.> THE ANNUAL REPORT OF THE DIRECTOR-GENERAL OF HEALTH 1971·2
COMMONWEALTH DEPARTMENT OF HEALTH
II! .,.;;,;.J Annual Report Director-General of Health 1971-72
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AUSTRALIAN GOVERNMENT PUBLISHING SERVICE CANBERRA 1972
Published for the Commonwealth Department of Health by the Australian Government Publishing Service.
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Printed by Waite & Bull Pty. Ltd., Sydney.
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Contents
Introduction Hospital Insurance and Benefits Medical Insurance and Benefits Pharmaceutical Benefits Policy Secretariat and Legislation Planning and Research Establishments and Finance Automatic Data Processing Divisional Offices Northern Territory Health A.C.T. Health Quarantine Tuberculosis Public Health Therapeutic Substances National Biological Standards Laboratory Commonwealth Health Laboratories Commonwealth Acoustic Laboratories Commonwealth Radiation Laboratory Commonwealth Bureau of Dental Standards School of Public Health and Tropical Medicine Institu te of Child Health International Health National Health and Medical Research Council Commonwealth Grants National Fitness Appendix 1 - Statistics Appendix 2 - Publications Directory of Senior Officers < ,
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5 12 17 20 26 29 31 33 36 40 47 57 65 69 75 79 84 86 90 93 95 101 103 108 112 114 116 165 172
Senator The Hon. Sir Kenneth Anderson Minister for Health Commonwealth of Australia 1 present herewith my report of the activities of the Commonwealth Department of Health for the year ended 30 June 1972.
W. D. Refshauge Director·General of Health September 1972 Canberra, A. CT.
Introduction The year 1971-72 -- a year which marked the beginning of the Department's second half-century -- saw a steady continuation of the process of evolution which has characterised national health administration in Australia in recent years_ Changing patterns in many spheres of health presented new challenges to be met by the Department. The administration of the National Health Act, with its accompaniment of debate and investigation and the search for improvement, was again an important factor in the year's activities_ Many sections of the Act came under examination during the year and some major changes were introduced. In the hospital insurance sphere, for instance, several of the main recommendations of the Nimmo Enquiry into Health Insurance were implemented. With the co-operation of State authorities, the hospital insurance scheme was rationalised by confining benefit tal ~es to the level of hospital fees in force in the States, and by limiting benefits to 100 per cent of the charge. Benefit organisations were also required to introduce a rule preventing membership in more than one fund. Four States - Victoria, South Australia, Western Australia and Tasmania introduced a comprehensive fee system covering the cost of accommodation, treatment and ancillary items, while New South Wales was to introduce a similar system on I July 1972. In South Australia and Tasmania, the hospital insurance funds were able to introduce special tables to cover the cost of private hospital charges, and consideration of a private hospital table in other States was under review. In the medical benefits sphere, there was much debate throughout the year on the most common fee concept. The Department, in conjunction with health benefits organisations, monitored the State-by-State observance levels of the most common fees for medical services. A significant decline in the level of observance for general practitioner surgery consultations and home visits in New South Wales was demonstrated in the monitoring process_ Subsequently, the Government decided to initiate an inquiry into the fees to be adopted for the purpose of medical benefit payments for general practitioner surgery consultations and home visits in New South Wales_ Mr Justice Kerr, of the Commonwealth Industrial Court, was initially appointed to conduct the inquiry. Mr Justice Kerr was subsequently appointed as Chief Justice of New South Wales, and Mr Justice Mason, of the New South Wales Court of Appeal, took over the inquiry. After hearing evidence from interested parties, Mr Justice Mason determined the fees which he considered were fair and reasonable for these two services for the purpose of the National Health Act for the period I July 1971 to 30 June 1973 for . New South Wales_ Following Mr Justice Mason's report, its acceptance by the GoverJUllent, and subsequent consultations with the Australian Medical ASSOCiation, the Medical Benefits Schedules were being amended as from I July 1972 to increase the most common fees and Commonwealth benefits in each State by twenty cents for a general practitioner surgery consultation and forty cents for a home visit. Commonwealth benefits were to be increased by amounts equivalent to the rises in -
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the common fees so that the 'gap' between the levels of benefit payments and the most common fees would remain unchanged. No changes in medical fund benefits or fund contributions were involved. Apart from the inquiry by Mr Justice Mason, the process of revision and up-dating of the Medical Benefits Schedule continued throughout the year, and a number of amendments were made from I July 1971, I November 1971 and I February 1972. The I July 1971 amendments incorporated the increases in most common fees and benefits for general practitioner surgery consultations and home visits detailed in my report for 1970-71. Amendments were made also in other spheres covered by the National Health Act, including nursing home benefits. Benefits for nursing home patients were raised by $1.50 a day as from 21 October 1971, increasing the benefit payment for patients receiving ordinary care to $3.50 a day and for those receiving intensive care to $6.50 a day. Examination of the nursing home benefits area was still continuing at the end of the year. Vigorous efforts were made in the area of Subsidised Health Benefits to increase the enrolment of eligible people, especially low-income families and newly-arrived migrants, and to improve some aspects of the Plan.
Pharmaceutical Benefits In the pharmaceutical benefits area, the Pharmacy Guild of Australia in April 1972 accepted the Government's offer of an increase of seven cents in the fees payable for the dispensing of pharmaceutical benefits. The increase was made retrospective to I January 1972. The Government also agreed to a new inquiry into chemists' earnings, costs and profits, and an associated annual updating procedure. The Select Commi ttee of the House of Representatives on Pharmaceutical Benefits - established in 1970 to review all aspects of the scheme - completed its public hearings and tabled its report in the House on 25 May 1972. The report made a wide variety of recommendations concerning the prescribing, supply and manufacture of pharmaceutical benefits. It also expressed concern at the continuing rise in the usage of drugs in Australia. The continued sharp increase in expenditure on pharmaceutical benefits experienced in the preceding three years had been a source of concern, and the Government announced in the 1971-72 Budget that the level of patient contribution for each supply of a pharmaceutical benefit was to be itlcreased from 50 cents to $1.00 from I November 1971. In spite of this, the overall cost of the scheme showed a further increase during the twelve month period, although the rate of increase diminished. The total cost of providing benefits, including the patients' contribution on general benefit prescriptions, was $208.7 million during the year. compared with $184.7 million during 1970-71. Some of the increase was accounted for by changes in the list of benefits, increases in the prices of drugs and increases in the professional fees paid to chemists. Despite an increasing awareness within the health professions, and by the public generally, that Australians consume a large amount of pharmaceuticals, there is as yet no firm evidence to suggest that the peak of the usage graph has been reached. The available figures indicate that the rate of prescribing of pharmaceutical benefits for people other than pensioners may be levelling off - 4.17 prescriptions per head during 1971-72 compared with 4.29 per head the previous year. This may be related to the increase in the patient contribution for benefits. With pensioners, however, there has been no such levelling off. The annual average of prescriptions dispensed for pensioners during 1970-71 was 18.69 per head. In 1971-72, the figure was 19 Al per head.
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COMMONWEALTH EXPENDITURE ON NATIONAL HEALTH BENEFITS 1971-72
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Pensioner
$27.8m
National Health expenditure Overall, Commonwealth expenditure on National Health benefits showed a further significant increase in 1971-72, rising by $97.1 million to a total of $496.2 million. Expenditure on pharmaceutical benefits (not including the patients' contribution on general benefit pres~riptions) rose by $13 million to $173.3 million, on nursing home and handicapped children's benefits by $21.1 million to $71 million, on hospital benefits by $18 million to $91.4 million, on medical benefits by $37 million to $132.6 million and on the Pensioner Medical Service by $7.9 million to $27.8 million. This expenditure, together with expenditure on grants and health services, involved the Department in the supervision of $582 million during the year. Quarantine Outside the benefits area, the Department's other divisions and branches faced a heavy workload throughout the year. In the Quarantine division, for instance, the large numbers of ships and aircraft continuing to arrive from overseas maintained the pressure on staff involved in the health clearance of incoming passengers. But in spite of disease outbreaks overseas, notably a smallpox epidemic in Yugoslavia, no cases of human quarantinable disease were recorded in Australia. However, the epidemic served as a sharp reminder that smallpox remains a threat to all countries, and that health authorities must maintain continuous quarantine vigilance. The vigilance of the Animal Quarantine Branch helped keep Australia free of exotic animal disease during the year. The branch took prompt action in March this year when it was notified of an outbreak of strangles - an upper respiratory tract infection - among a shipload of 172 horses from Britain, and the animals were quarantined on arrival. All affected horses responded to treatment and were released from quarantine after three weeks. Earlier, a ban had been placed on the importation of horses into Australia via the Panama Canal because of an outbreak of Venezuelan equine encephalomyelitis in -
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Texas, Mexico and Central America. However, the quarantine ban on the importation of dogs and cats into Australia from the United Kingdom, which had been in force since October 1969, was lifted on 12 July 1971. These animals can now be imported provided they fulfil certain residential conditions in the United Kingdom first. Further consideration was given during the year to the establishmen t of a high security animal quarantine station which could be used to import livestock from a larger number of overseas countries. In August 1971 a working party visited Norfolk Island to investigate the possibility of establishing such a station. The proposal for a station there is now receiving close attention. The activities of the Plant Quarantine Branch have become increasingly international in scope, particularly in the South-East Asian and Pacific spheres. Another highly successful course in plant quarantine methods for foreign students was held in Australia from October to December 1971, attracting twenty students from thirteen countries. The Branch is also assisting the Indonesian Government to develop its plant quarantine service.
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Anti-smoking programme The Department's involvement in the comparatively new area of behaviour-based health problems continued to grow, and towards the end of the year a new commitment - a national educational programme on the dangers of cigarette smoking - was undertaken in conjunction with State health authorities. The Government decided in April 1972 to amend the Broadcasting and Television Act to require that all radio and television advertisements for cigarettes or cigarette tobacco be accompanied by a health warning statement. The amending legislation was passed by Parliament in June 1972 to operate from a date to be proclaimed. GROWTH OF COMMONWEALTH SPENDING ON NATIONAL HEALTH BENEFITS 1966-67 TO 1971-72 ...- - - - - - - - - 180 .
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Year ended 30 June
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: Hospital Benefits
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67';'869 7071 72
Pensioner Nursmg Home Medical Service Benefits
Medical Benefits
Pharmaceutical Benefits
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The Government also decided to make $500,000 a year available for the next three vears for an educational programme. The Department will be responSible for the development and implementation of the programme in conjunction with State health authorities.
Drug education campaign The National Drug Education Campaign continued in vigorous fashion, with emphasis in the past year on the involvement of youth in efforts to overcome the drug problem in Australia. The Drug Education Sub·Committee of the National Standing Control Committee on Drugs of Dependence promoted activities on both national and State levels to involve youth in education programmes. Seminars for young people were conducted by health authorities in all States and Territories, culminating in a national seminar conducted by the Department in Canberra in May this year. Another national seminar arranged by the Department involved representatives from the mass media throughout Australia, who discussed the best ways and means of reporting on drug abuse problems. Drug safety Another aspect of the Department's concern about drugs was highlighted during the year when the anti·depressant drug Imipramine was reported as being a possible cause of congenital abnormalities. This focussed attention on the work of the Australian Drug Evaluation Committee, which was able to allay public fears as well as international concern, but at the same time warned that doctors should exercise care in prescribing any psycho·active drug during pregnancy,.. The Department reinforced the warning by sending telegrams to all Australian doctors.
Tuberculosis The tuberculosis control campaign continued its successful course throughout the year, with a further reduction in new notifications and reactivations. The Australian mass X·ray campaign has undergone substantial modifications in recent years. The minimum age of those liable for X·ray has risen to twenty·one years (twenty·five in Western Australia), while the interval between surveys is now between three and four and a half years (according to incidence of disease in the area) instead of the annual X·ray iniiially aimed for. Surveys have not only detected tuberculosis in an early stage but have also identified high risk groups for special attention. In addition, as a bonus, they have detected many thousands of cases of other diseases including cancer, bronchiectasis and heart lesions. The continuance of the surveys has been recommended by the National Tuberculosis Advisory Council while public health benefits result. In some States, only a small percentage of cases is now detected by the mass X·ray services, and in these States we can look forward to a suspension of services at least temporarily. It would appear that the nex t five to six years will see a phasing out of surveys in some areas and substantial modifications in others.
Pesticides survey In the public health field, a highlight of the year was the pUblication of the results of the 'Market Basket' Pesticides Survey, which had been conducted by the Commonwealth and State Departments of Health under a grant from the National Health. and Medical Research Council. The survey showed that the average AustralIan does not consume pestiCides in excess of 'safe' levels laid down by expert commIttees of the World. Health Organisation and the Food and Agriculture Orgamsatlon. There was eVIdence, however, that residues of HCB (a seed dressing for wheat) and dieldrin which may occur could be a potential health hazard and the CounCIl recommended stringent controls over the two substances. ' 9
Enviro nmenta l health The Department is vitally concerned with the maintenance and enhanc ement of the environment, and a significant development in this area was the achievement by July 1971 of a voluntary changeover by detergent manufa cturers from non-biodegradable to biodegradable synthetic detergents. This followed a recommendation in 1969 by the National Health and Medical Researc h Council. The achievement has already resulted in a significant reduction in pollutio n of rivers and streams because sewage plants are now able tD operate with greater efficiency. An Environmental Health Section within the Public Health Branch has assumed full responsibility for providing secretarial assistance to the appropriate committees of the National Health and Medical Research Council. The section is also providing advice to other Departments and organisations on matters concerning human health and the environment.
Medical research The National Health and Medical Research Council continu ed its functio n of advising the Commonwealth and State Governments on a wide range of matters relating to health, medical and dental care, and of allotting funds for medical research. In June 1972, the Government approved a substantial increase in these funds for the next triennium. A total of $13.5 million has been made available, an increase of $6.5 million over the amount available in the last three years. During the year, the Council continu ed its inquiry into multiph asic health screening services. An expert sub-committee was established to report on the feasibility of evaluating the different areas of multiphasic health screenin g which are, or are likely to be, used in Australia.
Territory services The Departm ent's work in the Norther n Territory and the Austral ian Capital Territory was marked by a further steady expansion during the year. In the Norther n Territor y there was a concent ration of activity in the rural health field, particularly in relation to morbid ity among Aboriginal people. A notable advance in this field was the opening in February this year of a Child Health Unit in Alice Springs where children - mainly Aborigines - are being given convale scent and nutritional care after discharge from hospital before returning to their homes. An improved heal th service is now being provided for the expanding popUlation of the East Arnhem area, following the completion of an aircraft hangar at Gove and the stationing of an Aerial Medical Service aircraft there. Stages one and two of the Gove District Hospital at Nhulunbuy were handed over during the year, providing sixty-four beds for residents of the area. Since November 1971, trained nursing assistance has been provided at a number of Territory Welfare settlements, and at present ten sisters and one registered nursing aide are statione d at vanous locations. Plans are well advanced to provide houses and four-wh eel dnve vehIcles for rural health sisters at Wave Hill and Borroloola, to prevent interrup tion to health services caused by the wet season. . . . An inquiry into health services in the Norther n Territor y, which began 111 Apnl 1972, was still continuing as the year ended. . In the Australian Capital Territory, there were Significant de~elop ments III the planning and development of hospital services. The functlOnal bnef for a proposed health complex in the Belconnen area of Canberra, to IIlclude a large general hospital, was finalised, while the commlsslOlllng of stage one of the Woden VaJley Hospital continu ed on schedule. In addition, an agreement for the constru ctIon of a 300.bed private hospital, to be run by the Little Company of Mary, was signed III October 1971, and the Government approved the development of stage two of a
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hospital services complex which will provide a central linen and sterilising service for hospitals and other health services in the A.C. T. In May this year, the Government announced its agreement in principle to the establishment of an independent statutory authority to manage, control and administer Government hospital, health and ancillary services in the A.C.T. A further detailed examination of the matter is now under way.
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Ho sp ita l Ins ura nc e an d Be nef its The rationalisation of the hospital insurance scheme, based on the recommendations of the Nimmo Commi ttee of Enquiry into Health Insurance, continu ed in 1971-72. As a result of the implem entation of a number of major recommendations, further improvements have been made for member s of hospital benefits funds. The Departm ent continu ed to encourage State hospital authorities to adopt the principle of all-inclusive fee charging for public hospitals - that is, the charging of a single daily rate with no separate charges for individual extra services (apart from radiology and pathology, which are covered under the medical benefits scheme). State authorities in New South Wales and Queensland continu ed to charge separately during ~he year for individual services to patients in the interme diate and private wards of public hospitals. The benefits for treatme nt in these wards (and in private hospitals in the two States) were aligned with the charges prescrib ed by the State authorities. However, towards the year's end, the New South Wales Government announced the introdu ction from I July 1972 of a new system involving a daily charge made to cover both accomm odation and miscellaneous hospital services for both private and interme diate patients. As in Victoria, a compon ent of $2 a day was to be included in the ward charges in lieu of separate charges for extra services. During the year, all States and the Australian Capital Territor y increase d their public hospital fees - Tasmania on I July 1971, New South Wales, Victoria and the A.C.T. on I August, South Australia and Western Australia on I Septem ber and Queensland on 1 November. Hospital benefits funds in each State (with the excepti on of those in South Australia, which had already done so on I March 1971) re·struc tured their hospital tables, replacing the former multiple table system with tables matching the various increased ward charges. Contrib utors were automatically up-graded to tables which provided a corresponding level of cover to that for which they had been insured. In determining contrib ution rates to meet the new benefit levels, the Government was concerned that the reserves held by funds be taken into account , and the funds were directed as to the rates to be charged. For New South Wales funds, the following conditio n of registration under the National Health Act was applied: 'That the organisation will cause such alterations to be made to its rules as are necessary to enable it to comply with any direction given to It by the Mll1lster in relation to the fund benefits to which all or any of its contrib utors are entitled m respect of charges for services provided whilst inpatien ts in hospital'. Fund benefits were also limited so that they could not exceed the actual charges made by hospitals. Previously (with the excepti on of Western AustralI a) benefits were paid at the full insured rate, regardless of whether or not they exceeded the hospital charge. The only exception to this rule IS m Queensland, where free publIc ward treatme nt is available. In the interests of provldmg an mcentlV e to voluntary health insurance in Queensland, a fund benefit of $4 a day was approved for insured patients hospitalised in public wards. 12
Benefits organisations were also required to introduce a rule precluding from membership a contributor or dependant already insured or covered by membership of another hospital benefits organisation. The one exception to this requirement was again Queensland, where dual membership was allowed up to the end of the financial year, pending the introduction of a private hospital table. Because of all these factors, the increases in contributions needed to provide the higher benefit payments were minimised. In New South Wales, for example, the contribution rates of the two major funds for public ward hospital coverage were Lt,c;d on a contribution benefit ratio of 1: 16 - that is, 10 cents family cCilltribution per week for each $1.60 per day fund benefit. This was an improvement on the previous ratio of I: 12, or 10 cents for each $1.20. As a result, contributors now receive significantly greater value for their contributions. While the public ward hospital fee rose by fifty per cent, the equivalent hospital insurance contribution rose by only seventeen per cent. Weekly family contribution rates for the major funds in each State are shown below: N.S.W. Public Hospital Ward: Public or Standard Intermediate Private Private Hospitals VIC. QLD. S.A. 92c $1.28 $1.60 $1.90 W.A. $1.05 $1.65 TAS. 70c $1.00 $1.20 $1.70
82c 80c $1.28 $1.30 $1.52 $1.75
80c 98c
Private hospital insurance During the year, considerable progress was made towards arranging insurance sufficient to cover private hospital charges. In this regard, a significant development was the emergence of the National Standing Committee of Private Hospitals as a national body representing private hospitals. This Committee speaks for 213 hospitals throughout the Commonwealth which together have more than eighty-one per cent of the private hospital bed capacity. Its aims are to rationalise fee-charging poliCies and stabilise fees in order to facilitate the provision of hospital benefits for private hospitals. In Queensland, negotiations with representatives of private hospitals and the hospital benefits funds have resulted in a move towards an all-inclusive charging system for private hospitals and in the extension of benefits from the public hospital private ward table in a way which will cover charges made for 82 per cent of private hospital beds in the State. The additional benefits of $9.00 per day payable for services on and after I July 1972 will require no increases in contributions. Special benefits will be paid for the limited number of extra services involving extra charges. In Western Australia, the majority of private hospital charges are covered by benefits available under the public hospital/private ward table. In Tasmania, agreement was reached to provide increased hospital benefits of $2 a day, without any increase in contributions, to meet increases in basic private hospital charges from $30 to $32 a day. Negotiations are proceeding in New South Wales and Victoria with private hospitals and hospital benefits funds regarding the position of private hospitals in the hospital benefits scheme. Attention has been given to the problems of contributors who receive hospitalisation while temporarily absent from their State of residence. Organisations have agreed to introduce a rule whereby a contributor who is insured for a particular level of public hospital cover is fully covered against the costs of bemg hospltahsed at an equivalent standard whilst temporarily in another State. 13
Special account arrangements Expenditure under the special account arrangements continued to increase in 1971/72. The amount reimbursed to the organisations during the year was $30,986,348 compared with $19,604,794 in 1970/71. This represents an increase of 58 per cent. It is expected that the special account expenditure will again increase in 1972/73 when the full effects of the increased hospital charges introduced in 1971/72 will be experienced (benefits for special account contributors have increased in line with the increased hospital charges). Special account contributors are guaranteed payment of hospital benefits at the full rates for which they are insured. The importance of this assistance to insured persons can be gauged by the fact that in 1971/72 the Commonwealth payment was equivalent to 15.8 per cent of total fund benefits paid by organisations.
Report on benefits organisations All benefits organisations are now required under Section 76A of the National Health Ad to provide annual returns with separate information, on each fund they are registered to operate. Under the Act, information is required on eight specific items relating to the financial operations of the funds, covering contributions and other amounts payable to the fund, benefits and other amounts payable out of the . fund, management expenses, the balance of funds at the end of the year and details of the investment of reserves. Provision is also made under the Act for the inclusion of 'such other information as the Minister requires to be included'. The report for the year ended 30 June 1971 was tabled in the Senate on 18 May 1972 and in the House of Representatives on 23 May 1972.
Subsidised Health Benefits Plan The Subsidised Health Benefits Plan, which helps low-income families, Social Service beneficiaries receiving unemployment, sickness or special benefits, and newly-arrived migrants with the costs of health insurance, was amended during the year to provide beneficiaries with concessions on pharmaceutical benefits. This followed the Government decision in the 1971 Budget to increase the patient contribution for these benefits from 50 cents to $1.00. As from 1 November 1971, beneficiaries under the Plan continued to pay 50 cents for each benefit prescription. The income eligibility limits for low-income families were raised follOWing the increase in the Commonwealth minimum wage granted by the Commonwealth Conciliation and Arbitration Commission. The current levels of assistance, effective from 5 June 1972, are: (a) weekly gross income not exceeding $51.50 - no contributions payable to a health benefits fund; (b) weekly gross income exceeding $51.50 but not exceeding $54.50 - one third of normal contributions payable; and (c) weekly gross income exceeding $54.50 but not exceeding $57.50 - two thirds of normal contributions payable. The eligibility limits for applicants of penSionable age, which are expressed on a 'means as assessed' basis, were raised by eqUIvalent amounts. Expenditure during the year in connection with the Plan totalled $9,886,494, comprising $7,925,683 for hospital benefits, $1,725,680 for medical benefits and $235 131 for pharmaceutical benefits. Si~;ce the inception of the Plan on 1 January 1970, the number of people availin themselves of the assistance offered has been kept under, reView, and action ghas been taken to ensure that as many eligible people as pOSSIble are made aware of their entitlement to subsidised health benefits. Dunng the past year 14
publicity material on the Plan was circulated on an even wider basis. Pamphlets advertising details of the Plan are now available from chemists, hospitals, doctors, health benefits organisations and the Commonwealth Departments of Labour and National Service, Social Services and Health. Other action taken to publicise the Plan includes the circulation of printed material with child endowment payments and negotiations with the Australian Council of Trade Unions seeking the Council's assistance in informing its members of the availability of subsidised health benefits. As a fnrther aid to newly-arrived migrants in the community, the Plan was advertised in thirty-six foreign language newspapers published in Australia. Preparations are also under way to print pamphlets on the Plan in ten foreign languages. Early in 1972 the Department decided. to adopt a new approach to increase public awareness of the Plan. A pilot campaign of intensive publicity was conducted in the Wollongong area. As a result of the campaign, it was concluded that, in addition to the normal media advertising, personal counselling by social workers and other people in contact with potential beneficiaries should be utilised to a far greater extent. This approach is being considered further in conjunction with the Australian Council of Social Service. During the year, administrative changes were introduced, aimed at improving the operation of the Plan. The application form, used by people on low incomes when applying for assistance, and the entitlement certificates issued by the Department of Social Services to eligible people, were simplified. A.D.P. procedures are also being applied to the Plan's operation, by the use of a computer·printed index of beneficiaries. This should assist the Department in the verification of claims made by organisations for medical and hospital benefits paid under the Plan.
Registration Committee The Registration Committee is required to examine, report on and make recommendations to the Minister on applications for registration, on suspension or cancellation of medical and hospital benefits organisations, and on changes to contributions. benefits and conditions of payment of benefits. The Committee met 35 times during the year to consider 403 proposed rule amendments and the accompanying detailed submissions on the financial implications for the funds of the proposals. During the year one medical and hospital benefits organisation was registered while one medical and hospital benefits organisation and one hospital (only) organisation were de-registered.
Nursing Home Benefits Benefits for Ilursing home patients were increased as from 21 October 1971. For patients receiving ordinary nursing home care, benefits rose from $2 to $3.50 a day or $24.50 per week. Benefits for patients receiving intensive care, who receive a supplementary benefit of $3.00 per day in addition to the ordinary benefit, increased from $5 per day to $6.50 per day or $45.50 per week. As announced in October 1971, the increase was an interim measure, pending completion of a review of the present arrangements relating to the care of, and assistance to, those requiring nursing home treatment. This review is continuing with the aim of introducing new long-term arrangements as soon as it is practicable to do so. As an integral part of the review, the Nursing Home Section undertook a survey of nursing home fees throughout Australia beginning in February 1972. The information obtained from this survey is to be used in the Government's assessment of the adequacy of the existing arrangements. In 1971/72 the Commonwealth paid an amount of $70,592,804 ($47,638,764 ordinary benefit and $22.954,040 supplementary benefit) for patients in nUrsing
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homes. The benefits are paid to the proprietor of the nursing home who is required to offset the appropriate amount against the total nursing home charge to the patient. As at 30 June 1972, there were 1,230 approved nursing homes and 51,286 approved beds in Australia.
Handicapped Children's Benefit A Commonwealth benefit of $1.50 a day is payable in respect of each handicapped child, under the age of 16 years, accommodated in approved handicapped persons' homes conducted by religious or charitable organisations. At the close of the year there were 49 approved handicapped persons' homes in Australia. Commonwealth Health Insurance Council The Commonwealth Health Insurance Council met in Canberra on 17 and 18 November, 1971. The functions of the Council are to advise the Minister for Health on rna tters relating to the hospital and medical benefits schemes and to recommend means by which improvements in methods and standards may be effected. At the meeting, the Council discussed a wide range of matters, including introduction of private hospital tables, portability of benefits, possible extension of hospital insurance into the nursing home system, more effective contributor representation on management boards, community rating, hospital benefits for newly-born children, the Subsidised Health Benefits Plan and special account arrangements. New developments Under the present provisions of the National Health Act. Commonwealth benefits are not payable for newly-born children who occupy a bed in the same hospital as the mother. This proviSion reflected the charging policy of hospitals, which generally did not levy a charge for the baby. Recently, however, some hospitals have begun to charge separately lor babies receiving intensive care in special intensive care units. From the viewpoint of the contributor this is an unsatisfactory situation, and the Department is currently undertaking an investigation into ways in which insured people can continue to receive adequate benefit protection. Another matter under consideration concerns a recommendation of the Nimmo Committee, that the honorary system for the provision of medical services in hospitals be abolished. Although the abolition is generally favoured, the major problem concerns the method of payment for such services. This question has been the subject of discussions between the Commonwealth and State Governments during the year and has involved the Branch in much detailed investigation.
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Medical Insurance and Benefits This was the second year of operation of the new Health Benefits Plan under which medical benefits are closely related to the most common fees charged by doctors. Because the success of the scheme depends on the substantial observance of these fees by the medical profession, another continuing survey was made during the year of the level of observance. The survey covered a large proportion of contributors' claims handled by the principal medical benefits organisations in each State. In general terms the patterns of observance were stable for States other than New South Wales, where there was a substantial decline in the level of observance for general practitioner surgery consultations and home visits from the September quarter 1971 onwards.
Inquiry into G.P. fees in New South Wales This led to the establishment of an inquiry into the fees to be adopted for general practitioner surgery consultations and home visits in New South Wales for the purpose of the medical benefits scheme. The Government initiated the inquiry because it was concerned that a large proportion of patients in that State were not receiving the degree of protection which the reconstruction of the Medical Benefits Scheme in July 1970 was designed to provide. The scheme had proved successful in all other States and a satisfactory insurance cover had also been achieved in New South Wales except in relation to general practitioner surgery consultations and home visits. The decline in observance began after fees for these services were increased on 1 July 1971. The Federal Council of the Australian Medical Association had advised the Minister for Health in April 1971 that the common fees on which benefits should be based for New South Wales from 1 July 1971 were $3.80 for a general practitioner surgery consultation (Item 1 of the Medical Benefits Schedule) and $5.05 for a general practitioner home visit (Item 4). The Medical Benefits Scheme aims to ensure that contributors should not be required to meet more than eighty cents of the cost of an Item 1 service or more than $1.20 of the cost of an Item 4 service where the common fee is charged, and accordingly the Government increased benefits as from 1 July 1971 to meet this objective. Table 32 on page 136 shows the marked deterioration in the level of observance which occurred in New South Wales after that date. It was evident that a substantial number of general practitioners were charging fees higher than those which the A.M.A. Federal Council had submitted to the Government as the basis for the increased benefits introduced in July 1971. It was also evident that differences of opinion had arisen within the profession in New South Wales as to what the most common fees should be and, in fact, sixteen of twenty-seven local A.M.A. associations in that State had recommended to their members the adoption offees higher than those advised by the A.M.A's Federal Council. Some sections of the profession maintained that the fees proposed by the Federal Council had been wrongly based and that higher fees should have been adopted. 17
The Government decided that a judicial inquiry should be held to determine what were fair and reasonable fees for the purposes of benefits for Items I and 4 in New South Wales for the period from I July 1971 to 30 June 1973. Mr Justice Kerr of the Commonwealth Industrial Court was initially appointed to conduct the inquiry, but following his subsequent appointment as Chief Justice of New South Wales, Mr Justice Mason of the New South Wales Court of Appeal took over the inquiry, which was held in Sydney in April 1972. Following the inquiry, Mr Justice Mason determined that, for the particular purpose in question, the fair and reasonable fees for these services at I July 1971 were $3.90 for Item I and $5.45 for Item 4, and that these were the fees on which the next review in mid-1973 should be based. In his report to the Minister. Mr Justice Mason stated: 'The effect of the determination is that the most common fees for Items I and 4 in N.S.W. have been lower than the amounts which I have determined for almost one-half of the two years for which the amount has been determined. If it should be thought that some step should be taken so that doctors will receive the income which they would have received had the fee determined by me prevailed throughout the period of two years, the amount J have determined for Item 1 could be increased by an additional ten cents for the balance of the period, bringing it up to a total of $4.00. It does not seem to me that Item 4 necessarily stands in the same position. It is a service less frequently occurring and it has, in relation to Item I, increased at a greater rate since J 968.' Having regard to the views expressed in the report, the Government decided to adopt $4.00 and SS.4S as the appropriate fees on which benefits should be based for the period from I July 1972 to 30 June 1973. The Minister advised the Federal President Elf the A.M.A. that the Government was prepared to accept a flow-on to the other States of the twenty cents and forty cents increases in common fees for Items 1 and 4, with effect from I July 1972, if the Association so desired. This offer was accepted. The Government decided that the increases in common fees were to be met entirely by corresponding increases in Commonwealth benefits. The insured patient will continue to be required to meet no more than eighty cents for an Item I service or $1.20 for an Item 4 service, provided the doctor charges the appropriate common fee. The existing fund benefits for these services remain unchanged. Consequently no increase in medical benefit fund contributions will be necessary as a result of these fee adjustments.
Medical Benefits Schedule Advisory Committee The Medical Benefits Schedule Advisory Committee, which advises on anomalies in the most common fees for services listed in the Medical Benefits Schedule and on the inclusion of appropriate items to cover new or changed medical procedures, met five times during the year. The Schedule was amended by Regulations on three occasions_ Apart from the changes on I July 1971 already mentioned, other amendments were introduced on I November 1971 and I February 1972.
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Benefits for services by approved dentists Significant among these amendments was the inclusion from I November 1971 of Commonwealth and fund benefits in cases where a prescribed medical service is rendered in an operating theatre of an approved hospital by a legally qualified dentist or dental practitioner approved by the Director-General of Health for the purposes of the National Health Act. Sixty-nine items were included in the Schedule for this purpose. The items were limited to those medical services which were already listed in the First Schedule to the National Health Act. The services do 18
not include routine dental procedures such as the extraction of teeth or ordinary diagnostic or dental treatment procedures. As the dentists or dental practitioners had to be approved by the Director-General, it was decided to establish committees to consider applications for approval. A Medical Benefits (Dental Practitioners) Advisory Committee and a Medical Benefits (Dental Practitioners) Appeal Committee, composed of dental practitioners nominated by the Australian Dental Association, were set up for this purpose. The number of dentists and dental practitioners approved as at 30 June 1972 was 111. Up to that date Commonwealth benefits of $4128 had been paid in respect of 194 prescribed medical services by dentists and dental practitioners.
Recognition of specialists and consultant physicians During the year, the Specialist Recognition Advisory Committees met on a total of 46 occasions to consider 636 applications from medical practitioners for recognition as specialists and consultant physicians. The Specialist Recognition Appeal Committee met on 13 occasions and considered 70 appeals. The total number of medical practitioners recognised as specialists for the purposes of the National Health Act as at 30 June 1972 was 4935 and the total number of consultant physicians was 1292.
Pensioner Medical Service Expenditure on the Pensioner Medical service during 1971/72 increased by 39.7 per cent to a total of $27.8 million. This increase was due in part to the normal growth in numbers of pensioners and dependants, but was mainly caused by the increased fees payable to participa ling doctors, which became operative on I July 1971. The fees rose from $1.85 to $2.50 for surgery consultations and from $2.35 to $3.60 for home visits. The number of participating doctors at 30 June 1972 was 6817. Pensioner Medical Service entitlement cards for Social Service pensioners are now being issued by a computer process, introduced on I January 1972. The cards are issued annually and will be renewed automatically at the end of each calendar year. The issue of cards on an annual basis will be extended at the beginning of 1973 to Repatriation pensioners.
Committees of Inquiry Medical Services Committees of Inquiry, which investigate services by doctors participating in the Pensioner Medical Service, finalised four references during the year. In three cases, deductions amounting to $2686 were made from doctors' claims and three reprimands were issued of which two were gazetted. In the fourth case the explanation by the doctor concerned was accepted, and no further action was taken.
19
Pharmaceutical Benefits The year saw some major changes in the Pharmaceutical Benefits Scheme. Tht Government, during its consideration of the 1971-72 Budget, decided to increase the patient contribution from 50 cents to $1.00 for each supply of a benefit. At the same time, it was decided to extend the Subsidised Health Benefits Plan (formerly known as the Subsidised Medical Services Scheme) to include pharmaceutical benefits - the patient contribution for eligible people under the Plan would remain at 50 cents for each supply. In other important developments, dispensing fees for chemists were increased by seven cents per prescription from 1 January 1972, and agreement was reached with the Pharmacy Guild of Australia on a new inquiry into chemists' earnings, costs and profits for the 1972-73 year. The cost of the scheme The total cost of providing pharmaceutical benefits in 1971-72, including the patients' contribution on prescriptions supplied to people other than eligible pensioners and their dependants, was $208.7 million. This represented an increase of $24.1 million or 13.0 per cent on the 1970-71 figure, and compared with an increase of $26 million or 16.4 per cent in 1970-71 over the previous year. Increased costs were distributed as follows: Increase in 1970-71 over 1969-70 $'000 Increase i111971-72 over 1970-71 $'000
Commonwealth expenditure Prescription benefits available to the general public Benefits provided in public hospitals and through miscellaneous services Pensioner pharmaceutical services Total increased Commonwealth expenditure Increased patient contribution on prescriptions supplied to the general public Total increased costs
14,948 4,496 4,112 23,556
1,885 4,284 6,824 12,993
2,442 $25,998
---
1l,083 $24,076
General pharmaceutical benefits The increased patient contribution of $1.00 for general benefit prescriptions supplied to the public (other than those entitled to pensioner pharmaceutical benefits or covered by the Subsidised Health Benefits Plan) came into effect on I November 1971. In the period of the financial year prior to the introduction of the new 20
PHARMACEUTICAL BENEFITS
64 100 ..f
65
66
67
68
69
70
71
72
75 50 25 ~
Number of prescriptions (millions)
1962-63 - 1971-72
6 5 4 3 Number of prescriptions per head of population
2 1
1962-63 -
1971-72
$3r-~--~--~--+---r--+---r--+-~ $2~~--~--~-=
Average cost per prescription
$1
1962-63- 1971-72
$16r-~---+---r---r--~--+---~~--~ $14~~---+---r---r--~--+---~~--~
$12 $8 $6 $4 $2
$10~~---+---r---r--~~
f-+-1~+--t-+--+-=~@TImmm
Cost per head of population
1962-63- 1971-72
64
65
66
67
68
69
70
71
72 21
contribution (covered by payments during the months of July to November 1971 inclusive), benefit prescriptions increased by 1.293 million. By contrast, in the subsequent period (covered by payments made in the months of December 1971 to June 1972 inclusive), prescription volume fell by 1.553 million. Prior to the introduction of the new contribution rate, it had been estimated that benefit prescriptions in this period would increase by 2.485 million. Thus, in the seven-month period following the implementation of the new rate, the number of benefit prescriptions was 4.038 million less than estimated. The average cost per prescription rose following the implementation of the new rate of patient contribution because relatively low cost items of $1.00 and less in value were no longer benefits for members of the general public. A further factor which had a significant influence on the average cost per prescription was the increase of seven cents per prescription in the dispensing fee, which was effective from 1 January 1972. This increase accounted for $0.920 million of the $1.885 million increase in Government expenditure on prescription benefits provided to the general public. Increased prescribing of benefits for the general public occurred in most therapeutic groups. The rate of increase in prescription volume and cost was particularly high in preparations used for bronchial spasms and the tranquilliser, anti-depressant, analgesic, diuretic and skin sedative groups of drugs. The largest increase occurred in the erythromycin group, but this was offset to some extent by a lower rate of prescribing of other antibiotics, particularly those in the tetracycline group. The table below provides examples of groups of widely used drugs in which the rate of cost increase greatly exceeded that of prescription volume:
GENERAL PHARMACEUTICAL PRESCRIPTION BENEFITS TABLE OF DRUG USUAGE - SELECTED GROUPS
1971-72.
Variation from 1970/71 Cost $'000 1,138 821 2,386 1,020 548 537 1,412 765 8,627
DrngCroup Analgesics Drugs acting on blood vessels Preparations for bronchial spasms Diuretics Corticosteroids Drugs acting on the heart Tranquillisers Skin sedative applications
Cost $'000 8,523 9,759 6,641 7,527 2,301 1,887 2,708 2,076 41,422
Prescription Volume $'000 3,215 2,238 1,857 2,201 578 649 758 1,270 12,766
% 15.4 9.2 56.1 15.7 31.3 39.8 109.0 58.4 26.3
Prescription Volume $'000 294 60 321 253 68 39 378 420 1,833
% 10.1 2.8 20.9 13.0 13.3 6.4 99.5 49.4 16.8
22
As stated earlier, people covered by the Subsidised Health Benefits Plan continued' after 1 November 1971 to receive benefits on payment of a 50 cent contribution. The following figures serve to illustrate the increased usage of the Plan as eligible people became aware of the concession:
Quarter ended
---31 March 1972 30 June 1972 39,906 74,333
Subsidised Health Benefits Prescriptions
Cost
$ 98,081 189,888
The cost of benefits provided in public hospitals and through miscellaneous services rose by $4.284 million or 15.9 per cent to $31.201 million. This continued high rate of increase is due mainly to the increasing number of drugs available as benefits and the incidence of cases of serious illness and accidents, both road and industrial, which are treated in public hospitals. These patients require intensive care which can often include extended lise of expensive drugs, some of which are available only in approved hospitals. The increased cost of benefits supplied through public hospitals follows a similar nattern to the cost of benefits supplied to the community at large. There arc indications that some States are achieving a measure of control of costs by purchasing drugs by contract.
Pensioner pharmaceutical benefits An increase of 1.435 million benefit prescriptions supplied to penSioners and their dependants was accompanied by an even more marked increase ot' $6.824 million or 15.1 per cent in cost. Increased prescribing was spread widely over the range of benefits provided but was most pronounced for those drugs which had a higher cost than the average for the therapeutic group to which they belong. This was most evident in the tranquilliser, analgesic, diuretic, preparations for bronchial spasms and corticosteroid drug groups. The table below provides examples of areas where significant cost and prescribing increases occurred: PENSIONER PHARMACEUTICAL BENEFITS TABLE OF SELECTED BENEFIT DRUG GROUPS
,/
Drug Group Analgesics Tranquillisers Diuretics Corticosteroids Preparations for bronchial spasms Water & electrolyte replacements Drugs acting on heart
1971/72 Cost Prescriptions $'000 $'000 6,412 4,320 5,611 1,007 1,412 1,171 1,646 21,579 3,431 1,265 1,536 196 558 713 832 8,531
Variation from 1970/71 Cost $'000 947 890 845 417 354 340 303 4,096
% Prescriptiolls $'000 17.32 25.95 17.73 70.65 33.49 40.91 22.54 23.43 334 165 183 48 82 167 56 1,035
% 10.77 15.01 13.55 32.08 17. I 2 30.53 7.27 13.81 23
The seven cent increase in the dispensing fee per prescription effective from January 1972 increased Government expenditure for the year by $506,400.
Dispensing fees Following discussions between the Minister for Health and representa tives of the Pharmacy Guild of Australia, the Government decided to increase dispensing fees by seven cents per prescription from 1 January 1972. The new fees are 39 cents for ready-prepared prescriptions and 64 cents for extemporaneous preparations. These rates will remain in force until I January 1973. Total remuneration paid to approved suppliers of pharmaceutical benefits rose from $58.1 million in 1970-71 to $64.1 million in 1971-72. The additional payment of seven cents per prescription will increase Commonwealth expenditure by $5.4 million in 1972-73. Agreement was also reached on a new enquiry into chemists' earnings, costs and profits being carried out for the financial year 1972-73 under the auspices of the Joint Committee on Pharmaceutical Benefits Pricing Arrangements. The new enquiry will provide information required under both the Government's 'cost accounting' approach and the Guild's 'regression' approach so that both could be evaluated and compared. Planning for the new enquiry has proceeded quickly and smoothly and it is expected that the results will become available during the first half of 1974. They will be used as the basis of new rates of remuneration to be retrospective to I July 1973. IIi the meantime the Government has expressed willingness to update the January 1972 levels of dispensing fees, using an agreed formula, as at I January 1973 while the enquiry is in progress. Other areas of agreement reached in relation to the Joint Committee were the strengthening of the powers of the independent chairman so that he can make recommendations to the Minister in cases where Guild and Government representatives on the committee cannot reach agreement. Further, should either the Guild or the Government be unwilling to accept decisions of the chairman on issues relating to the enquiry, provision will be made for these issues to be referred to judicial arbitration by either party without delay. The Government also agreed to give special consideration to the problems associated with increased costs being passed on to chemists in regard to drugs of addiction and to the problems associated with the reduction in discounts allowed to wholesalers by manufacturers. In the light of the results of these enquiries, it has been agreed that appropriate retrospective adjustment will be made to the remuneration paid to chemists insofar as pharmaceutical benefit prescriptions are involved. The Joint Committee made its recommendations on these two special enquiries to the Minister during June 1972. Changes in listing Seventy-one new items were added to the list of pharmaceutical benefits during 1971-72 as a result of recommendations of the Pharmaceutical Benefits Advisory Committee. Twenty-six of these items were new forms and strengths of existing benefits. Seventy ready-prepared items and sixty-four ingredient items for use iii extemporaneous dispensing were deleted from the list of benefits. Restrictions were amended on fifteen drugs during the year. The more important changes to the list of benefits related to drugs used in the treatment of hypertension, mental illness, asthma and gastric ulcers. The major tranquillisers and also the minor tranquilliser diazepam are now available, for conditions for which they are clearly indicated, without the need for an authorisation by a Commonwealth Director of Health. Two of the group of drugs known as beta-blockers, prindolol and propranolol, were made available from I April 1972 for use in the treatment of severe hypertension.
24
The instructions and the method of application for authority to prescribe the asthma drug disodium cromoglycate (In tal) were simplified, and the new asthma drug salbutamol (Ventolin) in the aerosol form became available as an unrestricted benefit.
Price negotiations Pharmaceutical manufacturers continued to be faced with rising costs and a number of price increases were accepted. Price negotiations continued to be conducted with manufacturers to obtain reduced prices where this was considered appropriate, and resulted in subStantial savings in the cost of the scheme. Changes which occurred in the terms of trade between manufacturers and wholesalers were borne in mind during the price negotiations. During 1971-72, negotiations on products prior to their listing as pharmaceutical benefits or to changes in their listing resulted in savings estimated at $383,000 for a full year. For products currently listed as benefits and not subject to changes of listing, price negotiations have been carried out which are expected to result in savings of $1.95 million per annum at current prescription volumes.
Select Committee on Pharmaceutical Benefits The Select Committee on Pharmaceutical Benefits, established in September 1970 by the House of Representatives, completed taking public submissions in December 1971. The Department gave further evidence to the Committee in December. The Committee's report was tabled in the House of Representatives on 25 May 1972. It contained some forty-three recommendations covering a wide range of matters from the profitability of the pharmaceutical manufacturing industry and the education of medical practitioners to the consumption of drugs by the general public and the cost to the patient of those drugs. The recommendations are being examined by the Department.
Committees of Inquiry The Pharmaceutical Services State Committees of Inquiry considered 103 references during 1971-72 concerning the services or conduct of pharmacists approved to supply pharmaceutical benefits. These references related mainly to the alleged supply of pharmaceutical benefits which failed to meet the required standards of dispensing, but also included such alleged offences as dispensing of a drug other than that prescribed. As a result of the Committees' recommendations (including forty-three references unresolved in 1970-71), eighty-two chemists were warned to exercise more care in dispensing and twenty-three were given Ministerial reprimands. Nine of the reprimands were published in the Commonwealth Gazette. One chemist was suspended for a period of one month, while no further action wa& taken in three cases. All cases carried over from 1970-71 were finalised during the year while thirty-eight cases remained unresolved at 30 June 1972. The Medical Services State Committees of Inquiry considered five references during the year, mainly concerning alleged irregular prescribing of pharmaceutical benefits by doctors. Four cases were unresolved in 1970-71. Following the Committee's recommendations $817.05 was recovered. Three doctors received Ministerial reprimands, one of which was published in tbe Commonwealth Gazette. No further action was taken in one case and five cases remained unfinalised at 30 June 1972. During the year, court action was taken in connection with three chemists and one doctor. Two of the chemists and the doctor were fined for submitting false statements. Charges against the third chemist were proven but no conviction was recorded. 25
Policy Secretariat and Legislation The continued growth of interest in health matters led to another increase in workload for the Policy Secretariat and Legislation Branch during the year. The Legislation Section examined a wide variety of Commonwealth and Territories legislation, while the Policy Secretariat coped with an increased number of questions on notice and representations to the Minister. The Public Information Section also expanded its role of providing information to press and public, arranging Departmental publications and organising public relations projects. During the year the previously separate Commonwealth and Territories Legislation Sections were combined.
Territories Legislation Fourteen Ordinances and Regulations were made for the Australian Capital Territory and the Northern Territory. They included the Nurses Registration Ordinance (No.2) 1971 and the consequent amendment to the Nursing Regulations, which introduced an alternative course of training for general nurses in the Australian Capital Territory. The course is designed to permit persons with higher academic qualifications to graduate as a general nurse in two years instead of the conventional three years. The Canberra Hospital Ordinance (No.2) of 1971 authorised the Canberra Hospital Management Board to commission the Woden Valley Hospital. [n addition this Ordinance recognised the increased responsibility placed on individual members of the Board by remunerating Board members. The Public Health (Dairy) Regulations 1971 substantially amended the eXisting legislation to support legislation introduced by the Minister for thc Interior establishing a Milk Authority for the Australian Capital Territory. [n addition to the legislation made during the year, instructions on twenty matters were forwarded to the Parliamcntary Counsel for the preparation of amending legislation. The instructions covered a wide range of topics including public health, hospital management, professional registrations and drug control.
,
.
Commonwealth Legislation The Nationnl Health Act 1971 received Royal Assent on 20 October 1971. The Act validated variations to items of benefits which had been made by National Health (Variations of Benefits) Regulations Nos. I and 2, increased Commonwealth benefit in respect of nursing homes and increased the charges for dispensing of pharmaceutical benefits to persons other than pensioners and those covered by the Subsidised Health Benefits Plan. The secti011 collabLHated with officers of the Postmaster-General's Department in the preparation of amendments to the Broadcasting and Television Act. The amending Act, which received Royal Assent on 7 June 1972, provides, from a date to be proclaimed, for each television and radio advertisement for cigarettes or cigarette tobacco to be accompanied by a warning that smoking is a hazard to health.
26
Twelve sets of regulations were promulgated and in addition nineteen proclamations and statutory instruments were made. A Radium Agreement was concluded with the North Brisbane Hospitals Board in conjunction with the Commonwealth Radiation Laboratory. Instructions for the preparation of legislation on a further ten matters were directed to the Office of the Parliamentary Counsel.
Policy Secretariat The increased workload of the Policy Secretariat reflected the continuing strong interest in health matters by Parliamentarians, professional and community organisations and members of the general public. More than 700 questions on notice and without notice were addressed to the Minister during the year, and he received some thousands of written representations. In addition to work associated with Parliamentary questions and representations to the Minister 1 the Policy Secretariat undertook policy investigations and provided information for several top-level conferences, notably the 1972 Australian Health Ministers' Conference. It also provided secretarial services for a number of con ferences.
Public Information Section The Public Information Section continued and expanded its role as a clearing house of information for press and public, as the agency responsible for the production of a wide variety of putlications and as an organising medium for public relations projects. The ever-increasing interest of the public in health matters, particularly those relating to behavioural issues, was reflected in an increased volume of inquiries from the mass media during the year. Many news organisations now employ specialist writers on health topics, and it has been the Section's aim to assist them with the
A public relations project at the University of Sydney, organised by the Department's Public Information Section. A special desk was set up at the seventh national conference of the Australian Council of Social Service to provide information for delegates on the Subsidised Health Benefits Plan. 27
provision of available information. Considerable time was devoted also to providing an information service direct to members of the public, ranging from children seeking help with school projects to post-graduate students. writing theses. Information to the public at large is also provided by mass printing and distribution of leaflets, booklets and brochures, with particular emphasis on publications explaining the National Health Scheme. During the year the Section was responsible for the printing and distribution of some ten million leaflets, covering most aspects of the Health Scheme. In addition, the Section undertook an increasing variety of other publishing work, including annual reports, amendments to medical benefits schedules, drug education pamphlets and service documents for the medical profession and other specialised groups. Publication of the Department's official quarterly journal 'Health' also continued and publication of the quarterly journal' Animal Quarantine' in a new form was begun. The expansion of information and pUblishing activities was matched by an increase in public relations projects. One of the major undertakings organised by the Section during the year was a national seminar on 'Drugs and the Mass Media' which brought together in Canberra media representatives and drug educators from every State. The seminar discussed ways of enlisting the co-operation of newspapers, radio and television in the campaign against drug abuse. Another major assignment was the planning and execution of a pilot publicity campaign on the Subsidised Health Benefits Plan, in the Wollongong area of New South Wales. The co-operation of many local people and organisations was sought in publicising the Plan, and thousands of pamphlets were distributed throughout the area. The campaign produced a marked increase in the number of applications for Subsidised Health Benefits assistance. As a consequence of the experience gained in Wollongong, the Section began producing and distributing comprehensive information guides on Subsidised Health Benefits for social workers throughout Australia. The Section also planned an advertising campaign on Subsidised Benefits in Australia's foreign-language press.
28
Planning and Research Recruitment to the recently-created positions within the Planning and Research Sections of the new Planning and Research Branch was completed towards the end of the year. These sections, together with the Central Statistical Unit, comprise the Branch. The establishment of the Branch reflects the growing demand for, and interest in, planning and research connected with health care administration.
Research Section The activities of the Research Section have been functionally divided into three areas: 1. Institutional care, where effort is concentrated on the public and private hospital systems, nursing homes and mental health institutions. 2. Medical care, covering the wide range of medical and paramedical services available to individuals, including those provided by government and voluntary non-profit organisations. 3. General services, which relates to the range of public and environmental health services and general overview of the delivery of such services in Australia. During the year, the survey of public hospitals for the year 1968/69 - concerned with obtaining information on inpatient utilisation and the revenue and costs of approved public hospitals - was finalised. The collation of similar information for 1969/70 and 1970/71 is now well under way. A further examination of the levels and movements in fees charged in nursing homes was also completed. As part of the continuing investigation into domiciliary care, the survey of incomes and expenditures of home nursing organisations was again extended to cover the period ending 30 June 1971. The provision of information to the Department on developments in the field of health economics, both within Australia and overseas, continued. The Research Section was also involved in the preparation and analysis of material and the preparation of detailed information on various aspects of the provision of health care, both in Australia and overseas. The section is in the process of finalising its work on estimated total current account expenditure on health services throughout Australia during 1969/70. A number of the recommendations contained in the report by the Senate Standing Committee on Health and Welfare with reference to Mentally and Physically Handicapped Persons in Australia, which are of particular interest to the Department, are being investigated.
Planning Section The Planning Section is primarily designed to stimulate the planning and re-planning of Commonwealth involvement in the delivery of health care, but it also contains secretariats for the National Medical War Planning Committee and the Hospital and Allied Services Advisory Council. It is intended that separate units in the section be involved with the personal and public aspects of health care. The former group will cover the provision of health services to individuals, both by institutions and private practitioners, while the
....-<.
29
latter group will be involved in the planning of activities within the public, preventive and environmental health areas. The National Medical War Planning Committee and its subordinate committees continued to investigate the medical and ancillary resources which would be needed to treat casualties in the event of a nuclear attack on any of the major cities in Australia. The Standing Committee is currently preparing a 'Model Plan' of medical services for a national emergency. This will be of assistance to Medical Planning Committees in each State in drawing up their own individual operational plans. The object of this 'Model Plan' is to present a common basis of principles or measures to adopt which would be instrumental in creating some uniformity of planning ideas. Preliminary action was taken during the year to establish within the Planning Section a secretariat to service the Hospital and Allied Services Advisory Council and its four committees. The Council, which comprises the Permanent Heads and the Chief Medical Officers or Management Officers from the Commonwealth and State Departments of Health, has been set up by the Australian Health Ministers to advise the Ministers on a number of important matters relating to hospitals and allied services. The establishment of the secretariat within the Commonwealth Department of Health arose from the offer of the Commonwealth to provide a secretariat to service the Council and its committees.
'.
Central Statistical Unit The Central Statistical Unit consolidated and reviewed a number of statistical series during the year. The unit also developed, and now regularly publishes, a Quarterly Review of Health Statistics which is being widely distributed. In its initial development, the unit has placed emphasis on proViding expert advice in the application of statistical techniques, analysis and presentation of data. The unit provided advice during the year in connection with hearings conducted by the Select Committee on Pharmaceutical Benefits. The unit is also responsible for the co-ordination of statistical information and the maintenance of appropriate standards of presentation. In this connection and as a result of many enquiries, the unit has begun to develop as a central repository and channel for statistical information. Other work in which the unit is involved includes the planning and development of new and revised statistical series. Among new developments is the compilation of statistics on the number of medical practitioners in Australia, the revision of health insurance benefit statistics and the provision of more detailed and regular statistics on health institutions.
,(
30
Establishments and Finance The Establishments and Finance Branch is responsible for the provision of management services and for financial control. The increase in all spheres of the Branch's functions in 1971-72 reflected the general growth of activities in the Department as a whole.
Organisation and Classification During the year the establishment of the Department increased to 5,668, including 430 industrial staff. This represented an overall increase of 441, compared with 495 in 1970/71, and reflected the economic restraints which were applied during the year to effect greater economies throughout the Commonwealth Public Service. Two major establishment reviews were undertaken during the year. These concerned non-professional quarantine staff and specialists, and the implementation of a new work level structure for social workers. The Departmental-Public Service Board working party, established to determine staffing requirements within the Northern Territory, completed two interim reports and approval for eighty-two additional positions was obtained. Following the establishment of a Health Insurance and Benefits Division, reviews to determine the support staff for both the Hospital Insurance and Benefits and Medical Insurance and Benefits Branches were conducted. A review of the Administration, Pharmaceutical Chemistry and Antibiotic Products Sections of the National Biological Standards Laboratory was also undertaken. Overall reviews of the Commonwealth Radiation Laboratory and the Automatic Data Processing Branch, and a joint review with the Methods Section of the National Health Division, began during the year.
Methods The value of the departmental suggestions scheme was again demonstrated during the year. The scheme, introduced some years ago, invites suggestions for improved efficiency of operations, and monetary awards can be made if suggestions are adopted. In 1971-72, annual savings of some $6,000 were directly attributable to improvements made as a result of suggestions through the scheme. In recognition of their suggestions, several officers received cash awards ranging from $10 to $100. Following a review of delegations under the Public Service Act and Regulations, increased powers were given to Divisional Offices to allow greater autonomy for local management. A large number of office machines proposals, designed to reduce manual effort, were investigated. One of the larger proposals, which resulted in the installation of automatic collating facilities, is estimated to result in savings of 59,000 per annum. A Methods team was established in the Northern Territory during the year and a number of procedural reviews were carried out to simplify existing systems . -
..
31
Training A progranune of formal induction and job rotation was continued for school-Ieaver clerks in their first year with the Department. Formal training for graduate clerks was again organised in Central Office on an inter-departmental basis through the social welfare group graduate training scheme. Departments combining in this scheme include Health, Repatriation, Social Services, Education and Science and the Superannuation Board. The year saw an increase in the number of training programmes conducted within the Department. These courses dealt with work control and establishments for supervisors, advanced selection interviewing, dictation techniques, supervision, techniques for counter officers, communications, laboratory office management, procedural training in general benefits, in-service training, first aid and fire control procedures. The number of officers studying under the fees reimbursement scheme in 1971 totalled 287. In 1970, of a total of 208 departmental officers enrolled in the scheme, 71.4 per cent were reimbursed fees, which on a comparative basis was the second highest rate of reimbursement for studies successfully completed in the Commonwealth Public Service.
Finance Section The general expansion of Departmental activities resulted in an increase in the volume of work required of the Central Office Finance Section. Although 1971/72 saw the fust full year's operation of the A.C.T. Health Services Accounts Section as a separate unit, the transfer of this activity from a Central Office function was largely offset by an increasing number of accounts related to expansion in other areas. A new approach to the preparation of forward estimates of revenue and expenditure was introduced during the year and imposed an increased responsibility on the Central Office Finance Section. In addition, the continuing operations of the Senate Estimates Committee lmd changes in the format of the Department's estimates for 1972/73. resulted in a substantially increased workload being undertaken by the funds and estimates group. The accounting procedures investigation sub-section continued its work on a departmental accounting manual and investigated accounting procedures in use in Central Office and the Northern Territory divisional office. The revenue review sub-section completed a number of examinations during the year. The main examinations undertaken were concern@d with charges for services provided at hospitals in the Territories and for services provided under the Quarantine Act for vaccinating overseas travellers and importing plants and goods. The sub-section also continued to provide accounting analysis services for other sections, mainly by commenting on the proposed WHO financial programme and on the preparation of government hospital accounts.
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Automatic Data Processing
The Automatic Data Processing Branch continued to work effectively throughout the year in meeting a range of complex and demanding systems processing requirements. The main activity was again focussed on a relatively small number of major departmental functiuns, but minor work in other areas was also undertaken.
Applications Section In general, the Applications Section was largely occupied on work relating to the Pharmaceutical Benefits Scheme, the reconstructed Medical Benefits Scheme, the system for nationwide monitoring of licit transactions in drugs of dependence, and the maintenance of the MEDLARS service for the National Library of Australia. Additional work undertaken by the section included: (a) a joint review of the data processing requirements for a program of ultrasonic research at the Commonwealth Acoustic Laboratories; (b) systems activity in connection with various surveys undertaken by the Commonwealth Radiation Laboratory, the Psychiatric Services Branch of A.C.T. Health Services, and the sub-committees of the Human Pituitary Advisory Committee; and (c) design and programming activities in relation to the Subsidised Health Benefits provisions of the National Health Scheme_ Major systems now in operation required substantial review and amendment during ·the year to accommodate significant developments in the areas concerned_ These developments included the introduction of the increased patient contribution and of Subsidised Health Benefits provisions to the pharmaceutical benefits area, adjustment of professional fees payable to chemists and the introduction of new internal pharmaceutical benefits and procedures. The medical benefits common fee monitoring system was also substantially changed. A number of new proposals for A.D.P. systems facilities were referred to the Branch during the year. It was found necessary, however, to closely limit activity to the wide range of priority A.D.P. work which emerged. The development of the new communications-based pharmaceutical benefits processing system did not proceed as fast as originally anticipated, and implementation will now begin during the early part of 1972/73. However, substantial progress has been made and all components of the system are in an advanced stage of proving. Comprehensive procedures governing the operation of the whole system have been developed and training activities across all relevant work areas are proceeding satisfactorily. These activities have been facilitated by direct communications links established for this purpose between the Department's computer in Canberra and visual display equipment located in its offices in Brisbane and Melbourne, and by arrangements with the Post Office for access to limited facilities of the Commun User Data Network during various phases of its development. Major extensions to the drugs of dependence system for monitoring licit transactions were made during the year. These extensions are aimed at improving 33
At work in the Automatic Data Processing Branch of the Department's Central Office in Canberra.
the reporting facilities available to State Departments of Health and the Commonwealth Department of Customs and Excise. The system is proving to be valuable in control activities relating to the use of drugs of dependence. Increasing experience with the system may indicate worthwhile extensions or modifications which can be effected. The 1971/72 report mentioned the implementation of a system which provides, on a continuing basis, information on the observance by doctors of most common fees for individual medical benefit items. The system is based on arrangements made with major medical benefits organisations in each State, each of which submits information on a regular and routine basis. Approximately half the total number of medical services processed through the benefits organisations are encompassed by the system. MEDLARS is a medical literature information retrieval system sponsored on an international basis by the National Library of Medicine in the United States. A full MEDLARS computing facility was provided to the National Library of Australia throughout the year. Resources were devoted to this project to improve the efficiency of the processing mechanism and to modify it to best suit the operating environment of the Department of Health's facilities. Work will continue in this area. 34
Operations Section The responsibilities of the Operations, Software and Communications Section include the scheduling and running of the computing facilities, the maintenance of control programmes supplied by the manufacturer, and the development of general purpose programmes to promote efficiency in computer use and operation and to meet the Department's requirements in the communications area. The section also provides programmes and systems testing facilities to the Departments of Social Services and Repatriation. A two-shift operation of the Department's two I.B.M. 360/65 computers continued throughout the year. The operations sub-section monitored equipment performance and formulated and implemented operational procedures to meet the specific requirements of the Department, and to ensure the effective and reliable operation of the computing facilities. The demand for computing facilities increased steadily throughout the year. Simulation studies are in progress to determine the most cost-effective means by which the increasing needs for computing capacity can be met in the fu ture. The software sub-section, in addition to providing normal maintenance support, was extensively involved in the evaluation, and subsequent implementation, of the various enhancements incorporated in the most recently released versions of the operating system available from I.B.M. Special communications software to support the new pharmaceutical benefits on-line system of data acquisition and error correction is in the final stages of development and proving. This work is closely co-ordinated with similar activity undertaken by the Post Office at the Brisbane Common User Data Network centre.
