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

ENGLISH ONLY REPORT ON NATIONAL HEALTH ACTIVITIES IN AUSTRALIAI 1980 - 1981 Introduction: In the past year a major review of the whole Australian health care system was completed with the publishing of the report of an independent Commission of Inquiry. The findings and recommendations in the report have been the subject of much careful consideration by the Gov.ernment and it is expected that the report will be of considerable assistance to policy makers in years to come. Thete has been increasing concern about escalating costs of health services, and the Government has the responsibility for ensuring that resources are allocated wisely. Additionally, preliminary assessments were made of the implications of recent population projections which indicate that while Australia's population will increase only slowly (from l4.8m. in 1981 to l8.0m. in 1995) there will be general aging of the population and that persons aged 65 years and over will increase from 1.45m. in 1981 (9.7% of the population) to 2.15m. in 1995 (11.9% of the population). The increased proportion of aged persons in the community is likely to result in a relative increase in the per capita demand for health services and raises for consideration the possible need to allocate fewer health resources to acute and paediatric care and increased resources to the care of chronic and long term illness and disability. Following are some of the national health activities undertaken during the year. In the short space available the listing of these activi~ies should be seen as illustrative rather than all-encompassing. International Year of Disabled Persons: As a special initiative for the International Year of Disabled Persons, the Australian Government has introduced a new Program of Aids for Disabled People (PADP), which is to be an on-going program. The aim of this new program is to increase the level of independence of disabled people in the community (i.e. non-institutional) setting. A range of aids to daily living (such as home modifications, wheelchairs, domiciliary oxygen and walking aids) may be provided without charge to people who are not eligible to receive them under other existing programs. From 1 January 1981 the Government also extended the Medical Benefits Schedule so that people with cleft lip and/or cleft palate conditions can receive medical insurance benefits (including Commonwealth Government benefits) for orthodontic and associated dental treatment. During the year, the Commonwealth Department of Health conducted a national seminar on nursing disabled persons. The aim,of this seminar was to have members of the nursing profession share and disseminate their knowledge about caring for people with disability or handicap. Transcripts of papers presented at the seminar have been published.

1

Submitted by the Director-General of Health, Australia.

- 2 -

Preventive Medicine: Nutrition The Commonwealth Department of Health sponsored a National Nutrition Education Conference in January 1981 to co-ordinate State, Territory and Commonwealth activities and resources for the dissemination of nutrition information to the community. Conference participants included representatives of State and Territory Health authorities and specialists from the fields of nutrition and education. A report of the proceedings of the Conference has been compiled, which includes a series of recommendations for nutrition education both for the general community and for special groups. Smoking Consultations with the tobacco industry are proceeding on the implementation of plans for the printing of tar and nicotine yields on cigarette packets; the establishment of upper limits for tar and nicotine yields of cigarettes; and the progressive reduction of permitted tar and nicotine levels in cigarettes. Alcohol The most recent Australian Bureau of Statistics figures indicate that in 1979/80 there was no change in the estimated per capita consumption of alcohol as compared with 1978/79. While this is encouraging, alcohol abuse still presents a major social problem, and the Department of Health is continuing to seek ways and means of promoting more responsible use of alcohol by the communi"ty. Family Planning A leaflet, Health and Planning Your Family, has now been released in English, Chinese, Kampuchean, Vietnamese and Laotian. The leaflets are intended to provide migrant women with helpful information in their own language and are available through Department of Immigration and Ethnic Affairs outlets, family planning centres and other health agencies in the States. Occupational Health: A seminar on the occupational health needs of women was held in Canberra in May 1981, sponsored by the National Women's Advisory Council. A plan of action for dealing with the particular problems of women, both in the workforce and at home, was adopted at that seminar. A Report on the Health Hazards of Asbestos was adopted by the National Health and Medical Research Council at its 9lst Session in June 1981. A specialist Subcommittee, comprising representatives from the asbestos mining, milling and manufacturing industries, unions and governments, examined the matter over a period of two years. The Subcommittee believes that the question of substitution of other materials for asbestos - insofar as it is reasonably practicable and safe to do so - should be actively pursued.

"jil

- 3 -

Health Manpower: The supply of health manpower continued to receive special attention as the increase in supply in all health occupations exceeded the increase in population. The current and future supplies of doctors and of dentists have been examined in some detail. As the result of these examinations the Government has decided that the States and medical schools should be encouraged to more critically assess the need for the projected supply of doctors and that controls on medical immigration should cont1nue~ In the case of dentists, the immigration of dentiltl to Australia il to be monitored more closely. At the 1980 Australian Health Ministers' Conference it was agreed to establish a National Nursing Manpower Task Force with the objective of monitoring future nursing manpower needs. The Task Force is a follow-up to the 1978 National Nursing Personnel Survey which established a national nursing manpower data base. It is currently gathering information on existing mechanisms of collecting nursing manpower statistics with a view to developing a national profile for examining furture manpower needs. Health facilities planning and information system: The Australian Department of Health and Department of Housing and Construction have continued the development of a special planning and information system to assist in the methodical, logical and practical planning, design, construction and commissioning of hospitals and other types of health facilities. Components of the system which have been completed or are near completion include manuals providing guidelines on the following subjects: cost control, functional area cost analysis. functional briafina, plannina networKs, nursing policy formulationi a computer-baaed reference system designed to provide highly specific reference. to sources of information which may be of assistance in reaching decisions during planning and design of health facilities. Research: The 1980-81 annual Government allocation to medical research was increased by more than 30 per cent to $18.7 million. The increased allocation allowed the National Health and Medical Research Council to expand existing programs and to introduce several new initiatives.

FRANCAIS SEULEM!NT

RAPPORT 5UCCINT SUR Llil3 ACTIVITli3 SANITAIRm3 EN POLYNE3IE FRANCAISE, 1980

I

L

Cauvrant 4 000 km2, in'galement r'partiee sur pr~a d. 4 millions de km2 de surface ooeanique, lea nombr81ses tles formant la Polyn8eie ae regrou.pent en oinq a.rohipels •. La Sante IUbllqu~

doi t tenir oompte de oes oontr&inte. pogr.,..

pbiquea et dee 'laments demographiques. Grice II. une excellente intrastruoiure, 1& oauverture sani ta.ire eat largement et Pa:MOIlt .... 8Ur6 •• La poPllation est .atimee II. 146 120 habitants 1 - llJDGm' PWR LA SANTE Ell

1er jan~er 1980,

*

L'H8pi tal Territorial de M8J1Iao a un bldget autonome de oelui de la DLreotion de la Sante IUbl1que deplis 1979. Cleat un hldget annexe EIlquel il: fet ajauter des subventions du Terri toire. L'Insti tu.t de Reoherohes "Leui. JIala.rcW" re90i t 6galEl1lent des subventions du Territoire. ,

I. I

Voioi les sommes aocordees par le Terri toire :

I

i ~

~

1 a I

Pouro entage par DtSpenses (U au.bven- , rapport au. lhd.set tiona du Territoire du Territoire :

c

• &

mreot!on de 1a S""t4 II1bU"".

1 108 329 000 FOP 400 000 000 FOP 195 710 000 FOP 1 704 039 000 FOP

a I I I

HlIp.

~"I'l"H. de -

. • , : : : lJ

5,91

%

2,13 ~

I. R. K. L. M.

: I

( Total DISpenses pour la. Sante

Budget du Territoire

, 18 763 075 000 FOP

I I I &

1.04 " 9,06 %

D6penaee Sant' par ha.bi ta.nt , 11 662 FCP

2 - ORQWSATIOI

m SERVIcm

Elle eat quasi identique cD Coad.t' R'gLonal avec I

a celle

prisent'e

a

la dernibre aession

- H8pi tal Terri tori al

~e

1Iamao............. I

416 11 ts 104 11 ts

- H8pi tal sp601alis6 de Vaiam1

(phtis101ogl.e + psyohiatrie + chronltlues) - nLapeDllaire de Mama.o - Centre de Protection Maternell" - Service d·Hygl.ime Scolaire - Servioe d·Hyg1.ene Dentaire - Servioe d'Hyg1.ene et de Salubri t' IUblique - Serviae d'~aation

.t

Infantile

) .) ,tWdeo1ne ) Pr6venti ve )

Sanitaire

)

- 3 H8pitaux secondaires •••••••••••••••••• I 215 lits - 45 1Dfirmeries et di apensa.1. res. •••••••••• I 302 l i ts - Centre anti-hans6ni en - Centre d'.Aocue11 des personnee 8.g4es .l·oela, 11 tal t ajcu ter I - La creation d'un wrew de Statistiques Sani taires en Ac6t 1980, - LI&oqui&i tion d'un avion sani taire en 1981 et, - La or4ation dL1 ConeEdl aJ.p6rialr de 1a Saut' en 1:981. 3 - PERSONNElS

m

SERVICE DE SANTE RJBLIWE EN 1980

- .'deoiDB ••••••••••• S 88 - Dentist .... • ••••••• : 14 - Pha:rmaD1 ens. • • • • • . . ,

4

- IDfirm1era D.E.* ••• : 257 - Adjoints de soins** : 139

-

* **

D.E. : D1pl8me d'Etat L'appellation d'adjointB de 80ina oorrespond en fait l 1a oat'gorie d 'i nii rmi eres-w.:d.li a.i reB.

-3-

4 - AC'l'IVITm 111 SERVICE DE SANTE RJBLJWI a) M'decine Preventive - Ann§e 12§0 Lee etablissements de IUdecine Preventive, mal," 1cr vooation

im tiale, fonotionnent usentiellement oomme diapena&ires de aoina •

~ C. P. I. ~gUtne

. Hombre de Consultations 65 300 13 329 56 329

• I I I I

Soolaire Dentaire

Bl'11~ne

• c

- ...

b) 1l6dec1ne de Soins - Annee 1980 Conaultant•••••••••••••••• t 239 879 Conaultations ••••••••••••• I 425 244 Ho.P1talis6••••••••••••••• a 20 033 Jc:urMea dlHo.pi tali Bat10n , 222 633

5 - MORBI I!I TE a) llala.d:1ea 1e8 plus frequentes

- Apparedl respiratoire •••••••••••••••••••••••••••••••••• I 34,5 - P~ et ti.ou oellula1re 8OUS-outan4 ••••••••••••••••••• : 8.4 - A vi~8_, •••••••••••••••••••••••••••••••••••••••••••••• :

% ~

% 7,0 % 6,4

- Oreil1e et apophyse maatofde ••••••••••••••••••••••••••• : - Inf'ectiEUSes intestina.les (prinoipalement diarrheiques): - Pla1es et traumatismes des va.1.SS88I1X s8Jl8lins •••••••••• : Des oonsultations.

