Annual report of the Regional Director to the Thirteenth Session of the Regional Committee, 1 July 1962 - 30 June 1963

REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN EM/RC13/2 WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN ANNUAL REPORT of the REGIONAL DIRECTOR to the THIRTEENTH SESSION OF THE REGIONAL COMrnTI'EE 1 July 1962 - 30 June 1963 The RegionGl Director wishes to express his deep r ecr et a t havins to announce the l oss of two members of his staff in the a ircraft that crashed near Cairo on 12 May 1963. The trasic death of Dr. A.S. Wallace Gnd of Mr. Luis Miguel has cQused s r eat sorrol'; in the Recional Office and in t he Organization as a whole . TABLE OF CONTE~~S I N T ROD U C T ION G ENE R A L REV t E W I REGIONAL COMMITTEE . . II ADVISORY AND TEC8~ICAL SERVICES EDUCATION AND TRAINING MEDICAL EDUCATION , ASSISTANCE TO EDUCATIONAL INST1TUTIONS A~~ GROUP TRAINING ACTIVITIES AUXILIARY TRAINING . . FELLOHSHIPS PROGRAMME COMMUNICABLE DISEASES MALARIA ERADICATION TUBERCULOSIS . ' ... ENDEMO-EPIDEMIC DISEASES BILHARZI ASIS SMALLPOX YELLO\<i FEVER CO~UNICABLE EYE DISEASES VETERINARY PUBLIC HEALTH BRUCELLOSIS HYDJ..TIDOSIS ?VELIC HEAL'I'H SERVICES HEALTH EDUCt\T:LON . . . HEALTH LABORATORIES AND RELATED SERVICES MATERNAL fIND C~ILD HEALTH NURSING PUBLIC HEALTII ADmNISTRATION GENERAL . . . . . . . COl-1fl'RJNITY DEVLLO ptilE/'.iT RURAL HEALTH HIj/RC13/2 page i 13-14 15-19 19- 23 23-26 27- 33 33-35 36-39 40-43 44- 45 45- 47 47- 48 48 48-51 51-52 53-60 60- 63 64- 66 66-67 67- 68 EM/RC1)/2 page i i VITAL AND HEALTH STATISTICS • • HEALTH PROTECTI ON AND PROMOTION CANCER CONTROL ENVIRONJ'llENTAL HEALTH HUMAN GEl'J"ETICS MEDICAL REPJl.BILI TATrON AND PHYSIOTHERAPY MElI.'TAL r;.EALTH NUTRITION •• RA.DIi>.TION MEDICnTE III FUB~IC I NFORNATION IV ADI"lINISTRJIT I ON AND FINANCE; GENERAL • PERSONNEL BUDGET AND PItTANCE ANNEXES ANNEX I P~OJECTS BY COUNTRIES 68-71 71-72 72-7 '0 78- 79 79- 6) 83- 82 88- 90 91- 95 96 96-98 93-99 ANNEX II ACREEMENTS SIGNED BET'vIEEN 1 JULy 1962 AND 30 JUNE 196) I N T ROD U C T , ON In my last report the statement was made that in recent times perhaps two factors were mainly responsible for the present trend of reorienting health towards the community as a focal point. TI1e first was the impact of the social science techniques, and the second the polarization of social groups by industry. The old concept of the community as a beneficiary has given way to an approach based on the clear understanding that the community is an active participant and not a passive one. This constitutes an important point to be borne in mind in the planning, operation and evaluation of the health ser- vices in the countries. There is now in the Region, by and large, a keen sense of self discovery and of self awareness associated with a new leve l of aspiration w~ich has great influence on health needs. In any new plan, considerati on will naturally have to be given to these ne\'/ concepts. * * * During recent years, the trend toward planning for national development in t he form of broad integrated programmes, emphasizing amongst others the interdependence of soc ial, economic and health factors, has been gathering momentum. Several countries of the Region have created national development counCils, in which the various ministries are r epr esented. It is of course important from every point of view that t~e Ministry of Health should be adequately represented on such council s . A broad approach to socio-economic and cultural problems in rural and urban situations is also in line with the present trend towards integrated planni ng of national development programmes; it EM/RCl)/2 page 2 is not surprising therefore that the search f or a solution to some of these pr oblems has l ed many nations of the world, i ncludi ng some in this Regi on, to experiment with community development methods and techniques . The Regiona l Off ice has actively assisted in a number of such programmes within the Region. * * * The importance of close cooperation between Governments, United Nations, the special ized agencies and ot her i nternational organizations , and the need for more coordination of work between them, is now recog- nized to a greater extent , and the advisory role of w1l0 is being .i ncreasingly sought in the preparation of more progressive and effective health development plans. It is hoped that countries where WHO Representatives nave been e stablished have benefited from their on-the- spot advice in t his connexion . The crt: ::. tion of t he Economic Commission for Africa in Addis Ababa which i ncludes in its membership six of the countries of the Region, wil l help further t::'e col l abor ation between Gover nments, the World Health Organization, and t;rh= o the r Uni t;ec Nations agencies . WHO is par tici- pating actively in t he work of t his Commissi on and the one for Asia and the Far East (ECAFE), esp~cially in the field of national pl anning and development programmes . A main functi on of the Economic Commissions is to help j.n t he orderly expansion of national economies so that the provision of social services keeps pace with the better use of resour ces and improvements i n education, agriculture and i ndustry and with the needs of so ciety at al l times . In planning for the provision of such serviCeS education and training of heal th personnel is a most important item because programmes may demand considerable capital investment and recurrent expenditure over a long period . case \~i th medical educati on. * * * This is particularly the EM/RCl)/2 page 3 One of today's import~~t problems generally and particularly in this Region is to reconcile the viewpoints of the curative and preventive arms of the medical profession . This has been said many times before , but a solution of the matter becomes increasingly urgent in order to ensure that both receive their proper emphasis in our programme of medical educat ion. As far back as 1952 the report of the Fifth World Health Assembly on its techni cal discussions concerning the Methodology of Health Protection in Local Areas stated "the education of the doctor in the dual aspec ts of preventive and curative medicine was stressed and it "las held that a doctor who was engaged in treatment only, was only half a doctor. This was especially true in a rural health situation wh ere t.he doctor in charge had t o perfon!] both types of services". The problem of interesting doctors in preventive medicine is general in this Region . The reason lies not so much in the attitude of the doctors themselves as many authorities might believe but in the type of medical education provided f or them, and in this fi e ld a careful re- examination is needed bot~ of the objectives and of the methods of medical education . Science having made very rapid advances in the field of health, i t is now widel y r ecognized that mer ely to treat a patient is not enough and that the condition of his f ami ly and of the community in which he lives plays a fundamental part in regulating disease and i11- health. Our medical educators have until very recently not concerned themselves much with t he wider problems of t he family and the community. Future doctors must be aware of the:'r influence on health and of the remedies available and necessary t o deal wi t h adverse health situations . The lVIedical Education Conference held in Teheran J.2.st Oct:j b<..r. helped greatly to arouse interest throughout the Region and bc!;!ond its boundaries. Participants and observers were people who ranked high in academic ar,d administrative positions . A number of Deans were present. EM/RC13/2 page 4 The conclusions underlined the importance of such gatherings and the Regional Office was called upon further to stimulate activities in the medical education field . It is planned to go further ahead with meetings and consultant advisory services. .. .. * Our increasing attention to medical education in the Region does not detract from our conti nued assistance to programmes for training of auxiliary personnel. It is recognized that the health auxiliary worker has, side by side with his professional colleague, a definite r61e to play in the development and strengthening of health services in many countries of the Region and for marv years to corne. Many WHO-assisted projects for the training of heal th auxiliaries in various countries of the Region have been in operation during the year. Successive groups of trainees have compl eted their programmes, the majority belonging to the traditional categories of health or medical assistants, assistant sanitarians and assistant nurse midwives . However, by virtue of advance planning, the training of ot her categories of health auxiliaries such as laboratory assistants and dental assistants has also been undertaken in the past few years. Regular r evi ewing and evaluation of health condi- tions as they exist or are envisaged in the different countries, ensures that efforts are directed to training the right type of health auxiliary worker who will meet the r apidly changing l ocal needs in the public health field. An important development i n t he domain of auxiliary training during the year was t he ini tiation of ac tivities for the preparation of tutors and supervisors of auxiliary workers . ~,o inter-country projects, both in Beirut, need special montion. One was started last October for the training of laboratory technician tutors, the other, for the training of psychiatric nurses, \'jas completed in August 1962. Plans are under way to repeat these courses. EM/RC13/2 page 5 Other similar inter-country projects are also contemplated including a course for training X-ray technicians (in Baghdad), and another course for trai ning sanitarian tutors. * * * Fellowships In the overall programme of activities in the Region have accounted for 20% to 33% of the expenses for field operations during the last five year s. It should be remembered that the actual amount spent is considerably higher than t hat budgeted, which shows that a good part of any accrued savings is direc ted towards fellowships in order to meet Government requests which have increased year by year. For instance, the number of awards in 1962 \~as ) 1'( corr,pared wi ttl 306 in 1961 and 221 in 1960. Since the evaluation study of our Regional fellowships programme covering the first eleven years, the results of which were included in the Regional Direotor's Annual Report to the Regional Committee, in 1960, more countries. ,lave me.de successful attempts at advance planning of their IfdO fellowship programme . It is felt, however, that there is still room and need for further improvement in this connexion. The programme now covers Ii wider range of study as \'/el l as more highly specialized fields such as drug control, radiation prot ection and radioisotopes, virology and mental health. It has now been decided that, in order further to follow up the matter and afford an opportunity for an exchange of views and experiences, a meeting should be held in the autumn of 1963 in Alexandria with the national directors r esponsible for fellowship programmes. It is hoped that this meeting will succeed in analysing the probl ems and further stimulating this important aspect of our work. * * * Almost all the great variety of large-scale maladies in the Region are in greater or less degree linked to the environmental conditions EM/RC13/2 page 6 under which the people live. Thus the enteric infections and infestations as well as malaria, bilharziasis, t rachoma , tuberculosis, onchocerciasis and even l epr osy are subject to cont rol through improvlng the environmental. health. I n many respects the r ate of progress in the realm of environmental health in the Eastern Medi terranean countries seems to be very satisfactory. In providing public water supplies, for example, several countries have achieved records that are remarkable, especially when compared with previous situations. It is evident, that the stimulative activities of WHO and ceoperating agencie s in t he Community \1ater Supply Programme are having effect . HOI'iever, it is disillusioning to discover that, on the whole, the number of additional people being supplied with water is not nearly equal t o the grcwt~ in population. lI':i1ile we are running fast, we are falling behind. We must increase the gait. Another important fact is that excellent and costly water supply works are not being maintained , operated or managed in a manner to achieve their intended purpo se or t o ccnserve the investments. There is a great dearth of personnel qualified to perform even the simple functi ons involved. They must be found and trained if health is to be protected ~~d money is not to be wasted . It has l ong been the desire of the Organization to make some telling progress in the difficult matter of rural sanitation. For many reasons the ach ievement has been uncertain and slow. Demonstration proj ec ts have failed to "demonstrate " and we concluded long ago that efforts in this field vlere apt to fail unless adequate collaboration of all r elated bodies Via s assured. Now , i n Pakistan, it has been decided that attempts to establish and operate health centres should go hand in hand with measures enabling the tributary population t o enjoy a reasonable degree of sanitation , and especially a c l ean water supply. WHO agrees cOmpletely with this view, and UNICEF concurs to the extent of putting up almost two EM/RCI3/2 page 7 million dollars to provide the blessings of sanitation to the e~t ire population of eighty-six rural health centres. This probably represents a "break-through" for both rural sanitation and rural health service that will be emulated in many other places. * * * Malaria eradication programmes in the Region have continued to progress steadily. Out of the 171 mill ion population under malaria risk, about 46.6 million or 27% were protected during 1962 compared with the 38 million or 22% protected in the previ ous year. The success of this huge campaign, which is the largest public health scheme undertaken in our Region, has been achieved in five countries or t erritori es and is noVi clearly in sight in many others. Although eradication in some countries will be delayed because their programmes started late or local conditions or technical problems hampered progress, advances have been constant, and this permits us to look at t he future with well-based optimism. It is, moreover, encouraging to note t hat the new countries that have subscribed to the eradication poli cy are already well advanced in establishin3 pr e- eradication programmes. This is an important further step towards t he final goal of global eradicati on. The new approach is enabling these countries t o implement the eradication programme starting from a sound basis of administrative and technical preparedness , thus avoiding hindrances to progress experienced in some other countries. The i ncr eased participation of the public health services in the malaria activities and the improved effic i ency and extended coverage of their rural health sector is another healthy sign that in t he final stages of the programmes, full responsibility for consolidation and maintenance wil l progressively be handed over to these service s. The demand of t he programmes for special i zed personnel have generally been met satisfactorily through the assistance to national tra.ining centres and award of f ellowships. EM/RC13/2 page 8 Progress has been achieved also in the field of international coordination through meetings 8.:1d exchange of i nformati on. Iran and Iraq held t r.eir bi- annua l meetings in October 1962 and April 1963 , and Syria joined Turkey in a meeting in April 1963. PaId stan acted a s host to the annual Burma-Indi 'l- Pakiste.n Bordor rllalaria Eradication Coordinat i on Conference. The interest and participat i on of i:1ternational and bilateral agencies in the programmes were 8nhanced and maintained by their attendance at the varIOUS meetings and by 20nstant contacts t hrough the Regional Office. * * * The three smallpox eradicat i on campaigns noVi under way have been showing enccuragi ng result s . I n the Sudan the fi r s t phase ended in August 1962. ~18 success of primary vaccinations was approximately 95% and t hat of the secondar y about 85%. The second phasG , which s t arted last November in thr ee southern provinces , is continuing . In the East Vling of Pakist an , w:-Ji ch is one of t l':.e most highly endemic areas i n the world, a programme to aohi eve complete protection is being implemented i n two phases. The first phase , mass vaccinati on , will f ini sh to\·;ards t be end of 1963 and the second phase of f ollow-up contr:::>l measur e s, which wi l l start in November, is expocted to be c omplet ed in 1972. A smallpox eradication campaign in 'de st P8.kistan is expected to start i n Ju ly and continue for h lo years. Fre8ze- dried smallpox vaccine is produced in the country in suffici ent qu,·.nt1ty f or bcti:. East and West 'ili ngs . Yemen l aunched a three-ye~r mass vacc i nation campaign l E'.st July . Saudi Arabia is expected t o start a three-year eradicat i on c:o.mpaign i n It is hoped that t,lOse countr i e s which have not ye t dral'm-up plans for eradicati on wil l do so in t he near future so t ;·,u. t t he: global eradication campaign may be furthered. * * * EI'I/RCI3/2 page 9 Since last year, WHO short-term consultants have reported new bilharziasis foci in the Southern Province of Lebanon and, in t he south of Somalia, a prevalence of urinary bilharziasis especially i n t he area of the Juba and Shibeli rivers. In addition, the increasing population and widening areas of i r r'igat i on in the United Arab Republic continue to accent the need for study and research to provide more effective and economical means of snail control, and also necessitate broadening the scope of the bilharziasis control programme and enlisting t~e cooperation of the irrigation and agricultural departments as well as that of indi vidual l :,ndowners. In Iraq, the new WHO team at t he bilharziasis control project has , been' actively engaged in planning the future programme of work. In parts of the Sudan and the United Arab Republic surveys have been made by the WHO Bilharziasis AdviSOry Team which indicate t he feasibility of field trials of Aqualin, a chemical t hat acts not only as an efficient mollusci- cide but a l so as a potent herbicide. Other chemical compounds such as leI 24223, Bayluscide (rayer 73) and sodium pentachlorophenate are also proving effective as field molluscicides. But the progress in the control of bilharziasis is still not in proportion to the growing problem. * * * As f ar as maternal and child health is concerned, in a region with an infant mortality rate higher than 100/1000 live births, it would be unrealistic not to conc entrate on eliminating the causes of maternal, infant and child mor tal ity with the means at our disposal rather than attempt at t his stage to organize service3 for i nfants under a month old, prematurely born or otherwise. I t is t he older i nfant , and the child from one to four years W:10 is more likely to be debilitated or die from diarrhoeal disease, malnutrition, parasitism and communicable diseases , and if t heir mortality and morbidity are reduced , experience has shown that the state of t he infant of less t han a month 1s also improved. EM/RC13/2 page 10 Thus in the fi eld of nutrition, too, the concentration should be on improving the condition of the pregnant and lactating woman, the infant and pre-school child, and for thi2 it is necessary for every centre to be able to give effec tive nutrition and electrolyte rehabilitation services. Among the factors influenc ing this "vulnerable" group and requiring attention is irradiati on of the mother by X-ray or fluoroscope. * * * So far activities aimed at radiation protection in the Region have mainly consisted of assistance to governments in establishing national specialized services. This has been so a lso with regard to cancer control, although in t his field there is a new development. Epidemiological studies are about to be carried out in a few countries of the Region because of the high incidence of some malignant localizations, such as bladder canc er, oral cancer, oesophagus cancer. WHO is planning to participate in thi s r esear ch work. It has been r ecognized that, for early detecti on of cancer and subsequent cure of the disease , exfoliative cytology is the best method to employ. vlliO intends to encourage the use of the method and to this purpose is considering organizing a Regional training course for doctors and technicians. * * * Another activity has r ecently been added to the responsibilities of the Regional Office: the practical a pplication of a growing science, human genetics. Nobody can ignore its importance to the practising physician and the contributions it can make in elaborating a public health doctrine. EM/RC13/2 page 11 It is true that problems of !-Jcredity and congenital malformations are not at the present time the first concern of public health authorities in many of the countries of the Region, but these problems may become important with advances of clinical medicine and therapeutics, and also with the improvement of private and public hygiene. Consequently WHO efforts in this field will be aimed first at research projects based on statistical and genealogical studies, second at medical educati?n which should include human genetics, the most important element in biology, with a large number of specific ramifications in clinical pathology and practical medicine. * * * It has been estimated that perhaps not more than 15% of the countries of the world have statistical services suffiCiently well organized to give the reliable data so essential to public health administrators in their fight against disease. In our Region the lack of statistical information is particularly conspicuous, but all countries are becoming aware of the need, and several have r equested WHO assistance in building up their health statistical services . It is hoped that the Seminar on Vital and Health Statistics to be held in Damascus this October will help to stimulate developments in this field. * * * In concluding my introductory remarks, it is interesting to recall the words of the Director-General of the vlorld Health Organization at the First Session of the Regional Committee in 1949. Tne Organization, he said at that time , was very young , but on condition t hat it could work with mature people who were able t o function in terms of time - at least two or three generations ahead - there was no reason why it should not develop from strength to strength and prove a splendid instrument for the benefit of mankind. EM/RC13/2 page 12 In r ev i ewing our work as a wholo, I believe t hat t he programme of tne Organization, and t l1e l ong-term national programmos t nat are deve loping show an advance in this mature t hinking that is a pre- r equisite t o success, and that we in this Region iave contributed to the progress the Organization ias undoubtedly made. The way has no~ been s~ooth , and we may expect to encounter new obst acles as we advance and enter new fi elds. But if we continue to 00- operate c:'osely as we have done so eff ective ly in the past , with a. mature ar.d farsighted approach , the i nhabitants of t he Region will stead1 l~' advance towards attaining "the h ighest possible level of heal tl1" • G ENE R A L REV lEW D1/RC 1 3/2 page 13 I THE REGIONAL CO[1l'llITI'EE FOR THE EASTERN MEDITERRANEAN TWELFTH SESSION 1. Sub-Committee A of the Regional Committee met in Riyad, Saudi Arabia, from 6 t o 10 October , and Sub-Committee B met i n Geneva from 19 to 21 · September 1962 . 2 . The chief points mentioned i n t he discussions on t he Annual Report of the Regional Director were: The necessi t y for health s ervices to be adequately r epr esented on the Government bod'! responsible for coordinating development plans, i n order to ensure that health was given h igher priority in national long-term pr ogramming and in maki ng r equests for assistance f rom United Nations and ot her sour ces . Continuance of WHO assistance was essent ial for the control or eradi cation of communicabl e diseases and t o help in dealing with new· probl ems arising f r om improvements i n environ- mental heal t~l and economic and social standards generally . In t he all- impor t ant fi eld of educati on and training, medical education (to i nclude preventive De~icine and publ ic health), health educat i on; and train ing in paediatrics , nutrition, vital and health statisti cs , nursing, maternal and child health, psychiatry, cancer control and radia t ion protection were t he most urgently needed . WHO f ellowships in all these subjec ts were recommended with preference being given t o training within the Region; "traini ng and orientation visi t s " to VlHO Headquarters and t he Regional Offic e s for national health '" or kers and offici al s wer e also urged . 3. The Proposed Programme ar:.d Budget Estimates f or the Region for 1964 were considered and endorsed for t ransmissi on to the Di r ec tor-General. Prominence given t o Educat i on and Traini ng in the Regional Programme and the new approach to medical education as well as the continued emphasis on fellowships were noted wi th satisfaction . The importance of inter- countr-J programmes and tho cOEsi der ation giver.. to cancer contr ol , radiation prot ection, nutri t i on and mental heal th wer e noted wi t h appreciation . EM/Rc 1 3/2 page 14 4. Technical matters on the agenda were: Malaria Eradication Programmes in the Eastern Mediterranean Region, Epidemiological Approach to Tuberculosis Control in the Community, Use and Abuse of Drugs, Improvement of Vital and Health Statistics in countries of the Eastern Mediterranean Region, Tinea Capitis and its Control in the light of experiences gained with Griseofulvin, Rural Health and Community Development in the Eastern Mediterranean Region. 5. It was decided to use Arabic as an official language of the Regional Office, and the Regional Director was requested to take the necessary steps for its use as a working language of the Regional Office as from 1965. 6. The subject of the Technical Discussions was Solar Radiation and its Related Heat Effect on the Human Organism. Documents prepared b,y the Regional Office or ~I experts in countries of the Region or elsewhere formed the basis of the discussions. "Infantile Diarrhoea" was chosen by Sub-Committee A as the subject for Technical Discussions in 1964; both sub-committees had decided to discuss "Hospital Administration" in 1963. II ADVISORY AND TECHNICAL SERVICES EDUCATION AND TRAINJN G MEDICAL EDUCATION , ASSISTANCE TO EDUCATIONAL INSTITUTIONS AND GROUP TRAINING ACTIVITIES EM/RC13/2 page 15 7. In my last Annual Report, and for the purpose of analysing the variety of situations i n the countries of the Region, an attempt was made to place them in certain cat~gori es according t o educational status and development , though not necessarily from t he economi c point of view. Countries placed in the first category were those which had academic undergraduate institutions and i n certain instances post-graduate training facilities; in the second category were those which had a corps of foreign trained profe ssiona~ workers , that is to say medical and health 2.d.'1linistrators, general practitioners and specialists; in the third category were those which for practi cal purpose s had very f~w or even no national physicians. It is expected that thi s third group will rapidly disappear during the next f ew years, j:artly due to t he Horld Health Organi zation's assistance through the undergraduate fellowships t o which afterwards special refererlce will be made. 8. D~ring the period under ~eview activiti es have been l argel y centred around the Medical Education Conf er ence held in Teher an, wher e the countries represent ed came mostly from those in the first and second categori~s. There were thirty-one participants from this Region, and one each fron Turkey (Eur opean R8gion ) and Afghanistan (South-East Asian Region) , \';i th twenty- six observers both from member countries and from United Nations, United Nations specialized agencies and other interested organizations. A special group of consultants from s even different countries was engaged t o assist the Confer ence in its discussions. With the thirteen pro f~ssional staff from t he Regional Offic e and WHO Headquarters the t otal number of persons attending and assisting at the EM/Rc13/2 page 16 Conference, not including the numerous clerical and secretarial staff, amounted to seventy-nin~. 9. It may be appropriate to quote in extenso from the main part of the Introduction to the Report of the Conference as it reflects the idea behind it: "Several factors contributed to the need for approaching problems of medical education in the Eastern Mediterranean area at the Regional level. "One was to expose the great variations in the medical manpower ratios in different Regional countries and to examine the role of medical education in closing these gaps. A second lay in the existence of' rroblems especially marked in developing countries and concerned with the staffing of medical schools in relation to the type of physician which might be agreed as the most effective in countries of present stages of development. This implied intercountry dis"ussions and perhaps the crystallizing of thought as to the purpose of medical education and its relation to the national needs of the moment and for the foreseeable future. A third lay in hearing and examining the opinions of those who had tried out, and adopted in whole or in part, or perhaps had rejected, certain of the new techniques of medical education aimed at the production of better qualified dootors. "The world wide dissatisfaction with both methods and the content of medical education to-day , a dissatisfaction which has been uncovered and proclaimed within the medical profession itself, has not been overlooked ~J the relevant authorities in the Regional countries. Remedies for weaknesses and suggestions for improvements have been tried out here and there, in accordance with their applicability to the environ- mental circumstances . Experience has been gained which needs to be exchanged and criticized more intimately than is possible in the columns of articles in the medical press. "Conferences of those directly concerned with medical education are agreed to be most desirable in the above regard. The initial step is the national conference which, always with the proviso that it be well prepared, can turn ' the thinking of its responsible participants into patterns feasible for implementation in their own country. Such conferences have been held in Iran, Pakistan and in the United Arab Republic, countries each with several medical schools. From this first EM/RC 1 312 page 17 step and with the experienc e thus gained, a Regional Confer ence would facilitate the clarification of thes e s and points when subjected t o the study and comments of those meetil'1..g similar circumstances in other countries. 