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

....

WORLD HEALTH ORGANIZATION

RIGlOttAL OFFICE FOR tHE WlSTERN PACIFIC BUREAU R~GIONAL DU PACIFIOUE OCCIOINTAL

•

ORGANISATION MONDIALE • DE LAIANTE

REGIONAL C<»1ITTEE TWenty-ninth session Manila V 21-25 August l978 BRIEF REPORTS RECEIVED FROM GOVERNMENTS ON '!HE PROGRESS OF '!HEIR HEAL'IH ACTIVITIES Attached are brief reports received from governments on the progress of their health activities in the following countries or areas: Australia People's Republic of China * French Polynesia Hong Kong Japan ** .Macao ** Malaysia New Caledonia New Zealand ** Papua New Guinea ** Republic of Korea Singapore * Socialist Republic of Viet Nam

**

.'~ .

~

Available in French only

** Available in English only

ORIGINAL: AUSTRALIA NATIONAL HEALTH ACTIVITIES DURING 1977-1978 1 1.

ENGLISH

ORGANIZATION OF HEALTH SERVICES

1~1 Australia is a Federation of six States and two Territories. Health care is delivered through both private and public agencies, with involvement at the Federal, State and local levels of government. There are constitutional limitations placed on the powers of the Federal Government the resique of power being vested in the State Governments.

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1.2 Since 1946 the Federal Government has had powers to make national laws, binding to the States, in respect to pharmaceutical, hospital and sickness benefits, and medical and dental services. The Federal Government also has used its powers under Section 96 of the Constitution to make grants to the States for health purposes. In addition, the Federal Government gives financial assistance to action organizations conoerned with publio health matters. Forty-four percent of total health care expenditure in Australia is met by the Federal Government. An increased emphasis has been placed on the planning of servioes in order to effect a more equitable distribution of health care resources, and based on the need to ourtail escalating health care expenditure. which is currently 7.67% of Gross Domestio Produot (1976-77 - latest available figure).

1.3 The State and Territorial governments all have health authorities that operate autonomously at that level, and are ooncerned with the delivery and administration of health care. To assist coordination between the Federal and State levels of government, Federal and State health ministers meet yearly to discuss mutual problems and health matters of national concern. Advice is given to the Australian Health Ministers Conference on matters related to hospital and allied services through the Hospitals and Allied Services Advisory Council (HASAC), an independent advisory body established 1n 1970. 1.4 Different emphases are evident in the organization of services in different States and Territories. Some health authorities have regionalized services for administrative effectiveness and the development of flexibility in respect to regional needs. A number of States have recently integrated their health services by incorporating separate health authorities operating within the respective States into single bodies through the creation of Health Commissions. 1.5 Health-Care functions are also carried out by local government, semi-government instrumentalities, voluntary agencies, profit-making non-governmental organizations, private medical and alli~d health professionals.

1Submitted by Dr R. Cumming, Assistant Director-General, International Health Branch, Australia

., >

- 2 2. HEALTH INSURANCE IN AUSTRALIA

2.1 Universal health insurance was introduced into Australia from 1 July 1975. This programme, known as Medibank, was non-contributory and financed from consolidated revenue, replacing the previous voluntary health insurance arrangements. Subsequent alterations to the Scheme have allowed Australians to choose between insurance with a registered private health insurance organization, including Medibank (Private), for at least basic benefits, or to be enrolled in Standard. Medibank, the Government operated Healt~ Insurance Program which is administered by the Health Insurance Commission. Modifications effected on 1 October 1976 also provided for a health insurance levy for persons insured under Standard Medibank, equivalent to 2.5 per cent of personal taxable income, with a maximum levy payment of $300 per annum (family) and $150 per annum for a person without dependants. 2.2 During the year 1977/78 certain legislation was passed in connexion with health insurance and the provision of health services.

2.2.1 The Health Insurance Amendment Act 1978 amended the Health Insurance Act 1973. The major provisIons of this Act concerned the level of medical benefits payable for medical services, the abolition of bulk-billing (except for pensioners with pensioner health benefits entitlements) and the authorization of an optional deductibles scheme. 2.2.2 National Health Act Amendment Act 1977 is ~n amendment to the National Health Act 1953 and the Nursing Homes Assistance Act 1974, and authorizes new nursing home arrangements under which benefits were substantially increased. 2.2.3 The National Health Act 1977 authorised the Governor-General to provide, or arrange for the provisIon of, diagnostic and therapeutic services for patients of medical practitioners and hospitals. This amendment was necessary to allow the Department's health laboratories to charge patients for pathology services provided. 2.2.4 The National Health Amendment Act 1978 inserted a new part to the Act to es£abilsh a scheme to provIde f:inanclal assistance to persons who live in isolated areas and also must travel long distances to obtain specialist medical treatment. These provisions are to come into operation on a date to be proclaimed by the Governor-General. This Act also contained provisions to permit insurance organizations to operate optional deductibles plans.

2.2.5 The Hospitals and Health Services Commission (Repeal) Act 1978 repealed the Act whIch estabiished the Ho~pltais and Realth ServIces Commission. This Commission was establised in 1973 to advise the Government in relation to the provision of a high standard of health care in Australia. It was disbanded because the future responsi~ility for the development of plans and policies in the health and welfare field is to be undertaken by the Social Welfare Policy Committee of Ministers and its supporting Permanent Heads Committee. These Committees will be supported by a policy secretariat under the control of the former Chairman of the Hospitals and Health Services Commission, Dr Sidney Sax.

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3.

REFUGEES FROM INDO-CHINA

3.1 The past year has seen a dramatic increase in the number of refugees arriving in Australia from Indo-China aboard a variety of craft ranging from small wooden fishing boats to coastal freighters. From June 1977 to April 1978 there were 837 refugees. In addition to the escalation of conventional quarantine functions, further direct involvement has been necessary to isolate and secure arrival boats, and to provide health screening of the refugees. 4. ABORIGINAL HEALTH

4.1 The Aboriginal Health Worker Program, described in last year's paper, has progressed excellently. The recognition of the author! ty of the Aboriginal Health Workers in their home communities is increasing in a most satisfactory way and it is believed that this will contribute to future effectiveness of health services at rural grass roots level where there are aboriginal communities. 4.2 With regard to aboriginal health, increasing stress is being laid on the environmental factors influencing community health, particularly among rural aboriginal communities. The most common factors of significance relate to deficiencies in the availability of a good quality water supply, poor living conditions, and high levels of unemployement.

4.3 In the continuing development of a base-line assessment of aboriginal health throughout Australia there was considerable progress towards the establishment of a national system of aboriginal health statistics. 5. QUARANTINE

5.1 As noted in the previous year's report, eXisting facilities in Australia are not adequate for the safe treatment of persons suffering from emerging, highly infectious viral haemorrhagic fevers. In consequence, a high security treatment unit will be constructed at the Infectious Diseases Hospital, Fairfield, Victoria. This facility is to operate as a national reference treatment centre for all States. 6. DRUGS OF DEPENDENCE

6.1 An Australian Royal Commission of Inquiry into Drugs was established in October 1977. Its functions include inquiry into controls over importation, exportation and manufacturing, monitoring of the legal trade, international obligations and statistics over the last 10 y~ars, the administration of the National Drug Education Program, and the extent to which drugs are illegally used or misused, and the diversion of drugs from legal to illegal use.

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7.

COMMUNICABLE DISEASES

7.1 The general pattern of diseases notified throughout 1971 remained similar to that of the previous year, with gonorrhea, syphilis and hepatitis A (infectious hepatitis) the three most frequently notified. Of major concern is the emergence of penicillinase producing gonococcal infections in Australia. Most of the cases have been either imported or are contacts of imported cases. 8. NATIONAL COMMITTEE ON HEALTH AND VITAL STATISTICS

8.1 This unit was set up to identify existing statistical collections for usage and improvement, in relation to health care needs for pre-determined health planning priorities. It reports to the Australian Health Minister's Conference through the Hospital and Allied Services Advisory Council (HASAC). Six working parties cover a broad spectrum of Australian health care: Hospital Statistics; Perinatal Health Statistics; Health Status of the Population; Human Resources; Physical Resources and Financial Data.

ENGLISH ONLY'

SOl.'-iE NAJOR EVENTS IN THE ItEAL'l'H',ORK OF

THE IN THE

PEOPL~·S ~A3T

RlWUBLIC OF Cti ... NA

ONE YEAR SINCE JULY,

1971

,... -

:l'l.l

July, 1978

)

·

In the past on~ ye~r since last July, it has convened in our country the 11th National Congress of the Chinese COilullunist Party and the 5th National ~eoplels Congress which laid down the general tusk for the Party and peonle of the whole country in the new period of development in our socialist revolution and construction, namely: "To carry out the line of t~e 11th Party C",ngress, steaflfastly continue the revolution ~nder the dict~torship of the nroletariat, deer:>en' the three great revolutionary movements ofcla£s, struggle. the struggle for production and scicntifi~ex)eriments. and transform China into a great and powerful socialist country with modern agriculture, industry, national defence and science and technology by the end of the century." Based on the line formulated by the Party Congress and the general task set forth for the hew ~eriod, a N: t,tonal ;;';ci ence Conference was convened by the Central COi;lAilit.tee of the t>arty. 'l'he Conference expounded points relating to the theory, line, principle, oolioy and programme for the modernization of our a:.cience and technology, and has work~ out arrang'ements for its realization. The general task in the new yeriod of our socialist revolution ,.nd construction has Dut forth an even higher demands of our heal th \'fork. Under the good c,_,e of the Party Central Comhlittee headed b,' Chairman Hua Kuo-feng and of the Sthte Council_ it has held in ~)e}dn9 this June the Natiunal tvledical $cience Conference. 'l'he Confarence Was att.ended by lOore than 1,300 medical and hec.:.lth wor'kers. It has commended t.he advanced units and individuc.ls. Awards were given to 691 scientific and technological ~rojects for it.s outstanding fruit.ion. D~ring the Conferc;:nce, a orotrcult;Tie for the development of medical science and technology,pharmacology and health work (1918-1985) has been draft.ed, exneriences exchnnged' and sununarized. The Conference served to mobilize all Desitive factors to our march towards the modernization of medical science and technology, ~rouse tht:~m strifing fer .th, fulfilment of t the general task of the new period and for t.he im)revement of neOllels health.

"

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1 -

.'

The general goal for the modernization of our medical science and technology is to initially introducing an unified new medicine and new l)harmacologYi bringing China's medical science UP to advanced world standards, with a number of important items taking the lead. The fulfilment of the general goal and the 8 year nrograa~e requires herculeus efforts. However, the center of gravity of our work shall be on the prevention and treatment of those corll..,. monly seen diseases seriously inflicting upon people's health. Only by taking a firm hold on the prioity work while giving an overall consideration to the rest, can we'"' keep a correct orientation for our medical and health work to develop. In order to further improve our health work, the ~ace for the development of medical science must be quickened. '!'he right oath to develop our medical science i~ to int~jrating the traditional Chinese medicine and the western medicine. Me have, in the past, developed our medical science along this path and have rich experiences which has laid a foundation for us to creat in the future a, new unique medicine and pharmacology. Under the new historical condition, we shall keep on develo::>ing our medical science along the sarile path. We shall develop both the traditionul Chinese medicine and the weatern medicine, int.egrate them in the course of its develooment and apply the integrated medicine in the fields of basic medicine, clinical and preventive medicine research, medical education and hospital build-up. For the realization of the modernization in our medical scienc' it is a matter of must for us to implement the policy of "letting a hundred schools of thought contend" and to animate academic activities. Among the 19 medical journals previously published by the Chir'ese Medical Association, the Chinese Pharl1lac::ological Association, The Chinese Nursing Association and the Chinese AntiTu Association that had been once forced to terminate its ::')uLlicatjon, 4 have been re~ublished and another 11 are ~lanned to republish this Autumn. 11edical societies of diffe:rent discir)linarics under t he Chinese Hedical Association have been restored. \;e have also formed a' ~reparatory con~ittee for the setting u·" of f

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of

th(_~

Society of the 'l'raditional Chinese Medicine.