5.2 % 4,8 %

.../ ...

-4-

.

b) In tte oontre lea grandee end6mi es - Ann'e 1S80

•

717 - ••1ad1 ell V6uri ermea z Syphilis.... I 367 BlermDrra.4P-. '717 - ~b.roulo.e •••••••••••••••••••••••• I 82 - Lipr............................... )24 ~e •••••••••••••••••••••••••••••

,

oas II

" nouveaux oas en 1980 oas recenses ~ 31-12-79

lIu:ql1els il fillt ajQ.1.ter 10 nouV4Nl1X 0 . . en

1980.

0) lu:tt. oontr. 1. Oancer 88 oas ai caal's en 1980.

La mise en place en 1981,

ell

sain de la Direction de 1& Sante

lUbl1qu.e, d'un fiolder oentra.l du. Oancer permettra de oonnattre la si1uation ooncernant oette maladi e aveo plus d I exact! tu.de et de oiaion Q!.1ant d_ 1wncre. 111

pre-

nombre de oas,

8l.Jt

looalisatioDB et l 1& freqp.ence

6 - OlUEN'l'ATIONS - PFPmJTIVl!3 Lea .txuoUlr.. ao1u.Uea du. Servio. de 1a Sante vont Itr. not ...

b1ement -'1101"6 . . p&r 1& oonatxuotion d. DalV4NI1X diapenaa.irea , 1a ON .... tion mi.e en ohanUer dlun servioe d'Hemod1aly1te r4nale l IIH8p;t.tal d. J,lamao, d'un 1aboratoir. de Sante }ubl1qu.e III

et d'un S.rvioe d ' Ep1d6miolog1.e

se:ln de 1a Dlrection de la Sante }Ubl1qu.e. 11 est prew de dBve10pper 11 act! vi t6 du. Servioe d I Eduoati on

Sa.n1ta.1.re et d. rendre

lUX

organismes de Medeoine Preventive (0. P. It,

H7gi.~n. Soolaire et Hygiene Denta.ire) lEUr vocation im tiale.

Le Consei1 Su.perl81r de 1a Sante a termine 1'etablissement de 1& oarte sani ta.ire du Terri to1re et oontim. 1a mise en place d'une 1....

gislation saui taire a.<Wquate.

*

Oentre de Protection Infantile.

ENGLISH ONLY 1980 COUNTRY HEALTH RE~ORT FOR THE TERRITORY OF GUAM 1 Public health programmes The Division of Public Health is charged with the responsibility of maintaining and improving the health status of the people of Guam throup the implementation of such programmes as: communicable and chronic disease control; maternal and child Health; nursing; crippled children services; dental; emergency medical services; vital statistics; medical records; laboratory; epidemiology; health education and nutrition; hearing and 8peech; and pharmacy. Epidemiology A disease currently of particular epidemiological interest on Guam is salmonellosis. The incidence of bacteriologically confirmed cases of thi8 disease has increased from 24 per 100 000 population in 1974 to 119 per 100 000 population in 1980 without the benefit of any special case-finding activities. This disease is most common in the "less than 1" age group. Although cases occur in every month of the year, the incidence appears to increase with increased raintal1 •. An area for future study will be to attempt to determine whether salmonella bacteria may be introduced into the environment of infants by family members who may be short-term asymptomatic carriers or by mechanical carriage on soiled footwear, etc •

...

Health education and nutrition Education support services were provided to the maternal and child health and family planning programme. With the assistance of nursing staff, prenatal classes for expectant parents were started. Educational encounters for family planning increased by 10%, but decreased by 16% for maternal and child health. An application was made for federal funding for a health education risk reduction programme. As conceived, the programme will bring information to working adults concerning personal behaviours that 'may be hazardous to their health and community resources that are available to help them adopt a more healthy life-style. In addition, the programme will compile descriptive data about the health of people of Guam.

Dental health The Dental Section of the Department of Public Health and Social Services, Government of Guam, is mandated the responsibility for the treatment of Guam's children through age 16. The programme's intent is the reduction of the high rate of dental caries in the younger age groups, a8 well as a comprehensive education programme to increa8e awarenes8 of the importance of good oral health.

...

1Submitted by Government of Guam •

the

Director

of

Public

Health

and Social Services,

- 2 -

-

The acbool dental prolr..... include. a fluoride mouthrin •• ' ~prolr"."'" in every scbool each week durina the school year and dent.l he41th instruction. In June, the Department of Public Health and Social Service. w. . awarded a arant to fluoridate the water supply of the entire Island over the next three years. Nursing In addition to providina direct patient care services, the Public Health Nursing Section was also involved in~ organizing the first co_unity health nursing course at the University of Guam in cooperation with the World Health Oraanization; the development and implementation of the Public Health Nursing Health Information System; the development of the first nurse practitioner protocol for use in the Women's Health Care Services; the development and implementation of the newborn/pos tpartum project; implementation of the prenatal classes, which is now an ongoing actlvlty; providing a workshop on PPD skin test administration and reading to the school health counsellors; participation in several islandwide blood pressure screening projects; and training of two nurses as nurse practitioners. The haDe health services programme has been successful in either avoiding or shortening patient hospitalization, increasing utilization of available hospital beds for the acutely ill, and promoting utilization of patients in their home environment. Diabetes is the major leading reason for referral, followed by cardiovascular diseases, geni to-ur inary disease, and Park inson 's disease. A special project for ostomy patients was implemented by one of the home health nurses, who is a registered enterostomal therapist. Crippled children's services (CCS) Any child under 21 years of age who is a U.S. citizen or permanent resident alien suspected of having a crippling or potentially crippling condition, is eligible for diagnostic work-up. Free diagnostic services are available for children having presumptive and/or probable diagnosis of a CCS priority eligible medical condition. Categories that receive high priority include: cardiac, otological, neurological, orthopaedic, and reconstructive (plastic) patients. Review of the 1980 birth certificates for projection of high risk infants based on compi ication of pregnancy, complication of labour, birth weight, apgar score, and congenital anomalies, and which could possibly have or develop a crippling condition, showed an unduplicated count of 833 or 29.4% of the total live births. Home training programme The haDe training programme (HTP) is a project under the crippled children's services. special mental retardation

It

••

A

- 3 -

-

The goal of HTP is to identify children from birth to three years of age having significant delays in their growth and psychomotor development and to devise and implement a treatment plan to a •• i.t them in developing to their fulle.t potential. The .ervice. provided include: developmental a.se.sment by the home educator, psychologist, and/or administrator; medical a.se.sment, management, and treatment; home tra1n1ng services; centre-based group activities; and coun.elling services for parents and .ibling. for better understanding, acceptance, and participation in training the child with developmental delay •• Comaunicable and chronic disea.e control The Co. .unicable and Chronic Di.ea.e Section i. re.ponsible for the epideaiological control of communicable disea.e. within the Territory of Guam. The Section operates s tanding control programmes for tuberculosis, Hansen's disease, sexually transmitted diseases, immunizable childhood diseases, and hepatitis. The Chronic Disease Unit consists programme in hypertension control. of the recently established

The following is the status of programme activities; (l)

The tuberculo.is programme has continued to decrease the case rate per 100 000 active tuberculosis (54.4 per 100 000 in 1980 coapar.d with 52 per 100 000 in 1981). In 1980 there were 343 c . . es of gonorrhoea and 64 c.... of syphilis compared with 280 gonorrhoea and 54 syphilia cau. in 1979. The i.mmunization leveh for pre-.chool children are above 901. There were 23 hepatiti_ (all types) cales reported for the period January to June 1981, compared with 51 cases for the sa. . period in 1980. The major function of the hypertension programme in 1981 has been to conduct screening projects to identify hypertensives. Prom 111 to 18% of the population groups have been identified .s having moderate to severe hypertension.

(2)

(3)

(4)

Maternal and child health/family planning The maternal and child health programme was strengthened in several areas in the paat year. Major improvements include the development of policies and procedures to guide the programme, the recruitment of an obstetrician-gynaecologist to serve as medical adviser to the programme in the ar.a of Women's Health Services, reviewing of medical charts, recruibDent of a progr .... paediatrician, and the training of an additional obstetrician-gynaecologist nurse practitioner to provide additional parental and family planning services.

- 4 -

In the family planning programme, infertility services were offered for the first time. The programme's health educator also received training in natural faaily plannin& instruction and i. training clinic staff in this area. 'l1le intensive infant care project (IICP) has purchased a broad range of equipaent for the Guam Me.oria1 Hospital NICU, including isolettes, IVAC, apnea .onitor, and an oXYlen monitor, a.ona others. A pilot teenaae pregnancy project was also initiated to provide instruction and counselling to teenage mothers who are not attendinl school. This project will be expanded to include an adolescent clinic. Statistically, Guam's intant mortality rate dropped point ever; 10.8 deaths per thousand live births in 1979. to its lowest

Other plans tor 1982 also call for revamping the IICP project to provide an objective assessment of high-risk conditions, establi.hment of a pilot dental education programme in the village clinics, utilization of the POPBAS system of identification of high-risk pregnancies, and revision of the maternal and child health care State Plan. .

..

ORIGINALJ

ENGLISH

REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN JAPANl (1980) The health situation in Japan has greatly improved recently along with its social and economic development. In this report, some basic heal th statistics will be presented to show the health situation, while recent topics in the field of health and medical services will be highlighted. 1. Vital statistics (Table 1) (a) Population

The total population of Japan according to the national census on 1 October 1980 was 116 212 000. The population has more than doubled since 1920 when the figure of 55 960 000 W8I recorded in the first national census. The 746 800 recorded the rate

1980 national census showed an annual average increase of 0.9% or over a one-year period. This increase was equivalent to the one during the periOd 1956-1960. but showed a decline compared with recorded during the period 1970-1975. which was 1.4%.