11 10. It is certainl y premature to ask what the r esults of this Conference have b8en, and perhaps will be in t he future, yet there are certain indications of its influenc e . (a) The Regional Office will hold a follow-up meeting with a small group of distinguished medical educators from this Region to deter- mine the Office's role in the field of medical education. (b) Two countri es have held national cor.ferences since the Conference in Teheran . (c) Plans are being !11ade to strengthen the staff of the Regional Office with Medical Education consultants, in order further to assist the Region as a whole as well as the countries individually . It is clearly felt that the first aim of the work of \lIRO in this Region is to stimulate the development and use of existing resources. It is expected that the above-menti oned meeting wil l further help t o identify fields in which WHO can be helpful and in which with the limited budgetary resources available a naximum of effect can be achieved. 11. The great est single obstacle in all heal th work is certainly the l ack of qualifi ed health workers and in particular that of medically qualified personnel . Be it in the building.;up of a central administration, in the establishment of curative services, in the establishment of a medical education institute , the f irst question - before going into t he organizational aspects and t he financial implications - is usually where to get the staff . This, of course is not only a question of quantity but also of quality and of how t o ensure that th8 student is well trained and well ori8nted. The objective of the educational process in a medical teaChing institution was well studied during the Conference and has been EM/RC13/2 page 18 particularly oriented towards the needs in this Regi on . "In the developing countries undoubtedly bas ic medical education should be designed with emphasis on the naticnal health and medical circumstances and conditions and the specific problems of areas, t o form basic practitioners."* 12. In view of this the Conferenc e held in Teheran proceeded to determine the objective of medical education based on the understanding that t he Regional countries have a co~mon denominator in their programm~s in medical schools and in their objectives. This objective has been defined: "The objective of medical education should be to develop a broadly educated person, who is motivated with the desire to serve his country and possesses the human qualities of devotion to duty, kindness, tolerance, patience and compassion; the future physician must also poss~ss a wide knowledge of the social and economic conditions of his country and the world at large, and be equipped with adequate knowledge of basic medical scienc es, preventive medicine and clinical subjects; he should be imbued with a desire to keep up his studies and be capable of undertaking training for specia- lization. He should have rec eived practical training in clinical and rural health work, for at least one year. There should be provision for the training of specialists in accordance with a ratio based on the needs of the commu- nity as determined by a national planning board. Specialist training should be undertaken only after the graduate has had not less than two years of practical experience in general duties involving intimate contact with routine medical and health work. n** 13. Serious efforts have alrea~' been made by Regional countries to expand their medical education f ac ilities. The United Arab Republic has added two more schools to the f our existing previously, in Pakistan discussions on expansion are under way, t~ ~ Syrian Arab Republic is discussing t.:nE 0stabli~r:m ·." nt of :J. second medical school. * Report on Conference on Medical Education in the Eastern Mediterranean Region, WHO , EMRO 1963 (EM/Conf.Med.Educ./10 - EM/Ed.Tr./43) page 14 **ib:ld. page 20 urse t utor. wi th a dummy. ex plains va r ious stages of delive ry . MIDWIFERY TRAINING (S UDA N) Routine med ica l check-up of newly regis - tered chi ldren. at th e AI O beid we lfare Centre. whe re student-mi dwives get prac ti ca l tra ining. A vi ll age midwi fe comes back fro m her da ily rounds . 1· Nu rses get p l·act ica l ex peri e nce under t he su pe rvi sio n of a WHO sen ior ad v""r. \.' .. Gondar st udent sanitar ians perfor m c h lo rin e residual te st. at a nearb y wate r t ap (above) o r chec k new ly bui lt la tr ines (I ight). TRAINING O F HEALTH W ORKERS (ETHIOPIA) Si nce 1954. WHO ha s been assisting the Government of Ethiopia to esta blish a network of heal th centres , radiating from t h e city of G ondar, near Lak e Tana. T rai ning is given to auxi- li a ry health work ers of all categories. A happy Ethiop ian m Olher With he r nev bor n io t he seve n-bed maternity ward; Gondar. T he ward has Its ou tward ex te nsic in t he fo rm of a home de livery ser vic An o bste tr ic course brings toget her, a round plastic dummies, Yemenite probationa ry nurses at th e Sanaa Hea lt h Cent re . Ro ut ine medical check -up of a you ng Yemenite und er th e superv isio n o f th e WHO nurse educator. JRSING EDUCATION (YEMEN) Mothers are ta ug ht how to ma ke t he best us e o f loca lly av ail ab le and inexpensive fo odstuffs. i I j I ., A model health and traini ng centre has been establish e d in Sana'a with WHO assistance. It provides both preventive and curative services and also training for nurses, sanitarians and other health workers. Long needed laboratory tec hnicians get pract ical e )(perle nce under t he watchful eye of a WHO medical office r . T RAINING OF AUXILIARY HEALTH WORKERS (SOM ALIA) • '- ' ~ t~ A new batch o f ,tude ll t Ilealth officer, on the ir first day of tra llll ng. In Mogadi s hu . WHO assi s t s, jointly with UNICEF . a scho ol for auxiliary health pe rso nn el , which trains h ealth offic e rs, nut"se-midwives and sanitarians for th e country's growing he :dth se rvkes . -• r EM/RC13/2 page 19 14. Some other countries such as Et;1icpia , S=.udi Arabia and Tuni~ia ~avc entered i nto an active planning stage and the Regional Office is assisting in varying degrees in this process. 15. In the post-graduate field assistance has been mainly confined to the field of public health post-graduate training, be it for the medically qualified or for those coming from the public health engineGring profession. Some medical faculties in the Region provide post-graduate training in clinical and other specialities. In contrast to this situation in the medical field the situation in the nursing field is less favourable, a situation which weighs heavily on the curative as well as the preventive services. Only one post-basic school f or advanced preparation of nurses so far exists. But developments are under way in two more countries which begin to enter the stage of planning for post-basic training of nurses. AUXILIARY TRAINING 16. Promoting the training of health auxiliaries has continued to be an important activity of the Education and Training Section of the Regional Office. There is a growing recognition of t he role played by auxilia~v personnel in strengthening national health programmes in various countri es. Although the level of training of auxiliaries varies from one country t o another, yet the typos of the traditional categorie s in the fi elds of curative and preventive medicine, nursing and envir onmental health are usually the same. Their training and use is being given high priority. 17. It is worthwhile to note that the training of health auxiliaries is going on simultaneously with that of professio~al personnel in many countries of the Region. However, in several localiti es the ratio between the two categories has still to be watched and f ollowed up closely in an attempt to keep a reasonable balance between them. Eth i opia and Somalia are clear exaoples of countri es where training of health auxiliaries is going on relatively more rapidly than the preparation of professionals which EM/RC13/2 page 20 naturally requires a longer time, thus making it difficult t o provide effective technical supervision for auxiliary health workers. In this sense, some of the training projects may appear rather ambitious, in that too much is being attempted in too short a time. However, this temporary and transitional phase is not expected to last long, and it is believed that in the near future a new point of balanc e will be attained where the preparation of profeSSional health personnel will keep pace and thus bridge the gap. It is evident that this development is directly dependent on progress in the basic school education, on the establishment of higher educational institutions as well as on the growing administrative and financial capacity of countri '~ s to absor b t rained auxiliary and pro- fessional personnel. 18. Another point which needs emphasis is the necessity for better planning and coordination of training activities with the general development of the national programme as a whole, in order to ensure timely employment of graduates as well as adequate staffing of health services in their successive stages of growth. We have been occasionally faced with situa- tions where graduates could not be absorbed in time by the national health administration owing to budgetary or staffing problems. Happily enough , difficulti es of the sort are usually not permitted to last too long and are ultimately overcome through cooperative effort. Health personnel , it is realized, forms part of the t otal manpower of a country and can only be increased and developed in normal r elati onship with manpower in other fields, just as the development of health activities and programmes needs t ,o be a balanced part of social and economic development programmes. 19. Although basic standards of training are usually maintained and frequently r eviewed, no attempts ar e being made by this Organization to render the curricula strictly uniform and standardized. It is realized that each country has its own wealth and limits of r esources as well as EM/RC13/2 page 21 its particular conditi ons and needs , t o which the training of auxiliari8s must be car efully adapt~d. Tne planning e~d operation of the training progr amme is ther efor e usually l eft f or the staff of the proj ect t o achieve , in consultation with t he r espe c t i ve Governments and the Regional Offic e . It is r ealized that this function has t o be dictated by local conditions: educa tional, cultur al, s ocio- economic, etc. , of the individual countri es, as well a s by thG pri ority health needs of eacc, l ocality . The same applie s tc the l ength of t he training c curse for the various categori e s which is rarel y identical in countrie s where such f acilities exist, as this is determined ~J sever a l f ac t ors, i ncluding the urgency of the need f or auxiliary workers, t he availability of personnel f or training, and their educ8.tional baCkground. This point c ould be clearly illustrated by the fact that the training course for a ssistant s anitarians lasts now f or twelve mont hs in Somalia , two years in Saudi Arabia and t hr ee y ears in Ethiopia, despite the f act t hat the pro j ects in the three countri es are WHO-assist ed. Neverthel ess, it is felt that constant evaluation and adjustment of the t r a i ning programme i s a necessity r equiring continuous exploration in collaborilti cm with the countri es concerned. 20. The status o f the h eal th auxilia~J workers is b e c oming more and more r ecognized and b<2 tt -or defi ned in sever al countri e s of th" Region. Appropriate grading and r emuner at i on are be ing provided f or them t o give them more s e:ouri t y and fur t her prospe(!ts f or advancement. Job descrip- tions with the r e sponsibilit ies ar e bei ng worked out, usually in the beginning of t he t r a ining programme . It is important f or the trainee t o know where h", h:ls t o go i n hi s t raining, f or t he t eaching staff t o adapt f orrr.al and practica l t r a i ni ng, and f or t ne he9.1th administration t o plan properly the f ac ili t i e s needed a s w~ll as the programmes which can be carri ed out by this ty pe of personnel. In this connexion it is important t o not e t ha t mor e fi eld faciliti e s are being established, with WHO a s s istc.l1c e , f e r pr act ica l training purposes. EM/RC13!2 page 22 21. There is a tendency to raise the requirements of admission to training courses in operation for auxiliaries. In more than .one country completion of secondary school education has become a prerequisite for entry, the training standards have also to be raised accordingly. This is obviously a process of normal growth taking care of the increasing number of boys and girls graduating from secondary schools which in turn leads also to bet tr=r 's f" r v:"ces beinG r ender"j to tr.e community . 22. More WHO f elloViships are being a~larded to train teachers and super- visors of health u'_:::ili [~ . ~()B . Special tutors' courses are being organized as inter-country projects to train tutors for auxiliary health personnel. This is illustrated by t he Laboratory Technicians Tutors Course which started in Lebanon in October 1962. It has been decided in principle to repeat this course and other similar courses in the future. Plans are also under way to establish in 1964 another inter-country project for the trai ning of sanitarian tutors. cians is also being planned. Another course for X-ray techni- 23. Further t~aining opportunities though not under WHO sponsorship have been made avail able during the year for graduates from the Health Training Centre, Gondar, inc ludin~ t hr oSe public heal th offi cers w::'o were admitted in October 1962 to diploma courses at the School of Public Health, American University of Beirut. This is the first time public health officers have graduat ed at this l evel, and proceeded abroad for further training in public health. 7he preliminar y results of this "experiment" appear to be encouraging and its application to other categories will have to be considered in t he future . 24. It is .. lso interesting to note that a number of assistant public health nurse-mid\nves cradu~ted from the Health Centre and Training School, Sana'a and were immediately employed by the Government of Yemen. This is the first timo in the history ?f that country that national women workers have been t ay.Gn into regular civil service . EM/RC1)/2 page 23 25. Frequent visits by Regional Offic e staff have been made during the y ear to tLe vari ous proj ects. In addition, up-to-date literature on various subj ects, particularly on health education, have been made available to these proj ects by this Organization with a view to keeping staff and trainee s abre2.st of r ecent advance s and inJ ~ctills mor " ]-,cal th education into t he curri culum. This is apart from t eaching equipment, including films , film strips and other demonstration material which are being i ncr eas ingly provided f or training purposes. * FELLOWSHIPS PROGRAMME ;::6. ThE: WHO f ellowship pre gramme continuc2s to f orm a basic component of the Regional Office 's education and training activities. The programme is particularly interesting not only because of its important long-term objectives , but in that j.t also de monstrates plainly the value of continued joint efforts made by t he various countries and the Regional Office for attaining a common objectb " . This pr ogramme has pr oven to be an indis- pensable means f or pr omot ing health in many countrie s by training and preparing perconnel f or health work at various L,vels. This appli es particulRrly to countrie s where t her e is a s eri ous gap between needs and resources whi ch lll '!kes it difficult t o dE: vot e adequate effort and funds for training purposes. zr. The vlHO f elloHship programme needs t o be clos el y linked with the devel opment of t hEo o'!8r a ll heal t h programme in every countF,i, henc e the need for adva tlc(; planning and effective coordination of health training acti vi ties \'Ii t h th ~) r a t o of gr owth of health s ervices. 28 . The totC:ll nUI!l!)er of f ellowships awarded from 1949 up to the end of 1962 r ·:oached 2252. The number awarded in 1962 was 317 a s compared to 306 in 1961 and 221 in 1960. 29. The 8or:ccr a l pi cture r egarding the type , l ength and place :Jf study is on the who l e sioila r to t hat encounter ed in r ecent y ears, except for * See also Fi gures I- IV EM/RCl3/2 page 24 the number of intra-regional f ellowships which has declined in 1962, despite the policy of the Regional Office to utilize, whenever possible, training f acilities existing within the Region. This has probably emerged from the fact that it has not been pOSSible, on technical grounds , to plac e many F~llows for training within the Region during 1962, parti- cularly at the post-graduate and highly specialized level. In addition , f ewer training courses in malaria eradication were organized during 1962 as compared to previous years , thus leading to a reduction in the number of WHO F.~llows attending such courses. ;I). The total number of study visits amounted t o 350 in 1962. This is higher than the t otal number of f ellOWShips , namely 317, as quoted abcve, because some of the f ellowships included visits to more than one r egion. 31. For a few countries like Ethiopia, Lib).' " and Somalia, WHO awards for undergraduate medical studies occupy a high order of priority in the WHO fellowship programmes f or these countries. It is interesting t o note that during the year, 66 students from Cyprus, Ethiopia, Jordan, Lib,ya, Saudi Arabia, Somalia and Yemen have been studying undergraduate medici ne under WHO sponsorship. In line with the general policy of the Organization, trairdng faciliti es available within the Region are made use of for placement o f F0 11ows, more so o f medical students. 32. The 66 WHO Fallows r eferred t o above are studying undergraduate medicine in the f ollowing countries: Recipient country Germany Israel Italy L<;banon Pakistan United Arab Republic Number of WHO Fdl.ows 1 8 18 8 4 27 In this connexion, the t able on the following page reveals some inter esting trends a s far as WHO f ellowship awards in undergraduate STATUS AT END OF 1962 OF FELLOWSHIPS AWARDED FOR lJ}J1)ERGRADUATE MEDICAL STUDIES 1950 - 1962 Status of Fel low:> in r e l2.t ion Fe llows ha ving cumpleted Number of Number of Fellows to study s t udies Year f (-:ll owship classified by Yia r Study Still Fellowships Hurking in No inf ormation awards of f i rst award compl e t ed studying cancel l ed flo me country on professi onal activity - 1950 4 4 4 - - 3 1 1951 10 10 4 - 6 3 1 1952 5 5 3 - 2 3 - 1953 4 2 2 - - 2 - 1954 4 4 2 1 1 1 1 1955 5 5 3 - 2 2 1 1956 5 5 1 2 2 1 - 1957 llf 14 2 6 6 1 1 1958 11 11 1 '7 3 - 1 1959 20 20 2 11 7 2 - 1960 15 i 14 - 13 1 - -1961 12 12 - 12 - - - 1962 19 14 - 14 - - - Total 128 120 1 24 66 30 18 6 ===, ~ _ . ~~== o- =~ == . = = === .. " ====== .=--===- -==== ". ~~=== = .. ~=== === == ==== =====- ===-: ' ~===== ';7 ';;; ~ . =~ -==~~===:::-=====:- *Since some awar ds wer e cancel l ed and lat er on r einstated, t he number of indivi dua l s receivi ng fellowships is for some years l ess than the number of fellowship awards . ~~ ()Q 0 CD I-' F\)~ VlF\) EM/RC13/2 page 26 medicine are concerned. The s e: t r ends could bo summarized a s follows : 1. WHO f ellowship awar ds in und8rgradt:ate medicine have b28n i ncr easing. During the period 1950-1956, an aVt'r agG of 5 to 6 awards were mo.d .:: p er annum, compar c:d t o o.n a ver age of about 15 awards per year t h0r eafter. 2. DurLl.g th" period 1950-1955 incluslvl'; , YJ s tudents f r om differ ent countries w"re awa rded WHO f ell owships t o study unde:rgradu[,t 8 mE;dicine . Of t hose . 18 have cempl e t te d their studi e s and 14 'J f t h e l a tter are known t o be working i n t h", medi cal pr 'J f essi:m in their countrie s of origin. It shoul d be noted thn.t awards t o 11 Fel l c ws we r e disconti nued during t he s a me p8riod owing t o variOus r L!asons , incl uding unsatisfact "l ry ac ad,-,mic perfc) r manc e . 3. I n contrast . 90 s tud"nts wer e awa rded IJlHO fello\,- ships t o study und8r gr a duo.te medicine during th'~ period 1956-1962 inc lusive . Tt" , majori t ;{ of t hcse a r e still in tra i ning . 4. It should be r eali zod t hat the figures cited abov e invol v e l ong- t erm and costly f f, llowship awards ; which in most i nsta nc e s cov" r s eve r a l year s of stucl,.v . 33 •. · The WHO fellOWShip programmG f a ces a constant chD.llenge , ow.: that calls f or continued c coperation bc t w8en t he various c"uritries and t he WHO Regional Offi ce for t he Eas t e r n 118di t e rr::meall . still ,"!. dema nd f or mor ", vigour in. dGal i ng with the probl ems inVOlved, y" t the programme is u ndc:l.iably achi e vipg gre.:t t momentum. The importanc G of the f ellowship programme call s for incr eo. s ed r e fining and adjusti ng of the procedura l and administn,tive as pGct s . It is f or thi s r eason tha t a s pec ial meet i ng i s plc:.mwd t ,) be hel d a t the end of 1963 i n order t o discuss common pr oblems with r espons ible off icers of Mini stri e s of Health who deal with the fe llowship programme . The Conference o n Med ica l Education (16 to 24 Octo ber 1962) brought toget her in Teheran public health administrators an d medical educators from 12 countr ies. A Group Meeti ng on Communi ty Water Supply was held in Beirut, from 13 to 17 Novem ber 1962. It was atte nded by leadi ng health policy-makers and sanitary engineers from 10 countries in th e Region. Openll1g sesSion In th e A, of the Teheran Universit A Travelling Seminar ' convened by WHO fro r in UAR, Lebanon and vis ited related instituti Institu te in Karach i (pi' TWELFTH SESSION OF THE WHO REGIONAL COMMITTEE (SUB-COMMITTEE A) ~ I ~ " . .1 7 ~ ¢ ..... Represen tat ives at the 1 962~sessi() n in Rl yad of Sub-Co mm ittee A of t he wHo Regio nal Co mm ittee. Fifteen Gov ernm e nts . the Un ited Nation s, severa l o f i ts sub sidiary bodies, the Arab Leagu e and a number of non-governm enta l o rg a - nizati o ns, were represe nte d at th e meeting of Sub·Comm ittee A o f the WHO Regional Committe e for the Eastern M editerranean , which was held from 6 to 10 October 1962, in Riyad - Saudi Arabi a. Rep rese ntat ives of Som alia and Saud i Arab ia. Sabah Hos pital, a skilled nurse incubator for premature babies, clubs ar e o rga n ized in every : hygiene is taug ht as a game, ds on Kuwai t' s mai n crossroad s AC 000 n"'''_''_''''' _~''J"'>._ he r ::u'"r-.flll ( ... HEALTH AND WELFARE SE RVICES (KUWAIl All schoo l c hi ldren a re t realed with a n- tibiot ic ointm e nt to prevent t rac homa, ;-- -.. \ ,~< ''\ )'<I~ ' • • a' . .... '" f I -. .. The central k itc he n I,rovides ove r 50,000 mou ths with brea kfast and lundl. Kuw ai t 's wat~,. dis t illation plant, the wo r ld's larges t, fulfils one of man 's old e st dreams: chan gi ng seawater Into .. drink ing wa t er , It s uppli es water to th e e ntire po pulation, na Hall, Medica l Facu lty '\adiological Healt h was to 31 December 1962, ;tan , w herc part icipants incl udi ng t hc Cancer : ). A national Tubercu losis Control Ce nt re was inaug urated last t'la rc h in Rawalp ind i (Pa tan). Dr. Ra na Abd ul Ha mi d , Cen tral Min is ter of Hea lth , opened t he new Cent re (rigl WHO-sponsored act ivi ti es In Somal ia wel'c reviewed last fail In Al exandr ia, by Mr. Mohamed Ahmed Moha med Addan . Hea lt h Mini ste r of So malia. seve ra l other health offi cials and t he WHO Regiona l Direc to r . NUMBER OF FELLOWSHIPS AWARDED BY WHO EMRO 1949 -1962 FELLOWSHIP EXTENSIONS NOT INCLUDED ,--._- --_ .. _-- -- -_ .. _ ---_ .. -_._------- - ------- - -- YEAR COUNTRY 1949 19501951 1952 19531954 1955 1956 1957 1958 1959 1960 1961 1962 TOTAL .-- ~ ADEN - - - - 1 - - - - - - - 2 3 CYPRUS - ) - 3 2 - - - 1 4 3 1 1 24 49 ETHIOPIA 4 1 3 10 9 6 1 5 3 7 8 5 7 8 7 93 f--JRAN 8 10 7 27 34 1 6 29 1 5 34 38 27 13 21 41 320 IRAQ 1 2 3 13 1 9 6 9 7 1 2 1 8 16 12 22 26 166 ISRAEL 1 2 9 15 1 2 7 7 5 10 1 1 1 1 10 8 15 123 JORDAN - 1 5 2 4 3 6 3 5 & 13 18 1 8 13 99 KUWAIT x - - - - - - - - - - - - 3 ) 6 ~BAt-WN 1 4 8 6 1 7 8 8 9 18 17 15 1 ) 12 13 149 LIBYA - - , 5 6 4 7 3 9 5 13 12 7 2 74 PAKISTAN 7 4 '2 12 1 4 4 13 4 1 1 , 0 20 19 39 35 204 SAUDI ARABIA - 2 4 3 3 1 4 4 5 , 14 14 1 5 15 85 SOMAL IA - - - - - - 5 1 6 9 12 n 20 21 86 SUDAN - 1 5 1 8 5 7 7 20 1 9 25 28 28 22 176 SYRIAN A R. - 4 10 5 16 6 22 1 0 17 6 8 8 1 6 20 148 TUNISIA xx - - - 12 1 4 1 2 1 9 2 2 1 6 15 110 UAR 1 0 7 1 0 9 31 1 e 3 :! 1 1 26 3 8 1 2 17 J1 37 290 YEMEN - - - - - 2 1 2 2 2 - 3 1 3 31 6 7 1 TOTAL 3 2 51 84 11 0 173 81 1 G 7 9 6 196 201 /1 7 221 306 317 2252 • JOIn.c1 th< Or g.n lHtloo In M. y 1960 As s ig ned l o El!it l r n Med lt trr;,ne;,n Region In May 1956 JSO JOO 150 IS O I n f) 50 n 19 49 1950 1951 1952 1953 1954 19:;5 19 55 19 57 195 0 1~59 1960 1961 1962 NUMBER OF FELLOWSHIPS AWARDED FROM 1949 THROUGH 1962 BY SUBJECTS o 10 20 3C 40 SO 100 150 200 HEALTH ORGANIZATION AND SERVICES S.nit.tion Nursing M.tern.l .nd ,Child H .. lth He.lth St.tistics Ment.1 He, l th Occupational Hu lth Health Educotion _ Nutrition _ Reh.bilit.tion _ Conlrol 01 Drugs • Oonl,l Hulth II COMMUNICABLE DISEASES SERVICES Tuberculosis l ~boriltory Venere_l Di5~~se5 ~nd Trepontm~toses lr~chom~ 8ilh~rliasis Veto"n"y Public He.lth I Chemotherapy . Ant ibiolit> Other Communicab le Dlse~5e5 250 P H A II I MEDICAL EDUCATION, CLINICAL AND BASIC MEDICAL SCIENCES IEE~~~~[ An •• sthesiology R.diology Surg~ry ~nd Me dicine H .. m.tology _ Mtdic~l t:d uc iltion _ ailSIC Medic.l Sciences Other Mod i,,1 Spoci.litle. IV UNDERGRADUATE STUDIES (without extensions) Medicine Nursing • Ph"m.cy • S,nll,ry Engine. ri ng • Oenti stry EXTENSION OF UNDERGRADUATE STUDIES 300 Medicine >- o :::> ..... (J') lL. o w Cl. >- ..... (J') Cl. I (J') 3: a -, ...J lJJ U. V! W V! et: ::l o U et: W :J: I- o o z « 1, 1 I- « ::l o « cr (!) I- I.Il o n. V! l- V! :; >- o ::l l- V! V! W o ::l l- V! W I- « ::l o « et: (!) a: w o Z ::l r-- ------~. NUMBER OF o C) I I \ \ \ \ \ \ , , I I \ i I I r ) Q 0 0 0 c.:> lfl " ,., l'l .... fE llOWSHIPS o <D '" u, U' ~ ~ . ~ STUDY VISITS BY WHO EMRO FELLOWS 1949 - 1962 1< PERCENTAGE DISTRIBUTION AS PER REGION OF STUDY INTRA REGIONAL - - - -- EURO 70 l . . . . . . . AMRO _._._._.- OTHE8 REGIONS "t ,, '" I' I "-." /" " , I "-" "-IT1 ..... \ I "-::0 I " n I '" , I "'-n SO - \ / , / \ Z I ' " / -< I , I , I , V , , / 0 '0 i . \ .J' "T') \ .... .- I ~J\ / \ l> I .- 3J J .- I < I A . \ '/J) 20 ~ " . . ... . ... . . '\ . I , -< /' (.,~ , / 0 \/ / '- " x.... 10 -I / "- ~ / .-- "- "- ~.~ ' :.- _.- ' - _ .-...., /'-.. . ~ ,..; .'-//' '-' "- -' . / ...,- '- /" .. ... . '-- ./ "- / - '" ----o ~ 1949 SO 51 52 53 54 55 56 57 58 59 60 61 62 Vur COMMUNICABLE DISEASES * MALARIA ERADICATION EM/RCl3/2 page Z7 STATUS OF lVIALARI A ERADICATION ACTIVITIES IN THE EASTERN MEDITERRANEAN REGION 34. The t able (page 32 ) shows the present s tatus of malaria eradication programmes in the twcnt:T-fi ve count ri es and territorie s of t he Region . 35. Free from mal aria are five countri es and t er r itories , namel y, Aden (Stat e ), Cyprus, French Somali land, Gaza Strip and Kuwait , with a t otal population of about 1.4 millions , wher e the disease has been eradicated or was original~y a bsent. The vigilance operations, established in t he past, ar e continuing in these ar eas successfully , and no i ndigenous cases have been reported during the past year. The vector control activities have been maintained , with the aiffi of reduC ing the risk of infec t ions secondary t o i mportation of cases . )6. Iran, Iraq , I srael , J ordan, Lebanon and Syria are among the countri es with advanced eradicat i on programmes . Spraying with insecticides has general ly boen di scontinued in I srael and Lebanon ; ver y limited attack operations ar e being conti nued in J ordan and Syria, with most of the popu- l ation already in the consolidation phase . In I ran , almost four-fifths of the country's populat ion under risk are in the conso l idation or attack phase, wher eas i n t he r emai ni ng f ifth (southern) some t echnical problems have delay ed the cOrlple t ion of t he attack phase . Tne same applies t o Iraq, where tota l cover age of attack areas i n the north has been hampered by unavoidabl e causes . 37. I n Pakistan, the pr ogramme is expanding according t o pl an , and the r esu l t s £!.chieved t o- da te ar E hig.'rJ.ly r ewarding. Er adicat ion is pr ogressing satisfactori ly i n Libya, although problems of communication and personnel have caused some delays in the time ly oper a tions of the programme . * See: Document Er~/RC13/4 EM/RCI3/2 page 28 38 . Tuni sia and the United Ar ab Republic are in the preparatory phase, and are progressively strengthening their peripheral health s ervices before launching a full- scale attack on the disease, which is at present largely controlled by general health measures. 