ninth annual report - world health organization
TRANSCRIPT
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC
TENTH SESSION
NINTH ANNUAL REPORT OF
TH E REGIONAL DIRECTOR (1 July 1958 - 30 June 1959)
TO THE
WP/RC10/2
/
REGIONAL COMMITTEE FOR THE WESTERN PACIFIC
NINrH ANNUAL REFORI'
OF
THE REGIONAL DIREOl'OR
(1 July 1958 - 30 June 1959)
World Health Organization
Western Pacific Regional Office
V£D11a, Philippines
July, 1959
WP/RC10/2
1
2
3
4
5
6
1
2
CONTENTS
PARr I. GENERAL
INl'RODUCl'ION ................................................... THE REGIONAL COMMI'l"l'EE · ....................................... . REGIONAL OFFICE ................................................
General ................................... ~ ............. . Organizational structure and area representatives ........ Regional office staff •••••••••••••••••••••••••••••••••••• Project staff ............................................
AGREEMENTS" WITH GOVERNMENTS ••••••••••••••••••••••••••••••••••••
CO-ORDINATION OF WORK WITH mHER ORGANIZATIONS ................. The United Nations and the ~ecial1zed agencies •••••••••• With other intergovernmental organizations •••••••••••••••
5.2.1 5.2.2
South Pacific COmmission ••••••••••••••••••••••••• Colombo Plan •••••••••••••••••••••••••••••••••••••
With non-governmental organizations ...................... other jOint work · ....................................... .
PUBUC INFORMATION ............................................. 6.1 6.2 6.3
General •.••••.•••••••••••••••.•••.••••••••...•••••••••••• World Health Day celebrations ............................ other activities · ....................................... .
PARr II. GENERAL srATEMENT OF ACrIVITIES IN THE REGION
PUBUC HEAI1rH SERVICES · ....................................... . 1.1
1.2 1.3 1.4 1.5 1.6 1.7 1.8
Assistance to governments in developing and strengthening their health services .................. Maternal and Child Health ................................ N'Ul'sing •••••••••••••••••••••••••••••••••••••••••••••••••• EnVironmental Sanitation ................................. Health Education ••••••.•••••••••••••• ~ •••.•.••••••••••••• ............................................ Mental Health statistics ............................................... Programme analysis and evaluation ••••••••••••••••••••••••
EDlJCATION .ANI) TRAINING •••••••••••••••••••••••••••••••••••••••••
2.1 2.2
Assistance to educational institutions ................... Fellowships ..............................................
i
1
4
5
5 5 5 6
6
6
6 7
7 8
8 8
9
9 9 9
11
11 14 15 16 17 18 19 20
21
21 23
4
CONI'ENTS
COMMUNICABIE DISEASES ..........................................
3.4
Malaria .................................................. . Tuberculosis and BeG ••••••••••••••••••••••••••••••••••••• Venereal Diseases and Treponematoses •••••••••••••••••••••
3.3.1 3.3.2
Yaws ••••••••••••••••••••••••••••••••••••••••••••• Venereal Diseases ••••••••••••••••••••••••••••••••
Other Communicable Diseases ••••••••••••••••••••••••••••••
3.4.1 3.4.2 3.4.3 3.4.4
I.eprosy •••••••••••••••••••••••••••••••••••••••••• Stnal.lpox ••••••••••••••••••••••••••••••••••••••••• Trach.oma ••••••••••••••••••••••••••••••••••••••••• Clonorchiasis and paragonimiasis •••••••••••••••••
AorIVITIES OF THE EPIDEMLOLOGICAL IN.CELLIGENCE srATION •••••••••
PARr III. SPECIAL EVAWATION SUMMARIES
~
24
24 26 27
27 29
29
29 30 31 32
32
Projects completed during the period under review.................. 36
PARI' IV. PROJEOI' Us:r
Projects in operation from 1 July 1958 to 30 June 1959 ••••••••••••• 45
ANNEXES
1 Us:r OF REGIONAL OFFICE posrs •••••••••••••••••••••••••••••••••• 87
2 CONST.Jl:frANTS EMPLOYED DURING THE YEAR •••••••••••••••••••••••••••
:; PROJEar~ REGIONAL OFFICE INTERNATIONAL srAFF EMPLOYED AS OF 30 JUNE 1959 •••••••••••••••••••••••••••••••••••• 91
4
5
6
7
GEOGRAPHICAL msrRIBurloN OF INrERNATIONAL STAFF •••••••••••••••
usr OF SUPPIEMENTARY AGREEME:NrS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULy 1958 TO 30 JUNE 1959 ••••••••••••••••••
DISTRIBtY.rION OF VISITS III ACCORDANCE WITH COUNTRY OF erUDY fJ\1D l\i!!GIONS •••••••••.•••••••••••••••••••••••••••••••••••••
FELUJWSHIP AWARDS ACCORDING TO FIELDS OF SJ:.IUDY lill]) COUNTRIES OF ORIGIN - 1 JULY 1958 TO 30 JUNE 1959 ••••••••••••••••••••••••
ii
93
95
97
99
PAm I. GENERAL
1 IMRODUOI'ION
The general policy of strengthening public health administrations was maintained during the period under review with main emphasis on the training of all categories of health personnel, the control of communicable diseases, the development of specific services such as maternal and child health and nursing, and the stimulation of enviromnental sanitation programmes.
A study of this report will show that there have been a number of developments during the period under review. Progress assessment of current projects has resulted in the withdrawal of international personnel from five WHO-assisted projects: the yaws control project in Laos, the nursing education projects in Japan and Malaya, the midwifery project in the Philippines and the exchange programme between the London School of Tropical Medicine and Hygiene and the University of Malaya. Special short evaluation reports on these projects are to be found in Part III.
Considerable progress has been made in the field of malaria eradication and during the period under review the programme has been considerably expanded as a result of the additional funds provided by the Malaria Eradication Special Account. As requested by the Regional Committee at previous sessions a training course in malaria eradication techniques for all categories of personnel has been established at the Institute of Malariology, Tala, Philippines with the assistance of the United States International Cooperation Administration (ICA) and WHO. steps are also being taken to establish a training course in the French language. It is hoped that all Member Countries in the Region embarking on malaria control or eradication programmes will take advantage of the regional facilities now offered.
The projects in the major yaws endemic areas have continued to progress towards the complete control of the disease and in the remaining areas appropriate projects were started or planned. The emphasis on eradication of the disease coupled with the development of improved rural health services was continued.
The trend towards integrated public health services has continued to make progress. steps are also being taken to establish or strengthen rural health services. These developments are particularly important because many of them are occurring in countries where progress has been hampered by unsettled conditions, shortage of medical and auxiliary staff and lack of funds. However, it must be realized that the extent to which rural health services can be developed in areas where a subsistence economy predominates in many districts, cannot as yet be fully assessed. At this stage rural health services in such areas need to be developed mainly as pilot projects designed to give a sound basis for advice to govermnents on the extension of their programmes.
Quite considerable progress has been made in the bilharziasis project in the Philippines. One of the main purposes of this project is the systematic development of efficient procedures and methods for bilharziasis control. Techniques for determining base-line data from which to measure future progress and methods of evaluating the public health significance of bilharziasis have also to be worked out. After a number of years of
/investigation ", ••
wr/rl.v.J.U/c. 'page 2
investigation spent on testing workable control measures, the period under review saw the assessment of the results achieved so far. The integration of bilharziasis control into the total health programme of the local services will be tried out on a conununi ty-wide basis in three municipalities in Leyte. The results obtained will be assessed after two years and it is hoped they will provide sufficient information to develop a national programme.
Of special interest in the field of environmental sanitation has been the continued interest shown by Member Governments in the possibilities of compo sting of municipal refuse and night-soil for the production of a hygienic compost for utilization by farmers. This activity which was given impetus by the First Zonal Seminar on the Collection, Disposal and utilization of Organic Wastes held in Taiwan in October/November 1956, has grown to a point where a number of countries have not only completed pilotcompo sting plants but are installing or have installed full-scale plants.
Interest in vital and health statistics has continued to grow and a number of governments have notified the Regional Office of their wish to participate in the proposed regional seminar in 1960. The hospital records project in Singapore is developing into a medical statistics project which has as its direct objective the improvement of vital and health statistics throughout Singa.pore. A project which is designed to reorganize and strengthen the statistical services of the Government at local, provincial and national levels is expected to start early in 1960 in Viet Nam.
The advantages of inter-country programmes have been emphasized by the Regional Committee on a number of occasions and seven such programmes were arranged in the Region during the period under review: a dental health seminar, a seminar on veterinary public health, a tuberculosis refresher course, a ' conference on maternity and child care, a leprosy conference (organized by Headquarters), a seminar on mental health and family life and an inter-regional yaws control co-ordination meeting.
The second dental health seminar which was held in Australia gave new stimulus to workers in this field. Its impact is not, however, limited to the Western Pacific Region but will have a global effect as a result of the decision of the International Journal of Dental Health to publish the seminar report in full.
The seminar on veterinary public health was the first of its kind to be arranged in the Region. PartiCipants discussed the inter-relationship of human and animal health and disease, control of food products of animal. origin of importance in the transmission of the disease, veterinary public health organization and practice, including collaboration between medical, veterinary, sanitary and allied disciplines.
The other inter-country programmes are discussed in the pertinent sections of the report and summaries of all the meetings are to be found in Part IV.
I should like to take this opportunity to thank the Governments of Australia, Fiji, Japan, Federation of Malaya and the Philippines, not only for acting as hosts, but for the assistance they gave in the way of accommodation, staff, transportation and the many arrangements they made to facilitate the organization of such meetings.
Despite the encouraging developments in the period under review major ::o .... ob1 e ms remain much the same. Lack of effective administration and
~ /delegsted supervision '-
...
WF7ro;~Uf"l:!
page 3
delegated supe~s~on due, not only to non-availability of personnel but also to economic factors, limit the willingness of doctors to undertake full-time government work. The attention of governments is drawn to this fact .as in some areas the position is serious enough to threaten the success of such vast undertakings as malaria eradication. The change over from malaria control to eradication is placing a heavy load on all governments in terms of money and personnel, particularly in the higher echelons, and if the programme is to be carried through to a successful conclusion, the fullest co-operation and support of all government departments involved in the programme are essential.
The problem of long-term financing mentioned in my last contribution is still no nearer solution. Attention is drawn to the danger of too much reliance on Foreign Aid as this may lead to the development of programmes which the countries can hardly hope to continue. It is felt that more intensive examination or discussion of the situation in the countries as a whole, either between agencies, or between governments and agencies, might prevent this situation from arising.
With the appointment of area representatives more information is available on the long-range plans of countries and in certain areas the governments are increasingly seeking advice on the formulation of their health programmes. It is hoped that this trend will continue and that an ever-growing number of governments will provide the Organization with infoDmation on their long-term health planning, so that this m~ be fully discussed, and when requested to aSSist, the advice given will be realistically based on the primary needs of the countries concerned.
In Part II will be found a general statement of activities in the Region during the period under review where the points I have mentioned are described in further detail.
/ ~
I. I:
Regional Director /'
/2 THE REGIONAL •••
wr/rl'vJ..U/c. page 4
2 THE REGIONAL COMMITTEE
The ninth session of the Regional Committee for the Western Pacific was held in Manila from 26 September to 2 October 1958 in the new Conference Hall, which was formally opened by His Excellency the President of the Republic of the Philippines.
The meeting was attended by repre sent ati ves of all Member States in the Region, and of the Governments of France, the Netherlands, Portugal, the United Kingdom of Great Britain and Northern Ireland, and the United States of America, responsible for territories in the Region. Representatives of the United Nations, UNICEF, the Technical Assistance Board, the South Pacific COmmission, the International Committee of Military Medicine and Pharmacy and of fourteen non-governmental organizations in official relationship with WHO, "rare also present. The Assistant Director-General, Advisory Services attended the meeting.
The Committee noted with satisfaction the progress made in health work in the Region, that interest in comprehensive rather than specialized programmes was grOwing, and that a preliminary evaluation of fellowships awarded under the education and training programme had been made.
The Committee noted the close co-operation with other agencies working in the field of health. It reiterated the importance of association in a project of more than one international organization and expressed the hope that this co-operation would continue.
The programme and budget proposals for the Western Pacific Region in 1960 were considered by the Sub-Committee on Programme and Budget and further discussed in plenary session. Broad priorities recommended by the Committee at previous sessions were reviewed and a new list established which included some of the earlier priorities and some that had developed in recent years. The Committee noted with satisfaction the proposed programme for malaria eradication.
The Committee noted the decisions and practical measures recommended by the Eleventh World Health Assembly for the eradication of smallpox, and the Regional Director was requested to assist governments that asked for advice on planning and executing smallpox programmes and to report to the next meeting of the Regional Committee on the action taken, the difficulties and problems met and the results obtained.
Special field visits were arranged by courtesy of the Philippine Government to institutes, demonstration and training centres, and community development programmes in and around Manila. The possibility of similar visits at future sessions of the Committee was conSidered, and it was agreed that the Regional Director should discuss this matter with the government concerned and that the visits should be arranged, whenever pOSSible, during rather than follOwing the session.
The technical discussions, on malaria eradication, occupied three sessions. The chief points raised were the importance of health education; training courses and security of employment for the malaria eradication staff; the initial prOvision of a special malaria eradication division, which could later be merged with the general public health service; and the possible difficulty of maintaining public interest as eradication was approached. It was suggested that emphasis on the social and economic benefits of eradication might assist in raising funds from a variety of sources.
)The topic selected •••
WP/RCIO/2 page 5
The topic selected for the tenth session was liThe control of tuberculosis".
The tenth session of the Committee will be held in Taipei, China and the eleventh in Manila.
3 REGIONAL OFFICE
3.1 General
The new building to house the Regional Office for the Western Pacific was finally completed in February 1959. It acconnnodates the entire staff of the Regional Office, the offices of the UNICEF and United Nations Technical Assistance Resident Representatives in the Philippines and the United Nations Information Office.
The Conference Hall is independent of the main office building and is able to acconnnodate about 200 people. It was fini shed in time to be used by the Regional Committee during its ninth session and at the request of FAO and ILO was lent for two conferences organized by those agencies. Its use will be limited to meetings of the United Nations agencies and international meetings of non-governmental organizations which have official relations with WHO. .
Plans are being made for a visitors I programme which will permit the public, especially school children, to have a guided tour through the building with talks on United Nations and WHO activities.
3.2 Organizational structure and area representatives
There has been no change in the organizational structure of the Regional Office or in the number of area representatives as approved for 1959. The appointment of an area representative for China, Hong Kong, Japan, Korea, Macau, Guam and the Trust Territories of the Pacific Islands means that for the first t:iJne all areas of the Region are now covered. The duty station of the new area representative is in Taipei. The post was filled by the reassignment of the former WHO Medical Adviser to the UNICEF Asia Regional Office.
3.3 Regional office staff
The rapid expansion of the programme under the Malaria Eradication Special Account has resulted in an increased work-load at all levels of the Regional Office. However, as a result of the ~olicy to integrate malaria eradication activities with the normal vlOrk of the Regional Office, the situation has been kept well under control by the additional staff financed under the Special Account.
With the transfer of the Regional Adviser in Tuberculosis to the area representative post in Sydney, the two positions of regional adviser in tuberculosis and regional adviser in venereal diseases and treponematoses were combined, and a post established entitled regional adviser in connnunicable diseases. This post has been filled by the former Adviser in Venereal Diseases and Treponematoses and as a result of the vacant post thus created, it is hoped to recruit a regional adviser in nutrition before the end of the year.
/3.4 Project •••
W.I:"/!'t.IJJ.U/c page 6
3.4 Project staff
Because of the increasing financial assistance given by WHO to some of the malaria eradication projects it became necessary to establish the post of administration officer. The holder of this post will be assigned to malaria projects to advise governments on administrative and financial matters connected with the eradication programme. It is expected that an assignment suCh as this will ensure effective operation of the projects.
Although there has been some improvement in the accommodation provided for project staff in the Region in the past year, much still remains to be done. Some of the facilities vTere found to be totally inadequate and in certain cases no accommodation could be provided with the result that there was del~ in implementing the project. Since this problem is of vital importance to the implementation of the planned projects and the efficiency and personal welfare of the field staff, greater attention will be given to the improvement of the situation in co-operation with the governments concerned.
Annexes 1 - 4 give detailed information on the staffing pattern in the Region.
4 AGREEMENrS WITH GOVERNMENr S
Supplementary agreements relating to plans of operation for twenty-four projects were signed during the period under review. Eleven of these were projects for WhiCh assistance in the form of equipment and supplies is being given by UNICEF. A list of the agreements is given in Annex 5.
5 CO-ORDINATION OF WORK vliTH Ol'HER ORGANIZArIONS I\-
The work of the Regional Office during the period under review has again included continuous and varied collaboration with representatives of the United Nations, the specialized agencies and other organizations, intergovernmental and non-governmental. The present section of the report gives a brief review of the main activities in WhiCh the Regional Office has collaborated.
5.1 The United Nations and the specialized agencies
Close co-operation has been maintained with UNICEF. The project summaries in Eart IV of the report give some indication of the scope of UNICEF assistance to national projects to which WHO has assigned international staff. In addition, sixteen programmes in which WHO gave teChnical advice, also received supplies and equipment from UNICEF.
Close liaison has also been maintained with the regional representatives of the Technical Assistance Board. Whenever possible arrangements have been made for representatives of the Regional Office to meet the regioOal re~resentatives of the Board during their country visits and to partiCipate in the discussions with government officials. The office of the United Nations Technical Assistance Board in Sydney has continued to give assistance in travel arrangements for fellows studying in Australia and New Zealand.
Special mention should be made of the assistance rendered by the Regional Representative of the Technical Assistance Board in the Philippines, Mr. c. Hart Schaaf, Who has worked very closely with the Regional Office, and during his two years' assignment in the Philippines has rendered many valuable services to WHO-assisted projects.
lIn the Philippines •••
WP/ RCiO/2 page 1
In the Philippines, the administrative committee composed of representatives of the United Nations, UNICEF, the Technical Assistance Board and WHO has continued to meet regularly to discuss and solve administrative problems.
The principal fields of interest shared with FAO related to veterinary public health, mental health and nutrition education. FAO accepted an , invitation to participate in the first WHO Seminar on Veterinary Public Health organized in the Region and provided the services of three short-term consultants. FAO also seconded a staff member to WHO during the .First Asian Seminar on Mental Health and Family Life. Additional information on these seminars is given in Part IV of this report.
An FAO headquarters staff member visited the Regional Office for discussion prior to the FAO/UNICEF SChool Feeding Seminar held in Tokyo in November 1958. WHO was represented at this meeting by a staff member from the South-East Asia Regional Office who visited the Western Pacific Regional Office for briefing. There have been a number of meetings with staff from the FAO Regional Office, Bangkok, in connexion with the nutrition programme in the Philippines.
WHO project staff in Cambodia and Viet Nam continued to collaborate with the UNESCO project staff.
In agreement with the Regional Office for South-East ASia, observers were sent to the United Nations/ECAFE Seminar on Regional Planning in Relation to Urbanization and Industrialization held in Tokyo, the United Nations/FAO Census Training Centre held in Tokyo, and the United Nations/ UNI'AA/ECAFE II Six Countries" Seminar on Planning and Administration of National Programmes on Community Development held in Bangkok. An observer from the Regional Office attended the opening session of the I10 Asian Seminar on Labour Statistics held in Manila.
Although it was not possible to send an observer to the fifteenth session of ECAFE '~ich was held in BroadbeaCh, Australia, a statement on the health problems concerned with industrial, agricultural and economic development was submitted by the Organization.
5.2 With other intergovernmental organizations
5.2.1 South Pacific Commission
An observer from the South Pacific Commission attended the last session of the Regional Committee held in Manila. Matters concerning the Commission and the Organization were the subject of informal discussions among the representatives of Australia, Netherlands New Guinea, New Zealand, France, the United Kingdom and the United States of America, the Regional Director, a representative of the Director-General and the observer from the Commission.
A senior staff member of the Regional Office attended as observer the South Pacific Conference at Rabaul in May 1959. An informal meeting with the Senior COmmissioners of the United States of America, the United Kingdom, France, Netherlands, Australia, New Zealand and the Secretary-General of the Commission was also arranged and matters of direct interest to both organizatiorls were discussed, including relationship and WHO programme procedures. The Organization's desire for full co-operation with the Commission was re-emphasized and a closer understanding reached between the two organizations. A visit of the Secretary-General of the Commission to Manila in the near future has been announced.
/The Organization •••
,t .. I 6~""_UI t...
page 8 .
The Organization was also represented at a tuberculosis conference organized by the Commission in .}:elii1a l i Jl959- in Pago-Pago, American Samoa.
'l-.I . t \. (,r-) ,,,:'\("1'\-'.."')\ '( \~.,.\ ..:.:~i'::;
5.2.~ Colombo Plan
There has been closer co-operation with the Colombo Plan than in previous years. The fellowships provided by this organization in connection with some of the WHO-assisted projects have contributed greatly to the progress made.
The Regional Public Informatio~ Officer attended a conference of national information officers organized by the Colombo Plan Council for Technical Co-operation in South and South-East ASia and held in Singapore in September.1958.
5.3 With non-governmental organizations
As in the past, the Regional Office sent observers to a number of conferences organized by non-governmental organizations. WHO was represented at the Pan Pacific Conference on Rehabilitation w.hich was organized by the International Society for the Welf'are of Cripples and held in Sydney, the VII International Congress on Leprology in Tokyo organized by the International Leprosy Association, the workshop of the International Conference of Social Work in Kyoto, the International study Conference on the Child in the Family sponsored by the International Union of Child Welfare and the ninth meeting of the International Conference of social Work both of which were held in Tokyo, and the thirty-fifth Council of the World Medical Association in Sydney.
The World Federation for Mental Health assigned two members of its senior staff to serve on the faculty of the First Asian Seminar on Mental Health and Family Life.
5.4 other joint work
Excellent co-operation and increasing joint planning with the United States International Cooperation Administration (ICA) have marked the period under review. In certain countries of the Region many programmes are interwoven with lCA-assisted projects and in the field of malaria control in particular, this .joint assistance has done much to accelerate progress.
WHO was invited to send representatives to a meeting of the chiefs of the public health divisions of the various ICA missions in the Near East and Far East Missions w.hich was held in Manila in November 1958. Representatives attended from WHO Headquarters and the WHO Regional Offices for South-East Asia, Eastern Mediterranean and Western Pacific. The lCA Planning Committee met with representatives of the Western Pacific Regional Office for the purpose of developing jOintly the tentative agenda and work plans of the Joint Meeting. This was considered a most successful meeting and it is felt that many of the matters discussed, particularly those relating to inter-agency relations, will lead to even closer relationship in the future.
Relations with French Economic Aid continue to be cordial.
The Rockefeller Foundation, the China Medical Board and the Asia Foundation have maintained their interest in a number of WHO-assisted projects and have contributed to progress in the field of education and training through the award of fellowships. The Asia Foundation provided
/thirteen fellowships •• ,
thirteen fellowships to permit participants from certain countries to attend the First Asian Seminar on Mental Health and Family Life.
6 PUBLIC INFORMATION
6.1 General
The Public Information Office started a long-range plan to develop an effective system of direct distribution of information material to influential newspapers, magazines, radio and television networks in the western Pacific. The office has also oriented its work towards providing the press and radio wi th more exhaustive background material on health subjects necessary for authoritative health reporting. Public information work dur::t.ng the WHO/FAO Seminar on Veterinary Public Health in Tokyo can be cited aShan example of this new emphasis. Comprehensi ve background notes on four topics connected with the aeminar were prepared for the information of the press; the material was issued to reporters Who attended the two press conferences convened by the office in connexion with the seminar, in Tokyo and in Manila. As a follow-up, the background notes were sent to all the seminar participants wi th the request that the material be made available to the press in their own country as a basis for interviews, feature articles or radio programmes.
6.2 World Health Day celebrations
The celebration of 1959 World Health Day stimulated wider activities in the field of mental health. In the Federation of Malaya, the occasion was observed with the establishment of a "MentaJ. Patients Welfare Association"; posters, leaflets and visual aids were prepared by the Central Mental Hospital in Tanjong Rambutan.
In Netherlands New Guinea several government departments co-operated in publishing special articles on mental heaJ.th in the local press.
Discussions, social meetings and exhibitions held during World Health Day in Singapore were attended by groups of health workers.
Varied activities marked World HeaJ.th Day in Viet Nam. There were clean-up campaigns, intensified smallpox vaccination and large meetings in several provinces of the country. The Secretary of State and the DirectorGeneral of Health presided over the main ceremony in Saigon Which was given good publicity by the press and the radio.
Planning for World HeaJ.th Day in the Philippines (celebrated 22 July) indicated a determined effort to achieve wider public understanding of health problems.
6.3 other activities
Intensified public information work was undertaken during the ninth session of the Regional Committee and the opening of the new regional headquarters building. Press coverage was also provided during the First Asian Seminar on Mental Health and Family Life, and the Maternity Care Conference·.
The Regional Office co-operated with a television network in ManiLa on the production of a tele~sed programme presented in connexion with the first public showing in the Philippines of the WHO film "Waters of Affliction". The film has also been shown to health officials in Japan, Korea and the Philippines; steps are being taken to have the English cormnentary translated
finto the languages •••
Wi: /""V"''''I c:.. page 10
into the languages of the Region. The WHO anniversary film, "People Like Maria", was televised and shown to groups of health workers in the Philippines.
An increasing number of information pamphlets was distributed to schools, government offices, students, United Nations associations and professional groups.
/PPJ:fl II ••.
PARI' II.
