The work of WHO in the South-East Asia Region: Biennial Report of the Regional Director, 1 July 1995 - 30 June 1997

Preface l~V,/ll.Sl' OVl~K a tho~isand dulys uie will step into a new cenlri~?). ?he renewed HFA slratefiy u~ill have been drawn up, and we will he ji~rging ahead to coniplete the unJinisbed agenda u)e had set ji~i,,. ol~ne1ue.s in 1977. Though we will enter the 21sl centuqj with durrrztirzg chulle~~ges still juci~rg rr.s, ux uiiN havc? the .sati.fuctiou r!/'haz1i118 uchi~~ued INUI!~ .sIIcc~.ss~.s,~(J~Iz~!~ by WfO alzd itsMen~/~c,r ,Statc-; - i~zcreased lijk expecrarzcy, reduced nnraternal arzd irlfiozt ~nortuli!)< eradicafio~deliminrrfion of dreaded diseases such as .snzallpox, polion~yelitis, neoilatal tetanus, leprosy and druc~mculia~is. All this u~us made possible through the great aduances achier/ed in medici~ze and public health and in the ecorronlic and .sociul .spheres. Brrl our achieveme~zts will he ,j?rxl~i[)o.sed u'ith the re.irrrjiencc o/' diseases that were once th014gbt lo hririe hc.c.rr conlrolled or eliminured. 7he people ofthe del/ekJ/)irlg co~otlrics, es~wciall)? those in the South-Errst Asia Region, wiN har'e the bane ofco/>irig u~ilh the double htrrdetz oJ-diseuses - a sil~ration conlpounded by the acrrtc scarci!)! cf resources. /)I 1hi.s hleak .scerzurio, [he silzjer liiziizg u.~iN bef~ro~iided by the e~rlighle~ied /hc!ulth r;~.sio~rciric~.s u~bo lctke a holislic vteu' c$ health u.s UII i~llejircrl /)arI (/' deuel~q~n~erzl, who have tiizjlirichi~ig fiiilb I!? con~n~ri~zit>' /~arlicl()atio~r, and u~ho have the courage (IJ lbeir coirr~ictioiti lo bn'i~g aahorit the nwessar~ f>olitical commitrnerzt to nzake health ajiu~rdame~~tal right (gall and not o~zly ofsorne. '/be World IIeallh Orguizizafiotz's response to global chaizges, u8/?etber thq)' are in /he jie1d.s cf cco~zornics and trade, or in .c~;L,II~(' a)ld t~'~hll~l(~): JVCS bec~12 exen~j~lified hp the F~~r/p-e<qhth Worlrl Ilcrrllh A.ssen~h/v :Y resolrrtiorz oil rerleu~irlg the Ile~llb~fi~r-All .Strc~tc~j,. Ebllou~i~zg the fil[~hal frrrnzeu~ork Ji,r the corzsziltatio~~ procc>ss lo take ilzto accorozl the elnerging health challeriges ai2d i~utio~zal and i12terzzalio~1alpolicv reorielztations in order to det~elop a II~UI .strateg): the South-East Asia Kegi(l12 of W10 took the leud vii i org~r~izi~zg I-o roia co~~.sr/futio~.s rr~l)ic/i ~./~/II/~//(L/(,(/ irr /he iiztercottrztr) nrceliizg 011 Evalz~atio?~ ~ird N~~rrer~~ul (!/ //IC, llFA Slrate~y in Ilecember 196. Renewirw /he IIFA .stra/egy ~1011~ ,fi~rirr.s nil irrtegral part (f the r~ational hect/lh /I/UIII?;I~$ /IYOL.~.S.S (f (ill /hc, ,tfoirher Sto/(.s. A .S~ll4/(4/~ ~l'~ll// (!/'/!71, /<<,l~<,lt~~/ (?/'//FA ,s/l'(i/<',qy ~~l/(/~~<li'f~lli:~ /?us [IC~C~~~CII 1/1e CI~~L~IIIZU~~~I~I (?/'the a~rzsctltutii'e r~zc,<~trr(qs orr l/(rr/l/i Ile~~e~oJ~rrzerl/,/i~r ,So~t/l~-l<~~.st Asia 111 the trexl c~~zlir~., I~~LIICLJ 1~~~1/1c~(l 10 druji a Declart~tioiz oil Ilealth Developnze~z/,/i~r .Sr)ir/b-/!(IS/ .I.irrr in the 21st Ce)ztzrv~ fir corzsideralion by hfi/zr.s/c,n. c!/'//e<i/f/~ (!/' the cozrrztrie.s ofthis Regiorz at their 15th inec?tirzL: ill AII~~II.~/ 1097 .fi zs .. IS .. MU C'/)CIC~<I/ eoc~r~l, /he harhi)illg(v oJ' hoji~ ,/iw b~(/ (!/' //1c, u80rld:spoor u~ho i~rbuhit t11i.s Rqiorr. 7he Ik.c:luv~rl~)/r, iil <:s.i('~rc<: is a reuflirtfratioii (!/'the <~/hicul conccl~l (?J'tJrlrri!y cirrd a~c~icrl~rrs/ic(~ u.5 Jirz~dan~erztul 111 /he /)urs~tif of health Jbr all. Sz~staiiiirzg the heullh advocacy role of the Orgrrrrizutior~ thv Regional Oj'ce hos YnozPd into high gear with a seriev cfii?i/iu/iz'e,s such as the aizlruul nr<~etiizgs qf the IIeal/h Miizister; UIIL/ the //ealfl? .Secretari~,.s oJ' /he .SEAR cot(] rh-ies, the iirr '(11t~i1rc~i11 f!f parliunreizlariarzs urzd the sigiting h ~IIIIUII/~II~I I,/' lIirder.staizdi~rg rr3i/h A.SI:J1N. The r~arici1r.s elerire~r/.s I!/ 1/11. .A.rl:,I,v socioeconomic deveI(~/>nzozt ~/icll!es u'il/ ofir a atrrziqrrc, o/,x~r/o//c/r, ,for health advocac~j and for prornotiizg techrzicul co(q/eru/io~r amorzg co~riztn.e.s A .siglz~/ica~zt i1ilJ1elu.s lo heakh det~elol,~ilerlt ill //I<, l~'~,,:iolr /l(fs heeiz f~mliidc,d hp the szrppon extetzded /o .s/r<rir,:th~ir /hl, dr.s~ri<-/ hwlth sys/ern iii nrost cf the cour~tne.s. 7hi.s u~y~rorccb. u~./ir'c,l)~ supported hv WT/O, protiides a unique opf~or/ir~zi!>~ /o Ji),stl,r integrated health development. In pursuing this ~oal, u nrcrio~r shortcomirzg, namely, the lack of linkages between prirnuq. Oerrlth care and the fin-t and intermediate re/crral leue/s, has CCI~IIP 111 light. Iloujetier, urr exunrple of a succe.ss/irl ejrort il I /his ciir<,c/i(~r z i.s the M(~l?gar ~lislricr health services prt!jec/ in llhirtrait 111 rr u~ell-n~en'Ied ack~tou'ledgmerrt c?/ll!ts out.~tandi1'1?g /~,r/i~rilra~/~(: lltii project was. uzr~arded the Susukawa Health PhJi~r 1907. Another cau.w J?)r gratification is /he increasirrg rect~gr~ilio~~ being given to /he importance of comnruni!y uctiort ,/br heulth. The success of the Integrated Family Health package in Indonesia, the Basic Minimum Needs Programme in Thailand, the Community Health Care programme in Myanmar and the Village Health Care Post Movement in Bangladesh aresome of the outstanding examples. These are epitomes of the decentralization process in health management, starting from the centre and moving down to the district and local leve1.c. Ibe concept of single-day immunization by several countries has been translated into action with outstanding success. Six countries in SEAR conducted their national immunization days (NIDs) in December 1996 - Januay 1997, as a result of which over 165 million children aged below fie years were immunized. ?he scale of mass mobilization of health personnel and community members to conduct these MDs was extraordinay and is an unprecedented historical event. ?he concept ofpartnership in health is now the accepted norm of all agencies engaged in health development. WHO played an active role in helping the countries in theirjoint endeavours with various UN agencies, the World Bank, the Asian Development Bank and NGOs. A publication entitled Partnerships: A New Health Vision, which describes the parameters for intersectoral collaboration and the need to identzb new partners in health ddopment, has just been published by the Regional Oflice. The development, with WHO support, of a tetraualent live attenuated dengue vaccine at Mahidol University in Thailand constitutes a significant breakthrough as this is the first time a developing countty has achieved such a landmark. Following the establishment of a supplementay intercounty programme, the Regional Offe developed a programme of assistance in three strategic areas, namely, Advocacy for Health, Technical Cooperation among Countries, and Intercounty Cooperation on Standard-Setting and Innovations. This new initiative has yielded fruilful results in promoting and strengthening cooperation among countries. The Health Secretaries of SEAR countries and the Consultatiue Committee for Programme Deuelopment and Management (CCPDM) felt that, in the light of the global competition for resources, county endeavours for timely utilization of WMO junds may have to be supplemented by regional mechanisms in order to protect future allocation of ItWO Regular budget to the Region. 7hrough this process it will be ensured that, apart from supporting the countries in greatest need, substantial amounts of funds are again channelled back to the countries concerned. Arrangements have been made to utilize the vast fund of talent available at W?fO collaborating centres and at other centres of wise in the Region. 7his has greatly helped in maximizing the utilization of national expertise and in improving the quality of UVHO collahoratiw programmes. A management working group, set up in the Kegional Oflice with the objective of reducing wastage and increasing operational efficiency, bad made suggestions for efecting saying.<, some of which have been implemented. 7his has helped maintain the administratiw services costs at the lowest level in the entire WHO system Computerization is an area where SEAR was a late entrant, but it is now surging ahead. LAN and E-mail systems have been established in the Regional Ofice as well as in the oflice.$ oJ' WfC) Representatives. The Regional Office Administration and Finance Information System has been fully implemented and is heing linked to the Actioity Monitoring System, which, as a part of the WHO Global Management Information System, will contribute to improved moniton'ng of programme implementation. Detaik of the collaborativeprogrammes in the Member States, with their successes and constraints, are elaborated in the main body of this Report, which I present with great pleasure to the 50th session of the Regional Committee. Dr Uton Mucbtar Rafei Regional Director