Acade:l!ic

discussions, symnosiums of various disciplinaris have been organized in an increasing number and wider scale. We shall continue to persist in the principle of "walking on two legs" by relying both on the nrofessionals and the masses. PLofessionals are the n~instay in this general task and efforts are n.:eded to run better the present existing medical colleges -, and medical schools. At the same time, medical institutions are l:>rofe~sional

. encouraged to adopt various measnres to raise the

level of their staffs. '1'0 those medical and health workers working at the basic level including barefoot doctors in the number of millions, we must exert all efforts to raise gradually their capabilities equivalent to that of a medical school graduates. By so doing can our medical scientific contingent reinforced for the constant improvement of our medical services. While develoning our medical science independently and selfreliantly, we must learn conscientiously from other countries their advanced experiences and strong points. ledge as the common wealth of all m'-mkind~hall

scientific knowbe fully utilized. develo~

Our learning from others must be combined with our own initiativeness. By this, our medical and health work can speedy pace. in a

*

*

*

The Patriotic Sanitation Novement widely launched in our rural and urban areas since liberation was initiated and led by our great leader and teacher Chairman l'o'lao before his death. The late Premier ~~ou En-lai was the chairman of the Central ~atriotic Sanitation Movement Committee and had given a personal lead to this work. During that 2 decades and more, glaring achievements had been scored. Since the smashing of the "gang of four", new nrogress has been made in this movement which had been once slackened insorne areas due to the interference of Lin Piao and the "gang of four". The country as a whole has witnessed certain achievements in the implementation of the "Notifica;tion on the Launching with vast Efforts of the Patriotic Sanitation Hovem.ne' issued by the State Council. tance. ~.

Take Tang Shan Prefecture for ins-

At the first winter following the severe earthquake in - 3 -

the Pref(~cture ~~ccines

July,

1976, the Patriotic Sanit<.• tion Hove;lIent {.nd at the Selme t

was irllI:1ediately unfolded in that area.

iw<;:,

and innoculations were widely given to the nUDber of 15 According to the statistics from the Health DC'';)

Dlillion oersonal times over the total 7 million population of the ,'refecture. ctnlenl of 'l',.ng Shan i?refecture, the incidence " f conmnmicable discdsc:of the Prefecture decreased by 46.8% in 1977, the lowest year in lQ vears prior to the earthquake, du& to the l.ovewent launched and Hleasures taken. Aooroved by the Party Central Committee .md Chairman Hua, ".

~~triotic

Sanitation

t.he Central ,JatrioticSanitation t-'lovellient Committee has been reestablished in April this year with vice chairman of the Chinese Corr~rnunist.

Part.y Li Hsien-nien t.aking t.he chairmanship.

Corresnon-

ding cOHlmittees and its executive bodies have been re-established and reinforced to strengthen the leadershi? and arouse the maEses .~

for the earlier realization of the will left over. by Chairman Nao that to wiping out., in the main, rats, bedbugs, flies quitoes ~1::

~md

mos-

places wherever nossible.

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* l~uo­

In his renort delivered at the 1st. session of the 5th National Peon I e' S Congress on the work of the government, Chairman Hua feng has pointed out explicitely th2tz Family planning is a very significant matter. the nat ional cerned. ~conorlly

Planned control It

of nO:"lulation growth is conducive to the planned develonment of and to the heal tll of mother and child. also benefits the· peonle Where ,roduction,work hnd study are conWe must continue to give it serious attention and strive to lower the annual rate of gr()\-. \.h of China' s po ·ulation to less th .. n 1% within 3 years." As the result of health education, the consciousness of the masses in nractisizing family olanning is constantly on the rising wbile the birth rate and population growth rate on the declining. Tlw grow!:h rate in the Provinces (Ivlunicipalities) of Peking, Shan9-

hJi, Tientsin,

Sz~chuan,

Hopei, Liaoning, Shantung, Kiangsu and

lllF)ei h;:.tve been brought lower than 1 ~.• With the approval of the ~arty Central ~o~uittee and th~ Stale Council, a new Leading Group under the State Council in

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charge of family nlanning has been set

u~

in June this year.

It

h,1s its first meeting convened mainly discussing .:m IHeasur~s to fulfil thegodl of 1 .wering the growth rate of our population to less than 1% within 3 years. Taking 1:he country as a whole, our work in \.his reS'10ct is irs )iring, and will be becoming better in the future. As long as we tflke a firm hold in our work, it is entirely possible to reach the target within 3 year time •

*

•

*

The smashing of the "gang of four" m<.trked the successful cqnclusion of the Great Proletarian Cultural Revolution in our country. For the achievement of markl'd success in 3 years in gras')ing the key link ,if class struggle und bringing great ordl;'r across t.he land, 1978 counts as an important year. leadership of the Party ~entral b~en

Under t.he

Committee and the State Council, taken, conferellces convened and

a number of measures have

v.,st efforts exerted to :;alve timely thos,. pressing 9roblems caused by the interference and sabotage of the "gang of four". lidving sh.·ttered the lnentle mal.lacles the "gang of four" I

tr led to 1ns-

f. sten on them, our medical workers ali

i

our ryeot)le art;: now bold

in th",ir thinking and high in their ,"'>01 itical consciousness.

')ired ,:.nd jubiLint, they are bursting wl, h soaring enthusiasm to worlt for socialist revolution and construction, and for an earlier

r, alizu.tion of the 11lu.gnificant goal of the 4 our country.

lIIoderni~ationf!

of

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ORIGINAL:

ENGLISH

BRIEF REPORT ON PROGRESS OF HEALTH ACTIVITIES IN HONG KONG, 1977 1 GENERAL HEALTH AND VITAL STATISTICS The general state of health of the population 1n Hong Kong remained good during the year. The major communicable diseases are under control and no epidemic has been reported. The crude birth rate at 17.5 per thousand population remained at about the same level compared with the rate of 17.2 for 1976. The infant mort~lity rate showed a further decline to 13.9 per thousand live births and . is now at a lower level than a number of European and American countries. The maternal mortality rate continued to remain very low at 0.16 per thousand total births. The crude death rate was 5.2 per thousand population, the same as the previous year. COMMUNICABLE DISEASES Hong Kong continued to remain free from any quarantinable diseases. The total number of notifiable communicable diseases during 1977 was 12 087. Tuberoulosis comprised 59.5S of the total. Diehtheria Only one case was reported in 1977 oompared with 2087 cases in 1959. Malaria There was no indigenous infeotion reported. Of the 40 cases recorded, practically all of them were imported and one was induced after blood transfusion • Measles A total ot 1537 notifications was reported. The deoreasing trend for this disease since 1968 can be attributed to the availability throughout the year of tree vacoine for immunization of ohildren between the ages of nine months to five years. Influenza There were three outbreaks of influenza observed in 1977. The first outbreak was in April-June and the causative agent was A/Victoria/3/75(H3N2), which had been prevalent in Hong Kong since April 1975. The second outbreak occurred 1n June-August and was oaused by influenza B/Hong Kong/5/72 virus. The third outbreak involving mainly ohildren and young adults started in late November reaching its peak in December. The oausative agent was influenza A(H1Nl) subtype; it was antigenically similar to A/USSft/90/77 virus. The subtype A(H1N1) had been prevalent worldwide in the period 1947-1956.

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1Submitted by the Director of Medical and Health Services, Hong Kong.

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Rubella An outbreak of rubella occurred in the spring ot 1977. It commenced in early Maroh and quickly rose to peak inoidence in April. Thereafter, it gradually deolined in the tollowing three montha. The infection was generally mild atfeoting mainly children and young adults. Preparation is in hand to otter rubella vaocination to young girls and women in the reproductive age group later in 1978. HEALTH SERVICES Tuberoulosis and Chest Service There was a further tall in the tuberculosis death rate trom 12.8 of 1976 to 11.8 per 100 000 population. The notitication rate had also dropped trom 178 in 1976 to 159 per 100 000 population. During the Year, 98' of the newborn were given BeG probably the highest in the world. There has been a notable decline in intant mortality trom tuberoulosis and the disease is now rare under the age ot 15. Social Hygiene Servioe New cases ot venereal diseases reoorded numb~red 4808, a decline ot 24, oompared with the previous year. Approximately 4, ot the oases oame trom the teenage group. New oases ot leprosy identitied and treated number 13 representing a rate ot 1.6 per 100 000 population. Family Health Servioe The Family Health Service operates a total of 41 oentres, eaoh of whioh provides a oomprehensive health oare programme tor women ot ohildbearing age and ohildren trom birth to five years. Family planning is now an important and popular aspeot ot the Family Health Servioe. In 1971, over 90' ot newborns were brought to a centre tor attention and advice on at least one oC08sion. In 1978 the service is expeoted to oommence a oomprehensive observation soheme to provide special observation to intants and children with hllher than average risk ot developing disability oonditions, so that early remedial aotion oan be taken. Health Education A oentral health eduoation unit is being established. The Unit will serve as a ooordinating and advising unit working closely with interested departments and voluntary organizations in promoting health tduoation work.

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HOSPITALS AND OUT-PATIENT SERVICE At the end of 1977, a total of 19 276 hospital beds was available in Hong Kong. In addition, there were 393 beds in Government maternity homes and 110 beds in private maternity/nursing homes. The total 19 779 beds represented a ratio of 4.4 beds per thousand population. There are 52 Government general outpatient clinics and specialist -- facilities are available in the polyclinics or specialist clinics. During the year, pressure remained heavy on all these clinics. Evening outpatient .sessions and Sunday and public holiday sessions continued to be opened among clinics situated in the more densely populate~'areas. The NarcotiCS and DrUS Administration Division was responsible tor undertaking various activities in the treatment and rehabilitation ot drus addicts and research and health education in the dangers ot drug addiction. Four methadone maintenance centres and 17 methadone detoxification centres tor outpatients were in operation to cater for the demand for treatment facilities. MEDICAL DEVELOPMENT

, A White Paper entitled -The Purther Development ot Medical and Health Services in Hong Konl- published in 1974 provides a blueprint for future development ot the servioes in the next 10 years. The development is reviewed annually. The last review was oompleted in 1977. A 10-year Medioal Development Prolr...e containing proposals for the further development ot the servioes has been prepared. The resionali.ation ot medical and health servioes waa implemented in April 1977. The ..in objective ia to put into the best posaible use the faoilitl.. and resouro.. 1n eaoh resion and ao to produoe a more eftective serviee. The objective has largely been aohieved. The Eaat Kowloon Polyolinio CStase I) and a ohild asseasment olinio were opened durins the year. Building work oontinued during the year on the new 1300-bed Psychiatrio Wing ot the Princess Margaret Hospital and the Caritas Medioal Centre extension. Conatruotion work tor a new Dental Centre containing the Dental Therapist Training Sohool and a Sohool Dental Clinio is nearing oompletion. A Medical School at the Chinese University ot Honl Kong (CURK) and a Dental School at the University ot Honl Kong will be established by 1980. Planning work has already commenoed on the new 1400-bed Sha Tin Hospital which ia going to be the relional hospital tor the Eastern New Territories and the teaching hoapital tor the second medical school at CURK. Work on the oonstruction of a Dental Teachinl CliniC which will provide c11nical teaching facilitiea for the dental students of the Dental School ia expected to comaenoe in 1978.

