elements to achieving the goals of Health For 811. The Committee recommended that, rather than undertaking a multiplicity of studies, efforts should be made to concentrate on a few critical areas with interdisciplinary and holistic approaches that would contribute towards maximum impact on the health care programme in relation to national goals. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continued to be one of the major sources of support to research in this region. The five collaborating centres in the Region participated in several multinational collaborative studies. Research in the Region was mainly related to the evaluation of the safety of existing contraceptive drugs and methods, development of new fertility-regulating agents; health service research, and infertility. Institution-strengthening activities continued to provide facilities for basic and clinical research, including research training. There were 24 scientists from this region who served as members of the 14 task forces in the Special Programme. The UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases (TDR), another major source of research support, continued to promote and support research related to the major tropical diseases prevalent in the Region, such as malaria, leprosy and filariasis, as well as activities to strengthen the research capabilities of the countries where these diseases are endemic. Through continued promotional activities of the TDR Programme at regional and national levels, the number of scientists and institutions that participated in the Programme has steadily increased. The major research activities contributing to the Programme in the countries of the Region were in the field of chemotherapy of malaria, leprosy and filariasis. Participation in other components of the Programme, including socio-economic aspects and applied research, was increasing. Activities for strengthening research capability that were important and relevant to the countries of the Region were also increasing, both in the training of scientists and strengthening of research facilities. Most of the major focal institutions dealing with research and training in tropical diseases were receiving TDR grants in accordance with the strategic plans of the Research Strengthening Group. 9. WOMEN, HEALTH AND DEVELOPMENT While women as consumers of health services are the beneficiaries of family health activities, their role as providers or as active agents of health development has also been recognized by WHO. Thus, like all other regions and the global headquarters of WHO, the South-East Asia Region has also established a programme on Women, Health and Development (WHD), which is being planned and implemented by a core group specifically charged with this task. This core group, in consultation with the SEAR0 advisory group on this subject and the units concerned, has developed a regional progranune on WHD covering the period up to 1985. The regional WHD programme is not a vertical one but is an integral part of all the ongoing programmes of WHO, including maternal and child health and family planning, primary health care, expanded prorgramme on immunization, communicable and non-communicable diseases control, mental health, medical and health education and health information development. Though women face the same health problems as men, they undergo many additional risks because of their different anatomical and physiological norms, cultural environment, and the extra physical demands of menstruation, pregnancy and lactation. Taking into account the high materna 1 and infant mortality and morbidity, and the fact that in the majority of the Member Countries of this region more than 80 per cent of women are delivered by traditional birth attendants (TBAs) at home, the regional WHD programme focuses on the training programme of TBAs in collaboration with the Nursing Unit in the Regional Office. The main emphasis is on safe delivery and on the addition of PHC components integrated into the training programmes. In order to accomplish this, an inter-country consultative meeting on "Programme Planning for TBAs in Primary Health Care" was held, followed by several meetings on topics such as "Supervision of TBAs" and "Evaluation of Training Programmes". These were being followed up at the national level. The Regional WHD Group functions at the national level in collaboration with the WHO Programme Coordinator and Representative and country focal points nominated by the government concerned. The first meeting of the country focal points was held in New Delhi in 1980, One of its important recommendations was to review ald evaluate the existing data and information on the health status of women in the Region and to promote the development and collection of sex-wise data to facilitate the study of the health status of women. Thus, to study the health implications on women, of the changing social, demographic and economic conditions, the current data collection systems at the national level have been urged to collect sex-wise inEormation. This ir~formation is principally on the incidence and prevalence of diseases and the degree and extent of health care provision, especially at the PHC level. In addition to the routine collection of information within the context of the national health information systems, a special study is envisaged in 1984185 on the review of the health status of women in the Region with speciai reference to their nutritional status. Three persons acting as focal points - from India, Indonesia and Thailand - presented policy option papers on "Women as Providers of Health Care" at a consultative meeting held in Geneva from 16-20 August 1982 on three specific issues identified by a similar consultation in 1980. The responsible officers from the six WHO Regional Offices met in Geneva with the headquarters focal unit on 3 and 4 August 1982 to exchange information and views on the regional and global programme for 1982-85 and to plan WHO'S contribution to the 1985 World Conference of the United Nations Decade for Women to be held in Nairobi. A second meeting of national focal points in WHD for the Region was held in New Delhi on 18-19 November 1982 together with the headquarters staff member responsible for the subject and the WHO Programme Coordinators and Representatives to exchange and updat.e information on ongoing collabora- tive programmes and to discuss the regional contribution on WHD to the above conference. As a means of exchanging information and promoting inter-agency regional collaboration in the programme, there was active participation by the WHD core group in two inter-agency committee meetings on women in development sponsored by ESCAP. An important contribution to the inter- agency meeting held in Bangkok in January 1983 was a paper on the guidelines for the formulation of "Indicators for Women in Health Development". Further collaboration will be provided in the sub-regional technical meeting for South-East Asia in preparation for the World Conference to be sponsored by ESCAP in late 1983. Various non-governmental organizations also serve as health-care providers, including the Red Cross Society, women's organizations, Girl Guides, nurses' associations and mothers' clubs. The Regional Office promotes the involvement of non-governmental organizations in WHO programmes and continues to disseminate information on these activities. 10. TECHNICAL INFORMATION AND REFERENCE SERVICES Towards the end of the year under review, two new series of sales publications were started through the Regional HeLLIS Committee: these were the SEARO Technical Publications Series (TPS) and the SEARO Regional Health Papers (RHP). The first in the Technical Publications Series, The Concept of Health Services Research, was issued, as was the first of the Regional Health Papers, the Decade Commencement Report for the International Drinking Water Supply and ani if at ion Decade (1981-1990). Further titles for these series were in various stages of production. Reports brought out under printed cover included a Manual on Child Mental Health and Psychosocial Development (in four parts) and the Report of an Inter-country Workshop on Rehabilitation of the Disabled in the Community. Significant among the other documents in preparation was a revised edition of Strategies for Health for All by the Year 2000, which contains the various country plans. as well as those of WHO, to achieve HFA/2000 . - through the primary health care approach. A total of 168 assignment reports of short-term consultants and long-term staff, final reports on projects and those on meetings and seminars was edited, processed and issued. In addition to the above, wide distribution was given to a large number of other documents. The report and minutes of the thirty-fifth session of the Regional Committee, and the report on the technical dis- cussions held during the session on "Control and Prevention of Leprosy in the Context of Primary Health Care", were edited and issued in bound form. Sales - The total sales during 1982 amounted to US$66 821*, of which sub- scriptions accounted for US&O 193 and other sales ~~$26 628 (as compared with US$68 355 in 1981). The sales for the first six months of 1983 amounted to US&4 314. *All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50 per cent discount (40 per cent in respect of subscriptions) and, in some cases, an additional 10 per cent trade discount, have been allowed. Therefore, the commercial value of the publi- cations sold should be taken to be approximately double the figures given.
Various non-governmental organizations also serve as health-care providers, including the Red Cross Society, women's organizations, Girl Guides, nurses' associations and mothers' clubs. The Regional Office promotes the involvement of non-governmental organizations in WHO programmes and continues to disseminate information on these activities. 10. TECHNICAL INFORMATION AND REFERENCE SERVICES Towards the end of the year under review, two new series of sales publications were started through the Regional HeLLIS Committee: these were the SEARO Technical Publications Series (TPS) and the SEARO Regional Health Papers (RHP). The first in the Technical Publications Series, The Concept of Health Services Research, was issued, as was the first of the Regional Health Papers, the Decade Commencement Report for the International Drinking Water Supply and ani if at ion Decade (1981-1990). Further titles for these series were in various stages of production. Reports brought out under printed cover included a Manual on Child Mental Health and Psychosocial Development (in four parts) and the Report of an Inter-country Workshop on Rehabilitation of the Disabled in the Community. Significant among the other documents in preparation was a revised edition of Strategies for Health for All by the Year 2000, which contains the various country plans. as well as those of WHO, to achieve HFA/2000 . - through the primary health care approach. A total of 168 assignment reports of short-term consultants and long-term staff, final reports on projects and those on meetings and seminars was edited, processed and issued. In addition to the above, wide distribution was given to a large number of other documents. The report and minutes of the thirty-fifth session of the Regional Committee, and the report on the technical dis- cussions held during the session on "Control and Prevention of Leprosy in the Context of Primary Health Care", were edited and issued in bound form. Sales - The total sales during 1982 amounted to US$66 821*, of which sub- scriptions accounted for US&O 193 and other sales ~~$26 628 (as compared with US$68 355 in 1981). The sales for the first six months of 1983 amounted to US&4 314. *All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50 per cent discount (40 per cent in respect of subscriptions) and, in some cases, an additional 10 per cent trade discount, have been allowed. Therefore, the commercial value of the publi- cations sold should be taken to be approximately double the figures given. The Regional Office took part, for the first time, in the Calcutta Book Fair held from 4 to 21 February 1983. Represented by the Head of Sales, SEAR0 did a brisk over-the-counter trade, sales amounting to over US$^ 500. In addition, selected publications were displayed in World Health House at meetings, seminars, etc. Visiting groups of nursing students, librarians and health educators from countries of the Region were given briefings on WHO'S publications programme and system of concessional sales rates.
PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services There is now wide public and political recognition of the importance of the strategies and plans of action for health for all as a result of the efforts that have been made at global, regional and national levels to re-orient health policies toward HFA goals and primary health care. It is necessary that national administrations tailor their managerial processes for implementing these strategies and plans of action. This task implies that the extensive analytical and planning work that has been going on will have to be supplemented by intensive efforts to re-orient resource allocation through programme budgeting towards priority programmes and the under-served populations. Furthermore, new approaches for more effective management of programme implementation, including procedures for better monitoring and control, are needed. Practical measures for the objective evaluation of health impact, service coverage and quality are also needed in order to determine whether or not the present strategies require revision. The emerging managerial processes for health should thus place a balanced emphasis on policy formulation, programming, budgeting, implementation, evaluation and information support. As the development of the health services infrastructure proceeds with emphasis on under-served populations, the concern for improving management is seen to extend right down to the village level. The good performance of health service units at any level calls for a broad mix of abilities by the managers at that level. Some of these abilities can be provided through training. However, much of the effectiveness of the services depends on routine systems and procedures through which day-to-day work is carried out. In many countries, these administrative and operational procedures prove inadequate under the pressure of the rapidly expanding services: supplies and essential drugs are not being regularly maintained at the peripheral level; staff are not routinely supervised, and sometimes they are not even appropriately trained; equipment, vehicles and facilities are not well maintained, and critical preventive and promotive tasks are not routinely carried out, particularly in the more remote areas. The question thus becomes one of routine, efficient management of health services. It is often difficult to identify and define these problems clearly. It is even more difficult to apply solutions on a country-wide basis. Health services research offers various types of problem diagnoses that are gaining limited use in operational problems and situations. The talents and experience of health service administrators, on the one hand, and the research disciplines, on the other, should be combined so as to gain a better understanding of why the effectiveness of health services is limited and how today's problems can be resolved within the existing policy and resource constraints. 1.1.1 Health Planning, Programme Formulation and Evaluation In the countries of this region health planning systems and procedures have in general been strengthened and oriented towards the solution of health problems and the achievement of objectives. To some extent, these planning systems have, in addition, become further decentralized to the provincial and district levels. It is nevertheless also generally true that little progress has been made in improving the management of programme implementation and day-to-day operations. In the year just completed, there has been a considerable interest in evaluation activity. Most countries have begun to take a hard look at the coverage of health services and its quality and the problems being encountered within the services. Through such evaluation efforts it should be possible to identify and define more clearly those operational and managerial difficulties that constitute the primary constraint in the extension of health services to the total population. The task will then be one of solving and circumventing these operational problems. BANGLADESH completed its plan of action for HFA and, in addition, formulated its health manpower plan, revising that plan to reflect certain policy and organizational changes that had recently been introduced. Project formulation activity was directed towards the preparation of 13 project proposals to be funded by UNDP. In addition, a country resource utilization (CRU) review was completed in order to analyse the resource flow and determine net additional requirements for possible external funding. Efforts were made to analyse the problems within the medical logistics system, and the resulting report is under consideration by the Government. In BHUTAN'S first year of membership in the Organization, action began for the development of its HFA strategy. In addition, steps were initiated for the formulation of a master plan of operations for WHO'S programme of collaboration in close consultation with the Ministry of Planning and Development. In BURMA, efforts continued for the formulation of the national HFA plan of action, The Government decided to establish a planning and training unit in the Ministry of Health, and the operational objectives and staffing pattern of this unit were being defined. Burma has been successfully formu- lating its fourth Five-Year Plan through the application of the country health programing (CHP) approach. The implementation of primary health care is expected to be further supported by the national JCHP-PHC Core Group, which was established in May 1983. A joint UNICEF-WHO team visited Burma in June 1983 and held discus- sions with the JCHP-PHC Core Group on ways of strengthening implementation of the People's Health Plan, especially in three important aspects, i.e., intersectoral coordination, management and resource mobilization. Hospital management was strengthened by organizing managerial training through several workshops. A new format for the inspection of hospitals was developed. A new evaluation system was also being introduced with objective approaches, and a national supervisory group was established in order to undertake programme monitoring and evaluation. The inter-country programme continued to support training in planning, management and administration. In INDIA, a national coordinating committee for HFA was established under the chairmanship of the Prime Minister, and the Central Council of Health and Family Welfare was made responsible for reviewing progress under the Sixth Plan. IJHO collaboration continued to be directed towards training in management and health economics, particularly within national institutions. In addition, a network of national training institutes was established to review training needs and develop curricula for management training for several critical types of staff. In order to speed up the development of the management system, a programme in managerial processes for national health development (MF'NHD) has been formulated. This programme will focus on the strengthening of health management at the state and district levels. At a workshop held in Gujarat State, district health officers were introduced to the concepts and procedures of operational problem analysis through the use of a community-level survey. Tbe programme of the workshop also included definition of operational problems found through the survey and the formulation of district action plans for solving those problems. This style of training in problem solving will be gradually expanded in the coming years. Health policy formula ti or^ in INDONESIA continued with emphasis on the strengthening of infrastructures and procedures at the provincial and regency levels and further functional decentralization towards the health centre level. The conceptualization of the national health system was finalized and presented to the National Health Conference, from which feedback was provided to the planning group. Long-term and five-year planning continued, with the establishment of "quality of life indicators" for HFA/2000. In addition, working groups estimated programme costs and helped with an analysis of alternative mixes of programmes in support of HFA. Manpower constraints were analysed. WHO consultant support was provided in reviewing organizational problems and in looking into the improvement of community participation. In MALDIVES, the overall progress in the implementation of the HFA strategy was monitored through such means as meetings of field-level staff and on-site visits to outlying areas by high-level officials. In MONGOLIA, policy guidance was strengthened through the establishment of a commission for implementing the national HFA strategy, which reviewed and reformulated the strategy. A protocol for the study of health manpower utilization was developed and norms of manpower were set. Detailed health programming has been delegated to the aimak level. In addition, the formulation of a project on a model PHC system in one aimak was completed and a statistical manual of health services development over a 60-year period was published. Evaluation was undertaken through the analysis of aimak health services and by reviewing annual aimak reports. This review was followed by a three-day seminar. Workshops in planning and management were held for aimak-level staff, to be followed up by similar workshops this year. Several innovative activities pertaining to policy analysis and planning were undertaken in NEPAL, including an HRG/CRU review, a study of alternative PHC approaches, the formulation of the joint UNICEF-WHO nutri- tion support programme, and the setting up of the JCHPlPHC support group. The health planning system has been laying stress on decentralization to the district,and JCHP/PHC support will foster such decentralized monitoring and management. The major policy re-orientation towards primary health care progressed in SRI LANKA with the beginning of the implementation of the new primary health care model. In addition, a policy review of the financing of health care was being undertaken following the completion of a broad study of health costs and financing alternatives. Issues such as the shortfall in the recurrent budget resulting from past increases in capital expenditure were being studied. A wide range of alternative options was under review, including payment schemes and various types of health insurance. Decentralization of the health administration to local administrative areas was still under way. The earlier country resource utilization review in Sri Lanka resulted in several proposals for external funding and follow-up actions are being taken. With support from the Asian Development Bank, a primary health project for 33 AGA divisions is being implemented. An evaluation, including a situation analysis of primary health care and basic health services in two districts, was undertaken recently. Policy and planning activities in THAILAND lay emphasis on multi-sectoral and decentralized aspects. The Social Development Project under the National Economic and Social Development Board succeeded in designing a basic minimum needs approach for use in situation analysis and planning at the local level. The Ministries of Interior, Agriculture, Education and Public Health are collaborating in this innovative approach to social development. A notable development in the managerial process is the Thai programme budgeting exercise. This innovation was being introduced so as to facilitate the management of the WHO programme by the Royal Thai Government. It has proved to be instrumental in the difficult process of generating and sustaining ministry-wide consensus not only on how WHO resources are to be used but on the more important aspects of national health policy and programing. Other activities included the analysis of manpower requirements for district hospitals, monitoring the implementation of development projects in 37 provinces, implementing an effective programme budgeting system, and supporting the formulation of integrated health development projects. Studies have also been carried out to determine the unit costs of services in district and provincial hospitals. The health policy study centre at Mahidol University has compiled a bibliography of health services and social science research. It has also identified government sources of health data and established a health services research information centre. A one-month course in planning and management has been established for middle-level health managers. Inter-country activities in MPNHD have concentrated on the develop- ment and testing of improved methods for evaluating primary health care and the basic health services. In addition, support has been provided to a number of national programming and evaluation activities. Strong linkages have been established between the development of the managerial process, health services research and primary health care. As an example, an inter-country consultation was held on financial planning for HFA/2000. This meeting was expected to result in proposals for studies of health care costs and financing alternatives. Technology development has been undertaken in the area of microprocessing in support of health management. 1.1.2 Organization of Basic Health Services In BANGLADESH: the Government speeded up the further development and management of the thana health complex system throughout the country. WHO, through consultancy services, contributed to the Government's effort in strengthening managerial processes, including health planning and informa- tion system development. Also with continued WHO assistance, integration of health services and family planning has been implemented in thana health complexes. The new model thana health complex concentrating on the delivery of the eight elements of PHC, based on the recommendations of the tripartite review of six pilot thana health complexes, has already been developed. With WHO support and in collaboration with UNICEF, and subsequent to an orienta- tion course for thana health complex managers, a plan has been developed for adopting the new model in six thanas. In BHUTAN, the Government's policy and strategy for the decentraliza- tion and strengthening of the dzongda administrative activities facilitated health development at this level through the strengthening of basic health units. Health activities were integrated under the basic health units and linked with the dzongda administration. The training and retraining of health assistants and other health personnel of basic health units continued at the Family Welfare Training Centre, Geylegphug, with WHO and UNFPA support. Initial steps have been taken in Geylegphug district to conduct a survey of infant and maternal morbidity and mortality in order to support the establishment of an MCH and family planning information system as a part of the health information system. In BURMA, WHO'S resources have been directed towards ensuring increased attention to the management, supervision and evaluation of the activities for the development of health services in support of PHC. Management training has been given to township medical officers, township health officers and health assistants in charge of rural health centres. Orientation of village people's council members in PHC has become a regular feature in launching the programme in new townships. The programme has been moving faster than anticipated, using US AID finance and supplying UNICEF medical kits to community health workers. In INDIA, the health service delivery system is based on the functioning of a network of primary health centres having at least six beds in each and supported by three sub-centres in each community development block. The multipurpose workers' scheme provides the out-reach to this network of primary health centres using one male and one female worker for every 5 000 rural population. The total number of functioning primary health centres is 5 850; there are 60 000 sub-centres. Accordingly, training programmes were stepped up, and 160 984 multipurpose workers have been trained and placed in those facilities. Under the subsidiary health centre scheme, the existing rural dispensaries have expanded services from the curative aspect to the delivery of the total health package for a population of 20 000 each. One out of every four primary health centres was being upgraded to be a conunity health centre with 50 beds to provide a referral service to the other three centres with specialities in surgery, medicine, obstetrics and paediatrics. WHO supported training programmes related to the strengthening of rural health services, provided supplies and equipment and assisted in evaluation studies. In MALDIVES, the apex of the health system is the Government Hospital in Male. Supervisory and referral services from specialists has often been obtained primarily through WHO, although some other bilateral and voluntary agencies provide support in this area. Health centres in the atolls are manned by community health workers and health assistants with minimal curative, preventive and promotive functions. In December 1982, a WHO conqultant assisted in developing a country plan of work for 1983 and 1984. The plan consists of training he trainers and middle-level primary health care managers, carrying out of a situation analysis and development of simple primary health care, a monitoring and evaluation system and the development of PVC services, training and research. The number of hospital beds at aimak and somorl levels in MONGOLIA has been increased by 10-12 per cent over the baseline of the previous year. Many specialized unlts, including units for intensive therapy, functional diagnosis, psychone~irology and rehabilitation, have been established. At the time of writing, there were 22 physicians and 107 hospital beds for every 10 000 poplation. The budget allocation for health has increased by 8 per cent and forms 10 per cent of the total state budget. A new ontological centre, as well as a number of specialized medical centres, were put into operation in Ulan Bator during the year. WHO has supported training in planning and management for medical and other health workers at aimak level. In NEPAL, community healrh services have been fully integrated in 6 districts and partially integrated in 17 districts. Support had been given through UNFPA for developing new physical Facilities for the Integrated Community Health Services Development Project (ICHSDP). Technical support was provided also to strengthen the functional capabilities of ICHSDP in the area of management, supervision and evaluation. WHO supported national staff in undertaking training courses in evaluation, management and logistics. Progress made in the development of the health infrastructure in THAILAND was remarkable under the Fourth Five-Year Plan, which provided a major thrust to the strengthening of health services. Some 100 district hospitals were constructed along with 1 200 health centres covering about 80 per cent of the tambons. During 1982, WHO supported the training of 3 664 voluntary health communicators in six provinces, four refresher courses for tambon trainers and a workshop on PHC. 1-1.3 Health Services Research During the year under review, there was substantial progress in the development of activities in heaith services research in countries of the Region in support of national, regional and global stategies to attain the goal of HFAl2000. The dissemination of the concept of health services research (HSR) and the establishment of an HSR information system linked to the Health Literature, Librarv and Information System (HeLLIS) network are being implemented in almost all the countries. The conceptual description of health services research as recommended by the eighth session of the South-East Asia Advisory Committee on Medical Research (SEAIACMR) and further endorsed at the Third Meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries, held in Chiang Mai (Thailand) in December 1982, was disseminated to all countries. Regional and national assessments of health services research activities were carried out by national HSR focal points and the results of these assessments were analysed by the Regional Office and then disseminated again to the countries for further updating on a regular and continuing basis, A regional action plan for 1983 through 1985 was developed in support of the national HSR work plans. WHO also assists the countries in overcoming the continuing problems of coordination among various research institutes, research scientists and workers, and multidisciplinary and multi-sectoral levels of the administration. A consultative meeting of the national focal points for HSR and HeLLIS was he13 in the Regional Office in January 1983 in which the guideline for the standardization of HSR information was developed. This guideline will be pre-tested in selected countries before being used in the others for the collection, processing, dissemination and storing of HSR information on a continuous basis in support of activities in this area. The Pusat Penelitian Pelayanan Centre in Surabaya, Indonesia, which is a WHO Collaborating Centre for Health Services Research, undertook research activities on the development of appropriate technology for different aspects of primary health care in rural areas, appropriate staffing patterns for health centres, training modules for village health volunteers, modules for health information system and operational research1 systems analyses (ORSA), and a manual for training in management sciences. The Centre also designed and conducted a study on the utilization of health centre manpower and reported the results. Studies on the financial aspects of health care delivery are receiving increasing attention in many countries. In Bangladesh, one such study was completed during the period under review and the final draft of the study report was under preparation. In Sri Lanka, a study on commodity requirements and expenditure flow in respect of the health sector was completed and the data were being analysed. In Thailand, the first phase of the study on health financing related to health care in provincial and district hospitals was completed and the next phase was under way. Another study, on the unit cost of primary health care centres, was started. To promote health services research on financing for HFA/2000 activities, an inter-country seminar was organized in the Regional Office in March 1983. This activity has helped in sensitizing the countries to recognize research jn Einancing health care as one of the priority areas in health services research. In the area of maternal and child health, the collaborative studies on the risk approach undertaken in Surma, India, Indonesia, Sri Lanka and Thatland luring the second phase as a follow-up of the related pre-natal studies, were completed. The results of the studies were being analysed for utilization in the development of MCH care in rural areas within the framework of the national PHC programmes. So far, ongoing health services research in the field of MCH in this region has focused on (i) the risk approach to MCH care; (ii) diagnosis and management of hypertensive disorders of pregnancy and childbirth; (iii) perinatal mortality and low birth weight; (iv) community participation in the utilization of maternal and child health and family planning services, and (v) breast-feeding patterns. Hypertensive disorder of pregnancy and childbirth was studied in Burma, Sri Lanka and Thailand, with support from WHO. The study would be completed in Burma and Thailand by the end of 1983 and in Sri Lanka in 1984. The results of the study on pregnancy and prenatal morbidity and mortality, including low birth rate, in Sri Lanka would be available in 1983. The ad hoc survey on infant and young child morbidity and mortality -- in Burma was completed during the year. Studies on the reproductive health of adolescents were started in Bangladesh. There is a growing awareness in the Member States of the importance of including the hehavioural aspects of health in their efforts for health system development. To this end, a meeting of the scientific working groups was convened in the Regional Office in April 1983 in order to identify the needs and modalities for behavioural sciences research in the field of health in the countries of the Region; follow-up action is being taken. WHO supported national workshops on the methodology of behavioural sciences research in the field of health in Nepal and Thailand. A detailed research protocol on mental health was drafted and finalized during a meeting of investigators from India, Indonesia, Mongolia, Sri Lanka and Thailand, held in October 1982; the protocol is under implementation. Proposals on community participation in immunization and the assessment of the role of school children have been submitted by Indonesia and Thailand and are being processed for WHO support. As regards health services research related to manpower development, the Regional Office supported Nepal and Sri Lanka in bringing together multidisciplinary groups to identify researchable problems with the help of expertise provided by WHO. The Inter-regional Workshop on Alternate Research Methodologies for HMD Research, held in New Delhi in 1982, served a very useful purpose in bringing together an international group of experts who, along with national personnel, analysed these alternative methodologies, their specific usefulness for the solution of certain types of research studies, and the detailed ways by which information relating to these newer methodologies could be more widely disseminated. The inter- country case studies on teamwork by health workers stimulated national workers to undertake a chain of comparable studies in their own countries for improving the delivery of health care at the community level. 1.2 Primary Health Care (PHC) The countries of the Region are fully geared to primary health care as the key approach to the goals of Health for All. The strengthening and development of health infrastructure in most of the countries progressed according to schedule. Additional efforts were made for the extension of the services through various types of community health workers. Increasing attention was given to the strengthening of national capabilities at the intermediate level, as it is this level which is of crucial importance in organizing, supervising and monitoring primary health care. Considerable progress was made in respect of the Joint Committee on Health Policy (JCHP) studies, jointly sponsored by WHO and UNICEF to support primary health care, in Burma and Nepal. The JCHP/PHC support group in Nepal arranged situation surveys in four districts. Following the visit of a WHO/ UNICEF mission to Nepal in Novemher 1982, action was being taken to organize district-level JCHP activities with the help of the health and population committees established in all the districts under the Decentralization Act. In Burma, a core group was formed to review the mechanisms and modalities of joint support to the implementation of PHC. A I+JHO/UNICEF mission visited the country in late June. Several inter-regional meetings of significance in the context of PHC were organized by the Regional Office. The first was an intersectoral action study, held in Trivandrum, India, and attended by participants from India, Indonesia, Sri Lanka and Thailand. Another inter-regional workshop on community participation, was organized in December 1982 at Korat, Thailand, as a follow up of the hi-regional workshop held in Pattaya, also in Thailand. As a follow-up to the ~egional ljorkshop on the Primary Ilealth Care Approach in the Control of Malaria, which had been held in New Delhi last year, an inter-country workshop was organized in Phuket, Thailand, in October 1982 to consider the manpower aspects of the control of malaria through primary health care. I.JHC) gave support to the ASEAN Training Centre for PHC, Mahidol Ilniversity, Thailand, and also supported the Consultative Meeting for Bi-regional Activity on PHC in ASEAN Countries held in Bangkok during December 1982. In the area of strengthening of manpower for primary health care, the Regional Office cooperated with ESCAP in the holding of the fifth Regional Seminar on Basic Community Services and Primary lIealth Care in Bangkok and Chiang Mai during October-November 1982 by providing fellowships and technical staff support. A number of activities have been initiated in the Region for the development of urban primary health care. After preliminary meetings and detailed case studies in Bangkok, Colombo, New Delhi and Jakarta, a regional workshop was conducted in Few Delhi in January 1983 and, as a follow-up, a case study on problems of urban primary health care was initiated in Rangoon. Efforts were being made to start activities in the countries for: (i) review of national PHC development efforts in respect of unserved and underserved urban population groups; (ii) strengthening of city health departments, and (iii) preparation of appropriately stratified profiles of the health situation in urban areas so that appropriate measures might be designed to meet the needs of the target groups. Preparations have also been completed for holding an inter-regional conference on PNC in Pyongyang in September 1983, in collaboration with the Government of the Democratic People's Republic of Korea. As for activities in the countries, in BANGLADESH, the development of primary health care is closely linked with the strengthening of thana health complexes, which provide the first referral facility where professionally trained staff are available. An action-oriented course was conducted for health service managers of six thanas in December 1982 and resulted in the strengthening of the functions of thana health service delivery. The objectives of the course were to improve the existing services by utilizing available resources better and to focus service delivery on health problems of significance. Emphasis was laid on management, health information, community participation, team-work and intersectoral coordina- tion. A committee consisting of representatives from the Health Ministry, UNICEF and WHO was set up to review and frame guidelines on the functions, duties and responsibilities of all the thana health staff and community institutions concerned. The committee has already begun its work. In BIIUTAN, primary health care was implemented through the network of basic health units (BHU) and the services of village health volunteers. The number of BHUs increased during the reporting period from 46 to 50. Each of these covered a population of 4 000 to 6 000. Efforts were being made ro have more BHUs so as to reach the target of one BHU per 2 000 to 3 000 population. After the success of a pilot project set up in 1981 to train village health volunteers, a second group of volunteers was trained and deployed in Wangdiprodrang and .Takar zones. Another group was deployed after training in Geylegphug district with the involvement of female village volunteers. Village health volunteers work under the supervision of the health staff at the basic health units and district hospitals. WHO and UNFPA supported the training programme, while UNDP and UNICEF provided supplies and equipment for these activities. In BURMA, considerable progress was made in the development of primary health care. All of the 147 townships as planned were involved in the development of the I'HC programme at the end of the period 1977-82. Out of these 147 townships, 22 have been fully covered by community health workers, and 87 townships achieved 50 per cent coverage; in the remaining tor~nships coverage was less than 50 per cent. During the period 1982-86, PHC work will be extended further to cover another 82 townships. In fact, PHC activities had already begun in 40 townships in this second phase. A pilot study was initiated in respect of the townships with 100 per cent coverage by community health workers, with a view to introducing a new kind of manpower: the "ten-household health worker". One such worker is selected from every ten households in a village and given training in first aid, distribution of oral rehydration salts, health education, reporting of births and deaths, and outbreak of epidemics. These "ten-household health workers" are supervised by community health workers. The primary health care programme continued to receive support from IJ[10, UNICEF and US AZD, especially in training activities and the provision of medical kits for community health workers. A study on the utilization and impact of these kits in the PHC programme was initiated by the Tnstitute of Economics, University of Rangoon. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, a phased strategy for devrloping primary health care was being implemented as an integral part of socio-economic development, with the responsibility for coordination vested in the community leaders. Community participation is the important component and farmers' cooperatives assume responsibility for mobilizing local resources as well as for the planning, management and supervision of health facilities. The essence of the PRC activities is based on the "section doctor" system, which is functioning in both rural and urban areas. This system is manned by a multidisciplinary team of doctors consisting of a physician, a paediatrician, a gynaecologist or trained midwife, and a public health specialist. Each member of the team is responsible for a specific number of people in a defined geographical area, identified by the People's Committee. Health care therefore is not bound within hospitals in DPR Korea, where health services are provided at homes and places of work through routine and regular visits by qualified doctors attached to the nearest hospital or clinics at ri, county or district level. The section doctor system is also well supported by a chain of referral services. Urban health care is organized and delivered through a system of well-staffed and well-equipped polyclinics (along with the section-doctor system) which serve a population of 20 000-50 000. In INDIA, primary health care is based on the provision of a network of primary health centres. As a part of its 20-point Programme for total development, the Government pursues a long-term comprehensive health plan in multisectoral setting, drawing support from all relevant sectors. Although major investments are being made in the Sixth Plan on the rapid extension of the health infrastructure, there is a need to strengthen field supervision and guidance of manpower, and for an adequate drug supply and referral system. A National Coordination Committee for Health for All, under the chairmanship of the Prime Minister and with ministers of all relevant economic and social welfare ministries as its members, has been set up. In order to have a better supervision and referral system, upgrading of 25 per cent of the existing primary health care centres as first-level referral institutions continued, The existing community health volunteer scheme, now modified into a health guide scheme, will be fully financed by the Central Government in order to facilitate smooth implemen- tation of training activities. Already 182 077 health guides and 366 499 dais have been trained and deployed to deliver services in the rural areas. - Village health committees have been set up in every village to supervise and support the work of the health guides. Strengthening the capabilities in planning, implementing and monitoring for primary health care at the intermediate level received greater attention. WHO continued to support the training programme related to the strengthening of rural health services, workshops, seminars and evaluation studies. A national conference on urban slums, held in New Delhi, recommended that the health guides scheme and multipurpose health workers scheme be extended to the urban poor. Preparation of health information profiles in major cities was being initiated with WHO support. In INDONESIA, the primary health care programme covered every province. There were more than 1 800 medical doctors at the primary health centres in the villages. Village health development activities covered about 1 400 villages and were supported by the government budget while a substantial number of villages were developing PHC services utilizing community resources. The priority activities in primary health care included the strengthening of health centres and sub-centres, community participation in terms of voluntary activity and community funds, inter- sectoral collaboration for health development, and income generation. WHO supported a training course for trainers of PHC teams at the provincial level in Rali in October 1982. Another meeting of provincial health officers for primary health care was organized in Yogyakarta in April 1983. A national meeting on urban primary health care, with the participation of five cities, was convened during 1982. Following this meeting, local committees responsible for the development of their communities in various aspects, including health, were established. In collaboration with UNICEF income generation was promoted as one of the priorities, whereby small loans for health development activities relevant to the locality were approved by the committee. The committee also paid attention to the improve- ment of sanitary conditions, while the Government's health facilities in the area took care of the delivery of health services. Under the "little doctor" scheme, intelligent and active school children were selected on a voluntary basis and trained in basic health knowledge: they could thus be used as change agents for health, educating their friends, members of their families and their communities as a whole. In MALDIVES, primary health care activities were progressing steadily. With the addition of three new medical doctors, the services of Male Hospital improved considerably. The Government also inaugurated the first of four regional hospitals. Services from specialists under WHO consultancy support were made available to some remote atolls. The Allied Health Services Training Centre accelerated its training programmes in order to produce more community health workers, family health workers, nurse-aides and traditional birth attendants. The Government gave high priority to health, which was reflected in a higher budgetary allocation to the health sector to the extent of nine per cent of the total government budget . In MONGOLIA, the Ministry of Public Health, with the technical support of WHO, reformulated its strategies for Health for All by the Year 2000. The plan of action has also been prepared in conformity with the recently revised national HFA strategies. The development of strategies and the plan of action for HFA goals generated unprecedented enthusiasm for national health development. This contributed to the crystallization of policies and an increased awareness about the existing health status, and stimulated corrective action. An intersectoral task force was set up, with the Minister of Public Health as its chairman, and it identified contribu- tions that other sectors could make towards achieving the goal of HFAf2000. The Government stressed the importance of the cooperative programme in the development of the model for primary health care in Huvsgul Aimak. This model was under implementation at the beginning of January 1983 and will be used as a model primary health care system to be adopted in the other aimaks in the future. NEPAL continued its efforts for strengthening and expanding primary health care services, with 1JKO providing support through long-term staff, short-term consultants, fellowships and subsidies under the Integrated Community Health Services Development Project. During 1982, a national health workers' seminar was held with the assistance of WHO to identify and work out solutions to problems and constraints in implementing the project. The number of fully integrated districts under the project was still 6 but the number of partially integrated districts had gone up to 17. In addition to receiving the support of TWO, this project is assisted by UNDP, UNFPA, US AID, CIDA, the Netherlands and Japan. In another three districts, primary health care activities were implemented with the greater involvement of traditional practitioners, who had also received training in PHC under a UNDP-funded project. This project concentrated on four areas, viz., produc- tion of drugs, supply and logistics, promotion of traditional medicine, and training of community health leaders. Volunteers from each ward were selected by the ward committee and were trained in simple curative and preventive services by the health post in-charge using a training manual developed with WHO'S technical support. The Organization assisted the Government in conducting an HRGICRU review as a step towards mobilization of further external resources For PHC. Preparations were under way to hold a meeting of funding agencies towards the end of 1983. In order to maximize tye utilization of existing resources and stimulate community participation, the Government was exploring alternative approaches to primary health care. These will involve collaboration from voluntary social organizations and institutions such as panchayats and non-governmental health and non-health personnel, including ayurvedic practitioners. In SRI LA1K4, there is a strong commitment to the goal of Health for All by the Year 2000 using primary health care approaches. The National Health Development Council, under the chairmanship of the Prime Minister, provided clear policy guidelines for health development. The National Health Development Cowittee, along with its six standing committees on various conponents of health development, are responsible for planning, implementing and monitoring health development activities under the policy guidelines prov.ided by the Council. An in-depth analysis of the health care delivery system led to the identification of strengths and weaknesses and enabled the authorities to decide on corrective action wherever necessary. As a result, a programne cn "Improvements to the Health Care Delivery System" was formulated and approved by the National Health Development Committee. The programme aims at establishing a health infrastructure based on primary health care throughout the country. IJHO supported the Ministry of Health in organizing a seminar on primary health care for Yembers of Parliament in February 1983. The seminar provided an opportunity for exchanging views and experiences on the political processes and the action required to consolidate national efforts towards the goal of ~~Ai2000. The seminar uas also able convincingly to put forward the importance of the PllC approach for health development to the parliamentarians, who are responsible for resource allocation. As far as urban primary health care is concerned, the Colombo Municipality is actively involved in the delivery of health services to the people in the slums of the city. A case study on urban PHC in Colombo was presented in the regional meeting in New Delhi. As a follow up, another study on strengthening the structure and functioning of the municipal health department of Colombo was under way. In THAILAND, while refinement of the HFA strategy and plan of action was going on, the long-term policies for health and social development, including the objectives and indicators of basic minimum needs, were defined by the Health Planning Division in collaboration with the National Economic and Social Development Board. Priorities were set for 37 provinces under the National Impoverished Area Development Project. A middle-level PHC management training programme for district health personnel was under way. Primary health care activities have already been started in over 50 per cent of Thai villages and have been concentrated on the impoverished areas. About 35 200 village health communicators, 2 150 village health volunteers in rural areas, and 200 health volunteers for urban slum areas, were trained, bringing the total of village health communicators to 213 606 and village health volunteers to 21 507. An appropriate management mechanism was developed to launch the self-reliant "village health programme". This programme was based on the promotion of micro-development efforts in conjunction with the development efforts of major socio-economic sectors, with a view to maximizing the self-help and self-reliance efforts of the people. The first group of villages was selected and successfully developed; these became fully competent in handling self-managed and self-financed PHC schemes and could be used as models in the training and development of other villages. In the area of urban primary health care, the first group of health volunteers from Bangkok completed their training and were fully employed in providing primary health care in the underserved areas of the city. A seminar on urban primary health care development was organized in Udorn Thani Province. 1.3 Traditional Medicine As recommended by the International Conference on Primary Health Care in Alma-Ata, countries in the Region continued their efforts to utilize traditional medicine and its practitioners for primary health care. An inter-country workshop on the involvement of traditional practitioners in primary health care was conducted, with participants from seven countries of the Region. The recommendations of the workshop were being implemented. Another inter-regional workshop, on the utilization of traditional herbs and medicines for PHC, was organized in New Delhi in December 1982. This workshop recommended guidelines for preparing a list of essential traditional medicines for PHC. WHO also co-sponsored the first international conference on "Elements in Health and Diseases" during 6-10 February 1983 in New Delhi. This conference, which covered a number of aspects of the role of different elements in various systems of traditional medicine, was attended by more than 100 participants belonging to different disciplines from 21 countries. In regard to activities in individual countries, in BANGLADESH, consultancy services were provided by WHO to assess the availability of different medicinal herbs and traditional medicines as well as to determine the demand for traditional medicines in primary health care in order to suggest ways and means of producing adequate amounts of these medicines. Two projects were prepared, one on the development of the traditional system of medicine and the other on the homoeopathic system of medicine; both were awaiting UNDP support. In BHUTAN, the traditional system of medicine was being widely used for primary health care. The government dispensary-cum-pharmacy in Thimphu, which had been manufacturing traditional drugs manually, was equipped with modern machinery through UNDP assistance towards the end of 1982 and its building was expanded so that manufacturing, packing, storage, etc., could be undertaken in a systematic manner. With the technical support of WHO consultants, an analysis of the existing situation in the field of traditional medicines was completed and a list of traditional medicines was prepared for inclusion in the ayurvedic kits for primarj health care. WHO also provided consultants for advising the Government on drug manufacturing and for preparing curricula and training materials for the training course for traditional practitioners. A training textbook was prepared and printed. Supplies and equipment, including some raw materials not available in the country, were also provided. In BURMA, traditional medicine was being utilized to a certain extent in primary health care services in rural areas in order to lower the cost of drugs for primary health care as well as to promote self-reliance. A short-term consultant visited the country to survey the availability of medicinal herbs and plants, to assess their demand for primary health care and to suggest their cultivation and collection, as well as ways and means of improving the production of traditional medicines. Two UNDP-assisted projects related to traditional medicine - Development of Traditional Medicine Manpower (BUR PTR 005) and Standardization and Pharmacological and Toxicological Evaluation of Traditional Drugs and Herbal Medicine (BUR PHC 002) - have been prepared with technical inputs from WHO and are in the pipeline. In INDIA, where traditional medicine has deep roots and is culturally acceptable, many systems of traditional medicine are practised. The Government has prepared a list of essential drugs for primary health care, which consists of both the traditional and modern medicines. Practitioners of the traditional system of medicine have been appointed as the third member of the medical team at some primary health centres in order to supervise and guide the provision of traditional medicine. The two WHO Collaborating Centres for Research in Traditional Medicine - the University of Ayurveda at Jamnagar and the Department of Ayurveda, Banaras Hindu University - continued to receive support from WHO for research activities in traditional medicine. The Faculty of Indian Medicine of the Institute of Medical Sciences, Banaras Hindu University, organized a network of ayurvedic medical services for primary health care which consisted of an ayurvedic hospital, an ayurvedic health centre and a sub-centre. It also trained primary health care workers in the ayurvedic system of medicine. The Research Institute at Coimbatore finalized the research results on the treatment of rheumatoid arthritis by traditional medicine and the Indian Council of Medical Research was studying the report. The Government of MONGOLIA established an Institute of Folk Medicine under the Ministry of Public Health for the development of research in various aspects of traditional medicine. A WHO consultant visited this institute and recommended a number of steps for the further development of folk medicine. The Government also included a new project on traditional medicine for WHO support in the ensuing biennium and identified priority activities which, inter alia, included the training of Mongolian nationals in Ayurveda, collection and translation of ancient manuscripts on folk medicine, application of scientific techniques in drug preparation and testing, and the establishment of linkages with some institutes of traditional medicine in India. In NEPAL, 15 ayurvedic preparations were included in the essential drugs list for primary health care and were being produced by Singha Durbar Vaidya Khana. Village health workers were provided with ayurvedic kits containing these medicines. Singha Durbar Vaidya Khana was modernized and reorganized along commercial lines for undertaking large-scale production. A WHO consultant assisted in the development of a syllabus for training and collaborated in the training of the first group of 57 ayurvedic physicians (out of a total of 191). The remaining physicians were trained by national specialists. These trained ayurvedic physicians have been assigned to three pilot districts to intensify activities on the utilization of traditional medicines for primary health care. Fellowships have been awarded to three ayurvedic physicians for further training in India. A study tour was also arranged for two top officials responsible for the subject of traditional medicine. In SRI LANKA, a WHO consultant collaborated with the Government in reviewing the existing situation regarding traditional medicine, in devising ways and means to improve the methods and materials for teaching traditional medicine and in suggesting possible actions for involving the practitioners of ayurvedic medicine in PHC. Another consultant reviewed the situation regarding homoeopathy and advised on the strengthening of this system and its utilization for primary health care. With WHO support, a national expert conducted a survey of traditional herbs and plants with the specific purpose of identification, cultivation and preservation of traditional medicinal plants, and prepared guidelines for the establishment of a herbarium. THAILAND has been showing increasing interest in the use of traditional medicine in primary health care. The new Institute of Ayurvedic Medicine started with the first group of students at the college level. The award of WHO fellowships to strengthen the capability of the teachers of this institute was being processed. The Department of Medical Sciences has taken the initiative to promote the cultivation of medicinal herbs and plants in several provinces. WHO awarded a fellowship for training in acupuncture. 1.4 Family Health Maternal and child health, including family planning, is a priority programe in all the Member Countries. These activities are being supported by WHO in collaboration with UNFPA and UNICEF. The major thrust of WHO'S regional programme in this area was directed towards strengthening the managerial capabilities at different levels of the national health organization and developing appropriate and adequate manpower dealing with maternal and child health in the context of primary health care, including the reorientation of basic, post-basic and continuing education. Family planning programmes continued to receive support as an integral part of maternal and child health services in most countries. The main back-up support to national family planning programmes was in the fields of needs assessment, planning, monitoring and evaluation. In pursuance of the Regional Committee resolution on Infant and Young Child Feeding, SEA/RC34/R8, endorsing the regional plan of action, WHO provided technical support to several countries in implementing the plan. With the objective of strengthening the information base related to breastfeeding and weaning foods, the regional programme supported the preparation of annotated bibliographies on breastfeeding and weaning practices in several countries of the Region. The regional MCH programme supported a number of seminars, workshops and discussion groups organized by non-governmental organizations, professional associations and consumer protection groups at both national and international level. These were related to the promotion of breast- feeding, strengthening of public information, communication and education on infant and young child nutrition, development of improved health and social status of women in relation to infant and young child health and feeding, and promotion of appropriate and timely complementary feeding practices, making use of local food resources. The multidisciplinary Regional Advisory Team on MCH/FP with expertise in obstetrics and gynaecology, maternal and child health and paediatrics, health education and statistics continued to support most Member States in project formulation, implementation, monitoring and evaluation in the field of family health. Activities in individual countries were as follows: In BANGLADESH, the Government gave top priority to population control. The recent trend of laying more emphasis on the mother and child has brought about the full integration of the population control programme with the health activities at the thana level. The medical officer in charge of the thana health complex has been redesignated as thana health and family planning officer, with control of the personnel of both the Health and Population Control Divisions. The SIDA-funded "Sterilization Surveillance Team" has become fully operational, with four national staff and three expatriate consultants posted in the four divisions of the country. The fourth expatriate consul- tant was expected to join the team soon. A Joint SIDAIWHO Evaluation Mission reviewed the project and commended the progress made. A baseline survey of 240 selected health complexes started on schedule and was progressing as planned. The survey results were expected to be available during the pro- posed Joint SIDA/WHO/World Bank Evaluation Mission from 20 to 29 September 1983. Bearing in mind the interest of the Government in promoting maternal and child health services, this baseline survey included a questionnaire on MCH facilities as well. Furthermore, in order to ascertain the voluntary nature of acceptance of sterilization as the well-informed person's choice for family planning and to attain high client satisfaction with the quality of services including follow-up, a client satisfaction survey is being planned, for which the protocol has already been developed through the joint effort of national and WHO staff. In BHUTAN, the UNFPA-funded project on the development and strengthening of MCH/FP services supported the development of physical facilities for the Family Welfare Training Complex at Geylegphug, four basic health units at Tala, ~iajam, Bhangtar and Changikha, and two MCH clinics at Phuntsholing and Geylegphug. A member of the Regional Advisory Team on MCH/FP assisted the Government in improving the health information system in MCH/FP and in conducting the feasibility study on an infant and maternal mortality and morbidity survey in Geylegphug district. A WHO consultant was assigned to train nine medical officers to perform mini-laparotomy and vasectomy operations and to assist in the organization of voluntary sterilization camps in the southern part of Bhutan. The training programme for various categories of health workers is carried out in the Family Welfare Centre at Geylegphug. Two groups of malaria workers received reorientation in January 1983 and a workshop for zonal medical officers and health supervisors of the MCH/FP programme was organized. In order to mobilize more health manpower at the grassroofs level, and to encourage community participation in primary health care, village volunteers selected by the community in groups were given three weeks' training at the Model MCH/FP Basic Health Unit set up in Surey. In BURMA, emphasis was given to the training of traditional birth attendants (lethes) since their specific role as primary health care workers has been recognized. The task-oriented training programme for lethes now includes the identification of high-risk cases. During the period under review, WHO'S programme was revised to enhance not only the training of lethes but also that of their trainers and to prepare a'nd print manuals for their field work. The study on the risk approach in MCH care, and an -- ad hoc survey on infant and young child mortality and morbidity, continued according to schedule. Maternal mortality has also been included under the ad hoc survey since this year. In INDIA, technical support was provided, under the UNFPA-funded laparoscopy sterilization programme, in the review of guidelines for laparoscopic sterilization. Action was also initiated for providing techni- cal backstopping to "area projects!.' funded by UNFPA, for the integrated development of maternal and child health and family planning. A member of the Regional Advisory Team on MCHIFP, together with UNFPA and national officials, participated in the review of the service delivery component and the work of ANM training centres under the family welfare area project in Rajasthan. The joint WHO/UNICEF-supported programme on the teaching of maternal and child health for medical undergraduates and interns was evaluated by a WHO consultant. Based on his findings, steps were initiated for further improving this teaching programme. A low-cost edition of the Handbook for the delivery of care to mothers and children in a community development block was published in response to increasing popular demand. The pre-testing of the Handbook for the care of children, birth to puberty, is continuing. Providing basic services where they are needed most is the MATER essence of the primary health AND Ct care approach. Most countries , in the Region are strengthening HEALTt their PHC services. especially in the rura, areas. Picture shows I PHC worker visiting a home. 1 PHC workers may refer mothers to seek medical advice in rural for themselves and Midwives and auxiliary nurse midwives w0r.k in the field and their training (as shown here in a rural setting) is an important comiJonenf of PHC work. -* Fa- NUTRITION AND HEALTH EDUCATION Health educa!ion, including the nutritional education of mothers, is an important activity in the Region. To prodide effective med~cal czre. the emoh~sts now ,n med,c~l education rs to make the tra,nma more relevant to the needs of thi community. Nutrition is one of the eight identified elements of PHC. Some of our Member Slates are taking *4@ steps to ensure that a supply of ., ., nutritious foods 1;ke milk IS avadahle to their people. Technical support was given to district-level workshops on neonatal care for paediatricians and obstetricians with a view to strengthening the neonatal services and training at peripheral level. In INDONESIA, programme activities relating to maternal and child health, family planning, community health nursing and nutrition were supported so as to achieve the national objectives set under Pelita 111, which aimed at reducing maternal, infant and young child morbidity and mortality. With a view to improving the managerial capabilities in maternal and child health and family planning at central and provincial level, regional study tours by appropriate national personnel were assisted. The school health programme was assisted through training programmes within the Region aimed at upgrading the managerial and technical skills of school health personnel, especially at provincial level. A WHO consultant reviewed and analysed the maternal and child health programme activities, which contributed towards the development of the MCH programme for the Pelita IV period. The Ministry of Health formulated a Ministerial Decree on the marketing of breast-milk substitutes. To facilitate this, WHO provided information on national codes of marketing of breast milk substitutes from several countries of the Region. Action was initiated for providing support to a national workshop to draw up a plan of action for infant and young child nutrition. WHO supported the preparation of an annotated bibliography on studies on breastfeeding and complementary feeding practices which helped in developing the much-needed information base on the subject. A national workshop on the risk approach in maternal and child care was organized with WHO'S technical and financial assistance. The main objective of this workshop was to create an awareness of the concept and principles of the risk approach in MCH care and ascertain as to what extent the strategy could be applied with the available data collected through the integrated health information system. WHO supported the participation of senior paediatricians in the ASEAN Conference on Perinatology with a view to further strengthening the perinatal and neonatal services at the community level. In MALDIVES, the family health programme continued to receive WHO assistance, especially in the area of family health education. The health education specialist of the Regional Advisory Team on MCH/FP reviewed the programme and recommended specific actions to improve the family health education programme. It was planned to start a study on maternal and infant mortality and morbidity in the northern and southern regions of the country in order to identify areas needing special attention and to develop strategies for the improvement of family health activities. Operational research was also being planned for 1984 in order to assess community participation in the delivery of family health services. In MONGOLIA, WHO-assisted programme activities in maternal and child health were closely coordinated with those supported by UNICEF and UNFPA. The assignment of a national project manager has greatly facilitated the coordinating function, and also in monitoring and evaluating the activities. Based on data from research studies, the project "Epidemiological Studies of Population Growth" was reformulated, with a view to expanding the M2H services according to the model established in six aimaks on an experimental scale. National efforts to improve the quality of MCH services further were supported through the development of health manpower in specialized fields of paediatrics and obstetrics, such as intensive care, perinatology and acute respiratory infections, and in the planning and management of MCH services. This support was provided through training fellowships and national training workshops and seminars, and the supply of equipment to maternity homes and obstetric units. Technical support was provided for the further development and improvement of MCH services in the fields of paediatric nutrition, epidemiological statistics and perinatology and also for health education for mothers and school-children. In NEPAL, maternal and child health activities in both integrated and non-integrated districts received WHO support. These activities were coordinated with those in family planning supported by UNFPA and US AID. Technical advice was given in formulating new projects for UNFPA funding. WHO programme activities were mainly directed towards increasing trained manpower at the peripheral level through fellowships and the organization of national training courses for various categories of health workers. Regional conferences for family planning officers, which dealt with both technical and administrative matters, were supported. The Organization ~rovided technical support for drawing up a study protocol for obtaining epidemiological data on maternal mortality and morbidity. The study was to involve a central maternity hospital, provincial hospitals and the community. In SRI LANKA, the family health projects funded by UNFPA supported the various training programmes in maternal and child health and family planning for peripheral-level instructors and supervisors and also for matrons, nursing sisters, and tutors in nursing schools. Both registered medical practitioners (RMP) and assistant medical practitioners (AMP) were trained in the insertion of IUCD. In addition, ayurvedic practitioners were trained to motivate and deliver family planning services, especially as regards the provision of oral pills. Workshops were held for storekeepers to improve logistics and supply management. The laparoscopic sterilization programme was started at the clinic of the Family Health Bureau in November 1982, following the training programme organized by Johns Hopkins University. Up to the time of report- ing, 268 laparoscopies had been performed. The evaluation unit in the Family Health Bureau has been strengthened with support from the project "Streng- thening of Research and Evaluation Unit of the Family Health Bureau". The Family Health Impact Survey was completed and the data were being analysed. In THAILAND, UNFPA-funded family health projects provided technical support to the National Family Planning Programme with a view to maintaining high coverage and quality of MCH and family planning services. Provision was also made for fellowships to train health personnel in family planning and related fields in order to improve programme development and management. In order to enable the community to identify the health status of the target group (mothers and children) simplified MCH indicators are being identified from 12 selected tambons (districts). The research efforts in the field of MCH in this region are based on the guidelines provided by the South-East Asia Advisory Committee on Medical Research, as well as by the Regional Cormnittee and the World Health Assembly. In order to find ways and means to ensure that minimal health care reached at least the high-risk and underprivileged groups of mothers and children and their families, the regional programme supported studies on the risk approach to MCH care (see section 1.1.3). These studies were conducted in Burma, India and Thailand. Action was initiated for the preparation of a study proposal on the risk approach to MCH care in Sri Lanka, and the collaborative study on the outcome of pregnancy (including perinatal mortality and low birth weight), which had started earlier, was progressing as planned. Birth weight has been selected as an indicator for monitoring progress towards Health For All by the Year 2000 since it reflects the mother's reproductive capability and predicts the chances of the infant's survival and subsequent growth and development. Countries therefore were attempting to collect data on perinatal, neonatal, infant and early childhood mortality and morbidity. The regional programme supported these national efforts through collaborative research studies and surveys. A regional profile on perinatal mortality and morbidity was under preparation, based on data from studies on this subject. Countries in the Region recognize that adolescents also form a risk group for health and social problems. Accordingly, the regional programme has been assisting Bangladesh and Sri Lanka in undertaking studies related to the reproductive health of adolescents. One of the main causes of maternal deaths in this region is the group of hypertensive disorders of pregnancy and child birth. WHO therefore supported collaborative research in Burma, Sri Lanka and Thailand to develop intervention techniques for the prevention and management of these disorders within the framework of primary health care. A survey of infant and young child mortality and morbidity was supported by WHO in Burma, and a feasibility study for undertaking a similar survey was conducted in a southern district of Bhutan. The possibility of carrying out a feasibility study on one or two islands of Maldives was also being explored. In order to realize the objective of community participation and self-care in MCH, India and Sri Lanka were receiving support in testing the methodology for community diagnosis and participation in a control trial. 1.5 Nursing In developing nursing programmes at the country level, closer collaboration between education and service is essential to bring about changes for increasing the contribution of nursing to the delivery of health services. Governments in the Region have therefore developed strategies for HFA that utilize nurses in diverse roles and functions. Some countries are using nurses as teachers and supervisors of PHC workers. A few countries are making use of nurses for the delivery of direct care to the community while some others primarily for institutional services. In those countries where there is a scarcity of nurses, they are working as both PHC practitioners as well as teachers and supervisors. To meet the needs of the countries, the education of nurses must be reoriented towards the community and nursing systems restructured to serve the objectives of PHC. In BANGLADESH, the main emphasis is on the development of continuing education programmes for nursing staff, following the creation of a Continuing Education Unit under the Nursing Division in 1981, with one part- time staff. Efforts have been made to strengthen the national capability in planning, developing, organizing and implementing continuing education programmes, and the impact of these activities is now felt. Two full-time well-trained national staff have been appointed to extend the programme further to meet the identified needs. WHO provided technical support in these efforts. Academic time schedules and rotation plans for clinical experience for all levels of students were developed under the guidance of a WHO nurse at the College of Nursing. The results of one year's field testing indicated that public health nursing students had improved their skills, ranging from 29 per cent to 65 per cent. Technical assistance was given to BHUTAN in the pre-planning phase of developing a basic nursing programme. Appropriate lists of text-books and references, minimal teaching equipment and office supplies were prepared, and these were under procurement, partly with WHO assistance. In BURMA, the Nurses' Association, in collaboration with the Nursing Division, is playing a leading role in developing continuing education programmes by organizing a series of national workshops, conferences and seminars. In INDIA, WHO collaborated in the development of a centre to train nurses in oncology at Safdarjung Hospital, New Lklhi. A WHO short-term consultant carried out a situational analysis as a basis for identifying the required content of the training programme. Patient care standards were formulated and the nursing service in the cancer units reorganized in order to maintain the prescribed standards. The revised curriculum for multi- purpose workers was completed and was being implemented. Training materials and visual aids were developed and supplied to the training centres. A national nursing workshop held in INDONESIA in January 1983 defined the role, functions and jobs of nurses in the context of the Indonesian situation and proposed patterns of nursing education suited to the country's needs. The workshop also recommended that a national commissionlcommittee on nursing should be created to assume responsibility for developing nursing in the country. Another workshop on the proposed revised pattern of the educational programme was held in February and formulated the educational requirements for entry into nursing courses. Continued support to the community health nursing specialization at the Faculty of Public Health was ~rovided by WHO. Several short courses and workshops were conducted in community health nursing and clinical nursing. The Working Group on Accreditation of Health Nurses (SPKs) continued its work of formulating criteria and standards for accreditation. In MONGOLIA, the Medical Technicum Institute took a further step in following up the implementation of the recommendations nade by the WHO nursing consultant assigned in 1981 in connection with the implementation of the revised curriculum and assessment of field practice. NEPAL made much progress in the training of post-basic nursing students. A complete revision of the course content for "Adult Nursing" was presented to the Faculty Board for its consideration. A long-term plan for the development of nursing services has been formulated. Close collaboration between nursing service and education was established in order to strengthen both areas. Several group educational activities were organized focusing on the role of nurses in primary health care. In SRI LANKA, curricula of basic nursing training programmes were revised, including the functions of nurses in primary health care. The tutor:pupil ratio improved in basic as well as post-basic faculties. Re-training courses for midwives already in service were organized in order to orient them with PHC concepts and their expanded roles; 594 midwives received training. In THAILAND, a new nursing faculty was established at Srinakarinwirot University, and the first group of students were admitted to this basic Baccalaureate Degree programme in June 1983. Further technical support will be provided by WHO in the preparation of the faculty members. 1.6 Health Education The major objective of the health education programme in the Region is to establish a partnership between health services on the one hand and the individual, the family and the community on the other, in the develop- ment and maintenance of the health of all people. The activities in the countries during the year reflected this objective. Involvement, in its broader context, requires health workers to employ educational approaches that would, in addition to informing and motivating the people, enable them to take appropriate actions as well as generate self-help and self-reliance. This calls for educational dexterity which is not normally held by personnel, especially at field level. All the Member States of the Region, therefore, paid particular attention to the training of health personnel in health education for individual, family and community involvement. Another major preoccupation throughout the Region was the preparation of appropriate learning aids. In addition, efforts were made to identify the proper role of public information and existing mass communication and traditional media in educational programmes and to integrate them as essential components of the overall educational activities, as required. The Member States, as a whole, recognize that current patterns of individual, family and community behaviour are fundamental to the organization, implementation and evaluation of educational activities. An effort was, therefore, made to utilize available data about such behaviour, to undertake research only where necessary, to train health workers in research methodology and to disseminate research information among the health professionals concerned. WHO provided technical support to health education units at national, state and local levels of the health organiza- tions in the Member States in these and other health education and community participation activities. Regarding inter-country activities, the Regional Of £ice, in collabo- ration with the Member States, organized (i) an Inter-country Consultation on Community Participation in Primary Health Care at Korat, Thailand, (ii) an Inter-country Consultative Meeting on Health Education in Family Health in the Regional Office, and (iii) a Meeting of the Scientific Working Group on Health Rehaviour Research in the Regional Office. These activities provided the opportunity for senior administrators and health education specialists not only to exchange views and experiences but also to examine the situations in their own countries in the light of the experiences of the entire group and to identify measures that needed to be taken to solve the problems. In BANGLADESH, during the year under review, the activities of all the seven units of the Health Education Bureau in Dhaka, i.e., training, educational support service, primary health care (national health programme), school health education, hospital health education, field practice and demonstration, and research and evaluation, continued to make progress in their respective spheres. The School Health Education Unit, in particular, collaborated with the Ministry of Education and helped the latter to assume greater responsibilty for health education. The health education specialists assigned to the divisions, districts and sub-divisions supported health education activities carried out by health personnel in communities. The World Bank has been assisting the Government in strengthen- ing health education services since 1980, and has been providing funds to support the position of the WHO health education specialist in Bangladesh. In BHUTAN, a WHO consultant was assigned in 1982 to identify learning resource materials, both for community education and staff training, and to develop some of them together with the staff of the Family Welfare Training Complex. Another WHO consultant was assigned to Bhutan in 1982 to collaborate with the Ministry of Education in the field of school health education. He reviewed the present health curricula of primary and secondary schools and of teacher training institutions, and prepared textbooks on Health for Growth for Classes IV and V, and a Manual for Teachers. The same consultant was being recruited again to assist the Government fzther in school health education and teachers' training. Four short-term consultants were assigned to BURMA during the year. One of them helped to review health education in primary and secondary schools and teachers' colleges and to develop further plans to strengthen health education as an integral part of the national education system. She also helped organize a national workshop on school health education for teachers. A second consultant assisted the Central Health Education Bureau in planning and conducting a three-month course in health education for assistant health education officers. A third consultant collaborated in the planning and conduct of a course in health education for basic health workers. Since the Government proposes to expand and extend its current health education services, a fourth consultant was assigned to assist in preparing a project document for a new UNDP-funded health education project. This project is expected to come into operation in 1984. In INDIA, at the request of the Government, a subsidy was provided for an intensive pilot project on school health services. In addition, WHO gave financial assistance for a state-level workshop on the development of need-based health education. Fellowships for national health and health education officials were awarded. A short-term consultant was assigned in 1982 to assist the Regional Office in health behaviour and health education studies connected with water supply and sanitation projects, especially in the states of Rihar, Rajasthan and Uttar Pradesh. To support education activities, the State Health Education Unit in Bihar was being re-established. In INDONESIA, the Organization assigned three short-term consultants to assist in health behaviour studies and health education in water supply and sanitation projects in three provinces. Each of them surveyed the social, psychological and cultural determinants of individual, group and community behaviour required for the development of health education support programmes in water supply and sanitation and, in addition, developed and conducted a training programme for the health staff and for community leaders. They also developed educational resource materials and a health education plan in support of the rural water supply and sanitation programmes. The WHO health education specialist in Irian Jaya completed his four-year assignment in July 1982. During the period of his assignment, he assisted in the development of a health education unit at the provincial level and similar but smaller units in nine districts. Senior staff for the provincial health education unit were trained abroad, while the others were trained in the country itself. Equipment and supplies and transport were provided. Thus, the project was successful in laying down a stable founda- tion of a health education service in Irian Jaya. In addition, a WHO consultant was assigned to examine the socio- cultural and psychological barriers to the acceptance and adoption of health innovations in the predominantly traditional communities of Irian Jaya. He assisted in conducting a seminar on health, culture and community, which was attended by senior officials both from the Province and from the central Ministry of Health. Another WHO consultant was assigned to review the potential of the community and private organizations to participate further in health development and to suggest approaches or models that would enable the health services to involve the community and private organizations more actively. Fellowships have been provided for the training of national health officials in health education. In MALDIVES, UNICEF and WHO staff assisted the Government in preparing a public information and education-for-health programme. A plan of work was developed. While UNICEF was involved in the development of communication activities, WHO was concerned with school health education, training of health workers for health education, preparation of learning- resource material, and extension of health education to the islands. A WHO consultant was assigned co MONGOLIA to provide further support in school health education, a project for whicb a long-tenn health education specialist had been appointed in the previous year. This consultant also collaborated with the national Health Education House in extending its services in support of primary health care. In NEPAL, WHO continued to provide technical support to the llealth Education Section. The Work Plan which had been developed in collaboration with WHO, UNFPA and UNICEF was being implemented; so was the Sanitation Promotion Programme, developed in collaboration with UNICEF. The routine health education activities were also being carried out as planned. Training programmes in health education for various categories of health personnel, and for personnel of the Ministry of Education, were organized. A National Workshop on Health Behaviour Research on Health Problems was held in January 1983. WHO provided funds, equipment and supplies for these activities, and awarded fellowships for the training of health education specialists and media personnel. In SRI LANKA, the Organization collaborated in the further develop- ment of health education by providing supplies and subsidies for group educational activities. An M.Sc. course in health education is being started at the Post-Gradaate Institute of Medicine. A WHO consultant was recruited to assist in the preparations for this course. In addition, a WHO headquarters consultant prepared a protocol for a study of the patterns of visits by family welfare workers to homes and communities, the educational activities undertaken on such visits and the effectiveness of these activities. In THAILAND, regional health education offices, staffed by qualified health education specialists, were established in four of the regions, and in the absence of health education units in the provinces, the current information and training units were being utilized as focal points for health education. As well as collaborating in these activities, the Organization provided subsidies for group educational activities, equipment and supplies, and fellowships for training health education personnel. These and other inputs have helped the Government to extend, expand and sustain health education and thus community involvement in primary health care programmes. 1.7 Nutrition Nutrition is an area of the highest priority in the South-East Asia Region. This is justifiably so since this region has by far the world's highest incidence of protein-energy malnutrition, goitre, cretinism, anaemia, and vitamin A deficiency blindness. Approximately 30 per cent of the ~egion's 35 million annual births belong to the category of low birth weight, at least 60 per cent of pre-school children are malnourished, and some 60 per cent of this region's 300 million women are anaemic. It is realized that a concerted effort is required by the Member Countries, WHO and other agencies if the basic minimum nutritional goals of HFA 2000 - i.e., at least 90 per cent of birthweights above 2500 G., and at least 90 per cent of children having their weight for age above the malnutrition cut-off point - are to be achieved in this region. Under the regional nutrition programme an effort was made within the limited resources to accept the enormous challenge of malnutrition that exists in South-East Asia. TJHO and UNICEF are assisting two countries, Burma and Nepal, in developing nutrition projects through the Joint WHO/UNICEF Nutrition Support Programme. These aim at ensuring maximum impact on malnutrition and mortality on a national scale over the next five years. The regional programme against goitre is being stepped up, with each affected country mapping its goitrous populations and drawing up fresh plans of action for ensuring the effectiveness of both long-term (iodized salt) and short-term (iodized oil) control activities. The establishment and development of national nutrition units in most countries has been a key feature of the WHO regional programme in this . . area. Such units are ncv function:?; in eight countries 2nd were actively supported in identifying population groups and prevalence rates of mal- nutrition, determining underlying causes, establishing priority intervention programmes, formulating effective national food and nutrition strategies, developing a 'critical mass' of trained manpower, and in monitoring the progress of the programme. In addition, WHO has been collaborating with most countries in developing nutrition surveillance systems for the timely warning of impending food and nutritional crises, ensuring health/nutrition- oriented development programmes, and in assessing the impact of such programmes on human well-being. In BANGLADESH, the collection and analysis of data examining the effectiveness and extent of nutritional inputs through primary health care was in the final stages. In addition, the mapping of goitre/cretinism, largely to be found in the north and in the eastern peripheral hill-tracts, was almost complete. Both these activities were being conducted by the Institute of Public Health Nutrition with the assistance of a staff member from the Regional Office. A research project was also set up in order to measure low birth weights in both urban and rural babies and correlate them with 55 variables relating largely to the nutritional status and health of nothers. In BHUTAN, nutrition policy and planning aims at establishing nutrition-through-primary health care on a firm footing. A WHO consultant assisted the Government in its plans for establishing a nutrition cell within the Ministry of Health but with relevant intersectoral linkages. As a result, a project was drawn up, to be funded by UNDP, for the development, staffing and initial functioning of the nutrition cell. Nutrition activities will be focused on documenting the magnitude of the problem, identifying populations most at risk, establishing effective national nutrition strategies, and evaluating their impact. Tackling the country's goitre problem would also be an important activity. Preparations were under way for a joint WHO/UNICEF-funded survey of goitrelcretinism throughout Bhutan. Following the assignment of a UNICEF consultant to advise the Government on the iodization of salt and its distribution, an iodization plant was under construction at Phuntsholing. The iodized oil injection programme, aimed at small selected population groups, continued. In BURMA, the year saw the completion of a research project, under which the prevalence of malnutrition and an assessment of infant feeding practices were analysed in 12 sampling sites throughout the country; an assessment was also made of nutrition training and inputs delivered through the primary heaIth care system. Based on these findings, the project protocol for the Joint WHO/UNICEF Nutrition Support Programe was drawn up which will be funded by the Government of Italy. This project will under- take intensive coverge of 147 townships with a wide range of effective nutrition-through-primary health care inputs. Emphasis on nutrition training characterized the nutrition programme in Burma, with traininglorientation courses having been held for assistant midwives, midwives, lady health visitors of the 42 townships covered under the first year of the Second People's Health Plan, as well as sister tutors and staff nurses of the training teams. At central level, training included medical students, post-graduates and school teachers. An intersectoral national seminar was held on national approaches to nutrition in primary health care. In INDIA, WHO continued its support to the National Institute of Nutrition in Hyderabad, which continued to play the role of an important traininglresearch institution in nutrition in the Region. The Organization provided two guest lecturers for the trainees of both the three-month certificate course and the one-year M.Sc. course. In addition, a plan of action was drawn up for undertaking a careful analysis of course content and teaching methodology to ensure that training and research were of maximum effectiveness and relevance to the nutritional problems of India in particular and the Region in general. Both WHO and UNICEF are jointly supporting the efforts to intensify goitrelcretinism control in India. This support included the establishment of a tripartite (Government of India, WHO, UNICEF) goitre control working group, participation in the preparation of a video film, and support to the All India Institute of Medical Sciences in its detailed survey of goitre and infantile hypothyroidism in the country. INDONESIA developed a very progressive nutrition programme largely operative through the Directorate of Nutrition and the Centre for Research and Development in Nutrition (CRDN), with support for nutrition manpower training and research from both the University of Indonesia and the Academia of Nutrition. WtiO zssistance is a part of the large total support available for nutrition programmes, coming from the World Bank. US AID, UNICEF and UNFPA. An evaluation of CRDN was undertaken, resulting in recommendations concerning staff training, management capabi.lities, teaching role, and the development of CRDN's nutritional surveillance capability. The applied nutrition programme, based on the UPGK model (family nutrition intervention programme), continued to expand and now covers about 20 000 villages, accounting for approximately one third of Indonesia's children under five years of age. In MALDIVES, the third round of the longitudical pilot study measuring prevalence rates of malnutrition on Seenu atoll was completed. It was planned that, based on the analysis of the data, a further survey representative of the country as a whole would be undertaken, and a longi- tudinal surveillance capability established. This would be important for monitoring progress towards the achievement of the national rarget of reducing the prevalence of malrlutrition in 0-5-year-old children from 67 per cent to 30 per cent by 1990. In MONGOLIA, a WHO consultant assisted the Government in formulating the Perspective State Programme in the area of infant and young child nutri- tion. He also helped with several training programmes for paediatricians, neonatologists and middle-level rural health staff. Nutrition activities in NEPAL received a substantial boost through the 3oint WHO/UNICEF Nutrition Support Programme. A ~roject proposal, for funding by the Italian Government, was drawn up for the intensive coverage of the population in five districts (over one million people! with conver- gent inputs of nutrition through primary health care, including non-health sector activities at community level. Training courses in nutrition for health post staff were held in each of Nepal's six fully integrated districts as a part of the plan to introduce child weighing at all health posts. The research project to assess the prevailing nutrition situation and the effectiveness of nutrition services delivered through primary health care was completed. The first phase of another research project defining possible indicators for use in a national nutrition surveillance system was also completed. The project for iodized oil injection continued, extending the coverage to 11 districts and giving injections to a total of 530 198 people. Currently the programme is being implemented in the mountain/ mid-hill districts of Gorkha, Lamjung, Manang and Mustang, with support from both WHO and UNICEF. Discussions took place on the forn~ation of a goitre/cretinism control working group to ensure optimal coordination and effective coverage of both iodized salt and iodized oil programmes. In SRI LANKA, a study of practical problems in promoting the acceptability of low-cost weaning foods in poor rural communities was completed by the Food and Nutrition Policy Planning Division. The Division also completed a largescale nutrition survey involving 24 districts to investigate the determinants of nutritional status, review the findings in the light of current policies and performance, and make recommendations on future strategy. In THAILAND, the National Workshop on Nutrition in Primary Health Care was conducted in both Bangkok, where the national food and nutrition policy was analysed for further improvement, as well as in Cholburi Province, where the underlying causes of malnutrition and the effectiveness of current community-level nutrition activities were critically reviewed. As a result of this workshop it was planned to implement, on a trial basis, a new integrated training programme on food and nutrition for villagers in 12 districts with UNICEF support. The WHO-supported research project on testing the effectiveness of iron-fortified fish sauce in combating anaemia entered its final stage. Preliminary results showed a reduction of the prevalence of anaemia in the target population. The main thrust of the regional research programme in nutrition largely centred round the priorities identified by a Scientific working Group in Nutrition. The two projects selected by the majority of the countries included: (1) Situation analysis of the current status with regard to the content and implementation of the nutrition component of PHC. (2) Development and evaluation of simple procedures for food and nutrition surveillance for the identification of mothers and children at risk and for the monitoring and evaluation of nutrition programmes at the community level using auxiliary paramedical personnel and other health volunteers. Other, less commonly selected research projects included the develop- ment of lorcost weaning foods, development of more effective nutrition education, and the identification of the underlying causes of malnutrition in deprived population groups. Although many of these nutrition research projects were still under way, they generated activities aimed at making nutrition inputs through PHC more effective. This was particularly the case with Project 1, from which both interim and final results led to improved nutrition training, further research studies, and new national projects on effective nutrition interventions through PHC. The refinement of indicators for the establishment of a nutrition surveillance capability was proved to be effective in pilot studies in some countries for both early warning of nutritional crises and the monitoring of development projects. 1.8 Medical Care - As part of their efforts to attain HFA/2000 goals, countries of the Region have been paying due attention to the strengthening of medical care facilities - one of the important elements of a comprehensive health system. In BHUTAN, general and specialized medical and health care, parti- cularly for the rural sector, was further strengthened. The number of basic health units (BHUs) has gone up from forty-six to fifty and all of them are functioning as the base of health care delivery at the peripheral level. In three hospitals at Thimphu, Geylegphug and Tashigang, which are to function as referral hospitals, the diagnostic and treatment facilities were streng- thened with equipment and supplies provided by WHO. Three fellowships were awarded for post-graduate training in ophthalmology, obstetrics and gynae- cology, and paediatrics, which would pave the way for further strengthening of the referral system. A Central Quality Control Laboratory for drinking water supply was established at the Pathology Department of Thimphu Hospital, as part of the public health laboratory service system. In BURMA, a large part of the regular budget of the Ministry of Health was earmarked for medical care in order to accelerate medical referral support to township hospitals as an integral part of the People's Health Programme on PHC. The 200-bed hospital in Rangoon is also nearing completion with a grant from the Government of Japan. In January 1983, the Asian Development Bank signed an agreement to provide a US $70 million loan for the construction of a hospital in Rangoon to replace the old Rangoon General Hospital. A WHO consultant provided technical support to two works- hops on hospital administration which were held in October and November 1982 in Mandalay and Rangoon respectively. Operational manuals for hospitals were revised and arrangements for conducting refresher training programmes in hospital and nursing administration completed. Formats for preparing hospital profiles and for hospital inspection were also developed. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, consultancy services were provided for technical collaboration in orthopaedics, micro-surgery, anaesthesia and neurology. Consultants were also assigned for demonstrating techniques in lymphangiography, arteriography and pulmonary radiology. Fellowships were awarded in the field of medical care and some supplies and equipment were provided for training and research. In MALDIVES, WHO and UNICEF collaborated with the Government for the further improvement of the medical care services delivered at the health centres on various islands. One national official completed post-graduate studies in gynaecology and joined the Government Hospital in Male, which is at the apex of the referral system. In addition, two others graduated in medicine under WHO~UNDP fellowships and joined the same hospital. The services of one surgeon and one anaesthetist were made available on a bilateral basis. The health centres in the atolls continued to provide essential curative facilities. Surgical specialists for conducting operations as well as to provide consultancy services in various other disciplines were assigned by WHO as requested by the Government. The first of four regional hospitals (three with UNICEF assistance and one with WHO support) has been functioning since last year and work on the second was started during the period under review. The atoll health centres need additional manpower to cope with the work as each centre has to cater to many islands distributed all over an atoll. Lack of suitable transport facilities has aggravated the problem further. In MONGOLIA, a number of activities have been undertaken to improve medical care provided to the rural population, particularly in developing and strengthening the material base of aimak and somon hospitals, and staffing and equipping rural health institutions. A comprehensive programme of supplying aimak joint hospitals with special vehicles equipped with X-ray apparatus, laboratory and dental equipment, etc., has been launched. Strengthening of medical care facilities would also form an important component of the development of the primary health care programme, for which a model is proposed to be developed in Huvsgul aimak. As a part of this activity, both the hospital and paramedical services would be expanded with the assistance of lJHO and other multilateral agencies. 1.9 Care of the Aged, .Disability Prevention and Medical Rehabilitation Present knowledge of the magnitude of the problem of disability in the Region continues to be limited. Relatively few Surveys or research studies have been undertaken in this field. Available information is mostly based on hospital statistics. The problem of comparability of the data was further accentuated by different definitions and criteria used in these activities. On the basis of data available from national sample surveys, about 10 per cent of the population in the developing communities are estimated to be suffering from disabilities due to birth defects, sequelae of communi- cable diseases, malnutrition, injuries and other degenerative disorders. A large proportion of the handicapped are found in remote rural areas where resources are generally lacking or inadequate. In the absence of reliable data this programme did not qualify for priority allocation of funds in the countries of the Region. The fundamental approach to tackling this problem was, therefore, the integration of activities with primary health care, priority being given to the generation of epidemiological information to define the problem and its extent. Apart from physical disabilities, the programme development in this area included special activities for the mentally handicapped, the blind, the deaf and dumb, and the aged population. Rehabilitation of the mentally retarded needs skilled manpower trained specially to handle such people. Activities for the prevention and control of blindness are developing as a major regional programme. Social rehabilitation of the totally blind is also progressing satisfactorily. A programme for the prevention of deafness and rehabilitation of the deaf through the provision of hearing aids and vocational training is in the preliminary stages - national and regional strategies are yet to be formulated. Prevention of accidents and management of accident victims are receiving the increasing attention of Member States. Following the United Nations World Assembly on Aging held in July 1982 in Vienna and based on the World Plan of Action, a programme for health promotion and rehabilitation of the elderly is under formulation. The programme of disability prevention and rehabilitation with emphasis on community-based disability prevention and rehabilitation, received considerable national attention through WHO-sponsored inter- regional, inter-country and national activities. The WHO Manual for Training the Disabled in the Community was reviewed and incorporation of recommenda- tions in a revised version was made at an inter-regional Consultation on Community-based Rehabilitation held in Colombo from 28 June to 3 July 1982. An inter-country Workshop on Rehabilitation of the Disabled in the Community held in the Regional Office in December 1982 considered the need for policy formulation in disability prevention and rehabilitation and framed guide- lines for such formulation and planning at national level and the mobi- lization of resources for implementing community-based activities. Two consultants assisted in planning and conducting this workshop. The programme on care of the aged in the Region was further invigo- rated following the endorsement of the world plan of action on aging at the United Nations World Assembly on Aging, which was attended by participants from this region. Appreciating the demographic trends as reflected in the increasing numbers of the elderly, the countries of the Region took active measures to promote and preserve the traditional extended family system and also considered developmental aspects to integrate elder citizens in the socio-economic development process through pre-retirement training and post-retirement employment. In order further to promote the action programme in support of the elderly in the Member States, a Regional Office staff member, together with the Manager of the Global Programme of the Elderly, visited Burma, India, Indonesia and Thailand. During their visit they discussed the existing situation regarding the health problems of the eiderly and government programmes for them. They also stressed the advisability of developing national plans of action for the elderly," Following the participation of representatives from Bangladesh, India, Nepal; Sri Lanka and Thailand in the preparatory meetings, delegations from Member States in this region took an active part in the proceedings of the United Nations World Assembly on Aging held in Vienna. Participants from Bangladesh, India, Indonesia, Sri Lanka and Thailand attended the inter-regional Workshop on Education and Training in Health Care of the Elderly held in Singapore, and formulated a draft manual for training in health care of the aged. In BANGLADESH, non-governmental organizations took an active interest in national and community-level rehabilitation programmes. In the proposed plan of action to establish integrated primary health care services, institutional facilities will be strengthened not only for referral responsibilities and the training of manpower resources but also for establishing disability prevention and rehabilitation services at the community level. A WHO consultant visited Bangladesh during March-May 1983 to assess the infrastructure and facilities for the development of community-based disability prevention and rehabilitation programmes, including the training of manpower for services in this area. WHO fellow- ships were awarded for training in medical rehabilitation/physiotherapy and artificial limb manufacturing and prosthetic fittings. In BURMA, the UNDP-assisted project made satisfactory progress with the training of community leaders and health workers in a community-based survey for the identification of the disabled, the organization of services including referral facilities, and the manufacture of orthotic and prosthe- tic appliances. A consultant collaborated with the Government in developing institutional facilities and a curriculum for training in physical medicine. Another consultant(specialist in bio-engineering) advised on the development of appropriate orthotic and prosthetic aids. A limited supply of these items was made available to the Hospital for the Disabled, Thamaing, Rangoon, from the Artificial Limbs Manufacturing Corporation of India (ALIMCO), Kanpur under TCDC. The Organization also supported the training of community health workers, midwives and township medical officers in the use of the WHO Manual on Training the Disabled in the community; a WHO consultant from head- quarters also assisted in this training programme; the national project manager visited various rehabilitation centres/institutes in India on an observation tour. In INDIA, the Ministry of Social Welfare constituted a nacional coordination committee with representatives from the Ministries of Health and Family Welfare, Labour and Education. With UNICEF collaboration, train- ing and demonstration activities in community-based disability prevention and rehabilitation were strengthened. A proposal to expand these activities at the district level to cover a population of 1.5 to 2 million was under the Government's consideration. These activities would be integrated in primary health care and facilities would be strengthened in health and medical service institutions at the intermediate and central levels. A national seminar on rehabilitation was conducted. A national consultant assisted the Department of Rehabilitation at Safdarjang Hospital in New Delhi in planning and organizing diploma courses in prosthetics and orthotics and in developing appropriate teaching materials. WHO provided support to this department and to the Medical College in Trivandrum for the establishment of training-cum-demonstration centres for community-oriented disability prevention and rehabilitation. The Organization also supported a preliminary study on the assessment of disability in cardiac patients undertaken at the Department of Cardiology, All India Institute of Medical Sciences, New Delhi. Two national courses for doctors in the management of cerebral palsy in children were coducted with WHO support at the Children's Orthopaedic Hospital in Bombay. With similar support from WHO, the National Institute of Prosthetic and Orthotic Training (NIPOT)/ALIMCO organized three training courses in prosthetics and orthotic technology at Bairoi, Cuttack. Fellowships were awarded for training in occupational therapy. In INDONESIA, the Solo Rehabilitation Centre was strengthened for training, services and research in community-based disability prevention and rehabilitation. The Chief of Rehabilitation from WHO headquarters visited Indonesia during the year to review developments and advise on extension of this programme. Fifty-one "Loka Bina Karya" (community- oriented base stations for the rehabilitation and social reintegration of the disabled) were functioning in more than 25 provinces on a cooperative basis offering guidance and training, and assisting in upgrading socio- economic skills and knowledge for promoting disability prevention and rehabilitation of the handicapped. The Ministry of Social Welfare convened a meeting of non-governmental organizations and the Departments of Education, Religion, Industries and Health to consider the recommendations of the United Nations World Assembly on Aging. The Ministry of Internal Affairs played a leading role in this meeting, following which another meeting was held with representatives of the United Nations system to discuss their role and to coordinate efforts at the national level. The resources of religious organizations and private foundations will be mobilized for the development of this programme in rural and urban communities. An ASEAN seminar on psycho-geriatrics was organized in Jakarta with WHO collaboration. In MALDIVES, a plan of action has been developed for the national programme on disability prevention and rehabilitation. The implementation of the plan faces some constraints, especially lack of manpower resources. In SRI LANKA, the rehabilitation services are all hospital-based. A committee is being constituted with representatives from different ministries and training centres to discuss and develop a plan of action. The field-testing of the WHO programme on community-based rehabilitation and training materials was completed and a training-cum-demonstration centre developed. A national public health policy has been adopted in THAILAND to foster programmes for the prevention of disability and rehabilitation of the disabled. In the Fifth National Economic and Social Development Plan provision has been made for a medical rehabilitation centre and extension of rehabilitation services to rural areas. The WHO Manual on Training the Disabled in the Community was translated into Thai and was being published. Short-term courses for physicians in rehabilitation and the training of prostheticlorthotic technicians were in progress. A National Committee with the Minister for Interior as chairman was constituted to review the recommendations of the United Nations Assembly on Aging in order to formulate a national plan of action. The programme for the elderly would be integrated with primary health care. The tradition of caring for the elderly in Thai society will be promoted through existing social institutions and temple priests who will enlist the participation of the community. Epidemiological surveys were conducted in 25 districts to assess the social and health status of the elderly. Provincial hospitals would conduct geriatric clinics for the routine physical examination and health education of aging people. 1.10 Oral Health Strengthening of oral health care facilities, as one of the support- ing elements of a comprehensive health system, received attention in WHO'S collaborative programme in the Region. Efforts to maintain decayed, missing and filled teeth (DMFT) at the present level continued. Following the first inter-country meeting of senior dental officers, held in Chiang Mai hailan and) in November 1981, which had recommended the setting up of a network of national oral health centres in the countries of the Region, consultancy services were made available to Burma, India, Indonesia, Nepal, Sri Lanka and Thailand to review the status of oral health and to examine the feasibility of establishing such centres with a view to effecting improvements in the oral health status of the people. A WHO dental technician was assigned to the oral health project in BANGLADESH to give training in modern techniques to dental technicians and students in Dhaka Dental College and the Paramedical Institute. Two consultants assisted in the organization and conduct of the second national workshop on oral health and oral health education at Dhaka attended by 50 participants. An oral health survey was carried out in five districts with the assistance of a WHO consultant. The programme and syllabus for a short training course on oral hygiene for teachers of primary and secondary schools were also prepared. Collection of epidemiological data in respect of oral health continued. In BURMA, the Institute of Dental Medicine is engaged in training dental surgeons and also in promoting the dental and oral health of the working people. Government hospitals, secondary health centres and school health centres in various states and divisions of the country provided dental health services under the People's Health Plan. A WHO consultant assigned to INDIA during the year recommended the establishment of a network of oral health centres by strengthening the existing institutions in the country. In INDONESIA, a consultant reviewed the existing oral health situa- tion and recommended that a national centre for oral health should be developed by strengthening existing institutions. Another consultant reviewed the school oral health service and suggested simple but meaningful ways of evaluating these services. Fellowships were awarded for training in various aspects of dental health. A WHO consultant who visited NEPAL in 1982 to review oral health activities has suggested that basic oral health care should be included in the existing primary health care projects utilizing dental auxiliary personnel. With WHO support the Health Education Bureau in Colombo, SRI LANKA, organized a national workshop for the purpose of planning an oral health survey to collect more definite data on the prevalence and severity of oro- dental disorders. The Organization also provided a subsidy for the conduct of a seminar on preventive oral health care for dental surgeons and school dental nurses. Fellowships were awarded for training in oral microbiology. 1.11 Mental Health, Drug Dependence and Alcoholism Efforts to facilitate the formulation of national policies and to improve the data base for programme planning continued. Work also progressed on the other two cornerstones of programme planning, namely, the development of appropriate technology and the instruments for programme evaluation. WHO-supported research in mental health during the year entirely focused on these two components of programme planning: a regional workshop agreed on the outline of the mental health skills to be taught to various levels of health workers (the 'mental health kit') and identified gaps in the existing technology in need of urgent attention; an inter-country research project aimed at identifying optimal intervention strategies for patients with basically psychosocial problems. Several countries from the Region participated in an inter-regional study on optimal strategies for the involvement of PHC personnel in problems related to abuse of drugs or alcohol. Work on indicators of mental health and on the quality of efforts to improve mental health began in several countries. In BANGLADESH, WHO assistance continued to focus on the establishment of a model area of community-oriented mental health care as a nucleus for improved post-graduate training and for increasing task orientation of the ongoing training programmes for non-specialized health workers. In BURMA, the focus continued on the United Nations Fund for Drug Abuse Control (UNFDAC)-supported drug-abuse control programme, which has made considerable progress, with a rapid increase in treatment and rehabilitation facilities and with increasing efforts to reach the rural opium users through an integrated approach using the PHC infrastructure. One of the major tasks, viz., the establishment of a system monitoring the prevalence of narcotics abuse, was to be undertaken later. The National Mental Health Programme in INDIA was considered by the Central Council of Health and a strong supportive resolution recognizing the importance of mental health as an integral part of all health efforts was adopted. Training courses in basic mental health skills were started in several states of the country and a rapid increase in coverage for severe mental disorders can be expected. In INDONESIA, multisectoral coordination in the mental health programme was further strengthened through the establishment of community mental health development boards (BPKJM) in all provinces of the country. These boards are truly multi-sectoral and can serve as valuable models of intersectoral coordination for other countries of the Region. In addition to this critical link of multisectoral collaboration at the higher managerial level, the second critical link of an integrated mental health programme, i.e., the training of general doctors in basic mental health skills, was equally being pursued and training courses in mental health were organized for puskesmas (PHC centre) doctors. Regarding the third critical link - the interface between the formal health sector and the community - work has begun on indicators of the social relevance of health services. MONGOLIA has a strong network of specialized psychiatric and psychoneurological facilities and manpower. WHO continued to assist in improving manpower in various subspecialities through fellowships. In addition, increasing attention was paid to psychosocial factors in health, and Mongolia is participating in the regional study on mental health in PHC, focusing on patients whose problems are basically psychosocial. In SRI LAMA, a national mental health plan has been drafted and WHO'S assistance was geared towards assisting in its implementation. Training courses in basic mental health skills for PHC physicians were started and a programme for the active rehabilitation of the numerous long-stay patients in the two mental hospitals of the country was initiated with WHO support. After the specific inclusion of child mental health into the PHC package a multidisciplinary Child Mental Health Core Group has been established and is coordinating a wide spectrum of activities, ranging from improvement in the care of abandoned children and efforts to improve special education for mentally handicapped children to the improvement of child psychiatric care. This group coordinates the work on indicators of child mental health and healthy psychosocial development, which is expected to generate a base for interventions into families at risk of non-compliance with a variety of preventive and promotive programmes also. In THAILAND, the mental health programme was expected to gain additional momentum through the establishment of a multi-sectoral National Advisory Group under the chairmanship of the Minister of Public Health. Various forms of integrated mental health care delivery were tried out in some model districts, training material was prepared and brief training courses in mental health for various levels of PHC personnel were held in several provinces. In the framework of the drug abuse control programme supported by UNFDAC, intensive training and research activities have continued. The programme was subjected to an in-depth evaluation by UNFDAC. 1.12 Drug Policies and Management WHO has been collaborating actively with all the countries of this region in evolving rational drug policies. The concept of essential drugs continued to receive further support. Most countries initiated measures to develop and strengthen their pharmaceutical supply system (PSS) so that essential drugs could be made available for primary health care. However, much more remains to be done in this field in order to ensure an uninter- rupted supply of essential drugs of assured quality to those who need them most and to attain self-reliance in all the components of PSS. The ASEAN TCDC programme in pharmaceuticals was further supported by WHO. While some of the planned activities were funded by the UNDP project, pooled funds from this Regional Office as well as from the Regional Office for the Western Pacific and WHO headquarters were provided for implementing the remaining activities. The technical content of the programmes pertaining to the preparation of reference substances and the development of a drug information system was coordinated by Thailand and Indonesia respectively. An inter-country workshop was organized in Kathmandu to review the present situation in regard to drug legislation in the countries of the Region and to provide further guidelines to develop and strengthen drug legislation as a part of drug policy and management. Problems and constraints were identified and guidelines were provided for comprehensive legislation, including drug ethics. Strategies for TCDC were outlined. The Government of BANGLADESH announced a new drug policy that is in many ways based on the recommendations of WHO. A large number of drugs of doubtful therapeutic efficacy or safety have been weeded out. The policy aims at attaining self-reliance in regard to the production of essential drugs and ensuring the supply of such drugs at economic prices for the primary health care programme in the country. It also lays emphasis on the strengthening of quality assurance programmes. WHO collaborated with the Government in implementing different facets of the drug policy. National staff received training in the quality control of drugs. A WHO consultant assisted the Pharmaceutical Production Unit of the Government in the further development and strengthening of the production of some of the essential drugs. AsDB and UNICEF provided assistance for buying the raw material and equipment and drug kits required for peripheral health care. Another WHO consultant evaluated the present storage and distribution system and advised on its improvement and strengthening. DANIDA and SIDA, in collaboration with WHO, were to send a mission to identify problems in implementing the new drug policy and offer further collaboration in this field. In BURMA, the Food and Drug Control Administration was strengthened through a UNDP project. A WHO consultant in pharmacology helped establish the laboratory methodology for the pharmacological evaluation and quality control of drugs. The pharmacognosy laboratory was strengthened and methods for the testing of medicinal plant preparations were established with the assistance of another WHO consultant. A bio-assay laboratory was set up and a consultant helped establish methods and protocols for the assay of biological preparations mentioned in the standard phanr.acopoeia. Yet another consultant prepared a project document for UNDP assistance for the further strengthening of the infrastructure for food and drug control administra- tion. WHO consultants are to assist the Government in establishing and strengthening the infrastructure for quality control and the training of drug and food inspectors. In INDIA, personnel from the states were trained in quality control procedures so as to enable them to improve the quality control system in their states. Drug control laboratories were also strengthened by the provi- sion of supplies and equipment. WHO gave technical and financial support in organizing a programme for the monitoring of adverse drug reactions. Technical support was given to INDONESIA for strengthening drug policy and management. A WHO consultant from headquarters prepared a project document for manpower training in different aspects of drug policy and management. Another consultant from headquarters assisted the Government in preparing detailed specifications for supplies and equipment required for the proposed formulation unit in the public sector. Under a programme of collaboration for the further development and implementation of HFA strategies, WHO assigned consultants in the field of drug utilization studies, for establishing good manufacturing practices (GMP) and for setting up a drug monitoring system. In MALDIVES, a WHO staff member assisted in the preparation of an essential drugs list and also in the formulation of the outlines of a drug policy. The Government took the decision to procure drugs through its State Trading Organization. A WHO consultant (pharmacist) was assigned to assist in setting up a procurement and distribution system. In MONGOLIA, advice was given to the Government on modernizing the infusion manufacturing plant. Assistance was also provided in the field of drug policy and management and for drug utilization studies at the aimak level. Quality control programmes were also strengthened. The biomedical project for the manufacture of human gamma globulins was approved by the Government. A national seminar was held in 1983 on the subject of drug supplies and management. In NEPAL, the drug programme continued to receive support through the training of national personnel in the storage and distribution system, promotion of traditional medicine and strengthening of Royal Drugs Limited. National staff were trained in different aspects of quality control. A WHO consultant organized training for health-post staff and for village health volunteers. A pharmaceutical engineer and a refrigeration engineer assisted Royal Drugs Limited in strengthening the managerial and technical components of drug production. In SRI LANKA, WHO provided further support to strengthen the pharmacy training programme. A consultant assisted the State Pharmaceutical Corporation in evaluating the technical component of the project for the preparation of infusions. WHO staff gave technical support in preparing the proposed project for the manufacture of essential drugs, which was still in the planning stage. In THAILAND, drug policy and management were developed through WHO collaboration. A drug policy was formally adopted by the Government as a part of health policy. Assistance to strengthen the drug information system further was continuing. A WHO consultant assisted in preparing a framework for a drug utilization study in PHC. 1.13 Medical Stores Management During the year under review, efforts were being made in all the Member States to improve the existing supply and logistic system. Each country is strengthening the procurement, storage and distribution system, especially with regard to essential drugs and medicines as well as other important supplies and equipment by establishing or further developing a network of stores, and by providing increased transport facilities under the control of the central medical stores. In these national efforts technical advice was given to several countries (Bangladesh, Burma and Nepal) by Regional Office staff during their visits. Training in the management of stores was provided through fellowships. In BANGLADESH, WHO collaborated in planning a network of regional stores in the four divisions of the country to facilitate timely distribu- tion of drugs and medicines and essential supplies and equipment to medical and public health institutions, including teaching institutions in medicine and public health, thana health complexes and union health subcentres. Zn BURMA, a review of the existing facilities and staff support to the medical stores management systems led to the sanctioning of 144 posts of additional staff of various categories which would strengthen the manpower of the system. This additional staff would be appointed in the central medical stores in Rangoon, the sub-depots at Mandalay and Taunggyi and transit camps of supplies in all parts of the country. 1.14 Maintenance and Repair of Health Equipment The Organization continued to extend technical cooperation in further strengthening the physical facilities and training of manpower for the repair and maintenance of health equipment in countries of the Region. In BANGLADESH, establishment of a national electro-medical equipment maintenance and training centre at Mohakhali, Dhaka, was finally approved and its implementation given high priority. Eight technicians were sent on WHO fellowships in X-ray and nuclear medicine and in the repair and maintenance of advanced diagnostic laboratory equipment. A WHO electro-medical engineer continued to give necessary technical assistance. In addition, the Organization provided supplies, including equipment, instruments and spare parts to be used in training. In BURMA, an official was trained abroad in the field of maintenance and repair of medical equipment. As regards activities at the regional level, the ongoing UNDP-funded project 'Training in Maintenance and Repair of Health Equipment for the Least Developed Countries' for which WHO is the executing agency, was engaged in the training of national personnel in the repair and maintenance of health equipment. So far, 13 fellowships have been awarded under this project - four for candidates from Bangladesh, five from Bhutan, one from Maldives and three from Nepal. 1.15 Health Legislation There is a growing awareness of the need for establishing appropriate health legislation in support of strategies for HFAI2000 including primary health care, overall national health policy and specific areas such as essential drugs, food safety, breast-milk substitutes, workers' health, environmental health, disease control, drug addiction and alcoholism. Since health legislation concerns not only the ministry of health but other ministries as well, the review of the existing health laws and regulations, which was technically supported by WHO in Bangladesh, Sri Lanka and Thailand, involved also other relevant ministries. The draft health legisla- tions to support the ongoing "health for all" activities in these countries are now available and under consideration by the government concerned. As a follow-up of WHO assistance to Bangladesh in the past, the proceedings of a national seminar on health legislation held in Dhaka were sent for publication in the International Digest of Health Legislation. A consultant was assigned to Bangladesh to make preliminary studies of the existing health laws.
Time and Place of Forthcoming Sessions of the Regional ~ommittee - The Regional Committee decided to hold its thirty-sixth session in 1983 in Nepal, and decided provisionally to hold the thirtyseventh session in the Regional Office in 1984. It noted the advance notice given by the Government of Bunna of its wish to host the thirty-eighth session in 1985. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION During the year, several developments in the area of regional programme planning characterized significant progress that deserve mention: In pursuance of the wish of the Regional Committee which, at its thirty-fifth session in 1982, approved the recommendations of the Small Committee, the annual programme review for the year 1982 was carried out by the Small Committee (hereafter to be called the Consultative Committee on Programme Development and Management). The WHO regional secretariat facilitated this review by providing an annual report on the financial implementation and technical aspects of country and regional programmes during 1982. While the Consultative Committee will henceforth conduct six-monthly programme implementation reviews as a routine, the annual reviews present opportunities for examining more closely the financial implementation in correlation with the technical progress and relevance, thus enabling the Regional Committee to involve itself meaningfully in WHO programme reviews. The Consultative committee" recommendations with regard to inte- grated evaluation of WHO and national programmes would lead to the further refinement of retrospective WHO project evaluation methods. They would also result in the selection of at least one major and priority programme for integrated evaluation in 1984 to test a simple practical method and gain experience for further development. Specific efforts were made to make use of the two principal managerial tools of WHO - the Seventh General Programme of Work and the Medium-Term Programme, 1984-1989, for the Region - in the formulation of the biennial programme budget. The detailed elaboration of the first (1984-1985) biennial programme budget gives evidence of application of the principles of unified managerial process; programmes were selected in accordance with their relevance and responsiveness to the needs of the countries; objectives were translated into specific activities, and activities corresponded with budgetary provisions. All this makes the programmes more amenable to evaluation. For the preliminary proposals for the second (1986-1987) biennial programme budget, further use of the General Programme of Work and the MediumTerm Programme has been ensured by the elaboration of a countrywise list of relevant activities based on the programme trends and anticipated achievements in 1984-1985. Combined with the process of review of implemen- tation, this helps in the updating of the medium-term programmes and ensures their continuing relevance and usefulness. Regional (inter-country) programmes continue to be planned and directed towards providing complementary support to the country programmes, maintaining close relevance to the main objectives and approaches of the Seventh General Programme of Work and the activities proposed in the MediumTerm Programme. The perspective plan for the intersountry programme approved by the thirty-fifth session of the Regional Committee forms the basic framework of the biennial programing of inter-country activities. Selective, highly critical and flexible use of WHO resources was demonstrated in all countries of the Region, but more specifically under the new approaches tried out in two countries: (1) In Thailand, the experiment with WHO programme budgeting to establish national involvement in the management of WHO resources and make optimal use of these resources continued to progress. Useful experience was generated in the application of the new process, which is being objectively analysed for its wider application in the future. (2) In Indonesia, special collaboration resulted in the formulation of the main directions of WHO technical cooperation and coordination in the context of the national medium-term plan (Pelita IV) and the use of WHO resources in the overall context of national and other (external) resources. These nascent developments are forerunners of the most effective use of WHO programme budgets varying according to the situations and possibilities in the countries. The Regional Programme Committee, the highest policy-level advisory arm to the Regional Director in the secretariat, reviewed its past work and revised its terms of reference, which now include giving guidance to the secretariat in formulating the programme, conducting in-depth programe reviews, and enhancing inter-programme coordination. Additionally, the Committee developed a revised format for preparing plans of action for all major WHO collaborative projects as a managerial tool to monitor and control the delivery of WHO inputs efficiently. The Committee further rationalized and refined the WHO information systems, including the quarterly programme delivery status report and the sixmonthly report by WPCRs. There has been further strengthening and use of country-level mechanisms for monitoring WHO programe implementation with the close participation of ministries of health. This has resulted in more frequent dialogues between the government and WHO and corrective actions jointly proposed and carried out to achieve timely and more relevant programme implementation. An additional important function of the joint government-WHO mecha- nisms has been close consultation during programme formulation, a process that is instrumental in maintaining the continuing relevance and responsive- ness of WHO collaboration to national priorities and preferences. The same mechanism is slated to play its due role in integrated national-WHO programme evaluation and the coordinated use of other (external) resource inputs in priority national health programmes. Some of the currently perceptible trends of the regional. pr3:ramne can be mentioned as follor~s: (1) >T,e partnership between governments and L'W0 in programne development , management and evaluation is growing and finding expression in the work of the Regional Comn' ,lttee and the government-WHC management mechanisms in the countries. These inechanisn~s are assuming a positive role in determining the selective use af WHO resogrces for technical cooperation and coordination, (2) 'Ifie fact that WI10 resources for technical cooperation are 'unique' in many respects and, unlike project funding by other agencies, may be a critic31 input for thp. estab- lishment of sound national prosrammes vhicll generate resources from withi-n and outside the country, has co~x to be appreciat~d. (3) Fragmented, short-term UkIO project support is giving way to major collnhorative programmes integrate* more cl.oselv inti. the national programmes. (4) There is a demand for timely and effective technical inputs by WHO in the natiociil programxe development process, particuiarly in tlroee programmes whicii receive funds from external agencies. (5) A uniform understanding of the WHC managerial tools, and their integrated application among all I.TiCt staff snd among nationa.1 offici.als involved in colla7>orative progrsnme development and manasenent, appeers to be cri-tical. (6) Additional regional planning efforts are required for a regional health resources group or similar meclianism tu mobilize international resourres for health rievelopment. The Planning and Coordination Unit of the Regional Office, consisting of a multi-.disciplinary group, i.e., a health planner, an operational research specialist, a management specialist, a public health administrator and a health information specialist, continued to provide support to Member Countries in the deve:o?ment of the managerial process for national health development, including WHO inforrnntion systeins. Its activities included operationalization of the concepts contained in the Seventh General Programme of Work and ?he for~oi~lation and Cnplementatinl of regional medium- term programmes in conforruity witn the Seventh GPW. The implementation of the new managerial framework for optinal use of mO's resources in direct support of Member States is currently under consideration. Support was also provided to the countries in progralimt. impl.ementation, monitoring and evaluation, in reviewing their health rescurces dtilization and require- ments, and in developing the managerial information system as a part of the managerial process for heaith development at both the country as well as Regional Office levels. As for research administration and promotion of research in the Region, three principal meci1ani.srr.s are uti!ized. in co:lf ornity with the advice of the Regional Ccmnittee, the South-East Asia Advisory Committee on Medical Research (SEAIACMR) was established in 1976 to advise the Regional Director on the development of the Organization's research programme in South-East Asia. Members of this committee represent a wide variety of disciplines with a judicious mix of scientific specialities and a balanced geographical representation from the countries of the Region. The SEA/ACMR, together with its sub-committees and scientific working groups, provides the Regional Director with advice on technical and policy aspects of biomedical, health services and behavioural sciences research. The SEAR0 Research Development Comrp.ittee (RDC) is responsible for providing administrative and technical guidance for the formulation and implementation of the Regional Research Programme, including collaborative research programmes with other WHO Regions, The Committee functions as an in-house advisory body to the Regional Director and, along with the Regional Research Unit, is concerned with the implementation and monitoring of the Regional Research Programme. The Research Review Committee (RKc) is responsible for the technical review of specific research projects submitted to the Regional Office, and its recommendations are reviewed by the RDC, The RRC consists of the relevant technical and administrative staff. Technical merits and relevance, including ethical, administrative and financial aspects, are reviewed by the RRC. The periodic meetings of directors of medical research councils (MRC) or analogous bodies and concerned research foci in relevant ministries provide a forum for promoting research, coordination and management at the country and regional levels. An in-depth study of specific issues is achieved through ad hoc SEAIAMR sub-committees and scientific working groups. Links and close liaison between SEA/AMR and WHO headquarters and other Regions are ensured through participation in the Global ACMR and the ACMR meetings of other Regional Offices. Representatives of RPD/HQ and other WHO Regional Offices are also invited to sEA/ACMR meetings. 3. ADMINI STRATION 3.1 General The Second Meeting of the Ministers of Health of the South-East Asia Region, hosted by the Government of Bangladesh, was held in Dhaka in September 1982. In July 1982, the Director-Genera1 of WHO, Dr Mahler, visited 'Illailand, where an honorary degree was conferred on him by His Majesty the King on behalf of Mahidol University. In September, he attended the thirty- fifth session of the Regional Committee, held in Dhaka. In November, the Director-General visited Indonesia to participate in a workshop on "Government of Indonesia/blHO Cooperation in the Development and Implemen- tation of the National Strategies for Health For All by the Year 2000". On his way back to Geneva, he stopped over in New Delhi for discussions with India's health authorities on the management of the WHO programme and the Government's main directions in health efforts planned for 1984-1985. In July, the Regional Director visited Sri Lanka for discussions with the ninister and the Deputy Minister of Health and other health authorities on the WHO collaborative programme. He attended a meeting of
Support was given to health libraries in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand during 1982-8 3, to establish student loan libraries. During the year the Library received 7 510 books, pamphlets, WHO publications, current periodicals and reports; 2 974 persons (2 234 WHO staff and 740 others) visited the Library and 1 431 books and periodicals were issued on loan to Regional Office and field staff as well as on inter-library loans; 6 659 items were consulted in the Library itself. The Library actively participated in the activities of the Health Literature, Library and Information Services Network in the Region. Apart from assistinn in obtaining PEDLARS/MEDLINE services and photoco~ies. the - - Library provided assistance in bringing out Index Medicus for WHO South-East Asia Region, and also in the publication of the HeLLIS Newsletter. 8. RESEARCH PROMOTION AND DEVELOPMENT The South-East Asia Advisory Committee on Medical Research (SEA/ACMR) has, since 1976, held nine sessions, the ninth session having been held in April 1983. The documents on "Research Needs for Health for All hv the Yegr nittee of the SEA/ACMR, were widely circulated. The countries were utilizing these documents in focusing their research efforts on their national strategies. In pursuance of World Health Assembly resolutions, particularly Keszlution WIA30.$01 which stressed wider collaboration with medical research councils or analogous bodies to ensure (a) effective coordination of national, regional and global research programmes, (b) increased technical collaboration with and among research institutions in collaborative research and training, and (c) improvement of communication between scientists, follow-up actions were taken by the Regional Office through the meetings of directors of medical research councils or analogous bodies and concerned research foci in the relevant ministries (MRCs) held periodically. To date, three such meetings have been held, in the years 1979, 1981 and 1982. Through these meetings, guidelines have been developed for more effective promotion of research at the country level. These guide- I.ines include mechanisms and criteria for determining research policies and priorities; mechanisms of coordination involving all concerned research bodies at the national level; organization of mission-oriented research programmes; strategies for focusing research towards the national goals cf HFA/2000, and development of ethical review mechanisms and career structures for research in Member Countries. These meetings have also promoted technical cooperation among the Member Countries in research, with identification of focal points for such cooperation. The third meeting of the MRCs considered the outcome of a working group on the role of basic and applied research as well as research management in relation to HFA/2000. As regards the role of basic and applied research, the meeting recommended that basic research, which forms an integral component of a mission-oriented research programme relevant to solving priority health problems and contributing to the attainment of ~FA/2000, should be promoted by WHO as a matter of priority. With respect to research management, an outline of a training programme was developed for consideration by the research organizations in the Member Countries. In view of the necessity to utilize advances in health technology for the better health care of the people, large-scale field studies to test such technologies were needed. As such, the third MRCs meeting considered this issue and provided guidelines to tackle it. Action has been initiated for supporting a large-scale study in a country of the Region where, apart from the research objectives, managerial issues were being studied and documented for presentation at the fourth MRCs meeting. As an outcome of the meetings of the MRCs held thus far, the Member Countries strengthened their coordination mechanisms, established ethical review procedures and developed mechanisms for collaboration with universities, non-governmental organizations and research foci in other related ministries. They also promoted a multi-disciplinary approach to researchable problems and attracted additional national and external funds for research. The major thrust of the national research activities was in support of their national strategies for Health for All by the Year 2000. Following the organizational study on coordination and management of WHO collaborating centres by a working group and the subsequent discussion on the subject at the thirty-fifth session of the Regional Committee, the managerial mechanisms of collaborating centres were streamlined. In the field of health behaviour research, a scientific working group was convened on 7-8 April 1983 to review the current status of WHO activities in health behaviour research and to plan future actions, Based on its recommendations, an action plan was developed for implementation in the coming years. In consonance with the SEAIACMR guidelines to focus research efforts towards the goal of HFA12000 with health services research as the key component, national meetings were supported in four countries. These meetings were aimed at providing a sharper focus on specific research topics geared to national priority needs. Subsequently, an inter-country consultative meeting was to review the progress made since the March 1979 consultation and further identify research topics and TCDC activities in a collaborative effort to meet the needs and priorities of the Region. In this context, diarrhoeal disease research, as a case, should involve such studies as the factors related to diarrhoeal morbidity, community participation, and socio-behavioura 1 aspects in close collabora- tion with other related programme areas and disciplines. The ninth session of the SEAJACMR, held in April 1983, had research development in the Region as a major item on its agenda. The Committee reviewed major research areas that are being pursued and supported by the Region with special reference to the guidelines laid down by it, such as "Research Needs For Health For All" and "Concept of Health Services Research". The Committee, among other things, drew special attention to research areas and their promotion and management such as maternal and child health, nutrition, diarrhoea1 diseases, environmental health, behavioural research, and health services research which are key supportive elements to achieving the goals of Health For 811. The Committee recommended that, rather than undertaking a multiplicity of studies, efforts should be made to concentrate on a few critical areas with interdisciplinary and holistic approaches that would contribute towards maximum impact on the health care programme in relation to national goals. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continued to be one of the major sources of support to research in this region. The five collaborating centres in the Region participated in several multinational collaborative studies. Research in the Region was mainly related to the evaluation of the safety of existing contraceptive drugs and methods, development of new fertility-regulating agents; health service research, and infertility. Institution-strengthening activities continued to provide facilities for basic and clinical research, including research training. There were 24 scientists from this region who served as members of the 14 task forces in the Special Programme. The UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases (TDR), another major source of research support, continued to promote and support research related to the major tropical diseases prevalent in the Region, such as malaria, leprosy and filariasis, as well as activities to strengthen the research capabilities of the countries where these diseases are endemic. Through continued promotional activities of the TDR Programme at regional and national levels, the number of scientists and institutions that participated in the Programme has steadily increased. The major research activities contributing to the Programme in the countries of the Region were in the field of chemotherapy of malaria, leprosy and filariasis. Participation in other components of the Programme, including socio-economic aspects and applied research, was increasing. Activities for strengthening research capability that were important and relevant to the countries of the Region were also increasing, both in the training of scientists and strengthening of research facilities. Most of the major focal institutions dealing with research and training in tropical diseases were receiving TDR grants in accordance with the strategic plans of the Research Strengthening Group. 9. WOMEN, HEALTH AND DEVELOPMENT While women as consumers of health services are the beneficiaries of family health activities, their role as providers or as active agents of health development has also been recognized by WHO. Thus, like all other regions and the global headquarters of WHO, the South-East Asia Region has also established a programme on Women, Health and Development (WHD), which is being planned and implemented by a core group specifically charged with this task. This core group, in consultation with the SEAR0 advisory group on this subject and the units concerned, has developed a regional progranune on WHD covering the period up to 1985. The regional WHD programme is not a vertical one but is an integral part of all the ongoing programmes of WHO, including maternal and child health and family planning, primary health care, expanded prorgramme on immunization, communicable and non-communicable diseases control, mental health, medical and health education and health information development. Though women face the same health problems as men, they undergo many additional risks because of their different anatomical and physiological norms, cultural environment, and the extra physical demands of menstruation,
PART I I ORGANIZATIONAL AND ADMINISTRATIVE MATTERS I. REGIONAL COMMITTEE The thirty-fifth session of the Regional Committee for South-East Asia was held in Dhaka, Bangladesh, from 14 to 20 September 1982. This was the first occasion that a session was held in Bangladesh. It was attended by representatives from all Member Countries of the Region, including Bhutan, which had become a Member of WHO in March 1982 and had joined the South-East Asia Region. In addition, the session was attended by UNDP, UNICEF, ILO and 13 non-governmental organizations having official relations with WHO, as well as seven observers from bilateral and voluntary agencies and WHO collaborating centres. The session was declared open by the outgoing Chairman, Dr Bahrawi Wongsokusumo (Indonesia). The Minister of Health and Population Control, Government of the People's Republic of Bangladesh, inaugurated the meeting. The inaugural meeting was also addressed by the Secretary, Ministry of Health and Population Control (Health ~ivision), Bangladesh, the Regional Director and the Director-General of WHO. The Regional Committee elected Mr Md. Siddiquer Rahman (Bangladesh) as Chairman and Dr N.L. Maskey (Nepal) as vice-chairman. Introducing his Annual Report, the Regional Director said that a number of significant steps had been taken to develop, implement and monitor the strategies and plans of action for achieving the goal of Health for All, to which all the Member States were committed. Among the eight essential elements of primary health care, top priority had been given to maternal and child health, including family planning, in most countries of the Region. Nutrition and health education also received high priority. Provision of oral rehydration to curtail mortality caused by diarrhoea1 diseases was receiving attention in most countries, with emphasis being given to the production of oral rehydration salts. Major efforts in stimulating activities under the expanded prograrmne on immunization were concerned with the training of manpower in technical and managerial aspects in addition to the development of a viable cold chain in each country. The incidence of malaria was showing a declining trend in the Region as a whole, but there was no room for complacency, Technical, managerial and manpower problems were still affecting the programme adversely. Progress in the control of leprosy was hampered by the social stigma attached to the disease as well as the emergence of drug resistance and difficulties in case-finding and case-holding. In regard to safe drinking water and sanitation, the lack of which continued to be a major cause of water-borne diseases, some progress had been made in providing safe water, but basic sanitation had received very little attention. Dependence on sophisticated and expensive technology was a major obstacle to the expansion of sanitation services, especially in rural areas. The IDWSSD programme should help in tackling these problems. The research programme in the Region had been reoriented towards supporting efforts to achieve the HFA goal, and the thrust was on solving human rather than technological problems through the application of existing knowledge. In order to improve health planning and management at the national level, the Organization had developed guidelines, modules and methods and had supported training activities. The major tools for WHO'S managerial process, namely, the Seventh General Programme of Work, the medium-term programme and programme budgeting, had now been linked appropriately. In order to optimize the utilization of available resources for health develop- ment, a number of innovative exercises had been undertaken in the Region. Meeting the needs of health services formed the principal basis for health manpower development in the countries, and to this end planning, production and utilization of manpower were integrated and balanced in order to obtain best results. However, coordination among health, education and other relevant ministries was essential. Despite difficulties in health development in the Region, the tangible progress made so far would provide the basis for launching future action. During the discussions on the Annual Report, the Regional Committee noted the progress made by the countries in developing their managerial systems for health development. All had medium-term programmes for health development and at least two countries had long-term health plans. The need was expressed for involving the private sector and non-governmental agencies in national health development efforts in view of the shortage of resources. Community involvement was considered essential for achieving success in developing primary health care. Considerable progress had been made in providing PHC, but there was a need for introducing innovative approaches to improve the quality and to expand the services. Provision of PHC to the urban poor in addition to unserved and underserved people of the rural areas also deserved attention. It was noted that WHO, in cooperation with UNFPA and UNICEF, had been collaborating with Member Countries to develop a balanced programme for maternal and child health and family planning services, nutrition and health education. Some countries felt that WHO should increase its quantum of assistance to the family planning programmes. The Committee expressed gratification that governments had initiated measures to implement the World Health Assembly resolution on infant and young child feeding despite opposition from vested interests. Noting that a comprehensive regional research-cum-action programme on nutrition had been developed and implemented in phases to combat mal- nutrition, the Committee suggested that a time-bound programme should be drawn up for controlling goitre. It was explained that efforts were under way in this regard. The Regional Conunittee stressed the need for studies leading to more effective action for changing the health behaviour of individuals. It also emphasized the need for ensuring adequate and timely supply of essential drugs to far-flung rural areas in support of primary health care. In this connection, the Committee noted with great satisfaction the efforts of several countries towards development of a drug policy, prepara- tion of a national list of essential drugs and introduction of appropriate legislative measures. In order to ensure the quality and safety of the drugs in use, the Committee requested WHO to strengthen the existing drug testing laboratories and stimulate mutual cooperation among Member States in this field. While discussing communicable diseases, the Committee expressed concern over the reduction in the budgetary allocation for malaria control in several countries. The Committee was informed that research was under way to find alternative methods of vector control and that resistance of plasmodium to chloroquine was also being monitored in several places. Further, border coordination meetings were organized between neighbouring countries within the Region, and the Regional Office was also continuing close collaboration with the WHO Western Pacific Region in this respect. The Committee felt that there was a need for more frequent meetings between the countries affected. In regard to leprosy, which was an important and priority problem in the Region, the Committee hoped that the recommendations emerging from the technical discussions on leprosy held during the session would help devise various measures to improve the existing programmes. The Committee was informed that the programme on diarrhoea1 diseases aimed at curtailing mortality by providing oral rehydration. In addition to large and small-scale production, development of logistics and supply, operational research and training of health workers in the use of oral rehydration salts were also undertaken. The Committee stressed further promotion of the expanded programme on immunization. It was noted that so far WHO assistance had been given for developing technical and managerial manpower and dependable logistics systems and promoting motivation for community participation. All the countries of the Region were implementing the programme and most of them were trying to become self-reliant in the production of vaccines. Some countries sought assistance from WHO to study the social, psychological and economic aspects of the reve en ti on and control of sexually-transmitted diseases. The Regional Committee requested the Organization to provide more material assistance, such as drugs to combat pulmonary tuberculosis, which continued to be a public health problem in the Region. It was felt that efforts to prevent the emerging public health problems of cardiovascular diseases., cancer and diabetes should be supported by the Organization and that national programmes to control these diseases should be integrated with primary health care activities. The Committee advocated the use of a multi-sectoral approach by both WHO and national health authorities against smoking, as more and more younger people were taking to the habit. The Regional Committee discussed the subject of environmental health, particularly in the context of the International Drinking Water Supply and Sanitation Decade. Two major problems were identified, namely, lack of coordination due to management of the national programme by many agencies other than the ministry of health, and paucity of funds. It requested WHO to make efforts to mobilize greater resources in support of water supply and sanitation programmes than hitherto available. In regard to research, the Committee was informed that the South-East Asia Advisory Committee on Medical Research was constantly reviewing the priorities for research in support of HFA and reorienting the research activities accordingly. Also, health services research was given due priority and management of research had been streamlined in consultation with national research councils or analogous bodies. The Regional Committee recommended that WHO should promote and support research on operational aspects and lay more stress on applied research, though basic research in the context of the HFA/2000 concept should not be ignored. The Organization should also give direct assistance to the development of appropriate research protocols as many countries lacked trained manpower for this work. It was felt that development of a suitable mechanism for the exchange of research information among countries of the Region should also be stimulated and supported by WHO. The Committee felt that high priority should be given to strengthen- ing the health information systems in the countries. The main constraint in their development was not lack of finances but the lack of personneL in both quality and quantity. It was noted that many countries had, with WHO assist- ance, already made a beginning in strengthening the health information system. The need for coordinated planning and implementation of manpower development activities by relevant health authorities on the one hand and the universities and ministries of education on the other, was stressed. WHO'S role in the review and recasting of curricula of different categories of health workers to meet the needs of primary health care was appreciated, and the Regional Committee felt that these efforts needed to be strengthened further. Concerning the regionalization of the fellowships programme, it was mentioned that the Regional Office had been utilizing, to the maximum extent possible, the training institutions available within the Region. Proposed Programme Budget for 1984-1985 The Sub-committee on Programme Budget appointed by the Regional Committee to examine the programme budget noted that the proposals for the 1984-1985 biennium (1) had been prepared in conformity with the Seventh General Programme of Work and other policy guidelines, (2) were adequately linked to the medium-term programme of the Seventh General Programme, and (3) were generaily in support of the primary health care package. The Regional Cormnittee approved the report of the Sub-committee and requested, inter alia: (a) the Director-General to consider a substantial increase in the regional allocations; and (b) the Regional Director to revise the terms of reference for the Sub-committee on Programme Budget in accordance with the deliberations of that Sub-committee. Health for All by the Year 2000 In reviewing the progress made in Member States as well as at the regional level in the development, updating and implementation of the strategies for health for all, the Regional Committee felt that these should be accelerated, especially as there were only 18 years to go for the year 2000. It emphasized that WHO should give attention to the priority programme areas identified by Member States for the allocation of resources and concentration of efforts. It also stressed the urgent need for countries to develop plans of action in the light of the strategies in order to facilitate their implementation, as also for meaningful monitoring of activities. Report on the Study of WHO'S Structures in the Light of Its Functions The Regional Committee considered two major topics under this item, viz.: (1) the future role of the WHO programme coordinators and represen- tatives and the authority required to be vested in them for effective country-level operation of WHO'S collaborative programmes; and (2) the procedures and style of work of the Regional Committee, based on the recommendations made by the Small Committee appointed by the Regional Director in pursuance of resolutions SEA/RC34/R6 and SEA/RC34/Rll. The Small Committee suggested that the role to be played by the WHO programme coordinator and representative (WPCR) and the additional authority to be vested in the WPCR should be determined for each country on the basis of a dialogue between the Regional Office and the government so that the WPCR could collaborate with the government optimally in developing health policies and plans as well as in implementing and evaluating the programmes emanating from these policies and plans. As regards the style of work of the Regional Committee, the Small Committee emphasized the need for concen- trating discussion in the Regional Camnittee on only high priority issues related to programme development and management and undertaking an in-depth review of WHO'S collaborative programme twice every year by the Small Committee. Coordination and Management of WHO Collaborating Centres The discussion on this topic was based on the report prepared by a working group appointed by the Regional Director. This group had considered resolution EB69.R21 approving a set of regulations for the collaborating centres which had been endorsed by the Health Assembly in May 1982. The Regional Committee, in approving the recommendations, took note of two important provisions of the new regulations, viz.: (1) reorientation of the functions of collaborating centres to support the Organization's programme as a whole and not research activities alone, and (2) selection of centres also from among those showing potential and promise and not only from those which are already centres of excellence. Technical Discussions These were held on the subject of "Control and prevention of leprosy in the context of ~rimary health care". The Technical Discussions group considered different aspects of leprosy control, such as situation analysis, policies, constraints faced by programmes, and strategy for the prevention and control of leprosy as an integral part of primary health care. It recommended, among other things, that: (1) in view of the limited value of monotherapy in the control of leprosy, multi-drug therapy should be intro- duced in the Region in a phased manner; (2) keeping in view the need for community education, rescheduling and reprogramming should be undertaken; (3) an adequate supply of drugs must be ensured by mobilizing resources within the country as well as internationally; and (4) recognizing the role of voluntary organizations, their activities at the country and regional levels should be coordinated. With regard to the thirty-sixth session, to be held in 1983, "Monitoring and evaluation, including information support for primary health care programme with special reference to family health" was chosen as the topic for the technical discussions. International Flow of Resources for the Strategy for Health for A11 In noting the progress made concerning the Health Resources Group for Primary Health Care (HRG) and country resource utilization, the Regional Committee raised a number of issues, such as the venue of the meetings of HRG, how best HRG activities could be carried out in the context of TCDC, assistance by WHO in documentation, and larger representation from the Region in HRG meetings. The Regional Committee nominated Bangladesh and Sri Lanka to represent the Region on HRG for two years, Special Programme for Research and Training in Tropical Diseases Noting that only 6.9 per cent of the total operational funds of the Special Programme had been invested in this region, the Committee agreed that in order to attract more of these funds, there was a need for promoting and strengthening national capabilities, developing well-formulated pro- posals and streamlining government machinery for the speedy clearance of projects for timely submission. It nominated India to represent South-East Asia on the Joint Coordinating Board for three years effective January 1983, in addition to the ongoing Member, Thailand. Progress Report on Activities for the International Drinking Water Supply and Sanitation Decade Following a detailed discussion on this subject while reviewing the Regional Director's annual report, the Committee felt that, since the outlook for external support for national Decade programmes had not been very encouraging, it was imperative that governments review their plans and targets. WHO'S contribution, though not very significant, could play an effective catalytic role and provide necessary stimulus, and the Committee thought it would be worthwhile to maintain a reasonable allocation in the WHO country budgets for supporting Decade activities. Use of the Injectable Contraceptive Depotlnedroxyprogesterone Acetate (DMPA) in Countries of the Region The views and experiences of several Member States in the use of this contraceptive varied. While most considered it highly effective with a very low rate of failure, some were concerned over its possible long-term side-effects and complications. The Committee was informed that WHO would be ready to collaborate with the countries in organizing scientific studies or consultations as required. Use of Traditional Practitioners of Medicine for Primarv Health Care Activities The Regional Committee recognized that a great deal of work had been done in developing national pharmacopoeias and collecting information on traditional systems of medicine. Nevertheless, there was a need to establish a mechanism for the exchange of information. Also, governmental action would be required to improve manufacturing practices further, as well as quality control of traditional drugs. Since integration of traditional and modern systems of medicine was a complex matter, the Committee felt that a working group could be set up to find the right approach and methodology. Time and Place of Forthcoming Sessions of the Regional ~ommittee - The Regional Committee decided to hold its thirty-sixth session in 1983 in Nepal, and decided provisionally to hold the thirtyseventh session in the Regional Office in 1984. It noted the advance notice given by the Government of Bunna of its wish to host the thirty-eighth session in 1985. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION During the year, several developments in the area of regional programme planning characterized significant progress that deserve mention: In pursuance of the wish of the Regional Committee which, at its thirty-fifth session in 1982, approved the recommendations of the Small Committee, the annual programme review for the year 1982 was carried out by the Small Committee (hereafter to be called the Consultative Committee on Programme Development and Management). The WHO regional secretariat facilitated this review by providing an annual report on the financial implementation and technical aspects of country and regional programmes during 1982. While the Consultative Committee will henceforth conduct six-monthly programme implementation reviews as a routine, the annual reviews present opportunities for examining more closely the financial implementation in correlation with the technical progress and relevance, thus enabling the Regional Committee to involve itself meaningfully in WHO programme reviews. The Consultative committee" recommendations with regard to inte- grated evaluation of WHO and national programmes would lead to the further refinement of retrospective WHO project evaluation methods. They would also result in the selection of at least one major and priority programme for integrated evaluation in 1984 to test a simple practical method and gain experience for further development. Specific efforts were made to make use of the two principal managerial tools of WHO - the Seventh General Programme of Work and the Medium-Term Programme, 1984-1989, for the Region - in the formulation of the biennial programme budget. The detailed elaboration of the first (1984-1985) biennial programme budget gives evidence of application of the principles of unified managerial process; programmes were selected in accordance with their relevance and responsiveness to the needs of the countries; objectives were translated into specific activities, and activities corresponded with budgetary provisions. All this makes the programmes more amenable to evaluation. For the preliminary proposals for the second (1986-1987) biennial programme budget, further use of the General Programme of Work and the MediumTerm Programme has been ensured by the elaboration of a countrywise list of relevant activities based on the programme trends and anticipated achievements in 1984-1985. Combined with the process of review of implemen- tation, this helps in the updating of the medium-term programmes and ensures their continuing relevance and usefulness.
