Twenty-fifth annual report of the Regional Director to the Regional Committee for the Western Pacific covering the period, 1 July 1974 - 30 June 1975

WPR/RC26/4 WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC TWENTY-FIFTH ANNUAL REPORT (1 July 1974-30 June 1975) OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC TWENTY-SIXTH SESSION WPR/RC26/4 THE WORK OF WHO IN THE WESTERN PACIFIC REGION TWENTY -FIFTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR THE WESTERN PACIFIC , t Covering the period, 1 July 1974 - 30 June 1975 • World Health Organization Regional Office for the Western Pacific Manila, Philippines June 1975 I • The following abbreviations are used in this report: ADB CARE CIDA ESCAP FAO lAEA ILO ISVS SEAMHO SEAMIC SPC UNDP UNESCO UNFPA UNICEF USAID WFP World Bank Asian Development Bank Cooperative for American Relief Everywhere Canadian International Development Agency Economic and Social Commission for Asia and the Pacific Food and Agriculture Organization of the United Nations International Atomic Energy Agency International Labour Organisation International Secretariat for Volunteer Services Southeast Asian Medical and Health Organization Southeast Asian Medical Information Centre South Pacific Commission United Nations Development Programme United Nations Educational, Scientific and Cultural Organization United Nations Fund for Population Activities United Nations Children's Fund United States Agency for International Development World Food Programme International Bank for Reconstruction and Development -ii- - CONTENTS INTRODUCTION ••••••••.•••••••••••••••••••••••••••••••••••••••••. ix 1 2 3 4 PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION STRENGTHENING OF HEALTH SERVICES •••••••••••••••••••••••••• 3 1.1 Planning and management of health services ••••••••••• 3 1.1.1 1.1.2 1.1.3 1.1.4 1.1.5 Country health programming •••••••••••••••••••• Health Planning unit ••.••••••••••••••••••••••• Health planning manual ...•.•..••... 0 •••••••••• Training in health planning and management •••• Advisory services ..•• e,' 0 •••••••••••••••••••••• 3 4 4 5 5 1.2 Organization and delivery of health care ••••••••••••• 6 1.3 Development of health laboratory services •••••••••••• 9 FAMILY HEALTH ••••••••• 0 ••••••••••••••••••••••••••••••••••• 10 2.1 Maternal and child health and family health •••.•••••• 10 2.2 Nutrition ....••..•...........• 0............ .......... 12 2.3 Health education .......................••............ 13 HEALTH MANPOWER DEVELOPMENT ••••••••••••••••••••••••••••••• 15 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Hea 1 th man p owe r p lann iog ..•..•.•.••..•..•..•.•..•••.• Training of auxiliary health personnel ••••••••••••••• Educational methodology and technology ••••••••••••••• Direct assistance to countries ..•.....•.•..••.••••••• Fellowships programme .....................•.......... Inter count ry progranmles ••••.•.••••••.••.••••.••..••.• Group educational activities .......•.•••.•..•••.....• 15 15 16 16 18 29 29 COMMUNICABLE DISEASE PREVENTION AND CONTROL ••••••••••••••• 30 4.1 Epidemiological surveillance of communicable diseases ................. 0 ••••••••••••••••• Q • • • • • • • 30 4.2 Malaria.............................................. 31 4.2 .1 General review ................................ 31 4.2.2 Progress of work in the malaria projects •••••• 32 4 • 2 • 3 Prob lerns •..•.....••....•........•.•........... 39 4.3 Parasitic diseases other than malaria •••••••••••••••• 41 4.3.1 4.3.2 Filariasis Amoebiasis .................................... .................................... -iii- 41 42 5 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.3.3 4.3.4 CONTENTS Common intestinal helminthiasis ............................. Schistosomiasis ........ 0 ..................... 0 ......................... .. Smallpox eradication ••••••••••••••••••••••••••••••••• Bacterial diseases .••••••.••••.••••.•••••• 0 •••••••••• 4.5.1 4.5.2 4.5.3 4.5.4 4.5.5 Cholera •.•.....•.•••. 00 •• 0 ••••• 0 ••••••••••• 0 •• Plague ... D ... 0 ..................... 0 .......... 0 .. 0 ........ 0 0 ...... 00 .... .. Enteric fever (typhoid/paratyphoid fever) "'00 Diptheria. pertussis and tetanus ••.••••••••••• Streptococcal infections ..•••• 0 •••• 0 •••••••••• Mycobacterial diseases 4.6.1 Tuberculosis ................. ,. .... 0 ......................... 0 ...... .. 4.6.2 Leprosy ......•••••• o •••••• o ••••••••••••••••••• Viral diseases ..................... 0 .................................. 0 ..... . 4.7.1 4.7.2 4.7.3 4.7.4 4.7.5 4.7.6 4.7.7 4.7.8 Poliomyeli tis ....................................... 0 ................. <) Japanese encephalitis ••••.•...•.••••.•.•.••••• Dengue fever/dengue haemorrhagic fever •••.••.. Measles ................................................................. .. Hepatitis A (infectious hepatitis) ................. COl luf luenza ...... ,. ......................................................... .. Rubella ......... 0 .. G ............................... .. Korean haemorrhagic nephrosonephritis (Korean haemorrhagic fever) •••••••••••••.••• Venereal diseases and treponematoses •••••••.••••••••• Veterinary public health ••••••••.•••••••••••••••••••• Vector biology and control .•••••••.••••.••.•.•••.•••• 4.10.1 Vector control in general ••••••••••••••••••••• 4.10.2 Aedes aegypti survey and control •••••••••••••• 4.10.3 Vector control training ••••••••••••••••••••••• NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL ••••••••••. 5.1 5.2 5.3 5.4 5.5 Cancer •. 0 ••••••• 0.0 .................. Q ................................ .. Cardiovascular diseases ••••••••••••••••••••••••••••.. Metabolic diseases .... " ............................................... .. Dental health ... 0 ..... G • • ," .... o ................................ . Mental health ............................ 0 ... 0 ...................... . 5.5.1 Prevention and control of alcoholism 42 42 42 43 43 43 43 44 44 45 45 47 48 48 49 49 49 49 50 50 50 50 51 51 51 51 52 52 52 52 53 54 54 and drug dependence ...................................... 0 .. • .. 55 5.6 Biomedical aspects of radiation ••••••••••••••• 0...... 55 -iv- - " - 6 7 8 9 CONTENTS PROPHYLACTIC AND THERAPEUTIC SUBSTANCES 56 6.1 Specifications and quality control of pharmaceutical preparations •••••••••••••••••••••••• 56 6.2 International standards for biological products ........................................... 56 6.3 Health laboratory technology •••••••••••••••••••••.••• 57 PROMOTION OF ENVIRONMENTAL HEALTH 58 7.1 Provision of basic sanitary measures •••••••••••...••• 59 7.2 Pre-investment planning ..•...••.••••.•............... 60 7.3 Control of environmental pollution and hazards ••••••• 60 7.4 Health of working populations •••••••••••••••••••••••• 61 7.5 Establishment and strengthening of environmental health services and institutions •.•••••••••••.•••.• 62 7.6 Food standards prograIImle .:........................... 62 DEVELOPMENT OF HEALTH STATISTICAL SERVICES ••••••••••••••.• 63 COOPERATION WITH OTHER ORGANIZATIONS ••••••••••••.•••••.•.• 64 9.1 Cooperation with the United Nations and related agencies ..........................•........ 64 9.1.1 9.1.2 9.1.3 9.1.4 9.1.5 9.1.6 9.1. 7 9.1. 8 9.1. 9 9.1.10 Economic and Social Commission for Asia and the Pacific (ESCAP) ••••••••••••••. Mekong Committee, Bangkok ••.••••....•••••••.. United Nations Development Programme (UNDP) •. United Nations Fund for Population Activities (UNFPA) .......•.........•....... Food and Agriculture Organization (FAO) •••••• International Labour Organisation (ILO) •••••• United Nations Children's Fund (UNICEF) .•.••. United Nations Educational, Scientific and Cultural Organization (UNESCO) ••••••••• International Bank for Reconstruction and Development (World Bank) .•.•••••••••••• World Food Programme (WFP) ••..•••..••..•...•. 64 64 65 66 66 66 67 68 68 68 "9.2 Cooperation with intergovernmental organizations ••••• 68 9.2.1 9.2.2 Asian Development Bank (ADB) ••••••••••••••••• South Pacific Commission (SPC) •••••••.••••••. 68 68 9.3 Cooperation with other organizations ••.•.••.••••••••• 69 9.3.1 9.3.2 Southeast Asian Medical Organization (SEAMHO) Southeast Asian Medical and Health Information 69 Centre (SEAMIC) ............................ 69 -v- CONTENTS. 9.4 Other joint work 69 10 CONSTITUTIONAL, LEGAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS •••••••••••••••••••••••••••••••••••••••••••••• 70 10.1 The Regional Commit tee ••••.•.••••.•••..•.••••.•••••. 70 10.2 Regional Office ..................................... 72 10.2.1 Organizational structure .•••.•.....••.••..•. 72 10.2.2 Salaries and allowances ••••••••••••••••..••• 72 10.2.3 Regional Office building •.••.•.•••.••.•••.•. 72 10.2.4 Regional obligations and expenditures •••.••• 74 11 PUBLIC INFORMATION •.••...•••••..•••.••.••.••...••••.....•. 77 12 WHO PUBLICATIONS ••••.••••••.•••••.••••••••••.••••..•••...• 78 '- PART II. EVALUATION SUMMARIES OF SELECTED PROJECTS MATERNITY-CENTRED FAMILY PLANNING, PHILIPPINES (PHI MCH 002) ••. 83 TRAINING IN THE FIELD OF HEALTH PLANNING (ICP SHS 003) 87 TEACHER TRAINING CENTRES FOR HEALTH PERSONNEL (ICP HMD 007) •.•• 92 REGIONAL TUBERCULOSIS COURSE (ICP MBD 002) •••••••...•...•.....• 98 PART III. PROJECT LIST PROJECTS IN OPERATION FROM 1 JULY 1974 TO 31 MAY 1975 •.•••••..• 104 ANNEXES 1 STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC ON 30 JUNE 1975 ........................... '145 2 TRANSLATED WHO PUBLICATIONS ~SSUED BY OTHER PUBLISHERS IN THE WESTERN PACIFIC REGION •••••••.•.••••.•.. 147 -vi- CONTENTS. TABLES AND GRAPHS NUMBER OF FELLOWS BY COUNTRY, 1 JUNE 1974 - 31 MAY 1975 19 BREAKDOWN OF SOURCES OF FUNDS FOR FELLOWSHIPS AWARDED FROM 1 JUNE 1974 - 31 MAY 1975 ••••..••.••.••••••••••••••••••••• 21 TYPES OF STUDIES ARRANGED, 1 JUNE 1974 - 31 MAY 1975 ••••••••••• 21 PROFESSION OF FELLOWS, 1 JUNE 1974 - 31 MAY 1975 ................. 23 FIELDS OF STUDY OF FELLOWS, 1 JUNE 1974 - 31 MAY 1975 .......... 25 PLACES OF STUDY OF FELLOWS, 1 JUNE 1974 - 31 MAY 1975 27 TABLE OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION, 1950-1974 ••••••••••••••••• 75 GRAPH OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION, 1950-1974 ••••••••••••••••• 76 '-' -vH/viii- INTRODUCTION As in last year's Annual Report, accomplishments, problems encountered and future action to be taken are presented under the major programme headings. Strengthening of Health Services Accomplishments Highlights of the progress made in health planning and management included the establishment of a Health Planning unit in the Regional Office and the commencement of country health programming in Laos. The Health Planning unit serves as the technical secretariat of the Regional Programme Committee, coordinates the planning and evaluation of regional programmes, and assists in the formulation and management of projects within the framework of these programmes. The unit is also able to assist in studies to improve health care delivery systems and in monitoring the information needed for planning and managing national programmes. Country health programming, introduced in Laos for the first time in the Region, is a pragmatic exercise in planning developed by WHO, intended to be carried out by national authorities themselves. The experience gained in Laos will be of value in introducing the same approach to planning in other areas of the Region. Increasing attention has been paid to ensuring that ,delivery of health services extends to greater numbers of the population, particularly at the periphery. In a number of countries new categories of health auxiliary have been established to render primary health care, and numerous operational studies are being pursued to maximize the performance of existing health personnel and services. Efforts have also been made to ensure more active participation of local groups in community health, to improve existing health insurance schemes, in the Philippines for example, and to conduct pilot studies, in the Republic of Korea for example, on the introduction of such schemes as an integral part of the health care system. Some progress was achieved in strengthening national health laboratory services at central level. Consideration was also given to expansion of laboratory services at the periphery. The programme for improving the quality of laboratory services was maintained, through visits by WHO advisers, participation by countries in proficiency testing programmes in the fields of venereal disease serology and biochemistry, and refresher courses for laboratory staff conducted with the assistance of WHO. The Fiji School of Medicine developed its programme for training laboratory technicians from the South Pacific area. In support of the WHO expanded programme on immunization, assistance was provided to countries desiring to expand vaccine production and to maintain or improve the quality of their products, especially smallpox vaccine. -:i".x- Problems and what needs to be done The constraints in accelerating progress in delivery of health services are, basically unfavourable attitudes, inadequately trained manpower, and low health budgets. Traditional, life-long attitudes and practices among populations and in the health services themselves frequently impede efforts to introduce meaningful changes. There is a lack of professional and auxiliary health manpower in many countries, while insufficient provision for refresher training and the absence of work incentives contribute to lower standards of performance. Most developing countries are primarily concerned with rapid economic development which partly explains why many national health budgets remain static and do not keep up with population growth. It is evident that a concerted and sustained programme of education should be developed for the general population, national officials and health workers. The population must be made to participate directly in safeguarding community health, since it is the individual himself who has primary responsibility for protecting his own health. National officials, too, must not only recognize the value of health for its own sake but also its economic value in terms of national development. In the main, the technical and administrative means for strengthening health services already exist. They must, however, be continuously adapted to local needs and improved further in the course of operation of health services. In addition, basic and refresher training need to be given further impetus to build up the skills necessary for expanding national health care services. There is a continuing need for greater support in the development of health laboratory services, in particular horizontal coordination and collaboration with other divisions of health departments. The establish- ment of national health laboratory advisory committees, bringing together users of laboratory services, should be encouraged. To increase coverage, promote coordination and possibly provide increased services at less cost, consideration must continue to be given to expanding laboratory services at the periphery and staffing them with a medical laboratory assistant who is a mUltipurpose microscopist. Lack of adequately-trained senior officers, skilled in organization, administration, supervision and management of health laboratory services, remains a problem. Governments are urged to provide better incentives to keep highly trained individuals in the service. Additional training in management and logistics would also be advantageous, particularly if health laboratory services are to be expanded and extended to the periphery. The training given to other categories of laboratory personnel, including laboratory assistants, needs to be reviewed with a view to providing adequate basic and refresher courses which meet local requirements and are able to be implemented. Since the quality of laboratory services provided depends on accuracy of examinations carried out, participation in proficiency testing and training programmes remains essential for improvement of national quality control programmes. -x- - - Governments able to produce their own vaccines are urged to ensure their quality and to consider increasing production in order to cover the total population at risk. Family Health Accomplishments Family health, a major component of primary health care programmes, continued to be an area of key concern. A major challenge for all those concerned with delivery of health care was development of means to extend essential primary health services to under-served rural areas. Efforts were made to rationalize resources, promote systematic approaches and encourage community participation to improve both the quality and the extent of family health care. The maternity-centred family planning project in the Philippines was an example of this approach. While some governments in the Region have been endeavouring to extend basic maternal and child health care to the under-served population others are in the position to render specialized care through highly qualified personnel. The development of national expertise in nutrition continued slowly but steadily, enabling more specific and detailed activities to be undertaken in several areas. The workshop on the teaching of nutrition in schools of medicine enhanced this progress. Integration of health education in all health programmes continued to receive emphasis. A new trend was the development of efforts in health education, in accordance with sociological concepts, from the very early planning stage of community~based health programmes. Stress was placed on collaboration between health and welfare workers from all agencies at community level. Problems and what needs to be done There is growing realization that despite continuing efforts to provide family planning advice as part of maternal and child health services, the emphasis on limitation of family size has been greatly affecting the role played by health personnel, especially nurses and midwives, in providing general maternal and child care. This may in some instances lead to deterioration in the quality of maternal and child health services. Work still remains to be done in extending the services to cover a larger portion of the popUlation. Continued efforts must therefore be made to promote general maternal and child health care at the periphery through health workers simply trained for the task, rather than attempt to develop specialized systems applicable only to selected groups. An integrated approach is essential in nutrition, as it concerns several professional disciplines. To achieve coordination, the importance of national food and nutrition policies must be recognized, and the laborious multidisciplinary task of formulating them undertaken. -xi- Though support in training health educators and teachers of health education will continue, increased emphasis must be given to the development of simple and practical methods for training other health workers in the community approach and health education of the public. Health Manpower Development Accomplishments One of the most effective methods found for teacher preparation in terms of quality and quantity has been the WHO-sponsored regional teacher- training programme conducted at the Regional Teacher-Training Centre, University of New South Wales, Sydney, which began operation in 1973. Senior educators of health training institutions, as well as WHO staff, have participated in several workshops at the Centre. There has been a rapid positive response in setting up national teacher training centres, first in the Republic of Korea and shortly thereafter in the Philippines. Plans have also been finalized for a Master's programme in health personnel education, due to commence in mid-1975 within the University of New South Wales. The new building for the National Institute of Public Health in Saigon was completed and the inauguration ceremony held on 3 March 1975. The building comprises classrooms, offices, a laboratory block and an auditorium. Postbasic and postgraduate courses for health personnel were strengthened in many countries, including Fiji, Malaysia, Papua New Guinea, Philippines, Republic of Korea, Singapore and Western Samoa. Medical undergraduate and basic nursing education programmes were also strengthened in several countries. An agreement was signed by the Royal Government of Laos, the Claude Bernard University, Lyons, France, and WHO, under which the University will provide teachers in various disciplines for short courses at the Royal School of Medicine, Vientiane. It is expected that this will go a long way towards facilitating the procurement of suitably qualified staff for the School. Participants in the meeting of directors or representatives of schools of public health emphasized the need for a closer relationship between those engaged in the delivery of health services and those responsible for health manpower development. The regional seminar on medical assistants provided an excellent opportunity for exchange of information on the use of this category of health worker within the Region, an important development having been the decision of Fiji to train such personnel. As in previous years the provision of important part of the regional programme. 415 individual fellowships were awarded. 1 fellowships has formed an During the period under review lFor details see Part I, Section 3, pp. 18-28. -xii- Problems A major problem in most countries of the Region is lack of a national health manpower policy upon which to base long-term plans for the development and utilization of staff. There is also a dearth of factual data on health manpower needs. Confusion regarding the titles given to different categories of health personnel and absence of precise definitions of duties to be performed are frequently encountered, resulting in poor utilization of health workers trained. In several countries, the number of different categories of health worker, particularly at the auxiliary level, adds to the problem. While WHO assistance in preparing national staff and developing courses relevant to national needs has been given to many health training institutions, progress has been relatively slow. Inadequate provision for continuing education of health workers has also been a common serious problem. What needs to be done Ministries of Health, as consumers of health manpower, need to become more involved in planning and developing curricula for the training of various categories of health worker to ensure that training programmes are relevant to needs. It is important also that health manpower plans be fully-developed components of national development plans. Continued support needs to be given to developing the programme of the Regional Teacher-Training Centre. Countries where national teacher- training centres are being set up will also require support for some time to come. Closer links need to be forged between teacher training programmes per se and development of health services. Efforts must be exerted to see that programmes are of a multidisciplinary nature and involve all categories of health worker. Utilization of the WHO fellowships programme must be further improved, with particular attention being paid to the placement of fellows after their return from study. Communicable Disease Prevention and Control Accomplishments Technical guides on clinical and laboratory diagnosis, prevention and control of epidemics, and epidemiological surveillance of dengue haemorrhagic fever, formulated by the WHO Technical Advisory Committee at its first meeting in March 1974, have been distributed. The second meeting of the Committee, held in February 1975, reviewed the current situation and prepared revisions to the guides. WHO advisers assisted governments, particularly during the recent outbreaks in the South Pacific area, in the control of vector mosquitos. Consultant services were provided in clarifying the epidemiology of enteric infections, diphtheria, pertussis and tetanus, in evaluating a World Food Programme-assisted schistosomiasis control programme, and in -xiii- advising on the organization of epidemiological services. More attention was given to strengthening epidemiological services and surveillance and training personnel in epidemiology. Countries were encouraged to intensify their programmes of immunization against the more common communicable diseases, for which effective immunizing agents are available. BCG vaccination continued to be emphasized in the Region. It is expected that coverage will be extended to greater numbers when the UNICEF-assisted BCG vaccine production unit at Alabang Laboratory, Philippines, becomes fully operational. The WHO Regional Tuberculosis Control Team continued to render technical support in the various tuberculosis programmes under way. In cooperation with the United States Public Health Service and the Governments concerned, a study to determine the prevalence of tuber- culosis and leprosy in American Samoa and Western Samoa, where different methods of control are utilized, was initiated. Malaria continued to lose ground in most of the northern, central and southern parts of the Region. The whole of Peninsular Malaysia was brought under the malaria eradication programme, with additional areas entering the consolidation phase. Vigilance operations continued in countries or areas where malaria has already been eradicated. There was a modest but meaningful expansion of antimalaria activities in Laos, made possible by increased international and bilateral assistance. In the South-West Pacific considerable progress was made with the eradication programme in the British Solomon Islands Protectorate where a number of persisting foci of transmission were eliminated and the overall incidence was brought down sharply. In Papua New Guinea problems are ofa different magnitude and progress was necessarily slow; however, the manpower situation is gradually improving. The programmes in both countries continued to receive highest priority and substantial outside assistance. Problems and what needs to be done It is disheartening to note that despite efforts and investments, year in and year out, communicable diseases remain major public health problems, particularly in the developing countries of the Region. The same situation prevails in other Regions, and for this reason the control of communicable diseases is one of the priorities in WHO's programme of work. Diphtheria, tetanus, pertussis and tuberculosis are still prevalent in the Western Pacific Region. In addition, the helminthic infections, among them ascariasis, ankylostomiasis, paragonimiasis and taeniasis, remain as public health problems. Malaria and schistosomiasis still pose problems as deterrents to rural development. A resurgence of enteric infections, such as typhoid fever, and of sexually-transmitted diseases, has been observed. Outbreaks of dengue fever/dengue haemorrhagic fever have become common during the past three years. Unfortunately, basic epidemiological information regarding many of the communicable diseases in developing areas is lacking. One of the objectives of the programme. in the Region is therefore to strengthen -xiv- .... -- epidemiological services and surveillance mechanisms, though statistical and laboratory support of this activity ,in a number of countries also need to be further improved. The first requirement is an analysis of existing staff resources and determination of what staff will be needed in the future to be responsible for epidemiology. The shortage of medical officers trained in epidemiology is a continuing problem. The need to establish postgraduate or special courses in epidemiology within the Region is under study. Although allied health personnel are involved in epidemiological activities, their training often does not prepare them adequately for this work. Such preparation is particularly important as they often remain in the same services and positions for longer periods than medical officers (for example, epidemiologists), and can therefore help to ensure continuity. The potential of institutions for training staff at this level in epidemiology merits further study. Considering the gratifying results obtained from the Organization's smallpox eradication programme, there is a need for Member States to accelerate immunization against diphtheria, pertussis and tetanus, tuberculosis, poliomyelitis and other diseases for which effective immunizing agents are already available. Countries capable of producing greater quantities of potent and effective vaccines than they require themselves may wish to consider assisting their more needy'neighbours through donations. Meanwhile, more effective and easily administered vaccines must be developed. A major constraint in the implementation of control programmes is lack of funds. The provision of adequate and safe water supplies, improvement of waste disposal, application of insecticides, all need sizeable investments. The search for effective, simple and cheap measures against the more common communicable diseases must therefore be continued. To this end the greater involvement of the Region in research might enable concerted efforts to be made. In communicable disease control, there is still a need for greater coordination and cooperation, not only with the basic health services but also with other organizations and agencies involved in overall development. Efforts made by other agencies could be more effective in the control of certain diseases such as schistosomiasis, in which agricultural, and especially irrigation and drainage, agencies can play an important role. The need for community involvement in disease control, or for that matter any health activity, is again emphasized. Health education is necessary for this purpose. However, although lip service has been paid to this activity, little has been achieved and it is timely that it be made more practical, effective and extensive. The future of the antimalaria programme in areas where the disease remains a major public health problem, such as Cambodia, Laos, Papua New Guinea and South Viet-Nam, depends to a large extent on support provided by the governments involved and the assistance available from external sources, including the development of adequate technically- qualified health manpower with managerial capabilities. -xy- Some of the technical problems encountered are interwoven with operational difficulties, the solution of which will require a multi- disciplinary approach and increased support, particularly from the rural health services. A thorough orientation on malaria of the staff of the health services will also be necessary. At the same time the community to be served should be more closely involved. In the meantime, attention should be paid to resolving some of the technical and operational difficulties through specific research. Non-communicable Disease Prevention and Control Accomplishments In the field of dental health, WHO has advocated delegation to dental auxiliaries of duties that are repetitive in nature, so that dentists have more time for clinical duties. Courses in specific areas, such as dental technology and dental therapist training, were supported. Further encouragement was given to fluoridation of water supplies and, where this was not practicable, alternative methods of reducing the prevalence of dental caries; for instance, the use of topical fluorides in existing school toothbrushing programmes was encouraged. In pursuance of resolutions adopted by the twenty-third and twenty- fifth sessions of the Regional Committee, various activities, mainly in the Philippines and South Virt-Nam, were initiated in the field of drug dependence and alcoholism. A working group on measures for the prevention and control of drug abuse and dependence, convened in December 1974, formulated a strategy for a balanced programme to combat this growing problem. In the past, cardiovascular diseases, cancer and metabolic diseases were mainly prevalent in the developed areas of the Region. A review of available statistics has now indicated that, even in developing countries, these diseases are becoming significant causes of mortality. They therefore represent an additional burden on already overburdened health care facilities. A number of countries have not only become aware of the medical uses of radiation and radioisotopes but also have taken action to expand their activities in this field. Lack of supporting services due to the scarcity of qualified physicists, engineers and radiological technicians has been a major constraint. However, improvements have been initiated in radiation dosimetry in a number of countries, and due attention has been given to radiation hazards and the need to build up national radiation protection programmes. Problems and what needs to be done One great danger in initiating measures to control cardiovascular and metabolic diseases and cancer is the possibility that the interest and attention of authorities providing funds for control of these 1 . Resolution WPR/RC23.R8, Handbook of Resolutions and Decisions of the Regional Committee for the Western Pacific, 1974, 8th ed. section 1.7.4, page 109; resolution WPR/RC25.R3, Report of the Regional Committee, twenty-fifth session, 1974, Part IV, page 31. -xvi- - , .- -- diseases might be focused on the provision of highly sophisticated hospitals and medical centres for the diagnosis and treatment of a few cases at great cost. A community approach is likely to be more effective wherein, after a careful epidemiological analysis of the nature and extent of the problem, the causes are established and attention is paid to prevention through greater involvement of the health services. The care and maintenance of X-ray and other medical and laboratory equipment continues to be a major problem, particularly in the developing countries, because of rapid deterioration due to climate, lack of spare parts and planned repair services, and shortage of trained personnel. Although some improvements have been made, this programme needs more active government support. Promotion of Environmental Health Accomplishments Long-term cooperative projects were operational in 13 countries. In the Philippines, WHO became the executing agency for UNDP-assisted comprehensive water quality management studies, a new type of project. Consultant services were provided to 10 countries, in areas ranging from water supply and sewerage studies to environmental health manpower development studies. Problems and what needs to be done Since problems are created by constraints whose removal is a slow process, there has been no appreciable change compared with previous years. In several cases, institutional overlap contributed to ineffective utilization of already scarce resources. WHO cooperative programmes can only have a catalytic and guiding function. The ultimate responsibility for action rests with governments, who have to define priorities, establish institutional and legal control and provide resources in terms of budget, manpower, facilities and equipment. Governments have several options in approaching environmental issues. One option is to make concentrated efforts in given sectors, such as community water supply. Another option is to launch comprehensive environmental health programmes as part and parcel of broader development objectives related, for instance, to agriculture, industry, tourism or human settlements. Development of Health Statistical Services Accomplishments Collaborative efforts between governments and WHO have given particularly encouraging results in developing services for health records and health statistics in the countries and territories of the South Pacific. In Malaysia, the Republic of Korea and South Viet-Nam, the WHO-assisted health statistical projects continued to provide technical support in national disease surveillance. National health statistical units extended their activities to include the collection of additional health information needed by national health administrations in the planning, management and evaluation of their health programmes. -xvii- Problems and what needs to be done The shortage of trained staff for national health statistical units and the incomplete and inaccurate nature of the present health statistical returns from the general health service are the main difficulties faced in developing services in many countries. In seeking to remedy these shortcomings, further cooperation from the private health sector is needed in many cases. As it will take time to remedy these problems, supplementary, and perhaps more accurate, information can in the meantime be obtained by conducting small-scale ad hoc statistical surveys on certain health problems in preparation for large-scale programmes. Statistical units must be linked more closely with both epidemiological and planning services to provide a stronger basis for comprehensive monitoring and processing of information needed by national health administrations. * * * On 14 May 1975 the Democratic Republic of Viet-Nam and the Kingdom of Tonga were admitted as Members of WHO by the Twenty-eighth World Health Assembly. They are most welcome in the Western Pacific Region. -xviii- , - Prime Minister Tun Abdul Razak addressed the opening ceremonies of the twenty-fifth session of the WHO Regional Committee for the Western Pacific in Kuala Lumpur. He is shown in top photograph greeting Dr R.W. Cumming, Australia. Others in the photograph are from left: Dr Chen Hai-Feng, chief representative, People's Republic of China; Dr Glyn Howells, chief representative, Australia and Dr Francisco J. Dy. Lower photograph, Dr Dy delivering his speech at the opening ceremony. -PART I. GENERAL STATEMENT OF ACTIVITIES IN THE REGION .- 1 STRENGTHENING OF HEALTH SERVICES 1.1 Planning and management of health services WPR/RC26/4 page 3 Notable developments during the year were (i) the introduction of country health programming in Laos; (ii) the establishment of a health planning unit in the Regional Office; and (iii) the preparation of a health planning manual for review by a panel of experts with a view to eventually distributing it to Member States in the Region. Activities also continued in the training of national health staff and the provision of advisory services in planning and management. 1.1.1 Country health programming It has already been stated that in the Organization's concept of country health prog~amming, the main emphasis is on the identification of priority health problems for which realistic programmes can be set up. In Laos, although agreement in principle between the Government and the Organization was reached early in 1974, country health programming could not commence until the Coalition Government had been set up and had declared its new policies. On 11 December 1974, the Prime Minister, as President of the Council of Ministers, issued a decree delegating responsibility for country health programming to the Minister of Public Health, the Minister of Finance and the Secretary General of the Government. The Prime Minister also established a national committee for country health programming under the direct responsibility of the Minister of Public Health, the Neo Lao Hak Sat (Pathet Lao) and the resource allocation agencies, that is, the Ministry of Finance and the Ministry of Planning and Coordination. The committee was set the task of producing a coordinated health plan consistent with national health policy. A team of WHO advisers consisting of an expert in health planning and a health economist under the WHO Representative, assisted the committee in the initial task of assessing the country health situation and the resources available for health. This first stage was carried out in January and February 1975 and culminated in a report submitted by the committee to the Government for review. The second stage, which commenced in April 1975, will lead to health programme proposals which. if accepted by the Government, will be incorporated in the five-year overall economic development plan for Laos. Except for the health economist, who has been replaced by the technical officer of the Regional Office Health Planning unit, the WHO advisers remain the same for the second stage as for the first. The country health programming exercise in Laos is the first to be undertaken in the Western Pacific Region, although there have been similar exercises in countries of other WHO Regions. WPR/RC26/4 page 4 1.1.2 Health Planning unit Although it had existed on a probationary basis since 1973, the Health Planning unit, because of lack of necessary technical staff, could not be formally established until October 1974. The unit renders consultative services to governments upon request. In the Regional Office, it serves as technical secretariat of the Regional Programme Committee in the formulation of programmes of assistance, and takes part in evaluating them. It helps regional and field staff upon request in the planning, management and evaluation of programmes and projects. It carries out special studies and reviews and provides technical support in operational research procedures, with particular reference to increasing the effectiveness and efficiency of health service delivery. A more recent activity has been preparation of the contribution of the Western Pacific Region to the Sixth General Programme of Work for a Specific Period (1978-1983) of the Organization as a whole. Beginning in 1975, the unit will playa more active role in the regional course in national health planning, held in collaboration with the Institute of Public Health, University of the Philippines and country health planning courses, conducted in response to requests from individual governments. 1.1.3 Health planning manual A draft health planning manual was prepared by the teaching staff of the regional course in national health planning. It was intended originally for the purpose of instruction on 'planning; then, as experience grew, it was adapted to the special needs of the developing countries in the Region. In order to obtain an objective appraisal of the contents and suitability of the manual, it was decided to invite an expert panel to review it. The panel, which met in Manila from 17 to 28 February 1975, consisted of a public health administrator, a development economist and an expert in health planning, the latter two being seconded by the Asian Institute for Economic Development and Planning, Bangkok and the WHO Regional Office for the Americas, Washington. It found that the draft manual represented an advance over other treatments of health programme planning, in that (a) it was concerned with inputs and parameters derived from the policy making level of the system; (b) an effort was made to articulate programme planning to project management; (c) consideration was given to the possibility of incorporating planning for individual problems into a coherent overall framework; and (d) it acknowledged the availability of knowledge at least partially tested through training courses. In considering the entire scope of national health planning, from analysis and orientation of the system at one extreme to the management of health development projects and rationalized service delivery at the WPR/RC26/4 page 5 other, the panel noted that less attention had been paid to political and intersectoral interaction with the health system, and to the required analysis of the system as a whole. The panel recommended that programme planning be regarded initially as a worthwhile contribution to health administration in countries of the Region, perhaps leading in some instances to improvement in other sectors. Subsequently, steps could be taken for more extensive planning of health system reform, strengthening of health services and improved intersectoral cooperation for development. The draft manual is now being revised in accordance with the recommendations of the panel. When finalized, it will be used in the health planning courses and distributed to Member States in the Region. 