Organizational Structure Regional Directof I I 1 I FIELD PROGRAMMES

The Work of 1HO : inthe Suuth-East Asia Region Bienaial Report of the Regional Director I July I995 - 30 June 1997 World Health Organizarion Regronal OfC~rr for Sourh-East Asra New I)elh~ Ju11r1947 - 0 . Biennial Report of the Regional Director 1 July 1995 - 30 June 1997 The Work of WHO in the South-East Asia Region Biennial Report of the Regional Director 1 July 1995 - 30 Jane 1997 World Health Organization Regional Office for South-East Asia New Delhi June 1997 ISBN 92 9022 2069 0 World Health Organization 1997 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office lor South-East Asia, application should be made to the Regional OHice for South-East Asia, World Health House, lndraprastha Estate, New Delhi 110002, lndia. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Printed in lndia Contents Page Prefoce Executive Jummory Section 1 - Governing Bodies I. Governing Bodies I World Health Assembly 1 Execut~ve Boaid 2 Reg~onal Comrn~tter 3 Section 2 - Health Policy and Management 2. General Programme Development ond Monogement . . . , . . . 5 Manogerlol piocess for WHO'S programme development 5 WHO response to global change 6 Sloft aeve7oprnenl 7 Renew~ng the health-for~all strategy . . . . 7 Management and support to lnforrnation systems . . . . . 8 Regtonal Director's Development Programme . . . . . . 9 Coordination wlth othei orgon~zotlons . . 9 Mobilization of external health resources . . . . . . . . . 12 Health M~nisters' rneettng . .. .. . 12 Health Secretai~es' meet~ng . .. 13 3. Health, Science ond Public Poliry 14 Leadership lor health . . . . . . . . . 14 Women, health and development . . . . .... .. I5 Health iegislotion, ethical dimensions of health care and bioe~hics . 15 Research policy and stiotegy coordination .... , . 15 iii Page 4. Ndional Health Polities and Programme Development and Management ........... Support to development. management and coordination of country programmes ..... . . 18 Technical cooperation among countries I<> Collaboration wlth countries and peoples in greatest need I (> Procurement services /excluding drugs, biologicals and conlracephves) 10 Emergency preparedness and humanitarian action 71 Safety promotion and ~niury prevention . . 21 5. Biomedical and Health Information and Trends 13 Ep~demiology statistics trend assessment and country health ~nlormotion Publ~shlng and language servces Health literature and l~brary services l~nclud~ng HELLIS1 Section 3 - Health Services Development 6. Orgonizdion and Monogement of Health Systems Bored on Primary Hecllth Core Y> Health systems research and development 79 Policy development and restructuring of notional health systems 29 Health economics, resource allocation and financing strategies 3 I D~str~cl health systems 3 1 7. Human Resources for Heokh Human resources for health .... Fellowsh~os . , ...... 8. Essential Drugs 40 Action programme on essent~al drugs 40 Procurement of drugs biolog~cals and contraceptives 4 1 9. Quality of Core and Health Technology n 7 Technology for health care 43 Drugs and b~olo~~cals, quality, safety and eiflcacy 44 Tradit~onal medlclne 45 Section 4 - Promotion and Protection of Health Care 10. Reprodudive, Family and Community Health and Population Issues Reproduct~ve health . . 47 Chid health . . . .... . 49 Adolescent health . . . . . .... . 49 Women's health . . . . . . . . . . . . . 50 Agng and health . .......... 5 1 Specie\ Prog~amrne oi Research, Development and Reseorch Troinlng In Human Reproduction . . . 5 1 OccuFot~ona! hmllh .., . . 52 11. Healthy Behaviour and Mental Health 53 Mental health . . . . ... . .. 53 Substance abuse ncluding alcohol and tobocco . . . 54 Health promol~on .... ...... 55 Commun~cat~ons and publ~c relations . . 55 Krhabii~tat~on . . . . . . . 56 12. Nutrition, Food Security and Safety . . . . . . . . . 58 Nutrlt~on 58 Food safety 59 13. Environmental Health . . . . . . . . . . . , . . . . 60 Water supply and son~tatlon in human settlements 60 Fnvironmenia\ heahh in urban devetopmenl 6 1 Assessment of env~ronmental health hazards 62 Prornotron 01 chemical saleh/ 62 lncorporoton of health concerns lnto env~ronmentol management 63 Section 5 - Integrated Control of Diseases 14. Erodication/Elimination of Specific Communicable Diseases . . . . 65 Drac~inculiasrs [Gu~neoworm diseose) . . . . 65 Leprosy . . . . . . . . . 65 Pol~om~el~t~s . . 66 Neonatal tetanus . . . . . . . . . . . , . . . . . 67 Measles .... ...... ... . . . . 68 Page 15. Control ol Other Communicable Diseases Vaccine-preventable diseases . . . . . . . . , 69 Diarrhoea1 and acute respiratory disease control . . . . 70 Integrated management of sick child initiative , . 71 Tuberculosis , . /I Emerging infectlous d~seases including cholera and other epldemli. diarrhoeas, zoonoses and antimicrobial resistance /% Other communicable d~seases . . /5 AIDS and sexually transmitted diseases . . . . . . 71 Control of tropical diseases . . . . . . 78 - Special Programme for Research and Training in Tropical Diseases 87 Prevention of blindness and dealness . . 8 :I 16. Control of Noncommunimble Diiecnes 84 Control of noncommun~cable diseases . . . . . . 84 Oral health . . . . . . . . . . . . . . . 84 Section 6 - Administrative Services 17. Penonnel Personnel services and admln~strotlon 18. General Administration 89 Admln~strat~ve support to techn~col programmes 89 19. Budget and RMIK~ Budget and finance Annex - Organizational structure . . . . . . . . . . . . . . . . . . . . . . . . 91 Preface l~V,/ll.Sl' OVl~K a tho~isand dulys uie will step into a new cenlri~?). ?he renewed HFA slratefiy u~ill have been drawn up, and we will he ji~rging ahead to coniplete the unJinisbed agenda u)e had set ji~i,,. ol~ne1ue.s in 1977. Though we will enter the 21sl centuqj with durrrztirzg chulle~~ges still juci~rg rr.s, ux uiiN havc? the .sati.fuctiou r!/'haz1i118 uchi~~ued INUI!~ .sIIcc~.ss~.s,~(J~Iz~!~ by WfO alzd itsMen~/~c,r ,Statc-; - i~zcreased lijk expecrarzcy, reduced nnraternal arzd irlfiozt ~nortuli!)< eradicafio~deliminrrfion of dreaded diseases such as .snzallpox, polion~yelitis, neoilatal tetanus, leprosy and druc~mculia~is. All this u~us made possible through the great aduances achier/ed in medici~ze and public health and in the ecorronlic and .sociul .spheres. Brrl our achieveme~zts will he ,j?rxl~i[)o.sed u'ith the re.irrrjiencc o/' diseases that were once th014gbt lo hririe hc.c.rr conlrolled or eliminured. 7he people ofthe del/ekJ/)irlg co~otlrics, es~wciall)? those in the South-Errst Asia Region, wiN har'e the bane ofco/>irig u~ilh the double htrrdetz oJ-diseuses - a sil~ration conlpounded by the acrrtc scarci!)! cf resources. /)I 1hi.s hleak .scerzurio, [he silzjer liiziizg u.~iN bef~ro~iided by the e~rlighle~ied /hc!ulth r;~.sio~rciric~.s u~bo lctke a holislic vteu' c$ health u.s UII i~llejircrl /)arI (/' deuel~q~n~erzl, who have tiizjlirichi~ig fiiilb I!? con~n~ri~zit>' /~arlicl()atio~r, and u~ho have the courage (IJ lbeir coirr~ictioiti lo bn'i~g aahorit the nwessar~ f>olitical commitrnerzt to nzake health ajiu~rdame~~tal right (gall and not o~zly ofsorne. '/be World IIeallh Orguizizafiotz's response to global chaizges, u8/?etber thq)' are in /he jie1d.s cf cco~zornics and trade, or in .c~;L,II~(' a)ld t~'~hll~l(~): JVCS bec~12 exen~j~lified hp the F~~r/p-e<qhth Worlrl Ilcrrllh A.ssen~h/v :Y resolrrtiorz oil rerleu~irlg the Ile~llb~fi~r-All .Strc~tc~j,. Ebllou~i~zg the fil[~hal frrrnzeu~ork Ji,r the corzsziltatio~~ procc>ss lo take ilzto accorozl the elnerging health challeriges ai2d i~utio~zal and i12terzzalio~1alpolicv reorielztations in order to det~elop a II~UI .strateg): the South-East Asia Kegi(l12 of W10 took the leud vii i org~r~izi~zg I-o roia co~~.sr/futio~.s rr~l)ic/i ~./~/II/~//(L/(,(/ irr /he iiztercottrztr) nrceliizg 011 Evalz~atio?~ ~ird N~~rrer~~ul (!/ //IC, llFA Slrate~y in Ilecember 196. Renewirw /he IIFA .stra/egy ~1011~ ,fi~rirr.s nil irrtegral part (f the r~ational hect/lh /I/UIII?;I~$ /IYOL.~.S.S (f (ill /hc, ,tfoirher Sto/(.s. A .S~ll4/(4/~ ~l'~ll// (!/'/!71, /<<,l~<,lt~~/ (?/'//FA ,s/l'(i/<',qy ~~l/(/~~<li'f~lli:~ /?us [IC~C~~~CII 1/1e CI~~L~IIIZU~~~I~I (?/'the a~rzsctltutii'e r~zc,<~trr(qs orr l/(rr/l/i Ile~~e~oJ~rrzerl/,/i~r ,So~t/l~-l<~~.st Asia 111 the trexl c~~zlir~., I~~LIICLJ 1~~~1/1c~(l 10 druji a Declart~tioiz oil Ilealth Developnze~z/,/i~r .Sr)ir/b-/!(IS/ .I.irrr in the 21st Ce)ztzrv~ fir corzsideralion by hfi/zr.s/c,n. c!/'//e<i/f/~ (!/' the cozrrztrie.s ofthis Regiorz at their 15th inec?tirzL: ill AII~~II.~/ 1097 .fi zs .. IS .. MU C'/)CIC~<I/ eoc~r~l, /he harhi)illg(v oJ' hoji~ ,/iw b~(/ (!/' //1c, u80rld:spoor u~ho i~rbuhit t11i.s Rqiorr. 7he Ik.c:luv~rl~)/r, iil <:s.i('~rc<: is a reuflirtfratioii (!/'the <~/hicul conccl~l (?J'tJrlrri!y cirrd a~c~icrl~rrs/ic(~ u.5 Jirz~dan~erztul 111 /he /)urs~tif of health Jbr all. Sz~staiiiirzg the heullh advocacy role of the Orgrrrrizutior~ thv Regional Oj'ce hos YnozPd into high gear with a seriev cfii?i/iu/iz'e,s such as the aizlruul nr<~etiizgs qf the IIeal/h Miizister; UIIL/ the //ealfl? .Secretari~,.s oJ' /he .SEAR cot(] rh-ies, the iirr '(11t~i1rc~i11 f!f parliunreizlariarzs urzd the sigiting h ~IIIIUII/~II~I I,/' lIirder.staizdi~rg rr3i/h A.SI:J1N. The r~arici1r.s elerire~r/.s I!/ 1/11. .A.rl:,I,v socioeconomic deveI(~/>nzozt ~/icll!es u'il/ ofir a atrrziqrrc, o/,x~r/o//c/r, ,for health advocac~j and for prornotiizg techrzicul co(q/eru/io~r amorzg co~riztn.e.s A .siglz~/ica~zt i1ilJ1elu.s lo heakh det~elol,~ilerlt ill //I<, l~'~,,:iolr /l(fs heeiz f~mliidc,d hp the szrppon extetzded /o .s/r<rir,:th~ir /hl, dr.s~ri<-/ hwlth sys/ern iii nrost cf the cour~tne.s. 7hi.s u~y~rorccb. u~./ir'c,l)~ supported hv WT/O, protiides a unique opf~or/ir~zi!>~ /o Ji),stl,r integrated health development. In pursuing this ~oal, u nrcrio~r shortcomirzg, namely, the lack of linkages between prirnuq. Oerrlth care and the fin-t and intermediate re/crral leue/s, has CCI~IIP 111 light. Iloujetier, urr exunrple of a succe.ss/irl ejrort il I /his ciir<,c/i(~r z i.s the M(~l?gar ~lislricr health services prt!jec/ in llhirtrait 111 rr u~ell-n~en'Ied ack~tou'ledgmerrt c?/ll!ts out.~tandi1'1?g /~,r/i~rilra~/~(: lltii project was. uzr~arded the Susukawa Health PhJi~r 1907. Another cau.w J?)r gratification is /he increasirrg rect~gr~ilio~~ being given to /he importance of comnruni!y uctiort ,/br heulth. The success of the Integrated Family Health package in Indonesia, the Basic Minimum Needs Programme in Thailand, the Community Health Care programme in Myanmar and the Village Health Care Post Movement in Bangladesh aresome of the outstanding examples. These are epitomes of the decentralization process in health management, starting from the centre and moving down to the district and local leve1.c. Ibe concept of single-day immunization by several countries has been translated into action with outstanding success. Six countries in SEAR conducted their national immunization days (NIDs) in December 1996 - Januay 1997, as a result of which over 165 million children aged below fie years were immunized. ?he scale of mass mobilization of health personnel and community members to conduct these MDs was extraordinay and is an unprecedented historical event. ?he concept ofpartnership in health is now the accepted norm of all agencies engaged in health development. WHO played an active role in helping the countries in theirjoint endeavours with various UN agencies, the World Bank, the Asian Development Bank and NGOs. A publication entitled Partnerships: A New Health Vision, which describes the parameters for intersectoral collaboration and the need to identzb new partners in health ddopment, has just been published by the Regional Oflice. The development, with WHO support, of a tetraualent live attenuated dengue vaccine at Mahidol University in Thailand constitutes a significant breakthrough as this is the first time a developing countty has achieved such a landmark. Following the establishment of a supplementay intercounty programme, the Regional Offe developed a programme of assistance in three strategic areas, namely, Advocacy for Health, Technical Cooperation among Countries, and Intercounty Cooperation on Standard-Setting and Innovations. This new initiative has yielded fruilful results in promoting and strengthening cooperation among countries. The Health Secretaries of SEAR countries and the Consultatiue Committee for Programme Deuelopment and Management (CCPDM) felt that, in the light of the global competition for resources, county endeavours for timely utilization of WMO junds may have to be supplemented by regional mechanisms in order to protect future allocation of ItWO Regular budget to the Region. 7hrough this process it will be ensured that, apart from supporting the countries in greatest need, substantial amounts of funds are again channelled back to the countries concerned. Arrangements have been made to utilize the vast fund of talent available at W?fO collaborating centres and at other centres of wise in the Region. 7his has greatly helped in maximizing the utilization of national expertise and in improving the quality of UVHO collahoratiw programmes. A management working group, set up in the Kegional Oflice with the objective of reducing wastage and increasing operational efficiency, bad made suggestions for efecting saying.<, some of which have been implemented. 7his has helped maintain the administratiw services costs at the lowest level in the entire WHO system Computerization is an area where SEAR was a late entrant, but it is now surging ahead. LAN and E-mail systems have been established in the Regional Ofice as well as in the oflice.$ oJ' WfC) Representatives. The Regional Office Administration and Finance Information System has been fully implemented and is heing linked to the Actioity Monitoring System, which, as a part of the WHO Global Management Information System, will contribute to improved moniton'ng of programme implementation. Detaik of the collaborativeprogrammes in the Member States, with their successes and constraints, are elaborated in the main body of this Report, which I present with great pleasure to the 50th session of the Regional Committee. Dr Uton Mucbtar Rafei Regional Director THIS REPORT is o summary of the work of WHO and its Member States in corrying out their collaborative programmes during the period 1 July 1995-30 June 1997. It is a microcosm of the situation that obtains today in the Region, with the rapidly changing epidemiological, economic and social scenarios and the all-round efforts being made to face them. The overall picture that emerges is one of optimism at having made considerable progress, which will determine the future course of action for health development in the South-East Asia Region. The Fortyninth and the Fiftieth World Health Assemblies were held in Geneva during the reporting period. The Forty-ninth World Health Assembly, held in May 1996, discussed the World Health Report 1996; the budgetary reform; WHO'S response to change; renewal of the Health-for-All Strategy, and the Organization's Constitution. In the area of communicable diseoses, attention was focused on the destruction of stocks of variola virus and on new, emerging and re-emerging infectious diseases. The Fiftieth World Health Assembly, held in Geneva in May 1997, approved the programme budget far 1998- 1999. It reviewed the preparation for the 10th General Programme of Work, and discussed the World Health Report 1997; WHO reform; budget and finance matters, and control of tropical diseases, including malaria and filariasis. The 97th session of the Executive Board, held in January 1996, reviewed the method of work of the World Health Assembly, the progress report on WHO reforms and the role of WHO country ofices. Exacutlw Summary Governing Bodies General Programme and Management ' The 98th session of the Executive Board held in May 1996, which elected Mr Sangay Ngedup of Bhutan as its Chairman, considered the reports of WHO scientific advisory bodies and meetings of experf committees and study groups and reviewed the evaluation of specific programmes and budgetary reforms. The 99th session of the Executive Board, held in January 1997, discussed the financial situation of the Organizafion. It also discussed renewal of the HFA strategy; the role of WHO country offices, and personnel policy and practices. Both Indonesia and Sri lanka were designated to select one person each to serve os members of the Executive Boord. The 48th session of the Regionol Committee was held in Colombo, Sri tanka, in September 1995. In a spirit of solidarity, the Committee decided to have a supplementary intercountry programme with the focus on advocacy for health, technical cooperofion among countries andstandard-setting and innovations. It also agreed to transfer necessary resources from country budgets. Aher considering the subject of alternative financing of heolth care, the Committee indicated that Member States would need to undertake regulatory measures to rationalize the mix of public and private sector health services. The 49th session of the Regional Commiffee, held in Chiang Moi, Thailand, in September 1996, took note of the preparation of the strategic programme budget with products for each specific programme and annual detailed plans of action to achieve them. To promote gender equality, the Committee urged Member States to encourage participation of women in the meetings of WHO Governing Bodies. The Ministers of Health of the Region have established a tradition of meeting regularly to promote mutual cooperation br health development and to enhance regional solidarity. At their 13th meeting in Colombo in 1995, the Ministers decided tho! the chairman of the meeting should act as chairman of the Health Ministers' Forum till the selection of a successor at the next meeting. They also decided that the Health Secretaries of the Member States should meet regularly. The 14th meeting of the Heolth Ministers, held in Jakarfa/Bandug in 1996, stressed, among xII ma Work of WO In SEA other things, the need to combat new, emerging and reemerging infectious diseases. The first meeting of the Health Secretaries was held in New Delhi in 1996. The Health Secretaries decided that they should meet annually with a well-focused agenda. The second meeting, held in Bali, Indonesia, in 1997, agreed that a part of the country budget, which could not be utilized in time, might be used for supporting countries in greatest need. They recommended that Member States should increase efficiency in implementing WHO collaborative programmes. As part of the managerial process for WHO programme development, and in accordance with the recommendations of the Executive Board working group on WHO response to global change, a product~riented approach was used for developing the strategic programme budget proposals for 1998- 1999, and the detailed plons of action at the country and regional levels during 1996 1997. With a view to protecting the regional allocation and safeguarding the needs of the Member States, an Ad hoc Working Group suggested certain criteria for regional allocations for submission to WHO/HQ. To streamline the technical aspects of programme delivery, the capability of WHO country office staff to manage the Organization's collaborative programmes was strengthened. Following a resolution of the World Health Assembly /WHA48.16), the Regional Office organized a series of meetings on renewal of HFA strategies. The Member States, as a result, are proceeding with renewing their HFA strategies as an integral part of national health planning process. The Regional HFA Strategy for 20002020is being developed on the basis of inputs generated by country exercises undertaken to formulate their five-year/perspective plans. A major initiative has been taken to strengthen WHO'S partnership with other UN agencies and to forge new alliances with multilateral and bilateral organizations and financial institufions such as the World Bank and the Asian Development Bank. A Memorandum of Understanding (MoU) between the Association of South-East Asian Nations (ASEAN) and the WHO ~xwutlve Summary xiii Health, Srienre and Public Poliry Regional Offices for South-East Asia and the Western Pacific has been signed and a framework of cooperation agreed upon. Conclusion of a similar MoU for mutual cooperation between the South Asian Association for Regional Cooperation (SAARCJ and . WHO/SEAR is under process. It is expected that cooperation between these important regional country groupings and WHO will strengthen Member States' capabilities to deal with common health problems. In order to further consolidate cooperation between WHO and the World Bank, a meeting of the WHO Representatives in the Region and the World Bank officials was organized in 1995. WHO continued to liaise actively with major bilateral agencies for mobilizing resources for health, and provided support to the Asian Development Bank in reorienting its health sector support policy. leadership for health was significantly emphosized and advanced by several global-level meetings convened recently by the United Nations. It is now recognized that health is the cornerstone of social development. The Bretton Woods organizations and other donors are now devoting more resources for health development. The themes of the global UN meetings have been widely disseminated in the Region. The ongoing exercises for renewing the HFA strategy will enhance leadership for health at all levels. Several initiatives undertaken by the Regional Office are contributing to building up leadership for health and placing heolth high on national development and political agendas. The country profiles on Women's Health and Development (WHDj are being completed to address the gaps in reliable and uptodate information obout prevailing and emerging WHD issues. Realizing the role of health legislation in fostering equity and bringing about quality assurance and cost-effectiveness in health services, the Regional Office continued its support to Member States in dealing with matters concerning health legislation, ethics and bioethics. Both Indonesia and Nepal were supported in dealing with heolth legislation issues. legislation on human organ transplantation in India was prepared with WHO collaboration, IV The Work of WHO In SEA while Sri lanka received technical assistance in organizing a regional training workshop on medical ethics. In furtherance of the health research policy of the Organization, the Regional Office supported research projects in communicable diseases, heolth economics, reproductive health ond maternal health. Commissioned research was also promoted on adolescent health and women's health and development. The Region's research promotion efforts were duly recognized by the aword of the Jacques Parisot Foundation Prize for 1996 to Dr K.A.K. Wiiewardene of the University of Keleniya, Sri lanka. Active collaboration has been pursued with Member States in revising and implementing their health policies. In strengthening the national managerial process, the Regional Office supported ~~~~~~~~building and interacted with national authorities in finalizing national health plans. WHO'S inpuh helped in generating the necessary technical and financial support to the countries from bilateral and multilateral agencies. Y While technical cooperation among countries proceeded smoothly as in the past, cooperation between countries in tackling common health problems such as border meetings to control malaria and kala-azar, and holding of joint national immunization days was facilitated by WHO. The countries in greatest need were supported technically and financially in developing their health plans, health care financing, heolth infrostructure management, manpower planning and strengthening district health systems. All the countries were supported through the provision of a wide range of medical supplies and equipment. Six countries benefited from the emergency preparedness programme of the Organization. The Regional Office actively collaborated with the countries in institutionalizing health sector emergency management in addition to carrying out training activities and providing medical supplies during emergencies arising from floods and other calamities. Accident prevention and safety promotion were also promoted in the Region. National Health Policies and Programme Development and Management Executhne Summary xv Biomediral and Health Information and Trends Organization and Management of Health Syxtems Based on Phrrry Health Cure Though allMember States have communicable disease surveillance progrommes, epidemiological services need further strengthening. Technical odvisory committees were set up to guide surveillance activities in many countries and notificafian of communicable diseases has been made compulsory by all countries, except Bangladesh, Bhutan and Nepal. The third evaluation of the implementation of strategies for health for all was completed and national and regional reports were prepared. With the ossistance of the Regional Ofice, Member States continued their efforts to further strengthen their notional heolth information systems (HISS) through improvement of the quality of health ond health-related data, rational reduction of HIS dato-load and wider application of informatics technology. Many publications were issued with some being translated into notional/local languages. The Regional Office Librory extended its facilities to Member States, UN agencies and research workers. Continued support was provided in strengthening the countries' health literature, library and informotion services. WHO actively promoted health sysfenis research in 011 countries through grants, training modules and workshops. This hos helped in promoting an awareness of the skills needed in HSR as also the utilization of the research results. While advocacy for the decentralization of health systems was conhnued, ptonning at nahonat and district lev& and micropianning at the health centrelevel were supported. Healthy village concepts are emerging in several countries following the Healthy Cities apprmch. Because of shortage of resources for health core financing, alternative sources of funding, including privotization, were promoted. Technical support was provided to Member Countries in carrying out studies and relevant training was provided to health personnel. The focus of WHOprogrammes has been on equitable access to health and quolity of health care and community action for health. Strengthening the organization and management of district heolth systems based on primary health care was pursued. WI The Work of WHO In SEA Community participation in accelerating health development at the district level was strengthened. The intercountry collaborative programme on 20 'model' districts has generated the active participation of nationals in furthering this programme. All the countries are developing two model districts eoch using the guide lines and training modules developed at on intercountry training workshop. The crowning success of the Region's attempts at strengthening the district health system is epitomized by the Mongar experiment which received the Sasokawo Health Prize in 1997. Though there is some imbolonce, in varying degrees, in the HRH policies followed by the countries in the Region, there has been a narrowing of the gap between plans and their octual implementation. The Regional Office initiotives included the formulation of on HRH policy, improving undergraduate and postgraduate medical education ond training as well as promoting closer linkages between medical education and health services. A regional project to promote innovative strategies in medical and nursing education and develop six centres of excellence was started. The trend towards short-term fellowships and study tours was g continued. Several institutions in the Region, particularly in India, Indonesia, Sri Lanko and Thailand, played host to fellows from other Regions. A fellowship evaluation tool, developed by WHO/HQ, was field-tested in Sri Lanka. The regional consultation on Fellowship Policy and Evaluation, held in 1996, made recommendations which ore expected to improve and strengthen the regional fellowship programme. All Member States now have projects under the Action Programme on Essential Drugs. Various components of the drug policy such as drug registration and regulatory control, drug quality assurance, rational use of drugs and monitoring and evaluation of national drug policies were further developed and strengthened. As o result of the implementation of national drug policies, availability of essential drugs for primary health core has improved in most countries. Two technical cooperation projects involving countries in the South-East Asia and Western Pacific regions that are currently operationalaim at improving collaboration between ASEAN Exocutlve Summary Human Resources for Health Essential Drugs and Qualify of Care and Health Technology Healthy Behmriour and Mental Health and SEAR countries in the field of essential drugs. The Regional Office continued to procure drugs, biologicals and contraceptives for WHOsupported programmes. Efforts were continued to improve national capabilities for quality control of drugs and biologicals. WHO collaborafing centres continued the testing of EPI vaccines and training of nationals in quality control of vaccines. The application of the WHO Certification Scheme for the quality of pharmaceutical products moving in international commerce has become more relevant since India, lndonesio and Thailand ore producing raw materials as well as finished products for export. Through the mechanism of bi-regional technical cooperation, good manufacturing practices are being implemented in many countries. Traditional medicines are practised in most countries of the Region even though their regulation, standardization, manufacture, quality control and utilization are at varying stages of development. A study tour organized for participants from Bangladesh, Indonesia, Myanmar, Nepal, Sri Lanka and some countries of the Western Pacific region to India and China exposed them to the advances made in the field of traditional medicine. Most countries hove augmented their laboratory infrastructures. Effom have been made to propagate the concept of quality assurance in laboratory services. laboratory ne~orks ore being established in many countries at the central, intermediate and peripheral levels; however, linkages need further strengthening. The concept of public mental health has gained wide acceptance, though much of the technologies needed for its implementofion are still to be developed. WHO continued its advocacy for extending the concept of mental health. Notable developments were the designation of the Schizophrenia Research Foundation in Chennai, India, as the new WHO Collaborating Centre for Research and Training in Mental Health; holding of a training workshop on Health Behaviour Research Methodology, and development of indicators for the quolity of community life based on a protocol developed by WHO. Developmenf of community-based programmes for the reducfion of illicit drugs wos supported in some countries. The rvlli The Work ot WHO in SEA implementation pion of the third phase of the uNDCP-supported Drug Abuse Control Project in Sri lanka was drafted. Anti-tobacco activities received increased attention in all countries. Focal points for tobacco control were appointed. Legislative measures for banning tobacco smoking in public places were introduced in some countries. The heolth education infrastructure has been decentralized to the community level in many countries, with volunteers playing a critical role in information dissemination. Health education services were extended and progress achieved in the development of o critical mass of trained manpower. The concept of community-based rehabilitation (CBR) continued to be promoted. The WHO manual on CBR was translated into local languages in Banglodesh and Bhutan as also in India and Myanmar. Support was extended to the establishment of a notional CBR programme in Bhutan and for reviewing the feasibility of local production of lowsost artificial limbs in Sri lanka. Nutrition continues to be a priority areo in the Region, and the focus of WHO'S support was on improving the quality of national I progrommes to oddress the priority areas of protein energy ma/nuhition, iodine deficiency disorders, vitamin A deficiency and iron deficiency anaemia. SEAR0 supported the production of a national nutrition survey report os well as evaluation of the deworming programme in Moldives and development of a household food security study in Myanmar. In the field of food safety, support was provided to review programmes and identify priority areas for action for legislation ond training. Within the fromework ofthe regionalstrotegy forreproductive health, all countries have developed national strategies and identified safe motherhood, family planning, HIV/STD/RTl,prevention of inferfility and adolescent reproductive health as priority areos for action in their reproductive health packages. In addition to WHO, other UN agencies such as UNFPA, UNICEF, the World Bonk and the Asion Development Bonk and bilateral organizations are involved in reproductive health programmes of the country level. The Scientific Working Group on Operational Research in Reproductive Health Nutrition, Food Safety Reproductive, Family and Community Health and Population issues ~xecutlva Summary XIX identified priority areas for operational research and recommended ways for promoting and strengthening research. One priority area is the development of modules for delivery of integrated reproductive health services for which a prototype protocol was developed. Moternal mortality continues to be high in the countries of the Region, except DPR Korea, Sri lanka and Thailand. A significant reduction in infant mortality in the Region was noticeable. The change in adolescent likstyles wos recognized in most countries and adolescent heolth was included as a component of the reproductive health package. WHO was involved in providing training ond IEC materials and in conducting country as well as regional training courses in adolescent health. The concept of women's health gained wide recognition, especially aher the lnternational Conference on Population and Development in Cairo in 1994. The number of elderly persons is increasing in all countries of the Region, underscoring the importance of evolving programmes for the care of the elderly. The Speciol Programme of Research, Development and Research Training in Human Reproduction (HRPJ emphasized the need for improving reproductive health, and mony countries maintained a high level of co/loboration with this programme. Two important activities carried out were: evaluation of the programme's impact in terms of strengthening research capabilities in the South-East Asia and Western Pacific regions, and holding of a series of regional workshops on ethical issues in reproductive health. In addition. several workshoos. svmoosia and scientific I .. , , meetings were held in reproductive heolth epidemiology, human reproductive research methodology, quality assurance of oral I and injectable controceptive~ dato 'management and communication and sociol science in human reproduction. Efforts were made to strengthen the occupational heolth programmes through training courses for diffirent categories of heolth personnel. The International Symposium on Occupational Health Research, held in Thailand in 1995, identified major forms of occupational hazards and their impact and possible intervention strategies and approaches. XX ma Work of WHO In SEA WHO'S collaborative programme focused on drinking-water qualify surveillance and operation and maintenance of water supply facilities. Short-term training courses and study tours in various water supply and sanitation topics such as reuse and recycling of waste water and wastes were conducted for participants from Bangladesh, Indio, Maldives, Myanmor and Sri Lanka. Promofion of the Healthy Cities approach was started in Chittagong, Bangladesh, and later extended to Kathmandu and Bangkok. Twenty steps to a Healthy City were identified and pamphlets describing these steps were disseminated to countries olong with other promotional moterial. The programme for environmental health hazords focused on developing national capacities ond capabilities to assess and manage health hazords as a result of environmental pollution. Regional technical guidelines on air quality monitoring were prepared. In order to strengthen national chemicol safefy programmes, WHO initiated the preparation of national chemical profiles in five countries, of which three have been completed. Studies on chemical emergency preparedness and response were completed in India, Sri Lonka and Thailand. An assessment of the chemical sofefy programmes in selected countries wos undertaken in 1996 to drah a regional action plan to promote chemical safety. Countries were assisted in identifying and assessing health hazards and issues involved in environment, housing, public works, agriculture and industries. Based on these intersectoral assessments, notion01 action plans were developed incorporating health and environment strategies in all development sectors. Support wos provided for identilying prior;?. health and environment actions for incorporation into the nations/ Agenda 2 1 of different countries. Indio, the only country in the Region where guineaworm disease is present, made steady progress towords its eradication. WHO played an important role in establishing the National Guineaworm Eradication Programme and helped in developing and updating an operational manual. Only nine guineaworm disease cases were reported in 1996, and it is expected that the country will achieve zero-incidence in 1997. Environmental Health Eradication1 Elimination of Specific Communicab/e Diseases Executive Summary XXI Control of other Communicable Diseases The leprosy control programme has been integrated into the basic health services in all countries, except India where a vertical programme is in operation. Two countries in the Region achieved the eliminotion goal of case per 10000 population, and three more countries, nomely, Bhutan, Indonesia and Maldives, are expected to reach this goal by the end of 1997 or in early 1998. Special action projects were launched in 1996 in lndonesio, Myanmar and Nepal. Bangladesh and lndio are expected to launch similar compaigns shortly. Eradication of poliomyelitis is a topprioriiy programme of WHO. Coordination efforts of the Organization led to the synchronizotion of national immunization days in eight countries in three regions when more than 40 per cent of the world's children aged below five years received oral polio voccine. Training was provided to all national and regional reference laboratories in mhpproved standard methods for polio virus isolation. Five countries hove affoined the target of elimination of neonatal tetanus (Nl), i.e. less than one case per IOW live births. In 1996, all countries conducted a review of the achievement of NTelimination following the Wrecommended methodology. Countries were encouraged to implement the HighRisk Approach for NT ond it is expected that Bongladesh, India, Myanmar ond Nepal will prepore country plans of action for implementing this approach. By the end of 1995, the SEAR hkmber States, except lndia and Nepal, had maintained national measles vaccine coverage of more than 80 per cent in children under one year. Although the incidence of measles hos shown o downward trend, all SEAR countries still have loci of susceptible populations. The countries are preparing long-term plans of oction for measles control ond elimination. The coverage rates for EPktarget diseases were over 80 per cent and the political commitment to continue the EPI programmes remained strong. Increasing emphasis has been given to identifying the remaining foci of susceptible children that hove not been reached by the immunization programme. In addition to the EPI-target diseases, childhood immunization against hepatitis B was introduced in some countries. xxll me work of WHO In SEA The acute respiratoty infections (ARIJ and diarrhoea1 diseases control (CDDJ programmes were aimed at reducing mortality and morbidity amongst children. Technical guidelines for the control ond treatment of ARI were revised and training courses were conducted. A combined ARI/CDD curricula was developed for selected nursing training schools in Indonesia. While bocterial drug resistance studies were completed in Thailand, similar studies are proposed to be initiated in other countries. The first integrated course on the monagement of childhood illnesses was completed. Progress was made on the WHO/UNICEF Initiative on Integrated Management of Childhood lllnesses with some districts in India and Nepal being selected for its implementation. Considerable progress has been made towards achieving the global target for tuberculosis control by implementing the directly observed treatment, short-course (DOTS) strategy. Revised national TB programmes have been developed in five countries. WHO continued to colloborote with the World Bank and other agencies for implementing TB control programmes in Bangladesh, Bhutan, India, Indonesia, Myanmar, Nepal and Sri Lanka. A regional strategy for TB control in SEAR was developed. The need for human resources development was addressed through international training workshops. Operational reseorch studies were conducted in Bangladesh, India, Nepal ond Thailand. Some of the new, emerging and reemerging infectious diseases are cholera, zoonoses, rabies and plague. With regard to plague, WHO collaborative activities consisted of provision of technical information; training of nationals in laboratory diagnosis and production of diagnostic reagents; promotion of laboratory diagnosis and surveillance, and development of a rapid response mechanism. In addition to the current infectious disease problems, potential problems associated with the increase in a number of drug-resistant bocterial and parasitic infections were posing grave concern. Member States were supported in the containment of dengue outbreaks. The Dengue Bulletin (formerly known as Dengue Newsletter) was published in December 1996 and is expected to be an annual feature. The development of a tetravalent live attenuated dengue vaccine at Mahidol University in Thailand, with technical and financial support from WHO, was successfully Exocutlva Summary xxlll undertaken. Hepatitis 6 control programrnes were established in many countries of the Region and heputitis B voccinotion wos extended to more provinces in lndia, Maldives and Thailand within the framework of EPI. Sextually transmitted diseases and AIDS continued to spread ominously. More emphosis was being given to advocacy at the country level as well as to expanding the progromme to the community level. A review of HIV/AIDS care approaches was carried out in Thailand and an initiative was taken to develop a model which could subsequently be implemented throughout the country. The Regional Office continued to mobilize additional notional and international resources. It played an important advocacy role by highlighting the devastating potential of the AlDSpondemic. An integrated approach to STDcontrol, monitoring of gonococcal anti-microbial sensitivity and guidelines for STD management were developed. Collaboration for the control of malaria and drug resistance in border areas between Bangladesh, Bhutan, lndia and Nepol was initiated. The Organization helped lndia and lndonesio in their negotiations for financial assistance from the World Bank and the Asian Development Bank for their malaria control programmes. Similar support was given to Bongladesh and Myanmar. The regional monitoring system for vector resistance to insecticides wos strengthened. The Special Programme for Research and Training in Tropic01 Diseases PDR) sponsored research activities on leprosy and filariasis in addition to malaria and leishmaniosis. These activities included studies on drug resistance and drug efficacy; malaria vaccine development; health financing of malaria programmes; vector control, and drug-regimen compliance. The prevention of blindness progromme continued to focus attention on the promotion of primary eye care using the PHC network and control of avoidable blindness through restorative interventions. Comprehensive national cancer control programmes were formulated in several counfries of the Region. Demonstration areas for an integrated control of major noncommunicable diseases such as cancer, cardiovascular diseases and diabetes were Tho Work ot WHO In SEA initiated. A common package of interventions was established for various levels of health care. The oral health programme continued to lay emphasis on the prevenfian and control of caries and periodontal diseases. Bangladesh was assisted in its school or01 health programme, while India and Indonesia received support in the implementation of primary oral heolth projects. In line with the decision of the Executive Board and to moke the best possible use of national expertise, a start was made with the creation of one post of National Profession01 Officer. Seven mare posts ore being established. As of 30 June 1997, there were 105 Professional staK of which 18 were women. During the period under review, 258 short-term staff were recruited, of which 68 were women. Some offices within the Regional Office building were remodelled to create a better working environment and to moke optimal use of available space. The Budget and Finance unit continued to provide support to the timely delivery of the collaborative programme through budgetary and fiscal measures. Executive Summary xxv Section 1 Governing Bodies The Forvninth World Health Assembly, held in Geneva in May 1996, elected Dr Alberto Mozza (Argentina) as President. From the South-East Asia Region, HE. Mr A.H.M. Fowzie (Sri Lankal was elected as one of the Vicepresidents Professor A.K. Shamsuddin Siddiquey [Bangladesh) was elected as ViceChairman of Committee '6' and Dr jigmi Singay (Bhutan) as Rapporteur of Commiiiee 'A'. Indonesia was elected to designate a person to serve on the Executive Board for a term of three years to fill the vacancy of the outgoing member, Nepal, from the South-East Asia Region. In its 31-point agenda, the Health Assembly reviewed and approved the reports of the Executive Bwrd's 96th and 97th sessions and also approved the reports of the main committees. The discussion on WHO reform in response to global change covered, inter olio, renewal of the HFA strategy and review of the WHO Constitution. The Health Assembly adopted 29 resolutions. The Fiftieth World Health Assembly, held in Geneva in May 1997, elected H E. Mr Saleem lqbal Shervani, Minisler of State for Health and Family Welfare (India), as President. Dr S.R. Simkhada [Nepal) was elected as one of the ViceChoirmen of Committee '6'. Sri Lanka was elected to designate a person to serre as a member of the Executive Board in place of the outgoing member. Thailand. The Health Assembly reviewed the reports of the Executive Bwrd's 98th and 9ah sessions. World Health Assembly Executive Board The Health Assembly discussed the World Heolth Report 1997 which had 'Conquering suffering, enriching humaniiy' as its theme. The Health Assembly reviewed and npproved the progrornme budget for 1998~1999 the work of the preparation of the loth General Programme of Work and endorsed the reports of Committee 'A' ond Committee 'B'. Discussions were held on WHO reform, budget and finance matters and control of tropical diseases, including malaria and filariasis. The Heollh Assembly adopted 38 resolutions. The 97th session of the Executive Board was held in Geneva in January 1996. In the context ofWHO's response to global change, the progress report on reforms, the role of WHO country offices, review of the Orgonizotion's Constitution and reassignment of Member States to different regions were some of the subiecls discussed. The 98th session of the Executive Board was held in Geneva in May 1996 and Mr Songay Ngedup [Bhutanl wos elected as Chairman. It discussed the reports of scientific advisory bodies, WHO response to globol change, the review and evaluation of specific programmes and budgetary reform. The 99th session of the Executive Board was held in Geneva in January 1997 In the context of the item on WHO reform, the Board discussed, inter olio, renewol of the HFA strategy, review of WHUs Constitution and the role of WHO country offices. The Board considered proposals for further savings, including the possibility of holding biennial instead of annual meetings of the Heolth Assembly. It also reviewed and endorsed the programme budget for 1998-1 999 The 100th session of the Executive Board was held in Geneva in May 1997 immediately oher the Fiftieth World Health Assembly. The Board discussed the drah global health policy and the role of WHO country offices, the progress report of its special group on the review of the WHOConstitution and the implementation of Rule 52 of the Rules of Procedure of the Executive Board regarding the nomination for the post of DirectorGeneral. Two sessions of the Regional Committee for South-East Asia were held during the period covered by this report: while the fortyeighth session wos held in Colombo, Sri Lanka, from 12 to 18 September 1995, the fortyninth session was heid in Chiang Mai, Thoiland, from 9 to 14 September 1996. At the forbighth sesslon, the Regional Committee reviewed the report of the Regional Director covering the period 1 July 1993 to 30June 1995. The Committee agreed on a supplementary intercountry programme with the focus on three broad areas, namely, advocacy for health, technical cooperation among countries and international cooperation on standard-setting and innovations. The Committee agreed to implement these programmes by transferring resources from country budgets for 1996-1 992 During the technical d~scussions on Alternative Financing of Health Care, the Committee urged the Member States to study and explore alternative financing of heoith care and introduce suitable reform measures to ensure quality of service, social responsibility and consumer protection. The forbpinth session of the Regionoi Committee considered the report of the Regional Director for the period 1 July 1995 to 30 June 1996. The Committee olso noted the recornmendotions of on ad hoc working group on regional allocations, the observations and recommendations of the Regional Consultation on WHO Constitution and the implementation status of supplementary intercountry programmes. The Committee felt that the Executive Board members from the Region should be associated with important meetings organized by the Reg~onal Office, including policy-level meetings such as the Regionol Committee. It urged the Member States to encourage and promote the participation of women in the meetings of WHOgoverning bodies as well as in the work of the Organization. The Committee endorsed the proposed programme budget for 1998-1999, which wos prepared using the concept of strotegic budgeting with products for specific programmes. Technical discussions were held on Quality Assurance in Laboratory Practices. The Committee emphasized the need to develop national laboratory policies with quality assurance as an integral part of laboratory services, and urged the Member States to strengthen their capacities for improving the performance and quality of laboratory practices. The Committee urged the Member States to develop, improve and integrate their national health systems into the managerial processes for health development, and requested the Regional Director to continue to publish the Regional Health Report annually, focusing on specific themes of relevance to the Region. 4 The Work of WHO in Su Section 2 Health Policy and Management Member States were provided technical support for developing their annual deta~led plans of oction for implementing the strategic programme budget for 19%1997 Country programme formulotion missions vis~ted some countries lo ossist in the preparation of annual plans of action Support was also extended for the formulotion of the programme budget for the 1998- 1999 biennium. The Regional Committee, in 1995, took the initiative to rationalize, strengthen and enhance the allocation for an intercountry programme for tackling emerging health problems of common concern to Member States, utilizing resources from country allocations during the 19961997 biennium. in a spirit of regional solidariiy it was agreed by the Health Secretaries at their second meeting that, in order lo accelerate implementation in the 1996.1997 biennium, funds from some countries, with their concurrence, should be allocated to those which were in greatest need. In order to improve the utiliza~ion of funds, the criteria adopted for selecting activities were the following: countries should be fully ~nvolved in the activ~ties wh~ch should be of short duration, demonstrating tongible/measurable outputs; funds should be liquidated in 1997 itsell; the focus should be more on training and General Programme Development and Msnagement 5 developing modules and/or standard guidelines; recruitment of experts should directly benefit countries; making provision for the organization of intercountry seminars/workshops, and conduct of operational research of short duration which would produce tangible results for immediate application. The Consultative Cornminee for Programme Development and Management [CCPDM), at its meeting held in April 1996, reviewed the implementation of the WHO collaborative programmes for the 1994- I995 biennium, ond the 12-month implementation of the 19%- 1997 programme budget at its meeting held in April 1997. It also reviewed the proposed intercountry programme budget for the 1998- 1999 biennium and the progress made in the implementation of the supplementory intercountry programme IlCP 11). The 44th and 45th meetings of the Regional Director with the WHORepresentotives were held in November 1995 and November 1996, respectively, where diverse issues related to programme development and management in the Member Stotes were reviewed In pursuance of the recommendations of the Execut~ve Board workng group on WHO Response to Global Change, consideroble progress was mode in the implementation of the reforms in the Region. Using the product-oriented approach, strategic programme budget proposals os well os detailed plans of action were developed at country and regional levels in 19%~ 1997. An od hoc working group met in October 1995 to discuss the issue of regional ollocotions, including establishing appropriate criteria for these allocations. Efforts are in hand to enhance the role of the Executive Board (EB] members from the Region for harmonizing the work of the Regional Committee with that of the EB and the World Heolth Assembk. Adequate and timely briefing of the EB members was orronged so that the interests and concerns of the Region were properly represented at the meetings of the EB and its various working groups. WHO response to global change A consultotion on the WHO Constitution was organized in August 1996. While noting the conclusions and recommendations of this 8 The Work of WHO h SEA consultation, the forty-ninth session of the Regional Committee felt that even though there was no need to make extensive changes to the Constitution, it was time to carefully examine the Organization's finoncial and administrative procedures in order to ensure a systematic and timely implementation of its activities. In pursuance of resolution EB99 R24, the EB special group met in April and May 1997 and adopted a provisional programme of work for the current year and reviewed, in particular, some issues relating to WHO regional arrangements within the framework of the Constitution. The Staff Development ond Training Committee established explicit policy guidelines to enable the maximum number of staff members, both in the Regional Office and country offices, to benefit from training programmes. Various types of group training activities were conducted. As many as 19 Professional and 92 General Service (GSI staff members from the Regional Office and eight staff members from country offices were trained in different computer software programmes, while 32 GS staff attended secretarial effectiveness courses. In addition, five Professional staff members attended the Interregional Seminar of WHO Representatives in Geneva while eight newlyrecruited Professional staff attended the introductory briefing programme at WHO/HQ. Participation of eight staff members [both Professional and GSl was approved for taking part in such diverse act~vities as Public Service International [PSI) Regional women's Conference, Management of Field Coordination for Senior UN System Represenlat~ves, local Salary Survey Methodology and UN Solary and Post Adjustment System The Regional Office took the lead in the exercise for renewing the health-forull strategy by organizing an informal consultation in August 1995. The subject has since been discussed by the CCPDM, the Regional Committee, the Health Ministers, the Health Secretaries and the meeting of parliamentarians. An intercountry meeting on Evaluation and Renewal of HFA Strategies was organized in December 1996. Staff development Renewing the health-for-all strategy General Programme mvelopment and Management 7 Various forms of health sector reforms were init~ated in the countries of the Region. Member States, as per their planning cycles, proceeded with the formulation of health development plans as part of their national development process. Renewing the HFA strategy formed an integral part of national health planning process. Following a consultative meeting on Health Development in South-East Asia in the 2lst century, held in March 1997, a regional intersectoral meeting on the subiect was held in June 1997 at which a droh declaration on health development in the South-Eost Asia Region in the 2ist century was formulated. The draft declaration will be submined to the 15th meeting of the Ministers of Health in August 1997 for consideration and endorsement. This process and its outcome will have a strong bearing on the health-for-all strategy at country and regional levels. Managemant The Regional Office continued to provide technical assistance in and support to setting up Local Area Nehvork (LAN) and E-mail connections in the information offices of WHO Representatives (WE) which required these facilities. systems All the WR offices now have LAN and E-mail connections. Development of WHCYs Global Management Information System (WHOMIS] was undertaken, with its maior component, the Activiiy Monitoring System (&IS), being in its final stages of refinement and implementation. The first version of the AMS has already been installed in the Regional Office. The new client/sewer-based Administrotion and Financial Information System (RO/AFI) has been functional since July 1996. A new computing centre facility, with a larger network, was completed in the Regional Office in February 1996. The centre plays a leading role in upgrading the hardware/sohware infrastructure in order to accommodate modern clientserver applications as well as to implement new communication facilities, including access to the Internet and video conferencing. The World Wide Web server has been set up and SEARCYs home page is available for global lnternet access by external users as also for the office staff via the lnternet on the SEAR0 LAN. 8 me Work of WHO in SEA Under the Regional Director's Development Programme (RDDP),support was provided for: establishing a radio communication system between basic health units and district hospitals (Bhutan); procurement of cardiac surgery equipment (DPR Korea), and procurement of oral polio vaccine and meeting the operational expenses in respect of social mobilization and other components of national immunization day INID] activities in some countries. Assistance was given to Bangladesh and DPR Korea to meet emergency health situations arising from floods. Support was provided for upgrading and strengthening training facilities at the Regional Health Training Centre in Sri Lanka. Improving the technical skills/performance of peripheral health workers, purchase of vaccines for strengthening NID activities in Indonesia and Nepal and supply of o high-speed chromatograph to the Reseorch Institute of Biology in Pyongyang {DPR Koreo) were some of the other activities supported under the Programme. Participation of officials from Bangladesh, Bhutan and Nepal in the border meetings on malaria and kalauzar was supported. Funds from the RDDP were utilized for a Joint WHO/FAO/UNICEF ICN Notional Action Plan followup meeting. Meetings on primaly health care, tPi vaccine supply, psychosocial rehabilitation, integrated control of noncommunicoble diseases and strengthening of ethics in medical education and practice in SEAR were also supported. The first two meetings of the Health Secretaries of the SEAR countries were organized by utilizing funds from the RDDP. WHOcontinued its collaboration and partnership with various United Nations agencies and worked closely with UNICEF, UNDP, UNFPA, FAO, UNCCP, UNHCR and UNESCO as well as with other relevont organizations. A Memorandum of understanding IkUj was concluded between the Association of South-East Asian Nations IASEAN] and the World Health Organization. The Regional Directors for the South-East Asia and Western Pocific regions signed the MoU on behalf of WHO. As a result, relations between the two organizations have been formalized and further strengthened. Regional Director's Development Programme Coordination with other organizations Generel Programme D.velopmenl and Management S Another MU between WHO and the South Asian Association for Regional Cooperation (SAARC) for mutual cooperation in dealing with common public health problems in Member States is in the process of being concluded. Meanwhile, WHO continued to collaborate with SAARCs Regional Tuberculosis Centre located in Nepl. UNDP continued to support a number of health sector projects in SEAR countries. WHO executed the UNDP-funded projects on: primary health care in Bangladesh; improving rural community access to PHC and prevention and control of AIDS in Myanmar; human resource development for water supply ond sanitation in Nepal and control of AIDS/HIV in Sri Lonka. WHO participated in the meetings of a number of expert committees of the Economic and Social Commission for Asia and the Pacific IESCAPI An agreement was reached with ESCAP to further strengthen the collaboration in the fields of rehabilitation, HIV/AIDS, the Healthy Cities programme, social development, poverty alleviation and sustainable development, and statistics. UNESCO: in collaboration with WHO, organized an international seminar on Culture and Health in Chiang Rai, Thailand, in May 1996. This was the first initiative of its kind taken for health advocacy from the cultural perspective. WHOcont~nued to collaborate with UNFPAat the technical level, particularly in the area of reproductive health, and in the implementation of UNFPA~funded projects in Bhutan and DPR Korea.UNFPA has joined the Joint Committee on Health Policy UCHP) which has been reconstituted as the WHO/UNICEF/UNFPA Coordinating Committee on Health. WHO worked closely with UNICEF in priority health programmes such as immunization, use of oral rehydration therapy, promotion of breast-feeding, universal iodization of salt, measles control, polio eradication, child nutrition, child survival and sanitation. WHO collaborated with FA0 in the nutrition programme, and with UNHCR in the health education project for refugees in Rakhine district in Myanmar. An MoU has been signed between the United Nations 10 The Work ol WHO In SEA High Commissioner for Refugees and WHO for closer cooperation in the field of humanitarian assistance in emergencies. I WHOcontinued to execute 22 components of the Fourth Population and Health Project in Bangladesh which is funded by the World Bank ConsortiumThe Organization worked closely with the Government of Bangladesh ond the World Bank and other external agencies in the formulation of the Fifth Population and Health Project. WHO also provided technical support to the World Bank-funded proiects in lndia, Indonesia, Nepol and Sri Lanko. WHO was involved in the reorientation of the health sector policy of the Asian Development Bank [ADB). It worked closely with the ADB-funded projects in Bangladesh, Indonesia and Nepal. Following a ioint WHO and Government of Japan mission, the latter made o commitment to support EPI su~eillonce octivities in Myanmar; made voluntary contributions to strengthen nation01 capacities for iodine deficiency disorders (IDDl control in Bhutan and Myanmar, and pledged to contribute about US$14 million towards the polio vaccination programme in lndia during 1 W6~ 1997 and 30 million Japanese Yens for NID octivities in Thailond. WHO supported the efforts of various bilateral organizations in the formulation of health programmes to be assisted by them. These included the Danish lnternationol Development Agency IDANIDA), the Australian lnternationol Development Assistance Bureau (AIDAB), the Canadion lnternationol Development Agency [CIDA), the DirectorateGenerol for lnternational Cooperation of the Netherlands, the German Agency for Technicol CooperationlGTZ), the Norwegian Agency for International Development INORAD), the Overseas Development Administration [ODA) of the United Kingdom, the US Agency for lnternational Development [USAID) and the Finnish lnternational Development Agency (FINNIDAI WHO continued its initiative to enhance partnership with nongovernmental organizations and, in the process, closely collaborated with a number of NGOs in wideranging health programmes in the Region. Notable among them were Rotary International, Nippon Foundation and Lions lnternational. General Programme Development and Management 11 Mobilization of external health resources Health Ministers' meeting WHO continued to work closely with international and bilateral agencies to mobilize resources for priority health programmes in the Region. It provided technical support in the preparation of the health sector documents for the Sixth Round-Table Meeting for Bhutan, which was held in Geneva in January 1997. In order to strengthen national capacity for aid negotiations for mobilizing external resources for health, an intercountry workshop was organized in Kathmondu in April 1997 where the five leastdeveloped countries of the Region, namely, Bangladesh, Bhutan, Maldives, Myanmar and Nepal, The Regional Office continued to liaise and work closely with the relevant units at WHO headquarter for mobilizing extrabudgetory resources in order to support the Organization's collaborative programmes in the Region. The 13th meeting of Ministers of Heolth of the SEAR countries, held in Colombo, Sri Lanka, in September 1995, established an innovative mechanism by institutionalizing the working of these meetings the chairman of a meeting will act as chairman of the Health Ministers' Forum till the election of a successor at the next meeting Accord~ngly, H E Mr A.H.M. Fowzie, Minister of Health, Highways and Soc~ol Services, Sri Lanka, sewed as Chairman of the Health Ministers' Forum during 1995-96 In this capacity, he visited several countries which helped to promote regional solidariiy and mutual cooperation in health development, particularly in the field of human resources for heolth The Health Ministers also decided that the Health Secretaries of the Member States should meet regularly. The 14th meeting of the Health Ministers took ploce in Jakarta/Bandung, Indonesia, in October 1996. HE. Prof Dr Suiudi, Minister of Heolth of the Republic of Indonesia, assumed the chairmanship of the Heolth Ministers' Forum for 1996-97. A Monograph on Poverty and Health, by the Margo Institute, Sri Lonko, was circulated at this meeting. The Ministers noted that the Governments were responsible for developing suitable health policies and regulatory frameworks for the realization of the objective of improving the health status of the people in the light of the expanding 12 Thm Work of WHO in SEA The recent international conferences, most notably the Fourth World Conference on Women, held in Beiiing in 1995, have given high priority to women's health as an essential part of their empowerment. Countries have been taking steps to translate into action the commitments mode at these conferences. These have included the development of national policies on women, the creation or strengthening of appropriate national machinery for the advancement of women and gender sensitization of health programmes. The Regional Office undertook the preparation of country profiles on Women's Health and Development [WHDI The profiles and guidelines were initially field-tested in Myanmar and Thailand. A working group meeting on WHD county profiles was held in Myanmar in March-April 1997 to launch the second phase of the complet~on of the country profiles in all SEAR Member States. Acknowledging the role of health legislation in the implementation of HFA strategies, Bongladesh. Indio, Indonesia, Myanmar, Nepal and Thailand, in collaboration with WHO, have been reviewing and updating their health legislation. Indonesia has a specific programme dealing with health legislation, ethics and bioethics. With assistance from WHO, Nepal finalized a new Health Act in an effort to provide health services equitably WHO collaborated with India in the area of organ transplantation and brain death, which resulted in the enactment of an Act on humon organ transplantation WHO supported principal investigator-initiated research projects in the areos of communicable diseases; health economics; human resources for health; reproductive health; adolescent health; maternal health, plague surveillance; preinvasive and invasive lesions of the cervix and outreach-clinics coverage. Commissioned research was promoted on adolescent health; county profiles on women's health and development; health care financing; study of factors and policies that determine geographical and sectoral distribution of doctors Women's health and development Health legislation, ethical dimensions of health care and bioethics Research policy ond strategy coordination Hulth. Sclanca and Publlc Policy 15 I and a study of general practice and its implications for medical education. In order to strengthen research development activities, the Regional Office developed an 'institutional memory' for the regional research programme; conducted a health systems research (HSR) workshop, and reviewed the existing training modules on MCH/FP. It also assessed the current status of the prevalence of hepatitis B; developed research proiects on health futures trend assessment; conducted health policy research workshops, and supported a research project on field-testing of women's health. The 22nd session of the South-East Asia Advisory Committee on Health Research ISEA/ACHR], held in Dharan, Nepal, in April 1996, discussed such topics as research in occupational health; eth~cal issues in health, and promotion of research in health sector reforms. The tenth meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries [MRC] was held in Bandung, Indonesia, in October 1996. The meeting discussed the complementarity of health research activities supported by various agencies at the country level; research on health in the urban environment; research for promoting heolth in public policies, especially development policies, and research relofing to health in border areas with emphasis on disease su~eilionce The 23rd session of the SEA/ACHR, held in Chiang Rai, Thailond, in April 1997, discussed and made recommendations on: ii] strategies for effective promotion of the application of research results in health development; [ii] health futures research - its role in the formulation of the HFA strategy for the next century, and (iii) ethical issues in health. Though the meeting felt that both the ACHR and MRC had distinct roles and functions to it recommended that they should continue to work independently but with necessary coordination, and their future meetings should be held concurrently, followed by a ioint meeting of the two bodies. An intercountry nutrition-cum-research workshop, in June 1996 in Jakarta, reviewed the results of nutrition research activities carried out in the Region in the context of the nutrition ne~ork. 16 rho Work of wno In su November 1996 clarified the methodologies used in estimating the health and health-related indicators, and recommended that WHO should continue to use data from both national and other sources in preparing the Regional Health Report and other regional publications The Reg~onal Office published the Regional Health Report for 1996 and 1997 The 1996 edition provided a general perspective of health development in the ten countries of the Region within the context of the polit~cal, social, economic and environmental situation. The 1997 edition reviewed the HFA development and its impact, achievements and lessons learnt during the last bventy years in the South-East Asla Region. Preparation and production of documents, improvement of scientific communication, translation of WHO publications into national/local languages ond promotion of the sale of WtiO books were the main activities carried out during the period under review. Two Issues of the biannual Regronal Heolth Forum were issued in February 1996 and July 1996. The wentieth volume (1996) of the Dengue Newslener, which has been renamed as the Dengue Bu/letin, was issued An intercountry workshop on Improving Scientific Communication in South-East Asia, held at SEAR0 in November 1996, brought together participants from seven countries. They deliberated on the current status of scientific communication in the Region and recommended ways and means of improving it. Several documents/publications were issued on health topics which included, among others, a manual for the prevention and management of drug-related problems. Translation of WHO publications into national/local languages continued to receive active support and encouragement in order to make them easily available to health workers and the general public. The languages included Bahasa Indonesia, Bengali, Korean and Thai as well as several maior Indian languages, Publishing, language and library services Blomedlcal and Health lnformatlon and Trends 25 Health Literature and Ubmry Sewices (including HELLIS) Several reprint agreements were signed with private publishers to enable them to sell their lowpriced editions through their own networks, thereby broadbasing WHO'S dissemination efforts. The WHO publications registered the following sales figures: I Table I. Soles oi WHO publrcaoons The Regional Office Library continued to provide technical informotion and literature support toWHO staff members, Member States, United Nations agencies and biomedical resenrchers As the Regional HELLIS (Health Literature, Library and Information Service] Focal Point, it continued to plan, promote and monitor the HELLIS network activities and liaised with international agencies and other networks. I : The entire collection of books, monographs, proceedings, reports, pamphlets, WHO publications and issues of current periodicals has been reclassified according to the National library of Medicine /USA) classification scheme. The complete catalogue of monographs and periodicals has been computerized. Besides the in-house daytoday consultation, Library users were provided with computerized search faciliy for MEDLINE,AIDSLINE, WHOLIS, SEALIS, IMSEAR and FUGLIS database. The Library continued to provide support to Member States in strengthening their health literature, library and information services. NOTE The above figures represent actual receipts after deduction of oll discc>unts I and application of the concessionol conversion rate of Geneva cover I 1 prices to Indian Rupees Item Subscriptions and sales of publications In order to strengthen the WR offices' information retrieval and document delivery capabilities, the Books Management System IBMS) 26 ma Work of WHO In SEA 1995 US$ 161 012 1996 US$ 162 624 July 1995- Moy 1997 US$ 360 734