The higher rate recorded during the period 1970-1975 can be attributed to the second wave of the so-called "baby boom", the women born during the period of the first "baby boom", i.e. 1947-1949 reaching child-bearing age. The phenomenon seems to have ended in 1976. In terms of age composition of the population in 1980, the younger age group (0-14 years) accounted for 23.5% •. the working age group 05-64 years) 67.3% and the older age group (65 years or more) 9.1%. (b) Live birth rate

The live birth rate stayed at a level of around 30 per thousand population through the Meiji Era (1868-1912) and the Taisho Era (1912-1926) up to the post-war period around 1949. placing Japan in the category of countries with a high live birth rate at that time. Since then, the rate has continued to decrease sharply. reaching a low of 16.9 in 1961, which is almost as low as that of the European countries. In 1962. the rate showed a slight upturn as a result of the "second baby boom". however, since 1974, it has started to decrease and the decline continues. (c) Death rate (Table 2)

The number of deaths in 1980 was 722 792; the death rate was 6.2 per thousand popUlation. The chief causes of death were cerebrovascular diseases. malignant neoplasms. and heart diseases. in that order. Tuberculosis has already disappeared from among the ten leading causes of death and the emphasis of national health activities is now on chronic degenerative diseases.

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

Division,

- 2 -

(d)

Infant mortality rate

-

The infant mortality rate of Japan stayed at a level of more than 150 per thousand births until the end of the Taisho Era (1912-1926). It started to drop thereafter, and was less than 100 in 1940. The rate further decreased to 13.1 in 1970, and reached a record low rate of 7.5 in 1980. Thi. was much higher than the rates of European countriee before the Second World War, but it decreased very sharply after the war at a speed never attained by other countries. Japan now has one of the low.st infant mortality rates in the world. 2. Life expectancy (Table 3)

According to the first life expectancy table, covering the period 1891-1898, the average life expectancy at birth was 42.8 years for males and 44.3 years for females. Since then, the average life expectancy at birth has improved very much in line with the overall development of medical and public health activities. The life expectancy was 50 years in 1947 (50.06 for malee and 53.96 for females) and reached 60 yean for females in 1950 and for males in 1951. The rate of increase was unprecedented in the world: the aV,erage annual increase was 1.69 years for males and 1.72 years for females during the period 1945-1955, and subsequently 0.41 years for males and 0.52 years for females. In 1980, average life expectancy was 73.32 years for males and 78.83 yearB for females. Thus the average life expectancy at birth for both males and females has overtaken the levels of the Western developed countries and even attained the levels of some Scandinavian countries. This rapid improvement is largely due to the decreaee in infant mortality rates and mortality rates from tuberculosis in youth. 3. Measures for health eromotion

Cerebro-cardiovascular diseases and other degenerative diseases have become one of the major national health problems in Japan as in Western countries. To prevent these diseases and to promote health, health promotion centres have been established in the regions as local centres to carry out health promotion measures since 1972. If health is to be maintained and promoted, daily activities mus t provide for a proper balance of physical exercise, nutrition and rest. It is difficult for most people, however, to judge correctly whether their individual daily livee are satisfactory or not from the viewpoint of health maintenance and promotion. The work of the health promotion centres is to provide expert advice to individuals, by teams, on how to live 24 hours a day. The centres have the following three functions~ (1) examination and judgement of health aspects of individual lives, (2) prescriptions on changing lifestyles, and (3) provision of actual guidance.

- 3 -

4.

Degenerative disease control (a) Cerebro-cardiovascular disease control

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

The number of deaths from cancer accounted for 22.4% of total deaths in 1980. In terms of sites of cancer, both male and female suffer mainly from stomach cancer, which is a characteristic of this disease in Japan. Cancer control measures consist of (1) heal th education, (2) medical examination, (3) completion of medical institutions specializing in cancer, (4) training of cancer experts and (5) development of research. There is one national cancer centre in Tokyo and nine regional cancer centres in nine areas, which serve the entire country. These regional centres function as centres for cancer diagnosis and treatment in the respective region. Through mass medical examination, cancer ca.es are often detected and treated in their early stage. 5. Communicable disease control

Fairly extensive preventive vaccination programmes have been carried out in Japan under the requirements of the Preventive Vaccination Law, including regular vaccination for diphtheria, whooping cough, poliomyelitis, rubella and emergent ones for influenza, Japanese encephalitis, and Weil's disease. However, the Government has recently been confronted with serious problems because of accidents or health hazards due to serious side-effects from vaccinations which, although very rare, have presented grave social problems. To cope with these problems, the special aid system for vaccination-induced accidents was introduced in February 1977. The incidence of tuberculosis has been decreasing year by year. The total number of newly registered tuberculosis cases during the year 1980 was 70 916 (morbidity was 60.7 per 100 000 popUlation. which was less than one third the morbidity rate in 1968). The main emphasis has been on preventive measures, and extensive mass health examinations have been maintained.

- 4 -

6.

Maternal and child health

Pregnancy and births are required to be registered with local health authorities by the Maternal and Child Health Law. and maternal and child health programmes are focused upon the care and protection of the pregnant women and infants. Since the maternal death rate is still relatively high, although some improvements are being made. the problem of expectant mothers is a serious one. In dealing with this problem. the Government is giving priority to the following programmes. (1) improvement of the ratio of those taking advantage of the free twice-yearly health examination provided for pregnant women. which has been carried out since 1969; (2) strengthening of the manpower, both in quantity and qual ity. at community level required for maternal and child health promotion, which haa been carried out since 1968. 7. Environmental health (a) Food sanitation

There are 6529 food sanitation inspectors, as of 31 December 1980, mainly stationed at health centres, who carry out food sanitation inspection. In order to improve the efficiency of the inspection programme aimed at assuring the safety of food, an active training programme has been conducted for these inspectors. In addition, food sanitation inspectors stationed at 13 major ports and 3 airports engage in the sanitary control of food imports; the reevaluation of the safety of food additives and insecticide residues. in food has been maintained since 1974 and 1964 respectively. This was done for 30 kinds of food additives and insecticide residues in 53 agricultural products during the year 1979. (b) Water supply March 1979 the total during the 1985.

The population served with water supply systems as of 31 was approximately 104 250 000, eguivalent to 90.3% of population. About 13 000 million m3 of water was supplied year 1976, which will be increased to about 21 000 m3 or more by 8. Health manpower and medical facilities (Table 4)

The number of physicians, who form the core of the health manpower. was estimated at about 150 229 as of the end of 1979 (129.4 per 100 000 population). The number of medical schools is 79 at present and the total number of students admitted to those schools was about 8260 in 1980. The physician-population ratio is estimated at 157 per 100 000 in 1985. The number of dentists, pharmacists. public health nurses. midwives. and clinical nurses has increased over the previous year. The increase in the number of clinical nurses has been particularly remarkable.

•

- 5 -

'" Table 1VITAL STATISTICS AND OTHER STATISTICS 1979 Number Population (estimated) Live birth. (per 1000 population) Death. (per 1000 population) Natural increa.e (per 1000 population) Infant deaths (per 1000 live births> Neonatal deaths (per 1000 live births) Still births (per 1000 births) Perinatal deaths (per 1000 live births) Marriage (per 1000 population) Divorce (per 1000 population) 115 465 000 1 642 582 689 659 952 923 12 923 8 590 82 319 20 496 788 505 135 250 14.2 6.0 8.3 7.9 5.2 47.7 12.5 6.8 1.17 Rate Number 116 212 000 1 576 878 722 792 854 086 11 840 7 795 77 444 18 386 174 707 141 692 13.6 6.2 7.3 7.5 4.9 46.8 11. 7 6.7 1.22 1980 Rate

...

~

~,

),

•

);

Table 2.

DEATHS BY LEADING CAUSES 1979 1980 Number Rate (per 100 000 population)

Number

Rate (per 100 000 population)

1-

Cerebrovascular diseases Malignant neoplasms Heart diseases Pneumonia and bronchitis Senility without mention of psychosis Accidents Suicide Cirrhosis of the liver Hypertensive diseases Diabetes mellitus

158 974 156 661 III 938 32 859 29 227 29 419 20 823 16 143 16 382 9 264

137.7 135.7 96.9 28.5 25.3 25.5 18.0 14.0 14.2 8.0

162 300 161 681 123 473 39 230 28 949 32 147 20 522 15 911 16 488 10 171

139.7 139.1 106.2 33.8 24.9 0\

2. 3. 4. 5. 6. 7. 8. 9.

27.7 17.7 13.7 14.2 8.8

10.

- 7 ..i.

Table 3.

AVERAGE LIFE EXPECTANCY AT BIRTH Sex Sex Female 44.3 44.85 44.73 43.20 46.54 49.63 37.5 51.1 53.96 59.4 59.8 62.97 61. 5 64.9 65.5 65.7 67.69 67.75 68.41 67.54 67.60 69.61 Year 1959 59* 1960 61 62 63 64 1965* 66 67 68 69 1970* 71

Year 1891 - 1898* 1899 - 1903* 1909 - 1913* 1921 - 1925* 1926 - 1930* 1935 - 1936* 1945 46 47* 48

Male 42.8 43.97 44.25 44.06 44.82 46.92 23.9 42.6 50.06 55.6 56.2 . 59.57 58.0 60.8 61. 9 61.9 63.41 63.60 63.88 63.59 63.24 64.98

Male 65.21 65.32 65.37 66.03 66.23 67.21 67.67 67.74 68.35 68.91 69.05 69.18 69.31 70.17 70.50 70.70 71.16 71.76 72.15 72.69 72.97 73.46 73.32

Female 69.88 70.19 70.26 70.79 71.16 72.34 12.87 72.92 73.61 74.15 74.30 74.67 74.66 75.58 75.94 76.02 76.31 76.95 77 .35 77 .95

.-

1949 1950 - 1952* 1950 51 52 53

72 73 74 75 76 77

...

54 55* 1955 56 57 58

78 79 80

78.33 78.89 78.83

*Complete life table.

