designed research investigations. The principal research problems identified include: (1) factors which motivate health workers to provide care in rural areas; (2) the need to monitor the content of training programmes for auxiliary health workers to ensure that they are relevant to real health needs; (3) case studies of the strategies that might best be used to reorientate the training towards community needs, and (4) choosing effective methods to convert uni-purpose health workers into multi-purpose personnel. Another consultant helped national personnel in Indonesia, Nepal and Thailand to focus attention on specific problems which lend them- selves to research in the area of medical education. The Regional Office participated in a WHO Headquarters Working Group on the "Assessment of Health Workers' Performance". lhese studies, the central concern of which is the evaluation of health workers in the context of primary health care, are being conducted in Nepal and Sri Lanka. 7.1 Medical Education 7.1.1 Undergraduate Medical Education The objective of health for all cannot be attained until and unless training programmes for all health workers are directly related to pressing and urgent health problems and are geared to the effective provision of primary health care. Over the last few years consider- able efforts have been made in the Region to reorientate the contents of medical education programmes, and to revise substantially the methods by which these programmes are planned, implemented and evaluated. In spite of the resources mobilized by Member countries, by the Organization itself and by other agencies, the following major problems and difficulties remain: (a) The contents of the curricula in some countries are still oriented towards the developed countries and do not prepare doctors for primary health care work, thus contri- buting directly to the migration of doctors; (b) Many of the under- graduate programmes are largely theoretical and not tuned to equip students with the necessary practical skills to enable them to work as members of health care teams, or to manage a rural health centre on minimal resources, and (c) Very few countries in the Region possess teachers with the skills to produce locally-relevant and problem-centred teaching and learning materials. These and other problems must be tackled on a country-wide and Regionride basis, in order to keep up the momentum of HFAl2000. During the course of the year, the Organization continued to assist medical colleges in all the countries in reorientating their curricula and making them relevant to the needs of the community. In BANGLADESH,following a review of the project on medical education, the main purpose of which was to reorient and remodel medical educa- tion at both undergraduate and post-graduate level, it was decided that the project should be reformulated with new strategies. In April 1981, a joint UNDP/WHO mission visited Bangladesh to make recommenda- tions regarding the new project on "Assistance to the Centre for Medical Education and Development". 'Ihe Bangladesh Medical Council, together with the Ministry of Health, reviewed the existing undergraduate medical curriculum in March 1981 and formulated reconmendations for redesigning it. During the fiscal year 1980-81, three more medical colleges were opened by the Government, one each at Khulna and Pabna and an under- graduate medical college component at the Institute of Post-graduate Medicine and Research at Dacca. An important part of the WHO fellowships programme is the provision of post-graduate training for teachers in the pre-clinical sciences, in order to meet the acute shortage in the existing and newly opened medical colleges. In BURMA, a consultant assisted the Directorate General of Medical Education in reviewing the need for strengthening communication skills in the English language for medical students, and in developing a plan in this regard. If effective, this project will have implica- tions for other countries in the Region which have the same problem of a low proficiency in English among students of health training institutes. In DPR KOREA, the Organization collaborates in the programme for equipping medical teachers with improved linguistic skills. A long-term staff member has continued to provide consultative assistance to the State Medical Institute, Ulan Bator, MONGOLIA. In NEPAL, long-term consultative assistance to the Institute of Medicine, Tribhuvan University, has been provided. Many training programmes for teachers of all categories of health workers have been held. Short-term consultants have assisted the Institute in revising its training programmes in clinical pharmacology, community medicine and anatomy. A feasibility study was carried out concerning the use of Birgunj and Pokhara zonal hospitals as out-reach teaching hospitals for the Institute. A decision to use the hospitals in this manner could go a long way towards ensuring orientation of all medical training directly to community needs. SRI LANKA has been receiving fellowships in support of the qualitative improvement of undergraduate training programmes, which will be most important in view of the estabIishment of further training institutes at Galle and Jaffna. A short-term consultant assigned to THAILAND has submitted a very wide-ranging report concerning the ways in which medical education might best be reoriented towards community needs; the feasibility of using provincial and district hospitals for teaching medical students and a range of options for solving the problem of over-concentration of physicians in the cities. Recommendations have been made for establishing innovative, community-oriented institutions in rural areas. The universities, together with the Ministry of Public Health, are actively undertaking a reorientation of the training programmes for health personnel, particularly of medical students, to support national health development. 7.1.2 Post-graduate Medical Education The Organization has continued to provide support for the development of post-graduate medical education in the Region. In BANGLADESH, consultative assistance has been provided to the National Institute of Preventive and Social Medicine, Dacca, in developing competency-based courses in biostatistics, and for the creation of a statistical cell within the Institute. In INDONESIA, since 1979 the Consortium of Medical Sciences has been working on programmes for the establishment of post-graduate education in the basic sciences. Long-term consultative support has been provid- ed to the Faculty of Public Health, University of Indonesia. During the period under review the assistance was mainly directed towards improving the training programmes, all of which are learner-centred and competency-based, in the Department of Occupational and Environ- mental Health. In SRI LANKA, with the Government's decision to provide post-graduate education within the country as well as to hold post-graduate examina- tions locally from 1980, the Post-graduate Institute of Medicine was reconstituted by an Act of Parliament in January 1979 to enable it to assume a new role. Nine boards of studies have since been established, i.e.,in surgery, medicine,cammunity medicine, anaesthesia, obstetrics and gynaecology, paediatrics, radiology, pathology and general practice. Local post-graduate examinations have been conducted in MD Community Medicine, US Surgery Part I, MD Medicine Part I and MS Obstetrics and Gynaecology Part I. WHO consultants were provided to act as external examiners for these examinations. WHO also assisted in developing the library facilities for post- graduate students in Colombo and Kandy. In THAILAND, the Organization has been helping the Faculty of Public Health, Mahidol University, to train national teaching staff as well as to develop educational curricula and an evaluation methodology. During 1980, consultants in veterinary public health and nurse practitioner evaluation collaborated with the Faculty of Public Health. As a follow-up of the Consultation meeting held in 1978, which had reconmended that a network of national training institutes be formed to collaborate and share the facilities and expertise in a mutually supportive and complementary manner, an expert group was called together in the Regional Office in October 1980 to consider details of the establishment of such a network. A regional meeting was held in February 1981 at the All-India Institute of Hygiene and Public Health, Calcutta, to discuss the activities of a regional network of public health training institutes. The participants developed the details, prepared a work schedule with time targets and undertook responsibility for the various activities. The Regional Office participated in the Third International Congress of the World Federation of Public Health Associations, held in Calcutta in February 1981. Representatives from the countries of this region as well as Regional Office staff participated in the Ninth Inter-regional Meeting of Directors or Representatives of Schools of Public Health for the African, Eastern Mediterranean, South-East Asia and Western Pacific Regions of WHO, held in Cotonou, Benin, in March 1981. 7.1.3 Continuing Education In order to attain the goal of health for all through the primary health care approach, all categories of health workers are faced with formidable challenges concerning their roles and the various circw stances under which they have to practise their professions. Continu- ing education is regarded as one of the essential means for helping them to keep their knowledge as up to date as possible, and to acquire the skills and attitudes needed to respond to changing health needs. An inter-country project on continuing education for all categories of health workers has provided assistance through the organization of consultative meetings and workshops and the distribution of relevant publications. 7.1.4 Teacher Training Programes The development of teacher training programes continues to play a pivotal role in many support activities. Teacher training, if appro- priately planned and implemented, can be expected to contribute directly to the qualitative improvement of the training programmes for preparing all types of health workers. It would include assistance to teachers (a) in developing curricula which are based on high priority health needs, competency-based and learner- and problem- centred; (b) in evaluating the quality of the health workers that they are producing, using their findings to improve further the quality of their training programes, and (c) in planning, producing, using and evaluating problem-based health learning materials which are relevant to both high priority health needs and the health workers' job descriptions. It would also include assistance to institutions, and to the countries in the ~egion, in developing their own structures so as to encourage the promotion of relevant teacher training programmes. In Sri Lanka and Thailand, the two Regional Teacher Training Centres continued to provide courses in educational science for teachers of health professionals. They organized a wide range of short courses on such topics as construction of self-learning packages, attitudes and their measurement, clinical evaluation techniques and the concept of the health care team. In INDIA, the National Teacher Training Centre at the Jawaharlal Institute for Post-graduate Medical Education and Research, Pondicherry, has conducted two two-week courses in educational planning and evaluation for medical school teachers. A second National Teachers' Training Centre has been established at the Post-graduate Institute in Chandigarh, and it is now developing training programmes for teachers in northern India. INDONESIA, which has been assisted through the provision of short- term consultants, has designated five national teachers' training centres. Every government medical school already possesses an educational unit, and during the past year efforts were made to develop similar units in all the dental schools in the country. 7.2 Education and Training in Maternal and Child Health Development of national self-reliance in education and training in maternal and child health care is a priority concern in WHO activities at country level. Towards this end and in the spirit of TCDC, imple- mentation of a regional teacher education program in maternal and child health, using the existing training facilities in the Region, has been stimulated. The Organization's technical cooperation aims at ensuring that the training content in basic and continuing education programnes in MCH for all levels of health workers is specifically oriented towards the tasks to be performed and geared to the primary health care approach. As a follow-up of the UNICEPIWHO Course for Senior Teachers of Child Health, educational materials were supplied to some former fellows to help them strengthen and support the child health education programmes in their respective national teacher institutions. In BURMA, WHO supported training programmes for lady health visitors, midwives and auxiliary midwives. The role of the traditional birth attendant ("let-the") in primary health care continued to be promoted. A pilot training programme for let-the's was established with emphasis on asepsis and safety during delivery. In INDIA, training under the re-modelled undergraduate paediatric curriculum was started again, based on the findings of an evaluation. The programme on the teaching of MCH as well as paediatrics to medical undergraduates and interns continued to receive support through intra- country fellowships. The usefulness of the "Handbook on Delivery of Care to Mothers and Children in a Community Development Block" as a teachingllearning manual for faculty members, undergraduates and interns was assessed and confirmed by a WHO consultant. The Ad hoc Committee on Paediatric Education reviewed the second draft of the "Handbook on Child Health" and made necessary recommendations. The final draft is now under preparation. The in-service training programme in MCH for primary health centre physicians was evaluated by another WHO consultant. District-level obstetricians and paediatricians were trained in perinatal and neonatal care through national workshops organized with the aid of grants. As a follow-up of the WHO inter-regional course on "Fertility Management and MCH Caret',some of the former fellows were provided with educational materials to help to strengthen national institutions. In MONGOLIA, emphasis was laid on giving training in MCH to health personnel at aimak level, through the organization of national seminars and courses and the award of fellowships for study outside the country. WHO consultants provided technical support for the training of national workers in the methodology for research projects in MCH, including infant and child nutrition. In NEPAL., training in MCH and family planning was integrated with that of peripheral-level workers, including panchayat-based personnel. The training of health manpower to strengthen MCH referral services was supported through fellowships for study outside the country. In SRI W, the training of medical officers in performing steri- lizations continued. Orientation and on-the-job training for family health workers in using the available manuals was also undertaken. It was planned to make an evaluation of the impact on family health programmes of the training of various categories of health workers. In THAILAND, training in MCH and family planning for different levels of health personnel was supported through the organization of appropriate national seminars, workshops and courses. Fellowships, for studies both within and outside the Region, were also awarded. 7.3 Education and Training in Sanitary Engineering As mentioned in the last Annual Report,practical training of environ- mental health personnel to meet the needs of Member countries in the coming decade is being reoriented. To start with, fellowships for senior staff are being recast to make the content of the studies more relevant. During this year, a group of engineers from India were sent to the World Bank on a special orientation mission on project "pre- feasibility" and project preparation, evaluation and appraisal. After being briefed, they accompanied World Bank staff on country missions. By becoming familiar with the criteria used by the World Bank for project formulation and appraisal, the Government of India plans eventually to set up project cells at the central level and urge State governments to do so at State level, to ensure that all projects prepared will be sound,from the social, institutional,economic, public health and financial aspects, to be able to attract both internal and external investment. A short management course is being arranged for senior managers at central or state level. In order to monitor pollution of inland and coastal waters a special three-month course was organized at the International Institute for Hydraulic and Environmental Engineering, Delft, Netherlands, and started in mid-June 1981. As stated earlier, consultative support was provided to INDONESIA for improving the training programe in sanitary engineering at the Department of Occupational and Environmental Health. In the planning,management, implementation, operation and maintenance of small water supplies, difficulties are experienced in arranging group educational and observation tours in selected countries. The necessary mechanism is being evolved to tackle these problems, and it expected that these difficulties will be overcome shortly and regular exchange group visits may be arranged to foster TCDC. 7.4 Training in Epidemiology WHO provided technical cooperation to Thailand in establishing a field-oriented course in epidemiology, for which a WHO epidemiologist vas assigned in May 1980 for a period of two years. The training course started in June 1980 with five trainees. A formal introductory course on general epideniology,biostatistice and selected c-nicable diseases was given during the first month, with emphasis on the epidemiological methods of investigating outbreaks. The participants were assigned to the various divisions of the Ministry of Public Health, where these epidemiologists-in-training were responsible for disease surveillance, outbreak investigations and the development1 execution of epidemiological research studies. A study tour is being arranged for a medical officer to visit the Centre for Disease Control, Atlanta, Georgia, USA, in view of the fact that the field training programme in Thailand is organized in basically the same way as the epidemiological intelligence services course at CDC. The second group of five trainees started the programe on 25 May 1981. This field-oriented course in epidemiology in Thailand stimulated the Indonesian authorities to visit Bangkok to study the various aspects of the course and possibilities of adapting it for use in Indonesian universities. WHO organized and supported the visit of a group of four Indonesian officials to Bangkok in January 1981. It is expected that the recommendations of this group will help to establish a Master's degree course in epidemiology in Indonesia, with emphasis on field training. 7.5 Training of Auxiliaries and Community Health Workers The countries of the Region have continued to train various categories of health manpower, particularly for the rural areas. Programmes have been started for training the trainers, for the preparation of relevant health learning materials and visual aids, and for the continuing education of vorkers. In BANGLADESH, different types of health manpower are being produced and used to expand primary health care activities in rural areas within the context of HFA strategies. Community health workers at the village level will be the focal point for the implementation of primary health care, whereas other categories of health manpower will be involved in the training, supervision and provision of referral services for PHC. The Government continues to train multipurpose field-level workers, namely, the family welfare workers and the family welfare assistants, whose activities are mainly in the fields of family planning and maternal and child health. The Government is now planning to integrate the health and family planning prograllmes so that a package of the combined services will be delivered to the rural population. It has also continued the training of the village doctor or "Palli Chikitshak" with the objective of providing one such worker to each of the 68 000 villages in the country; already 5000 such workers have been trained. Voluntary health workers (male) and traditional birth attendants (female) have been trained in the six primary health care pilot thanas (districts). A long-term WHO staff member is in position at the Paramedical Institute to assist in training for the health services. Another was assigned to help with the training of medical assistants. In BURMA,the basic training of community health workers, basic health staff, and state/divisional and central level staff was supported through WHO subsidies. Comaunity health workers received refresher training during the period under review. The field staff of the special disease control programmes were given training to convert them into multipurpose health workers, to be eventually posted at rural health centres. US AID assistance has enabled the rapid expansion of the training of community health workers. In INDIA, the community health volunteer scheme has continued to be implemented and has so far covered 2366 primary health centres and almost half the population. The training programme under the multipurpose workers' scheme has been completed in 183 districts and is in progress in 142 districts. Under this programme medical officers of primary health centres, extension educators, health assistants and multipurpose health workers have been given reorientation training. The revised basic training programme for multipurpose health workers (female) was developed and implemented in all basic training schools. A programme of continuing education for community health volunteers was launched through a correspondence course on an experimental basis for a limited area. Manuals for community health volunteers, male and female multipurpose health workers and health assistants have been prepared. Training guides for the trainers of various categories of health workers have been prepared and are under print. Training materials and aids were developed and supplied to the training centres. The training programme for various categories was reviewed and modified. An integrated programme for medical officers of primary health centres has also been developed. In INDONESIA, the PKMD (village community development) programme is now operating in 12 out of 27 provinces. It is focusing attention on training at various levels of the administration and ultimately will include the training and utilization of voluntary health workers at village level. More than 1000 voluntary health workers have been trained. The concepts of primary health care are now being incorporated into the curriculum of professional and other health workers. Manuals and guidelines developed for the voluntary health workers are being tested. In MALDIVES, the Allied Health Services Training Centre continued to produce middle-level and peripheral health manpower consisting of cormnunity health workers, family health workers, nurse aides, and cornunity health aides. A regular training course was also organized for traditional birth attendants ("foolumas") and dispensers. The primary health care programme in NEPAL, utilizing ward-level health volunteers, is being initiated. The manual for the volunteers has been developed and field tested. The National Institute of Health Sciences at Kalutara, SRI LANKA, is responsible for the training of paramedical workers. WHO has assisted the Institute by assigning a consultant, and in organicing workshops on teachers training in primary health care and on health management. The Institute is also supported by UNICEF, US AID and UNDP. In THAILAND, WHO, with the collaboration of UNICEF, has continued to assist in the training of village health volunteers and village health communicators. Health Learning Materials In addition to efforts for developing the capabilities of the countries in the production, use and evaluation of locally relevant health learning materials, WHO has distributed sets of health learn- ing materials (REMAHA [Resource educational material for health auxi- liaries], source library and student loan libraries) to institutes in the Region, for different categories of health workers. Health Literature. Library and Information Services (HELLIS) Network The Health Literature, Library and Information Services (HELLIS) Net- work, which was established following the inter-country consultation meeting of librarians and administrators from health science institu- tions in the Region, has started functioning. National networks have been formed and focal points identified in Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand. A consultant was assigned to design and prepare a detailed curriculum for the Regional Training Programme for Health Science Librarians in the HELLIS Network. This curriculum was considered and modified at an inter-country consultation meeting of health science librarians in December 1980, during which a task force was formed to develop recom- mendations for the standardization of procedures for the Network. WHO has assisted India, Indonesia and Thailand in holding national meetings for the Network. The Organization also collaborated with India in strengthening the National Medical Library in New Delhi and in organizing training courses for library staff in the country. 7.6 Group Educational Activities During the period under review, 116 group educational activities were organized, of which 53 were national, 47 were regional and 16 were inter-regional (see Annex 4). These were mainly seminars, workshops, conferences, short courses and consultative meetings and were attended by a total of 530 participants from the countries of the Region. Representatives of other United Nations agencies, staff members from WHO Headquarters and field project staff also participated in some of these activities. Of the 53 national-level meetings, 36 were supported by the respective country WHO budgets and 17 by the inter-country budget. The subjects covered were primary health care,appropriate technologies for health, the Expanded Programme on Imaunieation, nursing, malaria, mental health, maternal and child health, environmental health, sexually-transmitted diseases, nutrition, medical rehabilitation, health economics, planning, traditional medicine and health manpower development. A growing number of activities deal with research in various priority areas such as tuberculosis, health services research, diarrhoea1 diseases, family planning and dengue haemorrhagic fever. Special mention should be made of two important meetings, viz.,inter- country meetings of the SEAJACMR Sub-comaittee on Research Needs for Health for All by the Year 2000, and the Inter-country Meeting on Preparation of Health Education Specialists in support of Health for All by the Year 2000, as both of them are expected to contribute to efforts for achieving HFA goals. The following three tables give details of these educational activi- ties: (a) BREAKDOWN OF INTER-COUNTRY ACTIVITIES (BY TYPE), WITH NUMBER OF PARTICIPANTS, HELD DURING THE PERIOD 1 JULY 1980 - 30 JUNE 1981 Malaria Border Consultative *Sponsored and paid by the host country. (b) NUMBER OF COUNTRIES REPRESENTED AND NUMBER OF PARTICIPANTS IN INTER-COUNTRY ACTIVITIES, 1 JULY 1980 - 30 JUNE 1981 (Total Number of Activities - 40) I Total 505 + 25* *Participants sponsored and paid by the Government to attend the Border Malaria Coordination Meeting - Bangladesh-Burma-India (India being the host country). (c) BREAKDOWN, BY COUNTRY, OF NATIONAL GROUP EDUCATIONAL ACTIVITIES FOR THE PERIOD 1 JULY 1980 - 30 JUNE 1981 7.7 Fellowships During the thirteerrmonth period from 1 by 1980 to 31 by 1981, 1079 fellowships were awarded using various sources of funds: 931 (86.3%) from the Regular Budget, 89 (8.22) from LINDP, 37 (3.4%) from UNFPA and 22 (2.1%) under inter-regional and other projects funded by WHO Headquarters. The WHO fellowships awarded under the Regular Budget consisted of: 87 (9%) against the 1979 budget, 662 (71%) against the 1980 budget, and 182 (20%) against the 1981 budget. 7.7.1 Implementation Under the Regular Budget for the 1980-1981 biennium, a Sum of US$^ 186 500 was ~rovided for fellowships, constituting 22.6% of the total budget. For 1980, against a total of 1061 fellowships available, 824 (77.7%) have been awarded so far, and the balance of 237 (22.3%) is expected to be awarded before the end of 1981. The planned fellow- ships programme for 1980 will thus be implemented fully. UNDP provided ~~$418 087 for fellowships during 1980, forming 8.2% of the total UNDP budget for the Region. The number of fellowships planned during 1980 was 91, of which 45 (49%) had been awarded by the year-end. The balance of 46 (51%) fellowships has been carried over to 1981. Under UNFPA funds, a total of ~~$199 669 vas provided for fellowships during 1980 - 6.9% of the total UNFPA budget for the Region. The number of fellowships planned during 1980 was 56, of which 25 (45%) , had been awarded by year-end; the remaining 31 (55%) fellowships have been carried over to 1981. Table (a) shovs that 53% of all fellowships were avarded for study within South-East Asia; of the other Regions, the European Region received the highest number of fellows, and the Western Pacific also received a large number. Table (b) shovs that about 58% of the fellows were professional health workers such as doctors, nurses and environmental health engineers and that 75% of the awards were for males and 25% for females. The table also shows the distribution of the fellowships among age groups: 43% were avarded to candidate6 between the ages of 35 and 44 years. Of the fellowships avarded, 245 (23%) were of a duration of one month or less, 470 (44%) for up to three months, 151 (14%) for up to six months, 177 (16%) for up to twelve months and 36 (3%) for duration beyond a year. As for placement, 558 (52%) of the fellows were placed for study in one country, 173 (16%) were in two countries, 194 (18%) visited three countries,ll2 (10%),four countries and 42 (4%) five or more countries. Delays in receiving applications continue, however, to hamper imple- mentation. For 1981, even as of the end of the first quarter, only 23% of the applications had been received against the number of fellowships planned. Since the time available for handling placements during the programme year is thus cut short, many of these fellowships may have to be carried over to the next year. Owing to time cons- traints, because of completion of the current biennium, there might be a considerable bottleneck for the 1982 fellowships programme. Long delays in receiving reports for proficiency in English, vhich is essential for placement in certain countries, also create problems. Zhis problem emphasizes the need for giving early training in English to prospective candidates for fellowships, and for governments to make advance planning in this regard. The cost of fellowships has been rapidly increasing, especially in Europe and North America, and in some cases has almost doubled in comparison to the cost in the last biennium. This trend is expected to continue aiid points to the need for careful selection of host countries for fellowships and, again, towards the desirability of using regional training facilities and institutions. The Regional Office has been constantly striving to improve the administrative procedures for the handling of fellowships. It was noted that the gap between the receipt of applications and placement requests sometimes extended up to four months on account of incomplete applications, lack of proper medical certificates, delsys in obtaining English proficiency certificates, and incomplete academic documents. While the Regional Office continues to try to improve the process, governments can certainly help by ensuring that the applications are complete in all respects before being forwarded to the Regional Office. Graph 2 shows the progress of cumulative percentage delivery of fellowships under the Regular Budget. It was noted that 81% of awards were issued within one month after receipt of acceptance, 15% within two months and 4% after three months or more. During the period under review. an average of 69.27% termination reports and 36% of utilization reports were received against those that were due. An analysis of the 237 utilization reports received shows that 97% of the fellows were suitably employed, 52% established new services and 73% were imparting knowledge to others. In accordance with the reconmendations of the Conference on Regional Cooperation in the Implementation of WHO Fellowships Programe, held in 1979, study tours are being organized for national officers handling the fellowships progranme in order to acquaint them with the problems and procedures. The. first group study tour, consisting of five participants, was conducted in May 1981. %o more such study tours will be organized later in 1981. 7.7.2 Regionalization The increasing trend towards regionalization of the fellowships programe has been maintained. The figures for the previous four years are presented in Table (c). 7.7.3 Subjects of Fellowships Table (d) shows the distribution of the fellowships awarded, by country and by subject. 7.7.4 Fellows from Other Regions During the period under review, placements in this region were arrang- ed for 101 fellows from the following 22 countrie8 and territories outside South-East Asia: Afghanistan, Canada, Egypt, Ethiopia, Fiji, Figure 2 WHO FELLOWSHIP PROGRAMME (REGULAR BUDGET) CWLATIVE PERCENTAGE DELIVERY. 1980 (By stages of operation) Status of: 0----o applications received - placements requested - placements accepted - awards issued Iraq, Japan, Republic of Korea, Kuwait, Malaysia, Mauritius, New Zealand, Papua New Guinea, Philippines, Saudi Arabia, Singapore, Somalia, Western Samoa, Sudan, Viet Nam, Yemen and Zambia. The figures for the previous year were: 68 fellows from 18 countries. DISTRIBUTION OF FELLOWSHIPS (1 May 1980 - 31 May 1981) (a) By Budget and by Region - Analysis of 1079 fellowships (b) By Type, Sex, Age and Duration Region where trained South-East Asia Western Pacific Europe USA Africa and Eastern Mediterranean Total - Percent- age 5 3 10 2 7 9 I Source of Funds Type WHO Regular Budget 472 10 2 275 7 5 7 931 5Pe Profes- sional Others . No. (%) 628 (55%) 451 (42%) Sex UNDP 61 1 20 5 - 8 7 Sex Male Female Age No. (%) 806 (75%) 273 (25%) UNFPA 2 1 3 2 13 - 39 Age Under 25 26-34 35-44 45-54 5 5+ Not known Duration No. (4) 14 (1%) 246 (23%) 464 (43%) 302 (28%) 41 (4%) 12 (1%) Duration Under 1 month Up to 3 months Up to 6 months Up to 12 months Above 12 months HQ and others 20 2 - - - 22 No. (%) 245 (23%) 470 (44%) 151 (14%) 177 (16%) 36 (3%) Total 5 74 109 297 9 3 7 1079 - 104 - (c) Regionalization of Fellowships (d) Fellowships Awarded (Under All Budgets), By Subject of Study and Country of Origin of the Fellow (1 May 1980 - 31 May 1981) Calendar year 1977 1978 19 79 1980 Number of fellowships awarded 5 78 676 591 1 005 Number of regional fellowships awarded 196 (34%) 299 (44%) 280 (47%) 544 (57%) Group Subject No. 1. Public Health Administration 2. Environmental Health 3. Nursing 4. Maternal and Child Health 5. Communicable Diseases and Laboratory Services 6. Clinical Medicine 7. Basic Medical Sciences and Education 8 Others Total BHU - - - - - 3 3 BAN 13 15 - 37 13 17 114 BUR 21 3 5--- 8 28 1 14-47 16 81 DPRK 7 3 - - - - 30 IN0 44 3210 522 12 51 1 31 176 IND 17 43 49 15 27 196 MAL 8 2 - - 4 1 1 18 MON 5 - 2 8 3 852413920 7 30 NEP 14 18 8 17 37 12 15 124 SRL 28 2 21 10 27 109 THA 78 714 513 6 14 20 33 198 Total 235 95 58 90 252 86 177 1079 % - 22 9 5.3 8.3 23 8 868 16.4 7.8 Regional Office Library During the period 1 July 1980 - 30 June 1981, the Regional Office Library received 7933 books, pamphlets, WHO publications, current periodicals and reports; 2393 persons (1963 WHO staff and 430 others) visited the Library and 5141 books and periodicals were issued on loan to Regional Office and field staff as well as on interlibrary loans. Photocopies of 1125 pages were supplied. For references needed by the Regional Office. field staff and Headquarters, 64 loan requests were sent to local libraries. Reference material was supplied in connexion with various seminars and meetings held in the Regional Office and outside. The Library, which is the UEDLINE Coordinating Station for South-East Asia, continued to provide, free of cost, WEDLINE searches requested by Member countries. It scrutinized the requests and obtained print- outs for searchable requests from the National Library of Medicine, Bethesda, Maryland, USA, under a special agreement. Photocopies of references not available in countries were also provided to them, free of cost, from sources in Delhi, in WHO Headquarters and in the United States of America. As part of the development of the Health Literature, Library and Information Services Network in the Region, the Library actively participated in both national and regional group educational activities on the subject. It is proposed to bring out, by the end of 1981, an experimental issue of the Regional Health Literature Index for South-East Asia. Three Student Loan Libraries were established in 1980-81. The Regional ..Office Librarian visited Mongolia in June 1981 to assist the Government in planning a Republican Reference Medical Library and to discuss other related matters. 