1.1.4 Training in health planning and management The seventh regional course on national health planning started in Manila in June 1975. An objective is further to strengthen the curriculum adopted at the sixth regional course, held in Manila from io June to 16 August 1974, which incorporated the concepts underlying country health programming and project formulation and management into the framework of national health planning. Unlike previous years, the Institute of Public Health, University of the Philippines, is assuming more technical and administrative responsibilities for the course. In line with the policy of assisting governments, on request, in arranging courses in health planning a national course was completed in the Republic of Korea. The language employed was Korean and the teachers were staff of the School of Public Health, Seoul National University, who had earlier participated in one of the WHO regional courses in Manila. The teaching material used was for the most part contributed by WHO and translated into Korean. Towards the end of the course, two seminars were organized with the assistance of two advisers from the Regional Office. An evaluation revealed sustained interest on the part of the participants, who expressed a desire to be kept up to date in the field of planning, through refresher courses and the provision of current literature in health planning and management. Negotiations were started with the University of the Philippines to take over full responsibility for future regional courses in national health planning with WHO providing technical and material support as might be needed and meeting the cost of attendance of participants nominated by Member States in the Region. 1.1.5 Advisory services In the Philippines, technical support was given in connexion with the second phase of operational research in health care delivery, involving supervision, logistical support and information monitoring. WPR/RC26/4 page 6 In the Republic of Korea. assistance was given in preparing a plan of work to be carried out in the pilot area in Yong-in Gun. Kangwon Province. In Tonga. WHO consultant services were provided to help in formulating the health component of the Third Four-Year Development Plan. The objectives under the proposal for the health component were to reduce the natural growth rate of the population, to bring to a lower level preventable and reducible conditions, including communicable diseases, and to improve the organization and administration of health services and basic sanitation, including rural water supplies, with particular attention to pollution of the shoreline. Two consultants made two visits to assist Western Samoa in preparing its Third Five-Year Economic Development Plan (1975-1979). They commenced by helping to make a situational analysis, identifying problem areas, and preparing a procedural guide for formulation and submission of project proposals under the Plan. In addition to the specific activities in the project proposals, general measures were advocated, to ensure clarity, cohesion and balance in the health component of the Plan. Later they helped to finalize the health component of the Plan and organize a Health Planning and Information unit in the Ministry of Health. The objectives of the health plan were to lower the incidence of communicable diseases, particularly waterborne diseases. and to improve the nutritional status of vulnerable groups in the population (pregnant mothers, babies and infants), health knowledge and hygienic practices. 1.2 Organization and delivery of health care Emphasis continued to be given to the delivery of basic health services, particularly in relation to extended coverage, increased utilization, active community involvement, training and retraining of health manpower, and supervision with a view to improving the organization and operation of health services at all levels. Attention was paid to strengthening the role of the physician as the manager of a multidisciplinary team and encouraging him to delegate to other health workers those tasks that do not need his particular skills. Assistance was provided in specialized fields such as psychiatric, occupational health and community health nursing for specific groups and within the framework of tuberculosis control programmes. In the British Solomon Islands Protectorate, Laos, Philippines, Republic of Korea and Western Samoa, where either a sanitary engineer or a sanitarian is assigned in a general health services development project, priority areas of activity continued to be the improvement of water supplies and excreta disposal, solid waste management, food handling and staff development. In Australia, a WHO public health nurse assisted the medical consultant assigned by the Government in advising on the development of WPR/RC26/4 page 7 community health services for the aboriginal population in the Northern Territory. In the British Solomon Islands Protectorate, the Medical Review Committee made important recommendations concerning the structure of the Medical Department and methods for handing over some staff functions to local councils. If the recommendations are approved by the Legislative Assembly, the basic health services project will be of active assistance in implementing the changes envisaged. During the period under review particular attention was paid to the functions of the district health services and rural health units. With the assistance of the WHO public he::1.lth nurse/midwife of the intercountry public health advisory services pruject, plans were implemented to use a rural area in North Malaita as a teaching and demonstration centre to upgrade the services given in the clinics and provide realistic experience in public health nursing for student nurses and midwives. A WHO consultant assisted Brunei, and another assisted Tonga, in extensively revising and updating their more important health legislation. Activities under the rehabilitation of the physically handicapped project in Cambodia, made excellent progress despite difficult conditions. In the first phase, the National Rehabilitation Centre was equipped and national staff were employed. The establishment of physiotherapy and orthotic services in theHSpital d'Amitie Khmero-Sovietique (AKS Hospital) was completed, and personnel were selected. The second and third phases of construction of the Centre also progressed satisfactorily. Candidates were selected for a one-year course of training as physiotherapy auxiliaries. Training and service work in prosthetics and orthotics at the Centre commenced, and activities in a sheltered workshop were extended as part of the vocational rehabilitation programme. The WHO adviser in hospital administration continued work in the organization of medical care. Due to the emergency situation, project activities were adapted at the request of the Government to meet the current needs. Initially, progress was made in improving a ward in the AKS Hospital. Later, emphasis was placed on strengthening the functioning of dispensaries in Phnom-Penh with the technical assistance of WHO and material assistance from UNICEF, CARE and CIDA. Two WHO nurses were assigned for a brief period and a WHO consultant was recruited to assist in planning and implementing management logistic arrangements. Four Cambodian doctors were employed by WHO to work full time in the dispensaries. A WHO nurse nutritionist was assigned during the planning phase, which included the operation of feeding centres for malnourished children in addition to the normal activities of the dispensaries. Assistance was given to Fiji in the field of nutrition through the intercountry public health advisory services project. Areas of mal- nutrition were defined, causes were investigated and recommendations were made on the corrective measures to be taken. A survey was made of health manpower, with particular reference to the need for training medical assistants. A nurse manpower study was also carried out. WPR/RC26/4 page 8 In Laos, activities continued in health centres and subcentres of the health zones. The draft of the manual for health zones was completed. Assistance was given in preparing the material needed for country health programming and in training a new type of worker, a mUltipurpose auxiliary nurse/midwife, to staff the subcentres. Plans are under way to extend primary health care to the village level. A greater coverage of the population will be obtained by training village health workers who will be technically supervised from, and refer to, the subcentre and health centre levels. Activities in the hospital administration project progressed satisfactorily. The legislative background for a unified pattern of hospital administration and organization was created, through a decision to place all existing hospitals under the control of the Ministry of Public Health. WHO assistance concentrated on hospital regulations and the extension and modernization of existing facilities. A new hospital record system was prepared and tested. A draft manual for hospital administrators, with particular reference to c.onditions in Laos, was prepared. WHO assistance in the rehabilitation of the physically handicapped project continued up to June 1975. A WHO consultant is assisting in redefining possible future assistance and evaluating the existing training programme. The WHO advisers assigned to Peninsular Malaysia assisted mainly in preparation of the he< Lth component of the Third Malaysia Plan. Assis- tance with teaching community health nursing was also provided in the postbasic programme at the University of Malaya Medical Centre. In Sarawak, the public health nurse was fully involved in all activities for implementation of the total health care programme. In that capacity, she also assisted in matters relating to the preparation and posting of the two new categories of health worker, i.e. community nurses and junior hospital assistants, who will serve at the lowest periphery of the services. In the New Hebrides, project activities continued at the North Efate demonstration and training centre. Efforts were made to improve the supervision and technical support of the male nurses being prepared to give preventive and curative services in isolated health posts. In- service training continued. Progress was also made in coordinating specialized activities and in integrating the malaria control programme with the basic health services. Commendable progress was made in the Philippines. The primary care clinics staffed by re-trained midwives were extended to the whole of Rizal Province. The second phase of the operational research study, dealing with managerial aspects of supervision, supplies and information monitoring, is nearing completion and is being evaluated. Manuals for each category of health worker were completed and, after testing in the field, will be submitted to the Department of Health for consideration, with a view to adopting them on a national scale. The Government decided to extend the system, newly developed in Rizal Province. throughout the country. - " --- WPR/RC26/4 page 9 A WHO consultant in mental health/psychiatric nursing assisted national nurses in organizing a workshop on community mental health nursing which stimulated interest in community mental health among other health disciplines. In the Republic of Korea, a system of integrated delivery of basic health services, using re-trained single-purpose nurse aides as multi- purpose health workers of first contact, was initially implemented in one ~ (district) of Yong-in Gun. The system is now being extended to two further myun. A draft manual for each category of health worker in the ~ was prepared and is now undergoing field testing. A WHO consultant assisted in a study of the interrelationship of hospital intern training and service needs in rural areas. Recommenda- tions were made on how training can best be modified to meet such needs. Singapore received WHO assistance in overseeing the Government's massive hospital rebuilding programme. A WHO consultant in investigative cardiology provided assistance to the Institute of Medical Specialties. Progress continued in the national health services development project in Western Samoa. The results of the earlier study on staff activities are being utilized to restructure activities and strengthen the delivery of health care at the community level. A WHO sanitarian is providing support in the second course for assistant health inspectors. A WHO hospital administrator was assigned to assist in the first phase, construction of outpatient and emergency units, operating theatres and the central sterile supply department, of redevelopment of Apia General Hospital. Two WHO advisers assigned to the intercountry public health advisory services project in the South Pacific, assisted the British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, New Hebrides and Tonga in strengthening their public health services, particularly in relation to family health, and the organization and teaching of community health nursing, including supervision, especially at the peripheral and intermediate levels. Fifteen governments expressed interest in the intercountry hospital management, design and maintenance project, support of which is still under negotiation with UNDP. The Government of the Philippines has already agreed in principle to arrange courses in medical administration and architecture. The Government of New Zealand is similarly considering arranging courses in the maintenance and repair of medical equipment and that of Papua New Guinea courses in hospital unit administration. 1.3 Development of health laboratory services Important problems affecting health laboratory services throughout the Region are (1) the unbalanced development of central laboratories to the detriment of those at the periphery; (2) poor development of community health activities; and (3) under~utilization of technicians working at the periphery. WPR/RC26/4 page 10 To obviate these deficiencies efforts have been made to increase horizontal coordination and collaboration between health laboratory services and other divisions of health departments. Encouragement has been given to establishing health laboratory advisory committees, to bring together users of laboratories (practitioners in hospitals and health centres, epidemiologists, environmental health engineers) in order to coordinate the planning and development of health laboratory networks and define their programmes of work. Through such committees, more attention can be focussed on the community and its health problems as a whole. In this way, health laboratories gain recognition as essential components of health organizations. Laos, Papua New Guinea and South Viet-Nam, particularly, have been developing their services in this way by integrating case-finding in major programmes against diseases, such as tuberculosis and malaria, with the activities of the medical laboratory assistant. Checking and control remain the responsibility of the existing specialized microscopist. Central laboratories are now established in most countries of the Region. To increase coverage of the population, government interest centres on either establishing new laboratories at the periphery or strengthening existing ones. 2 FAMILY HEALTH From the administrative standpoint, the term family health in WHO covers maternal and child health, nutrition, health education and human reproduction. Similarly, as far as the development of health services is concerned, the term implies not merely an amalgamation of fertility regulation with maternal care, but an approach whereby an effort is made to improve the health of the various individuals in the family through multidisciplinary services and thus influence society as a whole. Disease patterns depend to a large extent on external factors. Improvement of health, changes in morbidity and reduction in mortality rates cannot be seen as the responsibility of the health services alone but should be considered as part of overall development. In this particular context, coordination with activities in fields other than health is essential. In circumstances where regular medical services are restricted to small groups of the population, primary health care attempts to provide on a large scale services which can be rendered by auxiliary workers. 2.1 Maternal and child health and family health In developing societies the early diagnosis, treatment and referral, as necessary, of cases of disease encountered among mothers and children is as important as the classic concept of the role of maternal and child health, namely prevention of disease by means of immunization, improve- ment of nutrition, and modification of behaviour in relation to factors that can influence health. - " -WPR/RC26/4 page 11 The basic aim of activities related to mothers and children within the WHO programme for strengthening of health services is to meet the outstanding needs of a considerable number of people rather ~han to develop optimal services for limited groups. Some countries in the Region can afford to render services to mothers and children through highly qualified staff, whereas others strive to have the services carried out at the peripheral level by lower categories of worker trained for the purpose. During the reporting period, maternal and child health/family planning projects commenced in New Hebrides and Papua New Guinea with assistance from UNFPA and WHO. Throughout the Gilbert and Ellice Islands family health care has become part of the regular duties of the district nurses, with the active involvement of all island staff in family planning aspects. The census of December 1973 showed a population increase rate of 1.7%, compared to 2.5% at the beginning of the previous five-year period. Following changes in official policy on family planning UNFPA assistance to Laos was discontinued. It is hoped that results obtained in training multipurpose auxiliaries will be maintained through regular government training schemes. In Malaysia, a post of Medical Officer, Maternal and Child Health/ Family Planning, has been created in all States. A programme to intensify the integration of maternal and child health, family planning, nutrition, health education and school health is being developed in 20 districts with the aim of ensuring better care for a greater proportion of children and mothers through primary health care provided by community nurses. The National Family Planning Board is cooperating with the Maternal and Child Health/Family Planning Division of the Ministry of Health in intensifying the rendering of services in the field of family planning. The maternal and child health-based family planning project was launched in the Province of Bohol, Philippines. With the assistance of UNFPA and in collaboration with the Population Council, New York, the Government intends to determine the effectiveness of family planning activities carried out as part of a well organized maternal and child health care programme in a large, predominantly rural, area. In the Republic of Korea, the maternity-centred family planning programme extended to three government hospitals. All have been able to improve their maternal and child health services, particularly with regard to family planning. UnderUNFPA auspices, assistance was given to the Seoul National University Research Institute of Reproductive Medicine arid Population, in developing a plan of operation and discussing collaboration under the WHO Expanded Programme of Research, Development and Research Training in Human Reproduction. WPR/RC26/4 page 12 In South Viet-Nam, priority was given to developing 20 pilot centres for training in family health and strengthening activities for training health personnel in maternal and child health/family planning. In Tonga, the maternal and child health family planning programme continued to receive priority. Its implementation, together with tuberculosis, typhoid and poliomyelitis immunization, has become the main activity of the district nurses. Family planning was introduced into the basic nursing curriculum and an increase of acceptors was observed during the reporting period. Systematic follow-up of acceptors and supervision of field workers improved. Construction of a new family welfare centre in Apia, Western Samoa, was completed during the period under review. Maternal and child health/ family planning services are now available in all districts and two mobile clinics are operating on the islands of Upo1u and Savai'i. Throughout the Region education and training activities in maternal and child health/family planning remained a priority. Nurses were trained in the provision of care to families. Workshops were organized for faculty of schools and colleges of nursing and midwifery with the aim of integrating population dynamics, human sexuality and family planning into the basic curricula. Assistance was provided in organizing national workshops. An intercountry seminar on the role of nurses and midwives in family planning was held in Manila, from 16 to 23 September 1974. Twenty-one nurses and midwives from 16 countries or areas attended. The aim was to study the effect of involvement in family planning on professional activities. The wide range of subjects discussed - family health care, family planning as a health-related activity and primary health care in rural areas - reflected the interests of the participants and their concern for the people they served. Many participants expressed the need for further studies to be undertaken at national level on the optimum utilization of manpower in developing health programmes. 2.2 Nutrition The World Food Conference, held in Rome from 5 to 15 November 1974, drew attention to critical world-wide nutrition problems. The Western Pacific Region has been fortunate in that it has escaped the major famines experienced in other parts of Asia and in Africa; but rising costs, underemployment and the drift to the towns make it unlikely that there has been any general improvement in nutritional status in the Region. With expanding population matched against limited gains in food production, the future for mothers and children, who are the most severely affected by malnutrition, is sombre. WHO has continued to help Member States in the Region" to develop national expertise. Assistance was given to Cambodia, Fiji, Laos, Malaysia, New Hebrides, Philippines, South Viet-Nam and Western Samoa. A workshop on the teaching of nutrition in schools of medicine was held ,- 0' A family visiting the immunization and family family health services. Kaugere Clinic, Port Moresby where planning counselling are part of the -.- WPR/RC26/4 page 13 in Manila from 24 to 30 September 1974. Participants from 12 countries or areas in the Region attended. During the year, it was necessary to terminate two posts of intercountry advisers, one based in Manila and one in the South Pacific, as funds were no longer available from sister United Nations agencies. However, an intercountry team consisting of a medical and a non-medical nutritionist will be provided under the regular budget in 1976. Following an encouraging increase in interest, three countries took significant steps towards the formulation of national integrated food and nutrition policies. To foster the process, closer links were established with FAO and UNICEF at both country and regional level. The development of national food and nutrition policies is part of the general trend towards improved planning, but worldwide press publicity resulting from the World Food Conference has, without doubt, been a further stimulus. In line with its policy of cooperation (see 9.2.2) with the South Pacific Commission, which is developing a long-term nutrition project, WHO assisted in one of the Commission's in-service training courses. Collaboration was also developed with the East-West Centre of the University of Hawaii, the area of mutual interest being the basic training of non-medical nutritionists which must always be adapted to local circumstances. 2.3 Health education Success in health programmes depends to a large extent on the willing and active cooperation of a well informed public. Health education activities therefore received continued support. The main objective was to integrate health education in all health programmes, with particular emphasis on strengthening community involvement in WHO-assisted programmes. Emphasis was also placed on establishing close cooperation among all agencies and institutions concerned with community efforts for development. The aim was to broaden the responsibilities of health workers to include developmental activities which promote health and to make full use of resources available in a community for improvement of its health status. Health education activities continued to be developed and strengthened as an integral part of family health programmes in Laos, Malaysia and Tonga. In Gilbert and Ellice Islands, health education was combined with environmental sanitation activities in promoting basic sanitation in rural communities, to deal with the pr09lem of high infant and child mortality and morbidity resulting from the endemicity of gastroenteric infections. A team approach involving health, rural development, education and welfare workers was encouraged. The involvement of community leaders and village councils was also streng7thened. Stress in all these activities was placed on creating a better understanding of the interrelationships between control of infection, nutritional status, maternal and child health, family planning and the WPR/RC26/4 page 14 psychosocial aspects of health of the family and its members. The integrated, as opposed to single-line, health educational approach has given encouraging results. For health education activities to be successful, they have to be based on a careful diagnosis of the community's perception of its own health problems, and its beliefs, values, hopes and aspirations. In Laos, health education strategies and approaches are being formulated in the light of systematic sociological studies on the potential for community involvement in a largely self-supporting village-based health programme. An ex:ellent illustration has been provided of how plans for health education and consumer involvement can be included at a very early stage of programming for primary health care services. In Papua New Guinea, efforts were made to integrate health education into the basic general health services. A national workshop on strengthening community involvement in family health was held at ~baul, Papua New Guinea, from 5 to 16 August 1974. Health education and communication approaches were developed and a variety of educational and information materials for use by field workers were designed and tested. Continued efforts were made to encourage Member States in the Region to establish and strengthen the infrastructure for health education at the national and provincial administrative levels. Plans were approved by the Government of Malaysia further to expand the health education network from the national to the provincial level. A health education section was recently established within the Health Department in Western Samoa. Similar trends in strengthening the organizational network of health education services were observed in many other countries. Research and evaluation activities aimed at bringing about further improvements in health education methods and approaches were encouraged and supported. Consultant services were provided to the Philippines to assist the Department of Health in assessing the health education services in the country and its future needs. In collaboration with UNESCO, assistance was provided for research, development and training in family planning communication at the Institute of Mass Communication, University of the Philippines. Continued emphasis was placed on training in health education, both for health personnel and for specialists. Assistance was provided in establishing a postgraduate diploma course in health education at the Public Health Institute, Kuala Lumpur, Malaysia, and the advisory services of a health education specialist continued to be provided to the National Institute of Public Health in South Viet-Nam for the training of intermediate-level health educators entitled health education assistants. Advisory services were also provided to Papua New Guinea in strengthening its diploma course in health education. This course prepares non-graduates with health experience to serve as district health education officers. ... -- WPR/RC26/4 page 15 Support for developing health education personnel through fellowship programmes continued. 3 HEALTH MANPOWER DEVELOPMENT Assistance to countries in the broad field of health manpower development has continued to be a major component of WHO's regional programme through the provision of lecturers and consultants, the award of fellowships, and the organization of group educational activities, such as courses, seminars and workshops. The programme has taken a new direction aimed at developing a closer working relationship between authorities responsible for the preparation of health personnel and those responsible for health care delivery. This new concept, while having been readily accepted, will take more time to introduce and implement. The greatest progress has been made in teacher training, as is evidenced by the establishment of two national teacher training centres - one in the Philippines and the other in the Republic of Korea. This represents the second phase of the Regional Teacher Training Centre (RTTC) programme and follows on the consolidation of the training programme at the Centre in Sydney. Several governments have begun to recognize the benefits that can be derived from utilizing medical assistants and a greater number of auxiliary health workers in their various programmes. In response to requests WHO has provided advisory assistance to help in training these categories of personnel. 3.1 Health manpower planning Although discussions at various meetings have shown that there is a growing awareness of the need for health manpower planning throughout the Region, requests from Governments in this field have not materialized. It is noteworthy however that many WHO-assisted projects for the development of health services have given particular attention to present and potential health manpower resources and how to utilize them. 3.2 Training of auxiliary health personnel A seminar on medical assistants, the first in the Region, was held in Manila from 1 to 7 October 1974. Nineteen participants from 13 countries or areas attended. Discussions emphasized the benefits of utilizing auxiliary health personnel to a much greater extent and a number of conclusions, useful as a basis for future action, were reached. Following a feasibility study carried out with the assistance of WHO, Fiji decided to commence training this category of health personnel. A long-term post of national coordinator of studies for medical assistants was approved, starting in 1975. WPR/RC26/4 page 16 Assistance was provided to Laos by a WHO consultant who advised on the need for training auxiliaries. In Papua New Guinea, courses for auxiliary health workers were further developed. WHO assistance was provided in curriculum planning and the preparation of instruction manuals. 3.3 Educational methodology and technology The Regional Teacher Training Centre in Sydney was active in developing training programmes in educational methodology and technology, directed particularly towards the establishment of national teacher training centres in various countries of the Region. National workshops supported by consultants from the Centre were held in Australia (August 1974), Japan (December 1974), Philippines (April 1975), Republic of Korea (May 1975) and South Viet-Nam (September 1974). The activities of the Centre are described in more detail under "Evaluation Summaries of Selected Projects", Part II, pages 92-97. Within the postbasic nursing education component of the project of WHO assistance to the University of Malaya, faculty and students have been actively developing educational aids for nursing and midwifery teaching and specifically programmed instructional materials. Under the nursing education project in Papua New Guinea, where nurse teachers, nurse administrators and community health nurses are being prepared, educational material has also been developed. 3.4 Direct assistance to countries WHO assistance to Cambodia, limited because of the political situation, was augmented by the award of a large number of fellowships. The public health nurse educator assisted in the development of an urban centre for training various categories of health personnel, including nurses, midwives and sanitarians, and taught public health nursing at the national school of nursing and midwifery. She also participated in an emergency programme to provide health services to the community. Two WHO advisers, in the fields of pathology and paediatrics, are ilOW assigned to the Fiji School of Medicine. Activities in the period under review included undergraduate teaching to medical, dental and laboratory students and post-graduate teaching for the continuing education of hospital staff. In Laos, four WHO advisers - in pathology, preventive medicine, physiology and dental techniques - continued to provide assistance to the Royal School of Medicine. In addition, a tripartite agreement was signed during the period under review, between the Royal School of Medicine, the Claude Bernard University, Lyons, France and WHO, which .. -A National Teacher Training Centre for Health Professions was established at the Seoul National University College of Medicine, the first of its kind in the Western Pacific. An inauguration photograph shows Dr Charles J. Ross-Smith, WHO Assistant Director of Health Services delivering an address on behalf of the WHO Regional Director. Other speakers were Dr Shimsok Hahn, President of Seoul National University; Mr Sung Ok Cho, Vice-Minister of Education; Dr C.H. Chong, WHO Representative, Seoul and Dr E. Hyock Kwon, Director of the Centre. WPR/RC26/4 page 17 provides for the assignment of teachers of biology, pharmacology and biochemistry on a contractual basis. Consultant services were provided in the fields of preventive and social medicine, pharmacology, chest diseases, and medical education. Three WHO nurse educators continued to give assistance to the three-year nursing education programme in Vientiane. Two Laotian nurses are studying abroad on WHO fellowships to become nurse teachers; the first in the country to be so prepared. Assistance was continued to the Faculty of Medicine, University of Malaya by providing WHO consultants to assist in the Master of Science programmes in public health and pathology. The WHO nurse educator continued to assist in developing postbasic courses for nurse adminis- t)~"t:ors and teachers, and midwife teachers. A WHO sanitarian tutor assisted the Public Health Institute of Malaysia for six months. A WHO nurse educator continued to assist in the development of basic nursing education programmes in New Hebrides. Assistance extended to all nursing schools, with more emphasis on the British Base Hospital, Port Vila. In association with the WHO-assisted development of health services project practical community health nursing experience, both in a rural area and in urban Port Vila, was provided for second- and third- year nursing students. In Papua New Guinea, two WHO senior nurse educators continued to assist in developing postbasic programmes for nurse teachers, community health nurses and nurse administrators. A WHO adviser on the organization and implementation of courses in administration for various categories of health personnel completed his assignment in April 1975. A WHO lecturer in paediatrics worked in the Faculty of Medicine, University of Papua New Guinea from August 1974 to March 1975. WHO consultants in immunology, nutrition and epidemiology continued to help in strengthening the faculty of the Institute of Public Health, University of the Philippines which not only awards postgraduate public health qualifications but also provides instruction to undergraduates of the College of Medicine, University of the Philippines. From December 1974 to April 1975, a WHO consultant assisted the Philippines in revising the basic nursing curricula in government and private schools and colleges of nursing. In the Republic of Korea, assistance was provided to the School of Public Health, Seoul National University and to the National Institute of Health under an amalgamated project for education and training of health personnel to which are assigned two WHO advisers - a public health administrator and a public health nurse educator. The two advisers, while strengthening the faculties of the two Institutes, assisted in establishing field practice areas and planning curricula. The public health administrator also played a major role in setting up the National Teacher Training Centre, while the public health nurse educator continued to assist in the Master of Public Health course, public health nursing programmes of the School of Public Health, Seoul WPR/RC26/4 page 18 National University, and the nursing/midwifery programmes at the National Institute of Health. A national nurse on the faculty of the School of Public Health, Seoul National University, completed a WHO fellowship in higher education in November 1974 and returned to her position. In South Viet-Nam, construction of the teaching and administration block, library block, laboratory block and the auditorium of the National Institute of Public Health was completed. Regular courses were offered for: public health technicians - 3-year with 154 enrolment; public health assistant technicians - one-year with 95 enrolment; midwifery monitors - four and a half months with 41 graduates; and midwifery supervisors - four a half months with 71 graduates. The number of short courses and seminars which took place during the period under review was 6, with a total attendance of 348. A noteworthy achieve- ment in the area of training was the development of two field training and demonstration centres where major parts of the regular courses were conducted. Six long-term WHO advisers continued to assist the Institute as well as consultants in the fields of audiovisual aids, environmental health, medical education, and social paediatrics. WHO assistance to this project, as well as to the other projects in South Viet-Nam, was suspended - hopefully temporarily - with the recent change of government inilieco~try. Assistance to nursing education in Western Samoa, which began in August 1972, ended in December 1974, when the WHO nurse educator completed her assignment. The basic nursing education programme was strengthened, and an in-service programme for nursing personnel introduced. Altogether sixty-eight students enrolled during three years of the nursing education programme, which now has five nationals on the teaching staff, two of whom are qualified nurse teachers. A third national nurse is currently completing nurse teacher training on a WHO fellowship. Two national nurses will complete studies in public health nursing in 1975. 3.5 Fellowships programme The fellowships programme proceeded smoothly. Whenever possible, arrangements were made for candidates to study in countries within the Western Pacific Region. One of the difficulties encountered was delay in the receipt of fellowship application forms from some countries. Ability sufficiently to speak the language of the proposed place of study also remained a problem, especially when attempting to enrol fellows in full-time courses. Tables appearing on pages 19-28 give details of the number of fellowships awarded, as well as other relevant data. The second edition of the registry of training courses available for health personnel in the Western Pacific Region was sent to Member States in the Region. • Philippines Malaysia Republic of Korea Cambodia Western Samoa Singapore New Hebrides Fi j i Trust Territory of the Pacific Islands South Viet-Nam Papua New Guinea Australia British Solomon Islands Protectorate Japan Hong Kong Cook Islands Ni ue Laos American Samoa Gilbert and Ellice Islands New Zealand Tonga French Polynesia Guam ( <:> t:l:l:~::::::::::::::J 0> .~ '" ..... <:> OJ <:> '" <:> ~. ~ ~ <:> 0\ <:> 0> <:> 'g ~ 0</ I=<' (1) ....... I=<' 1-'(") '-ON ....... 0\ N ....... 0-1'- ( -BREAKDOWN OF SOURCES OF FUNDS FOR FELLOWSHIPS AWARDED FROM 1 JUNE 19'74-31 MAY 1975 -~ o 4.1% Regular UNFPA UNDP E D ~ , TYPES OF STUDIES ARRANGED 1 JUNE 1974-31 MAY 1975 25.30/0 Fellows attending programmes t a i lor edt 0 sui tin d i v i d u a'\ r e qui rem en t s Fellows participating in long-term activities organized by WHO (i. e. courses of more than one week duration) 'g~ (JQ ::tl (1), Nl!5 I-' N ,0\ N, N-I:- -PROFESSION OF FELLOWS 1 JUNE 1974-31 MAY 1975 1\\ \ \\ \I - 1.00/0 0.70/0 Physician Nurse Sanitarian Laboratory Technician Dentist. Dental Assistant Hospital Administrator Statistician Health Educator Rad i 0 gra pher /Radi ologi st Others WPR/RC26/4 page 23/24 "- -I::: :: I 11111111111 FIELDS OF STUDY OF FELLOWS 1 JUNE 1974-31 MAY 1975 2 . 90/0 Strengthening of Health Services Family Health Health Manpower Development WPR/RC26/4 page 25/26 Communicable Diseases Prevention and Control Non-Communicable Diseases Prevention and Control Prophylactic and Therapeutic Substances Promotion of Environmental Health Health Statistics I~"'-' .. CJ PLACES OF STUDY OF FELLOWS 1 JUNE 1974-31 MAY 1975 In countries within the region only In other regions only In the Western Pacific and other regions WPR/RC26/4 page 27/28 --' Four Regional Directors of WHO visited a Philippine barrio, where they met a midwife in charge of a prima.ry care clinic, on a field trip during the Sixth Meeting of Directors or Representatives of Schools of Public Health. Startingfrorn the second person on the left are Dr Cornlan A. A. Quenum, AFRO; Dr Francisco J. Dy, WPRO; Ms Elena Hernandez, ~idwife; Dr Abdul H. Taba, EMRO and Dr Victor T.H. Gunaratne, SEARO. Participants in the Second WHO Regional Seminar on Environmental Pollution: Water Pollution, held in Manila are shown during a visit to an industrial textile waste treatment plant. 3.6 Intercountry programmes WPR/RC26/4 page 29 WHO assistance, through consultants and fellowships, continued to the one-year diploma course at the Regional Centre for the Training of Anaesthetists, University of the Philippines, Manila. Fellowships were awarded for three participants in the course ending in December 1974, and for 11 in the course which commenced in January 1975. During the period under review assistance in strengthening basic nursing and midwifery education programmes was continued to Cook Islands and Fiji through the intercountry nursing advisory services project for the South Pacific. This project, which began in 1967, terminated in December 1974. Accomplishments over the seven-year period included the revision of basic nursing curricula and the development of continuing nursing education programmes, each activity covering six countries or areas. In Fiji, assistance from the project was given in planning and implementing public health nursing courses at basic and postbasic levels and in planning the nursing component of a course for the Vocational Teacher's Certificate, offered under the auspices of the University of the South Pacific. Assistance under the intercountry postbasic nursing and midwifery education project was given to Fiji, Malaysia and Papua New Guinea. A study is under way on the feasibility of establishing an intercountry centre for postbasic education in nursing and midwifery, to meet the needs of countries with only a small number of students. 3.7 Group educational activities Sixteen intercountry group educational meetings and courses were held during the year, as listed in the Project List, Part III. WHO financed the attendance of 291 participants in these meetings. A total of 92 participants attended 24 interregional seminars and courses. An activity of special significance in March 1975 was the sixth meeting of directors or representatives of schools of public health from the African, Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO. There were 35 participants from 28 countries in the four Regions of which seven participants were from seven countries in the Western Pacific Region. Common problems related to health manpower planning and development were discussed, as well as the future role of schools of public health and the implications of multidisciplinary cooperation. A workshop on training of nursing teachers took place from 19 to 30 August 1974. The purpose was to exchange information on the present situation and to identify ways of improving the preparation of teachers for nursing and midwifery schools. There were 19 participants from 19 countries or areas in the Region. WPR/RC26/4 page 30 4 COMMUNICABLE DISEASE PREVENTION AND CONTROL 4.1 Epidemiological surveillance of communicable diseases Although only about one third of the countries or areas in the Region have established epidemiological services within their health services what information is available confirms that communicable diseases have remained leading causes of disease and death. WHO assistance has placed emphasis on the development of epidemio- logical services for improved surveillance, with necessary support by laboratory and health statistics services, and progress was made in Malaysia and the Republic of Korea. A WHO epidemiologist was recently assigned to the intercountry epidemiological and surveillance services project in the South Pacific. During the period under review, consultant services were provided to the Philippines, to Singapore, where a special situation exists in that the epidemiological unit is at present part of the Ministry of the Environment, .and to South Viet-Nam. 4.1.1 Reporting of communicable diseases Reliable epidemiological information from many areas is lacking, making it difficult to obtain a coherent picture of the communicable disease situation in the Region. Such information is essential for regional planning. A number of countries are contributing to the development of an epidemiological intelligence network for the Region. Since November 1974 Singapore has issued a monthly Epidemiological News Bulletin, a valuable addition to such reporting, and in at least two other countries the regular publication of a similar report is being planned. The South-East Asian and Western Pacific Regions of WHO have collaborated since March 1975 in the preparation of a quarterly Dengue Newsletter. 