PROPOSED PROGRAMME BUDGET FOR 1978 AND 1979

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH-EAST ASIA

PROPOSED PROGRAMME BUDGET

FOR 1978 AND 1979

NEW DELHI, JULY 1976

CONTENTS

Explanatory Notes

Regional Direc tor ' s Programme Statement

Surmnary of Regional Health Programme by Source of Funds

Summary by Programme

Summary by Major Programme and Organizational Level

Regular Budget Estimates f o r 1976 t o 1979 by appropriat ion sec t ion , with t e n t a t i v e pro jec t ions f o r 1980 and 1981

Programme Analyses (See indez for Major P r o g r m e s and P r o g r m e s on page 15)

Summary of Direct Technical Co-operation wi th , and Services t o , Governments

Information Annexes:

Annex 1 (Regional Office, Country and Inter-country statements with tabulat ions)

(See index on page 1231

Annex 2 (Additional Pro jec ts ) (See index on page 411)

BURMA

HW 003 Institute of Medicine I and School of Preventive and Tropical Medicine, Rangoon (UNDP BUR/681020)

The project terminates in 1976.

HW 004 Sanitary Engineering Education end Training, Rangoon Institute of Technology (UNDP BUR/70/008)

To assist the Institute of Technology in the teaching of sanitary engineering.

A visiting professor of sanitary engineering was assigned to the Inetitute from May 1969 to the end of 1971 to help with the development af training programes in sanitary engineering. Another professor was provided in May 1973, but was able to continue only up to August of that year; since then efforts have been made to recruit a replacement, who, it ia now expected, will join in September 1976. In addition, consultant services were provided in 1971 and 1972 to help in specific fields, and fell- ships were awarded to teaching staff for post-graduate study in public health engineering and ehart observation study in teaching and general sanitation.

Assistance to the project is now expected to continue until the mid of 1978, when this will be merged with BUR HMD 005, "Education and Training of Health Manpower (WDP No. BllR/71/520).

HW 005 Education and Training of Health Manpower (UNDP BUR/71/520)

To strengthen undergraduate and post-graduate education in the three existing medical institutes in Burma, as well as the education and training of nurses, midwives, lady health visitors and various categories of auxiliary health personnel, and to assist in the expansion and strengthening of the Hlegu Rural Health Demonstration Area aa the common training area for all members of the health team.

The project was approved in March 1973, and a project manager, a professor of maternal and child health and a nurse educator were appointed, followed, in 1974, by the assignment of consultants in the fields of pharmacology, chemical pathology and biostatistics. In 1975, in addition to an epidemiologist, consultants in immunohaematology and microbiology were provided. A consultant in immunafluarescence completed his assignment in February 1976, and three more consultants in clinical biochemistry, operational research in medical education and radiology will be provided in 1976. Consultant services to be provided in 1977 will cover the fields of paediatric nursing education, forensic medicine, human genetics and cytagenetics techniques. Assistance to the appropriate department. in the three Institutes of Medicine is also being given through fellowships abroad.

BURMA

NUT 001 Nutr i t ion Services

TO a e s i s t i n s t rengthening t h e n u t r i t i o n a c t i v i t i e s of hea l th se rv ices through the Nutr i t ion Unit of t h e Directorete-General of Health i n its programme of in-service o r i e n t a t i o n couraes f m medical personnel.

In 1971, t h e Regional Adviser on Nut r i t ion a s s i s t e d i n e s t a b l i s h i n g a p i l o t n u t r i t i o n r e h a b i l i t a t i o n cen t re i n Rangoon. I n 1971-1972, a coneul tant (under Burma 0086) helped to devise a methodology f o r t h e evaluat ion of t h e g o i t r e con t ro l programme. I n 1972 and 1974, consu l t an t s helped i n conducting o r i e n t a t i o n courses f o r senior hea l th o f f i c e r s and paed ia t r i c i ans .

An o r i e n t a t i o n course i n n u t r i t i o n f o r township medical o f f i c e r s was conducted i n 1975 with the a s s i s t ance of a consul tant .

Fellowships were provided f o r t h e t r a i n i n g of key personnel i n n u t r i t i o n .

Prom 1977 t h e a c t i v i t i e s of t h i s p ro jec t w i l l be covered under the Family Health p ro jec t .

HED 001 Health Education

TO a e s i s t i n the development of hea l th education ae rv ices and i n giving t r a in ing i n hea l th education t o teachers and thoee holding key pas t s i n t h e school organizat ion and i n the general hea l th se rv ices ; t o a s s i s t i n the developolent of the heal th education manpower needed f o r services and t r a i n i n g prograwes, and of t h e necessary educational ma te r i a l s .

In 1966 and 1968, a s s i s t a n c e was given i n organizing courses f a r var ious ca tegor ie s of teachers and hea l th educators. I n 1971 and 1972, c o n s u l t m t s a s s i s t e d with a t r a i n i n g course and i n reviewing the hea l th education a c t i v i t i e s . This review was followed by t h r e e t r a i n i n g courses held i n 1973 f o r township heal th o f f i c e r s and f o r s t a f f of t h e Medicel I n s t i t u t e and of t h e Teacher Training College.

I n 1974-75, a short-term consul tant a s s i s t e d t h e Government i n reviewing t h e s t a t u s of hea l th education se rv ices a t national/state/divi~ional l e v e l of t h e h e a l t h adminis t ra t ion and i n formulating plane for f u r t h e r s t rengthening these se rv ices .

In 1976, i t is proposed t o provide fe l lowships f o r t r a i n i n g add i t iona l hea l th education s p e c i a l i s t s , as wel l as suppl ies and equipment.

The pro jec t terminates i n 1976.

HMD 001 Nursing Advisory Services

To a s s i a t i n t h e development of nursing and midwifery education and se rv ices .

Aesistance t o the p ro jec t s t a r t e d i n 1959 with the assignment of a WHO p a e d i s t r i c nurse, and was continued u n t i l 1966. Subsequently, through fellowships and shor t courses, emphasis has been placed on t h e education of qua l i f i ed nurs ing and midwifery personnel f o r spec ia l i zed se rv ices and on the improvement of b a s i c and post-basic programes. I n 1971, courses i n neurological and eye, ear, nose and t h r o a t (ENT) nursing were he ld , and a course on the care of s u r g i c a l p a t i e n t s and another on the care of orthopaedic p a t i e n t s was organized i n 1972. In 1973, t h r e e courses were a s s i s t e d , i . e . , on neonata l nurs ing care, nursing care of s u r g i c a l p a t i e n t s , and methods of teaching. I n 1974, courses were held on teaching i n schools of nurs ing, neonata l nursing care, neurological pa t i en t care, and orthopaedic nursing care. The a c t i v i t i e s of p ro jec t SE ICP HMD 001, "Continuing Education f o r Nurees" have been co-ordinated with t h i s p ro jec t f o r seve ra l years . I n 1975, a s h o r t course i n neonatal nursing was given and t h e orthopaedic course begun i n 1974 continued. Fellowships and suppl ies and equipment were a l s o given.

In 1976, the re w i l l be only provis ion f o r fe l lowships and suppl ies and equipment; i n 1977, the p ro jec t w i l l be merged i n t o a new one, i . e . , BUR HMD 006.

170

BURMA

MCH 003 Develorment of Family and Child Health

This p ro jec t w i l l merge with BUR MCH 004 from 1977.

MCH 004 Family Health

To a s s i s t i n planning, implementation and evaluat ion of family hea l th programme, with emphasis an maternal and c h i l d hea l th and n u t r i t i o n a c t i v i t i e s ; and development of s t a f f of the family heal th programme.

In 1975, p ro jec t s "Family Health" (Burma 0006) and "School Health Services" (Burma 0103) were merged i n t h e p ro jec t "Development of Family and Child Health" (BUR MCH 003) which, together with p ro jec t "Nutr i t ion Services" (BUR NUT 001) w i l l be merged i n t o t h i s p ro jec t from 1977.

In 1969, a WHO consul tant (project SEAR0 0175) a s s i s t e d t h e Government i n reviewing the school heal th se rv ices i n Burma. I n 1970, a consul tant advised on the s t rengthening of maternal and ch i ld hea l th se rv ices (Burou, 0006). From 1971 t o 1974, WHO has a s s i s t e d i n the conduct of nat ional courses f o r school hea l th t e a m (Burma 0006). t h e establishment of a p i l o t n u t r i t i o n r e h a b i l i t a t i o n cen t re i n Rangoon, and o r i e n t a t i o n courses f o r sen io r hea l th o f f i c e r s and paed ia t r i c i ans (BUR NUT 001), and in t h e evaluat ion of g o i t r e con t ro l programme (Burma W86). I n 1975, e WHO consul tant a s s i s t e d i n the development of growth c h a r t s f a r MCH work (BUR DHS 002). and under p ro jec t "Nutr i t ion Services" (BUR NUT 001), a s s i s t a n c e was provided i n t h e establishment of a new n u t r i t i o n r e h a b i l i t a t i o n cen t re and l o c a l t r a i n i n g courses f o r township medical o f f i c e r s i n n u t r i t i o n a c t i v i t i e s . In 1976, the family hea l th programme has been i d e n t i f i e d as one of the p r i o r i t y hea l th programmes which would be ca r r i ed out during t h e period 1977 t o 1982.

From 1976 t o 1978, a s p e c i a l i s t i n maternal and ch i ld hea l th w i l l be assigned to Burma to a s s i s t i n the development of the new family hea l th programme which w i l l be baaed on the s t r a t e g i e s i d e n t i f i e d during the country hea l th programming. Short p r a c t i c a l t r a i n i n g w i l l be given f a r paediat r ic lons and o b s t e t r i c i a n s during 1977. 1978 and 1979. During t h e same per iod, study tour s w i l l be organized f o r school h e a l t h teams. Subsidy w i l l be provided i n 1977. 1978 and 1979 f a r p a r t i c i p a n t s end teaching s t a f f i n t h e in t ra-country t r a i n i n g i n maternal end c h i l d hea l th and school hea l th f o r bas ic heal th se rv ices s t a f f and school hea l th teams, including medical o f f i c e r s , nurses, ch i ld ren a f f i c e r s , hea l th educators and i n n u t r i t i o n t r a i n i n g f a r medical o f f i c e r s , lady hea l th v i s i t o r s , midwives and i n thc t r a i n i n g on neonatology and o b s t e t r i c s f a r lady hea l th v i s i t o r s and midwives.

UNICEF w i l l a s s i s t i n t h e family hea l th programme by providing medical supp l i e s i n order t o meet the supply requirement of t h i s progranrme.

BURMA

dSD 00- St rengthening of Health Se rv i ce s i n t h e Sevly I n d u s t r i a l i z e d Areas (West Bank of Irrawaddy River) ( W P BUR/7L/026)

TO a s s i s t i n provid ing i n t e g r a t e d b a s i c h e a l t h s e r v i c e s f o r t h e workers and t h e i r f a m i l i e s i n the i n d u s t r i a l i z e d areas and t o s t r eng then the h e a l t h coverage of t h e popula t ion i n t h e sur rounding areas; t o develop adequate occupa t iona l h e a l t h s e r v i c e s f a r t h e i n d u s t r i a l workers and t o p r o t e c t the workers from i n d u s t r i a l h e a l t h hazards ; t o develop e s s e n t i a l l a b o r a t o r y f a c i l i t i e s a t d i f f e r e n t l e v e l s i n t h e p r o j e c t area.

In Karch/April 1975, a p repa ra to ry mi s s ion from t h e Regional O f f i c e v i s i t e d Burma f o r t h e p r epa ra t i on of a d r a f t UNDP p r o j e c t document i n co-operation w i th t h e Min i s t ry of Health and RR UNDP, Rangoon. The d r a f t document was prepared and submitted t o t h e Government f o r c l ea r ance and onward t ransmiss ion t o UNDP f o r approval .

The p r o j e c t i s expected t o s t a r t f unc t i on ing i n 1978, when a p r o j e c t manager and a consu l t an t (sani- t a r y eng inee r ) w i l l b e r e c r u i t e d . Fellowships w i l l a l s o be awarded and s u p p l i e s and equipment w i l l be made a v a i l a b l e . I n 1979, c o n s u l t a n t s i n va r ious f i e l d s such as c l i n i c a l management, ins t ruments , i n d u s t r i a l hygiene and s a n i t a r y engineer ing , t oge the r w i t h f e l l owsh ips and s u p p l i e s and equipment, w i l l be provided.