Tne Chief of Salary and Allowances, International Civil Service Commission (ICSC), New York, visited the Regional Office in October 1982 and held discussions with the administrative staff of WHO and other United Nations agencies' administrations regarding the methodology for the conduct of general service staff salary surveys. In December, the Director of the Joint Medical Service from Geneva visited India and had discussions with the staff and the Regional Staff physician in the Regional Office. He also visited the various medical facilities available to staff in New Delhi. In April, the Secretary of the WHO Staff Pension Committee in Geneva paid a visit to familiarize staff members with matters related to the operation, rules and regulations of the United Nations Joint Staff Pension Fund. 3.4 Budget and Finance The obligations incurred on field activities under various funds during 1978-1979 and 1980-1981, together with an estimate for 1982-1983, are shown in Figure 2. Total obligations under the regular budget for 1982-1983 as of 30 June 1983 are b37 976 477. This represents 71.5 per cent of the total revised regional allocation of $53 096 000. It is estimated that the remainder of the regional allocation will be obligated by 31 December 1983. 3.5 Regional Office Building The construction of the new annex building was progressing satis- factorily, and the cost was within the originally budgeted amount of ~~$675 000. An allocation of $250 000 was made by the Thirty-fifth World Health Assembly in May 1982 (resolution WHA35.12) for an additional stand-by generator for the Regional Office. The entire work was completed in May 1983 within the amount budgeted. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 June 1982 to 31 May 1983 the cost of supplies and equipment amounted to $8 523 676, of which $132 628 (15.5 per cent) was for local purchases. A comparative statement showing the procurement trend during the period from 1977 to 1982 (calendar year) is given in Table 13. Among items available locally in countries of the Region and purchased by the Regional Office were: motor vehicles, motorcycles, bicycles, spare parts for vehicles, audio-visual equipment, teaching aids, laboratory equipment and supplies, chemicals, drugs and pharmaceuticals, hospital equipment and supplies, diagnostic, operative and other instruments, rubber and plastic goods, refrigerators, cold boxes, airconditioners, and office equipment and supplies. Figure 2. OBLIGATIONS INCURRED ON FIELD ACTlVITIES IN THE SOUTH-EAST ASIA REGION US$ (Millions) Regular Budget UNDP UNFPA ( Other Sources Total Field 1978-1979 Obligations US$ (millions): 51.5 Table 13 Procurement of Supplies and Equipment Year Total Local purchase Local purchase procurement within the as a percentage Region of the total (US$) (US$) (US$) Emergency Supplies Supplies, totalling $143 705, were procured to meet emergency conditions caused by natural disasters and epidemics, as follows: Bangladesh. For increased drug-resistant P.falciparum infections and cases of cerebral malaria: quinine hydro- chloride injections and tablets; for outbreak of diarrhoea: Ringer's lactate with giving sets. Burma. For hepatitis outbreaks: RIA kits, gamma globulin, - drugs, ointments, injections, penicillin, bandages and syringes. For plague outbreak: anti-plague vaccine, strepto- mycin, chemicals, reagents, and laboratory supplies. Maldives. For diarrhoea epidemic: ampicillin capsules, injections, drugs, nalidixic acid tablets, cholera vaccine, laboratory equipment, bleaching powder. Nepal.: For hepatitis outbreak: human albumin, plasma protein fractions, vitamins, gamma globulin, oral rehydration salts, syringes. For an outbreak of meningococcal meningitis: meningococcal vaccine. Sri Lanka. For shigella epidemic: Ampicillin capsules, furoxone tablets and gentamycin injections. Purchases - Revolving Fund/Reimbursable Basis During the period under review, Bangladesh, Burma, Nepal and Sri Lanka made use of the Organization's procurement facilities under the Revolving Fund and reimbursable schemes amounting to $151 908. The purchases covered hospital and laboratory equipment and supplies, typewriters, drugs, vaccine, chemicals, bleaching powder, teaching material, books and renewal of subscriptions to journals. 5. COLLABORATION WITH OTHER AGENCIES 5.1 United Nations 5.1.1 United Nations Development Programme (UNDP) During the reporting period, WHO implemented 38 country and inter- country projects funded by the United Nations Development Programme in the Region, the total delivery of UNDP projects amounting to US$ 3 750 000. he operational projects covered programme areas such as strengthening of manpower and training, development of traditional medicine, environmental health, planning, management and evaluation, expanded programme on immunization, food and drug quality control, communicable-disease control including immunology, and the prevention and control of visual impairment and blindness. Active collaboration was maintained with UNDP Resident Representa- tives and governments in order to evolve new country and inter-country projects to be covered during the current indicative planning figure period (1982-1986). The financial stringency in UNDP continued, and a critical assessment of ongoing projects was undertaken during tripartite reviews. Officials from UNDP headquarters visited the Regional Office to review inter-country project activities and explore possibilities of introducing economies without affecting the planned activities. This action has resulted in the further streamlining and expeditious approval of the ongoing inter-country projects. Regular tripartite reviews of country projects were carried out, leading to better implementation. Close follow-up and attention are being paid to the development of new country and inter-country projects. As a follow-up to the Substantial New Programme of Action for the Least-Developed Countries, a series of country review meetings is being organized, either as round-table meetings under the auspices of UNDP, or as consultative groups under the aegis of the World Bank. A series of such meetings was concluded by the UNDP Bureau for Asia and the Pacific from 9 to 18 May in Geneva where the needs of five countries, including Bhutan and Maldives, were reviewed. A staff member from the ~egional Office assisted the countries from this region at these meetings. Bangladesh and Nepal, which use the World Bank Consultative Group mechanism, were also present at the round-table meeting as observers. The earlier country resource utilization reviews carried out in Nepal and Sri Lanka resulted in a greater awareness of health resources needs among economic development and aid coordinators in the countries. 5.1.2 United Nations children's Fund (UNICEF) WHO is closely collaborating with UNICEF both in the countries and in the Regional Offices of UNICEF in New Delhi and Bangkok. The main thrust of collaboration has been in common programme areas such as EPI, diarrhoea1
PART I I1 ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST This part of the report contains programme summaries in respect of each country, giving a brief account of the major problems of the country and highlighting the government's efforts during the year, in relation to WHO collaboration. The information is complementary to that already given in Part I. Each programme summary is followed by a list of the projects in the country for which WHO has given assistance during the whole or part of the period under review. Inter-country projects are listed at the end. In the project list, in the first column (under "Source of Funds"), the following abbreviations are used: Abbreviation Meaning R Regular Budget UNDP United Nations Development Programme FP United Nations Fund for Population Activities FT Trust Fund UF United Nations Children's Fund VF Voluntary Fund for Health Promotion - all sub-accounts AS Special Account for Servicing Costs FSSTD UN Financing System for Science and Technology Development The projects are listed in accordance with the programme classi- f ication. 1. BANGLADESH The indices for national strategies for Health for A11 were reviewed during 1982. A plan of action was prepared in order to implement the strategies for HFA/2000 and update their 77 indicators. Throughout the period efforts continued for finalizing the health manpower plan, which set as its objective the task of identifying the needs for health manpower of all categories required to operate the health care system during the years 1985, 1990 and 2000. Work on the decentralization of the administration has progressed considerably with the thana as the pivot, 45 thanas having been upgraded in 1982. The posts of gramsarkars were abolished and the functions of the alli chikitshaks were temporarily suspended. In order to take the medical !ervices to the rural sector, it has been made compulsory for new medical recruits to perform five years' service including three in rural areas. An expert committee was set up to formulate and draft a national drug policy consistent with the health needs of the country. The selection of essential drugs was made. Most of the nearly 1 763 varieties of drugs, except 250 or so, will be abolished. Efforts continued for improving the collection of health information on morbidity and mortality, and on births and deaths by village in the six pilot thanas. To strengthen the operations of the Health Information Unit the technical advisory committee was revived. WHO assisted in the development of the basic legal health infra- structure by integrating all existing health laws and recommending areas for legal reforms and revision. A survey of the country's supply management system was carried out at the request of the Government. Particular attention was paid to the identification of bottlenecks and constraints and to the provision of drugs and medical supplies to the rural population. Work on the development of primary health care in the thanas concentrated on the creation of the basic infrastructure. Guideline models for community participation and thana health and family planning personnel in terms of organization, management functions, duties and responsibilities, as well as an orientation curriculum based on the guideline models were finalized and issued. The first orientation in the new model thana health service delivery (PHC) for the thana health service managers of six thanas was held in December 1982. Progress was made in the establishment and construction of a national workshop and training centre for the maintenance of electromedical equip- ment. The solution of the problem of repair and maintenance of equipment at hospital, district and constituent thana levels awaits the completion of the central organization and the extension of its facilities to the periphery. Group educational activities with mass media support continued to highlight disability prevention and rehabilitation. WHO collaboration included technical guidance and the supply of manuals on the training of the disabled and other reference materials. In the field of health laboratory services, the new facility for tetanus toxoid was opened and a small batch was prepared and found to be satisfactory in local quality tests. Construction of a reference and control centre and of units for the production of diphtheria and pertussis vaccines was nearing completion. A certificate course and several in-service training courses in public health nutrition were completed. Data on the completed survey under the goitre control programme and on the situation analysis of the nutrition component of the primary health care programme were being analysed. A formula on weaning food has been developed for trial. An analysis of the country's food products and a study on the growth pattern of Bangladesh children were in progress. A national workshop on the development of health education in primary schools was conducted, as were several workshops and in-service training programmes for various categories of health personnel. Manuals on a health education curriculum for nurses and medical assistants and on school health education were developed and a handbook on health education completed. To improve the standard of voluntary sterilization, a joint SIDA/ World BankIWHO-sponsored project entitled "Sterilization Surveillance Team" was started in 1982. Its main objective is to monitor the standard of sterilization in order to improve the overall standards. There would be four teams located in each administrative division. Three of the four WHO personnel for this programme are now in position. The main pharmaceutical production unit was completed in 1982. WHO has agreed to provide four air-conditioning units to facilitate limited production. Following the discussions held during the World Health Assembly in May 1983 among the representatives of the Bangladesh delegation, WHO, DANIDA and SZDA, it was decided that two joint missions should visit Bangladesh. The first mission will produce a detailed plan for the quality control of drugs with an implementation schedule, budget details and training needs. The second mission will plan the implementation of the essential drugs programme. The terms of reference of both the missions have been prepared and it is expected that the missions would visit the country in August 1983, The Board of DANIDA has approved that, in cooperation with WHO and SIDA, DANIDA will proceed with the detailed planning of possible assistance to the Bangladesh Essential Drugs Programme. Communicable disease control programmes continued to be a major activity. Diarrhoea1 diseases ranked as the major cause of morbidity and mortality, especially among infants and children. Steps were being taken to step up the production of ORS to meet the country's demands. The development of epidemiological services and health information systems is essential for the control of priority diseases such as diarrhoea (including cholera), diphtheria, whooping cough, tetanus, measles and poliomyelitis, and slow but steady progress was registered. ~abies control was given priority and a draft countrywide control programme was drawn up. Also, a zoonosis unit was established at the National Institute of Preventive and Social Medicine. The expanded programme on immunization has shown some progress. Several hundred EPI centres were established at district, thana, family welfare and union health centres. In Dhaka, two cold rooms were established for the storage and distribution of drugs and vaccines. District stores were set up and every thana health centre was supplied with a refrigerator and other cold chain materials. Malaria remained a major public health problem. There was a loca- lized epidemic of P.falciparum and cerebral malaria in two south-eastern districts towards the end of 1982. The RIII level of chloroquine-resistant P-f. strains increased to 16 per cent in 1982. WHO gave assistance by procuring and airlifting emergency supplies of parenteral and oral quinine to combat the epidemic. In the rest of the country the overall situation improved marginally. A WHO-sponsored external assessment in November/ December 1982 recommended epidemiological stratification of the country into three strata and a revised strategy to control malaria. A draft four-year plan of operations was drawn up after the completion of the epidemiological stratification. Tuberculosis and leprosy control activities were continued. Although there are an estimated 200 000 cases of tuberculosis and 150 000 cases of leprosy in the country, only a fraction of this number is registered for treatment. Three hundred and fifty thanas examine sputum and carry out passive tuberculosis case-finding. A mass KG vaccination campaign was organized in November 1982 to cover the high defaulter rate. Four mobile leprosy teams were established to serve 104 leprosy treatment centres. Three leprosy clinics with 20 beds each were also set up. High-potency vitamin A capsules were distributed twice a year to children in the 0-6 age group and to those in the 7-15 age group with nightblindness. The rate of nightblindness in children (0-6 years) has dropped from 2-3 per cent in 1973 to 1.14 per cent. A survey to estimate the prevalence of xerophthalmia began towards the end of 1982. The prevalence of diabetes is being studied through a survey in urban and rural areas. The Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders was designated as a WHO Collaborating Centre with training and research as the principal objectives. Environmental health activities were supported by WHO through two projects, viz., (i) community water supply and sanitation, and (ii) assist- ance to the WASAs in Dhaka and Chittagong. The water supply component and coverage, with UNICEF financial inputs, is more pronounced than the sanita- tion part. The installation of tubewells continued. The capacity to produce 40 000 water seals annually was reduced owing to a shortage of materials. Assistance to the Dhaka and Chittagong WASAs has been extended up to 1984. Oral health and dentistry are in an early stage of development with a dentist to population ratio of 1~300 000. Results of a survey encompassing eight areas indicated a higher prevalence of periodontal disease to dental caries. An oral health education programme has been formulated. WHO gave support to the paramedical institutes in the training of mid-level and peripheral health workers. Five educational workshops were conducted for a total of 1 978 participants. Existing methods of teaching and course curricula were also reviewed. The National Institute of Preventive and Social Medicine continued to conduct post-graduate courses in community medicine as well as in-service training and workshops for government technical staff. WHO provided techni- cal assistance for some of these courses. Progress had been made in the development of nursing education. A four-year course was established to produce senior registered nurses, mainly trained to provide hospital bedside care. A training programme for junior nurses was started in order to produce auxiliaries who could work in medical institutions and also carry out primary health care in the community. These programmes have been recently evaluated and modified. Assistance for research promotion and development covered training in research methodology and the promotion of health services research in respect of primary health care in the Bangladesh Medical Research Council. Projects in Operation Number (Source of Funds) - Title BAN CHP 001 (R) Country Health Programming BAN RPD 001 (R) Research Promotion and Development BAN SPM 001 (R) Organization of Health Services Planning and Administrat ion BAN SPM 002 (R) Strengthening of Thana Health Complexes and Development of Primary Health Care BAN SPM 003 (R) Repair and Maintenance of Electro-Medical Equipment BAN ADR 001 (R) Disability Prevention and Rehabilitation including Health Care of the Aged BAN ATH 001 (R) Development of Health Laboratories and Allied Laboratory Services BAN MCH 005 (VF) Sterilization Surveillance Team BAN NUT 002 (DP) Institute of Public Health Nutrition BAN HED 002 (R/FT) Development of Health Education Services BAN MNH 001 (R) Mental Health BAN PHB 001 (R) Pharmaceutical and Biological Quality Control BAN PHB 003 (FSSTD) Strengthening of Bangladesh Council of Scientific and Industrial Research Laboratory, Chittagong BAN ESD 001 (R) Strengthening of Epidemiological Services BAN ESD 002 (DP) Epidemiology and Disease Control BAN MPD 001 (R) Malaria Control BAN BVM 001 (R/VF/FT) Mycobacterial Disease Control BAN EPI 001 (R/VF) Expanded Programme on Immunization BAN PBL 001 (R) Prevention of Blindness BAN CAN 001 (R) Cancer Prevention and Control BAN CVD 001 (R) Cardiovascular Disease Control BAN ORH 001 (R) Oral Health BAN OND 001 (R) Other Noncormounicable Diseases (Diabetes, ~ndocri- nology) BAN EHP 001 (DP) Assistance to Water and Sewerage Authority (Dhaka and chittagong) BAN BSM 001 (R) Community Water Supply and Sanitation BAN PTR 001 (R) Training of Mid-level and Peripheral Health Workers BAN PTR 002 (DP) Training of Medical Assistants BAN PTR 003 (DP) Strengthening of Health Manpower Development BAN PTR 005 (DP) National Institute of Preventive and Social Medicine BAN PTR 006 (R) Assistance to ~edical Colleges in the raining of Teachers BAN PTR 007 (DP) Training of Senior Nurses BAN EDS 001 (R) Nursing Advisory Services and Training 2. BHUTAN The Royal Government's Fifth Six-year Plan (1981-87) erophasizes decentralized development, reduction of regional disparities, accelerated community-based rural development, and improvement of existing institutions and service facilities. Allocation for health constitutes 5.3 per cent of the total plan alLocation for this six-year period The overall objective of the country's health plan is to strengthen the basic health services and ~rimary health care activities to facilitate the attainment of HFA/2000, A Master Plan of Operatio~s for Health Services Development in Bhutan has been signed by the Roya? Goveran~ent and WHO. In view of the predominance of the rural sector, the underlyi3g health development strategies lay emphasis on rural health services through basic health units (BHUs) and district hospitals. There are 50 basic health units providing health care at the peripheral level, each supported by a three-nember team of a health assistant, an auxiliary nurse-midwife and a basic health worker. The BHUs are supported by 16 district hospitals, while three referral hospitals provide specialized services. Other service units in the rural areas are 39 dispensaries of the modern system and five of the indigenous traditional medicine. The Government has also expanded the voluntary village healtn volunteer programme from four districts last year to one more district, where female health volunteers have been introduced for the first time. These village health volunteers provide preventive and simple curative care. In the field of MCB, WHO has been executing UNFPA-funded projects. Construction of a training complex has been completed. The activities envisaged include training in MCH and family welfare, training the trainers for village health volunteers and the retraining of other health workers, Assistance is also extended in the implementation of health education elements in connexion with which three textbooks on hygiene and sanitation have been finalized. Surveys of maternal and infant morbidity and mortality for the development of an MCH and family planning information system as part of the National Health Information System were initiated. Training of practitioners of traditional medicine and identification and improvement in the processing of locally available herbs for medicinal purposes have also been supported by WHO. The Traditional Drugs Production Unit has been contributing towards meeting the local needs. The programme of immunizing children against tuberculosis, diph- theria, pertussis and tetanms (DPT), polio and measles continued according to schedule. A project document covering UNDP assistance to EPI for the period 1983-1986 was submitted to UNDP. The project will extend immunization activities within the context of comprehensive primary health care services to cover larger geographical areas and a larger percentage of the children in the target population within these areas, The formation of tne new Nationai Nutrition Unit in Bhutan has given a substantial boost to nutrition strategies/activities, A national baseline survey of goitre/cretinism/hypothyroidism has just been completed with joint WHO~UNICEF support. The country's salt iodization plant has also been completed, and these, together with the iodized oil injection programme, clearly indicate a concerted effort to eradicate the enormous problem of goitre/cretinism. he country faces a number of problems in the maintenance and supply of equipment in the remote areas, especially in basic health units. However, assistance has been provided in the repair and maintenance of electro-medical equipment. As yet, there is no firm system for the development of skilled personnel in this area. Fellowships have been awarded to technicians who, on return, have been deployed in the hospitals. A plan to have a mobile team for the repair and maintenance of equipment has been evolved and submitted to UNICEF and UNDP. Other activities which have been supported include the strengthening of health laboratory services, the diarrhoea1 disease control programme and the training of PHC workers in oral rehydration therapy. WHO consultants were also assigned to assist in designing study protocols for the collection of statistical information on illnesses. A national commission for the IDWSS Decade has been established and WHO, in coordination with UNICEF, has supported the finalization of the Water Decade Plan. External support in the health field has come from UNDP, UNFPA, UNICEF, WFP and WHO. A major project for multifaceted health services development, funded by UNDP and executed by WHO, ended in 1982. For the period 1983-87, another UNDP project has been developed in the areas of nursing, health manpower development, planning for basic services, primary health care, drug selection and management, strengthening of referral and district hospitals, expanded programme on immunization and control of rabies and other zoonoses. Projects in Operation Number (Source of Funds) Title - BHU CHP 001 (R) Country Health Programming BHU SPM 001 (DP/VF) Development of Health Services BHU ATH 001 (R) Promotion of Health Laboratory Services BHU MCH 001 (FP) Development and Strengthening of MCH and FP Services BHU BVM 001 (R) Diarrhoea1 Diseases Control Programme BHU HST 001 (R) Strengthening of Health Information System 3. BURMA The Second People" Health Programme (PHP), which started on 1 ~pril 1982, includes five programme areas with related health strategies in which community involvement and intersectoral collaboration are highlighted. The objective is to continue the integration of health services delivery with a strong PHC programme in support of national strategies for HFA/2000. The implementation of the People's Health Programme has progressed by increasing the coverage of townships annually. The total coverage attained is 187 out of 316 townships. Impact surveys/studies in support of the evaluation of PHC were started. A pilot community household survey on health and health care was completed and lay reporting of morbidity and mortality information has been introduced, Country and programme profiles were updated regularly. Monitor- ing and evaluation systems were strengthened and the health information service is now equipped with a computer system, The PHP is continuing its extension of PHC coverage at community levels. The training of health personnel of vertical programmes to become multipurpose health workers and the deployment of voluntary health workers continued. Community acceptance has continued to help in rapid progress being made in the training of voluntary health workers. The training of specialists and general medical officers in clinical skills and hospital management continued. Intensive care facilities are better equipped with trained staff. With support from the Asian Development Bank, the project for upgrading hospitals for better facilities, to set up a referral system for PHC, became operational. The supply system was strengthened with the expansion of a network of sub-depots and warehouses for storage and the better and timely distribution of supplies and drugs. Repair and maintenance services for electro-medical equipment were extended by the establishment of workshops in hospitals and the training of staff. The services of hospitals of traditional systems of medicine were expanded in Rangoon and Mandalay. The use of traditional medicine in primary health care continued to be encouraged by the training of village health workers. The network of traditional medicine dispensaries is being expanded by ten dispensaries every year. Under the family health programme with special emphasis on maternal and child health, school health and nutrition, 3 600 auxiliary midwives were trained; training of other MCH workers and traditional birth attendants (TBAs) is being given prominence as part of the PHC support programme. Studies were carried out on the training and role of TBAs in primary health care and the detection of high-risk maternity cases. The task-oriented training programme of TBAs was renewed and updated. Ad hoc studies on infant -- and early childhood morbidity and mortality are being carried out. A number of TBAs were selected by the community for training as voluntary health workers (auxiliary midwives). A WHO-funded research project was campleted, including estimates oE the extent and prevalence of malnutrition in much of Burma, and identifying aspects of the national nutrition programme that needed strengthening for increased impact. An excellent nutrition-through-PHC programme has been developed as part of the second People's Health Plan- The Joint WH0,'UNICEF Nutrition Support Programme has pro~rided a major boost to the nutrition programme, and allowed a rapid intensification of inputs such as child weighing, nutrition education, nutrition and diarrhoea surveillance among at least half of the country's population, A measurable impact on malnutrition and mortality is anticipated. Training of various categoriefi of health ~taff and community health workers in VBDC activities continued. Collection of blood slides by VHWs and basic health workers has improved. Although the blood examination rase has also improved, further improvement is needed to achieve satisfactory coverage. A meeting of all state/divisional health directors was held to review progress and to plan activities for 1983, Studies on chloroquine and insecticide resistance were continued. The training of townnhip medical officers in EFT continued. The cold chain has been developed in spite of the limitations ~osed by the irregular electricity supply. Poliomyelitis immunization in the townships of the Rangoon and Elandalay city development areas continued, with the vaccines supplied by the 'Save the Children Fund' of the United Kingdom through WHO. As tetanus toxoid is becoming available in adequate quantities, tetanus imm~~nization of all farmers and workers has started and will continue over the current plan period to achieve maximun coverage. In the leprosy control programme, the BCG cohort studies, the dapsone resistance study and the rifaqicin trial progressed according to plan. Data from the rifampicin trial are being processed, In regard to rural water supply, the construction of deep tube-wells, reconditioning of old wells and the construction of small water supply systems are being carried out. A ~ational Water Committee has been formed, headed by the Minister of Agriculture and Forests. A project for conducting water and sanitation pre-feasibility studies in two major towns and feasi- bility studies in five small towns is under implementation. Baseline data on the water and sanitation si.tuation in 45 000 out of 65 000 villages are being processed. Sanitation activities continued in rural and per1-urban areas. A WHOIUNICEF-supported pilot sanitation project to study the problems of latrine construction has been implemented, and a plan of action for its expansion is being drawn up with WHO'S assistance, The training of various categories of health workers, continuing education programmes and the training of trainers of CHWs were coordinated by the project 'Development of Procedures and Staff ~raining" The project document for the strengthening of the Post-graduate School of Public Health was finalized and was under review by UNDP. Health education activities were continued. A project document on the strengthening of the Health Education Sureail in support of the IDWSSD was prepared and was awaiting clearance. Implementation of the project is expected to start in early 1984. A four-month national certificate course in health education was conducted with WHO assistance. Support was provided t.o the Burma Pharmaceutical Industry through staff development and the provision of equipment for the production and quality control of biologicals. The prodcction of tetanus vaccine and DT vaccines increased in 1952 All the rabies vaccine and about 30 per cent of the anti-sneke venom serurr. continued to be produced in freeze-dried form. Laboratory services improved with the establishment of Type C and Type D laboratories at station and township hospitals. Laboratory training in communicable-disease detection was conducted. The food and drug quality control project was extended for one year with a budget of US$ 608 297 provided by UNDP, In the 1982-85 UNDP colrntry programme a new project was included for the development cf the food and drug control infrastructure, The activities of the United ~atiocs/Rurma Drug Abuse Control Programme included staff training, est.ablish.nent arid management of treatment centres, and laboratory facilities for drug abuse control. Under this programme, the second phase of which started in July 1982, a detoxification hospital and a rehabi1ita:ion centre were opened. A project. docu~nent for conducting, with UNDP funds, research into the standardization and pharinncolcgical and toxicological evaluation of traditional drugs and herbal medicines was finalized and was awaiting clearance for implementation- The cardiovascular diseases project was concentrating on education and expansion of the technical services and faci1i:ies for the prevention, early diagnosis and effective management of major cardiovascular problems. The cancer project is concerned with manpower and the strengthening of the existing radiotherapy centres in Rangoon, Mindalay and Taunggyi and the strengthening of cancer registries in Mandalay and Taunggyi. The UNDP-funded project 'Community-oriented programme for disability prevention ann renabilitation' was started in 1982 and training courses wera cocducted. Appropriate technology plays an important role in developing prosthesis for this programne, which is implemented by PHC workers. A WHO inter-country Co~sultation on Prevention of Blindness due to Glaucoma was held in R-angoon in Piarch 19E3 at which a regional plan of action was formulated+ The :,ye, Ear, Nose and Tkroat Hospital, Rangoon, will be upgraded as a Regional Centre under this programme, A study to assess the incidence of deafness amongst primary school children was conducted and a programme formulated to integrate deafness control into PHC, Intersectoral collaboration in the planning and implementation of IDWSSD acti.vities is promoted by the Xinistry of Planning and Finance. Burma has agreed to participate in the IJNICEF/WHO Joint Support to Governments for the Implementation of PHC IJCHP)? and activities to implement this programme have co~menced. Burma has also agreed to participate in the WHO~UNICEF Nutrition Support program, and a project proposal has been submit:ed to the Steering Committee for funding. The proposal includes nutrition education and services, including a component. for the control of diarrhoea1 diseases. Trojects in *eration --- Number (Source of Funds) -- Title -- BUR CHP 002 (8) Country Iiealth Programming BUR RPD 001 (11: Sealth Research in support of the People's Health Programme BUR SPM 001 (R) BUR PHC 001 (R) BUR WKH 001 (DP) BUR ADR 001 (DP) BUR ATH 001 (R) BUR ATH 002 (R) BUR ATH 003 (DP) BUR MCH 004 (R) BUR HED 002 (R) BUR PHB 001 (R) BUR BVM 001 (VF/FT) BUR EPI 001 (R) BUR VBC 001 (R/VF) BUR CAN 001 (R) BUR CVD 001 (R) BUR EHP 001 (R) BUR BSM 003 (DP) BUR BSM 004 (DP) BUR PTR 001 (R) BUR PTR 002 (DP) BUR HST 001 (R) Hospital Services Management Primary Heath Care and Basic Health Services Strengthening of Health Services in Newly Indus- trialized Areas (West Bank of Irrawaddy River) Training and Rehabilitation of Disabled Supply System and Maintenance and Repair Workshop for Health Equipment Promotion of Health Laboratory Technology Food and Drug Quality Control Laboratory Family Health Development of Health Education Development of Production and Quality Control of Biological and Pharmaceutical Products Leprosy Control/Research Activities Expanded Programme on Immunization Vector-borne is ease Control Cancer Control Cardiovascular Diseases Environmental Health Planning and Management Development of Urban Water Supply Programme Identification Study for community Water Supply and Sanitation Development of Procedures and Staff Training Education and Training of ~ealth Manpower Health Information Services L. 3E?I!)CiWTIC PEOPI,EIS REPUBLIC OF R0RZ.A Health status in the DemocraEic People's Republic of XOrea is reflected. among other things, by a high level of life expectancy at birth (over 74 years) and low infant rcrtality (12 per 1 GO0 Live births). Such a level of heslth was achieirrJ through the adoption of the National Realti1 Policy and its successful implementation during the last few decades. The health policy is based on the "Jucht" idea, wherein "nan" is conceived as the master of nature anti snciety sr~d the mnst precious being in the world. As such, it has becomr the obligation of the State to improve continuously the people's health status so that all. working people live long and kappily in good health, being act<velg involved in all efforts towards better health stat!is and better sacio-eccncrr.ic. condi.tions- During the year, in the context of the natiorral strategies for :%?I, the Democratic People's Republic of Korea adopied certain basic principlns in the implementatign of its !.ealth efforts. These are' (1) to consclidete and further improve the free medical care system that is ~~niversally available in the country; (2) to maintain its Eocus cn the preventive aspects of medicine as enshrined in the Public Health Law; (3) to modernize medical science and technology further by properiy blending the t radit icnal Korean medicine 2-d moder- medicine towards better public health services; (4) to prduce anc deploy health manpower in a planned manner so that they serve the pecple as genuine health worko~s~ devoted t3 the Juche idea, and (5) to participate in the exchange of scientific and techni- cal knowledge with friendly countries and international. organizations such as WHO.. Most of the colmmon comunicable diseases that are prevailing in other Member Countries of the Region have ceased to exist as public health problems in t'he 3emocratic People's Republic of Korea, where the disezse pattern has al-ready ;hanged from that of comunicable diseases to the problems of non-connuni.cable and negeneratjve diseases. The country's target is to increase life expectsncy at birth to 80 years by the end of the present decade. With a growing increase in the population of the aged and with the control of ccmuricable disezses. current health problems centre round diseases such as cancer and other neoplastic conditions, cardiovas- cular diseases, etc, Health faciiities are geared to the provision of comprehensive care to farmers.. industriai workers and mothers and children, as well as tc older citizens, proportion is, as stated above, increasing in tne demogrsphic ccmposition. Thus the health care delivery system envisage? a st,rong t.x~ponent of gerontology and rehabilitaticn. The 1)emocratic People's Repubiic of Korea has been self-sufficient in medical supplies in terns of drugs a~d equi.pment. It is advantageously utilizing the resources of traditional Korean medicine, fully integrated with the modern system of medicine. Moreover, climatic (nature) cure for certain illnesses forms an important aspect of geriatric and rehabilitative care. The country is receiving WHO'S technical cooperation in the nrea of computerization. In this regard hospital and clinic records, health situa- tion and trend assessment, as well as the management information areas will become well organized with the promotion of electronic data processing facilities. In order to improve further the country's capability in dealing with the current health care problems, WHO inputs were provided in areas such as open heart surgery along with anaesthesiology, care of post-operative cardiac surgery cases and emergency cardiovascular patients, improvement of radiological diagnostic methods and radiation safety measures, organization of health services, and further improvement of the traditional system of medicine. In order to meet the increasing requirements of its health care system and its future needs, the ~emocratic People's Republic of Korea is paying attention to the area of research. The Korean Academy of Medical Sciences and other research institutes are conducting various types of research on basic science subjects, clinical medicine, hygiene, pharma- cology, traditional Korean medicine, etc. The Government has identified its needs so as to modernize the material and technical equipment of those research institutions, including electronic data processing facilities. WHO consultants assigned to the country trained national professionals in their respective specialities, in addition to other technical inputs. The Government is laying emphasis on the training of health professionals to improve their proficiency in the English language as a step towards assimilating international knowledge and skills available from other Member Countries. Projects in Operation Number (Source of Funds) Title KRD SPM 001 (R) Strengthening of Medical Care Services KRD ATH 001 (R) Laboratory Sciences and Techniques KRD CAN 001 (R) Cancer Control KRD CVD 001 (R) Cardiovascular Diseases KRD EHP 001 (DP) Environmental Health Protection in Rural Areas KRD RCE 001 (R) Environmental Health KRD MPM 001 (R) Strengthening of Health Manpower Development 5. INDIA In consonance with the Global Strategy for Health for All by the Year 2000, the Government of India expressed its commitment by placing in October 1982 its Statement on ~ational Health policy before Parliament. The policy deals realistically with various dimensions of health - political, cultural, socio-economic, nutritional, environmental, educational, preventive and curative - all as part of primary health care. It outlines the required reorganization of the health services' infrastructure and overhaul of the existing approaches to the education and training of medical and health personnel, relevant to the actual needs and priorities of the community, ensuring the involvement and participation of the community and voluntary organizations. It also sets out the specific goals to be achieved by 1985, 1990, 1995 and 2000 in pursuance of the national commitment for the attainment of the goal of HFA/2000, Similarly, a draft National Medical and Health Educa~ion Policy is being evolved, which takes into account the current phenomenal growth of the health services and the required reform of undergraduate and post-graduate curricula and training to provide these with a community bias, along with a balanced growth and placement of medical: paramedical and other health personnel, and inter-relationships and interaction between the allopathic, Indian and Homoeopathy systems of medicine in the delivery of primary health care. The Government intensified its long-term comprehensive health plan in the context of the Prime Minister's 20-Point Programme for Total Development, Strict monitoring is being maintained at the Centre and in the states on the basis of specific indicators and targetted goals in respect of the national priority programmes of family welfare; augmentation of primary health care facilities; acceleration of maternal and child health care and nutrition programmes; control of tuberculosis, leprosy and blind- ness, and the provision of safe drinking water supplies and improved sani- tation, all with special attention to underserved and underprivileged areas. WHO continued its collaboration in the above-mentioned endeavours. Mechanisms were developed for a joint Ministry of Health and Family Welfare/ WHO programme planning, implementation and monitoring of the inter-related WHO activities. These included the establishment of a national coordination committee under the chairmanship of the Secretary, Health; a steering committee under the Additional Secretary, Health, for follow-up of the decisions of the Coordination Committee, and mini-task forces for detailed programme formulation and monitoring of the WHO collaborative activities. The Government also considered how best it could increasingly support TCDC activities between countries of the Region and India, initially in the priority areas of health manpower development, expanded programme on immunization, and control of diarrhoea1 diseases. To help strengthen the development of the integrated health infor- mation system, in addition to supplies and equipment, a grant was provided to the Central Bureau of Health ~ntelligence. A workshop on "Uniform system of medical records and reports in district hospitals" was supported. Consultants were assigned to assist the All India Institute of Hygiene and Public Health, Calcutta, in health information systems, health economics, and planning and management. In collaboration with the health services of Gujarat, the National Institute of Health and Family Welfare, New el hi, and the Indian Institute of Management at Ahmedabad, WHO supported an innovative approach to manage- ment training, addressed to district health officers and designed to facili- tate the application of management principles within the working situation of their district health services, A national-level follow-up workshop on health economics and management was held to evaluate the group educational activities already conducted. In regard to health manpower development, WHO collaborated in the upgrading and strengthening of the network of national teachers' training centres for various categories of workers; setting up of more centres for the training of trainers; preparation and printing of training materials for health workers, and feilowships and group educational activities in support of national priority programmes. It participated with the Medical Council of India in educational planning. High priority continued to be given to the promotion of family planning as a people's programme on a voluntary basis. ~hrough its Special Programe of Research, Development and Research Training in Human Repro- duction, WHO directed its collaboration to the development of a new birth control technology, assessment of the safety of existing contraceptive methods and techniques, and approaches to the delivery of family planning related to their safety, adaptability and efficacy. Support was provided to the WHO Collaborating Centres for Research in Human Reproduction in New Delhi, Chandigarh and Bombay. In the field of maternal and child health care, WHO collaboration, in conjunction with UNICEF, covered neonatology; high risk infants; integrated MCH/FP curriculum development for an integrated package of maternal and child health, family planning and communicable diseases control with the primary health care approach; establishment of paediatric and obstetric units in district headquarters' hospitals; urban family planning and KH centres; workshops for state-level MCH officers, and supported by the joint WHO/UNICEF expanded programmes on immunization, diarrhoea1 diseases control, anaemia and other nutritional deficiencies. Studies on the risk approach in MCH/FP care were supported in Pune. Support was also extended to state nutrition divisions; the Nutrition Cell of the Directorate General of Health Services; the National Institute of Nutrition, Hyderabad, and the All-India Institute of Hygiene and Public Health, Calcutta, in the training of personnel, in research and development, in the production and distribution of nutrition education material, and in group educational activities, WHO/UNICEF support for goitre control included the installation of iodization plants in the states, award of fellowships for state nutrition officers to observe developments in other countries, and the organization of workshops in endemic states. An important element of WHO'S programme was increasingly directed to health education as part of national programmes, and to the evaluation of community involvement in primary health care, With WHO and SIDA collabora- tion, the Government launched an intensive pilot project on school health services in 25 blocks in 17 states and 3 union territories. Five workshops were organized by the Central Health Education Bureau with WHO collaboration with a view to developing need-based health education material. To strengthen the epidemiological surveillance of communicable diseases on a regional basis, formats for data collection, operational details of the project field area and the curriculum of training were formulated. WHO collaborated in the training in epidemiology at the post-graduate level at the All-India Institute of Hygiene and Public Health, Calcutta, and at the intermediate (district) level at the Natlonal Institute of Health and Family Welfare, New Delhi. The Organization continued to collaborate with the National Malaria Eradication Programme in planning policies and strategies, and in the imple- mentation and evaluation of antimalarial activities. To control the spread of P.falciparum infection, the National Malaria Eradication Programme continued to receive assistance froa SIDA and hX0. This programme was in operation in 112 districts in six zones. Applied research activities were undertaken in two zones. A considerable number of training and orientation activities were assisted at the National Institute of Communicable Diseases, Delhi. The Special Programme for Research and Training in ~ropical Diseases provided support to various research projects in vector and drug resistance, chemotherapy and vector biology and control. A major thrust in the revised strategy of the National Leprosy Eradication Programme brought about an intensified drive for the detection and treatment of leprosy patients, particularly infectious patients under the multi-drug regimen of treatment. his treatment regimen was implemented in two districts, Wardha (14aharashtra) and Purulia (West Bengal), while four more districts were taken up under this scheme with effect from 30 January 1983. SIDA, in association with WHO, provided technical and material support to the programme through consultancies for evaluation, group educatioilal activities, and supplies of drugs and equipment. A WHO consultant reviewed the training programme for medical officers and paramedical personnel in the light of the new leprosy multi-drug regimen control strategy in endemic States. WHO continued its collaborative research with Indian scientists in the chemotherapy, immunology and epidemiology of leprosy. In tuberculosis, support continued to be given to the National Tuberculosis Institute, Bangalore, in its major responsibilities for training and evaluation of the national control programme Training included courses for and reorientation of teachers of medical colleges, Assistance was also provided to the Tuberculosis Research Centre, Madras, for its research studies on drug regimens; for a course on the treatment of tuberculosis under programme conditions with special emphasis on short- course regimens and their applicability in the field. A consultant assisted the Tuberculosis Research Centre in reviewing progress in the laboratory aspects and in the further development of the research programme in the microbiology and imunology of tuberculosis. The follow-up studies on the BCG Vaccine Trial i.n the Chingleput area continued with WHO collaboration. Collaboration also continued to be extended to the National Expanded Programme on Immunization, particularly in the promotion of integrared immunization services Sample surveys were carried out to collect baseline data on poliomyelitis and neonatal tetanus. A measles immunization study was undertaken by a number of medical colleges to determine the need for and the administrative feasibility of introducing measles vaccine in the routine immunization services. A meeting of principal investigators of the measles immunization project was held in April 1983. These activities were supported from WHO funds. The ~affkine Biopharmaceutical Corporation, Bombay, continued to receive assistance in the production of oral polio vaccine and the Central Research Institute, Kasa~li, in neurovirulence testing of the batches produced Since October 1982, the Diarrhoea1 Diseases Control Programme has become a national programme. A Diarrhoea1 Diseases Control Cell was estab- lished at the ~irectorate General of Health Services, with responsibility for programme planning and evaluation, training of manpower, research, logistics and supplies' Guidelines were developed to help the states and. union territories in the implementation of :he Programme. primary health centres, sub-centres and village health guides received oral rehydration salt packets along with other essential drugs. Research on the etiology. pathogenesis and therapy of diarrhoea1 diseases caused by various agents, primarily Escherichia coli, cholera vibrins and rotaviruses, along with - operational research on rehydration therapy as part of prknary health care, was supported by WHO in association with the Indian Council of Medical Research and government laboratories and i~stitutions. The Sexually-transmitted Diseases Control Programme decided to establish four regional teaching-cum-training centres, four regional reference laboratories, and four regional survey-cum-mobile units WHO assisted in training courses, awarded fellowships, and helped with the procurement of laboratory equipment. Collaboration was extended to the National Committee on Zoonoses Control, the National Institute of Corn~nunicable ~iseases, the Indian Veterinary Research Institute, Izatnagar, and other institutions under the Ministries of Health and Agriculture, and to state animal husbandry depart- ments in the conduct of training co.Jrses and the preparation of manuals, and in a project for the control of canine and human rabies in the elh hi Administration area. Progress xas made in the WHD/UNDP-supported inter- country project in human diploid-cell anti-rabies vaccine at the Pasteur Institute. Coonoor. Assistance was given in the establishment of a network of surveil- lance centres, improved diagnostic facilities and research on the etiologi- cal strains ana patnogenesis of liver diseases and cancer. A four-day workshop for state public health officers conducted at the NICD and meetings of the directors of five national surverllance ceritres were also supported The hatlonal Guineaworm Eraa~cation Prograwe continued to receive support in all aspects of planning, researcn and evaluation through inter- national and national consultants aud the holding of meetings of the public health engineers ar'd health administrators concerned from the aeven endemic states. biHO assistance in the form of laboratory material and equipment, grants to conduct special studies and serninars/courses, and consultants to help with courses and research activities, was provided to strengthen biomedical research activities at various instituti.ons under the ICMR. Fellowships were awarded for training in research in latest techniques in the respective specialities. The National Progracme for tne Control of Bli-ndness was intensified under tne 20-?oint Programme- WHO provided assistance in the field of community ophthalmology, development of specialities in advanced diagnostic and treatment technologies management informt ion systems ; and training caurses for ophthalmic assistants at the Rajendra Prasad Centre of O?hthalmi.c Sr:ierlres. All. India Institute of Medical Sciences, New Delhi. Support was given to a rneetiilg of national experts called to review the strategy and. developments in the nati.or.al programme. As part of the Government's activities in cancer research and in the setting up of cobalt therapy unj.ts and cancer detection centres, supplies and equipmen: were provided. Two consultants were assigned to the ICMR to evaluate epidemiological studies on cancer and review the working of cancer registries and early cancer detection centres in the country. A nurse educator consultact assisted the Cancer Department of Safdarjung Hospital, New Delhi, in oncology nursing; and formulated guidelines for the develop- ment of patiect care standards. WHO supported a number of cardiology instit.utions/departnent.s and intensive care units for the management of ischaemic heert diseases with grants, fellowships and equipment. Consultants collaborated in workshops on the epidemiolcgicaL, microbiological and irmnunologiral aspects of the control of rheumati.~ fever and rheumatic heart diseases ar :he Pea:-graduate Institute, Chandigarh, and Lady Hardinge Medical College, New Delhi; also on lipids and lipoproteins and diseases at the. AIIklS, New Delhi. Gtoap educational activities were assisted and a consultant helped the Institute of Genetics, Hyderabad, with its multi- disciplinary research activities in genetics. Another consultant assisted a national workshop at the Elaillana Azad Medical College, New Delhi, on new knowledge on satimic:obial resista~ce and therapy. Support was given to . . four Crainrng courses in the area of health laboratory services. A workshop on abdominal u::rasonFc techniques was conducted. W@ assistance was provided to the central institutions in mental health at Ranchi and Bangalore in various areas of expertise, as also in the development of coinrnunity mental health programmes at state level. The Organlzaticn supported the establishment of a training and demonstration centre for comunlty-oriented disability prevention and rehabilitation at both Safdarjung Hospital, New Delhi, and at the Medical CoLlege in Trivandrum, A short course on orthopaedic ngrsing and rehabili- tation at the Jawaharlal Institute of Poat-graduate Medical Education and Kesesrch, Pondicherry, was also assisted, WHO coliaborated tn planning and coordinating the development of community water supply and sanitation in rural and urban areas. The WHO/ World Bank Cooperative Programme provided inputs for the preparation of sector memoranda as well as :he World Bank Project Handbook. Several courses and study tours were specially designed to meet the needs of senior sanitary engineering/envi:onlnenta? engineering personnel. A consultant assisted the Deparcment of Environment in air pollution control. Another was assigned to Goa to study surface iron-ore mines. Projects in keration - Number (Source of Fuqds) Title - IND CXP 00: (R) Country Health Programming IND RPD 001 (R) Eiomedical Research IND SPM 001 !K) Health Economics and Management IND PHC 001 (R) IND ADR 001 (R) IND ADR 002 (R) IND ATH 001 (R) IND ATH 002 (R) IND ATH 003 (R) IND ATH 004 (R) IND ATH 005 (R) IND MCH 003 (R) IND NUT 005 (R) IND HED 005 (WVF) IND MNH 002 (R) IND PHB 001 (R) IND PHB 003 (R) IND ESD 001 (R) IND ESD 003 (R) IND MPD 001 (R/VF) IND BVM 001 (R/vF/FT) IND BVM 002 (WVF) IND BVM 003 (R) IND BVM 004 (R) IND BVM 005 (R) IND SME 001 (VF) IND EPI 001 (R) IND PBL 001 (R) IND CAN 001 (VF) IND CAN 006 (R) IND CVD 002 (R) Strengthening of Community Health Services Medical Rehabilitation Prevention of isa ability Related to Accidents Appropriate Technology for Health Promotion of Health Laboratory Services and Health Laboratory Technology Laboratory Quality Control and Standardization Virological Techniques Radiation Health Protection Strengthening of Maternal and Child Health Services Nutrition Programmes Development of National Health Education Services Mental Health Quality Control of Pharmaceuticals and ~iologicals Technology in Vaccine Production Epidemiological Surveillance Port Health Malaria Eradication Leprosy Control Tuberculosis Control Sexually-~ransmitted Disease Control Programme ~iarrhoeal Diseases Control Programme National Surveillance Centre for Viral ~epatitis National Smallpox Eradication Programme Expanded Programme on Immunization Prevention of Blindness Cancer Control Pilot Project, Tamil Nadu Cancer Control and Prevention Cardiovascular Disease Control IND ORH 002 (R) IND EHP 001 (R) IND BSM 005 (R) IND RCE 001 (R) IND FSP 002 (R) IND PTR 001 (R) IND EDS 001 (R) IND EDS 002 (R) IND EDS 003 (R) IND HST 001 (R) IND HST 002 (R) Oral Health Assistance to National Environmental Engineering Research Institute, Nagpur Community Water Supply and Sanitation Environmental Pollution Control Food Standards Programme Training of Basic Health Workers Medical Education and Training National Medical Library Nursing Development Strengthening of Health Statistics Services Development of MedicalIHealth Records in Hospitals 6. INDONESIA Indonesia's national health policy, which has the aim of achieving the goal of HFA12000, is rooted in the constitutional provision, the 1960 Health Law, the Guidelines of State Policy formulated by the elected People's Consultative Assembly for five-year development plans since 1969, and the Guidelines for the Prospective Long-term Socio-Economic Development Plan until the Year 2000. To achieve HFA the Ministry of Health has formulated the National Health System (SKN), which includes health policy principle, principles of the Long-term Health Development Plan and the basic structure of the National Health System at all levels through the primary health care approach, Throughout the year, 15 service and broad support programmes for the Long-term Health Development Plan were formulated. The policy principles of the National Health System were incorporated in the broad outline of State Policy for ~epelita IV which was approved by the ~ational Consultative Assembly in March 1983. Based on this, Repelita IV is being formulated with WHO participation. The per capita health expenditure from the Ministry of Health budget increased consistently throughout Repelita 111, from US$ 1.57 in 197911980 to about US$ 3.34 in 1982/1983. The World Bank has estimated that per capita health expenditure from all sources including the private sector amounts to about US$ 13.4. The total Ministry of Health budget for the five-year period of Repelita 111 in 1978 of Rp.667.6 billion has in fact risen to Rp.1.121 trillion, which is almost double the initial allocation. The pioneering exercise initiated last year for closer GOIIWHO collaboration for the further development and accelerated implementation of the national policies, strategies and plans of action for HFA to the mutual benefit of both partners and other Member States continued. A protocol is being finalized in which the innovative mechanisms of WHO technical coopera- tion at the country level are included. This innovative approach was to be implemented starting in 1983. The national managerial process for health development, including the formulation and implementation of long-term, medium-term and annual plans, continued to be strengthened. Mid-term programme reviews for Pelita I11 were completed as an input for ~epelita IV formulation. The committee on manpower development and special working groups continued to fornulate a long-term health manpower plan with a systems approach. The priority being given to the expansion of the health infrastruc- ture in support of the community-based Village Community Health Development (PKMD) Programme continued. The number of health infrastructure facilities has increased from 1 637 health centres in 1970 to 5 153 health centres, 12 386 sub-centres and 1 979 mobile health centres in 1983. One hundred and three health centres in geographically difficult areas are being equipped (53 by the Government and 50 by the World Bank) with hospital beds. The PKMD Programme has expanded to cover selected sub-districts and villages in all 27 provinces of the country. The Government-supported PKMD Programme now covers 1 360 villages in 323 sub-districts, and an additional 400 villages have implemented PKMD programmes through their own initiative and resources. Emphasis continued to be laid on strengthening the family health programme, especially the delivery of a comprehensive family-oriented programme at the health centre level. Training of traditional birth attendants (TBAS), sub-centre midwives, and health centre and NCH staff at kabupaten, provincial and central levels continued. School teachers are being trained as PHC workers and as local coordinators of the PKXD in their 'cmmunities which also include prokesas (village volunteers) and TEAS. Programme activities included: training of teachers and school health coordinators, development of training materials and manuals, case-finding and treatment, revision of the school health curriculum and screening of handicapped children. Training ~f all categcries of health manpower team, especially from health centres, hospitals and provincial levels, through in-country and regional study tours and fellowships continued. The activities for the prevention and control of protein-energy malnutrition, iron-deficiency anaemias, xerophthalmia and goitre continued to expand. A model of a nutritional surveillance system is being implemented in four provinces, A st'idy on breast-feeding patterns was completed. Medical care services continued to be upgraded through the expansion of hospital facilities, increase of manpower and provision of drugs and equipment, Development of a referral system from the PHC level to health centres and sub-centres and to peripheral, provincial and teaching and specialized hospitals was being undertaken. Programmes for the care of the aged, disability prevention and medical rehabilitation with a multi-sectoral approach were initiated and data from the WHO-assisted national health survey on physical, mental and special sense organ disabilities were being analysed, The oral health programe includes dental services to school children, strengthening oral surgery and dental laboratory services in hospitals, preparing dentists, dental nurses and dental technicians, conducting dental surveys, and developing an information base for the planning, management and evaluation of dental health services, The mental health programme was being integrated into health centre services and in general hospitals ~ttention is also being given to the training of different categories of health personnel and to improvement of the management of mental hospitals. The Ministry of Health has, with the coilaboratlon of WHO, formulated a comprehecsive National Drug Policy, Based on the project proposal prepared by a WHO consultant, the Golrernment signed an agreement with the Government of Japan to establish a drug referral quality control laboratory and strengthen several provincial laboratories in order to ensure the quality of drugs marketed in Indonesia. WHO also collaborated in the preparation of a tender document for the establishment of a new goverrment-owned essential drugs formulation plant. Consultants on drug utilization have visited Indonesia to investigate the possibility of undertaking a drug utilization study which is an essential tool for the managerial process. The ASEAN TCDC project on pharmaceuticals is Deing implemented as scheduled. WdO continued co support tne commur~~cacle-disease control programme, ~pidemiological surveillance is being strengthened at all levels, the activities being directed to early reporting of cases, deaths and epidemics, their investigation and the provision of preventive and control measures for all diseases under the Irlternatiooal Health Regulations and those covered by the National Epidemic and Quarantine Act. Training activities for programme expansion were planned and supported by the WHO Regional Training Centre for Diarrlloeal Diseases based in the Directorate General of CDC in Jakarta. Reaearch activities included finalizing protocols for studies in the areas of epidemiology and microbiology. Malaria continued to be a major public health problem, especially in the outer islands. The Fourth Indonesia-Malaysia-singapore Border Malaria Coordination Meeting at Bandung in November 1982 and the country's parti- cipation in the Ninth South-Kest Pscific Malaria Conference at Sydney in February 1983, as well as the group educational activity for health-centre medical officers of West Nusa Tenggara in November i982 were supported by WHO. The US AID-assisted malaria project in Ti.mor progressed satisfactorily. Negotiations oetweerl tile Government and the World aar~k for initiating a health project with a malaria control component in three provinces of Sulawesi were concluded. Besides routine and special anti-nalaria measures, operational field studies on alternative vector control measures, drug trials and studies of the impact of popuiation movements were also under- taken. Monitoring of F.falciparum drug response was extended to hitnerto uncovered areas such as Sulawesi and haluku and expanded in areas already covered, A consultant assFsted in assessing the tuberculosis control programme arla estimated tke prevalence and Incidence of tne disease for the perrod 1960-2000 uriiizing a. mathematical nadel. This review was used for develop- rng a Long-term plan. Case control studies oil the efficacy of BCG were carried out. The programme for the control of sexually-transmitted diseases and yaws was assisted by two consultants. In addition to the monitoring of penicillin-resistant gonococcal infections, reorientation cf the programme to prevent complications in the female popuiation i.s being considered. The expanded programme on imunization was extended to cover 2 345 sub-districts with a population of over 100 million. An overall evaluation of the programme was conducted by a joint Governrcent/WHo/UN~CEF/US AID team. The prograume is being reoriented for closer coordirlation and colla- boration with other health prograumes serving the same target age groups of mothers and cnildren as MCH an6 falnlly planning. A natiorlal advisory board on immunization has been set up by the Minister of Health. DT and TT immuni- zation to cover school children nas been planned. A consultant on cold chain reviewed the performance of cold rooms. The trial of solar-energy refrigerators is contir~uing. Two consultants reviewed national vaccine quality control policies in the framework of WHO/UNDP support. A study protocol was prepared for community part~cipation. Leprosy surveys are being conducted in North Sumatra, West Nusa Tenggara and Souctl-East Sulawesi, and preparations for random surveys in Aceh and South Kalimarltan are tel1,g rcade. The ~ational Leprosy raining Centre in Ujung Padang continued its training and refresher training activities, Implementaticn of the national vector biology and control programme continued. Training or six candidates in M.Sc.(Entomology) continued at the University of Bogor, and 51 assistant entomologists drawn from Java-Bali and the outer islands were given training in vector-borne disease control at group educational activities in order to meet manpower nefds at the central, provincial and field levels. National courses were developed for training in epidemiology with emphasis on field training, in addition to the M.Sc. in epidemiology at the Faculty of Public Health which started in 1983. The Organization provided support to activities in the :ields of cancer, cardiovascular diseases, radislogical health m6 accidents. The Centre for Research in Cancer and Radiology serves as :he Won-Communi.cable Diseases Research Centre. Support was provided for drafting a national plan of action for the prevention of blindness, and a national workshop was ~rganized, A pilot project on primary eye care was started in 6a?i Province. A survey of eye morbidity was conducted in selected provinces and the results are being analyaed. Training activities initiated earlier by WHO continued. Quality assurance and control of pharmaceuticals and 5iologicals continued to be carried out by laboratories of the Directorate General of Food and Drugs, the Biomedical Research Centre, the National Institute of Health Research and Development, as well as Eio-Farma. The Water Supply and Sanitation Decade programme has been placed on a sound footing The foraulation of the IDWSSD plan was supported by WHO. Technical cooperation was also extended for the ccnduct of rural water supply feasibility studies, training of environmental health manpower and manpower planning, end the development of socio-behavioural and health education programmes in relation to community water supply and sanitation. A sector review of rural water supply was carried out. Health professionals were actively involved in the water and sanitation decade programme. Two consultants on food safety assisted the Directorate of Food and Beverages Control and the Directorate of Hygiene and Sanitation in organiz- ing and conducting a training course. In addition to the computer centre in the Bureau of Planning, two subsystems are being supported. A comprehensive nospital reporting and statistics subcentre is in operation and another subsystem for health centre reporting and recording incorporates data on ail tne activities of these centres. A WHO mission reviewed the health manpower deve;o?ment prograrme of the Long-term Health Development Plan and made recommendations for streng- thening it. WHO support was also provided in rne formulation of the environmental health manpower component of the natlortal Winking Water Supply and Sanitation Programme, 1981-1990- The Centre for ducati ion and Training wa; suppcrtzd in its efforts to develop and inpiement various nursing educatior~al programmes.. The four nurse teacher training schools continued the training of PK teachers through regular one-year courses and six-week updating courses in selected clinical nursing specialities- The supplemental and re-training courses for nurseslmidwives who were grc3uates of the old pre-PK programme, the post-PK clinical nursing specialization programme, and the "crash programme to pro- duce assistant paramedics" were continued. A natianal nursing workshop held in 1983 fornulated a definition of the rcles. functions and responsibilities of nursing personnel, a pattern of education and leveis of position for nursing personnel and a proposed structure for the management of nursing development efforts in. the country, Another national workshop approved a new pattern of education for health personnel, including nursing. Based on this, the future nursing educsticn progranl~~~es envisaged are niploma 3 (3 years' education from senisr high s-.hool!. Diploma 4 (one-year clinical nursing specialization) and Sarjane-l. (university degree progranune). WHO technical cooperation continued to support the Faculty of Public Health and the Consortium of Health Sciences A short-term consultant assisted in plann~ng and implementing the S-1 (baccalaureate)-level degree programme in community health nursing while long-term WHO staff supported the implementatio~ of the S-1 and S-2 (master)-level degree programmes in environmental health. The long-term staff prcvided, in addition, technical collaboration in health manpower planning. formulation of a proposal for UND? support in healtb manpower development for the Drinking Water Supply and Sanitation Decade Programme and in the cocduct of a training seminar on investment planning in water supply and sanitation WHO continued to support the National Institute of Health Research and Development and its specialized research centres. The Institute is the focal point for the national scientific information network providing scientific and research informati.on for health development' Assistance was continued for strengthening the development of research manpower, provision of a computer and other equipment and the strengthening of research manage- ment. Technical cooperation was also extended for strengthening the opera- tional capabi.lities of the ~ational Scientific Information Network and the development of more effective collaboration with the universities. WHO'S collaborative programme in Indonesia was being implemented with many projects and inputs firlanced by other united Nations agencies in addition to those funded by bilateral aid. Close contacts are maintained witn these agencies and their miss: 3 ons . Projects in Operation ---- Number (Source of Funds) Title IN0 CAP 001 (R) Country aralth Pr~~gramming IN0 RPD 001 (R; Strengthening of Heaith Research and Development Capabilities IN0 SPM 001 (R) Health Services Development IN0 SPM 003 (DP) Strengthening of Health Services (Province of 1rian Jaya) IN0 PHC 001 (R) IN0 PHC 002 (R) IN0 ATH 001 (R) IN0 HSR 001 (R) IN0 PPF 001 (R) IN0 HED 001 (R) IN0 MNH 001 (R) IN0 ESD 003 (R) IN0 MPD 001 (R) IN0 BVM 001 (R/VF/FT) IN0 BVM 002 (VF) IN0 EPI 001 (R) IN0 ORH 001 (R) IN0 EHP 001 (R) IN0 BSM 004 (VF) IN0 BSM 005 (DP) IN0 BSM 006 (DP) IN0 FSP 001 (R) IN0 MPM 001 (R) IN0 PTR 001 (R) IN0 PTR 002 (R) IN0 PTR 003 (DP) IN0 PTR 004 (DP) IN0 EDS 001 (R) IN0 EDS 002 (R) IN0 HST 001 (R) Health Care Delivery in the Context of primary Health Care Special Collaboration on Health for All Appropriate Technology for Health Strengthening of Health Services Research and Develspment capabilities Maternal and Child Health in the Context of Family Health Health ducat ion Strengthening of Mental Health Services Strengthening of Epidemiological Surveillance and Control Malaria and Vector Biology and Control Programme Bacterial, Viral and Mycotic Diseases Leprosy Control Expanded Programme on Immunization Dental Health Services Development Promotion of Environmental Health Rural Water Supply for Central Java Province Rural Water Supply, Nusa Tenggara Timur (NTT) Rural Water Supply, South Sulawesi Food Safety Health Management Training Post-graduate Medical Education in Public Health Nursing Education and Services Nursing Manpower Development Training in Pre-~nvestment Planning in Community Water Supply Undergraduate Medical Education Training in Hospital Nursing Management Strengthening of Hospital and Health Centre Statis- tics in the Context of National Health Information System Development 7. MALDIVES The national strategies for Health for All, formulated as a part of the country health programming exercise, were reviewed and updated. The country health programme enunciates the Government's policy of equitable distribution of health resources. The national plan of action to implement the strategies has been developed. In an attempt to strengthen the adminis- trative set up for implementing the action plan, the national planning agency was upgraded as the Ministry of Planning and Development; the Ministry of Health has also been strengthened. In order to achieve the full participation and involvement of the population in the implementation of HFA strategies, a public health team led by the Minister of Health visited 10 atolls in the north to conduct meetings of public, atoll administration and health workers. The programme is continuing so as to cover the rest of the country. Allocation for the health budget continued to increase. construction work .on the second Regional Hospital at Seenu Atoll made progress and the foundation of the third Regional ~oapital at Raa Atoll was laid. Construc- tion of a health centre at Maamigili at Ari Atoll was also begun. The existing recording and reporting procedure was studied and a new recording-cum-reporting format for both family health workers and community health workers has been developed. WHO provided technical co-operation to facilitate identification of the support required by the existing national PHC programme at its mid and peripheral levels. A plan of work for the country for 1983 and 1984 was prepared. The specific areas identified for support included (i) training of trainers and middle level PHC managers, (ii) situation analysis and development of simple PHC monitoring and evaluation system, and (iii) development of a centre for PHC services, training and research. A short-term consultant in engineering was provided to the Government Hospital, Male, to repair the X-ray machines of the hospital. Surgical and medical treatment of ENT under the Prevention of Deaf- ness programme was provided at the Government Hospital, Male, through consultancy services. The development of health laboratory services received further impetus. A project document to strengthen laboratory support at all levels of health care delivery has been prepared, which also includes development of a nucleus laboratory. TCDC activities were further promoted by identifying the needs in the three designated areas, namely, (1) diarrhoea1 diseases, (2) health manpower development, and (3) immunization. The national health activities received support and collaboration from UNICEF, UNDP, the International Human Assistance programme, Damien Foundation, etc., in addition to WHO. The Organization, through its regular programmes, continued to provide assistance in such service areas as health manpower training, prevention of blindness, ENT, nursing services, family health and nealth educatio;l, promotion and development of primary neaith care services, EPI, health ir~formation system devel.opment, contiol of malaria and leprosy, training of national staffl and water and sanitation. The family health education prcgramme nas been reviewed and plans are under way to conduct a feasibility study on maternal and infant mortality and morbidity. Tne study will identify specific areas wnich would require improvement of strategies r family nealth. It is planned 20 undertake operational research to assess the extent of community participation in family health service delivery. A longitudinal pi1,ot study to measure the prevalence races of malnutrition was conducted in Seen12 Atoll. Tile data obtained from the study would be utilized for establishing longitudinal surveiliance capabllicy. Following a Workshop on health Educatior. Communications organized in August 1982, a programme on public information and education for health has been developed by UNICEF and WHO. The programme provides for collaboration in developing support conmunicaticn activities, school health education, training for health raucation, preparation of learning resource materl.al and extension of health ed..ication to the islands. Following an assessment of the problem of blindness in Maldives, and at the request of the Government, a contractual services agreement was entered into between tne Director, hrvind Hospi.ta1, Madurai (India) and WHO (as the Executing Agency) in December 1982 for the organization of an eye camp project in a group of atolls. The first eye camp in the history of Maldives was organized in one of the remote atolls in the north at the beginning of 1983, screening a total of L 312 patients including 532 school children. Altogether 245 operations were performed and sight was restored to 171 blind persons. Tnis pro,ect was organized with the support of the International Agency tor the Prevention of Rlindness, mobilized through the Br~tish National Colmnittee for the Prevention of Blindness. It will serve as a orer runner to the establishment of a permanent infrastructure for a programme on prevention of bll.ndness. Training programnes for com~xnity-health workers, nurse-aides and foolumas contifiued, Activities aimed at improving the design of the curri- -- culum for preparing middle-ievel and peripneral workers, the teaching/ learning process of teachers and the co~mnunication skills of student health workers, and establishing a system of monitoring and evaluating the work performance, including contiming education of trained health workers, were undertaken, Malaria control activities, integrated with those of primary healtn care, made notable progress with the intensification of spraying operations, surveillance of malaria cases and treatment of patients, During the period under review, a total population of 12 241 was covered with DDT resldual spraying and 142 350 by anti-nlalarie treatment. The total number of blood slides examined was 65 543 with 31 positives (P.vivax), giving a 0.05 per -- cent slide positivity rate and an API of 0.2 per thousand. Case-finding surveys for leprosy and tuberculosis, case-holding and treatment, and examination of household contacts during supervision trips continued. Cornunity health workers supervised the treatment of patients in the atolls, The multiple-drug therapy for leprosy is being introduced gradually in Kaaf Atoll, Trlese activities were supported by tne Damien Foundation and WHO. In regard to immunization, which made flirther progress, during 1982 (January to Decemberj a total of 3 030 BCG and 9 231 measles vaccinations was given to children of various ages. DPT, polio and DT vaccines were also given Tetanus t8,xoid was given to pregnant women, women of child bearing age and other adclts bring the year an epidemic of diarrhoea occurred, affecting 102 out of 202 islands of the country. The entire government machinery was alerted and kept at the disposal of the Epidemic Control Committee. The intensive government measures, complemented by extensive support from WHO and other agencies of the United Nations, made it possible to contain the scourge. 'WHO assistance was also provided in drawing up a national programme for the control of diarrhoea1 diseases. Chlorination with bleaching powder, strengthened during the diarrhoea epidemic for ensuring safe drinking water to the people, was continued. Activities relating to the construction of Latrines and rain-water tanks through the United Nations Capital Development Fund (UNCDF) and UNICEF aid also made progress Under the UNCDF project construction material for latrines and fibreglass rain-water tanks have so far been supplied for 30 islands, Sixty water tanks and two latrine units were installed in the atolls and two steel tanks for water storage were installed in Male. In addition. 42 UNCDF-supplied fibreglass ram-water tanks were erected in Maie and the atoils, The national plan for IDWSSD was prepared, and a similar scheme for Male was revised and approved. The Government was active in mobilizing external resources for implementing the Decade plan, in order to meet the current resource gap. As a major element of primary health care in Maldives, the Decade plan and its implementation will play an extremely important role in implementing the country's HFA strategy. Projects in Operation Number (Source of Funds) -- ~itle -- MAY SPM 001 (RIVF) Public Health Administration MAV MPD 001 (R) Malaria Control MAV BVM 001 (VF) Leprosy and Tuberculosis Programme bl4V BSM 001 (R) Water Supply and Sanitation MAV PTK 001 (DP) Training of Auxiliary Health Personnel MAV PTR 003 (DP) Fellowships (Medical Education - on-comunicable is ease Prevention and Control) MAV FTR 004 (DP) Health Nanpower Development 8. MONGOLIA A special intersectoral commission at the State Planning Cornittee was set up in May 1982 by a Government Decree. The Health Minister is the Chairman of this commission and its members represent other sectors: ministries of communal economy, water supply, agriculture, and consumer goods production, the State Planning Cormnittee, the Central Statistical Bureau and the Committee of Science and Technology. This commission has been created to deal with the implementation of the National HFA Strategy. It is to review periodically the HFA strategy and plan of action documents and identify the contributions of other sectors in the health development of the cauntry. The Commission has formulated its terms of reference and drafted a plan of work. The Government has drawn up a long-term plan for health services development up to the year 2000. The National HFA Strategy has been prepared on the basis of and in conjunction with this long-term plan. Some progress has been achieved in implementing the National HFA Strategy, For instance, the network of health institutions expanded during the period 1981-1982 by 6 per cent. The number of doctors and paramedical personnel employed in the national health services increased by 6.2 per cent. Financial allocations for health have gone up by 8 per cent. A survey of the national health status has been conducted in urban areas covering a population of about 22 000, The survey also covered a rural population of about 4 000. Altogether about 200 000 out-patient visits are to be studied and 40 000 persons will be subjected to direct medi-cal examination by teams consisting of doctors of twelve different specialities. The data gathered during the national health survey are being pro- cessed by computer. The study will be continued in the rural areas including Ih U1 somon of Huvsgul aimak, During the last two years nine OPD visits on an average have been registered per person per annum. As a result of the efforts undertaken, the child mortality rate has declined by 9 per cent and the infant mortality rate by 1.8 per cent. The Finance and Health Ministries have jointly reviewed the health budget and increased, since January 1982, the budget allocations for the development of out-patient and specialized medical services. The annual health budget has increased by 6-8 per cent. Outlays on health provided by the Government through the Ministry of Public Health and other channels amount to 10 per cent of the State annual budget. The Huvsgul aimak project for the development of a comprehensive and effective model of health care delivery system which would eventually be replicable in other parts of rural Mongolia became operational on 1 January 1983 and a project manager has been appointed. The detailed plan of action for the year 1983 was drawn up and approved by the Health Minister. The main activities of the project include organization of national workshops on various aspects of primary health care and seminars on health and management of primary health care, improvement of community involvement and intersectoral collaboration, testing of different mobile forms of health services in remote areas, training of staff in planning, management, evalua- tion and health information system, and implementation of a continuous training prograrmne for conrmunity activities. A set of standard designs of various health facilities was prepared and submitted to the Government, and national architects have been trained to enable them to design hospital buildings, out-patient units, SANEPID stations, etc. A WHO consultant on computer-based health information systems visited the country in April 1983 and made recommendations for the development of computer-based HIS. A national workshop in planning and management was conducted in June 1982 in Ulan Bator for 18 senior public health administrators. Its overall objective was to familiarize the participants with modern methods of health planning and management and enable them to use the knowledge and skills to improve the planning process and management procedures. A national seminar on mental health problems was held in October 1982. A consultant visiting Mongolia at the same time participated in the training activities and submitted recommendations on the development of mental health services. Recent developments in the field of maternal. and child health were the procurement of additional equipment, assessment of the utilization of the equipment and the performance of health staff, manpower training, and the organization of a scientific-cum-practical conference in MCH. Altogether 21 national seminars were held on various MCH problems for doctors and paramedical staff, for a total of 424 participants. Four WHO consultants and two engineers from Denmark visited the country during the period to advise on various aspects of MCH services, Research studies on maternal mortality and morbidity, infant nutrition problems, the female fertility pattern and the organization of MCH services in rural areas were conducted. The project document of the BIOMED project was given a new shape in July 1982 and the Russian and Mongolian versions prepared and submitted to the Council of Ministers. The project document was approved by the UNDP Governing Council in February 1983. A UNIDO mission visited Mongolia in January 1983 and held discussions with the health authorities in regard to the BIOMED project . Training courses on methods of diagnosis, treatment and prevention of meningitis were held, attended by 22 specialists. A mass immunization campaign with the "triple" vaccine has resulted in the eradication of diphtheria. During the year the general communicable-disease morbidity rate declined by 9 per cent (measles by 69.8 per cent, viral hepatitis by 16.9 per cent, typhoid by 6.3 per cent) as compared to the corresponding period of the preceding year. In support of the national cancer control programme, the recently procured gamacamera was installed and put into operation in the "Isotop" laboratory at the First Ulan Bator City Clinical Hospital. A total of 729 patiants has already been subjected to gamacamera screening. Under the environment health programme, a strategy of environmental protection up to the year 2000 has been drafted and preparatory work for identifying activities to be undertaken to achieve the IDWSSD goal started. A system of sanitary control of Selenge river basin is coning into operation. Reconstrurtion and n~odernization of water supply and sewage disposal systems are under way in Ularl Bator city, The project document on the co~struction of a district water reservoir in Ulan Bator was drawn up. Under the health manpowor development project the first draft of a new project document on the development of the national library service was completed, Advanced traini~g cournes in 14 specialities were held for 160 physicians and 1092 paramedical personnel. A natioilal seminar on post- graduate training was held with 50 medical teachers in attendance. A new comprehensive long-term national programme on the prevention and control of cardiovasc~~lar ise eases among the rural population for the period up to the year 2000 was formulated, A mass screenin.g campaign was undertaken in one aimak rural area and in Ulan Bator city. Altogether a population of 9 000 - 7 000 rural and 2 000 urban - was examined by teams of doctors belonging to 12 different specialities in order to find out CVD cases and identify risk factors. Projects in Operation --- Nu~nSer (Source of ~unds) p- Title - MOG CHP 001 (R) Country Health Prograffiming HOG SPM 001 dH.) Management of Health Services MOG PHC 001 (K) Development of Infrastructure for Primary Health Care MOG MCH 002 <R) Maternal and Child Health MOG MCH 003 (FP) Epidemiological Studies of Population Growth and Strengthening of MCH Services MOG MNH 002 (R) Mental Health Services MOG PHB 001 (R) Pharmaceuticals and Biologicals - Control and Production MOG ESD 002 (R) Communicable Diseases - Prevention and Control MOG OND OOi (R) Non-comunicable Diseases - Prevention and Control MOG EHP 001 (R) Strengthening of Environmental Health Services MOG PTR 001 (R) Health Manpower Development 9. NEPAI. His Majesty's Government of Nepal is implementing the Sixth Plan with the three main objectives of (i) increasing production at a faster rate; (ii) increasing employment opportunities; and (iii) meeting the basic minimum needs of the people. To achieve the objectives of the Sixth Plan and the goal of Health for All by the Year 2000, Nepal needs sustained and sizeable external assistance, which it is seeking through local-level consultation meetings of donor representatives and the Nepal Aid Group, Despite the financial constraints the Government is facing, the budget allocation for health for Fiscal Year 1982183 was increased by 43.5 per cent over that of L981182. The HRG/LT(LI Review in March 1982 reveal-ed that roughly 90 per cent of the national health budget supports primary health care, clearly indicating the Government's firm commitment to PHC and YFA!200O. Activities under technical cooperation among developing countries (TCDC) received further impetus as a result of a resolution adopted by the Second Meeting of the ~inisters of Health of the countries of the WHO South- East Asia Region. WHO has assisted the Governinrnt in the preparation of TCDC nerds in the three areas identified by the Health Ministers Meeting, viz., health manpower training, iimnunization, and diarrhoea1 diseases control. In pursuance of the resolution of the Health Ministers Meeting, a health delegation from Tnailand, headed by the Deputy Prime ~inister, visited Neual in March 1983. A Memorandum of Understanding was signed by the two countries which identified the areas of mutual collaboration in the framework of primary health care. The areas identified, apart from the three defined by the Health Ministers, were FPIMCH, traditional medicine, health laboratory services, and non-communicable diseases control. Out of the areas so far identified for cooperation among the South Asian nations, Repal coordinates the Working Group on Health and Population Activities. The first meeting of this Working Group was held in Kathmandu in June 1982, and the Second Meeting in January 1983. Research activities have been strengthened considerably since the establishment of the Nepal Medical Research Conunittee in May 1982. WHO assisted in the conduct of the First National Workshop on Research Methods in Health Sciences. The Department of Health Services and the Institute of Medicine are jointly undertaking a WHO-assisted research study on the performance of health auxiliaries at the peripheral level. The Organization continued to support the Government in further strengthening the planning and progrannning capabilities of the Health Planning Unit of the Ministry of Fealth; improving the Health Infonation System and the Health Data Bank; developing procedures and methodologies for district-level health planning, and improving the planning of health manpower, including nursing personnel. Efforts are being made by the Government to consolidate the integra- tion of basic health services in the six operational distric:~ under the Integrated Community Health Services Development Froject and to expand the activities to other districts of the country. The Community Health Leaders (CHL) Programme nade satisfactory progress. An evaluation workshop on this programme was held in July 1982, the major outputs of the workshop being a revised implementation strategy and proposed programme changes in the light of the first year's experience. The Government has also been looking into the possibility of deliver- ing the PHC package through other channels. One such approach was to train the panchayat-based health workers of the FP/MCH project to become multipurpose workers and, simultaneously, to introduce the CHL programme in the FP/MCH districts, WHO is supporting this alternative approach. Nepal has been selected for UNICEF/WHO JCHP/PHC Support so as to receive further assistance in the implementation of primary health care. A joint UNICEF and WHO team visited Nepal in November 1982 and discussed with senior government officials and UNICEF and WHO staff the concepts of JCHP/ PHC Support and the steps to be taken to translate these concepts into action plans. Based on the suggestions made by the team, the district plans for JCHP/PHC Support in four selected districts are being developed. WHO'S coll.aborative efforts in the development of health laboratory services in the country have been progressing satisfactorily. A WHO/DANIDA workshop on quality control was held in September/October 1982, and another workshop on bacteriology in December 1982. The plan of operation for the WHO/DCA (Swiss Government) Health Laboratory Service Project was prepared and approved by the Government. The Organization continued its technical support to the development of MCH services, including family planning, in both integrated and non- integrated districts. A national conference on family planning was held in August 1982. The National Commission on Population meeting in January 1983 formulated population policies and programmes, which will form the basis for future population activities in Nepal. In the promotion of nutrition, WHO, in collaboration with UNICEF, assisted in the nutrition training of MCH workers and district-level health personnel; carrying out a nutritional survey of a resettlement area; deve- loping the multisectoral approach in some selected districts; monitoring the growth of children; preparing the protocol for breast feeding, and developing legislation on the marketing of breast-milk substitutes. A proposal for a joint UNICEF~WHO nutrition support programme to be funded by the Government of Italy was prepared. This proposal was approved by a WHO/UNICEF Steering Committee in April 1983. The goitre control programme also progressed satisfactorily. The Government of India is supporting the programme with iodized salt. In collaboration with UNICEF, WHO has provided technical support to the iodized oil injection programme as part of overall national goitre control activities. So far, 15 districts have been covered with the programme of iodized oil injection. WHO provided assistance in the conduct of training programmes in health education for different categories of health personnel and primary school education supervisors, and in the production of simple educational materials. A national workshop on 'Behavioural Science Research on Health Problems' was held in January 1983. The system of epidemiological surveillance of cammunicable diseases has been intensified, especially in 23 districts. The case-finding of viral encephalitis was completed in October 1982, and that of brucellosis has started in Xathmandu Valley and will be gradually expanded to other areas WHO is also collaborating in the development of the lay reporting system. The report on 'Status of ~abies' was published, and WHO is assisting in the potency testing of the anti-rabies vaccine produced locally. In the field of diarrhoea1 diseases control WHO has collaborated in the formulation of a national plan of action and the conduct of two national training workshops. It is also assisting two new research projects, viz,, Impact of Oral Rehydration Therapy among Rural Nepalese Children, and Acceptability of Sanitary Intervention among Rural Population with reference to Diarrhoea1 is ease Control. The malaria control programe recorded good progress, WHO providing assistance in all aspects of implementation, viz., spraying operations, epidemiological surveillance, case finding and treatment, entomological studies, training and field research, community participation and health education. The Twelfth Nepal-India Border Malaria Conference was held in Kathmandu in September 1982, and the annual internal and external assess- ments of the malaria control programme were also conducted as planned, with the collaboration of WHO, Concerted efforts are being made for leprosy control by various approaches' It is planned to introduce the multiple-drug therapy regimen in phases throughout the country, Immuno-epidemiological studies are being undertaken at the Mycobacterial Research Laboratory of Anandban Leprosy Mission Hospital. With a view to enhancing community participation in leprosy control, a seminar on the role of non-governmental organizations in leprosy control was conducted in August 1982. In regard to tuberculosis control, WHO is assisting in manpower development, A group training course in tuberculosis control for auxiliary health workers was conducted in Kathmandu in October 1982, Another training course for health workers and members of voluntary social organizations from Nuwakot and Sindupulchowk districts was held in Nuwakot in May 1983. The Expanded Immunization Project (EIP) progressed satisfactorily, the total number of districts covered by the national EPI now being 42 (28 districts by the EIP and 14 districts by the Integrated community Health Services Development Project), The approach adopted is to cover new districts each year by the EIP and to hand them over to the ICHSDP for maintenance at a later date, The Prevention and Control of Blindness Project carried out a nation- wide survey of blindness and blinding conditions. Based on the findings of the survey and the experience gained since then, the project document was rewritten and signed by the Government and WHO in January 1983. In the field of water supply and sanitation, a National Group has been established to coordinate the activities among sector agencies and inputs by external donors. WHO is collaborating closely with the ~ational Group and the sector agencies and is also assisting the Government in preparatory activities for the 'Country of Concentration initiativeB. Proposals for some 60 to 80 projects to be implemented by the Department of Water Supply and Sewerage are under preparation, as are 28 package project proposals for the Ministry of Panchayat and Local Development. The Organiza- tion is also executing a UNDP-funded project, 'Training of Manpower for the Drinking Water and Sanitation Programne (Phase I)', the main thrust of which is to strengthen the Institute of Engineering in order to train the type of manpower needed for the Programme within the country. Apart from WHO and UNDP, the World Bank, UNICEF and bilateral agencies are also assisting the programe; A two-week training programme on environmental sanitation was conducred for trainees from non-governmental organizations in October 1982. WHO has assisted in the conduct of seven teacher training workshops. So far, fifteen two-week workshops have been held involving more than 200 faculty members of the Institute of ~edicine- The organization has also collaborated in the preparation of the project proposal for health learning materials and in the conduct of the second Health Manpower Planning Exercise, which took place in ~uJ.,~j~u~ust 1982. In the field of nursing education, the community health nursing programme, assisted by WHO, is progressing satisfs~toril~. A survey of learning needs for nursing faculties was carried out and the auxiliary nurse-midwife (ANM) curriculum was revised,. The curriruliim for medical and surgical nursing was finalized, and the programme is to commence in the next Fiscal Year. WHO is executing a UNFPA-funded project, providing technical support in staff training and curriculum development, production of textbooks and teaching materials, research in family health, and the establishment of a health post for services and student training (as part of the Institute of Medicine). A significant development during the period was the Government's decision to award the degree of MBBS to the graduates of the Community Physician Course, who are expected to graduate within the next six months. Projects in Operation Y Number (Source of ~unds) ~itle - NEP CHP 001 !R) Country Health Programming NEP RPD 001 (R) Research Promotion and Development NEP SPM 001 IR) ~ealth Planning and Programming NEP SPM 003 (FP) Strengthening of Integrated Community Health Project in the Ministry of Health at the Central Lere 1 NEP PHC 001 jR) Community Health Services and Primary Health Care ~evelopment NEP PHC 002 (DP) Primary Health Support Services Programme NEP ATH 001 (R) Deveiopment of Laboratory Technology Services NEP MCH 003 (R) Development of Maternal and Child Health Services NEP MCH 004 (FP) Assistance to FPiMCH Project NEP NUT 003 (R/VF) ~utrition NEP HED 001 (R) Health Education NEP PHB 001 (DP) Strengthening of Royal Drugs Research Laboratory NEP ESD 001 (K/VF) Development of Epidemiological Surveillance NEP MPD 001 (K/VF) Malaria Control NEP BVM 001 (K/VF/FT) Leprosy Control NEP BVM 002 (R) ~uberculosis Control NEP EPI 001 (R/VF) Expanded Programme on Immunization NEP PBL 001 (RIVF) Prevention of Blindness NEP BSM 001 (R) community Water Supply arld sanitation NEP BSM 002 (DP) raining of Manpower for the Drinking Water and Sanitation Programe NEP PTR 001 (R) raining of Health Manpower NEP PTR 003 (FP) strengthening of Health Manpower Training of Integrated Community Health Project NEP PTR 004 (FP) Family Health and Family planning Teaching, Services and Research 10. SRI LANKA The Government of Sri Lanka has formulated the strategies and plans of action for Health for All by the Year 2000. Since the implementation of chese strategies and plans of action entailed radical changes both in attitudes and in the functioning of the health delivery system, the Government made considerable efforts to make the philosophy of primary healuh care fully ~~nderstood, A Seminar of Parliamentarians was organized in collaboration with UNICEF and WHO to bring about relevant understanding among politicians. Primary health care was a major subject of discussion at the annual meetings of professional bodies. The Ministry of Health also conducted orientation courses for health administrators and health workers and mounted educational programmes for the people through mass media. All these efforts of the Government have resulted in increasing support from the public, politicians and professional bodies to the health strategies adopted far ths realization of the HFA goal. The recognition that implementation of these strategies will require shifting of resources as well as mobilization of additional resources prompted the Government to undertake the study of the financing of health services in collaboration with WHO. The study was completed in July 1982 and has since been discussed at the highest level. As a result, primary health care featured prominently in the ~overnment's Public Investment Programme, 1982-1986, and led to an almost doubling of the Government's budge: for health for 1983. The management of larger structural changes to secure inter-sectoral cooperation and people's involvement made further progress during the year. The Ministry of Health, in collaboration with WHO, is engaged in identifying and analysing the operational management-cum-service delivery problems and constraints in txo districts. Based on this exercise, a seminar is planned in order to design guidelines for the nation-wide implementation of decentralized administration. The National Health Council, the National Health Development Committee and some of its standing committees actively participated in the formulation and implementation of primary health care programmes. Implementation of the improved health care delivery system commenced during the year and was progressing according to schedule. All the allo- cations for the establishment of Gramodaya health centres in the 33 AGA (Assistant Government Agent) divisions were identified and steps to procure land and design the buildings have been completed; construction has begun in a few places. WHO closely supported the Planning Unit in the implementa- tion of the improved primary health care delivery system, In addition to the development of physical facilities equal attention has been given to the preparation of the health workers who are to deliver the primary health care programme to the people. The training of family health workers and reorientation of PHC workers progressed satisfactorily. The National Institute of Health Sciences, Kalutara, has played a significant role in the preparation of primary health care workers. Other health manpower development activities also progressed satisfactcrily. Efforts were made to set up small units for the formulation of essential drugs for PHC and the production of sterile infusions and oralites, Funds for the production of sterile infusions are being provided by the Government of Switzerland through UNIDO and UNICEF is financing the production of oralites, WHO support was provided for the development of technical specification of equipment for both infusion plant and oralites. Technical support was also given for the training of key personnel required for the tableting and capsulating plant, and for the three-year diploma course in pharmacy, The infrastructure for the implementation of the family health programme and its management was considerably strengthened through the collaborative efforts of WHO; funds for these activities mainly came from UNFPA. A study to evaluate the perfolmance of family health workers was designed, The training of ayurvedic physicians in the promotion and delivery of family planning services, designed initially for a duration of one year, was completed and 101 ayurvedic practitioners were trained, The expanded programme on immunization continued to operate most satisfactorily during the year, the coverage for full immunization being around 56 to 58 per cent, The incidence as well as mortality due to immuni- zable diseases has dropped significantly. The cold chain established with UNICEF assistance operated satisfactorily.. After initial delays, the diarrhoea1 diseases control programme was finally launched in 1982, The Epidemiological Surveillance Unit has served as the centre for the Expanded Programme on Immunization and the Diarrhoea1 is eases Programme and, in collaboration with WHO, is collecting epidemiological information on measles so as to decide if measles vaccination should be included in EPI. The National Malaria Control Programme continued to operate according to plan. The incidence of malaria cases during 1982 was 38 566, though falciparum malaria increased slightly. The malaria vector remained sensitive to malathion, Owing to improved surveillance the outbreaks of falciparum malaria were controlled expeditiously, Some of the activities of malaria control such as passive case-detection and treatment of malaria cases have been merged into the general health services. The accelerated rabies control programme has had some success in reducing the number of human cases of rabies. A new Rabies Control Act, developed in collaboration with WHO, has been passed by the Cabinet, A multidisciplinary National Coordinating Committee for the Preven- tion of Blindness with responsibility for the formulation of a national plan for the prevention of blindness and its monitoring and evaluation was appointed. WHO assistance was provided for a review of eye care activitieb as well as an assessment of the present needs for ophthalmic pathology and research, A regional centre for the training of ophthalmic auxiliaries at the Eye Hospital in Colombo has started functioning and the training of the first group of 10 trainees commenced in April 1983, Phases 1 and 2 of the study for testing the feasibility and effi- ciency of PHC workers to detect early lesions of oral cancer came to an end. Further areas in Jaffna and Galle were selected to test the replicahility of the results of phases 1 and 2 carried out in Kandy Apart from this study, WHO extended technical support to the national efforts in developing manpower for strengthening the treatment of cancer and the promotion of the anti-smoking campaign. A community-oriented national programme utilizing PHC workers for the control of cardiovascular diseases was developed, and activities started in Kalutara with a survey of one thousand households covering a population of about fifty thousand persons. Fifteen public health midwives have been trained for this purpose, The oral health programne was developed at a national seminar in collaboration with WHO, The training of PHC workers also commenced, based on the recommendations of this seminar. The oral health programme completed preparations for the conduct of an island-wide epidemiological survey of dental health status, A core group on child mental health was established by the ~ational Health Development Committee to coordinate and review the recommendations of the WHO-assisted Workshop on Child Mental Health and to monitor the progress of the programme. In collaboration with WHO and UNICEF the national core team developed indicators for child mental health which are being field-tested in Kurunegala and Kotte areas. A start was made for the rehabi- litation of chronic mental patients with the help of social workers, WHO assisting with the training of social workers as well as the rehabilitation of chronic patients in the community, The Food and Nutrition Policy Planning ~ivision undertook nutrition surveillance work, promotion of breast-feeding and low-cost weaning foods, and also evaluated the various food supplement programmes such as the food stamps scheme and the Triposha and fish biscuit programmes. Action was also taken for producing low-cost weaning foods, promoting breast-feeding and regulating the use of breast-milk substitutes. The traditional systems of medicine received further attention during the year. The committee on integration of traditional systems of medicine and their role in the primary health care programme completed its delibera- tions. Priority projects were prepared with WHO ccllaboration which have been accepted for funding in UNDP'S third country programme covering the period 1984186. WHO also collaborated with the national authorities in reviewing the training of undergraduate ayurvedic physicians. The National Decade Programme for water supply and sanitation is now reoriented with greater emphasis on strengthening institutional and human resource development and coverage with affordable service levels. A detailed sector manpower study and training plan that was prepared in 1981 is now being implemented in stages. Water supply to rural areas is being provided through a rapidly expanding ground-water development programme; related hydrogeological investigations are being carried out. A detailed work study was conducted to identify the methods of work and procedures, infrastruc- ture, staffing and management of operation and maintenance. The training of operational and maintenance staff was accorded high priority. WHO is providing assistance to training programmes in public health engineering at the Universities of Peradeniya and Moratuwa. The research sub-committee that has been set up under the National Health Development Committee for the coordination of all health-related research activities in the country as well as dissemination of research results, has developed its operational strategies and started functioning as the central coordinating body. A multidisciplinary programme of coordi- nated research, research development and research training in health sciences and services is being implemented with WHO support. The programme aims at formulating research projects addressed to the priorities of HFA 2000 and developing trained research manpower for the country's self- reliance in this field. A number of workshops on research methods were organized. The base for operational research has been broadened to include field organizations, universities, voluntary organizations, etc, In the field of operational research, studies directed towards the problem relating to MCH figured significantly during the year. Promotional activities for tropical disease research and research in human reproduction have been further intensified. With WHO support the University of Peradeniya organized an International Meeting on the Impact of Population Movement on Tropical Diseases which generated interest among scientists for research into the health problems of population movement, particularly in the context of the new human settlement in the Mahaweli Development Project areas. The design for improving existing health information systems was completed and the trial run of the improved design commenced in April 1983 in Kegalle with a control in the Kalutara area. Both WHO and UNICEF have ccllaborated closely with the national authorities in the trial run of the information system, In an effort to stimulate non-governmental organizations to take a more active part in national health development efforts, an inventory of NGOs, including potential resources and their areas of interest, was compiled as an initial step in collaboration with the MARGA ~nstitute. Projects in o eration -2- Number (Source of Funds) Title -- SRL CHP 001 (R) Country ~ealth programing SRL RPD 001 (R) Research Promotion and Development SRL PPS 001 (R) Development of Primary Health Care SRL SPM 001 (R) planning, Management and Information System Development SRL WKH 001 (VF) Occupational Health and Industrial Hygiene SRL ATH 001 (R) Strengthening of Laboratory Services SRL MCH 001 f,R/FP) Family Health SRL MCH 002 (FP) Strengthening of Hospital-based Family Planning services SRL MCH 003 (FP) Family Health Teaching, Service and Research in ~edical School, Peradeniya SRL MCH 004 (FP) Family Health ~eaching, Service and Research in Medical School, Galle SRL MCH 005 (FP) ~amily Health Teaching, Service and Research in Medical School, Colombo SRL MCH 007 (FP) strengthening of Family Health Services SRL MCH 008 (FP) SRL HED 001 (R) SRL HED 002 (FP) SRL MNH 001 (R) SRL PHB 003 (R) SRL PPC 001 (R) SRL MPD 001 (R) SRL BVM 001 (R) SRL BVM 003 (R) SRL EPI 001 (R) SRL PBL 001 (R) SRL VBC 002 (DP) SRL PPN 001 (R) SRL ORH 001 (R) SRL EHP 001 (R) SRL EW 002 (DP) SRL BSM 002 (RIFT) SRL FSP 001 (R) SRL PTR 001 (R) SRL PTR 002 (R) SRL PTR 003 (R) SRL PTR 004 (R/DP/UF/FT) SRL PTR 006 (FP) SRL PTR 008 (FP) SRL EDS 001 (R) Strengthening of the Research and Evaluation Unit of the Family Health Bureau Health Education Family Health Education Mental Health Drug policies and Management Surveillance and Control of Communicable Diseases Malaria Control Veterinary Public Health Diarrhoea1 Diseases Control and Prevention Programme Expanded Programme on Immunization Prevention of Blindness Vector Control Phase I1 Prevention and Control of Nonconnnunicable Diseases Community Oral Health Training in Public Health ~ngineering Institutional Support to the National Water Supply and Drainage Board Community Water Supply and Sanitation Food Hygiene Medical Education Nursing Education Post-graduate Medical Education Development of National Institute of Health Sciences Training of public Health Midwives Training of Ayurvedic Practitioners in Family Planning Services Delivery (Pilot Study) Educational Technology SRL EDS 002 (FP) Strengthening of ~ursing1Midwifery Education The rratinnal policy for HFA by the year 2000 with PHC as the key approach is receiving ,clear arhd steady support fron the Government. the National Economic and Social Development Uoar.3, the. ~niversities and other related sectors. Primary 'ealth care is being fully launched i.n the 38 prcvinces of the National Rural Poverty Area 3eve:opment Prograr.une covering around 20 000 villages. Efforts tcviards decentra1izsti;n of the system of plancing and management at the provincial and district, Levels are being actively uursued.. In the field of Government./l?i3 c:::laboration, The Prcgram.e ~udgeti.ng Lxercise has corrtirlued to develop, wit!] the R'rG/T,Pi.O Coordinating Committee now entirely maraging the ccllabarat ive programme and ljuiget activi.ties at the central level. A pilot project to stxdy fi.na?ci.al procedures at all levels was initiated. The WH(? Programne Budget f~r 3984-1985 wan prepared and approved by the RTG/WHO Coardinating Comictee, in acccrdance with the thrusts in the WHO Seventh General Progr-arpme sf Work. A project was formulated in order to extend coverage to achieve effective PHC activities. to give, pro$~essi.vely, maximcm responsibility to :he community in the planning and execution of district and village projects related to the. elements of PHC and basic healrh activities consonant. with national policies, strategies and plans of action for Health for All. Exten- sive field work in the villages, incl~lding the dever.opnent of models far village health pr~agrammes, was carried out wit11 Eul? community i.nvolvement. A three day first national conference attended by top level administrators and technical officers from various ministries held in February 1983 considered s proposal for utilizing basic ninimmnln! needs for long-term social development planning. A preliminary study on the feasibility of utilizing basic. minimum needs at village level was conducted. The ASEAN raining Centre for Primary Health Care Development, a joint venture of the Ministry of Pub1j.c Beaith and Mahidol university, has, with support from Japan, been carrying out: programe development and national consultative and educational activities sinte October 1987. A con- sxltation with ASEAN countries 9n expectations for the ATC/PSC programme of research and training for the next three years was held. WHO collaboration in health development activities has been focused on identifying new avenues for technical cooperation through the Programme Budgeting Exercise- The Social Development Project ~ontinued to play a decisive role in the development of a common policy and framework for intersectoral action on basic minimum needs with primery health care as an inte~ral part cf the ~ational Poverty Area Development Programe. The concept af using villages as training and development centres as proposed in the WHO Pro3rame Budget for 1984-1985 has been accepted hy t.he Ninistries of ~g+i.culture and Cooperatives, Education. Interior and Public Health, The development of the health infrasfructrire is being vigorously pursued. There is: however. a recognition that the entire infrastructure needs revision in order to increase its effici.ency and: most importantly, to prepare !he system in regard :o the technical, managerial and adminis- trarive aspects for the new functions required :D support pH': village development, ~articularly the self-managed PHC scheme. The need for adequate technical and managerial strengthening of the health infrastructure is recognized. The quality of primary health care workers needs to be improved and the need for periodic retraining is felt, Supervision is another impor- tant area which requires a very specific effort for further improvement. These problems are receiving the attention of the ~ational Coordinating Committee on Primary Health Care. The development of the health infrastructure in the provinces was also vigorously pursued during the year to facilitate the implementation of PHC activities, Training of village health comunicators was undertaken in six provinces. Refresher courses fcr tambon trainers as well as a workshop on PHC were conducted. In the area of TCDC amongst Member States, a Memorandum of Under- standing was signed between His Majesty's Government of Nepal and the Royal Thai Government. WHO suppc.rtt?d this effort. A national evaluation of EPI, primary health care and maternal and child health was conducted. An assessment of the diarrhoea1 diseases control programme was also carried out. Malaria control measures were continued, but technical problems such as drug resistance and vector exophily persisted. While the mortality trend showed a decline, the case incidence registered a small increase. A large-scale field trial of mefloquine to combat the multi-drug resistant P.falciparum has been initiated. Efforts were being made to involve the community in malaria control activities. The field epidemiology training programme in Thailand has continued to provide training in the field application of epidemiological methods to national professionals. Training courses for epidemiological reporters and pre-service training courses for epidemiological workers have been con- ducted. Also workshops on epidemiological surveillance for epidemiological workers have been organized,, The lay reporting system has been instituted and evaluated in Chonburi Province. The field epidemiology training programme, which is to be incorporated in the health development plan, has resulted in larger and more effective services. Disease surveillance at the local and national level is being improved and it is anticipated that within two years all surveillance data will be stored and analysed by computer. Computerization is also being introduced for the entire health information system on the one hand, and nutrition and MCH monitoring and evaluation on the other. A computer master plan within the Ministry of Public Health has been drawn up. The National Cancer Institute is working on the epidemiological surveillance of cancer of the cervix in Nakorn Nayok Province. several institutions in and outside Bangkok are involved in the project on prevention and control of cardiovascular diseases, rheumatic heart diseases and rheumatic fever. Information collection has started. It is proposed to start a study on hypertension. Two national staff were sent on WHO fellowships to receive training in the prevention and control of cardiovascular diseases. 'Ihe WHO Collaborating Centre for Occupational Health at the Department of Occupational Health has initiated a programme of primary health care to under-served working populations in small scale industries and agriculture. Feasibility studies on training primary health workers for the delivery of health services in general industry, mining and agriculture have been conducted. Also a study of working conditions, occupational health hazards and the health status of women workers in 'hailand has been carried out. A workshop on the development of a training curriculum in occupational health and safety and a manual of operation for PHC workers in the work place was held in Chiang Mai in February 1983 which also reviewed the experie~ce obtained in PHC trials for working populations in ihailand. In the field of oral health, the study of the relationship of dental caries, dental fluorosis, and level of fluoride content in drinking water, in Doi Saket district, Chiang Mai, continued. A survey on needs and demands for oral health services in adults was also carried out in Chiang Mai. In addition, a workshop for regional chief dental officers and the staff of regional dental health centres was conducted. A comprehensive communit y-oriented programme on the prevention of blindness is being implemented and the manpower needed is being provided through training at provincial hospitals. A national committee has been appointed to coordinate the activities. Steps have been initiated for setting up an Institute of Public Health Ophthalmology in Korat, where access to field work in a rural setting is readily available. WHO colla- boration has included formulation of a plan of action for this institute and a scheme for low-cost spectacles as well as provision of ophthalmic pathology/microbiology services and manpower training. In the field of environmental health, special studies related to the development of the Decade Plan are progressing. The draft report on insti- tutional aspects and management infomation system. will be completed soon. The National Survey on Excreta Disposal and the Law Cost Sanitation Study, including preparation of a master plan for Cholburi as a pilot study, have been completed. For the Decade Plan the National Economic and Social Development Board has prepared a contract document with the Asian Institute of Technology. In regard to drug dependence, an extensive evaluation of the UNFDAC- financed project was carried out and its report is awaited. As regards health manpower development, the Ministry of Public Health and the Universities have agreed to increase the production of doctors. The clinical training of doctors will be carried out in provincial and district hospitals specially equipped for teaching medical students. Extensive coordination between the Ministry of Public Health and the Universities facilitates systematic review of the production and training of all the required categories of health personnel. A procedure to improve community health through more systematic data collection in MCH by staff at the tambon level has been instituted. The National Research Council has drawn up a national policy and plan for research, including research in the field of health. There has been, since the beginning of the Programme of Human Reproduction Research, active collaboration in institution-strengthening on research, reflecting the high priority given by the Government to research in family planning. The two Collaborating Centres for Research in Bangkok, at Chulalongkorn and Mahidol Universities, worked closely with national authorities on questions of national relevance and carried out clinical and epidemiological studies on the short- and long-term safety of current methods of fertility regulation. Other studies being supported include those on pharmacokinetic and metabolic aspects of new methods of contraception. Primate facilities were also strengthened in the Department of Biology of Chulalongkorn University. Two institutions in Chiang Mai collaborated on metabolic and epidemiclogical studies related to long-term sequelae of steroidal contraceptives. Some studies related to male fertility, sexually transmitted diseases and infertility are also being supported. The UNDP/World Bank/Special Programme for Research and Training in Tropical Diseases (TDR) continued to support research projects in the fields of malaria, schistosomiasis, filariasis, leprosy, vector ecology and control and social and economic research, besides training and the streng- thening of institutions to increase the country's research capability. Projects in Operation - Number (Source of Funds) - Title THA CHP 001 (WVF) Country Health Programming THA RPD 001 (FT) Research Studies on Mansonia Mosquitoes THA RPD 002 (R) Promotion of Research TI& SF.X 901 (R) Planning, Management and Information Systems Development THA PHC 001 (R/VF/FT) Development of Primary Health Care TPA WKH 001 (I?) Development of Occupational Health THA ADR 001 (R) Development of Care of the Aged, Disability Prevention and Rehabilitation THA ATH 001 (X) Development of Appropriate Technology for Health (including Health Laboratories) THA MCH 003 (P) Fellowships in Family Planning and Related Fields THA MCH 004 (FP) Expansion of Family Planning Services and Support of Infrastructure of the National Family Planning Programme THA MCH 007 (R) Development of Maternal and Child Health ?HA ElCH 008 (FF) Support to NFPP for Improved Programme Management and Expansion of Family Planning and Contraceptive Delivery Services THA NUT 004 (R) Integration of Nutrition into Primary Health Care THA HED 001 (R) THA MNH 001 (R) THA DPM 001 (R) THA PHB 001 (R) THA ESD 003 (R) THA MPD 001 (R) THA MPD 002 (R) THA BVM 001 (R) THA EPI 001 (R) THA PBL 001 (R) THA VBC 001 (R) THA CAN 001 (R) THA CVD 001 (R) THA ORH 002 (R) THA EHP 001 (DP) THA EHP 002 (R) THA FSP 001 (R) THA MPM 001 (R) THA PTR 001 (R) THA PTR 002 (FP) THA EDS 001 (R) THA HST 001 (R) THA HLE 001 (R) Development of Health Education Development of Mental Health Development of Drug Policies and Management Development of Pharmaceuticals and Biologicals Development of Epidemiological Surveillance Malaria Control Filariasis Control Bacterial, Viral and Mycotic Diseases Control Development of Expanded Programe on Immunization Prevention of Blindness Development of Vector Biology and Control Development of Cancer Control Development of Cardiovascular Diseases Control Development of a Training and Demonstration Centre for Oral Health Environmental Health Development of Environmental Health Management, including Impact Assessment Development of Food Control Development of Health Manpower Planning and Management Promotion of Training Training and Follow-up Support of Peripheral and Primary Health Care Workers Curricula and Faculty Development Development of National Health Information System Development of Health Legislation 12. INTER-COUNTRY Projects in Operation Number (Source of Funds) - Title ICP CHP 001 (R) Managerial Process for Health Development ICP CHP 002 (DP) Strengthening of Managerial Capacities for Health Development ICP CWO 002 (R) Liaison with ESCAP ICP a40 100 (AS) Coordination with other Organizations ICP RPD 001 (R) Biomedical Research ICP RPD 002 (VF) Collaboration in Research Programmes ICP RPD 100 (R) Research Promotion and Development ICP DGP 001 (R) Regional ~irector' s Development Programme ICP PPS 100 (R) Health Services Development - Programme Planning and General kt ivities ICP SPM 002 (R) National Health Information Systems Development ICP SPM 003 (DP) Strengthening of Health Services Administration through Training in Planning ICP PHC 002 (R) Promotion of Health for All with Primary Health Care as Key Approach, including Appropriate Technology for Health ICP PHC 004 (R3 Promot ion and Development of Traditional Medicine with Special Reference to Primary Health Care ICP PHC 005 (DP) Medicinal Herbs and Ayurvedic Drugs ICP PHC 006 (DP) Primary Health Care Promotion and Development ICP PHC 007 (DP) Traditional Medicine ICP PHC 008 (DP) Acupuncture as Traditional Medicine Practice ICP ADR 001 (WVF) Care of the Aged, Disability Prevention and Medical Rehabilitation ICP ATH 001 (R) Standardization of Diagnostic Material and Laboratory Practices ICP ATH 100 (R) Appropriate Technology for Health ICP HSR 001 (R) Health Services Research ICP FCH 003 (R) ICP MCH 011 (FP) ICP MCH 013 (R) ICP W2H 100 (R) ICP NUT 005 (R/VF) ICP NUT 100 (R) ICP HRP 100 (VF) ICP HED 005 (R) ICP NED 100 (R) ICP MNH 003 (R) ICP MNH 100 (R) ICP DPM 001 (R) ICP DPM 002 (DP) ICP PHB 002 (DP) ICP ESD 005 (R) ICP ESD 100 (R) ICP MPD 001 (R) ICP MPD 004 (DP) ICP MPD 100 (R) ICP BVM 001 (WVF) ICP BVM 003 (VFIFT) ICP BVM 004 (VF/FT) ICP BVM 006 (R) ICP BVM 007 (VF) ICP EPI 001 (R/VF) ICP EPI 002 (DP) ICP TDR 100 (FT) Education and Studies in MCH Regional Team on Family Health Promotion of Family Health Maternal and Child Health htrition in Primary Health Care Nutrition Regional Research Adviser Promotion of Health Education Health Education Promotion of Mental Health Mental Health Development of Essential Drugs: Legislation and Quality Control Drug Policies Management Technical Cooperation in Pharmaceuticals in ASEAN Countries Strengthening of Epidemiological Surveillance System Epidemiologica 1 Surveillance Malaria Control and Coordination of Ant i-malaria Activities in the Region Regional Manpower Development Programme in Malaria Malaria and Other Parasitic Diseases Prevention and Control of Bacterial and Viral Diseases Leprosy Control Control of Zoonoses and Food-borne Diseases Research in Bacterial and Viral Diseases Prevention and Control of Diarrhoea1 Diseases Expanded Programme on Immunization Expanded Programme on Immunization Strengthening of Biomedical Research Capability ICP PBL 001 (WVF) Prevention of Blindness and Visual Impairment ICP PBL 002 (WVF/FT) Prevention of Blindness ICP PBL 003 (DP) Prevention and Control of Visual Impairment and Blindness ICP PPN 100 (R) Non-communicable Disease Prevention and Control - Programme Planning and General Activities ICP CAN 001 (R) Cancer Control and Prevention ICP ORH 001 (R) Development of a Training and Demonstration Centre for Oral &alth ICP OND 001 (R) Other Non-communicable Diseases Control and Research in Chronic Liver Diseases ICP PPE 100 (R) Promotion of Environmental Health - Programme Planning and General ktivities ICP EHP 001 (R) WHO/World Bank Cooperative Programme in Environ- mental Health ICP EHP 002 (VF) Building up of Information Services in Environ- mental Health in South-East Asia ICP BSM 001 (R) Community Water Supply and Sanitation ICP BSM 002 (DP) Development of Drinking Water Supply and Sanitation Programme ICP BSM 003 (vF) G'IZ/WIIO Cooperation Project for International Drinking Water Supply and Sanitation Decade ICP BSM 004 (DP) International Drinking Water Supply and Sanitation Decade Advisory Services ICP RCE 001 (WFT) Environmental Pollution Control ICP PRI 100 (R) Health Manpower Development - Programme Planning and General Activities ICP PTR 001 (WFP) Orientation of the Curricula of Health Personnel to Community Needs ICP PTR 002 (R) Post-graduate Training Programmes for Health Personnel ICP PTR 003 (R) Continuing Education for Health Personnel ICP PTR 005 (DP) Training in Maintenance and Repair of Health Equipment ICP HST 100 (R) Health Information - Development of Health Statistical Services ICP HLT 001 (R) Health Literature, Libraly and Information Services 13. INTER-REGIONAL PROJECTS IN OPERATION IN SOUTH-EAST ASIA Number Title - IRP VBC 043 Rodent Control Demonstration Study Unit, Rangoon IRP VBC 025 Vector Biology and Control Research Unit, Jakarta, Indonesia IRP VBC 050 Vector and Rodent Control Sub-unit, Semarang, Indonesia IRP MNH 030 Treatment and Research Component of the United Nations/ Burma Programme for Drug Abuse Control, Phase I IRP MNH 918 Treatment of and Research on Drug Dependence in Thailand IRP MNH 818 Treatment of and Research on Drug Dependence in Thailand - Health Research Institute
6. PUBLIC INFORMATION The period under review saw a steady strengthening of emphasis and effort in providing health information to the mass media as well as to the lay public. Steps were taken to develop the public relations aspects of the dissemination of information. Through various communication-oriented activities a better under- standing of the role of the Organization was sought to be projected. The promotive and preventive aspects of health, especially in the context of the goal of Health For All by the Year 2000, were highlighted through the HFA12000 Newsletter. A conscious effort was made to draw the attention of the media to the fact that health development, in order to be effective and successful, needs to be a multisectoral effort with the active involvement of the community. The main thrust of the activities during the year was on media relations in general: briefing them during the Regional Committee meeting, on the occasion of World Health Day and during important group educational activities or meetings in which the media had an interest. The highlights of the activities were as follows: Regional Committee. The Regional Committee's thirty-fifth session, held in Dhaka, was widely covered by the local and regional media. Special newspaper supplements were published on the occasion of the second meeting of the Health Ministers of South-East Asian countries. These carried messages from the Chief Martial Law Administrator and the Health Minister of Bangladesh as well as from WHO'S Director-General and the Regional Director. World Health Day. This year's theme, "Health for All by the Year 2000: the Countdown has Begun", was well received and generated considerable interest among the media. The Regional Director addressed a well attended press conference, recorded a special talk for All India Radio and a state- ment for Indian television. National programmes on the radio were also broadcast, featuring interviews with some staff members. An article from the Region was included in the WHO information kit which was distributed worldwide. Several schools, non-governmental organizations and health education bureaux used this information material to organize programmes to observe World Health Day. These activities included exhibitions, symposia, debates and the screening of films related to various health topics. World Health. A number of articles devoted to various interesting and innovative approaches in health development in the Region were carried by World Health magazine during the year. These included subjects such as water, blindness and sanitation. The special World Health Day issue also carried an article and photographs contributed from the Region. Group Educational Activities. Press releases were issued in respect of activities related to financial planning for health for all and medical research. These evoked an encouraging response from the media and resulted in requests for more information. Cooperation with United Nations Information Centres and Other Agencies. The Regional Office maintained its collaboration with the New Delhi United Nations Information Centre by providing inputs to its weekly newsletter. Work on producing an information- booklet-depicting the role o£ various United Nations agencies in India was begun. An exchange of material including films was maintained with some other United Nations information centres. In collaboration with UNICEF, exhibits on low-cost aids for the handicapped were displayed at an exhibition entitled "Helping the Handi- capped1' organized by the Department of Social Welfare, Government of India. Photographs and Films. Black-and-white photographs were supplied to the media on a variety of subjects. The World Health Day information kit as well as World Health magazine were also provided with exclusive photographs. Work on producing mobile display modules with photographs was initiated. These modules would be used at various group educational activities and on special occasions. WHO films were shown regularly on television programmes, and the film on primary health care in lhailand was released and much appreciated. An effort was made to expand the film library in order to make more films available to a larger number of institutions. Visitors. In keeping with the public relations aspects of public information, visits by students were encouraged. An increasing number of such groups was received and briefed by the appropriate units in the Regional Office. Requests for information on the Organization and its activities, mostly from school children, were also complied with.
batches produced by the Institute were tested by WHO at WHO Collaborating Centres. Haffkine Biopharma was provided by WHO with a new seed for the production of type 111 oral polio vaccine. In NEPAL, technology for the production of BPL-inact ivated anti-rabies vaccine for human use was established. Batches were tested for quality control in CRI, Kasauli, and were found to be satisfactory. In THAILAND, national staff were trained in production technology and the quality control of DPT vaccine. The inter-regional UNDP project on the experimental production of anti-rabies vaccine in tissue culture at Coonoor (India), made satisfactory progress. Two short-term consultants were assigned and the Pasteur Institute, Coonoor, was provided with equipment. The Pasteur Institute, Paris, has provided a new strain adapted to tissue culture to the Pasteur Institute, Coonoor. After a few batches of anti-rabies vaccine are prepared and tested for potency, national staff from other countries of the Region will be trained in production technology. 5. PROMOTION OF ENVIRONMENTAL HEALTH Community Water Supply and Sanitation occupy a position of high priority in the health development efforts of most countries in the Region. Community water supply, being a basic unfulfilled need, has received substantial allocations in national budgets in spite of the scarcity of capital. The same, however, cannot be said in respect of sanitation. Six countries in the Region hutan an, India, Indonesia, Maldives, Nepal and Sri Lanka) already have produced their first draft Decade plans. Nepal and Sri Lanka are already reviewing their Decade plans in the light of the current situation and the review was expected to be completed in the latter half of 1983. There is a growing interest in research and development effort to find indigenous solutions to tackle the increasing environmental pollution problems associated with industrialization. Rapid techniques of stream pollution monitoring and water quality surveillance have been given high priority both by the Member States and in WHO'S cooperative effort with them. There is also a trend towards taking a more holistic approach in research in environmental health, taking into account social, ecological, economic and other factors that have traditionally been kept outside the purview of ad hoc research projects, which have often been concentrated more on "hardware" technology. A preliminary field testing of a comprehensive questionnaire on the status of food safety programmes has been completed and preparations were under way for final field testing in order to obtain feedback from countries. 5.1 Environmental Health In line with the collective decisions of Member States, both in the World Health Assembly and in the Regional Committee, a serious exercise has been undertaken, during the year under review, to programme WHO'S 1984-1985 biennial budget tcwards optimal use in support of the countries' HFA goals. Whi1.e different mechanisms have been used in different countries for this exercise, there has been a reductior~ in the programme budget for environ- mental health. The World Bank has also, as a matter of policy, phased out its cooperative programme with various Specialized Agencies, including WHO, Reduced resources can be looked upon as a constraint. However, the Organization has tried to adapt by pooling resources for programme planning purposes and thus providing the cecessary inputs to specific activities that countries have not found possible to meet within the country budget. These resources have also beer1 used for inter-country manpower development activities, At the regional levei, an inter-country course on project formulation and appraisal for water supply and sanitation with emphasis on community self-reliance, operation arid maintenance, was organized at the Anna University, Madras, in which sectox officials from India, Nepal, Sri Lanka and Thailand ~artici~ated, Eurma was supported through consultancy inputs for an evaluation of household and school latrines with special emphasis on technical solutions adopted at community level, study of the health educa- tion and motivation components of the pilot project on sanitary disposal of human wastes, and a study on solid waste disposal for Rangoon. In Nepal, consultant assistance was provided under the same programme for review of the sector in order to assist the Government in its preparations for the proposed donor consultation in late 1983, Under the Global Environmental Monitoring System's (GEMS) water programme, a special course on analytical quality control was held in Indonesia, and preliminary activities were started for preparing, under contractual agreements, profiles of the chemical safety situation in India, SrF ianka and Thailand in preparation for an inter-country workshop on this subject in 1985. In its continuing collaboration with ESCAP, the Organization prepared a working docgnent on the pollution and health problems related to the in- correct application of low-cost techniques for water supply and sanitation. This was to be presented at the tenth session of the ESCAP Committee on Natural Resources in Bangkok in October 1983. The Decade Commencement Report mentioned earlier has been published. The UNDP-funded project "Asia and the Pacific Regional IDWSS Decade Advisory Services" (~~~/81/024) began activities in October 1982. Local institutions within each country were undertaking case studies to monitor and evaluate Eecade problem areas, including community education and participation, institutional development, human resources development, and appropriate technology.. This project includes countries from three WHO regions, South-East Asia, Western Pacific and Eastern Mediterranean, SEAR0 acting as the focal point. In view of the comparatively small budget allocation approved for this project, the project has been designed to provide a catalytic input of an evaluative character into national. programmes to prepare guidelines for the training of national staff in the particular areas of study. Thus, the project is tailored co each country" requirements, the case studies being selected through discussions with local institutions in the country to ascertain the priority needs., Project inputs include (1) networking of institutions, (2) case studies to document Decade problems, (3) training, and (4) regional and country guidelines for improved project planning. With regard to research in environmental health, a consultative meeting was convened in October 1982 to review the progress as well as to set priorities in research and to reorient the environmental health research programme towards HFA/2000 and Decade goals. The recornendations of the meeting are being pursued for research promotion and implementation. Priorities will be given to topics such as health aspects of water supply and sanitation programmes, support programmes (such as behavioural studies, community participation, institutional aspects) and appropriate technology. There are four on-going environmental health research projects: the study on health benefits of water supply in a rural area (Jhansi, India), field-testing of an integrated water-supply and waste-water utilization system for villages (NEERI, ~ndia), study of ground-water pollution from pit latrines in Bangladesh, and use of domestic sand-filter jars for water purification in Thailand. In its cooperation with the Member States for the International Drinking Water Supply and Sanitation Decade, the Organization concentrates on five areas: promotion of the Decade, institutional development, develop- ment of human resources, information exchange and technology development, and financial resources (mobilization). hring the year under review, WHO has collaborated substantially in different aspects of community water supply and sanitation with nine of the eleven countries of the Region. It has also provided technical cooperation to five countries in the field of control of environmental pollution and to four countries in food safety. In addition, six countries of the Region have participated in inter-country activities during the year under review. The specific activity areas where technical collaboration has taken place with different countries during the year are shown in Table 4. In BANGLADESH, the recently completed UNDP/WHO project for the Water Supply and Sanitation Authorities (WASAS) has been of value in terms of providing information on institutional review, tariffs and operation and maintenance, and also in assisting the Government in meeting the World Bank/ IDA loan covenants. Further support to the WASAs is necessary, and it is essential to take up the second phase of this project without delay. The two long-term WHO staff assigned to the Department of public Health Engineering have assisted in various facets of its work, including evalua- tion of the latrine construction programme, development of self-help, the operation and maintenance of rural water supply systems, and the study of ground-water pollution from pit latrines. A serious constraint has been the lack of manpower, particularly at the technicians' level, and efforts were directed towards remedying this deficiency. Development of an information system on water quality surveil- lance is also an area that is being given attention in the Government/WHO collaborative efforts. Some of the external investment could not be absorbed properly and viable projects within the framework of a Decade Plan should now be generated in order to attract additional external funding. The Organization collaborated in some aspects of Decade plan preparations. With greater involvement of the Ministry of Health in Decade activities the critical issues facing the sector could be solved - given the fact that the Table 4 ~~viromentel Health cooperative kfiuifies with WHOISEARO (1 July 1982 - 30 June 1983) Activity Area BAN BHU BUR DPRK IN0 IN0 HAV MDG NEP SRL TW Inter-counfry COMNITY WATER SUTPLY AND SANITATION Promolion of the wead* Sector policy review and formularion x x Development OF overall Decade pien and progra-e x xxx xxx Inregration with PHC and other developments x x Review and reorientation of ~ecade plane x x Review with donors x x Delineation of vertical and horizontal responsibilities for decision making on planning, implenenletian and operatian and m.inten.nce Inafitufional Developmenr NAC LC TST Scudiea on rural WS administration and mananemenc - Studies on urban US adminierrstion and man.genenc Studies an rural saniterion administrarion and management Studies on tariffs and aubaidiea Studies on operation and maintenance Upgrading existing supplies Socic-behavioural acudiea Healfh education unrer surveillance Upgrading planning capabilities INO. MY.) ME, NEP,) (1) SRL 6 TBA) Developnenf of Human Resources Manpower inventory and survey Projection of manpower needs "Anpower inp1emenr.rion .L"die. Total ornporer plan Training of profe.sional and .ub- professional sraff Integration of HBD with PHC IND. NEP, SRL 6 TH* (2) IND (3) Infometion Blehenge and Techwlogy Development 1nform.tim for Decade plan ~nformacion for monitoring progress xxx x*x xxx Ilanagemnt info-rioo system (MIS) WETRI x x x x Appropriate technology development x x x x x x x Financial Resources PPIS x x x *XX mnar cltalogve mnor conavlcations seeror reviers Country secror digests xxx xxx xxx CONTROL OF EWIROWNTAI POLLIJIION wafer eontro1 x I XX Air pollurion control x x Indualry-specific pollution control x x x EHIA x X FWD SAFETY Ilanpover Development Reid Testing Integrated Food Safety wesrionnaire Revie" of Food legislation Strenzthenin~ of national food control Nore: NAC - National Action Committee; TST - Technical Support Team; HRD' Hurnsn Resources Development; - ~ETRI - ~rograwe on &change and Transfer of Informe~ion; PPIS = Project and ~rogralnoe Information System; EHIA = Enviromenfal Healfh Impact AerersmenL. (1) UNDP International ~rinki~g iieter supply and Sanitation @cede Advisory Services Project. (2) ~egional w~oluorld ~nnk IEOI) course on ~rojsct Formulation and ~ppraisal for water supply and saniration, *nna University, Iladras. 3 special Course on Water Pollution Monitoring and Control, International Institute for Hydrology and Enuiromentsl Engineering, Oelff, Netherlands. provision of water supply and sanitation has been declared as a major objective at the highest level of decisionmaking. In BHUTAN, a draft National Plan for the International Drinking Water Supply and Sanitation Decade was prepared by the Royal Government with the cooperation of WHO. Simultaneously, a project proposal has been formulated for the provision of low-cost sanitation in schools, basic health units and dispensaries throughout the country; this was under consideration for funding by UNDP. WHO'S collaborative activities in environmental health in BURMA have been progressing slowly but steadily. A national water committee was estab- lished to coordinate all activities of water and sanitation. However, each agency is preparing, departmentally, its own review and work programme. The manpower situation was reviewed and, based on the results, a plan for man- power development was under preparation through WHO/GTZ project cooperation. A country-wide survey under UNDPIWHO assistance was in progress to determine the status of existing water supply and sanitation facilities. This should constitute a useful inventory for planning new projects. A rural sanitation project was completed with WHO and UNICEF support. A new UNDPIWHO project for feasibility studies for water supply and sanitation in seven towns was approved by the Government. The Government's policy was to generate water and sanitation schemes as much as possible on a self-help basis, right from the initial stages of the Decade. In this way, it could channel as much of the external assistance as possible to production units for pipes, pumps, cement, etc., so that dependence on the import of these commodities could be eliminated. Institutional arrangements were available for promoting community involvement at all levels in all parts of the country through village or town committees. As regards the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, in the year under review cooperation was extended through a UNDP/WHO Preparatory Assistance Programme to identify a new project for the protection of environmental health in rural and semi-rural areas. A WHO mission visited Pyongyang and neighbouring areas and assisted the Government in developing a project proposal, which was awaiting approval. Fellowships were awarded under the WHO regular budget programme. In INDIA, efforts for providing water supply to "problem" villages were accelerated, particularly in view of the acute drought conditions that prevailed in many states. Provision of rural water supply to drought- affected villages received top priority, as it was one of the elements of the Government of India's 20-point development programme. WHO assisted in preparing a draft master plan for the Decade. WHO'S technical input in this exercise was utilized by the Government. In addition, ten senior engineers from different states went on a special six-week tour to selected countries in Latin America in order to study an integrated approach for rural piped-water supply schemes. In particular, engineers considered community education and participation, appropriate technology, operation and maintenance, and the financial and managerial aspects of developing self-reliant rural water-supply schemes. Seventeen senior Indian engineers attended a three-week course at Anna University of Technology, Madras, on project formulation and appraisal for water supply and sanitation - a course in which the World BankIEconomic Development Institute collaborated. Simultaneously, a few experienced engineers also went on observation tours of spot-source rural water-supply systems and self-help sanitation facilities in three Asian countries. In the field of environmental pollution, a special course that had been organized at the International Institute for Hydraulic and Environ- mental Engineering, Delft (the Netherlands), last year was repeated during the year under review. Seventeen Indian engineers and scientists attended this 12-week course, which was found to be very useful. The feasibility of arranging similar courses in India itself in future was under review, WHO provided specific assistance through short-term consultancies in identified areas, such as environmental management of iron-ore mines, air pollution control, waste-water treatment and development of water-pollution control laboratories. INDONESIA prepared its Decade Plan after the second national workshop held under GTZIWHO assistance. A National Workshop on Sanitation was also held in late 1982 with assistance from CDGjGTZIWHO. The Government was intending to prepare a further detailed plan at the provincial level with additional assistance from GTZ~WHO. A rural water supply institutional study was completed under the GTZjWHO project; this has contributed towards the Decade planning exercise. The training of engineers and consultants in pre-investment planning for water supply projects with UNDP/WHO assistance was nearing completion. Ma~power shortage continued to remain the major constraint. A comprehensive rural water supply and sanitation manpower training project assisted by UNDPjWHO commenced activities in 1983. Rural water supply feasibility studies were in progress in three provinces; these were executed by WHO with UNDP and GTZ funding. These projects have health education components, financial studies and hydrogeological investigations built into them. The environmental health programme in Indonesia continued to remain the largest in the Region. The review of the sector by all ministries concerned in developing policies and programmes through the two-workshop approach (a first workshop in which the broad strategies of Decade plans are discussed, and a second workshop which reviews and examines the plan resulting from the first) and the clear decisions by Government on areas for collaboration by inter- national agencies, including WHO, have placed the Decade programme in Indonesia on a sound foundation. The integration of social studies, health education and community participation in many of the rural water supply and sanitation projects is worthy of mention. Another positive aspect of the Indonesian programme is the active involvement of the health professionals in the Decade programme in the country. It is important, therefore, that the external agencies coordinate their activities better so that the excellent mechanism for planning that exists in Indonesia is supported effectively through external resources. The critical issues in Indonesia, however, are in project implementation where, due to acute scarcity of manpower, the Government often finds it difficult to implement the projects in the field. This can only be resolved when the national manpower situation improves. MALDIVES faces a very difficult problem in water supply and sanitation. The delicate balance of the ground-water lens under the atoll, the risk of pollution of the ground-water by human excreta, the saltwater intrusion through recessive draw-off from the wells, insufficient rainfall occurring only for a few months in the whole year - all these contribute to technological problems of the first magnitude. These have to be tackled with considerable expertise, so that the available potable drinking water can be managed and used properly without polluting the groundwater source, especially as Maldives cannot afford high-technology/high-cost solutions such as de-salination. These problems were being addressed and, given the commitment of the Government and the cooperative support that is tradi- tionally exhibited by the people of the atolls, the problems can be solved. A manpower survey was already at hand. A WHO team, together with the country engineer and the staff of the Maldives Water and Sanitation Authority, were to finalize the manpower plan in the second half of 1983. An appraisal of the sector was carried out by the donors concerned in connection with the immediate works programme for Male water supply and sanitation. In MONGOLIA, environmental health activities were directed towards strengthening laboratories for water quality surveillance and for the development of sewage treatment and disposal facilities. Environmental control became a routine part of the work of the Institute of Hygiene and aimak sanepid stations. WHO has supported their development by providing essential equipment and supplies and by training personnel with the help of consultants. In NEPAL, the manpower survey and planning for the Decade was undertaken through consultancy support provided jointly by WHO and the World Bank and the manpower plan is nearing completion. A draft proposal for the training of village-level technicians for potential donor support was also prepared. A proposal for twinning the Institute of Engineering, Nepal, with a university in the Region, possibly in India, was pursued and a delegation of sector officials from Nepal, including a UNDP consultant and WHO staff visited three universities in India and held discusssions with the Ministry of Education, Government of India. Their proposals were made available to His Majesty's Government for decision. Two senior engineers from Nepal also participated in the project formulation course in Madras and a total of 13 fellowships were awarded in water and sanitation to sector officials. WHO country engineers provided assistance to the Asian Development Bank in the preparation of an investment plan in the sector for Nepal. A crucial development in Nepal was the decision of the Government to review the Decade Plan through the establishment of task forces. These were to go into the different aspects of the Plan and prepare an updated sector policy document, together with project data sheets for identified priority projects in the updated Decade Plan. WHO is collaborating in this endeavour. In SRI LANKA, two senior engineers were trained in project formu- lation at the regional course held at Anna University, Madras. Through short, in-service training courses, some 200 technical officers and water supply maintenance personnel were also trained. Substantial progress continues to be made in the provision of rural water supply through deepwell handpumps. Hydrogeological and geophysical investigations on WATER AND SANITATI( lity water sr. ., &:-L .. forts of mo. Commur rpply and san,ta!ion occupy a position ur rrry,, briorily in the health develop- ment el. st countries in the Region. In many countries of the Region, ~roblems related to the heafrh of workers are increasing wilh growing indusfrialization. Narionalactiviries in this area are Iherelore being focusedon meering the needs for occupational heahh services as oar1 of comprehensive health development erforls. Mannar island were completed and production wells were under construction. During the period under review, the UNDP/WHO project for institutional support to the National Water Supply and Drainage Board was subjected to an intensive evaluation, as UNDP had selected this project for reporting to its Governing Council session in May 1983. This external evaluation, in which the Government, UNDP and WHO were associated, made recommendations for reorientation of the project in the remaining months of 1983 and identified the terms of reference for its extension beyond 1983. The Government gave priority to the operation and maintenance of existing supplies, upgrading existing water supply and sanitation facili- ties, and manpower development in order to consolidate the achievements made so far. Many schemes constructed in the past were expensive to maintain and increasing amounts of the development budget were used to subsidize operation and maintenance. The objective of the current priority activities was to remove this constraint, thus obtaining greater benefits from the investments already made. Task forces were set up to review different aspects of the programme and a national workshop was to be held later in the year to review the recommendations of the task forces so that an updated Decade Plan could be prepared. WHO continued to participate in the Government's endeavours in this regard, as it has done in the past. In THAILAND, several water supply and sanitation schemes were in progress, but no comprehensive Decade Plan was yet available at the time of reporting. The Government established a Centre for Integrated PLan of Operations under the National Economic and Social Development Board, and this centre was not only proceeding with Decade planning but was at the same time studying the establishment of permanent systems for information gathering and processing to enable continuous updating of the Plan and better management of its implementation. WHO'S resources were increasingly utilized in supporting village self-help in the planning, designing and operation of water and sanitation facilities as part of primary health care. 5.2 Occupational Health Needs of services related to workers' health were increasingly being focused as part of comprehensive health services and occupational health was gradually taking its due place in the health development efforts of several countries of the Region. WHO'S activities in this field consisted in providing consultancy services, awarding fellowships for training and support of national group educational activities, and conducting surveys/ studies. In BURMA, a WHO consultant assisted in setting up the Central Occupational Health Laboratory in November 1982. The instruments were provided through the UNDP-assisted project on the "strengthening of Health Services to the Newly Industrialized Areas" (west Bank of the Zrrawaddy river). The labo;atory was able to analyse samples delivered by the field survey teams of the occupational health unit. The WHO consultant conducted courses for the training of medical officers, technologists and laboratory inspectors in occupational toxicologyi practical laboratory techniques and procedures in occupational toxicology. Another consultant conducted a training course in occupational hygiene with reference to the monitoring of the working environment and the setting up and maintenance of hygiene standards for the medical officers and occupational hygienists. Emphasis was placed on monitoring techniques and also on the maintenance of supplies and equipment. Assistance was also provided in the upgrading of the existing occupational health (hygiene) laboratory. In INDIA, the 8th National Conference on Industrial Safety and Health was organized in New Delhi by the National Safety Council in October 1982. A consultant visited INDONESIA in 1982, reviewed the draft long-term programme in occupational health, and examined the possibility of developing a comprehensive programme for underserved working populations. 'The long-term programme in occupational health in Indonesia was finalized along with a proposal for occupational health care services provided through health centres. Broad lines of collaboration and coordination between the Ministries of Health and Labour in occupational health were identified. In THAILAND, the Department of Occupational Health, functioning as the WHO Collaborating Centre for Occupational Health, embarked upon a programme of primary health care for underserved working populations in small-scale industries and agriculture. It also submitted a request to UNDP for assistance in developing this important and wide-ranging programme of work aimed at the delivery of health care to underserved working popula- tions. WHO supported the Division of Occupational Health in carrying out feasibility studies in the training of primary health care workers for the delivery of health services in general industry, mining and agricultural workplaces. A workshop on educational material for primary health care workers was held in Bangkok in February 1983. With WHO support, the Department of Occupational Health, Faculty of Medicine, Mahidol University, Bangkok, conducted a study of working conditions, occupational health hazards and the health status of women workers in Thailand. 5.3 Radiation Medicine WHO technical collaboration with Member States continued as regards the strengthening of radiation medicine services and for standardizing radiotherapy dosimetry through a joint WHOIIAEA programme. In BANGLADESH, the Nuclear Medicine Department at the Institute of Post-graduate Medicine and Research (IPGMR) in Dhaka is well staffed and was supported by Bangladesh's Atomic Energy Commission. The Institute con- ducted ultrasonography and is well equipped with a gamma camera, scintilla- tion scanner and a three-channel renogram. The radiation protection services in the country continued to receive regular supplies of films from WHO. In BURMA, films continued to be supplied as part of the radiation protection services. It is hoped that with the arrival of BRS machines, facilities for radio-diagnosis would be explored for extension to the periphery. In INDIA, a consultant assisted the Department of Radio-diagnosis of the All India Institute of Medical Sciences (AIIMS) in New Delhi in the conduct of a workshop on abdominal ultrasonic techniques. The consultant delivered lectures on the use of medical ultrasound, especially for the diagnosis of abdominal lesions and a talk on "~dvances in medical ultra- sound diagnosis in 1983" both at AIIMS in New Delhi and at the Sion Hospital in Bombay. In MALDIVES, a WHO consultant trained national counterparts, and repaired and serviced the X-ray machine in the Male Central Hospital. WHO support was provided to facilitate the attendance of a nuclear medicine physician of the Isotope Laboratory in Ulan Bator, MONGOLIA, at the inter-qegional training course and study tour on nuclear medicine for the period September-October 1982. Films for film badges continued to be supplied. A WHO consultant assisted the Post-graduate Institute of Medicine, Colombo, SRI LANKA, as external examiner for parts I and 11 of the M.D. examination in radiology. In THAILAND, WHO activities in the field of radiation medicine included the BRS ~roject, quality assurance work in nuclear medicine and diagnostic radiology. As an experimental study, BRS (basic radiological system) machines are being provided to Burma, Indonesia and Nepal, and would be followed up for further utilization. 5.4 Food Safety Programme Although countries in the Region realized the need to develop food safety programmes in an integrated manner, activities were limited. This was mainly owing to a lack of resources and weak coordination among related implementing agencies or departments. Most food safety programmes in countries of the Region still concentrated on "centralized" activities, such as the establishment of regional or provincial laboratories and provision of central services; food legislation was mainly directed to urban areas. Careful planning and implementation of an integrated food safety programme with a multi-disciplinary team approach continued to be the main objective of WHO'S effort in this field. It must be realized that such a programme should cover all aspects of public health, and must be focused more at the rural and peripheral levels, where the majority of the popula- tion live. Health education and community participation must play a major role in this approach. In BURMA, WHO continued implementing the UNDP-supported project on food and drug control laboratories. In INDONESIA, a training course for food inspectors was held with support from WHO. A consultant assisted in the formulation of guidelines, legislation or codes-of-practice that would promote the establishment of an effective and appropriate food safety and control programme applicable to public places. Earlier, on a separate assignment, the same consultant had studied and reviewed the locally adapted food hygiene and sanitation control programme in Padang, West Sumatra. Another consultant was assisting the Government in strengthening a national food control infrastructure and system, keeping in view the development of an integrated food safety programme with a comprehensive team approach. In SRI LANKA, a group educational activity for the training of some 35 public health inspectors responsible for food safety was supported. In THAILAND, the recruitment of a consultant to assist the Government in the analysis of carbamate residue in food by a special technique in the later part of 1983 was under way. The questionnaire on food safety intended to assess country needs was pre-tested in Thailand. Fellowships on programmes related to food safety, and some supplies and equipment, continued to be provided by WHO in India, Indonesia, Sri Lanka and Thailand. 6. HEALTH INFORMATION AND STATISTICS The focus of the WHO programme in this area continued to be the development of national health information systems (NHIS) and their sub-systems and the strengthening of their infrastructures. The development of national capability in the field of health information and statistics and the conduct of national health studies and surveys were also supported. Keeping in view the wider perspective of the Seventh General Programe of Work for implementing the global, regional and national strategies for HFA/2000, the programme's scope and functions were further broadened. Reorientations ensued, necessitating closer collaboration with other programmes at all levels in order to provide a smooth transition from the Sixth to the Seventh GPW. A global consultative meeting on the health situation and trend assessment programne (HSTAP) was convened in Geneva in February 1983, which was attended by senior national personnel from some of the countries of the South-East Asia Region. The meeting drew up the guiding principles for the direction and development of the programme. At the regional level also, several consultations were initiated between technical programmes of communicable and non-communicable diseases, health information and statistics, the managerial process for national health development (MPNHD), and other related programmes to discuss the concept and direction of the new HSTAP and to plan for collaborative action at national, regional and global levels. In the Regional Office, the Health Statistics Unit, which is responsible for the development of HSTAP, was strengthened by the addition of a health information specialist in November 1982.