8. RESEARCH PROMOTION AM) DEVELOPMENT The South-East Asia Advisory Cormittee on Medical Research (SEA/ACMR), established in 1976, has continued to function as an advisory body to the Regional Director on the implementation of the Regional Research Programme. Through various study groups and consultative meetings, detailed plans for research have been developed in the six priority areas identified by the SEA/ACMR at its first session in 1976. The activities are being implemented by the Regional Office, and their current status is as follows: In the field of research on health services delivery, twelve studies are currently in operation, the results of which will be useful in improving the health care programmes in the respective countries as well as in formulating a regional plan which could be adapted to suit varying national conditions and requirements. National and inter- country meetings have been organized to promote the health service research methodology and to bring together multidisciplinary groups of scientists considered essential for the success of primary health care programes. In regard to traditional medicine, a consultative meeting was held in Varanasi (India) in November 1980, where six research protocols on specific priority areas within the traditional medicine programme were developed. Research proposals based on the protocols outlined have been invited from the countries of the Region. As for research on communicable diseases, an inter-country consulta- tive meeting on tuberculosis has worked out the details of the research needs on a priority basis, as well as an outline of a plan for their implementation. A comprehensive regional research programme in dengue haemorrhagic fever has been elaborated and is in operation. Its components include studies on clinical, epidemiological, immunopathological and vector aspects as well as a programme for the development of a dengue vaccine. A meeting to evaluate the progress of the DHF research programme, particularly that of dengue vaccine, was held in March 1981. This meeting considered the progress made in regard to the vaccine and prepared a provisional work-plan for studies for a further period of 18 to 24 months. It is hoped that these studies may lead to the preparation of a vaccine suitable for preliminary human trials. Ten research studies are currently in progress in dengue haemorrhagic fever and one institution in a Member country is being strengthened to undertake research on the arboviruses with particular reference to dengue. A scientific working group on research in diarrhoea1 diseases met in February 1981 to consider the status of the control progrsmmes as well as research required to improve control measures. In addition, 14 research studies were reviewed by the working group for possible SEAR0 support. The Regional Office is currently supporting four such studies in Member countries. In regard to research on liver diseases. the national coordinators appointed by the governments are implementing studies of regional interest as determined by the respective study groups. In addition, the national coordinators have promoted the establishment of national task forces which are formulating research of regional and national interest. An intercountry consultative meeting is scheduled to be held later in 1981 to evaluate the programme, and, as a prelude to this consultation and to serve as a basis for it, national meetings are being promoted in the countries; two such meetings have already been held. Sixteen research projects on liver diseases supported by the Regional Office are in operation. A research study group meeting on leprosy held in June 1980 developed draft protocols for (a) operational studies on methods of improved case-finding and case-holding and release of inactive cases from control, and (b) field trials of multi-drug therapy regimens. These are currently being promoted in countries of the Region. The Regional Collaborative Studies on drug-resistant P.falciparum to 4-aminoquinolines are progressing satisfactorily. A meeting of the principal investigators is proposed to be held later in 1981 in collaboration with the WHO Regional Office for the Western Pacific and the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. This meeting is expected to review progress and identify further research requirements. Two research studies are currently in progress in the field of environmental health. These are concerned with the health benefits of water supply and sanitation and the field testing of an integrated water supply and wasterater utilization system for villages. Other studies of relevance to the Water and Sanitation Decade are being planned. The six research areas concerned with nutrition in primary health care are being implemented in most of the countries of the Region. Meetings of the principal investigators of two of the major projects concerned with this subject were held in the Regional Office in November 1980 and February 1981 respectively. In general, most of the research studies promoted by the Regional Office follow the health services research approach, and are concerned with utilizing available knowledge in a form suitable for adaptation to local situations. Basic research is being promoted primarily in the field of DHF, a disease of particular relevance to South-East Asia and its neighbouring regions. Advisory services have been provided as required to scientists to help them develop research designs and also to guide them on specific techniques required for their research programs. The Visiting Scientists and Research Training Grants programme, which originally and hitherto has been more or less open-ended, is now being focused on achieving maximum impact on the research activities promoted by the Regional Office. Towards this end, specific criteria have been formulated based on the recommendations of the SEA/ACHR at its sixth session in 1980. Thus. the grants are now being awarded primarily for training related to projects supported or planned for support under the Regional Research Programme. Pollorup meetings have so far been held in two countries to consider the guidelines developed at the first meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries. held in December 1979. These guidelines cover areas such as the organization of research, its management and coordination, identification of research priorities, development and operation of task forces on priority research subjects, procedures for the formulation and review of research proposals, ethical review procedures and managerial aspects relating to the utilization of research results. A, second meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the relevant ministries is scheduled to be held in the third quarter of 1981. Consideration will be given to the recommendations made at the Seventh Session of the SEA/ACMR that such meetings be held annually, as they are seen as a very useful mechanism to promote research at national level. In order to build up national research capability, courses on research methodology are being further promoted in the countries concerned. A network of institutions is being established in consuItation with governments in order to.promote collaboration between the scientific expertise within the countries and WHO'S activities. Such collaborat- ing centres are being developed in the fields of diarrhoea1 diseases, nutrition, liver diseases, filariasis, mental health, DHF, health services and traditional medicine. At present there are 33 WHO Collaborating Centres in this region. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continued to remain a major source of encouragement to research in the Region. The identification of priori- ties by the Regional Consultative Meeting in 1979 and subsequent promotive and catalytic activities supported by the Regional Office have resulted in the development of several additiopal field research projects in collaboration with the Special Programme. Topics currently being investigated correspond to the broad areas identified by the Consultation. The UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases has continued to promote and support research in the major tropical diseases such as malaria, filariasis and leprosy, as well as activities to strengthen regional capabilities for research on these diseases. With an increased awareness of the aims and objec- tives of this Special Programme, the number of scientiets and institu- tions in the Region who are participating has steadily increased. In the collaborative studies carried out in the Region, the research supported by the Special Programme has so far been mainly in the fields of malaria chemotherapy and leprosy chemotherapy and immuno- logy. The scientists trained vith the support of the Special Programe are returning to their countries and starting to engage in research activities in their specialties. Promotional activities under the Special Programme have continued through visits to the appropriate centres by Regional Office staff. Regional meetings related to research in tropical diseases have promoted greater liaison with the scientists in various institutions. In keeping with the universal goal of health for all, the Regional Research Programme is being oriented towards contributing to this objective, The SEA/ACW., at its sixth session in 1980, recommended that the research priorities be reviewed by a sub-committee in the light of these new trends. Such a sub-committee was convened by the Regional Director and prepared a conceptual framework within vhich the priorities could be identified. The Seventh Session of the SEA/ ACMR, held in April 1981, considered these suggestions and recommended a scheme for selecting priorities within primary health care require- ments. Further action in developing the detailed activities will be undertaken by the Regional Office with the assistance of the SEA/ACMR and other scientists as required. The SEAIACMR in future sessions is expected to try to evaluate the impact of the Regional Research Programme, taking into consideration the contributions of the inter-country project as well as of the research promotion and development projects in the countries. he purpose of this evaluation would be to study the impact of the WHO research programme at country level on the generation of further national activities, allocation of greater national resources and attraction of external assistance to Member countries. 9. TECHNICAL INFORMATION AND REFERENCE SERVICES Three titles - "A guide to the care of the low birth-weight infant", "Health research - a simplified community-based approach", and "The health care system of Thailand: a case study" - were brought out under the WHO Regional Publications, South-East Asia Series, during the year. In all, 150 assignment reports of short-term consultants and .long-term staff, final reports on projects and reports on meetings and seminars were edited, processed and issued. Reports brought out under printed cover for wider distribution included the following: (a) Prevention and Control of Pulmonary Hypertension - Report of an Inter-country Seminar; (b) Regional Network of Public Health Institutions for South-East Asia - Report of a WHO (SEARO) Expert Group; (c) Meeting of the Bi-regional Research Study Group on Culex-borne Bancroftian Filariasis; (d) Research in Viral Haemor- rhagic Fevers in the Eastern Mediterranean, South-East Asian and Western Pacific Regions - Report of a meeting; (e) Strategies for Health For All by the Year 2000 - Report of a Joint WHO/UNICEF Regional Meeting; (f) Team-work for Primary Health Care - Report of a WHO (SEARO) Expert Group; (g) Malaria Research and Training in Nepal - Report of an AsDBfWHO Mission; (h) Report of a WHO Seminar on "Anti-malaria Operations with Special Reference to Applied Field Research in Malaria"; (i) Maternal and Child Health and Family Planning in the People's Republic of China - Report on a WHO Study Mission; (j) Central and Regional Occupational Health and Industrial Hygiene Laboratories: Project Findings and Recommendations - Report prepared for the Government of the Republic of Indonesia by WHO Acting as Executing Agency for UNDP; (k) Relief Cataract Services in the South-East Asia Region - Report of an Inter-country Workshop (issued also as Eye Health in South-East Asia Series No. 31, and (1) The Development of Research Protocols on Priority Areas in Traditional Medicine - Report on a Regional Meeting. In addition, wide distribution was given to a large number of other documents. The report and minutes of the thirty-third session of the Regional Committee and the report of the technical discussions held during the session on "Health Manpower Planning and Community Participation for Primary Health Care", were, as usual, edited and issued with a printed cover. A "Supplement to the Handbook of Resolutions and Decisions of the WHO Regional Committee for South-East Asia" was brought out, incorporating the resolutions adopted at the thirty-third session. Sales - The total sales of WHO publications during 1980 amounted to ~~$74 758*, of which subscriptions accounted for US$42 620 and other sales ~~$32 138. These included counter sales, single copy orders, receipts on behalf of Headquarters and lorpriced Regional Office publications. The sales for the first five months of 1981 amounted to US$47 000. Exhibitions and displays WHO participated in the Second United Nations Book Exhibition, held in Bangalore (India) from 5 to 12 April 1981, and set up a stall for displaying its publications. A card calendar with information on WHO publications and on their availability through the Regional Office was printed and distributed to the visitors. Selected books were on display in World Health House during important meetings, seminars and courses, such as the ICMRIWHO Scientific Group Meeting on Vaccination Against Tuberculosis, Meeting on the Preparation of Health Education Specialists in Support of Health for All by the Year 2000, Seminar on New Approaches Developed for the Control of Sexually-transmitted Diseases, Meeting on Promotion of Lay Reporting System in Primary Health Care, and Consultation on Regional Training Prograurnes for Health Sciences Librarians. Groups of nursing students and health educators visiting the Regional Office were regularly briefed on WHO publications and their availability at concessional rates. *All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50% discount (40% in respect of subscriptions) and, in some cases, an additional 10% trade discount have been allowed. Therefore, the commercial value of the publi- cations sold should be taken to be approximately double the figures given. PART I1 ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1. REGIONAL COMMITTEE The thirty-third session of the Regional Committee for South-East Asia was held in Male, Republic of Maldives, from 1 to 7 September 1980. It was attended by representatives from all Member countries of the Region, as well as by representatives of the United Nations Development Programme, of the United Nations Children's Fund, and of three non-governmental organizations in official relations with WHO. In the absence of the Chairman and the Vice-Chairman, the session was opened by the Regional Director. Mr Maumoon Abdul Gayoom, President of the Republic of Maldives, inaugurated the meeting. The inaugural session was also addressed by the Minister of Health of Maldives,and the Director-General of WH0,Dr Halfdan Mahler, delivered a keynote address to the Regional Committee in which he referred to the essentials of the strategies of health for all and the need to avoid inflexibility in the approaches adopted. He stressed that proper use of WHO by Member States in accordance with the constitu- tional role of the Organization could greatly contribute to health development throughout the world. The Regional Committee nominated Dr U KO KO (Burma) as the next Regional Director, to succeed to Dr V.T.H. Gunaratne. Recognizing the significant contribution made by Dr Gunaratne to international health work, the Committee adopted a resolution declaring him "Regional Director Emeritus" of the World Health Organization. In his annual report, the Regional Director pointed out that the health status of the people of the Region had distinctly improved over the past decade, with a noticeable increase in life expectancy at birth in most countries. Thus, despite formidable health problems and paucity of resources, Member countries had made commendable progress in health development. Details were given of activities under way,for example, to establish PHC, to control the communicable diseases such as malaria, to implement EPI, carry out water supply and sanitation schemes and conduct medical and health services research. The Regional Director considered that with even more strenuous efforts by governments in the coming years and with will and determination, the objective of health for all would be attainable. Taking note of a resolution of the World Health Assembly on infant and young child feeding, the Regional Committee recommended that WHO should further intensify coordination of its work with that of other international and bilateral agencies in order to mobilize the necessary resources and public opinion for the promotion of activities directed towards the utilization of weaning foods. The Committee noted with satisfaction that the Regional Office had taken the initiative of developing a research-cum-action programme in nutrition, with particular emphasis on primary health care, and underlined the key role of women in ensuring the success of this programme. With regard to drug policies and management, the Committee stressed the need for technical support to promote rational drug policies at the country level as well as to improve pharmaceutical supply systems. It was explained that the Organization was having a dialogue with the drug industry in an attempt to bring down the prices of essential drugs to a level that any developing country could afford. The need for a uniform policy regarding smallpox vaccination was expressed; vaccinations continued to be given to certain groups, such as defence personnel, in some countries. It was considered that priority should be accorded to diarrhoea1 diseases in countries of the Region, and the Committee noted with satisfaction that a Scientific Group set up by the Regional Advisory Committee on Medical Research had been working on the development and implementation of a service-cum-research programme for the control of these diseases. The Committee reviewed the difficulties in the eradication and control of malaria. The lack of coordination between the ministries of health and of agriculture in some instances contributed to the emergence of resistance of vectors to certain insecticides. The rational use of alternative insecticides and the avoidance of in- discriminate spraying could lead to progress in this area. It was affirmed that the declaration of the International Drinking Water Supply and Sanitation Decade (1981-90) was a step in the right direction and that its success was crucial for achieving the goal of health for all for two reasons: safe water and sanitation constituted a vital element in the basic health service package,and the experience gained from the efforts of the IDWSS Decade should provide an impor- tant basis for the strategies for health for all to be formulated. The Committee adopted a resolution urging Member States to develop a plan of action in accordance with accepted national and regional strategies and to commit themselves fully to its implementation. The Committee appreciated the Regional Director's proposal to establish a multisectoral body to support national strategies for securing intersectoral collaboration - a body which would not only serve as a broad-based advisory group to the Regional Director but also help mobilize collective support for the 'health for all" activities. The proposals for the UNDP Regional Programme of Technical Cooperation for the health sector for Asia and the Pacific for the period 1982-86 were endorsed in principle, and Member States were asked to support these proposals through their national coordinating authorities at the appropriate forums. The Committee noted that the structure and contents of the Seventh General Programme of Work (1984-89) would be based on the strategies for health for all by the year 2000, reflecting the principles contained in the Alma-Ata Declaration. It was felt that the Progrannne should lay stress on the comprehensive health development of Member States and should be a manifestation of the total picture obtaining in the countries. On the subject of the periodicity of Health Assemblies, the Committee felt that it would be advantageous to continue the present practice of annual sessions and passed a resolution to this effect. 'Ihe Committee endorsed the work-plan for the study of the Organiza- tion's structures in the light of its functions. It stressed also the importance of strengthening the functioning of WHO at the country level and recommended the redesignation of the WHO Programme Coordi- nators to "WHO Representatives". It appointed a Sub-committee on Programme Budget to review the proposed programme budget for 1982-1983 and later approved the report of the Sub-committee endorsing the budget proposals. Technical discussions were held on the subject of "Health Manpower Planning and Community Participation for Primary Health Care". The Regional Committee accepted the suggestion of the Thirty-third World Health Assembly that the technical discussions to be held during the thirty-fourth session of the Committee should be on "The Role of Ministries of Health as Directing and Coordinating Authorities on National Health Work". It was, however, decided that the scope of the discussions would be limited to intersectoral coordination in national health work. The Regional Committee adopted a total of 14 resolutions. It also accepted an invitation from the Government of the Republic of Indonesia to hold its thirty-fourth session in Indonesia in 1981 and that of the Government of Bangladesh to hold the 1982 session at Dacca. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION The managerial process of WHO's programme development has been further integrated and unified, particular attention being given to responding to the countries' needs and priorities as emerging from their poli- cies, strategies and plans of action to attain health for all. In this regard, the discussions of WHO's governing bodies, particularly those in the Regional Committee, have provided guidance and direction. Having received comments and guidance from the regional consultative group which had reviewed the first draft of the regional contribution to the programme outline and contents of the Seventh General Programme of Work, the Regional Office revised the regional contributions, which have been incorported into the consolidated version of the Seventh General Programme of Work. Under the regional medium-term programme of health planning and management, country health programming has been supported in Member countries leading to the formulation of medium-term health plans and long-term outlines and strategies for health for all (see also Section 1.1). me Regional Office elaborated a detailed plan of action for the 1981- 83 period to implement the strategy for supporting the managerial process of national health development,to help countries to integrate this process further as a continuing effort to improve the entire range of management of health development. The plan of action, inter alia, provides for the orientation and training of national and WHO - programme managers in the concept and practice of an integrated managerial process. Policy and programme reviews by the Regional Programme Committee continued to provide advice to the Regional Director on important issues and questions relating to the formulation, implementation and evaluation of WHO programmes. In its work, the Programme Committee has striven to concentrate upon key policy and programme matters deserving the attention of the Regional Director, and has been guided by the work of the Headquarters Programme Committee and the Global Programme Committee. The work of the Regional Programme Committee has been reviewed, and conclusions were reached on how to improve its work through selective emphasis upon policy and programme matters. While programme budgeting principles continue to be applied both in country and inter-country programmes, the Regional Office has provided support to the detailed formulation of the programme budget for the 1982-1983 biennium in one country, to establish a clear linkage of the WHO programme with the national programme,and to relate programme objectives and activities to the budgetary tables. In the light of past experience with the WHO information system and the review conducted at Headquarters by an Advisory Group responsible to the Director-General, the Regional Office has undertaken a fresh scrutiny of the entire information system programme with a view to making it more relevant, efficient, useful and economical. As a component of the information system, the monitoring of the implementa- tion of the WHO programme through a Programme Delivery Status Report has been streamlined. This procedure is being re-examined within the overall review of the information system. In pursuance of the policy for the increased involvement of national expertise in the work of WHO, and to foster technical cooperation among Member States, a preliminary inventory of resource persons and institutions has been prepared. In the light of the Regional Committee's observations on the progress report on the Seventh General Programme of Work at its 33rd session, a regional document on the Seventh General Programme was drafted, reflecting the objectives and approaches of the regional programme to serve as the basis for elaborating the types of activities in the medium-term programme period, 1984-89, corresponding to the period of the General Programme of Work. 3. ADMINISTRATION 3.1 General The Director-General and the Regional Director visited Mongolia and DPR Korea in July 1980 to participate in the signing ceremonies of the Charter for Health Development. Tne Director-General also visited the Republic of Maldives in September to attend the thirty-third session of the Regional Committee, and took an active part in the discussion on some of the important items on the agenda: Strategies for Health for All by the Year 2000, the Seventh General Programme of Work, WHO'S structures in the light of its functions,the International Drinking Water Supply and Sanitation Decade, etc. In December, one of the Assistant Directors-General visited India to attend the Working Group meeting on Global Strategy for the Programme of Essential Drugs and to hold discussions with the senior staff of the Regional Office. He also visited Sri Lanka to discuss the progress being made in the cancer control programme. In February, another Assistant Director-General attended the third annual meeting of the WHO Programme Advisory Group on the Prevention of Blindness held in the Regional Office from 9 to 13 February, and subsequently went to Bangladesh to participate in the Regional Conference on Diarrhoea1 Diseases (16-21 February). In February-March 1981, a third Assistant Director-General visited India, Sri Lanka and Thailand. In India, he spent two days in discussions in the Regional Office and attended an in-house meeting of WHOIUNICEF staff. Later, he visited Calcutta to attend the Third International Congress of the World Federation of Public Health Associations (23-26 February). He studied and discussed various aspects of health services development with senior government officials in Sri Lanka and, in Tnailand, he participated as a guest lecturer in the ESCAPIRTI Course on Planning, Development and Health. During the period under review, the Regional Director received various officials well known in the health field and senior officials from the health ministries of Member States, including health teams from the DPR Korea and the USSR. Other visitors were staff members of several United Nations organizations and the Asian Development Bank, Manila. The Regional Director, Dr V.T.H. Gunaratne, relinquished office on 28 February. Before his departure, he visited various countries in the Region to discuss health programmes with the senior officials includ- ing ministers of health. He also attended the twenty-second session of the Global ACMR in October. He addressed various important meetings and seminars in the health field, including the Regional Workshop on Appropriate Technologies with special reference to PHC, held in the Regional Office, the Regional Consultative Meeting on the preparation of the Seventh General Programme of Work, and the Regional Consul- tative Meeting on the Study of WHO'S Structures in the light of its Functions. Another important meeting held in the Regional Office was the WHO Programme Advisory Group on the Prevention of Blindness, which was attended by eminent experts and chaired by Sir John Wilson, President of the International Agency for the Prevention of Blindness. Dr Gunaratne received the prestigious Crystal Award of the Inter- national Agency presented to him by Sir John Wilson. The new Regional Director, Dr U KO KO, assumed Office on 1 March 1981. He paid brief visits to some of the countries in the Region to discuss WHO'S collaborative programmes with senior health officials. In .March, the Indian Academy of Medical Sciences conferred on him an Honorarv Fellowship of the Academy. He also addressed various regional and inter-regional meetings, seminars, workshops, etc., including the Meeting of the Scientific Working Group on Diarrhoea1 Diseases, Global Advisory Committee on Medical Research Sub-committee on Research Administration, Neeting of the Research Study Group on Tuberculosis, Inter-regional Workshop on Appropriate Technology for Health, Research Study Group Meeting on Dengue Haemorrhagic Fever, Particularly with Reference to Dengue Vaccine Development, Seventh Session of the South-East Asia Advisory Committee on Medical Research, and the Regional Advisory Group Meeting on Mental Health. Tne Executive Board's working group appointed to study the functions and activities carried out by the Secretariat, in its programme of country tours, visited the Regional Office and the WPC's Office in Sri Lanka in March to study the inter-relationship of the functioning of WHO at different levels and to identify possible areas for improve- ment. They held discussions with the staff in order to collect information in connexion with their study. Two members from the staff of WHO'S External Auditor visited the Regional Office, Indonesia and 'Ihailand during the year. A member of the Internal Audit Unit at Headquarters visited the Regional Office in May and the WPCs' Offices in Sri Lanka and Nepal. The Chief of Accounts also visited the Regional Office towards the end of May to discuss financial matters with budget and finance staff. Another Headquarters staff member paid a one-week visit in February to discuss personnel and recruitment matters. Administrative arrangements were made for the conduct of various WHO-sponsored meetings, seminars, workshops, etc. held in the Regional Office or in the countries of the Region during the year under review. An important development was the increased delegation of authority to the WHO Programme Coordinators, with a view to speeding up delivery of the WHO collaborative programme at country level. This is being done initially on a trial basis, and adequate guidelines have been prepared to facilitate proper exercise of these delegations. In addition, the staffing pattern of the WPCs' Offices was reviewed. In pursuance of the discussion at the thirty-third session of the Regional Committee (resolution SEA/RC33/R10), the Regional Director has made arrangements to convene a meeting of a "small committee" before the start of the next session of the Regional Committee, to: (i) review existing terms of reference of the Sub-committee on Programme Budget; (ii) review existing guidelines and criteria for the establishment of inter-country projects; (iii) analyse all regular and extra-budgetary programmes, and (iv) evaluate the inter-country programme. The small committee will present its findings to the Regional Director, who will submit them to the Regional Committee at its 34th session. 3.2 Organizational Structure The organizational structure of the Regional Office as on 31 May 1981 is shown in Annex 1. 3.3 Personnel 3.3.1 Staffing The distribution of professional staff in the Region by nationality as on 31 May 1981 is shown in Annex 2. A column giving the worldwide distribution of WHO staff by nationality has also been included. Ihe following table shows the number of posts in the professional category in ;he Region and the number actially filled as on 31 May 1981: Seven posts were inactivated because (a) four were to be filled by short-term consultants, (b) two posts were not to be filled, and (c) recruitment for one post was held in abeyance. Seventeen posts were actually filled by short-term consultants. During 1980, 205 consultants were employed in field programes for periods ranging from two weeks to eleven months. From 1 January to m w u am um d al UV U CCM ma0 u b ma s w uu C .)*+ s w 3rlu umw w hu V d O mbu 0.4 a mu 0 15 15 Organizational Location Regional Office Field Programmes Total - . g .rl u U W rl a m 2 ?I I4 -rl e a 0 Wd P) u a bU m 4 uw mm 0 w FSM 2 4 6 w U % h \ Q v P w m u m c s + d uu UC z 2 dU d m 3 u u m 0 0 Q PI u 0 7 7 rl m m rl b 0 w m rl u m m m 0 rl a w E %" dm 4 P w a o u m m wm 16 176 192 rl m m rl C d U P) rl rl rl w w P 0 u m u a 0 D, 16 169 185 U @J rl 4 sl w 4 rl m 7 u 0 ld m u m 0 PI 14 150 164 31 Hey 1981, 87 consultants were employed. Zhe dietribution of consultants recruited during the period 1 June 1980 - 31 May 1981 by nationality is shown in Annex 3. During the period 1 June 1980 - 31 Kay 1981, eight professional and six general service staff members left WHO service: two staff members (one professional and one general services) died. Four general service staff members completed 30 years of service with WHO, two general service staff members 25 years, and one general service staff member 20 years. 7.3.2 Staff Training Two courses on Presentation Techniques were held in New Delhi from 3 to 6 November 1980, with twelve participants. The courses were designed to train the staff in the technique of presentation of their functions with particular reference to day-to-day administrative and technical matters. The Director-General granted study leave for short periods to three staff members to receive training in their respective fields of work. 3.3.3 Employment Conditions The salary scales of the general service staff in Burma, India, Indonesia, Nepal, Sri Lanka and Thailand were revised. Also, a salary scale for the general service staff in Bhutan was established. Ad hoc - meetings were held with the representatives of the various agencies of the United Nations system in New Delhi to discuss matters of common concern. A regular dialogue also continued with staff representatives on matters of mutual interest. 3.4 Budget and Finance With the introduction of biennial accounting as of 1980-1981 total obligations incurred on field activities in the biennium can be reported only in the early part of 1982. However, there are clear indications that the budgetary resources for the South-East Asia Region continue to increase. The obligations incurred on field activities under various funds during 1976-1977 and 1978-1979, together with an estimate for 1980-1981, are shown in Figure 3. A statement showing the financial status of the regular budget programmes for 1980-1981 as of 30 June 1981, together with estimated obligations for the full biennium, will be issued later as an addendum to the Annual Report. 3.5 Regional Office Building The long-term and short-term accommodation requirements of the Regional Office were reviewed by the Regional Committee at its Figure 3. OBLIGATIONS INCURRED ON FIELD ACTIVITIES IN THE SOUTH-EAST ASIA REGION US$ (Millions) I Regular Budget Total Field Obligations US$ (millions) UNDP UNFPA 0 Other Sources thirty-third session, and in resolution sEA/RC33/R8 it endorsed the following proposals for financing under the Real Estate Fund: Extension to the building .. $ 435 000 New electric sub-station . . $ 60 000 New air-conditioning plant . . $ 180 000 Based on the recommendation made by the Sixty-seventh session of the Executive Board, the Thirty-fourth World Health Assembly approved the above proposals and allocated a sum of ~~$675 000 for the execution of the above jobs. The construction plans and drawings have been prepared for submission to the local authorities, and the necessary approval for the proposed construction has been sought. The construction is likely to start before the end of 1981 and, subject to availability of construction material such as cement and steel, the work is expected to be completed by the end of 1982. The installation of the electric sub- station and the air-conditioning plant will be taken in hand when the above construction is nearer completion. The Regional Office has installed the WANG word processing system in order to improve the production process and to meet the increasing workload of the reporting and information systems. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 June 1980 - 31 May 1981, procurement action was taken for supplies and equipment amounting to $7 695 784 under all sources of funds. These consisted of hospital supplies, X-ray equipment, drugs, vaccines, biologicals, spraying equipment and pesticides, laboratory equipment, supplies for environmental health programmes and teaching programmes, vehicles, office and administrative supplies and medical literature. The Eollowing categories of procurement need special mention: Emergency supplies Requests to meet emergency conditions caused by floods, an earthquake and epidemics were received, and the following supplies were procured, totalling ~~$169 000. Bangladesh For flood disaster relief: Medicaments, water purifying tablets, bleaching powder, anti-snake venom serum and 4.5 million tablets of Cliquinol (obtained by Headquarters free of cost, the Regional Office meeting the airfreight charges). Burma - For fire disaster relief, Taungdwingyi: Medicaments, consisting of oral rehydration solution, ampicillin and tetracycline capsules and Ringer's lactate with giving sets (procured in India and airfreighted). For fire disaster relief, Uandalay: Medicaments, consisting of oral rehydration solution, ampicillin capsules, metronidazole tablets, furacin ointment and water purifying tablets (procured in India and airfreighted). Maldives For polio and conjunctivitis outbreaks: 15 000 doses of oral polio vaccine and 85 doz. tubes of tetracycline eye ointment Nepal To control an outbreak of gastro-enteritis in hilly areas: Rehydration solution. For relief of earthquake victims: Medicaments, water purification tablets, surgical bandages. Thailand For relief after an outbreak of diphtheria: Diphtheria antitoxin, 300 ampoules. India - For the control of Japanese encephalitis: Freeze-dried vaccine. Purchases - Revolving Fund/reimbursable basis Bangladesh, Burma, India, Nepal and Sri Lanka made use of the Organization's procurement facilities under the Revolving Fund and reimbursable schemes amounting to $274 189. The purchases were for hospital and laboratory equipment, teaching materials, drugs, vaccines, bleaching powder and renewal of sub- scriptions to journals and procurement of medical books. Local procurement Wherever possible, having regard to prices and quality, purchases were made within the Region. The total amount spent on such purchases during the period under review was US$968 975 representing approxi- mately 13.5% of the total purchases made by the Regional Office. A comparative table showing the procurement trend over the last decade is given below: PROCUREMENT FIGURES OF SUPPLIES AND EQUIPMENT AND MEDICAL LITERATURE, BY CALENDAR YEAR 5. COLLABORATION WITH OTHER AGENCIES With the endorsement of the goal of health for all by the United Nations General Assembly as per its resolution A/RES/34/13, collabora- tion among the agencies of the United Nations system has increased not only for the mobilization of extrabudgetary resources to intensify the primary health care programmes but also for the identification of areas of appropriate collaboration in order to avoid duplication of efforts. Follow-up actions continued on the Meeting on Financing of Primary Health Care Programmes in Asia hdd in July 1979. in US Dollars) Local Purchase as a percentage of Total 19.89% 24.04% 9.37% 10.02% from 1977. Year - 1971 1972 1973 1974 1975 1976 1977* 1978 1979 1980 *Local 5.1 United Nations There is continuing close coordination with the Regional Representa- tive for Western South Asia of the United Nations High Commissioner for Refugees stationed in Bangkok in respect of refugees in Indonesia and Thailand. Procedures for the United Nations Interim Fund for Science and Technology for Development (IFSTD) have been finalized by the United Nations Conference on Science and Technology for Develop- ment (UNCSTD) and circulated to the countries in the Region. Earlier, in response to a request from UNDP, several countries in the Region had prepared and submitted project proposals for finances from the Fund. However, these resources being small as compared to the requests, no final decision on these requests has yet been taken by the UNDP Administrator. Total Procurement 763 137 1 424 086 1 807 730 3 415 000 2 782 000 3 124 000 3 801 567 8 926 324 10 749 445 7 682 169 purchase figures (Expressed Local Purchase within the Region 756 243 2 146 229 1 007 565 769 500 are available only Proposals for assistance from the Voluntary Fund for the United Nations Decade for Women have been sent to the UNDP Resident Represen- tatives in the countries concerned. With increased resources becoming available to the Fund, UNDP was asked to assist with the development of project proposals through its country offices and with their submission to the Fund. The resources of the Fund are to be utilized to supplement activities in the areas designated by the General Assembly which are designed to implement the goals of the United Nations Decade for Women, viz., equality, development and peace, priority being given to the related programmes and projects of the least developed, land-locked and island countries. The Regional Office was represented at the World Conference of the United Nations Decade for Women: Equality, Development and Peace, held in Copenhagen in July 1980. A Meeting on Women in Health and Development was held in the Regional Office on 12 and 13 December 1980 at which Bangladesh, Burma, India, Indonesia, Maldives, Mongolia, Sri Lanka and Thailand were represented. In pursuance of the United Nations General Assembly resolution ~/RES/34/13, the Secretary-General, after consultations with the appropriate national authorities, has designated a number of UNDP Resident Representatives in the Region as resident coordinators of the United Nations system's operational activities for development. In April 1981 the WHO Programme Coordinator in Indonesia visited stricken areas in Irian Jaya, on behalf of the United Nations Disaster Relief Organization, following an earthquake. 