4.1.2 Planning for control of communicable diseases In order to measure the effectiveness of WHO assistance in the control of communicable diseases, an effort is being made to develop regional priorities by disease and by country. This approach should also facilitate the emergence of centres of excellence where they are most needed. 4.1.3 Immunization services Coverage of the population by immunization programmes is often poor outside the urban centres, with little subsequent evaluation. Available data suggest that the high price of vaccine, lack of , • WPR/RC26/4 page 31 transportation and facilities for keeping vaccine continuously cool, and other operational constraints, often appear as insurmountable handicaps in achieving satisfactory coverage of the vulnerable population, usually composed of children. In accordance with the resolution adopted by the Twenty-seventh World Health Assembly on the WHO Expanded Programme on Immunization,l the planning, implementation and evaluation of immunization services has been receiving attention. A minimum reduction of 50% in morbidity and mortality for each disease within 10 years is envisaged as a regional target, though it will be impossible to scrutinize the results critically unless surveillance improves. 4.2 Malaria 4.2.1 General review The gains in the regional antimalaria programme were largely preserved, and there was a moderate improvement in the situation, despite certain difficulties. The malaria-free status of countries where the disease is no longer endemic was maintained, although Singapore experienced slightly more local transmission within introduced outbreaks. Substantial progress was made in the staged eradication programmes. In the British Solomon Islands Protectorate, the malaria situation in most of the New Georgia group of islands reached a stage at which indoor spraying operations could be discontinued. In Peninsular Malaysia, an assessment was made of progress in the programme, which now extends over the entire territory. The incidence of malaria in Sabah was, for a number of reasons, higher than in the very favourable year of 1973, underlining once more the need for continued surveillance and sustained support of the prog- ramme in this State, where the malariogenic potential is generally high. The control programme in Sarawak continued satisfactorily. The control programme in Papua New Guinea made important headway in consolidating current operations, but the results will not be apparent for another year, pending further strengthening of the health manpower component. The Philippine malaria eradication programme had to be adjusted to the difficult situation which emerged with the withdrawal of bilateral assistance in 1973 and the increase in the cost of commodities during 1974. However, a careful epidemiological evaluation was made, the activities were rephased, and serious setbacks were prevented. Trials for integration of the malaria eradication service and the general health services in selected Provinces were prepared. ISee resolution WHA27.57, Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board, Vol. II, First edition (1973-1974), page 9. WPR/RC26/4 page 32 The modest control programmes in Laos and New Hebrides proceeded well. In both programmes, the areas of operation could be expanded. Further progress is anticipated. An entomological study was carried out in the New Hebrides. Increased UNDP and WHO assistance was provided to the projects in Cambodia and South Viet-Nam. Coordination with international and bilateral agencies, through the WHO Representatives, resulted in substantia~ assistance to anti- malaria programmes in the Region. Independent Assessment Teams reviewed the programmes in the British Solomon Islands Protectorate and Papua New Guinea early in 1975. WHO continued to assist the regional training programme. With the cooperation of the national authorities, a general course in malariology for professionals was organized at the Public Health Institute, Kuala Lumpur, Malaysia from September to November 1974. Similarly, a combined course in parasitology, entomology and epidemiology for senior technical staff was conducted at the national Malaria Eradication Training Centre, Manila from 3 September to 25 October 1974. A national seminar for district medical officers and district malaria supervisors was held in Port Moresby, Papua New Guinea in October 1974. In Brunei, which entered the maintenance phase the organization of malaria vigilance was reviewed. found generally satisfactory and minor improvements five The were years ago, situation was suggested. The field research study on chloroquine resistantP. falciparum undertaken with WHO assistance by the Malaria Eradication Service in the Philippines progressed smoothly. Low-level resistance to choloroquine proved to be considerably more widespread than originally suspected. 4.2.2 Progress of work in the malaria projects 4.2.2.1 Countries or areas belonging to the northern zone Hong Kong Another year without an indigenous case of malaria was added to the record. Hong Kong has remained free from the disease for the last seven years. The 21 cases notified during 1974 (2 P. falciparum, 16 P. viva x , 2 P. malariae and 1 unknown) were investigated exhaustively. Routine malaria vigilance activities continued. Japan Whereas the receptivity of originally malarious areas on Honshu is now presumed to be zero, some of the southern Ryukyu Islands remained receptive to malaria. There has, however, been no report of recent local transmission. Macao WPR/RC26/4 page 33 Routine vigilance operations and protective measures were maintained. Of the two P. vivax infections registered in 1974, one was imported, and the other was possibly due to local transmission. Republic of Korea Although malaria was endemic throughout the country before 1950, it disappeared from most areas without the application of specific control measures. At present the disease appears to be confined to a limited, remote area in the northeast, where the number of cases, all P.vivax infections, registered during 1974 showed a further decline from 747 in 1973 to 611 in 1974. Case-finding and treatment by the provincial health staff continued, with technical support from the central authorities. 4.2.2.2 Countries or areas belonging to the central zone Brunei A review of available records suggests that no local transmission of malaria has taken place in Brunei since the end of the consolida- tion phase in 1969. The compactness of the territory and the relative ease of communication with all inhabited areas facilitate the discovery of malaria foci. Vigilance operations are facilitated by the relatively low receptivity of some of the more vulnerable areas. In other areas protective measures were continued, to keep receptivity down. In some of the latter areas further strengthening of vigilance is planned. During 1974, 12 cases of malaria were reported. All proved to be imported. Peninsular Malaysia The project made good progress. The preparatory phase operations which commenced in the State of Johore brought the whole of Peninsular Malaysia under the eradication programme. At the same time additional sectors in Penang entered the consolidation phase; spraying operations were started in Negri Sembilan and Melaka. Of the 7.5 million people living in attack phase areas, 5.3 million were protected by indoor spraying. In addition 3.2 million were covered by antilarval operations in urban and peri-urban areas. Further withdrawal of indoor spraying operations from sectors of Kedah and Penang, which are inhabited by another one million people, was recommended for 1975. The incidence of malaria showed a further decline and is estimated to have fallen below 30 000 cases annually, i.e. to less than 10% of the pre-operational figure. This improvement has accelerated various development programmes in areas which were previously highly malarious. WPR/RC26/4 page 34 Most senior posts at headquarters and State level were filled. To strengthen the national health manpower resources, additional expatriate staff were recruited. Spraying operations were carried out virtually on schedule, and coverage and acceptance were satisfactory. Steps were taken to improve supervision of State laboratories. In parts of the country, the importation of cases into freed areas from within the State or from other States has been a matter of concern. The land development projects, under the Federal Land Development Authority, which are mostly located in potentially malarious areas, create an additional challenge. To cope with the difficulty, close coordination with the Authority and special mobile teams for the application of additional preventive measures have been established. The occurrence has also been noted of chloroquine resistant strains of P. falciparum, which are thought to be spreading. Sabah and Sarawak, Malaysia Although the exceptionally dry weather of 1973 had brought the incidence of malaria in Sabah to a record low level, the incidence in 1974 was slightly above the average for the previous two years. Heavy rains increased receptivity and resulted in small outbreaks in areas that had been free of transmission for several years. Population movements due to floods, economic reorientation following a slump in timber prices on the world market, road construction projects in hinterland areas, etc. were contributing factors. The higher incidence figure is partly due also to improved notification with four new1y- established treatment posts reporting 2500 additional cases during the second half of the year. Another 9 treatment posts scheduled to be established in 1975 will bring the total to 35 posts, providing almost the entire population of the State with easy access to malaria diagnostic and treatment facilities. Operations continued satisfactorily, slight amendments having been made in the original plan to deal with the epidemiological situation. Poor quality of performance and lack of effective supervison, particularly in the remote areas, remained major operational difficulties. There was increasing evidence of the occurrence of chloroquine-resistant strains of P. falciparum. The programme in Sarawak proceeded smoothly, with increasing participation in malaria case detection and treatment by rural health services personnel, including staff of the static and mobile dispensaries, rural health supervisors, medical auxiliaries, and maternal and child health and tuberculosis workers. Active case detection was limited mainly to agricultural development, resettlement, logging and road construction areas. Annual incidence remained low, at less than two cases per thousand population. Staff vacancies were filled and additional posts created. '. - , -Philippines WPR/RC26/4 page 35 In the six sectors, with a total population of 2 million, where malaria eradication is being pursued, progress during 1974 was generally satisfactory. In the remaining malarious area, with a total population of 11 million, the status quo was maintained although it proved to be impractical to complete the second indoor spraying cycle as originally scheduled. Elsewhere population movements and operational difficulties limited field activities. The overall incidence of malaria declined, despite small outbreaks in pre-maintenance phase areas. Surveillance operations were generally maintained, with the introduction of some modifications. Considerable progress was made in the preparation of trials aimed at the functional integration of the malaria eradication programme into the general health services in the provinces of Ilocos Sur and Marinduque. For the purpose of detailed planning, execution and evaluation of the trials, one central, two regional and two provincial committees were formed. WHO assisted in orienting the provincial health officers and malariologists involved in the trials. Additional assistance was provided in the training and reorientation of rural health officers and antimalaria personnel. Singapore The malaria vigilance activities, conducted and coordinated by the Environmental Public Health Division, Ministry of the Environment, continued. Of the 416 cases detected during 1974, 286 were imported, mainly from Indonesia (151) and Malaysia (117). A total of 128 cases were classified as due to (suspected) local transmission, including both indigenous and introduced cases. Two induced infections with P. vivax occurred. The number of cases imported from Malaysia showed a slight decline. The figure is expected to decrease further in the next few years under the impact of the eradication programme attack measures to be initiated in southern Malaysia in 1975. 4.2.2.3 Countries belonging to the western zone Cambodia The antimalaria project continued in the 12 operational zones. Previously non-malarious areas in the central plain became no longer free of transmission because of a changed malariogenic potential. Regional indoor spraying operations continued in the zones of Pailin, Battambang, Kg. Thom, Siemreap and Kg. Som. WPR/RC26/4 page 36 UNDP and WHO accelerated assistance to the control programme by providing antimalarial drugs and transport, carrying out training, and supporting communications between the central and peripheral services. Laos The new UNDP/WHO assisted malaria control project commenced. Additional assistance provided by the Governments of Japan and the United States of America, UNICEF and the International Red Cross enabled the authorities to carry out geographical reconnaissance, spraying operations, delimitation of malarious areas, mass drug distribution and evaluation of operations according to plan. Additional bilateral assistance from USAID permitted a further expansion of operations in 1975. The DDT indoor spraying operations were expanded in 1974 to cover a total of 83 000 people, including 31 350 refugees. In villages indirectly protected by these operations, as endemicity was relatively low, mass drug distribution was carried out. During 1975 it is expected that about 180 000 people will be protected. The preliminary results of the indoor spraying operations indicate a sharp decline in the parasite rates. In areas previously covered, a slight reversal of this trend was noticed due to the increased use of temporary farm huts in jungle clearings. Nineteen technicians underwent three months of training in malaria field work and microscopy, for assignment to malaria .treatment posts in the provinces of Luang Prabang, Sayabouri and Borikhane. South Viet-Nam UNDP/WHO assistance in malaria control began during the period under review. There was a slight increase in the overall malaria incidence, as well as in the proportion of malaria cases among patients admitted to hospitals. Because of an imminent depletion in stocks of DDT, indoor spraying operations were limited to one cycle. Close toone million people in the more malarious areas were directly protected by indoor spraying operations in 1974. In the less malarious coastal areas, with about 11.4 million people at risk, malaria case detection and treatment, including remedial measures in malaria foci, continued. 4.2.2.4 Countries and territories belonging to the South-West Pacific zone Australia The Section of Tropical Medicine at the School of Public Health and Tropical Medicine, Sydney, continued to function as the central , WPR/RC26/4 page 37 vigilance unit. The School maintains a central register of malaria cases, acts as a reference laboratory and assists in epidemiological investigations, with the help of the Malaria Research Unit of the Army as required. At the State level, routine vigilance operations in the receptive areas by the general health services of the Northern Territory, Queensland and Western Australia continued. The organization was further strengthened through training of health staff in the WHO regional courses, development of health services in the Torres Strait area, and introduction of additional vigilance measures. A total of 39 cases, all imported, were detected in the receptive areas during 1974. British Solomon Islands Protectorate The malaria eradication programme continued to receive highest priority and support from the Government. There was an overall improvement in the malaria situation in all districts. In the Western district, the New Georgia group of islands entered the consolidation phase, although in some parts on marginal criteria. Thus indoor spraying operations were discontinued in an area containing about 12% of the total population of the Territory. The Gilbertese settlement at Waghina ceased to be a major cause for concern, while that in the Shortland Islands still created minor difficulties. Malaria in the district is almost entirely due to P. vivax. In the Central district, there was a dramatic drop in the incidence of malaria on Guadalcanal, with a shift from P. falciparum to P. vivax infections, although transmission was not halted completely. There were similar improvements in the Malaita district, now fully covered by active case detection, as well as in the Eastern district, where infections due to P. viva x predominated. Additional attack measures were shown to be indispensable in limited areas. Apart from a reduction in the interval between spraying cycles from 6 to 4 months, mass drug administration took place. Anti- larval measures, including a larviciding trial using Abate, are currently under study in North Guadalcanal. Involvement of the rural health services at village level is slowly improving. A rearrangement of staff within the Medical Department, took place in October 1974 with the adoption of a ministerial system of government. The malariologist is now in charge of community health, which should enhance further integration of the malaria eradication service into the general health services at the periphery. WPR/RC26/4 page 38 New Hebrides Control of malaria progressed most satisfactorily. Geographical reconnaissance was completed on Efate, updated on Santo and started on Malekula Island, in preparation for the introduction of spraying operations in 1975. After a focal spraying cycle in June 1974, the second full DDT indoor spraying cycle was completed on Efate in November 1974. Epidemiological and entomological evidence points to an interruption of transmission on the island. The operations were combined with Abate treatment against Aedes aegypti. Active case detection on Efate and Santo continued. Further pre-operational surveys, partly combined with a filariasis survey, were carried out on other islands. The overall epidemiological situation in the Territory is now clear. The seasonal nature of transmission, found in the detailed WHO-assisted entomological studies carried out on Efate has been confirmed. The same trend was noted on Santo and Malekula islands, and was most pronounced on Tanna. The annual incidence of malaria is estimated at 23 200 cases. Malekula and Pentecost islands are particularly malarious. There are 101 health posts in the Territory where antimalarials are available. The participation of these health posts in malaria case detection was further promoted, with expansion of the central laboratory proving essential for the purpose. Lack of health manpower for proper supervision appears to be the major constraint. Of the 90 000 inhabitants of the islands, 15 300 were covered by effective control measures at the end of 1974, 38 400 by passive case detection posts, and 25 300 by dispensaries without diagnostic facilities, leaving 10 800 without easy access to antimalarials. Papua New Guinea The reporting year was one of transition, with considerable changes in manpower for malaria control at central and intermediate echelons. UNDP/WHO assistance started in 1973, contributing to consolidation of the services towards the end of 1974, although some posts at the central and district levels remained unfilled. The training of area supervisors, who constitute the backbone of field operations within the districts, is receiving additional emphasis in 1975. The foundation was laid for a number of improvements in the execution and supervision of field operations, including the introduction and updating of geographical reconnaissance, strengthening of spraying operations, establishment of epidemiological indicator areas where serial parasite surveys will be conducted, collection of basic entomological data and introduction of routine entomological evaluation. A population of 1.5 million was protected by regular antimalaria operations, i.e. about 54% of the total population. - _. Mass blood examination (top photograph) followed by drug administration (lower photograph) form part of the supplementary measures undertaken in remalnlng malaria foci in the British Solomon Islands Protectorate with WHO and UNDP assistance. The photographs were taken on Vanguni Island (Western District) which entered the consolidation phase in 1974. In 1974 the new WHO-assisted malaria training centre in WPR/RC26/4 page 39 Madang conducted four courses for technical personnel: one for area supervisors, two for microscopists and one for entomology technicians. In-service training for entomology technicians was carried out in Port Moresby. With the assistance of staff assigned to the Madang training centre, refresher training for team and squad leaders in geographical reconnaissance and spraying operations was organized in a number of districts. To promote coordination with the rural health services, WHO assisted in a seminar-workshop for district medical officers and district malaria supervisors, held in Port Moresby. Although passive case detection is operating most satisfactorily in some areas, there is considerable room for further assistance to the antimalaria programme in the districts. The programme was reviewed by an independent assessment team in February and March 1975. Further recommendations were made for strengthening the manpower component and the supervision of operations, and for future expansion of activities into areas not yet covered. The epidemiological situation showed a modest improvement from an overall parasite rate of 9.8% in 1973 to 7.8% in 1974. 4.2.2.5 Other countries and territories belonging to the Pacific zone No changes were recorded in the countries and territories included in the WHO supplementary list of non-malarious areas. 4.2.3 Problems Common problems, technical and administrative, which interfered with the effective implementation of malaria control and eradication programmes, can be summarized under three headings as follows. 4.2.3.1 Technical problems Resistance to DDT has not yet developed in any of the major malaria vectors, despite prolonged use of the insecticide in the programme. However, close vigilance will have to be maintained on the possible development of such resistance in areas that have been under spraying for many years. In parts of Cambodia, Laos and South Viet-Nam, and in Sabah, where A. balabacensis is the vector, difficulties were experienced in mountainous forested areas where, due to a combination of human and vector habits, DDT indoor spraying alone failed to interrupt the malaria transmission. The situation in these areas is further complicated by the occurrence of multi-drug resistant strains ofP. falciparum, rendering mass drug administration ineffective as a supplementary measure. It is obvious that without a scientific breakthrough, eradication of malaria cannot be expected in these areas within the foreseeable future. The degree of control attainable in the meantime will be largely dependent on the support given, including external assistance whenever necessary, and on the general socioeconomic development. WPR/RC26/4 page 40 In some South-West Pacific areas, technical difficulties were experienced due to A. farauti's habit of biting outdoors in the early evening, a phenomenon thought to have become more pronounced following DDT indoor spraying. It appears that the problem is largely confined to areas where vector densities are extremely high. In those areas, the introduction of additonal attack measures seems to be indispensable. Such measures have been undertaken in the British Solomon Islands Protectorate, and it is hoped that the difficulty will be overcome. Multi-drug resistance of P. falciparum appears to be spreading, and low-level resistance has been shown to be widely distributed in Peninsular Malaysia and the Philippines. With the exception of Sarawak, where the incidence of malaria has been brought down to a very low level, the British Solomon Islands Protectorate, New Hebrides, Papua New Guinea, and perhaps Timor, choloroquine resistant strains of P. falciparum have been found in all places where this parasite is endemic. 4.2.3.2 Operational difficulties Peace and order are prerequisites for an effective antimalaria programme. Operations were severely hampered in some countries where insecurity rendered certain areas virtually inaccessible. In the majority of countries, certain popUlation groups at malaria risk were difficult to reach to institute effective control operations, due to the prevailing conditions of terrain and communica- tions. The semi-nomadic way of life of some communities and the use of temporary shelters added to the difficulties. In such areas, probably because of inadequate support and orientation of staff, the contribution of the rural health services to antimalaria activities remained, with few exceptions, below expectations. Elsewhere the prolonged DDT indoor spraying campaign encountered growing resistance from the population necessitating a shift from DDT wettable powder to the more acceptable, but more expensive, DDT emulsion. 4.2.3.3 Administrative constraints There was a great variety of administrative constraints, but two appeared to be outstanding: lack of financial support and training. Although there is no strict parallel between income per capita and progress made in an antimalaria campaign, as technical, operational and other administrative factors are also involved, there is little doubt that progress is greatly influenced by the amount of financial support available. For example, governments with sufficient funds have been able to strengthen their health manpower by recruiting expatriate officers. This has happened in British Solomon Islands Protectorate, Brunei, Malaysia and Papua New Guinea. " .. WPR/RC26/4 page 41 The maintenance of gains and further progress, in areas without excessive operational difficulties, will greatly depend on the availability of funds for support of field operations, including the supply of commodities. Where national resources are inadequate, the continuation, reinstatement or augmentation of external assistance will be a decisive factor. Despite tremendous achievements during the last decade in the development of health manpower for malaria activities, there remains a continuous need for training in malariology throughout the Region, particularly in the South-West Pacific and Cambodia, Laos and South Viet-Nam. WHO and UNDP are giving full attention to this aspect. In some instances, difficulties are experienced with the recruitment of suitable candidates. There are some technical and operational difficulties, beyond control at present, which will prevent the achievement of optimal results. Sustained support of control programmes by governments, where necessary augmented by international and bilateral assistance, will be required to overcome the administrative hurdles jeopardizing achievements and preventing further progress. In the absence of a major scientific breakthrough in antimalarial technology, the support of governments is required in research, to elucidate and solve the technical and operational problems. 4.3 Parasitic diseases other than malaria 4.3.1 Filariasis The intercountry filariasis advisory services project continued to assist with filariasis survey and control in certain countries and territories in the South Pacific. In the Ellice Islands, mass drug administration commenced in July 1972, using diethylcarbamazine citrate at 6 mg/kg body weight, once a week for 12 weeks, followed by once a month for 12 months. The drug was administered to 91% of the population in Funafuti atoll with 78% taking the prescribed 24 doses. A post control assessment in 1974 showed that the microfilarial rate of several islands had dropped from an average of about 20% to less than 1%. The infection rate of Aedes polynesiensis also fell substantially. In Niue, mass drug administration was carried out in 1972 on the same basis as in the Ellice Islands. Post control assessments were planned for early 1975. A survey was undertaken on three islands of the New Hebrides. The microfilarial rate in periodic Wuchereria bancrofti was about 10%. In nearly 200 Anopheles farauti dissected, the infection rate was 6.7% and the infective rate 1.1%. These data will be used in an assessment of the incidence of filariasis after DDT spraying for antimalaria purposes, since the vector mosquito is the same. WPR/RC26/4 page 42 The Fourth WHO/SPC Joint Seminar on Filariasis and Vector Control was held in Apia, Western Samoa, from 1 to 10 July 1974. Seventeen participants from 13 countries and territories in the South Pacific attended as well as 7 observers. One of the conclusions was that for mass drug administration at least one round of diethylcarbamazine citrate at 4-6 mg/kg body weight, with a total dosage of not less than 72 mg/kg, was required and that timing of the operation should be determined by local conditions. 4.3.2 Amoebiasis A high incidence was reported from South Viet-Nam and the Trust Territory of the Pacific Islands (over 2000 cases/year). WHO would welcome requests for assistance in this field. 4.3.3 Common intestinal helminthiasis Although the statistics are incomplete, surveys indicate a high prevalence of these infections in most of the developing countries in the Region. In many instances, the nature and extent of the problem has not been adequately defined nor has much attention been given to control because other concerns have had higher priority. During the period under review a consultant assisted Guam in evaluating the island-wide antihelminthiasis campaign. 4.3.4 Schistosomiasis The incidence of schistosomiasis continued to be a major problem in the Philippines. It persisted in Cambodia, though its exact distribution outside Kratie has not been determined, some areas of the People's Republic of China and Khong Island in Laos. It is no longer considered a major problem in Japan. In the Philippines, control through agro-engineering methods continued. A team consisting of an epidemiologist, a malacologist and an agro-engineer, provided by WHO, evaluated the World Food Programme-assisted control of schistosomiasis through agro-engineering measures project. It was concluded that the attempts at control merely scratched at the surface of a very substantial problem. It was recommended that control be closely coordinated with the long-term development programmes of other government agencies such as the National Irrigation Authority. 4.4 Smallpox eradication No cases were reported in the Region. In most countries of the Region, smallpox vaccination continued to be included in routine immunization campaigns. , 4.5 Bacterial diseases 4.5.1 Cholera WPR/RC26/4 page 43 During 1974 El Tor cholera was endemic in Cambodia, the Philippines and South Viet-Nam. Outbreaks occurred in Peninsular Malaysia and Sarawak and there were isolated outbreaks in Guam and Singapore. Whether the latter were due to imported or indigenous vibrios is not known. As in 1973, most isolates were of the Ogawa immunotype. In all, 1833 cases, with 40 deaths, were notified from the above-mentioned countries between the end of June 1974 and early May 1975. A WHO consultant assisted the Philippines with the epidemiological surveillance of enteric infections. Observations had suggested that early oral administration of glucose-electrolyte solution could prevent dehydration from diarrhoea. In January 1975, staff from WHO Headquarters and a consultant assisted the Government of the Philippines in elaborating a protocol for a WHO- sponsored programme of research on the effectiveness of oral rehydration in domiciliary treatment of diarrhoeal diseases in a rural community. The programme itself commenced in Bacolod in May 1975. Should the technique prove effective, its use could be extended to a larger number of developing countries for combating cholera and other diarrhoeal diseases. 4.5.2 Plague Plague continued to occur exclusively in South Viet-Nam, where incidence has been generally high since 1966, with 400 to 5000 cases reported annually. In 1974, 1552 cases, including 108 deaths, were reported. WHO provided a sanitarian to assist in strengthening the qUarantine services and a consultant in plague-oriented rodent control, who placed emphasis on the need for a plague control unit in the Ministry of Health. 4.5.3 Enteric fever (typhoid/paratyphoid fever) The incidence of typhoid and paratyphoid fever continued to decrease in the Republic of Korea during 1974; 656 cases, including 7 deaths, were reported, an eight-fold decrease compared with 1969. Improved water supply is believed to be the main factor responsible for this improvement. In Malaysia and the Philippines, the incidence of enteric fever increased. In the Philippines a WHO consultant assisted in strengthening enteric fever surveillance. His conclusions pointed to water rather than food as the probable vehicle of transmission. Conversely, the 200 cases of typhoid fever reported from Singapore during January 1975 appeared to be conveyed mainly by "laksa", a coconut snack popular among Malays. WPR/RC26/4 page 44 In both the Philippines (City of Manila) and Singapore, efforts were made to ensure: longer hospitalization with repeated bacterio- logical examination; bacteriological follow-up of discharged patients; and thorough treatment of carriers. Only one among 253 strains of Salmonella typhi isolated in Japan during 1973 was found, by the National Institute of Health, Tokyo, to be resistant to chloramphenicol, tetracycline, streptomycin, kanamycin and aminobenzyl penicillin suggesting that, in general, these anti- biotics can still be relied upon in the treatment of typhoid fever. 4.5.4 Diphtheria, pertussis and tetanus Diphtheria and tetanus remained under satisfactory control in Hong Kong, Japan, New Zealand, Singapore and most of the islands of the South Pacific. In Malaysia and the Republic of Korea, the incidence of diphtheria continued to drop. It is encouraging to note that the decreasing incidence of both diphtheria and tetanus observed in these countries seems to be largely attributable to effective immunization. In the Philippines the number of reported cases of diphtheria increased two-fold between 1971 and 1972. A consultant who assisted in carrying out a survey and advised on the organization of control programmes concluded that every effort should be devoted to the immunization of young infants up to 2 years of age, in order to stop the upward trend of diphtheria incidence. Tetanus was also a serious problem, causing the deaths of over two thousand newborn children. To cope with the problem, there seems to be no alternative but to attempt to extend vaccination against tetanus to all pregnant women. The Government is planning to increase the production of DPT vaccine with the assistance of UNICEF. Epidemiological information on the incidence and control of pertussis is either scarce or unreliable. There has been some controversy regarding untoward reactions occurring after administration of pertussis vaccine. For this reason the Government of Japan adjusted its policy in 1975 by encouraging vaccination against pertussis on an individual basis rather than through mass immunization. In Singapore, acceptance of the pertussis component of DPT vaccination has been optional since 1971. There was some hesitation to vaccinate against pertussis among paediatricians in the Republic of Korea because of the untoward reactions. In considering this problem, it is important to note that prudence in the choice of B. pertussis strains and bacterial quantity are major factors in ensuring the safety and efficacy of the vaccine. 4.5.5 Streptococcal infections Through lack of specific laboratory services for streptococcal infections, epidemiological information on streptococcal sore throat, rheumatic fever, streptococcal pyoderma and acute glomerulonephritis is fragmentary. Nevertheless, there is evidence which suggests that streptococcal infection might be a major cause of rheumatic carditis and glomerulonephritis in the Region. - WPR/RC26/4 page 45 A WHO consultant provided assistance in assessing the streptococcus surveillance programme in Singapore. The annual incidence of rheumatic fever was found to be 6.4/100 000 for all ages and 18.8/100 000 for children aged 5 to 14. Beta haemolytic streptococci were found in 72.2% of young patients with skin diseases. Cases of rheumatic fever were treated by intramuscular administration of benzathine penicillin (1.2 million units/month) to prevent recurrence, which was recorded in only 4 out of 270 cases under surveillance. It was suggested that this type of surveillance programme be extended to other areas in the Region by designating the National Streptococcal Reference Centre in Singapore a WHO Collaborating Centre for Streptococcal Infections. 4.6 Mycobacterial diseases 4.6.1 Tuberculosis Since effective antituberculosis drugs were introduced and scientific proof of the protective value of BCG vaccination against tuberculosis was obtained after the Second World War, mortality and morbidity of the disease have shown a remarkable and steady reduction in almost every country in the world. The speed of these reductions has varied a great deal, depending to a considerable extent on the organization and efficiency of national tuberculosis control services. WHO, in the light of practical experience in developing countries, has formulated a number of guiding principles for the organization of effective national tuberculosis control programmes, namely: (1) the programme must be nationwide as in many countries tuberculosis is widespread in rural as well as in urban areas. In some Asian countries, over 80% of the population lives in rural areas. Among this group there is often a higher prevalence of infectious tuberculosis which has never been diagnosed, and as a result response to treatment with modern drugs is usually quick and persistent; (2) existing personnel working in the peripheral health and medical institutions must be trained for the purpose of expanding control activities to every part of the coun'try. Because these workers often have to carry out other health activities and the duration of the training in tuberculosis control is short, they need close supervision and refresher training periodically; (3) methods for mass application have to be specific, accurate, simple, time-saving, acceptable to the recipients and low in cost. Direct vaccination with BCG of young children and the use of sputum microscopy as the primary method of case-finding are good examples of such methods; WPR/RC26/4 page 46 (4) to obtain the best cooperation, first priority in receiving treatment - which should be provided free - must be given to patients with symptoms, generally highly infectious, who are also well motivated. Recovery of this category of patient is a very effective measure in terms of cost benefit and at the same time ensures the protection of a large number of the rest of the population; (5) all the methods adopted in a national tuberculosis programme must be applicable with the existing and immediately available resources. Sophisticated and expensive methods of diagnosis and treatment, which might be suitable on an individual basis, are not useful in a mass control programme. These principles are accepted and applied widely in the Region. Services for tuberculosis control, including prevention, case-finding and treatment, are improving year by year. WHO assistance to national tuberculosis programmes is provided mainly by the intercountry regional tuberculosis control team. During the period under review, the members, individually or as a team, visited American Samoa, Laos, Malaysia, Papua New Guinea, Philippines, Republic of Korea, South Viet-Nam and Western Samoa. A WHO adviser was assigned to Honiara, British Solomon Islands Protectorate in April 1975 to assist in strengthening the control acti- vities, including vaccination with BCG, which had been started as early as 1950. He is expected to assess current activities and to train district health workers in methods of prevention, case-finding and home treatment. In Cambodia, tuberculosis control activities were confined to Phnom-Penh. Additional material assistance was approved in March 1975. The tuberculosis programme in Malaysia progressed well. In Sarawak, assistance was provided in assessing the results of vaccination with BCG. The programme in Peninsular Malaysia is one of those visited each year by participants in the tuberculosis course organized by WHO and the Japanese Overseas Technical Cooperation Agency (see Part II, page 99). To strengthen tuberculosis control within the development of health services project in Laos, national vaccinators and peripheral health workers were trained by members of the WHO intercountry team in case- finding techniques. In Papua New Guinea, assistance was provided in reviewing the epidemiological situation with regard to tuberculosis, particularly in the highland areas, leading to a recommendation for a change in the vaccination strategy. A district near Port Moresby was selected as the pilot area for trial of an integrated tuberculosis control service operated by existing staff of the general health services who would also be trained in collecting basic information for assessing the prevalence and distribution of tuberculosis in the country. • • WPR/RC26/4 page 47 During the period under review the programme in the Philippines expanded. A further group of provincial coordinators for tuberculosis control activities in the provinces was trained, which means that the reorganized integrated tuberculosis control services should cover a total of 42 provinces by the end of 1975. The WHO intercountry team carried out an assessment and gave additional training in some provinces, resulting in improved implementation of the programme. Active negotiations are under way between the Government and the Philippine Tuberculosis Society regarding the organization of a national tuberculosis institute for the training of health workers. In the Republic of Korea the national tuberculosis programme, already in operation for 13 years, continued to make good progress. The third survey of tuberculosis prevalence was launched in March 1975; the results are awaited with great interest. The national programme is one of those visited each year by participants in the tuberculosis course organized by WHO and the Japanese Overseas Technical Cooperation Agency (see Part II, page 99). In Singapore the second survey of tuberculosis prevalence was launched on 7 April 1975, with assistance from the WHO intercountry team in selecting a sample population. The survey also extends to cardiac and renal diseases. In South Viet-Nam efficiency in terms of case-detection and number of cases under ambulatory treatment was found to be much higher in those provinces with organized tuberculosis services than in the Capital and those provinces without organized services where a traditional approach was still followed. Plans were made for expansion of the integrated tuberculosis control service to additional provinces, and with the assistance of WHO, a system for checking the efficiency of the case-finding activities carried out by the provincial laboratories was established. The tuberculosis course organized by WHO and the Japanese Overseas Technical Cooperation Agency was completed on 25 October 1974 (see also P art II, pages 98-102 and Part IiI, page- 137). Most of the equipment supplied by UNICEF for the production of freeze-dried BCG vaccine was delivered to the Regional BCG Vaccine Production Centre, Alabang, Philippines. Trial production is expected to commence in mid-1975. 