The p r o j e c t i s expected t o con t inue u n t i l t h e end of 1981.

PHC 001 Pritoary Heal th Care and Bas ic Health Se rv i ce s

TO a s s i s t i n t h e development of t h e primary h e a l t h care programme, i nc lud ing t h e t r a i n i n g of t r a i n e r s of primary h e a l t h workers and primary h e a l t h workers themselves, and i n t h e s t r eng then ing of b a s i c h e a l t h s e r v i c e s aimed a t provid ing e f f e c t i v e suppor t t o and supe rv i s ion of t h e primary h e a l t h care programme, i nc lud ing a s s i s t a n c e i n d e a l i n g w i th t h e problems of t u b e r c u l o s i s and l ep rosy i n the community.

s i n c e 1969, WHO has a s s i s t e d i n t h e p r epa ra t i on of t h e master p l an of ope ra t i on f o r h e a l t h s e rv i cee i n Burma. In l a t e 1975 and e a r l y 1976, t h e Government rece ived a s s i s t a n c e i n ca r ry ing out count ry h e a l t h programming f o r t h e per iod 1977 t o 1982. Primary h e a l t h care and b a s i c h e a l t h s e r v i c e s have been i d e n t i f i e d as t h e coun t ry ' s t o p p r i o r i t y programmes f o r t h i s pe r iod .

I n 1977, 1978 and 1979 t h e t r a i n i n g p r o g r a m f o r t h e t r a i n e r s of primary h e a l t h workers as w e l l as t h a t of t h e primary h e a l t h workers themselves w i l l b e a s s i s t e d through t h e p rov i s ion of subs id i e s f o r p a r t i c i p a n t s , f o r t h e de s ign and produet ion of t e ach ing m a t e r i a l s and manuals, and f o r t h e procurement of s t a t i o n e r y . A s tudy t o u r f o r h e a l t h o f f i c i a l s as w e l l as f o r personnel o f people ' s counci l s and communities w i l l be organized t o observe primary h e a l t h care p r o g r a m s i n s e l e c t e d coun t r i e s . In 1977, a s t a t i s t i c i a n w i l l con t inue t o a s s i s t t h e Heal th Department i n d e a l i n g w i th t h e s t a t i s t i c s of communicable d i s e a s e s . A f e l l owsh ip w i l l be awarded t o enable a t t endance a t t h e Workshop on Tuber- c u l o s i s S imula t ion Model i n o rde r t o c a r r y ou t an epidemiologica l assessment and f o r e s t o f the t ube rcu los i s c o n t r o l programme. Two f e l l owsh ips w i l l be awarded f a r l ep rosy workers i n b a s i c h e a l t h s e r v i c e s i n o rde r t o a t t e n d t h e PraguefDelhi courses on epidemiology i n 1977, 1978 and 1979. A f e l l owsh ip w i l l a l s o b e awarded t o b a s i c h e a l t h s t a f f engaged i n b l i ndnes s prevent ion a c t i v i t i e s t o under take an obse rva t i on t o u r d u r i n g 1977 and 1979. P r a c t i c a l t r a i n i n g i n h e a l t h informat ion systems w i l l be provided by t h e award of a f e l l a r e h i p i n 1977, 1978 and 1979. I n o rde r t o observe t h e u t i l i - z a t i o n of indigenous medicine i n primary h e a l t h care i n o t h e r c o u n t r i e s , two f e l l owsh ips each w i l l be awarded i n 1977, 1978 and 1979. Suppl iea and equipment w i l l be provided i n suppor t of h e a l t h Informat ion and h e a l t h educat ion a c t i v i t i e s . Support w i l l a l s o b e g iven f o r t h e product ion of i nd i - genous medic ina l p r epa ra t i ons w i th in t h e count ry f o r use by primary h e a l t h care and b a s i c h e a l t h Se rv i ce s . UNICEF w i l l provide a s s i s t a n c e by procur ing f i r s t - a i d k i t s and p a r t o f medical s u p p l i e s needed by primary h e a l t h workers. The community is expected t o provide a c t i v e suppor t t o t h i s programme by provid ing primary h e a l t h workers and s"pporting t h e i r medical supply needs and a l s o ca r ry ing out co rnun i ty works necessary f o r t h e p r even t ion of d i s e a s e and promotion of h e a l t h i n t h e cooanunity .

166

BURMA

PPS 001 Plannieg and St rengthening of Health Se rv i ce s

To a s s i s t i n t h e p lanning and s t r eng then ing of h e a l t h s e r v i c e s , w i t h p a r t i c u l a r emphasis on t h e development of comprehensive h e a l t h care; i n t h e implementation of a n a t i o n a l h e a l t h p l an and t h e t r a i n i e g of h e a l t h personnel , ~ a r t i c u l a r l y a u x i l i a r y workers, f o r the b a s i c h e a l t h s e r v i c e s .

In 1969, a p l a n of ope ra t i on was prepared , w i th s t r e s s on the development of a phased comprehensive progrenune In 1970. a consu l t an t a s s i s t e d i n conducting a r e f r e s h e r course f o r h e a l t h a s s i s t a n t s , and a master p l an of ope ra t i on was s igned i n 1972. I n 1973-1974. ano the r consu l t an t a s s i s t e d i n the plan- n ing and development of h e a l t h s e r v i c e s and t h e eva lua t i on of t h e r e s u l t s of UNICEF a s s i s t a n c e . I n 1974, a f u r t h e r consu l t an t helped wi th t h e p r e p a r a t i o n of t h e second master p l an of ope ra t i on f o r t h e s t r eng then ing of h e a l t h s e r v i c e s , which was f i n a l i z e d i n March 1976. A consu l t an t w i l l provide f u r t h e r a s s i s t a n c e i n 1976. Fellowships w i l l a l s o b e awarded.

From 1977, t h i s p r o j e c t w i l l merge w i th p r o j e c t "Primary Health Care and Basic Health Services" formulated as a follow-up of the count ry h e a l t h p rog raming e x e r c i s e undertaken i n 1976.

HSD 001 R e h a b i l i t a t i o n of the Handicapped

This p r o j e c t te rminates i n 1976.

HSO 002 Maintenance and Repair Workshop f o r Health Equipment

TO ~ ~ ~ 1 s t i n e s t a b l i s h i n g workshop and i n t r a i n i n g s t a f f i n t h e aa in t enance and r e p a i r of equipment w e d i n h e a l t h i n s t i t u t i o n s .

Following a s s i s t a n c e provided i n 1969, 1970 and 1971 by a c m a u l t a n t under p r o j e c t Buwa 0085, "Train- i n g of Electro-medical Technicians", a t r a i n i n g programme f o r h o s p i t a l equipment r e p a i r t e chn ic i ans was s t a r t e d a t t h e Cen t r a l Medical S t o r e s Depot. Equipment was provided by UNICEF and WHO.

During t h e per iod 1971-1975, when t h e engineer a s s i e t e d t h e p r o j e c t , t h e Cen t r a l Medical Stores Depot was expanded and workshops were s e t up i n Rangoon and o t h e r p laces . A cur r iculum was d r a m up f a r a b a s i c t r a i n i n g course i n mechanical and e l e c t r i c a l theory and i t s p r a c t i c a l a p p l i c a t i o n . Simultaneously wi th t h e development of more workshops, t h e t r a i n i n g of a r t i s a n s and t echn ic i ans continued.

I n June 1976, a consu l t an t took up a four-month assignment t o a s s i s t and adv i se t h e Government on t h e f u r t h e r development of t r a i n i n g programmes and schoo l s f a r t e c h n i c i a n s and a r t i s a n s , as w e l l as on t h e i n s t a l l a t i o n , maintenance and r e p a i r of equipment u t i l i z e d i n t h e h e a l t h s e r v i c e s .

Fellowships were awarded and s u p p l i e s end equipment provided.

HSD 003 Hosp i t a l Se rv i ce s Management

TO a s s i s t i n h o s p i t a l a d m i n i s t r a t i o n and management, i nc lud ing the planning and development of f a c i l i t i e s f o r t h e d i a g n o s i s , t r e a tmen t , care and r e h a b i l i t a t i o n of the s i ck .

I n 1975, a team of c o n s u l t a n t s was ass igned t o adv i ee on t h e management of t h e new or thopaedic h o s p i t a l . I n 1976, fellowship and s u p p l i e s and equipment w i l l b e provided.

:ni'a~ided Programme of Immunization

The obJectives of the Government during the period 1977-1982 include the reduction of the annual incidence of diphtheria from 20 to 5 per 1000, pertussis from 40 to 15 per 1000, tetanus neonstorurn from 5 to 2 per 1000 live births, poliomyelitis from 5 to 1 per 1000 and the annual risk of infection of tuberculosis from 1.66% to 1%, and to maintain srnallpox-free state. In order to achieve these objectives the expanded pragramne of immunization will be launched in the country involving amallpox, DPT, DT, TT and poliomyelitis vaccination. Immonization will be carried out by the basic health services, with the necessary co-operation of the community, healLil sLaff and international organizatians, such as WHO and UNICEF.

WHO will assist the Government in planning, implementation and evaluation of the expanded programme of immunization. Study tours will be organized for senior national staff engaged in the program. WHO will also assist in the production and quality control of biological products.

Vector-borne Disease Control

The Government has amalgamated the existing independent programmes of malaria control, denguelhaernorrhagic fever, Japanese encephalitis and filariasis into a single comprehensive programne of vector-borne disease control.

The objectives during the next five-year period includes 31% reduction in annual parasite incidence for malaria. 24% reduction in the case fatality rate for dengvelhaemorrhagie fever and 25% reduction in the filariaeia infection rate. Important activities which will be carried out include spraying of inaecticidea, bio-eoviron- mental measures, epidemiological surveillance and radical as well as prophylactic treatment scheme. The programe will be supported by the eomunity, the government and international agencies, such as WHO end UNDP.

WHO Co-operation

WHO will co-operate with the government by providing expert advice, fellowship training programs and cornmadicy support lor essential insecticides and drugs. Funds from UNDP will also be available for thin program.

Promotior< of Environmental Health

The environmental sanitation programme is recognized as one of the most urgent priorities during 1977-1982; it includes provision of a safe water supply to some 9 million of the rural population, through drilling of tubewells, chlorination and improvement of unhygienic wells, and construction of pit latrines and septic tanks far some 6 million of the population. The programme will receive the active support of local population who traditionally provide excellent contributions in kind and maintenance work. International aseietanee will be obtained from bilateral as well as multilateral agencies. This programme is a multi-sectoral programme involving Mlolstries of Health, Agriculture and Fareets, Home Affairs and People's Councils.

WHO will assist in obtaining international assistance from bilateral as well as multilateral agencies. In addition, WHO in co-operation with UNICEF, will provide technical co-operation in the form of e demonstration project with a view to identifying the most appropriate and economical methods for a rural water supply programme.

BURMA

GENERAL

me Country Health Programming, which w a s carried ou t by t h e Government of Burma since November 1975, w i t h t h e a s s i s t a n c e of WHO, has i d e n t i f i e d t h e most ~ r e v a l e n t causes of morbid i ty and m o r t a l i t y , i n o rde r of p r i o r i t y , as: mala r i a , pulmonary t u b e r c u l o s i s , g a s t r o - i n t e s t i n a l d i s e a s e s , n u t r i t i o n a l d i s e a s e s , maternal and p e r i n a t a l cond i t i ons , leprosy . zoonosea, a c c i d e n t s , immunizable comun icab l e d i s e a s e s , snake -b i t e s , c a rd iovascu l a r d i s e a s e s , vector-borne d i s e a s e s (excluding ma la r i a ) , neoplasm, r e s p i r a t o r y i n f e c t i o n s , trachoma, mental d i s e a s e s , d e n t a l d i s o r d e r s , "on-infectious eye d i s e a s e s , and s k i n diseases.

The o b j e c t i v e s f o r the o v e r a l l h e a l t h programme dur ing the per iod 1977-1982 were s e t f o r 8 .4% reduc t ion i n crude m o r t a l i t y r a t e from 10.9 t o 9.98 per 1000 popu la t i on , and 26.1% reduc t ion i n i n f a n t m o r t a l i t y r a t e from 56.0 t o 41.4 per 1000 l i v e b i r t h s .