- 8 -

Table 4.

NUMBER OF MEDICAL CARE PERSONNEL

Total number

Rate (per 100-000 population) 129.4 43.8 95.4 15.1 22.6 394.5

Physician Dentht Pharmacist Public health nurse Midwife Clinical nurse

150 229 50 821 110 774 17 583 26 267 458 362

ENGLISH ONLY

1 BRIEF REPORT ON TH! PROGRESS OF HEALTH ACTIVITIES IN MACAU - 1980/1981

1 - SAIITARY CONDITIONS '. -

-

T~

sanitary conditions of tho Territory may be considered good.

Diaea.e. like malaria, cholera, diphteria and poliomyelitis continue nOD-8xi.tent in Macau. However, there are ahout 100 known ca.es of lepro8Y,o£ which 60 per cent are hospitalized. Pre.ently, only the \

multi-bacillar" c...s and the ones with Bevero neurotrophio disturbances or .eyere leprotic reactions are institutionalizod.

In 1980, several new cases were detected, fact that leads us to believe that there are undetected cases within the population. There has been a decrease of Pulmonary Tuberculosis, relatively to the number ot patients. In 1980, 2}1 new cases were detected. However, the fact that in Macau all women givo birth in maternity wards, where the new-born are inoculated with BeG and because of the work done by thB Anti-Tuberculo.ia Department, we are rather optimistic about the stabilization ot the diaease in the future.

There are two hospitals for a population of 400.000 inhabitants. HOSPITAL CENl'RAL CONDE DE S. JANUARIO - The Government Hospital, with 400 beds. It is well equipped, well kept Altho~h ~ld ~as

a good attendance.

it is open to all, it serves basically the portueuese community

(10.000 people) and people from a low income bracket. The hospital's main ,problem is the lack of doctors in some basic Rpccialtico.

lSubmitted by the Government of Macau.

-"",

\,.,',

2.

mAte W HOSPITAL - A Hospital with 1.200 beds. which serves _ ch~ese

oommunity. It 1s well equipped. It. doctors are licensed in

the People's Republic ot China and they exist in eufficient quant1tl

, - SPECIALIZED DEPAR'l'MENl'S

In l'acau. we have tM tollow1.n« specialized Govern.ent de)lU'tMnts.

ANTI-TUBERCULOSIS - Supervieed by a specialized phraiclan, who 1s presently studJ1aI in Japan with a World Health Organization srant. This u~nt

pertor.ed 5.'50 chest x-ray. in 1980. I •

TUBEltCULD TESTS PERFORMED 119 SCHOOLS

1978 TubeM\alin Tests

1919 }02 115 101 604

1980 , .. 0'7

2.045 1.140 905 4.090

Poeitive aeaction Ne..tive aeaction TOTAL

729 2.198

5.964

MlNl'AL HEALTH - It i. non-operative because we have no psychiatrist.

1979 1.t Consultatione 2nd Coneultationa TOTAL

1980 1.226 4.470 5.696

..

1.03' '.443 4.416

•

• . I

Thi.

4I~~A.

41.trlbute. milk, tree ot cb!u:p, to needy ch11Gr.D. 1

Pow4ere4 .M.1.lk -OIn1&oConuDHclMilk

1.330 490

1.437 007 913

... "

-

6@J-MtP! l'~l.

DISE4SE - Supervi.ecl 'by a pl\y'.ic1al'l eapeo1&lia.cl 10

W.

~Y'

a .anatoriua wIth 60 patlant.. at

~ ••nt.

SC!!92L IJ!AItTB - B&cl a '1&nIficant 1nc1'8_nt 1n the beain.n1nc

ot

1981.

All 01 Macau' • •choal popllation (60.000) waa inooulated ap1nat JIOl,10JQel1t1••

.It:l'I-MtJ:MlD -

A1 thouah the dieeaae 11 &I

not active in Macau, th1.

da,llU"'t_nt 18 MJ.nta.t.oed

a preoautionar.Y Ma.un.

HEALfB II SPORTS - :Becau.. ot the fact that in Macau -.ny :people

pract10l .porta

V8

have recentely created

th~a

upart..nt. The 1'8apective

le.Ulat1ClD baa ..lre~ been plbliahecl.

... - SUPPOJl'1' PBOM THE WOJUJ) HEALTH ORGANIUTIOI T~

WHO'. lealonal Off1ce for the We.tern lacifio baa aiven ua exoelaat

aupportl

CONSULTANTS - During thia period we have had vi.ita trom consultant, on leprosy. occupational health. cancer and ._lar1&.

I. on

CRANTS - Presently we have an employee in New Zealand. eSp8cializ1na t~

_tntenance of medical equipnent and a pl\y.lcian in Japan tor a

courae on 'l'uberculo8i8.

ENGLISH ONLY BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN MALAYSIA1 1. COUNTRY~'.

1.1.

M ..a...~YSlzf. is a federation of 13 states and a Federal Eleven of the States and the Federal Territory are in Peninsular Malaysia and the remaining two states Babah and Sarawak are in the Island ·of ~rne:o. The Total land'area is 127,581 sq.miles (330,484~). Peninsular Malaysia is 50,806 sq.miles (131t588Km. ) and the States of SaQah and Sarawak cover an area of 76.775 ·Bq~miles 2 198,896Km). The annual rainfall is between 60 and 160 inches. The daily average temperature varies ,iran 700 F to 900.,. Relative humidity is everywhere generally high but the night temperature is comparatively cool. Te~r~tory.

2.

POPUI..ATION

I

2.1.

Thu estimated population and population density are as follows ;-

1980 Population Density/

__ i~~~!~2el~___ 11.138 1.002 1.295 13.435

_~9!!! __

Peninsular Malaysia

'"

••

219 35 27 105

~bah

••

,. ••

SBrawak M~YSIA

•• •• 1

••

3.

~l.LTH S'l'.~TUS

3 . 1 . ' l ' h e general health of the

popul.l!lt~on continues to improve and the various health indicators which have steadily deolinedrefleot the effectiveness of the health policies and innovati18 measures which the Government and the Ministry of Health had taken for health imprOVement.

·1

of Health, Malaysia.

Submitted by the Division of Planning and Development, Ministry

· •• 2./-

.

-

2.

-

l' '., ,

% 1957 (Year of 1979 (lAtest, "~:Deoline 4vailabie') !~~~e~22~~£:1 .......... ., ------;'j

-----.,.-

•C 'da' Pf.tlfRs+., ;*""'.1'l ,( r" >.1,

12~40

" f~80 16.Qo.

. '

~

,'.20 43.90

~aaa~l

MOl'ta-li ty

Ra,te' ' ..

29.60 75.5° 10.6,5 2.82 ", I

"•. :: r,~fant ~P;tPlity :. ,,,. , ,,~~te. . , '

,; , ; "

t ~

'!'

",

i:

"

2.6.97 ' ~.~Q, '

1

"

64.28 77.46 75.53

,,; TOCidlar, 'Mer-taU ty iJ,illte,

Maternal Mortality Rate ", I

0.69

3.2.. .'.. ", I

The PrQPo~tionQl Death Rate ,(50+ years) has inoreased "from 32.8% 'in 1957 to 59.9% in 1978. 4lmo,t 6~ ot ~the deaths are now ooouring in the older ese-group. ,!, <~~ •

\

'

~,'.

'

~" -.J.),

. ' -T~, life expeotancy at birth for tha male and female popu1.8t.iGnwhich was 56 and 58 years respectively in 1957 has increased to 67.12 and 72.68 year. in 1978. 46.2 in The Crude Birth Rate was 30.5 in 1979 as oompared to '1957. The R~t~"of Nature~'InoreaBe has therefore d~olined ~rom 33.7 in 1957 to 24.7 in 1979.

3.4.

4.

}lE;lLTH lI100ET : ,b.. ;

4.1.

The Health Budget for 1981 is M8 1011.7 million (MI 891.9 million for Operating Expenditure and H$ 119.8 million for Developnont Expenditure). The' Operating Expenditure is Q.13~ of the 'total oountry appropriation tor tho Operating Budget whilst the DevelopmentE¥,penditUre is 1.41% ,of the fotal Developmer;1t or Capital InYfUiJ~ent appropriation.

4.2.

usa 31.37

The per capito health expenditure: is MI 75. 29 or Both tho Operating and cnpitnl Investment Budsets are funded out of the Current kooount.

..3/-

-

.3

-

The breakdown of the 1981 Budget ~ Progra~~s are as follows, ..... ::...-.. . ...... .... . ................... , , ~ ,.

.

'

;

r·,· '.

'.,

. '~v~lop.ent or Capital .+n~~~p1e,t Ex;pendj.ture :'. ,

, (,c •...•

.oJJfl~ti~, ~~~tm'.: J . . ~ q~nera~ .ldm~ni~tr,tion - Public Health

;

11.84

.

"

.

.

24 52? 850

.'l U -

"

... . Denta~ Care' - Training ~ Phar;maoy & Suppliee - RtitsQaroh - Planning & Development - Engineering Services

;:Pf,l,h~'A~ ~. .ca~e

220 767 780 'j'

!.'

5alf1273 300 47 ,889 100

2.42 21.82 51.53

lt7 654 950 19 5'79 420 ? 108 000

4.71

4.73

---........... .

1539.700 978 000 --~- ~

100.00 III_=-

_ .._---

0.76 0.1, 0.10

1.94

5.1.1 •. Capital InveBtment, 'F'.'M.P.l The total Alloc')t~on approved for the F.M.P. is HI558,440,OOO and this amount ;s distributed 00 followsI· Preventive sector Curllti VQ 'sector Supportive sector

.... .,.. •••

g, 127,897,657 )65, 687,323 64,855,020

~

of

In physical turms the F.M.P. comprised ot 3.123 projects - 1,278 projects are carr*ed-over trom the T.M.P. and 1,845 new projects. The distribution the projects by sectors is as follows:No. 1m 1 059

.ector Curative soctor Supportive' soc tor frev~ntive

••• •••

•••

275

5.1.2.

~~eTotal No •. of Projects in the Third Malaysia Plan (~) 'was 2,176. Of these 1,930 were tull1 funded and 246 partially funded.