4.6.2 Leprosy The effect on the life of a patient, both personal and in the community, of the discovery that he has leprosy is often unrelated to his degree of illness or mental state. Patients are barred from normal social activities within the community and the family, long before signs of the disease are visible. In many communities, such people are not accepted even after it has been proved that they are not infectious and not dangerous to others. The traumatic effect on the patients, which always leads to concealment and withdrawal, is the result of ignorance, fear, myth and superstition and is totally unwarranted • WPR/RC26/4 page 48 The advent of effective antileprosy drugs at the beginning of the Second World War made possible the domiciliary treatment of leprosy. A public health approach, highly recommended by WHO, permits patients to remain with their families while under treatment. Their relation- ship with the family and the community thus remains intact. When complications arise they can be treated at general hospitals for the shortest possible period of time. A diagnosis of leprosy was, in the past, made only by highly trained dermatologists or leprologists. Emphasis in diagnosis is now placed on bacteriological rather than morphological differentiation of skin lesions. With this change in emphasis, multipurpose health workers at the periphery can be trained and given the responsibility for leprosy case-finding and supervision of domiciliary treatment. They can in fact be utilized to supervise home treatment and also to carry out preventive measures against other diseases. Health education of the patient and his family, starting at the time of diagnosis, can be applied as psychotherapy and can prevent disability. These criteria have been followed by WHO in assisting national leprosy control services in British Solomon Islands Protectorate, Laos, Malaysia, New Hebrides, Philippines, Republic of Korea and South Viet-Nam. In the New Hebrides, 10 medical assistants, 11 nurses and 53 dressers had been trained by the end of 1974 with emphasis on early diagnosis of leprosy, follow-up of patients, surveillance of contacts, prevention of disabilities, health education and organization of a leprosy control service. Good results were achieved in case-finding, with 425 cases on the active register. Voluntary contributions continued to be received through the WHO Voluntary Fund for Health Promotion for various countries, from the German Leprosy Relief Association, the Order of Malta, the Lepers' Trust Board, Inc. of New Zealand and the Sasakawa Memorial Health Foundation, Tokyo. The first seminar on cooperation in Asia in the control of leprosy was organized during the first week of December 1974 in Tokyo and Okayama, Japan, by the newly established Sasakawa Memorial Health Foundation. Directors of national leprosy programmes from twelve south-east asian countries and two representatives of WHO attended. 4.7 Viral diseases 4.7.1 Poliomyelitis In Papua New Guinea, the Philippines and South Vie t-Nam , the incidence of poliomyelitis was high in 1974 because the coverage of their poliomyelitis vaccination programmes was low. The Republic of Korea recorded the lowest incidence since 1965, with only 22 cases - WPR/RC26/4 page 49 reported. In Peninsular Malaysia, where a programme using live vaccine was implemented following a large epidemic in 1972, incidence in 1974 remained low. Four cases were reported from French Polynesia. The small number of cases (4) notified in Laos during 1974 could have been due to underreporting. In other countries of the Region, poliomyelitis was under satisfactory control. 4.7.2 Japanese encephalitis There was no major epidemic in the Region during the period under review. Sera from about 400 suspected cases were examined in the Republic of Korea. Official statistics indicated at least 126 aetiologically confirmed cases. 4.7.3 Dengue fever/dengue haemorrhagic fever Four thousand two hundred and sixty-one cases were reported in South Viet-Nam in 1974. Many factors suggest the likelihood of a large epidemic during the 1975 rainy season. WHO assistance in vector control was provided to Peninsular Malaysia for the 1974 epidemic season. 1482 cases were reported; but the out- break was quickly brought under control. Despite the absence of systematic control, low incidence was observed in the Philippines. Vector control and source reduction campaigns were intensified in Singapore. Although vector mosquito density was low throughout the year, dengue virus transmission continued, with approximately 200 cases. During the period under review there were extensive outbreaks of dengue fever in the South Pacific area beginning in May and June 1974, when 1243 of the 7000 residents of Nauru were stricken by Type 1 virus which had been absent for 30 years. From August to December 1974, 5746 cases caused by Type 1 virus occurred among the population of 63 000 of the Gilbert and Ellice Islands. Sporadic outbreaks of Type 1 dengue fever occurred in the Trust Territory of the Pacific Islands, 26 cases being reported from April to the end of November 1974. Dengue fever due to Type 1 virus also spread to Tonga, where 303 cases were reported from July to October 1974. Fiji was attacked early in 1975, more than 2000 cases being reported from January to March. WHO assistance was made available to the afflicted countries and territories. 4.7.4 Measles Reliable statistics on measles outbreaks have not been available in the Region. Immunization with live vaccine is carried out in Australia, Japan and New Zealand. During the period under review Malaysia made plans for a vaccination programme. 4.7.5 Hepatitis A (infectious hepatitis) Only a limited number of countries in the Region were able to provide reliable reports on the occurrence of hepatitis A. During 1974, there were 3895 cases in New Zealand, approximately 2500 in Australia and 304 or over in South Viet-Nam. WPR/RC26/4 page 50 4.7.6 Influenza No major epidemic of influenza occurred in the Region during the reporting period. All the strains of influenza A virus isolated in Australia, Hong Kong, Japan, the Philippines, Republic of Korea and Singapore were H3N2 variants with only minor antigenic differences. 4.7.7 Rubella In January a rubella vaccination programme was officially approved in Japan. Schoolgirls between the ages of 11 and 13 (5th and 6th grades) are encouraged to take a single inoculation of live vaccine. The possibility of secondary transmission is reportedly negligible. 4.7.8 Korean haemorrhagic nephrosonephritis (Korean haemorrhagic fever) Despite previous failures to ·isolate·the causative agent, a viral aetiology seems highly likely. During 1974, 106 cases were reported from the two Provinces in the classic endemic area. Since 1973 the search for an aetiologic agent has been extended, by the WHO Interregional Vector Ecology and Control Research Unit (VECRU) in Seoul, to small field mammals. The National Institute of Health, Seoul and the Arbovirus Research Unit, Yale University, United States of America, collaborated with VECRU until it ceased operation, after six years at the end of 1974. Results of virus isolation tests on 304 urine specimens from small field mammals and nearly 20 blood specimens from patients were negative. Since an arenavirus such as lymphocytic choriomeningitis virus, Junin virus (Bolivian haemorrhagic fever) or Lassa fever virus was strongly suspected, sera collected from 400 small field mammals were tested for antibody against a few arenagroup viruses. No evidence of infection was obtained. Since early 1975, the search has been directed to patients and well-documented cases. More sophisticated techniques such as immunoelectronmicroscopy have been applied to confirm antigens presumed to be viral in material from patients. 4.8 Venereal diseases and treponematoses In the absence of mandatory notification bf venereal diseases, statements regarding incidence cannot be based on available statistical reports. Contact-tracing and rational standard treatment are usually carried out only in urban centres. In Papua New Guinea, the emergence of venereal syphilis along a new highway was reported and a warning was given that there might be asexual spread among children in adjacent areas. Donovanosis in an urban area reached the high rate of 175.5 per 100 000 in the space of one year. Singapore intensified control measures and introduced a computerized register for venereal diseases. In the Republic of Korea and Singapore, efforts to combat venereal diseases centred on control of prostitutes. - -WPR/RC26/4 page 51 Some countries are considering the extension of venereal disease control services to peripheral areas, but the necessary concomitant development of laboratory services usually creates difficulties. Cases of yaws were reported from some parts of the Region. Limited re-emergence was observed in islands of Papua New Guinea. Developments in the control of venereal diseases could usefully focus on the improvement of surveillance through more complete reporting. 4.9 Veterinary public health Cases of rabies were reported from the Philippines, the Republic of Korea, and South Viet-Nam. The Philippines is studying the feasibility of large-scale production of vaccine for dogs before launching a country-wide rabies eradication campaign. 4.10 Vector biology and control 4.10.1 Vector control in general With WHO advice and assistance, a vector control unit is being established in the Department of Medical Services, Sarawak, and similar units are to be set up in the Department of Medical Services, Sabah, and the Ministry of Health, Malaysia. Assistance was provided for the same purpose to Fiji, following the recent outbreak of dengue fever, and to the Philippines and Western Samoa. 4.10.2 Aedes aegypti survey and control Out of 32 countries or areas in the Region,Ae. aegypti is present in at least 24. It has been found in many new localities (such as Honiara in the British Solomon Islands Protectorate and Kota Kinabalu in Malaysia), and it has also spread to inland areas. Emergency assistance was given by WHO to control this mosquito during the outbreaks of dengue/dengue haemorrhagic fever in Fiji and Tonga in early 1975, and to obtain fenitrothion (Sumithion). WHO-assistance in surveying and controlling Ae. aegypti was also provided to American Samoa, Malaysia, Nauru, New Hebrides, Papua New Guinea, the Trust Territory of the Pacific Islands and Western Samoa. After a few applications of Abate to control the larvae, Ae. aegypti has been eliminated in two out of the three localities in Brunei where it was previously found. Revised technical guides for vector surveillance and control were prepared during the Second Meeting of the Technical Advisory Committee on Dengue Haemorrhagic Fever, held in Bangkok from 26-28 February 1975. As requested in the Technical Discussions which took place during the twenty-fifth session of the Regional Committee, a list was prepared, for easy reference of governments, of the places in the Region where spraying equipment and insecticides for Ae. aegypti control could be procured at short notice during an outbreak of dengue haemorrhagic fever. WPR/RC26/4 page 52 4.10.3 Vector control training Assistance was given in conducting national courses on vector and rodent control in Sarawak, Sabah and Peninsular Malaysia, and in the Republic of Korea. A two-week course on the biology and control of urban rodent and vector populations was held in Singapore in November 1974. Twenty-two participants from 12 countries and areas attended. The course was sponsored jointly by WHO and the Danish International Development Agency, with the assistance of the Ministry of the Environment, Singapore. 5 NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL 5.1 Cancer It is now generally recognized that mortality and morbidity from neoplastic diseases have been increasing in both the industrialized and the developing countries. Recent reports have clearly shown that crude rates of mortality from malignant neoplasms have risen considerably, though in varying degrees, in almost all countries. This trend has been attributed partly to the increasing average age of the population and partly to improved diagnostic facilities together with increasing public awareness of the disease. In all countries there is a clear difference between the sexes in the frequency of neoplasms of various sites. In females, neoplasms of the breast and cervix uteri predominate, while in males, the lung, stomach and nasopharynx are affected most frequently. Information on the attack rates of neoplastic diseases of various sites is inadequate in almost all areas. Available data are mostly derived from notifications from hospitals, clinics or laboratories, which do not show the true distribution. During the period under review a consultant assisted the Philippines in reviewing the community-based cancer control service introduced in 1968. The cytological survey for cervical cancer being carried out in Rizal Province was found to be progressing well. Over 4500 women had been examined. Prevalence appeared unusually low, although the results will have to be confirmed by detailed evaluation. The consultant found that the Central Tumour Registry had recorded, coded and tabulated a total of more than 20 000 cases. Consultant services were also provided to Fiji and South Viet-Nam. 5.2 Cardiovascular diseases Cardiovascular diseases have recently become a major cause of death and morbidity, even in countries with a primarily agricultural economy, and there are signs that the problem is becoming even more , President Ferdinand E. Marcos and Mrs Imelda R. Marcos of the Republic of the Philippines received Dr Francisco J. Dy and participants in the Second WHO Regional Seminar on the Prevention and Control of Cardiovascular Diseases at the Malacanang Palace in Manila. Lower photograph shows the seminar participants visiting the Philippine Heart Center for Asia, a project of Mrs Marcos and the Heart Foundation of the Philippines. WPR/RC26/4 page 53 serious. Control of the major communicable diseases, improvement of living standards and increasing life expectancy lead to an increase in the frequency of chronic degenerative diseases, of which cardio- vascular diseases are the most important. A major task in medicine today is not only to expand the services for diagnosis and treatment of these diseases in urban areas of developed countries, but to try to prevent the anticipated increase of the problem in rural areas of developing countries. Although knowledge of the aetiology and control of cardiovascular diseases has grown considerably in recent years, its practical application has in general been less satisfactory in most countries. The reason may be that health authorities have given the problem low priority. One of the main obstacles is that too much emphasis has been placed on clinical practice, rather than study of the aetio1ogica1 and ecological factors affecting development of the diseases. Because of the widespread distribution and increasing frequency of cardio- vascular diseases throughout the world, a community approach to the problem is required. The present situation can be improved only if existing knowledge of prevention and control can be applied widely within the general health services. The second regional seminar on the prevention and control of cardiovascular diseases was held in Manila from 31 March to 5 April 1975. Eleven participants from 11 countries or areas attended. While discussions during the first seminar on the subject, held in 1968, emphasized rheumatic fever, rheumatic heart disease and disorders related to infections, the second seminar reviewed important problems such as hypertension and ischaemic heart disease, which are increasing in many countries of the Region. It was concluded that, while the incidence of rheumatic fever and rheumatic heart disease may be expected to decrease in many parts of the world, as a result of improving socioeconomic conditions, the establishment of registers and measures for eliminating the secondary causes of rheumatic fever and rheumatic heart disease should be a priority throughout the Region. Studies on the control of hypertension and ischaemic heart disease were also recommended for some countries. The inauguration of the Heart Center for Asia in the Philippines on 14 February 1975 aroused considerable interest in epidemiological research on cardiovascular diseases. With assistance from consultants provided by WHO, Fiji, Singapore and Tonga established registers of rheumatic fever and rheumatic heart disease. Such registers are undoubtedly valuable in ensuring follow-up of patients and maintenance of prophylactic treatment for streptococcal infections. 5.3 Metabolic diseases Cases of diabetes mellitus discovered during a survey conducted with WHO assistance in Tonga in 1973, together with new cases, have been registered, treated and followed up at the General Hospital in Nuku'a1ofa. WPR/RC26/4 page 54 5.4 Dental health During the period under review the intercountry dental health adviser visited Cambodia. Fiji. Malaysia, Papua New Guinea, Republic of Korea and Singapore. In Cambodia. the advisory services covered training in dental technology, especially in relation to the management of maxillofacial injuries, and training and utilization of dental auxiliaries. In the Republic of Korea, advice was given on the development of a special category of dental hygienist for utilization as necessary in clinical or non-clinical areas. In Fiji, the advisory services extended to training dental therapist tutors and organizing a national seminar. A WHO consultant in prosthodontics assisted in conducting an intensive course for practising dentists and helped to train dental technicians. Teaching texts, visual teaching aids and models in prosthodontics were developed. In South Viet-Nam, the dental nurse tutor and the intercountry dental health adviser assisted in designing equipment to be made in the country itself. A WHO-assisted course in public health dentistry was organized by the Government of Malaysia and the Government of Singapore from 1 May to 30 June 1975. The course. which was related to successful dental health programmes in Malaysia and Singapore, reflected the increased interes.t shown in the Region in improving national dental care programmes. It aimed at identifying areas where dental care could be integrated into other health services, and demonstrating suitable patterns of basic dental health services in urban. semi-urban and rural situations. Attention was also paid to dental health planning and management. 5.5 Mental health Although relatively low priority is accorded to mental health in many countries of the Region, because .of other more pressing health needs and limited resources, growing concern has been observed, particularly in countries where the problem of drug dependence is increasing. During the year fellowships were awarded for training in mental health and, following the recommendations of the seminar on mental health: teaching of psychiatry in medical schools, held in Manila from 15 to 21 January 1974, efforts were made to strengthen the psychiatric training given to medical students. Consultant services were provided to Laos to assist in strengthening its mental health services, in particular the training of personnel in psychiatric care, the improvement of facilities and extension of the scope of psychiatric care to include drug dependents, epidemiological investigations to study the nature and extent of the problem, and health education of the public. • -A course in the clinical and laboratory aspects of pros- thodontics was given to dental practitioners and tutors in the Suva Dental Centre, Fiji by a WHO consultant, Dr T.G. Goodall. Participants also included dental officers from Tokelau and the Gilbert and Ellice Islands. Assistance in dental therapist/hygienist training was given under the intercountry dental health advisory services project. WPR/RC26/4 page 55 5.5.1 Prevention and control of alcoholism and drug dependence The growing concern of countries in the Region with problems associated with drug dependence and alcoholism was reflected in resolutions adopted bI the Regional Committee at its twenty-third and twenty-fifth sessions. In pursuance of these resolutions, a number of activities were initiated during the period under review. Assistance was provided to the Philippines by two consultants in collecting data on epidemiology, patterns of drug abuse, and available facilities for treatment, rehabilitation and research. Assistance had been provided to Malaysia for a similar epidemiological study in 1973. To formulate a strategy for combating the problem of drug dependence, a working group on measures for the prevention and control of drug dependence, the first of a series which will consider different aspects of the prob'lem, was held in Manila from 9 to 17 December 1974. The need for a balanced programme, combining treatment and rehabilitation, and educational, legislative and sociocultural approaches was emphasized. The Group recommended that assistance be provided to governments in collecting epidemiological data, planning and developing courses of action, training personnel in methods of treatment and rehabilitation, and evaluating the progress of control programmes. In the Philippines, assistance was provided to the College of Education, University of the Philippines, in introducing preventive education on drug abuse into schools. Curricula were developed for students of various ages, and materials designed for use in schools and for teaching young people outside school. A WHO consultant assisted South Viet-Nam in establishing a national centre for the treatment and rehabilitation of drug dependents. 5.6 Biomedical aspects of radiation The use of radiation and radioisotopes for medical and other purposes remains highly developed in some countries of the Region while, in others, particularly in rural areas, even the most essential basic X-ray diagnostic procedures need improving and strengthening. During the period under review significant steps were taken to expand and improve the medical use of radiation and radioisotopes. There are in most countries fully qualified medical specialists able to develop radiation medicine to meet the needs at all levels of medical care; but there is generally a shortage, or even a lack of, supporting services, due to the scarcity of qualified physicists, and engineering and radiological technicians. lReso1ution WPR/RC23.R8, Handbook of Resolutions and Decisions of the Re ional Committee for the Western Pacific, 1974, 8th ed. section 1.7.4, page 109; resolution WPR RC25.R3, Report of the Regional Committee, twenty-fifth session, 1974, Part IV, page 31. WPR/RC26/4 page 56 Care and maintenance of medical equipment are often neglected, leading to rapid deterioration which sometimes prevents its proper use. In addition, some countries do not have planned repair services, with the result that equipment is often out of order for long periods of time or is operated far below its capacity. It has been noticeable that improvements in this regard are being made in some countries. Assistance was provided to Laos, Malaysia and the Philippines in developing national medical equipment maintenance programmes. Assistance was also provided to the British Solomon Islands Protectorate, Cook Islands, New Hebrides, Niue, Tonga and Western Samoa. Significant improvements were made in radiation dosimetry. Assistance in radiation health was provided to Malaysia, the Philippines, the Republic of Korea and Singapore. The joint IAEA/WHO postal dose inter-comparison service for checking the dosimetric procedures in connexion with radiation continued, with the participation of 23 institutions in 8 countries and the postal personnel radiation monitoring service was continuously provided to 13 institutions in 4 countries. While main emphasis in the regional programme remained on improvement and expansion of the medical uses of radiation due attention was also paid to radiation protection. Malaysia, the Philippines and the Republic of Korea were assisted in establishing national programmes for this purpose. 6 PROPHYLACTIC AND THERAPEUTIC SUBSTANCES 6.1 Specifications and quality control of pharmaceutical preparations In Cambodia, a WHO consultant assisted in preparing an overall plan of phased development for drug quality control and production, and drew up a project document for submission to UNDP. The same consultant carried out a similar assignment in South Viet-Nam. In the Republic of Korea, a WHO consultant is assisting in the structural identification of natural products and medicinal drugs, and the separation, identification and quantitative analysis of pesticides and medicinal drugs. 6.2 International standards for biological products With the increasing emphasis on immunization programmes, considera- tion is being given to large-scale vaccine production and WHO is providing assistance for this purpose to a number of countries. In a project to produce LEP rabies vaccine in the Philippines, the initial phase to standardize production techniques was completed during the period under review. Production should eventually reach 300 000 doses a year. .. - WPR/RC26/4 page 57 A second project for industrial-scale production of DPT vaccine, using fermentors, was initiated with the assistance of UNICEF. It is expected to raise production capacity from 200 000 doses, which represents 10% of the needs, to four million doses a year. A WHO consultant assisted in the preparation of a long-term develop- ment programme for the Institute of Immunology, Hong Kong, which should lead to improved production, particularly of tissue culture vaccines. Quality control remains an aspect that is much neglected in vaccine production. Too often there is confusion between the control that takes place in the production laboratory itself and the responsibilities of the quality control laboratory which has to ensure that standards have been met. When plans are considered for the development of production laboratories, equal attention must be given to the establishment of quality control facilities. 6.3 Health laboratory technology During the period under review assistance was provided in improving the quality of health laboratory services and training, and improving the technical skills of, laboratory personnel. With the extension of laboratory networks to the periphery, emphasis has been placed on training medical laboratory assistants (multiple-skill microscopists) in addition to level B laboratory technicians. l Recruited at a lower educational level, laboratory assistants require only six months' training, as opposed to a three year course for technicians. They are then able to carry out a limited number of tests, but can nevertheless provide laboratory support in major control programmes such as, for example, those against tuberculosis, malaria or filariasis. When assigned to areas where primary health care is well organized, they can be highly effective in terms of· output and cost. Assistance in training such staff is being given to Papua New Guinea at the intermediate level, the curriculum, teaching materials and close supervision being provided from the central level. ' Lack of supervisory staff in some central- and many intermediate- level laboratories has impeded the development of health laboratory services. Pathologists will not be available for many years and technologist training centres are needed to produce supervisors for intermediate- and peripheral-level laboratories who have a basic knowledge of health laboratory management, maintenance and public health microbiology. Through strengthening of management in the health laboratory services, the requirements of laboratory workers can be better defined and the workload of each technician more accurately assessed. In many countries there has been increased emphasis on refresher training and less on formal preparation of laboratory technicians. The refresher training is given either in a group or on an individual tutorial basis. ~ld Hlth Org. techno Rep. Ser., 1966, No. 345. WPR/RC26/4 page 58 Several fellowships were awarded for the training of level B laboratory technicians. It is important, however, that these technicians be trained in centres where conditions are similar to those in their own countries. In this connexion a WHO adviser was assigned to assist in strengthening the laboratory technician training centre in Fiji and improving the trainees' performance. In Malaysia, consultant services were provided to assist in the development of blood banks. In Cambodia, Laos, Papua New Guinea, South Viet-Nam and Tonga full- time staff were assigned to assist in the development of health laboratory services. With the idea of harmonizing the techniques used in different countries, a course for laboratory workers on enteric bacteriology, including cholera, was held in Manila from 30 September to 25 October 1974. One point brought forward by the participants was that lack of media, which are expensive, posed a major problem in bacteriological work in the Region. The establishment of a centre to produce and distribute media needed for public health work at minimal cost was advocated. The proficiency testing programme for syphilis serology continued, with 70%-80% of the results from the 11 participating countries or areas in the Region meeting the international standard. A WHO consultant in venereal disease serology and bacteriology will visit the laboratories taking part in the study to discuss their results. The directory of medical and allied laboratory services in the Western Pacific Region, designed to make available all pertinent information on health laboratories and thus facilitate collaboration within national health services, is in the final stages of preparation. 7 PROMOTION OF ENVIRONMENTAL HEALTH A number of national environmental health programmes in the Region made good general progress, with improvement in institutional arrangements and expansion of facilities and services. Assistance was given to the Republic of Korea in a sector study on water supply and sewerage, Laos and South Viet-Nam in the expanded programme of UNICEF assistance in the field of sanitation, and the Philippines in a comprehensive water quality management project for Laguna de Bay and the preparation of several proposals for new projects to be financed by UNDP. UNICEF continued to provide significant material assistance for WHO-assisted rural water supply projects in the Philippines, Republic of Korea and countries and territories of the South Pacific. .. A comprehensive programme of water quality management is being carried out at the Laguna de Bay, Philippines, by the Laguna Lake Development Authority (LLDA) with WHO/UNDP participation. The top photograph shows a visit to the project by 'Dr Francisco J. Dy where he met Brig. General Amado Santiago, LLDA general manager. Lower photograph shows Dr Dy with Dr Lennart Hesselvik, WHO Director of Health Services and Dr H. Lenarz, WHO Limnologist at the LLDA laboratory. WPR/RC26/4 page 59 Implementation of the long-term intercountry programme in environmental health continued, although a possible reduction in the number of review and planning missions originally envisaged for 1975 was foreseen because of budgetary limitations. The regional seminar on environmental pollution: water pollution was held in Manila from 17 to 24 March 1975. Twenty-one participants from 14 countries or areas attended with 10 official observers representing national and international agencies. 7.1 Provision of basic sanitary measures In the Cook Islands, assistance continued in drawing up plans for water supply, sewerage and drainage schemes to serve the Island of Rarotonga. In the Gilbert and Ellice Islands, assistance was given by a WHO sanitarian in drawing up a scheme for obtaining water from small wells. In Guam, assistance was provided in improving the community water supply and included the preparation of proposals for a waterworks ordinance and for drinking water standards. In Laos, the preparation of detailed plans for a phased UNICEF- supported programme in rural sanitation was followed by the provision of assistance with training courses for sanitary agents and community development personnel in the initial stages of implementation. In Malaysia, assistance to the Ministry of Health continued in planning and executing programmes for the development of state rural water supplies and sanitary facilities. Rural water supply programmes for the States of Sarawak and Sabah became well established and an extensive programme for Peninsular Malaysia was initiated in 1974. Consultant services were provided to the Ministry of Health in carrying out sewerage feasibility studies for several urban areas in Peninsular Malaysia. Assistance was also given in reviewing sewerage schemes for Kuala Lumpur and Ipoh. In Papua New Guinea, a WHO engineer provided assistance with various programmes for the improvement and construction of water supply, sewerage and other sanitation facilities. In the Philippines, a national course on the operation and maintenance of water supplies was conducted with WHO assistance. It was decided that a number of the seventeen participants would be able to assist in future training courses to be organized regularly by the Local Water Utilities Administration. Assistance was given to the Department of Health in formulating a comprehensive plan of action to improve rural sanitation planning. Construction of rural water supply and waste disposal facilities continued, with UNICEF assistance, in the demonstra- tion province of Rizal. WPR/RC26/4 page 60 In the Republic of Korea, assistance continued to the Ministry of Construction in the planning and execution of several large water supply schemes, including a project to ensure an adequate supply to the Seoul Metropolitan Area. Two WHO engineers continued to assist in the planning and execution of the Ministry of Health and Social Affairs' large rural water supply programme, and in the elaboration of plans for the construction of nightsoil treatment plants. In the South Pacific area, the intercountry environmental health advisory services project provided technical assistance to British Solomon Islands Protectorate, Fiji, Gilbert and Ellice Islands, Tonga and Western Samoa in planning rural water supply and other sanitation schemes. UNICEF continued to give significant material assistance for most of the water supply schemes. The management and disposal of solid wastes in the Saigon Gia Dinh area of South Viet-Nam were reviewed and a modest plan of action prepared. Plans for an expanded programme of UNICEF support for improvement of sanitary facilities at rural maternity centres and schools were completed. A new WHO-assisted project in this field became operational at the beginning of 1975. 7.2 Pre-investment planning In Malaysia, a WHO consultant assisted in drawing up a plan to improve the management of solid wastes in the Kuala Lumpur Metropolitan Area. In the Republic of Korea, a joint World Bank/WHO team assisted in carrying out a study of the water supply and sewerage system which included the identification of priority programmes and projects. Advice was provided by WHO on the formulation of a request to UNDP for preparatory assistance in developing a project document for a large- scale sewerage project in the Seoul Metropolitan Area. In Singapore, assistance continued to the Ministry of the Environment in elaborating a master plan for the development of closed storm drainage facilities and schemes to include designs and methods for the capture of storm water for possible reuse. This project was financed by UNDP and is expected to reach completion by July 1975. In South Viet-Nam, the UNDP-assisted water supply and sewerage in urban communities project commenced in March 1975, after a delay of one year due to difficulties in recruitment. A reformulation of the project document was envisaged, however, to determine which tasks should be subcontracted. 7.3 Control of environmental pollution and hazards Assistance was provided in reviewing the air and water pollution monitoring programme in Guam, resulting in recommendations for the addition of new activities, institution of a data collection, storage and retrieval programme, and development of manpower. - ' ... WPR/RC26/4 page 61 In Hong Kong, the progress of the UNDP-assisted treatment of agricultural wastes project was monitored. The final assessment and recommendations for future action will be made in 1976. In Papua New Guinea, a WHO consultant assisted in carrying out a survey of water pollution problems and advis~d on setting up a control programme. In the Philippines, the UNDP-financed assistance provided to the Asian Development Bank in connexion with the development of water resources in Laguna de Bay was concluded successfully (see Section '9.2.1, page 68, and 'PartIII,' page 121). Assistance was also given to the National Pollution Control Commission in formulating a medium- term programme for noise nuisance control. The preparatory phase of the UNDP-assisted national pollution control programme project in South Viet-Nam was concluded successfully in 1974. WHO also assisted in planning and conducting a national seminar on environmental pollution. A large number of participants attended this seminar, which was instrumental in impressing on government officials and the public at large the importance of preventive action in preserving or restoring the quality of the environment. 7.4 Health ofworkin& populations Assistance during the period under review included the provision of consultant services, the award of fellowships and the organization of the first regional course in occupational health. In Malaysia, the occupational health advisory services project became operational with the assignment of a WHO adviser in June 1975. The project aims at strengthening the organization responsible for occupational health, developing a national programme to protect workers against occupational hazards and establishing a national occupational health centre for research, training and demonstration. In the Philippines, a consultant helped to assess the health services and assisted in formulating a plan for the of these services in line with growing industrialization. in industrial health were awarded. industrial development Fellowships Assistance to the Republic of Korea took the form of fellowships in industrial hygiene. In Singapore, a consultant assisted in studying the scope of occupational health nursing in the country, drawing up a five-year programme of development for the occupational health nursing section of the industrial health unit, determining the qualifications, training programme and duties of occupational health nurses in the private sector, elaborating a system of supervision by the Government, and studying the feasibility of setting up a register of occupational health nurses. A fellowship in industrial hygiene was also awarded. WPR/RC26/4 page 62 The first regional course in occupational health was held at the School of Tropical Medicine, University of Sydney, from 4 November to 13 December 1974. Thirteen participants from six countries or areas in the Region attended (see Section 9.1.6, pages 66-67). A consultant in occupational health visited a number of industria- lizing countries and territories in the South Pacific area in order to assist in assessing the health and safety measures in force in small industries. Preventive health programmes to suit the individual needs of each country were recommended. The priorities defined for possible implementation were an occupational health centre in Fiji, personnel training in Papua New Guinea, a laboratory service in the Trust Territory of the Pacific Islands and an accident clinic in Western Samoa. Emphasis in all cases was placed on legislation through depart- ments of labour and closer cooperation between them and departments of health with the implementation of an occupational health service within the structure of the existing health services. 7.5 Establishment and strengthening of environmental health services and institutions During the period under review assistance was given to the following countries and territories: British Solomon Islands Protectorate, in preparing a project document for UNDP assistance to set up a training course for assistant health inspectors; Gilbert and Ellice Islands, in developing training courses for assistant health inspectors and planning and executing sanitation programmes for rural areas; Laos, in planning a course for assistant health inspectors; Malaysia, in developing national environmental health programmes and the necessary institutional support; Papua New Guinea, in the development of a comprehensive environmental health service, including advice on how to improve the course for health inspectors; Philippines, in reviewing environmental health manpower resources; manuals for health inspectors and supervisors were prepared; Singapore, to the Ministry of the Environment, in setting up manage- ment accounting for the solid waste collection and disposal system. 7.6 Food standards programme Activities continued as part of the overall environmental health assistance in Laos, the Philippines and South Viet-Nam. ... WPR/RC26/4 page 63 In Malaysia, assistance was completed in planning a national seminar and preparing a code of practice in food hygiene. In the Republic of Korea, assistance was provided in developing activities and methods to improve the national food control programme. 8 DEVELOPMENT OF HEALTH STATISTICAL SERVICES The health statistics services of a number of developing countries or areas in the Region were strengthened, to enable them to provide the information necessary for assessing the health situation, evaluating the national health and medical care services, and formulating national health plans. Efforts were made to develop health statistical services at various levels of the health administration, including improvement of recording and reporting systems, particularly at the periphery. More systematic procedures were introduced for the collection, analysis and compilation of health statistical information. The WHO statistician attached to the intercountry project assisted in improving the system of recording and reporting routine health activities at the national and peripheral levels in American Samoa, British Solomon Islands Protectorate, Cook Islands, New Hebrides, Tonga and Western Samoa. The WHO statistician attached to the intercountry family health advisory services project assisted in assessing the family health programme and improving the system for recording and reporting health activities in the Gilbert and Ellice Islands. In Laos, attention was given to ensuring the availability and adequacy of health statistical data from government hospitals and health centres for country health programming. In Malaysia, a monitoring system for communicable diseases was developed. A WHO consultant assisted in reorganizing the maternal and child health/family planning recording and reporting procedures at different levels of the health administration. A pilot study was formulated in Johore State for reorganization of the system for collecting morbidity statistics, to ensure reliability and prompt notification of communicable diseases from hospitals, out-patient clinics and the peripheral health services. A WHO consultant helped to reorganize the medical records service of a hospital in New Hebrides. In the Republic of Korea, assistance continued in organ~z~ng and strengthening the central statistical unit in the Ministry of Health and Social Affairs. Efforts were made to improve the collection of data on communicable diseases, with attention being paid to the establishment of a system for monitoring unusual occurrences. WPR/RC26/4 page 64 In South Viet-Nam, assistance was given in developing an improved procedure for collecting and processing health statistical information. Collection of data in the peripheral health services was also developed, including collection of demographic data through household surveys conducted by village health workers. 