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Commencing from April 1977, six voluntary organizations supplying community nursinf services are being assisted with medical subventions with a vIew to assess ng the value and the contribution of this service in the context of the overall medical and health services in Hong Kong. In October 1977, a White Paper on the Further Development of Rehabilitation Services in Hong Kong over the next ten years was published. The objectives and targets listed in the Paper, and the progr4ss of implementation will be rev~ewed annually. It is expected that the first such review will begin in 1978. , A Green Paper on the Services for the Elderly was published 'in 1977. Public comments on the proposals In the Green Paper are being examined. It is envisaged that a Whit'e Paper on the future development of the services for the elderly will be prepared in 1978.

ORIGINAL: REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN JAPAN (1977)

ENGLISH

The health situation in Japan has greatly improved recently along with its social and economic development. In this report, some basic health statistics will be presented to show the health situation in Japan, and some recent topics in the field of heal~h and medical services will be highli-gh ted. 1. Vital statistics (Table 1) (a) Population

The total population of Japan, as of 1 October 1976, is estimated to be 113 086 000, which means a double increase was made within the past 55 years since 1920 when the figure of 55 960 000 was recorded as the total number of population of Japan. On the other hand, the last national census of 1975 indicated the total population of Japan being 111 937 000, which showed an increase of 1 150 000 (1.0% yearly average increase) within a one-year period in comparison with the above. This yearly average increase ratio was equivalent to the ones recorded between the period of 1960-1965, and showed a considerable decrease from the ratio recorded d~ring the period of 1970-1975 which was 1.4%. . Such higher increase ratio recorded during the period of 1970-1975 can be attributed to the fact that we had a second wave of so-called "baby boom" for that period because the women who were born during the period of the first "baby boom", i.e., around 1947 to 1949, gave births. It can be said that such phenomenon seems to have reached the ending stage in 1976. In terms of age composition of population in 1976, the younger age group (0-14 years) occupied 24.3%, the productivity age group (15-64 years) 67.8% and the older age group (65 years 01" more) 8.1%. {b} 01"

Live birth rate

The live birth rate of Japan had stayed at the level of a little more less 30 per 1000 population through the Meiji Era (1868-1912) and the Taisho Era (1912-1926) to the post-war period around 1949, which meant that Japan fell into a group of countries with high live birth rate at that time. From then on, the rate continued to decrease sharply, and it reached the low rate of 16.9 in 1961, the rate almost as low as those of the European countries. In 1962, the rate changed its direction a little upwards, and this tendency has been kept since then. It recorded the rate of a little more than 19 from 1971 to 1973 as a result of the so-called "second baby boom" after the war. (c) Death rate (Tables 1 and 2)

The number of deaths in 1976 was 703 274; the death rate was 6.3 pel" 1000 population, which was the same as in 1975. The order of leading causes of death is as follows: the first is cerebrovascular diseases, the

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second malignant neoplasm, the third heart diseases. Tuberculosis has been ranked tenth since 1972. Therefore, relatively speaking, the emphasis of national health activities is now placed on chronic diseases. (d) Infant death rate

The infant death rate of Japan stayed at the level of more than 150 per 1000 births until the end o~ the Taisho Era (1912-1926)0 It started to drop thereafter, and recorded the rate of less than 100 in 1940, further dipped to 13.1 in 1970, and reached the record-low rate of 9.3 in 1976 (Table 1). The rate was much higher than those of European countries before the Second World War, but it decreased very sharply after the war at the speed never attained by other countries. Now Japan is ranked as one of the lowest infant death r~te countries in the world. 2. Life table (Table 3)

According to the first life table covering the period from 1891 to 1898, the average life expectancy at birth was 42.8 years for male and 44.3 years for female. Since then, the average life expectancy at birth has improved very much in line with overall development of medical and public health activities. It marked the level of 50 years in 1947, i.e., 50.06 years for male and 53.96 years for female, then marked the level of 60 years for female in 1950 and for male in 1951. The speed of increase was really unprecedented in the world: it increased at the average annual rate of 1.69 years' 'for male and 1. 72 years for female during the period from 1945 to 1955, and then it kept on increasing at the average annual rate of 0.41 years for male and 0.52 years for female, although it slowed down a little bit in 1955. In 1976, it marked 72.2 years for male and 77.4 years for female, thus the average life expectancy at birth for male approached or overtook the levels of western developed countries excluding some Scandinavian countries, and one for female also much approached the levels. The rapid improvement of the average life expectancy at birth is largely due to the decrease of the inf~nt death rate and the youth death rate by tuberoulosis. 3. Measures for health promotion

Cardiovascular diseases and other degenerative diseases have become one of the major national health problems in Japan as it is the case in western countries. To prevent these diseases and to promote health, health promotion centres are being established in the regions as the headquarters to carry out health promotion measures since 1972. If we want to maintain and promote our health, we should lead our lives in such a way as physical exercise, nutrition and rest can well balance each other. It is difficult for most of us, however, to judge correctly whether our individual daily lives are good enough 'or not from the view point of health maintenance and promotion. The work of health promotion centres is to give some advice to the individuals how to lead their 24-hour life by expert teams. For that task, the centres have the following three functions: (1) examination and judgement of health aspects of individual lives, (2) prescription on the change of lives, and (3) actual guidance.

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4.

Degenerative disease control (a) Cerebro-cardiovascular disease control

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

The number of deaths by cancer reached 19.4% of the total number of deaths in 1975. In terms of sites of cancer, both male and female suffer mainly from stomach cancer, which is a characteristic of cancer in Japan. As for cancer control measures, there are such measures as (1) health education, (2) medical eXamination, (3) completion of medical institutions for cancer, (4) training of cancer experts, and (5) development of research. As regards medical institutions, there are one national cancer centre in Tokyo and nine regional cancer centres in nine blocs, serving the entire country. These regional centres are functioning as the centres for cancer diagnosis and treatment in the respective region. Through mass medical examination of cancer, early cancer cases are often detected and treated in their early stage. 5. Communicable disease control

Fairly extensive preventive vaccination programmes have been carried out in Japan under the requirements of the Preventive Vaccination Law; the regular vaccination for smallpox, diphtheria, whooping cough, poliomyelitis, rubella and the emergent one for influenza, Japanese encephalitis, and Weil's disease. However, the Government has recently been confronted with the serious problems because the accidents or health hazards due to serious side-effects of those preventive vaccinations have been constituting grave social problems. To cope with these problems, the special aid system for the vaccination-induced accidents was established in February 1977. The incidence of tuberculosis has been decreasing year by ye~r. The total number of newly registered tuberculosis cases during the year 1976 was 97 924 (morbidity was 86.6 per 100 000 population) which was almost one

- 4 -

third of that of 1965 (morbidity, 309.9). Main emphasis has been laid on the preventive measures, and extensive mass health examination has been continuously kept on. 6. Maternal and child health

Under the requirements of the Maternal and Child Health Law, pregnancy and births are required to be registered at local health authorities, and maternal and child health programmes in our country are focussed upon the .~care an~ protection of those pregnant women and infantsu Since the maternal death rate is still quite high, although some improvements are being made, the problem of expectant mothers is of a serious one particularly among all maternal and child health pro&rammes (Table 1). In order to cope with this problem, the Government has regarded the following programmes as the priority ones, i.e., (1) improvement of the ratio in taking advantage of free health examination provided for pregnant women (twice a year) which has been carried out since 1969, 2) strengthening of manpower, both in quantity and quality, at community level required for maternal and child health promotion which has been carried out since 1968.

7.

Environmental health (a) Food sanitation

6329 food sanitation inspectors (as of 31 December 1976) mainly stationed at health oentres carry out food sanitation inspection. In order to improve the effioienoy of the inspection programme aiming at assurance on the safety of food, the active training programme for those inspectors has been carried out. In addition, the food sanitation inspectors stationed at 12 major ports and 3 airports engage in the sanitary control of food to be imported; the reevaluation of safety of the food additives and insecticide residues in food has been kept continued since 1974 and 1964 respectively. It is being made for 25 kinds of food additives and insecticide residues among 52 agricultural products during the year 1976. (b) Water supply

---

The number of population served with water supply systems, as of 31 March 1976, was approximately 98 397 000, which was equivalent to 87.6% of the total population. About 12 800 million m3 of water was supplied during the year 1975, which will be increased at about 21 000 million m3 and more by 1985. 8. Health manpower and medical facilities (Table 4)

In terms of Physicians who should be the core for the health manpower, the number was estimated to be about 132 479 as of the end of 1975 (118.4 per 100 000 population). The number of medical schools is 72 at present and the total number of capacity of students to be admitted into those schools is about 7480 in 1977; the physician-population ratio is estimated to be 150 per 100 000 in 1985. The number of dentists,

- 5 -

pharmacists, public health nurses, midwives and nurses has increased over the previous year, particularly the increase in the number of nurses has been remarkabl~. TABLE 1. VITAL STATISTICS AND OTHER STATISTICS

. ~

1975 Rate -'OJ ••

1976 Number Rate

Number Japanese Population (estimated) Live birth (Rate: Per 1000 population) .,

111 274 000* 1 901 440 702 275 Per Per 546 1 199 165

17 01 603 10.8

112 420 000 1 832 617 703 270 1 129 347

16.3 603 1000

Death (Rate: Per 1000 population) Natural increase (Rate: 1000 population) Maternal death (Rate: 10 000 births) Infant death (Rate: 1000 live births) Neonatal death (Rate: 1000 live births) Still-birth (Rate: total births)

, 209 1000 6.8 50.8 16.0 8.5 1.07 474 17 105 11 638 101 930 27 133 871 543 124 512 2.6 903 6.4 52.7 1408 7.8 1. 11

Per 19 103 Per 12 912 101 862 Per 30 513 941 628 119 135

Per 1000

Perinatal death (Rate: 1000 births) Marriage (Rate: Per 1000 population) Divorce (Rate: Per 1000 population)

'Japanese population obtained from results of one per cent sample tabulation of the 1975 Population Census.

.' - 6 -

TABLE 2.

DEATH BY LEADING CAUSES

1975 Number Rate Number

1976 Rate

(1)

(Per .100 000 population) "

(Per 100 000 population)

Cerebrovascular diseases Malignant neoplasms Heart diseases Pneumonia and bronchitis Accidents Senility without mention of psychosi~ Suicide Hypertensive diseases Cirrhosis of liver Tuberculosis (all forms)

174 367 136 383 99 226 37 462 33 710 29 916 19 975 19 831 15 129 10 567

156.7 122.6 8902 3307 30.3 2609 18.0 1708 13.6 9.5

173 745 140 893 103 638 36 616 31 489 29 659 19 786 19 829 15 462 9 578

15405 125.3 9202 3206 28.0 26.4 17.6 17.6 13.8 805

(2) (3)

(4) (5) (6) (7) (8) (9) (10)

- 7 -

TABLE 3.