39 . Three countries have now pre- eradication progr ammes in operation and the se are Ethiopia, Saudi Ar abia and Somalia. In the Sudan , preparations f or the initiation of a pre- eradication programme are ac tively under way and a plan of operation is bei ng negotiated with the Government. Yemen is expected t o join thi s group of countrie s during 1963; later on the Aden Prot ectorat e is expected to do so . Although Saudi Arabia is placed in this group because of its recogniz ed need f or devel opment of rural health services, nevertheless , a l arge part of the country has already been covered by successful attack measure s which have very impreSSively reduced the incidence of tne disease. Actually an area of its northern t erri t ory ha:~ already r eached an advanced stage similar to that of a consolidation phase . Extensive spraying oper a tions have also been conductc. in the Sudan and to a lesser extent , in Ethiopia and Somalia . PROGRAMMES AND PLANNING ACTIVITIES 40. As a rule; i:l. pli'lll of acticn i s prcpe.r ed a t tho end of each y ear for every programme . These yearly plans adhere to the general lines and principles of th~ original pl ans of operation. They arc based on the yearly eval~at i on of the progra~e~ and the asse ssment of r esults. It appears no 1'/ t hat some of t he plans of operation , espeCially those of advance programmes, require essent ial changes and amendments t o provide f or the requiremcnt~ of the maintenance phase and the mer ger of the malaria eradicat services i f"! the general health or ganization of the countrie s concerned. For this purpose, a number of these pr ogrammes have been visited during the year f or study of the conditions and r equirements prior t o the gradual mer ging of the two services. EM/RC13/2 page 29 41. Based on this criteria , a new plan of oper ati on has been f inalized for Iran, which is being s i gned by the Government, WHO and UNICEF. The plan for Iraq and Jordan is at present under revision. A new plan has also been prepared for Saudi Arabia. In the Sudan, a plan of operation for the establishment of a malaria training centre in Sennar has been finaliz ed. It comprises a new approach to training in the field of malaria eradication. The good network of health services in the country will be used to implement an integrated malaria eradication programme and for this purpose, their personnel will r eceive specialized training in malaria eradication at the Sennar training centre. In Somalia, a detailed plan of action has been developed pro jecting the expansion of health servic es and regularizing the oper a t ion of the present Malaria Service. Its finalization and impl ementation, however, depend upon the completion of the Five-year Plan f or health development i n the country, which is still await ing Government appr oval. 42. AmOl"'.g other countries, Yemen is expected to start its pre- eradi cation progTamme during 1963. One malariol ogist and possibly a sanitarian will be sent t o the country to make the initial malaria survey and conduct an investigation of t he existi ng hea l th facilities. A short-term consultant will be visiting Tunisia during the year and, if necessary, also during 1964 , t o study th0 possibili t y of impl ementing the mal aria er adi cation programme through the existing health services . COORDINATION ACTIVITIES 43. With the progress of t he er adication programme in various countries, the coordination of their respective operations , particularly in the border areas, acquires prominent importance . As i n previous y ears, the Regional Offic e has actively pursued the organizat i on of int er-country and inter- regional conferences as Q means of consolidat i ng pr ogramme coordination . Iran and .Iraq have held two inter-country conferences during t he peri od EM/RC13/2 page 30 under review, in October 1962 and in April 1963. Syria and Turkey had their first border meeting in April 1963. Pakistan acted as the host for the third Burma-India-Pakistan Coordination Conference in November 1962, and participated in the fourth Asian Malaria Conference at Manila, in September, while Somalia was r epresented at the third African Malaria Conference. 44. Another inter-regional malaria conference is scheduled to take place at the end of 1963 in one of the north African countries, possibly Libya. Participants are being invited from the six African countries of the Eastern Mediterranean Region plus Saudi Arabia, and Algeria and Morocco from the European Region. 45. The WHO inter-country evaluation team has continued to coordinate and evaluate the activiti es in Iraq, Jordan, Lebanon and Syria. A coordinated plan of operation for these countri es, which was completed last year, requires revision and adjustment in view of the rapidly evolving situation. 46. The Malaria Eradication Coordination Unit a ttached to the Regional Office has continued to organize and consolidate activities in the different countries besides maintaining, as usual, coordination with the Division of Malaria Eradication at WHO Headquarters and with the other international agencies. 47. Apart from a f ew problem areas where, due to resistance of the vector species to the insecticides used, complicated in some instances by nomadism, It is as in southern Iran, the future prospects look quite encouraging. gratifying to note that governments, realizing the importance of an expanded basic health service network for a total coverage case detection operation, are taking active steps in that direction. It has been proved that the facilities of the existing malaria eradication organizations alone are inadequate to pl"ovide a fully reliable system and that reliance on t he heal th services cont ribution for this purpose is essential. This is becoming a pressing need with the rapid progressi on of the eradication campaign towards its goal of complete er adication. EM/RC13/2 pege 31 i+8 . On the othc:r h2nc, th" studies conducted in problem area s, including the us" of promising n(;w insecticid,o s and ant i-ma l aria drugs, show tha t the difficu l ti <:s en(;ou~ter<,d ~'~n (,ften b '" dealt with effe8ti vely. 49. ··WHO Advisory stE, ff \'larking i n th'j vCirious mal arir, projects in the Region during t his period comprise : 15 malariologists, 7 elltomol ogists, 5 sanitary .:mgineers, 9 82.ni tari ,m s, li admini stra ti Vii: offiu ers, 6 tech- nician instructor~: , a 9.5% increase over 1962. 50. Every effor t )-:;"is bGen made to fill t he vacant posts a s early as possible, huwev'::r, scarcity of qualifi ed and exp",rienced candidates has r C' 5ul t ed i~ leaving a f'2\1 of thiCm unfill ed E. G yet. The situation is lik(, ly t o ir;;provc; i n vi oVI o f the Drg:J.ni zati cn IS world-vlide 0xtensi ve effort to loc:, t8 a suff i c i ent number of sui t able personnel for tra ining and subsequent 2.ppointment to "the Regilm2.1 programmes. 51. The sum alloce.tcd by \'iHO for millnricc e r adic a tion in this Region f or 1963 amounts t J US ;;, 910,187 which rr:,;)res'2nts approx::'mntely one fifth of the total ,",ll::lca ticm to the Region for a ll activities. As usual, most of the amount is t o cover t he costs of advisory services, fell owships [LYld s ome supplie s aD(: equipment. 52. The Unit,,,d Nati:ms Children's Flmd (UNICEF) i :;; mainta ining its 2,s sistc.nce t o the [,;10b2.1 m".l8.r ia ,,:r adication progr amme at a n annual ceiling of US $ 10 mi llion ·::o f \'ini ct thi s Regi on is rec:eiving i n 1963 about US $ 1,028,250 f or programmes in Ir'ln, IrClq, Jorda n, L"banon Md th8 Syrian Ara b Re publ i c. '1':'1" i1' assistanc e t o the programme in Paki " t 1ln as well as t o pre- e r J.dicr:tion programme s h et S been under review fu'1d will be considered i n 1964 . UNICEF is aW:l i t::'ng th" gove rmnent' s de cisi on in connexion with t i c; finaliz.,:tion of th E' ir plc:ns f or a malari" eradica"tion progro.mme in Tuni s l."1, and the United Arab Republic b"f::lre nego tiating the already formally off~red assi st~~ce . i EM/RC13/ 2 page 32 STATUS AND DEVELOPMENT OF MALARI A PROGRAt"1MES IN THE EASTERN MEDITERRANEAN COUNTRIES - 1962 (POPULATION I N THOUSANDS ) Ty pe 01' I Tot al No . Progr amme Count ries of Popul ation f<Ialar ia ADEN COLONY i eradicat'.:d CYPRUS ! or c:ri gin- FR . SCM/ILIA I ally fre e \GAZA STRIP , KUVIAIT T O T A L I I ! !IRAN i ' I RIl.Q. I I SRAEL JORDA.t'l Eradica- LEBANON t i on LIBYA PAKI STAN SYRI AN \ I ARAB REP. I TUNISI A i ID· A.n . t T OT A L I I I . 'ETHIOPIA ! Pre- Eradica- t ion T O T A L iSAUDI ARABI A I ISOfI\ALI A SUDAN Uncom- !ADEN PROT . mittcd ~IN countries SCAT & (wit h limi- OMAN ted control ~QP.TAR TOT A L IT .OMAN N 155 581 70 377 219 1,402 21,500 7 ,085 2,200 1,700 1,880 1,250 94 ,547 4 ,930 If ,168 26 ,080 165,3)fO 20,000 5,000 2,030 12 ,109 39 , 139 660 152 550 55 86 5 ,000 6 ,503 pPUlahun l Population ' E r a d i c Ii t i o n der Mal - Protected Qy y ee:r : y ear end- .do. r isk ! <'.11 Methods start l i ng conso- Typ i'.t tacki lidation I j I I : I eradicat ed s i nce I 155 I 155 Mal ari a 1 581 I 581 I'lalar.ia er adicat ed since 70 70 Malari a E:r adi cat ed s i nce Jrf , 377 Malar i<2 eradicat ed since I - ! - Free from malaria I ! 1,18) ; 1 ,183 ; , I 15 ,173 13 ,481+ 1957 I 1971 I Qy s t ag! 4,500 I 4,600 1957 , 1964 i countryl 2,200 2 , 200 1957 : 1963 COuntryl 906 I 906 1959 i 1965 I COuntry1 683 i 683 1957 1964 I countryi I i , 31 31 1959 : 1964 . COuntryl 89,500 4,400 1961 ; 1974 I by etag( I ! I I I 1 ,588 1,588 1956l 1964 j country\ I 1,914 I 1 ,914 I Prepar at ory phase I 20 ,259 6 , 115 I Preparato~J phase i , ! 1136 85'j I 35 ,921 I • I , , 10 ,000 790 4 ,000 546 1,776 131 12,109 8,000 27 ,885 9,467 660 152 550 55 86 3,500 5,00) G RAN D T OT A L 212,384 170,925 46,571 =:;:;;==~=;;;;;.;;:;:==;:===:.;================.:==========-===========::.;~= ======~ STATUS OF MALARIA E:RADICAT ION ACllVITIES IN THE EASTER N MEDITERRANEAN REGI ON - JUN E 1963 .y ) ~ ~ I \.' \ .. I~ ~ I ' ~, \ ',q~~ , :-;. , , ..... 'I> I "" __ _ ' I ___ -: .'. -........ -- ...... . ',"'.......... I ..... . ....... _. "'~ J . '.' '. " . -..... .' .. ' ... " . ->. ~~ .. ' . . . ~ . ' . .. ' .... . . ... .. ' .... " .... .. eo" .. . . .... .' .. " .. :: .... . -... . .. . .. : !':» ;. ........... r ..• :~:.::: '-: . __ .'-:'. :: _. 1 .... . . .' . . . . . . r .. . I> :.:. : .. ::,. '. : .:: .. '/".::>, .~ r' ......... .. ,". -III ~ ~ Maintenance Phase Consolidation Phase Attack Phase Preparatory Phase [>::.:1 Pre-eradicati o n Programme .. :.:. (area under attack measures) § .... ;. Uncolllmitted to Malaria Eradication Policy STATUS OF MA LARIA PRO GR AM MES 1962 RELATI VE DIS TRIBUTIO N OF TO TA L POPULATION, 11'1 EACH COUNTRY o W ..... ..: u o ..: Q: W Z 0 ;::: ..: u 0 ..: oc W 0 ":z Q:o w- ..... , ..: w u OC Go 1: 0 O W u ..... Z ~ ::> 1: ACCO RDING TO EX POSURC TO MALA RIA ,----,----- ,.---.-~. r ---, --~""T---'---r--- "/., 1 0 0 no 80 I U co 30 10 10 o ADEN COLON Y - - - ------- - ---- -- --- --- -[ - --- - -] ----- - ---- ----- --- -- -- ------------'- CYPRUS 1_- ---------------------------------, FRENCH SO MIIlI LAI, D 1-- -----~ ~--------------------------------------~ GAZA STR IP KUWAIT IRAN IRAO ISRAEl J ORDAN LE BANO" LIBYA PA KISTAN SYR IA N A R TU NISIA U A R ETHIOPIA SAU DI ARA B IA SOMA LIA SUDAN YE MeN J r=-:-_ ____ -'w~///;w;,w;zd0Z;Z;W7,7Z7Z77/,?;%0'7%?;S>;l-· L _ _ ___ t;~·--/~/#c0:Wff.10W'$ffiWffil _ __ ~r~0'P;;wp$&W.$000W~W0w/?1 W/$ff-0-'.Mffh-"ffP4%/-%Al r:_- __ __ __ _ ___ _ ,- l c L -~ ADE N PROTECTDRATL .............................................. ... AND PERSIAN GULF TERRITORIES "'0 C--- -] Not u"l d cr 'T\ ~ l.lf l l r is k Of m~l~r l l erldlt l ted c: ~ ~ U;1 der m. L.rll risk prote ct ed ~ _ Undc: . m ; t ;l.r I J ris k not prot ected EM/RC13/2 page 33 53. Th:? United St",t es Agency fo !' International Development (US-AID) is maintaini l1[5 i ts:cz;sistance t o ma l ar ia eradication prograr.ll!les during 196) in Eth i opia, Iran , J ordan and Libya , and h~s advanced l oans t o Pakistan. 54. During t he period ur.der r eview, f ellowships wer e aWlrded t o for t y- f our candidat es f r om countri es of t hi s Region to attend i nt ernati onal t r aining centres inc luding fi. ve who wer e e;r<.mtcd t r avel or sci entific worker s exchange f el l ol'lsnips . TUBERCULOSIS 55. The concept of a pilot ar ea i n whi2h t o test practi cal methodology f or aciopticm and sxpansion i nto the nat i onal Tuberculos i s Programme continues t o gain gr ound i n most countri es of the Region. 56. Such WHO-assisted proJ ects s tarted in Cypr us i n 1962 , and in Saudi Ar abia , Libya and Paki stan i n 1963 . The J ordan programme is expec t ed t o start in the second hal f of 1963. 57 . WHO a ssistanc e t o the t ubercul osis control pr oj ec t in Kuwait terminat ed mid- 1963. It ha s successf ully demonst rated a coordinated national Tuber culosi s Contr ol programmE: by undertaki ng prevalenc e surveys, establ i shing a nat ional Tuber culosis Centre working cl os ely with clini cs , hospi t a lc (8spec i a lly Tuberculosis Sanatori a ) , scho')l :illd other health services ; s etting up unifor rr: r ecords and t he nucleus of a ce.se r egister ; t raining hDm" '1 isi t i !1g per sonne l f or tube r c-... l1n te::tine; , BeG vaccination , and domicil i ar-j f ollow- up , and up- :;radi!1~ diagncsti c tub", r cu l os i s facilitie s such as l abor~tory, mass radiogr~phy ~nd tuber culin testing. 58 . The vffiO/UNICEF J oint Co~mittee on He~lt~ Policy dec ided in early 1962 that continued UNICEF a id to c: xpans i on of national tuber cu~ o :ois centre l pr ogrammes would be: conditioned by the r esul t s of an asses sment of t he pilot <,.r e<:. oper ati ons . In Tunisi a , a!1 evaluat ion t eam was trained a t EM/RC13/2 page 3!' the Regional Tuberculosis Training Centre to undertake urine testing for isoniaz id, and t o make post-BCG tuberculin testing in Sousse (the pilot area). The ~EO Team at the Tra ining Centre is assisting in the other phases of assessment . 59. Tuberculosis Control programmes that have started as Tuberculosis Demonstration and Tr aining Centres ar e developing the concept of national pilot area proj ects. With the arrival of the mobile X-ray unit in Ethiop ~ a , a p~eval enc e survey of sample groups of population in Addis Ababa was started . Statistical assistance f or this survey has been given by the Regi onal Epidemiological and Statistical Centre, and the Statistical Section of the Economic Commission for Africa . Trials will also be ma2e t o integr at e simple tuberculosis control measures in the work of primary health centres. 60. Where no specialized tuberculosis control progr ammes exist, WHO enc our ages aiid assists an integrated programme . The same staff doing general public health services would also perform tuberculosis diagnostiC, curative , and preventive s ervices . This is the case in Yemen and Aden Prot ect orate . 61. I t is r ecogr..L:; ed t llat statistica l ane.lysis and evaluc.tion play an increasingl y i mpor tant role, especially in a sseSSing the operational performances of pilot ar ea proj ects with a vi ew t o expanding into national tuber2ul o:Jis cont;:'c l pr-')grarmnes . Whil e s t a tistical assistance has so far been [~vcn ty t he Regional Epidemiologica l and Statistical Centre , parti cuLcrly for the prevalence surveys, each of the countries i s, however, encourag~d t o utilize thei r nati onal statistical departments, which are well devel oped in many of them . 62. Emphasis is given t o the tra ining of key personnel, and the IntGr- Regi onnl ':'ubercul usi s Courses i n Prague and Rome continue t o r ece iVe Fellows f r om thi s Region. The Regional Tra ining Centre in Tunis continues EM/RC13/2 page 35 t o ori ent the Forle.nini students i n public health nethodology i n the field of t uberculosis. 63. Seminars and melOtine;s on tuberculosis have a lso beem encouraged. The Internati onal Children 's Centre, Pari s, organi zed a Seminar on Tuberculosis in Infancy and Childhood in Tunis i n AprH 1963. with the assistanc e of the Tunisian Gover-nnent and fellowships provided by the Regional Office for French-speaking participants from the Eastern Medi terranean Region C'.nd frem the Eur::Jp"'2.n Regj.on (Algeria, Morocco, Turkey) . 64. An inf or mal mee ting of Regi onal Advisers in Tubercul :)sis was held in G",neva in March 1963 , which the Re gi onal Tuberculosis Adviser attended. As a r esul t of the very valuable interchange of experi ences ,. it . is expected that the draft of a detailed guide f or pilot area pro j ects will be made, for cons iderat ion by each of the Regions, and eventual adoption at the inter-regional tuberculosis meeting to be held in Kuala Lumpur in 1964. These discussions sho1.<ld a lso bear on the dE:liberations of the next WHO-UNICEF Jdnt Committ"e on H"alth Policy meeting in 1965 , and those of future Expert Committe~s on Tuber cul osis. 65. The introduction of freez e-dri ed BeG has stimulated the United Arab Republi c to ask WHO's advice on t h2 establishment of a freeze-dried BCG production laboratory. Other countries have started using this product. EM/Rc13/2 page )6 ENDEMO-EPIDEMIC DISEASES * BIIJiARZIASIS 66. Bilharz i asis continues t o Gr ow i n proportions a s a public health problem in this Regj.on. New f cc i c:.re being discover ed in countries hitherto knolnl to be free frem its scourge . It has been r eported since last y ear i n the Southern Province in Lebanon. The area involved i s irrigated by means of a canal t aking water from the Litani River. Ther e are several villages along the canal which runs between the hi l ls and the sea with land under fruit cultivation on either s i de . In surveying this canal, Bulinus truncatus was found particularly ncar the village of Sar af and i n which an infection r ate in the age group of 10 t o 19 was found t o be as high as 33.3%. A short-term consultant was assigned t o organiz e a project f or the control of this f ocus in Lebanon and t o advise on the measur es which should be t~ken t o prevent outbreaks i n other f oci. 67. So far the availabl e evidenc e indi cat e s thi t the present bilharziasis pr oblem in Lebanon could be controll ed within a relatively short period of time, but in view cf the present and future irri gati on schemes, the potential risk of its spread should a lways be bor ne in mind. A permanent bilharziasis control centre has been est ablished in Saida in order t o study the epidemiol ogy c f t he disease and carry out th" treatment of the infec t ed i ndividual s, wi despr ead snail surveys and control, t o conduct heal th education of the population, environmental sanitation and. training of the personnel. Such activities may spread t o other parts of th~ country under the auspic es of the Ministry of He~lth. Th·" centre i s fairly well- equipped and has been provide-cd with personnel who have been trained by t he WHO short-ter~ consu l tant. A survey of t he snails was carried out by the consultant and i s bei ng continued now by the counter part and the staff. A house-to-house survey and s earch for infected individuals has * See: Document EM/RC13/5 EMjRC 1 3/2 p2.ge 37 be en s:\,st '2mat i c 2.11y ::;tr,r t ",d i n Se,r,.f~.nd rt S w01 l ;), s i n t h e ne ighbouring vi l L:1ge s . Out ef 296 indi vi duc. l s ()y.amin c,d 9. 5% wer e f ound infected with uri n :o.ry S . h il.8mat o bium , and t h e tr e2.tment of thc: sc pa ti ,.onts wa s c 2.rr i ed ou t by t h e c ',msu l taDt = d his count " rpa r t . 68 . Th e pr8blem of bilhar z i C1.si s i n Somali a rJ!. s b",;:;n sur vey ed by a sh or t- t erm con su l t "n t who Vias ils::; ign c,d f or- t his p<~,rticular wur k by t he Regiona l Offi ce . He r e p::J rt cd tha t t h e pr ::J blem was ne t r:. s cc mp1ic2t c d a s it is i n <=xtcnsively irrigc. t ed countri es . The d ilnge r l i es i n t h0 plan s f or t he d<= ve1opmcnt o f irri[,;2.t i on in 0r dcr t o incre<lst th" a r e a a f the cu l tiva ble l E-nd i n Soma li <l . Ef fec tive cont r ol measur e s, j,f s tart E: d b e f or e t hi s extensie n , \'li l l b e compc:r:o.ti v <..ly ea s~', e.n d 2.ccordi ng t o the views o f the shor t - t erm c on sultant , wil l r E: quirf:' f r om 5 - 10 y e2.rs . Thi s could be a chi ev ed by tr8ati ng t h e infec t " d po pula ti on , and s i multaneously :c.tta cking s na il s by a pp lying mollusc i c ide s t o c oll ec t i ons o f wa t er and rivers i n contact ilr eas a r ound human :-:'abit a t i ons . 69. In t h e north of Somalia til" r e is no bilhur z i a s is nor di d the consul t :lnt f ind bilha rzia sna il s , becau s e o f th e gener a lly dr y s o i l , du e t o t he: abse nc e o f rive r s . Wave r supply is mainly frem wells ilnd r a in wat e r . In the s ou t h ~owev er , urinary b i l h :;,rzia s is as well 2.5 anky lo s t omi o.si s and ils::;aria s is " r c qu i t " c ::Jmmon e s pe Cia lly i n t h e rlr e D. o f t h e Jube. a nd Shj be li ri V '-'Y'S . Bu liYluS ,o.byssinicu s Vias col l e c t ed . 70 . Of 438 pe 'Jp l s c: xami m :ci. in t h(: nor t h ,,11 gave urin t ,sampl es bu t n on e h as bilha r z i C', 'OV '2 . In the" s ou t h , out of 1301 ,exami ned persons on ly 1254 g2.ve Urj, D'::; s :lmp l "s . ,'\mong th~se examined 25 '.5% Vlor e pos1 ti v ,~ f or Schi s t o s oma h a emat obium ova ; the h i ghest per c el'ltage WEt S i n th(; age gr oups 10- 14 i n be th ma l e s (;1.2%) and f ",mal e s (22 ,'7%) . 71 . The bi l ha r z i a s i s control pr o j '~c t in I r un ha s be"n showi ng apprec i able a c tivi ty . The pr oGramme wa,; d i s cussed with v:" r i ous experts f r ::Jm the ' Regi ona l Off ice [md \'IHO Hec:.dquart" r:,: . I t wa s a lso r evi ewed recentl y by EM/RC 1 3/2 page 38 the WHO BilhQrzi~sis Advisory T8am . It is hoped that after a survey and study of the malacologic al situation an attack phase of control of the snails wil l be evolved. The WHO Mal acol ogist was appoi nted, and started work on the projec t in July 1962 . 72. At the bilharzia~is control proj ec t in Iraq t he new WHO team consisting of an epidemi ol ogist and a ma l aco l ogi st, have been actively engaged in planning the future progrnmme of work which has as its main objectives the carrying out of an epidemiological survey on statistical scientific pr ocedures in order t o obtain the base- line da t a and, in the fi eld of malacology, studie s of t he snail ecol ogy and population dynami cs conducted according to an outlined scheme . As snail control by mollusc i- cides is considered a t t he present time the most pr omising and practi cal single method in the control of the incr easing pr obl em of bilharziasis, it is planned t o conduct trials with the most r ecently known and effective molluscicides. Horr Ra j ab has be(;n s el ect ed as an ideal project ar ea . 73. In the United Arab Republic wher e bilharziasis is considered one of t he most i mportant public hGal th problems , increasI ng population ~~d increasing ar eas of irrigation accent the need for continued study and r esearch t o provide mor e effective and economical means of snail control. The advantages of a dual-purpose chemical such as Aqualin, (whose active principle is Acrol ein), which acts not onl y as an effi Ci ent molluscicide but also as a potent herbicide , killing aquatic weeds which normally make the habitat s ideal f or snails in s ever a l r espect s, ar e obvious from the vi ewpoi nt of snai l contr ol. The sc ope of the bi l harzi asis control progr amme i s expect ed t o be broadened and the much needed cooperation of the irriE;ation c_nd ?.gricul tura l departments, as w-clT ,~ s- that of individual landowners enlisted. 74. Surveys made by t he ~~O Bilhar zi a sis Advisory Team indicated that f ield trial s of Aqualin wor e f easibl e in parts of the Sudan and the United Arab The medical ass,stants on this team performi ng a surgical ·"- I -~ • An anatomy and physiology course in th e same institution. .. operation. were trained at t he Medical Assistants School of Omdurma n. w hich produces most of Sudan 's auxi liary medical manpowe,·. Stud ents learn to han dle surgical ins - tru ments. TRAIN IN G OF MEDICAL ASSISTANTS (SUDAN) Medica l ass istant students get practical experience in diagnosis. MALARIA ERADICATION (SOMALIA) -he first view of a Somal i village from the malar-ia tcam's jeep, Labor'atory wot'k a'; t he WHO-assisted Mal ana Era- dication Centre, Mogad is hu , Blood samples an d sus- pected mosqu it ces undergo systematic exa min at ions , A spraying sq uau 011 it s way t( Taki ng a blood sample fro lll a yo ung "suspect" for furthe r microscopic exa- nllnation and diagnosis. MALARIA ERADICATION (PAKISTAN) Inte ns ive fie ld u ·allll ng is give n to sp,-ay- ing squads befo re th ey <Ire se nt to o perat io na l areas. .. I -- / I 1/ WHO Senior leprosy adviser shakes hands with a newcomer - and evaluates the extent of damage to his patient 's nerves . The mobile unit of the lep rosy treat- ment centre in Dacca holds regular consultations in nearby villages , exami- ning susp icious cases and contacts, registering patients and distr ibuting anti leprosy tabl ets and vitam ins. The WHO adviser and his Pakista ni colleague examine a new patient : loss of sensation is tested by merely touching the patient's legs with a piece of cotton wool. ' . ~ .. ~l';"'... - ~~ ~~ 7~~ .~~. LEPROSY l CONTROL (PAKISTAN) EM/RCI3/2 page 39 Republic. Ot her cllemic:;.l s Wt re giv::m tri2.ls such as t he chemical compound known a s ICI 24223 (ise-butyl-tripheny l - methyl2.mine ). A small canE.I in thG arc;a of the Bi l harz iasis Control Pilot Pro j.-:;c t and TrE.ining Centre , UAR, was sel ected a s sui t ablB for making Ct f i r; l d test wi t.h t he l ioited amount of chemi ca l available . It was <c onc l uded t hat this compound wa s very effective wh en applied i n the proper f ormulation . Similarly , a small amount of Bayl usc ide (Bayer 73) wetS t ri ed in order t e run r. cmp 2.rativG fi eld experiments during tho same per i od . Almost simil!lr were th E; r esults obt ained by t he: above- mentioned chcmic:lI s, the; e stimate of kill due t o Bayluscide f or Bulinus was 99.60% f or t he 48-hour and seven-day surveys. Sodium pentachl or ophenatc was also applied t o the c2.nal a t the concentrat i on of 9.p.p.m. f er nine- E.nd- a-ha l f hours . Prc- E.nd post -treatm·:mt snO'.il populati on density survey s wer e conduc t ed in the same m3.nner as i n a ll tIle previou s trial s with the other molluscicide; s . A t ot a l J f 90 samples W2. S t aken fr·om three s t <,.tions a l ong the can~l. The same procedUl~e wc:s f ollowe <;1 in the untreat ed control canal. The species f ound i n these cQnal s were Bulinus t r uncatus, Biomphalaria ~lexandrina , Physa and various oper culates. I n additi on t o these , a gocd number of Lvmnaca cailliaudi , intermediat e host snai l s f or th·" bovine liver fluke (Fasci oliasi s.) wer e a lso f ound i n the c2nal sel ected f or treatment. 75. Results indi ccc t ", that Na PCP w,u; v e:ry effec tive, wi t h no live sna ils f ound c.t either th" 48- hour ur sev (') n- day survey of the tre,,-: t ed canal. Further observations ()n t he ceffccti vene s s of t he above mc, l luscicides and cert ain effect ive herbicides il n ; continuing with encouraging r esults . This project ho.s attracted t he iltt l:ntion of a number of bilharziasis exper t s who vi s ited i t. Further r eGi onal ac tivities will take pl ace t owards the end of the y ear, a s it i s i ntended to pl an f J r t r a ining e f personnel in the bilharziasis cont ro l in the proj 0ct 0 :1 an int~r- regional basis . EMjRC13!2 page 40 SMALLPOX 76. Three count ries in our R88;i cn Vlhor " smallpcx i s endemi c , have l aunched er adication campa igns , and one 8ther country i s about t o s t art such ~ campai gn in 1963 . The r e sul ts h:;.ve , so fe.r, been 6ncouI' :J.ging , "'.nd our Region is now advanc ing t ow:J.rds smallpox 2r adi ca t ion . 77. Pakistcm , which hilS G~n ar ea s f highest c. ndc:mi c i t y, is among thos e countrie s und0rto.king such "-11 "xt 0nsivu effort . I n East Pakistan 27 ,8)C,289 per s ons wer e vaccina t ed between Nov ember 1961 and November 1962. In the Sudan, 3 , 354 , 572 persons wer e vacc i nated butw88n February and August 1962. 78 . WHO assi s t anc e t o t he se cc;untri " s hc.s been 5.n the f or m of t echni cal advic e, vehic l <;; s, r E: friger o.t ing f acil l ti es, vaccine , suppli es and equipment. UNICEF i s now a s s i sting in the: smOl l 1pox er adi co.tion pr ogrClmme s i n mor e than one country of our Regi on. The f ollowing i s t he pr ogress aehi ev2d by the Pa ki.stan : ----- 79. The East Viing , with a popu l ation of 50. 8 million people , i s cne of the most highl y endcernio r 0gionG i n th <;; wor ld f or sm:J. l l pox . undertak"n an eradica t i on pr c gr amme t o a chi"ve comple t e pr c t r"ction of the whol e populat ion ag",i ns t smo.l lpox., i n t we pha s es , t o b·.:, impl emented on a zena l ba s i s . Th" first ph:ts c wi ll be t .;r minat ed at the end of 1963 and the s Eocond subs,cqu12nt f ollow-up io; t o be. undGr tak" n i n t hr ee r ounds of t hr ee years Gach , t o beo conducted f r om the end cf Nov(;mber 196) t o 1972. 80 . Thu Gover mn",nt s t art ,, (1 il m:lSS v::ccina tion campa ign i n Novemb"r 1961 and i t i s ;:xp<;;c t (;d t h 'l.t t he whol e: populo.t i or:. of Ec_s t Paki s t an will be vac ci nilt <.d by t he end of 1963 . Th" numbC'r of persons va cc i nat ed f r om Ncvember 1961 t :; November 1962 J.mount '2d t o 27 , 830 , 28<) . This r epre s ents mor e t hem hal f t h2 t Dt a l popuL:tiGn of t hs provine ~ . EM/RC13/2 page 41 81. I n or d",r t o ass(;ss th8 me thods , both t ,- chni cal and a dministra tive , employ 8d i n the vD.ccina tivn c ampaign , and t,~ d(. t ermine wha t changes, i f e.ny, shou l d be madE: in th(.' orgt:mi -:ati,"n and c cnduct of t ho surveillanc e phas e of th~ province-wide mas s campaign , D. pla n of oper a t ion f or a small- pox ev:".lu2_ti on and asse: ssment pr o j (.'c t Vias drawn up t e' bu carried out over a peri!)d of one Yl':ar f r om June 1963 t e J u ly 1964 in the distri ct of Ku shtia . \VHO has agret.d t o provide &n (;pidGmio l ogi st fJr on e y ",ar, suppli 0s o.nd equi pment in the amount of ~ 10,000 . 82 . In H€st Paki s t an, thE: Govornment is working on c: sch",mc f or smallpox e r adication, of two Y8ars ' dur at i on, t o begin in July 1963 and c ontinue t o 31 June 1965. An amount of about PR o 10,000 , 000 i s t o be a llocated f or this pro j ect. A WHO advi ser a ssist",d i n the pr epar a ti on of this scheme during hi s vi sit t:l Pakistan i n Dec ember 1962 . 