INTRODUCTION A review of activities always provides a welcome opportunity for introspection and stock-taking. During the six-year period of the Sixth General Programme of Work of WHO, which is concluding in 1983, gigantic strides were taken by the Member States in their health development endeavours. Similarly, there was serious rethinking of a fundamental nature at. the global level leading to a firm commitment to the objective of Health for All by the Year 2000 with primary health care as the key approach. This revolutionary change in the thought process of the health leaders of the wor1.d brought in its train a new direction in the joint collaborative efforts of the countries and the Organization as reflected in the Seventh General Programme of Work (1984-1989). Officially, the implementa- tion of the Seventh GPW will commence from next year. But so strong was the resolve of the Member States to achieve the goal of HFA and so emphatic were they in demanding action that a number of activities, including the formulation of national, regional and global strategies for HFA and the corresponding plans of action and their implementation and monitoring. began during the period of the Sixth General Programme of Work itself. Thus, the latter part of the period covered by this Programme, especially the last biennium, saw a dramatic transition of thought and action away from the conventional, beaten track to a more revolutionary and dynamic posture for health development as conceived in the Seventh GPW. The activities of the period under review have therefore to be seen in this context. Health Planning and Management - - During the early part of the Sixth General Programme period, commendable advances were made in most countries in health planning in respect of both organization and process development. Thus we saw the development of ever- improving health planning organizations and the training of health planners in almost all countries, notably Bangladesh, Burma, Indonesia, Nepal and Thailand. While organizational strengthening was continuing, country health programming (CHP) provided a process which was not only accepted but practised almost -- in toto or in an adapted form in most countries. This helped in systematizing planning, which had hitherto been largely - ad hoc, - by rationalizing the demands of the health sector and asserting its cause in the competitive field of resource allocation by the economically-oriented central planning commissions or similar bodies. Through these efforts, health planning became more problem-oriented, more systematic and more participative. With increasing commitment to HFA, health planning also became mission-oriented to a great extent. As a follow up of their commitment to HFA/2000 the countries are now moving into the stage of implementation of the HFA strategy which brings with it certain noticeable trends that augur well for the future. The focus of atten- tion is shifting to the operational levels of services and is being expanded to include activities in other sectors. Thus, during the period under review we saw Bangladesh expanding its PHC focus beyond the six pilot thanas; Burma paying increasing attention to improve the management of services at the township level: India initiating action for the development of management systems at state and district level: Indonesia decentralizing its extensive health plan- ning efforts and focusing more on the provincial and regency level; Mongolia taking steps for aimak development; Maldives for the development of atolls, and Nepal for the development of districts and panchayats. Sri Lanka has been developing its district health management system and Thailand has been introducing basic minimum needs through its Social Development Project at village and commune levels simultaneously, involving four sectors including health. Together with the actual implementation process most national health administrations are beginning to take an objective and evaluative look at their health development activities to ensure that they are relevant, effective and generating the expected benefits. This increasing interest in evaluation is not limited to national programmes but also includes WHO'S collaborative programme, whenever possible in the context of the national programme. During the period under review, the Indonesia-WHO collaborative programme was evaluated by a joint Government-WHO team, resulting in valuable feed-back for improving the colla- boration for accelerated HFA efforts. Early this year, an evaluation of various elements of PHC was carried out in two districts in Sri Lanka. The results served as useful inputs for improving PHC activities. The involvement of Member States in the work of WHO, which has been an established practice in this region. was further enhanced through evaluative reviews of WHO colla- boration by government representatives, who constituted a committee established by the Regional Director under resolution sEA/Rc35/~5. As a result of this experience, a practical and simple method for joint Member state/~~0 programme evaluation was being evolved. The review also provided useful guidance to the monitoring of both the financial implementation and technical progress of collaborative programmes as a part of WHO'S own managerial process. Health Information Systems Health information is an essential element in all these activities. However, the national health information systems (NHIS) in most countries of the Region continue to remain weak. One major reason for this is the unsuitability of sophisticated methods and technology in the prevailing situation in the countries. That a simple yet effective method of appropriate information generation can be applied in the developing countries has been amply exemplified by the successful experimentation with the "lay reporting system" and its application in PHC in our Region. This is certainly an achievement. Guidelines have been produced for further expansion of the lay reporting system. These have won acclaim and are being used in many developing countries. In addition to promoting and supporting the lay reporting system, WHO has been collaborating with the governments in the development of a suitable infrastructure for NHIS depending on the specific needs as well as the stage of development of the national health infrastructure in the countries. The Organization's programme for health information system development is now oriented heavily towards health situation analysis and trend assessment in order to support the proper planning, monitoring and evaluation of activities aimed at the achievement of HFA/2000, which is now the stated policy of all our Member States. Organization of Primary Health Care The commitment to HFA/~OOO has helped change the direction of the national health policies in order to provide appropriate health care for the entire population. Thus there is an overwhelming emphasis on equity and expansion of coverage to the unserved and underserved populations. While the importance of consumers of health services is being increasingly recognized and the parti- cipation and involvement of the community is being sought, a realization has dawned regarding the value of utilizing locally developed, cost-effective technology appropriate to the specific situations in the countries of the Region. As an inevitable corollary, therefore, the primary health care approach has been universally applied in the plans and programmes for health development. In this context, we see that in Bangladesh the network of thana health complexes continues to be the anchor of the health development programme: in Bhutan and Nepal, rural health posts are attracting considerably increased resources for further development and expansion: in Burma and India, rapid training and deployment of an adequate number of appropriate community health workers and volun- teers to strengthen the infrastructure at the grassroots level have been receiving the main stress: the Democratic People's Republic of Korea and Mongolia have been developing and maintaining health systems that provide health care to the entire population in the context of their socio-political situation: the PKMD programme in Indonesia has been the basic step in developing a viable infrastructure for sustained primary health care services, especially to the rural population, and has evoked the interest of both the public and the private sectors in its implementation; efforts in Maldives are being focused on manpower training and community participation; Sri Lanka has a new blueprint for the development of its PHC services dovetailed into the decentralized district-level socio- economic development programme: and Thailand is boldly and successfully experimenting with village-based community- managed PHC programmes. Health Legislation While the principle of PHC has been fully incorporated in the framework of plans and programmes for health development, governments have also made an effort to provide a supportive legal framework by revamping health legislation to strengthen and expand primary health care services. In Bangladesh, an improved set of health laws has been drafted with WHO support; in Burma, a national committee under the guidance of the Deputy Minister of Health has re-examined the existing health legislation to bring it in line with the Constitution and the Government's health policies, including Health for All: in Indonesia, health legislation has been strengthened to ensure the mobilization of adequate trained medical personnel for rural health services; Mongolia and the Democratic People's Republic of Korea have health laws that provide the frame- work for health services for the entire population; the Decentralization Act (2039) in Nepal delegates the authority for developmental activities to the district level, including the development of the health sector, which will facilitate the implementation of PHC programmes and reduce administrative bottlenecks; Sri Lanka has redrafted its health laws in support of the PHC approach. Urban Primary Health Care The efforts of the countries of the Region for the development of primary health care services are no longer limited to the rural areas; the lack of primary health care in urban slums is receiving increasing attention. The urban population in the Region has been increasing consistently and is likely to grow further, aggravating the already grim situation in the large city slums. Member States are becoming more and more concerned about this issue: studies have been undertaken in a number of cities, and in some cases measures have been initiated to amelio- rate the situation. For instance, India has prepared a plan for the reorganization of primary health care in the cities. In Indonesia and Thailand, community health workers have been deployed in some underserved urban areas. WHO has also initiated action for organizing consultation meetings involving urban development authorities, city corporations/municipa1ities and the governments both at the national and regional levels in order to define clearly a strategy for providing PHC to urban slums and underserved areas. Innovative Approaches in Support of PHC/HFA 2000 In addition to these conventional efforts, a number of innovative approaches have been experimented within the Region with WHO support and initiative, especially in respect of better coordination and utilization of health resources at country level for implementing HFA strategies. Some examples are cited below: In Thailand, a flexible programme budgeting exercise has been undertaken. This is meant to develop a process and a monitoring mechanism for unhindered utilization of WHO resources for health developmentwithin the country ceiling by the national authorities according to priorities identified by them. In Indonesia, a special programme of collaboration has been initiated in order to determine ways for the most effective utilization of all available resources, with WHO'S input playing a catalytic and coordinating role. Similarly, through multi-agency funding support (including that of WHO) Mongolia has launched an interest- ing experiment to develop a model of PHC services in an aimak; the model is being developed in a practical way, so that it can be replicated in other aimaks in a most cost- effective manner. Country Resource Utilization (CRU) reviews were conducted in Bangladesh, Nepal and Sri Lanka. These have facilitated a rational assessment of resource needs based on the trend of utilization of available resources for health development and have helped in the mobilization of appropriate and adequate resources to meet the defined needs. As a result of these reviews, a meeting of the funding agencies will be held in Sri Lanka later this year to explore the possibilities of financial assistance to health programmes drawn up on the basis of the CRU review in support of the national HFA strategy. Round-table Meeting of the Asia-Pacific Least Developed Countries, Geneva A Round-table Meeting of the Asia-Pacific Least Developed Countries took place in Geneva from 9 to 18 May 1983. This was a follow-up action for the Substantial New Programme of Action approved by the United Nations Conference on Least Developed Countries. This conference was a historic milestone in the evolution of international cooperation for development, Of the countries of the South- East Asia Region, Bhutan and Maldives participated and the documentation on these countries was presented by senior ministers. The conference thus provided an excellent forum for turning the focus on detailed sector needs, so that the donors could assess the problems and priorities of the countries concerned, with a view to mobilizing the resources required. The WHO/UNICEF Joint Committee on Health Policy (JCHP) has decided to coordinate the inputs of the two agencies, in consultation with the governments, in order to streng- then, and augment the ultimate impact of, the joint inputs on the development of PHC activities. This has already been planned in Burma and Nepal and is in the process of being implemented. An action programme on the nutrition component of primary health care, with funding support from Italy, has been planned jointly by WHO and UNICEF in Burma and Nepal and the implementation of the programme will start towards the end of this year. The mechanisms evolved in India for improving the development and management of the national health programme and for more effective utilization of WHO'S resources in support of national efforts include the Joint GOI-WHO Coordination Committee, under the chairmanship of the Secretary of Health and Family Welfare, which works at the policy level. It is supported by a steering committee composed of relevant health officials, which ensures the implementation of the policy decisions. In addition, in order to improve the technical content and management of the health programmes, a number of task forces have been established. These task forces, which are often multi- disciplinary in nature, consist of high-level national experts from various disciplines and are supported by WHO staff members whenever necessary. The organization of health systems based on primary health care, operational research at district level, the health information system and epidemiological services, blindness, leprosy and tuberculosis are some of the important areas for which task forces have been established. Family Health In the field of family health (a crucial component of primary health care), efforts have largely been directed towards strengthening managerial capabilities at different levels and developing appropriate and adequate manpower to deal with maternal and child health, including family plan- ning. In pursuance of the Regional Committee's resolution SEA/RC34/R8 on infant and young child feeding, endorsing the Regional Plan of Action, technical support was extended to a number of countries to strengthen the information base related to breast-feeding and weaning foods. A multi- disciplinary regional team continued to assist in project formulation, implementation, monitoring and evaluation in the field of family health. In most countries, family health is an integral programme of MCH and family planning including the components of nutrition and health education. In consonance with this trend and in view of the increased emphasis on MCH, Bangladesh has now fully integrated its population control programme with health development programmes, including MCH, at the thana level. The elaphasis xii on the training of traditional birth attendants (TBAs) continues. Family planning activities have been technically supported, whenever required by the governments, through the Family Health Team established in the Regional Office. Another team is supporting surveillance activities to improve the voluntary sterilization programme in Bangladesh. While WHO is promoting activities in the field. there is further scope for more active utilization by the governments of the technical expertise available in the Organization in support of their national programmes in MCH and family planning. Considerable emphasis is being laid on training in maternal and child health, with the focus on the care of the newborn and infants, particularly in India. In this context, WHO supported training programmes, including remodelling of the paediatric curriculum and integration of maternal and child health with family planning. Support was also provided for the development of a handbook on the delivery of MCH care to mothers and children in a community block and continued to be given for the pre-testing of a handbook on the care of children. District-level workshops on neonatal care for paediatricians and obstetricians continued with a view to strengthening neonatal care and training at the peripheral level. Other training efforts included the development of package curricula for various components of MCH care. In order not only to increase the coverage but also to provide better maternal and child health services, consideration was given under the Risk Approach Study to the development of intervention strategies relating to community participation, family self-help, intersectoral coordination and action, and appropriate technology for screening and management. Several countries in the Region participated in this activity. The growing acceptance of the concept of primary health care (PHC) has led to increasing epidemiological and health services research in improving MCH services in the context of PHC. In several countries of the Region, WHO supported research projects related to MCH, effective use of members of women's organizations, village volunteers and practitioners of traditional medicine for improving and expanding MCH/FP services. Research on the integration of family planning with other health services was another area of investigation aimed at improving maternal and child health. Since birth weight is one of the indicators selected for monitoring the progress towards Health for All by the Year 2000, a regional profile based on data from studies on perinatal mortality and morbidity is under preparation. The major objective of health education programmes has been to establish a partnership between health services on the one hand and the individual, the family and the community on the other, in the development and maintenance of the health of all the people. Another major preoccupation throughout the Region is the preparation of appropriate learning aids. In addition, efforts were made to identify the proper role of public information and existing mass communication and traditional media in educational programmes and to integrate them as essential components of the overall educational activities, as required. Efforts for developing nutrition projects through the Joint WHO/UNICEF Nutrition Support Programme continue. These aim at ensuring maximum impact on malnutrition and mortality on a national scale over the next five years. The establishment and development of national nutritional units in most countries is a key feature of the WHO regional programme in this area. The main thrust of the regional research programme in nutrition is concentrated around the priorities identified by the Scientific Working Group on Nutrition. Projects related to a situational analysis of the current status of the content and imple- mentation of the nutrition component of PHC have already generated activities aimed at making nutrition inputs through PHC more effective. This has led to improved nutrition training and new national activities on effective nutritional interventions through PHC. In addition, a major effort to increase the impact of goitre/cretinism control programmes is currently under way in the countries affected, largely through WHO and UNICEF support. Activities such as a national baseline survey in Bhutan, construction of salt iodization plants in Bhutan and Nepal, goitre/cretinism prevalence mapping in Bangladesh, an iodized oil injection programme and planning for salt iodization in Burma, and formation of a Government/WHO/ UNICEF goitre/cretinism working group in India highlight increased national and regional determination to control and ultimately eradicate endemic goitre/cretinism from the South-East Asia Region. Care of the Aged and Rehabilitation In the areas of care of the aged, disability preven- tion and medical rehabilitation, the approach has been to integrate these activities with primary health care, priority being given to the generation of epidemiological information to help define the problem and its extent. In order further to promote the action programme in support of the elderly in the Member States, preliminary discussions have been held in Burma, India, Indonesia and Thailand, and a plan of action for developing programme activities is under preparation. In India, active prepara- tions are under way to launch a comprehensive project for disability prevention and medical rehabilitation under the joint UNDP/UNICEF/WH~ "Impact" programme. Mental Health Substantial progress has been made in achieving the objectives and targets in the area of mental health, especially its integration as a. component of PHC. Efforts have continued in regard to the other two corner-stones of the programme, namely,development of appropriate technology and instruments for programme evaluation. A number of countries of our Region, notably Burma and Thailand, are now participating in an inter-regional study on the involvement of PHC personnel in problems related to alcoho- lism and the abuse of drugs. In respect of evaluation, efforts are being made to develop indicators of mental health. One additional country (Sri Lanka) has drafted a comprehensive National Mental Health Plan, and multi- sectoral coordinating bodies have been formed in Thailand and Indonesia. Essential Drugs Although efforts to develop the health-service infra- structure and facilities are continuing, one of the major difficulties faced by governments in providing primary health care to the needy is the shortage of essential drugs. Realizing that the availability of essential drugs of assured quality is crucial to the attainment of health for all, several countries in the Region have established drug manufacturing units in the public sector. In fact, at present the potential for attaining self-reliance in respect of essential drugs exists in Bangladesh, Burma, India and Indonesia, and to some extent in Nepal and Thailand. The main thrust of WHO activities in this area is to assist the countries in formulating drug policies, to popularize the concept of essential drugs, and to train technical manpower for strengthening pharmaceutical supply systems, including the improvement of drug supply and management programmes. Guidelines for establishing drug information centres and for developing legislation were provided by WHO, and the countries were assisted in strengthening their production units and introducing good manufacturing practices. With the active collaboration of DANIDA and SIDA, WHO is providing technical support to Bangladesh's drug policy and is assisting the countries in further strengthening self-reliance in the procurement or production of essential drugs and vaccines and establishing national quality control facilities. TCDC mechanisms have been effectively utilized between Indonesia and Thailand in support of their essential drugs programmes. Traditional Medicine Efforts to involve practitioners of traditional medicine and utilize traditional herbs and medicines in primary health care are also reaping dividends. Guidelines for preparing a list of essential traditional medicines for PHC have been drawn up. In Mongolia, there is evidence of new interest in this aspect of PHC and the country has established an Institute of Folk Medicine for the development of research in various aspects of traditional medicine. In some countries (e.g., Nepal), traditional medicine preparations have been included in the list of essential drugs for primary health care. In India and Sri Lanka, traditional medicine is being given increasing importance. In fact, in India, an additional position for a physician has been provided in primary health centres to accommodate a practitioner qualified in traditional medicine. There is also an effort in some countries to utilize practitioners of traditional medicine in rural communities as primary health care workers. Epidemiological Surveillance Epidemiological surveillance is attracting greater attention in the Region and WHO'S technical support is being given for implementing various training programmes for intermediate-level general field epidemiologists. The successful example of the f ield-training programme under- taken in Thailand during the past two years is now being emulated in other countries. As a result, Indonesia has initiated similar service-based, field-oriented instruction in epidemiology, utilizing the health service facilities of the Government, medical schools and research institutions. In both Indonesia and Thailand, the training programmes are well established and progressing satisfactorily with active WHO support. The objective is to utilize the two facilities for meeting the training requirements of the countries of the Region as soon as these are fully developed *nd, if necessary, to develop similar national courses in other countries where the need and the teaching potential exist. In India, WHO supported the establishment of regional and state epidemiological surveillance systems, including the training of field-level epidemiologists, collaborating particularly with the National Institute of Communicable Diseases in this respect. Malaria Malaria continues to be a priority health problem in most countries of the Region. Although it declined slightly during the year, it is now apparent that the incidence rate is showing a dangerous tendency to flatten into a plateau, particularly in respect of falciparum infections. Moreover, Plasmodium falciparum infections are showing an increasing trend, replacing, to some extent, those caused by P. vivax in Bangladesh, Bhutan, Burma, India, Indonesia, Nepal and Thailand. Fortunately, this has not happened in Maldives or Sri Lanka. An evaluation of the existing methodology for surveil- lance mechanisms and widespread presumptive treatment for fever cases shows that this methodology can successfully reduce mortality but is not effective in preventing transmission; the use of residual insecticide spraying, particularly DDT, must be continued where there is moderate or high transmission. However, vector resistance to DDT and some other insecticides continues and efforts to tackle this problem by integrated vector control methods have not yet succeeded. In addition, parasite resistance to the standard anti-malarial drugs continues to intensify in Burma and Thailand, and the problem is of a focal nature in eastern Bangladesh, and north-east India, and Indonesia. Field and clinical trials of new drugs or treatment regimens have been continuing with WHO'S support, but the lack of a long-acting drug or a vaccine, and the mounting cost of malaria control operations in terms of drugs, insecticides and personnel, pose serious threats to maintaining the present gains. The emerging policy of integrating malaria control programmes with primary health care services, which is being implemented energetically by several countries, mainly in low-risk areas, has been a particular object of WHO support during the year. Attention needs to be paid to strengthening these integrated programmes in terms of epidemiological assessment and systematic and detailed programme planning and in respect of manpower development, both with reference to the multipurpose PHC workers and the technical malaria support group. In areas of high risk or special risk (such as in development projects), a lengthy preparation for phased integration is proving to be essential. It is in terms of these areas that progress towards health for all will be evaluated. National malaria programmes are being supported by WHO in respect of planning and evaluation, development of applied field research concerning technical constraints, and organization of and participation in training activities. In particular, the monitoring information obtained from the Regional Collaborative Studies on drug- resistant falciparum malaria continues to be of great value to the national malaria programmes in revealing the intensity and spread of such resistance, and in indicating alternative drug strategies. Tuberculosis As one of the principal health problems in the Region, tuberculosis has received considerable attention from both governments and WHO, particularly in respect of early case detection and treatment, and also immunization of the most vulnerable group - young children. In Bangladesh, the integrated control programme, which tackles both tuber- culosis and leprosy, has been augmented by BCG vaccination of half a million children while, in India, WHO is continu- ing to provide a considerable amount of technical support, especially to the Tuberculosis Research Centre in Madras to undertake research in the treatment and prevention of the disease. Leprosy Leprosy is a problem in nine countries of the Region, and a reduction in the number of 5 million estimated cases continues to be difficult. The obstacles that need to be overcome relate to the social stigma of the disease, for which health education of individuals and the community needs to be strengthened. They also relate to the technical aspects of programme delivery, including early diagnosis and treatment, shortage of drugs and selection of the more efficient multidrug regimens. Research to overcome these obstacles continues to be an important element receiving WHO support, and needs to be taken advantage of by national authorities if progress is to be made in reducing the incidence of leprosy. WHO initiated practical measures to strengthen national leprosy services by providing technical support to reorient and strengthen community-based control programmes and by developing a regional plan of action in collaboration with other United Nations agencies and various bilateral and non-governmental organizations. In pursuance of the recommendations of the technical discus- sions on the control of leprosy in the context of primary health care during the thirty-fifth session of the Regional Committee, several countries have already strengthened the multidrug regimen in their national leprosy control programmes. Diarrhoea1 Diseases Diarrhoea1 diseases are recognized by all countries in the Region as a leading cause of morbidity and mortality, especially in young children. They are closely linked with diseases such as measles and whooping cough that may be controlled by immunization, and with malnutri- tion and acute respiratory infections, which account for 85 per cent of the mortality at that age. The mortality figures relating to diarrhoeal diseases have, however, been significantly decreased by oral rehydration therapy (ORT) using a scientifically proven salts-sugar combination administered at home. The national diarrhoeal diseases control programmes established in 10 countries of the Region have recognized the objective of reducing mortality as their priority task and have included efficient ORT strategies in their programme component. In order to improve the delivery of such treatment through the PHC system and involve mothers and families more intimately, WHO is directly contributing to manpower training and the initiation of studies on the optimal ways of involving the community and the household. Several studies on the accept- ance of ORT, and of its efficacy, have been completed and the results incorporated in the programme. Research in diarrhoea1 diseases, especially health services research, is being undertaken in seven countries. Expanded Programme on Immunization The Expanded Programme on Immunization continued to be implemented in 10 countries of the Region, with the support of WHO, UNICEF, UPJDP and other agencies. Activities were increased in most of the countries not only in t.erms of coverage but also through the introduction of more antigens against a broader array of childhood diseases, within the framework of PHC. Development of manpower. review and evaluation to promote effectiveness, and operations research were also supported. Although the immunization services have been integrated into the basic health services in most countries, reviews show that the peripheral health workers and village volunteers are not sufficiently involve6 in the programme. This situation needs rectification in order to make the national programmes optimally effective. During the year under review, the programmes in Indonesia and Thailand were reviewed by joint national and international teams, while in six of the countries, 94 immunization coverage surveys were made. It is apparent that the South-East Asia Region is far behind the target in achieving the main EPI objective of immunization of every child by 1990, although some countries, notably Mongolia, maintain a high immunization coverage. This is another aspect which demands the urgent attention of national authorities since it is recognized that much can be achieved in this area by improving managenent, including the supervision of implementation of the activities, within the existing resources. Viral Diseases Research in respect of the diagnosis and epidemiology of viral diseases is being promoted by \JHO in areas where these constitute a public health problem. Epidemiological and transmission studies on hepatitis B virus (HBV) are in progress, and research in Burma on the efficacy of HBV vaccine in disrupting transmission has already indicated the important role of such vaccines in preventing chronic liver diseases and probably hepatic cancer. In India, Mongolia and Nepal, the leading role played by non-A non-B hepatitis virus is being examined. Dengue haemorrhagic fever (DHF) continues to be a significant health problem in Burma, Indonesia and Thailand, but so far no notable evidence of spread, other than sporadic cases, has been received from potentially susceptible countries such as Eangladesh, parts of India, Maldives and Sri Lanka. Stress was laid on the need to strengthen DHF surveillance in these vulnerable areas. WHO supports national efforts in undertaking epidemiological studies, training of personnel and clinical managenent of cases, and also in the development of a dengue virus vaccine at the CJHO Collaborating Centre in Bangkok. The initial batches of dengue type 1-4 strains of candidate vacci~e are available for human trials. The problem of rabies is recognized in at least eight countries of the Region. WHO has supported the governments not only in developing the post-exposure vaccines for treatment in man but also i11 producing prophylactic vaccine for use in animals. The Organization provided considerable support to Bangladesh, Nepal and Sri Lanka to develop a balanced rabies control programme. At the Pasteur Institute in Coonoor, India, a regional centre for training in the methods of providing tissue culture rabies vaccine for human use is now being developed with WHO/UE;IDP support. Non-Communicable Diseases The major emphasis of CHO's technical collaboration with Member Countries in respect of non-communicable diseases is in the promotion of an integrated social and behavioural approach to the prevention, early detection and control of emerging health problems, particularly in cancer, cardiovascular diseases, chronic liver diseases including cancer, and accidents. Areas of such collabora- tion included \JIIO support for epidemiological studies to define the problem, the formulation of national plans for prevention and control, development of health educational materials for the primary prevention, early detection and management of these emerging health problems, and research in support of the activities. Sri Lanka is one of the target countries selected for the global cancer control programme for studies on the primary and secondary prevention of a form of cancer common in this region, i.e., oral cancer. At the same time, in India, Mongolia and Sri Lanka, the formulation and implementation of comprehensive cancer control programmes have made some progress. Epidemiological data on various forms of cancer are being collected through hospital and population-based cancer registries in several countries. The dissemination of information on the prevention and early detection of cancer is also being strengthened. Knowledge regarding effective relief from pain for curable cancer patients is being made available. In regard to other nnn-ccmmunicable diseases, early detection of diabetes and the prevention of deafness has received increasing attention and support. e early detection of diabetes is strengthened through an integrated approach for the prevention and control of non-communicable diseases. A community approach in the detection and control of diabetes is gaining support in a number of countries in the Region. To this end, the training of medical, para- medical and lay personnel is being organized. In this connection, the research efforts made by the Bangladesh Institute of Research and Rehabilitation in Ciabetes, Endocrine and Metabolic Disorders is worth mentioning. Prevention of deafness amon3 children was the subject of an inter-country workshop held in the Regional Office in late 1982. Activities aimed at the prevention of deaf- ness are being promoted in :,;ember States. In Thailand, for instance, technical support has been given for developing activities aimed at providing ear surgery as an outreach service through mobile teams. The Regional Office has collaborated in the conduct of national. workshops in several countries. Prevention of Blindness The collaboration of WHO with national programmes for the control and prevention of blindness has included aspects such as training, review and evaluation and mobili- zation of resources in support. of national activities. It is estimated that these are approximately 12 million blind in the Region, the majority living in the underserved rural areas. While at least half the cases are due to cataract and can be cured, the great majority of the remainder are attributable to preventible causes such as trachoma (particularly in Burma and Thailand), injuries and malnutrition (vitamin A deficiency in Bangladesh, India and Indonesia). Early detection and treatment could prevent deterioration of vision in people suffering frcm conditions such as glaucoma and diabetic retinopathy. Provision of eye care as an integral part of primary health care is the basis of national programmes, supple- mented by interventions against blinding infection and malnutrition, and by removal of cataracts through outreach surgical services such as eye camps. Community Water Supply and Sanitation -- Community water supply continues to receive h~qh priority in most countries of the Region. Consequent: on certain set-backs and causes for frustration due to lack of adequate resources and other factors during the last one or two years, the Member States in 1983 critically analysed and reviewed the constraints facing the sector to determine how best they could be resolved, to attain the national goals. In respect of water supply and sanitation programmes, greater attention is now being paid to institutional and manpower development. Mpropriate technology, health educa- tion, community participation, health systems research, and other "software" components of the programme are also receiving attention. Without these components, facilities constructed cannot be maintained by the communities at a cost they can afford, nor can the health benefits of these interventions be realized. One of the glaring disparities in the ongoing water supply and sanitation programmes is the heavy emphasis being laid on water supply, while very little attention is being given to the sanitation aspect in the national efforts for the Decade. This trend must be checked and a balance between these activities must be established. The health impact of water supply deve1.opment may be hampered if both these activities. along with health education, are not judiciously blended, With this in view, WHO has been organizing courses on formulation and appraisal of water supply and sanitation projects and on the technical, financial and cost-benef it analysis aspects of these projects. Low-cost technologies are now being increasingly used in water supply and sani- tation projects with the growing understanding of their easy application, cost-effectiveness and adaptability. This has enhanced their acceptability and encouraged the community to participate in their implementation. In its cooperation with Member Countries in Decade activities, WHO has acted as the executing agency for several country or inter-country projects funded by UNDP and by various bilateral and other funding agencies such as GTZ and DANIDA. New projects in which WHO collaboration is being sought involve less hardware and more technical and managerial components, e.g., planning, training, evaluation and other such activities. This trend is also reflected in WHO'S collaborative activities in water supply and sanitation programmes through its own funding. In order to involve high-level national technical and administrative authorities in the implementation of Decade programmes and make them fully conversant with the problems of the sector, a consultation meeting was scheduled to be held in August 1983 to review the Decade activities, identify the issues preventing its progress and to find alternative solutions. Environmental Pollution Several countries in this region that are going ahead with industrialization are now encountering more and more of the problems associated with environmental pollution that are traditionally faced by industrialized countries. In an effort to strengthen the role of health ministries in the identification and control of environmental hazards, WHO'S support is being increasingly sought in environmental monitoring, chemical safety and assessment of health effects, besides training and provision of information. The Organization has been providing technical support, especially in India, Indonesia and Thailand, through an inter-country project. Health Manpower Development As regards health manpower development, the thrust of the Organization's activities is on supporting the Member States in planning health manpower to meet the specific needs of their health systems. Towards this end, WHO has been promoting, at the national level, a more comprehensive approach to the problems of manpower development involving all aspects of manpower - planning, production and manage- ment. Member States are encouraged to develop effective coordination between all institutions responsible for the training of health personnel and the service agencies responsible for the delivery of health care. In the areas of health manpower planning and manpower management, some sustained efforts will have to be made at the national level. In this context, the development of a country-based health manpower information system is seen as an essential prerequisite for initiating more systematic and continued manpower planning and management activities. Greater attention will also have to he devoted to manpower management strategies in order to improve employment conditions and career development. This would lead to more effective utilization of trained manpower and minimize the losses sustained by the migration of health personnel and by their abandoning careers for which they have been trained. In the more conventional area of manpower production, the Organization's resources have been used to strengthen training programmes and institutions. This has involved support to faculty development, revision of curricula, improvement of evaluation methodology, and the promotion of teacher training in educational methodology. These training and support programmes have been utilized at the national level to improve the capacity and the quality of such training for various categories of health personnel, including doctors, nurses, as well as paramedical, ancil- lary and voluntary health workers, including traditional birth attendants. Pervading all these activities have been the Organization" efforts to modify the more traditional teaching and learning processes so that they are task-based and more effectively focused on meeting community needs. These efforts have had a commendable impact on training programmes in many countries of the Region for middle and peripheral-level health workers. In order to achieve community reorientation in medical education and the training of health workers, a much more comprehensive approach to the whole problem of education and training must be adopted at the national level, especially by the medical leadership, in the interest of the underserved and unserved people of each country. The Organization has been supporting a wide range of regional and national activities with the aim of reorient- ing medical undergraduate education towards community needs. These efforts have hitherto focused mainly on stimulating appropriate changes in curricula, improvement of learning and evaluation methods, strengthening of faculty development in community orientation through the establishment of departments of community medicine, and the adoption of field practice areas. The changes, however, have been confined to the area of educational development within the manpower production process, and have had only a limited impact on a critical problem facing the countries, namely, that of producing the right types of doctors in the right numbers, with the right competencies and at the right time and place. In many countries, there continues to be an incomplete appreciation of the import- ance of the additional roles that doctors need to play and the responsibilities they have to discharge as health team managers. leaders and teachers. Equally, the doctors complain of lack of job satisfaction and career opportu- nities, inadequate continuing education, and lack of facilities to utilize their knowledge and skills. There- fore, efforts have to be made to define, as clearly as possible, the most appropriate role of doctors in a given social, economic and political setting by taking into account the community's priority health needs, expectations and resources. A recognition of the important role of team work among health personnel at the PHC level has led to the initiation of country case studies, supported by WHO, in an attempt to identify the specific factors that promote or impair the ability of health personnel to work as a team. The need to adopt a more systematic approach for the provision of facilities for continuing education has been accepted and strategies and activities to achieve this objective are being formulated. The assessment of levels of perform- ance of health workers is seen as an essential element in manpower management procedures and provides important feedback for the evaluation of ongoing training programmes. The Organization has been active in developing a methodology and in elaborating specific test instruments for use in making such assessments. Health manpower development research has been focused on providing solutions to the numerous problems that countries are faced with in attempting to match manpower production to their needs. Awareness of the inadequacy of conventional biomedical methods for the solution of health service research problems led WHO to describe the alter- native methodologies available for this purpose and to define the specific advantages of these methodologies. At the national level, the Organization has promoted the wider dissemination of knowledge of these newer methodo- logies and their use on a wider scale. Promotion and Development of Research Yet another facet of WHO'S activities in support of health development efforts in this region is the promotion and institution of research to solve technical and operational problems in the field of health. At the country level, national councils for medical research or analogous bodies that play a coordinating role have been the focal points through which WHO has channelled its support for research development. At least nine countries have such mechanisms which have generated consi- derable enthusiasm and awareness about the crucial role of research in achieving HFA goals. They have also taken steps to develop not only actual research activities within the existing limited facilities but also in training research personnel and strengthening or developing suitable institutions to improve national research capabilities. WHO promoted periodic meetings of the directors of these bodies to help exchange views and experiences and to sharpen the common guidelines to pursue and manage research activities in the Region. The third meeting of the directors of medical research councils was held in December 1982 and deliberated on a number of topics, including health services research, training in research management, strengthening of national research capabilities, prepara- tion of plans of action for research development at national level, and other related subjects. In order to create self-reliance in conducting research at the country level, two major actions have been taken by WHO. The first was to train potential researchers in research techniques and appropriate protocol develop- ment, and the second was to identify potential institutions that could be strengthened by creating newer physical facilities and raising the technical capability of the existing personnel in their own discipline. Thus, a major component of WHO'S research programme in the Region is related to institution strengthening activities at the national level. The visiting scientists grant and research- training grants are now increasingly being used by national researchers. These grants are no longer awarded in an open-ended. manner. On the contrary, each grant-based training proposal is critically examined and is approved only when it is directly related to the needs of an ongoing research programme supported by WHO's research funds. The Organization's inputs to research support and research training, being complementary to each other, thus produce a multiplier effect. In addition, a network of national institutions has been identified and designated as WHO Collaborating Centres. The major objective of this network is to promote collaboration between scientific workers at the national level and WHO's activities related to the development of services, manpower and institutions or field-based research in health. This has an added advantage in that such collaboration and involvement of the national centres in health development work supported by WHO and the government helps to improve their own capability in specific fields. It also enhances cooperation and promotes better understanding between the Organization and the national institutions. In addition to the research activities supported by the regular budget, the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases has made a considerable contribution to promoting and supporting research, especially in the fields of malaria and leprosy in this region. Similarly, the WHO Special Programme of Research Development and Research Training in Human Reproduction continued to be the major source of support in research related to family planning and allied areas. In conformity with the social goal of Health for All, the regional research programme is being reoriented to meet the needs as identified in national, regional and global HFA strategies. The South-East Asia Advisory Committee on Medical Research (SEA/ACMR) has already articulated the basis of and principles determining the research priorities for HFA, in order to shape and guide this reorientation process. At the same time, the SEA/ACMR has strongly stressed the importance of health systems research, which should be the core of the research activi- ties in the Region. An effort has also been initiated by the Regional Office to promote behavioural sciences research, as it is now realized that individual and social behavioural patterns are likely to determine the success or failure of many health interventions. These patterns must therefore be clearly understood through research in order to generate meaningful efforts for self-care and community involvement. In all these activities, the members of the SEA/ACMR have played a very strong leadership role, not only by providing guidelines but also in stimulating the national authorities to align their research efforts to solve identified priority problems. The Regianal Office has now developed an effective and systematized management process to implement and coordinate WHO'S research programme both at the regional as well as at the country level through the involvement of its Research Promotion and Development (RPD) unit and a Research Development Committee as well as the Scientific Working Groups in specific programme areas. A "peer review" mechanism to scrutinize the research proposals technically and a process for ethical assessment of the proposals, where needed, are also available. There is no doubt that the RPD activities in the Region are now built on a sound base and are poised to make rapid progress durj.ng the Seventh GPW period, Women, Bealth and Development While women, as consumers of health, are the beneficiaries of health development activities, their role as providers or as active agents of health development has also been recognized by WHO. Thus, as in all other regions and WHO headquarters, the South-East Asia Region has also established a programme on Women, Health and Development (WHD), which is being planned and implemented by a core group specifically charged with the task. The programme is unique in the sense that it has identified appropriate entry points in the existing programmes for health develop- ment through a component for WHD. Thus the programme is a multifaceted one and is being developed as an integral component of the total effort for health development, without having a separate vertical identity. The programme has successfully involved the countries in activities through the establishment of national focal points nomi- nated by the government concerned and country working group assisted by the WPCR. One of the activities now being pursued by the regional CJHD and country focal points is the generation of sex-wise data at national level in order to define cl.early the problems related to women's health. The regional WHD group also actively participated in the interagency committee meetings on "Women in Development" under the aegis of ESCAP and is closely involved in the preparatory activities for the World Conference of the United Nations Decade for Women to be held in 1985. Health Ministers Meea The Second Meeting of the Ministers of Health of the countries of thi,s region, held at Dhaka following the thirty-fifth session of the Regional Committee. reviewed the developments that had taken place since their first meeting in September 1981. The ministers unanimously agreed on the selection of a few areas of common concern for developing concrete plans of action to promote technical cooperation among the countries. Health manpower training, diarrhoeas diseases control, and immunization were identified as areas of priority. It was felt that such identification would enable the Member Countries to take immediate advantage of the complementarity of the available expertise in the Region and lead to optimal utilization of scarce resources on a regional basis. As a follow-up action, the Regional Office has, in close consultation with the national authorities, made an effort to identify the specific needs of the countries in these three areas and the resources that may be mobilized from within the countries of the Region to meet these needs. Further action in this regard will be planned on the basis of the decisions taken at the Third Meeting of the Health Ministers immediately fol3owing the thirty-sixth session of the Regional Committee. Conclusion From the short resume given above it is apparent that, particularly during the period under review, the countries of the South-East Asia Region have made significant progress in their voyage towards attaining the goal of Health for All. WHO/SEARO has had the proud privilege of contributing to this colossal effort. 111 the process of developing the Organization's collaborative programmes with the countries, our sister agencies in the United Nations system, especially, UNDP, UNICEF and UNFPA, and a number of multilateral and bilateral agencies, such as the World Dank, Asian Development Bank, AGFUND, US AID, CIDA, DANIDA, SIDA, NORAD, ODA and GTZ, provided very useful. support and cooperation. Similarly, non-governmental voluntary agencies such as the Sasakawa Foundation, the Royal Commonwealth Society for the Blind, the Asian Foundation for the Prevention of Blindness, and many others collaborated in their specific areas of interest. For this cooperation and contribution I wish to convey my sincere appreciation to all of them. I would also like to express my deep gratitude to the people and governments of our Member States for their unflinching support and understanding and their patience and perseverance in working in collaboration with WHO, their own Organization, towards the goal of Health for All by the year 2000. Given the will, determination, commitment and sense of responsibility that have so forcefully been demonstrated by the Member States, I have no doubt that through our combined efforts we will certainly reach this goal, however arduous the path. I& I&- - Dr U KO KO Regional Director xxviii
7. HEALTH MANPOWER DEVELOPMENT The Organization's support to health manpower development within the Region continued to be based on three basic objectives: (i) strengthening the mechanism for, and linkages between, manpower planning, production and management; (ii) ensuring that all types of training programmes for health workers are consonant with the need to provide effective and efficient primary health care and consistent with the overall goal of HFA/2000, and (iii) assisting the countries of the Region in collaborating and cooperating with one another in all areas of health services and manpower development in the spirit of TCDC. Health Manpower Planning Health manpower planning exercises were conducted in Bangladesh, Burma, Indonesia, Nepal and Thailand. In BANGLADESH, WHO collaborated in the preparation of a draft health manpower plan. The process had been started in 1981 with the preparation of the Health Manpower Situation Report, followed by a national health manpower planning exercise in June 1981 and the preparation of individual outline plans for selected categories of health personnel. A health manpower plan steering committee and a working group were formed by the Government to carry out the process. The draft health manpower plan does not outline any decisions on health manpower; rather it presents possible options that decision-makers may consider and choose in the development of the national health plans. They would thus be considered when the Second Five-Year Plan (1980-85) mid-term review and the formulation of the Third Five-Year Plan are being undertaken. Thus it was ensured that the health manpower plans would be automatically included and implemented with the five-year health plans. In BURMA, health manpower planning was undertaken in conjunction with the development of country health programming (People's Health Programme) efforts. In the first country health programme (CHP), the manpower resources needed were considered separately under each of the primary and support programmes. However, in the second CHP cycle, which was conducted in 1980181, a separate health manpower planning and projections exercise was undertaken, consolidating all the manpower resources required for the four major programmes. These exercises, undertaken as part of the total health planning effort, ensured that the options and possibilities for manpower development were fully taken into consideration. The planning exercise in INDONESIA was one of the most comprehensive ones. The health manpower projections were developed as a part of a massive exercise in the Ministry of Health to produce a long-term health programme up to the year 2000. This major activity was managed by a network of committees involving the Minister of Health, all the senior staff of the Ministry of Health, as well as many middle-level and junior staff. The actual projection of health manpower requirements was made by 13 specific working teams coordinated and consolidated by the Health Manpower Develop- ment Working Group. The overall health manpower planning document is being used as a basis for the preparation of provincial health manpower plans for each of the 27 provinces for Pelita IV. In THAILAND, an important development was the efficient coordination between the Ministry of Public Health and the University Bureau by the Centre for Coordination on Health Manpower Development. The Centre has been working efficiently. Each university is represented and meetings are held regularly. A one-month planning course for 40 planning and evaluation officers in the office of Provincial Medical Offices was also implemented. Bangladesh and Burma participated, through contractual service agreements, in the global study on the development of simple methodologies for providing health and health-related manpower development. This study originated from a meeting on health manpower projections held in 1981 in Geneva where the health manpower projection methodology had been simplified and standardized and countries selected to test out the methodology. A second inter-regional meeting was held in December in 1982 in Harare, Zimbabwe, to review the experience of the participating countries in the use of the different methods of health manpower projections, Health Manpower Managems WHO has been promoting in Member States the balanced development of all the three components of the health manpower developoment process, viz., planning, production and utilization or management. Although a large number of countries had taken positive steps in developing health manpower plan- ning, much less attention was paid to health personnel management. This area included explicit employment and utilization policies, monitoring of manpower requirements and utilization, performance-based job descriptions, performance assessment, staff supervision, continuing education, and provi- sion of incentives and opportunities for career development. Many of these aspects had no doubt been included in overall health manpower planning as well as in health management training courses, but they did not get the consideration they deserved. To correct this situation, the Regional Office and WHO headquarters, in collaboration with the Member States, would undertake activities to strengthen this area. To this end an inter-regional meeting to consider health manpower management was being planned for the end of 1983. Health Manpower Development Research The Organization continued to foster the strengthening of HMD research in its Member Countries. An inter-regional Consultation on Alternate Methodologies for Health Manpower Development Research held in New Delhi in July 1982 served a very useful purpose in bringing together an international group of experts who deliberated on these alternate methodologies, their specific applicability and usefulness for the solution of different problems in the HMD field, and identified the ways by which information relating to these newer methodo- logies could be more widely disseminated to national researchers, policy makers and health service administrators. WHO has been promoting the concept of the team approach in education, training and the delivery of health services, particularly at the primary care level, as an important basis for health manpower development. A consul- tant assisted Indonesia, Nepal, Sri Lanka and Thailand in developing and formulating protocols for comparable national case studies on team work, designed to identify how different categories of health personnel worked together as a team at the community level and to recognize the specific factors that promoted or impaired the ability of people to work together as an effective team. In addition, the Organization continued to support individual research projects formulated by national workers which conformed to the overall guidelines provided by the Regional Advisory Committee on Medical Research. In BURMA, studies to determine the effectiveness of national workshops in educational science, and for the evaluation of the rotating house surgeon training programmes, have been technically reviewed. In NEPAL, assistance was provided for studies which attempted to assess the performance of health personnel working at health posts. In THAILAND, projects designed to assess whether the training of medical graduates prepared them adequately for their subsequent careers, especially in public health administration, were assured of support. Assistance was also being provided for projects attempting to devise aptitude tests for use in screening applicants for selection for entry into medical schools and for the mid-term evaluation of a special educational programme for training medical students for rural areas. In general, the state of development research in the countries of the Region is inadequate. While some isolated and sporadic studies have been undertaken they do not as yet constitute a part of a well planned and systematic effort and as such have had little impact on the solution of national problems. The major reasons for this were perceived as the lack or inadequacy of established institutional mechanisms at the national level where policy makers, health service administrators and research workers could meet together to identify researchable problems, determine their priority and decide on research procedures to be applied in search of solutions. In order to develop systematic HMD research, efforts should be made to bring together a critical mass of appropriate group of researchers belonging to relevant disciplines who could work as a team to tackle the multifaceted problems. Health Team Training Following an inter-country consultation on "~eam Work and its role in Primary Health Care Servicesf' held in 1981 in the Regional Office, a series of national case studies on team work was organized during the period under review. A consultant visited Indonesia, Nepal, Sri Lanka and Thailand in 1982 to discuss with the national authorities the protocol for the study, including the case study methodology, the criteria for the selection of study areas and field training for the research staff. These case studies, which started in the countries in late 1982, were in the final stages of completion and the data from these case studies would be analysed at the end of 1983 to identify the most effective model of team work in the provision of primary health care. This model would then be used to develop training programmes for inter-disciplinary health teams. Performance Assessment Perfcrmance assessment procedures are very important instruments for assessing whether an individual health worker can carry out a specific task effectively and efficiently. These could also be used to assess the effectiveness of PHC workers' training programmes, determine the quality of PHC services delivered, appraise PHC workers after the training and develop programmes of in-service training and continuing education. Keeping this in view a number of activities were zenerated to promote and establish perform- ance assessment in the countries of the Region. An Inter-regional Meeting on Performance Assessment was held in the Regional Office in late 1982. The meeting developed guidelines for the assessment of essential tasks performed by PHC workers and also for the supervisors and teachers of PHC workers for developing instruments for the assessment of PHC workers. In India and Indonesia, efforts for the production and field-testing of performance assessment instruments which were directly related to tasks commonly performed by PHC workers were under way. Support was provided by the Organization to conduct a nation-wide performance assessment study of all categories of PHC workers in Nepal. A set o: guidelines for developing and using performance assessment instruments and procedures was prepared by the Regional Office for publication. Continuing Education The value of continuing education as a means of keeping health workers more competent in the performance of their jobs is now universally acknowledged. In BANGLADESH, the Directorate of Nursing Services, Ministry of Health, continued to be very active in the continuing education of nursing personnel. Several in-service training sessions in community health nursing, community mental health and psychiatric nursing were conducted for 47 nurses. Training and in-service courses and workshops also were conducted for various categories of health workers in the areas of nutrition, health education, management and medical clinical specialities. The Bangladesh Medical Research Council organized a training course on research methodology during which 59 medical perscnnel were trained. In BURMA, reorientation courses were a regular feature of the primary health care programme to prepare health workers for their role in implement- ing PHC activities. Several training courses for various health workers were carried out, including management training, educational sciences, laboratory and X-ray, community health and midwifery. In INDIA, a programme of continuing education of community health vol~~nteers was launched through correspondence conrses on an experimental hasis, with training materials and visual aids, developed and supplied thro~gh training centres. Short trai.ning cocTrses in orthopaedi; and oncology nursing were carried out for nurses in service. INDONESIA continued the retraining of nursing personnel in community health nursing, in educational sciences (for teachers), in hospital nursing administrati.on, and in selected clinical nursing fields. Substanti-ie efforts !;ere made to develop mechanisms by which continuing education courses could be linked to career development in nursing and piven equivalent academic recognition at specific levels, Continuing education activities for v?rirli,~ health workers in the form of training or upgrading courses included a wide range of topics, from ~11~. management training of edministrative heal. th officials t rr specific programnle areas such as nutrition, MCH/FP, environmental heal.th, and occupationzl health in which both b,?19 and m~ltilateral funding agencies have assisted/collaborated. The Allied Flea1 th services Traicing Centre, ?4aie, HALDIVES, in colla- horation with lii110, carried out workshops and training courses on various topics, including orientation to primary health care, teaching methods, sea~~ally-transmitted diseases, diarrhoea1 diseases, and malariz for health workers and teachers. TICMGOLIA conducted seven nationai seminars in which 97 doctors anrl nllrses participated and discussed various MCH problems. In NEPAL, with WHO collaboration, a wide variety of training courses anrl workshops were continuously offered for various categories of health workers by the Ministry of Health and the different campuses under the Instjtute of Medicine, Trihhuvan University. The Institute conducted several workshops on teacher training, curriculum development, development of performence assessment instruments, and production of textbooks and teaching materials. A survey of learning needs of the nursing faculty was also carried out. As part of the various programmes of the Ministry of fjealth, several training courses and workshops for different categories of health workers were conducted in the areas of management of nursing services, training of trainers of TBAs (ANMs), maternal and child health and family planning services, laboratories, nutrition education, envi.ronmenta1 health, EPI, malaria and leprosy. Training in field research for doctors was also carried out. A WHO consultant assisted in conducting a two-week workshop on medical records and hospital statistics in March 1982, in which 40 medical records assistants from various hospitals, institutions and projects were trained. In SRI T.ANKA, training courses in midwifery, teaching and supervision in schools of nursing and nursing management were conduct~d through the Post-Basic School of Nursing. Various training and re-training courses for midwives and family health workers and their trainers were also carried out. Other continuing education activities included courses and workshops for other categories of health workers including doctors, in the areas of health education, mental health and rehabilitation. WHO collaboration in continuing education activities included consultancy support in conducting a course in health planning and management and technical and financial assistance in organizing workshops and seminars for community leaders. WHO collaborated in continuing education activities in THAILAND, where Mahido1 University received assistance in conducting various workshops on specific topics related to health planning, management and evaluation for 40 medical officers and 108 middle-level managers. Other in-service training courses included intensive training of doctors in geriatric medicine to improve health care of the elderly in the community and courses for tambon health personnel in medical care in which 3 497 persons were trained in collaboration with UNFPA. At the regional level, an inter-country workshop on the v valuation of TBA Training Programmes" was held in the Regional Office with partici- pants from five countries. An Inter-country Consultative Meeting on the "systematic Development of Continuing Education for Health Workers" was also held in June 1983. Health Learning Materials The countries of the Region recognize the need to ensure provision of adequate and appropriate health teaching and learning materials for health workers in training and in service, particularly for those workers engaged in primary health care activities. The Organization supported the countries in reviewing their specific needs, priorities and resources for the establishment of a system which would foster and develop self-reliance in the production of teaching-learning materials. Assistance provided to India for the training of traditional birth attendants enabled the national authorities to prepare and publish illus- trated handbooks and record books for use by dais. WHO extended support to the national authorities in Thailand in producing a TBA learning package and collaborated with Indonesia in the production of a TBA training kit. The Organization collaborated with Indonesia in translating into Bhasa Indonesia a WHO publication "Teaching for Better Learning" (a guide for teachers of primary health care staff). This book was used as the main guide and resource material for a workshop for nursing teachers held in June 1982. Copies of this were distributed to the workshop participants and schools of nursing. WHO provided assistance to Nepal in surveying its needs in this area and in preparing a comprehensive project document with which to seek external assistance for the implementation of its plans. The project aims at achieving self-reliance in the continued production of health learning materials for health workers at all levels by developing national expertise in the design, production, distribution and utilization of the material produced. 7.1 Education and Training of Professional Health Personnel 7.1.1. lhdergraduate Medical Education In BANGLADESH, the training of teachers of preclinical sciences in medical schools was supported through the award of fellowships; also, two short-term consultants were assigned to assist with the development of curricula and teaching methods in community obstetrics and social medicine. A comprehensive project to support the establishment of a centre for medical education was formulated with UNDP assistance and is under consideration by the Government. In BURMA, a revised undergraduate medical curriculum was being reviewed by the Government for approval. In INDIA, the Medical Education Review Committee appointed by the Government to report on all aspects of medical education completed and submitted its report. The Organization provided assistance to Banaras Hindu University, Varanasi, in conducting a workshop on the use of audiovisual materials and to the Medical Council of India in conducting a workshop for the deans of medical schools. In INDONESIA, the common core curriculum which had been formulated by the Consortium of Health Sciences on the basis of the country's health needs and conditions was being implemented in all government medical schools. The Organization provided a consultant to help develop a compre- hensive system for evaluating the effectiveness of the new curricula. The consultant also assisted the medical school at Bali in conducting a workshop designed to evaluate its community medicine teaching programmes. The training of medical school teachers was supported through fellowships. Technical support was provided to the National Medical Institute in MONGOLIA in the revision of curricula and for the implementation of several group educational activities and national workshops. In NEPAL, a firm and agreed policy decision on the type of doctors to be trained at the Institute of Medicine would facilitate the development of an appropriate curriculum. The Organization assisted in the training of pre- and paraclinical science teachers to serve at the Institute through its fellowship programme. In SRI LANKA, the training of teachers in all four medical schools was supported through fellowships. Assistance was provided to THAILAND in producing a journal for the continuing education of doctors and in undertaking a joint study by the Ministry of Public Health and the Universities in order to decide on the content and duration of the educational programme of undergraduates and report on the admission of additional students to three universities and for their training at provincial and district levels. 7.1.2 Post-graduate Medical Education The Regional Office continued to give support to post-graduate institutions in some Member States in developing and strengthening their training programmes. This support ranged from the recruitment of experts to the strengthening of the faculty through award of fellowships and study tours as part of their post-graduate training programe and the provision of supplies snd equipment. In this regard, Member Countries might wish to make greater use of the available resources within the Region with regard to their need for experts and facilities for the placement of their trainees. Close cooperation and collaboration among the post-graduate institutions in the Region, either through the TCDC mechanism or the establishment of a network, may be envisaged to enhance this development. In BANGLADESH, the Institute of Post-graduate Medicine and Research continued to provide training in various medical specialities. A tripartite review was conducted in February 1983 to evaluate the UNDP support given to the National Institute of Preventive and Social Medicine (NIPSOM). Lack of recognition for the degree awarded by the Institute for purposes of career development within the health services was one of the major constraints restricting the fuller use of NIPSOM's capabilities. The review recommended strengthening of the ~nstitute's field practice areas and the introduction of a management training component in the training programme. In INDONESIA, financial support was given through the Consortium of Health Sciences for the strengthening of curricula of selected post-graduate (clinical) training programmes, mainly those needed to support the second- level health services in the kabupaten (internal medicine, paediatrics, surgery, obstetrics and gynaecology) as part of the referral system. Core curricula of 1.7 clinical specialities have now been developed and are to be used for training in the different centres accredited by the Government. Support was also provided for the strengthening of the post-graduate train- ing programmes in basic medical sciences conducted in three universities. Long-term WHO staff support was provided to the Faculty of Public Health at the University of Indonesia for the purpose of strengthening the courses ~rovided for the MPH degree. A short-term consultant also provided support to the courses in biostatistics. Under the same project assistance was made available to the newly developed Faculties of Public Health in Surabaya (Airlangga University) and Ujung Pandang (~assanudin University). In SRI LANKA, the Organization continued to assist the Post-graduate Institute of Medicine by providing consultancy support in assessing student performances. The Regional Office was represented at the Conference on Post- graduate Medical Education in the ASEAN Countries held in Bangkok in November 1982. The meeting was organized by the Medical Association of South-East Asian Nations (MASEAN), and was supported by the Regional Institute of Higher Education and development (RIHED) and Mahidol University. Important recommendations included (i) pledge of full support to the governments of the Region in achieving the target of HFA/2000; (ii) establishment of common curricula and standards of evaluation with a view ultimately to achieving reciprocity in the Region; (iii) the use of ASEAN specialists in the training courses directed to the problems of the Region, and (iv) exchange of teachers and teaching materials. 7.1.3 Teacher Training Teacher training continued to receive technical support from the Organization during the period under review. Teacher training served many purposes at the same time, including: (a) assisting teachers to plan systematic, competency-based curricula directly related to national needs and priorities; (b) assisting teachers to refine and improve their skills as teachers, and to be able to develop and then use effective, relevant teaching and learning materials, and (c) developing and using methods of student evaluation which are consistent with competency-based, learner- centered training programmes. These purposes can only be served if programmes of teacher training are conducted on a large enough scale, and result in the production of a "critical mass" of trained teachers in all types of health workers' training institutions at local and national levels in the Member Countries. Most programmes of teacher training are too small in scale and too ad hoc in nature. They are of a small scale because only a few teachers receive training at any one time; they are ad hoc in nature because most training programmes provide for one training programme - e.g., in curriculum planning - and then there are no follow-up activities. These defects must be corrected in order to achieve the objectives of enabling teachers to plan, implement and evaluate their training programmes so that these are consistent with national health policies, needs, priorities and the demands of their peoples. The two Regional Teachers' Training Centres at Peradeniya, Sri Lanka, and Chulalongkorn University, Thailand, continued to offer training programmes and accept fellows from the countries of the Region. Neverthe- less, the bulk of the activities provided by these two centres are at the national level in the two countries. In INDIA, the National Teachers' Training Centre (NTTC) at Pondicherry offered two national courses for medical school teachers. Its newly-established sister-centre in Chandigarh provided one national-level course, It also offered a course for deans and principals of medical colleges in North India, with the explicit purpose of engendering high- level support for teacher training in that part of the country, and also organized two on-site training programmes for medical school teachers in the "evaluation of students" in Jammu and Kashmir. The NTTC at Chandigarh expects to expand the scope of its training programmes to include the teachers of nurses and auxiliary health workers. In INDONESIA, there is a well-established network of five national teachers' training centres (NTTCs). These centres are, in turn, supported by educational units which exist in all of the medical and dental schools in the country. The NTTCs and the educational units continued to provide wide-ranging staff development and teacher training programmes, which, in the medical schools, were substantially related to the introduction of the new national core curriculum in undergraduate medical education. Also, as part of the programme of assistance to the Faculty of Public Health, University of Indonesia, long-term consultative support was provided in order to assist in the expansion and further development of all of the Faculty's training programmes. In NEPAL, a major effort has been made by the Institute of Medicine, Tribhuvan University (and its affiliated institutions) in terms of its , teacher training and staff development programmes. This effort was streng- thened materially by long-term consultative support. Workshops and training programmes were organized in curriculum planning and design, the development of locallyrelevant teaching and learning materials, the adoption of appropriate educational processes, and methods of student evaluation. 7.2 Education and Training in Maternal and Child Health Education and training in maternal and child health and family planning (MCH/FP) for different categories of health personnel involved in the care of mothers and children received priority attention, in accordance with the medium-term programme relating to the Sixth General Programme of Work. Basic, post-basic and continuing education programmes in MCHfFP were supported, including training programmes for traditional birth attendants. Technical support was provided for the dissemination of the revised curricula, and the production and distribution of educational manuals on maternal and child health. Teacher training in MCH continued to be a priority activity, the aim being to strengthen the educational programmes in national training institutions and thereby promote national self-reliance. In BHUTAN, technical support was provided for the preparation of a teaching module based on the curricula developed by a consultant for the training of various categories of health workers in MCHfFP at the Family Welfare Training Complex at Geylegphug. In BURMA, WHO supported the training of different levels of health workers in maternal and child health. Emphasis was placed on improvement of the training of lethes, In INDIA, the programme on the teaching of maternal and child health to medical undergraduates and interns was evaluated. It was recommended that the programme be supported by WHO until all the medical colleges in the country were covered by this programme. The low-cost edition of the Handbook on Delivery of Care to Mothers and Children in a Community Development Block was being printed. The dissemination of the re-modelled undergraduate paediatric curriculum through the provision of intra-country fellowships continued. The Handbook for the Care of Children - Birth to Puberty was being pre-tested. The other training programmes supported were national workshops on neonatology for district paediatricians and obstetricians and a regional workshop in MCH for district public health nurses. In INDONESIA, training programmes related to the strengthening of provincial-level maternal and child health, family planning, school health, and community nursing services received support. Training fellowships within the Region were awarded and study tours arranged in order to help in health manpower and education and training in the above fields. MONGOLIA received WHO support for health manpower training in maternal and child health, especially at the aimak level. National seminars on various aspects of MCH were held for physicians and nurses. Training fellowships in paediatric and obstetric specialities were awarded so as to improve the quality of these services. In NEPAL, WHO provided assistance to national workshops for improving the skills of field workers in MCH. Regional conferences of family planning officers in four regions were also organized with WHO support, the aim being to strengthen the management and delivery systems of the MCH/FP programmes, set the annual targets of districts and prepare the programme and budget of the districts. Short-term training fellowships were provided to obstetri- cians in the field of family planning. In SRI LANKA, training for various health workers, such as medical officers, public health nurses and family health workers, was being given in groups. The training was based on the Family Health Workers' Manual prepared with WHOIUNFPAIUNICEF assistance in three languages, viz., English, Sinhalese and Tamil. THAILAND received support for the training of various officials, including health personnel at selected experimental tambons in Nakornsawan Province, to enable them to study simplified KH indicators for communities. Through an inter-country project, senior teachers involved in educa- tion and training in MCH from India, Indonesia and Thailand participated in the Regional Teacher Education Programme in MCH. 7.3 Education and Training in Enviro~ental Health In support of International Drinking Water Supply and Sanitation Decade manpower development programes in Member Countries, an inter-country regional course on project formulation and appraisal for water supply and sanitation was conducted during the year under review at Anna University, Madras, attended by 22 sector officials from four countries: India, Nepal, Sri Lanka and Thailand. In BANGLADESH, current efforts were directed towards training manpower at technician level. In BHUTAN, the manpower development component was to be included in every service project to ensure self-efficiency in this respect in the course of the Decade. In BUWA, a review of the manpower situation was made and a proposal for the preparation of a plan for manpower development through WHO/GTZ assistance was awaiting Government clearance. In MALDIVES, a manpower survey leading to the preparation of a manpower plan was expected to be carried out by the staff of the Maldives Water and Sanitation Authority in the second half of 1983 in collaboration with a WHO team. In SRI LANKA, the sector manpower plan prepared in 1981 was being implemented according to available resources and priorities. Through short in-service training courses some 200 technical officers and water supply maintenance personnel were trained. In THAILAND, a preliminary manpower review was carried out. In regard to INDIA, Ih'DONESIA and NEPAL, WHO supported the training programme in environmental health through various mechanisms, including surveys, national training courses, international fellowships, special courses abroad, travellinglobservation tours, etc. (see Section 5.1, "Environmental Health", for details.) 7.4 - Training in Epidemiology Xecognizing that field epidemiologists are a pre-requisite for organized preveati.on, control and surveillance of communicable and non- communicable diseases, an increasing number of countries in the Region showed active interest in the development of service-oriented training in epidemiology. Thailand had already completed the first two-year course on field-based epidemiology and the trainees joined the provincial health services; the second and third courses were in progress. Indonesia was currently implementing a similar activity for staff at the intermediate level. India and Burma were preparing to undertake similar activities. Ln INDONESIA, where the service-oriented training in epidemiology commenced in October 1982 with eight trainees, a long-term WHO staff member was assigned to assist the project. A similar surveillance and training project in epidemiology in THAILAND received additional long-term staff support commencing August 1982. This programme was coordinated and supported through an inter-country project. 7.5 Training of Auxiliaries and Cornunity Health Workers All countries in the Region recognize the importance of the role of paramedical pesonnel in the health services delivery system and have concentrated on the training of auxiliary health personnel. The trend is to train multipurpose health workers. In BANGLADESH, seven categories of paramedical workers were being trained at two institutes, one in Dhaka and the other at Rajshahi. Besides these training programmes, several other courses were being conducted by different government agencies. There was, however, little coordination and uniformity in training curricula, standards of trainins and evaluation, and criteria for student selection. A recognition of these problems led the Government to constitute a committee to study the manpower requirements for different types of technicians, their educational programmes and employment opportunities. This committee has submitted its recommendations to the Ministry of Health for its consideration. The State Medical Faculty also developed well-defined training objectives and curricula for the improvement of training programmes for laboratory technicians, sanitary inspectors, radiographers, radiotherapists and dental technicians. The Organization supported these activities. Support was also provided for national work- shops, study tours for teaching staff and the provision of supplies and equipment. In addition, WHO provided technical and material support to the training of medical assistants. In BHUTAN, the Thimphu Health School was responsible for the basic training of nurses (3-112 years), health assistants (2 years), auxiliary nurse-midwives (2 years), and basic health workers (1 year). In addition to these programmes, continuing education courses were conducted for zonal health supervisors, auxiliary nurse-midwives, volunteer village health workers and other non-health personnel such as border guards. To expand and improve existing MCH and FP services, re-orientation and in-service training programmes were organized at the Family Welfare Training Complex, Geylegphug, for health staff posted at basic health units and hospitals, malaria workers and their supervisors, and workers from other departments such as Education, Agriculture and Animal Husbandry. Learning modules for the refresher training of the auxiliary nurse-midwife and an instruction booklet on Talking Points for Family Welfare for use by the auxiliary nurse-midwives as self-instructional material were prepared. In BURMA, the Training Division in the Department of Health continued to coordinate the training of various Department of Health staff and auxi- liary health workers in support of the People's Health Programme. Workshops were held on health manpower planning for divisional and state health directors and on educational technology for township medical officers. The training of village health workers for 147 townships of the first People's Health Programe was completed and work began on extending this training to the 40 townships out of the 83 to be covered by the second People's Health Programme. Another category of voluntary health workers, "The Ten-Household Health Worker", was being trained in the original townships of the first People's Healeh Programme that were fully covered by village health workers. The Health Assistant Training School and Mandalay Division Health Department Training Centre continued to organize orientation training for the field staff of special disease control programmes to make them multipurpose health workers. In INDIA, the training of auxiliaries for health activities was expedited. The Village Health Guides scheme, now a fully centrally-sponsored scheme, continued. The Govern~nent increased the recruitment of female para- medical staff for sub-centres and for supervisory levels (auxiliary nurse- midwives and lady health visitors). One male and one female multipurpose health worker are now deployed in each of the existing 60 000 sub-centres. Training of more such staff continued, bearing in mind that tile 'lFAf2000 target was to staff YO 000 sub-centres. The plans for the village heal ti^ guides aimed at having one health guide for every 1 000 rural population. So far about 183 500 health guides have been trained. The training programme for dais, with a target of one for every village, has already trained about 301 100 dais. - WHO provided support to strengthen the basic training programmes of community health volunteers, multipurpose workers and health assistants. The revised basic training programme for multipurpose workers (female! was developed and implemented in all the training schools. Training materials and visual aids were developed and supplied to the training centres. Thirty-five heaith and family welfare training centres were stren:;!ie1,2d in order to provide basic training for health workers. In INDONESIA, training for paramedical personnel and village health workers was carried out at the provincial level with support from the Government. Training for trainers of primary health care teams at tne provincial level was undertaken in Bali with WHO support. Plans were being made to develop some health centres as field training and demonstration centres for trsining various categories of manpower at the national as well as international levels through TCDC. A health services research study on the development of criteria for assistance in PHC development was carried out, stressing the strengthening of the linkages between the health centre staff and the village health volunteer. Application of the results of tnis study led to support in continuing training and staff guidance, replenish- ment of drugs and the development of a two-way referral linkage, which iq turn reduced th? attrition rate of village health vollmteers and inproved the utilization of the health centres and sub-centres. In MALDIVES, the Allied Health Services Training Centre attached to the Ministry of Health continued the training of auxiliary health personnel, such as community health workers, family health workers, nurse-aides and foolumas (TBAs). To meet the increasing demand, a systematic programme of training selected candidates was in progress with the collaboration of i.RO and other agencies. A system for supervising trained health workers and evaluating their perfornance in the field was established. Guidelines for field experiences for community health workers and family health workers w!re completed. Considerable emphasis was laid during the year on upgrading the teaching staff of the Allied Health Services Training Centre. Efforts were continuing for the production of teaching-learning materials for training various categories of health workers in the local language. In NEPAL, the Institute of Medicine continued to train all categories of paramedical and auxiliary health workers, apart from medical doctors. The programmes provided for the basic-level training of auxiliary health workers (community medicine auxiliaries) and auxiliary nurse midwives, certificate- level training for health assistants, nurses, radiography assistants, pharmacy assistants, laboratory assistants and ayurvedic assistants, and degree programmes for nurses and comaunity physicians. The Training Cell of the Integrated Community Health Services Development Project (ICHSDP) conducted basic training programmes for the most peripheral government health workers and village health workers as well as orientation and refresher training prograrmes for all basic health staff within the project. The training programme for community health leaders or ward-level volunteers was also carried out by the Training Cell. WHO assisted the Institute of Medicine by the assignment of two long-term staff and a number of consultants and collaborated with UNFPA on the strengthening of the training cell of ICHSDP. In SRI LANKA, the National Institute of Health Sciences (NIHS) in Kalutara conducted training programmes for various categories of health workers. Direct technical and managerial support was provided by a long-term WHO staff member to facilitate the effective implementation of the objectives of the project. The NIHS conducted all basic training courses, viz., assistant medical practitioners, public health inspectors, public health nurses and public health midwives, with an overall output of 220. In addition, training courses were organized for the trainers of nursing training schools and other training centres as well as trainers of PHC workers. The training of 400 family health workers commenced according to schedule and the first group of 280 trainees completed their training in June 1983. The second group of 180 students was continuing their training. Group educational activities for medical officers of health and NIHS faculty for research development were also conducted. Efforts were being made to identify core curricula for team training and multi-disciplinary training so that the major mission of team training is fully established. A WHO consultant supported this effort. In THAILAND, the majority of the country's villages are covered by trained village health volunteers and village health communicators. The training programmes for village health volunteers continued (the target being 100 per cent coverage of the villages), and are supported by WHO and UNICEF. Efforts were made to upgrade the recruitment procedure as well as the training curricula. Apart from the programme for the training of trainers, manuals and teaching-learning materials were also being developed. 'me ASEAN Primary Health Care Training and Development Centre is closely collaborating with the Ministry of Public Health in planning and developing the training programmes for auxiliary health workers. The Organization was closely involved in, and gave full support to, these efforts in manpower development. Traditional Birth Attendants (TBAs) Bangladesh, Burma, India, Indonesia, Maldives and Thailand continued to conduct training programmes for TBAs. The duration of this training ranges from one week in Thailand to six months in Indonesia and Maldives. Although a variety of teaching aids were available in most countries, there was a need for further promotion of their use during training programmes since an "expanded" role for TBAs in primary health care was gradually being recognized. In Burma and Thailand the PHC component has already been included in the training curricula of TBAs. A workshop on "Evaluating TBA Training ~rogrammes" was held in early 1983 in the Regional Office. This workshop dealt with the fundamental principles of evaluation, the evaluation process and construction of evaluation tools. The major outcomes of this meeting were the design of an evaluation system and a plan of action for implementing it in the countries concerned. 7.6 Group Educational Activities During the period under review, 65 meetings/group educational activities were organized, of which 17 were national, 38 were regional, and 10 were inter-regional. In addition, there were policy-level meetings and three border malaria coordination conferences (see Annex 4). These consisted mainly of seminars, workshops, short courses, conferences and consultative meetings. The 38 regional activities were attended by 512 participants from the countries of the Region. The breakdown, by country and by type, is given in Tables 5 and 6. Table 5 Number of Countries Represented and Number of Participants in Inter-country Activities, 1 July 1982 - 30 June 1983 (Total Number of Activities: 38) Country No. of Meetings Total No. of Attended Participants Bangladesh 22 3 7 Bhutan 5 5 Burma 15 38 DPR Korea 3 3 India 3 4 104 Indonesia 33 10 2 Maldives 13 15 Mongolia 11 19 Nepal 26 4 2 Sri Lanka 32 64 Thailand 3 3 83 TOTAL Table 6 Breakdown of Inter-country Activities, By Type, With Number of Participants, 1 July 1982 - 30 June 1983 Type of Activity Number Number of Participants Seminars Workshops Conferences Short Courses Consultative Meetings TOTAL 38 512 The subjects covered were TCDC, diarrhoea1 diseases, primary health care, the expanded programme on immunization, nursing, traditional birth attendants, malaria, medical research, mental health, maternal and child healthlfamily health, leprosy, environmental health, nutrition, health literature, ophthalmology, planning and management, cardiology, drug dependence, dental health, fellowships, health laboratory services, cytology, women in health and development, rehabilitation of the disabled, traditional medicine, prevention of blindness, rheumatic fever and dengue haemorrhagic fever, and health manpower development. 7.7 Fellowships During the twelve months from 1 June 1982 to 31 May 1983, 865 fellowships were awarded using various sources of funds - 737 (85 per cent) from the regular budget, 42 (5 per cent) from UNDP, 59 (7 per cent) from UNFPA and 27 (3 per cent) under inter-regional and other projects funded by WHO headquarters. Out of the WHO fellowships awarded under the regular budget, 691 (94 per cent) were against the 1982-83 budget and 46 (6 per cent) against the 1981 budget. Implementation Under the regular budget for the 1982-1983 biennium, as of 31 December 1982 a sum of US$^ 760 237 had been obligated for fellowships, constituting 44 per cent of the total fellowships budget. For the calendar year 1982, as against 978 fellowships planned, a further 122 (12 per cent) were added as a result of programme changes. Of the total of 1 100 fellow- ships, 603 (55 per cent) had been awarded by 31 December 1982 and, as of May 1983, a total of 802 (73 per cent), leaving a balance of 298 (27 per cent) that are expected to be awarded before the end of the biennium. UNDP provided $708 914 for fellowships during 1982, forming 15 per cent of the total UNDP budget for the Region. As at 31 December 1982 a sum of $365 519 had been obligated, constituting 51 per cent of the fellowships budget. During 1982, the number of UNDP fellowships awarded was 42. Under UNFPA funds, a total of $608 472 was provided for fellowships during 1982 for Mongolia, Nepal, Sri Lanka and Thailand, forming 24 per cent of the UNFPA budget. As at 31 December 1982, a sum of $487 609 had been obligated, constituting 80 per cent of the fellowships budget. The number of UNFPA fellowships swarded during 1982 was 97. Table 7 shows that 47 per cent of all fellowships were awarded for study within South-East Asia; 168 fellovships were arranged through more than one Region. Table 8 shows that about 52 per cent of the fellows were medical doctors and that 74 per cent of the awards were for males and 26 per cent for females. The table also shows the distribution of the fellowships among different age groups; 44 per cent were awarded to candidates between the ages of 36 and 45 years. With regard to the length of fellowships, 259 (30 per cent) were for durations of one month or less, 366 (42 per cent) for up to three months, 62 (7 per cent) for up to six months, 140 (16 per cenr) for up to twelve months, and 38 (5 per cent) for durations of more than one year. As for placement, 484 (56 per cent) of the fellows were sent for study in one country, 139 (16 per cent) in two countries, 130 (15 per cent) in three countries, 69 (8 per cent) in four countries, and 43 (5 per cent) in five or more countries. One of the. major problems in implementing fellowships was the delayed receipt of applications, which prevented timely processing. Within the first three months of 1983, only 25 per cent of the applications had reached rhe Regional Office for fellowships planned for 1983. Because of stiff English-language requirements imposed by institu- tions in the United Kingdom and United States, placements were delayed or alternative placements were arranged. As in the past, short programing by the receiving countries caused upsets and resulted in reprogramming and/or cancellation of fellowships. It is therefore essential that the proposed duration and the number of countries to be visited by a fellow are carefully considered by the country's health authorities before recoinmendations are made to the Regional Office. Fellows from other Regions. During the period under review, place- ments in the South-East Asia Region were also arranged for 154 fellows from other Regions - 4 from the African Region; 2 from the Region of the Americas; 87 from the Eastern Mediterranean Region; and 61 from the Western Pacific Region. Evaluation. During the year, an average of 46 per cent of termination reports and 33 per cent of utilization reports were received against those due. An analysis of the 260 utilization reports received showed that all the 260 (100 per cent) fellows were suitably employed, 140 (54 per cent) established new services, and 190 (73 per cent) were imparting knowledge to others. Table 7 Distribution of Fellowships, By Budget and By Region (1 June 1982 to 31 May 1983) Regions Source of Funds Percentage where trained WHO Regular UNDP UNFPA HQ and Total Budget others South-East Asia 345 16 39 10 410 4 7 Western Pacific 5 9 4 - 4 6 7 8 - -- Europe 10 3 6 - - 10 9 13 Americas 96 5 10 - 111 13 More than one Region 13 4 11 10 13 168 19 TOTAL 7 37 4 2 59 27 865 10 0 Table 8 Distribution of Fellowships, By Type, Sex, Age and Duration (1 June 1982 to 31 May 1983) A Type Ty Pe No. (%) Medical 447 (52) Non-Medical 418 (48) TOTAL 865 B Sex Sex No. (%) Males 640 (74) Females 225 (26) TOTAL 865 C Age A& e No. (%) Under 25 2 From 26-35 277 (32) From 36-45 380 (44) From 46-55 197 (23) Over 55 9 (1) TOTAL 865 D Duration Duration No. (%) Under 1 month 259 (30) Up to 3 months 366 (42) Up to 6 months 62 (7 Up to 12 months 140 (16) Above 12 months 38 (5) TOTAL 865 A new system of evaluation of fellowships undertaken through the revised termination-of-studies reports has proved to be technically more sound than the old system and is likely to establish a dialogue between the fellows and the Regional Office. However, the ultimate outcome of the whole trial will be &ssessed in the following years together with the findings of the revised utilization reports recently introduced. Regionalization. Gui-ded by the needs of the programme, the training of fellows in the developed countries will continue in order to derive benefits from technological advances found there. However, in view of the increased cost of such training, and with further advancement of facilities in the Region, placements of fellows within the Region may be further emphasized. The figures for the previous years of regional awards are presented in Table 9. Table 10 shows the number of fellowships awarded (under all sources of funds), by subject of study and country of origin. It should be recognized that training facilities in many fields are now available in the countries of the Region and bilateral arrangements already exist between the countries of the Region for the training of their personnel. The fields in which facilities are available in the countries may be identifiel and, in the spirit of TCDC, bilateral arrangements could be made between the countries. Alternatively, the existing bilateral arrangements could be expanded to cover training in those fields. Mutual recognition should, in this regard, be accorded to the degrees awarded by institutions within the Xegion under TCDC mechanisms. Second Regional Conference on WHO Fellowships Programme The Second SEA Regional Conference on the WHO Fellowships Programme with Particular Reference to its Impact was held in the Regional Office from 4 to 8 October 1982. The principles of WHO'S new policy on fellowships were accepted in general at the Conference, which considered the existing fellow- ships policy and procedures for its implementation. Recommendations made by the Conference were forwarded to the Member Countries for implementation. Language Proficiency The peed to i-nprove competence in English was perceived in many countries. The better use of available fellowship and study tour facilities, increased accessibility to learning material and information published in international literature and the need to participate more actively in regional and global networks and other international linkage mechanisms were cited as reasons for improving language competence at national levels. The Organization, as a preliminary step, made available the services of a conscltant to Burma, Indonesia and Thailand to assist these countries in assessing their language training needs and to explore suitable approaches for the solution of this problem. Grouping of Fellowsi~ips In accordance with the recommendations of the Second Conference on the TWO Fellowships Programe held in 1982, efforts were made to have the short-term fellowships for training in the sane field grou~ed together. Table 9 Regionalization of Fellowships Calendar No. of fellowships Regional fellowships year awarded hmber Percentage Table 10 Subject BAN BHU BUR DPRK IND IN0 MAV MOG NEP SRL THA Total Public Health Administration Environmental Health Nursing Maternal and Child Health Communicable Diseases and Laboratory Services Clinical Sciences Basic Medical Sciences and Education Others TOTAL 82 2 34 21 219 162 9 39 149 95 53 865 Cost of Fellowships The tuition fees for training in the United Kingdom increased tremendously, and this has restricted the placement of fellows in that country to candidates for whom training was not available elsewhere. Countries in the Region have also started charging training fees even for short programmes. If no such charges were levied by the countries for the fellows from within this region, this would go a long way towards achieving the objectives of TCDC. Since the British Council, London, decided to increase its handling charges nearly fourfold, adtdnistrative arrangements with the Council were discontinued from 1 April 1983. Alternative arrangements were being made in this regard. 7.8 Health Literature, Library and Information Services (HeLLIS) The national and regional HeLLIS networks continued to develop during the period under review. The second Regional Training Workshop on Health Science Library Networks was held in the Regional Office from 10-20 August 1982. Fourteen medical librarians from seven countries participated in the workshop, which was part of the programme of the HeLLIS Mtwork to train librarians in the network activities. A memorandum of understanding between the Karolinska Institute Library and Information Centre, Sweden, and the Organization was signed in February 1983 for the supply of MEDLARS services to the countries in the South-East Asia Region for an initial period of three years. The first issue of the Index Medicus for WHO South East Asia Region, covering the period from June 1980 to May 1981, was published as a result of the active collaboration of national HeLLIS focal points, coordinated by the Regional Office. The second issue was under preparation. A new development during the year related to efforts to link up the establishment of a health services research information system with that of the existing HeLLIS network. In January 1982, a Consultative Meeting was held in New Delhi in which the health service research group and the HeLLIS national focal points participated. The purpose of the Consultation was to develop guidelines on the standardization of procedures in health services research (HSR) information system, including identification of sources of HSR information, collection, processing of the information and plans for its dissemination. At the national level, a number of HeLLIS network activities were progressing. In BANGLADESH, plans are being made for organizing training courses for medical librarians. An Annotated Bibliography of Medical Literature on BURMA (1866-1976) with a supplement up to 1980 was published. In INDIA, the second, third and fourth training courses in health science libraries were conducted at the National Medical Library in New Delhi. A course on information storage and retrieval in health, family welfare and population was held at the National Institute of Health and Family Welfare, New Delhi, in July 1982. A national Workshop on Cooperative Acquisition was also organized by the National Medical Library in New Delhi in late 1982. In INDONESIA, a two-week training programme for assistant librarians for health science libraries and documentation centres was conducted. A five-day workshop on network mechanisms, tools and management of networks was also held. A consultant assisted the national authorities in NEPAL in the development of a draft plan for the establishment of a national health library and documentation centre and also a plan for lieLLIS network activities in the country. In SRI LANKA, two meetings of the national HeLLIS network were held. The national network also compiled a Union List of current periodicals and a Directory of Nealth Science Libraries in Sri Lanka. In THAILAND, work started on compiling a Directory of National HeLLIS Network Libraries and also for updating the Union List of Serial Holdings in Mahidol University. Regional Off ice Library The Library provided health literature and information services to WHO headquarters, Regional Office staff, WHO Programe Coordinators and Representatives and field staff in the Region. It made use of local and regional resources and also provided MEDLARS/MEDLINE and SDI searches and photocopies of references. Reference material was supplied for seminars, meetings, workshops, etc. The Library was also used for reference by local medical and scientific personnel, engineers, university teachers, students and nurses. In addition, inter-library loan services were provided to local libraries. Countries in the Region were provided free EIEDLARS/MEDLINE retrospective searches as well as photocopies of references not available in the country. For obtaining photocopies, the resources of the SEAR0 Library, WHO headquarters Library, Geneva, the National Medical Library, New Delhi, and the Siriraj Medical Library, Bangkok, were utilized besides those of the United States National Library of Medicine, Bethesda, Maryland. As stated in Section 7.8, under an agreement between the Karolinska Institute, Stockholm (Sweden) and the Regional Office, the Member Countries of the Region would be provided free MEDLARSIMEDLINE services for a period of three years. The Library provided orientation on the role of WHO in activities relating to health literature, library and information services to medical librarians participating in various training courses in Delhi. During the period under review, four such courses were held besides a workshop on cooperative acquisitions in which the Library participated. Support was given to health libraries in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand during 1982-8 3, to establish student loan libraries. During the year the Library received 7 510 books, pamphlets, WHO publications, current periodicals and reports; 2 974 persons (2 234 WHO staff and 740 others) visited the Library and 1 431 books and periodicals were issued on loan to Regional Office and field staff as well as on inter-library loans; 6 659 items were consulted in the Library itself. The Library actively participated in the activities of the Health Literature, Library and Information Services Network in the Region. Apart from assistinn in obtaining PEDLARS/MEDLINE services and photoco~ies. the - - Library provided assistance in bringing out Index Medicus for WHO South-East Asia Region, and also in the publication of the HeLLIS Newsletter. 8. RESEARCH PROMOTION AND DEVELOPMENT The South-East Asia Advisory Committee on Medical Research (SEA/ACMR) has, since 1976, held nine sessions, the ninth session having been held in April 1983. The documents on "Research Needs for Health for All hv the Yegr nittee of the SEA/ACMR, were widely circulated. The countries were utilizing these documents in focusing their research efforts on their national strategies. In pursuance of World Health Assembly resolutions, particularly Keszlution WIA30.$01 which stressed wider collaboration with medical research councils or analogous bodies to ensure (a) effective coordination of national, regional and global research programmes, (b) increased technical collaboration with and among research institutions in collaborative research and training, and (c) improvement of communication between scientists, follow-up actions were taken by the Regional Office through the meetings of directors of medical research councils or analogous bodies and concerned research foci in the relevant ministries (MRCs) held periodically. To date, three such meetings have been held, in the years 1979, 1981 and 1982. Through these meetings, guidelines have been developed for more effective promotion of research at the country level. These guide- I.ines include mechanisms and criteria for determining research policies and priorities; mechanisms of coordination involving all concerned research bodies at the national level; organization of mission-oriented research programmes; strategies for focusing research towards the national goals cf HFA/2000, and development of ethical review mechanisms and career structures for research in Member Countries. These meetings have also promoted technical cooperation among the Member Countries in research, with identification of focal points for such cooperation. The third meeting of the MRCs considered the outcome of a working group on the role of basic and applied research as well as research management in relation to HFA/2000. As regards the role of basic and applied research, the meeting recommended that basic research, which forms
These activities comprised institution-based eye care, together with outreach services predominantly by the voluntary sector supported by the local community, service organizations, the Royal Commonwealth Society for the Blind and the Christoffel Blindenmission. Two WHO consultants were assigned during the year - one to assess and advise on a scheme for low-cost spectacles and the other on ophthalmic pathology/microbiology services. A consultant from WHO headquarters evaluated the ongoing eye camp progranune and also advised on the ophthalmic auxiliaries training centre, which started activities in March 1983. Helen Keller International, in collabora- tion with Sarvodaya, a national voluntary organization, launched a primary eye care and blindness rehabilitation project. In THAILAND, assistance was provided in the formulation of a national plan for the prevention of blindness and the preparation of an epidemio- logical survey on the prevalence of blindness. The strengthening of inter- mediate-level eye care through the training of medical officers and nurses in community-oriented ophthalmology was supported through the establishment of an Institute of Public Health Ophthalmology in Korat. A WHO consultant assisted in the formulation of a plan of action for this institute and a scheme for low-cost spectacles. Another consultant assisted in the provision of ophthalmic pathology/microbiology services and advised on manpower training. 3.4 Immunology Clinical imunology has made remarkable progress in the last decade. WHO has been assisting countries in introducing immunological techniques, particularly in the diagnosis of communicable diseases. A programme has been developed for introducing rapid techniques in the diagnosis of viral diseases. Production of reagents for enzyme-linked immunoassay (ELISA) was initiated at the National Institute of Virology, Pune (India). Similarly, production of immunological reagents such as anti-sera conjugates against human immunoglobulins and other antigens was initiated at the Department of Pathology, Ramathibodi Hospital, Bangkok. A workshop on imunological techniques in streptococcal infection was organized at Lady Herdinge Medical College, New Delhi. National staff from India, Indonesia and Thailand received training in advanced techniques in immunology during a course organized by WHO headquarters and held at Iausanne (~witzerland). WHO continued to assist the Department of Bio- chemistry, AIIMS, New Delhi, in the development of the ICMR/WHO Immunology Research and Training Centre. A WHO consultant from headquarters assisted in initiating a project in allergology in Thailand. 4. HEALTH LABORATORY SERVICES The programme on health laboratory services in the countries of this region received WHO support through the assignment of short-term consul- tants, training of national staff in advanced laboratory technology, and the provision of supplies and equipment. Support was also provided in quality control, training of tutors and improvement of the quality of laboratory services at peripheral levels of health care. 4.1 Organization of Laboratory Services Most countries, with WHO collaboration, improved expertise for the diagnosis and epidemiological surveillance of bacterial diseases, parti- cularly entero-pathogens. Since viral diseases are emerging as important health problems, WHO collaborated in strengthening laboratory competence for the diagnosis of viral diseases and introduced technology for isolation and identification. An inter-country Workshop on Cell-culture Technology was organized at the National Institute of Virology (NIV), Pune (India), in August 1982. National staff from India, Indonesia, Nepal and Thailand were trained in the preparation of primary cultures, preservation and propagation of cell lines, quality control in cell-culture work, continuous-culture systems, etc. A manual was prepared on cell-culture technology based on the Workshop. In continuation of the programme of rapid techniques in the diagnosis of viral diseases, WHO gave further support to develop facilities for the production of reagencs at NIV. National workshops on rapid techniques will be organized and supported in Burma and Thailand. WHO provided a consultant, as well as supplies and equipment for organizing these activities. In order to improve the diagnostic facilities and to support the prevention and control of rheumatic heart disease, WHO supported a national workshop in New Delhi. A manual prepared by the workshop faculty was distributed to some of the countries in the Region. Further efforts are under way to organize national workshops on techniques for the preparation and standardization of reagents and the methodology for the diagnosis of haemolytic streptococcal infections. In order to improve the quality of work and the management of labora- tory services at the middle and peripheral levels, WHO, in collaboration with DANIDA, supported training in quality control. Thus, an inter-regional course on quality control in haematology was organized at Kuala Lumpur in November 1982 in which national staff from Sri Lanka and Thailand participated. The Director of Laboratory Services in Nepal participated in the workshop on laboratory management held in Islamabad in May 1983. In order to improve the quality of laboratory work further, WHO headquarters prepared several documents on quality control in clinical chemistry, reference sera, methods of evaluation of diagnostic kits, and standardization of equipment required in developing countries; these documents were distributed to the countries. With regard to activities at the country level, the Institute of Public Health (IPH) in BANGLADESH was further strengthened by the provision of supplies and equipment. National staff were trained in quality control, laboratory-animal breeding technology and water bacteriology. With the support of WHO, eight in-service training courses were being planned for laboratory technicians from peripheral laboratories to improve the quality of their work. A consultant was provided for the repair and maintenance of equipment at IPH. In BURMA, a workshop that had been held last year on laboratory management was evaluated and found to have had an impact on the improvement of health laboratory services. National staff were trained both in the country and abroad in different disciplines of laboratory sciences. Consultants were being provided for developing and further strengthening a programe on quality control in clinical chemistry. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, consultants assisted in the further strengthening of laboratory technology, particularly in enzymology, lipid biochemistry and oncogenic viruses. In INDIA, a national workshop in immunological techniques in streptococcal infections was organized. National workshops on anaerobic bacteriology and antibiotic sensitivity were also held. Training of laboratory technicians from public health laboratories was supported by WHO. In INDONESIA, national staff received training in laboratory technology and quality control. National workshops in virology and in bacteriology were organized with WHO support, and a consultant trained national laboratory staff in virological techniques, particularly in the plaque-reduction neutralization test and the identification of dengue virus isolates. In MALDIVES, laboratory services were strengthened by the provision of two consultants. During an epidemic outbreak of shigella dysentery, a WHO consultant organized full laboratory support for the isolation, identification, sero-typing and antibiotic sensitivity testings of enteropathogens. Another consultant further supported laboratory programmes by introducing laboratory management techniques. The laboratory at Male Hospital was reorganized and the quality of work upgraded. In order to strengthen health laboratory services in Maldives, a new project document was prepared and approved by the Government. The project envisages building up the laboratory infrastructure to support epidemiological surveillance and primary health care services. In NEPAL, WHO long-term staff continued to give support to laboratory services and further improved the quality of work at the district laboratories. The clinical chemistry programme was strengthened. A national workshop in microbiology was organized in December 1982 with the assistance of DANIDA. Further strengthening of central and peripheral laboratories is to be undertaken under a new health laboratory project supported by the Directorate of Development Cooperation and Humanitarian Aid (DCA), Switzerland. In SRI LANKA, a WHO consultant helped in strengthening the clinical chemistry programme. In THAILAND,.national staff were trained both within the country and abroad. A national workshop on laboratory techniques for the diagnosis of hepatitis was supported by WHO. The National Reference Centre on Streptococci trained national personnel in streptococcal microbiology. Mahidol University organized a seminar-cum-workshop on clinical laboratory equipment supported by WHO. 4.2 Quality Assurance Health laboratory services have been expanding in most countries of this region and simultaneously there was an increasing need to improve the quality and performance of laboratories in support of health programmes. In BURMA, the quality control programme in clinical chemistry was further strengthened. Burma is also participating in the global programme of intensive quality control monitoring. In INDIA, a conference of directors of the laboratories participating in the national quality control programme in clinical chemistry was held at the Post-graduate Institute, Chandigarh. The programme was reviewed and the problems and constraints in the development of clinical chemistry were identified. Recommendations were made for activating this programme. Support to quality control in haemotology was continued. A national conference on standardization and quality control of the methods employed in coagulation disorders was scheduled to take place at the All-India Institute of Medical Sciences, New Delhi, in November 1983. In SRI LANKA, a consultant assessed the present status of clinical chemistry and made recommendations for developing a national quality control programme. The clinical chemistry programme in THAILAND continues to receive WHO support. 4.3 Vaccine Production While India and Indonesia have developed production facilities to the extent of near self-sufficiency, a number of other countries in the Region were in the process of developing or strengthening their laboratories for the production of vaccines required for EPI. WHO has been collaborating with the governments to improve the quality of production and to increase output. In BANGLADESH, production of tetanus toxoid has now been taken up on a bigger scale. The vaccine batches have been tested locally as well as at CRI, Kasauli, and given to human volunteers, and found to be of good quality. WHO continued its collaboration through training, supplies and equipment and the provision of a consultant. It was expected that Bangladesh would produce its total requirement of TT and several experimental batches of DT and DPT in 1983. In BURMA, a WHO consultant assisted Burma Pharmaceutical Industry in strengthening the production and quality control of DPT vaccines. In INDIA, the Pasteur Institute at Coonoor established production of DPT vaccine. National staff were trained in fermentation technology. The batches produced by the Institute were tested by WHO at WHO Collaborating Centres. Haffkine Biopharma was provided by WHO with a new seed for the production of type 111 oral polio vaccine. In NEPAL, technology for the production of BPL-inact ivated anti-rabies vaccine for human use was established. Batches were tested for quality control in CRI, Kasauli, and were found to be satisfactory. In THAILAND, national staff were trained in production technology and the quality control of DPT vaccine. The inter-regional UNDP project on the experimental production of anti-rabies vaccine in tissue culture at Coonoor (India), made satisfactory progress. Two short-term consultants were assigned and the Pasteur Institute, Coonoor, was provided with equipment. The Pasteur Institute, Paris, has provided a new strain adapted to tissue culture to the Pasteur Institute, Coonoor. After a few batches of anti-rabies vaccine are prepared and tested for potency, national staff from other countries of the Region will be trained in production technology. 5. PROMOTION OF ENVIRONMENTAL HEALTH Community Water Supply and Sanitation occupy a position of high priority in the health development efforts of most countries in the Region. Community water supply, being a basic unfulfilled need, has received substantial allocations in national budgets in spite of the scarcity of capital. The same, however, cannot be said in respect of sanitation. Six countries in the Region hutan an, India, Indonesia, Maldives, Nepal and Sri Lanka) already have produced their first draft Decade plans. Nepal and Sri Lanka are already reviewing their Decade plans in the light of the current situation and the review was expected to be completed in the latter half of 1983. There is a growing interest in research and development effort to find indigenous solutions to tackle the increasing environmental pollution problems associated with industrialization. Rapid techniques of stream pollution monitoring and water quality surveillance have been given high priority both by the Member States and in WHO'S cooperative effort with them. There is also a trend towards taking a more holistic approach in research in environmental health, taking into account social, ecological, economic and other factors that have traditionally been kept outside the purview of ad hoc research projects, which have often been concentrated more on "hardware" technology. A preliminary field testing of a comprehensive questionnaire on the status of food safety programmes has been completed and preparations were under way for final field testing in order to obtain feedback from countries. 5.1 Environmental Health In line with the collective decisions of Member States, both in the World Health Assembly and in the Regional Committee, a serious exercise has been undertaken, during the year under review, to programme WHO'S 1984-1985
legislation or codes-of-practice that would promote the establishment of an effective and appropriate food safety and control programme applicable to public places. Earlier, on a separate assignment, the same consultant had studied and reviewed the locally adapted food hygiene and sanitation control programme in Padang, West Sumatra. Another consultant was assisting the Government in strengthening a national food control infrastructure and system, keeping in view the development of an integrated food safety programme with a comprehensive team approach. In SRI LANKA, a group educational activity for the training of some 35 public health inspectors responsible for food safety was supported. In THAILAND, the recruitment of a consultant to assist the Government in the analysis of carbamate residue in food by a special technique in the later part of 1983 was under way. The questionnaire on food safety intended to assess country needs was pre-tested in Thailand. Fellowships on programmes related to food safety, and some supplies and equipment, continued to be provided by WHO in India, Indonesia, Sri Lanka and Thailand. 6. HEALTH INFORMATION AND STATISTICS The focus of the WHO programme in this area continued to be the development of national health information systems (NHIS) and their sub-systems and the strengthening of their infrastructures. The development of national capability in the field of health information and statistics and the conduct of national health studies and surveys were also supported. Keeping in view the wider perspective of the Seventh General Programe of Work for implementing the global, regional and national strategies for HFA/2000, the programme's scope and functions were further broadened. Reorientations ensued, necessitating closer collaboration with other programmes at all levels in order to provide a smooth transition from the Sixth to the Seventh GPW. A global consultative meeting on the health situation and trend assessment programne (HSTAP) was convened in Geneva in February 1983, which was attended by senior national personnel from some of the countries of the South-East Asia Region. The meeting drew up the guiding principles for the direction and development of the programme. At the regional level also, several consultations were initiated between technical programmes of communicable and non-communicable diseases, health information and statistics, the managerial process for national health development (MPNHD), and other related programmes to discuss the concept and direction of the new HSTAP and to plan for collaborative action at national, regional and global levels. In the Regional Office, the Health Statistics Unit, which is responsible for the development of HSTAP, was strengthened by the addition of a health information specialist in November 1982. Activities concerning the lay reporting of health information, and its application in primary health care programmes in a number of countries in the Region were successfully implemented. A guideline on the subject was also produced which was used in developing lay reporting systems. The experience gained in the countries of the Region was being used in some other regions to develop similar lay reporting systems. The documentation produced in SEAR0 based on the experiences in the countries of the Region provided the main basis of work for a workshop in Nairobi in 1981, and consultative meetings in Addis Ababa and in Senegal in 1983. The Regional Office provided consultancy support in statistical and information analysis in an institutional study for the International Drinking Water Supply and Sanitation Decade (IDwssD) programme in Indonesia, and another study on nursing manpower planning, also in Indonesia, The Regional Office actively collaborated in the collection, colla- tion and synthesis of regional information for measuring health progress in Member Countries, according to the 12 global indicators for monitoring HFA strategies. An important activity at the regional level was the collation and synthesis of regional health information and the preparation and dissemi- nation of the information as a regional health bulletin. The main objective of the bulletin was to present to the decision makers at the national and regional levels the prevailing health situation in the countries of the Region. This annual regional publication was distributed to Member Countries, WHO headquarters and other WHO regional offices, as well as to other United Nations agencies. At the national level, collaboration with the countries was shaped according to the specific needs of their health systems and the prevailing stage of infrastructural development. In BANGLADESH, a new development was the establishment of a Central Health Information Service in the Office of the Director-General of Health Services. WHO actively collaborated in the development of an NHIS within the context of MFNHD. At the PHC and thana health complex levels, attention was focused on studying the utilization of these services and promoting the use of lay reporting and recording procedures of information on mortality and morbidity* This work was initiated on a pilot basis in one thana and was to be gradually expanded to other thanas in a phased manner. Medical record procedures and statistical systems were promoted in the major hospitals and other medical establishments. Consultancy services were provided for reviewing and developing the medical and health record systems in hospitals and health centres in support of the organization of health services planning and administration, Fellowships were awarded in health information systems. In BUM, the Health Information Service played the role of the lead agency in the monitoring and evaluation of the country's health programmes and published regular health statistical reports. There was a major improve- ment in providing more complete information for planning and monitoring by the introduction of lay reporting in 12 survey townships. A training workshop for state/divisional statistical technicians and survey townships personnel was conducted in November 1982. The workshop achieved its objective of preparing the staff at the peripheral level for the monitoring and evaluation of health programmes. Other training activities included computer training for personnel of the health information service and potential users of the Department of Health. In INDIA, the development of the health information system at the intermediate and peripheral levels continued to be given high priority. In recognition of this principle, the Central Bureau of Health Intelligence (CBHI) organized a workshop in New Delhi in March 1983 on a uniform system of medical records and reports from district hospitals. Standard forms were introduced by means of which data would be submitted by district health officers to CBHI under the recently introduced integrated health information system. For monitoring and evaluation purposes, the WHO Programme Coordinator and Representative to India and a WHO consultant, together with a national officer, undertook a joint field visit to Uttar Pradesh during which relevant aspects of the functioning and development of the national health information system were reviewed. A training course in epidemiology for health planning and delivery was organized by the National Institute of Health and Family Welfare with a view to improving the competence of health planners and administrators in the planning, development and management of epidemiological activities. The Regional Office actively participated in the preparation and conduct of the course. In INDONESIA, further strengthening of the human and physical infrastructure helped improve the integrated recording and reporting system as well as analysis of information generated at health centres. The Bureau of Planning was strengthened in the field of data analysis, software management and development, and data base management. Data management capabilities and monitoring of the hospital recording and recording system were further strengthened. The translation of the ICD IX revision was almost complete. The Working Group on Health Information prepared a manual with conceptual and operational guidelines for the development of the health information management system. Creation of a technical unit with a team on health information within the Ministry of Health helped to ensure the much needed coordination. This team coordinates the efforts of all ministerial units according to their information needs. In MALDIVES, the recording and reporting procedures being used by family and community health workers were studied. Based on the results of the study new forms were developed for recording and reporting by field health workers (FHws) and community health workers (CHWS). These new forms were discussed and approved at a meeting held under the chairmanship of the Deputy Director of Public Health and were to be tested by FHWs and CHWs. A long-term WHO statistician continued to help his counterparts in these and related activities. In MONGOLIA, a comprehensive study of the health status of the population was undertaken with WHO collaboration in Huvsgul aimak. As an integral part of the PHC system, the Huvsgul project will provide baseline information on vital events, morbidity, mortality, sickness, absenteeism and nutritional patterns. The methodology of the study was tested in different parts of the country. A study on the requirement of computerization for the national health information system was carried out by staff from WHO headquarters and the Regional Office. The current structure and functions of health information services were reviewed as well as their links with other government statis- tical institutions. Statistics from maternity hospitals and pharmaceutical services were likely to be the first modules to be developed under the computerization scheme. In NEPAL, assistance in the field of health information systems continued under the aegis of the project on health planning and programming. The WHO health planning and management specialist now working in the Planning Unit participated in the national planning activities, including improvement of the health information system and establishment of a health data bank. WHO personnel also continued to collaborate in the monitoring of HFA strategies using global indicators. In SRI LANKA, as a result of the review of the existing health information system, the design of an improved system was developed. The steering committee on NHIS started to implement the new system on a trial basis in Kegalle district from April 1983. An evaluation of the trial run was planned for late 1983. Appropriate training of the staff, both at the central level and in Kegalle district, was carried out for this purpose. Other important activities in this field included the preparation of a sampling procedure for an oral health survey, publication of the annual health bulletin and a proposal for the development of a data base and operations room in the Planning Division. THAILAND has made considerable progress in the development of the computerized data processing system. The computerized Master Plan for the Ministry of Public Health was completed. One microcomputer was procured for the Division of Epidemiology with WHO funds and another for the monitoring and evaluation of nutrition and MCH with financial aid from US AID. The revision of record and report forms was undertaken by a ministerial committee, and two sets of manuals on the recording and reporting system were prepared for publication. Training activities included a seminar on the development of hospital statistics and information systems in the Bangkok Metropolis Authority and short courses for hospital staff.
control were under study by national staff, Aplocheilus dayi for the control of Anopheles culicifacies in slow-flowing water, and Poecilia reticulata for the control of Culex quinquefasciatus in Colombo. A total of 163 susceptibility tests covering 11 anopheline species and a number of insecticides were carried out during 1982. A.culicifacies, the only known malaria vector in the country which is resistant to DDT, continued to show susceptibility to malathion, the insecticide being used in the Anti-Malaria Campaign, and to dieldrin, fenitrothion, propoxur, bendiocarb and chlorphoxim. In THAILAND, the monitoring of susceptibility/resistance of malaria vectors and suspected vectors to DDT, malathion and fenitrothion continued as planned. A total of 94 tests covering seven anopheline species - A.minimus, A.balabacensis (A.dirus), A.maculatus, A.aconitus, A.sundaicus, A.philippinensis and A.annularis - was carried out with large samples of mosquito populations collected from fixed catching stations throughout the country, but mostly from the northern region. The results of tests showed no significant change in susceptibility/resistance status and level from previous test results. The vector problem in Thailand appeared to be more due to exophily and refractory behaviour (avoiding contact with the sprayed surfaces) than to physiological resistance. Entomological evaluation on the effect of fenitrothion residual spraying (which had recently been introduced by the malaria programme) in mosquito control and consequently malaria transmission did not show any significant difference in comparison with DDT. Further research was in progress to clarify the situation. With support from the UNDPIWorld Bank/WHO TDR Programme, two research projects on genetic variations in correlation with behaviour traits, one dealing exclusively with A.minimus and the other dealing with A.bala- bacensis, A.maculatus and A.philippinensis, were being carried out by scientists from Mahidol University. A WHO consultant from headquarters visited research institutions involved in research and field trials on biological control agents. The Department of Microbiology at Mahidol University was searching for new isolates of spore-forming bacteria and evaluating existing strains in the laboratory and on small-scale field trials, paying particular attention to the pathogens' persistence and recycling potential for mosquito control. A WHO consultant visited the project to advise on rodent research and control. WHO headquarters is assisting the Division of Medical Entomology in its project on integrated control against Aedes aegypti, with emphasis on community participation, in Lopburi province. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES The major emphasis of WHO technical collaboration with Member States in the field of non-communicable diseases lay in the promotion of an integrated social and behavioural approach to the prevention, early detection and control of emerging health problems such as cancer, cardiovascular diseases, chronic liver diseases (including liver cancer), diabetes and accidents. 3.1 Cancer Consultancy services were provided to Bangladesh, Democratic People's Republic of Korea, India and Indonesia to review the progress made and advise on further technical collaboration. National meetings were supported through the provision of subsidies, and fellowships were awarded for training in oncology, chemotherapy, etc. Health education material on the prevention and control of cancer and the health hazards of smoking was made available to all Member States. In BANGLADESH, a consultant assisted in cancer registration, including training. Another consultant collaborated in the training of health personnel in cancer control activities and the organization of chemotherapy services for cancer patients. A team of two consultants visited the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA during the year. One of them assessed the existing facilities for the surgical management of thoracic cancer, delivered a series of lectures and organized several demonstrations on lung cancers and mediastinal and cardiac neoplasms. The other consultant reviewed the ongoing research acti- vities in relation to cancer immunology and advised on training, services and research, and also gave lectures on modern aspects of cancer immunology. Fellowships were awarded and supplies and equipment were also provided. In INDIA, the services of several consultants were provided for the (i) development of a framework for assessing the epidemiological aspects of cancer; (ii) establishment of a national cancer control body; (iii) planning of epidemiological studies and working of early cancer detection centres; (iv) development and maintenance of cancer registries; (v) cytopathological techniques and research methods icluding immunopathology and ultrastructural cytopathology, and (vi) clinical research in cancer and cytogenetics. The Ministry of Health, the Indian Council of Medical Research, the Regional Cancer Centre in Trivandrum and the Cytology Research Centre in New Delhi were involved in these activities. WHO provided a subsidy for the conduct of a national workshop on cancer held at the Tata Memorial Centre, Bombay, in November 1982, and also for a national seminar on strategies in cancer control which took place at the Cancer Institute, Madras, in December. The Gujarat Cancer and Research Institute organized a workshop on the early detection of cancer in July. Fellowships for training in cancer prevention and control and the diagnostic/prognostic cytology of cancer patients were awarded. The Arignar Anna Memorial Cancer Hospital conducted a programme of continuing medical education in 1982 in collaboration with the Indian Medical Association. In INDONESIA, a consultant assisted in designing a population-based cancer registry in Yogyakarta, in preparing a national cancer control programme, in developing cancer registration in teaching hospitals, and in analysing cancer data from the departments of pathology of hospitals. He also organized and conducted a short course in cancer epidemiology. WHO assistance to MONGOLIA consisted of the supply of a gamma camera basic system and accessories to augment the community-based cancer control programe. Fellowships were awarded for training in the epidemiology of cancer. In SRI LANK!., a national cancer policy and a cancer control programme have already been formulated. As a part of the global cancer control programme, support was provided by WHO headquarters and the Regional Office for studies to determine the most satisfactory means for the early detection of oral cancer at the primary health care level. The feasibiliry and effectiveness of the primary health care approach for the early detection of cancer by primary health care workers was demonstrated. WHO also gave financial support for carrying out a reproducibility study in,the Jaffna and Galle areas and for designing and implementing a cancer health education project aimed at the primary and secondary prevention of oral cancer, and the expansion of coverage by the existing cancer registry. 3.2 Cardiovascular Diseases The major components of WHO support in this programe area were the provision of subsidies for the conduct of national group educational activi- ties andlor surveys, consultancy services and fellowships for improving national expertise and facilities for the control of cardiovascular diseases. In BANGLADESH, a national workshop on cardiology was held in November 1982 to enable medical officers to learn about the prevention and treatment of various cardiovascular diseases, particularly rheumatic fever, rheumatic heart diseases, hypertension, cardiac emergencies and cardio- pulmonary resuscitation. Fellowships were awarded for training in laboratory technology, cardiovascular radiology, anaesthesia, cardiac rehabilitation and cardiology. In BURMA, a national workshop on the diagnosis, management and prevention of cardiovascular diseases was organized in November 1982 with financial support from WHO. A total of 16 participants drawn from hospitals, school health services and primary health care programmes attended the workshop, which provided the participants with an opportunity to learn the preventive approach to cardiovascular diseases. Fellowships were awarded for training in the technology of intensive cardiac nursing. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, a team consisting of two consultants carried out a number of operations using artificial circula- tion systems and delivered lectures on various aspects of artificial hearts and lungs, the pathophysiology of artificial circulation and the principles of haemodynamics. Another team of four consultants (a cardiologist, a cardiac surgeon, an anaesthetist and a vascular surgeon) assessed existing facilities and assisted in strengthening training, services and research in their fields of speciality. Their activities included giving demonstration lectures and training for health personnel in the post-operative care of patients. Fellowships were awarded for training in cardiovascular diseases. In INDIA, a consultant visited selected institutions concerned with the prevention and control of cardiovascular diseases to assess the existing facilities for the analysis of serum lipid. He discussed with physicians and cardiologists the importance of standardizing methods for the estimation of lipids, lipoproteins and serum enzymes and advised on the establishment of referral centres for internal and external quality control of lipid analysis and the introduction of a programme of quality control into service and research laboratories. Consultancy services were also provided to the Institute of Genetics and Hospital for Genetic Diseases in Hyderabad for the further development of research and service facilities at the Institute. A national workshop on recent advances in genetic diseases, attended by 50 research workers, was held in Hyderabad in August 1982. A contractual technical services agreement was finalized with the Haematology Unit of the All India Institute of Medical Sciences (AIIMS), New Delhi, for undertaking investigations relating to platelet functions in ischaemic heart diseases and high-risk subjects. A national workshop on the immunology and genetics of rheumatic fever and rheumatic heart diseases with special reference to India and South-East Asia was held in Chandigarh in December 1982 with support from WHO. Another national workshop on lipids and lipoproteins in health and disease with special reference to India was organized by the Department of Cardiology at AIIMS, New Delhi, in November 1982 with support from the Organization. In MONGOLIA, a new comprehensive long-term national programme on the prevention and control of cardiovascular diseases among the rural population was formulated for the period up to the year 2000. A national seminar on CVD prevention and control was held for physicians in Ulan Bator and a mass screening campaign was conducted in one aimak and in Ulan Bator city. Altogether 9 000 persons - 7 000 rural and 2 000 urban - were examined by a team of 12 doctors of different specialities in order to diagnose CVD and identify the risk factors. A national seminar on the health hazards of smoking was being planned with WHO support. In SRI LANKA, the cardiology unit at the General Hospital in Colombo, in collaboration with the National Institute of Health Sciences, Kalutara, and with financial support from WHO, started a study on the community control of cardiovascular diseases. This includes epidemiological studies on the rural and semi-rural population to identify risk factors, health education for promoting cardiovascular health, early detection and diagnostic facilities, and treatment including referral and follow-up services. The areas selected will serve as a training-cum-demonstration centre for the community control of cardiovascular diseases as an integral part of primary health care. Plans were formulated in THAILAND to initiate studies on the preven- tion and control of cardiovascular diseases through an integrated approach towards the control of non-communicable diseases in general. Two senior physicians were provided opportunities to undertake a study tour of appropriate centres in the USA and Finland. 3.3 Prevention of Blindness Avoidable blindness and the backlog of the curable blind pose major public health problems in the Region as a whole. Given the estimated national blindness rates, which range from 0.5 per cent to over 2.5 per NON- COMMUNICABLE DISEASES FuNo,uing the,, par1,crpatron m the .:'orid Assemb.y on Apng held rn Venn* m July 1987 und real8ztng Ifre demogmolrc !rcnds as ,c/lecled in the ,nocor,no n!,nlbers of the eld~rl,. coun'ncs of , . the Region are taking act& measures ro promote andpfeserve the traditional extended family system and integrate elder citizens into the socio-economic development process. Governments are paying considerable attention to the problem of drsability, emphasis beiog laid on community-based programmes for disability prevention and rehabilitation. With WHO support, appropriate, low-cost aids are being developed for the dicabled. such as this prototype ofa wheel-chair designed tor Asian conditions and adapted to local life-styles. There is g/owlng awareness of the eilenl 01 avoidable blindness whtch poses a major puhhc health problemin 118s Rcgjon. National prog,ammeS arc based on the ~rinoole of eve cars rlelrverv as an integralpart ofprimary health dare. ' EXPANDED PROGRAMME ON IMMUNIZATION rhe Expanded Programme on Immunization continued to expandin rrrmr of rhe rarget population cover~d. Several countries have srarred giving oral pobomyeliris vaccine to children at mass immunization camps. HEALTH LABORATORY SERVICES In the control of comrnunicsble dscases, the role of health laboratory servjces ,s crucrel WHO ,s supporl~ng Membcr Sfares !n the qua1,ly control 01 laborarory work Here a ~?t,ore,ory lechntc,an ,s prroannq hact.?t~oloq~cal m~rlta cent, the number of the blind in the Region amounts to approximately 12 million; the majority of these are to be found in the underserved rural areas. While a large majority of these - 50 to 75 per cent - are due to cataract and are therefore curable, 80 per cent of the remainder are the result of preventable causes such as infections (including trachoma), injuries and blinding malnutrition. In still others - such as those going blind from glaucoma, diabetes and retinopathy - early detection and timely treatment could prevent deterioration of vision. Many of the underlying causes are age-related and their incidence is bound to increase unless energetic community-oriented measures are taken. WHO continued to support national authorities in undertaking activi- ties in the areas of programme formulation, implementation, review and evaluation. The national programmes are based on the principle of eye care delivery as an integral part of primary health care, supplemented wherever indicated by programmes specially directed against blinding infection, including trachoma and blinding malnutrition, and the restoration of sight in cataract patients, through outreach surgical services. These activities supported primary eye care services, on the one hand, and, on the other, were backed up by institutionalized services comprising speciality and sub-speciality interventions. Special emphasis was placed on various aspects of manpower training and deployment at all levels of the health delivery system. At the regional level, an inter-country consultative meeting with participants from four countries - Bangladesh, Burma, India, Sri Lanka - was held in Rangoon. This meeting, which was an activity under the UNDP-funded project for the prevention of blindness from glaucoma, prepared plans of action for programmes to be carried out in the four participating countries. The post of Regional Adviser responsible for the coordination of activities of the Regional Prevention of Blindness Programme continued to be funded through a contribution to the Voluntary Fund for Health Promotion by the Royal Commonwealth Society for the Blind and the Asian Foundation for the Prevention of Blindness. In BANGLADESH, implementation of the national programme continued, with the activities mainly related to the training of manpower, strengthen- ing of the apex institution (the Institute of Ophthalmology in Dhaka) and outreach programmes for cataract. A one-day appraisal and reorientation course for divisional and district health officials was held in November 1982 which laid special emphasis on blinding malnutrition. The study on vitamin A prevalence - a collaborative effort of the Government of Bangladesh, Helen Keller International and WHO - was started in mid-1982 and the results were expected by the end of 1983. The distribution of vitamin A high-potency capsules to the target population continued. A non-governmental organization, the Bangladesh National Society for the Blind, is an active partner in programme activities and, with bilateral aid, established a 130-bed eye infirmary and training complex in Chittagong which was opened in January 1983. This institution already trains medical officers and paramedical staff in community-oriented eye care services. The Regional Office provided assistance in the preparation of curricula for these courses. Through the efforts of the Government and the voluntary sector, a total of approximately 47 000 cataract operations were performed at institutions and through "eye camp" services. A WHO consultant visited Bangladesh for one month to review and advise on ophthalmic pathology and microbiology services. In BURMA, assessment, mass treatment, consolidation and reassessment activities continued in the areas where trachoma is highly endemic. A WHO staff member visited Rangoon to document and evaluate the trachoma control programme. A preliminary review showed a drop in blindness caused by trachoma from 2.03 in 1968-72 to 1.02 in 1976-78. A consultant assisted in developing a plan for the provision of low-cost, affordable spectacles and low-vision aids. Supplies and equipment were provided for the upgrading and strengthening of the Eye, Ear, Nose and lhroat Hospital in Rangoon, to serve as an apex institution for the programme. The field activities in the control of blindness carried out in the country included mass screening for active trachoma cases followed by treatment; field out-patient eye clinics in rural areas; village and school eye health services and dissemination of health education on eye care and training of basic health workers in the control and prevention of blindness. In INDIA, implementation of the revised work plan of the national programme for the control of blindness was initiated, greater emphasis being placed on the training of paramedical staff. A WHO consultant prepared a report on the feasibility of including a low-cost spectacle scheme in the national programme. Another consultant visited selected centres in four different states to ascertain the role of non-governmental organizations in the national programme activities. The Organization supported meetings of advisory committees set up by the Ministry of Health and Family Welfare and also participated in a task force meeting convened to develop detailed programme budgets for 1984-1985. It also entered into contractual service agreements with state-level advisers for the programme. With regard to the development of eye services at primary health centres, the Government has adopted a policy whereby such developments will run concurrent with the training of ophthalmic assistants. It is expected that by the end of the Sixth Five-Year Plan all the 2 000 primary health centres will have ophthalmic assistants posted in them. One of the shortcomings in the programme is the absence of a uniform and effective monitoring mechanism, and the national committee is planning corrective measures. Eighteen centres took part in the training of ophthalmic assistants, and 1 530 primary health centres now provide primary eye care services. In order to facilitate participation of the voluntary sector, the Government has streamlined the procedures for providing financial support to non- governmental organizations in eye camp programmes. The record of activities directed towards the elimination of curable blindness from cataract has surpassed the efforts in the previous year. It was expected that a total of 900 000 cataract operations would be performed during 1982-83 as against 650 000 in 1981-82. In INDONESIA, the formulation of the national plan for inclusion in Pelita IV was awaiting the results of a national survey of the prevalence and causes of blindness, which were expected to be available in late 1983. A WHO consultant reviewed the preliminary survey results, the draft national plan and the proposed Bali project for outreach eye care services including cataract surgery. The Chief of the Eye Health Services visited the Regional Office and the WHO Collaborating Centre on Public Health Ophthalmology in New Delhi. Preliminary survey results show a blindness prevalence rate of 0.52 per cent of which 50 per cent is due to cataract. Thus the backlog of cataract would be expected to be in the region of 375 000 cases. A serious constraint in coping with these large numbers is the shortage of suitably trained personnel and the lack of adequate outreach services. The programme against nutritional blindness supported by Helen Keller International has initiated pilot studies in the fortification of monosodium glutamate with vitamin A while continuing with the distribution of high potency vitamin A capsules and nutrition education. In MALDIVES, in pursuance of a request made by the Government, an eye camp project was organized through a contractual technical services agreement with an ophthalmic institution in India to undertake activities in a group of remote atolls. A total of 245 operations was performed, including 171 cataract operations. This project was funded by extrabudgetary resources mobilized from the British National Committee for the Prevention of Blindness and the Japan Shipbuilding Industry Foundation. Technical collaboration with NEPAL continued and the ongoing prevention of blindness programme carried out activities as planned. The survey report was finalized. In-service training for ophthalmic assistants continued at both Kathmandu and zonal eye centres. Ten ophthalmic assistants returned after training in India and were in position. Four medical officers were continuing their training in India. The Zonal Eye Centre in Dhangadi, in the West Zone, was commissioned in late 1982 with a bed capacity of 60 and out-patient and operation theatre facilities. It is a low-cost structure designed by a WHO staff member and built under his supervision. Field activities included house-to-house searches for blinding sequelae of trachoma, cataract and xerophthalmia, and treatment for these conditions. Four other eye centres became operational in 1982 - Biratnagar, Bhadrapur, Nepalganj and Lahan. These institutions have provided in-patient services as well as outreach services through eye camps and mobile surgical facilities. A long-term WHO staff member and five consultants assisted national staff in both training and eye care delivery activities under the programme. The activities have been supported financially by the Netherlands, Norwegian and French agencies, the Swiss Red Cross and the Christoffel Blindenmission. In SRI LANKA, activities for the prevention of blindness were carried out by government institutions and non-governmental organizations. These activities comprised institution-based eye care, together with outreach services predominantly by the voluntary sector supported by the local community, service organizations, the Royal Commonwealth Society for the Blind and the Christoffel Blindenmission. Two WHO consultants were assigned during the year - one to assess and advise on a scheme for low-cost spectacles and the other on ophthalmic pathology/microbiology services. A consultant from WHO headquarters evaluated the ongoing eye camp progranune and also advised on the ophthalmic auxiliaries training centre, which started activities in March 1983. Helen Keller International, in collabora- tion with Sarvodaya, a national voluntary organization, launched a primary eye care and blindness rehabilitation project. In THAILAND, assistance was provided in the formulation of a national plan for the prevention of blindness and the preparation of an epidemio- logical survey on the prevalence of blindness. The strengthening of inter- mediate-level eye care through the training of medical officers and nurses in community-oriented ophthalmology was supported through the establishment of an Institute of Public Health Ophthalmology in Korat. A WHO consultant assisted in the formulation of a plan of action for this institute and a scheme for low-cost spectacles. Another consultant assisted in the provision of ophthalmic pathology/microbiology services and advised on manpower training. 3.4 Immunology Clinical imunology has made remarkable progress in the last decade. WHO has been assisting countries in introducing immunological techniques, particularly in the diagnosis of communicable diseases. A programme has been developed for introducing rapid techniques in the diagnosis of viral diseases. Production of reagents for enzyme-linked immunoassay (ELISA) was initiated at the National Institute of Virology, Pune (India). Similarly, production of immunological reagents such as anti-sera conjugates against human immunoglobulins and other antigens was initiated at the Department of Pathology, Ramathibodi Hospital, Bangkok. A workshop on imunological techniques in streptococcal infection was organized at Lady Herdinge Medical College, New Delhi. National staff from India, Indonesia and Thailand received training in advanced techniques in immunology during a course organized by WHO headquarters and held at Iausanne (~witzerland). WHO continued to assist the Department of Bio- chemistry, AIIMS, New Delhi, in the development of the ICMR/WHO Immunology Research and Training Centre. A WHO consultant from headquarters assisted in initiating a project in allergology in Thailand. 4. HEALTH LABORATORY SERVICES The programme on health laboratory services in the countries of this region received WHO support through the assignment of short-term consul- tants, training of national staff in advanced laboratory technology, and the provision of supplies and equipment. Support was also provided in quality control, training of tutors and improvement of the quality of laboratory services at peripheral levels of health care.