1 PUBLIC EEAIJrH SERVICES
GENERAL sr.A!rEMENT OF AarIVITIES IN THE REGION
WP/RC10/2 page 11
1.1 Assistance to governments in developing and strengthening their health services
Assistance to national health administrations in the development and strengthening of their public health services has continued to be an important feature of the work of the Regional Office during the period under review. Direct advice has been given in the form of consultations between regional public health administrators, area representatives, regional advisers and government officials. During these visits subjects discussed with the health administrations included the training of local personnel, progress of WHO-assisted projects in the countries concerned, availability of local staff for present health problems, additional facilities for the training of WHO fellows, arrangements for seminars and refresher courses, and the scope of WHO, UNICEF and other assistance in relation to futur requests for participation in the health programmes contemplated by the various administrations. At the same time every opportunity has been- taken to discuss immediate and long-term problems, the progress made towards integrated national programmes, the value of systematic health planning and the determination of priority needs.
If WHO's programme is to be fully rea.l1stic there must be the closest possible co-operation between governments and the Organization and full understanding of WHO's policies. WHO's main task is to assist and advise governments but unless national counterparts are available and have been trained to take over and administer the projects Which are being dev loped with assistance from WHO, such projects cannot be effectively absorbed into a country's health service. The degree of local partiCipation on the part of governments in most health projects and the progress made towards integrated national programmes have been influenced by three factors: (1) the stage of development of the national health services, (2) personnel resources, and (3) duration of WHO assistance. In the past year, although there were still delays in some projects in the provision of suitable counterpart personnel, local partiCipation has substantially increased, especially Where assistance has been given for some years and technical personnel have returned from fellowships.
In China, for example, organized health services were already well established throughout the island When the maternal and child health programme started in 1952. The number of WHO staff assigned to the proj ct has gradually been reduced since then but the project activities hav continued and expanded. Government staff have taken over medical leadership and much of the teaching and supervisory responsibilities in midwif ry and public health nursing. In the Federation of Malaya, local participation in the Rural Health Training Centre Project in Jitra has increased considerably during the year and in May 1959 the work in connexion with planning the programme and teaching and supervision was handed over to th national counterparts, the WHO adviser being transferred to the Ministry of Health in Kuala Lumpur. Jitra will continue to be used as a training centre for personnel drawn from the different States and with the Government's deCision to expand its rural health services, the Centre's activities in the future are expected to increase. The Health Visitors Course, which was established with WHO assistance and is recognized by the Royal Society for
/the PrOmotion of •••
the Promotion of Health, London, is being carried on by a health sister. It is the Government's plan to conduct the course at the Public Health Institute Vlhich will be established in Kuala Lumpur • Hospital administrators and hospital record officers are being trained with WHO assistance and non-medical hospital administration is now recognized as a career. As the number of well-qualified personnel has risen in Viet Nam, the Government has assigned more teaching and supervisory staff, particularly nurses, to key positions, and this has done much to strengthen local partiCipation in various aspects of the maternal and child health project. A joint national/WHO/USOM Committee for the exchange of ideas and integrated planning of nursing/midwifery and maternal and child health has been established and the possibility of a tuberculosis service being included is at the moment under consideration.
Singapore is comparatively more fortunate than some of the countries in the Region in that it is capable of training a variety of health personnel locally and of making available to the neighbouring countries its training facilities. The role WHO plays in assisting the Government in the development of its training programmes is described in the summary review of projects. Plans for the training of radiographers locally are also under consideration and it is anticipated that some of the neighbouring countries may, in the future, have their radiographers trained in Singapore. There is also a hope that Singapore may before long be able to offer post-graduate training in paediatriCS, not only to its own medical graduates, but also to those from countries within the Region. It is possible that the training may cover the entire field of maternal and child health including domiciliary midwifery service Vlhich the Government is trying to extend throughout the island with WHO assistance.
In Laos WHO assistance to the yaws project has terminated. The Government plans to continue one team for a further two years to resurvey the known residual foci of infection and to help the rural health personnel with the surveillance of yaws. The establishment of a mobile rural unit is being considered by the Government. In the British Solomon Islands Protectorate, Gilbert and Ellice Islands Colony, and Western Samoa, resurvey work in connexion with the yaws projects is being carried out by the rural health personnel and WHO assistance is now limited to brief follow-up visits. The governments of the area have given much thought to the improvement of their general health 'services, especially in the rural areas, and to the integration of yaws control into those services; creditable progress has been made, in spite of serious financial and staffing difficulties.
In the field of environmental sanitation the assistance given by the Organization has stimulated not only national governments, but local governments and communities, in their efforts to solve problems in this field. The programme of environmental sanitation improvements in rural demonstration areas in China has been accomplished in co-operation with the local communities who have contributed from 36 to 58c{o of the total costs. Interest in the processing and utilization of organic wastes has grown and many efforts are being made to solve this problem.
The speed with Which governments of the Region are progressing towards integrated nat:1.onal programmesvaries from country to country. In some
/countries this is •••
I~.: I.,v-vj , page 1,
countries this is well advanced, in others it is being steadily develop d, while there are still areas where much work still remains to b done.
In Cambodia, the aim of the rural h alth training centre is to plan and implement a comprehensive well-balanced public health programme in one province, using project personnel and facilities for field training of all categories of health personnel. The interest of officials at ministry level has been maintained as there is a stable cadre of senior officers. The pace at which the project has proceeded has been determined by Cambodian financial and personal resources and this has provided a firm basis for future activities. Interest in the project resulted in the Ministry's request for the addition of a sanitarian in 1959. There is also close co-operation between the other WHO-assisted programmes and the rural health centre, rural midwives working in close contact with the project and Cambodian personnel from the maternal and child health centres in Phnom-Penh being attached to the rural health centre on a rotation basis. The success of the project, which is as yet not fully operational, lies in the acceptance by Cambodians of the new approach to the health problems of the people. An opinion was expressed in Cambodia that the centre at Takbmau, when fully developed, will be a model for an integrated national programme. The forward look in the approach of the Government to public health has been reflected by the increase in the health budget from 80 million to 221 million riels over a period of five years.
The public health -study tour which followed the Regional Committee Meeting in 1957 and the conference which was conducted in conjunction with the study tour exerted a profound influence on the health administration in China. Since then much progress has been made toward regionalization, co.ordination and integration of medical care and public health. Whereas fo~erly a number of individual projects were controlled from separate project centres, efficiency and economy have now been secured by providing a single system of supervision and guidance for all work done under these projects, in the field or in provincial hospitals and health centres. The Taiwan Provincial Health Administration has established an institute of maternal and child health under 'Which are grouped maternal and child health, mass immunization against pertussis and diphtheria, trachoma control, tuberculosis control, and venereal disease control, for purposes of better planning, administration and supervision. A pilot project of combined superviSion has been initiated in one region and is to be carried out at first by teams of public health nurses, who will make supervisory field visits to health stations and health centres. It is planned that a doctor will eventually be added to the team and the pilot project will develop into a national generalized public health supervision activity.
Under the new reorganization plan of the Philippines, the half-century old system of centralized administration direction has given way to.the delegation of authority and functions to regional directors heading the eight health districts in 'Which the country has been divided. New features of the plan leave onl.y staff functions (advisory and consultative) to the bureau and division chief's while the overall administration of the health and med1cal services in each region is concentrated in the hands of the region.aI.. director. Also envisaged is an integrated system of' a.dmini stering healt.h and medical services so that long-range planning of activities and services can be undertaken in the most practical and economical way. It is appreCiated that there are still many initial difficulties but these bave been recognized and it is hoped that they will gradually be overcom •
In Korea, the WHO f'ellowship programme has been one of the major contributing factors towards strengthening of' health services. K y t chnical
/personnel in the •••
personnel in the Ministry of Health and Social Affairs, certain subsidiary institutions such as the National Institute of Health and the National. Rehabilitation Centre, just to mention two, and the co-ordinator of the leprosy control programme have had post-graduate training abroad under WHO auspices. This has greatly helped in the planning, administration and supervision of national health programmes.
In Viet Nam the rural health services are being rapidly extended as a result of assistance from ICA. The introduction of a modern method of budgeting in the Ministry of Health which is now being planned with the assistance of Michigan State University, is still another step forward to modernize its administration. Through the maternal. and child health, environmental sanitation and tuberculosis control projects, WHO is assisting the Ministry of Health to develop policies in these fields. Another direct contribution to the future increase in public health manpower is the award of a WHO fellowship to a promiSing Vietnamese doctor, who has been selected for the position of professor of preventive medicine.
1.2 Maternal and Child Health
The immediate objectives of governmental maternal and child health programmes in this region vary because of the widely differing needs and condi tions. During the past year, the Organization' s activities have included the prOvision of assistance to a number of Member Countries in strengthening various aspects of their maternal and child health programmes, chiefly through assistance in training various categories of personnel for maternal and child health work, in planning the progressive development of maternal and child health services and in studying certain technical problems.
There is grOwing awareness of the need for closer co-operation between the professional. groups concerned with the health care of mothers and children if programmes are to be planned and carried out as effectively as possible. The Conference on Maternity Care which met in Manila from 9 to 20 March 1959, was designed to meet this need at regional level. The partiCipants included clinicians, maternal and child health officers, nurses and midwives from sixteen countries and territories in the Region, representatives from ICA and UNICEF, and WHO staff. The main purpose of the Conference was to encourage representatives of the health team engaged in maternity care to exchange ideas, information and experiences, to discuss some of the principal problems encountered in the Region, to consider ways in which they might be dealt with more effectively and, ultimately, to stimulate action resulting in i~roved maternity care services. An evaluation of the conference by the partiCipants indicated that the immediate objectives had been successfully achieved.
In an increaSing number of countries efforts are now being made to improve the quality and broaden the scope of maternal and child health services, primarily through in-service or refresher training courses for professional staff and strengthening field supervision. The maternal and child health project in Taiwan, which was started in 1952 along these lines, has made steady progress towards achieving its objectives. The scope of training activities has gradually been extended and includes refresher courses for private practicing midwives; services and facilities have also been improved in a large proportion of the island's health stations. Since the Maternal. and Child Health Institute was established last year with administrative responsibility for all maternal and child health work, attention has been focused on integrating services and supervisory activities more closely with the general public health programme. WHO assistance is
Ito be withdrawn •••
A nurse supervisor giving a demonstration on the proper care of infants at a Philippine rural health center.
MATERNAL AND CHILD HEALTH
To help protect the health of mothers and children, WHO is assisting Governments in strengthening maternal and child health programmes.
(
A WHO midwifery tutor was sent to Singapore to help establish a training scheme for midwives and to institute a domiciliary service.
,., .... , .. ,-page 15
to be withdrawn in August 1959 and the project will be continued by the Government.
The improvement of maternal and child health involves concern with the whole pattern of a people's way of life. The socio-anthropological studies carried out during the year in the Federation of Malaya and Tonga have indicated the very significant influence of the social and cultural pattern of the country on child nutrition and child rearing. The need for more attention to be given the study of these factors and for giving them greater consideration in maternal and child health work is clear.
Prematurity is listed as one of the leading causes of infant death in many countries and territories of this region. It has however become evident that the standard definition of prematurity is not equally applicable to all areas of the world. Four countries in this region are now co-operating with WHO in a world-wide study on birth weight, from which it is hoped to reach more realistic ~ocal definitions of the terms prematurity and immaturity, and to obtain information on the local effect on birth weight of certain specific factors. These studies may suggest lines on which local programmes to reduce the number of babies with low birth weight might be based.
Efforts are being made to strengthen nutrition activities in a number of countries. There i6 however still a great need for more precise knowledge of the nature and extent of the problems, for study of possible resources for dealing with them, and for maternal and child health workers to be more adequately prepared in the field of nutrition.
During the past year there has been evidence of a trend towards closer co-ordination of preventive and curative health services for mothers and chUdren in a few countries, but as yet the need for this approach has not yet received suffiCiently wide recognition.
UNICEF's assistance to many maternal. and child health programmes in this region has again been extremely useful and is much valued both by governments and by the Organization.
1.3 Nursing
The continuous improvement and expansion of health services throughout the Region demands a constant increase in the number of well-training health workers of which nurses and midwives represent the largest group. Programmes for the preparation of nurses and midwives are now established in most of the countries and response to recruitment is much improved. III countries where it is not yet possible to recruit candidates with secondary education, these programmes are still at the auxiliary level. In those countries where there are no fully-qualified nurses and very few doctors to provide guidance, supervision and leaderShip to these workers, the improvement in quality of services is far from satisfactory and much more assistance is needed.
The expansion of preventive health services particularly in the rural areas with the trend to integrate individual services into the total health progrBl'llll1e; the improvement of services, such as psychiatry and mental health, paediat~cs and other fields, has also increased the need for more and better_prepared nurses.
In the early years of WHO assistance in the Region, refreSher courses an~ in-service training were given to supplement inadequate general nursing
/education and to •••
I "I -
page 16
education and to prepare nurses for hospital services and special fields such as maternal and child health. As the standards of general and basic nursing education improve the trend is changing and these courses are now chiefly directed towards improving knowledge and skills in fields such as nursing service administration, clinical teaching and orientation to the broader concepts of public-health services. The theoretical content in the behavioural SCiences, public health and psychiatric nursing and other fields are now receiving greater emphasis in the basic nursing curriculum. The lack of qualified teaching personnel for directed clinical learning experiences and well-developed services often makes it difficult to apply this theory, in practice. Encouraging progress has been made in the integration of public health nursing in the basic curriculum in the Philippines and China during the period under review. Generalized public health nursing supervision has also commenced in these two countries. Domiciliary midwifery and community health experience is now a required part of the midwifery programme in many of the countries and steps are being taken to introduce or extend this experience in others.
As candidates with higher basic educational background and a higher standard of professional training become more plentiful, there is an increasing number of requests for fellowships. The value and success of the fellowship programme over the years is being demonstrated by the excellent contribution the majority of the fellows are making on their return to their own countries. Where it has been possible to establish post-basic courses at national level, larger numbers of nurses are being prepared in their own country for leadership positions. Examples of this are the courses to prepare teachers for clinical nurSing, midwifery and public health nursing in Japan; the course in public health nursing and psychiatric nursing in Singapore, and in public health nursing in the Federation of Malaya and the Philippines. The establishment of post-basic and graduate courses to prepare nurses for teaching and administrative pOSitions is under consideration in two countries. The shortage of personnel qualified for faculty positions and the limitations imposed by budget is however hampering progress in this field.
The WHO-assisted projects in Japan, Federation of Malaya and th.e Philippines ~eached the stage where WHO staff could be withdrawn during the period under review. (See Part III for summaries on these programmes)
WHO-sponsored or -assisted regional and inter-regional conferences and national ~conferences continue to play an important ..role in providing an opportunity for exchange of ideas, information and experiences. National nurses and several WHO staff members from the Region attended the WHO Maternity Care Conference, the First Asian Seminar on Mental Health and Family Life and three attended the Conference on Auxiliary Nursing sponsored by the WHO Regional Office for south-East Asia. The Nursing Adviser acted as a ~taff member for the First Conference on Mental Health in Nursing spon~ored by the Filipino Nurses Association and participated in a nursing con~erence sponsored by the New Zealand Registered Nurses' Association in we~lington in May 1959.
The year's activities have been encouraging. Long-term planning by governments has enabled the Regional Office to assist them to evaluate the quality and adequacy of present nursing and midwifery education programmes and services, to evolve plans for improvement and to meet future needs.
1.4 Environmental Sanitation
Although the need for improvement of environmental sanitation is generally recognized in Member Countries, progress has been slow due to a large measure
Ito the fact •••
NURSING
The improvement of nursing and midwifery education in the Region is being pursued through a number of long-term projects, assisted by WHO. Nurse training in psychiatry is also being taken up.
A WHO nurse educator is shown with a midwifery student in the Federation of Malaya.
Bedside teaching at the First National Hospital in Tokyo.
, page 17
to the fact that under-developed countries have assigned a relatively low priority to capital expenditures for the construction of sanitary facilities. Efforts need to be made to convince general administrators that capital investments in the improvement of water and sewerage facilities are essential for the continuing economic development of all countries.
Special emphasis has been given during the period under review to the strengthening of training activities in Member Countries. Assistance has been given to several governments in the training of both professional and subprofessional workers in this field.
Of particular interest is n on-the-job n training in design of water-borne sewerage systems being given to a group of young engineers from Member Countries in connex:1.on with the China "environmental sanitation project. These young engineers have been awarded fellovTships for training with the Taipei Sewerage and Drainage Corps as well as the Taiwan Institute of Environmental Sanitation where the Organization is assisting the Government in the planning of a water-borne sewerage system for Taipei with a design population of over 1 000 000. "These fellows are obtaining invaluable experience in the actual planning and design of water-borne sewerage and sewage treatment by working for a period of six months as members of the engineering teams.
As further study of the existing situations in the countries of the Region with respect to environmental sanitation continues, the needs of the countries and of the Region become clearer. A pressing necessity is the need for both increasing within countries the awareness of existing sanitation conditions and also for expert advice on the possibilities of improvement of environmental sanitation services with the administrative and economic framework of the countries. In order to plan programmes for improvement of the environment efficiently and effectively, it is essential that inventories of existing administrative and technical services, physical facilities and human and other resources be made. Efforts to co-ordinate programmes of environmental sanitation with epidemiological and biostatistical data provided by existing services within the countries is indicated. A major problem is that of the training of both professional and subprofessional personnel for the execution of technical environmental sanitation activities. There is also a definite need for research and for field trials leading to the establishment of standard rural sanitary facilities which meet minimum criteria of sanitary quality, economy, utilization of local materials, ease of construction and acceptability within local cultural patterns. Immediate and preSSing problems of environmental sanitation need to be given priority for immediate solution. The use of raw night-soil for fertilization of agricultural crops destined for human consumption mavr be cited as an example. The best utilization of funds and energy can be obtained only by sound and steady growth of environmental sanitation services in both national and local governments. This desired end could be greatly facilitated by the provision of short- and long-range planning within the governmental agencies concerned.
1.5 Health Education
WHO's assistance to governments in strengthening their health services has included health education of the public. Evidence of development in this field is shown by two events: (1) a six-day health education conference for WHO.assisted projects in China (Taiwan) was .considered a success both by the Government and those attending. The conference was sponsored by the Chinese Government with techni.cal assistance from the Regional NurSing and Health Education Advisers. It brought together thirty-five members of the WHO-assisted project personnel with the object of clarifying the major health education problems connected with project operations and developing suitable
and practical approaches to these problems based on modern health education concepts. It is hoped to arrange a two-d~ follow-up meeting of the conference group in the latter part of 1959; (2) in late 1958.the Government of Guam, the United states Navy, the Trust Territory of the Pacific Islands, and the Guam Tuberculosis Association, jointly sponsored a four-week health education training course in a camp just outside Agana, Guam, for xhirty-six Micronesian health and education workers in these territories. The Regional Health Education Adviser served as course adviser. This course was a follow-up of the joint South Pacific Commission/WHO Health Education Training Course held in Noumea, New Caledonia in 1957, and the value of the recent Guam course was such that the Administration of the Trust Territory of the Pacific Islands has decided to hold a similar course for its island people in 1960 at the recently completed Pacific Islands Central School in the Ponape District.
Three WHO fellows - two from the Territory of Papua and New Guinea and one from New Zealand - have returned to their countries following the completion of their ov.erseas training in health education. Two Korean fellows will complete a twelve-month study programme in health education in the Philippines in the second half of 1959. Also during the reporting period the first WHO E~ert Committee Report on Health Education of the Public was translated into Korean for use in the Ministry of Health' s e~anded training programme for health workers. Following a four-week visit to Korea at the request of the Ministry of Health the Regional Health Education Adviser assisted the Ministry in preparing a series of recommendations to guide the development of health education in this country. Additional health education assistance is now available to the Ministry through the recent addition (October 1958) of a health education adviser to the Office of the EconOmic Co.ordinator's Health Division staff.
other health education activities during the period under review have included advisory services in the planning phase of a number of country and inter-country projects. Educational guidance was given in the planning of a regional guide for the organization and administration of inter-country programmes. This guide will be used by the regional inter.country meeting planning committees and will also serve as reference material for the directors and consultants connected with the meetings.
1.6 Mental Health
The Western Pacific Regional Office is aware of the widely divergent pattern of mental health ideas and activities in the countries and territories of this region. One of the difficulties which we face, not only in this region but in the Organization as a whole, is the lack of information on the extent of psychiatric disorders.
Some progress has been made towards the solution of this problem, mainly through the initiation by Headquarters of a long.term programme for the study of the epidemiology of mental disorders. In order to ascertain the extent of the mental health problems in the Region, an e~loratory approach was made to a number of governments to obtain their reaction to the carrying out of sample surveys in the field of epidemiology of mental disorders. On the whole the response has been one of interest.
The First Asian Seminar on Mental Health and Family Life ,.,hich was sponsored by the Philippine Government in collaboration with WHO, the Asia Foundation and the World Federation of Mental Health and brought together partiCipants from Burma, China, Hong Kong, India, IndoneSia, Japan, Korea, the Federation of Malaya, Pakistan, Sarawak and Thailand showed that this was one of the best means of fostering interest in mental health problems
/and their possible •••
ENVIRONMENTAL SANITATION
l
(c)
(a)
Governments everywhere are striving to improve environmental sanitation which in most countries of the Region is still inadequate. WHO is assisting by providing technical guidance in instituting environmental sanitation programmes and in trainingpersonnel to run them.
Photos taken at the Kobe Composting Plant in Japan, show (a) refuse being collected (b) the refuse being received in the plant (e) ground refuse to be mixed with digested sewage sludge being transported to ·composting vault, and (d) farmers using the hygienically processed compost as fertilizer.
(d)
Jl ..... J .... ~v-.ItooiJ t_
page 19
and their possible solutions. One of the results of the seminar is the establishment of the Asian Federation of Mental Health, composed of representatives from China, Hong Kong, India, Japan, the Philippines and Singapore and a plan on the part of three countries (Ceylon, Korea and Thailand) to establish a mental health society so they could also join the Federation.
In the WHo-assisted mental health project in the Philippines the emphasis given to the improvement of physical facilities, administration and services which has characterized previous years was followed by the opening of a day rehabilitation centre ~ere less mentally disturbed patients receive professional guidance and attention during the day but are permitted to go home at night. This extension centre has somewhat reduced the undue case load at the National Mental Hospital and has stressed the feasibility of effective treatment of selected cases under a dispensary type of psychiatric service. Consideration is being given to the possible affiliation of this establishment with neighbouring local health services, hospitals and welfare agencies with a view to widening its activities and establishing an effective referral service. It may also be developed as an orientation and training centre in psychiatric work for public health and hospital workers, as well as medical and nursing students.
In continuation of the programme to assist the mental health project in the Philippines by prOviding adequately trained public health workers, further fellowships were awarded to six medical officers and two nurses for training in Australia. Arrangements were made by the Director, Mental HYgiene Authority, Melbourne. On the return of the fellows an attitude of professional growth and staff improvements were created in a very short period of time.
Consultants in mental health from Johns Hopkins Hospital assisted the exchange project at the Institute of Hygiene during the period under review. Lectures in mental health were given to graduate workers and medical students at the university of the Philippines and advice given on the establishment of a special mental health department at the Institute of HYgiene.
In the Territory of Papua and New Guinea, a post of assistant director in mental health was established and appointment will be made shortly. Plans are under preparation for the erection of a new mental hospital in the vicinity of Port Moresby.
1.7 Statistics
It needs scarcely be said that vital and health statistics serve as a basis for determination of health needs of the people, for effective planning of health programmes and for evaluation of medical and health services of the government.
During the period under review, there has been an increased awareness of the importance of vital and health statistics in countries and territories in the Western Pacific Region. This awareness is evidenced by the growing number of requests from governments for advisory services and by the interest formally expressed by many governments in partidpating in seminars on vi tal and health statistics to be held in this region and in receiving reports prepared by the Regional Statistician on the vital and health statistics system of the countries visited.
The hospital records project in Singapore is developing into a medical statistics project which has as its direct objective the improvement of vital
/ and health •••
and health statistics throughout Singapore. The WHO expert for the hospital records project in the Federation of Malaya has started a training course for medical records officers with the objective of improving the hospital records system of the medical service in the Federation. It is expected that the implementation of the project will also improve morbidity statistics of the country and provide hospital utilization data to serve as a basis for the planning of medical and health services.
At the request of the Government, the Regional Statistician was sent to China (Taiwan) to provide technical assistance in the compilation and analysis of' data obtained from a sample survey of tuberculosis prevalence conducted on the island. Statistical assistance has also been given to national and international project officers in this region in the analysis of collected data and in the evaluation of project achievements. This gives evidence that during the period under review the statistical side of many field projects has been appreciably enhanced through the use of sound statistical methods. It is encouraging to note that some of the WHO fellows undertook overseas training in other technical branches with emphasis on health statistics and statistical methods.
In Viet Nam a vital and health statistics project, 'Which is designed to reorganize and strengthen the statistical services of the Government at local, provincial and national levels, is expected to start early in 1960, 'While in the Philippines a health statistics project and a hospital records project are planned for 1961. Two fellowships will be awarded before the end of 1959 to government officers from China and Japan to enable them to undertake postgraduate studies in vital and health statistics and tuberculosis statistics respectively.
Since the training of personnel is most essential for improvement of statistical services and because the most efficient w~ of training statistical personnel is by conducting seminars or training courses, plans for 1960 include a regional seminar on vital and health statistics of six weeks duration, which has as its objective the provision of additional training for workers in national statistical services, and many governments have expressed interest in sending participants. This will be the second vital and health statistics seminar to be held in the Region and it is anticipated that the seminar will arouse an increased awareness of the important role which improved statistical services can play in national development. It is proposed that in the near future, 11. seminar on vi t8J. and health statistics should be conducted for territories in the South Pacific area.
