SEMIlIIAR ON EDUCATION AU;J TRI.rNIEG 01" SLlJITl-;'!'ION PbRSONNI::L Sponsored by the WORLD HEALTH ORGANIZATION REGI01;A]~
OFFICE FO:, THE
1.oJESTERl~
PACIFIC
TOKYO, JAPAN
21
October -
5
November
1959
FINAL REPORT
World Health OrGanization Western Pacific Regional Office Manila, Philippines January,
1960
CONTENTS --------
1.
:mTRODUCTION • •
.......• • • >
• •
2.
• • • • • • • • • • • • • • • • • • • • •
·..
1
:3 :3 3 4
Eevironm-.;.Ltfl J :P(l$ltll probleiDB in the}lcSLern Pacific ReGion ••• • • • • • • • • • • Climatic and geographic factors • • • • • Disease patterns • • • • • • • • • • • • • • • Agricultural activities and the development of rural areas • • • • • • • • • • Increasing population grm,th, urbanization and industrializ~tjon • • • • •• • ••• • • 2.1.5 Competition for water • • • • • • • • • • • • The social environment • • • • • • • • • •••
·.
5 5 6
6 7 7
2.2
• • • • • • • • • • • 2.2.1 Organization of environmental sanitation services • • • • • • • • • • • • • • • • • •
~lLzation
of Personnel • • •
• • • • • • • • • • • • • • • • 2.4 Status, incentives and conditions of employment • • AVAILABILITY AND E1'TENT OF TRAINING OF ENVIRONMENTAL SANITATION FERSONNEL •• • • • • • • • • • • • • • • • •
Demand for services
9 10
u· 11 11 11
3.1 Categories of personnel • • • • • • • • • • • • • • 3.2 Availability of personnel • • • • • • • • • • • • • 3.3 Personnel needs, present and future • • • • • • • •
4. EDUCATION AND TRAIN:mG OPERATIONS FOR SANITATION PJffiSONNEL • 4.1 The medical health officer • • • • • • • • • • • 4.2 Sanitary or public health enGineer • • • • • • • • • 4.3 Health inspectors • • • • • • • • • • • • • • • • • 4.4 Other personnel • • • • • • • • • • • • • • • • • • RESEARCH, DEVELOPMENT AND DEMONSTRATION
12 12
·.
13 13 14
5.
5.1 Existing and needed research, development and demonstration. •••••••••••••• • II • •
5.2 Needs for better facilities • • • • • • • • • • • 5.3 Pressing needs • • • • • • • • • • • • • • • • • 5.4 Assistance for research, development and demonstration • • • • • • • • • • • • • • • •
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·
14 15 16 16
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i
6.
ESTABLISHHii;NT OF PRIOHITruS IN TRATIHNG EDUCATION • • • • • •
· . ... . .. · . . • •
• •
17 17 18 18
7.
CONTENT OF EDUCi,TIONAL AND TRhINnJG PROGRl,HMES OF STUDY FOR El'IVIRONl1ENTAL SlJUTATION PERSONNEL •
•
Education and training of the medical officer of health • • • • • • • • • • • • • • • • • • 7.2 Education and traininG of sanitary or public health engineers • • • • • • • • • • • • • • Undergraduate training • • • • • • • • • Post-graduate training • • • • • • • • •
·.. ·..
·.
19 19 20 21 21 21 22 22 23 23 23
7.3 Education and training of
sanita.4"1a~ ...
• • • • • • •
7.4 Education and training of health or sanitary inspectors • • • • • • • • • • • • • • • • • 7.5 Education and training for lower grades of sanitation personnel • • • • • • • • • • • • • • • • 7.6 Education and trainine of basic science personnel • • 7.7 Training of operations of small plants • • • • • • •
7.8 Types of educational institutions for training 8.
••••••••••••• • • • EVALUi.TION OF OVERSEllS VERSUS LOCAL AND REGIONAL TRAINING • • • • • • • • • • • • • • • • • • • • 8.1 Overseas training • • • • • • • • • • • • • • • 8.2 Advantages and disadvantages of overseas study and training • • • • • • • • • • • • • • • • 8.3 Types of overseas study and training • • • • • • •
sanitation personnel
. · . . ·
·. . ·.
..
8.4 Faculty exchange programmes • • • • • • • • • • • • •
·
·
24
25 25 25 26
9.
FffiMALIZED IN-5ERVICE TRAINING UNDER HEALTH AND REI1l.TED AUTHORITIES VERSUS PROGRAlj}lES IN UNIVERSITIES • • • • •
9.1 Patterns in the Western Pacific Region • • • 9.2 Advantages and disadvant[',ces • • • • • • • • • • • • 10. DEMONSTRATION, PRACTICE AND FIELD AREAS AS JillJUNCTS TO EDUC1.TION AND TRAINING PROGRAMMES FOR ENVIRONl1ENTAL SANITATION PERSONNEL • • • • • • • • • • • • • • • • • •
·...
~
10. 1 Definitions 10.2 10.3
• • • • • • • • Organization and programme • • • • • • • • • • • •
.••
27
• • • • • • • •
27 27
Character of demonstration, practice and field areas • • • • • • • • • • • • • • • • •
.
.
27
ii
10.4 10.5
Financinc urr!lnsements • Luportance of evaluation ~nd
. . .. .. . . ...
28 28 28 28
li.
follow-up • • • • • • SE;IN,::PB FOR SENIm p-,-m.C;Ot,~I2L L~'D S1-I(}:T COURS::;;S FOR OPERATING PERSONNEL • • • • • • • • • • • • • • • • • • • Seminc,rs • • • • • li.l • • • • • • • • • • • • • • li.2
11.3 11.4 12. 13.
·. Refresher course • · . • • • • • • • • . . • • • • Auxiliary trilinin.s • . . • • • • • • • • • • • • •
29 29 29 30
Evalu1!tion of progrrulliucs •
• • • • • • • • • • •
ACCREDITATION OF ENVIRONmNnL Si.NITilTION ruRtiONNEL AT REGIONAL, NATIONAL AND INTERNbTIONAL mVJ.HS • • • • • •
Co-OP~RhTION AMONG GOVERNU'::NT ACE~r.'i"ZS ON DEPLRTH'::NTS IN ENVIRONHENTAL CONTROL • • • • • • • • • • • • • • • • • •
31 31
13.1
13.2 13.3
• • • • • Incentives for co-operation and co-ordination • • Attainment of co-op8r~tion and co-ordination ENVIRONl':t~~NTLL
Need for co-oper1!tion and co-ordination
14.
EDUCATION OF THE PUBLIC IN
HeLLT H •
•
14.1 14.2
14.3 15.
Introduction • • • • • • • • • • • • • • • Indoctrination of professional groups in environmentul health • • • • • • • • • • Initiation of environmental health proGrammes
.... • •
• • •
32 32 33 33
·..• • • •
33 34 35
PARTICIPLTIOJIJ BY HEALTH' PERbCNNEL IN PROllarIONi~L ACTIVITIES FOR ENVIRON}1ENTilL Hij,f.LTH • • • • • • • • FINAL CONCLUSIONS • ACKNOOEDGEHENTS
16. 17. I
·............... • •
•
37 39
• • • • • • • • • • • • • • • • • •
APPENDICES FINAL LIST OF SElHNJ,R PARTICIPi;.mS, OBSgJ1VERS, AND 'VEO STAFF PARTICIPilwrS TOPICS FOR DISCUSSION GROUPS SEMINAR SCHEDUlE
II III
iii
t
HG~:lt~"· in LOlUe
;C'~-"\~ C,j 1n;,l':j. '::..1 "\) 1,.t lj.E; in ;-,~!e l.~~,:tex·n P·.~cific :·te:.,ion of the ':rlorld 0:,:', . :..:.r~L~;_.t:·'_{)n h,.:·'F~ entLl'cd ~l:)on 1l~.1 Clc.~ of r~_. ,id populL.tion ["ro1ith, in~;t<...ncc8 ~~;",!..:'..'ci,. t!(;(~ ,ii t~·.:. L.:L'lOf.t 1.3:L.;.·)lu:~iv8 ur:)~.n dnd. industrial 1
de'.relopmcdt, in ot!lGN~ i_ ~)l ~J1 ~lno~ t .'c ~,. ':~i<)n~:TJ'- rur:.l economy. Eecm se they upjEcci;:teL: 'eli', need fer aceelGr~tin,-- t~18 ;x.ce of [O,,:n:Lt~ry adjustment of the C)llV:'_TCJni",lent in uretor to CLire for their LI'm,Tin,; popul;..,tion, and beccUEe thoy roeo; IL-lZe t",o ir,lPortanclO of :Jroperl~ truined and utilizorl [;pocialh:ts in the; l,ro'::' . L i._re£.; 01' cl1v._ronmont,,:l [;<.tnit&tion, the J:.lember"',)\12rnm(mtr cf \JHO in thcJG~ tern Pacific ll:'Cion aGreed thQt their firi;;t re::i (",,<;.1 GCdlrr-T in enV'J.l'Ork,l(J,kJ, lo::nit.:LJ.on [,hould be devoted to a stuc~y 0!:0113 ;:::duc2.tion, tn~inin:: G.nci utilizc.tlon 01 pU01ic he~lth workers 1'110 could meet the challenGe of populL'tion Gro'lth and ckncinc; environment. Accordincly, p<;.rticipants frow the Hember Governments in the ReGion "rho bi.:ve an interest in the education, tr<::.inin[ 1:nd utilize.tion of personnel in environment",l Stini to.tion, to:'ct:1cr "-rj.th expert consultants and a selected ':HIO stuff were o.sseml.!lod in u sm11inur thc,t had as its objectives: (a) A renmr of the :;JrcGcmt st,.tus in member countries of educ,-,tion 2nel trainin,; of s<lnitl.tion personnel. An tiSs6::;cmcnt of the present c.nd future require:<lents of these countriGs for tr<.:inl{.d i;cI'cconnol in the field of environracnto.l sc::ni k tion. The exchan;;e of id0t:S unci informdion on the needs and problems of sL:.ni t;:. tion trclinin~; for ,11 types of sanitation ('Torker[; •
..
(b)
(c)
(,1) (e)
ThE:: GVc.ludtion of ,romising L)rG.ctic8S .::.nd trends in environmentc;.l S[:nit,:tion tr<.:inin, • The Gstublislmlsnt 0;: :.:" Li c i,rinciples ,-,nd procedures for the co-ordinution of truinineo: und. utilizution of sanitation T,lOrkers. The declirution of Li.lsic i)rinciplc-lE; for im;)l'8vin::.- smlitation training. The identifier.. tion of i:ii jor urec:G for action c.nd study in educa tion u),:, tri.:ininl sui tcblo to tho conditions <.:nd resources of the iJc5tcrn R:cifj_c ReGion.
(f) (:')
Tho Government of Jqxcn s-r,-,ciously i.,':r0od to )lay host to the Seminar. Eichteen countries :::.nci terri turi es of the \';estern Pi.: cifi c Re£ion responded to tho ,'JFor s invitc,ti,)n to the ~emimr by sending thirtynine particip.::nts to it. In addition, eloven observers from v;'Tious countries in tbe ReGion liTere in attondt,ncQ nG well <.tS a 1"fHO techni c8.1 staff of ten under tho Dlrector of the b0l:linar, ]VIr. Paul Biorstein. A list of participcnts, ollsorvcrs, Lnd 'iiRO tee;1nicGl staff is to be found in Appendix I.
*
For tho purpose of the Semin.::.r, tho torm "environmentL:l sanitLtion" Wo.s considored to comply with the d6fin:ition set O'lt in the sGcond report of the EX,>crt Committee on EnviroTh~ental Sanitation WHO Tec'm. Rep. Sere 1952, 47.
PreliirD.n~ry ivork prior to the mee-cin,; included uddressinC; to 211 intonded p~:rt:"ci;x.nts e~ questionnairo thLit asked for specific information concerninc existinc facilities for education arw traininc of sanitation personnel, th8 current scheme of utilizinG of such p8rsonnel anu the enumeration of topics of special interest tlXlt ;Jarticip,:nts T",ishcd to have considered by the Semin~,r.
Two consultants were invj. ted to py-ovicle expurt advice on the planninr; and conduct of tho Semin&r by the\A[HO t8chnical de'ff: Professor Gordon N. Fuir of Harvard University, and Professor Ccrneliul.l lJ. :cTuse of the Jehns Hopkins University. A number of the HemLer countries were visited by these consultants beforu the seminar in order trot thoy might observe exif,tine education[~l ,,-nO. traininG institutions and discuss 1uth public health, enGineering, "-Dd related ofi"ici2ls in the different countries the needed trc.\ininl:. and utiliz2tJ.on c'::' 1,wrkers in environmental sanitation. The visits proved to be of c;rec..t v,-lue in the general planning of the Seminar and pnrticulnrly in the soloct:i,on of sui table topi cs for discussion [TOUpS. The topics actu,,-lly chosen are listed in Appendix II and the reports of the Discussion Groups are the sum and suustance of this dOClll11ent.
2.
INAUGm:,ATION AND O,lGANIZ1I'I'ION
On 21 October 1959, at the Asia Center of Japan in Tokyo, Dr. Ryotaro Asuma, Governor of Tokyo I.fetropolis, 1.;elcomed the partiCipants, observers, and visitors to the openin;' session, indiC~'.tin[; that he was dcli"ht8d to hc.ve in Tokyo cuch an i~~,)ort[,nt sClllim:r, so far re~,ching in its effects, because in Jap~m, stet.e nnd local public eod.ies alike, were livery ent.husizlstic in their efforts in o.l1vo.ncinL· the lofty cause of the :orld He,-~l tl1 Orcanizetion." The Honour2-ble Mr. Yoshio\'h:ctc.n<:.be, j\Jinister oi Health and "alfare, Japan, then expressed his appreCiation of those persons Clnd p=tics 1\;'110 had co-operc,ted in makinG the semim,r a reali t.y and obsl'rved th2-t environmental sanite'.tion is a 11 common concern of ;\11 thE) countries represented to meet the need, '\-Thich is evii,;,mt even more nOl'l, for cr8atinc improved environments for healthful 2-nd pleasant livin2:." In conclusion, i'ir. Paul Bicrstcin, the SCininar Director, read a from Dr. LG. Fe,n;:;, H.eciom:l Diroctor, ft:PRO, outlininc: the broad objecti ves of tho Semim::r, ClS an ,-,ns,wr to thu quosti on f\ How best to train and utilize personnel in the broad field of envJ.ronmental sanitation. 1I The messq;c went on to state that, "int'olE,.ent jJrepLlrc.tion of programmes of s[autation depends upon experience <.:.nd traininc of those responsi bleil-and tb<:t IIlrJHO has given a hiLh jJriority to educc.tion and traininc; of personnel." It further uri:od "inCl'ue,sed aW,.,reness of both time-tried and new techniques <.:.nd proceduros in thG field but, also, the will to apply them. ii messo.l~e
,.
Followirlb the opening cereillonies, th8 seminar schedule shown in Appendix III was presented by the Seminar Director and Professor Fc:.ir explained the task thc:t lay before 0.1'(1 the need to succeed in the coming deliberations in spite of the many diffurences in admini::;trative or['cmizntion am1 tho 2)p<'Tbntly bm·lilclcrinc ,"rray of ",en:onnGl involved in
page :3 t
in providinF environmentccl sanitation sCJrvices. He stressed that mental sani tQtion we,::: not the preror;~ti ve of c.ny one professionul but a service pruvided lJy u(;.ny diociplincs, both prof0ssion::>.1 [<nd professional, Horking in harmony ui ther ia thin hu.:lth clcp<:;rtmcmts across departmental boundcries.
environcroup subor
Before tho Bcmine.r we.s divided into ,,;orldng groups, the consultants gave reports of impressionE oetained durinG their pre-seminar visits ~nd a number of country reports and invited '"orkine; papcr8 W8re discussed for the purpose of providinc a bc.c!qrround of infurmation for the deliberations thnt were to follow. Each or.e; of five workinc: croups then considered a different one of the to;Ji cs listed In Appemlix II fonnine three series of five topics or a total of fifteen. On thG COnri)letion of each series of discussions, the rapporteurs for the '.orkin[ groups submitted a str.tem"nt of findings for consideration and ultinmto approval in plenary sessions of the ,seminar. The conclusions roc.ched in these deliber ..,tions and discussions form the body of this technical report. As shom in Appendix III suveral field tro.ps were urranged by the Host Country for the purpose of inspectinG usoful ,<arks for environmental sanik:tion and wi tnessin[~ their oper,:tion. Furtheruore, a number of motion pictures [md filmstrips were run off to illustrate a variety of aids for the trnininG of s[.nit&tion personnel r.nd successful techniquos for organizinc community effort in solvinG tY":cJical environmental sanitation problems. 2.
mCHNICJ11, P':::PCiftT
2.1.1
Clim~tic
and geo;:-raphic factors
Envlroruilontal health conditions 2nd the prob18ms created by them are l&rgely determined by the physicL,l, biolorjcal nnd soGinl constitution of an area. ThG~icstern Pc.cific :ttcc;ion is not homogeneous va th respect to raany of its cnviroruncntLll factors. The Re "i. on I s estimated 200 000 000 peoplo are divided about equr.lly between its tropicc.l ,end tomperate clim;;.tic zones. PhysioLTuphically, the }~e[!ion is chc.racterized by relatively fl,:t corul islands, volcanic isLnd cheins and complexes, the island contin,mt of f.ustn,lic. nnd peninsulas of the; Ilsiatic rtcinland. Tht.; General limitution of space by oro~ruphic L:ncc meteorolor:ic construints concontrntes the populations 2lonc the C02-stel plcdns 1!nd wi thin inland drainaC;e basins. ilrablo land is scurce und requires skillful manae:ement for suitable usc.; 2.nc. intensive developmont under oxistinc varintions of rdnfall and tOiJocraphy. kvc1s of nutrition cliffer considerably ,.ithin the lecLl.on. Thus the calorie [cnd protoin int2ko in tho southern tomperate zone is 1'lilOne the hir:hest in the.wrld, while that in some of tho tropical areas are considerably below 8stimL'.t(;d minimal requirumunts. Luck of adequate communication fucilitios ,md the isoldion of islund complexes makes for difficulties in the transport of needed fooda and materiL~ls.