In INDONESIA, health legislation was one of the priorities identified during the process of developing the Indonesian Government/W~O innovative programme in achieving HFA/2000. For this purpose, WHO would provide necessary support. Considerable efforts will be needed for the promotion and development of adequate health legislation in countries of this region. Thailand is the only country which has at the moment a WHO-assisted project on this subject. In the coming biennium, activities are likely to he extended in Indonesia. In addition, an overall review will be undertaken with the aim of initiating necessary inter-country activities in this field. 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES 2.1 Epidemiological Surveillance Member States continued to stress the importance of epidemiological surveillance services to support the planning, implementation and monitoring of disease control efforts. Despite this emphasis, the shortage of trained and skilled manpower in this field, especially at the inter- mediate level of national health systems, remained a problem, affecting the efficiency of surveillance activities adversely. WHO continued to provide technical back-stopping, training facilities and research grants in this area in support of national efforts. In BANGLADESH, WHO technical staff collaborated with the Institute of ~~idemiology under the National Institute of Preventive and Social Medicine (NIPsOM) in developing an efficient field surveillance system in ten districts where epidemiological units had been set up. In this process, they trained the local personnel in epidemiological techniques, helped in establishing a reporting and recording system and worked with the national staff in running the units smoothly at the initial stages. All the ten units were now functioning under the supervision of the national staff. A consultant in entomology assisted the Institute in the epidemiological investigation of leishmaniasis in the country and advised on a work plan for field diagnostic activities and the setting up of a diagnostic unit for parasitic diseases. An epidemiological survey on kala-azar in Fulbaria and another on filaria in the Dhaka metropolitan area were carried out. These surveys not only provided reliable epidemiological data but also helped in devising steps for the control of these diseases. 'She WHO public health veterinarian assisted in generating epidemio- logical and epizootical data on zoonotic diseases, namely, rabies, brucellosis and bovine tuberculosis, which will be used as baseline information for these diseases. He also participated in the development of an action programme for the control of rabies which was being implemented. In INDIA, WHO provided technical support to preparations for setting up regional and state epidemiological surveillance systems through the services of a consultant assigned to the National Institute of Communicable Diseases, Delhi. The proposal emanating from this process would be discussed by a national task force at the end of this year in order to reach a consen- sus on practical measures necessary to develop the national epidemiological surveillance system further. In MONGOLIA, special field teams were active in conducting epidemio- logical surveillance and instituting preventive and control measures against communicable diseases such as viral hepatitis, enteric fever, meningitis, and poliomyelitis. WHO supplied reagents for laboratory diagnosis. The Organization continued to support NEPAL in strengthening the Epidemiology and Statistics Division of the Ministry of Health in the fields of epidemiological surveil?ance and control of zoonotic diseases including rabies, The surveillance system for ten communicable diseases was developed in 23 districts, Publication of the quarterly epidemiology bulletin facilitated dissemination of information. However, shortage of trained manpower and logistics problems continued to persist. Surveys of neonatal tetanus, poliomyelitis and viral encephalitis were carried out with WHO assistance and the results were made available for decisionmaking. A seminar on the epidemiology of zoonoses was organized and its proceedings were published and distributed. Active surveillance of rabies continued. 2.2 Diseases Subject to the International Health Regulations Cholera was again reported in some countries of the Region. Interestingly, classical vibrio chol-era, besides El Tor serotypes, was identified among cases detected in 1982. As for plague, the disease was under active surveillance in Burma, where human cases were reported in April 1983. Table 1 gives the breakdown by country of the number of cases and deaths due to cholera and plague during the period 1980-1982. 2.2.1 Acute Diarrhoea1 Diseases Ten out of 11 countries of the Region had developed national control programmes against diarrhoeal diseases (CDD) which were being implemented according to schedule. Some countries such as Bhutan, Maldives, Mongolia and Nepal completed operational plans in 1983. The service component of the programme in each country was fully integrated with primary health care services. Research was developed nainly to solve operational problems, namely, delivery of oral rehydration therapy, to ensure community involvement and to clarify the socio-behavioural aspects of diarrhoeal diseases and their control, The priorities for research to support diarrhoea1 diseases control have changed in the course of the years from etiological and clinical studies to community involvement, socio-behavioural aspects of control, transmission studies and management problems. Delivery of oral rehydration therapy (ORT), the main strategy of the programme to reduce mortality, is currently carried out in all the above countries, depending on the availability of oral rehydration salts, produced locally and/or supplied by UNICEF, and on the absorptive capacity of the existing health infrastructure. Early diagnosis and administration of treatment at home have a positive impact on mortality in infants and children under five years of age. However, the extent of mortality reduction achieved so far was being measured by appropriate surveys and monitoring of the performance of the programme. Table 1 Diseases Subject to the International Health Regulations Notified by Countries of the South-East Asia Region 1980, 1981, 1982 (Information compiled from data made available to WHO headquarters by governments) Country Year Cholera Plague Cases Deaths Cases Deaths Burma India 1980 8 344 1981 4 681 1982 4 656 Indonesia 1980 5 541 1981 7 399 1982 8 183 Nepal Sri Lanka 1980 104 1981 574 1982 309 Thailand 1980 4 331 1981 39 1982 638 Inter-country training activities continued in Bangladesh (Inter- national Centre for Diarrhoea1 Disease Research, Bangladesh, Dhaka), India (National Institute of Cholera and Enteric Diseases, Calcutta) and Indonesia (Director-General, CDC, PIinistry of Health, and University of Indonesia, Jakarta). During the year under review three courses were conducted and 54 persons from eight countries were trained. The character of the regional training programme appeared to be changing as the main concern now was to develop faculty for national training that would be concerned with the training of intermediate and peripheral health workers and the education of mothers/family members in early diagnosis, treatment and referral of cases needing specialized care. Bangladesh, Burma, India, Indonesia, Nepal, Sri lanka and Thailand were at present implementing national training programmes. Maldives was expected to initiate such a programme by mid-1983, Bhutan in late 1983 and Mongolia in 1983-1984. Three modes of acquisition of Oral Rehydration Salts (ORS) by national CDD programmes could be seen in the countries: (i) large-scale production, using automatic or semi-automatic machines, as in India, Indonesia, Nepal and Thailand, (i i) cottage-scale production, using unskilled or semi-skilled personnel and simple equipment, as in Bangladesh and partly in India, Thailand and Indonesia, and (iii) procurement from outside the country with or without the assistance of agencies such as UNICEF. UNICEF provided ORS to countries where no production existed, such as Sri Lanka, Maldives and Bhutan, or where the production was insufficient (Burma, Bangladesh). Despite these efforts, ORS supplies were inadequate to cope with the existing needs and the production capacity must be increased urgently. The national policy in BANGLADESH adopted the use of both the standard ORS according to WHO formula and the early treatment at home with sugarlsalt solutions or with any available home fluids in the absence of standard ORS. This policy appeared to be increasingly accepted because of its impact on mortality reduction and easy applicability in the field situation prevailing in the country. The International Centre for Diarrhoea1 Diseases Research in Bangladesh (ICDDRB), a WHO Collaborating Centre, organized several inter- countrylinter-regional courses in clinical and laboratory aspects in addition to its extensive research activities in this field. The demonstration area at the Infectious Diseases Hospital in Bangladesh received full WHO support and was involved in various in-service and regular training courses for national health staff. Cottage-scale production of ORS continued, based on existing facilities in several general/infectious-disease hospitals involved in the management of diarrhoea. In BURMA, the first global test of training modules for intermediate supervisors of the peripheral staff responsible for programme delivery was successfully conducted during the year. The Department of Medical Research, Ministry of Health, was identi- fied as one of the global centres to study various etiological factors giving rise to acute diarrhoeas and to explore alternative drug management schedules of diarrhoeas. The research on etiological factors has been making progress. INDIA finalized the revised version of the national CDD programme document, which envisages phased implementation of activities such as research, training, ORS production and delivery, strengthening of the logistic system, and the setting up of sentinel areas and clinical demonstration centres. National seminars on oral rehydration therapy (ORTI for faculty members, clinicians and managers were followed by courses for district health staff, initiated in West Bengal in 1983. WHO extended technical support and subsidies for continuing national seminars on ORT and training for primary health centre staff. India recognized CDD as one of the priority objectives for the long-term health development programme and consequently increased considerably its own budget allocation. The National Institute of Cholera and Enteric Diseases (NICED), Calcutta, continued as the WHO Regional Training Centre for CDD and expanded its activities such as preparation of curricula for PHC workers, setting up of a research area for community involvement, and the provision of faculty assistance to other countries of the Region in their training activities, when required. In INDONESIA, one of the three regional training centres on CDD continued its national and inter-country training activities on the clinical aspects of diarrhoeal diseases. A course for paediatricians and faculty members from schools of medicine selected from six countries was expected to take place towards the end of 1983 on the management of diarrhoea cases complicated by other diseases such as acute respiratory infection, measles, pertussis, severe malnutrition, and deficiency syndromes. A consultant assisted the national programme in designing and conducting mortality/morbidity surveys in 1982-83 and two others helped in initiating a cost-benefit study on ORS production. In NEPAL, the plan of the national CDD programme was revised, improved and finalized for implementation. WHO provided technical support in drawing up the plan and continued its assistance in its implementation. The implementation of the research programme was assisted through consultancy services, and further similar support was given for implementing the comprehensive plan for service-cum-training. Two national seminars on the clinical management of acute diarrhoea1 diseases were held in April 1983 in which 54 staff participated. Staff members from NICED, Calcutta, WHO headquarters and the Regional Of fice participated as faculty members in these seminars, which took place in Kathmandu and Pokhara. SRI LANKA has been implementing a phased national CDD programme since July 1982, expanding the activities progressively so as to cover the entire country by the end of 1985. The service component of the programme, delivered through PHC, is preceded by the intensive training of different categories of staff involved in field activities and management. Seminars for paediatricians and teachers from schools of medicine were held in Colombo and Jaffna. Oral rehydration salts, now supplied by UNICEF, would be supplemented by national production in forthcoming years. Plans were being prepared, together with UNICEF, to start in 1983 a semi-automatic ORS production line with a capacity to meet 40 per cent of the country's need for ORS . In THAILAND, which operates a well-defined national programme, the first comprehensive programme review took place in March 1983 and the results were presented to the national health administration for corrective actions where needed. The review revealed, though indirectly, that wide application of ORT dramatically decreased the mortality due to diarrhoea, especially among infants. Three WHO consultants assisted the review as well as in the mortality/morbidity survey carried out in 1982. 2.2.2 Plague Burma remained the only country in South-East Asia where cases of plague were reported. During the reporting year, there was an outbreak with 157 cases which were confirmed by laboratory tests. Activities against plague were therefore stepped up in order to destroy the rodents and fleas and interrupt the transmission of the disease. The outbreak, however, was quickly controlled as a result of early diagnosis and prompt institution of preventive and curative measures by the national authorities. WHO supplied vaccines and medicines. Strict surveillance was being continued as a routine plague control measure. 2.3 Malaria and Other Parasitic Diseases Malaria has remained a principal health problem in eight countries of the Region, namely, Bangladesh, Bhutan, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. In Maldives the problem is less acute. Of the other parasitic diseases encountered in the Region, filariasis and leishmaniasis caused concern in some areas, while trematode infections such as schistoso- miasis and similar water-related diseases had a more limited focal distribu- tion. Intestinal helminthiases occurred almost throughout the Region. 2.3.1 Malaria The overall malaria situation in the Region in 1982 improved slightly over the previous year, with a small reduction in malaria-positive cases and a similar reduction in the incidence of Plasmodium falciparum infections. The epidemiological data indicate appreciable reductions in case incidence in Bangladesh, Burma, Indonesia (Java and ~ali) and Sri Lanka, and a conti- nued marginal decrease in India. Except for an outbreak (which accounted for nearly half of all detected cases), the incidence pattern in Maldives remained the same. Nepal and Thailand registered small increases during 1982. P.falciparum infections generally followed the same trend as that of overall incidence in most countries, although in Bangladesh and Sri Lanka they increased despite reduction in total incidence. Maldives has remained free of indigenous P.falciparum for several years. The major constraints of the programme continued to be operational and administrative in nature. They included migration of infected people into receptive areas and of healthy people into endemic areas. The two outstanding technical problems met with during the past two decades have not abated: while vector resistance to pesticides has remained fairly stable, parasite resistance to drugs continued to spread. Vector resistance persisted as a widespread problem in India, Indonesia, Nepal and Sri Lanka, and was monitored by susceptibility testing, the testing materials being supplied by the Organization to the malaria control programmes on a regular basis, while assistance and training in their use were provided, where necessary, by WHO entomologists. Technical cooperation extended by WHO related to the development of mediumterm programmes and evaluation of the existing programmes, together with training activities and the development and implementation of applied field research. The Organization's functions included promotion of cooperation in border areas among neighbouring countries, promotion of intersectoral coordination at country level and assistance in developing national self-reliance for the production of insecticides and anti-malarial drugs, and procurement of supplies and equipment. Annual assessments of the programmes were undertaken in India, Nepal and Sri Lanka, consultants being provided by WHO for the purpose. These assessments were undertaken jointly with representatives of the respective governments and the bilateral agencies that assist some of the programmes. Support by WHO of the malaria border coordination meetings was maintained, and the Regional Office acted as the focal point for the exchange of infor- mation arising from these meetings, which in 1982 were held between India, Maldives and Sri Lanka at Male, between India and Nepal at Kathmandu, between Bangladesh, Burma and India at Dhaka, and between Indonesia, Malaysia and Singapore at Randung. In February 1983 Indonesia participated in a South-West pacific malaria meeting held at Sydney, Australia. The importance of applied field research in overcoming constraints to the national' programmes continued to be stressed by WHO. One of the principal studies supported to a large extent from WHO regional funds has been the monitoring of resistance of P.fa1ciparum to 4-aminoquinolines and other antimalarials. In respect of vectors, regional studies are being undertaken on Anopheles species complexes, vector resistance to insecti- cides, and the use of biological agents for mosquito control. A number of investigations have also been made on operational, epidemiological and ecological aspects of anti-malaria work, while methods to solve the problems that confront integration of malaria and primary health care systems in low and high-risk areas, a key aspect of HFA, were examined at inter-country workshops held in the Regional Office and in Thailand. The Regional Collaborative Studies on Drug Resistant Falciparum Malaria, started in 1977, have reached the point where, with some exceptions, the sensitivity levels of P.falciparum to 4-aminoquinolines have been determined in the participating countries. With the exception of certain islands of Indonesia the objective of collection of baseline data on current geographical distribution, prevalence and degree of resistance has been achieved. At the Third Review meeting held in Jakarta in May 1983, monitoring of the response of P.falciparum to chloroquine was incorporated as an operational aspect of each malaria programme. By applying the micro in vitro technique, countries participating in the Regional Collaborative Studies are actively assessing the sensitivity levels of P.falciparum to mefloquine before wide-scale introduction of this new drug into their programmes. Studies have been initiated on the use of alternative drugs and drug combinations for use in areas where chloroquine is no longer effective for suppression or treatment of falciparum malaria. The creation of applied research units within national antimalaria organizations has been promoted by WHO, the external assistance required for their activities being met partly from regional funds, partly from the UNDPfWorld Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), and from bilateral sources. Among the wide range of research objectives, stress has been laid on the resolution of problems delaying integration of malaria control services, especially those aspects relating to case-detection and treatment, with the primary health care system, and the promotion of community participation. To this end, following the "Workshop on PHC Approach in the Control of Malaria in the South-East Asia ~egion" held in the Regional Office in May 1982, a second inter-country Figure 1. INCIDENCE OF MALARIA AND P,falclparum INFECTIONS IN SELECTED COUNTRIES OF THE WHO SOUTH-EAST ASIA REGION ;kg&g%9p . .+,, A&&& Upahwn Infections - Slide Positivity Rate % Slide ddup~ufl Rate X '000 % '000 X BANGLADESH BURMA NEPAL MALDIVES Mill. X '000 % 5. '000 % 500 - 2 .. 4 1 -- 2 78 79 80 81 82 78 79 80 81 82 78 79 80 81 82 78 79 80 81 82 INDIA INDONESIA SRI LANKA THAlLAh'D 'Provisional workshop, "~an~ower Requirements for the Planning and Management of Malaria Control Programmes in the Light of the Revised Strategy and Primary Health Care Approach", was organized at Phuket, Thailand, in October 1982. A11 malarious countries of the Region, including Bhutan, participated in one or both of these workshops. The vital role played by training is recognized, and training activities were strongly supported by WHO through fellowships, subsidies for national training courses, and supply of equipment, particularly audio-visual aids and teaching microscopes. An important aspect of the two workshops mentioned above was a critical appraisal of malaria training in the context of primary health care and participation of the community in parasite and vector control activities, these being educational inputs essential for the objective of HFA. Collaboration was maintained with the WHO Inter-Regional Malaria Training Secretariat at Kuala Lumpur, visits by the Director to the national malaria training centres in Burma, Indonesia and Thailand being supported by the Regional Office, as were participants from the Indian, Indonesian and lhai centres at a "training for trainers" course held at the Secretariat in April 1983. A consultant at the Regional Office examined the regional situation in respect of the production of national malaria training manuals and course curricula. In his report he commented that curricula and manuals, although available for most categories of staff, were often insufficiently updated in the light of current feasible strategies, particularly in respect of stratification of malarious areas, integration with PHC, and active participation of the community. The overall state of antimalaria programmes in the Region as of 1 January 1983 was as follows: Item - Millions 1 January 1983 Population in the Region 1 094 Population in originally malarious areas 1 016 Population in areas under antimalaria operations 95 6 Population in areas with no specific antimalaria operations 6 0 Summaries of antimalaria activities in individual countries, high- lighting WHO inputs, are as follows: In BANGLADESH, the improving epidemiological situation was indicated by declines in case incidence and the slide positivity rate, but the significance was lessened by a continuing low annual blood examination rate (ABER, 2.6 per cent) and increase in the proportion of P.falciparum infections. There have been some improvements in case incidence in the more malarious districts except Chittagong Hill Tracts, where a sharp rise occurred largely in immigrants among whom there was a notable mortality. Spraying and surveillance operations continued to be hampered by the shortage of field workers caused by delays in recruitment and release of funds; spray coverage was not completed and blood smear collections were low owing to impaired supervision. Passive case detection through the thana health complexes and sub-centres was deficient and these institutions need to be activated for full participation in the programme. Entomological activities continued to be hindered because of shortage of funds as well as lack of transport and technical support. A programme of entomological activities with emphasis on vector susceptibility and impact of spraying operations is, however, being developed and built into the new plan of operations. WHO provided two consultants for an external review of the programme, which was conducted jointly by the Government, WHO and the Netherlands in NovemberfDecember 1982. This review indicated that the present structure for implementation of the antimalaria measures was cumbersome and compli- cated, making effective supervision and epidemiological evaluation virtually impossible. It was stressed that the approach to the malaria problem in Bangladesh needed to be reoriented, activities being designed to meet the requirements of the three identified epidemiological strata. A new plan of operations based on the review report is being developed, and will hopefully generate much needed assistance from bilateralfmultilateral sources. The programme was encumbered not only with a shortage of DDT but also with poor quality DDT. Independent chemical analysis of four samples of indigenously produced and imported DDT showed all to be below WHO specifications. It is not surprising therefore that DDT spraying has not been having the desired impact on malaria transmission. The problems appeared to be related to poor field storage of the imported DDT and poor quality control of indigenously produced DDT. This lends urgency to the need for reactivating the DDT factory at Barakunda, to which the Government has now given a high priority among AsDB-financed projects. In December 1952 WHO provided two consultants to an AsDB mission to review the malaria control programme and advise on rehabilitation of the DDT factory. The Regional Collaborative Studies on P.Ealciparum sensitivity have progressed as planned, though some initial failures with the micro technique were encountered. The distribution of chloroauine-resistant strains of P.falciparum is concentrated in the forested hilly Anopheles balabacensis belt, andhus determination of the susceptibility of the plains-dwelling A,philippinensis to sporogonic development of resistant P.falcipaz'um would be an operationally appropriate research study. WHO support was provided for short training and orientation courses for health personnel at different echelons, and refresher training of technical personnel in the programme. During the period under review a total of 21.5 personnel attended the courses. In addition, senior staff at the central and district levels received WHO support for undertaking observation study tours of antimalaria programmes in the Region. WHO also awarded a 12-month fellowship for study in the USA. The Organization supplied emergency antimalaria drugs to control an outbreak in the Chittagong Hiil Tracts, in addition to providing other supplies and equipment required for the programme. In BHUTAN, around 15 per cent of the population continued to be at risk from malaria, approximately 65 per cent of confirmed malaria infections being attributable to P.falciparum. Among the population at risk, 88 per cent lived in areas covered by surveillance and spraying and 12 per cent by spraying alone. DDT was applied biannually, and the principal vector was A.maculatus. Anti-malaria activities were undertaken in three zones, where 14 malaria centres (12 with and 2 without surveillance) covered a population of 151 000. Each zone has a malaria laboratory and an additional laboratory is situated at Geylegphug in the Central Zone where incidence is high. Malaria control work has not yet been entrusted to the PHC system, which does not provide total population coverage, but where the basic health units have been established (and dependent on the outcome of a pilot study now in progress), integration is being embarked upon following reorientation training of workers. In BURMA, 92 per cent of the population inhabited originally malarious areas. Drug distribution is the basis of the programme, although RI-level resistance to chloroquine and amodiaquine was widespread during the review year and was beginning to appear also to the combination of sulfadoxine and pyrimethamine in the south-east. Intradomiciliary spraying with DDT protected 13 per cent of the population (although the vectors A.annularis and A.balabacensis showed resistance to this insecticide focally), drugs protected 22 per cent, 43 per cent were in surveillance areas and 14 per cent in vigilance areas. The specialized work of the Vector-borne Disease Control Unit in respect of spray and radical treatment operations, evaluation, training and research was linked to the case- detection and treatment activities of the community health workers and public health supervisors in the township health services by VBDC teams located at divisional/state level, The malaria situation improved somewhat during the year, the API being halved, the SPR reduced by a quarter and the proportion of P.falciparum falling to around 77 per cent from 83 per cent. However, these gains may have been deceptive since the ABER continued to be extremely low. Assistance extended to the progrmme by WHO was used largely for fellowships and supplies and the support of a WHO malariologist. Support was also provided by UNICEF and the Government of Canada (CIDA) in respect of insecticides, drugs and equipment. The Netherlands Government support of two WHO vector-borne disease specialists (an entomologist and a sanitarian) continued, although the incumbents left Burma in November 1982 and, pending further inputs to the grant, have not yet been replaced. A national entomo- logist was supported by WHO for an extensive study tour of international approaches to integrated mosquito control methodology. The Director of the WHO Inter-regio~al Malaria Training Secretariat for Asia visited Rangoon in November 1982, and three consultants were assigned to provide advice to the Department of Medical Research on the immunodiagnosis of malaria, epidemio- logical research in malaria, and the establishment of a clinical research unit for cerebral malaria. In INDIA, 95 per cent of the population continued to live in mala- rious areas, all of which were under surveillance and antimalarial treatment of fever cases was provided. Population additionally protected by measures directed against the vectors also continued to be around 57 per cent. During the 1982-83 period, 30 per cent of the national health budget was devoted to the implementation of the Modified Plan of Anti-Malaria Operations introduced in 1977 by the National Malaria Eradication Programme (NMEP). This plan, which has an urban component now covering 125 towns, has resulted in an overall decline of malaria incidence, and relies to a considerable extent on community participation. Liberal distribution of anti-malarial drugs through more than 325 000 community health workers and volunteers, together with the spraying of residual insecticides where the MI reached two or above, have been responsible for the reduction of morbidity and mortality in rural and remote areas since the peak incidence in 1976. The data for the year under review, supported by a strong ABER, indicate a further reduction over the previous year of 33 per cent in the API, 26 per cent in the SPR and 10 per cent in the SfR. The programme has continued to be integrated progressively with the general health services at district level, and cost sharing with the several states is on a 50:50 basis, although the inability of some states to provide sufficient funds has of necessity resulted in local relaxation of the API criterion for introduction of spraying. Little change has occurred in the extent or distribution of vectors resistant to pesticides. The principal vector in the rural areas, A.cuIicifacies, in many districts is focally resistant to DDT and HCH, and in western India sometimes also to malathion. In some urban areas A.stephensi is doubly resistant to DDT and HCH. Rising costs of insecticides, particularly the organophosphorous (OP) compounds, have encouraged the trend towards self-sufficiency in their production. In the large areas of eastern India where falciparum malaria is prominent, the national programme has been reinforced since 1977 by a P.falciparum Containment Programme (PfCP), supported generous19 by the Government of Sweden (SIDA) through WHO. The Indian staff of the PfCP were strengthened during the year by four WHO staff members and one consultant whose duties included epidemiological, entomological and applied research work. ,The five-year period of SIDA support to the PfCP ended during the year under review, and a five-year renewal has been granted albeit with a 40 per cent reduction in funding necessitating a consolidation of the operations. The area originally covered by PfCP in much of north-eastern India (Zone-I) and parts of WesZ Bengal, Bihar and Orissa (Zone-111, was expanded to include parts of Andhra Pradesh, Madhya Pradesh, Karnataka and Tamil Nadu (~one-111), and in western India parts of Gujarat, Rajasthan and Maharashtra (zone-IV). The Andaman and Nicobar Islands were also included. Consolidation due to reduction in funding is requiring PfCP to relinquish Zone-IV and reduce Zone-I11 where falciparum malaria in any case forms less than 20 per cent of the malaria species incidence, and concentrate on the east and north-east where it may be as high as 70 per cent. The programme of intradomiciliary spraying, chemotherapy and surveillance undertaken by NMEP and PfCP resulted in further reduction of malaria despite the presence in parts of north-east India of P.falciparum resistant to chloroquine. This resistance has been monitored by teams of the Indian Council of Medical Research attached to NMEP regional offices, trained by WHO in the use of in vivo and in vitro parasite resistance tests; they have confirmed its presence focally in Zones I and 11 of PfCP. Upon confirmation of resistance by in vitro testing, using equipment provided by WHO, energetic steps have been taken by NMEP to eliminate the focus. Attention to urban malaria problems, in respect of which NMEP has a special programme, included the provision of a WHO expert to advise the Madras Corporation on methods of mosquito control. Training was a particular object of WHO support, fellowships being awarded and grants and subsidies arranged for institutional and field training courses. At the National Institute of Communicable Diseases, Delhi, WHO supported through subsidies and lecturers the regular courses held during 1982 for 53 malariologists, 81 epidemiologists and 23 entomologists nominated by NMEP and PfCP, state health departments, and agencies such as Defence and Railways. One NMEP officer attended the second Rome-Palermo- Adana Malaria Course commencing in April 1983, at WHO expense. Funds from an inter-country UNDP grant were provided for the purchase of audiovisual equipment and teaching microscopes, Periodic review meetings of PfCP were sponsored by WHO, and malaria coordination conferences were organized between India and Nepal at Kathmandu in September 1982, and between India, Maldives and Sri Lanka at Male in December 1982. In INDONESIA, the Malaria Control Programme, which was largely concentrated in Java and Bali, began to be extended to the outer islands with external assistance being made available. The programme in Timur with US AID assistance gathered momentum after the training of personnel. Malariometric surveys and selective spraying were being undertaken. Malaria control has been included in the comprehensive health programme financed by the World Bank in three provinces of Sulawesi, the loan agreement having been signed in February 1983 and the programme coming into operation in June 1983: ~~$9.4 million is earmarked for malaria control. The programme continues to be hampered because of delays in reporting from the provinces consequent on the introduction of the new reporting system. The available information for 1982 is indicative of an improvement in the epidemiological situation with a reduction of case incidence and the slide positivity rate. However, the percentage of P.falciparum infections, which has been steadily increasing in recent years,reached 53. As in the previous year, 85 per cent of malaria cases for Java and Bali were from Central Java, where technical problems of vector resistance and parasite resistance are prominent. In Bali, an improving epidemiological situation was disturbed following an outbreak of malaria in an offshore island which occurred with the arrival of returnee transmigrants from East Kalimantan. The outbreak was brought under control with prompt remedial measures. With the expansion of the transmigration programme the need for establishing check-posts to screen returnee transmigrants on visits to their home villages in Java and Bali has assumed operational importance. Limited spraying with fenitrothion was carried out in a few kecamatans of Central Java and its impact was much greater than with DDT. lhis justifies its wider application, particularly in Central Java. Routine entomological activities were continued in Java and Bali and in priority areas in the outer islands. Special investigations were in progress in five provinces of the outer islands and West Java Province. Testing of vector susceptibility to insecticides has been sporadic. A.aconitus in Central Java has maintained a high level of resistance to DDT and exhibits tolerance to dieldrin. A.barbirostris in Central Java has also become resistant to DDT, although A.sundaicus remains susceptible. Precipitin testing of A.aconitus and A.sundaicus has revealed the former species as highly zoophilic and the latter less so. The Regional Collaborative Studies on P.fa1ciparum sensitivity to 4-aminoquinolines using the micro in vitro technique were extended to Sulawesi and Nusa Tengara and resistant strains were encountered. These studies have confirmed resistant P.falciparum in 51 localities of 16 provinces where tests have so far been completed. Training and reorientation of staff have high priority in the programme to overcome manpower constraints at all levels. A total of 321 personnel received training and orientation at courses organized mainly at provincial level and met largely from national funds with smaller inputs from WHO. In addition, WHO awarded in 1982 nine malaria-related fellowships for training in entomology, epidemiology and tropical medicine and hygiene. One participant for the workshop on the training of trainers in Kuala Lumpur was supported by the Organization. WHO provided a consultant in entomology in April 1983, WHO assisted in the holding of the Fourth Indonesia-Malaysia- Singapore Malaria Border Coordination meeting at Bandung in November 1982. The recommendations covered a wide range of subjects aimed at further improving inter-country coordination, especially antimalaria operations in border areas. In MALDIVES, with the exception of a focal outbreak in one of the islands in the northernmost atoll during the later part of 1981 and early part of 1982 which was quickly brought under control, the overall epidemio- logical situation remained satisfactory. During the period August 1982 - February 1983 only nine locally transmitted cases were detected in the country as against 24 cases during the previous six-month period and 64 cases during the period August 1981 - February 1982. The three P.falciparum cases detected during 1982 were imported from outside the country. DDT spraying was carried out in two northern atolls and one southern atoll where there was evidence of local transmission and/or presence of vector(s). Limited anti-larval operations were also attempted. Surveillance and chemotherapy continued to be carried out by the primary health care system, which was being strengthened. As stated earlier, the Fifth India-Maldives-Sri Lanka Malaria Coordination Conference was held in Male in December 1982. In the field of management some important steps were initiated. WHO collaboration in terms of fellowships, local cost subsidy and supplies continued, and a WHO sanitarian remained in position during the year. The problems encountered were mostly operational in nature; the communication and transportation problems remained unchanged. The parasite (P.vivax) was sensitive to anti-malarials and the vectors (A.tesselatus and A.subpictus) were susceptible to DDT. In NEPAL, the overall malaria situation remained unchanged, although there was an increase in the number of microscopically diagnosed cases of malaria due to an increase of imported cases and further improvement in ABER in both NMEO and integrated community health services development project (ICHSDP) districts. In all NMEO regions there was an increase of malaria cases but in the integrated districts there was a substantial reduction of cases; this is particularly significant in view of the increased ABER. The number of P.falciparum infections increased, constituting 6.2 per cent of total infections. A characteristic feature of the improved ABER in 1982 was an increase in PCD (passive case-detection) collections largely by volunteers, with a yield of 15 per cent of total cases. An encouraging development was the establishment of 15 malaria clinics which also swelled PCD collections. However, the cooperation from hospitals and health posts in this activity has seemed lukewarm and should be actively promoted to facilitate transfer of districts to ICHSDP. A noteworthy feature was the high community acceptance of insecticide spraying, but the full impact of spray coverage in transmission was impaired because the pre-monsoon spray cycle was delayed and not all contiguous localities in an epidemiological belt were sprayed. The entomological activities were related to routine investigations and conduct of susceptibility and bio-assay tests. A.annularis and A.culicifacies continued to be resistant to DDT but susceptible to malathion whereas A.fluviatilis and A.maculatus were still susceptible to DDT. Bio-assay tests with DDT supplies from two different sources gave 100 per cent and 79 per cent mortality after 14 weeks. The Research and Training Centre at Hetauda, despite its limitations in physical facilities, equipment and trained manpower, has been active in training, conducting 8 courses totalling 24 weeks and training 181 parti- cipants. The research activities at this inadequately financed centre were largely entomological field studies on the ecology and bionomics of vector mosquitoes. The programme was also involved in the Regional Collaborative Studies on P.falciparum sensitivity to 4-aminoquinolines, and was pursuing studies on relapse pattern with single-dose treatment regimen, on G6PD deficiency, and on species complex of vector mosquitoes. The Health Education Section of the NMEO has initiated a number of activities, including the training of volunteers to promote community participation in malaria control activities. The internal assessment report reflects an increasing self-reliance in this activity. The external assessment was carried out jointly by the Government/US AID/WHO in March 1983; WHO provided two consultants. The assessment team was impressed with the gains of the NMEO in 1982 in respect of reduction in the number of vacant posts, higher spray coverage, improved PCD collections and efficiency of laboratory services. The recommendations of the team included reference to the need for development of criteria for the transfer of districts to ICHSDP, there being five districts projected for integration in 1983-84. With more and more districts under NMEO responsibility passing to ICHSDP, the operationally difficult districts in the Far-western Region with a population of 0.7 million, presently without specific antimalaria measures, may be brought into the NMEO fold. WHO collaboration during the period was in the form of technical support, and included provision of four consultants, fellowships, local cost subsidies and supplies and equipment. A consultant in bioenvironmental interventions was expected to be in position in mid-1983. Consultants will also be provided for a joint India-Nepal investigation on persistent transmission along the border, as resolved at the India-Nepal Malaria Coordination Conference held in Kathmandu in September 1982. In SRI LANKA, malaria incidence has shown a favourable trend; API has declined from 4.5 per 1 000 in 1981 to 3.62 per 1 000 in 1982 and SPR from 5.3 per cent in 1981 to 3.6 per cent in 1982. However, a slight - increase over the previous year of P.,falciparum infections was noticed owing to some focal outbreaks. Spraying of houses with malathion (zg/m2) every three months has been the principal anti-vector measure. However, the spraying programme has been rationalized following stratification of malarious areas into high- risk/special-risk and low-risk areas. In addition, limited larviciding end space spraying have been carried out as supplementary measures. Country-wide surveillance operations have been undertaken to monitor the epidemiological situation, and malaria cases have been given radical treatment. Monitoring of vector susceptibility to insecticides and parasite sensitivity to anti- malarial drugs was also carried out regularly. A.culicifacies continued to remain susceptible to malathion but resistant to DDT. Up till now there is no evidence of diminished sensitivity of IJ.falciparum to chloroquine. A new plan of operation covering the period 1982-1986 was signed in September 1982. WHO collaboration in respect of fellowships, local cost subsidy and supplies continued as before, and WHO project staff consisted of a malariologist, an entomologist and a sanitarian. The main constraints have been lack of staff of the category of regional malaria officers and inadequate supervision resulting in unsatisfactory spray coverage. The principal problem areas continued to be those where illicit gem mining and 'chena' (slash and burn) cultivation occurred. In THAILAND, out of 45.4 million people living in the malarious areas of the country, nearly 78 per cent live in areas where the ultimate goal is to eradicate malaria, whereas the programme objective with regard to the remaining areas inhabited by 22 per cent of the population is to keep the disease under a satisfactory level of control. Although the declining trend in mortality due to malaria has been maintained, no significant decline in case incidence has been noticed during the period, and the proportion of P.falciparum infections has remained unchanged. However, a satisfactory level of control has been maintained in the northern and north-eastern parts of the country, although the disease incidence along the eastern border has remained high because of technical problems such as drug resistance and vector exophily, and because of population movement. While a high degree of P.falciparum resistance to chloroquine is now prevalent in the whole country, this problem has assumed a particularly serious character in the south-eastern part of the country, where the sulphadoxine-pyrimethamine combination that replaced chloroquine is now believed to provide only a 10 per cent cure rate. In view of the prevailing situation a large-scale one-year field trial of mefloquine to combat this multi-drug resistant P. falciparum was initiated by the malaria service early in 1983 with the support of the Regional Office and the Malaria Action Programme of WHO headquarters; 100 000 doses of the drug are being supplied free of cost to the project. P.vivax infections were still sensitive to chloroquine, but were responsible for only 31 per cent of the infections. In addition to the routine DDT residual spraying campaign, the dosage being zg/m2, some areas of the country were protected by duniciliary spraying with fenitrothion (lg/m2) procured through Japanese ~ ~ assistance; he principal vectors, A.minimus and A.balabacensis (A.dirus). are still susceptible to DDT but are showing increasing evidence of exophilic and exophagic tendencies. The programme has taken steps to involve the community in malaria control activities. In addition to health volunteers, malaria volunteers covering 90 per cent of the villages assist in screening malaria cases. The volunteers work closely with health communicators, who are responsible for educating the public, In this connection, the health care approach to malaria control in the light of the revised strategy was the subject of the WHO-supported workshop held in Phuket, mentioned earlier. Final evaluation of the US AID anti-malaria project, which has provided for the establishment of malaria clinics and strengthening of research facilities, takes place this year. WHO collaboration continued as before in respect of fellowships, grants and supplies. During the review period the Organization had a malariologist and an entomologist in position and, for part of the period, a technical officer. Early in 1983, as part of the Sir Robert Jackson Commission sponsored by the United Nations, the WHO malariologist participated with HQ personnel in a malaria and nutrition survey of the migrant populations along the Thai-Kampuchean border. 2.3.2 Schistosomiasis INDONESIA launched a well planned and coordinated programme for the control of schistosomiasis due to S. japonicum in Central Sulawesi, where the disease is endemic. The programme aims at supervised comprehensive treatment of cases and surveillance of the vector. Experience gained in this project would play a significant role in planning for the prevention and control of vector-borne parasitic diseases in the country's trans- migration schemes. A WHO consultant visited the country in April 1983 to assist in the development of plans for research on schistosomiasis. His findings contributed substantially in developing a comprehensive plan for pre-emptive surveillance and control of parasitic diseases prevalent in areas where transmigrations are to be carried out from 1984 onwards. Endemic foci of Schistosomia mekongi on the Thai-Kampuchean border continued to be present leading to sporadic cases. The WIO TDR (Special Programme for Research and Training in Tropical 9iseases)~was collaborating with the Centre of Malacology, Mahidol University, in assessing the role of the intermediate host in transmission and in designing practical methods for its overall surveillance. Another small endemic focus still exists in Gymvi, Maharashtra (India). The Government of India is planning to conduct a study on this focus. 2.3.3 Filariasis Filariasis continued to be one of the major health problems among parasitic diseases, especially in Bangladesh, Burma, India, Indonesia and Sri Lanka. In BANGLADESH, surveys have indicated rather high microfilaria rates in some parts of the country, as high as 15 per cent positive results in some samples. Efforts were made to organize the control activities in a planned manner; however, inadequate resources and manpower are the limiting factors. In BURMA, special surveillance carried out in July-December 1982 showed a 2.44 per cent positivity rate among the surveyed population. The number of slides examined for filariasis in the country was increasing steadily and, during the second half of 1982, out of 48 383 slides checked 1 182 were found positive. The vector, Culex quinquefasciatus, is distributed all over the country and the disease, primarily recognized as mainly an urban problem, is now detected even in very small and contained rural settings. In INDIA, the disease is endemic, Lbancrofti being the predominant parasite. The therapy with DEC was the main control measure used in the national project since the vector control activities undertaken in the project did not produce the desired results. The WHO/TDR Programme continued to support studies in INDONESIA aimed at improved surveillance and better knowledge on vector behaviour and parasite transmission. Reseasch on filariasis in Bengkulu, supported by a TDR grant, confirmed a high endemicity of B.ma1ayi and identified precisely the vectors and their bionomics. Confirmation of the nocturnal periodicity of the parasite in the peripheral blood of the patient had implications for the surveillance programme. A working group on filariasis (and schistosomiasis) has been estab- lished with the objectives of setting priorities, preparing and implementing appropriate programmes and supervising studies leading to improvement of the services. Tne coordinating and programming role of the group was co~isidered important in view of the planned relocation of a greater number of transmigrants to less populated islands where filariasis was endemic. In SR1 LANKA, research is being carried out on the application of biological vector control methods. Results so far achieved showed that use of B.thuringiensis as an antilarval agent might find its place as an effective control technique against Sulex qu+fasciatus in areas where the vector popula on was dense and filariasis reached high endemicity In THAILAhD, where microfilaria rates were around 2 per cent, the control strategy depended upon DEC mass treatment to reduce microfilaraemia and interrupt the transmission chain, 2.3.4 Leishmaniasis This remains an important problem in India (four endemic states) and Bangladesh. In BANGLADESH, the diagnostic unit for parasitic diseases set up at the National Institute of Preventive and Social Medicine, Dhaka, in 1982 with the assistance of a MI0 consultant, could now be the potential centre for conducting surveys and surveillance more systematically than ever before. Malaria poses serious public health problems in many countries of the Region. Regular blood exam;nat;ons of cases of fever are part of the strategy against malar;;.. MALARIA In order to control malaria cffecrwe~y !t ,s necessary lo undersrond ,Is vecrors better. Here [no mal3ria workers are collecting mosquito samples for entomological studies. h7icroscopic examination of blood shdes under field conditions to confirm malaria and establish slide positirity rates. Spraying is one of Lhz strategies employed for controllinq the incidence of malarin. Spvl,,,,, examinarion is an;moorlanl in r!le drrecrirri of infecoous cases of luberculos~s. Here. a parienr is de1;vermq a sample lo a heallh worker. COMMUNICABLE DISEASES A new area of kala-azar was detected in 1982 in Fulbaria, Mymensingh, where an extensive survey was carried out, in which both clinical and laboratory-oriented investigations of both bone-marrow and spleen were conducted. An entomological survey confirmed the abundance of sandflies in this area. Measures were undertaken to effect surveillance on a continuing basis and in a systematic manner. INDIA, where a task force on kala-azar has been functioning since 1979, designed practical plans for the surveillance and control of the disease in Rajasthan, Orissa, West Bengal and Bihar. Studies on the ecological aspects and behavioural patterns of the sandfly continued. Research on elucidating the inter-relationship among the vector, the parasite and the host was also bring conducted. 2.4 Bacterial Diseases Leprosy and tuberculosis control programmes are carried out as either separate or combined activities usually integrated with general health services. WHO continued to assist countries in the Region by making available the necessary technical knowledge and expertise, supported national and inter-country training activities, and organized workshops, seminars and meetings for the exchange of experience. Many countries expressed their special interest in the application of multidrug therapy in leprosy control to prevent dapsone resistance and reduce the mycobacterium load in the environment. The Japan Shipbuilding Industry Foundation and other aid organizations and voluntary agencies were playing a major role in leprosy control programmes. Through the TDR Programme WHO assisted the countries in undertaking field research to develop efficient and feasible methods and techniques which were acceptable to the community, for leprosy control activities. 2.4.1 Tuberculosis Tuberculosis is one of the leading health problems in South-East Asia. Early detection of infectious cases and their efficient treatment, together with imunization, specifically of the vulnerable group of children, continue to be the main strategies for control and prevention. BCG vaccination was undertaken as a part of the expanded programme on imunization (EPI) in all the countries in the Region. BANGLADESH has been implementing a combined programme for the control of tuberculosis and leprosy. By the end of 1982, more than 45 000 new cases had been reported by tuberculosis clinics and rural health centres, approximately 25 per cent of them being infectious. In December 1982, BCG vaccination as a continuous programme was sanctioned to cover all children below the age of 15 years, and about 500 000 children have been vaccinated so far. The Government is making serious efforts to increase the coverage as the target population to be vaccinated is estimated to be 45 million. Orientation training in tuberculosis and leprosy commenced in December 1982 and continued through February 1983. In INDIA, both tuberculosis and leprosy control are included in the twenty-point priority programme of the Government. WHO continued to provide technical assistance, specifically to the Tuberculosis Research Centre in Madras, which is engaged in a number of clinical, laboratory and field research activities, with a view to improving tuberculosis control. In MALDIVES, case detection by direct sputum smear examination continues wherever the possibilities of slide collection exist. The positivity rate is 0.8 per cent. Job-oriented training for both community health and family health workers was carried out. In NEPAL, WHO has been assisting manpower development through fellowships and in-service training programmes. A group training course for junior auxiliary health workers was conducted in October 1982. The programme, however, continued to face difficulties in ensuring timely and adequate supplies of anti-tuberculosis drugs owing to procurement and distribution problems. One of the brighter aspects of the programme, however, was the cooperation between the national health authorities and the Nepal Anti-~berculosis Association in the delivery of the treatment component of the programme at the peripheral, community level, especially to identify defaulters and follow-up with treatment. 2.4.2 Leprosy Leprosy continued to pose a serious health problem in many countries of the Region. According to latest data available, there are not less than five million leprosy patients in the Region and the problem exists in 9 out of the 11 Member Countries. In spite of efforts being made in the countries of the Region for many years to control this disease, only around 60 per cent of the estimated five million cases could be registered for treatment, As a follow-up action to implement the recommendations of the technical discussions held during the thirty-fifth session of the Regional Committee on "Control and Prevention of Leprosy in the Context of Primary Health Care", the Organization continued to support Member States and initiated measures for carrying out the following practical steps to strengthen the leprosy services in the Region: (1) collaboration with national authorities for the reorientation and refinement of community-based national plans and strategies for leprosy control, including the development of an appropriate information system, essential laboratory services, training of personnel and monitoring and evaluation of the programmes, and (2) development of a regional plan of action in support of national programmes for leprosy control in collaboration with other United Nations agencies concerned as well as multilateral, bilateral and non-governmental organiza- t ions. Also, a Meeting on Action Plans for Leprosy Control, held in New Delhi from 23-25 August 1982 and attended, among others, by donor agencies, developed a guideline for preparing plans at country level. In BANGLADESH, leprosy control activities were being intensified through (a) health education, (b) survey of the total population, especially in endemic areas by house-to-house visits, (c) training of the health staff including thana health administrators and all basic auxiliary workers, and (d) regular treatment for leprosy cases at the thana health complexes. In BHUTAN, where 50 per cent of leprosy patients have been registered for treatment, arrangements were being made for introducing the multidrug regimen. Control activities were being supported mostly by voluntary organizations from abroad. In BURMA, the rifam~icin trial, which had completed six years of operation, was extended further up to 1985. The WHO statistician attached to this project completed his assignment in December 1982. The outcome of the rifampicin trial is very satisfactory: effective results of the introduction of rifampicin were noticed after two years of treatment - lowering of the incidence of leprosy in comparison with the control group. The dapsone-resistance survey in Myingyan township progressed satisfactorily. Results of the survey indicated that 36 per cent of open cases were suspected to be resistant cases, increasing at the rate of three per cent a year. Mouse foot-pad inoculation was being regularly used at the Immunology Section of the Department of Medical Research, Rangoon, though the capa- bility of this laboratory was limited to two specimens a week. Training of the leprosy staff - mostly refresher courses for retraining - was conducted regularly. It is planned to train 658 workers in leprosy from 1983 to 1986. WHO was collaborating with the national training programmes for leprosy control. In general, the leprosy control programme in Burma is being operated as an integral component of the health services. SO far, 165 of the 314 townships in the country have been covered with the leprosy control programme being operated as an integral part of primary health care. In INDIA, a well-planned project for the intensification of leprosy control was being implemented in six districts chosen on the basis of high endemicity and other criteria. Three national consultants were recruited with WHO support and funds from SIDA, to coordinate the implementation of the multidrug regimen in these districts. Training of the staff dealing with, anti-leprosy work was conducted at Karigiri in Tamil Nadu and at Agra in Uttar Pradesh. WHO also supplied equipment to the training centres and awarded fellowships to a number of trainees. Both institutional as well as field research activities were undertaken to solve problems of early diagnosis and field operations. In INDONESIA, leprosy control was being carried out by the Government as well as voluntary organizations at the national level in collaboration with WHO. The main activity was the training of national health staff of varip~s categories at the National Leprosy Training Centre, Ujung Padang, which was, assjsted by. a consultant leprologist. Two further primary health chre centres havk undertaken case-holding as a step towards the integration bf leprosy control activities with the general health services preceded by a random 'sampling survey. Random sampling surveys were also conducted in three provinces, namely, North Sumatra, South-east Sulawesi and East Java, funded by the Sasakawa Memorial Health Foundation, Japan, the Lhmien Foundation, Belgium, and the National Leprosy Relief Fund. Two provinces woula be surveyed to assess the leprosy situation during the remaining mbnths of the year. A WHO leprologist participated in the random sampling surveys and a WHO statistician assisted in statistical analysis both in the preparatoj phase as well as during the survey. The OMSLEP (WHO) system of recording and reporting was being tried in Cirebon district, West Java, with WHO collaboration. Facilities for the mouse foot-pad inoculation technique were developed and the technique used in the Central Laboratory, Jakarta, with encouraging results. In MALDIVES, leprosy control activities continued mostly through regular case-holding and supervisory visits. The operational cost of the programme was being met by the Damien Foundation, which also provided a medical officer for this task. Multidrug therapy was introduced on one island with high endemicity and would be extended further in the next phase to the southern islands of Gaafu Dhaalu and Gaafu Alifu atolls so that ultimately multidrug therapy would become the routine method of treatment. The leprosy control programme in NEPAL was being carried out in a coordinated manner. The Government's leprosy unit coordinates the activities of both external and internal agencies working in the country. All these agencies have specific roles to play in the national leprosy control programe. .Multidrug therapy was introduced in Bagmati Zone (Central Region) and would be gradually extended to the entire area of the Central Region by 1985. A WHO medital officer visited Nepal during February-March 1983 to monitor the multidrug therapy activities and review the situation in order to assess the need for further assistance. Facilities for the mouse foot-pad inoculation technique were developed in Anandban Hospital. Intensification of the control measures for the entire country was planned and efforts were under way for training adequate numbers of health manpower in support of the leprosy control prograttnoe. Supervisory visits frcm the Central Region to the periphery were further geared up in order to improve the programme activities. In SRI LANKA, the national ant i-leprosy programme continued with two medical officers and 16 trained public health inspectors who were directly responsible for leprosy control work. Active case-finding was done by school surveys, surveys of special population groups and contact surveillance. It is observed, however, thet the largest number of cases were reported by medical and paramedical personnel of the health services and by general practitioners. In THAILAND, the third survey under the protocol of evaluation of leprosy control activities in Khon Kaen Province was completed. The relevant information derived from this survey would be used in developing a model for leprosy control activities as an integral part of health care services. Case-finding and case-holding activities in most of the provinces were being intensified together with the multidrug therapy in field operations. Mouse foot-pad inoculation was being carried out in the Central Laboratory, Bangkok, which also undertakes immuno-pathology studies as a research activity. Primary health care workers were being trained in various aspects of leprosy control in all provinces. 2.4.3 Sexually-Transmitted Diseases Sexually-transmitted diseases (STD) contiriued to be a problem in countries of the Region not only from the point of view of public health but also on account of their adverse economic and social effects on the patient as well as on the community. To complicate the situation further, penicillinase-producing gonococci infections appeared to have increased further in Indonesia and Thailand. A slowly but steadily increasing trend in India and Sri Lanka was also causing concern. In INDIA, the STD control programme laid greater emphasis on the training of health manpower. Educational activities continued to be organized for medical officers, who were also awarded fellowships in order to enable them to acquire additional knowledge. During the Fourth Five-Year Plan, the STD control programme had been included as a purely central sector scheme, under which provision was made for the establishment of regional teaching-cum-training centres, one regional centre, four regional STD reference laboratories and four regional survey-cummobile STD units. Following the training workshop held in May 1982 in Calcutta for the laboratory technicians of district hospitals from eight states, which on evaluation indicated that 95 per cent of the participants had learnt adequate laboratory techniques in the field of STD, another workshop was organized in December 1982 for medical officers working in the district hospitalsjprimary health care centres in five more states. Tnis workshop provided adequate orientation to the medical officers in improving the clinical, diagnostic, therapeutic and laboratory aspects of STD control activities. In INDONESIA, WHO consultants reviewed the existing data on the epidemiology of the disease in order to assess the control programme, and participated in the evaluation of regular mass treatment of infected persons for the control of STD. It was observed that most infectious cases occurred in the age group of 20-29 years, followed by those of 15-19 and 30-39 years. The national STD control programme directed its efforts towaras the control of syphilis through the training of health personnel at all levels, development of diagnostic capabilities, development and distribution of material for health education of the community, and systematic antibiotic prophylaxis of the high-risk groups, SRI LANKA has a modest STD control programme, as most of the cases of sexually-transmitted diseases are being treated by private practitioners. The Directorate of Health Services orgznized several review meetings on the progress of the national activities against STD in order to improve the national programme and its coverage, In THAILAND, while the STD control programme continued as planned, the laboratory and research section of the Venereal Diseases Division of the Ministry of Public Health initiated studies on penicillinase-producing Neisseria gonorrhoea and pelvic inflammatory diseases in the infected population. The results of the study, which were being analysed at present, wou1.d be presented at a regional meeting of the International Union Against the Venereal Diseases and the Treponematoses to be held in June 1984. Methods for laboratory diagnosis including culture for Hemophilus duereyi and Chlamydia also were further improved. 2.4.4 Diphtheria, Pertussis and Tetanus The epidemiological data and the activities related to the control of these diseases are described under 2.6, "Expanded Programme on Immunization". 2.5 - Viral, Chlamydial, Rickettsia1 and Related Diseases This group of diseases was creating growing concern to public health administrations on account of their increasing trend. The so-called fevers of unknown origin, hepatic disorders of non-defined etiology, and cerebro- meningial symptoms of suspected viral origin, were mostly being precisely diagnosed now as a result of the availability of rapid viral techniques for diagnosis. Application of modern techniques is now being taught at inter- country and national workshops to enable rapid diagnosis of DHFIDSS, viral 0 hepatitis, influenza, and other viral respiratory tract infections which continued to remain undiagnosed in the not-too-distant past. These techniques would be more widely used in the near future as a result of extensive training programmes for building up adequate laboratory manpower and efforts to develop laboratory facilities, including the production and distribution of reagents. In the case of viral hepatitis, studies continued for defining the pattern of transmission and the efficacy of the hepatitis B vaccine in preventing chronic liver diseases. WHO has been assisting three countries (Indonesia, Sri Lanka and Thailand) in the conduct of epidemiological studies on dengue virus infection and transmission in selected areas where the disease is either endemic or silent. The results are expected in 1985 and, if valid, will have an important impact on improvement of the surveillance of the disease. They will also help in understanding the pattern of virus transmission in different ecological conditions. Meanwhile, support is being provided for the development of a dengue vaccine at the WHO Collaborating Centre for Research in the Immunopathology of DHF and Dengue Vaccine Development in Bangkok, Thailand. The candidate vaccine has been processed to the stage where initial human trials can be planned. The South-East Asia Region has been recognized as the global focal point for the coordination of research on DHFIDSS. 2.5.1 Trachoma Activities for the control of trachoma are carried out as part of the programme for the prevention of blindness (see 3.3, "Prevention of Blindness" ) . 2.5.2 Poliomyelitis All countries of the Region participated in the International Programme of Poliomyelitis Surveillance. The vaccination component is described under 2.6, "Expanded Programme on Immunization". In MONGOLIA, during an outbreak of poliomyelitis, sero-studies confirmed the existence of polio I strains in 70.2 per cent of the cases, polio I11 in 6.4 per cent and other enteroviruses in 23.2 per cent. Improvement of epidemiological surveillance of the disease and stricter monitoring of vaccination at district level were achieved which contributed to the control of the disease. 2.5.3 Dengue Haemorrhagic Fever (DHF) DHF with or without accompanying dengue shock syndrome (DSS) persists as a major health problem in Burma, Indonesia and Thailand. Sporadic cases diagnosed clinically occurred in Bangladesh, India and Sri Lanka. WHO continued to provide technical cooperation for the development of epidemio- logical and entomological surveillance, strengthening of virus laboratory services, improvement of diagnosis, clinical management of dengue cases, specifically with shock syndrome, and in research and training activities. WHO consultants collaborated in ongoing research-cum-service activities in Sri Lanka and Thailand. Epidemiological research studies on DHF/DSS which had been started in the previous years, continued in the endemic and silent areas in Thailand, Indonesia and Sri Lanka. In August 1982, an inter-country meeting of principal investigators of these studies was convened in New Delhi with the objective of assessing the progress made, reviewing the methods and protocols for improving them, and analysing the results obtained so far. The WHO Collaborating Centre for Research in the Immunopathology of DHF and Dengue Vaccine Development in Bangkok, Thailand, continued to receive WHO support. The Australian Development Assistance Bureau (ADAB) also contributed financially through WHO/WPRO to the research work of this centre. The experimental part of the development of a vaccine, including testing on animals, was completed and plans were being drawn up to initiate the first human trials by the end of 1983 or early 1984. The Centre continued its research on the clinical, epidemiological, diagnostic and immunopathological aspects of the disease and on the improvement of diagnosis. 2.5.4 Viral Hepatitis This disease has been assuming increasing importance as a serious health problem in several countries of the Region in recent years. Hepatitis A affects mainly the child population, and B is prevalent in adults. The recent outbreaks of viral hepatitis in India and Nepal, and the reported increase of cases in Mongolia, indicated that non-A, non-B virus might be the leading cause of the majority of reported hepatitis cases. National task forces on liver diseases including hepatitis in Bunna, India and Mongolia identified areas for research, such as community-based transmission studies, linkages between acute viral hepatitis and chronic liver disorders, development of technologies for rapid diagnosis including the production of reagents, and methods to strengthen surveillance. In BURMA, research on hepatitis B virus infection and its transmis- sion continued, producing already significant findings which contributed towards improvement of the surveillance of the disease. The prophylactic immunization to prevent HBV infection in newborns continued and preliminary results appeared to be encouraging, showing the protective efficacy of the vaccine in the majority of cases. The follow-up of vaccinated children during the first two years, which was continuing, was likely to provide more valid results contributing towards the formulation of preventive strategies. In NEPAL, an outbreak of viral hepatitis in Kathmandu Valley was investigated with the assistance of a WHO consultant who confirmed that the majority of cases were of non-A and non-8 etiology. A study on viral hepatitis was initiated in 1982 and would continue in 1983. 2.5.5 Japanese Encephalitis Cases of the disease were reported from Burma, India and Nepal. However, systematic surveillance of the disease needs to be organized. particularly in Nepal. 2.6 Expanded Progranune on Immunization hring the year under review, implementation of the Expanded Programme on Immunization (EPI) continued in 10 countries of the Region, with the full support and cooperation of WHO, UNICEF, UNDP and other participating agencies. In most of these countries, not only did coverage of the target population increase considerably but the number of different vaccines used in EPI also increased. For example, in addition to DPT, introduction of oral poliomyelitis vaccine and measles vaccine was being attempted in several countries. The main components of WHO collaboration for the development of EPI in Member States include the organization of training courses and workshops, technical back-up support through Regional Office staff and consultants, support to operational research, assistance in the conduct of programe reviews, advisory services in identifying and procuring appropriate supplies and equipment, and the holding of meetings to permit an exchange of ideas and knowledge between countries. bring the year under review, the main thrust of the immunization programme was directed towards the implementation of the Five-Point Action Programme on EPI endorsed by the World Health Assembly in 1982 in resolution WHA35.31. Promotion of EPI within the context of PHC: Immunization services have been integrated into the basic health services in most countries of this region. Recent national programme reviews have combined assessment of EPI and MCH activities (~ri Lanka - 1981) and with various components of PHC activities (Thailand and Indonesia - 1982). Development of human resources for EPI: In support of national programmes, several inter-country and national EPI courses and workshops were held with WHO collaboration. A joint WHO/UNICEF Inter-country Workshop on Repair and Maintenance of Refrigerators for Repair Technicians was held in India in January 1983. An Inter-country EPI Workshop for Mid-Level Managers was held in Burma in 1983 in which 23 national participants were trained from six countries of the Region. In addition, 12 national EPI management courses for mid-level workers were conducted in three countries with WHO support. During 1982, under EPI, fellowships were awarded to 12 persons from five countries of the Region for training abroad. Financial resources for EPI: In general, the WHO budget to support immunization activities in SEAR countries remained stable when adjusted for inflation, as were the national budgets. It was felt that additional funds would be required from both internal and external sources if the target of providing immunization to all children by 1990 was to be met. Review of evaluation of programmes for improving coverage: National immunization programmes, along with some components of PHC, were evaluated in Thailand by a joint Government/UNICEF/WHO team, and in Indonesia by a joint Government/UNICE~/US AID~WHO team. These reviews, including one week of field surveys in rural areas, generated information on the immunization coverage, the level of PHC activities at village and district levels, the level of knowledge and motivation of the health staff and of the community health worker, the level of knowledge and the degree of participation of the community, the logistics and cold-chain problems, and finally the surveillance of the EPI target diseases. Analysis of the information derived from these reviews facilitated the identification of problems and issues to be tackled for the improvement of the programme and indicated ways and means to tackle them. Actions were taken in most countries based on these findings. In addition to these international reviews, most of the countries in the Region have systematically implemented immunization coverage surveys in selected areas. In 1982, 94 immunization coverage surveys were conducted in six countries. These coverage surveys were very useful, as they not only provided information on the immunization coverage, on the reasons for failures of immunization, and on the sources of immuniza- tion, but also stimulated the EPI staff at all levels in better performance based on a better understanding of the problems and their solutions. The figures for reported rates of coverage in respect of individual countries and for the whole Region are given in Tables 2 and 3. To assist in progranrme review, training, management, immunization coverage surveys and evaluation of EPI, WHO staff visited nine out of eleven countries of the Region. In addition, a total of 12 consultantships were provided to seven countries. Surveys to assess the incidence of polio, neonatal tetanus and measles were conducted in Burma, India, Indonesia, Maldives, Nepal and Sri Lanka. Research efforts as a part of programme operations: A number of research projects for increasing the efficiency and effectiveness of the immunization prograrmne in rural and urban areas were supported both techni- cally and financially. In Nepal, a simplified protocol for an epidemiologi- cal survey to establish baseline data on the diseases, which was required in order to measure the impact of EPI, was developed and field tested with the assistance of WHO. A research project in Thailand to evaluate the use of birth certificates and letters to parents to improve immunization coverage in urban areas was recently completed. Studies on the suitability of cold-chain equipment were carried out in Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. As a result of these studies, new products were developed and existing equipment improved. A collaborative field trial of solar-powered refrigerators was under way in India, Indonesia and Maldives. India was conducting a field trial of a newly developed cold-chain monitor in two states, while Nepal was field testing a measles vaccine potency indicator. The results of research projects already carried out in the countries of the Region were being utilized for improving programmes or for more extensive studies. The main activities in the countries are as follows: In BANGLADESH, the programme was further expanded to provide services at 600 immunization centres. Although the reported number of immunizations provided in the year under review increased considerably, it did not reach the target laid down in the plan of operation for 1979-1983. Table 2 shows that the percentage of children reported immunized by 12 months of age was still very low. Regarding supplies and equipment, at present, each district EPI unit is provided with one deep-freezer, two refrigerators, five cold boxes and one vaccine carrier. The production of tetanus toxoid has started. Annual production of the toxoid was expected to be 4 million doses, which was sufficient to meet the needs of the country. In BHUTAN, the number of children immunized with BCG, DPT (three doses), polio (three doses) and measles either declined or remained at the same level as in the preceding year. For example, BCG was provided to 17 044 children in 1982, as against 27 721 children in 1981; three doses of DPT were provided to 4 237 children in 1982 as against 5 384 children in 1981. To strengthen the programme further, a UNDP-funded EPI project is being developed. In BURMA, EPI was extended to an additional 18 townships, for a total of 121 townships under the programme in 1983. Compared with the 1981 data, the number of immunizations provided to eligible children increased Table 2 CHILDFEN KEPOKTED IMMUNIZED KY 12 EtONTHS OF AGE AND PREGNANT WOmN IMMllNIZED AGAINST TETANUS IN SEAR COUNTRIES Country Children (up to 12 months) Pregnant Women Year KG UY't 3 0PV 3 Measles Estimated TT 2 Estimated o f elieible target eligible tarret data u ,, .. ------------ (percentage)------------ (number) (percentage) (number) Bhutan 8.5 4.2 4.2 17.5 50 000 0 64 000 198 2 - Bunna 20.3 8.2 1.7 fl 1 122 000 8.7 1 300 000 1982 -- - -- - - India 13.7 34.7 10.9 0 . 2 20 998 000 17.3 26 398 000 1982 Indonesia 53.6 0.8" 0 . (1 0.1 4 910 000 12.2 6 083 000 1982 a. w Maldives 21.1 1.9 1 .Y 74. 9 6 000 14.9 8 UO0 1982 Mongolia 49.8 75.3 86.4 95.5 63 000 0 714 000 1982 Nepa 1 43.4 17.1 2.9 2.1 504 000 27.1 650 000 1982 Sri Lanka 63.0 77.3 75.1 0 417 000 40.9 476 000 1982 SEAR 21.9 24.9 9.7 0.6 32 676 000 15.2 40 735 000 - Source: Estimated from data available in SEAR0 by 13 April 1983. Note: Figures not available for DPK Korea. - "DPT (2 doses) = 22.8 per cent; **DPT (2 doses) = 55.6 per cent. Table 3 WOMEN OF CHILD-BEARING AGE (15 TO 44 YEARS) IMMUNIZED AGAINST TETANUS* IN SEAR COUNTRIES, 1978-1982 (~urnber) Country Year Percentage Estimated eligible 1978 19 79 1980 1981 1982 1978-1982 of eligible target 1982 target Women 15-44 years Bangladesh 2 179 4 760 5 617 21 486 43 100 77 142 0.4 19 537 000 Burma 20 280 31 109 44 847 71 894 112 804 280 934 3.6 7 755 000 India 3 507 450 3 716 552 4 605 612 5 235 272 6 523 722 23 588 608 16.1 146 501 000 U 0 Indonesia 144 105 227 712 475 291 472 706 741 227 2 061 041 6.1 33 889 000 -- - -- - - - - - - - - Maldives 8 00 803 615 14 3 1 719 4 080 12.4 33 000 Nepal 0 31 872 35 040 106 610 211 270 384 792 11.4 3 371 000 Sri Lanka 125 069 166 257 185 675 174 755 194 795 846 551 25.1 3 371 000 Thailand 104 512 193 756 267 739 330 389 386 889 1 283 285 11.9 10 778 000 SEAR 3 904 395 4 372 821 5 620 436 6 413 255 8 215 526 28 526 433 12.7 225 235 000 Note: Figures not available for Bhutan, DPR Korea and Mongolia. - *Tetanus toxoid, two doses. by 72 per cent for DPT (three doses) and 49 per cent for BCG. Polio vacci- nation was introduced in Rangoon Municipality in 1982, and in four townships of Mandalay city in 1983. The coverage survey conducted in Rangoon Municipality in March 1983 showed that 53 per cent of the children surveyed had received three doses of the polio vaccine. Thirteen immunization coverage surveys and 11 polio and neonatal tetanus surveys were conducted in different areas of the country, and contributed to building up the baseline data. A staff member from WHO headquarters visited Burma to advise on the strengthening of polio surveillance and to plan a study to determine whether oral polio vaccine can be successfully given to infants of less than three months of age. The protocol of the study was under finalization. Two national mid-level management courses held with WHO support in 1982-83 were attended by 50 health staff. An evaluation workshop for township officers of states/divisions was held in Rangoon in 1982, and reorientation training of basic health workers was conducted in phase I1 townships in 1983. In INDIA, the reported coverage of eligible children by three doses of DPT and three doses of polio vaccine increased slightly compared with the coverage in the previous year, while the coverage by BCG declined from 25.4 per cent in 1981 to 15 per cent in 1982. Twenty-six immunization coverage surveys were conducted in different states with a broad range of results. The national survey of polio and neonatal tetanus incidence, started in 1980, continued in 1982. A national consultant assisted in conducting the survey in Bihar. hro consultants, one of them a national, were assigned to assist the national authorities in the evaluation of EPI in two states - Uttar Pradesh and Maharashtra. The measles immunization feasibility study continued during the period under review. The results of this study were discussed at the fourth meeting of professors/assistant professors of medical colleges who participated in the measles project, held in Delhi in April 1983. The national workshop on the control of poliomyelitis was held in November 1982, when all aspects of poliomyelitis surveillance and control in India were discussed. The workshop was attended by two staff members from WHO headquarters, who also visited Bombay, Tamil Nadu and Gujarat to study different aspects of polio in the country. Ten national mid-level management courses, held with WHO support in different states, were attended by 220 health staff. Two cold-chain and logistics courses were held with 25 participants. By 1982, the immunization programme had been introduced in over 60 per cent of all kecamatans in INDONESIA (compared with 5 per cent of kecamatans in 1977). The reported coverage in 1982 of eligible children was 53.6 per cent in BCG, 22.8 per cent in two-dose scheduled DPT, 0.9 per cent in three doses of polio in children and infants, and 12.2 per cent in two doses of TT in pregnant women. Polio and measles vaccines were given in a limited area. Thus, achievements in immunization coverage and implementation of EPI target vaccines were not adequate when compared with the geographical expansion of the programme. A joint Government1~~0/UNICEF/US AID evaluation team conducted a mid-term review of the immunization programme and some selected PHC activities in September-October 1982. The programe review provided valuable data on the implementation of EPI in the country and problem areas were indicated. As a follow-up of the recommendations made by the review team, a National Advisory Board on Immunization was established, efforts to coordinate the activities of the programme closely with PHC were given priority and were progressing well, and the priority of the programme for reduction of mortality among children under five years of age was recognized at the decision-making level. A long-term epidemiologist continued to provide technical support to EPI activities. A consultant was assigned to assist the nacional staff in EPI and communicable disease control in Jakarta municipality. With UNICEF support, a national course on repair of refrigerators was conducted in Jakarta with 20 participants. In MALDIVES, although all EPI target vaccines are provided for children in more than 80 per cent of the country's territory, the percentage of coverage is still low in the case of three doses of DPT and polio (see Table 2). Mass vaccinations against measles were carried out during 1981-1982, with a 74.5 per cent coverage. EPI training has already been included in the curriculum of community health workers, nurse aides and family health workers. Lectures regarding EPI were included and carried out for atoll chiefs, assistants of atoll chiefs and island chiefs during refresher courses organized by the Ministry of Atolls Administration. A national cold-chain and logistics course was held in April 1983, which was attended by 20 participants, under UNDP funds. Material supplied by WHO was translated into the national language for this course. Immunization coverage continued to remain very high in MONGOLIA and the EPI target diseases were completely under control. The cold-chain system for vaccine storage and distribution was further improved. Forty-three per cent of all somons have cold chain equipment. Four refrigerators were donated by Luxembourg through WHO in 1982. A regional EPI staff member visited the country to assist the national authorities in reviewing the programme. In 1982, EPI was further expanded in NEPAL and is currently being implemented in a total of 46 districts. The reported coverage of children below 12 months of age in 1982 increased and was as follows: BCG, 43.4 per cent; DPT (three doses), 17.1 per cent; polio (three doses), 2.9 per cent; measles, 2.3 per cent; and pregnant women with TT (two doses), 27.1 per cent. At present, measles and polio vaccines are provided at the large hospitals only, but it has now been decided to start polio and measles imunizations in 36 districts in a phased manner. During the year under review, a WHO consultant and a staff member from WHO headquarters visited the country to develop and field test the simplified protocol for an epidemiological survey to establish baseline data on the five EPI target diseases. Twenty-seven health workers were trained at a national EPI mid-level management course funded by WHO. Seminars and refresher training courses were conducted for senior supervisors, senior sanitarians and senior EPI staff and for district supervisors. Immunization was provided to eligible children within the context of MCH services throughout SRI LANKA. The programme was delivered through fixed and outreach centres. The target of 80 per cent coverage by all vaccines for children under one year and 50 per cent coverage by two doses of tetanus toxoid for pregnant women had been set for 1981. However, the programme could not achieve this target. In any case, in 1982, the reported coverage of children under one year was as follows: BCG, 60 per cent, three doses of DPT, 66.3 per cent, three doses of polio, 68.9 per cent, and two doses of TT to pregnant women, 36.1 per cent. A WHO consultant was assigned to help the Government in conducting a survey to study the public health importance of measles and the feasibility of introducing measles vaccine in the country; the survey showed that measles morbidity and mortality was a serious public health problem. The Government initiated action based on the results of the survey and the recommendations of the consultant. In THAILAND, the programme made impressive progress in different areas, and as a result there was evidence of a reduction in the incidence of some EPI target diseases. In 1982, the reported percentage of children immunized by 12 months of age was as follows: BCG - 76.6 per cent, DPT (two-dose schedule) - 28.8 per cent, polio (three doses) - 35.4 per cent, pregnant women with TT (two doses) - 28.8 per cent. There was strong evidence that the medium-term objective of the programme, i.e., to increase the coverage of children under one year of age and of pregnant women to over 80 per cent at the end of 1986, would be reached successfully. Twenty imunization coverage surveys were conducted in 1982. A joint Government/WHO/UN1~~~ review of EPI and selected PHC activities was carried out in August-September 1982. The recommendations of the review team for the further strengthening of the programme were under consideration by the Ministry of Public Health. 2.7 Veterinary Public Health (VPH) Several countries in the Region are active in the field of veterinary public health and zoonotic diseases. Having identified rabies control as the priority zoonotic problem, India established a national programme on rabies control with technical inputs from WHO. The Medical Officer in Veterinary Public Health from the Regional Office visited Sri Lanka where a new Rabies Control Act had been enacted, and evaluated the rabies control programme. A national training course on rabies diagnosis was organized in Indonesia; the Medical Officer also visited Indonesia to advise on the rabies control programmes in outlying areas. The rabies control programme in Thailand was also reviewed. WHO continued to support the training of VPH officers. WHO staff participated in a workshop/seminar organized by the National Institute of Communicable Diseases, Delhi, to train VPH officers. A national seminar on zoonoses was organized in Nepal with WHO support. The production of tissue-culture vaccine for veterinary use, which was initiated in India, Indonesia and Thailand, was further strengthened by technical inputs from the Regional Office and a WHO staff member from the WHO Regional Office for the Americas. The seed virus provided by WHO was adapted to BHK 21 cell line. In BANGLADESH, a WHO consultant assisted in strengthening the surveillance of zoonotic diseases, particularly Japanese encephalitis and brucellosis. Support was provided to MALDIVES in establishing the diagnosis of an epizootic in cats. WHO supported countries of the Region by providing reagents for the surveillance of plague and brucellosis. Burma was supported in the prevention and control of plague. India organized inter-state coordinating meetings on plague. The WHO programme on the production of tissue culture anti-rabies vaccine for human use (at the Pasteur Institute, Coonoor, India) was further strengthened by the assignment of a consultant and the provision of supplies and equipment. A new rabies virus strain adapted to human diploid and vero cell lines would be provided on a bilateral basis to the Pasteur Institute, Coonoor, by the Pasteur Institute, Paris. An inter-country training course on tissue culture vaccine production is to be organized at the Pasteur Institute, Coonoor. 2.8 Vector Biology and Control (VBC) The major problems faced in implementing the VBC programme were vector resistance to the commonly used and cheaper insecticides, refractory behaviour, toxicity and the high cost of newly developed insecticides, high refusal rate against residual house spraying and increasing concern regarding environmental pollution by chemicals. In order to detect resistance in time and space, WHO has been promoting susceptibility monitoring in those programmes that are dependent on the use of chemical pesticides. Testing materials were provided regularly for this purpose. In BANGLADESH, following the recommendations made by the inter national assessment team that visited the country in December 1982, plans were made for the reorganization of entomological activities. The entomological manpower was adequate to carry out a sound plan of work if the present administrative constraints could be overcome. Results of studies carried out by the National Institute of Preventive and Social Medicine revealed an increasing trend in the density of sandflies especially in Pabna district, where high numbers of kala-azar cases were reported. The high density of Culex quinquefasciatus, which has become resistant to a number of insecticides, was causing great concern in Dhaka city. So far, no record of DDT resistance has been reported in any of the known malaria vectors - Anopheles balabacensis, An. philippinensis, A.minimus and A.sundaicus - but nevertheless the first and second vectors were showing refractory behaviour towards indoor residual house spraying. In BURMA, the Vector-Borne Disease Control Programme (VBDC) continued to be supported by Canada and the Netherlands in collaboration with WHO. By the end of the fiscal year 1982-83, CIDA had contributed C$ 3 480 000, and the balance of C$ 2 170 000 is due in 1983-84 and 1984-85. The two WHO long-term staff members with the project, supported by the Netherlands, left Burma in November 1982 on completion of their assignment. Training courses for various categories of staff in the VBDC project were carried out with WHO support. Monitoring the susceptibility of vectors of malaria, DHF and filariasis to insecticides continued to provide useful information. Results of tests of malaria vectors were similar to earlier findings. - Aedes aegypti, a vector of DHF, continued to be susceptible to malathion and twephos, whereas Culex quinquefasciatus, a vector of filariasis, is showing a decreasing trend in its susceptibility to fenthion, estimated by eight-fold and eleven fold decreases in areas with 11 and 16 years of insecticide spraying respectively. With financial support from the UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases, plans were being made to strengthen the entomology section of the Department of Medical Research. Colonies of various mosquito species and populations and Toxorhynchitus splendidus were being maintained in the laboratory for biological control studies. Cytogenetic studies on two populations of A.ba1abacens.i~ with contrasting larval habitats, one from Taikki, breeding in forest rain pools, and the other from Moulmein, breeding in wells, were continuing. In INDIA, vector resistance to the insecticides commonly used, especially in A,culicifacies and A.stephensi, the major rural and urban vectors of malaria, continued to be an important problem facing the programme. Entomological studies from Orissa revealed the presence of six anopheline species known to play a role in malaria transmission in this part of the country; in connexion with this work, a gel diffusion technique for identifying the origin of the mosquito bloodmeal was successfully established in the laboratory at the regional office of the P.falciparum Containment Programme in Bhubaneswar. Studies carried out by the entomologi- cal teams in the north-eastern region on the effect of ecological changes on the malaria vectors A.balabacensis and A.minimus were progressing. WHO provided a consultant to examine the mosquito and rodent problem in Madras city. The recommendations of the consultant conform closely to the initiatives being developed by the authorities, although implementation was restricted by limitations of funds. The Vector Control Research Centre of the Indian Council of Medical Research, located in Pondicherry, received an award of $96 000 from the UNDPIWorld Bank/WHO TDR Programme for strengthening its institutional capability for research and training in the field of biological control of vectors. The Centre was involved in a wide variety of studies on vectors of filariasis, malaria and arbovirus diseases. Within the framework of "Integrated Development for Vector Control", with significant participation from the community, the Centre entered the third year of its filariasis control demonstration project in Pondicherry. For the building up of trained manpower to meet the future needs of the country in research in pestlvector control, Madras University is in the process of establishing a two-year M.Sc. course in medical entomology. Valuable vector studies were also being undertaken at NICD, Delhi, and the National Institute of Virology, Pune. In INDONESIA, the DDT-resistant A.aconitus in Central and East Java continued to cause a serious problem to the malaria programe. Space spray- ing with organophosphorous compounds was carried out to prevent malaria outbreaks. A WHO consultant visited Kalimantan to investigate the problem of A.balabacensis and to advise on its control. Another consultant visited Indonesia to advise on entomological activities, especially in the outer islands. Insecticide trials against vectors of malaria, DHFJdengue, filariasis and bubonic plague were continued by the WHO Inter-regional Vector Biology and Control Research Unit-2, Jakarta, and its sub-unit in Semarang, in collaboration with the Ministry of Health. During the past seven years (1976-821, four organophosphorous compounds, one carbamate, two pyrethroids and one chlorinated hydrocarbon, in different insecticide formulations and dosages, were tested in order to determine their residual effectiveness in village-scale trials (Stage V trials). Bacillus thuringiensis H-14, the microbial vector control agent, was tested against Aedes aegypti and Culex quinquefasciatus in urban areas, Ansopheles sundaicus in lagoons and A.barbirostris in fresh-water ponds. The UNDPJWorld Bank WHO TDR Progranune provided additional funds to the M.Sc. Course in Medical Entomology at Bogor Agricultural University for 1983. A WHO consultant was sent to review the curricula and contents of the course and explore other sources for future international and bilateral assistance. In MALDIVES, A.subpictus and A.tesselatus were recorded from a few islands in connexion with malaria transmission. Both malaria vectors continue to show susceptibility to DDT and temephos. Larviciding with ECOPRO-1700 in pellet formulation was found effective for up to three weeks against anopheline and culicine mosquitoes in fresh water. Culex guinquefasciatus continued to pose a severe challenge to control methods in the capital, Male. In NEPAL, the results of insecticide susceptibility tests showed that the DDT-resistant populations of A.annularis and A.cu1icifacies in the terai continued to be susceptible to malathion. While A.maculatus and A.fluviatilis continued to be susceptible to DDT, the finding of small numbers of the latter species in DDT-sprayed dwellings raised the question of incipient resistance. In cytogenetic studies on A.annularis, two species, A and B, were identified, with B being prevalent in areas of low receptivity where it appears to be the malaria vector. The insecticide trials undertaken with bendiocarb, fenitrothion, malathion and pirimiphos- methyl against DDT-resistant A.annularis in Lumbini district did not provide conclusive results. Bio-assay studies on the residual effect of old and new stocks of malathion and DDT from different sources were in progress. In SRI LANKA, WHO provided a consultant sanitary engineer to advise on mosquito control in Colombo. Through the better utilization of available resources, development of new methodologies and promotion of inter-sectoral collaboration, it is expected to extend and intensify the present mosquito control operations and to achieve greater effectiveness. The consultant highlighted the role played by the Low-Lying Areas Development Board and the benefit gained in the reclamation of marshes. Another WHO consultant from headquarters visited Colombo to review and advise on biological control agents. A research proposal from the Medical Research Institute on the prospect of further development and field evaluation of B.sphaericus MU-4, originally isolated in Sri Lanka, B.thuringiensis H-14, and other new pathogens was accepted for funding by TDR. Ztyo larvivorous fish for mosquito control were under study by national staff, Aplocheilus dayi for the control of Anopheles culicifacies in slow-flowing water, and Poecilia reticulata for the control of Culex quinquefasciatus in Colombo. A total of 163 susceptibility tests covering 11 anopheline species and a number of insecticides were carried out during 1982. A.culicifacies, the only known malaria vector in the country which is resistant to DDT, continued to show susceptibility to malathion, the insecticide being used in the Anti-Malaria Campaign, and to dieldrin, fenitrothion, propoxur, bendiocarb and chlorphoxim. In THAILAND, the monitoring of susceptibility/resistance of malaria vectors and suspected vectors to DDT, malathion and fenitrothion continued as planned. A total of 94 tests covering seven anopheline species - A.minimus, A.balabacensis (A.dirus), A.maculatus, A.aconitus, A.sundaicus, A.philippinensis and A.annularis - was carried out with large samples of mosquito populations collected from fixed catching stations throughout the country, but mostly from the northern region. The results of tests showed no significant change in susceptibility/resistance status and level from previous test results. The vector problem in Thailand appeared to be more due to exophily and refractory behaviour (avoiding contact with the sprayed surfaces) than to physiological resistance. Entomological evaluation on the effect of fenitrothion residual spraying (which had recently been introduced by the malaria programme) in mosquito control and consequently malaria transmission did not show any significant difference in comparison with DDT. Further research was in progress to clarify the situation. With support from the UNDPIWorld Bank/WHO TDR Programme, two research projects on genetic variations in correlation with behaviour traits, one dealing exclusively with A.minimus and the other dealing with A.bala- bacensis, A.maculatus and A.philippinensis, were being carried out by scientists from Mahidol University. A WHO consultant from headquarters visited research institutions involved in research and field trials on biological control agents. The Department of Microbiology at Mahidol University was searching for new isolates of spore-forming bacteria and evaluating existing strains in the laboratory and on small-scale field trials, paying particular attention to the pathogens' persistence and recycling potential for mosquito control. A WHO consultant visited the project to advise on rodent research and control. WHO headquarters is assisting the Division of Medical Entomology in its project on integrated control against Aedes aegypti, with emphasis on community participation, in Lopburi province. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES The major emphasis of WHO technical collaboration with Member States in the field of non-communicable diseases lay in the promotion of an integrated social and behavioural approach to the prevention, early detection and control of emerging health problems such as cancer, cardiovascular diseases, chronic liver diseases (including liver cancer), diabetes and accidents.
ANNUAL REPORT OF THE REGIONAL DIRECTOR WORLD HEALTH ORGANIZATION REGIONAL OFFlCE FOR SOUTH-EAST ASIA WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA THIRTY-FIFTH ANNUAL REPORT . OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR SOUTH-EAST ASIA 1 JULY 1982-30 JUNE 1983 In the effort to achieve the socialgoalof Hea/ih /orA!f, WHO ;s actively col/~horaiing w;fh the Member Couniries in the Region to develop primary heahh care, which brings basic services to the doorsteps of those ;r, need. INTRODUCTION PART I - GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES Planning and Development of Health Services Health Planning, Programme Formulation and Evaluation Organization of Basic Health Services Health Services Research Primary Health Care (PHC) Traditional Medicine Family Health Nursing Health Education Nutrition Medical Care Care of the Aged, Disability Prevention and Medical Rehabilitation Oral Health Mental Health, Drug Dependence and Alcoholism Drug Policies and Management Medical Stores Management ~aintenance and Repair of Health Equipment Health Legislation 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES Epidemiological Surveillance Diseases Subject to the International Health Regulations Acute Diarrhoea1 Diseases Plague Malaria and Other parasitic Diseases Malaria Schistosomiasis Filariasis Leishmaniasis Bacterial Diseases Tuberculosis Leprosy Sexually-Transmitted Diseases Diphtheria, Pertussis and Tetanus Viral, Chlamydial, Rickettsia1 and Related Diseases Trachoma Poliomyelitis Dengue Haemorrhagic Fever (DHF) Viral Hepatitis Japanese Encephalitis Expanded Programme on Imunization Veterinary Public Health (VPH) Vector Biology and Control (VBC) 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES 7 7 3.1 Cancer 3.2 Cardiovascular Diseases 3.3 Prevention of ~lindness 3.4 Immunology 4. HEALTH LABORATORY SERVICES 84 4.1 Organization of Laboratory Services 4.2 Quality Assurance 4.3 Vaccine Production 5. PROMOTION OF ENVIRONMENTAL HEALTH 88 5.1 Environmental Health 5.2 Occupational Health 5.3 Radiation Medicine 5.4 Food Safety Programme 6. HEALTH INFORMATION AND STATISTICS 9 8 7. HEALTH MANPOWER DEVELOPMENT 102 Education and Training of Professional Health Personnel Undergraduate Medical Education Post-graduate Medical Education Teacher Training Education and Training in Maternal and Child Health Education and Training in Environmental Health Training in Epidemiology Training of Auxiliaries and Community Health Workers Group Educational Activities Fellowships Health Literature, Library and Information Services (HeLLIS) Regional Office Library 8. RESEARCH PROMOTION AND DEVELOPMENT 125 9. WOMEN, HEALTH AND DEVELOPMENT 127 10. TECHNICAL INFORMATION AND REFERENCE SERVICES 129 PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1. REGIONAL COMMITTEE 2. REGIONAL PROGRAMME PLANNING AND DIRECTION 3. ADMINISTRATION General Organizational Structure Personnel Staffing Staff Training Employment Conditions Budget and Finance Regional Office Building 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT 144 5. COLLABORATION WITH OTHER AGENCIES 146 United Nations 146 United Nations Development Progrannne (UNDP) 146 United Nations Children's Fund (UNICEF) 146 United Nations Fund for Population Activities (UNFPA) 147 Economic and Social Commission for Asia and the Pacific (ESCAP) 147 World Food Programme (WFP) 147 United Nations Industrial Development Organization (UNIDO) 148 Specialized Agencies 148 Food and Agriculture Organization of the United Nations (FA01 148 International Labour Organisation (ILO) 149 United Nations Educational, Scientific and Cultural Organization (UNESCO) 149 International Bank for Reconstruction and Development (IBRD) 149 Asian Development Bank (AsDB) 149 Bilateral and Other Agencies 149 Non-Governmental Organizations (NGOS) 150 6. PUBLIC INFORMATION 151 PART I11 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST Bangladesh Bhutan Burma Democratic People's Republic of Korea India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Inter-Country Inter-Regional Projects in Operation in South-East Asia ANNEXES Organizational Chart 205 Geographical Distribution of International Staff Assigned to the South-East Asia Region as of 31 May 1983 206 Distribution of Short-Ten Consultants by Nationality (1 June 1982 - 31 May 1983) Distribution of Consultants by Subject Areas (1 June 1982 - 31 May 1983) Meetings and Courses Organized or Assisted by WHO and Held in the South-East Asia Region (1 July 1982 - 30 June 1983) Conferences and Meetings in the South-East Asia Region Called by Governments/Other Organizations at which WHO was Represented (1 July 1982 - 30 June 1983) Inter-Regional Activities Outside the Region with Participants from the South-East Asia Region (1 June 1982 - 31 May 1983) List of Technical Reports Issued by the Regional Office (1 June 1982 - 31 May 1983) FIGURES Incidence of Malaria and P.falciparum Infections in Selected Countries of the WHO South-East Asia Region Obligations Incurred on Field Activities in the South-East Asia Region INTRODUCTION A review of activities always provides a welcome opportunity for introspection and stock-taking. During the six-year period of the Sixth General Programme of Work of WHO, which is concluding in 1983, gigantic strides were taken by the Member States in their health development endeavours. Similarly, there was serious rethinking of a fundamental nature at. the global level leading to a firm commitment to the objective of Health for All by the Year 2000 with primary health care as the key approach. This revolutionary change in the thought process of the health leaders of the wor1.d brought in its train a new direction in the joint collaborative efforts of the countries and the Organization as reflected in the Seventh General Programme of Work (1984-1989). Officially, the implementa- tion of the Seventh GPW will commence from next year. But so strong was the resolve of the Member States to achieve the goal of HFA and so emphatic were they in demanding action that a number of activities, including the formulation of national, regional and global strategies for HFA and the corresponding plans of action and their implementation and monitoring. began during the period of the Sixth General Programme of Work itself. Thus, the latter part of the period covered by this Programme, especially the last biennium, saw a dramatic transition of thought and action away from the conventional, beaten track to a more revolutionary and dynamic posture for health development as conceived in the Seventh GPW. The activities of the period under review have therefore to be seen in this context. Health Planning and Management - - During the early part of the Sixth General Programme period, commendable advances were made in most countries in health planning in respect of both organization and process development. Thus we saw the development of ever- improving health planning organizations and the training of health planners in almost all countries, notably Bangladesh, Burma, Indonesia, Nepal and Thailand. While organizational strengthening was continuing, country health programming (CHP) provided a process which was not only accepted but practised almost -- in toto or in an adapted form in most countries. This helped in systematizing planning, which had hitherto been largely - ad hoc, - by rationalizing the demands of the health sector and asserting its cause in the competitive field of resource allocation by the economically-oriented central planning commissions or similar bodies. Through these efforts, health planning became more problem-oriented, more systematic and more participative. With increasing commitment to HFA, health planning also became mission-oriented to a great extent. As a follow up of their commitment to HFA/2000 the countries are now moving into the stage of implementation of the HFA strategy which brings with it certain noticeable trends that augur well for the future. The focus of atten- tion is shifting to the operational levels of services and is being expanded to include activities in other sectors. Thus, during the period under review we saw Bangladesh expanding its PHC focus beyond the six pilot thanas; Burma paying increasing attention to improve the management of services at the township level: India initiating action for the development of management systems at state and district level: Indonesia decentralizing its extensive health plan- ning efforts and focusing more on the provincial and regency level; Mongolia taking steps for aimak development; Maldives for the development of atolls, and Nepal for the development of districts and panchayats. Sri Lanka has been developing its district health management system and Thailand has been introducing basic minimum needs through its Social Development Project at village and commune levels simultaneously, involving four sectors including health. Together with the actual implementation process most national health administrations are beginning to take an objective and evaluative look at their health development activities to ensure that they are relevant, effective and generating the expected benefits. This increasing interest in evaluation is not limited to national programmes but also includes WHO'S collaborative programme, whenever possible in the context of the national programme. During the period under review, the Indonesia-WHO collaborative programme was evaluated by a joint Government-WHO team, resulting in valuable feed-back for improving the colla- boration for accelerated HFA efforts. Early this year, an evaluation of various elements of PHC was carried out in two districts in Sri Lanka. The results served as useful inputs for improving PHC activities. The involvement of Member States in the work of WHO, which has been an established practice in this region. was further enhanced through evaluative reviews of WHO colla- boration by government representatives, who constituted a committee established by the Regional Director under resolution sEA/Rc35/~5. As a result of this experience, a practical and simple method for joint Member state/~~0 programme evaluation was being evolved. The review also provided useful guidance to the monitoring of both the financial implementation and technical progress of collaborative programmes as a part of WHO'S own managerial process. Health Information Systems Health information is an essential element in all these activities. However, the national health information systems (NHIS) in most countries of the Region continue to remain weak. One major reason for this is the unsuitability of sophisticated methods and technology in the prevailing situation in the countries. That a simple yet effective method of appropriate information generation can be applied in the developing countries has been amply exemplified by the successful experimentation with the "lay reporting system" and its application in PHC in our Region. This is certainly an achievement. Guidelines have been produced for further expansion of the lay reporting system. These have won acclaim and are being used in many developing countries. In addition to promoting and supporting the lay reporting system, WHO has been collaborating with the governments in the development of a suitable infrastructure for NHIS depending on the specific needs as well as the stage of development of the national health infrastructure in the countries. The Organization's programme for health information system development is now oriented heavily towards health situation analysis and trend assessment in order to support the proper planning, monitoring and evaluation of activities aimed at the achievement of HFA/2000, which is now the stated policy of all our Member States. Organization of Primary Health Care The commitment to HFA/~OOO has helped change the direction of the national health policies in order to provide appropriate health care for the entire population. Thus there is an overwhelming emphasis on equity and expansion of coverage to the unserved and underserved populations. While the importance of consumers of health services is being increasingly recognized and the parti- cipation and involvement of the community is being sought, a realization has dawned regarding the value of utilizing locally developed, cost-effective technology appropriate to the specific situations in the countries of the Region. As an inevitable corollary, therefore, the primary health care approach has been universally applied in the plans and programmes for health development. In this context, we see that in Bangladesh the network of thana health complexes continues to be the anchor of the health development programme: in Bhutan and Nepal, rural health posts are attracting considerably increased resources for further development and expansion: in Burma and India, rapid training and deployment of an adequate number of appropriate community health workers and volun- teers to strengthen the infrastructure at the grassroots level have been receiving the main stress: the Democratic People's Republic of Korea and Mongolia have been developing and maintaining health systems that provide health care to the entire population in the context of their socio-political situation: the PKMD programme in Indonesia has been the basic step in developing a viable infrastructure for sustained primary health care services, especially to the rural population, and has evoked the interest of both the public and the private sectors in its implementation; efforts in Maldives are being focused on manpower training and community participation; Sri Lanka has a new blueprint for the development of its PHC services dovetailed into the decentralized district-level socio- economic development programme: and Thailand is boldly and successfully experimenting with village-based community- managed PHC programmes. Health Legislation While the principle of PHC has been fully incorporated in the framework of plans and programmes for health development, governments have also made an effort to provide a supportive legal framework by revamping health legislation to strengthen and expand primary health care services. In Bangladesh, an improved set of health laws has been drafted with WHO support; in Burma, a national committee under the guidance of the Deputy Minister of Health has re-examined the existing health legislation to bring it in line with the Constitution and the Government's health policies, including Health for All: in Indonesia, health legislation has been strengthened to ensure the mobilization of adequate trained medical personnel for rural health services; Mongolia and the Democratic People's Republic of Korea have health laws that provide the frame- work for health services for the entire population; the Decentralization Act (2039) in Nepal delegates the authority for developmental activities to the district level, including the development of the health sector, which will facilitate the implementation of PHC programmes and reduce administrative bottlenecks; Sri Lanka has redrafted its health laws in support of the PHC approach. Urban Primary Health Care The efforts of the countries of the Region for the development of primary health care services are no longer limited to the rural areas; the lack of primary health care in urban slums is receiving increasing attention. The urban population in the Region has been increasing consistently and is likely to grow further, aggravating the already grim situation in the large city slums. Member States are becoming more and more concerned about this issue: studies have been undertaken in a number of cities, and in some cases measures have been initiated to amelio- rate the situation. For instance, India has prepared a plan for the reorganization of primary health care in the cities. In Indonesia and Thailand, community health workers have been deployed in some underserved urban areas. WHO has also initiated action for organizing consultation meetings involving urban development authorities, city corporations/municipa1ities and the governments both at the national and regional levels in order to define clearly a strategy for providing PHC to urban slums and underserved areas. Innovative Approaches in Support of PHC/HFA 2000 In addition to these conventional efforts, a number of innovative approaches have been experimented within the Region with WHO support and initiative, especially in respect of better coordination and utilization of health resources at country level for implementing HFA strategies. Some examples are cited below: In Thailand, a flexible programme budgeting exercise has been undertaken. This is meant to develop a process and a monitoring mechanism for unhindered utilization of WHO resources for health developmentwithin the country ceiling by the national authorities according to priorities identified by them. In Indonesia, a special programme of collaboration has been initiated in order to determine ways for the most effective utilization of all available resources, with WHO'S input playing a catalytic and coordinating role. Similarly, through multi-agency funding support (including that of WHO) Mongolia has launched an interest- ing experiment to develop a model of PHC services in an aimak; the model is being developed in a practical way, so that it can be replicated in other aimaks in a most cost- effective manner. Country Resource Utilization (CRU) reviews were conducted in Bangladesh, Nepal and Sri Lanka. These have facilitated a rational assessment of resource needs based on the trend of utilization of available resources for health development and have helped in the mobilization of appropriate and adequate resources to meet the defined needs. As a result of these reviews, a meeting of the funding agencies will be held in Sri Lanka later this year to explore the possibilities of financial assistance to health programmes drawn up on the basis of the CRU review in support of the national HFA strategy. Round-table Meeting of the Asia-Pacific Least Developed Countries, Geneva A Round-table Meeting of the Asia-Pacific Least Developed Countries took place in Geneva from 9 to 18 May 1983. This was a follow-up action for the Substantial New Programme of Action approved by the United Nations Conference on Least Developed Countries. This conference was a historic milestone in the evolution of international cooperation for development, Of the countries of the South- East Asia Region, Bhutan and Maldives participated and the documentation on these countries was presented by senior ministers. The conference thus provided an excellent forum for turning the focus on detailed sector needs, so that the donors could assess the problems and priorities of the countries concerned, with a view to mobilizing the resources required. The WHO/UNICEF Joint Committee on Health Policy (JCHP) has decided to coordinate the inputs of the two agencies, in consultation with the governments, in order to streng- then, and augment the ultimate impact of, the joint inputs on the development of PHC activities. This has already been planned in Burma and Nepal and is in the process of being implemented. An action programme on the nutrition component of primary health care, with funding support from Italy, has been planned jointly by WHO and UNICEF in Burma and Nepal and the implementation of the programme will start towards the end of this year. The mechanisms evolved in India for improving the development and management of the national health programme and for more effective utilization of WHO'S resources in support of national efforts include the Joint GOI-WHO Coordination Committee, under the chairmanship of the Secretary of Health and Family Welfare, which works at the policy level. It is supported by a steering committee composed of relevant health officials, which ensures the implementation of the policy decisions. In addition, in order to improve the technical content and management of the health programmes, a number of task forces have been established. These task forces, which are often multi- disciplinary in nature, consist of high-level national experts from various disciplines and are supported by WHO staff members whenever necessary. The organization of health systems based on primary health care, operational research at district level, the health information system and epidemiological services, blindness, leprosy and tuberculosis are some of the important areas for which task forces have been established. Family Health In the field of family health (a crucial component of primary health care), efforts have largely been directed towards strengthening managerial capabilities at different levels and developing appropriate and adequate manpower to deal with maternal and child health, including family plan- ning. In pursuance of the Regional Committee's resolution SEA/RC34/R8 on infant and young child feeding, endorsing the Regional Plan of Action, technical support was extended to a number of countries to strengthen the information base related to breast-feeding and weaning foods. A multi- disciplinary regional team continued to assist in project formulation, implementation, monitoring and evaluation in the field of family health. In most countries, family health is an integral programme of MCH and family planning including the components of nutrition and health education. In consonance with this trend and in view of the increased emphasis on MCH, Bangladesh has now fully integrated its population control programme with health development programmes, including MCH, at the thana level. The elaphasis xii on the training of traditional birth attendants (TBAs) continues. Family planning activities have been technically supported, whenever required by the governments, through the Family Health Team established in the Regional Office. Another team is supporting surveillance activities to improve the voluntary sterilization programme in Bangladesh. While WHO is promoting activities in the field. there is further scope for more active utilization by the governments of the technical expertise available in the Organization in support of their national programmes in MCH and family planning. Considerable emphasis is being laid on training in maternal and child health, with the focus on the care of the newborn and infants, particularly in India. In this context, WHO supported training programmes, including remodelling of the paediatric curriculum and integration of maternal and child health with family planning. Support was also provided for the development of a handbook on the delivery of MCH care to mothers and children in a community block and continued to be given for the pre-testing of a handbook on the care of children. District-level workshops on neonatal care for paediatricians and obstetricians continued with a view to strengthening neonatal care and training at the peripheral level. Other training efforts included the development of package curricula for various components of MCH care. In order not only to increase the coverage but also to provide better maternal and child health services, consideration was given under the Risk Approach Study to the development of intervention strategies relating to community participation, family self-help, intersectoral coordination and action, and appropriate technology for screening and management. Several countries in the Region participated in this activity. The growing acceptance of the concept of primary health care (PHC) has led to increasing epidemiological and health services research in improving MCH services in the context of PHC. In several countries of the Region, WHO supported research projects related to MCH, effective use of members of women's organizations, village volunteers and practitioners of traditional medicine for improving and expanding MCH/FP services. Research on the integration of family planning with other health services was another area of investigation aimed at improving maternal and child health. Since birth weight is one of the indicators selected for monitoring the progress towards Health for All by the Year 2000, a regional profile based on data from studies on perinatal mortality and morbidity is under preparation. The major objective of health education programmes has been to establish a partnership between health services on the one hand and the individual, the family and the community on the other, in the development and maintenance of the health of all the people. Another major preoccupation throughout the Region is the preparation of appropriate learning aids. In addition, efforts were made to identify the proper role of public information and existing mass communication and traditional media in educational programmes and to integrate them as essential components of the overall educational activities, as required. Efforts for developing nutrition projects through the Joint WHO/UNICEF Nutrition Support Programme continue. These aim at ensuring maximum impact on malnutrition and mortality on a national scale over the next five years. The establishment and development of national nutritional units in most countries is a key feature of the WHO regional programme in this area. The main thrust of the regional research programme in nutrition is concentrated around the priorities identified by the Scientific Working Group on Nutrition. Projects related to a situational analysis of the current status of the content and imple- mentation of the nutrition component of PHC have already generated activities aimed at making nutrition inputs through PHC more effective. This has led to improved nutrition training and new national activities on effective nutritional interventions through PHC. In addition, a major effort to increase the impact of goitre/cretinism control programmes is currently under way in the countries affected, largely through WHO and UNICEF support. Activities such as a national baseline survey in Bhutan, construction of salt iodization plants in Bhutan and Nepal, goitre/cretinism prevalence mapping in Bangladesh, an iodized oil injection programme and planning for salt iodization in Burma, and formation of a Government/WHO/ UNICEF goitre/cretinism working group in India highlight increased national and regional determination to control and ultimately eradicate endemic goitre/cretinism from the South-East Asia Region. Care of the Aged and Rehabilitation In the areas of care of the aged, disability preven- tion and medical rehabilitation, the approach has been to integrate these activities with primary health care, priority being given to the generation of epidemiological information to help define the problem and its extent. In order further to promote the action programme in support of the elderly in the Member States, preliminary discussions have been held in Burma, India, Indonesia and Thailand, and a plan of action for developing programme activities is under preparation. In India, active prepara- tions are under way to launch a comprehensive project for disability prevention and medical rehabilitation under the joint UNDP/UNICEF/WH~ "Impact" programme. Mental Health Substantial progress has been made in achieving the objectives and targets in the area of mental health, especially its integration as a. component of PHC. Efforts have continued in regard to the other two corner-stones of the programme, namely,development of appropriate technology and instruments for programme evaluation. A number of countries of our Region, notably Burma and Thailand, are now participating in an inter-regional study on the involvement of PHC personnel in problems related to alcoho- lism and the abuse of drugs. In respect of evaluation, efforts are being made to develop indicators of mental health. One additional country (Sri Lanka) has drafted a comprehensive National Mental Health Plan, and multi- sectoral coordinating bodies have been formed in Thailand and Indonesia. Essential Drugs Although efforts to develop the health-service infra- structure and facilities are continuing, one of the major difficulties faced by governments in providing primary health care to the needy is the shortage of essential drugs. Realizing that the availability of essential drugs of assured quality is crucial to the attainment of health for all, several countries in the Region have established drug manufacturing units in the public sector. In fact, at present the potential for attaining self-reliance in respect of essential drugs exists in Bangladesh, Burma, India and Indonesia, and to some extent in Nepal and Thailand. The main thrust of WHO activities in this area is to assist the countries in formulating drug policies, to popularize the concept of essential drugs, and to train technical manpower for strengthening pharmaceutical supply systems, including the improvement of drug supply and management programmes. Guidelines for establishing drug information centres and for developing legislation were provided by WHO, and the countries were assisted in strengthening their production units and introducing good manufacturing practices. With the active collaboration of DANIDA and SIDA, WHO is providing technical support to Bangladesh's drug policy and is assisting the countries in further strengthening self-reliance in the procurement or production of essential drugs and vaccines and establishing national quality control facilities. TCDC mechanisms have been effectively utilized between Indonesia and Thailand in support of their essential drugs programmes. Traditional Medicine Efforts to involve practitioners of traditional medicine and utilize traditional herbs and medicines in primary health care are also reaping dividends. Guidelines for preparing a list of essential traditional medicines for PHC have been drawn up. In Mongolia, there is evidence of new interest in this aspect of PHC and the country has established an Institute of Folk Medicine for the development of research in various aspects of traditional medicine. In some countries (e.g., Nepal), traditional medicine preparations have been included in the list of essential drugs for primary health care. In India and Sri Lanka, traditional medicine is being given increasing importance. In fact, in India, an additional position for a physician has been provided in primary health centres to accommodate a practitioner qualified in traditional medicine. There is also an effort in some countries to utilize practitioners of traditional medicine in rural communities as primary health care workers. Epidemiological Surveillance Epidemiological surveillance is attracting greater attention in the Region and WHO'S technical support is being given for implementing various training programmes for intermediate-level general field epidemiologists. The successful example of the f ield-training programme under- taken in Thailand during the past two years is now being emulated in other countries. As a result, Indonesia has initiated similar service-based, field-oriented instruction in epidemiology, utilizing the health service facilities of the Government, medical schools and research institutions. In both Indonesia and Thailand, the training programmes are well established and progressing satisfactorily with active WHO support. The objective is to utilize the two facilities for meeting the training requirements of the countries of the Region as soon as these are fully developed *nd, if necessary, to develop similar national courses in other countries where the need and the teaching potential exist. In India, WHO supported the establishment of regional and state epidemiological surveillance systems, including the training of field-level epidemiologists, collaborating particularly with the National Institute of Communicable Diseases in this respect. Malaria Malaria continues to be a priority health problem in most countries of the Region. Although it declined slightly during the year, it is now apparent that the incidence rate is showing a dangerous tendency to flatten into a plateau, particularly in respect of falciparum infections. Moreover, Plasmodium falciparum infections are showing an increasing trend, replacing, to some extent, those caused by P. vivax in Bangladesh, Bhutan, Burma, India, Indonesia, Nepal and Thailand. Fortunately, this has not happened in Maldives or Sri Lanka. An evaluation of the existing methodology for surveil- lance mechanisms and widespread presumptive treatment for fever cases shows that this methodology can successfully reduce mortality but is not effective in preventing transmission; the use of residual insecticide spraying, particularly DDT, must be continued where there is moderate or high transmission. However, vector resistance to DDT and some other insecticides continues and efforts to tackle this problem by integrated vector control methods have not yet succeeded. In addition, parasite resistance to the standard anti-malarial drugs continues to intensify in Burma and Thailand, and the problem is of a focal nature in eastern Bangladesh, and north-east India, and Indonesia. Field and clinical trials of new drugs or treatment regimens have been continuing with WHO'S support, but the lack of a long-acting drug or a vaccine, and the mounting cost of malaria control operations in terms of drugs, insecticides and personnel, pose serious threats to maintaining the present gains. The emerging policy of integrating malaria control programmes with primary health care services, which is being implemented energetically by several countries, mainly in low-risk areas, has been a particular object of WHO support during the year. Attention needs to be paid to strengthening these integrated programmes in terms of epidemiological assessment and systematic and detailed programme planning and in respect of manpower development, both with reference to the multipurpose PHC workers and the technical malaria support group. In areas of high risk or special risk (such as in development projects), a lengthy preparation for phased integration is proving to be essential. It is in terms of these areas that progress towards health for all will be evaluated. National malaria programmes are being supported by WHO in respect of planning and evaluation, development of applied field research concerning technical constraints, and organization of and participation in training activities. In particular, the monitoring information obtained from the Regional Collaborative Studies on drug- resistant falciparum malaria continues to be of great value to the national malaria programmes in revealing the intensity and spread of such resistance, and in indicating alternative drug strategies. Tuberculosis As one of the principal health problems in the Region, tuberculosis has received considerable attention from both governments and WHO, particularly in respect of early case detection and treatment, and also immunization of the most vulnerable group - young children. In Bangladesh, the integrated control programme, which tackles both tuber- culosis and leprosy, has been augmented by BCG vaccination of half a million children while, in India, WHO is continu- ing to provide a considerable amount of technical support, especially to the Tuberculosis Research Centre in Madras to undertake research in the treatment and prevention of the disease. Leprosy Leprosy is a problem in nine countries of the Region, and a reduction in the number of 5 million estimated cases continues to be difficult. The obstacles that need to be overcome relate to the social stigma of the disease, for which health education of individuals and the community needs to be strengthened. They also relate to the technical aspects of programme delivery, including early diagnosis and treatment, shortage of drugs and selection of the more efficient multidrug regimens. Research to overcome these obstacles continues to be an important element receiving WHO support, and needs to be taken advantage of by national authorities if progress is to be made in reducing the incidence of leprosy. WHO initiated practical measures to strengthen national leprosy services by providing technical support to reorient and strengthen community-based control programmes and by developing a regional plan of action in collaboration with other United Nations agencies and various bilateral and non-governmental organizations. In pursuance of the recommendations of the technical discus- sions on the control of leprosy in the context of primary health care during the thirty-fifth session of the Regional Committee, several countries have already strengthened the multidrug regimen in their national leprosy control programmes. Diarrhoea1 Diseases Diarrhoea1 diseases are recognized by all countries in the Region as a leading cause of morbidity and mortality, especially in young children. They are closely linked with diseases such as measles and whooping cough that may be controlled by immunization, and with malnutri- tion and acute respiratory infections, which account for 85 per cent of the mortality at that age. The mortality figures relating to diarrhoeal diseases have, however, been significantly decreased by oral rehydration therapy (ORT) using a scientifically proven salts-sugar combination administered at home. The national diarrhoeal diseases control programmes established in 10 countries of the Region have recognized the objective of reducing mortality as their priority task and have included efficient ORT strategies in their programme component. In order to improve the delivery of such treatment through the PHC system and involve mothers and families more intimately, WHO is directly contributing to manpower training and the initiation of studies on the optimal ways of involving the community and the household. Several studies on the accept- ance of ORT, and of its efficacy, have been completed and the results incorporated in the programme. Research in diarrhoea1 diseases, especially health services research, is being undertaken in seven countries. Expanded Programme on Immunization The Expanded Programme on Immunization continued to be implemented in 10 countries of the Region, with the support of WHO, UNICEF, UPJDP and other agencies. Activities were increased in most of the countries not only in t.erms of coverage but also through the introduction of more antigens against a broader array of childhood diseases, within the framework of PHC. Development of manpower. review and evaluation to promote effectiveness, and operations research were also supported. Although the immunization services have been integrated into the basic health services in most countries, reviews show that the peripheral health workers and village volunteers are not sufficiently involve6 in the programme. This situation needs rectification in order to make the national programmes optimally effective. During the year under review, the programmes in Indonesia and Thailand were reviewed by joint national and international teams, while in six of the countries, 94 immunization coverage surveys were made. It is apparent that the South-East Asia Region is far behind the target in achieving the main EPI objective of immunization of every child by 1990, although some countries, notably Mongolia, maintain a high immunization coverage. This is another aspect which demands the urgent attention of national authorities since it is recognized that much can be achieved in this area by improving managenent, including the supervision of implementation of the activities, within the existing resources. Viral Diseases Research in respect of the diagnosis and epidemiology of viral diseases is being promoted by \JHO in areas where these constitute a public health problem. Epidemiological and transmission studies on hepatitis B virus (HBV) are in progress, and research in Burma on the efficacy of HBV vaccine in disrupting transmission has already indicated the important role of such vaccines in preventing chronic liver diseases and probably hepatic cancer. In India, Mongolia and Nepal, the leading role played by non-A non-B hepatitis virus is being examined. Dengue haemorrhagic fever (DHF) continues to be a significant health problem in Burma, Indonesia and Thailand, but so far no notable evidence of spread, other than sporadic cases, has been received from potentially susceptible countries such as Eangladesh, parts of India, Maldives and Sri Lanka. Stress was laid on the need to strengthen DHF surveillance in these vulnerable areas. WHO supports national efforts in undertaking epidemiological studies, training of personnel and clinical managenent of cases, and also in the development of a dengue virus vaccine at the CJHO Collaborating Centre in Bangkok. The initial batches of dengue type 1-4 strains of candidate vacci~e are available for human trials. The problem of rabies is recognized in at least eight countries of the Region. WHO has supported the governments not only in developing the post-exposure vaccines for treatment in man but also i11 producing prophylactic vaccine for use in animals. The Organization provided considerable support to Bangladesh, Nepal and Sri Lanka to develop a balanced rabies control programme. At the Pasteur Institute in Coonoor, India, a regional centre for training in the methods of providing tissue culture rabies vaccine for human use is now being developed with WHO/UE;IDP support. Non-Communicable Diseases The major emphasis of CHO's technical collaboration with Member Countries in respect of non-communicable diseases is in the promotion of an integrated social and behavioural approach to the prevention, early detection and control of emerging health problems, particularly in cancer, cardiovascular diseases, chronic liver diseases including cancer, and accidents. Areas of such collabora- tion included \JIIO support for epidemiological studies to define the problem, the formulation of national plans for prevention and control, development of health educational materials for the primary prevention, early detection and management of these emerging health problems, and research in support of the activities. Sri Lanka is one of the target countries selected for the global cancer control programme for studies on the primary and secondary prevention of a form of cancer common in this region, i.e., oral cancer. At the same time, in India, Mongolia and Sri Lanka, the formulation and implementation of comprehensive cancer control programmes have made some progress. Epidemiological data on various forms of cancer are being collected through hospital and population-based cancer registries in several countries. The dissemination of information on the prevention and early detection of cancer is also being strengthened. Knowledge regarding effective relief from pain for curable cancer patients is being made available. In regard to other nnn-ccmmunicable diseases, early detection of diabetes and the prevention of deafness has received increasing attention and support. e early detection of diabetes is strengthened through an integrated approach for the prevention and control of non-communicable diseases. A community approach in the detection and control of diabetes is gaining support in a number of countries in the Region. To this end, the training of medical, para- medical and lay personnel is being organized. In this connection, the research efforts made by the Bangladesh Institute of Research and Rehabilitation in Ciabetes, Endocrine and Metabolic Disorders is worth mentioning. Prevention of deafness amon3 children was the subject of an inter-country workshop held in the Regional Office in late 1982. Activities aimed at the prevention of deaf- ness are being promoted in :,;ember States. In Thailand, for instance, technical support has been given for developing activities aimed at providing ear surgery as an outreach service through mobile teams. The Regional Office has collaborated in the conduct of national. workshops in several countries. Prevention of Blindness The collaboration of WHO with national programmes for the control and prevention of blindness has included aspects such as training, review and evaluation and mobili- zation of resources in support. of national activities. It is estimated that these are approximately 12 million blind in the Region, the majority living in the underserved rural areas. While at least half the cases are due to cataract and can be cured, the great majority of the remainder are attributable to preventible causes such as trachoma (particularly in Burma and Thailand), injuries and malnutrition (vitamin A deficiency in Bangladesh, India and Indonesia). Early detection and treatment could prevent deterioration of vision in people suffering frcm conditions such as glaucoma and diabetic retinopathy. Provision of eye care as an integral part of primary health care is the basis of national programmes, supple- mented by interventions against blinding infection and malnutrition, and by removal of cataracts through outreach surgical services such as eye camps. Community Water Supply and Sanitation -- Community water supply continues to receive h~qh priority in most countries of the Region. Consequent: on certain set-backs and causes for frustration due to lack of adequate resources and other factors during the last one or two years, the Member States in 1983 critically analysed and reviewed the constraints facing the sector to determine how best they could be resolved, to attain the national goals. In respect of water supply and sanitation programmes, greater attention is now being paid to institutional and manpower development. Mpropriate technology, health educa- tion, community participation, health systems research, and other "software" components of the programme are also receiving attention. Without these components, facilities constructed cannot be maintained by the communities at a cost they can afford, nor can the health benefits of these interventions be realized. One of the glaring disparities in the ongoing water supply and sanitation programmes is the heavy emphasis being laid on water supply, while very little attention is being given to the sanitation aspect in the national efforts for the Decade. This trend must be checked and a balance between these activities must be established. The health impact of water supply deve1.opment may be hampered if both these activities. along with health education, are not judiciously blended, With this in view, WHO has been organizing courses on formulation and appraisal of water supply and sanitation projects and on the technical, financial and cost-benef it analysis aspects of these projects. Low-cost technologies are now being increasingly used in water supply and sani- tation projects with the growing understanding of their easy application, cost-effectiveness and adaptability. This has enhanced their acceptability and encouraged the community to participate in their implementation. In its cooperation with Member Countries in Decade activities, WHO has acted as the executing agency for several country or inter-country projects funded by UNDP and by various bilateral and other funding agencies such as GTZ and DANIDA. New projects in which WHO collaboration is being sought involve less hardware and more technical and managerial components, e.g., planning, training, evaluation and other such activities. This trend is also reflected in WHO'S collaborative activities in water supply and sanitation programmes through its own funding. In order to involve high-level national technical and administrative authorities in the implementation of Decade programmes and make them fully conversant with the problems of the sector, a consultation meeting was scheduled to be held in August 1983 to review the Decade activities, identify the issues preventing its progress and to find alternative solutions. Environmental Pollution Several countries in this region that are going ahead with industrialization are now encountering more and more of the problems associated with environmental pollution that are traditionally faced by industrialized countries. In an effort to strengthen the role of health ministries in the identification and control of environmental hazards, WHO'S support is being increasingly sought in environmental monitoring, chemical safety and assessment of health effects, besides training and provision of information. The Organization has been providing technical support, especially in India, Indonesia and Thailand, through an inter-country project. Health Manpower Development As regards health manpower development, the thrust of the Organization's activities is on supporting the Member States in planning health manpower to meet the specific needs of their health systems. Towards this end, WHO has been promoting, at the national level, a more comprehensive approach to the problems of manpower development involving all aspects of manpower - planning, production and manage- ment. Member States are encouraged to develop effective coordination between all institutions responsible for the training of health personnel and the service agencies responsible for the delivery of health care. In the areas of health manpower planning and manpower management, some sustained efforts will have to be made at the national level. In this context, the development of a country-based health manpower information system is seen as an essential prerequisite for initiating more systematic and continued manpower planning and management activities. Greater attention will also have to he devoted to manpower management strategies in order to improve employment conditions and career development. This would lead to more effective utilization of trained manpower and minimize the losses sustained by the migration of health personnel and by their abandoning careers for which they have been trained. In the more conventional area of manpower production, the Organization's resources have been used to strengthen training programmes and institutions. This has involved support to faculty development, revision of curricula, improvement of evaluation methodology, and the promotion of teacher training in educational methodology. These training and support programmes have been utilized at the national level to improve the capacity and the quality of such training for various categories of health personnel, including doctors, nurses, as well as paramedical, ancil- lary and voluntary health workers, including traditional birth attendants. Pervading all these activities have been the Organization" efforts to modify the more traditional teaching and learning processes so that they are task-based and more effectively focused on meeting community needs. These efforts have had a commendable impact on training programmes in many countries of the Region for middle and peripheral-level health workers. In order to achieve community reorientation in medical education and the training of health workers, a much more comprehensive approach to the whole problem of education and training must be adopted at the national level, especially by the medical leadership, in the interest of the underserved and unserved people of each country. The Organization has been supporting a wide range of regional and national activities with the aim of reorient- ing medical undergraduate education towards community needs. These efforts have hitherto focused mainly on stimulating appropriate changes in curricula, improvement of learning and evaluation methods, strengthening of faculty development in community orientation through the establishment of departments of community medicine, and the adoption of field practice areas. The changes, however, have been confined to the area of educational development within the manpower production process, and have had only a limited impact on a critical problem facing the countries, namely, that of producing the right types of doctors in the right numbers, with the right competencies and at the right time and place. In many countries, there continues to be an incomplete appreciation of the import- ance of the additional roles that doctors need to play and the responsibilities they have to discharge as health team managers. leaders and teachers. Equally, the doctors complain of lack of job satisfaction and career opportu- nities, inadequate continuing education, and lack of facilities to utilize their knowledge and skills. There- fore, efforts have to be made to define, as clearly as possible, the most appropriate role of doctors in a given social, economic and political setting by taking into account the community's priority health needs, expectations and resources. A recognition of the important role of team work among health personnel at the PHC level has led to the initiation of country case studies, supported by WHO, in an attempt to identify the specific factors that promote or impair the ability of health personnel to work as a team. The need to adopt a more systematic approach for the provision of facilities for continuing education has been accepted and strategies and activities to achieve this objective are being formulated. The assessment of levels of perform- ance of health workers is seen as an essential element in manpower management procedures and provides important feedback for the evaluation of ongoing training programmes. The Organization has been active in developing a methodology and in elaborating specific test instruments for use in making such assessments. Health manpower development research has been focused on providing solutions to the numerous problems that countries are faced with in attempting to match manpower production to their needs. Awareness of the inadequacy of conventional biomedical methods for the solution of health service research problems led WHO to describe the alter- native methodologies available for this purpose and to define the specific advantages of these methodologies. At the national level, the Organization has promoted the wider dissemination of knowledge of these newer methodo- logies and their use on a wider scale. Promotion and Development of Research Yet another facet of WHO'S activities in support of health development efforts in this region is the promotion and institution of research to solve technical and operational problems in the field of health. At the country level, national councils for medical research or analogous bodies that play a coordinating role have been the focal points through which WHO has channelled its support for research development. At least nine countries have such mechanisms which have generated consi- derable enthusiasm and awareness about the crucial role of research in achieving HFA goals. They have also taken steps to develop not only actual research activities within the existing limited facilities but also in training research personnel and strengthening or developing suitable institutions to improve national research capabilities. WHO promoted periodic meetings of the directors of these bodies to help exchange views and experiences and to sharpen the common guidelines to pursue and manage research activities in the Region. The third meeting of the directors of medical research councils was held in December 1982 and deliberated on a number of topics, including health services research, training in research management, strengthening of national research capabilities, prepara- tion of plans of action for research development at national level, and other related subjects. In order to create self-reliance in conducting research at the country level, two major actions have been taken by WHO. The first was to train potential researchers in research techniques and appropriate protocol develop- ment, and the second was to identify potential institutions that could be strengthened by creating newer physical facilities and raising the technical capability of the existing personnel in their own discipline. Thus, a major component of WHO'S research programme in the Region is related to institution strengthening activities at the national level. The visiting scientists grant and research- training grants are now increasingly being used by national researchers. These grants are no longer awarded in an open-ended. manner. On the contrary, each grant-based training proposal is critically examined and is approved only when it is directly related to the needs of an ongoing research programme supported by WHO's research funds. The Organization's inputs to research support and research training, being complementary to each other, thus produce a multiplier effect. In addition, a network of national institutions has been identified and designated as WHO Collaborating Centres. The major objective of this network is to promote collaboration between scientific workers at the national level and WHO's activities related to the development of services, manpower and institutions or field-based research in health. This has an added advantage in that such collaboration and involvement of the national centres in health development work supported by WHO and the government helps to improve their own capability in specific fields. It also enhances cooperation and promotes better understanding between the Organization and the national institutions. In addition to the research activities supported by the regular budget, the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases has made a considerable contribution to promoting and supporting research, especially in the fields of malaria and leprosy in this region. Similarly, the WHO Special Programme of Research Development and Research Training in Human Reproduction continued to be the major source of support in research related to family planning and allied areas. In conformity with the social goal of Health for All, the regional research programme is being reoriented to meet the needs as identified in national, regional and global HFA strategies. The South-East Asia Advisory Committee on Medical Research (SEA/ACMR) has already articulated the basis of and principles determining the research priorities for HFA, in order to shape and guide this reorientation process. At the same time, the SEA/ACMR has strongly stressed the importance of health systems research, which should be the core of the research activi- ties in the Region. An effort has also been initiated by the Regional Office to promote behavioural sciences research, as it is now realized that individual and social behavioural patterns are likely to determine the success or failure of many health interventions. These patterns must therefore be clearly understood through research in order to generate meaningful efforts for self-care and community involvement. In all these activities, the members of the SEA/ACMR have played a very strong leadership role, not only by providing guidelines but also in stimulating the national authorities to align their research efforts to solve identified priority problems. The Regianal Office has now developed an effective and systematized management process to implement and coordinate WHO'S research programme both at the regional as well as at the country level through the involvement of its Research Promotion and Development (RPD) unit and a Research Development Committee as well as the Scientific Working Groups in specific programme areas. A "peer review" mechanism to scrutinize the research proposals technically and a process for ethical assessment of the proposals, where needed, are also available. There is no doubt that the RPD activities in the Region are now built on a sound base and are poised to make rapid progress durj.ng the Seventh GPW period, Women, Bealth and Development While women, as consumers of health, are the beneficiaries of health development activities, their role as providers or as active agents of health development has also been recognized by WHO. Thus, as in all other regions and WHO headquarters, the South-East Asia Region has also established a programme on Women, Health and Development (WHD), which is being planned and implemented by a core group specifically charged with the task. The programme is unique in the sense that it has identified appropriate entry points in the existing programmes for health develop- ment through a component for WHD. Thus the programme is a multifaceted one and is being developed as an integral component of the total effort for health development, without having a separate vertical identity. The programme has successfully involved the countries in activities through the establishment of national focal points nomi- nated by the government concerned and country working group assisted by the WPCR. One of the activities now being pursued by the regional CJHD and country focal points is the generation of sex-wise data at national level in order to define cl.early the problems related to women's health. The regional WHD group also actively participated in the interagency committee meetings on "Women in Development" under the aegis of ESCAP and is closely involved in the preparatory activities for the World Conference of the United Nations Decade for Women to be held in 1985. Health Ministers Meea The Second Meeting of the Ministers of Health of the countries of thi,s region, held at Dhaka following the thirty-fifth session of the Regional Committee. reviewed the developments that had taken place since their first meeting in September 1981. The ministers unanimously agreed on the selection of a few areas of common concern for developing concrete plans of action to promote technical cooperation among the countries. Health manpower training, diarrhoeas diseases control, and immunization were identified as areas of priority. It was felt that such identification would enable the Member Countries to take immediate advantage of the complementarity of the available expertise in the Region and lead to optimal utilization of scarce resources on a regional basis. As a follow-up action, the Regional Office has, in close consultation with the national authorities, made an effort to identify the specific needs of the countries in these three areas and the resources that may be mobilized from within the countries of the Region to meet these needs. Further action in this regard will be planned on the basis of the decisions taken at the Third Meeting of the Health Ministers immediately fol3owing the thirty-sixth session of the Regional Committee. Conclusion From the short resume given above it is apparent that, particularly during the period under review, the countries of the South-East Asia Region have made significant progress in their voyage towards attaining the goal of Health for All. WHO/SEARO has had the proud privilege of contributing to this colossal effort. 