5.1.1 United Nations Development Programme (UNDP) As the executing agency for 35 country and inter-country UNDP-funded projects in the Region, the Regional Office has been maintaining close liaison with UNDP at different levels - at the country level between the WHO Programme Coordinators and the Resident Representa- tives, and at the regional level with the Resident Representatives as well as with the Regional Bureau for Asia and the Pacific. The total delivery of UNDP projects in 1980 amounted to USS4.5 million. The Regional Office participated in two important meetings convened by UNDP - the Inter-governmental Meeting on Inter-country Programming for the Least Developed Countries (LDCs) in Asia and the Pacific, held in November 1980 at Dacca, and the Inter-governmental Meeting of Development Assistance Coordinators in Asia and the Pacific, which took place in New Delhi in February 1981. At the former meeting the importance of health was stressed, and a sectoral review of the health problems in LDCs was sent to UNDP Headquarters for presentation at the United Nations Conference on LDCs scheduled to take place in Paris in the third quarter of 1981. The latter meeting was the result of a year-long programming exercise and discussions between UNDP and the WHO Regional Offices for South-East Asia and the Western Pacific. Consultations also took place between SEAR0 and WPRO for the joint submission of regional and sub-regional health programmes to UNDP for the 1982-86 IPF (Indicative Planning Figure) period. The Regional Office collaborated with UNDP at the country level in the preparation of its country programmes in respect of Bangladesh, Bhutan, Maldives and Nepal, which were presented to the UNDP Govern- ing Council in June 1981. As a result of the changed criteria to be applied in determining the indicative planning figures (IPF) for the period 1982-86, allocations to countries are expected to be compara- tively higher. As a consequence, the share in the countries' IPFs for health and related fields is also expected to go up, with special emphasis on increased assistance to the LDCs. As a result of UNDP's becoming the focal point for the IDWSSD and its acceptance of WHO'S goal of health for all, collaboration with UNDP at all levels has become much closer, and a continuous dialogue has been maintained for the smooth implementation of UNDP-funded programmes. 5.1.2 United Nations Children's Fund (UNICEF) Since both WHO and UNICEF are committed to primary health care, contact was maintained with UNICEF to explore ways of further reinforcing mutual collaboration. An "in-house" UNICEF/WHO meeting was held in New Delhi in February 1981 which identified specific areas and activities from among those included in the broad concept of primary health care, with the aim of giving a concrete shape to joint efforts. WHO also participated in the UNICEF East Asia and Pakistan Regional staff meeting held in Bangkok in March 1981. At this meeting the progress of implementation of primary health care in various countries was reviewed with the focus on organizational developments, manpower aspects and community participation. At a high-level meeting between the Director-General of WHO and the Executive Director of UNICEF in New York in November 1980 the programme areas identified for collaboration included EPI, diarrhoea1 disease control, essential drugs, water and sanitation, nutrition and child health, which are the essential components of health for all. In pursuance- of a directive following this meeting, regular consulta- tions at country level between representatives of the two agencies are taking place. In addition, two important meetings were held - one in the Regional Office in February 1981 and the other at Bangkok in March 1981 - to find ways and means of overcoming difficulties in implementing the programmes and to identify the role of each organization. Reciprocal briefing for new staff members of both organizations at regional and country levels has been agreed to and is to take place as a regular feature. 5.1.3 United Nations Fund for Population Activities (UNFPA) In 1980, the Regional Office executed 17 projects involving a total delivery of $2.3 million. In the implementation of these projects, continuous dialogue was maintained with the UNFPA Coordinators through the WHO Programme Coordinators in the countries concerned and with UNFPA Headquarters in New York. The visit of the UNFPA Coordi- nators in Bhutan and Thailand to New Delhi in February 1981 was utilized to hold discussions on some of the administrative questions concerning the UNFPA-funded projects being executed by WHO in these two countries. In Bangladesh, India and Indonesia the governments themselves are executing UNFPA projects in the health field. Nevertheless, the Regional Office is closely collaborating by providing technical assistance, when requested. In Nepal, WHO is the co-executing agency for four UNFPA-funded projects approved during 1980. UNFPA's approval was received for the continuation, though on a restricted scale, of the Regional Team on Family Health, which is based in New Delhi and Thailand and which provides appropriate technical backstopping to the Member countries of the Region. The Regional Office provided full cooperation to UNFPA by deputing its staff to participate in UNFPA basic needs assessment missions to Bhutan, Maldives, Sri Lanka and Thailand. Similar assistance was provided to the UNFPA Coordinator in India in the annual country review of the UNFPA programme. Regional Office staff also partici- pated in the tripartite project review in Bhutan which was carried out in May-June 1981. 5.1.4 Economic and Social Commission for Asia and the Pacific (ESCAP) As in the past, the Regional Office has maintained liaison with ESCAP through the WHO Programme Coordinator to Thailand assisted by a medical officer. WHO actively participates in ESCAP's meetings, seminars, etc., and their reports are regularly distributed to the Eastern Mediterranean and Western Pacific Regional Offices. The Asian and Pacific Development Institute located in Bangkok was closed down in July 1980 and integrated with the Asian and Pacific Development Centre in Kuala Lumpur. WHO also provided assistance through faculty and fellowships for ESCAP's Programme on Health and Society under the Technical Cooperation Division. In November 1980, ESCAP and WHO jointly organized a research seminar in Bangkok on the social and psychological aspects of fertility and family planning behaviour. 5.1.5 International Atomic Energy Agency (IAEA) Several institutions in the Region participated in the twenty-sixth IAEAIWHO postal dose inter-comparison programme. The Regional Office distributed sets of dosimeters to the institutions and transmitted the reports from the institutions to IAEA through WHO Headquarters. Ihe Regional Office continues to collaborate closely with IAEA. The inter-comparative personal monitoring film badge service continued in a number of countries, and film badges and films were made available to the institutions. The radiation to which the staff in these institutions are exposed is being monitored. 5.2 Specialized Agencies 5.2.1 Food and Agriculture Organization of the United Nations (FAO) FA0 continued to be associated with a UNDP-funded project in Burma on the food and drug quality control laboratory. mere have been regular consultations with FA0 in fields of mutual interest. 5.2.2 International Labour Organisation (ILO) Relations with the International Labour Organisation remained cordial. 'Ihe Regional Adviser on Noncommunicable Diseases participated in a UNDP-sponsored preparatory mission in Burma in connexion with a project on the training and rehabilitation of the disabled. It is expected that both WHO and ILO will be executing the project. The WHO Programme Coordinator to Thailand represented the Organization at the ILO Meeting of the Designated Bodies to be part of the 'Inter- national Occupational Safety and Health Hazard Alert System' in the Asian and the Pacific Regions, held in Bangkok in December. A draft project proposal on the Asian Regional Research Project for Improving Quality of Working Life - to be implemented in Bangladesh, India and Sri Lanka in this region - has been circulated to the countries concerned before the project is started. 5.2.3 United Nations Industrial Development Organization (UNIDO) UNIDO, the associated agency for the UNDP-funded project, "Primary Health Support Services Programme", in Nepal, is expected to provide experts in the production of drugs and also procure equipment for the project. Continuous consultations were held with UNIDO, and two of its staff members visited the Regional Office in March 1981 for discussions. 5.2.4 United Nations Educational, Scientific and Cultural Organization (UNESCO) Collaboration with UNESCO was maintained in technical fields of mutual interest. The UNESCO Senior Programme Specialist in Basic Sciences in New Delhi visited the Regional Office for discussions on a draft proposal for preparatory assistance by UNDP for an inter-country project on the strengthening of the regional network for improving the species of locally available medicinal and aromatic plants and their use in the chemical and pharmaceutical industry. A technical paper on the reliability of roof-runoff for domestic water supply in selected areas of Indonesia, prepared by the UNESCO Regional Adviser for Hydrology stationed in Jakarta, has been circulated to the WHO sanitary engineers in the Region. 5.2.5 World Food Programme (WFP) Liaison with the WFP was maintained through WHO Headquarters at the organizational level. At the country level, both the Regional Adviser on Nutrition and the WHO Programme Coordinators in the countries concerned were in liaison with WFP officials in respect of the various WPF projects. WHO was represented in WFP appraisal missions on transmigration schemes in Indonesia and the Mahaweli Ganga development programme in Sri Lanka, as well as in a mission on the preparation of a terminal report on milk marketing and dairy development in India. The Regional Office reviewed different proposals for assistance from the WPF from Bangladesh, Bhutan, India, Indonesia and Sri Lanka. 5.2.6 International Bank for Reconstruction and Development (IBRD) Collaboration continued with the World Bank in promoting and assisting the development of the water supply and sanitation sector through the regionalized WHO/IBRD Cooperative Programme. In addition to Bank- oriented activities, which included participation in water supply- sanitation project identification, and preparation and/or supervision in Bangladesh, India, and Thailand, the staff of the Cooperative Programme increased their involvement in sector support programme development and IDWSS Decade planning efforts. Among these activities were manpower development missions to Nepal and Thailand, health education project identification missions to the States of Bihar and Rajasthan in India and to Thailand, and assistance in developing IDWSS Decade national plans in Bangladesh, India and Maldives. The Regional Cooperative Programme staff, consisting of a sanitary engineer and a financial analyst, carried out 22 missions, five of which were joint missions with World Bank teams; three were assisted by WHO Headquarters staff, and two were joint missions with UNICEF. One WHO staff member participated in the WHO~IBRD Workshop held in Washington in October. The Director of the Population, Health and Nutrition Department of the Bank visited Sri Lanka during February. 5.3 Asian Development Bank (AsDB) Relations with the Asian Development Bank continued to be close and cordial. Working arrangements were signed between WHO (represented by the Western Pacific Regional office) and the AsDB in November 1980. The report of the assessment/review mission to Nepal on malaria research and training was finalized and forwarded to AsDB. WHO provided staff support to the Bank's following activities: fact- finding mission for the Thai rural water supply, project review mission on the production and distribution of drugs in Indonesia, fact review mission on the health and population project in Thailand, and follow-up mission to Sri Lanka on health services. The Director of the Infrastructure Division of the Bank held discussions in the Regional Office during a visit to New Delhi. 5.4 Bilateral and Other Agencies The Organization continued to maintain contacts with bilateral and other agencies and provided technical advice and expertise, where necessary, to Member countries receiving assistance on a bilateral basis. The major agencies/governments which assisted health programmes in the Region were: the Swedish International Development Authority (SIDA), the Government of the Netherlands, the Danish International Development Agency (DANIDA), the Canadian International Development Agency (CIDA), the Japan Shipbuilding Industry Foundation (JSIF), the Norwegian Agency for International Development (NORAD), and the Ministry of Overseas Development of the United Kingdom. Assistance provided by these organizations was in such fields as prevention of blindness, vector-borne disease control, tuberculosis, leprosy, malaria, water supply and cancer. 5.5 Non-governmental Organizations in Official Relations with WHO Cooperation continued with the local and national agencies affiliated to international non-governmental organizations. As mentioned above, representatives of three non-governmental organizations attended the thirty-third session of the Regional Committee for South-East Asia in September 1980. 6. PUBLIC INFORMATION The accent during the year under review was on expanding and broaden- ing the base of activities for the dissemination of information to help motivate the community's interest and involvement in achieving the universal goal of health for all. Consequently, information material was produced and provided to a variety of users and potential users. The experiment of sending information material to the zonal offices of the Indian Railways for use by their sub-units, which was started last year, was extended to cover departments in other ministries such as information and broadcasting, social welfare, food and agriculture and defence health organizations. 'The names of health educators in the Region were added to the mailing list of the newsletter "HFA/2000", and steps were taken to make the newsletter more reflective of WHO activities, particularly in the field of research development. A Regional Directory of Non-Govern- mental Organizations working in the health and related sectors was also prepared and relevant information material sent to them for their use and further dissemination. Regional Committee: The thirty-third session of the Regional Committee held in Male was a unique media experience, with the local radio and television beaming the opening and closing sessions live, and the newspapers giving the event wide coverage. World Health Day: The 1981 World Health Day theme, "Health for All by the Year 2000g', generated a great deal of interest in the media with special radio and television programmes being produced in many count- ries. To cope with the demand for materia1,over 9000 information kits were distributed. These kits consisted of articles, photographs and wall-charts with contributions from the Unit. A limited number of stickers (9000) was also produced to highlight the HFAj2000 theme. These sets were sent to the mass media, health education bureaux, social welfare agencies, educational institutions and community groups in the Region. Government and national leaders throughout the Region participated in programmes organized to observe the event. The Regional Director's World Health Day broadcast in English and Burmese for All India Radio was translated into other languages and relayed in the Overseas Programme for listeners in South-East Asia, Africa and West Asia. The Delhi Television station also telecast a statement by the Regional Director on World Health Day. In addition, health education units and municipal and social welfare agencies organized special programmes to mark World Health Day. Exhibitions, symposia and workshops were held where the salient features of the theme were explained and the need for community participation and involvement was stressed. Group Educational Activities: The media showed keen interest in the educational activities organized by the Regional Office, particularly those related to HFA, prevention of blindness, and traditional birth attendants (TBAs). As in the past, facilities were provided to media representatives to cover subjects of interest to them and to interview participants. World Health: The magazine carried a number of articles related to the Region, with special contributions on HFA, primary health care, blindness, and women and development. The WHO Chronicle also carried write-ups devoted to health development activities in the Region. Cooperation with Information Centres of the United Nations and Other Agencies: Tne Regional Office continued its collaboration with the United Nations Information Centre, New Delhi, in bringing out a weekly newsletter. On an experimental basis, a basic foide; on WHO and its activities was produced in Nepalese, in collaboration with the United Nations Information Centre, Kathmandu. Similarly, colla- boration was extended to UNICEF, New Delhi, in a media workshop held in Lucknow on "children, water and health". The UNDP office in New Delhi was provided with media support services on the launching of the Water Decade. The Information Unit also participated in various seminars and workshops concerned with health and socio-economic development organized by the United Nations or other agencies. Photographs and Films: The Regional Office photo library continued to expand its services within limited resources, with photographs being provided to an ever-increasing number of publications, both within and outside the Organization. The film on primary health care in Thailand was completed and released, and steps were taken to procure the entire set of seven films on PHC to be given on loan in the Region. Similarly, the existing films were lent to educational institututions, national health officials and WHO staff in the field, and efforts made to procure more copies of WHO films for wider coverage. Visitors: An increasing number of people, including medical and nursing students, school and college students and teachers, social welfare workers and others, visited the Regional Office to learn about the Organization's work, aims and objectives, and were provided with information material, which was also sent in response to a large number of requests. PART 111 ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST This part of the report contains programme summaries in respect of each country, giving a brief account of the major problems of the country and highlighting the government's efforts during the year, with special refer- ence and in relation to WHO collaboration. The information is complemen- tary to that already given in Part I. Each programme summary is followed by a list of the projects in the country for which WHO has given assist- ance during the whole or part of the period under review. Inter-country projects are listed at the end. In the project list, in the first column (under "Project Number and Source of Funds"), ,I 8, R means Regular Budget "UNDP" United Nations Development Programme VI~PM United Nations Fund for Population Activities 8fFTtt Trust Fund "UF" United Nations Children's Fund "VF" Voluntary Fund for Health Promotion - all sub-accounts. The projects are listed in accordance with the programme classification. 1. BANGLADESH The Government has adopted, as one of its national health policies, the provision of primary health care to the people. "Health for All by the Year 2000" is a long-term national objective, and a firm political commit- ment has been made to provide medical care to the entire population. Under the aegis of the Planning Commission and the Yinistry of Health and Population Control, a national workshop on strategies for HFA/?000 was conducted, followed by the preparation of a country paper on national strategies for HFA, in June 1980. The country paper provides the guide- lines and sets the targets in the health and health-related areas to be achieved by the turn of the century. The plan of action for the primary health care project has been finalized by the Government. UNICEF, the World Bank, WFP, UNDP and WHO held regular meetings of the United Nations Inter-agency Working Group on Primary Health Care Activities and reviewed with government representatives the progress achieved. The Ministry of Health and Population Control regularly surveys the status of development of the thana health complex scheme and ensures supervision thrcughout the country A significant development has been the reorganization of the health services in order to establish a unified approach to the delivery of health and family jlanning services. The Uealth and Population Control Divisions of the Ministry cf Health and Population Control are in the process of being integrated. The offices of the nirector of 'Jealth Services (curative) and the Director of Health Services (Preventive) have been combined to form a Directorate General of liealth Services. With the physical integration of the two divisions of the Ministry, the Civil Surgeon will be in charge of both health and population control services at the district level; at the thana and village levels also, a unified administration of both services will be ensured. Field personnel formerly working in health and population control will be renamed as health and family planning field workers respectively. A management workshop was held for senior government officials to give them orientation in management concepts and skiils for the better adminis- tration of health services. Attention is being given to the establishment of a more effective management structure. Development of a comprehensive health information system for the country is a priority need. In order to bring about necessar" changes, the health information system has been reviewed. Wbi1.e the existing systems continue in most parts of the country, steps are being taken to introduce lay reporting in phases for the collection of health information. Lay reporting is being practised on an experimental basis in two thanas. Training courses in the repair and maintenance of hospital equipment have continue6,and eight major teaching and service hospitals and institutions in Dacca and the Medical College at Xynensingh received assistance in the repair and installation of specialized equipment. A plan for the estab- lishment of four regional workshops and one in each medical college was prepared. Programmes for the prevention and control of communicable diseases, which continue to be priority health problems, are based on a pragmatic approach. Activities for the prevention and control of diarrhoea, malaria and immunizable diseases will constitute the entry points for the imple- mentation of primary health care. A national oral rehydration project as part of diarrhoea1 disease control has been initiated. Mortality from these diseases was reduced substan- tially through oral rehydration; ORS packets are produced locally and distributed by village voluntary health workers. Malaria, though still endemic in the country, is under control generally. However, P.falciparum resistance to chloroquine is slowly increasing, even though it occurs mainly in the border areas in the eastern part of the country. A five-year scheme for the expanded programme on immunization was approved by the Planning Commission. Immunization centres have been established in metropolitan areas, in the thana health complexes of primary health care pilot areas and in clinics run by certain voluntary organizations. BCG, tetanus toxoid and DPT are given as a routine, and poliomyelitis and measles vaccines at immunization centres having the necessary cold-chain facilities. Preparations are being made to increase the geographical coverage of EPI. Workshops were conducted on nutrition, the prevention of blindness, mental health, cardiovascular-disease control, cancer and diabetes. The preven- tion and control of noncmunicable diseases is gaining momentum within the general health services. A workshop on the promotion of research methodology, with emphasis on health services research, was conducted. Health education activities are making progress, with the development of the infrastructure within the general health services. Sub-divisional health education officers have been appointed and trained. The Health Education Bureau at central level was organized providing a higher status for the senior staff. A Master of Public Health (Health s ducat ion) course and other post-graduate courses in public health have been started at the National Institute of Preventive and Social Medicine. The major thrust in environmental health is on water supply and sanita- tion, and the programme for the provision of safe water to the rural population and for the introduction of sanitary water-seal latrines continues, being implemented more or less in line with the primary health care programe. Planning for the International Drinking Water Supply and Sanitation Decade is being initiated. International and bilateral agencies such as the World Bank and the Asian Development Bank and the Government of the Netherlands are supporting the development of piped water supplies in district towns. This scheme is in the pre-investment stage. The country paper on strategies for health for all provides broad guide- lines for health manpower production during the Second Five-Year Plan as well as the next three five-year plans up to the end of the century. A steering committee and working group appointed by the Government are now preparing a health manpower situation report, and a national workshop is to be held to formulate the outline of the health manpower plan in the context of the Second Five-Year Plan and the national strategies for HFA. In the field of medical education, changes have been envisaged in teaching methodologies, including curriculum development, as well as in the preparation of non-medical teachers for the basic medical sciences. During 1980-1981, three medical colleges were opened, bringing the total to eleven; however, the intake of students has not been substantially increased. Similarly, eight more medical assistant training schools have been started. There is a great shortage of teachers, particularly in basic science subjects. The Government has formulated a plan to train more nurses to achieve a target of 10 000 during the Second Five-Year Plan period. The Ministry of Health and Population Control has decided to open 38 schools for senior registered nurses (a four-year programe) at the sub-divisional level, and to implement the junior nurse programme in 170 thana health complexes (an 18lwnth programme). The project "Assistance to Medical Education Centre and Development", which covers the development of teaching methodology in the medical colleges and other teaching institutions, along with the formation of teacher training cells in the medical colleges, has been reformulated. In order to provide relief to more than eight million people who were affected by floods during the year the National Oral Rehydtation Pro- gramme arranged for the supply of oral rehydration salt packets; as a result, mortality from diarrhoea was kept to the minimum. Projects in operation Number and Source of Funds Title - BAN CHP 001 Country Health Progradng R BAN RPD 001 Research Promotion and Development R BAN SPM 001 Organization of Health Services Planning and R Administration BAN SPM 002 strengthening of Thana Health Complexes and Development R of Primary Health Care BAN SPM 003 Repair and Maintenance of Electro-medical Equipment R BAN ATH 001 Development of Health Laboratories and Allied Laboratory R Services BAN NUT 002 UNDP BAN HED 002 R BAN MNH 001 R BAN PHB 001 R BAN ESD 001 R/VF BAN ESD 002 UNDP BAN MPD 001 R/VF BAN BVM 001 RVF/TF BAN SME 001 VF BAN EPI 001 R/ BAN PBL 001 R BAN CAN 001 R BAN CVD 001 R BAN ORH 001 R BAN OND 001 R BAN EHP 001 UNDP BAN BSM 001 R BAN PTR 001 R - 133 - Institute of Public Health Nutrition Health Education Mental Health Pharmaceutical and Biological ~uality Control Strengthening of Epidemiological Services Epidemiology and Disease Control Malaria Control Mycobacterial-Disease Control Smallpox Eradication Expanded Programme on Immunization Prevention of Blindness Cancer Prevention and Control Cardiovascular-Disease Control Oral Health Other Noncommunicable Diseases (Diabetes, Endocrinology) Assistance to Water and Sewerage Authority (Dacca and Chittagong) Community Water Supply and Sanitation Training of Mid-level and Peripheral Health Workers BAN PTR 002 Training of Medical Assistants UNDP BAN PTR 003 Strengthening of Health Manpower Development UNDP BAN PTR 005 National Institute of Preventive and Social Medicine UNDP BAN EDS 001 Nursing Advisory Services and Training R 2. BHUTAN* The development of health services in Bhutan is making steady progress. If the existing momentum is maintained, the target of providing basic health care to the people can be attained in the near future. At the end of 1980, there were 44 basic health units and 41 dispensaries providing basic health care to the population, in addition to 16 general hospitals and two leprosy hospitals. The dispensaries and the basic health units are the peripheral health posts responsible for both preven- tive and curative services. Following the decision of the Government, all the existing dispensaries are being converted gradually into basic health units. These are supervised by the zonal medical officers concerned, stationed in the zonal hospitals, which serve as referral points to basic health units. The General Hospital at Thimphu also functions as the national referral hospital. Assistance to health services from the United Nations system was started in 1974, with the operation of the UNDP-funded project "Development of Yealth Services" following visits by UNDP missions in 1972 and 1973. Under the UNDP project, being executed by WHO, technical experts - both long- term and short-term - in different specialties were provided, fellowships were awarded, and equipment was procured for the Thimphu General Hospital and some other zonal hospitals. 'The Fifth Five-Year Plan of the country, covering the period April 1981 - March 1986, has been formulated. However, the beginning of the plan ueriod has been uostponed by one year, the interregnum being treated as the hridging year. It is envisaged that, during the coming plan period, the Government will consolidate the achievements in the health sector and strive for improvement of quality of work, limiting expansion of services to the minimum required. Percentage outlays for the health sector rose from 2.94 in the First Plan period (1961-66) to 6.06 in the fourth plan (1976-81). The UNDP third country programme will also be synchronized with the Fifth Five-Year Plan period, and the total funds available from indicative ?laming figure (IPF) resources for 1981-1985 will be about $26.9 million (the illustrative IPF for 1982-1986 being $36.5 million). Of this amount, the health sector is likely to receive approximately $1.4 million, accounting for five per cent of the total input by UNDP. The concept of primary health care has been accepted: village health ~lorkers - volunteers drawn from the community, including community leaders and Buddhist lamas - are given training in first aid, sanitation, ky~iene and nutrition and sent back to work in their communities. With supervision, they are enabled to become more reliant and confident in the delivery of health care. They are supported by the basic health units. "'Putan is a Member of the United Nations but not of WHO. Though some of the programmes - such as those of the Expanded Programme on Immunization and leprosy control - are run as vertical programmes, they are being implemented at the periphery by basic health workers, who are in fact, multipurpose workers. The malaria workers, in turn, will be trained to carry the message of family welfare to the communities they serve. One of the significant developnents in the health sector is the establish- ment of a nutrition cell in the Department of Health to formulate a national nutrition policy, to implement this policy and to coordinate all the activities in this field. The development of health services is beset by many problems, of which lack of adequately trained manpower is a major one. To help overcome this inadequacy, the Health School attached to the Thimphu General Hospital runs courses for basic health workers (of 12 months' duration), assistant nurses (12 months) and health assistants (24 months). In addition, during 1982-1986 UNDP has earmarked an amount of $898 000 for fellowships in fields such as nursing, laboratory, X-ray and dental techniques and physiotherapy for studies outside the country. A family welfare training centre is being constructed at Geyldgphug with UNFPA funding, When the centre is ready in March 1982, it will provide facilities for training different categories of workers in the concepts of maternal and child health and family welfare. The Royal Government encourages the development of traditional medicine as well, and the School of Traditional Medicine continues to train students in this system. The School is being enlarged to serve the needs of practical training and provide treatment facilities. Following a tripartite review of the two projects being executed by WHO - Development of Health Services, funded by UNDP, and Development and Strengthening of Maternal and Child Health and Family Planning Services, funded by UNFPA - held in June 1981, a plan of action was chalked out for the near future, and it was agreed that a meeting of all the agencies active in the health sector would be called to ensure optimization of inputs from the agencies and to avoid overlapping. During the period under review, WHO provided assistance in tuberculosis and malaria control and in the preparation of curricula for the training courses to be held at the Family Welfare Training Centre. Fellowships were awarded for basic nursing, in public health administration and in health education. Equipment was procured for Thimphu General Hospital and some zonal hospitals and for basic health units. Under the UNFPA-funded project, the Government is proceeding with the construction of the family welfare training centre and three basic health units. Other agencies of the United Nations system that are active in health and related sectors in Bhutan are: UNICEF, UNDP, FA0 and WPF. In addition, a number of voluntary agencies and the Government of India are involved. Number and Source of Funds Projects in Operation Title - BHU SPM 001 Development of Health Services UNDP BHU MCH 001 Development and Strengthening of MCH and FP Services FP 3. BURMA In Burma, the country health programming (CHP) methodology has been used as a mechanism for national health planning. The second CHP cycle was started in July 1980 in preparation for formulat- ing the People's Health Programme for 1982-86. The programming phase ended with the identification of five broad programme areas and areas of health strategy in which cornunity involvement and intersectoral coordination are prominent, and of which health services research and health information services are essential components. This phase was followed by detailed project formulation and the develop- ment of monitoring and evaluation procedures. The current People's Health Programe (1978-82) has been implemented in a phased manner since April 1978 by increasing the number of townships to be covered every year. The country profile and profiles for individual programmes have been prepared and are regularly updated for management purposes. In order to formulate the programme of health information services and systems the existing health statistics activities have been reoriented, in line with the information needs of the People's Health Programme. The Government has devised a built-in monitoring and evaluation system based on the guidelines evolved by WHO for progrannne evaluation. Primary health care and basic health services are at the centre of health develoment efforts, the main emphasis being laid on the extension of coverage by primary health care at the grass-roots level. Important developnents in this regard are the conversion of workers in vertical campaigns into multipurpose basic health staff, and the utilization and deployment of voluntary health workers. The training programme for CHWs was supported by WHO, and received kits from UNICEF and US AID. Traditional systems of medicine are being integrated into the primary health care programme and community health workers are being trained in the use of these systems as part of their basic training. The Institute of Traditional Medicine, Mandalay, conducts a three-year course with 50 new enrolments a year. Two traditional medicine hospitals and 79 traditional medicine dispensaries are expected to be in operation by 1981. In regard to medical care, efforts continued to extend health facilities in order to provide referral services for primary health care. Training courses for specialists and general medical officers in clinical manage- ment skills were conducted. In the field of rehabilitation, a new UNDP-funded project, "Training and Rehabilitation of the Disabled", is being developed for implementation during 1981. The family health care programme, with emphasis on maternal and child health and nutrition, continued to expand, 2880 voluntary auxiliary midwives having been trained and placed in position as of April 1981. A pilot project for training traditional birth attendants has been completed, and plans are being developed to expand it into a national programme. The water supply and sanitation activities of the environmental health programme include a deep tube-ell programme. Out of a target of 3000 tubwells, 1160 were completed as of 1980181. Water supplies to 11 station hospitals and 42 village schools and rural health centres (jointly) have been completed in 1980181, bringing the Third Plan totals to 47 and 94 respectively. Also, 14 000 latrines in rural and 17 000 in urban areas were completed in 1980181, bringing the total for the Third Plan to 92 700 in rural and 100 000 in urban areas. The Department of Health has completed the formulation of an environmental health programme for the next four-year period beginning in 1982183. This progr-e emphasizes the development of traditional village water sources such as wells and ponds and the provision of household latrines, mainly in rural areas. A UNDP/WHO project for a "Programme Identification Study" has been finalized for approval. A proposal for a UNDPIWHO project on low-cost technology and behavioural studies has been prepared. Preliminary activities have started for Water Decade planning as a WHOIGTZ regional project. Control activities against malaria, filariasis, dengue haemorrhagic fever and Japanese encephalitis were continued during 1980-81. Malaria remains the major public health problem, and P.falciparum is the dominant species in the country. Epidemiological surveys in relation to filariasis were