The achievement in physioal terms at the end of the 1980 is as follows:Completed 1,022 or Under Construction 512 or the remaining 642 or stages of planning.

46.96%.

23.5~; and 29.51~ are in

various

..4/-

, ... ·4 ... '

In planning the FMP cognisance bad been taken of Government's New Eoonomio Policy (NEP) and the n.ed to provide basio health oare tor the tota~ ~op~lation. In .upporting ~he NEP the Ministry of Heal'th0-10H) would cone,ern tteelf with improving the health standotlrd of the indi vidual and thus the oommuni ty. The MOB will acoord hipest priority to population groups l i ving in eoon0ll1oally depressed .r... •• .ell as .~ea. whioh are un.erved or und4~•• rV84b,y ••••nttalh.alth serVic ••• "

" The approach to health plann1ng in the FMP wos based on health problem identific~tion and the promotion of he.~th programmes to resolve them. Ov.rall objectives a. well,a. programme objocti ves have been oletlr4r defined 'Dd appropriate strategies identified in order to aohieve tlwae Ob.t.Clt;i.~8.

5.2.1..

Objective of the MOH: , '

,'". , :;

The Objective of the NOH, in line with the New EqOQqnic: POlloy, is to f~o1litatfl1 the attainment and maintenanoe by the individual of a stan_ dard of health which will enable him to lead an economically' and socially productive life. Based on this Object~ve, the MOH has , ,:i.~ent~J:i.odproblem pri~~itie.':4lnd adopted certain broad strategies as well as 8~cifio strategi.s after examining various' option. through'the'.ppl1ca, ti on of the fol:J,owing cri teri~u

.

f' J

~.: \:' . ".:'

.. .,va:i.lability, feasibility and '.if-eotiveness of' technologY. ' . .

~ th~ :,,:;'

extl)nt the' technology qa,n be used 1>y low cate~ory staff,' and pe wi,.dely: .pplled.

,

-' ,multiple effects' ~,\'a number of health " , problems. ' , ,

'

:,

'

.

'. -

manpower implioation. oost faotor.

',,' i

"

,

••6/~"

r

- 5

strategies in the FMP: . Some" specific strategies adopted are: ~nd,

..

emphasis on iden,t;f.ti.edtarget population areas for a m~re eq~i~able resource allOC.:ltion. '

:'

J

emphasis to preventive 'sod promotive aspects. emphasis to preventible communic~ble dise.9sus. provision of currtive and rehabilitative services which aro apprQpriate, acaessible, effecti Vo and effici~nt:•.4· use of appropriQte technologies whioh oan be wid~ly applied or which can solve a number of health and health-related problems. comprehensive care to the f~mily

as a unit.

....

maximum utilisation of oommunity resources • improvement of management, of heal'th services through bettor m~nagement techniques, studies and information system. competency-based or task-oriented training to eqUip henlth and health-related personnel with the necessary knowledge, skill and attitude 80 thnt they o~n better ralate their , functions to the needs and expectations of ; thi communi ty. , co-ordination of multi-agency efforts to improve and maintain a he(;lltlQ' 11 ving epvironm~nt. collaboration with othe,r ag~ncies and promote inter-agency cl:):-or~~at~.on,;in health-reloted issues. ' promotion of biomedical, clinical and health service res(ti:trch. Health service research is bf pllr.~icu~iil1portfl~e: because it concerns itself with management issues.' strengthen administrati~ and suppprtive ser, vioes to A~~lth and health-related aotivites, and provision of appropriate oareer development of healtp and health-related personnel • ~:

, 'I

.."

';',:'

:!'

•• 7/-

-

6

H£riLTH PROBll£MS I

...

, . fn~~, e."e,r,~ng. , , <', "- \ '. •

Malaysia is at the'cross-roade of health problems w~~e diseases common in developing oountries, viz., q~~toab1e diseases Dnd diseases a.sociated with poor environmental conditions, are rapidly declining and diseases prevalent in devoloped countries, such ss, orgenic disorders. industrial and motor aocidents and oocupational diseases are ... ~.

emphasis~nd tBchn~lQgy so that the 'oable ~aeaees C~~ ~ 'ooptrolled or

Such a situation cnlls for an orderly change in residual effects of communieradioated and appropriate ca~b11i'1'~,dtveloped to cope with the increasing proble~ of ·industri~l ana,occupation,'ll haznrds, org!lnio disorders, Ohanain,S life styles, etc •• ' ',: ", d .:

"

This t,herefore calls for the systematic training and ",rft"","4lilling of me4icaJ.~nd. allied personnel to enabls them to .tfeotive~ deal with such changing problems. ",. ,t·· ','

The wo~ programme is used here to mean a group of related acti vi ties delivered by, a set of specific resources for t~each1evement of defined objectives. Each programme has its · oWnpro~aDlQle objective(s), strategy/strategies and aotivity/ · activities. : ..., . : ' ; , i

Operational constraints of the programmes were identified and appropriate steps will be taken to minimise or ,r~ovs tAaQl ;in the cou;.se of iOlplementation. The activitios of ~he MOH in the FMP were organised alopg 22 progJ"immes and· grouped into three sectors, viz., preventive, cura~i~e and supportive. Highlightm of some of the programmes are Fnmi}: Health Proifomme: • t"

• '.,j

. ~::

The cr~otion of this programme is in the context of a compr~honBive serVice aimed at the family ae a unit. .~part from providing the routine maternal and child health servico, the scope has been widen to include out-of-BChool children, adolescents, youths. women during the Child-bearing intarvals as well as the father in the f:lmily.

..8/-

. . 7

.

Environmental sani tab on Programme: This programme will be fnrther intensified as the coverage of tho rural population is still far from sati~fnctory~ Fo02 Quality Control Programme: Whilst efforts will be further intensified in tho hygiene of food proparation and handling and of tood premisee, the inspeotion of tood tor quality will be strengthened through the establishment of Food Laboratory Servioesa Vector-borne Disease.Control Programme: There are three major vector-borne diseasee in tho country. They are malaria, filariasis and dengue/dengue harmorrhagic fever. All are borne by mosqUitoes, though of different species. The intention,is to,gfo~ptho control of these and other vector-borne disea~es by phases under one programme as many of the steps in and resources needed far intervention are similar. Communicable D+sease~ Pr~vention

;

.

and Control Programme:

The incidence of communicable diseases with effective vaccines for prevention had been considerably reduced. vaccination and other control activities will bo intensified. Measles vacoination for example will be introduced. on 0 routine r-5Isis.

5.4.6.

'Health Education Programme: JUnong all the strategies, health eduoation had been identified as one of those which ranks very high, because the technology i6 relatively cheap, can be widely applied, and will bonefit many health problems when carried out effectivelYQ

•• 9/-

8

In-patient Cnre Programme: The proposals in FMP are: equity in the distribution of beds between areas by constructing new hospitals or e¥p~nding existing ones. balance in the distribution of beds among disciplines •

-

: ,I currently

.. . to further develop suppo~t faOilities/services doficient. to establish medical £ludit mechanism. to improve hospital manng~ment, and

..

to improve training f cilities nnd libraries.

5.4.8.

Out-patient Care Programme (O.P.D.): Out-patient services are provided by ho~pital­ based out-patient departments, urban polyclinics, health centres and mobilo teams. On the overage 2.2 persons/1000 populntion/d'lY attend hosp;i.taloutpatient departments. 14 million O.P.D_ 'attepdances were recorded in 1980 compared with 5.7 million in 1970. 3~ of O.P.D. workload are referred to ' specialists. About 30% are ,seen after normal working hours. ' The MOll recogniseatho t.c;ct'that in'many COBes the O.P.D. is tl1e first point of oontact 'of tho e:l;Qk patient with the health service. An effectiv~O.P.D. service which c~n diagnose illness early and,provide effective ambulant tre~tment will ~ot only eharten suffering but !ileo minimise hospi tal adm1~l'Jion. . , Laboratory Support Programme: Radiol0gic3l Support Programme: In order to cope with increas~ ~nd'variety of demond, under the FMP furthel," expansion' ~n(t improvements to these progrnmmee are. . . necessary. ",".

.,10/-

9

personal, Dental Care Programme: . : It is proposed to increase the s~ope of dental care population which currently is restricted to treatment of emergencies only. Thore will be a ~ore organ;ised and ~yatem8tic 8'pproach to pre-school children. '

to

t~

adu~t

5.,4.11.

P.reventi VEl !){,tntal Care

Progr~mmo a

Prevention ot dentnl cariee through the fluoridation ot public wl)tor supplies will continue. ~ealth

Manpower Planning and Trainins Programme: :

1 ' ...

Shortage of health manpower of various types effect the running of health programmes. There is a lag-t$.me of 1-6 yeo:rs iI;1 manpower prodUction. Unless there is proper manpower planning linked to faciliy clevel:0pment 3ndpr,ogramme structures, there is 1ike~ to be under-production, ov",r-production or production of. the wrong type of 'personnel. Acti Vi. ties in relation to Penlth manpower planning ~ll be further emphasised. On the production side, the emphasis will be on making it more effective andeffioient - effeotive from the point of apprwpr;iatanesa And relevance of curricula and educltional methodology, and efficient from the PQ~~t of r~source utillzotion t , "

,

,

Pharmacy and SURplies Programmes The areas of conCdrn of this programme are logistics, drug quality and s~foty, and research • •lcti vities r~lating to logistics will be improved by providing better physical f'lcilities, and Ildoption of more effecti va procedures and pr.~ctices. A standard drug list will be developed, and drug information centres will be established in hospitals. Local production of quality pharmaceutical preparation will be increased., ~part from strengthening the enforcement of current drug and pharmacy lllwB. imported ~nd locally manufactured drugs will be tested. registered and' ' licensed. Local pharmaceutical factories and manufacturer.s ,of traditional medicines ale? will be licensed. '0

..11/.. ,

1'0

-

'~4. ;

Bio~dical ReB~arch

An: .

"' ::1.,", ....