111 the process of developing the Organization's collaborative programmes with the countries, our sister agencies in the United Nations system, especially, UNDP, UNICEF and UNFPA, and a number of multilateral and bilateral agencies, such as the World Dank, Asian Development Bank, AGFUND, US AID, CIDA, DANIDA, SIDA, NORAD, ODA and GTZ, provided very useful. support and cooperation. Similarly, non-governmental voluntary agencies such as the Sasakawa Foundation, the Royal Commonwealth Society for the Blind, the Asian Foundation for the Prevention of Blindness, and many others collaborated in their specific areas of interest. For this cooperation and contribution I wish to convey my sincere appreciation to all of them. I would also like to express my deep gratitude to the people and governments of our Member States for their unflinching support and understanding and their patience and perseverance in working in collaboration with WHO, their own Organization, towards the goal of Health for All by the year 2000. Given the will, determination, commitment and sense of responsibility that have so forcefully been demonstrated by the Member States, I have no doubt that through our combined efforts we will certainly reach this goal, however arduous the path. I& I&- - Dr U KO KO Regional Director xxviii PART I GENERAL REVIEW OF ACTIVITIES 1. STRENGTHENING OF HEALTH SERVICES 1.1 Planning and Development of Health Services There is now wide public and political recognition of the importance of the strategies and plans of action for health for all as a result of the efforts that have been made at global, regional and national levels to re-orient health policies toward HFA goals and primary health care. It is necessary that national administrations tailor their managerial processes for implementing these strategies and plans of action. This task implies that the extensive analytical and planning work that has been going on will have to be supplemented by intensive efforts to re-orient resource allocation through programme budgeting towards priority programmes and the under-served populations. Furthermore, new approaches for more effective management of programme implementation, including procedures for better monitoring and control, are needed. Practical measures for the objective evaluation of health impact, service coverage and quality are also needed in order to determine whether or not the present strategies require revision. The emerging managerial processes for health should thus place a balanced emphasis on policy formulation, programming, budgeting, implementation, evaluation and information support. As the development of the health services infrastructure proceeds with emphasis on under-served populations, the concern for improving management is seen to extend right down to the village level. The good performance of health service units at any level calls for a broad mix of abilities by the managers at that level. Some of these abilities can be provided through training. However, much of the effectiveness of the services depends on routine systems and procedures through which day-to-day work is carried out. In many countries, these administrative and operational procedures prove inadequate under the pressure of the rapidly expanding services: supplies and essential drugs are not being regularly maintained at the peripheral level; staff are not routinely supervised, and sometimes they are not even appropriately trained; equipment, vehicles and facilities are not well maintained, and critical preventive and promotive tasks are not routinely carried out, particularly in the more remote areas. The question thus becomes one of routine, efficient management of health services. It is often difficult to identify and define these problems clearly. It is even more difficult to apply solutions on a country-wide basis. Health services research offers various types of problem diagnoses that are gaining limited use in operational problems and situations. The talents and experience of health service administrators, on the one hand, and the research disciplines, on the other, should be combined so as to gain a better understanding of why the effectiveness of health services is limited and how today's problems can be resolved within the existing policy and resource constraints. 1.1.1 Health Planning, Programme Formulation and Evaluation In the countries of this region health planning systems and procedures have in general been strengthened and oriented towards the solution of health problems and the achievement of objectives. To some extent, these planning systems have, in addition, become further decentralized to the provincial and district levels. It is nevertheless also generally true that little progress has been made in improving the management of programme implementation and day-to-day operations. In the year just completed, there has been a considerable interest in evaluation activity. Most countries have begun to take a hard look at the coverage of health services and its quality and the problems being encountered within the services. Through such evaluation efforts it should be possible to identify and define more clearly those operational and managerial difficulties that constitute the primary constraint in the extension of health services to the total population. The task will then be one of solving and circumventing these operational problems. BANGLADESH completed its plan of action for HFA and, in addition, formulated its health manpower plan, revising that plan to reflect certain policy and organizational changes that had recently been introduced. Project formulation activity was directed towards the preparation of 13 project proposals to be funded by UNDP. In addition, a country resource utilization (CRU) review was completed in order to analyse the resource flow and determine net additional requirements for possible external funding. Efforts were made to analyse the problems within the medical logistics system, and the resulting report is under consideration by the Government. In BHUTAN'S first year of membership in the Organization, action began for the development of its HFA strategy. In addition, steps were initiated for the formulation of a master plan of operations for WHO'S programme of collaboration in close consultation with the Ministry of Planning and Development. In BURMA, efforts continued for the formulation of the national HFA plan of action, The Government decided to establish a planning and training unit in the Ministry of Health, and the operational objectives and staffing pattern of this unit were being defined. Burma has been successfully formu- lating its fourth Five-Year Plan through the application of the country health programing (CHP) approach. The implementation of primary health care is expected to be further supported by the national JCHP-PHC Core Group, which was established in May 1983. A joint UNICEF-WHO team visited Burma in June 1983 and held discus- sions with the JCHP-PHC Core Group on ways of strengthening implementation of the People's Health Plan, especially in three important aspects, i.e., intersectoral coordination, management and resource mobilization. Hospital management was strengthened by organizing managerial training through several workshops. A new format for the inspection of hospitals was developed. A new evaluation system was also being introduced with objective approaches, and a national supervisory group was established in order to undertake programme monitoring and evaluation. The inter-country programme continued to support training in planning, management and administration. In INDIA, a national coordinating committee for HFA was established under the chairmanship of the Prime Minister, and the Central Council of Health and Family Welfare was made responsible for reviewing progress under the Sixth Plan. IJHO collaboration continued to be directed towards training in management and health economics, particularly within national institutions. In addition, a network of national training institutes was established to review training needs and develop curricula for management training for several critical types of staff. In order to speed up the development of the management system, a programme in managerial processes for national health development (MF'NHD) has been formulated. This programme will focus on the strengthening of health management at the state and district levels. At a workshop held in Gujarat State, district health officers were introduced to the concepts and procedures of operational problem analysis through the use of a community-level survey. Tbe programme of the workshop also included definition of operational problems found through the survey and the formulation of district action plans for solving those problems. This style of training in problem solving will be gradually expanded in the coming years. Health policy formula ti or^ in INDONESIA continued with emphasis on the strengthening of infrastructures and procedures at the provincial and regency levels and further functional decentralization towards the health centre level. The conceptualization of the national health system was finalized and presented to the National Health Conference, from which feedback was provided to the planning group. Long-term and five-year planning continued, with the establishment of "quality of life indicators" for HFA/2000. In addition, working groups estimated programme costs and helped with an analysis of alternative mixes of programmes in support of HFA. Manpower constraints were analysed. WHO consultant support was provided in reviewing organizational problems and in looking into the improvement of community participation. In MALDIVES, the overall progress in the implementation of the HFA strategy was monitored through such means as meetings of field-level staff and on-site visits to outlying areas by high-level officials. In MONGOLIA, policy guidance was strengthened through the establishment of a commission for implementing the national HFA strategy, which reviewed and reformulated the strategy. A protocol for the study of health manpower utilization was developed and norms of manpower were set. Detailed health programming has been delegated to the aimak level. In addition, the formulation of a project on a model PHC system in one aimak was completed and a statistical manual of health services development over a 60-year period was published. Evaluation was undertaken through the analysis of aimak health services and by reviewing annual aimak reports. This review was followed by a three-day seminar. Workshops in planning and management were held for aimak-level staff, to be followed up by similar workshops this year. Several innovative activities pertaining to policy analysis and planning were undertaken in NEPAL, including an HRG/CRU review, a study of alternative PHC approaches, the formulation of the joint UNICEF-WHO nutri- tion support programme, and the setting up of the JCHPlPHC support group. The health planning system has been laying stress on decentralization to the district,and JCHP/PHC support will foster such decentralized monitoring and management. The major policy re-orientation towards primary health care progressed in SRI LANKA with the beginning of the implementation of the new primary health care model. In addition, a policy review of the financing of health care was being undertaken following the completion of a broad study of health costs and financing alternatives. Issues such as the shortfall in the recurrent budget resulting from past increases in capital expenditure were being studied. A wide range of alternative options was under review, including payment schemes and various types of health insurance. Decentralization of the health administration to local administrative areas was still under way. The earlier country resource utilization review in Sri Lanka resulted in several proposals for external funding and follow-up actions are being taken. With support from the Asian Development Bank, a primary health project for 33 AGA divisions is being implemented. An evaluation, including a situation analysis of primary health care and basic health services in two districts, was undertaken recently. Policy and planning activities in THAILAND lay emphasis on multi-sectoral and decentralized aspects. The Social Development Project under the National Economic and Social Development Board succeeded in designing a basic minimum needs approach for use in situation analysis and planning at the local level. The Ministries of Interior, Agriculture, Education and Public Health are collaborating in this innovative approach to social development. A notable development in the managerial process is the Thai programme budgeting exercise. This innovation was being introduced so as to facilitate the management of the WHO programme by the Royal Thai Government. It has proved to be instrumental in the difficult process of generating and sustaining ministry-wide consensus not only on how WHO resources are to be used but on the more important aspects of national health policy and programing. Other activities included the analysis of manpower requirements for district hospitals, monitoring the implementation of development projects in 37 provinces, implementing an effective programme budgeting system, and supporting the formulation of integrated health development projects. Studies have also been carried out to determine the unit costs of services in district and provincial hospitals. The health policy study centre at Mahidol University has compiled a bibliography of health services and social science research. It has also identified government sources of health data and established a health services research information centre. A one-month course in planning and management has been established for middle-level health managers. Inter-country activities in MPNHD have concentrated on the develop- ment and testing of improved methods for evaluating primary health care and the basic health services. In addition, support has been provided to a number of national programming and evaluation activities. Strong linkages have been established between the development of the managerial process, health services research and primary health care. As an example, an inter-country consultation was held on financial planning for HFA/2000. This meeting was expected to result in proposals for studies of health care costs and financing alternatives. Technology development has been undertaken in the area of microprocessing in support of health management. 1.1.2 Organization of Basic Health Services In BANGLADESH: the Government speeded up the further development and management of the thana health complex system throughout the country. WHO, through consultancy services, contributed to the Government's effort in strengthening managerial processes, including health planning and informa- tion system development. Also with continued WHO assistance, integration of health services and family planning has been implemented in thana health complexes. The new model thana health complex concentrating on the delivery of the eight elements of PHC, based on the recommendations of the tripartite review of six pilot thana health complexes, has already been developed. With WHO support and in collaboration with UNICEF, and subsequent to an orienta- tion course for thana health complex managers, a plan has been developed for adopting the new model in six thanas. In BHUTAN, the Government's policy and strategy for the decentraliza- tion and strengthening of the dzongda administrative activities facilitated health development at this level through the strengthening of basic health units. Health activities were integrated under the basic health units and linked with the dzongda administration. The training and retraining of health assistants and other health personnel of basic health units continued at the Family Welfare Training Centre, Geylegphug, with WHO and UNFPA support. Initial steps have been taken in Geylegphug district to conduct a survey of infant and maternal morbidity and mortality in order to support the establishment of an MCH and family planning information system as a part of the health information system. In BURMA, WHO'S resources have been directed towards ensuring increased attention to the management, supervision and evaluation of the activities for the development of health services in support of PHC. Management training has been given to township medical officers, township health officers and health assistants in charge of rural health centres. Orientation of village people's council members in PHC has become a regular feature in launching the programme in new townships. The programme has been moving faster than anticipated, using US AID finance and supplying UNICEF medical kits to community health workers. In INDIA, the health service delivery system is based on the functioning of a network of primary health centres having at least six beds in each and supported by three sub-centres in each community development block. The multipurpose workers' scheme provides the out-reach to this network of primary health centres using one male and one female worker for every 5 000 rural population. The total number of functioning primary health centres is 5 850; there are 60 000 sub-centres. Accordingly, training programmes were stepped up, and 160 984 multipurpose workers have been trained and placed in those facilities. Under the subsidiary health centre scheme, the existing rural dispensaries have expanded services from the curative aspect to the delivery of the total health package for a population of 20 000 each. One out of every four primary health centres was being upgraded to be a conunity health centre with 50 beds to provide a referral service to the other three centres with specialities in surgery, medicine, obstetrics and paediatrics. WHO supported training programmes related to the strengthening of rural health services, provided supplies and equipment and assisted in evaluation studies. In MALDIVES, the apex of the health system is the Government Hospital in Male. Supervisory and referral services from specialists has often been obtained primarily through WHO, although some other bilateral and voluntary agencies provide support in this area. Health centres in the atolls are manned by community health workers and health assistants with minimal curative, preventive and promotive functions. In December 1982, a WHO conqultant assisted in developing a country plan of work for 1983 and 1984. The plan consists of training he trainers and middle-level primary health care managers, carrying out of a situation analysis and development of simple primary health care, a monitoring and evaluation system and the development of PVC services, training and research. The number of hospital beds at aimak and somorl levels in MONGOLIA has been increased by 10-12 per cent over the baseline of the previous year. Many specialized unlts, including units for intensive therapy, functional diagnosis, psychone~irology and rehabilitation, have been established. At the time of writing, there were 22 physicians and 107 hospital beds for every 10 000 poplation. The budget allocation for health has increased by 8 per cent and forms 10 per cent of the total state budget. A new ontological centre, as well as a number of specialized medical centres, were put into operation in Ulan Bator during the year. WHO has supported training in planning and management for medical and other health workers at aimak level. In NEPAL, community healrh services have been fully integrated in 6 districts and partially integrated in 17 districts. Support had been given through UNFPA for developing new physical Facilities for the Integrated Community Health Services Development Project (ICHSDP). Technical support was provided also to strengthen the functional capabilities of ICHSDP in the area of management, supervision and evaluation. WHO supported national staff in undertaking training courses in evaluation, management and logistics. Progress made in the development of the health infrastructure in THAILAND was remarkable under the Fourth Five-Year Plan, which provided a major thrust to the strengthening of health services. Some 100 district hospitals were constructed along with 1 200 health centres covering about 80 per cent of the tambons. During 1982, WHO supported the training of 3 664 voluntary health communicators in six provinces, four refresher courses for tambon trainers and a workshop on PHC. 1-1.3 Health Services Research During the year under review, there was substantial progress in the development of activities in heaith services research in countries of the Region in support of national, regional and global stategies to attain the goal of HFAl2000. The dissemination of the concept of health services research (HSR) and the establishment of an HSR information system linked to the Health Literature, Librarv and Information System (HeLLIS) network are being implemented in almost all the countries. The conceptual description of health services research as recommended by the eighth session of the South-East Asia Advisory Committee on Medical Research (SEAIACMR) and further endorsed at the Third Meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries, held in Chiang Mai (Thailand) in December 1982, was disseminated to all countries. Regional and national assessments of health services research activities were carried out by national HSR focal points and the results of these assessments were analysed by the Regional Office and then disseminated again to the countries for further updating on a regular and continuing basis, A regional action plan for 1983 through 1985 was developed in support of the national HSR work plans. WHO also assists the countries in overcoming the continuing problems of coordination among various research institutes, research scientists and workers, and multidisciplinary and multi-sectoral levels of the administration. A consultative meeting of the national focal points for HSR and HeLLIS was he13 in the Regional Office in January 1983 in which the guideline for the standardization of HSR information was developed. This guideline will be pre-tested in selected countries before being used in the others for the collection, processing, dissemination and storing of HSR information on a continuous basis in support of activities in this area. The Pusat Penelitian Pelayanan Centre in Surabaya, Indonesia, which is a WHO Collaborating Centre for Health Services Research, undertook research activities on the development of appropriate technology for different aspects of primary health care in rural areas, appropriate staffing patterns for health centres, training modules for village health volunteers, modules for health information system and operational research1 systems analyses (ORSA), and a manual for training in management sciences. The Centre also designed and conducted a study on the utilization of health centre manpower and reported the results. Studies on the financial aspects of health care delivery are receiving increasing attention in many countries. In Bangladesh, one such study was completed during the period under review and the final draft of the study report was under preparation. In Sri Lanka, a study on commodity requirements and expenditure flow in respect of the health sector was completed and the data were being analysed. In Thailand, the first phase of the study on health financing related to health care in provincial and district hospitals was completed and the next phase was under way. Another study, on the unit cost of primary health care centres, was started. To promote health services research on financing for HFA/2000 activities, an inter-country seminar was organized in the Regional Office in March 1983. This activity has helped in sensitizing the countries to recognize research jn Einancing health care as one of the priority areas in health services research. In the area of maternal and child health, the collaborative studies on the risk approach undertaken in Surma, India, Indonesia, Sri Lanka and Thatland luring the second phase as a follow-up of the related pre-natal studies, were completed. The results of the studies were being analysed for utilization in the development of MCH care in rural areas within the framework of the national PHC programmes. So far, ongoing health services research in the field of MCH in this region has focused on (i) the risk approach to MCH care; (ii) diagnosis and management of hypertensive disorders of pregnancy and childbirth; (iii) perinatal mortality and low birth weight; (iv) community participation in the utilization of maternal and child health and family planning services, and (v) breast-feeding patterns. Hypertensive disorder of pregnancy and childbirth was studied in Burma, Sri Lanka and Thailand, with support from WHO. The study would be completed in Burma and Thailand by the end of 1983 and in Sri Lanka in 1984. The results of the study on pregnancy and prenatal morbidity and mortality, including low birth rate, in Sri Lanka would be available in 1983. The ad hoc survey on infant and young child morbidity and mortality -- in Burma was completed during the year. Studies on the reproductive health of adolescents were started in Bangladesh. There is a growing awareness in the Member States of the importance of including the hehavioural aspects of health in their efforts for health system development. To this end, a meeting of the scientific working groups was convened in the Regional Office in April 1983 in order to identify the needs and modalities for behavioural sciences research in the field of health in the countries of the Region; follow-up action is being taken. WHO supported national workshops on the methodology of behavioural sciences research in the field of health in Nepal and Thailand. A detailed research protocol on mental health was drafted and finalized during a meeting of investigators from India, Indonesia, Mongolia, Sri Lanka and Thailand, held in October 1982; the protocol is under implementation. Proposals on community participation in immunization and the assessment of the role of school children have been submitted by Indonesia and Thailand and are being processed for WHO support. As regards health services research related to manpower development, the Regional Office supported Nepal and Sri Lanka in bringing together multidisciplinary groups to identify researchable problems with the help of expertise provided by WHO. The Inter-regional Workshop on Alternate Research Methodologies for HMD Research, held in New Delhi in 1982, served a very useful purpose in bringing together an international group of experts who, along with national personnel, analysed these alternative methodologies, their specific usefulness for the solution of certain types of research studies, and the detailed ways by which information relating to these newer methodologies could be more widely disseminated. The inter- country case studies on teamwork by health workers stimulated national workers to undertake a chain of comparable studies in their own countries for improving the delivery of health care at the community level. 1.2 Primary Health Care (PHC) The countries of the Region are fully geared to primary health care as the key approach to the goals of Health for All. The strengthening and development of health infrastructure in most of the countries progressed according to schedule. Additional efforts were made for the extension of the services through various types of community health workers. Increasing attention was given to the strengthening of national capabilities at the intermediate level, as it is this level which is of crucial importance in organizing, supervising and monitoring primary health care. Considerable progress was made in respect of the Joint Committee on Health Policy (JCHP) studies, jointly sponsored by WHO and UNICEF to support primary health care, in Burma and Nepal. The JCHP/PHC support group in Nepal arranged situation surveys in four districts. Following the visit of a WHO/ UNICEF mission to Nepal in Novemher 1982, action was being taken to organize district-level JCHP activities with the help of the health and population committees established in all the districts under the Decentralization Act. In Burma, a core group was formed to review the mechanisms and modalities of joint support to the implementation of PHC. A I+JHO/UNICEF mission visited the country in late June. Several inter-regional meetings of significance in the context of PHC were organized by the Regional Office. The first was an intersectoral action study, held in Trivandrum, India, and attended by participants from India, Indonesia, Sri Lanka and Thailand. Another inter-regional workshop on community participation, was organized in December 1982 at Korat, Thailand, as a follow up of the hi-regional workshop held in Pattaya, also in Thailand. As a follow-up to the ~egional ljorkshop on the Primary Ilealth Care Approach in the Control of Malaria, which had been held in New Delhi last year, an inter-country workshop was organized in Phuket, Thailand, in October 1982 to consider the manpower aspects of the control of malaria through primary health care. I.JHC) gave support to the ASEAN Training Centre for PHC, Mahidol Ilniversity, Thailand, and also supported the Consultative Meeting for Bi-regional Activity on PHC in ASEAN Countries held in Bangkok during December 1982. In the area of strengthening of manpower for primary health care, the Regional Office cooperated with ESCAP in the holding of the fifth Regional Seminar on Basic Community Services and Primary lIealth Care in Bangkok and Chiang Mai during October-November 1982 by providing fellowships and technical staff support. A number of activities have been initiated in the Region for the development of urban primary health care. After preliminary meetings and detailed case studies in Bangkok, Colombo, New Delhi and Jakarta, a regional workshop was conducted in Few Delhi in January 1983 and, as a follow-up, a case study on problems of urban primary health care was initiated in Rangoon. Efforts were being made to start activities in the countries for: (i) review of national PHC development efforts in respect of unserved and underserved urban population groups; (ii) strengthening of city health departments, and (iii) preparation of appropriately stratified profiles of the health situation in urban areas so that appropriate measures might be designed to meet the needs of the target groups. Preparations have also been completed for holding an inter-regional conference on PNC in Pyongyang in September 1983, in collaboration with the Government of the Democratic People's Republic of Korea. As for activities in the countries, in BANGLADESH, the development of primary health care is closely linked with the strengthening of thana health complexes, which provide the first referral facility where professionally trained staff are available. An action-oriented course was conducted for health service managers of six thanas in December 1982 and resulted in the strengthening of the functions of thana health service delivery. The objectives of the course were to improve the existing services by utilizing available resources better and to focus service delivery on health problems of significance. Emphasis was laid on management, health information, community participation, team-work and intersectoral coordina- tion. A committee consisting of representatives from the Health Ministry, UNICEF and WHO was set up to review and frame guidelines on the functions, duties and responsibilities of all the thana health staff and community institutions concerned. The committee has already begun its work. In BIIUTAN, primary health care was implemented through the network of basic health units (BHU) and the services of village health volunteers. The number of BHUs increased during the reporting period from 46 to 50. Each of these covered a population of 4 000 to 6 000. Efforts were being made ro have more BHUs so as to reach the target of one BHU per 2 000 to 3 000 population. After the success of a pilot project set up in 1981 to train village health volunteers, a second group of volunteers was trained and deployed in Wangdiprodrang and .Takar zones. Another group was deployed after training in Geylegphug district with the involvement of female village volunteers. Village health volunteers work under the supervision of the health staff at the basic health units and district hospitals. WHO and UNFPA supported the training programme, while UNDP and UNICEF provided supplies and equipment for these activities. In BURMA, considerable progress was made in the development of primary health care. All of the 147 townships as planned were involved in the development of the I'HC programme at the end of the period 1977-82. Out of these 147 townships, 22 have been fully covered by community health workers, and 87 townships achieved 50 per cent coverage; in the remaining tor~nships coverage was less than 50 per cent. During the period 1982-86, PHC work will be extended further to cover another 82 townships. In fact, PHC activities had already begun in 40 townships in this second phase. A pilot study was initiated in respect of the townships with 100 per cent coverage by community health workers, with a view to introducing a new kind of manpower: the "ten-household health worker". One such worker is selected from every ten households in a village and given training in first aid, distribution of oral rehydration salts, health education, reporting of births and deaths, and outbreak of epidemics. These "ten-household health workers" are supervised by community health workers. The primary health care programme continued to receive support from IJ[10, UNICEF and US AZD, especially in training activities and the provision of medical kits for community health workers. A study on the utilization and impact of these kits in the PHC programme was initiated by the Tnstitute of Economics, University of Rangoon. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, a phased strategy for devrloping primary health care was being implemented as an integral part of socio-economic development, with the responsibility for coordination vested in the community leaders. Community participation is the important component and farmers' cooperatives assume responsibility for mobilizing local resources as well as for the planning, management and supervision of health facilities. The essence of the PRC activities is based on the "section doctor" system, which is functioning in both rural and urban areas. This system is manned by a multidisciplinary team of doctors consisting of a physician, a paediatrician, a gynaecologist or trained midwife, and a public health specialist. Each member of the team is responsible for a specific number of people in a defined geographical area, identified by the People's Committee. Health care therefore is not bound within hospitals in DPR Korea, where health services are provided at homes and places of work through routine and regular visits by qualified doctors attached to the nearest hospital or clinics at ri, county or district level. The section doctor system is also well supported by a chain of referral services. Urban health care is organized and delivered through a system of well-staffed and well-equipped polyclinics (along with the section-doctor system) which serve a population of 20 000-50 000. In INDIA, primary health care is based on the provision of a network of primary health centres. As a part of its 20-point Programme for total development, the Government pursues a long-term comprehensive health plan in multisectoral setting, drawing support from all relevant sectors. Although major investments are being made in the Sixth Plan on the rapid extension of the health infrastructure, there is a need to strengthen field supervision and guidance of manpower, and for an adequate drug supply and referral system. A National Coordination Committee for Health for All, under the chairmanship of the Prime Minister and with ministers of all relevant economic and social welfare ministries as its members, has been set up. In order to have a better supervision and referral system, upgrading of 25 per cent of the existing primary health care centres as first-level referral institutions continued, The existing community health volunteer scheme, now modified into a health guide scheme, will be fully financed by the Central Government in order to facilitate smooth implemen- tation of training activities. Already 182 077 health guides and 366 499 dais have been trained and deployed to deliver services in the rural areas. - Village health committees have been set up in every village to supervise and support the work of the health guides. Strengthening the capabilities in planning, implementing and monitoring for primary health care at the intermediate level received greater attention. WHO continued to support the training programme related to the strengthening of rural health services, workshops, seminars and evaluation studies. A national conference on urban slums, held in New Delhi, recommended that the health guides scheme and multipurpose health workers scheme be extended to the urban poor. Preparation of health information profiles in major cities was being initiated with WHO support. In INDONESIA, the primary health care programme covered every province. There were more than 1 800 medical doctors at the primary health centres in the villages. Village health development activities covered about 1 400 villages and were supported by the government budget while a substantial number of villages were developing PHC services utilizing community resources. The priority activities in primary health care included the strengthening of health centres and sub-centres, community participation in terms of voluntary activity and community funds, inter- sectoral collaboration for health development, and income generation. WHO supported a training course for trainers of PHC teams at the provincial level in Rali in October 1982. Another meeting of provincial health officers for primary health care was organized in Yogyakarta in April 1983. A national meeting on urban primary health care, with the participation of five cities, was convened during 1982. Following this meeting, local committees responsible for the development of their communities in various aspects, including health, were established. In collaboration with UNICEF income generation was promoted as one of the priorities, whereby small loans for health development activities relevant to the locality were approved by the committee. The committee also paid attention to the improve- ment of sanitary conditions, while the Government's health facilities in the area took care of the delivery of health services. Under the "little doctor" scheme, intelligent and active school children were selected on a voluntary basis and trained in basic health knowledge: they could thus be used as change agents for health, educating their friends, members of their families and their communities as a whole. In MALDIVES, primary health care activities were progressing steadily. With the addition of three new medical doctors, the services of Male Hospital improved considerably. The Government also inaugurated the first of four regional hospitals. Services from specialists under WHO consultancy support were made available to some remote atolls. The Allied Health Services Training Centre accelerated its training programmes in order to produce more community health workers, family health workers, nurse-aides and traditional birth attendants. The Government gave high priority to health, which was reflected in a higher budgetary allocation to the health sector to the extent of nine per cent of the total government budget . In MONGOLIA, the Ministry of Public Health, with the technical support of WHO, reformulated its strategies for Health for All by the Year 2000. The plan of action has also been prepared in conformity with the recently revised national HFA strategies. The development of strategies and the plan of action for HFA goals generated unprecedented enthusiasm for national health development. This contributed to the crystallization of policies and an increased awareness about the existing health status, and stimulated corrective action. An intersectoral task force was set up, with the Minister of Public Health as its chairman, and it identified contribu- tions that other sectors could make towards achieving the goal of HFAf2000. The Government stressed the importance of the cooperative programme in the development of the model for primary health care in Huvsgul Aimak. This model was under implementation at the beginning of January 1983 and will be used as a model primary health care system to be adopted in the other aimaks in the future. NEPAL continued its efforts for strengthening and expanding primary health care services, with 1JKO providing support through long-term staff, short-term consultants, fellowships and subsidies under the Integrated Community Health Services Development Project. During 1982, a national health workers' seminar was held with the assistance of WHO to identify and work out solutions to problems and constraints in implementing the project. The number of fully integrated districts under the project was still 6 but the number of partially integrated districts had gone up to 17. In addition to receiving the support of TWO, this project is assisted by UNDP, UNFPA, US AID, CIDA, the Netherlands and Japan. In another three districts, primary health care activities were implemented with the greater involvement of traditional practitioners, who had also received training in PHC under a UNDP-funded project. This project concentrated on four areas, viz., produc- tion of drugs, supply and logistics, promotion of traditional medicine, and training of community health leaders. Volunteers from each ward were selected by the ward committee and were trained in simple curative and preventive services by the health post in-charge using a training manual developed with WHO'S technical support. The Organization assisted the Government in conducting an HRGICRU review as a step towards mobilization of further external resources For PHC. Preparations were under way to hold a meeting of funding agencies towards the end of 1983. In order to maximize tye utilization of existing resources and stimulate community participation, the Government was exploring alternative approaches to primary health care. These will involve collaboration from voluntary social organizations and institutions such as panchayats and non-governmental health and non-health personnel, including ayurvedic practitioners. In SRI LA1K4, there is a strong commitment to the goal of Health for All by the Year 2000 using primary health care approaches. The National Health Development Council, under the chairmanship of the Prime Minister, provided clear policy guidelines for health development. The National Health Development Cowittee, along with its six standing committees on various conponents of health development, are responsible for planning, implementing and monitoring health development activities under the policy guidelines prov.ided by the Council. An in-depth analysis of the health care delivery system led to the identification of strengths and weaknesses and enabled the authorities to decide on corrective action wherever necessary. As a result, a programne cn "Improvements to the Health Care Delivery System" was formulated and approved by the National Health Development Committee. The programme aims at establishing a health infrastructure based on primary health care throughout the country. IJHO supported the Ministry of Health in organizing a seminar on primary health care for Yembers of Parliament in February 1983. The seminar provided an opportunity for exchanging views and experiences on the political processes and the action required to consolidate national efforts towards the goal of ~~Ai2000. The seminar uas also able convincingly to put forward the importance of the PllC approach for health development to the parliamentarians, who are responsible for resource allocation. As far as urban primary health care is concerned, the Colombo Municipality is actively involved in the delivery of health services to the people in the slums of the city. A case study on urban PHC in Colombo was presented in the regional meeting in New Delhi. As a follow up, another study on strengthening the structure and functioning of the municipal health department of Colombo was under way. In THAILAND, while refinement of the HFA strategy and plan of action was going on, the long-term policies for health and social development, including the objectives and indicators of basic minimum needs, were defined by the Health Planning Division in collaboration with the National Economic and Social Development Board. Priorities were set for 37 provinces under the National Impoverished Area Development Project. A middle-level PHC management training programme for district health personnel was under way. Primary health care activities have already been started in over 50 per cent of Thai villages and have been concentrated on the impoverished areas. About 35 200 village health communicators, 2 150 village health volunteers in rural areas, and 200 health volunteers for urban slum areas, were trained, bringing the total of village health communicators to 213 606 and village health volunteers to 21 507. An appropriate management mechanism was developed to launch the self-reliant "village health programme". This programme was based on the promotion of micro-development efforts in conjunction with the development efforts of major socio-economic sectors, with a view to maximizing the self-help and self-reliance efforts of the people. The first group of villages was selected and successfully developed; these became fully competent in handling self-managed and self-financed PHC schemes and could be used as models in the training and development of other villages. In the area of urban primary health care, the first group of health volunteers from Bangkok completed their training and were fully employed in providing primary health care in the underserved areas of the city. A seminar on urban primary health care development was organized in Udorn Thani Province. 1.3 Traditional Medicine As recommended by the International Conference on Primary Health Care in Alma-Ata, countries in the Region continued their efforts to utilize traditional medicine and its practitioners for primary health care. An inter-country workshop on the involvement of traditional practitioners in primary health care was conducted, with participants from seven countries of the Region. The recommendations of the workshop were being implemented. Another inter-regional workshop, on the utilization of traditional herbs and medicines for PHC, was organized in New Delhi in December 1982. This workshop recommended guidelines for preparing a list of essential traditional medicines for PHC. WHO also co-sponsored the first international conference on "Elements in Health and Diseases" during 6-10 February 1983 in New Delhi. This conference, which covered a number of aspects of the role of different elements in various systems of traditional medicine, was attended by more than 100 participants belonging to different disciplines from 21 countries. In regard to activities in individual countries, in BANGLADESH, consultancy services were provided by WHO to assess the availability of different medicinal herbs and traditional medicines as well as to determine the demand for traditional medicines in primary health care in order to suggest ways and means of producing adequate amounts of these medicines. Two projects were prepared, one on the development of the traditional system of medicine and the other on the homoeopathic system of medicine; both were awaiting UNDP support. In BHUTAN, the traditional system of medicine was being widely used for primary health care. The government dispensary-cum-pharmacy in Thimphu, which had been manufacturing traditional drugs manually, was equipped with modern machinery through UNDP assistance towards the end of 1982 and its building was expanded so that manufacturing, packing, storage, etc., could be undertaken in a systematic manner. With the technical support of WHO consultants, an analysis of the existing situation in the field of traditional medicines was completed and a list of traditional medicines was prepared for inclusion in the ayurvedic kits for primarj health care. WHO also provided consultants for advising the Government on drug manufacturing and for preparing curricula and training materials for the training course for traditional practitioners. A training textbook was prepared and printed. Supplies and equipment, including some raw materials not available in the country, were also provided. In BURMA, traditional medicine was being utilized to a certain extent in primary health care services in rural areas in order to lower the cost of drugs for primary health care as well as to promote self-reliance. A short-term consultant visited the country to survey the availability of medicinal herbs and plants, to assess their demand for primary health care and to suggest their cultivation and collection, as well as ways and means of improving the production of traditional medicines. Two UNDP-assisted projects related to traditional medicine - Development of Traditional Medicine Manpower (BUR PTR 005) and Standardization and Pharmacological and Toxicological Evaluation of Traditional Drugs and Herbal Medicine (BUR PHC 002) - have been prepared with technical inputs from WHO and are in the pipeline. In INDIA, where traditional medicine has deep roots and is culturally acceptable, many systems of traditional medicine are practised. The Government has prepared a list of essential drugs for primary health care, which consists of both the traditional and modern medicines. Practitioners of the traditional system of medicine have been appointed as the third member of the medical team at some primary health centres in order to supervise and guide the provision of traditional medicine. The two WHO Collaborating Centres for Research in Traditional Medicine - the University of Ayurveda at Jamnagar and the Department of Ayurveda, Banaras Hindu University - continued to receive support from WHO for research activities in traditional medicine. The Faculty of Indian Medicine of the Institute of Medical Sciences, Banaras Hindu University, organized a network of ayurvedic medical services for primary health care which consisted of an ayurvedic hospital, an ayurvedic health centre and a sub-centre. It also trained primary health care workers in the ayurvedic system of medicine. The Research Institute at Coimbatore finalized the research results on the treatment of rheumatoid arthritis by traditional medicine and the Indian Council of Medical Research was studying the report. The Government of MONGOLIA established an Institute of Folk Medicine under the Ministry of Public Health for the development of research in various aspects of traditional medicine. A WHO consultant visited this institute and recommended a number of steps for the further development of folk medicine. The Government also included a new project on traditional medicine for WHO support in the ensuing biennium and identified priority activities which, inter alia, included the training of Mongolian nationals in Ayurveda, collection and translation of ancient manuscripts on folk medicine, application of scientific techniques in drug preparation and testing, and the establishment of linkages with some institutes of traditional medicine in India. In NEPAL, 15 ayurvedic preparations were included in the essential drugs list for primary health care and were being produced by Singha Durbar Vaidya Khana. Village health workers were provided with ayurvedic kits containing these medicines. Singha Durbar Vaidya Khana was modernized and reorganized along commercial lines for undertaking large-scale production. A WHO consultant assisted in the development of a syllabus for training and collaborated in the training of the first group of 57 ayurvedic physicians (out of a total of 191). The remaining physicians were trained by national specialists. These trained ayurvedic physicians have been assigned to three pilot districts to intensify activities on the utilization of traditional medicines for primary health care. Fellowships have been awarded to three ayurvedic physicians for further training in India. A study tour was also arranged for two top officials responsible for the subject of traditional medicine. In SRI LANKA, a WHO consultant collaborated with the Government in reviewing the existing situation regarding traditional medicine, in devising ways and means to improve the methods and materials for teaching traditional medicine and in suggesting possible actions for involving the practitioners of ayurvedic medicine in PHC. Another consultant reviewed the situation regarding homoeopathy and advised on the strengthening of this system and its utilization for primary health care. With WHO support, a national expert conducted a survey of traditional herbs and plants with the specific purpose of identification, cultivation and preservation of traditional medicinal plants, and prepared guidelines for the establishment of a herbarium. THAILAND has been showing increasing interest in the use of traditional medicine in primary health care. The new Institute of Ayurvedic Medicine started with the first group of students at the college level. The award of WHO fellowships to strengthen the capability of the teachers of this institute was being processed. The Department of Medical Sciences has taken the initiative to promote the cultivation of medicinal herbs and plants in several provinces. WHO awarded a fellowship for training in acupuncture. 1.4 Family Health Maternal and child health, including family planning, is a priority programe in all the Member Countries. These activities are being supported by WHO in collaboration with UNFPA and UNICEF. The major thrust of WHO'S regional programme in this area was directed towards strengthening the managerial capabilities at different levels of the national health organization and developing appropriate and adequate manpower dealing with maternal and child health in the context of primary health care, including the reorientation of basic, post-basic and continuing education. Family planning programmes continued to receive support as an integral part of maternal and child health services in most countries. The main back-up support to national family planning programmes was in the fields of needs assessment, planning, monitoring and evaluation. In pursuance of the Regional Committee resolution on Infant and Young Child Feeding, SEA/RC34/R8, endorsing the regional plan of action, WHO provided technical support to several countries in implementing the plan. With the objective of strengthening the information base related to breastfeeding and weaning foods, the regional programme supported the preparation of annotated bibliographies on breastfeeding and weaning practices in several countries of the Region. The regional MCH programme supported a number of seminars, workshops and discussion groups organized by non-governmental organizations, professional associations and consumer protection groups at both national and international level. These were related to the promotion of breast- feeding, strengthening of public information, communication and education on infant and young child nutrition, development of improved health and social status of women in relation to infant and young child health and feeding, and promotion of appropriate and timely complementary feeding practices, making use of local food resources. The multidisciplinary Regional Advisory Team on MCH/FP with expertise in obstetrics and gynaecology, maternal and child health and paediatrics, health education and statistics continued to support most Member States in project formulation, implementation, monitoring and evaluation in the field of family health. Activities in individual countries were as follows: In BANGLADESH, the Government gave top priority to population control. The recent trend of laying more emphasis on the mother and child has brought about the full integration of the population control programme with the health activities at the thana level. The medical officer in charge of the thana health complex has been redesignated as thana health and family planning officer, with control of the personnel of both the Health and Population Control Divisions. The SIDA-funded "Sterilization Surveillance Team" has become fully operational, with four national staff and three expatriate consultants posted in the four divisions of the country. The fourth expatriate consul- tant was expected to join the team soon. A Joint SIDAIWHO Evaluation Mission reviewed the project and commended the progress made. A baseline survey of 240 selected health complexes started on schedule and was progressing as planned. The survey results were expected to be available during the pro- posed Joint SIDA/WHO/World Bank Evaluation Mission from 20 to 29 September 1983. Bearing in mind the interest of the Government in promoting maternal and child health services, this baseline survey included a questionnaire on MCH facilities as well. Furthermore, in order to ascertain the voluntary nature of acceptance of sterilization as the well-informed person's choice for family planning and to attain high client satisfaction with the quality of services including follow-up, a client satisfaction survey is being planned, for which the protocol has already been developed through the joint effort of national and WHO staff. In BHUTAN, the UNFPA-funded project on the development and strengthening of MCH/FP services supported the development of physical facilities for the Family Welfare Training Complex at Geylegphug, four basic health units at Tala, ~iajam, Bhangtar and Changikha, and two MCH clinics at Phuntsholing and Geylegphug. A member of the Regional Advisory Team on MCH/FP assisted the Government in improving the health information system in MCH/FP and in conducting the feasibility study on an infant and maternal mortality and morbidity survey in Geylegphug district. A WHO consultant was assigned to train nine medical officers to perform mini-laparotomy and vasectomy operations and to assist in the organization of voluntary sterilization camps in the southern part of Bhutan. The training programme for various categories of health workers is carried out in the Family Welfare Centre at Geylegphug. Two groups of malaria workers received reorientation in January 1983 and a workshop for zonal medical officers and health supervisors of the MCH/FP programme was organized. In order to mobilize more health manpower at the grassroofs level, and to encourage community participation in primary health care, village volunteers selected by the community in groups were given three weeks' training at the Model MCH/FP Basic Health Unit set up in Surey. In BURMA, emphasis was given to the training of traditional birth attendants (lethes) since their specific role as primary health care workers has been recognized. The task-oriented training programme for lethes now includes the identification of high-risk cases. During the period under review, WHO'S programme was revised to enhance not only the training of lethes but also that of their trainers and to prepare a'nd print manuals for their field work. The study on the risk approach in MCH care, and an -- ad hoc survey on infant and young child mortality and morbidity, continued according to schedule. Maternal mortality has also been included under the ad hoc survey since this year. In INDIA, technical support was provided, under the UNFPA-funded laparoscopy sterilization programme, in the review of guidelines for laparoscopic sterilization. Action was also initiated for providing techni- cal backstopping to "area projects!.' funded by UNFPA, for the integrated development of maternal and child health and family planning. A member of the Regional Advisory Team on MCHIFP, together with UNFPA and national officials, participated in the review of the service delivery component and the work of ANM training centres under the family welfare area project in Rajasthan. The joint WHO/UNICEF-supported programme on the teaching of maternal and child health for medical undergraduates and interns was evaluated by a WHO consultant. Based on his findings, steps were initiated for further improving this teaching programme. A low-cost edition of the Handbook for the delivery of care to mothers and children in a community development block was published in response to increasing popular demand. The pre-testing of the Handbook for the care of children, birth to puberty, is continuing. Providing basic services where they are needed most is the MATER essence of the primary health AND Ct care approach. Most countries , in the Region are strengthening HEALTt their PHC services. especially in the rura, areas. Picture shows I PHC worker visiting a home. 1 PHC workers may refer mothers to seek medical advice in rural for themselves and Midwives and auxiliary nurse midwives w0r.k in the field and their training (as shown here in a rural setting) is an important comiJonenf of PHC work. -* Fa- NUTRITION AND HEALTH EDUCATION Health educa!ion, including the nutritional education of mothers, is an important activity in the Region. To prodide effective med~cal czre. the emoh~sts now ,n med,c~l education rs to make the tra,nma more relevant to the needs of thi community. Nutrition is one of the eight identified elements of PHC. Some of our Member Slates are taking *4@ steps to ensure that a supply of ., ., nutritious foods 1;ke milk IS avadahle to their people. Technical support was given to district-level workshops on neonatal care for paediatricians and obstetricians with a view to strengthening the neonatal services and training at peripheral level. In INDONESIA, programme activities relating to maternal and child health, family planning, community health nursing and nutrition were supported so as to achieve the national objectives set under Pelita 111, which aimed at reducing maternal, infant and young child morbidity and mortality. With a view to improving the managerial capabilities in maternal and child health and family planning at central and provincial level, regional study tours by appropriate national personnel were assisted. The school health programme was assisted through training programmes within the Region aimed at upgrading the managerial and technical skills of school health personnel, especially at provincial level. A WHO consultant reviewed and analysed the maternal and child health programme activities, which contributed towards the development of the MCH programme for the Pelita IV period. The Ministry of Health formulated a Ministerial Decree on the marketing of breast-milk substitutes. To facilitate this, WHO provided information on national codes of marketing of breast milk substitutes from several countries of the Region. Action was initiated for providing support to a national workshop to draw up a plan of action for infant and young child nutrition. WHO supported the preparation of an annotated bibliography on studies on breastfeeding and complementary feeding practices which helped in developing the much-needed information base on the subject. A national workshop on the risk approach in maternal and child care was organized with WHO'S technical and financial assistance. The main objective of this workshop was to create an awareness of the concept and principles of the risk approach in MCH care and ascertain as to what extent the strategy could be applied with the available data collected through the integrated health information system. WHO supported the participation of senior paediatricians in the ASEAN Conference on Perinatology with a view to further strengthening the perinatal and neonatal services at the community level. In MALDIVES, the family health programme continued to receive WHO assistance, especially in the area of family health education. The health education specialist of the Regional Advisory Team on MCH/FP reviewed the programme and recommended specific actions to improve the family health education programme. It was planned to start a study on maternal and infant mortality and morbidity in the northern and southern regions of the country in order to identify areas needing special attention and to develop strategies for the improvement of family health activities. Operational research was also being planned for 1984 in order to assess community participation in the delivery of family health services. In MONGOLIA, WHO-assisted programme activities in maternal and child health were closely coordinated with those supported by UNICEF and UNFPA. The assignment of a national project manager has greatly facilitated the coordinating function, and also in monitoring and evaluating the activities. Based on data from research studies, the project "Epidemiological Studies of Population Growth" was reformulated, with a view to expanding the M2H services according to the model established in six aimaks on an experimental scale. National efforts to improve the quality of MCH services further were supported through the development of health manpower in specialized fields of paediatrics and obstetrics, such as intensive care, perinatology and acute respiratory infections, and in the planning and management of MCH services. This support was provided through training fellowships and national training workshops and seminars, and the supply of equipment to maternity homes and obstetric units. Technical support was provided for the further development and improvement of MCH services in the fields of paediatric nutrition, epidemiological statistics and perinatology and also for health education for mothers and school-children. In NEPAL, maternal and child health activities in both integrated and non-integrated districts received WHO support. These activities were coordinated with those in family planning supported by UNFPA and US AID. Technical advice was given in formulating new projects for UNFPA funding. WHO programme activities were mainly directed towards increasing trained manpower at the peripheral level through fellowships and the organization of national training courses for various categories of health workers. Regional conferences for family planning officers, which dealt with both technical and administrative matters, were supported. The Organization ~rovided technical support for drawing up a study protocol for obtaining epidemiological data on maternal mortality and morbidity. The study was to involve a central maternity hospital, provincial hospitals and the community. In SRI LANKA, the family health projects funded by UNFPA supported the various training programmes in maternal and child health and family planning for peripheral-level instructors and supervisors and also for matrons, nursing sisters, and tutors in nursing schools. Both registered medical practitioners (RMP) and assistant medical practitioners (AMP) were trained in the insertion of IUCD. In addition, ayurvedic practitioners were trained to motivate and deliver family planning services, especially as regards the provision of oral pills. Workshops were held for storekeepers to improve logistics and supply management. The laparoscopic sterilization programme was started at the clinic of the Family Health Bureau in November 1982, following the training programme organized by Johns Hopkins University. Up to the time of report- ing, 268 laparoscopies had been performed. The evaluation unit in the Family Health Bureau has been strengthened with support from the project "Streng- thening of Research and Evaluation Unit of the Family Health Bureau". The Family Health Impact Survey was completed and the data were being analysed. In THAILAND, UNFPA-funded family health projects provided technical support to the National Family Planning Programme with a view to maintaining high coverage and quality of MCH and family planning services. Provision was also made for fellowships to train health personnel in family planning and related fields in order to improve programme development and management. In order to enable the community to identify the health status of the target group (mothers and children) simplified MCH indicators are being identified from 12 selected tambons (districts). The research efforts in the field of MCH in this region are based on the guidelines provided by the South-East Asia Advisory Committee on Medical Research, as well as by the Regional Cormnittee and the World Health Assembly. In order to find ways and means to ensure that minimal health care reached at least the high-risk and underprivileged groups of mothers and children and their families, the regional programme supported studies on the risk approach to MCH care (see section 1.1.3). These studies were conducted in Burma, India and Thailand. Action was initiated for the preparation of a study proposal on the risk approach to MCH care in Sri Lanka, and the collaborative study on the outcome of pregnancy (including perinatal mortality and low birth weight), which had started earlier, was progressing as planned. Birth weight has been selected as an indicator for monitoring progress towards Health For All by the Year 2000 since it reflects the mother's reproductive capability and predicts the chances of the infant's survival and subsequent growth and development. Countries therefore were attempting to collect data on perinatal, neonatal, infant and early childhood mortality and morbidity. The regional programme supported these national efforts through collaborative research studies and surveys. A regional profile on perinatal mortality and morbidity was under preparation, based on data from studies on this subject. Countries in the Region recognize that adolescents also form a risk group for health and social problems. Accordingly, the regional programme has been assisting Bangladesh and Sri Lanka in undertaking studies related to the reproductive health of adolescents. One of the main causes of maternal deaths in this region is the group of hypertensive disorders of pregnancy and child birth. WHO therefore supported collaborative research in Burma, Sri Lanka and Thailand to develop intervention techniques for the prevention and management of these disorders within the framework of primary health care. A survey of infant and young child mortality and morbidity was supported by WHO in Burma, and a feasibility study for undertaking a similar survey was conducted in a southern district of Bhutan. The possibility of carrying out a feasibility study on one or two islands of Maldives was also being explored. In order to realize the objective of community participation and self-care in MCH, India and Sri Lanka were receiving support in testing the methodology for community diagnosis and participation in a control trial. 1.5 Nursing In developing nursing programmes at the country level, closer collaboration between education and service is essential to bring about changes for increasing the contribution of nursing to the delivery of health services. Governments in the Region have therefore developed strategies for HFA that utilize nurses in diverse roles and functions. Some countries are using nurses as teachers and supervisors of PHC workers. A few countries are making use of nurses for the delivery of direct care to the community while some others primarily for institutional services. In those countries where there is a scarcity of nurses, they are working as both PHC practitioners as well as teachers and supervisors. To meet the needs of the countries, the education of nurses must be reoriented towards the community and nursing systems restructured to serve the objectives of PHC. In BANGLADESH, the main emphasis is on the development of continuing education programmes for nursing staff, following the creation of a Continuing Education Unit under the Nursing Division in 1981, with one part- time staff. Efforts have been made to strengthen the national capability in planning, developing, organizing and implementing continuing education programmes, and the impact of these activities is now felt. Two full-time well-trained national staff have been appointed to extend the programme further to meet the identified needs. WHO provided technical support in these efforts. Academic time schedules and rotation plans for clinical experience for all levels of students were developed under the guidance of a WHO nurse at the College of Nursing. The results of one year's field testing indicated that public health nursing students had improved their skills, ranging from 29 per cent to 65 per cent. Technical assistance was given to BHUTAN in the pre-planning phase of developing a basic nursing programme. Appropriate lists of text-books and references, minimal teaching equipment and office supplies were prepared, and these were under procurement, partly with WHO assistance. In BURMA, the Nurses' Association, in collaboration with the Nursing Division, is playing a leading role in developing continuing education programmes by organizing a series of national workshops, conferences and seminars. In INDIA, WHO collaborated in the development of a centre to train nurses in oncology at Safdarjung Hospital, New Lklhi. A WHO short-term consultant carried out a situational analysis as a basis for identifying the required content of the training programme. Patient care standards were formulated and the nursing service in the cancer units reorganized in order to maintain the prescribed standards. The revised curriculum for multi- purpose workers was completed and was being implemented. Training materials and visual aids were developed and supplied to the training centres. A national nursing workshop held in INDONESIA in January 1983 defined the role, functions and jobs of nurses in the context of the Indonesian situation and proposed patterns of nursing education suited to the country's needs. The workshop also recommended that a national commissionlcommittee on nursing should be created to assume responsibility for developing nursing in the country. Another workshop on the proposed revised pattern of the educational programme was held in February and formulated the educational requirements for entry into nursing courses. Continued support to the community health nursing specialization at the Faculty of Public Health was ~rovided by WHO. Several short courses and workshops were conducted in community health nursing and clinical nursing. The Working Group on Accreditation of Health Nurses (SPKs) continued its work of formulating criteria and standards for accreditation. In MONGOLIA, the Medical Technicum Institute took a further step in following up the implementation of the recommendations nade by the WHO nursing consultant assigned in 1981 in connection with the implementation of the revised curriculum and assessment of field practice. NEPAL made much progress in the training of post-basic nursing students. A complete revision of the course content for "Adult Nursing" was presented to the Faculty Board for its consideration. A long-term plan for the development of nursing services has been formulated. Close collaboration between nursing service and education was established in order to strengthen both areas. Several group educational activities were organized focusing on the role of nurses in primary health care. In SRI LANKA, curricula of basic nursing training programmes were revised, including the functions of nurses in primary health care. The tutor:pupil ratio improved in basic as well as post-basic faculties. Re-training courses for midwives already in service were organized in order to orient them with PHC concepts and their expanded roles; 594 midwives received training. In THAILAND, a new nursing faculty was established at Srinakarinwirot University, and the first group of students were admitted to this basic Baccalaureate Degree programme in June 1983. Further technical support will be provided by WHO in the preparation of the faculty members. 1.6 Health Education The major objective of the health education programme in the Region is to establish a partnership between health services on the one hand and the individual, the family and the community on the other, in the develop- ment and maintenance of the health of all people. The activities in the countries during the year reflected this objective. Involvement, in its broader context, requires health workers to employ educational approaches that would, in addition to informing and motivating the people, enable them to take appropriate actions as well as generate self-help and self-reliance. This calls for educational dexterity which is not normally held by personnel, especially at field level. All the Member States of the Region, therefore, paid particular attention to the training of health personnel in health education for individual, family and community involvement. Another major preoccupation throughout the Region was the preparation of appropriate learning aids. In addition, efforts were made to identify the proper role of public information and existing mass communication and traditional media in educational programmes and to integrate them as essential components of the overall educational activities, as required. The Member States, as a whole, recognize that current patterns of individual, family and community behaviour are fundamental to the organization, implementation and evaluation of educational activities. An effort was, therefore, made to utilize available data about such behaviour, to undertake research only where necessary, to train health workers in research methodology and to disseminate research information among the health professionals concerned. WHO provided technical support to health education units at national, state and local levels of the health organiza- tions in the Member States in these and other health education and community participation activities. Regarding inter-country activities, the Regional Of £ice, in collabo- ration with the Member States, organized (i) an Inter-country Consultation on Community Participation in Primary Health Care at Korat, Thailand, (ii) an Inter-country Consultative Meeting on Health Education in Family Health in the Regional Office, and (iii) a Meeting of the Scientific Working Group on Health Rehaviour Research in the Regional Office. These activities provided the opportunity for senior administrators and health education specialists not only to exchange views and experiences but also to examine the situations in their own countries in the light of the experiences of the entire group and to identify measures that needed to be taken to solve the problems. In BANGLADESH, during the year under review, the activities of all the seven units of the Health Education Bureau in Dhaka, i.e., training, educational support service, primary health care (national health programme), school health education, hospital health education, field practice and demonstration, and research and evaluation, continued to make progress in their respective spheres. The School Health Education Unit, in particular, collaborated with the Ministry of Education and helped the latter to assume greater responsibilty for health education. The health education specialists assigned to the divisions, districts and sub-divisions supported health education activities carried out by health personnel in communities. The World Bank has been assisting the Government in strengthen- ing health education services since 1980, and has been providing funds to support the position of the WHO health education specialist in Bangladesh. In BHUTAN, a WHO consultant was assigned in 1982 to identify learning resource materials, both for community education and staff training, and to develop some of them together with the staff of the Family Welfare Training Complex. Another WHO consultant was assigned to Bhutan in 1982 to collaborate with the Ministry of Education in the field of school health education. He reviewed the present health curricula of primary and secondary schools and of teacher training institutions, and prepared textbooks on Health for Growth for Classes IV and V, and a Manual for Teachers. The same consultant was being recruited again to assist the Government fzther in school health education and teachers' training. Four short-term consultants were assigned to BURMA during the year. One of them helped to review health education in primary and secondary schools and teachers' colleges and to develop further plans to strengthen health education as an integral part of the national education system. She also helped organize a national workshop on school health education for teachers. A second consultant assisted the Central Health Education Bureau in planning and conducting a three-month course in health education for assistant health education officers. A third consultant collaborated in the planning and conduct of a course in health education for basic health workers. Since the Government proposes to expand and extend its current health education services, a fourth consultant was assigned to assist in preparing a project document for a new UNDP-funded health education project. This project is expected to come into operation in 1984. In INDIA, at the request of the Government, a subsidy was provided for an intensive pilot project on school health services. In addition, WHO gave financial assistance for a state-level workshop on the development of need-based health education. Fellowships for national health and health education officials were awarded. A short-term consultant was assigned in 1982 to assist the Regional Office in health behaviour and health education studies connected with water supply and sanitation projects, especially in the states of Rihar, Rajasthan and Uttar Pradesh. To support education activities, the State Health Education Unit in Bihar was being re-established. In INDONESIA, the Organization assigned three short-term consultants to assist in health behaviour studies and health education in water supply and sanitation projects in three provinces. Each of them surveyed the social, psychological and cultural determinants of individual, group and community behaviour required for the development of health education support programmes in water supply and sanitation and, in addition, developed and conducted a training programme for the health staff and for community leaders. They also developed educational resource materials and a health education plan in support of the rural water supply and sanitation programmes. The WHO health education specialist in Irian Jaya completed his four-year assignment in July 1982. During the period of his assignment, he assisted in the development of a health education unit at the provincial level and similar but smaller units in nine districts. Senior staff for the provincial health education unit were trained abroad, while the others were trained in the country itself. Equipment and supplies and transport were provided. Thus, the project was successful in laying down a stable founda- tion of a health education service in Irian Jaya. In addition, a WHO consultant was assigned to examine the socio- cultural and psychological barriers to the acceptance and adoption of health innovations in the predominantly traditional communities of Irian Jaya. He assisted in conducting a seminar on health, culture and community, which was attended by senior officials both from the Province and from the central Ministry of Health. Another WHO consultant was assigned to review the potential of the community and private organizations to participate further in health development and to suggest approaches or models that would enable the health services to involve the community and private organizations more actively. Fellowships have been provided for the training of national health officials in health education. In MALDIVES, UNICEF and WHO staff assisted the Government in preparing a public information and education-for-health programme. A plan of work was developed. While UNICEF was involved in the development of communication activities, WHO was concerned with school health education, training of health workers for health education, preparation of learning- resource material, and extension of health education to the islands. A WHO consultant was assigned co MONGOLIA to provide further support in school health education, a project for whicb a long-tenn health education specialist had been appointed in the previous year. This consultant also collaborated with the national Health Education House in extending its services in support of primary health care. In NEPAL, WHO continued to provide technical support to the llealth Education Section. The Work Plan which had been developed in collaboration with WHO, UNFPA and UNICEF was being implemented; so was the Sanitation Promotion Programme, developed in collaboration with UNICEF. The routine health education activities were also being carried out as planned. Training programmes in health education for various categories of health personnel, and for personnel of the Ministry of Education, were organized. A National Workshop on Health Behaviour Research on Health Problems was held in January 1983. WHO provided funds, equipment and supplies for these activities, and awarded fellowships for the training of health education specialists and media personnel. In SRI LANKA, the Organization collaborated in the further develop- ment of health education by providing supplies and subsidies for group educational activities. An M.Sc. course in health education is being started at the Post-Gradaate Institute of Medicine. A WHO consultant was recruited to assist in the preparations for this course. In addition, a WHO headquarters consultant prepared a protocol for a study of the patterns of visits by family welfare workers to homes and communities, the educational activities undertaken on such visits and the effectiveness of these activities. In THAILAND, regional health education offices, staffed by qualified health education specialists, were established in four of the regions, and in the absence of health education units in the provinces, the current information and training units were being utilized as focal points for health education. As well as collaborating in these activities, the Organization provided subsidies for group educational activities, equipment and supplies, and fellowships for training health education personnel. These and other inputs have helped the Government to extend, expand and sustain health education and thus community involvement in primary health care programmes. 1.7 Nutrition Nutrition is an area of the highest priority in the South-East Asia Region. This is justifiably so since this region has by far the world's highest incidence of protein-energy malnutrition, goitre, cretinism, anaemia, and vitamin A deficiency blindness. Approximately 30 per cent of the ~egion's 35 million annual births belong to the category of low birth weight, at least 60 per cent of pre-school children are malnourished, and some 60 per cent of this region's 300 million women are anaemic. It is realized that a concerted effort is required by the Member Countries, WHO and other agencies if the basic minimum nutritional goals of HFA 2000 - i.e., at least 90 per cent of birthweights above 2500 G., and at least 90 per cent of children having their weight for age above the malnutrition cut-off point - are to be achieved in this region. Under the regional nutrition programme an effort was made within the limited resources to accept the enormous challenge of malnutrition that exists in South-East Asia. TJHO and UNICEF are assisting two countries, Burma and Nepal, in developing nutrition projects through the Joint WHO/UNICEF Nutrition Support Programme. These aim at ensuring maximum impact on malnutrition and mortality on a national scale over the next five years. The regional programme against goitre is being stepped up, with each affected country mapping its goitrous populations and drawing up fresh plans of action for ensuring the effectiveness of both long-term (iodized salt) and short-term (iodized oil) control activities. The establishment and development of national nutrition units in most countries has been a key feature of the WHO regional programme in this . . area. Such units are ncv function:?; in eight countries 2nd were actively supported in identifying population groups and prevalence rates of mal- nutrition, determining underlying causes, establishing priority intervention programmes, formulating effective national food and nutrition strategies, developing a 'critical mass' of trained manpower, and in monitoring the progress of the programme. In addition, WHO has been collaborating with most countries in developing nutrition surveillance systems for the timely warning of impending food and nutritional crises, ensuring health/nutrition- oriented development programmes, and in assessing the impact of such programmes on human well-being. In BANGLADESH, the collection and analysis of data examining the effectiveness and extent of nutritional inputs through primary health care was in the final stages. In addition, the mapping of goitre/cretinism, largely to be found in the north and in the eastern peripheral hill-tracts, was almost complete. Both these activities were being conducted by the Institute of Public Health Nutrition with the assistance of a staff member from the Regional Office. A research project was also set up in order to measure low birth weights in both urban and rural babies and correlate them with 55 variables relating largely to the nutritional status and health of nothers. In BHUTAN, nutrition policy and planning aims at establishing nutrition-through-primary health care on a firm footing. A WHO consultant assisted the Government in its plans for establishing a nutrition cell within the Ministry of Health but with relevant intersectoral linkages. As a result, a project was drawn up, to be funded by UNDP, for the development, staffing and initial functioning of the nutrition cell. Nutrition activities will be focused on documenting the magnitude of the problem, identifying populations most at risk, establishing effective national nutrition strategies, and evaluating their impact. Tackling the country's goitre problem would also be an important activity. Preparations were under way for a joint WHO/UNICEF-funded survey of goitrelcretinism throughout Bhutan. Following the assignment of a UNICEF consultant to advise the Government on the iodization of salt and its distribution, an iodization plant was under construction at Phuntsholing. The iodized oil injection programme, aimed at small selected population groups, continued. In BURMA, the year saw the completion of a research project, under which the prevalence of malnutrition and an assessment of infant feeding practices were analysed in 12 sampling sites throughout the country; an assessment was also made of nutrition training and inputs delivered through the primary heaIth care system. Based on these findings, the project protocol for the Joint WHO/UNICEF Nutrition Support Programe was drawn up which will be funded by the Government of Italy. This project will under- take intensive coverge of 147 townships with a wide range of effective nutrition-through-primary health care inputs. Emphasis on nutrition training characterized the nutrition programme in Burma, with traininglorientation courses having been held for assistant midwives, midwives, lady health visitors of the 42 townships covered under the first year of the Second People's Health Plan, as well as sister tutors and staff nurses of the training teams. At central level, training included medical students, post-graduates and school teachers. An intersectoral national seminar was held on national approaches to nutrition in primary health care. In INDIA, WHO continued its support to the National Institute of Nutrition in Hyderabad, which continued to play the role of an important traininglresearch institution in nutrition in the Region. The Organization provided two guest lecturers for the trainees of both the three-month certificate course and the one-year M.Sc. course. In addition, a plan of action was drawn up for undertaking a careful analysis of course content and teaching methodology to ensure that training and research were of maximum effectiveness and relevance to the nutritional problems of India in particular and the Region in general. Both WHO and UNICEF are jointly supporting the efforts to intensify goitrelcretinism control in India. This support included the establishment of a tripartite (Government of India, WHO, UNICEF) goitre control working group, participation in the preparation of a video film, and support to the All India Institute of Medical Sciences in its detailed survey of goitre and infantile hypothyroidism in the country. INDONESIA developed a very progressive nutrition programme largely operative through the Directorate of Nutrition and the Centre for Research and Development in Nutrition (CRDN), with support for nutrition manpower training and research from both the University of Indonesia and the Academia of Nutrition. WtiO zssistance is a part of the large total support available for nutrition programmes, coming from the World Bank. US AID, UNICEF and UNFPA. An evaluation of CRDN was undertaken, resulting in recommendations concerning staff training, management capabi.lities, teaching role, and the development of CRDN's nutritional surveillance capability. The applied nutrition programme, based on the UPGK model (family nutrition intervention programme), continued to expand and now covers about 20 000 villages, accounting for approximately one third of Indonesia's children under five years of age. In MALDIVES, the third round of the longitudical pilot study measuring prevalence rates of malnutrition on Seenu atoll was completed. It was planned that, based on the analysis of the data, a further survey representative of the country as a whole would be undertaken, and a longi- tudinal surveillance capability established. This would be important for monitoring progress towards the achievement of the national rarget of reducing the prevalence of malrlutrition in 0-5-year-old children from 67 per cent to 30 per cent by 1990. In MONGOLIA, a WHO consultant assisted the Government in formulating the Perspective State Programme in the area of infant and young child nutri- tion. He also helped with several training programmes for paediatricians, neonatologists and middle-level rural health staff. Nutrition activities in NEPAL received a substantial boost through the 3oint WHO/UNICEF Nutrition Support Programme. A ~roject proposal, for funding by the Italian Government, was drawn up for the intensive coverage of the population in five districts (over one million people! with conver- gent inputs of nutrition through primary health care, including non-health sector activities at community level. Training courses in nutrition for health post staff were held in each of Nepal's six fully integrated districts as a part of the plan to introduce child weighing at all health posts. The research project to assess the prevailing nutrition situation and the effectiveness of nutrition services delivered through primary health care was completed. The first phase of another research project defining possible indicators for use in a national nutrition surveillance system was also completed. The project for iodized oil injection continued, extending the coverage to 11 districts and giving injections to a total of 530 198 people. Currently the programme is being implemented in the mountain/ mid-hill districts of Gorkha, Lamjung, Manang and Mustang, with support from both WHO and UNICEF. Discussions took place on the forn~ation of a goitre/cretinism control working group to ensure optimal coordination and effective coverage of both iodized salt and iodized oil programmes. In SRI LANKA, a study of practical problems in promoting the acceptability of low-cost weaning foods in poor rural communities was completed by the Food and Nutrition Policy Planning Division. The Division also completed a largescale nutrition survey involving 24 districts to investigate the determinants of nutritional status, review the findings in the light of current policies and performance, and make recommendations on future strategy. In THAILAND, the National Workshop on Nutrition in Primary Health Care was conducted in both Bangkok, where the national food and nutrition policy was analysed for further improvement, as well as in Cholburi Province, where the underlying causes of malnutrition and the effectiveness of current community-level nutrition activities were critically reviewed. As a result of this workshop it was planned to implement, on a trial basis, a new integrated training programme on food and nutrition for villagers in 12 districts with UNICEF support. The WHO-supported research project on testing the effectiveness of iron-fortified fish sauce in combating anaemia entered its final stage. Preliminary results showed a reduction of the prevalence of anaemia in the target population. The main thrust of the regional research programme in nutrition largely centred round the priorities identified by a Scientific working Group in Nutrition. The two projects selected by the majority of the countries included: (1) Situation analysis of the current status with regard to the content and implementation of the nutrition component of PHC. (2) Development and evaluation of simple procedures for food and nutrition surveillance for the identification of mothers and children at risk and for the monitoring and evaluation of nutrition programmes at the community level using auxiliary paramedical personnel and other health volunteers. Other, less commonly selected research projects included the develop- ment of lorcost weaning foods, development of more effective nutrition education, and the identification of the underlying causes of malnutrition in deprived population groups. Although many of these nutrition research projects were still under way, they generated activities aimed at making nutrition inputs through PHC more effective. This was particularly the case with Project 1, from which both interim and final results led to improved nutrition training, further research studies, and new national projects on effective nutrition interventions through PHC. The refinement of indicators for the establishment of a nutrition surveillance capability was proved to be effective in pilot studies in some countries for both early warning of nutritional crises and the monitoring of development projects. 1.8 Medical Care - As part of their efforts to attain HFA/2000 goals, countries of the Region have been paying due attention to the strengthening of medical care facilities - one of the important elements of a comprehensive health system. In BHUTAN, general and specialized medical and health care, parti- cularly for the rural sector, was further strengthened. The number of basic health units (BHUs) has gone up from forty-six to fifty and all of them are functioning as the base of health care delivery at the peripheral level. In three hospitals at Thimphu, Geylegphug and Tashigang, which are to function as referral hospitals, the diagnostic and treatment facilities were streng- thened with equipment and supplies provided by WHO. Three fellowships were awarded for post-graduate training in ophthalmology, obstetrics and gynae- cology, and paediatrics, which would pave the way for further strengthening of the referral system. A Central Quality Control Laboratory for drinking water supply was established at the Pathology Department of Thimphu Hospital, as part of the public health laboratory service system. In BURMA, a large part of the regular budget of the Ministry of Health was earmarked for medical care in order to accelerate medical referral support to township hospitals as an integral part of the People's Health Programme on PHC. The 200-bed hospital in Rangoon is also nearing completion with a grant from the Government of Japan. In January 1983, the Asian Development Bank signed an agreement to provide a US $70 million loan for the construction of a hospital in Rangoon to replace the old Rangoon General Hospital. A WHO consultant provided technical support to two works- hops on hospital administration which were held in October and November 1982 in Mandalay and Rangoon respectively. Operational manuals for hospitals were revised and arrangements for conducting refresher training programmes in hospital and nursing administration completed. Formats for preparing hospital profiles and for hospital inspection were also developed. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, consultancy services were provided for technical collaboration in orthopaedics, micro-surgery, anaesthesia and neurology. Consultants were also assigned for demonstrating techniques in lymphangiography, arteriography and pulmonary radiology. Fellowships were awarded in the field of medical care and some supplies and equipment were provided for training and research. In MALDIVES, WHO and UNICEF collaborated with the Government for the further improvement of the medical care services delivered at the health centres on various islands. One national official completed post-graduate studies in gynaecology and joined the Government Hospital in Male, which is at the apex of the referral system. In addition, two others graduated in medicine under WHO~UNDP fellowships and joined the same hospital. The services of one surgeon and one anaesthetist were made available on a bilateral basis. The health centres in the atolls continued to provide essential curative facilities. Surgical specialists for conducting operations as well as to provide consultancy services in various other disciplines were assigned by WHO as requested by the Government. The first of four regional hospitals (three with UNICEF assistance and one with WHO support) has been functioning since last year and work on the second was started during the period under review. The atoll health centres need additional manpower to cope with the work as each centre has to cater to many islands distributed all over an atoll. Lack of suitable transport facilities has aggravated the problem further. In MONGOLIA, a number of activities have been undertaken to improve medical care provided to the rural population, particularly in developing and strengthening the material base of aimak and somon hospitals, and staffing and equipping rural health institutions. A comprehensive programme of supplying aimak joint hospitals with special vehicles equipped with X-ray apparatus, laboratory and dental equipment, etc., has been launched. Strengthening of medical care facilities would also form an important component of the development of the primary health care programme, for which a model is proposed to be developed in Huvsgul aimak. As a part of this activity, both the hospital and paramedical services would be expanded with the assistance of lJHO and other multilateral agencies. 1.9 Care of the Aged, .Disability Prevention and Medical Rehabilitation Present knowledge of the magnitude of the problem of disability in the Region continues to be limited. Relatively few Surveys or research studies have been undertaken in this field. Available information is mostly based on hospital statistics. The problem of comparability of the data was further accentuated by different definitions and criteria used in these activities. On the basis of data available from national sample surveys, about 10 per cent of the population in the developing communities are estimated to be suffering from disabilities due to birth defects, sequelae of communi- cable diseases, malnutrition, injuries and other degenerative disorders. A large proportion of the handicapped are found in remote rural areas where resources are generally lacking or inadequate. In the absence of reliable data this programme did not qualify for priority allocation of funds in the countries of the Region. The fundamental approach to tackling this problem was, therefore, the integration of activities with primary health care, priority being given to the generation of epidemiological information to define the problem and its extent. Apart from physical disabilities, the programme development in this area included special activities for the mentally handicapped, the blind, the deaf and dumb, and the aged population. Rehabilitation of the mentally retarded needs skilled manpower trained specially to handle such people. Activities for the prevention and control of blindness are developing as a major regional programme. Social rehabilitation of the totally blind is also progressing satisfactorily. A programme for the prevention of deafness and rehabilitation of the deaf through the provision of hearing aids and vocational training is in the preliminary stages - national and regional strategies are yet to be formulated. Prevention of accidents and management of accident victims are receiving the increasing attention of Member States. Following the United Nations World Assembly on Aging held in July 1982 in Vienna and based on the World Plan of Action, a programme for health promotion and rehabilitation of the elderly is under formulation. The programme of disability prevention and rehabilitation with emphasis on community-based disability prevention and rehabilitation, received considerable national attention through WHO-sponsored inter- regional, inter-country and national activities. The WHO Manual for Training the Disabled in the Community was reviewed and incorporation of recommenda- tions in a revised version was made at an inter-regional Consultation on Community-based Rehabilitation held in Colombo from 28 June to 3 July 1982. An inter-country Workshop on Rehabilitation of the Disabled in the Community held in the Regional Office in December 1982 considered the need for policy formulation in disability prevention and rehabilitation and framed guide- lines for such formulation and planning at national level and the mobi- lization of resources for implementing community-based activities. Two consultants assisted in planning and conducting this workshop. The programme on care of the aged in the Region was further invigo- rated following the endorsement of the world plan of action on aging at the United Nations World Assembly on Aging, which was attended by participants from this region. Appreciating the demographic trends as reflected in the increasing numbers of the elderly, the countries of the Region took active measures to promote and preserve the traditional extended family system and also considered developmental aspects to integrate elder citizens in the socio-economic development process through pre-retirement training and post-retirement employment. In order further to promote the action programme in support of the elderly in the Member States, a Regional Office staff member, together with the Manager of the Global Programme of the Elderly, visited Burma, India, Indonesia and Thailand. During their visit they discussed the existing situation regarding the health problems of the eiderly and government programmes for them. They also stressed the advisability of developing national plans of action for the elderly," Following the participation of representatives from Bangladesh, India, Nepal; Sri Lanka and Thailand in the preparatory meetings, delegations from Member States in this region took an active part in the proceedings of the United Nations World Assembly on Aging held in Vienna. Participants from Bangladesh, India, Indonesia, Sri Lanka and Thailand attended the inter-regional Workshop on Education and Training in Health Care of the Elderly held in Singapore, and formulated a draft manual for training in health care of the aged. In BANGLADESH, non-governmental organizations took an active interest in national and community-level rehabilitation programmes. In the proposed plan of action to establish integrated primary health care services, institutional facilities will be strengthened not only for referral responsibilities and the training of manpower resources but also for establishing disability prevention and rehabilitation services at the community level. A WHO consultant visited Bangladesh during March-May 1983 to assess the infrastructure and facilities for the development of community-based disability prevention and rehabilitation programmes, including the training of manpower for services in this area. WHO fellow- ships were awarded for training in medical rehabilitation/physiotherapy and artificial limb manufacturing and prosthetic fittings. In BURMA, the UNDP-assisted project made satisfactory progress with the training of community leaders and health workers in a community-based survey for the identification of the disabled, the organization of services including referral facilities, and the manufacture of orthotic and prosthe- tic appliances. A consultant collaborated with the Government in developing institutional facilities and a curriculum for training in physical medicine. Another consultant(specialist in bio-engineering) advised on the development of appropriate orthotic and prosthetic aids. A limited supply of these items was made available to the Hospital for the Disabled, Thamaing, Rangoon, from the Artificial Limbs Manufacturing Corporation of India (ALIMCO), Kanpur under TCDC. The Organization also supported the training of community health workers, midwives and township medical officers in the use of the WHO Manual on Training the Disabled in the community; a WHO consultant from head- quarters also assisted in this training programme; the national project manager visited various rehabilitation centres/institutes in India on an observation tour. In INDIA, the Ministry of Social Welfare constituted a nacional coordination committee with representatives from the Ministries of Health and Family Welfare, Labour and Education. With UNICEF collaboration, train- ing and demonstration activities in community-based disability prevention and rehabilitation were strengthened. A proposal to expand these activities at the district level to cover a population of 1.5 to 2 million was under the Government's consideration. These activities would be integrated in primary health care and facilities would be strengthened in health and medical service institutions at the intermediate and central levels. A national seminar on rehabilitation was conducted. A national consultant assisted the Department of Rehabilitation at Safdarjang Hospital in New Delhi in planning and organizing diploma courses in prosthetics and orthotics and in developing appropriate teaching materials. WHO provided support to this department and to the Medical College in Trivandrum for the establishment of training-cum-demonstration centres for community-oriented disability prevention and rehabilitation. The Organization also supported a preliminary study on the assessment of disability in cardiac patients undertaken at the Department of Cardiology, All India Institute of Medical Sciences, New Delhi. Two national courses for doctors in the management of cerebral palsy in children were coducted with WHO support at the Children's Orthopaedic Hospital in Bombay. With similar support from WHO, the National Institute of Prosthetic and Orthotic Training (NIPOT)/ALIMCO organized three training courses in prosthetics and orthotic technology at Bairoi, Cuttack. Fellowships were awarded for training in occupational therapy. In INDONESIA, the Solo Rehabilitation Centre was strengthened for training, services and research in community-based disability prevention and rehabilitation. The Chief of Rehabilitation from WHO headquarters visited Indonesia during the year to review developments and advise on extension of this programme. Fifty-one "Loka Bina Karya" (community- oriented base stations for the rehabilitation and social reintegration of the disabled) were functioning in more than 25 provinces on a cooperative basis offering guidance and training, and assisting in upgrading socio- economic skills and knowledge for promoting disability prevention and rehabilitation of the handicapped. The Ministry of Social Welfare convened a meeting of non-governmental organizations and the Departments of Education, Religion, Industries and Health to consider the recommendations of the United Nations World Assembly on Aging. The Ministry of Internal Affairs played a leading role in this meeting, following which another meeting was held with representatives of the United Nations system to discuss their role and to coordinate efforts at the national level. The resources of religious organizations and private foundations will be mobilized for the development of this programme in rural and urban communities. An ASEAN seminar on psycho-geriatrics was organized in Jakarta with WHO collaboration. In MALDIVES, a plan of action has been developed for the national programme on disability prevention and rehabilitation. The implementation of the plan faces some constraints, especially lack of manpower resources. In SRI LANKA, the rehabilitation services are all hospital-based. A committee is being constituted with representatives from different ministries and training centres to discuss and develop a plan of action. The field-testing of the WHO programme on community-based rehabilitation and training materials was completed and a training-cum-demonstration centre developed. A national public health policy has been adopted in THAILAND to foster programmes for the prevention of disability and rehabilitation of the disabled. In the Fifth National Economic and Social Development Plan provision has been made for a medical rehabilitation centre and extension of rehabilitation services to rural areas. The WHO Manual on Training the Disabled in the Community was translated into Thai and was being published. Short-term courses for physicians in rehabilitation and the training of prostheticlorthotic technicians were in progress. A National Committee with the Minister for Interior as chairman was constituted to review the recommendations of the United Nations Assembly on Aging in order to formulate a national plan of action. The programme for the elderly would be integrated with primary health care. The tradition of caring for the elderly in Thai society will be promoted through existing social institutions and temple priests who will enlist the participation of the community. Epidemiological surveys were conducted in 25 districts to assess the social and health status of the elderly. Provincial hospitals would conduct geriatric clinics for the routine physical examination and health education of aging people. 1.10 Oral Health Strengthening of oral health care facilities, as one of the support- ing elements of a comprehensive health system, received attention in WHO'S collaborative programme in the Region. Efforts to maintain decayed, missing and filled teeth (DMFT) at the present level continued. Following the first inter-country meeting of senior dental officers, held in Chiang Mai hailan and) in November 1981, which had recommended the setting up of a network of national oral health centres in the countries of the Region, consultancy services were made available to Burma, India, Indonesia, Nepal, Sri Lanka and Thailand to review the status of oral health and to examine the feasibility of establishing such centres with a view to effecting improvements in the oral health status of the people. A WHO dental technician was assigned to the oral health project in BANGLADESH to give training in modern techniques to dental technicians and students in Dhaka Dental College and the Paramedical Institute. Two consultants assisted in the organization and conduct of the second national workshop on oral health and oral health education at Dhaka attended by 50 participants. An oral health survey was carried out in five districts with the assistance of a WHO consultant. The programme and syllabus for a short training course on oral hygiene for teachers of primary and secondary schools were also prepared. Collection of epidemiological data in respect of oral health continued. In BURMA, the Institute of Dental Medicine is engaged in training dental surgeons and also in promoting the dental and oral health of the working people. Government hospitals, secondary health centres and school health centres in various states and divisions of the country provided dental health services under the People's Health Plan. A WHO consultant assigned to INDIA during the year recommended the establishment of a network of oral health centres by strengthening the existing institutions in the country. In INDONESIA, a consultant reviewed the existing oral health situa- tion and recommended that a national centre for oral health should be developed by strengthening existing institutions. Another consultant reviewed the school oral health service and suggested simple but meaningful ways of evaluating these services. Fellowships were awarded for training in various aspects of dental health. A WHO consultant who visited NEPAL in 1982 to review oral health activities has suggested that basic oral health care should be included in the existing primary health care projects utilizing dental auxiliary personnel. With WHO support the Health Education Bureau in Colombo, SRI LANKA, organized a national workshop for the purpose of planning an oral health survey to collect more definite data on the prevalence and severity of oro- dental disorders. The Organization also provided a subsidy for the conduct of a seminar on preventive oral health care for dental surgeons and school dental nurses. Fellowships were awarded for training in oral microbiology. 1.11 Mental Health, Drug Dependence and Alcoholism Efforts to facilitate the formulation of national policies and to improve the data base for programme planning continued. Work also progressed on the other two cornerstones of programme planning, namely, the development of appropriate technology and the instruments for programme evaluation. WHO-supported research in mental health during the year entirely focused on these two components of programme planning: a regional workshop agreed on the outline of the mental health skills to be taught to various levels of health workers (the 'mental health kit') and identified gaps in the existing technology in need of urgent attention; an inter-country research project aimed at identifying optimal intervention strategies for patients with basically psychosocial problems. Several countries from the Region participated in an inter-regional study on optimal strategies for the involvement of PHC personnel in problems related to abuse of drugs or alcohol. Work on indicators of mental health and on the quality of efforts to improve mental health began in several countries. In BANGLADESH, WHO assistance continued to focus on the establishment of a model area of community-oriented mental health care as a nucleus for improved post-graduate training and for increasing task orientation of the ongoing training programmes for non-specialized health workers. In BURMA, the focus continued on the United Nations Fund for Drug Abuse Control (UNFDAC)-supported drug-abuse control programme, which has made considerable progress, with a rapid increase in treatment and rehabilitation facilities and with increasing efforts to reach the rural opium users through an integrated approach using the PHC infrastructure. One of the major tasks, viz., the establishment of a system monitoring the prevalence of narcotics abuse, was to be undertaken later. The National Mental Health Programme in INDIA was considered by the Central Council of Health and a strong supportive resolution recognizing the importance of mental health as an integral part of all health efforts was adopted. Training courses in basic mental health skills were started in several states of the country and a rapid increase in coverage for severe mental disorders can be expected. In INDONESIA, multisectoral coordination in the mental health programme was further strengthened through the establishment of community mental health development boards (BPKJM) in all provinces of the country. These boards are truly multi-sectoral and can serve as valuable models of intersectoral coordination for other countries of the Region. In addition to this critical link of multisectoral collaboration at the higher managerial level, the second critical link of an integrated mental health programme, i.e., the training of general doctors in basic mental health skills, was equally being pursued and training courses in mental health were organized for puskesmas (PHC centre) doctors. Regarding the third critical link - the interface between the formal health sector and the community - work has begun on indicators of the social relevance of health services. MONGOLIA has a strong network of specialized psychiatric and psychoneurological facilities and manpower. WHO continued to assist in improving manpower in various subspecialities through fellowships. In addition, increasing attention was paid to psychosocial factors in health, and Mongolia is participating in the regional study on mental health in PHC, focusing on patients whose problems are basically psychosocial. In SRI LAMA, a national mental health plan has been drafted and WHO'S assistance was geared towards assisting in its implementation. Training courses in basic mental health skills for PHC physicians were started and a programme for the active rehabilitation of the numerous long-stay patients in the two mental hospitals of the country was initiated with WHO support. After the specific inclusion of child mental health into the PHC package a multidisciplinary Child Mental Health Core Group has been established and is coordinating a wide spectrum of activities, ranging from improvement in the care of abandoned children and efforts to improve special education for mentally handicapped children to the improvement of child psychiatric care. This group coordinates the work on indicators of child mental health and healthy psychosocial development, which is expected to generate a base for interventions into families at risk of non-compliance with a variety of preventive and promotive programmes also. In THAILAND, the mental health programme was expected to gain additional momentum through the establishment of a multi-sectoral National Advisory Group under the chairmanship of the Minister of Public Health. Various forms of integrated mental health care delivery were tried out in some model districts, training material was prepared and brief training courses in mental health for various levels of PHC personnel were held in several provinces. In the framework of the drug abuse control programme supported by UNFDAC, intensive training and research activities have continued. The programme was subjected to an in-depth evaluation by UNFDAC. 1.12 Drug Policies and Management WHO has been collaborating actively with all the countries of this region in evolving rational drug policies. The concept of essential drugs continued to receive further support. Most countries initiated measures to develop and strengthen their pharmaceutical supply system (PSS) so that essential drugs could be made available for primary health care. However, much more remains to be done in this field in order to ensure an uninter- rupted supply of essential drugs of assured quality to those who need them most and to attain self-reliance in all the components of PSS. The ASEAN TCDC programme in pharmaceuticals was further supported by WHO. While some of the planned activities were funded by the UNDP project, pooled funds from this Regional Office as well as from the Regional Office for the Western Pacific and WHO headquarters were provided for implementing the remaining activities. The technical content of the programmes pertaining to the preparation of reference substances and the development of a drug information system was coordinated by Thailand and Indonesia respectively. An inter-country workshop was organized in Kathmandu to review the present situation in regard to drug legislation in the countries of the Region and to provide further guidelines to develop and strengthen drug legislation as a part of drug policy and management. Problems and constraints were identified and guidelines were provided for comprehensive legislation, including drug ethics. Strategies for TCDC were outlined. The Government of BANGLADESH announced a new drug policy that is in many ways based on the recommendations of WHO. A large number of drugs of doubtful therapeutic efficacy or safety have been weeded out. The policy aims at attaining self-reliance in regard to the production of essential drugs and ensuring the supply of such drugs at economic prices for the primary health care programme in the country. It also lays emphasis on the strengthening of quality assurance programmes. WHO collaborated with the Government in implementing different facets of the drug policy. National staff received training in the quality control of drugs. A WHO consultant assisted the Pharmaceutical Production Unit of the Government in the further development and strengthening of the production of some of the essential drugs. AsDB and UNICEF provided assistance for buying the raw material and equipment and drug kits required for peripheral health care. Another WHO consultant evaluated the present storage and distribution system and advised on its improvement and strengthening. DANIDA and SIDA, in collaboration with WHO, were to send a mission to identify problems in implementing the new drug policy and offer further collaboration in this field. In BURMA, the Food and Drug Control Administration was strengthened through a UNDP project. A WHO consultant in pharmacology helped establish the laboratory methodology for the pharmacological evaluation and quality control of drugs. The pharmacognosy laboratory was strengthened and methods for the testing of medicinal plant preparations were established with the assistance of another WHO consultant. A bio-assay laboratory was set up and a consultant helped establish methods and protocols for the assay of biological preparations mentioned in the standard phanr.acopoeia. Yet another consultant prepared a project document for UNDP assistance for the further strengthening of the infrastructure for food and drug control administra- tion. WHO consultants are to assist the Government in establishing and strengthening the infrastructure for quality control and the training of drug and food inspectors. In INDIA, personnel from the states were trained in quality control procedures so as to enable them to improve the quality control system in their states. Drug control laboratories were also strengthened by the provi- sion of supplies and equipment. WHO gave technical and financial support in organizing a programme for the monitoring of adverse drug reactions. Technical support was given to INDONESIA for strengthening drug policy and management. A WHO consultant from headquarters prepared a project document for manpower training in different aspects of drug policy and management. Another consultant from headquarters assisted the Government in preparing detailed specifications for supplies and equipment required for the proposed formulation unit in the public sector. Under a programme of collaboration for the further development and implementation of HFA strategies, WHO assigned consultants in the field of drug utilization studies, for establishing good manufacturing practices (GMP) and for setting up a drug monitoring system. In MALDIVES, a WHO staff member assisted in the preparation of an essential drugs list and also in the formulation of the outlines of a drug policy. The Government took the decision to procure drugs through its State Trading Organization. A WHO consultant (pharmacist) was assigned to assist in setting up a procurement and distribution system. In MONGOLIA, advice was given to the Government on modernizing the infusion manufacturing plant. Assistance was also provided in the field of drug policy and management and for drug utilization studies at the aimak level. Quality control programmes were also strengthened. The biomedical project for the manufacture of human gamma globulins was approved by the Government. A national seminar was held in 1983 on the subject of drug supplies and management. In NEPAL, the drug programme continued to receive support through the training of national personnel in the storage and distribution system, promotion of traditional medicine and strengthening of Royal Drugs Limited. National staff were trained in different aspects of quality control. A WHO consultant organized training for health-post staff and for village health volunteers. A pharmaceutical engineer and a refrigeration engineer assisted Royal Drugs Limited in strengthening the managerial and technical components of drug production. In SRI LANKA, WHO provided further support to strengthen the pharmacy training programme. A consultant assisted the State Pharmaceutical Corporation in evaluating the technical component of the project for the preparation of infusions. WHO staff gave technical support in preparing the proposed project for the manufacture of essential drugs, which was still in the planning stage. In THAILAND, drug policy and management were developed through WHO collaboration. A drug policy was formally adopted by the Government as a part of health policy. Assistance to strengthen the drug information system further was continuing. A WHO consultant assisted in preparing a framework for a drug utilization study in PHC. 1.13 Medical Stores Management During the year under review, efforts were being made in all the Member States to improve the existing supply and logistic system. Each country is strengthening the procurement, storage and distribution system, especially with regard to essential drugs and medicines as well as other important supplies and equipment by establishing or further developing a network of stores, and by providing increased transport facilities under the control of the central medical stores. In these national efforts technical advice was given to several countries (Bangladesh, Burma and Nepal) by Regional Office staff during their visits. Training in the management of stores was provided through fellowships. In BANGLADESH, WHO collaborated in planning a network of regional stores in the four divisions of the country to facilitate timely distribu- tion of drugs and medicines and essential supplies and equipment to medical and public health institutions, including teaching institutions in medicine and public health, thana health complexes and union health subcentres. Zn BURMA, a review of the existing facilities and staff support to the medical stores management systems led to the sanctioning of 144 posts of additional staff of various categories which would strengthen the manpower of the system. This additional staff would be appointed in the central medical stores in Rangoon, the sub-depots at Mandalay and Taunggyi and transit camps of supplies in all parts of the country. 1.14 Maintenance and Repair of Health Equipment The Organization continued to extend technical cooperation in further strengthening the physical facilities and training of manpower for the repair and maintenance of health equipment in countries of the Region. In BANGLADESH, establishment of a national electro-medical equipment maintenance and training centre at Mohakhali, Dhaka, was finally approved and its implementation given high priority. Eight technicians were sent on WHO fellowships in X-ray and nuclear medicine and in the repair and maintenance of advanced diagnostic laboratory equipment. A WHO electro-medical engineer continued to give necessary technical assistance. In addition, the Organization provided supplies, including equipment, instruments and spare parts to be used in training. In BURMA, an official was trained abroad in the field of maintenance and repair of medical equipment. As regards activities at the regional level, the ongoing UNDP-funded project 'Training in Maintenance and Repair of Health Equipment for the Least Developed Countries' for which WHO is the executing agency, was engaged in the training of national personnel in the repair and maintenance of health equipment. So far, 13 fellowships have been awarded under this project - four for candidates from Bangladesh, five from Bhutan, one from Maldives and three from Nepal. 1.15 Health Legislation There is a growing awareness of the need for establishing appropriate health legislation in support of strategies for HFAI2000 including primary health care, overall national health policy and specific areas such as essential drugs, food safety, breast-milk substitutes, workers' health, environmental health, disease control, drug addiction and alcoholism. Since health legislation concerns not only the ministry of health but other ministries as well, the review of the existing health laws and regulations, which was technically supported by WHO in Bangladesh, Sri Lanka and Thailand, involved also other relevant ministries. The draft health legisla- tions to support the ongoing "health for all" activities in these countries are now available and under consideration by the government concerned. As a follow-up of WHO assistance to Bangladesh in the past, the proceedings of a national seminar on health legislation held in Dhaka were sent for publication in the International Digest of Health Legislation. A consultant was assigned to Bangladesh to make preliminary studies of the existing health laws. In INDONESIA, health legislation was one of the priorities identified during the process of developing the Indonesian Government/W~O innovative programme in achieving HFA/2000. For this purpose, WHO would provide necessary support. Considerable efforts will be needed for the promotion and development of adequate health legislation in countries of this region. Thailand is the only country which has at the moment a WHO-assisted project on this subject. In the coming biennium, activities are likely to he extended in Indonesia. In addition, an overall review will be undertaken with the aim of initiating necessary inter-country activities in this field. 2. DISEASE PREVENTION AND CONTROL - COMMUNICABLE DISEASES 2.1 Epidemiological Surveillance Member States continued to stress the importance of epidemiological surveillance services to support the planning, implementation and monitoring of disease control efforts. Despite this emphasis, the shortage of trained and skilled manpower in this field, especially at the inter- mediate level of national health systems, remained a problem, affecting the efficiency of surveillance activities adversely. WHO continued to provide technical back-stopping, training facilities and research grants in this area in support of national efforts. In BANGLADESH, WHO technical staff collaborated with the Institute of ~~idemiology under the National Institute of Preventive and Social Medicine (NIPsOM) in developing an efficient field surveillance system in ten districts where epidemiological units had been set up. In this process, they trained the local personnel in epidemiological techniques, helped in establishing a reporting and recording system and worked with the national staff in running the units smoothly at the initial stages. All the ten units were now functioning under the supervision of the national staff. A consultant in entomology assisted the Institute in the epidemiological investigation of leishmaniasis in the country and advised on a work plan for field diagnostic activities and the setting up of a diagnostic unit for parasitic diseases. An epidemiological survey on kala-azar in Fulbaria and another on filaria in the Dhaka metropolitan area were carried out. These surveys not only provided reliable epidemiological data but also helped in devising steps for the control of these diseases. 'She WHO public health veterinarian assisted in generating epidemio- logical and epizootical data on zoonotic diseases, namely, rabies, brucellosis and bovine tuberculosis, which will be used as baseline information for these diseases. He also participated in the development of an action programme for the control of rabies which was being implemented. In INDIA, WHO provided technical support to preparations for setting up regional and state epidemiological surveillance systems through the services of a consultant assigned to the National Institute of Communicable Diseases, Delhi. The proposal emanating from this process would be discussed by a national task force at the end of this year in order to reach a consen- sus on practical measures necessary to develop the national epidemiological surveillance system further. In MONGOLIA, special field teams were active in conducting epidemio- logical surveillance and instituting preventive and control measures against communicable diseases such as viral hepatitis, enteric fever, meningitis, and poliomyelitis. WHO supplied reagents for laboratory diagnosis. The Organization continued to support NEPAL in strengthening the Epidemiology and Statistics Division of the Ministry of Health in the fields of epidemiological surveil?ance and control of zoonotic diseases including rabies, The surveillance system for ten communicable diseases was developed in 23 districts, Publication of the quarterly epidemiology bulletin facilitated dissemination of information. However, shortage of trained manpower and logistics problems continued to persist. Surveys of neonatal tetanus, poliomyelitis and viral encephalitis were carried out with WHO assistance and the results were made available for decisionmaking. A seminar on the epidemiology of zoonoses was organized and its proceedings were published and distributed. Active surveillance of rabies continued. 2.2 Diseases Subject to the International Health Regulations Cholera was again reported in some countries of the Region. Interestingly, classical vibrio chol-era, besides El Tor serotypes, was identified among cases detected in 1982. As for plague, the disease was under active surveillance in Burma, where human cases were reported in April 1983. Table 1 gives the breakdown by country of the number of cases and deaths due to cholera and plague during the period 1980-1982. 2.2.1 Acute Diarrhoea1 Diseases Ten out of 11 countries of the Region had developed national control programmes against diarrhoeal diseases (CDD) which were being implemented according to schedule. Some countries such as Bhutan, Maldives, Mongolia and Nepal completed operational plans in 1983. The service component of the programme in each country was fully integrated with primary health care services. Research was developed nainly to solve operational problems, namely, delivery of oral rehydration therapy, to ensure community involvement and to clarify the socio-behavioural aspects of diarrhoeal diseases and their control, The priorities for research to support diarrhoea1 diseases control have changed in the course of the years from etiological and clinical studies to community involvement, socio-behavioural aspects of control, transmission studies and management problems. Delivery of oral rehydration therapy (ORT), the main strategy of the programme to reduce mortality, is currently carried out in all the above countries, depending on the availability of oral rehydration salts, produced locally and/or supplied by UNICEF, and on the absorptive capacity of the existing health infrastructure. Early diagnosis and administration of treatment at home have a positive impact on mortality in infants and children under five years of age. However, the extent of mortality reduction achieved so far was being measured by appropriate surveys and monitoring of the performance of the programme. Table 1 Diseases Subject to the International Health Regulations Notified by Countries of the South-East Asia Region 1980, 1981, 1982 (Information compiled from data made available to WHO headquarters by governments) Country Year Cholera Plague Cases Deaths Cases Deaths Burma India 1980 8 344 1981 4 681 1982 4 656 Indonesia 1980 5 541 1981 7 399 1982 8 183 Nepal Sri Lanka 1980 104 1981 574 1982 309 Thailand 1980 4 331 1981 39 1982 638 Inter-country training activities continued in Bangladesh (Inter- national Centre for Diarrhoea1 Disease Research, Bangladesh, Dhaka), India (National Institute of Cholera and Enteric Diseases, Calcutta) and Indonesia (Director-General, CDC, PIinistry of Health, and University of Indonesia, Jakarta). During the year under review three courses were conducted and 54 persons from eight countries were trained. The character of the regional training programme appeared to be changing as the main concern now was to develop faculty for national training that would be concerned with the training of intermediate and peripheral health workers and the education of mothers/family members in early diagnosis, treatment and referral of cases needing specialized care. Bangladesh, Burma, India, Indonesia, Nepal, Sri lanka and Thailand were at present implementing national training programmes. Maldives was expected to initiate such a programme by mid-1983, Bhutan in late 1983 and Mongolia in 1983-1984. Three modes of acquisition of Oral Rehydration Salts (ORS) by national CDD programmes could be seen in the countries: (i) large-scale production, using automatic or semi-automatic machines, as in India, Indonesia, Nepal and Thailand, (i i) cottage-scale production, using unskilled or semi-skilled personnel and simple equipment, as in Bangladesh and partly in India, Thailand and Indonesia, and (iii) procurement from outside the country with or without the assistance of agencies such as UNICEF. UNICEF provided ORS to countries where no production existed, such as Sri Lanka, Maldives and Bhutan, or where the production was insufficient (Burma, Bangladesh). Despite these efforts, ORS supplies were inadequate to cope with the existing needs and the production capacity must be increased urgently. The national policy in BANGLADESH adopted the use of both the standard ORS according to WHO formula and the early treatment at home with sugarlsalt solutions or with any available home fluids in the absence of standard ORS. This policy appeared to be increasingly accepted because of its impact on mortality reduction and easy applicability in the field situation prevailing in the country. The International Centre for Diarrhoea1 Diseases Research in Bangladesh (ICDDRB), a WHO Collaborating Centre, organized several inter- countrylinter-regional courses in clinical and laboratory aspects in addition to its extensive research activities in this field. The demonstration area at the Infectious Diseases Hospital in Bangladesh received full WHO support and was involved in various in-service and regular training courses for national health staff. Cottage-scale production of ORS continued, based on existing facilities in several general/infectious-disease hospitals involved in the management of diarrhoea. In BURMA, the first global test of training modules for intermediate supervisors of the peripheral staff responsible for programme delivery was successfully conducted during the year. The Department of Medical Research, Ministry of Health, was identi- fied as one of the global centres to study various etiological factors giving rise to acute diarrhoeas and to explore alternative drug management schedules of diarrhoeas. The research on etiological factors has been making progress. INDIA finalized the revised version of the national CDD programme document, which envisages phased implementation of activities such as research, training, ORS production and delivery, strengthening of the logistic system, and the setting up of sentinel areas and clinical demonstration centres. National seminars on oral rehydration therapy (ORTI for faculty members, clinicians and managers were followed by courses for district health staff, initiated in West Bengal in 1983. WHO extended technical support and subsidies for continuing national seminars on ORT and training for primary health centre staff. India recognized CDD as one of the priority objectives for the long-term health development programme and consequently increased considerably its own budget allocation. The National Institute of Cholera and Enteric Diseases (NICED), Calcutta, continued as the WHO Regional Training Centre for CDD and expanded its activities such as preparation of curricula for PHC workers, setting up of a research area for community involvement, and the provision of faculty assistance to other countries of the Region in their training activities, when required. In INDONESIA, one of the three regional training centres on CDD continued its national and inter-country training activities on the clinical aspects of diarrhoeal diseases. A course for paediatricians and faculty members from schools of medicine selected from six countries was expected to take place towards the end of 1983 on the management of diarrhoea cases complicated by other diseases such as acute respiratory infection, measles, pertussis, severe malnutrition, and deficiency syndromes. A consultant assisted the national programme in designing and conducting mortality/morbidity surveys in 1982-83 and two others helped in initiating a cost-benefit study on ORS production. In NEPAL, the plan of the national CDD programme was revised, improved and finalized for implementation. WHO provided technical support in drawing up the plan and continued its assistance in its implementation. The implementation of the research programme was assisted through consultancy services, and further similar support was given for implementing the comprehensive plan for service-cum-training. Two national seminars on the clinical management of acute diarrhoea1 diseases were held in April 1983 in which 54 staff participated. Staff members from NICED, Calcutta, WHO headquarters and the Regional Of fice participated as faculty members in these seminars, which took place in Kathmandu and Pokhara. SRI LANKA has been implementing a phased national CDD programme since July 1982, expanding the activities progressively so as to cover the entire country by the end of 1985. The service component of the programme, delivered through PHC, is preceded by the intensive training of different categories of staff involved in field activities and management. Seminars for paediatricians and teachers from schools of medicine were held in Colombo and Jaffna. Oral rehydration salts, now supplied by UNICEF, would be supplemented by national production in forthcoming years. Plans were being prepared, together with UNICEF, to start in 1983 a semi-automatic ORS production line with a capacity to meet 40 per cent of the country's need for ORS . In THAILAND, which operates a well-defined national programme, the first comprehensive programme review took place in March 1983 and the results were presented to the national health administration for corrective actions where needed. The review revealed, though indirectly, that wide application of ORT dramatically decreased the mortality due to diarrhoea, especially among infants. Three WHO consultants assisted the review as well as in the mortality/morbidity survey carried out in 1982. 2.2.2 Plague Burma remained the only country in South-East Asia where cases of plague were reported. During the reporting year, there was an outbreak with 157 cases which were confirmed by laboratory tests. Activities against plague were therefore stepped up in order to destroy the rodents and fleas and interrupt the transmission of the disease. The outbreak, however, was quickly controlled as a result of early diagnosis and prompt institution of preventive and curative measures by the national authorities. WHO supplied vaccines and medicines. Strict surveillance was being continued as a routine plague control measure. 2.3 Malaria and Other Parasitic Diseases Malaria has remained a principal health problem in eight countries of the Region, namely, Bangladesh, Bhutan, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. In Maldives the problem is less acute. Of the other parasitic diseases encountered in the Region, filariasis and leishmaniasis caused concern in some areas, while trematode infections such as schistoso- miasis and similar water-related diseases had a more limited focal distribu- tion. Intestinal helminthiases occurred almost throughout the Region. 2.3.1 Malaria The overall malaria situation in the Region in 1982 improved slightly over the previous year, with a small reduction in malaria-positive cases and a similar reduction in the incidence of Plasmodium falciparum infections. The epidemiological data indicate appreciable reductions in case incidence in Bangladesh, Burma, Indonesia (Java and ~ali) and Sri Lanka, and a conti- nued marginal decrease in India. Except for an outbreak (which accounted for nearly half of all detected cases), the incidence pattern in Maldives remained the same. Nepal and Thailand registered small increases during 1982. P.falciparum infections generally followed the same trend as that of overall incidence in most countries, although in Bangladesh and Sri Lanka they increased despite reduction in total incidence. Maldives has remained free of indigenous P.falciparum for several years. The major constraints of the programme continued to be operational and administrative in nature. They included migration of infected people into receptive areas and of healthy people into endemic areas. The two outstanding technical problems met with during the past two decades have not abated: while vector resistance to pesticides has remained fairly stable, parasite resistance to drugs continued to spread. Vector resistance persisted as a widespread problem in India, Indonesia, Nepal and Sri Lanka, and was monitored by susceptibility testing, the testing materials being supplied by the Organization to the malaria control programmes on a regular basis, while assistance and training in their use were provided, where necessary, by WHO entomologists. Technical cooperation extended by WHO related to the development of mediumterm programmes and evaluation of the existing programmes, together with training activities and the development and implementation of applied field research. The Organization's functions included promotion of cooperation in border areas among neighbouring countries, promotion of intersectoral coordination at country level and assistance in developing national self-reliance for the production of insecticides and anti-malarial drugs, and procurement of supplies and equipment. Annual assessments of the programmes were undertaken in India, Nepal and Sri Lanka, consultants being provided by WHO for the purpose. These assessments were undertaken jointly with representatives of the respective governments and the bilateral agencies that assist some of the programmes. Support by WHO of the malaria border coordination meetings was maintained, and the Regional Office acted as the focal point for the exchange of infor- mation arising from these meetings, which in 1982 were held between India, Maldives and Sri Lanka at Male, between India and Nepal at Kathmandu, between Bangladesh, Burma and India at Dhaka, and between Indonesia, Malaysia and Singapore at Randung. In February 1983 Indonesia participated in a South-West pacific malaria meeting held at Sydney, Australia. The importance of applied field research in overcoming constraints to the national' programmes continued to be stressed by WHO. One of the principal studies supported to a large extent from WHO regional funds has been the monitoring of resistance of P.fa1ciparum to 4-aminoquinolines and other antimalarials. In respect of vectors, regional studies are being undertaken on Anopheles species complexes, vector resistance to insecti- cides, and the use of biological agents for mosquito control. A number of investigations have also been made on operational, epidemiological and ecological aspects of anti-malaria work, while methods to solve the problems that confront integration of malaria and primary health care systems in low and high-risk areas, a key aspect of HFA, were examined at inter-country workshops held in the Regional Office and in Thailand. The Regional Collaborative Studies on Drug Resistant Falciparum Malaria, started in 1977, have reached the point where, with some exceptions, the sensitivity levels of P.falciparum to 4-aminoquinolines have been determined in the participating countries. With the exception of certain islands of Indonesia the objective of collection of baseline data on current geographical distribution, prevalence and degree of resistance has been achieved. At the Third Review meeting held in Jakarta in May 1983, monitoring of the response of P.falciparum to chloroquine was incorporated as an operational aspect of each malaria programme. By applying the micro in vitro technique, countries participating in the Regional Collaborative Studies are actively assessing the sensitivity levels of P.falciparum to mefloquine before wide-scale introduction of this new drug into their programmes. Studies have been initiated on the use of alternative drugs and drug combinations for use in areas where chloroquine is no longer effective for suppression or treatment of falciparum malaria. The creation of applied research units within national antimalaria organizations has been promoted by WHO, the external assistance required for their activities being met partly from regional funds, partly from the UNDPfWorld Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), and from bilateral sources. Among the wide range of research objectives, stress has been laid on the resolution of problems delaying integration of malaria control services, especially those aspects relating to case-detection and treatment, with the primary health care system, and the promotion of community participation. To this end, following the "Workshop on PHC Approach in the Control of Malaria in the South-East Asia ~egion" held in the Regional Office in May 1982, a second inter-country Figure 1. INCIDENCE OF MALARIA AND P,falclparum INFECTIONS IN SELECTED COUNTRIES OF THE WHO SOUTH-EAST ASIA REGION ;kg&g%9p . .+,, A&&& Upahwn Infections - Slide Positivity Rate % Slide ddup~ufl Rate X '000 % '000 X BANGLADESH BURMA NEPAL MALDIVES Mill. X '000 % 5. '000 % 500 - 2 .. 4 1 -- 2 78 79 80 81 82 78 79 80 81 82 78 79 80 81 82 78 79 80 81 82 INDIA INDONESIA SRI LANKA THAlLAh'D 'Provisional workshop, "~an~ower Requirements for the Planning and Management of Malaria Control Programmes in the Light of the Revised Strategy and Primary Health Care Approach", was organized at Phuket, Thailand, in October 1982. A11 malarious countries of the Region, including Bhutan, participated in one or both of these workshops. The vital role played by training is recognized, and training activities were strongly supported by WHO through fellowships, subsidies for national training courses, and supply of equipment, particularly audio-visual aids and teaching microscopes. An important aspect of the two workshops mentioned above was a critical appraisal of malaria training in the context of primary health care and participation of the community in parasite and vector control activities, these being educational inputs essential for the objective of HFA. Collaboration was maintained with the WHO Inter-Regional Malaria Training Secretariat at Kuala Lumpur, visits by the Director to the national malaria training centres in Burma, Indonesia and Thailand being supported by the Regional Office, as were participants from the Indian, Indonesian and lhai centres at a "training for trainers" course held at the Secretariat in April 1983. A consultant at the Regional Office examined the regional situation in respect of the production of national malaria training manuals and course curricula. In his report he commented that curricula and manuals, although available for most categories of staff, were often insufficiently updated in the light of current feasible strategies, particularly in respect of stratification of malarious areas, integration with PHC, and active participation of the community. The overall state of antimalaria programmes in the Region as of 1 January 1983 was as follows: Item - Millions 1 January 1983 Population in the Region 1 094 Population in originally malarious areas 1 016 Population in areas under antimalaria operations 95 6 Population in areas with no specific antimalaria operations 6 0 Summaries of antimalaria activities in individual countries, high- lighting WHO inputs, are as follows: In BANGLADESH, the improving epidemiological situation was indicated by declines in case incidence and the slide positivity rate, but the significance was lessened by a continuing low annual blood examination rate (ABER, 2.6 per cent) and increase in the proportion of P.falciparum infections. There have been some improvements in case incidence in the more malarious districts except Chittagong Hill Tracts, where a sharp rise occurred largely in immigrants among whom there was a notable mortality. Spraying and surveillance operations continued to be hampered by the shortage of field workers caused by delays in recruitment and release of funds; spray coverage was not completed and blood smear collections were low owing to impaired supervision. Passive case detection through the thana health complexes and sub-centres was deficient and these institutions need to be activated for full participation in the programme. Entomological activities continued to be hindered because of shortage of funds as well as lack of transport and technical support. A programme of entomological activities with emphasis on vector susceptibility and impact of spraying operations is, however, being developed and built into the new plan of operations. WHO provided two consultants for an external review of the programme, which was conducted jointly by the Government, WHO and the Netherlands in NovemberfDecember 1982. This review indicated that the present structure for implementation of the antimalaria measures was cumbersome and compli- cated, making effective supervision and epidemiological evaluation virtually impossible. It was stressed that the approach to the malaria problem in Bangladesh needed to be reoriented, activities being designed to meet the requirements of the three identified epidemiological strata. A new plan of operations based on the review report is being developed, and will hopefully generate much needed assistance from bilateralfmultilateral sources. The programme was encumbered not only with a shortage of DDT but also with poor quality DDT. Independent chemical analysis of four samples of indigenously produced and imported DDT showed all to be below WHO specifications. It is not surprising therefore that DDT spraying has not been having the desired impact on malaria transmission. The problems appeared to be related to poor field storage of the imported DDT and poor quality control of indigenously produced DDT. This lends urgency to the need for reactivating the DDT factory at Barakunda, to which the Government has now given a high priority among AsDB-financed projects. In December 1952 WHO provided two consultants to an AsDB mission to review the malaria control programme and advise on rehabilitation of the DDT factory. The Regional Collaborative Studies on P.Ealciparum sensitivity have progressed as planned, though some initial failures with the micro technique were encountered. The distribution of chloroauine-resistant strains of P.falciparum is concentrated in the forested hilly Anopheles balabacensis belt, andhus determination of the susceptibility of the plains-dwelling A,philippinensis to sporogonic development of resistant P.falcipaz'um would be an operationally appropriate research study. WHO support was provided for short training and orientation courses for health personnel at different echelons, and refresher training of technical personnel in the programme. During the period under review a total of 21.5 personnel attended the courses. In addition, senior staff at the central and district levels received WHO support for undertaking observation study tours of antimalaria programmes in the Region. WHO also awarded a 12-month fellowship for study in the USA. The Organization supplied emergency antimalaria drugs to control an outbreak in the Chittagong Hiil Tracts, in addition to providing other supplies and equipment required for the programme. In BHUTAN, around 15 per cent of the population continued to be at risk from malaria, approximately 65 per cent of confirmed malaria infections being attributable to P.falciparum. Among the population at risk, 88 per cent lived in areas covered by surveillance and spraying and 12 per cent by spraying alone. DDT was applied biannually, and the principal vector was A.maculatus. Anti-malaria activities were undertaken in three zones, where 14 malaria centres (12 with and 2 without surveillance) covered a population of 151 000. Each zone has a malaria laboratory and an additional laboratory is situated at Geylegphug in the Central Zone where incidence is high. Malaria control work has not yet been entrusted to the PHC system, which does not provide total population coverage, but where the basic health units have been established (and dependent on the outcome of a pilot study now in progress), integration is being embarked upon following reorientation training of workers. In BURMA, 92 per cent of the population inhabited originally malarious areas. Drug distribution is the basis of the programme, although RI-level resistance to chloroquine and amodiaquine was widespread during the review year and was beginning to appear also to the combination of sulfadoxine and pyrimethamine in the south-east. Intradomiciliary spraying with DDT protected 13 per cent of the population (although the vectors A.annularis and A.balabacensis showed resistance to this insecticide focally), drugs protected 22 per cent, 43 per cent were in surveillance areas and 14 per cent in vigilance areas. The specialized work of the Vector-borne Disease Control Unit in respect of spray and radical treatment operations, evaluation, training and research was linked to the case- detection and treatment activities of the community health workers and public health supervisors in the township health services by VBDC teams located at divisional/state level, The malaria situation improved somewhat during the year, the API being halved, the SPR reduced by a quarter and the proportion of P.falciparum falling to around 77 per cent from 83 per cent. However, these gains may have been deceptive since the ABER continued to be extremely low. Assistance extended to the progrmme by WHO was used largely for fellowships and supplies and the support of a WHO malariologist. Support was also provided by UNICEF and the Government of Canada (CIDA) in respect of insecticides, drugs and equipment. The Netherlands Government support of two WHO vector-borne disease specialists (an entomologist and a sanitarian) continued, although the incumbents left Burma in November 1982 and, pending further inputs to the grant, have not yet been replaced. A national entomo- logist was supported by WHO for an extensive study tour of international approaches to integrated mosquito control methodology. The Director of the WHO Inter-regio~al Malaria Training Secretariat for Asia visited Rangoon in November 1982, and three consultants were assigned to provide advice to the Department of Medical Research on the immunodiagnosis of malaria, epidemio- logical research in malaria, and the establishment of a clinical research unit for cerebral malaria. In INDIA, 95 per cent of the population continued to live in mala- rious areas, all of which were under surveillance and antimalarial treatment of fever cases was provided. Population additionally protected by measures directed against the vectors also continued to be around 57 per cent. During the 1982-83 period, 30 per cent of the national health budget was devoted to the implementation of the Modified Plan of Anti-Malaria Operations introduced in 1977 by the National Malaria Eradication Programme (NMEP). This plan, which has an urban component now covering 125 towns, has resulted in an overall decline of malaria incidence, and relies to a considerable extent on community participation. Liberal distribution of anti-malarial drugs through more than 325 000 community health workers and volunteers, together with the spraying of residual insecticides where the MI reached two or above, have been responsible for the reduction of morbidity and mortality in rural and remote areas since the peak incidence in 1976. The data for the year under review, supported by a strong ABER, indicate a further reduction over the previous year of 33 per cent in the API, 26 per cent in the SPR and 10 per cent in the SfR. The programme has continued to be integrated progressively with the general health services at district level, and cost sharing with the several states is on a 50:50 basis, although the inability of some states to provide sufficient funds has of necessity resulted in local relaxation of the API criterion for introduction of spraying. Little change has occurred in the extent or distribution of vectors resistant to pesticides. The principal vector in the rural areas, A.cuIicifacies, in many districts is focally resistant to DDT and HCH, and in western India sometimes also to malathion. In some urban areas A.stephensi is doubly resistant to DDT and HCH. Rising costs of insecticides, particularly the organophosphorous (OP) compounds, have encouraged the trend towards self-sufficiency in their production. In the large areas of eastern India where falciparum malaria is prominent, the national programme has been reinforced since 1977 by a P.falciparum Containment Programme (PfCP), supported generous19 by the Government of Sweden (SIDA) through WHO. The Indian staff of the PfCP were strengthened during the year by four WHO staff members and one consultant whose duties included epidemiological, entomological and applied research work. ,The five-year period of SIDA support to the PfCP ended during the year under review, and a five-year renewal has been granted albeit with a 40 per cent reduction in funding necessitating a consolidation of the operations. The area originally covered by PfCP in much of north-eastern India (Zone-I) and parts of WesZ Bengal, Bihar and Orissa (Zone-111, was expanded to include parts of Andhra Pradesh, Madhya Pradesh, Karnataka and Tamil Nadu (~one-111), and in western India parts of Gujarat, Rajasthan and Maharashtra (zone-IV). The Andaman and Nicobar Islands were also included. Consolidation due to reduction in funding is requiring PfCP to relinquish Zone-IV and reduce Zone-I11 where falciparum malaria in any case forms less than 20 per cent of the malaria species incidence, and concentrate on the east and north-east where it may be as high as 70 per cent. The programme of intradomiciliary spraying, chemotherapy and surveillance undertaken by NMEP and PfCP resulted in further reduction of malaria despite the presence in parts of north-east India of P.falciparum resistant to chloroquine. This resistance has been monitored by teams of the Indian Council of Medical Research attached to NMEP regional offices, trained by WHO in the use of in vivo and in vitro parasite resistance tests; they have confirmed its presence focally in Zones I and 11 of PfCP. Upon confirmation of resistance by in vitro testing, using equipment provided by WHO, energetic steps have been taken by NMEP to eliminate the focus. Attention to urban malaria problems, in respect of which NMEP has a special programme, included the provision of a WHO expert to advise the Madras Corporation on methods of mosquito control. Training was a particular object of WHO support, fellowships being awarded and grants and subsidies arranged for institutional and field training courses. At the National Institute of Communicable Diseases, Delhi, WHO supported through subsidies and lecturers the regular courses held during 1982 for 53 malariologists, 81 epidemiologists and 23 entomologists nominated by NMEP and PfCP, state health departments, and agencies such as Defence and Railways. One NMEP officer attended the second Rome-Palermo- Adana Malaria Course commencing in April 1983, at WHO expense. Funds from an inter-country UNDP grant were provided for the purchase of audiovisual equipment and teaching microscopes, Periodic review meetings of PfCP were sponsored by WHO, and malaria coordination conferences were organized between India and Nepal at Kathmandu in September 1982, and between India, Maldives and Sri Lanka at Male in December 1982. In INDONESIA, the Malaria Control Programme, which was largely concentrated in Java and Bali, began to be extended to the outer islands with external assistance being made available. The programme in Timur with US AID assistance gathered momentum after the training of personnel. Malariometric surveys and selective spraying were being undertaken. Malaria control has been included in the comprehensive health programme financed by the World Bank in three provinces of Sulawesi, the loan agreement having been signed in February 1983 and the programme coming into operation in June 1983: ~~$9.4 million is earmarked for malaria control. The programme continues to be hampered because of delays in reporting from the provinces consequent on the introduction of the new reporting system. The available information for 1982 is indicative of an improvement in the epidemiological situation with a reduction of case incidence and the slide positivity rate. However, the percentage of P.falciparum infections, which has been steadily increasing in recent years,reached 53. As in the previous year, 85 per cent of malaria cases for Java and Bali were from Central Java, where technical problems of vector resistance and parasite resistance are prominent. In Bali, an improving epidemiological situation was disturbed following an outbreak of malaria in an offshore island which occurred with the arrival of returnee transmigrants from East Kalimantan. The outbreak was brought under control with prompt remedial measures. With the expansion of the transmigration programme the need for establishing check-posts to screen returnee transmigrants on visits to their home villages in Java and Bali has assumed operational importance. Limited spraying with fenitrothion was carried out in a few kecamatans of Central Java and its impact was much greater than with DDT. lhis justifies its wider application, particularly in Central Java. Routine entomological activities were continued in Java and Bali and in priority areas in the outer islands. Special investigations were in progress in five provinces of the outer islands and West Java Province. Testing of vector susceptibility to insecticides has been sporadic. A.aconitus in Central Java has maintained a high level of resistance to DDT and exhibits tolerance to dieldrin. A.barbirostris in Central Java has also become resistant to DDT, although A.sundaicus remains susceptible. Precipitin testing of A.aconitus and A.sundaicus has revealed the former species as highly zoophilic and the latter less so. The Regional Collaborative Studies on P.fa1ciparum sensitivity to 4-aminoquinolines using the micro in vitro technique were extended to Sulawesi and Nusa Tengara and resistant strains were encountered. These studies have confirmed resistant P.falciparum in 51 localities of 16 provinces where tests have so far been completed. Training and reorientation of staff have high priority in the programme to overcome manpower constraints at all levels. A total of 321 personnel received training and orientation at courses organized mainly at provincial level and met largely from national funds with smaller inputs from WHO. In addition, WHO awarded in 1982 nine malaria-related fellowships for training in entomology, epidemiology and tropical medicine and hygiene. One participant for the workshop on the training of trainers in Kuala Lumpur was supported by the Organization. WHO provided a consultant in entomology in April 1983, WHO assisted in the holding of the Fourth Indonesia-Malaysia- Singapore Malaria Border Coordination meeting at Bandung in November 1982. The recommendations covered a wide range of subjects aimed at further improving inter-country coordination, especially antimalaria operations in border areas. In MALDIVES, with the exception of a focal outbreak in one of the islands in the northernmost atoll during the later part of 1981 and early part of 1982 which was quickly brought under control, the overall epidemio- logical situation remained satisfactory. During the period August 1982 - February 1983 only nine locally transmitted cases were detected in the country as against 24 cases during the previous six-month period and 64 cases during the period August 1981 - February 1982. The three P.falciparum cases detected during 1982 were imported from outside the country. DDT spraying was carried out in two northern atolls and one southern atoll where there was evidence of local transmission and/or presence of vector(s). Limited anti-larval operations were also attempted. Surveillance and chemotherapy continued to be carried out by the primary health care system, which was being strengthened. As stated earlier, the Fifth India-Maldives-Sri Lanka Malaria Coordination Conference was held in Male in December 1982. In the field of management some important steps were initiated. WHO collaboration in terms of fellowships, local cost subsidy and supplies continued, and a WHO sanitarian remained in position during the year. The problems encountered were mostly operational in nature; the communication and transportation problems remained unchanged. The parasite (P.vivax) was sensitive to anti-malarials and the vectors (A.tesselatus and A.subpictus) were susceptible to DDT. In NEPAL, the overall malaria situation remained unchanged, although there was an increase in the number of microscopically diagnosed cases of malaria due to an increase of imported cases and further improvement in ABER in both NMEO and integrated community health services development project (ICHSDP) districts. In all NMEO regions there was an increase of malaria cases but in the integrated districts there was a substantial reduction of cases; this is particularly significant in view of the increased ABER. The number of P.falciparum infections increased, constituting 6.2 per cent of total infections. A characteristic feature of the improved ABER in 1982 was an increase in PCD (passive case-detection) collections largely by volunteers, with a yield of 15 per cent of total cases. An encouraging development was the establishment of 15 malaria clinics which also swelled PCD collections. However, the cooperation from hospitals and health posts in this activity has seemed lukewarm and should be actively promoted to facilitate transfer of districts to ICHSDP. A noteworthy feature was the high community acceptance of insecticide spraying, but the full impact of spray coverage in transmission was impaired because the pre-monsoon spray cycle was delayed and not all contiguous localities in an epidemiological belt were sprayed. The entomological activities were related to routine investigations and conduct of susceptibility and bio-assay tests. A.annularis and A.culicifacies continued to be resistant to DDT but susceptible to malathion whereas A.fluviatilis and A.maculatus were still susceptible to DDT. Bio-assay tests with DDT supplies from two different sources gave 100 per cent and 79 per cent mortality after 14 weeks. The Research and Training Centre at Hetauda, despite its limitations in physical facilities, equipment and trained manpower, has been active in training, conducting 8 courses totalling 24 weeks and training 181 parti- cipants. The research activities at this inadequately financed centre were largely entomological field studies on the ecology and bionomics of vector mosquitoes. The programme was also involved in the Regional Collaborative Studies on P.falciparum sensitivity to 4-aminoquinolines, and was pursuing studies on relapse pattern with single-dose treatment regimen, on G6PD deficiency, and on species complex of vector mosquitoes. The Health Education Section of the NMEO has initiated a number of activities, including the training of volunteers to promote community participation in malaria control activities. The internal assessment report reflects an increasing self-reliance in this activity. The external assessment was carried out jointly by the Government/US AID/WHO in March 1983; WHO provided two consultants. The assessment team was impressed with the gains of the NMEO in 1982 in respect of reduction in the number of vacant posts, higher spray coverage, improved PCD collections and efficiency of laboratory services. The recommendations of the team included reference to the need for development of criteria for the transfer of districts to ICHSDP, there being five districts projected for integration in 1983-84. With more and more districts under NMEO responsibility passing to ICHSDP, the operationally difficult districts in the Far-western Region with a population of 0.7 million, presently without specific antimalaria measures, may be brought into the NMEO fold. WHO collaboration during the period was in the form of technical support, and included provision of four consultants, fellowships, local cost subsidies and supplies and equipment. A consultant in bioenvironmental interventions was expected to be in position in mid-1983. Consultants will also be provided for a joint India-Nepal investigation on persistent transmission along the border, as resolved at the India-Nepal Malaria Coordination Conference held in Kathmandu in September 1982. In SRI LANKA, malaria incidence has shown a favourable trend; API has declined from 4.5 per 1 000 in 1981 to 3.62 per 1 000 in 1982 and SPR from 5.3 per cent in 1981 to 3.6 per cent in 1982. However, a slight - increase over the previous year of P.,falciparum infections was noticed owing to some focal outbreaks. Spraying of houses with malathion (zg/m2) every three months has been the principal anti-vector measure. However, the spraying programme has been rationalized following stratification of malarious areas into high- risk/special-risk and low-risk areas. In addition, limited larviciding end space spraying have been carried out as supplementary measures. Country-wide surveillance operations have been undertaken to monitor the epidemiological situation, and malaria cases have been given radical treatment. Monitoring of vector susceptibility to insecticides and parasite sensitivity to anti- malarial drugs was also carried out regularly. A.culicifacies continued to remain susceptible to malathion but resistant to DDT. Up till now there is no evidence of diminished sensitivity of IJ.falciparum to chloroquine. A new plan of operation covering the period 1982-1986 was signed in September 1982. WHO collaboration in respect of fellowships, local cost subsidy and supplies continued as before, and WHO project staff consisted of a malariologist, an entomologist and a sanitarian. The main constraints have been lack of staff of the category of regional malaria officers and inadequate supervision resulting in unsatisfactory spray coverage. The principal problem areas continued to be those where illicit gem mining and 'chena' (slash and burn) cultivation occurred. In THAILAND, out of 45.4 million people living in the malarious areas of the country, nearly 78 per cent live in areas where the ultimate goal is to eradicate malaria, whereas the programme objective with regard to the remaining areas inhabited by 22 per cent of the population is to keep the disease under a satisfactory level of control. Although the declining trend in mortality due to malaria has been maintained, no significant decline in case incidence has been noticed during the period, and the proportion of P.falciparum infections has remained unchanged. However, a satisfactory level of control has been maintained in the northern and north-eastern parts of the country, although the disease incidence along the eastern border has remained high because of technical problems such as drug resistance and vector exophily, and because of population movement. While a high degree of P.falciparum resistance to chloroquine is now prevalent in the whole country, this problem has assumed a particularly serious character in the south-eastern part of the country, where the sulphadoxine-pyrimethamine combination that replaced chloroquine is now believed to provide only a 10 per cent cure rate. In view of the prevailing situation a large-scale one-year field trial of mefloquine to combat this multi-drug resistant P. falciparum was initiated by the malaria service early in 1983 with the support of the Regional Office and the Malaria Action Programme of WHO headquarters; 100 000 doses of the drug are being supplied free of cost to the project. P.vivax infections were still sensitive to chloroquine, but were responsible for only 31 per cent of the infections. In addition to the routine DDT residual spraying campaign, the dosage being zg/m2, some areas of the country were protected by duniciliary spraying with fenitrothion (lg/m2) procured through Japanese ~ ~ assistance; he principal vectors, A.minimus and A.balabacensis (A.dirus). are still susceptible to DDT but are showing increasing evidence of exophilic and exophagic tendencies. The programme has taken steps to involve the community in malaria control activities. In addition to health volunteers, malaria volunteers covering 90 per cent of the villages assist in screening malaria cases. The volunteers work closely with health communicators, who are responsible for educating the public, In this connection, the health care approach to malaria control in the light of the revised strategy was the subject of the WHO-supported workshop held in Phuket, mentioned earlier. Final evaluation of the US AID anti-malaria project, which has provided for the establishment of malaria clinics and strengthening of research facilities, takes place this year. WHO collaboration continued as before in respect of fellowships, grants and supplies. During the review period the Organization had a malariologist and an entomologist in position and, for part of the period, a technical officer. Early in 1983, as part of the Sir Robert Jackson Commission sponsored by the United Nations, the WHO malariologist participated with HQ personnel in a malaria and nutrition survey of the migrant populations along the Thai-Kampuchean border. 