extended, and case distribution, treatment and larviciding activities were intensified. Cases of dengue haemorrhagic fever were reported mainly from Rangoon. Focal space spraying and blood sampling were conducted in selected townships of Rangoon and Mandalay. The Expanded Prograame on Immunization (EPI) covered 104 tovnships as of April 1981. During 1980-81, an evaluation was carried out in 53 townships, using the standard cluster survey technique recommended by WHO. In the field of health manpower development, the training of different categories of health workers was reviewed. Manuals were published for all categories of basic health staff, and a task analysis study of health workers at the peripheral level was undertaken. The curriculum for a management training programme is being developed. The project document for a new UNDP project, "Planning and Manpower Development for Primary Health Care", is being finalized, and implementa- tion is to start during 1981. In regard to referral laboratory services, the emphasis is on upgrading and strengthening facilities at the periphery, including the training of personnel at different levels. Facilities for drug abuse control work were strengthened in selected laboratories. Plans are under way to develop food and drug legislation, inspection and infrastructure. UNDP is expected to support these activities, in addition to the ongoing food and drug control laboratory project. Activities in regard to biomedical and health systems research were carried out in support of the people's Health Programme. The research covered leprosy, malaria, DHF, Japanese encephalitis, diarrhoea1 diseases, viral hepatitis, toxaemias, nutrition and various aspects of maternal and child health. More attention is being given to intersectoral coordination and coopera- tion in the implementation of health and health-related programmes. An intersectoral seminar on integrated vector-borne diseases control in connexion with the construction of dams was conducted in April 1981, to highlight the health and environmental aspects of development projects, especially irrigation projects, and to develop guidelines for future coordinated intersectoral action. Projects in Operation Number and Source of Funds Title - BUR CHP 001 Country Health Programming R BUR RPD 001 Health Research in support of the People's Health R Programme BUR SPM 001 Hospital Services Management R BUR PHC 001 primary Health Care and Basic Health Services R BUR WKH 001 Strengthening of Health Services in Newly Industrialized R/UNDP Areas (West Bank of Irrawaddy River) BUR ATH 001 Supply System and Maintenance and Repair Workshop R for Health Equipment BUR ATH 002 Promotion of Health Laboratory Technology R BUR ATH 003 Food and Drug Quality Control Laboratory UNDP BUR MCH 004 Family Health R BUR PHB 001 R BUR ESD 003 UNDP BUR BVM 001 RIVFITF BUR EPI 001 R BUR VBC 001 RIVF BUR EHP 001 R BUR PTR 001 R BUR PTR 002 UNDP BUR HST 001 R Development of Production and Quality Control of Biological and Pharmaceutical Products Expansion of Epidemiological Surveillance in Comunity Health Services Leprosy ControlIResearch Activities Expanded Programme on Immunization Vector-borne Disease Control Environmental Health Planning and Management Development of Procedures and Staff Training Education and Training of Health Manpower Development of Health Information Services The Fourth Session of the Sixth Supreme People's Assembly of the Democratic People's Republic of Korea on 3 April 1980 adopted the Public Health Law enunciating the basic principles of health care, providing for a system of complete and universal free medical care services, the protec- tion of the health of people in accordance with the policy of prophylactic medicine, the development of Juche-based medical science and technology, the guarantee of material resources for public health work, the considera- tion of health workers as the true servants of the people, and the estab- lishment of health agencies, their direction and management. This enact- ment further gave a concrete shape to the concept of health care and paved the way for providing the most advanced system of public health services to every citizen in the country. Thus the promotion of health and the prevention of diseases through the primary health care approach in the context of "Health for All by the Year 2000" were identified as important objectives to be attained, and the health system of the country was geared to respond to this challenge by legislative and executive action. The medical care services have been further strengthened. Integration of traditional medicine with modern medical care, personalized periodic/ annual physical examination, and maintenance of health through an efficient system of medical records and follow-up, through the "section- doctor" method, and by health education and prophylaxis received greater attention in polyclinics. Health centres are being constructed in different parts, the Chang Guang Health Centre, inaugurated in Pyongyang, serving as a national model. An institute for research in indigenous medicine went into operation. A large, modern maternity home for the care of the mother and child was completed in the record time of one year and commissioned; it provides most modern facilities for advanced ante- nstal, obstetrical and gynaecological investigations, and for the treatment and health care of the new-born, including premature babies. Health and allied personnel are being trained to shoulder greater responsibilities in the delivery of primary health care, as well as specialized medical services and biomedical research. In collaboration with WHO, personnel were trained in recent advances in medicine. Emergency health services have been developed, and flying squads and ambulance services bring medical relief to workers in all parts of the country. A new 250-bed Institute for Cancer Research is under construction in Pyongyang. Ontological departments have been established in all eleven provinces, and personnel who have been trained abroad, with WHO colla- boration to manage cancer patients, are actively participating in services at central and intermediate levels. Facilities are being organized to increase the potential of the public health system for the prevention of cancer by health education and by improving the end-results through early detection and diagnosis and standardized treatment procedures. Based on an epidemiological study in Pyongyang, a school health programme has been formulated for the prevention and control of rheumatic fever, including rheumatic heart diseases. The Cardiology Institute has developed facilities for open-heart surgery and has trained cardiac surgeons to facilitate the establishment of six cardiac surgical centres in the country. Treatment of allergy receives greater attention. Specialized services in angiology, haematology, orthopaedics, neurology, ophthalmology and endocrinology were strengthened. Occupational and environmental health aspects received greater attention; the health of industrial workers is being carefully monitored and their welfare promoted through special holiday schemes for rest and recuperation in sanatoria. The development of appropriate technology in the field of pharmaceuticals, drugs and medical instruments made satisfactory progress. Supplies and equipment for physiotherapy, dental health and ophthalmology are being manufactured and made available to district hospitals and polyclinics. Special attention is being paid to the identification and scientific cultivation of oriental plants of medicinal value. Medical research on the prevention and control of public health problems receives priority consideration in the medical faculties and in special research institutes for cardiovascular diseases, cancer and indigenous medicine, and institutional facilities for the promotion of these research activities have been strengthened. In collaboration with WHO, equipment was provided for ultrasonic diagnosis, cardiac catheterization and scanning photocytometry. During 1980-81, in cooperation with WHO, 13 fellowships were awarded to physicians for training in the quality control of drugs, urology and cardiovascular diseases, as well as training in foreign languages for health personnel. Thus, WHO technical collaboration has been intensified for the development and promotion of primary health care in the context of health for all. Projects in Operation Title - KRD SPM 001 Strengthening of Medical Care Services Laboratory Sciences and Techniques KRD PHB 001 Drug Quality Control R KRD CAN 001 Cancer Control R KRD CM 001 Cardiovascular Diseases R KRD RCE 001 Environmental Health R KRD FSP 001 R Food Hygiene KRD MPM 001 Strengthening of Health Manpower Development R 5. INDIA me Government of India's Sixth Five-Year Plan (1980-1985) views health in totality, as part of the strategy of human resources development, recognizing that the problem of diseases can be successfully tackled only when such an effort is accompanied by an attack on poverty itself. The Plan therefore assigns high priority to programmes for the promotion of gainful employment, eradication of poverty and population control, and for meeting the essential basic needs of the people such as water supply, environmental sanitation, education, nutrition and maternal and child welfare. The Plan also gives high priority to primary health care and seeks to coordinate the programmes in other related sectors in its implementation. The increased requirements for financial and material resources in the health sector are proposed to be met through higher budgetary allocations. Indicators have been selected to monitor progress towards health for all. Five working groups have been set up to prepare reports on the various components of the national plan, including one on intersectoral coordi- nation. It is also proposed to set up a National Coordination Committee for "Health for Allq'under the chairmanship of the Prime Minister, with ministers in charge of the economic and social welfare sectors as members. The Minimum Needs Programme is the main instrument through which the health infrastructure in the rural areas has been expanded and further strengthened to ensure primary health care to the rural population. By the end of 1979, 5400 primary health centres and 50 000 sub-centres had been established. This programme is to be accelerated over successive plan periods to achieve by 2000 AD the target of establishing one primary health centre for every 30 000 people (20 000 in tribal and hilly areas) and one subrentre for every 5000. WHO and UNICEF continue to provide support to the rural health programme. According to the latest census figures (year 1981), India has a population of 684 million, recording a growth of 24.75 per cent since the last census in 1971. This large net addition to the population has been the result of a sharp decline in the death rate coupled with a much slower decline in the birth rate. Life expectancy has increased to 54 years for males and 53 years for females and the rate of infant mortality has come down to 127 per 1000 from 135. The crude death rate has decreased from 15.7 to 14.8 per 1000. The Family Planning Programme, which received a serious setback during 1977-78, is picking up again. It has been widely recognized that family planning cannot be the sole responsibility of a single department but of the Government as a whole. Ihe specific activities of each ministry in relation to family planning are to be identified and the responsibilities fixed. Besides assisting in the undergraduate teaching of paediatrics, maternal and child health and nutrition, WHO, through its Special Programme of Research,Development and Research Training in Human Repro- duction, is closely collaborating in the Family Planning Programme by providing support to institution-strengthening and research activities. An evaluation of the in-service training programme in XH/PP for physi- cians working in primary health centres indicated that the programme has been very useful. Four workshops on neonatology were held. Models of the undergraduate MCB/FP curriculum as well as of the remodelled paediatric curriculum for undergraduates and interns are being demons- trated at B.J. Medical College, Ahmedabad, and at the medical colleges in Trivandrum and Jabalpur. The National Institute of Health and Family Welfare received assistance in testing the teaching modules and in conducting a national workshop on health economics and planning. A basic research model for evaluating the work of primary health centres was prepared and some guidance given on the criteria on the basis of vhich research priorities might be determined. The Community Health Volunteer (CHV) Scheme has been extended to 2366 primary health centres, covering almost half the population of the country. The objective of this scheme is being extended, to have one CHV for every 1000 people. The Government has given the highest priority to the HCH component of primary health care in line with its determination to halve the maternal and infant mortality by 2000 AD. It is planned to attain this target through the expansion of service facilities and by the training and deployment of large numbers of auxiliary nurse midwives supported by trained dais at conmunity level. - The National Institute of Prosthetic and Orthotic Training, Cuttack, con- ducted a disability survey during the year. With a grant from WHO, a programme, "Training the Disabled in the Community", is being undertaken by the Kerala State Council for Child Welfare, Trivandrum. An accident analysis centre has been set up at the Lok Nayak Jaya Prakash Narayan Hospital, New Delhi, and the collection of data is in progress. A national seminar on road traffic accidents was held in November 1980 at the Maulana Azad Medical College, New Delhi, to asseas the magnitude of the problem and draw up a proposed national policy in respect of accidents. At the Public Health Laboratory, Trivandrum, vhich also functions as a regional laboratory, training in applied bacteriology techniques, quality control checks and laboratory management was given to the technical staff. Similar training was carried out for the technical staff of the regional and district public health laboratories. On a request from the Government, WHO is procuring reagents and other laboratory media for the reference centre at the All-India Institute of Medical Sciences, New Delhi, to investigate the epidemic of hepatitis in parts of the country. Integration of health education with all the subjects of the undergraduate medical curriculum is proposed. The goal is for all medical colleges to adopt a curriculum which prepares the students in the use of health educa- tion as a therapeutic and preventive technique in their dealings with patients and with the public. During 1980, the total production of iodized salt amounted to 120 000 metric tons. A. part of the reviev of the national goitre control progranme, it vas decided to examine the possibility of setting up one iodization plant each at Kalka and Pathadcot to cater to the requiremnts of the States of Hhachal Radesh, Punjab and Haryana and the Union Territory of Chandigarh. The drug industry in India is fairly well developed, and both bulk drugs and formulations are manufactured. WHO provides aaristance in the training of personnel in drug analysis and control, and supplies and equipment to drug testing laboratories. The country is self-sufficient in the production of a11 vaccine8 except those against DPT, polio and measles. Action has been taken to increase the DPT-production capacity at the Central Research Institute, Kasauli, and the Haffkine Bio-Plu~~~ceutical Corporation Ltd., Bollbay. A new unit for the production of this vaccine is being opened at the Parteur Insti- tute, Coonoor, and polio vaccine is to be produced at Haffkine, and is expected to be available by the end of 1981. The National Inatitute of C-nicable Diseases received assistance in establishing the in vitro culture of human filaria and guidance in formulating epiddological studies on filariasis. A national workshop on filariasis was organized by the Institute to review, among other things, the epidemiology of and recent advances in chmotherapy and vector control related to bancroftian and malayan filariaaia and to identify the gaps in knowledge and relevant areas for future research. A national seminar on dengue haemorrhagic fever and Japanese encephalitis was held at the School of Tropical Medicine, Calcutta. The NICD organized a threemonth training course in the epidemiology of c~unicable diseases and their control for medical officers, district and municipal health officers, etc., and also several workshops on such topics as the epidaiolagical surveillance of roonoses of public health importance and field training in epidemiological research methodology vith special reference to tropical diseases. Under the National Malaria Eradication Programe all the P.falciparum containment programme areas took active steps to increase insecticidal coverage. Areas were selected for such coverage on the basis of a thorough epidemiological analysis of data employing stratification techniques, thus enabling the States to accord prioritiem for spraying and supervision. A draft five-year plan for the Expanded Rogr- on Inmunization was prepared to ensure a balanced expansion of the activities. Folders on "Recognize the Disease" were distributed to State EPI officers to enable them to train peripheral health staff to identify the EPI diseases and report the cases to the centres. In order to collect reliable baseline data on the incidence of poliomyelitis and neonatal tetanus and to chalk out priority areas vith a high incidence of these diseases, guidelines for sample surveys were prepared in consultation with IQIR and WHO, and such surveys have been conducted or are being planned in a number of States and U~liort Territories. Since 1980, the programme of tetanus toxoid vaccination has been extended to children in the 10 to 16-year age-group. A study on the need for measles vaccination and the administrative feasibility of introducing it in the routine imunization services is under progress. A total of 2.7 million cases of leprosy had been recorded and 2.3 million cases brought under treatment as of 31 March 1981. In addition to supply- ing four tons of DDS (100 mg), and 25 motor-cycles and 12 jeeps, WHO has provided two consultants - a reconstructive surgeon and an epidemiologist- cum-leprologist - to make an on-the-spot, in-depth study of the problem of leprosy in various institutions in the country and to make pragmatic suggestions for improving the methodology of leprosy control. A national worksbon on research ?n leprosy, i~cludile immunology, microbiology and vaccine production, was held at the National Institute of Mental Health and Neurosciences, Rangalore. Out of about 600 tr:Derculosis clinics in India, 351 have been upgraded as district tuberculosis centres; 43 300 beds are now available for in- patient treatment and 17 tuberculosis training and demonstration centres provide training to medical personnel in different parts of the country. In order to make the control programme against sexually-transmitted diseases more effective and meaningful, it is proposed to make it an entirely central programme. With WHO assistance, workshops on STD were organized for junior medical officers from a number of States and Union Territories with the aim of improving working knowledge and focusing attention on the various lacunae in the control of STD. Medical officers engaged in STD work in the districts/~HCs/sub-centres/STD clinics, etc., attended these workshops. At its sixth meeting, the Central Coordination Committee of the National Programme for the Preve~tion of Visual Impairment and the Control of ':lindness, decided to review the performance of the existing 40 mobile units in the field before setting up more units. The curriculum and syllabus for the training of ophthalmic assistants were approved. Cancer control programes at rke State level include the organization of centres for early detection, diagnosis and treatment; development of cancer health education activities, including the production of a multilingual film on cancer prevention, detection and control, and the strengthening of facilities for training in and organizing exfoliative cytological services. Standardized treatment schedules, including combi- nation cancer therapy, have been drawn up. Regional cancer centres have been established in six more States; in many States, early detection centres are under development. National and state-level meetings were organized for formulating a national plan for the prevention and control of cardiovascular diseases. Group educational activities at zonal and State levels were organized to promote community-oriented prevention and control activities, including cardiac resuscitation and rehabilitation. WHO assisted the National Environmental Engineering Research Institute in making a critical review and assessment of water treatment plants in the country, including the managerial aspects. A project proposal for WHO support to the field testing of integrated water supply and wastewater utilization systems for villages has been developed and accepted. The project agreement for hydrogeological and artificial recharge studies to augment the water supply in Madras city has been signed by UNDP and the Government of India. The Government of Tamil Nadu has decided to implement the Cauvery Canal Project for meeting the water supply require- ment of the Madras Metropolitan Authority up to the year 2000. The project, "Conjunctive use of surface and ground water, including arti- ficial recharge in the Arni-Korattaliyar Basin", has been approved by the Government of India and will be executed by the United Nations Department of Technical Cooperation for Development. The Central Board for the Prevention and Control of Water Pollution, New Delhi, was advised on the treatment and disposal of distillery spent wash water, including the possible recovery of useful by-products. A national workshop on food control strategy was held early in 1981 with the assistance of WHO and FAO, to consider ways and means of protecting the consumer against health hazards and commercial exploitation, promoting the nutritional status of the population by ensuring the safety and quality of food supplies, improving food exports through more adequate food quality control and inspection procedures prior to shipment, etc. WHO has assisted in strengthening teacher training and developing teaching aids in the National Teacher Training Centre at Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry. A Regional Teacher Training Centre was established at the PGI, Chandigarh, and a workshop on educational technology was organized at this centre. The National Academy of Medical Sciences also held a one-week workshop on objective methods of assessment in higher professional examinations. With a WHO grant, a short course on orthopaedic nursing and rehabilitation was conducted at the Jawaharlal Institute of Post-graduate Medical Education and Research, Pondicherry, for staff nurses/nursing sisters engaged in teaching in medical colleges/hospitals at district level. The training programme under the Multipurpose Health Workers Scheme has been completed in 183 districts and is in progress in 142. Under the programme 8539 medical officers attached to PHCs, 3616 extension educa- tors, 25 051 health assistants and 98 888 multipurpose health workers have been given reorientation training. The revised basic training programme for multipurpose health workers (female) was developed and implemented in all basic training schools. A programme of continuing education of community health volunteers (CHV) has been launched. Manuals for CHVs, male and female MPWs and health assistants, as well as guides for the trainers of various categories of health workers, have been prepared. Training material and aids have been developed at the Gandhigram Institute of Rural Health, Madurai, and the National Institute of Health and Family Welfare, New Delhi, and supplied to various centres. The programme for various categories has been reviewed and modified; an integrated programme for medical officers assigned to PHCs also has been drawn up. The Directorate-General of Health Services has developed prototypes of health records and reports, which have been standardized. This will ensure uniformity of the health information system in primary health care throughout the country. Lay reporting classification lists have been tried in selected areas by the Central Bureau of Health Intelligence. The instruction booklet on lay reporting of health information has also been distributed by the Bureau. WHO has provided assistance in training medical records technicians at Safdarjung Hospital, New Delhi. Projects in Operation Number and Source of Funds Title - IND CHP 001 Country Health Programming R IND ISP 001 Building up of National Information System R IND RPD 001 Biomedical Research R ZND SPM 001 Health Economics and Management R IND PHC 001 Strengthening of Health Administration (Rural) including R Planning and Evaluation IND ADR 001 Medical Rehabilitation R IND ADR 002 Prevention of Disability Related to Road Traffic R Accidents IND ATH 001 Development of Medical Uses of Ionizing Radiation and R Protection Programme IND ATH 002 Promotion of Health Laboratory Services and Health R Laboratory Technology IND ATH 003 Laboratory Quality Control and Standardization R IND ATH 004 Virological Techniques R IND ATH 005 Radiation Health Protection R IND MCH 003 Strengthening of Maternal and Child Health Services R IND NUT 005 R IND HED 005 R IND MNH 002 R IND PHB 001 R IND PHB 002 R IND PHB 003 R IND ESD 001 R IND ESD 003 R IND MPD 001 R/VF IND BVM 001 R/VF/TF IND BVM 002 R/VF IND BVM 003 R IND SME 001 VF IND EPI 001 R IND PBL 001 R IND CAN 001 VF IND CAN 006 R IND CM 002 R IND ORH 002 R - 150 - Nutrition Programmes Development of National Health Education Services Mental Health Quality Control of Pharmaceuticals and Biologicals Production of Freeze-dried BCG Vaccine Technology in Vaccine Production Epidemiological Surveillance Port Health Malaria Eradication Leprosy Control Tuberculosis Control Sexually-transmitted Disease Control Programe National Smallpox Eradication Programe Expanded Programe on Immunization Prevention of Blindness Cancer Control Pilot Project, Tamil Nadu Cancer Control and Prevention Cardiovascular Disease Control Oral Health IND OND 001 R IND EHP 001 R IND BSM 005 R IND BSM 006 UNDP IND RCE 001 R IND FSP 002 R IND PTR 001 R IND EDS 001 R IND EDS 002 R IND EDS 003 R IND HST 001 R IND HST 002 R Prevention and Control of Diabetes Assistance to National Environmental Engineering Research Institute, Nagpur Community Water Supply and Sanitation Madras Metropolitan Water Supply and Sewerage Board Environmental Pollution Control Food Standards Programme Training of Basic Health Workers Medical Education and Training National Medical Library Nursing Development Strengthening of Health Statistics Services Development of Medical/Health Records in Hospitals 6. INDONESIA The goal of achieving health for all by the year 2000, to which the Indonesian Goverument is committed, is in line with Article 27 of the 1945 Constitution and the application of the five principles of Pancasila. Intensive and extensive activities were continued throughout the year to evolve strategies and plans of action for achieving the health goal through the primary health care approach and the development of the national health system. The national health system is seen as a dynamic and functional system at all levels of the health administration, and will be restructured so as to respond to community aspirations and demands, and to encourage involvement and participation. Recognizing the importance of manpower resources for achieving health for all, the Committee of Manpower Development continued its efforts to design a system based on a long-term plan, close coordination between manpower producing and consuming institutions, efficient management and a career system for all categories of health manpower. The health planning capa- bilities at the central, provincial and regency levels continued to be strengthened, with emphasis on the monitoring, control and evaluation of plan implementation. Arrangements are being made for a mid-term review of Pelita 111, and, based on the results, the formulation of Pelita IV within the framework and targets of the long-term health plan will be undertaken. The 1981 Census showed that the crude mortality rate had dropped from 18.7% in 1971 to 12.45% in 1980, with a reduction in the infant and child mortality rate and increasing trends in life expectancy. This improvement in the health situation has been the result of major efforts, including the development of a strong infrastructure of health services, implemen- tation of the PKMD operational model of primary health care, involvement of the cornunity organization at the village level and urban kampungs, improvement in social services, and expansion and development of educa- tional and agricultural infrastructures. The Government continued its efforts to strengthen integrated health services in support of primary health care, health manpower development, improvement of environmental sanitation and provision of essential drugs. The budget allocation for the Ministry of Health in Pelita I11 amounts to Rps. 667.6 million, constituting 3.1% of the total government budget as compared to 1.6% in Pelita 11. Efforts to strengthen the health care delivery infrastructure continued through the expansion of the health centre network and promotion of PKMD. The number of functioning health centres increased from 3445 in 197911980 to 3676 in 198011981. Emphasis was placed on the training of health centre staff as a functioning primary health care team; during the year, 6985 health centre staff from 1195 health centres completed their training. The Ministry of Health, in collaboration with UNICEF and WHO, made an assessment of primary health care activities related to traditional birth attendants (TBAs), village volunteers and school-teachers, and a plan of action to implement the recommendations arising out of the assessment has been prepared. To improve the monitoring and control of field activities, a model health centre reporting and recording system was developed, and 1030 health centre personnel out of the Pelita III target of 5000 were trained. A study tour was organized for eight provincial-level supervisors to observe health centre reporting and recording in countries of the Region. With WHO collaboration, work on revising and updating the Health Centre Reference Manual was continued. Emphasis is being laid on the strengthening of MCH activities in primary health care, the tr$ining of TBAs in 13 UNICEF-assisted areas, and the formulation of programmes for the remaining years of Pelita 111. In the third population project assisted by IBRD, a health component is included in order to strengthen MCH and TBA training in six provinces; WHO collabo- rated in this programme. Two surveys were conducted in Jakarta and West Java to estimate the number of handicapped children in elementary schools. Four workshops were held to review the school health programme and to draw up plans for 1980181 - 1982183 for each development region of the country. The development of a nutritional surveillance system continues. Applied nutrition programmes are being expanded, supported by both government and external resources. The integrated health nutrition-family planning pro- gramme aims at covering two thirds of all villages by the end of Pelita 111. Indonesia is participating in the research collaborative studies on nutrition in primary health care, and the Nutrition Research Centre has been designated as a WHO Collaborating Centre. Programmes for the control of protein-energy malnutrition, vitamin A deficiency, endemic goitre and anaemia continued to expand with ,WHO'S technical cooperation and assist- ance from UNICEF, as well as from bilateral and multilateral sources. Pelita 111 aims also at integrating nutritional programmes with PKMD and family planning, developing sound food and nutrition policies, increasing food production and promoting effective intersectoral coordination. The Government continued to strengthen the infrastructure of health laboratory services at the central, regional, provincial and regency levels. Training activities using the educational material developed earlier through WHO assistance are making progress. In regard to health education, which is being implemented as an integral part of health programmes, techniques to achieve community participation in support of primary health care and to strengthen health education units at the central, provincial, regency and sub-district levels are being implemented. WHO continued to assist the Government at both national and provincial levels (Irian ~a~a). The rural water supply project in Nusa Tenggara Timur and South Sulawesi lays emphasis on intensive health educa- tion efforts to achieve community participation for the extension of the programme and the operation and maintenance of water supply and sanita- tion. WHO, UNICEF, the World Bank, WFP and US AID continued to collaborate in this programme. Formulation of a drug policy and attaining self-sufficiency in the produc- tion of essential drugs are priority programmes, to which WHO, UNDP and UNICEF extended technical support. A WHO~UNDP project conducted a compre- hensive feasibility study which is expected to help attract aid from the Asian Development Bank and bilateral agencies for implementation. With WHO assistance, the ASEAN Task Force continued its efforts to implement the recommendations of the ASEAN meeting on drug policy, legislation, evaluation and quality assurance. Malaria control is accorded priority in the national strategy for HFA and in the long-term plan. Malaria operations were continued in Java and Bali, as well as in transmigration and socio-economic development areas. The special thermal fogging measures and intensified case detection and treatment, as well as surveillance activities, have resulted in the containment of malaria in several pockets of high incidence. US AID has finalized an agreement for a malaria control programme in the province of East Timor. WHO continued to play a catalytic role in attracting extra- budgetary resources from bilateral and multilateral agencies. The Expanded Programme on Irnmunization,which covered only 50 sub-districts in 1976,now operates in 1661 sub-districts. Bio Farma's production of vaccines meets the needs of the BCG, DPT and TT programmes, although polio and measles vaccines are being imported. An assessment of the EPI national coverage indicated that the overall coverage was 63% for BCG and DPTl and 55.3% for DPT2. A health information sub-system was designed, to provide basic data on EPI activities and data to monitor the production and distribution of vaccine to the provinces. The training material for the mid-level supervisors' course was translated and material for health education and disease recognition, prepared by WHO, is being printed by WHO Headquarters. A manual on immunization was also printed for distri- bution to health centres. A study on the immunologic response to three doses as compared to two doses of DPT was completed. A case control study of BCG vaccination in childhood is being designed with support from WHO, UNICEF and US AID. The National Leprosy Training Centre in Ujung Pandang continued the train- ing and refresher training of medical officers and other health personnel. About 450 persons have been trained and, in turn, have given training to more than 17 500 health centre personnel. Random surveys in the provinces of Nusa Tenggara Timur and South Sulawesi were completed, showing preva- lence rates of 3.9 and 4.2 per 1000, respectively. Preparatory activities and/or implementation of random surveys in the provinces of North Sumatra, South Kalimantan, South-East Sulawesi and West Nusa Tenggara are in pro- gress. Leprosaria patients in the provinces of North and Central Sulawesi and Maluku have been screened with the aim of integrating the services of these institutions into the community. WHO technical cooperation was provided for strengthening the epidemio- logical surveillance system at all levels and for improving the entomo- logical services for vector-borne diseases. Assistance to the national tuberculosis control programme was also continued. The national diarrhoea1 disease programme, which continued to expand, is based on educational efforts and on making ORS packets available at low cost at the PHC level. WHO and UNICEF provided assistance for increasing the national production of ORS. A proposal for the establishment of a Regional Training Centre in Diarrhoea1 Diseases in Indonesia is being finalized. An M.Sc. course in epidemiology with emphasis on epidemiological field practice is being designed. The M.Sc. course in medical entomology conti- nued to receive WHO support. The national programmes for the control of yaws and STD also received WHO assistance. The Organization provided consultant support in the fields of cancer, the epidemiology of cardiovascular diseases and radiological health to review the national programme. 