It is felt that vital and health statistics systems in operation in countries of this region, as well as their statistical developments and achievements, should be made known to all other countries and territories within the Region. The dissemination of statistical information may arouse the interest of governments in the improvement of national vital and health statistics with a view to fulfilling national needs and eventUally attaining international unifOrmity and comparability. For this reason, the Regional Statistician's field visit reports,atter clearance by the governments concerned were distributed to Member states in the Region.
1.8 Programme analysiS and evaluation
Programme analysis and evaluation which is a new activity recently developed by the Organization has now become a routine in all WHO-assisted projects in this region. Country projects are periodically assessed by the
/project statf •••
EDUCATION AND TRAINING
A.C
An anatomy demonstration in the Central Medical School, Fiji, where 'WHO lecturers are teaching biology and physiology,
HEALTH EDUCATION OF THE PUBLIC
Health education class in a school in Taiwan,
RURAL' HEALTH
A WHO medical officer conducting a I' , 'n a rural area in Cambodia, WHO c InIC I , bl' h , ' t' the Government In esta 15 -
IS assis Ing h ing a public health programme at t e Drovincial level.
I'Ir I rtlv.s.UI ~ page 2l.
project staff in collaboration with their national counterparts, and intercountry projects, such as seminars, conferences and training courses, are evaluated by the regional staff after the meeting. It is believed that programme analysis and evaluation will make it possible to prevent repetition of mistakes and to gain knowledge necessary for the planning and operation of future programmes. It is hoped that all countries and territories in the Region will share in the experience gained from past evaluations.
During the period under review, twenty-one project staff members attached to fourteen country projects submitted assignment reports with a broad review of project activities and a critical assessment of the results so far achieved. Four country projects terminated during the period under review; the final reports of these projects laid special emphasis on evaluation of project achievements in relation to objectives, special attention being paid to the extent to w.hich the national health service had been strengthened in the spheres concerned. In addition to the routine evaluations made by the project staff in countries and territories of this region, two field projects in operation in China (Taiwan) were systematically evaluated by the project staff in respect of accomplishments achieved in the past years.
The inter-country projects completed since the last meeting of the Regional Committee have been evaluated at the Regional Office in terms of organization and achievements of the meetings.
Seven consultants on specialized health fields were sent to countries in the Region during the period under review to assess particular aspects of health problems and their reports, including appraisal and recommendations, were forwarded to the governments concerned.
Evaluation of fellowships continued from the previous year and every fellowship awarded in the Region was routinely assessed after return of the fellow with respect to his contribution to the country and to the benefits derived by the country from the fellowship.
The services of the Regional Statistician and Programme Evaluator are available to the national health administrations who might wish to request assistance in the evaluation of their national health programmes.
2 EDUCATION AND TRAINING
2.1 Assistance to educational institutions -
One of the Organization's main preoccupations is assistance to governments to help them overcome the shortage of trained personnel as without sufficient numbers of competent workers progress in the solution of health problems will be slow. In the western Pacific Region, therefore, WHO, in addition to awarding fellowships, has for some years assisted a number of medical schools and public health institutions to develop national training facilities.
The type of assistance required has differed in accordance with the situation prevailing in the various countries. In some pIeces there are medical schools where standards need to be raised and output increased, in others, attention is focussed on the development or strengthening of a speci~ic department, while in still others assistance is required in the upgrading of a school to university level. The services provided have, therefore, varied from the assignment of lecturers for a period sufficient to ~ermit the training of staff competent to take their place, visits of
/ short -term ••••
VU: / L\\.i.J..Uj c:. page 22.
short-term consultants, exchange programmes and grants to permit wider training of auxiliary personnel in their own or neighbouring countries,
In Cambodia, WHO continued to support the Royal School of Medicine by providing lecturers in physiology, ophthalmology and radiology. The lecturers in physiology and radiology have completed their assignments and are being replaced by lecturers in other fields of basic medicine. The lecturer in ophthalmology has trained a national counterpart who, after post-graduate stUdies, will be capable of undertaking clinical work in the Institute of Ophthalmology and doing part of the teaching in this subject at the Royal School of Medicine. Financial assistance has been given to ten Cambodian students to permit them to study at the School, and Laotian students, four of whom are on WHO., fellowships, are also receiving training.
The WHO-sponsored lecturer in social medicine at the University of Malaya completed his. assignment and was repatriated to the United Kingdom, His counterpart commenced a WHO fellowship at the London School of Hygiene and Tropical Medicine as part of the exchange programme between the University and the London School. The course for the Diploma in Public Health is now soundly established, and as this is the only course outside of the United Kingdom recognized by the British Medical CounCil, I wish again to emphasize its value to governments of this region. WHO awarded fellowships to candidates from Burma, Japan and Netherlands New Guinea for the 1958-59 course and candidates from the Federation of Malaya, Japan, Korea and Netherlands New Guinea for the 1959-60 course which began in April 1959. It is hoped that an increasing numbe~ of re~uests for fellowships for the course will be received in the future as support of this course means practical application of the regional committee's recommendation on intra-regional training.
In Fiji, the WHO lecturers in biology and physiology continued their teaching activities at the Central Medical School. This project will be continued until the end of 1961 by which time it is hoped that the students under training in the otago UniverSity on WHO or China Medical Board fellowships will be in a position to take over the work of the WHO lecturers.
Under the exchange ~rogramme between the Institute of Hygiene of the University of the Philippines and the Johns Hopkins School of Hygiene and Public Health, short-term consultants in mental health and public health nutrition, as well as a lecturer in mental health for one academic year, have been provided during the period under review, Comparison of the present status of the Institute with that at the inception of the project (1953) reveals that the enrollment of students and the size of the faculty have doub~ed, the national budget and research funds almost trebled, and research activities and services rendered to other agencies increased to a great e~tent. In addition, there have been marked changes in physical faCilities, new e~uipment, including books and periodicals, has been purchased, and the Institute building was rehabilitated in 1956. New courses have been initiated, new departments established, and as a result of the increase in the size of the faculty and the provision of new equipment and faCilities, the quality of teaching has improved and the research activities of the staff have increased. The Institute of Hygiene is now in a position to meet the needs of the Philippines for well-trained public health personnel and with continued efforts could well become a~public health centre of interest to many others in the Region. In fact, starting this school year, several Korean doctors were sent to the Master in Public Health course on ICA fellowships, apart' from the two WHO fellows who were enrolled at the Institute during the ye~ under review.
/The assignment •••
,,~ I ;41<J-Vj "-
page 23
The assignment of a senior nursing educator for three years at the Institute of Public Health, Tokyo, terminated during the period under review. The instructors I course in nursing, midwifery and public health nursing, which was initiated just prior to the arrival of the WHO nursing educator in TOkyo, is now well established and the faculty of nursing at the Institute has expanded in terms of the number of staff. WHO has also contributed to the strengthening of the teaching activities of the staff by giving fellowships for overseas study. WHO fellows from China have been trained in various training courses and/or in several faculties, particularly epidemiology and biostatistics.
2.2 Fellowships
During the period under review, eighty-eight fellowships (including three granted from EURO and Headquarters funds) were awarded by the Regional Office under its regular, Technical Assistance and Malaria Eradication Special Account (MESA) programmes. It should be noted that second or third year awards for which funds had been obligated before the period are not included in this figure, nor are students included who have attended a national course , with help in maintenance and travel costs.
Of the 88 fellowships, ?f9 or 44."5fo were awarded for study within the Western Pacific Region (intra-regional) while 11 were for study partly in the Region with visits to other countries outside the Region (inter-regional). This year's percentage of intra-regional fellowships (44.~) is s11ghtly lower than that reported last year ( 48. 7%) •
The Regional Committee has on a number of occasions adopted resolut10ns recommending that training facilities within the Region should be used as widely as pOSSible, and this pOint 1s once again brought to "lihe attention of governments as up to $2000 can be saved on a twelve-month fellowship if placement is made within the Region.
During the period under review, placement for study within the Region was also arranged for a number of candidates from Africa - 2, Americas - 1, Eastern Mediterranean - 2, and South-East Asia - 18. Annex 6 gives the distribution of vis1ts ~o this region by countries of study and region of origin.
I am glad to be able to infonn the Committee that there has been an impl'{)vement in the selection of candidates with adequate language preparation. Hovever, borderline cases do occur from time to time and I would stress again that nomination of fully-qualified candidates is most important, not only in ensuring that the awardee is able to obtain the maximum benefit from the fellowship, but also in promoting and maintaining good relationships with the teaching staff or receiving institution.
The fact that requests for assistance are greater than our resources underlines once again the importance of early submission of fellowship applications. Schools of public health and nursing in the United States of' America and Canada have set definite closing dates for accepting applications and if the completed fonns are not received in the early part of the year, placement of candidates becomes difficult, if not impossible. It would greatly facilitate matters if governments unable to meet the deadline for submission of fellowship fonns would inform the Regional Office so that the resultant II savings If may be used to implement some of the projects in the supplementary list. In this way the money available will be used to the best advantage of all government s in the Region.
/ A further report •••
It.: I",\'v-V I Co
page 24
A further report on the appraisal of WHO fellowships awarded in the western Pacific Region was distributed to governments during the period under review. This appraisal was based on 128 follorT-up reports of fellows with utilization statements from governments obtained two or more years after the fellows' return home. The co-operation of former fellows and beneficiary governments in submitting these reports is gratefully acknowledged. Further efforts are, however, necessary to secure complete returns about all former fellows in order that the appraisal can become progressively more systematic.
The distribution of the fellowships according to fields of study and countries of origin is shown in Annex 7.
It will be noted that there has been a slight decrease in the number of fellowships awarded in the fields of tuberculosis control, nursing and maternal and child health, and an increase in those in dental health, mental health, rehabilitation and occupational health, as compared to the previous years' awards. The distribution as far as the major fields, such as public health administration, environmental sanitation and malaria control are concerned remains much the same.
In conclusion, it can be stated that steady progress has been made in perfecting the use of fellowships as a tool for achieving specified aims. The report on the employment of returned fellows in the western Pacific Region showed that 9610 of them were doing work which was appropriate to the studies undertaken. It is also gratifying to be able to report that in a number of countries the return of technical personnel from WHO fellowships has resulted in increased activity in WHO-assisted projects. The continued full use of returned fellows in their field of study will do much to ensure that the fellowship programme is a successful one.
3 COMMUNICABLE DISEASES
3.1 Malaria
Technical assistance and advice to malaria programmes have been considerably extended during the year under review and encouragement has been given to governments conducting malaria control programmes to change their objective from control to eradication. Fellowships in the field of malaria eradication have been awarded to strengthen malaria services and recent technical information has been distributed to antimalaria workers in the Region.
Continued emphasis has been given to inter-country co-ordination and co-operation of malaria programmes, especially among countries with common box:ders. In addition to the Antimalaria Co-ordination Board (the members of which are the Governments of Burma, Cambodia, the Federation of Malaya, Laos, Thailand and Viet Nam) and the Borneo Conferences (the participants of which are representatives of the Governments of Brunei, Indonesia, North Borneo and Sarawak), similar inter-territorial co-ordination of malaria programmes is being established between the British Solomon Islands protectorate, Netherlands> New Guinea, the Territory of Papua and New Guinea and possibly New Hebrides. The third meeting of the Antimalar1a Co-ordination Board took place in Rangoon in December 1958 with partiCipants from .the six Member Governments and observers from the respective United States Operations Missions. It is planned to hold the fourth meeting in Kuala Lumpur next December. The seventh Borneo Conference was convened in Kuching last December, with representatives from all the participating governments, and an eighth meeting was held at Keningau, North Borneo, in June 1959.
IAn agreement is •••
A canvasser taking blood samples from a child. There are 500 canvassers and 100 helpers working with Malaria units of the Philippine Government's Department of Health, financed by the 'WHO Malaria Eradication Special Account (MESA).
MALARIA
SMALLPOX
Hunting for mosquitoes among the foliage and undergrowth along a river, bank in the rural areas of the Philippines. New settlements and virgin areas being opened in the expansion of the Philippines offer many problems to the malaria eradication campaign.
A quarter of a million doses of vaccine were shipped to Singapore from Manila during a smallpox-outbreak.
t\ ... J ..... v-...,;t "-page 25·
An agreement is being negotiated between the Government of the Philippines and WHO for the implementation of international training courses in malaria eradication techniques for senior officers (malario10gists, entomologists'w1d sanitary engineers or sanitarians) and junior officers (technical grades) at the Institute of Malariology, Tala. The courses are being conducted by the Department of Health with assistance from WHO and lCA and are open to partiCipants from all countries within the Region and outside. steps have also been taken towards the establishment of a training course in the French language.
In China (Taiwan) the surveillance programme, which was worked out in co-operation with the Government and ICA started in July 1958 and is progressing well. Very intensive action is being taken against the few remaining foci of transmission. This programme is partly financed under MESA.
An extensive surveillance programme financed under MESA was implemented in the Philippines from July 1958, covering two-thirds of the population in the malarious areas. Spraying operations continue in the rest of the country and are being extended to the difficult mountainous areas by the efforts of the Government assisted by ICA.
In CambOdia, as a result of investigations by the No. 3 Advisory Team on Malaria Eradication, a new anopheline speCies, A. pampanae, was described. Further investigations are recommended to assess its importance as a vector of malaria. The team also suggested continued investigation of' the secondary vectors, A. 1eucosphyrus balabacensis and also A. maculatus in which oocyst infections have been detected. Assistance from l.mSA was given by provision of additional international staff - an entomologist and a sanitarian. Plans have also been made to try medicated salt in certain parts of Cambodia in an effort to stop malaria transmission in difficult areas. In this pilot project, assistance from MESA is being given by the prOvision of two international staff' members.
Country-wide insecticide coverage was reached in Sarawak towards the end of 1958 and since the middle of that year surveillance activities have been established in certain areas as a pilot project in order to find the most effecti ve and safe method suitable under local conditions.
FollOwing the visit of a consultant to Japan the Government is preparing plans to achieve total eradication. The Vietnamese Government, assisted by ICA, launched an extensive spraying programme. WHO has assisted in organiZing preparatory surveys and training of malaria personnel. A malaria preeradication survey was started in June 1959 by the Korean Government assisted by a WHO pre-eradication survey team. In Netherlands New Guinea a malaria control project is progreSSing, aiming at finding a method for interruption of transmission. For this purpose a pyrimethaminized salt project has been implemented during the year. The malaria project in this territory is assisted by UNICEF. For some years country-wide malaria surveys and investigations to ascertain a method to achieve interruption of transmission have been carried out by the Government of the Terri tory of Papua and New Guinea" and plans have been prepared for an eradication campaign. The Goveroment of the Federation of Malaya has agreed to establish a malaria pre-eradication survey, the plans for which are in preparation, and it is ant;icipated the project will begin in January 1960, with WHO providing as~istance under MESA.
The Third Asian Malaria Conference was convened in New Delhi in March 1959, providing an opportunity not only for malaria experts from countries
lin tl;le south-East •••
(t~ ,""V"'V) c:. page 26
in the South-East Asia and Western Pacific Regions to exchange views and have technical discussions, but also for the respective ministers of health to aonfer on the administrative aspects of malaria control and eradication oampaigns, and to share experiences in the planning of operations.
As in previous years, UNICEF and lCA have been of considerable assistance in developing and expanding malaria activities in a number of countries in the Region.
3.2 Tuberculosis and BGG
Our objectives continued to be, firstly, to work out and apply simple, cheap and effective methods of controlling tuberculosis on a public .health basis; secondly, to encourage and assist control programmes based on such methods; thirdly, to stress the importance of training more skilled personnel and assisting in such training so far as resources permitted; and fourthly, to encourage BOG vaccination and its consolidation into public health programmes.
Progress and results: in China (Taiwan), 'Where international personnel have been assigned throughout the year, more chest clinics have been approved, case-finding and bacteriology have increased greatly, and over 12 000 patients are receiving domiCiliary chemotherapy under supervision. The BGG work is tully consolidateCf:loand, as the result of a special effort, about 50% of the children tested were in the pre-school age group.
In Viet Nam, 'Where a WHO senior adviser has been assigned, progress has been made and the new dispensary opened this year.
The cumulative totals of the BOG campaigns assisted by WHO and UNICEF at Decembtllr 1958 are as follows:
Oo\Ultry given co~letin~ ne~ative vaccinated test test
Brunei 33 018 27 427 10 022 10 293 Gambodia 1 236 113 1 146 127 572 8,58 567 022 Hong Kong 529 462 467 743 123 294 247 647 Malaya 658 521 616 91~7 328 357 359 341 Sarawak 154 551 129 303 57 243 58 594 Viet Nam 965 810 8,58 361 306 414 301 22:2
TOFAL 3 577 475 3 245 908 1 398188 1 544 200
The BOG campaignslin China (Taiwan), Philippines and Netherlands New Guinea showed the following cumulative totals at May 1959:
tested •••••••••••••••••• 16 846 383 completing test ••••••••• 14 880 340 negative •••••••••••••••• 8 176 922 vaccinated •••••••••••••• 8 196 856
The BGG campaign in Singapore showed the following cumulative totals at April 1959:
tested •.•••.•••••••••••• completing test ••••••••• negative •••••••••••••••• vaccinated ••••••••••••••
228 949 220 237 90 034
123 187
/I nt ern at ional ...
H': I-'V-V' '-page 27
International assistance is continuing in China (Taiwan), the Philippines and Viet Nam; it ceased during the year in Cambodia and Netherlands New Guinea where the work is being carried on under government auspices.
A refresher course in tuberculosis was held in January and February with the collaboration of the Government of Fiji. It was attended by assistant medical officers from many Pacific Island territories and was extremely successful.
As regards assessment, tuberculosis researCh is very active now~s and the views of experts are liable to Change, all of 'WhiCh makes the assessment of control methods difficult. However, I believe that the II forward look ", meaning our expectation of more widespread chemotherapy, especially on a dOmiciliary basis, and the development of a heat-resistant BCG vaccine in Japan, is justified. The most convinCing assessment of the programme in China (Taiwan), for example, will be to repeat the prevalence survey in five years time.
WHO believes that the assessment of BCG vaccination is very important. Because of the difficulty of training national personnel in the teChnical methods, I am proposing to you a regional BCG assessment and advisory team for 1961 whiCh will not only carry out the work but also train local personnel.
As regards assessment of the vaccine itself, an independent expert visited selected laboratories in March and April 1959 and reported on their teChnical standards.
TeChnical questions whiCh still await solution include a truly portable x-r~ unit for survey work; the best drug or drug combination for treatment programmes and the most effective methods of organizing and supervising them; and perfecting the heat-resistant BCG vaccine from Japan so that it can be used on a world-wide scale.
A major trend is the 1/ forward look If I have mentioned before and I am happy to note that governments are already alive to this for tuberculosis control was Chosen as the subject of our TeChnical Discussions for this year. Another trend is the increased number of requests for WHO assistance. In addition to those mentioned already, the Federation of Malaya will have the services of a consultant later this year and French Polynesia will have another next year. A realistic plan devised for tuberculosis control in western Samoa has led to a request for a similar project in American Samoa.
Although I have naturally stressed the countries and territories whose programmes are assisted by WHO, I do not forget those 'WhiCh are doing notable work without any help from us. They include Australia, Hong Kong, Japan, New Zealand and Singapore. I am happy to acknowledge the help of several of them in receiVing WHO fellows for training and for their participation in our Expert Panel on Tuberculosis.
3.3 Venereal Diseases and Treponematoses
The activities during the past year continued to be concerned with ~iving technical advice to governments on their yaws problems, assisting with the effective planning, organization and execution of control projects and with raising the level of technical training of national personnel. The immediate objective of these activities was the control and eventual eradication of yaws but an ultimate objective was the encouragement of countries to
/establish as •••
,,- I ~'V-""I .... page 28
establish as effective a rural health service as available resources would permit, through the development of the necessary post campaign follow-up activities.
The Organization continued to give technical assistance to the control projects in operation in Laos, the Federation of Malaya, Netherlands New Guinea, the Philippines and the Pacific Islands Territories of the British Solomon Islands Protectorate, the Condominium of the New Hebrides, Fiji, the Gilbert and Ellice Islands Colony and western Samoa. Full-time WHO personnel were assigned to Laos and to the Pacific Islands Territories Where they assisted the projects in the Condominium of the New Hebrides, Fiji and western Samoa.
In the Condominium of the New Hebrides, 99.210 of the population was examined and treated at the im tial treatment survey in 1958. The prevalence of total active yaws found was 12.510 and of infectious yaws 6.02%. The field teams carried out the work often in difficult terrain, including some Which was virtually untouched by medical workers before the yaws campaign. Co-operation was good except that the "Jon Frum It adherents of Tanna declined to ,be treated. The resurvey of the territory ,.,as started.
In Laos, the initial mass treatment survey was completed when the field teams visited some remote and formerly inaccessible areas. An average prevalence of 3.7?J{o of yaws was found among the 450 000 people examined, or more than 80% of the estimated population of the area of operation. Resurveys of the high endemic areas of the provinces were carried out and based on the findings it is estimated that the prevalence of yaws fell in savannakhet from 5.12% to 0.2r:1{o, in Pakse from 3.2410 to o.6(Jjo and Saravanne from 1.94% to 0.4r:1{o. WHO aSvistance to the yaws portion of the project has terminated and a final report on the work is being prepared.
In Western Samoa, during the 'Yaws Week III of 1958, the rural health personnel succeeded in completing the third resurvey of the total population in twelve days. Only 12 cases of infectious yaws were found among the 105 822 people examined, a prevalence of 0.001%. Thus the prevalence of infectious yaws has progressively fallen since the initial treatment survey in 1955-56 When it was 33.r:1{o. This fully integrated project has come closer to the eradication of the disease.
In Fiji, the Government undertook the resurveys in combination with a BCG campaign. The British Solomon Islands Protectorate and the Gilbert and Ellice Islands Colony have planned for resurveys with the help of the WHO-yaws control team, Pacific Islands Territories, later in 1959. In Netherlands New GUinea, the campaign has been extended into the previously uncontrolled areas and vigilance has been maintained on the frontiers of these areas. In the Philippines the integration of the work into the rural health units was continued.
Negotiations were completed with the Government and UNICEF for a control project for Cambodia which is due tv start later in 1959. The control project proposed for the Kingdom of Tonga was postponed until December 1960 at the request of the Government and the New Zealand Government has requested an assessment during 1960 of the yaws work done in the Cook Islands.
Th.'e continued assistance of rCA to the project in Laos and of UNICEF to the o~her projects greatly facilitated their development and effective oper~tion.
/The first •••
VENEREAL DISEASES
An Island-wide venereal disease control programme is being carried out in Taiwan with WHO assistance.
YAWS CAMPAIGN
An Assistant Medical Officer examines children during a yaws campaign in Fiji. A WHO team has been helping Governments of South Pacific island territories in a yaws eradication campaign.
.1- I •. ,..,.. '" J ... page 29
The first inter-regional yaws control co.ordination meeting was held in Kuala Lumpur in April 1959. Participants from Burma, Cambodia, Indonesia, Laos, Federation of Malaya, Philippines and Thailand attended. The personal contacts between the partiCipants, all of Whom were actively engaged on yaws control projects, resulted in many informal discussions and in at least one agreement to hold an inter-country board or meeting to consider the problems of yaws eradication in the border areas. This meeting would not have been possible without the financial assistance given by UNICEF.
3.3.2 Venereal Diseases
Activities during the year were concerned with technical advice to governments on their venereal.disease problems, assistance in the effective execution of established cont~ol projects and in raising the level of technical training of their health personnel.
The control project in China (Taiwan) continued to receive technical assistance from the Organization, but progressively greater responsibility for the project operation was placed on the national personnel in view of the impending withdrawal of WHO personnel.
Further progress was made in raising the standard of performance in this island.wide project which operates through 431 health units of the permanent health .service, by means of continual refresher training and supervision, thus making the complete integration of the work into that of the permanent health services more effective.
During the year 610 600 people were blood tested for the first time and 530 608 new patients were clinically examined. The treatment rate achieved was more than 85% of those patients found to require treatment and the reactivity rate among pregnant women examined fell further to 4.1% as compared with 4.9% for 1951 and 1.:;fo for 1954.
Special efforts were devoted to prevention of the disease among mothers and children through close co-operation with the maternal and child health programme, to the control of the disease among the armed forces through technical assistance and exchange of epidemiological information with the armed forces medical services, as well as to the control of the disease among the group of promiscuous women. Much thought was given to setting up trials with an effective prophylactic against the disease which would be acceptable to the patients.
Health education of the publiC, especially among selected groups at most risk, was extended, as well as epidemiologic field work. The traditional customs and beliefs of the people, although changing slowly in regard to the venereal diseases, still hampered the efforts at health education and follow-up.
The project continued to receive UNICEF assistance in imported supplies and equipment and an agreement for the continuation of this assistance on a sliding scale throughout 1965 has been discussed. The Government has contributed a great deal to the successful operation of this large-scale project but the present conditions of limited funds and staff ceilings hBve hindered more rapid progress. The Joint Connnittee on Rural Reconstructiol1 continued to assist the project.
3.4 Other Communicable Diseases
3.4.1 Leprosy
The objectives have been to recommend, and to make more widely known, the approach to leprosy control recommended by the Expert COmmittee; to
...... ,_ ..... _ ... ,c-page 30
assist governments to plan control work on these lines; and to assist in training personnel.