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Services Section The Services Section is responsible for the continuing development of standards and control systems aimed at optimum use of computing facilities, for the provision of training courses, and for the provision of clerical and logistic support to the Branch. During the past year, manuals covering all aspects of programming and procedures for the use of facilities within the Branch were issued. Investigations and development continued into techniques for improving programming efficiency. Studies were made of the use of modular programming methods and preparations were made to evaluate special software that will allow independent testing of programme modules written in both high and low level programming languages. It is anticipated that the adoption of this technique will arso lead to improvements in the efficiency of A.D.P. project planning and control activities. During the year a total of thirty-five programmers-in-training and programming assistants attended training courses organised in conjunction with other Departments. Weekly afternoon seminars were held on a variety of topics and were well attended by A.D.P. staff. Investigations have been made into the use of instruction facilities using television. Extensive use was made of the system management facilities option of the operating system to collect detailed records of all processing. A system has been designed and introduced which provides figures on computer throughput and reports on non-adherence to standards by programming staff, and which enables machine costs to be charged. It is intended to develop this system and provide further reports on machine performance and costs, peripheral utilisation and other aspects which may increase efficiency in the utilisation of the available computer facilities.
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Divisional Offices The Divisional Offices in the State capital cities - which are largely responsible for the Department's day-to-day administrative functions - experienced another increase in workload during 1971-72. This was due mainly to the natural increase in utilisation of health benefits and, in most States, to additional responsibilities in automatic data processing and quarantine work. The year also saw an increase in the number of approved nursing homes and handicapped persons' homes and work of the State offices in these areas also increased substantially.
Health Benefits Administration of the provISIon of National Health Benefits continued to be a major function of the Divisional Offices. Extra work was involved during the year in handling changes introduced within the Subsidised Health Benefits Plan and in the level of nursing home benefits. The number of nursing home beds increased and there was a consequent stepping-up of inspection activities. In Western Australia, for instance. at the end of May 1972 there were 115 approved nursing homes with 4862 beds, while another six premises had been inspected and were awaiting approval. This compared with 108 approved nursing homes and 4275 beds in the State at 30 June 1971. More new nursing homes are being built and at the end of the year proposals were in hand for seventeen new premises in Western Australia, involving 858 beds. In Queensland, there was an increase of over 600 beds or approximately nine per cent in the number of approved nursing home beds available in that State. Following the introduction of the States Grants (Nursing Homes) Act, the State Government built three new modern nursing homes while plans were approved for a fourth. These homes will provide a high standard of accommodation for low-income, chronically ill patients. In Victoria, discussions were held with representatives of the large community-type private hospitals which have been a feature of the Melbourne area for many years. These discussions centred around the possibility of the introduction of an all-inclusive hospital fee and the problem of theatre fees for private hospitals performing a considerable amount of surgery.
Specialist recognition State offices of the Department continued to help the Specialist Recognition Advisory Committees in all States with their task of making recommendations on the eligibility of medical practitioners for the payment of specialist rates of medical benefits.
Quarantine services Quarantine work is one important function carried out by the Department through its Divisional Offices. In the past year, all mainland States experienced a significant increase in the number of dogs and cats going into quarantine, following the lifting of the ban on their importation from the United Kingdom in July 1971. In Victoria, an additional block of kennels had to be constructed at the Quarantine Station at Spotswood. 36
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In March 1972, an outbreak of strangles disease in a shipment of horses en route to Australia from the United Kingdom made it necessary to quarantine them on their arrival in Fremantle, Melbourne and Sydney. Western Australia and Victoria were able to admit consignments intended for their States into existing quarantine stations, but in New South Wales it was necessary to establish an additional quarantine station near Penrith for the duration of the incubation period of the disease. Prophylactic measures taken in quarantine prevented the spread of the disease to Australian horses. Substantial aircraft and shipping activities were recorded at all ports of entry during the year. The quarantine clearance of passengers, baggage and a growing volume of imports continued smoothly.
The lifting of the ban on the importation of cats and dogs from the United Kingdom meant an increase in work for the Department's quarantine stations throughout Australia. These kennels at the Bicton animal quarantine station, near Fremantle, Western Australia, coped with a constant stream of new arrivals.
Medical examinations and vaccinations The number of medical examinations performed by Commonwealth Medical Officers fell in some States. The decrease was partly attributable to fewer examinations being carried out on behalf of the Public Service Board because of the reduction in recruitment to the Commonwealth Service during the year. However, a further increase in the number of vaccinations given by Commonwealth Medical Officers to overseas travellers was again recorded. In New South Wales, for example, some 151,000 vaccinations were carried out in the Divisional Office while 109,000 certificates were validated for travellers who had been vaccinated privately. Two other services provided by Commonwealth Medical Officers during the year were the medical examination of migrants applying for permanent resident status and of meat inspectors. The latter examinations, for the Department of Primary Industry, were carried out because of the requirements of some overseas countries to which Australia exports meat.
Liaison activities The substantial increase in the utilisation of health benefits and the growing number of chemists' claims passed for payment under the Pharmaceutical Benefits Scheme brought about increased responsibilities for the Divisional Offices in checking claims and in their liaison and inspection activities. 37
The year saw an increase in the number of drugs listed as restricted phannaceutical benefits. In Western Australia, this led to an almost lOa per cent increase in the receipt of special authorities for such benefits in the 1971 calendar year. The liaison and inspection activities of pharmaceutical and inspection sections in the States continued to expand. Dep'artmental pharmacists maintained a continuing programme of visits to doctors and chemists to discuss prescribing practices and the operation of the Pharmaceutical Benefits Scheme. In addition, inspection pharmacists continued their work under the provisions of the Therapeutic Substances Act of obtaining drug samples for routine testing.
Automatic data processing All States experienced a substantial increase in the volume of work undertaken by their automatic data processing sections in processing chemists' claims under the Pharmaceutical Benefits Scheme. During the year planning was undertaken to provide accommodation and furniture and to install eqUipment necessary for the on-line system of data processing of chemists' claims. The training of data processing officers in the new procedures also began during the year. Arrangements began in all eastern States to implement the on-line system.
Training of overseas students Throughout the year, the Divisional Offices continued their liaison work with educational institutions providing training to students from African, Asian and South Pacific countries. The Department is one of three training authorities which assist the Department
The Department's Divisional Offices help to arrange the training of foreign students in Australia in a number of health disciplines. This student from Hong Kong is in his third and final year of the diploma course in occupational therapy, at the N.S. W. College of Occupational Therapy in Sydney. Here he operates a Larvic wood-turning lathe, a foot-powered treadle machine designed for use by people with lower limb deficiencies.
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of Foreign Affairs in administering these foreign aid training programmes. All requests for aid to train overseas students in postgraduate medical and dental work, nursing, and the practical aspects of public health are arranged by the Department through appropriate training institutions in the States. The training periods for the students vary from six months to four years. In New South Wales at the end of June 1972 twenty-eight students from overseas countries were studying at various institutions. They were training under such programmes as the Colombo Plan, the Commonwealth Practical Training Scheme and the Special Commonwealth African Assistance Plan.
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Northern Territory Health The year 1971-72 saw not only many advances but also much debate about difficulties encountered by the Northern Territory Medical Service. There were substantial achievements in the rural health field and these probably constitute the beginning of continuing improvement and expansion. On the other hand there was public criticism about some aspects of health services in the Territory. The public enquiry into health services in the Northern Territory began during the year. The appointment of a Chief Nursing Officer was greatly welcomed by all nursing sections, providing as it did a much needed focus for nursing in the Territory.
Aboriginal health The opening of the child health unit in Alice Springs and the opportunity to use departmental nursing staff in the field, working where problems of Aboriginal health arise, were major factors in the reversal of unfavourable trends in central Australia. The appointment of additional staff, the selection of nursing sisters with experience in the handling of sick Aboriginal children, and favourable seasonal
The opening of the Alice Springs Child Health Unit in February 1972 eased the demand for beds at Alice Springs Hospital. Here the Sister in charge of the unit, Sister Elizabeth Hildebrand, sits with Aboriginal mothers on the lawn in front of the unit, which was formerly the Mt. Gillen Motel. 40
~onditions led to a, marked decline in the. number of beds occupied by Aboriginal chIldren 111 the Ahce Spnngs HospItal. ThIs decrease was maintained for more than SIX months, providing much needed relief to the hospital staff. Environmental and social problems continued to increase in the Aboriginal communities throughout the Northern Territory. Overcrowding, with inevitable gross pollution of living areas, is still a major difficulty.
Communicable diseases The constant threat of malaria remains one of the major potential communicable disease problems in the Top End of the Territory. The occurrence of a weather pattern similar to that recorded during previous outbreaks of the disease caused considerable concern during the past year. Large numbers of the vector Anopheles [araut; were discovered breeding in the Gove area and in the City of Darwin itself. Fortunately re-introduction of the disease was prevented. Venereal disease notifications remained at. a low level. Increasing mobility and social change make control of these diseases more difficult, but it is planned to increase the number of investigating staff in an attempt to reduce their incidence_ The opening of a central chest clinic during the year and the provision of additional staff greatly helped the re-organisation of tuberculosis control services in the Northern Territory. Development of regionalised tuberculosis control can now proceed. Recruitment of a medical officer experienced in tuberculosis control for the Alice Springs region is proceeding. The main areas of emphasis in the care of leprosy over the past year were directed towards the rehabilitation and training of Aborigines in paramedical work to cope with the growing number of patients being treated in the rural areas. All five graduates of the 1971 paramedical course are working successfully in the field. In the past year the courses were modified, and the current training programme has fourteen trainees - ten engaged in general rehabilitation, two in laboratory work, one in physiotherapy and one on an advanced course. The leprosy service now has a full-time physiotherapist, and training of patients and staff was stepped up considerably in the past year. A number of projects have been introduced specifically to help rehabilitate patients at the East Arm Leprosy Hospital. Designed to interest patients from rural areas, they include small-scale agricultural and farming endeavours such as poultry-raising, gardening, and the conduct of a plant nursery. There is also a profitable printing shop. Preliminary study of a computer-based programme on the epidemiology of leprosy in the Northern Territory indicates that the great majority of patients no longer have the disease in active form. Any relapses are studied in detail with the help of the Medical Research Council, London. 1 _I
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Mental health Mental health services are now established and 1971/72 saw a marked increase in the activities and work load of this section. Close collaboration with experts in ethno-psychiatry continued, and the psychiatrists are accepting a key role in establishing a much closer and more meaningful contact with Aborigines in order that they may become increasingly involved in measures designed to solve their own health problems.
Schools Health Service In addition to the routine examination of children, the Schools Health Section is responsible for the ear, nose and throat specialist services. It conducts two clinics every week in Darwin, as well as arranging for the quarterly visits of ear, nose and throat surgeons from inter-State. The Health Education Section is working closely with the Schools Health Service in the field of education against drug abuse.
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Patient therapy at the East Arm Leprosy Hospital, near Darwin, includes the fashioning of gemstone jewellery. Father Tom Luby, the hospital chaplain, is pictured instructing two Aboriginal rehabilitation trainees in the gemstone craft. TIle trainees will, in tum, teach the craft to patients.
Discussions are also under way between the Health Education and Schools Health Sections and the Department of Education and Science with the object of developing a health education-orientated curriculum for Northern Territory community schools.
Infant health Attendance at clinics, enrolments of new babies, and immunisations all increased in the Northern Territory during the year. Talks on mothercraft to expectant mothers were continued, while the use of a mobile van to provide a service to some of the rapidly expanding areas around Darwin proved a great help. Home Nursing Service This is another section whose work continues to increase. In Alice Springs particularly, the problems of Aboriginal fringe dwellers are growing in number and variety and are imposing a heavy burden on the health services. The social difficulties created by the interaction between rural, urban, Aboriginal and European groups must be dealt with in a comprehensive way. At present the Home Nursing Service is carrying a heavy proportion of the workload. Inspection of children for eye and ear infections, the large number of treatments for these conditions, and the care of sores are all tasks which continue to increase. 42 y--
Public health nursing It is hoped to expand public health nursing so that effective community health action may be established in Aboriginal communities. There has been an increase in staff and a feasibility study is now being carried out into the establishment of public health nursing centres in remote localities. Two public health nurses are staffing the initial base in the Borroloola district. It is planned to establish further bases at strategically-located places in the outback. These will increase the availability of rural health services considerably.
Health laboratories Delay to building extensions prevented the establishment of a microbiology section in the laboratory at Alice Springs but it is expected that this will be ready by December 1972. Additional equipment has been acquired, and another technical officer began duty in Alice Springs in April 1972. In Darwin the staff has risen to twenty·four, which is the maximum the laboratory premises will hold. The workload continues to increase but no further building expansion is possible on the present site.
Research During the year several research projects forming part of the International Biological Programme in Human Adaptability studies were continued in the Territory. These projects have not required the close participation of the Department, but assistance is given when necessary. The longitudinal study of the nutritional status in childhood, diarrhoeal diseases and their inter-relationship, and the effects of socio-economic factors has continued at three Aboriginal communities along the Arnhem Land coast. Although the study is not due to be completed until February 1973, useful observations on possible effects of the local economy have already been highlighted. Data on the epidemiological study into leprosy has been processed by computer and the final report is being compiled. A research team is at present engaged in the Alice Springs area on an assessment of the vitamin C content of the diets of Aboriginal children and the degree of absorption of that vitamin. This study follows a smaller survey carried out by the team at Collarenebri, in New South Wales. The work supplements the wide ranging nutritional studies previously carried out by Dr. D. K. Kirke, the Senior Registrar in rural health at Alice Springs. Continuing research is carried out both in the hospitals and in rural areas. The 'Survey of Diarrhoeal Diseases in Malnourished Aboriginal Children', by Dr. A.C. Walker and Dr. J. G. Harry, recently published in the Medical Journal of Australia, and the facts presented by Dr. W. A. Langsford and Dr. D. S. M. Graham to the Senate Standing Committee on Social EnVironment, are illustrative of the information which can be derived from this work.
Quarantine The introduction during the year of large new jet aircraft into airline services operating through Darwin posed a special challenge to the Quarantine Section. However, the handling of these aircraft is being carried out efficiently. The introduction of direct flights to New Guinea has increased the risk of introducing exotic plant diseases, and special attention is being given to the problems associated with such flights. Ships arriving at east Arnhem Land ports continue to cause problems but planning is proceeding for the establishment of a full quarantine service at Nhulunbuy on the Gove Peninsula.
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Aerial Medical Service The third Aerial Medical Service centre in the Territory came into operation in January 1972 when an aircraft was stationed at Nhulunbuy. The service, staffed by a pilot, engineer and aerial medical sister, is already proving valuable in emergency evacuations. Routine flights will be introduced progressively as the full regional structure in the east Arnhem Land region comes into being. The service as a whole has been operating at maximum capacity for some time, and little increase in the activity of the six aircraft is possible. As a result the use of charter aircraft has increased markedly. An additional aerial medical doctor has been added to the Alice Springs section.
Dental health The Dental Section has made an intensive effort this year to upgrade the level of service provided in rural areas. Between July and December 1971, all Top End rural centres were visited at least once and a service was maintained throughout the year to Katherine and Stuart Highway centres. Subsequently, a caravan and additional dental officers were transferred to Alice Springs for the period from January to the end of May, to allow an intensive effort to be made in Tennant Creek and in the Alice Springs rural area. There is a long waiting list for the services of the section both in Darwin and Alice Springs, but until school therapists become available it is difficult to see a solution to this problem. The first Northern Territory cadet therapist commenced training in Hobart in February 1972. There are grounds for satisfaction with the development of orthodontic services. The demand is such that the assistance of viSiting consultants from Adelaide will be needed for some time. However the overall picture is much brighter than it was twelve months ago. The treatment load of oral surgery, general anaesthesia, facio-maxillary and fracture cases continues to increase. One staff member with special experience in this field is devoting most of his time to these cases. In the East Arnhem area it will soon be possible to provide a better service from the new clinic building at Nhulunbuy. The installation of equipment in the clinic has been completed and, in addition, a new dental unit has been installed in the caravan unit at Gave and a daylight processor for dental X-rays has been put into service.
This mobile infant health centre is used by the Northern Territory Medical Service to provide a service to some of the rapidly expanding areas around Darwin.
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Equipment standardisation has almost been completed and by the end of June 1972, all 'daily-use' units had been modernised. Laboratory services were upgraded by a training course in the early part of the year and a full range of modern crown and bridge and ceramics techniques are now employed in Darwin and Alice Springs.
Hospital services AIl easing of the load on the Alice Springs Hospital occurred during the latter part of 1971-72. In February 1971 the bed state had risen to a record of 229 inpatients, including a paediatric figure of 136. Since the opening of the child health unit at Alice Springs and the opportunity to use Departmental staff in the field, the number of occupied beds at Alice Springs has fallen by almost half that recorded during the peak period. It is hoped that the increasing development of community health services will permit this easing of pressure to be maintained. Training of hospital assistants has proved of benefit to the Alice Springs Hospital, where the use of these people enables the greatest benefit to be derived from the nursing skills of fully-trained staff. Extensions to the outpatients' department, which allow for modernisation and the provision of two additional consulting rooms, have almost been completed. The new administrative offices are also nearing completion. Two additional twenty·unit demountable quarters for resident nursing staff are being completed and a minor operating and an intensive care unit are in course of construction.
The first two phases of the modern Gove District Hospital were completed during the year. The hospital, which serves the rapidly expanding mining and industrial community on the Gove Peninsula, has accommodation for sixty-four inpatients, together with a well-equipped theatre block and outpatient, casualty and X-ray departments. At Tennant Creek the inpatient accommodation, although sometimes under stress, is generally adequate. The area of greatest pressure is the outpatients' department. New X-ray equipment has been installed and the department completely remodelled, giving a much more satisfactory facility. Public relations in the area have improved with the commencement of a regular bulletin of hospital news in the Peko Clarion. Community health work within the hospital has begun, and foreshadows the establishment of a community health centre to be built in the 1972·73 financial year. At Katherine Hospital, work has begun on the first stage of new nursing accommodation and the contract has been let for major extensions to the outpatients' department. Inevitably there will be some inconvenience during the construction work and a reduction in the number of authorised beds from sixty·five to fifty-one will mean that bed utilisation will rise. The Senior Registrar of the hospital has entered private practice, and thus Katherine Hospital has become the 45
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first of the smaller hospitals in the Territory to have a visiting medical officer from outside the Department of Health. There were two major developments during the year at the Gove District Hospital. The first was the opening of phase one of the hospital in November 1971, providing modern and well-equipped outpatient, casualty, consulting, treatment and X-ray departments, and a temporary inpatient capacity of ten beds. The well-designed and spacious outpatients' unit is a welcome replacement for the temporary faCilities utilised during the construction phase of the Gove project. The second major development was the handing over of phase two of the hospital project - the sixty-four bed modern ward and theatre block - in May 1972. Although full commissioning had not been completed at the end of the financial year, the hospital has become an established entity which compares favourably with any of similar size in the country. The volume of work at the hospital continues to rise and a third doctor has been added to the staff. In addition to providing facilities for the people of the new township of Nhulunbuy, the hospital also cares for the communities at Yirrkala and on Groote Eylandt. Considerable building activity occurred at Darwin Hospital during the year and the last of the old war-time and post-war temporary structures were demolished and removed. New buildings completed included demountable accommodation for eighty nurses and twenty professional officers. Work began on a new eight-unit doctors' quarters which will double the size of the single accommodation currently available. Work on the psychiatric day centre also began. The staffing situation improved considerably during the year, and more medical and nursing staff are now available. A number of the new medical staff are graduates of overseas universities, but the tight screening procedure and high standard required by the Registration Board of the Northern Territory has ensured that standards of medical practice have been more than maintained. Many of the staff below specialist level at the hospital now possess additional or higher qualifications gained after post-graduate study. Progress has continued in negotiations with the learned colleges seeking the establishment of training posts in the various specialties within the hospital. It is hoped that these talks will be satisfactorily concluded in the first half of the 1972-73 financial year.
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A.C.T. Health
A.c.T. Health Services not only provided a wide range of community health services during 1971-72, but also planned for future hospital and laboratory facilities, conducted a mental health survey and expanded mental health services. The construction of the 600-bed Woden Valley Hospital continued on schedule and it is expected that the first stage of the hospital will begin admitting patients in the first half of 1973. Agreement was reached during the year between the Commonwealth and the Little Company of Mary on the construction of the proposed 300-bed Calvary Hospital, to be built in the Belconnen district of Canberra. Building of this hospital is scheduled to start in 1974 for completion in 1976. Health education projects included active involvement in the National Drug Education Programme and the teaching of health education in schools and colleges. Child health and school dental services continued at an increased rate.
Mental health services Major functions of the Psychiatric Services Branch during the year included the full implementation of stage one and the planning of stage two of the three-stage plan for the development of msntal health services in the A.C.T. The Branch treated 1,430 new patients during the year either at its Civic and Kingston Clinics, in private homes or through the emergency crisis service. Acute depression, marital disharmony, neurotic behaviour and drinking difficulties were the main problems seen in adults. Among children, speech problems, uncontrollable behaviour, education difficulties and neurotic behaviour were the predominant problems. Although priority was given to short-term care and family crisis therapy, the Branch was increasingly involved in the provision of services to patients with more severe problems. A day centre was opened to provide a range of therapeutic occupational tasks for chronic patients and work assessment programmes for patients re-entering the work force. Programmes for the intellectually handicapped were strengthened by the addition of a district nurse and the assistance of speech therapists and the occupational therapist. At 30 June 1972, the number of intellectually handicapped people receiving counselling and domiciliary support was 72. Approximately 1,500 home visits to the handicapped were made during the year. Staffing of the Psychiatric Unit at Canberra Hospital was increased to enable the unit to extend its role of intensive treatment in the hospital. The Canberra Hospital Management Board has accepted responsibility for the operation of two small hostels in the suburbs of Downer and Narrabundah for the short-term care of intellectually handicapped children and of persons recovering from psychiatric disorder. Both these hostels are expected to open early in 1972-73. Further preventive programmes, including the training of community service volunteers in crisis support, were initiated. The Branch was also closely involved with the National Capital Development Commission concerning social and mental health factors in planning new towns in the A.C.T. 47
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A triple antigen injection - one of the main services provided ill the Department's immunisatiun prugramme in the A.C.T.
The Canberra Mental Health Survey, completed in October 1971, showed that 7.7 per cent of the population was suffering from moderate or severe psychiatric disturbance. The survey results suggest that these problems are most common among the elderly and the lower socio-economic categories. These results have been released in more detail and are available to those interested. Analysis of the results is continuing in order to assist with the development of further preventive programmes. A provisional plan for the development of stage two of the A.C.T. Psychi?tric Services has been completed. The plan recommends the provision of ex tra staff to increase services, and the construction and operation of health service hostels. The main emphasis in stage two, timed to begin in the latter part of 1972-73, will be on greater application of preventive programmes and the treatment and rehabilitation of persons with more severe psychiatric problems.
Hospital planning and development Progress was maintained during the year on the construction of stages one and two of the Woden Valley Hospital. It is expected that the hospital will admit its first patients during the first half of 1973. Alterations and additions to the Canberra Hospital laundry and sterilizing areas
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were carried out to provide an interim central linen and sterile supply service for both Canberra and Woden Valley Hospitals until the first stage of the major central hospital services complex at Crace is functioning. Parliamentary approval for the centralised services project was given in· March 1972 and detailed planning has now begun. A planning team supported by working parties completed a functional brief for stage one of the proposed Belconnen Health Complex, which will consist of a 400-bed general hospital. It is scheduled for completion in 1980. Other areas of planning and development included work on the proposed central health laboratory for the A.C.T., which is to be sited next to the Woden Valley Hospital; the proposed building to accommodate clinical and administrative health services in the A.C.T.; and the preparation of a brief for the National Capital Development Commission in respect of health and general services requirements for the proposed Community Health and Welfare Centre to be located at Phillip. Assistance was also given to the Canberra Hospital Management Board in the preparation of a long-term plan for the hospital's future development. Similarly, the Planning Section undertook, in association with the Psychiatric Services Branch, the production of functional briefs and preliminary plans for a number of proposed health service hostels for the A.C.T., ranging in size from ten to forty beds.
Woden Valley Hospital The Woden Valley Hospital is d'signed as a 600-bed general hospital. Set on a forty-acre site with an additional seven acres available for expansion, it consists of a ten-floor tower building connected to a small retail complex, a 100-seat lecture theatre and a two-floor building to accommodate geriatric, rehabilitation and psychiatric services. There are seven buildings for staff accommodation. Commissioning of the hospital was initiated by the Department of Health and in December 1971 this responsibility was transferred to the Canberra Hospital Management Board. A small commissioning team has been engaged in selecting and purchasing equipment. This team will remain with the hospital until hospital staff are appointed to continue the task. The tower building, which contains all service areas, out-patient and casualty, radiology, laboratory, theatres, administration and ward accommodation for 320 patients, is scheduled for completion late in 1972. The remaining ward areas are due to be completed twelve months later. Among the items of equipment selected for the hospital is a new design of 'high-low' bed which will be the standard bed throughout the hospital. The tower building alone has some 1,700 rooms and detailed room schedules have been prepared for each room. Master 'shopping lists' have also been prepared and arrangements made for the numerous pieces of furniture and equipment to be delivered into store so that the hospital may be equipped without delay as soon as the premises are handed over by the builders. The experience gained by the commissioning team should prove valuable in future A.C.T. hospital projects.
Transport services A transport sub-section was established during the year to develop and control existing ambulance facilities and to plan and implemept an inter-hospital transport service for the carriage of linen and sterile supplies. Inter-hospital transport will start in 1973. It is also planned to expand the existing day hospital transport service in 1973 to provide transportation of handicapped children to special schools. In August 1971 a custom-built motor crash rescue unit was added to the ambulance fleet. The three-ton unit is fitted with a winch, generating plant, air-compressor and associated power tools, enabling the unit to cope with large-scale emergencies such as tourist bus crashes. 49
,
.
The A.C. T. Ambulance Service crash rescue vehicle at the scene of an accident. The vehicle is fitted with an extensive range of rescue equ ipment. The thirty-seven ambulance staff carried forty-one per cent more patients during 1971-72 than in the previous year. The increase was due largely to the use of an additional day hospital bus. During the twelve months, 9,832 day hospital patients were transported. Ambulance mileage increased from 89,000 in 1970-71 to 110,343. In the past four years the number of patients carried has increased by 142 per cent from 6,128 to 14,838.
~
Immunisation Immunisation clinics were conducted regularly in the A.C.T. throughout the year. A total of 16,435 injections of either triple antigen or combined diphtheria and tetanus vaccine was administered during the year compared with 15,710 in 1970-71. Immunisation against poliomyelitis using Sabin vaccine was also continued and a total of 16,261 doses was administered. Measles immunisation continued on a regular monthly basis. A total of 1,626 doses was administered to children aged one to nine years. Rubella immunisation clinics for girls entering high schools and up to fourteen years of age were held during the school holidays. Attendance at these clinics was not as high as had been hoped, in spite of repeated publicity in the press, radio and the schools. A total of 298 doses was administered during the year. Similar immunisation clinics were also held at Jervis Bay and Wreck Bay.
Baby health centres New centres were opened in the suburbs of Latham, Fisher, Rivett and Holder in 1971-72. During the year there were 83,424 attendances at clinics and 18,626 home visits. An infant welfare sister from Canberra continued to visit Wreck Bay and Jervis Bay on a fortnightly basis. 50 r---.
Preparation-for-parenthood classes began in October 1971_ They consist of weekly discussion groups led by infant welfare sisters_ Lunchtime classes proved especially popular. Relaxa tion classes conducted by a physiotherapist are held in the Y.W.C.A. building, Canberra City, and in the Post Office building, Phillip. Monthly evening classes for expectant parents are also attracting good attendances.
Infant health Routine medical examination of infants and young childreJ] continued throughout the year both in Canberra and at Wreck Bay and Jervis Bay. There was a considerable variety in the type of conditions found but, grouping them together broadly, the more common groups of conditions were squints, retardation of growth or development for various reasons, ear conditions (including deafness), and orthopaedic abnormalities. In an attempt to meet the high demands on the infant health service, a modification of the system was introduced in April 1972 when, following an intensive training course, infant welfare sisters began screening all the nine-month-old babies. Medical teams are now concentrating on the three-year-01d children as well as examining all infants and children referred to them by the infant welfare sisters.
School medical service The modified system of nursing sisters undertaking all routine screening, with medical officers seeing only pupils referred to them, has worked satisfactorily. Medical officers are able to give more time to health education work both in the schools and in the pre-schools. The total number of children examined during the year was 19,162 compared with 19,610 the previous year. The incidence of notifiable defects for 1971-72 was 8.3 per cent, compared with 7.6 per cent in 1970-71 and 8.8 per cent in 1969-70. Figures for the incidence of the more common defects are given in Table 70, on page 156.
School dental service The number of children examined by the school dental service increased from 17,655 in 1970-71 to 20,990 in 1971-72. The service was able to cope with this increased patient load through the employment of more dental therapists. Four new clinics were opened in the A.C.T. during the year, bringing the total to thirty-five. The long-term investigation to assess the value of the fluoridation of Canberra's water supply continued. During the 1971 calendar year, 5,883 children aged from six to twelve years who had lived continuously in Canberra since fluoridation began were examined. These children had 39 per cent fewer defective permanent teeth and 55 per cent fewer decayed permanent teeth than children of the same age who were examined in 1964, prior to the start of fluoridation that year.
Chest clinic There was a further increase in the workload of the chest clinic in 1971-72. The number of patients seen by the clinic physicians increased from 2,243 in the 1970 calendar year to 2,635 in 1971, while 21,002 chest X-rays were taken in 1971 compared with 19,755 in 1970. The number of cases of tuberculosis notified in the A.C.T. increased by one to 17. There was also a significant increase in the application of fully supervised intermittent ehemotheraphy to patients during the year, resulting in their earlier discharge from hospital. These patients continued their treatment as outpatients under the supervision of chest clinic staff. A revised routine to protect Canberra Hospital staff against tuberculosis came 51
into operation during 1971 and is currently being extended to include the staff of nursing homes.
Veterinary services A wet summer and an unusually dry autumn created problems for primary producers in the A.C.T. in the past year. Heavy summer rains caused worm infestation losses among sheep and increased the development of liver fluke, whereas lack of autumn rains brought an end to hopes of plentiful winter feed. The elimination of cattle pleuropneumonia from most of Australia has virtually removed the restrictions on entry of healthy cattle to south-eastern N.S.W. and the A.C.T. As part of the national campaign to eradicate cattle tuberculosis and brucellosis, a program of testing, diagnosis and vaccination continued in the A.C.T. throughout the year. Tuberculosis has not been detected in Territory cattle for many years. Samples taken from half the cattle population showed an overall brucellosis infection rate of two per cent. However, the majority of A.C.T. herds - eighty-four percent in fact '- were found to be brucellosis free. Diagnosis and treatment of rural dogs for hydatid tapeworm infection followed a survey which showed Canberra town dogs were practically free of this tapeworm. An extensive survey has shown twenty-three per cent of A.C.T. rural properties have infected dogs.
/
,.
An A.C. T. Health Services veterinary officer (left) doses a sheepdog as part of the Department's hydatid control programme. A survey has shown that twenty-three per cent of rural properties in the A. C. T. have dogs infected with the hydatid tapeworm.
52
;--
,
Commonwealth Medical Officers The activities of Commonwealth Medical Officers reflect current changes in the characteristics of the Canberra population. Canberra is a city with a young age structure, but the older age group is now becoming larger. This change has brought an increase in medical examinations carried out for fitness to drive, sickness benefits, pensions and other welfare purposes. The introduction in February 1972 of cut-rate air fares brought a sharp increase in the number of travellers seeking the services of the overseas immunisation sub-section. The fast-growing population of the A.C.T., the rapid expansion of the A.C.T. Police Force, and a rise in the incidence of crime out of proportion to population growth resulted in an increase in forensic medical work. Medical officers of the Forensic Sub-section provide a twenty-four hour, seven day-a-week service to t , police on a roster system. Their duties include medical examinations of victims of crime, persons in custody on criminal charges, mental patients, persons charged with driving under the influence of liquor, persons requesting blood alcohol tests (the marked increase in apprehensions since the introduction of the breathalyzer has also resulted in an increase in the number of blood samples requested to be taken), sick or injured prisoners, and policemen injured on duty or returning to duty after injury at work. Medical officers are also required for attendance at crime scenes, examination of scenes of deaths in the jurisdiction of the coroner, and attendances at the Supreme Court, the Courts of Petty Sessions, and the Coroner's Court. In addition, the sub-section was engaged in experiments with the breathalyzer and in training police engaged in the use of the instrument. Lectures are also given to police recruits and other members of the force in aspects of forensic medicine_ National Fitness The A.C.T. National Fitness Advisory Committee recommended grants totalling $7,020 during the year to a wide range of recreational, youth and sporting groups. Applications for assistance increase annually. The committee organised a comprehensive swimming survey, following a request from the A.C.T. Advisory Council, and tested all A.C.T. form one pupils. A series of new vacation programmes proved popular and some 1,000 boys and girls received coaching in golf, tennis, squash, judo, ten-pin bowling, cricket, athletics, volleyball and basketball. Adult learn-to-swim classes were introduced for the first time and 150 people took part. Other adult recreation courses are planned for late 1972. The National Fitness Office continued its close association with community groups through activities ,uch as the Duke of Edinburgh Award Scheme, and by providing films. The office continued to service the A.C.T. Youth. Council and offered advice and assistance to numerous youth and sporting bodies. Nursing services In 1972 a Community Services Bureau was opened at Canberra Hospital. The bureau, staffed by a member of the District Nursing Service, aims to co-ordinate all helping agencies and nursing services so that arrangements can be readily made for the care of patients at home. During the year, 34,450 home visits were made by district nurses. One nursing officer attended a stomal therapy course in Melbourne in October 1971 and is now teaching district nurses and hospital nursing staff how to care for patients with stomas. An in-service programme offering lectures, demonstrations, films and discussion groups has been arranged for all A.C.T. Health Services nursing staff. 53
Health Education Continued involvement in the National Drug Education Programme, increased support for the teaching of health education in schools and colleges, and expanded supply of resource materials and the involvement of more A.C.T. Health Services staff in preventive health work were the major activities of the Health Education Section in 1971-72. Many requests were received during the year for help in running drug education programmes for community groups. Seminars were also conducted for community leaders, professional youth workers and school teachers. More than seventy sixth form students, representing nearly all A.C.T. secondary schools, attended a week·end health education camp. Short films on attitudes to drugs were shown on television and in Canberra theatres. The co·operation between professional staff from different sections of the A.C.T. Health Services enabled health education in schools to receive substantial support. At the request of school principals, the Health Services team met with small groups of senior students and explored their attitudes to health decisions. Special training was introduced for leaders in this scheme. The supply of publications, films and visual aids which are required to provide an adequate health education resources service has been steadily built up. There was an increasing demand for material on the use of alcohol and on problems associated with cigarette smoking as well as the more general information about drugs. The pre-service training of school teachers has begun in the A.C.T., and A.C.T. Health Services staff are involved in the teaching of the health component. The demand for this service is expected to increase steadily.
Institute of Anatomy During the latter half of 1971-72, the Nutrition Research Section of the Department of Health was moved from the Institute of Anatomy to Central Office at Phillip. The space vacated by this section was used to proVide improved accommodation for the Public Health Laboratory and also for the Veterinary and Meat Inspection sub·section. The A.c.T. Health Services Library was also moved into the Institute. In the museum, an exhibit demonstrating the function of the endocrine system was completed and installed. Further work was carried out on renovations to the older displays. Planning is in progress for displays on the skeleton, and for a comparative exhibit showing the development of the skeleton from fish to man. Further progress has been made in the classification and cataloguing of the national ethnographic collections and some new material has been added.
Professional Boards The Medical Board held ten meetings and registered fifty medical practitioners during 1971·72. Thirteen medical graduates were appointed as approved qualified persons to complete their pre·registration period of twelve months as junior resident medical officers at Canberra Hospital. The Dental Board held six meetings and registered eight dentists. The Board reviewed seventeen complaints concerning dental fees. The Pharmacy Board held six meetings and registered twenty pharmacists; the Veterinary Surgeons' Board held three meetings and registered two veterinary surgeons; the Optometrists' Board held three meetings and registered two optometrists. The Board submitted a recommendation to have advertising controlled under the relevant Ordinance. The Nurses Registration Board met six times and registered 359 nurses and
54
A 300-bed hospital is to be built in Canberra by the Little Company of Mary. An agreement for the constnlction and operation of the hospital was signed in October 1971 by the Provincial Superior of the order, Sister M. de Monfort, and the Commonwealth Health Minister, Senator Sir Kenneth Anderson. Construction of the hospital - the third major hospital in the Australian Capital Territory-- will begin in 1974.
ninety-four nursing aides. In November 1971, the Nurses Registration Ordinance and Regulations were amended to cover Canberra Hospital's new two-year course for general nurses. The second two-year programme for general nurses began in January 1972.
Health laboratory An important stage in the training programme for technical officers was reached in 1971-72. Five trainee technical officers completed the Biological Research Technicians' Certificate at Canberra Technical College. Individual staff members have previously taken this course, but this is the first group recruited for training to complete the certificate. There are currently twenty-five trainee technical officers on the staff. In the field of virology a significant step was taken during the year with the introduction of diagnostic tissue culture methods. At the same time, the range of viral serology increased_ Efforts are now being made to do all rubella serology at the laboratory. Work was also started on developing chromosome techniques and it is hoped the Laboratory will be able to offer an examination service during the coming year.
55
Public health General supervision was maintained over the manufacture, storage and sale of all foods. Milk processing and selling methods were regularly checked. Eleven prosecutions were laid for breaches of the regulations under the Public Health Ordinance. Throughout the year, quarantine inspections were made of international aircraft arriving at Canberra as a first port of entry. One international flight scheduled to land at Sydney was diverted because of fog, and a full·scale quarantine clearance was carried out. Thirty·five cases of gonorrhoea and five cases of syphilis were notified in the A.C.T. for the 1971 calendar year. This compared with fifty-two and seven cases respectively in 1970. However, the number of notified cases of gonorrhoea in the first five months of the 1972 calendar year increased to thirty-five.
56
Quarantine
..
During 1971-72, the Department's quarantine service had another busy and successful year carrying out its task of preventing the introduction of human, animal and plant diseases into Australia. Although outbreaks of smallpox and cholera occurred in a number of overseas countries, no cases were recorded in Australia during the year. In the animal quarantine sphere, the movement of horses, cats and dogs, and bovine semen came under review, while consideration was given to the establishment of a high security animal quarantine station on Norfolk Island. The plant quarantine service continued its research projects and investigations of disease outbreaks. Officers also arranged another international course in plant quarantine methods for students from overseas countries.
HUMAN
QUARANTINE
The continuing large numbers of ships and aircraft arriving from overseas resulted in a very active year for the Human Quarantine Branch. However, no human quarantinable disease was introduced into Australia. A severe outbreak of smallpox in Yugoslavia, which resulted in thirty-three deaths among 175 cases, served as a sharp reminder that the disease remains a threat to all countries. Because of the Australian migration programme from Yugoslavia, it was necessary for the Department to institute emergency procedures immediately notification was received of the outbreak. The only migrants permitted to enter Australia during the emergency were those who had been successfully vaccinated with Australian vaccine. However, Yugoslavia was declared free of the disease by the end of May and normal migrant flights were again permitted. During the year cholera was reported in a number of countries which had previously been free of the disease, including Singapore and West Irian. All infected countries were proclaimed under the Quarantine Act as countries from, or through which, cholera might be brought or carried. Travellers arriving by air from these countries were required to possess a valid cholera vaccination certificate.
Smallpox vaccination· requirements As from 1 March 1972, Australia relaxed its smallpox vaccination certificate requirements for travellers entering Australia by air from the United States and Canada. This innovation was part of a reciprocal agreement under which the United States and Canada agreed to permit air travellers from Australia to enter their countries without a smallpox vaccination certificate. Air travellers arriving in Australia from the United States or Canada are no longer subject to isolation in a quarantine station if they do not possess a valid smallpox vaccination certificate, provided they have not been outside those countries for at least fourteen days immediately before arrival in Australia. The relaxation was possible because both the United States and Canada had been free from smallpox for over twenty years.
57
Aircraft clearance The number of people arriving in Australia by air from overseas without a valid smallpox vaccination certificate continued to increase. The airlines, which are responsible for costs should a passenger be detained in quarantine, were again reminded that passengers must have valid certificates before boarding the aircraft in overseas countries.
ANIMAL
QUARANTINE
The Animal Quarantine Branch successfully continued its role of guarding Australia against the introduction of animal diseases from overseas.
..
Exports and imports In August 1971 a ban was placed on the importation of horses to Australia via the Panama Canal, because of an extensive outbreak of Venezuelan equine encephalomyelitis in Texas and Mexico. The disease also occurred in Central
An outbreak of strangles - an upper respiratory tract infection among a shipload of horses en route to Australia led to prompt action by the Animal Quarantine Branch in March 1972. The horses were quarantined on arrival and all the affected animals responded to treatment. Above, swabs and blood samples were taken on board ship before the horses were unloaded.
58
t. ,_
Dogs and cats began arriving in Australia again during the year from the United Kingdom, following the lifting of the import ban which had been imposed ill October J 969_ Some of the newcomers now travel by container -- the one being unloaded here holds twenty allimals. The cuntainer travels (111 the ship's deck ill a totally sheltered area, and the animals are exercised regularly by the ship's crew. America, including the Panama Canal zone. A similar ban was imposed by the New Zealand authorities, with whom close consultation was maintained. [n March 1972 an outbreak of strangles an upper respiratory tract infection --occurred on a ship carrying 172 horses from the United Kingdom to Australia and New Zealand, and the horses were quarantined on arrival. The Abbotsford Quarantine Station in Sydney could not accommodate all the horses consigned to that port, and a temporary quarantine station was established at Penrith. Affected horses responded to treatment and were released from quarantine after three weeks. The quarantine ban on the importation of dogs and cats into Australia from the United Kingdom, which had been in force since October 1969, was lifted on 12 July 1971_ These animals can now be imported provided they have been resident in the United Kingdom for twelve I1mnths, of which the last six months must be spent outside a quarantine station. [n February 1972 it was decided to permit the importation of bovine semen from Canada, Northern Ireland and the Republic of Ireland. Previously, semen 59
I
I:
il II
il II
could be imported only from New Zealand and the United Kingdom. The decision has given Australian breeders the opportunity of importing genetic material from some of the more popular modern breeds of cattle not available in Australia. The conditions of health certification for semen from Canada are very stringent. It is expected that many thousands of doses of semen will be imported from Canada during the next year.
... .
Cattle tick enquiry During the year the Minister for Health agreed with a recommendation of the Cattle Tick Control Commission that ihere should be a full·scale enquiry into aspects of tick control in Australia. These include a review of the present cost to the livestock industry of control measures and production losses, the effectiveness of controls, the feasibility of eradication and the adequacy of present research. The enquiry, which started in April 1972, is continuing.
,
High security quarantine Further consideration was given during the year to the establishmen t of a high security animal quarantine station through which livestock from a wider variety of areas may be imported. A major problem has been the difficulty of testing livestock for diseases such as foot and mouth disease and bluetongue. Advances in technical knowledge and the development of satisfactory test programmes have now cleared the way for Australia to consider setting up such a station. During August 1971, this Department appointed a working party to consider the criteria for such a station. A visit to Norfolk Island showed it to be a suitable location for a high security animal quarantine station and the proposal is receiving close attention.
New publication Publication of the quarterly journal 'Animal Quarantine' was recommenced in a new format during the year. The purpose of the magazine is to provide an extension link between the Branch and members of the veterinary profession and primary producers.
Overseas activities During the year, at the invitation of the United States Department of Agriculture, the Assistant Director·General (Animal Quarantine) and an officer of the C.S.I.R.O. visited the United States to study bluetongue vaccine research. Earlier in the year, the Assistant Director-General inspected the offshore animal quarantine station on Somes Island, New Zealand. In May-June 1972, he represented Australia at the annual meeting in Paris of the Office International des Epizooties and had discussions in Rome with officials of the Food and Agriculture Organisation. He also held discussions at the Ministry of Agriculture, Fisheries and Food in the United Kingdom and the Department of Agriculture, Canada. A senior veterinary officer attended the fifth regional conference of the Food and Agriculture Organisation on Animal Health and Production, held in Kuala Lumpur, and also visited Indonesia for discussions with the Department of Agriculture.
Overseas training In August 1971, two veterinary officers from the Departments of Agriculture in New South Wales and Western Australia visited the United States to study the campaign being conducted by the U.S. Department of Agriculture against the outbreak of Venezuelan equine encephalomyelitis in Texas. A veterinary officer
60
from the Tasmanian Department of Agriculture attended the course on foreign livestock disease conducted by the Canadian Department of Agriculture. Following a virulent outbreak of Newcastle disease in California, three veterinary officers from the Departments of Agriculture in New South Wales, Victoria and Queensland visited the outbreak area to gain first-hand experience in the control of this disease.
Meetings and conferences Senior officers of the Department attended meetings of the Standing Committee on Agriculture, the Australian Agricultural Council, the Cattle Tick Control Commission, the Commonwealth and States Veterinary Committee, the Australia-New Zealand Technical Committee, the Chief Quarantine Officers (Animals) Conference, the National Committee for the Eradication of Tuberculosis and Brucellosis, the Australian Veterinary Association, and the Exotic Diseases Sub-Committee and the Veterinary Public Health Committee of the National Health and Medical Research Council.
PLANT
QUARANTINE
A highlight of the activities of the Plant Quarantine Branch during the year was the third international course in plant quarantine held from October to December 1971. Twenty students from thirteen overseas countries attended the course. Participants were sponsored under the Colombo Plan, the Special Commonwealth African Assistance Plan and the South Pacific Aid Programme. Lectures and demonstrations were given by Departmental officers in Canberra and visits were made to the C.S.I.R.O., Forest Research Institute and Botanic Gardens. The course also included visits to rural areas·of New South Wales and Victoria and to Sydney and Melbourne to see the practical operation of plant quarantine.
This new-style post-entry plant quarantine house, developed for use at major ports of entry in Australia, has been installed in Perth. The house, based on a concept by Plant Quarantine Branch staff. is of all-aluminium construction with acrylic cladding, and has double entry doors and an insect-proo/porch. Similar houses are now being erected at other Australian ports. 61
Laboratory projects Among projects carried out at the Plant Quarantine Laboratory during the year was a series of tests to establish the effectiveness of methyl bromide on devitalising a range of Phaseolus species, heat therapy procedures for imported fruit tree vegetative propagation material, and a study of virus indexing procedures for fruit trees. Using loose smut of wheat (Usti/ago trWei) as a test organism, considerable progress was made in assessing aerated steam as a suitable seed treatment for quarantine purposes. The National Capital Development Commission called tenders during the year for a plant quarantine laboratory and facility to form part of a horticultural complex in the Weston Creek area of Canberra. It is expected that the new premises will be completed and occupied in 1973.
Nursery stock Nursery stock importations continued at a manageable level. Full disease screening of stone, pome, berry fruits and grape vines continued at the centres in Australia where qualified staff and facilities are available to undertake the specialised work involved. Two additional post-entry quarantine houses were built in Perth and Sydney during the year.
Disease outbreaks A report of a rust occurring in poplars was made from Wright's Creek, in the Hawkesbury district of New South Wales, on 27 January 1972 and within six weeks the disease was also found in Canberra, Tumut and Grafton. This outbreak was caused by Melampsora medusae, one of thirteen rust species capable of attacking poplars. The air-borne fungus was aided in its rapid spread by the cyclonic conditions which prevailed along the eastern coast of Australia during February. It was soon evident that there was no chance of eradicating the fungus because of the ideal dispersal conditions. Poplar rust is another plant disease with which Australia now has to live and only time will indicate how serious the disease will prove to be. The occurrence of southern leaf blight of maize early in 1972 may also have been caused by the unusual cyclonic weather conditions which prevailed during February. The disease has existed for several years in the region to the north of Australia, notably Malaysia, Indonesia, Papua New Guinea and the British Solomon Islands. Southern leaf blight is the disease which caused serious concern to the maize industry of U.S.A. in 1970. Preliminary reports from Northern Queensland indicate that an Australian hybrid variety, GH128, is extremely susceptible. The disease was subsequently found in southern Queensland, New South Wales and Northern Territory.
Military equipment from Vietnam Following the Prime Minister's announcement in August 1971 on Australia's military withdrawal from Vietnam, arrangements were made for quarantine officers to visit Vietnam to clear for quarantine Army equipment and stores being returned to Australia. One officer was on duty at Vung Tau from October to December and another from January to March. All the equipment was landed in Australia in an uncontaminated condition with no risk of introducing exotic plant or animal diseases.
Aid to Indonesia During the year, the Indonesian Government requested the Commonwealth to assist the Indonesian Plant Protection Service in its development programme. Using Colombo Plan aid, an initial programme was approved to spend S 112,000 up to June 1973 for equipment at Indonesian ports of entry.
62
Twenty students from thirteen countries came to Australia during the year to attend the third international course in plant quarantine. This group is pictured undergoing training at the plant quarantine facility at Yarralumla, in Canberra.
Plant Protection Committee The eighth session of the Plant Protection Committee for South-East Asia and the Pacific Region was held in Djakarta in October. The Assistant Director-General (Plant Quarantine) was the Australian delegate. Many items of importance to plant quarantine in Australia were covered by the Committee. These included measures relating to movement of plants from one country to another; pests of stored agricultural commodities with particular reference to their movement in international trade; container shipping and the possibility of Khapra beetle movement in containers; bulk importations of plant material; and quarantine equipment and facilities.
Biological control The rust disease Puccinia chondrillina, which attacks skeleton weed, was released in the field in the spring of 1971 after being established in quarantine by the C.S.I.R.O., Canberra. It was first released in the Australian Capital Territory, New South Wales and Victoria, and the initial dispersal has been spectacular. I
Khapra beetle During the year interceptions continued to be made of Khapra beetle, which is regarded as the most serious pest of stored products. All interceptions at ports of entry were handled with full precautions because the beetle is not known to be present in Australia.
, ~
63
Virus-tested fruit varieties The first accession list of virus-tested commercial fruit varieties available in Australia was widely distributed early in 1972. The work .was a co-operative effort by this Department and State Departments of Agriculture. Staff To keep pace with the continued expansion in container transport, timber imports, and the screening of imported plants in quarantine glasshouses and screening-houses, additional inspection staff were appointed during the year. There was also an increase in the numbers of professional staff. In August, a quarantine entomologist was appointed to the Quarantine Depot, Sydney. His duties involve the surveillance of imported and exported plant products to enable these items to be free of insect pests before import and export. A quarantine plant pathologist was appointed to the Plant Quarantine Laboratory, Canberra. This officer will develop further work on seed treatments for quarantine purposes.
Plant quarantine film In March a new film on plant quarantine, produced specifically for the migrant and overseas visitor, was released. Entitled 'Travelling Garden', it is an animated film which should remain topical for many years. Post-graduate scholarship The Officer-in-Charge of the Plant Quarantine Laboratory and Facility at Yarralumla, Canberra, was awarded a Commonwealth post-graduate scholarship to attend a nine-month course on glasshouse design and management at Silsoe, Bedfordshire, in England. After completing the course, this officer will undertake follow-up studies in England, Scotland, Holland and Canada.
64
Tuberculosis The tuberculosis control campaign continued to show further successes during the year. In a chronic, infectious and insidious disease, dramatic changes are not likely unless a new 'miracle' drug or immunising agent is discovered. However, despite occasional setbacks in some areas, the picture over recent years reflects the steady and continuous progress brought about by the campaign. New notifications and reactivations in 1971 totalled 1,631, a drop of 280 on the 1970 figures. This gave a tuberculosis incidence rate of 12.66 per 100,000 of population compared with 15.19 in 1970. The most substantial decline was registered in New South Wales, where the number fell by 159 or 21.8 per cent. In Victoria the decrease was forty-three or 8.9 per cent and in South Australia thirtyfive or 20.3 per cent. Statistics, although meaningful, cannot represent fully the changes that have taken place in the attitudes and outlook of tuberculosis sufferers. While the occurrence of the disease can still be a severe blow, it is no longer a disaster. Cure is almost certain and the time that the patient is off work and in hospital has been progressively shortened. Nevertheless any disease that is curable yet still kills some 200 Australians a year cannot be treated with complacency. NOTIFICATIONS AND REACTIVATIONS 1971
y
State N.S.W. Vic. Qld. S.A. W.A. Tas. A.C.T. N.T. Australia
Cases all fonns 571 439 261 137 131 44 l7 31 1,631
Rate per 100,000
of population 12.30 12.43 14.12 11.57 12.53 11.21 11.29 35.47 12.66
Tuberculosis in migrants The checking of medical documents and the X-rays of people wishing to enter Australia from overseas has become an important part of the operations of the Tuberculosis Division. In 1971 over 17,000 chest X-rays were read. The proportion of tuberculosis in migrants after arrival is much higher than in native-born Australians. In 1971 migrants made up an estimated 18.45 per cent of the population but provided 36.03 per cent of the new cases of tuberculosis. It is a 65
TUBERCULOSIS Notifications-All Forms (Excluding Reactivations)
1949·1971
<fl
c 0
5,000 4,000 3,000 2,000 1,000
~ u
z 0 0
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.0
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E
z
::J
ro ::J c c
«
1949 1951 1953 1955 1957 1959 1961 1963 1965 1967 1969 1971 tribute to the efficacy of tuberculosis control that the risk to the Australian-born of contracting this infection is now so low. The figures below show the position in the States and Territories: MIGRANT NOTIFICATIONS 1971
State N.SW. Vic. Qld. SA W.A. Tas. A.CT. NT Australia
Total no tifications 498 416 241 124 119 41 13 30 1,482
Migrant notifications 172 174 56 42 74 4 9 3 534
Percentage migrant no tifica tions 34.54 41.83 23.24 33.87 62.18 9.76 69.23 10.00 36.03
Percentage population migrants 1734 21.14 12.13 22.53 23.76 9.65 26.48 22.50 18.45
Northern Territory The Department's Tuberculosis Section in Darwin moved into new premises early in 1972, and a chest clinic staffed by specialists and capable of serving the tuberculosis needs of the 'Top End' of the Territory was established there. The clinic has some of the most modern X-ray equipment in Australia. This will meet all the clinic's radiographic needs and give it complete independence.
International conferences During the year the Commonwealth Director of Tuberculosis, Dr. Gwyn Howells, was appointed a member of the World Health Organisation Expert Panel on Tuberculosis. In October he was nominated by WHO as the Australian delegate to the second WHO Western Pacific Region seminar on tuberculosis control held in Seoul, Korea. A report covering the present and future measures of control in the 66
countries of this area and the conclusions of the seminar is to be published by WHO. The 21st Conference of the International Union Against Tuberculosis was held in Moscow in luly 1971 and several contributions were made by Australian delegates.
Miniature X-rays An interesting development in the last few years has been the increased use of 100mm chest X·rays. These miniature films are fully diagnostic .and with an automatic developer are available dry and readable a few minutes after exposure. The economies in film costs and storage are considerable. The central chest clinic in the Australian Capital Territory was the first in Australia to be equipped with such a machine and over ninety·nine per cent of its routine radiology is carried out with the 100mm camera. Machines have also been provided in those States where substantial saving in large films can be demonstrated. The capital cost is rapidly recouped by reduced maintenance expenditure.
Release of beds The release of beds previously used for tuberculosis continued during 1971. The major release was of fifty beds at Royal North Shore Hospital, Sydney. These beds will be used ill future for other types of chest patients. Twenty·nine other beds were also converted for non-tuberculosis purposes in New South Wales, twelve at Royal Prince Alfred Hospital and seventeen at St. Vincents Hospital. In Queensland, sixteen beds were released at the Townsville Hospital and forty beds at the Toowoomba Mental Hospital. Another thirty-three beds were released at Kalyra Hospital, Adelaide, and in Perth, twenty beds were transferred to general use at the Claremont Mental Hospital. A total of 188 beds were released during the year, bringing the number released since the scheme began to 4760 beds.
,
Project works During 1971 a new chest clinic was built at Geelong, Victoria at a cost of $143,000. The building, which will serve as a chest clinic and tuberculosis control centre for a large area and population, came into use early in 1972. The building was officially opened by the Minister for Health in March. The progressive
Tuberculosis patients in the pleasant open surroundings of the thoracic annexe attached ta the Toowaamba General Hospital. 67
modernisation project at Kalyra Hospital, Adelaide, is almost completed, and costs reimbursed by the Commonwealth so far exceed $340,000. The Perth chest clinic and tuberculosis divisional headquarters have been substantially remodelled at a cost of $90,000. During the year plans were approved for a new divisional and chest clinic headquarters for Adelaide. Building will commence in 1972 and the estimated provisional cost to the Commonwealth is $780,300. The Liverpool (N.S.W.) chest clinic was completed and came into use during the year. The total cost of this project is estimated at over $38,000. Modifications to the Orange Base Hospital chest clinic are proceeding at an estimated cost of $15,000. Building alterations to permit a research project into atypical mycobacterial infections to proceed have been completed. These involved the setting up of a laboratory and its equipment in Brisbane at a cost of $39,414. Approval in principle has been given by the Minister for Health for the building of a 9J11all ten-bed tuberculosis ward in the new State hospital on Thursday Island.
Publications The booklets published by the Department on tuberculin testing, mycobacteriology and chemotherapy of tuberculosis have continued in steady demand. A new pamphlet of information for patients and others, Tuberculosis from A-Z', has been well received.
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Public Health The Public Health Branch continued to investigate, and provide information on, a wide range of public health matters during 1971-72. The Branch's activities embrace such areas as infectious diseases, environmental health, traffic injuries, health advertisements, mental health, smoking and toxicology.
Aboriginal health The pattern of Aboriginal health has caused constant concern to individuals and Governments alike in recent years. The past year not only demonstrated a heightening of public interest in the major problems of chronic ill health, malnutrition and infant mortality levels but also revealed the considerable progress made in the more positive identification of the factors affecting Aboriginal health status. This progress was achieved Lj those who are responsible for the delivery of medical care to what has now become an increasingly complex and diverse Aboriginal society. Today, even in the isolated northern regions of the continent, there are comparatively few Aborigines remaining in their original nomadic state. Unfortunately, social progress in the fields of personal and community hygiene, sanitation, the awareness of causation of disease and the basic concepts of healthy living in larger communities has not kept pace with achievements 111 the medical field. It has become clear that the major problems of infant and child morbidity are primarily dependent on socio-economic advancement. While intensive medical, nursing and nutritional efforts will continue to save lives, the attainment by Aborigines of a health standard comparable with that of the European population will depend on many socio-economic considerations. These include the standard of housing, the availability of clean water, efficient sanitation, the level of income, the understanding of foodstuffs and their nutritional values, Aboriginal attitudes towards children, and many others. Many of these factors, of course, are not the direct responsibility of health authorities. The Commonwealth/State Conferences on Aboriginal Health Services, convened annually by this Department in collaboration with the Office of Aboriginal Affairs, have become an increasingly successful forum for the States to discuss many aspects of their programmes for Aboriginal advancement in the health field. The fifth such conference, held in May 1972, demonstrated that many of the concepts originally emanating from the Workshop on the Health and Nutrition of the Aboriginal Child, held in Sydney in December 1969, have now attained much wider acceptance. In particular, there has been an increasing emphasis on the importance of providing health services in the Aboriginal communities themselyes, wide-ranging health and hygiene education programmes, the employment of Aboriginal para-medical workers, the encouragement of surveys and research projects of a medical, social and anthropological nature, and the proVision of family planning advice where requested in order to meet the increasing interest of Aboriginal women in this subject. During the year the Social and Preventive Medicine Section provided information and briefs on various aspects of Aboriginal health problems, and advised the Office 69
of Aboriginal Affairs on medical and health aspects of proposed Commonwealth expenditure in the health field. The section also provided secretariat services for the Medical Research in Aborigines (Reference) Sub-committee of the National Health and Medical Research Council and the annual Commonwealth/State Conference on Aboriginal Health Services.
Nutrition The Nutrition Section has, in recent years, taken special interest in the nutrition of Aboriginal children, paying particular attention to the vitamin C content of their diet. During the past year, studies were undertaken with field work being carried out at Collarenebri, in western New South Wales, and in central Australia. The studies are designed to establish the vitamin C intake of Aboriginal children and its absorption by them, and are part of the concentrated effort being made to improve the nutrition and general health of Aboriginal children.
Advertising of medicines A new 'Guide to Advertising of Proprietary Medicines and Therapeutic Appliances', to assist the media in the preparation of radio and television scripts, was introduced during the year. In. addition, closer liaison was established with the Australian Media Accreditation Authority in an effort to achieve a greater understanding of the criteria required for scripts and so avoid delays in approving those scripts which fail to follow the guide. While the industry generally is most co-operative in using the Guide, in a few instances problems have arisen, mostly because of unfamiliarity with the agreed standards. The number of scripts submitted for approval rose to 1345 during the year. Details of approvals for the past four years are given in Table 56 on page 150. It will be noted from the table that the percentage of scripts approved to those submitted has dropped significantly during 1971-72. It is expected that, as the advertising media involved with radio and television become more familiar with the Guide, this percentage will improve.
Smoking and health Cigarette smoking is one of the largest single avoidable causes of morbidity and death in Australia today, and the goal of inducing adults to stop smoking and of persuading the young not to take up the habit presents a major challenge to the Department. The Department sees its role in this field as one of providing information, guidance and motivation so that individual decisions may be made on a sound basis. For this purpose, action in certain areas has been taken in accordance with Government policy. Reference was made in the 1970-71 Report to the voluntary code for advertising of Cigarettes on radio and television. This revised code, more explicit and restrictive than the previous one, took effect on 1 October 1971, replacing the code which had been in operation since 1966. In the light of a recent detailed review of the health hazards of smoking, the Government decided in April 1972 to sponsor a national educational programme on the subject. Amounts of up to $500,000 will be made available for this purpose for each of the next three years. This decision has significant implications for the Department, which will be responsible for the development and implementation of the programme. Action will also be undertaken to assist the States in expanding existing campaigns in this field. The Department recognises that health education on smoking is a long-term project and that preventive measures need to be extended beyond the formal school setting. An increase in the existing workload of the Department is envisaged, 70 I
necessitating appropriate staffing to effectively co-ordinate and supervise specific programmes and to evaluate achievement in this long-term' endeavour. The Government acted to obtain uniform action by the States and the Commonwealth in placing health warnings on cigarette packages. For this purpose liaison was established with the States and discussions were undertaken. The Department also provided advice and assistance in the development of an amendment to the Broadcasting and Television Act (1942-1971). This amendment will require that each radio or television advertisement for cigarettes or cigarette tobacco be accompanied by a health warning statement. This action is seen as a means of creating a receptive climate to reinforce the more general education programmes.