I n o rde r t o achieve t he se o b j e c t i v e s , a comprehensive approach wi th i n t e r - s e c t o r a l c o l l a b o r a t i o n has been cons idered by t h e Country Health Programming Group under t h e fo l lowing major s t r a t e g i e s : (1) community p a r t i c i p a t i o n i n primary h e a l t h care; (2) fami ly h e a l t h ; (3) h e a l t h educat ion; (4) epidemiological s u r v e i l - l ance and case-management; (5) immunization; (6) vec to r c o n t r o l ; ( 7 ) environmental s a n i t a t i o n ; (8) s t a f f and procedura l development; (9) development of h e a l t h informat ion sys tems; (10) medical s u p p l i e s ; (11) r e sea rch , and (12) co-ordina t ion .

WHO Ass is tance

I n the p a s t t h e o v e r a l l programmes of WHO a s s i s t a n c e have r e f l e c t e d a g radua l change from s p e c i a l i z e d d i s e a s e programmes t o an i n t e g r a t e d programme s t r e s s i n g h e a l t h manpower development and a s s i s t a n c e t o the s t r eng then ing o f s e c t o r s o f t h e h e a l t h s e r v i c e s such as v i t a l and h e a l t h s t a t i s t i c s , l abo ra to ry s e r v i c e s , the maintenance and r e p a i r of equipment, community water supply and s a n i t a t i o n . On the b a s i s of the d e l i b e r a t i o n s on Country Health Programming, WHO a s s i s t a n c e w i l l be concent ra ted an suppor t for the major s t r a t e g i e s which a re d i r e c t l y r e l a t e d t o t h e above o b j e c t i v e s .

Other Ass is tance

Based on country h e a l t h programming, UNDP, UNICEF and o t h e r c o l l a b o r a t i n g agencies w i l l a s s i s t t h e Government of Burma with p r i o r i t y h e a l t h programmes of primary h e a l t h care and b a s i c h e a l t h s e r v i c e s , fami ly h e a l t h , expanded p r o g r a m e of immunization, vector-borne d i s e a s e c o n t r o l and environmental s a n i t a t i o n .

Primary Health Care and Bas ic Health Se rv i ce s

The new approach o f t h e Government t o meet t h e b a s i c h e a l t h needs of the popula t ion i s t o provide p r i m r y h e a l t h care t o 26 000 " i l l a g e s ( ~ u t o f a t o t a l o f 58 212) not having d i r e c t access t o h e a l t h s e r v i c e s , through primary h e a l t h care workers a t t h e v i l l a g e l e v e l dur ing t h e f ive-year pe r iod of 1977-1982. I n t h e urban a reas , t h e primary h e a l t h care s e r v i c e w i l l be organized through 6600 urban u n i t s , out of 15 400 u n i t s , dur ing the same per iod . The programme has a popula t ion coverage t a r g e t o f 45% i n r u r a l areas and 43% i n urban areas. In o rde r t o provide necessary suppor t and r e f e r r a l s e r v i c e s f o r t h e primary h e a l t h workers , t h e e x i s t i n g b a s i c h e a l t h s e r v i c e s of r u r a l h e a l t h c e n t r e s , urban c e n t r e s and r u r a l s t a t i o n h o s p i t a l s w i l l be s t r eng thened by i n t e g r a t i n g t h e s p e c i a l d i s e a s e campaigns i n t o b a s i c h e a l t h s e r v i c e s , r e -o r i en t i ng t h e e x i s t i n g h e a l t h s t a f f and expanding t h e network of b a s i c h e a l t h s e r v i c e s . The programme w i l l r e ce ive the necessary suppor t from t h e community, the government organs and i n t e r n a t i o n a l c o l l a b o r a t i n g agenc i e s , such as WHO and UNICEF. C r i t i c a l suppor t p r o j e c t s f o r s u c c e s s f u l implementation of t h e programme are: s t r eng then ing of h e a l t h educa t ion , h e a l t h informat ion system development, s t r eng then ing o f epidemiologica l surveillance, s t r eng then ing of h e a l t h l abo ra to ry services, h e a l t h manparer development, provis ion o f medical s u p p l i e s and equipment and r e sea rch .

WHO Co-oqcration

WHO w i l l co-operate wi th the Government i n p lanning t h e primary h e a l t h care programme, t r a i n i n g the primary h e a l t h care workers and i n eva lua t i ng t h e programme and reprogramming as necessary . WHO t e c h n i c a l co-operation w i l l a l s o extend t o t h e development of h e a l t h informat ion sys tems, h e a l t h educat ion and i n t e g r a t i o n of t r a d i - t i o n a l medical p r a c t i t i o n e r s .

Family Health

The Government i n t ends , dur ing t h e f ive-year pe r iod , from 1977 t o 1982, t o reduce t h e maternal m o r t a l i t y r a t e from 1 .7 t o 1.02 per 1000 l i v e b i r t h s , t h e i n f a n t m o r t a l i t y r a t e from 56 t o 41 per 1000 l i v e b i r t h s , the s t i l l b i r t h r a t e from 16 t o 14.4 per 1000 l i v e b i r t h s , hypovi taminos is from 30% t o 272, pro te in-ca lory ma lnu t r i t i on i n e a r l y childhood from 5041 to 45%, i r o n de f i c i ency anaemia from 60% t o 54% and g o i t r e i nc idence from 40% L O

26%. In o rde r t o achieve t he se o b j e c t i v e s , t h e fami ly h e a l t h s e r v i c e w i l l b e organized through the p rov i s ion of maternal and c h i l d h e a l t h s e r v i c e s , s choo l h e a l t h s e r v i c e s , immunization s e r v i c e s , n u t r i t i o n a l counse l l i ng , s c r een ing s e r v i c e s , d i s t r i b u t i o n of n u t r i t i o n a l supplements and v i t amins , and by o f f e r i n % pe r sons1 h e a l t h care s e r v i c e s through rhe r u r a l h e a l t h c e n t r e s , maternal and c h i l d h e a l t h c e n t r e s , r u r a l s t a t i o n h o s p i t a l s , urban h e a l t h c e n t r e s and s choo l hea l t h teams. The programme w i l l r e c e i v e t h e neces sa ry suppor t from the community, the government and i n t e r n a t i o n a l agenc i e s , such as WHO and UNICEF.

WO Co-operation

WHO w i l l provide t e c h n i c a l co-operation f o r fami ly h e a l t h p r o g r a m e s through the s e r v i c e s of maternal and c h i l d h e a l t h s p e c i a l i s t s , award of f e l l owsh ips t o t h e n a t i o n a l s t a f f and s u b s i d i z i n g the c o s t of t r a i n i n g va r ious c a t e g o r i e s of h e a l t h s t a f f .

163 BURMA - Index

ProJee t N O .

ASE 001

BLG 002

BSM 002

BVD 001

BVD 002

BM 003

DHS 002

DHS 003

ESD 001

ESD 002

ESD 003

HED 001

HMD 001

HMD 003

HMD 004

HMO 005

HMD 006

*projec t

P ro j ec t T l t l e

Country Statement

Off ice of t h e WHO Repre sen t a t i ve

Development o f Product ion and Q u a l i t y Contro l of B i o l o g i c a l and P h a r m a c e u t i ~ a l Products (SQP 002)*

Environmental S a n i t a t i o n

Tuberculos is Contro l (MBD 002)*

Mycobacterial Diseases (MBD 003)*

Leprosy Contro l

[Department of Medical Research

Development of Health Information Se rv i ce s

S t r eng then ing of Health Se rv i ce s (Epidemiology)

Prevent ion Cantral and Su rve i l l ance of Conmunicable Diseases

Expansion of Epidemiological Su rve i l l ance i n Connnunity Heal th Se rv i ce s

Heal th Education

Nursing Advisory Se rv i ce s

I n s t i t u t e of Medicine I and School of P reven t ive and T rop ica l Medicine, Rangoon

San i t a ry Engineer ing Education and T ra in ing , Rangoon I n s t i t u t e of Technology

Education and T ra in ing of Heal th Manpower

Development of Procedures and S t a f f T ra in ing

number p r i o r t o the c u r r e n t programme

P ro j ec t T i t l e

R e h a b i l i t a t i o n of t h e Handicapped (SHS 001)*

Maintenance and Repai r Workshop f o r Heal th Equipment (SHS 003)*

H o s p i t a l S e w i c e s Management (SHS 004)*

St rengthening of Health S e w i c e e i n t h e Newly I n d u s t r i a l i z e d Areas (weat Bank of Irrawaddy River) (SHS O M ) *

Occupational Heal th

St rengthening of Laboratory Se rv i ce s

Food and Drug Qua l i t y Contro l Laboratory

Development of Family and Chi ld Hea l th

Family Heal th

Mental Heal th T r a i n i n g and Se rv i ce s

Ma la r i a E rad i ca t i on

N u t r i t i o n Se rv i ce s

Denta l Heal th Se rv i ce s (DNH 001)*

Primary Hea l th Care and Bas i c Heal th Se rv i ce s

Planning and S t r eng then ing of Heal th Se rv i ce s (SHS 002)*

Radia t ion Heal th

Expanded Progranrme on I m u o i z a t i o n

Vectar-borne Diseases Contro l (ESD 004)*

164

189

184

186

180

180

180

186

186

176

178

178

17 2

172

174

174

174

176

s t r u c t u r e .

Pase

166

166

166

168

184

184

184

170

170

182

178

172

182

168

166

182

178

182

project N O .

HSD 001

HSD 002

HSD 003

HSD 004

HWP 001

LAB 001

LAB 002

MCH 003

MQ( 001

MNH 001

MPD 001

NUT 001

ORH 001

PHC 001

PPS 001

RAD 001

SPI 001

VBC 001

160

BHUTAN

i HSD 001 Development of Health Services (UNDP BHU/72/006) i ! TO a s s i s t i n t h e development of in t eg ra ted hea l th se rv ices a t e l l l e v e l s , as p a r t of socio-economic

development, wi th p a r t i c u l a r emphasis on the bu i ld ing up of e f f e c t i v e and e f f i c i e n t hea l th services f o r the r u r a l population.

As a r e s u l t of the f i r s t UNDP reconnaissance mission i n March-April 1972 and subsequent meetings wi thin the United Nations agencies and with government o f f i c i a l s , i t was decided t h a t the highest p r i o r i t y i n hea l th should b e given to the development of hea l th se rv ices concerned with communicable-disease con t ro l , maternal and ch i ld heal th and environmental hea l th ( r u r a l water supply) and t o the t r a in ing of paramedical/auxiliary workers t o man t h e bas ic r u r a l hea l th se rv ices . Consequently, the project "Development of Health Services" was prepared and became opera t ive i n January 1975, i n co l l abora t ion with UNICEF's pro jec t e n t i t l e d "Development of Co-ardinated Services f o r Children i n Bhutan" and the p ro jec t s of the World Food Programme.

TWO long-term s t a f f - a publ ic hea l th a d m i n i s t r a t o ~ and a publ ic hea l th nurse educator - were provided i n 1975.

A short-term consul tant i n n u t r i t i o n was a l s o assigned i n 1975.

The p ro jec t is expected t o continue till 1977 i n t h e f i r s t i n s t ance , end is l i k e l y t o be extended t h e r e a f t e r with add i t iona l inputs sub jec t t o a v a i l a b i l i t y of UNDP funds.

BWTAN

GENERAL

The Kingdom of Bhutan is s i t u a t e d i n t h e hea r t of t h e Himalayas end has an area of about 46 000 sq. kms, and has a papulation of about one mi l l ion , of which about 30 000 are i n urban areas. The population densi ty i e roughly 22 per sq. km. The c a p i t a l is located a t Thimphu, which has a population of 10 000.

Bhutan's economy i s based mainly on a g r i c u l t u r e and animal husbandry. The area under c u l t i v a t i o n c o n s t i t u t e s about 9% of the t o t a l area. About 70% of t h e t o t a l area is under dense f o r e s t s .