9 COOPERATION WITH OTHER ORGANIZATIONS 9.1 Cooperation with the United Nations and related agencies Good working relationships were maintained with the United Nations and related agencies on subjects of mutual interest and concern. 9.1.1 Economic and Social Commission for Asia and the Pacific (ESCAP) In September 1974 information was received that the Economic Commission for Asia and the Far East had been renamed. It was explained that the inclusion of the word "social" brought the name into line with the new concept of an integrated approach to development, whereby the Commission placed equal emphasis, in its work, on rapid economic growth and social progress. The word "Pacific", which replaced "Far East", was more acceptable in present day usage. The WHO liaison officer based in Bangkok maintained close and effective contact with ESCAP during the year. WHO was represented at the following meetings organized by ESCAP: (a) First session of the ESCAP Committee on Natural Resources, Bangkok, 5-11 November 1974; (b) First session of the ESCAP Committee on Statistics, Jakarta, 21-27 November 1974; (c) Thirty-first session of the United Nations Economic and Social Commission for Asia and the Pacific, New Delhi, 26 February - 7 March 1975. 9.1.2 Mekong Committee, Bangkok Coordination with the Mekong Secretariat continued to be effected through the WHO liaison officer with ESCAP and the Office of the WHO Representative in Bangkok. The WHO consultant on environmental health services attached to the Mekong Committee completed his assignment in September 1974. The following meetings organized by the Mekong Committee were attended by WHO staff: (a) Sixty-seventh session (special) of the Mekong Committee, Vientiane, 6-11 November 1974; - WPR/RC26/4 page 65 (b) Sixty-eighth session (plenary) of the Mekong Committee, Vientiane, 29 January - 3 February 1975. 9.1.3 United Nations Development Programme (UNDP) Moves towards decentralization within UNDP resulted in the development of closer relationships with UNDP Resident Representatives at country and regional office levels. UNDP Resident Representatives participated in meetings of WHO Representatives in Manila; and WHO, in turn, was represented at the UNDP Regional Meeting for Asia and the Pacific held in Bangkok in April 1975. At the January 1975 session of the UNDP Governing Council, the second country programme for Laos was approved, with WHO being designated executing agency for several projects. Second country programmes are in various stages of preparation. Programmes for the British Solomon Islands Protectorate, Fiji, Singapore and Tonga will be presented for approval to the UNDP Governing Council at the January 1976 session and for the Philippines and the Republic of Korea at the June 1976 session. WHO submitted the necessary information to UNDP for this purpose. During the year, annual reviews of country programmes were held in Cambodia, Philippines and the Republic of Korea with the participation of WHO Representatives and/or field staff. Tripartite reviews of a number of projects took place during the year with WHO staff participating whenever possible. New proposals were also submitted through WHO Headquarters to UNDP Headquarters, New York, in connexion with its intercountry programming for Asia and the Pacific for 1977-1981. On 1 January 1975 new procedures for the operation of UNDP programmes and projects came into effect. During the period under review special efforts were made within WHO to improve the programme delivery of UNDP- financed projects. A system is being developed whereby the implementation of individual projects is carefully monitored so that corrective action can be taken if necessary in time to improve delivery. The report and recommendations of the Third Working Group on Technical Cooperation among Developing Countries, established by the UNDP Governing Council and considered at the tyenty-fifth session of the Regional Committee were unanimously supported. The Office of the United Nations Development Programme for the Western Pacific, previously located in Apia, Western Samoa, closed on 30 July 1974. It was relocated in Manila from where it will continue to operate until further notice and. in February 1975, was renamed Regional Office for the South Pacific. lReso1ution WPR/RC25.Rll, Report of the Regional Committee, twenty- fifth session, 1974, Part IV. page 37. WPR/RC26/4 page 66 The newly appointed UNDP Regional Representative for the South Pacific and Resident Representatives for Laos and the Republic of Korea, as well as the Regional Representative for the Far East, the acting Resident Representative for Cambodia and the Resident Representative for South Viet-Nam visited the Regional Office during the year for briefing on WHO's programme. 9.1.4 United Nations Fund for Population Activities (UNFPA) The close working relationship with UNFPA was maintained: at the country level through contact with UNFPA Coordinators in the formulation and implementation of country programmes; and at the headquarters level through meetings and discussions to improve the administration and management of UNFPA activities. During the year twelve Member States in the Region received assistance from UNFPA-funded projects. Some administrative difficulties, for example in recruiting staff and planning for extension, were still encountered in the implementation of UNFPA-funded projects due to uncertainties and delay of approval from UNFPA. The amount of UNFPA funds approved for WHO-assisted projects in 1975 is US$l 374 554, against US$l 774 129 in 1974. 9.1.5 Food and A&ricu1ture Organization (FAD) Collaboration continued at the regional level with the FAD office in Bangkok. Reports on staff activities were routinely exchanged. Both offices contributed to a WHO/USAID seminar on vitamin A held in Indonesia. In Malaysia, a mutual effort was made, with the assistance of a consultant and through visits of staff from both Organizations, to help in formulating a food and nutrition policy for inclusion in the Third Development Plan. During visits to other countries, WHO and FAD nutrition advisers helped in the development of food and nutrition policies and advised on the more technical aspects of applied nutrition work. The WHO Representative in Seoul attended the Twelfth FAD Regional Conference for Asia and the Far East held in Tokyo from 12 to 27 September 1974. WHO assistance was provided to Japan in August 1974 in connexion with the Joint FAD/WHO Food Contaminant Monitoring Programme. 9.1.6 International Labour Organisation (ILO) ILO provided a consultant for the first regional course on occupational health organized by WHO in Sydney, Australia, from 4 November to 13 December 1974. The objective of the course was to give introductory training to public health administrators in general principles of prevention, treatment and rehabilitation in relation to occupational diseases and injuries, including those occurring in small-scale industries. Topics - WPR/RC26/4 page 67 presented by the ILO consultant included safety programmes in industry. occupational hygiene in developing countries, safety problems in developing countries and international occupational health. An expert in vocational rehabilitation provided by ILO participated in the rehabilitation of the physically handicapped project in Cambodia. WHO was glad to have the opportunity to submit comments to ILO on the document entitled "Sharing in development: a programme of employment, equity and growth for the Philippines" (known as the Ranis Report), which dealt with the interrelationship of economic growth, employment and income distribution. These three areas have an impact on both individual and community health. WHO was represented at the following 110 seminars: (a) Asian Regional Seminar on Social Security, National Economy and Planning, Manila, 30 September - 12 October 1974; (b) ILO Asian Regional Seminar on the Management of Family Planning Programmes, Singapore, 5-9 November 1974. 9.1.7 United Nations Children's Fund (UNICEF) A new Memorandum of Understanding on collaboration between WHO and UNICEF was drawn up during the year. It was issued on 6 January 1975 with a covering letter jointly signed by the UNICEF Executive Director and the Director-General of WHO. The letter drew attention to the following two main principles which provide the basis for continuing future collaboration between the two Organizations: "(1) each organization - WHO and UNICEF - recognizes the separate and distinct competence, responsibilities and policies of the other. Collaboration between us is a partnership between equals who share certain common concerns .;u "(2) the main focus of our collaboration is on aid to countries. This means that the most important point of contact, consultation and collaboration is at the country level." At both the regional and country levels, a close working relation- ship was maintained. UNICEF Representatives were invited to participate in WHO meetings of particular interest and concern to them. The WHO/UNICEF joint study on alternative approaches to meeting basic health needs of populations in developing countries was completed during the year and the report was issued. The Regional Office contributed to the study by providing information on innovative procedures adopted in the People's Republic of China, Laos, Papua New Guinea and the Philippines. WPR/RC26/4 page 68 9.1.8 United Nations Educational, Scientific and Cultural Organization (UNESCO) WHO was represented at the Southeast Asia Regional Man and Biosphere Meeting on Integrated Ecological Research and Training organized by UNESCO in Kuala Lumpur from 19 to 22 August 1974. 9.1.9 International Bank for Reconstruction and Development (World Bank) A consultant made a preliminary visit to the Republic of Korea in July 1974, in preparation for the visit of a WHO/World Bank mission in September and October 1975 to assist the Government in conducting a study on water supply and sewerage. At the request of the Government of the Republic of Korea, comments were submitted on a report prepared by the Academy for Educational Development, Inc., New York, United States of America, which will form the basis of a request to the World Bank for a US$40 million loan for a programme of education and training for health professions. During the year, consultants from the World Bank visited the Regional Office, seeking technical information on several aspects of environmental health and on the Mindoro rural development project in the Philippines. 9.1.10 World Food Programme (WFP) In the Philippines, during November and December 1974, a WHO evaluation team composed of an epidemiologist, a malacologist, and an agro-engineer reviewed the control of schistosomiasis through agro- engineering measures project which is supported by the World Food Programme. 9.2 Cooperation with intergovernmental organizations 9.2.1 Asian Development Bank (ADB) To date, joint programme activities between WHO and the Bank have been limited to the Philippines, where WHO provided the services of a water pollution control specialist and consultants, until the conclusion of the Laguna de Bay water resources development project in late 1974. As a result, the UNDP-assisted Laguna de Bay comprehensive water quality management project commenced in January 1975 with WHO as Executing Agency. WHO was represented at the Eighth Annual Meeting of the Board of Governors of the Asian Development Bank held in Manila from 24 to 26 April 1975. 9.2.2 South Pacific Commission (SPC) The WHO Representative for the South Pacific area and field staff in the South Pacific area kept in close touch with the Commission in regard to its various health programmes. -" WPR/RC26/4 page 69 The WHO Representative attended the Fourteenth South Pacific Conference held in Cook Islands from 25 September to 7 October 1974. A Memorandum of Understanding was signed by representatives of the eight PartiCipating Governments in the South Pacific Commission which modified the working procedures of the Commission. The annual Session of the South Pacific Commission and the South Pacific Conference will in future meet in a joint session to be known as the South Pacific Conference. As well as the Fourth Joint WHO/SPC Seminar on Filariasis and Vector Control held in Apia from 1 to 10 July 1974, WHO was represented at the following meetings of the Commission: (a) SPC Sub-Regional Training Course on Food Crops and Home Economics, Truk, Trust Territory of the Pacific Islands, 12-24 August 1974; (b) Fourteenth South Pacific Conference, Rarotonga, Cook Islands, 25 September - 7 October 1974; (c) Sixth Conference of Directors of Health Services (SPC), Rarotonga, Cook Islands, 4-10 February 1975. 9.3 Cooperation with other organizations 9.3.1 Southeast Asian Medical and Health Organization (SEAMHO) While it is understood that discussions at Ministerial level are still in progress, no official word has yet been received on the formal establishment of SEAMHO. 9.3.2 Southeast Asian Medical Information Centre (SEAMIC) WHO was represented at the Third SEAMIC Conference held in Tokyo from 30 October to 1 November 1974 and at the Second SEAMIC Workshop held in Manila from 31 March to 5 April 1975. SEAMIC operates in Tokyo under the sponsorship of the International Medical Foundation of Japan. WHO has been in correspondence with SEAMIC on the question of possible areas of cooperation between the two organizations. 9.4 Other joint work WHO was represented at the following meetings: (a) a series of meetings conducted by the International Secretariat for Volunteer Services (ISVS) and the Philippine Public Health Association in Manila from 8 to 11 July 1974: Meeting of the Secretariat; First Asian Regional Conference of Public Health Associations; WPR/RC26/4 page 70 Workshop on the Mobilization of Response Structures from the Grassroots Towards Health Services; (b) Ninth Symposium of the International Union of School and University Health and Medicine, Tokyo, 29 October - 1 November 1974; (c) First Asian Regional Congress on Radiation Protection, Bombay, 15-20 December 1974; (d) Association of South-East Asian Nations Meeting of Population Experts, Manila, 17-19 December 1974; (e) Regional Post World Population Conference, Bangkok, 14-20 January 1975 (jointly organized by the United Nations Population Division, UNFPA and ESCAP); (f) International Conference on Children and National Development, Saigon, 14-23 January 1975 (supported by UNICEF and USAID); (g) International Conference on the Future Development of Tourism and Air Transport, Manila, 10-14 February 1975; (h) Workshop on Training of Community Nutritionists, Honolulu, 10-21 February 1975 (organized by the Food Institute of the East-West Center and the University of Hawaii and supported by the Hawaii State Government); (i) Fifth Conference of the Rural Reconstruction Organization, Manila, 24 February - 3 March 1975; (j) Population Council Meeting for Maternal and Child Health Family Planning Projects, Surabaya, Indonesia, 15-22 March 1975; (k) Fifth Congress of the Eastern Regional Organization for Planning and Housing, Manila, 16-22 March 1975. 10 CONSTITUTIONAL, LEGAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS 10.1 The Regional Committee The twenty-fifth session of the Regional Committee for the Western Pacific was held in Kuala Lumpur from 2 to 9 September 1974. The meeting was attended by representatives of 17 Member States, including those responsible for territories in the Region, and of Papua New Guinea, an Associate Member. Representatives of UNICEF, the International Committee of Military Medicine and Pharmacy, and nine nongovernmental organizations in official relations with WHO were also present. , Tan Sri Dato (Dr) Abdul Majid bin Ismail (centre) was chairman of the twenty-fifth session of the Regional Committee. Other officers were (from left): Dr J. Laigret (France) and Dr Peni Vuiyale (Fiji) rapporteurs; Dr Jacinto Dizon (Philippines), vice-chairman, Dr Francisco J. Dy, and Mr Weng-Hooi Cheong, chairman of Technical Discussions. Below, the Committee's official group photograph. WPR/RC26/4 page 71 The Annual Report of the Regional Director for the period 1 July ,1973 to 30 June 1974 was reviewed. The Committee examined the proposed programme budget estimates for 1976 and 1977 and, in requesting the Regional Director to transmit them to the Director-General, emphasized the importance of WHO's role in assisting governments to develop and implement new projects and in encouraging them to assume responsibility for ongoing projects that had proved feasible. The Committee considered a report by the UNDP Working Group on Technical Cooperation among Developing Countries. Welcoming the recommendations that report contained, the Committee commended the efforts being made by WHO to encourage developing countries to devise specific programmes on technical cooperation among themselves and expressed the hope that governments of developing countries would cooperate with WHO in those efforts. The Committee reviewed a report on the action taken in connexion with its previous resolutions on methods of disinsecting aircraft, Following the recommendation of the Twenty-seventh World Health Assembly most of the Member States in the Region have accepted as valid the disinsecting of aircraft on international flights by the dichlorvos vapour system, although some have reserved the right to dis insect on the ground as an additional measure if they consider it necessary. Follow- up studies on the possible deleterious effects of the system and the development of resistance in certain insects were proposed by the Committee. Although vigorous action is being taken to improve existing practices for controlling the quality of water and food in international aviation, the Committee emphasized the need for further improvement and constant vigilance to ensure that high standards are reached and maintained. A progress report presented to the Committee on the action taken in connexion with its previous resolutions on drug dependence revealed that while drug dependence stricto sensu affects relatively few in number of the Region's population, though it could become a more widespread and grievous problem in the future, in many countries and territories the abuse of alcohol is of more importance at the present time. The Committee emphasized the need for the regional programme to be continued and expanded to include both drug dependence and alcoholism so that the experience gained from projects conducted at national level, combined with the results of research, would lead to effective control methods. The Committee also considered that the excessive use of tobacco should be studied in conjunction with measures to be taken to combat drug dependence and alcoholism. The Committee supported the World Health Assembly's resolutions on the development of the antimalaria programme and the intensification of research on tropical parasitic diseases - especially on the Region's most prevalent parasitic diseases, schistosomiasis and filariasis. In addition, it cited cholera, dengue haemorrhagic fever, Japanese encephalitis, viral hepatitis, typhoid fever, and rabies as diseases that it would like to see given priority in WHO's research programme. WPR/RC26/4 page 72 The Committee noted the encouragement being given to Member States in the Region to utilize the methods of systems analysis in the formulation and management of projects and to involve themselves in studies aimed at adapting these methods to their individual needs. It requested the Regional Director to develop such methods so that Member States could be provided with assistance, guidance, and expertise. The Committee considered that its future sessions could be concluded in one week. It confirmed that its twenty-sixth session would take place at the Regional Office in Manila and accepted a tentative invitation from the Government of Japan to hold the twenty-seventh session in Japan. The theme of the Technical Discussions was "Control of vector mosquitos of dengue haemorrhagic fever". The Committee reviewed the purpose and procedures of the Technical Discussions and decided that they should in the future be replaced by a Technical Presentation dealing with a special subject or health problem, to be given by one or two recognized experts in the chosen topic. "The control of tuberculosis in the Western Pacific Region" was selected as the topic for the Technical Presentation in 1975. 10.2 Regional Office 10.2.1 Organizational structure 10.2.1.1 Regional office staff New posts of clinical nurse, clerk (storekeeper), maintenance man, clerk stenographer (Project Information Unit), clerk stenographer (Typing Pool) were established. Recruitment was completed for the aforementioned positions and also for the posts of conference secretary/administrative assistant (Health Manpower Development), budget clerk, clerk (Personnel) and clerk stenographer. Recruitment was completed for the posts of assistant budget and finance officer, regional adviser on communicable " diseases, editor, regional adviser on health manpower development, ~ regional adviser on maternal and child health and regional adviser on health education. During this period, the incumbent of the post of regional budget and finance officer was reassigned to the post of regional administration and finance officer; the vacant post of budget and finance officer was filled in May 1975. There are two vacant posts: regional adviser on strengthening of health services and the senior translator. 10.2.1.2 WHO Representatives The posts of WHO Representative, Philippines and the secretary to be attached to this officer, established in January 1973, are still vacant. New general services positions in the various offices of the WHO Representatives of the Region were established as follows: clerk stenographer and driver (Vientiane); secretary (Phnom-Penh); driver (Singapore); secretary (Saigon). Recruitment was completed for the posts of the drivers; the posts of the secretaries and the clerk stenographer are still vacant. --- 10.2.1.3 Project staff WPR/RC27/4 page 73 A total of 183 selection committees were held between 1 May 1974 and 30 April 1975. During this period, 37 project posts were filled either by recruitment or reassignment. One hundred and twenty-four short-term consultants were recruited. The total period of their assignment was 276.2 man-months. Following decisions by the Secretary-General of the United Nations, project staff and dependants were evacuated from Phnom Penh in March/ April 1975 and most staff and all dependants from Saigon in April 1975, although at the time this report went to press a skeleton staff remained in Saigon to try to continue the WHO contribution to the health of the people. 10.2.2 Salaries and allowances 10.2.2.1 A survey was made of the salaries and other conditions of service for staff in the general service category in Manila in January and February 1975; a new salary scale was established, effective 1 March 1975. New general service salary scales were established for Saigon and Phnom-Penh effective 1 July 1974, for Vientiane effective 1 August 1974, for Singapore effective 1 October 1974, for Seoul effective 1 November 1974 and for Kuala Lumpur effective 1 December 1974. 10.2.2.2 New salary scales for professional level and higher graded staff were established effective 1 January 1975 following similar action taken by the General Assembly of the United Nations in December 1974. 10.2.3 Regional Office building 10.2.3.1 The Conference Hall The Conference Hall was used for 15 conferences and seminars sponsored by WHO and two conferences sponsored by other Organizations which were of an international character and which met the established criteria for the use of WHO conference facilities. 10.2.3.2 Microform Microform equipment was purchased, a microform operator recruited and microform operations started before the end of 1974. 10.2.3.3 Repairs and maintenance As a result of partial conversion of archives into microform, the remaining archive files were transferred to a smaller room and the ex- archives room was converted into an office/workshop for the electrician and into storage space. New floors were laid in the conference hall lounge and the canteen. Two word-processing typewriters were purchased and secretaries and stenographers were trained in operating them. WPR/RC26/4 page 74 10.2.4 Regional obligations and expenditures Pages 75 and 76 of this report contain a statement and a graphic presentation of the obligations incurred for the Region for the period 1950-1974. A comparison of implementation in relation to funds available from the regular budget of the Organization for the fiscal years 1972, 1973 and 1974 shows 87.42% implementation in 1972, 89.52% in 1973 and 88.55% in 1974. The low rate of implementation in 1972, 1973 and 1974 resulted from directives from the Director-General not to obligate certain funds as follows: 1972 Undelivered programme, China (Province of Taiwan) "Activities not related to any specific Subject Heading" U8$130 894 US$587 890 Total ---------- US$718 784 1973 "Activities not related to any specific Subject Heading" 1974 "Activities not related to any specific Subject Heading US$622 353 US$900 000 Taking into consideration the above-mentioned amounts which could not be delivered, the implementation rates in 1972, 1973 and 1974 are 96.70%, 97.37% and 98.48% respectively. "- WPR/RC26/4 page 75 OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGIO~/ 1950-1974 (Expressed in millions of US Dollars) OBLIGATIONS YEAR Regular Budget1/ UNDP UNFPA TOTAL 1950 0.32 - 0.32 1951 0.39 0.10 0.49 1952 0.46 0.48 0.94 1953 0.60 0.47 1.07 1954 0.62 0.53 1.15 1955 0.74 0.58 1.32 1956 0.75 0.54 1.29 1957 1.05 0.57 1.62 1958 1.54 0.69 2.23 1959 1.94 0.62 2.56 1960 2.15 0.60 2.75 1961 2.19 0.54 2.73 1962 2.44 0.84 3.28 1963 2.59 0.74 3.33 1964 2.84 0.90 3.74 1965 3.14 0.813/ 3.95 1966 3.58 1.064/ 4.64 1967 4.05 0.755/ 4.80 1968 4.39 1.1~/ 5.52 1969 4.90 0.797/ 5.69 1970 5.33 0.828/ 0.01 6.16 1971 6.06 0.84- 0.30 7.20 1972 6.68 0.71 0.58 7.97 1973 7.52 0.96 1.07 9.55 1974 8.50 0.95 1.24 10.69 l/FigureS extracted from Official Records Nos. 34, 41, 47, 54, 62, 70, 78, 85, 93, 101, 109, 117, 126, 134, 142, 150, 159, 167, 175, 183, 191, 200, 208, 214 and 222 Financial Reports and Reports of the External Auditor to the World Health Assembly. 1/Inc1udes Voluntary Fund for Health Promotion, Funds-in-Trust and Reimbursable Funds. l/Includes the UNDP/SF component obligation of $1728. i/Includes the UNDP/SF component obligation of $56 417. ~/Inc1udes the UNDP/SF component obligation of $287 073. ~/Inc1udes the UNDP/SF component obligation of $429 632. lIIncludes the UNDP/SF component obligation of $319 764. ~Includes the UNDP/SF component obligation of $196 811. Millions of US$ 11.00 10.00 9.00 8.00 - Total obligation Regular budget ?:/ UNDPY GRAPH OF OBLIGATIONS INCURRED BY THE WORLD HEALTH ORGANIZATION WESTERN PACIFIC REGION Y 1950 - 1974 (Expressed in Millions of US Dollars) 9.00 8.00 7.00 J -- UNFPA I / I- 7.00 6.00 -I ~ / I- 6.00 5.00 -I "./ I- 5.00 4.00 -l ~ ./ I- 4.00 3.00 -I -'" ~ I- 3,00 2.00 -I -'" ~ I- 2.00 >, ...,,-..... /-~, / , ~-- ... ----_ ... _--- .......... , ,--------- ------- ...... ",. ------------- ---- ",."" 1.00 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 Y Figures extracted from OFFICIAL RECORDS Nos. 34,41,47,54,62,70,78,85,93,101,109,117,126,134, 142, 150, 159, 167, 175, 183, 191,200,208,214 and 222. (Financial Reports and Reports of the External Auditor to the World Health Assembly). ?:,/ Includes Voluntary Fund for Health Promotion, Funds-in-Trust and Reimbursable Funds. Y Includes the UNDP/SF component obligations of $1,728 in 1966, $56,417 in 1967, $287,073 in 1968, $429,632 in 1969, $319.764 in 1970 and $196,811 in 1971. J ( ! J' I 1.00 'O:E: III '"tI (]Q:;.:l Ill ....... ..... E!l "'N '" ....... J>- r 11 PUBLIC INFORMATION World Health Day WPR/RC26/4 page 77 The theme in 1975 for World Health Day, "Smallpox: point of no return", generated international interest which was broadcast widely throughout the Region, though the national committees for World ~ealth Day of some countries in the South Pacific area, where smallpox ~s of little relevance changed the theme to "Environmental health". An increase in the ~umber of cases of dengue fever prompted Fiji and Tonga to use the 7 April celebration to dramatize the importance of environmental health in the control of the disease. The Regional Committee Editorial comments in leading newspapers in Malaysia and the Philippines, made mention of the problem of dengue haemorrhagic fever, the Regioual Director's Annual Report and the resolution adopted by the Regional Committee on drug dependence and alcoholism. News items on the twenty-fifth session of the Regional Committee were published by newspapers in Indonesia, Malaysia, Papua New Guinea, the Philippines and Singapore; a total of 3500 column centimeters of news clippings having been received. The meeting of the Committee was reported extensively over Malaysia's national radio network, on international programmes and daily in television newscasts, both in Kuala Lumpur and a number of States in Malaysia. Representatives to the Regional Committee and WHO Secretariat took part in four feature programmes totalling almost two hours of television time. Mass media During the year under review, 17 000 column centimeters of news clippings on WHO, from newspapers in Australia, Fiji, Hong Kong, Indonesia, Japan, Malaysia, New Zealand, Papua New Guinea, Philippines, Republic of Korea, Singapore and South Viet-Nam, were collected. The Regional Office issued sixty-four news releases, ten special features and three press notes which were reproduced in newspapers and magazines and used by teachers in many schools for training health workers. The news media continued to report on WHO group educational meetings though increasing emphasiS was given to news on developments in social, economic and related fields. It can be foreseen that more emphasis will be given to reporting project activities and more background and interpretative material will be requested on WHO technical collaboration with Governments. WPR/RC26/4 page 78 Visitors . . One thousand five hundred students, teachers and other professional V1s1tors came to the Regional Office to ask for material on WHO d U~ited Nations Day, 1974 more than 1000 students and teachers ca:: t~n 11sten to talks a~out the Organization and to obtain pamphlets. A short talk on WHO.and f11m presentations were regularly given to groups of student vis1tors. One hundred and fifty-four written requests for material on WHO from countries within and outside the Region were received and answered. Publications The following publications were issued: (1) The Third Antonio G. Sison Memorial Lecture on Collaboration between the Philippines and the Wor~d Health Organization in the Promotion of Health, presented by the Reg10nal Director; and (2) a pictorial essay on health workers in the Region. Mis cellaneous Thirty-four institutions, departments of health, professional organizations, schools and offices from allover the Region borrowed a total of 88 films on the work of WHO. 12 WHO PUBLICATIONS In an attempt to disseminate information on WHO publications as widely as possible and, so far as practicable, through sales, a special scheme for the distribution and sale of WHO publications to health workers and institutions was established in the Regional Office some years ago. This enables interested persons to pay for WHO publications in their local currency. Reductions in price, which vary in accordance with the country concerned, are also given if publications are ordered in bulk. Subscriptions covering all WHO publications are also available at concessional rates. All persons who have shown interest in a particular field are regularly advised about any forth- coming publications in that field. Despite this publicity, WHO publications are not being read as widely as the Organization would like. An increasing number of WHO publications are being translated and distributed in other languages. As far as the Western Pacific Region is concerned, 41 Technical Report Series, 12 Public Health Papers, 6 Monograph Series and 7 Out-of-Series are now available in Japanese. In addition. the International Classification of Diseases, 8th revision, Volume I, has been translated into Korean; 2 Monograph Series and 2 Technical Report Series are available in Vietnamese and 1 Out-of-Series is available in Portuguese. Another 9 WHO publications are in the process of translation into Japanese. , -' • , WPR/RC26/4 page 79/80 It is hoped that other governments will be interested in following the example of Japan, thus making available to their own health workers translated texts of WHO publications. A complete list of what is now available in other languages as far as the Western Pacific Region is concerned is given in Annex 2. PART II. EVALUATION SUMMARIES OF SELECTED PROJECTS WPR/RC26/4 page 82 EVALUATION SUMMARIES OF SELECTED PROJECTS A complete list of projects current during the period under review is to be found in Part III. The following selected projects are described in fuller detail. Maternity-centred family planning, Philippines (PHI MCH 002) Training in the field of health planning (ICP SHS 003) Teacher training centres for health personnel (ICP HMD 007) Regional tuberculosis course, Tokyo (ICP MBD 002) 1. Title and project number Source of funds Participating agencies Project implementation dates WPR/RC26/4 page 83 Maternity-Centred Family Planning PHI MCH 002 (9603) UNFPA, UNICEF Government, WHO, UNFPA, UNICEF July 1971 - June 1975 2. Project background In 1970 the Department of Health requested assistance to support a programme of instruction in maternal and child health and family planning at training hospitals. The request was based on the fact that the Philippines was characterized by a young, rapidly increasing, population; predoininantly preventable patterns of disease; and unfavourable mortality and morbidity rates among mothers and children. It was hoped that to influence fertility would result in better chances of survival for the mother, the foetus, and the newborn child. Twenty- five of the 29 designated training hospitals in the country had . paediatric and maternity departments. These 25 hospitals were selected for introduction of the maternity-centred family planning project. 3. Objectives 4. 4.1 The objectives {)f the project can be summarized as follows: (a) to establish family planning as part of maternal and child health services in designated training hospitals in the Philippines; (b) to upgrade the maternal and child health services provided by these hospitals; (c) to strengthen training programmes in the designated hospitals and at the teaching institutions affiliated to them. Action taken Administration The project was administered from the Bureau of Medical Services, Department of Health. The Director of the Bureau of Medical Services was appointed Project Director, with other staff consisting of a senior executive assistant, a project coordinator, a statistician, a clerk and a driver. The functions assigned to the project office were supervision of project activities, management of assistance, coordination with governmental and other agencies, and coordination of training with the Institute of Public Health. WPR/RC26/4 page 84 4.2 Scheduling It was decided that the new activities would be implemented in 5 hospitals during phase I, in a further 10 during phase II and in the remaining 10 during phase III. 4.3 Hospital facilities Twenty-three of the 25 hospitals needed to improve their facilities. Construction and adaptation of premises was completed with UNFPA and UNICEF assistance. Water supply and sewage disposal facilities were improved with the assistance of a WHO sanitary engineer, although further work is still required. 4.4 Staffing The staff in each of the 25 hospitals was strengthened by the addition of an obstetrician/gynaecologist, a senior nurse, a midwife and a clerk, their salaries being paid by WHO, under UNFPA-assistance, during the first two years of operation and subsequently by the Department of Health. During the 1974/75 fiscal year the Department of Health took over responsibility for the 60 staff members assigned to the project at hospitals participating in phases I and II. Responsibility for the remaining 40, at hospitals participating in phase III, will be taken OV,er in 1975/76. 4.5 Training The training programme for staff involved in maternity-centred family planning activities at the 25 hospitals was designed by the Institute of Public Health, University of the Philippines. One hundred and nine medical officers, 54 nurses and 10 technologists, were trained at the Institute with the collaboration of the Philippine General Hospital. Eight additional nurses received training in the provision of comprehensive family planning services, including pelvic examination and IUD insertion. These nurses undertook special in- service training functions in their own hospitals. 4.6 Determination of tasks Descriptions of tasks for individuals were designed, which conformed with existing working patterns in the hospitals. 5. Results achieved 5.1 Family planning Deliveries and abortions the project totalled III 591. acceptors of contraceptives: at the 25 hospitals during the period of Among these patients 32 131 became direct IUD in 45.2%, oral contraceptives in 35.9%, WPR/RC26/4 page 85 condoms in 13.7%, and other methods in 5.2% of cases. Among the 48 367 acceptors resulting from the activities of the project, IUD was chosen in 38.3%, oral contraception in 39.4%, condoms in 16.3% and other methods in 6% of cases. Tubal ligation was introduced in January 1972, with 4804 inter- ventions carried out up to December 1974. Vasectomy was introduced early in 1975. 5.2 Maternal and child health All newborns were vaccinated with BCG and emphasis was placed on breast-feeding. To facilitate this, rooming-in was organized in all hospitals, except the Rizal Provincial Hospital where there was a rapid turnover of patients (24 hours post-partum hospitalization). Measures were promoted to catch up non-immunized children in other departments of the hospitals and nutrition education became a regular function. The hospitals taking part in the project became referral units, by virtue of their staffing and equipment, for all other units carrying out family planning. 5.3 In-service training A special feature of the tasks assigned to the project staff was training other personnel in the hospitals. Medical officers, nurses, nursing auxiliaries and administrative personnel in other departments besides those of paediatrics and maternity were orientated in the motivation of patients. 6. Problems 6.1 Staff support Implementation of project activities at some of the hospitals was delayed by the reluctance of responsible individuals to carry out family planning activities in their establishments and by the departure of specially-trained staff before they had made significant contributions to the project. These staffing difficulties were overcome. 6.2 Physical facilities Delays in construction and adaptation of facilities, and in the development of water supply and sewerage systems at some of the hospitals also hindered implementation. 7. Commitments and participating agencies Under UNFPA funds, WHO provided a medical officer and a public health nurse for two years (1972 to 1973), and a sanitary engineering consultant to assist the Department of Health in drawing up plans to improve water supply and sewerage at the hospitals taking part in phases II and III. WPR/RC26/4 page 86 UNICEF provided supplies, equipment and funds for the re-construction and adaptation of the buildings. 8. Evaluation The Institute of Public Health, the College of Public Administration and the College of Medicine, University of the Philippines participated in an assessment of the progress achieved, carried out by visiting the 25 hospitals. An assessment was made of the types of maternal and child health/ family planning services offered, the attitudes of staff towards family planning methods, problems encountered in rendering service, management of the hospitals and training undertaken. It was found that the hospitals were well managed and that the problem areas were similar to those encountered in other services. Apart from placing emphasis on organization and on coordination between the various wards in the hospitals, it was recommended that maternal and child health and family planning activities be made part of basic training programmes for residents, interns, nurses and midwives, that instruction be given in practical contraceptive techniques and follow up of patients, that the referral system be modified and that the setting of targets be included in the plans of work of the units concerned. , -, 1. Title and project number Source of funds Participating agencies Project implementation dates WPR/RC26/4 page 87 Training in the Field of Health Planning ICP SHS 003 (4101) Regular Government, WHO, UNICEF 1968 to date 2. Project background: From its inception, the Organization has by various resolutions of the World Health Assembly and the Executive Board enjoined national health administrations to plan the development of their health services. The launching of the first United Nations Development Decade provided developing countries allover the world with the impetus for national socio-economic development planning with a health sectoral component. To support national health administrations WHO then established a Health Planning unit at its Headquarters, which in turn sought to develop regional units and provide direct technical assistance to developing countries. In 1964, an intercountry seminar on national health planning, the first of its kind, was held in Manila. The conclusions underscored the need for training in health manpower planning and in relating health activities to the goals of overall national development. A health planning course for WHO staff was conducted in 1967 at the University of the West Indies, Kingston, Jamaica, with field observa- tions in Trinidad and Tobago. Two staff members from the WHO Regional Office for the Western Pacific participated. In 1968, a similar course was held for WHO staff in the Western Pacific Region. At the same time the present project, first entitled regional course on national health planning, was created to direct training activities in this field, and discussion on the organization of regular courses commenced with the Institute of Public Health, University of the Philippines. 3. Objectives The project has the following objectives: (1) to plan, organize and conduct international courses on national health planning in the Western Pacific Region; (2) to develop training facilities for the courses, including the provision of a suitable field .practice area; (3) to undertake studies in health planning methodology which will have practical application in the developing countries of the Region. WPR/RC26/4 page 88 4. Action taken 4.1 Strategy A strategy for training in health planning was soon adopted, placing immediate emphasis on training senior national health staff at the central level, particularly those responsible for preparation of health sectoral plans and for developing and implementing programmes under health plans. It was decided also to give priority to training staff of schools of public health and medicine who would later assume responsibility for introducing planning concepts and methods in their own courses. An intensive course was designed for this purpose. When the priority groups had been served, it was planned to give orientation to intermediate and local level staff, enabling them to provide better support in national health planning efforts. To give continuity to the programme, it was felt that a teaching institute should be involved in the training, particularly at university level, with the provision of technical and material support by WHO. 4.2 Collaboration with the University of the Philippines The Institute of Public Health, University of the Philippines, satisfied the above-mentioned general criterion and had the further advantage of proximity LO the Regional Office in Manila. In the agree- ment that was eventually concluded, two phases were determined for project development. In the first (1969-76), WHO would have administrative and technical responsibility for conducting the courses; in the second (beginning in 1977), the Institute would take over this responsibility, while WHO would continue to meet the cost of participants from other countries or areas together with such consultant and material assistance as might be needed. It was agreed that the duration of the second phase and further collaboration between the Organization and the Univer- sity would be decided upon following evaluation of the project at the end of 1976. One commitment of WHO during the first phase was the provision of training and salary subsidies for three faculty staff, to be phased out on a diminishing scale by the end of 1976. At the present time two faculty staff with the rank of assistant professor have already specialized; one in health and one in manpower planning. It has not been possible to recruit and train a health economist. 