The Region01 Office provided financial and technical assistance to Bhutan, India and lndonesia for conducting workshops in health systems research (HSR] Nepal conducted a number of HSR workshops. Technical support was provided to the data analysis workshop for HSR research prolects in Bangladesh and lndonesia A train~ng module for conducting HSR workshops was developed and f~eld-tested n lndonesia. The module would be available for conducting similar training workshops in other countries of the Region. Institutional strengthening grants were provided to countries to promote a strong network of HSR activities. All Member States in the Region have reemphasized the need to ~~erat~onolize the core principles of primary health care in their ne~l~~formulated health development plans, policies and strategies. The new heolth development plans formulated by the SEAR countries call for measures to turn the core PHC principles into an operational reality The Sasakawa Health Prize for 1997awarded to the Mongar Health systems research and development Policy develop- ment and restructuring of national health systems Organlmtlon and Management of Hlth Systems Based on PHC 29 I health services development proiect reflects the importance accorded to PHC. The Government's plan of action in Bangladesh has emphasized the need to strengthen the national capabilities at all levels in programme planning, management and monitoring, laying particular emphasis on decentralized planning and programme implementation. In Bhutan, the Government has revised its health care policy and strategies while preparing its Eighth Five-Year Plan 11997-2002)The revised policies call for reorganizing the health care structures by replacing the oldsh/le dispensaries with basic health unifs and upgrading selected busic health units to hospitals. India, with support from WHOand theworld Bank, has launched the state health systems projects in Andhra Pradesh, Karnataka, Puniab and West Bengal. This initiative aims at streng~henin~ the capacities of the state governments for strategic planning and analysis, enhancing their inputs for PHC, improving referral systems, mobilizing resources through usersharges and raising community awareness through interaction with the Ponchoyoti roj (village-level) institutions. Strengthening of national capabilities in programme development and management, including district health systems, has become a maior focus of DPR Korea's detailed plan of action for the current biennium. The fiveyear plan of Indonesia [Repelita VII), which is due to commence in early 1999, emphasizes the need to improve human resources for health in all types of health facilities, both in the private and public sectors. The emphasis in Maldives' long-term health plan is on integrating ,he centrallyoperated public health programmes into the regional hospital and Atoll health systems. Myanmar's new National Health Plan (199620011 emphasizes the need for further strengthening of health education and prevention of diseases and their effective cure through the PHC approach. In Nepal, the Government's decentralization of a development package consisting of resources, technical support, authority and responsibilities to the village development committees IVDCs) in 20 selected districts, with UNDP's financial support, is an important landmark in operationalizing the PHC principles Sri Lanka's perspective plan for health development (1994-20001 emphasizes the need to develop a cluster hospital 30 ma Work of WHO In SEA system and a programme on public investment in the health sector /1995-19991 The Eighth FiveYear National Health Plan of Thailand aims to improve access to health care; promote an integrated approach to planning and provision of health care; encourage increased participation of the people in tackling their health problems, and bring about more flexibility in the olanning and implementation of health services relevant to local needs As a follow-up of the technical discussions on alternative financing of health care, held during the 48th session of the Regional Committee in 1995, on intercountry consultation on Health Financing Reforms was organized in Bangkok in October 1 995 in collaboration with the WH3 Collaborating Centre for Health Economics, Chulalongkorn University. Protocols for evaluating studies on health financing reforms were developed at this meeting. Technical support was provided to Member States in organizing in~country training courses, seminars and workshops and conducting research studies in health economics. In Nepal, a WHO mission was fielded during September 1996 to provide technical assistance in the review, revision and augmentation of the issues related to public/privote mix, to be addressed in the Second Long-term Health Plan. A study was supported in Sri lanko on the assessment of the prospects of setting up paying wards in government hospitals as a complementary financing source The Centre for Health Economics in Bangkok has been actively involved in training and research in health economics Through this collaborating centre, WHO provided support to Bangladesh ond Maldives in undertaking training initiatives and evolving health care financing mechanisms. The intercountry collaborative programme on strengthening local care and distr~ct health systems (DtIS) has resulted in the development of practical guidelines and training modules that are adaptable to country-specific situations for operationalizing the PHC principles in the management of DHS. The process has also generated active participation of national teams in developing these training modules. Health economics, resource allocation and financing strategies District health systems Organization and Management of Hlth Systems Based on PHC 31 Nine Member States participated in the intercountry training workshop on Strengthening the Organization and Management of District Health Systems based on PHC, held in New Delhi in 1996 Using theguidelines and training modules developed at this workshop, Member States are implementing the activities identified for developing model districts - two in each country In Bangladesh, national and district-level intersectoral workshops, along with the health awareness workshops for community leaders and women's groups, were held and two districts were added for strengthening the district health system. Bhutan successfully implemented the inservice training on planning and management of DHS by integrating it wtth other related troining programmes. A training manual on strengthening the organization and management of district health systems based on PHC was developed in India based on the prevailing situation in the community health centres in two states - Uttar Pradesh and Madhya Prodesh. The programme in lndonesia focused on improving the management and quality of health care at all DHS levels. These activities have brought about better cooperation and coordinot~on between different units and directorates, The country collaborative programme in Myanmar led to the expansion of access to health care at the community level with the training of 922 new community health workers from 16 states. It also improved the quality of care at rural health centres by providing training and health care kits In order to improve access to referral services in remote areas, the collaborative programme in Nepal has led to the establishment of a 'mobile medical campus' on a regular basis. In Sri Lonka, orientation workshops on PHC-based DHS, along with training of community-based health volunteers, were conducted. WHOorgonized an intercountry troining workshop on Quality Assurance in Health Care at Surabaya, lndonesia, in December 1996 in which 28 participants from nine countries took part. SEAR0 is follow~ng up on the recommendations of the meeting to ensure that quality assurance is incorporated into the health care systems of all Member States Several countries in the Region are gradually introducing quality assurance programmes in hospital care. In lndonesia, standards 32 The Work of WHO In SEA related to medical and nursing care for hospitals were formulated and a ioint commission for hospital accreditation was established; 10 hospitals have already been accredited. A post-intervention assessment recorded marked improvements in the quality of hospital care. In Nepal, an inspection and quality control section was established in the Ministly of Health for improving the quality of health care. In Sri Lanka, the application of 32 national standards for hospital care grouped under five maior areas - intensive care, operation theatre, maternity care, paedialric care and general sanitation - was being promoted. In Thailand, the Health System Research lnstitute has been given the responsibility of introducing quality assurance in the national hospital system. An innovative seven-week international practical training programme on PHC at district level was launched for the first time, with WHO support, during the reporting period The Asian Institute of Healtli Development, Thailand, the National lnstitute of Health Sciences, Sri lanka, ond the Centre for Education and Training for Heolth Personnel, Indonesia, collaborated in this unique initiative. Three rounds of training have already been completed, and the fourth round would be conducted in the last quarter of 1997. Officials from other WHO regions are also participating in the course to enhance their skills in this area. Organhtlon and Management of Hlth Systems Based on PHC 33 Human resources for healfh Some of the main regional initiatives in the ore0 of human resources for health (HUH) were aimed at supporting the formulahon of an HUH policy and improving the content and process of underyroduate and postgraduate medical education and training. Promot~ng closer linkages between medical education and health services, use of associations in the reorientation strategy and supporting institutions which toke the lead in the desired educot~onol reforms were some of the other steps taken to improve HUH An intercountry project to develop and field-test a set ot relevant and practical indicators for health personnel was initiated. This pilot study, which examines the crucial oreos of productivity, accessibility, working conditions, motivation and the quality of was being conducted in Bhuton, Indonesia, Myanmar, Nepal ond Sri Lanka . Most of the Member States utilized the HRH management modules produced by WHO The South~East AsIan Regional Conference on Medical Education, held in February 1996 in Thailand, reviewed the state of medicol education in the Region. Banylodesh, Nepal, Sri Lanka and Thailand held follow-up meetings to discuss and 34 The Work of WHO in SEA disseminate the main outcomes and decisions of the regional conference A regional project to promote innovative strategies in medical and nursing education and to develop six centres of excellence in the Region was initiated. WHO encouraged the strengthening of national systems of postgraduate medical education, and facilitated the exchange of science and technology between the more developed countries, both within and outside the Region. In order to support policy development and appropriate planning of HRH, the Regional Office launched a number of intercountrj research studies. These included a study of the profile of the general practitioner in the 2ist century; analysis of policies affecting the geographical balance of human resources for health, inquirydlriven strategies for changing medical educotion, and assessing the social accountability of medical schools. WHOassisted Bhutan in the formulation of o Health and Medical Council Act which provides the basis for long term humon resources development In Bangladesh, Indonesia, Nepal and Sri Lanka, effective and mutually-supportive partnerships have been established with the UN and bilateral donor agencies In the countries where master plans for human resources had been developed, the roles and responsibilities of the paromedicols were formulated and their position within the health system delineated in each case Wti0 technical support was provided to the Royal lnstitute of Health Sciences, Bhutan, the lnstitute of Medicine and the Centre for Technical and Vocational Training, both in Nepal, the Poramed~cal Training Institute, Myanmar. the lnstitute of Health Sciences, Maldives, the Nation01 lnstitute of Health Sciences, Sri Lanka, and the Centres for Health Manpower Development, Indonesia. All these institutes have undertaken activities aimed mainly at improving the quality of their paramedical training programmes. An intercountry consultotion on Strategic Planning for Nursing/Midwifery Development in SEAR countries was held in Bangkok in October 1995 Participants identified future directions Human Resources for Health 35 for nursing/midwifey and specific strategies in eight key areas to achieve the desired outcome over the next 5-10 vears. Support was provided to expand educational opportunities for the advanced training of nurses. A prime example at the country level is the off-shore Master's Programme in Nursing Science being implemented in Myanmar in collaboration with the Universiiy of Adelaide, Australia. A Master's programme in nursing os well as a basic BSc nursing programme were also established in Nepal, while a post-basic BSc nursing course was being developed in Sri Lanka. Based on the assessed training needs, three regional troin~ng programmes were developed in India, Sri Lanka and Thailand. These were: community health nursing, critical care nursing (jointly offered by two centres in two countries1 and midwifery educat~on for safe motherhood. These training centres will also tacilitote development of educational innovations. An intercounty consultation on Collaboration between Nurslng Services and Education for Improving the Quality of Nursing Core and Education was held in Yangon, Myanmar, in October 1996 as a follow-up of the regional consultation on the same subject held in 1992. This meeting critically reviewed the findings of a multi-centre study as well as other country-level experiences in collaborative activities. Based on its outcome, guidelines were being developed to promote collaboration between nursing services and nursing education in SEAR countries. Midwifery training modules developed by WHO/HQ and field-tested in SEAR and other regions were being ~romoted for use in Member States. In addition, standards of midwifery practice for safe motherhood were being developed to improve and ensure the quality of midwifery services. A regional consultation was held at SEAR0 in October-November 1996 to review the standards being developed for their relevance in the countries of the Region. These standards were being fieldtested for their applicability and in Bhutan, Indonesia, Nepal and Thailand 36 The Work of WHO In SEA Member States in the Region continued to utilize the WHOfellowships programme for the development of human resources for health. During the reporhng period, the Regional Office received 1515 applications out of which 1057 fellowships were awarded. Table 2 shows the distribution of the fellowsh~ps awarded by sublect ond country. Table 2 O,sh~bu~ion of fellowships by subtecr of study and coun1ry of or,gin of feliows 11 July 1995 30 June 19971 The trend for short-term fellowships and study tours continued during the period under review Table 3 gives the details of the total number of fellowsh~~ applications received, including those processed, from each country of the Region. Table 3 Total ,,umber of feiiowsh~~ applications by duiorioo 1 I lulv 1995 30 Iune 19971 Country / <3 1 Per 13-6 1 hr 16-121 Par 1 >12 1 hr ITofolI months cent months cent monthr cent monthr cent DPR Korea 46 lndio 465 lndonerlo 33 Moldiver 17 Myonrnor I86 Nepal 213 Sr, Lanko 172 Thollond 33 I I lndonesia 1s the only country in the Reglon which is using a ; major part of the WHO country budget for incountry undergraduate 1 and postgraduate training On the other hand, some Member States : such as Bhutan, Maldives and Nepal have started using the contractual services agreement [CSA) mechanism for long~term training within the Region with a view to economizing on the cost, thereby training a larger number of persons. Thailand started implementing extraregional study tours using the CSA mechan~sm These are cost-effective and innovalive approaches to meet the training obiectives Bangladesh Bhutan Training programmes were arranged by the Reg~onal Office for 392 fellows from other WHO regions {AFRO. EMRO and WPRO1 at appropriate institutions in India, lndonesia, Sri lanka and Thailand. In keeping with a decision of the Executive Board, WHO/HQ hod developed a fellowships evaluation tool with the obiective of providing countries with an instrument to improve the selection process and to ensure that the fields of study were related to the stated natlonal health priorities as also to support countries n complying w~th policies, specially in the area of utilization. The evaluation tool wos 38 The Work of WHO In SEA 146 26 733 72 2 15 1 76 28 33 3 166 83 5 6 25 167 IW 30 field-tested in Sri Lanka and the results were presented at the regional consultation on Fellowships Policy and Evaluation held in August 1996 The consultation olso considered the evaluation reports of the WHO fellowships in the Region for the three bienniums, 19FO-1991, 1992- 1993 and 19941 995. The recommendations of the Consultation are being implemented to further strengthen the fellowships programme in the Member States. During the period under review, 97 meetings/group educational octivities were held. These were policy, advisory and technical meetings, covering such subiects as health legislation, applied research methodology, control of drug-resistant malaria, drinking-water quality surveillance, vaccine-preventable diseases, safe motherhood, multi-professional education and hospital waste management. Table 4 shows the distribution of participants in intercountry group educational octivities by type of activity. Gmup educational activities Tw d odlvi* Reglono rneellngi Woikrhops Canrullat~ve rneetrngs Short tralnlng courser Tot01 Human Resourws for Health 30 Numb 14 29 50 4 97 Number d participontr 295 484 950 121 I 850 Action programme on essential drugs All Member Stotes in the Region have projects under the Drug Action Programme (DAP] which is also known as the Action Progromme on Essential Drugs The guidelines for developing national drug pol~cies, published by WHOin 1988, were updated. In October 1995, the Government of Australia, in collaboration with WHO, convened on international conference in Sydney to exchange experiences in developing and implementing national medicinal drug policies in Asia and the Pocific regions. Participation by about 300 persons from almost 50 countries sewed to highltght the importance accorded to the development of national drug policies. Components of drug policy such as drug registration and regulatory control, selection and supply of drugs, pharmoceuticol quality assurance, rational drug use, economic strategies for drugs, monitoring ond evaluation of national drug policies, humon resources development and technical cooperation among countries were also further developed and strengthened in accordance with nation01 priorities. In November 1996, a meeting of the WHO/St'ARO Working Group on Drug Financing was convened in Tha~land to identify and improve financial mechonisms to promote equity tn the access to essential drugs at different levels of health care Drug regulatory administrations, espec~ally for India, Moldives Myanmar, Nepal and Sri Lanka, were strengthened with technical The Work of WHO In SEA support as well as supplies and equipment. National essential drugs lists have been revised. In March 1996, the first national list of essential drugs for India was formulated. Bangladesh and Nepal were assisted in developing their own reference substances. Indonesia was assisted in the preparation of a notional formulary for over-the-counter drugs The development and publication of the Delhi State Essential Drugs Formulary in Morch 1997 was supported. Bhutan, Maldives and Myanmar were assisted in the developrnent of standard treatment guidelines. The ASEAN technical cooperation in pharmaceuticals has entered its fifth phase, which extends from 1997 to 2001 The cumulative products of Phase IV (1992~19961 became evident in 1996 with the publication by lndonesia of the ASEPN Good Manufacturing Practices Guidelines (Third edition), 36 herbal monographs compiled in the Standard of ASEN Herbal Medicines [Volume I, and the development of 40 herbaria Thailand coordinated in the production of 27 ASEAN reference substances Sixty-five persons were trained through ASEAN courses and WHO fellowships. The bi~regonal technical cooperation in essential drugs began in 1996 with the aim of improving collaboration between theASEAN countries and those of the South~East Asia Region. While the ASEAN countries will be assisted to further develop their own programmes with assistance from WHO, they, in turn, will be involved in the development of programmes on quality assurance of drugs in other countries Procurement of drugs, biologicals and contraceptives is a necessary component of many WHOprogrammes. Pharmaceutical raw materials and finished formulations worth about US$] 5 million were supplied to meet the emergency situation following floods in DPR Korea In Myonmar, drugs for the treatment of malaria and tuberculos~s as well as contraceptives were supplied; in Bangladesh, essential drugs were provided for the Fourth Population and Health Project, while in Nepal, drugs for the treotrnent of tuberculosis were supplied using funds from the Norwegian aid agency, NORAD Procurement of drugs, biologicals and contraceptives Esl~ntlal Drugs 41 I Some Member States continued to use the WHO channel of ; procurement to meet their requirement of HIV test kits. These included i India. Maldives and Sri Lanka. Bangladesh, Maldives and Nepal ; utilized the WHO reimbursable scheme for procurement of vaccines. ! A survey of manufacturers within the Region led to increased local purchase of essential drugs. 42 me Work of WHO In 813 There has been a growing awareness in the countries of the Region of the utility of health care laboratories in clinical diagnosis and epidemiological surveillance. Support was provided to Member States for establishing internal quality control as an integral part of laboratoiy service, organizing external quality assessment and creating facilities for the diagnosis of emerging and re-emerging diseases WHO supported Member States in establishing quality assurance systems through group educational activities and consultant visits to further strengthen quality assurance in laboratory medicine. In the area of blood safety, national staff were trained through group educational activities and fellowships. In order to improve the efficiency of laboratories in blood transfusion centres, quality assurance programmes in HIV testing were supported through the International External Quality Assessment Scheme Guidelines for preventing HIV, hepatitis B virus and other infections at health care senings have been. developed far use in developing countries. Support to Bangladesh and Myanmar was provided for drawing up national policies for blood safety Qualm of Can and Health Technology Technology for health care Drugs and biologicals, quality, safety and efficacy WHO cont~nued to collaborate with more than 90 institutions in the Region to promote the quality of radiodiagnostic, therapeutic and protection services. To ensure uniformity in technology, especially at the peripheral and intermediate levels of health care delivery systems, and to provide updated information, guidelines on health laboratory services in support of primary health care, quality assurance in bacteriology and strengthening blood transfusion services were prepared and distributed. WHO has been collaborating with Member States to improve national capabilities for quality control of drugs and biologicals. In support of these endeavours, national drug quality control laboratories in Calcutta [India), Jakarta [Indonesia) and Nanthaburi [Thailand) have been designated as WHOcollaborating centres for quality assurance of essential drugs. The production of biologicals was assisted in Banglodesh ond Myanmar. The Institute of Public Health, Dhaka, has been coricentrating on improving the production and quality of tetanus toxoid, while production of DPT vaccine and snake venom antisero was being pursued. The Myanmar Pharmaceutical Factory was assisted in the production of tissue culture rabies vaccine, tetanus vaccine and snake venom ontisera. Strengthening of notional drug quality control Iaborotories hos been the mainstay of WHOsupport to Member Slates. In Bangladesh, in addition to the regular support being provided by WHO, the national laboratoty is being further strengthened through a component of the Fourth Population and Health Project funded by the World Bank. In India, many items of equipment were provided to the central drug testing laboratories in Mumbai and Chennoi. In Nepal, the Royal Drugs Research Laboratory was assisted by providing WHO fellowships to its staff for study in quality control of pharmoceuticols and standardization of reference substonces. Equipment for conducting pharmacological, microbiological and toxicological tests at the Laboratory was also provided. In Thailand, consultant support was given for analysis of drugs. 44 me Work of WHO in SEA Departments of food and drug administration (FDA1 have been established in Myanmar and Nepal, while lndia and Sri Lanka are in the process of reviewing the FDAs of other countries which may lead to the restructuring of their existing regulatory systems. Technical assistance was provided to Myanmar to enable the country to strengthen the system of registration of drugs A workshop on Good Laboratory Proct~ces was supported in Nepal India was supported in its study of the Food and Drug Administration of the United States and the Therapeutic Goods Administration of Australia. A proposal to establish a Drug Regulatory Authority in Sri Lanka was formulated with technical support from WHO Three Member States in the Region, I e. lndia, Indonesia and Thailand, are producing pharmaceutical raw materials as well as flnished products for export Application of the WHO Certification Scheme on the quality of pharmaceutical products moving in international commerce is now becoming more relevant as the importing countries are requesting certificates on pharmaceutical products as recommended under the Scheme The Regional Office is providing Information on the Scheme, especially to manufacturers in lndia, in order to ensure the quality of pharmaceutical products In Myanmar, WHO assisted in a study to assess the situation with regard to counterfelt drugs To improve the good manufacturing practices IGMP) inspection in Member States, an expert from Indonesia was assigned to review GMP inspection procedures and provide on-site training to national staff n Bangladesh, Myanmar, Nepal and Sri Lanka An interregional strategic planning meeting comprising staff of the Action Programme on Essentiol Drugs [DAPI,WHO/HQ, and that of the six WHO regional offices was convened in Geneva in October 1996. A major objective of the meeting was to review and revise the draft DAP Strategic Plan for 1996-2001 One of the topics discussed was traditional medicine (TRM) At the regional level, a study tour to Inda and China on quallty assurance of herbal medicines was organized in May 1997 in which one participant each from Bangladesh, Indonesia, Myanmar, Traditional medicine Quallty of Care and Health Technology 45 Nepal and Sri Lanka and one each from six countries of the Western Pacific Region took part. The three WHOcollaborating centres on TRM, located atJomnogar and Varanasi in India and Pyongyang in DPR Korea, were involved in the training of WHO fellows in Ayurveda and Korean traditional medicine In Bangladesh, WHO support focused on the strengthentng of the Government Unani and Ayurvedic Degree College in order to enhance the capabilities of its teachers and its laboraton/ and teaching facilities. In Bhutan, the TRM situation was reviewed and a medium-term plan for its development wos prepored The traditional systems of medicine being practised in India such as Ayurveda, Siddha and Unani were supported through o revision of the teaching curricula and strengthening of pharmacopoeial standards and laborotories DPR Korea was assisted in improving the quality of Korean traditional medicine services through training of staff of the General Hospital of Koryo Medicine in TRM, including acupuncture. In Myanmar, production of traditional medicines wos improved, while research work in the screening of aflatoxin and toxicological studies for safety of TRM was supported. Nepal was assisted in the production of manuals and guidelines for rational use of A~urvedic drugs prepored from medicinal plants. In Sri Lanko, TRM was assisted through upgrading of Ayurvedic dispensaries to A~urvedic centres for providing integrated health care. Production of Ayu~edic drugs ond integration of TRM into PHC were also supported. 46 The Work of WHO In SEA

Over the lost decade there has been o marked improvement in child survival and a significant reduction in infant mortality rates in most countries of the Region. The maternal mortality ratios [WAR) have, however, registered a very slow decline and remain high in most countries, except DPR Korea, Sri Lanka and Thailand. Bangladesh, India, Indonesia, Myanmar and Nepal have developed national reproductive health [RHI strategies, utilizing the framework of the regional strategy developed by SEAR0 through national workshops. While there hove been country-specific approaches and adaptations, all countries have agreed on the priority areas of safe motherhood, family planning, HIV/STD, reproductive tract infections (Rilsl, prevention of infertility and adolescent reproductive health These have been included in their essential reproductive health care packages. As maternal mortality still remains very high in most countries of the Region, WHO'S inputs have been directed towards activities aimed at reducing the ~'vVIR In Bangladesh, WHO support was Reproductive health Raproductlve, Famlly and Comm. Hlth and Population Issues 47 provided for the formulation of a detoiled implementation plan for the national moternal care and safe motherhood programme. Five doctors from Bangladesh received six-month training in essential obstetric care in Nepal. Bhutan, with technic01 support from WHO, identified priority RH interventions at the community, basic health unit, regional and national levels. In DPR Korea, WHO executed a UNFPA-funded project on strengthening of FP/MCH services. As a result, doctors were trained in intrauterine device [IUD) and sterilization techniques while national and provincial-level workers received training in MCH. In India, support was provided to state-level workshops on the target-free approach In Indonesia, WHO support was provided mainly to activities aimed at reducing maternal mortality, which included development of innovative mechanisms for operationalizing safe motherhood and an assessment of the MCH local area monitoring system in West Java and South Sulawesi. In Maldives, WHO assistance was given for strengthening the MCH and safe motherhood programmes. Accordingly, a comparative study of home-based maternal records in Seenu and Ha0 Dhoal regions was carried out Other activities in the country included workshops for trainers in ARI, Atoll team problem-solving exercises and training of other workers in MCH, all of which resulted in \I significant acceleration of the safe motherhood programme. In Myanmar, WHO support was provided to develop training moter~ols contoining wider concepts of reproductive health, including birth-spacing ond adolescent health. Maternal rnortality was treated as a priority problem in Nepal where WHO support was given mainly to strengthen the safe motherhood programme. In Sri Lanka, WHO'S catalytic support was provided to improve the quality of family health services and improve the management of MCH programmes at the periphery, targeted mainly at preventing neonatal tetanus and reducing perinatal morbidity and mortality. WHO support was also provided to organize troining in programme management information system for peripheral-level health workers In Thailand, WHO support was provided for a notional moternoi mortality survey. The Regional Office convened a scientific working group on Operational Research in Reproductive Health which identified priority The Work of WHO In SEA ?s aimed : .' --* h..... 1t improvin ""A ",.;,A,.. rrogrammt the health 6, rq,vtt,r,D L, r,,U,ro3 are receiving the highest priority in the Region. While a significant reduction in infant mortality rates has been recorded in most countries, maternal mortality still remains high. While country specific approaches are being followed, programmes covering safe motherhood, family planning, HIVISTD, reproductive tract infections and adolescent reproductive health are receiving increasing attention. Health volunteers are playing a vital role in informat~on dissemination and community mobilization to promote the health of the people.The prime focus 1s on women and children who are the main providers and receivers of health care. areas for operational research and recommended ways of promoting and strengthening research. One priority area identified was development of models for the delivery of integrated RH selvices. The Regional Office has developed a prototype protocol for country-specific adaptation and development of countryspecific models In addition to WHO, there are a number of maior donors (e.g. UNFPA, UNICEF, the World Bank and the Asian Development Bank] and bilateral agencies which ore supporting the RH programme at the country level However, high maternal mortality and reproductive disease burden still prevail in most countries of the Region. The weakest link in the RH programmes is inadequate supervision and monitoring which results in poor quality of care These areas need improvement Child health programmes in most countries of the Region include elements such as EPI, control of diorrhowl diseases (CDDI, acute respiratory infections (ARI), nutrition programmes including growth monitoring, vitamin A and iodine supplementation and promotion of breast-feeding Other child health~related programmes such as child labour and issues of street children are being implemented at country level through the involvement of NGOs, departments of labour, UNICEF and WHO Though considerable progress has been mode at country level to reduce infant and under~five mortality, there is still need to develop comprehensive strategies to tackle vorious issues involved in child health as well os in overall child development. Most countries in the Region have recognized the chang~ng patterns of adolescent lifestyles and the need for paying greater attention to adolescent health. Adolescent health programmes have been operational in India, Indonesia, Myanmar, Sri lanka and Thailand WHO support was provided mainly for the development of training and IEC materials Child health Adolescent health Reproductive. Family and Comm. Hlth and Population Issues 49 Women's health and conducting in-country as well as regional training programmes WHO assisted in organizing a workshop for the development and production of a resource manualcum-teachers' guide on adolescent health for use by teachers and National Setvice Scheme INSS) and National Cadet Corps [NCC) officers in India. The health of adolescents has been established as a priority in the nation01 health plan of Myanmar where action-cum-research on adolescent reproductive health has also been initiated. WHO fellowships were granted to four doctors in Sri lank0 to study the adolescent health programme in Singopore. Support was also provided for the development of a model book on odolescent health as well as to conduct a school-based drug prevalence study. The Technical Consultation on Adolescent Health, held in SEARO in October 1995, finalized protocols for situational onolysis of the status of adolescent health as well as for the development of models for odolescent reproductive health service delivev. Studies on situational analysis, commissioned in Bangladesh, Indonesia, Myanmar and Thailand, were nearing completion An intervention study on adolescent reproductive health was started in Tebet Health Centre in Indonesia. A study group on adolescent health, convened by UNICFF, WHO and UNFPA in 1996, recommended a common agenda and framework wh~ch may be used as a guide for formulat~ng progrommes for adolescent health in the Reg~on The concept of women's health gained international consensus aher the Internotional Conference on Population and Development held in Cairo in 1994. The WHO intercountry meeting on Development of Regional Strategies on Reproductive Health, held in SEARO in November 1995, recommended inclusion of sexuality, gender information, education and counselling in family planning, RTI/STD/lnfertility as well as adolescent health programmes at each level of core. The meeting also recommended inclusion of gender training and tra~ning to provide necessary manogerial skills appropriate for each level of care among health workers, with special focus on a womencentered approach in such programmes. 50 me Work of WHO ln SE* The number of the elderly is increasing rapidly in most countries of the Region. The effects of this increase are compounded by the fact that a much higher proportion of the elderly in the Region report health problems than their counterparts in industrialized countries do. This points to the substantial health needs of the elderly which need to be addressed appropriately. A WHO consultant reviewed the status of the programmes for the care of the elderly in several countries of the Region and made recommendations for their strengthening and expansion. WHO also participated in a consultation organized by ESCAP on Lifelong Preparot~on for Old Age in Asia and the Pacific where programmes for soc~al and economic support to the elderly were reviewed and appropriate recommendations were made WHOsupported the Collaborating Centre for Health of the Elderly in Pyongyang, DPR Korea, through a consultant to assist in its innovative research on the measurement of biological aging processes. The primary oim of the Special Programme of Research, Development and Research Trarning in Humon Reproduction IHRP) is to improve reproductive health. In the area of research on reproductive health, India, Nepal, Sri lanka and Thailand maintained a high level of collaboration with the Special Programme despite financial constraints. The HRP Committee on Resources for Research lCRRl met in India in October 1995 and in Fiji in October 1996 It reviewed and approved several long-term nstitutionoi development grants for selected institutions in Bangladesh, India, Indonesia, Myanmar, Nepal, Sri Lanko and Thailand In 1996, an evaluation was conducted of the impact of the HRP programme on strengthening research capabilities in Asia and the Pacific region with regard to reproductive health and translation of research into actlon. Another Important activity undertaken in 1996 was the holding of a series of regional workshops on ethical issues In reproductive health In addition, several workshops, symposiums and scientific meetings were held in the Region in such areas os reproductive health ep~demiology, human reproduction research methodology, assurance of oral and injectable contraceptives, Aging and health Special Programme of Research, Development and Research Training in Human Reproduction Reproductive. Famlly and Comm. Hlth and Population Issues 51 health data management, communications and social science in human reproduction. An international symposium was held in New Delhi in November 1995 on the present and future status of male contraception, which set up a work agenda in this area. Myanmar was supported in conducting an assessment of the contraceptive methods used in the national birth-spacing programme. Important research projects such as a multicentre casecontrol study on the relation between prostate cancer and vasectomy in Nepal and mole fertility regulation through testosterone buciclate iniections in Indonesia were supported. WHO supported an international symposium on occupational health research and practical approaches in small-scale industries in August 1995 at Pattaya, Thailand. The symposium identified moior forms of occupational hazards and their impact and possible inte~ention strategies and approaches. An international revolving seminor for training of trainers in ergonomics was also organized in Thoiland The meeting of the Regional Advisory Committee on Health Research, held in Nepal in April 1996, reviewed workers' health in relation to strengthening of research activities. A project aimed at improving the working environment through information and education of employers and employees was implemented in three selected factories in Bangladesh. A workshop for the development of intervention strategies for occupational health and safety was also being planned in the country. In Indonesia, efforts were continued for the networking of four provincial occupational health centres and operationalization of occupational health posts by producing educational materials for workers in small-scale industries. With WHO'S support, training courses in occupational health and safety were conducted for different categories of PtK-level health personnel in Myanmar and Sri Lanka. WHO also supported studies on lead poisoning in cottage industries in Myanmar 52 me Work of WHO in SEA WHO has continued to advocate extension of the concept of mental health care and psychiatry into the wider concept of public mental health As o consequence, the need to develop new technologies has been obvious. The Schizophrenia Research Foundation (SCARF] in Chennai, India, has been designated as the WHO Collaborating Centre for Research and Training in Mental Health. This centre has developed an instrument, based on extensive ethnographic work, to quantify the perceived burden on home care-givers of chronic psychotic potlents An innovative approach lo reduce family violence due to inebriation has been developed in Sri Lonka by an NGO wiih support from WHO Also, with WHO support, ethnographic work has been carried out in Indonesia to understand ihe motivational panerns in streetgong violence in Jakarta, leading io more effective rehabilitation techniques A training workshop on health behav~our research methodology was held in Yangon, Myanmar. The Regional Office prepared substantial reading and background material which can be used in similar training workshops in other countries of the Region. Mental health Healthy Eehavlour and Mental Health 53 Substance abuse including alcohol and tobacco The Indian Council of Medical Research, New Delhi, developed indicators for the quality of community life, based on the protocol developed earlier in a WHO intercountry workshop on Research for Mental Health Programmes. The result is on ethnography-based instrument to quantify feelings people have about their communities or neighbourhoods. This instrument can now be used in programmes which aim to increase community participation in an activity or in other communitybased proiects. Advances have been mode in some countries of the Region, especially lndia and Sri Lanko, in the development of community-based programmes of demand reduction of illicit drugs, In Sri Lanko, the National Dangerous Drugs Control Board compared the results of a communityariented outreach research work with drug users with the results obtained from clinic-based detoxification efforts The superiority of the former approach was so obvious that the Boord decided to transform the three existing detoxificotion centres into centres for community activities. The second phase of the UNKP-supported drug abuse control project in Sri Lanko ended in December 1995. The Regional Office assisted the notional authorities in drahing a document for the third phase of the proiect Technical support was provided to a network of NGOs to effect the agreed standards of drug services, including harm minimization These services included help in problems related to alcohol and opium use in rural areas as well as heroin use in urban areas Unlike alcohol control, anti-tobacco activities received increased attention in most countries of the Region where advocacy and public education on control measures took a positive turn. Focal points for tobacco control were appointed, and, in some countries, national committees were set up to study the relevant issues ond other problems. Notional seminars and conferences on tobacco were organized in two countries providing a forum for review and replanning. Legislative acts and executive instructions banning tobacco smoking in places were in Delhi, lndia, where the sale of cigarettes to people below 19 years of age is also prohibited. India, Indonesia and Thailand banned smoking on all 54 The Work of WHO In SEA domestic and some international flights. Advertisements promoting smoking have been banned in Sri Lanka and in the National Capital Territory of Delhi. Maldives has declared two islands as tobaccdree. The health education infrastructure has been decentralized in some countries to the communi'y level, with health volunteers playing a critical role in inforrnat~on dissemination and community mobilization. Health education services have been extended to a large number of schools, communities, hospitals, and, in some cases, to workplaces. These services focus on areas such as maternal and child health. immunization, cornrnun~cable diseases and noncommunicable diseases such as HIV/AIDS, cancer, cardiovascular diseases, hypertension and thalossemia. A series of in-service training programmes for various categories of health and health-related personnel such as primary health care workers, health devotees [as they are known in Myanmar) and doctors were organized at the community level Major strides were made towards the implementation of comprehensive school health education programmes School curricular reviews in Indonesia, Maldives, Sri Lanko and Thailand gave adequate recognition to subjects such as drugs, alcohol, counselling, sex-related problems, thalassemia, tobacco and life-skills. Deworming and nutrition supplement programmes have taken centrestage in the efforts to improve the health status of the school-going child in India and Maldives Information on WHO collaborative activities was provided to a number of organizations, individuals, health educators and other health personnel. The media was kept posted with WHO policies and strateg~es and specific activities Production and dissemination of informat~on materials were continued The regional newsletter, HFA 2000, was issued regularly during the reporting period. A fact file on Dominant Communicable Diseases in South-East Asia, a video on Bridging the Gaps - WHO in the South-East Asia Region, and regional versions of the World Health Report were and Health promotion Communications and public relations Healthy Behavlour and Mental Health 55 Rehabilitation distributed. World Health Day, World No-Tobacco Day and World AIDS Day were observed throughout the Region. They assumed i added importance with the active participation of NGOs, the mass 1 medio and educational institutions. The timely distribution of WH3 press releases and other information material, in addition to press briefings, concretized further the links with the medio. Recruitment of national consultants for communication and public relations, coupled with the training of local journolists, contributed significantly to increased, bolanced and fair reporting on health issues. The media seminar held in Indonesia in June 1997 was most timely, held as it was lust before the Fourth International Conference on Health Promotion. Strategies for proactive actions to make health intormation more accessible to Member States and for o wider network of interactive media are being developed. WHO continued to promote the concept of communitybosed rehabilitation [CBR) in the Region. A bi-regional troining workshop on Management of Rehabilitation Programmes was organized jointly by WPRO and SEAR0 in October 1996 in Ciloto, lndonesio, which focused on strengthening the managerial skills in developing and implementing CBR programmes in the two regions. A regional workshop on Strengthening CBR Progrommes as on Integral Part of Primary Health Care wos held in New Delhi in December 1996. It recommended some country ond region01 action points for sustainabilih/ and expansion of programme activities as well as for incorporation of rehabilitation components into existing health systems. Support wos provided to Bangladesh and Bhutan for translating the WHO manual on CBR into local languages. India ond Myanmar took up re-translation and/or reprinting of the manuol. In Bhutan, a national CBR programme was established as o priority programme of national health development. Technical support was provided to Sri Lanka for reviewing the feasibility of local production of lowzost artificial limbs and holding 56 The Work of WHO In SEA training programmes on CBR for health workers and volunteers. A training worksheet on CBR for provincial health personnel was produced in Indonesia, while seminars and conferences dealing with various aspects of disabilities were supported in India. A study was conduc~ed in Thailand on Alternatives for Community-based Rehabilitation Model, while the CBR programme was expanded in the country's northern provinces. Healthy Bahavlour and Mental Health 57 Nutrition WHOsupport was directed towards improving the quality of national programmes aimed at addressing the priority areas of protein-energy malnutrition (PEM] and micronutrient deficiencies such as iodine deficiency disorders, vitamin A deficiency and iron deficiency anaemia in women and children. A regional workshop on National Plans of Action for Nutr~tion was held at the Regional Office in November 1995. Nine countres developed their plans of action to reach the goals set at the International Conference on Nutrition [ICN) by the year 2000 An intercountry workshop on iron deficiency anaemia [IDA], held in Thailand in December 1995, emphasized the importance of IDA and a regional plan of action was developed for its prevention and control. The fourth meeting of the South-East Asia Nutrition Researchsum-Act~on Nehvork, held in Indonesia in June 1996, identified three themes for multicentric studies to be initiated in 1997 These studies related to social marketing for IDD intervention, feasibility of iron supplementation and incorporation of micronutrient-rich foods in household meals. A regional consultation on Elim~nation of Iodine Deficiency Disorders was held at SEAR0 in February 1997 which 58 The Work of WHO In SEA I ne prevention and control of iodine deficiency disorders. protein-energy malnutrition and iron deficiency anaemia are included in the national plans of action of most countries in the Region. Early detection and merits of these action plans. ion of safe water supply and xiate sanitation facilities are ...- ... ain focus of environmental health programmes in the Region. While there have been marked improvements in water supply to most urban and rural areas, sanitation and sewage di! facilities remain inadequate. Comprehensive school health education programmes, including deworming and nutrition supplements, are being introduced and strengthened in the countries to help improve the health status of school-gotng children. In some countries, schoolchildren are also mobilized to work as volunteers in special campaigns. The importance of health care laboratories for timely diagnosis and epidemiological surveillance is well recognized. The emphasis now is on improving quality control mechanisms and the efficiency of laboratoriesinthe Region. rev~ewed the progress made in universal salt iodization and reduction of the prevalence of IDD in the Region A train~ng workshop on Developing Applied Food and Nutrition Proiects was held in Thailand in May 1997 as a follow-up of the Jokorta meeting in order to facilitate implementation of identified priority action research. In addit~on to regional consultations and national workshops, support was provided to Member States for reviewing country programmes, undertaking IDD prevalence studies and tracking progress in the elimination of IDD Organizing training in laboratory-based quality control for iodized salt at manufacturer and consumer levels, implementing notional plans of action for nutrition, evaluating deworming progrommes in relation to nutrition status, preparing proposals for household food security studies and planning food safety programmes were also supported Assistance to countries in developing their food safety programmes was focused on reviewing existing progrommes and identiking priority areas of action for legislation, training, su~eillance and other institutional aspects. Maldives, Myanmar and Nepal received WHO assistance through short-term consultants. India received support in the form of laboratory equipment. Activities in Bangladesh included a series of food safety orientation workshops for civil surgeons, administrators and municipal health officials Some of the other areas that were supported covered strategy development for food safety prioritization in Indonesia, development of legislation on safety measures for food and meat imported into Maldives and a review of the newly-enacted food and drug administtation legislation in Myanmar. Technical assistance was provided to DPR Korea for the development of analytic01 techniques for detecting microbial and chemical food contamination and to Thailand for studies on aflotox~ns. Food salety Nutrition. Food Securlty and Safety 59 Water supply and sanitation in human settlements The focus of WHO support to countries concentrated on two moln areas - drinking-water quality surveillance ond operation and mainlenance of water supply facilities. A regional consultation on Drinking-Water Quality Surveillance and Control was held n Kathmandu, Nepal, in September 1996 in which most countries of the Region participated. Follow-up activities are in progress in Bangladesh, India, Indonesia, Maldives, Nepal and Thailand Support was provided for a meeting of the Water Supply and Sanitation Collaborative Council Working Group on Operation and Maintenance which was held in New Delhi in September 1996 This was followed by a national-level meeting of representatives of Indian states and union territories from both rural and urban sectors. It provided an endorsement of the need for greater emphasis by governments on the operation and maintenance of water supply and sanitation facilities. Field surveys of potential groundwater resources for water supply in Myanmar, a study of the financing of urban water supplies in lndia and monitoring studies of sonitot~on technologies in Bangladesh received WHO support Short-term troining and study tours in the reuse and recycling of wastewater, salt-water for toilet flushing and wostewotei management were organized for officials from Bangladesh, India, Mald~ves, Myanmar and Sri Lanko. Postgraduate training in sanitov engineering 60 Tha Work of WHO in SEA was supported for candidates from Bangladesh, Myanmar, Nepal and Sri Lanka. Training in better planning and management of water supply and sanitotion was supported in Bangladesh. Support was being extended for MIS development ond strengthening in Bangladesh and Myanmar. Short~term consultants were assigned to Maldives for the development of regulotory instruments to oversee the privatized water supply in Male and to Myonmor for the management of hospital wastes. Assignment of national consultants on R&D and human resources development wos supported in lndia. Considerable support was provided, both under the intercountry and country programmes, to Bangladesh and lndia to enable them to meet the emergency resulting from arsenic-contaminated water supplies in their border oreas. Short~term consultants were fielded to advise both countries on suitable approaches to be odopted for the identification and appropriate treatment of affected populations and for making alternative arrangements for water supply. A consultation on Arsenic in Drinking Water and Resulting Arsenic Toxicity, held in SEAR0 In April 1997, helped to develop a common framework of action that both countries will im~lement. Promotion of the Healthy Cities approach, which represents the main activity under this programme, was first started in Chittagong, Bangladesh, and extended to Kothmondu and Bangkok. Pamphlets eloboroting the twenv steps to a Healthy City were prepared and disseminated to Member States, along with other promotional material. Support in the form of short-term consultants, national consultants, office supplies and publications was extended to the communities which had already initiated the process of Healthy Cities as well as to those about to start it in Bangladesh, India, Myanmar, Nepal and Sri Lanka. In Sri Lanka, the concept of Healthy Cities was applied not only to urban centres but also to two villages which proved to be a successful model for possible replication. The World Health Day theme for 1996, Healthy Cities for Better Life, gave a timely fillip to the movemenl. Support was provided to the orgonization of the International Conference on Healthy Cities in lndia. Environmental health in urban development Environmental Health 61 Assessment of environmental health hazards Promotion of chemical safety This programme area focuses on developing national capacities and capabilities to assess and manage health hazards as a result of environmental pollution. In Indonesia, support was provided to develop the capacity of district and municipal environmental health staff to carry out comprehensive monitoring of environmental quality as well as in the development of a manual on planning, implementation and evaluation In Myanmar, assistance was provided to train a national officer in undertaking environmental assessment and management and in procuring laboratory and data-processing equipment. In Nepal, studies on hazardous and infectious wastes management and on cottage industries waste management were completed In Sri Lanka, assistance was provided to the Central Environmental Authority to develop its air quality monitoring system A draft regional document on technical gu~dance on air quality monitoring was prepared A regional consultation on Sound Management of Hospital Wastes was held in Tha~land in November 1996. A document entitled Action Plan for Development of National Programmes for Sound Management of Hospital Wastes was published. WHOj collaborative support to Member States has been directed towards building national capacities and capabilities for applying health-risk assessments, strengthening information on toxic chemicals, improving the management of chemicals as well as treating and preventing poisoning from chemicals. In Bangladesh, India, Indonesia and Sri Lanka, intersectoral briefing sessions and awareness-building meetings on chemical safety issues were held to plan for the International Programme on Chemical Safety training courses Support was provided to undertake research on the health effects of air pollution in Delhi and for a workshop on promoting the prevention of poisonings in India. In Indonesia, WHOassisted in the strengthening and development of the national poisons information network linking the Centre with districts. A survey to inventorize and register imported hazardous substances as well as local chemical products and radioactive substances was completed In order to assess the status of chemlcal safety In the Reglon wlth a vlew to strengthening nallonal chem~cal safety programmes the Reg~onol Office lnitlated the preparation of natlonal chemlcal profiles in six countries, three of which were completed. Studies on chemical emergency preparedness and response were completed in India, Sri lanka and Thailand. These studies revealed the need to strengthen or develop national chemical emergency measures within the context of emergency preparedness and response plans. An assessment of chemical safev programmes in selected countries was undertaken in December 1996 for drahing a regional action plan for the promotion of chemical safety To facilitate access to information on chemicals, CDROM packages on poisonings informotion management (INTOXI and environmental health criteria (INCHEM] were supplied to Member States Since the time the UN Conference on Environment and Development, held in 1992, produced Agenda 21 for environmentally-sound and sustainable development, the focus of this programme area has been to mobilize the health sector to advocate the incorporation of health issues and concerns into the policies of other sectors that are involved in planning and implementing national development activities. Through the Wt I0 Heolth-and~tnvironment IH&El Initiatives, Member States have been assisted in identifying and assessing health hazards and related issues in such sectors as environment, housing, public works, ogriculture and industries. Bosed on these intersectoral assessments under the H&t Initiatives, notional action plans were developed incorporating health-and-environment strategies in all development sectors In Bangladesh, two intersectoral meetings reviewed the national situational analysis of H&E issues and finalized an action plan on areas of priority concern In Bhutan, a report on the H&E situation was prepared. In Indonesia, support was provided to working groups involved in preparing the national Agenda 2 1 In Maldives, a s~tuational review was conducted in an intersectoral meeting that identified key Issues which were subsequently addressed in a national action plan In Myanmar, an intersectoral consultation was held to identify prority H&E actions for incorporation into the national Agenda 21. The Nepal Environmental Health Initiative, prepared in 1993, was updated for incorporation into the National Environmental Policy Incorporation of health concerns into environmental management Environmental Health 63 and Action. In Sri Lanka, a situational analysis was completed and a national action plan to address critical environmental concerns was prepared as an input to the national Agenda 21. In Thailand, the national situational analysis report was reviewed at an intersectoral meeting that generated a consensus on collaborative efforts in environmental planning, resourcesharing and capacity-building 64 The Work of WHO In SEA