Bhutan is following a system of annual plans which enables t h e government t o review t h e progress of var ious sciiemea and s h i f t the p r i o r i t i e s where necessary. A high-powered Planning Commission, presided over by the King, was s e t up i n 1971. The major areas for development i n t h e Third Pive-Year Plan (1971-76) were: (1) ag r i cu l tu re , including co-operatives, (2) power, (3) induetry end mining, (4) t r anspor t and comunicat iona, (5) s o c i a l se rv ices , and (6) miscellaneaua. The t o t a l out lay f o r t h e Third Plan a t the beginning of the plan period was R s . 355 mi l l ion , of which t h e provis ion f o r s o c i a l se rv ices (including heal th) was R s . 108.55 mil l ion. Health i s recognized as an e s s e n t i a l component of t h e o v e r a l l sacio-economic development and f inds an important place i n t h e development plans. Nearly 8% of the t o t a l out lay i n t h e Third Plan was earmarked f o r heal th . The Fourth Five-Year Plan has been launched i n Apri l 1976.

General Health Services

The heal th se rv ices under the Di rec to ra te of Health Services provide mainly medical r e l i e f from f i v e zonal hosp i t a l s , t h ree leprosy h o s p i t a l s , and 46 dispensar ies covering even t h e a reas remote from the c a p i t a l . There i s a t o t a l of 262 hosp i t a l beds. both general and o the r s .

Preventive measures have been confined t o malar ia e rad ica t ion , smallpox vaccinat ion, and a BCG m a s s campaign (aince 1966) through a BCG team. The important d ieeaaes a f f e c t i n g t h e population are in fec t ious and p a r a s i t i c d iseases and those of n u t r i t i o n a l d isordere .

The Government of Bhutan is developing r u r a l hea l th ee rv icee , t h e provis ion of r u r a l dr inking water and nu t r i t ion . Tuberculosis con t ro l w i l l be c a r r i e d ou t as an i n t e g r a l p a r t of t h e general hea l th se rv ices . The r u r a l hea l th se rv ices are being strengthened by the conversion of e x i ~ t i n g d i spensa r i e s i n t o bae ic hea l th u n i t s , t o be manned by teams with a minimum of t h r e e members: a hea l th a s a i s t e n t , a b a e i c hea l th worker and an a u x i l i a r y nurse- midwife. The main funct ions of these u n i t s are medical care, maternal and c h i l d h e a l t h and family planning, immunization, hea l th and n u t r i t i o n education and environmental s a n i t a t i o n . Specia l a t t e n t i o n is being given t o the development of hea l th manpower by t r a i n i n g the t h r e e types of hea l th workers t o man these u n i t s a t the Health School located i n t h e General l tospi ta l , Thimphu.

The Organization, through t h e p ro jec t f o r development of h e a l t h ae rv ices financed by UNDP, i n co l l abora t ion with o the r i n t e r n a t i o n a l agenciee (such as UNICEF and the World Food Programme) i s a s s i s t i n g t h e Government s p e c i f i - ca l ly t o e s t ab l i sh bas ic hea l th u n i t e , provide in teg ra ted cu ra t ive and prevent ive hea l th se rv ices , wi th s p e c i a l emphasis on maternal and ch i ld hea l th and t h e con t ro l of tube rcu los i s , t r a i n hea l th manpower f o r the b a s i c heal th u n i t s , ensure q u a l i t y con t ro l of dr inking water and advise on t h e improvement of t h e n u t r i t i o n of t h e papulation.

Project NO.

HSD 001

*Project

7

Project T i t l e

Country S tetement

Development o f Health Services (SHS 001)*

number prior to the current programme

BHmAN

page

159

160

structure.

- Index Project

0 . Project T i t l e

15

Page

BANGLADESH

9.2 Assistance to Countrx Programmes

Off ice of the WHO Representative

Medical o f f i c e r P5 Administrative o f f i c e r P2 Clerk-s tenographers DAC5

Custodial s ta f fltemporary aesistance

Conmon aervices

Total - BANGLADESH

O f which: Regular budget Other sources

1976

1 / 1 2 1 / 1 2 2/24

4

39 --sD

30 9

Number

1977

1 /12 1 / 1 2 2/24

4

---- 45

--=-

32 1 3

----

Revised

1976

70 000

1 0 200 30 000

110 200

Estimates

1977

40 100 27 400

5 800

7 3 300

11 900 19 000

104 200

of Poats Praporials

1978

44 100 29 800

6 600

80 500

1 3 800 22 000

---- 116 300

----

2 438 800 .==------

1 272 000 1 166 800

~ ~ ~-

w

p

RB

1978

1 / 1 2 1 / 1 2 2/24

---- 4

----

1979

46 900 3 1 500

7 600

86 000

1 5 800 25 000

126 800

1 8 9 0 500 -l.--l_-.

1 469 400 4 2 1 100

4 350 900 -.-*-.--- 910 200

3 440 700

I

Project NO.

ASE 001

1979

1 / 1 2 1 / 1 2 2/24

4

5 4 8 3 300 -_li_.=_l

1 127 900 4 355 400

I 4 3 I---

32 11

35 .--- 30 5

BANGLADESH

PHA 001 Pharmaceutical and Bio log i ca l Q u a l i t y Contro l

I n 1972, a consu l t an t made a s tudy of t h e methods f o r t h e purchase , s t o r a g e and d i s t r i b u t i o n of drugs , medical s u p p l i e s and equipment, and recommended a model. Subsequently, i n 1974, ano the r consu l t an t a s s i s t e d i n t h e i n s t a l l a t i o n and commiesioning of t h e a v a i l a b l e and h e r e t o f o r e u n u t i l i z e d maclrinery and equipment. During t h e second count ry h e a l t h programming e x e r c i s e , t h e country ' . l o g i s t i c , medica l supply and d i s t r i b u t i o n eystem was c r i t i c a l l y reviewed and ano the r model was recommended i n o rde r t o suppor t the i n t e g r a t e d h e a l t h and fami ly planning s e r v i c e s . At t h e same t ime, a l ist of b a s i c medi- c i n e s was developed. The Government i s very keen t o develop the pharmaceut ica l l abo ra to ry a t tached t o the Cen t r a l Medical S to re s t o s o l v e t h e chronic sho r t age of b a s i c medicines and even tua l l y t o a t t a i n ee l f - su f f i c i ency i n t h i s v i t a l s e c t o r . In view of t h i s , p l ans f o r s e t t i n g up workshops f o r t h e r e p a i r and maintenance of medical equipment have a l s o been prepared t o suppor t t h e h e a l t h s e r v i c e s .

A long-term s t a f f member i s proposed t o be provided from 1976 onwards t o g i v e adv i ce on pharmaceutical product ion . A consu l t an t i n drug q u a l i t y c o n t r o l has a l s o been proposed. Fellowships f o r t r a i n i n g n a t i o n a l workers i n the f i e l d of product ion and drug c o n t r o l l a b o r a t o r i e s w i l l a l s o b e awarded. Suppl ies and equipment w i l l i nc lude machinery f a r drug t e s t i n g .

BSM 001 Cornunity Water Supply and S a n i t a t i o n

I n improving the h e a l t h and we l f a r e of t h e popula t ion through t h e p rov i s ion of p ro t ec t ed water supply and s a f e d i s p o s a l of human e x c r e t a , s imul taneous ly w i th i nc rea s ing community p a r t i c i p a t i o n end c r e a t i o n of h e a l t h consc iousness , suppor t i n t h i s t a s k w i l l cont inue .

Since October 1972, under a massive UNICEF-aided Water Supply Programme, a l a r g e number of tubewells has been provided, i n c r e a s i n g t h e coverage t o one tubewel l fo r 250 popula t ion as a g a i n s t t h e previoue f i g u r e of one tubewel l f a r 350 popula t ion . Some headway has a l s o been made i n t h e p rov i s ion of s an i - t a r y l a t r i n e s i n t h e r u r a l area.

A s e n i o r s a n i t a r y engineer and a sen io r s a n i t a r i a n have been proposed from 1977 onwards t o take t h i s a d d i t i o n a l r e s p o n s i b i l i t y .

SES 001 Ass i s t ance t o Water and Sewerage Autho r i t y , Dacca and Chi t tagong (UNDP BGDl741038)

To a s s i a t the Government i n improving t h e water supply and s a n i t a t i o n s i t u a t i o n i n t h e me t ropo l i t an areas of Dacca and Chi t tagong i n an economically v i a b l e manner, a t t h e same t ime extending t o the consumers a s t anda rd publ ic u t i l i t y s e r v i c e which would meet t h e requi rements of community hea l t h .

BANGLADESH

CYO 001 Cardiovascular Diseases

To a s s i s t i n aeeeseing the morbidity and mor ta l i ty due t o csrdiavaacular d i seases , and t r a i n i n g specia- l i zed hea l th and a l l i e d manpower required f o r a prevention, c o n t r o l and r e h a b i l i t a t i o n programme. The p ro jec t w i l l a l s o a s s i s t i n t h e establishment of epidemiological, educat ional and therapeut ic se rv ices against cardiovascular d iseases .

The a c t i v i t i e s w i l l commence i n 1977 with a workshop of two weeks' durat ion f o r publ ic hea l th adminis- t r a t o r s , surgeons, physicians and medical educators t o develop a na t iona l programme f o r promoting cardiovascular heal th . A consul tant w i l l a l s o be provided i n 1979 t o a s s i s t i n the formulation of the programme. Fellowships w i l l be provided i n 1977 and 1979, and the re w i l l be another workshop t o evolve the programme Fur the subsequent period.

OM 001 Oral Health

To a s s i s t i n the development of d e n t a l hea l th se rv ices and of d e n t a l education.

Dental hea l th hae not received s u f f i c i e n t a t t e n t i o n because of t h e preoccupation of the hea l th author i - t i e s with other p r i o r i t y areas such as t h e con t ro l of communicable diseases . There is only one col lege f o r d e n t a l t r a i n i n g , e s t ab l i shed i n Dacca i n 1962, with a capaci ty of 30 t o 50 admissions per year. The pro jec t aims a t s t rengthening den ta l a c t i v i t i e s i n t h e pub l i c hea l th se rv ices and a t fu r the r developing the plans and programmes of t h e Dental College. For these purposes, provis ion has been made f a r e long-term den ta l o f f i c e r from 1977 onwards and a consul tant i n 1979. Fellowships, both i n t h e Region as wel l as ou t s ide , w i l l a l s o be provided.

MNH 001 Elental Health

To a s s i s t i n the t r a i n i n g of medical, nursing and a l l i e d hea l th workers f o r providing community- or iented mental hea l th care, i n the s t rengthening of comprehensive mental hea l th care se rv ices and i n the epidemiological inves t iga t ion of mental i l l n e s s .

From 1977 onwards, a long-term s t a f f member w i l l be provided to review and assess the s i t u a t i o n and t o promate s t rengthening of t h e seve ra l e s s e n t i a l components of a nation-wide commnnity-based mental hea l th service . I n i t i a l l y , e f f o r t s w i l l be d i r ec ted to t h e development of psych ia t r i c t r a i n i n g programmes i n medical col leges , nursing t r a i n i n g cen t res and post-graduate medical and nursing i n s t i t u t e s .

Fellowships w i l l be provided f o r t r a i n i n g teachers i n psychiatry and i n epidemiological and s o c i a l psychiat ry , as wel l as t o enable them t o observe recent developments i n psych ia t r i c t r a i n i n g and service . Group educat ional a c t i v i t i e s w i l l be undertaken i n 1977 and 1979. Assistance t o the p ro jec t w i l l continue f a r some years .

HWP 001 Occupational Health

To a s s i s t i n con t ro l l ing hea l th hazards i n indus t ry .

Following a review of t h e s t a t u s of occupational hea l th i n indus t ry made i n 1973 by a consul tant . who a lao advised on the development of an i n d u s t r i a l hygiene u n i t a t the c e n t r a l l e v e l , f u r t h e r consul tants w i l l be provided under t h e p ro jec t f o r s t rengthening the occupational hea l th se rv ices and f o r g iving advice on bu i ld ing up t h e i n d u s t r i a l hea l th s e r v i c e as an i n t e g r a l component of hea l th se rv ices and on updating l e g i s l a t i o n . Fellowships and supp l i e s and equipment are a l s o proposed.

Assistance t o the p ro jec t i s expected t o continue up t o 1983.