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In the absence of cb,o"cp and 2buncC,mt 50urces of pawer, tho economy of most OfG:lC X""'; on is bc:.sed on the exploitation of prir.mry products of al'Ticulturc, forestry and. minGr;:,l ,,,ealth. lit ohc prJs·"nt time there is some development e)f Bui te,tl;,; indu:;try in !:'lOSt countries, but for much of tbe rC['ion inClu~;trializcctior; 1<5 1'<..:r tcln.nel tlli.;t of its economic2.lly most accVi~ncod porti.ons; JqJ<...n ;.:nd peTta of Am,trc:lL:. Bro<..cclly speaking, the prevulonce of cnvironmentul di5,-,,-;BGS is e.n inverse measure of the degree of inc1ustrial d"velopmcnt and the m!'<Tli tude of per cc:put income. Hm'TOver, it is reclizcd that 2.lthough the; environment h ccnero.lly improvod as countries boc0me more hi,hly indu"trialized certain new environment2.l pro:)lems must. b,_ expuctod to occur £'.nd certain older ones expectod to become intensified. 2.1.2
Disease patterns
The different disease p(.ltturns of the v\kstern Pacific Rucion are undercoinu considerable modificc,tion as u rosult of widespread ill1lllunization and erclclictition programmes such as those for smullpox (ill1lllunization) and for l1lCllc·.rie c:nd yaws erc,c~icc,tion. Consequently life exp0ck.ncy is being lifted Llnd infLlnt mort2.lity reduced. However, the accompanyinG rise in popuJ.f'.tion pressure alone with more inti..,nse urbanization sometimes beset with exigencies of rcfU[ee resettlumont haVE) 12ft tubercuJ.osis as the publi c he2.lth problem of first magnitude in many of tho Hembor countrles. Altho~ch it has Ll[reed that hospitalization, BCG vaccination and modern th(cr2py constitute the first line of attack upon this disc1'Csc, it WI".'" SUGGested 2.t the same time th::<t zenoral sC'cni tction of the environment, reduction of crowding end improvement of nutrition are ossuDtial adjuncts to its ultimate suppression. R2.infall and its seasomcl dbtrilJUtion, t8mperccture c:.nd humidity, thc lli.. turG of tlle soil, th8 [cDen,l gcolo ..icL'.l structure, tho lovel of thc bTounc~ lrkter table, the lli.. turu and uxtcnt of plLmt :c.nd anirHel life and the stL·.tus of 2."riculturc tend housini_ arc importccnt f<;ctors o.ffectinc the dis(casc pc.ttern in particulc.r areas. In the tropical zones of the Region, accordin[,ly.nalc.ria still renains a major disease clement. In the tropical zone> in £enGr£'.l and in under-developed countries in iiThich rurcl s1'.ni tation is poor anc. niLht soil is s'Gill put to use as fertilizer, enteric infection and parasitism pi..,rsist gS h;adinc cause-s of illness, debility and death. As stated very briefly, it was the oplmon of the) S0miI12r that the principul diSd'..se entities of the Rq::ion that can be hopefully atto.cked by appropriate S[~ni tation moasures are tubercuJ.osis, unturic diseases, viral discases, includinf arthropod-bornu diseases such as Japanese B encephali tis in the more nC>lly d~veloped COuntri8S of the hOijion; and ma1£.ria, filari&sis, luprosy, Lcnd Y2cT,1S, in addition to the second group of disease mentioned abovo, in t he rclc,ti voly undcrdc;veloped countrios of the ReGion.
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It '''2.S noted that til8 n,~tur[~l 11id,,_'ry of disc2.sCS such ns tuberculosis anc\ oncylostomiQsis coule be si 'nificllntly mot.ifieel by c.;ood nutri tion ~:i1d thct envLronmontnl sal1it~tioD can be ,rc[,tly QSlJi~t(;d by sound 1::.gr~cultur2.1 lJrc.ctices. Thu benefit to,ublic htJnlth of Lmy orderly developm~nt scheme in rural ar",,-s should be felt indirectly tbroueh the raisine of the per ca;:JUt income nnd. the assocL .. toc. stcndcrd of l i vine. HowevEJr, it was cautioned that the o:)t.,;ning up of new settlcments or the 11::.r ce -sc,-,10 moc!ift cc.tion of n2.turcl environm,Jnt me.y oct times cruate hazards (c.;.c;. mal2.ri'~' oncephl'.l:Ltis, schi:,tosomi2.sis [mel scrub typhus) to the hoalth of now settlers unless the ddvolopmont !1uthorities work in close co-oper[~tion "i th appropriate he1::.1th aGencies. By co-ordinated plnnnine:; tho throat of "man-madell diseas0s may indeed be forstalled. The hazards of usine raw nieht soil as fortilizers were cited as examples of dangerous agricultural practices.
2.1.4
Increo.sing populntion crowth, urbcluzatlon and industrialization
'"
Expnndinc populations, whether by n[~tural increase, immigration or intornal migrntion intensify the problems of food and water supply, the disposel of night soil 1::.nd other w",ste ffi1).tcri1l.1s and housing. The r1::.pid spread of laree metropolitan complexes mc.y evoko especially acute situations. Hi;:oher income groups and more viE;orous people move, en masse, out of the city as population pressures mount. The dwellings vacated by them are often poorly suited to the needs of the remaininc older citizens, lower income eroups and the indicont. Progressive blieht, overcrowding and slums t.hen str['.ncle the erowth of business, industry 1::.nd commerce and ~roatly increase the cost of community sorvices. At the same time, the derru:md for community scrvl ces in the II frinC'6 areas" outside the city 1:.re difficult to satisfy primnrily because development of suburban 1::.roas has not boen orderly and in keepinG with tll0 cconomical extension of services needed such as 'lr1D.ter m<',ins, sewurs c'.nd It.nd drainaco.
In tho judgment of the 0Gminar, ;overnmunts should rualize that thore must be adequ2.te planning to meet 0stim2:tGu nGeds if some of these difficulties arG to be avoided or mitieated. This implies tb1l.t techniques of motropolit<~n f'ovcrnmont must be devised thr.t will ostGblish Hide powors in plnnninf, and providing nocessary community services on a r0Giom"1 rccth0r thc::.n 0. loc[.l nutbority basis. It was emphasized in this connuction, that public h(;[lth interests must be fully represented on any such body. GrorJinc urbnnization and industrialization also intensify thG pollution of water, atmoSIJher'" and the land, incroase occupational disoase and disability, multiply industrial Qnd tr~ffic accidents, press the need for adequate hir;hways, schools, and hospj_tnls and ofton croate a sense of insccur~ty in .vorkors who m,,-y not be nbla to obtr.in suitable accommod=·.tion for their families at their new pl<~ces of employment. Mountin[ exposure of people to ionizing radintions was noted for some of the 1rkstorn Pacific countrios. The Seminar felt that the protection
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of the pul'lj.c [,J:..inst the ,mvJrorum.mtel haz:clds 'dCS not r<.-coi:inc: sufficient o.ttcntlon, esp<.-6c:,11y in refor'once to the unncccss:::.ry or lm"lro;xor usc of x-r2.y "nc. fluoroscop:LC m;:\chincs <,.nd 0.180 the uns<.f0 ,lil;ch:.Tr c of r::.dioacti V8 l!stec; intc e.ir Gnd ]'r:-,tur or ante) lc'n(l. The SL~fG dispo[;c:.l of radio(lcti VG Wi.'.c, tes , it was su:[cGtcd, mc.y be of p;:.rticulc.r im;Jortc.nce to ccuntrios 10l' ':Iinch the SLc. is 1.\ princip:ll source 'If food.
•
2.1.5
Competition for water
The repid crowth of ci tics c'.nc'. th" crc[:c].on or expansion of "w<..ter hungry" industries has caused c.n acutu short[c[e of water in m.:my aroc.s. As cities and motropolitan districts reach out into rural L,reas for further supplies of we-ter they may come into conflict 1"ith the. wat~r richts of farmers and other prior users. It was noted that countries in which wutor is in short supply should bu oncourai!cd to Bste.blish as quickly 2S possible a wntor control policy thcct ]'rill ensuro maximum dGvclopmlmt of availccble water resources for the ~rcatest benefit of the people. ConservGtion of watcr resources throu&'h tho re-use by industry nnd 8.[riculture of liquid wastes, including SGwn[':(J , althouGh often desirrcble, l"ns m"ntionod as hcvin~ possibly c.dverse public health implicc.tions unless such practices are properly controlled.
2.1.6
The social environment
An unc~erstcndinr of the; behnviour of mC'cn in his orG[:.nizc.tion of space and people is of utmost import,mcG in annlyzing problems of environmental ho:::lth in the Rq"ion. Social cnvironmunts arc developed, for the most p"crt in such a fe.shion, to ;Jrotect the people .,i thin them, but, Gt times, their guc:rdic.n fencc..s mz.y breal{.:oTm. Stressful socinl rulctionships then result in addition to unfavournble physi cd cnd bioloi.ical enVironmuntal cnnc:Ut.ions. The influence of poli tic<:ll, economicc:l and culturc,l factors in the pe.ttern of sociGties on the dcvulopment of countries or rct::ion must rocE..ive adequccte considcrction if environmental scnit2.tion is to be ~Nod. The inertia or resis te.nce of people to ch".nce of their :30ciL~l milieu Tdas noted. Loss of centL~ct with and the inc'.hili ty to cc!just soci'-'.l surroundines =y result in the fc:iluro of hel'lth ,:uthorities to rosolve community problems. The ability of the community or country to develop resources in an orderly manner w['.s disCUSSGd. '\vhon the economy riSGS, till) nutrition c:nd standnrd of li vinf im"rovc, ,;nd h,,:'.lth, hos)i tC'.l, modiccl and othur community services [(re provided c.r'd mcintc.ined CIt n h:i.i:hcr level of excellence. Hobilizntion of communities to proviclo self-help rnther than the creation of pc.ternalistic governments that after. foster incrcnsing dependency on outside sources, Wc'S considerud importc.nt. The cultural setting discloses its influLnce on public hec..lth in many wo.ys. Fetish ma[::ic, sup8rsti tions and demonism, i[nort.nce of thG causes of disLasa such ns the nssoci2.tion of disease with odours, li.lrl£.;uago bc:.rriers, ~:nd the (;xistence of disp2ro.te rnci1'.l (TOUPS in a sinGle community were mentioned as cultural factors thnt hnve contributed to failures of programmes for improving environmental sanitation.
;;
pugo 7 Vc;vol of Ct;n~rc\l uduc;:.<tion, st:.tus of ({amon, sociill habits, such as slGopinc in ono room, or gi.~ th::.rini; r.t a ,lull, fosti vc.ls, pilgriffit.[;o and other ffi8.SS r:,ov:"li1c;nts "f peojJlu, too, may affoct cnvironmc;ntal health adversuly. A 0.;:..siro to imtJrovc socL:.l st"tus TrJey lu1'.ct people to accept a privy or a piped ,-lOoter su~)ply to thuir hen,.fi t. !lowuvcr, t t may also loac1 them to SGck n~w homos in urbm a1','<'.s ,,;There. th,;y may bo exposod to gr"atcr social or economic str(;ss or to incr'cC:t;ed risk of inf0ction. It was fult th2'ct tho impGct of 1vusturn culturo upon 0mcrr,ino; people is often so sudden thz.t loc[:l pOlml[,tions aro doprivodClf important protuctivo social ill(.chanisms and t;l~.S C.t a timu I·'hen they may bu uxpoSGd to diseases to which 'c,hvy havu litnu or no immunity.
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2.2 2.2.1
UTILIZl,TION OF nRSONHEL
Orb2~ization of cnvironm:..ntal sanitation services
The administrative orr:anizc:tion for onvlronrnunt[,l sLnitation in the Hcmber Countries of the "\-10st0rn PGcific ex:U_bits thro~ basic patt~rns: Tho medical officor of hCL,lth - hm:clth insp(;ctor team. - This type of administrative unit, which functions norm2clly within ministries of health or otht.;r {'overrnnc.ntal [.uthori tics, hc:s cprune historically from th" UK mould. In general, it opur2tcs luth i', minimum of liaison between health 2.[encies und autonomous public ',lOrks 1'.c:enci8S at both countrywide anc1 locnl levels. j'!i th minor modifico.tions to suit rocional conditions, this systum is in opur2tion in ],ustralia, New Zcaland, Malaya anc1 oth"r Commonwualth countries of thu RGcion. The hc;alth officer - public hU[llth or Semi tary 0nt:incor - sanitarian or sanitary inspector team. Tlus type of ndm:i.nistrClti VB complex l-lhich is nOrIDo.lly confin-:;Q to ministries of heL_lth or uppcr uch310n of [;overnmont, is sh,"ped h:i_st0ric,~11y :i.n the U.S.L. m0uld. It operates with much variCltion in lCGall~T priJscribcd or finr.ncially inducod liaison betwcen hoalth aC"cncies [end othCTIlisc "utonomous public works agencies. This triumviral s chome me; becn adoptod by Japnll, the Philippinos and the Hupublic of Chinrt. The hycienic institute - hycicnic ulUncil team. - In constituting a hoC\lth agency this typo of adrrD_nio trCtti Vll structure is Gaet in the French mould. It is reprosGntod in the Rceion by Fronch Polynesia and in considerably modified form by the; nc;.vly indcpuntient countries of Vietnam and Cambodia. In this schcme of organization, environmental sanitation activities nre pnrts of local hdllth and mcC\ic21 sc.;rvicl)s that employ para-mcdicCll aides to 1?ssist th.:; chicf medical oi'ficer in sanitary inspection. Thoro if: very little liaison ',lith 2.utonomous public works agencies.
,.
Although the vLrious administri'.ti V0 organizations of the RGGion widely differ in their arU1S of rospnnsi.bili ty, the requircmonts for the education and training of persons i)nC? :;ed in th.; fic,ld of environrn0ntal sanitation is basically the same. It HaG notod thr.t a ocalth inspectorate is common to all types of achninistrcltive public hudth b()Ciies.
page 8
• Tho principal '.,re2.KnOSS of som" ::.yst'2ms points to :J. Covcrnmental structure that [,rants full autonomy to depE:r-CjTdlts of :'Ju'clic ',wrks or similar anJncies tho activities of which bear upon the public health but over tho operation of wbich o.xistinc hcc,lth [cuthorities have no discretionary control. Tho inclusion c.Ji th.i.n such 2.L"ncics of 2. compc;t0rt hu.\lth officur, public health enrinecr, chartist or tiolocist mi.'.;)i cmdoH thuso acencies with a hue.lth conscionc.o, bU'G Goes not c')nply with tho policy C'.cccpt;,;d by most political institutions as sound, ni.,mcly thc.t the Cc,;cncy -..i:-.:..cb promotes e.n activity should be separate from the 3.[uncy 'rTlJich insp ... cts .:md polices that activity_ Tho Scm:J.nE;r exprcs3.~d cc,nfic\c:nce in 211 threo typus of administro.tive orr.;anization and acknm,rled[od thG fact that health statistics indicate that the end-results of environm·"ntC'.l sanitation in tho countries in which the different pr,tterns of admiDistrc,tion ori[inated howe been oqually satisfactory, althourh purhilps differinG by certain time lctgs. Because of the unvironmontal conditions varying so widely in the HGmber coun'crios of the RO[;ion - from the industrialized conurbo.tions of temp~rate Japan and l.ustralia to thG tropical jun.::lus of New Guinea - it was considered that at the prescmt timu no organiz2.tion chart for environmental sani -Cation service could be drr,wn up Ghat would be flexible enough for acceptance as a 1rTorkable frame of reference for all Hcmber countries. The medical officer of hl;alth (HOH).- In all instancus this officer administers the public hsalth pro::ramme. It is his n:sponsibility, therefore to plan and implement the entire proventivs medical programme includine; environmonte.l simi tation acti vi tios. It was felt th2.t sr.ni tction should be the backbone of the prevonti ve medic2.l procr2mme in the Western Pacific Region and thi'.t the o.dIl1inistrcctor should thurefore be adcquc".tely indoctrinated in the sanitary sciences. A properly utilizc;d medical officer of health (I10H) will not perform environmentc.l ,wnitation functions himself but delegate them to those members of his stuff who are l>cst fitted to do so by training and experience. The individuals "rith sPGcial competencies, on the other he.nd, arc expected to keep the MOB iof'-lrmed ab0ut tho proGress of sanitc-.ry works and sanit:.:tion activities l.mdor their jurisdiction. Only in this way can necdGd support be rccoi ved c·ne' highcr-luvel action taken when necessary. The NOH should have a deep interest in the developm,Jnt and promotion of sanitr,tion pro,_;ramrnos, in L-lC C!valuttion of sanitary laws and reculations, in tho ori·anizc:.tion of communi t;y croups und in conducting developmontal studies and c,pidemicloFi cal surveys. j,lthough there have been remarkable en[,"ineerin::; accomplishm"nts in some countries without the intercession of the putlic hoalth en~;:ineGr, the assumption of cmgineering or quasi-onc:ineerin[ rosponsibili tius by the l'IOH was c,msidored to be wasteful of his timo and talent. It was agreed thcct ho should preferably serve in an advisory cap<.:city althOUGh In some situations he may be placed in suporvisory charso of thE:: physicc'l c)xccution of sanitary servic8S. The sapitary or public health anginoer. - At national and provincial lovols and in largo urban areas the advice of trained public health or sani tary on[;inecrs should be made available to health aCGncies Gither directly throUf'h the hee.lth dopartmc:nt or thrOUGh some other aGency to which ene:ineors trained in cnvirol1':ente.l sanitation are attached. The inclusion of the:. e:.ncinecr in the hualth tGam will facilitate the initiation l approval and sU,Jorvision of public sanitary works of all kinds, regardless
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page 9
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of their enc;inuorinD; COl.1pl"xity, thu promotion of industrial hYgiene and the control of air pollution. How2vor, suitablu legal or fin2~cial particip2tion by tho health acuncy in such un-lertakines must be cmthorized to this purpose. Tho Somin8.r was emphatic in voj_cinG its feelines that forceful lcpal or statutory arrL'1Gcntento bo mad...; to insure close cooperation and liaison betweon departments of health and departments of public ,ro!-ks in m,~ttc:rs of unvironmental S2-ni tation. Tho huc'.lth or sanit.?.ry inspc-ctor. - In the opinion of the Seminar the health or sanitary inspector should be iJ. key ar~ent in genc-ral CJnvironmental services, especially in the rural areas of undur-developed countries. It was acknowledged that all too ofton this type of person is employed to perform simplo medical duties rather than being engaged in preventive or sanitation operations. It was felt that rather than taking part in activities for which he has had little training, the health inspe ctor, under the supervision of tho MOR, heHl th officer or other person in responsible charge should carryon the many important environmental sanitation activities which touch upon all phases of community life and for which he is fitted by his knowledge of the physical, biological, engineering and social sciences applicable to public health programmes. In addition to the interpretation and enforcem0nt of public health laws, ordinances and regulations he must assist in activities of an investigational and educational naturo. OVerseers should help him to execute field projects when it is convenient or ess0ntiul th~t he take supervisory charge of them. It was acknowledged thnt representatives of other disciplines, too, must often be included on the environment~.l S2ni tation team. Examples are chemists and biologists in water supply; veterlnarians, chemists and toxicolozists in the sanitary control of food supplies; toxicologists in industrial hyfiene; toxicolocists and meteorolo~ists in the prevention of atmospheric pollution; entomoloeists and mammalogists in insect and rodent control; and a wide variety of other natural and social scientists in a multitude of other environmental health services.
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2.,
Demand for services.
The need to improve onvironmuntul huulth conditions being realized by the Member countries, their demand for all cateGories of adequately trained environmental sanitation personnel becomes evident. This is especially so in reference to medicul ofllcors of health and health inspectors. The demand for the services of trained public health enginesrs, although well established in countries adopting the "American System" of public he",lth organization, was not yot significantly manifest in countries With the "British System". It was noted, how(;ver, that there is an increasing appreciation of the value of public health engineers in wuter supply and sewurage llild, more lcctely also in industrial hygiene and in industrial waste disposal, especially in urban areas. The principal ar[uments in favour of the inclusion of engineering competency in health teams thct arc rosponsible for a sufficiuntly l~rge popul2.tion group revolve around the need for proper liaison betwuen hualth and works agencies. It is normally agreed, furthermore, that it is an important duty of the MOR to inturprct the mudiccl implicatiOns of public health activities or the public health implications of medical activities to his
page 10 fellcrw p~icie.nB i.!1 tbo cOl!\lllunity. In viCl."i of the f;,ct thc~t the environment of developing industril'l 1'8 well J.S 1'griculturl'l countries is becoming more l:mcl more l' cruc:turo of the on:,;incer, it sbould be evident th;.t til;] p,)blic ho,.lth en l ineer is needed e.t le:".~t equr.lly as much to interpret the ent;ineering implicc:tions of public hoc-lth or the public her,.lt"il imTJlicc.tions of enJineorinl.:: to his fellow cnl:,ire ers in the community.