AVERAGE LIFE EXPECTANCY AT BIRTH

Sex Year 1891-1898* 1899 ... 1903* 1909-1913* 1921-1925* 1926-1930* 1935-1936* J-

Sex Year 1957 1958 "

Male 42.8 43.97 44.25 44.06 44.82 46.92 23.9 42.6 50006 55.6 56.2 59.57 58.0 60.8 61.9 61. 9 63.41 63.60 63.88 63.59

Female . 44.3 44.85 44.73 43.20 46.54 49.63 37.5 51.1 53.96 59.4 59.8 62.97 61.5 64.9 65.5 65.7 67.69 67.75 68.41 67054

Male 63.24 64098 65.21 65.32 65.37 66.03 66.23 67.21 67.67 67.74 68.35 68.91 69.05 69.18 69.31 70.17 70.50 70.70 71.16 71.76 720'15

Female 67.60 69.61 69.88 70.19 70.26 70.79 71.16 72.34 72.87 72.92 73.61 74" 15 74.30 74.67 74.66 75.58 75.94 76.02 76.31 76.95 77.35

1959 1960* 1960 1961 1962 1963 1964 , 1965* 1966 1967 1968 1969 1970* 1971 1972 1973 1974 1975 1976

1945 1946 1947* 1948 1949 1950-1952* 1950 1951 1952 1953 1954 1955* 1955 1956

*Note:

Complete life tables"

- 8 -

TABLE 4.

NUMBER OF MEDICAL CARE PERSONNEL

1916 . Total No. Rate (Per 100 000 population) 118.4 38.9 84.3 14.3 23.7 338.2

Physician· Dentist· Pharmacist· Public health nurse Midwife Clinical nurse

132 419 43 586 94 362 16 212 26 804 382 459

.Figures stand for the data of 1915.

m/3t·R

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GOVERNO DE MACAU

REPARTICAo DOS SERVICOS DE SAOOE EASSIST£HCIA DiYino Tecnica

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REPARTleAO DOS SERVleOS DE SAUDE EASSIST£HCIA Divisao T6cnica

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m/31-R

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REPARJ~AO DOS SERVleOS DE SAUOE EASSISTENCIA Divisio Ticnica

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ENGLISH ONLY

BRIEF ON

REPORr

fH£ PfllGRESS OF HEALTH ACTIVITIES IN MALAYSU

**.*••*.*••**.*

10RLD HEAL1'H ORGANIZAfION RmlORAL COIIMI'r'rEE FOR THE IBSTERN PACIFIC

-

mRIJ ..RIIf!H SmSION

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

-' DIVISION OF PLANNOO AND DEVELOPIIU'l t MINISTRr OF HEALTH, MALAYSIA.

Kuala Lumpur, 5th August, 1918.

",

B.il.<S1 ) dIm. KK(BRP

&

K) '111/12

1. COUN'l'Rl

I

1.... MALAYSIA is a. federation of 1~ S~ate~ al:1 Co Ff)!cra1 TerritoIj', £lo':"on qf the States 21M .the Federal Territor'; nre in Peninsulllr !.!alaysia and t!'lc rema5.ning two Sta~es - SQbeh and Sarewak nre in the Island of Borneo. The to~nl la.'ld aroa is 12~,581 sq. miles 2 (330,484 Km). Peninsul/lr lolnloysia is 50,eo6 sq.crl.lot (1~1,5~ :(m ) and the Stete, ot Sabeh and Sarawak cover nn arl'!! of 76,715 sq.miles (190 C«)t; Kt1 ). :':he annuol rai!'l1'tll is

tatweea 60 and 160 inches. The daily average temperut~e v~ries from ?OoF to goor. Relative humidit~' is everywhere senerally high bl."; the nig.':t temperature is comparativelY cool.

2.1. fhe

e~imated

population and population density are as follows j977 £s~ (Pub.tion Peninsular' r.laleytia Sabah Sarawak IlALAISl.l\

-3. HE/.LfH STATUS s

Pens1ty/Sq.KI!I

... •••

,

..

r.lillion)' 10.54

8)

... •••

•••

o.m 1.12 12~53

11

9 )8

•••

3.1.' The general· health status of the populn'::;ion contin:.les to i!:lprove t\."ld the various mrtality indicators are continQO~ly on th~ decline. 1957 (Yeer 01' Independence) Crude Death Rate Neonatal Mortality Rate. Infant f40rtality Rate ~oddler

1976 (Lntest Avail~bl!L

.,!DQclino 50,,00

,.4.

J.lortality Rate

still Birth Rate Maternal Mortality Rate

... .. ... ... ,

12.40 30.00

6.20 19.01

75.49 11.00 24.00 ('1959) .2A12

;;0.70 2.56 16.90 0.78

36.63 59.33 '76.72 29.58 12.~

3.2. file Proportional Death Rate (;()+- years) has i~:,::,eased fro:!! 32.~ in '1957 to 55,. lbrethan half of the deaths are r,;)\, occuring in the older a~e-gl'Oup, ~J. ~he

In 1975.

life expectancy at birth for the cale and fe:l:ue populaticn which respectively in 1957 has increase:! to 65.4 end 70.7 years in 1975.

110.S

56 and 58 years

!he 6rude Birth Rate was 31.7 in 1976 as co~parcd to 46.0 in 1957. fhe Rate at Natural Increase has therefore declined fron 33.7 in 1~57 to 25.5 in 1976. relatively free froLl epidc::U.cs of ini'cc:tiou:; ditea1':c!;.

3.5.' Except tor ote-breaks in Choiera El Tor end DC!13U:i Hv.c:m'rh/l!>l.o rever, the cour¢1'1 has beon

- 2 ..

·'

40

HEilLTH BUOCZ':: :

4.1, Illld

Thc I{c:J.th E..·'!::,et ~C:' ~:'i3 .:.s ].:;:. (,(,~ LiEio;l (i.~ 'j'17 ;j~l.:on 1'0" Opcrc;;in~ r:~:penditu:.·l. 813 L'':'l:.ion ~or D·~ le~.cp;:I(r ':- ;::xp"ndi~'.lre), T:v] Op0rC~i.1"; E;;:p(;i1d:~.:re is ? .16% 1'1' tho total counti"J npp.'oprictbn for i: :) ()pr.:.~ .:re; S;J:':;::t \.:,5.h; tte D.:::dop;;]8nt E;:pen1iturc is 1o~.b of the total Davelopnant ai.' Ccpitcl Ir.'lcc',L:c;;!:!; t::Jpropdc'~lon.

14

4.2.

C~pito!Irva!:;~:J·;"t B:.J~e'~s

The per ocpit'l :~3cl;;il e:·~3:.citure is i.;:) 53,00 c.:' t,;:;;;; 2" .20, Both the Opere.tine; onnd C·.'3 ~u;·,c:,,;i 0:.1:; of ti:c CU1'rcr.~ Accoun';, The breakdown 01" the ;:~alth Budget is 03 f():lQW~ ••

!'! DcVclop::lere or ::ap5,tal In"estm~ E:·:;::cr,l.i'~~rc

~ 1;,.21

['7 8-,:} 3-'10

Operating Expcndi.;;.:re - G::;,'!.Adroinist.rctic.,l "

..

17 184 000 1~5

2.58 24~.8B 54~62

1.9:; OOJ

- Po.ticr.t C(I!'e

:;63" 402 000 ~1 377

ceo

·&Q.~·3~O

-

4 .. 71

~OO.:.<:2

.5.1.

Th3 heaH:, ::E'cto!'3.;~', pl::n i.> p.rL ~c.J pcrC:31 of th.: G(l·{~rr.ll,:n:;'!: total SQCl,o-eCO:1orn5.c prograt1l:!9 bcsed 0:'. t~.., :lcw 8co'"1'}r.i.c Pl~iC",:. :~:::; provi~:_on ,,: ir"p:-.}·':w health services v:il.llead ~o 8 be'.;ter c.:!':lity of lif·: I r"':'lct :..C'.:~ n~ .lor~c;.r.:; hCl':'S (':.J. :i r,creaS:l labour productivrty. Family plllnrlin:; lrsjir.:; to ;;::e (!c:;ircd p?pul::e;::,o.'. cl?c-;·r'.;L, vd.ll a::'so cont ..;5.bute to the develop!:!cn'; objecti... ~s oi'. irrpro',ing sT·;J,,::hr;i3 of li-tirC :md. c:r!<ll it:, cf .l.i:~ for (':Jpecially the rural people

liv:.rtg' In d(.prc,,~e1

z.l"''3US,

.

5.2. In o:-der to acn1.'H~ thi[:, tic') hr.~)J;;) ;;In:1 is b~sic2.l1:r on:) '!lhieh x.os 2-t c::m!'olidatin13 tho cxiS""inz seI'vic~s, u;:-g..-aG.:'ns :..:':! up·_'!::I;.:;';J3 fadl ~.~·ief. amI se:",'icl'ls 'co £,Muro bc"i::tcl'standaros of health. care lind the Pl'OjJ0!' t1::;;;riiJ:';:;:''',l o~· :iC;V fac.;.litic'J i;o ~::~,()re equ.itotJ.c ..::..is:ribU!;ion in areas and 8mnssl; ppuln.t.irm.<;r,J,JJs tb'.; ncec. '~:IC:; !:'?si;,

5.3.. Sino:: tl.c l~:~nching of t:1C Ccv(;r;:.,,:~:.:;: s Corcun:.':.y ;).::yp~o:,n():lt ?J.'o(;l'ru:il:Je in 1966. inc:'oasiIlG e~hasis h:lS teen ~i-.ren to joirt. ccllaborp.tio!l 1)c'·.v:cc~ ·i;h·) p~cplo a..~d the GO'l.:lrl'lJent in 'the improvement 0; the cO:::L:.:.;:;ity Il:':~ ir.dlvi::lill). l~tQlth, ~h;s 1": incorpo:'ated inthe v!lrioOs hecl~h progrru::.<nec ar.l ac~i·l::'tics cc!'r:.(\l c1;', at g:'O!;;:J lc\-el. .5.4. ' ;)<:':1::"e'/(,d i:1 tr.e iL;:~l'~:1Cl:~a'.:bn efi;.he h-:alth devclopr.::m!; plnm du.-i~ ti:e f~::."':~ t.:o yc~~s of tk p~l.n pc:::oc:.. ':118 p::'siccl ~:-c;;r,,;;s I':~ been 2$.fJfo 'lihere 5.29 projcc.ts (,<l'; of a t~t:ll 1.~'G') ;>roj<':,'.:s h',e b,~er: t;c-:~:etc:l byi:hc c!ld of 1977, costing so:w ~ 101.1 ml!.ion. C~· t".; :po,i.;(;t3c.:>!:)1;)t~(:, 57 .5~; 0:' j'):'" ;':--ojc::ts ~"C h::;Ql·th projects, 115' cedl.ccl proj cc;;s, 64 der.~el ;:;:'Ojeci;~, II t:'~r.i:-g P:'O~2:;~S and 33 other projects (oooical Stores, quarte~s, u~c •• )~ HEALTH SE:-t!IC"S :

SJ.tisf~ctory P:'\;E:,:'9S::; 11:::::;

c"'£:;

-

6_

6.1.1.

t:.3 br.::,l c rural health s~!"lice is estioated t9 be serri:'G ~c::rr ::rr;~ cf~r..; ;,c::d r.opulat:~')~ in PC'l5.n::::l'.r.r ~:Jlo.ysi.a be!: toa l:sser fC~~;'C0 :~.:1 Sc.b~h c··.':, S2i':";7:':;.-J, '*-.," thO·.c'l c: Jv;,.:·rp!:';'.;r;i; ~,j ~5.,,'{r:;. tho ·l".i~~st priQrity to \".!l? d(· ...·,:::.t)P~c~·; c·f b""..3~.c l"lt~~. ~ ';;t'..~::;h ~3I·':':::: .."\Sl i;; i5 e:Jt:"':~\.()I thrit 'complete

~].e exist:;'n,; hc·a.1.th :;.~rasi;.!'ucture of

-}-

eovernge of the rural population can only be achieved by 1985. In the interic period and as a stop.-gap ceasure it h:ls been decided to provide the tmServed 000 unde~-served popul~tion with health care based on an adaptation of Primary Henlth tare principles to suit the local situntion. In the r.talll~;5i:ln context the propos~ health measures to be ndoptE.<i will be known as Coanunity Health ~Iover:ent. 6.1.2. An intersectorial approach is being adopted in the planning andlnter in the impleClentation of' COlilClumty Health !;lovement Proe;rC!"..oe. Special eophasis is placed on direct comunity in'Tolvel!le!1t and participation in the planning and itIpleClentation ot this programe. 6.1.~.

