•• I \.oIt •• , .;!..J, WORLD HEALTH .., -- oy" ORGANISATION MONDIALE ORGANIZATION s DE LA SANT£ 1J,:,J "" .JI' REGIONAL OFFICE FOR THE BUREAU RmlONAL DE LA EASTERN MEDITERRANEAN ORIENTALE IGGlOtrAL COiil'1ITTEE FOR THE EN/RC12/9 ';AS'YSRlI LEDITERRANEAN 15 June 1962 I'weU'tll Sec sion ORIGINAL: ENOL IS!: Agenda item 10 (f) RURAL HEALTH AND CONMUNITY DEVELOPMENT IN THE EASTERN MEDITERRANEAN REGION Resu1 ts of an Enquiry
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ORGANISATION MONDIALE .JI' DE LA SANT£ ~.JI'-:-' 1J,:,JAden Colony Stone Aden Protectorate Mud, Stone, Tents, Thatch. French Somaliland Stone, Mud, Wooden cabins Tents Iran I Bricks,
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•• I \.oIt •• ~J , .;!..J, WORLD HEALTH .., -- oy" ORGANISATION MONDIALE ORGANIZATION s ~..u' DE LA SANT£
~.JI'...-:-' 1J,:,J "" .JI' ~, REGIONAL OFFICE FOR THE BUREAU RmlONAL DE LA
EASTERN MEDITERRANEAN M~DITERRAN~E ORIENTALE
IGGlOtrAL COiil'1ITTEE FOR THE EN/RC12/9 ';AS'YSRlI LEDITERRANEAN 15 June 1962
I'weU'tll Sec sion ORIGINAL: ENOL IS!:
Agenda item 10 (f)
RURAL HEALTH AND CONMUNITY DEVELOPMENT
IN THE
EASTERN MEDITERRANEAN REGION
Resu1 ts of an Enquiry
TABLE OF CONTENTS
I INTRODUCTION
II POPULATION AND VITAL STATISTICS
III HOUSING
IV ENVIRONMENTAL SANITATION
1. Water supplies
2. Excreta disposal
3. Food control (including milk)
4. General information on waste disposal
EMjRC12/9 page i
5. General information on measures, so far undertaken for the purpose of sanitation
V HORBIDITY
1. Notifiable diseases
2. Total number of persons suffering from blindness and deafness
3. Disease vectors and vector control
VI GENERAL INFORMATION ON RURAL AREAS AND RURAL ECONCMY
1. Definition used for distinguishing between urban
1
2
3
3
7
7 8
10
10
11
13
and rural areas 14
2. Number of rural communities, their average population and dispersion pattern 14
3. Types of agricul-rure and common crops l.!lcluding the relative importance of the various types 17
4. General state of nutrition in rural areas 21
5. The types of irrigation in the c amtry with particular lIlention of their possible influence on incidence of endemic diseases
6. Types of hcusing especially in relation to sanitation
22
in rural areas 26
VII GOVERNMENT ACTIVITIES ON THE NATIONAL LEVEL AIMING AT PROHOTION OF RURAL HEALTH
1, Special Ministry for Hunicipal and Rural Affairs
2. Special Agency dealing with rural health in the Ministry of Public Health
3. Cooperation in rural health of departments of other Ministries with the l-unistry of Public Health
4. Commi ttee for coordinating the work of various governmen tal agencies for promoting rural health
27
28
29
29
EM;1w12!9 page ii
TABLE OF CONTENTS (cont' d)
VIII VILIJ.GE HElJ.TH COOPERl.TIVE SJCIETIFS
IX HEAL'IH UNITS IN RURAL AREAS
Aden Protectorate French Somaliland Iran Israel Jordan Kuwait Lebanon East Pakistan West Pakistan Saudi Arabia Sudan Syrian Iwab Republic United Arab Republic
X SOCIAL CENTRES
French Somaliland Iran Jordan Kuwait Lebanon vlest Pakistan Saudi llrabia Syrian Arab Republic United Iwab RepUblic
XI BASIC EDUCATION AND SCHOOL HEALTH IN RURAL AREAS
31
31 32 33 33 34 36 37 39 40 43 43 44 45
50 50 50 51 51 52 52 52 53
1. Number of schools and school children 56 2. School health services and their influence on rural
health in general 56
XII HEALTH EDUCATION OF '!HE PUBLIC 62
XIII COMBINED UNITS 65
XIV COMl'IUNITY DEVELOPMENT SCHEMES 66
xv INTERNATIONAL ASSISTANCE 69
ANN E X - QUESTIONNAIRE ON RURAL HEALTH AND COMMUNITY DEVELOPMENT
I INTRODUCTION
EMtRC12/9 page 1
In view of the need for more information on rural health and community
development projects in the countries of the Region, the Regional Office
fer the Eastern Mediterranean, by circular letter of 4 April 1961 sent a
d8tailed Questionnaire on Rural Health and Community Development to all the
countries of the Region.
The questionnaire is annexed. It was designed with a view to
facilitating the description of the probl~ and to indicate the particular
subjects on which information was elicited.
The question" of rural health and community development is of great
concern in almost all countries of the Region as well as in countries O1,lt
side the Region and particularly for countries at the development stage.
At the eleventh session of the Regional Committee for the Eastern
Nediterranean the question of rural health was one of the technical matters
discussed and a document on the subject was presented to the Committee. l )
Answers to the questionnaire were received from tbe following countries
and territories:
Aden Colony Aden Protectorate French Somaliland Iran Iraq Israel Jordan Kuwait Lebanon Pakistan Saudi Arabia Sudan Syrian Arab Republic United Arab Republic
It will be seen that answers were received fran the majority of the
countries of the Region. The Regional Office wishes to express its thanks
to the Governments for submitting replies to the lengthy Questionnaire.
l)Rural Health. Document EMtRCll/l3, 26 July 1961.