2.4 Stc.tus, incentives r.nd conditions of employment !-Iedicd officer of hoc~lth. The Scmil'k".r felt thd the modic(,lly trained 1'dministr"tors of environmentr.l s,~.rri.t(:tion progrc.mmes ere often not well prepe,red for their duties. Their edUCe, tion in medi cine mny be excellent but yet not equip them sufficiently well to cope with the adjustments of the physical environment to popule.tion /Zroups. It was not(~d, for eXl.ll1lple, th~ t chiefs of environmento.l S1.:ni t, :tion prOc;rr::mI11CS nre sometimes trcmsferred to these positions from disti:nt br:.Jlches of public hec.lth such C'.S lIk'\ternal and child hee.lth. Such health officers ere poorly prept.red for effective utilization ~f -epGc:j.al.i.zod environmenkl he(,lth personnel in their organization whether as hec:lth inspectors or as public he('lth engineers. It was considered especially desir;:ble'lfurtherIDore, thct ell medic(:l he('.lth officers in tropic81 ruricl nre,~s should howe had post-gr[lduo.te training in tropicl'l hJ't'i~na, i:nd th[ct 0. NedicD.l Officer of He[~lth attached to an urbE~n area should h,;vc acquired post-gr:~dunte qUGlifications in environmento.l r.s well e.s bcncr2.1 public hoe,lth. Public hee;lth or stmitary ensineer. - The Groi.:test wenkness in the status, incentive and condition of employment of public health engineers by heLlth nuthori ties is crcC'.ted by the doubtful lq-;cl or stc,tutory responsibilities of l1lc1J1y eXisting h()[~lth e'bcncies for the sc.nitnry r.spects of public works. The Semimtr noted thc.t this 1-Till not permit public heLlth eni;"ineers to give their best service 2.nd thi::t in many countries of the Region in which enr:inoers [Te encaged by he:.lth <'.c:.eneies, their pay and promotion do not p[:rallel those of encineers in other publi c e.r;encies. For this renson, the Seminar recomnended th;:~t opportunities for pay nnd promotion be equalized for enr.;ino(;rs in r.ll public 2.[.enciGs. He<:lth inspectors or sc.nit~iri~.ns. It ,-11'S genclc.lly E:creed that the hcalth inspector or s<'.ni t[cri[:n engC'.e}~d in environmentL.l snni tntion opercctions should h,we c'.pproprir.te sktus in the he(.lth agency, not only because he is ilD importe.nt mc;mbc,r of the henlth tGrun but &lso becEcuse anhe,neing his prestiGo Hill lend greeter weight to his arguments and rocommendations in educ:cting thc public or in b(:·inin;; the co-operation of local o.uthori tios in sc.ni te'.tion projccts. It W2,S felt that improved status C2.n best be obtnined by ri':i.sinc tho level of eduQL;tion and tr[cining of this STouP <'-nd insuring thnt only 1-1011 qU[,liiiod personnel is employed. 1
. il
In tropical rure.l e.reas medical hcc'.lth offic8rs or medicnl officers usu[:lly have both curntive and pr8ventivo c.iuties. 2
In urban arens medicnl officers of health are usuo.lly ong[q;od in full-time preventive medicino.
page 11 !
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Th0 incrccsc in the numb-.:r '.)f uri vc:rsi ty ~;u:ciuct(;s in this [roup was welcomed. Spcci2.lizud trc:.ininc;, it -;1L8 Do-cod, should fit the Inspector ci thcr for '.vork rclquirinc c~e')i)C;r knowledCo of 2. Gi von rusponsibility or for broacL:r Gdminist,r'cti Vv rus ,)onsibili tics rcquirin,,: wider knowlGdco of his area of compc;tencG. In thc:so circunwt,-~ncos, hC(clth n;··t..nci~s should be willinc to consio.or favour,,:bly im;Jr(;v.. d conditions of se;rvi ce and hif!her posts af C' ::;):~intY'1(,nts fJr m(;mLcrs ref tl,e croup. The added incentives should them drm,T C\ fl.' ,!hor tY;-Je of inciivi1uc.l into the position of H... lllth Ins pc ctaI' or Snni t'crian.
3. LVLILA:3:i.LITY 3.1
f.ND EXTBNT OFITtAINING OF El'lVIRONHEHTAL SANIT1,TION p;r!SmmC:L
Caterories of personnel.
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As subm:Ltted by Hc;mbor countries, tho d,,:ta collected on the availability of sanikltion pc:rsonnel could not be comp2.red boc2use they did not share a cozmnon basis of porsonncl classl£ic2.tion. To croat" such 11 basiS, the group, thoro fore , clefinod tho qu'.lificc:tions and duties for each category of environmental srcnitntion personnel as shown in Table I. Subsequently this table servcd as ce. cuide foY' cnt6for:Lzing the 6nvironmental sanitiltion workers in tho ],·1comh.. r countries. Tho [roup felt that 11 cozmnon terminolo!Zy would be desir2ble for all cvuntries, but it recorniz8d thnt this may nGithcr be possible nor ossGntial. Tho main desideratum is that each c(mntry should be able to rGco[,nize haw its workurs compare with similar personnel of other countries. 3.2 Availability of personnel.
• An enumGration of cnvirorunontal sanitation pursonnel in Member countries, classified accordinG to the duties 2.nd qU111ifi~,tions proposed under 'I',·tle I, and G':ctheruu. from sorrino.r particip,-,.nts is presented in Table II. 3.3 Personnel nec;ds, proscmt ane: futuro
..
The available data on odstinc environmental sanitation pGrsonnol led the group to conclude that there is a sGrious Regional manpower shortage in a number of diffurent catC[.·ories. Australia, Nuw Zealand, Fiji and Belstern Silmoa, for example, show G. ratio of ono qualified hualth inspector (class Band C of Tilble I) to 5 000 to 10 000 population. Although this is regionally a compc\r£ttively Good v"clue, it is nowJ:.el'e considered adequate. In the nC)fr11y dovolopin£ countries of the) RCLion, moreoovur, this ratio runs as high as on~ inspector to 141 000 populiltien. This maGnitude is completely uns2.tisf1.:ctnry [',11'i should be lO':l'...rcu 2S soon as possible • Thoro is ",lth"r 2, complete abscnco or C\ serious shortuf,o of sanitary encineors in most of the countries. Only adequc,tcly qu£:lified en[,inocrs should be accordod this cl[:ssific:tion. The number of .vater 1r1orks Dnd seware tree. tmvnt plant opere: tors is quite high in many l1;.;mbcr Countries, but it was fol t that thG traininr- of th;;se IlOrkcrs should b" strencthunod and that luvcls of que.lification such as those indicated in Table I need to bu ust<.cblishod fDr the v1.crious [rados 'lf personnel in accorda.nce with plnnt sizo and comploxity.
page 12 Th;.; Seminar W2.S of tl"k oplnlon trot llklnpower requirements should not be based exclusively on ratio to the popliL: ·t;ion, furthermoro, trot no fixed r2.tio for the entire region is feasible. A proper assessment of needs must 1!ivo weicht to thu socio-cconomic conditions of ;.;ach country, its populdion (urc2.n, rur31 2.nd geographical), prc:vailinc diseases, accessibility of popuLted an.,as and numerous other f:J.ct0rs. It was noted with satisf[~c'Gion th~,t J~,pan is pruscntly undcrtakine; <J. study of th" workl02.d of its c;nvironlllcnt.:.l 3e.ni tr. tion PUH; .,·,nnel 'Ni th the olJju cti yes of cstim~'. tine pros0nt and future m'mpm·JCr no(,Qs 1-1i th ,,-recter cert.:.inty. It was sU:l.osted that othllr countriGs, too, mi~.ht c,v[:lll.2.to their personnel requirements throuCh sil,Ul,.r stu<~us.
4. EDUC'I,TION AND TR.1,IllING OPl:'RhTIONS FOE SANITATION mnsoNNEL As has boon brou['ht out in Suction 3, i t is difficult to iduntify cloarly tho various categories of sanitation personnel. For the ovaluntion of ,:duC['.tion and training operations curruntly under way in the Region, the group decid()d that four [,;uncral cateGorios should be considered: the Medi cal H•. .:11 th Officer, tho Sanitary or PubH c H,O(:,.lth Encincer, the Hc;",lth Insp~;ctor c:.nd persons "rho arc cithur not engaGed full time in sanitation practice or relatively small in number bscause of their high degree of specialization.
4.1
Tho medical health officer.
Thii; f!,I'0Up is basically trained in medicine. Th8rc ere 76 mwdical schools in tho 1,mO Hemtor countries in tbu l-J'l;stern Pacific Region. These offer instruction in social an~ preventive m0dicine .,ith varying umphu.sis on the sanitary s cionces. RGferunce to 11 \1PRO report on the extent and content of instruction in soci.:11 and preventive modi cine currently offered in the medical schools Qf the Regionl , led to the conclusion that the administrL'.tive officer of tho pulJlic hualth proGramme of a country should receive significantly more oriuntation and indoctrination in unvironrncntal sani tation than is commonly provided. Since the Seminar felt th1lt a satisfactory public heGlth progrClmmc must Qim for" hi;.;h standard of sani tation, it waG of the opinion thc.t post-!]2.duo.to tr1lining would be required to qUc'.lify tht; HcJalth Officer for the successful administration of up to de.te cnvironrnont2.1 S1l~li tc.tion ploo:~r<1Jnmc.s. Facilities exist, or ,-cr" ;:.bout to cxist, in tho Recion for one academic yeL'.r of ~os t-C:raduato courseS for I1edical Hco.:::l th Officers in Australia, Fiji, Japan, Kor,Al, New Zealand, the Philippines, and Singapore. Conceivably, these could meet most of the requirements of thu Region. However, there was cvncurrence in the need for a school of public health for those countries in which French is the lanGua[o for advanced education. It i-l2.S the considered opinion of thu Suminar that in spi to of a shortage 1
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I,
II " II !!
Toaching of Socic.l and Pr"venti vo l1ulicine in the lilcstorn Pacific Region: Report of a Study Group Convl.mcd in I'1lnila, 16-29 October 1957. (Mimeogrc:phod d'Jcument, ({flO Regional Office for tho Wustcrn Pacific)
TABLE I Suggested Minimum Qualificat:'ens and Duti€)s of Different Categar ie s categories 1 Health insj:€ctorss J... (includ ing sanitarl ans and princiral health insI=B ctors ~
or
Environmental Sanitation ?ersonnel
Qu.MU'ieat1 ons
Dut:le s
B.S. or eauivalent educat1.on and 5 years of supervisory experi~ ence.*
1 - Plan sanitat ion pr'lranine (inc Iud ing budgeting). 2 - Co-ordd.nate smitaxy insj:€ctors activities. ~ - Evaluate environmental sm i tation programme. - Assist (medical health officer or engireer) in administrative operations. 5 - PrepM"El or revieu r6gul~ions ('n environmental sanitation. 6 - Carry out special investi~ations and education of health inspectors. 1 - Supervisi on of inspr' ctors 2 - Contact ,.ith public (local authority, public grnu!l, commercial group). 3 - Pro motion c.f environmental sanitation pro grammes. , ,
B. (including chief and senior health or sanitary inspectors)
12 years of Q0hool or ~niversity entrance and ~anitation diploma or certificate, 1Ai th adeqI ate 3Y.:perience after qualification.
*
c.
(including health or sanitary inspectors, malaria inspectors and sanitary agents).
9 years of school plus formal full-time training with certification, prior to W1 ich he may "be considered as a probationer or trainoe. il*
1 2 -
3 -
4-
Inspection Conta~t with public (individual basis). Conduct sanitary surveys. Sample collection.
I
D. (Misc. Sanitary A:ides)
6 years C'% school with on-thejob (mat nly functional) training
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Field operations, employed mainly as foremen or overseers.
* Each year of successful undergraduate studies shall be considered as equivalent to one year of eXlBrience. " 11 11 " post-graud'lte 11 11 If " n " If two years 11 11 i*
For some countries, this certification is the diploma of the Royal Society of Healtfu; its eQlivalent is recommended for other countries •
...
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- 2 -
categoriAs 2 - Engineers: In Relll th Agencies (includinlS engineers eillployed by other agencies but performing these duties for the heillth agencies)
Minimum Qualifications
Duties (Duties depend upon seniority, experience Ilnd educational ql a Ufications ) Adviser health of'icials other than the engineering gnmup in the heA.lth aspects 0" sanitary VD rks. Represent public health agencies in inter-agencies planning and development with respect to public health engineering. Plan and promot& engineering activities that will improve environmental sanitation such as public water 51 pplies, se~erage, water pollution control, atmospheric pollution control, industrial hygiene and housing. Review and approve engireering plans for sanitary TAl rks and establish review and approval criteria. Make san1tary surveys and evci\. uate sanitary needs of c cr..ntry or area. Supervise by adequllte visits and sampling the performance of sanitary works, in the interest of public h~alth, including the safeguarding of public water supplies, useful am atic life, recreational facilities, and public convenience, the proper disposal of community wastes, the prevention of atmospheric pollution, the protection of .orking spaces, etc. Direct or participate in the collection of basic technical information, develorment of plans, preparation of designs and specifications for san:it ary Y£) rks. Supervise the construction and operation of sa'!. itary works • Assist public health or sanitary engineers. Employed in public health or public works agencies. 1 2 Direct and co-ordinate environmental sanitation activities. Provtde guidance and support for environmental sanitation programmes (administrative and medical aspects). Develop adequate and quulified staff far environmental sanitation activities (un -•
i..
B.S. degree in engineer!ng or equivalent education,'tlith advanced studies in sanitary engineering, industri~l hygiene or pub~ic health recommended.
1 2 -
3 -
456 -
B
I~ Public works or Related Agencies
B.S. degree in engineering or equivalent education, with advanced study in sanitary engineerinE5 recommerrled. Tech~ical
1 2 -
C.
Engineering Assistants
school graduation
3 -. Medical Health Officers
Basic degree in medicine ~vith M.P.H., D.P.H. or equivalent post-graudate education.
3 -
...
- 3 Categories Minimum Qualifications Duties
4-
"Jorks Operators: A. Large city dth ('omplex plant B.S. or equivalent education and 5 years of eXperience, 1 -
2 -
3 B. Small city ',)i t,h complu plant or .. It.rge city with simple plant 12 years of school or university entrance, certificate, and adequate experience after qualification. o "F,lars of school plus formal full-time training with certifie ate after adequ,~te experience.
SuperviBi.. on and management of plant operation and plrsonnel (including 'udgeting). Responsibility for treatment plant efficiency. Keep operating data and record.
Same as A .:n a smaller and less comp]e x plant.
C. Small t01-m with complex plant or l'lrge to',m Nith simple plant
Same as B but under superviBi.. on. ,
,
D. Small town with simple plant
6 yearl'l 0t ...chool with on-the job (mainly functional) training
Routine operation of a simple plant for a small town.
I
I
5 -
Basic Science persomel: Bacteriologist Chemist Entomologist Biolo~ist,
Degree in scienoe or equivalent education
Provide supplementary services and conduct resa~~ch in their specialized fields in suppar-t of environmental sani~ation activities and programmes.
I
,
,
,
I , ,
etc.
,
.
,
•
•
•
TABLE II Existing Number of Environmental Sanitation Personnel in Member Countries Inspectors A B
Countries
Population
C 825
D
-
Engineers In Health In Public Works Agencies Agencies 1 7 2 2600 159 14 68 8 4 1 364 0 22 30
Operators Engineering Assistants Water works 1 410 16 6883 ?? Few 11
Sewage works
;,ustralia El"unci
10,000,000
22
165
--l'nlaya
C.lina Fiji !'ong KOTlg Jc.pan Lorea .-
----
80,000 1 11 4 9,800,000 3 347 10 1 346,000 53 34 2,800,000 170 23 75 4 92,200,000 887 227'P-f- ~500 30 21,500,000 5(M.S.) 35 271 1582
° °
°
5
° 300 13 1 ..
30 0
° 5 1
?O
t->cw Zealand . k)thcrlands ::ew GuinEa 770,OUC L orth Borneo 420,000 Papua & N. Guinen 1,800,000 Philippines 23,000,000 ~Samoa 21,000 8:i.ngapore 1,500 ,000 -. -Vi.et Nam 13,000,000 Cambodia 4,800,000 T:-thiti 80,000
---.-
6,270 ,0,,0 2,3 00 ,000
-_ -.--- -_. ...
16 35
1
532 190
346
-
...
° 21 10 1 10
8
1
11
1° -
1
25 ~Oll
48 1 8
1 0
1*
1
3 66 ].22 34 4 ---
12 ...187 187 6 68 46 27
° 0
2 250 0 3 1 1 Note:
15 1 537 1 17 8 22 0
34 0 1 3 --_. - -
*From France for consultation
*"*
° °
°
° 9 ° ° 0
-
About 90% of inspectors indicated are qualified as veterinarians or pharmaceutists.
Blank space denotes figure una. vaila ble •
..
•
•
•
.
•
p£~ge
13
•
of Mc;dic;:;l Hc;alth Officc;rs, l~Lck of finccnclal incontivlos~~ Clnd poor professional stctus are preventinG tho full usc of availaLlo facilities. If thoso han6i caps wore overcome, oxistine; facilities, it was reasoned, might well becl'mc inadequate • 4.2 Sanitary or public health cn[,jncer.
"
Throughout the HemLer Ccuntrius 0f the R"cion thero .:1rc-' ,'ood tochnicnl colleges and er:ginoerint::, schools of uni v0rsi ties th::t prcp':Lre students for career in tilO vcrious Lr~.nchus of cnc;incerinc ut both under-graduate and post-c;rGduate levels. In UcTI(;ral, ins truction :Ln sanitary or public hcnlth un:--inocring is limited to un:.ler-craduate courses in water supply and waste Hater disp'Jsal in dopartm"nts of civil "n: in;.;erin;s without the benefit of instruction in ch:.;mical or bioloC;iccLl laborc.tory work. However, there are univursitiGS in Jnpan, the PhilippinGs, [end 'rc.iwan in which course work is sufficiently extensive to justify an undor-grllduate degree in sanitary or public he"lth engino0ring. Only two countries, Japllll and the Philippines, offer llost-c·.r;:;cluate study in this sp"cic.lized branch of onginoerinc;, but the duvelopmcnt of gradllilte-level instruction is being acti vcly explored in other ccuntries as well. None of the existing cn[;"ineering curricula as yet iive siEnific&nt coverage to the newly arising problems of induswricl hyzicn0, air pollution llnd radio-tion control. It was noted th:'lt many of the pr,ccticin[ sanitary en[inc:ers of thu ;iGgion had received thoir post-gradunte training abroad. Ideally the public hualth or sanitary cn["inecr should h&ve devoted at leL,st one acadamic yu,r to specialized post.-c;raCluate training to become sufficiently "lOll qw.lifiud for service in dther public hvalth or public works agencies. In vim'1 of the groat import&nc8 of sanitary works to the ,)uhlic heo.lth and their lnrge cost to tho connnunity, there appears to be ample justification for requirinc tho.t only persons of high education, training and experience should bo concerned with the major planning, inVestigation, dosicn and operation of the necessary structures. It would a~l"ear, therefore, tho.t a number of ;)ost-[;rnuuate courses in sanitary or -'ubli c health en,':ineoring difforine; in their lancuage medium are needed in the Region. Th0se should be cskblishGd to[cther with adequate research facilities D.nd USGfully, in many instances, in conjunction with schools of :)ublic health. Tho s;ccinlizud ncture and cost of such instituticns may be eXl"Jecterl to k0e:' their number dOlm to the actu;:;l rcquircm0nts of the countries or sub-rq~i ons of common l:'.nGc llil['e.