Programmes . <, .... , ••••

Health Service

Raae~rch Progrnmm~:

,'

The I~Btitute for Medical Rese~rch, alone or i,n 90llabor'ltion with other agencies undertook many reseorch activities, apart from carrying out high level labor::ltory inve'stigation and training of lllbor2tory perspnncl. M'lny of these l'esearch subjects 31"6' biomedio~l or clinica.l' :1n.n:lturs.' In the Pl4P, ,biomrc;licnl resetlrch progrnmme as onl) of the supporti ve tools' for ho::llth progrnmme development, will co-ordinate its activities with henlth programme development and . align itself with g.Jner::ll guidelines and prioritj.ee whioh will bo ust:)blishtid. Hu~lth sorvice rusunrch will be int~naitied , in, the FMP. The progr'ammo will look into such issues as manpower, org~nis3tion, resource utilization, service qt~lizQtibnt problem identificntion, quality of care, cost issues, information, need and demand, community responsa,and v'lrious other m~nagerial subjects. It is felt he~lth service research cnn improve tho effectiveness and efficioncy of ho~lth programmes, quality of decisions and the planning process.

One of tho main concerns in the FMP would be the cycling of rosccrch findings into dovelopment effort. Engineering Programme: The Environm~nt3l HEI!llth lind Engineering Unit currently providos expertise in environment:ll quality oontrol, urban engineuring and radiation protection. It is necessary to dQv~lopfurthElr tho engine~ring capabi~ty within tho MOH and ostablish appropriate stru.otures t~ it. The progr~mme willa provido ~ffectiva and effioient engineering support to ensure m'Jximum functioning of plllnts and equipment. proVido engineeting consultancy serVices. rad~ation hazar~s.

""

~

pr9Vide proper wDete collection, treatment and disposal systems in hospitals.

..12/-

11

Th~ progr~mmo envis~ges the establishment of differont 10vuls of workshops at hospitals. some of which will sorvo specific zones in addition to catering for locol needs.

PLANNING ~ DEVEWatENT DIVISION. MINISTRY OF I£J'LLTH t ~u,:~YSU,

KUJ~l

LUMPUR. DllTED a 14TH. SEPrlMBER, 1981.

KS/EJM/csl.

"

~GLISH

ONLY

1 BRIEF WORT. ON THE PBOGRESS OF HEALTH ACTIVITIES IN NEW ZJW.ANJ) 1980 - 1981

1.

GENERAL

The formation of the Special Advisory Committee on Health Services Organization (SACHSO) to develop proposals for the reorganization of health services and regional planning are recent attempts to achieve coordinated aQd comprehen.ive planning for New Zealand's health care system. Proposals for the reorganization of health services in New Zealand have been tested in two pilot areas, one urban, and one predominantly rural. Both areas have recently reported to the Minister of Health on the feasibility of these proposals. These reports, in conjunction with further advice fra. SACHSO, are currently under consideration by the Governaent. The health services have also been encouraged to participate in regional planning under the Town and Country Planning Act 1977, which allows and provides the mechanism for: (1) (2) (3) identifying regional health needs and tailoring national policies and proar..ae. to meet them; contributions to be made from planning process and scheme; the health .ervices to the regional planning of

-

enabling the health services to influence the organizations whose activities have health implications.

Initial steps are being taken towards the preparation of a regional health plan aa part of the regional planning schemes in a number of parts of New Zealand.

2.

HEALTH PROMOTION ACTIVITIES

2.1

Family health

In the field of parenthood health education, a number of groups were .et up throughout the country to coordinate and extend antenatal and postnatal education. Four l5-minute films about the health of children (age 6 month. to S year.) were completed. Theae were .hown on national television, and made available for public health education.

1

Submitted by the Director-General of Health, New Zealand.

- 2 -

The department assumed financial responsibility for the service component of national screening programmes for phenylketonuria and hypothyroidism. A new screening programme for maternal phenylketonuria was introduced. The Plunket Society continued to establish family support units. These units offer guidance, educat ion and support for mothers. There are now 16 fixed and 18 mobile units throughout New Zealand. A child health and development record book for parents was subject to field trials during the year. The book will be made available free to all mothers of new born infants. A new policy of routine health assessment of new entrants to primary school by public health nurses has been introduced in the school health programme. To improve screening and diagnosis of deafness, auditory brainstem response and impedance audiometry techniques are being introduced progre •• ively for the objective assessment of hearing los. in young children.

2.2

Disease prevention

To add emphasis to the importance that life style presents in the causation of noncODDllunicable diseases presenting public health problems, the term "disease control" has been replaced by "disease prevention". Priorities for the years 1981-1982 include "addiction prevention". This programme is chiefly related to introducing moderation and responsibility in the use of alcohol, and the department coordinates its activities with, and is supportive of, the efforts of the Alcoholic Liquor Advisory Council (ALAe), which is a statutory body funded by levy on the liquor industry. A further agreement has been signed wi th the tobacco companies for a three-year period. A recent analysis of tar levels has shown a further reduction in most brands. In the communicable di.eases fie ld, tuberculo. is has shown a further significant decrease for the second year running, and thil il delpite the detection of the disease in a large number of refugees from South-Kalt ~ia. The rubella pandemic reached New Zealand in late 1979 and continued throughout 1980. This has resulted in 33 confirmed cases of congenital rube lla to date. In only half this number have congenital defects been detected. Immunization levels have continued to improve and the "eradicate measles epidemics by 1983" programme has received further emphasis. The objective is the protection of at least 95% of children aged 1 to 10 years by 1983.

- 3 -

2.3

Health protection

Over the past 12 months, good progress has been made with the preparation of the Toxic Substances Regulations, which hopefully will be promulgated late in 1981. The Food Bill introduced last year has been reported back to Parliament after consideration of submission. by a select committee. Cert ification of exported food is an increasing responsibility of the division. Moves are being made to extend required certification of imported food. In the occupational health area a farm worker survey has been completed and other significant surveys completed by occupational heal th teams include work on visual display units and plain paper photocopiers. The Lead Proce.. Regulations review in conjunction with employers and unions is practically completed and a start has been made on Electroplating Regulations. One of the main concerns of the environmental branch has been with environmental noise control. Legislation on immediate statement of neighbourhood noise has been prepared as well as a major interdepartmental review of general environmental noise control.

.

3. CLINICAL SERVICES 3.1 (a) (b) Medicines Expenditure on pharmaceutical benefits increased by 10.9% 1980-1981, which was once again below the rate of inflation. durina

Restrictions on payment from public funds for minor tranquillizers have resulted in a 14% decrease in their prescription. The restriction has now been extended to hypnotics, with a similar reduction in usage. No more than 30 days' supply of minor tranquillizers and hypnotics can be obtained on a prescription form at the cost of public funds, because medical opinion is that they should be prescribed for a short period of time only. New Zealand completed the changeover to UlOO insulin during 1981. By using only one strength of insulin, it is hoped that confusion and errors in dose will be eliminated. Heroin has continued to be in short supply as a drug of abuse and so thefts of narcotics and psychotropic drugs (particularly barbiturates> from retail pharmacies have been carried out to supply the illicit market with substitute drugs. Efforts have been made to increase security of drugs and identify all prescribers and user. of barbiturates.

(c)

(d)

- 4 -

3.2

Practice nurses

An interdepartmental co~mittee has recommended that there should be no change in the practice nurse scheme, under which general practitioners can have up to 100% subsidy towards the salary of a registered nurse, with the object of improving primary health care delivery.

3.3

Health centres

Two more government-funded health centres were opened, bringing the total to 12. The demand for this type of community health facility has reduced.

4.

HOSPITAL SERVICES

During 1981, extensive audits and surveys have been undertaken of New Zealand's cardiac surgical services, on a scale probably unprecedented in other branches of surgery. New Zealand currently performs about 1000 cardiac operations per annum and it is now estimated that about 1800 operations per annum should be performed. New Zealand's three cardiac units are planning to expand to cope with this number of operations, but no further units are envisaged in the immediate future. A three yearly programme to provide high cost technological hospital services has been established with a view to effective planning to avoid the indiscriminate prOV1S10n of such services. The next three yearly programme will commence in 1983 and serious consideration will then be given to establishing a national unit for bone marrow transplants. Emphasis continues to be placed on community care, and home help services operated by the Social Welfare Department are to be transferred to hoepital board control to provide a unified service. At the same time, the policy for entitlement to home help is being reviewed with the intention of making the service more available to those whose neede are health-related. The increasing cost of hospital services has been held in real terms by strict financial control on the part of hospital boards. A major proposal being considered is to fund hospital boards through a population-based formula. The present method is based on a 1967 financial base (with adjustments) and does not directly account for demographic changes. Some areas appear to have an unfair advantage in funds for public hospital services. The construction of new hospital buildings is largely limited to replacement of substandard accommodation, except in Auckland where there is still some shortage of acute beds. Increasing eIIlphasis is being laid on the restriction of future operating costs in new or replacement buildings. The slow population growth and population movements within New Zealand have caused considerable revision in the planning of hospital services.

- 5 -

5.

DENTAL HEALTH

The dental health of children and adolescents has continued to improve. For the fir8t time children enrolled in the .chool dental .ervice require Ie •• than an average of one filling per y.ar, in their peraanent dentition. The reduction in treatment needs, and the decline in the child population i. enabling the objective of the school dental service, namely, to provide a high standard of dental care for pre-school, primary and intemediate school children, to be met with fewer staff. This, combined with changes in the employment patterns of women, has led to a reduction in number. of school dental nurses being trained, and the closure from 1982 of two of the three schools for dental nurses. Conlideration it beina given, following a paper by Dr D. Barme., Chief, Oral Health, WHO, to .etting a target for the dental health of New Zealand children of 1... than 3 DMF teeth at a.e 12/13 •

...

ENGLISH ONLY BRIEF REPORT OF THE STATE OF HEALTH IN THE PHILIPPINESl 1980 I. 1910. ~ • •k11i••i . . . . . . .rl •••• ~ .~iti.ant J.ad.~1a.

i. it .......al1 k.a1t1l .tat•• 1.

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.t t.Il....... ,.ar • . . .iIl. SO 7 ••r ........r ".i ..... r" .. ... .,..ili. 4ea'tll

r.M . f )7.6 ,.r 100,000 ,.pul.ti.a in 1'10 whi.h . . . . . . .U.ht iaen ... !T!r the .......i ••• 'Y.ar. ft • •

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Submitted by the Assistant Secretary of Health, Philippines.