EMtRC12/9 page 2
In addition to the data received from the Governments, information
from other sources has been included in this document. These sources
comprise the statistical publications of the United Nations and its
specialized agencies such as "Statistical Yearbook 1960", "Demographic
! Paldstan, West Brick & l10rtar Mud, I Brick & Cement Brick & Mortar , Cement & Stone & Mortar ! Concrete I I Paldstan, East Bricks lfud,
Bamboo , Tin i , i Saudi Arabia Cement, lfud I Stone , I j Sudan Mud Grass
l):Estimate.
2)Hore than one family per dwelling unit.
EMjRC12/9 page 5
Average number of rooms
per dwelling unit
Urban Rural
2.51 )
3 52)
3 3
5 1-5
1,81 ) 1.71)
5.5 4.7
3 3
I i
! ,
! i
EH/RC12/9 page 6
Country
Aden Colony
Aden Protectoratel )
French Somaliland
Iran
Israel
Jordan
Kuwait
Lebanon
Pakistan East6 ) ,lest
Saudi Arabia
Syrian Arab Republic
United Arab Republic7 )
TABLE 3 - Water SUpplies
Number of Supplies
Urban I Rural
2
1 5
119 5170
78 805
28 600002 )
13 ) 34) 3 3
4 17
9 610
88 1739
I Percentage uf population
I covered
Urban Rural % %
100
65 10
40 6
99 93
58 42
100 100
80 40 I
56 S)
30 10 I , 73 33 I 95 I 85 I
l)The vast majority of the Pr6tec1;orate popULat.1on relies on shallow and deep wells for its water supply. In a few of the larger towns, e.g. l'lukalla, tho water is piped some three miles to water points wi thin the town. Pollution of this pipeline to Hukalla resulte~ in an epidemic of typhoid in 1960. It was adequately controlled by chlorination but this is not a standard procedure.
2)Private wells and cisterns.
3)Water distribution through pipes into homes and at public places.
4)Water supplies through wells, tube-wells and reserve tanks.
5) 56 %. of urban population is provided with water piped into houses, and the remaining population with wells and hand-pumps.
6) .. b . IJr an Areas: Piped into houses, community and private wells and hand PU171.0S. Rural Areas. Community and private wells, hand-pumps and ponds.
n In 1960, 49 of the supplies in urban areas were wells and 39 piped water. Only six out of the 1739 supplies in rural areas are by piped water. Of the population covered by water supplies, this system in the cities sup;::li,;cl piped water into homes for 90;g and water distribution through public fowJi;a:'.ns for 10%; in rural areas the corresponding percentages were 5% and 95%.
2. Excreta disposal
EMjRC12/9 page 7
Information concerning systems of excreta disposal has been supplied
by the Aden Protectorate, French Somaliland, Israel, Jordan, Kuwait and
Pakistan.
No system of water borne sanitation exists anywhere in Aden Protectorate.
Random deposit and privy middens are the standard systems of excreta disposal.
In some towns municipal sweepers attempt to clear away the faecal deposits.
In the Wadi Hadhramaut human excreta is used extensively as fertilizer and
this results in a high incidence of infection witn pathogenic amoebae and
ascaris.
In French Sornaliland there are three excreta disposal systems in
Djibouti and none in the rural areas.
Israel reports that a number of 78 &lystems exist in the urban areas and
649 in. tile rural areas.
Jordan states that for 67% of the urban population an excreta disposal
system exists, namely for 6% through community sewerage systems and for 61%
through individual installations and that for 31% of the rural population
individual installations ~septic tanks, latrines, etc.) are used.
Kuwait reports that 95% of the urban and 80% of the rural p~pulation is
covered by two excreta disposal systems.
Lebanon reports that a number of systems are designed but not yet in
operation.
East Pakistan reports that three systems exist in the urban areas,
and three in the rural areas: 1) septic tank; 2) pit privies; 3) bore
hole latrines.
West Pakistan reports that two excreta disposal systems, viz. sewerage
and latrines exist in urban areas whereas in rural areas open fields are used
eXClusively. 10% of the urban population is served with sewerage system and
the rest have latrine system.
3. Food control (including milk)
Information concerning food control supplied by the countries is
tabulated in Table 4. It is seen that food control is carried out on a
EM,AlC12/9 page 8
very limited scale and exclusively for the urban areas with the exception
of Israel, Kuwait and Lebanon.
4. General information on waste disposal
Below is the information received.
Aden Colony Vehicular collection, tipping and burning.
Aden Protectorate Garbage is sometimes collected and deposited in one area
outside the settlements but the organization of refuse
disposal is hapharzard.
incinerate their garbage,
Some enlightened townships
French Somaliland In the urban areas and the main centres of the territory,
refuse is carried to sewage farms, where it is either
incinerated or left on the spot to be subsequently crushed
and then buried.
Iran
Kuwait
Lebanon
Pakistan, East
Pakistan, West
Saudi Arabia
Sudan
In rural areas, no refuse disposal service exists.
This is left to the numerous small savage carnivores
and birds of prey.
Human excreta is disposed of in pit privies; there is
no treatment of industrial wastes.
There are two means of waste disposall a) Dumping
b) Incineration
Dumped in sea or open air.
In urban areas refuse in disposal is by dumping or
filling low-land. In rural areas it is used as manure
apd for filling law-land.
Ordinarily the household refuse is thrown in the streets
and is used as manure in the fields.
Undertaken in urban areas only, covering about 40% of th,
urban population.
In towns wast is collected twice per week.
TABLE 4 - Food Control (including milk)
N111Ilber of staff ~gaged in control
activities Country
EM/RC12/9 page 9
Percentage of population
covered "-
Urban Rural Urban RurnJ %
Aden Colony 61 )
Aden Protectorate2 ) 0 0 0
French SomalilandJ ) 100
Iran 100 0
Israel 4 8 85
Jordan 280 0 87
Kuwait 150 3 100
Lebanon 13 22 90
Pakistan East 4094 ) 545 )'
Pakistan West 162 416 )
Saudi Arabia 30 0 aO Sudan 150 100
l)Part time
2) Health ordinances empower doctors and health st.llf to inspect shops.
3)FOod control was carried out in Djibouti town in 1960 under the Rupervision of the Veterinary Inspector assisted by a biologist, a chemist, and qualified national staff.