India is the only country in the Region where guineoworm disease Dracunculiasis is present WHO played o crucial role in the establishment of the (Guineaworm notional guineaworm erodicotion progromme IGWEPI and helped in developing and updating on operational manual. Technical and disease) financial support was provided for conducting meetings of the GWEP task force and in evaluations. The deployment of epidemiological su~eillonce teams in endemic states to monitor the programme activities and help district/PHC authorities in effective implementation of various operational components was also supported. In 1996, WHO supported workshops on establishing the criteria for the certification of guineowoim eradication; during 1996, oniy nine coses of guineoworm disease were reported, and it is expected that India will achieve zero incidence in 1997 The estimated number of leprosy coses in the Region decllned from 5.5 million in 1985 to 0 83 mill~on in 1996 while the registered coses decreased from 3 8 million to 0.63 million during the same period. The programme has been integrated into basic health seivices EradbatlonlEiimlnstlon of S~eclfic Communicable Diseases 65 Poliomyelitis in all countries, except in lndia where a vertical programme continues to be in operation in the endemic states and districts WHO supported training activities for leprosy health workers in Bangladesh, India, Indonesia, Myanmar and Nepal in various aspects of leprosy control, management techniques and prevention of disabilities. In Bangladesh where the programme is funded by the World &Ink, WHO has been assisting in !he planning, supervision and monitoring activities as well as in the training of health workers. In 1994, Sri Lanka and Thailand had achieved the goal of leprosy elimination (1 case per 10 000 populationl; it is expected that three other countries - Bhutan, Indonesia and Maldives - will achieve the goal by end 1W7/early 1998. Since 1995, Special Action Projects for Elimination of Leprosy (SAPEL) to provide service in difficult, isolated areas have been launched in several SEAR countries such as Bangladesh, India, Indonesia and Myanmar, to be followed by Nepal The leprosy elimination campoigns (LECs), which have been carried out since 1996 in Indonesia, Myanmar and Nepal, ore part of the notional campoigns with a timebound activity schedule for three months. These LEC activities will be extended to Bangladesh and lndia as well lo accelerate the elimination work. In order to improve implemen~ation, health system research in leprosy as well as research in some other aspects of the programme was carried out in lndia and Myanmar with WHO support. A WHO collaborating centre for this purpose was established in early 1997, in Chenno~, India. in collaboration with the Indian Council of Medical Research. Polio eradication is one of the priority programmes in the Reg~on. Improving cross-border coordination of polio eradication activities hos received, and will continue to receive, maximum support. In December 1996 and January 1997, intra- and inter-regional coordination led to the synchronized organization of national immunization days (NlDs] in eight countries of the South-East Asia, Eastern Mediterranean and Western Pacific regions. More than 40 66 lha work of WHO in SEA Many countries in the Region are strengthening their chemical safety programmes with support from WHO. These are primarily aimed at disseminating information on proper use of toxic chemicals in agriculture and industry and in preventing poisoning from toxic substances. There has been a steady decline in the number of leprosy cases in the Region, raising hopes of achieving the goal of elimination by the year 2000. Increased application of MDT in the endemic areas and vigorous public awareness campaigns have contributed significantly in this regard. Sustained efforts are, however, required, considering that the Region still accounts for over 70 percent of the registered cases in the world. Strengthening of immunization services in the Region has resulted in coverage rates of 80 per cent or higher against EPI target diseases. The most remarkable achievement was the organization of synchronized national immunization days in the South- East Asia and ne~ghbouring WHO 1 ; regions.This resulted in more than : 40 per cent of the world's children aged less than 5 years receiving , oral polio vaccine in campaigns conducted in December 1996 and January 1997. 1; per cent of the world's children aged less than five years received oral polio vaccine [OPV) in campaigns conducted during December 1996Januory 1997 In lndia alone, more than 2 5 million health workers and volunteers manned 650000 immunization posts While 1 1 16 polio cases were reported in the Region in 1996, which represent opprox~mately half the cases reported globally, only 101 cases were reported from countries other than lndia. Despite estimates that only 10-30 per cent of the global polio cases are reported, these data highlight the vital importonce of polio eradication in lndio to achieve the global torget by the year 2000 Training In WK)approved standard methods for poliovirus isolation and characterization has been provlded to personnel from all the national and regional reference laboratories in the Region. In order to galvanize financial support for sustaining NlDs and strengthening acute flaccid paralysis [AFP] and other vaccine preventable disease surveillance programmes, an interugency coordinating committee has been established at the regional level. Inter-agency coordinating committees have also been established at the notional level in Bangladesh, lndio, Indonesia, Myanmar, Nepal and Sr Lanka Five countries - Bhutan, DPR Korea, Maldives, Sri Lanka and Thailand - have attained the target of elimination of neonatal tetanus, ie. less than one case per 1000 live births In 1996, all countries of the Region conducted district-wise reviews of the achievements of neonatal tetanus INTI elimination programmes according to the WHOrecommended methodology. Surveys in lndia and Indonesia showed that many NT cases admitted to hospito were not routinely reported and that many cases did not report to a health care facilih/. The reported regional coverage with TT2t in pregnant women was 68 per cent. The Regional Office will continue to encourage countries to implement the High Risk Approach for neonatal tetanus. During 1996, Indonesia implemented the High Risk Approach, and it is expected that, in 1997, Bangladesh, India, Myanmar and Neonatal tetanus EradlcatlotvEllmlnatlon of Specific Comrnunlcable Dlseases 67 Measles Nepal will also prepare plans of actlon and implement the Hlgh R~sk Approach By the end of 1995, the Member Stales in the Region, except lnd~o and Nepal, had achieved and maintained a level of more than 80 per cent coverage of measles vaccination in children aged under one year. However, in 1996, the meosles coverage at the district levei was still not being monitored adequately, resulting in uneven coverage levels within countries, with pockets of unimmunized children 11 is estimated that less than one per cenl of measles coses occurring in the Region ore being reported. The number of reported cases decreased from 45 1 190 in 1989 10 84 5 I2 at the end of 1995 However, all Member States have foci of susceptible populations and large meosles outbreaks were reported during 1996. In 1996, the countries were grouped in three calegor~es according to the current status of measles controi programmes, and priority octivities for each group were identified. The countries ore preporing long-term plans of action for the control and elininallon of meosles. 88 The Work of WHO In SEA The past decade has been notable for the successful establishment of rouhne immunzation services in the Member States, resulting in the achievement of high coveroge rates against the EPI target diseases. Activities relating to control of diphtheria, pertussis and childhood tuberculosis are receiving increased attention. For all EPI antigens, Member States hove generally achieved and sustained coveroge at 80 per cent or higher With the stabilization of population coverage rates, increased emphass is being given to methods of identification of the remaining ioc of susceptible children: the 15-20 per cent of the population that has not yet been reached. In addition to the tradit~onol monitoring of vaccine supply and quality and coveroge rates, reg~onal and national EPI managers are working to strengthen the existing methods of surveillance in order to identify the susceptible population subgroups Childhood immunization with hepatitis 8 has been introduced In Bhutan, Indonesia, Maldives and Thailand, and selectively in some states in India While many countries in the Region are producing some tPi vaccines, India, Indonesia and Thailand have achieved a sustainable level of supply of quality vaccines Vaccine preventable Iseases d' Control of Other Communicable Diseases 69 Diarrhoea1 and acute respiratory disease control While Bhuton, DPR Korea, Indonesia, Mald~ves and Thailand have introduced HE vaccine in EPI, DPR Korea, lndonesia and Myanmar are producing plasmaderived HB vaccine, lndio and Thailand are planning to produce recombinant and plasmoderived HB vaccine, respectively. Bangladesh, Bhutan, lndia and Nepal have revised the technical guidelines for acute respiratory infections IARl). The control efforts are being progressively integrated into the child survival programme for communicable diseases control in lndia, lndonesia, Myanmar and Nepal. In other countries, the programme has initiated efforts to combine the ARI and control of diarrhoea1 diseases (CDDI programmes in accordance with national policies. After completing the training of notional ARI programme managers, the emphasis has shifted to district and provinciol-level programme chiefs. WHO supported the organization of ARI troining courses in Bongladesh, Bhutan, lndonesio and Nepal. An intercountn/ troining course for the training of trainers from prominent NGOs of Bangladesh, India, lndonesia and Nepal was organized in Pokhra. Nepal. The training material was refined on the basis of exchange of experiences at this meeting and translated and used for training trainers and community health workers in six states in lndia. In addition, training of trainers was supported by WHO in Bangladesh. India, Indonesia, Maldives, Nepal, Sri Lonka and Thailand. The ARI standard case management has been introduced in the training of auxiliaries in Bhuton, and in a medical school in Nepal In Thailand, the curriculum for the training of nurses was revised, while changes in the curriculum of undergraduate medical students were being introduced. The Region's first combined ARI/CDD curricula development workshop was held for selected nursing training schools in lndonesia. Bacterial drug resistance studies were completed in Thailand and similar studies were proposed to be initiated in Bangladesh in collaboration with the Shishu Hospital and the International Centre 70 he Work of WW In SEA for Diarrhoea1 Disease Research, Dhaka. Studies on indoor oir pollution were in progress in Nepal. Preparation 01 the first integrated training pockage on the management of childhood illnesses was completed Th~s course teaches doctors and senior heolth workers the skills needed for more accurate identification of ~llness in outpatient settings, ensures appropriate combined treatment of all maior illnesses and speeds up referral of severely-ill children. Substantial progress has been made on the WHO/UNICEF Initiative on Integrated Management of Childhood Illnesses Indonesia and Nepal have been selected as "early use" countries in the Region. Three representatives from lndones~a and Nepal were trained in the first clinical course for consultants in Addis Ababa, Ethiopia, in 1995, and two more were trained in Moy 1996. Districts where the integrated initiative will be implemented have been selected in both countries and the WHO material has been adapted and revised for their use The burden of tuberculosis in the Region is immense. Of the new cases reported globaliy in 1995, 42 per cent occurred in South-East Asia Two countries (Sri Lanka and Thailand] carried out joint reviews of the~r national tuberculosis programmesiNTPs] with WHOassistance. This has led to the development of revised NTPs with higher national prioriiy and to increased resources and donor assistance for their financing. All countries have rnanuals/guidelines lor TB control based on the Directly Observed Treatment, Short Course [DOTS) and have prepared fiveyeor plans WHO continued to provide intensified technical support to the World Bank-funded tuberculosis programme in Bangladesh which successfully implemented the revised strategy in almost 70 per cent of the country. In India, WHO provided technical assistance in the preparation of the World Bank proiect document and in monitoring the pilot proiect sites WHO successfully mobilized resources from several external donors for national TB programmes. These included Integrated management of sick child initiative Tuberculosis Control of Other Communicable Diseases 71 Emerging infectious diseases including cholera and other epidemic diarrhoeas, zoonoses and antimicrobial resistance DANIDA (Bhutan); SIDA, DANIDA and the British Overseas Development Agency (India]; the Australian lnternational Development Assistance Bureau (lndonesio]; Japan lnternational Cooperation Agency - JICA, NORAD and the British ODA (Nepal) and JICA /Sri Lanko] A workshop was held in June 1996 to stress the importonce of advocacy in the battle against tuberculosis and to develop guidelines and strotegies for TB advocacy for the Region An intercountry workshop was held in Indonesia in September 1996 to assist NTP managers develop advocacy strategies. In November 1995 a workshop was conducted in Nepal to train regional resource personnel from Member States to help strengthen NTPs in their respective countries as well as to provide consultancy service to others. The first Regional Tuberculosis Training Course was held at the National Tuberculosis Centre, Kathmandu, Nepal, in April 1997. In the ore0 of research, WHO is technically and financially supporting some operational research studies in Bangladesh, India, Nepal and Thailand. The last-named three courtries are taking port in the WHO global project on anti-tuberculosis drug resistance surveillance studies. An intercountry meeting on new, emerging and reemerging infectious diseases, held ot SEAR0 in August 1995, identified strategies ond approaches for effective control of these diseases. It recommended a review and strengthening of the epidemiologicol services and surveillance systems in order to develop rapid response mechanisms. The implementation of these recommendations was reviewed at on intercountry symposium in June 1996. A stand-by rapid response team has been formed at StARO A list of experts has been drawn up and some quantrties ot diagnostic reagents and other necessary supplies to meet emergency situat~ons have been procured and kept at the Region01 Office. Rapid response teams have also been formed in the countries of the Region which could be mobilized at short notice to assist in outbreak investigation and control within or outside the country 72 The Work of WHO In SEA The International F~eld Ep~demiology Training Course 11 2-weeks durat~on), was conducted by the Nattonal Institute of Communicable Diseases [NICD) Delh~, in October 1996 WHO supported the course and ass~sted in the development of its curriculum In order to improve the quality of disease surveillance in the Member Stotes, a consultohon on Case Definitions for the Surveillance of Communicable Diseases with Epidemic Potential was held in Colombo, Sri Lanka, in May 1997 Cholera, caused by the El Tor strain, has been reported from all the countries of the Region, except DPR Korea. Case management under the well-established nat~onal CDD programmes has resulted in reduced cholera case fatality rates to below one per cent from the earlier 1020 per cent. A new strain, Vcholerae 0139, was first reported in October 1992 from o large outbreak in Chennai, lndia The new strain, which almost completely replaced the 01 El Tor strain in 1993. disappeared from the Region in 19951996 However, during 1997, sporadic cases of cholera associated with the 01 39 strain were reported. The reasons of its emergence require further analysis and studies During 1995.1990, WHO provided financ~al support to the National Institute of Cholero and Enteric Diseases in lndia to produce, in sufficient quantities, the 01 39 antiserum to identiby the new strain The antiserum wos distributed by the Regional Office to all the cholero~prone countries in the Region and also to other WHO regions Zoonot~c diseases such as rabies, anthrax, leptospirosis, toxoplasmosis, cysticercosis and plague account for a relatively high amount of morbidity and mortality in the countries of the Region. During the reporting period, technical assistance was provided to national workshops on rabies control in lndia, Indonesia, Nepal and Sri Lanka. Technical information and recommendations for the development of guidelines on national rabies control were provided to Bangladesh. WHOsupported the quality testing of tissue culturederived rabies vacclne produced by the Pasteur Institute, Coonoor, lndia. Cholera Zoonoser Control 01 Other Communicable Diseases 73 Potential emerging dimses Antimitmbial resistante During 1995,WHO supported the training of six lnd~an nationals in laboratoly diagnosis and production of diagnostic reagents of plague at the WHO Collaborating Centre at CDC, Fort Collins, USA. Starting May 1996, the Haffkine Institute, Mumbai, India, has commenced producing plague diagnostic reagents which are used for rodent serosurveillance (predictive surveillance1 of plague in India A training workshop on laboratoly diagnosis and surveillance of plague was held in March 1996 at Yogyakarta, lndonesia, with participants from lndonesia, Myanmar, Nepal, Sri Lanka and Thailand. Technical assistonce was provided to lndonesia for preparing a research proposal on the development of cost-effective plague serosurveillance Activities to conduct predictive surveillance were also supported in Myanmar and Thailand. WHO provided technical information and d~ognost~c reogents for leptospirosis and brucellosis to Member States on request. Technical support was provided to the International Conference on Anthrax held in March 1997 in Kathmandu, Nepal. The Regional Office provided informotion to the Member States regarding o new variant of Creutzfeldtjakob Disease ICJD), ond initiated a proposal for establishing a surveillance mechanism in the Region. In additiori to the problems connected with current infectious diseases in the Region, there are ~otential problems associated with an increase in the number of drug-resistant bacterial and parasitic diseases and the emergence of new viral infections. The potential emerging infections in the Region are Hanta virus, yellow fever and Ebola-like haernorrhogic fever, a new variant of Creutzfeldt-Jakob Disease [CJD] and Ecoli 01 57. WHO provided technical information and recommendations regarding the prevenlion and control of these potential emerging diseases. Top priority has been accorded to study the emergence of drug resistance in pathogens and to disseminate information on un~forrn laboratory techniques ond data analysis methodology. Ten laboratories have been identified in the Region as part of the gonococcal antimicrobial susceptibility programme (GASPI with a view to monitoring, preventing and treating drug-resistant gonorrhoea which otherwise is facilitating HIVtransmission. The network of ten laboratories under GASP is supported by two regional laboratories in lndia and 74 The Work d WHO in SEA Thalland and one internot~onal laboratory in Australia for Imparting training and providing reference material A followup tralning workshop on the standardized methodology for monitoring drug resistance in Neisseria gonorrhoeae was held in Tha~land in January 1997 to strengthen the network A regional consultative meeting on Prevention and Control of Dengue/DHF, held in October 1995, reviewed the current situation and developed a revised strategy and plan of action for implementation at national and regional levels. A special consultative meeting on Management of Dengue Epidemic was organized in November 1996 at the Regional Office where recommendations for the management of dengue epidemic were developed It was decided to mod16 the Dengue Newsletter and publish 11 in an enlarged form, covering more aspects of the dengue problem Since December 1996 the newsletter has been renamed as Dengue Bullehn and is planned to be published annually Reg~onal guidelines for the prevention and control of DEN/DHF were being developed which would be finallzed in November 1997 The most Important progress in the Region has been the develop- ment of o tetravalent live attenuated dengue vaccine at Mahidol Univers~v, Bangkok, Thailand, with technical and financial support from WHO This voccine, produced by Pasteur Marieux, is undergoing Phase I and Phase il trials. WHO will also technically support the Phase Ill triols of this vaccine This is the first time a developing country has successfully developed a vaccine for human use. WHO supported the establishment of hepatitis B control programmes in the countries of the Region Hepatitis B vaccination under the framework of tPI was extended to more provinces in Indonesia, Maldives and Thaland Sri Lanka introduced vaccination for medical personnel in 1995 Ser~e~idemiological studies were carried out in Bangladesh and Bhutan. Hepatitis B vacc~nation within the framework of EPl was introduced by Bhutan in 1996 A demonstration proiect on hepatitis B immunization was started in New Delhi in October Viral hepatitis Control 01 Other Communicable Dtseases 75 Meningororral meningitis Japanese encephalitis 1996. Hepatitis B vaccine is produced rn DPR Korea and lndonesia. Myanmar has also developed hepatitis 6 vaccine and field trials are under way. Mandatory screening of blood and blood products is now being carried out in all countries of the Region, except Bangladesh and Nepal Compulsory screening of blood and blood products for the presence of hepatitis C virus (HCVtmarkers has been established in Thailand. Only a limited number of blood samples and blood products are screened for HCVmarkers in India, lndonesia and Sri Lanka. WHO supported the seroepidemiological studies of hepatitis C infection in some countries of the Region. Water-borne outbreaks of hepatitis E virus (HEVJ~,nfectionhave been reported in Bangladesh. Indonesia, Myanmar and Nepal This infection causes high mortality in pregnant women. WHO supported studies on experimental transmission of the infection in primates and on the molecular biology of HEV. The Organization also supported the procurement of necessary diagnostic reogents and provided technical backstopping for outbreak investigations in the countries of the Region. WHO provided information to Member States regarding the meningococcal meningitis situation in Africa, and urged special attention to the vaccination and active surveillance of pilgrims going to Mecca. WHO provided diagnostic kits to Bangladesh, Bhutan, Maldives, Myanmar and Nepal. National training courses for laboratory diagnosis, surveillance and prevention were supported by WHO in lndio, lndonesia and Myanmar. The human immunization strategy to control Japanese encephoiitrs UE) is used in India, Sri Lanka and Thailand. In the early 1990s. Thailand had ~ntroduced a mass vaccination campaign in 30 per cent of the endemic provinces, and, since 1996, this campaign has been extended to all rural areas. WHOprovided technical information to the endemic countries in the Region and helped in the procurement of JE vaccine 76 The Work d WHO in SEA