Communicable diseases The Public Health Branch acts as an agency for the dissemination of statistics on notifiable diseases in Australia. These statistics, which are compiled from reports from States and Territories, are circulated widely throughout Australia and overseas. Gonorrhoea again was one of the most commonly notified diseases in Australia during the calendar year 1971. The number of notifications, 10,539 cases, represented a substantial increase over the 9,562 cases notified in 1970. Syphilis notifications in 1971 were 1,077 cases, compared with 947 cases in 1970. Of some interest is the continued fall in the I ',tal number of notifications of venereal disease in the Northern Territory since 1968. Following the publication, in 1967, of the results of a survey on venereal disease conducted by the School of Public Health and Tropical Medicine, the Department in the Northern Territory adopted new procedures for case finding, reporting and follow-up of venereal disease notifications. At the same time, an Investigations Officer for infectious diseases was· appointed. This general intensification of anti-venereal disease activities proved highly effective and resulted in a rise in notifications of over 100 per cent in comparing 1966 figures to those of 1967, when 508 cases of syphilis and gonorrhoea were recorded. The figures for subsequent years have been 531 cases in 1968,501 cases in 1969, 463 cases in 1970 and 432 cases in 1971. It is considered that these numbers represent a very high proportion, probably ninety per cent, of cases occurring in the area. In this period, notifications have fallen progressively in spite of increasing population and hastening social change. The Department has recently appointed a health education medical officer to strengthen further its preventive programmes, particularly among the Aboriginal popUlation. The number of reported cases of infective hepatitis continued to remain fairly stable with 7,509 notifications in 1971. When compared with figures for the preceding four years of 11,316, 8,123, 7,450 and 7,571 cases respectively, the apparent decline in incidence has been maintained. However, notifications of infectious disease are not always representative of true trends in incidence. The reporting of seventy-two cases of serum hepatitis during the year contrasts with eighteen notifications in the period from July 1969 to December 1970, and suggests a relatively low, but rising, incidence of serum hepatitis in a community in which infective hepatitis is already exceedingly prevalent. Serum hepatitis is not confined solely to hospitals and institutions, where' it constitutes a particular hazard, but is also evolving as a disease of significant concern to the community. The short upward trend of diphtheria notifications during 1970, when seventy-five cases were reported, was halted during 1971 with notifications falling to thirty-one cases. There was, however, a rise in infantile diarrhoea to 982 cases from 738 cases in 1970. The situation 1Il relation to poliomyelitis remained stable, with only one 71
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notification of the disease being received during 1971. This case occurred in an individual who had not been vaccinated against poliomyelitis. This is an indication of the success of the poliomyelitis immunisation campaign. A total of 2,526,940 doses of Sabin vaccine were issued to the States and Territories during the 1971 calendar year.
Pesticides The Branch continued to provide expert advice on the toxicology of pesticides to relevant committees of the N.H. & M.R.C. and to committees for which the Department of Primary Industry is reponsible. In addition, officers of the Branch attended meetings convened by non-government organisations, and provided specific advice to State authorities on pesticide matters. The Branch also continued disseminating up-to-date information on public health aspects of pesticides, both locally. and overseas, through publication of the bi-annual Pesticides Review. This journal contains abstracts of published material on legislation, toxicology and pharmacology. It is circulated widely, both in Australia and overseas, to appropriate authorities and interested organisations.
Environmental health The Commonwealth recently established the Office of the Environment within the Department of Environment, Aborigines and the Arts and, following this. the Australian Environment Council was formed to advise on national policy where the environment is concerned. Health authorities have a vital interest in the quality of the environment and its influence on human health and welfare. Accordingly an Environmental Health Section was established within the Public Health Branch to provide secretariat services to those committees of the National Health and Medical Research Counc'il concerned directly with environmental health. The section also provides advice to other Departments and organisations. In this way the Department plays a complementary role to the activities of the Department of the Environment, Aborigines and the Arts. Occupational health also has been identified as an integral part of environmental health and the Environmental Health Section has assumed responsibility for the National Health and Medical Research Council functions in this area too. The Section assisted the International Health Section in the preparation of the brief provided for the United Nations' Conference on the Human EnVironment, held in Stockholm in June 1972. The Director-General was a member of the Australian delegation to the Conference.
National Poisons Service The primary function of the National Poisons Service is to provide technkal advice to doctors and hospitals on cases of poisoning. This advice is provided primarily through the National Poisons Register manual which is distributed to 550 organisations. During the year eighty monographs on the toxicological aspects of a variety of substances were included in the manual. In addition, 11,400 items on toxic components of various preparations were compiled for inclusion in the manual. These additions brought the total of preparations listed to some 24.000. A general review of the manual has been institu ted. The aim is to increase its usefulness and, for this purpose, a questionnaire has been sent to holders of the manual. The responses to the questionnaire are being processed. As a part of its function in the field of toxicology. the National Poisons Service also received and analysed reports of poisoning cases in Australia and Papua New Guinea. Statistics derived from these reports are used in epidemiological evaluation of trends of poisonings in Australia, and are included in the Poisons Information
72
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Bulletin, a bi-annual publicatio ". overseas. n, whIch IS dIstributed throughout Australia
and
of poison cases notitied during 1971 was 7,995 for Australia and Papua New Guinea. This compared with 8,191 cases in 1970, which is the revised figure obtained after evaluation of the poison case reports for that year. A dissection of the poison cases as related to children over the past three years is as follows: Age 0-5 years 0-7 years 1969 3739 3924 Year
The number
1970 3480 3631
1971 3550 3710
'Market Basket' Survey The results of the 'Market Basket' Pesticides Survey, mentioned in previous annual reports, were published during the year. The survey showed that the average Australian does not consume pesticides in excess of figures laid down by expert committees of the World Health Organisation and the Food and Agriculture Organisation. There was evidence, however, that residues of HCB (a seed dressing for wheat) and dieldrin which may occur could lead to a potential health hazard. The National Health and Medical Research Council. which commissioned the survey, recommended stringent controls over these two substances and recommended that a further survey to determine their levels in food should be undertaken in 1972.
Food Standards The Branch continued to provide the secretariat for the Food Standards Committee of the National Health and Medical Research Council, which met on three occasions. One of these meetings was devoted entirely to consideration of the Australian acceptance of recommended international food standards which are being developed by the F AO/WHO Codex Alimentarius Commission. The Committee also considered a number of proposed amendments to existing N.H. & M.R.C. recommended standards and the development of three new standards . During the year, senior officers of the Public Health Branch attended seven international sessions of the Joint FAO/WHO Food Standards Programme as members of the Australian delegation. These sessions included the Eighth Session of the Codex Alimentarius Commission and sessions of the subsidiary committees on foods for special dietary uses, food additives, labelling and hygiene, processed fruits and vegetables and pesticide residues.
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Nursing During 1971-72 the Nursing Section maintained liaison with international, national and State authorities and with professional nursing organisations, and continued to assemble information regarding all aspects of nursing. An important aspect of this section's activities is the organisation and supervision, in conjunction with the Departments of Foreign Affairs and Education and Science, of nursing training programmes for students from overseas. Assistance with these programmes is given by hospitals and health organisations in all States. Students undertaking post-basic and post-graduate nursing courses in Australia are either sponsored by their home governments, hold fellowships from the World Health Organisation or are sponsored by the special Commonwealth African Assistance Plan and CDmmonwealth Practical Training Schemes for Papuan and New Guinean students. 73
Of the post-graduate courses being undertaken, there are enrolments in nursing education, nursing administration, operating theatre management and ward management. Post-basic courses are being undertaken in occupational health, coronary care, intensive care, psychiatric nursing care, anaesthetic nursing and midwifery in hospitals_ Basic nursing training is not encouraged for reasons associated with reciprocity in registration_ However, two students from the British Solomon Islands are studying basic nursing in Australia, together with three students from Laos_ The total number of nominations received during 1971-72 was forty, and thirty-four students commenced courses during the year. As in past years, the Nursing Section continued to provide the secretariat of the Nursing Committee of the National Health and Medical Research Council and its ad hoc Sub-Committee on the Role of the Nurse in Australia.
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Therapeutic Substances The year presented many challenges and problems to the Therapeutk Substances Branch as it continued its administration of the Therapeutic Goods Act and Regulations and relevant items of the Customs (Prohibited Imports) Regulations. The basic function of the branch is to minimise the risks due to medication or other use of therapeutic goods. This function was brought into sharp focus in March 1972 when the anti-depressant drug Imipramine was reported as a possible cause of congenital abnormalities. The report was given wide publicity and focussed attention on the work of the Australian Drug Evaluation Committee (A.D.E.C.) one of the committees serviced by the Therapeutic Substances Branch. At the time. anti-depressants and tranquillisers had been under consideration by the A.D.E.C. for 18 months. All available data relating to their adverse reactions in clinical use, including cardiac irregularities, hypertension and interaction with other drugs, had been investigated. In addition, available animal data on the drugs' potential to produce congenital abnormalities were being looked at, together with any relevant reports of their effects on humans. Major obstetric hospitals in each State had been contacted and requested to provide details of any congenital abnormalities possibly related to therapy with these drugs. The evidence did not support statements implicating Imipramine as a cause of congenital abnormalities. By making these facts known. the Committee was able to allay public fears. The A.D.E.C. is continuing its close surveillance of anti-depressants and other drugs. and a Sub-Committee on Congenital Abnormalities has been established to provide for their detailed and specialised consideration.
Drug Evaluation Committee activities During 1971-72, 138 applications for general marketing and seventy-four applications for clinical trials were received for consideration. In addition to these, evaluation of more than 100 other pharmaceutical products was undertaken. These figures do not include homeopathic and herbal remedies which are being reviewed particularly in relation to the claims made. Data in respect of 700 of the latter products have been requested and approximately ninety submissions to date have been received. A.D.E.C. meetings have been of much longer duration to enable full consideration of the data submitted in support of applications, together with matters referred from the Adverse Drug Reactions Advisory Committee and various other expert committees advising the Department. This is reflected in an increase of thirty per cent in the number of resolutions made during the year. Three new sub-committees have recently been approved and will be known as the Committees on Congenital Abnormalities, Endocrinology and Vaccines respectively. These will provide wider expertise and allow for more detailed consideration of ma tters which are associated with these highly specialised disciplines. The A.D.E.C. has continued to place increased emphasis on the requirement to demonstrate efficacy, in addition to safety, in considering applications for the distribution of new drugs. Particular attention has been given to associated product 75
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and promotional literature to ensure the provision of adequate information under such headings as contra-indications, warnings, precautions, adverse effects and interactions. Minimum requirements for toxicity testing of intravenous fluids have been finalised. These also include testing of the plastics used for containers or lining of the containers for such fluids.
Adverse Drug Reactions Advisory Committee Despite staff shortages, 1971-72 has been a significant and productive year for tlie Adverse Drug Reactions Advisory Committee (A.D.R.A.C.). The reporting level increased by some thirty per cent (see table below) and the enthusiastic support of a few hospitals in the discharge sununary scheme has maintained the contribution from that source. The active participation of all major teaching hospitals in this scheme is highly desirable and it is hoped that information feedback will provide the necessary stimulant. Source of Adverse Drug Reaction Reports May 1971 - April 1972 Other (including Hospitals May June July August September October November December
Doctors G.P. Specialist
Total
pharmaceutical companies)
Total
Per cent from hospital.
70 70 56 57 81 72
80 77
January February
Man.;h April
Total
75 74 67 79 858
32 47 41 52 32 34 24 58 33 40 48 78 519
10 8
14 19 12 19 13 23 23 16 24 29 210
42 55 55 71
3 8
44 53 37 81 56 56 72 107 729
20 1 5 2 1 10 2 2 5 8 67
115 133 131 129 130 127 118 168 133 132 144 194 1,654
60.9 52.6 42.7 44.2 62.3 56.7 67.8 45.8 56.4 56.1 46.5 40.7 51.9
Although the simplified report form has received very favourable comment, reporting of adverse drug experiences in non-hospitalised patients remains inadequate and the co-operation of the various medical colleges has been sought in this regard. This is one of a number of important measures taken to improve the reporting level. Pharmacists have been invited to report to A.D.R.A.C. the adverse effects of non-prescription drugs, a source of community morbidity about which comparatively little is known. A pilot regional repqrting centre has been established in the Tamworth area to improve liaison and communication with the medical community, and response in the initial stages has been most encouraging. Another important development is the introduction of an intensive drug monitoring programme at the Austin Hospital, Heidelberg, Victoria (Med. J. Aust., 1972, I: 17; 878-880). Information flow has not been one way. As a result of reports received and information retrieved ·from the medical literature, a number of statements for publication have been prepared during the year. An Adverse Drug Reaction Bulletin, drawing attention to important adverse drug reactions documented in the medical literature or reported to the Registry, has been circulated to major
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hospitals throughout Australia on two occasions and, subject to its favourable acceptance, distribution to the entire medical profession on a regular basis is proposed. The third edition of the Report of Adverse Drug Reactions detailing local experience is in preparation and will be distributed early in the forthcoming financial year. One activity of the Committee not widely appreciated is its role in the screening of product literature circulated to the medical profession by the pharmaceutical industry, and investigation of complaints concerning misleading detailing. Specific amendments are requested as a result of reports received and major overall reviews are undertaken. In-depth investigation of problem areas identified is routinely undertaken and this year have included a survey of blood dyscrasias associated with anti-inflammatory agents, the potential cardiac toxicity of propellants in bronchodilator aerosols, and liver damage associated with laxative and slimming preparations containing oxyphenisatin and its derivatives. The latter culminated in the withdrawal of affected preparations from the Australian market. The ability of A.D.R.A.C. to rapidly analyse and disseminate adverse drug reaction data and effectively contribute to the international drug monitoring programme has been hampered by the lack of computer facilities. To assist in this regard the World Health Organisation has offered to Australia the computer programmes developed and utilised by the international system, and their modification to meet additional local requirements is now being undertaken.
Standard of therapeutic goods and related activities The National Therapeutic Goods Committee, consisting of representatives of the State and Commonwealth Health Departments, is concerned about the incidence of mix-ups and mis-labelling of therapeutic goods and their failure to comply with official standards, which have resulted in drug recall action. In the first six months of 1972 it was necessary to recall twenty-one product batches, compared with thirty-one for the whole 1971 year. The Branch is the co-ordinating authority in the Uniform Drug Recall Procedure. A large proportion of recalls result from complaints about various aspects of therapeutic goods by medical practitioners, pharmacists, hospitals and the public. As is perhaps inevitable, some complaints, after being fully investigated, do not indicate that a recall is necessary. However, they involve the Branch in a considerable amount of work and their number has increased markedly. In April 1971 the Committee expressed its concern about the advertising of therapeutic goods to the medical and allied professions. It was noted that such advertisements frequently contain no reference to the known contraindications, precautions, side effects, adverse reactions, drug interactions, or other important information about a product. In November 1971 the Committee considered a recommendation of the National Health and Medical Research Council that controls should be reviewed on the advertising of analgesics, vitamins, and substances included in the Uniform Poisons Schedules. Relevant recommendations of the Senate Select Committee on Drug Trafficking and Abuse and the Australian Drug Evaluation Committee were also considered. These also raised the question of the provision of adequate information to medical practitioners about products they may prescribe, and to patients about products they 'might purchase or have dispensed. A Sub-Committee on Advertising has been established and is currently formulating draft requirements for consideration by the Committee in the near future. The following table indicates the number of samples of controlled therapeutic substances assayed by the Customs Laboratories for the Committee for the year ended 30 June, 1972: 77
,
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State New South Wales Victoria Queensland South Australia Western Australia Tasmania
No. of samples Passed Failed 108 5 63 I 8 1 28 1 Nil Nil Nil Nil
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Drugs of Dependence This year has been a period of development and consolidation for the National Drug Education Programme, which was initiated early in 1971. The Commonwealth Government again, as in the previous year, made $500,000 available to the National Standing Control Committee on Drugs of Dependence to support Commonwealth and State projects in the field of drug education. One of the most significant features of the drug education programme during the year was the involvement of concerned persons through the discussion of problems at seminars. A follow-up seminar was held in Canberra in March this year for health educators from all States and both Territories who had attended previous seminars or a six-month training course on drug education techniques. In February a major step was taken in establishing a better working relationship between journalists and health authorities at a national seminar on 'Drugs and the Mass Media'. The seminar recommended the establishment of State Media Advisory Committees to maintain liaison with State representatives of the Drug Education Sub-Committee. During Maya National Youth Seminar was held in Canberra, and was attended by forty-two young people from all States and both Territories. Most of the participants were students from schools and universities or were young people involved in various youth organisations and activities. The seminar provided an opportunity for young people to examine and discuss the drug problem in an informal atmosphere. Copies of the handbook, 'The Use and Abuse of Drugs', as well as pamphlets and a discussion kit of information on the drug problem, were reprinted and are being distributed through State health authorities. Technical information bulletins on current local and overseas developments in the field of drug dependence were published every six weeks by the National Drug Information Service as an aid to educators and others concerned with the problems of drug abuse. A new drug education film called 'The Choice', aimed at adolescents and high school students, was used in schools during the year. It is intended for use by small audiences participating in discussion groups. Two pamphlets, 'Rumours' and 'Decision-Making', were prepared as accompanying background information for discussion leaders. A series of two-minute films was produced for the National Drug Information Service for use on television. Their purpose is to stimulate public awareness of problems associated with drug abuse and to provide details of sources of further information on the subject. The shorts have been shown on A.B.C. television in most States and the two Territories, and have been used on commercial television, as well as in cinemas and drive-in theatres in the A.C.T. The Drugs of Dependence Monitoring System, utilising the Department's computer facilities, continues to provide information on licit movement, manufacture, import and export of narcotics, amphetamines, phenmetrazine and methylphenidate. This information is used by Commonwealth and State authorities in their efforts to restrict the use of drugs to legitimate medical purposes, and prevent diversion to illicit sources. A recent Commonwealth-wide review of the system has shown it to be successfully achieving its aims.
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National Biological Standards Laboratory The volume of testing of therapeutic goods by the National Biological Standards Laboratory was reduced considerably during the year, largely because of the progressive transfer of resources to the work of developing standards. Staff previously employed on testing has been redeployed for standards work, following the promulgation of the Therapeutic Goods Act in October 1970. Testing therefore has had to be restricted to therapeutic products given high priority, including all products recommended for listing as pharmaceutical benefits, drugs and surgical dressings purchased by Commonwealth Departments, and some goods supplied on large tenders to State authorities. A Therapeutic Goods Standards Committee has now been appointed to advise the Minister for Health on standards and matters relating to them. A working party of Commonwealth and State officers continued to meet during the year to examine ways in which the Commonwealth and States can co-operate to ensure the quality of therapeutic goods for animal use. Following the precedent set for pharmaceutical benefits for human use, a draft Code of Good Manufacturing Practices for veterinary biologicals was drawn up by N.B.S.L officers. The document will be discussed soon with industry representatives. The current code for pharmaceutical products will in future be applied to the manufacture of pharmaceutical products for animal use. Informal discussions were held with the Technical Committee of the Australian Pharmaceutical Manufacturers' Association during the year to foster greater collaboration between N.B.S.L and the pharmaceutical industry in solving mutual problems. The discussions have proved most helpful. Laboratory officers also held discussions with a number of distinguished visitors from overseas.
I.
Inspection unit The close co-operation and collaboration established over the years with officers of State Health Departments continued during 1971-72. Joint visits were made to 248 pharmaceutical companies to assess compliance with the Code of Good Manufacturing Practice for Pharmaceuticals. Twenty-four companies submitted building plans for evaluation before starting construction of or making alterations to premises. The inspection reports show a general increased compliance with the Code, although there is concern with the inadequate quality control for therapeutic goods manufactured by certain sections of the industry. A comprehensive two-day symposium for Commonwealth and State inspectors was held in Melbourne in February, 1972. The meeting enabled inspectors to exchange views and discuss problems associated with the implementation of the Code of Good Practice prior to the introduction of licensing of pharmaceutical manufacturers.
Animal breeding A new animal breeding establishment was opened ill Canberra during the year. exclusively for the breeding of small animals. Facilities will shortly be available in this new area for experimental work on the establishment of axenic, gnotobiotic 79
colonies of rats, mice and guinea pigs - that is colonies of germ-free animals whose microbial flora are restricted to certain known micro-organisms. Such colonies would be a starting point for future specific pathogen free colonies. Experience gained in the establishment of these colonies will have a direct bearing on the facilities to be provided for the animal house in the proposed permanent N.B.S.L. laboratory complex.
Bacterial Products Laboratory Planning for the Brucella Vaccine Testing Laboratory in Canberra has now reached an advanced stage. Parliamentary approval has been given for the building, and tender documents are expected to be completed early in the financial year. It is expected that tenders will be called shortly afterwards and that the building will be completed by March, 1974. Brucella organisms are dangerous to humans and the accent in the design of the building has been on safety of laboratory staff. When completed, the laboratory will be one of the most sophisticated high security laboratories in Australia. The testing of clostridial vaccines for veterinary use continued to be the main routine job of the Bacterial Products Section. However, increasing attention was given to the testing methods themselves in an attempt to improve the reliability and reproducibility of results obtained. Work on human vaccines was begun with the testing of a small number of diphtheria vaccines. Pharmacology Laboratory Revisions to the Customs Prohibited Imports Regulations, implemented in 1970, made the submission of data on new imported drugs obligatory. The result has been a doubling of the number of submissions received at N.B.S.L. for evaluation of
The Pharmaceutical Chemistry Section of the National Biological Standards Laboratory staged a seminar for industry representatives during the year, to demonstrate the latest developments in infra-red spectroscopy, a technique used in Identifying drugs.
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preclinical pharmacology and toxicity, and there is no reason to suppose that the level will fall in the future. The evaluation of data on the safety of particular drugs or groups of drugs provided by manufacturers in response to requests from the Australian Drug Evaluation Committee and the Department continued. There appears to be an increasing need for this work. The review of dysmorphogenic studies on tricyclic anti-depressants, phenothiazines, butyrophenones and sulphonamides, which was in progress at the time of writing the 1970-71 report, is now largely completed. Much additional literature dealing with Imipramine was retrieved and evaluated when the drug was receiving adverse publicity during the year. Safety tests on official samples of injectable pharmaceuticals for human use were carried out as in previous years. These tests, which are conducted on a routine basis throughout the year, consist mainly of determinations of acute toxicity and examinations for pyrogens and histamine-like substances. Drugs listed as Pharmaceutical Benefits or tendered to Government authorities, including those previously tested in the Endocrine Products Section, were sampled and tested regularly by bioassay. Experience in new assay methods was gained during the year, particularly with heparin. Attempts were made to abolish the subjective element in the official assay procedure and many comparative studies with materials of varying origin were carried out by different methods. In view of the need to participate in the preparation of Australian standard~ attention was directed during the latter part of the year to a study of requirements for those products normally tested and for which standards will have to be written.
Pharmaceutical Chemistry Laboratory The automation of laboratory techniques, which has been under way now for several years, continued during the year and the equipment is proving to be just as valuable for research into problems of drug standards as for regular testing. For example, one of the main factors to be considered in determining limits for a test is to know what can be achieved by manufacturers. A survey of the available products is the best way to obtain the information. The automatic tablet balance and calculator have been interfaced to carry out both the present British Pharmacopaeia test and a statistical check on each sample. Comparison of the two, together with a study of the statistical theory involved, has led to proposals for a more realistic standard for uniformity of weight of tablets. Some 16,000 tablets were involved in the survey. The automatic balance is used to examine all tablet samples passing through the section, and both the existing official British Pharmacopaeia test and the proposed new test are being carried out at the same time. A survey was also made of the content of active material in tablets, based on the data accumulated on regular samples tested in the last eighteen months. This gave a useful picture of the variation in drug content about the nominal dose in commercial products, and this is being taken into account in drawing up standards. The importance of infra-red spectroscopy in identifying drugs has been mentioned in earlier reports. The laboratory had improved experimental techniques several years ago to reduce the time needed in sample preparation. The remaining bottleneck in rapid identification has been the time spent in checking files of reference spectra, but a method of searching files has been developed, using the programmable calculator. Studies on samples of metered aerosols showed a need to set limits for foreign particulate matter, including metal and rubber particles. An investigation of methods of measuring such foreign particles is under way. 81
A number of complaints were received in the section relating to pharmaceutical products. In many cases the complaints referred to differences in patient response to different brands of the same drug, or even to different batches by the same manufacturer. In several cases, when the products were examined, all the requirements of the official standards were met and differences in bio-availability were suspected. Dissolution tests were undertaken and in most cases the rates of drug dissolution could be correlated with the difference in patient responses. The construction of a multiple unit dissolution apparatus is being considered, to carry out a comparison of all brands of those drugs whose dose levels are critical. It is expected that useful data will be obtained for comparison with clinical and pharmacological studies.
Antibiotics Laboratory New fields of activity were entered in the past twelve months. The regular system of drug surveillance was maintained at a reduced level and some of the laboratory's resources were directed towards specific projects. Considerable progress was made in the investigation and evaluation of methods of assay and identification of antibiotics in commercial antibiotic sensitivity disc products. This work will assist the laboratory to frame standards for the control of these products. The laboratory continued to collaborate with the World Health Organisation in the establishment of international reference preparations for antibiotic substances, and with the Department of the Army in their field studies of surgical and medical equipment. Infra-red and gas chromatography equipment has been recently commissioned to enable the laboratory to keep pace with current trends towards the greater use of instrumentation in the characterisation and control of antibiotic substances. An atlas of approximately seventy antibiotic infra-red reference spectra is currently being compiled for use within the laboratory and for later publication. The laboratory continued to evaluate chemistry and quality control data submitted in support of new drug applications and drugs for listings as Pharmaceutical Benefits, and made significant contributions towards standards for sterility control of pharmaceuticals, and content of active ingredient in antibiotic products. The sterility testing unit extended the surveillance of single use disposable medical equipment to include other countries of manufacture.
Viral Products Laboratory During the year a great deal of consideration was given to the standards for vaccines used to protect poultry from various diseases. There has been a considerable increase in the use of these vaccines and a number of problems have become apparent. Avian vaccines are almost invariably derived from poultry and eggs. These starting materials may be a source of viruses which contaminate the vaccines, and the use of vaccine to protect against one disease may, in fact, spread another disease. To solve this problem it is necessary to have tests which will detect contaminating viruses. The most difficult and widespread contaminating group of viruses is the leukosis group. To test for such viruses, specific pathogen free poultry and eggs are required. Also the manufacture of uncontaminated vaccines requires the use of specific pathogen free flocks. Such a flock is not available in Australia. The Viral Products Section is at present developing special isolators and techniques along lines of overseas practice to enable a small specific pathogen free flock to be established. It is believed that this will permit proper control of the safety and potency of such vaccines as those for infectious bronchitis and the economically important Marek's Disease. New methods of testing using organ cultures for the former vaccine and focus counting for the latter have been developed.
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It is becoming increasingly clear that improvements in the safety of poultry vaccines with respect to contaminated viruses should be applied to all avian vaccines at the same time, and a co-ordinated programme of development for these vaccines is desirable. A total of forty-four batches of eleven different viral vaccines was examined during the year, involving 107 potency tests and twenty-two safety tests. The vaccines concerned were canine distemper, fowlpox, infectious bronchitis, infectious laryngotracheitis, influenza, measles, mumps, poliomyelitis (oral), rubella, smallpox and yellow fever. Twenty-two protocols were examined and evaluated. The stability of the Poliomyelitis (Sabin) Standards Reference Preparations has now been established and recommendations have been made for their adoption as the Australian Reference Substances. The establishment of a smallpox reference preparation has been undertaken and this will be calibrated against the International Standard.
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Commonwealth Health Laboratories During 1971-72, the Department's Health Laboratory Service continued to experience a high rate of increase in every phase of its activities. Nearly three million tests and investigations were carried out - an eighteen per cent rise on the workload for the previous year. Not only is there a continuing increase in the volume of work done, but the variety of investigational and diagnostic procedures offered is steadily broadening. The growth in demand for laboratory investigations by medical practitioners reflects the increasing complexity of modern medicine and its dependence upon the quantitation and diagnostic aids which the pathology laboratory can provide. Increasing emphasis is IlOW being placed on early detection of disease and preventive medicine. There has been an increase in tests done to exclude abnormalities. Repeated estimations, including biochemical and haematological profiles of patients, are becoming more frequent to assess the physiological status of the patient or to monitor his response to therapy. To meet these demands, the use of an increasing variety of instrumentation, greater specialisation of personnel, and new approaches to work-organisation and laboratory management have become essential aspects of the present-day laboratory. Health Laboratories are located at fifteen centres throughout Australia: Canberra, Cairns, Townsville, Rockhampton, Toowoomba, Lismore, Tamworth, Albury, Bendigo, Port Pirie, Kalgoorlie. Hobart, Launceston, Alice Springs and Darwin. The laboratories are, in most cases, attached to a base hospital and make available a free clinical pathology service to the base hospital, to other hospitals and to medical practitioners in the area. Their primary role is to assist medical practitioners in the diagnosis and treatment of disease in the local community. The laboratories may also undertake work of a publk health nature, such as thc bacteriological examination of milk, water supplies, and the investigation of local outbreaks of disease. Statistics of work carried out during 1971-72 are shown in table 75 on page 159.
Staffing During the year further progress was made towards the provision of technical staff in the numbers required in each laboratory to cope efficiently with increasing work demands. Of particular importance in this regard was the posting of eight additional medical laboratory technologists and twenty-two technical officer staff from the Department's cadetship and traineeship programmes. A total of twenty-seven medical laboratory technologists and thirty-one tcchnical officers have now graduated from the training programmes since their inception in 1968, and have been posted to various laboratories. However, difficulty was again experienced in recruiting sufficient qualified senior staff, particularly pathologists. At present there are vacancies at Launceston, Toowoomba, Townsville, Cairns, Rockhampton, Tamworth and Darwin laboratories for Specialists (Pathologists).
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Accommodation The provision of adequate laboratory accommodation and bench-space to meet demands is a major and challenging task. Over the last three years, most of the laboratories have required extensions or additions to existing accommodation to meet immediate needs. Plans are proceeding for new laboratory buildings or further additions to existing facilities in several areas, with the ultimate aim of providing all the laboratories with accommodation which is adequate to the needs of modern pathology practice.
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Fire at Albury Health Laboratory A fire at the Albury laboratory in December 1971 completely destroyed most of the laboratory building and the adjoining residence. Virtually all major items of laboratory equipment and stores were destroyed or damaged beyond repair. Despite the severity of the loss, the re-establishment of essential laboratory function was achieved remarkably quickly. Temporary premises were made available by the Albury Base Hospital and, with equipment and stores obtained from other health laboratories, basic and emergency services at Albury were restored within three days. Tests which could not be carried out at Albury were referred to the Canberra laboratory for processing and report. The efficiency with which this major setback was overcome was largely due to the extraordinary enthusiasm and dedication shown by the staff who worked day and night to re-establish the laboratory's functional capacity. Currently the laboratory, which is still located in temporary premises, is back to almost normal operation. Planning is proceeding towards the building of a new laboratory.
Work assessment system The implementation of a revised system for providing details of work carried out in all laboratories was completed during the year. Procedures for compiling details of tests and patient requests are now standardised. The new system, which provides much greater detail than was previously available, is already proving immensely nluable in the provision of meaningful data which can be helpful in determining work-trends, equipment, accommod,\tion and staffing needs. \
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Trainee pathologist scheme One trainee pathologist returned to duty towards the end of 1971 after successfully completing duties at the Post-Graduate Medical School, London, for the award of the Diploma of Clinical Pathology (D.C.P.).
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Commonwealth Acoustic Laboratories
This year marks the twenty-fifth anniversary of the Commonwealth Acoustic Laboratories. On 2 January 1947 a small group of scientists, who had conducted research under the auspices of the National Health and Medical Research Council on the effects of noise on servicemen and congenital deafness due to maternal rubella, joined the Commonwealth Department of Health, forming the nucleus of the Laboratories. Included was the late Mr. N. E. Murray, O.B.E., who directed the Laboratories for the first twenty-one years of their existence. During the past quarter-century, the major functions of the Laboratories have been the provision of hearing aids to deaf children, ex-servicemen and pensioners and their dependants, research on hearing aids and their application to individuals, the effects of noise on man and, more recently, the medical application of ultrasonics. The Laboratories' services are now provided at many centres throughout Australia. The first hearing aid developed by the Laboratories was issued in 1949. Since then a total of 91,844 hearing aids have been fitted and 72,489 are still being maintained. The hearing aid, known as the Calaid, has been continuously redesigned and new models introduced to include new concepts and developments in components and technology. An example of this was the introduction in 1965 of the Calaid E in-the-ear hearing aid, which was believed to be the first of its kind to be issued by a government hearing aid scheme anywhere in the world. As at 30 June 1972, a total of 207,444 people had had their hearing evaluated by the Laboratories. In many cases the equipment and tests used were specially designed and built by the Laboratories for Australian conditions. Investigations of effects of noise on man, with particular emphasis on the effects of noise on hearing and methods of protection, have been undertaken. From this work, hearing conservation programmes have been developed for protecting the hearing of workers in noisy industries and of personnel in the armed services. The characteristics of impulsive sound, which contribute to its loudness and detectability, have been established under controlled laboratory conditions with a view to improving techniques for the assessment of community reaction to noise and increasing understanding of the way the ear perceives this type of sound. The surgical and diagnostic applications of ultrasound have been investigated for more than a decade and highly specialised instrumentation has been designed for the visualisation of soft tissue organs in the human body. The techniques, some of which have now reached a sophisticated stage of development, have attracted considerable international interest. The achievements of the Laboratories, which rank high amongst similar institutions throughout the world, are due to the foresight which brought together the many professional skills required to assist those with impaired hearing and carry out investigations in the area in which acoustics impinges on man. Much of the credit for this must go to the original director. 86
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1971-72 There was a further increase in demand for audiological services during the past year and a new field services laboratory was opened at Dandenong, Victoria. Further progress was made in various research projects. Investigations of a different technique for carrying out examinations of soft tissue organs with ultrasonic echoscopy were started and a new method was developed for estimating the adequacy of the acoustical performance of ear protectors.
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SERVICES
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DEVELOPMENT
Audiology and psychology The number of people seeking hearing tests and related services including repeats rose by ten per cent during the year, and the number of hearing aids fitted increased by nine per cent. There was a notable increase in the number of babies who were referred and fitted with hearing aids before the age of eighteen months. The study of the benefits of binaural fitting of hearing aids to children continued and was extended to include older cltildren who can perform more complex audiometric tests. This should provide additional information of the effects of wearing two aids. The Development Section completed a calibration of bone conductors for audiometry and is investigating new applications of speech tests. Special attention has also been given to the development and application of new hearing aid techniques. Staff from all laboratories continued to visit country centres during the year. Engineering The design of a new body-worn hearing aid (Calaid C) was completed and arrangements were made for private industry to supply parts. Emphasis has been
Newly-appointed psychologists undergoing training in audiology at the Commonwealth Acoustic Laboratories' central laboratory.
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placed on durability, ease of maintenance and economy of running in the design of this aid. Six electric response audiometers, designed by the Laboratories, were produced and are to be issued to the branch laboratories for testing the hearing of young children and others who cannot or will not co-operate in conventional hearing tests.
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Noise investigations and acoustical advice The Laboratories continued investigations of noise from aircraft. ships, road transport and industrial and office machinery for the armed services, Commonwealth Government departments and other approved organisations. The investigations included a study Df the effects of noise on hearing and speech communication, with special reference tD the maintenance of safety standards. Advice was given, where required, on engineering noise reduction and on the selection of suitable communication equipment and ear protectors. Two electronic devices were developed to assist in data acquisition and processing in noise investigations. Both devices present information in the form of a statistical distribution and enable a continuous recording to be made of noise levels over a long period of time. In this way, it will be possible to derive an accurate description of the range of noise levels experienced by communities.
RESEARCH Audiology An investigation of the relationships between auditory threshold acuity, speech reception in quiet and in noise, and hearing handicap, was completed. It was found that everyday speech reception and hearing handicap are largely determined by degree of hearing threshold impairment, while threshold impairment at frequencies above 2000Hz has an adverse effect on speech reception in some noisy situations, thus contributing to hearing handicap. The results also indicated that the Articulation Index is generally effective as a method of predicting the intelligibility of speech to the deaf, and will help in the improvement of procedures for speech hearing testing and hearing aid fitting. An investigation of the acollstic impedance of the ear in patients with acoustic neuroma revealed that the resistive component of the impedance is often significantly greater at lDw frequencies on the affected side. This finding may prove to be of value in the audiolDgical detection of acoustic neuromas.
Psychoacoustics During the past year investigatiDns and pilDt surveys were carried out for a study of the effect of urban environmental nDise on hearing. An examination will be made of the differences in hearing between groups of ten-year-old children brought up in areas of Sydney which differ markedly in their background noise level. As the study seeks to establish very small differences between hearing in the diverse populations, new audiometric techniques have been devised which are suitable for ten-year-old children and which will also give necessary testing accuracy. This investigation is being carried out with the collaboration of the N.S.W. Department of Education. Preparations have been made for a study of the effect of prolonged exposure to noise from armoured vehicles on the hearing of military passengers and crew. This work will be done in collabDratiDn with the Second Cavalry Regiment stationed at Holdsworthy, N.S.W.
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An, investigation of the sound attenuation characteristics of thirty different ear protectors Ill. 619 nOIse spectra recorded in industry led to the development of a sImple techmque for selecting an ear protector giving adequate sound attenuation for a particular noise environment. The technique uses the facilities available on a standard sound level meter and thus obviates the need for much octave band analysis in hearing conservation work. A proposal has been made for its inclusion in an Australian standard dealing with hearing conservation.
Physiology The long-term evaluation of ultrasonic irradiation of the inner ear as treatment of Meniere's disease is continuing and encouraging results are being obtained. Preliminary investigations of the effects of ultrasonic irradiation on the inner ear of sheep have shown that the irradiation has a selective effect on the neurosensory epithelium and secretory tissues of the inner ear. The study is now being continued with guinea pigs to determine the mechanism of the functional changes caused by the irradiation.
Ultrasonics Regular clinics have been continued in several hospitals for ultrasonic examination of the abdomen, heart, breast, eye and brain. More than fifteen hundred patients were examined in these clinics during the year to clinically evaluate the performance of the ultrasonic echoscopes designed by the Laboratories. Continual improvement in the quality of ultrasonic cross-sectional displays of these soft tissue organs has been achieved by optimisation of various aspects of transducer signal processing and display techniques. A new ultrasonic examination technique, known as the wide aperture array technique, is being developed and is expected to improve the resolution, speed up the examination and remove artifacts from the echoscope display.
Standards Staff members continued their active participation in work connected with Australian standards. One with which they were involved was the recently published 'Methods of Measurement of Airborne Sound Emitted by Machines'. This standard establishes general' methods for measuring sound generated by machihes in different acoustic environments. Staff members also assisted in the drawing up of various draft standards, including 'Draft Australian Standard Code of Recommended Practice for Noise Assessment in Residential Areas' and 'Test Code for the Measurement of the Airborne Noise Emitted by Rotating Electrical Machinery'.
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Commonwealth Radiation Laboratory During the year the Commonwealth Radiation Laboratory (which, prior to 1 July 1972, was known as the Commonwealth X,Ray and Radium Laboratory) continued to provide advisory services in the physical aspects of medical radiology and radiotherapy. The new name of the Laboratory is more appropriate to its present functions, which are to maintain standards for the measurement of ionising radiations and of radioactive substances, procure and distribute all radioisotopes used in Australia for diagnostic investigations and treatments of patients, maintain a surveillance of levels of radioactivity in the Australian environment, and provide an advisory service for matters relating to protection of people against ionizing radiations, laser radiation and microwave radiation.
National standards As an agent of C.S.I.R.O., appointed under the Weights and Measures (National Standards) Act, the Laboratory maintains national standards for the measurement of X,rays and of radioactive nuclides. During the year, in collaboration with the National Radiation Laboratory of New Zealand, the X,ray standards were compared with similar standards held in England and New Zealand. The equipment and methods used for the standardisation of radionuclides have been improved and their capabilities extended. The number of radio nuclides which can be standardised at the Laboratory has been increased from sixteen to twenty,one.
Radiation dosimetry The methods used for calibrating clinical dosemeters were reviewed and modified where necessary to increase the accuracy of the results obtained. The Laboratory continued its work of developing equipment and methods for the measurement of X,rays of high energy. An extensive survey being undertaken on behalf of the National Health and Medical Research Council to determine the genetic and mean bone marrow doses to the Australian population arising from the medical, dental and chiropractic uses of X,rays and of radioactive substances is in progress. During the year the Laboratory took part in a survey conducted jointly by the International Atomic Energy Agency and the World Health Organisation. The object of the survey was to improve conditions of treatment by comparing methods of dosimetry at radiotherapy centres throughout the regions covered by the survey.
Radioisotopes The Laboratory is the central procurement authority for the purchase and distribution of all radioisotopes used in Australia for medical diagnosis or treatment. Of the 12,341 shipments of radioisotopes procured for medical use during the year, 10,922 (eighty, nine per cent) were obtained from the Australian Atomic Energy Commission and the remainder were imported from Belgium, France, Holland, India, Israel, Italy, Sweden, United Kingdom, United States of America and West Germany. The shipments included forty,one different radioisotopes in many forms. 90
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The Commonwealth Radiation Laboratory is concerned about the potentially dangerous levels of radiation which may be emitted by microwave ovens. Here a scientist monitors an oven to detect any leaking radiation.
Radioisotopes for medical purposes are issued free of charge, the cost being borne by the National Welfare Fund. Expenditure from this fund for radioisotopes supplied for medical purposes is shown in Table 82 on page 162. There is an increasing demand in Australia for the short-lived radiOisotopes available from the Australian Atomic Energy Commission. In particular, technetium-99m labelled radiopharmaceuticals are now used extensively for organ scanning. Three are used routinely, three are in the advanced stages of clinical trials and the use of others is being considered. These radiopharmaceuticals are either prepared at the Australian Atomic Energy Commission or at the Laboratory. During tht; year a new and improved solvent extraction method, which permits the separation of larger quantities of technetium-99m, was set up at the Laboratory.
Radium and radon The care and maintenance of the Commonwealth stock of radium continued during the year. Particular attention was given to the design of containers used to transport radium and radon to ensure conformity with relevant regulations. In March 1972, twenty-one radium needles and twelve radium tubes which had been held on loan for many years by the Medical Department, Fiji, were given to that Department by the Commonwealth.
Film-badge service The film-badge service issues film-badges to people working with ionising radiations to permit assessment of the doses of radiation received by them in their 91
work. In 1971-72, 74,345 films were assessed and reported on. The number of centres registered with the service is 1,646. During the year it became necessary to change the kind of film used for the service. This required an extensive series of experimental tests to determine the characteristics of the new film.
Diagnostic radiology A steady demand by government instrumentalities, hospitals and universities for the advisory services of the Laboratory on the physical aspects of diagnostic radiology continued during 1971-72. These services include the planning of X-ray departments, preparation of specifications and assistance with special projects.
Whole-body monitor During the year the capabilities of the whole-body m~mitor were improved and extended. The whole-body monitor is primarily an instrument designed to identify, and estimate the activity of, gamma-ray-emitting radioisotopes in the human body. Its practical applications include the monitoring of persons who work with radioactive materials, the study of the incidence of trace radioisotopes in samples of the population and the identification of slight impurities in some radiopharmaceuticals. In collaboration with physicians and other medical specialists, clinical studies on selected hospital patients were also undertaken during the year.
Radiochemistry and low-level radioactivity The Laboratory continued its programme of monitoring radioactive materials in the Australian environment. The French atomic weapons tests in the Pacific made necessary a programme of monitoring radioactive substances of short life. This work was carried out from June to November 1971. The routine monitoring of long-lived radioactive materials was continued independently. In 1971-72, 7,209 samples were processed and the results passed to the National Radiation Advisory Committee through the Atomic Weapons Tests Safety Committee.
Protection against radiations In Australia, the Commonwealth and State governments have powers to control the use of sources of ionising radiations within their territories. In addition to providing advice on this, the Laboratory co-operates with State authorities in their radiation control programmes. There has been particular interest in the safe transport of radioactive substances and in protection against the hazards associated with the use of lasers and microwaves. The use of lasers is increasing. Those now available range from the low-power devices used in schools to the high-power devices used in research establishments. All may present hazards to operators and the pUblic. The use of microwave ovens in places such as hospitals and restaurants to re-heat pre-cooked food is increasing. If not in proper adjustment, these ovens may leak microwave radiation and may give rise to a public health hazard. .~..
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Commonwealth Bureau of Dental Standards I During 1971-72, the Bureau of Dental Standards continued its programme of evaluating products available to the dentist, and of examining materials, instruments and equipment on behalf of the Standards Association of Australia and other bodies.
Testing programme Test reports were issued on 404 different samples during the year. Of these, 183 were for manufacturers and distributors, twenty per cent of them being for overseas firms. Some Australian manufacturers take the precaution of having each production batch checked by the Bureau before release. One hundred and ninety-seven of the samples were tested for the Services and public instrumentalities and the remaining twenty-four were products examined for general information purposes. A wide variety of products were tested - eighty-three of them dental instruments, fifty-five therapeutic and surgical items, thirty-nine metals and alloys, thirty-five mineral products, seventy cements, forty-seven synthetic resins and seventy-five waxes and impression materials. Such diversity calls for a wide range of testing procedures and equipment.
Standards programme Most of the materials used in substantial quantities in dental practice are now covered by Australian standards. Many of these are under revision at present to bring them in line with modern developments in dental techniques, manufacture and packaging. At the same time the revisions are being converted to metric (SI) units throughout. Most of the items now under consideration are more complex and less amenable to standardisation, and the Bureau has continued to assist the Standards Association of Australia through about twenty of its committees to produce dental and medical specifications. The Bureau participated, usually to a major degree, in the following standards recently published in the metric series: AS 1022 Dental Rubber Dam; AS 1032 Toothbrushes; AS 1043 Acrylic Denture Base Resin; AS 1086 Dental Chisels, Excavators, Probes and Scalers; AS 1093 Shanks and Chuck Fittings for Dental Rotary Instruments; AS 1094 Single-Use Syringes (Sterile) for General Medical Use; AS 1097 Dental Duplicating Materials; AS 1139 Intra-Oral X-ray Films; AS 1185 Elastomeric Dental Impression Materials; AS 1186 Dental Zinc Phosphate Cement; AS 1207 Metal Surgical Implants; AS 1208 The Use of Plastics for Surgical Implants; AS 1264 Single-use Hypodermic Cartridge Needles; AS 1282 Dental Alginate Impression Materials. 93
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The following standards have reached the public review stage: AS 1240 Latex Elastic Bands for Orthodontic Use; AS 1241 Shellac Dental Baseplates; AS 1253 Orthodontic Band Cements; AS 1258 Dental Gutta Percha Points; AS 1278 Direct Filling Composite Resin; AS 1283 Rubber Dam Punch. Other standards under consideration cover dental X-ray machines, dental operating lights, rubber dam punches, dental excavating burs, root canal instruments, dental waxes, anaesthetic solutions for injection, cartridge syringes and alginate impression material. In the international sphere, the Bureau has participated in further exchange testing between laboratories in various countries and in the work of a number of committees. Recently, various 'task groups' were formed to consider international (ISO) standards, and Bureau staff members were appointed to five of them. Information programme During the year a number of students and groups visited the Bureau for training and demonstration sessions. These included dentists enrolled for higher degrees, Army dental officers, individual dentists from various States of the Commonwealth and from overseas, Service hygienists, Service and apprentice technicians and large groups of dental nurses. Dental trade representatives from Australia and abroad also visited the Bureau to discuss new and improved products. Considerable assistance was given to dentists and others in the way of advice on the selection and use of materials, instruments and equipment. Research programme The time available for original research has been limited because of the demands of other work and the availability of technical staff. However, various investigations were carried out for the Services, manufacturers and members of the professions. Substantial investigations were conducted on testing methods for materials and instruments under consideration for standardisation. These include endodontic and orthodontic materials, instruments and appliances, dental baseplates, direct filling composite resins, casting materials and tissue conditioners. Direct assistance in research programmes being conducted by dentists was given in relation to metal-to-metal unions commonly found in dentistry, the effect of re-melting and re-using casting alloys, and the behaviour of dental goods in tropical regions. Research at the Bureau continues on atomic and infra-red absorption spectroscopic techniques for the analysis of a wide range of alloys and organic materials. The scope of identification and analysis of polymers will be greatly increased by the installation shortly of a gas chromatograph.
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School of Public Health and Tropical Medicine The School of Public Health and Tropical Medicine again undertook a wide variety of research projects during 1971-72, covering the fields of biochemistry, entomology, environmental health, occupational health, parasitology, pathology, microbiology, preventive and social medicine, radiation biology and tropical medicine. In addition, the School continued its broad scope of teaching activities and its consultative and advisory services.
Teaching A wide range of teaching was again undertaken at a variety of levels of instruction both within and outside the University of Sydney. At the postgraduate level, the most important activities were the two full-time courses leading to the Diploma in Public Health and the Diploma in Tropical Medicine of the University of Sydney. Fifteen Diplomas in Public Health and seven in Tropical Medicine were awarded during the year. Contributions were also made to a number of other postgraduate diploma courses and to courses leading to the degree of Master of Building Science in the University of Sydney, Master of Technology in Public Health Science, Master of Technology, the Graduate Diploma in Engineering and the Diploma in Public Health Engineering in the University of New South Wales. A three-week course in Occupational Health, given as part of the course for the Diploma in Public Health, was also made available to medical graduates in general and was well attended. At the undergraduate level, substantial contributions were made to the teaching of students in medicine, architecture, education and engineering in the University of Sydney, and in medicine at the University of New South Wales. Instruction was also given in courses of study at the Australian School of Pacific Administration and the New South Wales College of Nursing.
Biochemistry Studies on amino-acid separation by high voltage electrophoresis were undertaken throughout the year. Longitudinal studies in 'benign' proteinuria were continued and extended to include immunoglobulin assays. Work was also undertaken on the effect of weight reduction on the Cortisone Provocative Test (C.P.T.). This test has been used at the School for some years and, where possible, selected cases are followed up. It has been shown that in simple obesity (defined as obesity without apparent pathology and responding to dietary control) there has been a higher incidence of a disturbed C.P.T. than in a 'normal' cross-section of the Australian popUlation.
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Entomology 'II
The major task of sorting and identifying some 35,000 midge specimens, collected by truck trap at Gove, Northern Territory, in January 1971, has been almost completed. On the basis of identifications so far carried out, a preliminary ~,
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report has been prepared on biting midge activity at Gove. It was found that the most serious problem was in the Wallaby Beach area where species of the Culicoides omatus complex dominated. with greatest activity at dusk and dawn. Nhulunbuy township was relatively free from midge attack as the dominant species there was Culicoides marksi. which bites man infrequently. A late wet season survey of the anopheline mosquito problems at Gove was undertaken in May 1972 and two members of the section visited Darwin at the beginning of June to make a preliminary investigation of the unexpected prevalence of Anopheles parauti there. Work has continued on the manusc'ript of 'The Mosquitoes of the Australasian Region', which is now almost ready for publication. The most frequently encountered problem in medical entomology during the year was a continuing outbreak of scabies in nursing homes. Advice was given on diagnosis and methods of eradication were suggested when requested.
Environmental Health Section During the year the laboratory resources of the Environmental Health Section were largely devoted to establishing the composition of the sweat secreted by young Australian men and women in response to moderate exercise in a hot environment. Besides being of theoretical interest, this is a matter of practical importance in determining the salt requirements of Australians working in hot
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Large-scale construction work in remote areas of Australia is associated with occupational safety and health problems because of the lack of adequate inspection personnel. This sand-blaster erroneously believes he is protecting himself from silicosis with his strange head-gear, whereas he should be wearing a helmet supplied with clean air. The School of Public Health and Tropical Medicine recently completed a study of such hazards in remote areas of the Northern Territory.
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clima tes. Very comprehensive analyses of the sweat have been undertaken and the information gained has served to throw some light on the manner in which sweat is produced from the blood. Among the more interesting findings is that the ratio of sodium ions to chloride ions in sweat is fixed with remarkable precision, with the relation independent of age, sex, race, diet and the serum sodium and chloride levels. The analysis of the results obtained from work undertaken by Dr. G. M. Budd as part of the Human Adaptability Programme of the International Biological Programme in New Guinea was continued during the year. Definitive conclusions must await the completion of the analyses, but the preliminary results indicate that the thermal environment to which New Guinea coastal villagers are exposed during their normal outdoor occupations would average about 80°F Corrected Effective Temperature. During the course of an eight·hour day they would lose some two lit res of sweat and replace one litre of this by drinking, thus incurring in the course of the day a deficit of approximately two per cent of their body weight. Laboratory experiments conducted in the same investigations showed that all the New Guineans tested had low sweating capacities, comparable to those of unacclimatised Europeans. Europeans living on Karkar Island had, on the other hand, a much higher sweating capacity than the New Guineans - comparable to that of Europeans in temperate climates who have been irtifically acclimatised to heat.
Occupational Health A study of hypothenar hammer syndrome was conducted, in collaboration with Professor J. M. Little, Department of Surgery, University of Sydney, among motor mechanics of the Department of Supply and the New South Wales Department of Railways. It Ievealed that in this sample, there was much unrecognised disability due to damage to the superficial palmar branch of the ulnar artery amongst mechanics who used their hands as hammers on motor vehicle panel work. A study of phonogram operators, undertaken in the Chief Telegraph Office, Sydney, at the request of the Central Office of the Postmaster-General's Department, revealed certain unsatisfactory conditions of work which were leading to postural deformities. An extensive report has been provided, and publication of the findings is being considered. The study of coronary heart disease in the Commonwealth Public Service, the planning of which began in 1969, was continued. Methods of recording and of collating and analysing records of mortality and morbidity were explored, and overseas centres conducting research in this field were visited. A report is being prepared on this visit, with recommendations on the nature of the studies to be undertaken, and on programmes for the prevention of the disease in the service. The most comprehensive study of working environments yet undertaken in the Northern Territory by the Occupational Health Section was completed. In June-July 1971 a member of the Section visited the Darwin area, Groote Eylandt and Gove to investigate a number of aspects of the industrial environment as they might affect the health of workmen. The investigation at Groote Eylandt followed a request to the Director-General of Health by the Federated Miscellaneous Workers' Union of Australia concerning possible health hazards to men from dust arising from manganese mining on the island. It was found that there was no serious threat to the health of workmen at Groote Eylandt, although in a few isolated areas more effort could be required to linlit the dust exposure of some workers. Sand-blasting, which is used extensively at construction sites and to a lesser extent in development areas in the Northern Territory, may require more positive control to prevent unnecessary exposure of men to silicosis-producing dusts. In collaboration with the Department of Supply, a study was conducted of the 97
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A Commonwealth driver assists a girl, paralysed in all four limbs as a result of a car accident, to attend for treatment. The School of Public Health and Tropical Medicine has been conducting a study of the risks to patient and driver in the transport of disabled people in Commonwealth cars.
risks to patient and driver in the transport of disabled persons from their homes to hospitals, rehabilitation centres and doctors' and dentists' rooms in Commonwealth cars. Difficulties similar to those involving the use of steps are encountered in the transferral of patients to and from cars. Arising out of this study, a programme of training was initiated for Commonwealth car drivers in methods of handling patients, and recommendations were made concerning the design of suitable vehicles for transport of the disabled.
Parasitology Studies on filariasis, malaria and alimentary parasitism in the Upper Fly River area of Papua were undertaken when the area was visited in June 1971 in conjunction with the Army exercise 'Tiger Lily'. Malaria and filaria blood films, mosquitoes for dissection, and faecal specimens were collected in four villages on the Alice River and two villages north of Lake Murray. This material has been examined and a draft of a paper for publication has been prepared. Extremely heavy hookworm infestations were demonstrated in two soldiers who returned from South Vietnam in June 1971, and the Director-General of Medical Services, Army Headquarters, requested that the alimentary parasite survey of troops returning from South Vietnam, which began in 1966, should be reactivated. Since July 1971, 190 specimens have been examined but all parasite indices so far determined have been low.
PathologV and Microbiology Work is currently being undertaken on the microbiology of Sydney oysters in relation to public health. Samples of oysters, estuary water and sand are being examined for the presence of Vibrio parahaemolyticus, Salmonella species and faecal coliforms. The effect of such factors as rainfall, temperature and location of
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the growing areas on the distribution of these organisms and the possible ways in which the risk to the public of eating infected oysters may be minimised are also being investigated. Present results indicate that Vibrio parahaemolyticus is frequently present in oysters, but only in very small numbers. The exact significance of this finding is not yet known. Generally the oysters collected from commercial growing areas were of good microbiological quality.
Preventive and Social Medicine The study undertaken in conjunction with the Department of Public Health, Papua New Guinea, on Karimui Leprosy continued throughout the year. In December 1971 the population was again surveyed and the previous findings regarding the efficacy of BCG vaccination confirmed. The treatment programme, using DADDS (4,4' - diacetyldiaminodiphenyl sulphone) injected at intervals of seventy-five days, has continued to achieve excellent results but two cases of suspected drug resistance have been detected. These cases are now the subject of intensive study, including serum estimations of DDS (dapsone) and the growth of the organisms in mouse foot pads. A study of medical manpower in New South Wales, commenced in 1968, has been updated by a survey of the manpower situation as at the end of 1971. Contrary to popular opinion, there is no evidence of a decline in the number of
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Medical practitioners from New Guinea undertook postgraduate diplomas at the School of Public Health and Tropical Medicine for the fIrst time in 1972. These two doctors, IV. W. Tavil, of Rabaul (left), and L. Sialis, of Kavieng, are pictured in a parasitology class in the Diploma in Tropical Medicine course. A third doctor, K. Sugoho, of Lae, is reading for the Diploma in Public Health. 99
general practitioners, although the increase in their number has not been spectacular - a net gain of fifty-five between 1968 and 1971. During this same three-year period, however, immigration of medical practitioners made a significant contribution to the medical manpower in New South Wales, particularly with respect to resident medical officers in hospital posts. A study of 100 randomly selected amputees who have undergone an amputation during the past five years at the Royal Prince Alfred Hospital, Sydney, has begun. This survey is being undertaken in close collaboration with Vascular and Rehabilitation Clinics at the Hospital. Since the study began in March 1972, related literature has been reviewed, the aims of the study clarified, the methodology planned and a questionnaire prepared and pre-tested. The questionnaire proved satisfactory in trials and interviewing of respondents has begun. The main interview will be conducted by a social worker, but an evaluation of the amputee's performance in daily activities will be made by occupational therapists and physiotherapists working with the patient at the Rehabilitation Centre of the Hospital. Subsequently two further interviews - one with the amputee and one with the spouse - will be conducted by a social worker during a home visit to the respondent.
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Radiation Biology The work of the Radiation Biology Section has continued to expand in two well defined areas - dose response relationships to radiation exposure in tissue culture, and the immunological relationships resulting from the repair of radiation injury in the whole animal following tissue grafting.
Tropical Medicine Work on the 'Coastlown' project - a study of the health of Australian Aborigines - continued throughout the year. The population concerned is a rural-urban part-Aboriginal community centred on a New South Wales coastal town. All the field work for the project has been completed and analysis of the information arising from the survey in July 1972 was to be finished by August 1972. The report on the project is in preparation and should be completed by the end of 1972. 'Aboriginal Health', a review and analysis of Australian Aboriginal and part-Aboriginal mortality, morbidity and health ecology, has been completed and will shortly be submitted for publication. Australia was the host country for the Fifth South-West Pacific Malaria Conference which was held at the School of Public Health and Tropical Medicine in association with the World Health Organisation. Participants came from Australia, Indonesia, Papua New Guinea, British Solomon Islands Protectorate, and the New Hebrides. Professor R. H. Black was elected chairman of the conference. The malaria situation in the represented countries was reported, technical problems were discussed and inter-country co-operation arranged. A report of the Conference was issued by the World Health Organisation.
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Institute of Child Health The Institute of Child Health continued its research functions during the year, investigating many areas relating to the health and well-being of children. Prominent among its research projects are studies of children with rheumatic fever and chorea and of others with urinary tract infections. The Institute also continued its regular teaching and advisory functions. Overseas fellows from Indonesia and Cambodia received postgraduate training during the year and the staff of the Institute received many enquiries and requests for advice from universities and paediatricians in South-East Asia on paediatric problems and on the development of child health services.
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Child psychiatry Regular undergraduate teaching of medical and social work students continued in the field of child psychiatry. Demonstrations and lectures were held for candidates for entrance examination to the Australian and New Zealand College of Psychiatrists, and seminars in psychopathology were held for candidates taking the course in child psychiatry for the New South Wales Institute of Psychiatry. Metabolic Laboratories Steady progress was made in the studies centred around mammalian folic acid metabolism. One significant achievement related to the isolation of a binding protein for folic acid from the brush border membranes of the small intestine. Another study relating to the mechanism of action of dihydrofolate reductase, a critical site of action of malignant disease chemotherapy, was completed. Metabolic Clinic Preventive aspects of medical care are now receiving more attention and one significant recent contribution is the development of routine screening programmes to detect metabolic disorders before the chemical anomaly has had an opportunity to cause damage to the infant and child. The Institute continues to be the reference point for the further investigation and treatment of these disorders in N.S. W. The Metabolic Clinic handled over 500 patient visits in this preventive work. Rheumatic fever The long-term study of children with rheumatic fever and chorea, begun in 1952, was continued with further evaluation of the patients, many of whom have either reached adolescence or have become adults. Two hundred and eleven of them are now between fifteen and twenty-nine years of age. Of these, over seventy per cent had active rheumatic carditis at the time of their initial illness, and all have attended the after-care clinic. The research has suggested that the kind of medical management at the time of the acute illness and, later, during the period of continuous penicillin prophylaxis may contribute to, or can allay, excessive and unresolved anxiety about real or imagined cardiac disability. Such anxiety may be partly responsible for anti-social behaviour in rheumatic adolescents. 101
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A happy occasion at the Institute of Child Health in Sydney - a Christmas party for some of the children who take part in the Institute's research programmes.
Urinary tract infections A number of children with urinary tract infections who have shown recurrences of infection in association with persisting vesico·ureteric reflux have been submitted to anti-reflux surgery with impressively good results. Many more children with recurrent infections and ureteric reflux have been shown to lose the reflux spontaneously when prolonged chemotherapy has succeeded in eradicating infection. The patients under study have presented ample clinical evidence of the difficulties in diagnosis of urinary infections in small children and the necessity for regular and prolonged supervision of patients under treatment. Some of the latter have shown unsuspected recurrences of infection on routine urine examinations when there have been no symptoms or other indications to suggest this. Prolonged chemotherapy, often for years, is still considered to be the most effective way of eradicating chronic urinary infections when there is no indication for surgical treatment.
Social work The social workers have continued to play an active part in the teaching of medical students, in the assessment of 'problem cases' and in ensuring that long-term patients, especially from the Rheumatic Fever Clinic, the Metabolic Clinic and the Gastroenterology Clinic, have continued their treatment and understood the problems which may arise from their illness. This has enabled many problems to be prevented.
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International Health During 1971-72 the Departmeni contimled to play an active role in international health matters, both abroad and within Australia.
World Health Organisation The 25th World Health Assembly was held in Geneva from 9-26 May, 1972. As retiring President, the Director-General presided at the opening sessions until the new President was elected. More than sixty agenda items were considered both in plenary meetings and in the meetings of the two main committees. Such matters included the admission of new members, smallpox eradication, community health services, occupational health, drug quality and safety, environmental problems and drug dependance. I
Admission of new members As a recognised member of the United Nations, the People's Republic of China would be automatically entitled to membership of the World Health Organisation under Article 4 of the Constitution. The point at issue was the question of replacement of the Republic of China (Taiwan) by the People's Republic of China, and Pakistan moved a resolution to this effect. The voting was in favour of the admission of the People's Republic with seventy-six in favour, fifteen against and twenty-seven abstentions. The Director-General of WHO announced that the People's Republic of China had been unable to make arrangements to send an observer to the 25th World Health Assembly in view of the shortage of time. New Zealand proposed the admission to WHO of Bangladesh as a legally accepted member of the Commonwealth and as a country in particular need of any assistance WHO could give. The voting was in favour of the admission of Bangladesh with ninety-three for, none against and twenty-four abstentions. Australia proposed the application by Papua New Guinea for associate membership, and it was very pleasing to have a unanimous vote favouring the admission. The decision to admit Papua New Guinea was greeted by acclamation. The representative from Papua New Guinea, who served as an alternate delegate in the Australian delegation, spoke fittingly in reply on behalf of his country. Papua New Guinea has been assigned provisionally to the Western Pacific Region.