4) Urban: One sanitary Inspector for each municipality.
5)Rural: One sanitary Inspector for eaCh Thana health circle.
6)These are responsible for both urban and rural areas.
%
0
0
85
0
100
30
0
I
El1/RC12/9 page 10
5. General information on measures, so far undertaken for the purpose ot sam.titIon
Inrormation was received from the following countries:
Aden Protectorate. In Mukalla attempts have been made to fly-proof
the privy middens which lie in the walls of the houses.
French Somaliland. Intensification of research to allow for increasec
water supply. Insect control, mainly flies and mosquitoes (particula.rly
culex), and housing control.
Sanitary engineering work at Djibouti filling up areas where rain-water
is liable to stagnate.
Kuwait. Periodical medical examination of food handlers. Control of
slau~~ter houses, spraying of residues to control flies and other insects.
Health education of the public by distribution of hygiene leaflets and
posters.
Lebanon. Action is taken by physicians and sanitaTians to improve the
sani tary situation in rural areas.
East Pakistan. In the rural areas bushes and jungles are cut and tanks
and ponds are cleared.
West Pakistan. A separate pUblic health engineering Department has been
established to design, plan and construct water supply drainage and environ
mental sanitation work. A sum of Rs. 135 million has been earmarked in the
Second Five Year Plan (1960 - 65) for improvement of urban and rural water
supply and sanitation.
V MORBIDITY (Item h of questionnaire)
1. Notifiable diseases
!.:II the countries answering the Questionnaire have given detailed
information on the number of reported cases of various infectious diseases.
This information is reproduced in Table 5.
It is a well known fact that reporting of diseases is generally in
complete and that the degree of incompleteness varies from country to
country and within each country for the various geographical sub-divisions
of the country and that it also differs for the various diseases. The
information contained in Table 5 should therefore be interpreted with great
cClution.
EM,tRC12/9 page 11
Most of the countries reporting have been able to give information
covering the entire country without specification as to urban or rural
area. Such a specification is reported only from Jordan, West Pakistan,
the Syrian Arab Republic and the United Arab Republic. For further
details reference is made to Table 5.
Information concerning legislation and administrative arrangement for
the reporting of communicable diseases has been supplied by several
countries. This information is not reproduced here.
2. Total number of persons suffering from blindness and deafness
This information is generally not available in the countries included
in the study. From Saudi Arabia an estimate on the prevalence of blindness
is reported. This estimate is 2% of the urban population and 4% of the
rural population.
From Aden Protectorate the prevalence of blindness is reported as
very high, while the prevalence of deafness is not alarming.
From a survey of blindness, conducted in late 1961, the numbers of
blind persons were reported. The percentage of these numbers to the total
population of the country is also given:
Ethiopia
Iran
Israel
Syrian Arab Republic
Tunisia
United Arab Republic
Number of blind persons
90,000
280,000
4,500
4,154
18,000
37,179
In per cent of total population
0.45
1.39
0.21
0.09
0.43
0.14
EM,tRC12/S page 12
Saudi 10) Sudan Syrian Arab Republic United Arab Republic13)
Arabia
10191
754
829 0 0
168 3228 160
30
0 0 0 4
47 6571
0 5il)
0 9297
~2)
10017
87
Total Urban Rural Totail. ~ountry Cu<llltry
10808 73-36 531 234 287
127378 806 526 280
763 1290 538 752 14835
3 1 2 14 929 218 98 120 1167
24841 546 285 261 1807 1457 44 18 26 406
1263 22 2 20 179
6 45155
328 52 21 31 865 8
316 46360 1016 452 564 11707
120 20 46
259244
151 566134 137 32 105 1654
555 262
15178612 155125 64973 90152 182961
47345 755 35 720 1455546 12587 301182 1281 50000
982177
9)Including Bacillary dysentery and Amoebiasis 10)Figures relate to 1959
Urban Rurllll.
5281 2055
12658 2177
13 1 826 341
1073 734 339 67
27 152
762 103
13158 4549
34 12
52 99 878 776 141 414
475395 980151 115814 185368
5000 45000 395098 587079
11)rt is estimated that 95% of the population suffer from Trachoma 12)Includes Amoebiasis also
13)Figures relate to year 1955, except figures for Schistosomiasis, Ankylostomiasis, Filariasis and AsCariasis, which refer to year 1960
14)The figures givens against "7YJ>hoid" relate to "enteric group of fevers"
15)~ dysentery is a notifiable infectious disease. Separate figures from "BaCillary Dysentery" and "Amoebiasis II not available.
Total. ountry
i098
9
1308
11 150 la5 81
10
51
85
2943
1 76148
306
1293
7
TABLE 5 - Reported Number of cases of various diseases 1960
Jordan Kuwait
Urban Rural
855 243
4 5 845
4 644 644 182
9 2 7 108 42 15 243 172 478 69 12 16
0 10 2
21 13 38 0
0 0
48 )7 14 0 0
763 2180 995
1 24693 51455
0 266 40 38
576 889 404 561
7 171
West Pakistan Lebanon Total [Jrban R1l:i:'aJ.
3do ,1.5365 :;>;>65
)13 126114) 1267 6704 4516 2188
14 5 5 156 28 28
399 358 liL 22 2 2
9 7 7
0 0
198 3 )
688 274 414 404 404
0 0 3
102
0 0 0 11
I
26-112 304361$ 3043~ 1, ) (15)
*)Tota: cases'
l)Infected outside Colony
2)Al1 forms of dysenterY
3)Admissions to hospitals only
4) Is endemic in area
5)Cases of Ibejel seen near Saudi Arabia border
6)Imported cases
7)positive seroloay
East Pakistan
TotaJ..