4.3 Activities 4.3.1 Regional Course in National Health Planning Courses under WHO/University of-the Philippines collaboration commenced in 1969 and have been held yearly ever since, except in 1973 when the University, on behalf of WHO, organized an interregional course on planning, administration and management of health services, attended by participants from four WHO Regions. WPR/RC26/4 page 89 -The curriculum of the course has included: an introduction to economic and social development, demography and physical planning; lecture discussions on health and development; lecture discussions on the concept and methods of health planning; field practice in the application of health planning methods; and a final seminar to round up on training in and application of health planning methodology. Although the principles underlying the methodology of planning have remained the same, modifications have been introduced from time to time for adaptation to regional needs. More recently, the instruction has been broadened to include principles of country health programming and project formulation and management, including project systems analysis. A manual on health planning has been developed for use in the course and to provide guidance to national staff engaged in health planning. WHO has contributed the services of an expert in health planning to strengthen the Institute's health planning staff. Lecturers on ancillary subjects, such as physical planning and demography, have been obtained from universities or technical institutions in Manila on a contractual basis. The Asian Institute for Economic Development and Planning, Bangkok has almost uninterruptedly seconded staff to give annual lectures in economic and social development, and health economics. From 1975, the Regional Office will second staff to give lectures in management, health economics and operational research, as well as in health planning. 4.3.2 Countrx courses in health planning Country courses in health planning commenced in 1973 at the request of governments. They are of shorter duration than the regional course, the curriculum is abbreviated, there are no field exercises and the participants are drawn from the intermediate and local levels of administration. Courses were held as follows: Malaysia - country course; Papua New Guinea - sub-regional course for the South Pacific; Philippines - country course, primarily under the Institute of Public Health but with contributions by WHO and UNICEF; Republic of Korea - two-stage country course on health planning also with the collaboration of WHO and UNICEF. 4.4 Problems encountered Experience from conducting the regional course has so far posed the following problems: (a) language - only English has been used, limiting the opportunities for French-speaking countries in the Region; (b) methodology - as methods change, refresher or some other suitable training is required to keep planners up to date; WPR/RC26/4 page 90 (c) level of education and experience of participants - there is a wide range of educational background and experience among participants, and this creates some difficulty in deter- mining appropriate teaching methods. 4.5 Results A total of 156 national and WHO pe~sonnel received training in the regional and country courses from 1968 to 1974. The regional course was attended by nationals of Cambodia (1), Fiji (1), Guam (1), Japan (7), Malaysia (I), Papua New Guinea (3), the Philippines (19), Republic of Korea (10), Singapore (I), South Viet-Nam (5), Tonga (1) and Western Samoa (1). The country courses were attended by nationals of British Solomon Islands Protectorate (I), Fiji (I), Gilbert and Ellice Islands (I), Malaysia (30), Papua New Guinea (10), Philippines (26), Republic of Korea (22), Tonga (2), Trust Territory of the Pacific Islands (2) and Western Samoa (1) • . Participants in the regional and country courses held positions in the central, intermediate and local levels of administration, and included public health administrators, medical specialists, non-medical administrators/specialists, teachers of public health or medicine and other public health workers. 5. Evaluation The main objective of the project, namely, to plan, organize and conduct international courses on national health planning in the Western Pacific Region, has in the main been achieved, with the organi- zation since 1968 of the regional course each year, three country courses (Malaysia, the Philippines and the Republic of Korea), and the sub- regional course (for participants from the South Pacific area). Parti- cular attention has been paid to the training of national senior staff (planners and public health administrators), with the result that most of the developing countries in the Region now have the manpower potential to provide health planning leadership. From the beginning it was envisaged that there should be collaboration by a teaching institution, to provide the necessary atmosphere of learning and ensure continuity of training in the Region. The University of the Philippines, selected for this purpose, has been associated with the course from the start and is prepared to collaborate in a long-range programme. Other requirements for the organization of the course have been satisfied: the University now has a full-time training staff of two; the Regional Office can contribute more expertise to future courses; and successful links have been forged with national and international institutions, for example the Asian Institute for Economic Development and Planning, to ensure the availability of highly experienced staff to teach in the various aspects of planning. WPR/RC26/4 page 91 ~acilities for the successful prosecution of the regional course have also been acquired. The Institute of Public Health has provided ample space for the lectures and given participants access to its large library. WHO has provided equipment, books and other material which includes calculators, duplicating machines, visual teaching aids, and airconditioning units. Arrangements have also been made to use the health demonstration area of the WHO-assisted development of health services project in Rizal Province as a field practice area for the course. Another objective, implementation of studies on health planning methodology of practical application in the Region, has been m~t. These studies have to a certain extent been built into the course. The methods taught have been applied during field practice and at the same time experience gained has resulted in a number of modifications in the plan- ning procedures. Also, teaching of planning, particularly in the country courses has been orientated towards particular local needs. The teaching staff have gained further knowledge by undertaking WHO consultant- ships in country health planning, and participating in project formula- tion and management studies in some countries. All this experience has been of value in preparing the health planning manual now being finalized. oVerall the health planning courses, both regional and country, have largely fulfilled the original aims of the project. What remains to be determined is the impact the courses have had on health planning in the Region. It is hoped that formal evaluation of the project, scheduled for 1976, will provide more information on this point. There is no doubt that continued instruction in planning is justified: plan- ning methods are still evolving and improvements will no doubt continue, rendering the methods more readily applicable even in the emerging countries. In the last analysis a decision by WHO regarding continuation of its assistance in training experts in health planning must depend on the actual use being made by Member States of nationals who have already been trained. WPR/RC26/4 page 92 1. Title and project number Source of funds Participating agencies Project implementation dates· Teacher Training Centres for Health Personnel ICP HMD 007 (6002) Regular, UNDP Government, WHO, UNDP 1971 - present 2. Project background: In 1969, a group of WHO consultants drew up a plan for the establish- ment of a network of teacher training centres in medical faculties of universities and other institutions at regional and national levels throughout the world. The Center for Educational Development, University of Illinois, College of Medicine, Chicago, United States of America, was selected to serve as an interregional teacher-training centre to train staff for the regional centres. It was planned that the latter, in turn, would train staff to set up national teacher-training centres for health personnel. In January 1973, following feasibility studies, a centre for medical education and development was established within the Faculty of Medicine of the University of New South Wales, Sydney, Australia with the following functions: (1) to assist with educational development of the Faculty of Medicine of the University of New South Wales; (2) to serve as a national centre to study the education of health workers in Australia; (3) to serve as the WHO Regional Teacher-Training Centre for the Western Pacific Region. A director of the Regional Centre was appointed by the University in January 1973, with full-time secretarial assistance, under funds provided by the Government of Australia. An administrator was appointed in March 1973 under University funds. The technical programmes of the Regional Centre are assisted by part-time staff from other departments of the Faculty, from the Tertiary Educational Research Centre of the University and from institutions in Sydney. UNDP assistance for a duration of five years commenced in January 1973. - 0,-, WPR/RC26/4 page 93 It was expected that a few countries in the Region might be ready to establish national teacher training centres by 1975. 3. Objectives (a) to establish a regional teacher-training centre in the WHO Western Pacific Region, concurrently providing service and undertaking research; (b) to establish and develop national teacher-training centres in selected countries in the Region, with a view to strengthening institutions for the education of all categories of health worker, through improvement of curriculum design and teaching methods, and evaluation of the results from teacher and student performance; (c) to assist national centres in training the faculty of educational institutions for health personnel in modern teaching methods and ideas. 4. Action taken Staff of the Regional Teacher-Training Centre were trained through the award of fellowships and the assignment of consultants. Consultants from the Regional Centre assisted in national training activities, such as seminars and workshops, that it was considered might lead to the establishment of national teaching-training centres. 4.1 Training activities 4.1.1 Training of staff of the Regional Teacher-Trainin& Centre Selected academic staff drawn from the-health professions in Sydney were awarded WHO fellowships to the interregional centre for teacher-training at the Center for Educational Development, Chicago. The first staff to go to Chicago, in October 1971, were the director of the Regional Centre and the Director of the Tertiary Educa- tional Research Centre. They attended an orientation workshop. In the period 1972/13~i2 staff members of the University of New South Wales were awarded fellowships to attend a workshop in medical education held in Chicago. In 1974 three fellowships were awarded, including one for training of the future director of the Regional Teacher-Training Centre who was to take over in 1975. A further 4 fellowships, though not all for study in Chicago, were awarded in 1975, making a total of 21 fellowships awarded for staff of the Regional Centre. WPR/RC26/4 page 94 4.1.2 Programmes conducted by the Regional Teacher-Training Centre The following international seminars and workshops were organized at the Centre each with about 20 participants from countries within the Region: Inaugural international workshop for medical deans, 9-22 June 1973; Workshop for teachers in medical schools in the South Pacific, 1-16 September 1973; International general education workshop for teachers from the health professions, 11 November - 8 December 1973. Third WHO regional seminar on education and training: meeting of deans of medical schools, 12-18 February 1974; International workshop on curriculum development, 23 March - 6 April 1974; International workshop on methods of evaluation, 8-21 June 1974; International workshop on teaching/learning methods, 31 August - 14 September 1974. ~ (up to 30 June) International seminar on teacher-training centres for the medical and health professions, 31 January - 7 February 1975; International workshop on general health personnel education, 8-20 June 1975. A Master's course in health personnel education is scheduled to commence in July 1975. Governments have been invited to nominate parti- cipants. 4.1.3 National teacher-training activities S'even huiidred and eleven participants have attended short promotional seminars and single-topic workshops. Progressively, staff trained in the international workshops have taken over responsibility for conducting national teacher-training activities and promoting the develop- ment of teacher-training centres in their own countries. The following national workshops and seminars have been organized with the assistance of WHO consultants: - 1972, prior to the official opening of the workshops in Laos (45 participants); (80 participants); and South Viet-Nam WPR/RC26/4 page 95 Regional Centre, Republic of Korea (68 participants); Workshop in medical education, Malaysia (36 participants); Workshop in teaching microbiology, Australia (15 participants); Workshop on curriculum planning, Japan (20 participants); Workshop for medical students, Malaysia (35 participants); Workshop on audiovisual teaching methods, New Zealand (106 participants) ; Seminar on medical education, Saigon, South Viet-Nam (127 parti- cipants) and Hue, South Viet-Nam (100 participants); 1975 Workshop on evaluation of student learning, Philippines (39 participants) ; Workshop on curriculum development, Republic of Korea (40 participants) • 4.2 Consultant services 'Consu1tant serVices were provided by WHO for various purposes, as follows: 4.2.1 Consultants for the establishment of the Regional Centre and international teacher-training activities Studies on the "'feasibility of establishing the Regional Centre were carried out by consultants in 1970 and 1971. Consultants also assisted in organizing a workshop he,ld in Sydney in November 1971 for orientation of staff who might be associated with the Centre in the future in modern methods of medical education • . Six consultants' were provided in 1973 and three in 1974, to assist in international educational activities, including seminars and workshops, in the development of the Regional Centre and in curriculum planning. 4.2.2 Consultants for national teacher-training activities Sixteen consultants have been prpvided by }iliO to assist in organizing the seminars and workshops listed under 4.1.3 above. WPR/RC26/4 page 96 4.2.3 Consultants for the establishment of national teacher-training centres or alternative units In the Republic of Korea, assistance was given in planning for a national teacher-training centre which was officially inaugurated in January 1975, the first of its kind in the Western Pacific Region. In the Philippines, two consultants conducted a feasibility study which led to the establishment of a national teacher-training centre in the University of the Philippines early in 1975. The WHO medical officer attached to the Regional Teacher-Training Centre made a follow-up of the international activities conducted there and during visits to Japan, Malaysia, Papua New Guinea, Philippines, Republic of Korea and South Viet-Nam, explored possibilities for teacher- training development. 5. Staff at the Regional Teacher-Training Centre Building up of staff has proved difficult because of financial limitations. Until recently, apart from the director, the Regional Teacher-Training Centre's teaching staff was made up of a group of consultants and associates, all with full-time appointments in other health personnel training institutions. A full-time lecturer was appointed in December 1974. Early in 1975 a Kellogg Foundation grant was received which provided for the appointment of two academic staff members, staff training and other assistance. 6. Organization A coordination committee assists the director in the development of the Regional Teacher-Training Centre. It is composed of representa- tives from the Government of Australia, the University of New South Wales, UNDP and WHO. Other persons may be coopted as necessary. 7. Commitments of the participating agencies TIlis project is jointly funded under the WHO regular budget and by UNDP. Contributions have been as follows: Year 1971 1972 1973 1974 1975 (estimated) WHO regular budget US$ 9 997 21 424 94 754 66 769 ·86 800 279 744 UNDP US$ 41 910 95 184 198 314 335 408 Total US$ 9 997 21 424 136 664 161 953 285 114 615 152 - WPR/RC26/4 page 97 WHO p~ovided a medical officer for the Regional Teacher-Training Centre from August 1973 to December 1974. Consultants, fellowships, supplies and equipment were provided from both WHO regular and UNDP funds. The Government of Australia, through the University of New South Wales, provided office space and facilities for the Regional Centre and staff were appointed by the University of New South Wales. The W.K. Kellogg Foundation awarded the University a grant of A$132 730 (approximately US$179 850) for a four-year programme to accelerate development of the Regional Centre. The Australian National Hospitals and Health Services Commission and the Department of Health will provide the funds necessary to meet inflationary and on-going costs involved in the acceptance of the grant. The Commission has also provided funds for Australian participants from areas other than Sydney to attend international courses at the Regional Centre. 8. Evaluation A tripartite review of the Regional Teacher-Training Centre by representatives of the Government of Australia, the University of New South Wales, the Regional Centre, UNDP and WHO took place on 28 November 1974. There was general agreement that the courses and other activities to date have helped to stimulate awareness of health training needs in the Region. It was considered that the stated objectives were generally being met. Trainees of the Regional Centre had largely taken responsi- bility for activities in their own countries and had promoted teacher training at the national level. - Of particular importance was the formal establishment, early in 1975, of two national teacher training centres, in the Philippines and the Republic of Korea. Although the project plan of work envisaged the commencement of a Master's course in health personnel education in 1974, budgetary dif- ficulties prevented recruitment of the necessary staff. With the award of the grant from the Kellogg Foundation, this difficulty was overcome, and the course is expected to commence in July 1975. WPR/RC26/4 page 98 1. Title and project number Source of funds Participating agencies Project implementation dates Regional Tuberculosis Course ICP MBD 002 (1202) Regular Government, WHO 1966 - 1980 2. Project background: New approaches to the control of tuberculosis on a community basis were developed only after the Second World War. Training had, up to 1966, been carried out in Europe. It was then felt that, since con- ditions in Europe were so different from those in other areas of the world, the Regional Offices should themselves organize courses suitable to the countries concerned. The regional training course on the epidemio- logy and control of tuberculosis, the first in the series for the Western Pacific Region, was held in Singapore from 14 February to 13 May 1966. In 1965 and 1966, the WHO Regional Adviser on Tuberculosis for the Western Pacific served as guest lecturer at the Group Training Course in Tuberculosis Control, organized by the Government of Japan for developing countries in Asia, under the Colombo Plan. The possibility of WHO cosponsoring this activity with the Govern- ment of Japan was then discussed and as a result the first joint course, of four months duration, was held in 1967. The current course, which opened on 5 June 1975 in Tokyo, is the tenth annual course on tuber- culosis control held in the Region. 3. ObjeCtives The main objective of the course is to train key organizers/super- visors of national tuberculosis programmes in modern methods of control, so that they may promote programmes which are rational, realistic and efficient under socio-economic conditions in their own countries. Emphasis is placed on the following points: (1) how to think epidemiologically; (2) how to protect a healthy population from tuberculosis; (3) how to check the continuous spread of tuberculosis infection; (4) how to plan, organize, implement and assess the operations of a national tuberculosis control programme, always relating cost to benefit. , --- .. 4. Action taken WPR/RC26/4 page 99 Each year, governments of countries chosen by the Government of Japan and WHO are invited to nominate candidates for the course. They must be physicians, under the age of S0, who have, or will have, a leading role in national tuberculosis programmes and who possess a sufficient knowledge of English to benefit from the course. The majority of the participants who have taken part in the past have been programme directors or provincial medical officers. The first phase, lasting four months, is conducted in Japan. During the second phase visits, for a total period of two to three weeks, are made to a few countries where successful WHO-assisted national tuberculosis programmes are in operation. The teachers are staff from the Research Institute of Tuberculosis and other agencies in Japan. WHO staff and consultants, and the national staff of the countries visited. In the first phase of the course, the following broad topics are dealt with in lectures, group discussions, workshops, field visits or free study: statistics, epidemiology, general concept of tuberculosis, preventive measures, diagnostic measures in tuberculosis control, curative measures, a tuberculosis control programme, and the role of voluntary organizations. The table below shows the number of participants who have taken part in each course since 1966 together with their home country: Country or area 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 Total Western Pacific Region Cambodia - - - - - - - - - 1 1 Hong Kong - 1 - 1 - - - - - - 2 Japan 1 - - - - - - 2 - 2 5 Laos - - 1 - - - 1 - - - 2 Malaysia 1 1 1 1 1 - - - - - 5 Philippines 3 1 2 1 2 2 2 2 3 2 20 Republic of Korea 2 2 2 1 3 2 2 2 1 2 19 Ryukyus 1 - - - - - - - - - 1 Singapore 1 - - - - - - - 1 1 3 South Viet-Nam - - - - - 1 1 2 - 1 5 Total 9 5 6 4 6 5 6 8 5 9 63 Other Regions - 5 3 6 10 13 5 7 10 6 65 Grand total 9 10 9 10 16 18 11 15 15 15 128 WPR/RC26/4 page 100 5. Problems encountered The major problem encountered is that participants do not work on their national tuberculosis programmes for a sufficiently long time after their return from the course. 6. Commitments of the participating agencies The following contributions have been made by the Government of Japan each year: cost of direct travel of participants between home country and Japan; subsistence of participants during their stay in Tokyo and cost of internal travel and subsistence in Japan; fees of Japanese lecturers; accommodation and facilities of the Research Institute of Tuberculosis, Kiyose-shi, Japan. The following contributions have been made by WHO each year: travel and subsistence costs involved in deviating to the other countries for visits to national control programmes after the course; travel and subsistence costs for an average of six inter- national lecturers each year; travel and subsistence of WHO staff; equipment, documents and supplies. 7. Evaluation In view of the discontinuation of the two WHO interregional courses in tuberculosis control and the continuous need for developing countries in the Region to expand their tuberculosis services, the course will be needed for at least another five years. An important aspect dealt with in the course is the practical application of available technology and its importance in shaping policies at national level. Particular attention is paid to establishment of priorities and to consideration of constraints in developing countries. Teaching during the early years of the course was traditional, based on classroom lectures, i.e. on passive learning. In the past few years, however, emphasis has gradually shifted to active self-teaching and learning and decision-making under varying epidemiological conditions, health structures and constraints. For this purpose, group discussions on various topics are arranged. The participants themselves often select the topic and organize the discussions by electing a chairman and a rapporteur. Thus the lecturer and course organizer function as ob- servers or resource persons, interfering only when necessary or on request. - WPR/WR26/4 page 101/102 This change of approach has made possible the development of leadership among the participants and at the same time enabled the organizer conti- nuously to evaluate the proceedings and adapt the teaching. Further efforts are being made to emphasize community aspects, for tuberculosis is a health and social problem rather than a medical one, that can be solved within the context of a total national health programme. An operational research project was organized in Niigata Prefecture, Japan, for practical training in programme implementation and assessment. During the last two years, lectures on the management of health programmes have been introduced. They have covered operational research in tuberculosis control programmes, cost/benefit analysis of vaccination with BCG, planning and evaluation of vaccination programmes, and studies on manpower for the integration of BCG vaccination services. A simple non-interference model for planning a tuberculosis programme, and a simple interference model, simulating the effect of preventive and curative efforts of various intensity, have also been presented. These additonal subjects are enabling the participants to recognize the importance of other disciplines such as sociology, statistics and management science, not only in tuberculosis control, but for country health programming. Because of the commitments for technical cooperation in Asia made by the Government of Japan, all countries that are Members of the Colombo Plan can be invited to participate in the course. This means that governments of countries outside the Western Pacific Region of WHO can be invited to nominate participants and also that some countries in the Region, not members of the Colombo Plan, are unable to attend. There is an understanding between the organizers and WHO that at least 50% of participants in each course shall be from the Western Pacific Region and, for candidates needing training from countries or areas of the Region that are not Members of the Colombo Plan, the WHO/SPC refresher course on tuberculosis and leprosy is available once every five years. PART III. PROJECT LIST WPR/RC26/4 page 104 PROJECTS IN OPERATION FROM 1 JULy 1974 TO 31 MAY 1975 This part of the Annual Report contains a list of country and inter- country projects that were in operation during the whole or part of the period from 1 July 1974 to 31 May 1975. Projects for which no material assistance was provided during the period are not included. The dates following the project title indicate the duration of assistance to the project, whether such assistance is continuous or inter- mittent. For projects not completed during the period under review, the date of estimated termination has been given where possible. For projects - or phases of projects - completed during the period, details of the assistance provided by the Organization and a brief des- cription of the work done between the dates indicated are given. For continuing projects such details have not as a rule been included. No details are given for projects concerned entirely with the award of fellowships. As in former Annual Reports, an attempt has been made to summarize the immediate results of completed projects and, where the nature of the work has permitted, to show the extent to which the objectives of the projects have been achieved. Projects in individual countries are grouped in the alphabetical order of countries, followed by intercountry projects; within each country, and for intercountry projects, the listing is in accordance with the programme classification structure used in the Proposed Programme Budget for the Financial Years 1976 and 1977 (Official Records No. 220), the old project number being given, in parenthesis, after the new project identification symbol. The abbreviations used for sources of funds are as follows: R WHO regular budget UNDP United Nations Development Programme UNFPA United Nations Fund for Population Activities FR Reimbursable funds UNFDAC United Nations Fund for Drug Abuse Control Voluntary Fund for Health Promotion VD VL Special Account for Miscellaneous Designated Contributions (General) Special Account for the Leprosy Programme Names of any other agencies or entities cooperating in a project are given in parenthesis after the source{s} of funds. 1 " AMERICAN SAMOA HMO 099 Health manpower development: fellowships R LAB 099 Health laboratory services: fellowships R WPR/RC26/4 page 105 SES 099 Establishment and strengthening of environmental health services and institutions: fellowships R Assistance was also provided under the intercountry projects MBD 001 and DHS 001. (see also ICP HMD 007, ICP MPD 007 and ICP DNH 002). AUSTRALIA SHS 001 (4401) Community health nursing (June-August 1974) R - A consultant assisted the Government in the planning and development of community health nursing services for indigenous people and advised on the training of indigenous people at the auxiliary level. HMD 099 Health manpower development: fellowships R (see also ICP HMO 010, ICP HMO 012, ICP HMD 018, ICP MPD 006 and ICP CEP 003). BRITISH SOLOMON ISLANDS PROTECTORATE SHS 001 (4001) Basic health services (1965-78) R UNDP UNICEF To expand and strengthen the network of local health services and train auxiliary health personnel. HMO 099 Health manpower development: fellowships R MPD 001 (2001) Malaria eradication programme (1970-78) R UNDP This programme follows the malaria eradication pilot project (1961-64) and the malaria pre-eradication programme (1965-69), The project was visited by an independent assess~ent team composed of a malariologist, a public health administrator and an economist during the period March ~ April 1975 (see ICP MPD 002). MBD 001· (1201) Tuoercu1osis control (April 1975-April 1976) R - To review and evaluate the tuberculosis problem and the control services in the Protectorate; to improve further the quality of the control methods used, taking into consideration available resources; to strengthen further coordination between the tuberculosis services and the basic health services; to train the health staff involved in tuberculosis control activities and to promote community support and participation in the programme. WPR/RC26/4 page 106 BRITISH SOLOMON ISLANDS PROTECTORATE (continued) Assistance was also provided under the intercountry projects HMD OIl, BSM 001, RAD 001 and DHS 001. (see also ICP MCH 002, Iep HMD 010, ICP MPD 006, ICP MPD 007 and ICP DNH 002). BRUNEI SHS 001 (4101) Health legislation (June-October 1974) made a review of health legislation and regulations and the formulation of revisions to meet changing needs. CAMBODIA R A consultant participated in SHS 001 (4301) Hospital administration (1971-77) R To strengthen the medical care services, and particularly hospital and dispensary institutions, in Phnom-Penh and its environs and adapt them to the requirements of the emergency; to coordinate the medical and health care services to enable them to respond better to current demands; to optimize, through the formulation and continuous assessment of an overall health programme, the use of available resources for meeting the needs of the emergency; to train the necessary personnel; and to extend these activities to further areas as the situation improves. SHS 002 (4801) Rehabilitation of the physically handicapped (1971-77) R UNDP To establish a unit that could later become a school for training physical and occupational therapists and set up a national rehabilitation service. SHS 003 (4201 and 4202) Health laboratory services (1968- ) R UNDP To organize laboratory services to meet the needs of the health and medical services, strengthen and develop the resources of the Institute of Biology, improve laboratory services in the hospitals in Phnom-Penh and in the provinces and in urban and peripheral dispensaries, and train laboratory staff. MCR 001 (9601) Family health (1973-79) R UNFPA UNICEF To develop and strengthen (i) family health care, including maternal and child health, family planning and nutrition care, as part of the basic health services; (ii) maternity, family planning, paediatric and nutrition services in hospitals; and (iii) the family health aspects of the basic, postbasic, inservice and refresher training of all categories of health personnel concerned. - \ -- . , HMO 001 (6401) Development of health manpower (1971- ) R WPR/RC26/4 page 107 To develop and strengthen the centres for the training of all categories of health personnel and to develop a community health centre to serve as a model for centres to be established later in other parts of the country. HMO 099 Health manpower development: fellowships R ESD 001 (2901) Epidemiology and health statistics (1966- ) R To establish in the Ministry of Public Health an epidemiological and health statistical service responsible for planning and evaluating national disease control programmes; to study local epidemiological patterns of causes of morbidity and mortality as a basis for the formulation of such programmes; to reorganize the health statistics systems in hospitals, health centres, dispensaries and other health care institutions; and to train health service personnel in epidemiology and health statistics. During the period under review fellowships only were provided. MPD 001 (2001) Malaria control (1962- ) R UNDP To extend antimalaria activities in order to protect the people living under malaria risk; and to promote the development of an integrated health service by training malaria personnel for the provincial and district health organization and involving the rural health services in malaria case-detection and treatment. MBD 001 (1201) Tuberculosis control (1965- ) R UNDP To set up the nucleus of a national tuberculosis control service, with emphasis on preventive measures, and to carry out a control programme. sgP 001 (7401) Drug quality control (2-20 August 1974) UNDP A consultant studied the findings and recommendations of a consultant assigned to Cambodia in October 1969, obtained baseline data on the situation regarding drug quality control legislation, import and marketing practices and production and control services, and assisted in preparing an overall plan for phased development of drug production and quality control and a project document for submission to UNDP. PIp·OOl (3202) Preparation of· a master plan for Phnom-Penh (water supply, sewerage and drainage studies) (1972-75) UNDP To formulate a plan for improving urban health in Phnom-Penh and its environs through the provision of adequate quantities of safe water for domestic and other uses and of measures for the proper collection, treatment and disposal of waste water and the satisfactory removal of storm water. HWP 001 (5201) Occupational health advisory services (1974) R During the period under review fellowships only were provided. SESOOl(300l) Environmental health advisory services (1968-78) R To establish a public health engineering unit in the Ministry of Public Health and coordinate its work with the work of other units of the Ministry; and to draw up and implement countrywide environmental health programmes. Assistance was also provided under the intercountry projects HMD 007 and DNH 001. (see also ICP MeH 002, ICP HMO 010, ICP HMO 018, ICP MPD 006, ICP DNa 002, ICP LAB 004 and ICP CEP 003). WPR/RC26/4 page 108 COOK ISLANDS MCH 099 Maternal and child health: fellowships R UNFPA HMO 099 Health manpower development: fellowships R BSM 001 (3001) Environmental health engineering advisory services (1973-75) UNDP To develop plans for sewage disposal systems and for an improved water supply system for the island of Rarotonga, and water supply projects for the other islands, as well as programmes and standards for improved housing, and other sanitation activities. Assistance was also provided under the intercountry projects HMO 005 and DRS 001. (see also rep MCH 002, rcp HMO 010, rcp MPD 007, rcp MBD 004 and Iep DNH 002). FIJr SHS 001 Public health advisory services (12-26 October 1974) R - A consultant advised on the sound planning and implementation of a course for a new category of health personnel at the medical assistant level to be introduced in Fiji and formulated the main elements of a plan of action for possible future international assistance in the training of medical assistants. HMO 001 (6201) Fiji School of Medicine (1972-81) R - To strengthen the School of Medicine. HMO 099 Health manpower development: fellowships R DNH 001 (5501) Dental health advisory services (July-August 1974) R - A consultant advised on curriculum content in areas such as tooth replacement, restorative techniques, laboratory procedures and clinical pathology, and took part in the teaching of these subjects at the Suva dental centre. LAB 001 (4201) Health laboratory services (1974- ) R - During the period under review fellowships were awarded, in preparation for long-term advisory services scheduled to begin later in 1975. SES 099 Establishment and strengthening of environmental health services and institutions: fellowships R Assistance was also provided under the intercountry projects SHS 002, SHS 011, HMO 004, HMO 005, HMO 007, HMO 011, DNH 001 and BSM 001. (see also ICP MCH 002, rcp HMO 010, rep HMO 012, rcp HMO 018, rep MPD 007, rcp DNH 002 and rep CEP 003). Classroom and field training scenes during the sanitarian aids training programme in North Tabiteuea island, Gilbert and Ellice Islands. WHO provided a sanitarian and a health education adviser to conduct the training course. FRENCH POLYNESIA WPR/RC26/4 page 109 Assistance was limited to participation in intercountry group educational activities. (see ICP HMO 010, Iep HMO 018 and ICP MPD 007). GILBERT AND ELLICE ISLANDS MCR 001 (9601) Family health (1971-75) UNFPA UNICEF To organize and make available to the whole population services related to human r" oduction and fertility, including services for spacing and limitation of births and for treatment of subferti1ity, and to carry out a programme of information and education of the public. HMO 099 Health manpower development: fellowships R UNDP BSM 001 (3002) Sanitation and health education (1974-77) R - To improve environmental health in the rural areas by developing rural water supply schemes, constructing water-seal latrines. and undertaking other sanitation work at village level; to establish a training programme for sanitation staff and aUXiliary workers; and to establish a health education programme to promote the adoption of hygienic practices by rural inhabitants. Assistance was also provided under the intercountry projects SHS 002, SHS all and MCH 003. (see also ICP MCH 002. Iep HMO 018. rep MPD 007. rcp DNH 002 and rcp LAB 004). GUAM MPD 001 Control of intestinal parasitism (April-May 1975) R Following the visit of a WHO consultant in 1974. a consultant reviewed and analyzed the results of intensified surveys on intestinal parasitism; assisted the Government in assessing the results of control programmes for intestinal parasitism; and reviewed the prevalence of other parasitic disease problems and suitable control measures. BSM 001 (3201) Advisory (October-December 1974) water supplies. services on community water supplies R - A consultant assisted in the planning of CEP 001 Ertvironmertta1 pollution control (December 1974-February 1975) R - A consultant assisted the Government in strengthening the water pollution control laboratory and in organizing in-service training. (see also Iep sas 003. ICP MPD 007, ICP DNH 002, ICP LAB 004, rcp CEP 003 and ICP HWP 001). WPR/RC26/4 page 110 HONG KONG HMO 099 Health manpower development: fellowships R LAB 001 (4201) Health laboratory services (November 1974-January 1975) R - A consultant was provided to assist in establishing a programme of work for the Institute of Immunology, advise on the training of professional and technical staff needed for vaccine production. and study the possibility of the Institute's producing influenza virus vaccine. CEP 001 (3101) Treatment of agricultural wastes (March-April 1975) UNDP A consultant reviewed proposals for the treatment of agricultural wastes, and advised the Agriculture and Fisheries Department on the setting up of trial treatment schemes for pig and poultry manure. A return visit will take place in 1976. (see also rcp MCH 002, rcp HMO 010, rcp HMO 012, rcp MPD 006, ICP DNH 002, rcp LAB 004 and rcp CEP 003). JAPAN HMO 099 Health manpower development: fellowships R SQP 099 Specifications and quality control of pharmaceutical preparations: fellowships R SES 099 Establishment and strengthening of environmental health services and institutions: fellowships R DHS 099 Development of health statistical services: fellowships R (see also rcp SHS 003, rcp MCR 002, rcp HMO 007, rcp HMO 010, rcp HMO 012, rcp MPD 004 and rcp CEP 003). LAOS SHS001 . (4001) Development of health services (1968-79) R UNDP UNICEF To develop and strengthen the general health services, beginning in Vientiane Province, which will serve as a pilot area; to organize a central advisory body to review the organization, programmes and co-ordination mechanism of the health services; and to formulate and carry out a programme for training health manpower. Within the framework of the Master Plan of Operation for this project, assistance was also provided by the Regional Tuberculosis Control Team (ICP MBD 001). -- WPR/RC26/4 page 111 SHS 002 (4801) Rehabilitation of the physically handicapped (1967-77) R UNDP (UN Office of Technical Cooperation) To assess the extent of the problem of the physically handicapped, plan and operate rehabilitation facilities and train staff for them, and review legislation dealing with the physically handicapped. SHS 003 (4301) Organization of medical care (1974-80) R To strengthen medical care services, and particularly the hospital system, and adapt them to the requirements of the present situation; to improve cooperation between the medical and health care services; and to optimize, through the formulation and continuing assessment of an overall medical care programme, the use of the available resources to meet current needs. SHS 004 (4201) Health laboratory services, Vientiane (1953-77) R UNICEF To establish a public health laboratory service and train laboratory personnel. MCH 001 (9601) Family health (1971-75) UNFPA UNICEF To provide effective maternal and child health care and advise on family planning with the ultimate objective of securing a higher standard of living for the family as a Whole. Provided - a medical officer, a nurse educator, a health educator, a sociologist, and supplies and equipment. 1. In the pilot province of Vientiane, maternal and child health/family health services were integrated into the activities of all existing health centres and sub-centres (6 main centres and 15 sub-centres), as well as in 12 existing provincial maternal and child health centres and 18 district maternal and child health centres. Family planning services were also made available. In 1974 and 1975, school health activities were started in two health zones. Family planning activities conducted in special clinics by the Lao Family Welfare ASSOCiation, Operation Brotherhood and USAID commenced in 1970. By the end of 1974, the total number of acceptors, of all methods, was about 3000 from the government services and about 13 000 from all agencies in Laos. The main problem was that, in the areas covered by the project, the health services extended to only about 10 to 15% of the population. 