BANGLADESH

BW 001 Weobac te r i a l Disease Control

To a s s i s t i n the development, organizat ion, implementation and assessment of the su rve i l l ance and integrated c a n t r o l of tuberculosis and leprosy.

WHO ha8 a s s i s t e d the Government wi th tuberculosia c o n t r o l from time t o time s i n c e 1951. In 1973 and 1974, under the inter-country p ro jec t SEARC 0113, "Tuberculosis Training and Evaluation Team", a s s i s t ance has been provided i n conducting a n a t i o n a l sample survey f o r es t imat ion of the s i z e of the tuberculosis problem i n the country and i n s e t t i n g up a na t iona l tube rcu los i s i n s t i t u t e .

In t h e f i e l d of leprosy, a s s i s t ance s t a r t e d i n 1961. A survey conducted espec ia l ly i n t h e hyperendemic areas of t h e country provided t h e hea l th a u t h o r i t i e s with bas ic information regarding the s i z e of the leprosy problem and neceesary opera t iona l da ta f o r case-finding and treatment a c t i v i t i e s .

The p ro jec t is a r e s u l t of the merger of former p ro jec t s BAK MBD 001. "Tuberculosis Control", and BAN MBD 002. "Leprosy Control". Under t h e former, a na t iona l seminar an tuberculosis , organized j o i n t l y by the In te rna t iona l Union aga ins t Tuberculosis, t h e Government of Bangladesh and WHO, was held i n 1974, and under the l a t t e r , an assessment of the leprosy problem was made.

A nation-wide p r o g r a m is proposed to be organized with emphasis on maximum coverage of the e l i g i b l e young age group with BCG vaccinat ion. Training of hea l th personnel i n mycobacterial d isease (MBD) con t ro l , both wi thin the country and abroad, w i l l continue. The p ro jec t envisages t h e bui lding up of d ie t r i c t / sub-d iv i s iona l MBD con t ro l organizat ions , development of 4-8 model thanas f o r MBD con t ro l and t h e s t rengthening of thana hea l th complexes for passive case-finding and case-managaent i n r e l a t i o n t o both leprosy and tube rcu los i s , as an in teg ra ted f i e l d programme.

Assistance t o t h e p ro jec t w i l l continue t i l l 1983.

PBL 001 Prevention of Blindness

A nation-wide anti-blindness campaign aga ins t xerophthalmia with high potency vitamin ' A ' capsules ~ r o v i d e d by UNICEF f o r ch i ld ren under s i x years was introduced i n 1973, and a s a t i s f a c t o r y coverage wan achieved through family welfare workers (FWWs) aa pact of t h e in teg ra ted h e a l t h and family planning se rv ices . WHO has provided consul tants annually s ince 1972 - f i r s t t o design a compreheneive nat ional programme and to assess t h e programe, and pe r iod ica l ly t o review the progress. I n view of the development of the I n s t i t u t e of Publ ic Health Nut r i t ion (BAN NUT 002 - BUD/73/075), t h i s project w i l l be merged with t h a t I n s t i t u t e .

I n 1976-77, consultancy se rv ices w i l l b e provided f o r developing a na t iona l programme f o r t h e preven- t i o n of v i s u a l impairment and blindness. Fellowships are t o be awarded f a r t r a i n i n g i n spec ia l i zed aspects of community-oriented eye hea l th se rv ices .

Similar t echn ica l a s s i s t ance w i l l be provided i n 1978 and 1979 f o r the development of services and t r a i n i n g i n community-oriented eye hea l th care se rv ices as an i n t e g r a l p a r t of t h e ex i s t ing publ ic hea l th system.

In 1977. a na t iona l seminar an t h e organizat ion of primary and r e f e r r a l ophthalmic Services w i l l be supported.

CAN 001 Cancer

To a s s i s t i n t h e formulation of a na t iona l programme f o r the prevention and con t ro l of cancer, t r a i n i n g of hea l th and a l l i e d manpower f o r ant i -cancer a c t i v i t i e s and develop a pa t t e rn of se rv ices f o r ea r ly de tec t ion , diegnosie and treatment of cancer. The pro jec t w i l l also assist in epidemiolagicel inveati- gatione of the cancer problem.

The a c t i v i t i e s w i l l commence i n 1977, when a na t iona l workshop of two weeks' durat ion w i l l be held wi th t en p a r t i c i p a n t s (including pub l i c h e a l t h admin i s t r a to r s , surgeons, physic ians , r ad io the rap i s t s , r a d i a l o g i s t s and pathologis ts) t o prepare d e t a i l s of t h e se rv ices required f o r t h e development of t r a i n i n g and research on the prevention and con t ro l of cancer. A short-term consul tant w i l l be provided i n 1979 t o assist i n t h e formulation and implementation of t h e na t iona l cancer con t ro l programme. There w i l l be another workshop i n 1979, and fe l lowships w i l l be provided.

BANGLADESH

MPD 001 Malaria Eradication

To assist in the eradication of malaria from the entire country and to prevent the re-establishment of endemicity.

The malaria control project, started in 1959 with WHO/UNICEF assietance, clearly demonstrated the feasibility of malaria eradication. An eradication programe with WHOIDSAID assistance was launched in 1961 in a phased manner, and the entire country was brought under its operations in 1968. The progr-e made steady progress until 1970. However, owing to the disruption of activities in 1971 and the large influx of imported cases, resumption of transmission occurred in many areas.

The integration of malaria eradication with family planning and other health activities at the peripheral level wae implemented on a nation-wide basis in January 1974. The malaria situation was reviewed in 1974 and 1975 by independent assessment teams, whose recornendations are being implemented.

In 1975, eradication status was reached in an area of 34.2 million population, with populations of 29.6 million and 9 million in conealidation and attack phase areas, respectively. Technical problems still exist in forest belts, where, on account of the behaviour of the vector A. balabacensis and because of difficulty of access and transportation, interruption of malaria transmission through the use of conventional methods does not appear to be feasible.

In view of the persistence of transmission, particularly in the northern and eastern parts of the country, and because of the delay in the development of the minimum health infrastructure needed to ensure basic vigilance activities in areas of malariogenic potential, the progrme needs continuous support, which is being provided in the form of a long-term malariologist, short-term consultants, fellowships, and supplies and equipment for 1978 and 1979.

SPI 001 Smallpox Eradication

To achieve total eradication of smallpox by the year 1977.

The project began in 1961 (as PAK 0041). There was a remarkable increase in WHO support after 1972 by the provision of an epidemiologist, subsidies, supplies, etc. At present, 30 international staff are assisting the Government under this project. The strategy includes outbreak detection (surveillance, containment and vaccination). With these measures, transmission had been interrupted by the end of 1975. However, surveillance and maintenance will have to be continued far the succeeding two years. Provision has been made for long-term staff for co-ordination of the project activities and administrative support. Supplies and equipment will also be provided.

Since the last known case of smallpox in Bangladesh occurred on 16 October 1975, the programme is now in a phase of intensive surveillance, using well supervised and planned house-to-house searches carried out by 60 surveillance teams.

This phase will last until December 1977 when, it is hoped, an International Commission will certify the eradication of smallpox.

HMD 005 Strengthening of Health Man~ower Develoment Programme (UNDP BGD173/035)

TO c r e a t e en appropr ia te i n f r a s t r u c t u r e of hea l th profess ionals who w i l l form a continuous cadre f o r the del ivery of primary hea l th care.

Primary hea l th care through the development of in t eg ra ted bas ic hea l th se rv ices , including family planning, has assumed p r i o r i t y i n Bangladesh. It i s recognized t h a t primary heal th care w i l l succeed only i f e f f e c t i v e de l ive ry systems are operat ional . The foundation of such a del ivery system is the community-oriented hea l th e x p e r t i s e and se rv ices t h a t can b e rendered. Consequently, community- or iented and need-based medical education assume s ign i f i cance .

ESD 001 Strengthening of Epidemiological Services

Ta a s s i s t i n t h e improvement and s t rengthening of t h e su rve i l l ance and con t ro l of camunicable diseases as a p a r t of t h e in teg ra ted general hea l th se rv ices .

Assietance t o t h e p ro jec t s t a r t e d i n 1973 with t h e assignment of a WHO v i r o l o g i s t : i n January 1974, a WHO epidemiologist was assigned. A v i r o l o g i c a l laboratory fo r the su rve i l l ance of se l ec ted diseases has already been developed under UNDP ass i s t ance , and fe l lowships and c e r t a i n supp l i e s and equipment have a l s o been provided. A WHO consul tant was assigned i n 1975 t o review the con t ro l of dengue haemorrhagic fever with na t iona l and WHO s t a f f .

Provis ion has now been m d e f o r short-term consul tants t o plan morbidity surveys i n r e l a t i o n t o se l ec ted d i seases , and t o assess and review, from time t o time, t h e development of epidemiological se rv ices as a p a r t of in t eg ra ted h e a l t h s e r v i c e s . They w i l l a l s o a s s i s t i n t h e formulation of comprehensive immunization programmes, which w i l l be an important p a r t of development of the maternal and ch i ld hea l th programme. Fellawehips w i l l be awarded f o r t r a i n i n g workers i n epidemiology. Supplies and equipment have been provided f o r the smooth running of t h e p ro jec t .

Assistance to the p ro jec t w i l l continue f o r a number of years

ESD 002 Epidemiolony and Disease Control (UNDP BGD1731074)

To a s s i s t i n t h e establishment of an Epidemiology and Vector Control Uni t , which w i l l funct ion as the c e n t r a l t echn ica l u n i t f o r sys temat ic mul t i -disc ipl ined epidemiological s t u d i e s t o c o l l e c t information an t h e magnitude and d i s t r i b u t i o n of important major d i seases , zoonosis and d i sease vec to r s , t h e i r biology, ecology d e n s i t y , r e s i s t a n c e t o i n s e c t i c i d e s , and o the r f a c t o r s such as condi t ion of na tu ra l f o c i and rese rvo i r of in fec t ion . ?he Unit w i l l impart t r a i n i n g t o hea l th personnel i n the f i e l d of epidemiology and vector con t ro l .

Assistance t o t h i s p ro jec t s t a r t e d i n 1973. An epidemiologist and a v i r o l o g i s t have undertaken preparatory a c t i v i t i e s such as c o l l e c t i o n of e s s e n t i a l da ta and the t r a i n i n g of personnel. A j o i n t UNDPIWHO mission reviewed the p ro jec t i n 1975.

From 1977, i n add i t ion t o an epidemiologist and a v i r o l o g i s t , i t is proposed t o provide an entomologist and a p a r a s i t o l o g i s t . A consul tant w i l l b e ass igned i n 1976 and 1977. Fellovahips have been provided f o r t h e t r a i n i n g of na t iona l personnel i n t h e r e l a t e d f i e l d s .

Assistance t o t h e p ro jec t w i l l continue f o r a number of years .

142

BANGLADESH

HM) 001 Nureins Advisory Services and Training

TO assist i n the development of the nursing component of h e a l t h se rv ices as we l l as i n the development of educat ional programmes i n nursing and midwifery.

Assistance t o t h i s p ro jec t began i n 1972 with t h e assignment of a WHO nurse adv i se r t o advise and a s s i s t the Superintendent of Nursing Services. A publ ic hea l th nurse educator was assigned t o a s s i s t i n t h e development of a post-basic education p r o g r a m f o r nurse teachers , adminis t ra tors and c l i n i c a l s p e c i a l i s t s . The a c t i v i t i e s under t h e p r o j e c t have been concerned mainly with the acce le ra t ion of the production of t ra ined nurses through the post-basic preparat ion of nurse t u t o r s , the t r a i n i n g of t r a i n e r s f a r t h e family welfare v i s i t o r s , a n d the development, implementation or r ev i s ion of c u r r i c u l a f o r various t r a in ing courses. This p ro jec t hae helped t o l i n k the post-basic t r a i n i n g of nurses i n the College of Nursing with t h e nuraing t r a i n i n g cen t res of t h e d i s t r i c t h o s p i t a l s , t h e l a t t e r funct ioning as f i e l d p rac t i ce a reas f o r t h e col lege.