44 adtJinistrlltive/health districts have been surVeyed between September, 1977 ruul April, 1978, to identify the under-served or unserved. villoees and also to oscertnin community resources which could be utilised in developing the Comounity Heclth IIovement. the survey revealed that 2,:515 villages in Vlhich there. are about 12% ot the population of the 44 districts, were urner-served by· the existing basic health services of these districts. A Iflltional Workshop on 'Col:llDunity Health Movecent1 was held in Uey, 1978. It wns atterrled by repre sent ati ves from various government ~encies, universities, professional and voluntary organisations. The workshop . discussed the scope, feasibility and organisation of' 3 cocmunity health IllOvccent progrt\Clll'le to service the under-served creas in lblaysin: Detdled studies are bein(; lDIl~e ot the her.J.th probler.ls r.nd health related proble~ i!l these: under-servocl arDas lull after which heelth prCl(7C!J::lCS will be formulated for implementt',tion.

6.1.4.

In 1979 a similar survey will be carried out in the remaining adDinstrotive/health districts in Ftlninsull1r r.;alaysil1 and in Sabah 1100 Sarawok. In the meantille, 46 mbile rural health teaIlS have been created to provide basic c~ative and preventivc services in the rural areas. Their functions am locations are being reviewcd in ~/l.. light of th~ st.:r\"ey results and the stlldies of the helllth problems in the ~er-served areas.

6.1.5.

6.2.. Maternal and Child H':!alth ~~ :

A continuous roviEoll' aM evDlul1tion of the !hternal and Child Health Services is being carried out and the progr3r~es I1nd I1ctivities I1re b€ing cQdified in accordance with the \'l~r.knesses, gaps, and probleos encountered. Stress has been pbced on tho health staff t'.joptir.g n more positive a,nd, dynamc t'.ttittrle towards health Care and to move away fron the clinic-setting concept to the comunity concept. Jithough routine procedures and noms have been laid dOVln, they are ureed to exercise flexibility base on health and health-related problems 1'l1ced : by .the loc~ cocmunity. 6.2.2. ~isk

Approach for

l.t.~ternal

and Child Health :

6.2.~.

\7ith the assistll.noc or W.H.O, a protocol hes been draWl\- up. The· baseline surve-J has cOtlI!lenced and is currently undeI'\yay. The survey is scheduled to the cot:l?leted by the end of 1978 and thQ Task Force will be then review the results ot the survey ani appropriate recommendations for the delivery system to ~ modified. "Cold Chcintt : HEYing identified t!le weaknesses in the storage, transportation and distribution

~o

ot vapcines, neasures arc being t$ken to .ensure, the. potency of va,ccines at, the operational lcvel~ . , " ,

·'

6.2.•4. Oral Rehydration : A fellsibility study is bcillG cnrricd and if the results o.re favournble it will De introduced in pho.ses starting with the rurnl clinics.

6.2.5. Traditional BirthAtt~nd~nts (TnA) ;

A plcn has 'been drawn up for the training and utilizntion of TBAs as cocounity health ~/orkers in the Con"Junity Health tlovenent rror;rame. Priority will be given to the recote areas where then; are no covernment nidwives. The project is beine; assisted by UraCEF. The TBl\s will act as a tinson between the cocounity nnd the first level of organiscc! . health care priLllJ.ri.l.y as a. motivater in IXH o.nd first aider besides her role o.s a midwife. 6.2.6. InI;ernation:ll Year of the Child (1979) : 'A national cocunittee under the aebis of the Prioe Uinister's Department has been set-up to co-ordinate the efforts nnd activities of v:lrious cinistries and ocencies. In the health area, pre-school health progra=es will be strencthened, the national breast £ee1illB campaic..n will be t'ollowed-up,. national code ot' ethilcs by the mlk iMustry will be implCJ:lented and a national nutrition surveillance programme will be umcrtaken. 6.~.

-

Family Planning

Inter;ration

I

InI;e€7ation at' Family f1.nnning in 1.1.C.Hp Services has been achieved in 34% ot' the AI.C.H. service-delivery points involvinB a total at' 1,2~7 Maternal and Child Health Clinics, rilain Health Centres, Health Sub-Centres, l.iidwife Clinics and Rurcl. Comcunity Health Clinics. In the meantime, of the auxiliary stllff or 2, fh2 Assistant Nurses and l,iidwi ves h:we already been trained in racily planninG work. Hence, intec;ration can take place mre rapidly in the near future. rhe nugb~rs uf new acceptors and re_visits hava increased from 2,96~ and 2E,519 respectivdly in 1971 to 22,G)1 aoo 500,401 in 1976.

m

6.4. Communicable Diseases : 6.4.1. ~~

out-breaks occurred sporadically, focally and yearly over the past 10 years in Malaysia. In 1978 (up to 6.7.1978),1,009 cases with 37 deaths have been reported, affecting 12 of the 1~ States and the Federal Territory. A sizeable nunber ot' carriers has also been detected and todate stands at 1,101. Long-terr: rccedinl r.:easures in urbc.n slumps and rurnl kampongs, concurrent with ilJ!.1ediate interir: remedial measures are being vigcrously urrlertaken to control the outbreaks.

-'

6.4.2. typhoid has been showing a rising trend since 197310ccuring in sporadic focal outbreaks in snall estates, villages and towns. 6.4.~.

Infectious Hepatitis : The incidence of viral hepatitis including HA and HB is appr?xioately twic~--that of typhoid end it rises with the rising trend ot' typhoid. There is need to improve serelogical diagnosis and disease surveillance •. An InterRegional Seninar on Viral Hepatitis was held in Kuala Lumpur in December, 1977. Dengue Haemorrha~c Fever : The incidence ot' the disease has been kept in check froc 2,201 eases Ivith 104 deaths in 1974 to 773 cases with 37 deaths in 1977. Further atempts tre being made to lower the incidence of corbidity ani mortality.

6.4.4.

"

.

'.

-!i-

,,6.4.5~

Malaria: Undar the constant nttack of malaria eradication and mnlaria control activities, the incidence in Peninsular l'.Ialnysia h:!s fnllen fron 2.75 per 1000 popul ntion in 1970 t<'J 1.24 per 1000 in 1977. 6'2'/> of the 10.54 popul'1tion in Peninsular Malcysia are now livine; in !lnlarir.-tr:msmission-free creas. In Sabah and Sarawnk, despite the malaria control prograr.ncs, the incidenc~5 of mnlaria is' still high.

6.4.6. Pulmonary Tuberculosis is still a public health problem although its incidence has fallon from 0.92 per ~ooo

population 1970 to 0.72 per 1000 in 1976.

6.4.7.

Sexually Trans~ittcd Disenses (STD): A national STD survey done in 1976 showed a rising trend in the incidence of STD particularly gonorrhoea and syphilis. A national STD control proe:rr.t~'1e is being vlorked out for implementation as soon as it is ready. Non-Connunicable Diseases: Studies and surveys are being planned to obtain accurate epidecioloe;ical inforn3tion on cancers and cnrdiovasculnr diseases so that a comprehensive progr(UJme for the trentment, control, prevention o.nd rehabilation Can be planned. Sanitation and Rural COr'~1Unity

6.4.8.

~~..s.

~vironr.lental

,Inter Supply

6.5.1. lAnny of the cOllllllunicable diseases cor:l!lOnly occuring in this country are due to poor sanitation and improper water supply. Hence, every eophasis is being placed on improved sanitation service and Vlater supply in the rural arcc.s and urban slumps. In 1977, a total of 609 protected wells, 34,310 sanitary toilets and 21 gravity feed water supply systems were completed. in Peninsular !Iialaysic, thus providing an additioml populction of 173,000 with sanitary facilities. In Sabah, 80 rural water supply syster"lS and 1,438 sanitary toilets Ylere co~pleted and in Sarawak, 156 rurcl wQter supply systems and 7,402" sanitary" toilets were COlJpleted.

7.

MEDICAL CARE SERVICE: 7.1. The ljedicci Care Service is designed on a centripetal system lIith priraary medical cs.re at the periphery, secondary Iaedical care at the intemediate level and tertiary medical care at the centre. Whilst secondary medical care is being decentralised to district hospital level, tertiary medical care is being'regionalised in selected general hospitals to Berve the 2-3 million population of a region.

-'

7.2. The' referral' systeI:l has been reorganised so that a patient cell receive the appropriate level of care which his condition dictates both expeditiously and effectively.

7.3. The overall bed/population ratio is 2.7 beds per 1000 popUlation and the acute bed/population ratio is 1.8 beds per 1000 population in Peninsular !Aaloysia. J:'he admission rate per 1000 population is 55.4. The nverage occupancy rate is 67.23% and the average length of stay is 8 days. The overall b~l/population ratio for Sabah is 2.1 bed per 1000 popUlation and the acute bed/population is 1.8 beds. In SaravIa]{ the overall bed/population ratio is 2.46 beds per 1000 population and the acute bcd/population ratio is 1.76 beds. 8. 1!:,.NrAL SERVICE :

8.1. The dental service has also been patterned on a centripetal system. Using the rural health service facilities and schoels as the base, this service has perceated deep into the rural areas. Por schools Ylith enrolI:!ents too small for a resident dental nurse to be fully deployed and for isolated concentr:ltions of population v:here no health facility is provided, mobile dental squads have boen established to service the~.

r

-6-

8.2. There arc 674 dent31 clinics with 1,104 chairs nnd 22 mobile dentel squads in Peninsular Malnysin, }5 dental clinics with 52 choirs in Sabah ani 83 dental clinics with 134 chairs in Saray/ak. 8.3. In Peninsular Malaysia almost all the public water supply systems have been flouridated. Similarly the public water supply system for Kota Kinabalu in Sabnh has been flouridnted and 15 public water supply systems of the various townships in Sarawak have !Jeen flouridated. The progralilfao of water flouridntion is estimated to cover about 50% of the population or around 6 million people. .

9. TRAINlf«J: 9.1. Training facilities for b~sic training of para-medical and technical starf have been developcn and expandc-d ao rapidly that the stage h2s no'il reached where the country is no longer dependent on foreign sources for such training. :2 Medical Faculties, a Dental Faculty and 11 School of Pharmaceutical Sciences have been established in the local Universities.

-

9.2. Continuing medical education for the professional, technical and para-medical staff has not been neglected. Numerous post-groduate and post-basic courses have been locally estabiished in conjunction with the Universities, Training Institutions and Professional Org~nisations, on a perr.l2nent basis. It is hoped to further develope ::md expand this capability, so th1!t the ,country will be less dependant on foreign sources. 10. UAllAGEliErr,r:

10.1. The developcent of the Health t.~nngeIi1Cnt Information SysteCl (H!l.IS) is taking longer than expee':cu due to its cumplexities and r~fications. A nur.ber of orgnnizational and technical problems have been encountered or nre being encounterl~ but the first products of the prcject is expec:ee to be field-tested during the last quarter of this year. 11.

ACKNOI'ILEDGELIENT: The GovernClent of Malnysia and the Ministry of Health wish to place on record the deep npprecintion of the collabor:!tion received from I/.H.O., U.N.I.C.E.F., the World Bank, and other U.N. Agencies, Foreign Governuents and Organizations in support of the various projects and programoes cf the l'Wstry of Health ldalaysia. It is hoped that this cOrdial co-operation will continue for o.s lone; as is necessary.