It is good to report an increasing acceptance of the concepts of selective, rather than compulsory and total, segregation, and of more domiciliary and less institutional treatment. There is also a gro'Wing awareness of the need for changes in legislation in certain areas.
The prevalence of leprosy, so far as it can be estimated, varies greatly in diff'erent parts of the Region. In the British Solomon Islands Protectorate, where it is high, the control programme planned by the WHO consultant has been continued by the Government, with some supplies from UNICEF. In the Philippines, where it is moderate, the control programme has made notable progress under expert leadership. Specially-trained mobile teams are used for case.finding, while treatment is given by. permanent public health units reinforced by special treatment teams. Emphasis is on domiciliary chemotherapy and approximately 3500 cases have been found since the project started.
WHO has continued to help in training personnel by awarding f'ellowships, and has acted in an advisory capacity regarding enquiries from Cambodia, Korea and Viet Nam.
The exchange of scientific information was much stimulated by the WHO Inter-regional Leprosy Conference held in Tokyo last November and attended by participants from sixteen countries, a number of eminent consultants, and fifteen observers.
Technical questions still needing attention include the best methods for organizing case-finding and treatment programmes; techniques of health education f'or spreading modern concepts about the disease; and a number of problems "Which can only be solved by f'urther research.
One major difficulty is the reluctance in some quarters to bring legislation into line with scientific advances, and another is the slowness with which people, not only the general public but also professional and political groups,can be convinced of the modern viewpoint about the disease.
However, a trend can be observed: public opinion is moving in the right direction.
3.42 smallpox Eradication
In 1958 reports of smallpox cases indicated downward trends in CambOdia, Korea and Viet Nam. Cases ,,,ere also reported from the Federation of Malaya. A small outbreak occurred in Singapore in early 1959 following entry into the country of a case 'Who has previously submitted a valid international vaccination certificate.
In the endemic countries of the Region, smallpox control programmes are integrated into the national health programmes and, with one exception, all the countries produce smallpox vaccines, mostly of the wet type. The problems of eradication recognized by the health administrations are chiefly those connected with the org~ization and effective utilization of available health personnel and the use of potent vaccines in the field.
The positive aspects of smallpox eradication in the Region~ be summarized as follows: (a) award of fellowship to a professional laboratory
/worker from •••
I I
page 3J.
worker from Korea to study the production of freeze-dried smallpox vaccine; (b) request from the Government of Cambodia for WHO .technical advisory assistance in organizing and developing a national smallpox eradication campaign; and (0) ill making arrangements for the smallpox vaccines produced by the Pasteur Institute in Cambodia to be tested periodically at the Poliomyelitis Centre in Singapore; (d) report of the Ministry of Health of Japan that freeze-dried smallpox vaccine based on a modified Lister Institute technique can now~e mass-produced.
If a smallpox eradication campaign is to be organized in the Region, certain measures are recommended to governments; the utilization of WHO laboratory centres for testing the potency of vaccine produced by countries in the Region, rigid observance by individual countries of the international convention of smallpox vaccination for international travellers and requests to the Organization for technical advice in the planning and administration of smallpox eradication programmes. Funds will be made available for the services of a short-term consultant to render technical advice on eradication and fellowships provided for smallpox vaccine production, and a smallpox eradication conference in 1960 has been planned by Headquarters. It is hoped that countries in the Region where smallpox is still endemic will take full advantage of the assistance and services offered by the Organization.
3.4.3 Trachoma
As stated in my previous report, the trachoma control campaign in China (Taiwan) is one of the largest campaigns in the world. In June 1956 all the children in schools, numbering over two million had been examined and those found with trachoma, treated.
During the year under review the campaign was directed toward all new school entrants, the aborigines, and in selected high incidence areas, the family contacts of school-children. UNICEF continued to furnish antibiotic ointment and other supplies and WHO provided technical advice including the services of a short-term consultant. The consultant evaluated the results among the school-children, 500 000 family contacts of school-children and 140 000 aborigines. He also evaluated the results of the trials using several drugs in various forms on different treatment schedules.
In his general remarks, the consultant said, liThe develop~ent of the antitrachoma campaign in Taiwan is really remarkable and shows both the capacity of the organization and the high spirit of sacrifice of the technical staff and of the teachers· and u ••••• I can say that the results of the campaign are fairly good, but veiled by the presence of a high rate of new infections, and some re-infections and relapses •••••• I think that the continuation of the campaign will be very useful and that the success will be more evident with the addition of certain measures."
Among the first year pupils, he found that new school-children coming from communities where family contacts received blanket treatment had a lower incidence of trachoma and a good rate of cure in the treated cases. As an average, 28.?Jfo of cases were cured and 19.710 improved. However, he also found among middle and upper class pupils who had been treatec:l, a lcY{o relapse or re-infection and 27% new infection.
In the case of family contacts, the finding was that supervision was still inadequate, it was apparent that children under one year of age were inadequately treated, and among adults it was thought that there was an over.
economical use of the ointment.
/The results of •••
page 52
The results of the trials i'Tere evaluated. Although they were not absolutely conclusive, it brought out the fact that sulfa treatment was effective and without risk and that there was little difference in the effect of antibiotic treatment, whether given twice a day for six weeks or eight weeks either in the form of ointment or oily drops.
The consultant recommended the provision of an ophthalmologist on longterm assignment to go further into the epidemiology of trachoma in Taiwan, to assist in refresher training of the doctors and nurses connected with the campaign, in the supervision of the routine part of the mass campaign and in the planning, implementation and evaluation of additional trials. He also recommended antibiotic ointment alone during the first and second years and antibiotic ointment combined with sulfa tablets by mouth during the third year.
A WHO fellowship has been awarded to the national project leader so that he may have the opportunity of further study in the field of statistics and epidemiology. Every attempt is being made to hasten the recruitment of an epidemiologist for the Institute of Public Health in Taipei so that he can assist the mass campaign and provision for this post has been made in the WHO regular programme and budget.
Although health education and intensification of blanket treatment of family contacts might improve the situation, it may be necessary to institute annual examination and treatment of trachoma among school-children as has been the experience in several projects elsewhere.
4 3.4.4 Clonorchiasis and paragonimiasis
At the request of the Government, WHO assisted in a survey of the clonorchiasis and paragonimiasis situation in Korea, where fresh-water fish, crabs and crayfish are often consumed in a raw state. The survey was conducted by means of skin tests emplOying highly specific antigens.
Although there are known endemic areas, clonorchiasis and paragonimiasis are also found among people living beyond these areas as a result of the mass movement of the population during the armed conflict. It was found that these two conditions are very prevalent even among young children and to a greater extent in males than in females. The rates vary from place to place and the two conditions often co-exist. It is estimated that there are four and one-half million cases.of clonorchiasis and one and one-half million cases of paragonimiasiS in the Republic of Korea.
The Ministries of Education, Agriculture and Forestry and of Reconstruction in Korea are also very interested in the problem and fully share the concern of the Ministry of Health and Social Affairs. Advice and assistance have been given to the Ministry of Health and Social Affairs in the development of a project proposal.
4 AcrIVITIES OF THE EPIDEMIOLOGICAL INTELLIGENCE STATION
The E,pidemiological Intelligence Station in Singapore is responsible for the administration of International Sanitary Regulations and Conventions in a wide area covering the whole of the Western Pacific and South-East Asia Regions and a part of the Eastern Mediterranean and African Regions.
During the period under review, there were 1182 epidemiological reports and quarantine notifications received by cable, 4065 by airmail and 751 by surface mail, making a total of 5998 reports and notifications. Of this total, 5476 were received from national health administrations and local health authorities.
/Quarantinable •••
, page 33
Quarantinable diseases were known to have occurred in the following countries within the area served by the station during the period under review:
PlAGUE SMAIJPOX (continued) SMAIJPOX (continued)
Burma At ghani stan Sudan India Burma Tanganyika Iran Cambodia Thailand Kenya Ceylon UAR (Egyptian Region) Madagascar India Viet Nam
Indonesia CHOLERA Iran TYPHUS
Iraq Burma Kenya At ghani st an India Korea Iran Nepal Kuwait Korea Pakistan Malaya Union of South Afrioa Thailand Muscat and ()nan UAR (Egyptian Region)
Pakistan SMALLPOX Portuguese India YELLOW FEVER
Qatar AND RELAPSING FEVER Aden Colony Saudi Arabia Aden Protectorate Singapore Nil
Smallpox infection on board six ships was notified by health administrations, of 'Which one was a ship with pilgrims returning from Jeddah, and among the infected persons were 8 pilgrims, 4 international travellers and 3 crew members. There was also a report of disembarkation of a case of smallpox from an airliner.
Important and urgent epidemiological information, including notification of infected ships or aircraft, vmen received, was transmitted to WHO offices and the health administrations without delay. During the period under review 1248 advance notifications were despatched, of 'Which 289 were by telegram, 864 by airmail and 95 by messengers (for Singapore only).
A weekly bulletin giving the weekly incidence of quarantinable diseases in ports and airports and a summary of notifications f'rom governments under Articles 3 and 6 of' the International Sanitary Regulations were issued for broadcast by radio stations f'rom Singapore, Saigon, Manila, Sandakan, Hong Kong, Tokyo, Colombo, Madras, Karachi , Tananarive and Keelung. Information on outbreaks of' quarantinable diseases in local areas other than ports and airports, 'When assuming serious epidemic proportions, was included in the bulletin. The broadcast was made by the radio stations according to a f'ixed schedule, some daily and some once or twice during the week.
Inf'ormation received f'rom health administrations regarding the application or withdrawal of' sanitary measures against arrivals f'rom inf'ected local areas was transmitted to the other health administrations directly concerned by means of' advance quarantine notifications. Altogether 1208 quarantine notif'ications were despatched, of which 312 f'or national health administrations, 130 f'or local health authorities and 766 f'or WHO offices.
INFLUENZA
No serious epidemics of' inf'luenza were reported f'rom any of' the countries in our area. Localized epidemics were notif'ied in February from diff'erent parts of' India and investigations in all cases _except one had shown A2 strains to be responsible.
lIn Japan •••
/ - "/
page 34
In Japan several schools in Sai tama Prefecture, north of Tokyo, "Tere affected at the end of February and the beginning of March. There was also a mild epidemic in a psychiatric hospital near Tokyo. The viruses isolated were all found to belong to influence virus type A2.
Indonesia reported the presence of an influenza-like disease spreading within its territory in April and May 1959, which in some areas affected about 50{0 of the population.
Ceylon notified on 29 May 1959 that outbreaks of influenza were reported from various parts of the island.
In Australia the first case of influenza was reported on board a ship which arrived at Darwin from Hong Kong on 9 March. An epidemic of A2 influenza followed at Batchelor, in the Northern Territory, and among the native population at Arnhem Land. Two localities in Queensland were affected during the second half of April. Nine A2 strains were isolated from cases in Victoria during April and May, and one 'explosive ll outbreak was reported. Virus A2 was also isolated in Western Australia, and was responsible for outbreaks in Tasmania in March and at a mill tary station in New South Wales in April.
CHOLERA
Cholera incidence within the area in 1958 was higher than during the preceding four years, and outside India and Pakistan, epidemics were also present during the year in Thailand and in Nepal.
India and East Pakistan
In India and East Pakistan the number of cases rose from an annual total of 64 000 cases in 1957 to about 81 000 cases in 1958, but .Teekly notifications received from the respective health administrations during the first . half of 1959 indicated a definite decline in incidence.
West Pakistan
From West Pakistan where cholera had been absent since October 1949, there was reported an outbreak of cholera in November 1958 which affected four local areas including Karachi and Lahore cities. Altogether 321 cases with 64 deaths were reported during the period 1-26 November 1958, of which 289 cases with 49 deaths occurred in Rohri Town (.Sukkur District) where the outbre.ak originated. The source of infection was traced to a family which had ~eceived visitors from India Who brought with them holy water from the Gan~es river. The first two cases were children who drank the water and died of cholera on 2 November 1958.
Thmlano.
In May 1958 cholera broke out in Thailand where the disease had been absent since 1949. The first case occurred in Bangkok on 22 May 1958 and the epidemic spread rapidly to reach its peak in the .reek ending 21 June 1958 when 2140 cases were notified. Weekly incidence remained high throughout July but as from 1 August there was a sudden decline and the number of cases fluctuated between 14 and 157 cases. In the last week of January 1959 the weekly incidence abruptly increased from 16~ to 523 cases, and then to 998 and 1157 cases respectively in the next two weeks. In the subsequent week the number of cases dropped to 680 and as from the beginning of March there has been a steady decline. Altogether, 18 959 cases with 2336 deaths
/were reported •••
•• / ."w •• U/ ,_
page 35/36
were reported in the country since the beginning of the epidemic on 22 M~ 1958 to 27 June 1959, of which 11 164 cases with 867 deaths were recorded in Bangkok and the neighbouring Thonburi Province.
Nepal
.An epidemic in the Katmandu area accounted for 2557 cases with 367 deaths and lasted for 17 weeks from July to November 1958. This was the first official report from the Government of Nepal, but according to information unofficially gathered by SEARO, cholera was known to have occurred regularly in low prevalence in Katmandu area for 3 or 4 months in each of the past few years.
SMALLPOX
A localized outbreak of smallpox occurred in Singapore which accounted for 10 cases with 2 deaths during the period 13 April to 11 MS\)" 1959. The source of infection was traced to a new arrival from India.
/p AFfJ! III •••
"-I -' .... -"1 "-page 37
PARr III. SPECIAL EVALUATION SUMMARIES
A complete list of projects current during the year will be found in Part IV. The following projects are described in fuller detail as they were completed during the year.
Project number
Japan 14
Laos 2
Malaya 1
Philippines 29
Singapore 2
Title
Nursing Education
Treponematoses Control: completion yaws control part of project. New phase of project redefined as assistance to the Central public Health Laboratory
Nursing Education
Midwifery Training
University of Malaya
/Nursing EdUcation •••
page 38
1 Nursing Education Project, Japan
WHO's assistance to the project, Which started in August 1955, formally terminated in December 1958 When the WHO nurse educator completed her assignment. The project was developed with the following objectives: (a) to strengthen basic nursing, midvlifery and public health nursing education; (b) to develop a centre for post-basic training at the Institute of Public Health, Tokyo; and (c) to prepare qualified teachers for the centre.
The planning of the project was sound and the counterparts well equipped by training and experience. Funds to assign permanent staff were not available at the outset, but as the project developed, the ultimate placement of the temporarily appointed staff strengthened the field teaching agenCies and supported co-operation between the Institute and the field agencies: the national hospitals and the Tokyo Public Health Nursing School. Favourable attitudes and support on the 'part of officials has characterized the whole project. contacts during field trips were cordial and there have been instances of ready acceptance of suggestions by educational directors and school directors. There has been somewhat less evidence of insight on the part of nursing service administrators but when they have had a chance to work with well-prepared educational directors they have been sympathetic to suggestions for planning.
The WHO nurse worked as an adviser of the nursing staff at the Institute of Hygiene, contributing as requested in planning and teaching. Courses taught included n Methods of Teaching, If IIAdministration of Schools of Nursing, " "Curriculum Planning, " and a unit in 'Trends of Nursing. \I Activities outside of the Institute were planned by the Nursing Counsellor, Ministry of Health who was one of the counterparts. Weekly conferences were held with the counterparts during the first two years and on need less frequently in the third year. Weekly staff conferences permitted the exchange of viewpoints on current problems. Members of the staff attended courses given by the WHO nurse to the stUdents and pertinent ideas developed in those courses were applied as appropriate in the staff plans for successive years. Projects developed outside the Institute were used in the Institute teaching and vice versa.
The one-year instructors' course at the Institute of Public Health is now well established. The contents J methods and schedule are being planned on the basis of the responsibilities and conditions 'Which the graduates are likely to encounter in their own schools and on the basis of careful evaluation each year. Since April 1955, 59 clinical instructors and 38 midwifery instructors (13 in a seven-month course) have been trained. The content, methods and schedule for the Health Guidance Course are also evolving on the basis of future responsibilities of the graduates and on the basis of careful evaluation by the departments concerned. Field work is planned on an individual basis. Public health nurses have been added to the teaching force and the inclusion of preparation of teachers for schools of public health nursing is receiving consideration.
The Institute of public Health now has a nursing staff 'Who are qualified to carry on the programme. Fellowships to permit selected faculty members to undertake advanced study in special fields such as mental health and social and occupational health would help to strengthen the educational programmes being offered.
Prefectural chief nurses by their attendance at regional meetings are aware of the suggested methods of planning for schools of nursing. Statements presenting methods for planning classrooom work and clinical experience,
!developed for •••
developed for the three types of programmes, have been interpreted to and studied by educational directors of all the schools in Japan. These statements are 'lSeing used in the teaching of curricul'lml planning at the Institute. A study of curricula is in process 'Which is designed to result in recommendations for change in school regulations.
The Nursing Department at the Institute has been strengthened by the addition of two clinical nurse instructors and two midwifery instructors. Co-ordination of activities at the Institute and the activities of the n~sing office at the Ministry have been strengthened by the project activities which depend on both groups. Co-ordination of planning with field agencies has grown in effectiveness. The change in attitudes towards nursing education is not yet measurable, but increased interest is general and new methods of planning have been adopted in some schools.
By 1959, six fellows will have completed a year I s study abroad. During the three years of the project using the methods and carrying on the patterns already established at the Institute, a most effective team has evolved. This has necessitated an acceptance of newcomers into the long-established nursing department and a masterly integration by the chief nurse of their various purposes. A new interest in the problems of basic nursing education has grown and present planning promises concerted effort on how to integrate preventive and rehabilitative nursing into the courses of basiC nursing stUdents and midwives.
It is considered that the overall accomplishments especially in regard to the development of an educational centre at the Institute and in the development of teachers for that centre are very satisfactory. Intensive study related to the methods of planning proposed through regional meetings has helped schools to analyze the nature of the problems they encounter in carrying out the method. The data they contributed in 1957 demonstrated to them that a majority of their difficulties are not teaching and educational but relate to nursing service, school and hospital administration.
2 Treponematoses Control Project, Laos
In Laos, the yaws control project came to an end with the withdrawal of the WHO medical officer at the end of June 1959. However, the laboratory part of the work will be continued with the assistance of a WHO laboratory medical officer and redefined as the Central public Health Laboratory. The Government plans to continue one field team for a further two years to resurvey the known residual foci and to help the rural health personnel with the surveillance for yaws,and is considering the establishment of a mobile rural health service.
Since the start of the project in April 1953, 465 323, or 94% of the population of the 2610 villages of the area of operation were examined and an average prevalence of 3.65% of active yaws was found at the initial treatment survey (ITS). Because of disturbed conditions and of limitation of staff to cover the vast area, resurveys were carried out of selected villages in ~ich the prevalence of yaws had been found to be above average •
.At the first resurvey, 95% of the 84 468 people of 305 villages" in 'Which f'our-fifth of the total infectious cases and one-third of the total active cases had been found at the ITS, were examined. 'llle prevalence of yaws was found to have fallen from 7."5% to 1.6%. It is estimated that the average prevalence of yaws in the 'Whole area had fallen to 0.4%. After a second resurvey of a sample of 64 of these villages of high endemicity, it was
I estimated that ••• /
.. - (-·--~t -
page 40
estimated that the average prevalence of the disease ha.d. fallen further to 0.210. At a third resurvey of a sample of the villages, no new cases were found.
The campaign has succeeded in bringing yaws under control to such an extent that the plan of the Government to retain one field team for two more years, to carry out resurveys of the known residual foci and to help the rural health personnel with surveillance for yaws, should achieve the eradication of the disease. Furthe!j in 1961 an eValuation of the project by WHO' is planned.
The national personnel, consisting of one officier de sante, counterpart of the WHO medical officer,four nurse team-leaders, nine injectors, four chauffeurs, two coolies and one secretary were all trained in techniques and methods of carrying out a mass campaign against yaws, in health education of the public and iohe diagnosis and treatment of the common minor ailments. They in turn trained the rural health personnel of the area of operation and took medical care to many remote areas for the first time. Those transferred from specific yaws control work to the malaria control project and perhaps the mobile rural health service will be able to make good use of their training and will be able to contribute much through their enthusiasm for field work in rural areas and for helping others.
3 NurSing Education Project, Malaya
This project, Which started in 1950, was terminated in December 1958 when the international team completed its assignment. The objectives of the project were: (a) to improve the standard of basic and graduate nursing education and the quality of nursing services; (b) to prepare nurses for administrative and teaching posts; (c) to adapt the nursing education programme to local resources and needs; and (d) to develop a well-organized programme for midwives.
Assistance was given in public health nurSing; basic general and paediatriC nursing education, clinical teaching; a post-basic education programme in ward administration and teaching, and in midwifery education, including domiciliary midwifery.
The original three-month courses in public health nurSing was extended to a nine-month course recognized by the Royal SOCiety for the Promotion of Health,. London. A total of 52 nurses took the three-month course and 42 nurses had completed the nine-month course by the end of 1958.
Assistance in midwifery education was given in Penang, Kuala Lumpur for the State of Selangor, and in Perak.
The curricula, teaching schedules, practical experience and examination procedures for Division I and Division II pupil midwives were revised and reorganized in accordance with the requirements of the midwives ordinance and regulations, this included domiciliary experience for both groups. Five Division I midwifery schools "Tere established and Division II midwifery schools were established in approved hospitals.
Refresher courses for health nurses holding a midwifery certificate in the organization and administration of domiciliary services were conducted in Perak in 1958.
Assistance in basic nursing education including clinical teaching and post-basic courses for trained staff was given in the Penang School of Nursing and Penang General Hospital.
/Emphasis wa~ •••
Emphasis was placed on the improvement and strengthening of classroom and clinical teaching. This included rearrangement of subjects and subject matter, Changes in emphasis an~ content to meet local needs, the improvement of teaChing methods and examination procedures.
Clinical nursing and nursing service
Direct assistance was largely confined to the Penang General Hospital although nurses and hospital assistants from other states attended the courses, and the workshops and students from smaller hospitals in the Federation were assigned to Penang for affiliation.
Refresher courses of two to six weeks duration in general nursing and special areas, post-basic courses of four months in ward administration and teaching, and a continuous programme of in-service education for nursing service personnel helped to improve the quality and management of nursing care and the understanding of the educational needs of student nurses in the clinic al areas.
In co-operation with the nursing staff, studies were made of ward activities ,_ staff duties and functions and nursing care requirements and suggestions on staffing requirements, aSSignment of duties for professional and non-professional staff, minimum requirements for equipment and supplies, etc., were prepared and in so far as possible they were implemented by the Administration. A clinical teaching programme was initiated and although service demands and acute shortage of qualified staff imposed definite limi tat ions , it developed slowly. Rotation of key nursing staff within the hospital was restricted, particularly in the teaching wards, Vlhich resulted in more stabill ty • Unfortunately, the practice of transfer on promotion continued,
The clinical teaching programme and services in the paediatric ward developed progressively during the three and one-half years of WHO assistance in this field and continue to improve under the direction of interested medical and nursing staff.
Rotation of the ward sisters through the School of Nursing for orientation to the nursing education programme, and rotation of the local tutors from the school to the clinical areas for a period of three months each, was most effective in establishing better relationships and understanding. Potential tutors were assigned as counterparts to the WHO staff in the wards for periods up to one year for guided experience in teaching and supervision prior to going abroad for study.
Three nurSing workshops were organized and conducted in 1955 and 1956.
A procedure manual was prepared and printed in 1954 and was revised in 1956 and printed in a second edition in 1958. Copies were placed in every hospital in the Federation.
A nursing education committee was appointed as an advisory body to study problems relating to basic nursing education.
The entrance requirements for admission to nurSing have been raised to Senior Cambridge level and selection procedure has been improved. Response to recruitment is satisfactory and the number of nurses graduating each year is increasing.
/The rapid expansion •••
The rapid expansion of services and the Malayanization of services have created an acute shortage of personnel prepared for senior positions.
The number of qualified nurses receiving preparation in special fields in the country and abroad should be accelerated to prepare personnel for leadership positions in teaching, supervision and administration to assure continued development.
4 Midwifery Training Project, Philippines
This project, Which began in October 1953, was terminated in December 1958 When the assignment of the WHO senior nurse educator was completed. The objectives of the project were to assist the Government to: (a) improve the standard of midwifery service throughout the country; (b) develop a wellorganized training programme for midwives according to the principles of education and recognized standards of midwifery practice; (c) direct a study of maternity nursing needs and resources~
The planning of the Midwifery Advisory Committee in consultation with the WHO advisers and counterparts has been effective in achieving the objectives of the programme; well-prepared counterparts were available from the beginning. The project has expanded from mid,v1fery training to include assistanca to the government schools of nursing, to improve pub.l1.c health nursing experience with particular emphasis on maternal and child health, and the inauguration of a pilot demonstration of integrated public health nursing supervision in ten selected provinces.
The preparation of the public health nurse/midwife as a teacher and supervisor of midwives began with the organization of a four-week course for nurse/midwife supervisors and nurse/midwife instructors. The first four groups were taught by the WHO consultant with the assistance of the counterpart and a nurse/midwife instructor. The preparation for hilot teaching was integrated in the course and a domiciliary obstetrical service was started in order to provide essential experience in home delivery care. upon return to their prOvincial stations the supervisors were able to organize classes for the hilots following the criteria prepared. Plans were also made for continuous in-service training so that all the rural public health nurses and mid.1i ves would eventually benefit from this type of training.
The pilot project of hilot teaching (2000 trained), Which finished in December 1956, is now being extended so that the quota of 4000 trained hilots can be attained. Analysis of statistical data revealed that the trained hilot in the remote barrio can become a very helpful aide to the professional health worker as there have been referrals of over 57 250 patients to health centres since the beginning of follow-up meetings in 1955.