•
4.3
Health
ins~)'cctors.
. •
In the l,Iestern Pacific n"."irn, training facilities for hoalth ins;Joctors exist in c0nsiderablc number. Howl:vur, tho "r"r;rammes of trtiining vary widely in s coree and content ~!TIrl c)ften rQfl(;ct the, ,oli ticGl and administrati ve organization of l)arti cular countries all too closely. If the insl)ectorate grouJ is ~laced in four grades according to the extent of the associated education and training the 2. vaik bili ty of trainini.; fucili ties
*
Such as under-grnduate, ,-)o5t-,;r;:;dunte ;:;nd in-service training on full salary, und oIl!J;~nced salaries f')r qualifiod peo~)lo.
iXlgC
14
. for the ins,xcctoratc in the- R(,fion is inclicc"tcd by the.: w)tations included in Tablo III.
Grccdu I was considered to bo a,:;:rcximc:tcly equ<:ll to the; classification of Sc,nitarian or qwlified health ins~)Gctor in 'feeblc I, eencl, it was the o;)inion of tho grou;,' that this erc.do should exist in all countries. For certain countries, Korua, H.e;lUblic of China, Te.hi ti ccnd Viutnam, for exwr'le, this 1voul<l c<:'.ll for an u~gradin,: of (~xistinr traininG fcccilities but wi thout the cessation of training~)rOf£rammcs for and um,'loyment of leMer crades of ;:ersonncl. If countries such as Cc.:mbodia Clnd 1.:..05 should be unable to estClblish suit<:,blc cent"rs of their mm, trccinoes should bo sont to other countrius ',rith C,:Jln;,Ctr;:ble physical and social cmvironmcnt condi tions. As sUV{;estcd in Table III, tho traininG' of Grade III lJersonnel should be ffiClinly functional; in Grade IV solely functional. This does not im~ly, hawuver, that functional traininG is unnecessary for Grades I and II.
4.4 Othor ,ersonnel. In the schools of ~'ublic health in the Rec:ion training in the sanitaxy sciencos is a ;Jart of tho instruction fcr the Public H(;alth Nurse, the Health Educator, and certain basic science workers. However, similar training fer the rural community development worker, agricultur&l arent and school teacher is only just bu[';inning to be offered in the Region. The S81ninar is of the o;;inion that thGse ;,eOIjlu will ,)lay an incrQasint; Jart in the future development of environmuntal seeni tation es,)ecially in rural areas and that thuy should receive at least functional traininG in sanitation from a Sanitarian or Health Ins;'ccter assicned to this duty by the Health DO;J&rtmc.nt. At the nntiono.l ro[tional or provincial lc.vul the Community Development Aguncy should have seconded to it from the Hualth Departmont a Medical Officer of H8alth and a Hoalth Ins,x)ctor for tho l)lanning and croation of the sanitary phases of devclo)ment ;-,ro[rammes. The training of community devolo;,me: t 1-Torkors shculd h2.VG the Su;);"ort, encoura,,~emGnt and Co-o~)cration of health d0jX'.rtments at <:11 levels. 5. RES:CARCH, DEV;LOPl'ffi~NT
AND DEliON0TRATION
5.1 Existing
and needed resl:o.rch, ckvclolcmcnt and d0monstration.
During the discussion of this tO,'ic &n oxtensivo tabulation was ;:>re;Jared of the resu'.rch, dovelOllmc.nt c',nd demonstration operations currently in beine in the countrius of thcvkskrn Pacific Rerion. Becausu of the Great differences in the charc:cter of the ReGion, the problems thc:t are receiving attention rise in scale from the most elementary, such as im~;rovements in the design of manually o~erated well pum~')s, to the; most advancud and com;)lcx, such as the.- photo-chemistry of industrial air pollution and its control. As dcterrninud by the; Suminar those environm0ntal sanitc:tion ;Jroblcms of the R(;c;ion that need continuinb inv(;stigation or furtheJr res"arch can b", list~d by catc['orius as follows:
•
TABLE III EXISTING FACILITIES FOR THE TRABTIOO OF THE HEALTH INSPECTORATE GROUP
Personnel Gr,de I Grade II -
Usual Training Time
Australia X
Hong Borneo China Fiji
~
Japan X
-X
New Korea Zealand X
papua Philip- Eastern and New Guinea pines Samoa X
Singapore rahiti
~ietw
Jtlpa X
4 yrs 1-2 yrs
1961 A X X
X
1961
X
Gr,de III (M."inly Functional Training) Gr'"de IV Functional 'IT::Q ning Only)
3-6 mos
X
X
X
X
X
X
X
X
X
3
mOB
X .....
X .'
X
X
X
X
X
X
X
X
X
-.-.-
'---
X
detnteB that training facilities are available.
1/61 implies that facilities will be available in that year •
...,
•
•
•
•
«
vlo.stc dis,osal - ni:;ht soil-trcutm"nt cli ..'c.stion, )u.skurization, dowat0rinu a .... robic and anaerobic S0wace lagooninc; rofusc com .,osting wi th nnd 'wi thout niGht soil; corrosion of concrete SC1-1ers.
•
WEtter sup~)ly - disinfection - bacLrial, j)rotozoal and viral, romoval of toxic substo.ncos, es)ocic:.lly arsenic and hydraf·c.n sulfi (10 ; romoval of iron and manc;Etnose; removal of cnteri c bactcrio., viruses, protozoa and holminths.i hydrological data on surfnc,: .rater flows emc1 subsurfnce acquifors; use of fluorides and l)hos::m tes for ;)ruvcntion of duntal caries; industri2.1 pollution of stroams o.nd coasted tVo.t,:rs; dcsiCn and maintenance of manually o~)(Jrnted community 1-1e11 ;Jum)S; durability of ;)ipo materials. Noiso control in industry and AtmosiJheric pollution Radiation - procudure and reSl)Onsi bili ty for control; radioo.cti ve wastes; x-ray, betatron, and Cobalt-bO oquipmont; fallout. Rodent and insect control - physical control m0thods; chemical control mothods; bio1o[,ical c e ntro1 mothods; iJrob1oms of insecticide resistance. air~;orts
•
Food sanitatiop - raw fish, crustacoans and mollusks, from insecticides, herbicides and food additives.
contamination
Water consorvatian - conversion of soa water into fresh water; reduction of reservoir 0va;)ori.!tion; rainm2.kinG.
•
5:)ocia1 problems - h:ptos.)irosis; schistosomiasis; ;)hysica1 means of TB control; ['oiter from ~,ollutod wator, filariasis; pr.raconimiasis; chlonorchiasis. Standardization - nom,;ncle,tw·e, exanination of watur, sewage, and industrial wastes; eX2mination of milk and oth,.r dairy "Jroducts; eXllllline.tion of foods; and inter1lrG tation of rU3ults.
5.2 Needs for bottGr fnciliti<.;s Much of the current resoarch in environmental sanitation in tho Region is beine; conductod by the lClrge:r me tro;')olitan Horks boards tind by national and local :.overnmental heGlth and 'll-lrks a[encies. Excc •.'t in Japan, the uni versities nnd schools or insti tutes of ~)U1)lic health have not ;,layod nearly so rromin.:mt a roL. To a ,:roat extGnt, this is a concomitant of the lim:i:t.cd 8qui;lment of the Rccion for rost-[rGdu.::t0 study in uni versi ty departments S;)O cic:lizing in onvironmontal sanitation. It was stressed that one of the :)ur~'oses of ,Jost-graduate education of ~)ublic health or sanitary encinecrs .ras to instill tho II experimental api;roachll to environmental hl;GIth I)robloms and that nmvly dcvelolJinr craduate departments should bo equi;i)ed vrith adequCltu research tools for this purpose. The group fuIt, sincl' thu rosults of much fundam0nta1 research are already available in the literature, Regional rosearches should bo directed as cloSGly as possible to tho study of ,mys and moans for applying those rosults in th" Rcr:ion rnthor them concontrCltinc the efforts of aVCliL~bIu rosu<lrch workors on simile~r flIDdamcntc,l studios.
•
•
pace 16
5.3 Prossing
r0s~~rch
n0eus
It "r~,s i.lfTOl,d thcct on" of the. most ur[cnt needs of the Recion is a study of the bost m,,::tns c1' IJrovidinc: "nvironmuntal suni totion survic()s and the desirability of sl;ttinC Ul) regional <mthoritics, such ~s water and sewerac;c boards, thi'.t C2_n ,~l[m, dosicn, construct, fim:.nco, and manil['e necessary sanitary works in an ord8rly and economical fashion vii th adequate. ublic hcalth advicu and unLiur aduquat8 iJublic h_;alth control. Ano ch;r ~;rtlssinG problem in nuch of thu Region, it ,.as felt, wns centerod on the prevailins philosophy of niEht soil conservnncy, at the heart of ,-1hich liGS the quostion of the economy of this ~)ractico. It was SUU::ested that the lurgo subject can be ass",ssed fully only on a national and rq:;ional basis by the co-ordinatod and intuGrnted efforts of economists, agronomists, social anthropolo[;ists and psycholoGists, microbioloc,ists, chemists, sanitery eneinoGrs end administrcctors. Piecemeal studies, it was reasoned, could not solve tho iirobL;m defini tuly. Resu[\rch to,)ics requirinG ;J[\rticularly intensive study at this time wer8 listed as follows: urban rodl-velopmunt with jJarticular reference to low cost housinc; cmd community scrvi cos; niCht soil and refuse disposal and utilization; specialized trade end industri~l waste tre~tmGnt; wator resource cons0rvation; hydrologic and hydr~ulic design invustigations; bacterial, viral, and llarasitolurical efficiency of water treatment; offecti vo and solf-sustaining d0montrations of rur-al sanitation. 5.4 Assist[\ncG foy
•
I
resG2.rch, devcloi'ment inc"! demonstro.tion.
At the present time, subvontion of those o~orations originP.tes largo1y with the n<ltion2.1 and locel [ovcrnmcnts of tho Rucion. Little industrial support has been obtained so far. The merging people lean beaY1l7. u?on international aCt.;TIcies such as rCA, HIrO i?nd tho foundations for financial assistance. Th8 Seminar ,vas of the o~)inion that more industrial and university participation should bo so~~ht in the future. Th(J r;rowine 8xch"nge of rusc<1rch and tU<lchin[ i)crsonnel within tho Rcpion and outsidu of it was noted with s'_itisfaction. Examples are: the faculty oxchLnt;u ~Jroermllmt.l b"twuen the U;li versi ty of tho Philip,.)ines and the Johns Hopkins Univursity OV0r thu ~)est five years; lCA, WHO, RClclwfo1l0r Foundation, Colombo Plan Gem] Fulltriiht FullowshilJS for study abroad; tho \vHO :,rorrammc in Tahliln whcroby .rorkine; oxpuril-nce in sewuragu dosi[)1 can be obtainud by 0nlcino~rs cf the Rq:;ion; and th" "Third Country ProGrams" of rCA whereby Semi t,:-.tion and ;>utlic health workers from Taiwan, Koree. and other countries arc broucht to the Philippines for practical and acc:.demic tr:linin:.. It was acreed that a wider uxche.nf,e of)ersonnel of all catef!ories and levels is desirable and tlk,t !J. sui t<J.ble lJYOrrrrunme should be actively promoted to this ond. So fur most of the initiative along this line has been coming from the international aGencies. Although their leadership was comnlonded, it was felt that individual countries should be encouraged to do much moro on their mill, p'-lrticul.:lI'ly by ;::;rcviding suitable working exp~rience as well as academic traininc.
..
;x.:ge 17
•
Consi(c"ruble assist[:nc(; hns come, from int-.:rnution",.l u(;0ncies to some of tho c,'untries of the RLr:ion for buildinr: up collections of books, journals, r0)Orts Lend trai n:~nL' films in th0 fivlc i. of )ublic he;::.lth. :".n:l hnve cl,m" this by AlthOUGh, the more d8velo:)ed countries can thumsclv0s, ['. c:un0ral n0ed for "rl~er r0c"i. t l i rv ·-'rts ~:nd j')urno.ls by Member Countries i'o.S noted. T,)o often dotail"d informc.tion on specific subjects cen bo obtcined pres~ntly only by person&l cont&ct. Serious considcrf'.tion should, th<Jr..;forc, lJ(; ;;ive;n to TIlilkin;,. th\J NEO R0uional Office Library in Htniln of [rci:tc;r use to M0I1lU.T C'··unt-ries. Possibly, each Mombcr Country could forward sclocted )il).JTS i.end re)orts to tho R<J[ional VJHO libr[.ry for re:lroduction [mel distritutj.on .::,ftvr tr[lJ1sl<.,tion in full. It WetS SU[Cest0d th2.t 2.bstrClcts, on th0 one h[mu, ure; often too brief to to adequate and complote journals, on tho ether hand, too voluminous to bo accoptable for tr'-,.nsl<::.tion.
,,0
6.
ES'r."BLISI'IM';HT OF PRIOHTIES IN TR/1INING ilN"J EDUGilTION
•
The Se.minar felt that priori tics for thc tr1:'.inin;:: ".nd c;uucution of sanitation pc;rsonnel should bo se.t in 2..ccord-.;nco ,-lith thl> most pressing neeus of tho Region. In generul, this could bust be done by considuring individual countries as units, C'.lthouCh sometil1lus by goinG down to district levels within oClch country. Examples arc t.hG restriction of hydrated diseaso to New Zealand, tho prevc10ncc of schistosomillsis in !xl.rts of the Philippines nnd its absence from countrios like Malaya and Tuiwan, and tho hiElh incidenco of mc.l1:'.rie. on tho islc:.nd of NO'1 Guin0u [!D(l not on some other P<::cific islands. In its discussions the groul) found it pl'ofitc,ble to list by country what its representatives ostimatcd weru the top fivo ;lrublems in sanitation towards tho solution of which trnining ~.ncl oducctional e;fforts should be most clom,ly dir"ctud. Thu results ·.f these n:.tin[s ar" of much intQrest. Of all the =jor problems SU[CeStud, for exam;)10, 25/, wore associ2tod with the sup.,ly of We.ter, [.nd th<.; elis:!os2..1 of liquiL~ c,nel solid wastes in urban areas, 25% with W1:'.ter sUPllly and Gxcreta diS)OSIlI, 14)b with tho 8radication of mc.l~ria and othor arthro;::-od-bornu disoasos, 12% 'tIith the im~)rove mont of housing, 9% with the sC".nitdion of fooct, 5% with hypienic ;,robloms of industry, "'.nd 10'; with misc~ll1.~n(.ous mc.ttors, "uch as hG",lth education, and with isolatud ',croblems peculiur to a sj.lGclfic ['.re1:'. • . It would appenr, thorofore, tmt tho sL'nitc.ry control of wator and wastes in th~ urb<.m ane. rural "nvironrn0nt should have the hi['host priority in tho tr<:.ininr and education of sClniktion mL'.n;)oworj and furthor that wull establishud, orthodox instruction in tho principles of ~nvironrnental sanitation, including the t(;chniques of in:.ustriLd hygiono, will best S0rv0 the public hoalth of tho Region • 7.
•
•
CONTENT OF
EJ)UCATImV~L
AND TRllTIHNG PitOGRLll1lES OF STUDY FOi, H:l'iVIRONMl-';NTAL
SMUT, T . ON ff;RSONN'EL
•
In considerinG this t011ic the SGmlnar :iir0cted its c.ttuntion to each of the. catGC'Jric.s of ,)Grs·mnol includ0d in ',)rc;coodin,: d0lib(;r,~tions and decidod to ccnfino i ts~lf to D. listinG of' rcquir0d subjects rc:.thor then dotailed titlos of courses.
7.1
Educ,.tion end tro.inin[ c:f th..;
m~llic2.1
officer of bl.dth.
To t..; '"lacod in this c;,tC[~ory"vrs'Jns must ;',ossess a docreJe in roc-dicino and in 1'.,:,1, tion s;.1ccializl.d cduccction in tb..; SL:ni tory sciences. In i)Ostgro.du<:te ..;duc(.:tion, )rocrccmmes c;f stuc;Y shoulu include tho following subjects: Vit[,l r:t:.tistics e11e, stectisticccl m0thods; e;Jiu0miology; biological scionces b[~sic to lJrev,,'ltive medicine, (microbioloCY, ~xTccsitolot:y, immuno-chemistry, etc.), Publi c h..;[clth o.ciministr[ction, ..;nvironmE.ontal s[mitation; soci2.1 medicine; 2.ncC ..;lcctiv(;s for specio.lization such [:s tho man2·c(;ment of venvl'uo.l diseases, nutrition, tuberculosis ,"nd mental hyGiene. Morc specj.fically the offcrincs in dire ctod to the. fall ')winn c;nvir0llincnt[~1
s[:nitation should be
1. Lectures, discussions, dcm;nstrtLtions, trips and surveys concernod ,d til:
l[~borntory
oxorcis(;s, field
Rural wflt·or sU-;-Jply and excreta disl:;osal Public water supply 2.m} SCO,eJraC;8 Refuse colloction '-mel disposal Food and milk semi t2.tion Es sentials of : Y.... c.l t:U'ul ;,ousins; Animal res0rvoirs and vGotorsJf disc-ESC C:ntrol of the industri1.'.l environment Sanitary analysis
.' '"
?ublic rcl;::.tions and l"Gdcrs!li ,) in ~nvironmcntE:l sc.nitation: [!roujJ dyncmics, ;l<)rsonnc;l rcla ti'ms; uclG[,i'.tion of functions; lq 2.1 ,c;-:d financial m<:,ttcrs; and i)repc-::.y;::.tion of f')rms and rOjJorts. Broad concc~:ts
of ron ['.nd his rdL'ti')n to lri.s cnvir::mmcnt. s~cni t<'T~'
7.2 Educt.tion uncl training of To be do,roo end ;~lC'.cod
or j)ublic lh.-c:lth "ncine"rs
s::~ci[.lizod cduc~,tion
in this catc.['ory, ;,,,rs:ms must possess &n uncinuurin[' in the sani t::.ry sdences.
There arc fnur reneJral ET0US in w:l:_ch L1Ublic ;le[\ltl~ or s:;nitary (.;nE'inl-.rs [.ru usefully emplcY0d, n"m~ly: (1) public ;,wrks ar;encius, (2) ;Jublic h02.lth acencius, (3) indus triLl ~nvi.ronm"nts :_nd (4) private practice. For the c'untrics of th0 . I"stern Pc'cific Hc[': on, thc Somin[.r felt that sani t2.ry Cnl!inccrinr: CC,uc[,tion slnuL; concentrc:te'Jl1 tho sMi tr.ry needs of urbcm arc2.S but that much cmphe.sis shoulc: be ;;lcccd (:lso on rur1.'.l sani teL ti on • As ;:>rcviously stated, unLic;rcr<.cJw-ct:..; C'J'..lrSCS luudint to [; BS d0l.roe in Sani '.-ary Bne<incorin;; are currcmtly offered in a few of the 11mb,.r Cc:untries. Expcriunco in tho United Ste.tos inuic1.'.tos, !'l' :l"G ver, that 'Jnly 1.'. sroll
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portionof tl'~_ [rn(cuates of 5uch cours"s m~.y 1: .... CX'2,-,ctc:c! t:l LO into sani tti:ry un[ince:rin:: 'I)rc,ct~,c".. By contril::;t I':lmost 0.11 en~inGc;rs who take postgraduc:tef.vnrk in u:nit:..ry or:uLlic h0~,lth vn"'inc,xine, c:ntcr c.ml rcmcin in tt,is fc,;_ld. For the-IOu L,ni~ .:t :lcr rc.;asrms, V,,, S"minar was of the cIlinion th,'t Rep !mal Fl'· 'rvss should t,) tm-l2.rds the oduc[\tion of encin(;ers at the f~<:.duate level. SirCL it may bo ,,{;mc.timu bcfor;; a sufficient nwnber of cne-inccrs TtTill be available to miJet ,;V0n the- minimum nGcds of M0mber Countrios, ~owCOv0r, it may 'i)C ncc(:ssary to continuL for thG timG bvine, the currGnt prcccticc ,)f prcvidin[; undur;~r,'.duatc: sanit:::ry ongimwrinc instruction in a modified civil dlcinourin~, ~)r()~::ranmG.