The plan of a c t i o n i s designed t o develop, by 1980, a nursing co l l ege grant ing a post-basic degree i n nurs ing adminis t ra t ion and reaching, publ ic hea l th nursing and o the r s p e c i a l t i e s . An evaluat ion mechanism f o r the programme w i l l be developed, and a c e n t r a l index system of a l l nuraing personnel w i l l be completed. Support t o t h e Government's planning, i n an advisory capac i ty , w i l l continue.

Consultants, fe l lowships , group educat ional a c t i v i t i e s and suppl ies and equipment w i l l be provided i n 1978-1979.

HMD 003 train in^ of Medical Assistants (UNDP BGDl731072)

To increase the quant i ty and improve t h e q u a l i t y of hea l th se rv ices a t t h e l e v e l of t h e union hea l th centres by t r a i n i n g a new category of middle-level h e a l t h care worker t o be c a l l e d "medical aas i e t an t " . The medical a s s i s t a n t s , who w i l l be t r a ined i n s p e c i a l schools f o r two years followed by one year 'e f i e l d t r a in ing , w i l l compensate f o r t h e shor tage of medical o f f i c e r s i n r u r a l a r e a s and thus increase the range of hea l th se rv ices a t union hea l th cen t res by providing rou t ine medical se rv ices which do not r equ i re the medical o f f i c e r ' s Level of competence. They w i l l a l s o provide r e f e r r a l - l e v e l aervices beween t h e b a s i c hea l th workers i n t h e v i l l a g e s and medical o f f i c e r s located a t thana hea l th centree .

A medical o f f i c e r with publ ic hea l th and teaching experience w i l l organize and supervise the t r a i n i n g progrimme i n co l l abora t ion with the na t iona l p ro jec t o f f i c e r . Fellowships f o r the t r a i n i n g of teachers f o r the t r a i n i n g schools and supp l i e s and equipment f o r these schools w i l l be provided.

HM) 004 National I n s t i t u t e of Preventive and Soc ia l Medicine (UNDP BGDl731073)

TO develop a t i n s t i t u t i o n i n t h e country which w i l l provide poet-graduate t r a i n i n g and re f reeher courses i n t h e d i s c i p l i n e s of prevent ive and s o c i a l medicine. Such t r a i n i n g w i l l prepare the manpower required f o r hea l th adminis t ra t ion and ocher publ ic hea l th se rv ices . The I n s t i t u t e w i l l a l s o under- t ake research a c t i v i t i e s i n prevent ive and s o c i a l medicine and publ ic h e a l t h , w i l l provide t h e h e a l t h department v i t h advisory se rv ices i n developing hea l th p rogrames , and w i l l co-ordinate t r a in ing and research i n the f i e l d of publ ic heal th .

A long-term post of professor of publ ic hea l th admin i s t r a t ion has been provided t o a s a i s t the I n s t i t u t e i n o rgsn i r ing t r a i n i n g programes. Fellowships f o r t r a i n i n g teachers f o r the I n s t i t u t e and guppliee and equipment w i l l be provided.

BANGLADESH

NUT 002 I n s t i t u t e of Public Health Nutr i t ion (UNDP BGD/73/075)

To a s e i s t i n developing t h e I n s t i t u t e of Publ ic Health Nut r i t ion i n Dacca.

A long-term public hea l th n u t r i t i o n i s t w i l l a s s i s t i n the organizat ion and preparat ion of the programmes of t h e I n s t i t u t e . Fellowehips t o s t rengthen t h e t echn ica l l e v e l of s t a f f and ass i s t ance for t h e purchase of laboratory and f i e l d equipment w i l l be provided.

This i a a new pro jec t s t a r t i n g i n 1976 with t h e assignment of a publ ic hea l th n u t r i t i o n i s t , who w i l l continue through t o 1979. The p ro jec t w i l l provide fellowships and a s u b s t a n t i a l proportion of the p r o j e c t ' s budget w i l l be a l loca ted i n 1977 and 1978 f o r suppl ies and equipment.

The p ro jec t is expected to continue u n t i l the end of 1979.

HED 001 Public Health Education

Unobligated balance ava i l ab le f o r 1976 out of a voluntary con t r ibu t ion .


To develop hea l th education se rv ices a t the c e n t r a l , regional and d i s t r i c t l e v e l s of the hea l th adminiatcation in support of h e a l t h education a c t i v i t i e s i n hea l th programmes; t o develop hea l th education as an i n t e g r a l pa r t of the cu r r i cu la f a r medical, nursing and other hea l th profess ionals end t o develop l ea rn ing resource mate r i a l ; t o i n s t i t u t e post-graduate t r a in ing i n heal th education and t o develop hea l th education as a pa r t of the cu r r i cu la f o r primary and secondary echaals and teacher t r a i n i n g col leges .

The s t a t u s of hea l th education i n t h e country was reviewed i n 1973 by a WHO short-term consul tant . From 1976, a WHO hea l th education s p e c i a l i s t w i l l a s s i s t the Government i n implementing the consu l t an t ' s recommendations and i n developing hea l th education as an i n t e g r a l p a r t of t h e hea l th services . He w i l l a l s o a s s i s t the Government i n developing hea l th education as a pa r t of t h e c u r r i c u l a f o r primary and secondary schools and f o r teacher t r a i n i n g col leges . From 1978, another WHO hea l th education s p e c i a l i s t w i l l he lp i n developing in-service and pre-service t r a i n i n g programes i n hea l th education f a r hea l th personnel of d i f f e r e n t d i s c i p l i n e s . P r o g r a m s w i l l be developed f o r t r a in ing hea l th workers i n t h e i r hea l th education r e s p o n s i b i l i t i e s during t h e i r b a s i c and post-basic t r a in ing . I n addi t ion t o producing the text-books and other l ea rn ing resource mate r i a l required, t h e f a c u l t y of hea l th t r a i n i n g i n s t i t u - t i o n s w i l l be t r a ined f o r teaching hea l th education. The f e a s i b i l i t y of e s t ab l i sh ing a graduate programme f o r hea l th education s p e c i a l i s t s w i l l be inves t iga ted .

The work of t h e two WHO hea l th education s p e c i a l i s t s together w i l l r e s u l t i n the in teg ra t ion of hea l th education i n t o h e a l t h programmes, t h e h e a l t h education se rv ices a t the c e n t r a l , regional and d i s t r i c t l e v e l s assuming a supporting ro le .

The p ro jec t i e expected t o continue u n t i l 1983.

BANGLADESH

MCH 003 Strengthening of Family Planning C l i n i c a l Propramme with Specia l Emphasis on MCH-based Family Planning (UNFPA ~ ~ ~ / 7 4 / P 0 9 )

To a s s i s t i n the development of the family planning component of the maternal and ch i ld health-based family planning progr- of t h e country. This comprises the expansion of the c l i n i c a l programme by providing the necessary physical f a c i l i t i e s , equipment and suppl ies for family planning (bath terminal and spacing) . The c l i n i c a l programme is t o be so extended as t o ensure t h a t family planning se rv ices ere ava i l ab le t o the e l i g i b l e couples a t a l l points of entry i n the maternal and ch i ld hea l th and hea l th se rv ice f a c i l i t i e s . A long-term medical o f f i c e r has been working on t h i s p ro jec t s ince 1974 and UNFPA has been providing pre-project a s s i s t ance .

During the f i r s t t h ree years of t h e p ro jec t , fun& are being made a v a i l a b l e f o r providing tubectomy equipment t o ten D i s t r i c t Hospitals and expendable and non-expendable family planning equipment t o 44 sub-divisional hosp i t a l e . 356 thana hea l th cen t res , 93 maternal and c h i l d hea l th cen t res and 690 union eub-centres. The remaining union sub-centres w i l l be equipped i n the subsequent years sub jec t t o a v a i l a b i l i t y of UNWA funds.

MCH 004 Procurement of Supplies and Equiment f o r WHOIUNFPA-assisted Family P l e n n i n ~ Project8 (LINEF'A BGDI74lPll)

The pro jec t i s l i k e l y t o terminate i n 1976.

HRP 001 Teachina of Humen Ke~roduct ian, P o ~ u l s t i o n Dynaeics, Ilewgraphy, F m i l y Planning including MM-based Family Planning i n Medical Colleges (L.ZI'P.4 b L o l l ~ l P J 8 )

To provide comprehensive t r a i n i n g progratmes t o undergraduates i n t h e teaching of human reproduction. population dynamics, demography and family planning, including maternal and ch i ld heal th . so tha t they become competent t o undertake t h e i r d u t i e s i n t h e r u r a l and urban areas e f f e c t i v e l y i n order t o achieve the na t iona l gaala and asp i ra t ions .

With t h i s end i n view, the e x i s t i n g curriculum i n the medical co l l eges was reviewed by a consul tant i n 1975 and recornendations have been made f a r r ev i s ing the c u r r i c u l a i n l i n e with the above object ive .

This p ro jec t is expected t o continue u n t i l 1977, a f t e r which i t is hoped t o merge i t with the UNDP pro jec t "Strengthening of Health Manpower Development Pragrannne".

HRP 002 Mobile S t e r i l i z a t i o n Teams (UNFPA BGD175/P01)

S t e r i l i z a t i o n i s gaining popular i ty i n a r e a s where both t h e Government and pr iva te organizations are d i r e c t l y involved with family planning a c t i v i t i e s . It is estimated t h a t 145 000 s t e r i l i z a t i o n s w i l l be required during t h e two yea r s ending J u l y 1978 i n order to reach t h e F i r s t Five-Year Plan t a rge t . Achievement of t h e nbove t a r g e t , as wel l aa a t t a i n i n g appropr ia t e t a r g e t s i n f u t u r e plans , w i l l r equ i re spreading s t e r i l i z a t i o n se rv ices beyond urban a reas .

The purpose of t h i s p ro jec t i s t o equip mobile s t e r i l i z a t i o n teama (nine teams i n the f i r s t year and s i x teams i n the second year) t o provide s t e r i l i z a t i o n se rv ices t o t h e r u r a l areas and a lao f o r the t r a i n i n g of a t a f f i n s t e r i l i z a t i o n procedures i n t h e pe r iphe ra l i n s t i t u t i o n s .

Provision f o r 1978 and 1979 v i l l depend on t h e r e s u l t s of the evaluat ion of t h e p ro jec t t o be undertaken i n mid-1977.

BANGLADESH

HSD 002 Development of Health Laboratories and All ied Laboratow Services

TO organize a network of publ ic healch l abora to r i e s throughout t h e country st d i s t r i c t and sub- d iv i s iona l l e v e l s attached to the e x i s t i n g hosp i t a l s f o r both c l i n i c a l as wel l as publ ic h e a l t h , including sani tary laboratory work; a l s o t o s t rengthen f u r t h e r the I n s t i t u t e of Publ ic Health t o funct ion as a cen t ra l laboratory and produce and control the f o l l a r i n g vaccines; smallpox, TAB and betapropiolactone inac t iva ted rab ies and DPT.

Consultants w i l l he lp with t h e development of spec ia l i zed areas with regard t o laboratory se rv ices , vaccines, b io log ica l s and t h e i r q u a l i t y con t ro l .

Fellowshipe w i l l be awarded i n r e l evan t f i e l d s r e l a t e d t o the development of the publ ic hea l th l abora to r i e s and the production of q u a l i t y vaccines.

MCH 001 Development of Family and Child Health Services

The ob jec t ive of t h i s p ro jec t i s t o a s s i s t i n t h e development of the maternal and c h i l d hea l th eompo- nent of t h e maternal and ch i ld health-based family planning p r o g r a m . Bangladesh has undertaken the development of a nation-wide maternal and c h i l d health-based family planning programme with UNFPA ass i s t ance . This p ro jec t , t he re fo re , w i l l provide t echn ica l a s s i s t a n c e t o t h e maternal and c h i l d hea l th component of t h e family hea l th pragraorme. It is concerned mainly with the organizat ion of maternal and ch i ld hea l th f i e l d se rv ices a t t h e primary care l e v e l and t h e t r a i n i n g of higher category of personnel vho w i l l con t r ibu te t o the f u r t h e r development of manpower and bu i ld ing up of the r e f e r r a l System i n support of t h e per ipheral maternal and ch i ld hea l th se rv ices .