Close co-operation has been maintained with the Division of Personnel Training, Health Education and Information and four out of the five regional training centres established by this division have offered the midwifery-inservice course. In add! tion to the School of Midwifery of the Manila Matern! ty and Children's Hospital there are two regional schools, one in Cebu Which was reopened in October 1955, and the other in Butuan, Which was opened in 1958. In addition, the number of private midwifery schools has increased from nine to twenty-two •
The number of mothers coming to the clinics for post-natal examination has considerably increased as have those attending for nee-natal examination. Referral procedures have been started between many of the hospitals and the health agencies so that home nursing care can be given after discharge from
/hospital ••••
... , .. _--, -page 43
hospital. Government schools of nursing have received consultant advice on the use of UNICEF equipment and the need for improved pubxic health nursing experience with special attention on prenatal consultation, domiciliary midwifery and home visiting. Two provincial hospitals with SChools of nursing have recently added a maternity service unit to the out-patient department to be used entirely for expectant mothers, well-child conferences and mothers' classes; five others are planning to do the same. Each will have a community domiciliary service.
A guide for maternity nursing was developed and distributed to public health nursing personnel in the rural health centres. Ccpies were also plac~d in the libraries of government schools of nursing and private schools of midwifery.
The training programme has shown steady progress towards its objectives. There has been marked improvement in the health centres since the nursing personnel have had in-service training, as well as good follow-up of registered prenatals, organizatio.n of mothers' classes, and surveys have been made regarding the need for hilot teaChing. Statistical data have been compiled showing the provinces where special assistance is needed in strengthening the maternal and child health services. The Division of Personnel Training and Health Education and Information has drawn up plans for a much enlarged programme of in-service training which started in 1959. The rural health unit personnel who have been in the field since 1953 and 1954 will be the first recipients of the midwifery in-service training Which will be given at the regional training centres.
The recent establishment of the Maternal and Child Health Division in the Department of Health will focus attention on the special needs of the mother and child and will bring closer co-ordination between the different aspects of the programmes for training and service.
5 University of Mal~a Project J Singapore
This project, which started in 1952, has consisted of technical assistance to the Department of Social Medicine and Public Health, Which is responsible for post-graduate teaching in the course leading to the Diploma in Public Health.
The first course for the Diploma was officially opened by the ViceChancellor on 5 October 1953. At this time WHO had recruited four lecturers: a professor in health education from the United states of America, a reader in medical statistics from the United Kingdom, a professor in applied physiology from the Philippines and an Australian expert as lecturer in applied nutrition. These consultants reinforced the teaching staff of the faculty and acted as advisers to the government authorities in Singapore and the Federation of Malaya. They also helped to teaCh undergraduate medical students, and students in education, adult education and social SCience, and also to train such medical auxiliaries as statistical coders, sanitary inspectors and medico-social workers.
The last part of the project originally envisaged an interchange of teaching staff between the London School of Hygiene and the University of Malaya. However, the non-availability of staff for the exchange led to much delay and in the end a lecturer in public health from the London School was seconded to the project. From the pOint of view of the University the major advantages of the exchange project were ones of communication and friendship with the London School. A fellowship was granted to the national counterpart to attend the Diploma in public Health course in the London School of Hygiene.
The WHO lecturer conducted teaching in epidemiology of non-communicable diseases and in epidemiological methods. He also instituted and taught a course
lin medical •••
in medical genetics treated as a part of epidemiology. A proposed course in epidemiology was submitted to other members of the teaching staff concerned in epidemiology instruction. No formal agreement on this was rea~hed although many of the recommendations were in fact adopted during the assignment of the WHO vi si ting lecturer. The task of securing continuity on the withdrawal of the WHO lecturer was complicated by several factors, the major one being the lack of a suitable counterpart to take over his part of the teaching.
Work in the undergraduate field consisted of orientation of undergraduate tutorial work so as to stress the social implications of case studies. This was achieved by drawing attention to the social needs which cases illustrate and to the existence of social facilities for meeting those needs or of social means requiring development.
Little time was available for research which .was restricted to an epidemiological survey of the influenza outbreak carried out in conjunction with the Department of Bacteriology and to a study of neo-natal jaundice in collaboration with members of the Department of Paediatrics.
The most urgent need in the future is the provision of stUdents for the course leading to the Diploma in Public Health. This is the only such diploma granted outside of the United Kingdom that is registrable in the United Kingdom. The Organization is offering fellowships to countries in the Region with a view to giving as much support as possible to the course. It is hoped that other regional offices will also take advantage of the facilities offered and offer similar fellowships to countries in their regions.
/pp.m IV •••
PARr IV. PROJEcr LIsr
Projects in Operation from 1 JUly 1958 to 3Q June 1959
This part of the Report contains a list of projects which were in operation during the whole or part of the period under review. In country projects, the aim given in the list is that of the goverDment in establishing the project, irrespective of the form or extent of WHO's assistance.
In the first coltunIl • R' means the regular budget; ITA It means Technical Assistance funds; I MESA' means the Malaria Eradication Special Account; and 'UNICEF- the United Nations Children I s Fund. Names of other co-operating agencies are given in parenthesis.
Only projects in which actual field assistance has been provided by WHO are included in the following pages.
/ Australia •••
... , .. ..., .. v, ... page 46
Project No. Source of Funds Co-operating Agencies
Australia 1 R
Australia
British Solomon Islands Protectorate
Cambodia 1 TA MESA
Description
Fellowships
Dental health. A ten-month fellowship for the diploma course in public health dentistry in the United Kingdom followed by observation visits to Norway and Sifeden.
Drug control. A six-month fellowship to study biological standardization in the united states of America, Canada, the United Kingdom and Denmark. Another six-month fellowship to study bio-assay and organization of biological standards laboratories in the same countries.
Other communicable diseases control. An eight-and-a-half month fellowship to study leptospirosis and viral and rickettsial diseases in the United states of America, the United Kingdom, Denmark, Netherlands, and Italy.
Public health administration. A two-and-a-half month fellowship to study public health administration in the United states of America, Canada and the United Kingdom.
Participation in Regional Courses and Meetings
See WPRO 53; WPRO 63; Inter-regional 23; Inter-regional 31.
Participation in Regional Courses and Meetings
See WPRO 35.
Malaria Control (Oct. 1950 - )
Aim of the project. To organize antirnalaria services; to demonstrate methods of malaria control with malaria eradication as the ultimate objective; to train personnel.
Assistance provided by WHO during the year. A malariolOgist and a public health sanitarian; and with MESA assistance an entomolOgist and a sanitarian.
Probable duration of assistance. Until 1962.
Work during the ;period under review. The 1958 spraying campaign was completed on 31 July; 191 31+2 houses in 3483 villages were treated and 946 601 inhabitants protected. It was agreed that 1959 should be considered as a transitory phase and that an overall plan of operations for malaria eradication effective from January 1960, be prepared. The outstanding problem remains the interruption of transmission in areas populated with seminomadic people where secondary vectors such as A. leucosphyrus balabacens1s are to be found. During the present year suspicion was raised on the possible role of A. maculatus in which two
/gut infections •••
Cambodia :3 R UNICEF (Asia Foundation) (Col~mbo Plan) (rCA)
Cambodia 4 TA UNICEF
.. / . '" .... / ,-page 47
gut infections were discovered. Mass drug administration was continued in the Snuol area but failed to bring about the interruption of transmission. It was decided to spray the 'problem areas II twice a year and to keep these areas under close epidemiological supervision.
Nursing Education, Phnom-Penh (Dec. 1951 -
Aim of the project. To set up a school of nursing in Phnom-Penh; to develop nUl1 sing and midwifery training.
A.ssistance provided by WHO during the year. (a) A senior nurse educator and three nurse educators - t"TO in general nursing and one in midwifery; (b) one twelve-month fellowship in techniques of obstetrical care and organi~ation and administration of school of midwifery.
Probable duration of assistance. Until 1961.
Work during the period under review. One hundred and ninety-nine new students were admitted to the School of Nursing during the period under review and two hundred second year students continued on the block plan of theoretical and practical nursing experience. Twenty-five new monitors were assigned to the School of Nursing as counterpart personnel. They are receiving on-thejob training in teaching content and methods and in clinical teaching.
A planned clinical teaching programme was implemented in eight teaching wards in January 1959 with one WHO nurse educator, one senior national counterpart and fifteen monitors. Clinical experience in psychiatric nursing vIas introduced.
Improvements in the facilities of the maternity hospital and the establishment of pre- and post-natal clinics, which can be utilized as experience fields for students, has strengthened the training programme for midwives. A national midwife was appointed as Assistant Director of the School of Nursing (midwifery) on her return from fellowship study.
A number of nursing and midwifery candidates have been selected for advanced study under Colombo Plan, IDA and WHO sponsorship.
Maternal and Child Health, Phnom-Penh (Jan. 1952 - )
Aim of the proj ect • To teach modern methods of maternal and child care adapted to the country's resources and culture; to improve the teaching of obstetrics and child care in the PhnomPenh schools of nursing and midwifery; to improve the teaching of paediatriCS, obstetrics and gynaecology at the Royal School of MediCine; to demonstrate methods of combining curative, preventi ve and educational health services j to extend maternal and child health (including school health) services and make them part of the country's health services.
Assistance provided by WHO during the year. (public health).
A nurse educator
,/probable •••
WP/RCIO/2 page 48
Cambodia 5 TA (lCA) (French Economic Mission)
Cambodia 9 TA UNICEF UNESCO (Asia Foundation) (ICA)
Probable duration of assistance. Until 196o~
Work during the period under review. WHO assistance has been exclusively concerned with the school health programme.. In Phnom-Penh, five more schools were included in the project, making a total of thirteen. Health supervision and health teaching activities were carried out in all these schools; inservice training of school-dispensary nurses continued in eight.
Health teaching was also continued at the Ecole Normale in Phnom-Penh and at the National Elementary Teachers Training Centre in Kandal province.
The WHO nurse and USOM staff participated in two seminars organized by the Department of Education for provincial teachers.
Royal School of Medicine, Phnom-Penh (July 1953 _ )
Aim of the project. To improve the standard of teaching at the Royal School of Medicine to a professional level; to expand facilities for training of officiem de sante (assistant medical officers).
Assistance rovided b WHO during the year. (a) Four lecturers, one in ophthalmology, one in radiology part of the year), one in medical phYSics and one in physiology (only one month); (b) collective study grant for ten students enrolled in the medical degree class.
Probable duration of assistance. Until the end of 1962.
Work during the period under review. The Organization provided teaching in ophthalmology during the entire academic year, part of the year in medical physics, and radiology, and one month in physiology (due to the sudden serious illness of the lecturer).
In 1958-59 academic year there were 18 new students in the medical degree section; 12 in the second year of study. In the 'officier de sante tt section 29 students in the first year and 33 in the second year.
There are eight doctors undergoing specialization abroad Who will jOin the teaching staff of the school on completion of their training.
Rural Health Centre, Takhmau (Jan. 1957 - )
Aim of the project. To plan and implement a comprehensive and well-balanced public health programme at the provincial level; to develop model public health services in the province of Kandal; to use the facilities of the Takhmau centre for field training of all categories of medical and health personnel.
The project is to be carried out in conjunction with the development of rural communities and agricultural expansion and in co-operation with the UNESCO.assisted fundamental education projec.t in the rural areas. WHO activities are correlated with
/thoBe of the ttt
Cambodia
China 1 R UNICEF
.. ~ , .. _--,-page 49
those of the lCA, which is assisting the Government with the construction and supply phase of the project.
Assistance provided by WHO during the year. (a) A public health of'ficer, a public health nurse and a nurse/midwif'ej (b) medical li terature •
Probable duration of assistance. Until the end of 1962.
Work during the period under review. The project leader and public health nurse continued teaching health subjects (first aid and personal hygiene) to the fundamental educators trainees in conjunction with the UNESCO Fundamental Education project at Ton16 Bati. The WHO medical officer is also teaching preventive medicine at the Royal School of Medicine. Building of the project has been completed, the equipment provided by lCA installed, a prOvisional schedule of work established, counterpart personnel provided by the Government and the centre started work from the project site as f'rom 9 March. The Chief' Medical Off'icer of' the prOvince has been designated counterpart of' the project leader. With the addition, in March 1959, of the nurse/midwife, maternal and child health consultations started. There is close co-operation between the project staf'f' and lCA nurse and health educator.
Advisory activities by the project staf'f' to the network of' dispensaries, the transport of' trainees, the need to supervise midwives previously trained at Phnom-Penh, home Visiting, together with the distances involved, crea-re transportation problems.
Some items of' visual aid equipment have been provided by the Asia Foundation.
PartiCipation in Regional Courses and Meetings
See WPRO 39; WPRO 78; Inter-regional 23.
Venereal Disease Control, Taiwan (Aug. 1953 - )
Aim of the project. To train local personnel in case-f'inding, contact investigation, health education, and modern methods of' diagnosis and treatment; to improve laboratory methods; to establish an island-wide venereal disease control programme.
Assistance rovided b WHO durin the ear. (a) A venereologist; b f'our f'our-month f'ellowships in Japan; (c) medical literature
and supplie s •
Probable duration of' assistance. Until August 1959. Thereaf'ter periodic visits by short-term consultants.
Work during the period under review. Six hundred sixty-seven thousand three hundred fifty-one people were blood tested f'or the f'irst time and 571 687 new patients ~vere clinically examined. The treatment rate achieved was more than 85i of' those found to require treatment and the reactivity rate among pregnant women examined fell to 4.li as compared with 4.9~ for 1957 and 7.;J{o for 1954.
/Intensive continued •••
China 3 TA UNICEF
China 6 TA
Intensive continued in-service training and supervision further improved the standard of perfonnance of the 431 health units taking part in the programme. Close co.operation vlith the maternal and child health programme vas maintained for the prevention of the disease among mothers and children. The control programme of the anned forces was given technical assistance and stimulation. The control measures among the promiscuous groups of women were intensified.
The reference laboratory continued studies of the test perfonnance of the laboratories of the project and participated successfully in the serologic evaluation study with the Venereal Disease Research Laboratory in Chamblee, Georgia, United states of America.
Maternal and Child Health, Taiwan (Aug. 1952 . )
Aim of the project. To provide an efficient maternal and child health service throughout the island; to train nursing and medical personnel in all branches of public health relating to mothers and children; to improve health education.
Assistance provided by WHO during the year. (a) A public health nurse/midwife; (b) one twelve.month fellowship in midwifery teaching for study in Japan; (c) medical literature.
Probable duration of assistance. Until August 1959.
Work during the period under review. The Maternal and Child Health Institute, the Institute of Public Health, and a children's hospital in Taipei have been approved by the Provincial Health Administration as a combined teaching project.
Project team members continued to give lectures, field practice and experience to the students at the Provincial Taichung School of Nursing and Midwifery, and made supervisory visits to health stations in the cities and counties of the project area.
In-service training courses for health station, medical officers, staff level nurses and private midwives have continued satisfactorily. To date, 275 health stations have been covered, 235 medical officers, 368 staff level nurses and 859 private midwives have received training.
A tVl'elve-month fellowship in midwifery training for study in Japan was aVlarded.
Nursing Education, Taiwan (May 1952 - )
Aim of the project. To improve the standard of nursing education and the quality of nursing services by establishing a school of nursing at the University Hospital in Taipei.
Assistance provided by ~rr{O during the year. (a) One senior nurse educator until February 1959, three nurse educators in general nursing education, mental health and paediatrics; (b) two twentyfour month fellowships - one in obstetrics and one in paediatriCS, one second year award -nursing arts.
/Probable q ••
China 7 MESA (ICA)
China 13 TA UNICEF
I 'j
page 51
Probable duration of assistance. Until the end of 1960.
Work during the period under review. The Collegiate School of Nursing with a total of sixty-one students in three classes has made notable progress particularly in the development of comprehensi ve nursing care. The newly qualified instructors are assuming increasing responsibility for planning, teaching and evaluation of the students' programme and progress.
The shortage of well-prepared teaching and superviSOry staff is still a major problem. Assistance in the field of nursing service administration and supervision is recognized as an urgent need and it is planned to give special emphasis to this field in the next phase of the project •
. Malaria Eradication, Taiwan (Phase I: MS\Y 1952 - June 1958; Phase II: July 1958 - )
Aim of the project. To control malaria and eventually to eradi. cate it throughout the island, by use of residual insecticides.
Assistance provided by WHO during the year. (a) One two.and. one.half month fellowship to study malaria eradication and control in Thailand, Ceylon, India and the Philippines; (b) supplies and equipment.
Probable duration of assistance. Until 1962.
Work during the period under review. An extensive surveillance programme supported largely by MESA was initiated in July 1958. The results so far are very encouraging. Malaria is being progressively brought under control in the active malaria foci and the number of P. falciparum infections is steadily decreasing. The number of positive cases detected in 1958 was 533 as compared with 484 in 1957 and 488 in 1956, ,ihich represents respectively 0.09% (1958), 0.14% (1957) and 0.29% (1956) of the blood films examined during the years under reference. The surveillance programme was remodelled in January 1959 and still better results are to be expected.
Trachoma Mass Campaign, Taiwan (Oct. 1954 - )
Aim of the project. To control -"rachoma in over two million school.children by a mass campaign, and to organize services in schools and health stations.
Assistance rovided b WHO durin ear. (a) A short.term consultant; b one three-month fellowship for study of epidemiology and statistics in relation to trachoma control in Japan.
Probable duration of assistance. Until 1960.
Work during the -;period under review. The 'mo short-term consultant during his visit late in 1958 found a rate of relapse, re.infection or new infection among the middle grades in school which was considerably higher than should be expected. This was thought to be the result of a combination of several factors, such as over economical use of ointment, inadequate superVision,
/insufficient •••
""- t -'~-~I -
page 52
China 14 TA
insufficient health education. Plans are being finalized for a WHO short.term consultant to visit Taiwan in August 1959; he will be accompanied by the trachoma adviser from Headquarters.
Environmental Sanitation, Taiwan (Oct. 1954 - )
Aim of the project. To survey the organization and functions of governmental agencies concerned with environmental sanitation; to assess the chief problems and determine their relative urgency; to carry out a pilot project of modern and economic sanitation procedures; to train personnel.
Assistance rovided by WHO during the year. (a) Two sanitary engineers and one short-term consultant; b) one second-year award (extension); (c) supplies and equipment.
Probable duration of assistance. Until 1960.
Work during the period under review. Activities of the Taiwan Institute of Environmental Sanitation and of the Taipei Sewerage and Drainage Corps both of which are assisted under this project have continued to expand during the period under review. Training of both sanitarians and of foodhandlers has continued; 82 sanitarians have graduated from these classes and 4413 foodhandlers have attended these courses.
An additional six rural environmental sanitation demonstration projects w"ere initiated and completed during this period. These projects included school sanitation, 'later system, la.trines, surface drainage, improvement of animal shelters, village composting, rodent and insect control, etc.
The Taiwan Institute of Environmental Sanitation continued supervision of the wells and latrine programme throughout the country; during this period 1900 public .Tells and 10 public latrines were completed. School sanitation activities now carried on as a routine activity, included the installation of 47 water systems and 101 latrines at public schools. staff members of the lnsti tute completed the design of a sew"erage system for Keelung City to cover a population of 250 000. Also completed was the design for a new composting plant with a daily capacity of 20 tons of refuse at La-tung. This plant is presently under construction.
other activities of the Institute of Environmental Sanitation included a training course in sewerage and drainage design for public works engineers and a course on the radiation aspects of environmental sanitation.
Assistance was continued to the Taipei Sewerage and Drainage Corps Vlhich is planning and designing a water-borne sewerage system for the City of Taipei. A general report on the planning work of this organization was completed and distributed during this period. WHO provided a short-term consultant for revie"\v of this planning.
/China 17 •••
China 17 R UNICEF
China 20 R
China 27 R
, page 53
Tuberculosis Control, Taiwan (April 1951 - )
Aim of the project. To expand the tuberculosis control service and to incorporate in it the BCG work already in operation; to explore new methods of control of ambulatory cases by chemotherapy.
Assistance provided by WHO during the year. . (a) A medical officer and an x-ray engineering consultantj (b) one three-month fellowshipj (c) supplies and equipment.
Probable duration of assistance. Until 1961.
Work during the period under review. More chest clinics in health centres ,.,ere approved and a fourth tuberculosis centre opened late in the year. Case-finding continued from tuberculosis centres and community surveys and was intensified from health stations. Bacteriology, especially by culture, increased markedly. There were over 12 000 patients having domiciliary chemotherapy under supervision at the year's endj the chemo ... prophylaxis study among infants under five years completed; and two full-time surgeons were employed in the thoracic unit at Sung Shan. The fully-integrated BCG work continued and a speciaJ. effort was made to reach the pre-school group. The BOO vaccine production laboratory received a good report from an independent expert provided by WHO. Training of all grades of workers continues and included x-ray technicians who received refreSher courses from the ~mo x-ray engineer.
Mental Health, Taiwan (Oct. 1955 - )
Aim of the project. To advise on a mental health programme with special emphasis on child guidance and community mental hospitals.
Assistance provided by WHO during the year. (a) A short-term consultantj (b) tvo twenty-four month fellowships in psychiatric and mental health nursing for stUdy in the United Kingdom.
Probable duration of assistance. Until 1961.
Work during the period under review. The .WHO mental health consultant assigned to the Philippines spent one week in Taiwan while on his ivay to the United states of America on home leave. Views were exchanged and advice given to mental health workers in Taiwan with regard to the medical school curriculum, child guidance work, the operation of mobile mental health clinics and the reorganization of the provincial mental hospital.
Institute of Public Health, Taiwan (Aug. 1958 - )
Aim of the project. To strengthen the training particularly that in epidemiology and public health practice, and to train the staff of the Institute to elevate the standard of teaching.
Assistance provided by WHO during the year. Two twelve-month fellowships were awarded to staff members of the Institute, one to study industrial hygiene and the other preventive medicine and public health both in the United States of America.
/Probable •••
'itS: I rtl./.J,.'V I c. page 54
China 28 R
China
Cook Islands
Fiji 2 R (China Medical Board)
Probable duration of assistance. Until 1960.
Fellowships
Iv1aternal and child health. A twelve-month fello'\lship to study public health with emphasis on maternal and child health in the United states of America.
Nursing. A twelve-month fellovTship to study public health nursing with emphasis on maternal and child health in Hawaii.
Nutrition. A six-month fellovTship to study infant feeding and nutrition in Australia.
other communicable diseases. A twelve-month fellowship to study investigation and control of arthropod~borne diseases (other than malaria) in the United Kingdom.
Participation in Regional Courses and Meetings
See WPRO 53; 'VlPRO 60; WPRO 63; EURO 52; Inter-regional 23; Inter-regional 35; Inter-regional 37; Inter-regional 41.
PartiCipation in Regional Courses and Iv1eetings
See WPRO 35.
Central Medical School, Suva (Feb. 1955 - )
Aim of the project. To train assistant medical practitioners for government service in Fiji and adjacent territories, and to strengthen the staff of the Central l>1edical School.
Assistance provided by WHO during the year. (a) Two lecturers -one in biology and the other in physiology; (b) continuation of fellowships; (c) supplies and eqUipment.
The China Medical Board is assisting the School in the fonn of fellowships.
Probable duration of assistance. Until 1960.
Work during the period under reviei'T. Teaching in biology and physiology continued.
A junior lecturer of anatomy vas given high commendation scholastically and p~rBonally by the Faculty of Anatomy of the otago University during his one-year study there on a China Medical Board fellowship. On completion of his fellowship, the China Medical Board offered the School a book grant for the purchase of text and reference books I'Thich he would need in the teaching of anatomy.
Since the start of "lHO assistance to the School, the Assistant Medical Officers I class this school-year is the smallest.
/The class •••
Fiji
I " I
page 55
The class is composed of 4 Fijians, including a Fijian girl, 4 Gilbert and Ellice Islanders, 2 Papuans, 2 Solomon Islanders, 2 Tokelauans and 1 student each from the United states Trust Territories and Tonga. On the other hand, the preliminary class which is offered for students from island territories with inadequate education, has gro'WIl so large - 29 students, that it is no longer possible to carry out personalized teaching. Furthermore, difficulties are encountered due to the highly varying academic attainments in the class.
It is gratifying to report that the School is performing a very important role in the training of medical and auxiliary personnel.
Participation in Regional Courses and Meetings
See WPRO 35; WPRO 53; WPRO 63; Inter-regional 41.
FrenCh Polynesia Participation in Regional Courses and Meetings
See Inter-regional 41.
Gilbert and Ellice Islands Colony
Hong Kong 13 R
Hong Kong
Japan 4 R
Participation in Regional Courses and Meetings
See WPRO 35.
Fellowships
Dental health. A tw"enty-eight month fellowship in dental nursing for study in the Federation of Malaya and tvo twenty-four month fellowships also in dental nursing for study in New Zealand.
Malaria. A three-month fellowship to study malaria eradication in the Philippines.
PartiCipation in Regional Courses and Meetings
See WPRO 53; WPRO 60; 'tVPRO 63; WPRO 72; Inter-regional 23; Inter-regional 35; Inter-regional 41.
National Institute of Mental Health, Tokyo (June 1953 - )
Aim of the project. To survey needs and facilities and draw up a mental health programme; to carry out research; to train local professional and auxiliary personnel.
Assistance provided by WHO during the year. (a) A six-month fellowship for study of mental health in the United States of America; (b) medical literature.
Probable duration of assistance. Until 1961.