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Smallpox eradication A prolonged discussion took place on smallpox eradication. The recent outbreak in Europe had stimulated interest in this topic. The Yugoslavian delegation advised that their country had been considered free of smallpox as from 9 May 1972. It was agreed during the discussion that the outbreak in Yugoslavia again highlighted the absolute need for hospital personnel, including doctors, to maintain their vaccination status. Opinion was expressed that it was essential for doctors still to be taught more about smallpox and that use should be made of slides and tape recordings which are available from WHO for this purpose. Progress was reported in the smallpox eradication programme being carried out in India where it was indicated that seventy-five per cent of the cases came from
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At the Twenty-fifth World Health Assembly in Geneva, the Director-General of the Department, Sir William Refshauge (left), who was President of the Twenty-fourth Assembly, congratulates Dr B. D. B. Layton, of Canada, on his election as President of the Twenty-fifth Assembly.
three States only. The improvement was attributed to three factors: Increased primary vaccination, including neonatal vaccination; the availability of freeze-dried vaccine; and the multiple puncture method of vaccination.
Community health services The WHO Secretariat advised that a model could not be offered as a solution to the question of how the ideal community health service should be organised. During the discussions, certain points were made highlighting the difficulties both in research in, and the . development of, community health services. It was stated that research on comparative health service systems had not yet been sufficiently developed, and that perhaps the most difficult problem in such research was to establish universally acceptable frames of reference for assessing the effectiveness of health service systems. Initial steps had already been taken to identify problems and methods, but there was a pressing need for planning the comparison of various national health service systems. The Australian delegation took part in the debate and, among other points, put forward the following views: The study of community health has become a com bination of epidemiology and of investigation of the medical needs of the community, with all their ramifications. In the more developed countries, research indicates that present day priorities are largely, but not completely, associated with 104 I
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the chronic diseases and the chronically sick and disabled. Research methods are now more complex, more expensive and more time-consuming than in the past. An inter-disciplinary approach is often essential for a satisfactory solution. Thus if economy in personnel, time and funds is to be achieved, co-ordination of research and avoidance of unnecessary duplication is essential. Perhaps the greatest challenge to research in community health is the devising of means for changing attitudes and convincing doctors, nurses, students and others that new values are being explored in health. Preventive medicine at all levels - national, community and individual needs far more emphasis on improvement of the quality of living, and indeed on the future of mankind'. Other points made included the need for cost benefits analysis (agreed to be very difficult indeed); the need for health education; the need for investigation and assessment of mass screening techniques; and the problem of how to integrate occupational health services into the community health services. After considerable debate, a resolution was passed with a view to development by WHO of a comprehensive long-term research programme on the organisation of health care systems at local and nation-wide levels.
Occupational health An excellent report on occupational health was considered by the Assembly and this report will, it is expected, be published later. Occupational health was defined in this paper as the promotion of the physical, mental and social welfare of workers, as well as the protection of workers from risks associated with their employment. Hazards listed which may affect workers included toxic gases and solvents, heavy metals, ~egetable dusts, carcinogens (known and unknown), physical factors (such as noise, vibration, heat and high or low atmospheric pressures) and injuries of various kinds. There may also be special hazards for women employed in industry.
Drug quality and safety In discussion on the subject of drug quality, safety and efficacy, it was stated that safety and efficacy could not be separated and that therefore the requirements for the pharmaceutical quality of a new drug should be established concurrently with its safety and therapeutic effectiveness. Control measures should then be applied to ensure the precise quality of marketed preparations. It was also stated that control measures designed to ensure adequate quality, safety and efficacy of drugs could not be successful without the medical profession being well informed about both the risks and benefits of drug therapy. Continuing education and informa tion on the use of modern drugs was therefore essential to the total health effort. It was stated that control could be divided into four phases: Inspection of manufacturing facilities; analysis of drugs offered for sale; review of claims made for preparations; and publication of results of inspection and assessment to the medical profession, with general literature being available to the public. A resolution was adopted requesting WHO to report on the feasibility of an international information system to provide scientific data and conditions of registration of individual drugs, and to determine the practicable minimum requirements to develop a comprehensive approach to ensure the quality, safety and efficacy of drugs. It was also urged that all countries ensure that information regarding adverse reactions to drugs, after validation, be forwarded without delay to WHO.
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Environmental problems Two resolutions were adopted. The first drew attention to the importance of the problems of the environment and to the need for continued activity by WHO in this 105
field, using funds from the regular budget· and also from any international environmental funds that may be established, as well as from voluntary contributions. The second resolution stressed the import~nce of investigation and control of residues, additives and contaminants of food, and of continued collaboration with the Joint F AO/WHO Codex Alimentarius Commission in this regard.
Drug dependence It was agreed that drug dependence should be considered as a social hazard and that concerted action was needed at all levels for the treatment and prevention of the condition. It was recognised that drug dependence was a world-wide problem involving the supply, trafficking and illicit demand for drugs. The reduction of the demand for drugs was considered to be largely a health matter, and it was considered that WHO should provide leadership, guidance, technical assistance and research into the problem. It was also suggested that epidemiological studies of drug dependence should be undertaken and that WHO was the best organisation to implement such studies. It was stressed that education and rehabilitation were needed far more than repressive measures. A resolution was adopted requesting member states to increase efforts to promote programmes of education, epidemiological studies, prevention, treatment, rehabilitation, and research into drug dependence. It was also decided to explore ways of planning increased financial support to expand the WHO programme in the field of drug dependence. Regional Committee The 22nd Session of the Western Pacific Regional Committee of WHO, of which Australia is a member, met in Manila from 21-29 September 1971. The Australian delegation included representatives from Papua New Guinea and from the Australian Medical Association. Cancer research A new headquarters building for the International Agency for Research on Cancer in Lyon, France, has been donated by the French authorities. The opening ceremony was attended by President Pompidou of France on 9 June, 1972. Australia was represented at the opening by the Commonwealth Minister for Health. The furnishings for the delegates' lounge are a gift from Australia. The opening of the new building should materially assist the Agency in its role in research on the epidemiology of cancer. The building comprises a fourteen-storey tower block with laboratories, conference rooms and offices and an auditorium equipped with simultaneous interpretation equipment. These facilities will enable the Agency to centralise the headquarters programme and provide research facilities for visiting scientists. The programme of the International Agency for Research on Cancer endeavours to identify noxious factors in the environment which cause cancer in man and to evaluate the dangers to man of compounds suspected as the result of animal studies. Some seventy programmes have been initiated with research institutes in all five continents. The Agency is continuing to collect data on DDT. This pesticide is still the most useful in the fight to eradicate malaria-carrying mosquitos and food pests and no equally efficient, non-toxic and economical substitutes are readily available. Studies on DDT using high dose levels show that tumours can be induced in mice but, to date, there is no evidence that DDT causes cancer in man. The International Agency for Research on Cancer is continuing to collect pertinent human data. Food contamination is another subject under close study. It has been found that 106
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liver cancer in Mozambique is twenty-five times more frequent than in the U.S.A. and 100 times more frequent than in England. Research is being conducted to find the causal agents for primary liver cancer, one of the suspects being aflatoxin. Preliminary studies suggest a significant association between the levels of aflatoxin ingestion and liver cancer. The possible role of viruses in human cancer is of great significance although, as yet, no human cancer has yet been proved to be definitely of viral origin. An extensive study of 35,000 children in Entebbe, Uganda, may show whether the development of a particular type of childhood cancer known as Burkitt's lymphoma is in fact linked with herpes virus infection.
Third Commonwealth Medical Conference The Third Commonwealth Medical Conference was held in Mauritius from 2 to 12 November, 1971. Representatives of health services from most of the thirty-one Commonwealth countries discussed a variety of mailers such as co-operation in providing health services, education in the health fields, the recognition of professional qualifications and family planning.
External medical aid Departmental officers visited both Vietnam and Indonesia during the year to assess and report on medical aid programmes. In each case reports were made to the Department of Foreign Affairs, which is responsible for the implementation of the programmes. Only one Australian surgical team is now stationed in Vietnam, at Bien Hoa. The medical aid programme in future is expected to be directed more towards training of the Vietnamese and the provision of buildings for public health and preventive mediCine. In Indonesia there are six functioning medical aid projects and a further two under consideration. In each case the projects are primarily sponsored by voluntary effort in Australia and, subject to examination and approval, given additional support by the Department of Foreign Affairs.
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International training The Department acts as a training authority under various Australian and international schemes for overseas trainees in the health field. This involves arranging suitable training programmes and organising placements in training institutions for overseas postgraduate medical, dental and paramedical personnel sponsored under the Colombo Plan, the South-East Asia Treaty Organisation Air Programme, the Special Commonwealth African Assistance Plan, the South Pacific Aid Programme, the Australian International Award Scheme, the ANZAC Fellowship Scheme, the Commonwealth Scholarship and Fellowship Plan and the Commonwealth Practical Training Scheme for Papuans and New Guineans. Trainees in the health field sponsored by international bodies such as the UN and WHO, or by their home governments, are also the responsibility of this Department. In the twelve-month period ending 30 June 1972, some 130 overseas Fellows commenced their training. These included seventy-nine postgraduate doctors, thirty-eight paramedical trainees and thirteen postgraduate dentists. Many trainees required placement in several institutions and some individual training programmes involved as many as thirty-eight placements. Training was arranged in many fields of postgraduate medicine and surgery, dentistry, pharmacy, quarantine procedures, physiotherapy, occupational therapy, dietetics, medical records, librarianship, laboratory technology, radiography, drug control and pharmaceutical quality control and in other areas in which hospital training plays a major role. 107
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National Health and Medical Research Council During 1971-72 the National Health and Medical Research Council continued its role of advising the Commonwealth and the States on public health matters and on medical and dental care, and continued to plan and administer the funds made available by the Commonwealth for medical research. Two sessions of the Council were held - the seventy-third in Canberra in October 1971 and the seventy-fourth in Melbourne in May 1972. Developments in medicine and industry and changes in the structure of society have increased the complexity of the Council's functions in recent years. To assist it to carry out its functions, the Council now utilises the services of some 400 people who serve as members of its sixty expert committees and sub-committees. The Commonwealth Government provides support for medical research through
A study of viral hepatitis under way at Fairfield Hospital in Victoria - one of the many research projects supported by the National Health and Medical Research Council. The researchers, Dr. Ian Gust (left) and Mr. Jakov KaZdor, are fractionating serum obtained from a patient with serum hepatitis. 108
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the Medical Research Endowment Fund, from which grants are made on the recommendation of the National Health and Medical Research Council. In 1937, when the fund was established, an amount of $60,000 was allocated. This had risen to $6.9 million for the triennium 1970-72. In June 1972 it was announced that the Government would make $13.5 million available through the Council for the 1973-75 triennium. This substantial increase in the level of support will allow new research into areas of particular need, additional support for medical research institutes, and expansion of current project and training activities. The first area covers diseases and conditions which may cause prolonged disability or premature death, such as mental illness, renal and cardiac disease, respiratory disorders, injuries, addiction, arthritis and asthma. The second area relates to additional support for special research institutes. Certain institutes in Australia have developed specialised, in-depth research programmes with notable results. Two such institutes - the Walter and Eliza Hall Institute of Medical Research and the Howard Florey Institute of Experimental Physiology and Medicine - have established outstanding world-wide reputations and contributed Significantly to the advancement of knowledge in their respective fields. The Council is anxious that these institutions should be adequately supported. Finally, the Council will ensure that the traditional areas of medical research will receive increased support. Stimulus will be given to current research projects being carried out at universities, hospitals, research institutes and by individual medical and dental practitioners. (A separate report on medical research projects supported by the Medical Research Endowment Fund is published annually.) In exercising its advisory functions on public health matters the Council in 1971-72 made recommendations on a wide variety of subjects.
Child care centres While recognising the need for child care centres in an industrial society such as Australia, the Council emphasised the danger to the emotional development of a child of less than three years who is deprived of sufficient mother-contact. It recommended that child care centres should be structured and controlled according to standards and principles similar to those laid down by the Australian Pre-School Association.
Hexachlorophene The Council made recommendations concerning the availability of hexachlorophene in Australia. It recommended that all preparations of hexachlorophene for use on infants be available on prescription only. With the exception of two low-strength preparations, it also recommended that all other hexachlorophene preparations be available on prescription only.
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Food standards During the year the Council approved amendments to certain food standards induding the standards for metals in foods, soft drinks, spirits and liqueurs, wine, canned meat products, essences, fish and fish products, meat and meat products and the standard for labelling. The aim of these standards is to provide a model for State and Territory authorities concerned with legislation to protect the public from unnecessary or toxic additives to food and from misrepresentation of food contents.
Food and drink containers The Council noted the possible effects on human health and welfare caused by problems associated with the disposal of food and drink containers. It ,~
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recommended that such containers be required to be returnable for re-use or re-cycling, or to be degradable, or to be readily combustible with minimal release of air pollutants. Council also recommended that the appropriate authorities in the States and Territories incorporate these conditions in legislation.
Mercury in fish The Council noted that there was a proven hazard to human health from sea foods containing high levels of mercury. The Council recommended that appropriate authorities should keep a constant check on the mercury content. of oceans and inland waters and, if increasing levels of mercury were detected, actIOn should be taken to reduce the emission of mercury at its source. The Council also established a sub-committee to investigate metallic contamination of sea foods. Poly-unsaturated margarine The Council recommended that all margarine should be labelled to indicate the separate percentage content of poly-unsaturated and saturated fats in the product and that no measures should be taken which in any way prevented individuals from obtaining the type of fat they wished, or had been advised, to eat. Salt in baby foods The Council advised manufacturers that salt should not be added to baby foods. The Council had noted that additional salt was unnecessary for the health of infants and that experiments in young animals had shown that a high salt content in the diet could predispose to hypertension in later life. Preventive medicine At its seventy-fourth session, the Council received the report of an expert sub-committee, the ad hoc Sub-Committee on Future Needs in Preventive Medicine. This report will be published in the Council report. Influenza immunisation campaigns The Council advised that the benefits to be derived from mass vaccination programmes against influenza were doubtful. In addition, there was insufficient evidence that vaccination conferred significant protection upon the individual in terms of clinical disease. Poliomyelitis vaccine The Council reviewed its previous recommendations concerning the use of Sabin poliomyelitis vaccine in Australia. It agreed that Sabin vaccine was more effective than Salk and that immunisation with Sabin vaccine probably gives life-long immunity against poliomyelitis. The Council therefore considered that revaccination of persons previously immunised with Sabin vaccine was not necessary at present. However, it also stated that it was essential for all infants to receive a course of three doses of trivalent Sabin vaccine at minimum intervals of eight weeks. This would maintain herd immunity which is a major factor in reducing reservoirs of infection and thereby protecting adults from infection. In addition, Council stated that although mass immunisation programmes aimed at older age groups were not necessary, individuals of any age who had not received Sabin vaccine should be encouraged to seek it. Management of insomnia The Council approved a document entitled 'The Management of Insomnia'. This has been circulated to all doctors and medical students in Australia. 110
Maternal health The Council received the Maternal Health Committee's second report on maternal deaths in Australia. This report collated and analysed the findings of the State and Territory Maternal Mortality Committees for the period 1967 to 1970. It was published in booklet form and distributed to all doctors and medical students in Australia.
Multiphasic health screening Council received the report of the Multiphasic Health Screening Services Committee, established in 1971. Council noted that the development of multiphasic health screening appeared inevitable in Australia and that there was a need to guide its development and proper use until it had been adequately evaluated. Therefore Council established a sub-committee to investigate the feasibility of evaluating multiphasic health screening in Australia.
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Notification of diseases The Council noted that discrepancies had occurred between the collection of hospital morbidity statistics and notifications of infectious diseases to the State Health Departments. As it is important to have accurate epidemiological information for public health preventive measures, the Council reminded the medical profession of the need to report all cases of infectious diseases as quickly and accurately as possible.
Occupational health The Council received from the Occupational Health Committee the first two of the series of codes of practice concerned with methyl bromide fumigation. These codes deal with fumigation of ships' cargo spaces and dried fruit. The codes were published in booklet form and distributed to State and Commonwealth Government Departments and to representatives of industry.
Overseas Travelling Fellowships Each year the Council awards several C. J. Martin Travelling Fellowships to enable Fellows to work on specific projects overseas. The Fellowships are open to all candidates who have been engaged in medical, dental or related fields of research in Australia for a period of from two to seven years. The tenure of the Fellowships is normally two years overseas and one year in Australia, and the awards are usually made to workers intending to follow a research career in Australia. At its seventy-fourth session, the Council awarded three Fellowships for overseas studies. These related to metabolic problems in child.ren, biomedical computation and cancer research. The Council also awards each year several Public Health Travelling Fellowships to enable graduates working in the fields of public health to study overseas for a period not exceeding twelve months. At the seventy-third session, the Council awarded six Fellowships for graduates to study overseas in the United States, Canada, Britain and selected countries of Europe. The fields of study included alcoholism and drug dependence, community services for the aged, disaster control, psychological assessm ent of police recruits, air contaminants in occupational and general environments, dental auxiliaries in public health services, and government and community health agencies.
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Commonwealth Grants Commonwealth grants totalling $20 million were paid to State Governments and non-profit organisations during 1971-72 to promote and assist in the provision of a variety of health services.
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Public nursing homes Financial assistance towards the erection of new public nursing homes in Victoria, Queensland and South Australia was approved during the year. A total of $5 million is available on a matching basis under the States Grants (Nursing Homes) Act 1969 towards approved expenditure by the States for the erection of public nursing homes. The money is available, broadly on a population basis, during the five-year period which began on 1 July 1969. Matching grant payments during the year amounted to $459,913, bringing total payments under the Act to $796,917. Paramedical services In all, five schemes have now been approved for financial assistance under the States Grants (Paramedical Services) Act 1969 towards the cost of paramedical services to' aged persons in their homes. Four schemes have been approved in South Australia, two of them during the past year, and a fifth in Tasmania, The Commonwealth offer is for matching assistance totalling $250,000 a year and divided among the States broadly on a population basis. Expenditure incurred in the provision of approved paramedical services including physiotherapy, occupational therapy, speech therapy, chiropody and similar services may qualify for assistance. Matching grant payments during the year amounted to $6925.
.--~
Mental health institutions Under the States Grants (Mental Health Institutions) Act 1964-70, the Commonwealth reimburses one third of approved State expenditure on the buildings and equipment of mental health institutions. Since the inception of capital assistance in 1955 a total of $52 million has been paid to the States. Payments during 1971-72 amounted to $4,206,563.
Free milk for school children Free milk was supplied to 1.7 million children attending primary schools, kindergartens, creches, nursery schools and Aboriginal missions throughout the Commonwealth during 1971-72. The States Grants (Milk for School Children) Act 1950 provides for Commonwealth reimbursements of the cost of milk supplied by the States to school children, together with half of approved capital and incidental expenditure incurred in running the scheme. Payments to the States during the year totalled $11,565,486 for the cost of milk and $49,183 for other expenditure. In addition, $279,447 was spent on the cost of school milk in the Australian Capital Territory and the Northern Territory. 112
I
~.
I
Home nursing subsidy scheme A total of $1,835,215 was paid in subsidies to 115 approved home nursing organisations during the year. Under the Home Nursing Subsidy Act 1956, non-profit organisations which employ registered nurses and receive State or local government assistance are eligible for subsidies. Home nursing services under the Scheme are conducted by various organisations including public hospitals, religious and charitable organisations, municipal bodies and voluntary community groups. They provide a valuable service in giving treatment to persons who might otherwise require institutional treatment. Blood transfusion service The nation-wide blood transfusion service operated by the Australian Red Cross Society is subsidised by the Commonwealth to the extent of thirty per cent of the operating costs in each State, provided the State pays a further sixty per cent of the costs. The remaining ten per cent is met by the Society. Commonwealth payments during 1971-72 totalled $989,945. The Red Cross Society also operates blood transfusion services in the Australian Capital Territory and the Northern Territory where the Commonwealth makes grants to the Society amounting to ninety per cent of the operating expenses. Grants during the year amounted to $23,000 in the A.C.T. and $36,200 in the Northern Territory. In addition to these grants, the Commonwealth pays a substantial sum annually to the Commonwealth Serum Laboratories for processing costs involved in the production of blood fractions. In 1971-72, this payment totalled $1,155,000. Royal Flying Doctor Service A new level of Commonwealth assistance to the Royal Flying Doctor Service came into effect on I July 1971 and will continue for a period of three years. Grants for the operational requirements of the Service have been raised from $180,000 to $315,000 a year to meet increased costs. Capital assistance remains at $170,000 a year, on a dollar-for-dollar basis, towards an approved capital expenditure programme. Under the current arrangement the Commonwealth will also meet the estimated cost of $480,000 for the mandatory changeover of twelve base radio stations from double sideband to single sideband radio operation. Payments of $119,070 were made for this purpose during 1971-72 .
r
.
,
113
National Fitness The Government provided $418,000 during 1971-72 for National Fitness activities in Australia. Of this sum, $350,000 was paid into the National Fitness Trust Fund to be used as operational grants. The bulk of these funds ($270,308) was distributed to State National Fitness Councils to assist with salaries and with running costs of various physical recreation activities conducted by the Councils. Grants totalling $34,000 were also made available to State Education Departments to assist with in-service training of physical education teachers and to promote school camping. Grants to universities for physical education courses totalled $24,800. The A.C.T. National Fitness Advisory Committee received a grant of $7,500. while a grant of $6,600 was made available to assist with both the administration and the provision of scholarships for the Australian Recreation Diploma Course.
..
Capital grants A grant of $68,000 was made available on a $1 Commonwealth for $2 State subsidy basis for approved capital projects. Major projects approved to receive
Canoeing insmlction for youngsters at a National Fitness camp in Queensland. 114
,
~
capital assistance include the construction of an accommodation unit at Howman's Gap Camp in Victoria; the construction of National Fitness Centres at Bundaberg, Caloundra and Tully in Queensland; the rebuilding of Parnanga Camp and the purchase of Graham's Castle in South Australia; and the conversion of Guilford Sport and Recreation Centre and the development of the Sorrento Recreation Complex in Western Australia.
I
Commonwealth activity The Commonwealth Council f9r National Fitness met twice during the year while the executive officers of the State Councils met once. The main project discussed by the Council was the Youth Fitness Survey. This survey, conducted in 1969/70 into the fitness of thirteen to seventeen-year-old secondary school students attending Government schools in Australia, aims to esta_blish fitness norms for both boys and girls in the age group. The survey was directed by Dr A. W. Willee, Director, Physical Education Department, University of Melbourne. The draft report of this survey is still under active consideration. The National Fitness Section of the Health Department was expanded during the year and is now able to assist with enquiries from State Councils and other bodies concerning physical education, recreation and sport. To this end, the section publishes a newsletter every two months to inform those interested of developments both in Australia and overseas.
,
., ,I I
'I
'I
I '.-,
115
CONTENTS-Appendix I-StatiStics
TableNo.
NATIONAL HEALTH I. Departmental Expenditure - 1967-68 to 1971-72
. page
120
..
2. 3. 4. 5. 6. 7. 8. 9. 10. II. 12. 13.
HOSPITAL BENEFITS Number of registered organisations, membership and coverage - 1962-63 to 1971-72 . Number of registered organisations, membership and coverage - by States - 30 June 1972. Membership and coverage of the Subsidised Health Benefits Plan - by States - 30 June 1972 . Benefits paid to contributors by registered organisations - 1962-63 to 1971-72 Benefits paid to contribu tors by registered organisations - by States 1971-72 Amount of Commonwealth and fund benefits paid and other Commonwealth payments - 1963-64 to 1971-72 Amount of Commonwealth and fund benefits paid and other Commonwealth payments - by States - 1971-72 Number of days for which Commonwealth hospital benefits were paid - 1963-64 to 1971-72 Number of days for which Commonwealth hospital benefits were paid - by States - 1971-72 . Number of approved hospitals and number of beds - 1962-63 to 1971-72 Number of approved hospitals - by States - 30 June 1972 Number of beds in approved hospitals - by States _. 30 June 1972. NURSING HOME BENEFITS Amount of Commonwealth nursing home benefits paid - 1962-63 to 1971-72 Amount of Commonwealth nursing home benefits paid - by States 1971-72 Number of days for which Commonwealth nursing home benefits were paid - 1962-63 to 1971-72 Number of days for which Commonwealth nursing home benefits were paid - by States - 1971-72 . Number of approved nursing homes and number of beds - 1962-63 to 1971-72. Number of approved nursing homes - by States - 30 June 1972 . Number of beds in approved nursing homes - by States - 30 June 1972
121 121 122 122 123 123 124 124 125 125 126 126 oj
_ .... J
14. 15. 16. 17. 18. 19. 20. 116
127 127 128 128 129 129 130 ~,'
HANDICAPPED CHILDREN'S BENEFIT 21. Number of approved homes, number of children accommodated and amount of benefit paid -- 1968-69 to 1971-72 22_ Number of approved homes, number of children accommodated and amount of benefit paid - by States - 1971-72
130 131
f 23. 24.
...
I
' I
25. 26.
MEDICAL BENEFITS Number of registered organisations, membership and coverage - 1962-63 to 1971-72 . Number of registered organisations, membership and coverage - by States - 30 June 1972 Membership and coverage of the Subsidised Health Benefits Plan - by States - 30 June 1972 . Services received by contributors to registered organisations -- fee-forservice organisations only - 1962-63 to 1971-72
131 132 132 133 133 134 134 135 135 13 6
27. Services received by contributors to registered organisations - fee-forservice organisations only - by States - 1971-72 28. Amount of Commonwealth and fund benefits paid and other Commonwealth payments - 1962-63 to 1971-72. 29. Amount of Commonwealth and fund \-jenefits paid and other Common· wealth payments - by States - 1971-72 . 30. Cost of services and how cost is met - 1962-63 to 1971-72 . 31. Cost of services and how cost is met -- fee-for-service organisations by States - 1971-72 32. Percentage level of observance of the most common fee - by States quarters ended 30 June 1971,30 September 1971,31 December 1971 and 31 March 1972 PENSIONER MEDICAL SERVICE Number enrolled, number of medical services and average number of medical services per enrolled person -- 1962-63 to 1971-72 . Number enrolled, number of medical services and average number of medical services per enrolled person - by States - 1971-72 . Number of participating doctors, payments to doctors and average cost per enrolled person - 1962-63 to 1971-72 Number of participating doctors, payments to doctors and average cost per enrolled person - by States - 1971-72
33. 34. 35. 36.
137 13 7
138 138
37. 38. 39. 40. 41. 42.
PHARMACEUTICAL BENEFITS Cost of pharmaceutical benefits - 1962-63 to 1971-72 Cost of prescription benefits - by States - 1971-72 . Payments to hospitals and miscellaneous services - by States - 1962-63 to 1971-72 . Dissection of benefit prescription costs into ingredient cost and approved suppliers' remuneration - 1962-63 to 1971-72 . Dissection of benefit prescription costs into ingredient cost and approved suppliers' remuneration - by States - 1971-72 . Number of benefit prescriptions and average cost per prescription 1962-63 to 1971-72
139 139 140 140 141 141 117
43. Number of benefit prescriptions and average cost per prescription ~ by States ~ 1971-72 44. Number of benefit prescriptions per head of population and average cost per head of population ~ 1962-63 to 1971-72 45. Number of benefit prescriptions per head of population and average cost per head of population ~ by States ~ 1971-72 . 46. Drugs dispensed by chemists ~ 1971-72 . 47. Number of prescriptions and cost of more frequently prescribed therapeutic groups ~ 1970-71 and 1971-72 48. Number of pharmaceu tical chemists and medical practitioners dispensing pharmaceutical benefits prescriptions ~ 1949-50 to 1971-72 TUBERCULOSIS Number of allowances, notifications and mortality ~ 1952 to 1971 Number of allowances, notifications and mortality ~ by States ~ year ended 31 December 1971 Expenditure under the Tuberculosis Act ~ 1951-52 to 1971-72 Expenditure under the Tuberculosis Act ~ by States ~ 1971-72 Results of mass X-ray surveys ~ by States ~ year ended 31 December 1971 .
142 142 143 143 144 145
"
• 146 146 147 147 148
49. 50. 51. 52. 53.
PUBLIC HEALTH 54. Notifiable diseases: Number of cases notified ~ 1967 to 1971 55. Diseases notified in the States and Territories of Australia ~ year ended 31 December 1971 56. Radio and television scripts on medical matters examined ~ 1968-69 to 1971-72 QUARANTINE 57. Vessels boarded and cleared ~ by States ~ 1971-72 58. Infectious diseases on overseas vessels arriving in Australia 59. Animal importations subject to quarantine ~ 1971-72
148 149 150
~ --~
~
1971-72
150 151 151
60. 61. 62. 63.
NORTHERN TERRITORY HEALTH Aerial Medical Service ~ 1971-72 Health services provided at main Northern Territory hospitals~ 1971-72 Dental services provided in the Northern Territory ~ 1971-72 Licences issued under the public health ordinance ~ year ended 31 December 1971 . 64. Registrations granted ~ 1971-72 65. Samples collected for bacteriological examination by Health Inspection Section ~ 1971-72 66. School Medical Service examinations ~ 1971-72 AUSTRALIAN CAPITAL TERRITORY HEALTH 67. Licences issued under the public health ordinance .- year ended 31 December 1971 .
152 153 154 154 155 155 155
155
118
68. Registrations granted - 1971 -72 . 69. Samples collected by Health Inspection Section - 1971-72 70. School Medical Service examinations - 1970·71 and 1971·72 I,
156 156 156
NATIONAL FITNESS 71. Allocation of Commonwealth National Fitness Grants - 1971-72. 72. Allocations to State agencies - 1971·72 . COMMONWEALTH MEDICAL OFFICERS 73. Number of clinical examinations by Commonwealth Medical Officers by States - 1971·72 74. Number of vaccinations by Commonwealth Medical Officers - by States - 1971·72 COMMONWEALTH HEALTH LABORATORIES 75. Number of pathology examinations and laboratory tests performed and number of patient requests - 1971·72 NATIONAL BIOLOGICAL STANDARDS LABORATORY 76. Summary of all samples examined - 1971·72 77. Reasons for failure as percentage of total failures - 1971·72 78. Safety tests performed - 1971·72 . COMMONWEALTH ACOUSTIC LABORATORIES 79. Cases examined - 1971·72 80. Calaid hearing aids fitted - 1971·72 81. Cal aid hearing aids on loan at 30 June 1972 , I
157 157
.'
158 158
159
159 160 160
161 161 162
". COMMONWEALTH RADIATION LABORATORY 82. Expenditure from the National Welfare Fund on radio·isotopes for medical purposes - 1955·56 to 1971·72 162
, I -'---/
NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL 83. Grants made from the Medical Research Endowment Fund - 1971·72. COMMONWEALTH GRANTS 84. Allocation of Commonwealth Grants - 1962·63 to 1971·72 85. Allocation of Commonwealth Grants - by States - 1971·72
163
164 164
119
APPENDIX I-STATISTICS
NOTES ON STATISTICS: Subsidised Health Benefits Plan (S.H.B.P.) was previously known as Subsidised Medical Services (S.M.S.) Scheme. Apparent minor errors are due to rounding. p. Preliminary figures or series subject to revision. r. Figures or series revised since previous report. Derived statistics based on population estimates have been re-calculated to conform with revised population estimates. n.a. Not applicable. Nil. TABLE 1. DEPARTMENTAL EXPENDITURE 1967-68 TO 1971-72 Year ended 30 June 1968 1969
1970 $'000
1971
1972
$'000 SPECIAL APPROPRIA nONS Payments to or for the States Mental Health Institutions - contributions to Capital Expenditure States Grants - Nursing Homes
$'000
$'000
$'000
4,243
4,655r.
5,501r.
4,199 337 4,536 95,604 19,898 49,812 23,555 49,4 77 456 115,094 45,181 10,160 11,256r. 6.612 427,106r. 431,642[. 21,610 6,465 9,420 5,707 2,128 45,330 476,973r.
States Grants - Paramedical Services Total payments to or for the States National Welfare Fund Medical Benefits Medical Services for Pensioners
4,207 460 7 4,674 132,574 27,804 67,305 24,065 70,593 438 121,263 52,005 11,845 10,226 8,436 526,553 531,226 26,420 7,577 11,913 2,071 2,561 50,542 581,769
4,243 46,431 16,115 26,599 23,665 24,486 73,019 32,115 9,831 12,360r. 4,349 268,972r. 273,214r. 13,636 3,805 5,102 1,545 2,011 26,099 299,3l3r.
4,655r. 49,556 16,912 29,778 24,520 31,643 76 81,764 36,609 1O,054r. 12,381r. 4,624 297,918r. 302,573r. 15,038 4,221 6,128 1,192 2,226 28,805 331,378[.
5,501r. 56,863 19,230 40,258 24,157 46,960 485 95,650 41,069 10,051 11,326r. 4,955 351,004[. 356,505[. 17,762r. 4,531 7,625 1,252 2,698 33,868r. 390,373r.
Hospital Benefits Payments to Public Hospitals for Pensioners Nursing Home Benefits
Handicapped Persons' Homes - Children', Benefit Pharmaceutical Benefits Pharmaceutical Benefits for Pensioners
-
--,j
Milk for School Children Tuberculosis Medical Services and Allowances* Miscellaneous
Total National Welfare Fund Total Special Appropriations CONSOLIDATED REVENUE FUND Administrative Expenditure
_0
....
Australian Capital Territory Health Services. Northern Territory Health Services Capital Works and Services Payments to or for the States . Total Consolidated Revenue Fund Total Expenditure
• Includes anowances paid through the Department of Social Services - see Table 51.
120 j-
TABLE 2. HOSPITAL BENEFITS NUMBER OF REGISTERED ORGANISATIONS, MEMBERSHIP AND COVERAGE - 1962-63 TO 1971-72 No. of registered
II
••
Asat 30 June
organisations
Membership * OOO's 3,176 3,286 3,407 3,489 3,657 3,680 3,877 3,996 4,086r. 4,154p.
Estimated
coverage * OOO's 7,895 8,194 8,732 8,915 9,342 9,254 9,481 9,892 10,015r. lO,328p.
Percentage of population covered
II
II II , II II II
II '! ,
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
llO 112 III III
% 72r. 73r. 77 77r. 79r. 77 77 79 79 80p.
109 109 106 103 93 91
* As advised by the organisations. TABLE 3. HOSPITAL BENEFITS NUMBER OF REGISTERED ORGANISATIONS, MEMBERSHIP AND COVERAGE - BY STATES - 30 JUNE 1972
,I I State No. of registered organisations
Membership as at 30 June 1972*p. Ordinary account Special S.H.E. Plan Total estimated
account OOO's 38 10 5 4 3 2
coverage *p. OOO's 4,031 3,004 995 1,076 897 326
Approximate percentage of popUlation covered p.
i
New South Wales Victoria Queensland South Australia Western Australia Tasmania
34 23 8 9 7 10 91
OOO's 1,579 1,197 387 423 349 127
OOO's 8 6 1 6 8 2
% 84 84 53 84 85 83 80
Commonwealth
4,063
61
30
10,328
* As
advised by the organisations. Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia.
121
TABLE 4. HOSPITAL BENEFITS MEMBERSHIP AND COVERAGE OF THE SUBSIDISED HEALTH BENEFITS PLAN - BY STATES - 30 JUNE 1972
Membership as at 30 June 1972*p. Un employ· Low Income Members State New South Wales Victoria men!,
t
sickness and
Class A 3,158 1,195 320 1,622 2,854 471 9,620
Class B 195 77 9 98 76 67 522
special Class C beneficiaries 179 66 9 103 87 33 477 2,742 3,568 240 3,774 4,486 1,304 16,114
Migrants~
Total membership 7,531 5,738 589 6,208 8,471 1,923 30,460
Total estimated
1 ".
coverage*p 18,138 12,539 1,434 15,562 23,343 . 4,224 75,240
Queensland South Australia Western Australia Tasmania
1,257 832 11 611 968 48 3,727
Commonwealth
• As advised by the organisations. Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia.
t
~
Before 5 June 1972 From 5 June 1972 Class A - families with incomes up to $46.50 a week $51.50 a week Class B - families with incomes from $46.51 to $49.50 a week $51.51 to $54.50 a week Class C - families with incomes from $49.51 to $52.50 a week $54.51 to $57.50 a week Migrants are eligible for assistance under the Subsidised Health Benefits Plan for services rendered during the first two months after arrival in Australia. These figures represent the number of eligible migrants who were registered
with a hospital benefits organisation as at 30 June 1972.
TABLE 5. HOSPITAL BENEFITS BENEFITS PAID TO CONTRIBUTORS BY REGISTERED ORGANISATIONS - 1962·63 TO 1971-72 Average
Fund benefits* Year ended 30 June Excluding ancillary $'000 35,783 42,120 48,282 55,330 66,379 78,903 93,901 115,532 128,609 192,935 Ancillary $'000 944 1,162 1,537 2,232 2,632 2,879 3,182 3,524 3,737 3,726 Total $'000 36,727 43,282 49,819 57,562 69,011 81,782 97,083 119,056 132,346 196,661 No. of days fund benefit paid OOO's 10,419 9,576 9,988 10,252 10,444 10,572 10,963 11,576 12,162 12,785
daily fund benefit (excluding ancillary)
Average no.
~
of days fund benefit paid per member
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$. c. 3.43 4.40 4.83 5.40 6.36 7.46 8.57 9.98 10.57 15.09
3.32 2.86 3.00 2.97 2.91 2.89 2.89 2.94 2.99 3.12p.
•
Includes S.H.B.P. fund benefits reimbursements .
122
TABLE 6. HOSPITAL BENEFITS BENEFITS PAID TO CONTRIBUTORS BY REGISTERED ORGANISATIONS - BY STATES- 1971-72 Average
Fund benefits t Slate* Hxc/uding ancillary $'000 78,338 56,095 14,513 21,212 17,437 5,341 192,935 Ancillary $'000 2,901 388 195 72 157 13 3,726 Total $'000 81,239 56,482 14,708 21,284 17,594 5,354 196,661 No. of days fund benefit paid OOO's 5,216 3,251 1,464 1,379 1,106 369 12,785
r ,~
daily fund benefit (excluding ancillary) $. c. 15.G2 17.25 9.91 15.38 15.77 14.48
Average no.
of days fund benefit paid per member p.
r
I-:ow South Wales Victoria
...
I -
Queensland South Australia Western Australia Tasmania Commonwealth
3.22 2.73 3.80 3.23 3.11 2.97 3.12
15.09
• Benefits paid to Australian Capital Territory contributors included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia. t Includes S.H.B.P. fund benefits reimbursements
TABLE 7. HOSPITAL BENEFITS AMOUNT OF COMMONWEALTH AND FUND BENEFITS PAID AND OTHER COMMONWEALTH PAYMENTS1963-64 TO 1971-72
Commonwealth benefits
Other Commonwealth payments S.H.B.P. Total ComTotal fund monbenefit S.H.B.P. Com· wealth man- Special re- managemen! expendiwealth account imburseture benefits deficits ments expenses $'000 34,589 35,420 36,745 40,847 45,770 47,185 47,895 49,878 52,458 $'000 3,749 3,576 2,873 3,784 4,494 7,113 16,063 19,605 30,986 $'000 $'000 $'000 38,338 38,995 39,619 44,631 50,264 54,298 64,415 73,367 91,370
Year ended 30/une
UnInsured insured patients patients $'000 18,657 19,221 19,616 19,740 19,807 20,425 21,596 22,319 24,357 $'000 2,578 2,614 2,464 2,376 2,298 2,240 2,143 1,107 897
HospitalPenisati(Jn sioner free of charge patients $'000 $'000 13,354 13,585 14,665 18,731 23,665 24,520 24,157 23,555 24,065
Total fund benefits' $'000 43,282 49,819 57,562 69,011 81,782 97,083 119,056 132,346 196,661
r ~ I
1964 1965 1966 1967 1968 1969 1~70
1971 1972
2,897 3,139
425 3,616 7,407
33 269 518
• Includes S.H.B.P. fund benefit reimbursements.
1'1 I I;
I 123
I!
TABLE 8. HOSPITAL BENEFITS AMOUNT OF COMMONWEALTH AND FUND BENEFITS PAID AND OTHER COMMONWEALTH PAYMENTSBY STATES - 1971-72
Commonwealth benefits Total Com· mon-
Other Commonwealth payments Total S.H.B.P. Comfund benefit S.H.B.P. man" reo manageSpecial wealth ment expendi· account imburseture ments expenses deficits
Hospital. Un· State*
Insured patients
insured patients
isation Pen· sioner tree of charge patients
wealth benefits
Total fund benejits t
$'000 10,169 6,358 Queensland 2,235 South Australia 2,634 West. Australia 2,223 Tasmania 738 Victoria
$'000 409 203 84 66 108 27 897
$'000 165 150 2.561 236 22 6 3,139
$'000 9,367 5,495 3,807 1,971 2,333 1,093 24,065
$'000 20,110 12,205 8.687 4,907 4,686 1,863 52,458
$'000 13,897 6,922 4,469 3,744 1,340 613 30,986
$'000 3,148 1,402 11 888 1,665 292 7,407
$'000 222 99 1
$'000 37,379 20.629 13,168 9,601 7.804 2,789 91,370
$'000 81,239 56,482 14,708 21,284 17,594 5,354 196,661
New South Wales
62 113 21 518
Commonwealth 24,357
* Australian t
Capital Territory included in New South Wales - Northern Territory: Insured patients (Commonwealth and fund benefit) included in New South Wales, Victoria, Queensland and South Australia; uninsured patients, hospitalisation free of charge and pensioner patients included in South Australia only. Includes S.H.B.P. fund benefit reimbursements.
TABLE 9. HOSPITAL BENEFITS NUMBER OF DA YS FOR WHICH COMMONWEALTH HOSPITAL BENEFITS WERE PAID - 1963-64 TO 1971·72
Insured Year ended 30 June Ordinary account Special account S.H.B. Plan Hospitalisation free of charge
~-,~ Pensioners
Uninsured
Total
1964 1965 1966 1967 1968 1969 1970 1971 1972
OOO's 7,157 8,180 8,382 8,499 8,588 8,769 8,877 8,720 9,239
OOO's 2,230 1,490 1.478 1,421 1,368 1,498 1,919 2,045 2,346
OOO's
58 447 638
OOO's 3,221 3,209 3,080 2,970 2,872 2,800 2,678 1,384 1,121
OOO's
1,448 1,570
OOO's 3,709 3,770 4,074 4,516 4,726 4,905 4,840 4,712 4,813
OOO's 16,317 16,648 17.015 17,407 17,555 17,972 18,372 18,757 19,727
~
124 t·
TABLE ]0. HOSPITAL BENEFITS NUMBER OF DAYS FOR WHICH COMMONWEALTH HOSPITAL BENEFITS WERE PAID _ BY STATES _ 1971-72 Insured ~
I:;.
HospitalisaOrdinary State' Special
account 000',
account OOO's 1,091 465 404 235 103 49
S.H.B. Plan
tion tree Uninsured of charge Pensioners Total
000',
.... ,
New South Wales Victoria Queensland South Australia Western Australia Tasmania Commonwealth
3,726 2,594 713 1,014 899 293 9,239
294 130 2 71 113 28 638
OOO's 512 253 106 82 136 33
OOO's 82 75 1,280 118
11 3 1,570
OOO's 1,873 1,099 761 394 467 219
OOO's 7,578 4,617 3,266 1,913 1,729 625
2,346
1,121
4,813
19,727
• Australian Capital Territory included in New South Wales - Northern Territory: Insured patients included in New South Wales, Victoria, Queensland and South Australia; uninsured patients, hospitalisation free of charge and pensioner patients included in South Australia only.
TABLE 11. HOSPlf AL BENEFITS NUMBER OF APPROVED HOSPITALS AND NUMBER OF BEnS - 1962-63 TO 1971-72 No. of beds Total Public Private No. of beds per 1,000 of Total populalion
No. of approved hospitals As al 30 June Public Private
I.' I
-f
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
745 750 753 759 760 762 757 764 765 771
395 392 376 350 338 331 325 322 324 326
1,140 1,142 1,129 1,109 1,098 1,093 1,082 1,086 1,089 1,097
57,842 58.177 59,042 60,173 61,221 61,657 62,151r. 62,401 63,670 64,405
11,772 12,039 12,251 12,162 12,423 12,455 12,605 13,033 13,571 14,386
69,614 70,216 71,293 72,335 73,644 74,112 74,756r. 75,434 77,241 78,791
6.4 6.3 6.3 6.2 6.2 6.2 6.1 6.0 6.1 r. 6.1
'
...i
125
TABLE 12. HOSPITAL BENEFITS NUMBER OF APPROVED HOSPITALS - BY STATES - 30 JUNE 1972 Public Religious and charitable Private enterprise Private
State
State
Total
Religious and charitable
TOlal
TOlal al/ hospitals
,
New South Wales Victoria Queensland
South Australia Western Australia Tasmania Australian Capital Territory Northern Territory Commonwealth
223 154 137 64 100 26 2 5 711
32 7 13 3 5
255 161 150 67 105 26 2 5 771
79 86 10 42 10 3
21 18 27 11
13 5 1 96
100 104 37 53 23
8 I
355 265 187 120 128 34 3 5 1,097
..
~.
60
230
326
TABLE 13. HOSPITAL BENEFITS NUMBER OF BEDS IN APPROVED HOSPITALS - BY STATES - 30 JUNE 1972 Public Religious and State charitable Private en/er-
Private
State
Total
prise
Religious and charitable
Total
Total no. of beds
No. of beds per 1,000 of population
New South Wales Victoria
QueensLand South Australia Western Australia Tasmania Australian Capital Territory .
20,680 13,326 10,943 4,275 5,619 2,466 656 698 58,663
3,535 914 631 616 46
24,215 14,240 1/,574 4,891 5,665 2,466 656 698
2,554 2,239 367 1,507 304 59
1,529 1,760 1,902 630 1,111 400 24
4,083 3,999 2,269 2,137 1,415 459 24 14,386
28,298 18,239 13,843 7,028 7,080 2,925 680 698 78,791
6.1 5.1 7.4 5.9 6.7 7.4 4.4 7.8 6.1
."
••
~c
Northern Territory Commonwealth
5,742
64,405
7,030
7,356
~
126
,.
TABLE 14. NURSING HOME BENEFITS AMOUNT OF COMMONWEALTH NURSING HOME BENEFITS PAlO _ 1962-63 TO 1971-72
Public nursing homes ;f'
Private nursing homes Ordinary benefit $'000 4,133' 11,377 13,023 14,253 15,518 16,792 18,238 20,055 21,562 35,121 Supplementary benefit $'000
All nursing homes Ordinary benefit $'000 6,646' 17,880 19,796 21,223 22,767 24,486 26,039 28,453 29,750 47,639 Supplementary benefit $'000
'!
.~
Year ended 30 June
Ordinary benefit $'000 2,513 * 6,503 6,773 6,970 7,249 7,694 7,801 8,397 8,187 12,518
Supplementary benefit $'000
Total $'OOU
I'"'
1
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
1,406t 5,730 5,303 5,806
4, 199 t 12,777 14,424 17,148
5,605t 18,507 19,727 22,954
6,646* 17,880 19,796 21,223 22,767 24,486 31,643 46,960 49,477 70,593
As from 21 October 1971, ordinary benefit was increased from $2 to $3.50 a day. In addition to ordinary benefit, intensive care patients continued to receive the supplementary benefit of $3 a day. 'Six months, 1 January 1963 to 30 June 1963. t Six months, 1 January 1969 to 30June 1969.
TABLE 15. NURSING HOME BENEFITS AMOUNT OF COMMONWEALTH NURSING HOME BENEFITS PAlO - BY STATES - 1971-72
Public nursing homes Ordinary benefit $'000 2,882 4,146 2,822 689 1,454 525 12,518
Private nursing homes
All nursing homes Ordinary benefit $'000 21,792 8,543 7,363 3,964 4,268 1,608 101 47,639
State '1>1". . ' ... ,
Supplementary benefit $'000 868 1,863 1,606 418 780 270 5,806
Ordinary benefit $'000 18,910 4,397 4,541 3,275 2,813 1,083 101 35,121
Supple· mentary benefit $'000 8,058 2,762 2,515 1,673 1,641 465 34 17,148
Supplementary bene/it $'000 8,926 4,625 4,122 2,092 2,421 735 34 22,954
Total $'000 30,718 13,168 11,485 6,055 6,689 2,343 135 70,593
,-4
I ,,~
I
New South Wales Victoria Queensland South Australia* Western Australia Tasmania Australian Capital Territory Commonwealth .
As from 21 October 1971, ordinary benefit was increased from $2 to $3.50 a day. In addition to ordinary benefit, intensive care patients continued to receive the supplementary benefit of $3 a day. * Includes Northern Territory.
127
TABLE 16. NURSING HOME BENEFITS NUMBER OF DAYS FOR WHICH COMMONWEAL TH NURSING HOME BENEFITS WERE PAID - 1962·63 TO 1971·72 Public nursing homes Supple· mentary benefit Prh'ate nursing homes Supple· mentary benefit All nursing homes Supple· mentary benefit
.,
Year ended 30 June
Ordinar.v benefit OOO's
Ordinary benefit
Ordinary bellefit
"-
OOO's
OOO's
OOO's
OOO's
OOO's
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
1,257' 3,252 3,386 3,485 3,624 3,847 3,900 4,197 4,094 4,331
469t 1,910 1,768 1,935
2,067' 5,688 6,512 7,127 7,759 8,396 9,119 10,028 10,781 12,029
1,40Dt 4,259 4,808 5,716
3,324* 8,940 9,898 10,612 11,383 12,243 13,019 14,225 14,875 16,360
. \
.
.,
1,868t 6.169 6,576 7,651
Number of days for which ordinary benefit is paid includes the number of supplementary benefit days. • Six months, 1 January 1963 to 30 June 1963. t Six months, 1 January 1969 to 30 June 1969.
TABLE 17. NURSING HOME BENEFITS NUMBER OF DAYS FOR WHICH COMMONWEALTH NURSING HOME BENEFITS WERE PAID - BY STATES - 1971·72 Public nursing homes Sllpple· mentary benefit Private nursing homes Supplementary benefit All nursing homes Supplementary benefit
State
Ordinary benefit
Ordinary benefit
Ordinary benefit
"
J
OOO's
OOO's
OOO's
OOO's
OOO's
OOO's
New South Wales Victoria
Queensland South Australia* Western Australia Tasmania
993 1,437 977 230 509 184 4,331
289 621 535 139 260 90 1,935
Australian Capital Territory Commonwealth .
6,454 1,524 1,558 1,121 963 374 34 12,029
2.686 921 838 558 547 155 11 5,716
7,448 2,961 2,535 1.351 1,472 559 34 16,360
2,975 1,542 1,374 697 807 245 11 7,651
-4/"--~
Number of days for which ordinary benefit is paid includes the number of supplementary benefit days.
* Includes Northern Territory.
128
II I
I
TABLE 18. NURSING HOME BENEFITS NUMBER OF APPROVED NURSING HOMES AND NUMBER OF BEDS - 1962-63 TO 1971-72
No. of approved nursing homes ,
No. of beds Public 9,405 10,353 10,648 10,851 11,426 11,832 12,088 12,495 12,761 13,042 Private
~
As at 30 June 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
Public 91 98 103 104 111 114 119 119 123 128
Private Total homes 811 850 919 955 987 1,008 1,016 1,038 1,071 1,102 902 948 1,022 1,059 1,098 1,122 1,135 1,157 1,194 1,230
No. of beds per 1,000 of Total beds population 25,535 28,685 31,290 33,075 35,537 37,883 40,167 42,903 46,750 51,286 2.3 2.6 2.7r. 2.9 3.0 3.2 3.3 3.4 3.7
-)"-
16,130 18,332 20,642 22,224 24,111 26,051 28,079 30,408 33,989 38,244
4.0
TABLE 19. NURSING HOME BENEFITS NUMBER OF APPROVED NURSING HOMES - BY STATES - 30 JUNE 1972
Public Religious and charitable 13 32 12 2 13 1 Private enterprise
Private
State New South Wales Victoria
State 12 15 11 2 12 3
Total 25 47 23 4 25 4
Religious and charitable 101 18 46 39 28 27 1 1 261
Total 484 215 140 126 93 41 2 1 1,102
Total all nursing homes 509 262 163 130 118 45 2 1 1,230
Queensland South Australia. Western Australia Tasmania
Australian Capital Territory Northern Territory
383 197 94 87 65 14 1 841
Commonwealth
55
73
128
129
• -,
TABLE 20. NURSING HOME BENEFITS NUMBER OF BEDS IN APPROVED NURSING HOMES - BY STATES - 30 JUNE 1972
Public Religious and State
Private
State 1,903 3,017 -2,093 268 955 468
charitable
Total 2,988 4,216 2,892 721 1,721 504
Private enterprise
Religious and charitable 4,313 698 1,200 1,350 1,091 716 71 6 9,445
Total 20,759 4,699 4,894 3,376 3,264 1,027 219 6 38,244
Total no. of beds 23,747 8,915 7,786 4,097 4,985 1,531 219 6 51,286
No. of beds per 1,000 of population 5.1 2.5 4.2 3.4 4.7 3.9 1.4 0.1 4.0
~
New South Wales Victoria
Queensland South Australia Western Australia
Tasmania Australian Capital Territory . Northern Territory Commonwealth
1,085 1,199 799 453 766 36
16,446 4.001 3,694 2,026 2,173 311 148
-"\.._-"--
8,704
4,338
13,042
28,799
TABLE 21. HANDICAPPED CHILDREN'S BENEFIT NUMBER OF APPROVED HOMES, NUMBER OF CHILDREN ACCOMMODATED AND AMOUNT OF BENEFIT PAID - 1968-69 TO 1971-72
As at 30June
No. of approved handicapped persons' homes as at 30 JlIne
No. of handicapped children accommodated at 30JlIne
No. of days for which benefit paid
Total amount benefit paid $ 76,020' 485.353 455,745 437,984
1969 1970 1971 1972
17 36 44 49
926 1,155 1,262 1,295
50,680' 323.568 303.830 291,989
* Six months 1 January 1969 to 30 June 1969
130
TABLE 22. HANDICAPPED CHILDREN'S BENEFIT NUMBER OF APPROVED HOMES, NUMBER OF CHILDREN ACCOMMODATED AND AMOUNT OF BENEFIT PAID - BY STATES - 1971-72
1
. '.
No. of approved handicapped persons' homes as at
State
30 June 1972
No. of handicapped children accommodated at 30 June 1972
No. of days for which benefit paid
Total amount benefit paid $
New South Wales Victoria
.,
Queensland South Australia Western Australia
Tasmania Australian Capital Territory Northern Territory Commonwealth
17 9 7 6 5 3 1 1 49
462 300 114 234 134 44 1 6 1,295
111,445 57,980 24,336 54,744 27,307 13,680 366 2,131 291,989
167,168 86,970 36,504 82,116 40,961 20,520 549 3,197 437,984
TABLE 23. MEDICAL BENEFITS NUMBER OF REGISTERED ORGANISATIONS, MEMBERSHIP AND COVERAGE - 1962-63 TO 1971-72
No. of registered As at 30 June organisations
Membership * OOO's 2,952 3,095 3,217 3,313 3,418 3,456 3,635 3,753 3,874r. 4,028p.
Estimated
coverage *
Percentage of population covered r.
1963 1964 1965 .• 1%6 1967 1968 1969 1970 1971 1972
78 81 80 80 78 78 78 77 81 81
OOO's 7,686 8,058 8,462 8,679 8,846 8,817 9,017 9,453 9,673r. 10,134p.
% 70 72 74 75 75 73 74 76 76 78 p.
~~ rr I
,
.
*
As advised by the organisations.
r. Most of these figures have been revised. See Notes on Statistics, page 120.
l I
i
I
I~ ~
131
I
l
TABLE 24. MEDICAL BENEFITS NUMBER OF REGISTERED ORGANISATIONS, MEMBERSHIP AND COVERAGE - BY STATES - 30 JUNE 1972 Membership as at 30 June 1972* p. No. of registered organisations OOO's 29 19 8 7 8 10 Ordinary accountt OOO's 1,510 1,141 393 412 348 128 Special account OOO's 44 8 8 2 2 1 S.H.B.
State
Plan OOO's 8 6 1 6 8 2
Approximate percentage of Total estimated population covered p. coverage*p. OOO's 3,925 2,904 l,029 1,057 893 326
~
New South Wales Victoria Queensland South Australia Western Australia Tasmania Commonwealth
% 81 82 55 83 85 83 78
,-...-"
81
3,932
64
32
10,134
* As
t
advised by the organisations. Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia. Ordinary account includes contract organisations.
TABLE 25. MEDICAL BENEFITS MEMBERSHIP AND COVERAGE OF THE SUBSIDISED HEALTH BENEFITS PLAN - BY STATES - 30 JUNE 1972
Membership asat 30 June 1972*p.
Low income memberst State Class A Class B
Unemployment, sickness and special Class C beneficiaries
Total estimated Total Migrantst membership coverage * p.
New South Wales Victoria Queensland South Australia Western Australia
Tasmania Commonwealth
3,288 1,181 552 1,624 2,855 471 9,971
203 75 38 98 76 69 559
185 67 40 103 87 33 515
3,202 3,538 661 3,775 4,490 1,304 16,970
1,283 816 172 611 968 48 3,898
8,161 5,677 1,463 6,211 8,476 1,925 31,913
19,422 12,4543,501 15,567 23,358 4,169 78,471
.-
..
advised by the organisations. Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia. t Before 5 June 1972 From 5 June 1972 Class A - families with incomes up to $46.50 a week $51.50 a week Class B - families with incomes from $46.51 to $49.50 a week $51.51 to $54.50 a Week Class C - families with incomes from $49.51 to $52.50 a week $54.51 to $57.50 a week :j: Migrants are eligible for assistance under the Subsidised Health Benefits Plan for selVices rendered during the first two months after arrival in Australia. These figures represent the number of eligible mlgrants who were registered with a medical benefits organisation as at 30 June 1972.
* As
132
TABLE 26. MEDICAL BENEFITS
~
I J
SERVICES RECEIVED BY CONTRIBUTORS TO REGISTERED ORGANISATIONS - FEE·FOR.SERVICE ORGANISATIONS ONLY - 1962-63 TO 1971-72 Percentage of G.P. consultations* to total no. of services
I~ Year ended 30 June
No. of services received
Average no. of services per
Average no. of services per person covered Average cost
contributor
per service
t
~I
...
,
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
OOO's 23,431 24,308 25,847 28,210 29,269 31,991 34,134 38,076 39,555 43,271
% 72 71 70 69 68 63 63 62 62 60 8.0 7.8 8.3 8.7 8.7 9.4 9.7 10.4 10.3 11.0 3.1 3.1 3.2 3.3 3.4 3.7 3.8 4.2 4.1 4.4
$. c. 3.69 3.85 4.02 4.20 4.48 4.67 4.87 5.13 6.04 6.78
*General practitioner surgery consultations and home visits.
t
Average eost per matched service only from 1967-68 (a matched service is one for which both Commonwealth benefit and fund benefit are paid).
TABLE 27. MEDICAL BENEFITS SERVICES RECEIVED BY CONTRIBUTORS TO REGISTERED ORGANISATIONS - FEE-FOR·SERVICE ORGANISATIONS ONLY - BY STATES - 1971-72 Percentage of Average no. of No. of services recei.'ed* G.P. consul- t Average no. of services per tations to total sen' ices per person Matched Unmatched no. of serl'ices contributor p. covered p. OOO's 16,069 10,995 4,577 4,621 3,337 1,065 OOO's 667 480 204 641 477 137 Average cost per matched service
II
~
State t
I
New South Wales Victoria
Queensland South Australia Western Australia ~c~ .~-- Tasmania Commonwealth
% 59 63 63 56 56
55 60
11.0 10.2 12.3 12.7 11.1 10.1 11.0
4.5 4.0 4.8 5.0 4.5 4.0 4.4
$. c. 7.42 6.79 5.99 6.04 6.02 5.83 6.78
40,664
2,607
I
• A matched service is one for which both Commonwealth benefit and fund benefit are paid. Either no Commonwealth benefit or no fund benefit is paid for an unmatched service. t Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia. :\: General practitioner surgery consultations and home visits.
133
TABLE 28. MEDICAL BENEFITS AMOUNT OF COMMONWEALTH AND FUND BENEFITS PAID AND OTHER COMMONWEALTH PAYMENTS1962-63 TO 1971-72
Other Commonwealth payments S.H.B.P. [und benefit reimbursements
Year
Common·
ended 30/une
wealth benefits $'000 22,982 24,232 34,594 40,507 42,885r. 45,475 48,411 54,935 92,361 127,061
Special account deficits $'000 492 615 682 775 956 956 1,146 1,820 2,231 3,787
S.H.B.P. management expenses $'000
Total Commonwealth expendilUre $'000 23,474 24,847 35,276 41,282 43,841 46,431 49,556 56,863 95,604 132,574
Fund benefits' Excluding ancillary Ancillary $'000 32,042 34,442 36,880 42,560 46,898 50,332 55,539 65,693 81,231 101,'291 $'000 1,564 1,708 1,996 1,942 2,042 2,244 2,492 2,857 2,657 2,806 Total [und benefits $'000 33,606 36,150 38,876 44,502 48,940 52,576 58,031 68,550 83,888 104,097
$'000
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
,
97 885 1,498
12 128 228
• Includes S.H.B.P. fund benefits reimbursements.
TABLE 29. MEDICAL BENEFITS AMOUNT OF COMMONWEALTH AND FUND BENEFITS PAID AND OTHER COMMONWEALTH PA YMENTS BY STATES - 1971-72.
Other Commonwealth payments S.H.B.P. fund benefit State·
Fund benefits t Total Commonwealth expenditure
S.H.B.P. managemen!
/
..
Commonwealth benefits $'000 50,952 33,146 12,753 15,074 11,652 3,484 127,061
Special account
reim-
deficits $'000 2,555 635 356 98 102 41 3,787
bursements $'000 691 318 106 179 174 29 1,498
expenses
Excluding anci/lary Ancillary $'000 45,125 28,341 9,428 9,374 6,927 2,096 101,291
Total [und benefits $'000 46,334 28,980 9,761 9,686 7,130 2,206 104,097
New South Wales Victoria Queensland South Australia Western Australia
Tasmania Commonwealth
$'000 90 42 15 36 37 7 228
$'000 54,288 34,142 13,230 15,387 11,965 3,562 132,574
$'000 1,209 639 332 312 203 110 2,806
• Australian Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia. t Includes S.H.B.P. fund benefits reimbursements.
134
TABLE 30. MEDICAL BENEFITS COST OF SERVICES AND HOW COST IS MET - 1962-63 TO 1971-72
Percentage of total cost met by (fee-for-service I
I
~.
.;
organisations) -
Total cost of matched Year ended 30 June services*
Commonwealth benefit
Fund benefit
Insured member % 36.3 37.3 31.9 30.4 32.3 32.6 34.7 35.5 24.4 18.9
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$'000 86,213 93,313 104,624 119,021 131,770 141,982 157,862 183,406 224,674 275,541
% 26.6 25.9 32.9 33.9 32.2 32.0 30.2 28.9 39.6 44.5
% 37.1 36.8 35.2 35.7 35.5 35.4 35.1 35.6 36.0 36.6
* As
from 1969-70 the total cost excludes services by contract organisations. During the year 1971-72 there were 232,760 matched services performed by contract organisations, the total cost being $925,024.
TABLE 31. MEDICAL BENEFITS COST OF SERVICES AND HOW COST IS MET - FEE·FoR·SERVICE ORGANISATIONS - BY STATES - 1971-72
Percentage of total cost met by Total cost of matched State * services
Commonwealth Benefit
Fund Benefit
Insured Member
New South Wales Victoria
Queensland South Australia Western Australia
Tasmania
$'000 119,265 74,675 27,410 27,910 20,071 6,210
% 42.6 44.0 46.4 48.4 49.1 47.8 44.5
% 37.8 37.8 34.4 33.6 33.6 32.4 36.6
% 19.6 18.2 19.2 18.0 17.2 19.8 18.9
-
.
Commonwealth
275,541
* Australian
Capital Territory included in New South Wales - Northern Territory included in New South Wales, Victoria, Queensland and South Australia.
135
TABLE 32. MEDICAL BENEFITS PERCENTAGE LEVEL OF OBSERVANCE OF THE MOST COMMON FEE' - BY STATES - QUARTERS ENDED 30 JUNE 1971,30 SEPTEMBER 1971,31 DECEMBER 1971 AND 31 MARCH 1972 New South Wales Victoriat Queensland
Service
June Sep. Dec. March Sep. Dec. March June Sep. Dec. March 1971 1971 1971 1972 1971 1971 1972 1971 1971 1971 1972 Qtr. Qtr. Qtr. Qtr. Qtr. Qtr. Qtr. Qtr. Qtr. Qtr. Qtr.