'Ihe mental health programme aims at integrating mental health services in the health centres and general hospitals and promoting community mental health in its promotive, preventive, curative and rehabilitative aspects. A case study on child mental health was completed. A WHO Collaborating Centre for Training and Research in Mental Health has been established at the Directorate of Mental Health. The national dental health programme continued to receive WHO technical cooperation. The Government accords high priority to water supply and sanitation projects and considers environmental health as a key element for achieving HFA goals. INPRES national funds continued to be made available to expand water supply and sanitation coverage in rural areas. WHO supported the Directorate of Rural Water Supply and Sanitation, Ministry of Health, and CIPTA KARYA in developing plans for HFA, IDWSSD, medium-term (Pelita) and annual plans. Other fields of assistance included the training of environmental health manpower, development of environ- mental pollution control programmes, food sanitation and sanitation of public places, preparation of designs for rural water supply and latrine progranrmes,and the training of national consulting firms in pre-investment planning and feasibility studies to achieve self-reliance. The national programme also continued to receive considerable support from WHO, UNDP, UNICEF, IBRD, AsDB, US AID, GTZ as well as Japanese, Dutch, Swedish, Swiss, French, Belgian and Australian agencies. A long-term plan for health manpower is being formulated to achieve the national strategy for HFA through the national health system. A Minis- terial Decree was issued for the reorganization of the educational aystem for various categories of manpower. A two-year MPH course at the Faculty of Public Health has been formulated and is scheduled to start in July 1981. Recognizing the importance of post-graduate training, the Ministries of Health and Education are proposing the establishment of new faculties of public health, the first in Surabaya, to be followed by two other faculties in Ujung Pandang and Medan. A proposal for establishing a university-level Faculty of Nursing at the University of Indonesia is under consideration. WHO is playing a catalytic role with US AID, the Ford Foundation and GTZ for providing assistance to the Faculty of Public Health. Also, consultants were assigned to revise the curricula in oral health and in environmental health. Technical cooperation with the Consortium of Medical Sciences was continued. Workshops were held on core curriculum development, develop- ment of community-oriented medical education, creation of teacher training centres in medical and dental faculties, and curriculum development in basic medical sciences and clinical specialties. A team of nurses continued to assist the Centre of Education and Training and the province of Irian Jaya in nursing education. The number of health nurse (PK) schools was increased from 66 in 1980 to 94 in 1981 through the conversion of earlier model schools. Consultants on tools for educa- tional evaluation, hospital nursing legislation and registration were assigned. Two newly constructed and properly equipped nursing training centres in Jakarta and Ujung Pandang were completed and funded by JICA. The national project also receives assistance from UNDP, IBRD and the Government of the Netherlands. Pelita 111 gives priority to strengthening the capabilities of the National ~nstitute of Health Research and Development and its six research centres. The Institute received assistance in completing a needs assess- ment study, in evaluating research projects, to develop inventories of research activities and identify areas for collaborative studies in the universities, and in conducting group educational activities on research methodology. The national health information system is being developed in a phased manner. WHO continued its technical cooperation for developing an inte- grated information sub-system within the Directorate General of Medical Care. A hospital record and reporting system integrating laboratory reports and activities is being designed. Projects in Operation Number and Source of Funds Title - IN0 CHP 001 Country Health Programming R IN0 RPD 001 Strengthening of Health Research and Development R Capabilities IN0 SPM 001 Health Services Development R IN0 SPM 002 Health Care Delivery in the Context of Primary Health R Care IN0 SPM 003 Strengthening of Health Services (province of Irian LMDP Jaya) IN0 ATH 001 Laboratory Services Development R IN0 MCH 003 Medical Servicee for Family Health R IN0 NUT 003 Nutrition R IN0 HED 001 Health Education R IN0 MNH 001 strengthening of Mental Health Services R IN0 PHB 001 Quality Control of Food and Drugs R IN0 ESD 003 R Strengthening of Epidemiological Surveillance and Control ? IN0 MPD 001 R Malaria Control Programme IN0 BVM 001 R/TF Control of Bacterial and Intestinal Diseases IN0 BVM 002 VF Leprosy Control IN0 BVM 003 VF Campaign for Control of Yaws in Sub-District of North Morotai IN0 EPI 001 R Expanded Programme on Immunization IN0 ORH 001 R Dental Health Services Development IN0 EHP 001 R Environmental Health Planning and Management IN0 BSM 003 UNDP Rural Water Supply for East Java Province IN0 BSM 004 VF Rural Water Supply for Central Java Province IN0 BSM 005 UNDP Rural Water Supply, Nusa Tenggara Timur (NTT) IN0 FSP 001 R Food Safety IN0 MPM 001 R Education and Training for Manpower Planning and Management IN0 PTR 001 R Post-graduate Medical Education in Public Health IN0 PTR 002 R Nursing Education and Services IN0 PTR 003 UNDP Nursing Manpower Development IN0 PTR 004 UNDP Training in Pre-Investment Planning in Community Water Supply Undergraduate Medical Education IN0 EDS 001 R IN0 HST 001 R Strengthening of Hospital Statistics 7. MALDIVES In the Maldivian context, the social goal of health for all includes, inter alia the provision of drinking water and basic sanitary facilities, - -$ comprehensive mother and child care, basic health education for all the people, immunization, a regular supply of essential drugs and herbs for both modern and traditional systems, a health infrastructure for the delivery of basic health services and the control of endemic diseases. A national health plan to achieve the objectives of health for all has been finalized and approved by the President. The Charter for Health Development,the main concern of which is to enhance the quality of life of people through improvements in health, was signed by the Government of Maldives in September 1980. The Government has allocated six per cent of the national budget for the health sector. In pursuance of the Gpvernment's policy, the Ministry of Health, through the national health services, is extending the basic health services. Minimum curative facilities are provided by the hospitals and health centres. A systematic programme for training health manpower is being implemented through the collaboration of United Nations agencies and with bilateral support. WHO has been assisting in the development of compre- hensive health services, including the training of paramedical and auxiliary health personnel. In addition, WHO teams consisting of specia- lists in general surgery, gynaecology, ENT and anaesthesiology assisted by examining and treating large numbers of patients and by training national staff. The Government is proposing to open four regional hospi- tals - an effort which both UNICEF and the International Human Assistance Programme are expected to support. The Government also plans to upgrade the hospital laboratory in Male to function as a public health laboratory. Case-finding surveys for leprosy and tuberculosis, case-holding and treat- ment, and examination of household contacts during supervisory visits were continued. Community health workers supervised the treatment in the atolls. Immunizations with DPT and BCG vaccines are being carried out. The leprosy and tuberculosis programme is expected to be supported by the Damien Foundation. Under the national health plan the Ministry of Health is taking action to eradicate malaria within two to three years. Additional inputs are expected to be channelled to this programme so as to interrupt malaria transmission completely by 1985. The Allied Health Services Training Centre continues to train middle and peripheral-level health workers. Two United Nations Volunteers - a public health nutritionist and a public health nurse - joined the Centre during the year. WHO supports the Centre through the assignment of a long-term public health nurse educator. Three groups of family health workers have been trained, and ten community health workers are undergoing training at present. A group of ten nurse-aides is also under training and ten foolumas (traditional birth attendants) have completed the training. Four workshops for health personnel were conducted. With WHO support curricula for various courses are being developed to suit the present needs. Needs for manpower for health development have also been investigated and reports prepared with WHO'S assistance. A national plan for water supply and sanitation to cover all the inhabited islands has been prepared. After necessary review and modification, if necessary, the plan will be sent to UNDP for its assistance in approaching donor countries/organizations to assist with implementation. The United Nations Capital Development Fund project providing for the construction of latrines in Male and 30 other selected islands has been taken up for execution, and materials are being procured. Two United Nations Volunteers have been appointed by UNDP to supervise the work. In order to prevent the recurrence of diarrhoea1 diseases, chlorination of all drinking water wells in the country is being continued with bleaching powder supplied by UNICEF. The work on constructing rain-water tanks and community latrines has been completed in two islands, and is in progress in four others. Projects in Operation Number and Source of Funds Title - MAV SPM 001 Public Health Administration R/ VF MAV MPD 001 Malaria Control R MAV BVM 001 Leprosy and Tuberculosis Programme R/VF/TF MAV BSM 001 Water Supply and Sanitation R MAV BSM 002 Water Supply and Sewerage for Male UNDP MAV PTR 001 Training of Auxiliary Health Personnel R/UNDP MAV PTR 002 Fellowships (Medical Education) UNDP MAV PTR 003 Fellowships (Medical Education - Noncommunicable UNDP Diseases Prevention and Control) 8. MONGOLIA The Government of Mongolia, during the year, signed the Charter for Health Development and has formulated HFA strategies. Such a formulation has stimulated greater efforts towards specifying the health objectives and reviewing the existing strategies. The new Five-Year (1981-86) Health Plan reflects the newly formulated strategies. It lays stress on the expansion and strengthening of out- patient primary health care and the accessibility of specialized referral services to the rural population. A mechanism for intersectoral coordina- tion exists. The Planning Unit of the Ministry of Public Health is striving to bring about a better balance between centralized and decentralized planning and programming by transferring to the provincial health directorates more responsibilities in the development of detailed programmes and projects. Two courses and two seminars were attended by 110 public health adminis- trators and health statisticians, and a national workshop on detailed health programming and project formulation is scheduled for the second half of 1981. A plan of work has been formulated for the establishment of a computerized information system, and steps are being taken to utilize the services of a statistical project under UNFPA to establish this system. Efforts to arrive at a clearer determination of the health problems have continued. The national sample survey of morbidity is still going on; similar sample surveys for psychiatric and cardiovascular morbidity have been completed, as have also studies of infant and maternal mortality and morbidity. Standard architectural designs for health institutions, including designs for inter-somon and somon health centres, have been prepared by a group of architects under the guidance of a WHO hospital architect. Family health has,for a number of years, been the largest cooperative programme and has received continuous support from WHO, UNICEF and UNFPA. Apart from the epidemiological studies on population already completed, six new studies have been planned and the respective research protocols prepared with the assistance of a WHO consultant. Two courses on the "Epidemiology of Population Growth" have been held for 85 obstetricians and paediatricians and two on the prevention and diagnosis of respiratory diseases with 26 participants have been conducted. In six aimaks, work has started on the development of MCH centres and the establishment of paediatric intensive care units and mobile MCH teams. The model MCH centres established earlier in Ulan Bator under the same programme have given encouraging results in the areas which they serve; the infant morta- lity rate has dropped by 50% in comparison with the rates of previous years in the same areas. Further in-depth evaluation is, however,necessary before final conclusions can be drawn as to the effectiveness of this part of the programme. Extensive KAP (knowledge, attitude and practices) studies with teachers, parents and school children have been carried out. Based on the results, a new family health education programme has been formulated for experi- mental use. Several booklets have been compiled to guide the teachers in the implementation of the programme, and a draft of the book, "Healthy Family", has been prepared. The programme for the training of health personnel continued to lay emphasis on developing the pedagogical skills of teachers of health professionals. Seminars on the "Organization and Evaluation of Students' Field Practice", and "Education Science for Health Professional Teachers", and two workshops, on "Health Education in Medical Education Curricula" and "Preventive Aspects of Health Care in the Curricula of the Health Professionals' Education Institute" were conducted. A medical teacher has been awarded a one-year fellowship to study educational science for health professionals,and is expected to head this unit on his return to Mongolia. WHO has provided a consultant on the further development of the Central Research Laboratory (which is already reasonably well equipped) , who advised on plans for the library of the Medical Institute to function as a National Health Science Library, with a network of institutions at aimak level, and is collaborating in the implementation of post-basic training programmes for health personnel. The epidemiological surveillance services have been further supported, and a new programme for the control of hepatitis during the period 1981-85 has been formulated. The Expanded Programme on Immunization is continuing successfully. A unit responsible for operating the cold chain system has been established. A national coordinating group for the control of intra-hospital infections has been established, a one-week course on the control of such infections being held during the year. The regular registration of grippe cases continues. A seminar on the prevention of influenza was held in Ulan Bator for 127 participants. A three-day seminar was held on the prevention of intestinal infections, and a coordinating group for the control of intestinal diseases is soon to be organized. The study of environmental health problems and the effectiveness of the existing sewage purification plants continues. A work plan for close co- operation between the Ministries of Public Health and Water Economy in the context of the WHO cooperative programme has been adopted; it includes a proposal for the investigation of tertiary sewage treatment and reuse of the treated water. Assistance was given in experimenting on a new method of fermentation for the bacteriological examination of water in several aimak laboratories and in introducing disinfection methods in the water distribution points. A seminar on sanitary engineering and also a two- month course were given. Aimak laboratories and the laboratory at the Institute of Hygiene have been strengthened with supplies and equipment, enabling them to undertake adequate examinations of water. The programme for the control of noncommunicable diseases made good pro- gress. A WHO consultant's recent finding that there was a high percentage of streptococcal carriers among school children has led to the establish- ment of a coordinating group for the control of rheumatic fever. The screening for heart diseases continues, and guidelines for the treatment of hypertension and ischaemic heart disease have been prepared and distri- buted among physicians. A seminar on the primary prevention of noncommuni- cable diseases was organized. Epidemiological studies of cancer and chronic liver diseases have conti- nued. A national conference on chronic liver diseases was held for 80 physicians. The construction of the Cancer Research Institute is making headway. A five-year programme for the control of noncommunicable diseases with an integrated approach is under preparation. The epidemiological study of mental diseases covering a population of 150 000 has been completed. An advanced course in psychiatry was organized for 13 physicians. The expansion of mental health services continued, with the opening of new inter-aimak dispensaries, an increase in the capacity of rehabilitation centres, and the strengthening of referral services in logopedology, forensic psychiatry and clinical psychiatry. Drug quality control laboratories have been supported in order to be able to introduce several new methods of investigation. A ten-day seminar on the organization and management of drug supply and distribution was held, attended by heads of city and aimak pharmacies. The work on establishing an independent system of drug quality control is continuing. Projects in Operation Number and Source of Funds Title - MOG CHP 001 Country Health Programming R MCG SPM 001 Management of Health Services R MCG MCH 002 Maternal and Child Health R MCG MCH 003 Epidemiological Studies of Population Growth FP Ma: MNH 002 Mental Health Services R ME PHB 001 Pharmaceuticals and Biologicals - Control and Production R MCG PHB 002 Brucella Vaccine Production UNDP - 163 - MOG ESD 002 Communicable Diseases - Prevention and Control R/ VF MOG OND 001 Noncomunicable Diseases - Prevention and Control R MOG EHP 001 Strengthening of Environmental Health Services R MOG PTR 001 Health Manpower Development R/UNDP 9. NEPAL Nepal is now in the first year of the period covered by its Sixth Plan (1980-1985), which was approved at the tenth meeting of the National Development Council, chaired by His Majesty the King. The Sixth Plan was prepared by the National Planning Commission based on the fundamental principles of speeding up production, increasing employment opportunities and meeting the basic minimum needs of the people. The Plan consists of central and district-level development programmes, to be implemented by the newly-formed Ministry for Local Development in coordination with other ministries. The concept of health for all is basically the same as one of the funda- mental principles of Nepal's Sixth Plan, i.e., to meet the basic minimum needs of the people. The Government reaffirmed its adherence to this principle by signing the Charter for Health Development in August 1980. The National Steering Committee for HFA/2000 Basic Minimum Needs met in Kathmandu in March 1981 to revise the HFA document prepared in November 1979. It was proposed to add cottage industry and forests to the original five sectors involved in HFA, namely, health, primary and adult education, food and agriculture,water supply and sanitation and basic communications. A series of studies in relation to HFA is being carried out, on population projection (completed),on manpower requirements, physical infrastructure and logistics support. The HMG/WHO Management Group, created in November 1979, has been promoting activities pertaining to HFA, strengthening the implementation and manage- ment of health programmes and providing special field supervision. A sub- committee appointed by the Group is being formed to coordinate health research activities. The first draft of the country programme for Nepal for the period July 1980 - December 1985, prepared by the Joint Programming of the United Nations Resources (JPR) group, was completed in June 1981. A national workshop on the development of health planning procedures and health information systems at district level revised the format of the district health profile. Steps are being taken towards the further development of the Health Data Bank. Together with the Integrated Community Health Project (ICHP), the Health Planning Unit has developed a study protocol on "lay reporting of morbidity and mortality". A multisectoral community and Integrated Health Services Development Board has been formed to facilitate the integration of health services and the development of primary health care, the immediate priority being given to the 23 integrated districts. The community health leaders scheme, utiliz- ing ward-level health volunteers, will be implemented as planned in 13 districts during the Sixth Plan, and will start later in 1981 as soon as the manual is printed. As for group educational activities, a district management workshop for integrated health services and a workshop on the role of the public health nurse in community and family health were held in Kathmandu. Apart from WHO'S inputs, UNFPA has approved three projects in support of the Integrated Community Health Project. UNICEF and US AID are also continuing their support to the project. The "Primary Health Support Services Programme", with four components - the training of community health volunteers, central and local production of traditional drugs, the logistic system for drugs and supplies, and the increased production of essential drugs at the Royal Drugs Limited - made progress. In relation to the International Year of Disabled Persons (19811, WHO has collaborated with the Government in the Nepal disability survey, in the establishment of a research cell and documentation,and in public education for community awareness. There are 49 fully operational district laboratories in the country, and training programmes for laboratory technicians, laboratory assistants and microscopists are making progress. Nepal will be participating in a field operational study for the establishment of health laboratory technology at the peripheral level, as a supportive service to primary health care. The FP/MCH project is satisfactorily meeting its planned targets for service delivery, and its activities have been integrated into the basic health services in all 23 districts of the Integrated Community Health Project. With the support of UNFPA, a study was carried out on the feasibility of utilizing dhami-jhankris (faith healers) in forming a communication network to reach the rural population with credible and comprehensive messages about health and family planning. Workshops for medical officers and district family planning supervisors were conducted. Apart from WHO'S inputs, UNFPA, UNICEF and US AID are continuing their assistance to the FP/MCH project. In regard to nutrition, activities such as the detailed work plan for the Nutrition Unit during the Sixth Plan period, evaluation of the progress of nutrition promotion using the multisectoral approach in Makwanpur and Newalparasi Districts, and planning for the extension of this approach to Dhankuta and Banke Districts,were undertaken. A workshop on the management of malnourished cases was organized for medical officers. The distribution of iodized salt for the prevention of goitre and cretinism is proceeding according to plan. The programme for the injection of iodized oil, jointly supported by UNICEF and WHO, is now in operation in six districts. WHO is participating in a UNICEF-funded Government project on a xerophthalmia survey for vitamin A deficiency among children in ten districts. The Government and United Nations agencies such as UNDP, FAO, WFP, UNICEF and WHO are developing an intersectoral action programme for rural children and their families. To encourage wider dissemination of health education, the Health Education Section of the Department of Health Services has conducted a series of health education training workshops for educational supervisors and subsequently school teachers, in collaboration with the Curriculum Text- book and Supervision Department Centre of the Ministry of Education. Epidemiological surveillance activities are gaining momentum. WHO colla- borated with the Government in project formulation, in an epidemiological survey of communicable diseases, in the development of a lay reporting system and in the use of epidemiology in primary health care. A surveil- lance system for communicable diseases and virus encephalitis surveillance and control were supported. The level of malaria incidence during 1980 remained about the same as in 1979. Cases imported from abroad accounted for 26.5% of all cases; 19.6% of these were P.falciparum, which constituted 74% of total falciparum infections in the country; a number of the imported Pf. cases were sus- pected to be resistant to 4-aminoquinolines. All three cycles of spraying were carried out in 1980 - some areas of the Western and Central Regions with malathion and the rest with DDT. Surveillance and research activities are being continued, and efforts are being made to secure community involvement through health education activities. About 33% of the total population of the country has so far been covered by the National Leprosy Control Project. Control activities in the Western and FarWestern Regions are carried out by the organization,"International Nepal Fellowship", with the guidance of the central office of the national project, which is directly responsible for the activities in the Eastern and Central Regions. The Netherlands Leprosy Relief Association is also assisting the project in various parts of the country. Plans were drawn up for the intensification of control activities through community parti- cipation and the introduction of the multidrug regimen of treatment in Bara and Parsa Districts. A Leprosy Services Development Board was formed in August 1980 to strengthen the national programme. Under the Tuberculosis Control Project, during the period from mid-July 1980 to mid-January 1981, seven districts were covered by BCG vaccination. The Second National Tuberculosis Seminar was held in Biratnagar in November, and a Regional Workshop on Tuberculosis at Pokhara in November- December, both supported by WHO. The Expanded Programme on Immunization is now operating in 24 districts, and the Integrated Community Health Project in nine districts. The Family Planning and MCH Project and voluntary associations are also giving immu- nizations. DPT and BCG immunizations are given to children and tetanus toxoid to women of child-bearing age; measles and polio vaccines are available at present only in the larger hospitals. In September 1980, an EPI project, to be implemented with UNICEF assistance during the Sixth Plan, was formulated with the help of WHO. The epidemiological survey for blindness is progressing satisfactorily. Eye centres are to be established in Nepalganj and hangarh hi during September 1981, and the existing eye centre in Butwal will be streng- thened. Also, ophthalmic assistants and other ophthalmic personnel receive training mainly through fellowships abroad, and basic health service staff will be given in-service training in the prevention and treatment of eye diseases, in surveillance and in the reporting system. The programme receives funds from the Dutch Government; support from other agencies, such as the Swiss Red Cross, the 'Save the Child' organization of Sweden and NORAD, is also expected. The Zoonotic Diseases Control Section, within the Department of Health, is collaborating with the Epidemiological Division in virus encephalitis surveillance and control. The Mrigendra Medical Trust, in collaboration with the National Council for Science and Technology, is conducting a research programme on cor pulmonale. The Ministry of Local Development and the Department of Water Supply and Sewerage continued to construct rural water supply schemes. Ninety-five surveys and designs have been completed and training programmes for workers such as overseers and water supply technicians have continued. The Decade Plan for 1981-1990 has been revised and approved by the sector agencies. Three project proposals for the construction of water supply schemes in different areas of the country, as well as one proposal for the training of manpower, to be financed through external sources, have been prepared. At the Institute of Medicine, Tribhuvan University, which continued to be the main institution for health manpower training. WHO has collaborated with the Teacher Training Cell in curriculum development, evaluation and improvement of teaching methodology. A number of workshops are being organized for the instructors in the Institute. A survey to assess the needs of the teachers for teacher training is also under way. A post-basic community nursing course was started in March 1981. The teaching of clinical anatomy and clinical pharmacology was strengthened through the provision of learning materials and by revising the curriculum. Projects in Operation Number and Source of Funds Title - NEP CHP 001 Country Health Programing R NEP RPD 001 Research Promotion and Development R NEP SPM 001 Health Planning and Programing R NEP SPM 002 Development of Health Services VF NEP SPM 003 Strengthening of Integrated Connrmnity Health Project in FP the Ministry of Health at the Central Level NEP PHC 001 Community Health Services and Primary Health Care R Development NEP PHC 002 Primary Health Support Services Programme UNDP NEP ATH 001 Development of Laboratory Technology Services R NEP MCH 001 Family Health Aspects of Integrated Health Service FP Siraha and Saptari Districts NEP MCH 003 Development of Maternal and Child Health Services R NEP MCH 004 Assistance to FP/MCH Project FP NEP NUT 003 R/ VF Nutrition NEP HED 001 F NEP ESD 001 R NEP MPD 001 R/ VF NEP BVM 001 R/VF/TF NEP BVM 002 R NEP EPI 001 R NEP PBL 001 R/VF NEP BSM 001 R NEP PTR 001 R NEP PTR 002 UNDP NEP PTR 003 FP NEP PTR 004 FP Health Education Development of Epidemiological Surveillance Malaria Control Leprosy Control Tuberculosis Control Expanded Programme on Immunization Prevention of Blindness Community Water Supply and Sanitation Training of Health Manpower Institute of Medicine (Teaching Hospital) Strengthening of Health Manpower Training of Integrated Community Health Project Family Health and Family Planning Teaching, Services and Research 10. SRI LANKA The infrastructure for national health development consists of the National Health Council, the National Health Development Couunittee and its six standing committees. To support the national health development network further and to ensure overall community participation, the Govern- ment has decided to establish health development committees at district, divisional and village levels. The National Health Council has formulated policies and primary health care strategies as well as health development goals, objectives and plans for intersectoral action for the achievement of HFA. The National Health Development Committee has drawn up a primary health care programme which envisages the reorganization and expansion of the infrastructure of health facilities to make them more accessible to the total population. Health programmes are being restructured to have a greater impact on health problems. WHO has been giving support to these activities of the Conunittee. Preliminary figures from the 1981 Census show a population of 14.9 million and an average annual growth rate of 1.7% during the decade 1971 - 1981. This achievement supplements the health picture of Sri Lanka, which conti- nues to remain impressive. The Government's commitments to health develop- ment are reflected in the increase in the total expenditure estimates of 19.0% from 1980 to 1981. The Health Ministry's per capita expenditure estimates for health were Rs.58 in 1980 and Rs.68 in 1981. The Government has issued a "White Paper on the re-organization of the Ministry of Health" which envisages the establishment of four teaching hospital authorities and nine provincial health authorities with broad powers and functions and a considerable degree of autonomy. A national seminar on health services research was held in February 1981 to identify national priorities in this regard, and the recommendations of the seminar are expected to result in the preparation of a comprehen- sive work-plan. An action-curresearch programme in nutrition has been formulated, and three projects have been started: (1) situation analysis of the current status with regard to the content and implementation of the nutrition component of PHC; (2) identification of practical problems in promoting the acceptability of lorcost weaning foods among poor rural conmunities, and (3) development and evaluation of a single procedure for food and nutritional surveillance for the identification of mothers and children at risk. WHO has provided support to the Food and Nutrition Policy Plan- ning Division of the Ministry of Plan Implementation in undertaking these projects. The Government strongly supports WHO'S proposal on the code of marketing for infant foods. Restrictions have been placed on the advertising of milk for babies. In collaboration with WHO, the Government organized an international seminar to promote breast-feeding. The Ministry of Indigenous Medicine has completed a detailed project for the development of traditional medicine, including the identification, planting and preservation of medicinal trees; training of traditional practitioners, and modernization of the Ayurvedic Drugs Corporation to promote efficient production. A country-wide survey of electro-medical equipment has been undertaken to identify problems of equipment management in the field. A plan for the establishment of four decentralized units in order to make maintenance facilities more accessible at the periphery has been approved. Also, a protocol has been prepared for strengthening laboratory services at peripheral, district and central levels to support primary health care and to ensure necessary reference facilities. A national committee for the observance of the International Year of Dis- abled Persons has been constituted and a survey of disabled persons in the Kurunegala area conducted. WHO has assisted the family health programme by supporting a scheme for the expansion of facilities available for hospital-based family planning services; such facilities are being established at selected district hospitals. At the same time, an intensive training programme in sterili- zation and the delivery of family health services at district hospitals is being run for doctors and para-professional staff. With support from WHO, a manual for use by the family health worker has been published by the Family Health Bureau of the Ministry of Health. In the field of health education, a village health volunteer programme conforming to the indigenous methodology in community programmes has been in operation for about four years and is showing very promising results. The health education activities, which are need-based, are carried out by these village-level volunteers, who are trained and guided by the health workers. A project proposal for the manufacture of essential drugs for primary health care has been submitted to the Asian Development Bank for assist- ance. Other components of the praject, including the development of the necessary cadre of personnel in pharmacy and drug utilization studies, will be supported by WHO. As part of its long-term drug management policies, the Government plans to organize regular diploma courses in pharmacy. Regulations are being drawn up to control the manufacture, distribution and sale of drugs and to ensure safe food handling. WHO is assisting in the revitalization of the quality assessment laboratory established with support from the Government of Japan. In the field of mental health, WHO provided consultants on the organiza- tion and management of the two mental hospitals and the development of ambulatory care, including day care and rehabilitation services for the mentally ill. WHO has also assisted the Medical Research Institute, Colombo, in develop- ing and strengthening its capability for the epidemiological surveillance of comnicable diseases as well as the development of a surveillance programme for arboviruses, especially dengue and Japanese encephalitis. Epidemiological services have been further strengthened by decentralizing the activities and improving service capabilities at both the centre and the periphery. The malaria control programme continued to make progress. Epidemiological and entomological findings have revealed that malathion spraying continues to be effective in controlling the spread of the disease. The WHOIUNDP vector control programme continues to achieve results as planned. A tripartite review meeting was held in November 1980. Under the Expanded Programme on Immunization, which is ~rogressing aatis- factorily, the cold chain at the periphery has been strengthened, and vaccine carriers have been issued. A mobile maintenance unit for servicing and repairing EPI refrigerators/freezers is being established. The pro- gramme has also been started in the estate sector. Estate superintendents and estate medical assistants were given training with assistance from UNICEF. With WHO collaboration, the Government has formulated a rabies control programme aimed at eradicating the disease in five years and is seeking financial assistance from bilateral agencies for this purpose. A diar- rhoeal diseases programme also has been formulated, for which the manu- facture of oral rehydration salts is expected to be funded by UNICEF, with other components being supported through the WHO programme on diarrhoea1 diseases. In regard to the prevention of blindness, two mobile ophthalmic units have been provided, and the mobile ophthalmic camps organized in the rural areas have been carrying out cataract operations. With WHO collaboration, a curriculum for the training of ophthalmic auxiliaries has been developed, planning for the training of health and allied community personnel in community-oriented public health ophthalmology undertaken, and a national plan drawn up. The National Advisory and Coordinating Body for the Control of Cancer has made considerable progress in developing a national strategy and a plan of action. Projects for the establishment of a cancer registry, early detection, diagnosis and treatment, rehabilitation of cancer patients, cancer education and training have been formulated. With WHO support, a national plan for preventive dental health care has been developed. An island-wide epidemiological survey of the state of dental health, a caries prevention fluoride programme in school dental health services, and workshops for dental and medical personnel and primary health care workers were among the major activities organized in the field of dental health. The national plan for the International Drinking Water Supply and Sani- tation Decade was finalized and forwarded to international and bilateral agencies interested in the development of this sector. Institutional support to the National Water Supply and Drainage Board continues to be provided through a UNDP-funded project. Significant progress has been made in providing on-the-job training to junior design engineers and other technical staff, and bringing about improvements in the general capabilities of the Board to design water supply schemes. The public health engineering programmes at the Universities of Peradeniya and Moratuwa received WHO support in developing and teaching core and optional courses, in laboratory development, and in teaching undergraduate students to conduct basic laboratory analyses for water and wastewater. Training programmes have been expanded to increase the output of medical officers, assistant medical practitioners and nurses, and a crash pro- gramme for the training of 2600 family health workers has been introduced. The UNDP-funded United Nations Volunteer Programme is providing medical doctors to Sri Lanka. The Health Planning Unit carried out a study on health manpower, the report of which was discussed at a national workshop in November 1980 at which senior officials of the Ministry of Health made recomendations on staffing norms for the various health institutions. Courses on occupational health and safety were held, and the Ministry of Health, in collaboration with the Ministry of Labour and Colombo Univer- sity, has prepared a plan of action for improving occupational health and safety. Two country-level courses in planning and management were conducted for district-level planning assistants and statistical survey officers. The Education Technology Institute at the University of Peradeniya is being strengthened by WHO so as to be able to function as a national and regional teacher training centre in medical education technology. Assistance has also been given to the new medical faculties of the Universities of Galle and Jaffna, and financial support provided for the improvement of library facilities for post-graduate students in Colombo and Kandy. Development of the National Institute of Health Sciences is progressing well under the collaborative programme of WHO. In addition to regular training for paramedical personnel, a workshop was held on teacher train- ing for primary health care, and the Institute held its first course in community health management for middle-level managers. To strengthen staff teaching capabilities, UNICEF-funded study tours for Institute staff were arranged. In addition to WHO and UNICEF, UNDP and US AID are participating in the project. Steps to promote TCDC have been taken in the fields of virological medical research, indigenous systems of medicine, radiotherapy and radiology. With WHO assistance, a protocol for the development of an improved health information system has been prepared and is being implemented. Health legislation was reviewed, and a draft bill for rabies control, one for the regulation of the medical profession and their professional conduct, and one to replace the 1952 Health Services Act, were prepared with WHO assistance. Projects in Operation Number and Source of Funds SRL CHP 001 R SRL RPD 001 R SRL SPM 001 R SRL SPM 002 R SRL SPM 003 R SRL SPM 004 R SRL PHC 001 R SRL WKH 001 R SRL WKH 002 R SRL ADR 001 R SRL ATH 001 R SRL MCH 001 R~FP SRL MCH 002 FP SRL MCH 003 FP SRL MCH 004 FP SRL MCH 005 FP SRL NUT 001 R Title - Country Health Programming Research Promotion and Development National Health planning Medical