2. With the aim of introducing maternal and child health and family planning subjects into all training curricula, the following basic and refresher training programmes were carried out: (i) Nine with lectures (20 hours) and practical work for medical students. students did three weeks of practical work in conjunction the community medicine programme; WPR/RC26/4 page 112 LAOS (continued) (ii) lectures (20 hours) for student medical assistants. Twelve students did three weeks of practical work in the health zones; (iii) three refresher courses, lasting three days each, in the provinces of Luang Prabang, Pakse and Savannakhet for a total of 35 auxiliary rural midwives; (iv) one two-week refresher course for 14 members of the teaching staff of the auxiliary schools; (v) four refresher courses of two weeks' duration for 48 health personnel working in maternal and child health centres and health centres. 3. In 1974, health education, oriented particularly towards family health, commenced to be introduced into the existing health services at peripheral and central level. The subject was included in all the training programmes mentioned above. Lectures on health education in family health were given to the students of the Pedagogic School in Vientiane (5 hours) and a pamphlet on family health, as well as other health education materials, was prepared. 4. A demographic survey on aspects of health and reproduction was completed in the health zone of Thadeua. The first results available indicate that natality is about 34 0/00; general mortality about 10 0/00; and infant mortality is about 121 0/00. The natality rate in the zone of Thadeua has decreased compared with that revealed by the demographic survey of 1973. Results also show that rural communities in the province of Vientiane are not either ethically or morally resistant to fertility regulation, except to induced abortion. The most popular and most acceptable method is oral contraception. Sociological surveys carried out between 1973 and 1974 indicated that the traditional rural society in Laos is strongly motivated towards maintaining health. An estimated 10% of a village family's annual income is spent on health. The same society in the province of Vientiane is also able to participate in the organization of a community health service for primary health care, an important factor for extending and improving health service coverage. It is hoped that results obtained in training multipurpose auxiliaries will be maintained through regular Government training schemes. NUT 001 (5601) Nutrition advisory services (1968-76) R UNICEF To improve nutritional levels in the community and to coordinate, under a national nutrition policy, all health aspects of food and nutrition work carried out by international and national governmental and nongovernmental agencies. • , WPR!RC26!4 page 113 HMO 001 (6201 and 4401) Health manpower development (1967-78) R - To strengthen the faculty of the Royal School of Medicine including the school of nursing and midwifery. HMO 099 Health manpower development: fellowships R MPD 001 (2001) Malaria control (1969- ) R UNDP To build up the administrative and operational facilities of the Central Malaria Service to the level required to carry out an antima1aria programme, in the first place in the Vientiane plain. MNH 001 Mental health (January-March 1975) R - A consultant studied the current status of mental health needs and services, advised on practical methods for strengthening the mental health services and integrating them into the general health services, and assisted in planning and formulating a national ~nta1 health programme. RAD 001 (6402) Training in the maintenance of X-ray and other laboratory equipment (1975- ) R - To advise the Ministry of Publi.c Health on the development of a programme in the maintenance and repair of X-ray and other medical equipment; to develop a teaching programme for the training of engineering technicians suited to the needs of the country. DHS 001(4901) Vital and health statistics advisory services (1968-78) R - To establish a vital and health statistics service in the Ministry of Public Health and to train staff. Assistance was also provided under the intercountry projects HMO 007, ~D 001 and BSM 002. (see also ICP MCH 002, rcp HMO 010, ICP HMO 012 and ICP MPD 006). MACAO Assistance has been limited to participation in intercountry group educational activities (see ICP CEP 003). MALAYSIA SHS 001 (4001) Development of health services advisory services C1964-75} R UNICEF To strengthen and expand the basic health services and train personnel according to a consolidated plan which includes phasing of expansion and the development of uniform standards throughout the country. WPR/RC26/4 page 114 MALAYSIA (continued) MCH 001 (9601) Development of maternal and child health/family planning ro rammes in the rural health services (1973-75) UNFPA - To strengthen the maternal and child health family planning services as an integral part of the rural health services; to organize the training of medical, nursing and other health personnel in the clinical, medical and health aspects of maternal and child health/family planning; and to evaluate these activities. NUT 001 (5601) Nutrition advisory services (1967-77) R UNICEF (FAO) To plan and carry out nutritional surveys in a pilot area where an applied nutrition programme is being launched, develop nutrition education and supplementary feeding programmes and train the personnel needed for implementing and evaluating the health aspects of the programme. HMD 001 (6201) University of Malaya (1965- ) R To strengthen the teaching staff of the Faculty of Medicine of the University of Malaya, particularly in the fields of preventiv~ medicine, public health, nursing and medical recording. HMD 003 (6401) Public Health Institute (1970- ) R UNICEF To develop the Public Health Institute, whose functions are to provide a high standard of training for health personnel, geared to needs of the country; to undertake studies in public health and disseminate the knowledge thus gained; to provide services, not otherwise available, for the improvement of health programmes and for demonstration purposes; and to assist the Ministry of Health in the coordination of its various health training programmes. HMD 099 Health manpower development: fellowships R ESD 001 (2901) Epidemiological services (1971- ) R To establish, in the Division of Communicable Disease Control, Ministry of Health, an epidemiological and statistical service responsible for planning and evaluating national disease control programmes; to study the local epidemiology of causes ~ of morbidity and mortality as a basis for the formulation of such programmes; to improve liaison and coordination among the Ministry's communicable disp~se control, medical records and health statistics services, the laboratory services (particularly the Institute of Medical Research) and other peripheral government units concerned with disease control; and to train staff in epidemiological work. MPD 001 (2001) Malaria eradication programme, Peninsular Malaysia (1967-82) R MPD 002 (2002) Malaria control, Sabah (1961-82) R To improve the control of malaria with the aim of eventually eradicating the disease. MPD 003 (2003) Malaria control, Sarawak (1961-78) R To maintain the gains already achieved by continuing antimalaria operations throughout the malarious areas; to provide health assistance, particularly to the groups engaged in developing natural resources; and to continue the training of basic health service personnel and voluntary agents for work in the malaria programme. '-" MBD 099 Mycobacterial diseases: fellowships R WPR/RC26/4 p.age 115 VBC 001 (3701) Vector control (June-September 1974) R - A consultant assisted the Ministry of Health in establishing a vector control unit, and in organizing a nationwide survey of Aedes aegypti and a programme for its control. MNH 001 Prevention and control of druB abuse (1975- ) R - During the period under review, fellowships were awarded in preparation for advisory assistance in 1976. LAB 001 (4201) Institute of Medical Research (September-October 1974) R - Following a visit made in 1973, a consultant assessed the quality of blood transfusion laboratory technology and assisted with training in this aspect of the work of the blood transfusion service. LAB 099 Health laboratory services: fellowships R HWP 001 Occupational health advisory services (1975-80) R - To estab~ish an occupational health unit which will promote the formulation of measures and development of services for the health protection of workers; to train health workers in occupational health; and to eatab1ish a National Occupational Health Centre which will undertake research, training and demonstration activities and thereby assist other institutions in developing related occupational health services. SES 001(3001) Environmental health advisory services (1966-76) R UNICEF To develop a national environmental health scheme, to implement sanitation projects, including water supplies for rural communities, through the health authorities and other governmental agencies, and to train sanitation staff. Assistance was also provided under the intercountry projects SHS 003, HMD 003, HMD 007, HMD 011, MBD 001, BSM 002 and RAD 003. (see also ICP MCH 002, ICP HMO 012, ICP HMO 018, ICP MPD 006, Iep DNH 002, ICP LAB 004, ICP CEP 003 and ICP HWP 001), NEW HEBRIDES SHSOOI (4001) Development of health services (1969-80) R UNDP UNICEF To develop the general health services, establish methods and practices for the efficient operation of the rural health programme (particularly as regards maternal and child health, tuberculosis control and antima1aria and environmental sanitation work), and provide training, including in-service training, for health service personnel. SHS 002(4301) HOSpital administration (September 1974-February 1975) R A consultant assisted in setting up a hospital records system for the new British National Service Base Hospital. MCH 001 (9601) Development of family health services (1974-76) UNFPA - To develop and strengthen family planning services in urban and rural areas. WPR/RC26/4 page 116 NEW HEBRIDES (continued) HED 099 Health education: fellowships R HMO 001 (4401) Nursing education (1970-76) R - To formulate and implement short-term and long-term plans for the strengthening and development of a system of nursing education in the country. HMO 099 Health manpower development: fellowships R MPD 001 (2001) Malaria control (1970-81) R - To build up the operational facilities for an antimalaria programme and organize antimalaria operations within the framework of the general health services. DNH 099 Dental health: fellowships R SES 099 Environmental health: fellowships R DHS 099 Development of health statistical services: fellowships R Assistance was also provided under the intercountry projects SHS 002, MBD 006, BSM 001 and MPD 004. (see also ICP MCH 002, Iep HMO 018, Iep MPD 006 and Iep MPD 007), NEW ZEALAND HMO 099 Health manpower development: fellowships R SES 099 Environmental health: fellowships R DHS 099 Development of health statistical services: fellowships R (see also ICP HMO 007, ICP HMO 010, Iep HMO 012 and rep CEP 003). NIUE HMO 099 Health manpower development: fellowships R Assistance was also provided under the intercountry project RAD 001. (see also rep MPD 007 and rcp DNH 002). PAPUA NEW GUINEA SHS 001 General health services development (1974-79) R UNICEF To strengthen the planning, organization and management of an integrated general health service throughout the country; to improve the delivery of the health services; to review, update and initiate education and training schemes for health manpower; to stimulate and encourage participation of the population in community health activities. -- .- WPR/RC26/4 page 117 MCH 001 (9601) Family health (1974-78) UNFPA To make priority measures for the improvement of family health available to the population in general; to reduce unnecessary maternal deaths and morbidity due to unwanted pregnancies; to achieve family sizes compatible with the provision of more adequat~ care, and through this to achieve better individual, community and national development. HED 099 Health education: fellowships R HMO 001 (6201) Medical Faculty. University of Papua New Guinea (1970-80) R To strengthen the faculty of the School of Medicine (formerly the Papua Medical College) and raise the standard of teaching. HMO 002 (4401) Nursing education (1970-77) R To assist in planning for current and future needs in nursing education and administration and to establish post-basic courses to prepare nurse teachers and nurse administrators. Assistance continues to the established post-basic course in community health nursing. HMO 003 (5501) Port Moresby Dental College (1975- ) R period under review a fellowship was awarded in preparation advisory services scheduled to begin later in 1975. During the for long-term HMO 004 (6401) Education and training advisory services (1971-76) R To plan, implement, and evaluate various types of courses in training institutions under the jurisdiction of the Division of Medical Training and other institutions designated by the Government for the purpose of training government personnel. HMO 099 Health manpower development: fellowships R MPD 001 (2001 and 2002) Malaria control (1973-79) R UNDP To intensify the antimalaria programme and extend it progressively, in order to reduce malaria incidence to a level that will not affect socio- economic development; and to train staff for the programme. The project was visited by an independent assessment team, composed of a malariologist and a public health administrator, during the period February to March 1975. (see rcp MPD 002). MBD 001 (120l) Tuberculosis control (June-September 1974) R A consultant studied the epidemiology of tuberculosis and the measures employed for the control of the disease, recommended improvements, and assisted in integrating control activities into the work of the general medical and health services. He also advised on the teaching of tuberculosiS in the medical course and in training programmes for nurses and other medical workers. WPR/RC26/4 page 118 PAPUA NEW GUINEA (continued) LAB 001 (4201) Health laboratory services (1974-76) R To organize, strengthen and develop the central public health laboratory at Port Moresby; and to train various categories of technicians, particularly public health microbiology technologists and technical assistants, for operating the health laboratory services at different levels. SES 001 (3001) Environmental health advisory services (1973- ) R - To develop an environmental health programme in the Department of Public Health, improve the coordination of environmental health activities, carry out surveys of environmental health problems (particularly those related to water supply, waste disposal, and environmental pollution) throughout the territory, prepare designs, standards and specifications for water supply and waste disposal facilities, and review the training programme for healt~ inspectors. Assistance was also provided under the intercountry projects SHS 003, MeH 003, HMO 003, HMO 007, MBD 001 and HMO 011. (see also Iep MCH 002, rep HMO 010, rcp HMO 012, rep HMO 018, rep ESD 001, rcp MPD 006, rcp MPD 007, ICP DNH 002, ICP CEP 003 and ICP HWP 001). PHILIPPINES SHS 001 (4001) General health services development (1969-77) R UNICEF To improve the organization and administration of the health and medical care services, undertake national health planning in the context of overall planning for development, review health manpower education and training schemes, and develop working relationships between the national health administration and other agencies, both public and private, that are concerned with health. '- SHS002(4l0l) National health planning (1972-77) R - During the period __ under review the staff of the intercountry health planning training project SHS 003 (4101) collaborated in a review of the national health policy, in the training in planning of national health staff, and in the preparation of guidelines for a national planning exercise. Consultations were held in connexion with the general health services development project Philippines SHS 001 (4001) for the consideration of norms and procedures for the operations 0:1; the rural health services. MCH 002 (9603) ·~ternity-centred family planning (1971-75) UNFPA UNICEF tsee pages 83-86 for a full description of this project). WPR/RC26/4 page 119 MCH 003 (9606) Boho1 Province MCH-based family planning (1974- ) UNFPA To improve maternal and child health and regulate fertility; to determine and demonstrate the effectiveness of a project in which family planning services are delivered through a well-organized maternal and child care programme in a large, predominantly rural, area. HED 001 (4501) Research, development and training in family planning communications. Institute of Mass Communication, University of the Philippines (1973-74) FR A health education specialist assisted in developing and testing communication approaches, designing educational and information ~teria1s, and organizing training programmes in communication techniques and methods. The two major accomplishments were training of "hi1ots" (indigenous midwives) and the development of Barrio Women's Clubs to enable mothers in rural areas actively to participate in family welfare and community development. HMO 001 (6401) University of the Philippines (1971-81) R To strengthen the staff of the University of the Philippines. in particular that of the Institute of Public Health. which is the only school of public health in the country and which serves as a regional training centre and is used by WHO in the organization of courses on national health planning. HMO 002 Nursing education (December 1974-Apri1 1975) R In connexion with the Government's study to revise the basic nursing curricula in schools and colleges of nursing, a consultant advised on the need for adjustments in the content of nursing education programmes to meet the requirements of the health services and organized and conducted a seminar on curriculum development for directors of schools and colleges of nursing. HMD 003(9604) Nursing education in family planning (1971-74) UNFPA To organize national workshops to prepare faculty members to integrate population dynamics, human sexuality and family planning in basic nursing curricula. Provided: The public health nurse assigned to the intercountry family health field advisory services project MCH 003 (9603) as consultant for all activities. A consultant in nursing education for three months in 1973 to evaluate the educational soundness and assist in the final preparation of a Guide for the Teaching of Population Dynamics, Human Sexuality and Family Health in the Nursing and Midwifery Curricula which was subsequently published by the Department of Health and the Institute of Public Health. University of the Philippines and is being used extensively by the faculties of schools of nursing and midwifery throughout the country. The major activities over the four-year period were a series of four one-month workshops for faculty from 71 schools of nursing and midwifery. An additional workshop was held in January 1975 utilizing funds from the training component of the intercountry project MCH 003. Following these workshops, except that held in January 1975, teaching supplies and equipment were provided to the schools that sent participants. Follow-up visits were made to approximately two-thirds of the schools to provide assistance in the integration process. WPR/RC26/4 page 120 PHILIPPINES (continued) HMO 004 (9605) Assistance to the teaching programme of the Institute of Public Health, University of the Philippines, in family planning, human reproduction and population dynamics (1971-74) UNFPA - To expand the teaching facilities and activities of the Institute of Public Health in family planning; to strengthen the long-term academic programme of the Institute in family planning; and to develop the Institute's leadership in curriculum planning in family planning, human reproduction and population dynamics. Provided - 2 fellowships, supplies and equipment, and local costs. Four training courses were given for staff of the maternity-centred family planning programme of government training hospitals. The courses emphasized administration, planning, implementation, evaluation and teaching methods. The last course was held in May 1974. About 75% of the staff in 25 hospitals of the maternity-centred family planning programme have been trained. In addition, 2 seminars were held for school physicians. HMO 099 Health manpower development: fellowships R ESD 001 Communicable (lseaae control (September-December 1974) R - A consultant (September-December 1974) reviewed the epidemiological features of diphtheria, pertussis and tetanus and assessed the control measures - in particular the tmmunization programmes - being undertaken. A second consultant (September-November 1974) assisted the Government in elucidating the epidemiology of diarrhoeal diseases, especially the reasons for their high prevalence in both urban and rural areas, and in assessing the national diarrhoeal diseases control programme. In November and December 1974, a team, composed of an epidemiologist, a ma1acologist and an engineer/agronomist, reviewed the schistosomiasis control programme. MPD 001(2001) Malaria eradication programme (1958- ) R MBD 001 (1201) National Tuberculosis Institute for Training and Research (1975- ) R UNICEF - During the period under review fellowships were awarded in preparation for long-term advisory services scheduled to begin in 1976. VPH 001 (280l) Rabies control (July-September 1974) R - A consultant assessed the progress made in the production and control of LEP rabies vaccine since his visit in 1973, assisted in improving the quality of the vaccine so that it may meet international requirements, and made suggestions for commencing medium-scale production. CAN 001 (8101) Cancer control (1975- ) R - During the period under review a fellowship was awarded in preparation for advisory services scheduled to begin later in 1975. -WPR!RC26!4 page 121 DNH 001 (5501) Dental health advisory services (1975- ) R UNICEF During the period under review fellowships were awarded. Advisory services were provided from the intercountry project (DNH 001). MNH 001 (5401) Mental health advisory services (November-December 1974) R A consultant assisted in organizing a national workshop on modern trends in the delivery of mental health and psychiatric care, with special reference to the role of nursing personnel in hospital and community-based health services. MWrl 002 (7301) Organization of drug abuse control programmes (November 1974- May 1975) R A consultant assisted the College of Education, University of+.a Philippines, in developing a drug education programme, integrated Wi:~l health education. R"'.D 001 Radiation health advisory services (1975- ) R period under review fellowships were awarded in preparation services scheduled to begin later in 1975. During the for advisory LAB 001(4201) Health laboratory services (1975- ) R During the period under review fellowships were awarded in preparation for advisory services scheduled to begin later in 1975. CEP 001 (3203) Laguna de Bay water resources development (1972-74) UNDP! Asian Development Bank - The services of a technical officer (for 1 year from Aug. 1973) and of 3 consultants (2 in 1972 and 1 in 1973) were provided to assist the Asian Development Bank in connexion with the studies (on hydraulic control structure, water supply, and water quality) conducted by consultant engineering firms with the aim of providing information and engineering data for the immediate development of the water resources of the Laguna de Bay for various uses, including provision of flow control for the protection of areas of metropolitan Manila. WHO's tasks were to assist in the preparation of detailed terms of reference for the contractors engaged by the executing agency, review and comment on the short list of consultants and the proposals submitted by them to the executing agency, and provide technical advice on the pollution control and water quality management needs and the public health aspects of the water supply study. The lake, which earlier had been regarded as a possible source of raw water for immediate development as a municipal water supply, was found in the course of the study to be mildly eutrophic because of the inflow of pollutants from the urban and rural areas of the watershed. The WHO staff helped to evaluate the degree of eutrophication of the lake, particularly with regard to the advisability of developing it immediately. In view of the degraded ecological state of the lake, it was recognized that the one-year studies undertaken needed to be continued and expanded. A proposal was therefore prepared for the continuation of water quality studies for 2 more years, with UNDP financing and WHO as executing agency. WPR/RC26/4 page 122 CEP 002 Assistance for comprehensive water quality management of Laguna de Bay (1975-77) UNDP - To support the Government's comprehensive programme aimed at abating and controlling pollution in Laguna de Bay and at the improvement of lake water quality for water supply. fisheries. irrigation and other purposes. HWP 001 Industrial health advisory services (January-February 1975) R A consultant was provided to study the industrial health services. He also assisted in formulating a plan for developing industrial health services to keep pace with growing industrialization. SES 001 (3001) Environmental health advisory services (August-September 1974; April-June 1975) R A consultant assisted the local water utility administration in organizing and conducting a course on the operation of municipal water systems. A consultant studied the epidemiological. social and economic significance of inadequate environmental sanitation in rural areas; reviewed the programmes in this field currently in operation or planned by the Department of Health and other agencies; and studied the feasibility of establishing a basic information system to provide the Government with data necessary for planning. SES002 Environmental sanitation training (May-July 1975) R A consultant is making a review of the present manpower situation; assessing the existing training programmes. particularly those for sanitary inspectors; and studying proposals for the establishment of new categories of environmental health personnel. DHSOOl(490l) Improvement of medical records (1975-76) R To assist in developing a medical records system for use in hospitals by first establishing a model medical records department in one hospital and training personnel. Assistance was also provided under the intercountry projects SHS 001. SHS 003, MCH 003. HMO 007, MBD 001, MNH 001, RAD 001. and RAD 003. (see also rcp MeH 002, rcp HMO 010, ICP HMO 012. rcp HMO 018. rcp MPD 006. rcp 11BD 002. rcp DNH 002, ICP LAB 004, ICP CEP 003 and rcp HWP 001). REPUBLrc OF KOREA SHS 001 (4001) General health services development (1963-77) R UNICEF To promote through the development of the general health services, the health pro~ection of the population so that it is able to participate more fully in the social and economic development of the country. ", '-" WPR!RC26!4 page 123 SHS 003 (4301) Organization of medical care (November-December 1974) R A consultant made a review of hospital intern and resident experience with a view to relating it more closely to the needs of the rural areas. MCH 001 (5104) Maternal and child health services (1974- ) R To strengthen and develop maternal and child health services as part of the general health services; to carry out field studies with a view to increasing the coverage of basic maternal and child health care; and to improve the training of maternal and child health personnel. MCH 002 (9602) Maternity-centred family planning (1973-74) UNFPA To develop the staff and facilities of the 3 government hospitals for demonstration of and training in maternal and child health and maternity- centred family planning activities. Provided - 3 fellowships, supplies and equipment, and local costs. Following the recruitment and training of hospital physicians, nurses and statisticians, matern~l and child health and family planning programmes were initiated in the Chungnam, Namwon and Andong hospitals, beginning in March 1973. The project is being absorbed by the national family planning project, which includes the extension of maternal and child care and family planning activities to 102 hospitals in the country. NUT 099 Nutrition: fellowships R HMO 001 (6401) Education and training of health personnel (1969-78) R UNFPA UNICEF To provide education and training for health and medical workers, including undergraduate and postgraduate training for physicians and basic and postbasic training for nurses, sanitarians and other health workers; to advise on the establishment of the national teacher training centre for health personnel. HMO 002 (9601) WorkShops in family planning for teachers in nursing! midwifery schools (1971-74) UNFPA To organize workshops for teachers in nursing/midwifery schools with the objective of securing well-qualified staff to teach family planning and to integrate it into the basic curriculum. Provided - the WHO public health nurse assigned to the intercountry family health field advisory services project MCH 003 (9603) as consultant for the first workshop. The WHO public health nurse educator assigned to the education and training of health personnel project Republic of Korea HMO 001 (6401) as consultant for the second workshop. The activities of this project consisted of two workshops, in 1971 and 1973, to assist the faculties of the schools of nursing in integrating population dynamics and family planning into their basic curricula. ESD 001 (2901) Epidemiology and statistics advisory services (1968-78) R To organize and develop a central epidemiological service and a disease intelligence network in the Ministry of Health and Social Affairs; to improve the collection, recording and utilization of health s·tatistics; and to coordinate health laboratory services with the epidemiological services. WPR/RC26/4 page 124 REPUBLIC OF KOREA (continued) MBD 001 (1201) Tuberculosis control (1962-73; 1974) R UNDP UNICEF During the period under review a fellowship was awarded to supplement the advisory assistance provided by the regional tuberculosis control team Iep MBD 001. MBD 002 (1301) Leprosy control (1961-76) R UNDP UNICEF During the period under review assistance was limited to the award of a fellowship. DNH 099 Dental health: fellowships R DEM 001 (7401) Drug quality control (June-August 1975) R A consultant is providing assistance in the structural identification of natural products and medicinal drugs and in the separation, identification and quantitative analysis of pesticides and medicinal drugs in mixed preparations by chromatographic methods. LAB 001 (4201) Health laboratory services (1974- ) R During the period under review assistance was limited to the award of a fellowship. BSM 001 (3201) Advisory services on community water supply and sewerage (1972-77) R To plan and implement a comprehensive urban and rural water supply and sewerage programme. CEP 001 (3102) Air pollution control advisory services (1975- ) R During the period under review, a fellowship was awarded in preparation for advisory services scheduled to begin later in 1975. CEP 002 (3103) Water pollution control advisory services (1975- ) R During the period under review, a fellowship was awarded in preparation for advisory services scheduled to begin later in 1975. FSP 001 (3601) Food hygiene (1974-77) R - To review food sanitation legislation, organize food sanitation and chemical quality control services at central and local levels, and carry out an inservice training programme. Assistance was also provided under the intercountry projects SHS 003, HMD 007, MBD 001, DNH 001 and RAD 003. (see also ICP MCH 002, ICP HMO 010, Iep HMD 012, ICP HMO 018, Iep MBD 002, Iep DNH 002, ICP LAB 004, Iep CEP 003 and Iep HWP 001). SINGAPORE SHS 001 Hospital administration (1975-77) R - redevelopment of the Outram Road General Hospital Premier Hospital and the building of a university Kent Ridge. To oversee the as the Singapore teaching hospital at WPR/RC26/4 page 125 HMO 001 (6401) University of Singapore (1968-76) R - To strengthen the teaching staff of the Faculty of Medicine of the University, particularly in the fields of preventive medicine, public health, organization of medical care and, since 1974, occupational health and occupational health nursing. Consultant services in other fields and fellowships were provided between 1952 and 1966. HMO 002 (6301) Development of medical specialties (1971-75) R - To establish and organize specialist units in hospitals and to train in advanced techniques staff to man these units. ESD 001 (1001) Communicable diseases advisory services (1972-77) R - To develop and strengthen the epidemiological service of the Ministry of the Environment, study the epidemiology of the main causes of morbidity and mortality (particularly communicable diseases), develop procedures for the investigation, prevention, diagnosis and control of certain diseases, and train staff in epidemiological work. RAD 099 Biomedical aspects of radiation: fellowships R PIP 002 (3303) Closed storm drainage system design (1973-75) UNDP To draw up plans for closed storm drainage. pumping and water storage schemes to serve new developments and other selected areas; and to prepare a preliminary plan for a closed storm drainage and storm-water capture scheme to replace the existing open drain system serving the developed ·areas of Singapore. SES 001 (3001) Environmental control advisory services (January-March 1975) R - A consultant assisted the Ministry of the Environment in designing an accounting system in connexion with the management and disposal of solid wastes. DHS 099 Development of health statistical services: fellowships R Assistance was also provided under the intercountry project RAD 003. (see also rcp MCH 002, ICP HMO 010, ICP HMO 012, ICP MPD 006, ICP MBD 002, ICP LAB 004, ICP CEP 003 and ICP HWP 001). SOUTH VIET-NAM SHS 001 (4101) National health planning (1972- national health planning unit in the Ministry of national health policy and a national health and staff. ) R - To strengthen the Health, formulate a manpower plan, and train SHS 002 (4001) General health services development (February-August 1974) R - A consultant advised the national health administration on the public health nursing aspects of the general health services, assisted in developing the general health services, particularly those in rural areas, and participated in surveys and assessment of the health situation and available resources. WPR/RC26/4 page 126 SOUTH VIET-NAM (continued) SHS 003 (4201) Health laboratory services (1964- ) R UNICEF To establish a central health laboratory service and train health laboratory workers; and, later, to organize regional and peripheral health laboratory services. MCH 001 (9601) Family health (1973-77) UNFPA UNICEF To strengthen family health services by improving the health care of mothers and children and providing married couples with information and services for the planning of their families. HMO 001 (6001) Medical education (1972-77) R aspects of the curricula of schools of medicine. to preventive medicine and public health. To strengthen various with particular attention HMO 002(6401) National Institute of Public Health (1969-82) R VD To build up a national institute of public health which will serve as a centre for the planning, standardization, organization, coordination, implementation and evaluation of training programmes for various categories of medical and health workers. HMO 003 (5501) Training of dental auxiliaries (1974-79) R To strengthen the organization for the delivery of dental health services. develop dental service programmes, consolidate and develop programmes for training dental auxiliaries and educate the public in dental health. HMO 099 Health manpower development: fellowships R ESD 001 (2901) Epidemiological surveillance and quarantine (1970- ) R , To develop epidemiological services at the central and regional levels, strengthen the application of the International Health Regu1ation~ (1969) and train staff for these purposes. MPD 001 (2001) Malaria control (1974-77) UNDP To strengthen the antima1aria service in order to reduce malaria morbidity and mortality to the greatest possible extent, giving particular attention to high risk population groups; and subsequently to reduce malaria to a level at which it will no longer constitute a public health problem, with the objective of eventually eradicating the disease. MBD 001 (1201) Tuberculosis control (1958-77) R UNDP national tuberculosis control programme as a permanent part health services. To set up a of the basic MNH 002 Drug abuse control (2-10 December 1974) made a review of the epidemiological information in South Viet-Nam. advised on a future programme establishing a national centre for the treatment dependents. R UNFDAC A consultaLt available on drug problems of action and assisted in and rehabilitation of dLi'. .. , - , , WPR/RC26/4 page 127 SQP 001 (7402) Drug quality control (December 1974-January 1975) UNDP Under preparatory assistance, a consultant helped to assess the technical aspects of the production and quality control of drugs and to formulate a project for the reorganization of the drug quality control laboratory, including staff training, proposed to be carried out with UNDP assistance. ISB 001 (4202) Production and control of biologicals (1972-79) R To improve the production and control of biologicals (especially cholera, typhoid and plague vaccines and freeze-dried smallpox vaccine); and the management. breeding and care of laboratory animals. BSM 001 (3201) Water supply and sewerage in urban communities (1975-77) UNDP To improve urban health through the provision of adequate quantities of safe water for domestic and other uses and the proper collection, treatment and disposal of waste water. BSM 002 (3401) Solid wastes management (June-July 1974) UNDP A consultant helped to assess the situation with regard to solid wastes management and to formulate a programme based on proposals for organizational and technical improvements. He also recommended alternative methods of refuse disposal and assessed the nature and extent of the international assistance that the Government would require to implement a programme. BSM 003 Advisory services on programmes for the provision of water supplies and sanitary facilities (1975-76) R To achieve and maintain satisfactory levels of environmental health. specifically in government health and educational institutions in rural areas. CEP 001 (3101) National pollution control programme (1974) UNDP To formulate and implement a phased country-wide environmental pollution control programme; to prepare legislation and institutional arrangements for the implementation of the programme; and to establish a system of regional monitoring and laboratory facilities. Provided - a consultant (April 1974; October-December 1974); air pollution control equipment costing US$ 21 000 (an additional US$ 19 000 was provided by the Government); two fellowships on air pollution control techniques, for a chemist and an engineer. Under this preparatory assistance, the consultant reviewed the water pollution control situation and helped to formulate, in consultation with the Ministry of Health. proposals for a further programme of activities in air and water pollution control to be carried out with UNDP assistance in 1976 and 1977. A draft Clean Air Act was prepared under a fee-contract and submitted to the Government. It is now under study for adaptation to local conditions. SES 001 (3001) Environmental health advisory services (1965-77) R To achieve and maintain satisfactory levels of urban and rural environmental health and to assist in developing and implementing programmes towards these objectives. WPR/RG26/4 page 128 SOUTH VIET-NAM (continued) DHS 001 (4901) Vital and health statistics advisory servi~es(1969-75) R To organize an efficient and up-to-date system of collecting and recording vital and health statistical data so as to produce vital and health statistics that will meet national and international needs; and to train personnel in the administration and operation of a nationql health statistical service. Assistance was also provided under the intercountry projects SHS 003, MCH 003, HMD 007, MBD 001 and DNH 001. (see also ICP MCH 002, ICP HMD DID, ICP HMD 012, ICP HMD 018, ICP MPD 006, ICP MBD 002, icp DNH 002, ICP LAB 004, ICP CEP 003 and ICP HWP 001). TONGA SHS 001 (4101) National health planning (September-December 1974) R A consultant made an appraisal of the arrangements for health planning and gave guidance to national staff on the concepts and methods of health planning. He also assisted with the organization of a health and manpower planning exercise, designed in the context of the country's national development plan. SHS 002 (4102) Health legislation (September-December 1974) R A consultant reviewed the content of health and other relevant legislation and regulations and submitted recommendations concerning any revisions reqUired. MCH 001 (9601) Maternal and child health/family planning (1972-76) UNFPA UNICEF To organize and implement a family planning programme within the health services, particularly as part of maternal and child health care, and to train the necessary staff. HMD 099 Health manpower development: fellowships R Assistance was also provided under the intercountry projects SHS OIl, BSM 001 and RAD 001. (see also ICP MCH 002, ICP HMD 010, Iep ESD 001, ICP MPD 007 and ICP DNH 002). TRUST TERRITORY OF THE PACIFIC ISLANDS HED 099 Health education: fellowships R HMD 001 Refresher course for indigenous doctors (March-April 1975) R Consultants in the fields of internal medicine, surgery, and maternal and child health assisted in the organization of a refresher training course for Micronesian doctors. j " , , ,~ Refresher training in surgery, internal medicine and paediatrics was given by a team of WHO consultants to 21 Micronesian medical officers. This was the first time WHO had participated in this kind of programme in the Trust Territory of the Pacific Islands. Photographs show (top) Dr W. Zylstra, specialist internist, during a lecture; Dr Frank Palacios, Director of Communicable Diseases, TTPI, in discussions wit h Dr David Johnson, consultant surgeon; and lower photograph, a group of the Micronesian medical officers who took part in the refresher course. HMO 099 Health manpower development: fellowships R DNH 099 Dental health: fellowships R LAB 099 Health laboratory technology: fellowships R WPR/RC26/4 page 129 SES 099 Establishment and strengthening of environmental health services and institutions: fellowships R DHS 099 Development of health statistical services: fellowships R Assistance was also provided under the intercountry project MCH 003. (see also ICP HMO 010, ICP HMO 018, rcp MPD 004, rcp MPD 007, rcp MBD 004 and ICP DNH 002). WESTERN SAMOA SHS 001 (4001) National health services development (1967- ) R UNDP UNICEF To develop and strengthen the organization and operation of the general health services, particularly at district and local levels; to improve the operation of the rural health programme; to organize inservice training for medical and allied personnel; to conduct epidemiological studies on the most important causes of morbidity and mortality in the country; and to plan disease control programmes as part of the general health services. SHS 002 (4101) National health planning (May-August 1974) R A consultant assisted in assessing the accomplishments of the health sector under the country's current development plan; in organizing a planning unit in the Ministry of Health which will meet the requirements of the planning process; and advised and participated in the drawing up of the health sectoral plan to be incorporated in the Government's forthcoming overall development plan. SHS 003 (4301) Hospital administration (1971-76) R UNDP To assist in planning and strengthening the organization of the Apia General Hospital