/Japan 10 •••
Japan 10 TA
Japan 14 R
Japan 18 R
Japan 19 TA
Assistance to Institute of Public Health, Tokyo (March 1955 - )
Aim of the project. To strengthen post-graduate training of health personnel in the departments of the Institute, particularly the Departments of Epidemiology, Medical-Social Services and Environmental Sanitation.
Assistance provided by WHO during the year. (a) One six-month fellowship for the study of epidemiology; (b) medical literature.
iTobable duration of assistance. Until the end of 1959.
Work during the period under review. In September 1958, the Chief of the Department of Epidemiology was granted a six-month fellowship to observe the method of teaching in epidemiology at schools of public health and other institutions in the United States of America. He stayed for some time at the Harvard School of Public Health as a visiting scientist.
The Dean of the Institute attended the session of the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel in Geneva in July 1958.
Nursing Education, Tokyo (Aug. 1955 - DeC. 1958)
Aim of the project. To strengthen basic nurSing, midwifery and public health nursing education; to develop a centre for postgraduate training at the Institute of Public Health, Tokyo, and to train qualified teachers for the centre.
Assistance provided by IolHO durin the year. (a) One nurse educator; b one thirteen-month fellowship in paediatric nursing for study in Neif Zealand.
Work during the period under review. See final summary of this project in Part III.
Fellowships
Health education. A twelve-month fellolvship to study public health administration with emphasis on health education in the United States of America.
Maternal and child health. A six-month fellmfship to study maternal and child health administration in the United Kingdom, the Netherlands, Germany, Denmark and Slteden.
Occupational health. A six-month fellow-ship to study insecticide hazard control in Denmark, Sweden, the United Kingdom, France, Switzerland and Germany.
Venereal diseases. A six-month fellovTship to study venereal diseases control in the Philippines, Hong Kong, China (Taivan), the United Kingdom, the Netherlands, and Germany.
Fellowships
Tuberculosis. A six-month fellowship to study tUberculosis control (occupational therapy. and vocational rehabilitation) in the United Kingdom, Denmark, the Netherlands, Germany, SWitzerland, and Italy.
I .......... • , ..
Japan 20 MESA
Japan
Korea 10 R
Korea 13 MESA
MaJ.aria Eradication Survey, Japan (18 Aug. - 16 Sept. 1958)
Aim of the project. Co-operation ,·Tith national experts in studying the malaria si tuatioll in Japan.
Assistance provided by WHO during the year. A short-term consultant.
Work during the period under review. Halaria incidence in Japan has been regularly declining since the end of the war. The number of notified cases vTas about 33 in 1957 and 28 in 1958. Follmn.ng the visit of the short-term consultant it was recommended that a comprehensive survey be carried out to detect the possible existence of residual foci. Following these suggestions the following steps are now being considered by the Japanese Government: (1) case-finding and residual foci detection during the first year; (2) .if necessary more extensive treatment of detected cases during the second year; (3) vector control, if so justified, in selected areas during the third year.
Participation in Regional Courses and Meetings
See WPRO 53; WPRO 60; WPRO 63; EURO 52; Inter-regional 17; Inter-regional 23; Inter-regional 35; Inter-regional 37; Inter .. regional 41; Inter~,:rep;ional 77; Inter ... regional 79.
Fellowships
Dental health. A tweJ.ve-month fellowship to study public health with specialization in dental health administration in Australia.
Leprosy control. A two-and-~alf month fellowship to observe leprosy control in the Ehilippines, Singapore, the Federation of Malaya, Thailand and Hong Kong.
Maternal and child health. A twelve-month fellowship for the diploma course in public health in Singapore followed by observa. tion visits to the Federation of MaJ.B\Ya, Thailand, Hong Kong, the Philippines and China (Taiwan).
Vital and health statistics. A six-month fellowship to study public health administration and health statistics in China (Taiwan) J
the Philippines, Singapore, Australia and New Zealand.
Malaria Pre.eradication Survey (June 1959 - )
Aim of the project. To survey the malaria situation in the country with a view to preparing a plan for eradication.
Assistance provided by WHO during the year. A malariologist, aneentornologist and two laboratory techniCians.
Probable duration of assistance. until March 1960.
Work during the period under review. The plan of operations covering this pre.eradication survey was 7igned by t~e Government
land the •••
Korea
Laos 2 TA (ICA)
Laos 8 TA
Laos
MaJ.aya 1 TA
and the Organization in February and April 1959 respectively.
Implementation of the project began early in June with the arrival of the project leader and laboratory technicians in Korea. The entomologist took up his duties towards the end of the same month.
Participation in Regional Courses and Meetings
See WPRO 53; WPRO 60; WPRO 63; WPRO 72; EURO 52; Inter-regional 2~ Inter-regional 41; Inter-regional 79.
Treponematoses Control, Thakhet, Savannakhet, Saravane and Pakse (Jan. 1953 - )
Aim of the project. To survey the yaws Situation; to train local personnel in diagnosis and treatment; to carry out a mass campaigr (house-to-house case-finding and treatment of all accessible clinical cases and contacts, and health education) so as to reduce the incidence of yaws to a level at whiCh the public healtl programme can maintain control.
Assistance provided by WHO during the year. One venereologist and one serologist.
Probable duration of assistance. Until 1961.
Work during the period under review. See final summary on the yaws part of this project in Part III.
Fellowships
Surgery and medicine. One nine-month and three twelve-month fellowships for undergraduate medical assistants' studies in Cambodia.
Participation in Regional Courses and Meetings
See WPRO 39j WPRO 78; Inter-regional 23.
Nursing Education Kuala L ur Penang June 1950 - Dec: 1958)
Aim of the project. To improve the standard of basic and graduate nursing education and the quality of nursing services; to prepare nurses for administrative and teaching posts; to adapt the nursing education programme to local resources and needs; to develop a well-organized programme for midwives.
Assistance provided by WHO during the year. One senior nurse educator, one ward tutor and two midwifery tutors.
Work during the period under review. See final summary of this project in Part III.
!Malaya 3 •••
Malaya :; R UNIOEF
Malaya 9 R UNICEF
Malaya 12 TA
page 59
Yaws Control
WHO has been giving technical advice to this national programme which has also received supplies from UNICEF. Two fellowships were awarded - one for a two-week study in Indonesia and the other a nine-week study in _Indonesia, Thailand and the Philippines.
,
Rural Health Training Centre, Jitra, Kedah (NOV. 1954 - )
Aim of the project. To establish a training centre at Jitra for assistant health nurses, rural midwives, dispensers and sanitary overseers.
staff trained at Jitra will be assigned to ninety main health centres which the Government is building. These centres and their sub-centres, in addition to their routine work, will have special ~esponsibilities for the welfare of mothers and children, such as domiciliary midwifery, infant care and dental hygiene.
Assistance rovidied b WO during the ear. (a) A medical officer and a public health nurse; b medical literature.
Probable duration of assistance. Until 1959.
Work during the period under review. The fifth and sixth training courses for auxiliary rural health workers were completed. Project activities were expanded to include an orientation course for basic and supervisory health staff which was held at Jitra in October 1958; six public health nurses, six health inspectors, four hospital assistants and four health sisters from the different states attended.
The training programme is nOvT established on a sound basis and the project is progressing steadily. Efforts are being made to expand and improve the rural health services but the shortage of basic and supervisory personnel is still a major problem and more are required to provide adequate guidance and supervision to the auxiliary field workers. There is also a need to co-ordinate public health training for all categories of rur.al health workers at the Federal level.
Early in 1959, the WO medical officer visited all the states in the Federation to reView the organization and work of the rural health centres, and to discuss the programme with state Chief Medical and Health Officers, state Health Matrons, and other government health officials. For the remainder of the year, the WO medical officer will be assigned to Kuala Lumpur to provide advisory assistance at Federal level in developing the rural health services programme.
Nutrition (July - Nov. 1956; April 1958 - )
Aim of the project. To study protein deficiency in childhood and its relation to cultural and social habits; to collect information on the incidence of protein deficiency, its
/distr1bution by •••
Malaya 15 TA
Malaya 19 TA
distribution by race and area, its public health importance and methods Which might be used for eliminating it.
Assistance provided by WHO during the year. A social anthropologist.
Probable duration of assistance. Until 1959.
Work during the period under review. Socio-anthropological investigations relating to health problems, ,particularly that of protein malnutrition, in Malay children were continued. Intensive studies were carried out in two selected communities -one in Malacca and the other in Perak. The information obtained included data on the general social and economic background of the people, the number of children born to each woman in the village and their subsequent fate. Data were obtained on beliefs and practices regarding sickness and treatment, on infant and child feeding, and on maternal care, and budget and dietary surveys were carried out to determine the percentage of income spent by each family on food.
Hospital Records, Penang (Nov. 1956 -
Aim of the project. To review and reorganize the hospital records systems in the Federation and in Singapore (Singapore 9); to establish and implement a suitable training programme for local personnel in the Federation of Malaya.
Assistance provided b WHO during the year. (a) A hospital records officer; b technical literature.
Probable duration of assistance. Until 1960.
Work during the period under revie"T. The first phase of the project, i.e. improvement of the medical records system at the Penang General Hospital to serve as a training field, was completed, and a training course for medical records officers commenced in May and ended in June 1959. This is the first residential part of the course to be followed by apprOXimately six months' instruction by correspondence and finally by a oneweek refresher course. Ten officers who had been engaged on medical records keeping in hospitals in nine States of the Federation of Malaya attended the course. A second course will be held to cover all the other states -which have not been able to send partiCipants.
An exhibition on medical records keeping was held at the same time as the course , with a view to stimulating the interest of the medical staff of all hospitals in the Federation in this work. The exhibits were in part supplied by a total of forty-one hospitals and other institutions in Australia, New Zealand, the United Kingdom and the United States of America. Arrangements were made for the exhibits to be transported to other hospitals.
Fellowships
Clinical medicine. One two-year fellowship to study radiography in the United Kingdom.
I .... r ... " Or l-
Part IV, page 60, add
Malaya 14 TA
Hospital Administration, Penang (May 1956 -
Aim of the project. To review the hospital administration system; to devise a suitable scheme for training lay hospital administrators, taking account of the facilities available, in the Federation or overseas.
Assistance provided by WHO during the ear. (a) A hospital administrator; b supplies and equipment; (c) medical literature.
Probable duration of assistance. Until 1960.
Work during the period under review. During the period under review, a major accomplishment was the inclusion of hospital administration in the Federation of Malaya scheme of service. Thus, hospital administration is now firmly established as a career.
The non-medical hospital administrators who received preliminary training were assembled to attend a workshop in Penang. During and following this workshop, the responsibilities and duties of hospital a&ninistrators were re-examined and redefined in the light of experience acquired. Two additional hospital administrators started training. During their training, a case study .Tas made of the General Hospital in Kuala Lumpur. The administration of the mental hospital was reorganized. In addition to a non-medical hospital administrator, it was suggested that there should be a post for a training and w"elfare officer.
A study of common administrative problems of district hospitals has been initiated,
Malaya
Netherlands New Guinea 2
R UNICEF
Netherlands New Guinea 7
R
Netherlands New Guinea 10
TA
Netherlands New Guinea
New Hebrides
New Zealand 1 R
.. _,_._--, -page 61
Rehabilitation. Two three-year fellowships to study physiotherapy in Australia.
Participation in Regional Courses and Meetings
See WPRO :t9; '-1PRO 53; vlPRO 60; WPRO 63 j WPRO 78; Inter-regional 23; Inter-regional 41.
Malaria Control
This project is receiving technical advice from WHO and supplies and equipment from UNICEF. During the period under review two fellowships were awarded, one of four months to visit India, the Federation of Malaya and the Territory of Papua and New Guinea and the other of three months to visit India, Ceylon, the Federation of Malaya and Cambodia.
Fellowships
Nutrition. A six-month fellowship for study in Guatemala.
Urban Environmental Sanitation (2 Feb. - 5 March 1959)
Aim of the project. To advise the Government on the im;provement of the water supply and se"trerage systems in Biak.
Assistance provided by WHO during the year. A short-tem consultant.
Work during the period under review. At the request of the Government a short-term consultant was provided from 2 February to 5 March 1959 to .advise on the improvement of the water supply and sewerage systems for the town of Biak,
PartiCipation in Regional Courses and Meetings
See WPRO 63; Inter-regional 23.
PartiCipation in Regional Courses and Meetings
See WPRO 35; Inter-regional 77.
Fellowships
Mental health. A two-month fellowship to study mental health legislation in the United Kingdom.
Rehabilitation. A four-month fellowship to study physiotherapY ( administration and sertices) in the Ubi ted Kingdom, Norway, Sweden, Denmark, the Netherlands, Germany and Switzerland.
/New Zealand , ••
..... , ... ,v .... v, "-page 62
Ne\v Zealand
Niue 1 R
Niue
North Borneo 5 TA MESA UNICEF
North Borneo
Papua and New Guinea 6
R
Papua and New Guinea
Participation in Regional Courses and Meetings
See WPRO 53; WPRO 63.
Fellowships
Public health administration. A twelve-month fellowship for the diploma course in public health in the United Kingdom.
Participation in Regional Courses and Meetings
See WPRO 35.
Malaria Control, Keningau (July 1955 - )
Aim of the project. To study the malaria situation; to train local personnel and to carry out a control programme.
Assistance provided by WHO during the year. A malariologist, an entomologist and a sanitarian.
Probable duration of assistance. Until 1962.
Work during the period under review. Although the results achieved so far can be considered as satisfactory further information is needed on the possibility of stopping transmission in some areas. The present control programme should be converted into an eradication programme, the first step being a pre-eradication malaria pilot project. Spraying operations are presently carried out twice a year with DDr or dieldrin, according to the vector involved. Drug administration as a supplement to spraying operations gave very favourable results.
Participation in Regional Courses and Meetings
See Inter-regional 23.
Fellowships
Leprosy control. A six-month fellowship to study and observe the latest developments .in the prevention, treatment and control of leprosy as well as the rehabilitation and health education aspects of this problem in various parts of the world including Japan, the Philippines, Hong Kong, Thailand, India, Ceylon and the Federation of Malaya.
Tuberculosis control. A six-month fellowship to study tuberculosis control in Denmark, the United Kingdom and Kenya.
PartiCipation in Regional Courses and Meetings
See 1.r?RO 35 j WPRO 63.
/Philippines •••
Philippines 4 R
Philippines 9 TA FAO (ICA)
page 63
Mental Health, Manila (Phase I: Nov. 1949 - Jan. 1953; Phase II: Feb. 1957 - )
Aim of the project. To assist the Government in organizing and formulating a programme of mental health at all levels, including the rendering of technical advisory assistance in mental health to non-governmental agencies.
Assistance rovided b WHO during the year. (a) One medical officer; b fellowships awarded to six medical officers and two nurses for a period of four months in Australia to study the clinical and nursing aspects of psychiatry and general administration of psyChiatric services.
Probable duration of assistance. Until 1961 (assistance from 1960 onwards limited to fellowships).
Work during the period under review. Advisory services continued to be rendered by the consultant at the National Mental Hospital and to private or vol~tary mental health clinics. Visits were made to survey the possibilities of establishing regional mental health services; Cebu, Davao and Zamboanga were suggested as suitable sites.
Despite administrative difficulties, the National Mental Hospital introduced new services within its compound such as an admission and diagnostic centre and a rehabilitation village. The establishment of a hospital service at the old North General Hospital building, Where the patients st~ed in the clinic in the daytime only and follow-up was arranged through a domiciliary service, evoked favourable community response. This extension clinic has absorbed an appreciable case load from the mental hospital and has proved an economical and successful means of handling less-disturbed mental patients. Consideration is being given to the possible affiliation of this establishment with neighbouring local health services, hospitals and welfare agencies w~th a view to widening its activities and establiShing an effective referral service. It may also be developed as an orientation and training centre in psychiatric work for public health and hospital workers as well as medical students and nurses
Bilharziasis Control Pilot Project, Leyte (June 1952 - )
Aim of the project. To study and develop control measures against bilharziasis; to test and apply these measures on a community-wide basis; to train professional personnel Who will provide technical guidance and the health service personnel who will undertake the bilharziasis control in their localities; and to plan a national bilharziasis control programme Which can be introduced in the endemiC areas of' the country.
Assistance provided by WHO during the year. One epidemiologistparaSitologist, one sanitary engineer and one short-term consultant in land-use contributed by FAO under TA.
Probable duration of assistance. End of 1961 ...
Work during the period under review' • Initial steps were ta.k~n to test the therapeutic ef'fects of Glucosam1ne and TWSB (antimony di-mercapto-succinate) against bilharziasis. Follow-up ~
Philippines 12 TA (Johns Hopkins University)
(Rockefeller Foundation)
Philippines 29 TA UNICEF
of control measures, which included improved agricultural practices, pOinted to re-introduction and multiplication of snail hosts 'Whenever primitive practices "Tere resumed. A revievT of the work of previous years Showed that the following methods were more or less effective against the snail vector: (1) removal of vegetation, (2) drainage or removal of water, (3) ponding or confinement of excess water, (4) earth filling or grading, (5) introduction of brackish water, (6) better agricultural practices, and (7) combinations of above.
In tb.e next tiro years, the integration of bilharziasis control activities into the total health programme of the local health services will be tried out 011 a community-wide basis in three municipalities in Leyte. The results obtained will be assessed after two years and it is hoped that they will provide sufficient information to develop a national programme. A research programme and training of the technical staff for the integrated programme w:lll be undertaken on a long-term basis at the Palo Laboratory; the staff will also provide consultative assistance in schistosomiasis control in the field. The training of regular loc~ health personnel in schistosomiasis control will be incorporated in the government in-service training programme.
Institute of Hygiepe, University of the Philippines, Manila {July 1953 - 1 Aim of the project. To strengthen the faculty of the Institute of Hygiene by exchanging members of the teaching staffs between the Institute and the Johns Hopkins University School of Hygiene and Public Health.
Assistance provided by WHO d.uring the year. An associate professor in mental health a~d one short-term consultant in nutrition.
Probable duration of assistance, Until 1962.
Work during the period under re eWe The short-term consultant in nutrition spent two months wit the Institute. Aside from giving lectures, he provided adeq~ate guidance in starting research work which is a very important acti vi ty in the Institute but had not yet been properly undertaken in the faculty concerned. The associate professor of mental health remained one academic year at the Institute providing instruction and guidance on future developments in this field.
Midwifery Training, Philippines (Oc't;. 1953 - Dec. 1958)
Aim of the project. To study the mid,dfery services and training facilities; to develop a well-organized training programme for midwives; to train village midwives (hilots); to study maternity-nursing needs and resources; to formulate a midwifery practice act.
Assistance provided b;r WHO during the year. (a) One nurse/m.idvTife, (b) one twelve-month fellowship in maternal and child health nursing for study in the United States of America.
Philippines 43 R (ICA)
Philippines 49 R UNICEF
Philippines 50 TA
Work during the period under review. See final sunnnary of this project in Part III.
Environmental Sanitation (June 1955 - )
Aim of the project. To co-ordinate and strengthen environmental sanitation work.
:':'::'=':;';~=':';~~";';;';~~~:';:';'~;;;':;:;;;:;.l.~~ye~ar;;;;... ( a) A sanitary engineer;
Probable duration of assistance. Until 1960.
Work during the period under review. A reorganization of the Philippine Department of Health has resulted in decentralization of public health activities in the Philippines. Regional public health engineers as well as some provincial public health engineers have been appointed.
The long-range plan for environmental sanitation in the Philippines is being implemented to the extent possible under the austerity programme of the Government.
A pilot compo sting plant for the City of Manila has been designed and is presently under construction. A number of . smaller conununities have requested assistance from the Department of Health in planning compo sting operations.
The post-graduate course at the Institute of Hygiene in the University of the Philippines leading to the degree of Master of public Health Engineering is continuing with six candidates for this degree presently enrolled.
Leprosy Control
WHO has been giving technical advice to this national programme which has also received supplies from UNICEF. One eight-month fellowship was avTarded for study in administration and management of leprosaria and preventoria in Japan, United States of America, Brazil and Africa.
Virology Centre
Aim of the project. To assist in the establishment of a virology centre which will operate under the Public Health Research Laboratory of the Department of Health. The centre will consolidate the work of the present virology units, provide diagnostic laboratory services, particularly for the Disease Intelligence Centre, and conduct research to identify and classify the etiological factors of the virus diseases of the country.
Assistance provided by WHO during the year. A six-month fellmrship for a medical officer who will be assigned to the laboratory and serve as counterpart to the WHO consultant who will arrive in 1960.
/Probable •••
page 66
Philippines 51 R
Philippines 53 MESA (ICA)
Probable duration of assistance. End of 1961.
Work during the period under review. The medical officer "Tas awarded a fellowship in virology and has visited virus laboratories in the United States of America at the Department of Microbiology, School of Medicine, University of Miami; Albany, Alabama, and Georgia, and in Japan at the National Institute of Health.
The Government has in the meantime organized a technical committee to advise on requirements of physical facilities and supplies and equipment 'Which it is intended should be ready at the time of the expert's arrival in 1960.
Environmental Sanitation Training Course (June 1958 - )
Aim of the project. To provide assistance in the organization of an advanced training course and in demonstrating environmental sanitation Qctivities in a selected area.
Assistance provided by WHO during the year. (a) A sanitarian; (b) supplies and equipment; (c) technical literature.
Probable duration of assistance. Until 1961.
Work during the period under revie"T. This project "rhich began in June 1955 with the arrival of a WHO sanitarian has been operating under difficulties due to the inability of the Government to provide the necessary funds both for the stipends for trainees and for physical facilities for the training centres.
The first training course of ten weeks duration was however completed during this period with twenty-three inspectors completing the course. The second training course will begin early in July 1959.
Plans are being made for expansion of this type of training to other regional training centres throughout the country.
Malaria Eradication (Phase I: Aug. - Dec. 1956; Phase II: June-Nov. 1957; Phase III: July 1958 - )
Aim of the project. To eradicate malaria through surveillance in areas qualifying for the interruption of spraying operations.
Assistance provided by WHO during the year. A six-week short term consultant on surveillance.
Probable duration of assistance. Until 1962.
Work during the period under revie"lf. The extensive surveillance scheme recommended by the malaria advisory team to consolidate eradication over large areas of the Philippines was implemented on 1 July 1958. Field operations continued according to plan until the end of 1958, and an agreement was signed to continue the surveillance system during the first six months of 1959.
Inuring that •••
Philippines 54 R
Philippines
Sarawak 5 TA MESA
page 67
During that period a full-scale eradication plan was worked out 'Which will form the basis for the future plan of operations.
The results achieved so far are not absolutely conclusive. Some areas under discontinuation are to revert to spraying and appropriate measures to increase the efficiency of surveillance have been outlined in the nevr plan of operations.
Fellowships
Occupational health. A twelve-month fellowship to study public health with emphasis on industr.ial health in the United states of America.
other medical and surgical specialities. A two-month fellowship to observe the organization and operation of neuro-surgical services in the Union of Soviet Socialist Republics.
Public health administration. A twelve-month fellowship to study public health with emphasiS on rural and university health services in the United States of America and Canada.
Rehabilitation. A twelve-month fellowship to study reconstructive surgery as related to poliomyelitis in the United states of America.
PartiCipation in Regional Courses and Meetings
See WPRO 53; WPRO 63; WPRO 78; Inter-regional 17; Inter-regional 23; Inter-regional 35; Inter-regional 37; Inter-regional 41.
Malaria Pilot Project (July 1952 - )
Aim of the project. To study the efficacy, for malaria control in Sarawak, of indoor spraying with residual insecticides in an experimental area; to train professional auxiliary and ancillary personnel for malaria control throughout the country.
Assistance provided by WHO during the year. Two malarlologists and an entomologist.
Probable duration of assistance. Until 1960 (TA); 1962 (MESA).
Work during the period under review. There was considerable expansion of the programme during 1958 and 83.9% of the land area was included in the residual spraying operations. This afforded direct protection of 53.810 of the estimated population of 648 000, the remainder of the population being in the few large cities determined by mass blood surveys. During the year also a total of 62 058 houses were sprayed: 41 284 once and 20 774 twice.
The spraying programme has continued according to plan and large-scale surveys have been made to define more exactly the area of endemicity. Extension of the pilot surveillance .system has revealed that in some areas transmission has not been completely stopped.
II ... J •• ~"" ........ J .-page 68
Sarawak
Singapore 2 TA (wndon School of Hygiene and Tropical Medicine)
Singapore 4 R UNICEF
Singapore 8 TA
Participation in Regional Courses and Meetings
See IVPRO 60; WPRO 63; WPRO 72; Inter-regional 23.
University of Maiala (Sept. 1952 - Aug. 1958)
Aim of the project. To develop the teaching of preventive and social medicine in the Faculty of Medicine; to establish a firstclass post-graduate school of public health.
b one twelve-month fellowship for the public Health in the United Kingdom.
Work during the period under review. See final summary of this project in Part III.
Institute of Health (Jan. 1956 - )
Aim of the project. (a) To provide maternal and child health services, school dental services and health education for the population (about 125 000) living near the Institute; (b) to train at the Institute (i) undergradUd.te medical and postgraduate public health students of the ·University of Malay-a (included students from other countries of the Region), and (ii) health visitors, health inspectors and otre r auxiliary personnel.
Assistance rovided by vmo during the year. (a) One senior nurse educator public health since February 1959; (b) t'WO tvTel ve-month fellowships.
Probable duration of assistance. Until 1962.
Work during the period under review. The pilot district nursing service was successfully developed. Two of the graduates of the first public health/district nursing course have been appointed to take charge of this service and the WHO nurse educator was transferred to another project in January 1959. Another WHO nurse educator joined the project in February 1959.
The second integrated public health/district nursing course with twelve students commenced in April 1959.