'-

MINISTRY OF HEALTH,

LlALAYSIA, KUALA LUUPUR.

DATED : 5TH AUGUST, 1918.

EJfl/kt.

.

.(

ORIGINAL: .---

FRENCH

NEW CALEDONIA AND DEPENDENCIES BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES1 1976 - 1971 1. POEulation 1961 19 68 196,9 1970 1976 2. 92 085 inhabitants 94 300 inhabitants 100 512 inhabitants No census 133 233 inhabitants

Health services activity Year 1916 1917 Difference Outpatients 116 514 116 871 +357 Visits 294 093 267 460 .26 633 Inpatients 13 357 12 940 -417 Hospital days 279 534 278 032 .1 502

3.

Health eXEenditure

Health expenditure is covered by two sources of funds: the budget of the Territory and the funds allocated by the Government of France. (a) Territory budget (in US$) (operational) Percentage Health expenditure/ Territory budget 12.03% 12.32% +0.29%

Financial year

Territory budget

Health expenditure

1976 1977 Difference %

US$ 131 066 322 US$ 136 635 460 +5 569 138 +4.25%

15 774 942 16 846 667 +1 071 725 +6.19%

1 Presented by Dr M. Charpin, General Medical Officer, Army Surgeon, Director of Health and Public Hygiene, New Caledonia and Dependencies.

- 2 -

(b)

Funds from the Government of France FIDES

= Investment

and Socio-economic Development Fund US$ 24 023 US$223 103

1976 allocation 1977 allocation (c) Total health ex~enditure

1976 financial year

Regular budget FIDES Total ."

US$ 15 714 942 24 023 US$ 15 798 965 US$ 16 846 667 223 103 US$ 17 069 770 +US$ US$ US$ 1 270 805 118.58 128.11

1977 financial year

Regular budget FIDES Total

Progressive increase 1976-1977 Cost per capita 4. Staffin~

( 1976 ( 1977

(a)

Personnel employed by the health service: 1976 Medical officers Pharmacists Dentists Social workers Registered midwives Assistants (registered nurses) Nurses (Territory diploma) Nursing aids and assistant nurses Laboratory assistant - chemist (dietician) prosthesist - laboratory technician masseur Priests Assistant students Nurse students Clerks Public works and transportation personnel 57 3 6 4 8 82 70 203 6 3 34 31 62 369 1977 59 3 6 4 6 102 76 203 7 3 42 31 62 369

- 3 -

(b) Two other medical officers are employed by the Youth and Sports Service and the Occupational Health Unit and ten are working for the CAFAT and mutual insurance companies. (c) There were 53 medical officers in the private sector by 1 January 1978. 5. Organization (a) Health institutions in Noumea: 471 beds including"'30 in the sanatorium 299 beds (226 for psychiatry and 73 for geriatrics) 156 beds in 2 villages

Gaston Bourret hospital Nouville asylum - Raoul Follereau Centre - Tuberculosis clinic - Leprosy clinic - Mental health clinic - Oncology group - Sanitation control office (b) aids.

The Noumea nursing school prepares registered nurses and nursing

(c) The infrastructure has been considerably improved during the last few years. At present 15 medical centres and 13 infirmaries provide 360 hospital beds and are manned by 18 medical officers who carry out routine medical treatment, oase detection and prophylaxis, as well as general hygiene activities in their respective medical districts. 6. Control of social diseases

The following social diseases are the responsibility of the Division of Social Hygiene of the Health and Public Hygiene Service set up by Decree No. 331 of 10 June 1966: (a) Lepros~ - By 1 January 1978, 586 cases had been registered in the Territory, inclu ing 58 new cases detected in 1977. The Melanesian ethnic group is the most affected: 73.20% The total prevalence index (number of leprosy patients in relation to the population) dropped from close to 10% in 1970 to 4.39% in 1977. (b) Tuberculosis - Tuberculosis remains endemic in the Territory: 155 new cases were detected in 1977.

- 4 -

BOG immunization was given to 11 155 persons during 1911: 9653 post-immunization tuberculin tests were carried out, including 4198 which were positive (i.e. 49.65%). 16 894 routine chest X-ray examinations were carried out; 463 suspect cases were detected, with 155 confirmed. (c) Sexually transmitted diseases - Syphilis seems to be declining: 331 cases in 1977 compared with 398 in-1916. Gonococcal infections - 448 cases in 1911 - are also declining. (d) Mental health - The mental health clinic is manned by a full time psychiatrist and a part-time psychologist. AlthO~Sh the number of outpatients (300) and visits (1159) are stable, the number of child patients visiting the clinic has increased (34.6% of the outpatients and 21.4% of the visits). (e) Malignant neoplasms - 202 malignant neoplasms were detected in 1911, including 61 among the local population. They included mainly epithelial tumours: squamous carcinoma cylindrical carcinoma glandular carcinoma undifferentiated carcinoma 104 48 22 7

Cobalt treatment is available in a clinic in Noumea so that patients who previously had to be sent to AUstralia or France can now be dealt with locally. (f> The four main causes of adult mortality in the Territory are: cardiovascular diseases neoplastiC conditions traumatological conditions pleuropulmonary conditions

The main causes of neonatal and perinatal mortality are prematurity and cardiorespiratory deficiencies and, among young children, toxicosis and dehydration. Morbidity is not specifically tropical, apart from ichtyosarcotoxism (515 cases were registered in 1917) occurring all the year round, dengue fever which remains stationary (260 cases in 1977 against 283 in 1976). Epidemic episodes of measles (982 cases) and chickenpox (845 oases) of no particular gravity also occurred.

An important epidemic of scabies occurred among school children often accompanied by a superimposed infection and pediculosis. Efforts are still needed to educate the people in general hygiene and food habits, and to control alcoholism which is a serious social problem.

- 5 -

7.

Present trends

The free medical care system represents a heavy financial burden for the Territory insurance schemes. Social welfare should be progressively coordinated and eventually managed by a General Health Insurance Service. It is planned to set up a Territorial Hospital Centre with an autonomous budget, thus making it possible to deal with increasing needs -- for speOialized medical care • The cost of such care should be known exaotly for all the possible improvements to be implemented effectively. The rural medical centres, which are fairly well equipped, will, under the supervision of central services, playa major role in the treatment of diseases considered to be social problems. They will utilize the modern therapeutic means at their disposal, and will endeavour to prevent those diseases in rural communities. <

The number of medical officers in Noumea is sufficient: but the need for health education remains. Two approaches will be attempted which will require a new administrative framework: - control of malnutrition through better use of local resources and development of neglected crops. - control of dental disorders, starting with children. ~regnant

women and school

-1

ORIGINAL: NEW ZEALAND BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES 19771781 1. REVIEW AND RE-ORGANIZATION OF THE HEALTH SERVICES

ENGLISH

First steps have been taken in the provision of a comprehensive scheme for future organization of the health services in New Zealand. The move has been made by the SpeCial Advisory Committee on health services organization, set up in 1976 to advise the Government on the provision of such a scheme. The committee has prepared a discussion document designed to assist in the coordination and planning of all health services, shifting the emphasis from those which are hospital-based to those which incorporate profeSSional and voluntary organizations and which are preventive and community-based. Initial implementation involves an examination of methods of advising Government on making health services policy and on the establishment of two pilot s_chemes in representative rural and metropolitan areas. At the to consider the private appropriate national level, a sector advisory committee has been established finance, personnel, administration and the legal implications of schemes. Consideration is being given to the establishment of committees for this purpose. ''''

The pilot schemes established in the rural area of Northland have already become the responsibility of a locally appointed health services advisory committee which will examine the proposals contained in the discussion document and develop and modify them to meet local needs. Wellington has been selected as the metropolitan area and, although the structure of the committee may vary, the same principles will be applied. 2. 1. New Health Benefits CLINICAL SERVICES

Non-disposable syringes and needles are now available free of charge for diabetics presenting a medical certifioate to a retail pharmaCist. Subsidies up to $100 for wigs and hail' pieces are available for people suffering from specified medical conditions or the effect of therapy. Replacements are only subsidized for children. Artificial eyes are subsidized up to a maximum of $30.

/"

lSubmltted by the Dir.ector-General of Health, New Zealand.

- 2 -

Contraceptives and pregnancy tests will be free from 1 August for patients requiring them on approved medical grounds or when medical practitioners consider payment by the patient inappropriat~. 2. Increased Health Benefits

The monetary value of the patient benefits payable by the Government to meet part of doctors' consultation fees has been increased for: -~

services provided by general practitioners to children; 'for all patients of specialists; and for maternity services which are free to patients, if carried out by general practitioners; child immunizations are free; benefits for radiological services; and hearing aids are to be increased.

3.

Pharmaceutical Benefits

In- the 1977/78 financial year, the drug bill reached $97.9 million. This amount does not include the cost of drugs dispensed in hospitals. Attempts are being made to contain this expenditure.

4.

Practice Nurse Subsidy Scheme

Since 1974 schemes have been operating whereby the Government meets all costs to general practitioners of employing registered general nurses, provided they are carrying out nursing duties associated with the doctor's practice. There are two programmes. Doctors may elect to have 50 per cent or 100 per cent of the nurse's salary subsidized. As at March 1978, 644 nurses were employed under these schemes.

3.

HOSPITAL SERVICES

In the 1977 budget, the Government introduced a special tax on tobacco and alcohol sales. Proceeds were earmarked for the development of community care projec~s. During the 1977/78 financial year, $3.369 million derived from this tax was allocated to hospital boards for community health programmes designed to reduce demands for hospital beds and inpatient services by: (1) (2) (3)

promoting good health and preventing illness; and deferring or obviating the need for hospital admissions; or assisting in earlier discharges, and rehabilitation in the community.

- 3 -

A wide variety of programmes have been initiated by boards including the employment of a substantial number of social and other health workers and of home helps. Vehicles and other back-up resources have also been provided. New or expanded community psychiatric services, including the employment of community psychiatric workers, have been developed. Services for the aged in the community have also benefited by the provision of geriatric day hospitals, expanded meals-on-wheels and other support services. A number of boards have made use of a special fund set aside for -~ family health counselling services, establishing such centres within their districts or providing additional service$ in conjunction with voluntary .organ.i,zati'ons active in this field. The reports of special committees set up to consider the development of cardiac surgical and neurosurgical units and renal dialysis and transplantation facilities were considered by the Government. As a result, approval was given for a fourth open heart surgical unit to be situated in the South Island. The development of another neurosurgical unit in the South Island was approved. A comprehensive report on the development of renal dialysis and transplantation facilities throughout the country was adopted and is now being put into effect. A significant expansion of home dialysis services will result. The first C.T. scanner is currently being installed, and following its evaluation, two further units have been promised by the Government, to other major centres of population. The national pituitary hormone laboratory set up to extract human growth hormone and human pituitary gonadotrophin from glands oollected locally, has produoed its first trial batches and will be in full production soon. The establishment of a blood fractionation plant to supply the needs of New Zealand for blood fractions, previously imported from Australia, has recently been considered by the Government and approved in prinoiple, subjeot to the results of a feasibility study. 4. MENTAL HEALTH

New Zealand is in the middle of an officially designated Mental Health year. The major thrust for this project has come from the Mental Health Foundation, an independent body established with wide public partioipation and funded from the donations of over $2 million attracted by a national Telethon Appeal in 1977. The foundation has, as a major aim, the eduoation of the public and the encouragement of innovative schemes in the mental health field. Postgraduate training in psychiatry is receiving special emphasis from the recently established Council for Postgraduate Medical Education. Plans for programmes in each of the four centres in which there is an aoademic department of psychiatry attached to the university, envisage the training ultimately to the standard required for the entrance examination of the Royal Australian and New Zealand College of Psychiatrists.