It. The malaria problem in the Region has been compounded with the spread of multidrug resistance. Surveillance activities, ~nclud~ng checklng of blood smears to detect P Falciparum, have been increased and strengthened in the countries to effectively deal with the ?", ,,+;,.. During the reporting period, STD/AIDS continued to spread in the Region. More emphasis is now being given to advocacy at country level and to extending the progromme to the communiv level. Various advocacy materials were produced/updated and distributed. These included a booklet titled AIDS. No Time for Complacency, a video entitled Facing the Challenge. AIDS in South-East Asia and o on khool AIDS Fducation, including a video film, a story book and o poster. A publication entihed NGOs and AIDS: Responding to the Expanding Epidemic was also produced In terms of the STD/AIDS prevention strategies implemented so far, the approaches involving targeted interventions and peer education among ind~viduals with high-risk behaviour were found to be useful The effectiveness of the 100 per cent condom-use programme in Thailand can be assessed by the declining incidence of HIV among military recruits from 3 6 per cent in 1993 to 2.1 per cent in 1995 The Sonagochi proiect in Calcutta, India, is another success story. The proiect, besides imparting peer educot~on, includes many other initiatives such as prov~sion of health care, literacy programmes for peer educators and schooling for the children of sex workers. The interventions among injecting drug users IIDUsl, including the needieexchange programme, were being implemented successfully in Nepal. In Myanmar, the IDUs have begun to modify their drug-iniecting behav~our as a result of the information, education and communication IlEC) programme initiated by the nation01 AlDS progromme. Various workshops and consultotions Initiated by the Regional Office focused on an integrated approach to STD control, monitoring of gonococcal ontimicrobial sensitivity and development of STD treatment guidelines In the area of HIV/AIDScare, a review of the care approaches was being conducted in Thailand which also included the role of religious leoders The purpose of this WH3supported initiative was to develop a model of continuum HIV/AIDS care which could subsequently be implemented throughout the country A similar programme was being implemented in Manipur, India. The Regional Office developed HIV/ADS Counselling A Module for Trainers which was made available to the Member States More than 10000 copies of the popular Regional Office booklet Understanding and AlDS and sexually transmitted diseases Control of Other Communlcable Dlseases 77 Control of tropical diseases Malaria livtng with AlDS were distributed for use by health care workers, NGOs and training institulions in the Region. A Handbook on AlDS Home Care was also produced and distributed widely. The Bamranaradura Infectious Diseases Hospital in Thailand has been designated as the WHO Collaborating Centre for training and research on AlDS clinical management and counselling. A quarterly newsleiier, AIDSwatch, is being produced since October 1996 and is accessible worldwide through the Internet. Moreover, to facilitate information exchange and sharing of experiences among Member States, the Regional Office convenes every year o meeting of national AlDS programme managers. One such meeting was held in Dhaka in November 1996 in collaboration with UNAIDS A SEARO/WPRO biregional meeting was held in October 1996 in New Delhi to discuss STD/AIDScontrol in border areas. Multidrug resistant malaria has been identified as a regional problem. In the South-East Asia Region, 3.42 million cases of malaria were reported in 1995 and 3.16 million in 1996. Foci of multidrug resistant malaria have been reported in border areos between Myanrnor, China, Laos and Thailand, indicating a shift from the usual epicentre on the border between Thailand and Cambodia. The incidence of malaria in the countries of the SEA Region during the last three years is given in Table 5 and Figures I and 2. Supported by WHO, a regional collaborative effort to control malaria at international borders was ini~iated by Bangladesh, Bhutan, India and Nepal. Border districts affected by malaria were identified and action plans were developed ioinhy by districts sharing international borders. Guidelines on managing malario outbreaks and a uniform format for reporting control activities have been developed for border districts. Technical support was provided to India and Indonesia in the~r negotiations for obtaining assistance from the World Bank and the Asian Development Bank, respectively, for malaria control programmes. Similar supporl was ~rovided to Bangladesh and Myanmar in their efforts to receive continued assistance from the World Bank and UNDP respectively. 78 Thm Work of WHO In SEA Table 5 Mularia prohie of Counhiei in South East Asfa Region Molorious positive^ Moloria deolhr Per cent Countv Ysor population' . Reported E~timotad IWO' (WO) 10001 ' Raportod Ertirnoted Rangiadertl I994 I01 500 I67 I 154'' 48 64 1 278 5 000 1995 103 500 153 1 389" 4967 1 393 5 WO 1996 103707 101 1250" 5380 794 4500 Madver 1994 239' Sr Lonko 1994 14 264' 273 275 17 18 50 100 I995 10 l/5 142 I50 1633 5 10 1996 10 328' 184 IVC 2439 I7 30 Tho~lc>nd 1994 40 831 102 200 55 89 900 950 1'495 40 291 83 I50 54 71 850 900 I996 40 724 88 150 52 56 870 SEAR 1994 1177461 3080 21812 3878 7444 39540 1995 1174473 3621 21470 4003 7171 31474 1996 1710054 3330 19143 4138 6424 29930 NOTES Figures for 1996 ore provisional Fgum n shoded are" ~elote lo Jovu and Boi ~nly = D~IIO no, ovatloble " = 10 lo 21 tmported coiei only ' M~dyeor eil~matei of people vrng n malor~oui region Co~nlry ertrnole Proleoled born last ywr Incomplete infoirnat~on Control of Other Cornmunlcable Dlseases Figure. Malaria Profile of Soulh-East Asia Region Laboratow-confirmed malaria cases lDDO Year Annual clinical malaria incidence in SEAR countries Per Thousand Populatan 140 120 rm ........................... ................................... m ............... .................. w ........................ ..................................... m 8*N BHU IND IN0 MMR NEP SRL THL ea *s3 e lppl m 1P85 In Mald~ves no ind~genoui case has been reporled since 1984 80 The Work Of WHO h SEA A workshop on Management of Severe and Complicated Malaria, supported by extrabudgetary funds from Japan International Cooperation Agency UICA), was conducted by SEAROand WHO/HQ in Yangon, Myanmar, in March 1997, in which officials from Indonesia, Myanmar and Sri Lonka participated. As a follow-up, the participants will conduct similar training for professional staff in ther respective countries uslng funds from the some source. As a first step n the reestablishment of the regional collaborative programme on Control of Drug-resistant Malaria, a workshop was organized iointly by the Regional Office and WHO/HQ in Anuradhapura, Sri lonka, in January 1997, with participants from Bangladesh, Bhutan, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand A stondord protocol for monitoring the therapeutic efficacy of antimalaria treotment was adopted at this meeting. Each country will initiate monitoring of treatment failure as a followup activiy. Visceral leishmaniosis [kalaazar) continues to be an important public health problem in rural areas bordering Bangladesh, India and Nepal, where opproximately 1 10 million people are at risk. To address this problem, WHO has advocated border collaboration between the three countries. WHO is supporting these countries in assessing the extent of the problem. Lymphatic i~lariosis is widespread in several countries of the Region and it is estimated that over 53 million people are affected with microfiloria and/or the disease, lndia alone accounting for 48 million. A datobase on f~loriasis has been established by WHO to strengthen the regtonal colloborotive programme on filariasis control. The Regionol Office provided technical support to all malarious countries in the Region in the following areas: 1 1) staff training and monitoring of malar~a vector resistance; 121 carrying out critical reviews of vector control activities; (3) assisting plans of vector control operations, and 14) searching for alternative vector control measures. An intercountry workshop on Plann~ng and Implementing Vector Control for Maloria was organized in 1996 in Bangalore, India, which developed policy guidelines for vector control. It recommended Disease vector control Control of Other Cornmunlcable Diseases 81 Special Programme for Research and Training in Tropical Diseases (TDR) strengthening of research in vector biology and control and the need to es~ablish firm partnerships with other sectors, including the private sector and NGOs, for effective and sustainable control of malaria and other disease vectors. The Vector Control Research Station at Salatiga, Indonesia, has been designated as the WHO Collaborating Centre for Pesticide Evaluation and Vector Control in April 1997 The regional monitoring system for vector resistonce to insecticides was further strengthened. The Regional Office supported the national dengue/dengue haemorrhagic fever control programmes in t Bangladesh, India, Indonesia, Myanmar, Sri Lanka and Thailand, using community vector control opprooches The TDR activities and research in the Region focused on leprosy and filoriasis in addition to malaria and leishmaniasis. Studies were sponsored on drug resistance and drug efficacy (Myanmar, Thailand\; malaria vaccines development (Indial; health financing of malaria programmes [Thailand); vector control strategies [Myanmar, Sri Lonka]; drug regimen compliance [Myonmarl, and the correlation between molar~a incidence and change in vegetation (Thailand). With regard to lymphatic filariasis, studies to test new drug regimens such as omocarzine, diethylcarbamozine and penicillin were conducted in India to develop new strategies for morbidity control. Additional studies to evaluate foot care were clso conducted in the country The economic affordability 01 filariasis control interventions was the subiect of several ongoing research prolects in lndia, and a workshop in this regard was conducted at the Vector Control Research Centre, Pondichery in March 1996 Recognizing the need for better drugs and diagnostic tests, regional studies on visceral leishmaniasis focused on immunotherapy (India), new drug regimens (India) and simple diagnostic tests for use under field conditions (Nepal/. A monkey model for visceral leishmaniasis was being investigated in lndia. In the area of strategic research, on agreement was signed in February 1997 between TDR and the National Science and Technology Development Agency, Thailand, to set up a joint venture for screening and developing new drugs against tropical diseases using molecular biology and combinatorial synthesis. 82 Th* Work oi WHO in SEA The malor focus of Wti0collabotation in the prevention of bl~ndness [PB~) conlinues to be the promotion of primary eye core using the PHC network, and control of avoidable blindness through restorative ~nterventions such as eye camps, outreach services and strengthening of referral facilities WHO provided support for conducting several workshops on primary eye care in Bangladesh and in developing o recording and reporting system for monrtoring the progress of PEL programmes ar the drstrict level in India. In Myanmar, a community-based eye restoration project was tormulated in Mandalay, and o model primary eye core proiect in Sintgoing was being extended to other arms Technical skills ond faci- lities for ophthalmological services were strengthened through fielding of a short-term consultant and provision of supplies and equipment. Wlth support from AGFUND, several countries in the Reg~on conducted ivorkshops to review the exrsting strategies for the prevention of blindness. The findings of these exercises were utilized at a regional workshop on the Assessment of National Progtarnrnes for Prevention of Blindness which was held in New Delhi. In addition, on in-depth evoluotion of the impact of the PBL programme on the status of eye heal~h was conducted in Nepal. As regards the prevention of deafness and hearing impairment, efforts were being mode to ascertain the magnitude and the etiological pattern oi the problem ~hrough a multicentric study in four selected countries of the Region With WHO'ssupport, the WHO Coilaboro~ing Centre for prevention of Deofness in Bangkok produced a manual on primory ear core for physiclons ond medico1 ossistonts working or the PiiC level WHO also provided support to Bangladesh, Myanmar, Nepal and Sri Lanko for training different categories of health workers in primary ear core With WHO support, Myanmar was oiso developing a lralning manual on ear core for stoff at the basic heolth services level Prevention of blindness and deafness Control ol Other Communicable Diseases 83 Control of non- communicable diseases Through its publication on national cancer control programmes, WHO has laid down the guidelines for planning cancer control programmes with o clear public health orientation. This has formed the basis for the formulation of comprehensive national cancer controi programmes in several countries of the Region, notably India and Indonesia. WHO has continued to advocate the importance of cancer care and pain control. Following an intercountry workshop held in the Regionol Office in 1995, WHO supported the initiation of the process of identifying demonstration areas for integrated control of major noncommunicable diseases, mainly cancer, cardiovascular diseases and diabetes. A common package of interventions was being introduced for various levels of heolth core, and preventive interventions were being developed focusing on common risk factors like tobacco and alcohoi use, dietary habits, exercise and blood pressure control. In India, these demonstration studies were conducted among the employees of certain enterprises and their families, while in Thailand these covered the entire population of a province. The oral health programme continued 10 focus on the prevention and control of the two most predominant oral conditions - cories ond periodontal diseases. Support was provided to Bangladesh for conducting school oral health programme using a communiiybased oral disease prevention strategy. Primary oral health projects, with 84 The Work of WHO In SEA the emphasis on the preventive and promotive aspects, were also implemented in selected areas in India and lndonesia. These proiects were supported by AGFUND A workshop on the effectiveness of various alternative technologies such as water fluoridat~on, fluoridated toothpaste, salt and milk was conducted in Indonesia With WtiO support, the primary oral health projects started in o few townships in Myanmar were extended to all the 12 townships as planned Training workshops were conducted in the project townships where information and educational materials for dental personnel as well as the general public were developed. In Sri Lanka, o workshop on the production of IEC materials on dental health for the Health Education Bureau and a training course on oral health education for dental surgeons were conducted w~th WHO support. The expanded field trials of the atraurnatic restorative technique, which were initiated in Chiong hi, Thailand, in collaboration with the WHOCollaborating Centre for Dental Health in the Netherlands, were nearing completion. This technique was introduced to dental experts in Indonesia and Myanmar ttirough WHOsponsored consultants from Thailand Control of Noncornrnunlcable Diseases 85 Section 6 Administrative Services The orgon~zot~oriol structure of the Regonol Off~ce as on 30 June 1997 is given as Annex There were 130 estobllshed Profess~onol posts in the South-East Asia Region on '30 June 1997 as compared to 149 on 30 june 1995 and 146 on 30 June 1096 The decreose in the number of posts was due molnly to the closing down of the Globol Programme on AIDS Toble 6 shows the number of posts n the Profess~onol cotegory in the Region, funded from all sources and the number actually fllled by long ierm stoff os of 30 June 1997 Toble 6. Number 01 pioleii~oool poils. by locor~ori oh oi .I0 June 1991 r Regional Posts ond Country intercountly Fs~ablished 69 6 1 Frozen I Filled by appanlmenl 56 49 To be led I? 12 Total 3 Personnel services and administration "Include one post i,lled by rhortierm rtaii lemporair~ hlnclude lour poils Illled by short term iloH remporarly Personnel 87 Of the 105 Professional staff as of 30 June 1991, 44 147 per cent) were nationals of the SEA Region. Out of the totol number of staff in position, 18 [I 7 per cent] were women. The Regional Office hos undertaken a study to identify the constroints in hiring and retaining more women on the staff of WHO During the perlod under revtew, 258 short-term stofi were hlred, of whom 145 I56 per cent) were nat~onals from the SEA Region Out of the totol number of short-term staff appointed, 68 (26 per cent) were women One post of National Professional Officer (NPO) was established in Bhutan under a trial arrangement agreed to by the Executive Board and in line with the Organization's policy to utilize notional expertise wherever possible Proposals have been made to establish seven more posts of NPOs in the Region 88 The Work 01 WHO In SEA The ~enovotion programme in the Reg~onal Offlce wos completed io \he Cofeteiio, the Conference Holl and its lobby, and the areas Additional renovotion work was continued to improve the aircondi\ioniny and electrical wiring infrostruclure. Some offices were remodelled to Increase the efiiciency of space utilizotion. Negoliotions with municipal authorities were in progress to obtain permission \o constrirci on add,t~onol office floor rn !he annexe, for which funding had earlier been obtained from the Real Estate Fund Administrative support to technical programmes Budget and finance The 19961997 biennium began with a 10 per cent reduction in the working allocahon under the WHO Regular budget, three-quarters of wh~ch was restored by WHO/HQ in early 1997 These funds were pooled at the reglonol level for use in the countries The implementation of WHO collaborative programmes in the Member States during the 1W1997 biennium focused on the timely delivery of quality technical programme. It is noteworthy that the SEA Region devotes 75 per cenl of its region01 allocation to country i programmes, which is the highest in the Organization I I Audit reviews highlighted the need for improved accountabilih/ i for local expenditures and for supplies and equipment. The Budget and Finance Unit continued to provide support to i I the budgetary control and management of all accounts under the Regular and extrabudgetary programmes in the Region. Organizational Structure Regional Directof I I 1 I FIELD PROGRAMMES

Over the lost decade there has been o marked improvement in child survival and a significant reduction in infant mortality rates in most countries of the Region. The maternal mortality ratios [WAR) have, however, registered a very slow decline and remain high in most countries, except DPR Korea, Sri Lanka and Thailand. Bangladesh, India, Indonesia, Myanmar and Nepal have developed national reproductive health [RHI strategies, utilizing the framework of the regional strategy developed by SEAR0 through national workshops. While there hove been country-specific approaches and adaptations, all countries have agreed on the priority areas of safe motherhood, family planning, HIV/STD, reproductive tract infections (Rilsl, prevention of infertility and adolescent reproductive health These have been included in their essential reproductive health care packages. As maternal mortality still remains very high in most countries of the Region, WHO'S inputs have been directed towards activities aimed at reducing the ~'vVIR In Bangladesh, WHO support was Reproductive health Raproductlve, Famlly and Comm. Hlth and Population Issues 47 provided for the formulation of a detoiled implementation plan for the national moternal care and safe motherhood programme. Five doctors from Bangladesh received six-month training in essential obstetric care in Nepal. Bhutan, with technic01 support from WHO, identified priority RH interventions at the community, basic health unit, regional and national levels. In DPR Korea, WHO executed a UNFPA-funded project on strengthening of FP/MCH services. As a result, doctors were trained in intrauterine device [IUD) and sterilization techniques while national and provincial-level workers received training in MCH. In India, support was provided to state-level workshops on the target-free approach In Indonesia, WHO support was provided mainly to activities aimed at reducing maternal mortality, which included development of innovative mechanisms for operationalizing safe motherhood and an assessment of the MCH local area monitoring system in West Java and South Sulawesi. In Maldives, WHO assistance was given for strengthening the MCH and safe motherhood programmes. Accordingly, a comparative study of home-based maternal records in Seenu and Ha0 Dhoal regions was carried out Other activities in the country included workshops for trainers in ARI, Atoll team problem-solving exercises and training of other workers in MCH, all of which resulted in \I significant acceleration of the safe motherhood programme. In Myanmar, WHO support was provided to develop training moter~ols contoining wider concepts of reproductive health, including birth-spacing ond adolescent health. Maternal rnortality was treated as a priority problem in Nepal where WHO support was given mainly to strengthen the safe motherhood programme. In Sri Lanka, WHO'S catalytic support was provided to improve the quality of family health services and improve the management of MCH programmes at the periphery, targeted mainly at preventing neonatal tetanus and reducing perinatal morbidity and mortality. WHO support was also provided to organize troining in programme management information system for peripheral-level health workers In Thailand, WHO support was provided for a notional moternoi mortality survey. The Regional Office convened a scientific working group on Operational Research in Reproductive Health which identified priority The Work of WHO In SEA ?s aimed : .' --* h..... 1t improvin ""A ",.;,A,.. rrogrammt the health 6, rq,vtt,r,D L, r,,U,ro3 are receiving the highest priority in the Region. While a significant reduction in infant mortality rates has been recorded in most countries, maternal mortality still remains high. While country specific approaches are being followed, programmes covering safe motherhood, family planning, HIVISTD, reproductive tract infections and adolescent reproductive health are receiving increasing attention. Health volunteers are playing a vital role in informat~on dissemination and community mobilization to promote the health of the people.The prime focus 1s on women and children who are the main providers and receivers of health care. areas for operational research and recommended ways of promoting and strengthening research. One priority area identified was development of models for the delivery of integrated RH selvices. The Regional Office has developed a prototype protocol for country-specific adaptation and development of countryspecific models In addition to WHO, there are a number of maior donors (e.g. UNFPA, UNICEF, the World Bank and the Asian Development Bank] and bilateral agencies which ore supporting the RH programme at the country level However, high maternal mortality and reproductive disease burden still prevail in most countries of the Region. The weakest link in the RH programmes is inadequate supervision and monitoring which results in poor quality of care These areas need improvement Child health programmes in most countries of the Region include elements such as EPI, control of diorrhowl diseases (CDDI, acute respiratory infections (ARI), nutrition programmes including growth monitoring, vitamin A and iodine supplementation and promotion of breast-feeding Other child health~related programmes such as child labour and issues of street children are being implemented at country level through the involvement of NGOs, departments of labour, UNICEF and WHO Though considerable progress has been mode at country level to reduce infant and under~five mortality, there is still need to develop comprehensive strategies to tackle vorious issues involved in child health as well os in overall child development. Most countries in the Region have recognized the chang~ng patterns of adolescent lifestyles and the need for paying greater attention to adolescent health. Adolescent health programmes have been operational in India, Indonesia, Myanmar, Sri lanka and Thailand WHO support was provided mainly for the development of training and IEC materials Child health Adolescent health Reproductive. Family and Comm. Hlth and Population Issues 49 Women's health and conducting in-country as well as regional training programmes WHO assisted in organizing a workshop for the development and production of a resource manualcum-teachers' guide on adolescent health for use by teachers and National Setvice Scheme INSS) and National Cadet Corps [NCC) officers in India. The health of adolescents has been established as a priority in the nation01 health plan of Myanmar where action-cum-research on adolescent reproductive health has also been initiated. WHO fellowships were granted to four doctors in Sri lank0 to study the adolescent health programme in Singopore. Support was also provided for the development of a model book on odolescent health as well as to conduct a school-based drug prevalence study. The Technical Consultation on Adolescent Health, held in SEARO in October 1995, finalized protocols for situational onolysis of the status of adolescent health as well as for the development of models for odolescent reproductive health service delivev. Studies on situational analysis, commissioned in Bangladesh, Indonesia, Myanmar and Thailand, were nearing completion An intervention study on adolescent reproductive health was started in Tebet Health Centre in Indonesia. A study group on adolescent health, convened by UNICFF, WHO and UNFPA in 1996, recommended a common agenda and framework wh~ch may be used as a guide for formulat~ng progrommes for adolescent health in the Reg~on The concept of women's health gained international consensus aher the Internotional Conference on Population and Development held in Cairo in 1994. The WHO intercountry meeting on Development of Regional Strategies on Reproductive Health, held in SEARO in November 1995, recommended inclusion of sexuality, gender information, education and counselling in family planning, RTI/STD/lnfertility as well as adolescent health programmes at each level of core. The meeting also recommended inclusion of gender training and tra~ning to provide necessary manogerial skills appropriate for each level of care among health workers, with special focus on a womencentered approach in such programmes. 50 me Work of WHO ln SE* The number of the elderly is increasing rapidly in most countries of the Region. The effects of this increase are compounded by the fact that a much higher proportion of the elderly in the Region report health problems than their counterparts in industrialized countries do. This points to the substantial health needs of the elderly which need to be addressed appropriately. A WHO consultant reviewed the status of the programmes for the care of the elderly in several countries of the Region and made recommendations for their strengthening and expansion. WHO also participated in a consultation organized by ESCAP on Lifelong Preparot~on for Old Age in Asia and the Pacific where programmes for soc~al and economic support to the elderly were reviewed and appropriate recommendations were made WHOsupported the Collaborating Centre for Health of the Elderly in Pyongyang, DPR Korea, through a consultant to assist in its innovative research on the measurement of biological aging processes. The primary oim of the Special Programme of Research, Development and Research Trarning in Humon Reproduction IHRP) is to improve reproductive health. In the area of research on reproductive health, India, Nepal, Sri lanka and Thailand maintained a high level of collaboration with the Special Programme despite financial constraints. The HRP Committee on Resources for Research lCRRl met in India in October 1995 and in Fiji in October 1996 It reviewed and approved several long-term nstitutionoi development grants for selected institutions in Bangladesh, India, Indonesia, Myanmar, Nepal, Sri Lanko and Thailand In 1996, an evaluation was conducted of the impact of the HRP programme on strengthening research capabilities in Asia and the Pacific region with regard to reproductive health and translation of research into actlon. Another Important activity undertaken in 1996 was the holding of a series of regional workshops on ethical issues In reproductive health In addition, several workshops, symposiums and scientific meetings were held in the Region in such areas os reproductive health ep~demiology, human reproduction research methodology, assurance of oral and injectable contraceptives, Aging and health Special Programme of Research, Development and Research Training in Human Reproduction Reproductive. Famlly and Comm. Hlth and Population Issues 51 health data management, communications and social science in human reproduction. An international symposium was held in New Delhi in November 1995 on the present and future status of male contraception, which set up a work agenda in this area. Myanmar was supported in conducting an assessment of the contraceptive methods used in the national birth-spacing programme. Important research projects such as a multicentre casecontrol study on the relation between prostate cancer and vasectomy in Nepal and mole fertility regulation through testosterone buciclate iniections in Indonesia were supported. WHO supported an international symposium on occupational health research and practical approaches in small-scale industries in August 1995 at Pattaya, Thailand. The symposium identified moior forms of occupational hazards and their impact and possible inte~ention strategies and approaches. An international revolving seminor for training of trainers in ergonomics was also organized in Thoiland The meeting of the Regional Advisory Committee on Health Research, held in Nepal in April 1996, reviewed workers' health in relation to strengthening of research activities. A project aimed at improving the working environment through information and education of employers and employees was implemented in three selected factories in Bangladesh. A workshop for the development of intervention strategies for occupational health and safety was also being planned in the country. In Indonesia, efforts were continued for the networking of four provincial occupational health centres and operationalization of occupational health posts by producing educational materials for workers in small-scale industries. With WHO'S support, training courses in occupational health and safety were conducted for different categories of PtK-level health personnel in Myanmar and Sri Lanka. WHO also supported studies on lead poisoning in cottage industries in Myanmar 52 me Work of WHO in SEA

There has been a growing awareness in the countries of the Region of the utility of health care laboratories in clinical diagnosis and epidemiological surveillance. Support was provided to Member States for establishing internal quality control as an integral part of laboratoiy service, organizing external quality assessment and creating facilities for the diagnosis of emerging and re-emerging diseases WHO supported Member States in establishing quality assurance systems through group educational activities and consultant visits to further strengthen quality assurance in laboratory medicine. In the area of blood safety, national staff were trained through group educational activities and fellowships. In order to improve the efficiency of laboratories in blood transfusion centres, quality assurance programmes in HIV testing were supported through the International External Quality Assessment Scheme Guidelines for preventing HIV, hepatitis B virus and other infections at health care senings have been. developed far use in developing countries. Support to Bangladesh and Myanmar was provided for drawing up national policies for blood safety Qualm of Can and Health Technology Technology for health care Drugs and biologicals, quality, safety and efficacy WHO cont~nued to collaborate with more than 90 institutions in the Region to promote the quality of radiodiagnostic, therapeutic and protection services. To ensure uniformity in technology, especially at the peripheral and intermediate levels of health care delivery systems, and to provide updated information, guidelines on health laboratory services in support of primary health care, quality assurance in bacteriology and strengthening blood transfusion services were prepared and distributed. WHO has been collaborating with Member States to improve national capabilities for quality control of drugs and biologicals. In support of these endeavours, national drug quality control laboratories in Calcutta [India), Jakarta [Indonesia) and Nanthaburi [Thailand) have been designated as WHOcollaborating centres for quality assurance of essential drugs. The production of biologicals was assisted in Banglodesh ond Myanmar. The Institute of Public Health, Dhaka, has been coricentrating on improving the production and quality of tetanus toxoid, while production of DPT vaccine and snake venom antisero was being pursued. The Myanmar Pharmaceutical Factory was assisted in the production of tissue culture rabies vaccine, tetanus vaccine and snake venom ontisera. Strengthening of notional drug quality control Iaborotories hos been the mainstay of WHOsupport to Member Slates. In Bangladesh, in addition to the regular support being provided by WHO, the national laboratoty is being further strengthened through a component of the Fourth Population and Health Project funded by the World Bank. In India, many items of equipment were provided to the central drug testing laboratories in Mumbai and Chennoi. In Nepal, the Royal Drugs Research Laboratory was assisted by providing WHO fellowships to its staff for study in quality control of pharmoceuticols and standardization of reference substonces. Equipment for conducting pharmacological, microbiological and toxicological tests at the Laboratory was also provided. In Thailand, consultant support was given for analysis of drugs. 44 me Work of WHO in SEA Departments of food and drug administration (FDA1 have been established in Myanmar and Nepal, while lndia and Sri Lanka are in the process of reviewing the FDAs of other countries which may lead to the restructuring of their existing regulatory systems. Technical assistance was provided to Myanmar to enable the country to strengthen the system of registration of drugs A workshop on Good Laboratory Proct~ces was supported in Nepal India was supported in its study of the Food and Drug Administration of the United States and the Therapeutic Goods Administration of Australia. A proposal to establish a Drug Regulatory Authority in Sri Lanka was formulated with technical support from WHO Three Member States in the Region, I e. lndia, Indonesia and Thailand, are producing pharmaceutical raw materials as well as flnished products for export Application of the WHO Certification Scheme on the quality of pharmaceutical products moving in international commerce is now becoming more relevant as the importing countries are requesting certificates on pharmaceutical products as recommended under the Scheme The Regional Office is providing Information on the Scheme, especially to manufacturers in lndia, in order to ensure the quality of pharmaceutical products In Myanmar, WHO assisted in a study to assess the situation with regard to counterfelt drugs To improve the good manufacturing practices IGMP) inspection in Member States, an expert from Indonesia was assigned to review GMP inspection procedures and provide on-site training to national staff n Bangladesh, Myanmar, Nepal and Sri Lanka An interregional strategic planning meeting comprising staff of the Action Programme on Essentiol Drugs [DAPI,WHO/HQ, and that of the six WHO regional offices was convened in Geneva in October 1996. A major objective of the meeting was to review and revise the draft DAP Strategic Plan for 1996-2001 One of the topics discussed was traditional medicine (TRM) At the regional level, a study tour to Inda and China on quallty assurance of herbal medicines was organized in May 1997 in which one participant each from Bangladesh, Indonesia, Myanmar, Traditional medicine Quallty of Care and Health Technology 45 Nepal and Sri Lanka and one each from six countries of the Western Pacific Region took part. The three WHOcollaborating centres on TRM, located atJomnogar and Varanasi in India and Pyongyang in DPR Korea, were involved in the training of WHO fellows in Ayurveda and Korean traditional medicine In Bangladesh, WHO support focused on the strengthentng of the Government Unani and Ayurvedic Degree College in order to enhance the capabilities of its teachers and its laboraton/ and teaching facilities. In Bhutan, the TRM situation was reviewed and a medium-term plan for its development wos prepored The traditional systems of medicine being practised in India such as Ayurveda, Siddha and Unani were supported through o revision of the teaching curricula and strengthening of pharmacopoeial standards and laborotories DPR Korea was assisted in improving the quality of Korean traditional medicine services through training of staff of the General Hospital of Koryo Medicine in TRM, including acupuncture. In Myanmar, production of traditional medicines wos improved, while research work in the screening of aflatoxin and toxicological studies for safety of TRM was supported. Nepal was assisted in the production of manuals and guidelines for rational use of A~urvedic drugs prepored from medicinal plants. In Sri Lanko, TRM was assisted through upgrading of Ayurvedic dispensaries to A~urvedic centres for providing integrated health care. Production of Ayu~edic drugs ond integration of TRM into PHC were also supported. 46 The Work of WHO In SEA

The Region01 Office provided financial and technical assistance to Bhutan, India and lndonesia for conducting workshops in health systems research (HSR] Nepal conducted a number of HSR workshops. Technical support was provided to the data analysis workshop for HSR research prolects in Bangladesh and lndonesia A train~ng module for conducting HSR workshops was developed and f~eld-tested n lndonesia. The module would be available for conducting similar training workshops in other countries of the Region. Institutional strengthening grants were provided to countries to promote a strong network of HSR activities. All Member States in the Region have reemphasized the need to ~~erat~onolize the core principles of primary health care in their ne~l~~formulated health development plans, policies and strategies. The new heolth development plans formulated by the SEAR countries call for measures to turn the core PHC principles into an operational reality The Sasakawa Health Prize for 1997awarded to the Mongar Health systems research and development Policy develop- ment and restructuring of national health systems Organlmtlon and Management of Hlth Systems Based on PHC 29 I health services development proiect reflects the importance accorded to PHC. The Government's plan of action in Bangladesh has emphasized the need to strengthen the national capabilities at all levels in programme planning, management and monitoring, laying particular emphasis on decentralized planning and programme implementation. In Bhutan, the Government has revised its health care policy and strategies while preparing its Eighth Five-Year Plan 11997-2002)The revised policies call for reorganizing the health care structures by replacing the oldsh/le dispensaries with basic health unifs and upgrading selected busic health units to hospitals. India, with support from WHOand theworld Bank, has launched the state health systems projects in Andhra Pradesh, Karnataka, Puniab and West Bengal. This initiative aims at streng~henin~ the capacities of the state governments for strategic planning and analysis, enhancing their inputs for PHC, improving referral systems, mobilizing resources through usersharges and raising community awareness through interaction with the Ponchoyoti roj (village-level) institutions. Strengthening of national capabilities in programme development and management, including district health systems, has become a maior focus of DPR Korea's detailed plan of action for the current biennium. The fiveyear plan of Indonesia [Repelita VII), which is due to commence in early 1999, emphasizes the need to improve human resources for health in all types of health facilities, both in the private and public sectors. The emphasis in Maldives' long-term health plan is on integrating ,he centrallyoperated public health programmes into the regional hospital and Atoll health systems. Myanmar's new National Health Plan (199620011 emphasizes the need for further strengthening of health education and prevention of diseases and their effective cure through the PHC approach. In Nepal, the Government's decentralization of a development package consisting of resources, technical support, authority and responsibilities to the village development committees IVDCs) in 20 selected districts, with UNDP's financial support, is an important landmark in operationalizing the PHC principles Sri Lanka's perspective plan for health development (1994-20001 emphasizes the need to develop a cluster hospital 30 ma Work of WHO In SEA system and a programme on public investment in the health sector /1995-19991 The Eighth FiveYear National Health Plan of Thailand aims to improve access to health care; promote an integrated approach to planning and provision of health care; encourage increased participation of the people in tackling their health problems, and bring about more flexibility in the olanning and implementation of health services relevant to local needs As a follow-up of the technical discussions on alternative financing of health care, held during the 48th session of the Regional Committee in 1995, on intercountry consultation on Health Financing Reforms was organized in Bangkok in October 1 995 in collaboration with the WH3 Collaborating Centre for Health Economics, Chulalongkorn University. Protocols for evaluating studies on health financing reforms were developed at this meeting. Technical support was provided to Member States in organizing in~country training courses, seminars and workshops and conducting research studies in health economics. In Nepal, a WHO mission was fielded during September 1996 to provide technical assistance in the review, revision and augmentation of the issues related to public/privote mix, to be addressed in the Second Long-term Health Plan. A study was supported in Sri lanko on the assessment of the prospects of setting up paying wards in government hospitals as a complementary financing source The Centre for Health Economics in Bangkok has been actively involved in training and research in health economics Through this collaborating centre, WHO provided support to Bangladesh ond Maldives in undertaking training initiatives and evolving health care financing mechanisms. The intercountry collaborative programme on strengthening local care and distr~ct health systems (DtIS) has resulted in the development of practical guidelines and training modules that are adaptable to country-specific situations for operationalizing the PHC principles in the management of DHS. The process has also generated active participation of national teams in developing these training modules. Health economics, resource allocation and financing strategies District health systems Organization and Management of Hlth Systems Based on PHC 31 Nine Member States participated in the intercountry training workshop on Strengthening the Organization and Management of District Health Systems based on PHC, held in New Delhi in 1996 Using theguidelines and training modules developed at this workshop, Member States are implementing the activities identified for developing model districts - two in each country In Bangladesh, national and district-level intersectoral workshops, along with the health awareness workshops for community leaders and women's groups, were held and two districts were added for strengthening the district health system. Bhutan successfully implemented the inservice training on planning and management of DHS by integrating it wtth other related troining programmes. A training manual on strengthening the organization and management of district health systems based on PHC was developed in India based on the prevailing situation in the community health centres in two states - Uttar Pradesh and Madhya Prodesh. The programme in lndonesia focused on improving the management and quality of health care at all DHS levels. These activities have brought about better cooperation and coordinot~on between different units and directorates, The country collaborative programme in Myanmar led to the expansion of access to health care at the community level with the training of 922 new community health workers from 16 states. It also improved the quality of care at rural health centres by providing training and health care kits In order to improve access to referral services in remote areas, the collaborative programme in Nepal has led to the establishment of a 'mobile medical campus' on a regular basis. In Sri Lonka, orientation workshops on PHC-based DHS, along with training of community-based health volunteers, were conducted. WHOorgonized an intercountry troining workshop on Quality Assurance in Health Care at Surabaya, lndonesia, in December 1996 in which 28 participants from nine countries took part. SEAR0 is follow~ng up on the recommendations of the meeting to ensure that quality assurance is incorporated into the health care systems of all Member States Several countries in the Region are gradually introducing quality assurance programmes in hospital care. In lndonesia, standards 32 The Work of WHO In SEA related to medical and nursing care for hospitals were formulated and a ioint commission for hospital accreditation was established; 10 hospitals have already been accredited. A post-intervention assessment recorded marked improvements in the quality of hospital care. In Nepal, an inspection and quality control section was established in the Ministly of Health for improving the quality of health care. In Sri Lanka, the application of 32 national standards for hospital care grouped under five maior areas - intensive care, operation theatre, maternity care, paedialric care and general sanitation - was being promoted. In Thailand, the Health System Research lnstitute has been given the responsibility of introducing quality assurance in the national hospital system. An innovative seven-week international practical training programme on PHC at district level was launched for the first time, with WHO support, during the reporting period The Asian Institute of Healtli Development, Thailand, the National lnstitute of Health Sciences, Sri lanka, ond the Centre for Education and Training for Heolth Personnel, Indonesia, collaborated in this unique initiative. Three rounds of training have already been completed, and the fourth round would be conducted in the last quarter of 1997. Officials from other WHO regions are also participating in the course to enhance their skills in this area. Organhtlon and Management of Hlth Systems Based on PHC 33

The orgon~zot~oriol structure of the Regonol Off~ce as on 30 June 1997 is given as Annex There were 130 estobllshed Profess~onol posts in the South-East Asia Region on '30 June 1997 as compared to 149 on 30 june 1995 and 146 on 30 June 1096 The decreose in the number of posts was due molnly to the closing down of the Globol Programme on AIDS Toble 6 shows the number of posts n the Profess~onol cotegory in the Region, funded from all sources and the number actually fllled by long ierm stoff os of 30 June 1997 Toble 6. Number 01 pioleii~oool poils. by locor~ori oh oi .I0 June 1991 r Regional Posts ond Country intercountly Fs~ablished 69 6 1 Frozen I Filled by appanlmenl 56 49 To be led I? 12 Total 3 Personnel services and administration "Include one post i,lled by rhortierm rtaii lemporair~ hlnclude lour poils Illled by short term iloH remporarly Personnel 87 Of the 105 Professional staff as of 30 June 1991, 44 147 per cent) were nationals of the SEA Region. Out of the totol number of staff in position, 18 [I 7 per cent] were women. The Regional Office hos undertaken a study to identify the constroints in hiring and retaining more women on the staff of WHO During the perlod under revtew, 258 short-term stofi were hlred, of whom 145 I56 per cent) were nat~onals from the SEA Region Out of the totol number of short-term staff appointed, 68 (26 per cent) were women One post of National Professional Officer (NPO) was established in Bhutan under a trial arrangement agreed to by the Executive Board and in line with the Organization's policy to utilize notional expertise wherever possible Proposals have been made to establish seven more posts of NPOs in the Region 88 The Work 01 WHO In SEA

Nutrition WHOsupport was directed towards improving the quality of national programmes aimed at addressing the priority areas of protein-energy malnutrition (PEM] and micronutrient deficiencies such as iodine deficiency disorders, vitamin A deficiency and iron deficiency anaemia in women and children. A regional workshop on National Plans of Action for Nutr~tion was held at the Regional Office in November 1995. Nine countres developed their plans of action to reach the goals set at the International Conference on Nutrition [ICN) by the year 2000 An intercountry workshop on iron deficiency anaemia [IDA], held in Thailand in December 1995, emphasized the importance of IDA and a regional plan of action was developed for its prevention and control. The fourth meeting of the South-East Asia Nutrition Researchsum-Act~on Nehvork, held in Indonesia in June 1996, identified three themes for multicentric studies to be initiated in 1997 These studies related to social marketing for IDD intervention, feasibility of iron supplementation and incorporation of micronutrient-rich foods in household meals. A regional consultation on Elim~nation of Iodine Deficiency Disorders was held at SEAR0 in February 1997 which 58 The Work of WHO In SEA I ne prevention and control of iodine deficiency disorders. protein-energy malnutrition and iron deficiency anaemia are included in the national plans of action of most countries in the Region. Early detection and merits of these action plans. ion of safe water supply and xiate sanitation facilities are ...- ... ain focus of environmental health programmes in the Region. While there have been marked improvements in water supply to most urban and rural areas, sanitation and sewage di! facilities remain inadequate. Comprehensive school health education programmes, including deworming and nutrition supplements, are being introduced and strengthened in the countries to help improve the health status of school-gotng children. In some countries, schoolchildren are also mobilized to work as volunteers in special campaigns. The importance of health care laboratories for timely diagnosis and epidemiological surveillance is well recognized. The emphasis now is on improving quality control mechanisms and the efficiency of laboratoriesinthe Region. rev~ewed the progress made in universal salt iodization and reduction of the prevalence of IDD in the Region A train~ng workshop on Developing Applied Food and Nutrition Proiects was held in Thailand in May 1997 as a follow-up of the Jokorta meeting in order to facilitate implementation of identified priority action research. In addit~on to regional consultations and national workshops, support was provided to Member States for reviewing country programmes, undertaking IDD prevalence studies and tracking progress in the elimination of IDD Organizing training in laboratory-based quality control for iodized salt at manufacturer and consumer levels, implementing notional plans of action for nutrition, evaluating deworming progrommes in relation to nutrition status, preparing proposals for household food security studies and planning food safety programmes were also supported Assistance to countries in developing their food safety programmes was focused on reviewing existing progrommes and identiking priority areas of action for legislation, training, su~eillance and other institutional aspects. Maldives, Myanmar and Nepal received WHO assistance through short-term consultants. India received support in the form of laboratory equipment. Activities in Bangladesh included a series of food safety orientation workshops for civil surgeons, administrators and municipal health officials Some of the other areas that were supported covered strategy development for food safety prioritization in Indonesia, development of legislation on safety measures for food and meat imported into Maldives and a review of the newly-enacted food and drug administtation legislation in Myanmar. Technical assistance was provided to DPR Korea for the development of analytic01 techniques for detecting microbial and chemical food contamination and to Thailand for studies on aflotox~ns. Food salety Nutrition. Food Securlty and Safety 59