Development of hea l th manparer and r e f e r r a l se rv ices f o r the maternal and ch i ld hea l th programme w i l l include a l s o the s t rengthening of undergraduate and post-graduate p a e d i a t r i c education programmes and p a e d i a t r i c se rv ices . In 1977, a consul tant w i l l explore t h e p o s s i b i l i t i e s of developing a diploma course i n maternal and c h i l d hea l th wi th in t h e ex ie t ing resources of the Population and Family Planning Division of the Ministry of Health, Family Planning and Population Control. I n 1977, 1978 and 1979, provision has been made f o r a medical o f f i c e r (maternal and ch i ld hea l th s p e c i a l i s t ) t o a s s i s t i n the establishment of a diploma course i n maternal and ch i ld hea l th and t o provide t echn ica l advisory se rv ices i n the development of the per ipheral maternal and ch i ld hea l th s e r v i c e s . Consultants w i l l be provided i n the f i e l d s o f paed ia r r i c s and s o c i a l o b s t e t r i c s . Fellowships w i l l b e awarded i n various f i e l d s of maternal and chi ld heal th .

A c t i v i t i e s under t h i s p ro jec t w i l l be c lose ly co-ordinated wi th UNFPA-funded p ro jec t s .

MCH 002 Training of Bealth Personnel i n Family Planning (UNFPA BGD174lP07)

To a s s i s t i n the t r a i n i n g of paramedical personnel f o r t h e maternal and c h i l d health-based family planning programme i n t h e r u r a l areas. The ca tegor ie s of personnel covered by t h i s p ro jec t c o n s i s t of t r a i n e r s , family welfare v i s i t o r s (PWVs) and v i l l a g e l e v e l workers, family welfare a s s i s t a n t e (PWAs) and family planning a s s i s t a n t s (FPAs). The proposed scheme c a l l s f o r t h e r e t r a i n i n g of the ex ie t ing lady hea l th v i s i t o r s (LHVa) and lady family planning v i s i t o r s (LFPV6) as we l l as t h e t r a i n i n g of new personnel.

Assistance was given t o t h i s p ro jec t i n 1974 by t h e nurse educators i n p ro jec t BAN HMD 001, and a c lose warking r e l a t i o n s h i p e x i s t s between these two pro jec t s . A publ ic hea l th nurse educator was assigned i n 1975. The r e t r a i n i n g of LWs and LFPVa i s nearing completion; a l s o , the second group of the new category of W s i s now under t r a i n i n g and t r a i n e r s of FWAs and FPAs are being prepared. A s t a r t has been made t o improve t h e e x i s t i n g t r a i n i n g cen t res .

Work w i l l continue on providing s u i t a b l e t r a i n i n g cen t res and on preparing t h e required numbers of paramedical personnel t o s t a f f the thana hea l th c e n t r e s and d e l i v e r hea l th care i n the v i l l ages .

Funds for honoraria and t h e s a l a r i e s of t r a i n e r s and other personnel are included under ' Incent ive Payments' and t h e s t ipends f o r the t r a i n e e s come under 'Group Training ' . Furni ture , veh ic le s , audio- v i s u a l and other teaching equipment and funds f o r r e n t and repa i r of premises f o r t h e t r a i n i n g centres and the h o s t e l s f a r t r a inees have a l s o been provided. Fe l l a r sh ipe f o r t r a i n i n g abroad w i l l be given t o t h e personnel who w i l l supervise t h e a c t i v i t i e s of t h e W s .

Assistance i s expected t o continue u n t i l 1979 sub jec t t o a v a i l a b i l i t y of UNFPA funds.

%

H8

RB

7

Project No.

PPS 001

HSD 001

BANGLADESH

3.1 General tlenlth Services

3.1.1 Program>ne Planning and General Activities

Organization of Health Services, Planning and Administration

Public health administratorlplanner P5

Scatistictan P4 secretarial assistant DAC4

L'ellowsl~ips Supplies and equipment

3.1.2 Health Services Development

Development of Health Services and Training of Auxiliaries

Public health officer P5 Auxiliary health training officer P4

Medical officer P4 Pilblic health nurse

educator P3 Sanirarian P3 Secretarial assistant DAC4

iellowsliips Supplies and equipment

Proposals

1978

42 200 42 200 2 400

86 800

9 100 5 000

-.

100 900 ---

42 200

42 200

30 300 30 300 2 400

---- 147 400

9 100 3 000

---- 159 500

----

1979

44 700 44 700 2 800

92 200

9 500 15 000 - 116 700

44 700

44 700 44 700

32 000 32 000 2 800

200 900

9 500 5 000

215 400

Revised

1976

- 63 700

9 200 400 - 73 300 -

85 100

18 200 3 000

106 300

1976

1/12 1/12 1/12

1/12

1/12

1/12

11 4

1/12

4

3/36

Estimate8

1977

38 500 38 500 2 100

79 100

6 600 10 000 -

95 700

38 500

38 500

27 900

2 100

107 000

16 900 8 000

131 900

Number

1977

1/12 1/12 1/12

1/12

1/12

1/12

1/12

1/12

---- 4

----

2/30

of Posts

1978

1/12 1/12 1/12

---- 3 3 3 3 ----

1/12

1/12

1/12

1/12 1/12 1/12

5

1/12

1979

1/12 1/12 1/12

1/12

1/12

1/12 1/12

1/12 1/12 1/12

6

1/12

136

BANGLADESH

PPS 001 Organiza t ion of Health Se rv i ce s . Planning and Adminis t ra t ion

TO a s s i s t i n e s t a b l i s h i n g and s t r eng then ing a sound o rgan i za t i on f a r h e a l t h planning i n t h e H i n i s t r y of Heal th , i n t r a i n i n g personnel i n h e a l t h p lanning, i n developing a h e a l t h informat ion system. i nc lud ing t h e development of a r e f e r r a l Bystem, and i n p lanning h e a l t h and manpower s t u d i e s wi th t h e aim of improving t h e d e l i v e r y of medical care w i t h emphasis on r u r a l areas. Prom 1974 onwards, t o develop a s u i t a b l e planning methodology i n accordance w i th t h e long-term n a t i o n a l development plan. and a s u i t a b l e informat ion system f o r f u r t h e r h e a l t h p lanning and eva lua t i on of i n t e g r a t e d h e a l t h s e r v i c e s and fami ly planning.

Af t e r a review, i n 1973, of the s e r v i c e s i n v i t a l and h e a l t h e t t a i i t i c s by a c o n s u l t a n t (SEAR0 0110) and a Kegional O f f i c e s t a f f member, and advice from a f u r t h e r consu l t an t on t h e development of a h e a l t h informat ion system and t h e co-ordination of s t a t i s t i c a l and epidemiologica l a c t i v i t i e s , p lans were made f o r t h e f u t u r e programme. A WHO t a s k force helped t o conduct a workshop on count ry h e a l t h p rog raming , and seminars and t r a i n i n g a c t i v i t i e s f o r n a t i o n a l s t a f f were organized.

I n 1974, a h e a l t h s t a t i s t i c i a n advised on t h e es tabl i shment of a u n i t of h e a l t h informat ion at t h e Elinistry of Healtb and Family Planning. The same expe r t was aga in deputed i n 1975 as a follow-up of h i s previous v i s i t . Fur ther t o t h a t t h e medical r eco rds o f f i c e r working w i th p r o j e c t ICP SHS W2 was twice a s s igned du r ing 1975 t o a s s i s t t h e a u t h o r i t i e s i n handl ing medica l records. I n t h e l a s t q u a r t e r of 1975, a long-term s t a t i s t i c i a n was added t o t h e team t o adv i se t h e Government on t h e es tabl i shment o f a d i v i s i o n o f v i t a l and h e a l t h s t a t i s t i c s and t o t r a i n n a t i o n a l s t a f f . Fellowships f o r s t u d i e s on h e a l t h p l ann ing /pub l i c h e a l t h as w e l l as s u p p l i e s and equipment, w i l l be provided.

A publ ic h e a l t h admin i s t r a to r (replacement) took up h i s d u t i e s i n May 1976. I n t h e yea r s t o come a s s i s t a n c e w i l l be g iven towards ( i ) s t r eng then ing t h e p lanning c e l l f a r t h e formula t ion of s n a t i o n a l planning po l i cy and methodology; ( i i ) s e t t i n g up h e a l t h informat ion and epidemiologica l s e r v i c e s , and ( i i i ) conducting s u r v e y s f s t u d i e s on problems of s p e c i a l h e a l t h concern.

This p r o j e c t is expected t o con t inue f a r s e v e r a l yea r s .

HSD 001 Development of Health Se rv i ce s and T ra in ing of A u x i l i a r i e s

To a s s i s t i n t h e f u r t h e r development and s t r eng then ing of i n t e g r a t e d h e a l t h programmes f o r r u r a l areas ( thana h e a l t h c e n t r e s , e t c . ) by p lanning, implementing and e v a l u a t i n g t r a i n i n g and reorientation programmes f o r p r o f e s s i o n a l , a u x i l i a r y h e a l t h and a l l i e d workers.

During 1974 and 1975, t r a i n i n g a c t i v i t i e s cont inued, b u t much more emphasis w i l l be p laced on improving t h e cont inuing a c t i v i t i e s and on t r a i n i n g (by eva lua t i on and prompt feedback) i n 1976 and 1977.

I n 1977-78, i n f u r t h e r e f f o r t s t o improve the development of i n t e g r a t e d r u r a l h e a l t h s e r v i c e s , a comprehensive h e a l t h team, i nc lud ing a h e a l t h e d u c a t i o n i s t , a s a n i t a r i a n , a nurse and a pub l i c h e a l t h n u t r i t i o n i s t w i l l con t inue t o a s s i s t t h e Government.

I t is expected t h a t the p r o j e c t w i l l con t inue f o r a number of yea r s .

environmental health also contribute to disaaso prevention through improving knowledge of the need for, methods of and provision of facilities for improved personal health care.

Promtion of Environmental Health

Sustained improvement in the health of a population depend to a large extent on limitation of exposure to diseases. The development of basic sanitary facilities (water supply. swage and garbage disposal) deaenres high priority, especially in the prevention of vater-borne communicable diseases. Much collaborative effort of Government,WHO and other W agencies is necessary in this field.

Coordination

WHO is also playing a major role in co-ordinating aoai~tance in health and family planning fields from other international agencies, such as the World BaaL. UNPPd. UNICEF, UNDP, and bilateral agenciee, such am the Canadian, Danish. Swedish, UK and USA international development agencies (CIDA, DANIDA, SIDA, VK-ODA and US AID, respecitvely), a8 well as from more than 80 international and national voluntary agencies.

BANGLADESH

GENERAL - Bangladesh is one of t h e most densely populated coun t r i e s i n t h e world. According t o t h e 1974 census, the eountry'8 population i s 71.78 mil l ion. The t o t a l area of t h e country being 55 598 square miles, t h e population densi ty per square mile is 1375 excluding r i v e r l i n e area . Apart from over-population, f requent and seasonal , na tu ra l d i s a s t e r s , such as cyclones and f loods which aggravate t h e ravages f r w camunieable d i seases , a r e other main problems of the country. The people s u b s i s t mainly on a g r i c u l t u r e end t h e i r aocio-economic s t a t u s is low, the g rass n a t i o n a l product i n 1970 being only about US $72 per a M U per cnpi ta .

The population is mainly r u r a l , the rural-urban r a t i o being 91.22 : 8.78. The sex r a t i o ia 108 males per 100 females. There i s a preponderance of younger age groups, chi ldren i n t h e 0-9 years age-group c o n s t i t u t i n g 35.8% of the t o t a l population, while c i v i l i a n labour f o r c e is about 35.2% of t h e t o t a l population. The l i t e r a c y r a t e i n the population over 5 years age is only 22.2%. The average household has 5.6 members.

There has not been much s i g n i f i c a n t change i n t h e s t a t e of hea l th of the population during t h e l a s t few years. The b i r t h r a t e i s 47, and the death r a t e is 17 per 1000 of t h e population. The na tu ra l population growth r a t e is estimated ae 3% per annum. The i n f a n t mor ta l i ty r a t e i e estimated as 149 per 1000 l i v e b i r t h s and maternal morta l i ty r a t e as 30 per 1000 l i v e b i r t h s . Expectation of l i f e a t b i r t h i n 1962-63 was 49.6 years for males and 46.9 years for females. Communicable d i seases , e spec ia l ly water-borne d i seases , such as s a l m n e l l o e i s . s h i g e l l o s i e , cholera and o the r diarrhoea1 diseases c o n s t i t u t e the major hea l th problems. Moreover, some s tud ies have shown t h a t over 90% of the population under 15 yeare of age i s in fes t ed with i n t e s t i n a l warms, which i n i t s e l f must have a s i g n i f i c a n t e f f e c t upon t h e s t a t e of n u t r i t i o n of these chi ldren. Direct malnutr i t ion, e spec ia l ly among ch i ld ren under 5 years , causes grave concern as shown by some l imi ted ease s t u d i e s conducted i n 1972 and 1974.