Stores Management Strengthening of Electro-Medical Division Development of National Health Information Services Development of Traditional Medicine Occupational Health and Industrial Hygiene Epidemiology of Pesticide Toxicology and Occupational Health (Teaching) Medical Rehabilitation Strengthening of Laboratory Services Family Health Strengthening of Hospital-based Family Planning Services Family Health Teaching, Service and Research in Medical School, Peradeniya Family Health Teaching, Service and Research in Medical School, Galle Family Health Teaching, Service and Research in Medical School, Colombo Public Health Nutrition 11. THAILAND The Ministry of Public Health and the National Economic and Social Development Board (NESDB), to achieve the goal of health for all, have adopted a conceptual framework for long-term social development objectives with special emphasis on intersectoral and interagency collaboration in policy development and political support for structural changes. A "National Social and Health Development Project - NESDB" has been developed, under which various studies related to intersectoral coordina- tion for long-term planning and long-term strategies, social indicators, monitoring and evaluation models, etc., have been proposed. An initial assessment of the planning procedures of various ministries at central and provincial levels has been started. Activities in the areas of health planning, management and information system development were concerned mainly with the formulation of guide- lines for long-term health development and the translation of these policies and strategies into the broad programmes and strategic objectives of the Fifth Five-Year Health Development Plan. In addition to technical collsboration in the above areas, WHO has extended assistance to a variety of activities, including the setting up of an epidemiological surveillance system at PHC level, planning for the production and supply of essential drugs for the PHC programme, planning for baseline and analytical studies of the cost of rural health services, the development of a manual, and staff training for the health information systems. The national PHC programme, to provide 50% of the villages with village health volunteers and comunicators by 1981,is progressing satisfactorily, as are studies on the role of the community, health education through village health volunteers and communicators, use of specially trained volunteers in remote areas, and the role of district and provincial hospitals. The population project in 20 provinces financed by the World Bank and US AID has been contributing to primary health care. UNFPA and UNICEF have supported PHC training programes. Plans were drawn up for the further development of laboratory services through the strengthening of regional laboratories and by bringing laboratory services closer to the peripheral health units. A referral service is being promoted from the peripheral units, through the districts and provinces to the regional laboratories. Formal training for laboratory workers is being expanded in order to provide personnel for small labora- tories in district hospitals. Family planning activities continued satisfactorily. WHO is involved in the execution of two UNFPA projects. Seminars and training programmes on family planning were held, and a national MCH project is being formulated. A proposal for development communication in health education in the context of health for all, has been formulated. The training programme in health education for school-teachers was continued. A consultative meeting on the development of health education services in relation to PHC was held during the year. The nutrition project aims to cover, by 1986, all 25 000 villages targeted in the PHC programe. A village nutrition project, intended to reduce the incidence and prevalence of protein-energy malnutrition among the vulnerable population, including infants and pre-school children, is being implemented. A nutrition workshop was conducted in Ubol Province for all categories of provincial health personnel. The research project on the "Impact of Nutrition Education on the Growth of Pre-school Children in Rural Areas" has been conducted in two provinces, Mahasarakarm and Suphanburi. In this project, which is sponsored by US AID, village health volunteers and village health communicators have been trained in weighing pre-school children, in using the growth chart and in motivating mothers to improve the feeding of their children, using locally available foods. National drug policies in support of HFA strategies are being formulated, and working groups have been set up to deal with the manufacture, consump- tion, utilization, distribution and control of drugs, research as well as manpower development. Among the main concerns in the drug policy is the supply of safe and quality drugs at reasonable prices throughout the country, especially for primary health care. The working of the Government Pharmaceutical Organization, a state-owned pharmaceutical production unit which manufactures and supplies about 15% of the drugs required by public sector hospitals, was reviewed by a WHO consultant,who has made recommen- dations to enable it to play a more meaningful role in the pharmaceutical supply system. He has also made suggestions for the more effective enforcement of quality control measures. In late 1980,the Ministry of Public Health constituted a National Advisory Board with responsibility for promoting, supporting and coordinating technical development for the prevention and control of communicable and nonconrmunicable diseases. Standardization of technical practices, techni- cal information and related research and manpower development have been particularly emphasized. A two-year plan of action dravn up for the ~oard's operation includes survey and identification of national expertise and institutions as technical resources in various fields of disease prevention and control, identification of five high priority problems, organization of seminars and workshops to promote the exchange of relevant technical information, and the ~romotion of research and training. WHO is supporting the activities of the Board. The incidence of malaria increased in 1980, particularly on the Thai- Kampuchean border, and also in the south, where there are major problems, including the prevalence of highly resistant parasite strains. Recent clinical studies show that most of the infections are unresponsive to the combination of pyrimethamine and sulfadoxine as well.WH0 assistance has been provided for monitoring vector susceptibility to insecticides. In November 1980, a National Malaria Conference to exchange information and improve cooperation among malaria field workers, academics working in malaria research and public health administrators was held with support from WHO. A WHO-sponsored national seminar on the prevention of blindness was con- ducted at Ramathibodi Hospital. Eye health care is being extended from the provincial hospitals to the district hospitals and health centres and is being included in the primary health care programme. Mobile eye units were started as pilot projects in the provinces to extend services to the village level. The EPI project in the Five-Year Health Plan (1982-861, which has been finalized, includes extension of target coverage to 80 per cent of infants under one year of age with BCG. DPT and polio vaccines, and to 70 per cent of pregnant women with tetanus toxoid. The immunization targets for 1980 were achieved. A national childhood mortality survey of four specific diseases - neonatal tetanus, diphtheria, measles and acute diarrhoea - was conducted with support from WHO and UNICEF. The epidemiological surveillance system was assessed. A pilot project for cornunity surveillance and a field epidemiology training programme were started. Programmes for the control of leprosy, tuberculosis, sexually-transmitted diseases, dengue haemorrhagic fever and filsriaais continue to be imple- mented. An evaluation of the leprosy control activities was carried out. An international training course was held for programme managers in diarrhoeal-disease control, and plans were made for a training programme on the implementation and management of diarrhoeal-disease contrtol. A national seminar on cancer control, held to consider the national policy and plan of action, stressed the importance of community-based activities for control. A national seminar on cardiovascular diseases was held, to scrutinize national policies and strategies and to promote coordination among various agencies, and an epidemiological study of cardiovascular diseases was formulated and carried out in one province. The National Economic and Social Development Board, which is the focal point of activities for the International Drinking Water Supply and Sanitation Decade, is collaborating in the development of an information system for the Provincial Water Works Authority. UNDP has been convening meetings of United Nations and bilateral agencies to exchange information on Decade activities. The UNDP-funded WHO project on rural environmental health has been concen- trating its efforts on the conversion of open wells into protected wells equipped with locally developed PVC hand pumps. Surveys were carried out in the districts to identify existing sources of drinking water and family excreta disposal methodr. The small diameter tube-well drilling operations are being strengthened, and the training of tube-well drilling operators is in progress. Thailand is participating in the WHO/UNEP/GEMS project to monitor water and air pollution. UNICEF is supporting the construction of village water supply systems. Three divisions in the Ministry of Public Health are involved in the food safety programe, and their work has included the monitoring of pesticide residues in food, analysis of bottled water and examination of food additives. Action is under way to formulate a long-term health manpower development plan. A series of training programmes for middle management personnel has been initiated; among the activities under way are the training of village health volunteers and village health communicators in primary health care, measures for increasing the production of auxiliary health personnel, in- service training for district health officers and other health personnel, and the organization of seminars for health personnel concerned with primary health care. The health information system has been improved, especially at peripheral levels. In the area of primary health care, information is collected and distributed regularly to the agencies concerned. Some vital statistics data have been analysed and processed in collaboration with the National Statistical Office and the results fed back to the institutions concerned. Various training courses were conducted for improving the quality of the health information system, and manuals on the recording and reporting systems have been prepared in order to facilitate the training programme as well as the generation of data at the peripheral level. Projects in Operation Number and Source of Funds Title - THA CHP 001 Country Health Programming R THA RPD 001 Research Studies on Mansonia Mosquitoes TF THA SPM 001 Planning, Management and Information Systems Development R THA SPM 002 National Centre for Development of Health Planning and R Management THA PHC 001 Development of Primary Health Care R/ VF/TF THA WKH 001 Development of Occupational Health R THA ATH 001 Development of Health Laboratories R THA HSR 001 Development of Health Services Research R THA MCH 003 Fellowships in Family Planning and Related Fields FP THA MCH 004 Expansion of Family Planning Services and Support of FP Infrastructure of the National Family Planning Progranme THA MCH 005 FP Field Trials on New Patterns of Family Planning Services THA NUT 003 R THA HED 001 R Nutrition Training and Studies, Food Marketing and Distribution Development of Health Education THA MNH 001 R Mental Health THA PHB 001 R THA ESD 003 R Development of Vaccine Production Development of Epidemiological Surveillance THA MPD 001 R Malaria and Vector Control THA MPD 002 R Filariasis Control THA EPI 001 R Development of Expanded Programme on Immunization THA CAN 001 R Development of Cancer Control Development of Cardiovascular Diseases Control THA CVD 001 R THA ORH 002 R Development of a Training and Demonstration Centre for Oral Health Environmental Health THA EHP 001 R/UNDP THA FSP 001 R THA HPM 001 R Development of Food Control Development of Health Manpower Planning and Management THA PTR 001 R Promotion of Training THA PTR 002 FP Training and Follow-up Support of Peripheral and Primary Health Care Workers THA EDS 001 R Curricula and Faculty Development Development of National Health Information System THA HST 001 R Number and Source of Funds 12. INTER-COUNTRY Projects in Operation Title ICP CHP 001 Improvement of National Health Planning through Country R Health Programing ICP CWO 002 Liaison with ESCAP R ICP CWO 100 Coordination with other Organizations FP ICP RPD 001 Biomedical Research R ICP RPD 002 Collaboration in Biomedical and Health Services R/VF ICP RPD 100 Research Promotion and Development R ICP DGP 001 Regional Director's Development Programme R ICP PPS 100 Health Services Development - Programme Planning R and General Activities ICP SPM 001 Health Research and Development R ICP SPM 002 National Health Information Systems Development R ICP SPM 003 Strengthening of Health Services Administration through UNDP Training in Planning ICP PHC 002 Organization and Administration of Primary Health Care R ICP PHC 004 Traditional Medicine R ICP PHC 005 Medicinal Herbs and Ayumedic Drugs UNDP ICP ADR 001 Care of the Aged, Disability Prevention and Medical R Rehabilitation ICP ATH 001 Standardization of Diagnostic Material and Laboratory R Practices ICP ATH 002 R ICP MCH 003 R ICP MCH 011 FP ICP MCH 013 R ICP MCH 100 R ICP NUT 005 R ICP NUT 100 R ICP HRP 100 VF ICP HED 003 FP ICP HED 005 R ICP HED 100 R ICP MNH 003 R ICP WH 100 R ICP DPM 001 R ICP PPC 100 R ICP ESD 005 R ICP ESD 100 R ICP MPD 001 R ICP MPD 002 VF Development of Appropriate Technology for Health in Relation to Primary Health Care Education and Studies in MCH Regional Team on Family Health Promotion of Family Health (including ~utrition) Maternal and Child Health Nutrition in Primary Health Care Nutrition Regional Research Adviser Development of Health Education in Family Health Workshops and Seminars in Health Education Health Education Regional Meetings on Mental Health Mental Health Development of Drug Policy in Relation to Primary Health Care Communicable Disease Prevention and Control - Programme Planning and General Activities Strengthening of Epidemiological Surveillance System Epidemiological Surveillance Advisory Services in Malaria Control and Coordination of Antiaalaria Activities in the Region External Cross-checking of Blood Films 1CP MPD 004 UNDP ICP MPD 100 R Regional Manpower Development Programme in Malaria Malarla and Other Parasitic Diseases ICP BVM 001 R/ VF Prevention and Control of Diarrhoea1 Disease of Children ICP BVM 002 R Inter-Country Training Activities for Sexually Transmitted Diseases Control ICP BVM 003 W/TF Leprosy Control ILP BVM 004 R/VF/TF Control of Zoonoses and Food-borne Diseases Tuberculosis Control and Research ICP BVM 005 R ICP EPI 001 R/ VF Development of Expanded Programme on Immunization LCP EPI 002 UNDP Strengthening of Expanded Programme on Immunization LCP TDR 100 TF Strengthening of Biomedical Research Capability Prevention of Blindness and Visual Impairment ICP PBL 001 R/ VF ICP PBL 002 W/TF Prevention of Blindness Control and Prevention of Blindness and Visual Impairment ICP PBL 003 UNDP ICP VBC 100 R Vector Biology and Control Nonconaunicable Disease Prevention and Control - Programme Planning and General Activities ICP PPN 100 R LCP ORH 001 R Regional Oral Health Training Programme ICP OND 001 R Other Noncommunicable Diseases ICP IMM 001 R Training in Immunology ICP PPE 100 R Promotion of Environmental Health - Programe Planning and General Activities ICP EHP 001 R ICP EHP 002 VF ICP BSH 001 R ICP BSH 002 UNDP ICP BSM 003 VF ICP RCE 001 R ICP PPM 100 R ICP PTR 001 R ICP PTR 002 R ICP PTR 003 R ICP PTR 004 R ICP PTR 005 UNDP ICP EDS 001 R ICP HST 100 R ICP HLT 001 R Sector Developent in Environmental Health Building up of Information Services in Environmental Health in South-East Asia Cormunity Water Supply and Sanitation Development of Drinking Water Supply and Sanitation Programme GTZ/WHO Cooperation Project for International Drinking Water Supply and Sanitation Decade Environmental Pollution Control Health Manpower Development - Programme Planning and General Activities Education and Training in Comnity Health Developant of National Post-graduate Training Centres Continuing Education for Health Workers Training of Health Personnel (including community health workers) for Primary Health Care Training in Maintenance and Repair of Health Equipment Educational Technology Health Information - Development of Health Statistical Services Health Literature, Library and Information Services Project No ICP MCH 003 IR/ IRP/DGP/105 BAN ORH 001 THA ORH 002 SRL ORH 001 BAN ATH 001 IN0 SPM 002 ICP PHC 002 THA SPM 001 IR/IRP/ER0/018/VN IRIIRP/MNH/030/FD SRL MNH 001 IN0 MNH 001 THA SPM 002 BUR WKH 001 THA WlCH 001 SRL WKH 001 INTER-REGIONAL ACTIVITIES OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION (1 May 1980 - 30 June 1981) Title Number of Participants Seminar on the Organization 2 (1 from Burma and of MCH Services at the Grass- 1 from Sri Lanka) roots Level, Beijing (23 June - 4 July 1981) Course on Oral Public Health 4 (1 from Bangladesh, Services in Rural Areas, 2 from Sri Lanka and Sofia, Bulgaria (15 September - 1 from Thailand) 10 October 1980) Course on Occupational Health 4 (2 from Bangladesh and in Agriculture, with Particular 2 from Indonesia) Fmphasis on the Prevention of Toxicocity by Pesticides, Lods, Poland (8 September - 11 October 1980) Course on Planning, Organization 2 (1 from Indonesia and and Management of Health Care 1 from Thailand) Delivery in Support of Planning Health Care, Sofia (7-28 October 1980) Course on Health Aspects and 4 (1 from Bangladesh, Relief Management in Natural 1 from India and Disasters, Brussels (12-24 2 from Thailand) October 1980) Training Course I1 on Treatment 12 (5 from Burma, and Rehabilitation of Drug- 1 from India, dependent Persons, Hong Kong 1 from Indonesia, (28 October - 17 November 1980) 1 from Sri Lanka and 4 from Thailand) Fourth International Training 1 from Thailand Course in Occupational and Environmental Toxicology, Belgrade (14 May - 19 June 1981) Workshop on Organization of 3 (1 from Burma, Occupational Health Services, 1 from Sri Lanka and Bulgaria (1-19 June 1981) 1 from Thailand) Project No. IRI IRPIMNHI~Z~ Title - WHO/UNFDAC Seminar on Public Health Problems and Psycho- tropic Substances - Development of a Manual, Helsinki, Finland (7-27 June 1981) IK/IRP/MCH/037/FP.80 IR Course in Fertility Manage- ment and MCH Care, Singapore (24 November 1980 - 3 January 1981) ICP PHC 004 Inter-regional Meeting on Standardization and Use of Medicinal Plants, Beijing (17-27 September 1980) IK/IRP/MCH/O~~/FP.~O Follow-up Meeting of Ex- participants of the IR Courses on Fertility Management and MCH Care, Manila (21-26 July 1980) Number of Participants 2 (1 from India and 1 from Thailand) 2 (1 from Burma and 1 from Nepal) 3 (1 from Bangladesh, 1 from India and 1 from Sri Lanka) 6 (1 from Bangladesh, 1 from Burma, 1 from India, 1 from Indonesia, 1 from Nepal and 1 from Railand) ANNEXES Annex 2 GEOGRAPHICAL DISTRIBUTION OF INTERNATIONAL STAFF ASSIGNED TO THE SOUTH-EAST ASIA REGION AS OF 31 MAY 1981 Country Australia BANGLADESH Bulgaria BURMA Canada Colombia Cyprus Denmark Egypt France Germany, Federal Republic of Ghana INDIA INDONESIA Iran Italy Japan Lebanon Liberia Malaysia Malta MONGOLIA NEPAL Norwav Phi lippines Poland SRI LANKA Sweden Switzerland Tanzania THAILAND Turkey Union of Soviet Socialist Republics United Kingdom United States of America Yugoslavia Other countries Grand Total WHO (Global) Total 26 8 8 6 36 24 4 12 30 77 4 3 18 6 2 5 10 3 3 17 10 2 9 4 1 10 7 24 16 18 16 29 12 10 7 45 109 156 20 470 1414 South-East Regional Office - 2 - 1 - - - - - 1 - - 4 - - - - - - - - - - - - - - 1 - - 1 - - 2 1 - - 13 Asia Region Field staff including WPCs 6 Reg. Advisers 4 4 2 Total 4 6 2 5 i 6 1 1 2 1 1 2 1 1 3 3 3 4 ~ 2 1 2 1 2 1 1 2 1 1 1 1 1 5 1 6 2 8 - 1 2 8 1 8 10 18 3 - 134 2 1 2 5 2 1 1 2 1 1 1 1 1 5 1 6 2 8 1 1 2 9 1 8 12 19 3 - 147 Annex 3 Nationality DISTRIBUTION OF SHORT-TERM CONSULTANTS BY NATIONALITY 1 JUNE 1980 - 31 KAY 1981 Australia BANGLADESH Bulgaria BURMA Canada Chile Czechoslovakia Denmark Egypt Germany, Federal Republic of Hungary INDIA INDONESIA Italy Japan Malaysia NEPAL Netherlands Norway Philippines Po land Romania SRI LANKA Switzerland THAIJAND hion of Soviet Socialist Republics United Kingdom United States of America Yugoslavia Number of STCs Recruited Annex 4 MEETINGS AND COURSES ORGANIZED OR ASSISTED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 July 1980 - 30 June 1981) 1-2 July SEAIACMR Sub-committee on Research Needs for Health for All by the Year 2000 (ICP RPD 001) New De lhi 13-24 July Short Course on Clinical Teaching and Supervision in Nursing (ICP PTR 003) Nepal 16-17 July National Workshop on Medical Rehabilitation (SRL ADR 001) Colombo 16-17 July National Workshop preparatory to Survey of Disabled (SRL ADR 001) Kurunegala (Sri Lanka) 28-31 July National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) Jakarta 28 July - Meeting on Reproductive Health of Adolescents 2 August Bangkok 30 July - Short Course on Clinical Teaching and Supervision 12 August in Nursing (ICP PTR 003) Nepal 4-11 August Preparation of Health Education Specialists in Support of Health for All by the Year 2000 (ICP HED 005) New De lh i 13-14 August National Seminar on Health and Law Bangkok New Delhi 18-20 August National Workshop for Developing Training Programmes in Medical Librarianship (IND EDS 002) 18-22 August National Seminar on Systems for Management of Mass Casualties (THA SPM 001) Pattaya (Thailand) 18-22 August Workshop on Statistics and Information Training Programmes (THA HST 001) Thailand 25-30 August Meeting on School Health Services (ICP MCH 003) Bangalore (India) 28-30 August State-level Seminar on Health Economics and Planning (IND SPM 001) Srinagar (India) 15-18 September Family Health Workers Refresher Course (MAV PTR 001) Male 15-26 September Inter-country Workshop on Production of Immuno- logical Reagents (ICP IHM 001) Bangkok 17-25 September National Workshop on Educational Science for Medical Teachers and Other Health Professionals (IND EDS 001) Pondicherry (India) 25-27 September Bangladesh-India-Burma Border Malaria Coordination Conference (ICP MPD 001) Calcutta 25 September - 7 October Inter-country Training Course for Trainers of Mid-level Management Personnel (ICP EPI 001) Kathmandu 28 September - 14 October National Workshop on Developing Health Planning Procedures and Health Information System for Decentralized Planning at District Level (ICP SPM 003) Kathmandu 29 September - 3 October Inter-country Seminar on Poliomyelitis(1CP ESD 005) New Delhi 29 September - 4 October Inter-country Workshop on Relief Cataract Services (ICP PBL 002) Hyderabad (India) 1 October Training of Voluntary Workers in Island (MAV PTR 001) Naifarn (Maldives) 6-9 October 6-10 October Workshop on Educational Science (ICP PTR 003) Maldives New Delhi Consultation on Development of Regional Public Health Training Programme (ICP PTR 002) 6-14 October National Workshop for Senior-level Officers (BAN SPM 001) Dacca 8-10 October State-level Seminar on Health Economics and Planning (IND SPM 001) Goa (India) 13-16 October Inter-country Consultative Meeting on Drug Policies and Management (ICP DPM 001) New Delhi 20-24 October Regional Workshop on Appropriate Technologies with Special Reference to PHC (ICP ATH 002) New Delhi 20 October - 1 November Inter-country Training Course for Trainers of Mid-level Management Personnel (ICP EPI 001) Colombo 22 October - 1 November Workshop on Neonatology (IND MCH 003) New Delhi 22 October - 1 November Workshop on Neonatology (IND MCH 003) Hyderabad (India) 24-25 October India-Maldives-Sri Lanka Border Malaria Coordination Conference (ICP MPD 001) Madras Meeting of Traditional Medicine Practitioners (MAV PTR 001) Maldives 26 October 2 7-31 October 27-31 October Meeting of Traditional Medicine Practitioners (MAV PTR 001) Maldives New Delhi New Delhi Meeting on Lay Reporting of Health Information for Primary Health Care (ICP SPM 002) Expert Group Meeting on Team Work and Its Role in the Provision of PHC Services (ICP PTR 0031 ICP PTR 004) 27-31 October October 3-7 November 3-8 November Workshop for Faculties of Conmnity Medicine (BAN PTR 005) Dacca Training of Supervisors of PHC Workers in Health Manpower Management Bangkok New Delhi New Delhi Inter-country Meeting on Sexually-Transmitted Diseases Control (ICP BVM 002) Inter-country Consultative Meeting on Research in Health Behaviour, Health Education and Community Participation (ICP RPD 002) 10-14 November Inter-country Workshop on Child Mental Health and Psycho-Social Development (ICP MNH 003) Jakarta 10-13 November First National Seminar on Accident Prevention and Relief (IND ADR 002) New Delhi 10-20 November 10-22 November Workshop on Neonatology (IND MCH 003) Bombay Workshop on Rapid Techniques in Virology (ICP Rm) 002) Pune (India) 11-13 November Meeting for Development of Research Protocols on Priority Areas in Traditional Medicine Varanasi 17-19 November First National Malaria Conference (THA MPD 001) Haad Yai (Thailand) 17-21 November 19-21 November The Immunology of Tissue Antigens (HLA) and Their Role in Disease (BAN OND 001) Dacca Meeting of the Principal Investigators of the Nutrition Research Project - Situation Analysis of Nutrition content of PHC New Delhi 20-21 November 20-21 November Epidemiology Training for Zone Chiefs (THA MPD 001) Thailand Dacca National Workshop on the Formulation of the National Programme for Prevention of Visual Impairment and Blindness in Bangladesh (BAN PBL 001) The Immunology of Tissue Antigens (HLA) and Their Role in Diseases (BAN OND 001) 2L-28 November Dacca 24-28 November National Workshop on Mental Health (BAN MNH 001) Dacca 24 November - 4 December Workshop on Neonatology (IND MCH 003) Cuttack (India) Meeting of the Ad & Conanittee on ~utrition Research (ICP RPD 002) New Delhi 25 November 1-6 December 2-4 December National Workshop on Mental Health (BAN MNH 001) Dacca Bangkok National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) 8-10 December National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) New Delhi Course on Health Planning and Management (ICP SPM 003) Colombo New De lhi New Delhi Dacca Sri Lanka 9-19 December 15-19 December Consultation on Regional Training Programmes for Health Sciences Librarians (ICP HLT 001) 15-19 December Meeting to Discuss the Role of WHO in Pharmaceuticals 17-20 December National Workshop on Prevention of Cardio- vascular Diseases (BAN CVD 001) 29 December 1980 - 9 January 1981 1981 - 5-9 January Inter-country Workshop on Health Manpower Planning Methodology (ICP PTR 001) Steering Committee of Task Force on Service Research in Family Health Colombo New Delhi Chandigarh West Java 12-14 January Task Force Meeting on MCH/FP and Review of Child Handbook (IND MCH 003) Ninth Meeting of the Steering Committee of the WHO Task Force on Oral Contraceptives 12-15 January 2-4 February Workshop on Research and Development of Appropriate Technology in Environmental Health at Village level (ICP ATH 002) 3-6 February ~ational Seminar on ATH in Relation to PHC (ICP ATH 002) Bangkok Dacca New Delhi 2-14 February EPI Mid-level Management Workshop for Trainers (ICP EPI 002) 5-9 February Second Meeting of the SEA~ACMR Sub-committee on Research Needs for HFA/2000 (ICP RPD 002) 9-13 February Third Meeting of the h-ogramne Advisory Group on Prevention of Blindness New DeIhi New Delhi 10-11 February Regional Consultative Meeting on the Preparation of Seventh General Programme of Work (ICP SPU 001) 12-13 February 15-18 February Regional Consultative Meeting on Study of WHO'S Structure in the Light of Its Functions New Delhi New Delhi Ei&th Meeting of the steering Committee of the WHO Task Force on Psycho-Social Research in Family Planning 17-21 February Workshop on Nutrition Monitoring and Evaluation (ICP NUT 005) New Delhi Calcutta 18-20 February Seminar on the Follow-up of the Consultation on Regional Public Health raining Programme (ICP PTR 002) 19-20 February 19-20 February UNICEF/WHO In-house Meeting New Delhi New Delhi Joint ICMR/WHO Research Seminar on Psycho-Social Factors Affecting Family Planning Joint Meeting of the ICMR Acceptability of Task Force and the WHO Psycho-Social Task Force 21 February 23 February New Delhi ICMR/WHO Seminar on Recent Advances in Induced Abort ion Research New Delhi National Workshop on Malaria Control (BAN MPD 001) 24-26 February 24-27 February Dacca New Delhi Steering Committee Meeting of the WHO Task Force on Sequelae of Abort ion 26-27 February 2-3 March Global ACMR Sub-cornittee Meeting on Nutrition New Delhi New Delhi Regional Scientific Working Group on Diarrhoea1 Diseases (ICP RPD 002) 3-11 March Workshop on Methods and Materials in TBA Training Programmes (ICP PTR 003) New Delhi 4-6 March 9-21 March Global ACMR Sub-Cornittee on Research Administration New Delhi Rangoon EPI Mid-level Management Workshop for Trainers (ICP RPD 002) 16-19 March Meeting on Tuberculosis Research and Services (ICP RPD 002) New Delhi Consultative Meeting on Programme Planning for Raditional Birth Attendants in Primary Health Care (ICP PTR 003) New Delhi 16-19 March 16-22 March Regional Training Course in the Micro in-vitro Method for Testing Drug Resistance to P.falciparum (ICP Rm) 001) 23 March - WHO/UNDF' Asia Regional Training Project - IR 3 April Training Course on Diarrhoea1 Diseases: Laboratory Aspects 24-31 March Meeting on Appropriate Technology for Health 30-31 March Research Study Group ~eeting on DHF (ICP RPD 002) 30 March - Workshop on Antibiotic Sensitivity ~esting 10 April (ICP ATH 001) 1-6 April Regional ACMR: Seventh Session 6-11 April Seminar for the Sedaw Gyi, Burma (BUR VBC 001) 7-11 April Regional Advisory Group Meeting on Mental Health (ICP MNH 003) 21-23 April National Conference on Appropriate Technology for Primary Health Care (ICP ATH 002) 18 May - 13 June CDD Programme Management Course 25 May - 6 June Training Course in Maintenance and Repair of Refrigerators (ICP EPI 001) 22 June - WHO/DANIDA Course on Vector and Rodent Biology 16 July and Control Prabudhabat (Thailand) Dacca New Delhi New Delhi New Delhi New Delhi Burma New Delhi New Delhi Calcutta Bangkok Ciloto (Indonesia) Annex 5 CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY GOVERNMENTS/OTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED (1 July 1980 - 30 June 1981) 1980 - 14 July ESCAP: Inter-agency Task Force on Water for Asia and the Pacific Bangkok 21-25 July Government of India: Meeting of Working Group for Professional Preparation of Health Education Specialists New Delhi 28 July ITNDP: Formulation of UNDP Country Prograrmne for Maldives, 1982-86 Male Ministry of Public Health, Thailand, and Mahidol University: National Seminar on the Role of Universities in Research to Support National Health Development 29 July - 1 August Bangkok July Government of Maldives: Developnent Plan of Maldives Male UNICEF: Mid-term Review of UNICEF Programme, Maldives 4-5 August Male 5-6 August Government of India: Seminar on Oral Rehydration Simla (India) Government of India: Seminar on Oral Rehydration Therapy 8-9 August Lucknow (India) 19 August - 17 October 20 August Government of India: Course for Senior Health and Hospital Administrators New Delhi Government of India: Working Group on Infant Feeding New Delhi ICMR: Meeting of the Advisory Committee on Ophthalmic Research 26-27 August New Delhi 15-16 September 19-20 September ESCAP: Seminar on Household Surveys Bangkok Government of India: Meeting of the Vaccine Production Board Kasauli (India) 22-26 September UNESCO: Meeting on a Regional Network for Scientific and Technological Information in East and South-East Asia Bangkok Kathmandu Jaycees: Seminar on Drug Abuse and Addiction Kathmandu 23 September 23-26 September Government of India: Workshop on the Integration of Health Education in the Undergraduate Medical Curriculum Madras 23-29 September ESCAP: Committee on Industry, Technology, Human Settlement and the Environment, 4th Session Bangkok Colombo Plan Bureau: Workshop on Drug Abuse Prevention and Control Dacca 29 September - 4 October 2-8 October Government of India: Workshop on Recent Advances in Leprosy Research Bangalore (India) Bangkok 9-15 October ESCAP: Second Asian and Pacific Ministerial Conference on Social Welfare and Social Development ESCAP: Meeting on Inter-agency Committee on IRD 17 October 20-24 October Bangkok Bangkok United Nations: Working Group of the Committee for Development Planning ESCAP: Preparatory Committee for the Third Asian and Pacific Population Conference: First Session Bangkok 29 October - 4 November 3-7 November ESCAP: Inter-governmental Meeting of Heads of Standards Institutions Bangkok 7 November ESCAP: Inter-agency Consultative Meeting on the Plan of Action to Combat Desertification Bangkok ILO: Inter-country ~eminar/Workshop on Curricula Development for Population and Family Welfare Education in Asia 10-14 November Pattaya (Thailand) 17-22 November FAO: Workshop on the Integration of Women in Agriculture and Rural Development Hyderabad (~ndia) ESCAP: -- Ad Hoc Meeting with Inter-agency and Non-governmental Organizations concerned with Youth Development in the Region 18-22 November Bangkok 18-24 November ESCAP: Committee on Trade, 23rd Session Bangkok AsDB: Reconnaissance Mission: Health and Population Sector, lhailand Bangkok/ Koraput 21 November - 12 December 24-28 November ILO: Meeting on Working Conditions and Environment Bangkok 29 November AcWorth Leprosy Hospital Society for Research, Rehabilitation and Education in Leprosy: Consensus Conference on Classification of Leprosy Bomb a y 8-16 December UNESCO: Regional Seminar on Rural Development Planning Bangkok 11 December 16-22 December 18-19 December 1981 - 6 January 14 January 2 7-30 January 28 January 4-5 February 6-20 February 15-20 February 16 February 18 February 18-25 February 5 March 10-21 March 29 April 7 May 21-22 May ESCAP: Inter-agency Task Force on Water for Asia and the Pacific, Sixth Session UNESCO: Regional Meeting of Experts on the Role of Social Studies in Education for Peace and Respect for Human Rights in Asia and the Pacific ILO: Meeting of Designated Bodies (Part of the International Occupational Safety and Health Hazard Alert System in the Asian and the Pacific Region) ESCAP: Inter-agency Task Force for Integrated Rural Development ESCAP: Integrated Rural Development (IRD) - Inter-agency Task Force ESCAP: Technical Meeting on Ageing for Asia and the Pacific Region ESCAP: Inter-agency Committee on Integrated Rural Development (IAcIIRD) for Asia and the Pacific ESCAP: Ad Hoc Inter-agency Meeting on Women in Development Government of Thailand: International Crafts Conference and Exhibition (CONEX '81) ESCAP: International Colloquium of Decision-making Executives for Coordinated Action ESCAP: Inter-agency Task Force on Human Settlements (5th) ESCAP: Inter-agency Task Force on Integrated Rural Development South Asia Cooperative Environmental Programe (SACEP): High-level Meeting to Initiate the South Asia Cooperative Environmental Programme ESCAP: Inter-agency Task Force on Integrated Rural Development ESCAP: Thirty-seventh Session ESCAP: Inter-agency Meeting on Women in Development ESCAP: Inter-agency Task Force on IRD ESCAP: Inter-agency Meeting on Social Development Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Colombo Bangkok Bangkok Bangkok Bangkok Bangkok 1-10 June 2-8 June 4-10 June 9-1 5 June 26 June UNESCO: Seventh Regional Consultation Meeting on Bangkok Programming and Evaluation of the MEAN Prograrmne of Educational Innovation for Development (APEID) ESCAP: Regional Consultation on Consumer Protection Bangkok ESCAP: Workshop on Research towards a Methodology Bangkok for Defining the Transport Needs of Isolated Communities ESCAP: Committee on Statistics - Fourth Session Bangkok ESCAP: Seventh Session of the Inter-agency Task Bangkok Force on Water for Asia and the Pacific Annex 6 LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 June 1980 - 31 May 1981) . Document SEAIATHI~ SEAICancerlLO SEA/Cancer/Ol SEAICancerlO2 SEA/Cancer/43 SEAlCVD128 SEA/Choleral32 SEAIRES129 SEAlCDl82 Title Appropriate Technology for Health (ATH) Report on regional meeting on appropriate technology for health in relation to primary health care, New Delhi (ICP ATH 002), 24-30 October 1980 Cancer Assignment report on cancer control in Sri Lanka (SRL CAN 006), December 1979 - January 1980 Assignment report on training and services in cytology, India (IND CAN 006), April-May-1980 Assignment report on cancer epidemiology and research in Sri Lanka (SRL CAN 001), 26 August - 25 September 1980 Assignment report on cancer prevention and control in Bangladesh (BAN CAN 001), 10 September - 14 October 1980 Cardiovascular Diseases Assignment report on cardiovascular diseases prevention and control, India (IND CVD 002), April-May 1980 Cholera Assignment report on biomedical research on the production of oral rehydration solution in Sri Lanka (ICP RPD 001), 22-30 May 1980 Cmunicable Diseases Assignment report on the development of the special hospital for cmunicable diseases, Jakarta, Indonesia (IN0 ESD 003), 8 November 1979 - 6 February 1980 Author Regional Office Dr M.D. Snelling Prof. Irena Koprowska Dr Ivan Koza Dr N.L. Petrakis Dr J.G. Sloman Mr Jack Richman Dr Prakorb Boonthai Document SEA/CD/83 SEAIDHI53 sEAIDH~S~ SEA/DH/~~ SEA/DD/ 10 SEA/DD/11 SEA/DD/~~ SEAlDrugs135 SEA/Drugs/36 SEA/Drugs/37 SEAIEcon. /5 I Title Assignment report on strengthening of the arbovirus surveillance programme in Sri Lanka (SRL ESD 002), 22 June - 19 September 1980 Dental Health Assignment report on oral health, Bangladesh (BAN ORH 001) 3 July - 20 September 1980 Assignment report on dental health in Indonesia (IN0 RPD 001), 15 June - 13 August 1980 Assignment report on preventive dental health in Sri Lanka (SRL ORH 0011, 13 October - 21 November 1980 Diarrhoea1 Diseases Assignment report on an epidemic of gastroenteritis in Maldives (ICP BVM 001). 