Control of non- communicable diseases Through its publication on national cancer control programmes, WHO has laid down the guidelines for planning cancer control programmes with o clear public health orientation. This has formed the basis for the formulation of comprehensive national cancer controi programmes in several countries of the Region, notably India and Indonesia. WHO has continued to advocate the importance of cancer care and pain control. Following an intercountry workshop held in the Regionol Office in 1995, WHO supported the initiation of the process of identifying demonstration areas for integrated control of major noncommunicable diseases, mainly cancer, cardiovascular diseases and diabetes. A common package of interventions was being introduced for various levels of heolth core, and preventive interventions were being developed focusing on common risk factors like tobacco and alcohoi use, dietary habits, exercise and blood pressure control. In India, these demonstration studies were conducted among the employees of certain enterprises and their families, while in Thailand these covered the entire population of a province. The oral health programme continued 10 focus on the prevention and control of the two most predominant oral conditions - cories ond periodontal diseases. Support was provided to Bangladesh for conducting school oral health programme using a communiiybased oral disease prevention strategy. Primary oral health projects, with 84 The Work of WHO In SEA the emphasis on the preventive and promotive aspects, were also implemented in selected areas in India and lndonesia. These proiects were supported by AGFUND A workshop on the effectiveness of various alternative technologies such as water fluoridat~on, fluoridated toothpaste, salt and milk was conducted in Indonesia With WtiO support, the primary oral health projects started in o few townships in Myanmar were extended to all the 12 townships as planned Training workshops were conducted in the project townships where information and educational materials for dental personnel as well as the general public were developed. In Sri Lanka, o workshop on the production of IEC materials on dental health for the Health Education Bureau and a training course on oral health education for dental surgeons were conducted w~th WHO support. The expanded field trials of the atraurnatic restorative technique, which were initiated in Chiong hi, Thailand, in collaboration with the WHOCollaborating Centre for Dental Health in the Netherlands, were nearing completion. This technique was introduced to dental experts in Indonesia and Myanmar ttirough WHOsponsored consultants from Thailand Control of Noncornrnunlcable Diseases 85

Human resources for healfh Some of the main regional initiatives in the ore0 of human resources for health (HUH) were aimed at supporting the formulahon of an HUH policy and improving the content and process of underyroduate and postgraduate medical education and training. Promot~ng closer linkages between medical education and health services, use of associations in the reorientation strategy and supporting institutions which toke the lead in the desired educot~onol reforms were some of the other steps taken to improve HUH An intercountry project to develop and field-test a set ot relevant and practical indicators for health personnel was initiated. This pilot study, which examines the crucial oreos of productivity, accessibility, working conditions, motivation and the quality of was being conducted in Bhuton, Indonesia, Myanmar, Nepal ond Sri Lanka . Most of the Member States utilized the HRH management modules produced by WHO The South~East AsIan Regional Conference on Medical Education, held in February 1996 in Thailand, reviewed the state of medicol education in the Region. Banylodesh, Nepal, Sri Lanka and Thailand held follow-up meetings to discuss and 34 The Work of WHO in SEA disseminate the main outcomes and decisions of the regional conference A regional project to promote innovative strategies in medical and nursing education and to develop six centres of excellence in the Region was initiated. WHO encouraged the strengthening of national systems of postgraduate medical education, and facilitated the exchange of science and technology between the more developed countries, both within and outside the Region. In order to support policy development and appropriate planning of HRH, the Regional Office launched a number of intercountrj research studies. These included a study of the profile of the general practitioner in the 2ist century; analysis of policies affecting the geographical balance of human resources for health, inquirydlriven strategies for changing medical educotion, and assessing the social accountability of medical schools. WHOassisted Bhutan in the formulation of o Health and Medical Council Act which provides the basis for long term humon resources development In Bangladesh, Indonesia, Nepal and Sri Lanka, effective and mutually-supportive partnerships have been established with the UN and bilateral donor agencies In the countries where master plans for human resources had been developed, the roles and responsibilities of the paromedicols were formulated and their position within the health system delineated in each case Wti0 technical support was provided to the Royal lnstitute of Health Sciences, Bhutan, the lnstitute of Medicine and the Centre for Technical and Vocational Training, both in Nepal, the Poramed~cal Training Institute, Myanmar. the lnstitute of Health Sciences, Maldives, the Nation01 lnstitute of Health Sciences, Sri Lanka, and the Centres for Health Manpower Development, Indonesia. All these institutes have undertaken activities aimed mainly at improving the quality of their paramedical training programmes. An intercountry consultotion on Strategic Planning for Nursing/Midwifery Development in SEAR countries was held in Bangkok in October 1995 Participants identified future directions Human Resources for Health 35 for nursing/midwifey and specific strategies in eight key areas to achieve the desired outcome over the next 5-10 vears. Support was provided to expand educational opportunities for the advanced training of nurses. A prime example at the country level is the off-shore Master's Programme in Nursing Science being implemented in Myanmar in collaboration with the Universiiy of Adelaide, Australia. A Master's programme in nursing os well as a basic BSc nursing programme were also established in Nepal, while a post-basic BSc nursing course was being developed in Sri Lanka. Based on the assessed training needs, three regional troin~ng programmes were developed in India, Sri Lanka and Thailand. These were: community health nursing, critical care nursing (jointly offered by two centres in two countries1 and midwifery educat~on for safe motherhood. These training centres will also tacilitote development of educational innovations. An intercounty consultation on Collaboration between Nurslng Services and Education for Improving the Quality of Nursing Core and Education was held in Yangon, Myanmar, in October 1996 as a follow-up of the regional consultation on the same subject held in 1992. This meeting critically reviewed the findings of a multi-centre study as well as other country-level experiences in collaborative activities. Based on its outcome, guidelines were being developed to promote collaboration between nursing services and nursing education in SEAR countries. Midwifery training modules developed by WHO/HQ and field-tested in SEAR and other regions were being ~romoted for use in Member States. In addition, standards of midwifery practice for safe motherhood were being developed to improve and ensure the quality of midwifery services. A regional consultation was held at SEAR0 in October-November 1996 to review the standards being developed for their relevance in the countries of the Region. These standards were being fieldtested for their applicability and in Bhutan, Indonesia, Nepal and Thailand 36 The Work of WHO In SEA Member States in the Region continued to utilize the WHOfellowships programme for the development of human resources for health. During the reporhng period, the Regional Office received 1515 applications out of which 1057 fellowships were awarded. Table 2 shows the distribution of the fellowsh~ps awarded by sublect ond country. Table 2 O,sh~bu~ion of fellowships by subtecr of study and coun1ry of or,gin of feliows 11 July 1995 30 June 19971 The trend for short-term fellowships and study tours continued during the period under review Table 3 gives the details of the total number of fellowsh~~ applications received, including those processed, from each country of the Region. Table 3 Total ,,umber of feiiowsh~~ applications by duiorioo 1 I lulv 1995 30 Iune 19971 Country / <3 1 Per 13-6 1 hr 16-121 Par 1 >12 1 hr ITofolI months cent months cent monthr cent monthr cent DPR Korea 46 lndio 465 lndonerlo 33 Moldiver 17 Myonrnor I86 Nepal 213 Sr, Lanko 172 Thollond 33 I I lndonesia 1s the only country in the Reglon which is using a ; major part of the WHO country budget for incountry undergraduate 1 and postgraduate training On the other hand, some Member States : such as Bhutan, Maldives and Nepal have started using the contractual services agreement [CSA) mechanism for long~term training within the Region with a view to economizing on the cost, thereby training a larger number of persons. Thailand started implementing extraregional study tours using the CSA mechan~sm These are cost-effective and innovalive approaches to meet the training obiectives Bangladesh Bhutan Training programmes were arranged by the Reg~onal Office for 392 fellows from other WHO regions {AFRO. EMRO and WPRO1 at appropriate institutions in India, lndonesia, Sri lanka and Thailand. In keeping with a decision of the Executive Board, WHO/HQ hod developed a fellowships evaluation tool with the obiective of providing countries with an instrument to improve the selection process and to ensure that the fields of study were related to the stated natlonal health priorities as also to support countries n complying w~th policies, specially in the area of utilization. The evaluation tool wos 38 The Work of WHO In SEA 146 26 733 72 2 15 1 76 28 33 3 166 83 5 6 25 167 IW 30 field-tested in Sri Lanka and the results were presented at the regional consultation on Fellowships Policy and Evaluation held in August 1996 The consultation olso considered the evaluation reports of the WHO fellowships in the Region for the three bienniums, 19FO-1991, 1992- 1993 and 19941 995. The recommendations of the Consultation are being implemented to further strengthen the fellowships programme in the Member States. During the period under review, 97 meetings/group educational octivities were held. These were policy, advisory and technical meetings, covering such subiects as health legislation, applied research methodology, control of drug-resistant malaria, drinking-water quality surveillance, vaccine-preventable diseases, safe motherhood, multi-professional education and hospital waste management. Table 4 shows the distribution of participants in intercountry group educational octivities by type of activity. Gmup educational activities Tw d odlvi* Reglono rneellngi Woikrhops Canrullat~ve rneetrngs Short tralnlng courser Tot01 Human Resourws for Health 30 Numb 14 29 50 4 97 Number d participontr 295 484 950 121 I 850

WHO has continued to advocate extension of the concept of mental health care and psychiatry into the wider concept of public mental health As o consequence, the need to develop new technologies has been obvious. The Schizophrenia Research Foundation (SCARF] in Chennai, India, has been designated as the WHO Collaborating Centre for Research and Training in Mental Health. This centre has developed an instrument, based on extensive ethnographic work, to quantify the perceived burden on home care-givers of chronic psychotic potlents An innovative approach lo reduce family violence due to inebriation has been developed in Sri Lonka by an NGO wiih support from WHO Also, with WHO support, ethnographic work has been carried out in Indonesia to understand ihe motivational panerns in streetgong violence in Jakarta, leading io more effective rehabilitation techniques A training workshop on health behav~our research methodology was held in Yangon, Myanmar. The Regional Office prepared substantial reading and background material which can be used in similar training workshops in other countries of the Region. Mental health Healthy Eehavlour and Mental Health 53 Substance abuse including alcohol and tobacco The Indian Council of Medical Research, New Delhi, developed indicators for the quality of community life, based on the protocol developed earlier in a WHO intercountry workshop on Research for Mental Health Programmes. The result is on ethnography-based instrument to quantify feelings people have about their communities or neighbourhoods. This instrument can now be used in programmes which aim to increase community participation in an activity or in other communitybased proiects. Advances have been mode in some countries of the Region, especially lndia and Sri Lanko, in the development of community-based programmes of demand reduction of illicit drugs, In Sri Lanko, the National Dangerous Drugs Control Board compared the results of a communityariented outreach research work with drug users with the results obtained from clinic-based detoxification efforts The superiority of the former approach was so obvious that the Boord decided to transform the three existing detoxificotion centres into centres for community activities. The second phase of the UNKP-supported drug abuse control project in Sri Lanko ended in December 1995. The Regional Office assisted the notional authorities in drahing a document for the third phase of the proiect Technical support was provided to a network of NGOs to effect the agreed standards of drug services, including harm minimization These services included help in problems related to alcohol and opium use in rural areas as well as heroin use in urban areas Unlike alcohol control, anti-tobacco activities received increased attention in most countries of the Region where advocacy and public education on control measures took a positive turn. Focal points for tobacco control were appointed, and, in some countries, national committees were set up to study the relevant issues ond other problems. Notional seminars and conferences on tobacco were organized in two countries providing a forum for review and replanning. Legislative acts and executive instructions banning tobacco smoking in places were in Delhi, lndia, where the sale of cigarettes to people below 19 years of age is also prohibited. India, Indonesia and Thailand banned smoking on all 54 The Work of WHO In SEA domestic and some international flights. Advertisements promoting smoking have been banned in Sri Lanka and in the National Capital Territory of Delhi. Maldives has declared two islands as tobaccdree. The health education infrastructure has been decentralized in some countries to the communi'y level, with health volunteers playing a critical role in inforrnat~on dissemination and community mobilization. Health education services have been extended to a large number of schools, communities, hospitals, and, in some cases, to workplaces. These services focus on areas such as maternal and child health. immunization, cornrnun~cable diseases and noncommunicable diseases such as HIV/AIDS, cancer, cardiovascular diseases, hypertension and thalossemia. A series of in-service training programmes for various categories of health and health-related personnel such as primary health care workers, health devotees [as they are known in Myanmar) and doctors were organized at the community level Major strides were made towards the implementation of comprehensive school health education programmes School curricular reviews in Indonesia, Maldives, Sri Lanko and Thailand gave adequate recognition to subjects such as drugs, alcohol, counselling, sex-related problems, thalassemia, tobacco and life-skills. Deworming and nutrition supplement programmes have taken centrestage in the efforts to improve the health status of the school-going child in India and Maldives Information on WHO collaborative activities was provided to a number of organizations, individuals, health educators and other health personnel. The media was kept posted with WHO policies and strateg~es and specific activities Production and dissemination of informat~on materials were continued The regional newsletter, HFA 2000, was issued regularly during the reporting period. A fact file on Dominant Communicable Diseases in South-East Asia, a video on Bridging the Gaps - WHO in the South-East Asia Region, and regional versions of the World Health Report were and Health promotion Communications and public relations Healthy Behavlour and Mental Health 55 Rehabilitation distributed. World Health Day, World No-Tobacco Day and World AIDS Day were observed throughout the Region. They assumed i added importance with the active participation of NGOs, the mass 1 medio and educational institutions. The timely distribution of WH3 press releases and other information material, in addition to press briefings, concretized further the links with the medio. Recruitment of national consultants for communication and public relations, coupled with the training of local journolists, contributed significantly to increased, bolanced and fair reporting on health issues. The media seminar held in Indonesia in June 1997 was most timely, held as it was lust before the Fourth International Conference on Health Promotion. Strategies for proactive actions to make health intormation more accessible to Member States and for o wider network of interactive media are being developed. WHO continued to promote the concept of communitybosed rehabilitation [CBR) in the Region. A bi-regional troining workshop on Management of Rehabilitation Programmes was organized jointly by WPRO and SEAR0 in October 1996 in Ciloto, lndonesio, which focused on strengthening the managerial skills in developing and implementing CBR programmes in the two regions. A regional workshop on Strengthening CBR Progrommes as on Integral Part of Primary Health Care wos held in New Delhi in December 1996. It recommended some country ond region01 action points for sustainabilih/ and expansion of programme activities as well as for incorporation of rehabilitation components into existing health systems. Support wos provided to Bangladesh and Bhutan for translating the WHO manual on CBR into local languages. India ond Myanmar took up re-translation and/or reprinting of the manuol. In Bhutan, a national CBR programme was established as o priority programme of national health development. Technical support was provided to Sri Lanka for reviewing the feasibility of local production of lowzost artificial limbs and holding 56 The Work of WHO In SEA training programmes on CBR for health workers and volunteers. A training worksheet on CBR for provincial health personnel was produced in Indonesia, while seminars and conferences dealing with various aspects of disabilities were supported in India. A study was conduc~ed in Thailand on Alternatives for Community-based Rehabilitation Model, while the CBR programme was expanded in the country's northern provinces. Healthy Bahavlour and Mental Health 57

Member States were provided technical support for developing their annual deta~led plans of oction for implementing the strategic programme budget for 19%1997 Country programme formulotion missions vis~ted some countries lo ossist in the preparation of annual plans of action Support was also extended for the formulotion of the programme budget for the 1998- 1999 biennium. The Regional Committee, in 1995, took the initiative to rationalize, strengthen and enhance the allocation for an intercountry programme for tackling emerging health problems of common concern to Member States, utilizing resources from country allocations during the 19961997 biennium. in a spirit of regional solidariiy it was agreed by the Health Secretaries at their second meeting that, in order lo accelerate implementation in the 1996.1997 biennium, funds from some countries, with their concurrence, should be allocated to those which were in greatest need. In order to improve the utiliza~ion of funds, the criteria adopted for selecting activities were the following: countries should be fully ~nvolved in the activ~ties wh~ch should be of short duration, demonstrating tongible/measurable outputs; funds should be liquidated in 1997 itsell; the focus should be more on training and General Programme Development and Msnagement 5 developing modules and/or standard guidelines; recruitment of experts should directly benefit countries; making provision for the organization of intercountry seminars/workshops, and conduct of operational research of short duration which would produce tangible results for immediate application. The Consultative Cornminee for Programme Development and Management [CCPDM), at its meeting held in April 1996, reviewed the implementation of the WHO collaborative programmes for the 1994- I995 biennium, ond the 12-month implementation of the 19%- 1997 programme budget at its meeting held in April 1997. It also reviewed the proposed intercountry programme budget for the 1998- 1999 biennium and the progress made in the implementation of the supplementory intercountry programme IlCP 11). The 44th and 45th meetings of the Regional Director with the WHORepresentotives were held in November 1995 and November 1996, respectively, where diverse issues related to programme development and management in the Member Stotes were reviewed In pursuance of the recommendations of the Execut~ve Board workng group on WHO Response to Global Change, consideroble progress was mode in the implementation of the reforms in the Region. Using the product-oriented approach, strategic programme budget proposals os well os detailed plans of action were developed at country and regional levels in 19%~ 1997. An od hoc working group met in October 1995 to discuss the issue of regional ollocotions, including establishing appropriate criteria for these allocations. Efforts are in hand to enhance the role of the Executive Board (EB] members from the Region for harmonizing the work of the Regional Committee with that of the EB and the World Heolth Assembk. Adequate and timely briefing of the EB members was orronged so that the interests and concerns of the Region were properly represented at the meetings of the EB and its various working groups. WHO response to global change A consultotion on the WHO Constitution was organized in August 1996. While noting the conclusions and recommendations of this 8 The Work of WHO h SEA consultation, the forty-ninth session of the Regional Committee felt that even though there was no need to make extensive changes to the Constitution, it was time to carefully examine the Organization's finoncial and administrative procedures in order to ensure a systematic and timely implementation of its activities. In pursuance of resolution EB99 R24, the EB special group met in April and May 1997 and adopted a provisional programme of work for the current year and reviewed, in particular, some issues relating to WHO regional arrangements within the framework of the Constitution. The Staff Development ond Training Committee established explicit policy guidelines to enable the maximum number of staff members, both in the Regional Office and country offices, to benefit from training programmes. Various types of group training activities were conducted. As many as 19 Professional and 92 General Service (GSI staff members from the Regional Office and eight staff members from country offices were trained in different computer software programmes, while 32 GS staff attended secretarial effectiveness courses. In addition, five Professional staff members attended the Interregional Seminar of WHO Representatives in Geneva while eight newlyrecruited Professional staff attended the introductory briefing programme at WHO/HQ. Participation of eight staff members [both Professional and GSl was approved for taking part in such diverse act~vities as Public Service International [PSI) Regional women's Conference, Management of Field Coordination for Senior UN System Represenlat~ves, local Salary Survey Methodology and UN Solary and Post Adjustment System The Regional Office took the lead in the exercise for renewing the health-forull strategy by organizing an informal consultation in August 1995. The subject has since been discussed by the CCPDM, the Regional Committee, the Health Ministers, the Health Secretaries and the meeting of parliamentarians. An intercountry meeting on Evaluation and Renewal of HFA Strategies was organized in December 1996. Staff development Renewing the health-for-all strategy General Programme mvelopment and Management 7 Various forms of health sector reforms were init~ated in the countries of the Region. Member States, as per their planning cycles, proceeded with the formulation of health development plans as part of their national development process. Renewing the HFA strategy formed an integral part of national health planning process. Following a consultative meeting on Health Development in South-East Asia in the 2lst century, held in March 1997, a regional intersectoral meeting on the subiect was held in June 1997 at which a droh declaration on health development in the South-Eost Asia Region in the 2ist century was formulated. The draft declaration will be submined to the 15th meeting of the Ministers of Health in August 1997 for consideration and endorsement. This process and its outcome will have a strong bearing on the health-for-all strategy at country and regional levels. Managemant The Regional Office continued to provide technical assistance in and support to setting up Local Area Nehvork (LAN) and E-mail connections in the information offices of WHO Representatives (WE) which required these facilities. systems All the WR offices now have LAN and E-mail connections. Development of WHCYs Global Management Information System (WHOMIS] was undertaken, with its maior component, the Activiiy Monitoring System (&IS), being in its final stages of refinement and implementation. The first version of the AMS has already been installed in the Regional Office. The new client/sewer-based Administrotion and Financial Information System (RO/AFI) has been functional since July 1996. A new computing centre facility, with a larger network, was completed in the Regional Office in February 1996. The centre plays a leading role in upgrading the hardware/sohware infrastructure in order to accommodate modern clientserver applications as well as to implement new communication facilities, including access to the Internet and video conferencing. The World Wide Web server has been set up and SEARCYs home page is available for global lnternet access by external users as also for the office staff via the lnternet on the SEAR0 LAN. 8 me Work of WHO in SEA Under the Regional Director's Development Programme (RDDP),support was provided for: establishing a radio communication system between basic health units and district hospitals (Bhutan); procurement of cardiac surgery equipment (DPR Korea), and procurement of oral polio vaccine and meeting the operational expenses in respect of social mobilization and other components of national immunization day INID] activities in some countries. Assistance was given to Bangladesh and DPR Korea to meet emergency health situations arising from floods. Support was provided for upgrading and strengthening training facilities at the Regional Health Training Centre in Sri Lanka. Improving the technical skills/performance of peripheral health workers, purchase of vaccines for strengthening NID activities in Indonesia and Nepal and supply of o high-speed chromatograph to the Reseorch Institute of Biology in Pyongyang {DPR Koreo) were some of the other activities supported under the Programme. Participation of officials from Bangladesh, Bhutan and Nepal in the border meetings on malaria and kalauzar was supported. Funds from the RDDP were utilized for a Joint WHO/FAO/UNICEF ICN Notional Action Plan followup meeting. Meetings on primaly health care, tPi vaccine supply, psychosocial rehabilitation, integrated control of noncommunicoble diseases and strengthening of ethics in medical education and practice in SEAR were also supported. The first two meetings of the Health Secretaries of the SEAR countries were organized by utilizing funds from the RDDP. WHOcontinued its collaboration and partnership with various United Nations agencies and worked closely with UNICEF, UNDP, UNFPA, FAO, UNCCP, UNHCR and UNESCO as well as with other relevont organizations. A Memorandum of understanding IkUj was concluded between the Association of South-East Asian Nations IASEAN] and the World Health Organization. The Regional Directors for the South-East Asia and Western Pocific regions signed the MoU on behalf of WHO. As a result, relations between the two organizations have been formalized and further strengthened. Regional Director's Development Programme Coordination with other organizations Generel Programme D.velopmenl and Management S Another MU between WHO and the South Asian Association for Regional Cooperation (SAARC) for mutual cooperation in dealing with common public health problems in Member States is in the process of being concluded. Meanwhile, WHO continued to collaborate with SAARCs Regional Tuberculosis Centre located in Nepl. UNDP continued to support a number of health sector projects in SEAR countries. WHO executed the UNDP-funded projects on: primary health care in Bangladesh; improving rural community access to PHC and prevention and control of AIDS in Myanmar; human resource development for water supply ond sanitation in Nepal and control of AIDS/HIV in Sri Lonka. WHO participated in the meetings of a number of expert committees of the Economic and Social Commission for Asia and the Pacific IESCAPI An agreement was reached with ESCAP to further strengthen the collaboration in the fields of rehabilitation, HIV/AIDS, the Healthy Cities programme, social development, poverty alleviation and sustainable development, and statistics. UNESCO: in collaboration with WHO, organized an international seminar on Culture and Health in Chiang Rai, Thailand, in May 1996. This was the first initiative of its kind taken for health advocacy from the cultural perspective. WHOcont~nued to collaborate with UNFPAat the technical level, particularly in the area of reproductive health, and in the implementation of UNFPA~funded projects in Bhutan and DPR Korea.UNFPA has joined the Joint Committee on Health Policy UCHP) which has been reconstituted as the WHO/UNICEF/UNFPA Coordinating Committee on Health. WHO worked closely with UNICEF in priority health programmes such as immunization, use of oral rehydration therapy, promotion of breast-feeding, universal iodization of salt, measles control, polio eradication, child nutrition, child survival and sanitation. WHO collaborated with FA0 in the nutrition programme, and with UNHCR in the health education project for refugees in Rakhine district in Myanmar. An MoU has been signed between the United Nations 10 The Work ol WHO In SEA High Commissioner for Refugees and WHO for closer cooperation in the field of humanitarian assistance in emergencies. I WHOcontinued to execute 22 components of the Fourth Population and Health Project in Bangladesh which is funded by the World Bank ConsortiumThe Organization worked closely with the Government of Bangladesh ond the World Bank and other external agencies in the formulation of the Fifth Population and Health Project. WHO also provided technical support to the World Bank-funded proiects in lndia, Indonesia, Nepol and Sri Lanko. WHO was involved in the reorientation of the health sector policy of the Asian Development Bank [ADB). It worked closely with the ADB-funded projects in Bangladesh, Indonesia and Nepal. Following a ioint WHO and Government of Japan mission, the latter made o commitment to support EPI su~eillonce octivities in Myanmar; made voluntary contributions to strengthen nation01 capacities for iodine deficiency disorders (IDDl control in Bhutan and Myanmar, and pledged to contribute about US$14 million towards the polio vaccination programme in lndia during 1 W6~ 1997 and 30 million Japanese Yens for NID octivities in Thailond. WHO supported the efforts of various bilateral organizations in the formulation of health programmes to be assisted by them. These included the Danish lnternationol Development Agency IDANIDA), the Australian lnternationol Development Assistance Bureau (AIDAB), the Canadion lnternationol Development Agency [CIDA), the DirectorateGenerol for lnternational Cooperation of the Netherlands, the German Agency for Technicol CooperationlGTZ), the Norwegian Agency for International Development INORAD), the Overseas Development Administration [ODA) of the United Kingdom, the US Agency for lnternational Development [USAID) and the Finnish lnternational Development Agency (FINNIDAI WHO continued its initiative to enhance partnership with nongovernmental organizations and, in the process, closely collaborated with a number of NGOs in wideranging health programmes in the Region. Notable among them were Rotary International, Nippon Foundation and Lions lnternational. General Programme Development and Management 11 Mobilization of external health resources Health Ministers' meeting WHO continued to work closely with international and bilateral agencies to mobilize resources for priority health programmes in the Region. It provided technical support in the preparation of the health sector documents for the Sixth Round-Table Meeting for Bhutan, which was held in Geneva in January 1997. In order to strengthen national capacity for aid negotiations for mobilizing external resources for health, an intercountry workshop was organized in Kathmondu in April 1997 where the five leastdeveloped countries of the Region, namely, Bangladesh, Bhutan, Maldives, Myanmar and Nepal, The Regional Office continued to liaise and work closely with the relevant units at WHO headquarter for mobilizing extrabudgetory resources in order to support the Organization's collaborative programmes in the Region. The 13th meeting of Ministers of Heolth of the SEAR countries, held in Colombo, Sri Lanka, in September 1995, established an innovative mechanism by institutionalizing the working of these meetings the chairman of a meeting will act as chairman of the Health Ministers' Forum till the election of a successor at the next meeting Accord~ngly, H E Mr A.H.M. Fowzie, Minister of Health, Highways and Soc~ol Services, Sri Lanka, sewed as Chairman of the Health Ministers' Forum during 1995-96 In this capacity, he visited several countries which helped to promote regional solidariiy and mutual cooperation in health development, particularly in the field of human resources for heolth The Health Ministers also decided that the Health Secretaries of the Member States should meet regularly. The 14th meeting of the Health Ministers took ploce in Jakarta/Bandung, Indonesia, in October 1996. HE. Prof Dr Suiudi, Minister of Heolth of the Republic of Indonesia, assumed the chairmanship of the Heolth Ministers' Forum for 1996-97. A Monograph on Poverty and Health, by the Margo Institute, Sri Lonko, was circulated at this meeting. The Ministers noted that the Governments were responsible for developing suitable health policies and regulatory frameworks for the realization of the objective of improving the health status of the people in the light of the expanding 12 Thm Work of WHO in SEA The recent international conferences, most notably the Fourth World Conference on Women, held in Beiiing in 1995, have given high priority to women's health as an essential part of their empowerment. Countries have been taking steps to translate into action the commitments mode at these conferences. These have included the development of national policies on women, the creation or strengthening of appropriate national machinery for the advancement of women and gender sensitization of health programmes. The Regional Office undertook the preparation of country profiles on Women's Health and Development [WHDI The profiles and guidelines were initially field-tested in Myanmar and Thailand. A working group meeting on WHD county profiles was held in Myanmar in March-April 1997 to launch the second phase of the complet~on of the country profiles in all SEAR Member States. Acknowledging the role of health legislation in the implementation of HFA strategies, Bongladesh. Indio, Indonesia, Myanmar, Nepal and Thailand, in collaboration with WHO, have been reviewing and updating their health legislation. Indonesia has a specific programme dealing with health legislation, ethics and bioethics. With assistance from WHO, Nepal finalized a new Health Act in an effort to provide health services equitably WHO collaborated with India in the area of organ transplantation and brain death, which resulted in the enactment of an Act on humon organ transplantation WHO supported principal investigator-initiated research projects in the areos of communicable diseases; health economics; human resources for health; reproductive health; adolescent health; maternal health, plague surveillance; preinvasive and invasive lesions of the cervix and outreach-clinics coverage. Commissioned research was promoted on adolescent health; county profiles on women's health and development; health care financing; study of factors and policies that determine geographical and sectoral distribution of doctors Women's health and development Health legislation, ethical dimensions of health care and bioethics Research policy ond strategy coordination Hulth. Sclanca and Publlc Policy 15 I and a study of general practice and its implications for medical education. In order to strengthen research development activities, the Regional Office developed an 'institutional memory' for the regional research programme; conducted a health systems research (HSR) workshop, and reviewed the existing training modules on MCH/FP. It also assessed the current status of the prevalence of hepatitis B; developed research proiects on health futures trend assessment; conducted health policy research workshops, and supported a research project on field-testing of women's health. The 22nd session of the South-East Asia Advisory Committee on Health Research ISEA/ACHR], held in Dharan, Nepal, in April 1996, discussed such topics as research in occupational health; eth~cal issues in health, and promotion of research in health sector reforms. The tenth meeting of Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries [MRC] was held in Bandung, Indonesia, in October 1996. The meeting discussed the complementarity of health research activities supported by various agencies at the country level; research on health in the urban environment; research for promoting heolth in public policies, especially development policies, and research relofing to health in border areas with emphasis on disease su~eilionce The 23rd session of the SEA/ACHR, held in Chiang Rai, Thailond, in April 1997, discussed and made recommendations on: ii] strategies for effective promotion of the application of research results in health development; [ii] health futures research - its role in the formulation of the HFA strategy for the next century, and (iii) ethical issues in health. Though the meeting felt that both the ACHR and MRC had distinct roles and functions to it recommended that they should continue to work independently but with necessary coordination, and their future meetings should be held concurrently, followed by a ioint meeting of the two bodies. An intercountry nutrition-cum-research workshop, in June 1996 in Jakarta, reviewed the results of nutrition research activities carried out in the Region in the context of the nutrition ne~ork. 16 rho Work of wno In su November 1996 clarified the methodologies used in estimating the health and health-related indicators, and recommended that WHO should continue to use data from both national and other sources in preparing the Regional Health Report and other regional publications The Reg~onal Office published the Regional Health Report for 1996 and 1997 The 1996 edition provided a general perspective of health development in the ten countries of the Region within the context of the polit~cal, social, economic and environmental situation. The 1997 edition reviewed the HFA development and its impact, achievements and lessons learnt during the last bventy years in the South-East Asla Region. Preparation and production of documents, improvement of scientific communication, translation of WHO publications into national/local languages ond promotion of the sale of WtiO books were the main activities carried out during the period under review. Two Issues of the biannual Regronal Heolth Forum were issued in February 1996 and July 1996. The wentieth volume (1996) of the Dengue Newslener, which has been renamed as the Dengue Bu/letin, was issued An intercountry workshop on Improving Scientific Communication in South-East Asia, held at SEAR0 in November 1996, brought together participants from seven countries. They deliberated on the current status of scientific communication in the Region and recommended ways and means of improving it. Several documents/publications were issued on health topics which included, among others, a manual for the prevention and management of drug-related problems. Translation of WHO publications into national/local languages continued to receive active support and encouragement in order to make them easily available to health workers and the general public. The languages included Bahasa Indonesia, Bengali, Korean and Thai as well as several maior Indian languages, Publishing, language and library services Blomedlcal and Health lnformatlon and Trends 25 Health Literature and Ubmry Sewices (including HELLIS) Several reprint agreements were signed with private publishers to enable them to sell their lowpriced editions through their own networks, thereby broadbasing WHO'S dissemination efforts. The WHO publications registered the following sales figures: I Table I. Soles oi WHO publrcaoons The Regional Office Library continued to provide technical informotion and literature support toWHO staff members, Member States, United Nations agencies and biomedical resenrchers As the Regional HELLIS (Health Literature, Library and Information Service] Focal Point, it continued to plan, promote and monitor the HELLIS network activities and liaised with international agencies and other networks. I : The entire collection of books, monographs, proceedings, reports, pamphlets, WHO publications and issues of current periodicals has been reclassified according to the National library of Medicine /USA) classification scheme. The complete catalogue of monographs and periodicals has been computerized. Besides the in-house daytoday consultation, Library users were provided with computerized search faciliy for MEDLINE,AIDSLINE, WHOLIS, SEALIS, IMSEAR and FUGLIS database. The Library continued to provide support to Member States in strengthening their health literature, library and information services. NOTE The above figures represent actual receipts after deduction of oll discc>unts I and application of the concessionol conversion rate of Geneva cover I 1 prices to Indian Rupees Item Subscriptions and sales of publications In order to strengthen the WR offices' information retrieval and document delivery capabilities, the Books Management System IBMS) 26 ma Work of WHO In SEA 1995 US$ 161 012 1996 US$ 162 624 July 1995- Moy 1997 US$ 360 734