24610*
9280*
27810 8856 686
)827 18790 )137 3060* 1969
8146 0 0
775 0
1086 15843
0 13497*
6313
7.39* 1333437
I 0 223752
79600 238400
0 27218 5756
8)From 1955-1960 a total of 6525 cases of 'bejel
I Aden Aden French I
eolollY Protec- Somali Iran Iraq Israel
torate land
Tuberculosis, all forms. (i) ••• 884 i 9904 11588 802 ~uberculosis, all formsl (ii) 980 2014 5231 I 1903 yphilis and its sequelae (i) 57 365 • 211597) 135 4 ~yphilis and its sequelae (11) 391 ••• L 174548)
Symbols used. (i) new cases (ii) total known cases ••• Data not available
If no information is given, space is left empty.
!
,
3. Disease vectors and vector control
EMjRC12/9 page 13
The questionnaire asked for information on the vectors of Nalaria,
Leishmaniasis, Filariasis and Bilharziasis. The information to this point
of the questionnaire is swnmarized in Table 6. The answers relate evidently
to the whole territory of the country. Specification on urban and rural
areas was not received from any of the countries.
en measures so far undertaken in vector control, Iran reports that
antianophelin residual spraying is under way as well as focal control
programmes against other vectors and Lebanon reports that fly and mosquito
control programmes are being undertaken.
In Pakistan anti-malaria measures consisting of intensive and systematic
insecticidal spraying of selected areas in most of the districts of the
country are adopted. A scheme for eradicatiCll of malaria has been
formulated in collaboration with WHO and the eradication programme has
started. The total cost of the scheme is estimated at Ra. 540 million
and the programme is expected to be completed within fifteen years.
From the United Arab Republic the fOllowing information has been
received concerning vectOl' control measures:
a) Mollusc1cides are applied to sites in which snails infected with
cercaria are discovered,and whenever more molluscicide is available, it
is applied to streams infested with snails wi thin a radius of 500 metres
around villages.
b) Snail control by engineering methods - In cooperation with the
Irrigation Department (Hin1stry of Public WOl'ks) measures are taken to
render water-ways unsuitable for snails.
c) Health education, directed to encourage the people to keep their
water-ways clear of vegetation and to arouse their interest so as to
cooperate with the programmes.
d) For malaria, larviciding and house spraying are carried rut.
EM/RC12/9 page 14
VI GENERAL INFORMATION ON RURAL AREAS AND RURAL. ECONOMY (Item 5 of questionnaire)
1. Defini tion used for distinguishing between urban and rural areas,
In Iran an urban area is defined as any community having a popULation
of 5,000 or mare, other areas are considered rural.
Aden Colony is regarded as an exclusively urban area.
In Israel an urban population includes all localities with a population
exceeding 5,000 of whom less than 50% earn their living by agriculture, or
with a population of 2,000 - 5,000 of whom less than a third earn their
living by agriculture.
"Rural Population" includes all other localities.
In Pakistan a village generally means any area for which a separate
record of rights exists, or which has been separately assessed to land
revenue or which may be especially declared to be an "estate"i.e. a
village by Government.
For other countries in the Region, no specific definition exists for
distinguishing between urban and .rural areas, but a listing is made of all
ci ties and towns which are considered urban, and areas outside these
communities are regarded as rural.
2. Number of rural communities, their average population and dispersion pattern,
Information in this subject is summarized in Table 7." It is seen
that the structure and settlemmt p<lttern differs widely fran country to
country and also within the country. In the United .Arab Republic and in
Kuwait the villages are generally large with popUlations averaging
4 - 5,000 and in the United .Arab Republic they are located within short
distances of each other. In the Syrian Arab Republic and particularly
~ the villages are generally much smaller with a population of a .few
hundred, and are more scattered. In the Arabian Peninsula the villages
have an average population of about 1,500.
Aden Protectorate
Iran
Lebanon
Pakistan, East & .vest
Pakistan, East West
United Arab Republic
TAllLf; 6 - Vectors and Intermediate Hoste of Disease
Malaria
A. gambiae A. sergenti A. dthali
A. culicifacies A. fiuviatus A. maculipennis A. superpictus
complex
A. sacharovi, A.stephensi
A. superpictus A. sacharovi
A. culicifacies A. stephensi A. superpictus A. fiuviatus
. A. pharoensis A. sergenti
Leishmaniasis
Unknown
Ph. papataci Ph. perniciosus Ph. caucasicus several others
Phlebodomus Sp •
Ph. papatasii
Filariasis
\vuchereria bancrofti
(Draconculosis) Cyclops coronatus Cyclops locarti several others
Mosquito Culex
Bilharziasis
B. contortus B. forskalii
Bulinus truncatus
EN,tRC12/9 page 16
TABLE 7 - Nwnber of rural COInml.Uli ties, their average population and dispersion pattern
Aden Protectorate
French Somali land
Iran
Israel
Jordan
Kuwait
Lebanon
Pakistan East West
Saudi Arabia
Syrian Arab Republic
United Arab Republic
Nwnber of rural communities
50,000
827
23
2500
61424 35412
3600
6100
4000
Average population
300-3000
500
250
450 Jewish 1700 Arab
5000
200
783 782
1500
500
4000
Dispersion pattern
In certain ''Wadis'' (e.g. the Hadhramhaut) villages may be only a mile apart whilst in less fertile areas the distances may be as great as 20 to 30 miles.
Villages are located at inter-sections of caravan routes and connected through roads and trails, the le:1gth of which are difficult to estimate.
Average 15 - 20 Ians.
In Western and Northern districts, distances between villages are 5 - 10 kms, in Southern districts villages are more dispersed.
Average 10 Ians.
About 5 kms.
Average 1 mile. Varies greatly.
Average 10 - 15 kms.
About 3 kms.
~/RC12/9 page 11
3. Type ... of agriculture and common crops including the relative importance of the various types
Information under this item has been calculated from figures published
in the l'roduction Yearbook, 1960, Vol. 14; FAO.
In Table 8 is given the total area for each of the countries in the
Region and the relative distribution of total areas on the various forms of
land use. The table should be interpreted with care since there may be
wide vari.at;i.ons· among the reporting countries in defining the various forms
of land use.