4-17 June 1980 Assignment report on diarrhoea1 diseases in Sri Lanka (ICP RPD 001), 9 May - 17 June 1980 Diarrhoea1 disease control programme in South-East Asia - Report on an inter- country meeting, Nev Delhi (ICP BVM 001.01), 24-28 November 1980 Drugs Assignment report on quality control of food and drugs, Indonesia (IN0 PHB 001), August 1980 Assignment report on Pharmaceutical Centre, Manggarai,Jakarta (INO PHA 001), 19 May - 23 August 1980 Report on inter-country consultative meeting on drug policies and management (ICP DPM 001). New Delhi, 13-16 October 1980 Economics Assignment report on health economics and planning in Thailand (THA SPM 001), 27 April - 8 June and 7 July -8 October 1980 Author Dr Douglas M.Watts Dr Jelena Aurer- Kozel j Dr Peter B.V.Hunter Dr Kjeld Jensen Dr A.V.X.V.de Silva Dr J.S. Weisfeld Regional Office Dr B.A. Hatthevs Dr W. Marty Regional Office Ms Anne Mills I Author Mr K.R. Cripwell Regional Office NT K.R. Cripvell Prof. Nelson L. Nemerow Dr E. Strijak Mr S.K. Tasgaonkar Regional Office Mr R. Stamper Regional Office Plr M.A. Hussain Document SEA/Educ./37 SEAIEduc . / 38 SEA/E~UC. /39 sEA/EH/ 240 SEA/EH/241 SEA/EH/242 SEA/EH/243 Title Education Assignment report on training of health personnel (including comaunity health workers) for primary health care (ICP HM) 0131, 5 November - 10 December 1979 Paport of a WHO expert group (rn regional network of public health training institution8 for South-Eemt JLlia (ICP PTR 002), New hlhi, 6-10 October 1980 Assignment report on development of comrnrnication skills in English fpy medical education in Burma(TCP PTR 0041, 16 August - 21 Septembar 1980 Environmental Health Assignment report on induawial wastes treatwnt for environmental pollution control, India (IND SES 0011, 1-26 January 1980 Assignment report on drinking water quality #urveillence in Bangladeah (IRP BSM 043), 7 March - 1 April 1980 Assignment report on Taung Zin Water Supply System (improvements and extenrionl, &Irma (BUU EHP Q01), 31 December 1979 - 30 March 1980 Agency terminal report on pollution SEA/EH/244 SEA/EH/245 investigation and control, Uaharashtra, India, project findings and reconunenda- tions (WHO project IND CEP 005, UNDP project IND/75/044) Assignment report on building up of informtion services in environmental health in the South-East Asia Region (ICP EHP 0021, 11 March - 25 April 1980 Report of an inter-regional seminar on SEA/EH/246 environmental health development, New Delhi, 11-16 December 1978 Assignment report on UNDP/WHO Inter- regional Cooperation Project - large- scale shallow tuberelllhand-pump scheme for the Terai, Nepal (ICP BSM 0021, 2 December 1979 - 4 February 1980 I Document Title Assignment report on strengthening of health services in newly industrialized areas on the west bank of Irrawady Rive. Burma (sanitation aspects) (BUR WKH 001 18 August - 16 October 1980 Agency terminal report (project finding, and recomendations) rural water supply East Java, Indonesia (WHO project IN0 PIP 003 - UNDP project INS/73/003) Assignment report on atmospheric trans- port and diffusion of industrial air pollutants for environmental pollution control, India (IND EHP 001), 13 August 12 September 1980 Assignment report on distillery effluenl India, (IND RCE 001), 20 October - 7 November 1980 Assignment report on operation and main, tenance of logging equipment, rural water supply, Thailand (THA EHP 001). July-November 1980 Assignment report on design and operatii of urban water treatment plants in Indi; (IND EHP ODl), 3 November - 5 December 1980 Epidemiology Assignment report on epidemiological study of the problem of unidentified fevers in Sri Lanka (SRL ESD 0021, 28 October 1979 - 25 January 1980 Assignment report on epidemiology and disease control, Bangladesh (BAN ESD DOZ), 10 August 1976 - 30 April 1980 Assignment report on epidemiological surveillance in Thailand (THA ESD 003), 28 June - 24 August 1980 Assignment report on epidemiology and disease control, Bangladesh (BAN ESD 002), 25 August - 23 November 1980 Assignment report on development of epidemiological surveillance, Nepal (NEP ESD 001), 1 September - 28 November 1980 ~- - Author Dr D. Kantawala Regional Office Prof .Elmer Robinso. Mr John M.Sidwick Mr Alan McFiggans Dr S.P. Mathur Prof. P.L. hopper' Dr Sujarti Jatanasen Dr Aung Myat Prof. J. Cervenka Dr Talaat Helmy Girgis Dr Sujarti Jatanasen Document SEAIEPIl19 SEAlEPIl20 SEAlEPIl21 SEAIEPI122 SEAlFill21 SEAIFood Hyg./5 SEA/Haem.Fever/36 SEA/Haem.Fever/37 SEAIHaem.Fever/36 TStle Expanded Promamme on hnization Assignment report on strengthening and developing the cold chain in the expanded programme on imunization, Burma (BUR EPI 001), 22 June - 29 July 1979 Assignment report on expanded programe on immunization in Indonesia (ICP SPI 003), October 1977 - December 1979 Assignment report on expanded programme on immunization in Nepal (ICP SPI 0031, January-February 1980 Assignment report on expanded programe on immunization in Burma (BUR EPI 001), 27 May - 16 June 1960 Filariasis Assignment report on filariasis research (National Institute of Comnunicable Diseases, Delhi), India (IND ESD 001), 10 November - 7 December 1980 Food Hygiene Assignment report on food and drug control, Thailand (THA FSP 001), 16 September - 15 October 1980 Haemorrhagic Fever Assignment report on epidemiological situation of dengue fever at Uale and sane other atolls, and long-term planning for prevention and control, Maldives (ICP ESD 001), 28 December 1979 - 26 February 1980 Report on a meeting on research in viral haemorrhagic fevers in. the Eastern Mediterranean, South-East Asian and Western Pacific Regions (ICP RPD 002), New Delhi, 10-14 March 1980 Assignment report on strengthening of epidemiological surveillance and control of dengue haemorrhagic fever in ~ndonesia (INO ESD 003), 19 July - 14 August 1980 Author Mr James Cheyne Dr Daniel Tarantola Dr Idadul Islam Dr Nadda Sriyabhaya Prof. G.S. Nelson Mr J.G. Cunrmings Dr Abdul Quadir Khan Regional Office Dr S.B. Halstead - Document Title Health Education Assignment report on National Institute of Preventive and Social Medicine (study programme in health education), Bangladesh (BAN PTR 005), 1 January - 25 March 1980 Assignment report on strengthening of tk health manpower development programe ir Bangladesh (BAN PTR 003), 20 February - 19 April 1980 Report on research in health behaviour, health education and cormunity parti- cipation - Report of an inter-country meeting (ICP RPD 002), New Delhi, 3-8 November 1980 Assignment report on health education in the basic training programmes for nurses and midwives in Sri Lanka (SRL HED 001), 2 June - 9 August 1980 Assignment report on health education in Maldives (MAV PTR 001). 13 September 12 November 1980 Health Laboratory Methods See SEA/Occ .Hlth/23 Assignment report on clinical bacterio- logy in Mongolia (MOG LAB 003). 13 December 1979 - 12 February 1980 Assignment report on health laboratory services in Sri Lanka (SRL LAB 001), January-March 1980 Assignment report on promotion of health laboratory services and technology in pondicherry , India (1ND ATH 002), 2-30 June 1980 Assignment report on development of health laboratories and allied laboratory services (BAN ATH 001), May-July 1980 Assignment report on health laboratory promotion and health laboratory techno- logy in Karnataka, India (IND ATH 002), 1 July - 30 September 1980 Author Dr Thomas H. Gray Dr Theodore L. Bell Regional Off ice Prof. H.J. Weddle Mr O.M. Sutisnavutra Dr Imrich Odler Dr M.I. Jhala Dr Ivan Ivanov Mr B.T. Suitters Dr Ivan Ivanov I Document Title Assignment report on strengthening of laboratory services, Thailand (THA LAB 001), January-March 1980 Assignment report on health laboratory promotion and health laboratory techno- logy, Kerala, India (IND ATH 002), 1-31 October 1980 ~ssignment report on food and water control in Burma (WHO Project BUR ATH 003 - UNDP Project BUR/74/027), 31 August - 11 October 1980 Assignment report on health laboratory services in Thailand (THA ATH 001), August-November 1980 Health Literature Assignment report on the developnent of the South-East Asia Regional Health Literature Library and Information Services Network (HELLIS) (ICP HLT 001), 13 February- 12 March 1980 Assignment report on the development of health science information and documen- tation network in Indonesia (IN0 RPD 001), 16 June - 14 August 1980 Health Manpower Development Assignment report on strengthening of health manpower development, Mongolia (MOG PTR 001), September-October 1980 Assignment report on National Institute of Preventive and Social Medicine,Dacca, Bangladesh (BAN PTR 005), 3 July - 3 December 1980 (see also SEA/Med.Educ.) Health Services Development Report on the joint WHOIUNICEF meeting on strategies for health for all by the year 2000 (ICP PHC 002), 24-30 June 1980 Health manpower planning and community ~artici~ation for primary health care (Report and background documentation of the technical discussions held during the Thirty-third session of the WHO Regional Committee for South-East Asia, September Author Dr Y.S. Nimbkar Dr Ivan Ivanov Dr Bjorn Fredebo Thomsen Mr B.T. Suitters Mr Parlinah Moed jono Mrs Khin Thet Htar Prof. A.A.Podkolzin Prof. Z. Bencic Regional Office Regional Office r Document SEA/HSD/19 SEA/HSD/ZO 1 SEA/Med .Educ .I381 SEA/HS /I66 : SEA/HS/167 I I SEAILepI72 SEA/RES/30 SEAILepj73 SEAIT31158 SEAILepl74 SEA/Ma1/124 SEA/Ma1/125 SE~/Ma1/126 SEA/Ma1/127 Title Assignment report on health services developnent, Indonesia (IN0 SPM 001). 9-18 December 1980 Report of a WO (SEAR01 except group meeting on team work for primary health care (ICP PTR 003), 27-31 October 1980 Health Statistics See SEA/Med .Educ./381 Report on a meeting on lay reporting of health information for primary health I care (ICP SPM 002), 27-31 October 1980 Leprosy Report on an inter-country consultative meeting on leprosy research and control, New Delhi (ICP RPD 002.61),2-7 June 1980 Status report on leprosy and tuber- culosis control programme, Maldives (MAV BVM 001), January 1981 Assignment report on leprosy control in India (IND BVM 001), 7 July - 8 October 1980 Malaria Malaria research and training in Nepal - Report of an AsDBlWHO Mission, 26 January - 25 April 1980 Seminar report on anti-malaria operations with special reference to applied field research, Bangkok, mailand (ICP RPD 002), December 1979 Assignment report on anti-malaria programme, Thailand (nlA MPD 001), 1 September 1974 - 31 March 1980 Assignment report on malaria eradication, India (laboratory husbandry of the larvivorous fish Nothobranchius pentheri), (IND MPD 001), 4 June - 4 July 1980 Author Dr Eric N. West Regional Off ice Regional Office Regional Office Dr Anan C. Pakdi Dr Ernest P. Fritschi Dr G. Sambasivan Regional Office Dr Peter F. Beales Dr Richard Haas Document I SEA/Ma1/128 4EA/Ma1/129 SEA/Ma1/130 SEA/Mal/l31 i SEA/Ma1/132 I SEA/Mrl/ll3 SEA/Ma1/134 SEA/Ma1/135 SEA/Med.Educ .I378 SEA/MCH/137 SEA/MCH/138 SEA/MCH/139 SEA/MCH/140 Title Assignment report on malaria control in Maldives (MAV MPD 001), October 1974 - July 1980 Report of a mission on malaria manpower development and training in Burma (ICP MPD 004), 1-8 November 1980 Report of a mission on malaria manpower development and training in Bangladesh (ICP MPD 004), 1-8 November 1980 Report of a mission on malaria manpower development and training in Indonesia (ICP MPD 0041, 23-29 November 1980 Report of a mission on malaria manpower development and training in Nepal (ICP MPD 004), 23-29 November 1980 Report of a mission on malaria manpower development and training in Sri Lanka (ICP MPD 004), 30 November - 10 December 1980 Report of a mission on malaria manpower development and training in Thailand (ICP MPD 0041, 8-23 November 1980 Report of a mission on malaria manpower development and training in India (ICP MPD 0041, 27-31 October and 15-16 December 1980 Maternal and Child Health See SEA/Med.Educ .I378 Assignment report on public health admin- istration (MCHIFP programmeslimproving MCH/FP services),Maldives (MAV SPM 001), 23 January - 23 March 1980 Assignment report on health laboratory services in Sri Lanka (SRL LAB 001), January-March 1980 Report of an inter-country meeting on school health, Bangalore, India (ICP MCH 003), 25-30 August 1980 Author Dr J.R.M. Schepens Prof. B. Richter Prof. E.M.Ungureanu Prof. B. Richter Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Dr D.A. Sonnadara Dr H.I. Jhala Regional Office Document SEAlMCHl141 SEAlMCHl142 SEAIMCHI 143 1 SEAlMCHlFPl77 SEAlMCHlFPl7.9 SEAIMCHIFP I79 SEAIMed .Educ .I387 SEA/MCH/FP/~O SEA/MCH/FP181 SEA/MCH/FP/82 SEAIMed.Educ.1378 SEAlMCHl137 Title Assignment report on strengthening of gynaecologicallobstetrical services, Maldives (MAV SF'M 001), 31 October - 1 December 1980 Report on a meeting on reproductive health of adolescents in some countries of South-East Asia, Bangkok (ICP MCH 003), 28 July - 2 August 1980 Meeting on women in health and develop- ment programme, New Delhi (ZCP SPM OOl), 12-13 December 1980 Maternal and Child Health (Family Planning) Agency terminal report on mobile steri- lization teams,Bangladesh (BAN HRP 002), June 1979 1 Agency terminal report on strengthening of family planning with special reference to MCH-based family planning, Bangladesh (BAN MCH 003) Report on a WHO study tour on maternal and child health and family planning in the People's Republic of China (ICP MCH 013), 2-15 November 1980 See SEAIMed .Educ .I387 Project findings and recmendations on family planning manpower training, Bangladesh (BAN MCH 002), December 1980 Report on maternal and child health and family planning for family health care work - evaluation of in-service training programmes for physicians working in primary health centres, India (IND MCH 0031, August-November 1980 Medical Education Assigment report on post-graduate medical education in Sri Lanka (SRL PTR 003), March 1980 Author Dr Urmil Sham 6 Dr Shashi Chhabra Regional Office Regional Office Regional Office Regional Office Regional Of £ice (Dr T. Perera) Regional Office Dr Preecha Vichitbandha Mr G.G. Mitchell Document Title Author Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003). March 1980 I Mr R.R. MacDonald Assignment report on Institute of Medicine (Teaching Hospital), Nepal (NEP PTR 0021, 18 February - 18 March 1980 Assignment report on Institute of Medicine (Teaching Hospital), Nepal (NEP PTR 002), October 1980 Assignment report on undergraduate I Dr Palitha Abeykoon medical education, Indonesia (IN0 EDS 001). March-May 1980 i Dr A. Timappaya, Mr J.S. Shastri 6 Mr J. Sarvay Dr A. Tinnnappaya, Mr J.S. Shastri b Mr J. Sarvay Assignment report on National Institute of Preventive and Social Medicine (training in biostatistics), Dacca, Bangladesh (BAN PTR 005), 25 February - 25 May 1980 Assignment report on post-graduate 1 Dr O.P. Bhardvaj medical education in Sri Lanka ! (strengthening of Radiology Department, ' Post-graduate Institute of Medicine) (SRL PTR 003), 26 May - 20 June 1980 I Dr Talaat Helmv Girgis Assignment report on medical education in Indonesia (IN0 HMD 001), 4 March 1979 - 4 March 1980 Dr Douglas J.Magin Assignment report on medical education in Indonesia (IN0 EDS 001), August 1975 - August 1980 Dr Paul Alexander Assignment report on a curriculum for veterinary public health in the Master of Public Health Programme of Mahidol University, Bangkok (THA EDS 001). 14 July - 13 August 1980 Prof.. M. Abdussalam Assignment report on National Institute of Preventive and Social ~edicine, Dacca (training in population dynamics) (BAN PTR 005), 25 Hay - 24 August 1980 Dr T.H. Girgis Agency terminal report on education and training of health manpower, Burma (project findings and recommendations) (BUR HMD 005) Regional Office Author Dr Dan. E. Benor Dr G.H. Begbie Mr Ross Mitchell Dr Allan Tait Prof. Zdenko Skrabalo Dr Jiri Rotta Dr K.K. Mittal Regional Office Miss E. Kunderman Me Mary Jane Amundson Miss A. Banu Document SEA/Med .Educ . 1389 SEA/Med.Educ.I390 SEA/Nurs/304 ~~~lMentl60 SEA/Ment/61 SEAINCDIS SEA/NCD/6 SEA/NCD/ 7 SEA/Nurs/302 SEA/Nurs/303 SEA/Nurs/304 SEA/Ment/60 SEA/Nurs/305 Title Report on a visit to lhailand (curriculum development in health services) (THA EDS 001), 18 November - 5 December 1979 Assignment report on bachelor degree programme, Tribhuvan University, Kathmandu, Nepal (NEP PTR 001), 27 December 1979 - 21 September 1980 (see also SEAIHMD) Mental Health See SEA/Nurs/304 Assignment report on organization and management at the Angoda and Mulleriyawa hospitals, ambulatory psychiatric care in Sri Lanka (SRL MNH 001), 26 March - 20 May 1980 Noncmunicable Diseases Assignment report on antidiabetic services, Bangladesh (BAN OND 001), 30 March - 28 April 1980 Assignment report on noncmunicable diseases prevention and control (MOG OND 001), 7 September - 6 October 1980 Assignment report on other non- comnicable diseases (diabetes, endocrinology),Bangladesh (BAN OND 001), 11 November - 2 December 1980 Nut-sin& Survey report on nursing and midwifery education and personnel in the South- East Asia Region, 1979 (ICP PTR 003) Assignment report on nursing advisory services in Sri Lanka (SRL HMD 002), 2 October 1979 - 29 March 1980 Assignment report on mental health/ psychiatric nursing development in India (IND EDS 003), 30 December 1979 - 12 May 1980 Assignment report on nursing education and services, Nepal (NEP PTR 001) January-September 1980 / Nutrition I Document Assignment report on development of health services (health and nutritional status of school children) Bhutan (BHU HSD 001), 11 January - 11 April 1980 Assignment report on nutrition surveil- lance monitoring, evaluation and planning, Indonesia (IN0 NUT 003), 1 June - 30 July 1980 I I Title Report of the meeting of principal investigators of Nutrition Research Project No.1 on situation analysis of the nutrition component of primary health care (ICP RPD 002), 10-28 November 1981 Author Dr C.C. Mahendra Dr Hartmut Schubel Regional Of £ice Paper on workshop on nutrition monitorin Regional Office and evaluation, New Delhi (ICP NUT 005), 17-21 February 1981 Report of the meeting of the Sub-committee on Nutrition Research Programme, New Delhi (ICP RPD 0021, 25 November 1980 Occupational Health Assignment report on development of central and regional occupational health and industrial hygiene laboratories in Indonesia (WHO Roject IN0 HWP 001 - UNDP Roject INS/72/028), 25 October - 31 December 1979) Assignment report on development of occupational health laboratory techniques in Thailand (THA HWP 001), 1-18 January 1980 Assignment report on commissioning and strengthening of chemistry laboratory for occupational health and industrial hygiene, Bangladesh (BAN HSD 002), 14 December 1979 - 26 February 1980 SEA/Nut/78 Regional Office Assignment report on prevention and treatment of malnutrition, Burma (BUR MCH 004), 5 August - 16 September and 2-18 October 1980 Dr Somchai Durongde j I Dr Arie de Bruin Dr Arie de Bruin Dr Branislav Tokovic t Document SEA/Occ .Hlth/24 SEA/Occ.Hlth/25 SEA/Med/Educ .I380 SEA/OMC/Z~ SEA/Ophthal/32 SEA/O~~ tha 1/33 SEA/Ophthal/34 SEA/Ophthal/35 SEA/Ophthal/36 SEA/Pharmacolopy/9 SEA/RES/36 SEAIFiadllO9 Title Agency terminal report on Central and Regional Occupational Health and Industrial Laboratories, Indonesia - project findings and recmendations, (IN0 HWP 001) Asaignment report on occupational health and safety in agriculture (analysis of pesticides) in Sri Lanka (SRL WKH 001), 19 October - 23 November 1980 Organization of Medical Care See SEAlMed .Educ. 1380 Ophthalmology Assignment report on prevention of blindness in Bangladeah (BAN PBL 001), December 1979 - February 1980 Anaignwnt report on prevention of blindness in Sri Lanka (ICP PBL 001), 3 March - 1 April 1980 Asaigmnent report on prevention of blindness in Sri Lanka (SRL PBL 001), May-June 1980 Assignment report on organizing relief from eye diseases in Maldives (MAv SPM 001), 18 June - 14 July 1980 Report of an inter-country workshop on relief cataract services in the South- East Asia Region, Hyderabad, India (ICP PBL 0021, 29 September - 4 October 1980 Pharmacology Assignment report on health research in support of the People's Health Rograme in Burma (BUR RPD 001), December 1980 Radiation Assignment report on aafe use and main- tenance of radiological equipment in Maldives (MAV PTR 001), 9-23 June 1980 Author Regional Office Dr S. Lj. Victorovic Dr K. Konyama Prof. P.K. Khosla Prof. P. Siva Reddy Dr O.N. Krishna Regional Off ice Prof. D.R.Laurence Mr M.L. Bhutani SEAIMed .~duc .I383 1 See SEAhled .Educ .I383 SEA/Rad/llO I Document 1 I Title Assignment report on repair of X-ray machines and advice on training in repair and maintenance of X-ray equipnent in Maldives (MAV PTR 001), 22 June - Author Mr I.C. Perera Assignment report on the development of cancer control in Zhailand (THA CAN 001), 15 September - 15 October 1980 I Research Stud y, Research Training, etc. 8 July 1980 i Dr Sven Walbom- Jorgensen Assignment report on strengthening of the Electro-Medical Engineering Division, Sri Lanka (SRL SPM 003), June-November 1980 Assignment report on health manpower development research in selected countries of South-East Asia (ICP HMD 013), 31 January - 30 April 1980 Dr C.A. Greatorex See SEAfCholera132 1 see SEAIkp/72 See SEA/HE/111 SEAITrad.Med.114 See SEAITrad.Med.114 SEA/RES/32 ( See SEAlNut175 I See SEAlNut176 See SEAINutI77 See SEA/Pharmacology/9 I Sexually-Transmitted Diseases (STD) I Report on an inter-country meeting on the control of sexually-transmitted diseases (ICP BVM 002), New Delhi, 3-7 November 1980 1 Dr Sharad Kumar Regional Office Document I=== Title Traditional Medicine Report on a regional meeting on the development of research protocols in priority areas in traditional medicine, Varanasi (India) (ICP RPD 002), 11-13 November 1980 Tuberculosis Assignment report on tuberculosis contro programme in Nepal (NEP BVD 002), December 1979 - April 1980 Assignment report on tuberculosis contro programme in Nepal (NEP BVM 002), October-December 1980 Assignment report on epidemiological research in tuberculosis: Tuberculosis Research Centre, Madras, and National Tuberculosis Institute, Bangalore (India) (IND BVM 002). 19 August - 6 September 1980 See SEAILepl73 Vector-Borne Diseases Control Assignment report on strengthening of epidemiological surveillance, Indonesia (IN0 ESD 003), January 1978 - December 1979 Assignment report on vector control (Phase 111, Sri Lanka (SRL VBC 002), July-August 1980 Report on a visit to Indonesia on strengthening of epidemiological surveillance and control (IN0 ESD 003), 19 September - 20 November 1980 Veterinary Public Health See SEA/Med .Educ .I386 Author Regional Office Dr Kyaw Myint Sir John Crofton Dr Tadao Shimao Mr Raymond T. Collins Mr J.E. Graham Dr D.A. Muir
A comparative table showing the procurement trend over the last decade is given below: PROCUREMENT FIGURES OF SUPPLIES AND EQUIPMENT AND MEDICAL LITERATURE, BY CALENDAR YEAR 5. COLLABORATION WITH OTHER AGENCIES With the endorsement of the goal of health for all by the United Nations General Assembly as per its resolution A/RES/34/13, collabora- tion among the agencies of the United Nations system has increased not only for the mobilization of extrabudgetary resources to intensify the primary health care programmes but also for the identification of areas of appropriate collaboration in order to avoid duplication of efforts. Follow-up actions continued on the Meeting on Financing of Primary Health Care Programmes in Asia hdd in July 1979. in US Dollars) Local Purchase as a percentage of Total 19.89% 24.04% 9.37% 10.02% from 1977. Year - 1971 1972 1973 1974 1975 1976 1977* 1978 1979 1980 *Local 5.1 United Nations There is continuing close coordination with the Regional Representa- tive for Western South Asia of the United Nations High Commissioner for Refugees stationed in Bangkok in respect of refugees in Indonesia and Thailand. Procedures for the United Nations Interim Fund for Science and Technology for Development (IFSTD) have been finalized by the United Nations Conference on Science and Technology for Develop- ment (UNCSTD) and circulated to the countries in the Region. Earlier, in response to a request from UNDP, several countries in the Region had prepared and submitted project proposals for finances from the Fund. However, these resources being small as compared to the requests, no final decision on these requests has yet been taken by the UNDP Administrator. Total Procurement 763 137 1 424 086 1 807 730 3 415 000 2 782 000 3 124 000 3 801 567 8 926 324 10 749 445 7 682 169 purchase figures (Expressed Local Purchase within the Region 756 243 2 146 229 1 007 565 769 500 are available only Proposals for assistance from the Voluntary Fund for the United Nations Decade for Women have been sent to the UNDP Resident Represen- tatives in the countries concerned. With increased resources becoming available to the Fund, UNDP was asked to assist with the development of project proposals through its country offices and with their submission to the Fund. The resources of the Fund are to be utilized to supplement activities in the areas designated by the General Assembly which are designed to implement the goals of the United Nations Decade for Women, viz., equality, development and peace, priority being given to the related programmes and projects of the least developed, land-locked and island countries. The Regional Office was represented at the World Conference of the United Nations Decade for Women: Equality, Development and Peace, held in Copenhagen in July 1980. A Meeting on Women in Health and Development was held in the Regional Office on 12 and 13 December 1980 at which Bangladesh, Burma, India, Indonesia, Maldives, Mongolia, Sri Lanka and Thailand were represented. In pursuance of the United Nations General Assembly resolution ~/RES/34/13, the Secretary-General, after consultations with the appropriate national authorities, has designated a number of UNDP Resident Representatives in the Region as resident coordinators of the United Nations system's operational activities for development. In April 1981 the WHO Programme Coordinator in Indonesia visited stricken areas in Irian Jaya, on behalf of the United Nations Disaster Relief Organization, following an earthquake. 5.1.1 United Nations Development Programme (UNDP) As the executing agency for 35 country and inter-country UNDP-funded projects in the Region, the Regional Office has been maintaining close liaison with UNDP at different levels - at the country level between the WHO Programme Coordinators and the Resident Representa- tives, and at the regional level with the Resident Representatives as well as with the Regional Bureau for Asia and the Pacific. The total delivery of UNDP projects in 1980 amounted to USS4.5 million. The Regional Office participated in two important meetings convened by UNDP - the Inter-governmental Meeting on Inter-country Programming for the Least Developed Countries (LDCs) in Asia and the Pacific, held in November 1980 at Dacca, and the Inter-governmental Meeting of Development Assistance Coordinators in Asia and the Pacific, which took place in New Delhi in February 1981. At the former meeting the importance of health was stressed, and a sectoral review of the health problems in LDCs was sent to UNDP Headquarters for presentation at the United Nations Conference on LDCs scheduled to take place in Paris in the third quarter of 1981. The latter meeting was the result of a year-long programming exercise and discussions between UNDP and the WHO Regional Offices for South-East Asia and the Western Pacific. Consultations also took place between SEAR0 and WPRO for the joint submission of regional and sub-regional health programmes to UNDP for the 1982-86 IPF (Indicative Planning Figure) period. The Regional Office collaborated with UNDP at the country level in the preparation of its country programmes in respect of Bangladesh, Bhutan, Maldives and Nepal, which were presented to the UNDP Govern- ing Council in June 1981. As a result of the changed criteria to be applied in determining the indicative planning figures (IPF) for the period 1982-86, allocations to countries are expected to be compara- tively higher. As a consequence, the share in the countries' IPFs for health and related fields is also expected to go up, with special emphasis on increased assistance to the LDCs. As a result of UNDP's becoming the focal point for the IDWSSD and its acceptance of WHO'S goal of health for all, collaboration with UNDP at all levels has become much closer, and a continuous dialogue has been maintained for the smooth implementation of UNDP-funded programmes. 5.1.2 United Nations Children's Fund (UNICEF) Since both WHO and UNICEF are committed to primary health care, contact was maintained with UNICEF to explore ways of further reinforcing mutual collaboration. An "in-house" UNICEF/WHO meeting was held in New Delhi in February 1981 which identified specific areas and activities from among those included in the broad concept of primary health care, with the aim of giving a concrete shape to joint efforts. WHO also participated in the UNICEF East Asia and Pakistan Regional staff meeting held in Bangkok in March 1981. At this meeting the progress of implementation of primary health care in various countries was reviewed with the focus on organizational developments, manpower aspects and community participation. At a high-level meeting between the Director-General of WHO and the Executive Director of UNICEF in New York in November 1980 the programme areas identified for collaboration included EPI, diarrhoea1 disease control, essential drugs, water and sanitation, nutrition and child health, which are the essential components of health for all. In pursuance- of a directive following this meeting, regular consulta- tions at country level between representatives of the two agencies are taking place. In addition, two important meetings were held - one in the Regional Office in February 1981 and the other at Bangkok in March 1981 - to find ways and means of overcoming difficulties in implementing the programmes and to identify the role of each organization. Reciprocal briefing for new staff members of both organizations at regional and country levels has been agreed to and is to take place as a regular feature. 5.1.3 United Nations Fund for Population Activities (UNFPA) In 1980, the Regional Office executed 17 projects involving a total delivery of $2.3 million. In the implementation of these projects, continuous dialogue was maintained with the UNFPA Coordinators through the WHO Programme Coordinators in the countries concerned and with UNFPA Headquarters in New York. The visit of the UNFPA Coordi- nators in Bhutan and Thailand to New Delhi in February 1981 was utilized to hold discussions on some of the administrative questions concerning the UNFPA-funded projects being executed by WHO in these two countries. In Bangladesh, India and Indonesia the governments themselves are executing UNFPA projects in the health field. Nevertheless, the Regional Office is closely collaborating by providing technical assistance, when requested. In Nepal, WHO is the co-executing agency for four UNFPA-funded projects approved during 1980. UNFPA's approval was received for the continuation, though on a restricted scale, of the Regional Team on Family Health, which is based in New Delhi and Thailand and which provides appropriate technical backstopping to the Member countries of the Region. The Regional Office provided full cooperation to UNFPA by deputing its staff to participate in UNFPA basic needs assessment missions to Bhutan, Maldives, Sri Lanka and Thailand. Similar assistance was provided to the UNFPA Coordinator in India in the annual country review of the UNFPA programme. Regional Office staff also partici- pated in the tripartite project review in Bhutan which was carried out in May-June 1981. 5.1.4 Economic and Social Commission for Asia and the Pacific (ESCAP) As in the past, the Regional Office has maintained liaison with ESCAP through the WHO Programme Coordinator to Thailand assisted by a medical officer. WHO actively participates in ESCAP's meetings, seminars, etc., and their reports are regularly distributed to the Eastern Mediterranean and Western Pacific Regional Offices. The Asian and Pacific Development Institute located in Bangkok was closed down in July 1980 and integrated with the Asian and Pacific Development Centre in Kuala Lumpur. WHO also provided assistance through faculty and fellowships for ESCAP's Programme on Health and Society under the Technical Cooperation Division. In November 1980, ESCAP and WHO jointly organized a research seminar in Bangkok on the social and psychological aspects of fertility and family planning behaviour. 5.1.5 International Atomic Energy Agency (IAEA) Several institutions in the Region participated in the twenty-sixth IAEAIWHO postal dose inter-comparison programme. The Regional Office distributed sets of dosimeters to the institutions and transmitted the reports from the institutions to IAEA through WHO Headquarters. Ihe Regional Office continues to collaborate closely with IAEA. The inter-comparative personal monitoring film badge service continued in a number of countries, and film badges and films were made available to the institutions. The radiation to which the staff in these institutions are exposed is being monitored. 5.2 Specialized Agencies 5.2.1 Food and Agriculture Organization of the United Nations (FAO) FA0 continued to be associated with a UNDP-funded project in Burma on the food and drug quality control laboratory. mere have been regular consultations with FA0 in fields of mutual interest. 5.2.2 International Labour Organisation (ILO) Relations with the International Labour Organisation remained cordial. 'Ihe Regional Adviser on Noncommunicable Diseases participated in a UNDP-sponsored preparatory mission in Burma in connexion with a project on the training and rehabilitation of the disabled. It is expected that both WHO and ILO will be executing the project. The WHO Programme Coordinator to Thailand represented the Organization at the ILO Meeting of the Designated Bodies to be part of the 'Inter- national Occupational Safety and Health Hazard Alert System' in the Asian and the Pacific Regions, held in Bangkok in December. A draft project proposal on the Asian Regional Research Project for Improving Quality of Working Life - to be implemented in Bangladesh, India and Sri Lanka in this region - has been circulated to the countries concerned before the project is started. 5.2.3 United Nations Industrial Development Organization (UNIDO) UNIDO, the associated agency for the UNDP-funded project, "Primary Health Support Services Programme", in Nepal, is expected to provide experts in the production of drugs and also procure equipment for the project. Continuous consultations were held with UNIDO, and two of its staff members visited the Regional Office in March 1981 for discussions. 5.2.4 United Nations Educational, Scientific and Cultural Organization (UNESCO) Collaboration with UNESCO was maintained in technical fields of mutual interest. The UNESCO Senior Programme Specialist in Basic Sciences in New Delhi visited the Regional Office for discussions on a draft proposal for preparatory assistance by UNDP for an inter-country project on the strengthening of the regional network for improving the species of locally available medicinal and aromatic plants and their use in the chemical and pharmaceutical industry. A technical paper on the reliability of roof-runoff for domestic water supply in selected areas of Indonesia, prepared by the UNESCO Regional Adviser for Hydrology stationed in Jakarta, has been circulated to the WHO sanitary engineers in the Region. 5.2.5 World Food Programme (WFP) Liaison with the WFP was maintained through WHO Headquarters at the organizational level. At the country level, both the Regional Adviser on Nutrition and the WHO Programme Coordinators in the countries concerned were in liaison with WFP officials in respect of the various WPF projects. WHO was represented in WFP appraisal missions on transmigration schemes in Indonesia and the Mahaweli Ganga development programme in Sri Lanka, as well as in a mission on the preparation of a terminal report on milk marketing and dairy development in India. The Regional Office reviewed different proposals for assistance from the WPF from Bangladesh, Bhutan, India, Indonesia and Sri Lanka. 5.2.6 International Bank for Reconstruction and Development (IBRD) Collaboration continued with the World Bank in promoting and assisting the development of the water supply and sanitation sector through the regionalized WHO/IBRD Cooperative Programme. In addition to Bank- oriented activities, which included participation in water supply- sanitation project identification, and preparation and/or supervision in Bangladesh, India, and Thailand, the staff of the Cooperative Programme increased their involvement in sector support programme development and IDWSS Decade planning efforts. Among these activities were manpower development missions to Nepal and Thailand, health education project identification missions to the States of Bihar and Rajasthan in India and to Thailand, and assistance in developing IDWSS Decade national plans in Bangladesh, India and Maldives. The Regional Cooperative Programme staff, consisting of a sanitary engineer and a financial analyst, carried out 22 missions, five of which were joint missions with World Bank teams; three were assisted by WHO Headquarters staff, and two were joint missions with UNICEF. One WHO staff member participated in the WHO~IBRD Workshop held in Washington in October. The Director of the Population, Health and Nutrition Department of the Bank visited Sri Lanka during February. 5.3 Asian Development Bank (AsDB) Relations with the Asian Development Bank continued to be close and cordial. Working arrangements were signed between WHO (represented by the Western Pacific Regional office) and the AsDB in November 1980. The report of the assessment/review mission to Nepal on malaria research and training was finalized and forwarded to AsDB. WHO provided staff support to the Bank's following activities: fact- finding mission for the Thai rural water supply, project review mission on the production and distribution of drugs in Indonesia, fact review mission on the health and population project in Thailand, and follow-up mission to Sri Lanka on health services. The Director of the Infrastructure Division of the Bank held discussions in the Regional Office during a visit to New Delhi. 5.4 Bilateral and Other Agencies The Organization continued to maintain contacts with bilateral and other agencies and provided technical advice and expertise, where necessary, to Member countries receiving assistance on a bilateral basis. The major agencies/governments which assisted health programmes in the Region were: the Swedish International Development Authority (SIDA), the Government of the Netherlands, the Danish International Development Agency (DANIDA), the Canadian International Development Agency (CIDA), the Japan Shipbuilding Industry Foundation (JSIF), the Norwegian Agency for International Development (NORAD), and the Ministry of Overseas Development of the United Kingdom. Assistance provided by these organizations was in such fields as prevention of blindness, vector-borne disease control, tuberculosis, leprosy, malaria, water supply and cancer. 5.5 Non-governmental Organizations in Official Relations with WHO Cooperation continued with the local and national agencies affiliated to international non-governmental organizations. As mentioned above, representatives of three non-governmental organizations attended the thirty-third session of the Regional Committee for South-East Asia in September 1980. 6. PUBLIC INFORMATION The accent during the year under review was on expanding and broaden- ing the base of activities for the dissemination of information to help motivate the community's interest and involvement in achieving the universal goal of health for all. Consequently, information material was produced and provided to a variety of users and potential users. The experiment of sending information material to the zonal offices of the Indian Railways for use by their sub-units, which was started last year, was extended to cover departments in other ministries such as information and broadcasting, social welfare, food and agriculture and defence health organizations. 'The names of health educators in the Region were added to the mailing list of the newsletter "HFA/2000", and steps were taken to make the newsletter more reflective of WHO activities, particularly in the field of research development. A Regional Directory of Non-Govern- mental Organizations working in the health and related sectors was also prepared and relevant information material sent to them for their use and further dissemination. Regional Committee: The thirty-third session of the Regional Committee held in Male was a unique media experience, with the local radio and television beaming the opening and closing sessions live, and the newspapers giving the event wide coverage. World Health Day: The 1981 World Health Day theme, "Health for All by the Year 2000g', generated a great deal of interest in the media with special radio and television programmes being produced in many count- ries. To cope with the demand for materia1,over 9000 information kits were distributed. These kits consisted of articles, photographs and wall-charts with contributions from the Unit. A limited number of stickers (9000) was also produced to highlight the HFAj2000 theme. These sets were sent to the mass media, health education bureaux, social welfare agencies, educational institutions and community groups in the Region.