ThG first two y"c.rs of most cnc;incorin[! curricula aro cssc;ntially tho sume, their concern buing f~ith th0 bl'.sic sci"nces, matheIa[:tics and tho llber[;l r.rts. Tho last two Y0c.rs normc:.lly include som3 profossional onginocrinc subjects. It was surcostou tho.t undlirGraduo.to off~rings in 13 ani tary or )ublic hedth Lnc:ineJcrin,e should includu thc following:
1.
Witpin rGquircd arGUs: sanitary physics, ch0mistry 2nd biology; ,vater supply and S0wcrct{,'e; hydroloCY and hydraulics; purification of wE:.tur and trcr.tro1ont of S0W2,';'-. ~vithin
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2.
electi vc ::md survey arecs: hc~\tinc, li[;htinc und vvntilation; industrinl end atmospheric hyL'icnG; epidomiology, biostatistics and public he<h administration; milk and food sanitntion; vector control
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7.2.2
Post-craduE.:tc traininr
Tho f70uP f ,-It thnt (;ni. inGc;rs are of ton It.eking in their understanding of tho thcorcticc:l, cI-:.cmic!ll and biolof':ical implications of the adjustments of GnvirnT''''' 'nt.s f"r whi ch thliY aro res) msi tlc [mu :;f the works that they arc called upon to plan, desicn, c"nstruct nnd 0l)"rato. Gr&duDto training should, therefore, bo dusignGd to provide this unGGrstaniing. Successful study will then ic;eJntify morG fully tho compG tonct:; uf th0 sani tury enginoer as a m,-mbc:r of thc public hc[~lth as well o.s th0 en[.;inuuring profession. Bofl)rG cntcoring Ul}()ll [;rc,duc.tc study ... ns;inecors c.rG wull advised to obtain somo ex~),-rionce in linvironmc.ntal snni tation. SuZ/'.ostod subject matter felr )ost-:'rcdude study is listed be-lOW: ~JatGr
supply [end se-weJraGo includin:; inc:ustrial wastes.
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GonGral planninG, hycr~:,Lcic and hylrc'.ulic dositn, ccon,:mic desicu, oC0n0rnic <mel fin[mci&l con&idcr<'.ticns, operc:tion, mana[?omont, and i)ublic heJc,lth control. Genore.l chemistry unci chvrnistry :Ji wc.t"r, sewaGc and industrial wastes.
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Snni tary bi'Jlogy. Planktolc)cy, be, cturiolr;[,y, virology, pCirasi tology, ont0mology and imrauno10 [;y •
pa~e
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. (}.;nc..ral salli t[;tion. Rural sani tatlon, r0fuse coll(,ction and disposal, insc,ct f':<,~ L~nJ
s;:cni ktLn, h',msing, rrylent central.
Inclustrial hy[;i0nG. Atmospheric LJ"llution, ionizing ro'dic,tions, inc\ustri2,1 c,nvir'.nrncntal c0ntr;:,1. EpiLl..;rniology, bio-st&tistics, and :Jublic he2-lth aclrrrinistrntion. Brocd concopts oJf
man's rela tionshiiJ tu his environmont.
Public relations nnu LUcl.:.rship. Those subjGcts shJuld bu supplcmc..ntcd by "lectivu courses in onginG8rinc or Jubli8 health within tho studGnt's 6Unc,ral crua of specialization or research.
7.3
Education [',nel traininl: of sani t<:cri~ns.
Tho co.terory of sanitarian is relicti voly now to some parts of t he Region. It is acknowlodt,:ed in its own right in some cCWltrics and exists in equivalence in the person of the principal, chief or semior health inspector in other countries. l:lhure this co.tegory of ,Jubli c hGnlth offiCJ,al has been included in tho table of public health organization it d,notes supervisory, advisl)ry or c'lnsultant resjJonsibilitius cme! the lJoSSGssien of a bc-cholor's decreo in sanitcry scivnc.:., ;:JUblic health or hygiene. Instruction in the first two academic years 1':'cu2inC to such a uGt::ree is cenornlly concGrnGd with basic so)cial, biolcCical end physical s ciGnccs, as well as gcncTul liben:l ~'.rts subjects. The le,st tTNr) yer:rs, ,Thich may be taken in a school (If public hcnlth or simil1:r institution aro devotod to the, spccinlizGd instruction shown in the foll'ldne: 1.
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L"ctures, laboratory and fiulJ GXvrcisc..s in Arclli tGcture nnd engineering: liietvr sup:r:;ly, dr"cinaco, and sewerncc of buildings, heating, ventilation ,md li2hting of builclincs, housin[, surveyinG, dral"in L: und sketching. General sz.nitntion: Food sani tntion, veet~)r control, refus" collo ction and dis;)osal, control of sw.immin:~ "Jools and rccr"ation ar(;as, rur1ll and indus trial (;nviroruncntnl ~)roblvms. Public health: Laws, codes, "nl! leE'al ;Jrr)ceclurcs, administration, biostatistics, opidaniolol',Y. Public re12tions and l"Cldurship Electives: in some specialty such as h'lusinE, rural health work, or occupationc:l hccclth.
2.
Fiald in-servicc) training for threG months each in rural and urban arG2S rospc cti vely •
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Th.. s,"iTIin,:r L;lt thr.t th" syllClbus nf tn:irlin; r')r thu insi,~ctor[~l cE.t",orics, 0XCU; t for l~nl;·th s.n,l l,.;v~l d' in3truction, shoulc~ be the same as thc~t felr th<.' s<ni·L;;~rL,n. :;Cor the; 10'kr rL;.~,"s:if i1ucclth ins~),"ctor, furthermorl.., thl..oreticc'.l ',f(;rk sh';uld. 'l..n.rC'.lly ,-i V0 W2.y to ~r,.ctical instruction.
Thu lc.nr:th of thu trdnin:' :'cricKl felr hu:ltll (wvrsucrs, hL;nlth nidos nnd similar C[ctoc;orius 01 >.. rsGnnul m:::y bu cxpuctc(l to vary from c()untry to c'luntry. TC2.chinc shoul( bo :;ntiruly functionrl, i.G. ccncernod 1,u th tho ncquisition of technicnl skills in c;nvlr')nm"nt<:l sanitation, such as the constructi OD of rural wulls, l:Jri vic;s [!Dc! In trinos (md the use of residual s~)rays for mosquito control. In nrldition to mnnilJul[,tive skills, how0ver, humnn relation skiD.s "l,ould also be devololJGd. Thcl trninoe should c:enerally be choscm bec.".uso of his ste.tus in thJ villc-['os, tho traininc!, buin,,: ['oc.red to his basic oducction. SUbjuct mnttur will vary with local DOGds. Tho Seminar believud that '.')rkers in thuse ETL:cles should be trc.ined and om;iloyed in onvironmuntc.l sanitc:tion only tut it appruciatod that some countries will continuu to instruct these.; cracles of s2.!1itation personnel in the administration of first aid 2.nd lJro~hylc'.ctic as wull as curative biolOEd.cals ccnd drugs until it becomes feasible to trnin other personnGl for medical care activities alone. Al thr)u~':h t hu persons in chccrge ,)f furlllttOillil tr;:.inin:' m;:~y be t8 chni cally well q\l2.1ifiod, most of them will b£.vc red little or no tvc.chL'1g experience. For their """cfit, ther8foru, there should be occasional wClrkshops on functi onal teachin[, methods c:mL.ucte;d by hi :her-:l "'vel sani ta ti on pers onne1. Althcu[~;l vilhc;c s2.ni tL.tion is c.n im"'ortD-nt 2.cti vi ty of community devolopmcnt workurs, hc",l th c.Uth::ll'i ties are s01dom 21liud with l)roi'Tammes that will jJrepc.ro these worb.. rs for th(;ir clutiLs. This situation is unfortUD2te and should be r0medi"d as soon as 1,;:>ssiLlv. Tr&ininG sponsored by the h .. alth aeency shoulcl, once acain, ~)() functional. A qualified sanitcricill OI" he;::lth ins;?u~tor shclulcl :_ivc i t emu he should confine himself to tua c!1inc basi c skills in excreta '-.'isposal, rural 1fIcc tor sup;)ly, rufuse disposal, and simple typus of veoctcr control.
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7.6.
Educc.tion and truininc of bo.si c science personnel
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The purpose of givinc instruction in environmuDt,-:l sanitation to bc:sic science p::;rscnncl is to direct thuir thinkinr to pertinent problems of onvironmental sc.:ni trction. The first two YCL,rs of uni versi ty (,duce-,tion should parallel those cf the sanitLrian or ~josslbly of th0 cn,;ineur. HOT,kver, the Inst hm years should bo confined marG s?vcifically to stUdies in the physicLl or bioloi~icc'l sciences and to 2. more circumscribed subject within thom. liadiclo;:-ic2.l ,)hysics, b[~ctCJriolofY, ;>r..rnsitolorY and entomoloey nrc eXD.m;-Jlus of mnximum sp0cialization. It was noted that &.sic Scicnc0 Pursonnul mcy also bL recruited from the pru-clinical Y0ars of medical schools. Grc,duc.to cduc2.tion of Basic Science Personnel is [,"cnurc.lly desire.blc. It Ivads to C\dw:ncud ",nd rosu::.rch dvgrees.
paGe 22 Basic Science Personnel CGn me.ke im:Jortc.nt ccntributicns to vnvironmeontal sr.nitc,tion. 1xrun;bs are studios undorlyinQ" the toxicoloCY of water an,,, food, the chemistry L.n" biol::;CY of stre2.m iJollution, control and uradication of m~:lari<'. t'.nd fil~:riasis, and the microbioloGY of wc,tor, sowa[e <lnd polluted wo.tors in ::en"ral. Physio10C'ists =y ~e included in these ranks and concern thomsLlvos with rOS1Jonso to ntmos·,.:,hcric ;)ollution, industri<ll onvironment, hcr.t, nuise, li:.:ht and {"thor c..nvircnmcntc,l fe, ctors.
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7.7 Trainin:.: of opi;;r;;.tions of small pl<cnts:
: of toose ',vcrkers must vo.ry liJ"i th tho nc, turu of' tho plants The trdninc that they aro to opGrato. Pro.ctical, short courses of one.; :Jr two weeks durution are cenGrally offGrcc.l :':Ii"': should inclu,~" instruction in: -Technical R€:sp'msjbilitios of tho Opcr-o.tor. -Opurl::.tin;? Tochniques: sam)ling; control tusts, such as test for coliform buctoria, residual chlorine, fluorides, and alkalinity; ,-~nd interpretation of tGst results. -Maintenance Tochniques: functions of i)reCOSScs can r..;quipmont; maint(.nanco of processuS nnd equipmunt; ,-cml uso of altornate processes t.. nd eqJ. ipm'-:nt. -Oporc.tinc Hecords cnd Reports: volumes of water trcatud ute. materials used, dosages,
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-Lo:;al and Ethical Responsibilitios of the O,)("rc,tor Other muc.ns for tr~ininf workers in this c~·.tc?ory includG their attendance at prof8ssiol12.l moutings and conferences; lectures followed by question and answer pGriods ilnd round table discussions.
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7.8
Typos of educational institutions for traininG.
sanit,~tion
iJ0rsonnel
Medical Cf'f'; cer of Hc;alth (p{Jst-~Tc,dUilte): Institutes or schools of public hec.lth offering a certificate or c1i~Jloma or ~ professionul or research dOi,roo; aD(' departments of proventi ve medicine in modical schools offerinr 11 CPH or DPH )ro[rammo or a resG,;rch de[;roe. Stmi'Gary or Public Health ini'ineer (post-;,Taduate): Schools or departments of en[:"incerin'" preferably in a univursity that includes a school of public hOi.,lth ur an intcr0sto(~ clE:purtmont of pruvuntive medicine; and schools of public health or public h0alth institutes with adequato spucializod instructiom:l staff and Jnboratorius. Sanitarian: Two years in a depE,rtmont of liber~l arts or science in a univorsity follov10d by two years in ~ school of public health or public health institute or in a deps.rtmcmt of public hr..;alth or sanii,ary science in a scientific school or university. Hoc:lth Inspector: Training cente.;rs oporated by a department of health or prcforabl)r by a dop<lI'tment of education; ,mcl technical institutions '\\7ith c·:llege ccrtific2.t0 or diploma iJrogranmes. A lJart-time, day or niGht school progranmu may be lJuTsued.
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23
Otht..;r P'_l'sonnc.;l such ccS .:)c'lli'c."ry AE:~nts [~nd He-ulth Oversoors: Traininc centc:rs c;:Jeratod by a dopartment of hu",lth and int,-,nd0d to m0ct lucc::l ne0cl.s L'r s l~" cifi c environmontul semi tc:tion survi CGS •
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Basic ':'cLmcu Pc:rsonnel: Scbools of liberal arts or science off8ring instruction loadinc; to c bache-lor! s de-[ree in tho biol;).ico.l or ;:Jh;)Tsi cal s cie-nces; uni vorsi ti,.:.s :)fforin L instruction and research in the area of th._ stuc~.un't! s spocj,r.lty Clnel lCL,din~; to an udvuncod degree; schools of public heul th or publi c huc.lth institute offcrinF op. 'ortuni tics for study and roso;Tch, and lOClding to rosoa:och dc,~roes at the l1C\st,cr;.~ .01' D''Jctor;s Ie-vel. Works OJ,)erator: In-service- training directed by the ;,lUblic hu.,lth engineer or public works cnginGur and concorned Hi th routine duties of works maintonanctS and operation, conferences conducted by technice..l societios, and fOI'TllC.l short courses, with or without examination and certification, riven by tho dopartment of public hoalth or tho public 1rlt)rks dopartm8nt. 8. EVALUl,TION OF OVE.11S:<:AS Vml.Su~)
WChL i,ND REGIONi,L TRAThlING
8.1
Oversoas training
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Whore there are no sui tc;ble op;:)Qrt~mi tics for academic study at home students should be sunt abroad for neodod education either with the Region or in other lands. If, a considern'blG and continuing number of trained ~)eople is required, Governme-nt should be cncouraced to dGvelop its own institutions for the education of professional officers and a satisfactory standard for thb 0ducation of professional officers and a satisfactory standard of schools or courses for the training of subprofessiono.l groups. To do this tho country must ungage an ablo instructional staff, dther local or forden, and devclo) examr,Jlcs of efficient sanitary surnces to illustr1'.te the prc:ctico.l nspects of environmental health operations. Tho use of expntriato instructors should be a tumporary expe-
d1entonly. OverseeS training is p<:',rticul2.rly usuful to sdnior staff m.;mbers and persons engaged in or likely to be ,.mga,-od in t0aching, but preferably after they havo taken advant1'.[0 of the hii'hest 18v81 of tr<>ining that is offered local~or regionally. Bofore [oing abroad, trainees should h,-~v8 recei vod a m<:.ximum of one year of r,Jractical fiold experienco in their own country,
8.2 Advantages and disadv2nt2Ees of oversuas study and training.
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In the discussion of ovor:>,,"'l study ~:nd trc.ininc, a numbEr of advantages and disadvantages woro considored as follows!
1.
Advantages of ovursuas study <,nd training may include opportunities
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for:
page 24 Acquisi tion of fc:miliEcri ty ,,,i th up-to-dnte impr'JV0d methoJs of pre! cti cc]. BroadeninG of outlook and GX",erionce Gcining thE) satisfo.ction and prGstigo that i!O Hith a recoi:nized degree or uiploma Obtaining ins,)irC'.tion and incuntivus Impl'oving chances f.)r ;Jromotion Exch.-:.nge of views "nd ideas with teachers, follow students anJ practitioners PromotinG intornc.tionul good will 2nd understanding for the student's country Investicr.tin(; spc]ci[.l lJroblc..ms Ctnel elevol"l)ing skill in the usc of specializc]d equipment Making vcluable porsonal nnd profossional contncts
2.
Disadvantages "ssociated wi th ovorsuC'os tr"ininc ,',nd study [erG: Difficulty of adLlptation to tho lancuc.,::o, customs Ctnd climnto of the host country AssiEnment to a country the climatic, social, and f;cmoral natur~ of which is so differGnt from tho home country that much of the eJQerionce cained is not applic::tble in that country Teclmical loval of training too advancod so that concepts are not immediately useful in home country Disruption of normal family lifo and possible personal fincncial burden at home GroC'.ter exponse than home trainine:
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8.3
Types of overs<...as study
[~ncl
trc:ining
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. Overseas traininG may include ono or more of tho followin[~ throe categories: academic study, obs~rvCttional travels, on-the-job training in [;overnmcntal officos or engineering pro.ctice. The desired typos of education o.nd tro.ininc should be determined by tho sponsoring country after full appraisal of all significo.nt circumstances including the qualificatioW! of the persons solectod. The puriod of arodemic study should bu of sufficient duro.tion to purmit completion of work for the degreo, diploma or certificate normally associated ."ri th successful complotion of the selected course of study. Observ.::tion tours should be closely related to the needs ()f the spcmsorin[ country as well as the student. They shculd be- confine-l to regions, countries, <mc\ iJlo.ces offl:rinc the exper:i.once needed but loft suffi cicntly flexible to permit o.dvanto.geous chances of itinerary. They should be nei thor too long nor too short. T;lurs I)f threo to six mrmths I duration 1ull suffico in most cases. To be avoided o.rc tours to so many places that the trainess has no chance of studying tho working of the programme he is to observe or of partici~ating in them in some measure himself. To make obscrvo.tion tours successful, ai;encies anL1 w(1rks thClt the trainee is to visit should bo advised cf his tro.vel schedule aftor they have agreed to the conditions of his stay and tho naturu of his interests. Field tri~s should not be schoduled for Sc2.sons of inclement weather.
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Prcwrannne3 such ~'s the; 8",{(,ro.,-0 cicsi6U )roEr,munc spcnsorod by HHO, in Chinn, in Hhich the tn',inoo is actU2.lly 0mi.lloyud by a working arency appear tc b~ p~,rti.cQl<:'rly useful. R"siJcnsibility f()r trmning of this kind might Llso t" c~S0uJ..,,(l hy Me trolJcli tan BC2.rds of 1t.orks, consulting firms and similar lJoclios thi.~t ;JOSS0SS spcc.i.al competence in unvironmICntal sanitation • It "vms not(;d th:.:.t th0Y,; hi::s been li ttl" usc c;i 0xiGtinf, inter-regional traininr f<.'.cili tiQS by H<;~l."cr C;untries of the ',icstern Pacific. Assignment of Retirmal lXlrscnnel to them uauld ;::void somo of the disadw::.ntu!;es of oversu'.s tr<:cininc; fnr instanc0, th<lSv rcl,:tec\ tD clim:ltic differences, dt;t;rec of technclcc'icnl ndvancomcmt, ox;)"nsu c:nc\ SC":"flranCQ of family tics. Jill intc;r"stinf.: examplo of nvailablc intra-rce;ioni.ll training is the
lCA Third C'lUntry Progrnm now in operation in the Philippines.