2.3.2 Schistosomiasis INDONESIA launched a well planned and coordinated programme for the control of schistosomiasis due to S. japonicum in Central Sulawesi, where the disease is endemic. The programme aims at supervised comprehensive treatment of cases and surveillance of the vector. Experience gained in this project would play a significant role in planning for the prevention and control of vector-borne parasitic diseases in the country's trans- migration schemes. A WHO consultant visited the country in April 1983 to assist in the development of plans for research on schistosomiasis. His findings contributed substantially in developing a comprehensive plan for pre-emptive surveillance and control of parasitic diseases prevalent in areas where transmigrations are to be carried out from 1984 onwards. Endemic foci of Schistosomia mekongi on the Thai-Kampuchean border continued to be present leading to sporadic cases. The WIO TDR (Special Programme for Research and Training in Tropical 9iseases)~was collaborating with the Centre of Malacology, Mahidol University, in assessing the role of the intermediate host in transmission and in designing practical methods for its overall surveillance. Another small endemic focus still exists in Gymvi, Maharashtra (India). The Government of India is planning to conduct a study on this focus. 2.3.3 Filariasis Filariasis continued to be one of the major health problems among parasitic diseases, especially in Bangladesh, Burma, India, Indonesia and Sri Lanka. In BANGLADESH, surveys have indicated rather high microfilaria rates in some parts of the country, as high as 15 per cent positive results in some samples. Efforts were made to organize the control activities in a planned manner; however, inadequate resources and manpower are the limiting factors. In BURMA, special surveillance carried out in July-December 1982 showed a 2.44 per cent positivity rate among the surveyed population. The number of slides examined for filariasis in the country was increasing steadily and, during the second half of 1982, out of 48 383 slides checked 1 182 were found positive. The vector, Culex quinquefasciatus, is distributed all over the country and the disease, primarily recognized as mainly an urban problem, is now detected even in very small and contained rural settings. In INDIA, the disease is endemic, Lbancrofti being the predominant parasite. The therapy with DEC was the main control measure used in the national project since the vector control activities undertaken in the project did not produce the desired results. The WHO/TDR Programme continued to support studies in INDONESIA aimed at improved surveillance and better knowledge on vector behaviour and parasite transmission. Reseasch on filariasis in Bengkulu, supported by a TDR grant, confirmed a high endemicity of B.ma1ayi and identified precisely the vectors and their bionomics. Confirmation of the nocturnal periodicity of the parasite in the peripheral blood of the patient had implications for the surveillance programme. A working group on filariasis (and schistosomiasis) has been estab- lished with the objectives of setting priorities, preparing and implementing appropriate programmes and supervising studies leading to improvement of the services. Tne coordinating and programming role of the group was co~isidered important in view of the planned relocation of a greater number of transmigrants to less populated islands where filariasis was endemic. In SR1 LANKA, research is being carried out on the application of biological vector control methods. Results so far achieved showed that use of B.thuringiensis as an antilarval agent might find its place as an effective control technique against Sulex qu+fasciatus in areas where the vector popula on was dense and filariasis reached high endemicity In THAILAhD, where microfilaria rates were around 2 per cent, the control strategy depended upon DEC mass treatment to reduce microfilaraemia and interrupt the transmission chain, 2.3.4 Leishmaniasis This remains an important problem in India (four endemic states) and Bangladesh. In BANGLADESH, the diagnostic unit for parasitic diseases set up at the National Institute of Preventive and Social Medicine, Dhaka, in 1982 with the assistance of a MI0 consultant, could now be the potential centre for conducting surveys and surveillance more systematically than ever before. Malaria poses serious public health problems in many countries of the Region. Regular blood exam;nat;ons of cases of fever are part of the strategy against malar;;.. MALARIA In order to control malaria cffecrwe~y !t ,s necessary lo undersrond ,Is vecrors better. Here [no mal3ria workers are collecting mosquito samples for entomological studies. h7icroscopic examination of blood shdes under field conditions to confirm malaria and establish slide positirity rates. Spraying is one of Lhz strategies employed for controllinq the incidence of malarin. Spvl,,,,, examinarion is an;moorlanl in r!le drrecrirri of infecoous cases of luberculos~s. Here. a parienr is de1;vermq a sample lo a heallh worker. COMMUNICABLE DISEASES A new area of kala-azar was detected in 1982 in Fulbaria, Mymensingh, where an extensive survey was carried out, in which both clinical and laboratory-oriented investigations of both bone-marrow and spleen were conducted. An entomological survey confirmed the abundance of sandflies in this area. Measures were undertaken to effect surveillance on a continuing basis and in a systematic manner. INDIA, where a task force on kala-azar has been functioning since 1979, designed practical plans for the surveillance and control of the disease in Rajasthan, Orissa, West Bengal and Bihar. Studies on the ecological aspects and behavioural patterns of the sandfly continued. Research on elucidating the inter-relationship among the vector, the parasite and the host was also bring conducted. 2.4 Bacterial Diseases Leprosy and tuberculosis control programmes are carried out as either separate or combined activities usually integrated with general health services. WHO continued to assist countries in the Region by making available the necessary technical knowledge and expertise, supported national and inter-country training activities, and organized workshops, seminars and meetings for the exchange of experience. Many countries expressed their special interest in the application of multidrug therapy in leprosy control to prevent dapsone resistance and reduce the mycobacterium load in the environment. The Japan Shipbuilding Industry Foundation and other aid organizations and voluntary agencies were playing a major role in leprosy control programmes. Through the TDR Programme WHO assisted the countries in undertaking field research to develop efficient and feasible methods and techniques which were acceptable to the community, for leprosy control activities. 2.4.1 Tuberculosis Tuberculosis is one of the leading health problems in South-East Asia. Early detection of infectious cases and their efficient treatment, together with imunization, specifically of the vulnerable group of children, continue to be the main strategies for control and prevention. BCG vaccination was undertaken as a part of the expanded programme on imunization (EPI) in all the countries in the Region. BANGLADESH has been implementing a combined programme for the control of tuberculosis and leprosy. By the end of 1982, more than 45 000 new cases had been reported by tuberculosis clinics and rural health centres, approximately 25 per cent of them being infectious. In December 1982, BCG vaccination as a continuous programme was sanctioned to cover all children below the age of 15 years, and about 500 000 children have been vaccinated so far. The Government is making serious efforts to increase the coverage as the target population to be vaccinated is estimated to be 45 million. Orientation training in tuberculosis and leprosy commenced in December 1982 and continued through February 1983. In INDIA, both tuberculosis and leprosy control are included in the twenty-point priority programme of the Government. WHO continued to provide technical assistance, specifically to the Tuberculosis Research Centre in Madras, which is engaged in a number of clinical, laboratory and field research activities, with a view to improving tuberculosis control. In MALDIVES, case detection by direct sputum smear examination continues wherever the possibilities of slide collection exist. The positivity rate is 0.8 per cent. Job-oriented training for both community health and family health workers was carried out. In NEPAL, WHO has been assisting manpower development through fellowships and in-service training programmes. A group training course for junior auxiliary health workers was conducted in October 1982. The programme, however, continued to face difficulties in ensuring timely and adequate supplies of anti-tuberculosis drugs owing to procurement and distribution problems. One of the brighter aspects of the programme, however, was the cooperation between the national health authorities and the Nepal Anti-~berculosis Association in the delivery of the treatment component of the programme at the peripheral, community level, especially to identify defaulters and follow-up with treatment. 2.4.2 Leprosy Leprosy continued to pose a serious health problem in many countries of the Region. According to latest data available, there are not less than five million leprosy patients in the Region and the problem exists in 9 out of the 11 Member Countries. In spite of efforts being made in the countries of the Region for many years to control this disease, only around 60 per cent of the estimated five million cases could be registered for treatment, As a follow-up action to implement the recommendations of the technical discussions held during the thirty-fifth session of the Regional Committee on "Control and Prevention of Leprosy in the Context of Primary Health Care", the Organization continued to support Member States and initiated measures for carrying out the following practical steps to strengthen the leprosy services in the Region: (1) collaboration with national authorities for the reorientation and refinement of community-based national plans and strategies for leprosy control, including the development of an appropriate information system, essential laboratory services, training of personnel and monitoring and evaluation of the programmes, and (2) development of a regional plan of action in support of national programmes for leprosy control in collaboration with other United Nations agencies concerned as well as multilateral, bilateral and non-governmental organiza- t ions. Also, a Meeting on Action Plans for Leprosy Control, held in New Delhi from 23-25 August 1982 and attended, among others, by donor agencies, developed a guideline for preparing plans at country level. In BANGLADESH, leprosy control activities were being intensified through (a) health education, (b) survey of the total population, especially in endemic areas by house-to-house visits, (c) training of the health staff including thana health administrators and all basic auxiliary workers, and (d) regular treatment for leprosy cases at the thana health complexes. In BHUTAN, where 50 per cent of leprosy patients have been registered for treatment, arrangements were being made for introducing the multidrug regimen. Control activities were being supported mostly by voluntary organizations from abroad. In BURMA, the rifam~icin trial, which had completed six years of operation, was extended further up to 1985. The WHO statistician attached to this project completed his assignment in December 1982. The outcome of the rifampicin trial is very satisfactory: effective results of the introduction of rifampicin were noticed after two years of treatment - lowering of the incidence of leprosy in comparison with the control group. The dapsone-resistance survey in Myingyan township progressed satisfactorily. Results of the survey indicated that 36 per cent of open cases were suspected to be resistant cases, increasing at the rate of three per cent a year. Mouse foot-pad inoculation was being regularly used at the Immunology Section of the Department of Medical Research, Rangoon, though the capa- bility of this laboratory was limited to two specimens a week. Training of the leprosy staff - mostly refresher courses for retraining - was conducted regularly. It is planned to train 658 workers in leprosy from 1983 to 1986. WHO was collaborating with the national training programmes for leprosy control. In general, the leprosy control programme in Burma is being operated as an integral component of the health services. SO far, 165 of the 314 townships in the country have been covered with the leprosy control programme being operated as an integral part of primary health care. In INDIA, a well-planned project for the intensification of leprosy control was being implemented in six districts chosen on the basis of high endemicity and other criteria. Three national consultants were recruited with WHO support and funds from SIDA, to coordinate the implementation of the multidrug regimen in these districts. Training of the staff dealing with, anti-leprosy work was conducted at Karigiri in Tamil Nadu and at Agra in Uttar Pradesh. WHO also supplied equipment to the training centres and awarded fellowships to a number of trainees. Both institutional as well as field research activities were undertaken to solve problems of early diagnosis and field operations. In INDONESIA, leprosy control was being carried out by the Government as well as voluntary organizations at the national level in collaboration with WHO. The main activity was the training of national health staff of varip~s categories at the National Leprosy Training Centre, Ujung Padang, which was, assjsted by. a consultant leprologist. Two further primary health chre centres havk undertaken case-holding as a step towards the integration bf leprosy control activities with the general health services preceded by a random 'sampling survey. Random sampling surveys were also conducted in three provinces, namely, North Sumatra, South-east Sulawesi and East Java, funded by the Sasakawa Memorial Health Foundation, Japan, the Lhmien Foundation, Belgium, and the National Leprosy Relief Fund. Two provinces woula be surveyed to assess the leprosy situation during the remaining mbnths of the year. A WHO leprologist participated in the random sampling surveys and a WHO statistician assisted in statistical analysis both in the preparatoj phase as well as during the survey. The OMSLEP (WHO) system of recording and reporting was being tried in Cirebon district, West Java, with WHO collaboration. Facilities for the mouse foot-pad inoculation technique were developed and the technique used in the Central Laboratory, Jakarta, with encouraging results. In MALDIVES, leprosy control activities continued mostly through regular case-holding and supervisory visits. The operational cost of the programme was being met by the Damien Foundation, which also provided a medical officer for this task. Multidrug therapy was introduced on one island with high endemicity and would be extended further in the next phase to the southern islands of Gaafu Dhaalu and Gaafu Alifu atolls so that ultimately multidrug therapy would become the routine method of treatment. The leprosy control programme in NEPAL was being carried out in a coordinated manner. The Government's leprosy unit coordinates the activities of both external and internal agencies working in the country. All these agencies have specific roles to play in the national leprosy control programe. .Multidrug therapy was introduced in Bagmati Zone (Central Region) and would be gradually extended to the entire area of the Central Region by 1985. A WHO medital officer visited Nepal during February-March 1983 to monitor the multidrug therapy activities and review the situation in order to assess the need for further assistance. Facilities for the mouse foot-pad inoculation technique were developed in Anandban Hospital. Intensification of the control measures for the entire country was planned and efforts were under way for training adequate numbers of health manpower in support of the leprosy control prograttnoe. Supervisory visits frcm the Central Region to the periphery were further geared up in order to improve the programme activities. In SRI LANKA, the national ant i-leprosy programme continued with two medical officers and 16 trained public health inspectors who were directly responsible for leprosy control work. Active case-finding was done by school surveys, surveys of special population groups and contact surveillance. It is observed, however, thet the largest number of cases were reported by medical and paramedical personnel of the health services and by general practitioners. In THAILAND, the third survey under the protocol of evaluation of leprosy control activities in Khon Kaen Province was completed. The relevant information derived from this survey would be used in developing a model for leprosy control activities as an integral part of health care services. Case-finding and case-holding activities in most of the provinces were being intensified together with the multidrug therapy in field operations. Mouse foot-pad inoculation was being carried out in the Central Laboratory, Bangkok, which also undertakes immuno-pathology studies as a research activity. Primary health care workers were being trained in various aspects of leprosy control in all provinces. 2.4.3 Sexually-Transmitted Diseases Sexually-transmitted diseases (STD) contiriued to be a problem in countries of the Region not only from the point of view of public health but also on account of their adverse economic and social effects on the patient as well as on the community. To complicate the situation further, penicillinase-producing gonococci infections appeared to have increased further in Indonesia and Thailand. A slowly but steadily increasing trend in India and Sri Lanka was also causing concern. In INDIA, the STD control programme laid greater emphasis on the training of health manpower. Educational activities continued to be organized for medical officers, who were also awarded fellowships in order to enable them to acquire additional knowledge. During the Fourth Five-Year Plan, the STD control programme had been included as a purely central sector scheme, under which provision was made for the establishment of regional teaching-cum-training centres, one regional centre, four regional STD reference laboratories and four regional survey-cummobile STD units. Following the training workshop held in May 1982 in Calcutta for the laboratory technicians of district hospitals from eight states, which on evaluation indicated that 95 per cent of the participants had learnt adequate laboratory techniques in the field of STD, another workshop was organized in December 1982 for medical officers working in the district hospitalsjprimary health care centres in five more states. Tnis workshop provided adequate orientation to the medical officers in improving the clinical, diagnostic, therapeutic and laboratory aspects of STD control activities. In INDONESIA, WHO consultants reviewed the existing data on the epidemiology of the disease in order to assess the control programme, and participated in the evaluation of regular mass treatment of infected persons for the control of STD. It was observed that most infectious cases occurred in the age group of 20-29 years, followed by those of 15-19 and 30-39 years. The national STD control programme directed its efforts towaras the control of syphilis through the training of health personnel at all levels, development of diagnostic capabilities, development and distribution of material for health education of the community, and systematic antibiotic prophylaxis of the high-risk groups, SRI LANKA has a modest STD control programme, as most of the cases of sexually-transmitted diseases are being treated by private practitioners. The Directorate of Health Services orgznized several review meetings on the progress of the national activities against STD in order to improve the national programme and its coverage, In THAILAND, while the STD control programme continued as planned, the laboratory and research section of the Venereal Diseases Division of the Ministry of Public Health initiated studies on penicillinase-producing Neisseria gonorrhoea and pelvic inflammatory diseases in the infected population. The results of the study, which were being analysed at present, wou1.d be presented at a regional meeting of the International Union Against the Venereal Diseases and the Treponematoses to be held in June 1984. Methods for laboratory diagnosis including culture for Hemophilus duereyi and Chlamydia also were further improved. 2.4.4 Diphtheria, Pertussis and Tetanus The epidemiological data and the activities related to the control of these diseases are described under 2.6, "Expanded Programme on Immunization". 2.5 - Viral, Chlamydial, Rickettsia1 and Related Diseases This group of diseases was creating growing concern to public health administrations on account of their increasing trend. The so-called fevers of unknown origin, hepatic disorders of non-defined etiology, and cerebro- meningial symptoms of suspected viral origin, were mostly being precisely diagnosed now as a result of the availability of rapid viral techniques for diagnosis. Application of modern techniques is now being taught at inter- country and national workshops to enable rapid diagnosis of DHFIDSS, viral 0 hepatitis, influenza, and other viral respiratory tract infections which continued to remain undiagnosed in the not-too-distant past. These techniques would be more widely used in the near future as a result of extensive training programmes for building up adequate laboratory manpower and efforts to develop laboratory facilities, including the production and distribution of reagents. In the case of viral hepatitis, studies continued for defining the pattern of transmission and the efficacy of the hepatitis B vaccine in preventing chronic liver diseases. WHO has been assisting three countries (Indonesia, Sri Lanka and Thailand) in the conduct of epidemiological studies on dengue virus infection and transmission in selected areas where the disease is either endemic or silent. The results are expected in 1985 and, if valid, will have an important impact on improvement of the surveillance of the disease. They will also help in understanding the pattern of virus transmission in different ecological conditions. Meanwhile, support is being provided for the development of a dengue vaccine at the WHO Collaborating Centre for Research in the Immunopathology of DHF and Dengue Vaccine Development in Bangkok, Thailand. The candidate vaccine has been processed to the stage where initial human trials can be planned. The South-East Asia Region has been recognized as the global focal point for the coordination of research on DHFIDSS. 2.5.1 Trachoma Activities for the control of trachoma are carried out as part of the programme for the prevention of blindness (see 3.3, "Prevention of Blindness" ) . 2.5.2 Poliomyelitis All countries of the Region participated in the International Programme of Poliomyelitis Surveillance. The vaccination component is described under 2.6, "Expanded Programme on Immunization". In MONGOLIA, during an outbreak of poliomyelitis, sero-studies confirmed the existence of polio I strains in 70.2 per cent of the cases, polio I11 in 6.4 per cent and other enteroviruses in 23.2 per cent. Improvement of epidemiological surveillance of the disease and stricter monitoring of vaccination at district level were achieved which contributed to the control of the disease. 2.5.3 Dengue Haemorrhagic Fever (DHF) DHF with or without accompanying dengue shock syndrome (DSS) persists as a major health problem in Burma, Indonesia and Thailand. Sporadic cases diagnosed clinically occurred in Bangladesh, India and Sri Lanka. WHO continued to provide technical cooperation for the development of epidemio- logical and entomological surveillance, strengthening of virus laboratory services, improvement of diagnosis, clinical management of dengue cases, specifically with shock syndrome, and in research and training activities. WHO consultants collaborated in ongoing research-cum-service activities in Sri Lanka and Thailand. Epidemiological research studies on DHF/DSS which had been started in the previous years, continued in the endemic and silent areas in Thailand, Indonesia and Sri Lanka. In August 1982, an inter-country meeting of principal investigators of these studies was convened in New Delhi with the objective of assessing the progress made, reviewing the methods and protocols for improving them, and analysing the results obtained so far. The WHO Collaborating Centre for Research in the Immunopathology of DHF and Dengue Vaccine Development in Bangkok, Thailand, continued to receive WHO support. The Australian Development Assistance Bureau (ADAB) also contributed financially through WHO/WPRO to the research work of this centre. The experimental part of the development of a vaccine, including testing on animals, was completed and plans were being drawn up to initiate the first human trials by the end of 1983 or early 1984. The Centre continued its research on the clinical, epidemiological, diagnostic and immunopathological aspects of the disease and on the improvement of diagnosis. 2.5.4 Viral Hepatitis This disease has been assuming increasing importance as a serious health problem in several countries of the Region in recent years. Hepatitis A affects mainly the child population, and B is prevalent in adults. The recent outbreaks of viral hepatitis in India and Nepal, and the reported increase of cases in Mongolia, indicated that non-A, non-B virus might be the leading cause of the majority of reported hepatitis cases. National task forces on liver diseases including hepatitis in Bunna, India and Mongolia identified areas for research, such as community-based transmission studies, linkages between acute viral hepatitis and chronic liver disorders, development of technologies for rapid diagnosis including the production of reagents, and methods to strengthen surveillance. In BURMA, research on hepatitis B virus infection and its transmis- sion continued, producing already significant findings which contributed towards improvement of the surveillance of the disease. The prophylactic immunization to prevent HBV infection in newborns continued and preliminary results appeared to be encouraging, showing the protective efficacy of the vaccine in the majority of cases. The follow-up of vaccinated children during the first two years, which was continuing, was likely to provide more valid results contributing towards the formulation of preventive strategies. In NEPAL, an outbreak of viral hepatitis in Kathmandu Valley was investigated with the assistance of a WHO consultant who confirmed that the majority of cases were of non-A and non-8 etiology. A study on viral hepatitis was initiated in 1982 and would continue in 1983. 2.5.5 Japanese Encephalitis Cases of the disease were reported from Burma, India and Nepal. However, systematic surveillance of the disease needs to be organized. particularly in Nepal. 2.6 Expanded Progranune on Immunization hring the year under review, implementation of the Expanded Programme on Immunization (EPI) continued in 10 countries of the Region, with the full support and cooperation of WHO, UNICEF, UNDP and other participating agencies. In most of these countries, not only did coverage of the target population increase considerably but the number of different vaccines used in EPI also increased. For example, in addition to DPT, introduction of oral poliomyelitis vaccine and measles vaccine was being attempted in several countries. The main components of WHO collaboration for the development of EPI in Member States include the organization of training courses and workshops, technical back-up support through Regional Office staff and consultants, support to operational research, assistance in the conduct of programe reviews, advisory services in identifying and procuring appropriate supplies and equipment, and the holding of meetings to permit an exchange of ideas and knowledge between countries. bring the year under review, the main thrust of the immunization programme was directed towards the implementation of the Five-Point Action Programme on EPI endorsed by the World Health Assembly in 1982 in resolution WHA35.31. Promotion of EPI within the context of PHC: Immunization services have been integrated into the basic health services in most countries of this region. Recent national programme reviews have combined assessment of EPI and MCH activities (~ri Lanka - 1981) and with various components of PHC activities (Thailand and Indonesia - 1982). Development of human resources for EPI: In support of national programmes, several inter-country and national EPI courses and workshops were held with WHO collaboration. A joint WHO/UNICEF Inter-country Workshop on Repair and Maintenance of Refrigerators for Repair Technicians was held in India in January 1983. An Inter-country EPI Workshop for Mid-Level Managers was held in Burma in 1983 in which 23 national participants were trained from six countries of the Region. In addition, 12 national EPI management courses for mid-level workers were conducted in three countries with WHO support. During 1982, under EPI, fellowships were awarded to 12 persons from five countries of the Region for training abroad. Financial resources for EPI: In general, the WHO budget to support immunization activities in SEAR countries remained stable when adjusted for inflation, as were the national budgets. It was felt that additional funds would be required from both internal and external sources if the target of providing immunization to all children by 1990 was to be met. Review of evaluation of programmes for improving coverage: National immunization programmes, along with some components of PHC, were evaluated in Thailand by a joint Government/UNICEF/WHO team, and in Indonesia by a joint Government/UNICE~/US AID~WHO team. These reviews, including one week of field surveys in rural areas, generated information on the immunization coverage, the level of PHC activities at village and district levels, the level of knowledge and motivation of the health staff and of the community health worker, the level of knowledge and the degree of participation of the community, the logistics and cold-chain problems, and finally the surveillance of the EPI target diseases. Analysis of the information derived from these reviews facilitated the identification of problems and issues to be tackled for the improvement of the programme and indicated ways and means to tackle them. Actions were taken in most countries based on these findings. In addition to these international reviews, most of the countries in the Region have systematically implemented immunization coverage surveys in selected areas. In 1982, 94 immunization coverage surveys were conducted in six countries. These coverage surveys were very useful, as they not only provided information on the immunization coverage, on the reasons for failures of immunization, and on the sources of immuniza- tion, but also stimulated the EPI staff at all levels in better performance based on a better understanding of the problems and their solutions. The figures for reported rates of coverage in respect of individual countries and for the whole Region are given in Tables 2 and 3. To assist in progranrme review, training, management, immunization coverage surveys and evaluation of EPI, WHO staff visited nine out of eleven countries of the Region. In addition, a total of 12 consultantships were provided to seven countries. Surveys to assess the incidence of polio, neonatal tetanus and measles were conducted in Burma, India, Indonesia, Maldives, Nepal and Sri Lanka. Research efforts as a part of programme operations: A number of research projects for increasing the efficiency and effectiveness of the immunization prograrmne in rural and urban areas were supported both techni- cally and financially. In Nepal, a simplified protocol for an epidemiologi- cal survey to establish baseline data on the diseases, which was required in order to measure the impact of EPI, was developed and field tested with the assistance of WHO. A research project in Thailand to evaluate the use of birth certificates and letters to parents to improve immunization coverage in urban areas was recently completed. Studies on the suitability of cold-chain equipment were carried out in Bangladesh, Burma, India, Indonesia, Nepal, Sri Lanka and Thailand. As a result of these studies, new products were developed and existing equipment improved. A collaborative field trial of solar-powered refrigerators was under way in India, Indonesia and Maldives. India was conducting a field trial of a newly developed cold-chain monitor in two states, while Nepal was field testing a measles vaccine potency indicator. The results of research projects already carried out in the countries of the Region were being utilized for improving programmes or for more extensive studies. The main activities in the countries are as follows: In BANGLADESH, the programme was further expanded to provide services at 600 immunization centres. Although the reported number of immunizations provided in the year under review increased considerably, it did not reach the target laid down in the plan of operation for 1979-1983. Table 2 shows that the percentage of children reported immunized by 12 months of age was still very low. Regarding supplies and equipment, at present, each district EPI unit is provided with one deep-freezer, two refrigerators, five cold boxes and one vaccine carrier. The production of tetanus toxoid has started. Annual production of the toxoid was expected to be 4 million doses, which was sufficient to meet the needs of the country. In BHUTAN, the number of children immunized with BCG, DPT (three doses), polio (three doses) and measles either declined or remained at the same level as in the preceding year. For example, BCG was provided to 17 044 children in 1982, as against 27 721 children in 1981; three doses of DPT were provided to 4 237 children in 1982 as against 5 384 children in 1981. To strengthen the programme further, a UNDP-funded EPI project is being developed. In BURMA, EPI was extended to an additional 18 townships, for a total of 121 townships under the programme in 1983. Compared with the 1981 data, the number of immunizations provided to eligible children increased Table 2 CHILDFEN KEPOKTED IMMUNIZED KY 12 EtONTHS OF AGE AND PREGNANT WOmN IMMllNIZED AGAINST TETANUS IN SEAR COUNTRIES Country Children (up to 12 months) Pregnant Women Year KG UY't 3 0PV 3 Measles Estimated TT 2 Estimated o f elieible target eligible tarret data u ,, .. ------------ (percentage)------------ (number) (percentage) (number) Bhutan 8.5 4.2 4.2 17.5 50 000 0 64 000 198 2 - Bunna 20.3 8.2 1.7 fl 1 122 000 8.7 1 300 000 1982 -- - -- - - India 13.7 34.7 10.9 0 . 2 20 998 000 17.3 26 398 000 1982 Indonesia 53.6 0.8" 0 . (1 0.1 4 910 000 12.2 6 083 000 1982 a. w Maldives 21.1 1.9 1 .Y 74. 9 6 000 14.9 8 UO0 1982 Mongolia 49.8 75.3 86.4 95.5 63 000 0 714 000 1982 Nepa 1 43.4 17.1 2.9 2.1 504 000 27.1 650 000 1982 Sri Lanka 63.0 77.3 75.1 0 417 000 40.9 476 000 1982 SEAR 21.9 24.9 9.7 0.6 32 676 000 15.2 40 735 000 - Source: Estimated from data available in SEAR0 by 13 April 1983. Note: Figures not available for DPK Korea. - "DPT (2 doses) = 22.8 per cent; **DPT (2 doses) = 55.6 per cent. Table 3 WOMEN OF CHILD-BEARING AGE (15 TO 44 YEARS) IMMUNIZED AGAINST TETANUS* IN SEAR COUNTRIES, 1978-1982 (~urnber) Country Year Percentage Estimated eligible 1978 19 79 1980 1981 1982 1978-1982 of eligible target 1982 target Women 15-44 years Bangladesh 2 179 4 760 5 617 21 486 43 100 77 142 0.4 19 537 000 Burma 20 280 31 109 44 847 71 894 112 804 280 934 3.6 7 755 000 India 3 507 450 3 716 552 4 605 612 5 235 272 6 523 722 23 588 608 16.1 146 501 000 U 0 Indonesia 144 105 227 712 475 291 472 706 741 227 2 061 041 6.1 33 889 000 -- - -- - - - - - - - - Maldives 8 00 803 615 14 3 1 719 4 080 12.4 33 000 Nepal 0 31 872 35 040 106 610 211 270 384 792 11.4 3 371 000 Sri Lanka 125 069 166 257 185 675 174 755 194 795 846 551 25.1 3 371 000 Thailand 104 512 193 756 267 739 330 389 386 889 1 283 285 11.9 10 778 000 SEAR 3 904 395 4 372 821 5 620 436 6 413 255 8 215 526 28 526 433 12.7 225 235 000 Note: Figures not available for Bhutan, DPR Korea and Mongolia. - *Tetanus toxoid, two doses. by 72 per cent for DPT (three doses) and 49 per cent for BCG. Polio vacci- nation was introduced in Rangoon Municipality in 1982, and in four townships of Mandalay city in 1983. The coverage survey conducted in Rangoon Municipality in March 1983 showed that 53 per cent of the children surveyed had received three doses of the polio vaccine. Thirteen immunization coverage surveys and 11 polio and neonatal tetanus surveys were conducted in different areas of the country, and contributed to building up the baseline data. A staff member from WHO headquarters visited Burma to advise on the strengthening of polio surveillance and to plan a study to determine whether oral polio vaccine can be successfully given to infants of less than three months of age. The protocol of the study was under finalization. Two national mid-level management courses held with WHO support in 1982-83 were attended by 50 health staff. An evaluation workshop for township officers of states/divisions was held in Rangoon in 1982, and reorientation training of basic health workers was conducted in phase I1 townships in 1983. In INDIA, the reported coverage of eligible children by three doses of DPT and three doses of polio vaccine increased slightly compared with the coverage in the previous year, while the coverage by BCG declined from 25.4 per cent in 1981 to 15 per cent in 1982. Twenty-six immunization coverage surveys were conducted in different states with a broad range of results. The national survey of polio and neonatal tetanus incidence, started in 1980, continued in 1982. A national consultant assisted in conducting the survey in Bihar. hro consultants, one of them a national, were assigned to assist the national authorities in the evaluation of EPI in two states - Uttar Pradesh and Maharashtra. The measles immunization feasibility study continued during the period under review. The results of this study were discussed at the fourth meeting of professors/assistant professors of medical colleges who participated in the measles project, held in Delhi in April 1983. The national workshop on the control of poliomyelitis was held in November 1982, when all aspects of poliomyelitis surveillance and control in India were discussed. The workshop was attended by two staff members from WHO headquarters, who also visited Bombay, Tamil Nadu and Gujarat to study different aspects of polio in the country. Ten national mid-level management courses, held with WHO support in different states, were attended by 220 health staff. Two cold-chain and logistics courses were held with 25 participants. By 1982, the immunization programme had been introduced in over 60 per cent of all kecamatans in INDONESIA (compared with 5 per cent of kecamatans in 1977). The reported coverage in 1982 of eligible children was 53.6 per cent in BCG, 22.8 per cent in two-dose scheduled DPT, 0.9 per cent in three doses of polio in children and infants, and 12.2 per cent in two doses of TT in pregnant women. Polio and measles vaccines were given in a limited area. Thus, achievements in immunization coverage and implementation of EPI target vaccines were not adequate when compared with the geographical expansion of the programme. A joint Government1~~0/UNICEF/US AID evaluation team conducted a mid-term review of the immunization programme and some selected PHC activities in September-October 1982. The programe review provided valuable data on the implementation of EPI in the country and problem areas were indicated. As a follow-up of the recommendations made by the review team, a National Advisory Board on Immunization was established, efforts to coordinate the activities of the programme closely with PHC were given priority and were progressing well, and the priority of the programme for reduction of mortality among children under five years of age was recognized at the decision-making level. A long-term epidemiologist continued to provide technical support to EPI activities. A consultant was assigned to assist the nacional staff in EPI and communicable disease control in Jakarta municipality. With UNICEF support, a national course on repair of refrigerators was conducted in Jakarta with 20 participants. In MALDIVES, although all EPI target vaccines are provided for children in more than 80 per cent of the country's territory, the percentage of coverage is still low in the case of three doses of DPT and polio (see Table 2). Mass vaccinations against measles were carried out during 1981-1982, with a 74.5 per cent coverage. EPI training has already been included in the curriculum of community health workers, nurse aides and family health workers. Lectures regarding EPI were included and carried out for atoll chiefs, assistants of atoll chiefs and island chiefs during refresher courses organized by the Ministry of Atolls Administration. A national cold-chain and logistics course was held in April 1983, which was attended by 20 participants, under UNDP funds. Material supplied by WHO was translated into the national language for this course. Immunization coverage continued to remain very high in MONGOLIA and the EPI target diseases were completely under control. The cold-chain system for vaccine storage and distribution was further improved. Forty-three per cent of all somons have cold chain equipment. Four refrigerators were donated by Luxembourg through WHO in 1982. A regional EPI staff member visited the country to assist the national authorities in reviewing the programme. In 1982, EPI was further expanded in NEPAL and is currently being implemented in a total of 46 districts. The reported coverage of children below 12 months of age in 1982 increased and was as follows: BCG, 43.4 per cent; DPT (three doses), 17.1 per cent; polio (three doses), 2.9 per cent; measles, 2.3 per cent; and pregnant women with TT (two doses), 27.1 per cent. At present, measles and polio vaccines are provided at the large hospitals only, but it has now been decided to start polio and measles imunizations in 36 districts in a phased manner. During the year under review, a WHO consultant and a staff member from WHO headquarters visited the country to develop and field test the simplified protocol for an epidemiological survey to establish baseline data on the five EPI target diseases. Twenty-seven health workers were trained at a national EPI mid-level management course funded by WHO. Seminars and refresher training courses were conducted for senior supervisors, senior sanitarians and senior EPI staff and for district supervisors. Immunization was provided to eligible children within the context of MCH services throughout SRI LANKA. The programme was delivered through fixed and outreach centres. The target of 80 per cent coverage by all vaccines for children under one year and 50 per cent coverage by two doses of tetanus toxoid for pregnant women had been set for 1981. However, the programme could not achieve this target. In any case, in 1982, the reported coverage of children under one year was as follows: BCG, 60 per cent, three doses of DPT, 66.3 per cent, three doses of polio, 68.9 per cent, and two doses of TT to pregnant women, 36.1 per cent. A WHO consultant was assigned to help the Government in conducting a survey to study the public health importance of measles and the feasibility of introducing measles vaccine in the country; the survey showed that measles morbidity and mortality was a serious public health problem. The Government initiated action based on the results of the survey and the recommendations of the consultant. In THAILAND, the programme made impressive progress in different areas, and as a result there was evidence of a reduction in the incidence of some EPI target diseases. In 1982, the reported percentage of children immunized by 12 months of age was as follows: BCG - 76.6 per cent, DPT (two-dose schedule) - 28.8 per cent, polio (three doses) - 35.4 per cent, pregnant women with TT (two doses) - 28.8 per cent. There was strong evidence that the medium-term objective of the programme, i.e., to increase the coverage of children under one year of age and of pregnant women to over 80 per cent at the end of 1986, would be reached successfully. Twenty imunization coverage surveys were conducted in 1982. A joint Government/WHO/UN1~~~ review of EPI and selected PHC activities was carried out in August-September 1982. The recommendations of the review team for the further strengthening of the programme were under consideration by the Ministry of Public Health. 2.7 Veterinary Public Health (VPH) Several countries in the Region are active in the field of veterinary public health and zoonotic diseases. Having identified rabies control as the priority zoonotic problem, India established a national programme on rabies control with technical inputs from WHO. The Medical Officer in Veterinary Public Health from the Regional Office visited Sri Lanka where a new Rabies Control Act had been enacted, and evaluated the rabies control programme. A national training course on rabies diagnosis was organized in Indonesia; the Medical Officer also visited Indonesia to advise on the rabies control programmes in outlying areas. The rabies control programme in Thailand was also reviewed. WHO continued to support the training of VPH officers. WHO staff participated in a workshop/seminar organized by the National Institute of Communicable Diseases, Delhi, to train VPH officers. A national seminar on zoonoses was organized in Nepal with WHO support. The production of tissue-culture vaccine for veterinary use, which was initiated in India, Indonesia and Thailand, was further strengthened by technical inputs from the Regional Office and a WHO staff member from the WHO Regional Office for the Americas. The seed virus provided by WHO was adapted to BHK 21 cell line. In BANGLADESH, a WHO consultant assisted in strengthening the surveillance of zoonotic diseases, particularly Japanese encephalitis and brucellosis. Support was provided to MALDIVES in establishing the diagnosis of an epizootic in cats. WHO supported countries of the Region by providing reagents for the surveillance of plague and brucellosis. Burma was supported in the prevention and control of plague. India organized inter-state coordinating meetings on plague. The WHO programme on the production of tissue culture anti-rabies vaccine for human use (at the Pasteur Institute, Coonoor, India) was further strengthened by the assignment of a consultant and the provision of supplies and equipment. A new rabies virus strain adapted to human diploid and vero cell lines would be provided on a bilateral basis to the Pasteur Institute, Coonoor, by the Pasteur Institute, Paris. An inter-country training course on tissue culture vaccine production is to be organized at the Pasteur Institute, Coonoor. 2.8 Vector Biology and Control (VBC) The major problems faced in implementing the VBC programme were vector resistance to the commonly used and cheaper insecticides, refractory behaviour, toxicity and the high cost of newly developed insecticides, high refusal rate against residual house spraying and increasing concern regarding environmental pollution by chemicals. In order to detect resistance in time and space, WHO has been promoting susceptibility monitoring in those programmes that are dependent on the use of chemical pesticides. Testing materials were provided regularly for this purpose. In BANGLADESH, following the recommendations made by the inter national assessment team that visited the country in December 1982, plans were made for the reorganization of entomological activities. The entomological manpower was adequate to carry out a sound plan of work if the present administrative constraints could be overcome. Results of studies carried out by the National Institute of Preventive and Social Medicine revealed an increasing trend in the density of sandflies especially in Pabna district, where high numbers of kala-azar cases were reported. The high density of Culex quinquefasciatus, which has become resistant to a number of insecticides, was causing great concern in Dhaka city. So far, no record of DDT resistance has been reported in any of the known malaria vectors - Anopheles balabacensis, An. philippinensis, A.minimus and A.sundaicus - but nevertheless the first and second vectors were showing refractory behaviour towards indoor residual house spraying. In BURMA, the Vector-Borne Disease Control Programme (VBDC) continued to be supported by Canada and the Netherlands in collaboration with WHO. By the end of the fiscal year 1982-83, CIDA had contributed C$ 3 480 000, and the balance of C$ 2 170 000 is due in 1983-84 and 1984-85. The two WHO long-term staff members with the project, supported by the Netherlands, left Burma in November 1982 on completion of their assignment. Training courses for various categories of staff in the VBDC project were carried out with WHO support. Monitoring the susceptibility of vectors of malaria, DHF and filariasis to insecticides continued to provide useful information. Results of tests of malaria vectors were similar to earlier findings. - Aedes aegypti, a vector of DHF, continued to be susceptible to malathion and twephos, whereas Culex quinquefasciatus, a vector of filariasis, is showing a decreasing trend in its susceptibility to fenthion, estimated by eight-fold and eleven fold decreases in areas with 11 and 16 years of insecticide spraying respectively. With financial support from the UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases, plans were being made to strengthen the entomology section of the Department of Medical Research. Colonies of various mosquito species and populations and Toxorhynchitus splendidus were being maintained in the laboratory for biological control studies. Cytogenetic studies on two populations of A.ba1abacens.i~ with contrasting larval habitats, one from Taikki, breeding in forest rain pools, and the other from Moulmein, breeding in wells, were continuing. In INDIA, vector resistance to the insecticides commonly used, especially in A,culicifacies and A.stephensi, the major rural and urban vectors of malaria, continued to be an important problem facing the programme. Entomological studies from Orissa revealed the presence of six anopheline species known to play a role in malaria transmission in this part of the country; in connexion with this work, a gel diffusion technique for identifying the origin of the mosquito bloodmeal was successfully established in the laboratory at the regional office of the P.falciparum Containment Programme in Bhubaneswar. Studies carried out by the entomologi- cal teams in the north-eastern region on the effect of ecological changes on the malaria vectors A.balabacensis and A.minimus were progressing. WHO provided a consultant to examine the mosquito and rodent problem in Madras city. The recommendations of the consultant conform closely to the initiatives being developed by the authorities, although implementation was restricted by limitations of funds. The Vector Control Research Centre of the Indian Council of Medical Research, located in Pondicherry, received an award of $96 000 from the UNDPIWorld Bank/WHO TDR Programme for strengthening its institutional capability for research and training in the field of biological control of vectors. The Centre was involved in a wide variety of studies on vectors of filariasis, malaria and arbovirus diseases. Within the framework of "Integrated Development for Vector Control", with significant participation from the community, the Centre entered the third year of its filariasis control demonstration project in Pondicherry. For the building up of trained manpower to meet the future needs of the country in research in pestlvector control, Madras University is in the process of establishing a two-year M.Sc. course in medical entomology. Valuable vector studies were also being undertaken at NICD, Delhi, and the National Institute of Virology, Pune. In INDONESIA, the DDT-resistant A.aconitus in Central and East Java continued to cause a serious problem to the malaria programe. Space spray- ing with organophosphorous compounds was carried out to prevent malaria outbreaks. A WHO consultant visited Kalimantan to investigate the problem of A.balabacensis and to advise on its control. Another consultant visited Indonesia to advise on entomological activities, especially in the outer islands. Insecticide trials against vectors of malaria, DHFJdengue, filariasis and bubonic plague were continued by the WHO Inter-regional Vector Biology and Control Research Unit-2, Jakarta, and its sub-unit in Semarang, in collaboration with the Ministry of Health. During the past seven years (1976-821, four organophosphorous compounds, one carbamate, two pyrethroids and one chlorinated hydrocarbon, in different insecticide formulations and dosages, were tested in order to determine their residual effectiveness in village-scale trials (Stage V trials). Bacillus thuringiensis H-14, the microbial vector control agent, was tested against Aedes aegypti and Culex quinquefasciatus in urban areas, Ansopheles sundaicus in lagoons and A.barbirostris in fresh-water ponds. The UNDPJWorld Bank WHO TDR Progranune provided additional funds to the M.Sc. Course in Medical Entomology at Bogor Agricultural University for 1983. A WHO consultant was sent to review the curricula and contents of the course and explore other sources for future international and bilateral assistance. In MALDIVES, A.subpictus and A.tesselatus were recorded from a few islands in connexion with malaria transmission. Both malaria vectors continue to show susceptibility to DDT and temephos. Larviciding with ECOPRO-1700 in pellet formulation was found effective for up to three weeks against anopheline and culicine mosquitoes in fresh water. Culex guinquefasciatus continued to pose a severe challenge to control methods in the capital, Male. In NEPAL, the results of insecticide susceptibility tests showed that the DDT-resistant populations of A.annularis and A.cu1icifacies in the terai continued to be susceptible to malathion. While A.maculatus and A.fluviatilis continued to be susceptible to DDT, the finding of small numbers of the latter species in DDT-sprayed dwellings raised the question of incipient resistance. In cytogenetic studies on A.annularis, two species, A and B, were identified, with B being prevalent in areas of low receptivity where it appears to be the malaria vector. The insecticide trials undertaken with bendiocarb, fenitrothion, malathion and pirimiphos- methyl against DDT-resistant A.annularis in Lumbini district did not provide conclusive results. Bio-assay studies on the residual effect of old and new stocks of malathion and DDT from different sources were in progress. In SRI LANKA, WHO provided a consultant sanitary engineer to advise on mosquito control in Colombo. Through the better utilization of available resources, development of new methodologies and promotion of inter-sectoral collaboration, it is expected to extend and intensify the present mosquito control operations and to achieve greater effectiveness. The consultant highlighted the role played by the Low-Lying Areas Development Board and the benefit gained in the reclamation of marshes. Another WHO consultant from headquarters visited Colombo to review and advise on biological control agents. A research proposal from the Medical Research Institute on the prospect of further development and field evaluation of B.sphaericus MU-4, originally isolated in Sri Lanka, B.thuringiensis H-14, and other new pathogens was accepted for funding by TDR. Ztyo larvivorous fish for mosquito control were under study by national staff, Aplocheilus dayi for the control of Anopheles culicifacies in slow-flowing water, and Poecilia reticulata for the control of Culex quinquefasciatus in Colombo. A total of 163 susceptibility tests covering 11 anopheline species and a number of insecticides were carried out during 1982. A.culicifacies, the only known malaria vector in the country which is resistant to DDT, continued to show susceptibility to malathion, the insecticide being used in the Anti-Malaria Campaign, and to dieldrin, fenitrothion, propoxur, bendiocarb and chlorphoxim. In THAILAND, the monitoring of susceptibility/resistance of malaria vectors and suspected vectors to DDT, malathion and fenitrothion continued as planned. A total of 94 tests covering seven anopheline species - A.minimus, A.balabacensis (A.dirus), A.maculatus, A.aconitus, A.sundaicus, A.philippinensis and A.annularis - was carried out with large samples of mosquito populations collected from fixed catching stations throughout the country, but mostly from the northern region. The results of tests showed no significant change in susceptibility/resistance status and level from previous test results. The vector problem in Thailand appeared to be more due to exophily and refractory behaviour (avoiding contact with the sprayed surfaces) than to physiological resistance. Entomological evaluation on the effect of fenitrothion residual spraying (which had recently been introduced by the malaria programme) in mosquito control and consequently malaria transmission did not show any significant difference in comparison with DDT. Further research was in progress to clarify the situation. With support from the UNDPIWorld Bank/WHO TDR Programme, two research projects on genetic variations in correlation with behaviour traits, one dealing exclusively with A.minimus and the other dealing with A.bala- bacensis, A.maculatus and A.philippinensis, were being carried out by scientists from Mahidol University. A WHO consultant from headquarters visited research institutions involved in research and field trials on biological control agents. The Department of Microbiology at Mahidol University was searching for new isolates of spore-forming bacteria and evaluating existing strains in the laboratory and on small-scale field trials, paying particular attention to the pathogens' persistence and recycling potential for mosquito control. A WHO consultant visited the project to advise on rodent research and control. WHO headquarters is assisting the Division of Medical Entomology in its project on integrated control against Aedes aegypti, with emphasis on community participation, in Lopburi province. 3. DISEASE PREVENTION AND CONTROL - NON-COMMUNICABLE DISEASES The major emphasis of WHO technical collaboration with Member States in the field of non-communicable diseases lay in the promotion of an integrated social and behavioural approach to the prevention, early detection and control of emerging health problems such as cancer, cardiovascular diseases, chronic liver diseases (including liver cancer), diabetes and accidents. 3.1 Cancer Consultancy services were provided to Bangladesh, Democratic People's Republic of Korea, India and Indonesia to review the progress made and advise on further technical collaboration. National meetings were supported through the provision of subsidies, and fellowships were awarded for training in oncology, chemotherapy, etc. Health education material on the prevention and control of cancer and the health hazards of smoking was made available to all Member States. In BANGLADESH, a consultant assisted in cancer registration, including training. Another consultant collaborated in the training of health personnel in cancer control activities and the organization of chemotherapy services for cancer patients. A team of two consultants visited the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA during the year. One of them assessed the existing facilities for the surgical management of thoracic cancer, delivered a series of lectures and organized several demonstrations on lung cancers and mediastinal and cardiac neoplasms. The other consultant reviewed the ongoing research acti- vities in relation to cancer immunology and advised on training, services and research, and also gave lectures on modern aspects of cancer immunology. Fellowships were awarded and supplies and equipment were also provided. In INDIA, the services of several consultants were provided for the (i) development of a framework for assessing the epidemiological aspects of cancer; (ii) establishment of a national cancer control body; (iii) planning of epidemiological studies and working of early cancer detection centres; (iv) development and maintenance of cancer registries; (v) cytopathological techniques and research methods icluding immunopathology and ultrastructural cytopathology, and (vi) clinical research in cancer and cytogenetics. The Ministry of Health, the Indian Council of Medical Research, the Regional Cancer Centre in Trivandrum and the Cytology Research Centre in New Delhi were involved in these activities. WHO provided a subsidy for the conduct of a national workshop on cancer held at the Tata Memorial Centre, Bombay, in November 1982, and also for a national seminar on strategies in cancer control which took place at the Cancer Institute, Madras, in December. The Gujarat Cancer and Research Institute organized a workshop on the early detection of cancer in July. Fellowships for training in cancer prevention and control and the diagnostic/prognostic cytology of cancer patients were awarded. The Arignar Anna Memorial Cancer Hospital conducted a programme of continuing medical education in 1982 in collaboration with the Indian Medical Association. In INDONESIA, a consultant assisted in designing a population-based cancer registry in Yogyakarta, in preparing a national cancer control programme, in developing cancer registration in teaching hospitals, and in analysing cancer data from the departments of pathology of hospitals. He also organized and conducted a short course in cancer epidemiology. WHO assistance to MONGOLIA consisted of the supply of a gamma camera basic system and accessories to augment the community-based cancer control programe. Fellowships were awarded for training in the epidemiology of cancer. In SRI LANK!., a national cancer policy and a cancer control programme have already been formulated. As a part of the global cancer control programme, support was provided by WHO headquarters and the Regional Office for studies to determine the most satisfactory means for the early detection of oral cancer at the primary health care level. The feasibiliry and effectiveness of the primary health care approach for the early detection of cancer by primary health care workers was demonstrated. WHO also gave financial support for carrying out a reproducibility study in,the Jaffna and Galle areas and for designing and implementing a cancer health education project aimed at the primary and secondary prevention of oral cancer, and the expansion of coverage by the existing cancer registry. 3.2 Cardiovascular Diseases The major components of WHO support in this programe area were the provision of subsidies for the conduct of national group educational activi- ties andlor surveys, consultancy services and fellowships for improving national expertise and facilities for the control of cardiovascular diseases. In BANGLADESH, a national workshop on cardiology was held in November 1982 to enable medical officers to learn about the prevention and treatment of various cardiovascular diseases, particularly rheumatic fever, rheumatic heart diseases, hypertension, cardiac emergencies and cardio- pulmonary resuscitation. Fellowships were awarded for training in laboratory technology, cardiovascular radiology, anaesthesia, cardiac rehabilitation and cardiology. In BURMA, a national workshop on the diagnosis, management and prevention of cardiovascular diseases was organized in November 1982 with financial support from WHO. A total of 16 participants drawn from hospitals, school health services and primary health care programmes attended the workshop, which provided the participants with an opportunity to learn the preventive approach to cardiovascular diseases. Fellowships were awarded for training in the technology of intensive cardiac nursing. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, a team consisting of two consultants carried out a number of operations using artificial circula- tion systems and delivered lectures on various aspects of artificial hearts and lungs, the pathophysiology of artificial circulation and the principles of haemodynamics. Another team of four consultants (a cardiologist, a cardiac surgeon, an anaesthetist and a vascular surgeon) assessed existing facilities and assisted in strengthening training, services and research in their fields of speciality. Their activities included giving demonstration lectures and training for health personnel in the post-operative care of patients. Fellowships were awarded for training in cardiovascular diseases. In INDIA, a consultant visited selected institutions concerned with the prevention and control of cardiovascular diseases to assess the existing facilities for the analysis of serum lipid. He discussed with physicians and cardiologists the importance of standardizing methods for the estimation of lipids, lipoproteins and serum enzymes and advised on the establishment of referral centres for internal and external quality control of lipid analysis and the introduction of a programme of quality control into service and research laboratories. Consultancy services were also provided to the Institute of Genetics and Hospital for Genetic Diseases in Hyderabad for the further development of research and service facilities at the Institute. A national workshop on recent advances in genetic diseases, attended by 50 research workers, was held in Hyderabad in August 1982. A contractual technical services agreement was finalized with the Haematology Unit of the All India Institute of Medical Sciences (AIIMS), New Delhi, for undertaking investigations relating to platelet functions in ischaemic heart diseases and high-risk subjects. A national workshop on the immunology and genetics of rheumatic fever and rheumatic heart diseases with special reference to India and South-East Asia was held in Chandigarh in December 1982 with support from WHO. Another national workshop on lipids and lipoproteins in health and disease with special reference to India was organized by the Department of Cardiology at AIIMS, New Delhi, in November 1982 with support from the Organization. In MONGOLIA, a new comprehensive long-term national programme on the prevention and control of cardiovascular diseases among the rural population was formulated for the period up to the year 2000. A national seminar on CVD prevention and control was held for physicians in Ulan Bator and a mass screening campaign was conducted in one aimak and in Ulan Bator city. Altogether 9 000 persons - 7 000 rural and 2 000 urban - were examined by a team of 12 doctors of different specialities in order to diagnose CVD and identify the risk factors. A national seminar on the health hazards of smoking was being planned with WHO support. In SRI LANKA, the cardiology unit at the General Hospital in Colombo, in collaboration with the National Institute of Health Sciences, Kalutara, and with financial support from WHO, started a study on the community control of cardiovascular diseases. This includes epidemiological studies on the rural and semi-rural population to identify risk factors, health education for promoting cardiovascular health, early detection and diagnostic facilities, and treatment including referral and follow-up services. The areas selected will serve as a training-cum-demonstration centre for the community control of cardiovascular diseases as an integral part of primary health care. Plans were formulated in THAILAND to initiate studies on the preven- tion and control of cardiovascular diseases through an integrated approach towards the control of non-communicable diseases in general. Two senior physicians were provided opportunities to undertake a study tour of appropriate centres in the USA and Finland. 3.3 Prevention of Blindness Avoidable blindness and the backlog of the curable blind pose major public health problems in the Region as a whole. Given the estimated national blindness rates, which range from 0.5 per cent to over 2.5 per NON- COMMUNICABLE DISEASES FuNo,uing the,, par1,crpatron m the .:'orid Assemb.y on Apng held rn Venn* m July 1987 und real8ztng Ifre demogmolrc !rcnds as ,c/lecled in the ,nocor,no n!,nlbers of the eld~rl,. coun'ncs of , . the Region are taking act& measures ro promote andpfeserve the traditional extended family system and integrate elder citizens into the socio-economic development process. Governments are paying considerable attention to the problem of drsability, emphasis beiog laid on community-based programmes for disability prevention and rehabilitation. With WHO support, appropriate, low-cost aids are being developed for the dicabled. such as this prototype ofa wheel-chair designed tor Asian conditions and adapted to local life-styles. There is g/owlng awareness of the eilenl 01 avoidable blindness whtch poses a major puhhc health problemin 118s Rcgjon. National prog,ammeS arc based on the ~rinoole of eve cars rlelrverv as an integralpart ofprimary health dare. ' EXPANDED PROGRAMME ON IMMUNIZATION rhe Expanded Programme on Immunization continued to expandin rrrmr of rhe rarget population cover~d. Several countries have srarred giving oral pobomyeliris vaccine to children at mass immunization camps. HEALTH LABORATORY SERVICES In the control of comrnunicsble dscases, the role of health laboratory servjces ,s crucrel WHO ,s supporl~ng Membcr Sfares !n the qua1,ly control 01 laborarory work Here a ~?t,ore,ory lechntc,an ,s prroannq hact.?t~oloq~cal m~rlta cent, the number of the blind in the Region amounts to approximately 12 million; the majority of these are to be found in the underserved rural areas. While a large majority of these - 50 to 75 per cent - are due to cataract and are therefore curable, 80 per cent of the remainder are the result of preventable causes such as infections (including trachoma), injuries and blinding malnutrition. In still others - such as those going blind from glaucoma, diabetes and retinopathy - early detection and timely treatment could prevent deterioration of vision. Many of the underlying causes are age-related and their incidence is bound to increase unless energetic community-oriented measures are taken. WHO continued to support national authorities in undertaking activi- ties in the areas of programme formulation, implementation, review and evaluation. The national programmes are based on the principle of eye care delivery as an integral part of primary health care, supplemented wherever indicated by programmes specially directed against blinding infection, including trachoma and blinding malnutrition, and the restoration of sight in cataract patients, through outreach surgical services. These activities supported primary eye care services, on the one hand, and, on the other, were backed up by institutionalized services comprising speciality and sub-speciality interventions. Special emphasis was placed on various aspects of manpower training and deployment at all levels of the health delivery system. At the regional level, an inter-country consultative meeting with participants from four countries - Bangladesh, Burma, India, Sri Lanka - was held in Rangoon. This meeting, which was an activity under the UNDP-funded project for the prevention of blindness from glaucoma, prepared plans of action for programmes to be carried out in the four participating countries. The post of Regional Adviser responsible for the coordination of activities of the Regional Prevention of Blindness Programme continued to be funded through a contribution to the Voluntary Fund for Health Promotion by the Royal Commonwealth Society for the Blind and the Asian Foundation for the Prevention of Blindness. In BANGLADESH, implementation of the national programme continued, with the activities mainly related to the training of manpower, strengthen- ing of the apex institution (the Institute of Ophthalmology in Dhaka) and outreach programmes for cataract. A one-day appraisal and reorientation course for divisional and district health officials was held in November 1982 which laid special emphasis on blinding malnutrition. The study on vitamin A prevalence - a collaborative effort of the Government of Bangladesh, Helen Keller International and WHO - was started in mid-1982 and the results were expected by the end of 1983. The distribution of vitamin A high-potency capsules to the target population continued. A non-governmental organization, the Bangladesh National Society for the Blind, is an active partner in programme activities and, with bilateral aid, established a 130-bed eye infirmary and training complex in Chittagong which was opened in January 1983. This institution already trains medical officers and paramedical staff in community-oriented eye care services. The Regional Office provided assistance in the preparation of curricula for these courses. Through the efforts of the Government and the voluntary sector, a total of approximately 47 000 cataract operations were performed at institutions and through "eye camp" services. A WHO consultant visited Bangladesh for one month to review and advise on ophthalmic pathology and microbiology services. In BURMA, assessment, mass treatment, consolidation and reassessment activities continued in the areas where trachoma is highly endemic. A WHO staff member visited Rangoon to document and evaluate the trachoma control programme. A preliminary review showed a drop in blindness caused by trachoma from 2.03 in 1968-72 to 1.02 in 1976-78. A consultant assisted in developing a plan for the provision of low-cost, affordable spectacles and low-vision aids. Supplies and equipment were provided for the upgrading and strengthening of the Eye, Ear, Nose and lhroat Hospital in Rangoon, to serve as an apex institution for the programme. The field activities in the control of blindness carried out in the country included mass screening for active trachoma cases followed by treatment; field out-patient eye clinics in rural areas; village and school eye health services and dissemination of health education on eye care and training of basic health workers in the control and prevention of blindness. In INDIA, implementation of the revised work plan of the national programme for the control of blindness was initiated, greater emphasis being placed on the training of paramedical staff. A WHO consultant prepared a report on the feasibility of including a low-cost spectacle scheme in the national programme. Another consultant visited selected centres in four different states to ascertain the role of non-governmental organizations in the national programme activities. The Organization supported meetings of advisory committees set up by the Ministry of Health and Family Welfare and also participated in a task force meeting convened to develop detailed programme budgets for 1984-1985. It also entered into contractual service agreements with state-level advisers for the programme. With regard to the development of eye services at primary health centres, the Government has adopted a policy whereby such developments will run concurrent with the training of ophthalmic assistants. It is expected that by the end of the Sixth Five-Year Plan all the 2 000 primary health centres will have ophthalmic assistants posted in them. One of the shortcomings in the programme is the absence of a uniform and effective monitoring mechanism, and the national committee is planning corrective measures. Eighteen centres took part in the training of ophthalmic assistants, and 1 530 primary health centres now provide primary eye care services. In order to facilitate participation of the voluntary sector, the Government has streamlined the procedures for providing financial support to non- governmental organizations in eye camp programmes. The record of activities directed towards the elimination of curable blindness from cataract has surpassed the efforts in the previous year. It was expected that a total of 900 000 cataract operations would be performed during 1982-83 as against 650 000 in 1981-82. In INDONESIA, the formulation of the national plan for inclusion in Pelita IV was awaiting the results of a national survey of the prevalence and causes of blindness, which were expected to be available in late 1983. A WHO consultant reviewed the preliminary survey results, the draft national plan and the proposed Bali project for outreach eye care services including cataract surgery. The Chief of the Eye Health Services visited the Regional Office and the WHO Collaborating Centre on Public Health Ophthalmology in New Delhi. Preliminary survey results show a blindness prevalence rate of 0.52 per cent of which 50 per cent is due to cataract. Thus the backlog of cataract would be expected to be in the region of 375 000 cases. A serious constraint in coping with these large numbers is the shortage of suitably trained personnel and the lack of adequate outreach services. The programme against nutritional blindness supported by Helen Keller International has initiated pilot studies in the fortification of monosodium glutamate with vitamin A while continuing with the distribution of high potency vitamin A capsules and nutrition education. In MALDIVES, in pursuance of a request made by the Government, an eye camp project was organized through a contractual technical services agreement with an ophthalmic institution in India to undertake activities in a group of remote atolls. A total of 245 operations was performed, including 171 cataract operations. This project was funded by extrabudgetary resources mobilized from the British National Committee for the Prevention of Blindness and the Japan Shipbuilding Industry Foundation. Technical collaboration with NEPAL continued and the ongoing prevention of blindness programme carried out activities as planned. The survey report was finalized. In-service training for ophthalmic assistants continued at both Kathmandu and zonal eye centres. Ten ophthalmic assistants returned after training in India and were in position. Four medical officers were continuing their training in India. The Zonal Eye Centre in Dhangadi, in the West Zone, was commissioned in late 1982 with a bed capacity of 60 and out-patient and operation theatre facilities. It is a low-cost structure designed by a WHO staff member and built under his supervision. Field activities included house-to-house searches for blinding sequelae of trachoma, cataract and xerophthalmia, and treatment for these conditions. Four other eye centres became operational in 1982 - Biratnagar, Bhadrapur, Nepalganj and Lahan. These institutions have provided in-patient services as well as outreach services through eye camps and mobile surgical facilities. A long-term WHO staff member and five consultants assisted national staff in both training and eye care delivery activities under the programme. The activities have been supported financially by the Netherlands, Norwegian and French agencies, the Swiss Red Cross and the Christoffel Blindenmission. In SRI LANKA, activities for the prevention of blindness were carried out by government institutions and non-governmental organizations. These activities comprised institution-based eye care, together with outreach services predominantly by the voluntary sector supported by the local community, service organizations, the Royal Commonwealth Society for the Blind and the Christoffel Blindenmission. Two WHO consultants were assigned during the year - one to assess and advise on a scheme for low-cost spectacles and the other on ophthalmic pathology/microbiology services. A consultant from WHO headquarters evaluated the ongoing eye camp progranune and also advised on the ophthalmic auxiliaries training centre, which started activities in March 1983. Helen Keller International, in collabora- tion with Sarvodaya, a national voluntary organization, launched a primary eye care and blindness rehabilitation project. In THAILAND, assistance was provided in the formulation of a national plan for the prevention of blindness and the preparation of an epidemio- logical survey on the prevalence of blindness. The strengthening of inter- mediate-level eye care through the training of medical officers and nurses in community-oriented ophthalmology was supported through the establishment of an Institute of Public Health Ophthalmology in Korat. A WHO consultant assisted in the formulation of a plan of action for this institute and a scheme for low-cost spectacles. Another consultant assisted in the provision of ophthalmic pathology/microbiology services and advised on manpower training. 3.4 Immunology Clinical imunology has made remarkable progress in the last decade. WHO has been assisting countries in introducing immunological techniques, particularly in the diagnosis of communicable diseases. A programme has been developed for introducing rapid techniques in the diagnosis of viral diseases. Production of reagents for enzyme-linked immunoassay (ELISA) was initiated at the National Institute of Virology, Pune (India). Similarly, production of immunological reagents such as anti-sera conjugates against human immunoglobulins and other antigens was initiated at the Department of Pathology, Ramathibodi Hospital, Bangkok. A workshop on imunological techniques in streptococcal infection was organized at Lady Herdinge Medical College, New Delhi. National staff from India, Indonesia and Thailand received training in advanced techniques in immunology during a course organized by WHO headquarters and held at Iausanne (~witzerland). WHO continued to assist the Department of Bio- chemistry, AIIMS, New Delhi, in the development of the ICMR/WHO Immunology Research and Training Centre. A WHO consultant from headquarters assisted in initiating a project in allergology in Thailand. 4. HEALTH LABORATORY SERVICES The programme on health laboratory services in the countries of this region received WHO support through the assignment of short-term consul- tants, training of national staff in advanced laboratory technology, and the provision of supplies and equipment. Support was also provided in quality control, training of tutors and improvement of the quality of laboratory services at peripheral levels of health care. 4.1 Organization of Laboratory Services Most countries, with WHO collaboration, improved expertise for the diagnosis and epidemiological surveillance of bacterial diseases, parti- cularly entero-pathogens. Since viral diseases are emerging as important health problems, WHO collaborated in strengthening laboratory competence for the diagnosis of viral diseases and introduced technology for isolation and identification. An inter-country Workshop on Cell-culture Technology was organized at the National Institute of Virology (NIV), Pune (India), in August 1982. National staff from India, Indonesia, Nepal and Thailand were trained in the preparation of primary cultures, preservation and propagation of cell lines, quality control in cell-culture work, continuous-culture systems, etc. A manual was prepared on cell-culture technology based on the Workshop. In continuation of the programme of rapid techniques in the diagnosis of viral diseases, WHO gave further support to develop facilities for the production of reagencs at NIV. National workshops on rapid techniques will be organized and supported in Burma and Thailand. WHO provided a consultant, as well as supplies and equipment for organizing these activities. In order to improve the diagnostic facilities and to support the prevention and control of rheumatic heart disease, WHO supported a national workshop in New Delhi. A manual prepared by the workshop faculty was distributed to some of the countries in the Region. Further efforts are under way to organize national workshops on techniques for the preparation and standardization of reagents and the methodology for the diagnosis of haemolytic streptococcal infections. In order to improve the quality of work and the management of labora- tory services at the middle and peripheral levels, WHO, in collaboration with DANIDA, supported training in quality control. Thus, an inter-regional course on quality control in haematology was organized at Kuala Lumpur in November 1982 in which national staff from Sri Lanka and Thailand participated. The Director of Laboratory Services in Nepal participated in the workshop on laboratory management held in Islamabad in May 1983. In order to improve the quality of laboratory work further, WHO headquarters prepared several documents on quality control in clinical chemistry, reference sera, methods of evaluation of diagnostic kits, and standardization of equipment required in developing countries; these documents were distributed to the countries. With regard to activities at the country level, the Institute of Public Health (IPH) in BANGLADESH was further strengthened by the provision of supplies and equipment. National staff were trained in quality control, laboratory-animal breeding technology and water bacteriology. With the support of WHO, eight in-service training courses were being planned for laboratory technicians from peripheral laboratories to improve the quality of their work. A consultant was provided for the repair and maintenance of equipment at IPH. In BURMA, a workshop that had been held last year on laboratory management was evaluated and found to have had an impact on the improvement of health laboratory services. National staff were trained both in the country and abroad in different disciplines of laboratory sciences. Consultants were being provided for developing and further strengthening a programe on quality control in clinical chemistry. In the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, consultants assisted in the further strengthening of laboratory technology, particularly in enzymology, lipid biochemistry and oncogenic viruses. In INDIA, a national workshop in immunological techniques in streptococcal infections was organized. National workshops on anaerobic bacteriology and antibiotic sensitivity were also held. Training of laboratory technicians from public health laboratories was supported by WHO. In INDONESIA, national staff received training in laboratory technology and quality control. National workshops in virology and in bacteriology were organized with WHO support, and a consultant trained national laboratory staff in virological techniques, particularly in the plaque-reduction neutralization test and the identification of dengue virus isolates. In MALDIVES, laboratory services were strengthened by the provision of two consultants. During an epidemic outbreak of shigella dysentery, a WHO consultant organized full laboratory support for the isolation, identification, sero-typing and antibiotic sensitivity testings of enteropathogens. Another consultant further supported laboratory programmes by introducing laboratory management techniques. The laboratory at Male Hospital was reorganized and the quality of work upgraded. In order to strengthen health laboratory services in Maldives, a new project document was prepared and approved by the Government. The project envisages building up the laboratory infrastructure to support epidemiological surveillance and primary health care services. In NEPAL, WHO long-term staff continued to give support to laboratory services and further improved the quality of work at the district laboratories. The clinical chemistry programme was strengthened. A national workshop in microbiology was organized in December 1982 with the assistance of DANIDA. Further strengthening of central and peripheral laboratories is to be undertaken under a new health laboratory project supported by the Directorate of Development Cooperation and Humanitarian Aid (DCA), Switzerland. In SRI LANKA, a WHO consultant helped in strengthening the clinical chemistry programme. In THAILAND,.national staff were trained both within the country and abroad. A national workshop on laboratory techniques for the diagnosis of hepatitis was supported by WHO. The National Reference Centre on Streptococci trained national personnel in streptococcal microbiology. Mahidol University organized a seminar-cum-workshop on clinical laboratory equipment supported by WHO. 4.2 Quality Assurance Health laboratory services have been expanding in most countries of this region and simultaneously there was an increasing need to improve the quality and performance of laboratories in support of health programmes. In BURMA, the quality control programme in clinical chemistry was further strengthened. Burma is also participating in the global programme of intensive quality control monitoring. In INDIA, a conference of directors of the laboratories participating in the national quality control programme in clinical chemistry was held at the Post-graduate Institute, Chandigarh. The programme was reviewed and the problems and constraints in the development of clinical chemistry were identified. Recommendations were made for activating this programme. Support to quality control in haemotology was continued. A national conference on standardization and quality control of the methods employed in coagulation disorders was scheduled to take place at the All-India Institute of Medical Sciences, New Delhi, in November 1983. In SRI LANKA, a consultant assessed the present status of clinical chemistry and made recommendations for developing a national quality control programme. The clinical chemistry programme in THAILAND continues to receive WHO support. 4.3 Vaccine Production While India and Indonesia have developed production facilities to the extent of near self-sufficiency, a number of other countries in the Region were in the process of developing or strengthening their laboratories for the production of vaccines required for EPI. WHO has been collaborating with the governments to improve the quality of production and to increase output. In BANGLADESH, production of tetanus toxoid has now been taken up on a bigger scale. The vaccine batches have been tested locally as well as at CRI, Kasauli, and given to human volunteers, and found to be of good quality. WHO continued its collaboration through training, supplies and equipment and the provision of a consultant. It was expected that Bangladesh would produce its total requirement of TT and several experimental batches of DT and DPT in 1983. In BURMA, a WHO consultant assisted Burma Pharmaceutical Industry in strengthening the production and quality control of DPT vaccines. In INDIA, the Pasteur Institute at Coonoor established production of DPT vaccine. National staff were trained in fermentation technology. The batches produced by the Institute were tested by WHO at WHO Collaborating Centres. Haffkine Biopharma was provided by WHO with a new seed for the production of type 111 oral polio vaccine. In NEPAL, technology for the production of BPL-inact ivated anti-rabies vaccine for human use was established. Batches were tested for quality control in CRI, Kasauli, and were found to be satisfactory. In THAILAND, national staff were trained in production technology and the quality control of DPT vaccine. The inter-regional UNDP project on the experimental production of anti-rabies vaccine in tissue culture at Coonoor (India), made satisfactory progress. Two short-term consultants were assigned and the Pasteur Institute, Coonoor, was provided with equipment. The Pasteur Institute, Paris, has provided a new strain adapted to tissue culture to the Pasteur Institute, Coonoor. After a few batches of anti-rabies vaccine are prepared and tested for potency, national staff from other countries of the Region will be trained in production technology. 5. PROMOTION OF ENVIRONMENTAL HEALTH Community Water Supply and Sanitation occupy a position of high priority in the health development efforts of most countries in the Region. Community water supply, being a basic unfulfilled need, has received substantial allocations in national budgets in spite of the scarcity of capital. The same, however, cannot be said in respect of sanitation. Six countries in the Region hutan an, India, Indonesia, Maldives, Nepal and Sri Lanka) already have produced their first draft Decade plans. Nepal and Sri Lanka are already reviewing their Decade plans in the light of the current situation and the review was expected to be completed in the latter half of 1983. There is a growing interest in research and development effort to find indigenous solutions to tackle the increasing environmental pollution problems associated with industrialization. Rapid techniques of stream pollution monitoring and water quality surveillance have been given high priority both by the Member States and in WHO'S cooperative effort with them. There is also a trend towards taking a more holistic approach in research in environmental health, taking into account social, ecological, economic and other factors that have traditionally been kept outside the purview of ad hoc research projects, which have often been concentrated more on "hardware" technology. A preliminary field testing of a comprehensive questionnaire on the status of food safety programmes has been completed and preparations were under way for final field testing in order to obtain feedback from countries. 5.1 Environmental Health In line with the collective decisions of Member States, both in the World Health Assembly and in the Regional Committee, a serious exercise has been undertaken, during the year under review, to programme WHO'S 1984-1985 biennial budget tcwards optimal use in support of the countries' HFA goals. Whi1.e different mechanisms have been used in different countries for this exercise, there has been a reductior~ in the programme budget for environ- mental health. The World Bank has also, as a matter of policy, phased out its cooperative programme with various Specialized Agencies, including WHO, Reduced resources can be looked upon as a constraint. However, the Organization has tried to adapt by pooling resources for programme planning purposes and thus providing the cecessary inputs to specific activities that countries have not found possible to meet within the country budget. These resources have also beer1 used for inter-country manpower development activities, At the regional levei, an inter-country course on project formulation and appraisal for water supply and sanitation with emphasis on community self-reliance, operation arid maintenance, was organized at the Anna University, Madras, in which sectox officials from India, Nepal, Sri Lanka and Thailand ~artici~ated, Eurma was supported through consultancy inputs for an evaluation of household and school latrines with special emphasis on technical solutions adopted at community level, study of the health educa- tion and motivation components of the pilot project on sanitary disposal of human wastes, and a study on solid waste disposal for Rangoon. In Nepal, consultant assistance was provided under the same programme for review of the sector in order to assist the Government in its preparations for the proposed donor consultation in late 1983, Under the Global Environmental Monitoring System's (GEMS) water programme, a special course on analytical quality control was held in Indonesia, and preliminary activities were started for preparing, under contractual agreements, profiles of the chemical safety situation in India, SrF ianka and Thailand in preparation for an inter-country workshop on this subject in 1985. In its continuing collaboration with ESCAP, the Organization prepared a working docgnent on the pollution and health problems related to the in- correct application of low-cost techniques for water supply and sanitation. This was to be presented at the tenth session of the ESCAP Committee on Natural Resources in Bangkok in October 1983. The Decade Commencement Report mentioned earlier has been published. The UNDP-funded project "Asia and the Pacific Regional IDWSS Decade Advisory Services" (~~~/81/024) began activities in October 1982. Local institutions within each country were undertaking case studies to monitor and evaluate Eecade problem areas, including community education and participation, institutional development, human resources development, and appropriate technology.. This project includes countries from three WHO regions, South-East Asia, Western Pacific and Eastern Mediterranean, SEAR0 acting as the focal point. In view of the comparatively small budget allocation approved for this project, the project has been designed to provide a catalytic input of an evaluative character into national. programmes to prepare guidelines for the training of national staff in the particular areas of study. Thus, the project is tailored co each country" requirements, the case studies being selected through discussions with local institutions in the country to ascertain the priority needs., Project inputs include (1) networking of institutions, (2) case studies to document Decade problems, (3) training, and (4) regional and country guidelines for improved project planning. With regard to research in environmental health, a consultative meeting was convened in October 1982 to review the progress as well as to set priorities in research and to reorient the environmental health research programme towards HFA/2000 and Decade goals. The recornendations of the meeting are being pursued for research promotion and implementation. Priorities will be given to topics such as health aspects of water supply and sanitation programmes, support programmes (such as behavioural studies, community participation, institutional aspects) and appropriate technology. There are four on-going environmental health research projects: the study on health benefits of water supply in a rural area (Jhansi, India), field-testing of an integrated water-supply and waste-water utilization system for villages (NEERI, ~ndia), study of ground-water pollution from pit latrines in Bangladesh, and use of domestic sand-filter jars for water purification in Thailand. In its cooperation with the Member States for the International Drinking Water Supply and Sanitation Decade, the Organization concentrates on five areas: promotion of the Decade, institutional development, develop- ment of human resources, information exchange and technology development, and financial resources (mobilization). hring the year under review, WHO has collaborated substantially in different aspects of community water supply and sanitation with nine of the eleven countries of the Region. It has also provided technical cooperation to five countries in the field of control of environmental pollution and to four countries in food safety. In addition, six countries of the Region have participated in inter-country activities during the year under review. The specific activity areas where technical collaboration has taken place with different countries during the year are shown in Table 4. In BANGLADESH, the recently completed UNDP/WHO project for the Water Supply and Sanitation Authorities (WASAS) has been of value in terms of providing information on institutional review, tariffs and operation and maintenance, and also in assisting the Government in meeting the World Bank/ IDA loan covenants. Further support to the WASAs is necessary, and it is essential to take up the second phase of this project without delay. The two long-term WHO staff assigned to the Department of public Health Engineering have assisted in various facets of its work, including evalua- tion of the latrine construction programme, development of self-help, the operation and maintenance of rural water supply systems, and the study of ground-water pollution from pit latrines. A serious constraint has been the lack of manpower, particularly at the technicians' level, and efforts were directed towards remedying this deficiency. Development of an information system on water quality surveil- lance is also an area that is being given attention in the Government/WHO collaborative efforts. Some of the external investment could not be absorbed properly and viable projects within the framework of a Decade Plan should now be generated in order to attract additional external funding. The Organization collaborated in some aspects of Decade plan preparations. With greater involvement of the Ministry of Health in Decade activities the critical issues facing the sector could be solved - given the fact that the Table 4 ~~viromentel Health cooperative kfiuifies with WHOISEARO (1 July 1982 - 30 June 1983) Activity Area BAN BHU BUR DPRK IN0 IN0 HAV MDG NEP SRL TW Inter-counfry COMNITY WATER SUTPLY AND SANITATION Promolion of the wead* Sector policy review and formularion x x Development OF overall Decade pien and progra-e x xxx xxx Inregration with PHC and other developments x x Review and reorientation of ~ecade plane x x Review with donors x x Delineation of vertical and horizontal responsibilities for decision making on planning, implenenletian and operatian and m.inten.nce Inafitufional Developmenr NAC LC TST Scudiea on rural WS administration and mananemenc - Studies on urban US adminierrstion and man.genenc Studies an rural saniterion administrarion and management Studies on tariffs and aubaidiea Studies on operation and maintenance Upgrading existing supplies Socic-behavioural acudiea Healfh education unrer surveillance Upgrading planning capabilities INO. MY.) ME, NEP,) (1) SRL 6 TBA) Developnenf of Human Resources Manpower inventory and survey Projection of manpower needs "Anpower inp1emenr.rion .L"die. Total ornporer plan Training of profe.sional and .ub- professional sraff Integration of HBD with PHC IND. NEP, SRL 6 TH* (2) IND (3) Infometion Blehenge and Techwlogy Development 1nform.tim for Decade plan ~nformacion for monitoring progress xxx x*x xxx Ilanagemnt info-rioo system (MIS) WETRI x x x x Appropriate technology development x x x x x x x Financial Resources PPIS x x x *XX mnar cltalogve mnor conavlcations seeror reviers Country secror digests xxx xxx xxx CONTROL OF EWIROWNTAI POLLIJIION wafer eontro1 x I XX Air pollurion control x x Indualry-specific pollution control x x x EHIA x X FWD SAFETY Ilanpover Development Reid Testing Integrated Food Safety wesrionnaire Revie" of Food legislation Strenzthenin~ of national food control Nore: NAC - National Action Committee; TST - Technical Support Team; HRD' Hurnsn Resources Development; - ~ETRI - ~rograwe on &change and Transfer of Informe~ion; PPIS = Project and ~rogralnoe Information System; EHIA = Enviromenfal Healfh Impact AerersmenL. (1) UNDP International ~rinki~g iieter supply and Sanitation @cede Advisory Services Project. (2) ~egional w~oluorld ~nnk IEOI) course on ~rojsct Formulation and ~ppraisal for water supply and saniration, *nna University, Iladras. 3 special Course on Water Pollution Monitoring and Control, International Institute for Hydrology and Enuiromentsl Engineering, Oelff, Netherlands. provision of water supply and sanitation has been declared as a major objective at the highest level of decisionmaking. In BHUTAN, a draft National Plan for the International Drinking Water Supply and Sanitation Decade was prepared by the Royal Government with the cooperation of WHO. Simultaneously, a project proposal has been formulated for the provision of low-cost sanitation in schools, basic health units and dispensaries throughout the country; this was under consideration for funding by UNDP. WHO'S collaborative activities in environmental health in BURMA have been progressing slowly but steadily. A national water committee was estab- lished to coordinate all activities of water and sanitation. However, each agency is preparing, departmentally, its own review and work programme. The manpower situation was reviewed and, based on the results, a plan for man- power development was under preparation through WHO/GTZ project cooperation. A country-wide survey under UNDPIWHO assistance was in progress to determine the status of existing water supply and sanitation facilities. This should constitute a useful inventory for planning new projects. A rural sanitation project was completed with WHO and UNICEF support. A new UNDPIWHO project for feasibility studies for water supply and sanitation in seven towns was approved by the Government. The Government's policy was to generate water and sanitation schemes as much as possible on a self-help basis, right from the initial stages of the Decade. In this way, it could channel as much of the external assistance as possible to production units for pipes, pumps, cement, etc., so that dependence on the import of these commodities could be eliminated. Institutional arrangements were available for promoting community involvement at all levels in all parts of the country through village or town committees. As regards the DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, in the year under review cooperation was extended through a UNDP/WHO Preparatory Assistance Programme to identify a new project for the protection of environmental health in rural and semi-rural areas. A WHO mission visited Pyongyang and neighbouring areas and assisted the Government in developing a project proposal, which was awaiting approval. Fellowships were awarded under the WHO regular budget programme. In INDIA, efforts for providing water supply to "problem" villages were accelerated, particularly in view of the acute drought conditions that prevailed in many states. Provision of rural water supply to drought- affected villages received top priority, as it was one of the elements of the Government of India's 20-point development programme. WHO assisted in preparing a draft master plan for the Decade. WHO'S technical input in this exercise was utilized by the Government. In addition, ten senior engineers from different states went on a special six-week tour to selected countries in Latin America in order to study an integrated approach for rural piped-water supply schemes. In particular, engineers considered community education and participation, appropriate technology, operation and maintenance, and the financial and managerial aspects of developing self-reliant rural water-supply schemes. Seventeen senior Indian engineers attended a three-week course at Anna University of Technology, Madras, on project formulation and appraisal for water supply and sanitation - a course in which the World BankIEconomic Development Institute collaborated. Simultaneously, a few experienced engineers also went on observation tours of spot-source rural water-supply systems and self-help sanitation facilities in three Asian countries. In the field of environmental pollution, a special course that had been organized at the International Institute for Hydraulic and Environ- mental Engineering, Delft (the Netherlands), last year was repeated during the year under review. Seventeen Indian engineers and scientists attended this 12-week course, which was found to be very useful. The feasibility of arranging similar courses in India itself in future was under review, WHO provided specific assistance through short-term consultancies in identified areas, such as environmental management of iron-ore mines, air pollution control, waste-water treatment and development of water-pollution control laboratories. INDONESIA prepared its Decade Plan after the second national workshop held under GTZIWHO assistance. A National Workshop on Sanitation was also held in late 1982 with assistance from CDGjGTZIWHO. The Government was intending to prepare a further detailed plan at the provincial level with additional assistance from GTZ~WHO. A rural water supply institutional study was completed under the GTZjWHO project; this has contributed towards the Decade planning exercise. The training of engineers and consultants in pre-investment planning for water supply projects with UNDP/WHO assistance was nearing completion. Ma~power shortage continued to remain the major constraint. A comprehensive rural water supply and sanitation manpower training project assisted by UNDPjWHO commenced activities in 1983. Rural water supply feasibility studies were in progress in three provinces; these were executed by WHO with UNDP and GTZ funding. These projects have health education components, financial studies and hydrogeological investigations built into them. The environmental health programme in Indonesia continued to remain the largest in the Region. The review of the sector by all ministries concerned in developing policies and programmes through the two-workshop approach (a first workshop in which the broad strategies of Decade plans are discussed, and a second workshop which reviews and examines the plan resulting from the first) and the clear decisions by Government on areas for collaboration by inter- national agencies, including WHO, have placed the Decade programme in Indonesia on a sound foundation. The integration of social studies, health education and community participation in many of the rural water supply and sanitation projects is worthy of mention. Another positive aspect of the Indonesian programme is the active involvement of the health professionals in the Decade programme in the country. It is important, therefore, that the external agencies coordinate their activities better so that the excellent mechanism for planning that exists in Indonesia is supported effectively through external resources. The critical issues in Indonesia, however, are in project implementation where, due to acute scarcity of manpower, the Government often finds it difficult to implement the projects in the field. This can only be resolved when the national manpower situation improves. MALDIVES faces a very difficult problem in water supply and sanitation. The delicate balance of the ground-water lens under the atoll, the risk of pollution of the ground-water by human excreta, the saltwater intrusion through recessive draw-off from the wells, insufficient rainfall occurring only for a few months in the whole year - all these contribute to technological problems of the first magnitude. These have to be tackled with considerable expertise, so that the available potable drinking water can be managed and used properly without polluting the groundwater source, especially as Maldives cannot afford high-technology/high-cost solutions such as de-salination. These problems were being addressed and, given the commitment of the Government and the cooperative support that is tradi- tionally exhibited by the people of the atolls, the problems can be solved. A manpower survey was already at hand. A WHO team, together with the country engineer and the staff of the Maldives Water and Sanitation Authority, were to finalize the manpower plan in the second half of 1983. An appraisal of the sector was carried out by the donors concerned in connection with the immediate works programme for Male water supply and sanitation. In MONGOLIA, environmental health activities were directed towards strengthening laboratories for water quality surveillance and for the development of sewage treatment and disposal facilities. Environmental control became a routine part of the work of the Institute of Hygiene and aimak sanepid stations. WHO has supported their development by providing essential equipment and supplies and by training personnel with the help of consultants. In NEPAL, the manpower survey and planning for the Decade was undertaken through consultancy support provided jointly by WHO and the World Bank and the manpower plan is nearing completion. A draft proposal for the training of village-level technicians for potential donor support was also prepared. A proposal for twinning the Institute of Engineering, Nepal, with a university in the Region, possibly in India, was pursued and a delegation of sector officials from Nepal, including a UNDP consultant and WHO staff visited three universities in India and held discusssions with the Ministry of Education, Government of India. Their proposals were made available to His Majesty's Government for decision. Two senior engineers from Nepal also participated in the project formulation course in Madras and a total of 13 fellowships were awarded in water and sanitation to sector officials. WHO country engineers provided assistance to the Asian Development Bank in the preparation of an investment plan in the sector for Nepal. A crucial development in Nepal was the decision of the Government to review the Decade Plan through the establishment of task forces. These were to go into the different aspects of the Plan and prepare an updated sector policy document, together with project data sheets for identified priority projects in the updated Decade Plan. WHO is collaborating in this endeavour. In SRI LANKA, two senior engineers were trained in project formu- lation at the regional course held at Anna University, Madras. Through short, in-service training courses, some 200 technical officers and water supply maintenance personnel were also trained. Substantial progress continues to be made in the provision of rural water supply through deepwell handpumps. Hydrogeological and geophysical investigations on WATER AND SANITATI( lity water sr. ., &:-L .. forts of mo. Commur rpply and san,ta!ion occupy a position ur rrry,, briorily in the health develop- ment el. st countries in the Region. In many countries of the Region, ~roblems related to the heafrh of workers are increasing wilh growing indusfrialization. Narionalactiviries in this area are Iherelore being focusedon meering the needs for occupational heahh services as oar1 of comprehensive health development erforls. Mannar island were completed and production wells were under construction. During the period under review, the UNDP/WHO project for institutional support to the National Water Supply and Drainage Board was subjected to an intensive evaluation, as UNDP had selected this project for reporting to its Governing Council session in May 1983. This external evaluation, in which the Government, UNDP and WHO were associated, made recommendations for reorientation of the project in the remaining months of 1983 and identified the terms of reference for its extension beyond 1983. The Government gave priority to the operation and maintenance of existing supplies, upgrading existing water supply and sanitation facili- ties, and manpower development in order to consolidate the achievements made so far. Many schemes constructed in the past were expensive to maintain and increasing amounts of the development budget were used to subsidize operation and maintenance. The objective of the current priority activities was to remove this constraint, thus obtaining greater benefits from the investments already made. Task forces were set up to review different aspects of the programme and a national workshop was to be held later in the year to review the recommendations of the task forces so that an updated Decade Plan could be prepared. WHO continued to participate in the Government's endeavours in this regard, as it has done in the past. In THAILAND, several water supply and sanitation schemes were in progress, but no comprehensive Decade Plan was yet available at the time of reporting. The Government established a Centre for Integrated PLan of Operations under the National Economic and Social Development Board, and this centre was not only proceeding with Decade planning but was at the same time studying the establishment of permanent systems for information gathering and processing to enable continuous updating of the Plan and better management of its implementation. WHO'S resources were increasingly utilized in supporting village self-help in the planning, designing and operation of water and sanitation facilities as part of primary health care. 5.2 Occupational Health Needs of services related to workers' health were increasingly being focused as part of comprehensive health services and occupational health was gradually taking its due place in the health development efforts of several countries of the Region. WHO'S activities in this field consisted in providing consultancy services, awarding fellowships for training and support of national group educational activities, and conducting surveys/ studies. In BURMA, a WHO consultant assisted in setting up the Central Occupational Health Laboratory in November 1982. The instruments were provided through the UNDP-assisted project on the "strengthening of Health Services to the Newly Industrialized Areas" (west Bank of the Zrrawaddy river). The labo;atory was able to analyse samples delivered by the field survey teams of the occupational health unit. The WHO consultant conducted courses for the training of medical officers, technologists and laboratory inspectors in occupational toxicologyi practical laboratory techniques and procedures in occupational toxicology. Another consultant conducted a training course in occupational hygiene with reference to the monitoring of the working environment and the setting up and maintenance of hygiene standards for the medical officers and occupational hygienists. Emphasis was placed on monitoring techniques and also on the maintenance of supplies and equipment. Assistance was also provided in the upgrading of the existing occupational health (hygiene) laboratory. In INDIA, the 8th National Conference on Industrial Safety and Health was organized in New Delhi by the National Safety Council in October 1982. A consultant visited INDONESIA in 1982, reviewed the draft long-term programme in occupational health, and examined the possibility of developing a comprehensive programme for underserved working populations. 'The long-term programme in occupational health in Indonesia was finalized along with a proposal for occupational health care services provided through health centres. Broad lines of collaboration and coordination between the Ministries of Health and Labour in occupational health were identified. In THAILAND, the Department of Occupational Health, functioning as the WHO Collaborating Centre for Occupational Health, embarked upon a programme of primary health care for underserved working populations in small-scale industries and agriculture. It also submitted a request to UNDP for assistance in developing this important and wide-ranging programme of work aimed at the delivery of health care to underserved working popula- tions. WHO supported the Division of Occupational Health in carrying out feasibility studies in the training of primary health care workers for the delivery of health services in general industry, mining and agricultural workplaces. A workshop on educational material for primary health care workers was held in Bangkok in February 1983. With WHO support, the Department of Occupational Health, Faculty of Medicine, Mahidol University, Bangkok, conducted a study of working conditions, occupational health hazards and the health status of women workers in Thailand. 5.3 Radiation Medicine WHO technical collaboration with Member States continued as regards the strengthening of radiation medicine services and for standardizing radiotherapy dosimetry through a joint WHOIIAEA programme. In BANGLADESH, the Nuclear Medicine Department at the Institute of Post-graduate Medicine and Research (IPGMR) in Dhaka is well staffed and was supported by Bangladesh's Atomic Energy Commission. The Institute con- ducted ultrasonography and is well equipped with a gamma camera, scintilla- tion scanner and a three-channel renogram. The radiation protection services in the country continued to receive regular supplies of films from WHO. In BURMA, films continued to be supplied as part of the radiation protection services. It is hoped that with the arrival of BRS machines, facilities for radio-diagnosis would be explored for extension to the periphery. In INDIA, a consultant assisted the Department of Radio-diagnosis of the All India Institute of Medical Sciences (AIIMS) in New Delhi in the conduct of a workshop on abdominal ultrasonic techniques. The consultant delivered lectures on the use of medical ultrasound, especially for the diagnosis of abdominal lesions and a talk on "~dvances in medical ultra- sound diagnosis in 1983" both at AIIMS in New Delhi and at the Sion Hospital in Bombay. In MALDIVES, a WHO consultant trained national counterparts, and repaired and serviced the X-ray machine in the Male Central Hospital. WHO support was provided to facilitate the attendance of a nuclear medicine physician of the Isotope Laboratory in Ulan Bator, MONGOLIA, at the inter-qegional training course and study tour on nuclear medicine for the period September-October 1982. Films for film badges continued to be supplied. A WHO consultant assisted the Post-graduate Institute of Medicine, Colombo, SRI LANKA, as external examiner for parts I and 11 of the M.D. examination in radiology. In THAILAND, WHO activities in the field of radiation medicine included the BRS ~roject, quality assurance work in nuclear medicine and diagnostic radiology. As an experimental study, BRS (basic radiological system) machines are being provided to Burma, Indonesia and Nepal, and would be followed up for further utilization. 5.4 Food Safety Programme Although countries in the Region realized the need to develop food safety programmes in an integrated manner, activities were limited. This was mainly owing to a lack of resources and weak coordination among related implementing agencies or departments. Most food safety programmes in countries of the Region still concentrated on "centralized" activities, such as the establishment of regional or provincial laboratories and provision of central services; food legislation was mainly directed to urban areas. Careful planning and implementation of an integrated food safety programme with a multi-disciplinary team approach continued to be the main objective of WHO'S effort in this field. It must be realized that such a programme should cover all aspects of public health, and must be focused more at the rural and peripheral levels, where the majority of the popula- tion live. Health education and community participation must play a major role in this approach. In BURMA, WHO continued implementing the UNDP-supported project on food and drug control laboratories. In INDONESIA, a training course for food inspectors was held with support from WHO. A consultant assisted in the formulation of guidelines, legislation or codes-of-practice that would promote the establishment of an effective and appropriate food safety and control programme applicable to public places. Earlier, on a separate assignment, the same consultant had studied and reviewed the locally adapted food hygiene and sanitation control programme in Padang, West Sumatra. Another consultant was assisting the Government in strengthening a national food control infrastructure and system, keeping in view the development of an integrated food safety programme with a comprehensive team approach. In SRI LANKA, a group educational activity for the training of some 35 public health inspectors responsible for food safety was supported. In THAILAND, the recruitment of a consultant to assist the Government in the analysis of carbamate residue in food by a special technique in the later part of 1983 was under way. The questionnaire on food safety intended to assess country needs was pre-tested in Thailand. Fellowships on programmes related to food safety, and some supplies and equipment, continued to be provided by WHO in India, Indonesia, Sri Lanka and Thailand. 6. HEALTH INFORMATION AND STATISTICS The focus of the WHO programme in this area continued to be the development of national health information systems (NHIS) and their sub-systems and the strengthening of their infrastructures. The development of national capability in the field of health information and statistics and the conduct of national health studies and surveys were also supported. Keeping in view the wider perspective of the Seventh General Programe of Work for implementing the global, regional and national strategies for HFA/2000, the programme's scope and functions were further broadened. Reorientations ensued, necessitating closer collaboration with other programmes at all levels in order to provide a smooth transition from the Sixth to the Seventh GPW. A global consultative meeting on the health situation and trend assessment programne (HSTAP) was convened in Geneva in February 1983, which was attended by senior national personnel from some of the countries of the South-East Asia Region. The meeting drew up the guiding principles for the direction and development of the programme. At the regional level also, several consultations were initiated between technical programmes of communicable and non-communicable diseases, health information and statistics, the managerial process for national health development (MPNHD), and other related programmes to discuss the concept and direction of the new HSTAP and to plan for collaborative action at national, regional and global levels. In the Regional Office, the Health Statistics Unit, which is responsible for the development of HSTAP, was strengthened by the addition of a health information specialist in November 1982. Activities concerning the lay reporting of health information, and its application in primary health care programmes in a number of countries in the Region were successfully implemented. A guideline on the subject was also produced which was used in developing lay reporting systems. The experience gained in the countries of the Region was being used in some other regions to develop similar lay reporting systems. The documentation produced in SEAR0 based on the experiences in the countries of the Region provided the main basis of work for a workshop in Nairobi in 1981, and consultative meetings in Addis Ababa and in Senegal in 1983. The Regional Office provided consultancy support in statistical and information analysis in an institutional study for the International Drinking Water Supply and Sanitation Decade (IDwssD) programme in Indonesia, and another study on nursing manpower planning, also in Indonesia, The Regional Office actively collaborated in the collection, colla- tion and synthesis of regional information for measuring health progress in Member Countries, according to the 12 global indicators for monitoring HFA strategies. An important activity at the regional level was the collation and synthesis of regional health information and the preparation and dissemi- nation of the information as a regional health bulletin. The main objective of the bulletin was to present to the decision makers at the national and regional levels the prevailing health situation in the countries of the Region. This annual regional publication was distributed to Member Countries, WHO headquarters and other WHO regional offices, as well as to other United Nations agencies. At the national level, collaboration with the countries was shaped according to the specific needs of their health systems and the prevailing stage of infrastructural development. In BANGLADESH, a new development was the establishment of a Central Health Information Service in the Office of the Director-General of Health Services. WHO actively collaborated in the development of an NHIS within the context of MFNHD. At the PHC and thana health complex levels, attention was focused on studying the utilization of these services and promoting the use of lay reporting and recording procedures of information on mortality and morbidity* This work was initiated on a pilot basis in one thana and was to be gradually expanded to other thanas in a phased manner. Medical record procedures and statistical systems were promoted in the major hospitals and other medical establishments. Consultancy services were provided for reviewing and developing the medical and health record systems in hospitals and health centres in support of the organization of health services planning and administration, Fellowships were awarded in health information systems. In BUM, the Health Information Service played the role of the lead agency in the monitoring and evaluation of the country's health programmes and published regular health statistical reports. There was a major improve- ment in providing more complete information for planning and monitoring by the introduction of lay reporting in 12 survey townships. A training workshop for state/divisional statistical technicians and survey townships personnel was conducted in November 1982. The workshop achieved its objective of preparing the staff at the peripheral level for the monitoring and evaluation of health programmes. Other training activities included computer training for personnel of the health information service and potential users of the Department of Health. In INDIA, the development of the health information system at the intermediate and peripheral levels continued to be given high priority. In recognition of this principle, the Central Bureau of Health Intelligence (CBHI) organized a workshop in New Delhi in March 1983 on a uniform system of medical records and reports from district hospitals. Standard forms were introduced by means of which data would be submitted by district health officers to CBHI under the recently introduced integrated health information system. For monitoring and evaluation purposes, the WHO Programme Coordinator and Representative to India and a WHO consultant, together with a national officer, undertook a joint field visit to Uttar Pradesh during which relevant aspects of the functioning and development of the national health information system were reviewed. A training course in epidemiology for health planning and delivery was organized by the National Institute of Health and Family Welfare with a view to improving the competence of health planners and administrators in the planning, development and management of epidemiological activities. The Regional Office actively participated in the preparation and conduct of the course. In INDONESIA, further strengthening of the human and physical infrastructure helped improve the integrated recording and reporting system as well as analysis of information generated at health centres. The Bureau of Planning was strengthened in the field of data analysis, software management and development, and data base management. Data management capabilities and monitoring of the hospital recording and recording system were further strengthened. The translation of the ICD IX revision was almost complete. The Working Group on Health Information prepared a manual with conceptual and operational guidelines for the development of the health information management system. Creation of a technical unit with a team on health information within the Ministry of Health helped to ensure the much needed coordination. This team coordinates the efforts of all ministerial units according to their information needs. In MALDIVES, the recording and reporting procedures being used by family and community health workers were studied. Based on the results of the study new forms were developed for recording and reporting by field health workers (FHws) and community health workers (CHWS). These new forms were discussed and approved at a meeting held under the chairmanship of the Deputy Director of Public Health and were to be tested by FHWs and CHWs. A long-term WHO statistician continued to help his counterparts in these and related activities. In MONGOLIA, a comprehensive study of the health status of the population was undertaken with WHO collaboration in Huvsgul aimak. As an integral part of the PHC system, the Huvsgul project will provide baseline information on vital events, morbidity, mortality, sickness, absenteeism and nutritional patterns. The methodology of the study was tested in different parts of the country. A study on the requirement of computerization for the national health information system was carried out by staff from WHO headquarters and the Regional Office. The current structure and functions of health information services were reviewed as well as their links with other government statis- tical institutions. Statistics from maternity hospitals and pharmaceutical services were likely to be the first modules to be developed under the computerization scheme. In NEPAL, assistance in the field of health information systems continued under the aegis of the project on health planning and programming. The WHO health planning and management specialist now working in the Planning Unit participated in the national planning activities, including improvement of the health information system and establishment of a health data bank. WHO personnel also continued to collaborate in the monitoring of HFA strategies using global indicators. In SRI LANKA, as a result of the review of the existing health information system, the design of an improved system was developed. The steering committee on NHIS started to implement the new system on a trial basis in Kegalle district from April 1983. An evaluation of the trial run was planned for late 1983. Appropriate training of the staff, both at the central level and in Kegalle district, was carried out for this purpose. Other important activities in this field included the preparation of a sampling procedure for an oral health survey, publication of the annual health bulletin and a proposal for the development of a data base and operations room in the Planning Division. THAILAND has made considerable progress in the development of the computerized data processing system. The computerized Master Plan for the Ministry of Public Health was completed. One microcomputer was procured for the Division of Epidemiology with WHO funds and another for the monitoring and evaluation of nutrition and MCH with financial aid from US AID. The revision of record and report forms was undertaken by a ministerial committee, and two sets of manuals on the recording and reporting system were prepared for publication. Training activities included a seminar on the development of hospital statistics and information systems in the Bangkok Metropolis Authority and short courses for hospital staff. 7. HEALTH MANPOWER DEVELOPMENT The Organization's support to health manpower development within the Region continued to be based on three basic objectives: (i) strengthening the mechanism for, and linkages between, manpower planning, production and management; (ii) ensuring that all types of training programmes for health workers are consonant with the need to provide effective and efficient primary health care and consistent with the overall goal of HFA/2000, and (iii) assisting the countries of the Region in collaborating and cooperating with one another in all areas of health services and manpower development in the spirit of TCDC. Health Manpower Planning Health manpower planning exercises were conducted in Bangladesh, Burma, Indonesia, Nepal and Thailand. In BANGLADESH, WHO collaborated in the preparation of a draft health manpower plan. The process had been started in 1981 with the preparation of the Health Manpower Situation Report, followed by a national health manpower planning exercise in June 1981 and the preparation of individual outline plans for selected categories of health personnel. A health manpower plan steering committee and a working group were formed by the Government to carry out the process. The draft health manpower plan does not outline any decisions on health manpower; rather it presents possible options that decision-makers may consider and choose in the development of the national health plans. They would thus be considered when the Second Five-Year Plan (1980-85) mid-term review and the formulation of the Third Five-Year Plan are being undertaken. Thus it was ensured that the health manpower plans would be automatically included and implemented with the five-year health plans. In BURMA, health manpower planning was undertaken in conjunction with the development of country health programming (People's Health Programme) efforts. In the first country health programme (CHP), the manpower resources needed were considered separately under each of the primary and support programmes. However, in the second CHP cycle, which was conducted in 1980181, a separate health manpower planning and projections exercise was undertaken, consolidating all the manpower resources required for the four major programmes. These exercises, undertaken as part of the total health planning effort, ensured that the options and possibilities for manpower development were fully taken into consideration. The planning exercise in INDONESIA was one of the most comprehensive ones. The health manpower projections were developed as a part of a massive exercise in the Ministry of Health to produce a long-term health programme up to the year 2000. This major activity was managed by a network of committees involving the Minister of Health, all the senior staff of the Ministry of Health, as well as many middle-level and junior staff. The actual projection of health manpower requirements was made by 13 specific working teams coordinated and consolidated by the Health Manpower Develop- ment Working Group. The overall health manpower planning document is being used as a basis for the preparation of provincial health manpower plans for each of the 27 provinces for Pelita IV. In THAILAND, an important development was the efficient coordination between the Ministry of Public Health and the University Bureau by the Centre for Coordination on Health Manpower Development. The Centre has been working efficiently. Each university is represented and meetings are held regularly. A one-month planning course for 40 planning and evaluation officers in the office of Provincial Medical Offices was also implemented. Bangladesh and Burma participated, through contractual service agreements, in the global study on the development of simple methodologies for providing health and health-related manpower development. This study originated from a meeting on health manpower projections held in 1981 in Geneva where the health manpower projection methodology had been simplified and standardized and countries selected to test out the methodology. A second inter-regional meeting was held in December in 1982 in Harare, Zimbabwe, to review the experience of the participating countries in the use of the different methods of health manpower projections, Health Manpower Managems WHO has been promoting in Member States the balanced development of all the three components of the health manpower developoment process, viz., planning, production and utilization or management. Although a large number of countries had taken positive steps in developing health manpower plan- ning, much less attention was paid to health personnel management. This area included explicit employment and utilization policies, monitoring of manpower requirements and utilization, performance-based job descriptions, performance assessment, staff supervision, continuing education, and provi- sion of incentives and opportunities for career development. Many of these aspects had no doubt been included in overall health manpower planning as well as in health management training courses, but they did not get the consideration they deserved. To correct this situation, the Regional Office and WHO headquarters, in collaboration with the Member States, would undertake activities to strengthen this area. To this end an inter-regional meeting to consider health manpower management was being planned for the end of 1983. Health Manpower Development Research The Organization continued to foster the strengthening of HMD research in its Member Countries. An inter-regional Consultation on Alternate Methodologies for Health Manpower Development Research held in New Delhi in July 1982 served a very useful purpose in bringing together an international group of experts who deliberated on these alternate methodologies, their specific applicability and usefulness for the solution of different problems in the HMD field, and identified the ways by which information relating to these newer methodo- logies could be more widely disseminated to national researchers, policy makers and health service administrators. WHO has been promoting the concept of the team approach in education, training and the delivery of health services, particularly at the primary care level, as an important basis for health manpower development. A consul- tant assisted Indonesia, Nepal, Sri Lanka and Thailand in developing and formulating protocols for comparable national case studies on team work, designed to identify how different categories of health personnel worked together as a team at the community level and to recognize the specific factors that promoted or impaired the ability of people to work together as an effective team. In addition, the Organization continued to support individual research projects formulated by national workers which conformed to the overall guidelines provided by the Regional Advisory Committee on Medical Research. In BURMA, studies to determine the effectiveness of national workshops in educational science, and for the evaluation of the rotating house surgeon training programmes, have been technically reviewed. In NEPAL, assistance was provided for studies which attempted to assess the performance of health personnel working at health posts. In THAILAND, projects designed to assess whether the training of medical graduates prepared them adequately for their subsequent careers, especially in public health administration, were assured of support. Assistance was also being provided for projects attempting to devise aptitude tests for use in screening applicants for selection for entry into medical schools and for the mid-term evaluation of a special educational programme for training medical students for rural areas. In general, the state of development research in the countries of the Region is inadequate. While some isolated and sporadic studies have been undertaken they do not as yet constitute a part of a well planned and systematic effort and as such have had little impact on the solution of national problems. The major reasons for this were perceived as the lack or inadequacy of established institutional mechanisms at the national level where policy makers, health service administrators and research workers could meet together to identify researchable problems, determine their priority and decide on research procedures to be applied in search of solutions. In order to develop systematic HMD research, efforts should be made to bring together a critical mass of appropriate group of researchers belonging to relevant disciplines who could work as a team to tackle the multifaceted problems. Health Team Training Following an inter-country consultation on "~eam Work and its role in Primary Health Care Servicesf' held in 1981 in the Regional Office, a series of national case studies on team work was organized during the period under review. A consultant visited Indonesia, Nepal, Sri Lanka and Thailand in 1982 to discuss with the national authorities the protocol for the study, including the case study methodology, the criteria for the selection of study areas and field training for the research staff. These case studies, which started in the countries in late 1982, were in the final stages of completion and the data from these case studies would be analysed at the end of 1983 to identify the most effective model of team work in the provision of primary health care. This model would then be used to develop training programmes for inter-disciplinary health teams. Performance Assessment Perfcrmance assessment procedures are very important instruments for assessing whether an individual health worker can carry out a specific task effectively and efficiently. These could also be used to assess the effectiveness of PHC workers' training programmes, determine the quality of PHC services delivered, appraise PHC workers after the training and develop programmes of in-service training and continuing education. Keeping this in view a number of activities were zenerated to promote and establish perform- ance assessment in the countries of the Region. An Inter-regional Meeting on Performance Assessment was held in the Regional Office in late 1982. The meeting developed guidelines for the assessment of essential tasks performed by PHC workers and also for the supervisors and teachers of PHC workers for developing instruments for the assessment of PHC workers. In India and Indonesia, efforts for the production and field-testing of performance assessment instruments which were directly related to tasks commonly performed by PHC workers were under way. Support was provided by the Organization to conduct a nation-wide performance assessment study of all categories of PHC workers in Nepal. A set o: guidelines for developing and using performance assessment instruments and procedures was prepared by the Regional Office for publication. Continuing Education The value of continuing education as a means of keeping health workers more competent in the performance of their jobs is now universally acknowledged. In BANGLADESH, the Directorate of Nursing Services, Ministry of Health, continued to be very active in the continuing education of nursing personnel. Several in-service training sessions in community health nursing, community mental health and psychiatric nursing were conducted for 47 nurses. Training and in-service courses and workshops also were conducted for various categories of health workers in the areas of nutrition, health education, management and medical clinical specialities. The Bangladesh Medical Research Council organized a training course on research methodology during which 59 medical perscnnel were trained. In BURMA, reorientation courses were a regular feature of the primary health care programme to prepare health workers for their role in implement- ing PHC activities. Several training courses for various health workers were carried out, including management training, educational sciences, laboratory and X-ray, community health and midwifery. In INDIA, a programme of continuing education of community health vol~~nteers was launched through correspondence conrses on an experimental hasis, with training materials and visual aids, developed and supplied thro~gh training centres. Short trai.ning cocTrses in orthopaedi; and oncology nursing were carried out for nurses in service. INDONESIA continued the retraining of nursing personnel in community health nursing, in educational sciences (for teachers), in hospital nursing administrati.on, and in selected clinical nursing fields. Substanti-ie efforts !;ere made to develop mechanisms by which continuing education courses could be linked to career development in nursing and piven equivalent academic recognition at specific levels, Continuing education activities for v?rirli,~ health workers in the form of training or upgrading courses included a wide range of topics, from ~11~. management training of edministrative heal. th officials t rr specific programnle areas such as nutrition, MCH/FP, environmental heal.th, and occupationzl health in which both b,?19 and m~ltilateral funding agencies have assisted/collaborated. The Allied Flea1 th services Traicing Centre, ?4aie, HALDIVES, in colla- horation with lii110, carried out workshops and training courses on various topics, including orientation to primary health care, teaching methods, sea~~ally-transmitted diseases, diarrhoea1 diseases, and malariz for health workers and teachers. TICMGOLIA conducted seven nationai seminars in which 97 doctors anrl nllrses participated and discussed various MCH problems. In NEPAL, with WHO collaboration, a wide variety of training courses anrl workshops were continuously offered for various categories of health workers by the Ministry of Health and the different campuses under the Instjtute of Medicine, Trihhuvan University. The Institute conducted several workshops on teacher training, curriculum development, development of performence assessment instruments, and production of textbooks and teaching materials. A survey of learning needs of the nursing faculty was also carried out. As part of the various programmes of the Ministry of fjealth, several training courses and workshops for different categories of health workers were conducted in the areas of management of nursing services, training of trainers of TBAs (ANMs), maternal and child health and family planning services, laboratories, nutrition education, envi.ronmenta1 health, EPI, malaria and leprosy. Training in field research for doctors was also carried out. A WHO consultant assisted in conducting a two-week workshop on medical records and hospital statistics in March 1982, in which 40 medical records assistants from various hospitals, institutions and projects were trained. In SRI T.ANKA, training courses in midwifery, teaching and supervision in schools of nursing and nursing management were conduct~d through the Post-Basic School of Nursing. Various training and re-training courses for midwives and family health workers and their trainers were also carried out. Other continuing education activities included courses and workshops for other categories of health workers including doctors, in the areas of health education, mental health and rehabilitation. WHO collaboration in continuing education activities included consultancy support in conducting a course in health planning and management and technical and financial assistance in organizing workshops and seminars for community leaders. WHO collaborated in continuing education activities in THAILAND, where Mahido1 University received assistance in conducting various workshops on specific topics related to health planning, management and evaluation for 40 medical officers and 108 middle-level managers. Other in-service training courses included intensive training of doctors in geriatric medicine to improve health care of the elderly in the community and courses for tambon health personnel in medical care in which 3 497 persons were trained in collaboration with UNFPA. At the regional level, an inter-country workshop on the v valuation of TBA Training Programmes" was held in the Regional Office with partici- pants from five countries. An Inter-country Consultative Meeting on the "systematic Development of Continuing Education for Health Workers" was also held in June 1983. Health Learning Materials The countries of the Region recognize the need to ensure provision of adequate and appropriate health teaching and learning materials for health workers in training and in service, particularly for those workers engaged in primary health care activities. The Organization supported the countries in reviewing their specific needs, priorities and resources for the establishment of a system which would foster and develop self-reliance in the production of teaching-learning materials. Assistance provided to India for the training of traditional birth attendants enabled the national authorities to prepare and publish illus- trated handbooks and record books for use by dais. WHO extended support to the national authorities in Thailand in producing a TBA learning package and collaborated with Indonesia in the production of a TBA training kit. The Organization collaborated with Indonesia in translating into Bhasa Indonesia a WHO publication "Teaching for Better Learning" (a guide for teachers of primary health care staff). This book was used as the main guide and resource material for a workshop for nursing teachers held in June 1982. Copies of this were distributed to the workshop participants and schools of nursing. WHO provided assistance to Nepal in surveying its needs in this area and in preparing a comprehensive project document with which to seek external assistance for the implementation of its plans. The project aims at achieving self-reliance in the continued production of health learning materials for health workers at all levels by developing national expertise in the design, production, distribution and utilization of the material produced. 7.1 Education and Training of Professional Health Personnel 7.1.1. lhdergraduate Medical Education In BANGLADESH, the training of teachers of preclinical sciences in medical schools was supported through the award of fellowships; also, two short-term consultants were assigned to assist with the development of curricula and teaching methods in community obstetrics and social medicine. A comprehensive project to support the establishment of a centre for medical education was formulated with UNDP assistance and is under consideration by the Government. In BURMA, a revised undergraduate medical curriculum was being reviewed by the Government for approval. In INDIA, the Medical Education Review Committee appointed by the Government to report on all aspects of medical education completed and submitted its report. The Organization provided assistance to Banaras Hindu University, Varanasi, in conducting a workshop on the use of audiovisual materials and to the Medical Council of India in conducting a workshop for the deans of medical schools. In INDONESIA, the common core curriculum which had been formulated by the Consortium of Health Sciences on the basis of the country's health needs and conditions was being implemented in all government medical schools. The Organization provided a consultant to help develop a compre- hensive system for evaluating the effectiveness of the new curricula. The consultant also assisted the medical school at Bali in conducting a workshop designed to evaluate its community medicine teaching programmes. The training of medical school teachers was supported through fellowships. Technical support was provided to the National Medical Institute in MONGOLIA in the revision of curricula and for the implementation of several group educational activities and national workshops. In NEPAL, a firm and agreed policy decision on the type of doctors to be trained at the Institute of Medicine would facilitate the development of an appropriate curriculum. The Organization assisted in the training of pre- and paraclinical science teachers to serve at the Institute through its fellowship programme. In SRI LANKA, the training of teachers in all four medical schools was supported through fellowships. Assistance was provided to THAILAND in producing a journal for the continuing education of doctors and in undertaking a joint study by the Ministry of Public Health and the Universities in order to decide on the content and duration of the educational programme of undergraduates and report on the admission of additional students to three universities and for their training at provincial and district levels. 7.1.2 Post-graduate Medical Education The Regional Office continued to give support to post-graduate institutions in some Member States in developing and strengthening their training programmes. This support ranged from the recruitment of experts to the strengthening of the faculty through award of fellowships and study tours as part of their post-graduate training programe and the provision of supplies snd equipment. In this regard, Member Countries might wish to make greater use of the available resources within the Region with regard to their need for experts and facilities for the placement of their trainees. Close cooperation and collaboration among the post-graduate institutions in the Region, either through the TCDC mechanism or the establishment of a network, may be envisaged to enhance this development. In BANGLADESH, the Institute of Post-graduate Medicine and Research continued to provide training in various medical specialities. A tripartite review was conducted in February 1983 to evaluate the UNDP support given to the National Institute of Preventive and Social Medicine (NIPSOM). Lack of recognition for the degree awarded by the Institute for purposes of career development within the health services was one of the major constraints restricting the fuller use of NIPSOM's capabilities. The review recommended strengthening of the ~nstitute's field practice areas and the introduction of a management training component in the training programme. In INDONESIA, financial support was given through the Consortium of Health Sciences for the strengthening of curricula of selected post-graduate (clinical) training programmes, mainly those needed to support the second- level health services in the kabupaten (internal medicine, paediatrics, surgery, obstetrics and gynaecology) as part of the referral system. Core curricula of 1.7 clinical specialities have now been developed and are to be used for training in the different centres accredited by the Government. Support was also provided for the strengthening of the post-graduate train- ing programmes in basic medical sciences conducted in three universities. Long-term WHO staff support was provided to the Faculty of Public Health at the University of Indonesia for the purpose of strengthening the courses ~rovided for the MPH degree. A short-term consultant also provided support to the courses in biostatistics. Under the same project assistance was made available to the newly developed Faculties of Public Health in Surabaya (Airlangga University) and Ujung Pandang (~assanudin University). In SRI LANKA, the Organization continued to assist the Post-graduate Institute of Medicine by providing consultancy support in assessing student performances. The Regional Office was represented at the Conference on Post- graduate Medical Education in the ASEAN Countries held in Bangkok in November 1982. The meeting was organized by the Medical Association of South-East Asian Nations (MASEAN), and was supported by the Regional Institute of Higher Education and development (RIHED) and Mahidol University. Important recommendations included (i) pledge of full support to the governments of the Region in achieving the target of HFA/2000; (ii) establishment of common curricula and standards of evaluation with a view ultimately to achieving reciprocity in the Region; (iii) the use of ASEAN specialists in the training courses directed to the problems of the Region, and (iv) exchange of teachers and teaching materials. 7.1.3 Teacher Training Teacher training continued to receive technical support from the Organization during the period under review. Teacher training served many purposes at the same time, including: (a) assisting teachers to plan systematic, competency-based curricula directly related to national needs and priorities; (b) assisting teachers to refine and improve their skills as teachers, and to be able to develop and then use effective, relevant teaching and learning materials, and (c) developing and using methods of student evaluation which are consistent with competency-based, learner- centered training programmes. These purposes can only be served if programmes of teacher training are conducted on a large enough scale, and result in the production of a "critical mass" of trained teachers in all types of health workers' training institutions at local and national levels in the Member Countries. Most programmes of teacher training are too small in scale and too ad hoc in nature. They are of a small scale because only a few teachers receive training at any one time; they are ad hoc in nature because most training programmes provide for one training programme - e.g., in curriculum planning - and then there are no follow-up activities. These defects must be corrected in order to achieve the objectives of enabling teachers to plan, implement and evaluate their training programmes so that these are consistent with national health policies, needs, priorities and the demands of their peoples. The two Regional Teachers' Training Centres at Peradeniya, Sri Lanka, and Chulalongkorn University, Thailand, continued to offer training programmes and accept fellows from the countries of the Region. Neverthe- less, the bulk of the activities provided by these two centres are at the national level in the two countries. In INDIA, the National Teachers' Training Centre (NTTC) at Pondicherry offered two national courses for medical school teachers. Its newly-established sister-centre in Chandigarh provided one national-level course, It also offered a course for deans and principals of medical colleges in North India, with the explicit purpose of engendering high- level support for teacher training in that part of the country, and also organized two on-site training programmes for medical school teachers in the "evaluation of students" in Jammu and Kashmir. The NTTC at Chandigarh expects to expand the scope of its training programmes to include the teachers of nurses and auxiliary health workers. In INDONESIA, there is a well-established network of five national teachers' training centres (NTTCs). These centres are, in turn, supported by educational units which exist in all of the medical and dental schools in the country. The NTTCs and the educational units continued to provide wide-ranging staff development and teacher training programmes, which, in the medical schools, were substantially related to the introduction of the new national core curriculum in undergraduate medical education. Also, as part of the programme of assistance to the Faculty of Public Health, University of Indonesia, long-term consultative support was provided in order to assist in the expansion and further development of all of the Faculty's training programmes. In NEPAL, a major effort has been made by the Institute of Medicine, Tribhuvan University (and its affiliated institutions) in terms of its , teacher training and staff development programmes. This effort was streng- thened materially by long-term consultative support. Workshops and training programmes were organized in curriculum planning and design, the development of locallyrelevant teaching and learning materials, the adoption of appropriate educational processes, and methods of student evaluation. 