..

we" Ia_.al •• , Di.o ..... • 1 tho •• art. flaMrcul ••i •• all P.ra., G•• tre-eateriti. an. C.liti •• Di •••••• ot tho T...ou1ar IT......

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with. total .t lO,n5 ..... tho UU·. are .Wt•• 1ty 1,4'1 ~.i.i ... , 1,'" nur •••• ',005 .i'.iy. . . .t 2,22' aanitar,y i ....cter.. C_~ia.ntary te tbe •• boal til per ..DB.1 &1'0 171 tp •• raaont , ••ti.t. wh. are in char.o .t tho lID '.ntal c......... !be ' •••I'D8• • t h ••pital ••a the othor h ...... aro ......t ".y 1,'14 ... tera

aft" 6,56' nur ••••

ORIGINAL: REPUBLIC OF KOREA PROGRESS REPORT ON NATIONAL HEALTH SITUATION I

ENCtlSH

The following il an outline of the national health lituation in the Republic of Korea which has developed as a result of the Government'a national policies and successive five-year Economic Development Plans. The Governaent is addressing itself with 8 strong will to achieving the goal of eltablilbing a democratic welfare state in tbe 1980s. Medical security scheme The . . ciical security scheme haa been divided into two sYltems. the medicaid progra. .e and medical insurance. As regards the medicaid progr.... , the Government enacted a law for medical assistance in December 1977 for indigent and low-income persons, in order to give them greater medical benefits at the same level as medical insurance COltl. The Government introduced the medical insurance scheme in July 1977 for 3.1 million workere and their dependanta ~n firms with more than SOO staff; thil Icheme wal extended in January 1981 on a mandatory baaia to include tho.e working in finDS with 100 worker. and over, na. . ly 6.7 aillion perlonl. Provilion is also made on a voluntary baaia to include firms _ployina 1... than 100 a ta ff. In January 1979. under a .. parate plan, 2.7 million civil aervanta and teacher. in private Ichool. and their dependanta became compulaorily insured. Since July 1981. the Covernaent has been carrying out a pilot medical inlurance scheaae for rural areas by which 200 000 residenta of three counties have become eHaible for insurance benefits. If succe88ful, this scheme will be extended to cover 30% of rural residents by 1986. By the end of 1981 the nuaber of sublcriberl and dependants covered by the medical insurance scheme will be 11 million (28% of the total population). When 3.7 million low-inca.. persons under the public alsistance progra. .e are added to the above figure, 37.5% of the nation's total popUlation will be eligible in 1981 for medical insurance and aedical care benefits. By 1991, all people will be covered by the medical lecurity sche.e. Medical service resources To obtain the maximum utilization of medical manpower, medical coverage has been re-organized from the current myon-level to village-level, thus introducing primary health care to the graslroots level. For this purpose the Government has designated certain doctorlesl areas as special areas to which medical manpower could be directed. With the alleviation of economic constraints on medical services through the expansion of medical security coverage, the demand for medical services has gradually increased. The Covernment is therefore aubetantially renovatina exiatina public medical facilitiea, including aedical equipment, such aa national/provincial hospitals, health centrea and sub-health centres which play a key role in providing primary health care. Meanwhile, to assure the expansion of private medical facilities,

ISubaitted Korea.

by the Ministry of Health and Social Affairs, Republic of

- 2 -

the Government has already been providing financial support for the construction of hospitals, especially in rural areas and industrial complexes lacking adequate facilities. There is now a capacity of 65 000 beds in all hospitals, equivalent to one bed per 587 persons, which is on the way to covering 94% of the required demand by 1986. Family health services The Government is planning to reduce the rate of population growth to 1.61% by 1986. Under this plan, the Government has strengthened its family planning campaign for low-income people in urban areas and residents of remote area.. In parallel with the family planning project, it has already commenced a project to build a total of 91 large-acale maternity health clinica, mostly in rural and fiahery areaa, by 1983, of which 14 clinica are under con.truction and will be completed thia year. Expectant mothen and infanta, e.pecially thou in needy familiea, will 'be able to receive better health services, includina nutrition, from these c Hnics. Preventive medicine activities To prevent acute communicable diseases, early case-finding and detection programmes have been undertaken through the health network system in parallel with health education through the maas media, to enhance people 'a knowledge by all p088ible means. Vaccination againat acute communicable diseases has been stepped up under yearly progrAlllllled activities. To control chronic communicable diseaaes such as tuberculosis, leprosy, venereal diseases, parasitic diseases etc., the Government is also making effort. to promote early detection and treatment at the inatitutional level. Mental disorders have become a aajor health problem which requires the enactment of a law of wide acope providing for effective control. Some other chronic diseasea such aa cancer have also been included in meaaures for reaearch to find effective control aethod •• Sanitary water aupply To aupply sanitary water to residents in rural and fishery areaa J the Government constructed 29 145 simple piped-water supply systems during the period 1967-1981, covering 53% of the total rural and fiahery popUlation in the country. The Government will construct a further 17 619 systems during the period 1982-1986, which will increase water supply coverage from 53% to 93% of the total rural and fiahery population by the end of the project. Food and drug control Quality checks on products from food and drug makers have been continued in order to prevent dangerous or sub-standard items from reaching consuaers. With a view to making government quality control agencies efficient and reliable bodies, the Government plana to set up an institute to conduct research on safe food and medical supplies. To strengthen narcotics control, the Government will intensify its pUblicity caapaign againat the use of habit-forming drugs, including hiroppon.

- 3 -

Environmental pollution control With the inauguration of the Office of Environment in 1980 and the reinforcement of the National Environment Protection Institute, the Government has placed a high priority on the preservation of a sound environment, and is taking all possible measures to improve national health through the prevention of hazards due to air pollution, water pollution, soil pollution, noise, vibration and offensive Qdours. Six regional offices have been playing a key role in monitoring environment pollution and surveillance, particularly in large cities and industrial coaplexes where pollution levels are high. Elderly and disabled persons In line with the 1981 International Year of Disabled Peraona, the Government has carried out various commemorative programmes and enacted a law in June 1981 for the welfare of physically and mentally disabled persons. This law provides for the promotion of medical rehabilitation, including disability prevention and vocational training. The Government also enacted a law for the welfare of the aged in June 1981, which includes provisions for improving their health and social activities.

ORIGINAL: SAMOA COUNTRY STATEMENTl 1. INTRODUCTION

ENGLISH

The country's aims and strategies to meet the goal of health for all by the year 2000 through primary health care are exemplified by its Fourth Five-Year Development Plan for Health. This has been aSlessed after the first 18 months, the planning time frame being 1980-1984. The assessment of each project was feasible after an interview with the divisional and sectional staff closely associated with and responsible for the implementation of the project objectives.

2.

PROGRESS

HE. 1

South Pacific pharmaceutical services

This project, which aims at setting up a central pharmaceutical buying and distribution system for the island countries of the South Pacific, has not yet been finalized by SPEC and WHO. The total number of drugs imported has been reduced following the introduction of a list of eS8ential drugs for Samoa. Fourth Development Plan estimates:

$50 000.

Achievements: This project is in the planning stage, awaiting advice from SPEC and WHO, as it is a regional programme involving other countries of the South Pacific. HE. 2.01 Primary health care

The primary health care projects aim to promote a greater selfreliance in health at village level by promoting self-help in family planning, environment and nutritional measures. Likewise, minor medical complaintl which are now treated at the hospital and health centres, can and will be dealt with at village level by a trained health aid in each village responsible to the Women's Committee. The following major activities have been implementation during the first phase of the project. (1) identified for and

Training of 200 health aids. 120 have been trained funding has been obtained from UNDP for a further course.

ISubmitted by the Director-General of Health, Health Department, Samoa.

- 2 -

.... (2) Initiation of primary health care in villagel. Medical Itaff to districta have been increaBed from S in 1979 to 14 at pre.ent. National aeminara on primary health care have been held.

(3)

The increasing activity in projects HE. 2.02, 2.03 and HE. 4 and HE. 6.01 has raised the level of health care in rural areas. Fourth Development Plan estimates: $501 900.

Achievements: 120 health aids were trained during the period. Medical staff were increased and six additional health inspectors were sent to the districts. Seminara on occupational health and nutrition were held during the period. HE. 2.02 Family welfare and nutrition

Activities in this project started before the advent of the Fourth Development Plan, and have continued as expected. Development and strengthening of the general health services, particularly of those contributing to the health protection of mothers and children, have been carried out accordingly. Fourth Development Plan estimates: Achievements; $86 000.

The Nutrition Education Centre has been completed.

The percentage of women aged 15 - 49 years using family planning methods has increased from 8.4% in 1978 to 15% in September 1980. During 1980, a total of 116 tubal ligations, 18 hysterectomies and 2 oophorectomies were performed at the National Hospital. The latest report of the section indicates that the services aspects of child health are quite good, over 80% of all children being seen at a child health clinic. This is a marked improvement since 1976 when the average was less than 60%. A new family planning project to increase coverage with community participation and voluntary assistance commenced in June 1980. HE. 2.03 Environmental sanitation

The project aims at raising the standard of health of the country, through improved sanitation by the provision of sanitary latrinea, adequate water supply, vector control and food hygiene. Fourth Development Plan estimates: $143 000.

Achievements; During 1980-1981, about 870 water seal latrines were constructed. A vector control unit was organized during the Third Development Plan (1978-1979) and continued to expand its activities in 1980. A further training programme for assistant health inspectors is scheduled to commence later in 1981 through the Public Works Department.

- 3 -

.... HE. 3.01 Physician assistants The primary aim is to train 10 nurses in 1981 to create a structure of qualified health workers between the district medical officer. (DMO) and the district nurses to alleviate the chronic shortage of district medical officers. The course will be repeated in 1982. Fourth Development Plan estimates: $125 000.