83. Freez e-dri e:d sma llpGx va ccine is pr oduc ed in E:.st P:ckistan in suffi ci ent quant itie s and can ,,::.si l y cove:r the noeds of East and West Pakistan. The production of vac cine in t h z: " l even months J anuary t c N .'v embe r 1962 , amounted t o 37,294,500 dos ,,"s , wi th t he r a t e of about 1,000 ,000 do ses a week . Thi s can b e' r:.isud t ·, 2 ,000,000 dos e s a week. UNICEF a ssisted t h" Sm" llpoll. Vacc i ne. Pr:)duction Labor a t Dry with the pr ocur ement of p l ant equ i pment ilnd veh i c l es in thG amcunt Qf .:fi 37,000. Siludi Ar abia : 84. A pl an :) f oper a tion f or t ht e r adication " f sme.llpox ','las s i gned by W'rlO on 4 Octc ber 1962 an d by the Gc vernment on 10 October 1962. The purpose of this projec t is t c e r adica t e sma llpcx through va ccination of t he entire populat i on within thr"e y ears . This i s t o be undertaken i n thr ee phas es . Th" f i rs t phil::;c i s t h " vaccinat ion :)f t he; popul:ltion i n the East, North a nd C"ntre of the c ountFJ ; the second phase c overs the va cci·nntion of the population in Hidjaz, and t he third phaso c ov ers the v<,_ccinati ':;n (i f t h e populat i on in t he South er n part :-; f the; c ountry and tht EM/RC1)/2 page 42 Taif Zone . villO assistance i s in the f orm of a short-term consultant , vaccine and vehicles . The t arget date f or the i mplementation of the proj ec t is second half 1963. Sudan: --- 85. An eradicati on campai gn was stc.rted in February 1962 in Kordofan and Dnrfour, the two wester n provinces , and the total number of persons vacci- nated amounted t o 3,354,572 by August 1962, as a f irst phase of the programme. The succ ess of primary v~ccinations was about 95% and that of the secondary vacc inations about 85%. The second phase started from the first week of November 1962 in tho three s outhern provinces. 86 . According to the plan for the eradication progr amme , the country has been divided into f our zones . The first zone , the western provinc es (Kordofan and Darfour) "There) the vacc i nation campaign end-=d in August 1962, t he second zone (the three southern provinces ) wher " t he vaccination campaign is beinG undertaken , the t l1ir d zone (Blue Nile and Khartoum provinc e ) where the campaign is due t o begin 1963, and the f ourth zone (Kassal a , the Red Sea H~ ll s ~n~ the nerther n provinces) where the campaign is scheduled to start in 1964 . Yemen : 87. A short-term consultant provided by WHO visited Yemen in order t o assist the Government in t he launching of their smallpox control and er adi- cation campaign . He stay0d in the country f or three months and contributed also towards the tra ininG of per s onnel. Forty male dressers wer e trained . 88. The mass vaccination campa i gn i s t o be continued f or three y ears, aiming at the eradicati on of t he disease t hr ough the vacc i nation of the entire populat ion. The campa i gn st arted in Sana ' a . The town was divided into s even zones , and vaccinat ion was carried out from house to house . On 10 September 1962, the t own of Sam: I 2. ~12. S complet ely vaccinated. a~/Rc13/2 pac" 43 89 . The mass v('.ccinatton slovlC:d d :Jwn a t t he €oDd :;, f Sc:pt c r;lber :md fin 2.11y ccme t o .:t standstill, but shortly el ft ",r , '" 1 :1'11 vl2.S p,,"ss<:.:d m2.kin,5 v8.ccin£:- t i on ag~inst smallpox c ompul s ory . Thus, ~ince 15 DSC2mb«r 1962 thro<:.: teams were f ormed to underta ke vac cin~tion i n Hij j ~ , Man£:kh~, Imran , Hodcida , Beit- t.l - FaGib, Mocha , Baida , Rad2.? , I bb, Yarim :md Do. mnr . 90 . Smullpox Incidence in the Region . Th e f olloviing ti;~bl", sho\·/3 t ot2.1s of smn.llpox case s r epClrted du~'ine; the peri r:>d. un~k·r rev icv! as curnp2.red t o the tctals of t he pre:ced i ng period . Countri e s AdGn St a te Aden Prot ector ate Et ni opia Iran Muscat and Oman Pakistan East West Karachi Saudi Arabia Sudan Truc i ? l Stat (; S Dub:!i Fuj airah ShdY.hdGm Yemen July 1961 t o June 1962 o o 333 108 8 451 1453 ::.399 o 11 12 o D D Dat a not availab l e July 0 0 260 1 0 2341 735 82 1 f37 0 0 5 196 2 t o we~k cndec'. : (1963) 13 April 1) April 25 Mlly 2 Fe bruc.ry 13 April (Appr ox . ) 11 M<:lY (Appr ox . ) 18 May (Approx . ) 1 June II ["lay 4 May I 13 Apri l 13 April 10 ./ J <'.nui"·:'Y EM/RC13/2 page 44 YELLOW FEVER 91. Th0 Scientific Group on Yellow Fever Resear ch i n East Africa which met in Genev=. in May 1962 made pl ans f ·::J r thE: devel opment of r e s earch activiti es during 1962/63 , t o be cover ed by WHO r esearch funds. The r es ear ch pr Clgramme \l2. S di vided into two par t(; , first, the ser ol ogical stirvey of wide geographie o.l a r ea s not ye t st udi ed, and second , more ext ensive: ~tudi o s i n limited ~rGL.s . The r e sear ch proj ec t sponsor ed qy WHO was deve l op<:d by the <:' st abl isi1lJtC Dt of a r c; s tiar ch stat ion at Tchab:;r a in Western Ethi opia , ac cording t o t he r ecommendations made qy t he Scient ific Group . (1 ) An entomol ogi ca l survey was c arri~d out a t Assnb, in Ethiopia , and no Aedes aegypti cr l arvae were f ound . Assab was declared ther eaft "r fr <..o of yellow f ever . (2) I n mid-Novc=mbcr, th", Di r ector of t !k Pasteur I ns titut e , Addis Ababa , vi s i t ec t he fi eld station in Tchab0r a ar e" , Kaffa Province . He Vias acc r)r:1 panied by 2.Il entomol ogi st , an Ethi opian t echnici.:m and some c.w::i l i ary per sonnel. The t emn pr epared a dot ailed r epor t .In ye l l ow fever studies whi ch was sent t o Headquarter s f or publ i cati on . (3 ) Also ~ccording t o pl~n, an epidemiolQgic~l survey was carried out in th~ wh~l e of the Awas~ V~110Y i n November, and in the . l ue Nile Valley f r om Lak~ T~na t o t he Sudanes e beraer. Nc· c1il,1ca1 ~ a s e s 0 1· y e. llvw fever were c.i s cover"d . 800 o::.mplcs of blood WCY " col l ec t ed qy the end of Dec ember; a s ~1C 11 as 28 pools with more than 1000 mosquit oE- s . Th Cl most common s pecies i n t h e sy l vani c ar e?E wer e : Aedes aedimGrphus, ~ africanus, Erct mapodites , Culex nibulosus . The s or e. collected wer e lyophilized ",-t th l~ Pasteur I nsti tut <:. and I'/ill be test",d i n various l abor at ori es . (4) A yellow fever vaccination campa ign was s t arted i n t h e vlollega Province and will b -o carr i 8d out in all ar 82. S of t he Shaa Provi nc 8 belm: 2000 m.:tres ,ma " l ong the Rift Valley . 92 . During J anuary 1963, y ," l l ow L Ner r e s "n.r ch activiti es continued at Man() r a Stat i on , wher e oper atiuns wer " conductu l by a :nember of th .. Pnst vur I nstitute: . S::Jme difficulti es ' lIer e e;ncount",red r egardi ng the Er~/RCl3/2 page 45 brc:oding of vlhi t o mic e . An epid..:mi :.; l ogi cal and entomol ogical survey Vias carried out by ~n Epidemiologist ~nd an Entomologist in the southern part of t he country; the tw(' experts r eturned t o Addis Ababa at t h" end of J anuary wi th s2.tisfac t ory r Gsu l ts (400 scr n collec t ed ). 93 . The t ot ll l numb8r of y",llow fev8r v2.ccinCltions carrh,d out in the Wcllega Provinc e ;J.m'.JUnt,~d t ~ 40 ,000 L'Y t h" end of F"bruary. Five t eams of v3.ccinc:t ors st2.rt<;d vaccination in the Awash V,,-lluy and 45,000 vacci- nations hfl.e. be0n c <lr r i ed 'Jut bJ the 0nd of J anuary. In February/March a wide t our in Harrar-W·",bi-Chabe l h : ended a. lQrge scn.le investigation. 94 . The t otal number of s er fl. collec t ed i n th" course of the 1962/63 investigati ons amounted t v 1200. Thr8e met eorol ogica l stati ons ar e already functioning , in Boga , in I'1ancr a <lnd eme in thc for ·:,; st ar Ga . 95. Regarding the outbroak r .:portcd from the Tirgol area, in Ethiopia, near the Sudanese border, the Ethiopian Goverrunent report",d that it had been a ma l aria epid8mic and t.~at evid"nc E: of yellow f ever could not be f ound. 96. On t he b2.sis of ser ological surv0Ys on humans , t h8 Ethiopian hc;Qlth administr ation d8c l ar ed t ha t Illcubabor Province , Wclloga Provinc e and Soddu Sub-Province in Sidam::.> Bonana Provinc e , should be considered a s yel l ow fov0r i nf8c-t",cl ar .;·a z :0.5 of 1 June 1962 . COMMUNICABLE EYE DISEASES 97. Amcng these di s c;a s es, bactcr i ;,l (me. oUh:r f orms of eye i nfections , including t rachoma, t c,ko the l eading part in causi ng a l a sting impairment of vision and even bl i ndn8ss . Nothi ng but concentr at ed sy stematic control m"asur es can i'.ll eviat t; th"" s 0v"ri t :,' aCId bring ::.bout nn eventu.al r eduction in prev2.1cncc of thuse di s8ases. EM/RC13/2 page 46 98. Continuous effort s arG being made t o ovolv to nGW drug s of incre,J.sed e ffici ency "nd t o de:ve l op treatment methods '."hich might eve ntual ly l ead t o the preventicm from infection o f communicn.bh, eY0 d i seases . Of special inter c-st in this c ontext a r e vaccinetion tri als which c:n, cQrri od out t o define both the applica bil ity and benefit of th~ method . 99 . During th", year undtor r 2vi e l'l, th~ WHO- 2.ssistc:d vi r u l ogicc-.l resear ch unit a t t h e Ophthalmol ogica l Cc.ntrc i n Tunis has cuntinued i ts r esearch work on the cultivQtion of trach 0m? virus strC1.ins and hQS c arri ed on its i mmunol ogi cal s tudies and lab :)r ~,tory t e sts -~- f antibi otics and other drugs as to their e ffic acy on the tr=. choma virus. 100. ContrGl activiti es em :'. lare;0 sca l e heve be en c ontinued on -3. national ba sis in Tuni s i a and Ethiopia (Eritrea ) . In both o f t he s e countri e s, special treatment schemes are estc.blished r 8gul arly t o cove r all s ch ool-_ children and t otal populat i on e;roups. Control ac t ivities hiwe bec:n carried out f er s;.:vc:ral yeQrs a l so in the Uni t " d Ar a b Republic !'Iher " an interesting new administrative nppr :'" ch t o the prcblem of m::cnClging a me.ss treatment oper ation has been r ecentl y l aunch0d by the, Gc vcrnml:nt entrusting t he Agriculture CooPer2.tive Soc i e ty with th" r Esponsibility f or the proper execution o f the; prGj ect a t the. villrcg .:o l ~-v := l . particularly appli c: cl t e; schoolcbildren , <'.r e b EinG carri ed out ::m a na tional basis in Tripolitanic'_, Liby 2., o.nd in KUlva i t. 101. Trachoma morbidity surv~ys under wo..y in fiv <;; rur£:l hGCLlth c8ntre -' areas in West Po.kistan since June 1962 h~vc rec0ntly included t herapeutic trials t o define a pr,"cticabh way o f intesrati ng t r aC!lOme. control into the rura l health s ervic E.s of th .c country . 102 . The: Communicabl e Eye Di s eas l: Control P'!'(, j ec t i n Ire.q, <.;st a bl i shed in early 1961, h :ls developed and l:xpand 8d on scheduL: . WHO personnel a ssistanci.: t.:· t hE; Projc.ct Vias ext0nded till the 0'1d of J une 1963 . N 8 W pro jects H..:- re sk.rted in the Sud:l.n at tht; -:;r;c of 1962 and in J ordan i n EI'l/RC13/2 page 47 April 1963. Another Communic ilb1c Eye Distase Control Pr ::> jc:ct wi ll be e stablished in th<o' Provinc e ,)f Fars , Iran, in Jul y 1963. 103. Four ophtha lmol ogists froD f~ur cuuntrie s of our Region (Iraq, Pakistan, S"udi Arc.bia and Sude.n ) "_t tGnctecl, as \lIHO-Fellows, the vlHO Inte r- Regi ona l Tr2.ch0ma TrClining C<)UI'S;C O' t Aligar-h , I ndia , 28 October unti l 23 November 1962. They a lso f CJ l l c-we d , a s c bser vers, the WHO I nter-Regional Conference cn TrClch onJ2. , 26 Nov ember until 1 Dec embur, Clnd the Internation Cll Congress of OphthCllmology in Nm~ Ddhi, 3 unt il 8 Dec ember 1962. The Conferenc e: wa s a lso attendud b<J t hr c,,_' exper t physic ians fr :Jm three countri e s of the Ec.stern Modi t "rranec.n Regi on (Iran, Pakistan :md Uni t E:d Arab Republic). These arrangements offered an op:)oc>tuni ty of exchangi ng idea s of mutua l interest with ma ny expert s frum other countries of the world. VETERINARY PUBLIC HEALTH BRUCELLOSIS 104. Studies on th", pr'cva l enc 8 ~.nd Epidemiol ogy of Brucellosis in man and anim:lls, t oge the r with Gxp8r iment:.;.1 work on v2.ccina t i on of she e p and goats, h2.ve beGrt carri"d ou t i :1 t h i s R,~gion , duri :1g t~i e period under r evic,w. Gr2.nts wer e p1'ov id8d by WHO t o thr", E instituti ons tc ::: ontinue their r ,,::;earch work in thi s fi e ld. 'Er1CS0 arl-: th ,~·· R:-..z i I nstitute f o r S e r .:l and Va.ccine , Teheran, t h" Past eur I n s t i t u t (;, Teher an, and th~ Vet erinar'J I nstitut e , Beith Degan , Israel . The Razi Ins titute , Tehcr~n , ha s already started e pidemi ol ogi cal s tudie S i n two ondemic ar t.'as nnd experiments on vacc ination of sheep :;-:.r o being und8rtakGn :ct t hE: Insti t ut e . 105. The r es ,-,a r ch wurk during t h,,, p8riod unde r r evi ew , inc luded thc continua t i Gn of previous work in addi t Lm t o an expl or atory work f or possible trials of brucella vacc i ne in F,an , t o be carried :Jut i n human volunteers , in colla bor a t i on with the Pa stGur Institute: , Teher "n. EM/RC13/2 page 48 106. Tht Vetdin~ry I nst itut e; Bd th Dagan , I sra el , h e,' S C~lr0:ldycollaborat"d in WHO coordinated s tudi es in bruce llosis in past yea rs. The fi eld of s tudy i.ncludod u s ing diff", r ent va ,:c in(;s with the purpose of de t e:r mining the degr ee and l engt h of immunity :>Jnferred by these va ccin co s against "xposure to na tur a l infec t i on with bruc<;; l b . r~el itens i s . HYDATIIXJSIS 107 . Reso2.r ch on Hyda tid:)sis s t e.rt c:d i n the D" partm",nt c :C Tropicc.l Health , American University of Bc irut, in 1961, c:wer i ng studie s on the epidemi ol ogy and ec e l ogy of t h i s di scas(: , c ont inued in 1962 a s part o f WHO coordinat ed r e s ear ch . The f i e ld of s tudy induded : (1 ) Th", ep idemiol ogy (; f Echinococcus i s with s pecial r efer (;nce t o p(; s s lbl " wild- l i fe i nvol vm,mt , bin:;mics of OV 2. in pastur es and imp ortant sociol ogi cal f actors . ( 2 ) Studies cn ova c i dal pruper t i e s of chemicals . (3) Investigati on of factors r e sponsible f or d emonst!'able host r esist a nc e agai nst Echinococcus. (4 ') Studi e s '~,n the i mmuniza1:.ion Df def i ni ti v e and inter mediate' h os t s of Echinococcus . PUBLIC HEALTH SERVICES HEALTH EDUCATION 108 . Health educ Slt i an c~,nsti tut0 s c;n ;; :> f the basic f uncti on s of every health depa r tm ent a nd i s 2. sine qur: ~ Df CV GY"J he:.J.l th ac t ivity, i rrespective of the. l cv01 c f administration . Th ,:; u r gent n"cd f e r integra t ing h(;al th educati on wi th ot h er hee:l th ac t i vi ti c s f or t he Selke of a ssuring acc cpt 2.nce, continuation and impl .~mi.:ntSlti )n of programmc~~ by the peopl e ha s o.lways been r e commended t o the Gov'=I'nments in thi s R(; gi on . In additi on, in every WHO- 2.ssi s t cd pr o j ect health educati on h:l.s be(;n regarded 0.5 0. ma j or function interw,:w cn with " v ery hee. l t h a cti vi ty . EM/RC13/2 page 49 109. Theref or e, i n appraising h~alt~ education in this Region one shoul d not limit one self onl y to t he viork of t~e health educati on specialists i n the fi e ld . One should consider t he sum total of a l l t he act i vities i n t he f i eld of health education carr ied out by staff at the var ious l evel s of the hr;a l th sGrvic~ s and uYlder d i ffe r ent condi t i ons , i n controll ing spec ific di seases or in t.he promotion of general heal t h . These pl anned activit i es i n hea l t h educat i on , specific or general , a r e manifestl y i n need of coordinat ion . llO. For t his r eason, t.he WHO Regi onal Office f or the Easter n Medi terranean has l ong encouraged the for mat ion of str ong central bur eaux of heal t h education and a s and when appr opri a t e , provinc i a l bur eaux of health educa- t i on in t he Ministries of Public Health t hrougnout t he Region. Thi s necessit at es availa bility of an adequate number of pr of essi onally pr epar ed heal th educat or3 . Today, there ar e nearly seventy such per sons available i n t his Regi on a s cOr.1par ed to one or t wo only a decade s.go . Tni s gr owth , Gven t hough s t i ll much be low the actual necd, is to a l arge extent i ndica- t ive of the appreciat i on on t he part of tho Governments of t he f act tha t publ ic heal th improvement is poss i ble only w~en such movement meets active , voluntar y anel cons i s t ent partic i pat1c n of peoph:. Today, i n t wel Ve count ries of t his Region t her'e exist central bureaux or di visions of heal th edu ca'ti on . A signl ficar..t proport j on (;r t :Jese divisions are headed by qualifi ed heal t h education speCialists almost a ll of whom have r eceived gr ants from WHO f or post- gr aduate t r a i ning , fo r parti c i p~t i c;n i:1 30f1iY1arS or fo r s t udy t ours . I ll . Spec i a l attempts have been made by some of t he, Governments during t oe pa s t year to pr omote or organh:e their heal t h education service s . For exampl e , Kuwai t and t he Sudan have been actively engaged i n r eor gani zing t heir health edu~aticn activit i es . Emp!-:.asis was pl <lc ed on ~eal t h educat ion in t he Uni ted Ar ab Republic at t he Second Annual Confer ence fo r Teacher s and School Heal th personnel in I'ihi ch several hundred offi cials took par t, and a t the Conf erenc e f or Healt h Education 'tlorker s of t he c ountry, in bot h EM/RC13/2 page 50 of which WHO pnrticip~t8d . In Iran, a nuther grcup o f h e2.1th educators we r e trD.i nec, and ::'n Snudi Ar "l.bi ::;. prvvi sior:s we r e !.l::.de by t he Goverrml <2nt fe r f c·ur f811 o\Vshi"s t o b", n1'l2.rdcd t o n 2. t i ,:m'l.l s f or c r c.du2. t & s tudy i n the field of h enlth educ 'l.tion . The f~rc.\b St2.t cs <rra inine; Centro f or Educ a tion in Community Devel 'Jpmcmt c t Sirs- e l-Layyan, United Ara b Rc public, continued t o s ive some instr uc ti :m in publ ic h Ga lth in gen ",r .c:. l nne hOc-1tt] educ ation i n pnrticular tc, Qll t he: studs nts visiti ng th." c entr e f ·')r n period of tra inin6 ' I n 'l.ddi ticn, special instructi on i n h ealth educati on wa s g iven t c the trc.incc:s wh c came f :;,r the purpo s e o f s-wdying in the f ield ·:; f public health a::;i t r el::.t es t o community development. In orde r t o assist the Gov ernment s in strc ngth8ning ~'1eir h eal th educ a ti on services, s ix fell owships wor e provided by the, Regi on ::;.l Offi c e f ::;r study in h eal th educ a tion durin g this y eQr. 112. Another ind",x o f the appr eciation 0f h 2a lth educ a tion as a maj or h ealth functi on throu ghout this Region may be f ound in thli r e l a tive ly significant number of partic ipant s fro~ thi s Rogi~n in the Fifth Conferenc e of Int0rnati one. l Union f or HeQl t h Educ'ltion which wa s h eld in Philad e l phi "l. in July 1962 . 113 . During tho past yo~r , t he l'iliO Regi onal Adviser on Health Edu c a t i on visi t ed e ight count ri e s in th", Regl on f ·.J r the purpose of r evi ewing with the Gov ernment (, fficial s till: st:.tus o f health educat ion s ",rvic ,-, s =.nd t ::, make r2c (;rmnendatic~s f or strengthening such nc t i viti(;s . 114 . A numbe r of signific2.nt h e:.cl t ;: edu cation clc:tiviti ':' :3 with respec t to rw.laric. er adi c2.tion wer .: car r i ed out by the Governments duriJ'l.;:"; tht: pas t y ear. In Pnki s t an , t h o GovL. r nment ",st .,-bli shed 2. unit o f h ealth educntion in t h e malar- l ao 1,~ r (l,cli c 2.ti on pr0gr~ ... mrn0 . Also , f 0r tho firs t time nn intensiV t~ prc-s .;:::rvi cL: t r {':ining in hL!.-~lth \.~duc a ti ')n \,!~.:.. S g ivc.:n t o two group s '-,f healt h oduc 'ltion worke r s L : m=.L,"ri2. 0r adica tion in tho Enst and WGst pr ')vinc e s · ~ f tho c ountr y . In S",udi Ar abi :J. , provisions wer e: C1" de bJ the EM/RC 1 3/2 page 51 Government t o empl oy '" qu~lifi ed hE,"l t h "duc'"t or f <)r t he purpos e of initiati ng health education act i vi ties i n mal ar i a ~nd t o give some he,"lth "ducat i on prepar at i c:n to all m<:.12.r i e. 'Horker s . I n Ir~n , t en health eduea- tion specialists w"r e a ssi gned or cor. t i rl"cled to work in t:k f idd of malar i a er adication . I n t he Sudan , t he pl an of oper at ion f or t he: Malaria Eradi cat i on Tra i ni ng Cent r e pr ovides f or a f ellowship f or gr aduat e study i n health education . The c~ndidate upon completion of hi s studi es will be a ssigned t o the t eachi ng s t c.ff of t he tra i n i ng c e:nt r e f or t h .. purpos e of giving i nstructi on in h eal th edu ca t ion t o all ma l ar i a worker s of the country • 115. In summary , t he impor t ant rol e of health educat i on i n the prevention of di s c:a s8 and promot i on of h enl th i s becoming r ealized by health workers throughout th<.: Regi on. Thi s r ealizat ion has cry stalized i n two distinc t and y et i nter-re l a t ed mJacs of ac t i Jn : (1) t ha t <.ach health worker should devot e adequat ;; t i me and (,ffor t f 'Jr he.:1.1th educ c.tion as a part of hi s heal th activity a nd (2) t hat a cent r al bureau of heal t h educat i on, headed by a health educ ation spec i ali st shoul d be r espons ible f or over all plnnning and coor dination of such heal t h educat i on acti vities . The rol e c f the Eastern Moditerranean Rc[£i cnal Offi c ,- of t he Vior l d Heal t h Or ganization i n t his ffi.JV8m0nt he.s bECen t he.t vf direct as si st 8.nce in var iou s i orms and of pr ovi s i on ,) f expert advicG. HEALTH LABORATORIES AND RELATED SERVICES 116. I n the campai gns WHO i s conduct ing a~ainst communi cable diseas es, publ i c hea l th l abor at or i e s ar e play i ng an evcr incr eas ing r e l e . Requ8sts f or a s s ist;:mce i n tho plnnning , organi z? ti cm and devel opment of such labor a t ories and their r el a t ",d s Er vicEJs ar " bec oming mor e numer ous. 117. Ther e ar e about t wenty pr c! ject s i n t he Regi onal progr amme dealing with di ffer "nt l abor at or y ac t i vit ies , namely, public h0alth, virol ogy , EM/RC13/2 page 52 phe.rrr.acGut i c:cl pr·; duct:.Gn and bl ·:; ..:d bi?nks . i n t h e; f e r m c, f ac.vis6r::: . shl rt- t vr m cons ultants. supplh:s ,end e qui pment. 118 . Ex~~pl~s " f suet ~ssist~nc e 2r ~ : tc ·~hnidc.n f e r th" Cent!::!. l Publi c H",c.ltt L2.b ~) r ::t ') IJ' i n RiY:ld , Saudi ,Ir abia i 2. consul t ilnt f ,·. r t hl: c '.mc <..nb":J. t •. d ;,; " r ,=: pr ,_duction in th <.: Un i t "d Ar ",b R-=publ i~ and an .. xp"rt f c,r t h /., Virc L ,p'y fk s ,-i"rch Lc: b :. r (lt :; ry t o orscmL,·.,:. medi c ::l virc l oGY i ~ COD3ul t c:.nt f t.... r t[". ~ Pr _: ducti .::. n .,f Vacc l nc:s i n J c rdc-..n j c e,nsu l t a r.t f ::lr t t" Publ i c H"Cl l ti: and Endemic Di s~ <: s<.. s L".bor ,'lt ,c ry i n the Syrie.n Arab Re public wi th <omphasi s :.m f ')od c ~,ntr .~ l ; =:n :-.dvisGr f :J r th" Public H~alth Labor~t J ry in Cy prus; Hea l t h Ins t itute i n Daccc., East Pakist an i ~.n .'ldvi s"r f~r t h e: Public Hee>. l t h Le>.bor 2.t c r y iI', Iran, ~,nd " 11 2'.dvi s:::r t e, :-.ssist i n th <.: <, s t ahl i shment ccnsul tant :m druC c ': ntr<..,l h~.s v::'si trec Iraq , KUvl::: i t , Lcbancn, th ,,, Sud2.n and th~ Un i t " d Ar ?b Republ i c,; , t ·) :-.dv iSG " :1 t i:<.. pl:;.nning ".nd impr ov emlO'nt o f drug c ·::,ntr ::> l rn"asurc:s . 1:9 . A ccnsul t an t vi s it c.d Tur.i sL. t .) 2.s sist in th" cr::. wing up of l ee;isl 2. t i Gn An " dv i s"r h:::s b"cn appc i n t ",d t o Scm,,-lia f <T 2. ssist:,nc;~ i n th e.. ~rg2.nlZ c.ticn :md mar:ag8m0nt o f !:Jedical stoI' CS and ph C'.rmo.cy , ,":1C~ i n t Il l: <.}s t".b1i !"hm ~Ylt ~:' S8v -= rnm;;r.t:;l subcidic.ry stc r_·s , d i stric t , c "::'lt r J. l <1nd h :) spi t~l >i::,rm:lCL,s, ~ nd t o st anc 2.r diz c: 2.11 ·3 qu i pml.nt , h :·spi ta:' o r (, t h , r ,'li s", '.s w"ll <lS ph ;"r mac 0utic :?1 , surg ic ,,,-l. 'lnd medica l . Bl:)~ c. b::.nk s0rvi~"s h av l: c " ,;n Y" ,- qucsted by th" Syri an fl r i'.b Rc: publ i c and Leb? non . 120 . Th ..: R8e;i ona l Tr :;i"j ng C.)Ur s.: f ~r Lc"b ~r,-,t ,jr<J Tc: chnic 1..'lns in B,,·irut s t a r t e.. d i n Octoo8r 1962 ilnd is schvdul ed t;; c '~ ntinu" f e r e i Ghteen m:.;nths . i~ss i stil.nc e f :J r the ir.;r:r ~ v e.. rr. <..r.L 'o f n :.tiGn::.1 "r2.i ning f acti iti .:: s 2.S We l l. =::5 POLIOMYELITIS (LEBANON, TUNISIA) Hydrothe rapy of a you ng Saud i A"abian , w ho was left with both legs pa ralysed after poliomyeli ti s. He is tr eated at a Lebanese cen tre fo r t he rehabilitat ion of han dicapped children, assisted ea r lier by W HO . Child ren patiently await the ir turn to be admi nis t e- red the live oral vaccine dur ing the mass vaccinat ion cam paign aga inst po li o, recen tl y launched in Tunisi a. MATERNAL AND CHILD HEALTH (LIBYA) Under the supervision of a n ur s~ ed ucator , st udents attend to toodlers during a nutrit ion course. Women and chil dren ca lling at t he MCH Center in Beng hazi ge t free dr ugs including vitamins . KUW AI T - N umbering of househo lds In preparat ion for a TB p,-evale nce survey. '. i~: \ 1 UNISIA A young mother rece ives an ll -TB tablets fl poin ts out the necess ity of regular drug-ta king to e nsure / I / SUDAN A mem ber of t he Sudanese shows his tuberc ulin test I'e~ction fo r furth SO MALIA At t he Mogad ishu TB Centre. I 1 : _ ___ _ itol' who 'ea tm ent. SYR IA La borato ry exa mi nation fo r t ubel'- cle bacill i determ in es if a person is dange- rous to his su rrou ndings, At th e TB labora- tory in Damas, techn icians are taught me thod s of d iagnosis by dir ect microscopy . and cult ure of sputum and laryngea l swabs , TU BERCULOSIS CO NTROL ET HIOPIA - At the TB Cent re of Add is Ababa, this you ng contact of a TB case was found to react negat ivel y to a tu ber- culi n test and is be in g vacc ina ted with BCG . Eth iopian healt h person ne l are tra ined to ta ke ch est X- ra ys and to Interp re te the films . wh ic h are carefully filed fo r furt her fo llow- up of TB cases, App lication o f Aqual"l . an efficient herbic ide- molluscicid e. und e r the wate r surface by direct mete ring from shipp ing d r um and ci rcu lati ng pump , BI LHARZIASIS CONTROL (UN ITED ARAB REPUBLI C) A w ide range of tests o n ways to improve sn ai l control methods, includ ing the use of new molluscicides, have been carried out in the pilot art'3 of the Behcira Province ( United Arab Re public ), A WHO technIcian ap plies the new moll uscicide "Bayl usc lde" wIth a power sprayer to a cana l with a dense vege tation and a large snail popu lation. MATERNAL AND CHILD HEALTH'" Er~/Rc13/2 page 53 121 . In th~ r~ports of th~ I n s t fiv~ y0~rs the pol i cy in mat er na l and child h Galth ac t i vi ti es wh i ch is appli cabl ~ t o t h i s Regi on ha s be~n e xpounded anc illus trat ed f r nm var i ou s angl es . T~ avoi d r~ pctitionJ only a f ew a sp~ c t s o f mat ~rn~l ~nd chi ld ca r e which ha ve e i ther not been mention",d bcfor~ or \'Ih i ch ha v" n :.; t b~(;n su f f i Ci ent ly ", l e.b ::> r a t cd on wi l l b,~ discussl;d thi s y ear . THE OUT-PATIENT CLINI C 122. Many y ear s of cx~~rience i n t h i s Regi on ha ve shown t ha t a mong t hG important pre-r'2qui si t ee s f :w tho impr ovement of ma t 8rna l and ch i l d hee.l th , e.nd f or t h E: r eduction of ma t t:: r na l , i n f ant and chi l d mortali ty a r e the ava ile.bili ty of nde qu::.t dy s t aff ed , equipped and run out - pati ent c liniC S \~hich ar e at t e.ched .o i ther t o childr E;n ' s a nd mnt er n i t y hospit a l s or t ::> ma t 8rnity and p?.ed i atr i c war ds in gener a l n~)spi tC'.. l s . 123. To be i n a posi t i 0n t o l ead t he mat erna l and child he alth (and ·:lther heal th) e.ct i vi t ie s i n the. ar eP. th ~ ho sp i t nl :lu t- p C:.ti~nt clin i c sh0uld expnnd and improv e it s diagno s ti c a nd tr.oa t ment f a ciliti e s , appoint well qunl ified a nd cxp <:rionc E:d spec i al ist s , and i ntroduc e up t c da t G cura t i v e and preventiv e me thods of mnt " r nnl and ch i l d car e, in al l its a s pt:c t s . Wh8r 2vcr possibl e , g ener .::.l pr2.c t i t i on2rs anc. m0 d i cc. l -:- ff·i ccr ::; i n t h t: nr ea shou l d be en cGurcged t o rcf~r the i r Ci:'.S ",S t o th<i ou t - pa t i ent clini c f e r (; onsulta tion with t n o sp",(!i2.1ist !:3 and pr of c:s !:3or s , f or a ssi s tanc e i n diagnos i s :md treat r:J ent, B.nd f ,)r guida nc e i n t h ", pr c:v E:nti ve a s pects of materna l and chi l d ca r E: . It should b :. str l:ss cd t hat i n m·) s t of thE: cQuntri ",s i n thi s Rcgion r "duc tion I n r:l1:t "rnal , i nf nnt and chi ld mortal ity and improv8ment of t he h ",al th of mcth(:r s and chi ldr",n wi ll d epend most l y on the: s t a nd:J. r d of p(: r f orm:lnc", vf t he g,mur a l pr actitioner - whe ther he is empl Oy ed ,,5 Co m" d i cal ) f..:'ic er ( i n a he.:lltt. c2ntrt:: , dispens ary, rura l ho s pital , .,t c .), cr ~Ihether he is ene;ag ed i n pr i va t ", prac t i c2 . * See : Doc ument EM/RCl 3/ 6 Efv]/RC1)/2 page 54 124 . Th", expande d diagnc sttc o.nd tre(,tm8nt· ·r;: "ntreat the out-pati ent clinic as well e.s the prevl: ::>.ti v e acti vi ti " s woul d r ",duc e th ,.; need f Dr h ospi t al i za- ti on, and many ch ildren , j.nc l uding the dehydrat ed ane. ma lnourishGd , c ,ou l d bE: treated on o.n !'.mbu l o.t c FjT b :lsis . Thi s ,i ;1 itsd f wou l d in the; l ong run r esult in a c cm:ider::tbl e economy a,3 vle ll c:s :.n improvement in child heFll th . It would a lso he lp t o s ol vc su ch prob l(;ms o. s shcrtag e of h ospi t .J. l b"d s, the r"luctanc e of certain parents tJ hav" their cr~il dr8n hc sp i tali zed , the const antly increasing cost :)f in- pathmt car l. , the shortage uf p2.odi a tric nurses , and the dnngars of crc s s infl:cti:m i n t h", in~ pati"E;nt wnrds ·. 125 . I n many h o s pi t a l cut- pa ti ent clinics in t h e Region i nc luding univl.rsity hospi tFlls, ther e i s a t present a tremendous turn- over of pa tients, i nc l uc.ing childr en , the rush and e ver- cr owding s omGtime s r 8 sultj,ng among oth", r things in ... irons di a gnosis and in2.dequo. t e treatm.;mt , uDl1(;c e s sary admissi ~,ns :;.nd e v;"r - cr owding of ':la r d s . Tc: s ome ext(:n t t h ", S::ime appli (;s t o urban di s pensari ,.=s which are not 2_tt a chcd t :) hospita ls and t o s ':)m", of th e; rura l dispensccri es , ",her o on(O j)hysi c i an may s ee ov ur 200 pa t icmts i n :J. f ew h ours . On thec other hand in the ffic.t crna l a..1'ld chilO. health centr es, which have most l y been E; sta blisrk d s epar a t e ly fr 0m out- pa ti ent c linics, and from dispens;,-ri e: s and h l3al th c entr" s , a limi t "d numb" r of Ivc rnon ccne children is as a rule sa ,,:!, th", t .:mpo of wor l< i s u s u2_11y s l uw, the 'w ti vi tic s closing down 8n.r l y, of t en be f or e mid- day . An :1m21gCLrnati on of the CLcti vit i e s of mllt cr nal "'-llC c hi l d helll th c 0ntres with those 'Jf h s np j. t a l out- p :lt i cnt clini cs, as well as with dispens1wiu:; a nd h0al th centres, ';'!ould .'l l so h 21p t o so l v o t he s e difficulti e s . 