7.2 Education and Training in Maternal and Child Health Education and training in maternal and child health and family planning (MCH/FP) for different categories of health personnel involved in the care of mothers and children received priority attention, in accordance with the medium-term programme relating to the Sixth General Programme of Work. Basic, post-basic and continuing education programmes in MCHfFP were supported, including training programmes for traditional birth attendants. Technical support was provided for the dissemination of the revised curricula, and the production and distribution of educational manuals on maternal and child health. Teacher training in MCH continued to be a priority activity, the aim being to strengthen the educational programmes in national training institutions and thereby promote national self-reliance. In BHUTAN, technical support was provided for the preparation of a teaching module based on the curricula developed by a consultant for the training of various categories of health workers in MCHfFP at the Family Welfare Training Complex at Geylegphug. In BURMA, WHO supported the training of different levels of health workers in maternal and child health. Emphasis was placed on improvement of the training of lethes, In INDIA, the programme on the teaching of maternal and child health to medical undergraduates and interns was evaluated. It was recommended that the programme be supported by WHO until all the medical colleges in the country were covered by this programme. The low-cost edition of the Handbook on Delivery of Care to Mothers and Children in a Community Development Block was being printed. The dissemination of the re-modelled undergraduate paediatric curriculum through the provision of intra-country fellowships continued. The Handbook for the Care of Children - Birth to Puberty was being pre-tested. The other training programmes supported were national workshops on neonatology for district paediatricians and obstetricians and a regional workshop in MCH for district public health nurses. In INDONESIA, training programmes related to the strengthening of provincial-level maternal and child health, family planning, school health, and community nursing services received support. Training fellowships within the Region were awarded and study tours arranged in order to help in health manpower and education and training in the above fields. MONGOLIA received WHO support for health manpower training in maternal and child health, especially at the aimak level. National seminars on various aspects of MCH were held for physicians and nurses. Training fellowships in paediatric and obstetric specialities were awarded so as to improve the quality of these services. In NEPAL, WHO provided assistance to national workshops for improving the skills of field workers in MCH. Regional conferences of family planning officers in four regions were also organized with WHO support, the aim being to strengthen the management and delivery systems of the MCH/FP programmes, set the annual targets of districts and prepare the programme and budget of the districts. Short-term training fellowships were provided to obstetri- cians in the field of family planning. In SRI LANKA, training for various health workers, such as medical officers, public health nurses and family health workers, was being given in groups. The training was based on the Family Health Workers' Manual prepared with WHOIUNFPAIUNICEF assistance in three languages, viz., English, Sinhalese and Tamil. THAILAND received support for the training of various officials, including health personnel at selected experimental tambons in Nakornsawan Province, to enable them to study simplified KH indicators for communities. Through an inter-country project, senior teachers involved in educa- tion and training in MCH from India, Indonesia and Thailand participated in the Regional Teacher Education Programme in MCH. 7.3 Education and Training in Enviro~ental Health In support of International Drinking Water Supply and Sanitation Decade manpower development programes in Member Countries, an inter-country regional course on project formulation and appraisal for water supply and sanitation was conducted during the year under review at Anna University, Madras, attended by 22 sector officials from four countries: India, Nepal, Sri Lanka and Thailand. In BANGLADESH, current efforts were directed towards training manpower at technician level. In BHUTAN, the manpower development component was to be included in every service project to ensure self-efficiency in this respect in the course of the Decade. In BUWA, a review of the manpower situation was made and a proposal for the preparation of a plan for manpower development through WHO/GTZ assistance was awaiting Government clearance. In MALDIVES, a manpower survey leading to the preparation of a manpower plan was expected to be carried out by the staff of the Maldives Water and Sanitation Authority in the second half of 1983 in collaboration with a WHO team. In SRI LANKA, the sector manpower plan prepared in 1981 was being implemented according to available resources and priorities. Through short in-service training courses some 200 technical officers and water supply maintenance personnel were trained. In THAILAND, a preliminary manpower review was carried out. In regard to INDIA, Ih'DONESIA and NEPAL, WHO supported the training programme in environmental health through various mechanisms, including surveys, national training courses, international fellowships, special courses abroad, travellinglobservation tours, etc. (see Section 5.1, "Environmental Health", for details.) 7.4 - Training in Epidemiology Xecognizing that field epidemiologists are a pre-requisite for organized preveati.on, control and surveillance of communicable and non- communicable diseases, an increasing number of countries in the Region showed active interest in the development of service-oriented training in epidemiology. Thailand had already completed the first two-year course on field-based epidemiology and the trainees joined the provincial health services; the second and third courses were in progress. Indonesia was currently implementing a similar activity for staff at the intermediate level. India and Burma were preparing to undertake similar activities. Ln INDONESIA, where the service-oriented training in epidemiology commenced in October 1982 with eight trainees, a long-term WHO staff member was assigned to assist the project. A similar surveillance and training project in epidemiology in THAILAND received additional long-term staff support commencing August 1982. This programme was coordinated and supported through an inter-country project. 7.5 Training of Auxiliaries and Cornunity Health Workers All countries in the Region recognize the importance of the role of paramedical pesonnel in the health services delivery system and have concentrated on the training of auxiliary health personnel. The trend is to train multipurpose health workers. In BANGLADESH, seven categories of paramedical workers were being trained at two institutes, one in Dhaka and the other at Rajshahi. Besides these training programmes, several other courses were being conducted by different government agencies. There was, however, little coordination and uniformity in training curricula, standards of trainins and evaluation, and criteria for student selection. A recognition of these problems led the Government to constitute a committee to study the manpower requirements for different types of technicians, their educational programmes and employment opportunities. This committee has submitted its recommendations to the Ministry of Health for its consideration. The State Medical Faculty also developed well-defined training objectives and curricula for the improvement of training programmes for laboratory technicians, sanitary inspectors, radiographers, radiotherapists and dental technicians. The Organization supported these activities. Support was also provided for national work- shops, study tours for teaching staff and the provision of supplies and equipment. In addition, WHO provided technical and material support to the training of medical assistants. In BHUTAN, the Thimphu Health School was responsible for the basic training of nurses (3-112 years), health assistants (2 years), auxiliary nurse-midwives (2 years), and basic health workers (1 year). In addition to these programmes, continuing education courses were conducted for zonal health supervisors, auxiliary nurse-midwives, volunteer village health workers and other non-health personnel such as border guards. To expand and improve existing MCH and FP services, re-orientation and in-service training programmes were organized at the Family Welfare Training Complex, Geylegphug, for health staff posted at basic health units and hospitals, malaria workers and their supervisors, and workers from other departments such as Education, Agriculture and Animal Husbandry. Learning modules for the refresher training of the auxiliary nurse-midwife and an instruction booklet on Talking Points for Family Welfare for use by the auxiliary nurse-midwives as self-instructional material were prepared. In BURMA, the Training Division in the Department of Health continued to coordinate the training of various Department of Health staff and auxi- liary health workers in support of the People's Health Programme. Workshops were held on health manpower planning for divisional and state health directors and on educational technology for township medical officers. The training of village health workers for 147 townships of the first People's Health Programe was completed and work began on extending this training to the 40 townships out of the 83 to be covered by the second People's Health Programme. Another category of voluntary health workers, "The Ten-Household Health Worker", was being trained in the original townships of the first People's Healeh Programme that were fully covered by village health workers. The Health Assistant Training School and Mandalay Division Health Department Training Centre continued to organize orientation training for the field staff of special disease control programmes to make them multipurpose health workers. In INDIA, the training of auxiliaries for health activities was expedited. The Village Health Guides scheme, now a fully centrally-sponsored scheme, continued. The Govern~nent increased the recruitment of female para- medical staff for sub-centres and for supervisory levels (auxiliary nurse- midwives and lady health visitors). One male and one female multipurpose health worker are now deployed in each of the existing 60 000 sub-centres. Training of more such staff continued, bearing in mind that tile 'lFAf2000 target was to staff YO 000 sub-centres. The plans for the village heal ti^ guides aimed at having one health guide for every 1 000 rural population. So far about 183 500 health guides have been trained. The training programme for dais, with a target of one for every village, has already trained about 301 100 dais. - WHO provided support to strengthen the basic training programmes of community health volunteers, multipurpose workers and health assistants. The revised basic training programme for multipurpose workers (female! was developed and implemented in all the training schools. Training materials and visual aids were developed and supplied to the training centres. Thirty-five heaith and family welfare training centres were stren:;!ie1,2d in order to provide basic training for health workers. In INDONESIA, training for paramedical personnel and village health workers was carried out at the provincial level with support from the Government. Training for trainers of primary health care teams at tne provincial level was undertaken in Bali with WHO support. Plans were being made to develop some health centres as field training and demonstration centres for trsining various categories of manpower at the national as well as international levels through TCDC. A health services research study on the development of criteria for assistance in PHC development was carried out, stressing the strengthening of the linkages between the health centre staff and the village health volunteer. Application of the results of tnis study led to support in continuing training and staff guidance, replenish- ment of drugs and the development of a two-way referral linkage, which iq turn reduced th? attrition rate of village health vollmteers and inproved the utilization of the health centres and sub-centres. In MALDIVES, the Allied Health Services Training Centre attached to the Ministry of Health continued the training of auxiliary health personnel, such as community health workers, family health workers, nurse-aides and foolumas (TBAs). To meet the increasing demand, a systematic programme of training selected candidates was in progress with the collaboration of i.RO and other agencies. A system for supervising trained health workers and evaluating their perfornance in the field was established. Guidelines for field experiences for community health workers and family health workers w!re completed. Considerable emphasis was laid during the year on upgrading the teaching staff of the Allied Health Services Training Centre. Efforts were continuing for the production of teaching-learning materials for training various categories of health workers in the local language. In NEPAL, the Institute of Medicine continued to train all categories of paramedical and auxiliary health workers, apart from medical doctors. The programmes provided for the basic-level training of auxiliary health workers (community medicine auxiliaries) and auxiliary nurse midwives, certificate- level training for health assistants, nurses, radiography assistants, pharmacy assistants, laboratory assistants and ayurvedic assistants, and degree programmes for nurses and comaunity physicians. The Training Cell of the Integrated Community Health Services Development Project (ICHSDP) conducted basic training programmes for the most peripheral government health workers and village health workers as well as orientation and refresher training prograrmes for all basic health staff within the project. The training programme for community health leaders or ward-level volunteers was also carried out by the Training Cell. WHO assisted the Institute of Medicine by the assignment of two long-term staff and a number of consultants and collaborated with UNFPA on the strengthening of the training cell of ICHSDP. In SRI LANKA, the National Institute of Health Sciences (NIHS) in Kalutara conducted training programmes for various categories of health workers. Direct technical and managerial support was provided by a long-term WHO staff member to facilitate the effective implementation of the objectives of the project. The NIHS conducted all basic training courses, viz., assistant medical practitioners, public health inspectors, public health nurses and public health midwives, with an overall output of 220. In addition, training courses were organized for the trainers of nursing training schools and other training centres as well as trainers of PHC workers. The training of 400 family health workers commenced according to schedule and the first group of 280 trainees completed their training in June 1983. The second group of 180 students was continuing their training. Group educational activities for medical officers of health and NIHS faculty for research development were also conducted. Efforts were being made to identify core curricula for team training and multi-disciplinary training so that the major mission of team training is fully established. A WHO consultant supported this effort. In THAILAND, the majority of the country's villages are covered by trained village health volunteers and village health communicators. The training programmes for village health volunteers continued (the target being 100 per cent coverage of the villages), and are supported by WHO and UNICEF. Efforts were made to upgrade the recruitment procedure as well as the training curricula. Apart from the programme for the training of trainers, manuals and teaching-learning materials were also being developed. 'me ASEAN Primary Health Care Training and Development Centre is closely collaborating with the Ministry of Public Health in planning and developing the training programmes for auxiliary health workers. The Organization was closely involved in, and gave full support to, these efforts in manpower development. Traditional Birth Attendants (TBAs) Bangladesh, Burma, India, Indonesia, Maldives and Thailand continued to conduct training programmes for TBAs. The duration of this training ranges from one week in Thailand to six months in Indonesia and Maldives. Although a variety of teaching aids were available in most countries, there was a need for further promotion of their use during training programmes since an "expanded" role for TBAs in primary health care was gradually being recognized. In Burma and Thailand the PHC component has already been included in the training curricula of TBAs. A workshop on "Evaluating TBA Training ~rogrammes" was held in early 1983 in the Regional Office. This workshop dealt with the fundamental principles of evaluation, the evaluation process and construction of evaluation tools. The major outcomes of this meeting were the design of an evaluation system and a plan of action for implementing it in the countries concerned. 7.6 Group Educational Activities During the period under review, 65 meetings/group educational activities were organized, of which 17 were national, 38 were regional, and 10 were inter-regional. In addition, there were policy-level meetings and three border malaria coordination conferences (see Annex 4). These consisted mainly of seminars, workshops, short courses, conferences and consultative meetings. The 38 regional activities were attended by 512 participants from the countries of the Region. The breakdown, by country and by type, is given in Tables 5 and 6. Table 5 Number of Countries Represented and Number of Participants in Inter-country Activities, 1 July 1982 - 30 June 1983 (Total Number of Activities: 38) Country No. of Meetings Total No. of Attended Participants Bangladesh 22 3 7 Bhutan 5 5 Burma 15 38 DPR Korea 3 3 India 3 4 104 Indonesia 33 10 2 Maldives 13 15 Mongolia 11 19 Nepal 26 4 2 Sri Lanka 32 64 Thailand 3 3 83 TOTAL Table 6 Breakdown of Inter-country Activities, By Type, With Number of Participants, 1 July 1982 - 30 June 1983 Type of Activity Number Number of Participants Seminars Workshops Conferences Short Courses Consultative Meetings TOTAL 38 512 The subjects covered were TCDC, diarrhoea1 diseases, primary health care, the expanded programme on immunization, nursing, traditional birth attendants, malaria, medical research, mental health, maternal and child healthlfamily health, leprosy, environmental health, nutrition, health literature, ophthalmology, planning and management, cardiology, drug dependence, dental health, fellowships, health laboratory services, cytology, women in health and development, rehabilitation of the disabled, traditional medicine, prevention of blindness, rheumatic fever and dengue haemorrhagic fever, and health manpower development. 7.7 Fellowships During the twelve months from 1 June 1982 to 31 May 1983, 865 fellowships were awarded using various sources of funds - 737 (85 per cent) from the regular budget, 42 (5 per cent) from UNDP, 59 (7 per cent) from UNFPA and 27 (3 per cent) under inter-regional and other projects funded by WHO headquarters. Out of the WHO fellowships awarded under the regular budget, 691 (94 per cent) were against the 1982-83 budget and 46 (6 per cent) against the 1981 budget. Implementation Under the regular budget for the 1982-1983 biennium, as of 31 December 1982 a sum of US$^ 760 237 had been obligated for fellowships, constituting 44 per cent of the total fellowships budget. For the calendar year 1982, as against 978 fellowships planned, a further 122 (12 per cent) were added as a result of programme changes. Of the total of 1 100 fellow- ships, 603 (55 per cent) had been awarded by 31 December 1982 and, as of May 1983, a total of 802 (73 per cent), leaving a balance of 298 (27 per cent) that are expected to be awarded before the end of the biennium. UNDP provided $708 914 for fellowships during 1982, forming 15 per cent of the total UNDP budget for the Region. As at 31 December 1982 a sum of $365 519 had been obligated, constituting 51 per cent of the fellowships budget. During 1982, the number of UNDP fellowships awarded was 42. Under UNFPA funds, a total of $608 472 was provided for fellowships during 1982 for Mongolia, Nepal, Sri Lanka and Thailand, forming 24 per cent of the UNFPA budget. As at 31 December 1982, a sum of $487 609 had been obligated, constituting 80 per cent of the fellowships budget. The number of UNFPA fellowships swarded during 1982 was 97. Table 7 shows that 47 per cent of all fellowships were awarded for study within South-East Asia; 168 fellovships were arranged through more than one Region. Table 8 shows that about 52 per cent of the fellows were medical doctors and that 74 per cent of the awards were for males and 26 per cent for females. The table also shows the distribution of the fellowships among different age groups; 44 per cent were awarded to candidates between the ages of 36 and 45 years. With regard to the length of fellowships, 259 (30 per cent) were for durations of one month or less, 366 (42 per cent) for up to three months, 62 (7 per cent) for up to six months, 140 (16 per cenr) for up to twelve months, and 38 (5 per cent) for durations of more than one year. As for placement, 484 (56 per cent) of the fellows were sent for study in one country, 139 (16 per cent) in two countries, 130 (15 per cent) in three countries, 69 (8 per cent) in four countries, and 43 (5 per cent) in five or more countries. One of the. major problems in implementing fellowships was the delayed receipt of applications, which prevented timely processing. Within the first three months of 1983, only 25 per cent of the applications had reached rhe Regional Office for fellowships planned for 1983. Because of stiff English-language requirements imposed by institu- tions in the United Kingdom and United States, placements were delayed or alternative placements were arranged. As in the past, short programing by the receiving countries caused upsets and resulted in reprogramming and/or cancellation of fellowships. It is therefore essential that the proposed duration and the number of countries to be visited by a fellow are carefully considered by the country's health authorities before recoinmendations are made to the Regional Office. Fellows from other Regions. During the period under review, place- ments in the South-East Asia Region were also arranged for 154 fellows from other Regions - 4 from the African Region; 2 from the Region of the Americas; 87 from the Eastern Mediterranean Region; and 61 from the Western Pacific Region. Evaluation. During the year, an average of 46 per cent of termination reports and 33 per cent of utilization reports were received against those due. An analysis of the 260 utilization reports received showed that all the 260 (100 per cent) fellows were suitably employed, 140 (54 per cent) established new services, and 190 (73 per cent) were imparting knowledge to others. Table 7 Distribution of Fellowships, By Budget and By Region (1 June 1982 to 31 May 1983) Regions Source of Funds Percentage where trained WHO Regular UNDP UNFPA HQ and Total Budget others South-East Asia 345 16 39 10 410 4 7 Western Pacific 5 9 4 - 4 6 7 8 - -- Europe 10 3 6 - - 10 9 13 Americas 96 5 10 - 111 13 More than one Region 13 4 11 10 13 168 19 TOTAL 7 37 4 2 59 27 865 10 0 Table 8 Distribution of Fellowships, By Type, Sex, Age and Duration (1 June 1982 to 31 May 1983) A Type Ty Pe No. (%) Medical 447 (52) Non-Medical 418 (48) TOTAL 865 B Sex Sex No. (%) Males 640 (74) Females 225 (26) TOTAL 865 C Age A& e No. (%) Under 25 2 From 26-35 277 (32) From 36-45 380 (44) From 46-55 197 (23) Over 55 9 (1) TOTAL 865 D Duration Duration No. (%) Under 1 month 259 (30) Up to 3 months 366 (42) Up to 6 months 62 (7 Up to 12 months 140 (16) Above 12 months 38 (5) TOTAL 865 A new system of evaluation of fellowships undertaken through the revised termination-of-studies reports has proved to be technically more sound than the old system and is likely to establish a dialogue between the fellows and the Regional Office. However, the ultimate outcome of the whole trial will be &ssessed in the following years together with the findings of the revised utilization reports recently introduced. Regionalization. Gui-ded by the needs of the programme, the training of fellows in the developed countries will continue in order to derive benefits from technological advances found there. However, in view of the increased cost of such training, and with further advancement of facilities in the Region, placements of fellows within the Region may be further emphasized. The figures for the previous years of regional awards are presented in Table 9. Table 10 shows the number of fellowships awarded (under all sources of funds), by subject of study and country of origin. It should be recognized that training facilities in many fields are now available in the countries of the Region and bilateral arrangements already exist between the countries of the Region for the training of their personnel. The fields in which facilities are available in the countries may be identifiel and, in the spirit of TCDC, bilateral arrangements could be made between the countries. Alternatively, the existing bilateral arrangements could be expanded to cover training in those fields. Mutual recognition should, in this regard, be accorded to the degrees awarded by institutions within the Xegion under TCDC mechanisms. Second Regional Conference on WHO Fellowships Programme The Second SEA Regional Conference on the WHO Fellowships Programme with Particular Reference to its Impact was held in the Regional Office from 4 to 8 October 1982. The principles of WHO'S new policy on fellowships were accepted in general at the Conference, which considered the existing fellow- ships policy and procedures for its implementation. Recommendations made by the Conference were forwarded to the Member Countries for implementation. Language Proficiency The peed to i-nprove competence in English was perceived in many countries. The better use of available fellowship and study tour facilities, increased accessibility to learning material and information published in international literature and the need to participate more actively in regional and global networks and other international linkage mechanisms were cited as reasons for improving language competence at national levels. The Organization, as a preliminary step, made available the services of a conscltant to Burma, Indonesia and Thailand to assist these countries in assessing their language training needs and to explore suitable approaches for the solution of this problem. Grouping of Fellowsi~ips In accordance with the recommendations of the Second Conference on the TWO Fellowships Programe held in 1982, efforts were made to have the short-term fellowships for training in the sane field grou~ed together. Table 9 Regionalization of Fellowships Calendar No. of fellowships Regional fellowships year awarded hmber Percentage Table 10 Subject BAN BHU BUR DPRK IND IN0 MAV MOG NEP SRL THA Total Public Health Administration Environmental Health Nursing Maternal and Child Health Communicable Diseases and Laboratory Services Clinical Sciences Basic Medical Sciences and Education Others TOTAL 82 2 34 21 219 162 9 39 149 95 53 865 Cost of Fellowships The tuition fees for training in the United Kingdom increased tremendously, and this has restricted the placement of fellows in that country to candidates for whom training was not available elsewhere. Countries in the Region have also started charging training fees even for short programmes. If no such charges were levied by the countries for the fellows from within this region, this would go a long way towards achieving the objectives of TCDC. Since the British Council, London, decided to increase its handling charges nearly fourfold, adtdnistrative arrangements with the Council were discontinued from 1 April 1983. Alternative arrangements were being made in this regard. 7.8 Health Literature, Library and Information Services (HeLLIS) The national and regional HeLLIS networks continued to develop during the period under review. The second Regional Training Workshop on Health Science Library Networks was held in the Regional Office from 10-20 August 1982. Fourteen medical librarians from seven countries participated in the workshop, which was part of the programme of the HeLLIS Mtwork to train librarians in the network activities. A memorandum of understanding between the Karolinska Institute Library and Information Centre, Sweden, and the Organization was signed in February 1983 for the supply of MEDLARS services to the countries in the South-East Asia Region for an initial period of three years. The first issue of the Index Medicus for WHO South East Asia Region, covering the period from June 1980 to May 1981, was published as a result of the active collaboration of national HeLLIS focal points, coordinated by the Regional Office. The second issue was under preparation. A new development during the year related to efforts to link up the establishment of a health services research information system with that of the existing HeLLIS network. In January 1982, a Consultative Meeting was held in New Delhi in which the health service research group and the HeLLIS national focal points participated. The purpose of the Consultation was to develop guidelines on the standardization of procedures in health services research (HSR) information system, including identification of sources of HSR information, collection, processing of the information and plans for its dissemination. At the national level, a number of HeLLIS network activities were progressing. In BANGLADESH, plans are being made for organizing training courses for medical librarians. An Annotated Bibliography of Medical Literature on BURMA (1866-1976) with a supplement up to 1980 was published. In INDIA, the second, third and fourth training courses in health science libraries were conducted at the National Medical Library in New Delhi. A course on information storage and retrieval in health, family welfare and population was held at the National Institute of Health and Family Welfare, New Delhi, in July 1982. A national Workshop on Cooperative Acquisition was also organized by the National Medical Library in New Delhi in late 1982. In INDONESIA, a two-week training programme for assistant librarians for health science libraries and documentation centres was conducted. A five-day workshop on network mechanisms, tools and management of networks was also held. A consultant assisted the national authorities in NEPAL in the development of a draft plan for the establishment of a national health library and documentation centre and also a plan for lieLLIS network activities in the country. In SRI LANKA, two meetings of the national HeLLIS network were held. The national network also compiled a Union List of current periodicals and a Directory of Nealth Science Libraries in Sri Lanka. In THAILAND, work started on compiling a Directory of National HeLLIS Network Libraries and also for updating the Union List of Serial Holdings in Mahidol University. Regional Off ice Library The Library provided health literature and information services to WHO headquarters, Regional Office staff, WHO Programe Coordinators and Representatives and field staff in the Region. It made use of local and regional resources and also provided MEDLARS/MEDLINE and SDI searches and photocopies of references. Reference material was supplied for seminars, meetings, workshops, etc. The Library was also used for reference by local medical and scientific personnel, engineers, university teachers, students and nurses. In addition, inter-library loan services were provided to local libraries. Countries in the Region were provided free EIEDLARS/MEDLINE retrospective searches as well as photocopies of references not available in the country. For obtaining photocopies, the resources of the SEAR0 Library, WHO headquarters Library, Geneva, the National Medical Library, New Delhi, and the Siriraj Medical Library, Bangkok, were utilized besides those of the United States National Library of Medicine, Bethesda, Maryland. As stated in Section 7.8, under an agreement between the Karolinska Institute, Stockholm (Sweden) and the Regional Office, the Member Countries of the Region would be provided free MEDLARSIMEDLINE services for a period of three years. The Library provided orientation on the role of WHO in activities relating to health literature, library and information services to medical librarians participating in various training courses in Delhi. During the period under review, four such courses were held besides a workshop on cooperative acquisitions in which the Library participated. Support was given to health libraries in Bangladesh, Burma, India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand during 1982-8 3, to establish student loan libraries. During the year the Library received 7 510 books, pamphlets, WHO publications, current periodicals and reports; 2 974 persons (2 234 WHO staff and 740 others) visited the Library and 1 431 books and periodicals were issued on loan to Regional Office and field staff as well as on inter-library loans; 6 659 items were consulted in the Library itself. The Library actively participated in the activities of the Health Literature, Library and Information Services Network in the Region. Apart from assistinn in obtaining PEDLARS/MEDLINE services and photoco~ies. the - - Library provided assistance in bringing out Index Medicus for WHO South-East Asia Region, and also in the publication of the HeLLIS Newsletter. 8. RESEARCH PROMOTION AND DEVELOPMENT The South-East Asia Advisory Committee on Medical Research (SEA/ACMR) has, since 1976, held nine sessions, the ninth session having been held in April 1983. The documents on "Research Needs for Health for All hv the Yegr nittee of the SEA/ACMR, were widely circulated. The countries were utilizing these documents in focusing their research efforts on their national strategies. In pursuance of World Health Assembly resolutions, particularly Keszlution WIA30.$01 which stressed wider collaboration with medical research councils or analogous bodies to ensure (a) effective coordination of national, regional and global research programmes, (b) increased technical collaboration with and among research institutions in collaborative research and training, and (c) improvement of communication between scientists, follow-up actions were taken by the Regional Office through the meetings of directors of medical research councils or analogous bodies and concerned research foci in the relevant ministries (MRCs) held periodically. To date, three such meetings have been held, in the years 1979, 1981 and 1982. Through these meetings, guidelines have been developed for more effective promotion of research at the country level. These guide- I.ines include mechanisms and criteria for determining research policies and priorities; mechanisms of coordination involving all concerned research bodies at the national level; organization of mission-oriented research programmes; strategies for focusing research towards the national goals cf HFA/2000, and development of ethical review mechanisms and career structures for research in Member Countries. These meetings have also promoted technical cooperation among the Member Countries in research, with identification of focal points for such cooperation. The third meeting of the MRCs considered the outcome of a working group on the role of basic and applied research as well as research management in relation to HFA/2000. As regards the role of basic and applied research, the meeting recommended that basic research, which forms an integral component of a mission-oriented research programme relevant to solving priority health problems and contributing to the attainment of ~FA/2000, should be promoted by WHO as a matter of priority. With respect to research management, an outline of a training programme was developed for consideration by the research organizations in the Member Countries. In view of the necessity to utilize advances in health technology for the better health care of the people, large-scale field studies to test such technologies were needed. As such, the third MRCs meeting considered this issue and provided guidelines to tackle it. Action has been initiated for supporting a large-scale study in a country of the Region where, apart from the research objectives, managerial issues were being studied and documented for presentation at the fourth MRCs meeting. As an outcome of the meetings of the MRCs held thus far, the Member Countries strengthened their coordination mechanisms, established ethical review procedures and developed mechanisms for collaboration with universities, non-governmental organizations and research foci in other related ministries. They also promoted a multi-disciplinary approach to researchable problems and attracted additional national and external funds for research. The major thrust of the national research activities was in support of their national strategies for Health for All by the Year 2000. Following the organizational study on coordination and management of WHO collaborating centres by a working group and the subsequent discussion on the subject at the thirty-fifth session of the Regional Committee, the managerial mechanisms of collaborating centres were streamlined. In the field of health behaviour research, a scientific working group was convened on 7-8 April 1983 to review the current status of WHO activities in health behaviour research and to plan future actions, Based on its recommendations, an action plan was developed for implementation in the coming years. In consonance with the SEAIACMR guidelines to focus research efforts towards the goal of HFA12000 with health services research as the key component, national meetings were supported in four countries. These meetings were aimed at providing a sharper focus on specific research topics geared to national priority needs. Subsequently, an inter-country consultative meeting was to review the progress made since the March 1979 consultation and further identify research topics and TCDC activities in a collaborative effort to meet the needs and priorities of the Region. In this context, diarrhoeal disease research, as a case, should involve such studies as the factors related to diarrhoeal morbidity, community participation, and socio-behavioura 1 aspects in close collabora- tion with other related programme areas and disciplines. The ninth session of the SEAJACMR, held in April 1983, had research development in the Region as a major item on its agenda. The Committee reviewed major research areas that are being pursued and supported by the Region with special reference to the guidelines laid down by it, such as "Research Needs For Health For All" and "Concept of Health Services Research". The Committee, among other things, drew special attention to research areas and their promotion and management such as maternal and child health, nutrition, diarrhoea1 diseases, environmental health, behavioural research, and health services research which are key supportive elements to achieving the goals of Health For 811. The Committee recommended that, rather than undertaking a multiplicity of studies, efforts should be made to concentrate on a few critical areas with interdisciplinary and holistic approaches that would contribute towards maximum impact on the health care programme in relation to national goals. The WHO Special Programme of Research, Development and Research Training in Human Reproduction continued to be one of the major sources of support to research in this region. The five collaborating centres in the Region participated in several multinational collaborative studies. Research in the Region was mainly related to the evaluation of the safety of existing contraceptive drugs and methods, development of new fertility-regulating agents; health service research, and infertility. Institution-strengthening activities continued to provide facilities for basic and clinical research, including research training. There were 24 scientists from this region who served as members of the 14 task forces in the Special Programme. The UNDP/World BankIWHO Special Programme for Research and Training in Tropical Diseases (TDR), another major source of research support, continued to promote and support research related to the major tropical diseases prevalent in the Region, such as malaria, leprosy and filariasis, as well as activities to strengthen the research capabilities of the countries where these diseases are endemic. Through continued promotional activities of the TDR Programme at regional and national levels, the number of scientists and institutions that participated in the Programme has steadily increased. The major research activities contributing to the Programme in the countries of the Region were in the field of chemotherapy of malaria, leprosy and filariasis. Participation in other components of the Programme, including socio-economic aspects and applied research, was increasing. Activities for strengthening research capability that were important and relevant to the countries of the Region were also increasing, both in the training of scientists and strengthening of research facilities. Most of the major focal institutions dealing with research and training in tropical diseases were receiving TDR grants in accordance with the strategic plans of the Research Strengthening Group. 9. WOMEN, HEALTH AND DEVELOPMENT While women as consumers of health services are the beneficiaries of family health activities, their role as providers or as active agents of health development has also been recognized by WHO. Thus, like all other regions and the global headquarters of WHO, the South-East Asia Region has also established a programme on Women, Health and Development (WHD), which is being planned and implemented by a core group specifically charged with this task. This core group, in consultation with the SEAR0 advisory group on this subject and the units concerned, has developed a regional progranune on WHD covering the period up to 1985. The regional WHD programme is not a vertical one but is an integral part of all the ongoing programmes of WHO, including maternal and child health and family planning, primary health care, expanded prorgramme on immunization, communicable and non-communicable diseases control, mental health, medical and health education and health information development. Though women face the same health problems as men, they undergo many additional risks because of their different anatomical and physiological norms, cultural environment, and the extra physical demands of menstruation, pregnancy and lactation. Taking into account the high materna 1 and infant mortality and morbidity, and the fact that in the majority of the Member Countries of this region more than 80 per cent of women are delivered by traditional birth attendants (TBAs) at home, the regional WHD programme focuses on the training programme of TBAs in collaboration with the Nursing Unit in the Regional Office. The main emphasis is on safe delivery and on the addition of PHC components integrated into the training programmes. In order to accomplish this, an inter-country consultative meeting on "Programme Planning for TBAs in Primary Health Care" was held, followed by several meetings on topics such as "Supervision of TBAs" and "Evaluation of Training Programmes". These were being followed up at the national level. The Regional WHD Group functions at the national level in collaboration with the WHO Programme Coordinator and Representative and country focal points nominated by the government concerned. The first meeting of the country focal points was held in New Delhi in 1980, One of its important recommendations was to review ald evaluate the existing data and information on the health status of women in the Region and to promote the development and collection of sex-wise data to facilitate the study of the health status of women. Thus, to study the health implications on women, of the changing social, demographic and economic conditions, the current data collection systems at the national level have been urged to collect sex-wise inEormation. This ir~formation is principally on the incidence and prevalence of diseases and the degree and extent of health care provision, especially at the PHC level. In addition to the routine collection of information within the context of the national health information systems, a special study is envisaged in 1984185 on the review of the health status of women in the Region with speciai reference to their nutritional status. Three persons acting as focal points - from India, Indonesia and Thailand - presented policy option papers on "Women as Providers of Health Care" at a consultative meeting held in Geneva from 16-20 August 1982 on three specific issues identified by a similar consultation in 1980. The responsible officers from the six WHO Regional Offices met in Geneva with the headquarters focal unit on 3 and 4 August 1982 to exchange information and views on the regional and global programme for 1982-85 and to plan WHO'S contribution to the 1985 World Conference of the United Nations Decade for Women to be held in Nairobi. A second meeting of national focal points in WHD for the Region was held in New Delhi on 18-19 November 1982 together with the headquarters staff member responsible for the subject and the WHO Programme Coordinators and Representatives to exchange and updat.e information on ongoing collabora- tive programmes and to discuss the regional contribution on WHD to the above conference. As a means of exchanging information and promoting inter-agency regional collaboration in the programme, there was active participation by the WHD core group in two inter-agency committee meetings on women in development sponsored by ESCAP. An important contribution to the inter- agency meeting held in Bangkok in January 1983 was a paper on the guidelines for the formulation of "Indicators for Women in Health Development". Further collaboration will be provided in the sub-regional technical meeting for South-East Asia in preparation for the World Conference to be sponsored by ESCAP in late 1983. Various non-governmental organizations also serve as health-care providers, including the Red Cross Society, women's organizations, Girl Guides, nurses' associations and mothers' clubs. The Regional Office promotes the involvement of non-governmental organizations in WHO programmes and continues to disseminate information on these activities. 10. TECHNICAL INFORMATION AND REFERENCE SERVICES Towards the end of the year under review, two new series of sales publications were started through the Regional HeLLIS Committee: these were the SEARO Technical Publications Series (TPS) and the SEARO Regional Health Papers (RHP). The first in the Technical Publications Series, The Concept of Health Services Research, was issued, as was the first of the Regional Health Papers, the Decade Commencement Report for the International Drinking Water Supply and ani if at ion Decade (1981-1990). Further titles for these series were in various stages of production. Reports brought out under printed cover included a Manual on Child Mental Health and Psychosocial Development (in four parts) and the Report of an Inter-country Workshop on Rehabilitation of the Disabled in the Community. Significant among the other documents in preparation was a revised edition of Strategies for Health for All by the Year 2000, which contains the various country plans. as well as those of WHO, to achieve HFA/2000 . - through the primary health care approach. A total of 168 assignment reports of short-term consultants and long-term staff, final reports on projects and those on meetings and seminars was edited, processed and issued. In addition to the above, wide distribution was given to a large number of other documents. The report and minutes of the thirty-fifth session of the Regional Committee, and the report on the technical dis- cussions held during the session on "Control and Prevention of Leprosy in the Context of Primary Health Care", were edited and issued in bound form. Sales - The total sales during 1982 amounted to US$66 821*, of which sub- scriptions accounted for US&O 193 and other sales ~~$26 628 (as compared with US$68 355 in 1981). The sales for the first six months of 1983 amounted to US&4 314. *All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50 per cent discount (40 per cent in respect of subscriptions) and, in some cases, an additional 10 per cent trade discount, have been allowed. Therefore, the commercial value of the publi- cations sold should be taken to be approximately double the figures given. The Regional Office took part, for the first time, in the Calcutta Book Fair held from 4 to 21 February 1983. Represented by the Head of Sales, SEAR0 did a brisk over-the-counter trade, sales amounting to over US$^ 500. In addition, selected publications were displayed in World Health House at meetings, seminars, etc. Visiting groups of nursing students, librarians and health educators from countries of the Region were given briefings on WHO'S publications programme and system of concessional sales rates. PART I I ORGANIZATIONAL AND ADMINISTRATIVE MATTERS I. REGIONAL COMMITTEE The thirty-fifth session of the Regional Committee for South-East Asia was held in Dhaka, Bangladesh, from 14 to 20 September 1982. This was the first occasion that a session was held in Bangladesh. It was attended by representatives from all Member Countries of the Region, including Bhutan, which had become a Member of WHO in March 1982 and had joined the South-East Asia Region. In addition, the session was attended by UNDP, UNICEF, ILO and 13 non-governmental organizations having official relations with WHO, as well as seven observers from bilateral and voluntary agencies and WHO collaborating centres. The session was declared open by the outgoing Chairman, Dr Bahrawi Wongsokusumo (Indonesia). The Minister of Health and Population Control, Government of the People's Republic of Bangladesh, inaugurated the meeting. The inaugural meeting was also addressed by the Secretary, Ministry of Health and Population Control (Health ~ivision), Bangladesh, the Regional Director and the Director-General of WHO. The Regional Committee elected Mr Md. Siddiquer Rahman (Bangladesh) as Chairman and Dr N.L. Maskey (Nepal) as vice-chairman. Introducing his Annual Report, the Regional Director said that a number of significant steps had been taken to develop, implement and monitor the strategies and plans of action for achieving the goal of Health for All, to which all the Member States were committed. Among the eight essential elements of primary health care, top priority had been given to maternal and child health, including family planning, in most countries of the Region. Nutrition and health education also received high priority. Provision of oral rehydration to curtail mortality caused by diarrhoea1 diseases was receiving attention in most countries, with emphasis being given to the production of oral rehydration salts. Major efforts in stimulating activities under the expanded prograrmne on immunization were concerned with the training of manpower in technical and managerial aspects in addition to the development of a viable cold chain in each country. The incidence of malaria was showing a declining trend in the Region as a whole, but there was no room for complacency, Technical, managerial and manpower problems were still affecting the programme adversely. Progress in the control of leprosy was hampered by the social stigma attached to the disease as well as the emergence of drug resistance and difficulties in case-finding and case-holding. In regard to safe drinking water and sanitation, the lack of which continued to be a major cause of water-borne diseases, some progress had been made in providing safe water, but basic sanitation had received very little attention. Dependence on sophisticated and expensive technology was a major obstacle to the expansion of sanitation services, especially in rural areas. The IDWSSD programme should help in tackling these problems. The research programme in the Region had been reoriented towards supporting efforts to achieve the HFA goal, and the thrust was on solving human rather than technological problems through the application of existing knowledge. In order to improve health planning and management at the national level, the Organization had developed guidelines, modules and methods and had supported training activities. The major tools for WHO'S managerial process, namely, the Seventh General Programme of Work, the medium-term programme and programme budgeting, had now been linked appropriately. In order to optimize the utilization of available resources for health develop- ment, a number of innovative exercises had been undertaken in the Region. Meeting the needs of health services formed the principal basis for health manpower development in the countries, and to this end planning, production and utilization of manpower were integrated and balanced in order to obtain best results. However, coordination among health, education and other relevant ministries was essential. Despite difficulties in health development in the Region, the tangible progress made so far would provide the basis for launching future action. During the discussions on the Annual Report, the Regional Committee noted the progress made by the countries in developing their managerial systems for health development. All had medium-term programmes for health development and at least two countries had long-term health plans. The need was expressed for involving the private sector and non-governmental agencies in national health development efforts in view of the shortage of resources. Community involvement was considered essential for achieving success in developing primary health care. Considerable progress had been made in providing PHC, but there was a need for introducing innovative approaches to improve the quality and to expand the services. Provision of PHC to the urban poor in addition to unserved and underserved people of the rural areas also deserved attention. It was noted that WHO, in cooperation with UNFPA and UNICEF, had been collaborating with Member Countries to develop a balanced programme for maternal and child health and family planning services, nutrition and health education. Some countries felt that WHO should increase its quantum of assistance to the family planning programmes. The Committee expressed gratification that governments had initiated measures to implement the World Health Assembly resolution on infant and young child feeding despite opposition from vested interests. Noting that a comprehensive regional research-cum-action programme on nutrition had been developed and implemented in phases to combat mal- nutrition, the Committee suggested that a time-bound programme should be drawn up for controlling goitre. It was explained that efforts were under way in this regard. The Regional Conunittee stressed the need for studies leading to more effective action for changing the health behaviour of individuals. It also emphasized the need for ensuring adequate and timely supply of essential drugs to far-flung rural areas in support of primary health care. In this connection, the Committee noted with great satisfaction the efforts of several countries towards development of a drug policy, prepara- tion of a national list of essential drugs and introduction of appropriate legislative measures. In order to ensure the quality and safety of the drugs in use, the Committee requested WHO to strengthen the existing drug testing laboratories and stimulate mutual cooperation among Member States in this field. While discussing communicable diseases, the Committee expressed concern over the reduction in the budgetary allocation for malaria control in several countries. The Committee was informed that research was under way to find alternative methods of vector control and that resistance of plasmodium to chloroquine was also being monitored in several places. Further, border coordination meetings were organized between neighbouring countries within the Region, and the Regional Office was also continuing close collaboration with the WHO Western Pacific Region in this respect. The Committee felt that there was a need for more frequent meetings between the countries affected. In regard to leprosy, which was an important and priority problem in the Region, the Committee hoped that the recommendations emerging from the technical discussions on leprosy held during the session would help devise various measures to improve the existing programmes. The Committee was informed that the programme on diarrhoea1 diseases aimed at curtailing mortality by providing oral rehydration. In addition to large and small-scale production, development of logistics and supply, operational research and training of health workers in the use of oral rehydration salts were also undertaken. The Committee stressed further promotion of the expanded programme on immunization. It was noted that so far WHO assistance had been given for developing technical and managerial manpower and dependable logistics systems and promoting motivation for community participation. All the countries of the Region were implementing the programme and most of them were trying to become self-reliant in the production of vaccines. Some countries sought assistance from WHO to study the social, psychological and economic aspects of the reve en ti on and control of sexually-transmitted diseases. The Regional Committee requested the Organization to provide more material assistance, such as drugs to combat pulmonary tuberculosis, which continued to be a public health problem in the Region. It was felt that efforts to prevent the emerging public health problems of cardiovascular diseases., cancer and diabetes should be supported by the Organization and that national programmes to control these diseases should be integrated with primary health care activities. The Committee advocated the use of a multi-sectoral approach by both WHO and national health authorities against smoking, as more and more younger people were taking to the habit. The Regional Committee discussed the subject of environmental health, particularly in the context of the International Drinking Water Supply and Sanitation Decade. Two major problems were identified, namely, lack of coordination due to management of the national programme by many agencies other than the ministry of health, and paucity of funds. It requested WHO to make efforts to mobilize greater resources in support of water supply and sanitation programmes than hitherto available. In regard to research, the Committee was informed that the South-East Asia Advisory Committee on Medical Research was constantly reviewing the priorities for research in support of HFA and reorienting the research activities accordingly. Also, health services research was given due priority and management of research had been streamlined in consultation with national research councils or analogous bodies. The Regional Committee recommended that WHO should promote and support research on operational aspects and lay more stress on applied research, though basic research in the context of the HFA/2000 concept should not be ignored. The Organization should also give direct assistance to the development of appropriate research protocols as many countries lacked trained manpower for this work. It was felt that development of a suitable mechanism for the exchange of research information among countries of the Region should also be stimulated and supported by WHO. The Committee felt that high priority should be given to strengthen- ing the health information systems in the countries. The main constraint in their development was not lack of finances but the lack of personneL in both quality and quantity. It was noted that many countries had, with WHO assist- ance, already made a beginning in strengthening the health information system. The need for coordinated planning and implementation of manpower development activities by relevant health authorities on the one hand and the universities and ministries of education on the other, was stressed. WHO'S role in the review and recasting of curricula of different categories of health workers to meet the needs of primary health care was appreciated, and the Regional Committee felt that these efforts needed to be strengthened further. Concerning the regionalization of the fellowships programme, it was mentioned that the Regional Office had been utilizing, to the maximum extent possible, the training institutions available within the Region. Proposed Programme Budget for 1984-1985 The Sub-committee on Programme Budget appointed by the Regional Committee to examine the programme budget noted that the proposals for the 1984-1985 biennium (1) had been prepared in conformity with the Seventh General Programme of Work and other policy guidelines, (2) were adequately linked to the medium-term programme of the Seventh General Programme, and (3) were generaily in support of the primary health care package. The Regional Cormnittee approved the report of the Sub-committee and requested, inter alia: (a) the Director-General to consider a substantial increase in the regional allocations; and (b) the Regional Director to revise the terms of reference for the Sub-committee on Programme Budget in accordance with the deliberations of that Sub-committee. Health for All by the Year 2000 In reviewing the progress made in Member States as well as at the regional level in the development, updating and implementation of the strategies for health for all, the Regional Committee felt that these should be accelerated, especially as there were only 18 years to go for the year 2000. It emphasized that WHO should give attention to the priority programme areas identified by Member States for the allocation of resources and concentration of efforts. It also stressed the urgent need for countries to develop plans of action in the light of the strategies in order to facilitate their implementation, as also for meaningful monitoring of activities. Report on the Study of WHO'S Structures in the Light of Its Functions The Regional Committee considered two major topics under this item, viz.: (1) the future role of the WHO programme coordinators and represen- tatives and the authority required to be vested in them for effective country-level operation of WHO'S collaborative programmes; and (2) the procedures and style of work of the Regional Committee, based on the recommendations made by the Small Committee appointed by the Regional Director in pursuance of resolutions SEA/RC34/R6 and SEA/RC34/Rll. The Small Committee suggested that the role to be played by the WHO programme coordinator and representative (WPCR) and the additional authority to be vested in the WPCR should be determined for each country on the basis of a dialogue between the Regional Office and the government so that the WPCR could collaborate with the government optimally in developing health policies and plans as well as in implementing and evaluating the programmes emanating from these policies and plans. As regards the style of work of the Regional Committee, the Small Committee emphasized the need for concen- trating discussion in the Regional Camnittee on only high priority issues related to programme development and management and undertaking an in-depth review of WHO'S collaborative programme twice every year by the Small Committee. Coordination and Management of WHO Collaborating Centres The discussion on this topic was based on the report prepared by a working group appointed by the Regional Director. This group had considered resolution EB69.R21 approving a set of regulations for the collaborating centres which had been endorsed by the Health Assembly in May 1982. The Regional Committee, in approving the recommendations, took note of two important provisions of the new regulations, viz.: (1) reorientation of the functions of collaborating centres to support the Organization's programme as a whole and not research activities alone, and (2) selection of centres also from among those showing potential and promise and not only from those which are already centres of excellence. Technical Discussions These were held on the subject of "Control and prevention of leprosy in the context of ~rimary health care". The Technical Discussions group considered different aspects of leprosy control, such as situation analysis, policies, constraints faced by programmes, and strategy for the prevention and control of leprosy as an integral part of primary health care. It recommended, among other things, that: (1) in view of the limited value of monotherapy in the control of leprosy, multi-drug therapy should be intro- duced in the Region in a phased manner; (2) keeping in view the need for community education, rescheduling and reprogramming should be undertaken; (3) an adequate supply of drugs must be ensured by mobilizing resources within the country as well as internationally; and (4) recognizing the role of voluntary organizations, their activities at the country and regional levels should be coordinated. With regard to the thirty-sixth session, to be held in 1983, "Monitoring and evaluation, including information support for primary health care programme with special reference to family health" was chosen as the topic for the technical discussions. International Flow of Resources for the Strategy for Health for A11 In noting the progress made concerning the Health Resources Group for Primary Health Care (HRG) and country resource utilization, the Regional Committee raised a number of issues, such as the venue of the meetings of HRG, how best HRG activities could be carried out in the context of TCDC, assistance by WHO in documentation, and larger representation from the Region in HRG meetings. The Regional Committee nominated Bangladesh and Sri Lanka to represent the Region on HRG for two years, Special Programme for Research and Training in Tropical Diseases Noting that only 6.9 per cent of the total operational funds of the Special Programme had been invested in this region, the Committee agreed that in order to attract more of these funds, there was a need for promoting and strengthening national capabilities, developing well-formulated pro- posals and streamlining government machinery for the speedy clearance of projects for timely submission. It nominated India to represent South-East Asia on the Joint Coordinating Board for three years effective January 1983, in addition to the ongoing Member, Thailand. Progress Report on Activities for the International Drinking Water Supply and Sanitation Decade Following a detailed discussion on this subject while reviewing the Regional Director's annual report, the Committee felt that, since the outlook for external support for national Decade programmes had not been very encouraging, it was imperative that governments review their plans and targets. WHO'S contribution, though not very significant, could play an effective catalytic role and provide necessary stimulus, and the Committee thought it would be worthwhile to maintain a reasonable allocation in the WHO country budgets for supporting Decade activities. Use of the Injectable Contraceptive Depotlnedroxyprogesterone Acetate (DMPA) in Countries of the Region The views and experiences of several Member States in the use of this contraceptive varied. While most considered it highly effective with a very low rate of failure, some were concerned over its possible long-term side-effects and complications. The Committee was informed that WHO would be ready to collaborate with the countries in organizing scientific studies or consultations as required. Use of Traditional Practitioners of Medicine for Primarv Health Care Activities The Regional Committee recognized that a great deal of work had been done in developing national pharmacopoeias and collecting information on traditional systems of medicine. Nevertheless, there was a need to establish a mechanism for the exchange of information. Also, governmental action would be required to improve manufacturing practices further, as well as quality control of traditional drugs. Since integration of traditional and modern systems of medicine was a complex matter, the Committee felt that a working group could be set up to find the right approach and methodology. Time and Place of Forthcoming Sessions of the Regional ~ommittee - The Regional Committee decided to hold its thirty-sixth session in 1983 in Nepal, and decided provisionally to hold the thirtyseventh session in the Regional Office in 1984. It noted the advance notice given by the Government of Bunna of its wish to host the thirty-eighth session in 1985. 2. REGIONAL PROGRAMME PLANNING AND DIRECTION During the year, several developments in the area of regional programme planning characterized significant progress that deserve mention: In pursuance of the wish of the Regional Committee which, at its thirty-fifth session in 1982, approved the recommendations of the Small Committee, the annual programme review for the year 1982 was carried out by the Small Committee (hereafter to be called the Consultative Committee on Programme Development and Management). The WHO regional secretariat facilitated this review by providing an annual report on the financial implementation and technical aspects of country and regional programmes during 1982. While the Consultative Committee will henceforth conduct six-monthly programme implementation reviews as a routine, the annual reviews present opportunities for examining more closely the financial implementation in correlation with the technical progress and relevance, thus enabling the Regional Committee to involve itself meaningfully in WHO programme reviews. The Consultative committee" recommendations with regard to inte- grated evaluation of WHO and national programmes would lead to the further refinement of retrospective WHO project evaluation methods. They would also result in the selection of at least one major and priority programme for integrated evaluation in 1984 to test a simple practical method and gain experience for further development. Specific efforts were made to make use of the two principal managerial tools of WHO - the Seventh General Programme of Work and the Medium-Term Programme, 1984-1989, for the Region - in the formulation of the biennial programme budget. The detailed elaboration of the first (1984-1985) biennial programme budget gives evidence of application of the principles of unified managerial process; programmes were selected in accordance with their relevance and responsiveness to the needs of the countries; objectives were translated into specific activities, and activities corresponded with budgetary provisions. All this makes the programmes more amenable to evaluation. For the preliminary proposals for the second (1986-1987) biennial programme budget, further use of the General Programme of Work and the MediumTerm Programme has been ensured by the elaboration of a countrywise list of relevant activities based on the programme trends and anticipated achievements in 1984-1985. Combined with the process of review of implemen- tation, this helps in the updating of the medium-term programmes and ensures their continuing relevance and usefulness. Regional (inter-country) programmes continue to be planned and directed towards providing complementary support to the country programmes, maintaining close relevance to the main objectives and approaches of the Seventh General Programme of Work and the activities proposed in the MediumTerm Programme. The perspective plan for the intersountry programme approved by the thirty-fifth session of the Regional Committee forms the basic framework of the biennial programing of inter-country activities. Selective, highly critical and flexible use of WHO resources was demonstrated in all countries of the Region, but more specifically under the new approaches tried out in two countries: (1) In Thailand, the experiment with WHO programme budgeting to establish national involvement in the management of WHO resources and make optimal use of these resources continued to progress. Useful experience was generated in the application of the new process, which is being objectively analysed for its wider application in the future. (2) In Indonesia, special collaboration resulted in the formulation of the main directions of WHO technical cooperation and coordination in the context of the national medium-term plan (Pelita IV) and the use of WHO resources in the overall context of national and other (external) resources. These nascent developments are forerunners of the most effective use of WHO programme budgets varying according to the situations and possibilities in the countries. The Regional Programme Committee, the highest policy-level advisory arm to the Regional Director in the secretariat, reviewed its past work and revised its terms of reference, which now include giving guidance to the secretariat in formulating the programme, conducting in-depth programe reviews, and enhancing inter-programme coordination. Additionally, the Committee developed a revised format for preparing plans of action for all major WHO collaborative projects as a managerial tool to monitor and control the delivery of WHO inputs efficiently. The Committee further rationalized and refined the WHO information systems, including the quarterly programme delivery status report and the sixmonthly report by WPCRs. There has been further strengthening and use of country-level mechanisms for monitoring WHO programe implementation with the close participation of ministries of health. This has resulted in more frequent dialogues between the government and WHO and corrective actions jointly proposed and carried out to achieve timely and more relevant programme implementation. An additional important function of the joint government-WHO mecha- nisms has been close consultation during programme formulation, a process that is instrumental in maintaining the continuing relevance and responsive- ness of WHO collaboration to national priorities and preferences. The same mechanism is slated to play its due role in integrated national-WHO programme evaluation and the coordinated use of other (external) resource inputs in priority national health programmes. Some of the currently perceptible trends of the regional. pr3:ramne can be mentioned as follor~s: (1) >T,e partnership between governments and L'W0 in programne development , management and evaluation is growing and finding expression in the work of the Regional Comn' ,lttee and the government-WHC management mechanisms in the countries. These inechanisn~s are assuming a positive role in determining the selective use af WHO resogrces for technical cooperation and coordination, (2) 'Ifie fact that WI10 resources for technical cooperation are 'unique' in many respects and, unlike project funding by other agencies, may be a critic31 input for thp. estab- lishment of sound national prosrammes vhicll generate resources from withi-n and outside the country, has co~x to be appreciat~d. (3) Fragmented, short-term UkIO project support is giving way to major collnhorative programmes integrate* more cl.oselv inti. the national programmes. (4) There is a demand for timely and effective technical inputs by WHO in the natiociil programxe development process, particuiarly in tlroee programmes whicii receive funds from external agencies. (5) A uniform understanding of the WHC managerial tools, and their integrated application among all I.TiCt staff snd among nationa.1 offici.als involved in colla7>orative progrsnme development and manasenent, appeers to be cri-tical. (6) Additional regional planning efforts are required for a regional health resources group or similar meclianism tu mobilize international resourres for health rievelopment. The Planning and Coordination Unit of the Regional Office, consisting of a multi-.disciplinary group, i.e., a health planner, an operational research specialist, a management specialist, a public health administrator and a health information specialist, continued to provide support to Member Countries in the deve:o?ment of the managerial process for national health development, including WHO inforrnntion systeins. Its activities included operationalization of the concepts contained in the Seventh General Programme of Work and ?he for~oi~lation and Cnplementatinl of regional medium- term programmes in conforruity witn the Seventh GPW. The implementation of the new managerial framework for optinal use of mO's resources in direct support of Member States is currently under consideration. Support was also provided to the countries in progralimt. impl.ementation, monitoring and evaluation, in reviewing their health rescurces dtilization and require- ments, and in developing the managerial information system as a part of the managerial process for heaith development at both the country as well as Regional Office levels. As for research administration and promotion of research in the Region, three principal meci1ani.srr.s are uti!ized. in co:lf ornity with the advice of the Regional Ccmnittee, the South-East Asia Advisory Committee on Medical Research (SEAIACMR) was established in 1976 to advise the Regional Director on the development of the Organization's research programme in South-East Asia. Members of this committee represent a wide variety of disciplines with a judicious mix of scientific specialities and a balanced geographical representation from the countries of the Region. The SEA/ACMR, together with its sub-committees and scientific working groups, provides the Regional Director with advice on technical and policy aspects of biomedical, health services and behavioural sciences research. The SEAR0 Research Development Comrp.ittee (RDC) is responsible for providing administrative and technical guidance for the formulation and implementation of the Regional Research Programme, including collaborative research programmes with other WHO Regions, The Committee functions as an in-house advisory body to the Regional Director and, along with the Regional Research Unit, is concerned with the implementation and monitoring of the Regional Research Programme. The Research Review Committee (RKc) is responsible for the technical review of specific research projects submitted to the Regional Office, and its recommendations are reviewed by the RDC, The RRC consists of the relevant technical and administrative staff. Technical merits and relevance, including ethical, administrative and financial aspects, are reviewed by the RRC. The periodic meetings of directors of medical research councils (MRC) or analogous bodies and concerned research foci in relevant ministries provide a forum for promoting research, coordination and management at the country and regional levels. An in-depth study of specific issues is achieved through ad hoc SEAIAMR sub-committees and scientific working groups. Links and close liaison between SEA/AMR and WHO headquarters and other Regions are ensured through participation in the Global ACMR and the ACMR meetings of other Regional Offices. Representatives of RPD/HQ and other WHO Regional Offices are also invited to sEA/ACMR meetings. 3. ADMINI STRATION 3.1 General The Second Meeting of the Ministers of Health of the South-East Asia Region, hosted by the Government of Bangladesh, was held in Dhaka in September 1982. In July 1982, the Director-Genera1 of WHO, Dr Mahler, visited 'Illailand, where an honorary degree was conferred on him by His Majesty the King on behalf of Mahidol University. In September, he attended the thirty- fifth session of the Regional Committee, held in Dhaka. In November, the Director-General visited Indonesia to participate in a workshop on "Government of Indonesia/blHO Cooperation in the Development and Implemen- tation of the National Strategies for Health For All by the Year 2000". On his way back to Geneva, he stopped over in New Delhi for discussions with India's health authorities on the management of the WHO programme and the Government's main directions in health efforts planned for 1984-1985. In July, the Regional Director visited Sri Lanka for discussions with the ninister and the Deputy Minister of Health and other health authorities on the WHO collaborative programme. He attended a meeting of The thirty-fifth session of the WHO Regional Committee for South-Easf Asia was held in Dhaka in September 7982 - the lirst occasion th?t a session was held in Bangladesh. Picture shows Dr. U. KO KO, WHO Regional Director for South-East Asia, Addressmg the inaugural meeting. Others shown are (from Left) Mr. Md Siddiquer Rahman, Secretary, Ministry of Health and Population Control, Bangladesh, and Chairman of the thirty-fifth session: Dr. H. T. Mahler, Director-General. WHO: Maj-General M Shamsul Haq. Minister of Health and Population Control, Bangladesh: and Dr. Bahrawi Wongsokusumo, Inspector-General, Ministry of Health, Indonesia (outgoing chairman). MEETINGS The ninth session or the South-Earl Aria Advisor, Cornmiltre on Med1c:ii R~ssdcf~ was i~eld tn New Deili, April 1983. Picrure shows members of the SEAIACMR with senior staff of the Reyional OlOie. The Second Meeting of Ministers of Health of South-Easr Asian cotintries was held m Dhaka ,i> Seplrmbrr 1382. T/lr rnrnfsters called for acceleration of TCOC efforts in rhe areas oi heal% manpower mininu. diarrhoe?: diseases control and imrnu,.iizat,on. P.cr<,rr ,/,on F L,,~*z/t.n.~r~t.G~nr~dl H Aq frr'lad. Ctl~eI hoar! Lam Am, ,,,slrdr,?r, 6'.zrl08.?<l,icrr. ;t<r Ylres, I<: irje rrrel nv. SI,ater: a,,. twni Lt 1, rn R,q!v IJ .Vl Ssrlr/!o,.er R.~h,o~n Srcr?,irr/. Mst,,slr, 01 Hr;, ro ,?no f'r, .a: on ('nn'rr~. P.'ariq sdc?,: .!"a Cpr, Snnrr r .. Haq, A",.,srer of Hra to anr! PONL ?'.or) Conl~ol R.tno1aoe.r an,/ rr I! Rl?o, 2n.r 0 ,er,rt 7.. u A.7 KO MEETINGS At the 72nd session of the WHO Executive Board, which me1 in Geneva nn 17and faMay 1983, H. E MI M. M. Hussaln, Minister of Health. Republic of Maldives, was elected Chairman the Working Group on Research he1.d in ~ali (Indonesia) in August, and called on the Minister of Health and the Sec-retary-General of the Health Ministry in Jakarta. In Septenber, he was in Dhaka for the thirty-fifth session of the Regional Comaittee and the Second Health ~inisters' Meeting. In October, he visited Poland at the invitation of that country's Minister of Health, and also went to London to vi5i.t the Ross Institute before proceeding to Geneva to atte~d the Programme Comittee of the Executive Board. He attended the third meeting of the Directors of Medical Research Councils or .4nalogous Bodies a?d Concerned Research Foci in the Relevant Ministries, held in Chiang Mai hailan and) in December. He visited Calcutta in February 1983 to attend the Second Asian Conference on Diarrhoea1 Diseases. In March 1933, the Regional Director went to Manila to attend the Preparatory Committee meeting of the Inter-Parliamentary Conference on Health and Development in t;h~ Sobth-&st Asia and Western Pacific Regions. llhe Regional Director pal:! a i is it to Phutan from 15 to 22 June 1983 - his first visit to the Ringdor since its becominq a Yember of 'WHO. In New Delhi, the Regional Director received a number of minisiers, high-ranking officials,in the field of health, and seni.or staff of national health ministries or admi-nistrations, with whom he exchanged views on WHO'S collaborative programne of activities in the Region. Other important visitors to the Regional Office included senior staff members from United Nations agencies and officials of non-governmental organizations. The Regional Director inaugurated or addressed a number of important national, regional and international meetings, seminars and workshops held in New Delhi or other places in the Region. Notable among these, not coanting WHO meetings, were: (1) Dr B.L. Kapur Oration on "Medical Care for Xealth for A11 by the Year 2000", (New Delhi, 5 August 1982); (2) Thirty- seventh Intornstional Conference on Tuberculosis and Chest Diseases (Xew Delhi, 8 October i982); (3) Seven:h Annual Meeting of the International Nutritional Anaemia Consultative Group (New De lhi, 19-22 April 1983); (4) UNICEF SCAR0 Regional Staff Meeting, and (5) ESCAP-WHO-UNICEF Inter- governmertal Meeting on Health and Developnent, Bangkok (7-10 June 1983). In July 1982, Dr D. Tojada-de-Rivero, Assistant Director-General at hX0 headquarters, visited the Regional Office for discussions on furcher steps concerning the WHO/UNICEF Joint Comittee on Health Policy (JCHP) in Nepal and in Burma; in Novenber, he attended the meeting of the JCHP/PHC Core Group in Nepal. In August, Dr I. Ladiyi, another Assistant Director- General, visited New Delhi to attend the meeting on Action Plans for Leprosy Control. A third Assistant Director-General, Dr Lu Rushan, came in November for discussions on various sg~bjects such as cancer, cardiovascular diseases, mental health and essential lrugs with the national health authorities in India, He also -~isited some of the related national institutions in the country. He also vent to Sri Lanka for discussions on the cancer prevention and control progranme and to visit some institutions. Two internal auditors from headquarters visited the Regional Office in October/November. One of them undertook an audit of the office of the WHO Programme Coordinator and Representative in Bangkok, including an examination of the various administrative and financial procedures being followed in the Thai progranlme budget experiment. An internal auditor also visited Indonesia in November to review the grants nade to some ot the institutions in that cnuntry under tbe Special Fro~ra~xme for Research and Training in Tropical Diseases. A twomember team of external auditors visited the Region in November. After examining the records in the Regional Office, they visited field projects in India, Indonesia, Nepal and Sri Lanka. In early October 1982, the Regional Director received a threemember mission - two representatives from the USSR and one from WHO headquarters - with whom he held discussions on the recruitment of USSR nationals. Administrative arrangements were made for the conduct of various WHO-sponsored meetings, seminars, workshops, etc., held in the Regional Office or in the countries of the Region during the year under review. A Basic Agreement was concluded on 3 January 1983 between WHO and the Royal Government of Bhutan (which had joined the Organization and the South-East Asia Region in March last year). During the period under review, 33 more acceptances of the amendments to Articles 24 and 25 of the WHO Constitution, adopted in 1976 by the Twenty-ninth World Health Assembly to provide for an increase in the membership of the Executive Board from 30 to 31, were received. The total number of acceptances as of 31 May 1983 was 97, leaving 10 more required for the amendments to enter into force in accordance with Article 73 of the Constitution. 3.2 Organizational Structure The organizational structure of the Regional Office as of 30 June 1983 is shown in Annex 1. 3.3 Personnel 3.3.1 Staffing The distribution of professional staff in the Region by nationality as of 31 May 1983 is shown in Annex 2. A column giving the worldwide distribution of WHO staff by nationality has also been included. Table 11 shows the number of posts in the professional category in the Region funded from all sources and the number actually filled as on 31 May 1983: Established posts as of 31 May 1983 are 5 less in number than at the same time last year. One post has been inactivated as a result of a decision not to fill it in 1983. Luring 1982, 217 consultants were employed in field programmes for periods ranging from one week to eleven months. From 1 January to 31 May 1983, 79 consultants were employed. The distribution of consultants recruited during the period 1 June 1982 - 31 May 1983 by nationality and programme area is shown in Annexes 3 and 4 respectively. During the period 1 June 1982 - 31 May 1983, 13 professional and 14 general service staff members left WHO service. Table 11 Number of Posts Posts Organizational Location Regional Field Total Off ice Programmes Established posts for 1983 as of 31 May 1983 Posts inactivated/recruitment in abeyance - 1 1 Posts to be filled in 1983 18 162 180 Posts actually filled 17 14 8 165 Posts for which candidates already selected and recruitment in progress 1 5 6 Posts requiring selection/reselection - 9 9 One professional and one general service staff member completed 30 years of service with WHO, 2 professional and 9 general service staff menbers 25 years, and 1 professional and 15 general service staff 20 years. 3.3.2 Staff Training To ensure more effective involvement of staff in the work of the Organization, several presentations in an "Insight" series related to the work of various units were conducted for professional staff. In addition, orientationlbriefing sessions for general service staff from some of the WPCR offices were held in the Regional Office. One professional staff member and six genera1 service staff members were given training in general administration and management. In addition, the Director-General granted study leave for short periods to five staff members to receive training in their fields of work. 3.3.3 Employment Conditions The salary scales of the general service staff in Bangladesh, Bhutan, Indonesia and Thailand were reviewed and revised. Ad hoc meetings were held with the representatives of the various -- agencies of the United Nations system in New Delhi to discuss matters of common interest. A regular dialogue was maintained with the staff representatives on matters of mutual interest. The Post Classification Plan of the General Service (locally recruited) Staff was reviewed and updated with the assistance of a consultant and a headquarters staff member and has been in use since 1 March 1983. Tne Chief of Salary and Allowances, International Civil Service Commission (ICSC), New York, visited the Regional Office in October 1982 and held discussions with the administrative staff of WHO and other United Nations agencies' administrations regarding the methodology for the conduct of general service staff salary surveys. In December, the Director of the Joint Medical Service from Geneva visited India and had discussions with the staff and the Regional Staff physician in the Regional Office. He also visited the various medical facilities available to staff in New Delhi. In April, the Secretary of the WHO Staff Pension Committee in Geneva paid a visit to familiarize staff members with matters related to the operation, rules and regulations of the United Nations Joint Staff Pension Fund. 3.4 Budget and Finance The obligations incurred on field activities under various funds during 1978-1979 and 1980-1981, together with an estimate for 1982-1983, are shown in Figure 2. Total obligations under the regular budget for 1982-1983 as of 30 June 1983 are b37 976 477. This represents 71.5 per cent of the total revised regional allocation of $53 096 000. It is estimated that the remainder of the regional allocation will be obligated by 31 December 1983. 3.5 Regional Office Building The construction of the new annex building was progressing satis- factorily, and the cost was within the originally budgeted amount of ~~$675 000. An allocation of $250 000 was made by the Thirty-fifth World Health Assembly in May 1982 (resolution WHA35.12) for an additional stand-by generator for the Regional Office. The entire work was completed in May 1983 within the amount budgeted. 4. PROCUREMENT OF SUPPLIES AND EQUIPMENT During the period 1 June 1982 to 31 May 1983 the cost of supplies and equipment amounted to $8 523 676, of which $132 628 (15.5 per cent) was for local purchases. A comparative statement showing the procurement trend during the period from 1977 to 1982 (calendar year) is given in Table 13. Among items available locally in countries of the Region and purchased by the Regional Office were: motor vehicles, motorcycles, bicycles, spare parts for vehicles, audio-visual equipment, teaching aids, laboratory equipment and supplies, chemicals, drugs and pharmaceuticals, hospital equipment and supplies, diagnostic, operative and other instruments, rubber and plastic goods, refrigerators, cold boxes, airconditioners, and office equipment and supplies. Figure 2. OBLIGATIONS INCURRED ON FIELD ACTlVITIES IN THE SOUTH-EAST ASIA REGION US$ (Millions) Regular Budget UNDP UNFPA ( Other Sources Total Field 1978-1979 Obligations US$ (millions): 51.5 Table 13 Procurement of Supplies and Equipment Year Total Local purchase Local purchase procurement within the as a percentage Region of the total (US$) (US$) (US$) Emergency Supplies Supplies, totalling $143 705, were procured to meet emergency conditions caused by natural disasters and epidemics, as follows: Bangladesh. For increased drug-resistant P.falciparum infections and cases of cerebral malaria: quinine hydro- chloride injections and tablets; for outbreak of diarrhoea: Ringer's lactate with giving sets. Burma. For hepatitis outbreaks: RIA kits, gamma globulin, - drugs, ointments, injections, penicillin, bandages and syringes. For plague outbreak: anti-plague vaccine, strepto- mycin, chemicals, reagents, and laboratory supplies. Maldives. For diarrhoea epidemic: ampicillin capsules, injections, drugs, nalidixic acid tablets, cholera vaccine, laboratory equipment, bleaching powder. Nepal.: For hepatitis outbreak: human albumin, plasma protein fractions, vitamins, gamma globulin, oral rehydration salts, syringes. For an outbreak of meningococcal meningitis: meningococcal vaccine. Sri Lanka. For shigella epidemic: Ampicillin capsules, furoxone tablets and gentamycin injections. Purchases - Revolving Fund/Reimbursable Basis During the period under review, Bangladesh, Burma, Nepal and Sri Lanka made use of the Organization's procurement facilities under the Revolving Fund and reimbursable schemes amounting to $151 908. The purchases covered hospital and laboratory equipment and supplies, typewriters, drugs, vaccine, chemicals, bleaching powder, teaching material, books and renewal of subscriptions to journals. 5. COLLABORATION WITH OTHER AGENCIES 5.1 United Nations 5.1.1 United Nations Development Programme (UNDP) During the reporting period, WHO implemented 38 country and inter- country projects funded by the United Nations Development Programme in the Region, the total delivery of UNDP projects amounting to US$ 3 750 000. he operational projects covered programme areas such as strengthening of manpower and training, development of traditional medicine, environmental health, planning, management and evaluation, expanded programme on immunization, food and drug quality control, communicable-disease control including immunology, and the prevention and control of visual impairment and blindness. Active collaboration was maintained with UNDP Resident Representa- tives and governments in order to evolve new country and inter-country projects to be covered during the current indicative planning figure period (1982-1986). The financial stringency in UNDP continued, and a critical assessment of ongoing projects was undertaken during tripartite reviews. Officials from UNDP headquarters visited the Regional Office to review inter-country project activities and explore possibilities of introducing economies without affecting the planned activities. This action has resulted in the further streamlining and expeditious approval of the ongoing inter-country projects. Regular tripartite reviews of country projects were carried out, leading to better implementation. Close follow-up and attention are being paid to the development of new country and inter-country projects. As a follow-up to the Substantial New Programme of Action for the Least-Developed Countries, a series of country review meetings is being organized, either as round-table meetings under the auspices of UNDP, or as consultative groups under the aegis of the World Bank. A series of such meetings was concluded by the UNDP Bureau for Asia and the Pacific from 9 to 18 May in Geneva where the needs of five countries, including Bhutan and Maldives, were reviewed. A staff member from the ~egional Office assisted the countries from this region at these meetings. Bangladesh and Nepal, which use the World Bank Consultative Group mechanism, were also present at the round-table meeting as observers. The earlier country resource utilization reviews carried out in Nepal and Sri Lanka resulted in a greater awareness of health resources needs among economic development and aid coordinators in the countries. 5.1.2 United Nations children's Fund (UNICEF) WHO is closely collaborating with UNICEF both in the countries and in the Regional Offices of UNICEF in New Delhi and Bangkok. The main thrust of collaboration has been in common programme areas such as EPI, diarrhoea1 diseases, nutrition, water and sanitation, promotion of breas~ t'?.?:!i!;i ., , promotion of national codes for the marketing of breast-milk substitut~~~;, and primary health care. WHO and UNICEF are working closely tcgether iii Burna and Nepal in support of primary health care as part of tl~,* .!(::~> studies as well as in the joj.nt action progranme for nutrition. The !<~?i;<u:i~i Offices of both WHO and UNICEF have been reciprocally participating, 5.n c?;:c.! other's regional staff meetings. 5.1.3 United Nations Furid for Population Activities (ULUFPA) During the period under review, 22 country and inter-country prcjec?s in Bhutan, Mongolia, Nepal, Sri Lanka and Thailand were implemented v v;iii with funds provided by the United Nations Fund for Population Astiviiirs (UNFPA). In the implementation of these projects, active collaboratioii w::: maintained with the UNFPA represent:;lti.ves both at the country level 8s 5x.L~ as at UNFPA headquarters. Tile total deli.very of CXFP;? prcjec ts ~i!;o~i,:ti:?., ::, about US$^ million. Technical backctopping has been provided to these projects frcr i-1:: Regional Office. In addition, assistance was extended to UNFPA and t'iti national authorities in the evaluation of the projeccs through the partici-. pation of WHO technical staff in tripartite reviews and special evaluati;.~\ missions (fielded by IlNFPA headquarters) for reviewing country and int~r-. country projects, including the Regional Family Health Team. During the first quarter of 1983, UNPA reviewed and updated iis policies and procedures and issued separate guidelines on major coi;!ponerli:s of population activities. Guidelines on UNFPA support to family pl?-.:~ir. : programmes were epproved and issued, IlNFYA was also in the prccec-s ,>I issuing mcnitoriag instructioiis for inter-country projects funded b:" i.;. 5.1.4 Econonic and Social Comission for Asia and the Pacific (FSCiLq) 'VHO has been collaborating with ESCAP for a long time on a nunber of fronts, particularly in regard to the ESCA? Prograinme on Healtn and Society. Folloriing the Commission's consideration of United Nations General Asser;.:~>I!; Resolutio~i 36/43 and its resolution inter alia to consider speciffc stevs to support WiiO's Global Strategy for HFAl2000, an intergovernmental meetin:! was convened jointly by ESCAP, WHO and UNICEF to consider and recommend t3 the Comission measures for enhancing the collaborati-~e efforts of the thr!?.? orp,anizations and utilizing the expertise avail-able in the various healti- related divisions of ESCAP. Besides the ESCAP Programme of kealt: a:;? Society, WHO has been collaborating with the Comission in the ere-7~ I; social development, natural resources, environment and integrated --.ur? I. development, and the Asian and Pacific Population Conference. 5.1.5 World Food Programme (IIFP) Collaboration with the i~iorld Food Programme iias naiiltainsd !:.i.rt::i;:ii iTii0 headquarters. The World E'ood Programme has offered to discuss possible r:a:ls ir which it can cooperate in the programme for the control and eradicafi~:,:i nL leprosy. The areas of assistance include food aid in leprosy ccntruL mi eradication. A draft project paper for assistance to India was prepared for this purpose and the subject was being actively pursued. IXlring November 1982 an inter-United Nations kency Evaluation Mission (wHO/FAO/UNICEF/WFP) of the project, "Supplementary Nutrition for Pre-School Children, Preg~ant and Nursing Mothers" visited various states in India. me medical officer attached co the Regional Advisory Team on Maternal and Child HealthJFamily Planning and a temporary adviser to the Kegional Director participated in this evaluation mission, which made recorrunendations pertinent to the identified weaknesses, including problems connected with logistics and the management aspect of project imple- mentation. At country level, the WHO Programme Coordinators and Representatives maintained contacts with their counterparts in the other agencies while the Regional Office provided technical backstopping as necessary. 5.1.6 United Nations Industrial Development Organization (UNIDO) WHO and UNIDO continued to collaborate in the UNDP/&therlands-funded project in Nepal on the primary health support services programme. Following an evaluation of the project, an interim review report was received which suggested revisions to the project with substantial changes in the stra- tegies and operational framework. Comments were sent on the revised project document as well as on the plan of work. Collaboration continued with UNIDO for the implementation of that organization's assistance in respect of the project "Strengthening of the Royal Drugs Research Laboratory" i.n Nepal, Close collaboration is being maintained with UNIDO regarding its proposal for the supply of machinery for the production of infusions in Sri Lanka. A WHO consultant visited Sri Lanka in November 1982 in conjunction with the visit of a UNIDO mission and evaluated the project document for the establishment of a unit for the manufacture of sterile fluids. He also discussed the techno-economic aspects of the project with government officials and the authorities of the State Pharmaceutical Corporation in Co lomb n . 5.2 Specialized Agencies 5.2.1 Food and Agriculture Organization of the United Nations (PA@) WHO and PA0 actively collaborated in the implementation of UNDP assistance to the project "Food and Drug Quality Control Laboratory" in Burma. The two organizations agreed to collaborate in the project "~nfra- structure for Food and Drug Control Administration" in Burma for which the project document has been formulated. This document is currently being reviewed by the national authorities and UNDP. FA0 has been closely involved right from the formulation stage of the project. A staff member from FA0 headquarters who was in lndia as part of an FA0 mission visited the Regional Office and was briefed inter alia on the formulation of the above-mentioned project. 5.2.2 International Labour Organisation (ILO) WHO has been collaborating with ILO in organizing occupational health programmes, especially in regard to standards of occupational safety and the health aspects of the work environment. 5.2.3 United Nations Educational, Scientific and Cultural Organization (UNESCO) WHO has been collaborating with UNESCO in educational development and in a network of libraries. 5.2.4 International Bank for Reconstruction and Development (IBRD) WHO'S cooperation with the World Bank in the cooperative programme for water and sanitation is continuing, although the project in the Regional Office has been phased out. Frequent contacts are maintained with the World Bank in regard to areas of mutual interest. The Regional Office sent a representative to participate in the World Bank staff seminar held in Washington in January 1983. 5.3 Asian Development - Bank (AsDB) Close collaboration has been maintained with the Asian Development Bank, the Regional Office providing assistance to the Bank's mission to the countries of the Region. The Bank's pre-appraisal mission for the Second Loan Project in the Health and Fbpllation Sector in Bangladesh in April 1983 was assisted by a WHO staff member in the sector view and finalization of project components, including physical facilities, distribution of medical supplies, maintenance of medical equipment and strengthening of management training. WHO sanitary engineers in Kathmandu supported another mission of the Bank in February 1983 in connection with the water supply and sanitation sector. The Bank recently approved technical assistance to the Socialist Republic of the lhion of Burma for the formulation of a project to redevelop the Rangoon General Hospital complex. Some of the other areas of cooperation between the Bank and WHO include assistance provided by the Organization to the Bank in its loan review mission for the Bangladesh Public Health Programme, the Bank's Technical Assistance Grant for the Health and Population Sector Study in Indonesia, and participation by a representative of the Bank in the meeting on Financial Planning for HFA12000 held in March 1983 in the Regional Office. 5.4 Bilateral and Other Agencies The Regional Office maintained close collaboration with a number of bilateral and other agencies operating in the Region in the health and health related fields. The Swedish International Development Agency (SIDA) has, in colla- boration with WHO, assisted the P.falciparum Containment Programme in India. WHO is monitoring the sterilization programme in Bangladesh in collaboration with the national authorities and with assistance from SIDA. Technical cooperation was also extended to a SIDAIDANIDA mission which visited Bangladesh to assist the Government in the implementation of the national drug policy and the essential drugs programme. DANIDA-supported projects in India were evaluated by a representative who visited the country in March 1983. In close consultation with the national authorities in Nepal and the Directorate of Development Cooperation of Switzerland, a plan of operation was formalized for implementing the project on health laboratory services in Nepal. The project is to receive financial support from the Government of Switzerland. The German (Federal Republic) Agency for Technical Cooperation has been funding the inter-country project for the promotion of national Decade plans for water and sanitation. This project was to terminate in June 1983. WHO has maintained contacts with US AID, the Canadian International Development Agency (cIDA), the Danish International Development Agency (DANIDA), the Norwegian Agency for International Development (NORAD), and with the Governments of Finland and the Netherlands. Discussions took place &I February 1983 in Burma between the WHO Programme Coordinator and Representative and representatives of the International Development Research Centre, Ottawa, Canada, on possible collaborative research programmes. Netherlands assistance to health programmes in South-East Asia includes the development of the Nutrition Cell in Bhutan, the Vector Control Programme in Burma, the Primary Health Support services and Prevention of Blindness programmes in Nepal, the Thai Social Development project, and the regional support programme on diarrhoeal diseases control. In addition, in December 1982, on behalf of the Tool Foundation, Amsterdam, the Cross Cultural Consultancy Foundation, Naarden, prepared a feasibility study for the establishment of a pilot project to develop appropriate technologies for the preparation of ayurvedic drugs from herbs in Sri Lanka. Voluntary funds are also channelled through WHO for variaus programmes, including malaria, prevention of blindness, leprosy, diarrhoea1 diseases and WI. With a voluntary contribution from the Netherlands, WHO is executing, in collaboration with the Government of Thailand, a social development project with a strong health component. 5.5 Non-Governmental Organizations (NGOs) WHO has been promoting dialogues between non-governmental organiza- tions and ministries of health in the countries to enhance the involvement of NGOs in health work. National seminars between NGOs and the Governments of ~ri Lanka and Thailand were supported by WHO. similar support is also envisaged for some states in India. Documents were prepared in Sri Lanka and Thailand showing the inventory of NGOs' programmes in relation to primary health care. 6. PUBLIC INFORMATION The period under review saw a steady strengthening of emphasis and effort in providing health information to the mass media as well as to the lay public. Steps were taken to develop the public relations aspects of the dissemination of information. Through various communication-oriented activities a better under- standing of the role of the Organization was sought to be projected. The promotive and preventive aspects of health, especially in the context of the goal of Health For All by the Year 2000, were highlighted through the HFA12000 Newsletter. A conscious effort was made to draw the attention of the media to the fact that health development, in order to be effective and successful, needs to be a multisectoral effort with the active involvement of the community. The main thrust of the activities during the year was on media relations in general: briefing them during the Regional Committee meeting, on the occasion of World Health Day and during important group educational activities or meetings in which the media had an interest. The highlights of the activities were as follows: Regional Committee. The Regional Committee's thirty-fifth session, held in Dhaka, was widely covered by the local and regional media. Special newspaper supplements were published on the occasion of the second meeting of the Health Ministers of South-East Asian countries. These carried messages from the Chief Martial Law Administrator and the Health Minister of Bangladesh as well as from WHO'S Director-General and the Regional Director. World Health Day. This year's theme, "Health for All by the Year 2000: the Countdown has Begun", was well received and generated considerable interest among the media. The Regional Director addressed a well attended press conference, recorded a special talk for All India Radio and a state- ment for Indian television. National programmes on the radio were also broadcast, featuring interviews with some staff members. An article from the Region was included in the WHO information kit which was distributed worldwide. Several schools, non-governmental organizations and health education bureaux used this information material to organize programmes to observe World Health Day. These activities included exhibitions, symposia, debates and the screening of films related to various health topics. World Health. A number of articles devoted to various interesting and innovative approaches in health development in the Region were carried by World Health magazine during the year. These included subjects such as water, blindness and sanitation. The special World Health Day issue also carried an article and photographs contributed from the Region. Group Educational Activities. Press releases were issued in respect of activities related to financial planning for health for all and medical research. These evoked an encouraging response from the media and resulted in requests for more information. Cooperation with United Nations Information Centres and Other Agencies. The Regional Office maintained its collaboration with the New Delhi United Nations Information Centre by providing inputs to its weekly newsletter. Work on producing an information- booklet-depicting the role o£ various United Nations agencies in India was begun. An exchange of material including films was maintained with some other United Nations information centres. In collaboration with UNICEF, exhibits on low-cost aids for the handicapped were displayed at an exhibition entitled "Helping the Handi- capped1' organized by the Department of Social Welfare, Government of India. Photographs and Films. Black-and-white photographs were supplied to the media on a variety of subjects. The World Health Day information kit as well as World Health magazine were also provided with exclusive photographs. Work on producing mobile display modules with photographs was initiated. These modules would be used at various group educational activities and on special occasions. WHO films were shown regularly on television programmes, and the film on primary health care in lhailand was released and much appreciated. An effort was made to expand the film library in order to make more films available to a larger number of institutions. Visitors. In keeping with the public relations aspects of public information, visits by students were encouraged. An increasing number of such groups was received and briefed by the appropriate units in the Regional Office. Requests for information on the Organization and its activities, mostly from school children, were also complied with. PART I I1 ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO PROJECT LIST This part of the report contains programme summaries in respect of each country, giving a brief account of the major problems of the country and highlighting the government's efforts during the year, in relation to WHO collaboration. The information is complementary to that already given in Part I. Each programme summary is followed by a list of the projects in the country for which WHO has given assistance during the whole or part of the period under review. Inter-country projects are listed at the end. In the project list, in the first column (under "Source of Funds"), the following abbreviations are used: Abbreviation Meaning R Regular Budget UNDP United Nations Development Programme FP United Nations Fund for Population Activities FT Trust Fund UF United Nations Children's Fund VF Voluntary Fund for Health Promotion - all sub-accounts AS Special Account for Servicing Costs FSSTD UN Financing System for Science and Technology Development The projects are listed in accordance with the programme classi- f ication. 1. BANGLADESH The indices for national strategies for Health for A11 were reviewed during 1982. A plan of action was prepared in order to implement the strategies for HFA/2000 and update their 77 indicators. Throughout the period efforts continued for finalizing the health manpower plan, which set as its objective the task of identifying the needs for health manpower of all categories required to operate the health care system during the years 1985, 1990 and 2000. Work on the decentralization of the administration has progressed considerably with the thana as the pivot, 45 thanas having been upgraded in 1982. The posts of gramsarkars were abolished and the functions of the alli chikitshaks were temporarily suspended. In order to take the medical !ervices to the rural sector, it has been made compulsory for new medical recruits to perform five years' service including three in rural areas. An expert committee was set up to formulate and draft a national drug policy consistent with the health needs of the country. The selection of essential drugs was made. Most of the nearly 1 763 varieties of drugs, except 250 or so, will be abolished. Efforts continued for improving the collection of health information on morbidity and mortality, and on births and deaths by village in the six pilot thanas. To strengthen the operations of the Health Information Unit the technical advisory committee was revived. WHO assisted in the development of the basic legal health infra- structure by integrating all existing health laws and recommending areas for legal reforms and revision. A survey of the country's supply management system was carried out at the request of the Government. Particular attention was paid to the identification of bottlenecks and constraints and to the provision of drugs and medical supplies to the rural population. Work on the development of primary health care in the thanas concentrated on the creation of the basic infrastructure. Guideline models for community participation and thana health and family planning personnel in terms of organization, management functions, duties and responsibilities, as well as an orientation curriculum based on the guideline models were finalized and issued. The first orientation in the new model thana health service delivery (PHC) for the thana health service managers of six thanas was held in December 1982. Progress was made in the establishment and construction of a national workshop and training centre for the maintenance of electromedical equip- ment. The solution of the problem of repair and maintenance of equipment at hospital, district and constituent thana levels awaits the completion of the central organization and the extension of its facilities to the periphery. Group educational activities with mass media support continued to highlight disability prevention and rehabilitation. WHO collaboration included technical guidance and the supply of manuals on the training of the disabled and other reference materials. In the field of health laboratory services, the new facility for tetanus toxoid was opened and a small batch was prepared and found to be satisfactory in local quality tests. Construction of a reference and control centre and of units for the production of diphtheria and pertussis vaccines was nearing completion. A certificate course and several in-service training courses in public health nutrition were completed. Data on the completed survey under the goitre control programme and on the situation analysis of the nutrition component of the primary health care programme were being analysed. A formula on weaning food has been developed for trial. An analysis of the country's food products and a study on the growth pattern of Bangladesh children were in progress. A national workshop on the development of health education in primary schools was conducted, as were several workshops and in-service training programmes for various categories of health personnel. Manuals on a health education curriculum for nurses and medical assistants and on school health education were developed and a handbook on health education completed. To improve the standard of voluntary sterilization, a joint SIDA/ World BankIWHO-sponsored project entitled "Sterilization Surveillance Team" was started in 1982. Its main objective is to monitor the standard of sterilization in order to improve the overall standards. There would be four teams located in each administrative division. Three of the four WHO personnel for this programme are now in position. The main pharmaceutical production unit was completed in 1982. WHO has agreed to provide four air-conditioning units to facilitate limited production. Following the discussions held during the World Health Assembly in May 1983 among the representatives of the Bangladesh delegation, WHO, DANIDA and SZDA, it was decided that two joint missions should visit Bangladesh. The first mission will produce a detailed plan for the quality control of drugs with an implementation schedule, budget details and training needs. The second mission will plan the implementation of the essential drugs programme. The terms of reference of both the missions have been prepared and it is expected that the missions would visit the country in August 1983, The Board of DANIDA has approved that, in cooperation with WHO and SIDA, DANIDA will proceed with the detailed planning of possible assistance to the Bangladesh Essential Drugs Programme. Communicable disease control programmes continued to be a major activity. Diarrhoea1 diseases ranked as the major cause of morbidity and mortality, especially among infants and children. Steps were being taken to step up the production of ORS to meet the country's demands. The development of epidemiological services and health information systems is essential for the control of priority diseases such as diarrhoea (including cholera), diphtheria, whooping cough, tetanus, measles and poliomyelitis, and slow but steady progress was registered. ~abies control was given priority and a draft countrywide control programme was drawn up. Also, a zoonosis unit was established at the National Institute of Preventive and Social Medicine. The expanded programme on immunization has shown some progress. Several hundred EPI centres were established at district, thana, family welfare and union health centres. In Dhaka, two cold rooms were established for the storage and distribution of drugs and vaccines. District stores were set up and every thana health centre was supplied with a refrigerator and other cold chain materials. Malaria remained a major public health problem. There was a loca- lized epidemic of P.falciparum and cerebral malaria in two south-eastern districts towards the end of 1982. The RIII level of chloroquine-resistant P-f. strains increased to 16 per cent in 1982. WHO gave assistance by procuring and airlifting emergency supplies of parenteral and oral quinine to combat the epidemic. In the rest of the country the overall situation improved marginally. A WHO-sponsored external assessment in November/ December 1982 recommended epidemiological stratification of the country into three strata and a revised strategy to control malaria. A draft four-year plan of operations was drawn up after the completion of the epidemiological stratification. Tuberculosis and leprosy control activities were continued. Although there are an estimated 200 000 cases of tuberculosis and 150 000 cases of leprosy in the country, only a fraction of this number is registered for treatment. Three hundred and fifty thanas examine sputum and carry out passive tuberculosis case-finding. A mass KG vaccination campaign was organized in November 1982 to cover the high defaulter rate. Four mobile leprosy teams were established to serve 104 leprosy treatment centres. Three leprosy clinics with 20 beds each were also set up. High-potency vitamin A capsules were distributed twice a year to children in the 0-6 age group and to those in the 7-15 age group with nightblindness. The rate of nightblindness in children (0-6 years) has dropped from 2-3 per cent in 1973 to 1.14 per cent. A survey to estimate the prevalence of xerophthalmia began towards the end of 1982. The prevalence of diabetes is being studied through a survey in urban and rural areas. The Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders was designated as a WHO Collaborating Centre with training and research as the principal objectives. Environmental health activities were supported by WHO through two projects, viz., (i) community water supply and sanitation, and (ii) assist- ance to the WASAs in Dhaka and Chittagong. The water supply component and coverage, with UNICEF financial inputs, is more pronounced than the sanita- tion part. The installation of tubewells continued. The capacity to produce 40 000 water seals annually was reduced owing to a shortage of materials. Assistance to the Dhaka and Chittagong WASAs has been extended up to 1984. Oral health and dentistry are in an early stage of development with a dentist to population ratio of 1~300 000. Results of a survey encompassing eight areas indicated a higher prevalence of periodontal disease to dental caries. An oral health education programme has been formulated. WHO gave support to the paramedical institutes in the training of mid-level and peripheral health workers. Five educational workshops were conducted for a total of 1 978 participants. Existing methods of teaching and course curricula were also reviewed. The National Institute of Preventive and Social Medicine continued to conduct post-graduate courses in community medicine as well as in-service training and workshops for government technical staff. WHO provided techni- cal assistance for some of these courses. Progress had been made in the development of nursing education. A four-year course was established to produce senior registered nurses, mainly trained to provide hospital bedside care. A training programme for junior nurses was started in order to produce auxiliaries who could work in medical institutions and also carry out primary health care in the community. These programmes have been recently evaluated and modified. Assistance for research promotion and development covered training in research methodology and the promotion of health services research in respect of primary health care in the Bangladesh Medical Research Council. Projects in Operation Number (Source of Funds) - Title BAN CHP 001 (R) Country Health Programming BAN RPD 001 (R) Research Promotion and Development BAN SPM 001 (R) Organization of Health Services Planning and Administrat ion BAN SPM 002 (R) Strengthening of Thana Health Complexes and Development of Primary Health Care BAN SPM 003 (R) Repair and Maintenance of Electro-Medical Equipment BAN ADR 001 (R) Disability Prevention and Rehabilitation including Health Care of the Aged BAN ATH 001 (R) Development of Health Laboratories and Allied Laboratory Services BAN MCH 005 (VF) Sterilization Surveillance Team BAN NUT 002 (DP) Institute of Public Health Nutrition BAN HED 002 (R/FT) Development of Health Education Services BAN MNH 001 (R) Mental Health BAN PHB 001 (R) Pharmaceutical and Biological Quality Control BAN PHB 003 (FSSTD) Strengthening of Bangladesh Council of Scientific and Industrial Research Laboratory, Chittagong BAN ESD 001 (R) Strengthening of Epidemiological Services BAN ESD 002 (DP) Epidemiology and Disease Control BAN MPD 001 (R) Malaria Control BAN BVM 001 (R/VF/FT) Mycobacterial Disease Control BAN EPI 001 (R/VF) Expanded Programme on Immunization BAN PBL 001 (R) Prevention of Blindness BAN CAN 001 (R) Cancer Prevention and Control BAN CVD 001 (R) Cardiovascular Disease Control BAN ORH 001 (R) Oral Health BAN OND 001 (R) Other Noncormounicable Diseases (Diabetes, ~ndocri- nology) BAN EHP 001 (DP) Assistance to Water and Sewerage Authority (Dhaka and chittagong) BAN BSM 001 (R) Community Water Supply and Sanitation BAN PTR 001 (R) Training of Mid-level and Peripheral Health Workers BAN PTR 002 (DP) Training of Medical Assistants BAN PTR 003 (DP) Strengthening of Health Manpower Development BAN PTR 005 (DP) National Institute of Preventive and Social Medicine BAN PTR 006 (R) Assistance to ~edical Colleges in the raining of Teachers BAN PTR 007 (DP) Training of Senior Nurses BAN EDS 001 (R) Nursing Advisory Services and Training 2. BHUTAN The Royal Government's Fifth Six-year Plan (1981-87) erophasizes decentralized development, reduction of regional disparities, accelerated community-based rural development, and improvement of existing institutions and service facilities. Allocation for health constitutes 5.3 per cent of the total plan alLocation for this six-year period The overall objective of the country's health plan is to strengthen the basic health services and ~rimary health care activities to facilitate the attainment of HFA/2000, A Master Plan of Operatio~s for Health Services Development in Bhutan has been signed by the Roya? Goveran~ent and WHO. In view of the predominance of the rural sector, the underlyi3g health development strategies lay emphasis on rural health services through basic health units (BHUs) and district hospitals. There are 50 basic health units providing health care at the peripheral level, each supported by a three-nember team of a health assistant, an auxiliary nurse-midwife and a basic health worker. The BHUs are supported by 16 district hospitals, while three referral hospitals provide specialized services. Other service units in the rural areas are 39 dispensaries of the modern system and five of the indigenous traditional medicine. The Government has also expanded the voluntary village healtn volunteer programme from four districts last year to one more district, where female health volunteers have been introduced for the first time. These village health volunteers provide preventive and simple curative care. In the field of MCB, WHO has been executing UNFPA-funded projects. Construction of a training complex has been completed. The activities envisaged include training in MCH and family welfare, training the trainers for village health volunteers and the retraining of other health workers, Assistance is also extended in the implementation of health education elements in connexion with which three textbooks on hygiene and sanitation have been finalized. Surveys of maternal and infant morbidity and mortality for the development of an MCH and family planning information system as part of the National Health Information System were initiated. Training of practitioners of traditional medicine and identification and improvement in the processing of locally available herbs for medicinal purposes have also been supported by WHO. The Traditional Drugs Production Unit has been contributing towards meeting the local needs. The programme of immunizing children against tuberculosis, diph- theria, pertussis and tetanms (DPT), polio and measles continued according to schedule. A project document covering UNDP assistance to EPI for the period 1983-1986 was submitted to UNDP. The project will extend immunization activities within the context of comprehensive primary health care services to cover larger geographical areas and a larger percentage of the children in the target population within these areas, The formation of tne new Nationai Nutrition Unit in Bhutan has given a substantial boost to nutrition strategies/activities, A national baseline survey of goitre/cretinism/hypothyroidism has just been completed with joint WHO~UNICEF support. The country's salt iodization plant has also been completed, and these, together with the iodized oil injection programme, clearly indicate a concerted effort to eradicate the enormous problem of goitre/cretinism. he country faces a number of problems in the maintenance and supply of equipment in the remote areas, especially in basic health units. However, assistance has been provided in the repair and maintenance of electro-medical equipment. As yet, there is no firm system for the development of skilled personnel in this area. Fellowships have been awarded to technicians who, on return, have been deployed in the hospitals. A plan to have a mobile team for the repair and maintenance of equipment has been evolved and submitted to UNICEF and UNDP. Other activities which have been supported include the strengthening of health laboratory services, the diarrhoea1 disease control programme and the training of PHC workers in oral rehydration therapy. WHO consultants were also assigned to assist in designing study protocols for the collection of statistical information on illnesses. A national commission for the IDWSS Decade has been established and WHO, in coordination with UNICEF, has supported the finalization of the Water Decade Plan. External support in the health field has come from UNDP, UNFPA, UNICEF, WFP and WHO. A major project for multifaceted health services development, funded by UNDP and executed by WHO, ended in 1982. For the period 1983-87, another UNDP project has been developed in the areas of nursing, health manpower development, planning for basic services, primary health care, drug selection and management, strengthening of referral and district hospitals, expanded programme on immunization and control of rabies and other zoonoses. Projects in Operation Number (Source of Funds) Title - BHU CHP 001 (R) Country Health Programming BHU SPM 001 (DP/VF) Development of Health Services BHU ATH 001 (R) Promotion of Health Laboratory Services BHU MCH 001 (FP) Development and Strengthening of MCH and FP Services BHU BVM 001 (R) Diarrhoea1 Diseases Control Programme BHU HST 001 (R) Strengthening of Health Information System 3. BURMA The Second People" Health Programme (PHP), which started on 1 ~pril 1982, includes five programme areas with related health strategies in which community involvement and intersectoral collaboration are highlighted. The objective is to continue the integration of health services delivery with a strong PHC programme in support of national strategies for HFA/2000. The implementation of the People's Health Programme has progressed by increasing the coverage of townships annually. The total coverage attained is 187 out of 316 townships. Impact surveys/studies in support of the evaluation of PHC were started. A pilot community household survey on health and health care was completed and lay reporting of morbidity and mortality information has been introduced, Country and programme profiles were updated regularly. Monitor- ing and evaluation systems were strengthened and the health information service is now equipped with a computer system, The PHP is continuing its extension of PHC coverage at community levels. The training of health personnel of vertical programmes to become multipurpose health workers and the deployment of voluntary health workers continued. Community acceptance has continued to help in rapid progress being made in the training of voluntary health workers. The training of specialists and general medical officers in clinical skills and hospital management continued. Intensive care facilities are better equipped with trained staff. With support from the Asian Development Bank, the project for upgrading hospitals for better facilities, to set up a referral system for PHC, became operational. The supply system was strengthened with the expansion of a network of sub-depots and warehouses for storage and the better and timely distribution of supplies and drugs. Repair and maintenance services for electro-medical equipment were extended by the establishment of workshops in hospitals and the training of staff. The services of hospitals of traditional systems of medicine were expanded in Rangoon and Mandalay. The use of traditional medicine in primary health care continued to be encouraged by the training of village health workers. The network of traditional medicine dispensaries is being expanded by ten dispensaries every year. Under the family health programme with special emphasis on maternal and child health, school health and nutrition, 3 600 auxiliary midwives were trained; training of other MCH workers and traditional birth attendants (TBAs) is being given prominence as part of the PHC support programme. Studies were carried out on the training and role of TBAs in primary health care and the detection of high-risk maternity cases. The task-oriented training programme of TBAs was renewed and updated. Ad hoc studies on infant -- and early childhood morbidity and mortality are being carried out. A number of TBAs were selected by the community for training as voluntary health workers (auxiliary midwives). A WHO-funded research project was campleted, including estimates oE the extent and prevalence of malnutrition in much of Burma, and identifying aspects of the national nutrition programme that needed strengthening for increased impact. An excellent nutrition-through-PHC programme has been developed as part of the second People's Health Plan- The Joint WH0,'UNICEF Nutrition Support Programme has pro~rided a major boost to the nutrition programme, and allowed a rapid intensification of inputs such as child weighing, nutrition education, nutrition and diarrhoea surveillance among at least half of the country's population, A measurable impact on malnutrition and mortality is anticipated. Training of various categoriefi of health ~taff and community health workers in VBDC activities continued. Collection of blood slides by VHWs and basic health workers has improved. Although the blood examination rase has also improved, further improvement is needed to achieve satisfactory coverage. A meeting of all state/divisional health directors was held to review progress and to plan activities for 1983, Studies on chloroquine and insecticide resistance were continued. The training of townnhip medical officers in EFT continued. The cold chain has been developed in spite of the limitations ~osed by the irregular electricity supply. Poliomyelitis immunization in the townships of the Rangoon and Elandalay city development areas continued, with the vaccines supplied by the 'Save the Children Fund' of the United Kingdom through WHO. As tetanus toxoid is becoming available in adequate quantities, tetanus imm~~nization of all farmers and workers has started and will continue over the current plan period to achieve maximun coverage. In the leprosy control programme, the BCG cohort studies, the dapsone resistance study and the rifaqicin trial progressed according to plan. Data from the rifampicin trial are being processed, In regard to rural water supply, the construction of deep tube-wells, reconditioning of old wells and the construction of small water supply systems are being carried out. A ~ational Water Committee has been formed, headed by the Minister of Agriculture and Forests. A project for conducting water and sanitation pre-feasibility studies in two major towns and feasi- bility studies in five small towns is under implementation. Baseline data on the water and sanitation si.tuation in 45 000 out of 65 000 villages are being processed. Sanitation activities continued in rural and per1-urban areas. A WHOIUNICEF-supported pilot sanitation project to study the problems of latrine construction has been implemented, and a plan of action for its expansion is being drawn up with WHO'S assistance, The training of various categories of health workers, continuing education programmes and the training of trainers of CHWs were coordinated by the project 'Development of Procedures and Staff ~raining" The project document for the strengthening of the Post-graduate School of Public Health was finalized and was under review by UNDP. Health education activities were continued. A project document on the strengthening of the Health Education Sureail in support of the IDWSSD was prepared and was awaiting clearance. Implementation of the project is expected to start in early 1984. A four-month national certificate course in health education was conducted with WHO assistance. Support was provided t.o the Burma Pharmaceutical Industry through staff development and the provision of equipment for the production and quality control of biologicals. The prodcction of tetanus vaccine and DT vaccines increased in 1952 All the rabies vaccine and about 30 per cent of the anti-sneke venom serurr. continued to be produced in freeze-dried form. Laboratory services improved with the establishment of Type C and Type D laboratories at station and township hospitals. Laboratory training in communicable-disease detection was conducted. The food and drug quality control project was extended for one year with a budget of US$ 608 297 provided by UNDP, In the 1982-85 UNDP colrntry programme a new project was included for the development cf the food and drug control infrastructure, The activities of the United ~atiocs/Rurma Drug Abuse Control Programme included staff training, est.ablish.nent arid management of treatment centres, and laboratory facilities for drug abuse control. Under this programme, the second phase of which started in July 1982, a detoxification hospital and a rehabi1ita:ion centre were opened. A project. docu~nent for conducting, with UNDP funds, research into the standardization and pharinncolcgical and toxicological evaluation of traditional drugs and herbal medicines was finalized and was awaiting clearance for implementation- The cardiovascular diseases project was concentrating on education and expansion of the technical services and faci1i:ies for the prevention, early diagnosis and effective management of major cardiovascular problems. The cancer project is concerned with manpower and the strengthening of the existing radiotherapy centres in Rangoon, Mindalay and Taunggyi and the strengthening of cancer registries in Mandalay and Taunggyi. The UNDP-funded project 'Community-oriented programme for disability prevention ann renabilitation' was started in 1982 and training courses wera cocducted. Appropriate technology plays an important role in developing prosthesis for this programne, which is implemented by PHC workers. A WHO inter-country Co~sultation on Prevention of Blindness due to Glaucoma was held in R-angoon in Piarch 19E3 at which a regional plan of action was formulated+ The :,ye, Ear, Nose and Tkroat Hospital, Rangoon, will be upgraded as a Regional Centre under this programme, A study to assess the incidence of deafness amongst primary school children was conducted and a programme formulated to integrate deafness control into PHC, Intersectoral collaboration in the planning and implementation of IDWSSD acti.vities is promoted by the Xinistry of Planning and Finance. Burma has agreed to participate in the IJNICEF/WHO Joint Support to Governments for the Implementation of PHC IJCHP)? and activities to implement this programme have co~menced. Burma has also agreed to participate in the WHO~UNICEF Nutrition Support program, and a project proposal has been submit:ed to the Steering Committee for funding. The proposal includes nutrition education and services, including a component. for the control of diarrhoea1 diseases. Trojects in *eration --- Number (Source of Funds) -- Title -- BUR CHP 002 (8) Country Iiealth Programming BUR RPD 001 (11: Sealth Research in support of the People's Health Programme BUR SPM 001 (R) BUR PHC 001 (R) BUR WKH 001 (DP) BUR ADR 001 (DP) BUR ATH 001 (R) BUR ATH 002 (R) BUR ATH 003 (DP) BUR MCH 004 (R) BUR HED 002 (R) BUR PHB 001 (R) BUR BVM 001 (VF/FT) BUR EPI 001 (R) BUR VBC 001 (R/VF) BUR CAN 001 (R) BUR CVD 001 (R) BUR EHP 001 (R) BUR BSM 003 (DP) BUR BSM 004 (DP) BUR PTR 001 (R) BUR PTR 002 (DP) BUR HST 001 (R) Hospital Services Management Primary Heath Care and Basic Health Services Strengthening of Health Services in Newly Indus- trialized Areas (West Bank of Irrawaddy River) Training and Rehabilitation of Disabled Supply System and Maintenance and Repair Workshop for Health Equipment Promotion of Health Laboratory Technology Food and Drug Quality Control Laboratory Family Health Development of Health Education Development of Production and Quality Control of Biological and Pharmaceutical Products Leprosy Control/Research Activities Expanded Programme on Immunization Vector-borne is ease Control Cancer Control Cardiovascular Diseases Environmental Health Planning and Management Development of Urban Water Supply Programme Identification Study for community Water Supply and Sanitation Development of Procedures and Staff Training Education and Training of ~ealth Manpower Health Information Services L. 3E?I!)CiWTIC PEOPI,EIS REPUBLIC OF R0RZ.A Health status in the DemocraEic People's Republic of XOrea is reflected. among other things, by a high level of life expectancy at birth (over 74 years) and low infant rcrtality (12 per 1 GO0 Live births). Such a level of heslth was achieirrJ through the adoption of the National Realti1 Policy and its successful implementation during the last few decades. The health policy is based on the "Jucht" idea, wherein "nan" is conceived as the master of nature anti snciety sr~d the mnst precious being in the world. As such, it has becomr the obligation of the State to improve continuously the people's health status so that all. working people live long and kappily in good health, being act<velg involved in all efforts towards better health stat!is and better sacio-eccncrr.ic. condi.tions- During the year, in the context of the natiorral strategies for :%?I, the Democratic People's Republic of Korea adopied certain basic principlns in the implementatign of its !.ealth efforts. These are' (1) to consclidete and further improve the free medical care system that is ~~niversally available in the country; (2) to maintain its Eocus cn the preventive aspects of medicine as enshrined in the Public Health Law; (3) to modernize medical science and technology further by properiy blending the t radit icnal Korean medicine 2-d moder- medicine towards better public health services; (4) to prduce anc deploy health manpower in a planned manner so that they serve the pecple as genuine health worko~s~ devoted t3 the Juche idea, and (5) to participate in the exchange of scientific and techni- cal knowledge with friendly countries and international. organizations such as WHO.. Most of the colmmon comunicable diseases that are prevailing in other Member Countries of the Region have ceased to exist as public health problems in t'he 3emocratic People's Republic of Korea, where the disezse pattern has al-ready ;hanged from that of comunicable diseases to the problems of non-connuni.cable and negeneratjve diseases. The country's target is to increase life expectsncy at birth to 80 years by the end of the present decade. With a growing increase in the population of the aged and with the control of ccmuricable disezses. current health problems centre round diseases such as cancer and other neoplastic conditions, cardiovas- cular diseases, etc, Health faciiities are geared to the provision of comprehensive care to farmers.. industriai workers and mothers and children, as well as tc older citizens, proportion is, as stated above, increasing in tne demogrsphic ccmposition. Thus the health care delivery system envisage? a st,rong t.x~ponent of gerontology and rehabilitaticn. The 1)emocratic People's Repubiic of Korea has been self-sufficient in medical supplies in terns of drugs a~d equi.pment. It is advantageously utilizing the resources of traditional Korean medicine, fully integrated with the modern system of medicine. Moreover, climatic (nature) cure for certain illnesses forms an important aspect of geriatric and rehabilitative care. The country is receiving WHO'S technical cooperation in the nrea of computerization. In this regard hospital and clinic records, health situa- tion and trend assessment, as well as the management information areas will become well organized with the promotion of electronic data processing facilities. In order to improve further the country's capability in dealing with the current health care problems, WHO inputs were provided in areas such as open heart surgery along with anaesthesiology, care of post-operative cardiac surgery cases and emergency cardiovascular patients, improvement of radiological diagnostic methods and radiation safety measures, organization of health services, and further improvement of the traditional system of medicine. In order to meet the increasing requirements of its health care system and its future needs, the ~emocratic People's Republic of Korea is paying attention to the area of research. The Korean Academy of Medical Sciences and other research institutes are conducting various types of research on basic science subjects, clinical medicine, hygiene, pharma- cology, traditional Korean medicine, etc. The Government has identified its needs so as to modernize the material and technical equipment of those research institutions, including electronic data processing facilities. WHO consultants assigned to the country trained national professionals in their respective specialities, in addition to other technical inputs. The Government is laying emphasis on the training of health professionals to improve their proficiency in the English language as a step towards assimilating international knowledge and skills available from other Member Countries. Projects in Operation Number (Source of Funds) Title KRD SPM 001 (R) Strengthening of Medical Care Services KRD ATH 001 (R) Laboratory Sciences and Techniques KRD CAN 001 (R) Cancer Control KRD CVD 001 (R) Cardiovascular Diseases KRD EHP 001 (DP) Environmental Health Protection in Rural Areas KRD RCE 001 (R) Environmental Health KRD MPM 001 (R) Strengthening of Health Manpower Development 5. INDIA In consonance with the Global Strategy for Health for All by the Year 2000, the Government of India expressed its commitment by placing in October 1982 its Statement on ~ational Health policy before Parliament. The policy deals realistically with various dimensions of health - political, cultural, socio-economic, nutritional, environmental, educational, preventive and curative - all as part of primary health care. It outlines the required reorganization of the health services' infrastructure and overhaul of the existing approaches to the education and training of medical and health personnel, relevant to the actual needs and priorities of the community, ensuring the involvement and participation of the community and voluntary organizations. It also sets out the specific goals to be achieved by 1985, 1990, 1995 and 2000 in pursuance of the national commitment for the attainment of the goal of HFA/2000, Similarly, a draft National Medical and Health Educa~ion Policy is being evolved, which takes into account the current phenomenal growth of the health services and the required reform of undergraduate and post-graduate curricula and training to provide these with a community bias, along with a balanced growth and placement of medical: paramedical and other health personnel, and inter-relationships and interaction between the allopathic, Indian and Homoeopathy systems of medicine in the delivery of primary health care. The Government intensified its long-term comprehensive health plan in the context of the Prime Minister's 20-Point Programme for Total Development, Strict monitoring is being maintained at the Centre and in the states on the basis of specific indicators and targetted goals in respect of the national priority programmes of family welfare; augmentation of primary health care facilities; acceleration of maternal and child health care and nutrition programmes; control of tuberculosis, leprosy and blind- ness, and the provision of safe drinking water supplies and improved sani- tation, all with special attention to underserved and underprivileged areas. WHO continued its collaboration in the above-mentioned endeavours. Mechanisms were developed for a joint Ministry of Health and Family Welfare/ WHO programme planning, implementation and monitoring of the inter-related WHO activities. These included the establishment of a national coordination committee under the chairmanship of the Secretary, Health; a steering committee under the Additional Secretary, Health, for follow-up of the decisions of the Coordination Committee, and mini-task forces for detailed programme formulation and monitoring of the WHO collaborative activities. The Government also considered how best it could increasingly support TCDC activities between countries of the Region and India, initially in the priority areas of health manpower development, expanded programme on immunization, and control of diarrhoea1 diseases. To help strengthen the development of the integrated health infor- mation system, in addition to supplies and equipment, a grant was provided to the Central Bureau of Health ~ntelligence. A workshop on "Uniform system of medical records and reports in district hospitals" was supported. Consultants were assigned to assist the All India Institute of Hygiene and Public Health, Calcutta, in health information systems, health economics, and planning and management. In collaboration with the health services of Gujarat, the National Institute of Health and Family Welfare, New el hi, and the Indian Institute of Management at Ahmedabad, WHO supported an innovative approach to manage- ment training, addressed to district health officers and designed to facili- tate the application of management principles within the working situation of their district health services, A national-level follow-up workshop on health economics and management was held to evaluate the group educational activities already conducted. In regard to health manpower development, WHO collaborated in the upgrading and strengthening of the network of national teachers' training centres for various categories of workers; setting up of more centres for the training of trainers; preparation and printing of training materials for health workers, and feilowships and group educational activities in support of national priority programmes. It participated with the Medical Council of India in educational planning. High priority continued to be given to the promotion of family planning as a people's programme on a voluntary basis. ~hrough its Special Programe of Research, Development and Research Training in Human Repro- duction, WHO directed its collaboration to the development of a new birth control technology, assessment of the safety of existing contraceptive methods and techniques, and approaches to the delivery of family planning related to their safety, adaptability and efficacy. Support was provided to the WHO Collaborating Centres for Research in Human Reproduction in New Delhi, Chandigarh and Bombay. In the field of maternal and child health care, WHO collaboration, in conjunction with UNICEF, covered neonatology; high risk infants; integrated MCH/FP curriculum development for an integrated package of maternal and child health, family planning and communicable diseases control with the primary health care approach; establishment of paediatric and obstetric units in district headquarters' hospitals; urban family planning and KH centres; workshops for state-level MCH officers, and supported by the joint WHO/UNICEF expanded programmes on immunization, diarrhoea1 diseases control, anaemia and other nutritional deficiencies. Studies on the risk approach in MCH/FP care were supported in Pune. Support was also extended to state nutrition divisions; the Nutrition Cell of the Directorate General of Health Services; the National Institute of Nutrition, Hyderabad, and the All-India Institute of Hygiene and Public Health, Calcutta, in the training of personnel, in research and development, in the production and distribution of nutrition education material, and in group educational activities, WHO/UNICEF support for goitre control included the installation of iodization plants in the states, award of fellowships for state nutrition officers to observe developments in other countries, and the organization of workshops in endemic states. An important element of WHO'S programme was increasingly directed to health education as part of national programmes, and to the evaluation of community involvement in primary health care, With WHO and SIDA collabora- tion, the Government launched an intensive pilot project on school health services in 25 blocks in 17 states and 3 union territories. Five workshops were organized by the Central Health Education Bureau with WHO collaboration with a view to developing need-based health education material. To strengthen the epidemiological surveillance of communicable diseases on a regional basis, formats for data collection, operational details of the project field area and the curriculum of training were formulated. WHO collaborated in the training in epidemiology at the post-graduate level at the All-India Institute of Hygiene and Public Health, Calcutta, and at the intermediate (district) level at the Natlonal Institute of Health and Family Welfare, New Delhi. The Organization continued to collaborate with the National Malaria Eradication Programme in planning policies and strategies, and in the imple- mentation and evaluation of antimalarial activities. To control the spread of P.falciparum infection, the National Malaria Eradication Programme continued to receive assistance froa SIDA and hX0. This programme was in operation in 112 districts in six zones. Applied research activities were undertaken in two zones. A considerable number of training and orientation activities were assisted at the National Institute of Communicable Diseases, Delhi. The Special Programme for Research and Training in ~ropical Diseases provided support to various research projects in vector and drug resistance, chemotherapy and vector biology and control. A major thrust in the revised strategy of the National Leprosy Eradication Programme brought about an intensified drive for the detection and treatment of leprosy patients, particularly infectious patients under the multi-drug regimen of treatment. his treatment regimen was implemented in two districts, Wardha (14aharashtra) and Purulia (West Bengal), while four more districts were taken up under this scheme with effect from 30 January 1983. SIDA, in association with WHO, provided technical and material support to the programme through consultancies for evaluation, group educatioilal activities, and supplies of drugs and equipment. A WHO consultant reviewed the training programme for medical officers and paramedical personnel in the light of the new leprosy multi-drug regimen control strategy in endemic States. WHO continued its collaborative research with Indian scientists in the chemotherapy, immunology and epidemiology of leprosy. In tuberculosis, support continued to be given to the National Tuberculosis Institute, Bangalore, in its major responsibilities for training and evaluation of the national control programme Training included courses for and reorientation of teachers of medical colleges, Assistance was also provided to the Tuberculosis Research Centre, Madras, for its research studies on drug regimens; for a course on the treatment of tuberculosis under programme conditions with special emphasis on short- course regimens and their applicability in the field. A consultant assisted the Tuberculosis Research Centre in reviewing progress in the laboratory aspects and in the further development of the research programme in the microbiology and imunology of tuberculosis. The follow-up studies on the BCG Vaccine Trial i.n the Chingleput area continued with WHO collaboration. Collaboration also continued to be extended to the National Expanded Programme on Immunization, particularly in the promotion of integrared immunization services Sample surveys were carried out to collect baseline data on poliomyelitis and neonatal tetanus. A measles immunization study was undertaken by a number of medical colleges to determine the need for and the administrative feasibility of introducing measles vaccine in the routine immunization services. A meeting of principal investigators of the measles immunization project was held in April 1983. These activities were supported from WHO funds. The ~affkine Biopharmaceutical Corporation, Bombay, continued to receive assistance in the production of oral polio vaccine and the Central Research Institute, Kasa~li, in neurovirulence testing of the batches produced Since October 1982, the Diarrhoea1 Diseases Control Programme has become a national programme. A Diarrhoea1 Diseases Control Cell was estab- lished at the ~irectorate General of Health Services, with responsibility for programme planning and evaluation, training of manpower, research, logistics and supplies' Guidelines were developed to help the states and. union territories in the implementation of :he Programme. primary health centres, sub-centres and village health guides received oral rehydration salt packets along with other essential drugs. Research on the etiology. pathogenesis and therapy of diarrhoea1 diseases caused by various agents, primarily Escherichia coli, cholera vibrins and rotaviruses, along with - operational research on rehydration therapy as part of prknary health care, was supported by WHO in association with the Indian Council of Medical Research and government laboratories and i~stitutions. The Sexually-transmitted Diseases Control Programme decided to establish four regional teaching-cum-training centres, four regional reference laboratories, and four regional survey-cum-mobile units WHO assisted in training courses, awarded fellowships, and helped with the procurement of laboratory equipment. Collaboration was extended to the National Committee on Zoonoses Control, the National Institute of Corn~nunicable ~iseases, the Indian Veterinary Research Institute, Izatnagar, and other institutions under the Ministries of Health and Agriculture, and to state animal husbandry depart- ments in the conduct of training co.Jrses and the preparation of manuals, and in a project for the control of canine and human rabies in the elh hi Administration area. Progress xas made in the WHD/UNDP-supported inter- country project in human diploid-cell anti-rabies vaccine at the Pasteur Institute. Coonoor. Assistance was given in the establishment of a network of surveil- lance centres, improved diagnostic facilities and research on the etiologi- cal strains ana patnogenesis of liver diseases and cancer. A four-day workshop for state public health officers conducted at the NICD and meetings of the directors of five national surverllance ceritres were also supported The hatlonal Guineaworm Eraa~cation Prograwe continued to receive support in all aspects of planning, researcn and evaluation through inter- national and national consultants aud the holding of meetings of the public health engineers ar'd health administrators concerned from the aeven endemic states. biHO assistance in the form of laboratory material and equipment, grants to conduct special studies and serninars/courses, and consultants to help with courses and research activities, was provided to strengthen biomedical research activities at various instituti.ons under the ICMR. Fellowships were awarded for training in research in latest techniques in the respective specialities. The National Progracme for tne Control of Bli-ndness was intensified under tne 20-?oint Programme- WHO provided assistance in the field of community ophthalmology, development of specialities in advanced diagnostic and treatment technologies management informt ion systems ; and training caurses for ophthalmic assistants at the Rajendra Prasad Centre of O?hthalmi.c Sr:ierlres. All. India Institute of Medical Sciences, New Delhi. Support was given to a rneetiilg of national experts called to review the strategy and. developments in the nati.or.al programme. As part of the Government's activities in cancer research and in the setting up of cobalt therapy unj.ts and cancer detection centres, supplies and equipmen: were provided. Two consultants were assigned to the ICMR to evaluate epidemiological studies on cancer and review the working of cancer registries and early cancer detection centres in the country. A nurse educator consultact assisted the Cancer Department of Safdarjung Hospital, New Delhi, in oncology nursing; and formulated guidelines for the develop- ment of patiect care standards. WHO supported a number of cardiology instit.utions/departnent.s and intensive care units for the management of ischaemic heert diseases with grants, fellowships and equipment. Consultants collaborated in workshops on the epidemiolcgicaL, microbiological and irmnunologiral aspects of the control of rheumati.~ fever and rheumatic heart diseases ar :he Pea:-graduate Institute, Chandigarh, and Lady Hardinge Medical College, New Delhi; also on lipids and lipoproteins and diseases at the. AIIklS, New Delhi. Gtoap educational activities were assisted and a consultant helped the Institute of Genetics, Hyderabad, with its multi- disciplinary research activities in genetics. Another consultant assisted a national workshop at the Elaillana Azad Medical College, New Delhi, on new knowledge on satimic:obial resista~ce and therapy. Support was given to . . four Crainrng courses in the area of health laboratory services. A workshop on abdominal u::rasonFc techniques was conducted. W@ assistance was provided to the central institutions in mental health at Ranchi and Bangalore in various areas of expertise, as also in the development of coinrnunity mental health programmes at state level. The Organlzaticn supported the establishment of a training and demonstration centre for comunlty-oriented disability prevention and rehabilitation at both Safdarjung Hospital, New Delhi, and at the Medical CoLlege in Trivandrum, A short course on orthopaedic ngrsing and rehabili- tation at the Jawaharlal Institute of Poat-graduate Medical Education and Kesesrch, Pondicherry, was also assisted, WHO coliaborated tn planning and coordinating the development of community water supply and sanitation in rural and urban areas. The WHO/ World Bank Cooperative Programme provided inputs for the preparation of sector memoranda as well as :he World Bank Project Handbook. Several courses and study tours were specially designed to meet the needs of senior sanitary engineering/envi:onlnenta? engineering personnel. A consultant assisted the Deparcment of Environment in air pollution control. Another was assigned to Goa to study surface iron-ore mines. Projects in keration - Number (Source of Fuqds) Title - IND CXP 00: (R) Country Health Programming IND RPD 001 (R) Eiomedical Research IND SPM 001 !K) Health Economics and Management IND PHC 001 (R) IND ADR 001 (R) IND ADR 002 (R) IND ATH 001 (R) IND ATH 002 (R) IND ATH 003 (R) IND ATH 004 (R) IND ATH 005 (R) IND MCH 003 (R) IND NUT 005 (R) IND HED 005 (WVF) IND MNH 002 (R) IND PHB 001 (R) IND PHB 003 (R) IND ESD 001 (R) IND ESD 003 (R) IND MPD 001 (R/VF) IND BVM 001 (R/vF/FT) IND BVM 002 (WVF) IND BVM 003 (R) IND BVM 004 (R) IND BVM 005 (R) IND SME 001 (VF) IND EPI 001 (R) IND PBL 001 (R) IND CAN 001 (VF) IND CAN 006 (R) IND CVD 002 (R) Strengthening of Community Health Services Medical Rehabilitation Prevention of isa ability Related to Accidents Appropriate Technology for Health Promotion of Health Laboratory Services and Health Laboratory Technology Laboratory Quality Control and Standardization Virological Techniques Radiation Health Protection Strengthening of Maternal and Child Health Services Nutrition Programmes Development of National Health Education Services Mental Health Quality Control of Pharmaceuticals and ~iologicals Technology in Vaccine Production Epidemiological Surveillance Port Health Malaria Eradication Leprosy Control Tuberculosis Control Sexually-~ransmitted Disease Control Programme ~iarrhoeal Diseases Control Programme National Surveillance Centre for Viral ~epatitis National Smallpox Eradication Programme Expanded Programme on Immunization Prevention of Blindness Cancer Control Pilot Project, Tamil Nadu Cancer Control and Prevention Cardiovascular Disease Control IND ORH 002 (R) IND EHP 001 (R) IND BSM 005 (R) IND RCE 001 (R) IND FSP 002 (R) IND PTR 001 (R) IND EDS 001 (R) IND EDS 002 (R) IND EDS 003 (R) IND HST 001 (R) IND HST 002 (R) Oral Health Assistance to National Environmental Engineering Research Institute, Nagpur Community Water Supply and Sanitation Environmental Pollution Control Food Standards Programme Training of Basic Health Workers Medical Education and Training National Medical Library Nursing Development Strengthening of Health Statistics Services Development of MedicalIHealth Records in Hospitals 6. INDONESIA Indonesia's national health policy, which has the aim of achieving the goal of HFA12000, is rooted in the constitutional provision, the 1960 Health Law, the Guidelines of State Policy formulated by the elected People's Consultative Assembly for five-year development plans since 1969, and the Guidelines for the Prospective Long-term Socio-Economic Development Plan until the Year 2000. To achieve HFA the Ministry of Health has formulated the National Health System (SKN), which includes health policy principle, principles of the Long-term Health Development Plan and the basic structure of the National Health System at all levels through the primary health care approach, Throughout the year, 15 service and broad support programmes for the Long-term Health Development Plan were formulated. The policy principles of the National Health System were incorporated in the broad outline of State Policy for ~epelita IV which was approved by the ~ational Consultative Assembly in March 1983. Based on this, Repelita IV is being formulated with WHO participation. The per capita health expenditure from the Ministry of Health budget increased consistently throughout Repelita 111, from US$ 1.57 in 197911980 to about US$ 3.34 in 1982/1983. The World Bank has estimated that per capita health expenditure from all sources including the private sector amounts to about US$ 13.4. The total Ministry of Health budget for the five-year period of Repelita 111 in 1978 of Rp.667.6 billion has in fact risen to Rp.1.121 trillion, which is almost double the initial allocation. The pioneering exercise initiated last year for closer GOIIWHO collaboration for the further development and accelerated implementation of the national policies, strategies and plans of action for HFA to the mutual benefit of both partners and other Member States continued. A protocol is being finalized in which the innovative mechanisms of WHO technical coopera- tion at the country level are included. This innovative approach was to be implemented starting in 1983. The national managerial process for health development, including the formulation and implementation of long-term, medium-term and annual plans, continued to be strengthened. Mid-term programme reviews for Pelita I11 were completed as an input for ~epelita IV formulation. The committee on manpower development and special working groups continued to fornulate a long-term health manpower plan with a systems approach. The priority being given to the expansion of the health infrastruc- ture in support of the community-based Village Community Health Development (PKMD) Programme continued. The number of health infrastructure facilities has increased from 1 637 health centres in 1970 to 5 153 health centres, 12 386 sub-centres and 1 979 mobile health centres in 1983. One hundred and three health centres in geographically difficult areas are being equipped (53 by the Government and 50 by the World Bank) with hospital beds. The PKMD Programme has expanded to cover selected sub-districts and villages in all 27 provinces of the country. The Government-supported PKMD Programme now covers 1 360 villages in 323 sub-districts, and an additional 400 villages have implemented PKMD programmes through their own initiative and resources. Emphasis continued to be laid on strengthening the family health programme, especially the delivery of a comprehensive family-oriented programme at the health centre level. Training of traditional birth attendants (TBAS), sub-centre midwives, and health centre and NCH staff at kabupaten, provincial and central levels continued. School teachers are being trained as PHC workers and as local coordinators of the PKXD in their 'cmmunities which also include prokesas (village volunteers) and TEAS. Programme activities included: training of teachers and school health coordinators, development of training materials and manuals, case-finding and treatment, revision of the school health curriculum and screening of handicapped children. Training ~f all categcries of health manpower team, especially from health centres, hospitals and provincial levels, through in-country and regional study tours and fellowships continued. The activities for the prevention and control of protein-energy malnutrition, iron-deficiency anaemias, xerophthalmia and goitre continued to expand. A model of a nutritional surveillance system is being implemented in four provinces, A st'idy on breast-feeding patterns was completed. Medical care services continued to be upgraded through the expansion of hospital facilities, increase of manpower and provision of drugs and equipment, Development of a referral system from the PHC level to health centres and sub-centres and to peripheral, provincial and teaching and specialized hospitals was being undertaken. Programmes for the care of the aged, disability prevention and medical rehabilitation with a multi-sectoral approach were initiated and data from the WHO-assisted national health survey on physical, mental and special sense organ disabilities were being analysed, The oral health programe includes dental services to school children, strengthening oral surgery and dental laboratory services in hospitals, preparing dentists, dental nurses and dental technicians, conducting dental surveys, and developing an information base for the planning, management and evaluation of dental health services, The mental health programme was being integrated into health centre services and in general hospitals ~ttention is also being given to the training of different categories of health personnel and to improvement of the management of mental hospitals. The Ministry of Health has, with the coilaboratlon of WHO, formulated a comprehecsive National Drug Policy, Based on the project proposal prepared by a WHO consultant, the Golrernment signed an agreement with the Government of Japan to establish a drug referral quality control laboratory and strengthen several provincial laboratories in order to ensure the quality of drugs marketed in Indonesia. WHO also collaborated in the preparation of a tender document for the establishment of a new goverrment-owned essential drugs formulation plant. Consultants on drug utilization have visited Indonesia to investigate the possibility of undertaking a drug utilization study which is an essential tool for the managerial process. The ASEAN TCDC project on pharmaceuticals is Deing implemented as scheduled. WdO continued co support tne commur~~cacle-disease control programme, ~pidemiological surveillance is being strengthened at all levels, the activities being directed to early reporting of cases, deaths and epidemics, their investigation and the provision of preventive and control measures for all diseases under the Irlternatiooal Health Regulations and those covered by the National Epidemic and Quarantine Act. Training activities for programme expansion were planned and supported by the WHO Regional Training Centre for Diarrlloeal Diseases based in the Directorate General of CDC in Jakarta. Reaearch activities included finalizing protocols for studies in the areas of epidemiology and microbiology. Malaria continued to be a major public health problem, especially in the outer islands. The Fourth Indonesia-Malaysia-singapore Border Malaria Coordination Meeting at Bandung in November 1982 and the country's parti- cipation in the Ninth South-Kest Pscific Malaria Conference at Sydney in February 1983, as well as the group educational activity for health-centre medical officers of West Nusa Tenggara in November i982 were supported by WHO. The US AID-assisted malaria project in Ti.mor progressed satisfactorily. Negotiations oetweerl tile Government and the World aar~k for initiating a health project with a malaria control component in three provinces of Sulawesi were concluded. Besides routine and special anti-nalaria measures, operational field studies on alternative vector control measures, drug trials and studies of the impact of popuiation movements were also under- taken. Monitoring of F.falciparum drug response was extended to hitnerto uncovered areas such as Sulawesi and haluku and expanded in areas already covered, A consultant assFsted in assessing the tuberculosis control programme arla estimated tke prevalence and Incidence of tne disease for the perrod 1960-2000 uriiizing a. mathematical nadel. This review was used for develop- rng a Long-term plan. Case control studies oil the efficacy of BCG were carried out. The programme for the control of sexually-transmitted diseases and yaws was assisted by two consultants. In addition to the monitoring of penicillin-resistant gonococcal infections, reorientation cf the programme to prevent complications in the female popuiation i.s being considered. The expanded programme on imunization was extended to cover 2 345 sub-districts with a population of over 100 million. An overall evaluation of the programme was conducted by a joint Governrcent/WHo/UN~CEF/US AID team. The prograume is being reoriented for closer coordirlation and colla- boration with other health prograumes serving the same target age groups of mothers and cnildren as MCH an6 falnlly planning. A natiorlal advisory board on immunization has been set up by the Minister of Health. DT and TT immuni- zation to cover school children nas been planned. A consultant on cold chain reviewed the performance of cold rooms. The trial of solar-energy refrigerators is contir~uing. Two consultants reviewed national vaccine quality control policies in the framework of WHO/UNDP support. A study protocol was prepared for community part~cipation. Leprosy surveys are being conducted in North Sumatra, West Nusa Tenggara and Souctl-East Sulawesi, and preparations for random surveys in Aceh and South Kalimarltan are tel1,g rcade. The ~ational Leprosy raining Centre in Ujung Padang continued its training and refresher training activities, Implementaticn of the national vector biology and control programme continued. Training or six candidates in M.Sc.