To it are scnt ht;alth 1.1Orkers from ndrhb)uring countries for thlo ;,urposc of taking part in continuing public health activities and rcceivin~ training or studying approaches to c:nvironmGntal health problGms th:::.t are simil<lr to those th2t they will encounter 1;::.t0r in thuir heme luntls.
8.4 Faculty exchange programmes Fcculty exchange prn,;:.:,~.nnn0s were: connnencled by the SeminC'.r. In assessing the length of duty, it was racornized tTh~t visiting professors should be eiven enough time to acquire familiarity with local conditions rund problems before taking up their t(;<::.ching rcsp'JIlsibili tics. Unfortunately obli~a tions to their awn university may cut their stay abroad to no more tTh~n ono year. When first or now courses arc to be ino.ugnrated, the desired participation by excbcnge 0r visiting professors of highust reputation can be sccured only by cuttinc their llon~th :Jf p.ttcnde.nco still further. A longer period of residence is normo.lly ::~!'rc fruitful. P,]rmc:nent staff should tnkc: over us soon us thoy arc qualified to do so. An im)orto.nt quid pro ~ of exch1.'.ngc lJrogrannncs is the experience ancl refreshment they afford to the. visitor and thr,Jurh him to tho teachinG in his OVID university. It wns tho sense .)f thc Sunin::r tbct in so fi'.r as possible, tho ex chance programme should be impLm.,ntcd in ell countrios in the Roe;ion. L<::.n~:U£.r:e b<::.rriers b(;tween instruct,rs i'.nd trccinc<Js can be lawerod by providing students with notes;f instruction<::.l mstcric.l in their own languare, by the usc ·)f graphs, lr.:ntern slidos o.nd othor visual aids and by c2.roful enunciatic:>n end crmtr·)l ()f spGc.ld.nf P2.CG.
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9. 9.1
FCRI1AUZED IN-S2IWIC-.c TR.J~ThlING UlillER HEri.LTH AND P..iIATED LUTHOlUTIES VERSUS PHOGRA11NES IN UNIVERSITIES Patterns in the Western Pncific Rc,:;ion
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The Sominar defined 11 formC'.lizud in-sGrvice trninine" as instruction, whethc:r at a university or at c:. l)ublic hcnlth training institute sot up by the h,,2.1th nuthority, putlic 'w::rks d01').:lrtmcnt ~'r relc.tod u£ency, to porsonnel on study lu:,vG with pay flml ne cessary subsistoIlce allowance. Table IV shows the cat0[orios of pcioplc that are currently receiving l1in-service traininfll under departmGntal or university auspicos in the Member Countries reoroscnted at the SGThinar or will do so in a short time.
page
26 dis[,,~v2..nte.c()s
9.2 Aclvant2..[os nne!.
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The. S"mini.:r ''1''.S "f tlL~?inion that needed instruction should bo offered by uni versi tics Ivh,eT" traininc s' .. rVGS the- ;lUrl'CJSO ,jf prep2..rine p8rsonnel for irnportnnt ~lrQfvssional p.)sitions that ern be filled sntisfaet'.)rily only by inc1i viclunls who possess hir'her cL[,rucs or diplomas. When, on the other h<:md, it is the iJrim2.ry ;Jurr:csc of in-service tr,-tinin[~ to aequnint personnel with nOH techniques 2nd developments, the department of h.:alth itself, a rel"tecl public h()",lth tvc.chinf and demcnstrr,ticn ccntur or other r:ovurTh'1l nt institutc m".y bo best fitted tc c'nc1uct instruction. It folLlws that medic2.1 officCJrs ,_,f h .. :.'.lth, puLlic hULlth enGineers and sanitarians normally shoulc1. seek their formr.l ec\uc::.tion in universities, whereas other catof!ories of sc:.ni tc,ti:Jn ,x:rsonncl may well recci vo their training in courses adnunistcrod by thuir own departmonts or related service institutes. Relevant advantilfes ilnd c\isadv2..ntares of university study arc siven below:
1.
Advantafos: Better physical facilities Better &.nd fullur instruction Better frlUndntion in broad arens of portinent sciunccs GruC'.ter uniformity of (Alucation Maintenance of hiiher oduc[:tional str.nJc.rds Butter identificatLm of com;)otuncy by th0 nwr.rd of ro co(ni~ed dq:,<rous 'Jr di;JloImls
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.
2.
Disadvantaros: Gruater cost of instruction, particulrrly if students nre faw Possibility of unrecdistic instruction Reduced contact of stuclonts with public during university attcnci.nce Pooror op;)ortunitios for field obsurvntion DofGrmcmt of JJr2cticc:l experience
Because the sci0nc8 [:nu pn:cticu of iJublic henlth C.re not static, it should be possible for personn"l in professionecl cradus to attond rGfreshor courSGS nnd speciclized courses offered f.)r this purposo from time to timu at universities tha.t arc staffed 1,11,( equiPiX:c' to this purposu. The group cemmcmlod co-oper2. ti vo in-s ervi CU trm ninL bGtwcun un1versities and dop2.rtmonts of hcalth with ufficient use of availnble fncil1tes and pers onnel. Where uni versi ties nre not amenablc to such c~n arrangemont, courses of instruction by the ckpc.rtmcnt of health or related departmunts were considerod preforable to uniVersity offurin[Cs. It was noted that co-oporative in-survicu traL,ing is successfully in effect in Australia, New Zeeland and Sin;~·a,)ore.
•
.. TABlE IV Eattetn-of· .. fotmal1zed In-Service Training in the Western Pacific Region Dept. of Public Health Country M.O.H. Category of Personnel Health San SaniHealth ~orks Eng. tarian Insp. or P.H. San. Overseer Dperator Agent Insp. X X"" X
University Special Disease Inspector San. M.O.H. Eng. ~ X*
Sanitarian or P.H. Insp.
Category of Personnel Health Health Works Insp. San. Operator Operator Agent
Special Disease Inspector
I
"ustralia Brunei :':ambodia China IF'iji ~ong Kong ~a~n ~orea "
~ )
x* X
X .
X
1960 X X
X X
X X
~
IMalaya New GuineaNew Zealand N. Borneo Papua and Trust Territory :Philippines X
X X X X X X X
(Malkria) X
lC X.,..
X
(M.-l!ria) X (Mafaria) (Ma~ria)
iX* [X-
X* X X
X X X
rx X* X X* X*
X""
r x* X
(Hyt!atid) (Mataria) X
X*
X*(Malaria)
x* X X
(scius"osomiasis and X Malaria) X X (Filariasis) X* X (Fi1ariasis) x* X
Eastern Samoa Singapore Tahiti Vietnam
X* X X X
X* X
I
x* (Mataria) x* x* x* There is no training of this type of personnel in the country itself. (Note) New Zealand, Australia, Singapore and China provide joint University and Department of Health Training •
------
-~-
..
--- - -
.~
..
_-----_.-
•
page 27
10. DEl1ONSTT-{;,TION, PRi,CTICE AND FI 10.1 Definitions
~W A?.&':S AS ADJUNCTS TO "bDUC1,TIUl! AND TRAINING PROGR;,MNCS FOR z:tNIRONI1T::NTj,L SANITATION PERSONNEL
The Seminar arrivud at the; f:)llowinc -:"finitie-ns: Dum'Jnstrc.tion ar"us= These aru areas th£.t are dcvuloped for the purpose of acquaintin[, students wi th cquipmunt, fncili ties, structules or procedures umployed in unvironm0ntal sanitc.tion work, incluuinr the application of now tochniques. Practice areas: These nre aru:s in which students are ~:iven tho op-,Jortunity of acquiring the practical kmwlodce and skills tlw.t are mieded in the Qxecution of environm... ntal S[:nitc.tion projects. Inspcctors, for examplo, would take )[:rt in mixinc concrete; laying pipe; stripping, repairing and assembline pumps; taking lovels, and other operative as well as administrative pr8.ctices. Field areas: These are areas in which students, towards the und of their training period, are required to perform by thems ... lves selected tasks directed to the actual improvement of somo aspect of smitation in the given environment.
10.2 Orcanization and progranme The Seminar was of tho opinion that these three ty:)OS should be available to tho teaching institution for uso at instruction and for all catecories of personnel. However, that this might not be possible in all Member Countries at time. of training areas all levols of it was realized tho prosont
Althouf'h it may bo convenient administro.tively for the instructicmal or training arcas te or~anize and administer tho training areas themselves, this was nc,t considorcd absolutely esscntial. Hcwuv0r, there should always be one member of tho tr~ining staff whoso duty it should bo to co-ordinato the work of tho teaching staff, with that of the local health department staff c.nd tho connnuni ty leaders in the manaf:umont .Jf these aree.s.
10.3
Churactcr of demonstration, practicu 1md fiGld aruas.
These areas should be of such nature as to satisfy the full range of subjoct matter included in the trcining IJroeranme. Thoy should be desiened not only to illustrate but also to runplify practical experience. DGmonstration of or participation in operationul techniques should bo follGwd by cri tical appraisnl of iJrovud and dosirocl pGrformancc. Generally speakinG, trcining aruas should have two objectives, n~mely: (1) initiation of trdnccs in correct practices emu (2) informntion of tho public in whc.t cun bo done to improv~ insc.nitary or advurse surroundings. This second objective h"s not Ctlwc.ys been achiGved. The Group felt, in particular, that Govcrnm"nt, ~)<Jssibly throW'h a hoalth education officer, should exploit the educutional values of thoSG creas to brinG health depart.. mont personnel und connnunity leaders tcGether for tho purpose of onlisting their co-operation in improvinr: the cnvirGnmunt in their own localities.
pace 28 10.4 Fincncing arr~:l1£cm~nts
In iJ.cLlition t.:; bein[ )roviC.cd wi th nC)8dc;d facili tics, dcmonstrL~tiun, prc:cticc. 2.11 ..: field c:.rGLS shoulr2 hiJ.ve an o~l~riJ.tinL budf,-,t thiJ.t 1full support effoctivuly rcsciJ.rch iJ.S wull 2.S thG r:lcvclopmcnt of now i:nd imprcved techniques of "r;vironmcntiJ.l siJJ1iktion. The Scmin::.r i:rou,J sucscsted that erants or subsidies mirht corne n·)t only from local 2uthori tics and cGntral govGrnmcnts but o.lso from internntional c;ccmciGs. lecti vi tics should not be allcwed to stagnate for Inck 8f cqui)lr.ccnt or quC'.lified leaccrs. 10.5 I%)ortanco of cvaluiJ.tion ane: follo-VI-up
The criticcll but constructivG cv::.lu<ltion OJf (.nvironm0ntc.l sani t2.tion projects has alwc.ys been difficult. Assessment of the cffectivcnoss of demonstration, practicG and fiGld aroas as adjuncts to thG training of environmuntal sanitation pc-rsormol is no excc)tion. Appraisal should be conc0rnvd: (1) with the traininG school itsclf tOGether 'lith its p.djunct areas; and (2) Hith the performiJ.ncu cf the student on his return to home cl.uty. A follow-up of the stuclc..,nt by the tr<lining staff itself will ic1cJ:.tify curricular content c:nd methed thiJ.t neeus stronGtheninE. Evaluation and follow-up by an external o.gcncy (G .G. officials of the health authority) will contribute the weight of imp~rtiali ty.
11. 11.1 Semino.rs
SEMINARS FOR SENIOR Pl':RSONNEL AND SHORT COURSES FOR OPE~RATING ffiRSONNJ~L
A seminar may bu conceived of as a moeting of persons for the pur~osu of defininc the status of aV2ilablo knowlcd::c anct techniques in a number of areas of specialized interest common to the particip<lnts by isolr,ting needed information, oxchanrinc ickas, and advo.ncing the understanding of importo.nt matters by freG and o;xm discussion. It is distinct, therefore, from a mcatinc that has been called to{,"ethor to ru:.ch acrc0mLmt on policy 2nd procoduro. Henco, tho "roup was c:nvinced tu, t seminars arc cxtremely useful educational devices attcnc!ccncc at which should not be confinod to senior personnel alone. Junior fradcs that mc.y wt)ll be included, medical health officer- medical officors of health; sccnitt,ry or :.lUblic health cncineers in hecalth departmc,nts or public works offices; sanitarians and health inspectors; works opcrc.tors; other scicntific (:nd technical pcrsonnul; and teachers of onvironmental ht)iJ.lth subjects. ·When a seminar in Gnvironme;ntg-,l sanitlltion is convened 0spccicdly for exucutive and policy-making reprosentc.tiv(.s of public hct'lth or quasi public hC21th agencies it may addruss i tsc.If tc t':lJi cs)f major interest to: Chief Medical Her,lth Officors, Chief Public ;·Jorks Officers; Senior Smitary or Public Hc.aIth Engineers; ChiGf 52nitllrin.ns or Principal Hwlth Inspectors; and Ii:bor:tcry lJiructors. Both junior Ilnd sunior lx.;rSc)nnel, it WetS held, could profit much by attcndllnce c.t timoly national [,nd intcrnc.tionll1 seminc.rs. Re~rc.sEJDtation at and objectives of international seminars at resionc.l or area levels directod to problems of cnvironmuntal heE'.lth sh"uld gonurally be multidisciplinary although there may be occasional major topics that arc of concern only to more spe;cific members of the profGssian. The Seminar
page 29 stressed thCJ.t the success of meetings of this kind depends upon tho care exerciS8d in their preparation and organization. A period of preparation of at least six months Ims su;~gestGd. A pre;;ident and a socretary should be appointed well in advance of this time in order to develop sui table agenda. They should continue in offico until follow-up procedures co:verinG recommendations made have been completed. A full-time Secretariat seemed to be a sine quo non for the ~ogion. 11.2 Refresher course
•
A ref;rashcr course; was definod as a rapid rivicw of accepted principles and retraininc in established muthods with tho addition or interpolation of newly revealed information and newly developed techniques. It appeared from available information that refresher courses held in the ReGion had so far been addressed only to the sanitarian or health inspector. It was recommended that suitable courses be arranged also for works operators, more especially those situated in areas where it is impractical to provide adequate technical supurvision. Tho normal method for maintaining and improving profeSSional standards tnrouGh professional societies and associations, it was felt, should not be supplanted by refresher courses, but international meetings were placed apart because of their impact on the gem,ral ,'Ielfare of the Region. Refresher courses for medical health officers and for sanitary or public health engineers were desirable both in specific fields of knowledge and specific geographical areas that are, as yet, not covered adequately by meetings of organized professional societies. 11.3 Auxiliary training
The Group defined" auxiliary trainingt1 as parti cipation in seminars and short courses as a normal part of in-service trainin?. Professional societies and universities are, in general, the only educational bodies competent to provide these educational experiences for medical health officers and sanitary enginefJrs. Govornrl1,mt d,'partmcnts and private industry anxious to organize auxiliary training programmes should enlist the assistance of universities and professional societies wherever possible. Subsidiary training of sub-profussional :;roups, such as junior health inspectors, assistant health inspectors and "lorks operators, should draw, in so far as practicable, upon portinont facilities of professional societies and universities including inten;sted teaching personnel. In general, wide variation in basic education of sub-professional personnel precludes full partiCipation by professional and university groups. 11.4 Evaluation of pro~rammes
t
The organizers of sennnars, refresher courses and subsidiary training programmes should be encouraged to evaluate their benefit to trainees by means of follow-up questionnaires sent to the trainees and, where applicable, to their superiors. LGadership should be looked for from successful public h08.1th administrators, practitioners and teachers who are engaged in field work or Who have boen ~opt in touch 'iIi th significant developments by observl'.tional tours.
page
30 12. ACCI-lEDITATION OF :.;r'lVIEONHSNTAL Sl\NITj~nON P~'"i:-;ONN]£L AT REGIONAL, NlI'1IONAL b.ND IN'rERNAT:;:ONAL LEV::;1S
The group was unanimous in voicin6 tho opinion th",t a dc-finite and positive valuos append to trF; accr(;ditation of onvironlil(;ntal sanitation personnel by a competent professional or technical socioty,vhich enjoys the respect of tho profession and tho public. Such accreditation will make for desirable recosnition of tho importLncc of vnvironmental health workers to organizod society, publication of rGquirud qualifications for the various categories of pursonncl, and '--,sta.bliEhm(nt of their status in government service in equitable comparison with other i,:ovormlOnt servants. Accredi tation schemes proscmtly in operation in the l.(.:;[;ion 'l-lOrO found to be neither uniform nor well defined. This app8ar8d to be true especially in reference to the sanitarian or inspectorial group. For modical officers of health and sanitary or public health engineers, accroditation was generally reported to be explicit enough when it takes the form of registration prescribed by law. Countries following the IIBritish System of Public Health Organization" have continued to recognize re~ional committees of the ~oyal Society of Heal th of Groat Britain, as thei.r accrodi ting authon ties. Minimum qualifications are established for well defined cateLorios of members, modified in some instances, to fit local conditions. Although the procedure of the Royal Society of Health could bUide the Region in establishing a useful accreditation scheme for all the Member Countries, variations in the organizational structure of public health aUGhorities appear to confine meaningful accreditation for the present to those countries that have allied their requirements to those of the Royal Soci~ty of Health. However, this should not preclude the ultimate dGvelepment of acclcptable regional accreditation espocially if it could be administered by WHO. The gr~up felt that professional associations should oncourage the development of acceptable accreditation schemes if necessary through support of sui table logisla tion. Unqualified individuals would then eventually be kllpt from usin;; accredited pyefessional designations and thereby obscuring their social significance and professional meaning. Such action of professional societies was believed to be in line with fundamental objectives of promoting the social and intellectual welfare of their members through dissemination of now information, discussion of improvod techniques~ pUblication of the results of current studies, and presentation of novel solutions to important problems in their field of compotencu. Several national publi c health associations exist in t he Region. It was agreed that these have been of ,;reat usc: in establishing a common
•
understanding of tho responsibilities of the various catobories of environmental sanitation workers even without the medium of accreditation. However, it was believod that a strong need for setting desirable minimum standards of performance remains to be satisfied.
•
•
page 31 13. CO-OPF,RATlmJ i.i'l()N'r GOVBmEl~NT AGE:NCIES OR D;;PJJ{?'.ENTS IN El';VIRONMt]llTAL C8NTROL
13.1 Need for co-operation and co-ordination It was agreed that formal co-orw.nation of all levels of environmental sanitation activities bt)tHoer. .:;ovornml;ntal dopartmonts or agencies is essential to their success. The form that this co-ordination should take must depend on factorb, such as tho uxisting political, economic and social development, tho complexity of the country's organization, its size and population don5ity, tho availability of trained staff and the nature and intensity of nu(;dcd public hualth efforts. For EJxample, co-ordination should be easier in small countries, such as Tahiti or North Borneo, than in large, complex and politically institutionalized countries, such as Japan and some British Commonwealth countries. Co-ordination should likewise be simpler under a competent urban authority than in a poorly organized and disparate rural aroa. Co-ordination of the efforts of several departments is often essential as bearing upon tho attainment of a single desirable goal. In school design and construction, for example, there should be formal liaison between the education, public health and public works services if a fully satisfactory building is to be evolved. Examples of work done by departments or agencies other than the health department but involving important consideration of environmental hYgiene are: Public Works Agencies: public water supply, sewerage, building and housing, irrigation and refuse disposal. Agriculture, Forestry and Veterinary Authorities: irrigation and vector control, use of insectiCides, herbicides and piscicides, milk production, meat inspection, examination and manuring of fish ponds and agricultural land. Educational Authorities: school desibn, siting and construction, sanitation of school premises, indoctrination of the school population in hygiene, and health oducation of teachers at teachers' trainin b centres. Town plpnning Agencies: zoning and duvclopment of town and regional plans with referonce to drainage, so-called sanitary lanes, land use, recroational areas, and air, libht and water availability. Industrial, Labor and 1'l..:lfare Authorities: factory hYgieno, safe disposal of industrial wastes-liquid, solid and gaseous, reduction of ocoupational hazards and workers housing. Recreation AGencies: accommodation in hotels, boarding houses, motels, camps, caravan sites; airport hygiene; strain imposed on water, sewerage and refuse disposal systems by influx of visitors; food hygiene.
page
32 fira "nd rOL~cl hazards, 3anitL~tion of places
Polica Depccrtmcntsl of detention.