and any other hospitals that may be constructed, renovated or scheduled for development and advise on the non-medical aspects of hospital management. MCH 001 (9601) Maternal and child health/family planning (1971-76) UNFPA VD UNICEF To organize a family planning programme, including advice on the spacing and limitation of births and the treatment of subfertility, and train the necessary staff; to conduct surveys on the influence of high fertility and high birthrate on the health of mothers and children; and to undertake operational research on methods of meeting the country's family planning needs. HMO 001 (4401) Nursing education (1972-74) UNDP To improve the standard of nursing and midwifery education and services. Provided a nurse educator, 6 felLowships, supplies and equipment. WPR/RC26/4 page 130 WESTERN SAMOA (continued) Assistance was provided in revising the nursing curriculum, developing an inservice education programme for nursing personnel, and establishing an education committee for nursing and a community health demonstration area offering practical experience for nursing students. One national nurse teacher has been trained and a second is currently studying under a WHO fellowship. Two national nurses will complete their fellowship studies in public health nursing in 1975. Assistance will continue in 1975 with the provision of two further fellowships. HMO 099 Health manpower development: fellowships R UNDP MBD 001 (1201) Tuberculosis control (1960-63; 1966-68; 1971-74) R UNICEF Provided a medical officer, supplies and equipment (1960-63); consultants (1971-74); the services of the regional tuberculosis control team ICPMBD 001. The Government of Western Samoa launched the first nationwide tuberculosis campaign, with WHO assistance, in 1960. The campaign, which took three years to complete. was based on tuberculin testing of children under 15 and X-ray and bacteriological examination of persons aged 15 and over, when required. Tuberculin reactors were prescribed isoniazid for prophylaxis and cases of tuberculosis were treated with specific drugs. The second campaign was carried out during the period 1966-68. The whole population was tuberculin tested. Non-reactors were vaccinated with BCG. while reactors were examined further for pulmonary tuberculosis; all positive cases were treated. Following the first campaign, 2436 children received chemoprophylaxis and 1440 suspects diagnosed radiologically, including 312 cases proved to be positive through bacteriological examination, were placed on chemotherapy. During the second campaign, 1026 suspects diagnosed by X-ray, including 77 cases found to be positive through sputum microscopy. were placed on treatment, while 80 039 persons, representing 61% of the total population or 80% of the estimated total susceptible population, were vaccinated with BCG. The achievements of the two campaigns were significant, from the standpoint not only of prevention and therapy, but also public education. From the very beginning the tuberculosis service was, however, organized on a vertical specialized basis. Most of the control activities were carried out by staff of the tuberculosis clinic in Apia. Staff of the district health services rarely participated, except during the campaigns. Patients had to travel a long way to collect drugs and undergo follow-up examinations. For this reason, a considerable number were prematurely lost. The third phase of the project was launched in August 1971 with the aim of integrating tuberculosis control into the district health services. At the national level, the tuberculosis control unit was made - WPR/RC26/4 page 131 a section within the Division of Public Health of the Health Department. A working manual was prepared for all categories of workers at the central and district levels. Following a pilot trial in Leulomoega, tuberculosis control services including vaccination with BeG, case-finding and domiciliary treatment were extended to all sixteen districts of the country. Assistance was also provided under the intercountry projects SHS 003, SHS 011, MBD 001, BSM 001 and DHS 001. (see also Iep MeH 002, Iep HMO 010, Iep HMD 018, rep MPD 007, ICP DN1t002 and ICP LAB 004). INTERCOUNTRY PROGRAMMES SHS 001 (0901) Public health advisory services (1961- ) R - To meet requests from countries of the Region for advisory services in connexion with the planning of long-term projects or with specific problems. The following assistance was provided during the period under review: Health education, Philippines (September 1974-February 1975) A consultant reviewed the situation with regard to health education in the Philippines and studied the health system, in order to identify the health education needs (including manpower) and the factors affecting development. SHS 002 (4001) Public health advisory services, South Pacific (1962-63; 1965- ) R UNDP (South Pacific Commission) To assist countries in the area in strengthening and developing their general health services, particular attention being given to maternal and child health work integrated into the general health services. During the period under review, individual members of the team assigned to the project visited Fiji, the Gilbert and Ellice Islands, and the New Hebrides. SHS 003 (4101) Training in the field of health planning (1968-77) R UNICEF See pages 87-91 for a full description of this project. SHS 004 (4003 and 4102) Health planning and management (1968-78) R To assist governments in formulating national health plans as part of their national development programmes and to provide assistance in the fields of management and health practice research to WHO-assisted projects and to other government health activities upon request. During the period under review the first phase of the country health programming exercise being carried out in Laos was completed and the second phase commenced. Attention was given to drawing up general outlines for the preparation of plans of operation and plans of work. Assistance was WPR/RC26/4 page 132 INTERCOUNTRY PROGRAMMES (continued) provided to the general health services development project Philippines SHS 001 in designing the plan of work, which involves supervision, logistics and information monitoring, for the second phase of the operational study on rural health care services. SHS 011 (4201) Health laboratory services (1971-74) R To assist in the organization and development of public health laboratory services, coordinated with other laboratory facilities, that can support epidemiological work, rural health services and sanitation projects. During the period under review, assistance was given to Fiji, Tonga and Western Samoa. MCH 002 (9602) Seminar on the role of nurses and midwives in family planning, Manila (16-23 September 1974) R To consider family planning activities within the health services; exchange information on the extent to which nurses and midwives are involved in family planning activities in countries of the Region, the role they should play and the functions they should carry out; and discuss ways of integrating family planning activities into nursing and midwifery practice. There were twenty-one participants from the British Solomon Islands Protectorate, Cambodia, Cook Islands, Fiji, Gilbert and Ellice Islands, Hong Kong, Japan, Laos, Malaysia, New Hebrides, the Philippines, Republic of Korea, Singapore, South Viet-Nam, Tonga and Western Samoa, and observers from the United States Agency for International Development, the International Council of Nurses, the International Planned Parenthood Federation and the Family Planning Organization of the Philippines, Manila. Provided - 2 consultants, 1 temporary adviser and the cost of attendance of the participants. MCH 003 (9603) Family health field advisory services (1971-77) UNFPA To provide advisory services to governments in connexion with the strengthening and development of family planning programmes and their integration into basic health services. During the period under review, individual members of the team visited the Gilbert and Ellice Islands, Papua New Guinea, the Philippines and South Viet-Nam. HMD 001(6001) Participation in educational meetings (1964- ) R A ten week fellowship was awarded to a candidate from Malaysia to attend a training course on the maintenance and repair of X-ray equipment organized from 1 October to 13 December 1974, under WHO auspices in the Federal Republic of Germany, the Netherlands and the United Kingdom. A six-month fellowship was awarded to a candidate from the Philippines to attend the WHO interregional courses in epidemiology and control of communicable diseases, Prague (28 August to 27 November 1974) and Delhi (2 December 1974 to 28 February 1975). HMD 002 (6401) Institutions for the training of health personnel (1966- R Four fellowships were awarded to candidates from Fiji (3) and the Republic of Korea. -- WPR/RC26/4 page 133 HMO 003 (9604) Teaching of family planning, human reproduction and population dynamics in medical schools (1972- ) UNFPA To assist in developing a systematic and coordinated approach to the teaching of family planning, human reproduction and population dynamics in medical schools of the Region. During the period under review, a consultant provided assistance to Malaysia (September-October 1974) and to Papua New Guinea (June-August 1974), HMD 004 (4302) Regional centre for the training of anaesthetists (1970-80) R - To assist in the operation of a regional centre in M,a,,;;'la for training anaesthesio1ogists for the countries and areas of the Region. During the period under reView, fellowships were awarded to candidates from Cambodia, Fiji, Hong Kong, Niue, Papua New Guinea, the Philippines, South Viet-Nam and Trust Territory of the Pacific Islands. HMO 005 (4401) Nursing advisory services, South Pacific (1967-74) R To assist countries and territories of the area in strengthening nursing education and administration, and in developing nursing services. Provided a senior nurse educator. Assistance was provided to ten countries and territories: Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, and Ellice Islands, New Hebrides, Niue, Papua New Guinea, Tonga, Western Samoa; and to Nauru until it became independent in 1968. American Gilbert and Accomplishments include the revision of basic nursing curricula in six countries and territories, and the development of continuing nursing education programmes also in six countries and territories. Assistance was provided to Fiji in (a) planning and implementing courses in public health nursing at basic and post-basic levels, and (b) planning the nursing component of a course for the Vocational Teacherts Certificate at the University of the South Pacific. In 1971, the health services of the British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands. New Hebrides, and Tonga were assisted in carrying out surveys of nursing manpower and nursing education. In 1972, the nurse educator directed an intercountry nursing work- shop in Fiji. There were 20 participants from all the countries listed above except Niue and from French Polynesia. HMD 007 (6002) Teacher training centres for health personnel (1971-81) R UNDP Seepages 92-97 for a full description of this project. HMO 010 (4403) Workshop on training of nursing teachers, Manila (19-30 August 1974) R To exchange information on the current status of the preparation of teachers for schools of nursing and midwifery and discuss developments and advances in nurse and midwife teacher preparation; WPR/RC26/4 page 134 INTERCOUNTRY PROGRAMMES (continued) to identify ways and ~ans of tmproving the preparation of this type of teacher. There were nineteen participants from Australia, British Solomon Islands Protectorate, Cambodia, Cook Islands, Fiji, French Polynesia, Hong Kong, Japan, Laos, Malaysia, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Singapore, South Viet-Nam, Tonga, Trust Territory of the Pacific Islands and Western Samoa. Provided two consultants, a temporary adviser and the cost of attendance of the participants. HMO 011 (4404) Nursing education (1974-78) R To assist national health administrations in the development of basic and postbasic nursing and midwifery education programmes; to study, in cooperation with the staff of national health administrations and of other WHO-assisted projects, the feasibility of establishing an intercountry centre for postbasic education in nursing and midwifery to meet the needs of countries with only a small number of students; and, should the establishment of such a centre be considered feasible, to advise on and assist in planning it and setting it up. During the period under review, the nursing adviser attached to the project visited Australia, British Solomon Islands Protectorate, Fiji, New Zealand and Papua New Guinea. HMO 012 (6201) Workshop on the teaching of nutrition in schools of medicine, Manila (24-30 September 1974) R - To review the curriculum content and the methodology of teaching nutrition in medical schools in the Region, and to determine where improvements are needed and how best to effect them. There were sixteen participants from Australia, Fiji, Hong Kong, Japan, Laos, Malaysia, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Singapore and South Viet-Nam and observers from UNICEF, the Food and Nutrition Research Centre, Manila, and the Department of Health of the Philippines, Manila. Provided 3 consultants, 2 temporary advisers and the cost of attendance of the participants. HMO 016 Seminar on the teaching of community health in medical schools, Manila (7-12 April 1975) R To define the objectives in teaching community health to medical students, the subjects to be covered, the various types of learning experience to be offered, and methods for assessing student performance; to identify the main areas in which courses being offered at present can be improved and how the improvements can be achieved. There were twenty-two participants from Australia, Cambodia, Fiji, Hong Kong, Japan, Laos, Malaysia, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Singapore and South Viet-Nam. Provided 3 consultants and the cost of attendance of the participants. HMO 017 Meeting of directors or representatives of schools of public health, Manila (10-14 March 1975) R In continuation of the discussions held during previous meetings of Directors of Schools of Public Health in Geneva (1966), Manila (1967), Alexandria (1969), New Delhi (1971), and Brazzaville (1973); to review the action taken to ..... - " - WPR/RC26/4 page 135 implement the various recommendations of the last meeting and to discuss in depth (1) the role of Schools of Public Health in health manpower planning and development; and (2) the future of Schools of Public Health, taking into consideration, structural and organizational factors and the implications of multi-disciplinary cooperation. There were thirty-five paticipants from the African, Eastern Mediterranean, South-East Asian and Western Pacific Regions of the Organization and observers from the Association of Schools of Public Health of North America and the World Federation for Medical Education. The seven participants from the Western Pacific Region came from Australia, Japan, Malaysia, New Zealand, the Philippines, Republic of Korea and Singapore. Provided 1 consultant and the cost of attendance of the participants from the Western Pacific Region, HMD 018 (6101) Seminar on lIIedical asststantsrMe.nila (1-7 October 1974) R - To demonstrate the value of medical ass stanta' in improving the delivery of health services. There were nineteen partictpants from Australia, Cambodia, Fiji, French Polynesia, Gilbert and Ellice Islands, Malaysia, New Hebrides, Papua New Guinea, the Philippines, Republic of Korea, South Viet-Nam, Trust Territory of the Pacific Islands and Western 3amoa and observers from UNICEF and South Viet-Nam. Provided - 3 consultants and the cost of attendance of the participants, ESD 001 (2902) Epidemiological and surveillance services (1972-81) R To assist with epiderrLological surveys, the strengthening of epidemiological and related laboratory and statistical services, the establishment of disease intelligence networks, the investigation and control of outbreaks of communicable diseases such as cholera and other diarrhoeal infections, the evaluation of control programmes and the study of special disease problems in the South Pacific area. During the period under review, assistance was provided by the WHO medical officer to American Samoa, New Hebrides, Papua New Guinea, Tonga and Western Samoa. From April to June 1975 a consultant made a review of the National Leprosy Control Programme in Singapore, and determined the prevalence of leprosy in the country. MPD 002 (2002 and 2003) Malaria special studies and evaluation (1967- ) R UNDP To make independent appraisals of the status of malaria and of any special aspects of the malaria programme in the Region. During the period under review, independent assessment teams visited the British Solomon Islands Protectorate (24 March-18 April 1975) and Papua New Guinea (14 February-22 March 1975). MPD 004 (2201) Filariasis advisory services (1971-75) R To assist governments, especially in the South Pacific area, in studying the epidemiology of filariasis and in carrying out or evaluating programmes for controlling the disease. During the period under review, assistance was provided to Fiji, Nauru, New Hebrides, Trust Territory of the Pacific Islands, and Western Samoa on the survey and control of filariasis and Aedes aegypti. WPR/RC26/4 page 136 . INTERCOUNTRY PROGRAMMES (continued) MPD 006 (2004) Malaria training project (1973- ) R To provide training in malariology for professional and senior technical health personnel in the Region. During the period under review the following courses were held: Combined course in parasitology, entomology and epidemiology for senior technical staff, Manila, 3 September to 25 October 1974 - thirty- two participants attended from Australia, British Solomon Islands Protectorate, Cambodia, Hong Kong, Laos, Malaysia, New Hebrides, Papua New Guinea, the Philippines, Singapore, and South Viet-Nam and one observer from the Philippines. Provided - the cost of attendance of the participants. General course in malariology for professional staff, Kuala Lumpur, 17 September to 15 November 1974 - seventeen participants attended from Australia, British Solomon Islands Protectorate, Cambodia, Japan, Laos, Malaysia, Papua New Guinea, the Philippines, and Sudan. Provided - two consultants and the cost of attendance of the participants (except for the participant from Sudan whose attendance was financed by the WHO Regional Office for the Eastern Mediterranean). MPD 007 (2202) Fourth Joint WHO/South Pacific Commission Seminar on Filariasis and Vector Control, Apia (1-10 July 1974) R To review the nature and extent of filariasis in the South Pacific area; consider new developments in the diagnosis of the disease and in the study of its epidemiology; assess filariasis control programmes in operation in the area, including measures for control of the vector species; and demonstrate surveillance and control methods for other vectors of public health importance, particularly Aedes aegypti and the closely related species of the Stegomyia subgenus. There were seventeen participants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, French Polynesia, Gilbert and Ellice Islands, Guam, New Hebrides, Niue, Papua New Guinea, Tonga, Trust Territory of the Pacific Islands and Western Samoa; and observers from Western Samoa, the Pasteur Institutes, Paris and Noumea; the Office de la Recherche scientifique et technique d'Outre-mer (ORSTOM); the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States of America; the Institut de Recherches medicales "Louis Malarcie", Papeete, French Polynesia; and the University of Otago Medical School, New Zealand. Provided a consultant and the cost of attendance of the participants. MBD 001 (1201) Regional tuberculosis control tea~ (1961-80) R To assist countries or areas of the Region in assessing their tuberculosis programmes. During the period under review, the team members, either individually or as a team, visited American Samoa, Laos, Malaysia, Papua New Guinea, the Philippines, the Republic of Korea, Singapore, South Viet-Nam and Western Samoa. " - WPR/RC26/4 page 137 MBD 002 (1202) Tuberculosis course. Tokyo (2 June-25 October 1974) R (Overseas Technical Cooperation Agency, Japan) See pages 98-102 for a full description of this project. MBD 003 (1206) Regional BCG vaccine laboratory, Philippines (1973-79) R UNICEF To develop and expand the A1abang BCG vaccine laboratory into a regional laboratory for the production of freeze-dried BeG vaccine for countries "or areas of the Region. MBD 006 (1301) Leprosy control advisory services. South Pacific (1972-80) R VL To assist in assessing the leprosy problem in countries and territories of the area, in strengthening leprosy services and in training personnel. During the period under review assistance is being provided to New Hebrides. VIR 001 (2902) Technical advisory. committee on dengue haemorrhagic fever, second meeting. Bangkok (26-28 February 1975) R - The Technical Advisory Committee is composed of temporary advisers and staff members from the South-East Asia and Western Pacific Regions of WHO and from WHO Headquarters. At the second meeting, the Committee reviewed the epidemiological situation of dengue haemorrhagic fever and the technical guides on clinical diagnosis and treatment, laboratory diagnosis. prevention and control, and epidemiological surveillance prepared as a result of the first meeting. Recommendations on a programme of research were formulated. Provided 4 temporary advisers and the services of staff members. CVD 001 Seminar on the prevention and control of cardiovascular diseases, Manila (31 March-5 April 1975) R To review the information available on the prevalence and incidence of cardiovascular diseases; outline appropriate measures for prevention and community control and assess the present resources available for implementing such measures; and promote the exchange of experiences and cooperation between countries at different stages in the development of medical care in relation to cardiovascular diseases. There were eleven participants from Cambodia, Fiji, Japan, Laos, Malaysia, New Zealand, the Philippines, Republic of Korea, Singapore, South Viet-Nam and Western Samoa. Provided one consultant and the cost of attendance of the participants. DNH 001 (5501) Dental health adviSOry services (1972-77) R To advise on the establishment or strengthening of national dental health services, particularly those for preventive dentistry, on the basis of data gathered from national surveys, and to assist in setting up or improving programmes for training dental auxiliaries. During the period under review, the dental health adviser provided assistance to Cambodia, Fiji, Papua New Guinea, the Philippines, the Republic of Korea and South Viet-Nam. He also assisted in the planning of, and attended, the two-month course in public health dentistry held in Singapore and Malaysia from May to June 1975 (see Iep DNH 002). WPR/RC26/4 page 138 INTERCOUNTRY PROGRAMMES (continued) DNH 002 Course in public health dentistry, Singapore and Malaysia (1 May-3D June 1975) R To provide theoretical and practical instruction in the basic elements of dental public health practice in relation to on-going programmes, including the training and utilization of professionals and dental auxiliaries for the delivery of dental services. There were twenty-three participants from American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and Ellice Islands, Guam, Hong Kong, Malaysia, Niue, Papua New Guinea, the Philippines, Republic of Korea, Tonga, Trust Territory of the Pacific Islands, and Western Samoa, and three observers from Thailand. Provided - 4 consultants, 5 temporary advisers and the cost of attendance of the participants. MNH 001 (7301 and 7303) Prevention and control of drug abuse (1973-77) R To assist governments in developing effective policies and programmes for reducing the extent and severity of problems associated with the use of dependence-producing drugs and alcohol by collecting and interpreting epidemiological data; implementing and evaluating remedial measures and developing appropriate curricula for schools and for national institutions engaged in staff training. During the period under review. the following activities were undertaken: Working group on measures for the prevention and control of drug dependence. Manila. 9-17 December 1974 Seven temporary advisers and one consultant met to help formulate the strategies to be used in providing assistance requested. Epidemiological pilot study on drug abuse The second stage of this project was completed when two consultants worked in the Philippines from 3 July-16 September 1974 to gather epidemiological information on the drug problem and make recommendations on future action. Two consultants had already carried out a similar investigation in Malaysia in 1973. RAD 001 (4301) Training in maintenance and repair of X-ray and other laboratory equipment (1969-77) R To assist governments in assessing the needs regarding the maintenance of medical equipment. advise on the organization of maintenance services. and assist in training engineers and engineering-technicians in the installation. maintenance and repair of medical equipment and operators in the proper care and use of radiographic and electronic equipment. The technical officer assigned to the project was in Malaysia from September 1973 to July 1974. and provided assistance to the Philippines for four months· from November 1974. He also provided assistance, between April and June 1975, to the British Solomon Islands Protectorate. Cook Islands. New Hebrides, Niue. Tonga and Western Samoa. - ,-, WPR/RC26/4 page 139 From February 1975 an Associate Expert, provided under an agreement between the Government of Sweden and WHO, has been assisting the technical officer. RAn 003 (4703) Radiation health advisory services (1973- ) R To assist governments in the organization, management and operation of radiation medicine and radiation protection services, training programmes in radiation health, and the collection and analysis of data on radioactive pollution of the environment. The following assistance was provided during the period under review: A consultant (January-March 1975) assisted Malaysia in establishing and developing a radiation protection programme. A consultant assisted Malaysia, the Philippines, Republic of Korea and Singapore (December 1974-April 1975) to improve the calibration of radiation measuring instruments and assess the output from radiation sources used for medical purposes. LAB 004 (4206) Course for laboratory workers on enteric bacteriology, including cholera, Manila (30 September-25 October 1974) R To provide microbiologists from central public health laboratories with refresher training in methodology for the detection and,identification of enteric pathogens, including the enterobacteriaceae,Vtbrio cholerae and its biotypes, and ~ parahaemolyticus, and to discuss their clinical and public health importance. There were eleven participants from Cambodia, Gilbert and Ellice Islands, Guam, Hong Kong, Malaysia, the Philippines, Republic of Korea, Singapore, South Viet-Nam and Western Samoa and nine observers from the Philippines. Provided 4 temporary advisers and the cost of attendance of the participants. BSM 001 (3001) Environmental health advisory services, South Pacific (1965-77) UNDP To assist countries and territories in the area to improve community water supplies and environmental sanitation in general. During the period under review, assistance was provided to British Solomon Islands Protectorate, Fiji, New Hebrides, Tonga and Western Samoa in the preparation of plans for rural water supply facilities. BSM 002 (3201) Provision of basic sanitary measures (1968-77) R To assist governments in carrying out studies on water supply, sewerage and other environmental health programmes, and in developing such programmes. During the period under review the sanitary engineer assigned to the project made the following visits: Laos (August-October 1974). To assist in the detailed planning of a phased programme to improve community water supplies and sanitation in hospitals, maternity centres, health centres, schools, orphanages, and rural areas. WPR!RC26!4 page 140 INTERCOUNTRY PROGRAMMES (continued) Malaysia (November-December 1974). To assist in engineering studies of municipal sewerage schemes. In addition, a consultant (April-June 1975) assisted Malaysia to organize and conduct a seminar on food hygiene for senior health officers and advised on the preparation of a food hygiene code of practice. CEP 002 (3102) Environmental pollution control advisory services (1972-81) R To meet requests from governments for assistance in connexion with, environmental pollution control. The folloWing assistance was provided during the period under review: Malaysia (February-March 1975). A consultant reviewed aspects of the organizational structure for the collection and disposal of solid wastes in Kuala Lumpur, with particular reference to the quantity, characteristics and composition of the wastes produced and the possibilities for increased recycling, and submitted recommendations aimed at immediate improvements and future long-range policies for collection, recycling and disposal of solid wastes, including inservice staff training. Philippines (March-April 1975). A consultant assisted the National Pollution Control Commission and the Department of Health in making an assessment of the noise nuisance problem and existing methods of control and advised on the resources needed for the development of a control programme, including necessary legislation. CEP 003 Seminar on evironmental pollution: water pollution, Manila (17-24 March 1975) R To review the situation existing in countries or areas of the Region, including current government programmes and policies; to bring to light new problems and trends; to exchange experiences and ideas; and to formulate technical projections of the scale of problems and needs at national and regional level. There were twenty-one participants from Australia, Cambodia, Fiji, Guam, Hong Kong, Japan, Macao, Malaysia, New Zealand, Papua New Guinea, the Philippines, Republic of Korea, Singapore and South Viet-Nam and observers from the Asian Development Bank, ESCAP, UNDP, FAO, UNESCO, the WHO collaborating centre for surface and ground-water quality, the Manila Metropolitan Waterworks and Sewerage System, the Philippine Coast Guard and the Laguna Lake Development Authority. Provided 4 consultants, one temporary adviser and the cost of attendance of the participants. HWP 001 (5201) Course in occupational health, Sydney (4 November- 13 December 1974) R To provide orientation in the principles and practice of occupational health, prepare participants for contributing to the development and improvement of health and welfare services for workers, and provide information on recent advances in the organization .... , " - . - WPR/RC26/4 page 141/142 and administration of occupational health services. There were thirteen participants from Guam, Malaysia, Papua New Guinea, the Philippines, Republic of Korea and Singapore and 2 (privately sponsored) from Indonesia. Provided 2 consultants and the cost of attendance of the participants from the Region. HWP 002 (5202) Assistance in occupational health (November 1974-January 1975) R A consultant provided assistance to Fiji, Papua New Guinea, the Trust Territory of the Pacific Islands and Western Samoa by making an assessment of the health and safety measures in force in small industries, suggesting methods of improvement to the staff concerned and means for carrying them out, and making proposals for the provision of health services to the working population in small industries. DHS 001 (4901) Health statistics and records (1971-76) R To assist governments to develop a system of basic health statistics and records to meet the needs of the countries concerned and facilitate international comparison; and to train person~el. During the period under review, assistance was provided to American Samoa, British Solomon Islands Protectorate, Cook Islands and Western Samoa • Interregional Consultation on Health and Family Planning Manila, 1-6 July 1974 Workshop on Training of Nursing Teachers Manila, 19-30 August 1974 First Regional Workshop on the Teaching of Nutrition in Schools of Medicine Manila, 24-30 September 1974 Regional Seminar on the Role of Nurses and Midwives in Family Planning Manila, 16-23 September 1974 First Regional Seminar on Medical Assistants Manila, 1-7 October 1974 Working Group on Measures for the Prevention and Control of Drug Abuse and Dependence Manila, 9-17 December 1974 Second Regional Seminar on Environmental Pollution: Water Pollution Manila, 17-24 March 1975 Sixth Meeting of Directors or Representatives of Schools of Public Health Manila, 10-14 March 1975 Second Regional Seminar on the Prevention and Control of Cardiovascular Diseases Manila, 31 March - 5 April 1975 -- ',. ANNEXES ( STRUCTURE OF THE WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC ON 30 JUNE 1975 l Director-General L ________ .... -., Regional Committee I --------I L ----- I Regional Director I Liaison and Public Information Reports Officer I Director of Health Services I I Chief Administration and Finance Administrative Officer Administration and Finance Officer I I I Assistant Director Assistant Director Assistant Director Assistant Director of Health Services of Health Services of Health Services of Health Services ADHS (A) ADHS (R) ADHS (RS) ADHS (H) I I 1 I I Regional Advisers Resional Advisers Regional Advisers Regional Advisers 1/ Personnel BUdget and Finance Administrative in: in: in: in: - WHO Represen a Strengthening of Communicable Health Manpower Maternal and Child tatives (1) Officers (2) Officers (2) Services Officers (2) Health Services Dise.ases (2) Development Health (1) (2) Chronic Diseases (1) including Maternal and Child Vital and Health Environmental Library Services Health/Family Statistics (1) Health (2) (2) Planning (1) NurSing Adminis- l'vlalaria (2) Nursing Education Nutrition (1) g/ Counuy Liaison tration and Laboratory (1) Health Education Officers (2) Services (1) Services (1) (1) Vector Biology Nursing Family and Control (1) Health (1) Radiation (1) I I • I 1- _____ 1 ... _____ 1 ______ 1 _____ Field Staff !/ Seven WHO Representatives. with offices located in: Cambodia (Phnom-Penh): fiji (Suva) : Laos (Vientiane): Malaysia (Kuala Lumpur); the Philippines (Manila): the Republic of Korea (Seoul); South Viet-Nam (SaigC'nl. The office in Suva covers also American Samoa, Australia, British Solomon Islands Protectorate, Cook Islands, French Polynesia. Gilbert and Ellice Officer Islands, Nauru, New Caledonia, New Hebrides, New Zealand, Niue, Papua New Guinea, Timor, Tokelau Islands, Tonga, Wallis and Futuna Islands and Western Samoa. That in Kuala Lumpur covers also Brunei and Singapore. The one in the Philippines covers also Guam, Hong Kong, Japan, Macao and the Trust Territories of the Pacific Islands. ?:../ Two Country Liaison Officers with offices located in: \v'escern Samoa (Apia) and Papua New Guinea (Port l\'loresby) under the supervision of thl:: WHO Representative, Fiji (Suva). Translation Officers (3) i i>< ...... I Editor (1) ...... t:> .1>-1'-> lJ10'- .............. ...... -1'- .I>- 0'\ WPR/RC26/4 page 147 ANNEX 2 TRANSLATED WHO PUBLICATIONS ISSUED BY OTHER PUBLISHERS IN THE WESTERN PACIFIC REGIONI Monograph Series Language 2 7 21 39 40 41 42 56 Maternal Care and Mental Health by J. Bowlby The Cost of Sickness and the Price of Health by C.E.A. Winslow The Rural Hospital by R.F. Bridgman Excreta Disposal in Rural Areas and Small Communities (Extracts only) by E.G. Wagner and J.N. Lanoix Child Guidance Centres by D. Buckle and S. Lebovici Principles of Administration Applied to Nursing Service by H.A. Goddard Water Supply for Rural Areas and Small Communities by E.G. Wagner and J.N. Lanoix Cardiovascular Survey Methods by G.A. Rose and H. Blackburn Public Health Papers 8 The Role of Immunization in Communicable Disease Control by R. Cruickshank, G. Edsall, J. de Moerloose and V.M. Zhdanov Japanese Japanese Japanese Vietnamese Japanese Japanese Vietnamese Japanese Japanese lPublications translated and rights had been granted by WHO. bility for these translations or issued by publishers to whom translation The Organization does not accept responsi- undertake their distribution. WPR/RC26/4 Annex 2 page 148 Public Health Papers (continued) 30 33 34 38 42 43 44 45 46 48 50 * Noise: An Occupational Hazard and Public Nuisance by A. Bell The Physiological Basis of Health Standard for Dwellings by M.S. Goromosov The Principles and Practice of Screening for Disease by J.M.G. Wilson and G. Jungner Problems in Community Wastes Management by H.M. Ellis, W.E. Gilbertson, O. Jaag, D.A. Okun, H.!. Shuval and J. Sumner The Prevention of Perinatal Morbidity and Mortality Report on a seminar Principles of Health Planning in the USSR by G.A. Popov Planning and Programming for Nursing Services Mass Health Examinations Approaches to National Health Planning by Herman E. Hilleboe, Arne Barkhuus and William C. Thomas, Jr. Evaluation of Community Health Centres by Milton I. Roemer Hospital Legislation and Hospital Systems by R.F. Bridgman and M.l. Roemer Health Practice Research and Formalized Managerial Methods by F. Grundy and W.A. Reinke In press. Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese _. Japanese Japanese ,-" Technical Report Series 55 83 89 156 194 215 225 230 250 251 254 301 319 Public Health Administration First report of the Expert Committee Methodology of Planning and Integrated Health Programme for Rural Areas Second report of the Expert Committee on Public Health Administration Health Education of the Public First report of the Expert Committee Training of He,alth Personnel in Health Education of the Public Report of the Expert Committee Local Health Service Third report of the Expert Committee on Public Health Administration Planning of Public Health Services Fourth report of the Expert Committee on Public Health Administration Public Health Aspects of Housing First report of the Expert Committee Calcium Requirements Report of an FAD/WHO Expert Group Urban Health Services Fifth report of the Expert Committee on Public Health Administration Cancer Control First report of an Expert Committee Public Health Responsibilities in Radiation Protection Fourth report of the Expert Committee on Radiation Protein Requirements Report of a Joint FAO/WHO Expert Group WHO Expert Committee on Leprosy Third report WPR/RC26/4 Annex 2 page 149 Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Vietnamese WPR/RC26/4 Annex 2 page 150 Technical Report Series (continued) 320 327 365 367 389 403 406 409 410 429 432 439 University Health Services Fourteenth report of the WHO Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel The Use of Human Immunoglobulin Report of a WHO Expert Committee Epidemiological Methods in the Study of Chronic Diseases Eleventh report of the WHO Expert Committee on Health Statistics Treatment and Disposal of Wastes Report of a WHO Scientific Group Morbidity Statistics Twelfth report of the WHO Expert Committee on Health Statistics Principles for the Clinical Evaluation of Drugs Report of a WHO Scientific Group Research into Environmental Pollution Report of Five WHO Scientific Groups Planning and Evaluation of Health Education Services Report of a WHO Expert Committee Urban Air Pollution with Particular Reference to Motor Vehicles Report of a WHO Expert Committee Statistics of Health Services and of Their Activities Thirteenth report of the WHO Expert Committee on Health Statistics Research in Health Education Report of a WHO Scientific Group National Environmental Health Programmes: Their Planning, Organization and Administration Report of a WHO Expert Committee Language Japanese Japanese Japanese Japanese -Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Technical Report Series (continued) 440 456 459 469 472 480 481 484 485 493 499 506 507 510 Programmes of Analysis of Mortality Trends and Levels Report of a Joint United Nations/WHO Meeting Training in National Health Planning Report of a WHO Expert Committee WHO Expert Committee on Leprosy Fourth report Cerebrovascular Diseases. Prevention, Treatment and Rehabilitation Report of a WHO Meeting Statistical Indicators for the Planning and Evaluation of Public Health Programmes Fourteenth report of the WHO Expert Committee on Health Statistics Personal Health Care and Social Security Report of a Joint ILO/WHO Committee The Development of Studies in Health Manpower Report of a WHO Scientific Group Solid Wastes Disposal and Control Report of a WHO Expert Committee Human Development and Public Health Report of a WHO Scientific Group WHO Expert Committee on Smallpox Eradication Second report Organization of Local and Intermediate Health Administrations Report of a WHO Expert Committee Air Quality Criteria and Guides for Urban Air Pollutants Report of a WHO Expert Committee Psychogeriatrics Report of a WHO Scientific Group Statistical Principles in Public Health Field Studies Fifteenth report of the WHO Expert Committee on Health Statistics WPR/RC26/4 Annex 2 page 151 Language Japanese Japanese Vietnamese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese WPR/RC26/4 Annex 2 page 152 Technical Report Series (continued) * 511 * 517 519 522 * 533 536 * 546 *548 552 *554 * Development of Environmental Health Criteria for Urban Planning Report of a WHO Scientific Group Reuse of Effluents: Methods of Wastewater Treatment and Health Safeguards Report of a WHO Meeting of Experts Cell-Mediated Immunity and Resistance to Infection Report of a WHO Scientific Group Energy and Protein Requirements Report of a Joint FAO/WHO Ad Hoc Expert Committee Postgraduate Education and Training in Public Health Report of a WHO Expert Committee Bio-availability of Drugs: Pharmacokinetic Aspects Report of a WHO Scientific Group Assessment of the Carcinogenicity and Mutagenicity of Chemicals Report of a WHO Scientific Group Planning and Organization of Geriatric Services Report of a WHO Expert Committee WHO Expert Committee on Tuberculosis Ninth report Health Aspects of Environmental Pollution Control: Planning and Implementation of National Programmes Report of a WHO Expert Committee In press. Language Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese Japanese - .. Other Publications Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death Seventh revision, Volume I Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death Eighth revision, Volume I International Pharmacopoeia First edition, Volumes I, II and Supplement International Standards for Drinking-Water Third edition European Standards for Drinking Water Recommended Laboratory Methods for the Diagnosis of Plague Bulletin, WHO, 14, 1956 * Health Hazards of the Human Environment Oral Health Surveys. Basic Methods Fundamentals of Exercise Testing by K. Lange Andersen, R.J. Shephard, H. Denolin, E. Varnauskas and R. Masironi, in collaboration with F.H. Bonjer, J.R. Rutenfranz and Z. Fejfar Dictionary of Epilepsy Reports from the Regional Office * * Report on the Seminar on the Training of Health Workers in Health Education, Manila, 23 July - 3 August 1973 In press. WPR/RC26/4 Annex 2 page 153 Language Japanese Korean Japanese Portuguese Japanese Japanese Japanese Japanese Japanese Japanese Japanese

WORLD HEALTH ORGANIZATION • ORGANISATION MONDIALE DE LA SANTII REGIONAL OFFICE FOit THE WEST!ItN l'AC:IFIC: IUitEAU k'GIONAL DU l'AC:IFIQUE OC:C:IDENTAL REGIONAL COJIMI'rl'EE Twenty-sixth session Manila 1-6 September 1975 TWENIY-FIFTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE WPR;1\C26/4 Corr.2 1 September 1975 ORIGINAL: ENGLISH RmiONAL COMUTTEE FOR THE WESTERN PACIFIC Covering the period, 1 July 1974 - ,0 June 1975 Corrigendum Page 6, line two: Please change "Kangwon Province" to "Kyonggi Province".

WORLD HEALTH ORGANISATION MONDIALE DE LA SANT~ ORGANIZATION REGIONAL OFFICE FOR THE WEST!: ?.N PACIFIC BUREAU R~GIONAL DU PACIFIQUE OCCIDENTAL REGIONAL COMMITTEE Twenty-sixth session Manila l-6 September 1975 TWENTY -FIFTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE WPR/RC26/4 Corr.l 26 August 1975 ORIGINAL: ENGL TSH REGIONAL COMMITTEE FOR THE WESTERN PACIFIC Covering the period, l July 1974 - 30 June 1975 Corrigendum Table of contents, page vii/viii Page 19/20 Heading of graph should be changed to: NUMBER OF FELLOWS BY COUNTRY OR AREA 1 June 1974 - 30 May 1975