-. < ,
General practitioner -
Surgeryt . Home visitst Specialist Initial consultations Subsequent consultations Consultant physicianInitial consultations
75 67 73 55 96 77 73 86 85 94 79 77 81 76
53 35 73 53 96 76 74 87 85 95 79 79 82 71
52 33 70 52 95 74 72 88 84 94 77 79 81 63
49 31 70 53 95 74 73 87 85 94 78 79 81 59
73 69 78 66 75 57 67 80 79 87 70 69 67 72
69 67 78 64 74 56 65 80 80 89 71 69 68 70
67 63 79 64 76 57 75 79 79 90 73 67 69 69
73 69 91 77 91 88 69 87 78
72 68 90 78 91 87 65 87 77 97 53 89 78 74
70 65 90 76 91 88 61 86 76
68 62 91 77 91 89 62 86 74 93 56 90 79 72
Subsequent consultations Obstetrics Anaesthetics . Miscellaneous procedures Pathology Radiology Assistance at operations
97 51 90 79 75
96 53 90 79 73
Operations Whole of schedule
South Australia
Western Australia
Tasmania
Service
June Sep. Dec. March June Sep. Dec. March June Sep. Dec. March 1971 1971 1971 1972 1971 1971 1971 1972 1971 1971 1971 1972 Qtr. Qtr. Qtr. Qrr. Qtr. Qrr. Qtr. Qtr. Qrr. Qtr. Qtr. Qrr.
General practitioner Surgeryt . Home visitst Specialist Initial consultations Subsequent consultations
88 77 86 78 86 70 80 90 82 97 87 90 82 87
91 82 87 79 86 68 81 90 82 97 89 91 83 88
88 78 84 77
88 74 87 78 85 68 71 87 79 97 88 92 84 87
90 71 67 77 87 82 80 80 88 87 96 88 84 87
90 65 65 76 84 82 80 81 90 86 98 89 82 86
88 65 58 70 85 83 80 83 91 85 97 89 82 84
86 61 57 67 83 85 78 84 90 86 94 88 82 83
63 48 59 57 87 75 77 79 77 98 89 78 78 68
66 58 60 59 82 70 80 78 72 98 88 75 78 68
63 56 58 59 86 80 72 73 76 98 86 84 77 69
62 50 63 54 87 84 79 77 74 98 89 91 79 69
/~~~j
Consultant physicianInitial consultations Subsequent consultations Obstetrics Anaesthetics . Miscellaneous procedures Pathology Radiology Assistance at operations
Operations Whole of schedule
81 66 75 86 76 97 87 92 83 86
-.~
* Percentage of services for which the most common fee or less was charged, based on a survey of claims processed by
t
the principal registered organisations in each State in the quarterly periods shown.
Services for quarter ended 30 September 1971 and subsequent quarters relate to services rendered after 1 July 1971. :j: Figures for Victoria for quarter ended 30 June 1971 are not available.
136
TABLE 33. PENSIONER MEDICAL SERVICE I
'I
NUMBER ENROLLED, NUMBER OF MEDICAL SERVICES AND AVERAGE NUMBER OF MEDICAL SERVICES PER ENROLLED PERSON - 1962-63 TO 1971-72 No. of pensioners and dependants enrolled at 30 June Year ended 30 June OOO's 831 844 849 1,006 1,043 1,115 1,164 1,187 1,217r 1,255
Percentage of population enrolled
No. of medical services Surgery OOO's 4,278 4,406 4,389 4,670 5,215 5,757 6,291 6,761 7,157 7,545 Domiciliary
Average no. of medical services per enrolled Total person OOO's 7,389 7,426 7,248 7,494 8,187 8,655 9,157 9,557 9,939 10,272
.'"
-
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
% 7.7 7.7 7.5 8.8 9.0 9.3 9.5 9.5 9.5 9.7
OOO's 3,111 3,020 2,859 2,824 2,972 2,898 2,866 2,796 2,783 2,728
9.0 8.9
8.6 8.4 8.0 7.9 8.1 8.2 8.2 8.3
TABLE 34. PENSIONER MEDICAL SERVICE NUMBER ENROLLED, NUMBER OF MEDICAL SERVICES AND AVERAGE NUMBER OF MEDICAL SERVICES PER ENROLLED PERSON - BY STATES - 1971-72 No. of pensioners and dependants enrolled at 30 June OOO's 469 325 202 124 92 42 Average no. of
State
Percentage of population enrolled
No. of medical services Surgery Domiciliary OOO's 2,879 1,823 1,321 729 550 243 OOO's 964 815 378 345 148 78 Total OOO's 3,843 2,637 1,698 1,074 698 321
medical services per enrolled
person
~
11,-
% 9.7 9.1 10.9 9.7 8.7 10.6 9.7
New South Wales' Victoria Queensland South Australiat Western Australia Tasmania Commonwealth
8.3 8.3 8.5 8.8 7.8 7.8 8.3
I
f
~'r"
1,255
7,545
2,728
10,272
'Includes Australian Capital Territory. t Includes Northern Territory.
137
TABLE 35. PENSIONER MEDICAL SERVICE NUMBER OF PARTICIPATING DOCTORS. PAYMENTS TO DOCTORS AND AVERAGE COST PER ENROLLED PERSON - 1962-63 TO 1971-72
No. of participating doctors Year ended 30 June
at 30 June
Payments to doctors $'000 9,146 9,531 9,320 13,365 14,351 16,115 16,912 19,230 19,898 27,804
Average payment per doctor $ 1,520 1,598 1,578 2,246 2,360 2,573 2,665 2,969 3,045 4,138
Average cost per enrolled person $. c. 12.24 12.68 11.05 14.95 14.03 14.76 '14.93 16.50 16.51 22.52
<4
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
6,025 5,899 5,896 6,034 6,175 6,333 6,417 6,451 6,617 6,817
•
As from 1 July '1971, payments to doctors for medical services were increased from $1.85 to $2.50 for surgery consultations and from $2.35 to $3.60 for home visits (domiciliary).
TABLE 36. PENSIONER MEDICAL SERVICE NUMBER OF PARTICIPATING DOCTORS, PAYMENTS TO DOCTORS AND AVERAGE COST PER ENROLLED PERSON - BY STATES - 1971-72
No. of participating
State
doctors at 30 June
Payments to doctors $'000 10,379 7,218 4,517 2,979 1,835 876 27,804
Average payment per doctor $ 4,039 4,120 4,628 4,521 3,366 4,035
Average cost per enrolled person $. 22.40 22.62 22.62 24.47 20.42 21.38
New South Wales' Victoria
Queensland South Australiat Western Australia Tasmania.
2,615 1,738 1,005 675 562 222 6,817
c.
Commonwealth
4,138
22.52
As from 1 July 1971, payments to doctors for medical services were increased from $1.85 to $2.50 for surgery consultations and from $2.35 to $3.60 for home visits (domiciliary). * Includes Australian Capital Territory. t Includes Northern Territory.
l38
I
TABLE 37. PHARMACEUTICAL BENEFITS COST OF PHARMACEUTICAL BENEFITS - 1962-63 TO 1971-72
I
Commonwealth payments Prescription benefits Year ended 30 June General*
Patient
I~. Ir
contribution
Hospitals and miscellaneous services
on general
Pensioner t $ '1)00 19,831 20,602 21,564 24,071 29,280 32,115 36,609 41,069 45,181 52,005
Total payments
benefit prescriptions
Total cost $'000 91,653 94,412 99,044 109,265 119,628 123,639 138,503 158,660 184,659 208,735
,t
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$'000 47,093 46,461 48,930 53,078 56,656 56,800 64,025 73,228 88,176 90,062
$'000 9,986 11,776 11,708 14,635 15,344 16,219 17,739 22,422 26,918 31,201
$'000 76,910 78,839 82,203 91,784 101,281 105,134 118,373 136,718 160,275 173,268
$'000 14,742 15,574 16,841 17,481 18,347 18,504 20,129 21,942 24,384 35,467
As from 1 November 1971 patient contribution on general benefit prescriptions was increased from 50c to $1. Also S.H.B.P. patient category was introduced, with patient contribution remaining_at SOc . • Benefits supplied to persons other than those eligible 'to receive pensioner pharmaceu tical benefits. f Benefits supplied to persons eligible to receive pensioner benefits.
TABLE 38. PHARMACEUTICAL BENEFITS COST OF PRESCRIPTION BENEFITS - BY STATES - 1971-72
Commonwealth payments State '~; .~
Patient contribution
Total cost of prescription
..
General benefits $'000 36,066 25,391 12,433 7,916 5,985 2,271 90,062
Pensioner
on general
benefits $'000 21,530 12,577 8,368 4,749 3,324 1,457 52,005
Total* $'000 57,596 37,968 20,801 12,665 9,310 3,728 142,067
beneflls $'000 l3,971 9,883 5,055 3,164 2,490 903 35,467
benefits $'000 71,567 47.852 25,856 15,829 11,800 4,631 177,534
New South Wales! Victoria Queensland South Australia:/: Western Australia
tI; 1,-"
Tasmania Commonwealth
As from 1 November 1971 patient contribution on general benefit prescriptions was increased from SOc to $1. Also S.H.B.P. patient category was introduced, with patient contribution remaining at SOc. * Excludes payments to hospitals and miscellaneous services. t Includes Australian Capital Territory. :/: Includes Northern Territory.
TABLE 39. PHARMACEUTICAL BENEFITS PAYMENTS TO HOSPITALS AND MISCELLANEOUS SERVICES - BY STATES - 1962-63 TO 1971-72
Payments to hospitals New South Wales* $'000 2,890 3,341 3,039 6,692 5,233 6,222 6,586 8,038 9,194 10,920 QueensVictoria
Year ended 30 June
South Western land Australia Australia Tasmania $'000 597 712 738 607 1,110 1,416 1,403 1,828 2,153 2,150 $'000 822 892 764 700 1,100 1,286 1,803 2,133 2,679 3,065 $'000 247 75 414 713 538 602 706 739 919 796
Miscelianeous
.~
Total
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$'000 3.360 4,300 4,396 4,000 5,000 4.103 4,160 6,000 7,229 8,874
$'000 1,856 2.200 2,114 1,613 2,041 2,198 2,655 3,195 4,097 4,618
$'000 $'000 9,986 214 11,776 256 243 11,708 309 14,635 322 15,344 392 16,219 427 11,739 489 22,422 646 26,918 778t 31,201
~;'
t
* Indudes Australian Capital Territory. Miscellaneous services expenditure consisted ofBiological products and prophylactic materials Commonwealth Medical Officers and Immigration Service Miscellaneous (including bush nursing and testing expenses)
$'000 417 44 317
TABLE 40. PHARMACEUTICAL BENEFITS DISSECTION OF BENEFIT PRESCRIPTION COSTS INTO INGREDIENT COST AND APPROVED SUPPLIERS' REMUNERATION - 1962-63 TO 1971-72
Cost of ingredients Year ended 30 June 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 and containers
Suppliers' remuneration $'000 32,553 33,239 35,197 37,337 40,608 40,758 45,450 50,418 58,121r, 64,120
Total cost $'000 81,666 82,637 87,336 94,630 104,283r, 107,420 120,764 136,238 157,741 177,534
$'000 49,1l3 49,398 52,139 57,293 63,676 66,662 75,314 85,821 99,620r. 113,414
...
,
COS.t of ingredients and containers includes payments to suppliers for wastage on broken quantities of ready-prepared ltems.
Remuneration includes mark-up on wholesale price and professional fees but does not include discount allowed to suppliers by whOlesalers and manufacturers. Excludes costs in relation to hospitals and miscellaneous services.
140
TABLE 41. PHARMACEUTICAL BENEFITS DISSECTION OF BENEFIT PRESCRIPTION COSTS INTO INGREDIENT COST AND APPROVED SUPPLIERS' REMUNERATION - BY STATES - 1971-72
"-
State
Cost ofingrediellts alld con tainers $'000
Suppliers' remuneration $'000
Total cost $'000
New South Wales' Victoria
Queensland South Australiat
.-
Western Australia Tasmania
45,952 30,607 16,364 10,052 7,487 2.951 113,414
25,614 17,245 9,491 5,777 4,313 1,680 64,120
71,567 47,852 25.856 15.829 11,800 4,631 177,534
Commonwealth
Cost of ingredients and containers includes payments to suppliers for wastage on broken quantities of ready-prepared items.
Remuneration includes mark-up on wholesale price and professional fees, but does not include discount allowed to suppliers by wholesalers and manufacturers. Excludes costs in relation to hospitals and miscellaneous services .
t
• Includes Australian Capital Territory. Includes Northern Territory.
TABLE 42. PHARMACEUTICAL BENEFITS NUMBER OF' BENEFIT PRESCRIPTIONS AND AVERAGE COST PER PRESCRIPTION - 1962-63 TO 1971-72 No. of benefit prescriptions Year ended 30 June General benefits OOO's 29,518 31,040 33,715 35,085 36,751 37,053 40,453 44,071 48,971 48,492 Pensioner benefits Average cost per benefit prescription * General benefits
Pensioner benefits Total $. c. 1.93 1.86 1.83 1.89 1.94 1.94 2.00 2.08 2.21 2.45
Total OOO's
Ii
~>
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
OOO's 12,674 13,317 13,841 14,908 16,936 18,370 19,954 21,504 22,515 23,951
42,192 44,357 47,556 49,993 53,687 55,423 60,408 65,575 71,487 72,442
$. c. 2.09 2.00 1.95 2.01 2.04 2.03 2.08 2.16 2.30 2.59
$. c 1.57 1.55 1.56 1.61 1.73 1.75 1.83 1.91 2.01 2.17
,I
r-" I
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services.
• Includes patient contribution where applicable.
141
TABLE 43. PHARMACEUTICAL BENEFITS NUMBER OF BENEFIT PRESCRIPTIONS AND AVERAGE COST PER PRESCRIPTION - BY STATES - 1971-72 No. of benefit prescriptions General Pensioner
j Average cost per benefit prescription" General Pensioner
State New South Walest Victoria
benefits OOO's 19,159 13,462 6,897 4,345 3,383 1,246 48.492
benefits OOO's 9,979 5,620 3,973 2,188 1,538 652 23,951
Total OOO's 29,138 19,081 10,870 6,534 4,922 1,898 72,442
benefits $. c.
benefits $. c.
Totpl $. c.
....
Queensland South Australiat Western Australia Tasmania Commonwealth
2.61 2.62 2.54 2.55 2.51 2.55 2.59
2.16 2.24 2.11 2.17 2.16 2.24 2.17
2.46 2.51 2.38 2.42 2.40 2.44 2.45
#/
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services.
* Includes patient contribution where applicable. t Includes Australian Capital Territory. t Includes Northern Territory.
TABLE 44. PHARMACEUTICAL BENEFITS NUMBER OF BENEFIT PRESCRIPTIONS PER HEAD OF POPULATION AND AVERAGE COST PER HEAD OF POPULATION - 1962-63 TO 1971-72 Number of prescriptions per head of population r. Year ended 30 June 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 General t Pensioner:j: population population 2.94 3.04 3.23 3.31 3.44 3.43 3.68 3.93 4.29 4.17 15.42 15.82 16.42 16.66 16.59 16.81 17.61 18.46 18.69 19.41 Total population 3.89 4.01 4.22 4.35 4.59 4.66 4.98 5.29 5.66 5.63
Average cost per head of population" r. Generalt population $. c. 6.17 6.07 6.30 6.65 7.02 6.97 7.65 8.48 9.85 10.79 Pensionert population $. c. 24.13 24.47 25.57 26.91 28.68 29.39 32.31 35.25 37.50 42.15 Total population $. c. 7.53 7.47 7.74 8.23 8.91 9.03 9.96 11.00 12.49 13.79
..--~'-
~-'
-
,~
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services.
* Includes patient contribution where applicable. t Population excluding persons eligible to receive pensioner pharmaceutical benefits. :\: Population of persons eligible to receive pensioner pharmaceu tical benefits.
r Most of these figures have been revised. See Notes on Statistics, page 120.
142
> .'
TABLE 45. PHARMACEUTICAL BENEFITS NUMBER OF BENEFIT PRESCRIPTIONS PER HEAD OF POPULATION AND AVERAGE COST PER HEAD OF POPULATION - BY STATES - 1971-72
<C
Number of prescriptions per head
.... State
of population General population Pensiona population
Average cost per head o[population*
Total population
General population $. c. 11.57 10.99 10.62 9.64 8.88 9.03
Pensioner population
Total population $. c. 14.95 13.56 14.00 12.46 11.30 11.81
t
New South Walest Victoria Queensland South Australia:l: Western Australia
Tasmania Commonwealth
4.43 4.19 4.19 3.78 3.55 3.55 4.17
21.55 17.62 19.90 18.00 17.14 15.95 19.41
6.09 5.41 5.89 5.14 4.72 4.84 5.63
$. c. 46.49 39.44 41.92 39.05 37.05 35.66
10.79
42.15
13.79
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services. * Includes patient contribution where applicable.
t Includes Australian Capital Territory. :I: Includes Northern Territory.
TABLE 46. PHARMACEUTICAL BENEFITS DRUGS DISPENSED BY CHEMISTS - 1971-72 Percentage
Percentage
of total Therapeu tic category
of total Therapeutic category
prescriptions expenditure
Percentage of total of total prescriptions expenditure
Percentage
- .- Analgesics Antacids Anti-cholinergics Anti-convulsants Anti-depressants
Anti-diabetics An ti-histam ines
% 9.17 3.52 1.67 1.72 3.20 1.02 6.23
% 8.41 2.22 2.34 1.62 4.07 1.92 483
% Eye drops GastIo intestinal sedatives Genito-urinary infections Drugs acting on Heart - Drugs acting on Iron preparations Parkinsons - Drugs used for Penicillins
% 1.37 0.84 2.63 1.99 0.94 0.88 8.19 2.74 0.55 1.04 3.96 1.81 13.21
1.96 1.09 1.84 2.05 1.96 0.52 7.19 5.95 0.94 J.28 2.76 2.33 17.68
.. -:.......,..
-'
Blood vessels - Drugs acting on. Broad spectrum antibiotics Bronchial slJasm preparations Corticosteroids Diuretics Exp0ctorants and cough sup~ressants
5.18 9.39 3.33 1.07 5.16 1.79
8.34 11.67 4.54 1.86 7.40 0.63
Sedatives and hypnotics Sera vaccines
Sulphonamides Tranquillisers
Water and electrolyte replacemen t
Other drugs
.1
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services.
II I~ 143
TABLE 47. PHARMACEUTICAL BENEFITS NUMBER OF PRESCRIPTIONS AND COST OF MORE FREQUENTL Y PRESCRIBED THERAPEUTIC GROUPS 1970·71 AND 1971·72
Year ended 30 June
. 1972 ..oj
1971 Therapeutic category Prescriptions
Cost"
Prescriptions
Cost'
Analgesics Antacids Anti-cholinergics Anti-convulsants Anti·depressants Anti·diabetics AntiMhistamines Blood vessels - Drugs acting on.
Broad spectrum antibiotics Bronchial spasm preparations Corticosteroids Diuretics Expectorants and cough suppressants
Eye drops Gastro intestinal sedatives Genito-urinary infections - Drugs action on Heart - Drugs acting on . Iron preparations
Parkinsons - Drugs used for Penicillins
Sedatives and hypnotics Sera vaccines
Sulphonamides Tranquillisers Water and electrolyte replacement
OOO's 6,017 2,457 1,098 625 1,750 712 4,554 3.627 6,678 2,012 658 3,302 2,081 1,358 737 1,287 1,386 1,478 350 5,724 5,563 714 813 1,480 1,340
$'000 12,849 3,694 3,592 2,073 5,460 2,947 8,357 13,583 18,954 5,313 2,343 11,273 1,761 2,245 1,357 4,856 2,693 1,720
1,136 15,045 5,979 998 1,102 4,726 2,402
OOO's 6,646 2,550 1,213 1,248 2,315 740 4,517 3,754 6,803 2,414 774 3,737 1,294 1,418 789 1,330 1,481 1,418 376 5,210 4,311 681 927 2,023 1,690
$'000 14,934 3,948 4,147 2,871 7,228 3,408 8,580 14,814 20,721 8,053 1,308 13,138 1,119 2,424 1,484 4,676 3,533 1,676 1,554 14,534 4,872 971 1,852 7,028 3,208
,
Excludes benefit prescriptions dispensed by hospitals and miscellaneous services.
* Cost includes
the patient contribution on prescriptions available to the general public.
144
TABLE 48. PHARMACEUTICAL BENEFITS NUMBER OF PHARMACEUTICAL CHEMISTS AND MEDICAL PRACTITIONERS DISPENSING PHARMACEUTICAL BENEFITS PRESCRIPTIONS - 1949-50 TO 1971-72 A. Phannaceutical Chemists approved under Section 90 of the National Health Act 1953-1971 for the purpose of supplying pharmaceutical benefits. B. Medical Practitioners approved under Section 92 of the National Health Act 1953-1971 for the purpose of supplying ph ann aceu tical benefits in areas in which there are no other pharmaceutical services available. New South Wales * As at 30lune A 1,200 1,252 1,323 1,368 1,452 1,519 1,574 1,615 1,681 1,763 1,818 1,877 1,933 2,008 2,065 2,101 2,140 2,204 2,228 2,254 2,268 2,277 2,257 B
II. ~.
I
Victoria
Queensland A 285 332 348 388 437 476 520 554 571 603 645 676 696 721 750 775 805 818 843 866 893 909 922 B
South Australia t A 265 292 305 329 368 384 396 403 424 433 436 449 459 470 474 487 507 520 527 536 539 534 534 B
Western Australia
Common-
Tasmania
wealth A 3,080 3,231 3,353 3,502 3,754 3,923 4,093 4,227 4,368 4,552 4,696 4,838 4,941 5,100 5,243 5,375 5,501 5,638 5,728 5,806 5,876 5,912 5,891 B
A 1,038 1,054 1,070 1,102 1,170 1,206 1,245 1,284 1,299 1,348 1,383 1,402 1,414 1,445 1,482 1,520 1,545 1,583 1,602 1,616 1,628 1,633 1,617
B
A 202 208 212 221 232 243 261 270 282 292 296 311 312 325 338 354 363 370 382 387 398 406 410
B
A 90 93 95 94 95 95 97 101 111 113 118 123 127 131 134 138 141 143 146 147 150 153 151
B
r~~
1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
2 25 26 29 31 32 31 27 28 30 29 34 36 32 31 32 33 34 30 32 31 31 33
6 6 7 8 8 5 6 7 7 6 6 6 6 6 7 7 6 5 3 5
5 4 2
3 4 5 5 6 7 8 8 8 9 9 7 6 7 6 5 6 4 5 4 6 6 5
27 30 29 24 25 20 20 19 18 16 17 14 13 14 12 10 9 9 9 7 6 6 5
12 12 12 10 11 12 11 12 12 11 10 7 6 7 8 8 5 5 5 5 5 4 5
7 8 10 11 12 11 11
50 84 87 86 92
11 12 12 12 11
10 12 12 12 13 14 13 14 14 15
88 87 84 84 84 83 80 78 76 76 74 71
70 66 66 67 65 65
~.I -
• Includes Australian Capital Territory.
t Includes Northern Territory.
'I -
rr' , I
\ 145
TABLE 49. TUBERCULOSIS NUMBER OF ALLOWANCES, NOTIFICATIONS AND MORTALITY - 1952 TO 1971 Notifications *
Deaths All forms per 100,000 of population r. 55.4 56.5 55.1 50.0 46.9 41.9 37.7 35.6 39.7 34.0 35.6 35.5 30.9 25.5 22.0 19.4 18.6 14.9 13.7 11.6
No. of Year ended 31 December 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 '1968 1969 1970 1971 allowances current as at
No. pulmonary
31 December 6,127 5,696 5,742 5,029 4,182 3,326 2,750 2,503 2,235 2,017 1,845 1,796 1,573 1,378 1,177 1,009 858 625 532 420
No. all forms 4,786 4,979 4,952 4,602 4,419 4,035 3,708 3,582 4,084 3,570 3,825 3,883 3,446 2,903 2;549 2,293 2,233 1,823 1,712 1,482
No. all forms 1,290 974 897 729 724 585 538 549 489 447 475 440 413 294 321 275 243 213 203 182
All forms per 100.000 of population r. 14.9 11.0 10.0 7.9 7.7 6.1 5.5 5.5 4.8 4.3 4.4 4.0 3.7 2.6 2.8 2.3 2.0 1.7 1.6 1.4
~'
4,761 4,787 4,650 4,360 4,169 3,762 3,632 3,160 3,556 3,239 3,503 3,574 3,113 2,624 2,276 2,005 1,926 1,570 1,455 1,247
r. Most of these figures have been revised. See Notes on Statistics, page 120. Excludes reactivations.
•
TABLE 50. TUBERCULOSIS NUMBER OF ALLOWANCES, NOTIFICATIONS AND MORTALITY - BY STATES - YEAR ENDED 31 DECEMBER 1971 _ C,,--.
e---
Notifications* 1971 No.of--------------------------------allowances All forms current as at No. No. per 100,000 31 December pulmonary all forms of population 141 85 104 38 29 23 428 344 220 95 95 35 10 20 498 416 241 124 119 41 13 30 10.82 11.87 13.19 10.55 11.57 10,49 9.03 35.09
Deaths 1971 All forms per 100,000 of population
State New South Wales Victoria Queensland . South Australia Western Australia Tasmania Australian Capital Territory . Northern Territory
No. all forms 35 61 29 20 21
o:~ 1.7 1.6
l.7 2.0 2.0
8"
0.7 1 7 8.2 ;;> Commonwealth -------;4-;;2:;;0----;-1,-;;24-:;-7:;------:-=:-----:-:--:-:---7'~-------1,482 11.62 182 1.4
t
t
~
* t t 146
Excludes reactivations.
Included in New South Wales figure. Included in Sou th Australian figure.
TABLE 51. TUBERCULOSIS EXPENDITURE UNDER THE TUBERCULOSIS ACT - 1951·52 TO 1971·72
i"1
Year ended 30 June
Capital reimbursements to States $'000 1,290 2,327 2,591 3,422 3,495 4,757 4,257 2,822 1,458 776 756 984 598 703 689 499 780 847 593 469 438
Maintenance
reimbursements to States $'000 4,229 5,965 7,478 7,601 8,101 9,610 9,138 9,688 8,753 8,473 8,800 9,932 10,669 10,337 l3,577 11,238 11,508 11,743 10,882 10,938 9,941 '
Allowances paid to sufferers through Department of Social Services
Total $'000 9,074 12,107 13,822 14,832 14,976 17,289 15,905 14,636 l2,262 11,142 11,302 l2,523 12,861 12,497 15,552 12,930 13,380 13,511 l2,246 12,067 11,009
I '.
1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$'000 3,555 3,816 3,753 3,809 3,380 2,921 2,509 2,125 2,051 1,893 1,746 1,607 1,593 1,458 1,286 1,193 1,091 921 771 659 630
• Includes an amount of $345,785 payable through the Consolidated Revenue Fund.
TABLE 52. TUBERCULOSIS
~,
EXPENDITURE UNDER THE TUBERCULOSIS ACT - BY STATES - 1971·72
Capital reimbursements Maintenance reimbursements
Allowances paid to sufferers through Department of Social Services
State
to States $'000 70 119 6 155 88 438
to States $'000 3,073 3,289 1,558 757 884 380 9,941:1=
Total $'000 3,360 3,565 1,707 960 1,004 413 11,009
-~~~"-
New South Wales Victoria Queensland South Australia Western Australia Tasmania Commonwealth
$'000 217' 157 143 48t 32 33 630
* Includes the Australian Capital Territory. t Includes the Northern Territory. :1= Includes an amount of $345,785 payable through the Consolidated Revenue Fund.
I "
~ ,~
147
TABLE 53. TUBERCULOSIS RESULTS OF MASS X·RAY SURVEYS - BY STATES - YEAR ENDED 31 DECEMBER 1971 No. active and probably active T.B. cases 49 138 38 18 13 12 268
State New South Wales Victoria Queensland Sou th Australia Western Australia Tasmania
No. examined
Rate per 1,000 examined 0.12 0.20 0.22 0.17 0.16 0.16 0.18
J
.
400,356 694,459 169,208 105,988 82,580 74,088 1,526,679
Northern Territory Commonwealth
TABLE 54. PUBLIC HEALTH NOTIFIABLE DISEASES: NUMBER OF CASES NOTIFIED (RELATES ONLY TO DISEASES NOT.IFIABLE IN ALL STATES AND TERRITORIES) - 1967 TO 1971 Year ended 31 December
Disease Anthrax Brucellosis
1967 2 61 46 9,388 11,316 68 117
1968 3 154 29
1969 I 136 4 31
1970
1971
Cholera Diphtheria Encephalitis Gonorrhoea
137 75 76 9,562 7,571 37 67 72 234 I
77
* *
Hepatitis, infective Hydatids Leprosy Leptospirosis Malaria Paratyphoid fever Plague. Poliomyelitis Smallpox Syphilis Tetanus Tuberculosis . Typhoid fever Typhus (all forms) Yellow fever
9,932 8,123 73 113
• •
9,648 7,450 61 69 13
* *
31 64 10,539 7,509
1~/ 97 215 5
6
•
•
6 3
•
955 29 2,293 29 r. 7
840 18 2,233 79 7
1,072 19 1,823 34 3
947 21 1,712 19 5
1,077 . 24 1,482 36 7
.
{"" ~
The figures shown in this table are the number of cases notified by individual medical practitioners to State Health Departmen ts. • Cases previously notified on a financial year basis.
148
TABLE 'i'i. PUBLIC HEALTH DISEASES NOTIFIED IN THE STATES AND TERRITORIES OF AUSTRALIA - YEAR ENDED 31 DECEMBER 1971
Disease
N.S. W.
Vic.
Qld.
S.A.
W.A.
Tas.
A.C. T.
N.T.
,.
Acu te rheumatism Amoebiasis
• • •
7
Ankylostomiasis Anthrax Arbovirus infection Dengue Murray Valley Encephalitis Other Brucellosis Cholera Diarrhoea, infantile. Diphtheria Dysentery, bacillary. Encephalitis . Gonorrhoea Hepatitis, infective Hepatitis, serum Hydatids Leprosy Leptospirosis Malaria Ornithosis Paratyphoid fever Plague. Poliomyelitis Puerperal fever Q fever Rubella Salmonella infection. Scarlet fever . Shigella Smallpox Syphilis Tetanus - .- Trachoma Tuberculosis. Typhoid fever Typhus (all forms) Yellow fever .
29 2 2
*
2 1
3 78
• 21 667 22 40 6 33 14 2,127 1,895 66 3 1 2 36 11
• •
• 4 47 3 817 504 2 1 5
*
•
23 3,943 2,615 6 19
177 1 59 14 1,852 1,258
• 1 149 1,236 554 1 117 287 14 10 1
17 42 1 2
2 4 68 70 1
•
73 1 1 10 35 100 2
18 26 412 296 13 45
13 16
2 1 1 3 637 89 210 102 3 416 11 7 151 33 2
*
• 14 •
• 59 286 44 183 122 1 11 124 2
,
• 362 8
• 91 •
224 18 256 4
•
• 9
, 1 12 7 5
, 1 21 58
•
200 7 241 5
498 16 2
•
,
10 1 41
20 1 30 1
• 13
119 1
5
The figures shown in this table are the number of cases notified by individual medical practitioners to State Health Departments. 'Not notifiable
149
TABLE 56. PUBLIC HEALTH RADIO AND TELEVISION SCRIPTS ON MEDICAL MATTERS EXAMINED - 1968-69 TO 1971-72 Approved Number Type of script examined
Approved as amended Number Per cent
Rejected Number Per cent
Number
Per cent
% Radio 1968-69 1969-70 1970-71 r. 1971-72 Television -
% 372 375 356 218 80 166 97 71 452 541 453 289 46.2 57.8 44.3 21.8 33.6 55.2 44.9 20.6 43.3 57.1 44.4 21.5 70 60 68 166 15 21 6 68 85 81 74 234
% 8.7 9.3 8.5 16.6 6.3 7.0 2.8 19.8 8.2 8.5 7.3 17.4
805 649 804 1,001 238 300 216 344 1,043 949 1,020 1,345
363 214 380 617 143 113 113 205 506 327 493 822
45.1 33.0 47.3 61.6 60.1 37.7 52.3 59.6 48.5 34.5 48.3 61.1
1968-69 1969-70 1970-71 r. 1971-72 Total 1968-69 1969-70 1970-71 r. 1971-72
TABLE 57. QUARANTINE VESSELS BOARDED AND CLEARED - BY STATES - 1971-72 Surface State Vessels Crew
Air Vessels Crew
Passengers
Passengers
New South Wales Victoria
Queensland South Australia Western Australia Tasmania Northern Territory Commonwealth
1,330 428 1,074 275 2,002 418 345 5,872
65,753 20,144 46,012 12,793 106,587 10,832 10,755 272,876
38,169 14,405 12,4 70 4,418 89,682 73 904 160,121
4,467 435 374 5 950 1,664 7,895
49,476 9,842 3,244 52 10,890 12,649 86,153
398,436 50,210 26,912 160 93,785 82,761 652,264
150
TABLE 58. QUARANTINE INFECTIOUS DISEASES ON OVERSEAS VESSELS ARRIVING IN AUSTRALIA - 1971-72
Disease
No. of cases
... Chickenpox Gastro enteritis
Glandular fever Infectious dermatitis
Infectious hepatitis Influenza
Measles Mumps Rubella Scarlet fever Tuberculosis. Venereal disease
33 12 2 1 12 1 44 24 32 2 2
312 477
Total
TABLE 59. QUARANTINE
I 11\
ANIMAL IMPORTATIONS SUBJECT TO QUARANTINE - 1971-72
Type
Number
I I
Cattle - from New Zealand Horses - from United Kingdom from New Zealand Dogs and cats - from United Kingdom from New Zealand Pigs - from New Zealand . Small laboratory animals for scientific institutions Animals for permanent quarantine in registered zoological gardens and circuses
2,509 170 924
---10,042
752 694 23 4,718 252
Total .
lSI
TABLE 60. NORTHERN TERRITORY HEALTH AERIAL MEDICAL SERVICE - 1971-72 Alice
Darwin Routine flights - Doves Emergency flights - Doves Emergency flights - R.F.D.S. Ferry flights . Mercy fligh ts Charter fligh ts Charter boat . Hours flown - Doves Miles flown - Doves Landings made - Doves Radio medical consultations' Patients carried Dove R.F.D.S . . Charter diversion Commercial • Excludes radio telephone consultations. 266 313
Springs
Gove
Total
., 217 84 256 2 2 938.25 141,395 818 1,514 583 438 17 173.50 24,643 115 46 10 29 493 426 256 2 33 3129.55 438,274 2,592 3,568 1,726 438 1,838
31 2017.40 272,236 1,659 2,054 1,097 1,821
152
TABLE 61. NORTHERN TERRITORY HEALTH HEALTH SERVICES PROVIDED AT MAIN NORTHERN TERRITORY HOSPITALS - 1971-72 Alice Springs Tennant Creek
Darwin , ~
Katherine
Gave
No. of bed days No. of admissions
Average daily no. of inpatients No. of births . No. of deaths in hospital No. of postmortem examinations. No. of major operations No. of minor operations
No. of outpatient attendances
117,611 10,623 321 1,545 101 141 1,483 3,228 112,123 248,935 942.94 60,315 1,946 2,133 20,195 5,529 25,105
59,012 4,726 162 526 91 76 309 1,282 36,544 81, 623 t 309.17
4,701 782 13 78 20 18 83 15,704 17,224 65.24 2,839 128 146 9,227
16,802 1,991 46 161 17 32 41 383 14,451 40,608 153.81 6,192 446 354 20,573
1,660 413 4 3 4 107 38,426" 7,999 60.59 2,453
Dispensaries Prescrip tions dispensed .
Average no. of prescriptions dispensed per working day X-ray Department - :j: No. of exposures Ambulance Services No. of trips No. of patients carried No. of miles travelled Physiotherapy Department:j: No. of patients No. of treatments
17,809 815 953 33,266 1.782 11,698
During 1971-72 there were 3,280 outpatient attendances at Batchelor daily clinic. " Includes outpatient attendances at Yirrkala and Groote Eylandt. t Includes aerial medical and medical kits. :j: Inpatients and outpatients.
153
TABLE 62. NORTHERN TERRITORY HEALTH DENTAL SERVICES PROVIDED IN THE NORTHERN TERRITORY - 1971-72 Aerial Mobile Darwin based Overland Mobile Darwin based
Darwin
Dental Clinic
Nigh/cliff Dental Clinic
Alice Springs Clinic Mobile
Gove Dental Clinic
.
Consultations and examinations
Extractions Silicates Amalgam Inlays. Crowns Bridges Dressings X-rays. G.A.'s hospital Root treatmen t Scale and clean Peridontal treatment Orthodontist Oral surgery . Jaw fracture .
Other treatments Prosthetic Total treatments
1.846 3,639 1,659 5,976 91 99 31 1,830 2,680 108 626 290 343 2,139 169 42 3,927 2,646 28,141
1,540 1,510 833 3,786 32 32 4 1,003 724 4 225 87 10 304 18 1,127 583 11,822
3,048 1,292 323 1,978
1,958 1,070 318 1,311 5 3 228 235 18 62 13 1 273 178 5,673
110 63 25 76 4 18 141 394 7,472
2,226 1,732 754 2,934 26 62 21 896 966 70 212 224 2 1,183 24 6 891 1,109 13,338
1,389 259 68 549
31 8 4 13
453 1,127 298 1,350 7 23 1 321 335 34 133 11 4 11 1 903 480 5,492
19 3 2,343
Patients treated Aboriginal adults Paying 2 Exempt 415 Non-aboriginal adults Paying 10,370 Exempt 559 Children - Aboriginal 180 Non-aboriginal 8,480 Total patients treated 20,006
4 10 3,238 190 25 5,436 8,903
8 953 182 187 2,808 251 4,389
18 490 786 209 479 1,218 3,200
18 198 4,854 374 III 4,746 10,301
79 107 30 966 147 1,329
6 468 2,621 55 168 630 3,948
---:~
,
TABLE 63. NORTHERN TERRITORY HEALTH LICENCES ISSUED UNDER THE PUBLIC HEALTH ORDINANCE - YEAR ENDED 31 DECEMBER 1971 Tennant Creek Alice Springs 6 30 3 4
Darwin
Katherine 4
Barber shops. Boarding houses and caravan parks*
Dairies - Dairymen Eating houses Food shops (milk) . Itinerant food vendo" Milk vendors . Septic tank applications
28 88 2 49 39 22 2 58
10 10
4
5
12 19 4
• Figures do not include 18 licences issued to motels and roadside inns located within the Northern Territory.
154
.~
1
TABLE 64. NORTHERN TERRITORY HEALTH REGISTRATIONS GRANTED - 1971.72
I~. "I
Type Dental practitioners Medical practitioners
Number
Type Optometrists Pharmacists . Veterinary surgeons
Number
Nurses Nursing aides
14 81 471
2
14
TABLE 65. NORTHERN TERRITORY HEALTH SAMPLES COLLECTED FOR BACTERIOLOGICAL EXAM INA nON BY HEALTH INSPECTION SECTION -
1971-72 Tennant Creek
Darwin
Katherine
Alice Springs
Milk Water - City supply Swimming pools . . Picnic resorts and other supplies Fluoride
46 739 105 169 10
n.a.
104 n.a.
5 n.a.
12 n.a.
126 80 8 1 29
TABLE 66. NORTHERN TERRITORY HEALTH SCHOOL MEDICAL SERVICE EXAMINATIONS - 1971-72
Northern Region
Southern Region
Total
No. examined
5,016 40 1 106 6 2
7,193 112 1 169 10 34 14 276 503 290
12,209 152 2 275 16 36 14 401 512 339
"',,.
,
I
Defects notifiedVision Squint Hearing Severe dental caries Psychological and emotional Speech All others Commonwealth Acoustic Laboratory Parent interviews
125 9 49
r~ ~ Referrals - Child Guidance Clinic, Educational Clinic and
TABLE 67. AUSTRALIAN eAPIT AL TERRITORY HEALTH LiCENCES ISSUED UNDER THE PUBLIC HEALTH ORDINANCE - YEAR ENDED 31 DECEMBER 1971
Barber shops . Boarding houses
98 73 110 9
Eating houses Ice cream vendors
Meat vendors Milk distributors Milk vendors Prepared meat vendors.
87 97 280 271
155
TABLE 68. AUSTRALIAN CAPITAL TERRITORY HEALTH REGISTRATIONS GRANTED - 1971-72
Type Dental practitioners Medical practitioners Nurses Nursing aides
Number
Type Optometrists Pharmacists Veterinary surgeons
Number
8
2
50 359
20 2
94
TABLE 69. AUSTRALIAN CAPITAL TERRITORY HEALTH SAMPLES COLLECTED BY HEALTH INSPECTION SECTION 1971-72
For bacteriological examination Milk . Cream Meat. Other foods Water - City supply Swimming pools Picnic resorts and other supplies Fluoride . Sewerage Lake Burley Griffin and Molongo River.
For chemical examination 892
1,565 208
196 32 47 161
357 1,524 99
529 368 336
15 256 198
26 25
TABLE 70. AUSTRALIAN CAPITAL TERRITORY HEALTH SCHOOL MEDICAL SERVICE EXAMINATIONS - 1970-71 AND 1971-72
Year ended 30 June
1971 Number of children No. examined Defects notified Vision Squint Hearing. . Severe dental caries . Psychological and emotional Speech All others Referrals Child Guidance Clinic Educational Clinic . . . Commonwealth Acoustic Laboratory Parent interviews 19,610 718
1972 Number of children
19,162
50 263 11 72 56 317
796 42 224 6
142 42 346 153
99 14 112 1,480
34 104
2,599
156
TABLE 71. NATIONAL FITNESS
I'
I
ALLOCATION OF COMMONWEALTH NATIONAL FITNESS GRANTS - 1971-72 Item
$
State National Fitness Council State Education Departments Universities . .
Australian Recreation Leadership Training Course Total allocation to State agencies Central administration Australian Capital Territory grant Capital works Total allocation
270,308 34,000 24,800 6,600 335,708 6,792 7,500 68,000 418,000
TABLE 72. NATIONAL FITNESS ALLOCATIONS TO STATE AGENCIES - 1971-72 Item N.S. W.
Vic.
Qld.
S.A.
W.A.
Tas.
Aust.
$ National Fitness Councils Wages, salaries, allowances, over· time and services not otherwise
$
$
$
$
$
$
~.;1 ~ ___
provided for Services to associated groups, including leader training . to voluntary youth Grants organisations Subsidies to local national fitness committees Services to sports organisations
14,213 15,745 3,034 4,572 1,476 13,942 52,982 5,668 4,000 62,650
14,213 15,745 3,034 4,572 1,476 13,942 52,982 5,668 4,200 62,850
11,952 11,952 2,680 3,986 908 10,522 42,000 5,666 4,200 51,866
11,952 11,952 2,680 3,986 908 10,522 42,000 5,666 4,200 51,866
11,952 11,952 2,680 3,986 908 10,522 42,000 5,666 4,200 51,866
11,706 11,706 1,564 2,356 610 10,402 38,344 5,666 4,000 48,010
75,988 79,052 15,672 23,458 6,286 69,852 270,308 34,000 24,800 329,108
Development of camps and hostels Total National Fitness Councils Education Departments Universities
-I ,.", Ifl
Allocations to S tate Agencies
157
TABLE 73. COMMONWEALTH MEDICAL OFFICERS NUMBER OF CLINICAL EXAMINATIONS BY COMMONWEALTH MEDICAL OFFICERS - BY STATES - 1971-72 State Departments Seamen
, Pensioners 6,052 3,054 1,988 2,411 1,623 468 202 101 15,899 Others Total
New South Wales Victoria
Queensland Sou th Australia Western Australia Tasmania Australian Capital Territory Northern Territory .
24,004 19,478 5,934 4,236 3,449 1,058 11,061 1,985 71.205
1,044 308 179 54 261 27 10 1,883
5 27 30 5 7 313 805 1,192
31,105 22,867 8,101 6,731 5,338 1,560 11,576 2,901 90,179
Commonwealth
TABLE 74. COMMONWEALTH MEDICAL OFFICERS NUMBER OF VACCINATIONS BY COMMONWEALTH MEDICAL OFFICERS - BY STATES - 1971-72 Cholera and Combined Cholera and Typhoid
State
Smallpox
Yellow Fever
Typhoid and T.A.B.
Tetanus 702 72 161 40 166 25 258 1,307 2,731
Plague Influenza
New South Wales Victoria Queensland South Australia Western Australia Tasmania
Australian Capital Territory Northern Territory . Commonwealth
70,092 28,766 9,468 8,065 5,581 1.817 5,776 5,238 134,803
2,148 1,095 324 416 492 54 195 66 4,790
85,668 32,275 14.283 7,270 10,414 2,890 9,176 9,652 171,628
585 6,604 350 2,089 12 7 5,920 3,863 19,430
99 31 7
2 925 31 26 2 33 183 1,202
173 19 330
- ~--..-~'
158
TABLE 75. COMMONWEALTH HEALTH LABORATORIES r
NUMBER OF PATHOLOGY EXAMINATIONS AND LABORATORY TESTS PERFORMED AND NUMBER OF PATIENT REQUESTS - 1971-72
j II
:
•
Health Laboratory Albury Alice Springs Bendigo Cairns Canberra Darwin Hobart Kalgoorlie Launceston
No. of examinations and tests
No. of patient requests 30,325 12,435 55,006 116,016 168,923 70,867 52,134 17,304 23,948 64,892 13,370 127,900 60,643 83,606 96,934 994,303
r I'
Lismore Port Pirie Rockhampton Tamworth Toowoomba .
Townsville Total
94,792 43,081 143,147 278,301 679,068 212,129 145,083 42,224 62,891 236,963 22,844 430,102 169,227 232,239 268,101 3,060,192
In addition to normal diagnostic pathology work, Health Laboratories may undertake laboratory work of a public health nature - for example, bacteriological analysis of water. Serological examination of local donor blood is also undertaken in most of the Laboratories on behalf of the Red Cross Blood Transfusion Service. Figures relating to this additional work are included in the statistics presented abo~e.
TABLE 76. NATIONAL BIOLOGICAL STANDARDS LABORATORY SUMMARY OF ALL SAMPLES EXAMINE]) - 1971-72
Type For Department of HealthProducts on the Pharmaceutical Benefits list. Products recommended by the Pharmaceutical Benefits Advisory Committee New brands of existing Pharmaceutical Benefits Veterinary products Viral vaccines Veterinary an tibiotics Veterinary vaccines. Miscellaneous For other Commonwealth Departmeftts*
No. examined
Failures
Percentage of failures
~ lij II' I" " II
787 61 95 14 29 63 27 490 201 94 329 2,041
99 4 6 9 38 3 45 20 26 1 227
% 12.6 6.6 6.3 31.0 6Q.3 11.1 9.2 10.0 27.7 0.3 11.1
.~_
II
Miscellaneous drug samplest Dressings Medical equipment:j: Total. • Includes 149 samples examined and 24 failures also shown elsewhere;
t Samples of products about which complaints have been received, samples taken prior to granting authorities to import subject to Customs (Prohibited Imports) Regulations and samples tested on behalf of other authorities. :j: Number of batches tested.
r,
r•
(~
159
TABLE 77. NATIONAL BIOLOGICAL STANDARDS LABORATORY REASONS FOR FAILURE AS PERCENTAGE OF TOTAL FAILURES - 1971·72
Reason
Products for human use" %
Products for veterinary uset
% 4.7 2.3 51.2
Safety, contamination or misidentification St",ility Potency Disintegration Uniformity of weigh t Acidity or alkalinity Loss on drying Container content . Miscellaneous (e.g. colouring, physical appearance) Particulate matter Labelling Dressings (various reasons other than sterility):j:
0.5 6.1 26.0 4.6 10.2 3.1 6.1 3.6 9.7 5.6 11.2 13.3
41.9
t
* Six samples failed for two or more reasons. Five samples failed for two or more reasons. :j: Depending on types of dressing, up to twenty-six tests, such as absorbency, ash content, threads per inch, fluorescence, fabric construction, etc., may be applied.
TABLE 78. NATIONAL BIOLOGICAL STANDARDS LABORATORY SAFETY TESTS PERFORMED - 1971-72
Type
No. examined
Failed 11
Indeterminable 32
Sterility Histamine-like substances Toxicity Pyrogen' Disposable medical equipment Viral vaccine identity and safety testing
1,063 82 198 271
329 22
IS
_-"-..\.
160
TABLE 79. COMMONWEALTH ACOUSTIC LABORATORIES CASES EXAMINED - 1971-72 New cases attending laboratories Pensioners
-,
NS.W* 2,967 2,381 2,879 379 153 171 8,930 177
Vic. 2,190 1,597 1,991 147 158 126 6,209 219
Qld. 1,596 656 3,867 163 103 238 637 7,260 172
SAt
WA. 649 423 985 23 51 72 2,203 124
Tas. 323 115 493 40 18 35 1,024 28
Aust. 8,765 5,586 11,322 877 571 238 1,119 28,478 806
'.
Repatriation. Persons under 21 years Armed F orees (Serving) Commonwealth Departments State Departments Other, Total Civil Aviation referrals
1,040 414 1,107 125 88 78 2,852 86
* Includes Australian Capital Territory. t Includes Northern Territory. TABLE 80. COMMONWEALTH ACOUSTIC LABORATORIES CALAID HEARING AIDS FITTED - 1971-72
Calaids fitted Pensioners Repatriation .
NS,W' 3,365 1,127 827 4
Vic, 2,224 590 779 6 5 3,604
Qld. 1,585 418 571 1 17 2,592
SA·t 1,104 365 473 8 1,950
WA. 644 251 205 1 1 1,102
Tas, 350 194 126
Aust. 9,272 2,945 2,981 12 35 15,245
Persons under 21 years Armed Forces (Serving) Commonwealth Departments Total. I
3
5,326
671
"I_~
-,-:
* Includes Australian Capital Territory, t Includes Northern Territory.
'':0;-
161
TABLE 81. COMMONWEALTH ACOUSTIC LABORATORIES CALAID HEARING AIDS ON LOAN AT 30 JUNE 1972
~ S.A·t 3,609 2,500 1,726 19 465 8,319 W.A. Ta,. Au,t.
Calaids on loan Pensioners Repatriation . Persons under 21 years Anned Forces (Serving) Commonwealth Departments Miscellaneous
N.S. W. *
Vic.
Qld.
12,115 8,290 3,675 47 1,098 25,225
7,810 6,078 4,249 49 45 18,231
5,811 2,975 2,686 16 41 11,529
2,820 2,428 939 7 273 6,467
1,252 920 541 1 4
33,4.17 23,191 13,816 139 1,926 72,489
.
~
Total.
2,718
.-.
* Includes Australian Capital Territory. t Includes Northern Territory.
TABLE 82. COMMONWEALTH RADIATION LABORATORY EXPENDITURE FROM THE NATIONAL WELFARE FUND ON RADIO-ISOTOPES FOR MEDICAL PURPOSES1955-56 TO 1971-72
Year ended 30 June
Expenditure
Year ended 30 June
Expenditure
1956 1957 1958 1959 1960 1961 1962 1963 1964
$ 6,172 13,900 15,954 21,382 19,368 27,736 28,988 35,936 55,874
1965 1966 1967 1968 1969 1970 1971 1972
$ 67,942 81,75.5 132,201 154,764 257,277 410,144 616,807r_ 925,097
_~.I_~
162
TABLE 83. NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL GRANTS MADE FROM THE MEDICAL RESEARCH ENDOWMENT FUND - 1971-72' Research
Technical Postassistance and maintenance expenses
I
i ~
~""-r
Salaries,
scholarship stipends Undergraduate $ graduate~
graduate Universities, institutions and hospitals research
workers $
Equip-
Travelling fel/owment ships $ $
Miscelianeous grants
Total
Universities -
$
$
$
$
~
" ..
Sydney New South Wales Newcastle. Melbourne Monash Latrobe Queensland James Cook Adelaide. Western Australia Tasmania.
124.712 71,750 115,035 115,161 84,309 32,740 54,140 9,240
7,100 2,800 5,047 4,800 4,600 3,265 1,600 1,200
36,700 18,200 76,900 50,000 29,700 29,300
83,256 56,691 1,000 201,112 122,424 1,500 79,072 53,426 55,780 9,750
21,667 32,480 16,101 4,215 11,487 12,090 30,602 12,200 4,225
23,629 15,728
3,189 2,446 667 964 669
12,419 8,711 12,329
923 535
Australian National University
300,253 184,367 1,000 430,590 297,564 1,500 209,837 12,090 162,675 132,966 24,415 12,329
Total . Institutes and hospitals New South Wales Victoria Queensland South Australia Western Australia
607,087 131,805 316,775 7,850 2,530
30,412 5,511
240,800 17,900 35,000 6,500 5,700
664,011 78,839 215,000 16,257 1,310 6,750 550
145,067 6,893 1,650 1,664
72,816 4,251 39,678 3,102 4,096 1,351 2,975
9,393 308 1,080 193
1,769,586 245,507 609,183t 29,066 11,906 16,331 2,975 550 7,500+ 923,018 2,692,604
Tasmania.
Australian Capital Territory
Special Grants T,~
7,500+ 458,960 1,066,047 5,511 65,100 318,706 10,207 55,453 9,081 18,474
Total. Grand total
35,923 305,900
982,717 155,274 128,269
.~1
Recommended by the 72nd Session of Council, May 1971, and 73rd Session, October 1971, for use in 1971-72 . Induding $500 basic consumable allowance for Medical and Dental Postgraduate Scholars. t Including grants totalling $354,323 to the Walter and Eliza Hall Institute of Medical Research, Melbourne and $108,295 to the Howard Florey Institute of Experimental Physiology and Medicine, Melbourne. . + Council recommended grants of $3,500 and $4,000 for surveys requested by the Maternal Health Committee and the the Nursing Committee respectively. ~
•
p_.
163
TABLE 84. COMMONWEALTH GRANTS ALLOCATION OF COMMONWEALTH GRANTS - 1962-63 TO 1971-72
Year ended 30June
Home NUrsing Subsidy Scheme $'000 289 372 465 546 664 765 933 1,094 1,450 1,835
Red Cross Blood Transfusion Service
Milk for School Children Scheme $'000 7,454 7,775 8,059 8,493 9,021 9,831 1O,054r. 10,051 10,160 11,845
Paramedical Services
Scheme $'000
Mental Health Institutions Capital Grants $'000 1,590 1,595 2,504 4,539 4,973 4,243r. 4,655r. 5,501r. 4,199 4,207
Nursing Homes - fCapital Grants $'000
1963 1964 1965 1966 1967 1968 1969 1970 1971 1972
$'000 369 402 435 490 974 656 765 754 885 1,049
7
337 460
TABLE 85. COMMONWEALTH GRANTS ALLOCATION OF COMMONWEALTH GRANTS - BY STATES - 1971-72
N.S.W. $'000 Home Nursing Subsidy Scheme Red Cross Blood Transfusion Service
Vic. $'000 557 269 3,493 828
Qld. $'000 274 192 1,862 1,169 332
S.A. $'000 90 139 1,060 4 246
I14A. $'000 317 106 997 454 44
Tas. $'000 52 30 504 3 185 84
A.CT. $'000
N.T. $'000
Aust. $'000 1,835
545 254 3,649 1,325
Milk for School Children Scheme . . . Paramedical Services Scheme Mental Health Institutions Capital Grants Nursing Homes - Capital Grants
23 153
36 127
1,049 11,845 7 4,207 460
~-'t~
164
APPENDIX 2-PUBLICATIONS 1970.71
SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE ADAMS, A.I. 'Personal health services in Australia'. Minnesota Medicine, 1971, 54, 475-478. ADAMS, A.I. 'Factors influencing utilization and demand in an Australian urban community'. Proc. 6th International Scientific Meeting, I.E.A. (in press). ADAMS, A.I. 'Public expectations and the utilization of health services in urban Australia'. Medical Care (in press). ADAMS, A.!, 'The challenges of health services research'. Med. J Aust. (in press). ADAMS, A.I. 'Health maintenance organisation - relevant to the Australian scene?' Med. J. Aust. (in press). ADAMS, A.I. 'Organisation of medical care in Australia.' Zdrowie Publiczne (Poland) (in press). ADAMS, A.!, 'Developments in evaluating health services.' Hosp. & Health Admin. (in press). BEASLEY, F.A., BUDD, G.M., HICKS, K.E, MACPHERSON, R.K. and WELCH, I.A. 'Acclimatisation status of young Australian men.' Record of Proceedings, Twelfth Pacific Science Congress, 1971,1,320 (abstract). BLACK, R.H. 'Parasite density and malaria.' Tropical Doctor, 1971, I, 186-187. BLACK. R.H. 'Malaria.' In Encyclopaedia of Papua and New Guinea, 1971, vol. 2, ed. Ryan, P., pp. 679-684. Melbourne: Melbourne Uruversity Press. BLACK, R.H. 'Malaria in Australia.' School of Public Health and Tropical Medicine Service Publication No.9 (in press). BLACK, R.H. 'Manual of Planning.' Geneva: World Health Organization (in press). BLACK, R.H. 'Malaria in Australia, 1971.' Modern Medicine of Australia (in press). BOUGHTON, C.R., SCOTT, G.C., RUSSELL, D.A. and VINCIN, D.R. 'A preliminary report on the use of the depot sulphone preparation acedapsone ("Hansolar") in the control ot leprosy.' Med. J. AuSi., 1971, I, 1258-1263. BUDD, G.M. 'McDonald Island reconnaissance, 1971.' Polar Record, 1972,16,64-67. BUDD, G.M. 'Status of the Heard Island king penguins in 1971.' The Auk (in press). BUDD, G.M. 'Breeding of the fur seal at McDonald Island, and further population growth at Heard Island.' Mammalia (in press). BUDD, G.M. 'Australian physiological research in Antarctica.' In Antarctic Physiological and Psychiatric Research, ed. Gunderson, E.K.E Antarctic Research Series, American Geophysical Union, Washington, D.C. (in press). BUDD, G.M., HENDRIE, A.L., HICKS, K.E. and FOX, R.H. 'Thermal stress in New Guinea villagers.' Record of Proceedings, TWelfth Pacific Science Congress, 1971,1,319 (abstract). BUDD, G.M., HICKS, K.E. and MACPHERSON, R.K. 'Death from exposure.' Med. J. Aust., 1972,2, 1342 (correspondence). CAMPBELL, C.H. 'Exotic dISease in Sydney.' Med. J Aust., 1971,2,54. CAMPBELL, C.H. 'Papuan black snake venom.' Papua and New Guinea Med. J., 1971, 14,64 (correspondence). CAMPBELL, C.H. 'The effects of snake venoms and their neurotoxins on the nervous system of man and animals.' In Contemporary Trends in Neurology in Oceania. Philadelphia: Davis (in press). CHANCELLOR, A., ADAMS, A., KERR, C.B. and ANDERSEN, N. 'Community attitudes to general practice.' Ausl. Ann. of General Practice, 1971,16,165. CHEE, C.A., ILBER Y, P.L.T. and MOTTA, R. 'Bone marrow transplantation incompatibility modified by Fl graft inocula.' Rev. Europ. Etudes C/in. et Bioi., 1972, 17,53-65. DEBENHAM MARGARET L. 'Australasian Ceratopogonidae (Diptera, Nematocera). Part XV: The genu~ Alluaudomyia Kieffer in Australia and New Guinea.' Proc. Linn. Soc. N.S. W., 1971,96,128-174. . ... ." . DEBENHAM, MARGARET I.. 'Australian and New Gumea PlCture-wmg species of the genus Monohelea Kieffer (Diptera: Ceratopogonidae).' Aust. J Zool. Suppl. Ser., 1972, 12, 1-40. DE V ASSALL, F., ILBER Y, P.L.T. and NAGI, M.S. 's tored machine-separated lymphocytes In assessing immunodepression.' Europ. J Clin. BioI. Res. (in press).
165
.' .:'1
DONOV AN, J.K. and ILBERY, P.L.T. 'Metastases from anaplastic thyroid carcinoma responding to radioiodine.' c/in. Radial., 1971,22,401-404. FERGUSON, D.A. 'An Australian study of telegraphists' cramp.' Br. J. industr. Med., 1971,28, 280-285. FERGUSON, D.A. 'Shift work and health.' Pers. Pract. Bull., 1971,27,113-122. FERGUSON, D.A. 'A study of the sickness absence repeater.' Aust. N.2. J. Med., 1911,1,275 (abstract). FERGUSON, D.A. 'Repetition injuries in process workers.' Med. J. Aust.. 1971,2,408-412. FERGUSON, D.A. 'The optimum use of human resources.' In Introduction to Ergonomics: Special Readings. 1971, pp. 3-14. Melbourne: Productivity Promotion Council of Australia. FERGUSON, D.A. 'Human body dimensions and the design of seats.' In Introduction to Ergonomics: Special Readings. 1971, pp. 32-36. Melbourne: Productivity Promotion Council of Australia. FERGUSON, D.A. 'Fatigue and the organisation of work.' In Introduction to Ergonomics: Special Readings, 1971, pp. 126·132. Melbourne: Productivity Promotion Council of Australia. FERGUSON, D.A. 'Health effects of environmental degradation.' Sydney Uni. Environment Group (in press). FERGUSON, D.A. 'Ergonomics and the quality of living.' Appl. Ergonomics (in press). FERGUSON, D.A. 'The incidence of the hypothenar hammer syndrome.' Archives of Surgery (in press). FERGUSON, D.A. 'Some characteristics of repeated sickness absence.' Br. J. industr. Med. (in press). FOX, R.H., HACKETT, A.J., WOODWARD, P., BUDD, G.M. and HENDRIE, A.L. 'A study of temperature regulation in New Guinea people.' Record of Proceedings, Twelfth Pacific Science Congress. 1971, 1, 315 (abstract). FOX, R.H., HACKETT, A.J., WOODWARD, P., BUDD, G.M. and HENDRIE, A.L. 'A study of temperature regulation in New Guinea people.' Human Biology in Oceania (in press). GILLIES, MARGARET A. and SKY RING, A.P. (with the assistance of LIVINGSTONE, EVELYN). 'The pattern and prevalence of aspirin ingestion as determined by interview of 2,921 inhabitants of Sydney.' Med. I. Aus!., 1912, 1,974-979. HICKS, K.E. 'Computer calculalion and analysis of the P4SR Heat-stress Index.' Environmental Research, 1971,4,253-261. ILBER Y, P .L.T. 'Com partments of leukaemogenic response to radiation.' Nippon Acta Radiologica, 1971,31,331-339. ILBERY, P.L.T. and RICKlNSON, A.B. 'Radiation damage to lymphocytes: Its expression in the kinetics of short-term culture.' In Biophysical Aspects of Radiation Quality, 1971, pp. 297-310. Vienna: Inlemational Atomic Energy Agency. ILBERY, P.L.T. and RICKlNSON, A.B. 'Radiation carcinogenesis.' Aust. Radial. (in press). ILBERY, P.L.T., RICKlNSON, A.B. and THRUM, C.E. 'Blood lymphocyte replicating ability as a measurement of radiation dosage.' Br. J. Radial.. 1971,44, 834-840. KERR, C.B. 'Health problems of migrants.' In Racism: The Australian Experience: Prejudice and Xenophobifl, 1971, vol. 1, ed. Stevens, F.S., p. 76. Sydney: Australian and New Zealand Book Company. KERR, C.B. 'Inherited spinal muscular atrophies.' Minnesota Medicine, 1971, June, pp. 429-430. KERR, C.B. 'Haemophilia al Royal Prince Alfred Hospital, 1882-1910.' J. Roy. Pro AI! Hasp., 1971,2, 156. KERR, C.B. 'The foetus: Screening for genetic disorders.' J. Roy. Pr. AI! Hosp., 1971,2,190. KERR, C.B. 'Responsibility for socia-medical management,in rare diseases.' In The Problems of Medical Care. London: Tavislock Press (in press). KERR, C.B. 'Blood coagulation.' In Clinical Genetics, ed. Sorsby, A. London: Butterworth (in press). KERR, C.B. 'Cytogenetics and genetic mechanisms.' In Reproductive PhYSiology. ed. Shearman, R.P. Oxford: Blackwell (in press). KERR, C.B. ':erspectives of Auslralian medicine.' Sydney University Med. Soc. J. (in press). KERR, C.B. AntIpodean eqUIvalent of the Annals of Internal Medicine.' Ann. Intern. Med. (in press). KERR, C.B. 'Self·help via community health centres.' Med. J. Aust. (in press). KERR, c.B. 'Modern scientific developments - Boon or calastrophe?' Proc. Med. leg. Soc. N. S. W. (Ill press). KIRK, R.L., BLAKE, N.M., MOODIE, P.M. and TIBBS, G.J. 'PopUlation genetic studies in AustralIan Abongmes of the Northern Terrilory: The distribulion of some serum protein and enzyme groups among populations al various localities in the Northern Territory of Australia.' Human Biology in Oceania, 1971, I, 54-76. LEE, D.J. 'The funnel web spider.' Health in N.S. w., 1971, 12, 13-14.