Nursing Education (June 1952 - )
Aim of the project. To improve the standards of nursing education and nursing service in Singapore by developing (a) the clinical teaching units and the educational programme in the Singapore General Hospital, (b) clinical fields and educational progr.ammes in psychiatric nursing and mental health, (c) inservice education, refresher courses and special courses for. local registered nurses and (d) the training of local nurses for administrative and teaching positions.
/Assistance •••
Singapore 9 TA
-WJ:I ft.G~Uf Z page 69
Assistance provided b WHO durin One senior nurse consultant, two nurse educators one nurse educator (psychiatric) •
Probable duration of assistance. Until the end of 1960.
Work during the period under review. The psychiatric nursing courses have been granted recriprocal recognition by the General Nursing Council of England and Wales. One qualified national tutor has returned from study abroad and two psychiatric nurses are presently studying for their tutors diploma on government fellowships. The in-service education and clinical teaching programme in the general hospital and paediatric unit has demonstrated the value of this approach for improved nursing education and service. The Nursing Education Committee and its sub-committee have been actively engaged in studying the assistant nurse training and courses for special fields. A study group on nursing service administration has been meeting regularly to discuss administrative principles and procedures. The acute shortage of nurses prepared for teaching and other leadership positions is seriously affecting the development of education programmes.
Hospital Records (Nov. 1956 - )
Aim of the project. To review and reorganize the hospital records system in the Federation and in Singapore; to establish and implement a suitable training programme for local personnel in the Federation of Malaya.
Assistance provided by WHO during the year. A medical officer.
Probable duration of assistance. Until 1960.
Work during the period under review. The revision and reorganization of the medical records system in the Singapore General Hospital has been carried out to the greatest possible extent. The hospital records officer, 'Who had worked under the supervision and guidance of the WHO expert, was in mid-1958 sent to the United Kingdom for advanced training in hospital records keeping, so as to be able to return by mid-1959 and assume supervision of the. medical records department in the General Hospital. The WHO expert left the project on 9 August 1958 for repatriation to his home country.
No replacement has been made since the departure of the expert, as it has been difficult to recruit a medical statistician with a background of public health and hospital records. The project will be extended from the hospital level to the Ministry of Health where a statistical division is to be created to co-ordinate and supervise the collection of health statistics, including hospital statistics, throughout Singapore and to compile and analyze the data collected. It is hoped that a suitable expert will be recruited for the project before the end of 1959.
/Singapore 14 •••
Singapore 14 R
Singapore
Tonga 1 TA
Island-wide Domiciliary Midwifery Service (Jan. 1959 - )
Aim of the project. To extend supervision of midwifery practice throughout the whole island; to conduct refresher courses for qualified midwives; to integrate institutional midwifery at Kandang Kerbau Maternity Hospital Inth the domiciliary services in urban and rural areas; to extend domiciliary experience for midwifery trainees with special reference to experience in the rural areas.
Assistance provided by WHO during the year. One senior nurse educator (midwifery).
Probable duration of assistance. Until 1961.
Work during the period under revie,·,. An assessment of the needs for midwifery services in the rural areas has been done and a plan of action prepared. A vTell-qualified national counterpart has been appointed supervisor of midwives in the rural areas. Legislation has been enacted incorporating an extension of midwifery training to include domiciliary experience in the rural areas and making regular refresher courses for practicing midwives a statutory requirement.
PartiCipation in Regional Courses and Meetings
See WPRO 53; WPRO 72.
Environmental Sanitation Project (March 1958 - )
Aim of the project. To strengthen environmental sanitation services at all government levels; to study problems of rural and urban environmental sanitation, and the SOCial, economic and cultural factors that affect the improvement of environmental sanitation; to plan, execute and evaluate a pilot project to demonstrate modern methods in environmental sanitation to train environmental sanitation personnel and instruct other public health workers in sanitation.
Assistance rovided by WHO durin the year. (a) A social anthropologist and a sanitary engineer; b) supplies, equipment and technical literature.
Probable duration of assistance. Until March 1960.
Work during the period under review'. Technical studies of the problems associated with the introduction of improved environmental sanitation, especially into rural areas of Tonga, and social anthropological studies of the various ~actors relating to the acceptance of innovations, and the co-operation of communities in improving their environmental sanitation, have been undervray for a considerable period.
It is expected that these studies will lead to the initiation of pilot environmental sanitation programmes in a number of villages in the Kingdom of Tonga.
/Tonga ...
Tonga 5 R
Tonga
WPJRC1.0J2 page 71.
study of lrbther/Cb.i1d Relationships (Oct. 1958 - March 1959)
Aim of the project. To study the development of the relations between mother and child in Tonga, with particular reference to feeding and the child I s different responses to the motre r, relatives and strangers. The study should lead to better understanding of maternal and child health problems in the area.
Assistance provided bjY WHO during the lear. A short-term. consultant for six months.
Participation in Regional Courses and Meetings
See WPRO 35.
Trust Territories Participation in Regional Courses and Meetings of the Pacific Islands See WPRO 35j VlPRO 63; Inter-regional 41.
Viet Nam :3 TA UNICEF (ICA)
Maternal and Child Health (Dec. 1954 - )
Aim of the project. (a) To improve and develop existing facilities so as to provide a maternal and child health service as part of the general public health and medical care services; (b) to determine the categories and qualifications of staff required for the maternal and child health services and to provide for their reCruitment, training or refresher trainingj (c) to train staff from neighbouring countries -where the maternal and child health problems may be similar to those in Viet Namj (d) to study the maternal and child health problem by research and by the collection and analysis of statistical and demographic data.
Assistance rovided b WHO durin0' the ear. (a) A medical officer and three nurse educators; b medical literature.
Probable duration of assistance. Until 1960.
Work during the period under review. Alterations to improve facilities at the Tu-Du Maternity Hospital were completed and two demonstration wru:ds opened. The services have been reorganized to provide better facilities for teaching purposes. New premises are under construction -which will provide much-needed additional accommodation at the hospital, including an enlarged prenatal clinic.
At the Children's Hospital, a total of 180 beds is now in use. An extension to the out-patient department was completed, providing additional waiting accommodation and facilities for a child health clinic and dental clinic. A home visiting service based on follow-up of children discharged from hospital has made a very satisfactory start.
The in-service training programme for hospital nurses and midwi ves has continued in both institutions. At the Children IS
Hospital, a practical and clinical training course for students from affiliated schools of nursing and midwifery was started in March 1959.
.. ----------/Plans were •• -:-
page 12
Viet Nam 7 TA (lCA)
Viet Nam 9 R (rCA)
Plans were completed and a start made to implement the second phase of the project, Which includes strengthening of the paediatric and obstetric training and services at Hue, and the development of maternal and child health services in municipal dispensaries in the City of Saigon.
Close co-operation has been maintained with the UNESCO Fundamental Education project in Tan-An and with lCA. in developing plans for future maternal and child health activities and in the field of nursing.
The shortage of counterpart nurses for supervisory and training activities continues to be a problem. The development of the paediatric training programme for doctors and medical students has been retarded by the difficulty of recruiting a WHO paediatrician.
Tuberculosis _Control (Jan. 1958 - )
Aim of the project. To set up the nucleus of a national tuberculosis control service, Inth emphasis on preventive and public health work; to complete a tuberculosis dispensary in Saigon and to integrate it in the existing facilities; to continue the WHO/ UNICEF-assisted BeG vaccination project and integrate it in the national tuberculosis control service.
Assistance provided by WHO during the year. A medical officer.
Probable duration of assistance. Until 1960.
Work during the period under review. Slow progress was made in structural alterations to the new dispensary and installation of equipment, but the dispensary opened in its final form in 1959. More m tional staff were made available and training courses were undertaken. The dispensary is now being developed along the lines agreed and will be a service centre for part of Saigon-Cholon as well as a training centre. The volume of BCG vaccination decreased during the year and some difficulties have been experienced in gaining local understanding and acceptance of the public health approach to tuberculosis control.
Environmental Sanitation Project (NOV. 1956 -
Aim of the project. To strengthen national and local environmental sanitation services; to train professional and sub-professional personnel; to carry out pilot schemes of environmental sanitation.
Assistance rovided by WHO during the ear. (a) A sanitary engineer; b supplies, equipment and technical literature.
Probable duration of assistance. Until 1961.
Work during the period under review. Considerable strengthening of national environmental sanitation services of Viet Nam has resulted from the initiation of an environmental sanitation service within the Ministry of Health. This servi,ce is now staffed with the first two Vietnamese sanitary engineers to have received training abroad under rCA fellovTships as well as two of the sanitary agents who completed training in Viet Nam.
Viet Nero 16 MESA (ICA)
Viet Nero
Western Samoa
'floC I ~"'v"'vl .:. page 73
The service has been active in consultations for local governments, in assisting the operation of training courses for sanitary agents and special courses such as those for water examination, and additionally, in supervising and stimulating sanitary agents stationed in rural areas.
Four training courses for sanitary agents have been completed with eighty-eight Vietnamese graduating from this training.
It is planned that a group of government officials will visit compo sting operations in some of the Member Countries of the Region, in order to assist in planning compo sting operations for Saigon and other Viet Nam communities.
Malaria Eradication (Phase I: March 1959 - )
Aim of the project. To implement a national programme on malaria eradication.
Assistance provided by WHO during the year. A malariologist, an entomologist and a short.term consultant.
Probable duration of assistance. Until 1961.
Work during the Reriod under review. A request was received from the Government for a short.term consultant to visit Viet Nam to work out a plan of action, .and for a malariologist and an entomologist to assist in carrying out the eradication programme under MESA.
The consultant completed his assignment and towards the end of 1958 the Regional Malaria Adviser visited Saigon to discuss the plan of operations. Following these discussions with the Ministry of Health it was considered advisable to have an exchange of letters to cover the assistance to be provided during 1959 pending the elaboration of a complete plan of operations for malaria eradication effective January 1960.
Participation in Regional Courses and Meetings
See WPR~ 39; WPRO 63; WPRO 72; Inter-regional 23; Inter-regional 35; Inter-regional 41.
PartiCipation in Regional Courses and Meetings
See WPRO 35; WPRO 63.
/WPRO •••
./
WP/R!JlOj2 page 74
WPRO 22 R UNICEF
WPRO 24 R
Yaws Control, Fiji (Nov. 1954 - ), western Samoa (JUne 1955 - ) , British Solomon Islands protectorate (May 1956 - ), Gilbert and Ellice Islands (Jan. 1957 - ), Condominium of the New Hebrides (JUne 1958 - )
Aim of the project. To reduce the prevalence of yaws by mass examination and treatment with penicillin and, ultimately, to eliminate the disease as a public health problem; to train local personnel in the diagnOSiS, therapy and epidemiology of yaws.
Probable duration of assistance. Until the end of 1961.
Work during the period under review. The WHO team consisting of a medical officer, a serolOgist, and a nurse/administrative officer assisted with the operation of the projects in the Condominium of the New Hebrides and Western samoa. A short visit was paid to Fiji.
In Western Samoa, during another successful ·Yaws Week", the rural health personnel completed the third resurvey of the total population. One hundred five thousand eight hundred twenty-two people were examined in twelve days and only 12 cases of infectious yaws were found - a prevalence of O.OOl~. This fully integrated project has progressed closer to eradication of yaws.
In the Condominium of the New Hebrides, the initial. mass treatment survey was completed; fifty thousand four hundred fortythree, or 99.2!'jo of the estimated population was examined and treated with penicillin. The prevalence of total active yaws found was 12.5~ and of infectious yaws 6.02!'jo.
In the course of a stop-over in Fiji, a short visit was paid to the Rewa valley. The resurvey of the British Solomon Islands Protectorate and of the Gilbert and Ellice I slands Colony, where the initial mass campaign was completed sometime ago, has been planned for later in 1959.
The start of the control project planned for the Kingdom of Tonga has been postponed until December 1960. .An assessment of the yaws control work carried out by the Government in the Cook Islands has been planned for 1960, at the request of the Government of New Zealand.
Dental Survey, Taiwan (2 Oct. - 29 Nov. 1958)
Aim of the project. To make a study of nutrition in relation to dental diseases and deform! ties, and in partiCular, the relation between fluorine, dental" fluorosis and dental caries.
Assistance provided by WHO during the year.· The services of a short-tem consUltant for a period of tw months. This survey was part of a headquarters inter-regional project.
/Work •••
WPRO 30 R
WPRO 35 R
WP/RClO/2 page 75
Work during the period under review. A WHO consultant spent two months reviewing the dent81 training programme, the dental health services and surveying the water, diet, nutrition and the status of dental health among children in Kaohsiung and its environ. It was determined inter alia, that: (0.) the deciduous dentition was frequently extensively destroyed by dental caries; (b) in permanent teeth, the majority of carious lesions were found in the first permanent molar teeth; (c) the amount of dental caries in the children examined was approximately half of that found in children of similar age in countries such as Australia and the United states of America; (d) fluoride naturally present in well or spring water markedly reduced the amount of dental caries in the permanent teeth; (e) children who ate dai~y large quantities of salt-water fish had very little dental car~es -although the water content .of fluoride was apprOximately 0.5 ppm.
Inspection of BCG Production Laboratories (Phase III: 25 March _ 25 April 1959)
Assistance consultant
Work during the period under review. Continuing the policy of 1953 and 1956, it was arranged in 1959 for an independent expert in BCG vaccine production to visit selected laboratories in the Region -which had been approved by mro and to report on their technical excellence. The expert made his tour in March and April and submitted his reports. At the same time, he gave all possible assistance and information to the directors of the laboratories concerned.
Tuberculosis Refresher Course for Assistant Medical Officers, Fiji (12 Jan. - 6 Feb. 1959)
Aim of the project. A training course of one month duration in tuberculosis control with special emphasis on methods of prevention, diagnosis, treatment and domiciliary care.
Assistance Pl;ovided by WHO. (a) Ii short -term consultant; (b) thirteen fel101vships for participa:1tc from the British Solomon IslaiJ.ds Protectorate, Cook Islands, Fiji, Gilbert D.j."ld Ellice Islands Colony, 1:CiT IL;brides, Hi ue) Terri tory of Po:puo. and l\Teil Guinea J Tonga, Tn~Gt 'J.\;rritory of th.::: Pacific Islands and Western Samoa.
Work done. A post-graduate refresher course in tuberculosis organized by WHO and the Government of Fiji, was held in SUva in January -February. It lasted for four i-reeks and was attended by assistant medical officers from ten Pacific Island territories. Instruction was given by a WHO consultant and the Regional Tuberculosis Adviser, with the collaboration of many local speCialists, and included lectures, discussions, field trips, demonstrations, cinema films, expert panels and discussion groups.
jAll aspects •••
WP/RClO/2 PB8 76.
WPRO 37 R
WPRO 38 TA (South Pacific Commission)
All aspects of the subject vere covered, 'With special emphasis on practical matters which the participants could apply in their everyday york. The course vas believed to be extremely useful.
poliOmyelitis Centres, Singapore and Tokyo (June 1956 - )
Aim of the project. To set up laboratory centres to: collect and study strains of poliomyelitis virus from different parts of the Region j undertake epidemiological studies for the eventual use of the vaccines; train WHO fellows as far as facilities permit.
Assistance provided by WHO during the year. Grant for laboratory '\-TOrk.
Probable duration of assistance. Until 1961.
'Work during the period under review. In Japan, most of the activities of the Centre were concerned with the preparation of facilities and the training of staff for the production of Salk vaccine for poliomyelitis control in Japan. A member of the Centre I s staff was awarded a WHO fellowship to study and observe tissue culture techniques and the preparation and assay of Salk vaccine in Australia and Singapore.
The Singapore Poliomyelitis Centre continued to serve as a training centre in virological techniques for tvo WHO fellovs (one from the Philippines and one from Japan). The Governments of the Federation of Malaya and Hong Kong sent a medical officer and technician for training in virology.
Training in Health Education (July 1957 - July 1959)
Aim of the project. To provide training in health education for health and education yorkers of native Origin from the territories of the South Pacific by (1) a course to enable them (a) to study the basic prinCiples underlying health education and their application in the territories; (b) to exchange ideas on health education activities and programmes now in progress; and (c) to study plans for further development; (2) continuous guidance to the trainees in their own territories.
Assistance provided by WHO. A health education specialist until August 1958.
'Work done. The practical results of the Joint South Pacific Commission/WHO Health Education Training Course held in Noumea in 1957 are reported from Netherlands New Guinea where trainees who attended the course actively implement principles learned at Noumea as a result of the introduction of health education in the curricula of several schools. The Government of Guam sponsor d a four-week health education training course for thirty-six Micronesian health and education '\-TOrkers in the Territories as a follow-up of the course.
/Following the •••
WPRO ?f9 MESA
WPRO 43 R
ft. I L\\iJ.OVf <::0
page 77
Following the termination of assignment of the WHO health educator, the work has been continued by the South Pacific Commission. It has been mutually agreed that the project should be terminated. A new proj ect undertaken by SPC enq>hasizes the training and education approach rather than consultations.
Co .ordination of Malaria Programme (Oct. 1958 • )
Aim of the project. Co.ordination of antimalaria activities in the countries represented on the Antimalaria Co-ordination Board.
(a) A secretary-
Probable duration of assistance. until 1962.
Work durin§ the period under review. The malariologist appointed as secretary to the Board took up his duties in October 1958. One of his first tasks was to assist with the preparations for the third meeting of the Board, 'Which took place in Rangoon from 1 to 4 December 1958, and which was attended by participants from Burma, CambOdia, Laos, the Federation of Malaya, Thailand aDd Viet Nam. During the period under review the secretary paid official visits to the appropriate authorities in all these countries as well as field visits to the remotest border areas. In the course of these visits data have been collected relating to malaria eradication in border areas, and, 'When requested, technical advice has been given to stimulate co-operation and co-ordination between the neighbouring countries.
Conference on Maternity Care, Manila (9-20 March 1959)
Aim of the project. To provide an opportunity for exchange of ideas, information and experiences between representatives of the health team engaged in maternity care, to consider how the major problems encountered in the Region might be dealt with more effectively, and ultimately, to stimulate action resulting in improved maternity care services.
Assistance provided by WHO. (a) Five short-term consultants*j '(6) travel expenses and stipends of thirty .. two participants from Australia, Cambodia, China (Taiwan), the Federation of Malaya, Fiji, French PolyneSia, Hong Kong, Japan, Korea, Netherlands New Guinea, New Zealand, Philippines, Sarawak, Singapore, Territory of Pa.pua. and New Guinea and Viet Ham; (c) supplies and equipment.
Work done. The Conference was attended by thirty-two governmental participants, one representative each from ICA and UNICEF and seven WHO staff members. The disciplines represented included obstetricians, paediatricians, maternal and child health officers, nurses and midwives. Three of the consultants visited a number of the participating countries before the conference.
The major topics discussed were: (a) the basic elements of maternity care services in terms of current practices and local
/needs •••
* Including a staff member from Headquarters and AMRO
WPRO 50 R
WPRO 53 R
FAO
needs, (b) practical consideration of ways and means of progressive improvement in maternity care, (c) prep~".ration and effecti"le use of personnel concerned with maternity care, and (d) maternity care as an integral part of the overall health programme.
Information relevant to maternity care in the participating countries and territories was obtained from a questionnaire which participants were asked to complete before the conference. An analysis of the questionnaire replies was included among the conference working papers which covered selected technical and administrative aspects of maternity care.
The main topics of the conference were discussed in plenary sessions and in smaller group meetings. Two half -day sessions were allocated for field visits, and two for discussion of subjects of mutuaJ. interest selected by the participants.
At the end of the conference, individuaJ. questionnaires completed by the participants indicated that the immediate objectives could be considered to have been successfully achieved.
Public Health Administration (DPH Fellowships)
Aim of the proJect. To provide fellowships for candidates from various countries of the Region to study for the Diploma in Public Health at the University of Malaya, Singapore.
Assistance provided by WHO during the year. Three nine-month fellowships to candidates from Japan, Federation of Mala.ya. and Netherlands New Guinea.
Seminar on veterinary Public Health, Tokyo (20 April - 1 May 1959)
Aim of the project. To identify problems in the field of veterinary public' health; to determine guiding principles which may be applied in planning, organizing and execution of a programme for more effecti ve solutions of veterinary public health problems in the Region; to obtain the most effective co.ordination of veterinary public health activities among the various' re~onsible government agencies; to utilize existing resources and to train personnel; to detennine how assistance from existing bilateral and international agencies can most effectively be utilized.
Assistance provided by WHO. (a) Two short-term con sultant s* ; (b) travel expenses and stipends 'of thirt;}t-three participants from Australia, China (Taiwan), Federation of Mala.ya., Fiji, Hong Kong, Japan, Korea, New Zealand, Philippines and Singapore.
Work done. The chief topics discussed were (a) the interrelationships of human and an1ma.l health and disease; (b) .some zoonoses of major interest in the Region; (c) control of food products of animal origin of importance in the transmission of disease; (d) veterinary public health organization and practice, including collaboration between medical, veterinary, sanitary and allied diSCiplines, and education and training of personnel.
* /Twenty-three •••
One, a Headquarters staff member
WPRO 60 FAO (Asia Foundation) (WFMfI)
WPRO 62 R
Twenty-three working papers were presented as a basis for discussions. Nine field visits were arranged to fish markets, abattoirs and food processing establishments.
Three consultants were provided by FAO and the Japanese Government made available three experts as resource persons and discussion leaders.
First Asian Seminar on Mental Health and Famil 0, Philippines 7.21 Dec. 195
Aim of the project. To identify common practices and problems of family life and the pattern of change in family life of various countries in Asia today; to exchange views and information on methods of approach to these problems and to their solution.
The Asia Foundation provided fellowships for participants from Hong Kong, Japan, Korea, the Federation of Malaya, Palcistan and Thailand. FAO seconded a staff member and the World Federation for Mental Health, two staff members.
Work done. Working group discussions of the study topiCS were arranged for the partiCipants Who were mostly of senior rank in profession and position to secure the fullest participation from all members. Other variations in procedures consisted of formal lectures, multi-disciplinary panel discussions and interview presentation.
The seminar did not try to focus on one particular problem but attempted to list the effects of changing conditions and gave consideration to the planning of social activities that would be required to avoid or meet the ill.effects of these changes. Four study topics constituted the subjects of discussion by the groups.
Tangible gains from the seminar were the establishment of the Asian Federation of Mental Health consisting of the six Asian countries Which already had mental health SOCieties, viZ., Japan, China (Taiwan), Hong Kong, Singapore, India and the Philippines and a plan on the part of three countries (Ceylon, Korea and Thailand) to establish a mental health society so they could also join the Federation.
A resolution by the seminar participants requesting WHO assistance in the organization of another Asian seminar wi thin the next two to three years on the same subject was adopted.
Sewerage Planning and Design Training, Taiwan
Four six-month fellowships, two each from Japan and the Philippines.
/WPRO 63 •••
r WP/RC10/2 page 80
~PRO 6; R
W,PRO 64 R
WPRO 71 R
Seminar on Dental Health, Adelaide (10-20 Feb. 1959)
Aim of the proiect. (a) To review accomplishments in dental health during the las five years, e~ecially in the field of preventive dentistry; (b) to identify and discuss current dental health problems and the roles of the national health administration and the dental health profession in their solution; (c) to discuss the standardization of reporting dental health conditions.
Assistance provided by WHO. (a) Seminar director and three* consultants; {b) travel and stipends of forty-four participants from Australia, China (Taiwan) Federation of Malaya, Fiji, Hong Kong, Japan, Korea, Netherlands New Guinea, New Zealand, Philippines, Sarawak, Singapore, Territory of Papua and New Guinea, United states Trust Territory of the Pacific Islands, Viet Nam, Western Samoa, Pakistan, Ceylon, India, I~donesia and Thailand.
Work done. The chief topics discussed were: (a) current techniques for the prevention and control of dental diseases; (b) dental health programme administration and personnel utilization; (c) methods for recording, surveying, evaluating and reporting dental conditions; (d) evaluation of present services and plans for the development of dental health programmes in the countries partiCipating in the seminar. The seminar consisted of panel topic presentation followed by discussions, plenary sessions and working group deliberations. Ten wo:rking papers were prepared as background information for discussions. Interim and end of seminar eValuation were carried out. In terms of achievement of the seminar, 6l.?I/o of the replies considered the immediate effectiveness as excellent, ;7.8'/0 as good. The report has been distributed to governments. Two consultants were provided by the Australian Dental Association.
In the Territory of Papua and New Guinea planning of the dental health services has been influenced by the deliberations of the seminar.
Medical Literature and Teaching Equi~ment
Aim of the project. To supply small quantities of essential literature, equipment and supplies to Member Governments for work on demonstrations, training projects and pilot studies.
Assistance provided by ,-rn0 during the year. Medical literature to Japan and Viet Iiam.
Smallpox Eradication
One four-month fellowship from Korea for study of management and production of dried smallpox vaccine in the United Kingdom and Denmark.
* Including a WHO Headquarters staff member
/WPRO 12 •••
WPRO 12 R (ICA)
WPRO 18 R UNICEF
wp/Rc~o/2 page 8~
Training Course on MaJ.aria Eradication Techniques, Institute of Malario~ogy, Ta:iBO, RizSi, Philiwines
Aim of the project. To train various categories of personnel needed by countries in the western Pacific and SOuth-East Asia Regions.
Assistance provided by WHO during the year. A short-term consultant and a sanitarian.