- 4 -

5.

DENTAL HEALTH

A survey of 5-year old children has revealed that the mean number of decayed, missing and filled primary teeth (3.75) has halved since 1950. Thirty-four per cent of 5-year olds are now caries free. While children leaving th~ School Dental Service at age 13 are dentally fit, they still have a relatively high number of fillings. However, as a result of a further increase ·in the emphasis on prevention, the need for fillings has markedly declined in 1977. The amount of restorative treatment prqvided for teenagers under the dental benefits programme is al~o decreasing steadily. ~., . A comprehensive survey of adult dental health has shown that, although the percentage of the population without natural teeth is declining, tooth loss is still a feature of adult oral health. A workshop involving representatives of all groups concerned with the provision of dental services has been held recently to consider means of improving dental health in the community_ 6.

NURSING

The trend towards an increase in community health services outside the , acute care hospital system has continued. Twenty-eight per cent of nurses are now being trained in comprehensive programmes at six technical institutes. Planning is under way to develop a strategy to complete the transfer of hospital-based 3~year basio nursing programmes to technical institutes. Planning for an improved system of post-basio nursing education has also been completed. The aim is to improve the clinical knowledge and skills of registered nurses and to rationalise what has been a fragmented and outdated pattern. Further progress has been made toward implementation of the policy that professional nursing services be provided by registered nurses. The transfer of nursing education from service-based programmes to student-based programmes is an essential basis for this policy 7. 1. Family Health PUBLIC HEALTH

A post neonatal (28 days and under one year) mortalit~survey is being taken, over a year, to study the social and medical factors associated with each post neonatal death, to elicit causee and to remedy these where possible. Although the overall post neonatal death rate per thousand live births has been approximately halved in the past 20 years, a great deal of scope is left for further reduction.

- 5 -

A medical examination of infants at about nine months of age has been introduced. The purpose of this examination is to ensure earlier detection of defects, or delays in normal development which, if not treated early, could affect a child's future development and potential for learning. The examination is also of value in determining congenital anomalies or other handicaps not diagnosed at birth. Although general practitioners are not legally required to carry out this examination, it is expected that they will in the interest of the child. A new form of medical notification of birth or still-birth has been under the Obstetric Regulations 1975. The form has been drawn up . after consultation with the various specialist bodies concerned and the New Zealand Medical Association. Apart from. ensuring that some form of nursing and medical care will be available to babies with congenital defects or handicaps, early recognition of a number of similar defects occurring simultaneously and in the same place will allow for environmental influences to be promptly investigated. A National Congenital Anomalies Advisory Committee comprising a nominee of the Director, Division of Public Health, paediatricians, a geneticist and a statistician will be meeting regularly to monitor and interpret the returns. introduce~

2.

Disease Control

New Zealand is still free of the mosquito vectors causing diseases in man such as dengue fever and malaria. Because of this, the cabin area of all aircraft arriving in New Zealand from any foreign country is sprayed on arrival, prior to the disembarkation of passengers, with 2% d-phenothrin. A mosquito survey is being held in the northern part of New Zealand to check for the presence of other than endemic species of mosquitos. To date, only endemic species have been found and identified, i.e. Culex eervigilans, Culex quinquefasciatus, Culex asteliae, Aedes notoscrietos, maorigoeldia argyropus. Since the introduction in 1976 of the policy of concentrating on "at risk" population groups, the number of MMR (mass Miniature X-ray) vehicles has been reduced from nine to six and 40% less X-rays are now being taken to deteot one new case of pulmonary tuberculosis. The overall yield in 1977 indicated that the use of this system for finding tuberculosis in the community continues to be warranted. The rate of new cases of pulmonary tuberculosis among Polynesians in New Zealand is at present ten times higher than that of the remainder of the population. The policy of screening migrants from the Pacific Islands prior to arrival in New Zealand i5 continuing and it is antiCipated that these procedures will assist in the control of tuberculosis in this country. The Advisory Committee on Smoking and Health has recommended that legislation be introduced to replace the present voluntary agreement between tobacco manufacturers and the Government, whereby the advertising of Cigarettes is restricted. Some success has been achieved in that Air New Zealand, railways and other forms of public transport are now allocating non-smoking areas. A teleVision advertising campaign will commence shortly. It is aimed at making smoking socially less acceptable and discouraging young people from taking up the smoking habit.

- 6 -

A postgraduate education course on venereal disease was held for general practitioners in December 1977. Considerable interest was shown by the medical profession and the course will be repeated this year. There are currently three venereal disease answer phones operating in the Wellington, Christchurch and Napier districts with a further six on order for other health distric~s. The clinics, where an answer phone is operating, record the number of patients attending as a result of using the service. There is no means of ascerta1ning the number of people going to t~eir general practitioQer for diagnosis and treatment. A new venereal disease clinic was opened at New Plymouth in November 1977 bringing the total pumber of such clinics in New Zealand to 14. An audio-visual health education production unit has been established which will provide New Zealand orientated tape/slide programmes for use by health education personnel. Programmes on occupational dermatitis, scabies and sexually transmitted diseases are being produced at present.

3.

EnVironmental Health

Changes aimed at more effective financial control have occurred in the administration of government subsidies to encourage and assist local authorities in the prOVision of improved water supply and sewage disposal works. During the last eight years, 182 new or improved water supply schemes and 149 new or improved treatment and disposal schemes have been subsidized. Of these, 59 water supply schemes and 33 sewage disposal schemes have been completed. . New Zealand is actively partiCipating in the WHO/UNEP Global Environmental Monitoring Systems Water Monitoring Project for the initial period of three years and will provide water quality data from three stations. The Department of Health is the oollaborating 8iancy. The Hamilton Soienoe Centre of the water and Soil Division of the Ministry of Works and Development will coordinate sampling, analytioal and data processing and storage. Inoreasing attention is being given to the oontrol of noise. The department assists looal authorities to control environmental noise by making surveys upon whioh noise control ordinanoes can be based when looal authorities review their distriot town planning schemes. New Zealand has recently introduced regulations providing that newly-manufaotured or introduoed motor vehioles will be subjeot to maximum allowable noise limits. The oontrol of industrial air pollution is well established and the first "clean air zone" to control domestic air pollution has oome into effeot. Investigation of oxident formation has continued, with intensive monitoring and revision of emission inventories. Controls on motor vehiole emissions are being oonsidered. The results of monitoring at six stations are now reported as part of the WHO/UNEP GEMS air quality projeot.

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4.

Occupational Health and Toxicology

The Industrial Chemicals Committee established to advise on the hazard potential of chemicals used in industry continues to recommend investigations into the exposure of workers to these chemicals and to revi~w control measures. It is still considering potential carcinogens and aooeptable biological limit values for certain metals. Three occupational health teams, each comprising a scientist, an occupational health nurse and an industrial medical officer, have been establi~hed on a regional basis to assist district health offices with occupational health. They will investigate health problems in various industries, such as lead processing, fibreglass, rubber and forestry. The noise damage risk criterion has been reviewed and the level reduced from 90dBA to 85dBA.

ENGLISH ONLY BRIEF HEALTH REPORT PAPUA NEW GUINEA Area Country's capital city: Population Health budget National growth rate 464 112 kilometres Port Moresby 2.8 million K35 million: 8t Govt Exp Kl2 per capita per year 3t (2.8t)

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HEALTH SERVICES AND PROBLEM AREAS Distribution of rural population

The low density of population in most rural areas makes delivery of health services difficult. This situation is made worse by an underdeveloped road network and inadequate water transport and land transport facilities. The coastal community appears to be more concentrated, in one or more villages, than the Highlands community, which is greatly dispersed over a large and difficult terrain. This makes development, such as water supply construction, for a given community quite expensive and in many instances not feasible. 2. Urbanization

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The drift of rural population to the urban areas is inevitable. A number of social problems are becoming evident and are of great concern. This includes squatter settlements around four main centres, malnutrition, large consumption of alcohol and an increasing incidence of violence. Venereal disease has been noted to be increasing in two centres, but this is probably due to more intensive search and contact tracing being instituted. There exist housing problems in terms of availability and standards. Road and traffic accidents are emerging gradually. 3. Mortality and morbidity

Consolidation of the leading causes of death, admissions and consultations in hospitals, health centres and aid posts, resulted in a single list of 20 more specific causes. Thirteen of these were infectious diseases. The other two were nutritional deficiencies and complications of pregnancy, delivery and puerperium. The latter also includes a substantial proportion due to infection. As can be expected, a young population like papua New Guinea (45.1% of the population is under 15 years), suffers from infectious diseases more than any other cause. Most of the causes are highly

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- 2 vulnerable to standard preventive measures which do not require high technical skills. The thirteen infectious diseases include the pneumonia and bronchitis group; the enteritis and diarrhoeal group; tuberculosis; malaria; septicaemia; skin infections; measles; leprosy; acute respiratory infections; otitis media; conjunctivitis; and venereal diseases. 4. Health expenditure administration

The Departmentls total expenditure for 1976/77 amounted to 134 257 506, an increale of 13.6 million (lO.5t) over the previous year. Major increases occurred in salaries and wages, utilities, materials and supplies mainly due to inflation on imported medical equipment and pharmaceutical supplies. Approximately more than Sot of the health budget is absorbed into operative cost of four main urban hospitals. This pattern is subject to review in due course. 5. Manpower development

The 1974-78 National Health Plan fell short of the required target: of doctors due to low intake of students and because of the high attrition rate of nurses. We realize the cost involved. With the emphasis for primary health care, the training of paramedical workers, including training of health extension officers, nurses and aid post orderlies, is being encouraged in our training institutions. We will continue to recruit doctors from overseas until we are able to produce an adequate number. Malaria Malaria is still the most destructive public health threat in our country. Considerable internal and external aid resources have been devoted to the malaria control programme. The achievement is limited by inadequately trained manpower; scattered isolated communities living in difficult. terrain, with many good places available for mosquitoes to breed and inadequate allocation of land transport and water transport. This still leaves a lot to be done in this programme. The spraying operation continues in selected areas and integration of this programme into general health services is being encouraged through the decentralization of functions. Environmental health Approximately 80t of the rural population is without adequate water supply and very few have proper excreta disposal facilities. High incidence of diarrhoeal disease must be attributed to poor sanitation. We are grateful to UNICEF for their continued assistance in providing materials and tools for community water supply construction •

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6.

Family health

6.1 MCH services include antenatal, natal and postnatal care by the midwifery services. This is made available in hospitals, urban clinics, mobile clinics in outstations and health centres. 6.2 EXpanded programme on immunization

Incentive work has been initiated with collaboration from the World Health Organization and the Department of Health to immunize persons at risk against infectious diseases (pertussis, diphtheria, tetanus, tuberculosis and poliomyelitis). The aim of this policy is to achieve adequate coverage of the young population in the age group o - 5 years. 6.3 Family planning

The present family planning programme is not designed to affect population growth rates. Rather it aims at improving family health and welfare of both the baby and the mother. Family planning, for both purposes of spacing births and of limiting family Size, i8 traditionally accepted in most Papua New Guinea cultures. 6.4 Nutrition

Approximately more than 20~ of young children are malnourished, due to ignorance coupled with unbalanced intake of nutritious food. The programme in Papua New Guinea has received favourable attention from politicians, educationists, agriculturalists and the health worker. Local food production is being encouraged so as to be other than dependent on imported foodstuff. 6.5 Health education

The importance of health education cannot be over-emphasized. There is room to upgrade the existing facilities in our health education institution. The Government of Papua New Guinea, through the Department of Health, wishes to thank the external agencies, such as UNICEF, WHO, UNDP and member countries of the Western Pacific Region, for their continued collaboration in terms of skilled manpower and other resources.