126 . The further [lI·my 'm8 g8t S from the capi k.l city and the bi~ t uwns ~~nd into t C G rural arc:Cl :'; . tb~ frle r e " SS (: ( ~ ticcl . ... ,ould b" t:ei r; in~,,;:;rati or. of hospi t a l and prevcmti v,= s ervi ces fo r women :md c"'. i l dr en and f e r the popu l a- tion a s a wn Gl e . I n c.istric t rural h ospitals, whe ther or not they ha ve s c.:par ? t e !l1'lt cr n i ty :1.1:d childr .Jn t s wa r c.s, t he ou t - pc:tient c linic :::nd th" EM/RC1)/2 page 55 ma in h ea lth c ent r c a r e sometime s combined - or should b e. - i n t o one' s e r vice, the s t a f fing i ncludes s anitar i rms , nurses, midwive s ·:lS w(; l l a s the r est of th8 h eal t h t e am. 127 . The amalgamat i cn of . mQtern~. l and chi l d h e&l th c entr" a cti vi ti e s with ho spi tal ou t- pa t i 8nt c l ini C's, wil l r equire sev er nl adrnini s t r o.tive adjustm8nt s o.t 0.11 l evds, whil e a good wor k i ng r ela tionsh i p b8t we ",n th ,~ ha s pi t a l s ervice s , th0 healt h department , the medi c ~l f acu l t y and t he munic i pa l heo.lth o.nd r e l a t od ser v i ces i s essential . Th" " t radi t iona l " way :J f t hinkine; a nd f un c t i :Jning , in separ at: we.t e r t ight cornpartrmmts oft en on a c :Jmp", t i t i ve ba s i s, will be d i f f i cul t t o chilnge a t onc " and has t o bIJ brought a bout gr adu ally f e r t h e benef i t o f t he heal th of t h e; pepulati cn i n gener a l and of moth" r s and chi l dr on i n pa r t i cul a r . I n a un i v er s ity h ospitnl the v a lue of s uch an integr a t e d mat er nal and child health unit a t t h e out- pati ent clin i c f or t he t r .-:, i n ing :J f m(;d ico. l , nursi ng 2cnd midwifery students C2.nnot be suff i Ci ent ly omphas i zed . 128 . It i s gr ati f yi ng to r eport t hat i n Somalia , wher e a fi ve- y ea r heal t h pl an i s be i ng dr awn up , t h e mo.t ",r n2.1 ::nd ch i l d h ",(,l th Serv i ces a r e be i ng pl c.nned i n as s oc i c.t i on with hospi t a l ')ut- pnt ient clini cs nnd dispen so.rie s a t 1111 l ",v e l s and no i sol a t ,)d mnt fj r n2.1 and chi l d h ealth c cmt r c s ar (~ (envi saeed . PRESENT PRIORI TI ES AND FUTURE PROBLEMS 129. Th e pr ic:r i ti es which h o.ve b"en c s t a bl i sh ed in t h i s Rc [!; i cm during t h e pnst five y ears , e s pec i a l l y wi t h r Eo<; ,"" rd t J t h e t y pe of mater na l c.nd child h 80.1 t h Ser vice s 2nd r esear ch 8-c t i vi t i l: s r €. qu ired , h a v" e. f i r m technical baSis , as descri bed be l ow. 1)0 . I n most of t h" countri es i n t l1 i s Region t h e i n f an t mor t a lity-ra t e i s ove r 100/ 1000 li ve birt :'1s ; E'.nel r cug,'11y t h" r a t i o of ne on atal mort2.l ity (d eat hs of i nfant s under twent Y- 8i gh t days of age ) t o the pos t -neona t al morta li ty (d ':'2.t hs f r .:;m t VI("ntY- Gight days L :me y e c.r c f aQ;t:) may b Eo: 1 : 2 u p El'.I/RC13/2 page 56 t o 1 : 4 . I "1 the s e: CCIJ.;,tri ",s ti1e child me r tali t y ( d c:;.ths fr 0m on " t c f our ye2.rs o f 2.g e ) is ellso hi,;>;h, and the maj or CLUS';: S of both i nfi:mt a nd child morta lity ( di".rrho" ~l c.i s 2"-"v, malnut r ition , pa r asi ti s m ilnd corununicabl e disease s) ar e in mo st urgent need of pr2vention . Most 8f t hcS6 diseas e s a ppe:'.r during t he i'leaninE period and continue: thr·)ush thv second and t h ird y erir of l if" . It wc·ulcl thcre f c r e b" unr(o.o,l ist i c t·~ conc cmtrate on orga niziD['; sd"v i c e s f Jr the n" cn at e ( infar.t under tw enty- eight days) , such a s special ized s ervic L) s f or pr (;m:l turc ly borr. i n fants, which Vlould be cot t h e: expense o f the c Ider i n fant a nd child in the Se: c '~untri e s wher e thGr " is 2.1S0 :0. shortp.g'" c f qualj fi 0d heal th p", r s:;nm.l and of h ea lth f :;.cili ties i n gen e r a l . 131 . \\'hen t h e infant mortc:.li ty r :"te fall s below 50/1000 th (o neonCltal mortali t y r ate b ::gins t o eXCee d the p:) st-ne:matal morta lity-rat;:;, and in such c ountri es , wh"r e th e; bi r th T' 'lt e i s :el s e l ow, t h.:: c e nc t'ontr Gti .n ~, f the. mat e rna l a nd child health servi c e s on the pr ub1 2ms o f the nec- nat ?, l period is me r e justifie d . Pr "Oma t u r e bir t h in oconomic2.11y a dvClTlc<2d c:.>untri8s i s r~lativ2 ly 2."1 impcrt~nt f~ctor in necnatal ~ort2. 1ity ~nd morbidi ty and, s ometi me s , :of child morbidi ty > i ncludi:lg n euI'o l OE;ic a l a bnc:· rm2.1 i ties such as c erebr~l p~lsi e s . 132 . Thi s duc s n vt me 2.!1, fl J I'k v .o-l' , t~at th", nconnt:ll period shoul d b oo c·r h as been entir e l y neglec t cd i n ti~,8 ma t 8rnal a ne. chi ld health s !crvi css of this Re g i on . Th ", me2.sur ;cs dir .:: cte d ·t:) wa r e.s the L ;ducticn of rnat ti'l'n·a l , infa nt a nd chi ld mor t zeli ty !l.nd :norbi di ty, Ulr c u t>;h pre - na t al care Gnd o t h er mater nal and child h ealth a c t iv i t i e s i n mos t of th~ countries o f t his Ree;i on , aut ~ rr.atic ally bring cbou t ", c rn e r ec.ucti ul1 in nL on?tc:. l mor t ? lity and morbidity (.' sp E- c i ally t hose due t " birth injuri e:s , po st-n~tal iJ.sphyxi il e.nd c:t",l ... c ta s i s , di3.r rhoca o f th e n : wb :>rn , neo;1at 2.1 disorde r s ar ising fro r;] mat Grm:1 t oxa",mi a a nd sircilar- c ~ ndi t i ons , 2.nd t his i s conside r cd sufficie:nt a t t his "t :o.G '-" EM/RC13/2 page 57 13) . Wi t h tl~ ", improvement of SvC i D- eCon:Jmic conditions in the countri e s o f thi s Region and 1'li t h t he f c.ll of infant , child c:.nd mater nal mortali t y, increasi ng attention will have t o be given i n the matern~l and c~i ld hea lth services t o the problens o f th" p erina t al period : pr egn ::mcy wastage , still births, n20natal mort2.1i ty and mor bidity . Spec i al studics on t h o pr oblems of thi G p C:'ri Dd , in t h e: f i e lds of genetics, biochor.Ji stry, physio- logy, patho l ogy , pc.e di atri cs i.:'::1d obst"trics , wi ll a l s o b", increasingl y n eces sl'.ry when t he inf ant and child morta lity ha ve b o(;n reduced according t c the pr oportions menti Dn ed abOVe . 134 . The adVer s e eff e cts on the perim:.to.l and necnat e.l pe r iods of acute vir? l i nfec tions , e spec i ally during the early '.~eeks (Jf pregna ncy, dia b e t e s and other chrDnic diseases in the mot h e r, will becDme r e l a t i ve ly mor e i mport;;mt with the decrcQs<2 .o f nu tritional and r e l a t ed cDndi tions .,h ich are a t present conne c t ed wi th thi s pr obl em . 135. Mor eover, perinat?.l ,md n eon?.tal mor t 2.l i t y e.nd morbidity r a t e s which !1.re r e l a t ed to the age of the moth<::r , the number o f chi ldren she has h ad , the i ntc::rvc:.l bet\-Ie"n pregn'.nci es e tc . , wil l gradua lly change wi t h the change of cultural patt ~rns regarding a ge a t m2.rri a ge , size of f amily and simila r probl ems . 1 7. r ;;0 . ,'Jh ile provent iv2 health vlcrk which may be underta k en ~,t present i n th i:s fi ,,, ld 1 5 very limi t ed , th0r c ar2 a f (.\'1 'Jtr..tr f ac t or s that hav e ?. b e<::.ring on neonat2.l 2.nd perinatal m:Jrt ali t y and morbidity tha t nCGd immedi a t e E'.ctenti en . Among tho s e arc: : (1 ) Irr2.di:;.t ion of t he mother , espeCially early in pr egnancy , aJ X- ray or flu or osc ope . It is often di ff i cul t t o diffe r ent i ate b e twe en th·", effect () f de f "ctiv-: chromos omes , genes or both and of unf2.vour2.bl e intr?,- uterine envi r e nment when the: "genet ic" causes of f :>etal wa,stnge and of congeni t al acn()rm2.1i t ies ar 8 considc r 2d . I t i s no v: known . however. t ~ ~at gc:nc rr.utati o~1 is pro- portiDna l to t he amount e f r &di ati on r<2c ei ved . EM/RC13/2 . page 58 (2 ',1 ;;d01inistr :c. tLm of high d uses :: f (' ,~ rt2.in drU6S t :: ne wborn infant s , " r t ·, mothers duri ng l a bour , i ncluding chl or E'.mpheni col, sulfunarni c .;s 2.nd s or.1C Vit amin K pr~p ".::'aticns . Adl11 i nistr=.tL,n c f ccr t .":. in drus s t ') pr "c;mmt Ivor:-,0n , 137 . I n a ll thr<J," C8.S,'S, c:duc e.t i :m ,) f physi c ians , nur S,, 3 i~nd a ll health pcr s ci:ID,:: l "-nd o f t h ,_ :;ub l i c i s r equ i r .::d . CHILD HEALTH AND URBiiNIZiWION - FRI NGE ilREA3 138 . Many f amil i .:: s , uproot " d from rur :.l ~,rca ::, liv e in the< "fringe " a r 0a s of t owns wh i ch ",r o r;r owinc r 2.p i d l y C. G a r esult of i ndustriali z2.t i on , a nd nr (;O f i nding 1. t difficul t t r; b<.:c 8me adjust Ood t o iJ. wage- 88.r n",r f s ex i s t e nc€ aft er an iJ.gricultur~l li f~ . Th ", s (c f ilrlil i c s in which the m:;t her t oo , may be a w::gc- carner, r.1 :>.y b ..: in mor" urS,,:].t n e..:d in t h e; henl th , s ocial and va ri ous ot h e r fL,l ds th ~.n i'''.m:'.11 crs ire t he Sl:.r:J0 inc r; mc.; (l;r Jup but continuing the i r t radi ti ')nal wny of l ife. in r u r iJ. l surrou ndings . Infa nt l:.nd chi l d mJ::,t2.1 i ty c.na mc,rbidi ty may be _zcoeuing l y l1i 3h and t h" r;-,cnt 2.l heal th o.nd nu tri ti enal i mpli(o<" t ions t r cmc ndc'us . M:~t ,-- rn:::l an d ch i ld r-.oal t h ServiC e S nl- ed t o b c g:'v .~ n t o th·~ f emily 2.S an l r,t"Grnl P,Tt () f ".lrba n c ommunity d " v c: l opm2nt re S wcl l ~uo :) f g (m cr iJ. l h ",?l th , 3(.' c i o.l '> r 2.ny othe r r emedi c.l IlIcasur ,-, s whi ch may b e: c'.Y'ri:.d (O ut i :o. t,;" ;-.r", ,, . IMMUNIZATION PROCEDURES IN THE tiJATERNAL AND CHILD HEALTH SERVICE 139 . I mmurei z i:ti :n proc"dur '_3 3,nd schedules sh,:;. t;.ld b.: ba~",d :,n car Lful e pidE.mi ::, l vgi c::.l '"nd i mmun·)I .)gic': l invcstl e;:J. tL-,ns which nr " car ri cd out i n ,_,?cn c ountry a nd i:1 f act i n different o.Y'c::lS '_ f G2.c h cc untry . They shc u l d m::>rtr l i t y r 'lt_s, I _Vi birth Y'aLs , di ff cro:::t vpl d "mi c,l ogica l ann immuno l o- g iC 2..1 ;:c. tter ns; G.n :'..dGqunt(~ nU:Tlbc.:r Jf ~1\.:; 2. 1 t!l p...:r s ,Ame l J And a satisfe.ctory c~v(;r(l.g'2 by ho:::2.th s0rvj c .:..: s . Er1/RCl)/2 page 59 140 . Be f or e ini tiat i ng rout i n () c, r ma s s ir.1munizati :m proc " clure s aga inst poliomyel i t is ;:md diphtheri a , f' ~r e Xampl o , in "ny count ry in this REgi on it is n 2c2ssa r y t ·,; <.:st ~lblish th" incidcnc ·c 2.nd thG nur;;ber c f d"aths :J r s lO rious di S2.bili ti c: s f r om tho~se di S22.S(;S e,m:ong c hildr"n i n t hE; c ount ry ilS Th e l c VGl ') f immunity ae;a i nst thes u di8"' :'.5CS sh:)Ul d ,,ls:J b(; cl" t c rmined (using Schick t e sts and ..; t he: r me;th ,;d s ) arr,.~ nb reprt: s ,~ntativ·~ :mmp L; s in the popul ation . 141. It i s t 8 be k ,-pt in mi nd th2t i nf':lDt s rend childre n bdonging t::> the minori ty upper s .lci .) - e conumi c ;:;r :;c;ps in the ci t y C2.n 2.nd d~) r es ') rt t o s p0cia lists a nd 2:dkr a l prc'.cti ti :)ncors i n private pra ctic ,-, f ur such immuni- z c.tions, whi1 2 in most of the c,)untrL's of thi s R0gi on it i s t.'1 e ma j ority ar(; most l y a ffe c t 0d by rraG:; i mmuniz :c.ti ::,n c rc:npaigns . SOCIAL SERVICES FOR CHIWIEN 142 . Al th :-ugh th" s oc i 2.1 s Eo rvicc:o; i n OlJ St c ·:'mntr ies o f the R ::gi 0n 2.r" limite d in number ,"nd i n scep", and dv not consti t ut0 a prior ity n eed a m,Jng s t o.bl e popu l£!ti '~ns with strc;n c: fn.mily ti e s .• the h G2.1 ti'l a spc=cts :;f s CJcial \;"lfa r e progr",mmcs shculd not b e l ,.st sight c f and the f r)u nda tions f c r t h <.: i n tr:Jducti : n c f s,~unc. physica l n.:1C. m"nt",l h" a l th stand£!r cs into t hG s ~) cial servi c0 s ~h:lUld bc l o. i d d_ WTI n :Jw . S:.:c i a l we lfare, progrl'.fl'Imcs f or childr" n in inGti tuticns , h :·':J l. '-:; 2nd day - c,"r 0 c.::ntres , l'/') I.<l d benefit tremendousl y fr vni C) Op ,-, Y' E, ti ,m with the: h ... ?-lth 2u t h critics i n Gener a l Flnd the mat2r n 2. l 2.nd c;',:' l d hee,l th s e rviCE;S i n par t i cu l o.r, whi le th:.: hE;2.1 t h and mat"rnal a nd chile. h·,, ~l th progr a mrr.os W'~uld i r.1prov (o if th ... y I'I rc re C' lway s based c n s c une. s uci"l and cuI t ur2,1 prin cir:1" s wh ich :.r e ;.lpplic abl " t o the ar ea . 14) . Whil e t h0 health 2.nd s e ci.a l s~Tvic .; s in many c ~)untri " s 0f this REg i on a r o the r e sp:msibi l ity c f on e: Mini s try, ,~.t l c; wc;r l " v" ls t h.:: s oci&l wel f a re. and heal th pc r s onn01 a nd SG!'Vi C2S ::er e unfortuna t 0ly of t ",n quite s epar at" . EM/RC13/2 page 60 144 . The physice.l ,'Cnd mL'ntal s.sp,::c t s of h.:o 2. l tn ,,-nd dis<:;ase 2r s c l osely ti ~d up with t h e s ocia l aspec t s 2.nd it i s :)ft cn d i f f i cu l t t o d"fin", wh,:;r c on" be gins and th8 othur ends . r~()r"')V8r t h e 0r gani zati ) n wh e r ev er possib18 0 f integr at (;d s oc i a l arlC[ h e,l l t h s ee rvic <s s c: speci",l l y i n su ch f i ", l ds CcS urban and rura l currununi t y d ovel '~pment a nd r (;; l s. t ed 2.r ::as w:ml d r e su l t i n economi0s whi ch a r e r;l\lch nc~c.(kd i" me.ny c ount r i ,_s :,f t ne Regi on. NURSING 145 . The ",r.t in: pi cture ,.,f nursjng 0duc"ti"n is new b'.:: ing cc nsider ed t o d ", t ermin" why progr ammes b" l i 2v d7. L , b8 e xc :,11 2nt a t t h e time c,f t h eir ini tiat i on havG f o.il cc. to produce " ~hc r e sults (jxp,-,ctcd by nu r S0S ,,,-nd doc t ors, and n e-.:ded by the: public t ney S8rVG. 146 . Curri cu l 9. hav e. bGen u:1d", r scrutiny f e r som3 tim" . Chang-..: s h 2.V l7. b oon made: and c:Jnt inu€~ t c be mo.dt.J : ,)bs o l c'te t:'18 oric:s and t 0chniquGs ar:) be i ng gr2.du~~11y di scQrd8c o.nd ne\"! ,~r",,-s v I s tudy int r<;duc ,,,,d t :, prepar e s tud"nt s f 'Jr t h, ; br')2. c ::: r r>.nd incr~ .:t3 i ngly cor;,p10x f U:1ct i c,n s ,') f nursing . I n the mor e adva nced sci1'.:c: l s i n t h ", pr~. s t year , ':hc spot ligh t has swung t o me tho- d ol ogy 2.nd pr .:; s ent.:tti 'Jn : Docs t r.<: 9.rrangcment o f c:)urse s and c ont ent within c :)urs ", s r ':,pres0nt a we ll- knit body of kn:lid edgc ,) r :t sc o.ttc:ring of f acts , fi gures :lnd ideas? H:;w do,os t he:. 1.,,,:.,,11(;1' s t i mul a t e t n ," studen t t o 147 . Ccnsiccr2.t i ;,n of th0S,-, Qu,~ stivns h:::. s empha s i z",d t h e: r,e8d f ::> r clGs,:; t ,)a r.l w.Jr k in p l aTLl1i n!; amOD!! member s ( '!' th ,e t "aching s t 2.ff itself and be tween t G:lC :'li ng :md .:tdmini strati Vo: sb.ff ~ . I t :l2.G r oach Ed out t o i nc lud0 phy s i c ian l "c t ure:rs and i t i n c.r::mt t ea che r s . Gr "duillly a curri culum is ",mergi n g fr8(, of wo.st(;;ful r"pcti t ieD Vii t h c:ss cmti"l c : nt"nt welded t cgether Er~/Rcl3/2 pa ge 61 148 . Much L: be ini:': l U.rn",d a b :..ut h:,,, knowl edGe bec ome s meanin<.; ful 2nd subsequent l y ass imil~ted by the stude nt . The r ole o f t!-.e t ec:cher is n :> l onger that o f the lectu r er who l:le th ::d icnlly l'11pr csses her Im:;wl edge ()n the stud"nt but r a ther "Gr.e a gent who s tirs t hem t::> s eek knol'il edgo f or t h ems elve s . This sht: dut;3 by r ec ) gniz ing and putt ing t :; u s ..: those e l ements in the 0nvi r onment that pr r; mct e l "C',Y'ning . Sh 8 c2.nnot r emain in t h 8 c l assro',; m al'ld f il l i n h '_r t im.:: by d_ liverlng n s e ri c,s : f l ec ture s bu t r ::lther must f oll',;w h cr s t udont s wher e: , thr cug..'1 their s ens ory r ca ct i ::m, physical a nd mont'. l exerci se c!r:d :'moti ,)n?l i nvc lv '2m" nt , they l earn the a r t and sci enc e of nursing . 149 . As a r esul t e f t h i s study t h er e i" i nc r " 1lsing r cc ogni t i c!1 of t he need f vr j.mpr oved nurs ing s or vic e s ::.clminist rctt i cn . Learning dees not i n itsel f diffur onti"-t e b"bl()cn t hat which is goc d and tha t vlhich is bad . Mos t s tudents wi ll a bsQrb wh a t t h E' '~nvir()nment pr"s",nts and wi l l pr ac t ic e Th;.;s til" vicious " ircl ,; t:r_~t provideS poe r servi c o t ends t c..: c or.tinu\: un·or c k0n . 150 . It i s r eal i z ;;d t hat nurse educut:>rs must acc ept a l arge sha re. o f the r e spons ibi l i t y Lr c,:'rrec ting this s ituati ,m . H ~wev cr, t h ey cannot do it alene . Tn ere i s else n",ud [., r the r G'.) rganiza ti on of th" 0:ntir", adminis- tr".tivc s t ru ::: tur", of hcc.2.th i nst i t uti a ns t ::- ""nsur c thr. t post s a r e fill e d by persons qua lifieo f :)1" th ,,, j "' b f::> r wh i ch th ..,y ,:er e; eo mp l oycd, thcct the: pr i ori ty of n c-cds gG vcr n t iL ",xp.:mci t u r " ,::: budgc t " d funds , t~::. t clear' line s e f c omr.1Unicc,t i on ar ~ e stClbl i sh~d. t nElt personnel f ur!ct i cns are defi ned ~nd pr ovi s i on i s rn2.d" f ') r t h ", cn- g ,-, ing supc:rvi s i c,. and training .) f staff . This is th" f r amevwrk wi t hin 'Iih l ch nc)t :mly nurser: but doc t ors a nd a l l anci lla ry m0dica l pee r s on!!" l d,~p,md fe r a l a r ge par t of t[;clr educa tion and trainin g . I t r emains a n eGl ec t e d a r ea . 151 . The ~lliO- assisted Rcza Shah ~abir Schoo l of Nurs ing , Rcy (Iran- 37 ) , ha s i n the past y o..;, f'..r inv 1.,;. st i ~at l.:.' d N i... 3.kne S S 0 s in i t s 2ducati on2.1 pr-:>grarmne and has c l "''''.rly demGnstr:it e:ci t ha t t he: :c° 'lul t lies i n cli nical practic e . EM/RC13/2 page 62 Th ey s. t t ac kcd -:h;; proble r.J by appointing ? senior in"tr u8 t .:>r a s c ,:o rdinat ::' r b~tw0~n schoo l and ho spita l a nd r equEsting t~~t c v~ ry nurse educator a ssume r dsp1ns1bili ty f er c l inica l as wel l as ciassr Jom teaching . The c cor d i na- t or has .;ngaged t h," inter .:.st ~ f the s .::r vicds per sGllr. ~ l by c,)nsul t i ng t htm ;':nd thus sha ring wi t h thl: rn the r l; s ponsibility of student .:::duc"'.ti':ln . Hor 0nthusiasm pe r meat es throu p;h cut t he s " rvi.ccs ' a r e2..S 2..ff E;cting bot h doct0rs and nursing pcrsonn~l alik~ . 152 . It might dSQ be mcnti on"d a t t his t i me that in coop~r2.t i ::m with th t~ Uni ver si t y :) f Teh t ran a batt ",ry of intE; r ,,, st, 2..pt i tude ,lOd inte llige;nc ..: te sts war e used i n t he sel dc ti nn of atud 2nts fo r t he sch oo l l ast Octuber. Th i s c l a ss )ns ha d nc fa ilur,'.s , dismi ssal s or withdra wal s . 153 . Th~ assi stanc e of th~ WHO S.:.ni or Adviser a t t he lili artoum Nurs ing College i s ncw be i ng di r ec t ed t '~ ~/ards i mpr :lVi ng c lin i cal pr o::.c tice a r eas . The Ahmed Mah",r School and Hospita l in e ni r o (U . A. R. ) , trdns nurS E= S f or 'ldministrnt ive r e sp::,ns i bili ti cs in h ospi t ",ls 8...'1d d"monstrat~ s t h e va l u<: of clOSe .... orking r e lilti .)n s b8t WCd! s cheo l and he spi t a l in t ht: d e ve l opment of i t s med e l s chool nnd hospi tal . In the J or dan Schaul of NurS ing , Amma n, s tudent s nr c c l os ely supcr vi s 2d in thd clini ca l ar~~ s a nd be th doc t or s and schee l s t ilff pr cv i de pla~n ... d nn el i ncid"ntal t c ::.ching duri n.<; the s e periods . 154 . An i mp:lrt :.nt event i n the gr owth c f nursine ",ducat i on i n t he Regi on h::. s b.::en t he cr::eni n3 of t!':!," C::; ll,;ge d' Nurs i ng, fughdad . This Colleg e c f fe r s a f '; ur- y"ar ba si c c 'jur s", in nursing ",du G2tion l e2ding t o t h e Ba chel or' s degr c.-; i n nursi nG' The pur pose is t ,) :)r ')Inc) t e nur s ing and t hus :;n ::.bl " it t e ma k2 3. 6~ t::. t"r con t rib;.;.tL.,n t o t h " d '::v " l c pment of h ealth To acc '. mplish thi s ,:\ im , y ,: ung womE.:n I'/jll be prcpared bot h academica l l y and pr:; f uss i unal l y t J t c.k", r espons iblli t y for f i r st l e Ve l posi ti ,.n s a s t ... ·::.chc r s a nd s;,!p",rv i s ~'r " f e r the c\-,veL:'pment ' cf nursing "ducaticn and tre.ining and th.: a emi ni s t r ,:.t i c!l r: f nur sing s ervic e s f or tht.: c ountry . EI'1/RCI3/2 63 155. The; imr.:lic ati~ns 0f 12unching such ?-. pro j "c t a r e pr~)found [md f a r - r E:aching . It p r 0SE:nts a dE:ps.rtu r e fr om trJ.dlt:, on2.1 trilinins pa ttern s ; it r ecogniz es the nsLd f ·Jr a br j '.d;;r " ducatL.::l to pr epr.o. r e nurs",s 2nd conse;quently pl o.CE;S the "nu s 'In a b~idy "lho s'O funde.me nt21 a i m is E:duc a tion: thE: Univ ersity . It i mplies that th : prc.:::tic.~ of nursi:-J2; is incr.aasingly reccgnj ZE:d t (., b E: essc:.nti"l f Jr the s tr :ongth:mins ) f ITiedica l prac ti c e ["end that it r E:quires a distinct, a lt:-:ough rGlat c,d, bGdy "r knol"lh,dgG and skills t o e n c.ble it t o f ulfil this r 0 1 E: 2duqu,cltE: ly. 156. The Cc)lle g<= o f Nursing 8nvisag(. s the ;; r -.'paratl :on 0 f l eade r s who will, C-, s in oth E:r countri es , c cmtri but E: t oward the r c s0Eerch th" t it r '-=quires t o providE: the kind (.f nursing educatic!l tr::lt , whlJ.,,; fulfilling t h e demands o f r:Jodcrn medico.l s c ience, wi 11 naint[d n th 2 balanCE: in r Glati :m to the C:lUntry I s cul turc.l and 0ccn ')mi c s t a t us 2.nd cons cqu 2ntly i t s particula r nursing ne ed:: . F'r'Jm suc h collc:;0s i t is expect" d h,adcrs will emE: rbe W,,0 wi l l vlI'i to t he; nursi.ng textbooks of t h e f u tC; Y'2 . 157. Th E: Hi ghe r Insti tu t e o f Nursing, Al "xoeJ'dr i::t, has , in the t e n years o f its existenc e, provid ed t h E: mo.in "la bor a t ory" f or studying method in tho dev e 18 pment o f nurs ing 0c1ucati on . J'llany l (;ssor.s have been l E:ar n ed tha t will serve in guj di n e; t h e: Colles", in Bc.ghdacl . Such insti tut<.:s o f higher lear n ing, hJw<=vcr, 2.1 tr.cugh pr '/vidin:::; '" broader kind c f ,:.:cucatLm f or its stud"nts, ilr c ho:ndicappcd by t h e s'.m'" ;:: rcblem chat 'I f'fects ;:,11 schoo l s - une qual ~ev e l c pmcnt in the servic0s are~s . E~1/RCl3/2 page 64 GENERAL PUBLIC HEALT"rl A:lMINISTRATION 158 . Two very si g.."1ific 2.nt e.nd pr omi sing devel opme nts ilav(; been evo l ving during the y ecJ.r. Firstl y , mor e and mor e g:)ver=ects ar c 2.pprec i at i ng the need f o r the coordin;J.tior; of internat ion2.1 a id a s a wh(',l e : thi s i nclude s a id gi v €:n by t h8 various int cr c2.t i :.mal agenci es 2.nd th" t furth er ed under bi l ateral s chemes . This mus t i mprove the use of such a id and facilita t e plannin~ f or t he d ev el opment of c ountri e s . Sever a l gover nments of the Regi on durin~ t h e y ear have creat ed national dev el opment counci l s in whi ch t he variou s ministri e s ar ,~ r epr e s ent " d . I t is , of course , the de sire and policy of WHO th"t health ministries should h;J.v e adequate and proper repr esentation :m thes t c,~'uncils as d tvtl opment in so many f i e l ds is depe ndent 0n t h e h,';al th of the nrt ion . 159. Secondly , t his Or gani z2.t ion has ex pr e s s ,:d i t s willingne ss t o h t l p governments with the over ;:.l l pl anni n g of he D. l th services . And, h ", r e again, it mu s t bo empha siz.ed thD.t , i n pl anni ng , the hea l th s crv ic<:;s cannot b e di vorc t'; d f r om ::o th" r s crvic c s such ?S D.gri cul ture , ",ducation, i ndustri e. l dev el opment, irrigation anc. many mo r ,, , t ,,) j numer ous t o ms ntion here . I t is gr 2.tifying that during thee y ::a r bl:, Ce')untri cs Gf the R<:;gion ha v e e xpressed their desire, t e) r c: cci V 0 slxc i a l hel p fr om WHO i n this fi c ld . Of c ourse., in thi s R<:'g i 0n 2. 5 in any ot h ur part of t he wc:orl c::. , the t ota l s l.: rvices i n the vari 0us countries, including t h e hcal th s 8rv :!.ccs , a r e in v8ry differ ",nt 160 . It i s n ut i n t endcd , c,t t hi s jun cture:, t o di scuss t lw var ious r <J quiromcnts of nation2.1 h",'.) t h p l a nning and the i r r ·"lation t o) cOr:1pr ehensi v e plans for a c ountry's cevelopment . But , in r ec ent y ears t hroughout t ho wor ld, ther e id8as r,ave be on cvolvirlg and SOtr,j ccnc c:pts , ha llowE- d by t i me and unque s tion ed in t heir u sc ; arE b"ing slo l'TJ.y disc a r ded . Na t,urally , a ny deve l opmc'mt schem" Ef·1/RC1)/2 page 65 must bc, l'Ii thin t hc financ e s l ilH;ly t;..., be av =. i lable from i nt orna l and axtor nal s ources . I t i.s sound t ::; build cn D. fi rm f oundz.tion and t o kee p 2. health plan c .Jmm"nsur 'lt ,,, ,Ii tr. ,? c:·untry' s indige:1.ous c apability . And , b,:, f or e peri ph" ral s ervic(:s ,,-re, cons i d eI' -.o;c , i t is vt r y E:cc 2s s a ry f irst t o ce nsider t h 2 tra ining potent le, l like ly to ,oxi st, f :'r \lIi t heut tra ined s t a ff t here can be no scrvt c G gi vI=n to :.hG pl:0pl <- . 161. It is pa rticul a rly t o t he: cc'ne cpt 2f ~\ c:)un tr-y- ' s bas ic h"al t h s ervic e s tha t much t hought h i.: s be .on ;;i v en i n r ecent y "ar s . It iE roali z ~d me r " and more th2t t h o bz, ::o is of any na ti-:;n- wide s ervice mu::ot l i 2 i n 2. pr op",r l y e s t a bli shed health <".nd modi cal admini stration from th", ~.·",ri J:lhery t o the c 2ntre . It i s our conc cpc that t b " un i t uf su ch an administrati on should be t he h E:2.1 th centr", und.o:rtaking combin '"c: cur r: ti v" and prev8nti V 2 s ervic es, th" l a tte;r in b'.l th the j:Grscnal and cnvi r enment[t l fi elds . Further , theSe :c entre s r.1ust hav e acce ss t ::> va rieu s ~xp0rt serv i ces in both pr ev8r:tive [tnd cura ti ve mc:dicin" , and th eor e must be l ntell i ngent su pervi sion by rr.edical off i c8!"s with additiona l qUCllifi c'lti:)ns in public he a lth . l abor a t ory s ervic e s :m d r ef ",rral h uspi t a l s ervices i s wel l known and r e quires no str(; ssi ng , but gr eat thought shoul c~ be gi v c:. l1 t,,) ti1e ir int elligent 162 . Of particular current importanc ~ and i n t er est i s the r e l ation of a spe cial di s efts ("; c ()n t!'{)l s ervi ce· t .:} thi s gc.:n0r a l Dc-a l th s crvi (..! c . The appr oa ch must b ", pr ,:,grnC'. tic and unbi " Ssec. . Sumc dis e a s ~ s may lend thcm- particula r l y t hose in vlhich " '{d Y high degre'~ c f .expert knowl <;dg ,~ is r equired f or thei r tre a tment 2nd contr') l , may hav (,; t ,~, r :cma i n s cpar a t", f e r many years t e, come . Hcwc;v",r , in t his last cas ", t 11<::re wou ld very defi ni t uly gener a l 1:i"al th s ervi c(' s . I ntegr a tion 1s nut an a im in it self . Integr a ti cn al l o \~s f or ec on omy " nO. th ,_. 1ntellingent us ,~ of avai l abl " r c s ;)ur c", s , bu t in mOc'Grn sci ence t he PJssibility : f on" man b~ing :::.n (,Xp8rt in r.:o.ny f i elds i s EM/RC13/2 ,-, page Ob bec oming mor e "r,c mor.; r emot" . T'n"re f or", i n t he development of a compr t::hensi v ,=, and int0gr-c:t",d :-:"c:. l th s ervict whet "er a t villag~' , c ity or national lev01, gr 22. t car e mu s t be taken to mak e: pr oper usc of c xp 2rt knowl c:dge i :1 th" various fi e l ds of medicine and health. Thi s probl em, I am sur.;, i s worthy cf our utmost thought i n y ears to c eme . 16). \~iO, i n this Regi e n , ha s be~n hel pi ng several rura l health projects which , cn r eflection, seem perha ps to ha ve b8en ,)f isolat",d conc ept. It is now felt that further help in this fi01d sh::mld be mor e comprehensivo:; in the deve l opment of rura l heal th servic e s and their r elation t o health s ervic e s ~s a whol e . A start i s being mad e on this in Saudi Arabia and it is hoped that in futur e y ears furthe r such e,id - where consider a tion is g i v on t o villagE; , district and pr:)vincie.l health and medica l servic e s - will b e: s ought by countr i os in the Region and given by this Offic e . Regi ona l adviser s i n hoalth pl anni ne; and community d ev c l opment have now been a ppoint"d to the Regi onal Offi c" . COMMUNITY D1'VELO Pr-IENT 164 . Mention ha s be"n made of the c~angine c onc epts t Gwa rds further rura l hed th projects . HOWe ver, this would certai nly not preclude our part i - c i patiGn in community dovc: ::"opmlmt pro je' c t s starte:d by other Uni t ::e. Nations agencies ane. func ti oning on the sC2,l e of a pilot pr:)ject . I ndeed , during t he y 'jar , datil nc,v" been c ollect8d frG~! Re s ident Represt ntati v e s :) f t he Techni cal Assist c.nce Boar d en existing United Na ti ,)n s prG j 2CtS in c ommunity develr:pment in all countri e s of t h", Re~ion . Th is infor mati on will be used t o s timulate c l ose r elati ons be tween h ",al th and othe r asp.c c t s ;) f community deve l opment . P.nd thi s, of c~,urs c" start s best i n the pl anning stage of a pr oj.2ct. I t i s felt very s trongly that the health ac tiviti e s in communi ty doveleprr,ent pr0 j ::c t s must r ema i n i n the full control of h ealth departm.;nts . BILHARZIASIS CONTROL (IRAN ) (--- - . .. -"'~-~~ ------_. -.-.. , ... Snai l Co ll ecto rs sys te mat ica ll y exam ine all st re t ches of wate r for Bulinus trunca tus , the pa ras it e .carryi ng snail (r ight a nd above). In th e Oezfularea (Khuzistan) the staff of the WHO.sponso· red pr oject are making epidemiological and field studies in view of a control programme to be carried out in conjunction with far . reaching irrigat ion schemes. Fi eld malaco log lsts from the b e zful Bil harzias is Cont ro i St at ion collect sna il spec imen in one of the near by e x per ime ntal breedi ng places. RURAL HEALTH (SYRIA) House-to-house survey on health conditions IS carried out by the m idwi ves and sanita r ians at t ached to th e Hal ba rural he alth cent re. Over 200 villages have been invest igated. The he"d nurse midwife welco RURAL HEALTH A WHO sanita rian ex pl wate r to ke ep it safe, fo r further laboratory her consulting room, at the Sa kba Ce nt re. priest how to store boiled nrt takes a sam pl e of wa ter (LEBANON) The phYSi cian in charge of the Sakba rural health cent re exami nes the case history of an out-patient whi le mothers and chi ldren await their' turn. Chatt ing with mothers before taking up rou- tine d uti es. A home visitor inquires about children 's diet and ·ad vises their mother how to make the best use of locally available foods. A medical auxil iary of the rural health centre t akes a blood sample fro m a you ng " malaria suspect" for laboratory d iagnosis. RURAL HEALTH (PAKISTAN) Home visitors often walk over mil es of rough mountain tracks to cover every single village. Dais (tradit ional midwives) follow a one-year course at the Rural Health Centre of Warburton (West Pa kistan). EM/RC13/2 page 67 165. Close contact is continuing t o be maintained with the Economic Commission f or Africa (ECA) and the Economic Commission f or Asia and the Far East (ECAFE) , especially in t he exchange of ideas on community develop- mcntj and it is f elt that in this fi eld there is excellent opportunity for closer liaison between many other United Nations, and sometimes bilateral bodi es . . 