Work during the period under review. under the auspices of the Government of the Republic of the Philippines, and in co-operation with lCA, training courses on malaria eradication techniques have been inaugurated at the Institute of Malariology, Tala. An expert on the organization of international training courses in malaria eradication was assigned to the project for tWo months to assist in its implementation. Four courses a year are envisaged. They are of twe~ ve weeks duration : five weeks institutional training and seven weeks fie~d training, and Will be held alternatively for senior and junior personne~ with a maximum number of twenty-five students per course. The first ~ course for senior personne~ will take place at the end of the year. Participants from Korea attended the first course 'Which was held from 6 January to 30 March 1959. The second course 'Which started on 1 Apri~ was attended by participants from Hong Kong, Sarawak, Singapore and Viet Nam.
Control Co-ordination Meetin
Aim of the project. To make available to the different participants the considerable body of experience that has accrued from the yaws control projects in the different countries of the Western Pacific and SOuth-East Asia Regions and else'Where; to compare the different approaches and techniques employed to achieve the objectives of the different projects; to discuss common prob~ems and possib~e ways of solving them; to discuss the need for and the most effective way to secure the co.ordination of yaws control activities in the neighbouring .countries with a view to achieving the systematic eradication of the disease from the total geographic area.
Assistance provided by WHO. (a) Per diem of two secretaries; (b) transport of supplies and equipment.
UNICEF paid for the attendance of participants from Burma, Cambodia, Indonesia, Laos, Federation of Ma.laya, Philippines and Thai~and.
Work done. Country papers dealing with the yaws prob~em, control programme and its achievement to date of the several countries represented were presented and discussed. The following major topiCS were then introduced and discussed by the group: (a) the epidemio~ogy of yaws in relation to eradication campaigns; (b) the epidemio~ogy of receding yaws; (c) yaws eradication methods; (d) experiences with WHO recommended dosage of PAM in yaws campaigns; (e) the objectives of yaws campaigns;
I(f) research , ••
WP/RC10/2 page 82
EURO 52 TA
(f) research in yaws j (g) inter-country co-ordination in yaws control. The final report on the meeting has been prepared for distribution.
The active participation by all present in the discussions was an indication of the general interest in the topics considered. The personal contacts between the participants, 'Who were most actively engaged On yaws control projects, resulted in much informal discussions and in at least one agreement to hold an inter-country border meeting to consider common problems of yaws eradication in the border areas.
Eighth Anaesthesiolog;y Training Course J Copenhagen (Jan •• Dec. 1958)
Aim of the ro ect. To stimula.te the development and iqlrove t e standards 0 national anaesthesiology services by training courses for medical personnel.
Assistance provided by WHO. Three twelve.month fellowships to trainees from Japan, Korea and China (Tai'WBn).
Inter .. regional 17 Inter.regional Traini; Course on Bilharziasis J Cairo R (10 Nov. - 31 Dec. 19 )
Aim of the project. To train personnel in bilharziasis control.
Assistance provided by WHO. (a) Four lecturers - on epidemiology applied to billlarziasis, zoology/ecology applied to malacology and limnology, sanitary engineering, and health administration; (b) fellowships to twenty public health administrators, engine rs, epidemiologists and biologists f~om the African, the South-East Asia, the Eastern Mediterranean and western Pacific Regions. Of these twenty fellowships, two were awarded to partiCipants from Japan and the Philippines.
Inter-regional 23 Third Asian Malaria Conference, New Delhi (16-21 March 1959) MESA
Aim of the iaiject. To discuss the technical and administrative aspects of aria control and eradication campaigns in the western Pacific and South-East Asia Regions, the problems encountered and progress made following the two previOUS similar conferences;to advise on how to prevent the dangers to which insecticide resistance in anophelines would lead.
Assistance provided by WHO and work done. The conference was attended by twenty-one participants from Australia, Cambodia, China (Taiwan), Hong Kong, Japan, Korea, Laos, Federation of Malaya, Netherlands New Guinea, North Borneo, Philippines, Sarawak and Viet Nam, including seven ministers of health or their designated representatives. Forty-nine partiCipants from outside the Western Pacific Region alao were present.
/In order •••
WP/RCl.O/2 page 83
In order that the progress already aChieved in some countries should not be jeopardized, the conference recommended that the governments of those countries WhiCh had not yet embarked upon malaria eradication programmes should organize resources to take immediate steps to iJli>lement such programmes.
stress was laid on the iJli>ortance of planning, which should deal with four successive phases - a preparatory phase, an attack phase, a phase of consolidation and a phase of maint nance -and accomplished in accordance with a strict time-sChedul •
If not already in existence, government s were recommended to establish a malaria eradication service. Other recommendations of the conference were: (a) all categories of personnel of the service should receive adequate remuneration; (b) adequate provision should be made in the service for imparting health education on the various phases of eradication procedures; ( c) the utilization of existing legislative proviSions and the provision of supplementary legislation in order to fulfill the requirements of entry into premises; (d) governments should provide adequate workshop services for the maintenance of transport, in Charge of suitably qualified transport officers.
In view of the importance of the role of the WHO in malaria eradication programmes, the conference urged all governments and non-governmental bodies to contribute adequately to the WHO Malaria Eradication qpecial Account.
Inter-regional 35 Trainin Course on PUblic Health Laborator R and Rickettsial Diseases, Coonoor, India
Aim of the project. To promote the application of virology in public health; to explain and demonstrate laboratory techniques for virus and rickettsial diagnosis; to promote virus and rickettsial diagnostic work in existing public health laboratories.
Assistance provided by WHO. Fifteen fellowships were awarded to traineeo from the South-East Asia, Eastern Mediterranean and Western Pacific Regions.. Of these fifteen fellowships , five were awarded to trainees from the following countries of the Region: China (Taiwan), Hong Kong, Japan, Philippines and Vi t Nam.
Work done. The course was held at the Insti tut Pasteur, Coonoor. It placed emphasis on the importance and potentialities of the virus and rickettsial disease diagnostiC laboratory as an integral part of a country's public health services. The organization, functions and equipment ~ropriate to a laboratory of this type were explained. The basic techniques of virus and rickettsial work were demonstrated and practised.
Inter.regional 37 Training Course in Health PhYSiCS, Bombay (17 Nov •• 19 Dec. 1958) R
Aim of the project. To provide training in the heal.th aspects of the various applications of nuclear science; to exchange
/experience among •••
WP/RC10/2 page 84
experience among researCh workers of participating countries on the various aspects of radiation protection.
(a) A director of the course and two lecturers; b stipends for tw'enty-three participants including participants from Australia, China (Taiwan), Japan and the Philippines.
Inter-regional 41 Inter-regional Leprosy Conference, Tokyo (20-24 Nov. 1958) R
Aim of the Rroject. To bring together representatives from countries having similar epidemiological, social and administrative problems.
Assistance Rrovided by WHO and work done. Sixteen fellowships were awarded to partiCipants from South-East Asia, Eastern Mediterranean and western Pacific Regions. Of these sixteen fellowships, ten were awarded to participants from the following countries of the Region: China (Taiwan), Fiji, FrenCh PolyneSia, Hong Kong, Japan, Korea, Federation of MaJ.aya, Territory of Papua and New Guinea, Philippines and Viet Nam.
Many aspects of the organization of leprosy control in the area from 'Which the participants came, and the problems relating to the rehab ill tat ion of leprosy patients were discussed. The report of the conference showed that there was good support for future development of leprosy control projects in the area, in accordance with the policy of WHO.
Inter-regional 49 Malaria Eradication Advisory Teams (27 Feb - 9 July 1958) R
Aim of the project. To help in assessing conditions for, and development and progress of, the malaria eradication programme in different countries.
Assistance Rrovided by WHO and work done. An advisory team worked in Cambodia from 27 February to 9 July 1958.
Inter-regional 77 Grou Fellowshi s on Public Health Administration in the Union R of Soviet Socialist Repub ics Oct. - Nov. 19
Aim of the project. To study the organization and operation of health services in the Union of Soviet Socialist Republics.
Assistance provided by WHO and work done. Twenty-three fellowships were awarded to partiCipants from the African, South-East ASia, European, Eastern Mediterranean and ~Jestern Pacific .Regions and the Region of the Americas. Of these twenty-three fellowships, two were awarded to partiCipants from Japan and New Hebrides. The programme lasted six weeks and the itinerary included visits to medical and health institutions and services in Mb~cow, leningrad, Kiev, Tbilisi, SukhtUIJ.i, Sochi and Tashkent, ,enabling the partiCipants to study the various aspects of publlc bealth organization at different levels.
lInter-regional •••
Inter-regional 79 Training of ~~ia Eradication Personnel, Jamaica ~~ (~~-)
WP/RC10/2 page 85/86
Aim of the project. To train malariologists, entomologists, sanitarians and laboratory teChnicians for service in internationally assisted malaria eradication programmes.
Assistance provided by WHO and work done during the year. Two participants, one from Korea and the other from Japan, were awarded fellowships to attend the training course at Kingston and Jamaica.
/MINEX 1 •••
Organizational Unit
OFFICE OF REGIONAL mREcroR
Public Information
BUREAU OF HEAIJrH SERVICES
Advisory Services
Fellowships
Secretarial Pool for Advisory Services
LIsr OF REGIONAL OFFICE posrs
Post -I - Regional Director I - Reports and Liaison Officer I - Administrative Assistant L -. Secretary
I - Public Information Officer L - Information Assistant L - Secretary
I - Medical Director L - Secretaries (2) L - Clerk/statistician L - Clerk/stenographer
I - Regional public Health Administrators (;)
I - Regional Adviser on Health Education
WP/RC10/2 page 81
ANNEX 1
Nationality
China U.K. VACANr Philippines
Denmark Philippines Philippines
Philippines Philippines Philippines Philippines
11) China 1) Canada 1) Philippine.
of the Public Canada I - Senior ~egional Malaria Adviser VACANT I - Regional Malaria Adviser U.K. I ~ Entomologist China I - Public Health Engineer Philippines I ~ Administrative Assistant U.K. I - Regional Adviser on Communicable Diseases U.K. I - Regional Adviser on Hmri tiOD VACANJ! I • Regional Adviser on Maternal and Child Health U.K. I ~ statistician and Programme Evaluator China I - Regional Adviser on Nursing Canada I ~ Regional Adviser on Environmental Sanitation U.S.A.
I - Regional Adviser on Education and Training L ~ Technical Assistant L .. Secretary L - Clerk/stenographer
L - Secretary L ~ Clerk/Stenographers (9)
Japan Philippines Philippines Philippines
Philippines Philipp in s
OFFICE OF AJl.1INIsrRATION I - Senior Administration and Finance Officer U.S.A. Japan AND FINANCE I - Administration and Finance Officer
L - Secretaries
I - Internationally recruited L - Locally recruited
/Budget •••
(1) Philippine (1) VACANT
WP/RC10/2 Annex 1. page 88
Organizational Unit
Budget, Finance and Accounts
Personnel
Qen ral Services
AREA REPRESENTATIVES
Saigon (Cambodia, Laos, viet Nam)
Si!apore (Brunei, Fe\eration of Mal~a, North Borneo, Sarawak, Singapore)
~ (South Pacific Arear-Taipei fjf.orea, Japan, China (Taiwan), Hong Kong, Macau, United states Trust Territorie!7
Post -I - Budget and Finance Officer I - Finance Officer I - Accountant L ~ Assistant Accountants (2) L - Cashier L - Accounts Clerks (8) L - Clerk/Stenographer
I - Personnel Officer L - Personnel Assistant L ~ Clerk/Typist L ... Clerk/Typist
I - Administrative Services Officer I - Assistant Administrative Services Officer I - Translator (English-French) I - Assistant Translator (English-French) I - Translator (English-Chinese) L - General Services Assistant L - Travel Clerk L ~ Supply Clerk L - Registry Assistant L - Registry Clerk L • Clerk/Typists (5) L ~ Mail Clerks (2)
I - Medical Officer L - Secretary L .. Clerk/Typist
I - Medical Officer
I - Medical Officer L .. Secretary
I - Medical Officer L ... Secretary
SINGAPORE EPIDEMrOLOGICAL I - Medical Officer INTELLrGENCE srATION L - Administrative Assistant
L - Technical Assistant L - Technical Clerks (4) L ~ Administrative Clerks (2)
I - Internationally recruited L ... Locally recruited *Also Area Representative, Singapore
Nationality
U.K. U.K. VACANT Philippines China Philippines Philippines
VACANT U.S.A. Philippines VACANT
I'letherlands VA~ SWitzerland Switzerland China Philippines Philippines VACANT Philippines Philippines Philippines (1) China (1) Philippine I
U.K. Viet Nam Viet Nam
China
U.K. Australia
U.K. VACANT
China* India U.K. U.K. (1) India (1) U.K.
/ANNEY. 2 •••
WP/RC10/2 page 89/90
ANNEX 2
CONSUIlI'ANTS EMPLOYED DURING THE YEAR
project Field Number Nationality
Cambodia 1 Malaria Eradication 1 France Cambodia 5 ~OphtheJ.m01Ogy 1 France
Medical Physics 1 France
China 13 Trachoma 1 Italy China 14 Environmental Sanitation 1 Germany China 17 x-ray 1 U.K. China 24 Dental Survey 1 Australia
Me.l.aya 10 Tuberculosis Control 1 U.K. Malaya 12 Clinical Nutrition 1 Netherlands
Philippines 9 Bilharziasis 1 U.S.A. Philippines 12 ~Pub1iC Health Nutrition 1 U.S.A.
Mental Health 1 U.S.A.
Viet Nam 16 Malaria 1 France
WPRO 30 In~ection of BCG Production Laboratories 1 SWeden WPRO 35 Tuberculosis Refresher Course for Assistant
Medical Officers, Fiji 1 U.K. WPRO 43 (Education Consultant 1 U.K.
~obstetrics 1 U.K. PaediatriCS 1 Philippines
WPRO 53 Veterinary Public Health 1 U.S.A. WPRO 60 1Project CO-ordinator 1 Philippines
Clinical Psychology 1 Austria Psychiatric Education 1 China Home EconOmics 1 Canada
WPRO 63 Dental Health (3) 1 U.K. 1 U.S.A. 1 Norway
/ANNEY. 3 •••
WP/RCJ.O/2 page 91/92
.ANNEX 3
PROJEGr AND REGIONAL OFFICE IlifrERNATIONAL grAFF EMPLOYED AS OF 30 JUNE 1959
Country RegionaJ. Office Area - Field TotaJ.
AustraJ.ia 5 5
Austria 1 1
Bolivia 1 1
Canada 3 6 9
China 5 J. 3 9
Denmark 1 1 2
France 6 6
Germany 6 4 4
Greece 2 2
Ireland 1 J.
ItaJ.y 1 1
Japan 2 2
Netherlands 1 1 2
New ZeaJ.and 4 4
Philippines 3 4 7
South Africa 2 2
South Rhodesia 1 1
Switzerland 2 1 3
Thailand ... 1 1
Turkey 1 J.
United Kingdom 7 3 12 22
United states of America 2 5 7
TotaJ. -------.. 26 4 63 93 == ==- ==
/ANNEX 4 •••
GEOGRAPEICAL DIffi'RrBlJrION OF INI'ERNATIONAL ffi'AFF TERMINATED OR TRANSFERRED
Country Regional Off'ice Field Consultants
Australia 1
Austria 2 1
Canada 1 1
China 1 1
France :3
Germany 1
Italy 1
Netherlands 1
Norway 1
Philippines 2
Switzerland :L
SWeden 1
United Kingdom 1 4 5
United states of America 1 4 4
Total ----...... - 4 12 22 ======
__ au::
== u UE rs:::
WP/RC10/2 page 93/94
ANNEX 4
Total
1
:3
2
2
:3
1
1
1
1
2
1
1
10
9
38
/ANNEX 5 •••
WP/RCIO/2 page 95
ANNEX 5
LIS!' OF SUPPLEMENrARY AGREEMENrS SIGNED WITH MEMBER Coum'RIES DURING THE PERIOD 1 JULy 1958 TO 30 JUNE 1959
CoWltry Project Title WHO Number
British Solomon Nursing Education (agreement and amendment BSIP3** Islands Protectorate in letter form)
Cambodia
China (Taiwan)
Fiji
Japan
Korea
Netherlands New Guinea
New Hebrides
North Borneo
Philippines
Malaria Control (addendum in letter form)
Maternal and Child Health (addendum in letter form)
Venereal.Disease Control (Addendum VI)
Cambodia 1
Cambodia 4**
China 1**
Maternal and Child Health China 3** (Addendum II to planops for refresher training of private practising midwives, and Addendum IV to planops for expansion of maternal and child welfare services)
Nursing Education (revised agreement) China 6
Malaria Eradication (addend\.Ul1 in letter form) China 7
Mass diphtheria and pertussis immunization China 9* campaign (revised agreement and addendum in letter form)
Central Medical School (addendum in letter form) Fiji 2
Institute of Public Health (addendum in letter Japan 10 form)
Malaria Eradication (addend\.Ul1 in letter forn)
Malaria Survey (agreement and addendum)
Malaria Control (Addendum III)
YaW's Control (agreement)
Malaria Control (Addendum III)
Midwifery Training (addendum in letter fOrm.)
Maternal and Child Health (Annex III to Addendum II)
Leprosy Control (Addendum II)
Japan 20
Korea 13
Netherlands New Guinea 2*
New Hebrides 1**
North Borneo 5**
Philippines 29**
Philippines 40*
Philippines 49*
*UNICEF supply progrannne **Joint with UNICEF
/Mala.ria
WP/RC10/2 Annex g. page 9
Country
Philippines (continued)
Singapore
Viet Nam
Inter-regional
Project Title
Malaria Eradication (revised planops and addendum in letter form)
WHO Number
Philippines 53
Island-wide Domiciliary Midwifery (agreement) Singapore 14
Viet Nam II ,
Vital and Health statistics (agreement)
Malaria Eradication (agreement in letter form) Viet Nam 16
First Asian Seminar on Mental Health and Family Life (amendment in letter form)
Trial of malaria prophylaxis with medicated salt (Pinotti t s method) (agreement in letter form)
WPRO 60
WPRO 68
/ANNEX 6 •••
WP/RC10/2 page 97/98
ANNEX 6
DISTRIBUnON OF VISITS IN ACCORDANCE WITH COUNTRY OF STUDY AND REGIONS
Number of Visits from
count!l of stu~ AFR ~ ~ SEAR WPR Total - - -Australia 1 4 14 19(17*)
China 2 8 10(4*)
Federation of Malaya 2 4 7 13(1*)
Hong Kong 1 2 5 8
Japan 3 8 11(6*)
New Zealand 5 3 8(8*)
North Borneo 1 1
Territory of Papua 1 1 and New Guinea
Philippines 1 1 4 12 18(2*)
Sarawak 1 1
Singapore 1 3 11 15(7*)
Viet Nam 1 1
Total number of visits ---- 8 1 1 12;6= 62 106'4~*~
~he figure given in parenthesis represents the number of visits of more than three months t duration.
(These include only visits which were begun during the period and exclude those which, al.though continuing in the present period, were begun during the previOUS year. One fellow may visit more than one country in the course of a fellowship and the tabulation merely indicates the number of fellows a country has received during the period.)
/ANNEX 7 •••
FELLOWSHIP AWARDS 1 July 1958 to 30 June 1959
According to Fields of study and Countries of Origin
I f3 ~
~ eJ
<!! H ~ Fields of Study ~ ~~ ~ 0 ~ ~ 6:l ~ ~~ ~
eJ
~ § ~ ~ 0 ~ lJ:l
1. HEALTH ORGANIZATION AND SERVICES
PUBLIC HEAI1l'H ADMINIsrRATION
Public health a&~inistration
Diploma course in public health •.••••.••••••••••• 1 1 Diploma course in public health with emphasis
on preventive medicine and public health •.••••• 1 Diploma course in public health with emphasis
on rural and tmiversity health serVices •••••••• Public health administration •••..•••••••••••••••• 1 1
SANITATION
Environmental sanitation
Public health engineering •••••••••••••••••••••••• 1 Sewerage de sign ...............................•.. 2
NURSING
Nursing care and midwifery
Midwifery teaChing •..••.•••.•.....••.•••••••.•.•. 1 Diploma course in nursing education •••••••••••••• 1 Paediatric nursing ••.••.•••••••..•••••••••••..••. 1
Cf.l Cf.l f§ I §~ ~ ~§ ;
~ I~ gs ~ ~ ~ ~
1
1
A~ ~~ ~eJ
t'3 :=i
~~ ~
1
Cf.l
5@
~ re
1
2
i -.."j
10:;:
~~ roe \0 ... \O~
N
~
~ i5
~ H
Fields of study ~~ 0 ~ §j ~ E:l~ ~
~ ~~ 0
Techniques of obstetrical care' and organization of schools of midwifery •........•......•.•••.•• 1
public health nursing
Public health nursing ,-rith emphasis on maternal and child health .•...•....•....•••.... 1
:MATERNAL AND CHILD HEALTH
Organization of maternal and child health services
Diploma course in public health vith emphasis on maternal and child health ......•.....••...•• 1
Maternal and child health administration ••.•.....
0rHER HEALTH SERVICES
Mental health
Psychiatric and mental nursing •................•. 2 Child mental health .......................••.•..•• Mental health legislation ..............•.•••...•• Mental health (orientation and training in the
administration of a psychiatric hospital, organization, treatment and rehabilitation of psychiatric cases) ..........................
Health education
Health education
Occupational health
Diploma course in public health with emphasis on industrial health ............................ 1 -.. -
tQ
t!:l A! is ~ ~e;
~ ~ G~ ~ t!:l tQ
t5 0
~ a ;:s l:Q I-;j ~
1 1
1 ,.
1
tQ
E:l A ~ ~ ~ rJ
N
~ ~ ~ ~
1
tQ
~~ ~ ~g &!
t:.1 ~j
.. ~
8
1
to~ &5 CD CD I-' X o o
I I
~ co
~~ co ~ A
~
$ ~~ ~ ~ 0 eJ t:! i:l H 5 H Fields of Study
§ ~~ ~ .~~ ~ r£l <:8 ~ ~ ~ ~ ~o N ~ 51 ~ r;;l~ ~ 0 co f§ ~~ trl ~i 5 0
~~ ~ ~ ~ ~ H ~ ~ 0 Ii< t:r:: f-;j ~
Insecticide hazard control ..••...•....•......•.•. 1 Nutrition
Infant nutrition .••...•..•••........•..•.•.....•. 1 Nutrition ........................................... 1
Health statistics
Public health '\lith emphasis on health statistics . 1 «
Dental health
Diploma course in public health dentistry ........ 1 Dental nursing .............................. " ........ 3 Public health administration with specialization
in dental health administration •.•.•••••....•.• 1 Rehabili-'-cation
Physiotherapy ....................................... 2 1 Drug control
,
Biological standardization •...•.•.•.•.•••.••••.•. 2
2. COMMUNICABLE DISEASE SERVICES
COMMUNICABLE DISEASES AND LABORATORY
Malaria
Malaria eradication and control .........•.•...... 1 1 1 1 2
Venereal Diseases and Tre~onematoses 'O~= P' : (JQ ~
III (1) •
..... x f ~ i
Venereal diseases control .••..•......•••••.••.••• 4 2 1 i
, f:j
~ <:r: <:r: H tj Fields of' Study t=:l ~r,:l ~ 0
~ ~::s b:l ~ ~ II: ~~ 0 0 --,
'n:uberculosis l
Tuberculosis control ............................ 1 Tuberculosis control (occupational therapy
and vocational rehabilitation) ................ Other co~aunicable diseases i
Control of viral and rickettsial diseases ........ 1 Epidemiology and statistics in relation to
trachoma ...................................... 1 Investigation and control of arthropod-borne
diseases .......................................... 1 Epidemiolo~y (Teaching methods of epidemiolo~
and practical epidemiological study on food poisoning) ........................................
Management and production of dried smallpox vaCClne •................................•..•..
Leprosy control ................................. Administration and management of leprosaria and
preventoria •...•..............................
Laboratory
Virology ........................................
lEDICAL EDUCATIONz CLINICAL AIm BASIC MEDICAL ;CIENCES
:LIHICAL MEDICINE
Surgery and medicine
Undergraduate medical assistants' studies ....... Reconstructive surgery as related to
poliomyelitis ................................. -- -_ ... _._-
tJ)
o~ ~ h 0 ::.::
~ <:r:
H ~
~ tJ)
/-;) ~ 0
~~ ~ ::s II: I-;i ::.::
1
1
1 1
5
- .-
tJ)
~ ~ ~~ i ~ ~g N
~ :::;
~ ~ ~~
1
1
- -
tJ)
~ H
fu ~
~
1
1
11 ~ ___ l
'O!r> & g-~ (l)
f-.i~ O~l f\) "-
{' '" f
~
<l! ~ eJ
~ g H § Fields of Study ~~ ~
0 ~ ~ §j ~ §~ H eJ
5 ~ l2i
~ ~~ H 0 0 rz. ::r::: l-j
Anaesthesiology
Ano.esthesiology .•....•...........•..•.....•..•... 1 1
Radiology
RadiograpllY .................................................................... 1
other medical and sur~ical specialities
Organization and operation of neuro-surGical services ..............................................................................
BASIC MEDICAL SCIEnCES AND EDUClITION
Basic medical sciences
Physiology .....•...•...•.•....••....••...••...... 1
Total •••. 5 1 19 6 J_ It- 14 ==== == b== 1:=== === F=== -~=
,~ '\ \
tf)
001 tf) ~
~ A~ ti:! ~~ f21
h H
~ It ~~ ~
N tj U) [§ ~ ~~ ~ ~
H
~ ~~ ~ ~ I
1
1
7 5 4 1 2 1 2 16 1:=== =:;; ~ b: -- -
GPJUqD TOTAL ------ 88
'g~ CQ l:l (1) (j)
>< I-:-' o \,).1