•
166
I
~ ., \
LEE, D.l. 'Common Pests and Public Health in N Wales Government Printer (in press) ew South Wales' (revised edition). New South L1CKISS, J. NORELL 'Social devia '. Ab " MACPHERSON, R.K.· 'Environmen~~~~n heafnl?nal boys.' Med ~ Aust.. 1971, 2, 46()'470. 1972, vol. 1 ed. Ryan P pp 370-374 M tho In EncyclopaedIa of Papua and New Guinea, ?lbourne: Melbourne University Press. , . MIsuse of threshold hmIt values. Health Physics, 1971,21,611 (correspondence). MOODIE, P.M. 'The health dIsadvantages of Aborigines.' In Racism: The Australian Experience: A Study of Race Prejudice in Australia, 1972, ed. Stevens, F.S., vol. 2, pp. 235·242. Sydney: Australian and New Zealand Book Company. MOODIE, P.M. and PEDERSEN, E.B. 'The Health of Australian Aborigines: An annotated bibliography.' School.of Public Health and Tropical Medicine, The University of Sydney, 1971, ServIce PublIca han No.8. Canberra: Australian Government Publishing Service. MOODIE, P.M., GARNER, M.F., BACKHOUSE, 1.L. and TIBBS, G.l. 'Treponemal infection in the Australian Northern Territory Aborigines.' Bull. Wid Hlth. Org. (in press). McMILLAN, B. and KELLY, A. 'Attempts to cultivate Entamoeba polecki von Prowazek, 1912.' Trans. R. Soc. trap. Med. Hyg. (in press). McMILLAN, B., KELLY, A. and WALKER, J.e. 'Prevalence of Hymenolepis diminuta infection in man in the New Guinea Highlands.' Trop. geogr. Med, 1971,23, 39()"392. NELSON, W.P. and FERGUSON, D.A. 'Trends in occupational medicine in Australia.' In Proc. First South·East Asian Can! on Occup. Hlth, Singapore (in press). PATHOLOGY AND MICROBIOLOGY SECTION, School of Public Health and Tropical Medicine, The University of Sydney. 'Notes on the Laboratory Diagnosis of Cholera.' Canberra: Australian Government Publishing Service, 1971. RICKINSON, A.B. and ILBERY, P.L.T. 'The effect of radiation upon lymphocyte response to PHA.' Cell Tissue Kenet .. 1971,4,549·562. RUSSELL, D.A., SHEPARD, C.C., McRAE, D.H., SCOTT, G.e. and VINCIN, D.R. 'Treatment with 4,4'-diacetyldiaminodiphenylsulfone (DADDS) of leprosy patients in the Karimui, New Guinea.' Am. J. Trap. Med. & Hyg., 1971,20,495-501 SCOTT, G.C. 'A future for the medical and health care services in Australia.' Med. J. Aus!., 1971, 2,863-866. SCOTT, G.C. 'Some sociological observations on skin cancer in Australia.' Proceedings of the International Cancer Conference, Sydney, Australia, 1972, March, pp. 15-22. SMITH, G.C. 'Postgradjlate education in occupational health in the United Kingdom, United States of America, and Canada in 1969.' Br. 1. med. Education, 1971,5,124·133. SMITH, G.C. 'Asphyxia, suffocation.' In Encyclopaedia of Occupational Health and Safety, 1971, vol. 1, pp. 126-127. Geneva: International Labour Office. SMITH, G.e. 'Picric acid and derivatives.' In Encyclopaedia of Occupational Health and Safety (in press), SMITH, G.C. 'Occupational medicine.' Sydney University Medical Journal (in press). SMITH, G.C. 'Teaching and research in occupational health in different countries.' WH.o. Chronicle (in press). SMITH, G.C., REID, C.e. and LINCOLN, G.l. 'Occupational medicine in the University of Sydney.' Minnesota Medicine, 1971, June, 469·474. SUTTON, R.G.A. 'Bacterial food poisoning in Australia - A changing problem.' Food Techno!. in Aust., 1971, 23, 596-601. SUTTON, R.G.A. 'The epidemiological reporting of salmonellosis.' N.S. W. Veterin. Proceedings, 1971,7,43-44. SUTTON, R.G.A. and HOBBS, BETTYe. 'Resistance of vegetative cells of Clostridium welchii ·to low pH.' J. Med. Microbial., 1971,4,539-543. SUTTON, R.G.A., HOBBS, BETTY e. and KENDALL, MARGARET. 'Survival of food poisoning bacteria during cooking of meat.' J appl. Bact. (in press). WALKER, J.e. 'A fellodistomid cercaria from Mytilus planulatus.' Proc. Linn. Soc. N.S. W. (in press).
MAJOR G ' :
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INSTITUTE OF CHILD HEALTH. DANKS, D.M., STEVENS, B.J., CAMPBELL, P.E., GILLESPIE, J.M., WALKER·SMITH, J.A., BLOMFIELD, J. and TURNER, B., '''Menkes'' kinky hair syndrome.' Lancet (in press). GARDINER, A" PORTEOUS, N. and WALKER·SMITH, J.A. 'The effect of coeliac disease on the mother-child relationship.' Aust. Paediat. 1., 1972, 8, 39. HART, J. and PORTEOUS, N, 'Parent groups: an attempt at preventive psychiatry.' Med. J. Aust., 1971, 1, 1405. KATZ, J. 'Enuresis and encopresis.' Med. J Aust., 1972, I, 127. KNUCKEY, T., O'HALLORAN, M.T. and YU, J.S. 'Hypocalcaemia in infancy: a retrospective stUdy.' Aust. Paediat. J., 1971,7, 187. KOZLOWSKI, K. and YU, J.S. 'Pycnodysostosis.' Arch. Dis. Childh. (in press).
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LESLIE, G. and ROWE, P.B. 'Folic acid binding sites in the membranes of the small intestinal epithelium.' Proc. Aust. Biochem. Soc., 1971,4,110. . LESLIE, G. and ROWE, P.B. 'Folate binding by the brush-border membrane protems of the small intestinal epithelial cells.' Biochemistry, 1972, 11, 1696. LEWIS, G.P., BETHEL, M. and ROWE, P.B. 'Regulation of bovine methenyltetrahydrofolate . cyclohyd'rolase.' Proc. Aust. Biochem. Soc., 1971,4,43. OATES, R.K. and STAPLETON, T. 'Hypsarrhythmia developing in hospital: recovery WIth early treatment.' Aust. Paediat. J., 1971,7,209. , OATES, R.K. and TONGE, R.E. 'Phenytoin and the pseudolymphoma syndrome. Med. J Aust., 1971,2, 37l. OATES, R.K. and YU, 1.S. 'Children with non-organic failure to thrive: a community problem.' Med J Aust., 1971,2, 199. OATES, R.K., LEWIS, M.B. and WALKER-SMITH, 1.A. 'The Rothmund-Thomson syndrome: case report of an unusual syndrome.' Aust. Paediat. J., 1971,7,103. ROWE, P.B. and LEWIS, G.P. 'Mammalian Folate Metabolism I: activity of interconversion enzymes.' J bioi. Chern (in press). ROWE, P.B. and LEWIS, G.P. 'Mammalian Folate Metabolism II: regulation of the folate interconversion enzymes.' J bioI. Chem. (in press). SILlNK, M. and ROWE, P.B. 'Digestive mechanism for folic acid polyglutamates.' Proc. Aust. Soc. Med Res., 1971,2,474. SOEPARTO, P., STOBO, E.A. and WALKER-SMITH, 1.A. 'The role of chemical examination of the stool in the diagnosis of sugar malabsorption.' Arch. Dis. Childh., 1972, 47,56. STAPLETON, T. 'The role of the doctor vis-a-vis the school child.' Indian J. Paediat., 1971,38, 84. STAPLETON, T. 'Perspective in paediatrics.' J. trap. Paediat. and environ. Health., 1971,17,71. STAPLETON, T. (contributor). 'Human development and public health: report of a WHO scientific group.' Wid. Hlth. Org. techn. Rep. Ser., 1972, No. 485. STEENDIJI, R. and LATHAM, S.c. 'Hypophosphataemic vitamin D-resistant rickets: an observation on aeight and serum inorganic phosphate in untreated cases.' Helv. paedia/. Acta., 1971,2, 179. STUCKEY, S.l. and YU, 1.S. 'Dietary therapy in the prevention of mental retardation.' Aust. J. Ment. Ret., 1971, 1,205. WALKER-SMITH, 1.A. and REYE, R.D.K. 'Small intestinal morphology in aboriginal children.' Aust. N.Z. J Med., 1971,4,377. WALKER·SMITH, 1.A. 'Gastroenteritis.' Med. J. Aust., 1972, 1, 329. WALKER·SMITH, 1.A. 'Uniformity of dissecting microscope appearances in proximal small intestine.' Gut, 1972,13,17. WALKER-SMITH, 1.A. 'Variation of small intestinal morphology with age.' Arch. Dis. Childh., 1972,47, 80. YU, 1.S., O'HALLORAN, M., STUCKEY, S., HART, 1. and PORTEOUS, N. 'Phenylketonuria: a multidisclipinary approach to management.' Med. J. Aust., 1971, 1, 1404. YU, 1.5., OATES, R.K., WALSH, K.H. and STUCKEY, S.l. 'Osteopetrosis.' Arch. Dis. Childh., 1971,46,257. YU, 1.S., O'HALLORAN, M.T. and TURNER, B. 'The sex ratio in phenylketonuria and persistent hyperphenylalaninaemia.' Aust. Paediat. J, 1971,7,179. YU, 1.S., WALKER-SMITH, 1.A. and BURNARD, E.D. 'Neonatal hepatitis in premature infants simulating hereditary tyrosinosis.' Arch. Dis. Childh., 1971,46,306. YD, 1.S. 'Screening tests for metabolic diseases.' Med J Aust., 1972, 1, 24. YU, 1.S. and SOUTTER, G.B. 'Approach to mental retardation.' Bull. Post. Grad. Comm. (in press).
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COMMONWEALTH ACOUSTIC LA:BORATRIES BROCK, R.D., PEACOCK, W.l., KOSSOFF, G. and ROBINSON, D.E. 'Chromosome aberrations induced by ultrasonic irradiation.' In Proceedings International Workshop on Interaction of Ultraso.und and Biological Tissues, Seattle (in press). BYRNE, D.J. 'Audiologic quiz case.' Arch: Otolaryngol. (in press). CARPENTER, D. 'Integrated circuits and digital techniques in audiological equipment.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971, p.46. CARTER, N.L. 'Effect of rise time ahd repetition rate on the loudness of acoustic transients.' J. Sound Vib., 1972,21,227-240. DADD, M.J. and KOSSOFF, G. 'Grey scale requirements for opthalmological echograms.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971, p. 61.
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DADD, M.J. and WILCKE'N, D.E.L. 'EchocMdiography in left atrial myxoma: Relations to the findings in mitral stenosis.' Australas. J. Med. (in press). GARRETT, W.J. 'Ultrasonic diagnosis of placenta praevia.' Bull. Post· Grad. Committee in Med.. UnL of Syd., 1971, 27(4), 73. GARRETT, W.L and KOSSOFF, G. 'Film echoscopy in obstetrics.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971, p.59. GARRETT, W.J. and KOSSOFF, G. 'Ultrasonic diagnosis of hydatidiform mole by grey scale echography.' J. Asian Fed. Obstets. Gynaecol. (in press). GREEN, A.C. and BYRNE, D.J. The Pensioner HeMing Aid Scheme: A survey in South Australia.' Med. J. Aust. (in press). HEINKE, D.P. The use of multiple barriers in noise reduction.' In Institution of Engineers, Australia, Illawarra Group, Engineering Conference PaperY lY71, Barriers to Hnergy Flow, Nov., 1971, pps. 3-1 ~ 3 ~ 14. HUGHES. H.. DADD, M.J. and KOSSOFF, G. 'Cross sectional ultrasonography of the eye.' Transact. Aust. Col/ege Ophthalmologists (in press). JELLINS, J. and KOSSOFF, G. 'Effects of velocity changes on ultrasonic breast echograIns.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971, p. 60. KEEN, K. 'Preservation of constant loudness with interaural amplitude asymmetry.' J. Acoust. Soc. Amer., 1972.51. KOSSOFF, G. 'Cross-sectional echoscopy.' In Proceedings International workshop on Interaction of Ultrasound and Biological Tissues, Seattle, 1971 (in press). KOSSOFF, G. 'Developments in ultrasonic echoscopy.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971, p. 58. KOSSOFF, G. 'Improved ·techniques in ultrasonic echography.' Ultrasonics (in press). KOSSOFF, G. 'Radiation force.' In Proceedings of International Workshop on Interaction of Ultrasound and Biological Tissues, Seattle, 1971 (in press). KOSSOFF, G. 'Safety factors of the Ultrasonic round window irradiation technique.' Arch. Otolaryngol. (in press). KOSSOFF, G. 'A transducer with uniform intensity distribution.' Ultrasonics, 1971, 9(4), 196-200. KOSSOFF, G. 'Ultrasound in surgery and medical diagnosis ~ a review.' Aust. Physicist, 1971, 8(7),100-106. KOSSOFF, G. 'Visualization systems.' In Proceedings of International Workshop on Interaction of Ultrasound and Biological Tissues, Seattle, 1971 (in press). KOSSOFF, G. and GARRETT, W.J. 'Intracranial detail in foetal echograIns.' Investigative Radiol. (in press). KOSSOFF, G. and GARRETT, W.J. 'Ultrasonic film echography in gynaecology and obstetrics.' Obstets. Gynecol. (in press). KOSSOFF, G. and GARRETT, W.J. 'Intracranial detail in foetal echograms.' Investigative Radiol. Aust. N.2. J. Obstets. Gynaecol. (in press). KOSSOFF, G. and SHARPE, C. 'Ultrasonic eXaInination of pulp cavity in teeth.' In Digest of Ninth International Conference on Medical and Biological Engineering, Melbourne, 1971. p.256. MACRAE, J.H. 'Effects of body position on the auditory system.' J. Speech Hearing Res. (in p~ess).
MACRAE, J .H. 'N oise-induced heMing loss and presbyacusis.' Audiology, J. Auditory Communicat., 1971, 10, 323-333. MACRAE, J.H. and BRIGDEN, D.B. 'Auditory threshold impairment and everyday speech reception.' Audiology, J. Auditory Communicat. (in press). ROBINSON, D.E. The display of three dimensional ultrasonic data for medical diagnosis.' J. Acous!. Soc. Amer. (in press). ROBINSON, D.E. 'Ultrasonic data acquisition and display for diagnostic visualization.' In Proceedings of International Workshop on Interaction of Ultrasound and Biological Tissues, Seattle, Nov. 1971 (in press). ROBINSON, D.E. 'Ultrasonic systems for medical diagnostic visualization.' Research laboratory of Electronics, M.I. T., Qtly. Progress Report. No. 104, Jan., 1972. ROBINSON, D.E. and KOSSOFF, G. 'Performance tests of ultrasonic echoscopes for medical diagnosis.' Radiology (in press). ROBINSON, D.E., KOSSOFF, G., DADD, M.and JELLlNS, J. 'The present status of ultrasonic pulse-echo visualization for diagnosis.' In 24th Annual Conference on Engineering in Medicine and Biology, Las Vegas, Nevada, 1971, p. 259. SPROD, R. 'Noise in Industry.' Contacta, 1971, 37, 173-174. UPFOLD, L.J. 'Unusual findings in a Bekesy Audiogram.' J. Speech Hearing Dis., 1972, 37, 132-137.
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REPORTS BUGEJA, K. 'Select bibliography on traffic noise, 1957-1971.' CA.L. Bibliographic Report No. 9. 1971,4Opp. CARTER, N.L. 'Temporary hearing loss due to prolonged noise exposure: CA. L. Report No. 56, 1971, 30pp. Restricted report.
NATIONAL BIOLOGICAL STANDARDS LABORATORY ELLERY, B.W. and HOWES, D.W. 'Inactivation of infectious laryngotracheitis virus by disinfectants: Aust. Vet. J., ·1972, 47,330. ENGEL, G.B. 'The introduction of a dissolution test in pharmacopoeial specifications: W.H.O Ph arm. , 1970,70,459. ENGEL, G.B. and DODSON, L.F. 'The addition of drugs to intravenous fluids.' W.H.O Pharm., 1971,71,467. ENGEL, G.B. 'The addition of drugs to intravenous fluids.' Med. J. Allst., 2. ENGEL, G.B. 'The addition of drugs to intravenous fluids: Aust. J. hasp. pharm., 1971,4,27. HOWES, D.W. 'The mechanism of immunity to infectious laryngotracheitis.' Paper read to Aus!. Vet. Poultry Association meeting, March 1972. HOWES, D.W. and WlTHELL, J. 'SPF development at N.B.S.L.' Paper on the development of a specific pathogen-free flock of fowls. Animal Quarantine, 2, April-June 1972. TANNOCK, G.A. and GRIFFITH, I.P. 'Periodate degradation of influenza virion RNA: Paper in conjunction with I.P. Griffith of Commonwealth Serum Laboratories. Proceedings Aust. Biochemical Society, 1972,5, 47.
COMMONWEALTH RADIATION LABORATORY BONNYMAN, J. with HARLEY, J.H., MATTHEWS, W.K. and MORONEY, J.R. 'Strontium 90 and Caesium 137 monitoring and radiation doses to the Australian population: Chapter 2 of Report AWTSC No.2 Strontium 90 and Caesium 137 in the Australian Environment During 1969. Atomic Weapons Tests Safety Committee, Defence Standards Laboratories, Melbourne, May 197 \. (Released September 1971). BONNYMAN, J., DUGGLEBY, J.e., and MOLINA-RAMOS, J. 'Measurements of Caesium 137: Chapter 3 of Report AWTSC No.2. BONNYMAN, J. and DUGGLEBY, J.e. 'Measurements of Iodine 131 in milk supplies.' Chapter 3 of Report AWTSC No.3 Fallout over Australia from Nuclear Weapons Tested by France in Polynesia from June to August 1971. Atomic Weapons Tests Safety Committee, Defence Standards Laboratories, Melbourne, December 1971. (Released March 1972). KEAM, D.W. 'Absorbed dose considerations in the use of radiopharmaceutica1s in nuclear medicine.' Aust. BUll. Med. Phys. and Biophys., 1971,51,16. KOTLFR, L.H., NUNN, R.O. and STEWART:F.M. with THOMPSON, R.D. and WISE, K.N. 'Measurements of tofal beta activity in the fallout.' Chapter 2 of Report AWTSC No.3. PATERSON, I.e. 'Design of a thermo1uminescent dosimetry readout system: Aust. Bull. Med. Phys. and Biophys., 1971,51,9. STEVENS, D.l. with GIBBS, W.J., MORONEY, 1.R. and T1TTERTON, E.W. 'Strontium 90 and Caesium 137 monitoring and radiation doses io the Australian population.' Chapter 1 of Report AWTSC No.2. STEVENS, D.J. with GIBBS, W.l., MORONEY, 1.R. and TITTERTON, E.W. 'Radiation doses to the Australian population from fresh fission products in fallout.' Chapter I of report AWTSCNo.3.
TECHNICAL REPORTS BONNYMAN, J., DUGGLEBY, 1.C. and MOLINA-RAMOS, J. 'The concentrations of radioactive isotopes in Australian surface air during the period May 1965 - May 1970.' Tech. Rep. CXRL/5, June 1971. (Released September 1971). BONNYMAN, 1. and MOLINA-RAMOS, J. 'Concentrations of lead 210 in rainWater in Australia during the years 1964-1970: Tech. Rep. CXRL/7, August 1971. (Released September 1971).
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COMMONWEALTH BUREAU OF DENTAL STANDARDS CHONG, JOAN A. 'The rheology of e1astomeric dental materials.' J. Dent. Res., 1971, SO, 738. CHONG, M.P. and DOCKING, A.R. 'Toothbrush texture and its evaluation.' J. Dent. Res., 1971,50,737. COMMONWEALTH BUREAU OF DENTAL STANDARDS. 'The status of composite resins.' Dent. Abs., 1972, 17,35. COMMONWEALTH BUREAU OF DENTAL STANDARDS. 'A series of eight pamphlets on the use of amalgam alloy, silicate cements, elastomeric impression materials, plaster and stone,
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denture base acrylic resins, wax patterns, gold restorations, zinc phosphate cements.' Practical Guides, 1972, Nos. 1-8.
I, L i. ; 1",,1 • I I
DE FREITAS, l.F. The investigation of composite restorative materials by infrared spectroscopy.' J. Dent. Res., 1971,50,738. DOCKING, A.R. 'Bracket cements.' Aust. OrthOdontic J. (in press). DOCKING, A.R. 'Modern materials in dental practice.' Quart. Dent. Rev., 1971,5(2),67. DOCKING, A.R. 'The evaluation of elastic impression materials.' ASP Bulletin (in press). WARE, A.L. 'Properties of cements for orthodontic banding.' Aust. Orthodontic J., 1971, 2, 254.
COMMONWEALTH HEALTH LABORATORIES ALBREY, l.A., VINCENT, E.E.R., HUTCHINSON, l., MARSH, W.L., ALLEN, F.H. lNR., GAVEN, JUNE and SANGAR, RUTH. 'A new antibody, Anti FY3, in the Duffy blood group system.' Vox Sanguinis, 1971,20,29·35. DAVIES, D.W. 'The laboratory control of intravenous heparin therapy.' Med. J. Aust., 1971, 1001.
CENTRAL AND DIVISIONAL OFFICES CORDEN, M.W. 'The nutritionist at work. World trends in public health nutrition.' Food & Nu trition Notes and Reviews, 1971, 28, 120. CORDEN, M.W. 'Malnutrition in a land of plenty?' Food Technology in Australia, 1971,23, 388; reprinted in Food & Nutrition Notes and Reviews, 1971,28,163. ENGLISH, R. 'Suggested training course for public health nutritionists.' Food & Nutrition Notes and Reviews, 1971,28, 134. GREEN, A.C. 'Scarification, cupping and other traditional measures, with references to folk medicine in Greece and elsewhere.' Aust. J. Dermat., 1971, XII:2, 89. GREEN, A.C. 'On writi~g prescriptions: An introduction for new medical graduates.' South Australian Clinics: The Adelaide Children's Hospital, 1971, 5:4, 299. HARGRAVE, l.C. 'Problems of leprosy reconstructive surgery in Australia.' Med. J. Aust. (accepted for publication). HARRY, l.G. and WALKER, A.C. 'A survey of diarrhoeal disease in malnourished Aboriginal children.' Med. J. Aust., 1972, I, 904. HIPSLEY, E.H. 'Assessment of nutritional status.' Food & Nutrition Notes and Reviews, 1971, 28, 137. HIPSLEY, E.H. 'A view of health.' Food & Nutrition Notes and Reviews, 1971,29, 70. HIPSLEY, E.H. 'Diet and heart disease.' Med. J. Aust., 1971,1,219 (letter). HIPSLEY, E.H. 'Save, Perspectives in food and nutrition of Melanesian people.' Proceedings of the Sixth Waigani Seminar, University of Papua/New Guinea, Port Moresby. JACOBS, D.S., LANGSFORD, W.A., WARBURTON, M.F. and WHITE, G.E. 'Influenza vaccine in the N.T.' Med. J. Aust. (accepted for publication). McKENZIE, D.l. 'The use of child and family guidance clinics for pre-school children. Canberra Parents' Bulletin, March 1972,6·9. PRESTON, S.G. 'Industrial hygiene - an earlier Commonwealth interest.' Med. J. Aust" 1972, 1,430. SINCLAIR, H. 'About food preservation.' Primary Industry magazine Turnoff SOONG, F.S. 'Beliefs and practices of Chinese diabetic patients concerning the cause and treatment of their ill·health.' Singapore Med. J., 12:&,309·313. WELLS, RONALD. 'The lost years on the roads.' Med. J. Aust., 1972,1:4,186-187.
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COMMONWEALTH DEPARTMENT OF HEALTH CENTRAL OFFICE Director-General Sir William Refshauge, C.B.E., E.D., F.R.C.O.G., F.R.A.C.S., F.R.A.C.P. F .A.C.M.A., Hon. F .R.S.H. Deputy Directors-General Dr L. J. Wienholt, M.B., B.S., F.A.C.M.A. Dr H. M. Franklands, M.B., B.S., D.T.M., F.A.C.M.A. Management Services Division
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First Assistant Director-General D. G. Dunlop, B.Com., D.P.A., F.A.S.A., F.C.I.S., F.C.A.A. POLICY SECRETARIAT AND LEGISLATION BRANCH
Assistal'it Director-General R.I. Findlay, B.Ec. POLICY SECRETARIAT SECTION
Director: J. S. McCauley LEGISLATION SECTION
Director: W. F. Armstrong, B.Com., A.A.S.A. PUBLIC INFORMATION SECTION
Director: J. B. Lleonart PLANNING AND RESEARCH BRANCH
Assistant Director-General M. Carroll, B.Com., A.A.U.Q. RESEARCH SECTION
Director: R. Rofe, B.Ec. PLANNING SECTION
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Director: P. Pflaum, M.Ec. CENTRAL STATISTICAL UNIT
Director: R. V. Barnard, B.Sc., B.A., F .I.S. (Lond.) ESTABLISHMENTS AND FINANCE BRANCH
Assistant Director-General L. W. Lane. A.A.S.A. (Acting) FINANCE SECTION
Director: R. G. Walton, B. Com.
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ESTABLISHMENTS SECTION
Director: A. D. Morgan (Acting) ADMINISTRATIVE SERVICES
Director: D. H. Lever, A.A.S.A. A.D.P. BRANCH
Assistant Director-General R. H. Searle, B.Ec., Dip.Com., A.A.U.Q., A.A.S.A. APPLICATIONS SECTION
Director: J. G. Burt, B.Ec. OPERATIONS, SOFTWARE AND COMMUNICATIONS SECTION
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Senior Programmer: P. de Chazal, B.E. SERVICES SECTION
Senior Programmer: L. Ion, B.Sc.
Health Insurance and Benefits Division
First Assistant Director-General L. J. Daniels, O.B.E., B.Ec., A.A.S.A. HOSPITAL INSURANCE AND BENEFITS BRANCH
A ssistant Director-General D. Corrigan ORGANISATION SECTION
Director: F. Buising, B. Com., A.A.U.C. DEVELOPMENT SECTION
Director: I. Wingett, B.Ec., (Acting) HOSPITAL AND NURSING HOMES SECTION
Director: B. F. Seymour, B.A. MEDICAL INSURANCE AND BENEFITS BRANCH
Assistant Director-General L. B. Holgate, B. Com., F.A.S.A. FEES AND BENEFITS SECTION
Director: J. L. Hayes, Dip. Com., F.A.S.A. DEVELOPMENT SECTION
Director: V. E. Pickering, B.A. (Econ.) ADMINISTRATION SECTION
Director: J. P. Forner Medical Advisor: Dr L. J. O'Keefe, M.B., B.S.
National Health Division
First Assistant Director-General Dr K. W. Edmondson, M.B., Ch.B., D.P.H., F.A.C.M.A., F.R.S.H. PHARMACEUTICAL SERVICES BRANCH
Assistant Director-General R. E. M. Wilson, Ph.C.
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Directors 1. W. Shaw, B.Com. A. E. Shields, Ph.C., M.P.S. THERAPEUTIC SUBSTANCES BRANCH
Assistant Director-General Dr A. M. Walshe, M.B.> B.S., B.Sc.
Senior Medical Officer Dr B. L. Kirkup, M.B., B.S., D.P.H. DRUGS OF DEPENDENCE SECTION
Director: D. W. Murdoch, Ph.C. PUBLIC HEALTH BRANCH
Assistant Director-General Dr D. B. Travers, M.B., B.S., D.P.H., M.R.S.H. TOXICOLOGY SECTION
Director: Dr E. 1. Fitzsimons, M.B., B.S.> D.P.H. FOOD ADMINISTRATION SECTION
Director: Dr R. H. C. Fleming, M.B., B.Ch. NUTRITION SECTION
Director: Dr E. H. Hipsley, M.B., B.S. ENVIRONMENTAL HEALTH SECTION
Director: Dr N. M. Mitchell> M.B., B.S., D.I.H. SCIENTIFIC ADVISORY SECTION
Principal Chemist: S. W. C. Smith, Dip. App. Chern. NURSING SECTION
Principal: Miss M. E. Wilks, Dip. N. Ad., F.C.N.A.
Laboratory Services and Quarantine Division
First Assistant Director-General Dr A. D. Spears, M.B., B.S.> D.T.M. & H. GENERAL QUARANTINE AND HEALTH STANDARDS BRANCH
Assistant Director-General Dr K. H. S. Cooke, M.B., B.S., D.P.H. (Acting) INTERNATIONAL HEALTH SECTION
Director: Dr 1. S. Boxall, M.B.> B.S., M.R.A.C.P. ANIMAL QUARANTINE BRANCH
Assistant Director-General (Animal Quarantine) R. W. Gee> B.V.Sc.> M.R.C.V.S.
Senior Veterinary Officers I. D. Cameron-Stephen, M.R.C.V.S. H. R. Peisley, B.V.Sc., M.R.C.V.S., M.A.C.V.Sc.> Dip.Pub.Admin.
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PLANT QUARANTINE BRANCH
Assistant Director-General (Director ofPlant Quarantine) J. R. G. Morschel, B.Sc.Agr., H.D.A. Principal Plant Quarantine Officers 1. O. Smith, B.Sc.Agr., H.D.A. K. W. Dillon, B.Sc.
National Health and Medical Research Council Division
First Assistant Director-General Dr R. W. Greville, M.B., B.S., B.V.Sc., F.F.A.R.A.C.S., D.A., F.A.C.M.A.
Senior Medical Officer Dr R. E. Farnbach, M.B., B.S., D.P.H. (Acting)
Administrative Officer K. O'Brien, Ph.C., M.P.S.
Tuberculosis Division
First Assistant Director-General Dr G. Howells, M.D., B.S., F.R.A.C.P., M.R.C.P.
Medical Specialist Dr A. 1. Proust, M.B., B.S., F.R.C.P.E., M.R.C.P.
Administrative Officer T. C. Boag HEALTH STANDARDS BRANCH
Dr F. S. D. Thompson, M.R.C.S., L.R.C.P., D.P.H.
Senior Specialists
Geriatrics and Gerontology Dr D. de Souza, M.B., Ch.B., M.R.C.P., M.R.C.S.
Drugs of Dependence Dr Gerald Milner, M.D., M.R.C.Psych., M.A.N.Z.C.P., M.l.A.A.P., D.P.M.
Clinical Therapeutics Dr R.L. Hodge, M.D., F.R.A.C.P.
Special Projects ENQUIRY INTO PHARMACY EARNINGS, COSTS AND BENEFITS
Assistant Director-General H. West, B. Com., A.A.S.A., A.c.I.S.
175
STATE OFFICES
Sydney
Commonwealth Director of Health Dr R. R. Bull, M.B., B.S., D.P.H., F.A.C.M.A. Assistant Directors Medical: Dr W. M. Quinn, M.B., B.S., D.P.H. Establishments, Finance and General Services: 1. L. Cockburn, B.A. General Benefits: A. B. McDonald, A.A.S.A. Pharmaceutical: K. 1. Kelly, Ph.C., M.P.S. Psychologist-in-charge, Acoustic Laboratory: D. F. Fifield, B.A.
Melbourne
Commonwealth Director of Health Dr R. C. Webb, M.B., B.S., D.T.M.&H., F.A.C.M.A. Assistant Directors Medical: Dr A.M.V. Cocks, M.B., B.S., M.P.S. Establishments, Finance and General Services: K. F. Delaney, F .A.S.A. General Benefits: M. 1. Carlson Pharmaceutical: L. L. Lock, Ph.C., D.P.A. Psychologist-in-charge, Acoustic Laboratory: P. A. Murphy, B.A.
Brisbane
Commonwealth Director of Health Dr A. H. Humphry, O.B.E., M.B., B.S., D_T.M.&H., F.A.C.M.A. Assistant Directors Medical: Dr H. B. Cumpston, M.B., B.S., D.T.M.&H. Establishments, Finance and General Services: A. 1. Lavercombe, M.B.E., A.A.S.A. General Benefits: A. E. Garske, A.A.V.Q. Pharmaceutical: K. L. Bate, Ph.C. Psychologist-in-charge, Acoustic Laboratory: Mrs S. E. Forster, B.A. Dip.Soc. Work
Adelaide
Commonwealth Director of Health Dr A. C. Green, M.B., B.S., D.D.M_, D.T.M.&H., D.P.H., F.A.C.M.A., M.A.C.D. Assistant Directors Medical: Dr M. A. Walker, L.R.C.P.&S., L.R.F.P.&S. Establishments, Finance and General Services: N. 1. Gluyas, A.V.A. (Com.) General Benefits: 1. B. 1amieson, A.A.S.A. Pharmaceutical: A. P. Brammall, Ph.C., M.P.S. Psychologist-in-charge, Acoustic Laboratory: A. A_ Serradura, B.A., A.V.A. 176
Perth
,
Commonwealth Director of Health Dr 1. B. Mathieson, M.B.E., M.B., B.S., D.T.M. Assistant Directors Medical: Dr W. H. Young, M.B., Ch.B. Establishments, Finance and General Services: F. G. Dienhoff General Benefits: A. J. Wilson, A.A.S.A. Pharmaceutical: J. T. McDonough, Ph.C. Psychologist-in-charge, Acoustic Laboratory: V. Peters, B.A.
Hobart Commonwealth Director of Health Dr 1. B. Lilley, M.B., B.S. (Acting) Assistant Directors Establishments, Finance, General Services and General Benefits: R. J. Boxhall Pharmaceutical: J. R. Nolan, Ph.C. Psychologist-in-charge, Acoustic Laboratory: M. Lyrmont, B.A.
Darwin Commonwealth Director of Health Dr W. A. Langsford, C.SU., M.B., B.S., D.P.H., D.T.M.&H., F.A.C.M.A. Assistant Directors Health Services: Dr J. Y. Hancock, M.B., B.S., D.T.M.&H., D.P.H. Child and Rural Health: Dr D. S. M. Graham, M.B.E., M.B., B.S., M.R.C.G.P., D.Obst., R.C.O.G. General Health: Dr P. A. Dawes, M.R.C.S., L.R.C.P. Tuberculosis: Dr E. J. Strang, M.B., B.S., D.T.M. &H., D.P.H. Management Services: H. C. Harrison, F.A.I.M. Administration and Finance: B. V. McKay Planning and Development: D. A. Hyde Establishments and General Services: G. W. Monaghan Finance and Supply: P. F. Spitzer Long Term Planning and Research: N. B. Morton Public Health and Medical Services (Southern Region): Dr G. E. E. White, M.B., B.S., D.T.M.&H., M.P.S. School Medical Service Senior Medical Officer: Dr H. M. Phillipps, M.B.E., M.B., B.S. DARWIN HOSPITAL
..
'-.
.....
Medical Superintendent: Dr F. T. Foster, L.R.C.P., L.R.C.S., L.R.F.P.S., F.A.C.M.A. Matron: Miss 1. Reynolds, Dip. N.Ad. (Acting) Secretary: D. J. Spain, B.H.A.
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177
ALICE SPRINGS HOSPITAL
Medical Superintendent: Dr J. G. Hawkins, M.B.E., M.B., B.S. Matron: Mrs L. R. Johnston Secretary: G. Waye TENNANT CREEK HOSPITAL
Medical Superintendent: Dr W. E. Laufer, M.B., Ch.B., D.T.M.&H., D.P.H., M.D. Matron: Mrs R. C. Baird (Acting) Secretary: B. E. Dixon KATHERINE HOSPITAL
Medical Superintendent: Dr P.D'A. Short, M.B., B.S. Matron: Mrs C. D. Bathgate Secretary: W. J. Kerr GOVE DISTRICT HOSPITAL
Medical Superintendent: Dr J. V. Quinn, M.B., B.S. Matron: Mrs D. MacNeal Secretary: D. Barclay EAST ARM LEPROSY HOSPITAL
Medical Superintendent: Dr J. C. Hargrave, M.B.E., M.B., B.S., D.T.M.&H. Secretary: G. McFarlane (Acting) DENTAL SER'vICES
Chief Dental Officer: Dr C. H. Wall, B.D.S.
Canberra Commonwealth Director of Health Dr Ronald Wells, M.D., B.S., B.Sc., M.R.C.P., M.R.A.C.P., F.A.M., D.T.M.&H., D.C.T.M., F.R.I.P.H., F.A.C.M.A. Assistant Director (Medical Services) Dr H. C. Anderson, M.B., B.S., D.C.H., D.P.H. Psychiatric Services Senior Specialist: Dr B. L. Hennessy, B.Sc.(Med.)., M.B., B.S., D.P.M., M.A.N.Z.C.P. Commonwealth Health Laboratory Senior Specialist: Dr J. M. Crotty, M.B., B.S., D.T.M.&H., Dip.Bact., M.C.P.A. School Dental Service Chief Dental Officer: L. M. Carr, M.D.S., D.P.D., F.A.C.D.S. Public Health Medical Officer of Health: Dr M. Ryan, L.R.C.P. & S.I., D.P.H. Child Health Medical Officer-in-Charge: Dr B. H. S. Dixon, M.B., B.ch., L.R.C.P., D.P.H. ~o~~
178
Hospitals and Associated Services Principal Executive Officer: W. G. May General Services Senior Executive Officer: P. M. O'Reilly Ambulance Service Superintendent: G. W. Harris
School of Public Health and Tropical Medicine Principal Professor R. K. Macpherson, M.D., B.S., M.Sc., F.R.A.C.P. TROPICAL MEDICINE
Director: Professor R. H. Black, E.D., M.D., B.S., D.T.M.&H., F.R.A.C.P., Dip. Anth. Associate Professor: C. H. Campbell, M.D., B.S., D.T.M.&H., M.R.C.P., M.R.C.P.E., F.R.A.C.P. PREVENTIVE AND SOCIAL MEDICINE
Director: Professor C. B. Kerr, M.B., B.S., D.Phil., M.R.A.C.P. INDUSTRIAL HEALTH
Principal Medical Officer: Dr G. C. Smith, M.B., B.S., D.P.H., M.R.A.C.P., F.C.C.P. PATHOLOGY AND MICROBIOLOGY
Senior Medical Officer: Dr L. C. Rowan, B.Sc., M.B., B.S., F.R.C.P.A. BIOCHEMISTRY
Senior Medical Officer: Dr D. C. Torpy, B.A., M.B., B.S., D.T.M.&H. PARASITOLOGY
Senior Medical Officer: Associate Professor B. McMillan, M.B., B.S., D.T.M.&H., D.A.P.&E., M.R.A.C.P., F.R.C.P.A. RADIATION BIOLOGY
Senior Medical Officer: Associate Professor P. L. T. Ilbery, M.D., B.S., D.M.R.T., F.C.R.A., M.R.A.C.P. ENTOMOLOGY
Chief Entomologist: Associate Professor D. J. Lee, B.Sc. ADMINISTRATION
Registrar: M. D. Stewart, B.Ec.
Institute of Child Health Director Professor Thomas Stapleton, M.A., D.M., F.R.C.P. Associate Professor of Child Psychiatry: J. Katz, M.B., B.Ch., D.P.M. (R.C.P.&S.)
179
Medical Officers, Research and Teaching Dr P. Rowe, M.B., B.S., F.RA.C.P. Dr B. Dowd, M.B., B.S., F.R.A.C.P. Dr J. Yu, M.B., B.S., M.RA.C.P., D.C.H. (RC.P.&S.)
National Biological Standards Laboratory Director Dr L. F. Dodson, M.B., B.S., Dipl.Clin. Path., D.Phil. Assistant Directors Antibiotics: N. M. Semple, B.Sc. Bacterial Products: Dr D. J. McKay, B.Sc., Ph.D. Endocrine Products: Vacant Pharmaceutical Chemistry: C. E. Kendall, B.Sc. Pharmacology: Dr C. G. Haining, B.Pharm., Ph.D. Virology: Dr D. W. Howes, M.Sc., Ph.D.
Commonwealth Acoustic Laboratories Director R. A. Piesse, B.Sc., A.A.I.P., M.A.A.S. Chief Physicist (Ultrasonics Research): G. Kossoff, M.E., B.Sc., F.A.I.U.M. Chief Engineer (Engineering Services and Noise Investigations): J. A. Rose, A.S.T.C., M.A.A.S. Principal Psychologist (Audiology and Psychology Services): L. J. Upfold, B.A. Psychologist (Psychoacoustics Research): N. L. Carter, M.A. (Hons.), M.A.A.S., A.Mus.A. Psychologist (Audiology Research): J. H. Macrae, B.A. (Hons.), M.A.A.S.
Commonwealth Radiation Laboratory Director D. J. Stevens, O.B.E., B.Sc., F.C.R.A. (Hon.), Hon.F.I.R. Assistant Directors Principal Physicist (X-Rays): J. F. Richardson, M.Sc., F.Jnst.P., F.A.I.P., F.C.R.A.(Hon.), Hon.M.I.R Principal Physicist (Radioactivity): D. W. Keam, M.Sc.
Bureau of Dental Standards Director A. R. Docking, M.B.E., M.Sc., F.R.A.C.I., F.A.C.D.
OVERSEAS POST Chief Medical Officer, London Dr B. E. Welton, M.R.C.S., L.R.C.P., D.T.M.&H.
180
;
• ORIGINAL: ENGLISH AUSTRALIA REPORT ON NATIONAL HEALTH ACTIVITIES 1971-721 1. National Health Scheme
The Australian National Health Scheme is based on voluntary health insurance whereby the public may obtain financial protection against the cost of using hospital and medical services. Persons who insure themselves are eligible, after obtaining treatment, for Commonwealth Government hospital and medical benefits which supplement amounts payable by a health insurance organization known as fund benefit. A patient is required, however, to meet a small portion of the cost of medical services that he receives.
•
•
The financial year 1971-72 was the second year of operation of the Health Benefits Plan whereby medical benefits are closely related to the fees most commonly charged by medical practitioners. Following a review during the year the level of the most common fee was increased with effect from 1 July 1972, but as Commonwealth and fund benefits were also increased the patient's contribution towards the cost of a medical service remained the same. For example,where a general practitioner charges the common fee the patient is required to pay 80 cents for a surgery consultation and $1.20 for a home visit. Rationalisation of the hospital insurance scheme was completed during 1971-72. A situation has now been achieved whereby an insured patient is assured of adequate hospital benefit coverage against public hospital ward charges and charges for extra services. 2. Pharmaceutical Benefits Scheme
If
•• .."'" ,
In November 1971 the Commonwealth Government, bearing in mind the continuing sharp increase in the cost of the Pharmaceutical Benefits Scheme, considered that it was reasonable to increase the patient contribution from 50 cents to $1.00. The increase in the patient contribution was the first since 1960. Special arrangements have been made to assist pensioners and lowincome families. TIle main factors contributing to the increase in the co~t of the Scheme were the addition of new and expensive drugs and the relaxation of restrictions on prescribing of certain drugs, particularly in relation to the antibiotics, analgesics, anti-hypertensive and anti-depressant groups, and some increase in prescribing by doctors unaccounted for by the above two factors. In September 1970 the House of Representatives established a Select Committee to review all aspects of the Pharmaceutical Benefits Scheme. At its inaugural meeting, the Committee indicated that it intended to conduct an exhaustive inquiry ranging from the production of drugs to the scope of the Pharmaceutical Benefits Scheme and the prescribing and supply of benefits under the Scheme. The Committee's report was completed in May 1972 and contained some 43 recommendations covering a wide range of matters.
3.
Quarantine
During 1971-72 a substantial number of ships and aircraft arrived from overseas. However, no case of human quarantinable disease was introduced into Australia.
. .• /2
1~\\hm1.tte.d O'{ the australian E'anbassy in Manila, 1
September 1972
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The importation of smallpox into, and the subsequent outbreak of the disease, in Yugoslavia served as a sharp reminder that the disease remains a major threat to all countries including Australia. Because of the migration programme from Yugoslavia it was necessary for the Australian Government to institute emergency procedures immediately notification was received of the smallpox outbreak. The only migrants allowed to enter Australia during the emergency were those who had been successfully vaccinated with Australian vaccine. As from 1 March 1972, Australia relaxed its smallpox vaccination certificate requirements for air travellers entering Australia from the United States and Canada because both countries had been free from smallpox for over 20 years. This relaxation was port of a reciprocal agreement whereby the United States and Canada agreed to permit the entry from Australia for air travellers without a smallpox vaccination certficate.
4. Communicable Diseases The Commonwealth Department of Health acts as an agency for the dissemination of statistics on notifiable diseases in Australia. These statistics are circulated widely throughout Australia and overseas. Gonorrhoea again was one of the most commonly notified diseases in Australia during the calendar year 1971. The number of notifications, 10,539 cases, represented a substantial increase over the 9,562 cases notified in 1970. Of some interest is the continued fall in the total number of notifications of venereal disease in the Northern Territory since 1968 despite increasing population and hastening social change. The number of reported cases of infectious hepatitis continued to remain fairly stable with 7,509 notifications in 1971. Poliomyelitis notifications remained stable with only one case during 1971. The person concerned had not been vaccinated against poliomyelitis. During 1971 2.5 million doses of sabin vaccine were issued within Australia.
•
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e.
5.
Environmental Health
Health authorities have a continuing and vital interest in the quality of the environment and its influence on human health and welfare. During the year an Environmental Health Section was established within the Commonwealth Department of Health to provide secretarial assistance to the appropriate committees of the National Health and Medical Research Council. The Department of Health also provided advice to other Departments and organizations thus complementing the activities of the recently established Commonwealth Office of the Environment.
6.
Drugs of Dependence
The financial year 1971-72 was a period of development and consolidation for the National Drug Education Programme, which was initiated early in 1971. The Commonwealth Government has made available $500,000 to the National Standing Control Committee on Drugs of Dependence to support Commonwealth and State in the field of drug education.
projects
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Acti vi ties during the year included t:;e organization of seminars, the distribution of handbooks, pamphlets and films on drug education to State health authori ties ane, the production of technical information bulletins on current local and overseas developments in the field of drug dependence. The Drugs of Dependence Monitoring System, utilising the Commonwealth Department of Health's computer facilities, continues to provide information on licit movement, manufacture, import and export of narcotics, amphetamines, phenmetrazine and methylphenidate. This information is used by Commonwealth and State authorities in their efforts to restrict the use of drugs to legitimate medical purposes, and prevent diversion to illicit sources. A recent review has shown that the System is achieving its aims. -~
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7.
Vital Statistics
Estimated mean population Live births Crude birth rate per thousand Total deaths Crude death rate l)er thousand Infant deaths under one year Infant mortality rate per thousand live births
1970 12,506,776 257,516 20.59 113,048 9.04 4,604 17.88
1971 12,755,900 276,362 21.67 110,650 8.67 4,777 17.29
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ORIGINAL: POL~IA
FRENCH
FRENCH
BRIEF REPORT ON HFALTH ACTlvrrIES IN 1971
1
1.
POPUIATION
1962 1967 1971
98 378 119 168 2.
84 551 inhabitants n n
HFALTH SERVICE ACTIVITIES
.4f
• a)
Year 1969
Number of in-patients 13 405
Number of patient di'iYs 189 031 177 490 207 777
1970 1971 3.
10 927 13771 HEALTH EXPENDITURE
There are two different souroes of finanoing: French Polynesia and the French National Budget. Budget of French Po1mesia (CFP franos) Budget 3335 342 000 2 727 765 000
the budget of
Financial year
Health expenditure 417 947 000
•
1969
1970 1971 Balance +
316 451 000 422 297 000 +
3 709 919 000
12.54% 11.61% 11.14%
982 154 000 26.l7~
105 846 000 + 25.27%
+
b)
French National Budget (CFP francs) (FIDES '" Economic and Social Investment and Development F1.md) Year 1971: Authorized oommi tments Payment of other firm obligations 52 809 '70 1 + 33 809 704
1 Subml tted by the Director of Public Health. 2·5 August 1972.
- 2 'l'()~:!!:lJ:iea!th
>
t.= }
expenditure (CFP francs)
Financial lear 1969: Regular budget FIDES Total Financial lear 1970: Regular budget FIDES Total Financial lear 1971: Regular budget FIDES Total 422 297 000 33809000 316500000 21 250 000 418 000 000 14 200 000 432 200 000
337 550 000
456 MANPOWER
•
l!>l'1
106 000
4. c.)
Health services
Doctors
31 + 2
contractual service Pharmacists Dentists
27 + 6 contractual servj.ce
Y+
-j
5 ~.
(lontrai}tual serv:i.ce ./
2
3 4 1
8 1
9
'"
SocIal worker Midwives (State diploma» Health assistants ) NUl'::I0d )
..
~
260 )
290
559
Office clerks Op<"l'atlng personnel 'l'r~lJlsporta tlon
) personnel ) TOTAL
285
- 3 b) Number of doctors under an author1ty other than the health services: 2 (School Health) + 3 (Soc1al Welfare Fund)
c)
Number of doctors in the private sector as of 31 December 1971: 18.
5.
ORGANIZATION
The new Mamao hosp1tal, with 1ts modern and air-condit10ned bu11dings, was opened on 24 April 1970. With its 410 beds, it is one of the most successful ach1evements of its kind 1n the South Pacif1c.
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After the modernization of the Taravao hosp1tal, which has also been completed, it 1s planned to reorgan1ze the old Vaiam1 hosp1tal in order to establish modern Pneumo-phthisiology and Neuro-psychiatry services. Studies concerning the establishment of the Central Supply Pharmacy and the future home for the aged in Taravao, which are financed by the FIDES, are progressing satisfaotorily and it is expected that these services will be operational in 1973. 6. Leprosy In 1970 and 1971, the leprosy section, which had been reorganized in 1969, concentrated on a number of problems particular to Polynesia.
CONTROL OF MAJOR Pum..IC HEALTH PROBLEll4S
•• , II.
The endemy seems to have reaChed a turning point but an accurate picture of the situation will not be available until all Islands have been visited and the results of the family surveys on registered cases are known. Although Polynesian leprosy is not widespread and is not extensive, it remains a serious problem. Tuberculosis Tuberculosis remains at a stationary level and is still a problem in Polynesia. The Tuberculosis Control Centre continued its efficient and unceasing work in Tahiti but was handicapped elsewhere in view of the lack of mobile units for case-finding and the shortcomings of the integrated health network in the remote islands. It should be noted that there are atill 866 active tuberculosis cases and that 188 new cases, plus 18 relapses, have been traced 1n
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1970 (173 in 1969 and 167 in 19(8). relapses have been traoed.
In 1971, 193 new cases and 25
Efforts should bemade in the coming yeara to stop transmis8ion of the disease by means of sustained case-finding and control activities and to limit the scope of the endemic situation until the effects of the compulsory BOG vaccination are felt. Venereal diseases A "Venereal Diseases" section was created at the end of February 1970. The Endemics Service thus received 177 notifications and was able to identify 104 different female carriers. It is not possible to draw significant cono1usions at this stage. but there is no doubt that the existenoe of this specialized service will make it possible to tackle the problem of venereal diseases in Tahiti more effioient1y. Filariasis A pilot test oarried out in Moorea showed that with the only chemical weapon presently available, all filariasis control problems can be solved if the treatMent of traoed oarriers i8 supplemented by a mass administration of a single ponderal dose of diethylcarbamazine every two or three months to all persons over one year of age. Among the difficulties enoountered are the insularity and the carelessness of the population. 7. lmALTH SITUATION ~.
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An epidemic of dengue fever occurred in Polynesia in June-September 1971. EPidemiologically, 7~ of the total population were affected. Haemorrhagic cases were observed. Several severe forms and a few deaths were reported. CONCLUSION
Efforts made in previous years did not slow down in 1971; this is especially true as regards the oontrol of major public health problems. The opening of the new Mamao hospital reflects the modernization of the health infrastructure in French Polynesia.
ORIGINAL: JAPAN
ENGLISH
REPORT ON THE PROGRESS OF HEALTH ACTIVITIES FOR THE FISCAL YEAR 1971 1 (April 1971 - March 1972) 1. I
ORGANIZATION OF NATIONAL AND LOCAL HEALTH ADMINISTRATION
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On 1 July 1971, a new national government agency, the Environment Agency, was established in order to co-ordinate and implement the environmental pollution control programme at national level by absorbing the activities in that field carried out by various ministries, including the Ministry of Health and Welfare. Staffing and programmes of that Ministry, such as those connected with environmental pollution and nature conservation, were transferred to the new agency. The prefectural and municipal health centers, of which there are 832, continued to.carry out their routine functions as local community health service agencies. 2. HEALTH BUDGET
The total national health budget, including a subsidy to the local governments, for the fiscal year 1971 was ¥173 852 million; in the fiscal year 1970 it was ¥150 302 million. 3. VITAL STATISTICS
,
The estimated population as of 1 October 1971 was 104 345 000 (for 1970, 103 720 000). The following table gives some of the vital statistics data for the calendar year 1971 and a comparison with 1970. (Figures for 1971 are approximate.) 4.
1970 Births: Number Rate (per 1000 population) Deaths: Number Rate (per 1000 population) 1 934 239 18.8 712 962 6.9
1971 2 000 981 19.2 684 532 6.6
lSubmitted by the Embassy of Japan in Manila, 1 September 1972.
. - 2 1970 Infant deaths: Number Rate (per 1000 total live births) 25 412 13.1 1971 24 800 12.4
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The average life expectancy at birth for the Japanese people, prepared on the basis of the 1971 data, indicates 70.17 years for males and 75.58 years for females; the comparable figures for the previous year were 69.33 years for males and 74.71 years for females. 4. MATERNAL AND CHILD HEALTH
During the calendar year 1971, 1 569 502 visits were made to the clinics by mothers, and 5 711 357 by children (including 1 281 058 infants 3-year old). Public health nurses paid 287 148 home visits on mothers and 834 481 on children. At the end of March 1972, there were 595 maternal and child health centers in the rural areas (579 centers in 1971). During the calendar year 1971, 69 292 low weight babies were~ reported, indicating a decrease of 360 from that of 1970. 5. TUBERCULOSIS CONTROL
•
In the calendar year 1971, the number of deaths from tuberculosis decreased further; there being only 13 597, a rate of 13.0 per 100 000 population (for 1970, the rate was 15.4). During 1971, 45 293 000 persons (45 377 000 persons for 1970) received health examination for case-finding purposes. The case-finding rate was 0.07% (0.08% forl970); 4 691 000 were vaccinated with BCG. The total number of registered tuberculosis patients as of the end of 1971 was 618 711 (682 826 for 1970); 21.0% of them were hospitalized, 67.3% were under domiciliary treatment, 10.7% did not receive any medical treatment and the remaining 1.0% could not~ be traced. During the same period, 158 164 cases were newly registered (for 1970. the number was 178 940). For 1970, the total expenditure on tuberculosis treatment was estimated to be 135 billion yen. 6. CANCER AND CARDIOVASCULAR DISEASE CONTROL
~
The recent trend of deaths in Japan is that deaths from malignant neoplasms and other degenerative diseases have been increasing remarkably, comprising a more important proportion of the total deaths; particularly, the so-called adult diseases such as vascular lesions affecting the central nervous system, malignant neoplasms. heart diseases, have been placed as the first, second and third causes of deaths. As for cancer, we have been carrying out special measures for early detection and treatment for stomach cancer through the use of mass-
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examination cars and cancer treatment facilities, since this comprises a large portion of cancer cases: about 2200 patients were found to be suffering from stomach cancer during 1971 out of 2.2 million people aged 40 years old and over. As for cerebr,yv3scu1ar diseases, we have been also carrying out health screening thmugh the network of health eenters and home-visit guidance by the public health nurses; about 640 000 homes were visited annually.
7.
COMMUNICABLE DISEASES CONTROL
As in previous years, a successful innnunization progrannne was carried out during the calendar year 1971. The number given was as follows: 3 036 000 for smallpox; 1 873 000 for diphtheria; 593 000 for diphtheriawhooping cough combined; 3 005 000 for diphtheria-whooping cough-tetanus combined; and 2 661 000 for poliomyelitis (attenuated vaccine). The incidence of poliomyelitis was dramatically reduced after the successful oral administration of Sabin-type poliomyelitis vaccine. In 1971, only 6 cases were reported (in 1960, 5606 cases). The number of Japanese encephalitis eases has decreased c.ompared with 1970, and only 138 cases were reported. The number of persons who received voluntary immunization for Japanese encephalitis during 1971 is estimated to be about 28 million. The number of cases of dysentery has decreased yearly since 1960, except for a small increase in 1966; 5822 cases were reported in 1971.
8.
FOREIGN QUARANTINE SERVICES
During the calendar year 1971, 39 687 vessels (l 461 554 persons) and 35 710 aircrafts (2 470 032 persons) received health inspection at the time of their arrival from abroad; 234 445 persons were vaccinated against quarantinable diseases before going abroad (this number excluded those vaccinated at places other than the quarantine stations); 1024 ships were granted deratting certi.ficates and 7587 ships received deratting exemption certificates. Free pratique by radio was started on 1 January 1971. 9. ENVIRONMENTAL HEALTH .
As of the end of March 1971, a population of 83 754 000 (about 80.8% of the total population) was covered by some kind of public water supply system. At the end of March 1971, there were 180 cities operating sewage treatment plants and a population of 14 390 000 benefitted from
- 4 these services. At the end of March 1972, there were 1113 nightsoi1 treatment plants and 95 community sewage plants. At the end of March 1971, it is estimated that a population of 93 930 000 was covered by the wastes disposal programme, either by incineration or composing methods, and landfilling. Due to the concentration of people into urban areas and heavy industrialization, the environmental pollution problems of Japan are very serious at present. To cope with this situation, the Basic Law for Environmental Pollution Control was enacted in 1967, and various kinds of countermeasures are being taken. For example, environmental quality standards for air, water and noise have been established. To meet these standards, comprehensive environmental pollution control programmes for areas where environmental quality is already degradated or feared to be deteriorated are being set up year after year. At the end of 1970, an extraordinary session of the Diet, which was called the anti-pollution Diet, was convened to enact or amend 14 laws relating to the protection of the environment. In these laws and amendments, the attitude to give priority to the human life forcefully manifested, strengthening the air pollution or water pollution controls. 10, FOOD SANITATION
•
.~·I
During the calendar year 1971, 4767 inspectors were stationed in all health centers. 3 074 361 food handling establishments were inspected. For the same year, the total number of food poisoning cases reported was 1118, involving 30 731 patients and resulting in 46 deaths. Chemical synthetics to be used as food additives are fully controlled under an authorization system by the Government. At the end of 1971, 340 chemical synthetic food additives were authorized. 11. NUTRITION AND HEALTH PROMOTION
• .. f
During the calendar year 1971, 1 498 981 cases of individual nutrition guidance and 75 022 group sessions, including demonstrations by kitchen cars, were given by the nutrition staff of the health centers. As of the end of March 1972. there were 262 authorized dietitian training schools and 162 290 licensed dietitians.
In order to promote the health of people, particularly of the elderly, a "Health Index" was prepared to be used as a guide for the general public to improve their healthy daily living. 12 . DENTAL HEALTH
One hundred and twenty-two health centers are equipped with dental facilities and dentists. and continued to play an important role in the
..
'
- 5 -
preventive dental health programme. During the year 1971, 191 914 dental health guidance consultations were given to pregnant women and 1 648 147 to children. 13. MENTAL HEALTH improve the mental health programme of mental cases. The number of at the end of December 1971 as 1968, 1969 and 1970 is shown below: 1968 853 1969 874 1970 896 1971 902
Continuous efforts were made to during the year 1971, including care mental hospitals, mental beds, etc., compared with the same data in 1967. 1967 Number of mental hospitals Number of psychiatric units in general hospitals Number of mental beds 818
.-e .,
429 201 823
446 217 015
472 238 190
473 247 243
486 250 450
There are many governmental agencies carrying out the programme for the promotion of mental health guidance for the public as well as for mentally retarded children and adults. Services for counselling and home visit guidance of mental patients are being given at 832 health centers, under the auspices and technical guidance of 32 local mental. health centers. 14. MEDICAL SERVICES
At the end of the calendar year 1970, there were 7974 hospitals (7819 for 1969) with a total bed capacity of 1 062 553 (1 033 550 for 1969), showing an increase of 155 hospitals and 29 003 beds against those available in 1969. At the end of the calendar year 1970, there were 68 997 general clinics (68 305 for 1969) and 29 911 dental clinics (29 649 for 1969), showing an increase of 692 general clinics and 262 dental clinics. At the end of the calendar year 1970, there were 118 990 physicians (11.5 per 10 000 population), 37 859 dentists (3.7 per 10 000 population), 83 181 pharmacists (8.1 per 10 000 population) and 283 572 nurses (27.5 per 10 000 population). This means an increase of 3016 physicians, 453 dentists, 7094 pharmacists and 1033 nurses. A network of accident and emergency medical care has been established throughout the country; at the end of October 1970, the number of such facilities, either public or private, reached 4514 •
...
- 6 15. PHARMACEUTICAL CONTROL
During the calendar year 1971, 2131 pharmaceutical inspectors visited 215 025 pharmaceutical facilities (out of a total of 274 810 such facilities), such as drug and medical supply manufacturers, pharmacies and blood banks. The control of amphetamine preparations and narcotics and measures to deal with narcotic addicts were continued. As for the blood supply service, the Government, recognizing the seriousness of increased risk of serum hepatitis among the population due to "professional blood donors" which used to play the larger portion of blood supply resource, made a decision eight years ago to develop the nation-wide voluntary blood donation campaign; the ratio of voluntary donations to the total donations increased to 97.9% during the year 1971; in 1970 it was 94.9% (in 1964, only 7.7%). The 8th Revision of Japanese Pharmacopoeia was published in 1971. The monitoring system for adverse drug reactions established in March 1967 continued its activities in order to ensure the safety of drugs. During the fiscal year 1971, 338 cases of adverse reactions were reported through the doctors of those hospitals designated as part of the drug monitoring service (approximately 200 cases for 1970). Based on the information collected through the monitoring service and other sources, appropriate regulations on the use of antidepressants, antihypertensive diuretics and antidiabetic agents were drawn up in 1971. In April 1972, Japan was officially accepted as one of the 15 countries participating in the WHO Research Project for International Drug Monitoring •
•.,
••
ORIGINAL: MACAU BRIEF REPORT ON THE PROGRESS OF HEALTH ACTIVITIES - 1971 1. AREA AND POPULATION 1
ENGLISH
The ~otal area of the Portuguese Overseas Province of Macau is 15.515 km and its population is 248 636 inhabitants. aCQording to the census made in 1970/1971. 2. GENERAL MORTALITY
The total number of deaths and the rates per 1000 inhabitants in the last five years Were as follows: 1967 Deaths Rates per 1000 inhabitants 1576 5.42 1968 1508 5.18 1969 1474 4.98 1970 1516 5.13 1971 1543 6.22
,------------------~~~~~~~~
The 10 major causes of death in the last three years were as follows: 1969 Heart diseases Cancer - all types Senility Tuberculosis - all forms Vascular lesions affecting the central nervous system Bronchitis, emphysema and asthma All accidents Hepatic cirrhosis Symptoms and other ill-defined causes of morbidity Acute upper respiratory infections TOTAL (a) (80.69% of the total of deaths) 214 205 (a) 161 152 (a) 84 38 (a) (a) 1970 273 247 156 150 141 (a) 90 39 (a) (a) 1971 290 235 163 156 148 71 68 45 35 34 1245
>.