The Forvninth World Health Assembly, held in Geneva in May 1996, elected Dr Alberto Mozza (Argentina) as President. From the South-East Asia Region, HE. Mr A.H.M. Fowzie (Sri Lankal was elected as one of the Vicepresidents Professor A.K. Shamsuddin Siddiquey [Bangladesh) was elected as ViceChairman of Committee '6' and Dr jigmi Singay (Bhutan) as Rapporteur of Commiiiee 'A'. Indonesia was elected to designate a person to serve on the Executive Board for a term of three years to fill the vacancy of the outgoing member, Nepal, from the South-East Asia Region. In its 31-point agenda, the Health Assembly reviewed and approved the reports of the Executive Bwrd's 96th and 97th sessions and also approved the reports of the main committees. The discussion on WHO reform in response to global change covered, inter olio, renewal of the HFA strategy and review of the WHO Constitution. The Health Assembly adopted 29 resolutions. The Fiftieth World Health Assembly, held in Geneva in May 1997, elected H E. Mr Saleem lqbal Shervani, Minisler of State for Health and Family Welfare (India), as President. Dr S.R. Simkhada [Nepal) was elected as one of the ViceChoirmen of Committee '6'. Sri Lanka was elected to designate a person to serre as a member of the Executive Board in place of the outgoing member. Thailand. The Health Assembly reviewed the reports of the Executive Bwrd's 98th and 9ah sessions. World Health Assembly Executive Board The Health Assembly discussed the World Heolth Report 1997 which had 'Conquering suffering, enriching humaniiy' as its theme. The Health Assembly reviewed and npproved the progrornme budget for 1998~1999 the work of the preparation of the loth General Programme of Work and endorsed the reports of Committee 'A' ond Committee 'B'. Discussions were held on WHO reform, budget and finance matters and control of tropical diseases, including malaria and filariasis. The Heollh Assembly adopted 38 resolutions. The 97th session of the Executive Board was held in Geneva in January 1996. In the context ofWHO's response to global change, the progress report on reforms, the role of WHO country offices, review of the Orgonizotion's Constitution and reassignment of Member States to different regions were some of the subiecls discussed. The 98th session of the Executive Board was held in Geneva in May 1996 and Mr Songay Ngedup [Bhutanl wos elected as Chairman. It discussed the reports of scientific advisory bodies, WHO response to globol change, the review and evaluation of specific programmes and budgetary reform. The 99th session of the Executive Board was held in Geneva in January 1997 In the context of the item on WHO reform, the Board discussed, inter olio, renewol of the HFA strategy, review of WHUs Constitution and the role of WHO country offices. The Board considered proposals for further savings, including the possibility of holding biennial instead of annual meetings of the Heolth Assembly. It also reviewed and endorsed the programme budget for 1998-1 999 The 100th session of the Executive Board was held in Geneva in May 1997 immediately oher the Fiftieth World Health Assembly. The Board discussed the drah global health policy and the role of WHO country offices, the progress report of its special group on the review of the WHOConstitution and the implementation of Rule 52 of the Rules of Procedure of the Executive Board regarding the nomination for the post of DirectorGeneral. Two sessions of the Regional Committee for South-East Asia were held during the period covered by this report: while the fortyeighth session wos held in Colombo, Sri Lanka, from 12 to 18 September 1995, the fortyninth session was heid in Chiang Mai, Thoiland, from 9 to 14 September 1996. At the forbighth sesslon, the Regional Committee reviewed the report of the Regional Director covering the period 1 July 1993 to 30June 1995. The Committee agreed on a supplementary intercountry programme with the focus on three broad areas, namely, advocacy for health, technical cooperation among countries and international cooperation on standard-setting and innovations. The Committee agreed to implement these programmes by transferring resources from country budgets for 1996-1 992 During the technical d~scussions on Alternative Financing of Health Care, the Committee urged the Member States to study and explore alternative financing of heoith care and introduce suitable reform measures to ensure quality of service, social responsibility and consumer protection. The forbpinth session of the Regionoi Committee considered the report of the Regional Director for the period 1 July 1995 to 30 June 1996. The Committee olso noted the recornmendotions of on ad hoc working group on regional allocations, the observations and recommendations of the Regional Consultation on WHO Constitution and the implementation status of supplementary intercountry programmes. The Committee felt that the Executive Board members from the Region should be associated with important meetings organized by the Reg~onal Office, including policy-level meetings such as the Regionol Committee. It urged the Member States to encourage and promote the participation of women in the meetings of WHOgoverning bodies as well as in the work of the Organization. The Committee endorsed the proposed programme budget for 1998-1999, which wos prepared using the concept of strotegic budgeting with products for specific programmes. Technical discussions were held on Quality Assurance in Laboratory Practices. The Committee emphasized the need to develop national laboratory policies with quality assurance as an integral part of laboratory services, and urged the Member States to strengthen their capacities for improving the performance and quality of laboratory practices. The Committee urged the Member States to develop, improve and integrate their national health systems into the managerial processes for health development, and requested the Regional Director to continue to publish the Regional Health Report annually, focusing on specific themes of relevance to the Region. 4 The Work of WHO in Su

The ~enovotion programme in the Reg~onal Offlce wos completed io \he Cofeteiio, the Conference Holl and its lobby, and the areas Additional renovotion work was continued to improve the aircondi\ioniny and electrical wiring infrostruclure. Some offices were remodelled to Increase the efiiciency of space utilizotion. Negoliotions with municipal authorities were in progress to obtain permission \o constrirci on add,t~onol office floor rn !he annexe, for which funding had earlier been obtained from the Real Estate Fund Administrative support to technical programmes

THIS REPORT is o summary of the work of WHO and its Member States in corrying out their collaborative programmes during the period 1 July 1995-30 June 1997. It is a microcosm of the situation that obtains today in the Region, with the rapidly changing epidemiological, economic and social scenarios and the all-round efforts being made to face them. The overall picture that emerges is one of optimism at having made considerable progress, which will determine the future course of action for health development in the South-East Asia Region. The Fortyninth and the Fiftieth World Health Assemblies were held in Geneva during the reporting period. The Forty-ninth World Health Assembly, held in May 1996, discussed the World Health Report 1996; the budgetary reform; WHO'S response to change; renewal of the Health-for-All Strategy, and the Organization's Constitution. In the area of communicable diseoses, attention was focused on the destruction of stocks of variola virus and on new, emerging and re-emerging infectious diseases. The Fiftieth World Health Assembly, held in Geneva in May 1997, approved the programme budget far 1998- 1999. It reviewed the preparation for the 10th General Programme of Work, and discussed the World Health Report 1997; WHO reform; budget and finance matters, and control of tropical diseases, including malaria and filariasis. The 97th session of the Executive Board, held in January 1996, reviewed the method of work of the World Health Assembly, the progress report on WHO reforms and the role of WHO country ofices. Exacutlw Summary Governing Bodies General Programme and Management ' The 98th session of the Executive Board held in May 1996, which elected Mr Sangay Ngedup of Bhutan as its Chairman, considered the reports of WHO scientific advisory bodies and meetings of experf committees and study groups and reviewed the evaluation of specific programmes and budgetary reforms. The 99th session of the Executive Board, held in January 1997, discussed the financial situation of the Organizafion. It also discussed renewal of the HFA strategy; the role of WHO country offices, and personnel policy and practices. Both Indonesia and Sri lanka were designated to select one person each to serve os members of the Executive Boord. The 48th session of the Regionol Committee was held in Colombo, Sri tanka, in September 1995. In a spirit of solidarity, the Committee decided to have a supplementary intercountry programme with the focus on advocacy for health, technical cooperofion among countries andstandard-setting and innovations. It also agreed to transfer necessary resources from country budgets. Aher considering the subject of alternative financing of heolth care, the Committee indicated that Member States would need to undertake regulatory measures to rationalize the mix of public and private sector health services. The 49th session of the Regional Commiffee, held in Chiang Moi, Thailand, in September 1996, took note of the preparation of the strategic programme budget with products for each specific programme and annual detailed plans of action to achieve them. To promote gender equality, the Committee urged Member States to encourage participation of women in the meetings of WHO Governing Bodies. The Ministers of Health of the Region have established a tradition of meeting regularly to promote mutual cooperation br health development and to enhance regional solidarity. At their 13th meeting in Colombo in 1995, the Ministers decided tho! the chairman of the meeting should act as chairman of the Health Ministers' Forum till the selection of a successor at the next meeting. They also decided that the Health Secretaries of the Member States should meet regularly. The 14th meeting of the Heolth Ministers, held in Jakarfa/Bandug in 1996, stressed, among xII ma Work of WO In SEA other things, the need to combat new, emerging and reemerging infectious diseases. The first meeting of the Health Secretaries was held in New Delhi in 1996. The Health Secretaries decided that they should meet annually with a well-focused agenda. The second meeting, held in Bali, Indonesia, in 1997, agreed that a part of the country budget, which could not be utilized in time, might be used for supporting countries in greatest need. They recommended that Member States should increase efficiency in implementing WHO collaborative programmes. As part of the managerial process for WHO programme development, and in accordance with the recommendations of the Executive Board working group on WHO response to global change, a product~riented approach was used for developing the strategic programme budget proposals for 1998- 1999, and the detailed plons of action at the country and regional levels during 1996 1997. With a view to protecting the regional allocation and safeguarding the needs of the Member States, an Ad hoc Working Group suggested certain criteria for regional allocations for submission to WHO/HQ. To streamline the technical aspects of programme delivery, the capability of WHO country office staff to manage the Organization's collaborative programmes was strengthened. Following a resolution of the World Health Assembly /WHA48.16), the Regional Office organized a series of meetings on renewal of HFA strategies. The Member States, as a result, are proceeding with renewing their HFA strategies as an integral part of national health planning process. The Regional HFA Strategy for 20002020is being developed on the basis of inputs generated by country exercises undertaken to formulate their five-year/perspective plans. A major initiative has been taken to strengthen WHO'S partnership with other UN agencies and to forge new alliances with multilateral and bilateral organizations and financial institufions such as the World Bank and the Asian Development Bank. A Memorandum of Understanding (MoU) between the Association of South-East Asian Nations (ASEAN) and the WHO ~xwutlve Summary xiii Health, Srienre and Public Poliry Regional Offices for South-East Asia and the Western Pacific has been signed and a framework of cooperation agreed upon. Conclusion of a similar MoU for mutual cooperation between the South Asian Association for Regional Cooperation (SAARCJ and . WHO/SEAR is under process. It is expected that cooperation between these important regional country groupings and WHO will strengthen Member States' capabilities to deal with common health problems. In order to further consolidate cooperation between WHO and the World Bank, a meeting of the WHO Representatives in the Region and the World Bank officials was organized in 1995. WHO continued to liaise actively with major bilateral agencies for mobilizing resources for health, and provided support to the Asian Development Bank in reorienting its health sector support policy. leadership for health was significantly emphosized and advanced by several global-level meetings convened recently by the United Nations. It is now recognized that health is the cornerstone of social development. The Bretton Woods organizations and other donors are now devoting more resources for health development. The themes of the global UN meetings have been widely disseminated in the Region. The ongoing exercises for renewing the HFA strategy will enhance leadership for health at all levels. Several initiatives undertaken by the Regional Office are contributing to building up leadership for health and placing heolth high on national development and political agendas. The country profiles on Women's Health and Development (WHDj are being completed to address the gaps in reliable and uptodate information obout prevailing and emerging WHD issues. Realizing the role of health legislation in fostering equity and bringing about quality assurance and cost-effectiveness in health services, the Regional Office continued its support to Member States in dealing with matters concerning health legislation, ethics and bioethics. Both Indonesia and Nepal were supported in dealing with heolth legislation issues. legislation on human organ transplantation in India was prepared with WHO collaboration, IV The Work of WHO In SEA while Sri lanka received technical assistance in organizing a regional training workshop on medical ethics. In furtherance of the health research policy of the Organization, the Regional Office supported research projects in communicable diseases, heolth economics, reproductive health ond maternal health. Commissioned research was also promoted on adolescent health and women's health and development. The Region's research promotion efforts were duly recognized by the aword of the Jacques Parisot Foundation Prize for 1996 to Dr K.A.K. Wiiewardene of the University of Keleniya, Sri lanka. Active collaboration has been pursued with Member States in revising and implementing their health policies. In strengthening the national managerial process, the Regional Office supported ~~~~~~~~building and interacted with national authorities in finalizing national health plans. WHO'S inpuh helped in generating the necessary technical and financial support to the countries from bilateral and multilateral agencies. Y While technical cooperation among countries proceeded smoothly as in the past, cooperation between countries in tackling common health problems such as border meetings to control malaria and kala-azar, and holding of joint national immunization days was facilitated by WHO. The countries in greatest need were supported technically and financially in developing their health plans, health care financing, heolth infrostructure management, manpower planning and strengthening district health systems. All the countries were supported through the provision of a wide range of medical supplies and equipment. Six countries benefited from the emergency preparedness programme of the Organization. The Regional Office actively collaborated with the countries in institutionalizing health sector emergency management in addition to carrying out training activities and providing medical supplies during emergencies arising from floods and other calamities. Accident prevention and safety promotion were also promoted in the Region. National Health Policies and Programme Development and Management Executhne Summary xv Biomediral and Health Information and Trends Organization and Management of Health Syxtems Based on Phrrry Health Cure Though allMember States have communicable disease surveillance progrommes, epidemiological services need further strengthening. Technical odvisory committees were set up to guide surveillance activities in many countries and notificafian of communicable diseases has been made compulsory by all countries, except Bangladesh, Bhutan and Nepal. The third evaluation of the implementation of strategies for health for all was completed and national and regional reports were prepared. With the ossistance of the Regional Ofice, Member States continued their efforts to further strengthen their notional heolth information systems (HISS) through improvement of the quality of health ond health-related data, rational reduction of HIS dato-load and wider application of informatics technology. Many publications were issued with some being translated into notional/local languages. The Regional Office Librory extended its facilities to Member States, UN agencies and research workers. Continued support was provided in strengthening the countries' health literature, library and informotion services. WHO actively promoted health sysfenis research in 011 countries through grants, training modules and workshops. This hos helped in promoting an awareness of the skills needed in HSR as also the utilization of the research results. While advocacy for the decentralization of health systems was conhnued, ptonning at nahonat and district lev& and micropianning at the health centrelevel were supported. Healthy village concepts are emerging in several countries following the Healthy Cities apprmch. Because of shortage of resources for health core financing, alternative sources of funding, including privotization, were promoted. Technical support was provided to Member Countries in carrying out studies and relevant training was provided to health personnel. The focus of WHOprogrammes has been on equitable access to health and quolity of health care and community action for health. Strengthening the organization and management of district heolth systems based on primary health care was pursued. WI The Work of WHO In SEA Community participation in accelerating health development at the district level was strengthened. The intercountry collaborative programme on 20 'model' districts has generated the active participation of nationals in furthering this programme. All the countries are developing two model districts eoch using the guide lines and training modules developed at on intercountry training workshop. The crowning success of the Region's attempts at strengthening the district health system is epitomized by the Mongar experiment which received the Sasokawo Health Prize in 1997. Though there is some imbolonce, in varying degrees, in the HRH policies followed by the countries in the Region, there has been a narrowing of the gap between plans and their octual implementation. The Regional Office initiotives included the formulation of on HRH policy, improving undergraduate and postgraduate medical education ond training as well as promoting closer linkages between medical education and health services. A regional project to promote innovative strategies in medical and nursing education and develop six centres of excellence was started. The trend towards short-term fellowships and study tours was g continued. Several institutions in the Region, particularly in India, Indonesia, Sri Lanko and Thailand, played host to fellows from other Regions. A fellowship evaluation tool, developed by WHO/HQ, was field-tested in Sri Lanka. The regional consultation on Fellowship Policy and Evaluation, held in 1996, made recommendations which ore expected to improve and strengthen the regional fellowship programme. All Member States now have projects under the Action Programme on Essential Drugs. Various components of the drug policy such as drug registration and regulatory control, drug quality assurance, rational use of drugs and monitoring and evaluation of national drug policies were further developed and strengthened. As o result of the implementation of national drug policies, availability of essential drugs for primary health core has improved in most countries. Two technical cooperation projects involving countries in the South-East Asia and Western Pacific regions that are currently operationalaim at improving collaboration between ASEAN Exocutlve Summary Human Resources for Health Essential Drugs and Qualify of Care and Health Technology Healthy Behmriour and Mental Health and SEAR countries in the field of essential drugs. The Regional Office continued to procure drugs, biologicals and contraceptives for WHOsupported programmes. Efforts were continued to improve national capabilities for quality control of drugs and biologicals. WHO collaborafing centres continued the testing of EPI vaccines and training of nationals in quality control of vaccines. The application of the WHO Certification Scheme for the quality of pharmaceutical products moving in international commerce has become more relevant since India, lndonesio and Thailand ore producing raw materials as well as finished products for export. Through the mechanism of bi-regional technical cooperation, good manufacturing practices are being implemented in many countries. Traditional medicines are practised in most countries of the Region even though their regulation, standardization, manufacture, quality control and utilization are at varying stages of development. A study tour organized for participants from Bangladesh, Indonesia, Myanmar, Nepal, Sri Lanka and some countries of the Western Pacific region to India and China exposed them to the advances made in the field of traditional medicine. Most countries hove augmented their laboratory infrastructures. Effom have been made to propagate the concept of quality assurance in laboratory services. laboratory ne~orks ore being established in many countries at the central, intermediate and peripheral levels; however, linkages need further strengthening. The concept of public mental health has gained wide acceptance, though much of the technologies needed for its implementofion are still to be developed. WHO continued its advocacy for extending the concept of mental health. Notable developments were the designation of the Schizophrenia Research Foundation in Chennai, India, as the new WHO Collaborating Centre for Research and Training in Mental Health; holding of a training workshop on Health Behaviour Research Methodology, and development of indicators for the quolity of community life based on a protocol developed by WHO. Developmenf of community-based programmes for the reducfion of illicit drugs wos supported in some countries. The rvlli The Work ot WHO in SEA implementation pion of the third phase of the uNDCP-supported Drug Abuse Control Project in Sri lanka was drafted. Anti-tobacco activities received increased attention in all countries. Focal points for tobacco control were appointed. Legislative measures for banning tobacco smoking in public places were introduced in some countries. The heolth education infrastructure has been decentralized to the community level in many countries, with volunteers playing a critical role in information dissemination. Health education services were extended and progress achieved in the development of o critical mass of trained manpower. The concept of community-based rehabilitation (CBR) continued to be promoted. The WHO manual on CBR was translated into local languages in Banglodesh and Bhutan as also in India and Myanmar. Support was extended to the establishment of a notional CBR programme in Bhutan and for reviewing the feasibility of local production of lowsost artificial limbs in Sri lanka. Nutrition continues to be a priority areo in the Region, and the focus of WHO'S support was on improving the quality of national I progrommes to oddress the priority areas of protein energy ma/nuhition, iodine deficiency disorders, vitamin A deficiency and iron deficiency anaemia. SEAR0 supported the production of a national nutrition survey report os well as evaluation of the deworming programme in Moldives and development of a household food security study in Myanmar. In the field of food safety, support was provided to review programmes and identify priority areas for action for legislation ond training. Within the fromework ofthe regionalstrotegy forreproductive health, all countries have developed national strategies and identified safe motherhood, family planning, HIV/STD/RTl,prevention of inferfility and adolescent reproductive health as priority areos for action in their reproductive health packages. In addition to WHO, other UN agencies such as UNFPA, UNICEF, the World Bonk and the Asion Development Bonk and bilateral organizations are involved in reproductive health programmes of the country level. The Scientific Working Group on Operational Research in Reproductive Health Nutrition, Food Safety Reproductive, Family and Community Health and Population issues ~xecutlva Summary XIX identified priority areas for operational research and recommended ways for promoting and strengthening research. One priority area is the development of modules for delivery of integrated reproductive health services for which a prototype protocol was developed. Moternal mortality continues to be high in the countries of the Region, except DPR Korea, Sri lanka and Thailand. A significant reduction in infant mortality in the Region was noticeable. The change in adolescent likstyles wos recognized in most countries and adolescent heolth was included as a component of the reproductive health package. WHO was involved in providing training ond IEC materials and in conducting country as well as regional training courses in adolescent health. The concept of women's health gained wide recognition, especially aher the lnternational Conference on Population and Development in Cairo in 1994. The number of elderly persons is increasing in all countries of the Region, underscoring the importance of evolving programmes for the care of the elderly. The Speciol Programme of Research, Development and Research Training in Human Reproduction (HRPJ emphasized the need for improving reproductive health, and mony countries maintained a high level of co/loboration with this programme. Two important activities carried out were: evaluation of the programme's impact in terms of strengthening research capabilities in the South-East Asia and Western Pacific regions, and holding of a series of regional workshops on ethical issues in reproductive health. In addition. several workshoos. svmoosia and scientific I .. , , meetings were held in reproductive heolth epidemiology, human reproductive research methodology, quality assurance of oral I and injectable controceptive~ dato 'management and communication and sociol science in human reproduction. Efforts were made to strengthen the occupational heolth programmes through training courses for diffirent categories of heolth personnel. The International Symposium on Occupational Health Research, held in Thailand in 1995, identified major forms of occupational hazards and their impact and possible intervention strategies and approaches. XX ma Work of WHO In SEA WHO'S collaborative programme focused on drinking-water qualify surveillance and operation and maintenance of water supply facilities. Short-term training courses and study tours in various water supply and sanitation topics such as reuse and recycling of waste water and wastes were conducted for participants from Bangladesh, Indio, Maldives, Myanmor and Sri Lanka. Promofion of the Healthy Cities approach was started in Chittagong, Bangladesh, and later extended to Kathmandu and Bangkok. Twenty steps to a Healthy City were identified and pamphlets describing these steps were disseminated to countries olong with other promotional moterial. The programme for environmental health hazords focused on developing national capacities ond capabilities to assess and manage health hazords as a result of environmental pollution. Regional technical guidelines on air quality monitoring were prepared. In order to strengthen national chemicol safefy programmes, WHO initiated the preparation of national chemical profiles in five countries, of which three have been completed. Studies on chemical emergency preparedness and response were completed in India, Sri Lonka and Thailand. An assessment of the chemical sofefy programmes in selected countries wos undertaken in 1996 to drah a regional action plan to promote chemical safety. Countries were assisted in identifying and assessing health hazards and issues involved in environment, housing, public works, agriculture and industries. Based on these intersectoral assessments, notion01 action plans were developed incorporating health and environment strategies in all development sectors. Support wos provided for identilying prior;?. health and environment actions for incorporation into the nations/ Agenda 2 1 of different countries. Indio, the only country in the Region where guineaworm disease is present, made steady progress towords its eradication. WHO played an important role in establishing the National Guineaworm Eradication Programme and helped in developing and updating an operational manual. Only nine guineaworm disease cases were reported in 1996, and it is expected that the country will achieve zero-incidence in 1997. Environmental Health Eradication1 Elimination of Specific Communicab/e Diseases Executive Summary XXI Control of other Communicable Diseases The leprosy control programme has been integrated into the basic health services in all countries, except India where a vertical programme is in operation. Two countries in the Region achieved the eliminotion goal of case per 10000 population, and three more countries, nomely, Bhutan, Indonesia and Maldives, are expected to reach this goal by the end of 1997 or in early 1998. Special action projects were launched in 1996 in lndonesio, Myanmar and Nepal. Bangladesh and lndio are expected to launch similar compaigns shortly. Eradication of poliomyelitis is a topprioriiy programme of WHO. Coordination efforts of the Organization led to the synchronizotion of national immunization days in eight countries in three regions when more than 40 per cent of the world's children aged below five years received oral polio voccine. Training was provided to all national and regional reference laboratories in mhpproved standard methods for polio virus isolation. Five countries hove affoined the target of elimination of neonatal tetanus (Nl), i.e. less than one case per IOW live births. In 1996, all countries conducted a review of the achievement of NTelimination following the Wrecommended methodology. Countries were encouraged to implement the HighRisk Approach for NT ond it is expected that Bongladesh, India, Myanmar ond Nepal will prepore country plans of action for implementing this approach. By the end of 1995, the SEAR hkmber States, except lndia and Nepal, had maintained national measles vaccine coverage of more than 80 per cent in children under one year. Although the incidence of measles hos shown o downward trend, all SEAR countries still have loci of susceptible populations. The countries are preparing long-term plans of oction for measles control ond elimination. The coverage rates for EPktarget diseases were over 80 per cent and the political commitment to continue the EPI programmes remained strong. Increasing emphasis has been given to identifying the remaining foci of susceptible children that hove not been reached by the immunization programme. In addition to the EPI-target diseases, childhood immunization against hepatitis B was introduced in some countries. xxll me work of WHO In SEA The acute respiratoty infections (ARIJ and diarrhoea1 diseases control (CDDJ programmes were aimed at reducing mortality and morbidity amongst children. Technical guidelines for the control ond treatment of ARI were revised and training courses were conducted. A combined ARI/CDD curricula was developed for selected nursing training schools in Indonesia. While bocterial drug resistance studies were completed in Thailand, similar studies are proposed to be initiated in other countries. The first integrated course on the monagement of childhood illnesses was completed. Progress was made on the WHO/UNICEF Initiative on Integrated Management of Childhood lllnesses with some districts in India and Nepal being selected for its implementation. Considerable progress has been made towards achieving the global target for tuberculosis control by implementing the directly observed treatment, short-course (DOTS) strategy. Revised national TB programmes have been developed in five countries. WHO continued to colloborote with the World Bank and other agencies for implementing TB control programmes in Bangladesh, Bhutan, India, Indonesia, Myanmar, Nepal and Sri Lanka. A regional strategy for TB control in SEAR was developed. The need for human resources development was addressed through international training workshops. Operational reseorch studies were conducted in Bangladesh, India, Nepal ond Thailand. Some of the new, emerging and reemerging infectious diseases are cholera, zoonoses, rabies and plague. With regard to plague, WHO collaborative activities consisted of provision of technical information; training of nationals in laboratory diagnosis and production of diagnostic reagents; promotion of laboratory diagnosis and surveillance, and development of a rapid response mechanism. In addition to the current infectious disease problems, potential problems associated with the increase in a number of drug-resistant bocterial and parasitic infections were posing grave concern. Member States were supported in the containment of dengue outbreaks. The Dengue Bulletin (formerly known as Dengue Newsletter) was published in December 1996 and is expected to be an annual feature. The development of a tetravalent live attenuated dengue vaccine at Mahidol University in Thailand, with technical and financial support from WHO, was successfully Exocutlva Summary xxlll undertaken. Hepatitis 6 control programrnes were established in many countries of the Region and heputitis B voccinotion wos extended to more provinces in lndia, Maldives and Thailand within the framework of EPI. Sextually transmitted diseases and AIDS continued to spread ominously. More emphosis was being given to advocacy at the country level as well as to expanding the progromme to the community level. A review of HIV/AIDS care approaches was carried out in Thailand and an initiative was taken to develop a model which could subsequently be implemented throughout the country. The Regional Office continued to mobilize additional notional and international resources. It played an important advocacy role by highlighting the devastating potential of the AlDSpondemic. An integrated approach to STDcontrol, monitoring of gonococcal anti-microbial sensitivity and guidelines for STD management were developed. Collaboration for the control of malaria and drug resistance in border areas between Bangladesh, Bhutan, lndia and Nepol was initiated. The Organization helped lndia and lndonesio in their negotiations for financial assistance from the World Bank and the Asian Development Bank for their malaria control programmes. Similar support was given to Bongladesh and Myanmar. The regional monitoring system for vector resistance to insecticides wos strengthened. The Special Programme for Research and Training in Tropic01 Diseases PDR) sponsored research activities on leprosy and filariasis in addition to malaria and leishmaniosis. These activities included studies on drug resistance and drug efficacy; malaria vaccine development; health financing of malaria programmes; vector control, and drug-regimen compliance. The prevention of blindness progromme continued to focus attention on the promotion of primary eye care using the PHC network and control of avoidable blindness through restorative interventions. Comprehensive national cancer control programmes were formulated in several counfries of the Region. Demonstration areas for an integrated control of major noncommunicable diseases such as cancer, cardiovascular diseases and diabetes were Tho Work ot WHO In SEA initiated. A common package of interventions was established for various levels of health care. The oral health programme continued to lay emphasis on the prevenfian and control of caries and periodontal diseases. Bangladesh was assisted in its school or01 health programme, while India and Indonesia received support in the implementation of primary oral heolth projects. In line with the decision of the Executive Board and to moke the best possible use of national expertise, a start was made with the creation of one post of National Profession01 Officer. Seven mare posts ore being established. As of 30 June 1997, there were 105 Professional staK of which 18 were women. During the period under review, 258 short-term staff were recruited, of which 68 were women. Some offices within the Regional Office building were remodelled to create a better working environment and to moke optimal use of available space. The Budget and Finance unit continued to provide support to the timely delivery of the collaborative programme through budgetary and fiscal measures. Executive Summary xxv

India is the only country in the Region where guineoworm disease Dracunculiasis is present WHO played o crucial role in the establishment of the (Guineaworm notional guineaworm erodicotion progromme IGWEPI and helped in developing and updating on operational manual. Technical and disease) financial support was provided for conducting meetings of the GWEP task force and in evaluations. The deployment of epidemiological su~eillonce teams in endemic states to monitor the programme activities and help district/PHC authorities in effective implementation of various operational components was also supported. In 1996, WHO supported workshops on establishing the criteria for the certification of guineowoim eradication; during 1996, oniy nine coses of guineoworm disease were reported, and it is expected that India will achieve zero incidence in 1997 The estimated number of leprosy coses in the Region decllned from 5.5 million in 1985 to 0 83 mill~on in 1996 while the registered coses decreased from 3 8 million to 0.63 million during the same period. The programme has been integrated into basic health seivices EradbatlonlEiimlnstlon of S~eclfic Communicable Diseases 65 Poliomyelitis in all countries, except in lndia where a vertical programme continues to be in operation in the endemic states and districts WHO supported training activities for leprosy health workers in Bangladesh, India, Indonesia, Myanmar and Nepal in various aspects of leprosy control, management techniques and prevention of disabilities. In Bangladesh where the programme is funded by the World &Ink, WHO has been assisting in !he planning, supervision and monitoring activities as well as in the training of health workers. In 1994, Sri Lanka and Thailand had achieved the goal of leprosy elimination (1 case per 10 000 populationl; it is expected that three other countries - Bhutan, Indonesia and Maldives - will achieve the goal by end 1W7/early 1998. Since 1995, Special Action Projects for Elimination of Leprosy (SAPEL) to provide service in difficult, isolated areas have been launched in several SEAR countries such as Bangladesh, India, Indonesia and Myanmar, to be followed by Nepal The leprosy elimination campoigns (LECs), which have been carried out since 1996 in Indonesia, Myanmar and Nepal, ore part of the notional campoigns with a timebound activity schedule for three months. These LEC activities will be extended to Bangladesh and lndia as well lo accelerate the elimination work. In order to improve implemen~ation, health system research in leprosy as well as research in some other aspects of the programme was carried out in lndia and Myanmar with WHO support. A WHO collaborating centre for this purpose was established in early 1997, in Chenno~, India. in collaboration with the Indian Council of Medical Research. Polio eradication is one of the priority programmes in the Reg~on. Improving cross-border coordination of polio eradication activities hos received, and will continue to receive, maximum support. In December 1996 and January 1997, intra- and inter-regional coordination led to the synchronized organization of national immunization days (NlDs] in eight countries of the South-East Asia, Eastern Mediterranean and Western Pacific regions. More than 40 66 lha work of WHO in SEA Many countries in the Region are strengthening their chemical safety programmes with support from WHO. These are primarily aimed at disseminating information on proper use of toxic chemicals in agriculture and industry and in preventing poisoning from toxic substances. There has been a steady decline in the number of leprosy cases in the Region, raising hopes of achieving the goal of elimination by the year 2000. Increased application of MDT in the endemic areas and vigorous public awareness campaigns have contributed significantly in this regard. Sustained efforts are, however, required, considering that the Region still accounts for over 70 percent of the registered cases in the world. Strengthening of immunization services in the Region has resulted in coverage rates of 80 per cent or higher against EPI target diseases. The most remarkable achievement was the organization of synchronized national immunization days in the South- East Asia and ne~ghbouring WHO 1 ; regions.This resulted in more than : 40 per cent of the world's children aged less than 5 years receiving , oral polio vaccine in campaigns conducted in December 1996 and January 1997. 1; per cent of the world's children aged less than five years received oral polio vaccine [OPV) in campaigns conducted during December 1996Januory 1997 In lndia alone, more than 2 5 million health workers and volunteers manned 650000 immunization posts While 1 1 16 polio cases were reported in the Region in 1996, which represent opprox~mately half the cases reported globally, only 101 cases were reported from countries other than lndia. Despite estimates that only 10-30 per cent of the global polio cases are reported, these data highlight the vital importonce of polio eradication in lndio to achieve the global torget by the year 2000 Training In WK)approved standard methods for poliovirus isolation and characterization has been provlded to personnel from all the national and regional reference laboratories in the Region. In order to galvanize financial support for sustaining NlDs and strengthening acute flaccid paralysis [AFP] and other vaccine preventable disease surveillance programmes, an interugency coordinating committee has been established at the regional level. Inter-agency coordinating committees have also been established at the notional level in Bangladesh, lndio, Indonesia, Myanmar, Nepal and Sr Lanka Five countries - Bhutan, DPR Korea, Maldives, Sri Lanka and Thailand - have attained the target of elimination of neonatal tetanus, ie. less than one case per 1000 live births In 1996, all countries of the Region conducted district-wise reviews of the achievements of neonatal tetanus INTI elimination programmes according to the WHOrecommended methodology. Surveys in lndia and Indonesia showed that many NT cases admitted to hospito were not routinely reported and that many cases did not report to a health care facilih/. The reported regional coverage with TT2t in pregnant women was 68 per cent. The Regional Office will continue to encourage countries to implement the High Risk Approach for neonatal tetanus. During 1996, Indonesia implemented the High Risk Approach, and it is expected that, in 1997, Bangladesh, India, Myanmar and Neonatal tetanus EradlcatlotvEllmlnatlon of Specific Comrnunlcable Dlseases 67 Measles Nepal will also prepare plans of actlon and implement the Hlgh R~sk Approach By the end of 1995, the Member Stales in the Region, except lnd~o and Nepal, had achieved and maintained a level of more than 80 per cent coverage of measles vaccination in children aged under one year. However, in 1996, the meosles coverage at the district levei was still not being monitored adequately, resulting in uneven coverage levels within countries, with pockets of unimmunized children 11 is estimated that less than one per cenl of measles coses occurring in the Region ore being reported. The number of reported cases decreased from 45 1 190 in 1989 10 84 5 I2 at the end of 1995 However, all Member States have foci of susceptible populations and large meosles outbreaks were reported during 1996. In 1996, the countries were grouped in three calegor~es according to the current status of measles controi programmes, and priority octivities for each group were identified. The countries ore preporing long-term plans of action for the control and elininallon of meosles. 88 The Work of WHO In SEA