166. The Regional Office has also taken an interest in urbanization and in urban cummunity development. Her e it cannot be stressed too heavily that urbanization must be accompanied by a commensurate growth of heal th and sanitation s ervices. If priority must be given in the provision of these services it appears that the greatest hazards associated with these new town settlements are t hos e of overcrowding and the concomitent sanitary evils. This implies ther efore, that the provision of clean water, sewage and refu:;B disposal , and hous ing. properly d.eservc first priority. 167. The Regional Office participated in the activities of the Arab States Training Centre for Educati on i n Community Development, Sirs-el-Layyan (ASFEC), United Arab Republic, with other United Nations specialized agencies (ILO, FAO, and UNESCO) , and was r epresented a t the UNESCO Sominar on Methods of Evaluation of Local Development Proj ec ts held in December 1962, and the ASFEC Interagency Advisory Comrn;itt Ei.'" meetings. The Offic e was also represented in the United Nations Horkshop on Administrative Problems of Rapid Urbanization in the Arab State s he ld in !"larch 1963. RURAL HEALTH 168. Further pOints wi th r egard t o rural heal th s ervices must be mentioned. To deve lop rural health s ervi ces of an acceptabl e standard, t o avoid under staffing or i neffici ent opera tion and the wast 2 of money on buildings for whiCh staff are not available, the expansion of services must be equated with the rate of medical traini ng and the training of auxili ary personnel. EM,IRC13/2 page 68 169. The ut ilization of rural health proj ects as fi eld traini ng areas f or health personn81 of all types is being in~reasingly appr eciated. This nec essita t es careful consi deration of t~e administration of rural health facilit i es and the s ervices they are providing . 170 . With the expansion of rura l health service s ther e i s a lso a need f or the synchronous preparati on ane tra~ning of supervisory staff from different categori es, particularly i n medical , nursing and sanitation f i elds. It is also nec essary further to deve lop the provincial heal th department to meet t he needs of the expEmding s ervic e . A central agency in the Ministry of Health should also be created to be r esponsible for nati onal planning, devel opment, advic e and the overall supervision ef the rural health programme . 171. Environmental sanitation which often l ags behind other cOr:1ponents of rural health must devel op at the same pace as other s er vices . Such str css is now being given more fr equentl y 2nd Pakistan can be cited as .a r ecent example: . I ts plans t o pr ovide :m extensive water supply and sanitation programme as part of its rural nealth pl an, with the t echnical advice of the Regional Offic e and substantial aid from UNI CEF. VITAL AND HEALTH STATISTICS 172. There has been a greater appreciation duri ng the year of the need f or development of vital and health s t atistics and organization of statistical serviCeS i n the ministries of health . Requests f or assistance in the field of he<.l th s t ati sti.c s hav.; been r eceived from seve r a l countri e s . The need f or r eliable data ~n health is i ncreasingly f elt by national h~alth agencies as public health progr ammes ar e being intensified and extended . 173. Among the technical matters discuss ed at t he Twelfth Session of the Regional Committee wa s the "Impr ovement of Vi t al and Hee.l t h Statistics in t he Countrie s of the Easter n Mediterranean Region" and n. document on the EM/RC13/2 page 69 subj ec t was presented t Ci the Committee . From the discussion it was evident that a gradual i mprovement is being effected in many countri es . However, much remai ns to be done and there is a particular need for the training of statistioa l personnel and the statistical training of future physicians and other health workers. More WHO fellowships f or the purpose were urged. Refresher courses f or graduates of the International Statistical Education Centre wer e suggested; also that a manual on vital and health statistics f or t eaching purpos es be compiled Qy WHO. 174. The Committee urged Member States to pursue their efforts in the fi eld of vital and heal th sta t i stics particularly by undertaking periodic population censuses, improving their l egislati on on r egistration and r eporting of vita.l eV12nt s and development of the various fields of health statistics, establishing , if they have not al r eady done so , national committees on vi tal and health statistics ; orlani zing seminars and meetings on the subj ect and stimulating the training of statistical personnel. It r equested the Regional Direct or to continue t o provido; fellows~,ips and t eaching in health stati stics and t o r ender increasing statistical assistance and advice on statistical or ganizat i on and devel opment to countries requesting it. 175. Among the steps to stimulate health ste>.tistical development is a Seminar on Vital and Health Stati stics to be hel d in Damascus in the autu~~ of 1963. The Seminar will bring together public heal th administr at or s and health statisticians t o evaluate the present position and future needs in health statistics and r e lated vi tal s t a tistiCS, t o exchange information and t o deSign futur e ac t ion in the vari ous fields of health statistics on the basis of national and international experi enCe . 176. The Regional Office has , as i n previous years, pr ovided the services of adviser s and has awarded fellowshL ps f or statistical studi es in university and other educational centres or for practical tra ining i n countries where health administra t i ons have ampl e s t atistical services . The statistical El<I/Rc13/2 page 70 project provided since 1958 to the Ministry of Health of the Syrian Arab Republic was completed during the year and the fmther development of statistical services in the country is carried out under the guidance of the nati onal counterpart, who completed hi s studies in public health statistics abroad on a vlliO fellowship. The vital and health statistics proj ect in operation since J anuary 1961 in the Ministry of Health in Pakistan has effected improvement i n the statistical data of that country. A spocialist i n tuberculosis statistics has been connected with the Regional Training Programme at the National Tuberculosis Trainir~ Centre in Tunisia. A short-term consultant was provided for Kuwait for the purpose of instituting a system of health registration, and another consultant has visited Iran t o developing statistical servic es at the Institute of Par aSitology ruld Malariology. A t ot a l of 16 fellowships in health statistics wer e awar ded during the year. Twelve of these f ellow- ships were f or th2 training of statistical assist ants at the Inter nati onal Statistical Education Centre in Beirut for the academic year 1962/1963. 177. The Regional Statistical Adviser has assist ed in the planning and evaluation of projec ts and in r endering advice to governments, on several occasions during field trips t o t he countries conc erned. The amount of statistical work within the Regional Office and of collaboration with the various units of t~e Offic e has increa sed. The need f or strengthening the statistical services in the Office is now being increasingly f elt. 178. The Statistical Unit establishEd i n 1960 has pr ocessed and analyz ed statistical matcrial from several surveys including tuberculosis, communicable eye diseases, bilharziasis and diarrhoeal diseases. 179. The Arabic versi on of the Inter national Statistical Classification of Diseases , Injuri es and Causes of Death , which was distributed t o t he governments of the Arabic speaking countries in 1961, is now being studied by committees of experts established by governments of various countries. EM/RC 1 3/2 page 71 I n order t o coordinate work carried o~t on the nat ional level f or preparing the Ar abi c ver s i on of the cl a ssi ficat i on , a short-term consultant visited some of the countries; he has made r ecommendations concerning the pr ogress of this work. Further acti on ~y the Regional Office is awaiti ng comments and proposal s fr om the countri es concerned . HEALTH PROTECTION AND PROMOTION CANCER CONTROL 180. In the f i e ld of cancer the Regional Office has given assistance to governments in establ ishing their nnt ional s ervic Gs for detection, t r eat- ment and aft er-care of cancerous pat i ents. These s ervic es, most essen- tially cur ative, ar e the i ndispensabl e basis f or devel oping l at er a canc er control pr ogramme whi ch wi ll inc l ude a s eri es of measures of publi c health concern, such as mass Gcr' oe:1ing , r egistration, statistical data , epidemio- l ogi cal studi es , prevent:' cn , "duc ati on of t hs publ i c and the medical pr of essi on. Al l thes e various pr oblems have been s t udied b.Y a WHO Expert Committee and the r epor t of this Committ ~ee which has been widely distributed will s er ve a s gut c:c nce to health <luthori ties i n planning a canc er control progra:ll:1G. 181. In the Region there he.vp. already been s8veral advances: t he Cancer Institute creat ed i n Teheran a f eW years ago has recent l y been enlarged by doubling t ne bed capacity and adding an important r esearch department; in two other countries similar InstituteS ar e under construction; s everal cancer t reat ment departments are pl anned in mai n hospitals . The a ssistance given by \\.10 in this field consists of providing experts , granting f ellow- ships and somet imes participat ing in the purchase (Jf t E:chnical equipment. In the past y ear four fellowships have been awarded f or physi cians to specialize i n oncological sur ger y, r adiother apy and cytopat hol ogy . EM/RC13/2 page 72 182. Research on epidemiology of certain types of cancer is under conside- ration. It may be possible t o combine a bladder cancer survey with a bilharziasis survey already in operation; statistical and epidemiological studies could be undertaken on oral cancer in r e lation t o the betel and tobacco chewing habit, and on oesophagus cancer the high incidence of which in a certain group of population is une xpl ained. ENVIRONMENTAL HEALTH 183. Much has been said and repeated about the health r elationships of sanitation. The repetition s eems sometimes t o defeat its purpose, and to become trite and ineffectual. There ~emains a great gulf between possi- bility and actuality and, in spit :: of gains in some spots, there is a general sanitary degradation. There is an urgent need in the interests of health to correct a multitude of environmental conditions that cause disease or make life miser abl e . These things are important everywhere, but nowhere more so than in the :J::o.st"r n Mediterranean countries. Here we find as great a number of variety of problems related to environmental conditions as in any other part of the world. * 184. Prominent among this group of problems is the quest for water. Here in these t hirsty lands the race began, and early clvlllzat iuns n~stled and developed alongside the: water courses. As this growth continued through the centuries with accompanying devasta tion of the vegetative cover, the water r esources diminished in quantity and most of them have become fouled in quality. NOVl, with these water r esources limited, with population growths among the highest on earth, with industrialization and urbanization taking place in mammoth waves and with governments determined to r aise the standards of living for the 410 million population expected within forty years, t he water supply problems of the Re gion - already critical in many places - will soon assume alarming pr oportions. * See: Document EM/RC13/8 EM/RC13/2 page 73 185. In the environmental diseas es are incl uded not only the broad range of enteric infections and infestations, but many others such as malaria, bilharziasis, filari a Si S, trachoma , yaws and onchocerciasis, which in great er or less degree are connected with correctible environmental condi- t i ons . The health , and ther ef or e the economy - and ther ef or e the standard of living of t hi s Regi on - ar e perhaps mor e closely linked t o environmental enemi es than is t he cas e in most other pl aces . Her e,- even more than else- where , h2alth offici~ls should be centering t heir attention upon these realities . There is comforting evidenCe t hat this is happening. During 1962 there have been a number of highly enc ouraging events in the realm of environmental health , some of the highlights of which may be sWTh~arized as follows: Advi sers t o Health Ministries 186. Perhaps the greatest single lesson learned during fiftoen y ears of WHO work in pr omoting environmental sanitation on an internat i onal scale is that no worthwhile progr ess can be made exc ept in a cl imate , and under the umbrella , of understanding and competently- operating publ i c health agenCies . Without such backing , all so-called demonstration projects are doomed to failure. The first f oundation stone in th0 environmental health structure in any country is to provide a basic public health organization and t o include within it both a programme and per sonnel t o stimulate , carry forward, keep alive and expand environmental hea l th activities . 187 . During the y ear environmental health advisers have been on duty with the health agenc i es of Lebanon, Pakistan, Saudi Arabia and Tunisia, and the organizational and practical r esults of this service are testimonials to its effectiveness. Two additiona l countries ar e requesting similar service in 1963. T.~is type of a ssistance s t imulat es a chain of good r esults, and it i s hoped that soon advisers may be posted to all governments that need t hem . EM,IRC13/2 page 74 Assistance t o Educational and Re search Institutions 188. In order t o prepar e personne l for the manifol d activities relat ed to environmental health i n gov~rnmental or ganizations and elsewhere , and in order to cope intelligently with its intrica t e probl ems, educational and research programmes are required. WHO will always place primay emphasis upon these as a ~ ~ ~ t o its main obj ectives. Among the services given during 1962 in thi s fi eld of basic education and r esearch was the professorship in sanitary engineering in the School of Public Health at the American University of Beirut and the provision of a consultant t o the Sanitary Engineering Research Centre in Alexandria . 189. At the American Uni versity of Beirut the professor i n addition t o carrying out hi s r egular duties WaS inst rumenta l in or ganizing Lebanese sanitary engineers into an active gr oup and in stimulating the institution of a post- graduate pr ogramme in sanitary engineering at the University. This latter deve l opment can have great meaning f or the entire Region. 190. The potent ial for service of the Sanitary Engineering Research Centre at Alexandria can be fully envisaged only when one l ocks into the y ears ahead with their popul ation and natural resource pr oblems and crises. This institut i on should hel p to solve not only the impending sanitary problems of the United Arab Republic, but those of other countri es a s well. 191. In the future pr ogramme of the Orgal1 i zation educati on in sanitary scienc e and engineering will s t and hi&~ in pri ority. Already being consider ed is assistance to two other countries i n this field. Training of Sanita tion Personnd 192. Of ',"qual impor tanc e , and of mor e immediate utility, 1s the training of sanitarians and other l evels of sanitati on personnel f or s ervice i n health agenc ies . This has been recogni zed a s one of the most urgent needs in the Regi on, and the Organization hes given extensive aid to tra ining projects . I n I r aq, Saudi Ar abi a and the Syrian Arab Republic these tra ining Efl1/RC1 3!2 page 75 operations de.al exclusively with sanitarians , whil e s everal projects in other countries ar e giving tra ining to sanitation personnel al ong with other categories of health workers. This intensive and practical training permits gaps in he 8.1th agenci es t c be fi lled r elatively quickly and , . while the solution t o ~~e problem is not always i deal, it permits the operation of creditable health services ponding the acquisition of progressive experienc e and the r a ising of standards. Community Water Suppl y 193. Believing that clean and ample wat er f or domestic purpo s es is perhaps the greatest of the needs f or good health, the Orga."lization from its beginning has placed great emphasis upon this aspect of its programmes. For the past three years this has been intensifi ed under the Community Water Supply Progr amme . Partly as the r esult of stimulation by \\'HO and other agenCies, partly from the gr eat desire of people for this c:mmodity , there has been in most countries r ecently a satisfying upsurge of water supply devel opment. These accomplisr.ments and plans f or the future were dramatically brought out at the Eastern Mediterranean Group Meeting on Community Water Supply held at Beirut in November 1962. For exampl e, in one country 44.5 % of the t otal population is now suppli ed with clean piped water - statistics all the mor e gratifying when it is cons idered that 68.5 % of this country ' s people are classifi ed as rural. From another country it was reported that f orty-two municipal wat er supplies are under way at t r.e present time . In still another country f orty-eight municipal supplies have been compl et ed since 1955, eighty- one projects are now under construction and plans are r'eady f or t hiry mor e - an impressive total :)f 159 new water supplies s erving 3,145,000 people in this one country. In other countries tho r ecord is not quite s :) i mpressive, but the benign contagion is spreading - countries ar e rapidly realizing wha t water supply means to their life and economy. FWRC13/2 page 76 194. But the B~irut Group Meeting brought out two discouraging facts. The first is the inadequacy of availabl e personnel to maintain, operate and manage the wat~r supplies that ar e being built. Too many of them are not performing the health protection f or which they w~re intended and are falling too rapidly into obsolescence. It is mandatory that this condition be corrected. Otherwis~ the desired objectives of the programme will be defeated, and enormous amounts of good money will be wasted. 195. The socond and more shocking reve l a tion was that, in spite of the laudable progress now being made in wat er supply improvement, the population within the Region as a whole is growing much faster than is the number of people being s erved Qy water. We are still sliding downhill in this regard. Much acc eleration in th") rate of '{later supply is needed even t o keep pace - and even mor e to get ahead . Rural Sanitation 196. Sentim~ntali ty is added t eo the nor mal r easons f or improving the health and social l ot of the benighted rural people but, f or many reasons in addition to the enormity of the t~sk, the extensi on of the ble ssings of sanitaticn t o them has been f ound to be a most difficult undertaking. During the year there have been some devel opments in this realm which are outstanding and which may be pace-setting. In their extensive rural health programme the officials of Pakistan, on the basis of previous experience , have decided that safe wat '"r supplies must be available in the homes tribu- tary to health centres befor e the centres can carry on any r eally effective work. This implies good water supply and saf~ excreta disposal not only in the health centre and its adj acent village , but in the enti re area which it serves. With WHO technical supervision, UNICEF has agreed t o support such a programme in eighty-six rural communiti es at a cost f or materials approaching two milli0n dollars . The r esults should be impressive, and should show the way f or simi l ar p0licy and projects elsewhere. Housing EM/RC13/2 page 77 197. Improvement i n the housing of thE peopl e is recogni zed as one of the greatest s ocial needs i n the Eastern Medi terranean ar ea , and a factor of very great public heal th import anc e . Due t o traditional pat t erns of village devel opment in several countries, i t is almost impossibl e to attain a reasonable level of sanitat ion . Her e , more than in most pl aces , thc r eplanning and rebuilding of these congest",d settel ements, as well as the improvement of the actual housing structuros, become matter s of very direct and practical public health significance . During the year two eminent experts i n the fi e ld have carri ed cut extensive studi es i n Iraq , the Sudan and the United Arab RepubliC, wher e they have f ound much ac tivity. Their r eports shoul d be va l uabl e t o all thE; countries of the Regi on . Due t o their i mmensity and universali ty, the housing problems of most countries cannot soon be solved or greatly impr oved . However , all possible efforts toward betterment of housing should be systematically and r el entlessly pursued . Refuse Dispos al 198. The problem of f lies and rodents is a not orious one t hr oughout t he Middle East, and the effects upon health and comfort ar e obviously gr eat. Whil e climatic ccnditions undoubtedly have an i nfluence on the problem , the fact or of community house-keepi ng is probably of much greater importance. The sanitary stor age of garbage , r efuse, manure and f eca l matt er and its prompt and systemat i c collection and disposal would go a l ong way t oward controll i ng the fly and r odent pr oblem, as well as providing a mor e aesthetic aspec t t o the cowmunities. At the r equest of certain governments, WHO is fur nishing consul t ing servi ce in this field , and is e~ious to extend its assistance . EM/RCl)/2 page 78 Other Services 199. In additi on t o those in the above cat egories, many other services are given in the fi eld of sanitation. In twenty-four country projects f or which other units of the Organization are responsibl e , sanitary engineers or sanitarians are a ssigned, and the Organization is asked for many f orms of advic~ and assistance which do not lead immediately t o pr oj ects. During the year it is recall ed that such servic e was rendered by staff members in the fi elds of earthquake relief and r ehabilitation, atmospheric pollution, vector control , radi o-active waste disposal, stream pollution, industrial wastes and sewage treatment and the conservation of meat from the sacrificial slaughter of animals during the Mecca pilgrimage. HUMAN GENETICS 200. A WHO research proj ect is in operation f or the comparative study of congenital m~lformations. Arrangements wer e made f or two medical insti- tutions of the Region to participate in the study. 201. p, vlHO team of r adi ophysici st s visited the United Arab Republic in order t o carry cut t he measurements of natural radiation levels in the monazite area of Rosetta. 202. A WHO fellowship was granted t <) two medica l educators from the Regi on to participate i n a t r aining course on human genetics which took place in Denmark in 1962. Tne purpo se of the course was t o assist t eachers in medical schools in the design, content and methods of the t eaching of human genetics and t o show ho~! the subject can be integrated into the medical curriculwn. MEDICAL REHABILITATION AND PHYSIOTHERAPY 20). The place of medical rehabilitation servic es in a national health programme should be considered in th~ light of the overall health needs EM/RC13/2 page 79 and their priorities. Rehabilita tion has social, educa tional and vocnti ·:mnl implicati o:1.s. Preventi vo JTi(.asure 5 should have emphasi5. 204. I n t h is field the Regi onal Office is contributing throug!:. fellowships for study of rehabilita tion, training schools f:Jr physiotherapy (in Iran and Pakistan) and i n field project~; (L·; ' ~~no r;). Physiotherapists ar e provided for the la.st-menti onod activities . 205. Close cooperation is maintained I'lith t!'!e United Nations bodi e s interested in the subject, such as UNICEF, t he United Nations Bureau of Social Affa irs, ~Ihi ch is particula rly concerYkd with the soc i al aspects, and the I nternational Labour Organization \<rhic~ is responsible for the vocational and occupa tional a spects. The ILO is novi considering developing such services alongside 'llliO rehabi l itation projects in Iran, Lebanon and Tunisia. 1,'IENTAL HEALTH 206. The r ealization is growing th'C.t health as a status , whethe'c in national or internationa l, historic or contemporary life , is largely a function of social l evel and soc ial gradient. Indeed, health is a vital forc e and al though in the st:,ict t e rm5 of our .• istoric r e f erenc e, hsal th is a goal in itself, it is more c l early -evide nc today that W'lat begins as a goal should end a s a tool f or the promo t ion of the quality of living. Thi s is the positive meanins of health. H8B.1th fac tors beginning as causes may revert as e ff ect s cmd fiLal1y r ecur ilS eaU5-e S in the chain of repetitive cycles. It is therefor '2 e ssential f or thE. purpose of c omprehension and understanding, and indeed for tile important purpose of evaluation, that planning should be conce ived in t errr.s of dynamic proc eS 5es rather than discrete 8ntities . I n t hi s R0gion , t.he i mpact of t he soc ial processes of change and t~;e radIcal and mu l tipl ,,-' i nfluence s th8y Gxert on the culture and on it s institutions, and on Ylhat these institutions imply in terms of health and social stability , is not initia lly a l together benevol ent . But EM/RC13/2 page 80 t h e passing s houl d :lo t b e 8cmfus e d wi t il the p c. r:n~cn(]nt . .n. s ;. r e sult of this process of chang e t ens i on s and stre sses of h,-=.al t h have: bc com t; r i f e . Tree se: r e :::.c t i cm s indiciite , by t heir char ,,-.c ter , i ntcr.si ty ,,5 vle l l as extensi t y ., t he; d egr' ()(j o f i n vol v0mc:nt i n the s t ruggle t :l go forward . The t r,e ir il'lpact o f c ', a ngc . 207. In last y"a r' s re port t he vh.lII was 0 xpr ,os".~d t h;:, t t ile.. r eali zCtt i ol1 o f self by the p.V'lsses nas e nge nde r e d a stat .. ' of I G'de rini:~ of tol e ranc e t o pre cipitating f a c t ors . On t he o ther h<=.nd , the Ve l oci ty of change h:::.s been s o r emarl<a blo tha t mental ~leal th sc;rv ices i n g <) n,,!'3.1 , and !~o sp i t als in particular have not be"n abl e t o keep abr oas t of the: d c v i.loping need s o f d e v e l oping societie s , a s il r 2sul t o f \·Ir.icr. c e r tain de v o luti onary ;'Ieak- ne sse s have b0CO~E mnnifsst in th ~. GGrVic0s . Such i na de quac i es hQv e t ended t c prom :-1 t e .:l high'2t' c E:: iling of di soaS2 r. r",':. :C :-.c "';,. i.:: rL:,>-.:d b,v chrc!'1i c: i t y a nd complicati on s . Thes ·::; , t o ge t her 'lli th tf1 0 t rend t owards indi viduO!li ty in s ervi c0 s c.nd wGlf" r", havo 1'iade r estri cted budg" t s y c,t m:)!'c r e s t c i ct,,<l . No I-londer t hs.t ho spi t a ls in the W"'5t vii th t h e 5ilmc numbe r o f beds and wi th 0. wider l'2.nge of insti tut i c:>nr,l c a r e may indeed c ost L~33 , per cap i t a . t nan h ospit"l s in de v e l oping a r eas . Th o rntu r a l h i stol"J of dis ease, in many developing O!r 83.S i s a l lo.-jod tc dev "- 2. op t o i t 2 :::' i: t to l ogi cal lir:l1 ts * be f or e treE.tml-,nt i s i mpleml:ntcd . rfJor c;Cl ve r on e o f th", d:Lfficul ti ·~ s of stud(mts s tudy i n;; abr 0=.d d·ter a p 2ri oc. of i~13truct i on ::t ,:ome i 3 th? t t he: picture of d is0rders, t a king s chi z ophr 8nia a s an ex ampl e , i n the i r minds i s t he chroni c p i c t"rl and no t ;;1'1,,: p ictu::, c of tr.'" (j a r ly ::;2.s ·~ vlti cr, obtr. im; in t he We;3t . This is Onl? o f U',e problems b '2h:Lnd ma ny oxa minati. on fl'.ilure s. 208 . I n 'lid; o f t : :es l: fac to r s , p s;,' c i; irctr.i. e.: b r eak :L wns in d e vc l opi Eg countri,"s tend t o have thE: f ol l owing fi:'9.tur ~· s : 1 01'1 thr E:sr.:o ld o f prccipi tatLm, h i ghE:r inc idEnc e , chroni c ity , comp l ic2.ti c n5 , irr" v8rsibili t-" 10flge r pe riods o f hospi t a liza t ion . 'rhe s 0 fe a tur (c s 3.r <'; importc'tn t f rom t h e pr ognostic point o f view . They r:. t ,c.rd t!' (c" . -::'m,~ nt and thu s t:'l2Y dc:D'on ;;tra t e: l a ck of e ff 2cti v e- * Health ",ducati o!l has a V'2r'Y i '-!porta nt roL a t thi::; stagE: . Er~/RC13/2' page 81 ness of psychi a tric methods , which rLcy und0rmine p(~oplo ' s confidence in psychiatry. Th0 prograrr.me of mCl'!t".l he".l th for t he Region during the period 1962-65 deals j.n the first place with the following topics: The PromotiCln of Psychi i'.tri sts of the Se cond Line: 209. The present-de.y trend of dcaline; with pr obl ems Clf health in terms of long-term progral'JlTles in which the concepts of continuity and development are significant from the stand- point of v:llidi ty, brings to mind the question of future leadership, because no long- term programme is possible t o consider in isolation , without those \{-·o 2.re likely t o implement it, initially or in its futurE: ph::.ses . The two are inseparable . It is proposed to convene a r"eet i ng t o aff ord an opportunity f or second-line psychiatrists to discuss fu t ure; a ovelopments and also to study the ways and means of ho\'! to promote leildership i n P.1ent al health as part and parcel of the irrevocable r esponsibility of professors and roentill health leaders today . Furthermor e: , t he intention is to study the ways and means of keeping the young psychi atrist i n touch with t i':ese developments . Finally, one of t he ob j ects of t l-,e m"cting is t o provide th'3m Vii th a window through which t hey mily be abl o to follow interna tional events in mentQl heal th ~ii th int er ast. Geriatri cs 210 . As a r esult of re l2.t ive reduction in i nfa:1t i le mort::. lity and t he improve P.1ent of life expec t Qtion indi ces in adults, tr-,e structure of t he population in some countrios of t h", Regi:m is beginning to change . There are ~o~e elderly people living today and the trend is on t he increase. Cyprus affords t ho best possibilities f or such a study because of the high standard of health, nutrition and Ii teracy, and th" ver-J accurate popula- tion census. Tn" st:l~.ll popu l ation and snall siz e of the island and efficient means of communica ti on are factors contributing further t o t he validity of such studies. EM/RC13/2 page 82 211 . But i n t h ,- 0xp c:ri cnce of t hu Illes t the problem o f ;:;-:ri e.trics i s impossible t o dsal with out side a social wolfar e system. It is f or tunate that in Cyprus there i s a soci ? l welfare s ervic e whicn i s one of the most ;'1igilly d",ve lop0d in the; Rq;i 0n . Tr a ining Cour s e f or r"l0ntal H0spi tal Adr.1inistr<ltors more and mor~:;; of h i s 2..dmini strnti ... ,c ~asks . In this RogLm, fe w hospi t a l s have trainod adrllinistrator s <end i t i s intended tr.,,-t a short training ccurs8 for hcspi tal acimini .:.;trator'3 fo r a puri.od of s i. x months be; started as oarly a s pos~ibl e . The b(;st place 0nvisag(;d i s Be irut where there is 2.ccumulated experience i:1 a dmi nistr -:tic;f. en il L 'vel with the developi ng s tandard el f techni c,,- l vjork. Training of Psychiatric Nurse s 213. To mt:e t the s r"a t needs , th e} t r a i ning of psychiatri c :rc1rS(·S in the Reg i on continues . BudsetaY"J prov] s: 'J 'C, f or 2. fur th",r ~,'I" 1 ve nurse s to be tr2.in~d in Beir~t h2.s been ma de . month courst; i !: Tr..::.r s ing D.nd thrc .. in S0C i 2.1 t.:. chniqut: s ::.ni Occu~2.ti Qne l t h01'apy . I'1eeting on tJ1{'; RGh2.bili t2.ti aYl ~f Chronic Psychi 3.tri c P2ti (.nts 214 . This ~D,,8ting i.s to b,.:: j-,(: ld i.n Rey, Ir~,ll , "" 11~l" ,; th" h:) ~;pita l a c(;cmouates 1 , 200 chroni c p2ticnt s . It is me s t jns pirinc t e SSG th~ s t a ff of thi s :'lOsp i tal and communi t y volunt2.rj greu:! in ~,c: t i cn . 