Did not figure in the 10 major causes of death. 3. TUBERCULOSIS
Tuberculosis, mainly of the lungs, continued to be the transmissible disease with the greatest incidence in Macau, despite the work done by the the Prophylactic and Therapeutic Centre. lSubmitted by the Director of Health Services, Macau, dated 12 July 1972.
"J
- 2 Tuberculosis All forms: Pulmonary: Cases Deaths Cases Deaths 1967 1368 211 1328 193 1968 1330 235 1207 227 1969 1157 161 1142 155 1970 1000 150 928 147 1971 1304 156 1298 151
",.
The rates of mortality of tuberculosis in relation to the general mortality were The rates of the total newborn vaccinated by BCG 4.
13.4
15.6 33.1
10.9 45.2
9.9 41.1
10.1 51.2
TRANSMISSIBLE DISEASES
We emphasize the following: (a) Malaria continues to be eradicated; (b) No cholera cases were reported in 1971; (c) Diphtheria continued to decline; (d) The number of deaths from tuberculosis during the last few years has decreased. The following table shows the incidence and mortality of the main transmissible diseases in the last five years: C - cases 1967 C D C 1968 D C 14 6 18 1969 D C D - deaths 1970 D C 1971 D
~olera Whooping cough Diphtheria Amoebic dysentery Bacillary dysentery Unspecified dysentery Paratyphoid fever Typhoid fever Malaria Acute po1iome1itis Measles Syphilis Tetanus Tuberculosis - pulmonary Tuberculosis - other forms
-
6 31 9 18 1 11
18 3 2 1
-
20
103
2 7 523 38 158 2 4 '20 11 17 1328 193 1207 40 8 33
-
7 15 3 23
2 19 2 32 1 7 2 159 5 10 7 227 1142 8 15
-
-
3
-
-
1
1 6 155 6
1 -
-
-
9 1 9 1 34
32 42 1 16 928 72
- - 13 1 L 1 2 - 24 - - 1 1 1
-89
3 2 6 17 6 147 1298 151 3 6 5
1 -
• ./.. of
5.
MATERNAL AND INFANTILE ASSISTANCE
In 1971, 2637 children were born alive at the Macau hospitals and
l
- 3 -
maternities; 995 (36.20%) at government maternities. estimated number of births in Macau is 4724. There was only one death from maternal mortality. place during delivery, it was due to other cause.
However, the Although this took
The infant mortality rate (under one year of age) was 65 (13.75%). The major causes of death were: (1) (2) (3) (4) Prematurity Acute upper respiratory infections Pneumonia Tetanus 20 18 5 4
The only organized ante-natal assistance service and infant health service is provided by Government. Ante-natal Assistance Clinic Number of pregnant. registered for the first time in 1971 Number of attendances in the clinics Infant Health Service Clinic Number of children registered for the first time in 1971 Number of attendances in the clinics 6. SALUBRITY AND SANITATION 499 1 783 253 1 599
-.
The sewerage system in Macau has recently been reconstructed; it serves about 90% of the population. Plans are proceeding for the construction of other sewerage systems in the suburban areas where, due to existing circumstances, there are still thousands of huts without any hygienic conditions, occupied by farmers and domestic animal breeders. More housing estates are being built by the Government. The Macau population is provided with a drinking water supply, subject to the usual controls. An unspecified acute conjunctivitis outbreak occurred, the source of which was probably the sea water and a swimming pool.
7.
HEALTH AND SANITARY MANPOWER
The staff of the Macau Health Services consists of: 1 director (who is also the director of the General Hospital)
- 4 1 health officer for the City of Macau 1 health officer for the islands of Taipa and Co10ane (also practicing general clinic) 8 general clinic doctors 9 specialist doctors 1 school health doctor 1 malariologist 2 pharmacists 44 male and female nurses, the latter also practicing midwifery 43 auxiliary nurses 17 nuns, some of them working as nurses and others in the laundry and kitchen 1 X-ray technician 3 laboratory assistants 8 pharmacy assistants 1 social assistant 2 social workers 16 administrative officers 8 administrative auxiliaries 11 sanitary agents 18 skilled workers 8 motorists 185 servants and other minor personnel The following physicians and paramedical professionals were registered in the Macau Health Services on December 31, 1971, practicing either in private clinics or private hospitals: 118 57 87 1 22 7 doctors dentists Chinese traditional medicine practitioners (herbalists) odontologist midwives massagists 8. IMPROVEMENTS IN MEDICAL AND SANITARY INSTALLATIONS
•
+.
In 1971, the Macau Health Services continued to improve its installations by (a) building a mental hospital; (b) remodelling and enlarging the health centre of Taipa. New equipment has been bought for the clinics of Ophthalmology, Cardiology and Obstetrics, and is already in use. In addition, a mobile mass chest survey unit, a "Siemens" set of P.A.B.X and a synchronous main watch have been procured for the General Hospital. The items bought for estomato1ogy and radiology are being installed in their own departments.
-<
- 5 -
9.
HEAL TH SERVICES EXPENDITURE
In 1971, the Government contributed to the Macau Health Services with the following amounts: From the ordinary budget: From the Development Plan budget Patacas $4 706 000 (US$832 000) 8.9% of the total budget Patacas $635 545 (US$112 480) 6.3% of the total budget.
+
•
BRIEr ON
REPORr
THE
PROGRESS OF HtALTH ACTIVITIES IN llhLAYSIA
•••••••••••• ** •••* ••••••••••••••• **1lI.
T\IE~T'i_THIP.D
SESSIOlI
Of'
THE W.H.D. OF TH~
REGIONAL CDLU:'ITIEE \.1STERN PI,cIFlC
t.T GI!M. OOOOOOOOOOOOOOOOO~~JCOOO~OOOOOOOO
DIVISro:,
C:'
PLA'~ITW;
Arm HEALTH
RESE:.I~fI
LIrJTSTRY
or
llALHSlA, KUala Lu:npur.
17l'H I.UGIlST I 1972.
,.
BRIEF REPO.n ON TIlE PROGRESS Of' HEALTH ACTIVITm> 1L\L1'.'1SIA
IN
., ~HE
COUNr It(
Malaysia is a federation of 13 States, i/EST WJ.f.YSIA COl1!llsts of the eleven States of the formor Federation of llelaya. SIZE I
Ei.5T !{u'.L.l.YSIA comprises of Sarawnk and Sebah in the islaM of Borneo.
It covers an area of 127,501 square miles. Wcst Malaysia has on Ol'ea of about 50,006 Sq.mJ.es and East Malaysia hRs an area of approximately 76,775 sq.mlles.
lDCl.XION
I
Malaysia lies in a crescent close to the equator. between 1° and 7 Horth and Longitudes 0 0 100 and 119 East. East end West Malaysia are separated by 400 mles of' the South China Sea. I:est iJalaysin has a land frontier with Thoilend in the north, 'Ihile in the south the Republio of Sill(;epore is linked with it by 0
0
couseway. To tho "est, aCross
tl~e
Straits of Malacoa lies the KaliCl~ntnn
Indonesion .island of Sumatra. Eost Halaysla hus a land frontier TIlth its north-east lie the Philippine CLlJ.l1:l'E : Island~.
Indonesia
am
to
Malaysia is subjected" to rnc"ritioe influences and to the interplay of 1Iind systems which originate in the Indian Ocean and the South Chin:! SC~. 'rho IIve:-l\5o annual rainfall varies froc (0
to 160 inches.
Tho daily Qvor~~e tC!1?ernturo vades frorl 70 t~·. SOop. The relative hur:Udit)l 0
is overytlhero BGIlerally high, thotl(;h the oleN POPULATION I
teD:oel'~tu:-e
in mos'; plnces is cooparntivoly 10....
Malaysia br.s a tot:il popl'lation o~ 10,53'0,7:,; (197C Cer.su~, p~cvisionn1 figures). Of this fi(lU1'9 6,900,972 oro in West I.bloysio.. 62!3,2S9:o. S~bo.h
and 1,007,502 in Snrnwok.
This shows 1111
increase of 2,622,214 people in \'lost llolayslo since the 1')57 CC:lSUS population and increases of 17~,84e people in Sabo.h nnd of 262,973 people in Sarm-mk since tho 1960 Consus ·population.
The population densities in the vr.ri"us Str.t&S of
llI.l.1~5in
are as follows
IR
l,rOll j n
Perlis Kedoh PenMg Per!lk Selnngol' Negri Sembilon ~lalacca
.. .. .. ;.
P.1~.!.§.l l ..
Populnti.o.l! 124 156
Donsity per s9· miles lj()4
.. ••
••
. ?J07 ~
639 399
962 1m 777 104 1 SiJ3 513
265 1 ?4e 1~.;·:
.. .. .. .. ..
81',0 ~166
1 657 333
523 109
2565
485 306 4D7 2.50 . 1 291 6413 503088
'",
JOhore Pohnng :I:rong(5onu
.. ••
6,,7
639 176 ~ ~
·73?JO
"3 BeG
Kolcnton \YEST !.iI.LAYS Il. Sabah Sorawnk EjST WJ.t.'1SIA l1,\L/''1S11.
.. .. ..
"5 002
413 174
.,
..
...ll2 "SO fr>6 ·20 725 ~8
~-.531
120
..~~zg 620 269
~ 22
..
.. ..
030
J.6.1:? 1:"7 ';<)1 =::...:-:-==
,16,,5771 c. .::::=.
---1 007 5~2
21
,fl n
1() 5"6 ?4~ ::::====
~
-2-
The population in West g"bysin consists of threo min rnces - Unlays, Chinese nnd Indi:ms. The !o!aleys represent about· 53,~ or the population, theChinese 35.4% nnd the'InI!iallS incltillitC Pckistonis 10.6%., The recnining ;f1, consist of Eurnsbns, europeans and Others.
In Snbnh the Kndaznns ere the largest rncinl groups - about one-third of the populntion. In Snrowak, the Ibnn (Sea Doyok) is considered the lnrgest group, Co11oYled by Chinese and then /Jalay. HEALTH i.DlllNISTRhTIOrl , At the turn of thtl century, aloost all the oedicnl and health services were provided by Governnant. This accidental ::xmopoly Jlas, however, diluted by
the setting up of estnte and mines
hospitals by the rubber (!lid cining industries. established by cissionory bodies (!lid
In recent yeors, a fe'll privnte hospitals were
other ol'gonizations.
In 1')46, the Federution of' ::abya ,~gree(]ent decentrclised control to nn extent "here, exceptil)g for sooe federol institutions such cs oentol sarvico bacome fundotlontally a St~te oott~r. 'hospit~ls
nod IbprosoriDs, the executive control over the
In 1957, tlith the declurntion of Independenco, Health Federnl
becarac a Federal oatter, except tor certain preventive r.1ellsures in the Municipnlities ond other LocDl 1.uthority ,\reDs. an the fOl'Clltion of ,j:uc;rsia in 1963, Heclth in Sarowak become ~ttcr 0
"hile in the State ,of Sat"h it remined n State lJ:!tter until 1970. The Centrnl Gov0rnr.ICnt
:tssuoed responsibility for hcclth in this Stct" in 1971.
G];If~n/J,
HE/,LTH SITU,\TIOlI ,
Except for the Ou~L'i"'etJ: 0::' ~::ol:.:"~,
>.:J
cO'Jn':'l'"'J hr.s been free from oti1C!r qu~,rr.ntin~blc diseases.
The gener~l he11t~1 of ~jlC ~)O:':.:j.: ..~: C1 co!1ti:,t,tc:$ to i::prove ·':<l.:h the VnrioUs tlOrtclity l"ntes
prof~~essivelY declin5.i"!.~:.
VITAL ST;.TISTICS : The Rate of Natural IncrEcse is gr:tduolly declinil1b. Crude r.orlolity nnd oth'.r Ilortdity Hates ore steadily declining. T~BLE POPUL:.';:lC~I,
I
DE,\'iH R;.:2
;i;.n; OF' lli~URhL nCRE;:S~, C;JU"E BIRTP Rl,TE, CRUDE ~.iD C?UDE LORI'!.LITY R;..r::s IN w~T IdftLl.YS!1\
..... I I
YeoI'
Est inat ed Populotion (mid-year)
Rote of Nnturol Increose
Crude
Crude Dc~th
CrtJde
1,;0 rt 0.1 it y Infent Toddler
Re.te tinternnl.
Birth Rote
Rnte
NcoNotnl
1957 1960 19G5 1966 1967 1968 1969 19?0
6 278
?Sa·
33.7 31.4
46.2 40.9 36.7 37.3 35.3 35.2 33.0 32.2
12.4 9.5 7.9 7.6 7.5 7.6
30 ,30
76
11 C
3.2
6 909 009 0039 030 6 2S7 849 8.'i'B7 103
69 50
2B.(l "2'9.7 27.S
26 25
6 5 5 "
I
2.4 2.0;
48 45 42 43 41 , '
1.'79
24 23 25 23
o 788 736 9 018 636 10 536 743
n.7 25.0 25.2
5 5
7.2 6.9
4.2
-~I 1.57 1.48 I
.. Census.
'.
DEVELOP[J:;lT PL:.N:J I"lileysin is in th<! fourth Five yeoI' Devclopr,lent Plnn p~riod (1971-1975). The Health scctor of the plan is nstiontoo to cost 1l!5213.65. It invol vcsthc inplcLlcntntion of no less t trin 1292 covering both Ea~ and llest i!alaysia.
;"'0.: ccts
Tho f'l-m inclulcs 558 henlth projects, 292 hospital projects,
77 dental projects, 28 trnbir.o projects end 49 r.u.scallaneous projects for ;Jest :1alaysia, 129 projects for Sarall::1: and 159 projects in S:lbnh. Although 110
arc only in the second ycar of the; plan period, positive action has beon tal:.n to
iopl.areDt 887 projects or 6rJf, of the total planned projects.
or
these 340 proj ects hnve been coupleted
and comnissioned, 211 projects are in various sCDbes of oonstrootion, 108 hnve gone out on t.cmler and 228 are under planning.
~Alloo:ltion of health sector development expenditure - sec page ~ flUR.'J. HE/.LTH S;::IlVICl:: -'
To correct the rural distribution of the medioal Rnd health services in the ~untry, tho llUl'nll:enlth Sche~e
was introduced to provide preventive nnd curative service including dentcl-c~re ~n<1 nnternol
and child h<clth Co.N in the rurcl "raas uhore some f:f:f!, of thepopulction liv~. This involved tl:c building of (Ill
"ffective netool',ork of r.rnin health ccntr~, h,alth dub-centl:es and mdrives' clinics.
The following toble shO\1S theplrysical progress made in theimplementation of the Rural Iiealth Schanro.
X:,BLE
2
~!t·.L HEi.L:rH SC1~El!- C'rS55-1971)
1st. t:1lnya
2nd. J.lalnya
hun ~~---
( 1955-1960) 8 8
f'lnn .09(,1-1965) 31 114 617
1st.Malaysia ?len ( 1966-1970
2nd.1ialcysia
Total
l
P1.nn
~zL 3 14
--~
I;ain Health Centre Health Sub-Centre lIedvire Clinic
58 _ 300
5
47 194 908
26
1jS:.
~( /
Almost 4 r.rillion or tT/O-thirds of the rur,>.! population are nOf! provided l1ith bosic preven';i ve and curative services. The rocoter areas which ~e not let covered by this scheoe, ~bilc
dispens~ries ond subsidiary wctcrn~J and child hedth clinics arc provided service on a uec!Qy
or fortni[;htly bosis. I
Basing on the fin.iia<;s of the Operation Resenrch team, it
is phnned to decentralize the
~
health s~rvices nnd to up-gradc the stotus of theexisting r.ridVlife Clinics to villaue health oent:'Cs, to be effective nftcr the mid-ter;;, revi"," t51J the Second I.!nlaysia Plnn. TABLE 3
Tot~
t.ttcnd:'nccs at
Home Visits
Hoce Deliveries
.....J.l..e..':~ll.£.':!'trcs
1961 1966 1971 PUBLIC HLALi:H P,lOGill,.:;:S
5 1111 419 6 7(>f:, 719 7 }(l1 627
941 81q
so
119
1 480 360 1 987 293
68 105 77755
(n)
Qunrailtin~blG
Diseases
CholaI'(! EJ. Tor biotyl'c Ob~'ln occured in Ilcst lhlnysia nnd Snra"'lk. were reported in Snr~wnk
109 c~ses \lith dO:l.th
----.-.---
und 213
COSQ5
with 6 dcot:,S tlere reported in 8 sto!res in :Iest [:aloysia. Thus oocsurcs
Intensive control mcosures were institutec following epideluologicul investig.1tion.
in check chemprophYlnxis !lith tetrocycline, honlth educntion, nnd improvemant of er.viron:.lClltal sonitntion. The situotion L not! under control and 17 of the 22 infected districts have been dcclnrcd
"
free.
4 (b) Tuberculosis The lh,tional ~ubcrculosis Control Progt'oJJi.le uos offiehlly laanched in 1961 and hns· been fully operational ~incc 1965. Th~ nit! of the progrnr.une ~s to reduce end eventually eliciMtc thcneedless hurJtln .suffc"ins Cl:'.uscd by tuberculosis by using all the effective 11Capons :J'/!:lil:>blc . that .ore of proven ef'ric~cy and pr~ct'.icnl applicability. based on advances in bio..uedical, technologicol and opcrction~l ~c$cnrch.
In order to neet the nero to dovelop tM progronu:!e .~gionl.
SO
as to produce the L1:lXinnl opidcJ:lio-
inpnct on
th~
probJ.ea dafinite and precise priorities hove boen cstoblishc<l ruld ,at
present the tuberculosis prosraL11e h:!s defined the follouing three basic objectives:
(i) Prctoction of nt lenst threc-qU(llters of the susceptibl~ population uith
-
.
BCG vcccinction.
eii) Identificction of two-thirds of the infectious cases prevolent in the COLIlClunity. (iii) Render !It lC<!~t 95% of these infectious CaSes identified percnnently noninfectious rrith odcqunte treut~ent. To nehiove Hese obj activos the progrnmme has to rench the entire popul:ation 8Ild the !>easures have to bo of C\
per!lnncnt nature. The Nutional Tuberculosis Pro(;l'llLlUO has
therefore boen c\",l v'.)d
0,;
this blPis and c"nsists of the three inter related cocponents.
1. The Tr<tining I'ro:;raLnc. 2.
The IlCG Vaccin.otior: ::'rogr=e. Cose-~inding &
3. The
Trent'.,cnt Proc;rOJJt1o.
In addition the lbtiOilcl TUberculosis Conferences of 1969 has ngr~cnent thnt to achieve successful iupletlontntion the folloning [:re necessary. 4. Intogz-::tion of the progrC!~10 vith the busic hcclt h services.
S. Tuberculosis n~nf'.~;erirrl Tcnns.
6. Comr.:unity Partici?"tio:l.
1. The Training
F.'O.fi!..~~;<:"
TillS coononded theribhe:;t priority ~s no technical prograr.:rne· cen succeed tnll.ss trained SJdllc persons are ovnilnble in ::.deqll"te nUilbers to optratp. tho vn.Hous techniOlll cor.lponcnts eot:j)rising the project.
2. ~ Treatnent_!'':2.cl!,~.-!'.e. ,,;th ~I:c ~bj~ctjve of r~ndering nt le,st 95% of the infectious lIOure~s :.~etectcd perr...'!ncntly non-iI.fcotioU$ with ndequote trcotoent has however not been so cffcc'.iv~ cnrried out duo to vnrious fnctors. •
If-a current approach is the application ot st~nd(l1'<lisod fully f> Ie,SS ,
supervised drug l'cgiIlcns llhich con be i"plc::cntcd on
scale with Dore th"" I ...... ,
rN' 7"'·,J
effl L' ... at .. l. veness,
through on 1ntecr".tod treutnent ProOT"[U.1C at hospital 35 t'ell as rurol health cent:'c level, with tho necessnr:' reg~nr prcres~ional :;upervi~ion provided throu;;h tuberculosis [Jnntlgerial teons.
:5. .Integrat1_o-"....!!.J..t~tl':S....lJ..~~-1'.:r}.t_h-".?~.::.s.' 2lo bo affective tho prcgrar.1'1e l1ust be firnly structured on and fully integrated m.t.h t:1C b"sici health services end the country'::; networJ, of hospital$ LUld rural health units provices the ideal lJllchincry for the probI'cr:le to reach the entire population on a pernanent basis. Considcrnblc proGl hils been oade in tlus direction since 1969. "hen it 4. IVOS
fully realised and cgrccd upon 86 nccoss::.ry"
Tuberculosis linnolte!.~2.c21~ arc required in every st -te for ilf'fective integration o:ld t:laso tooo! headed by the Tuberculosis Specirlists and Sonior Officfrrs of Health consist of spociolised porsoll.'1, org~nisers
to proviGa trasic health per30nnel "ith continuous supervision, consult~ tr<tinin;; one
assistance. Those tews ::rc bcill(; forced in all thestates nnd it is expected th"t tncyi1in be fUll tunctionol by the end of 1973.
5
.
-
5. cooounity pA.!!-.i:..ip..n}.i2..".'
. ••. . .,_ .... at run nd active oo',~~t~lty !lo.rt~Cl-patl( 1W:>fnctors th~t hnve been retardlng prol7"ss are ~ a -Sl.· c fr,cts about tuberculosis ~d of tho, ai:.lS alld objectives tlII'i lock of COr-lluru.ty :l\7ur<mlss of the bu <'~fo"'r. arc bdn~ uede through health education to c"tivate tho co:muru.t:r to coLle of the pro~e. w. 4V_ 0 forward and toke full ro'/nntage of the facilities end services offered in the dctection, t;'Cntucnt
and prevention of tubereulosis.
C.
Malaria Follo'King the succt:&:sful i:nlnria Eradicntion Pilot Project in 19f1J/1964 nnd n courrtry ....:ride Fro.Eradiclltion survey in 1965/1')65, t~,e llatior.al I.!n1nria EradiClltwn PrograDue It \fas oriei,nclly plMncd for :I VaS
hunched in 1Cjj7.
1Q-yeo.r period bnt was ext"nded to 14 years.
It will be ollZ'l'ioo.
out in phases and sto;;os fron the Ilorth to the South. Up to the em. of 1971, the progr=.lC has oovered the States of Perlis, KcdM, PenallG, Keln!J1;an, ?erok, :i:rone;gnnu end Pchn.'lg coC!prising 2/3 of the area of liest lJa1:lysia entire population.
:un l.! t!>e
\lith the excoption of P~hcng which is in the prepnrntory phose, the othar 6
stotes "re in the nttnck phose. Generally, there hns been a shnrp drop in ~alnria incit!ence in tho five sktcs. :rhe progr~:r.e is buin:; proi,7essi vely o:pennded from yoar to year an:! the whole of ~'1Qst Kalaysia is expected to be covered by 1974. :rhe aiD is to Achieve total and cwplete eradication by 1982 \lith d. Leprosy Control. :rhe Ilotional Leprosy Control Proi,7=e "as launched in 1969 to reduce the incidence of lopro:lj' wld thnreby clilJinote the dlsc"sc as r. pu:,lic healtl. probleIJ in 20 yeors tice. approved for tk icp19lOc"kticn or Uo Plon. Urxler tr.ios Pz'Oi,7c.;:r:e, the trcetucnt of leprosy has been decentralised and fc.cilitiCf; nre provided at all the Hospitals [!nd Health Centres to treat the patients. Only patients requir±ng ~pccial hir;~ th~
continued support of II.H.O.
A
Su:J 01'
7 mUion ",,"s
infectious
cora c.l'e "dmtted into the leprosariw. Xhe intcgrt!tion of leprosy ond health services hns not &nly hro~ht
service with the senernl
~cal
dOlm tho co:.1; POI' OIlpitn
but has also help{)d to brenk public p!'eju::ice c"ainst the disease, and raised t!lC noraJ,s 0;: the patients. In.-Patient trGoto::0nt cost per peticnt per year is in, the region of i1,200.00coqJarcd to about '~20.00 per yoo:r per "ntiwt lIho is receiving Out-Patient treatwent. :rho nUrJbcr or patients now receiving Ot:t-<atient trc~tL'.(ont at vurious hospitals and Health Ccntru~ as 31,12.1971 is CboL1; 4,000. e, Inr.-runisation LlOuru.sation Progreu~e. Oll
agti~ot
Soollpox,
~iptheria,
Tetanus and Pertusis is routinely
pcrfor~ed
by
~
health centre or.d elidc. ,\ tot;il of 197,403 pritlnry VaCciMtions
liere
perforoed in 1971. Sooo
148,276 children conplctcQ their eourses cf inocubntion ngmnst dirthecin, tetonus, and pertu~Ls. ib Oases of Socllpox roCs been reported since 19f1J. Xhe inaidence of Diptheri· has dcelir~ frou ~.58
per 100,000 popul3tionin 1961 to 4.85 in 1970.
t. Environn.ontal Snnitation Enviro~ntlll
Sanitation i5 onc of the bosic services ,offered by the rural . hoalt" stntt. A pilot project l7as startcc' in 1967 in every state in lIest Malaysia covering IlpproxitJntely 3O,m pooplo and has proved successful, In 1972 it has been expanded to cover 300,000 population nn:l 1Iill be
further expended to cover 450,000 persons in 1973. g. School Health -St~ in 1967, the ISOhool health service covered rural primary schoob.
The Joint School llcalth
Cocnittee conducted st~tc-lcvel serincrs coveri~ about 1,500 key school am. health person.."lOl in 1971. h. Health Zduc~tion
Health Educ"tion P0I'UCr.tos all basic services and health activities and is c~rriod out by rill health steff either by the pe.son-to-person approach in the clinic or
duri~
hoDe v i . or by tho oou:runity
nppronch, utilinl'o(; individual am. group resources in the oomunity to e-et comunity parlioo.pntion
in ioprovi.~ their
0\;0
health end snnitr.r:-- conditions around thetlo
>-- ' 6 A proposnl for qUnli,icd Health EclucctiQll Officers to strengthen the health educction seIWOG hns been approved by the Gov'cr'nfJcnt. fIoolth Educntion activities of the ~ial;aria Eradication ProQ!aJ,lLlC The, l'ecent 001
as \1ell as nutrition ~nd faLuly henlth C(~uc~ti.on huve been intensified since cld-1971.
re-intcnsificntion of Cor.mmi;;y D~,clopf.lOllt by the loovernr:!cnt in August 1972 with ctJphnsis
ecenomc, educntionnl, health 1:nd civic sectors, is expected to g;:,ve a big boost to the l.linistryts
health education :mtl COi.lCur.ity or;:-:nnizction r:cti vitics.
i. F ncily PlonllinEj Fanily pIc.nning is odr.ci.,usterod by thc I1~tivnnl Fnr.ri.ly Planning Eoard \lith the objective of r¢ducillG population Grcf_~b to a llr.nac;c"bIe proportion so th~t the result of t he country's planned econonic developnent will y.j.eld src::-~tur b~ncfits Giid
incrcr sO tho peer CElpito incoae of the: rJ00ple.
Since 1971 the l,a.nistry 0;: Hedth h~z beo'l coll"bor~tin[; with the National Fa,uly PIc,mine 30nrd in intcgrc:.ting l':li.uly j"Jl::',ncinc s~rvic0S ~,.. ich the existing rur:'.l hc:r.lth sei"'Viccs, cspcciolly the naternal and cluld hoalth soJrviccs, covering 798,000 people in 1971, St"rtinC \lith pilot-demnstrction projects in ei:.,ht districts htcGrc~ion proc;rQi.'.'1C "ill be expandGd fro::! 1973 ''lith U:1'~f,
o:'e
and World Bon]: a55istoncc, so thnt i.ntec;rc,tiun win be 'covered approxi.Jctcly 86.r:rj, of the l'urnl population by tiD end of 1S76. HEALTH PLilHlHi'lG I, Heolth PlanninG ::'.01d ;{ese::.rc~l Division rI&S cstubli5hcG
1969.
The r;d.n ~ims of the di vis:~i1 is n~t only to fortmlr.te !Ievelop:r.ent plans for the health sector but o.lso to sup~:ryi~c ~a'~u'11 pro5-.:ct i~l~)lc!-:'lCnt[>.tionll Appropriate find ti!.lely evo.lu3.tivc \'Iorl{ lIill be undcrtcken from tine to t{f.lO so tL? ts lc~,d r.,[",,"r.u::-, efficiency Dnd effectiveness to ell dcvel0pfJont \1ork of the HeeJth sector, Tho role cf t:1:~ divisjon will essist the Cou!ltry in identifyinG hea.lt.h probletJS ~d needs, c5 1Iel1 c.S in estr.~~i.s~in6 r-olicies <:.nd finnl objectives within tile HC:llth sector which v:ill contribute to t;'j0 nntionf'..l :; ~\.~. fC:l~ soci~l <.:.nd cc")nQ[::l.c c1t;:vclo;:m~nt, 4onsonQ.nt end
eonpleoentnry to the objective r.=:tQ.~.:.'l!..sh(;rl in ci"-r.cr sectors .. PATIENT...c:~rtE
3:.:aVICE
'f /
Every existin~ hospitnl -. in tho cotn·.tr,: is be·ili."; i"~:~n'r:- ·. C"'~ c.nd cxpt'loC:ed ~!1d encillury dcp{l.rtncnt~ have been enlarged to cope with the eveI'· ·inc','.Jr.si.r"": u(:;[;])n::i for" r.J.8uicr!.1 cr-rc.
This dC~113.11d is incrcosiIlB
not only because of the GI'O\"iinS :Jopulat::.o!l bu';. {j,~.!:.) due to [jore ond norc people tnl<in:::; to ;:):)dcrn
oedical treat],:C:lt
0
The ovomll bed cepncity 01 GO'lcrn:lcr." hospibls has increosed fro" 20,337 in 1957 to 27,661 by the end of 1971, The nu:r;1ber of spcc~alis'~ units ere 'JI1 th(; incre~sG as r.:o.re ;!nu mrc ;.1ldicol spccialists bCCCk'lC
available.
Besides the b:J.sic sp0c5.~liti :5; units in r:1di0t;1(;r~.pYt n€uro-psjchiatry, plns'.:..ic sur.:;ary,
c')rdio-thoro.cic, end gcnito uI'in~j,'Y units hr.vc nIso been est;::blisbe.d"
.:22Z Hospital Mr.uss;'cns
.!l12 450 873 491 653
(
:197.1502 371
271 I,c;o
492 891
489 532
5 766 062 Ilospikl Out-Pctient 5 915 757 5 705 091 5 997 ~ tres.tnent Besides GovDrnn(;nt h0spitnls, there nrc inctlstri.11 nnd priv2.te hospitnls ::.nd no.tornity hOl]o$ uith
•
L,-
n total bed-coclpJ.cT.10!lt of 5' 517 ,'hich hr~,ned nbout 100,000 in-pnticnts and 1.07 clllicll \lut~pnticnts • No dnto nrc 3vnil.oblc r~ tho volune of p~t~l'nts handled by goner"l p"ectitioncrs but wit!: pr~ctising 1,1O)'C
t:lOn
.~~--
930 J.lcdicr:l prnctitio:-Ll"S, in
pr~v~·.t() s~ctcr
their contribution is significant.
"
,
\
'
7 DENTJ.L SERVICa} In the provision of Dcntnl Services, emphasis is plnoed on tha prevention of dental diseases tllXlne school children. A conprehcnsive Carr, of dcntnl trcotucnt is provided, and this incl'..l::!~s g~ootionSt sc~ling, polishing of toeth, topic:!l application of nwridcs, fillings
ot teeth, extrllctions, pI'Q-d.aion
of d,entures, ortoodentics and rlOjor oral surgery. Tho do is to render dental fitness to cveI7 child in sooool. Prioritics of troot!Jcnt arc also provided to nnte-nnt'al ond nursing tlothors o.r>l p"",sc!x>ol children. Eocl'(;ency dentol trectocnt is also p~ovidcd
for rer.:bers of the eenernl pl.lb!.ic
1I~"::>
c.re unable
to pny f(Jr this trcatne:lt by pri ve.te dentists. Like the oodicnl and hcelth services, the dantnl sem.,. ~
bE-i1'l6 «t>onded'priDaily il!to the 1'111'01 '!'CIOS.
orens. Of the 465 dentol clinics nbout fJ::f~ are to be fom<:! in th<> rural
There nrc 4a min If1
clinics, 140 screol dental clinics, 11 d«Jtnl clinics ottoched to Gener~l Hospitals,
dental clinics in
Idain Henlth Centres nnd 190 Her~th Sub-Ccntres ,nd 17 cobile clinics, 18 pnrt:"tioe clinics. Tho tot~ attendances recorded is 2,219,921. Tt.BLE
5
NUilllER OF DEm:.L CLINICS AND CLINIC ATTERDIJ£ES
19£0 .--. No. of Clinics ~s
~ 230
1962 267
146
.22§1 269
1964 287
.!t§? 322 1~/jQ
~ 395 11}1683
~.
~
427
450
~ 450
~
-'
1( lj{
450 Itt
Total attendances 655140 Thera
754896 851168
849670 928118
1169608 1427103 15)4147 1704417 1:
now n Dent<:J, Faculty at the University of Malnya for the trdning of dental surceons
run it;:.
presOI
t here ore 32 dental E!Lrlents undcrsoing trninine. J..s an ilIteriIulleasure, foreigft dental SUI'(;cons have been recruited on contr"ct rion nci"hbouri!1f, friendly countries like IOOonuill, Arab Reputlic Pokistan ,,00 Korea to overcoDC the present· srertngc of dental surgeice. enncted to require dental. surgeons on first registration to Governoent • The Dcntnl Division serv~
0:: i:apt,
In nddition, l~ion ~s beoo
conpulsory service of t"o years in the
r.cs
conplet ed the Dent"~ Epidemological Survey el1d has sutc.Utted a rc.port on 11as
this Survey whioh "'-'" t~bl~d at the Ree;ionnl liorkshop' of the Western Pacific R€.gion of If.!!.O. l.l;
very well received and follorine on this, the li.H,O. 'hes s~ested an extension of the Survey to inclu:le adults as soon as possible. (The ori!?1lill Survey lIns only on screel children), The Flwridation of Public \Inter Supplies, a public hea:),th l>EIa.ure to reduoe the incide~ or dental carriers, h~s been tipprovcd by the' C~binct nod active steps nre being taken to ictlloduoc fluoridation of \toter supplies throUGhout the country. At present, only the Weter SllPplies in the Stete of Johore ere being fluorid"ted.
~ .~
....
---
8
IILLOC:.TI011 f'C':l liEllLTII ... -.- .........
i,~'D
l'/,HILY H,;.IItIING
~-.---.---
•
.12.?~::.2.2.??
• r
.~
(Z IJillion)
!~e~_!l:ll_o,Ysic
Scbab
Sawarok
!~py.si-.~
Preventi ve Services -4' )
..
••
Control of COL'JunicuUe Di5C~SOS T • B. Control
.. .. •
. .. ••
••
;8.50 1.55 1.25
4.54
4.04
47.00 1,5:, 1.25 0.;0
••
Leprosy Control
••
..
Pronation of H~nlth Gnd Sanit~ticn Rur:ll Henlth Service Dent:ll Heclth Service Urban Heclth Service Curntive Services Nelf Hospitals
.. ..
••
.. ..
..
••
0.30 36.95 4.54 4.54 4.04 3.52 0.52
115.53 37.81 4_02
..
.. .. ••
.. ••
••
29.75 3.50 3.70 112.63 65.13
3.70 15.86 8.26 5.33 2.27 11.46 139.~5
.. ,.
IuproveJJ"nts, extensions c.r.i equi piJ::nrt Other Hospit~ls/lnsti~Ltions
.. ,.
8.29 3.02 0.15 2.07
84.6G 45.15 10,12 26.52 11.SS
36.80
at her Projects/Prol\rx.llJes ::raining P!"Ogt"~r':.;GS
.. ..
7.70 19,95
4.£0 2.39 1.62 0.59 25.00
Institutional Q~arters r. Hostels .. . .J;lisccll~neous
..
.. .. ••
9.£0
4.50 5./;5 ~.
0.68 1.39 . ......
.).00
7,S"
TOTi,L
.. ... ~.nJ
-.-
171,08
~---..-....--
.
...-.-----~-
-
17.57
213.65
• Ailocations for Fu:llly Plcnnin;;
f.:Olnri:! Eradication ere ",".de in the
Ordinu.~
Budget.
:/
....'----
9 II _ SARl\llAK, (E:.sT MALAYSI/,)
I. VIT,\L STI,TISTICS -'-
1960 Census
1965 Est.
1975 Est.
1. Annual populotion growth
M.A. 9.5
2.4 2~.0
2.5
I
/
• /
2. Rnte of natural increase 3. Crude Birth Rnte 4. Crude Deoth Rate 5. Intent f.lortality
25.6 30.0 4.9 31
25.3 5.0 60 N.JI.
28.0 5.0 43 N.ft.
6. Ihtcrnd Mortality Rote
o.a
II. EE.VELOPt.U::l~
In the 2nd I.~Dloysio Plan, grent enphasis is plnced on the expnnsion of the l':edlcol ond Health services into the rural Ilreas which are not covered by existing facilities. The intro-
duction of a new pottern of rurnl h"nlth units in the State is a .,ajor step fO!'llord in closing the [lops in the existing service systeu. For the period 1971-1975, the total allocation is ~17,570,010.
(D ~
G.ncrol Ho.sl'~~ Work on Phase II which· started in the latter pert of 1970, ",(IS
continued througlJout
1971. 'lihen conpleted this h~spitnl will have 570 beds. 'Iork on Phose III, i.c. conversion of tho old hospitcl building into Hospitnl Assistnnts' Hostel ond l;iedicn.l Headquarters started in Decel1bcr, 1971. Dispen.:!?~
II Chss IV quarters to ncconnodnte the hospitnl nssistant operating a Trevelling
Dispensary at Lubok Antu \Vus eonpleted durinc the yenr.
(iii)
Rurnl Henlth Units· TI10
rurnl healt" "f1'; ~p ew. qunrters building ,ias conpleted this yenr;
Work on the construction of four henlth sub-celltres stnrted in the lotter pnrt of 1971. These are in QCcordanee with the new pottern of rurd h."lth units being introduced in this pllln to provide a bett,,)."' scr:ice to the rurnl population. (iv) School Dental Service Seven school·dentel clinics with 0 chllirs were established in 1971.
F\Ul(;S undeL'
.this sub-he"d ere I!tilizc'(\ for the purcbnse of nnterial for the construction
of :;unhai":,' ·It:,,l'ine5 and \Yeter supplies to provide safe woter and sanitary facilities to the rural people as· it f.1eans of irlproving their health and standard of living. people benefited frou this schene. In 1971, 22,101
.-......
_---
., ,
10
(vi) !~E..":E.p:!'.c.c.,t;l. \'Io~-k on the extension of Occupaj;ionDl Therapy DcpnrtL1ent of the 3ar8wak liento1
llospitl)l
tiM
cOmpleted in llovc&lber, 1971. "0
IUpi'OVOllQnt
'k-rrJy roOD on thJ> Sioonggcng Hospito1 was coo;>leted in Dececber, 1971. TlOl'!(
In l.1il-i 1I0spitnl,
on the construction of 4 ndditionel beds to the existing
stlr(;ic.:u Hnrd end 4 isolr.tionbeds to the existing childrens' word were completed in Decenber,
1971. :10r!: vms o1so co!.lpleted on the' Seourity Cells for the tliri Hospital in Oct~ber, 1971.
!:!.~2!.i.n~1~~.!r:'~!.e::.s.
T
, :rhe :.r'~er
ralO llano\'( Tenu nrrived in
~:arch this Y03r to study the eradication progr!\Il!lll.
n thol'o\li;''l sttx:y the tCIlll reCOrJl'londed that tho project be redofined to that of control.
Tho aiu of t:lO nen Sarnwek ~.lnlo.rio Control Project is to noint!lin the gains that has been already achieved. In 1971, 1,643 cases were detected, The cain nrea of continued transnissioh were
the bOrdOl- n.:-en of first end Third Division, Puncn nreQ of Pourth Division nnd the two I S&lDll pookcts of l'ifth Division.
(ii) !1lJ>~~~,~.?n~~ Dy the end of 1971 616,900 vaccination has been given since the project started.
In
1971 alone $,270 vo.cciootion tIere Biven end 1,176 new cases were regist~l:9d. Of the 2,516 oases on trcntoent were registered, 22 percent failtld to colleot dMWI. ~
Centrol Caso
nCbi~i:cr by TB Coso Card System which was started at the boginning of 1970 is now fully opel'",tior.nl. This reGister will provide very useful epidenioloBicnl data for future plruming
and by inoo-opernting into this systec the return of treetnent coros at the end of one year, it i5possiblc to evnlunte the officiency of the treatment progrnnne of the whole State. Of tho 1,17G ho\'! CUses l'efjistcred in 1971,
035 wero spututJ positive.
New cases by x--roy shows
253 for advnnce, 59/f LlOderntely advnncod and 241 &liniLlnl. (iii)
.~nJ... !~o:"?:0:....r.:;P.r.0~e~:.~...2~ At the end of 1971 there were 57 !lural Henlth Supervisors in the State. These workers nrc rulnir.;ncd to rurnl nreas nnd each worker has to look aft~r five to eight villages ~lJprising two to tlu-ce thou:::nnd people. This progrlltllJe is beconing very populer oS
nora wllter supplies
nrc beinG established. Sinco 1967 when construction of water supplies was inclllied in the schC&lo, 301 :;ysteos tlere colJplated and they serve a population of 64,090. continue to provide assistnnce to the progrnnne. Xhe ilHO lind UNICEr
~\bJalj'..of worle done
by Rural Health Supervisor
, Xotnl Pipa/Grovity foed Pucp/Storngo/Cipo P~n/SntVStorngQ
1967 1
1960 13 1 3
1969
1970 25 .
"
19'11
106 16
---30
-
"7 8
9 9 161
Ilnin CntollDOllt i1aU
1
-
- .......?
,_~
... _2._ 2
4 1
3 10
18 16258
71 16940
-
5 61 22 101 1 192
Population sarvo Latrines
727
a069
4129
'.
11
(iv) ~.02:-'J?o!!.t.::1.E.c.;.m_~ This service is desiGllcd to build up !l
group of dentally fit children in prinnry sclools
~ est:ablishil16, in '~he sCOOols dental clinics, school dental clinic oorc completed.
st.tltred
by
dental nurses. Up~' date 118.5
or If9
l'n 1971 the tctal atteoo31lces
,10,195 compared witb
02,116 in 19'70.
-.
"
(v) !St"c"l:,",~""t1!:d" ~N-f.?...H"o."J.~.h..E.e.::yi~~ ~hi5
is n responsibility of cunicipalities nnd districts councils which nut:oor 22 in the
l::tnte.
Xhe nic:'Ji YOs
nrc
trtcinud by ;,:ooioal Departgent ...he ensures that they renched an adequate
stcnl.:u"<." befOre they are registered ns cidwives. Substantial aid is given by UI\ICEF in'tbe fora , ,of equip!ocnt, personal kits, skim cilk and vitamins capsules, The Uedical DepartLient studios
tho so."Viccby the provision at ~ and conSUDablo supplies. staZ:rcd by
Up to end ot :1971 110 tlinics
1n
uidui ves vere in opcrction.
:S..~.?f the
w0t!<•..d."!'.!. Pl. all
t'CH in the Stnte
1967
1960 410 382
, 19($ 415,002 100 ?34
1970 '+20 728
197'1 lqt 461 12 717 9917
Clinio'attendances
236 402 H••"_
HollO yisits Delivori03
ft.:'t H.A.
934a 9960
11 •.1.
0947
...~:n:ip.a:~Ao~. ileC.C;. ~plo :lllti~cn (dosos)
N.A. N.ft.
N.J.• ,
19 :507
15 120
17224
H.A. H.tl. N./u
55 347
40 450 52 C17
71 390
Polio".,eli:;is (doses) SIlllllpo::
Jf./\. Il.A.
,4462 24 oo;J
1tfh5 22472 2949
16436 2'7ll.5 .
Diph1;hel'i.a
1
~.A.
H.A. ..
14
---'0-
rI •
TR;.lI\IJ~.
This oontinue to recoive top priority,
Apart tron doctors, dentist, phllI'l:llcist and higher
cschelOn ot officor, oo:;\; onter,ories of staff arc trtcincd locnlly. ,. There ere trnining schOol tor nursos, .\ssistunt Uurses, Hospital Assistants and Rural HeolthSup<lrvlsors':in Kucbing, also It
There is
truini!(; school tor oid\livos in Sibu. ,\t tbe end OY01'Seas
or
1971, there tu'l1206 st!>!f of ill cl).tegories
undor troinil'l(;, 49 in \'/est 1~llYsia and
eentresaod 157 10eally trnined. '
In servieo!! troinillG oourses are conductod for dispensers, laborotor:YQSsistants, llII:lesthlltio technicinn and x..1.'":lY toOhnioi/lllS o ',' ,
,.
12
m It ~.r.?.d..t:.o:..il!!.
SIIBl,H (EIIST
1II.L.IYSIA)
: In 1971 it The services are adr-J.nistered by theDirector of hedical Services.
Until the end of 1970, Dedical nnd health services were State responsiblities. ooc:me a Federal subject.
·
,
II.
YE-.al Stptistics : ,;s can be scen frOG thp. table, oortality rates are declining over the yoors. /lnnex
rfl
III. ,i s'';:': of $2,433,000
"as budgetbed for developnent in 1971. Developr,lont projects in¢lllk'<1
construction Of ne·;; hospitels, dispe~.saries, dental clinics, nrc a hualth offices ard villages group s~entrcs, extcnsion/rcnov~tion
to existing ones;
and purchase of vehicles.
IV.
~.!l..b}Lc. ~.e.:o.l.t2.
: &. Child Health Services
(n) !~a.t.eE:..¥ ~~
:idcr!'.D.l nnd Child Hcclth Services, provided through health centres, village group sub-centre nobile clir~cs
continue to expand throughout the State, There ore at prescnt 14 health centres, bnunisation ogainst tuberculosis,
97 rillnse grot.'P sub-cent!'0s end 18 clinic-cun-dispcnsaries.
polioL~el:tis, diphtheria,· tetanus, vr~opir.g cough and sonllpox nre carried out. ~Annex
1127
or
tha 26,401 births registen-d in Scbah in 1971, 5,490 took place in hOspitcls and rmother
J,,542 ·.:ere supervised by rurel health nt:rs~s. :rhe tlnternnl cortality rate in 1971 is O.50/1,COO live births. Duo to shortage of st3ff it hos not yet been possiblo to provide an organised school health services, bu: t;-;e st<lff fron health centres ~lo
visit schools to imumsc
school chlldren.
I.nti...r.:::l --.-" 0<_._":.rio ~.
Co::mni!!n ' __ -
T;!i' ~.ti-c"lcrin CaIOpaign, uhich covers the ,'rhole State, has reduced the nur.;ber of I:1&laria cc~cs froLl
an esticcted 250,000 in 1958 to 11,507 in Q971.
In certein prebleTJ oreas trnnsoi$sion
continues, tilot.rt;h on n lesser scale. ~~u.t~~.r.c..t~'l.osis Control Pro[)r::"S7Je -
(c)
no 7uberculosis i.s done both ,SY nass x-ray
Contrel Prograon: ;;turted in 1960 and by t.he end of 1969 the control
:lctivitics lIerc clrcady covcrin.; 7C!j, of the ect:inated Stote Population. c~~p~i&~
,\t r'''€5cnt case detention
cnd sputuo ex"~in3tion.
Direct B.C.G. inoculr.tion is given to
c:llJ.d.'cn :cod 15 years and below. 1.'1 1971, 1,27} tt:berculosis cnses (including a,fel1 "hieh werc non-pulnonsry) were diagnosed.
In 19C:J:) thero ';ere 2,652.
56,512 persons "He inoculated with B.C.G. in 197'. conpared with
7,500 in 1960.
In F'cbruory 1970, thore I1cre diaGnosed.
\105
an outbreak of Cholera El Tor in Pnpar District.
Eleven pases
(c) ?J:.h.e!. Infectious Diseases t!5.th N'Z~M to tho prcY'Olence of other infectio' s diseases please see J\rmex rJ.
13
v. ClIr.ltive services ore providoo fret.! 14 hospitnls with 1,1384 beds on:! ?i13 static dispensaries
vith ,,32 rest boos. Three of the hospitnls provide specialist services.
liUIlber of patients
.ndr.d.ttod into hospitals nnd dispensnries l1ere 55,379 in 1971 os corJpnl'oo with 20,296 in '1960. (
I).nn~: VI.
if I
--
Dcntnl Services
...... -~.--
:Chere nns
(l;~neral
expansion of the dental services in 1970 with 10 dentnl officers '//Orking nt
OM title.
There lire nltogether 113 school dental clinics in the St"te ruld 27 scrool dental nurses. \Vere
23,20;; attcndcnces V!I• ~raining
recorded nt the Gencrcl. Dentol Clinics nnd 60, :520 at School Dent.nl Clinics.
• r·
of the following cotegories of st!!1'f ore Illrlertnken by the State
t_
(0.)
Staff nurses hssi5tont Burses Rural Health nurses Labornto~ technlcinns
(b) (0) (d) (0)
Junior tuberculosis and ~nti-nalarinl workers.
Other cate£;Orics of ·staff e.g. public health inspectors nnd radiographers eN trained i.n
I
.... Itl-
'.
14
.\NNEl( I
PUBLIC lIEllLTH SEilVICES IN SI"1:.?:,\K
,.
l.'r.?l~
01' 3Ei:vrCES
lIS _ ...
'.
,
... . 11
..f<r
DECEnBEa .'
J
1967
1960
1969 12 1 756 119 1 C75
1970 13 1 B1B 148 .
1971 13 1 047 152 ; 1 999
I!o!lpitols :losl1itcl ned::; Ob!ltcl;rios
(No.)
10 1702
(No.)
1 731 119 1 050
COO.)
106 1 000
Totnl Beds ....... or- .......... • _ •. ,
1 966
Di:::;no;.~ari.~ t
Pixcd Trnvcl1inG l1D.torni~y
4~
43 14 B5
42 16
41 10 100
41 22
14 73
t Child Heolth
Centres
97
'\06
r-
.
__.
r .;(SO j1J 11"L ncGi::;~cr~
Doctors (:,)
66 137 512 223 153 148 1
83 130 532 240 164
63 129 574 2% 164 153 I
00
!K)
i"!o:;ict;ol'cd I)D"ti~ts (,,) RC::.ictCl~i.,.~
139 589
139 636 ,
Hidui ves
Trnincd
:!·.ll"SOS
235 168 156
263
J\s~ist:::...t"J.t Utn":::;cs
1172 168 I
."llos!)itr..l .'lssistQnts
160
I
(n) Incl u,.:bC public nnd private practitioners.
_"'-
-~.-
-~
,,
";>
! VITI.lSOTISTI~
~'-(-"--'
.IN ,r"
I!
S;\8Ml
f
-------. fIORTt.lITY " ;'. T [ S
·---+1----'1
YriJr (3) Infant (4) Toddler __
[--(~-)-'~~f~a~. __.
'.
. i.. 1 : 7"
72.0 G.l 7.5 5.6 5~E
7.2
5.6 6"G
6.0. 4.1
4.5 5.1 4.0
1.15 1.37 2 1.14 0.58
Per 1,000 mi d-ycar popu latlon.
2 Dea ths under 4
~eeks
per 1, 000
li'~e
births.
3 Oeaths under 1 year per 1,000 live births. 4 Deaths 1-4 years per 1,000 persons aged 1.4 years. 5 Number of deaths from pueperal causes/l,ODD live births. : Revised fi gur 0$.
" 4If:'
~I
,
-.
~ ~ ..
. '-.
IU
M:,TERNAL AND CHILD HE;.LTH SERVICES p 0.
r
t
i
c u 1 n r
s
1963
19C4
1%5
1.
Cli.nics ------------o;>oc'a.tod ~(cst
I·
19E6
1961
4 __196~. 00
__~9&)_.
_~,; __ ~m
1971
Cocst
36 79
43
49 93 7 15 164 136
51 95
60 96 26
fJ)
Interior ond Lnbuan 3ondokan l:l\/~'Q'
81
81
as 7 13 148 131
92
92
'J'3 32 24 236
126 !19
7 (j
17 19 182 139
34 'Zl
34 'Zl
19 201
26
r 0
~
.1 L
150 94
233 212
242 262
i7'\ 319
: 1!l. 111.
l.!!:rE_n.G2t_~.-2. ~~~lH.icsl Domcili:!!I J.!idwire::z
102
m
l.:::ttcrn::ll ..I!c::llth .......Clinics lfOlI
__
_-
(.0 7 124 22 732 1 879 10 OW 2 4f57 110 787 904 10 Eat. 13 749 38 427 2104 11 432 ~
Cases at clinics
14350 39300 2406 13 125 3 fAA 14(l 313 '\ 914 25 419 1 502
12575 47731 ! 683
12 1jo3 49 W5
15 439 73 247 3252 34 Ov.3 12 326 176 'Zl0
ll<:l'pl:tlt visits at clinics Deli \'Cries superviSed Post-nnt::ll dooiciliary visits :.nto-nn.tal dam ciliary visits Ltten::.:mccs of mthe..'"S ct IXH clinics Health cducction scssions AttcndCl1lOC nt scssions Fntrily l'lanning attendances
16m
18417
35m
60 595 7050
669'.6 4542
'\ 952 5907 2307 140 .835 '\ 410 21 214 424
2 93422<;05
10562
34883 11297
48 102 15~
439
147914 1 034 24973 637
I· 129 050
5121
7024 1325C6
1'Tl 373 2466
188 375 3546
2 3:>6 27 918 6574
2 \WI33 621 ..· 5 311
3129 39926 10234
15m 204
52449 14 W)
66615 23 300
IV.
~nnt em Child Health Clinics
llC\7 Cnscs at clinics P.epcct visits at olinics HODe
12132 97 934 9 749 1 253
15 456 141 057 22 137 1 453
17142 143 751 25112 1 513
17 953 144 039 26 f:oO 1 620
17 504 171} 09C 53169 5 194
13
0~2
1e 439 211 356 92724 20 003
113 556 214 570 210 921 20951
193 303 45 757 12504
I
20 003
visits
223 792
TrilllC :.ntiGcn
"-4r
¥'
... .....
~
~
-'
17
S/,BAH:
NLMBERS OF CASES OF SOME INFECTIOUS DISEASES NOTIFIED OR TR[,TED AS IN-f';,TlENTS (1958-1970)' 1961 16 1962 1963 1964 26 5 1965 14 1966 1%7 39 20 1968
AT I 1969 -.-. - -
IV y-
1~ I
1958
1959
I 1960
Typhoid Paratyphofd Bad llary Oyset1tr~
-
-- --
.
970 47
I 1971
113
4
24
4 8
20 10 39
31
45 11 46 . 119
I I I
2415 49
15 169
21
79 185
73 184
4 80 212
1
22
15 56 128
N.h. 263 N;A..
N. A. 213 N. ,\. EO
44 157
62 159 5
85 184
Alloibiasis dysenb-y Acute Po lfomye litis 1 etanus G iphlherfa VhOllping CoUgh
m 8 31 11
113 3
I 100
7 14 10
9 22 31
Z
7 31
Z6 56 39
8
1 41 10 48
39 3S
41 13 192
50 28
56
39 12
I I
23
31 20
45
22 20
6 60
26 21
5
-
11
27
179
22
21
14
45
_.. _ ' - .
I
\#
~
..\ .,
\:
r~
-.:
, •
)lit
I
18 !'UBL1C :JID ~IYi.rE
ANNEX V
UEDICi.L ,\IID HE:ll.TH SERVIClS
II Type
S
AT
;51
s t
DECEMBER
I
ServiCE
1963
11~ :
1 1965 .
r A C IIosl'it~s
I
1966
1967
.1 I L I T
I'~~~'_]~~ 11W9 13 1316 113
I
L19;'. 11 17~ 13
IE S
Rospitcl Boos "
9 1143 92
9
obst otrics Total
~" 92 1336
9 1244 92 1336
9
12 1305 102 1407
1. 1699 113 1012
1~
1244
92 1336
171J8r· 136 10041 i I
r' :J iJ 10
1235
1429
Dispensmcs FixOO
20
?lO
35
Tr~vollill(5
36
37
(J
37
37
30 5i
3o 5
II
4 6
4
5 7
!i 10
5 10
!i 15
Unteruty :m:i llnild Rc:U.th Ccntros (b)
5
7
151
PER SON BEL
I Registered Dootors (0) Rcgistcro:.'. Dentists (0) Dent al Surccons
LiCCflSed Dentists
I ) )
I I I
~
51 5 R.A.
l·---.. 50
--.
1!i
----~·-· 64
50
66
Registcrcxl iJidvi yes (0) Trninc.:! Ht.C:'"Jcs Hospitr:.l :.ssi:;to.nts
r·
2 I •••
4 H./;.
5 N.A. 11)7
7 N.A. N. A. 203 551
134
1?>4
134 37J
193 4711 185
1264
m 99
40.;
Assisto.nt i!urscs (n)
172 I
95
173
247
~rQvcllillG dispalsn---ics
denote ""tor e.nd mbile
disp~=ries.
, Th<"J do not include visits by hos/>itnl
.. (b)
!lSsl.st.mts "ho trr.vol Ion toot' to hold clinics at reoote areAS • These lac.. wo min henlth contrtos
olinic.3 umoh aro
~te frore.
run ore perm.nent buildings, r<.:.n health centres.
They do not inclu:le the cim~ static
ORIGINAL:
ENGLISH
NEW ZEALAND BRIEF REPORT OF PROGRESS OF HEALTH ACTIVITIES I
INTRODUCTION The final report of the Royal Commission on Social Security was released during the year. The Commission concluded that the present structure and administration of health benefits in New Zealand are essentially sound. Its principle recommendations are for some increases in the general medical services benefit and an extension of the higher benefit, to include children up to their tenth birthday. Some changes are also recommended in specialist, pharmaceutical and supplementary benefits. The Commission's recommendations are currently subject to consultation wit~ medical and other professions concerned. During the year the Government set up a Royal Commission with terms of reference to examine plans, policies and programmes as well as the functions, organization, and finance and staffing provisions of New Zealand hospital services. Relationships between preventive health services, hospital services and domicilIary and outpatient services are also being examined. The Royal Commission is not expected to produce its final report until June 1974. 1. DISEASE CONTROL
w
•
The total number of notifiable infectious diseases rose to nearly , 8000 during the year, but some diseases showed a pleasing fall in incidenc~. In 1971, for the first time, no cases of diphtheria were recorded in New Zealand. Also for the first time, less than 600 cases of pulmonary tuberculosis were notified. A further fatal case of amoebic meningo encephalitis occurred this year and research into this very rare condition is taking place in several parts of the world. A bacteriologist from the National Health Institute is receiving training at the Amoebic Research Unit, Adelaide, in the special techniques required to isolate and identify the causative amoeba. 2. FAMILY PLANNING
I
The Government has approved a programme providing for increased financial assistance to the New Zealand Family Planning Association togethe~ with a grant of $25 000 to be divided between the United Nations Fund and . the International Planned Parenthood Federation •
• lSubmitted by the Director-General of Health, 16 August 1972. ~
J.,
~
2 -
3.
ENVIRONMENTAL HEALTH
A study of solid waste disposal methods was completed during the year and a guide to the methods best suited to New Zealand is to be published. A departmental committee is presently considering the adequacy of present legislation on noise control. The year has seen a continuing flow of applications from local authorities for subsidies towards new projects for main water supplies, sewerage reticulation and sewage treatment and disposal and it is evident that the extension of the subsidy scheme in 1969 has stimulated the provision of improved water supplies and sewage disposal. 4. DENTAL HEALTH
~
More than 750 000 children and adolescents received the advantages of preventive and restorative dental care. Further community acceptance of water fluoridation brought the benefits of this health promotion measure to half the total population of New Zealand. 5. NURSING EDUCATION
•
~
Following a WHO Consultant's report, "An Improved System of Nursing Education for New Zealand", some progress is being made to allow for the study of nursing within the system of general education. From 1973 Massey University will offer a two-year diploma programme to prepare qualified nurses as teachers, administrators, and clinical experts. The University of Canterbury will now accept qualified nurses in its programme for the Diploma of Education. Several university extension courses for nurses have been held and three separate universities are at present considering formal proposals to allow for the preparation of nurses. A committee set up by the Minister of Education will shortly make recommendations to Government on the education of the majority of nurses. 6. INTEGRATION OF HOSPITAL SERVICES
This year saw the completion of arrangements for the transfer of administrative control of all mental hospitals (except one providing the National Security Unit) to the control of various hospital boards of the regions in which they are situated. This completes the first major, political and administrative step towards the provision of a truly integrated hospital service. For the future it is expected that planning and provision
- 3 -
of psychiatric and related services will follow the pattern already established under hospital board control for general hospitals. Hospital boards will be encouraged to develop comprehensive services based on local needs and conditions.
7.
DRUGS - OVERSIGHT AND CONTROL
~
Suitable machinery for quality control and good practice in the manufacture of drugs is in the process of being formulated and established.1 Careful attention has been given to problems relating to the misuse of drugs that fall within the ambit of the Department. A handbook for health educators on the subj ect has been produced and greater attention directed to the treatment needs of those affected by drugs.
!
•
Since publishing its first report, the Board of Health Committee on Drug Dependency and Drug Abuse has continued to gather material for a further report giving emphasis to sociological, educational and rehabili4' tative aspects of drug dependency and non-medical drug abuse.
PRO G RES S
I N
HEALTH NEW
ACT I V I TIE S GUINEA
IN
PAP U A
1.
INTRODUCTION: There has been a m.mbw ot notable achievements made in the health services of Papua lew Qainea within the last twelve months., These are outlined in the contents ot this paper.
2.
NATIONAL HEALTH PLAN:
2.1
It has been increasingly evident for some time now that the countr~ needs a comprehensive National Health Plan to be able ••• (i) ~ meet the ever increasing demands of the people for health services through the best use of aVailable and otten limited resources for the greatest advantage ot the people; (ii} 1£ establish clearly priorities for health action in Papua New Guinea; (iii) to relate IlX>re closely the health services to the health problems""'ind needs; and (iv) !2. integrate and co-ordinate I health development with the National Development Plan. I
2.2
Within this first new National Health Plan, priorities for healti action will be related to the best utilisation of the limited resources available. It is a fact in our experience that the people's demands for health services and needs always exceed by • the resources aVailable. The preparati,on of a National Health Plan will therefore make sure that these limited resources are used effectively and efficiently. So far, work which has been carried out during the year has been orientated to meet World Health Organisation pre-conditions I for health planning. The National Inventory of Health Resources and the collection of basic data are alllX>st completed and these are important steps to build an objective basis for health planning. Preliminary action was taken to establish a Health Planning and Epidemiology Section. Planning has been assisted b: Dr. J.H. Hellberg, a Consultant from the Christian Medical Commission of the World Council of Churches, and short-term W.H.I Consul tants. I
3.
DISTRICT HEALTH OFFICERS: The District Health Officer is the key link in the long chain for the delivery of health services. As a healt administrator his role covers the adaptation of national policies for the efficient utilisation of district resources for health action and the mobilisation of community support for the health services and to meet district health problems. He creates a productive environment for health programmes through planning, organisation and good manage men The District Health Officer is the leader of a large health team compriSing doctors, dentists, pre-school teachers, health extension officers, nurses, health inspectors, aidpost orderlies and other health workers. During the year action was taken ••• (i) to provide more information to District Health Officers relevant to~ir-llOr4 and.~U.j, to use more the knowledge and experience of District Health Officers fo the development of new health policies and procedures. Information and PartiCipation: 3.1 Field visits by headquarters profeSSional and administrative "'taff increased during the year. Selected documents and paper:.' were distributed monthly, includiw; division/section "Activity
.. ·/2
2.