Information DepCirtments: dissemination of hJalth ildormation and education of tho public in health. Community Devolopment j..utilori tic;:;;: ,I\ultidisciplinary undertaking that cannot hope to SUCCGod without full co-ordin&tion of substantially all agencius of governm,;nt.
13.2 Incentives for co-operation c.nd co-ordil1Lttion The group 2.c:reed that incentives to co-op"r:CcG for bottor Gnvironmental control arc numerous. To m()ntion only a fc.;w: bot kr health results in less occupational absenteoism; reduction of disease vectors increases agricultural output; rood health makes for gr'.cater progress in school; visitors are attracted to recreational areas with bood sanitation. Since the control of the total environment involvos many onGinoering activities, it should be clear that the s()rvicos of capable sanitary onfine0rs must be available Gither "rithin the hualth dGpartm..-nt itself, in t he public works agency, or in other purtin()nt authoritios.
13.3 Attainment of
co-op~ration
and co-ordination
Co-operation and co-ordination for environmental sanitation IrO best implemented by governmental decree. Sanitary laws should prescribe clearly and simply the responsibilities of the different agencies in the various areas of environmental sanitation. It is well to remember, however, that no matter what their legal status, health dupartmunts remain ethically, if not logally, responsible for evury type of disease outbreak. For this reason alone, they should be vested with adequate authority for discm:rging this responsibility. Although, co-cp',ration through informal or personal understanding has proved effective, especially where it derives from regular ofHcial interdepartmental meetinbs, such co-operation la cks the legal backing that alone can identify responsibility. Interdepartmental ri valries and the fear th2.t one Ec[ency may usurp some of the power of another often militate against the achi 0vcment ·of neuded co-opera ti on. Members of thc Seminar looked with some; nis,.ivings on the all too common deficiency of co-ordinc'.tion b'.otwe0n puLlic 'Narks and public health departments in the pl[mninG, des i~~n and opera ti on of sanitary works. It was suggested that tho absunco from some hSf.lth dcpartm"nts of personnel competent to examine plans and operations and to advise the works agencies on important sanitary implications of their constructions and operations was, in part, responsible for this situation; but also that the lack of appreciation of the health dcpartr::Gnts r responsibility for providing regulatory and advisory s:crvicps was a factor that contributed to noninclusion in health departments of sanitary vngineering personnel. The Seminar l·ms somewhat undecided as to the bost way in which sani tary or publi c hec:lth enGilll;ers could bo employed by governments to effect interagency co-operation in enginooring undertakings, but there was full agreemcDt. that such onrinecrs should indeed have a part in the sanitation of urban aroas. The feeling that it was difficult to distinguish between the duties of qualifiod public health 011bineers in public works and in publi c hual th dopartments and that it was undesirable to
.,
page 33 !
•
duplicate thc,ir functions in both ub cnci0S lims voiced by some memb0rs of the Seminar. Others 'fOre convinced, however, that sanitary cngine-Jrs are indeed indispensublc m"mb,>r0 ()J~ public hdllth teams both in the normal business of the henlth departm'_nt and in interpreting to fellow Gni,ineers in other departments of 60vernlnent thu huulth iraplicutions of their public undertakinGs. A further suu,;cstion was that, where enginGers are not employed by the hlAllth dC;JGrtrrlcnt, thu modical officer of health or his senior sanitarian miGht serve as co-ordinator or alternatively, that a public health or sanitary enbineer should be assi~ncd from tho works department to the public health dcpurtmc;nt for li~.ison duties in areas of common intcre;st. 1/+,
EDUCLTION 01" 'I'M ?UBLIC IN ';jlJVIRONMCNTilL HEALTH
14.1
Introduction
..
Education of thl: public in ccnvironmE.mtal hcu.lth, it is general acknowledged, should not be divorced from uducc,tion in general health and community development. The success of environmental sanitation programmes has indeed been found to vary with the degree of public participation which is best secured through the education of the people in all sibnificant aspects of health. Obviously the educational programmes that evolved for a given region must show an awareness of the established oducational, economic, cultural, psycholOGical and aruainistrative patterns of the area • 14.2 Indoctrination of profes@ onal brouPS in environmental health
It was the sense of the Seminar that all groups of people, professional and non-professional, who arc abll: to influ0nce the understanding, attitudes, and beliofs of th3 population amid which they work and live should be indoctrinated in the principles of environmental health. holigious leaders, agricultural extension workers, village headmen, natural community leaders, native healers and health workers who arc close to the people were considered to bo suitable categories as well as teachers, doctors, engineers, and government officials, who, by virtue of the importunce attached to their position in tho community and by their own competence command the respect of the people. School Teachers. The school toacher who gives basic training in health education, cem create a "health conscious" community by introducing now idoas, attitudes and beliefs to parents through their children. That goneration, in turn, will eventually :::ovcrn tho community that has been made healthier in this w~y. In this connection, the group concurred in the following WHO statement: tlIt is important that every effort should be made to inculcate in the childron durinG their school life, the proper appreciation of sanitary standD,rds both by tuaching in the classrooms and by day to day familiarity with good sani t(!ry practico and hubi ts throUf:;h the provision of the best possiblu installntions for thoir use". The group
*
WHO Technical Report Series No. 77, 2xpert Committoe on Environmental Sanitation, Third report.
page 34 felt esp"cially stl'on;;ly that s[.lni t,-,ry f[.lcili tios in the schools of undordeveloped arc.:J.s sl;ou1d norrn[:lly be better than those in the average homo. Doctors. The doctor-pdtient relatLmship provides unique opportunities for the hLalth educc,tion of many puop1e. j,ll doctors arc, in a sense, educators. Too often, hO\'kVGr, their efforts are ineffective bocause they are too busy, do not roalize their teachinG: pot·_ntiali ties, are unaware of the educational needs '.Jf tho in-pc:tiunts and uso inappropriate methods of instruction. Hore sp.,cJ.fic indoctrinr:tion of physici,-,ns in htJa1th education, particularly as rvlated to~nvironm,.nt1'.1 hGa1th, should, therefore, be attompted throughout the RCGion. Engineors. The cnginoer who is fully qunlifiod in water supply, sewerage disposal, ventilation, heating and the control of industrial hazards is well equipped to assist in tho health education of the public. Unawareness of the heillth implicntions of their works, on the othur hand may cause rome engineers to contribute h...;a1th hazards where none existed before. Examples are the pollution of water supplics by th~ improper location or sanitation of laborors' camps and the intreduction or resurgence of malaria through water stabnating in borroH pits cmd b0hind improperly drained road fills as Hell as in improperly constructed ",nd operatod water supply reservoirs. All engineers Should, in fact, be indoctrinated in environmental health sincle there are but few enLincoring undortakings that do not touch in somo 1"'i.'Y on human health und wellbeing. Government officials. The Udootrination of government officials, particularly those responsible for the il110cation of funds and the construction and mam:.gumcnt of public works, is ess0ntial if the aims, activities and problems of tho health abency arc to be clearly understood and if tho health ilLoncy is to receive its f':.ir share of financial support. Agricultural GxtL'nsion offic0rs, district officers, and police, can Hhen suitably indoctrinated in environmental health, ,-,lso be useful allies in educating the public. Doctors, teG.chors and ,;nsincL:rs should bo taUL;ht the principles of health cduc<.tion as an intq:ra1 pc:,rt of their undergraduate education. Past defects can be romeditjd by short formal courses for those in government service. Mcctincs o.f professional associations may afford a forum for the indoctrination of the others. EVury school inspection, whether by a medical officer, school nurse or health inspector should reinforce the knowledge of s choo1 teach,~rs. Government officials can be reached through short formal courses, meetings of interdepartmcnta1 committees, and personal briefings. Interest in environmental sanitation can be ~tintained by news bulletins, pamphlets and meetings describing progress. 14.3 Initiation of environmGnkl huc.lth programmes
.
•
RathGr than buing impos,;d from the ~'utsidc, environmental health programmos should issue from within a community because its people have become aware of their health ne~ds and the failinGS of their existing surroundings. The urge for better hcal th j·,ill norm2.11y stem from the
page 95 educational work of health agencies. That it may find expression in consonance with the social, economic, and cultural patterns of the community health agGncios must direct, assist, stimul2tG and co-ordinate emerging , environmental health progrnmrous with wisdom, forosight and realistic restraint. Only i.ith propur guidance can villa[e commi ttces be expeoted to movu community d0volopm0nt in tho properlircction at an efficient and timely rate of spuucl. !ihcre environmental health progrc:..'1lrIlus must como from the outsido, their introc;uction should be preceded by thorough stud.os of the habits and customs of th0 population. Cultural am~ health values of the people as well as their probable r<;action to possible programmes <.:nd methods of their communication must be explored. The help of social anthropologists and social psychologists lTlD.y h£.ve to be sought in some circumstances. Experienced field health workers may be able to provide required anSWerS in other, generally simpler, situations. It is a further ~uty of health agencies to promote and stimulate sanitation activities by introducing suitable legislation in Governing bodies, directing the attention of responsible authorities to existing unfavourable environmental health conditions and makinb themselves heard in meetings of inquiry boards and planning committees whose decisions may affect the h(,a1th of the people. If interdepartmental action fails to prevent or correct health hazards, the health agency is justified in appealinti moro directly to the people in ordor to create public demand for the prevention or remedy of tho hazards in question.
•
15.
PARTICIPATION BY llliLLTH FZRSONNEL IN PROMarIONAL ACTIVITIES FOR ENVIRONMENTAL Hf~LTH
By promotional activities for environmental health, the group understood, in particular, tho usc of ~ mass media to acquaint the public with existing conditions and needs for thair betterment. Participation by health personnel wes consiclered an essential clement in required publicity. The Group was of the opinion th~t some techniques would be more succ()ssful th2.n othGrs in the c('untries of the Region. Those techniques aro listed not neC8ssarily in orc~er of importance as follows: Radio and television broadcasts Press rGleases Publication of regulnr anu occasional bulletins Circule.tion of ecluc2tion motion pictures to theaters, schools and private groups Talka to citizens' counCils, service and other organizations and neighborhood groups Preparation of exhibits, posters and publication of advertisements
•
As previOUsly suggested, however, suitable instruction in personal hygiene and environmental sanitation in schools and teachers' colleges for transmission to school children is probub1y the most important component of a long range policy for the promotion of environmental health. In addition, grants, loans or subsidies in aiJ of needed works or efforts and
pagu 36
• offers of tcochnico.l o.ssiet2nc8 may bo useful inccntivas for community botterm.:nt. Propcrjnforccm"nt of s~nit2ry lnws nncl re;[;ulations, finally is tho h2.llmc.rk of good govc:rnmcnt. That it is essential to the proper implcJllt:ntation and central of sani tccion thst hualth dcpartments be represented on r,;;;ional anJ 10c21 ~lannins bacerds hc:s bGcn SU66estc:c! before. If ne cess<:lry, such represcnto.ti on should be meek me.nd(;tory by c.p~ropriate legislation. It was realized by th0 Somin2.r thilt this may ble 1l difficult matter in countries in which public heD.lt1:l sc-rvices ;:,ro rocsnt innovations and vestod interests oppose ch'.cn(;e. For Q(lrJ.nistrativc and technical staff with sufficiont experience, the group felt that short courses or similar instruction in plo.nninG, oJ\,'-iDizationiJl, admi.nistr2tive, and financing procedures would provido suito.bl,; j).rc_p2.ration for effcctive loadership in initiating, promoting nnd impl(;montinf; import~,nt sanitary projects; furthermore that th,; time has come for h(;cllth personnel to receive more intensive training in the prcctices, techniquos, and procedures of the art of public relations which hns boen so offectiv0 in promotional activi tios of the commercial ",nd industrial 1florld; and last but not least that a sound apprGciation of the legal process0S, status and implications of thc.ir work should bo inculcated in all health pEJJ:'sonnel. The co-oporation of non-l:;ovcrnm,;ntcl he£:lth, educational and othorwise interested ort;c:nizations should be sought as a normal purt of good public relations. Aid from these greups can be inval~~ble and may bo obtained by some of tho promotional techniques that have been enumerated before. A useful list may include tho followinb groups. Professional and technical groups: public health associations, sani tary and other engincEJring sociuties, health inspectors' Associations, waterworks and sewerago associations, medical societies, industrial hygiene associations, architectural sociGt1t;s, hoating and ventilation associations. Civic b~: citizens' councils, si)Ortsme;n I s luD.t,;uos, welfare organiz2.tions, womc:n' s clubs, veterans I groups, service orgc:nizations, such as tho Lions anc Rotary clubs, youth clubs, such as Boy 2.nd Girl Scouts. TradG and commercial groups: manuf2cturGrs' associations, agricultural sociutics, pest control associ;:tions, food and milk aSSOCiations, chambers of coronerce, Ec:ucatione.l groups: paront-t0c:chor associations, tClchors' organizations, health education associations, alUF~i associations of public health tue.ching institutions.
•
•
page 37
16 • • Th<J lollOTtlin;; conclusions 'Ncr" reaciled (hrin. the Jiscus[',ions:
1. Propcr sanit2.tion of the const,:ntly c~.n,-inl; u!lvirorun(mt !)lays a vital role in proventing discccce "end in promotin[ cood hO<llth; th0re is urt::ent need to provide properl" tr;;.ined c.ncl adequ::Lcly puid personnel to ensure that zooc! onvironrn£ntal ",,-1 ju['tmcnts ~re inst.L tuted and maintained. 2. The; outst<.<n(Q.nc sanitation neud of~hc Wr..c.tern P~\cifi.c ltC['.ion is the prOVision, ~lS soon as poc5ib18, of scfe ;::ncJ. cdequat" '.-later supplies to all communities, especially to thoso people livinr; in areas 1'loore piped water supplies are feasible. High priority should be given to programmes which will plan and provide these water supplies, preferably on a selfsupporting <:nQ self-liquid..\tinr: basis, and full adv&ntage should be tuken of technical and financicl assistance availablu from natio~l and international agencies in the country concerned.
3.
Thore is a serious shortat";e of qualified s[\nitary (public health) enGineers throu/Zhout the ",restern Pacific Re(2;ion and facilities for training are insuLicient. Sc:nitary engineers employed in public health departments should have the sc.me st~:tus ('md promotionul opportunities in his field as onLinecrs employed in other government at::enciGs.
Tbere is need to conserve water supplies c:nd to control pollution of wnter by human, animal or industri&l wastes. l'IGmbor countries should give earnest consideration to th.,se probloms 11lhich are cllrcady acute in countrios whure industrializution and urbanizi,tion have incruc:sod r~pidly in recent years, and should therefore cruatc or expand ac:encies with adequ"ltu lu;:;al, fincmcial und aclmini&trcctive powers to conserve water and to control the pollution of we.ters intended for human use including recreation. It i& of considerL:ble imj)ortance th2.t the public health D.c£ncy should be represented on water pollution control and WGter conservation boards.
4.
5. Member countries should not rGly on intcrm\tion&l Clf:encios exclusively to provide financic:l Gssist,:"nce to s[illi tation personnel who sh01t1.d undertuke postgr[·.dlXCte study, but should be willing to meet some or all the expenditures involved espueir.lly in intern1'.tiom:l study tours by senior sanitation officers. AdequcctL financiul assistDYlce should also be IJrovided to professional personnel to unriertak£ postgraduate study in public health.
6. Whure sani tury enrinocrs onf.c:ged in providing a public hco.lth engineerin€:: service (G.g. the pl<:mning i.:nd construction of water supply and sewerqi.f'o sorvices) Gre" omployod by a c:overnment aL~ency othur than tho health agency, thu chief officers of the uGcncies concerned should confer und f;nter into.::! form.::!l arran. Gmcnt Which i·,ill require close co-opuration between the a~uncius con corned ~nd which will provide aacb1nery for continuing co-operation and for settlement of any matters in dispute.
page 38
• The number of h82.1th (s2nit3.ry) ins'Jectors is not 3.dequute in 3.ny country in the 'lostern Pcccific Re[,ion c1lld there is urL(;nt need to improve their st[,tus :md tr3.ining in mc,ny countries. Nine yea's of schooling toccth,;r \'li th onc YCLT of 2.dequute full-tiJlC tr:'ininr:; should be rccarded as minimum que.lifie<:-tions thourh hii,her be.si,e G(luci~tion is desirc;ble. Member countries whose ne()de for more hoalth (s;c.nitury) inspoctors 2.re most pressinG should provide financic,l etsshi:,ccf1.cO to ,;nublo this tr2.ining to be undortaken.
7.
8.
All countries throuGhout the ':Jest-ern Pacific Rcr:ion should adopt at
least the minimum qunlifico.tions as S8t out in tho seminar report for the various categories of envirorunental scnit2tion personnel so that standardization throughout the Rq;ion may be facilitated. llJHO should explore the possibility of establishing, at tho 3.ppropriato time, a regional accreditation schome for health inspectors Trlhich would be acceptable to all Member countries. In most countries of thfJ Region thero is need to introduce adequate courses of trc:ining for operiltors of small water trei,tmunt plants, sewage treatment facilities and refuse disposal p12nts. Member countries should promote the establishment of such traininG courses and carry out training programmes for this category of personnGl.
9.
10. Member countries should be urged to promote r()se~rch into particular problems in environment[u sanitation which may be of importanoo to the state ooncerned. The excellent research work now being undertakan in China (T2iwan) and Japan, p3.rticularly in the: compostinG of excreta and refuse was considered. WHO or other appropriate Unitad N2,tions A,'ency should tako such steps as may be nGCeSsal~ to establish and conduct an abstrc.cting and trc:nslatin:,; scrv,ice in the rtcg],on so as to provide for the dissemination of information on environmc:nt~,l sanit2tion among Member countries. 11. It was noted that consultc:nts can be prnviclod by c:.ppropriate int&rnational agancies when their survices cere rcquest0d by 11 Mamber country which has a particuillr problem in environmcnkl hY"icne. Such a consultant can often givf: advice as to the most effective and economical method of solving difficult problems Lend it \,2,;:; felt that Member countries should utilize this servi ce mora frequently. 12. It was noted tmt the J~:pan "'c:cGI"Norks and Sewerage AS50ciution had sug[;ested the orcanization of an AsLm FCldeI'cction of Nc1tional\IIiaterworks and SewerG.Ge AssociatJ_ons. Tho value of such an international body ~vas roco&nizod cmd it was felt that WHO and }lcmber countries should rive active support to the form2,tion of such an org1:!nization. Individu<:~l countries 1"ho have not alre~dy done so should stimuillto the establishment of nation3.1 waterworks and sewerage associa tions. Member countries should also promote tho ostc:.blishment of national environmental sc:.nitation associE,tions which may later bo combined as an inter-country or Asian federation.