1-:' is t h,,- intcnti·:;n t o study \;ay s and m", ,,,ns of rehabilitating chrenic p;~ti €nts 2.nu thco f "'3.s i - nursc:s can b", tr2.ined in t hee handling of eh r cr. i 2 p:ctients . T',' "' unit in Asfouri en Ho spit2.1, Lebanon , which t he Regional Office. ht:lped t o promote , has b<;;en most successful . Social techniques Er1/RC13/2 p8.ge 83 215. The changing t::mphasiG in menta l health and the; gro":ring ne ed f or mental health s ervices in dE:·ve1opi ng countri (; s make it n"cessaI"J that social t ec hn ique s should be (:'[o lved . Indeed i n any pi oneering work, . it is t he consider ed opinion of this Office that techniqu",s should pr ecede practic e s . Thi s Offic '; is c ons i der i ng th0 rtcrui t mcnt of a short-term consult c.nt i n social t cchniquo-, s w:-:o :rJs,s anple (;xperience in some parts of t h e Regi on and who has h i msel f d",v ," l op iJd E, socia l we lfare service of high competenc e in one country of the Regi on . His work would be part and parcel of al l hea lth planning . He may be i~ble to pioneer as v/ell the conc ept o f vIC1f" re and s oci2.1 work in the Regional sense, especially in the fi e ld of geri 'lt r ics 2.:ld educati on . NUTRITION Education and Tra ining of Hc 2.lth Personnd i n Nutriti on 216. In tra ining heal tc. personnel i n nutritien ths stre ss in the curricula should be on the: t each i nG c,f sound principle s e.nd on t !:l," stimulatien of imaginative thi nking and resou('ccfu1!1'~S S i. n the tr~i nees . ~1 cmorL:: ing s tructural f ormu l a e " nd da ily r e qu i r e m"nt s of t tle di fferent nutrients ( som" of which me.y be l::ypot hetical ) wi ll not 11 0 1p th E.> Gtudent s in u n d or- standi ng the pr::>bl em in its enti r e t y c r i n undert a king p'actical and applicC'.ble nutrition a ctivitie s in the h,;<:llth programme s in "I/::i ch they will work in the fu t ure . 217 . In the teaching c f nutr i t i on, it is not ah~ays suffi ciently emphas ized that t he early s i gns and symptoms of rrmlnut riti on a r e non-epecifi c and that not al l cases of gingi vi ties, a ngu.l c.r stomati t i s and follicular hyperker atosis, f e r (;xe.mp1 0 , C1'.n be a ttributed to d t fi cii:n c i ,os in 8.ecorbi c aCid, ribofla vin or Vitamin A. The varia t i ons in nornal pe r sons and i n c linica l signs need a lso to be kept in mind, ot herwi se non-existent EM/RCl)/2 page 84 specific defi cien:::i 8s mo.y be "detec t e;d" i n hc:~l thy i odi viduGis o.nd non- nutritional diseases mC1.Y be a ttributed t o defic iencies of sps cific nutritmts . 218 . Nutrition 3hou l. d norma lly no·t; b ·;; a ~, cpa!' atc s ubj ect in t he under- graduate tra L'"1ing of m8dica l 2.nc. nursing s tudent s , but should pe rme? t e the entire basi c curr::' cu1um .o5.0(;ci:111.1 under th", s'.lb j ec t s o f phys i o l ogy, biochemi stI'"lJ, piit hology , bacter iology , obste tri o.:3, intern;;.l anel s oo i 31 medicine , gene t ics and other relGv~nt subj ec t s . nutrition of auxili:lr'Y h e!.? l t h personne l should be simp1ifi0d but should f ollow the Siim€: basic prinCipl es . 219 . To 2.ssist in t he t C2.chinS on nutrit ion wh ich is given i"! t t r,,, differ ent t" aching departme nts, a nd t o provide the nec<.;ssar:r eoordinilti on i n a ll the [';'.': f ields, a nutri tion sp:cc i o.list ( 0. medica l or public hEalth nutri tioni st) i s r equire d . He shoul d "'-ls0 assi s t i n the pos t-gra duL1.t ,; trai ning in nutrition Et the 8c::ool o f Public Hen.l t h a nd in thE: post- graduate cour,,·-.: s in public :10",1 t h nur s ine; , as H011 0.:; c oordin'tte t hem with 'the unJ 2rgraduate training . Th,,, t(;;aching on nutrition to be g iven in refreshe r c::ours" s, sc:minar:o (1.nd in-serviCE: tra ining to all categori Gs 'Jf he8.1 t.h ;'l(,rsonn(; 1 in t h" ccun"Lry shoul d a1 s o be under the gc;ner2.1 guidanc -c ·)f t rlS publi c healt:--, nutriti oni st , ·,k.::' s.l1ould see to it th2t tra i !:ing is r01o.t cd to :::xi sting 10cll1 c onG.i c i ons and t hat se:ovice and tra i nipg .,~o hand i n he.nd . 220 . ft. non- rn"dicaJ. nutri c i ani s':; or :~ higllly qU2.1i f i eu hor:!e economist would b Eo of c:msi der able val uEo In ~.ssist ing t;--~.,. publ ic heal t ), r;utri tion i st 3.1s 0 in ",nsuring t hat t he tr3.ining (,f "".""r.18 c;conomi st;,; il.nd non- modi ,"al nutri tj.oni sts in public h 0o.1 th [,'.JtrH,1lm and mat"rna l "'.nd child fe " ding is baSed en t il8 SD:1<: gener a l princ iples . EM/RC13/2 pE'.ge 85 221. It is elso to be streEs~d t hat the public heal th nutrition sp0cialist of whom ther8 may be only one in mO\ny countr iee of th is Region. should not isolate himo:elf i n a r(;sear ch institut e , medical facc:ltI"J department or nutrition institute, but should, if 118 is not directly in cherge of a fe\~ hospitel bede, have access to hOEpitals and attend r ounds in order to keep fami liar with nutritional d8fi c i ~nc ies and thei r verieti ons which are met with in daily practice. He should ",l so bE: f[~mi liar with t he public health problems and progra rmnes in t he country and t h e appropriate pla.ce of nutriti onal ac tiviti es in tne t otal health prograrnme. 222 . The j oint WHO-FAO-m~ICEF ~s sisted nutrition proj ect i n Suden is a good example of how a proj cc t of this kind should be planned to embody these princ iples r elat .:.d to the t eaching of nutrition. Cooperation in All Fields Re l a ted t o Nutrition 223. Cooperation betwE:en food producers, t he economists and other spec iali s ts including health per sonne l i s absolutely c: 5sential at nationa l and international l eve l s . To ensure en adequat~ quality and quanti ty of nutritious f oods i~i1i ch can be cbtained by all members of the population , the policy in f eed producti on, importantion, processi:lg and marketing needs to be di rectc;d t ow[,rcs t his end. This i s by no means CFlSy , and s eriou .::. e ffort =..nd per S 8V 2 r a r.t.C C ar c :ce qu i r <.:: d . Assessment of the Situation 224 . Nati onal ce~lth Qrr.an i ~ati ons , wi t h t~c assi st~nc e of international or ganizat ions , as r equired , need t a aSsess and def i nE: clearly t he: magnitude of t he nutritional pr obl",m in t he i r ,l re a, it s importanc e in the future devel opm8nt s of tho c 'Juntry, and then t o esb.blish pr ogrammes , including heal t h , ba sed (In a kn.)wl edgc of the existing si tU:ltion 'lnd of all the compl ex f~ctors involved. 225. Nutrition surveys hav" b0en perfor med for this purpose . ~1any difficulties have been ~ncountcred whi ch have limited t he usefulness of EM/RCI 3/2 page 86 som~ o f the s e sur vey s J. f.", meu.ns fj f def ining the probl el~ . surveys may give;: f .']. l s" i mpY'2 ssi-:m of t"e t8t £'cl pi<:: tur -= . Short- t orm Thr, c linic3.1 part of the nutri ti en surv0Y 110€.ds t o b·-, pc:rfcrmc' d by skilled and nutr t tiGn21 3ig~s and sYr:1ptorn2., ::nd :)f th G: '~ r signific lln·:..-.: in the ~S3ess- f indings if j:)c r f c'Y'm"d quickl y, und nScd t v be cccrri cd (ju t OV i. r il l ong pe r iod of tim·:; by p" rsons who kr.:) VI tt8 1:,ngu8.6-= ,:.nd wno h::ve gai:-l(od t he confidence of t h e peopl~ . Qucstionn::~i rC' ~ aGe. brie: f ints rvie'tJs on what peop l G cat, ar E. of limi t iid v"'):",e in assessing t he: r e C'.l 3i tuation. 226 . The. s C'.:npi(;s of tht p :;pu la ti en t c bic surv~y "d nutr itionally should, more :)v~r, be r€;!:: r (; ~E;ntntivc , and · .. ;~neni :ver p0 ::5sibl;,.; t.!J r_ c l ini c;:l f:'ndi ngs , bioc~lemj_cal d,: t a and antrhopometric me~sur2ments s[lOuld b e r"lat e d t o f 00d int2.k0 j ,s.:: c r.:;r apr.i c: z..r .:,:.:' ~'..nd SC Ci O- '2conomic bQ.ckgI'c- ·,_.r(~u i n thE; s ame individua ls . On the be.sis c, f t hl: s e findings, constructivl~ acti on can be tak~n . I n many nutri ti. on surv<.ys :m d s tudit,s , i t is taken f c, r granted for <=xamj::l e U·.:-lt the p(jr~ons who :>-,,,v '" t h ", lClwcst s erum p:co t e i n l eve ls :lr <= o. lw2.Ys thCS9 f:)und t c ::::uffer f r o:] t hL m·.:) ;.;t s\'.: v :".r :: ;)cdci":'le..s, Clnd t o have the l owes t int '~l~", of prote in fo e ds in the ir d i e t s , IHhile other f ac t ors rEolatE: d t ·:) t he L evel o f s orum prc.t"in C::lC: tile p:'oduc ti .Jn of o "der:J~_ t"nd tc h 2 :JV 2r·looked . t o bnc t eri e. cl nd pC!ras i t e s is rel.at ed t o t~h: pr:~tt crn of s\Jrum f;rot~in.9 and Nut ri tie n Ac t i v i ti..: :o in th0 f\l;:,t '_r nal :~nd Child Heal tr, Sc:rvi e: " healt~ s ervices (p,,- 'Odi ,,-t ri c , obst"tric, c ::>mmuni ty h ,,:,: lth c8ntr0s i nc luding maternal and ohild heal th c ,,-ntrc's " nd r 0l ? t"d progr 'llnnc s) . EIvI/RC13/2 page 37 228 . I ntegr a t e d ou t - p2. t i "nt clinics 'J.nd m2.t0 r na l :m d child heal t~. cen t re s , a s desc r i bec'o in t llC chapt e r on m<:.tl: r'nal o.nd chil e'. he"l t h ( pa ge 53) t o be "ff e c t i v e in t he) fi l: ld. o f mat e r nal " n d chi ld nutr i t i on 2.nd in r e du cing i nfant a nd cr.ild mJ; 't~. :i. i tjT rend mor bi t.i ty , !-,,,, <::d t o i::s t a bl isi1 " f fec tiv<:: II ',1011- r un cent r e of t h i s type shc u l G. :~ rm t he nuc l ,~ u s of i n fc,nt c.nd chi ld :ntri t i on .'lc t i v i ties Ci f t he ma t or na l ·.mel cl1 i l el h", .:::. l th s0rvi c ,~ . 229 . Apa r t f r om tho I'loakn"ss :c s i n the nutr i ti c) n t r s.i nin3: pr ogr ammos already menticnea , ot her 0bstach,s ~lc,y l imit th" SUCC O S~~ of t he nutriti on a c t i vi ti e s , includi r.e; h""'. l t h ;,ducntion i n nutri t i on , :It the me'.. t e r nal and (1) S~ort'lg0 of s taf f , short ~jorking hou r s , '"-nel an ove r - r " pid e xv m s i cn of mat E. r na l ar,d 21 i1d tJc ?ll,h s e r v i cl s . ( 2 ) Neg1"c t o f t he prc- sc ~.):) l 2.g" chi ld and i ts w,,~~ni nG pr obl dr,s thr ou e;h conc cmt r at l on ~n t hE; i n f ant under nne y ear of e.ge . 0) F:d l u rc- t v r e:l. l i z", t h a t tnc f v;d :idvise d by !ie i1.lth p" r sonn81 has t o b8 3.cccptcd tra d i tl :ma 11y , or it 1..-1 11 no t be t2.k':;n , £.:spec i 2.11;:{ e,m ~..; n6 l\..'lwc: r s o c i ::;- [:c ::nomic E;r c u ps ~nd t hat t he r 0for c loc ul f 00d s u sed in inf an t and ch i l d feed i ng must b e: a da p t ed f p )m the: fo e,ds USE;(! in t !'. : ~' :\mi ly (li" t . I n thi 8 conncx i :m , i t is I3r .:::.t i fy i ng ~o no t <:. t:-:,'-\., ti-:!l; Pr c t ", i !'. Advisory Gr·:Ju.p , \'[;-JO, Fi,O , U'I eEF a[' ,: givinG i no1' '' :'..8 ing at t e n t ion t ,o the- inc r ,;a s ... ~d pr oduc ti on o f ind:i. 8~noV. ~1 pr :Jtec t iv l: f c:xls i n E:.; ,s:ch (; I.junt ry :"'.nd n')t :-: rl1y ) f l'ililk Gr ;;r ot .... in r ::' ch s u bst i t ut ;; s . (4 ) I gnor:m c e on t h ,., pllr t o f h,,::.l t h p" rs ::mno1 of p r cccl, i c2..1 d~tail s 0 n th~ f 00d~ , ~s~~ci~ l lY ~n~xp~~s i v~ it e!~s , ~v~ i l abl ~ on the ma r k0t, s0~,s,.mal va.ri a ti on s , [Jr i ce s , cook1n f', pr ocodur e s :tad s i mi l .:? r cic t :::. i ls v;h i ch ar c wi t :lin t he sph~;rE.· of h0me e c on.xnic s . (5) Th2 :TIotrle r i s ofte n t r e<'! t ed as 1'. pa ssive obs6 r v 2r ins t E;:ld of boing t r a ine d t ,: l,a k", ~.n a c t ive )Jart . (6) Ab s ence of c1 e3r m~di c nl direu t iv ~ s t o m~te rnal a n6 chi l d h e:\ l t h s t a ff :m inf a nt f <c ed l ne: end ,'lean i ng proc0dure s, d i a r r hOeal d i s eas e a nd malnutrition . Ef.~/RC13/2 p~se 88 (7) Lac k of c:)ntCtct b ':, t',ken cent Y"l] nutr'i ti 'Jn :~nd r",sc <"::.rcL ~ctjvit i cs wi t t t he fi~ld S~~Vi8~S . (8 ) I n t :.lC nutriti ')!1 2duc :::. t i on 2.r:tlvitL:s ~) f th", rnccc;...YTlc. l a::d c:_ild ~:':.:-:. l t l ~ s~:rvic :.: .s:> ":,,s 1~':'-; c i 2.1 1y -::n i nfe.nt f (,jG cl j ns ::nd wi.::-:1ning J f2j_ ~ ur·,:.; tc cons idEr t l:c: \:;c; ')D'_':Ilic-:.l :'!.nr, :? OC i.i. l 2DVironr:ic:nt o f €[:r:!f: (!~· ~ .il d ~.~)d each :;"-'2.!;1ily . [:.t c.r t,;·J typ~d i nst rtH: ti '_·ns .:lflC ::udi :'- v:"suc: .L .,",ids ~.r, . "~I f limi Gt.:d v ::~ l.u ;:; • (9) The d i ff l ec:.lty in ck fini'.2; t >: ,",,1. '·. t i .· r. bc l, ,, '~ .~n nut.rtt i (:n 2.nd i nfcct i cn i:1 <.11s :J rc~c;rs \)f 2:x':'; \'!7, !': and. c .:;v,,;l'...i!JJ:!ent . UNICEF' SUr:;pli,os .:::.n d Nut :"iticn ba:c i !:: . pon s ibi li ti03 ~re t h2r efor e indlc ' ted . RADI;;TION r,'j},DICH.w by :.: r gB.ni~ in2; ~v c.::. l t r :.tl nin,3 c our;:.t~S :-' -: t 0chnici.:-:.:: s c.nd r~frc,3ner C :)U~:; "-·. S f e r medic~ l ?rectiti~ner :~ . EI"l/Rc13/2 pagE; 89 232 . Ther e a r e two HI-IO pr o jects in th .: Regi on f or the Tr~ining of Personne l: one , in Ethiopi~, i~ for the t r a i ning i n r adiodialnosis of X- ray t ccl:micians c:rgent ly ne",ded in the.; country ; the other, a r eg i o:la.l project i:-, Iraq , is t o trQin tutor t .;:chni ci<1.ns i n medical r adiology , r adi .odiagnosi s C'nd r o.diothe rapy . As t'13 radiation hazards r esulting from the technical d oov c: l opment of t he X-ray equipment '-1.1' 00 increaSingly impor tant , spec i ill menti on of r~diation prot ec tion problcms i s ~ade dur ing th3 training in the two courses . The use of WHO project s taff f or the surv'i:y of X- r ay '-'nits i nsta ll ed i n the country has also been consi der ed . 233. A Mul tip l e SGmin~r on Radiologi c a l HeGl th was nrrangoo d by '-'IHO in sever al of th" larger cities in t he E3.stern r1ecli t erranean Regi on in December 1962 . The, progra mme i n each centre i:1c l uc.e d lecture s i"-lustrated with film and slide s and visits t o r adi ol ogicnl i nsta llQtions of hospi- t=.ls "Iher e pr ac ti ce.l d emonstr ':. t i ons ~Iert c::rri"d out . The parti cipants of t h e Seminar ,ler E; 10c?.1 h ·adi ng r ?diol ogi s ts l.'.nd t op r anki ng h ospita l a nd publ i c hce. l t h admi n i s trC'. t or s f rom the country and o.l so from ne ighbouring coun t ri '2s . The confe r " nc0 wa s e.t tended by a gr eat numbE:r of participants and S03 er:JS t o i1(Cvc been Vf: ry sUCC e ssful. A se.tisf?.ctory r e sult has already been obtained i n th2.t he:!lth institutions in several countri es of t he Regi on a r e o r ganiz ing similar conferenc e s f or the benefit of the medical prof essi on . 234 . In additi on t o h is visits i n t he Regi on t he Regiond Adv i ser po.rti- c ipatcd in a confer enc e on Publ i c H(; a l t}--_ I\spects of Prote c ticn aga inst I onizing Radi e.t i on sjeonsor ed r: t DU sso?ldor f by the EuropE:f'.D Region C'.l Office . Six c ountr ies of t h e Eastern ~lcd1 terranean Regi on we r e r e pr e sente d at th i s confe r ence. 235 . T.,e Regi onal Adv iser a lso ".ttend ,~ d t he meeting of an Export Cornmi ttee on Radiati on H" C\lth organized by I'JHO in Geneva . TIle report of t h is EM/Rc13/2 page 90 committee provides clear guidance to publ ic health authorities on the legislation, regulations and administrative structure required t o discharge their responsibilities f or radiation protection. 236. Evident progress has already been r eal ized in this field in some countries of the Region. Health authorities have undertaken to reduce radiation hazards, particularly those r esulting from the medical use of X-ray; r adiation control services wi thi n the Ministry of Health have been intensifi ed and hospital services developed in the main hospitals. III PUBLIC INFORIv1J\TION EIIl/RC 1 3/2 pase 91 237. Increased production of features ~nd pic ture-stories of worldwid~ inter est, strengt h8ning of means and methods to r~ach information t argets throughout the Regi on , and widespr ead publicity given to \<Jorld Health Day, hi&~lighted ~~bli c Informat ion activiti e s during t he period under r evieVi. 238 . Reports from r adio outlets and press cuttings (which r cm to over 1,000 co lurrills as a8ainst 730 l ast year) r efl ect an increasing amount of interest in Re6ional healt h top ic s on the part of journalistic circles , both in this Regi on and abroad. ~lore editorials and more ori s inal write-ups by editors and science co l umnists were publi shed during the . year, more news i tems originating at this Office were r el ayed by national press agencies or radio stations. 239. The wire servi ce coverage was especial l y Good, with severa l leading news agenCies providing a steady flow of i nformation to customer s in t he Region and out side. In addi tion to mere reproduction of pr ess r eleases or f eatures issued by this Unit, dailie s and per i odi cal s now publish more original articles supported by f acts and fi bUres from ~~O materi al ~ a trend favoured by closer cont acts between this Unit and individual editors . 240. Direct contacts with press 2.genci e s Ilnd correspond(mts t hroughout the Region a l so resulted i n t he publication of more f eatures in l eading dailies ilnd periodice. l s of internationa l r c:pute . Il l ustrated f eatures on Yemen ' s health pioneers , United Ar ab Republic ' s first \"loman i ndust rial hygi enist, Iran I s mal aria eradication drive, and heat diseases i n t1ecca, were eiv2n worldwide circulat ion t hr ough ma jor pr ess outlets i nc l uding Uni t ed Press International, a neviS aGency increas i ngly interested i n features and pictures pr oduced by t his Unit . 241. Other f eatures on such varied subjects as khat addiction, t rachoma control in Tunisia's d~ep south or bilharz i asis cont ro l acti vities on EM/RC13/2 page 92 Alexandria 's outskirts, reached international audiences by r eceiving good play in dailies and p~riodicals, near and far. 242. Experience gained during the past year has further confirmed the soundness of a more selective news r e l eas ing pattern, by issuing more press notes of specific inter est to s i ngle countries or groups of countries. Such press notes (37 issued during t he year) complemented without great despatching costs t he press relea ses (33) on topics of wider interest, distributed throughout the Region. The cooperation of \-iliO Representatives and Senior Advisers in ensuring that such materia l reached the right targets in good time , was highly valuable . 243. The year's events that made news include the Conference on Medical Education in Teher an, which f ocused publ ic attention on the magnitude and urgency of the demand in this Region f or more and better trained doctors. Widespread cover age was secured in the Regional press, newspapers in Iran, Lebanon, Pakistand and the United Arab Republic, i n particular, carrying daily despatche s on the proceedings. Press releases issued had a high rate of insertion (over 60 columns) and the coverage was boosted by direct contacts with editors and by exclusive service. Leading Iranian dailies published editorial s , features and interviews with participants, and local radio and t el evision programmes contributed to further highlighting the event. 244. The medica l student, his successes and f ailures t hr oughout centuries, his status today, his profeSSional outlook for the future, was the theme of an exhibit displayed on the Confer ence site. ~l so outlining the events which made medical history in this part of t he world, t his l5-pan81 travelling exhibit constitutes a timely public information t ool, now that medical education is being increaSingly emph!",sized in this Region. The production of the Public Information Unit, will keep up with such developments in medical education, and it is pr oposed t o deal with the subject in photo- story form, in thu coming year. EM/RC13/2 page 93 245. Excell ent support was given by pruss and r ndi o in Se.udi Arabia during t he Sess i on of Sub-Corr~ittee A of t he Regi onal Committ~e , held in Riyad in early October 1962. Coverage in the nati ona l press ran t o 55 columns and the local r adi c broadc~st a thir ty-minut e programme on the opening session and int erviews with hlHO offic ials. given by t he ARAfliCO Television Unit. Cover age was also 246. Also wor t h mentioning i s t~e pr ess coverage given t o t he Group ~leeting on Community Hat"r Supply , in Beirut. Press r el ease s and f eatures issued on the cccasi on wer e \'ddel y picksd U,} , and Sever al n(3.tional press agencies issued news items . 247. Interest in \!crld He3.1 th Day continues t o gr ow , and the humanitarian appeal of this year's theme , "Hunger: Disease of Millions", g:we a spec i al fillip t o the ce l ebra tions, possibly because i t coincided with the a im of FAO's Freedom from Hunger Campa i gn. The t r end, a lready noted i n past ye3.rs , of using Wor l d Heal th Day as ~ gener al public he?lth day , conti nues . Publi c meeti ngs alld. addresses , radio f eatures and press editorials , pictorial displays and exhibits were the methods Generally used to publici ze the theme . 248. The Day this y(,ar evoked ['. gr eat er r esponse among newspapers and other information medic. th<:.n in any pr(:viou:s year . There were mor e demandlO for t he WHO SGt of art icles , and tile press material i s sued r an t o some 300 co lumns, as against 180 l ast year. Over 700 phot ogr aphic prints were distributed, i n r esponse t o r equests from 9r 0SS outlet s and health depart- ments , and some 25 special supplements or double-spreads wer e published, i naddi tion to ful l t e:ct r eproduction of materia l on nutrition and hunger issued by this Unit. 249. The· r adio wa s a l so used mo r e ~xtcnsive ly thi s year, f or public i nter est i n radi o r emains str ong in this Region , in spite of t he gr owing t e levisi on audienc e . In addition to t he usual radio stat ements on the EM/RC13/2 page 94 occasion, a number of fi eld interviews with nutrition and maternal and child health advisers in Iraq, Lebanon, Tunisia and the United Arab Republic, were jointly prepared by the Unit and H0adquarters, and distributed to most radio stations in the Region. 250. Such on-thE-spot interviews on practical aspects of WHO-sponsored work arf:.' also being extensively used by the United Nations Radio in its "Round the World" progrilIllme, and it is proposed to carry out similar r ecordings in the future. Another \'!orld Health Day programme which reached a wide audience was a thirty-minute radio round-up on ".JHO activities, consisting of interviews and commentaries on the most topical problems dealt with by the Organization in this Region. Altogether, over furty programmes on WHO-sponsored ac tiviti es wer e produced during the year by fifteen radio outlets using scripts or tapes supplied by this Unit. 251. More human-interest picture stories wore produced during the year by photosraphers assigned to countries of the Region either by thE Regional Office or by Headquarters. Subjects covered include bilharziasis control (Iran, United Ar ab Republic), rural health (Pllkistan), onchocerciasis control (Sudan), leprosy treatment (Pakistan) and the health of Palestine Arab Refugees (Lebanon and Syria). 252. A Nile River story, outlining health and welfare f eatures along that major waterway of Ethiopia, the Sudan and the United Arab Republic, was prepared jointly with a photographer assigned ~, Headquarters. Another series of outstanding activities, including the widely varied aspects of rural heal th centres in both wings of Pakistan , was covered by another professional photographer on a United Nations assignment in thnt country. 253. Altogether some 60 picture stories were published during the period under review in regional and international illustrated periodicals. Note- worthy is the increasing interest shown by photo editors abroad in t opical material from this Region, such as the public hcnlth issues of Iran's Dez Dam or the pioneering health work ~oin8 on in emerging Yemen. EIvl/RCl)/2 !Jage 95 254. It is the purpose of t he: Publi c Information Unit in the REogi onal Office to stimulate public intE:rest i n Imo sponsor ed activities bJ hig:-llighti n8 t h", mc-jor Qchi"v"ments of Gov-.:rnme:nts wi th international cooper ati on. It must then catGr t o that inter 0st, while keeping abreast of incr easing demands fcor informati on materie.l - which more than doubled during the past few years. 255. Althou~~ it is obvicusly difficult t o Gauge the impact of informa- tion activities on public opinion, yet the steadily growinc; e.mount of WHO material in the press and r adi o seems t o be a wholcsoT11C: sympt om th.:l.t public informati on in this Region is taking an e.ctiVEo part in t he Organization's work by further stimule.tin8 peeple 's interest in heal th promoti on . EM/RC13/2 page 96 GENERAL IV ADI'1INISTRi\TION AND FINANCE 256. The structure of the Regional Offi ce and its administrative proc edures have devel oped gradually over 2 number of years. No ma jor changes have o(;curred for severa l years apart from minor modifications r esulting from nor ma l ~-rowth . It wa s t he r ef ore t houGht time ly durine the last year to review prvsent practi ces and procedures in order t o a ssess t o what extent t hes e misht be further improved . ,\ t various t imes between October 1962 ~d March 1963 three members of HeadquQrters ' Me.nas ement Sec t ion, in c l ose coop<; r .'l.tion with the Regiona l Offic e staff, studied items such as communications, mail and documents services, personnel procedures , r equirel:!ents fo r secretari al and clerical staff as well a s hOVI ava ilable space wi thir. the offic e buildins mi t;ht be utilized to maximum advantas e . 257. The conclusions and r ecommendati ons which became available in May/June 1963, ar e be i n;:; r eviewed and it i s bt.:l i eved that t his imalytica l study has been valuabl e and that even mor e benef its wi l l acc rue in the coming yea.r. Simultaneously with t he internal space survey, t he Host Govc rnrn"'nt i mpr ov e d t he o i t c by rcnc wins the f e nc e our roundinG the building . PERSONNEL 258 . In contrast t o t he stabili ty of t he ReGi onal Offi ce structure as such, t he chanGes in staffinG ~avc been exc eptionally heavy this year. Dr. A. A. Zaki , Public Health ridministrator f or Health OrGanization, l eft at the end of 1962 t o become /lIi nist cr of Heal th in the Sudan . I should like to take this opportuni ty to renew my best wishe s to a very hie;hl y estec~ed coll ea6U8 . 259. Three pr ofe s s i onal s t aff mer:Ibers , includinG a publ i c hc,:l th adviser, have r eached r etirement a0C and l eft. The advisers i n mat er nal and ch i ld EIVI/RC13/2 IX\[}2 97 heal th and environm0ntal hCQ.l th have been transferred to other \.;;{O offices. The Nutrition Adviser resisned to r eturn to his mID country. By 30 June 1963 two ..;xperienced proj ect staff members a s wel l as one advist:r e.nd one administrative officer had been transferred to the Re,~ional Office and a public hc:al th adviser and C.n epidcmioloJist had been recruited. Further- more the ReEional Adviser on Public Health Laboratory Methods wns appointed to take up his duti es on 1 July. The VI~O Representative in Ethiopia , Dr. P. Dcscoeudres , was transferred to the European Regiona l Offi ce in npril and was replaced by Dr. H.B.L. Russell on transfer from the South East Asia ReGional Office . 260. The turnover of General Servic es staff, and particularly of s ecretarial and steno i~raphic staff, he.s been very hi!j1. . In f(lct, about fifty per cent of the trained staff in this cate:;ory <8mployed a t 1 July 1961 l eft in the two-year period endinG 30 June 1963, some on transfer to other offices or a;~encies but the mo. jori ty thrOUGh emi ,]ation. This has necessitattd an almost continuous use of t emporary staff and' ha s r equired in-service tro.ininc followed by 10Dcer-term recruitment of those suitable for such employment . 