"Arable land and laRd·under ·tree- crops", includes land with crops
(double cropped areas are counted only once), land temporarily fallow,
temporary meadows for mowing or pasture, land with market and kitchen
gardens (including cultivation under glass), and land with fruit trees,
vines. shrubs. and rubber plantations.
"Meadows and pastures II refers to land with herbaceous forage crops,
other than rotation grasses and clovers.
"Forested land" includes all land~ with natural or planted stands
of treea of present or potential value.
"Unused but potentially productive": In most cases this is subject
ively determined by the reporting governments and represents anything from
land being at present reclaimed to land which may in the future be put to
agricultural use or 1:)e us.ed for forests.
"Built-on area, wasteland, and other "includes land occupied by
buildings, parks and ornamental gardens, roads or lanes., barren land,
wasteland, land under bodies of water.
Table 9 gives information on the area used for production of the
various kinds of cereals and in Table 10 is given the livestock population
for the countries for which information is available.
Country Year
Aden Colony 1955 Aden Protectorate 1956 Bahrain 1959 Cyprus 1958 Ethiopia 1959 French SomalUand 1959 Iran 1950 Iraq 1955 Israel 1959 Jordan 1954 Kuwait 1949 Lebanon 1959 Libya 1959
Cyrenaica 1957 Tripolitania 1959 Fezzan 1959
Muscat & Oman 1948 Pakistan 1957 Qatar 1947 Saudi Arabia 1952 Somalia
Ex _Iritish 1956 Ex-Italian 1957
Sudan 1954 Syr1a~ Arab Republic 1959 Trucial Onan 1947 Tunisia 1957 United Arab Republic 1957 Yemen 1947
TABLE 8 - Total Areas and their Relative Distribution on VariOUs Forms of Land Use ----- ------'=-----
-Total Area Percentage Distributjecn of total area
jArablc land Meadows Forested Unused but 1luil t-on area 1000 hectares and and land potentially wasteland
tree~rops Pastures !productive and other -% % % % %
technicians and sanitarians working in rural health centres receive in
service training, a constituent part of which is health education.
It is generally felt that the health education programme as a part of
the total public health progranrnes. applied in the United Arab RepubliC,
has resulted in better achievement of this programme.
XIII COl'JBINED UNITS (Item 12 of questionnaire)
A combined unit was in the questionnaire defined as a unit which
comprises rural health. basic education, social work and horticulture,
The existence of combined units was reported from the United Arab
Republic and from Jordan only. Plans for creating combined units have
been reported from Iran and Kuwait.
In Jordan the combined units from the ¥.inistry of Health. Education,
Social "elfare and Agriculture, work together and cover about 80% of the .
population,
Sanitary inspectors cooperate .with social welfare inspectors and
educational as well as agricultural visitors in IUral areas,
Existing plans are being extended on the above basis,
In the United Arab Republic a combined unit is defined as an organization
in which health. education, social and agricultural services in the area
served are integrated,
There is a number of 250 combined units in the country covering 21%
of the rural population. The combined units are administered by the
Ninistry of Local Government.
EMtRCl2/9 page 66
Within the five-year plan a further 500 combined units will be
established.
XIV COMMUNITY DEVELOPMENT SCHEMES (Item 13 of questionnaire)
The following conmunity development schemes were reported through the
questionnaire:
The Ministry of Interior under a Central Development Council is
responsible for planning and implementation of rural community welfare
development projects under village council.
speCially trained "Dehyars".
Kuwait
This work is done through
A long-term programme has been adopted by the Social Affairs Depart
ment in collaboration with the Economic Department to survey the soc1a.l
and economic status of Kuwait. This programme includes, inter alia, the
collection of statistical information on various aspects of life which
relate to the socio-economic structure of the community.
In 1957, the Department of Social Affairs and Labour had conducted
its first census. As already stated both the Deparlment of Education
and the Deparlment of Social Affairs and Labour had initiated their plan
of Fundamental Education Centres for training Kuwaitis in different crafts.
lebanon
The Deparlment of Community Developnmt has its own plans which are
not yet officially approved and information has not yet been communicated
to the Ministry of Health.
East Pakistan
There are twenty-two urllan community development projects, five in
Dacca and one in each District Headquarter. Each urban community develop
ment project consists of two officers, five mohalla level workers and two
organizers. They give training on a self-help basis on sanitation,
education, maternal and child welfare, gardening etc.
West Pakistan
EM/RC12/9 page 67
Under the Social Welfare Department forty-three urllan cOlllTlunity
development projects are to be opened under the second five year plan
(1960 - 65). Eleven of these projects have already been opened and eight
mora are beinlZ ooaned durinlZ 1961 - 62). Each project has the following
staff:
Social Welfare Organizers
Canmuni"t:Y \'lorkers
Clerks
Peons
Syrian Arab Republic
General:
2 (1 male and 1 female)
3 (2 males and 1 f:emale)
1 1
The Community Development progranrne in the Syriar. Arab Republic has
successfully passed through numerous vicissitudes and, thanks to the very
keen personal interest taken by three ministers in succession, is nQl( well
on the way to becaning a permanent and eJqlanding national programme.
During the last one year or so, it has made considerable progress.
A ten-year national programme for setting up 110 projects, including
seven projects to be launched during the first four years in the seven zones
of the Syrian Arab Republic, has been accepted in principle, and included
in the five-year plan. Funds have already been allocated for eight pilot
projects expected to cover a population of over 200,000 in eight nahias
(aaninistrative sub-divisions). One of these pilot proJects, HaranEl
Awamid, has been in operation for over two years and two other projects
atSalkhad and-Sheria for four months, The buildings for the fourth pilot
project, Jobet Burghal, are nearing completion and it is expected to be
launched in July 1961. The buildings for the fifth pilot project,
Kafferine, are under construction. The buildings for three projects at
Sheddadeh, Mayadin, and Abu Hureira, are being constructed durlllg 1961-62.
The ultimate obj ecti ve of Community Development is the same as laid
down by the United Nations in CCIJIIIWl1ty Development- and Related Services,
namely ba::Lanced development of the area in the light of local needs and
resources throulZh the use of modern technologj.cal and scientific aids and
EM,AiC12/9 page 68
introduction of an integrated approach, team relationship, administrative
coordination and people's participation in partnership with the government
on a self'help baSis.