Water supply and sanitation in human settlements The focus of WHO support to countries concentrated on two moln areas - drinking-water quality surveillance ond operation and mainlenance of water supply facilities. A regional consultation on Drinking-Water Quality Surveillance and Control was held n Kathmandu, Nepal, in September 1996 in which most countries of the Region participated. Follow-up activities are in progress in Bangladesh, India, Indonesia, Maldives, Nepal and Thailand Support was provided for a meeting of the Water Supply and Sanitation Collaborative Council Working Group on Operation and Maintenance which was held in New Delhi in September 1996 This was followed by a national-level meeting of representatives of Indian states and union territories from both rural and urban sectors. It provided an endorsement of the need for greater emphasis by governments on the operation and maintenance of water supply and sanitation facilities. Field surveys of potential groundwater resources for water supply in Myanmar, a study of the financing of urban water supplies in lndia and monitoring studies of sonitot~on technologies in Bangladesh received WHO support Short-term troining and study tours in the reuse and recycling of wastewater, salt-water for toilet flushing and wostewotei management were organized for officials from Bangladesh, India, Mald~ves, Myanmar and Sri Lanko. Postgraduate training in sanitov engineering 60 Tha Work of WHO in SEA was supported for candidates from Bangladesh, Myanmar, Nepal and Sri Lanka. Training in better planning and management of water supply and sanitotion was supported in Bangladesh. Support was being extended for MIS development ond strengthening in Bangladesh and Myanmar. Short~term consultants were assigned to Maldives for the development of regulotory instruments to oversee the privatized water supply in Male and to Myonmor for the management of hospital wastes. Assignment of national consultants on R&D and human resources development wos supported in lndia. Considerable support was provided, both under the intercountry and country programmes, to Bangladesh and lndia to enable them to meet the emergency resulting from arsenic-contaminated water supplies in their border oreas. Short~term consultants were fielded to advise both countries on suitable approaches to be odopted for the identification and appropriate treatment of affected populations and for making alternative arrangements for water supply. A consultation on Arsenic in Drinking Water and Resulting Arsenic Toxicity, held in SEAR0 In April 1997, helped to develop a common framework of action that both countries will im~lement. Promotion of the Healthy Cities approach, which represents the main activity under this programme, was first started in Chittagong, Bangladesh, and extended to Kothmondu and Bangkok. Pamphlets eloboroting the twenv steps to a Healthy City were prepared and disseminated to Member States, along with other promotional material. Support in the form of short-term consultants, national consultants, office supplies and publications was extended to the communities which had already initiated the process of Healthy Cities as well as to those about to start it in Bangladesh, India, Myanmar, Nepal and Sri Lanka. In Sri Lanka, the concept of Healthy Cities was applied not only to urban centres but also to two villages which proved to be a successful model for possible replication. The World Health Day theme for 1996, Healthy Cities for Better Life, gave a timely fillip to the movemenl. Support was provided to the orgonization of the International Conference on Healthy Cities in lndia. Environmental health in urban development Environmental Health 61 Assessment of environmental health hazards Promotion of chemical safety This programme area focuses on developing national capacities and capabilities to assess and manage health hazards as a result of environmental pollution. In Indonesia, support was provided to develop the capacity of district and municipal environmental health staff to carry out comprehensive monitoring of environmental quality as well as in the development of a manual on planning, implementation and evaluation In Myanmar, assistance was provided to train a national officer in undertaking environmental assessment and management and in procuring laboratory and data-processing equipment. In Nepal, studies on hazardous and infectious wastes management and on cottage industries waste management were completed In Sri Lanka, assistance was provided to the Central Environmental Authority to develop its air quality monitoring system A draft regional document on technical gu~dance on air quality monitoring was prepared A regional consultation on Sound Management of Hospital Wastes was held in Tha~land in November 1996. A document entitled Action Plan for Development of National Programmes for Sound Management of Hospital Wastes was published. WHOj collaborative support to Member States has been directed towards building national capacities and capabilities for applying health-risk assessments, strengthening information on toxic chemicals, improving the management of chemicals as well as treating and preventing poisoning from chemicals. In Bangladesh, India, Indonesia and Sri Lanka, intersectoral briefing sessions and awareness-building meetings on chemical safety issues were held to plan for the International Programme on Chemical Safety training courses Support was provided to undertake research on the health effects of air pollution in Delhi and for a workshop on promoting the prevention of poisonings in India. In Indonesia, WHOassisted in the strengthening and development of the national poisons information network linking the Centre with districts. A survey to inventorize and register imported hazardous substances as well as local chemical products and radioactive substances was completed In order to assess the status of chemlcal safety In the Reglon wlth a vlew to strengthening nallonal chem~cal safety programmes the Reg~onol Office lnitlated the preparation of natlonal chemlcal profiles in six countries, three of which were completed. Studies on chemical emergency preparedness and response were completed in India, Sri lanka and Thailand. These studies revealed the need to strengthen or develop national chemical emergency measures within the context of emergency preparedness and response plans. An assessment of chemical safev programmes in selected countries was undertaken in December 1996 for drahing a regional action plan for the promotion of chemical safety To facilitate access to information on chemicals, CDROM packages on poisonings informotion management (INTOXI and environmental health criteria (INCHEM] were supplied to Member States Since the time the UN Conference on Environment and Development, held in 1992, produced Agenda 21 for environmentally-sound and sustainable development, the focus of this programme area has been to mobilize the health sector to advocate the incorporation of health issues and concerns into the policies of other sectors that are involved in planning and implementing national development activities. Through the Wt I0 Heolth-and~tnvironment IH&El Initiatives, Member States have been assisted in identifying and assessing health hazards and related issues in such sectors as environment, housing, public works, ogriculture and industries. Bosed on these intersectoral assessments under the H&t Initiatives, notional action plans were developed incorporating health-and-environment strategies in all development sectors In Bangladesh, two intersectoral meetings reviewed the national situational analysis of H&E issues and finalized an action plan on areas of priority concern In Bhutan, a report on the H&E situation was prepared. In Indonesia, support was provided to working groups involved in preparing the national Agenda 2 1 In Maldives, a s~tuational review was conducted in an intersectoral meeting that identified key Issues which were subsequently addressed in a national action plan In Myanmar, an intersectoral consultation was held to identify prority H&E actions for incorporation into the national Agenda 21. The Nepal Environmental Health Initiative, prepared in 1993, was updated for incorporation into the National Environmental Policy Incorporation of health concerns into environmental management Environmental Health 63 and Action. In Sri Lanka, a situational analysis was completed and a national action plan to address critical environmental concerns was prepared as an input to the national Agenda 21. In Thailand, the national situational analysis report was reviewed at an intersectoral meeting that generated a consensus on collaborative efforts in environmental planning, resourcesharing and capacity-building 64 The Work of WHO In SEA

Action programme on essential drugs All Member Stotes in the Region have projects under the Drug Action Programme (DAP] which is also known as the Action Progromme on Essential Drugs The guidelines for developing national drug pol~cies, published by WHOin 1988, were updated. In October 1995, the Government of Australia, in collaboration with WHO, convened on international conference in Sydney to exchange experiences in developing and implementing national medicinal drug policies in Asia and the Pocific regions. Participation by about 300 persons from almost 50 countries sewed to highltght the importance accorded to the development of national drug policies. Components of drug policy such as drug registration and regulatory control, selection and supply of drugs, pharmoceuticol quality assurance, rational drug use, economic strategies for drugs, monitoring ond evaluation of national drug policies, humon resources development and technical cooperation among countries were also further developed and strengthened in accordance with nation01 priorities. In November 1996, a meeting of the WHO/St'ARO Working Group on Drug Financing was convened in Tha~land to identify and improve financial mechonisms to promote equity tn the access to essential drugs at different levels of health care Drug regulatory administrations, espec~ally for India, Moldives Myanmar, Nepal and Sri Lanka, were strengthened with technical The Work of WHO In SEA support as well as supplies and equipment. National essential drugs lists have been revised. In March 1996, the first national list of essential drugs for India was formulated. Bangladesh and Nepal were assisted in developing their own reference substances. Indonesia was assisted in the preparation of a notional formulary for over-the-counter drugs The development and publication of the Delhi State Essential Drugs Formulary in Morch 1997 was supported. Bhutan, Maldives and Myanmar were assisted in the developrnent of standard treatment guidelines. The ASEAN technical cooperation in pharmaceuticals has entered its fifth phase, which extends from 1997 to 2001 The cumulative products of Phase IV (1992~19961 became evident in 1996 with the publication by lndonesia of the ASEPN Good Manufacturing Practices Guidelines (Third edition), 36 herbal monographs compiled in the Standard of ASEN Herbal Medicines [Volume I, and the development of 40 herbaria Thailand coordinated in the production of 27 ASEAN reference substances Sixty-five persons were trained through ASEAN courses and WHO fellowships. The bi~regonal technical cooperation in essential drugs began in 1996 with the aim of improving collaboration between theASEAN countries and those of the South~East Asia Region. While the ASEAN countries will be assisted to further develop their own programmes with assistance from WHO, they, in turn, will be involved in the development of programmes on quality assurance of drugs in other countries Procurement of drugs, biologicals and contraceptives is a necessary component of many WHOprogrammes. Pharmaceutical raw materials and finished formulations worth about US$] 5 million were supplied to meet the emergency situation following floods in DPR Korea In Myonmar, drugs for the treatment of malaria and tuberculos~s as well as contraceptives were supplied; in Bangladesh, essential drugs were provided for the Fourth Population and Health Project, while in Nepal, drugs for the treotrnent of tuberculosis were supplied using funds from the Norwegian aid agency, NORAD Procurement of drugs, biologicals and contraceptives Esl~ntlal Drugs 41 I Some Member States continued to use the WHO channel of ; procurement to meet their requirement of HIV test kits. These included i India. Maldives and Sri Lanka. Bangladesh, Maldives and Nepal ; utilized the WHO reimbursable scheme for procurement of vaccines. ! A survey of manufacturers within the Region led to increased local purchase of essential drugs. 42 me Work of WHO In 813

Contents Page Prefoce Executive Jummory Section 1 - Governing Bodies I. Governing Bodies I World Health Assembly 1 Execut~ve Boaid 2 Reg~onal Comrn~tter 3 Section 2 - Health Policy and Management 2. General Programme Development ond Monogement . . . , . . . 5 Manogerlol piocess for WHO'S programme development 5 WHO response to global change 6 Sloft aeve7oprnenl 7 Renew~ng the health-for~all strategy . . . . 7 Management and support to lnforrnation systems . . . . . 8 Regtonal Director's Development Programme . . . . . . 9 Coordination wlth othei orgon~zotlons . . 9 Mobilization of external health resources . . . . . . . . . 12 Health M~nisters' rneettng . .. .. . 12 Health Secretai~es' meet~ng . .. 13 3. Health, Science ond Public Poliry 14 Leadership lor health . . . . . . . . . 14 Women, health and development . . . . .... .. I5 Health iegislotion, ethical dimensions of health care and bioe~hics . 15 Research policy and stiotegy coordination .... , . 15 iii Page 4. Ndional Health Polities and Programme Development and Management ........... Support to development. management and coordination of country programmes ..... . . 18 Technical cooperation among countries I<> Collaboration wlth countries and peoples in greatest need I (> Procurement services /excluding drugs, biologicals and conlracephves) 10 Emergency preparedness and humanitarian action 71 Safety promotion and ~niury prevention . . 21 5. Biomedical and Health Information and Trends 13 Ep~demiology statistics trend assessment and country health ~nlormotion Publ~shlng and language servces Health literature and l~brary services l~nclud~ng HELLIS1 Section 3 - Health Services Development 6. Orgonizdion and Monogement of Health Systems Bored on Primary Hecllth Core Y> Health systems research and development 79 Policy development and restructuring of notional health systems 29 Health economics, resource allocation and financing strategies 3 I D~str~cl health systems 3 1 7. Human Resources for Heokh Human resources for health .... Fellowsh~os . , ...... 8. Essential Drugs 40 Action programme on essent~al drugs 40 Procurement of drugs biolog~cals and contraceptives 4 1 9. Quality of Core and Health Technology n 7 Technology for health care 43 Drugs and b~olo~~cals, quality, safety and eiflcacy 44 Tradit~onal medlclne 45 Section 4 - Promotion and Protection of Health Care 10. Reprodudive, Family and Community Health and Population Issues Reproduct~ve health . . 47 Chid health . . . .... . 49 Adolescent health . . . . . .... . 49 Women's health . . . . . . . . . . . . . 50 Agng and health . .......... 5 1 Specie\ Prog~amrne oi Research, Development and Reseorch Troinlng In Human Reproduction . . . 5 1 OccuFot~ona! hmllh .., . . 52 11. Healthy Behaviour and Mental Health 53 Mental health . . . . ... . .. 53 Substance abuse ncluding alcohol and tobocco . . . 54 Health promol~on .... ...... 55 Commun~cat~ons and publ~c relations . . 55 Krhabii~tat~on . . . . . . . 56 12. Nutrition, Food Security and Safety . . . . . . . . . 58 Nutrlt~on 58 Food safety 59 13. Environmental Health . . . . . . . . . . . , . . . . 60 Water supply and son~tatlon in human settlements 60 Fnvironmenia\ heahh in urban devetopmenl 6 1 Assessment of env~ronmental health hazards 62 Prornotron 01 chemical saleh/ 62 lncorporoton of health concerns lnto env~ronmentol management 63 Section 5 - Integrated Control of Diseases 14. Erodication/Elimination of Specific Communicable Diseases . . . . 65 Drac~inculiasrs [Gu~neoworm diseose) . . . . 65 Leprosy . . . . . . . . . 65 Pol~om~el~t~s . . 66 Neonatal tetanus . . . . . . . . . . . , . . . . . 67 Measles .... ...... ... . . . . 68 Page 15. Control ol Other Communicable Diseases Vaccine-preventable diseases . . . . . . . . , 69 Diarrhoea1 and acute respiratory disease control . . . . 70 Integrated management of sick child initiative , . 71 Tuberculosis , . /I Emerging infectlous d~seases including cholera and other epldemli. diarrhoeas, zoonoses and antimicrobial resistance /% Other communicable d~seases . . /5 AIDS and sexually transmitted diseases . . . . . . 71 Control of tropical diseases . . . . . . 78 - Special Programme for Research and Training in Tropical Diseases 87 Prevention of blindness and dealness . . 8 :I 16. Control of Noncommunimble Diiecnes 84 Control of noncommun~cable diseases . . . . . . 84 Oral health . . . . . . . . . . . . . . . 84 Section 6 - Administrative Services 17. Penonnel Personnel services and admln~strotlon 18. General Administration 89 Admln~strat~ve support to techn~col programmes 89 19. Budget and RMIK~ Budget and finance Annex - Organizational structure . . . . . . . . . . . . . . . . . . . . . . . . 91

The past decade has been notable for the successful establishment of rouhne immunzation services in the Member States, resulting in the achievement of high coveroge rates against the EPI target diseases. Activities relating to control of diphtheria, pertussis and childhood tuberculosis are receiving increased attention. For all EPI antigens, Member States hove generally achieved and sustained coveroge at 80 per cent or higher With the stabilization of population coverage rates, increased emphass is being given to methods of identification of the remaining ioc of susceptible children: the 15-20 per cent of the population that has not yet been reached. In addition to the tradit~onol monitoring of vaccine supply and quality and coveroge rates, reg~onal and national EPI managers are working to strengthen the existing methods of surveillance in order to identify the susceptible population subgroups Childhood immunization with hepatitis 8 has been introduced In Bhutan, Indonesia, Maldives and Thailand, and selectively in some states in India While many countries in the Region are producing some tPi vaccines, India, Indonesia and Thailand have achieved a sustainable level of supply of quality vaccines Vaccine preventable Iseases d' Control of Other Communicable Diseases 69 Diarrhoea1 and acute respiratory disease control While Bhuton, DPR Korea, Indonesia, Mald~ves and Thailand have introduced HE vaccine in EPI, DPR Korea, lndonesia and Myanmar are producing plasmaderived HB vaccine, lndio and Thailand are planning to produce recombinant and plasmoderived HB vaccine, respectively. Bangladesh, Bhutan, lndia and Nepal have revised the technical guidelines for acute respiratory infections IARl). The control efforts are being progressively integrated into the child survival programme for communicable diseases control in lndia, lndonesia, Myanmar and Nepal. In other countries, the programme has initiated efforts to combine the ARI and control of diarrhoea1 diseases (CDDI programmes in accordance with national policies. After completing the training of notional ARI programme managers, the emphasis has shifted to district and provinciol-level programme chiefs. WHO supported the organization of ARI troining courses in Bongladesh, Bhutan, lndonesio and Nepal. An intercountn/ troining course for the training of trainers from prominent NGOs of Bangladesh, India, lndonesia and Nepal was organized in Pokhra. Nepal. The training material was refined on the basis of exchange of experiences at this meeting and translated and used for training trainers and community health workers in six states in lndia. In addition, training of trainers was supported by WHO in Bangladesh. India, Indonesia, Maldives, Nepal, Sri Lonka and Thailand. The ARI standard case management has been introduced in the training of auxiliaries in Bhuton, and in a medical school in Nepal In Thailand, the curriculum for the training of nurses was revised, while changes in the curriculum of undergraduate medical students were being introduced. The Region's first combined ARI/CDD curricula development workshop was held for selected nursing training schools in lndonesia. Bacterial drug resistance studies were completed in Thailand and similar studies were proposed to be initiated in Bangladesh in collaboration with the Shishu Hospital and the International Centre 70 he Work of WW In SEA for Diarrhoea1 Disease Research, Dhaka. Studies on indoor oir pollution were in progress in Nepal. Preparation 01 the first integrated training pockage on the management of childhood illnesses was completed Th~s course teaches doctors and senior heolth workers the skills needed for more accurate identification of ~llness in outpatient settings, ensures appropriate combined treatment of all maior illnesses and speeds up referral of severely-ill children. Substantial progress has been made on the WHO/UNICEF Initiative on Integrated Management of Childhood Illnesses Indonesia and Nepal have been selected as "early use" countries in the Region. Three representatives from lndones~a and Nepal were trained in the first clinical course for consultants in Addis Ababa, Ethiopia, in 1995, and two more were trained in Moy 1996. Districts where the integrated initiative will be implemented have been selected in both countries and the WHO material has been adapted and revised for their use The burden of tuberculosis in the Region is immense. Of the new cases reported globaliy in 1995, 42 per cent occurred in South-East Asia Two countries (Sri Lanka and Thailand] carried out joint reviews of the~r national tuberculosis programmesiNTPs] with WHOassistance. This has led to the development of revised NTPs with higher national prioriiy and to increased resources and donor assistance for their financing. All countries have rnanuals/guidelines lor TB control based on the Directly Observed Treatment, Short Course [DOTS) and have prepared fiveyeor plans WHO continued to provide intensified technical support to the World Bank-funded tuberculosis programme in Bangladesh which successfully implemented the revised strategy in almost 70 per cent of the country. In India, WHO provided technical assistance in the preparation of the World Bank proiect document and in monitoring the pilot proiect sites WHO successfully mobilized resources from several external donors for national TB programmes. These included Integrated management of sick child initiative Tuberculosis Control of Other Communicable Diseases 71 Emerging infectious diseases including cholera and other epidemic diarrhoeas, zoonoses and antimicrobial resistance DANIDA (Bhutan); SIDA, DANIDA and the British Overseas Development Agency (India]; the Australian lnternational Development Assistance Bureau (lndonesio]; Japan lnternational Cooperation Agency - JICA, NORAD and the British ODA (Nepal) and JICA /Sri Lanko] A workshop was held in June 1996 to stress the importonce of advocacy in the battle against tuberculosis and to develop guidelines and strotegies for TB advocacy for the Region An intercountry workshop was held in Indonesia in September 1996 to assist NTP managers develop advocacy strategies. In November 1995 a workshop was conducted in Nepal to train regional resource personnel from Member States to help strengthen NTPs in their respective countries as well as to provide consultancy service to others. The first Regional Tuberculosis Training Course was held at the National Tuberculosis Centre, Kathmandu, Nepal, in April 1997. In the ore0 of research, WHO is technically and financially supporting some operational research studies in Bangladesh, India, Nepal and Thailand. The last-named three courtries are taking port in the WHO global project on anti-tuberculosis drug resistance surveillance studies. An intercountry meeting on new, emerging and reemerging infectious diseases, held ot SEAR0 in August 1995, identified strategies ond approaches for effective control of these diseases. It recommended a review and strengthening of the epidemiologicol services and surveillance systems in order to develop rapid response mechanisms. The implementation of these recommendations was reviewed at on intercountry symposium in June 1996. A stand-by rapid response team has been formed at StARO A list of experts has been drawn up and some quantrties ot diagnostic reagents and other necessary supplies to meet emergency situat~ons have been procured and kept at the Region01 Office. Rapid response teams have also been formed in the countries of the Region which could be mobilized at short notice to assist in outbreak investigation and control within or outside the country 72 The Work of WHO In SEA The International F~eld Ep~demiology Training Course 11 2-weeks durat~on), was conducted by the Nattonal Institute of Communicable Diseases [NICD) Delh~, in October 1996 WHO supported the course and ass~sted in the development of its curriculum In order to improve the quality of disease surveillance in the Member Stotes, a consultohon on Case Definitions for the Surveillance of Communicable Diseases with Epidemic Potential was held in Colombo, Sri Lanka, in May 1997 Cholera, caused by the El Tor strain, has been reported from all the countries of the Region, except DPR Korea. Case management under the well-established nat~onal CDD programmes has resulted in reduced cholera case fatality rates to below one per cent from the earlier 1020 per cent. A new strain, Vcholerae 0139, was first reported in October 1992 from o large outbreak in Chennai, lndia The new strain, which almost completely replaced the 01 El Tor strain in 1993. disappeared from the Region in 19951996 However, during 1997, sporadic cases of cholera associated with the 01 39 strain were reported. The reasons of its emergence require further analysis and studies During 1995.1990, WHO provided financ~al support to the National Institute of Cholero and Enteric Diseases in lndia to produce, in sufficient quantities, the 01 39 antiserum to identiby the new strain The antiserum wos distributed by the Regional Office to all the cholero~prone countries in the Region and also to other WHO regions Zoonot~c diseases such as rabies, anthrax, leptospirosis, toxoplasmosis, cysticercosis and plague account for a relatively high amount of morbidity and mortality in the countries of the Region. During the reporting period, technical assistance was provided to national workshops on rabies control in lndia, Indonesia, Nepal and Sri Lanka. Technical information and recommendations for the development of guidelines on national rabies control were provided to Bangladesh. WHOsupported the quality testing of tissue culturederived rabies vacclne produced by the Pasteur Institute, Coonoor, lndia. Cholera Zoonoser Control 01 Other Communicable Diseases 73 Potential emerging dimses Antimitmbial resistante During 1995,WHO supported the training of six lnd~an nationals in laboratoly diagnosis and production of diagnostic reagents of plague at the WHO Collaborating Centre at CDC, Fort Collins, USA. Starting May 1996, the Haffkine Institute, Mumbai, India, has commenced producing plague diagnostic reagents which are used for rodent serosurveillance (predictive surveillance1 of plague in India A training workshop on laboratoly diagnosis and surveillance of plague was held in March 1996 at Yogyakarta, lndonesia, with participants from lndonesia, Myanmar, Nepal, Sri Lanka and Thailand. Technical assistonce was provided to lndonesia for preparing a research proposal on the development of cost-effective plague serosurveillance Activities to conduct predictive surveillance were also supported in Myanmar and Thailand. WHO provided technical information and d~ognost~c reogents for leptospirosis and brucellosis to Member States on request. Technical support was provided to the International Conference on Anthrax held in March 1997 in Kathmandu, Nepal. The Regional Office provided informotion to the Member States regarding o new variant of Creutzfeldtjakob Disease ICJD), ond initiated a proposal for establishing a surveillance mechanism in the Region. In additiori to the problems connected with current infectious diseases in the Region, there are ~otential problems associated with an increase in the number of drug-resistant bacterial and parasitic diseases and the emergence of new viral infections. The potential emerging infections in the Region are Hanta virus, yellow fever and Ebola-like haernorrhogic fever, a new variant of Creutzfeldt-Jakob Disease [CJD] and Ecoli 01 57. WHO provided technical information and recommendations regarding the prevenlion and control of these potential emerging diseases. Top priority has been accorded to study the emergence of drug resistance in pathogens and to disseminate information on un~forrn laboratory techniques ond data analysis methodology. Ten laboratories have been identified in the Region as part of the gonococcal antimicrobial susceptibility programme (GASPI with a view to monitoring, preventing and treating drug-resistant gonorrhoea which otherwise is facilitating HIVtransmission. The network of ten laboratories under GASP is supported by two regional laboratories in lndia and 74 The Work d WHO in SEA Thalland and one internot~onal laboratory in Australia for Imparting training and providing reference material A followup tralning workshop on the standardized methodology for monitoring drug resistance in Neisseria gonorrhoeae was held in Tha~land in January 1997 to strengthen the network A regional consultative meeting on Prevention and Control of Dengue/DHF, held in October 1995, reviewed the current situation and developed a revised strategy and plan of action for implementation at national and regional levels. A special consultative meeting on Management of Dengue Epidemic was organized in November 1996 at the Regional Office where recommendations for the management of dengue epidemic were developed It was decided to mod16 the Dengue Newsletter and publish 11 in an enlarged form, covering more aspects of the dengue problem Since December 1996 the newsletter has been renamed as Dengue Bullehn and is planned to be published annually Reg~onal guidelines for the prevention and control of DEN/DHF were being developed which would be finallzed in November 1997 The most Important progress in the Region has been the develop- ment of o tetravalent live attenuated dengue vaccine at Mahidol Univers~v, Bangkok, Thailand, with technical and financial support from WHO This voccine, produced by Pasteur Marieux, is undergoing Phase I and Phase il trials. WHO will also technically support the Phase Ill triols of this vaccine This is the first time a developing country has successfully developed a vaccine for human use. WHO supported the establishment of hepatitis B control programmes in the countries of the Region Hepatitis B vaccination under the framework of tPI was extended to more provinces in Indonesia, Maldives and Thaland Sri Lanka introduced vaccination for medical personnel in 1995 Ser~e~idemiological studies were carried out in Bangladesh and Bhutan. Hepatitis B vacc~nation within the framework of EPl was introduced by Bhutan in 1996 A demonstration proiect on hepatitis B immunization was started in New Delhi in October Viral hepatitis Control 01 Other Communicable Dtseases 75 Meningororral meningitis Japanese encephalitis 1996. Hepatitis B vaccine is produced rn DPR Korea and lndonesia. Myanmar has also developed hepatitis 6 vaccine and field trials are under way. Mandatory screening of blood and blood products is now being carried out in all countries of the Region, except Bangladesh and Nepal Compulsory screening of blood and blood products for the presence of hepatitis C virus (HCVtmarkers has been established in Thailand. Only a limited number of blood samples and blood products are screened for HCVmarkers in India, lndonesia and Sri Lanka. WHO supported the seroepidemiological studies of hepatitis C infection in some countries of the Region. Water-borne outbreaks of hepatitis E virus (HEVJ~,nfectionhave been reported in Bangladesh. Indonesia, Myanmar and Nepal This infection causes high mortality in pregnant women. WHO supported studies on experimental transmission of the infection in primates and on the molecular biology of HEV. The Organization also supported the procurement of necessary diagnostic reogents and provided technical backstopping for outbreak investigations in the countries of the Region. WHO provided information to Member States regarding the meningococcal meningitis situation in Africa, and urged special attention to the vaccination and active surveillance of pilgrims going to Mecca. WHO provided diagnostic kits to Bangladesh, Bhutan, Maldives, Myanmar and Nepal. National training courses for laboratory diagnosis, surveillance and prevention were supported by WHO in lndio, lndonesia and Myanmar. The human immunization strategy to control Japanese encephoiitrs UE) is used in India, Sri Lanka and Thailand. In the early 1990s. Thailand had ~ntroduced a mass vaccination campaign in 30 per cent of the endemic provinces, and, since 1996, this campaign has been extended to all rural areas. WHOprovided technical information to the endemic countries in the Region and helped in the procurement of JE vaccine 76 The Work d WHO in SEA

It. The malaria problem in the Region has been compounded with the spread of multidrug resistance. Surveillance activities, ~nclud~ng checklng of blood smears to detect P Falciparum, have been increased and strengthened in the countries to effectively deal with the ?", ,,+;,.. During the reporting period, STD/AIDS continued to spread in the Region. More emphasis is now being given to advocacy at country level and to extending the progromme to the communiv level. Various advocacy materials were produced/updated and distributed. These included a booklet titled AIDS. No Time for Complacency, a video entitled Facing the Challenge. AIDS in South-East Asia and o on khool AIDS Fducation, including a video film, a story book and o poster. A publication entihed NGOs and AIDS: Responding to the Expanding Epidemic was also produced In terms of the STD/AIDS prevention strategies implemented so far, the approaches involving targeted interventions and peer education among ind~viduals with high-risk behaviour were found to be useful The effectiveness of the 100 per cent condom-use programme in Thailand can be assessed by the declining incidence of HIV among military recruits from 3 6 per cent in 1993 to 2.1 per cent in 1995 The Sonagochi proiect in Calcutta, India, is another success story. The proiect, besides imparting peer educot~on, includes many other initiatives such as prov~sion of health care, literacy programmes for peer educators and schooling for the children of sex workers. The interventions among injecting drug users IIDUsl, including the needieexchange programme, were being implemented successfully in Nepal. In Myanmar, the IDUs have begun to modify their drug-iniecting behav~our as a result of the information, education and communication IlEC) programme initiated by the nation01 AlDS progromme. Various workshops and consultotions Initiated by the Regional Office focused on an integrated approach to STD control, monitoring of gonococcal ontimicrobial sensitivity and development of STD treatment guidelines In the area of HIV/AIDScare, a review of the care approaches was being conducted in Thailand which also included the role of religious leoders The purpose of this WH3supported initiative was to develop a model of continuum HIV/AIDS care which could subsequently be implemented throughout the country A similar programme was being implemented in Manipur, India. The Regional Office developed HIV/ADS Counselling A Module for Trainers which was made available to the Member States More than 10000 copies of the popular Regional Office booklet Understanding and AlDS and sexually transmitted diseases Control of Other Communlcable Dlseases 77 Control of tropical diseases Malaria livtng with AlDS were distributed for use by health care workers, NGOs and training institulions in the Region. A Handbook on AlDS Home Care was also produced and distributed widely. The Bamranaradura Infectious Diseases Hospital in Thailand has been designated as the WHO Collaborating Centre for training and research on AlDS clinical management and counselling. A quarterly newsleiier, AIDSwatch, is being produced since October 1996 and is accessible worldwide through the Internet. Moreover, to facilitate information exchange and sharing of experiences among Member States, the Regional Office convenes every year o meeting of national AlDS programme managers. One such meeting was held in Dhaka in November 1996 in collaboration with UNAIDS A SEARO/WPRO biregional meeting was held in October 1996 in New Delhi to discuss STD/AIDScontrol in border areas. Multidrug resistant malaria has been identified as a regional problem. In the South-East Asia Region, 3.42 million cases of malaria were reported in 1995 and 3.16 million in 1996. Foci of multidrug resistant malaria have been reported in border areos between Myanrnor, China, Laos and Thailand, indicating a shift from the usual epicentre on the border between Thailand and Cambodia. The incidence of malaria in the countries of the SEA Region during the last three years is given in Table 5 and Figures I and 2. Supported by WHO, a regional collaborative effort to control malaria at international borders was ini~iated by Bangladesh, Bhutan, India and Nepal. Border districts affected by malaria were identified and action plans were developed ioinhy by districts sharing international borders. Guidelines on managing malario outbreaks and a uniform format for reporting control activities have been developed for border districts. Technical support was provided to India and Indonesia in the~r negotiations for obtaining assistance from the World Bank and the Asian Development Bank, respectively, for malaria control programmes. Similar supporl was ~rovided to Bangladesh and Myanmar in their efforts to receive continued assistance from the World Bank and UNDP respectively. 78 Thm Work of WHO In SEA Table 5 Mularia prohie of Counhiei in South East Asfa Region Molorious positive^ Moloria deolhr Per cent Countv Ysor population' . Reported E~timotad IWO' (WO) 10001 ' Raportod Ertirnoted Rangiadertl I994 I01 500 I67 I 154'' 48 64 1 278 5 000 1995 103 500 153 1 389" 4967 1 393 5 WO 1996 103707 101 1250" 5380 794 4500 Madver 1994 239' Sr Lonko 1994 14 264' 273 275 17 18 50 100 I995 10 l/5 142 I50 1633 5 10 1996 10 328' 184 IVC 2439 I7 30 Tho~lc>nd 1994 40 831 102 200 55 89 900 950 1'495 40 291 83 I50 54 71 850 900 I996 40 724 88 150 52 56 870 SEAR 1994 1177461 3080 21812 3878 7444 39540 1995 1174473 3621 21470 4003 7171 31474 1996 1710054 3330 19143 4138 6424 29930 NOTES Figures for 1996 ore provisional Fgum n shoded are" ~elote lo Jovu and Boi ~nly = D~IIO no, ovatloble " = 10 lo 21 tmported coiei only ' M~dyeor eil~matei of people vrng n malor~oui region Co~nlry ertrnole Proleoled born last ywr Incomplete infoirnat~on Control of Other Cornmunlcable Dlseases Figure. Malaria Profile of Soulh-East Asia Region Laboratow-confirmed malaria cases lDDO Year Annual clinical malaria incidence in SEAR countries Per Thousand Populatan 140 120 rm ........................... ................................... m ............... .................. w ........................ ..................................... m 8*N BHU IND IN0 MMR NEP SRL THL ea *s3 e lppl m 1P85 In Mald~ves no ind~genoui case has been reporled since 1984 80 The Work Of WHO h SEA A workshop on Management of Severe and Complicated Malaria, supported by extrabudgetary funds from Japan International Cooperation Agency UICA), was conducted by SEAROand WHO/HQ in Yangon, Myanmar, in March 1997, in which officials from Indonesia, Myanmar and Sri Lonka participated. As a follow-up, the participants will conduct similar training for professional staff in ther respective countries uslng funds from the some source. As a first step n the reestablishment of the regional collaborative programme on Control of Drug-resistant Malaria, a workshop was organized iointly by the Regional Office and WHO/HQ in Anuradhapura, Sri lonka, in January 1997, with participants from Bangladesh, Bhutan, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand A stondord protocol for monitoring the therapeutic efficacy of antimalaria treotment was adopted at this meeting. Each country will initiate monitoring of treatment failure as a followup activiy. Visceral leishmaniosis [kalaazar) continues to be an important public health problem in rural areas bordering Bangladesh, India and Nepal, where opproximately 1 10 million people are at risk. To address this problem, WHO has advocated border collaboration between the three countries. WHO is supporting these countries in assessing the extent of the problem. Lymphatic i~lariosis is widespread in several countries of the Region and it is estimated that over 53 million people are affected with microfiloria and/or the disease, lndia alone accounting for 48 million. A datobase on f~loriasis has been established by WHO to strengthen the regtonal colloborotive programme on filariasis control. The Regionol Office provided technical support to all malarious countries in the Region in the following areas: 1 1) staff training and monitoring of malar~a vector resistance; 121 carrying out critical reviews of vector control activities; (3) assisting plans of vector control operations, and 14) searching for alternative vector control measures. An intercountry workshop on Plann~ng and Implementing Vector Control for Maloria was organized in 1996 in Bangalore, India, which developed policy guidelines for vector control. It recommended Disease vector control Control of Other Cornmunlcable Diseases 81 Special Programme for Research and Training in Tropical Diseases (TDR) strengthening of research in vector biology and control and the need to es~ablish firm partnerships with other sectors, including the private sector and NGOs, for effective and sustainable control of malaria and other disease vectors. The Vector Control Research Station at Salatiga, Indonesia, has been designated as the WHO Collaborating Centre for Pesticide Evaluation and Vector Control in April 1997 The regional monitoring system for vector resistonce to insecticides was further strengthened. The Regional Office supported the national dengue/dengue haemorrhagic fever control programmes in t Bangladesh, India, Indonesia, Myanmar, Sri Lanka and Thailand, using community vector control opprooches The TDR activities and research in the Region focused on leprosy and filoriasis in addition to malaria and leishmaniasis. Studies were sponsored on drug resistance and drug efficacy (Myanmar, Thailand\; malaria vaccines development (Indial; health financing of malaria programmes [Thailand); vector control strategies [Myanmar, Sri Lonka]; drug regimen compliance [Myonmarl, and the correlation between molar~a incidence and change in vegetation (Thailand). With regard to lymphatic filariasis, studies to test new drug regimens such as omocarzine, diethylcarbamozine and penicillin were conducted in India to develop new strategies for morbidity control. Additional studies to evaluate foot care were clso conducted in the country The economic affordability 01 filariasis control interventions was the subiect of several ongoing research prolects in lndia, and a workshop in this regard was conducted at the Vector Control Research Centre, Pondichery in March 1996 Recognizing the need for better drugs and diagnostic tests, regional studies on visceral leishmaniasis focused on immunotherapy (India), new drug regimens (India) and simple diagnostic tests for use under field conditions (Nepal/. A monkey model for visceral leishmaniasis was being investigated in lndia. In the area of strategic research, on agreement was signed in February 1997 between TDR and the National Science and Technology Development Agency, Thailand, to set up a joint venture for screening and developing new drugs against tropical diseases using molecular biology and combinatorial synthesis. 82 Th* Work oi WHO in SEA The malor focus of Wti0collabotation in the prevention of bl~ndness [PB~) conlinues to be the promotion of primary eye core using the PHC network, and control of avoidable blindness through restorative ~nterventions such as eye camps, outreach services and strengthening of referral facilities WHO provided support for conducting several workshops on primary eye care in Bangladesh and in developing o recording and reporting system for monrtoring the progress of PEL programmes ar the drstrict level in India. In Myanmar, a community-based eye restoration project was tormulated in Mandalay, and o model primary eye core proiect in Sintgoing was being extended to other arms Technical skills ond faci- lities for ophthalmological services were strengthened through fielding of a short-term consultant and provision of supplies and equipment. Wlth support from AGFUND, several countries in the Reg~on conducted ivorkshops to review the exrsting strategies for the prevention of blindness. The findings of these exercises were utilized at a regional workshop on the Assessment of National Progtarnrnes for Prevention of Blindness which was held in New Delhi. In addition, on in-depth evoluotion of the impact of the PBL programme on the status of eye heal~h was conducted in Nepal. As regards the prevention of deafness and hearing impairment, efforts were being mode to ascertain the magnitude and the etiological pattern oi the problem ~hrough a multicentric study in four selected countries of the Region With WHO'ssupport, the WHO Coilaboro~ing Centre for prevention of Deofness in Bangkok produced a manual on primory ear core for physiclons ond medico1 ossistonts working or the PiiC level WHO also provided support to Bangladesh, Myanmar, Nepal and Sri Lanko for training different categories of health workers in primary ear core With WHO support, Myanmar was oiso developing a lralning manual on ear core for stoff at the basic heolth services level Prevention of blindness and deafness Control ol Other Communicable Diseases 83