261. On the other hane the position of proj ect sta ff ha s improvtd durin,; the ye2.r under revi ew. Not less th~n forty reported f or duty, includinc one on transfer from th~ Re~ion21 Office and three malaria trainees appointed to este.blished ;Josts. The; policy of r e2ssicnment within t he ReLion of experienced project staff has he lped to fill other vacanci e s as and when projects v:ere completed . In t he s ame period t wcnty- ei :;ht project staff includinG the two transferred to the Re ,,;ional Office, left, the majority on transfer to other Ret:ions or for , '8riods of study. * * * I wish to take this occasion to than}, all the staff I"lho have l eft this Ree ion for thei r cood contribution t o our work and to we lcome those who have joined us durinci the ye ':!. r . EM/RC 1 3/2 pae;e 98 262. An irrepar abl e loss to th~ Offic~ wa s the d~ath of Dr. A.S. Wallace and of Mr. Luis Mi Gue l in the air acc ident near Ca iro on 12 M~y. Dr. vlallace (United KiIl0dom), 42 years old, h"d been with l-IHO since 1958 initi211y as \·mo RepresentativE: in Af ghanistan. H·· arrived at the Regi onal Office in October 1962 to fill the post of Adviser on Community Development, but had almost immediately to ac t first a s r eplace- ment on l'llC.tters relatinc to coordim·,tion with Technic 2.1 /\s sist2.nc e and UNICEF, t hereafter, on Dr. ZE'.ki' s departure, a s Public Hea lth J\dm.inistrator. He was returninG from an official mission t o Cyprus, with his wife, when the accident occurred. Mr. Mi Guel (Bolivia ), 44 years old, also joined WHO in 1958 initially a s sanitary enGi neer on the rura l environmental s anita tion pro j ect in Syria, and early in 1962 was transf",rred to the Bilharziasis Control Pilot Proj ect and Tr2.ir.inl3 Centre ne ar fl l exandria . home l eave with his f a t her. He was returninG from Both wer e devoted t o their work and ',lill be sorely missed both profess i on"lly and for their human qualities . Deep sympathy is f elt for Mrs. Mis-ue l I'. nd her four children a nd for the f amily of Dr. and Mrs. Ylallace. BUDGET AND FINANCE 263 . Sav inL;s becamt availabl e in t he) second h.'l.lf of 1962 both under Regular and particul a rly under T8chnica l [, s5isb.nce Funds . The r easons wer e a combination of factors: amended r equest s fr om Governments, delays i n r ecruitment, and t he utilization of short~term consultants in l ieu of lonG- t erm project staff. Every effort was made to di vert these s avings to meet priority r equests fro m c;overnments and parti cularly to\,.2.rds f ellowships. The r esults wer e successful i n t,1at aV2. i l ablc res-u l ar savin~s were fully utiliz ed and ~dditi onal f ellowsh i ps were Gr anted under t he Technical Assi s t ance pr05ramme to an 0xtent 8xceeding the oriSina l provi sions for fellowships by about fifty per cent. EM/RC 1 3/2 paCE: 99 264. The Techa ica l Assistance prosramme for the:: biennium 1963/64 is the first valid trie.l of pr oj ec t pl" ru"ling i n depth and for t he estimated duration of projects. The proGramm E: appr oved lat8 last ye C'.r is based on submissions by governments i :1 tree summer of 1962. It was t herefore not unexpected that the mrmifold needs of s overnments in the many fi elds cover ed by the various sp~cialized aGenc i es made it difficult for governments t o cover adequately the continu!~tion or completion of existins projocts and at the same time provide for planned new activities whether long- or short-term . I t proved ne cE:' ssary already at the start of the biennium to assist several Govor:1ments in obtaining approval for amend- ments of the approved proGr amme in close coo perc:tion \-li th t he RE;sident Technical Assistance Representa tives. So far satisfactoFI results have been obtained for proj e ~ts in Libya , Pakistan , Somali .,,; and Tunisia and modificeltions of the programme fo r t hree other countries were under negotiation at the end of June . Th,;sE; c.l tcrations r equire additional funds and consume savi nGS a s and when they occur. 265. Another interestinG deve lopment arisins from t he l'equirE; ments of governments for advisory servicos ne t cov2r 8d in existinG budGet s under ReGUlar or Te chnical ;,ssis t anc e funds is the increas 8 in requests to WHO for implementation of projects under a "fundS-in-Trust" arrangement. So f a r arrangements have been compl e t ed i n this manner for projects in Israe l and Saudi F,r2bia and aGr 8ement in principle has been worked out with Libya . In f.ddition s everell Government s have during t he y ear met requirements for equipment and suppli es by request i ng vJHO to make reimbursable purchases on t teir beha l f . ~ NNE XES PROJECTS BY COUNTHIES EM/ RC13/ 2 /\nn..:.:x I P :1;_' 2 i Th o fo~ lowin ,.~ stat · .. mc·nt Gl'iov;s U,·, ,;t ~· tus of prc j ects i n t he; Ec,s t 2r n M6ditc r r an(;a n R'~:.:ion 2 S of 30 Jun" 1963: PIC',nni n:; Complct0d Tt~ C~IS UNICEF Countr-j No . ,u)EN 8 9 CYPnUS 1 6 10 1] 12 15 17 Funds dc s J. :.,:n[: t " cl and i n::; L.ld,,':;' in currc;nt prO]E.mrrk S (1963- 1y65) \MO s t af'f i n th~ f ic lli I~t2rnD t i oE·:l.1 st 2.f f Gr ot!1i;,;;r \[r{O -:'\ssis t~nc{:. Hi t hcir?viTl ( i:1cluCi nc -:.11 i~roj"ct :; ~omf; 1.2t Gd b~ t~ !2,=n i .7 . 62 :~:".c', 30 .6 .6) ) Tecr,nioa l >-ss ist ::,r;c l,; Funds (Cc:t (; . :OI'"j I on ly) Uni t c;d N,!.t i oDf; Chilllrc:n' s Func~ Fund s- i n- Trust, ,=to . Prc j ",c t Sour c" St ::tus of Funds rJ1 c.~c..ri:2. ,";Y' :..c.ic:.;.t i 'Jn n,:;:;ul =.r :Fl :,nn i ni.: Tttb0 rcu] osis cont r o l pi l Gt s..r !""~ R,,,,:;U 1."1.1' PI -.L1in~ NUI'sl r: -; c:: duc 'C ti'~n n /UNI CEF In Q;>t..: r~t ic..'n Tu b" r culosi s contrc.l TfJUNI c..'EF In o)c; r ctt i on Le pr o"y cont r ol TA COr.J;:; l c: t "d Ru r a l h :.al t r: TlI/UNI CEF Flanni n:; Vc: t " r inCJ.ry p'.lbl1::; hL 'Il'ch Rc:;oJ.l2.r Pl~,nnin, : ?LIbHe h",a lth l:).bo1'? t ory ReGUlar Pl?nr.i n ,~ Survl:Y of ':::;2r i atri cs H ~\.:'ul [tr P 1 ilnr.i r'g EM/RC1)/2 I'.rm<;x I Countr-J ETHIOPI f\ IRAN No . 3 6 9 14 17 22 23 25 29 30 31 1 7 25 26 28 30 Proj ect Public ht;e. l t il acimini str:" t i OD Tub0rculosi s control Health trai ni n.:; c(;ntre , Gond::.r Mc.lari a. pr e- er 2.di ca t ion pr oGr amme ~1edi cal .::: duc2tion Provincial h,,;::.lth sGrvic i..:s j Eritr ea t~aternnl and chile'. ~'1e 2 1 t h , Eritre 'l. Su p.:; rvisory t uam for ' heal th centres Tr[~inin,J course for X-ray t echni cians Nutri t i on coordi naci ::m Survey on vital Q!ld health s t atistic s IhL:ri 0. 0radication (a) M2.12ria .:cr',di 8:.t ion (b) Nutriti o:1 insti tut", Communic ablt.; '-'y " d.i s~ as'c' control Public h", alth I nbor ator-! t~ental health I nc.ustria l and occupn t iorw.l health Source Statu s of Funds TA In opfCr ation TA/UNICEF I n oper ation Resul ar/ UNI CEF I n op.:;rat ion I,TEst. In oper ation ReE.;'Ul c"r Planning TA Plarmins TA/UNI CEF Compl et ed Res"Ul e.r/ UNI CEF I n opcr e.tion T.A./UNICEF In oper ation Ret:ul ar Pbrmi ne Recular Ploll'.I1inc; R"'Gular/ Comp18t ed UNICEF rVf!4' Q r,/ ......... ~n I n oper at ion UNICEF Ti;/UNICEF In operation TA/UNICEF Plarmin3 Rcsul'1r In operation Re::;ul ,ar I n operation TA Planninc; Country Dll\ N ( contd . ) IRAQ. No . 57 )5 42 43 45 47 4B 50 52 53 54 56 57 53 11 15 13 23 Nurs i n . c. duc ·~ tion, Red Lion e.nd SU!'l o'3c:-.ool of Nur sin!.,. , ncy Bil!13.r/~ i e. sis control o'3e: nool of phys::'oth,- r ::'.::y , Shiraz Assistanc~ t o provinci 2.1 f::'. culti~s of mcdi c in~ Ai r pollution c ontrol R(;h:~bi1 1 t 3.t ion C.cntre , J etmal abac. , T.::hc·r-an fl/ledic Q.l so c i ~l wo~ i-::. Source. of Funds TA TA Re2,-ula r Re Gular Tr".inir~~· school :or Th/mnCi::F s uni t 2r ie.n s (P~lasn~ School) Pos~- bilsic nurs i n..; 8cluca tl on Dru, ; contr ol F~. vus control i:n~r :; i:..;ncy rur.:t l housin~ Hi ':'f'! sC ~lool of midv.'i_""' ... r:" , 1\I~0 S :1 ~cl '];r Lli ni n--: or s3.ni t cry I:,..n:; in~c. r ~ Bl1harzi :u5is cont r ol Comr:lUni ca bl ·:; ::y <: disease contrul School i l C.~ lth s=rvic8s Re .;-ub.r R:: ~-ul,"r R'-,,.:;ul ar ~TSA/Re " u :Lar/ UNICEF TA Re L;ubr/ UNICEF T':'/UNICEF 33 ( a) Co ll ~ ~c of m~dic l nc. , B'l.:::hd3.c~ a ·1/Rc13/2 Ann<:x I St".tus Pla nni n.:; In oper a tion I n op.::r a t ion Plannin.:.; Pl :? nni nc; Planninc' Pl=i ng Plannin~~ PLl.nninc Pl? nnin:~ Comph.t",6. Comph:t",d PLm nin,::: Pl ar1J'.in..; In opc r 3.t i on In opere,tion I n opGr ntion Pla nnin;:; Plannin;:; Planr.i ng E~1/RC13/2 Annex I p9.~~e i v Country ISRAEL No . Pr oj ec t 35 Tr:.inin~ of h(;:l l k . ~(; r:3onnl.l 37 Co ll e~: 0 of nur s i n ....: I Bachdacl 38 Public h~~lth lo.bor r,t ory 42 Public h:J:J.l th advi sor y sc;rvi C:l! s 43 45 46 47 Canc er control F?vus control Stuc:.y of i"iat '~ r supply qu~lity Public hc~l t h aspects of bou si n:..: 49 Rural h",~,lth adv i sory t ee'.m 50 C:= n-:'r::.l patho l ocy ir, s t i tute 5 Nn.lar ia "r adicatl on 24 Chi ~d ~ sych i iltry and mental :: ",al t h 25 26 H~daS3C:: 11E:.dic a:" ~chcc l, J c:. r usall;m - U\ ) [,nc. t omy Ho s;) i tJ.l ad:r.i ni strati on 29 H'lci.e.ss :th :m,dica l s chool , J crus2.1(;m - (B ) Prevent ive and socia l medi cine 32 EV2.luation of " na t iona l hcCll th pr ogr amr.10 Sour ce: of Funds TA/UNI CEF Rc8ulilr/ UNICEF ReGUlar TA ReGul ar RSi:,"Ular Tf-t TA TA Rc(;Ular fiec:ul,' r Reimbursable/ RegJ l ar- Re i mbursable TA St~tus In o;Jer ation In oper ation Ple.nnin.; Pl::.nnin6 Pl :tnning Compl.::t e:d Planni ng PI ':.nnins Pl anni ns Plan.YJ. i nc Planninc In o:; ,-, r~tion Compl eted I n ope ration Planning Country' JORDAN KU\JiI,IT LEBANON No . 2 6 Proj e:c t NursinG educa tion r,1ill::ri:1 er~dicCltion 11 Communic::.bl e ey(; di"' (;~Se cont rol 21 23 24 25 27 28 29 30 31 1 2 School health services Product ion of vac cines Assi s t ancu to Childr en ' s Hos pi t al , Amman Publi c ~~alth ~dvisory s .:..: r v i c c s Munic i~al wat" r supplies ",nd v1<ts t e- v:u:t"r di spose. l R:habili t at i on ser vi ces Tube r culosis control (lJ:,tion::l Pilot Area ) Vi r ol o,,;), l :>,bor?t ory F-wus contr ol Tuberculos i s cont r ol Communicable eye di scaS8 contr ol 6 Vi t al a~~ h~~lth st"tistics 8 ?ublic htal t t advi sory ser vices 9 1 4 Dru:; control H",a l ti1 educiltion of the :~ubl i c Rur a l heal tn unit S:mrc8 of Fu.nds TA MEsA! TA/UNICEF TAj UNI CEF R", ~;ular Ret;ul ar/ UNI CEF TA Recular/ UNI CEF T '; R\; ,·;ular / UNICEF R~· ~;ular RCGular Hecul ar ~cc:ular ReEular Tt.jUNI CEF EM/RC13l2 . r,rmax I St 3.tt:.s In operat i on I n oper at ion Plarming In oper ation Pl anninG In oper a tion Planl'1i ng PlanninG Pl :m ni nc Compl et ed Compl (;t",d Pl anni nG Complet ed Plaru1i ng Compl ;; t cd Ple.nninc Pl anninc EM/RC13/2 Annex I p3.(Ie vi Country LIBYA No . 7 10 17 18 25 Proj <.?ct Nurs i nt: educe.tion Environmenta l he."l th Cornmunicable eye c.i s (.:,~sE: control Industria l and occupatio- Soc;rc f; of Funds [,1ESA/mn CIIF TA mel heal th TJ~ 31 nehab::'litClt i on of t he phys i c Q.l lj~ h3.ndic (~pped 39 41 Aneric:m Unl versi t y , &irut Blood bank 42 Munic i p~lity ~ealth ser vices 45 2 3 6 Bilh3.rziasis cont r ol rh t ernCll. and child ~~alth , Tripol itania Nursinc education, Tr l.pol i Communi c2.bl c- ey " clis~ 2. s(- control 7 Heell th tr~,inin( insti tutc:, B'-'Dc;l"li:;,.; i 8 9 Nursin[~ .;; duc rction, vJrc.: naic a Mrcl~ri 2. c.: r ad icat ion 12 r'b t ern"l :::!1d child heal th, Cyrenai c~ 22 23 Tub8rculo s i s c ontro ~. He~l th c c~tr~ J FGz~Qn ne :ulD.r R cc~ul 8.r Re c;u l ar TAjUNICEF Re ,::;uh r/ UNICEF Rcc;u lar/ UNI CEF rtel;ular/ UNICEF Til FIT T" r\ Status PI 3.nninc Pl ?,nninL PIZlnni n,,: PlanninG In op E. r ~.tion Plecnninc; Plannins Compl ctec. Pl annine; I n o;:;er at ion Pbn.'1inC In oper ation Plunnin,..; I n oi-'er2.tion I n opc.:rat ion I n oper at ion Pl anninl'; Count r y No . Proj ec t Sourc~ of Funrls PAKIST.:I N 22 S2.ni tilr'J en:::i n (; er in.:.; , VJE: s t P"ki s t an 25 Physiotherapy school, KElY".:chi Liur'sin,": cduc ,~ti cn , n " ,-;ul ar / ELst Pakist~n (Chi tta~onc ) UNICEF 33 Public Healtl:. I nstitute, 34 TE:E1cr-,in_: of s;mitury en:.; ineer i n ,.: , Uni v" rsi ty of En~: i [l'£: erin~; ~nd Tecr~~olo~ , LQhor~ I"la1ari a. eradi c~.tion 37 ,~ ssi s t '1DCe t o r.iE.'aical schools 39 40 Lspr osy cont r o l COr"m;unic2.bl e '~y,­ di z88.S t: contr ol 41 Ev:t1u2tion and 1'.ss essmcnt af the sma il:ox 0 radic~­ tion, East P3.1d stan fI.(:vis~r on r:ro sth~tics appJ.ic ~tion 43 Vi t(ll (lnd hce.lth st",·~isti cs 44 48 Nur s i n f:' educ2.t ion, vJest P" k i stan A s sist~nc8 to the DElt ional h"al t h l[;bor :ltori e s ect Tj.'. n(:~ul 'lr MESA Re ,.;lil a r/ UNICi::F TIVUNICEF hE.:[ ulnr/ UNI CEF UNDESA/ Ti-\/UNICEF Til Til/UNICEF I slamabad Re,';ula r )f9 r-1a}Clria ocrc,clic" tion trainin2 c~ntrE:S MESA/Regul ar EM/ RC13/2 Annex I pa,:e vii St a t us In opE:ration Pl a nnin:.: I n oper Oltion Pl anninG I n ope r a tion Plnnni nc Plan::ing Pb.nnin : I n oPer a t ion I n ope: r :=. tion Pl c..nn i nt: I n oper Clt i on EM/ RC1 ) / 2 j'"\nnex I ;)e.:,·2 vii i Country Pf,KISTAN (cont! el) SfI.UDI ARABIA No . 50 - 1 :::> - 52 54 55 56 4 5 6 7 13 15 Proj ect Tuhcrcul o;; is control ( Pi lr·t ~ r ," c 1°,,\.,., 1 " l' ncl.L' ) _ _ ..J ' • • .... ,_1 : \ _ " __ ._ ~ . Rur '!. l l-ii. ':1 tr·, Publi e h2 cc l t h a d vi. :;or y :'; CorviC8 S (\/est Pa!d s t :m) Coocun i.ty wate r' s u pply Senior .:..dvis~l· on <-nv iro nm" nt'll rHo", 1 t h t o C8n tY' ,).) Gov e r no ",nt Heal ti", ",du co.t ion a dv i s", r to Centro: l Gove r!'1r:lcnt Ma laria prc - br adi cat i o n Environmtmt~" l n '- .~.l t h L~prc 3,y cont r o l Pub l i c "',<2 ·'11 t h I:lno r CltoF,f Tuber8~lo~13 c o n tro l ( N~tion~l r) ilut ar ea) H,,;'r't l t i1 ;·lssi .'::t :~:::lts ' an6 Sani t Ctr i ans ' I nsti tut t.:: , BiYCtd 23 Publ i c :E~,l tr, ~~(l visOFy s t rvic t.:: s 24 28 Bi 1~ar ~ i =sis contre l 29 B~,sic , unl i e fl,, ·3.I'tf, ::'! .1rl r~ i ,-· d.ic:'.l c ·-~r ..:; 30 31 ser vices Nursi!1~; :lui VSl;:Y' t o Go v e r nment Sour c e of FunGs TJ\/UNICEF R._~ul Ctr/ UNICEF R8 ,.~ular C~!S/R e.:,ular lie ,3D b.r RC.ju lar ik :.:;u l :':r /FIT R,--, u l a r / UNICEF T il R8.,:u lar/FIT Re l;nbu rso:bl ,;/ UNICEF TA/ FIT Stiltus In ol)c r :ltion In op;.:;r 3.t i on Plann.int; Pl anninc Pla nninc.; Plannin-:; I n op;;r .3.tion I n ope r a t ion Flr,nnin,:,: In o ~)trati on I n op", re.tio n In op_ r a tio n Fl:J.nnln,~ Com;, l :.. ted Plcmninc Pl:,nninc Pla nnin;; Country No. Proj ec t SAUDI 32 Meat conservation ARABIA 33 Community water supply (cont'd) 34 Advisory assistance for health proGramminG 35 Trainir~ of medical health personnel 36 Management of medical stores and pharmacy 37 Brucellosis Survey 38 Assistance to municipal proGramming SOMALIA 2 Malaria pre-eradication programme 8 TraininG of health personnel 11 Tuberculosis control 12 Bilharziasis control 13 Basic health services 14 Public health advisory services 15 Trainin~; of nursinz personnel 16 Leprosy control 18 Environmental health 19 Smallpox control and eradication 20 OrGanization of medical care 21 Management of medical stores and pharmacy 22 Communicable ey:; disease control S')urce of Funds RebUlar FIT FIT Reeular FIT ReG'"Ular FIT MESA/TA Recular/ UNICEF TA/UNICEF Regular TA/UNICEF Regular TA/UNICEF TA ReGUlar TA TA TA ReGUlar EM/RC13/2 Annex I pae;~ ix Status Planning Plannine Plannine Planning Plannine Planning Planninl:l In operation In operation In operation Completed In operation In operation In operation Plannin.n: Completed Plannins Planning In operation Planning EM/RC 1 3/2 Annex I page x Country SUDAN SYR:I;AN ~ REPUBLIC 6 7 12 Proj ect M~laria pr e- eradicati on pr ocr amme NursinG educati on , Khartoum Lepr osy control 15 Communicabl e eye disease control Source of FLl!1ds MESA ReGular ReGular Tf.I/UNI CEF 16 Ven ",real c.iseases control TA 17 Dental ~ssistantst training 19 Hural heal th demonstra t ion ar ea 20 26 28 30 Nutr i tion I nstitute , Khartoum Onchocerciasis contr ol Smallpox eradication Radiation and isotopos services, Khartoum 32 Malaria er adication traininc centr e 35 Medical r esoaroll institute 36 Adviser on environmental health 38 Vital and health stat istics adviser to Government 39 Bilharz i asis Trainin~ Centre 2 4 Malari a eradicat ion Bilhar ziasis control RelC;ular TA/UNICEF Reimbursable/ Re'..,'Ular Regubr Reljular MESA Re ~;ular Rc ,::ular TA MESi\!rA/UNICEF Hecular Status In oper ation In oper ation PlanninG In operation PlanninG Completed In operation PlanninG In oper~tion PlanninG Planni nc In oper o.tion Planninc Planninc Phnninc:; PI anninc In operation Planni nG Country SYRIAN ARAB REruBLIC (cont'd) TUNISIA No . 13 16 20 32 33 Yr 39 44 45 46 47 3 Project Scnool health sGrvic ~ s (favus control) Rural health unit Communi ca:bl ~ ~y v disease control Public health and endemi c disei:'.ses labor atory Blood bank Ce.ncer contr ol Nursin0 education, Damascus TraininG of sanitarians DrUG contr ol Tuberculosis control (National pilot area ) Hospital ar chi t ect for accidents hospital Assistance to medical school, Al ,"ppo Communicable eye disease control 6 Mat ernal i:'.nd child health 17 18 20 22 Malaria 0r adi cation Environmental heal th Public health l aboratory Ophtha lmoloGical centr8 , Tunis 26 Production of phar maceuti cal s Sourc e of Funds Re(:,ular Recular Re2,ular ReGule.r TA TA Recul ar/UNICEF ReGular EM/Rc 1 3/2 Annex I paiSe xi Status Completed I n oper a t ion Plannin3 Planning Compl et ed Planninc In oper a tion In o;Jcr ation Planninc; Planning Planni n;s TA/Contingency/ ReGular Pl1!nn1ng TA/UNICEF TA/UNICEF Rec;ular/TA TA Re~lar Planning In operation PlanninG In operation Planning In operation Compl"t ed EM/RCI3/2 Anne:x I pace xii Country TUNISIA (cont'd) UNITED ,"RAB REPUBLIC No . Z1 29 Proj e:ct Medica l education Me:dical r0h~bilitation ceontre 31 Tra ininc of health ;Jersonnel 34 Nursins eaucf'.tion 33 Centrf'. l medicf'.l t~chnical services 23 Z1 f'ilal aria er adi cation Hi Gh InstitutE: of Public Health , AlexC'.ndri o. Premature i nfants' unit 32 Poli omy eliti s resef'.rch and trainins centr e 35 37 Nutrition i nst i tute Virol oey r e sear ch l a bora t o!"! Centr e for sanitary ens i neerinG r (; s <=arch of Source of Funds TA/UNICEF TA R\:~ular/UNICEF ReGular/UNICEF Reo c;ul ar TA/UNICEF Regul ar TA the University of Al exandria 44 48 Conc entrat ed serf'. pr oduction plant Drus control l abor f'. t ory 49 Bi lh~rz iasis cont rol pilot pr oj ect and trainin2; cent r e 50 Nursin;~ education 51 Rehabilitati on of t uber culosis patients 52 Dried small pox vaccine production TA TA Reculf'. r/UNICEF TA/UNICEF Re::.;ular Stf'.tus Planning Plannine; PlanniniS PlanninG In 0) 8ration PIQnnino Planni I18 PlanninG Plannirl8 Planning In oper ation PlanninG Planninc Planning In oper ati on In oper ation Plannirl6 Plannine; Country UNITED ARAB REPUBLIC (cont'd) YEMEN INTER- COUNTRY PROJECTS No. 54 55 57 3 Project VJprosy control Rur 2.1 health study Audiometric CGntr0 for school chi ldr cm Public hea lth administration 4 1-1al aria pr i;;- er adic ation 8 H~alth centre and tr:l i nin.:.; school, S::ma ' a 13 Communi cabl ~ ~yc di Sease control 15 Loco. l hc:alth servic" s Sourc \: of Funds RG[:;ular TA/UNICEF TA Re.:.;ular Re:::;ular TA/UNICEF (a ) Health c(';ntr i.., Hodeid~ R8 L,ular! (b ) Health centr e , Ta i z UNICEF 16 5 SClallpox eradi cation HLjt(;r I n:3ti t u t 2 of Nursin~, Univc:rsity of J\lexandria 7 Ar c.b Stat es Trainin,~ Centre for Education in Communi ty D2v"lo:;ment 19 Re~ional ~alari a eradica- tion t r c.i n i nt..: centre; 22 Advi sor on h(; alth education 23 36 Denta l heal th surv0Y Group mb:tin>:: on vi t a l and health statistic s 38 Se~inar on food hy~i i;;n" ::md zoonoses control and Vet er i nary public hc:alth pr 2.ctice R,-, ~;ular Tl\/UNICEF Tri ReGul aY' H€ ~'Ul o.r Ree:;ular EM/RC13/2 ftnni;; x I pc. ~c: xiii St~tus Compl et Gd Phnni~ In oper a tion In operation Plannin:.:; In oper a tion PlanninG PlanninG Plannin,~ I n op t:'ration In operation Complet ed I n oper a tion Planrlinc:; Pl,mninc Plannin .; EM/RC13!2 Annex I pe..G8 xiv Country INTER- COUNTRY PROJECTS (c ont'd) No. 42 42 43 44 P"['oj cct (a) Confer ence on mc:dica l educa t i on (b) Sp'ecial l,rou;l me etin:: on nedical ~ducat i on Advisory services Medicnl literature 45 Partic ipation in educational mcctin~s 51 53 Epidemi o lo~ical and statistical centr~ Virol oGY trai ninc 55 a ) Assi stance t o medical Sour ce of Funds Rt·_;ular Re::;Ul ar ReEular Re c::ular librar iE:s Regul ar b ) 56 Training Course for libr arians C:l!nouni t y wat"r supply C\'IS 58 Mal aria er adi c?tion ev?lu2.tion t eam 59 Re c ional st udy on diarrhoeal diseases 60 Group fdloNshi ps i n public health administra- ~1ESA/Regular TIecul e.r ti on (USSR) TIl 61 Tr ainin~ cours e f or l a bor::t ory t eCHnicians 62 ReGional tra inin0 cour se for medi ca l radio l osy t echnicians 63 Tre.inin...; i n m0nt2.l health (a) TraininG course fo r :; cncr al pr ac i ti on"r s (b) TraininG course f or psychi atric nur ses StP.tus Completed Planni nc In oper ation In oper ation In operation In operation Planni ng Pl anni nc; In op.;:ration In oper9. tion Plannin,.; PlanninJ Plannin,; Planni nG Planninr; Planninc Country INTER- COUNTRY PROJECTS (Cont'd) No. 66 71 72 Project Rural housinG Rc::.;ional confer ence on malaria er adicat i on TraininG course for waterworks enGineers 74 Me etinG on rehabilita tion of chr onic psychiatric patients 75 NQtiona l tuberculosi s centre wi t h r8'~ional traini nG pro~ramme 76 Pharmaceutical and medical stores adviser 77 Group meetinG on communi- Source of Funds Re,:,'Ul ar Rc:;ular C\!JS ReGular ty water supply CWS Seminar on tuberculosis in infancy and childhood Re;::ular 79 !{dvanccd trainin[; for sanitarians TA 32 ReGional Group meetinc on child psychiatry RCLular 84 Consultants on medicQ1 educ9.tion 88 Sma llIJOX eradication 89 Joint FAO/ iIHO/UNICEF nutrition seminar 90 ReGional traininG course in cancer control 91 Bilharziasis traininc course 92 Participation to inter- re Giona l conference on smallpox Rec;ulQr Recular He ,;;U1ar EM/RC13/2 Armex I pace xv Status Plarminr:; Compl eted PlanninG Pl:mning In operation I n operation Compl eted Completed P1arming Pl~nnin6 P1armin3 Plarming PlanninG PlanninE; PlanninE; Plarming EM/RC13/2 Annex I page xvi Country INTER- COUNI'RY PROJEGI'2 (cont'd) No. 93 94 96 gr 99 100 Proj ect Source Status of Funds Training course for medical p"dago.::;y Regular Plannine Group meeting on psychiatrists of the second line Regular Planning Municipal refuses disposal i n r e l ation to fly control RG£:,"Ular Plannine; Training of wat"rworkds personnel RC Grular Planninc; Symposium on diarrhoeal discases ReGUlar Planning Participation to joint FAO/WHO/lLO Seminar on industrial feeding (Near East)., 1965. Regular Planning il.NNEX II EM/RC13/2 ;\nn8X II AGREEtlIENTS SIGNED BETI'JEEN 1 JULY 1962 rND 30 JUNE 1963 CYPRUS 15 ETHI OPI A 6 ETHI OPIII 9 Public ~Lc·.l t.h L'Cbor?,t.0ry Exch3n;~:::; of LtJtt·~r /,dvis :;r or, p" t ;,o loci Tuberculosis Control :,c'd"ndum I t o plcln of O, ):T 2.t i on H,,2.1th Tralni nl.', C8ntre . Gondr, r Exchc'.n~e of' L" ttc r Continuatic'n of SGrViC 0S , 2 m"dic2.1 offi c8rs (end on" ::ubli c h,-, ~.l t h mlrs "'- :;jicl"ilf ,~ U,rouch 1964 ------------------ - ------_._,--- - ---~.---- ETHIOPIi, 14 IRAN 10 ~1c." l;:'.r I ,,, Pr"0- Gr :cdicC!.tion P.l 2.D 'Jf Op(:; r'~ition Exp?n:3ion o~' meet.c rmel 8.nc~ c:-; i1 6. h cal tr: serv ices [,drl:o':ldum II to the Plnn of O:'dE'.tlon Cov"rin_, fil '5t :oL, [:lOntils cf' t"11rc: Fiv 2- yc :llo Pl a n TrCJ.inin;;; Schoo l for S2.ni t'cri r.ms Pl~n of O::u r a ti on t1Ia lari 2. Ere.dic a tion Add"nc'.ur;] II Ext0ndin.~: validity throu,)l 1962 EM/RC13/2 Anne x I I IRAQ 18 IRAQ 35 m':'Q 37 IRr.Q 45 ISRf£L-UNICEF/7 JORDAN ;; JChDAN 6 JORDJ,N 6 C ::llr.r;lU"i,~ :. bJ '" Ey ~ Di ",,,, ,,:;3 (. S Cont rol Ad(~') il":um I t o ti' " P.l,ccn o ~~ Opc:r" tion Ts rE c src~ v :.:.r._ous ch::.~ _ :_~ S '.1nd I.; xt, · ~r:(..l. Y2.1i :::li ty t !lr ~;J;";! ! ::C964 Tr<:d ni n2, of H8 0. l.tn Pcrs'.:nrlLl Pl-:t.r:. Qf O;)~r2. t j.e:n Pl&~ of Opcr~tlon Exc h.~~~-:..~c of Lt;ttcrs Shcrt- tc,';n Con 'ou l t ':.:1t ~1ycosi s C!J!:trol Pl a n uf Op8r~tion "1 ~ t ~rn:il. ::. :-JG. chi J d L·'. :'.l c:--:' s 0r vic,c :crd tra ini n:: Pl~n of O~ ar~tiYn No , II ~1~1. 1r:::rl :: Er ~·~ (~ ~. c !",tion E:',- cI ·~c.n,-~c of L2 t t ._· r :: (" [':-,e(: ti o :l ~3 t .:) j~d.cle r~du!!. II I"12.1 {".. ~' i,:;. Er~~cii c C:. t i ( )n l~l(1d(;r h.~um II I t() "trl(.. P1 2~n of Op€: r a'ti '.)!l Cov~!' in .c; :,'rovi ~:, L)r. £'CJ r J3 K- :L75 motol'- cycl",s in 1962 JOHDi,N 23 JORDf.N 29 KUWII IT 6 KU\'I~,IT 9 LEB,\ NON 31 LEB:.NON 39 Exch~~~'~ 0f' l _tt~~ ;3ho:t- t<- n n Co!~ s ·.l l t ·,;,c 'I'.lb c.:rci.:.l os:;' :-; Centr e l (Na tL,nn1 P. l ot .!Ir e-a ) 21;:[1 cf Cp·.: r:cti on 2xci1n!~l.s~ of I i __ t t:.;r 3hcrt-t" r r:l consul t ::nt Dr1.-,. Cont "c l Exc:-!E:.n!~ 1.; of L~ t t c r .'31',ort- t Lr lr. Con :oul t :l.l1t M:! l~rin ~r~di c~lt ion EM/TIC 13/2 i,r.n,- x II !\dd" ndum IV t o t tl", f leen o f O l~ d" =-ti ')n ?rov ~ si on of 13 K- 175 ~o t~rcy~ l .os i n 1962 R_h"bili -.:. :... t ::)n o f th(. Phy;, l c:.l l y H ::" .1C1ic3j1;') '_ ';' Ple:.n o f O:~,·.;' r 2.tl ~ )~ : \m...: r i :::? l l UniV(;!'"':", l tJ' J Esirut :::xC! ~~:?~n ,:. :. :,)1' ~0t "LLJ Ex t <::r:<.li n :, V C.licli ty Bi1h? r zi -::; i " CO:ltrol E :fch ::.ri~ ~": of L.0~t~·~ S~.vrt- t \:, :,:n consul t :"!nt E~1/TIC1;J/2 Annux II LIBYA Exchange r)f Lette]" - Ext.::cdi;,g UNICE:"I f, assist ance fur 1962 : LIBYA 2 LIBYA ;; LIBYA '( LIBYA 12 LIBYA 22 PAKISTAN 36 Pr.KI STAN 36 PAKI STJ,N in ~1c.t c rn,:1 2.:ld Chile. H" c.lth, Tri ) oli t:-.ni " HO'il t[, Tra1ninc Ins t i tutf), BC)!l, :~12. 2i ~lb8rcu1osis Contr ol (N~tionc.1 Pilot Arda ) Pla n of 0,1'" r::. tion Vlllic:.i ty tr, r ouwh 1<)64 M~l~rin Er~dicat~on j\dd"r:<:'um I to Plan cf Opero'Lior; (Provi sion of DDT) Mccl [lI'i;..:. Er::.c~ic c. ti on :\r.k'.d ·lc;um II t o tlE Pl ;"Yl of Op",rrlti on Provi,;i:;n in 1963 :.:nd 1964 for sUP:JliGS 2.DC. Ev~ .1. 1u :~tion ~nd :~ss t:: ssm ,::;nt 8f' thl:.:. Sr.la l l ::·ox Er ~~c~ic;:,. t~()n; E,::.. zt P3.kist::'L Pl. '~r. of Op",r :::,ion Nursin :,' Ec1uc,c.ti cn, \·!,',st P;~!~ist an .L\dd l.:ndu:.l I t o t::-_ :::; :21::"'11 .)1' Op..:.: r u.t i on Ext.:.nsi cn of i nto'n;:t 2. onal assi strenc ", for fi v~ !rur s l nc schools P;~!<.IST;:.N 49 PAKISTAN 50 P;\KI STAN- UNIC"EF /2 PAKISTM~-UNICEF /17 PAKISTAN-UNICEF/16 SAUDI t Jl,\B!i. 4 St.UD I l.Ri\Bl i' El'l/RC13/2 Annex II M21 .::..ria Er 2.d~Lc:-=! ticn Trc~iYlin ._; Cc..ntr0s t,dc1enc~-J.m II t o tht.:::' r;. l :?D of :Jpe r::. t io!'.!. Tub ercul osi s Cc;n trol (Pilot t~r,:.;( ·_ ~ Pa..., .. F":.lr,> indi) Pl~~n of G; ::.: r Clti J!1 ~b t e rn2.l ",nd Chile. \'J81 L,I'€ /,dc.'2ndum II to Plan :)f Oper~:tj. on Rur2.1 H"a1 th Add0ndum II t G Pla.n of OpoI'2.t i on (ext2nsicn to mid- 1963) Urban Community Dev"lopmc:nt J\d::h=ndum I to chiC Pl:m of Op~r<::t i c-n EX)<l!lsion of tn,'. uro,;r[lr:lmc= to OOV2r 42 ",c.ai tioncJ. c':nr.muLity c.~vel o:Jr:1"mt pro j ec t s I'lali',r irl Pr 2- 2raC:1c2. tiOl: Pro,-~r :::mm" Plan of opera:.i(n Tub" rculos i s Control (National Pilot ~r8a ) Plc.n o f Ope.ratien Pub} i:: P"~cl.l tl~ i'. (~vi s :.. r;-:l S 'c T'ViC8i5 Excha:-l,L_:c of LcttGr' Ext(~n:3icn of Scrv~ e (:s throil...:~:: 1963 EM/nCl)/ 2 Arm<:; x I I p8.(~~ vi S.t.UDI flRJ1.BIl< 28 SI',UDI ARABI!. 30 SOMrlLIA 2 SOM,\LIf\ 2 SOMhLI,; 14 ----------------_._.- He "'. 1 th .Sur', ey E:..t~ch D.n,=>:; of L0tt(::r Te am of Exp2rts ------------_. __ ._ ._._- B2.sic Publ i c H<.:J.l th ;.!ld Mc.di cc.1 C::tr" S(.rvic 0s Pla n o f Op~rJ.ti on Sma11y ox Eradicati.on Plc-.n of O;:::"rati. or. Nursinc; i(dviser to t h" Gov" rnm'2nt Exch~"n . .::Eo o f Lett",r Short - tE.I':': Cons].; l t::mt in 1962 to bLJ continu(;d throuGh 1965-1961j M~tL,ri2. Pre- cr 3.c.ic::-.t ion Prc _:;ramme Adcl\o:ndum I t o P1c.n of Oper a tion Supr; l.L;s [:nd Equipm",nt -----------.-- fJic. l c.r i c. PrE- f:: r :ldlc ~:.ti on ilC:d.::!lc'.um II t('l ?::' ~n of O;: ,; r a tion ------- ---.---. ~l C'. l :;,j' :'.,: PrE'- '"rc:di cc.tion Pro,·;r a lllln2 i,dcic:ndur~ .. III to t h .c Ea:. of 0pGrat i on Frov i sio~;. for ::!.ddi t i oD? .. l SUPl;ll i=S 2. ::d Lqui pm0nt i n 1962 fo r- .~ ) 0) 000 -----------_._-------- Public He::'.:. l t I l l\dvisory Se rv lc c:- s Plan of Or~ r ~ tion SOIVI/.Ll;; 18 SOr1i\LI~, 19 SOMr,\LI i, 21 SOIVIALI;:' 22 SUDilN 17 SUDi\,N 22 SUDP.N 28 E,wironm,"nt~_l I-h; ,J.l th ExchQn~)~ of Letter EM/RC13/ 2 f .rLTl8 X II P:"<.:',.; vii Shc rt--:>_r:n Consulto.n t - ",dvisor y sc;rvic:cs to t h<= Gcvcr :-:I;;<en"L SIWt11 pox Contro l 3.n c'_ ~r',di::,ti:m Exc! . .3.n,;(-: of LE.:: t t c r Short- ter m Consuit :=.nt ----------- --- - ---------- r,j3.:lc,::;em<c nt of lVi-odi c'l l Stores 2nd Pharma cy Exchar.c;€ of L()ttcr Sho,'t- te:n-·1 Consul t,~_nC:. Communic ,:bl'o Eye Di s eas,,::; Control ExC(:nn:"':;2 of L8tter Short- ter m Consul t 2.nt J4 al ~~ie Pr~- srndi cet l on Pl~n of OD0rntio~ -- -------------- ,- ----- ----- - -------- Pl an of Ops r ati on Sm2::"lpoz Cont,, ') l and Er O\ c1ica~;i on PL: n of 0 ,: 0 I'2_tion Sm:-:. llpcx CQn tro l ;'!Dd Lr::~dic2.ti on :~ddccdum I to Pl e.n ;) 1"' O~Jt:. .. r[:~i or.:. EMjrtC13/ 2 1',!Ul,; x II ) 11':';0 viii SUD';N 32 SY1UfI SYRI .4 2 SYRIA 2 SYRIA 13 Malari D. Er adi c2tion Traini ~.:.; CGntr~ Pi'lr.. c f o l";c r r: tion - - ------- --- Th e: b"slc fl,.;r e ,:mc:nt bahh;l;fJ th" Government of ~h2 Syrian l\r ab h 8public a nd vmo was oonchlded i ~1 Ne v e:rnb",r 1962 Mal s ri a Erad i ce tion i .ddendum II t o Fl ~'.;l of Operat ion ExtGnc.i n~·· v",liell ty throu:::!1 196 2 ~1e.l e. ri a Er2..dic [~ti on Adde ntlum II I t o Pl an of Op·"r ation School H",,-::l t h Services (F~vus Coritr ol) E~C!1anGe of L2tt~r Sh;)~t- t. c rr.: Consul to.nt -------------- - -._--- SYRIA 30 SYRIA 32 SYRI,', 37 Publ ic n ,,:11 tb and :=:nd0mlc Di sG£'.se s Laboratory Exc:r..an[l~ of L~) t t·~ r Short- t errr. Consu l t an t Blc :oct Ben}:: Ex (::r:.:. nL~ '= of L~ t t, ~:r Shor t - t e rm Ccnsult:::.nt 1Jurs in!-~ Educ D.t i on, D::'!'rJ~ GCUS Pl an of C~~rati 8n TUNISIA 20 TUNISIA 26 ErfJ/RCI3/2 i,nnex II i.,;aC;t:: ix ---.- - - --- -- .-- ._-- ------------ Public I'Lal t ,·! Lo.bDJ' 0. tory Exc ; ·,c.n~· " ::; f I,·.,t t"r Visl t of Short- t-or'l! Consul t -::.nt -- - .---- - - -----. . ------ Produ ct i on of Pha rMa,;,:,ut icals Excha nC8 o f Lc ttcI' Sl-.!. ()rt- t CY'r(; Cr::nsul t~nt - .- -.------.---- TUNISIA 31 'fr &,ining of H82.1 t" 1 Personnel ExchanGe c f L:ttGI' Vi s it of Experts -----_._-_. __ ._------- - .. - ----- - - -- -- ---- UAR- EGYPT 25(E) Uj~n-EGYP'f 27 COl:lr'uni cc'.b l " Eye, Di s iCC.S-:' S Control ,\ dcJ.~ndum III to th ,c Plan of Operat i on EXT."rldin,..; v:.lidi ty throu : ~, De ctOrnber 196 2 Ot'kr- am(:ndments ir: th<" lif.;:h t of new rcquir(; rn·.:r: ts . '-; i .:·::: Insti tut,_, of Public Heal t il .';1 c xandri a :,m21-,clm8nt No . 1 to th, Pl :)':l of 0I_tor-etion Tr,'lLs :f 2f' o f UNIGSF s":.l~pl i ~s to Gov~:,nrnt:nt ---------- - ------- _ .. _-_. -- -_. __ . Uf,R- EGYPf ;;D U;,R- EGYPf 48 Pr E:m"-tur,, Inf:.'.r,t' [; U,1i t ;',m2!~clrnent No . 1 ta t I1 ,c: fL:m of Ope:rat i on 1'nllls f el' of DrE CSF supplies t o Gc,vernmEmt --.----- -----.--- Dru ' COtrLr'ol Lat; ::n·:·t t ory LXC!lan,,:;c: o f Lctt2r Short- t~r~ Con~ul t~nt fellowsh i ps a nd su,pli ~ s -------_._ -_._----_ .- ----.-- - .. ----- ---- Efvl/RC1)/2 Annex II pa.se x -------------- -- - ------ --- - - ------- UAR- EGYPT 49 UAR- EGYPT/UNICEF 2 UAR- EGYPT/UNICEF 5 UAR- EGYPT/UNICEF 6 YEHEN :3 YEMEN 1:' RiEtarziad s Cunt r ol Pilet Pro j ect and Tralning Cerfcr e Amendment No . 1 to t he Plan of Oper ation Transfer of Ti t l e of UNICEF suppli es t o 30vernm.:: nt --- ------ --- - --- -- ---- -- Ma t ernal ar;d Chi Id \1el fare Centre Plan of Oper ation Tub<: rculosis Control (Qalyub) ,\ ddendurn I to the PlaL of Operation Tr ans fer of UNICEF supplie s to Government --- - -------- Nutrit:c o0. Pl'ogr amr.1e 10. Beheira Pr ov i nce Plan of Oner at1on --- ---- ----- - ------- -- ----- Publi c Heal t h Admini " t rdt i on Plan of Operat ion Local neaLU-' cervi ces Pl a:", of Ope!<ltion