The immediate objectives of Community Development are in terms of
increasing agricultural production, eradication ~r reduction of human,
cattle and crop Cll.seases and epidemics, up-grading cattle, improving
sanitation, expanding health, maternal and child welfare services, prOViding
more and better roads, water supply and other facilities, working with the
coopera'tive s'ocieties, youth clubs and village councils, expanding
educational facilities through primary and nursery schOOls and introducing
home and rural industry.
Administrative Set-up
Ten multi-purpose "village level workers", graduates of agr:l:elll"ture
secondary schools with six months' supplementary training in practical
agriculture, cooperatives, rural health, rudimentary civil engineering and
prinCiple and methods of ~ommunity development have been provided in each
project. Each "vill!lile level worker" is in charge of one or mare villages
with 500-800 families. The "village level workers" are guided, supervised,
and controlled by seven subject-matter specialists ins
agriculture, anlll1al husbandry and veterinary aid, public health and medical
aid, cooperatives) social education, home economicsl and civil works
(vacant). There is a director of the project to coordinate the entire
programme. One project area covers a population of 25,000-40,000.
Institutional Pattern
The necessary institutions, such as, a dispensary with maternal and
child welfare centre, a veterinary dispensary with an articicial insemination
sub-centre, a poultry unit, a nursery, a central library and an information
centre with a cinebibliobus, are provided at the Project headquarters.
Financial Implications
Excluding the over-head cost on account of the training of staff and
the Department of CommU¢1;y Development at the State headquarters, each
project costs about L.S. 300,000 for buildings, water supply and electriCity,
L.S. 80,000 for equipment, .furniture and transport, L.S. 1l1,000 per annum
for salaries and allowances for staff, L.S. 50,000 for recurring
EM,tRC12/9 page 69
contingencies, and L.S. 25,000 for grants-in-aid. In addition short
tem loans of up to L. s. 150,000 are provided by the Agriculbura:1 Bank.
The totaJ estimated expenditure over the entire ten~year period is
L.S. 72,18 millions.
Results
Sig!iificant results were achieved in regard to increased agricultural
production through the use of improved seeds and chemical fertilizers on
wheat, (range of increase between 62.1% and 106.5% in demonstration pilot
areas in 1959-1960), cotton, vegetables and potato, control of cotton pests;
prophylactic inoculation of sheep, goats and poultry against epidemic
diseases; distribution of improved seedlings and plants and popularization
of horticulture, medical aid and maternal and child welfare service through
the health units, veterinary aid; organization and operation of cooperative
societies; hame economics; library service; nursery for young children;
training courses and study tours for fanners; cinema and some other aspects
of social education, and self-help works (schools and a canal).
Training Programme
Two six-month courses for training "village level workers" in the
principles and methods of cOlll11unity development, cocperatives, elements of
rural health, some aspects of civil engineering, and practical agriculture
and animal husbandry, have been organized and a third is in progress. The
minimum qualification for admission is a three-year diploma in agriculture.
A fellowmip has been provided by the United Na.tions and the candidate
has left for a six-month course. Two mare fellowmipshave been approved,
one for 1961 and the ather for 1962.
4. study tour for high level administrators, though approved by United
Nations could not be carried out so far, due to financial stringency.
xv INTERNATIONAL ASSISTANCE (Item 14 of questionnaire)
Und.E)r the poSsible scope of assistance from intema.tiona1organizations
in strengtllenine; tile various fields of activities COJ!¥lrised by the
questionnaire, the following countries Ilave indicated .need for such
assistance.
EM/RC12/9 page 70
Aden Protectorate
The Aden Protectorates are extremely backward and their natural
resources limited. Unless mineral deposits such as oil are discovered,
it is unlikely that they will even be able to finance health projects
which are essential to eradicate and control epidemic diseases, or to
supply medical services which should be the prerogative of all people.
British assistance through Community Development and Welfare f:unds
will not be adequate to bring about these changes, although their projects
for 1961-1963 will make a great difference to the present medical
organization. It has been the policy of the British not to initiate
services which could not be maintained by the individual States. This
has t.ended to limit development,
WHO and UNICEF must play an increasing part in the future health
schemes, but it should be borne in mind that recurrent expenses will
be a pennanent feature that cannot be supported by the indigenous economy
Vector disease surveys for malaria, bilharziafD-s ancLdraconiasis are
possible projects which, through a policy of eradication, could ease the
burden of the health services.
E.ducation for women is another essential step, if the infant
mortality rate is ever to be reduced to acceptable levels.
Communications are poor and evacuation of sick is mainly through
costly air transport, Highest priority should be given to roads, and
their development would result in greater security and stability in the
tribal areas,
All these projects are bound up with political advancement, which now
shows signs of rapid development,
French Samaliland
French Sanaliland has reported that financial aid from France within
the frame of F.I.D.E.S. for the moment suffices for the territory, and
that until now assistance from international organizations are not needed,
EM,.tRC12/9 page 71
The need for :further international assistance is warranted to carry
on expanding future programmes.
Jordan
There is need for cooperation with the international organizations
for raising the standards o:f living in the country.
Kuwait
Four specialized agencies FAO, WHO, IW and UNESCO provide their
consultative assistance to Kuwait through the Departments o:f Agriculture,
Public Health, Social Af:fairs and Labour and Education respectively,
Lebanon
WHO is already aSSisting the Lebanese Government through the operation
of a rural health unit as a model for other health centres in the country,
other WHO projects are contributing to improving health conditions in
rural areas a:fflicted by malaria and indirectly through training by
providing a prafessor in sanitary engineering to the American University
af Beirut.
The help o:f UNICEF in promoting health, particularly of children and
motbars in rural areas is anticipated in the :future, as there is a large
scope for assistance in these :fields.
East Pakistan
International assistance is being received in connexion with anti
malaria work, school-health won:, BCG vaccination campaign, maternal and
child wel:fare centres.