Reports". As well conference reports have been distributed more widely along with the occasional ~ublication (Selected Papers on National Health Planning) and new bulletins on communicable diseases and staff matters. Apart from keeping district health officers well informed about the Government, their Department and health matters, these documents are selected to encourage feed-back from District Health Officers.
3.2
District Health Officers have taken leading roles in the preparation of Basic Health Action documents covering tuberculosis and leprosy control, health inspection, dental health, venereal diseases control, immunisation programmes, prevention of endemic cretinism, and the aid-post system. Primarily directed at District Health Officers, these basic documents flow from a restatement and clarification of policy to realistic objectives and targets for health action, standardised procedures, and any professional/administrative information necessary for the effective delivery of health services. Through continuing action, these documents will become eventually an operations manual for District Health Officers. As well, District Health Officers participated in Workshops reviewing the school health services and laboratory services and helped prepare a "Manual for Quarantine Officers". Participation by field staff at National level has improved health services and programmes. Definition: The Health Department embarked on a course of action ••• (i) 1£ define clearly the role of the District Health Officer; (ii) 1£ set down in detail the duties and responsibilities of these key health administrators; (iii) 1£ increase their profeSSional and administrative authority ••• with increased deciSion making within Districts and a closer working relationship with Councils and area authorities; and (iv) 1£ do everything possible to strengthen their position. District Health Committees are being established in all districts to bring Government and Church health workers together regularly to discuss district health problems and needs and to work together to provide the best possible health services within available resources. Tuberculosis and Leprosy Control: During the year, District Health Officers were given greater responsibility for tuberculosis and leprosy control services. Effective control measures for these two important chronic endemic diseases require, in addition ••• (i) a continuing review of policies and procedures and supervision and assistance from specialists; (ii) area teams for surveye, ~solv"ing", and_ special investigations as directed by specialists; and (iii) the involvement of as many health workers as possible (or the integration of the tuberculoSiS and -leprosy control services within the general health services). The full impact of these changes may not become evident for some time. Management:
3.5
The 1971 District Health Inspector's Conference was preceded by a Management SeInlnar conducted by the AdInlIllstra-
... /3
3. tive staff College. Health Administrators were introduced to "Management by Objectives" as a lDBllagement approach for the improvement of health services. Then followed a week of discussions, led by the District Health Officers themselves on health problems and programmes. Modern management techniques are important for the best use of the limited resources available for health when compared with the demands and needs for health services.
4. '/
~---!~--
CHURCH HEALTH SERVICES: The Executive, Combined Churches Medical Council, met twice during the year with Senior Health Department Officers. Church health workers attended Senior Staff Conference Meetings and participated actively in District Health Committees, workshops to review National health policies and procedures, and the preparation of basic health documents referred to above. Without any large increase in assistance to the Church health services, there has developed a closer working relationship between Church and Government in the health field. The future relationship of the Church and Government in health will be one important action area during the preparation of the National Health Plan over the next year. During the year action began to rationalise health services in areas where there has been competition between Churches and between the Church and the Government in the provision of health services.
MEDICAL SERVICES: areas, namely ••• 5.1
Progress in this field has been in 3 main
The expansion of the Port Moresby General Hospital to meet the demand imposed on it by ••• (i) the Faculty of Medicine; (ii) other training institutions; and (iii) the rapidly growing population of Port Moresby. The Port Moresby General Hospital is the Teaching Hospital for the Medical Faculty, provides practical training experiences for nurses, radiographers, and medical technologists and is a centre for postgraduate education of health workers. A new three storey outpatient-casualty and ward building will accommodate intermediate patients and intensive care patients and will provide an additional 105 beds, enlarging the bed capacity of this hospital to 650. An adjoi 0.".-:three storey block will house the Pathology Departm~ut near a theatre suite and clinical teaching facilitiea. There will be a new central sterilising department and a new kitchen complex serving the whole hospital. Y,
5.2
A RadiotherapY Centre equipped with a Theraton 80 Cobalt Unit was opened at Lae early this year. A caesium ward has also been built and is being managed conjointly by the Centre and the Angau Memorial Hospital. The Radiotherapy Centre was established on the assumption (based on past experience) that 1,000 new caeeB ofcan~r,-w6\l1Q lie ' ,~- registered each year and approximately 50% of these would need radiotherapy as all, or part of their treatment. A committee has also been set up to administer the TUMOUR REGISTRY OF PAPUA NEW GUINEA. This was initially carrieil out by one person.
. .. /4
4.
A Workshop was held during the year to examine the feasibility of setting up a National Health Laboratory SerVice. The recommendations made by this Workshop were in favour of a National Health Laboratory Service and the decision for this was based on the need ••• (i) for a Central Referral Laboratory; (ii) training of laboratory staff; (iii) for the effective and efficient use of available resources; and-riv) to avoid duplication of equipment and work.
m
6.
MATERNAL AND CHILD HEALTH: 6.1 Localisation within the Health Department continues. In the Maternal and Child Health Section, 43 out of the 65 centres are now under the control of local staff and at the same time there are 202 local trained nurses and 43 expatriates employed in the MeH Section. A local officer is also head of the Maternal and Child Health Section. Home viSiting, coverage of 0-5 years and ante-natal population ••• Within the last 12 months there was a marked increase in the number of homes visited. 52% of the total number of. children 0-5 years and about 40-60% of antenatals were seen by MCH nurses within this same period. School Health Service ••• There waS also an increase in the number of children enrolled in the school health service. A policy document las been drawn up to cover a comprehensive school health service for the .country and this is awaiting ratification by the Senior Staff Conference of the Department of Public Health before implementation. Nutrition ••• Among the main paediatric probleme of this country is malnutrition of young children. The Health Department realises that no one So far has calculated the National burden of malnutrition in Papua New Guinea, but we are conscious of the need to accord nutrition programmes a higher priority for resources and to seek a more effective approach to malnutrition. The department therefore planned a Nutrition Education/Policy Workshop to be held towards the end of this year. The Government of Papua New Guinea has also requested WHO assistance in providing a Nutrition Consultant and Fellowships in Nutrition in the 1973 and 1974 programmes.
6.2
6.3
6.4
7.
MALARIA SERVICE: The Malaria Control Programme haa been given a higher priority in terms of allocation of resources. The programme gives some protection to approximately 50% of the country.1s--l'eplilati~m...---- There has been no major change in the programme but activities in the Malaria Service have been intensified to provide better training of staff, improved spraying techniques and the provision of entomology programmes in each operational district.
0 •••
/5
-;
4;;:
5. 8.
/
MEDICAL TRAINING: 8.1
A diploma course in community health for para-medical staff was started during the year and it is now nearing completion. A total of 16 students are undertaking this course. This course is designed for the training of nurses and health extension officers to provide supervisory services to many of the health programmes in the country. It is envisaged that these officers will take up such positions as District Community Health Nurse Supervisor, Hospital Secretary and District Health Extension Officer. ~
8.2
A second course in post-basic midwifery for nurses has also been started at the Port Moresby General Hospital. The next group of medical students to graduate at the end of this year will be awarded a degree in Medicine by the Faculty of Medicine at the University of Papua New Guinea. Previously a Diploma in Medicine was awarded by the Papuan Medical College. Health Education ••• Almost everyone of the 15 districts in the country has a District Health Educator. These he~lth workers are graduates of our own Institute of Health Education. A three tier system of nursing is being developed for Papua New Guinea conSisting of a registered nurse; an enrolled hospital nurse and enrolled community health nurse, and a nurSing aide. The syllabi for these courses has been completed and the first graduates from the registered nurse co.:::8e and enrolled hospital nurse course are due to graduate in December, 1973. These courses are all of three years duration. Post Basic Courses are conducted in midwifery, psychiatry and a Diploma Course in community health as mentioned above was commenced this year. Further Diploma Courses are in the planning stage and are expected to commence in 1973, these are nursing administration and nurSing education. A plan for the localisation of nurSing positions is proceeding well.
8.3
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8.5
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8.7
9.
QUARANTINE SERVICE: A new Quarantine Manual has been drawn up. It is envisaged that this will greatly facilitate the'lO'IIk of the Quarantine Officers and will enable them to provide a better service. MEDICAL RESEARCH: Various medical research programmes are being carried out in this country and the following are of importance to the health services ••• (i) Endemic Goitre and Cretinism; (11 ) TreponematOSiS Epidemiology; (iii) the Tropical Splenomegaly Syndrome; and (iv) Epidemiology of Lower Respiratory Tract Infection. Further research programmes are being planned to be undertaken in the immunological status of the people in Donovanosis, Tuberculosis and Leprosy. Assistance in outlining these areas of research came from Dr. W. Byrd, WHO Consultant to the Faculty of Medicine.
11.
CONCLUSION:
Papua New Guinea is very grateful for all the
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6.
assistance received from WHO over the past twelve months and would like to say that future and continued assistance from WHO will go a long way in helping us to solve many of our problems.
Department of Public Health, KONEDOBU. PAPUA NEW GUINEA
31st August, 1972.
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RAPPORT SUCCINT SUll. LES ACTIVITES Sl',1ITTl',IRES EN REFUBLIQUE LllliERE
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La sit1..w:tion sanitaire de la Republique Khmere qui a ete fortencnt pert'u:L'hee clu fnH; de Ie. guerl.'c d I invasion imposee de force par Ie Victcon~ at NV,l:T depuis 1970, n' est paG beaucoup amelioree duro:n:li 11 aD.'"1e,3 ecoulee. Au cont.rai:li0 les effets de la guerra se font de' plus en plus scntil", m?,;J.\]W~S par les faits suiwants : 1- Augme,c!.tation a\\ :potential d I hospitalisation t d I evacuation des blesses et d i approvisioxmemen"i; en medicaments et en materiel mectico"~8anitnire et renforccment du personnel medi~a1 a tous les echelons. 2- Deteriolotion des conditions d'hygiene dans les villes par suite d I aUf;t~,entationcontilluelle des refugies fuyant les zanes de conbats jusqulou 30 Juillet 1972 on constate 711.413 refugies. . 3- Absence c1' acti vi tOs sani tairea' dans quelques provinc(;l;;J et les zanes e:':centriques .. Cepelldallt; gr3.ce a I' effort continu du Gouvernement et a l' aide des divox';J Ol'Eanismcs intel.'nationaux(OMS,UNICEF ,CROIXROUGE INTERNATIOlJALE .... ) et aux dons des pays amis, 10 niveau de la sante gen61'ale ct~ la population peut t)tre IDro.ntenu dans des conditions satisfaisantGs; aucune epidemie meurtriera d~nt on redoutetoujoil:rs l' apparition, n 1 est constatee nulle part. Pour prevenir les €:l)idemies, les activites de nedecine preventive son'v poursu..i:llies sans relache surtout dans Ie domaino de la Vaccination, l'assaiuissement du milieu, l'education san.i"taire, etc... . ' . Quant aux activi tes de la medecine curative, elles sont egalement impoxtantEJ:3 et axees surtout sur les soins medica.ux que necessiten-t l'6tat at 10 llomDre des blesscs victimes de' guerreo Pour pouvoir £"(bsorbcr tous les nalades. le nombre d e . , lit a dft etre D.'l.-lzw.cnte reg'ulierement(voir tableau 1), de nouvel- ' les unites sani taires ont 6'(;8 creees t I' approvisionnement 811p_1 plementaira en DedicaL'.Gnts et materiels nedico-sanitail.'e l.'snforcc par les dons et les ~\ides hU.manitaires des pays amis. iI ~J};?~AU 1 nrF'RL~~Ql~\jq~@~ 8h-~N 1970 et 1971
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1 11Jl.l,JIDIES TRANmnSSIBLES
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1) l'!8;lad.ies J].C?11~i~.£['~~£:L~1()I~~nt,,§, : - ~ cas de pest,en bnl)oniquos declares a Svay-Rieng en Mai et . 1 cas ~ Phn()~1·":P0I1j:, en Ao·3.t 1972. Des mesuras de desinsectisation et deratisation ant 8'1;0 p:dses par 1n suite ' . t ! a.ucun cas de cholera ou de vario1e obserVe. , Vaccinn:i;ioa en 1971 : Anticholerique : 1.763.128 ! Antivariolique : 197.017 Antipesteux : 90 Anti amaril e : 15 2) Les g rande i2.. enrl;t::i·e.1l : r a) Pa1udiK;'~ : I.D palt:disme reste 1a ma1adie n01 du p~s.L I arret des aspe:csroni~-'d 'v.ne :par·t~ 1e brassage de 1a population d I autre part ont favorise considMJableIJont 1a pu11ulation des vecteurs et par consequent 1a transnission de 1a maladie 6979 cas de paludisme i primaire sont decl::-.res P2,"-, 1es tledecins en 1971. I' b) Tuberculose :1"J. tuberculose vient immediatement apres 1e , paludi'SL1e'"""tTI3\Ji.}Cs.s cle tube:rculose pu1monaire declares par medecins' en 1971). Les nctj:,ites de lutte on'jj enregistrees 1es resultata suivants en 19"71 : ! • 22.237 Non1:lre de c1epistaG8 bio1ogique • radio1ogique • 17.091 bacteriologique: 9.556 /' • 67.254 NO:'lbre do vaccination B.C.G. c) Les ma1DJ.ies ·V'(h:u31.'ielles: Recrudescence des maladies vene~:{ riefunes dans to'ut"Ci.3-J.8Sv::LTres dont; 1n. popUlation a presque doub16e depuis 1e ~ebllt ,do 1S- (;1l8rre, (73? cas de s;r.phi1is et449 cas de b1ennorrag~es decL1T'es pur llledec~ns en 1971). . ,?-) .~re etyi.~~:2 : . Lc;s a.ctivites de 1n. ,lutte anti1eI?reuse, et ant~p~aru.que 80n"(; cons~del'ableIi1ont pcrturbeea par l'insecurite. !Lo~~ ca~ enre~istres en 1971 : 60 cas - l~::pre pian : 193 cas Protec:t;:i.Oll 1ll;;\ter11.o11e at infantile ---",-.",,","-"'''''''''',CamillI tallts : 'y""," ., +- d.., ~1 .iJ."A, : 33.593 - pC,£3t ...... ',lCdJdl : 11 .. 322 - i1}~fan:tHes : 139.971 I,
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• 69.180 • 20 .. 532 :Postm·llata.1.. • - irdant:Lles : 310 .. 035 - H:r.r-x:' .I.\Y~r-' n ......::.-,,".,~;~:,;.-;..~ ol~i "'e • • . "~~'~.:~~",::::,,';; • -};o:J:l):r'o d t infirn0:des d I ;1.nfirm:o:~:·ios scolaires : ~
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CO'~HJfJ.ltationD
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1970 111
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1971 116 233
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-No:"h:~'3 d:). iwi"(;·')[J au 1.21' secours -NoJ::'»)~') d t t)10''10:3 recQvant dt:s S\".)i21G • • ..,.Po::~.::,,·-:.~ t:.::::ti; _~.::::~)
219
S t·:.{)la~.. ~:'.~ aO::~.D... S
<le I:.. popUlation benefician:t dos
· • ·
316.295
30%
· • 155$249 · 36% • · •
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- 3 - ~rg~8fus~.on sa:nsuine (C N T S ) - Dcnneurs retribuea : : 9.956 - NOJ:1.bre : 4.555.250 ml - Volume - :Bo£[lov.rs benevoles : -~-~
- Hombre
:
- Volume -I,ivX'8.isons • _ _ _i ' = " _
: • •
_ 2.450 623.250 ml : 406850500 ml 450.250 ml
•• TIopitaux et cliniques prives: ~IVITES
- Hopitaux d'etat
HOSPITALIERES ( 1971 )
- Nor.1bre de consul tents M,
no:ml)ro de consultations lTo:clbre des malades hospitD~iseo
- Hombre des journees de
:
• • • •
75.837
trErlitement
•
•
• B-:tISF 1l3PO'~T
O}! ES.4.I:r H SITUATION IN 1972
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I.
BASIC POUCIES
The basic goal of the l:inistry of Health & Social Affairs for 1972 is the continued improvement of health and social services, not only by diminishing or removing factors ',hich are impeding the rapid economic gro,.th of the country, but also by playing t'. If'ading role in overall social devclopmnnt of thp. country, To attain this goal, the ~Iinistry has establishsd programmes -.rith thf) following thr!:'.c IMjor componl'nts: development of human potentialities, control of the cnvironmcntlll hazard !'no. improvement of general living conditions.
•
For the development of human potentialities, the I;inistry is engaging in the following programmes Me. acti vi ties: Expnnsion of the rur(11 hecl th network will be undertaken in order to e:~end heE'lth services to doctorless f::'shery "nd farming .?reas. Fl'mily pl.;mning sFlrvices D.re not only essAnti.?l to the improvement of lM.terne-l hFlalth but nrc ?lso vit;ol for oopul1'!.tion control -.rhich ".re in r~lev1'\nce to success of the Third Five YeC'.r ~Tational Development Plan, beginning from this year. Promotion of food and ('rug quality ~dll be strongly emphasized by the l'inistrJ, not only to eJ.evate the het'.lth status of· the population, but also to facilitate p.conomic development in such fields. ) I
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The second major component of the i':inistry' s '.,fork is the imnrovement of thp. environmpnt. In rural areas the emphasis is basic environmental sanitation, especially simple sanita.rywt'.ter systr,ms. ,Installation of other sanitary facilities, such as bath houses ,.~se'\'ra.gc trc:atmE'nt plants and latrines is also forccsccn. Amelioration of environmental sanit!'tion in farming anel fishrry areas is not only bi;ncficial from th,; point of view of health, but is also in line ,-lith the GovcTnl'!1ent's pb'licy of stronger region~~ ~nd rur"l development in order to ensure a harmonious socioeconomic development of the country. ,..-.
on
The development of agriculture is p!1.~ticularly emphasized in the Third Five Year Nation~l Develoroment Plan. This };inistry' s fl.ctivities . C're sustaining this effort in -progre-.rrunes of erivironIDen1;d .snnitation and expansion of hel'lth net-"J'()rk in rural area.·
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The ste~dy and rapid deterioration of hUIlk'1.n environment in cities nnd industrial (1reas bpcruse of environrncnt,~l pollution is of great concern to the l"inistry. Programmps arc being developed to monitor the pollution of air, Hater and 5O.il, a.nd to take corrective and preventive action. The rapid industrialization of the country creates new hazards in the irnmecliate environment of the labour force. The l!inistl."y is therefore continuing the development of ind.ustrial health to promote industrial safety and hygiene and protect the health of the workers. The third facet of the !"inistry' 5 programe is the. improvem.ent of general living conditions. The partiCipation of women in co~~unity life will be strengthened; an .effort will bp. made to modernize housing, health dev0lopm8nt of future gp.nerations will be assured. Ne(;dy people will bo B>.l.ppor.t.e.d through s'3lf-hc-lp projr-cts to enhanco thnir possibilit3.c's for s(>lf-support. Victims of disasters, thE'; indigent and handicapped will be given assistance. Therp Ni11 bE a continuation of th(l effort to shift the emphasis in child 'tII3lfare froo institutional care to home care J
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supvorto(l by such programmes as Of!.y care centers, adoption programmes ,and foster home care. The Hinistry ,·!ill ,.rork to~...ards restraints in conventional rituals J since they are "Tasteful and incompatible with a modern socipty" '.' The preparatory stuoips for gradu3l iElplementation of a social . security s~rstem will continue, Promotion of harmonious labour-m.'l.n2gel'l.ent relr.tions ,·rill be undertaken to assure undi StL: bed economic gro~rt,h. Through the impleDentatio.n of the above j~eDtioned priorities J this :';inistry is n&king its contribution to,.;ards the developrr;ent of a healthy, safe f!..nd progressive society J in the interest of the general welfare of ",11 the people.
II.
I:AJOR P"l.OGRA1,}·!ES FubJ.ic E",alth Services
1.
1.1 Acute
cornmc~icable
Diseases
Control is being achieved over some virus diseases notably poliomyelities. No cases of small pox, "'pidemic typhus or relapsing fever ¥~re renortAd. The incidence of some a.cute comr:runicable diseases have been gr~dual1y reduced, but Japanese encephalitis and typhoid fever still remain as major public he~lth problems. '::L Tor cholera briefly invaded r.orea in 1969 and 1970.
A ll"lt''lork of 192 health centers, 46 city or provincial hospitals 11 quarantine offices ,'nth 8 branches have berm established for sUrvdllRncc of thes/O diseases. The pro~ra.l!lmeS €stablishC'd by the Government to control the acute commnicablc disease arc as follow: . ~nd
a. l-!obilc TraInS for Acute Cornrrunicable Disease control in each health center.
b.
Cholera Prevention
To prGvcnt the re-occurcncc or new invasion of cholera, carrier dat/Oction "/as carried out and nation-wido vaccina.tion of 30 million persons was conplctC'd. c. Counter-m':'asures for Typhoid Fever
Bncausc of insanit!!ry Hater supplies and poor dnvironmi;nt thG incidrncf) of typhoid fpvor still remains a. major public health problem. Thn r..ov('rnmcnt has b,wn engaged in installing simple piped \vatcr supply syst~ns in thr rur~l arras. Vaccination against typhoid fr.vor is being givC'n to poonle 1iving in encl.mnic areas, who ar:o illll1'wdiatE,ly exposed to the risks. Y::arly diagn~)sis and tr:catmF,nt ,-.rill also contribute to suppres-' sion of thr disrasc. d. Japannso ~nc"phalitis
Japanese encephalitis has blOon one of thl" most sr,rious diseases in. view of its endemicity and high mortality among children. A Ja.pancso encephalitis vector study unit has been established with the help of Y1!O . to study the natur~l history of the disease and preventive measures. Small scale vaccination is being carried out in southern part of the . _coUI1.~.!7'_ ., _"'."
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1. 2 f\1wrantine To prevent importation of disease, subject to the International Pe?lth Requlation, 11 quarantine offices ,dth 8 branches inspect ship and aircrrft pc-ssengers c-.nc crc"" including cnrgo and vaccination str,tus as required by the Henlth RequJ.c-.tion. They rlso tmd.ertnke rodent 2nd insect Control in the qU£l.r8ntine ?rens.
1.3 Tuberculosis Toberculosis is one of the major henIth problems in the country; thp.re <'.rn currently 200,000 infectous c<"scs in the country and no less thRn 30,000 individuals "rill develop <lctivn infectious pulmonnry tubercu""" losis, in 8.dclition, nround 20,000 p2ticnts will die from this cl.isc2.se each yer>.r. To combnt the problem, the Government hp.s institu~ed I1Jl 1'.nti-tubcl'culosis ·progrp.lTUllc b,~scd on thE provisions of the LC'.w for the Prevention of Tuberculosis. This progr[lInme cODT')riscs the set-up of n health network for tuberculosis control(s:'rvice) ,·dthin the, herlth infra.-structure, by '" ssigning 2,000 fu.ll-tws TB "rorkors ,mel. providing expenses from the Govcrnm-nt tot.1.11ing 151, of totrl hcrlth bud.get Nhich amounts to US$O.l P.;,r c"'pita. The methods and appro8ches in by collection and strong stree on a initial intensive pIllS streptomycin
1972 will be the continuation of the
BeG progra.llI'Ie with emphasis on cO'1lplete covera.ge of infants, case-finding
examination of sputum from symptomatic patients ,·dth treatel'1ent programme following standard procedure, e.g. triple therany follo\'ted by twice weekly high-dose TIm or PAS under sun~rvision.
The number of Cases of leprosy in Korea has been roughly estimated from 80,000 to 100,000 by various authorities and these were distributed throughput the country, mainly in the southern part. In 1961, the government concluded an agreement "dtll 'oIHO to develop a leprosy control project, which has bAen extended year after year. Under this project 33,$22 leprosy cr..ses ha.ve been detected, registered and treat~d under supervision by 12 mobile teams and 102 casG-~orkers distributed in the rural countries.
1.5
P~rasites
A.s parasitic inf8ctions flourish ,1idely througho.ut the country and especially in the rural eTfoas 1 tho government promulgated th<) law for the pr"vpntion of Parasitic Diseases in 1966, :md inititated th", nation-.dcle parasitq control nrograrnme in 1969. The emphasis is put on the encouragcmmt to sanitary disposal of night-soil. The 55 areas haY3 boen selected as night-soil prohibited areas, '-thGrc parasite-free vegc,tablcs are culti vated ext-ensi Vf,)_Y. In 1972, the Govorn:::'nt "HI conduct a mass survey for 7.98 million studEnts anel. t,rHl contim\cusly provide free treatments for tho:;) patients rlil'lCO h 1 "d .. ----Bt-·-add:\. tion, thC'pTogromnc ,dll be extcndcG to r-l"~c-ue,.W "/!Il')nt r'r the p'_rr>g"nimrs1's p~.tinnts rOf(fst-erad with hc!'lth cent~3rs.
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b.
Providing technical sf'rvicns to tho' h:oalth ccmtcrs in rolation to the family planning, c. Dovelopm8nt and publica.tion of teaching rrwterials in family planning, d •. Rjscarch, evaluation "nd analysis in family planning and popul3.tion growth. . e.' Coopnration 1vi th inte-rnal <md intcrnationnl orgap..izations engagod in family planning, end f. Othrr ~.ctiviti.s relet.3d to tho abovr, itp,ms.
In 19711 ~, total of 1,500 nPrsons including fordgn trainees "ere trainr>d "t the Institute. It is pbnned to provide training progrell1me for 1370 family plA.nning workors in 1972. 2.2 Hl'tcrne.l end Child Hf'alth Achievements for 1969-1971
2.3
Nutrition
In order to obtAin besic datn nnodod to plen thr> natiof,~ policy which is to promote the physicn· stp.nd,n'd p.nd strength of the people, to change thr. dietl'ry pattr:rn 'md to plAn the demand rnel supply of food resources, the ne.tion"..l nutrition survey will be> carried out i'nd the nutritionnl standerds for differont groups vdll be made • .The Food S'lnit"tion Lew revised on l>rch 30, 1967; it provided for the nmeliorn.tion of the nutritionnl st1'.tus of tho pcoplG. According to this le.w action has been tr.ken to C2.rrJr out the nation."l nutrition survey and to r-.mploy the nutrition guidance vlOrker to the locr.I government. \.
In 1969, tho r'~1'tionnl Nutrition IlJprovel!lent DGCr80 (Prosidontinl decree No. 4012) v~s promulgl" ted. This d8cro8 has [l.ccelr:rA.tcd the carrying out of the nutrition survry ~nd tho employment of nutrition guidnnce workers. ~11.191:2L--th9_ nutrition"l sbndardf) for dHf.:;r(mt groups will be st1>.blishedj nne! thn ch'l.ngo of the dioti'ry pr>tbcrn will be accelcraf;od throuRh Tlutrition oducntion. Tho] 3rd mtioni'.l nutrition 'survo~' will <'.150 be C<lrt'iect out, solccting 600 houssholds in "rei'S of Pusan, Kyongsnngpukdo, Kyonpsr.ngnnmdo rnel Cheju-do. G
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3.
~rodic'tl
Aff:'.irs Service
3.1
He'llth JI:ebvork
Tho h0<!lth net1'Tork in KorGO, consists of nc;,tion01 '1nd public hospi t(',ls, hct11th crnt:,',rs ,~nd hCi'lth s u b - c e n t e r s . " " :I~edic"l
['nel. Hc",lth Fl'cili ties
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-~-.-.
Z(6 Generd Hospit",ls 13. ,115 i 606 Clinics 5,700 I 2,386 'i'uboTcu:1F:ais:' : Dent",l clinics (1,426 , Epidomic Herb Dr. clinics 2,443 1,399 I HOP,lth centres 'I 192 t Health sub-centro ' 1,342 I ----.---. ,.--.. - _... ·-----·f-·--·----·-····· .. ,· .....;- -.--- ... ",--, ..-.--.--., .. ---..- - - .. -- ..
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l!rdical regiomliz~tion is r()(1rrangC'd :ond the country is dcvidcd into 1,102 r,3gions according to the new schr,ms. Th0 195 out of tho tok1 1,102 regions nro still cloctor1<"ss rrons, where either 3rd or 4th yen.r modical rosidcnts will bE' sGnt to thos(~ (lrC1CS strrting 1 April 1972. In nddition to this rearrangmcmt of regionplizption, IB mobile medical to'l.ms were cst.'l.blishnd e,~rly in 1971 and hilv() borm in operCl.tion in order to provide cfficif'nt mrdical trcntr'lcnt for the residents of remote rurE'l ~re!ls. '!);ach teen consists of " doctor, :. nurse,1\.' nurso !I.ide nnd (' driver.
Health Personnel <,pd ;':GOiCl'.l Educl'tion The nu.'TI.bor of registered l'l(xlicd ['.nd h,.'.)dth mmpowcr w,,"s <,s follow:
.................... 16,207 nurses .......................... .. 16,222 Phrrrnn.cists ......... . 16,636 The rlcdicci
D8ntists ..................... . 2,452 Hid"d. vas . ...................... . 6,059 Horb 11sd. Dr· ...... ......... .. 3,357
.
oducntion [lnel ::nnu111 gri'.cluntes \'mre <'.5 tollO'l'r: •••••••.•••••••• 780 (c.rmud gr,')du"tcs) ............................... 100 ., .•.••••••••••• 1,118 ............................ 2 J 591
Hediccl. schools ••••••••.••• 14 Dl3ntpl schools ............................ 3 Ph~rm~coautic"l school •. :: •• 14 tTursing 9C hools ........................ 49
Nurst} .Aid school ••.••••... ~ 40 ••••••.••••.•• 4,194 Herb medical school •••..... 1 ..•...........••.• 60 School of Public hS[llth ., •.• 1 ••••••••••••••••• 50 P"ra-Hedic"l personnel 3'~hccl .• 2 •••••..•••.•••••• 610 The Government plAns to incr8".sIJ the output of medicf:l workers to r<9<'ch the stl'nderd of one doctor per 1,21.3 people and nurse nor 623 people by 1986. To rench these proportion, 32,346 doctors !'.Dd 64,555 nurses aro needed. 3.3 Dent"l Hf'l'lth
--1--'
. Pre.smtly thero I'"re 1 ,309 ckcnt"l clinic (' s follow; 15 a~ .. the general -lwspit~ls rll-~t BitY'/pro~ll1c:t1'd. Hospitds, 30 at h,,~ltn centers, 1,237 pri1ctitioncrs and 16 mobile clinies.
- 6-
Th2 l'·!inistry h~ s made !'. long r".ngc pl[l.n for I'. progrrunm.J of flUOri'l'l3 rpplicO'.tio)ls to p::oovrnt dGc"~'ed tooth in 200,000 school children ennunlly. 223.052 "'lcoN torcr,tcd in 1971. In 1972 the progrrllll'10 "Till run frora April to D;crnbrr for 200,000 scheol children rt hcrlth cC'ntcrs or by mobile team. The liinistry oxpccts throug'.t this progrrun.mo d9crc~ses in the rate of decayed teGth to 5cr% in 1981 eg,:>inst th8 prcsrnt rete of 7Cf!, 3·.4 TI'flining ef Honl th lr!erkcrs
An train:'Lng ni'~g!"mmIlGS in p·.tblic hr;:'.J.th have be::m administratively centrdizec in the l'T"tiend Instituto of Hedth with qunlified full time st,:,-ff rnd ~. vroll equipped building for training ~nd laborrtory fn.cilities. Rof8I'osr:or and in-seI'vice) sup'~rvision COUrSC3!),re assontirl to maintr in stl'.ndards of op8I'Ptior., p",rticulr.rly in the oprr<1tion of the periphord units frr rCI:lovcd fren, the centI'"l n.uthority, Ref.reshf.r tr!'.ining for tho health f\ids ~nd specil'l:L~oc. trrir.ing for nrious types of health personnel hr.vc: b . 'en carrind out 'It the ~J[ttion[>l Institute of HC111th. 2,865 person' hl'.d been roc ~i ved tI'P,inings in 1971 ':-.nC: 1 J 966 will h- trained in 1972. 3.5 l:cdic"l Logistics . Thi' losistics l'l."nr ~"'I:lrnt of medic,,]. r:quipmcnt 1'no. supplies hr.s o ffecti VC' ly boen undert?-krn in continu8d ~cl1'ti.nistrdi vc fornrulation by rlnking criticr.l ~:r.."lysi5 of dOl,."nd/supply planning rt ~ll levels.
All possible offort h8s also boen g:i.v0n to the trClining programme fer tho irlprovC'l'lcnt of tochniqu0s of ?ell h('~lth \~rkors especially serving in logistic m1'n"grmcnt of both l\,clmnistrdi ve rnd t!',chnic<'l fields. In 1972, logistic managRNEmt is J11B.inly emphasized on stnndardization of medic"l instrumens r.t each bvel, improv8ment of techniciM 1 s qucl.ifiC6tion and rstablishJ11cmt of ccmtra.l mobile team to supf'I'visu and guide on local govcrnI:lcnt c.ctivith,s. 3.6, Hedicd InsurC'.nce
To '-stablish a social socurity systpm the governm('nt promulgatF"d the I'pN for Hedic,,1 Insurance in 1963. A pilot projE'ct was lannchcd for the enplo;)"ocs of pri vntr. ('nterpris!" in 1965. Three medical insurance corporlations hlWC been cstl'.b1ishcd. The nUl!lber ef beneficiaries are 3,672 · ..·insurpd persons and 13,169 dependents, as of Dec(,l!lber 1m . . In 1972 the govornmont will expand medical insurancc.90verago to secure a total of 9,000 insur('d persons. To improv(' th" administrC'.tic'lU of mGdic:\l insurance, the Hinistry nOvT has under study proposed le.W's relrting to .tho finrnci"!l l'l-o"magomcnt of the programme. The Govcrmcnt will cnd0,wour to double compulsery c<'vcr"ge by 1976 "nd include hnlf of thr; n.~tionn,l vwrk fnrc8 b3r the end of 1980. ,
'3. 7
N~t.i('·ll,~l
.
Inst:itut r.f
Hr~lth
Tho InstHut,; h,s Bur8'lu'"f',c1"-'linistrClti('n, Dept. "f Tr'l.ining Dtpt, c'f'11it:robi~']:f',Y; Thpt,' of Ph<>I':'lncalogy, Dept. r>f Hygiene, rulC!. the Dept. of Virology, Outlines of th'j functions ef Institutu <l.re r-s fol1owe;· n.
b. c. d. c.
In-si Tvico tr"1.ining r>f public hC!1.1th i.lt'rk('rs. Surv.;ys, studi"s np0 eV11u!'tion ("f nr:tioni>l he~lth progrrnmas. Proc'.uction,.,f ~ncl rr:,si311.rch on prevontive rnd th"r1'.peutic drugs fc·r.il1f cti' us diS"1~.s;_1S~ ______. ~_~ _ _ l :n~J~'sj.s) ;.ss'~Y, r"lF.<>rch, :'nc . 8v.11u:-tic'n " f drugs nnd f()0d. Sci: nt.ific inv':stig!'ti'-ns, ·~Xt.nini tin,s, rcs::r,rch "nd ov"luti(ln r,f inf,Jcti,us ~nc1 e"nbginlls ctiSCO'S'3 "nd 'tIl cnvir;-mm8nt~1 h~T"i'-T'" p:o:"·blrI:ls. c
- 7 -
r. g.
CoIL;ction, r,)s'J{'rch rnd :>n.~l~·sis (f n(.-c~~s,",ry !'I',tGl"i".ls fer the C0ntr r ,1 "f nnrcctics. AClninistr[l,tic'n rf lntinnr>l eXf'mn:.tiC'ns fnl' hr;i'lth \,j(':rkers.
,
AchieveMcnt 13,625 c(1ses II 3,425 II 8,784 II 1,4l7 24,223,597 c .c. 19 course (2,865 person) 28 subjncts 9,898 persc-,n
Assny &
Y;x~m.tiens
N{'ti('n~l Ass~y
Requested Assay 1j;v!1.1u~ticn rf St'lnd"rd &: ti.:x"rUn"tiC'n geth0d Rin10gics Production ActivitiF.-S , , In Servic':) Tr1l.ining Rese!',rch PrC'jocts Nption'll ~XM1.
P. H. Persnn'l.l
Pr0ducticn of Rinlngicc;J. l>t8:rhls in 1971 "nd Schedu] 'Oct P) nn jr 1922 :
N"IDC nf Bi010gics Chn1er2. Vl'.ccine Typhr,id V,eccine D,,». T. V,"I,ccinc Snall Pox Vaccine TE'to.nus Toxnid Typhus'V?,ccinc Polio Vnccine B. C. G.
Unit c.c. II
1971 12,130,950 7,850,000 1,lf62,00O 3,603,300 202,080 21,000 1,200,000 493,380 251,900 272,000 600 20,628 19,560 100
1972 19,000,000 7,000,000 1,;WO,OOO
I
d0se
" II
c.c. dOSG
P.P.D. ;:,ntigr;n J.-r.:. Antigen Fluke !'.ntip;cn 'Dbgnrstic Sere'Totnnus Antit"xin Diphth0ria Antit0xin Diphthcrh Vc>.ccinc J.E. Vt'ccinc '~idp1
c"c .. II
"
II
" " II .
Virl c.c • II II
464,460 30,000 607,000
-
O.T. 4~
3,600,000 80,000 200,000 1/;00,000 550,000 330,000 240,000 600 16,400 24,800 100 1,600 400,000 30,000
-.
"
-
1!:nviroIll'lentl'l Sorvices 4.1 11.. Envirrnmcnt~l Sani~tion
Improvomcnt "f Rur::l '.Tpter SupplieS
\
38 percent ('f- tn,} 'totr>l popu).ation in thi~ c,.untry i',~'C' ~8rv0\{ by either city "",",tor supply 0r's:iiipic ¢rr:,d "ntd~ slip}5:Ly syst9c~;. The rest nf59% '11'0 doponding f"·r th,ir' ;",t,,'~r 'supplies on public 01" 'pl:ivl1,tod "1'31~, <"nO. 3% of the populr-tion uti;t.iZ8 strcar.ls ri v~r !'nd etc., fc,r thoir drinking purposo • .Tn n,rdor, to reduce water born comunic0,blc dis'~~3:;S, tho g0'1fQrnm-."nt h1'sdocid.jd \;( imprc'vc rux:{Ilvw"~.tcr suppli('s, "1'9,]1'\,5 c~'n~~~lCt ..d .~6)~ s~~o ptped"r'lt?l" SUPR~.Y_,SYsteus since 1967 Which S"rYe 630~fJOO 121,) out -or--t0talpopul~ti0n.
... 8-
Fnr th0 ir.rproverl'mt of rur,~l "/~tp,r supplir:s 1 tha gt'Vornl'l,,,,nt h.-'s sr;t up ; ye,"'r p1"n (1972-1976). Du,rine this' pr:orir d; th" g,vcrnmcmt will cr·nstruct 8,880 simple pipeel. 'tlckr supply s~rst(mlS : .. nd 110 {400 PUb.l.iC ',~" \-nIls 50 th .. t "lMC'st 100% cf rur!'l VpuJ."ti0n (15,450,000) will br: c"Yord· with S"f3 loll'tor supplies "t the end ('f 1976. 500 si.'TIplo piped wdcr supply SySt0lUS "nO. 3,000 public ",,115 "'ill br c"nstructed in this ycc.r.
5 Yccr pll'n fc·r impr0v(,l'lmt (·f Rur"l TI",tc-r supplies l-Tumbcr nf Simplr Piped T.r<'tE'r Supply systems to be C0nstructcd by Ycn.r Unit: syst0m 1972 Sil'llplo Pipr:d ',r"tcr Supply Systrm 500 1973 2,095 r
1974 2,095
1975 2,095
1976 2,095
Tot?,l
8,8W
Public "Ic~ls 3,000 26,850 26,-850 26,850 26,850 26,850 b. ;;astc Dispc's3-1 Thf' mnst urgont pr·,b1clI:l in W(1.stc dispoMl is thG proper dispr:sel ..,f 16,800 trms 0f W<'.str ,...hich is prcduced in 32 cities under the Special Cl,Jansring '.roCts Frogr:1I'1l'l.J. Fer th::; prODGr disnns"l r·r W1l.st,), it undnr study tn r"Jpl['.c;) cpen dUMping Be thrcl.s loTith 511 nit:J ry l<'nd!ill. Fnr the pr"p"'r "'OISt" disposr1 in ru1'"l "1'r",s, th:l GrvcrnlYnt r.ncrur",gC's c 0 ffiprsting mc:th(ds f"r night s0il rnd unst,',s.
In (\rd:;r t" trnl't tho night s"i1, thr G:w"rru~rnt 1.al1 incr:::-".s0 th,; numb0r ~f S:;w"g:; TrJdncnt Plrmts "nc'! r'ight S"i1 TN"tncnt Pl~nts in rnjor cities. Th" Gc-v,)rnnrmt is ~lsc studying the crnstructie,n:!t c'~IT.lunity pl:'Dt such {l S Irm r ff T"111<-S <'no. Oxic.",ti<'n t'"nds fcr urb,m "TO,:'.S while nnc(\url'ging Cn I'1.p('sting !,!,:;th"cs f<'r rurrl rrc".s.
Th~ fight ",g'1.inst r.i('squit0s is n vitn.l ccnccrn v' this country,' sincEl sr:Vf'r.~.l iMport.~nt discns.-)s .",ro tr'1nsmittrri by th<"n: Jr.p!'nO'..s3 'Enceph"U tis 1 l'l",lClri", "nd Fill'ril' sis.
A mosquito surv:cy.cll,rrir:d (Jut during thr' l."st fow ~r03C'rs; using tr<'.ps inst.'lilod in 25 h€I'.lth crntrf;s thr0ugoout the c('untry, Sh0W_,d th('.t th3 4. ~est C0mmon spGcic)s "ro CulC'x pipi,"ns, /,ode:s veX<".ns, J,n0pheles sinensis <1nd Cul()x tritCl,(lniorhynchus.
For 1971 the Gcvernr.!ent c0mmitt~d "n"thor 4,805 g?llcns eof D.D.V.P. E'nd 56,400rg "f O-Dichlrr"bf;nzcne 1 pnd the r8st cf th8 r(".quirr.monts supplies by thn 10c~1 g8vornmonts.
4.2 "
En virclll!lEmtl'1 PC'lluticn
The p0pul<'ti<'n grcwth; thE' urbC'nizf'ti0n rnd the ",",rid industrid development h',\s brr·ught up thi' (1nvirC'nm,mtrl p<,llutinn prcblol'ls. ~!'lcont1y, the' l,~\·, I'n prnvrnti0n (Of public lluis,"ncc H<',S "mended in ('>rdcr to strongthon leg:-l p(1WOr sr thrt th~, strict crntr01 rg.~.inst sourC<:l ,. cr pr;llutants br, m,.. dc • .Thc l)~ l,.w is offcctiv(1 from Jp.m,~,22,19-7·l-.·-Th:iJ3 ministry "rill Cil.rrJr "ut th0 insp('ctirn cf 3,000 suspr,cted scurCt1s which p"ssibly. pr0Cl1.lco hrrmful' polluti'nts. 4 dr monit2::ing systc:m ~ll be. cst3bU5hed)i!l_S~<::uJ",. pnd 4 wc:tf'r ::i'Di..t8rin~ system. ~1l be 'st:-bb:Jhcd ~l"'np,sid() j:,~e .,Han RiV8r thi-s- year~ f('r' tho c~ ntiinucus m('m to ring p~osc.
- 9 -
Th.:~ sr,urcos 0f fn,:·d supply "nd thr circulatinn (,·f fr.>I")ds Rr8 very div,·rs, 1:k'1.king the' rnf:-rcrn'pt cf f(,,'cl senitntirn rc·gulRtiC'ns'"ditficult.
In 1971, as ,016 entrrprises wc,r4 lic(ns:'d fr'r foro' p\"cJ.';~V or ""d fcvtl Clistributinn: 22,000 f,~Ctl-rif'S ,~nd 66,013 r'Ol"st"ur?nts. C0 np"r8d. te) 1966, factcri8s h~vc incre.:'.s8d by 160% ~nd restaurants by 116;;; During 1971, 257,211 frr,d insp0cti r ns 1'11'2r8 cOlrricd rut. Of thr:sc, 76,9% p'iss:d, Hhcr,", <IS 600;!' rf the pr~ducts l'ln.d" in f"ct,~,ri(S or sr.rved in rr,st-"ure'.nts wcr<~ f"'uno t- vi.ulate thr 1C'.ws ~ind rrgu1:-tions rn f0r·d prncJuctir n f'nd instruc ti(,n. thr qu.~lity
The fr n". .ing l'l<~" surr swill b' taknn in 1972 in r:rchr to imprc.vc rf fud Dr"·r11.lcti ~n "nd distributir-,n: (1) (4) Strcnethrn th,: si'.nit"ry insp- cti('ll 1~()f'sUr0S k
(2) St'.lndnrdiz'1.tir'D "f f'cd lind foed I1dditivGs' (3) Pr::cvrntirn; f fond poiil"ning - RClS3e.rch inpr"V0 frcd qu"lity cr,ntr(l
5.1
Ph"rrn,.'1.cC'utic"l l'''nr'g()r1cnt
Il" 1972, prn bloMs rf drug se.tety ['no efficacy will b0 d,",nlt nr,inly by th·:: Grv('rn"!lcnt r>nd tho dr'I'l"stic productirn 0f raw l:k'1tr.ri.~ls will b(' c"lntinu"u£ly c·M.ph" SiZ0d. t.1Ul'lbC'r "f Ph? ITk~c::,;utic~.1 Cc'np2nir s ?.nd Pr"ducts By Yr::.r
I ~:~r
___
-~~~~-N_1-0_~ 'o~ ~~-'M.-?:=;_;~_-'_-'-_-_. -.--t<-I:=.=_·~_f_P_-~d=.U=~-~~-_·-_·-_·-_J 627 474 447 460 469 471 491 .
~----~,------
1965 1966 1967 1968 1969 1970 1971
'!
11,955 a,157 8,477 8,32 2 8,196 8,522 9,442
I I !
I ,
I
5.2 Qu"lity Cc.ntrrl Th'1 phrorm",cr:utical industry h~' s r"l'chrd .'1. st" ~o "Thrr; gr('\\.th is rnpid ~nrl productivity is r'-!"l!'<rkrobly ;'xpl'.nd!')cl. Th" G0v:crnr'lrnt h~s b,)on givnn c0nsicl.'Jr".bl;} ",ttcntirn t') the:. gui'r~ntQG of S<I.frty "nd cffic:'.cy cf drugs. ~t th·:; nn.tirn!'l lsvrl, [' study to rc-nv!'luC'.tr, thr snfcty ()f d.1 nuthrrizod(nb('ut 9,000 kinds) drugs h'.'.s .~J.rGndy bf;on undcrt"kon. In nefer futuri', "n oXl1mim.tirn "f ('"ch nnN o.rug 1'll'i11 be, uno()rt"k('n t,- doterrlinc sr>frty by , n,'.T1y t;stl'blish(]d Exprrt COl'l"1ittC'c, bcf0rc the I'uthr)rizr.tic<n f0r l!L-:nuf!J.ctur3 is issued. "
l
r-
Yr:?r .
-.--
-~
...
-
----
Insp0cti n n C"lSCS .--"
I
Vhbtinn Cl' sc; s -~-'
-
1965 1968 1970 1971
44,552 173,220 146 ,407
7,273
-,
Rl'tc l'f Violl'tion '.
C%) -- ..
I I----
'. .
16.24 . 10.02
146,630
--.._ ' - ,
17,363 5,952 4,893 - 10 -
4.06 3.34
--
Thr> phr:>rl'l"c(Outic1'l industry'is (OxT-l"ctco. tr c()ntinuo f':1pir1. gr"wth, fer tho d€'!"\.<>nrl. is likdy tr incr8,".>,sc "ccorr,ingly \,lith thr i~lpr0V(pl(nt ,.,r n.?,tiC'n:-l incrl'lt> lcvol. Tho phr.IT.l"'.cQuticr1 industry, ",hieh is n(\w "ble t" supply" 97"'. of the aOl'l0stic dOl'l."nn, "nd Mnucl '-xports \-lnrth nt'''r1y 7 r.1.i11i('n (clirrs. ')u'lli t.?ti vo il'lprov:';rtcnt is oxpr-,ctcd tr [I,cecl'lpr-ny the p,r0.rth, S" th[l,t in 1976 14h:m the .3rd Five Yer:>r l-T:-ti('n('l D0vc1cpmont p1rn ono.s, tho 1'nnul'l C'xpcrt ~nr.unts will rro.ch t.pprC'xil'lt.te1~r 15 l'lillicn (lellr-rs.
I
-_._--
~:~ 1969 1970
" ~k'n II
1966 1967 1968
:~0:::::::9 :~~~~: ,000 12,494,994,000 14,856,194,000 22,833,661,000
v=,lur. "f
IlbIbr Vr1uc 5W 1,261,257 1,.389,018
('~-'-D0i1[>r
7,892,888 10,.364,785
~r5 '~:::l~O
Vduo
2,48S,691 3,468,469 4,781,736 6,681,012
13,828,955 15,5 2 9,429 19;66$,69$ 22,074,62S
1 . 1971
I 47,809,642,000 ,--.---__._____ 5.4 ~T"rcrtics
291829,113,000 40,546,60e,000 ~~--
------I--....:..~~----~
l"nd PSychotT0pic Substr.ncrs
"
Nprcr,tic irrogu11'ri ti!Cs hl'V,l cl"'.nspicu 0usly dncr3!',s'3d since tho cn!,"[:t:mcornnt nf tight c0ntrC'1 in cr11!'b()rCtti0n with ;.>rosccuter' s ,~fficos pnd tho N"tirn:u f0lico in 1966. t ' Th" n:U11b,'r C'f vk1"ti"n Cf'SPI'l s'!ginst th::- t,!crcXc l~w in 1966 ,>/[>5 2,236, but in 1971 this 'l'IPS reducf'd t, 699 CC'.s('s. tTrrcotic inspc<crtrs of this ~anistry hC'vQ cr-nccntratf'o. C'n thr inv('stigaticn r.g<,inst sLlugg).:crs, -, c1nnct<"',stin8 f.'l.!"nufl"cturf'rs, traffickers, ~nd peppy cu1tiv?t~rs. The' Sl!1uggling route's hC'v(' bncn bl()ck.~d8d 1'nc hcbitu.:'l ('ff(.ndcr~ (Ire kept ;!nd"r survoillllnce.
-11-
ORIGINAL: FRENCH REPUBLIC OF VIET-NAM
BRIEF REPORT ON HEALTH ACTIVITIES IN 1971-1972 1
Health activities in the Republic of Viet-Nam during 1971 and the first semester of 1972 have been highlighted by the following two
features: I. II. preparation and implementation of the Four-Year Health Plan covering the period 1972 to 1975; continuation of programmes in the fields of health and medical care. PREPARATION AND IMPLEMENTATION OF THE FOUR-YEAR HEALTH PLAN
• •
1.
The Ministry of Health has undertaken the preparation of a four-year health plan (1972-1975), within the framework of the national development plan, since early 1971. Preliminary studies were made during the first semester of 1971 and the second half of the year was devoted to the actual drafting of the plan at central level and its revisions on the basis of information provided by the local authorities. During this period, meetings were organized between the authorities concerned in the Ministry of Health and the chief medical officers of the provincial health services. Short intensive training courses were organized for the benefit of the assistants to the provincial chief medical officers responsible for the preparation of the local health plans. The national health plan was implemented at the end of the first quarter of 1972.
....
A.
Its objectives are as follows: 1.
••
Medical care Expansion of the hospital bed capacity in proportion with the increase in needs (including those due to population growth) • Improvement in the techniques for the provision of medical care to the patients. Provision of the most comprehensive possible medical care.
2.
Control of communicable diseases Application of suitable measures in order to control diseases which are a potential danger to the community and which may be avoided through mass preventive programmes.
Submitted by the Director-General of Health, Ministry of Health, 12 August 1972.
1
- 2 3. Contribution to the improvement of the standard of living Improvement of living conditions through achievements in the field of environmental sanitation. Fighting poor and unsanitary health habits of the population through health education programmes and the development of the "sanitary hamlet" programme. Improvement of the living conditions of the rural population, the working class and the ethnic minorities. 4. Maternal and child health Provision of adequate and more efficient health care to expectant mothers. Co-ordination of activities in the field of health care for children in good health or sick. Strengthening of the school health programme, in particular at the level of the provincial primary schools. Laying the foundations for the future development of the family planning programme when legal obstacles are removed. 5. Rehabilitation Establishment of physiotherapy services in a number of hospitals. Establishment of a system for the follow-up of the handicapped through domiciliary services. Consideration of the construction of a rehabilitation centre for paraplegic children. 6. Health manpower development Training of more teaching staff, organization of refresher courses and seminars, improvement of the educational system for health manpower in order to upgrade these services from the quantitative and qualitative points of view. 7. Utilization of material and financial resources Optimum utilization of available material and financial resources. Consideration of a more rational and scientific utilization of facilities provided to the authorities concerned at all levels.
• •
....
- 3 -
B.
Priorities under this plan have been established as follows: 1. 2. 3. Training of health manpower. Provision for a systematic and rational operation of health services. Improvement of basic health services. Control of communicable diseases. Maternal and child health. Contribution to the improvement of the standard of living through the implementation of programmes designed to enhance the health status of all citizens.
, , ..r
4. S. 6.
)
•
II.
CONTINUATION OF PROGRAMMES IN THE FIELDS OF HEALTH AND MEDICAL CARE
(a) As far as medical care is concerned, the total number of hospital beds has been kept at the same level as the previous year. It should be pointed out, however, that two large hospitals located in Saigon are in the process of complete renovation, with the assistance of the Governments of Japan and of the Republic of Korea. It should also be mentioned that a plan was prepared for the creation of a number of rural health centres to be established under the responsibility of a medical officer at district level in areas serving some 100 000 population. Six such centres were being established at the end of the first semester of 1972. (b) The special "sanitary hamlet" programme, which is the mainstay of most public health programmes at the rural level, and which was assessed at the end of 1971 and beginning of 1972, is being further developed throughout the country. Two such hamlets have been organized in each province. (c) A pilot school-health programme for the benefit of a number of primary schools in rural areas was established with the aim of improving sanitary conditions in these schools and bringing preventive medical services to the schoolchildren. This project was implemented during the first months of 1972 in ten schools located in four provinces which are to serve as demonstration schools for the future development of this programme in the other provinces of the country. (d) The control of communicable diseases continues to be of concern to the authorities in the Ministry of Health: The mass immunization programme for the young generation, particularly infants and schoolchildren, was expanded throughout the country early in 1972. Plans of operation have been drawn up to extend BeG vaccination coverage to all newborn in government maternities, to the children attending
••
j
" - 4 MCH clinics and especially to the schoolchildren in the primary grades. Vaccination against smallpox, tetanus, diphtheria, whooping-cough and poliomyelitis will also be expanded in order to cover the majority of pre-school and school-age children. Satisfactory progress has been achieved with programmes for the control of plague, cholera and haemorrhagic fever. The same applies to programmes concerned with the control of tuberculosis, malaria, venereal diseases, leprosy, etc. (e) The maternal and child health programme has made substantial progress during the period under review (1971-1972) due to the establishment of a common plan of work for MCH and family planning. Pilot family planning clinics have considerably increased in number, from 13 at the beginning of 1971 to 40 at the end of the first semester of 1972. There is also a great increase in the number of women attending these clinics: the rate of attendance went from 5000 in 1971 to 13 000 - 15 000 during each of the first two quarters 6f 1972. (f) In the field of environmental pollution, an inter-ministerial committee was set up early in 1971 at the initiative of the Ministry of Health. However, this committee is still in the process of studying data. Some activities were launched in connexion with the education of the population concerning air pollution in the capital during the first semester of 1972. Conclusion 1. The most important event which occurred in the field of health activities during the period under review has been the development of the national Four-Year Health Plan. On the whole, achievements in the field of health can be said to be encouraging although recent developments resulting from the offensive of the Communists from the north have given rise to a series of new problems in view of the large number of civilians (some 600 000 persons) fleeing the invaded areas and seeking refuge in the various camps organized by the Government. Nevertheless, these problems have not prevented the normal development of existing programmes and the health status of displaced persons is being maintained at a satisfactory level due to the efforts of health personnel at all levels.
•
.~
2.
•
l,
J
ORIGINAL: WESTERN SAMOA NATIONAL HEALTH SERVICE, 11 AUGUST 1972 1 1. GENERAL
ENGLISH
,
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1.1 Western Samoa celebrated in June of this year, its first decade of independence marking its emergence from a New Zealand Mandatory Territory to that of an Independent State. 1.1.1 It comprises a total land area of 1133 square miles. The population density as of the last census is 126.6 per square mile. 1.1.2 Population. As of the last Census November 1971, the preliminary count was 143 547, showing an increase of 12 170, or 9.3%, during the intercensal period 1966-1971. However, emigration (excess of departures over arrivals) was 8970 during the same period. Without this excess, the population would have been 152 445 by applying a crude death rate of 8 per 1000 in the same period. Income per capita increased from WS$180 to $200 in 1971. 1.2 The Second Five-Year Economic Development Plan for the period 1971 1975 was published at the end of 1970. This was reviewed and the detailed sectorial plans for 1972 were prepared. This covered nine health projects with major emphasis on the development of the main central Apia General Hospital, Tuasivi Regional Hospital, District Hospital, environmental sanitation, family welfare, nutrition and the training of health personnel. The total National Health Development budget was WS$119 178 for 1972. This represented a 23.7% increase over 1971. The total health budget of WS$933 315 has increased by 15.0%. 1. 2.1
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1.2.2 The percentage of Health Expenditures to total Government Expenditures was 11% and current value per capita WS$6.50 - an increase of $1.25 over 1970. 1.2.3 The UNDP country programme for the period 1972-1976 has been under planning. The indicative figures of WS$5 000 000 for 5 years included four projects proposed by the Health Department, namely, National Health Development, Hospital Development, Nursing Education and Training of Health Personnel. 2. 2.1 SUMMARY AND ASSESSMENT OF HEALTH ACTIVITIES
Health Project Activities
lSubmitted by the Director of Health, 17 August 1972.
- 2 2.1.1 National Tuberculosis Project
The integration of tuberculosis control into the overall national health programme is making steady progress. The improvement in BeG coverage and case finding and the overall support of the people for these services have contributed much to the control of the disease. 2.1.2 Filariasis Control Project
The second mass drug administration was started in January 1971. It is expected that the project will be further integrated into the general health services, except for the entomological phase. During the year, selected blood surveys were carried out in six villages with a population of 1222 people. Only 5 or .041% were positive. Further surveys will be done this year. 2.1.3 Public Health Laboratory Services
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The improvement of the National Health Laboratory, Apia, and the establishment of the Regional Laboratory in Savai'i represent a significant contribution to the control of communicable diseases and overall medical services. 2.1.4 Water Supply improvement of water supply followed WHO assistance in of a detailed plan for development of water supply in A survey last year by a WHO expert showed a coverage of country.
Continued the preparation Western Samoa. 81% for all the 2.1.5
National Health Manpower Planning
A WHO consultant studied the problem of manpower last year. His report gave very valuable guidelines for the development of health manpower in the country. The overall doctor population for 1971 is 1 - 2815. If those in administration, on special assignment and post-graduate training overseas are deducted, the ratio is 1 - 4101 with a distribution of 1 in 2385 in the metropolitan area and 1 in 6638 in the rural area. Based on his recommendation on manpower study, long-term planning for training of health personnel, improvement of nursing education, a local training course for sanitation, in-service training, seminars and other training activities are in progress. 2.1.6 Family Welfare
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The establishment of the Family Welfare programme on September 1971 with WHO assistance, marked a longed for needed health service. The overall interest and support of the medical and paramedical personnel in the rural areas in two recent training seminars has been most encouraging. A survey on knowledge-attitude and practice in family planning has been conducted. 2.1.7 Health Statistics and Records
Valuable help from WHO experts and other assistance resulted in the establishment of a Health Statistics Section within the Public Health Division.
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Hospital Administration·
All but 2 of the 16 rural hospitals were fully staffed by the end of last year. A WHO consultant on hospital administration was made available to Apia Hospital late last year. 2.2.1 A re-development plan for the main Apia Hospital was approved. NZ$150 000 per year for 1972-1974 under New Zealand Aid have been set aside for a first stage construction of a 400-bed hospital. • j ,"
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Hospital Indices (1971)
The total bed capacity in all 16 hospitals was 626, with an overall bed population ratio of 4.3 per 1000, within a range of .9 to 7.2. The overall average bed days was 8.7 in Apia and the rural hospitals range 4.9 - 7.9 days. Percentage bed occupancy was 63% in Apia Hospital; in the rural hospitals it ranged from 16 to 79%. The number of hospital inpatients per 1000 of population was 95.1, the outpatient attendance including home visits was 1484.4; overall hospital mortality was 1.09 per 1000 population. 3. COMMUNICABLE DISEASES
Common enteritis and other diarrhoeal diseases (ICD A4 and AS) are still the most prevalent of the communicable diseases. They are still the second common causes of morbidity in all hospital inpatients and the third in mortality. Although reports were not complete, laboratory confirmations showed a reduction of almost 7% in 1971. Typhoid showed a continued decrease from 195 confirmed cases in 1967, 111 in 1968 to only 9 cases in 1971. WHO assistance both in expertise and immunization has been of great help. The five leading notifiable diseases are influenza, infantile diarrhoea, measles, unclassified diarrhoea and infectious hepatitis. Increasing immunization has helped to reduce typhoid and, to some degree, infectious hepatitis. 4. SANITATION
4.1 With an improved water supply, and the help of the guidelines of the planned cost-benefit study on the typhoid control programme, construction of water seal latrines was given serious attention by the Government last year. With the large outbreaks of typhoid in 1966 - 1968, the Government in 1968 advocated the removal of all sea drop latrines in the metropolitan and adjacent district areas and the introduction of water seal latrines in a "clean your village" campaign week. as a measure of public health motivation for the people. 4.2 Since 1968, the coverage of water seal latrines in the country is about 15%. The Government last year approved WS$ll 000 for a 50-50
- 4 Subsidizing Scheme to complete coverage throughout the country. target was 2000 units per year for 1971 - 1975. The
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4.3 A training course for sanitation workers has been approved and will commence next year. The additional sanitation personnel recruited have started reorientation training. 5. DEVELOPMENT OF RURAL HEALTH SERVICES ;
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5.1
Health Pilot Area
A pilot health project - trial and error and general evaluation area has been established (1968) about 18 miles from the urban national headquarters. Population (1971) - 12 111. Its establishment has played an invaluable part in the progress of all health activities in Samoa. At present, it is concerned with the following activities. 5.1.1 Technical Procedures Technical procedures to be tried out in the area: (a) (b) (c) (d) 5.1.2 an improved health recording and reporting system with family centred approach; the field manual for district health personnel; the integration of special campaigns into basic health services tuberculosis control and maintenance phase of filariasis control; the training and utilization of village birth attendants.
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Study Programme Study programme to be conducted in this area: (a)
workload analysis of the district health workers, leading to the establishment of a practical work programme and staffing pattern for the rural community; a family health survey with emphasis on the identification of morbidity - mortality patterns and the utilization of health services in the rural community.
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(b)
5.2 With the development of Tuasivi Regional Hospital, the post of regional medical officer of health, previously suspended owing to shortage of personnel. will be filled in the near future. 5.3 Regular monthly and quarterly meetings are held between the district medical officers and district nurses, WHO e~perts and National Health authorities to discuss the improvement of the health services.
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High priorities are given to the development of water supplies, water seal sewage disposal, improving housing and the general environment, preventive immunization and other follow-up health activities. 6. RADIATION MONITORING SERVICES
Western Samoa has been most fortunate in having established a radiation monitoring service with the New Zealand Government as part of the South Pacific International Health services. The last report received 30 March 1972 for 1971 - showed that average levels of radioactivity measured per each country station are "small fractions of the references levels and do not constitute a public health hazard".