Annex 6 LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 June 1980 - 31 May 1981) . Document SEAIATHI~ SEAICancerlLO SEA/Cancer/Ol SEAICancerlO2 SEA/Cancer/43 SEAlCVD128 SEA/Choleral32 SEAIRES129 SEAlCDl82 Title Appropriate Technology for Health (ATH) Report on regional meeting on appropriate technology for health in relation to primary health care, New Delhi (ICP ATH 002), 24-30 October 1980 Cancer Assignment report on cancer control in Sri Lanka (SRL CAN 006), December 1979 - January 1980 Assignment report on training and services in cytology, India (IND CAN 006), April-May-1980 Assignment report on cancer epidemiology and research in Sri Lanka (SRL CAN 001), 26 August - 25 September 1980 Assignment report on cancer prevention and control in Bangladesh (BAN CAN 001), 10 September - 14 October 1980 Cardiovascular Diseases Assignment report on cardiovascular diseases prevention and control, India (IND CVD 002), April-May 1980 Cholera Assignment report on biomedical research on the production of oral rehydration solution in Sri Lanka (ICP RPD 001), 22-30 May 1980 Cmunicable Diseases Assignment report on the development of the special hospital for cmunicable diseases, Jakarta, Indonesia (IN0 ESD 003), 8 November 1979 - 6 February 1980 Author Regional Office Dr M.D. Snelling Prof. Irena Koprowska Dr Ivan Koza Dr N.L. Petrakis Dr J.G. Sloman Mr Jack Richman Dr Prakorb Boonthai Document SEA/CD/83 SEAIDHI53 sEAIDH~S~ SEA/DH/~~ SEA/DD/ 10 SEA/DD/11 SEA/DD/~~ SEAlDrugs135 SEA/Drugs/36 SEA/Drugs/37 SEAIEcon. /5 I Title Assignment report on strengthening of the arbovirus surveillance programme in Sri Lanka (SRL ESD 002), 22 June - 19 September 1980 Dental Health Assignment report on oral health, Bangladesh (BAN ORH 001) 3 July - 20 September 1980 Assignment report on dental health in Indonesia (IN0 RPD 001), 15 June - 13 August 1980 Assignment report on preventive dental health in Sri Lanka (SRL ORH 0011, 13 October - 21 November 1980 Diarrhoea1 Diseases Assignment report on an epidemic of gastroenteritis in Maldives (ICP BVM 001). 4-17 June 1980 Assignment report on diarrhoea1 diseases in Sri Lanka (ICP RPD 001), 9 May - 17 June 1980 Diarrhoea1 disease control programme in South-East Asia - Report on an inter- country meeting, Nev Delhi (ICP BVM 001.01), 24-28 November 1980 Drugs Assignment report on quality control of food and drugs, Indonesia (IN0 PHB 001), August 1980 Assignment report on Pharmaceutical Centre, Manggarai,Jakarta (INO PHA 001), 19 May - 23 August 1980 Report on inter-country consultative meeting on drug policies and management (ICP DPM 001). New Delhi, 13-16 October 1980 Economics Assignment report on health economics and planning in Thailand (THA SPM 001), 27 April - 8 June and 7 July -8 October 1980 Author Dr Douglas M.Watts Dr Jelena Aurer- Kozel j Dr Peter B.V.Hunter Dr Kjeld Jensen Dr A.V.X.V.de Silva Dr J.S. Weisfeld Regional Office Dr B.A. Hatthevs Dr W. Marty Regional Office Ms Anne Mills I Author Mr K.R. Cripwell Regional Office NT K.R. Cripvell Prof. Nelson L. Nemerow Dr E. Strijak Mr S.K. Tasgaonkar Regional Office Mr R. Stamper Regional Office Plr M.A. Hussain Document SEA/Educ./37 SEAIEduc . / 38 SEA/E~UC. /39 sEA/EH/ 240 SEA/EH/241 SEA/EH/242 SEA/EH/243 Title Education Assignment report on training of health personnel (including comaunity health workers) for primary health care (ICP HM) 0131, 5 November - 10 December 1979 Paport of a WHO expert group (rn regional network of public health training institution8 for South-Eemt JLlia (ICP PTR 002), New hlhi, 6-10 October 1980 Assignment report on development of comrnrnication skills in English fpy medical education in Burma(TCP PTR 0041, 16 August - 21 Septembar 1980 Environmental Health Assignment report on induawial wastes treatwnt for environmental pollution control, India (IND SES 0011, 1-26 January 1980 Assignment report on drinking water quality #urveillence in Bangladeah (IRP BSM 043), 7 March - 1 April 1980 Assignment report on Taung Zin Water Supply System (improvements and extenrionl, &Irma (BUU EHP Q01), 31 December 1979 - 30 March 1980 Agency terminal report on pollution SEA/EH/244 SEA/EH/245 investigation and control, Uaharashtra, India, project findings and reconunenda- tions (WHO project IND CEP 005, UNDP project IND/75/044) Assignment report on building up of informtion services in environmental health in the South-East Asia Region (ICP EHP 0021, 11 March - 25 April 1980 Report of an inter-regional seminar on SEA/EH/246 environmental health development, New Delhi, 11-16 December 1978 Assignment report on UNDP/WHO Inter- regional Cooperation Project - large- scale shallow tuberelllhand-pump scheme for the Terai, Nepal (ICP BSM 0021, 2 December 1979 - 4 February 1980 I Document Title Assignment report on strengthening of health services in newly industrialized areas on the west bank of Irrawady Rive. Burma (sanitation aspects) (BUR WKH 001 18 August - 16 October 1980 Agency terminal report (project finding, and recomendations) rural water supply East Java, Indonesia (WHO project IN0 PIP 003 - UNDP project INS/73/003) Assignment report on atmospheric trans- port and diffusion of industrial air pollutants for environmental pollution control, India (IND EHP 001), 13 August 12 September 1980 Assignment report on distillery effluenl India, (IND RCE 001), 20 October - 7 November 1980 Assignment report on operation and main, tenance of logging equipment, rural water supply, Thailand (THA EHP 001). July-November 1980 Assignment report on design and operatii of urban water treatment plants in Indi; (IND EHP ODl), 3 November - 5 December 1980 Epidemiology Assignment report on epidemiological study of the problem of unidentified fevers in Sri Lanka (SRL ESD 0021, 28 October 1979 - 25 January 1980 Assignment report on epidemiology and disease control, Bangladesh (BAN ESD DOZ), 10 August 1976 - 30 April 1980 Assignment report on epidemiological surveillance in Thailand (THA ESD 003), 28 June - 24 August 1980 Assignment report on epidemiology and disease control, Bangladesh (BAN ESD 002), 25 August - 23 November 1980 Assignment report on development of epidemiological surveillance, Nepal (NEP ESD 001), 1 September - 28 November 1980 ~- - Author Dr D. Kantawala Regional Office Prof .Elmer Robinso. Mr John M.Sidwick Mr Alan McFiggans Dr S.P. Mathur Prof. P.L. hopper' Dr Sujarti Jatanasen Dr Aung Myat Prof. J. Cervenka Dr Talaat Helmy Girgis Dr Sujarti Jatanasen Document SEAIEPIl19 SEAlEPIl20 SEAlEPIl21 SEAIEPI122 SEAlFill21 SEAIFood Hyg./5 SEA/Haem.Fever/36 SEA/Haem.Fever/37 SEAIHaem.Fever/36 TStle Expanded Promamme on hnization Assignment report on strengthening and developing the cold chain in the expanded programme on imunization, Burma (BUR EPI 001), 22 June - 29 July 1979 Assignment report on expanded programe on immunization in Indonesia (ICP SPI 003), October 1977 - December 1979 Assignment report on expanded programme on immunization in Nepal (ICP SPI 0031, January-February 1980 Assignment report on expanded programe on immunization in Burma (BUR EPI 001), 27 May - 16 June 1960 Filariasis Assignment report on filariasis research (National Institute of Comnunicable Diseases, Delhi), India (IND ESD 001), 10 November - 7 December 1980 Food Hygiene Assignment report on food and drug control, Thailand (THA FSP 001), 16 September - 15 October 1980 Haemorrhagic Fever Assignment report on epidemiological situation of dengue fever at Uale and sane other atolls, and long-term planning for prevention and control, Maldives (ICP ESD 001), 28 December 1979 - 26 February 1980 Report on a meeting on research in viral haemorrhagic fevers in. the Eastern Mediterranean, South-East Asian and Western Pacific Regions (ICP RPD 002), New Delhi, 10-14 March 1980 Assignment report on strengthening of epidemiological surveillance and control of dengue haemorrhagic fever in ~ndonesia (INO ESD 003), 19 July - 14 August 1980 Author Mr James Cheyne Dr Daniel Tarantola Dr Idadul Islam Dr Nadda Sriyabhaya Prof. G.S. Nelson Mr J.G. Cunrmings Dr Abdul Quadir Khan Regional Office Dr S.B. Halstead - Document Title Health Education Assignment report on National Institute of Preventive and Social Medicine (study programme in health education), Bangladesh (BAN PTR 005), 1 January - 25 March 1980 Assignment report on strengthening of tk health manpower development programe ir Bangladesh (BAN PTR 003), 20 February - 19 April 1980 Report on research in health behaviour, health education and cormunity parti- cipation - Report of an inter-country meeting (ICP RPD 002), New Delhi, 3-8 November 1980 Assignment report on health education in the basic training programmes for nurses and midwives in Sri Lanka (SRL HED 001), 2 June - 9 August 1980 Assignment report on health education in Maldives (MAV PTR 001). 13 September 12 November 1980 Health Laboratory Methods See SEA/Occ .Hlth/23 Assignment report on clinical bacterio- logy in Mongolia (MOG LAB 003). 13 December 1979 - 12 February 1980 Assignment report on health laboratory services in Sri Lanka (SRL LAB 001), January-March 1980 Assignment report on promotion of health laboratory services and technology in pondicherry , India (1ND ATH 002), 2-30 June 1980 Assignment report on development of health laboratories and allied laboratory services (BAN ATH 001), May-July 1980 Assignment report on health laboratory promotion and health laboratory techno- logy in Karnataka, India (IND ATH 002), 1 July - 30 September 1980 Author Dr Thomas H. Gray Dr Theodore L. Bell Regional Off ice Prof. H.J. Weddle Mr O.M. Sutisnavutra Dr Imrich Odler Dr M.I. Jhala Dr Ivan Ivanov Mr B.T. Suitters Dr Ivan Ivanov I Document Title Assignment report on strengthening of laboratory services, Thailand (THA LAB 001), January-March 1980 Assignment report on health laboratory promotion and health laboratory techno- logy, Kerala, India (IND ATH 002), 1-31 October 1980 ~ssignment report on food and water control in Burma (WHO Project BUR ATH 003 - UNDP Project BUR/74/027), 31 August - 11 October 1980 Assignment report on health laboratory services in Thailand (THA ATH 001), August-November 1980 Health Literature Assignment report on the developnent of the South-East Asia Regional Health Literature Library and Information Services Network (HELLIS) (ICP HLT 001), 13 February- 12 March 1980 Assignment report on the development of health science information and documen- tation network in Indonesia (IN0 RPD 001), 16 June - 14 August 1980 Health Manpower Development Assignment report on strengthening of health manpower development, Mongolia (MOG PTR 001), September-October 1980 Assignment report on National Institute of Preventive and Social Medicine,Dacca, Bangladesh (BAN PTR 005), 3 July - 3 December 1980 (see also SEA/Med.Educ.) Health Services Development Report on the joint WHOIUNICEF meeting on strategies for health for all by the year 2000 (ICP PHC 002), 24-30 June 1980 Health manpower planning and community ~artici~ation for primary health care (Report and background documentation of the technical discussions held during the Thirty-third session of the WHO Regional Committee for South-East Asia, September Author Dr Y.S. Nimbkar Dr Ivan Ivanov Dr Bjorn Fredebo Thomsen Mr B.T. Suitters Mr Parlinah Moed jono Mrs Khin Thet Htar Prof. A.A.Podkolzin Prof. Z. Bencic Regional Office Regional Office r Document SEA/HSD/19 SEA/HSD/ZO 1 SEA/Med .Educ .I381 SEA/HS /I66 : SEA/HS/167 I I SEAILepI72 SEA/RES/30 SEAILepj73 SEAIT31158 SEAILepl74 SEA/Ma1/124 SEA/Ma1/125 SE~/Ma1/126 SEA/Ma1/127 Title Assignment report on health services developnent, Indonesia (IN0 SPM 001). 9-18 December 1980 Report of a WO (SEAR01 except group meeting on team work for primary health care (ICP PTR 003), 27-31 October 1980 Health Statistics See SEA/Med .Educ./381 Report on a meeting on lay reporting of health information for primary health I care (ICP SPM 002), 27-31 October 1980 Leprosy Report on an inter-country consultative meeting on leprosy research and control, New Delhi (ICP RPD 002.61),2-7 June 1980 Status report on leprosy and tuber- culosis control programme, Maldives (MAV BVM 001), January 1981 Assignment report on leprosy control in India (IND BVM 001), 7 July - 8 October 1980 Malaria Malaria research and training in Nepal - Report of an AsDBlWHO Mission, 26 January - 25 April 1980 Seminar report on anti-malaria operations with special reference to applied field research, Bangkok, mailand (ICP RPD 002), December 1979 Assignment report on anti-malaria programme, Thailand (nlA MPD 001), 1 September 1974 - 31 March 1980 Assignment report on malaria eradication, India (laboratory husbandry of the larvivorous fish Nothobranchius pentheri), (IND MPD 001), 4 June - 4 July 1980 Author Dr Eric N. West Regional Off ice Regional Office Regional Office Dr Anan C. Pakdi Dr Ernest P. Fritschi Dr G. Sambasivan Regional Office Dr Peter F. Beales Dr Richard Haas Document I SEA/Ma1/128 4EA/Ma1/129 SEA/Ma1/130 SEA/Mal/l31 i SEA/Ma1/132 I SEA/Mrl/ll3 SEA/Ma1/134 SEA/Ma1/135 SEA/Med.Educ .I378 SEA/MCH/137 SEA/MCH/138 SEA/MCH/139 SEA/MCH/140 Title Assignment report on malaria control in Maldives (MAV MPD 001), October 1974 - July 1980 Report of a mission on malaria manpower development and training in Burma (ICP MPD 004), 1-8 November 1980 Report of a mission on malaria manpower development and training in Bangladesh (ICP MPD 004), 1-8 November 1980 Report of a mission on malaria manpower development and training in Indonesia (ICP MPD 0041, 23-29 November 1980 Report of a mission on malaria manpower development and training in Nepal (ICP MPD 004), 23-29 November 1980 Report of a mission on malaria manpower development and training in Sri Lanka (ICP MPD 004), 30 November - 10 December 1980 Report of a mission on malaria manpower development and training in Thailand (ICP MPD 0041, 8-23 November 1980 Report of a mission on malaria manpower development and training in India (ICP MPD 0041, 27-31 October and 15-16 December 1980 Maternal and Child Health See SEA/Med.Educ .I378 Assignment report on public health admin- istration (MCHIFP programmeslimproving MCH/FP services),Maldives (MAV SPM 001), 23 January - 23 March 1980 Assignment report on health laboratory services in Sri Lanka (SRL LAB 001), January-March 1980 Report of an inter-country meeting on school health, Bangalore, India (ICP MCH 003), 25-30 August 1980 Author Dr J.R.M. Schepens Prof. B. Richter Prof. E.M.Ungureanu Prof. B. Richter Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Prof. B. Richter 6 Prof. E.M.Ungureanu Dr D.A. Sonnadara Dr H.I. Jhala Regional Office Document SEAlMCHl141 SEAlMCHl142 SEAIMCHI 143 1 SEAlMCHlFPl77 SEAlMCHlFPl7.9 SEAIMCHIFP I79 SEAIMed .Educ .I387 SEA/MCH/FP/~O SEA/MCH/FP181 SEA/MCH/FP/82 SEAIMed.Educ.1378 SEAlMCHl137 Title Assignment report on strengthening of gynaecologicallobstetrical services, Maldives (MAV SF'M 001), 31 October - 1 December 1980 Report on a meeting on reproductive health of adolescents in some countries of South-East Asia, Bangkok (ICP MCH 003), 28 July - 2 August 1980 Meeting on women in health and develop- ment programme, New Delhi (ZCP SPM OOl), 12-13 December 1980 Maternal and Child Health (Family Planning) Agency terminal report on mobile steri- lization teams,Bangladesh (BAN HRP 002), June 1979 1 Agency terminal report on strengthening of family planning with special reference to MCH-based family planning, Bangladesh (BAN MCH 003) Report on a WHO study tour on maternal and child health and family planning in the People's Republic of China (ICP MCH 013), 2-15 November 1980 See SEAIMed .Educ .I387 Project findings and recmendations on family planning manpower training, Bangladesh (BAN MCH 002), December 1980 Report on maternal and child health and family planning for family health care work - evaluation of in-service training programmes for physicians working in primary health centres, India (IND MCH 0031, August-November 1980 Medical Education Assigment report on post-graduate medical education in Sri Lanka (SRL PTR 003), March 1980 Author Dr Urmil Sham 6 Dr Shashi Chhabra Regional Office Regional Office Regional Office Regional Office Regional Of £ice (Dr T. Perera) Regional Office Dr Preecha Vichitbandha Mr G.G. Mitchell Document Title Author Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003). March 1980 I Mr R.R. MacDonald Assignment report on Institute of Medicine (Teaching Hospital), Nepal (NEP PTR 0021, 18 February - 18 March 1980 Assignment report on Institute of Medicine (Teaching Hospital), Nepal (NEP PTR 002), October 1980 Assignment report on undergraduate I Dr Palitha Abeykoon medical education, Indonesia (IN0 EDS 001). March-May 1980 i Dr A. Timappaya, Mr J.S. Shastri 6 Mr J. Sarvay Dr A. Tinnnappaya, Mr J.S. Shastri b Mr J. Sarvay Assignment report on National Institute of Preventive and Social Medicine (training in biostatistics), Dacca, Bangladesh (BAN PTR 005), 25 February - 25 May 1980 Assignment report on post-graduate 1 Dr O.P. Bhardvaj medical education in Sri Lanka ! (strengthening of Radiology Department, ' Post-graduate Institute of Medicine) (SRL PTR 003), 26 May - 20 June 1980 I Dr Talaat Helmv Girgis Assignment report on medical education in Indonesia (IN0 HMD 001), 4 March 1979 - 4 March 1980 Dr Douglas J.Magin Assignment report on medical education in Indonesia (IN0 EDS 001), August 1975 - August 1980 Dr Paul Alexander Assignment report on a curriculum for veterinary public health in the Master of Public Health Programme of Mahidol University, Bangkok (THA EDS 001). 14 July - 13 August 1980 Prof.. M. Abdussalam Assignment report on National Institute of Preventive and Social ~edicine, Dacca (training in population dynamics) (BAN PTR 005), 25 Hay - 24 August 1980 Dr T.H. Girgis Agency terminal report on education and training of health manpower, Burma (project findings and recommendations) (BUR HMD 005) Regional Office Author Dr Dan. E. Benor Dr G.H. Begbie Mr Ross Mitchell Dr Allan Tait Prof. Zdenko Skrabalo Dr Jiri Rotta Dr K.K. Mittal Regional Office Miss E. Kunderman Me Mary Jane Amundson Miss A. Banu Document SEA/Med .Educ . 1389 SEA/Med.Educ.I390 SEA/Nurs/304 ~~~lMentl60 SEA/Ment/61 SEAINCDIS SEA/NCD/6 SEA/NCD/ 7 SEA/Nurs/302 SEA/Nurs/303 SEA/Nurs/304 SEA/Ment/60 SEA/Nurs/305 Title Report on a visit to lhailand (curriculum development in health services) (THA EDS 001), 18 November - 5 December 1979 Assignment report on bachelor degree programme, Tribhuvan University, Kathmandu, Nepal (NEP PTR 001), 27 December 1979 - 21 September 1980 (see also SEAIHMD) Mental Health See SEA/Nurs/304 Assignment report on organization and management at the Angoda and Mulleriyawa hospitals, ambulatory psychiatric care in Sri Lanka (SRL MNH 001), 26 March - 20 May 1980 Noncmunicable Diseases Assignment report on antidiabetic services, Bangladesh (BAN OND 001), 30 March - 28 April 1980 Assignment report on noncmunicable diseases prevention and control (MOG OND 001), 7 September - 6 October 1980 Assignment report on other non- comnicable diseases (diabetes, endocrinology),Bangladesh (BAN OND 001), 11 November - 2 December 1980 Nut-sin& Survey report on nursing and midwifery education and personnel in the South- East Asia Region, 1979 (ICP PTR 003) Assignment report on nursing advisory services in Sri Lanka (SRL HMD 002), 2 October 1979 - 29 March 1980 Assignment report on mental health/ psychiatric nursing development in India (IND EDS 003), 30 December 1979 - 12 May 1980 Assignment report on nursing education and services, Nepal (NEP PTR 001) January-September 1980 / Nutrition I Document Assignment report on development of health services (health and nutritional status of school children) Bhutan (BHU HSD 001), 11 January - 11 April 1980 Assignment report on nutrition surveil- lance monitoring, evaluation and planning, Indonesia (IN0 NUT 003), 1 June - 30 July 1980 I I Title Report of the meeting of principal investigators of Nutrition Research Project No.1 on situation analysis of the nutrition component of primary health care (ICP RPD 002), 10-28 November 1981 Author Dr C.C. Mahendra Dr Hartmut Schubel Regional Of £ice Paper on workshop on nutrition monitorin Regional Office and evaluation, New Delhi (ICP NUT 005), 17-21 February 1981 Report of the meeting of the Sub-committee on Nutrition Research Programme, New Delhi (ICP RPD 0021, 25 November 1980 Occupational Health Assignment report on development of central and regional occupational health and industrial hygiene laboratories in Indonesia (WHO Roject IN0 HWP 001 - UNDP Roject INS/72/028), 25 October - 31 December 1979) Assignment report on development of occupational health laboratory techniques in Thailand (THA HWP 001), 1-18 January 1980 Assignment report on commissioning and strengthening of chemistry laboratory for occupational health and industrial hygiene, Bangladesh (BAN HSD 002), 14 December 1979 - 26 February 1980 SEA/Nut/78 Regional Office Assignment report on prevention and treatment of malnutrition, Burma (BUR MCH 004), 5 August - 16 September and 2-18 October 1980 Dr Somchai Durongde j I Dr Arie de Bruin Dr Arie de Bruin Dr Branislav Tokovic t Document SEA/Occ .Hlth/24 SEA/Occ.Hlth/25 SEA/Med/Educ .I380 SEA/OMC/Z~ SEA/Ophthal/32 SEA/O~~ tha 1/33 SEA/Ophthal/34 SEA/Ophthal/35 SEA/Ophthal/36 SEA/Pharmacolopy/9 SEA/RES/36 SEAIFiadllO9 Title Agency terminal report on Central and Regional Occupational Health and Industrial Laboratories, Indonesia - project findings and recmendations, (IN0 HWP 001) Asaignment report on occupational health and safety in agriculture (analysis of pesticides) in Sri Lanka (SRL WKH 001), 19 October - 23 November 1980 Organization of Medical Care See SEAlMed .Educ. 1380 Ophthalmology Assignment report on prevention of blindness in Bangladeah (BAN PBL 001), December 1979 - February 1980 Anaignwnt report on prevention of blindness in Sri Lanka (ICP PBL 001), 3 March - 1 April 1980 Asaigmnent report on prevention of blindness in Sri Lanka (SRL PBL 001), May-June 1980 Assignment report on organizing relief from eye diseases in Maldives (MAv SPM 001), 18 June - 14 July 1980 Report of an inter-country workshop on relief cataract services in the South- East Asia Region, Hyderabad, India (ICP PBL 0021, 29 September - 4 October 1980 Pharmacology Assignment report on health research in support of the People's Health Rograme in Burma (BUR RPD 001), December 1980 Radiation Assignment report on aafe use and main- tenance of radiological equipment in Maldives (MAV PTR 001), 9-23 June 1980 Author Regional Office Dr S. Lj. Victorovic Dr K. Konyama Prof. P.K. Khosla Prof. P. Siva Reddy Dr O.N. Krishna Regional Off ice Prof. D.R.Laurence Mr M.L. Bhutani SEAIMed .~duc .I383 1 See SEAhled .Educ .I383 SEA/Rad/llO I Document 1 I Title Assignment report on repair of X-ray machines and advice on training in repair and maintenance of X-ray equipnent in Maldives (MAV PTR 001), 22 June - Author Mr I.C. Perera Assignment report on the development of cancer control in Zhailand (THA CAN 001), 15 September - 15 October 1980 I Research Stud y, Research Training, etc. 8 July 1980 i Dr Sven Walbom- Jorgensen Assignment report on strengthening of the Electro-Medical Engineering Division, Sri Lanka (SRL SPM 003), June-November 1980 Assignment report on health manpower development research in selected countries of South-East Asia (ICP HMD 013), 31 January - 30 April 1980 Dr C.A. Greatorex See SEAfCholera132 1 see SEAIkp/72 See SEA/HE/111 SEAITrad.Med.114 See SEAITrad.Med.114 SEA/RES/32 ( See SEAlNut175 I See SEAlNut176 See SEAINutI77 See SEA/Pharmacology/9 I Sexually-Transmitted Diseases (STD) I Report on an inter-country meeting on the control of sexually-transmitted diseases (ICP BVM 002), New Delhi, 3-7 November 1980 1 Dr Sharad Kumar Regional Office Document I=== Title Traditional Medicine Report on a regional meeting on the development of research protocols in priority areas in traditional medicine, Varanasi (India) (ICP RPD 002), 11-13 November 1980 Tuberculosis Assignment report on tuberculosis contro programme in Nepal (NEP BVD 002), December 1979 - April 1980 Assignment report on tuberculosis contro programme in Nepal (NEP BVM 002), October-December 1980 Assignment report on epidemiological research in tuberculosis: Tuberculosis Research Centre, Madras, and National Tuberculosis Institute, Bangalore (India) (IND BVM 002). 19 August - 6 September 1980 See SEAILepl73 Vector-Borne Diseases Control Assignment report on strengthening of epidemiological surveillance, Indonesia (IN0 ESD 003), January 1978 - December 1979 Assignment report on vector control (Phase 111, Sri Lanka (SRL VBC 002), July-August 1980 Report on a visit to Indonesia on strengthening of epidemiological surveillance and control (IN0 ESD 003), 19 September - 20 November 1980 Veterinary Public Health See SEA/Med .Educ .I386 Author Regional Office Dr Kyaw Myint Sir John Crofton Dr Tadao Shimao Mr Raymond T. Collins Mr J.E. Graham Dr D.A. Muir
Annex 5 CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY GOVERNMENTS/OTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED (1 July 1980 - 30 June 1981) 1980 - 14 July ESCAP: Inter-agency Task Force on Water for Asia and the Pacific Bangkok 21-25 July Government of India: Meeting of Working Group for Professional Preparation of Health Education Specialists New Delhi 28 July ITNDP: Formulation of UNDP Country Prograrmne for Maldives, 1982-86 Male Ministry of Public Health, Thailand, and Mahidol University: National Seminar on the Role of Universities in Research to Support National Health Development 29 July - 1 August Bangkok July Government of Maldives: Developnent Plan of Maldives Male UNICEF: Mid-term Review of UNICEF Programme, Maldives 4-5 August Male 5-6 August Government of India: Seminar on Oral Rehydration Simla (India) Government of India: Seminar on Oral Rehydration Therapy 8-9 August Lucknow (India) 19 August - 17 October 20 August Government of India: Course for Senior Health and Hospital Administrators New Delhi Government of India: Working Group on Infant Feeding New Delhi ICMR: Meeting of the Advisory Committee on Ophthalmic Research 26-27 August New Delhi 15-16 September 19-20 September ESCAP: Seminar on Household Surveys Bangkok Government of India: Meeting of the Vaccine Production Board Kasauli (India) 22-26 September UNESCO: Meeting on a Regional Network for Scientific and Technological Information in East and South-East Asia Bangkok Kathmandu Jaycees: Seminar on Drug Abuse and Addiction Kathmandu 23 September 23-26 September Government of India: Workshop on the Integration of Health Education in the Undergraduate Medical Curriculum Madras 23-29 September ESCAP: Committee on Industry, Technology, Human Settlement and the Environment, 4th Session Bangkok Colombo Plan Bureau: Workshop on Drug Abuse Prevention and Control Dacca 29 September - 4 October 2-8 October Government of India: Workshop on Recent Advances in Leprosy Research Bangalore (India) Bangkok 9-15 October ESCAP: Second Asian and Pacific Ministerial Conference on Social Welfare and Social Development ESCAP: Meeting on Inter-agency Committee on IRD 17 October 20-24 October Bangkok Bangkok United Nations: Working Group of the Committee for Development Planning ESCAP: Preparatory Committee for the Third Asian and Pacific Population Conference: First Session Bangkok 29 October - 4 November 3-7 November ESCAP: Inter-governmental Meeting of Heads of Standards Institutions Bangkok 7 November ESCAP: Inter-agency Consultative Meeting on the Plan of Action to Combat Desertification Bangkok ILO: Inter-country ~eminar/Workshop on Curricula Development for Population and Family Welfare Education in Asia 10-14 November Pattaya (Thailand) 17-22 November FAO: Workshop on the Integration of Women in Agriculture and Rural Development Hyderabad (~ndia) ESCAP: -- Ad Hoc Meeting with Inter-agency and Non-governmental Organizations concerned with Youth Development in the Region 18-22 November Bangkok 18-24 November ESCAP: Committee on Trade, 23rd Session Bangkok AsDB: Reconnaissance Mission: Health and Population Sector, lhailand Bangkok/ Koraput 21 November - 12 December 24-28 November ILO: Meeting on Working Conditions and Environment Bangkok 29 November AcWorth Leprosy Hospital Society for Research, Rehabilitation and Education in Leprosy: Consensus Conference on Classification of Leprosy Bomb a y 8-16 December UNESCO: Regional Seminar on Rural Development Planning Bangkok 11 December 16-22 December 18-19 December 1981 - 6 January 14 January 2 7-30 January 28 January 4-5 February 6-20 February 15-20 February 16 February 18 February 18-25 February 5 March 10-21 March 29 April 7 May 21-22 May ESCAP: Inter-agency Task Force on Water for Asia and the Pacific, Sixth Session UNESCO: Regional Meeting of Experts on the Role of Social Studies in Education for Peace and Respect for Human Rights in Asia and the Pacific ILO: Meeting of Designated Bodies (Part of the International Occupational Safety and Health Hazard Alert System in the Asian and the Pacific Region) ESCAP: Inter-agency Task Force for Integrated Rural Development ESCAP: Integrated Rural Development (IRD) - Inter-agency Task Force ESCAP: Technical Meeting on Ageing for Asia and the Pacific Region ESCAP: Inter-agency Committee on Integrated Rural Development (IAcIIRD) for Asia and the Pacific ESCAP: Ad Hoc Inter-agency Meeting on Women in Development Government of Thailand: International Crafts Conference and Exhibition (CONEX '81) ESCAP: International Colloquium of Decision-making Executives for Coordinated Action ESCAP: Inter-agency Task Force on Human Settlements (5th) ESCAP: Inter-agency Task Force on Integrated Rural Development South Asia Cooperative Environmental Programe (SACEP): High-level Meeting to Initiate the South Asia Cooperative Environmental Programme ESCAP: Inter-agency Task Force on Integrated Rural Development ESCAP: Thirty-seventh Session ESCAP: Inter-agency Meeting on Women in Development ESCAP: Inter-agency Task Force on IRD ESCAP: Inter-agency Meeting on Social Development Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Bangkok Colombo Bangkok Bangkok Bangkok Bangkok Bangkok 1-10 June 2-8 June 4-10 June 9-1 5 June 26 June UNESCO: Seventh Regional Consultation Meeting on Bangkok Programming and Evaluation of the MEAN Prograrmne of Educational Innovation for Development (APEID) ESCAP: Regional Consultation on Consumer Protection Bangkok ESCAP: Workshop on Research towards a Methodology Bangkok for Defining the Transport Needs of Isolated Communities ESCAP: Committee on Statistics - Fourth Session Bangkok ESCAP: Seventh Session of the Inter-agency Task Bangkok Force on Water for Asia and the Pacific
Annex 4 MEETINGS AND COURSES ORGANIZED OR ASSISTED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 July 1980 - 30 June 1981) 1-2 July SEAIACMR Sub-committee on Research Needs for Health for All by the Year 2000 (ICP RPD 001) New De lhi 13-24 July Short Course on Clinical Teaching and Supervision in Nursing (ICP PTR 003) Nepal 16-17 July National Workshop on Medical Rehabilitation (SRL ADR 001) Colombo 16-17 July National Workshop preparatory to Survey of Disabled (SRL ADR 001) Kurunegala (Sri Lanka) 28-31 July National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) Jakarta 28 July - Meeting on Reproductive Health of Adolescents 2 August Bangkok 30 July - Short Course on Clinical Teaching and Supervision 12 August in Nursing (ICP PTR 003) Nepal 4-11 August Preparation of Health Education Specialists in Support of Health for All by the Year 2000 (ICP HED 005) New De lh i 13-14 August National Seminar on Health and Law Bangkok New Delhi 18-20 August National Workshop for Developing Training Programmes in Medical Librarianship (IND EDS 002) 18-22 August National Seminar on Systems for Management of Mass Casualties (THA SPM 001) Pattaya (Thailand) 18-22 August Workshop on Statistics and Information Training Programmes (THA HST 001) Thailand 25-30 August Meeting on School Health Services (ICP MCH 003) Bangalore (India) 28-30 August State-level Seminar on Health Economics and Planning (IND SPM 001) Srinagar (India) 15-18 September Family Health Workers Refresher Course (MAV PTR 001) Male 15-26 September Inter-country Workshop on Production of Immuno- logical Reagents (ICP IHM 001) Bangkok 17-25 September National Workshop on Educational Science for Medical Teachers and Other Health Professionals (IND EDS 001) Pondicherry (India) 25-27 September Bangladesh-India-Burma Border Malaria Coordination Conference (ICP MPD 001) Calcutta 25 September - 7 October Inter-country Training Course for Trainers of Mid-level Management Personnel (ICP EPI 001) Kathmandu 28 September - 14 October National Workshop on Developing Health Planning Procedures and Health Information System for Decentralized Planning at District Level (ICP SPM 003) Kathmandu 29 September - 3 October Inter-country Seminar on Poliomyelitis(1CP ESD 005) New Delhi 29 September - 4 October Inter-country Workshop on Relief Cataract Services (ICP PBL 002) Hyderabad (India) 1 October Training of Voluntary Workers in Island (MAV PTR 001) Naifarn (Maldives) 6-9 October 6-10 October Workshop on Educational Science (ICP PTR 003) Maldives New Delhi Consultation on Development of Regional Public Health Training Programme (ICP PTR 002) 6-14 October National Workshop for Senior-level Officers (BAN SPM 001) Dacca 8-10 October State-level Seminar on Health Economics and Planning (IND SPM 001) Goa (India) 13-16 October Inter-country Consultative Meeting on Drug Policies and Management (ICP DPM 001) New Delhi 20-24 October Regional Workshop on Appropriate Technologies with Special Reference to PHC (ICP ATH 002) New Delhi 20 October - 1 November Inter-country Training Course for Trainers of Mid-level Management Personnel (ICP EPI 001) Colombo 22 October - 1 November Workshop on Neonatology (IND MCH 003) New Delhi 22 October - 1 November Workshop on Neonatology (IND MCH 003) Hyderabad (India) 24-25 October India-Maldives-Sri Lanka Border Malaria Coordination Conference (ICP MPD 001) Madras Meeting of Traditional Medicine Practitioners (MAV PTR 001) Maldives 26 October 2 7-31 October 27-31 October Meeting of Traditional Medicine Practitioners (MAV PTR 001) Maldives New Delhi New Delhi Meeting on Lay Reporting of Health Information for Primary Health Care (ICP SPM 002) Expert Group Meeting on Team Work and Its Role in the Provision of PHC Services (ICP PTR 0031 ICP PTR 004) 27-31 October October 3-7 November 3-8 November Workshop for Faculties of Conmnity Medicine (BAN PTR 005) Dacca Training of Supervisors of PHC Workers in Health Manpower Management Bangkok New Delhi New Delhi Inter-country Meeting on Sexually-Transmitted Diseases Control (ICP BVM 002) Inter-country Consultative Meeting on Research in Health Behaviour, Health Education and Community Participation (ICP RPD 002) 10-14 November Inter-country Workshop on Child Mental Health and Psycho-Social Development (ICP MNH 003) Jakarta 10-13 November First National Seminar on Accident Prevention and Relief (IND ADR 002) New Delhi 10-20 November 10-22 November Workshop on Neonatology (IND MCH 003) Bombay Workshop on Rapid Techniques in Virology (ICP Rm) 002) Pune (India) 11-13 November Meeting for Development of Research Protocols on Priority Areas in Traditional Medicine Varanasi 17-19 November First National Malaria Conference (THA MPD 001) Haad Yai (Thailand) 17-21 November 19-21 November The Immunology of Tissue Antigens (HLA) and Their Role in Disease (BAN OND 001) Dacca Meeting of the Principal Investigators of the Nutrition Research Project - Situation Analysis of Nutrition content of PHC New Delhi 20-21 November 20-21 November Epidemiology Training for Zone Chiefs (THA MPD 001) Thailand Dacca National Workshop on the Formulation of the National Programme for Prevention of Visual Impairment and Blindness in Bangladesh (BAN PBL 001) The Immunology of Tissue Antigens (HLA) and Their Role in Diseases (BAN OND 001) 2L-28 November Dacca 24-28 November National Workshop on Mental Health (BAN MNH 001) Dacca 24 November - 4 December Workshop on Neonatology (IND MCH 003) Cuttack (India) Meeting of the Ad & Conanittee on ~utrition Research (ICP RPD 002) New Delhi 25 November 1-6 December 2-4 December National Workshop on Mental Health (BAN MNH 001) Dacca Bangkok National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) 8-10 December National Meeting on Development of Network of Health Literature, Library and Information Services (ICP HLT 001) New Delhi Course on Health Planning and Management (ICP SPM 003) Colombo New De lhi New Delhi Dacca Sri Lanka 9-19 December 15-19 December Consultation on Regional Training Programmes for Health Sciences Librarians (ICP HLT 001) 15-19 December Meeting to Discuss the Role of WHO in Pharmaceuticals 17-20 December National Workshop on Prevention of Cardio- vascular Diseases (BAN CVD 001) 29 December 1980 - 9 January 1981 1981 - 5-9 January Inter-country Workshop on Health Manpower Planning Methodology (ICP PTR 001) Steering Committee of Task Force on Service Research in Family Health Colombo New Delhi Chandigarh West Java 12-14 January Task Force Meeting on MCH/FP and Review of Child Handbook (IND MCH 003) Ninth Meeting of the Steering Committee of the WHO Task Force on Oral Contraceptives 12-15 January 2-4 February Workshop on Research and Development of Appropriate Technology in Environmental Health at Village level (ICP ATH 002) 3-6 February ~ational Seminar on ATH in Relation to PHC (ICP ATH 002) Bangkok Dacca New Delhi 2-14 February EPI Mid-level Management Workshop for Trainers (ICP EPI 002) 5-9 February Second Meeting of the SEA~ACMR Sub-committee on Research Needs for HFA/2000 (ICP RPD 002) 9-13 February Third Meeting of the h-ogramne Advisory Group on Prevention of Blindness New DeIhi New Delhi 10-11 February Regional Consultative Meeting on the Preparation of Seventh General Programme of Work (ICP SPU 001) 12-13 February 15-18 February Regional Consultative Meeting on Study of WHO'S Structure in the Light of Its Functions New Delhi New Delhi Ei&th Meeting of the steering Committee of the WHO Task Force on Psycho-Social Research in Family Planning 17-21 February Workshop on Nutrition Monitoring and Evaluation (ICP NUT 005) New Delhi Calcutta 18-20 February Seminar on the Follow-up of the Consultation on Regional Public Health raining Programme (ICP PTR 002) 19-20 February 19-20 February UNICEF/WHO In-house Meeting New Delhi New Delhi Joint ICMR/WHO Research Seminar on Psycho-Social Factors Affecting Family Planning Joint Meeting of the ICMR Acceptability of Task Force and the WHO Psycho-Social Task Force 21 February 23 February New Delhi ICMR/WHO Seminar on Recent Advances in Induced Abort ion Research New Delhi National Workshop on Malaria Control (BAN MPD 001) 24-26 February 24-27 February Dacca New Delhi Steering Committee Meeting of the WHO Task Force on Sequelae of Abort ion 26-27 February 2-3 March Global ACMR Sub-cornittee Meeting on Nutrition New Delhi New Delhi Regional Scientific Working Group on Diarrhoea1 Diseases (ICP RPD 002) 3-11 March Workshop on Methods and Materials in TBA Training Programmes (ICP PTR 003) New Delhi 4-6 March 9-21 March Global ACMR Sub-Cornittee on Research Administration New Delhi Rangoon EPI Mid-level Management Workshop for Trainers (ICP RPD 002) 16-19 March Meeting on Tuberculosis Research and Services (ICP RPD 002) New Delhi Consultative Meeting on Programme Planning for Raditional Birth Attendants in Primary Health Care (ICP PTR 003) New Delhi 16-19 March 16-22 March Regional Training Course in the Micro in-vitro Method for Testing Drug Resistance to P.falciparum (ICP Rm) 001) 23 March - WHO/UNDF' Asia Regional Training Project - IR 3 April Training Course on Diarrhoea1 Diseases: Laboratory Aspects 24-31 March Meeting on Appropriate Technology for Health 30-31 March Research Study Group ~eeting on DHF (ICP RPD 002) 30 March - Workshop on Antibiotic Sensitivity ~esting 10 April (ICP ATH 001) 1-6 April Regional ACMR: Seventh Session 6-11 April Seminar for the Sedaw Gyi, Burma (BUR VBC 001) 7-11 April Regional Advisory Group Meeting on Mental Health (ICP MNH 003) 21-23 April National Conference on Appropriate Technology for Primary Health Care (ICP ATH 002) 18 May - 13 June CDD Programme Management Course 25 May - 6 June Training Course in Maintenance and Repair of Refrigerators (ICP EPI 001) 22 June - WHO/DANIDA Course on Vector and Rodent Biology 16 July and Control Prabudhabat (Thailand) Dacca New Delhi New Delhi New Delhi New Delhi Burma New Delhi New Delhi Calcutta Bangkok Ciloto (Indonesia)