West Pakistan
As there are many health problems in the country, which have to be
faced, cooperation from international agencies like ICA, WHO, UNICEF etc.
for solving them is needed.
ANNEX
ANNEX pagei
QUESTIONNAIRE ON RURAL HEALTH AND COMMUNITY DEVELOPMENT
1. Population and vital statistics
(Tables I and II of Questionnaire for Second Report on World Health Situation, extract enclosed)
I Year Total Urban Rural country areas areas
i
Population
Average size of family
Live births (per iooo populatio~
Deaths (per 1000 population)
Infant deaths (under ~)e year-per lOGO live births
What is the extent of the problelnof nomadiSll1
2. Housing
! Year Total Urban Rural ccw.try a::'''eas areas
Building material usually used
Average number of rooms per dwel~ unit
EM,IRC12/9 ANNEX page 1i
3. Environmental sanitation
(Table XI of Questionnaire for Second Report on World Health Situation, extract enclosed)
Year Total Urban Rural country areas areas
Water Supplies
Number of supplies
Percentage of total population served -%
Excreta disEosal
Number of systems
Percentage of total population served - %
Food control ~ including milk)
Number of staff (specify) engaged in control activities
Percentage of total popu1ation covered ... %
.
General information on waste disposal
General information on measures, so far under-taken for the purpose of sanitation
A.
4~ Mo!'bidity
EM;RCl2/9 ANNEX page iii
('l'abl& XIV of Questionnaire for Second Report on World Health Situation, ~act enclosed)
Total Urban Year country areas
Number of reported cases:
Tuberculosis, all forms: (i) new cases
tuberculosis. all forms: ~(ti) total known cases
Syphilis and its sequelae: (i) new cases
Syphilis and its sequelae: (ii) total known cases
Typhoid fever
Cholera
Scarlet fever
Diphtheria
Whooping cough
Mimingococcal infections
Plague
Leprosy: (i) new cases
LeproSy: (li) total known cases
R,elapSing fever
Yaws: ( (i) new cases
Yaws: (ii) total known cases
Poliomyelitis
Infectious encephalitis
Smallpox
Measles
Yellow fever
Rabies in man
Trachoma (i) new cases
Trachoma (ii) total knO"\lIl cases
Typhus
Malaria: (i) new C;1ses
Malaria: (ii) recurrent cases
Trypanosonuasis
Rural areas
B.
C.
EM;RC12/9 ANNEX page iv
Diarrhoeal diseases among childret_
Bacillary dysentery
Amoebiasis
Schistosomiasis
Ankylostonuasis
Filariasis
Other (spec11'y)
Total number of persons, suffering from:
Blindness
Deafness
Disease Vectors
Which are the vectors of:
Malaria
Leishmaniasis
Filariasis
Bilharziasis
Which measures haVe, so far, been undertaken in vector control
Year Total country
5. General information on rural areas and rural economy
Urban areas
5.1 Which definition is used in the country for distinguishing between urban and rural areas?
In case no definition exists, please list the cities or towns which are considered urban, as distinct from the rest of the country which is considered rural.
Rural areas
5.2 Number of rural communities (villages) in the country, _______ _
Ter,+,~tt"''' c'o."inition' A ~·u:r2.1 COIll!l!'JIlity is a non-urban ---"7,n-:;-·t--;;;:l"·'~h-l.· s -l':;'-;"~d "Y' 1"~al p"b' < ~ a.,t"'n~' +.y _, ..J.. , "'........ ... .. .... '-'"'-'_ u ... _ .,.'.... '-' ~__ ....... ,. __ ...... _,
.. BUCP as a mayor or chairman of community council. Please state your own definition when necessary.
5.3 Average population of rural communities (villages)
If exact infomation is not available, give an est:lmate.
EM;iW12/9 ANNEX page v
5.4 What is: The disperaion patterns of rural communities (villages), such as average distance between villages.
~"ho t:l<"?os c? ":-,,,~::_;:c:.:.ture a..,d comnon, crops in the country, including the relative importance of the various types.
The general state of nutrition in rural areas.
The types of irrigation in the country with pal't:;'('LLd.J.' il181ri;:WIl of tnair possioie influence on incidence of endemic diseases,
The types of housing especially in relation to sanitation in rural areas.
6. Govermnental activities on the national level aiming at promotion of rural health
6.1 Does a special Ministry for Municipal and Rural Affairs exist?
If yes, describe the administrative set-up, functions arid aChievements of this Ministry.
Yes No
DO 6.2 Is there a special agency in the Ministry of Public Health, Yes No
which deals with rural health? 0 0 If yes, please give the name and address and describe
the composition and functions of this agency; and also in relation to the Public Health Administration.
6.3 Are departments of other Ininistries cooperating with the Ministry of Public Health in rural :.aalth?
Is there a committee for coordinating the work of various governmental agencie3 for promoting rural health?
If yes, describe composition of committee, its functions, activities and achievel1'.ents.
7. village health cooperative societies
7.1 Number of health cooperative societies
Percentage of rural population covered - %
-Are the health cooperative societies supported by public funds?
If yes, please indjcate from which government agency or agencies.
Yes No
DO
Yes No
OD
Yes No
DO
EM,1I.C12/9 .ANNEX page vi
7.3 Activities of village health cooperative societiesl Yes No
Employment of full-time doctor
Employment of part-time doctor
Distribution of drugs, free of charge
Distribution of drugs, at reduced rates
8. Health units in rural areas
DO DO
BB 8.1 Please list all the different types of health units existing
in your coiiiitry.
For each type please give the number of existing units, bllilding material used, cost of construction and attach blue-prints. It would also be useful to have a description of your pre£erence, from the operational point of view. regarding the various types now in use in your country. A map giving the location of the health units or centres in the country would also be appreciated.
Include also any information on the trend regarding low cost· building of health units to suit the economy of rural areas and to extend the rural health services.
If research and training on low-cost building is made, give information on agencies promoting such research and training.