(Entomology) continued at the University of Bogor, and 51 assistant entomologists drawn from Java-Bali and the outer islands were given training in vector-borne disease control at group educational activities in order to meet manpower nefds at the central, provincial and field levels. National courses were developed for training in epidemiology with emphasis on field training, in addition to the M.Sc. in epidemiology at the Faculty of Public Health which started in 1983. The Organization provided support to activities in the :ields of cancer, cardiovascular diseases, radislogical health m6 accidents. The Centre for Research in Cancer and Radiology serves as :he Won-Communi.cable Diseases Research Centre. Support was provided for drafting a national plan of action for the prevention of blindness, and a national workshop was ~rganized, A pilot project on primary eye care was started in 6a?i Province. A survey of eye morbidity was conducted in selected provinces and the results are being analyaed. Training activities initiated earlier by WHO continued. Quality assurance and control of pharmaceuticals and 5iologicals continued to be carried out by laboratories of the Directorate General of Food and Drugs, the Biomedical Research Centre, the National Institute of Health Research and Development, as well as Eio-Farma. The Water Supply and Sanitation Decade programme has been placed on a sound footing The foraulation of the IDWSSD plan was supported by WHO. Technical cooperation was also extended for the ccnduct of rural water supply feasibility studies, training of environmental health manpower and manpower planning, end the development of socio-behavioural and health education programmes in relation to community water supply and sanitation. A sector review of rural water supply was carried out. Health professionals were actively involved in the water and sanitation decade programme. Two consultants on food safety assisted the Directorate of Food and Beverages Control and the Directorate of Hygiene and Sanitation in organiz- ing and conducting a training course. In addition to the computer centre in the Bureau of Planning, two subsystems are being supported. A comprehensive nospital reporting and statistics subcentre is in operation and another subsystem for health centre reporting and recording incorporates data on ail tne activities of these centres. A WHO mission reviewed the health manpower deve;o?ment prograrme of the Long-term Health Development Plan and made recommendations for streng- thening it. WHO support was also provided in rne formulation of the environmental health manpower component of the natlortal Winking Water Supply and Sanitation Programme, 1981-1990- The Centre for ducati ion and Training wa; suppcrtzd in its efforts to develop and inpiement various nursing educatior~al programmes.. The four nurse teacher training schools continued the training of PK teachers through regular one-year courses and six-week updating courses in selected clinical nursing specialities- The supplemental and re-training courses for nurseslmidwives who were grc3uates of the old pre-PK programme, the post-PK clinical nursing specialization programme, and the "crash programme to pro- duce assistant paramedics" were continued. A natianal nursing workshop held in 1983 fornulated a definition of the rcles. functions and responsibilities of nursing personnel, a pattern of education and leveis of position for nursing personnel and a proposed structure for the management of nursing development efforts in. the country, Another national workshop approved a new pattern of education for health personnel, including nursing. Based on this, the future nursing educsticn progranl~~~es envisaged are niploma 3 (3 years' education from senisr high s-.hool!. Diploma 4 (one-year clinical nursing specialization) and Sarjane-l. (university degree progranune). WHO technical cooperation continued to support the Faculty of Public Health and the Consortium of Health Sciences A short-term consultant assisted in plann~ng and implementing the S-1 (baccalaureate)-level degree programme in community health nursing while long-term WHO staff supported the implementatio~ of the S-1 and S-2 (master)-level degree programmes in environmental health. The long-term staff prcvided, in addition, technical collaboration in health manpower planning. formulation of a proposal for UND? support in healtb manpower development for the Drinking Water Supply and Sanitation Decade Programme and in the cocduct of a training seminar on investment planning in water supply and sanitation WHO continued to support the National Institute of Health Research and Development and its specialized research centres. The Institute is the focal point for the national scientific information network providing scientific and research informati.on for health development' Assistance was continued for strengthening the development of research manpower, provision of a computer and other equipment and the strengthening of research manage- ment. Technical cooperation was also extended for strengthening the opera- tional capabi.lities of the ~ational Scientific Information Network and the development of more effective collaboration with the universities. WHO'S collaborative programme in Indonesia was being implemented with many projects and inputs firlanced by other united Nations agencies in addition to those funded by bilateral aid. Close contacts are maintained witn these agencies and their miss: 3 ons . Projects in Operation ---- Number (Source of Funds) Title IN0 CAP 001 (R) Country aralth Pr~~gramming IN0 RPD 001 (R; Strengthening of Heaith Research and Development Capabilities IN0 SPM 001 (R) Health Services Development IN0 SPM 003 (DP) Strengthening of Health Services (Province of 1rian Jaya) IN0 PHC 001 (R) IN0 PHC 002 (R) IN0 ATH 001 (R) IN0 HSR 001 (R) IN0 PPF 001 (R) IN0 HED 001 (R) IN0 MNH 001 (R) IN0 ESD 003 (R) IN0 MPD 001 (R) IN0 BVM 001 (R/VF/FT) IN0 BVM 002 (VF) IN0 EPI 001 (R) IN0 ORH 001 (R) IN0 EHP 001 (R) IN0 BSM 004 (VF) IN0 BSM 005 (DP) IN0 BSM 006 (DP) IN0 FSP 001 (R) IN0 MPM 001 (R) IN0 PTR 001 (R) IN0 PTR 002 (R) IN0 PTR 003 (DP) IN0 PTR 004 (DP) IN0 EDS 001 (R) IN0 EDS 002 (R) IN0 HST 001 (R) Health Care Delivery in the Context of primary Health Care Special Collaboration on Health for All Appropriate Technology for Health Strengthening of Health Services Research and Develspment capabilities Maternal and Child Health in the Context of Family Health Health ducat ion Strengthening of Mental Health Services Strengthening of Epidemiological Surveillance and Control Malaria and Vector Biology and Control Programme Bacterial, Viral and Mycotic Diseases Leprosy Control Expanded Programme on Immunization Dental Health Services Development Promotion of Environmental Health Rural Water Supply for Central Java Province Rural Water Supply, Nusa Tenggara Timur (NTT) Rural Water Supply, South Sulawesi Food Safety Health Management Training Post-graduate Medical Education in Public Health Nursing Education and Services Nursing Manpower Development Training in Pre-~nvestment Planning in Community Water Supply Undergraduate Medical Education Training in Hospital Nursing Management Strengthening of Hospital and Health Centre Statis- tics in the Context of National Health Information System Development 7. MALDIVES The national strategies for Health for All, formulated as a part of the country health programming exercise, were reviewed and updated. The country health programme enunciates the Government's policy of equitable distribution of health resources. The national plan of action to implement the strategies has been developed. In an attempt to strengthen the adminis- trative set up for implementing the action plan, the national planning agency was upgraded as the Ministry of Planning and Development; the Ministry of Health has also been strengthened. In order to achieve the full participation and involvement of the population in the implementation of HFA strategies, a public health team led by the Minister of Health visited 10 atolls in the north to conduct meetings of public, atoll administration and health workers. The programme is continuing so as to cover the rest of the country. Allocation for the health budget continued to increase. construction work .on the second Regional Hospital at Seenu Atoll made progress and the foundation of the third Regional ~oapital at Raa Atoll was laid. Construc- tion of a health centre at Maamigili at Ari Atoll was also begun. The existing recording and reporting procedure was studied and a new recording-cum-reporting format for both family health workers and community health workers has been developed. WHO provided technical co-operation to facilitate identification of the support required by the existing national PHC programme at its mid and peripheral levels. A plan of work for the country for 1983 and 1984 was prepared. The specific areas identified for support included (i) training of trainers and middle level PHC managers, (ii) situation analysis and development of simple PHC monitoring and evaluation system, and (iii) development of a centre for PHC services, training and research. A short-term consultant in engineering was provided to the Government Hospital, Male, to repair the X-ray machines of the hospital. Surgical and medical treatment of ENT under the Prevention of Deaf- ness programme was provided at the Government Hospital, Male, through consultancy services. The development of health laboratory services received further impetus. A project document to strengthen laboratory support at all levels of health care delivery has been prepared, which also includes development of a nucleus laboratory. TCDC activities were further promoted by identifying the needs in the three designated areas, namely, (1) diarrhoea1 diseases, (2) health manpower development, and (3) immunization. The national health activities received support and collaboration from UNICEF, UNDP, the International Human Assistance programme, Damien Foundation, etc., in addition to WHO. The Organization, through its regular programmes, continued to provide assistance in such service areas as health manpower training, prevention of blindness, ENT, nursing services, family health and nealth educatio;l, promotion and development of primary neaith care services, EPI, health ir~formation system devel.opment, contiol of malaria and leprosy, training of national staffl and water and sanitation. The family health education prcgramme nas been reviewed and plans are under way to conduct a feasibility study on maternal and infant mortality and morbidity. Tne study will identify specific areas wnich would require improvement of strategies r family nealth. It is planned 20 undertake operational research to assess the extent of community participation in family health service delivery. A longitudinal pi1,ot study to measure the prevalence races of malnutrition was conducted in Seen12 Atoll. Tile data obtained from the study would be utilized for establishing longitudinal surveiliance capabllicy. Following a Workshop on health Educatior. Communications organized in August 1982, a programme on public information and education for health has been developed by UNICEF and WHO. The programme provides for collaboration in developing support conmunicaticn activities, school health education, training for health raucation, preparation of learning resource materl.al and extension of health ed..ication to the islands. Following an assessment of the problem of blindness in Maldives, and at the request of the Government, a contractual services agreement was entered into between tne Director, hrvind Hospi.ta1, Madurai (India) and WHO (as the Executing Agency) in December 1982 for the organization of an eye camp project in a group of atolls. The first eye camp in the history of Maldives was organized in one of the remote atolls in the north at the beginning of 1983, screening a total of L 312 patients including 532 school children. Altogether 245 operations were performed and sight was restored to 171 blind persons. Tnis pro,ect was organized with the support of the International Agency tor the Prevention of Rlindness, mobilized through the Br~tish National Colmnittee for the Prevention of Blindness. It will serve as a orer runner to the establishment of a permanent infrastructure for a programme on prevention of bll.ndness. Training programnes for com~xnity-health workers, nurse-aides and foolumas contifiued, Activities aimed at improving the design of the curri- -- culum for preparing middle-ievel and peripneral workers, the teaching/ learning process of teachers and the co~mnunication skills of student health workers, and establishing a system of monitoring and evaluating the work performance, including contiming education of trained health workers, were undertaken, Malaria control activities, integrated with those of primary healtn care, made notable progress with the intensification of spraying operations, surveillance of malaria cases and treatment of patients, During the period under review, a total population of 12 241 was covered with DDT resldual spraying and 142 350 by anti-nlalarie treatment. The total number of blood slides examined was 65 543 with 31 positives (P.vivax), giving a 0.05 per -- cent slide positivity rate and an API of 0.2 per thousand. Case-finding surveys for leprosy and tuberculosis, case-holding and treatment, and examination of household contacts during supervision trips continued. Cornunity health workers supervised the treatment of patients in the atolls, The multiple-drug therapy for leprosy is being introduced gradually in Kaaf Atoll, Trlese activities were supported by tne Damien Foundation and WHO. In regard to immunization, which made flirther progress, during 1982 (January to Decemberj a total of 3 030 BCG and 9 231 measles vaccinations was given to children of various ages. DPT, polio and DT vaccines were also given Tetanus t8,xoid was given to pregnant women, women of child bearing age and other adclts bring the year an epidemic of diarrhoea occurred, affecting 102 out of 202 islands of the country. The entire government machinery was alerted and kept at the disposal of the Epidemic Control Committee. The intensive government measures, complemented by extensive support from WHO and other agencies of the United Nations, made it possible to contain the scourge. 'WHO assistance was also provided in drawing up a national programme for the control of diarrhoea1 diseases. Chlorination with bleaching powder, strengthened during the diarrhoea epidemic for ensuring safe drinking water to the people, was continued. Activities relating to the construction of Latrines and rain-water tanks through the United Nations Capital Development Fund (UNCDF) and UNICEF aid also made progress Under the UNCDF project construction material for latrines and fibreglass rain-water tanks have so far been supplied for 30 islands, Sixty water tanks and two latrine units were installed in the atolls and two steel tanks for water storage were installed in Male. In addition. 42 UNCDF-supplied fibreglass ram-water tanks were erected in Maie and the atoils, The national plan for IDWSSD was prepared, and a similar scheme for Male was revised and approved. The Government was active in mobilizing external resources for implementing the Decade plan, in order to meet the current resource gap. As a major element of primary health care in Maldives, the Decade plan and its implementation will play an extremely important role in implementing the country's HFA strategy. Projects in Operation Number (Source of Funds) -- ~itle -- MAY SPM 001 (RIVF) Public Health Administration MAV MPD 001 (R) Malaria Control MAV BVM 001 (VF) Leprosy and Tuberculosis Programme bl4V BSM 001 (R) Water Supply and Sanitation MAV PTK 001 (DP) Training of Auxiliary Health Personnel MAV PTR 003 (DP) Fellowships (Medical Education - on-comunicable is ease Prevention and Control) MAV FTR 004 (DP) Health Nanpower Development 8. MONGOLIA A special intersectoral commission at the State Planning Cornittee was set up in May 1982 by a Government Decree. The Health Minister is the Chairman of this commission and its members represent other sectors: ministries of communal economy, water supply, agriculture, and consumer goods production, the State Planning Cormnittee, the Central Statistical Bureau and the Committee of Science and Technology. This commission has been created to deal with the implementation of the National HFA Strategy. It is to review periodically the HFA strategy and plan of action documents and identify the contributions of other sectors in the health development of the cauntry. The Commission has formulated its terms of reference and drafted a plan of work. The Government has drawn up a long-term plan for health services development up to the year 2000. The National HFA Strategy has been prepared on the basis of and in conjunction with this long-term plan. Some progress has been achieved in implementing the National HFA Strategy, For instance, the network of health institutions expanded during the period 1981-1982 by 6 per cent. The number of doctors and paramedical personnel employed in the national health services increased by 6.2 per cent. Financial allocations for health have gone up by 8 per cent. A survey of the national health status has been conducted in urban areas covering a population of about 22 000, The survey also covered a rural population of about 4 000. Altogether about 200 000 out-patient visits are to be studied and 40 000 persons will be subjected to direct medi-cal examination by teams consisting of doctors of twelve different specialities. The data gathered during the national health survey are being pro- cessed by computer. The study will be continued in the rural areas including Ih U1 somon of Huvsgul aimak, During the last two years nine OPD visits on an average have been registered per person per annum. As a result of the efforts undertaken, the child mortality rate has declined by 9 per cent and the infant mortality rate by 1.8 per cent. The Finance and Health Ministries have jointly reviewed the health budget and increased, since January 1982, the budget allocations for the development of out-patient and specialized medical services. The annual health budget has increased by 6-8 per cent. Outlays on health provided by the Government through the Ministry of Public Health and other channels amount to 10 per cent of the State annual budget. The Huvsgul aimak project for the development of a comprehensive and effective model of health care delivery system which would eventually be replicable in other parts of rural Mongolia became operational on 1 January 1983 and a project manager has been appointed. The detailed plan of action for the year 1983 was drawn up and approved by the Health Minister. The main activities of the project include organization of national workshops on various aspects of primary health care and seminars on health and management of primary health care, improvement of community involvement and intersectoral collaboration, testing of different mobile forms of health services in remote areas, training of staff in planning, management, evalua- tion and health information system, and implementation of a continuous training prograrmne for conrmunity activities. A set of standard designs of various health facilities was prepared and submitted to the Government, and national architects have been trained to enable them to design hospital buildings, out-patient units, SANEPID stations, etc. A WHO consultant on computer-based health information systems visited the country in April 1983 and made recommendations for the development of computer-based HIS. A national workshop in planning and management was conducted in June 1982 in Ulan Bator for 18 senior public health administrators. Its overall objective was to familiarize the participants with modern methods of health planning and management and enable them to use the knowledge and skills to improve the planning process and management procedures. A national seminar on mental health problems was held in October 1982. A consultant visiting Mongolia at the same time participated in the training activities and submitted recommendations on the development of mental health services. Recent developments in the field of maternal. and child health were the procurement of additional equipment, assessment of the utilization of the equipment and the performance of health staff, manpower training, and the organization of a scientific-cum-practical conference in MCH. Altogether 21 national seminars were held on various MCH problems for doctors and paramedical staff, for a total of 424 participants. Four WHO consultants and two engineers from Denmark visited the country during the period to advise on various aspects of MCH services, Research studies on maternal mortality and morbidity, infant nutrition problems, the female fertility pattern and the organization of MCH services in rural areas were conducted. The project document of the BIOMED project was given a new shape in July 1982 and the Russian and Mongolian versions prepared and submitted to the Council of Ministers. The project document was approved by the UNDP Governing Council in February 1983. A UNIDO mission visited Mongolia in January 1983 and held discussions with the health authorities in regard to the BIOMED project . Training courses on methods of diagnosis, treatment and prevention of meningitis were held, attended by 22 specialists. A mass immunization campaign with the "triple" vaccine has resulted in the eradication of diphtheria. During the year the general communicable-disease morbidity rate declined by 9 per cent (measles by 69.8 per cent, viral hepatitis by 16.9 per cent, typhoid by 6.3 per cent) as compared to the corresponding period of the preceding year. In support of the national cancer control programme, the recently procured gamacamera was installed and put into operation in the "Isotop" laboratory at the First Ulan Bator City Clinical Hospital. A total of 729 patiants has already been subjected to gamacamera screening. Under the environment health programme, a strategy of environmental protection up to the year 2000 has been drafted and preparatory work for identifying activities to be undertaken to achieve the IDWSSD goal started. A system of sanitary control of Selenge river basin is coning into operation. Reconstrurtion and n~odernization of water supply and sewage disposal systems are under way in Ularl Bator city, The project document on the co~struction of a district water reservoir in Ulan Bator was drawn up. Under the health manpowor development project the first draft of a new project document on the development of the national library service was completed, Advanced traini~g cournes in 14 specialities were held for 160 physicians and 1092 paramedical personnel. A natioilal seminar on post- graduate training was held with 50 medical teachers in attendance. A new comprehensive long-term national programme on the prevention and control of cardiovasc~~lar ise eases among the rural population for the period up to the year 2000 was formulated, A mass screenin.g campaign was undertaken in one aimak rural area and in Ulan Bator city. Altogether a population of 9 000 - 7 000 rural and 2 000 urban - was examined by teams of doctors belonging to 12 different specialities in order to find out CVD cases and identify risk factors. Projects in Operation --- Nu~nSer (Source of ~unds) p- Title - MOG CHP 001 (R) Country Health Prograffiming HOG SPM 001 dH.) Management of Health Services MOG PHC 001 (K) Development of Infrastructure for Primary Health Care MOG MCH 002 <R) Maternal and Child Health MOG MCH 003 (FP) Epidemiological Studies of Population Growth and Strengthening of MCH Services MOG MNH 002 (R) Mental Health Services MOG PHB 001 (R) Pharmaceuticals and Biologicals - Control and Production MOG ESD 002 (R) Communicable Diseases - Prevention and Control MOG OND OOi (R) Non-comunicable Diseases - Prevention and Control MOG EHP 001 (R) Strengthening of Environmental Health Services MOG PTR 001 (R) Health Manpower Development 9. NEPAI. His Majesty's Government of Nepal is implementing the Sixth Plan with the three main objectives of (i) increasing production at a faster rate; (ii) increasing employment opportunities; and (iii) meeting the basic minimum needs of the people. To achieve the objectives of the Sixth Plan and the goal of Health for All by the Year 2000, Nepal needs sustained and sizeable external assistance, which it is seeking through local-level consultation meetings of donor representatives and the Nepal Aid Group, Despite the financial constraints the Government is facing, the budget allocation for health for Fiscal Year 1982183 was increased by 43.5 per cent over that of L981182. The HRG/LT(LI Review in March 1982 reveal-ed that roughly 90 per cent of the national health budget supports primary health care, clearly indicating the Government's firm commitment to PHC and YFA!200O. Activities under technical cooperation among developing countries (TCDC) received further impetus as a result of a resolution adopted by the Second Meeting of the ~inisters of Health of the countries of the WHO South- East Asia Region. WHO has assisted the Governinrnt in the preparation of TCDC nerds in the three areas identified by the Health Ministers Meeting, viz., health manpower training, iimnunization, and diarrhoea1 diseases control. In pursuance of the resolution of the Health Ministers Meeting, a health delegation from Tnailand, headed by the Deputy Prime ~inister, visited Neual in March 1983. A Memorandum of Understanding was signed by the two countries which identified the areas of mutual collaboration in the framework of primary health care. The areas identified, apart from the three defined by the Health Ministers, were FPIMCH, traditional medicine, health laboratory services, and non-communicable diseases control. Out of the areas so far identified for cooperation among the South Asian nations, Repal coordinates the Working Group on Health and Population Activities. The first meeting of this Working Group was held in Kathmandu in June 1982, and the Second Meeting in January 1983. Research activities have been strengthened considerably since the establishment of the Nepal Medical Research Conunittee in May 1982. WHO assisted in the conduct of the First National Workshop on Research Methods in Health Sciences. The Department of Health Services and the Institute of Medicine are jointly undertaking a WHO-assisted research study on the performance of health auxiliaries at the peripheral level. The Organization continued to support the Government in further strengthening the planning and progrannning capabilities of the Health Planning Unit of the Ministry of Fealth; improving the Health Infonation System and the Health Data Bank; developing procedures and methodologies for district-level health planning, and improving the planning of health manpower, including nursing personnel. Efforts are being made by the Government to consolidate the integra- tion of basic health services in the six operational distric:~ under the Integrated Community Health Services Development Froject and to expand the activities to other districts of the country. The Community Health Leaders (CHL) Programme nade satisfactory progress. An evaluation workshop on this programme was held in July 1982, the major outputs of the workshop being a revised implementation strategy and proposed programme changes in the light of the first year's experience. The Government has also been looking into the possibility of deliver- ing the PHC package through other channels. One such approach was to train the panchayat-based health workers of the FP/MCH project to become multipurpose workers and, simultaneously, to introduce the CHL programme in the FP/MCH districts, WHO is supporting this alternative approach. Nepal has been selected for UNICEF/WHO JCHP/PHC Support so as to receive further assistance in the implementation of primary health care. A joint UNICEF and WHO team visited Nepal in November 1982 and discussed with senior government officials and UNICEF and WHO staff the concepts of JCHP/ PHC Support and the steps to be taken to translate these concepts into action plans. Based on the suggestions made by the team, the district plans for JCHP/PHC Support in four selected districts are being developed. WHO'S coll.aborative efforts in the development of health laboratory services in the country have been progressing satisfactorily. A WHO/DANIDA workshop on quality control was held in September/October 1982, and another workshop on bacteriology in December 1982. The plan of operation for the WHO/DCA (Swiss Government) Health Laboratory Service Project was prepared and approved by the Government. The Organization continued its technical support to the development of MCH services, including family planning, in both integrated and non- integrated districts. A national conference on family planning was held in August 1982. The National Commission on Population meeting in January 1983 formulated population policies and programmes, which will form the basis for future population activities in Nepal. In the promotion of nutrition, WHO, in collaboration with UNICEF, assisted in the nutrition training of MCH workers and district-level health personnel; carrying out a nutritional survey of a resettlement area; deve- loping the multisectoral approach in some selected districts; monitoring the growth of children; preparing the protocol for breast feeding, and developing legislation on the marketing of breast-milk substitutes. A proposal for a joint UNICEF~WHO nutrition support programme to be funded by the Government of Italy was prepared. This proposal was approved by a WHO/UNICEF Steering Committee in April 1983. The goitre control programme also progressed satisfactorily. The Government of India is supporting the programme with iodized salt. In collaboration with UNICEF, WHO has provided technical support to the iodized oil injection programme as part of overall national goitre control activities. So far, 15 districts have been covered with the programme of iodized oil injection. WHO provided assistance in the conduct of training programmes in health education for different categories of health personnel and primary school education supervisors, and in the production of simple educational materials. A national workshop on 'Behavioural Science Research on Health Problems' was held in January 1983. The system of epidemiological surveillance of cammunicable diseases has been intensified, especially in 23 districts. The case-finding of viral encephalitis was completed in October 1982, and that of brucellosis has started in Xathmandu Valley and will be gradually expanded to other areas WHO is also collaborating in the development of the lay reporting system. The report on 'Status of ~abies' was published, and WHO is assisting in the potency testing of the anti-rabies vaccine produced locally. In the field of diarrhoea1 diseases control WHO has collaborated in the formulation of a national plan of action and the conduct of two national training workshops. It is also assisting two new research projects, viz,, Impact of Oral Rehydration Therapy among Rural Nepalese Children, and Acceptability of Sanitary Intervention among Rural Population with reference to Diarrhoea1 is ease Control. The malaria control programe recorded good progress, WHO providing assistance in all aspects of implementation, viz., spraying operations, epidemiological surveillance, case finding and treatment, entomological studies, training and field research, community participation and health education. The Twelfth Nepal-India Border Malaria Conference was held in Kathmandu in September 1982, and the annual internal and external assess- ments of the malaria control programme were also conducted as planned, with the collaboration of WHO, Concerted efforts are being made for leprosy control by various approaches' It is planned to introduce the multiple-drug therapy regimen in phases throughout the country, Immuno-epidemiological studies are being undertaken at the Mycobacterial Research Laboratory of Anandban Leprosy Mission Hospital. With a view to enhancing community participation in leprosy control, a seminar on the role of non-governmental organizations in leprosy control was conducted in August 1982. In regard to tuberculosis control, WHO is assisting in manpower development, A group training course in tuberculosis control for auxiliary health workers was conducted in Kathmandu in October 1982, Another training course for health workers and members of voluntary social organizations from Nuwakot and Sindupulchowk districts was held in Nuwakot in May 1983. The Expanded Immunization Project (EIP) progressed satisfactorily, the total number of districts covered by the national EPI now being 42 (28 districts by the EIP and 14 districts by the Integrated community Health Services Development Project), The approach adopted is to cover new districts each year by the EIP and to hand them over to the ICHSDP for maintenance at a later date, The Prevention and Control of Blindness Project carried out a nation- wide survey of blindness and blinding conditions. Based on the findings of the survey and the experience gained since then, the project document was rewritten and signed by the Government and WHO in January 1983. In the field of water supply and sanitation, a National Group has been established to coordinate the activities among sector agencies and inputs by external donors. WHO is collaborating closely with the ~ational Group and the sector agencies and is also assisting the Government in preparatory activities for the 'Country of Concentration initiativeB. Proposals for some 60 to 80 projects to be implemented by the Department of Water Supply and Sewerage are under preparation, as are 28 package project proposals for the Ministry of Panchayat and Local Development. The Organiza- tion is also executing a UNDP-funded project, 'Training of Manpower for the Drinking Water and Sanitation Programne (Phase I)', the main thrust of which is to strengthen the Institute of Engineering in order to train the type of manpower needed for the Programme within the country. Apart from WHO and UNDP, the World Bank, UNICEF and bilateral agencies are also assisting the programe; A two-week training programme on environmental sanitation was conducred for trainees from non-governmental organizations in October 1982. WHO has assisted in the conduct of seven teacher training workshops. So far, fifteen two-week workshops have been held involving more than 200 faculty members of the Institute of ~edicine- The organization has also collaborated in the preparation of the project proposal for health learning materials and in the conduct of the second Health Manpower Planning Exercise, which took place in ~uJ.,~j~u~ust 1982. In the field of nursing education, the community health nursing programme, assisted by WHO, is progressing satisfs~toril~. A survey of learning needs for nursing faculties was carried out and the auxiliary nurse-midwife (ANM) curriculum was revised,. The curriruliim for medical and surgical nursing was finalized, and the programme is to commence in the next Fiscal Year. WHO is executing a UNFPA-funded project, providing technical support in staff training and curriculum development, production of textbooks and teaching materials, research in family health, and the establishment of a health post for services and student training (as part of the Institute of Medicine). A significant development during the period was the Government's decision to award the degree of MBBS to the graduates of the Community Physician Course, who are expected to graduate within the next six months. Projects in Operation Y Number (Source of ~unds) ~itle - NEP CHP 001 !R) Country Health Programming NEP RPD 001 (R) Research Promotion and Development NEP SPM 001 IR) ~ealth Planning and Programming NEP SPM 003 (FP) Strengthening of Integrated Community Health Project in the Ministry of Health at the Central Lere 1 NEP PHC 001 jR) Community Health Services and Primary Health Care ~evelopment NEP PHC 002 (DP) Primary Health Support Services Programme NEP ATH 001 (R) Deveiopment of Laboratory Technology Services NEP MCH 003 (R) Development of Maternal and Child Health Services NEP MCH 004 (FP) Assistance to FPiMCH Project NEP NUT 003 (R/VF) ~utrition NEP HED 001 (R) Health Education NEP PHB 001 (DP) Strengthening of Royal Drugs Research Laboratory NEP ESD 001 (K/VF) Development of Epidemiological Surveillance NEP MPD 001 (K/VF) Malaria Control NEP BVM 001 (K/VF/FT) Leprosy Control NEP BVM 002 (R) ~uberculosis Control NEP EPI 001 (R/VF) Expanded Programme on Immunization NEP PBL 001 (RIVF) Prevention of Blindness NEP BSM 001 (R) community Water Supply arld sanitation NEP BSM 002 (DP) raining of Manpower for the Drinking Water and Sanitation Programe NEP PTR 001 (R) raining of Health Manpower NEP PTR 003 (FP) strengthening of Health Manpower Training of Integrated Community Health Project NEP PTR 004 (FP) Family Health and Family planning Teaching, Services and Research 10. SRI LANKA The Government of Sri Lanka has formulated the strategies and plans of action for Health for All by the Year 2000. Since the implementation of chese strategies and plans of action entailed radical changes both in attitudes and in the functioning of the health delivery system, the Government made considerable efforts to make the philosophy of primary healuh care fully ~~nderstood, A Seminar of Parliamentarians was organized in collaboration with UNICEF and WHO to bring about relevant understanding among politicians. Primary health care was a major subject of discussion at the annual meetings of professional bodies. The Ministry of Health also conducted orientation courses for health administrators and health workers and mounted educational programmes for the people through mass media. All these efforts of the Government have resulted in increasing support from the public, politicians and professional bodies to the health strategies adopted far ths realization of the HFA goal. The recognition that implementation of these strategies will require shifting of resources as well as mobilization of additional resources prompted the Government to undertake the study of the financing of health services in collaboration with WHO. The study was completed in July 1982 and has since been discussed at the highest level. As a result, primary health care featured prominently in the ~overnment's Public Investment Programme, 1982-1986, and led to an almost doubling of the Government's budge: for health for 1983. The management of larger structural changes to secure inter-sectoral cooperation and people's involvement made further progress during the year. The Ministry of Health, in collaboration with WHO, is engaged in identifying and analysing the operational management-cum-service delivery problems and constraints in txo districts. Based on this exercise, a seminar is planned in order to design guidelines for the nation-wide implementation of decentralized administration. The National Health Council, the National Health Development Committee and some of its standing committees actively participated in the formulation and implementation of primary health care programmes. Implementation of the improved health care delivery system commenced during the year and was progressing according to schedule. All the allo- cations for the establishment of Gramodaya health centres in the 33 AGA (Assistant Government Agent) divisions were identified and steps to procure land and design the buildings have been completed; construction has begun in a few places. WHO closely supported the Planning Unit in the implementa- tion of the improved primary health care delivery system, In addition to the development of physical facilities equal attention has been given to the preparation of the health workers who are to deliver the primary health care programme to the people. The training of family health workers and reorientation of PHC workers progressed satisfactorily. The National Institute of Health Sciences, Kalutara, has played a significant role in the preparation of primary health care workers. Other health manpower development activities also progressed satisfactcrily. Efforts were made to set up small units for the formulation of essential drugs for PHC and the production of sterile infusions and oralites, Funds for the production of sterile infusions are being provided by the Government of Switzerland through UNIDO and UNICEF is financing the production of oralites, WHO support was provided for the development of technical specification of equipment for both infusion plant and oralites. Technical support was also given for the training of key personnel required for the tableting and capsulating plant, and for the three-year diploma course in pharmacy, The infrastructure for the implementation of the family health programme and its management was considerably strengthened through the collaborative efforts of WHO; funds for these activities mainly came from UNFPA. A study to evaluate the perfolmance of family health workers was designed, The training of ayurvedic physicians in the promotion and delivery of family planning services, designed initially for a duration of one year, was completed and 101 ayurvedic practitioners were trained, The expanded programme on immunization continued to operate most satisfactorily during the year, the coverage for full immunization being around 56 to 58 per cent, The incidence as well as mortality due to immuni- zable diseases has dropped significantly. The cold chain established with UNICEF assistance operated satisfactorily.. After initial delays, the diarrhoea1 diseases control programme was finally launched in 1982, The Epidemiological Surveillance Unit has served as the centre for the Expanded Programme on Immunization and the Diarrhoea1 is eases Programme and, in collaboration with WHO, is collecting epidemiological information on measles so as to decide if measles vaccination should be included in EPI. The National Malaria Control Programme continued to operate according to plan. The incidence of malaria cases during 1982 was 38 566, though falciparum malaria increased slightly. The malaria vector remained sensitive to malathion, Owing to improved surveillance the outbreaks of falciparum malaria were controlled expeditiously, Some of the activities of malaria control such as passive case-detection and treatment of malaria cases have been merged into the general health services. The accelerated rabies control programme has had some success in reducing the number of human cases of rabies. A new Rabies Control Act, developed in collaboration with WHO, has been passed by the Cabinet, A multidisciplinary National Coordinating Committee for the Preven- tion of Blindness with responsibility for the formulation of a national plan for the prevention of blindness and its monitoring and evaluation was appointed. WHO assistance was provided for a review of eye care activitieb as well as an assessment of the present needs for ophthalmic pathology and research, A regional centre for the training of ophthalmic auxiliaries at the Eye Hospital in Colombo has started functioning and the training of the first group of 10 trainees commenced in April 1983, Phases 1 and 2 of the study for testing the feasibility and effi- ciency of PHC workers to detect early lesions of oral cancer came to an end. Further areas in Jaffna and Galle were selected to test the replicahility of the results of phases 1 and 2 carried out in Kandy Apart from this study, WHO extended technical support to the national efforts in developing manpower for strengthening the treatment of cancer and the promotion of the anti-smoking campaign. A community-oriented national programme utilizing PHC workers for the control of cardiovascular diseases was developed, and activities started in Kalutara with a survey of one thousand households covering a population of about fifty thousand persons. Fifteen public health midwives have been trained for this purpose, The oral health programne was developed at a national seminar in collaboration with WHO, The training of PHC workers also commenced, based on the recommendations of this seminar. The oral health programme completed preparations for the conduct of an island-wide epidemiological survey of dental health status, A core group on child mental health was established by the ~ational Health Development Committee to coordinate and review the recommendations of the WHO-assisted Workshop on Child Mental Health and to monitor the progress of the programme. In collaboration with WHO and UNICEF the national core team developed indicators for child mental health which are being field-tested in Kurunegala and Kotte areas. A start was made for the rehabi- litation of chronic mental patients with the help of social workers, WHO assisting with the training of social workers as well as the rehabilitation of chronic patients in the community, The Food and Nutrition Policy Planning ~ivision undertook nutrition surveillance work, promotion of breast-feeding and low-cost weaning foods, and also evaluated the various food supplement programmes such as the food stamps scheme and the Triposha and fish biscuit programmes. Action was also taken for producing low-cost weaning foods, promoting breast-feeding and regulating the use of breast-milk substitutes. The traditional systems of medicine received further attention during the year. The committee on integration of traditional systems of medicine and their role in the primary health care programme completed its delibera- tions. Priority projects were prepared with WHO ccllaboration which have been accepted for funding in UNDP'S third country programme covering the period 1984186. WHO also collaborated with the national authorities in reviewing the training of undergraduate ayurvedic physicians. The National Decade Programme for water supply and sanitation is now reoriented with greater emphasis on strengthening institutional and human resource development and coverage with affordable service levels. A detailed sector manpower study and training plan that was prepared in 1981 is now being implemented in stages. Water supply to rural areas is being provided through a rapidly expanding ground-water development programme; related hydrogeological investigations are being carried out. A detailed work study was conducted to identify the methods of work and procedures, infrastruc- ture, staffing and management of operation and maintenance. The training of operational and maintenance staff was accorded high priority. WHO is providing assistance to training programmes in public health engineering at the Universities of Peradeniya and Moratuwa. The research sub-committee that has been set up under the National Health Development Committee for the coordination of all health-related research activities in the country as well as dissemination of research results, has developed its operational strategies and started functioning as the central coordinating body. A multidisciplinary programme of coordi- nated research, research development and research training in health sciences and services is being implemented with WHO support. The programme aims at formulating research projects addressed to the priorities of HFA 2000 and developing trained research manpower for the country's self- reliance in this field. A number of workshops on research methods were organized. The base for operational research has been broadened to include field organizations, universities, voluntary organizations, etc, In the field of operational research, studies directed towards the problem relating to MCH figured significantly during the year. Promotional activities for tropical disease research and research in human reproduction have been further intensified. With WHO support the University of Peradeniya organized an International Meeting on the Impact of Population Movement on Tropical Diseases which generated interest among scientists for research into the health problems of population movement, particularly in the context of the new human settlement in the Mahaweli Development Project areas. The design for improving existing health information systems was completed and the trial run of the improved design commenced in April 1983 in Kegalle with a control in the Kalutara area. Both WHO and UNICEF have ccllaborated closely with the national authorities in the trial run of the information system, In an effort to stimulate non-governmental organizations to take a more active part in national health development efforts, an inventory of NGOs, including potential resources and their areas of interest, was compiled as an initial step in collaboration with the MARGA ~nstitute. Projects in o eration -2- Number (Source of Funds) Title -- SRL CHP 001 (R) Country ~ealth programing SRL RPD 001 (R) Research Promotion and Development SRL PPS 001 (R) Development of Primary Health Care SRL SPM 001 (R) planning, Management and Information System Development SRL WKH 001 (VF) Occupational Health and Industrial Hygiene SRL ATH 001 (R) Strengthening of Laboratory Services SRL MCH 001 f,R/FP) Family Health SRL MCH 002 (FP) Strengthening of Hospital-based Family Planning services SRL MCH 003 (FP) Family Health Teaching, Service and Research in ~edical School, Peradeniya SRL MCH 004 (FP) Family Health ~eaching, Service and Research in Medical School, Galle SRL MCH 005 (FP) ~amily Health Teaching, Service and Research in Medical School, Colombo SRL MCH 007 (FP) strengthening of Family Health Services SRL MCH 008 (FP) SRL HED 001 (R) SRL HED 002 (FP) SRL MNH 001 (R) SRL PHB 003 (R) SRL PPC 001 (R) SRL MPD 001 (R) SRL BVM 001 (R) SRL BVM 003 (R) SRL EPI 001 (R) SRL PBL 001 (R) SRL VBC 002 (DP) SRL PPN 001 (R) SRL ORH 001 (R) SRL EHP 001 (R) SRL EW 002 (DP) SRL BSM 002 (RIFT) SRL FSP 001 (R) SRL PTR 001 (R) SRL PTR 002 (R) SRL PTR 003 (R) SRL PTR 004 (R/DP/UF/FT) SRL PTR 006 (FP) SRL PTR 008 (FP) SRL EDS 001 (R) Strengthening of the Research and Evaluation Unit of the Family Health Bureau Health Education Family Health Education Mental Health Drug policies and Management Surveillance and Control of Communicable Diseases Malaria Control Veterinary Public Health Diarrhoea1 Diseases Control and Prevention Programme Expanded Programme on Immunization Prevention of Blindness Vector Control Phase I1 Prevention and Control of Nonconnnunicable Diseases Community Oral Health Training in Public Health ~ngineering Institutional Support to the National Water Supply and Drainage Board Community Water Supply and Sanitation Food Hygiene Medical Education Nursing Education Post-graduate Medical Education Development of National Institute of Health Sciences Training of public Health Midwives Training of Ayurvedic Practitioners in Family Planning Services Delivery (Pilot Study) Educational Technology SRL EDS 002 (FP) Strengthening of ~ursing1Midwifery Education The rratinnal policy for HFA by the year 2000 with PHC as the key approach is receiving ,clear arhd steady support fron the Government. the National Economic and Social Development Uoar.3, the. ~niversities and other related sectors. Primary 'ealth care is being fully launched i.n the 38 prcvinces of the National Rural Poverty Area 3eve:opment Prograr.une covering around 20 000 villages. Efforts tcviards decentra1izsti;n of the system of plancing and management at the provincial and district, Levels are being actively uursued.. In the field of Government./l?i3 c:::laboration, The Prcgram.e ~udgeti.ng Lxercise has corrtirlued to develop, wit!] the R'rG/T,Pi.O Coordinating Committee now entirely maraging the ccllabarat ive programme and ljuiget activi.ties at the central level. A pilot project to stxdy fi.na?ci.al procedures at all levels was initiated. The WH(? Programne Budget f~r 3984-1985 wan prepared and approved by the RTG/WHO Coardinating Comictee, in acccrdance with the thrusts in the WHO Seventh General Progr-arpme sf Work. A project was formulated in order to extend coverage to achieve effective PHC activities. to give, pro$~essi.vely, maximcm responsibility to :he community in the planning and execution of district and village projects related to the. elements of PHC and basic healrh activities consonant. with national policies, strategies and plans of action for Health for All. Exten- sive field work in the villages, incl~lding the dever.opnent of models far village health pr~agrammes, was carried out wit11 Eul? community i.nvolvement. A three day first national conference attended by top level administrators and technical officers from various ministries held in February 1983 considered s proposal for utilizing basic ninimmnln! needs for long-term social development planning. A preliminary study on the feasibility of utilizing basic. minimum needs at village level was conducted. The ASEAN raining Centre for Primary Health Care Development, a joint venture of the Ministry of Pub1j.c Beaith and Mahidol university, has, with support from Japan, been carrying out: programe development and national consultative and educational activities sinte October 1987. A con- sxltation with ASEAN countries 9n expectations for the ATC/PSC programme of research and training for the next three years was held. WHO collaboration in health development activities has been focused on identifying new avenues for technical cooperation through the Programme Budgeting Exercise- The Social Development Project ~ontinued to play a decisive role in the development of a common policy and framework for intersectoral action on basic minimum needs with primery health care as an inte~ral part cf the ~ational Poverty Area Development Programe. The concept af using villages as training and development centres as proposed in the WHO Pro3rame Budget for 1984-1985 has been accepted hy t.he Ninistries of ~g+i.culture and Cooperatives, Education. Interior and Public Health, The development of the health infrasfructrire is being vigorously pursued. There is: however. a recognition that the entire infrastructure needs revision in order to increase its effici.ency and: most importantly, to prepare !he system in regard :o the technical, managerial and adminis- trarive aspects for the new functions required :D support pH': village development, ~articularly the self-managed PHC scheme. The need for adequate technical and managerial strengthening of the health infrastructure is recognized. The quality of primary health care workers needs to be improved and the need for periodic retraining is felt, Supervision is another impor- tant area which requires a very specific effort for further improvement. These problems are receiving the attention of the ~ational Coordinating Committee on Primary Health Care. The development of the health infrastructure in the provinces was also vigorously pursued during the year to facilitate the implementation of PHC activities, Training of village health comunicators was undertaken in six provinces. Refresher courses fcr tambon trainers as well as a workshop on PHC were conducted. In the area of TCDC amongst Member States, a Memorandum of Under- standing was signed between His Majesty's Government of Nepal and the Royal Thai Government. WHO suppc.rtt?d this effort. A national evaluation of EPI, primary health care and maternal and child health was conducted. An assessment of the diarrhoea1 diseases control programme was also carried out. Malaria control measures were continued, but technical problems such as drug resistance and vector exophily persisted. While the mortality trend showed a decline, the case incidence registered a small increase. A large-scale field trial of mefloquine to combat the multi-drug resistant P.falciparum has been initiated. Efforts were being made to involve the community in malaria control activities. The field epidemiology training programme in Thailand has continued to provide training in the field application of epidemiological methods to national professionals. Training courses for epidemiological reporters and pre-service training courses for epidemiological workers have been con- ducted. Also workshops on epidemiological surveillance for epidemiological workers have been organized,, The lay reporting system has been instituted and evaluated in Chonburi Province. The field epidemiology training programme, which is to be incorporated in the health development plan, has resulted in larger and more effective services. Disease surveillance at the local and national level is being improved and it is anticipated that within two years all surveillance data will be stored and analysed by computer. Computerization is also being introduced for the entire health information system on the one hand, and nutrition and MCH monitoring and evaluation on the other. A computer master plan within the Ministry of Public Health has been drawn up. The National Cancer Institute is working on the epidemiological surveillance of cancer of the cervix in Nakorn Nayok Province. several institutions in and outside Bangkok are involved in the project on prevention and control of cardiovascular diseases, rheumatic heart diseases and rheumatic fever. Information collection has started. It is proposed to start a study on hypertension. Two national staff were sent on WHO fellowships to receive training in the prevention and control of cardiovascular diseases. 'Ihe WHO Collaborating Centre for Occupational Health at the Department of Occupational Health has initiated a programme of primary health care to under-served working populations in small scale industries and agriculture. Feasibility studies on training primary health workers for the delivery of health services in general industry, mining and agriculture have been conducted. Also a study of working conditions, occupational health hazards and the health status of women workers in 'hailand has been carried out. A workshop on the development of a training curriculum in occupational health and safety and a manual of operation for PHC workers in the work place was held in Chiang Mai in February 1983 which also reviewed the experie~ce obtained in PHC trials for working populations in ihailand. In the field of oral health, the study of the relationship of dental caries, dental fluorosis, and level of fluoride content in drinking water, in Doi Saket district, Chiang Mai, continued. A survey on needs and demands for oral health services in adults was also carried out in Chiang Mai. In addition, a workshop for regional chief dental officers and the staff of regional dental health centres was conducted. A comprehensive communit y-oriented programme on the prevention of blindness is being implemented and the manpower needed is being provided through training at provincial hospitals. A national committee has been appointed to coordinate the activities. Steps have been initiated for setting up an Institute of Public Health Ophthalmology in Korat, where access to field work in a rural setting is readily available. WHO colla- boration has included formulation of a plan of action for this institute and a scheme for low-cost spectacles as well as provision of ophthalmic pathology/microbiology services and manpower training. In the field of environmental health, special studies related to the development of the Decade Plan are progressing. The draft report on insti- tutional aspects and management infomation system. will be completed soon. The National Survey on Excreta Disposal and the Law Cost Sanitation Study, including preparation of a master plan for Cholburi as a pilot study, have been completed. For the Decade Plan the National Economic and Social Development Board has prepared a contract document with the Asian Institute of Technology. In regard to drug dependence, an extensive evaluation of the UNFDAC- financed project was carried out and its report is awaited. As regards health manpower development, the Ministry of Public Health and the Universities have agreed to increase the production of doctors. The clinical training of doctors will be carried out in provincial and district hospitals specially equipped for teaching medical students. Extensive coordination between the Ministry of Public Health and the Universities facilitates systematic review of the production and training of all the required categories of health personnel. A procedure to improve community health through more systematic data collection in MCH by staff at the tambon level has been instituted. The National Research Council has drawn up a national policy and plan for research, including research in the field of health. There has been, since the beginning of the Programme of Human Reproduction Research, active collaboration in institution-strengthening on research, reflecting the high priority given by the Government to research in family planning. The two Collaborating Centres for Research in Bangkok, at Chulalongkorn and Mahidol Universities, worked closely with national authorities on questions of national relevance and carried out clinical and epidemiological studies on the short- and long-term safety of current methods of fertility regulation. Other studies being supported include those on pharmacokinetic and metabolic aspects of new methods of contraception. Primate facilities were also strengthened in the Department of Biology of Chulalongkorn University. Two institutions in Chiang Mai collaborated on metabolic and epidemiclogical studies related to long-term sequelae of steroidal contraceptives. Some studies related to male fertility, sexually transmitted diseases and infertility are also being supported. The UNDP/World Bank/Special Programme for Research and Training in Tropical Diseases (TDR) continued to support research projects in the fields of malaria, schistosomiasis, filariasis, leprosy, vector ecology and control and social and economic research, besides training and the streng- thening of institutions to increase the country's research capability. Projects in Operation - Number (Source of Funds) - Title THA CHP 001 (WVF) Country Health Programming THA RPD 001 (FT) Research Studies on Mansonia Mosquitoes THA RPD 002 (R) Promotion of Research TI& SF.X 901 (R) Planning, Management and Information Systems Development THA PHC 001 (R/VF/FT) Development of Primary Health Care TPA WKH 001 (I?) Development of Occupational Health THA ADR 001 (R) Development of Care of the Aged, Disability Prevention and Rehabilitation THA ATH 001 (X) Development of Appropriate Technology for Health (including Health Laboratories) THA MCH 003 (P) Fellowships in Family Planning and Related Fields THA MCH 004 (FP) Expansion of Family Planning Services and Support of Infrastructure of the National Family Planning Programme THA MCH 007 (R) Development of Maternal and Child Health ?HA ElCH 008 (FF) Support to NFPP for Improved Programme Management and Expansion of Family Planning and Contraceptive Delivery Services THA NUT 004 (R) Integration of Nutrition into Primary Health Care THA HED 001 (R) THA MNH 001 (R) THA DPM 001 (R) THA PHB 001 (R) THA ESD 003 (R) THA MPD 001 (R) THA MPD 002 (R) THA BVM 001 (R) THA EPI 001 (R) THA PBL 001 (R) THA VBC 001 (R) THA CAN 001 (R) THA CVD 001 (R) THA ORH 002 (R) THA EHP 001 (DP) THA EHP 002 (R) THA FSP 001 (R) THA MPM 001 (R) THA PTR 001 (R) THA PTR 002 (FP) THA EDS 001 (R) THA HST 001 (R) THA HLE 001 (R) Development of Health Education Development of Mental Health Development of Drug Policies and Management Development of Pharmaceuticals and Biologicals Development of Epidemiological Surveillance Malaria Control Filariasis Control Bacterial, Viral and Mycotic Diseases Control Development of Expanded Programe on Immunization Prevention of Blindness Development of Vector Biology and Control Development of Cancer Control Development of Cardiovascular Diseases Control Development of a Training and Demonstration Centre for Oral Health Environmental Health Development of Environmental Health Management, including Impact Assessment Development of Food Control Development of Health Manpower Planning and Management Promotion of Training Training and Follow-up Support of Peripheral and Primary Health Care Workers Curricula and Faculty Development Development of National Health Information System Development of Health Legislation 12. INTER-COUNTRY Projects in Operation Number (Source of Funds) - Title ICP CHP 001 (R) Managerial Process for Health Development ICP CHP 002 (DP) Strengthening of Managerial Capacities for Health Development ICP CWO 002 (R) Liaison with ESCAP ICP a40 100 (AS) Coordination with other Organizations ICP RPD 001 (R) Biomedical Research ICP RPD 002 (VF) Collaboration in Research Programmes ICP RPD 100 (R) Research Promotion and Development ICP DGP 001 (R) Regional ~irector' s Development Programme ICP PPS 100 (R) Health Services Development - Programme Planning and General kt ivities ICP SPM 002 (R) National Health Information Systems Development ICP SPM 003 (DP) Strengthening of Health Services Administration through Training in Planning ICP PHC 002 (R) Promotion of Health for All with Primary Health Care as Key Approach, including Appropriate Technology for Health ICP PHC 004 (R3 Promot ion and Development of Traditional Medicine with Special Reference to Primary Health Care ICP PHC 005 (DP) Medicinal Herbs and Ayurvedic Drugs ICP PHC 006 (DP) Primary Health Care Promotion and Development ICP PHC 007 (DP) Traditional Medicine ICP PHC 008 (DP) Acupuncture as Traditional Medicine Practice ICP ADR 001 (WVF) Care of the Aged, Disability Prevention and Medical Rehabilitation ICP ATH 001 (R) Standardization of Diagnostic Material and Laboratory Practices ICP ATH 100 (R) Appropriate Technology for Health ICP HSR 001 (R) Health Services Research ICP FCH 003 (R) ICP MCH 011 (FP) ICP MCH 013 (R) ICP W2H 100 (R) ICP NUT 005 (R/VF) ICP NUT 100 (R) ICP HRP 100 (VF) ICP HED 005 (R) ICP NED 100 (R) ICP MNH 003 (R) ICP MNH 100 (R) ICP DPM 001 (R) ICP DPM 002 (DP) ICP PHB 002 (DP) ICP ESD 005 (R) ICP ESD 100 (R) ICP MPD 001 (R) ICP MPD 004 (DP) ICP MPD 100 (R) ICP BVM 001 (WVF) ICP BVM 003 (VFIFT) ICP BVM 004 (VF/FT) ICP BVM 006 (R) ICP BVM 007 (VF) ICP EPI 001 (R/VF) ICP EPI 002 (DP) ICP TDR 100 (FT) Education and Studies in MCH Regional Team on Family Health Promotion of Family Health Maternal and Child Health htrition in Primary Health Care Nutrition Regional Research Adviser Promotion of Health Education Health Education Promotion of Mental Health Mental Health Development of Essential Drugs: Legislation and Quality Control Drug Policies Management Technical Cooperation in Pharmaceuticals in ASEAN Countries Strengthening of Epidemiological Surveillance System Epidemiologica 1 Surveillance Malaria Control and Coordination of Ant i-malaria Activities in the Region Regional Manpower Development Programme in Malaria Malaria and Other Parasitic Diseases Prevention and Control of Bacterial and Viral Diseases Leprosy Control Control of Zoonoses and Food-borne Diseases Research in Bacterial and Viral Diseases Prevention and Control of Diarrhoea1 Diseases Expanded Programme on Immunization Expanded Programme on Immunization Strengthening of Biomedical Research Capability ICP PBL 001 (WVF) Prevention of Blindness and Visual Impairment ICP PBL 002 (WVF/FT) Prevention of Blindness ICP PBL 003 (DP) Prevention and Control of Visual Impairment and Blindness ICP PPN 100 (R) Non-communicable Disease Prevention and Control - Programme Planning and General Activities ICP CAN 001 (R) Cancer Control and Prevention ICP ORH 001 (R) Development of a Training and Demonstration Centre for Oral &alth ICP OND 001 (R) Other Non-communicable Diseases Control and Research in Chronic Liver Diseases ICP PPE 100 (R) Promotion of Environmental Health - Programme Planning and General ktivities ICP EHP 001 (R) WHO/World Bank Cooperative Programme in Environ- mental Health ICP EHP 002 (VF) Building up of Information Services in Environ- mental Health in South-East Asia ICP BSM 001 (R) Community Water Supply and Sanitation ICP BSM 002 (DP) Development of Drinking Water Supply and Sanitation Programme ICP BSM 003 (vF) G'IZ/WIIO Cooperation Project for International Drinking Water Supply and Sanitation Decade ICP BSM 004 (DP) International Drinking Water Supply and Sanitation Decade Advisory Services ICP RCE 001 (WFT) Environmental Pollution Control ICP PRI 100 (R) Health Manpower Development - Programme Planning and General Activities ICP PTR 001 (WFP) Orientation of the Curricula of Health Personnel to Community Needs ICP PTR 002 (R) Post-graduate Training Programmes for Health Personnel ICP PTR 003 (R) Continuing Education for Health Personnel ICP PTR 005 (DP) Training in Maintenance and Repair of Health Equipment ICP HST 100 (R) Health Information - Development of Health Statistical Services ICP HLT 001 (R) Health Literature, Libraly and Information Services 13. INTER-REGIONAL PROJECTS IN OPERATION IN SOUTH-EAST ASIA Number Title - IRP VBC 043 Rodent Control Demonstration Study Unit, Rangoon IRP VBC 025 Vector Biology and Control Research Unit, Jakarta, Indonesia IRP VBC 050 Vector and Rodent Control Sub-unit, Semarang, Indonesia IRP MNH 030 Treatment and Research Component of the United Nations/ Burma Programme for Drug Abuse Control, Phase I IRP MNH 918 Treatment of and Research on Drug Dependence in Thailand IRP MNH 818 Treatment of and Research on Drug Dependence in Thailand - Health Research Institute ANNEXES ORGAHlZATfONAL CHART REGIONAL DIRECTOR I I WHO PROGQdJME CWRDINATORS DIVXCIOI DIRECTOR PROGM IIUUO(FM ! L - - _ - _ - - - - , DIRECTOR DIRZCIOR CHIEF CBlEF CHIEF CHIEF D~uelopm~nl of Direare Control Health bdical Planning and Lnviromentnl Comprehensive and prevention nanpower ~esr.rch coordination ~enith Health Slrvicer Development DCR DDC CHW O(R CPC CEH Literacur. service. duction Library I REGIONAL ADVISCUS co.rmunicable Discares Halaria ncntal HI.I<~ Wafernal and Child Health I bpanded Propr-• on 1-nirariao Primary Fmily Health r.nily m..lrh care Health Education Non-c-unicable Diseases H~.lth L.borrrory S~rvicrr Nursing Health stacisrics Nucririon ~ ~~ Diarrhoea1 Dise..a. Leprosy ~nf-logy I Vector control Progr-r Deuelopwnr & External Resourc=' Coordinarion Il.nqcment I PERSONNEL 1-1 j Annex 2 GEOGRAPHICAL DISTRIBUTION OF INTERNATIONAL STAFF ASSIGNED TO THE SOUTH-EAST ASIA REGION AS OF 31 MAY 1983 -- -- - South-East Asia Region Country Field staff WHO (~lobal) Regional inc luding Total Total Office WPChRa & Reg. Advisers Afghanistan Australia BANGLADESH BURMA Canada Colombia Cyprus Czechoslovakia Denmark E~YP t France German Democratic Republic Germany, Federal Republic of maria INDIA INDONESIA Iran (Islamic Republic of) Italy Japan Lebanon Malaysia Malta MONGOLIA NEPAL New Zealand Poland Philippines Republic of Korea Sierra Leone SRI LANKA Sweden Switzerland Tanzania THAILAND Turkey Union of Soviet Socialist Republics Lhited Kingdom of Great Britain and Northern Ireland United States of herica Yugoslavia Other countries Grand Total 17 13 7 154 1 412 Annex 3 DISTRIBUTION OF SHORT-TERM CONSULTANTS BY NATIONALITY (1 June 1982 - 31 May 1983) Nationality kmber of STCs Recruited Australia BANGLADESH Belgium Bulgaria BURMA Canada Chile Denmark Finland France German Democratic Republic Germany, Federal Republic of INDIA INDONESIA Iran Italy Japan NEPAL Netherlands Norway Pakistan Poland Spain SRI LANKA THAILAND Union of Soviet Socialist Republics United Kingdom of Great Britain and Northern Ireland United States of Anerica Yugoslavia Annex 4 DISTRIBUTION OF CONSULTANTS BY SUBJECT AREAS (1 June 1982 - 31 May 1983) Subject Areas Number WHO'S general programme development and management 2 Health system development 18 Organization of health systems based on primary health care 14 Health manpower 3 7 Public information and education for health 15 Research promotion and development, including research on 8 health-promoting behaviour General health protection and promotion 6 Rotection and promotion of the health of specific population groups 6 Protection and promotion of mental health 1 Promotion of environmental health 19 Diagnostic, therapeutic and rehabilitative technology 28 Disease prevention and control 7 0 Support services 1 - - TOTAL 225 Annex 5 MEETINGS AND COURSES ORGANIZED OR ASSISTED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION (1 July 1982 - 30 June 1983) Date - 1982 - 5-8 Julv Title - Site - Regional Consultation for Regional Collaborative Activities in Health (ICP DGP 002) New Delhi 7-15 July National Seminar on Programme Management and Clinical Aspects of Diarrhoea1 Diseases (ICP BVM 007) Colombo National Workshop on Prevention of Road Traffic Accidents (EURO funds) 16-20 July 18-30 July 26-30 July Colombo National WorkshopISeminar for Entomologists (NEP MPD 001) He tauda (Nepal) Consultation on Methodologies in HMD Research as part of Health Systems Research (ICP HSR 001) New Delhi Course on Clinical Management of Acute Diarrhoea1 Diseases Calcutta 26 July4 August 2 August- 25 September Course for Junior Orthotic Technicians (IND ADR 001) Cuttack (India) New Delhi 9-11 August Meeting on Regional Assessment of Health Services (ICP HSR 001) Workshop on Recent Advances in Genetic Diseases (IND ATH 001) Hyderabad (India) 9-11 August 9-13 August Meeting to discuss the recommendations of MRCs Meeting held in Rangoon (2-6 November 1981) (ICP RPn 001) Workshop on Planning Management (ICP SPM 003) Bali (Indonesia) 9-21 August 10-20 August Rangoon New Delhi Second Regional Workshop on Health Library Network Activities (ICP HLT 001) 16-27 August Training Course on Cell Culture Technology (ICP ATH 001) Fune (India) Mw Delhi Core Group, Meeting of the Principal Investigators of Epidemiological Studies of DHF (ICP BVM 006) 17-18 August 23-25 August 23-28 August New Delhi Meeting on Action Plans for Leprosy Control with Emphasis on New Policy for Chemotherapy Consultative Meeting on Risk Approach Strategy in the Delivery of MCH Care (ICP MCH 003) Bandung (Indonesia) 30 August- Regional Workshop on Involvement of Practitioners 3 September of Traditional Medicine in PHC (ICP PHC 004) New Delhi 5-6 September 10-13 September Twelfth India-Nepal Border Malaria Coordination Conference (ICP MPD 001) Kathmandu Dhaka Second Meeting of the Committee Established Under Resolutions SEAfRC34fR6 and R11 to: (a) Review the implementation of the study of WHD's Structure in the Light of Its Functions (10-11 September) (b) Review the Organization's Collaborative Programme (11-13 September) Consultative Meeting on Health Education in Family Health (ICP MCH 011) 20-24 September New Delhi 28 September 2 October Workshop on Advances in Mental Health (ICP MNH 003) New Delhi 4-8 October Second South-East Asia Regional Conference on WHO Fellowships Programe with Particular Reference to Its Impact (ICP PTR 002) New Delhi 4-9 October Second Meeting of Investigators - Mental Health in Primary Health Care (ICP HSR 001) New Delhi 4-9 October Workshop on Regional Manpower Requirements for Planning and Management of Malaria Control Programme in the Light of the Revised Strategy and PHC Approach (ICP MPD 004) Phuke t (Thailand) 4 October - 5 November Fifth Seminar on Development of Basic Community Services through PHC (ICP PHC 006) Chiang Mai (Thailand) New lklhi 12-15 October Consultation on Environmental Health Research (ICP BSM 001) Meeting on Performance Assessment New Delhi Bangkok 26-29 October 1-21 mvember Raining for Physicians on Prevention, Treatment and Rehabilitation of Drug Dependent Persons Workshop for Raining of Doctors in Cardiology (BAN CVD 001) Dhaka 1-4 November 2-3 November 3-4 November 15-19 November 16-26 November 18-19 November Fourth Indonesia-Malaysia-Singapore Malaria Coordination Conference (ICP MPD 001) Bandung (Indonesia) Jakarta National Meeting on Prevention of Road Traffic kcidents Colombo Consultation on National Health Development Networksfcentres National Workshop on Diagnosis, Management and Prevention of Cardiovascular Diseases (BUR CVD 001) Rangoon Meeting on Women in Health and Development (ICP PPF 016) New Delhi 22-23 November National Workshop on Lipids and Lipoproteins in Health and Disease with Special Reference to India (IND CVD 002) New Delhi 24-27 November 1-4 December 2-4 December 3-4 December National Seminar on Cancer of the Head, Neck and Cervix (IND CAN 006) Bombay National Workshop on the Planning and Implementation of National Oral Health Survey, 1983 (SRL OM 001) Colombo Second Inter-country Meeting of CDD National Programme Managers Yogyakarta (Indonesia) National Workshop on Immunology and .Genetics of Rheumatic Fever and Rheumatic Heart Disease with Chandigarh Special Reference to India and South-Fast Asia (IND CVD 002) 6-11 December 13-14 December 13-18 December Seminar on Community Participation in Primary Health Care (ICP PHC 006) Chiang Mai (nailand) Male Fifth India-Maldives-Sri Lanka Border Malaria Coordination Conference (ICP MPD 001) Tnird Meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the Relevant Ministries (ICP RPD 001) Chiang Mai (mailand) Workshop on Rehabilitation of the Disabled in the Community (ICP ADR 001) 13-18 December Mw Delhi 18-20 December National Seminar on Strategies in Cancer Control (IND CAN 006) Madras Inter-country Workshop on Comonly Used Traditional Medicine (ICP PHC 005) New Delhi 20-23 December 1983 - 10-14 January 10-20 January Workshop on Urban Primary Health Care (ICP PHC 002) New Delhi Jakarta Course on Clinical Management of Acute Diarrhoea1 Diseases (ICP BVM 007) Consultation on Standardization of Procedures in Health Services Research Information System (ICP RPD 001) New Delhi 11-14 January 17-29 January Joint WHO/UNICEF Course on Repair and Maintenance of Refrigerators Pune (India) Rangoon 22 January- 9 February Training Course for Field Testing CDD Supervisory Skills (IRP BVM 281) 14-16 February Scientific Meeting of Indian Scientists with IMMLEP on the Immunoepidemiology of Leprosy New Delhi 17-18 February IMMLEP Steering Comnittee Meeting 21-25 February Workshop on Evaluation of Training Programmes for Traditional Birth Attendants (ICP PTR 003) New klhi 23-25 February Consultative Meeting on Prevention and Control of Blindness due to Glaucoma (ICP PBL 003) Rangoon 23 February- 15 March Course on Project Formulation and Appraisal Madras Calcutta New Delhi 25-27 February Third Regional Scientific Working Group/CDD Meeting (ICP BVM 006IICP BVM 007) 7-11 March Seminar on Financial Planning for HFA12000 (ICP CHP 002) 7-19 March 20-31 March 7-8 April Workshop on Mid-Level Management of EPI (ICP EPI 002) Rangoon Dhaka New De lhi Course on Clinical Aspects of Diarrhoea1 Diseases First Meeting of the Special Working Group on Health Behaviour Research (ICP RPD 001) South-East Asia Advisory Committee on Medical Research: Ninth Session (ICP RPn 001) New Delhi 18-20 April Meeting of the Small Committee Established Under Resolution SEA/RC34/R11 to Review the Organization's Collaborative Programme and Finalization of Detailed Programme Budget New Delhi 18-22 April 2-6 May Consultation on Drug Legislation (ICP DPM 001) Kathmandu Jakarta Third Review Meeting of Principal Investigators of the Regional Collaborative Studies on Drug-resistant Malaria (ICP MPD 001) 16-20 May 16-18 May 16-20 May The Role of PHC in the Prevention and Management of Alcohol and Drug Dependence New Delhi Meeting on National Family Planning Research (ICP MCH 013) Kathmandu New Delhi Task Force Meeting on the Development of Module Bank (ICP PTR 003) Meeting on Infectious Hepatitis (Follow-up Recommendation by I11 SWG/Hep 1981) (ICP BVM 006) 10-15 June 25 June-6 July Rangoon Course on Clinical Aspects of niarrhoeal Piseases (ICP BVM 007) Jakarta Consultative Meeting on a Systematic Approach to Continuing Fducation for Health Workers (ICP PTR 003) Srinagar (India) 27 June-1 July Meeting on National Family Planning Research (ICP MCH 013) Bangkok 14-16 June Annex 6 Date - 1982 - 12-17 July 20-21 July 26 July 27-28 July 2-13 August 4-9 August 8-15 August 9 August 16-18 August 19-23 August 23 August 27-28 August 27-29 August 4-14 September CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY GOVERNMENTSIOTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED (1 July 1982 - 30 June 1983) Organizer: Title Site - All India Institute of Hygiene and Public Health: Calcutta Zoonoses Training Course Government of India: Seminar on Promotion of De lhi Epidemiological Surveillance of Communicable Diseases on Regional Basis through the Branches of National Institute of Communicable Diseases Government of Thailand: Training Course on Pattaya Treatment of Drug and Chemical Dependent Personnel (Thailand) Government of India: National Meeting to Formulate New Delhi Plan of Action for Implementation of Recommendations of the Mexico Meeting on Road Traffic Accidents United Nations: Seminar on Recourse Procedures Bangkok and other Forms of Protection to Victims of Racial Discrimination and Pctivities to be Undertaken at National and Regional Levels World Tourism Organization: Regional Seminar on Jakarta Domestic Tourism, and 4th Joint Meeting of the WTO Commission for East Asia 6 Pacific and WTO Commission for South Asia Government of Nepal: National Seminar on Family Planning Government of Thailand: Seminar on Role of Private Sector in MCH Development Kathmandu Bangkok ASEAN: Seminar on Evaluation System for ASEAN Bangkok PHC Raining Centre ASEAN Population Coordination Unit: 6th Annual Yogyakarta Meeting of Heads/Experts of ASEAN Population (Indonesia) Programe UNICEF: Annual Programme Progress Review New Delhi Government of Tamil Nadu, India: 15th All-India Madras Inter-State Coordination Meeting UNDPIGovernment of India: Regional Conference on Udaipur Low Cost Sanitation (India) Government of Nepal: National Workshop on Research Kathmandu Methods in Health Sciences 1st Week September Government of Mongolia: Conference of Ministers of Health of Socialist Countries Ulan Bator 5-11 September SEAMIC: Tenth SEAMIC Workshop on Health Systems Development in the Context of Health for All by the Year 2000 6-13 September ESCAP: Sixth Session of the Committee on Industry, Technology, %man Settlements and the Environment Bangkok 18-19 September Indian Psychiatric Society: I1 Annual Conference of North Zone Indian Psychiatric Society and I11 Rajasthan Psychiatric Conference Bikaner (India) 20-21 September Government of India: Scientific Conference on the Control of Comunicable Diseases in Primary Health Care 20-29 September 22 September ESCAP: Zhird Asian & Pacific Population Conference Colombo University of Colombo: Workshop on Curriculum Development 22-26 September Government of Burma: Combined meeting of West Pacific Orthopaedic Surgeons and Orthopaedic Surgeons Association of Burma Rangoon 23 September Government of India: National Meeting of State Medical Officers on Control of Diarrhoea1 Diseases New Delhi Burma Medical Association: Surgery and Allied Specialities Conference 23-26 September Rangoon 26-27 September International Medical Sciences Academy: Seminar on Physical Migration New Delhi Bangkok ESCAP: Expert Group Meeting on Measuring and Mone- tizing Social Benefits of Projects for the Rural Poor 27 September- 1 October 4-9 October International Commission on Irrigation and Drainage: Special Technical Session on "Identification of Remedial Measures to Mitigate the Adverse Effects of Irrigation, Drainage and Flood Control Projects" New Delhi 4 October - 5 November ESCAP/UNIOEF: V Seminar (Regional) on Basic Community Services through Primary Health Care Bangkok New Delhi Family Planning Council: Workshop on the Promotion of Oral Pills in India 6-8 October New Delhi Colombo 6-10 October Delhi Tuberculosis Association: XXXVII National Conference on lbberculosis and Chest Diseases UNDP: Multilateral Development Cooperation - Trends and Issues 7 October Government of India: Regional Conference on Low Cost Sanitation ooty (1ndia) Bangkok 7-9 October 11-18 October UNESCO: Consultative Seminar on Population Education 12-13 October 15-19 October 25-29 October 27 October 29 October 1-4 November 2-6 November 2-8 November 4-6 November 4-9 November 5-6 November 8 November 8-16 November 9-11 November 16-22 November 17-19 November 18 November 21-27 November 22 November 23-26 November Government of Indonesia: Consultative Meeting on Ciloto the 1981 PK Curriculum (Indonesia) Cardiological Society of India: International Bombay Congress on Tropical Cardiology ASEAN: Consultative Meeting on Primary Health Care Bangkok Government of Sri Lanka: Review Meeting of UNICEF- Co lombo assisted Country Prograrmnes, 1984/85 Government of Sri Lanka: The Sri Lankan Child - A Colombo Focus for North-South Dialogue Mahidol University: Fourth Asian Congress of Bangkok hbtrition Government of India: National Workshop on "Nosocomial New Delhi Infections with special reference to Staphylococcus Aureus" ESCAP: Twenty-fourth Session of the Comittee on Trade Bangkok Government of India: National Workshop on Cooperative New Delhi Acquisitions of Health Science Literature Association of South-East Asian Institutions of Jakarta and Higher Learning: Seminar on Education for Environ- Yogyakarta mental Welfare and Posterity Government of India: National Workshop on Control New Delhi of Poliomyelitis Government of Sri Lanka: Seminar on New Dimension Colombo for the Role of Women ESCAP: Workshop on Mini and Microcomputers UNDP: NGOs Consultation on IDWSSD Bangkok New Delhi ESCAP: Comittee on Social Development (3rd Session) Bangkok Regional Institute of Higher Education and Develop- Bangkok mentIMedica1 Association of South-East Asian Nations : First MASEAN-RIHED Conference on Post- graduate Medical Education in the ASEAN Region Trade Fair Authority of India: Meeting of Private New Delhi Sector Companies and International Agencies Concerning Aids and Devices for the Handicapped Government of Indonesia: National Training Course Ci loto on Rabies (Indonesia) Government of India: National Meeting on Health New Delhi Management Heads in India ESCAP: Second Ad hoc Meeting of Agencies and Bangkok NGOs concerned with Youth Development 23-27 November ESCAP: Fourth Session of the Committee on Development Planning Bangkok 29 November 3 December ASEAN: Teaching Seminar on Psychogeriatrics Jakarta 30 November 2 December National Institute of Public Cooperation and Child New Delhi Development: National Seminar on the Child and the Law 1-4 December Centre for Education and Training, Government of Denpasar Indonesia: Meeting on Long-term Development of the (Indonesia) Nurse Teacher Training Programme Indonesian Association of Neurologists, Psychiatrists knpasar and Neurosurgeons: Annual Conference (Indonesia) 6-8 December 7 December ESCAP: Inter-Agency Task Froce on Water for Asia and Bangkok the Pacific (10th Session) 8-14 December ESCAP: WorkshoprumExhibition on the Improvement Bangkok of Non-motorized Transport 9 December Government of India: National Meeting of Task Force hedabad on Guineaworm Eradication (India) 13-18 December Management Development Institute: Approaches to Cost New Delhi Reduction - Focus on Effective Utilization of resources 15 December Dr A.V. Baliga Foundation: Seminar on Prevention New Delhi of Blindness among Children 20 December Government of India: Workshop on "Monitoring Adverse New Delhi Drug Reaction" 21 December (ongoing) UNICEF: Preparatory Meeting to Develop EPI-slide Sound New Delhi Audiovisual Aid for Administrators/Policy-makers 25-27 December Cancer Institute, Madras: Seminar on Cancer Control Madras Strategies 1983 - 3-5 January Government of Nepal: Second Meeting of the Working Kathmandu Group on Health and Population ktivities of the South Asian Nations 3-5 January Indian Association of Preventive and Social Lucknow Medicine: XI11 National Conference (India) Indian Psychiatry Association: Annual Conference Bombay 5-8 January 5-11 January 10-13 January United Nations: Expert Group on Fertility and Family New Delhi Centre for Education and Training and the Consortium Jakarta of Health Sciences: National Nmsing Workshop UNESCO: Elaboration and Promotion of Indicators in Colombo the Analysis and Planning of Progrmes for Youth 10-14 January 14-15 January Udayana University, Indonesia: Panel Discussion on "Integration of Comunitroriented Medical Education into the Curriculum of Medical Schools" Bali (Indonesia) 19-20 January Government of India: Meeting of National Comittee on Zoonoses New Delhi 20-25 January Indian Water Works Association: 15th Annual Convention Bombay 20-28 January 21 January Burma Medical Association: Annual Conference Rangoon New Delhi YWCA: Symposium on Social Awareness with Particular Reference to Women's Rights 24-25 January University of Colombo: Working Group on Indicators for Child Mental Health Colombo 27-29 January South-East Asia Cooperative Environment Progriumne: First Meeting of the Governing Council Colombo 28-30 January Indian Fublic Health Association: 27th Annual Conference Nagpur (India) 28 January- 1 February University of Sri Ianka: International Meeting on Impact of Population Movement on Tropical Diseases Transmission and Control Peradeniy a (Sri Ianka) 29-31 January Indian Association for the Advancement of Medical Education: Annual Conference Ranchi (India) Centre for Education and Training and the Consortium of Health Sciences: Meeting on New Patterns of Education for Health 2-5 February Surakart a (Indonesia) 7 February 7-9 February 7-10 February ESCAP: Inter-Agency Meeting on Integrated Rural Development Bangkok Indian Institute of Technology, Bombay: Seminar on Environmental Management Bombay National Institute of Science, Technology and Development Studies: International Seminar on "lhe Role of Fundamental Research in Developing Countries" New Delhi National Institute of Cholera and Enteric Diseases, Government of India: I1 Asian Conference on Acute Diarrhoea1 Diseases 21-24 February Calcutta 24 February 25-27 February Government of Sri Lanka: Seminar on Primary Health Care for Members of Parliament Colombo Indian Water Works Association: Operation and Maintenance of Water Supply and Wastes Water Systems (Rural and Urban) Bangalore (India) 25-28 February 2 6-2 7 February Burma Nurses Association: Annual Conference Rangoon Government of India: Meeting of Directors of National Laboratories Chandigarh (India) 28 February- 3 March 2 March 3-5 March Government of India: Workshop on Development of Epidemiological Services in StatesIUnion Territories New Delhi ESCAP: ESCAPI IRD Meeting Bangkok New Delhi Government of India: National Workshop on "Develop- ment of Uniform System of Medical Records and Reports from District Hospitals" 5 March Government of India: Technical Advisory Cmmittee on Malaria New Delhi 7-1 1 March 8-14 March Government of India: Seventh Non-Aligned Summit New Delhi Bangkok ESCAP: Worksh~~~umExhibition on the Improvement of Normotorized Transport 10 March Government of India: Meeting of National Coordination Committee on Blindness Mw Delhi 14-19 March Government of India: National Workshop on Antibiotic Sensitivity Testing New Delhi Colombo New Delhi 14-23 March Water Resources Board, Sri Lanka, and ODA, UK: Hydrogeological Workshop on Groundwater Resources 16 March 16-18 March Government of India: National Workshop on Health Economics Management Government of Indonesia: Consultative Meeting on Standanis for Hospital Wrsing Services Bogor (Indonesia) New De lhi 18 March Government of India: Workshop on Health for All by 2000, Zhe Count-Down Has Begun 18-21 March 21 March Burma Dental Association: Annual Conference Rangoon Bangkok Government of ihailand: Workshop on Research Methodology in Health Sciences 21-26 March 22-28 March UNICEF: Regional Staff Seminar New Delhi Bangkok Government of Thailand: Inter-regional Consultation on Asian Pacific Innovations in Educational Development 24 March Centre for Education and Training: Workshop on Fellowship Policies Jakarta New Delhi Government of India: Convention of Medical Research Organizations 26-27 March 28-31 March ASEAN Training Centre for PHC: International Consultation on Research, Training and Technical Cooperation Bangkok Kathmandu 29-30 March Government of Nepal: Local-Level Donor Representative Consultation Meeting on Agriculture Sector Development in Nepal 29 March - 1 April 30 March 4-5 April 5 April 6 April (on going) 7 Apri 1 7-16 April 14-18 April 15 Apri 1 15 April 19 April 19-22 Apri 1 19-2 9 Apri 1 25 April 25-27 April 26 April-3 May 27 April 29 April 2-6 May UNICEF: Regional Staff Meeting Bangkok Association of Indian Engineering Industry: New Delhi Ninth Annual Session Government of India: Meeting of Principal Investi- New Delhi gators of the EPI Measles Inmunization Project UNICEF: United Nations Inter-Agency Meeting on New Delhi Responses to Requests from Developing Countries Related to Human Nutrition Government of India: Preparation to .Develop FP/MCH/FH New Lklhi Teaching and Learning Materials Blhi Medical Association: Symposium on "Child kw Delhi Health - the Next Two Decades" Government of India: International Raining Coutse- New Delhi cum-Seminar on Narcotics Control and Enforcement Government of India: Health Management Workshop for hedabad District Health Officers (India) Voluntary Health Association of India: Discussions on Clioquinol and SMON New Lklhi UNDP: Meeting on the Establishment of Technical Bangkok Support Team for IDWSSD UNCP/World Bank, & Government of Sri Lanka: Course on Colombo Planning of Water & Sanitation Projects in Sri Lanka The Nutrition Foundation of India: 7th Annual Meeting New Delhi of the International Anaemia Consultation Group ESCAP: Thirtyninth Session Bangkok Government of Nepal and UNICEF: High-level Kathmandu Orientation Seminar on Basic Services in Local Development Government of Thailand: Conference on Malaria Pattaya Research (Thailand) Government of India: Second Training Course on Delhi Zoonoses Voluntary Health Association of India: Meeting on New Delhi Promotion of Breastfeeding Government of India: Meeting of National Cornittee New Delhi on Surveillance of Viral Hepatitis Government of Thailand: Workshop on Technology Chiang Mai Transfer for Production and Processing of (Thailand) Medicinal and Aromatic Plants 9-13 May 9-13 May 10 May 12 May 21 my 7-10 June 20 June Government of ihailand: Inter-Regional Seminar on Regulatory Administration for Promoting National Development United Nations: Asian Regional Seminar on the Inalienable Rights of the Palestinian People Government of IndiaIODA (UK): Review of Area Development in Five Districts of Orissa State ILQ: Review of Rural Development in India Government of India: Meeting on Yaws Eradication with Directors of Concerned States ESCAP: Inter-governmental Meeting on Health and Development Government of India: Meeting of the Steering Committee of Project "IMPACT" ESCAP: Fifth session of the Cormnittee on Statistics Bangkok Jakarta New De lhi New Delhi Mw Delhi New Delhi Bangkok Annex 7 IR/ IRP ADR 114 EUlICP ADR 1151 RB.82 SEIICP ADR 0011 RB.82 IRJ IRP CMB 006lFF IRI IRP DGP 1001 RB .82 SElICP MPD 0041 DP.83 SElINO MPD 0011 RB.82 IRI IRP PHC 0411 FZ.82 SEINEP PHC 0011 RB.82 SE/Mffi OND 0011 RB .82 SEfIND ATH 0051 IR/ IRP PPF 013 1 82.32 SEIICP SPM 0021 RB .82 EUIICP ADR 1151 RB.82 SEIICP DGP 0181 RB .82 IRIIRP BVM 2441 VC.82 INTER-REGIONAL ACTIVITIES OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION (1 June 1982 - 31 May 1983) Title - Workshop on Education and Raining in 6 (1 from Bangladesh, Health Care of the Elderly, Singapore 2 from India, (26-29 January 1983) 1 from Indonesia, 1 from Sri Lenka, 1 from Thailand) Second Meeting of the Health Resources 2 (1 from Bangladesh, Group Preparatory Committee, Geneva 1 from Sri Lanka) (10-11 February 1983) Ninth South-West Pacific Malaria Meeting, 2 from Indonesia Sydney (14-17 February 1983) Workshop on Training of Trainers for 3 (1 from India, Malaria Workers, Kuala Lumpur (4-15 April 1 from Indonesia, 1983) 1 from Thailand) Interregional Seminar on Primary Health 6 (2 from Maldives, Care, Yexian County, China (13-26 June 2 from Nepal, 1982) 2 from Thailand) Inter-regional Training Courae and Study 2 (1 from India, Tour on Nuclear Medicine, Moscow 1 from ~ongolia) (1 September - 31 October 1982) Inter-regional Workshop on Health 2 (1 from India, Statistics for Primary Health Care, 1 from Sri Lanka) Beijing (18-29 October 1982) Interregional Workshop on Health 3 (1 from DPR Korea, Planning for the Elderly, Budapest 2 from Sri Lanka) (8-12 November 1982) Interregional Workshop on Planning and 5 (2 from India, Management of National CDD Programme, 2 from Sri Lanka, Taiyuan, China (18-28 August 1982) 1 from Thailand) Annex 8 LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 June 1982 - 31 May 1983) Mcument Author Title - Advisory Committee on Medical Research SEA/ACMR/8 Regional Office Report to the Regional Director by the Regional Advisory Committee on its eighth session held at Kathmandu, Nepal (ICP RPD 0011, 24-28 May 1982 Cancer - SEAlCancer150 See ~EAIRes.153 SEAICancerl 51 Dr T. Hirayama Assignment report on cancer control in India (IND CAN 006). 14-28 December 1982 SEA/Cancer/52 Dr B.K. Armstrong Assignment report on cancer statintics and epidemiology in Indonesia (IN0 RPD 001), 23 November - 31 December 1982 SEA/ Cancer153 Dr C.S. Muir Assignment report on a visit to cancer regis- tries in India (IND CAN OOb), 6-16 December 1982 SEA/ Cancer154 See SEA/Nurs/326 SEA/Cancet/55 Dr Zivko Kulcar Assignment report on cancer prevention and control in Bangladesh (BAN CAN 0011, 20 December 1982 - 21 January 1983 Communicable Diseases SEAlCDl87 Dr D.R. Hopkins Assignment report on guinea-worm eradication programme in India (IND RPD 001), 26 April - 1 May 1982 Diarrhoea1 Diseases SEA/DD/15 Regional Office Report of the second meeting of the Regional Scientific Working Group on Diarrhoea1 Diseases in the South-East Asia Region. Bangkok, lhailand (LCP BVM 0061, 28-29 April 1982 SEA/DD/16 Regional Office Report of second inter-country meeting for national CDD programme managers, Yogyakarta, Indonesia (ICP BVM 007), 2-4 December 1982 Ikntal Health Dr I.J. Moller Assignment report on oral health in Burma (ICP ORH 001), 18-23 April 1982 SEAIDHI62 Dr I.J. Moller Assignment report on oral health in Mpal (ICP ORH 001), 25-28 April 1982 SEAIDHI63 Dr I.J. Moller Assignment report on oral health in Indonesia (ICP ORH 001)' 5-9 April 1982 SEAIDHI64 Dr I.J. Moller Assignment report on oral health in Chiang Mai, Thailand (ICP ORH 001), April 1982 SEAIDHI65 Dr I.J. Moller Assignment report on oral health in Chiang hi, Thailand (ICP ORH 001). August 1982 Drugs SEA/Drugs/43 Dr A.C. Bhattacharya Assignment report on pharmaceutical and biological quality control in Bangladesh (BAN PHB 001), 5 August 1981 - 31 May 1982 SEA/Drugs/44 Dr S. Raffaelli Assignment report on production and quality control of sterile infusion fluids in Mongolia (MOG PHB 001), 13-23 .September 1982 SEA/Drugs/45 See SEA/Food Hyg./8 SEA/Drugs/46 Mr G. Jamieson Assignment report on survey of the Central Medical Stores, %aka, Bangladesh (BAN PHB 001) 21 August - 12 October 1982 ~EA/Drugs/47 Dr J. Mongar Assignment report on biological standardi- zation and quality control of pharmaceuti- cals in Buma (BUR ATH 003) 9 November - 20 December 1982 Economics SEA/Econ./9 Dr G. Ferster Assignment report on health services development through health planning and evaluation (IN0 HSD 001), June 1977 - December 1982 SEA/Econ. / 10 Dr R.M. Ache Assignment report on health economics management (IND SPM 001), 18 December 1982 - 15 January 1983 Environmental Health SEA/EH/272 Regional Office Report on an intercountry workshop on rapid techniques for environmental impact assessment in developing countries, Bangkok (ICP RCE 001), 1-5 February 1982 SEA/EH/273 Mr V.J. hrmanuel, Project findings and recmendations Dr J.H. Austin, (Rural Water Supply and Sanitation Sector Mr P. Wallum and Review, Indonesia) (ICP BSM 003), 20 May - Mr R.A. Raitt 16 June 1982 SEA/EH/274 Regional Office Project findings and recommendations (Assistance to Water and Sewerage Authori- ties, Dhaka and Chittagong, ~angladesh) (BAN EHP 001), May 1978 - June 1982 Dr P.J. Huiswaard Mr P. Wallum Prof. N. Majumdar Mr H.J. Malla Mr K. Madhava Sarma Mr D.N. Wijeyaratne Mr G. Schultzberg and Dr C. MacCormack Mr J. Palaty Dr U.A.M. Perera Dr R. Sarin Regional Office Regional Off ice Assignment report on training in pre- planning for community water supply in Indonesia (IN0 PTR 004), 6-31 August 1982 Report on the inter-regional cooperation project for the International Drinking Water Supply and Sanitation Decade (ICP BSM 003), 14 February 1981 - 1 October 1982 Assignment report on undergraduate training in public health engineering in the Universities of Peradeniya and Moratuva, Sri Lanka (SRL EHP 001). 22 November 1981 - 21 July 1982 Assignment report on International Drinking Water Supply and Sanitation Decade: pre- paration of national plan for Bhutan (BHU SPM 001), 24 March - 23 July 1982 Assignment report on International Drinking Water Supply and Sanitation Decade: pre- paration of national plan for Bhutan (BHU SPM 001), 7 June - 6 August 1982 Assignment report on environmental health planning and management with particular reference to community water supply and sanitation in Burma (BUR EHP 001), January 1977 - August 1982 Assignment report on evaluation of water supply and sanitation projects applica- bility of guidelines for minimum evalua- tion procedures to Burma (BUR EHP 001), 11-17 October 1982 Assignment report on environmental health programme in Mongolia (MOG EHP 001), 9 August - 3 November 1982 Assignment report on health education components of the pilot project on sanitary disposal of human wastes in Burma (ICP BSM 001), 22 August - 21 September 1982 Assignment report on the national training course on analytical control in water quality monitoring in Indonesia (ICP CEP 004), 2-22 September and 1-23 December 1982 Baseline information in relation to socio- economic, water and sanitation practices for case studies in five villages in Wsa Tenggara Timur, Indonesia (IN0 BSM 005) Report on environmental health research consultation, New Delhi (ICP BSM 001), 12-15 October 1982 Mr P.P. Shrestha Assignment report on health education and information on rural water supply and sanitation in India (IND BSM 0041, 13 June - 13 December 1982 Mr J. Beighton Assignment report on air pollution control - strategies, tactics and requirements - in India (IND RCE 001), 10 October - 20 November 1982 Regional Office Report on socio-economic, financial and water tariff studies of rural water supply project, Nusa Tenggara Timur in Indonesia (IN0 BSM 005). 30 August - 30 October 1982 Mr A.S.M. Rao Assignment report on rural water supply for selected regencies in South Sulawesi in Indonesia (IN0 BSM 006), 6 July - 5 December 1982 Dr L.N.D. Abeyguna- wardene Assignment report on health education in support of rural water supply and sanita- tion in Nusa Tenggara Timur in Indonesia (IN0 BSM 005),16 September-13 December 1982 Dr S.P. Mathur Assignment report on rural water supply in Nusa Tenggara Timur in Indonesia (IN0 BSM 005), 10 August 1982 - 25 March 1983 Terminal report on training in pre-invest- ment planning for community water supply in Indonesia (IN0 PTR 004), 1981-1983 Dr P.J. Huiswaard Epidemiology sEA/Epid/l03 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 0021, 22 December 1981 - 1 January 1982 Dr Leon Rosen Prof. B. Cvjetanovic Assignment report on research in bacterial and viral diseases - development of epidemiological models in Bulma (ICP BVM 006), 4 February - 6 March 1982 Dr S.B. Halstead Assignment report on epidemological research on DHF dengue vaccine development in Thailand (ICP BVM 0061, 7-18 March 1982 Dr T.H. Girgis Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), 22 January - 21 April 1982 Prof. 2. Bencic Assignment report on National Institute of Preventive and Social Medicine, Dhaka, Bangladesh (teaching of epidemiology) (BAN PTR 005), 25 September - 18 December 1981 SEA/Epid/lO8 Dr Z.J. Brzezinski SEA/Epid/l09 Dr Z.J. Brzezinski SEA/Epid/llO Dr DDuglas N.Klaucke SEA/Epid/lll Prof. A.B. Chowdhury SEA/Epid/l12 Dr H.M. Gelfand Expanded Programe on Irmuunization SEAIEP1137 Dr K.B. Singh SEAIEPII38 Regional Off ice SEA/EPI/39 Dr N.A. Ward SEA/EPI/40 Dr R.A. Goodman SEA/EPI/~~ Mr A.O.B. Rosvall SEA/EPI/42 Joint Government/ wHOIUNICEF/US AID Assignment report on epidemiological surveillance and teaching of epidemiology at the All India Institute of Hygiene and Public Health, Calcutta, India (IND ESD 001), 17 February - 15 April 1982 Assignment report on epidemiological surveillance and teaching of epidemiology at the National Institute of Communicable Diseases, Delhi, India (IND ESD 001), 17 February - 15 April 1982 Assignment report on field epidemiology training programme in Indonesia (IN0 ESD 003), 12 June - 21 July 1982 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), 22 February - 21 August 1982 Assignment report on epidemiological surveillance at the National Institute of Connnunicable Diseases, Delhi, India (IND ESD 001), 1-23 October 1982 Report on surveys carried out under the expanded prograrmne on immunization (the public health importance on neonatal tetanus and measles in rural areas of Bhutan) (ICP EPI 002), 4 January - 27 March 1982 Report of a review team (Government of Thailand, WHOIUNICEF) (THA EPI 001), 23 August - 10 September 1982 Assignment report on the expanded programme on immunization and conrmuni- cable disease control in Jakarta Municipality (ICP EPI 0021, 1 June - 30 July 1982 Assignment report on sample survey of neonatal tetanus and paralytic polimye- litis in Kerala State, India (ICP EPI 0021, 5 June - 4 July 1982 Assignment report on expanded programme on immunization in Bangladesh (BAN EPI 001), 21 September 1981 - 20 August 1982 Report on a review of the expanded pro- gramme on immunization and selected primary health care activities in the Republic of Indonesia (ICP MCH Oil), 27 September - 15 October 1982 Dr R. Rothenberg Assignment report on sample surveys to estimate the annual incidence of neonatal tetanus and the prevalence of poliomyelitis in the Kingdom of Nepal (ICP EPI 002), 1 March - 1 April 1982 Filariasis SEA/Fi 1/24 See SEAIVBC 113 Food Hygiene SEAIFood Hyg.18 Dr V.C. Sane Assignment report on food and drug quality ~~~/Dru~s/45 control administration in Bunna (BUR ATH 003), 24 October - 30 November 1982 Haemorrhagic Fever SEA/Haem.Fever/43 Dr D.J. Gubler Assignment report on dengue haemorrhagic fever surveillance in Sri Lanka (SRL VBC 002), 28 April - 21 May 1982 SEA/Haem.Fever/44 Regional Off ice Report of an inter-country meeting of principal investigators on epidemiologi- cal studies on denguelhaemorrhagic fever, New Delhi (ICP BVM 006), 17-18 August 1982 Walth Education SEA/HE/122 Mr K.D.C. Perera Assignment report on resource material for training and cmunity health education and development of learning resource material production in Bhutan (BHu MCH 001), 1 June - 19 August 1982 Dr Sarah Israel Assignment report on training of health personnel and learning resource material in Bhutan (BHU MCH 001), 1 June-31 August 1982 See SEA/EH/287 See SEA/EH/291 Mr O.M. Sutisnaputra Assignment report on health education in Bhutan (health textbooks and teachers' guide for school health education in primary school) (BHu SPM 001), 26 June - 25 December 1982 Health Infomation (National Health Information Development system) SEA/HI/8 Mr J. Bansal Assignment report on national health systems development in Indonesia (ICP SPM 0021, 11-26 May 1982 SEA/HI/9 Regional Office Report of an inter-country workshop on family health information system, New Delhi (ICP MCH 010, 19-23 April 1982 Health Laboratory Methods SEAIHIMI185 Dr N.J. Marchette Assignment report on strengthening of health and development capabilities (laboratory aspects) in Indonesia (IN0 RPD 001), 28 March - 27 May 1982 SEA/HLM/186 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and laboratory practices in Burma (ICP ATH OOlJ, 3 May - 26 July 1982 SEA/HLM/18 7 See SEA/TB/169 SEA/HIM/188 Dr D.W. Scheuch Assignment report on laboratory sciences and techniques in Democractic People's Republic of Korea (KRD ATH 001), 10 May - 8 June 1982 SEA/HLM/189 Dr 0. Lauritsen Assignment report on strengthening of labo- ratory services in clinical chemistry in Sri Lanka (SRL ATH 001), 2-28 October 1982 SEA/HLM/190 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and Laboratory practices in India (ICP ATH 001). 3 May - 26 July 1982 SEA/HLM/191 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and laboratory prac- tices in Sri Ianka (ICP ATH 001) 3 May - 26 July 1982 SEA/HLM/192 Dr Zoltan Csizer Assignment report on development of health SEA/Vaccine/lOl laboratory services in the Institute of public Health, Dhaka, ~angladesh (BAN ATH 001), 28 December 1981 - 27 October 1982 sEA/HLM/19 3 Dr S. Raffaelli Assignment report on Unit for Manufactu- ring Sterile Infusion Fluids in Sri Lanka (evaluation of the project document) (SRL PHB 003), November 1982 SEAIHLMl194 Dr kshyant D.Banker Assignment report on standardization and quality control of biologicals in Burma (BUR ATH 0031, 25 October - 14 December 1983 Health Literature SEAIHLTI15 Miss U.Dhutiyabhodhi Assignment report on the development of activities relating to health literature, library and information services (H~LLIS) network (ICP HLT 001), 29 December 1981 - 31 March 1982 SEA/HLT/16 Mr Michael Camel Report on second regional workshop on health science library network activities, Mw Delhi (ICP HLT 001), 10-20 August 1982 SEA/HLT/17 Khin met Htar Assignment report on HeLLIS activities in Nepal (ICP HLT 001), 13 October - 11 November 1982 SEA/HLT/18 Khin met Htar Draft plan for a national health sciences library and documentation centre in Nepal (ICP H1.T 001), 13 October - 12 November 1982 Health Ministers' Meeting SEA/HM Meet ./2 Regional Office Meeting of Ministers of Health of Countries of WHO South-East Asia Region, Dhaka, 21-24 September 1982 Health Manpower Development SEA/HMD/35 Dr David Metcalfe Report on the examination for diploma in family medicine, Post-graduate Institute of Medicine, Colombo University, Sri Lanka (SRL PTR 003), 26 February - 14 March 1982 SEA/HMD/36 Dr Andrew G. Penman Assignment report on the workshop on training methodology for the teachers of primary health care workers at the National Institute of Health Sciences, Kalutara, Sri Lanka (SRL PTR 004) 31 December 1981 - 20 January 1982 SEA/HMD/37 Dr J. Badenoch Assignment report on the Post-graduate Medical Institute, Colombo, Sri Lanka (examination for M.D.) (SRL PI?, 003), December 1981 SEA/HMD/38 Dr (Mrs) Sandra Iass Assignment report on evaluation of the examination system of National Board/ Consortium of Medical Sciences, Indonesia (IN0 EDS 0011, September-November 1981 SEA/HMD/39 Dr William P. Golden Assignment report on health manpower plan- ning and management: development of health management through training, Indonesia (IN0 SPM 001), 22 May - 21 July 1982 SEA/HMD/40 See SEA/EH/277 SEA/&lD/41 Regional Office Report of a consultation on management training in support of ~rimary health care, New Delhi (ICP EDS 001), 21-23 December 1981 SEA/ HMD/42 See SEA/HSD/~ 6 SEA/HMD/47 Mr J.A. Gleeson Assignment report on MD (~adiology) Part I and and I1 examination at Post-graduate Insti- Mr R.F. Farr tute of Medicine, Colombo, Sri Lanka (SRL PTR 0031, 15-31 August 1982 SEA/ HMD/48 Mr R.F. Farr Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003), 15-21 August 1982 SEA/HMD/49 Prof. A. Keith Mant SEA/ HMD/50 Regional Off ice SEA/ HMD/ 5 1 Dr P.N.V. Kurup SEA/Trad.Med./26 SEA/HWD/5 2 Dr T.H. Weller Dr J.B. Cooper Prof. E. Bencic Dr T.E. Oppe Health Services Development SEA/HSD/42 Regional Office SEA/HSD/~~ Regional Office sEA/HSD/~~ ~egiona 1 Off ice SEA/HSD/45 Dr A. van der Werff Assignment report on external examination for MD (forensic medicine) Part I1 examina- tion of the Institute of Post-graduate Medicine, Colombo, Sri Lanka (SRL PTR 003), 18 July - 2 August 1982 Report of the second South-East Asia Regional Conference on WHO Fellowships Programme with particular reference to its impact, New Delhi(1CP PTR 002), 4-8 October 1982 Assignment report on strengthening of the undergraduate programme of ayurveda physi- cians and on the development of manpower in traditional medicine in Sri Lanka (SRL PPS 001), 26 July - 28 October 1982 Assignment report on curricula and faculty development at the Faculty of Public Health, Mahidol University, Bangkok, Thailand (THA EDS 001), 23 October - 11 November 1982 Assignment report on MD (psychiatry) Part I1 examination in Post-graduate Institute of Medicine, Colombo, Sri Lanka (SRL PTR 004). 13-29 November 1982 Assignment report on National Institute of Preventive and Social Medicine, Dhaka, Bangladesh (BAN PTR 0051, 23 September - 22 December 1982 Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003), 2-14 January 1983 Assignment report on strengthening of surgical services in ~aldives (audiology and speech pathology) (MAV SPM 001), 7 November - 17 December 1981 Report of a regional consultation on regional collaborative activities in health, Mw Delhi, 5-8 July 1982 Strategies for Health for All By the Year 2000 National plans of action for implementation of strategies for Health for All By the Year 2000, May 1982 Assignment report on the basic structure of the national health system in Indonesia (IN0 SPM 001), ~~ril 1982 Prof. J.B. McKinlay Assignment report on case studies on team work in primary health care (ICP PTR 001), 6-30 July 1982 Dr C.A. Greatorex Assignment report on development of primary health care in Sri Lanka (ICP PTR 001), 18 October - 11 November 1982 Prof. S. Chatto- padhy ay Assignment report on strengthening of health services administration through training in planning(1CP SPM 003), 1 August - 29 October 1982 Dr A. Timmapaya Assignment report on country health pro- gramming, Burma (BUR CHP 001) ,21 September - 20 November 1982 Mr S.K. Mitra Prof. T.R. Anand Assigmnent report on health legislation in Bangladesh (BAN SPM 001), 6 April - 30 July 1982 Assignment report on planning and manage- ment of medical care for primary health care in Nepal (NEP SPM 001), 24 November 1982 - 4 January 1983 Regional Office Report of a regional workshop on primary health care in urban areas of the South- East Asia Region, New Delhi (ICP PHC 002), 10-14 January 1983 Mr R.A. Raitt Assignment report on functioning of thana health cwplexes in Bangladesh (BAN SPM 002), 23 February - 20 April 1983 Prof. Gananath Obeysekera Assignment report on rural health services and cornunity participation in relation to the national health system of the Govern- ment of Indonesia (IN0 SPM 001), 30 June - 7 September 1982 Regional Off ice Terminal report of the project "Development of Health Services", Bhutan (BHU SPM 001), 1972-1982 Health Statistics SEA/HS/168 Leprosy SEAlLepl85 See SEA/HSD/53 Dr J.M.H. Pearson Assignment report on rifampicin trial in leprosy control in Burma (BUR BVM 001), 10 May - 3 June 1982 Dr Anan C. Pa kdi Assignment report on leprosy control services in Indonesia (IN0 BVM 001), January-June 1982 Malaria SEA/Ma1/146 Regional Office Recornendations arising out of the techni- cal discussions on control and prevention of leprosy in the context of primary health care, held during the 35th session of the Regional Committee, 14-20 September 1982 Mr C.T. Tamondong Assignment report on leprosy rifampicin trial in Burma (BUR BVM 0011, September 1976 - August 1982 Regional Office Report on an inter-country workshop on the primary health care approach in the control of malaria in South-East Asian countries, New Delhi (ICP PHC 0021, 10-14 May 1982 Mr J.R. Cullen Assignment report on malaria control in Thailand (THA MPD 001), 24 April 1980 - 30 September 1982 Dr Willem J.O.M. Assignment report on manuals and curricula van Dijk for training in the control of malaria in the context of primary health care (ICP MPD 004), 25 October - 5 November 1982 Regional Off ice Report of a regional workshop on regional manpower requirements for planning and management of malaria control programme in the light of the revised strategy, Phuket, Thailand (ICP MPD 004), 4-9 October 1982 SEA/Ma 1 /I50 See SEA/Res./54 Maternal and Child Health SEA/MCH/156 Dr Vitura Sangsing Assignment report on development of maternal and child health services in Nepal (NEP MCH 003), December 1981 - February 1982 SEA/WCH 115 7 Dr 2. Slomko Assignment report on maternal and child health services in Mongolia (MOG MCH 003), 20 August - 20 December 1981 sEA/WCH/158 Prof. Ranjit Roy Assignment report on family health pro- Chaudhury gramme in Sri Lanka (SRL MCH 001), March 1981 - July 1982 SEA/MCH/159 Dr E.V. Sebastian Assignment report on maternal and child health in the context of family health in ~ndonesia (IN0 PPF 001), 2 August - 8 December 1982 SEA/ZH/~~O Dr Nossikov Assignment report on epidemiological surveys of maternal and child health problems in Mongolia (MCG KH 003), 5 September - 3 December 1982 Mental Health - SEA/Ment/ 71 Nursing sEA/Nurs/317 Regional Office Report to the Regional Director on the meeting on women in health and development (WHD) programme, New Delhi, 18-19 November 1982 Prof. Y.M. Karash Assignment report on maternal and child health in Mongolia (MCG MCH 003), 11 August - 11 ilecember 1982 See SEA/Nurs/322 Regional Office Report of the second meeting of investi- gators on collaborative study on mental health in primary health care, New Delhi (ICP HSR 001). 4-9 October 1982 Dr M. Jean Flaherty, Assignment report on preliminary survey on Dr Elizabeth Kudzma nursing education and nursing services in and Indonesia (IN0 PTR 002 and IN0 EDS 001) Mr Robert A. mitt 29 December 1981 - 8 February 1982 Prof. Mari Seedor Assignment report on nursing development in India (IND EDS 003), 31 December - 29 April 1982 Ms Felicitas A. Assignment report on introduction of health de la Cruz assessment in India (IND EDS 003) ,1 January - 27 April 1982 Ms Anne Church Assignment report on paediatric nursing in Bangladesh (BAN EDS 001), 27 November 1981 - 19 May 1982 Dr Ruth M. Harner Assignment report on teaching methodology and evaluation of nurse teachers in Irian Jaya, Indonesia (IN0 PTR 003), 7 June - 8 July 1982 Ms Sally Ann Bryan Assignment report on training in mental health (psychiatric nursing) in Indonesia (IN0 PTR 002), 2 August - 1 October 1982 Dr Vunvilai Assignment report on training course on Chandrabha hospital nursing service management and establishing a model in Indonesia (IN0 EDS 0021, 1 August - 29 September 1982 Mr M.W. Radrigo Assignment report on nursing manpower development, Irian Jaya, Indonesia (IN0 PTR 003), September 1981 - November 1982 Mrs Marita Hrllberg assignm men^ report on rrvlew of nurse teacher programme in Indonesia (IN0 EDS 001), 22 January - 17 February 1983 Mr Richard J. Wells Assignment report on oncology nursing in Safdarjang Hospital, New Delhi, India (IND EDS 003), 20 October - 18 December 1982 ktrition SEA/Nut/83 Dr David G. Fish Assignment report on nutrition research project in Maldives (ICP RPD 002), 1 February - 1 April 1982 Dr Kalyan Bagchi Dr Kalyan Bagchi Assignment report on nutrition in Burma (BUR MCH 0041, 1 March - 29 April 1982 Assignment report on nutrition cell and development of national food and nutrition policy in Bhutan (BHU SPM 001), 3 May - 1 June 1982 Ophthalmology SEA/Ophthal/51 Dr H.F. Renkema Assignment report on prevention of blind- ness in Nepal (NEP PBL 001). November 1981 - February 1982 Assignment report on prevention of blind- ness in Nepal (NEP PBL 001), January - April 1982 Dr Jean-Marc Schepens Dr S. Franken Prof. Erik Linner Assignment report on prevention of blind- ness in Nepal (NEP PBL 001), March-May 1982 Assignment report on assessment of glaucoma as a cause of blindness in Burma (ICP PBL 0011, 25 April - 12 May 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in India (ICP PBL 001), 18 March - 17 April 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in Nepal (ICP PBL 001), 18-24 April 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in Thailand (ICP PBL OOl), 13-27 May 1982 Dr Yasufumi Emori Assignment report on development of appro- priate technology for low-cost vision aids in Sri Lanka (ICP PBL 001), 4 July - 30 October 1982 Dr Yasufumi Emori Assignment report on connnunity-oriented eye care programmes with specific reference to low-vision aids in India (ICP PBL 001), 5-31 July 1982 Dr Yasufumi Emori Assignment report on development of appro- priate technology for low-cost vision aids in Burma (ICP PBL 0011, 4 July - 3 October 1982 SEA/Ophthal/61 Dr Albert Kilstad Assignment report on prevention of blindness in Nepal (NEP PBL 001), 12 September 1980 - 31 December 1982 SEA/Rad/l16 Dr F. Cengic Assignment report on strengthening of radir logicalfiealth services administration in DPR Korea (KRD ATH 001), 24 September - 24 December 1982 Rehabilitation SEAIRehabl49 Dr W.G. Rama Rao Assignment report on training and rehabilita- tion of the disabled in Burma (BUR ADR 001), 16 November - 15 December 1982 SEA/Rehab/50 Dr J.H. tbble Report of the proceedings of an inter-country workshop on rehabilitation of the disabled in the comunity, New Delhi (ICP ADR 001), 13-18 December 1982 Research Study, Research Raining, etc. SEA/Res./50 Regional Office Report of the second meeting of the working group on the overall management of WBO colla- borating centres in South-East Asia Region, New Delhi (ICP RPD 001), 20-22 May 1982 SEAIRe s. 151 Regional Off ice Report of the working group meeting on - (a) implications for Member Countries of the varying emphasis given to various types of research including basic research, and (b) training in research management, Bali, Indonesia (ICP RPD 001), 9-12 August 1982 SEA/Res./52 Regional Office Report of the third meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the relevant ministries, Chiang Mai, Ihailand, 13-18 December 1982 SEAIRe s.153 Dr R.S. Verma Assignment report on biomedical research at ~~~/~ancer/50 the Cytology Research Centre, New Delhi (IND RPD 001), 15-27 December 1982 SEA/Res./54 See SEA/Mal/l50 SEA/Res./56 See SEA/EH/286 Sexually-Transmitted Diseases ( STD) SEA/STD/ 32 Prof. A.Z. Meheus Assignment report on control of sexually- transmitted diseases in Indonesia (IN0 BVM 0011, 12 August - 15 September 1982 Traditional Medicine SEAIRad. Med.121 Hakim Mohd. Abdul Razzack SEA/Trad. Med.122 nr P.N.V. Kurup SEAIRad. Med.123 Dr P.N.V. Kurup SEAlTrad. Med .I24 Dr Bhagwan Dash SEAITrad. Med.125 Regional Office SEAITrad. Med.126 See SEA/HMn/51 Tuberculosis SEAlTBl169 Dr S. Kudoh SEAITBI170 Prof. D.A.Mitchison Vector-borne Disease Control SEA/VBC/16 Dr A1 lan Barnes SEAlVBCl17 Dr R. Iyengar SEA/VBC/l8 ~r H.A. Rafatjah Assignment report on traditional system of medicine in Bangladesh (ICP PHC 004). 25 January - 24 February 1982 Assignment report on primary health support services programme in Nepal (traditional medicine) (NEP PHC 002), 29 December 1981 - 13 March 1982 Assignment report on traditional medicine in Nepal (ICP PHC 0051, 11 May - 24 June 1982 Assignment report on traditional medicine in Mongolia (ICP PHC 004), I3 July - 14 September 1982 Report of a regional workshop on involvement of practitioners of traditional medicine in primary health care, New Delhi (ICP PHC 004), 30 August - 3 September 1982 Assignment on tuberculosis laboratories in Indonesia (IN0 BVM 001), 4 July - 3 August 1982 Assignment report on lhberculosis Research Centre, Madras, India (IND BVM 0021, 16-29 November 1982 Assignment report on vector-borne disease control in Burma (BUR VBC OOl), 27 December - 5 March 1982 Assignment report on vector-borne disease control programme in Burma (BUR VBC 001), 15 November 1979 - 14 November 1982 Assignment report on mosquito/vector control in Colombo City and a popular approach towards malaria control in Sri Lanka (SRL VBC 002), 24 September - 14 October 1982
The purchases covered hospital and laboratory equipment and supplies, typewriters, drugs, vaccine, chemicals, bleaching powder, teaching material, books and renewal of subscriptions to journals. 5. COLLABORATION WITH OTHER AGENCIES 5.1 United Nations 5.1.1 United Nations Development Programme (UNDP) During the reporting period, WHO implemented 38 country and inter- country projects funded by the United Nations Development Programme in the Region, the total delivery of UNDP projects amounting to US$ 3 750 000. he operational projects covered programme areas such as strengthening of manpower and training, development of traditional medicine, environmental health, planning, management and evaluation, expanded programme on immunization, food and drug quality control, communicable-disease control including immunology, and the prevention and control of visual impairment and blindness. Active collaboration was maintained with UNDP Resident Representa- tives and governments in order to evolve new country and inter-country projects to be covered during the current indicative planning figure period (1982-1986). The financial stringency in UNDP continued, and a critical assessment of ongoing projects was undertaken during tripartite reviews. Officials from UNDP headquarters visited the Regional Office to review inter-country project activities and explore possibilities of introducing economies without affecting the planned activities. This action has resulted in the further streamlining and expeditious approval of the ongoing inter-country projects. Regular tripartite reviews of country projects were carried out, leading to better implementation. Close follow-up and attention are being paid to the development of new country and inter-country projects. As a follow-up to the Substantial New Programme of Action for the Least-Developed Countries, a series of country review meetings is being organized, either as round-table meetings under the auspices of UNDP, or as consultative groups under the aegis of the World Bank. A series of such meetings was concluded by the UNDP Bureau for Asia and the Pacific from 9 to 18 May in Geneva where the needs of five countries, including Bhutan and Maldives, were reviewed. A staff member from the ~egional Office assisted the countries from this region at these meetings. Bangladesh and Nepal, which use the World Bank Consultative Group mechanism, were also present at the round-table meeting as observers. The earlier country resource utilization reviews carried out in Nepal and Sri Lanka resulted in a greater awareness of health resources needs among economic development and aid coordinators in the countries. 5.1.2 United Nations children's Fund (UNICEF) WHO is closely collaborating with UNICEF both in the countries and in the Regional Offices of UNICEF in New Delhi and Bangkok. The main thrust of collaboration has been in common programme areas such as EPI, diarrhoea1 diseases, nutrition, water and sanitation, promotion of breas~ t'?.?:!i!;i ., , promotion of national codes for the marketing of breast-milk substitut~~~;, and primary health care. WHO and UNICEF are working closely tcgether iii Burna and Nepal in support of primary health care as part of tl~,* .!(::~> studies as well as in the joj.nt action progranme for nutrition. The !<~?i;<u:i~i Offices of both WHO and UNICEF have been reciprocally participating, 5.n c?;:c.! other's regional staff meetings. 5.1.3 United Nations Furid for Population Activities (ULUFPA) During the period under review, 22 country and inter-country prcjec?s in Bhutan, Mongolia, Nepal, Sri Lanka and Thailand were implemented v v;iii with funds provided by the United Nations Fund for Population Astiviiirs (UNFPA). In the implementation of these projects, active collaboratioii w::: maintained with the UNFPA represent:;lti.ves both at the country level 8s 5x.L~ as at UNFPA headquarters. Tile total deli.very of CXFP;? prcjec ts ~i!;o~i,:ti:?., ::, about US$^ million. Technical backctopping has been provided to these projects frcr i-1:: Regional Office. In addition, assistance was extended to UNFPA and t'iti national authorities in the evaluation of the projeccs through the partici-. pation of WHO technical staff in tripartite reviews and special evaluati;.~\ missions (fielded by IlNFPA headquarters) for reviewing country and int~r-. country projects, including the Regional Family Health Team. During the first quarter of 1983, UNPA reviewed and updated iis policies and procedures and issued separate guidelines on major coi;!ponerli:s of population activities. Guidelines on UNFPA support to family pl?-.:~ir. : programmes were epproved and issued, IlNFYA was also in the prccec-s ,>I issuing mcnitoriag instructioiis for inter-country projects funded b:" i.;. 5.1.4 Econonic and Social Comission for Asia and the Pacific (FSCiLq) 'VHO has been collaborating with ESCAP for a long time on a nunber of fronts, particularly in regard to the ESCA? Prograinme on Healtn and Society. Folloriing the Commission's consideration of United Nations General Asser;.:~>I!; Resolutio~i 36/43 and its resolution inter alia to consider speciffc stevs to support WiiO's Global Strategy for HFAl2000, an intergovernmental meetin:! was convened jointly by ESCAP, WHO and UNICEF to consider and recommend t3 the Comission measures for enhancing the collaborati-~e efforts of the thr!?.? orp,anizations and utilizing the expertise avail-able in the various healti- related divisions of ESCAP. Besides the ESCAP Programme of kealt: a:;? Society, WHO has been collaborating with the Comission in the ere-7~ I; social development, natural resources, environment and integrated --.ur? I. development, and the Asian and Pacific Population Conference. 5.1.5 World Food Programme (IIFP) Collaboration with the i~iorld Food Programme iias naiiltainsd !:.i.rt::i;:ii iTii0 headquarters. The World E'ood Programme has offered to discuss possible r:a:ls ir which it can cooperate in the programme for the control and eradicafi~:,:i nL leprosy. The areas of assistance include food aid in leprosy ccntruL mi eradication. A draft project paper for assistance to India was prepared for this purpose and the subject was being actively pursued. IXlring November 1982 an inter-United Nations kency Evaluation Mission (wHO/FAO/UNICEF/WFP) of the project, "Supplementary Nutrition for Pre-School Children, Preg~ant and Nursing Mothers" visited various states in India. me medical officer attached co the Regional Advisory Team on Maternal and Child HealthJFamily Planning and a temporary adviser to the Kegional Director participated in this evaluation mission, which made recorrunendations pertinent to the identified weaknesses, including problems connected with logistics and the management aspect of project imple- mentation. At country level, the WHO Programme Coordinators and Representatives maintained contacts with their counterparts in the other agencies while the Regional Office provided technical backstopping as necessary. 5.1.6 United Nations Industrial Development Organization (UNIDO) WHO and UNIDO continued to collaborate in the UNDP/&therlands-funded project in Nepal on the primary health support services programme. Following an evaluation of the project, an interim review report was received which suggested revisions to the project with substantial changes in the stra- tegies and operational framework. Comments were sent on the revised project document as well as on the plan of work. Collaboration continued with UNIDO for the implementation of that organization's assistance in respect of the project "Strengthening of the Royal Drugs Research Laboratory" i.n Nepal, Close collaboration is being maintained with UNIDO regarding its proposal for the supply of machinery for the production of infusions in Sri Lanka. A WHO consultant visited Sri Lanka in November 1982 in conjunction with the visit of a UNIDO mission and evaluated the project document for the establishment of a unit for the manufacture of sterile fluids. He also discussed the techno-economic aspects of the project with government officials and the authorities of the State Pharmaceutical Corporation in Co lomb n . 5.2 Specialized Agencies 5.2.1 Food and Agriculture Organization of the United Nations (PA@) WHO and PA0 actively collaborated in the implementation of UNDP assistance to the project "Food and Drug Quality Control Laboratory" in Burma. The two organizations agreed to collaborate in the project "~nfra- structure for Food and Drug Control Administration" in Burma for which the project document has been formulated. This document is currently being reviewed by the national authorities and UNDP. FA0 has been closely involved right from the formulation stage of the project. A staff member from FA0 headquarters who was in lndia as part of an FA0 mission visited the Regional Office and was briefed inter alia on the formulation of the above-mentioned project. 5.2.2 International Labour Organisation (ILO) WHO has been collaborating with ILO in organizing occupational health programmes, especially in regard to standards of occupational safety and the health aspects of the work environment. 5.2.3 United Nations Educational, Scientific and Cultural Organization (UNESCO) WHO has been collaborating with UNESCO in educational development and in a network of libraries. 5.2.4 International Bank for Reconstruction and Development (IBRD) WHO'S cooperation with the World Bank in the cooperative programme for water and sanitation is continuing, although the project in the Regional Office has been phased out. Frequent contacts are maintained with the World Bank in regard to areas of mutual interest. The Regional Office sent a representative to participate in the World Bank staff seminar held in Washington in January 1983. 5.3 Asian Development - Bank (AsDB) Close collaboration has been maintained with the Asian Development Bank, the Regional Office providing assistance to the Bank's mission to the countries of the Region. The Bank's pre-appraisal mission for the Second Loan Project in the Health and Fbpllation Sector in Bangladesh in April 1983 was assisted by a WHO staff member in the sector view and finalization of project components, including physical facilities, distribution of medical supplies, maintenance of medical equipment and strengthening of management training. WHO sanitary engineers in Kathmandu supported another mission of the Bank in February 1983 in connection with the water supply and sanitation sector. The Bank recently approved technical assistance to the Socialist Republic of the lhion of Burma for the formulation of a project to redevelop the Rangoon General Hospital complex. Some of the other areas of cooperation between the Bank and WHO include assistance provided by the Organization to the Bank in its loan review mission for the Bangladesh Public Health Programme, the Bank's Technical Assistance Grant for the Health and Population Sector Study in Indonesia, and participation by a representative of the Bank in the meeting on Financial Planning for HFA12000 held in March 1983 in the Regional Office. 5.4 Bilateral and Other Agencies The Regional Office maintained close collaboration with a number of bilateral and other agencies operating in the Region in the health and health related fields. The Swedish International Development Agency (SIDA) has, in colla- boration with WHO, assisted the P.falciparum Containment Programme in India. WHO is monitoring the sterilization programme in Bangladesh in collaboration with the national authorities and with assistance from SIDA. Technical cooperation was also extended to a SIDAIDANIDA mission which visited Bangladesh to assist the Government in the implementation of the national drug policy and the essential drugs programme. DANIDA-supported projects in India were evaluated by a representative who visited the country in March 1983. In close consultation with the national authorities in Nepal and the Directorate of Development Cooperation of Switzerland, a plan of operation was formalized for implementing the project on health laboratory services in Nepal. The project is to receive financial support from the Government of Switzerland. The German (Federal Republic) Agency for Technical Cooperation has been funding the inter-country project for the promotion of national Decade plans for water and sanitation. This project was to terminate in June 1983. WHO has maintained contacts with US AID, the Canadian International Development Agency (cIDA), the Danish International Development Agency (DANIDA), the Norwegian Agency for International Development (NORAD), and with the Governments of Finland and the Netherlands. Discussions took place &I February 1983 in Burma between the WHO Programme Coordinator and Representative and representatives of the International Development Research Centre, Ottawa, Canada, on possible collaborative research programmes. Netherlands assistance to health programmes in South-East Asia includes the development of the Nutrition Cell in Bhutan, the Vector Control Programme in Burma, the Primary Health Support services and Prevention of Blindness programmes in Nepal, the Thai Social Development project, and the regional support programme on diarrhoeal diseases control. In addition, in December 1982, on behalf of the Tool Foundation, Amsterdam, the Cross Cultural Consultancy Foundation, Naarden, prepared a feasibility study for the establishment of a pilot project to develop appropriate technologies for the preparation of ayurvedic drugs from herbs in Sri Lanka. Voluntary funds are also channelled through WHO for variaus programmes, including malaria, prevention of blindness, leprosy, diarrhoea1 diseases and WI. With a voluntary contribution from the Netherlands, WHO is executing, in collaboration with the Government of Thailand, a social development project with a strong health component. 5.5 Non-Governmental Organizations (NGOs) WHO has been promoting dialogues between non-governmental organiza- tions and ministries of health in the countries to enhance the involvement of NGOs in health work. National seminars between NGOs and the Governments of ~ri Lanka and Thailand were supported by WHO. similar support is also envisaged for some states in India. Documents were prepared in Sri Lanka and Thailand showing the inventory of NGOs' programmes in relation to primary health care.
Annex 8 LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 June 1982 - 31 May 1983) Mcument Author Title - Advisory Committee on Medical Research SEA/ACMR/8 Regional Office Report to the Regional Director by the Regional Advisory Committee on its eighth session held at Kathmandu, Nepal (ICP RPD 0011, 24-28 May 1982 Cancer - SEAlCancer150 See ~EAIRes.153 SEAICancerl 51 Dr T. Hirayama Assignment report on cancer control in India (IND CAN 006). 14-28 December 1982 SEA/Cancer/52 Dr B.K. Armstrong Assignment report on cancer statintics and epidemiology in Indonesia (IN0 RPD 001), 23 November - 31 December 1982 SEA/ Cancer153 Dr C.S. Muir Assignment report on a visit to cancer regis- tries in India (IND CAN OOb), 6-16 December 1982 SEA/ Cancer154 See SEA/Nurs/326 SEA/Cancet/55 Dr Zivko Kulcar Assignment report on cancer prevention and control in Bangladesh (BAN CAN 0011, 20 December 1982 - 21 January 1983 Communicable Diseases SEAlCDl87 Dr D.R. Hopkins Assignment report on guinea-worm eradication programme in India (IND RPD 001), 26 April - 1 May 1982 Diarrhoea1 Diseases SEA/DD/15 Regional Office Report of the second meeting of the Regional Scientific Working Group on Diarrhoea1 Diseases in the South-East Asia Region. Bangkok, lhailand (LCP BVM 0061, 28-29 April 1982 SEA/DD/16 Regional Office Report of second inter-country meeting for national CDD programme managers, Yogyakarta, Indonesia (ICP BVM 007), 2-4 December 1982 Ikntal Health Dr I.J. Moller Assignment report on oral health in Burma (ICP ORH 001), 18-23 April 1982 SEAIDHI62 Dr I.J. Moller Assignment report on oral health in Mpal (ICP ORH 001), 25-28 April 1982 SEAIDHI63 Dr I.J. Moller Assignment report on oral health in Indonesia (ICP ORH 001)' 5-9 April 1982 SEAIDHI64 Dr I.J. Moller Assignment report on oral health in Chiang Mai, Thailand (ICP ORH 001), April 1982 SEAIDHI65 Dr I.J. Moller Assignment report on oral health in Chiang hi, Thailand (ICP ORH 001). August 1982 Drugs SEA/Drugs/43 Dr A.C. Bhattacharya Assignment report on pharmaceutical and biological quality control in Bangladesh (BAN PHB 001), 5 August 1981 - 31 May 1982 SEA/Drugs/44 Dr S. Raffaelli Assignment report on production and quality control of sterile infusion fluids in Mongolia (MOG PHB 001), 13-23 .September 1982 SEA/Drugs/45 See SEA/Food Hyg./8 SEA/Drugs/46 Mr G. Jamieson Assignment report on survey of the Central Medical Stores, %aka, Bangladesh (BAN PHB 001) 21 August - 12 October 1982 ~EA/Drugs/47 Dr J. Mongar Assignment report on biological standardi- zation and quality control of pharmaceuti- cals in Buma (BUR ATH 003) 9 November - 20 December 1982 Economics SEA/Econ./9 Dr G. Ferster Assignment report on health services development through health planning and evaluation (IN0 HSD 001), June 1977 - December 1982 SEA/Econ. / 10 Dr R.M. Ache Assignment report on health economics management (IND SPM 001), 18 December 1982 - 15 January 1983 Environmental Health SEA/EH/272 Regional Office Report on an intercountry workshop on rapid techniques for environmental impact assessment in developing countries, Bangkok (ICP RCE 001), 1-5 February 1982 SEA/EH/273 Mr V.J. hrmanuel, Project findings and recmendations Dr J.H. Austin, (Rural Water Supply and Sanitation Sector Mr P. Wallum and Review, Indonesia) (ICP BSM 003), 20 May - Mr R.A. Raitt 16 June 1982 SEA/EH/274 Regional Office Project findings and recommendations (Assistance to Water and Sewerage Authori- ties, Dhaka and Chittagong, ~angladesh) (BAN EHP 001), May 1978 - June 1982 Dr P.J. Huiswaard Mr P. Wallum Prof. N. Majumdar Mr H.J. Malla Mr K. Madhava Sarma Mr D.N. Wijeyaratne Mr G. Schultzberg and Dr C. MacCormack Mr J. Palaty Dr U.A.M. Perera Dr R. Sarin Regional Office Regional Off ice Assignment report on training in pre- planning for community water supply in Indonesia (IN0 PTR 004), 6-31 August 1982 Report on the inter-regional cooperation project for the International Drinking Water Supply and Sanitation Decade (ICP BSM 003), 14 February 1981 - 1 October 1982 Assignment report on undergraduate training in public health engineering in the Universities of Peradeniya and Moratuva, Sri Lanka (SRL EHP 001). 22 November 1981 - 21 July 1982 Assignment report on International Drinking Water Supply and Sanitation Decade: pre- paration of national plan for Bhutan (BHU SPM 001), 24 March - 23 July 1982 Assignment report on International Drinking Water Supply and Sanitation Decade: pre- paration of national plan for Bhutan (BHU SPM 001), 7 June - 6 August 1982 Assignment report on environmental health planning and management with particular reference to community water supply and sanitation in Burma (BUR EHP 001), January 1977 - August 1982 Assignment report on evaluation of water supply and sanitation projects applica- bility of guidelines for minimum evalua- tion procedures to Burma (BUR EHP 001), 11-17 October 1982 Assignment report on environmental health programme in Mongolia (MOG EHP 001), 9 August - 3 November 1982 Assignment report on health education components of the pilot project on sanitary disposal of human wastes in Burma (ICP BSM 001), 22 August - 21 September 1982 Assignment report on the national training course on analytical control in water quality monitoring in Indonesia (ICP CEP 004), 2-22 September and 1-23 December 1982 Baseline information in relation to socio- economic, water and sanitation practices for case studies in five villages in Wsa Tenggara Timur, Indonesia (IN0 BSM 005) Report on environmental health research consultation, New Delhi (ICP BSM 001), 12-15 October 1982 Mr P.P. Shrestha Assignment report on health education and information on rural water supply and sanitation in India (IND BSM 0041, 13 June - 13 December 1982 Mr J. Beighton Assignment report on air pollution control - strategies, tactics and requirements - in India (IND RCE 001), 10 October - 20 November 1982 Regional Office Report on socio-economic, financial and water tariff studies of rural water supply project, Nusa Tenggara Timur in Indonesia (IN0 BSM 005). 30 August - 30 October 1982 Mr A.S.M. Rao Assignment report on rural water supply for selected regencies in South Sulawesi in Indonesia (IN0 BSM 006), 6 July - 5 December 1982 Dr L.N.D. Abeyguna- wardene Assignment report on health education in support of rural water supply and sanita- tion in Nusa Tenggara Timur in Indonesia (IN0 BSM 005),16 September-13 December 1982 Dr S.P. Mathur Assignment report on rural water supply in Nusa Tenggara Timur in Indonesia (IN0 BSM 005), 10 August 1982 - 25 March 1983 Terminal report on training in pre-invest- ment planning for community water supply in Indonesia (IN0 PTR 004), 1981-1983 Dr P.J. Huiswaard Epidemiology sEA/Epid/l03 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 0021, 22 December 1981 - 1 January 1982 Dr Leon Rosen Prof. B. Cvjetanovic Assignment report on research in bacterial and viral diseases - development of epidemiological models in Bulma (ICP BVM 006), 4 February - 6 March 1982 Dr S.B. Halstead Assignment report on epidemological research on DHF dengue vaccine development in Thailand (ICP BVM 0061, 7-18 March 1982 Dr T.H. Girgis Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), 22 January - 21 April 1982 Prof. 2. Bencic Assignment report on National Institute of Preventive and Social Medicine, Dhaka, Bangladesh (teaching of epidemiology) (BAN PTR 005), 25 September - 18 December 1981 SEA/Epid/lO8 Dr Z.J. Brzezinski SEA/Epid/l09 Dr Z.J. Brzezinski SEA/Epid/llO Dr DDuglas N.Klaucke SEA/Epid/lll Prof. A.B. Chowdhury SEA/Epid/l12 Dr H.M. Gelfand Expanded Programe on Irmuunization SEAIEP1137 Dr K.B. Singh SEAIEPII38 Regional Off ice SEA/EPI/39 Dr N.A. Ward SEA/EPI/40 Dr R.A. Goodman SEA/EPI/~~ Mr A.O.B. Rosvall SEA/EPI/42 Joint Government/ wHOIUNICEF/US AID Assignment report on epidemiological surveillance and teaching of epidemiology at the All India Institute of Hygiene and Public Health, Calcutta, India (IND ESD 001), 17 February - 15 April 1982 Assignment report on epidemiological surveillance and teaching of epidemiology at the National Institute of Communicable Diseases, Delhi, India (IND ESD 001), 17 February - 15 April 1982 Assignment report on field epidemiology training programme in Indonesia (IN0 ESD 003), 12 June - 21 July 1982 Assignment report on epidemiology and disease control in Bangladesh (BAN ESD 002), 22 February - 21 August 1982 Assignment report on epidemiological surveillance at the National Institute of Connnunicable Diseases, Delhi, India (IND ESD 001), 1-23 October 1982 Report on surveys carried out under the expanded prograrmne on immunization (the public health importance on neonatal tetanus and measles in rural areas of Bhutan) (ICP EPI 002), 4 January - 27 March 1982 Report of a review team (Government of Thailand, WHOIUNICEF) (THA EPI 001), 23 August - 10 September 1982 Assignment report on the expanded programme on immunization and conrmuni- cable disease control in Jakarta Municipality (ICP EPI 0021, 1 June - 30 July 1982 Assignment report on sample survey of neonatal tetanus and paralytic polimye- litis in Kerala State, India (ICP EPI 0021, 5 June - 4 July 1982 Assignment report on expanded programme on immunization in Bangladesh (BAN EPI 001), 21 September 1981 - 20 August 1982 Report on a review of the expanded pro- gramme on immunization and selected primary health care activities in the Republic of Indonesia (ICP MCH Oil), 27 September - 15 October 1982 Dr R. Rothenberg Assignment report on sample surveys to estimate the annual incidence of neonatal tetanus and the prevalence of poliomyelitis in the Kingdom of Nepal (ICP EPI 002), 1 March - 1 April 1982 Filariasis SEA/Fi 1/24 See SEAIVBC 113 Food Hygiene SEAIFood Hyg.18 Dr V.C. Sane Assignment report on food and drug quality ~~~/Dru~s/45 control administration in Bunna (BUR ATH 003), 24 October - 30 November 1982 Haemorrhagic Fever SEA/Haem.Fever/43 Dr D.J. Gubler Assignment report on dengue haemorrhagic fever surveillance in Sri Lanka (SRL VBC 002), 28 April - 21 May 1982 SEA/Haem.Fever/44 Regional Off ice Report of an inter-country meeting of principal investigators on epidemiologi- cal studies on denguelhaemorrhagic fever, New Delhi (ICP BVM 006), 17-18 August 1982 Walth Education SEA/HE/122 Mr K.D.C. Perera Assignment report on resource material for training and cmunity health education and development of learning resource material production in Bhutan (BHu MCH 001), 1 June - 19 August 1982 Dr Sarah Israel Assignment report on training of health personnel and learning resource material in Bhutan (BHU MCH 001), 1 June-31 August 1982 See SEA/EH/287 See SEA/EH/291 Mr O.M. Sutisnaputra Assignment report on health education in Bhutan (health textbooks and teachers' guide for school health education in primary school) (BHu SPM 001), 26 June - 25 December 1982 Health Infomation (National Health Information Development system) SEA/HI/8 Mr J. Bansal Assignment report on national health systems development in Indonesia (ICP SPM 0021, 11-26 May 1982 SEA/HI/9 Regional Office Report of an inter-country workshop on family health information system, New Delhi (ICP MCH 010, 19-23 April 1982 Health Laboratory Methods SEAIHIMI185 Dr N.J. Marchette Assignment report on strengthening of health and development capabilities (laboratory aspects) in Indonesia (IN0 RPD 001), 28 March - 27 May 1982 SEA/HLM/186 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and laboratory practices in Burma (ICP ATH OOlJ, 3 May - 26 July 1982 SEA/HLM/18 7 See SEA/TB/169 SEA/HIM/188 Dr D.W. Scheuch Assignment report on laboratory sciences and techniques in Democractic People's Republic of Korea (KRD ATH 001), 10 May - 8 June 1982 SEA/HLM/189 Dr 0. Lauritsen Assignment report on strengthening of labo- ratory services in clinical chemistry in Sri Lanka (SRL ATH 001), 2-28 October 1982 SEA/HLM/190 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and Laboratory practices in India (ICP ATH 001). 3 May - 26 July 1982 SEA/HLM/191 Dr Morris T. Suggs Assignment report on standardization of diagnostic material and laboratory prac- tices in Sri Ianka (ICP ATH 001) 3 May - 26 July 1982 SEA/HLM/192 Dr Zoltan Csizer Assignment report on development of health SEA/Vaccine/lOl laboratory services in the Institute of public Health, Dhaka, ~angladesh (BAN ATH 001), 28 December 1981 - 27 October 1982 sEA/HLM/19 3 Dr S. Raffaelli Assignment report on Unit for Manufactu- ring Sterile Infusion Fluids in Sri Lanka (evaluation of the project document) (SRL PHB 003), November 1982 SEAIHLMl194 Dr kshyant D.Banker Assignment report on standardization and quality control of biologicals in Burma (BUR ATH 0031, 25 October - 14 December 1983 Health Literature SEAIHLTI15 Miss U.Dhutiyabhodhi Assignment report on the development of activities relating to health literature, library and information services (H~LLIS) network (ICP HLT 001), 29 December 1981 - 31 March 1982 SEA/HLT/16 Mr Michael Camel Report on second regional workshop on health science library network activities, Mw Delhi (ICP HLT 001), 10-20 August 1982 SEA/HLT/17 Khin met Htar Assignment report on HeLLIS activities in Nepal (ICP HLT 001), 13 October - 11 November 1982 SEA/HLT/18 Khin met Htar Draft plan for a national health sciences library and documentation centre in Nepal (ICP H1.T 001), 13 October - 12 November 1982 Health Ministers' Meeting SEA/HM Meet ./2 Regional Office Meeting of Ministers of Health of Countries of WHO South-East Asia Region, Dhaka, 21-24 September 1982 Health Manpower Development SEA/HMD/35 Dr David Metcalfe Report on the examination for diploma in family medicine, Post-graduate Institute of Medicine, Colombo University, Sri Lanka (SRL PTR 003), 26 February - 14 March 1982 SEA/HMD/36 Dr Andrew G. Penman Assignment report on the workshop on training methodology for the teachers of primary health care workers at the National Institute of Health Sciences, Kalutara, Sri Lanka (SRL PTR 004) 31 December 1981 - 20 January 1982 SEA/HMD/37 Dr J. Badenoch Assignment report on the Post-graduate Medical Institute, Colombo, Sri Lanka (examination for M.D.) (SRL PI?, 003), December 1981 SEA/HMD/38 Dr (Mrs) Sandra Iass Assignment report on evaluation of the examination system of National Board/ Consortium of Medical Sciences, Indonesia (IN0 EDS 0011, September-November 1981 SEA/HMD/39 Dr William P. Golden Assignment report on health manpower plan- ning and management: development of health management through training, Indonesia (IN0 SPM 001), 22 May - 21 July 1982 SEA/HMD/40 See SEA/EH/277 SEA/&lD/41 Regional Office Report of a consultation on management training in support of ~rimary health care, New Delhi (ICP EDS 001), 21-23 December 1981 SEA/ HMD/42 See SEA/HSD/~ 6 SEA/HMD/47 Mr J.A. Gleeson Assignment report on MD (~adiology) Part I and and I1 examination at Post-graduate Insti- Mr R.F. Farr tute of Medicine, Colombo, Sri Lanka (SRL PTR 0031, 15-31 August 1982 SEA/ HMD/48 Mr R.F. Farr Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003), 15-21 August 1982 SEA/HMD/49 Prof. A. Keith Mant SEA/ HMD/50 Regional Off ice SEA/ HMD/ 5 1 Dr P.N.V. Kurup SEA/Trad.Med./26 SEA/HWD/5 2 Dr T.H. Weller Dr J.B. Cooper Prof. E. Bencic Dr T.E. Oppe Health Services Development SEA/HSD/42 Regional Office SEA/HSD/~~ Regional Office sEA/HSD/~~ ~egiona 1 Off ice SEA/HSD/45 Dr A. van der Werff Assignment report on external examination for MD (forensic medicine) Part I1 examina- tion of the Institute of Post-graduate Medicine, Colombo, Sri Lanka (SRL PTR 003), 18 July - 2 August 1982 Report of the second South-East Asia Regional Conference on WHO Fellowships Programme with particular reference to its impact, New Delhi(1CP PTR 002), 4-8 October 1982 Assignment report on strengthening of the undergraduate programme of ayurveda physi- cians and on the development of manpower in traditional medicine in Sri Lanka (SRL PPS 001), 26 July - 28 October 1982 Assignment report on curricula and faculty development at the Faculty of Public Health, Mahidol University, Bangkok, Thailand (THA EDS 001), 23 October - 11 November 1982 Assignment report on MD (psychiatry) Part I1 examination in Post-graduate Institute of Medicine, Colombo, Sri Lanka (SRL PTR 004). 13-29 November 1982 Assignment report on National Institute of Preventive and Social Medicine, Dhaka, Bangladesh (BAN PTR 0051, 23 September - 22 December 1982 Assignment report on post-graduate medical education in Sri Lanka (SRL PTR 003), 2-14 January 1983 Assignment report on strengthening of surgical services in ~aldives (audiology and speech pathology) (MAV SPM 001), 7 November - 17 December 1981 Report of a regional consultation on regional collaborative activities in health, Mw Delhi, 5-8 July 1982 Strategies for Health for All By the Year 2000 National plans of action for implementation of strategies for Health for All By the Year 2000, May 1982 Assignment report on the basic structure of the national health system in Indonesia (IN0 SPM 001), ~~ril 1982 Prof. J.B. McKinlay Assignment report on case studies on team work in primary health care (ICP PTR 001), 6-30 July 1982 Dr C.A. Greatorex Assignment report on development of primary health care in Sri Lanka (ICP PTR 001), 18 October - 11 November 1982 Prof. S. Chatto- padhy ay Assignment report on strengthening of health services administration through training in planning(1CP SPM 003), 1 August - 29 October 1982 Dr A. Timmapaya Assignment report on country health pro- gramming, Burma (BUR CHP 001) ,21 September - 20 November 1982 Mr S.K. Mitra Prof. T.R. Anand Assigmnent report on health legislation in Bangladesh (BAN SPM 001), 6 April - 30 July 1982 Assignment report on planning and manage- ment of medical care for primary health care in Nepal (NEP SPM 001), 24 November 1982 - 4 January 1983 Regional Office Report of a regional workshop on primary health care in urban areas of the South- East Asia Region, New Delhi (ICP PHC 002), 10-14 January 1983 Mr R.A. Raitt Assignment report on functioning of thana health cwplexes in Bangladesh (BAN SPM 002), 23 February - 20 April 1983 Prof. Gananath Obeysekera Assignment report on rural health services and cornunity participation in relation to the national health system of the Govern- ment of Indonesia (IN0 SPM 001), 30 June - 7 September 1982 Regional Off ice Terminal report of the project "Development of Health Services", Bhutan (BHU SPM 001), 1972-1982 Health Statistics SEA/HS/168 Leprosy SEAlLepl85 See SEA/HSD/53 Dr J.M.H. Pearson Assignment report on rifampicin trial in leprosy control in Burma (BUR BVM 001), 10 May - 3 June 1982 Dr Anan C. Pa kdi Assignment report on leprosy control services in Indonesia (IN0 BVM 001), January-June 1982 Malaria SEA/Ma1/146 Regional Office Recornendations arising out of the techni- cal discussions on control and prevention of leprosy in the context of primary health care, held during the 35th session of the Regional Committee, 14-20 September 1982 Mr C.T. Tamondong Assignment report on leprosy rifampicin trial in Burma (BUR BVM 0011, September 1976 - August 1982 Regional Office Report on an inter-country workshop on the primary health care approach in the control of malaria in South-East Asian countries, New Delhi (ICP PHC 0021, 10-14 May 1982 Mr J.R. Cullen Assignment report on malaria control in Thailand (THA MPD 001), 24 April 1980 - 30 September 1982 Dr Willem J.O.M. Assignment report on manuals and curricula van Dijk for training in the control of malaria in the context of primary health care (ICP MPD 004), 25 October - 5 November 1982 Regional Off ice Report of a regional workshop on regional manpower requirements for planning and management of malaria control programme in the light of the revised strategy, Phuket, Thailand (ICP MPD 004), 4-9 October 1982 SEA/Ma 1 /I50 See SEA/Res./54 Maternal and Child Health SEA/MCH/156 Dr Vitura Sangsing Assignment report on development of maternal and child health services in Nepal (NEP MCH 003), December 1981 - February 1982 SEA/WCH 115 7 Dr 2. Slomko Assignment report on maternal and child health services in Mongolia (MOG MCH 003), 20 August - 20 December 1981 sEA/WCH/158 Prof. Ranjit Roy Assignment report on family health pro- Chaudhury gramme in Sri Lanka (SRL MCH 001), March 1981 - July 1982 SEA/MCH/159 Dr E.V. Sebastian Assignment report on maternal and child health in the context of family health in ~ndonesia (IN0 PPF 001), 2 August - 8 December 1982 SEA/ZH/~~O Dr Nossikov Assignment report on epidemiological surveys of maternal and child health problems in Mongolia (MCG KH 003), 5 September - 3 December 1982 Mental Health - SEA/Ment/ 71 Nursing sEA/Nurs/317 Regional Office Report to the Regional Director on the meeting on women in health and development (WHD) programme, New Delhi, 18-19 November 1982 Prof. Y.M. Karash Assignment report on maternal and child health in Mongolia (MCG MCH 003), 11 August - 11 ilecember 1982 See SEA/Nurs/322 Regional Office Report of the second meeting of investi- gators on collaborative study on mental health in primary health care, New Delhi (ICP HSR 001). 4-9 October 1982 Dr M. Jean Flaherty, Assignment report on preliminary survey on Dr Elizabeth Kudzma nursing education and nursing services in and Indonesia (IN0 PTR 002 and IN0 EDS 001) Mr Robert A. mitt 29 December 1981 - 8 February 1982 Prof. Mari Seedor Assignment report on nursing development in India (IND EDS 003), 31 December - 29 April 1982 Ms Felicitas A. Assignment report on introduction of health de la Cruz assessment in India (IND EDS 003) ,1 January - 27 April 1982 Ms Anne Church Assignment report on paediatric nursing in Bangladesh (BAN EDS 001), 27 November 1981 - 19 May 1982 Dr Ruth M. Harner Assignment report on teaching methodology and evaluation of nurse teachers in Irian Jaya, Indonesia (IN0 PTR 003), 7 June - 8 July 1982 Ms Sally Ann Bryan Assignment report on training in mental health (psychiatric nursing) in Indonesia (IN0 PTR 002), 2 August - 1 October 1982 Dr Vunvilai Assignment report on training course on Chandrabha hospital nursing service management and establishing a model in Indonesia (IN0 EDS 0021, 1 August - 29 September 1982 Mr M.W. Radrigo Assignment report on nursing manpower development, Irian Jaya, Indonesia (IN0 PTR 003), September 1981 - November 1982 Mrs Marita Hrllberg assignm men^ report on rrvlew of nurse teacher programme in Indonesia (IN0 EDS 001), 22 January - 17 February 1983 Mr Richard J. Wells Assignment report on oncology nursing in Safdarjang Hospital, New Delhi, India (IND EDS 003), 20 October - 18 December 1982 ktrition SEA/Nut/83 Dr David G. Fish Assignment report on nutrition research project in Maldives (ICP RPD 002), 1 February - 1 April 1982 Dr Kalyan Bagchi Dr Kalyan Bagchi Assignment report on nutrition in Burma (BUR MCH 0041, 1 March - 29 April 1982 Assignment report on nutrition cell and development of national food and nutrition policy in Bhutan (BHU SPM 001), 3 May - 1 June 1982 Ophthalmology SEA/Ophthal/51 Dr H.F. Renkema Assignment report on prevention of blind- ness in Nepal (NEP PBL 001). November 1981 - February 1982 Assignment report on prevention of blind- ness in Nepal (NEP PBL 001), January - April 1982 Dr Jean-Marc Schepens Dr S. Franken Prof. Erik Linner Assignment report on prevention of blind- ness in Nepal (NEP PBL 001), March-May 1982 Assignment report on assessment of glaucoma as a cause of blindness in Burma (ICP PBL 0011, 25 April - 12 May 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in India (ICP PBL 001), 18 March - 17 April 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in Nepal (ICP PBL 001), 18-24 April 1982 Prof. Erik Linner Assignment report on assessment of glaucoma as a cause of blindness in Thailand (ICP PBL OOl), 13-27 May 1982 Dr Yasufumi Emori Assignment report on development of appro- priate technology for low-cost vision aids in Sri Lanka (ICP PBL 001), 4 July - 30 October 1982 Dr Yasufumi Emori Assignment report on connnunity-oriented eye care programmes with specific reference to low-vision aids in India (ICP PBL 001), 5-31 July 1982 Dr Yasufumi Emori Assignment report on development of appro- priate technology for low-cost vision aids in Burma (ICP PBL 0011, 4 July - 3 October 1982 SEA/Ophthal/61 Dr Albert Kilstad Assignment report on prevention of blindness in Nepal (NEP PBL 001), 12 September 1980 - 31 December 1982 SEA/Rad/l16 Dr F. Cengic Assignment report on strengthening of radir logicalfiealth services administration in DPR Korea (KRD ATH 001), 24 September - 24 December 1982 Rehabilitation SEAIRehabl49 Dr W.G. Rama Rao Assignment report on training and rehabilita- tion of the disabled in Burma (BUR ADR 001), 16 November - 15 December 1982 SEA/Rehab/50 Dr J.H. tbble Report of the proceedings of an inter-country workshop on rehabilitation of the disabled in the comunity, New Delhi (ICP ADR 001), 13-18 December 1982 Research Study, Research Raining, etc. SEA/Res./50 Regional Office Report of the second meeting of the working group on the overall management of WBO colla- borating centres in South-East Asia Region, New Delhi (ICP RPD 001), 20-22 May 1982 SEAIRe s. 151 Regional Off ice Report of the working group meeting on - (a) implications for Member Countries of the varying emphasis given to various types of research including basic research, and (b) training in research management, Bali, Indonesia (ICP RPD 001), 9-12 August 1982 SEA/Res./52 Regional Office Report of the third meeting of the Directors of Medical Research Councils or Analogous Bodies and Concerned Research Foci in the relevant ministries, Chiang Mai, Ihailand, 13-18 December 1982 SEAIRe s.153 Dr R.S. Verma Assignment report on biomedical research at ~~~/~ancer/50 the Cytology Research Centre, New Delhi (IND RPD 001), 15-27 December 1982 SEA/Res./54 See SEA/Mal/l50 SEA/Res./56 See SEA/EH/286 Sexually-Transmitted Diseases ( STD) SEA/STD/ 32 Prof. A.Z. Meheus Assignment report on control of sexually- transmitted diseases in Indonesia (IN0 BVM 0011, 12 August - 15 September 1982 Traditional Medicine SEAIRad. Med.121 Hakim Mohd. Abdul Razzack SEA/Trad. Med.122 nr P.N.V. Kurup SEAIRad. Med.123 Dr P.N.V. Kurup SEAlTrad. Med .I24 Dr Bhagwan Dash SEAITrad. Med.125 Regional Office SEAITrad. Med.126 See SEA/HMn/51 Tuberculosis SEAlTBl169 Dr S. Kudoh SEAITBI170 Prof. D.A.Mitchison Vector-borne Disease Control SEA/VBC/16 Dr A1 lan Barnes SEAlVBCl17 Dr R. Iyengar SEA/VBC/l8 ~r H.A. Rafatjah Assignment report on traditional system of medicine in Bangladesh (ICP PHC 004). 25 January - 24 February 1982 Assignment report on primary health support services programme in Nepal (traditional medicine) (NEP PHC 002), 29 December 1981 - 13 March 1982 Assignment report on traditional medicine in Nepal (ICP PHC 0051, 11 May - 24 June 1982 Assignment report on traditional medicine in Mongolia (ICP PHC 004), I3 July - 14 September 1982 Report of a regional workshop on involvement of practitioners of traditional medicine in primary health care, New Delhi (ICP PHC 004), 30 August - 3 September 1982 Assignment on tuberculosis laboratories in Indonesia (IN0 BVM 001), 4 July - 3 August 1982 Assignment report on lhberculosis Research Centre, Madras, India (IND BVM 0021, 16-29 November 1982 Assignment report on vector-borne disease control in Burma (BUR VBC OOl), 27 December - 5 March 1982 Assignment report on vector-borne disease control programme in Burma (BUR VBC 001), 15 November 1979 - 14 November 1982 Assignment report on mosquito/vector control in Colombo City and a popular approach towards malaria control in Sri Lanka (SRL VBC 002), 24 September - 14 October 1982
Annex 7 IR/ IRP ADR 114 EUlICP ADR 1151 RB.82 SEIICP ADR 0011 RB.82 IRJ IRP CMB 006lFF IRI IRP DGP 1001 RB .82 SElICP MPD 0041 DP.83 SElINO MPD 0011 RB.82 IRI IRP PHC 0411 FZ.82 SEINEP PHC 0011 RB.82 SE/Mffi OND 0011 RB .82 SEfIND ATH 0051 IR/ IRP PPF 013 1 82.32 SEIICP SPM 0021 RB .82 EUIICP ADR 1151 RB.82 SEIICP DGP 0181 RB .82 IRIIRP BVM 2441 VC.82 INTER-REGIONAL ACTIVITIES OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION (1 June 1982 - 31 May 1983) Title - Workshop on Education and Raining in 6 (1 from Bangladesh, Health Care of the Elderly, Singapore 2 from India, (26-29 January 1983) 1 from Indonesia, 1 from Sri Lenka, 1 from Thailand) Second Meeting of the Health Resources 2 (1 from Bangladesh, Group Preparatory Committee, Geneva 1 from Sri Lanka) (10-11 February 1983) Ninth South-West Pacific Malaria Meeting, 2 from Indonesia Sydney (14-17 February 1983) Workshop on Training of Trainers for 3 (1 from India, Malaria Workers, Kuala Lumpur (4-15 April 1 from Indonesia, 1983) 1 from Thailand) Interregional Seminar on Primary Health 6 (2 from Maldives, Care, Yexian County, China (13-26 June 2 from Nepal, 1982) 2 from Thailand) Inter-regional Training Courae and Study 2 (1 from India, Tour on Nuclear Medicine, Moscow 1 from ~ongolia) (1 September - 31 October 1982) Inter-regional Workshop on Health 2 (1 from India, Statistics for Primary Health Care, 1 from Sri Lanka) Beijing (18-29 October 1982) Interregional Workshop on Health 3 (1 from DPR Korea, Planning for the Elderly, Budapest 2 from Sri Lanka) (8-12 November 1982) Interregional Workshop on Planning and 5 (2 from India, Management of National CDD Programme, 2 from Sri Lanka, Taiyuan, China (18-28 August 1982) 1 from Thailand)