Achievements: A curriculum has been developed with the aid of a WHO consultant and the first course is planned to commence later in 1981. HE. 3.02 Health manpower development

This project is a continuation of activities started well before the Third Development Plan. Substantial assistance from New Zealand under the BAAP scheme and from WHO has been made available for the basic, postgraduate and inservice training of health personnel. The general objectives of the programme are to develop a more responsible health manpower geared to the needs of the country and to the National Development Programme. Considerable progress has been training programme at all levels. made in the expansion of the

Candidates fO,r medical courses, dentists and also paramedical courses have been sent for overseas training with a view to replacing retired and reemployed staff. Fourth Development Plan estimates: $741 000.

Achievements: Courses. A course for assistant health inspectors was conducted with the assistance of WHO. Fifteen assistant health inspectors completed the course. A second course will be held later this year. Planning collaboration course later collaboration for the Post-basic nurses' tralnlng course with WHO has been completed and 10 candidates will undergo the this year. The midwifery course has commenced with the of WHO.

A total of 20 candidates have been sent overseas for graduate. post basic and paramedical training with the help of New Zealand, WHO and UNDP. HE. 4 Health education

The general objective is to establish a health education section. It is intended to have the greatest impact on preventive measures at the community level. Fourth Development Plan estimates: $48 200.

- 4 -

Achievements; During 1980, the Health Education Section was established and a health education officer was appointed. Planning and activities have commenced with the help of two WHO consultants, one of whom (a United Nations Volunteer) was appointed for two years. HE. 5 Dental health service

The primary aim is to provide high quality dental care, including preventive and promotional measures for the school-going population. Fourth Development Plan estimates; $100 000.

Achievements: Indications are that the objectives have not yet been attained owing to lack of manpower and transport. Other activities mentioned in the Plan, including local training of dental nurses and reorganization of the Division, have not yet started although planning has been completed with the help of a WHO consultant. Public Service Commission approval has been granted. HE. 6.01 Control of communicable diseases

The objective ie to reduce the incidence of communicable disea.e •• The strategies to be adopted for this project include epidemic control to be consolidated in a single administration. A mUlti-purpose public health centre to facilitate the necessary epidemiological and control activities still needs further development. Fourth Development Plan estimates: $129 000.

Achievements; An expanded programme of immunization has been developed and the increased level of activities has begun to raise immunization levels. Planning with WHO's help is well ahead to develop a computerized recording system for this project. The control being planned. of diarrhoeal diseases, especially in infants, is

....

An intersectoral committee for the International Drinking-Water Supply and Sanitation Decade was set up in 1980, and planning to improve water supply and sewage disposal is well advanced.

HE. 6.02

Control of noncommunicable diseases

Following a report by Professor Zimmet, WHO con.u1tant, there has been a visit by Dr E.M. McLachlan for four weeks under New Zealand Aid. He, together with local doctors and the health education staff, has made tapes and recorded radio interviews. A seminar aided by SPC is planned for later in 1981 to advance work in this area. HE. 7.01 National Hospital project

Under the National Hospital project in the Fourth Development Plan, the building programme is to be continued and is to include the maternity and acute wards, laboratory, pharmacy, mortuary/ambulance depot complex, medical centre, kitchen, laundry, maintenance garage, and maintenance workshop.

- 5 -

Fourth Development Plan estimates;

$2.2 million.

Achievement: By the end of 1980, the Medical Centre, two acute wards and maternity wards were completed. 1he Laboratory Pharmacy complex and the remode 11 ing of the old wards 1 to 4 are all under construction. Work on the new laundry and maintenance workshop is to start in August 1981, and these and the remodelling of the kitchen and psychiatric ward should be completed by February 1982.

HE. 1.02

District hospitals

This project aims to improve the quality and extend the range of services in district hospitals and health centres in order to reduce to a minimum referrals of patients to the National Hospital. The district hospitals also serve as centres for district health activities. Fourth Development Plan estimates:

$545 000.

Achievements: To date, the construction of the new hospital at Aleipata and the further upgrading of Tuasivi Hospital have been completed. Falealili and Aana Alofi No. II (Leulumoega District Hospital) on Upolu Island and Palauli-i-Sisifo/Salega and Sataua District Hospital on Savaii Island are to be constructed or upgraded during the period of the Fourth Development Plan. Health centres are being planned and those at Aopo and Patamea are undergoing construction.

HE. 8

National laboratory

This project aims at providing additional staff to meet the basic needs of the service as well as providing essential equipment for the new medical laboratory under construction. Fourth Development Plan estimates;

$120 000.

Achievement: Although the staff establishment has not increased, The list of training has produced a higher quality of staff. equipment required for the new laboratory has been finalized, and funding obtained through New Zealand Aid.

•

ENGLISH ONLY BRIEF REPORT ON THE PROGRESS OF IH~AL'I'II ACTIVIT I ES IN

SINGAPORE - 1980

1

I

:Unppor. 1. aD I81ad. Republl0 with a total land area ot 6'18 .. lila. '!h. e.tiaated total popw.atlon 1. 2,413,900 ~1ri1tc • poplllation ....1.., ot l,9O1 PeraGU pel' IIq - .

eN4e 4eath rat. U. NMiDM atabl., bet_. ,.0 and ,., p.r ~

The on4e

~1Mh

rat. wu 17.1 per thOUNlld., tdll1. the

II

He'}» Serf1".

(A)

iln"el Seme"

Th. . an 1) PYVllJIIant hoepltal. with a total ot •• rHeftlopIHnt ot 811l4r&pore CMn. .a! JJo.pl tal 1. upeete4 to be oo.pleted lv 1982. Th.)fev SinppoN Oenera! Ho.p1t&1. 18 up.ot.d to proviu 1,627 bede with thAt po ••1b111V ot aD iDonu. to 2,100 b.cla lv the bui1d.1Dc ot . .ther ..-4 hI... '!he Do.pital will Singapore _ tU apeolaliti•• ot ratiothehpT, aephroloD. o&J'41othoraol• ........,.. plutie

8,078 HU.

.erY.

al"P17 ... paecU.atr10

IAU"pI'3'.

Better and .or. 8Oph1.tloated tao11itl •• will &1.80 be aftil.Ule _ . the nev ICMt lic:lp Ho.pital itt eoIIIP1eteel in 198,.

(D)

en"e lfMl'h car.

Strr1P"

'!h. Prll1&l7 Health Oar. S.rrio•• 00IIPI"1•• the tatpMl." • ..,1ieruJ. • 0h11el Health (1(<11) aDel Sohool HMJ.th Serft••••

th.rolI&h a nn_rlt ot 12 poqoUn10. and 1, O1ltpatl_t 41.p.naar1 ••• MOR Servi.e. are available a1i the 12 pol7oU.nl0. anel 11 MOIl o11Jl1oll 1Ihlob provide taa117 Jllann1Dc, ant .. Mel po. . . .atal tor .-.n ot ohild -baar1na ace. The.a oU.I110. alllO pronu a ooapnharul1". 111111Ul1.atlon .el"rioa to infant. aDel pre.ohool CIh1l4ren aca1n.t the OOIIIDOn inteotloua 41.e..e8 ot iAtlllUQ" Mel eh1l4h004..

'fhe Ou.1ipat1ent SerYio•• otter cen.ral ouratl... treatment

•.rri.o..

Il0l".

'!be Sobool Haal th Servloe. oonduot me410al .ore-inc tor thaD laal.t a 811110n aohool ohllclren. Beaic1u ..... aiDe their ceneral healtil anel nu1irl tlonal .tatUII, "hey al80 ...... the pupil.' ..,tloaal aad. 1nt.lleotllAl developaant. J'ol10w-up ••rno •• aN

provlcled at ou~pa~ien~ olinio. anel, where neoeaaa.ry, .peo1all.t ••••10Ga are helel in the In.iltute ot H.alth BIhool Clinl0.

1

Submitted by the Government of Singapore.

2

(0) PiVot '·10d1 cal j!,Qd :JupIlQttiul; :ioryigfJ/l

The hoapi tala are flu. )ported by the patholot,C", medioal laboratory, blood transfusion, radiology and pharmaceutioal services. Tho

recently ostablished Department of Nuclear Medicine of di~"'lO:Jtio

offore

0. r:J.lIL;0

l.Ind thorapoutio f ..~cilitiol3,

includin~

screening systems.

CD)

Dental Services

Dental Ser~iccs are available o.t 1 hospitals, 105 schools, 14 outpationt clinics and 2 dental centres. Attendances at dental olinio. totalled 109,805 in 1980. III

Environmental Health

CA) Cpmwanigabl, Diseases In 1980, a total of 18 sporadic oaS08 of E1 Tbr Cholera were reported. Ten of the oases wore ot aterotyp. Oi~wa and .isht of sterotype !naba. Three of the ca.ses were imported. Ther. was no death. A carrier of E1 Tor Cholera, atorotype Inaba" was pioked up durinc epidomiolo~ioa.l invooti;;atiouo. A total of 200 oa.oes of malaria were notifiod in 193QOf these, 195 ",ere 'imported and 5 were introduced. 151 cases of the infeotion were oaused by plasmodiwn viva.x:, 41 oue. by plasmodium taloipa.rwn and 2 ou- mixed infeotion.

(B)

lollution Control The Anti-Pollution Unit i8 responaibl. tor monitor1nB

and oontrollinc pollution. Th. ov.rall air pollution iev.la ot 1980 remained tairly .imUar to those at 1979 exoept tor a signifioant iDcr.... in susp.nded particulate l.v.la. 2

'!'he exoro1oe to pha.oo out oo.wmill. in urbQll arou

where th~ vere a .ouroe at s.r10ua air aDd water pollution vaa oompleted in 1980. Of the 37 aavm1l1. which wer. aftected by the exero1... 32 ha4 &lr.~ oOllUllODoed operat1OD at th.ir nev site••

-

""

'3 '!'he Unit intenaif10d it • • ftorta to oontrol air pollution troll sto.;Uonal"Y souro.s. It made 3181 tactory' inspections in 1980 and oonducted 491 source Glllisaion teata in 1980, vi til .aa;pha.eis bein, placed on tiDiber-b..ect faotori •••

1

With 1Ihe ooa1l1aud. il!lpl"We_ta 1a Jaealth _ aN

....no_.

e.t1c1eat that tU WHO tar.... 'Health tor All

lI.J tU

T... IDOO' CNIIl 'be uh1ew4.