8.2 Give a detailed description of the staffing of rural. health units and their sub-units, including inf onnation on training of personnel in the health units and of training centres for personnel to be employed in rural health work. What would be considered as ideal types of personnel, and number in relation to population served?
8.3 Activities of health units and sub-units in the field of:
a) preventive mediCine and immunization
b) sanitation
c) endemic medicine and parasitic diseases
d) curative medicine
e) maternity and child health and nursing
f) tuberculosis, venereal diseases, communicable eye diseases control
g) vector control
h) population served, and number of visits to health units
8,,4 Integration of health units in the general public health structure, especially with regard to referral hospital and referral laboratories.
8.5 Give a description of the equipment of rural health units.
~.6 live a description of the general income and expenditure patterns of rural health units and sub-unitB.
EMfiiCl2/9 ANNEX page vii
9. Social centres
9.1 Does the M1.nistry o£ Social AffaiJ;'a (or other governmental agency) deploy specific activit;eil for the purpose of increasing the standard of liv:l.ng of the rural population.?
If yes, describe the type of organization for thia P1l1'Pose and the extent and results of such actiVities.
9.2 Give a general description of the functions of social centres, size of staff and geographical location.
9 • .3 Is medical and health work included in the activities of social centres?
If yes, give information on health staff, specifically number of medical doctors, nurses , sanitarians and technicians.
10. Basic education and school health in rural areas
10.1 Number of primary school in rural areas
Yes No
DO
Yes No
DD
Number of children attending primary schools __________ _
Percentage of children of sohool age attending, ___________________ __
schools - %
10.2 Give a description of the school health services in rural areas. Is there any indioation that the school health service has influenced rural health in general?
ll. Health education of the public
Describe any efforts made towards introducing health education of the public in rural areas and the various methods employed for such education.
12. Combined units
Definition: A canbined unit may be one which comprises:
rural health, basic education, social work and horticulture.
What is your definition of combined units?
12.1 Are canbined units existing in the country?
If yes, describe which governmental agency is administering such combined units, the:ir number and percentage of the population covered.
12.2 ~ exi.sting for the creation of oombined--units'?
If yes, describe BUCh plans.
Yes No
DO Yes No
DO
EMAiCJ.2/9 ANNEX page viii
13. Community development scheme!
Describe fully any colTllTlUIlity developnent schemes or training centres in the country, both already existing and, in the planning stage.
14. International assistance
Indicate the possible scope of assistance from international organizations such as WHO and UNICEF ill strengthening the various fields of activity enumerated under 1-13 above.
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN
REGIOl;'AL COMHITTEE FOR THE EASTERI'l MEDITERP.A.NEAII!
Twelfth Session
Agenda item 10 (f)
4:11.01, ~' ~,
~:V, -"'!' 'IJ.,.!J ~:,." ~, ORGANISATION MONDIALE
DE LA SANTE
BUREAU REGIONAL DE LA MEDITERRANEE ORIENTALE
EM/RC12/9 Add.l 18 September 1962
ORIGrnAL: FRENCH
RURAL HEALTH AIID CmIT'IUNITY DEVELOPMENT
TIl THE
EASTERN MEDITER..'lANEAN REGION
Results of an Enquiry
Tunisia
I JNTRODUGTION
The following is a 5U.ll1Ina.I'Y of the answers received frcan the Government of
TlUriSia to the Questionnaire on Rural Health and Community Development sent to
the countries of the Region by circular letter of L. A.pril 1961 from the
Regional Office.
II POPUlATION AND VITAL STATISTICS (Item 1 of the Questionnaire)
Separate vital statistics ~igures for urban and rural areas of Tunisia do
not ex;Lst. The average size of the fxnily for the total country is estimated
at 5.5, livebirths are 45 D6r 1000 population, and deaths are '>stimated to be
20 per 1000 population. Infant deC\ths are estimated to be about 170 per 1000
li vebirths.
Registration of births is almost complete, "While registration of deaths
is estimated to be in the neighbourhood of 50%. In the city of Tunis vital
statistics are fairly reliable.
III HOUSDlG (Item 2 of the Questionnaire)
Housing statistics are not available at present. The average number of
::.'o"ms per dwelling unit is e&timated to be 3.3 for the whole country.
Eh/RC12/9 Add.1 page 2
IV ENVIRONMENTAL SANITATION (Item 3 of the Questionnaire)
For the year 1961, the total number of water supplies in Tunisia was
50,000 of which h6,000 were in urban and h,OOO in rural areas. This corres-
ponds to a coverage of 50% of the urban and of 10% of the rural population.
The number of systems for excreta disposal is h, all urban and covering about
5% of the total urban population.
V IDRBIDITY (It,em h of ilie QU8st,j.onrmiro)
The following number of cases of various diseasos were reported for the
year 1960 for the mole country. It, bas not, yet, been possible t,o subdivide
t,he figures on urban and rural areasl
TB (total known cases)
SyphiliS (total known cases)
Typhoid fever
Diphteria
Honingococcal infections
Relapsing fever
PoliOll\YBlitis
Rabbies :in man
Typlms
Halaria (new casos)
Brucellosis
Blindness (total number of blind r:c rsons)
1. Tuberculosis
80,000
15-30% of population
282
113 25 1
77 1
6
57h 1
18,000
The figures concern;i.ng tuberclllo8is refer to pulmonary t,uberculosis only
and arc probably ninimum figun:;s. Roliablo figures on tuberculosis morbidity
are available only for the Region cf SOUS~lO "here an anti-tuberculosis
campaign has been carried out ane: "hen:; 97% of tho population has been exa;mjned.
About 4% of the population of this area is infected with tuberculosis, an
infection rate which is belieVDd to be ilie highest in the countrY
2. SYph:ilis
No eJalct figures are avail10ble at present. Between 15 and 30% of the
population are infected according to serological tests.
3. Trachoma
EM/RC12/9 Add.l page 3
Statistics covering the whole population are not available. A systematic
study among school ch:i.ldren has given the following rosul ts: 60-80% infected
in the south, 35--45% infected in the centre, in Sahel and Cap Bonl and 15--25% infected in tho big cities and in the north of the country.