•
•
I
page 39 17. ACKNo.~L::.uG
,jl£:J)ITS
•
On tennirk~,tion of discussions the- pc.rticip(C.nts adopted tlJ0 following r<c;solutions: 1. Tlw m:..:mbors compricinu thc 3uuiinar cesir,,:
to congratukte th::; Japnnese Government for the very significant contnbution it ha" m;:lde to th0 :c:ucce-ss of -(,he sGJIlinftr. The liaison "'-nd admJnistrc.ti ve '"ork has b<.;en cnrried out in exemplary fashion by Japanese officors. wlLtl.st JC'.pc.neso scientific p0rsonnel (advisers c'.nd participants) have taken pc.rt in many intorosttns discussions Clnd demonstrntions: (b) to th&nk the Minister of H cd th nnd Nblfaro, the Governor of Tokyo-to, the Japan Watenrorks and Sew8raG8 Association, various ci vic and other organizations, <.nd indi viductls for their splendid cooperation r.nd hospitality: and (c) the manaRcmont and staff of the Asia Center of Japan for their assistance to the group and to the individual members who contributed to the smooth and efficient conduct of this seminar. 2. That the members here assembled desire also to thank the Director-General, World Health Organization and the Regional Director (HPR) for aut,horizing this seminar, which has been very successful, und to express their very warm appreciation of the considerable effort, skill, and time spent by officers of theloJestern Pacific Regional Office in organizing and condt".-;tj ng the seminar. The pc~rticipunts also wish to express their appreciation of the considerable contribution made by the seminar consultants who, through their broad knowledge and experience, were able to Guide the programme to a successful conclusion.
(c.)
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL OU PACIFIQUE OCOOENTAL
•
ORGANISATION MONDIALE DE LA SANtE
SEIITNAR ON 1J:.DUCATION A}!D TRAINING OF SA1FTL~ION !ElLClJNEL
APPENDI1. I WPR!BTSPIAc/4
4 Nov 59 ENGLISH ONLY
Tokyo, Japan 21 October - 5 November 1959
FINAL LIST OF SKIIN.i,R PARTICIPANTS, OBSERVEHS, AND "WHO STAFF PARTICIPM!TS Australia fiIr. Cyril E. FIOTN"er
Chief Hc<h In0pector Public Health Department Perth Dr. David "~i. Johnson Deputy Director, General He~lth and Medical Services, Queensland Brisbane
•
Brunei Towns
Dr. M.il. Roza11a Health Officer, Brunei State Brunei Town Dr. Pheng lianthel Chief, Nunicipal Hygiene Service Phnom Penh Mr. Tong ChunG 1:[u Teaching Asst of Environmental Sanitation National Tail-Tan Uni versi ty Taipei
Cambodia
China
r.tr. Dah Fong YunC Director, Institute of Taipei Fiji
~nvironmentn1
Sanitation
Dr. T.G. H,-,.ley Lecturer in Soci2.1 and Prevont.i ve Medicine Fiji School of Hedicine Suva Dr .Vlilliam H. HcDonuld De~uty Director, Medical Services Suva
•
\{ffi/ZTSP/AC/4 page :2 Dr. K.H. Black Health Officer Urban Sorvice Department Hong Kong Dr. Masahiro Goto Asst Chief, Plannin b Section, Public Health Bureau Ministry of Heolth and :Iv"elfare Tokyo Dr. Masami Hashimoto Chief, Department of Public Health Administration Institute of Public Health Tokyo Dr. Stngehisa Iwai Professor of Sanitary Engineering KYoto Univ~rsity !\voto Mr. Hi tsuo Kambayashi Asst Chief, Veterinary Sanitation Office, Food Sanitation Section, l/finistry of Health and Tokyo Mr. Yotaro Kobayashi Chief, Department of Architectural Health Institute of Public Hecllth Tokyo
Hong Kong
Japan
'~elfare
It
Dr. Takashi Kodama Director, Kanagawa Prefectural Public Health Laboratory Yokohama Hr. Taro Komoda Chief, Department of Public Health Pharmaceutics Institute of PuLlic Hoc: 1 th Tokyo Dr. Takeo Hatsui Chief, VetfJrinary Public Hecclth Institute of Public Hoalth Tokyo D()p~lrtm()nt
Dr. Tomihiro Numata Chief, Inspection and '(odent Control Section Tokyo Metropolitan Health Bureau Tokyo
6
•
I
.. Japan (cont'd) iIr. Flounio Chashi Dc)uty Chi c:f, ifatonJol'ki:; e'lid 8e;,I01'<.["e 8,: cti on l'li~istry of ;-1'-,,,1 th nnd!ielfc:re Q
'v'ffijeTSP/AC/4 page 3
Tok:yo
Dr. J.ldsc.t r) SaGo Asst Profc:.;sor, To[cyo i'1'Jtropolitan University Tokyo
Korea
Dr. ChenG Hak 1Ge Director of N:::.tional Health Seoul
C~ntre
l1e. Sun!! I\'yl.l Park Chief, Snnitation Sectien Ministry of Health and Social Affairs Seoul
Malaya
Dr. K. K. Beri Medical Officer of Health Rural Training School Jitra J:1r. Mohn. Hashim bin Abdul }T.s.lek Acting Chief Public Hoalth Inspectors Kuala Lumpur
4
N6therlands New Guinea
Dr. K. Biersteker Government Physician DepLrtmont of Hc::::.lth Hollandin Mr. John Knox Asst Director of Public W'orks Jesselton
North Borneo
Dr. Alnn J.B. Nicholson Deputy :')ire ctor of l!lcdi cc~l oervi cos Jcsselton
.. •
New Zea.land
Hr. Royle C. Lough Senior Designing Engineer Ministry of ',orks 1'lellin[;ton Dr. Hilliam Symes Regiona.l Modical Officer AdministrGltion of TPNG Port Moresby
Papoo & New Guinea
1~PR/ETSP/AC/4 page 4
• }tr. Nestor Lbaya
philippines
Training Project Enfineer Health Education <'.nd InfQrm<:tion Department of HUll th Mi:mila Dr. R. Les2.ca Professor o.nd Head Dep:lrtment of Puolic H;,.lch EnGineering Institute of Hy;iene, Univ0nity of the Pl1ilippine::; Manila Hr. Fernrndo M£i.nalolstas Sani tary~;ngineer M~\nila Health Department lifunila
Mr. Jesus Perlas Asst General Manager Ncctional W<,·c,urworks and SmV'erage Authority M£i.nil<'. Samoa Mr. Arthur B. McIntyre Chief Sanitariun Public Health Office PaLO Pago
Singapore
Thim Fat t Lye Public H,:o.lth i£nginccr Ministry of Health Singapore }tr.
Dr. Kr.h Honi; To.n Hu:,l th Officer Government Medical Sinc:apore Tahiti
Dep~Ttmcnt
Dr. hechel Tauzin Director of Public Health
Pap8ete Vietnam J~.
Nguyen Sy Tin Chief, Bureau of InsGct and Rodont Control Public Health Service Saigon
Hr. Due Hoang Tai Chief, Bure<~u of 1:kter, Foodstuff and Housing Control Department of Health Saigon
• OBS~B.VEns
WPR/ETSP/AC/4 page 5
China
l·!fr. Cbin Yuan Chu<:ng Senior Encinocr Tilhmn Im.tituto of ':'::nvironmental Sanitation T<'.ipei
lCA/China
rvrr. Joel 1. Connolly S&nitary Encineer Taipei Dr. Hideo Toyoda Office of the Scientific At'cache Embassy of the United St2.tes Tokyo l~.
Japan
ICA/Korea
P.A. Stephens Sanitary Engineer USOM
New Zealand
1'11:'. T.W. Adams Principal Inspector of Health Department of HGalth ~vellington
North Borneo
•
Mt-. C.P. Jayasuriya Asst. Engineer, li'o.tcr Section Public Works Department Jesselton Dr. Albert Talboys Sanitary Enr;'ineer
lCA/Philippines
Manila lCA/Thailand
Mt-. Alexander A. Robertson Sanitarian Cholburi Lt. Vladimir Sulevich Chief, Hygiene 2nd Sanitation Section Seoul Army Command Capt. Robert Shaw Sanitary Engineer 8th US Army Seoul
U.S. Army
U.S. Navy
Mt-. K. Y. Fr<mcis 1m Sanitary En~ineer Bureau of Yards & Docks Honolulu
1-1PRjETSPJACj4 pag e 6
• l·mo STJ,FF
}1r . Pau l Bie rst ein - Dl. Toc tor of Sem ina r WHO Re gio nal iw vis er on :::r .vir onm ent ul San i tut ion Nb. nila }1r . C. ChayLbon~> s e villO San i car y ,{;;EC:'cno or Sai gon
Pro f. Gor don H. F& ir Pro fes cor of En cin cer inG H2 rva rd Univer si.t y Cam brid ge, Ma ss.
Mr. Ko rok uro Hir ose En gin eer ing Dc pur tme nt Tokyo Un ive rsi ty Tokyo Dr. Isa mu Hor usa wa Ch ief , De pnr tme nt of Sa nit ary Enc ;ine erin g Ins titu te of Pu bli c Hce .lth Tok yo Pro f. C.Vl. Kru se As soc iat e Pro fes sor of Sn nit ary En t;in eer ing Joh ns Ho pki ns Un ive rsi ty Ba ltim ore , Har ylr.n d ~1r. Ge rar d l1u rph y WHO San i tnr ian Ma nila a
Mr. J. Sch elle nbe rg HHO Tr an skt or Ha nil a Mr. Alf red Sm yth e WHO San i tLl~ Bn cin c or Tai wan
Dr. A.Q.Y. Tom WHO Sa nit ary Engin~cr Ma nila
•
WORLD HEALTH ORGANIZATION
ORGANISAnON MONDIALE DE LA SANrE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL OU PACIFIQUE OCGOENTAL
SEHINLR ON IillUCl,TION AND TRAINING OF Sl,NITATION IERSONNEL Tokyo, Japan 21 October - 5 November 1959
APPENDIX II WPR;ETSP/11 c/l 5A 20 oct 1959 ENGLISH/FRENCH
TOPICS FOR DISCUSSION GROUPS 1.
Environmental Health Problems in the Western Pacific Region of WHO Impact of increasing populations, urbanization, and industrialization Importance of agricultural activities and rural areas Effect of competition for water - industrial, domestic, and irrigation Leader: Bierstein I I
2.
Availability and Extent of Training of Environmental Sanitation PersOlmel Available personnel by categories Health Officers Engineers Engineering Assistants Basic Science Personnel Health Inspectors Works Operators Definition of duties by categories Personnel needs in all categories, present and future Loader: Tom
II
•
3.
utilization of Personnel Organizations of environmental sanitation services Ratios of personnel of Qll categories to population Demand for services Status, incentives and conditions of omployment Leader: McDonald
- 2 -
4.
Educat20n
•
"(0
and Tra2n2ng
•
•
~h~
Ope rat2 ons
.
Existing facilities Need fer new facilities Possible regional centrLlization or decentralization of these facilities L(.uder: Lesaca
5.
Research, Development and DemonstrLtion Existing and needed operations in those three categories Needs for better fa ci li tics Support by privo:te .frmnctations, industri<.,l, national end international government. Provision of opportunities for exchange of personnel, library material and films. Desirability of regional translation and abstract service List of pressing res,arch problems that await solution Leader: Iwai
6.
EstablishmAnt of Priorities in Training and Education for Specific Aspects of Environmental Control and Methods for Satisfying These Priorities Should priorities be determined on a regional, sub-regional or country basis? What are the needs for specialized knowledge and how can they be met? Should piped water supply be given top priority in the Western Pacific Region of 1.rHO Luedel': Biersteker
..
7.
Co-operation Among Government j,gencies or Departments in Environmental Control What co-ordination is needed among public -,1fQrks, public health, community development, agriculture, oducation, tourism and industry? What incentives exist for co-operation? If they do not exist, how can they be promoted? 1c2.derc Knox
*
Education operations are understood to include lecture, laboratory and library activities
~~ Training operations are understood to includo practical and manipul[~tivo instruction and obsorvations. l
I I !
,
.. 8.
- 3 Participation by Health P0rsonnel in Promotional Activities for Environmental Hoalth Promotional techniques that are or might be utilized in promoting environmental health works. Inclusion of health personnel in regional and local planning activities Needed educational propar<,tion for administrative plmming and lecal and financial organization of environmental health projects Enlisting the co-oper[,tion of private health and educational organizations Leader, Lough
9.
Content of Educational and Training Programraes of Study for Environmental Sanitation Personnel Basic and specialized training for each category of personnel What types of educational institute or institutions should be developed for this purpose? Leader: Kruse
10.
Seminars for Senior Personnel and Short Courses for Operating Personnel Seminars for senior, executive and policy making personnel including administrative department heads, etc. Refresher courses for personnel at all levels Participation by professional societies and universities in auxiliary training Evaluatil"):1 ·-f t,he various programmes Role of WHO as catalyst Leader: Manalastas
..
11.
Education of the Public in Environmental Health Indoctrination of profGssional groups such as teachers, doctors, engineors and government officials Who should take tho lead in gaining conununi tJ support for environmental sanitation proj~cts? What is the role of the health agencies in promotion and stimulation of sanitation programmes? Loader: Bla ck
12.
Evaluation of Oversees vs Local and Regional Training Advantages and disadvantagos Value of intra- and intcr- regional observation tours Value of faculty exchan8e programmes Leader: Talboys
- 4 -
13.
Accreditation of Envirorunontul Sanitation Personnel at Regional, National and International Levels Value and availability Importunce of professional societies Value of unions, guilds, and similar associations
•
.
14.
Formalized In-8orvicc Training under Health l,uthorities vs Programmes in Uni versi ties Pattorn in tho Region Advantages and Disadvantages Loader: Robertson
15.
Demonstration and Practice Centers and Field Aroas as Adjuncts to Education and Training Programmes of Environmental Sanitation Personnel Organization and programme Character of demonstration areas Evaluation of importance Leader: Lee
t
WORLD HEALTH ORGANIZAnON
ORGANISATION MONDIALE DE LA SANtE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL ~-
APpmnrx III SE1HNAR ON EDUCATION AND WPR/ES/ETSP / AO/ 6(Rev .1)
TRAINING OF SANITATION PERSONNEL Tokyo, Japan 21 October - 5 Novemb€~
23 Oct 59 ENGLI SH/FRENCH SEMINAR SCHEDULE
1959
21 Ocwber 1959 - Wednesday 0900 - 1000 1000 - 1030 1030 - 1100 Orientati~n:
Mr. Paul Bierstein
Opening Cerem"nies Official Grcup photograph Orientation ( continued ) and election o-r officers. Luncheon perifld Intr~uctory
llOO - 1200
..
1200 - 1400 1400 - 1630 1700 - 2030
lectures:
Prflfessors Fair and
Krus~
Minister ,.,f Health's Reception - bus leaves A.ia Center 1700 returns at 2030 22 October 1959 - Thursday Phmary Session: Discussion rf Working Papers Luncheon period Plenary Sessi~n:
0900 - 1200 1200 - 1300 1300 - 1600
Discussion of Country Reports
No evening programme 23 October 1959 - Friday 0900 - 1200 1200 - 1.300 1.300 - 11,Q0 1630 - 1800 Discussion Groups: luncheon peried Discussion Groups: Film Showing Continue first series of t"'pica Initiate first series of topic. (1-5)
-2-
24 October 1959 - S'l.turda,'T 0830 - 0945 F].onar.)" Session: P1Gnil.ry .:)cs,;ion: Discussion Group.,; submit reports Discussion of Country reports Dise 1.!Ssion of Working papers Cum:!L,-(:u lll'st series of topics,
0145 - 1100 1100 - 1230
BaLmce of . i'ternoon and evening - no programme
25 October 1959 - SundaY No prog;ramme
26 October 1959 0900 -JA)O
-,Mond~v
Discussion Groups: Luncheon period
I::U.t.;i,.a.te S€riooi:i " topics (6-10)
1200 - DOO DOO - 1700
Field Trip "A" to Tallyo CQc.postingP1ant. and SWlamacbi NiiShtsail. TN<.l.tawnt Plant - about 4 hours No even:i.o.?; programm.e
0900 - 1200 12:)0 - 1300
Discussion groups: Luncheon period Discussion groups: submi t reports Discussion groups:
Continu.e Series 2 topics
1300- 1430 1430 - 1600 1630 - 1800
COii1.y1ete Serie s 2 topics, Init.iate Ssries
J topics
28 October 1959 0900 - 1200
~l..dnesday
PlonCll'Y Scs:sion: Series 1 topics Luncheen period Discussion Groups:
Discl.Wsion of Reports on
1200 - DOO 1300 - 1600 1730 - 2030
Continue Series
J topics
Official Social En"~,,~e.'!lent Reception by the Japen ·iiutor-lWrJr..s and S;;r:er(;.~~e association - bus leaves Asia Center at 1730 and returns
•
at 1030.
-
3 -
29 October 1959 - Thursdav 0800 - 1700 All d"Y fielcl trip3. Trio alternatives will be offered.
Field Trip "B" to Yokohan.a. slaughter hruse, Kirin brewery and Kawasaki night soil tre6.tnent plantaboo t 9 hours FieJd Trip 110" tc i'Jagasawa water treatrent plant, Ebara Infilco Mfg Co and Nippon Ircn vorks about 9 hours
30
October 1959 - Friday Discussion Graup3: submit repor ts Luncheon psricxi Plenary Session: Series 2 topics Plenary Session.: Series :2 topics Discussion of reports on Discussicn of reports on Complete Series 3 topics,
0900 - 12)0 )200-1300 ]300 - 1430 1430 - 1530 1545 - 1700 1730 - 20.00
Film showing Reception by Governor of Tokyo - bus leaves Asia Center at 1730 ani returns at ~O'
.. 0830 - 1030 1030 - 1230
31 Octo ber 1959 - Sa tur day Plenary Session: Series 2 topics P1emry Session: :in terest Dis cuss ion of reports on DJoicussion of item of spacial
1 November 1959 - Suni av No prograrrune
2 November 1959
-
Molld~:;'
;.
V1sn·~to Hakone
j ~ber ..l959 .. Tuesday 0900 - 1200 1200 - ]300 ]300 - 1600 Plenary Session: Series 3 topics Luncheon p3
Discussion of reports on
riod Dis cussion of reports on too plemr y lIB etings at which S;:;ries 1 and Scies 2 topics were ccns:idered
Plenary Session:
1630 - 1800
Film showing
4
..
4 November 1959 - WednesdaY 0900 - 1030 1030 - 1200
Plenary S;3ssim: Ss-r.bs 3 topics
Dis eli sairn of reports on
P1:>mry Session: Coo tinu;d dis OJ. ssim of reports on plemry llB8Ungs at whieh Series 1 and Series 2 topics were dis cussed Luncheon j:B riod
1200 - J3 CO ]300 - 1730
Field trip "D" to Morimga Milk Prosessing Plant and Jap9.n W.:o.tervorks and Sewerage Ass o cia tim abcut 4 1/2 hours
5 November 1959 - Thursday (]100 - 1200 1200 - ]300
Plenary Session: Dis cussim of ro ports on plenarymeetings at which Series 3 topics were disrussed. Luncheon j:B
riod
DOD - 1600
Pl .• mry Session: Prcp:l.ration of resolutions, recommendation s, Se.Qlimr evaha tions, etc.
•