,. ENGLISH ONLY REPORT ON PROGRESS OF HEALTH ACTIVITIES IN THE IEPlJBLIC OF KOREA FOR THE TWENTY-NINTH SESSION OF Til! WHO pGIONAL COMMITTEE FOR THE WESTERN PACIFIC

Since preaentation of the last report at the 28th seasion of the Regional Committee Meeting in Tokyo. Japan, signific.nt progrea. has been made in the improveaent· of health c.re activities in the aepublic of Kor ... .. aa outlia..d below: . 1. Medical Aid Prol&'4l11De

La.t year, 2 O9S 000 low income per.oa.••mOilS the total popul.tion obtained fr.e medic. I care under the medical aid progr.... which 1apleaented with govenuaent'. financial .upport fr_ January 1977.

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2.

Enl.rge.ent of Medic.l Insur.nce Sy.tem

In July 1977. the medical inaurance .yate. waa .xp.nd.d to a.sur. that gor. than 3 300 000 indu.trial employee••nd their f..tlt •• would be .ccorded ..dical .ecurity.

3.

Enlargement of Medical Eguipeent .nd 'acilities

'OUr fle.t of ho.pital .hip. has been expanded to fift ••n. includinl ais Ihip. newly cODitructed in 1977, and ia now,providlnl regular care to the inhabitantl of the remote i.let•• Four'proviacial ho.pitall vere al.o .nlarg.d to I.neral ho.pital. and two hua.dr.d he.lth centr•• and .is hundr.d forty lubc.ntre. were relnforc.d with .a4.rn ..dica! equipment and facil1tte••

4.

Coamunicable Di•••••• Surv.illanc. 4

Th. Gov.rn.ent il providinl fr.e preventive inocul.tion. for v.riou. communicable d1...... (cholera, encephaliti., typhoid, diphtheria. BOG. atc.) .nd i. tntenetfying the .ptdeaiological .urveillanc. activitt .. to check them in advanc•• S. .. Or

Jaerovaaent of Environmental Jlyaiene

In order to .eal with the increa.ing .nviroDmental pollution r •• ultinl fro. rapid indu.trt'llzation, the Goveroaent ..de . . . . .plng r.vi.ion of the Public Nui.anc. Control taw, ree.tabli.hlnl the Invlroaaental Pre.ervation Law and the Marine Pollution Pr.vention Law. In this connezion, the Government has alao introduc.d euerl.tic environmental pr.. ervation progr..... such as •• tabli.hment of envirOD1l8ntal queUty .tandard., d•• ignation of .pecial counteraea.ure. zonea where needed, more strict control Qf polluting ,ub,tance., and expan.ion of environmental re.earch. lSubaitted by Mr Woo Young Chung, Director-Gener.l, Bureau ot the International Organizationa. Republic of korea •

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The Government has installed simple piped water supply syst... at villages in TUral areas. thus increasing safe water supply rate up to 591 of the TUral population including 2059 places ips tal led in 1977. 6• Dt'ug Produc tion

In the was adopted progress by ones during sufficiency

aepublic of Iorea, the Good MA~facturini Practi~e Sy.tea in May 1977 and the drug manufacturers have made great replacing outdated facilities and techniques with modern recent years. We have consequently attained selfin essential dTUgs and are engaged in the export of pha~ceuticals. at international quality control standards. Population Control and Family Planning Prolra..e '.

7.

Inteneive efforts to maintain a reasonable population size have reduced the population growth rate from 2.921 in 19.2 to 1.681 in 1977. Family planning practice has now reached 441 of a total of S .illion married eligible couple•• 8.

Imerov....nt of Primary Health Care

Be.ide. the above-Gentioned medical aid programme, ealarged medical insurance .y.tem. and various ba.ic health ••rvice., the Government i. trying to expand the .ervices for prtmary health care. Thi. will be achieved through .trengthening and improving the fUnction and facilitie. of 202 health centre. located in each city/county and of 1336 subcentre. located ill each township level throuahout the country. In the aepublic of Iorea al.o, health care proble.. in rural communi tie. are no longer viewed in i.olation but are considered a. an integral part of the total developll8nt proP'...... Accordingly, through the "SAI-M4-UL UIt-DOlIG" or new village aoY. . .nt which atme at compreheneiv. c~nity d.velo,..nt by th. efforte of the people th.... lv•• and by the government'. a •• btance of .. terial and technical alde, our aoverument i ••xerting inten.iv• • ffort. to provide integrated health .ervice. for the entire population. lxample. of th•• ervice. to be provided include health .ducation progr..... for the aobili.ation of ca.munity people, aDd Mea end f~ily planning .ervice. throuah village .ath.r.' club•• Such all improvement of national health in th• •epublic of Xorea result. from the succe•• ful implementation of three consecutive five.year economic develo~llt p1an8. Throush the.e plan., coaplete. in 1976, the lepublic of Korea has now reached the .tage where we are able to utill.e the resources accumulated ln the process of economic grQwth since 1962 for improvement of the social well-belng of the people. In thelepublic of Korea, health and socialaffalr.a~e ane.sentlal part of our current socio-economic development poUcy. ' affort.arebei... , concentrated on the (apIe..ntation'of aneapanded health.progra..- a,..d at providing better .be.lth care at low cost to the eatire'P0pulaUon: a. ,: ~ell a. active promotion of social welfare.

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ORIGINAL: BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN SINGAPORE'

ENGLISH

1. Keeping the population healthy, efficient and productive is crucial to the total national development strategy of Singapore. In order to prevent illness, greater e~hasis has been placed on preventive medicine and health promotion in recent years. This strategy is also being adopted in the attempt to alleviate the problems of rising governmental health expenditure which rose by 73J over 5 years between 1973-1971. The per capita health expenditure was S$76.92 in 1977 as agaiPst S$46.94 in 1973. 2. In 1976, to control rising expenditure the outpatient, maternal and child health and school health services were integrated into the Primary Health Care Division. With these services under one administration, a more flexible and efficient utilization of existing manpower and material resources could be effected. Primary health care services provide all members of the family with good preventive services and therapeutic care as well as serving to soreen those acutely ill for seleotive institutional care, thus alleViating the pressure on high oost hospital servioes. More new generation polyclinics are being built in major housing estates to bring preventive health care, seneral curative and dental treatment under one roof. 3. A nurse-praotitioner scheme was instituted in 1977 under the Primary Health Care Division where speoially trained nurses at primary health care clinios soreen patients for minor ailments to assist doctors in managing the large numbers attending the clinics. A home nursing foundation was launched in 1976 through whioh volunteer and service nurses provide nursing care to the aged. siok. disabled and chronically ill in their own hoaes. 4. Health education, an important arm of preventive medicine. has been intensified. More systematic health education activities in the form of mass national health campaigns, regular talks. film shows and exhibitions have been organized. reaching out particularly to the school children. In 1916, a national health campalgn to educate the publio on the major infeotious diseases was successfully implemented. 5. Major improvement programmes have been implemented tor the eXisting hospitals to provide better accommodation and facilities in keeping with rising public expectations and to upgrade patient care in hospitals. A major project is the complete re-development of Singapore's largest hospital, the Singapore General Hospital. The total number of beds in the 13 Government Hospitals numbered 8574. 6. A programae was initiated in 1975 to provide comprehensive dental health care,for priaary school children through dental clinios provided within the school compound. To complement the expansion of the dental health services, the Institute of Dental Health, completed in 1977. will train more dental therapists and dental nurses.

1Subm1tted by the Permanent Secretary (Health)/Director of Medioal Services, Singapore.

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7. Environmental sanitation and anti-pollution measures continued to be upgraded. The environmental health services kept the Republic remarkably clean and maintained an adequate standard of personal hygiene among food establishments and food handlers. Street cleansing and refuse removal were increasingly mechanized, while refuse collection routes were streamlined. Construction of an incinerator capable of burning 1200 tons of refuse per day (of a total of 1300 tons generated each day) began in July 1976. The sewerage system was extended to provide sewers for increasing sectors of the popul!1tion. Th~ National Family Planning and Population Programme continued to be implemented vigorously, leading to a fall in the total fertility 'rate to around 2 children per woman in 1975. This has been maintained in 1976 and 1977. It is the demographic goal of the Government to maintain replacement level thereby reaching zero population growth in about 50 years' time when the population would have grown from its present 2.3 million to about 3.5 million.

8.

ORIGINAL: BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES IN SINGAPORE'

ENGLISH

1. Keeping the population healthy, efficient and productive is crucial to the total national development strategy of Singapore. In order to prevent illness, greater emphasis has been placed on preventive medicine and health promotion in recent years. This strategy is also being adopted in the attempt to alleviate the problems of rising governmental health expenditure which rose by 73% over 5 years between 1973-1977. The per capita health expenditure was S$76.92 in 1977 as against S$46.94 in 1973. 2. In 1976, to control rising expenditure" the outpatient, maternal and child health and school health services were integrated into the Primary Health Care Division. With these services under one administration, a more flexible and efficient utilization of existing manpower and material resources could be effected. Primary health care services provide all members of the family with good preventive services and therapeutic oare as well as serving to screen those acutely ill for selective institutional care,thus alleviating the pressure on high cost hospital services. More new generation polyclinics are being built in major housing estates to bring preventive health care, general curative and dental treatment under one roof.

3. A nurse-practitioner scheme was instituted in 1977 under the Primary Health Care Division where specially trained nurses at primary health care clinics screen patients for minor ailments to assist doctors in managing the large numbers attending the clinics. A home nursing foundation was launched in 1976 through which volunteer and service nurses provide nursing care to the aged, sick, disabled and chronically ill in their own homes. Health education, an important arm of preventive medicine, has been intensified. More systematiC health education activities in the form of mass national health campaigns, regular talks, film shows and exhibitions have been organized, reaching out particularly to the school children. In 1976, a national health campaign to educate the public on the major· infectious diseases was successfully implemented. 5. Major improvement programmes have been implemented for the existing hospitals to provide better accommodation and facilities in keeping with rising public expectations and to upgrade patient care in hospitals. A major project is the complete re-development of Singapore's largest hospital, the Singapore General Hospital. The total number of beds in the 13 Government Hospitals numbered 857ij. A programme was initiated in 1975 to provide comprehensive dental health care for primary school children through dental clinics provided within the school compound. To complement the expansion of the dental health services, the Institute of Dental Health, completed in 1977, will train more dental therapists and dental nUl'ses.

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6.

1Submitted by the Permanent Secretary (Health)/Director of Medical SerVices, Singapore.

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7.

Environmental sanitation and anti-pollution measures continued to be upgraded. The environmental heal th services kep't the Republic remarkably clean and maintained an adequate standard of personal hygiene among food establishments and food handlers. Street cleansing and refuse removal were increasingly mechanized, while refuse collection routes were streamlined. Construction of an incinerator capable of burning 1200 tons of refuse per day (of a total of 1300 tons generated each day) began in July 1916. The sewerage system was extended to provide sewers for increasing sectors of the population.

8. The National Family Planning and Population Programme continued to be implemented vigorously, leading to a fall in the total fertility rate to around 2 children per woman in 1915. This has been maintained in 1~76 and 1971. It is the demographic goal of the Government to maintain replacement level thereby reaching zero population growth in about 50 years' time when the population would have grown from its present 2.3 million to about 3.5 million.