HEALTH SECTOR POLICY

The pol icy of the Government i n t h e hea l th s e c t o r may be summed up as follows:

(1) To reduce population growth t o zero ( t h i s indeed is the Government's t a p p r i o r i t y ) .

(2) To e s t a b l i s h e f f e c t i v e primary hea l th care se rv ices t o c a t e r t o the whole population.

(3) To include primary hea l th care as a p a r t of t h e o v e r a l l development programme.

The WHO co l l abora t ive programme i s designed with t h i s Government pol icy i n view.

MAJOR PROGRAMME AREAS


In t h i s f i e l d , a s s i s t ance is given mainly through two major p ro jec t s :

(1) Organization of Health Services , Planning and Administration, and

(2) Development of Health Services and Training of Aux i l i a r i e s .

The former of these two pro jec t s has maintained a c lose l i a i s o n with the Planning Conmission as we l l as the Planning Ce l l i n the Ministry of Health and a l l t h e ex te rna l a i d agencies operat ing i n the heal th f i e l d .

Considerable progress has been made i n the development of a hea l th i n f o r r a t i o n system f o r the country. An o v e r a l l Maeter Plan f o r Integrated Development of Rural Health Services has a l s o been developed and signed by the Government, UNICEF and WHO.

I n t h e second p ro jec t , the review and recas t ing of t h e country 's medical education c u r r i c u l a and s y l l a b i has given a major s t imulus t o r eo r i en t ing medical s tuden t s towards community medicine. The requirements f o r expanding medical education f a c i l i t i e s , both i n bui ldings and teaching f a c u l t i e s , have been s tud ied , major problems ou t l ined and plans made to so lve them. The Paramedical I n s t i t u t e i n Dacca continued to t r a i n heal th inspectors , laboratory t echn ic ians , den ta l t echn ic ians , r a d i o t h e r a p i s t s and radiographers.

Health Manpover Development

The implementation of t h e Government'e p lan f o r hea l th de l ive ry (domici l iary v i s i t s , union sub-centres, r u r a l hea l th cen t res , sub-divis ional h o s p i t a l s , d i s t r i c t hosp i t a l s and medical col leges) r equ i res a major increase i n cornunity t r a ined personnel. WHO provides a s s i s t ance i n t h e development of classroom and f i e l d c u r r i c u l a , teaching w d t r a i n i n g evaluat ion far t h e following cadres of personnel: (1) hea l th a u x i l i a r i e s : (a) family welfare v i s i t o r s ( a s s i s t a n t nurse-midwives); (b) h e a l t h inspec to r s ; (c) laboratory technicians , (d) medical a s s i s t a n t s ; (2) nurses, (3 ) physicians and ( 4 ) s p e c i a l i s t s i n publ ic heal th .

The provis ion of family planning s e r v i c e s , based on maternal and c h i l d hea l th programme, i s a top p r i o r i t y . Major WHO emphasis is d i rec ted towards t r a i n i n g , model p ro jec t implementation and evaluat ion.

Communicable Disease Prevention and Control

Government p r i o r i t i e s on d i sease con t ro l focus on maintaining Bangladesh f r e e of smallpox and t h e c o n t r o l of malar ia , t ube rcu los i s , and leprosy. WHO a s s i s t s the Government's Mycobacterial Disease Control Programme - an in teg ra ted prevent ive , d iagnosis and treatment programe. Other p r o j e c t s i n hea l th education, oral h e a l t h , and

131 BANGLADESH - Index

..

Pro j ec t NO.

ASE 001

BSM 001

BVD 001

CAI9 001

CVD 001

ESD 001

ESD 002

HED 001

XED 002

HMD 001

HMO 003

HMD 004

liMD 005

HRP 001

HRP 002

HSD 001

*Project

P r o j e c t T i t l e

Country S ta tement

O f f i c e of t h e WHO Repre sen t a t i ve

Community Water Supply and S a n i t a t i o n

Mycobacterial Disease Cont ro l (HBD 003)*

Cancer

Card iovascular Diseases

S t r eng then ing of Epidemiologica l Se rv i ce s

Epidemiology and Disease Con t ro l

P u b l i c Heal th Education

Heal th Education

Nursing Advisory Se rv i ce s and T ra in ing

T r a i n i n g of Medical A s s i s t a n t s

Na t i ona l I n s t i t u t e of P r even t i ve and S o c i a l Medicine

S t r eng then ing of Heal th Manpower Development Programme

Teaching of Human Reproduct ion , Popula t ion Dynamics, Demography, Family P l ann ing i n c l u d i n g MCH- based Family P lanning i n Medical Col leges

Mobile S t e r i l i z a t i o n Teams

Development of Heal th S e r v i c e s and T ra in ing of Auxi l ia r ies (SHS 002)*

number p r i o r t o t h e c u r r e n t programme

Page

132

15 5

152,413

148

148,412

150,412

144

144

140

140,412

142,412

142

142

144

138

138

134,412

s t r u c t u r e .

P r o j e c t No.

HSD 002

HSD 003

HWP 001

MCH 001

MCH 002

MCH 003

MCH 004

MNH 001

MPD 001

N U I 002

OCD 003

ORH 001

PBL 001

FHA 001

PPS 001

RAD 001

SES 001

SPI 001


Development of Heal th Labo ra to r i e s end A l l i e d Labora tory Se rv i ce s (SHS 005)*

H o s p i t a l Adrnln is t ra t ion (SHS 00b)*

Occupat iona l Heal th

Development of Family and Chi ld Heal th Se rv i ce s

T r a i n i n g of Heal th Personnel i n Family P lanning

S t r eng then ing of Family P lanning C l i n i c a l Programme w i t h S p e c i a l Emphaeis an MCH-based Family P lanning

Procurement of Supp l i e s and Equip- ment fo r WHOIUNFPA-assisted Family P lanning P r o j e c t s

Mental Heal th

Ma la r i a E r a d i c a t i o n

I n s t - i t u t e of P u b l i c Health N u t r i t i o n

Other Non-Communicable Diseases

Ora l Heal th (DNH 001)*

P reven t i on of Bl indness (OCD 001)*

Pharmaceut ica l and B i o l o g i c a l Q u a l i t y Con t ro l (SqP 001)*

0 r ~ n n i r ; i ~ t o n of Heal th S e r v i c e s , P lanning a n d Admin i s t r a t i on (SHS 001)"

Rad i a t i on Heal th

Ass i s t ance t o Water and Sewerage Au tho r i t y , Dacca and Chi t tagong

Smallpox E rad i ca t i on (SME 001)*

Pe$e

136

412

150,412

136,412

136

138

138

150

146

140

412

150

148

152,413

134,412

412

152

146

-

EXPLANATORY NOTES

1 General

Pursuant t o r e s o l u t i o n UHA26.38 t h i s volume c o n t a i n s t h e Regional D i r e c t o r ' s Proposed P r o g r m e Budget f o r 1978 and 1979. The form of p r e s e n t a t i o n is b a s i c a l l y t h e same a s i n t h e p roposa l s f o r 1976 and 1977 submit ted t o t h e Twenty-seventh Regional Committee i n 1974. The p r e s e n t document a l s o i n c l u d e s t h e Revised Programme and Budget Es t ima tes f o r 1976 and 1977, a s w e l l a s a t e n t a t i v e p r o j e c t i o n f o r 1980 and 1981.

2 Form of P r e s e n t a t i o n

The programme budget is p resen ted w i t h i n t h e framework of the l a t e s t programme c l a s s i - f i c a t i o n s t r u c t u r e a s approved by the Director-General i n May 1976. T h i s c l a s s i f i c a t i o n comprises e l even a p p r o p r i a t i o n s e c t i o n s , subdivided i n t o major programmes and programmes.

The summary by programme appear ing on pages 6 t o 9 sets o u t t h e programme c l a s s i f i c a t i o n s t r u c t u r e a s a p p l i c a b l e t o the South-East As ia Region.

3 Contents

The Regional D i r e c t o r ' s programme s ta t ement on pages I t o 4 , is followed by v a r i o u s budget t a b l e s i n d i c a t i n g t h e r e v i s e d e s t i m a t e s f o r 1976 and 1977 and t h e p roposa l s f o r 1978 and 1979, under t h e r e g u l a r budget a s w e l l a s o t h e r sources of funds. A t e n t a t i v e budget p r o j e c t i o n under t h e r e g u l a r budget f o r 1980 and 1981 is given on page 14.

The p r o g r m e ana lyses a r e g iven on pages 17 t o 121. Each a n a l y s i s i s suppor ted by a schedu le showing t h e number of p o s t s and t h e es t ima ted o b l i g a t i o n s under t h e r e g u l a r budget and o t h e r s o u r c e s of funds broken down i n t o r e g i o n a l , country and in te r -coun t ry l e v e l s .

A summary of d i r e c t t e c h n i c a l co-operat ion wi th and s e r v i c e s t o governments appears on page 122.

Th i s summary i s followed by t h e d e t a i l e d in fo rmat ion annexes. Annex 1 beg ins wi th t h e budgetary p r o v i s i o n s f o r t h e Regional O f f i c e , t h e n fo l lows t h e i n d i v i d u a l country s t a t e m e n t s wi th p r o j e c t n a r r a t i v e s and t a b u l a t i o n s . The f i n a l p a r t o f Annex 1 shows a l l i n t e r - c o u n t r y a c t i v i t i e s .

Annex 2 c o n t a i n s r e q u e s t s from governments f o r a s s i s t a n c e which could n o t be accommodated w i t h i n t h e p lann ing a l l o c a t i o n s e s t a b l i s h e d f o r t h e Region by t h e Director-General under t h e r e g u l a r budget .

4 Funding

The proposed programme budget f o r 1978 and 1979 i s made w i t h i n a l l o c a t i o n s e s t a b l i s h e d by t h e Director-General i n c o n s u l t a t i o n w i t h t h e Regional D i r e c t o r . These a l l o c a t i o n s a s w e l l a s t h e budget l e v e l f o r 1977 i n c l u d e s a d d i t i o n a l a l l o c a t i o n s i n r e s p e c t of t h e l e a s t developed among t h e deve lop ing c o u n t r i e s (LDCs) and t h e most s e r i o u s l y a f f e c t e d c o u n t r i e s (MSAs), a s decided b y t h e Director-General i n l a t e 1975.

With r e g a r d t o p r o j e c t s under t h e United Nat ions Development Programme (UNDP) and t h e United Na t ions Fund f o r Popu la t ion A c t i v i t i e s (UNFPA), t h e p r e s e n t programme budget i n c l u d e s , a s i n t h e p rev ious i s s u e , a l l p r o j e c t s f o r which f i n a n c i n g may reasonably b e expec ted . The new I n d i c a t i v e Planning F igures ( IPFs) f o r UNDP a c t i v i t i e s cover ing t h e IPF c y c l e s t a r t i n g 1977 have n o t been e s t a b l i s h e d a t the t ime of d r a f t i n g t h i s document. Governments have, f o r t h a t r e a s o n , i n most c a s e s not r eques ted new a s s i s t a n c e under t h i s c y c l e (1977-1981) from LNDP. I n a d d i t i o n t h e l i q u i d i t y c r i s i s of UNDP i n 1975 and 1976 h a s had a d e t r i m e n t a l e f f e c t on t h e p lann ing o f UNDP f inanced a c t i v i t i e s f o r which WHO is t h e execu t ing agency. The p r o v i s i o n s t h a t have been shown f o r 1977, 1978 and 1979 r e p r e s e n t e i t h e r UNDP'S forward commitments o r c a r r j - o v e r of a l l o c a t i o n s from t h e c u r r e n t IPF cyc le .

5 Budgetary Concepts and Abbreviations

An exchange r a t e of 8.80 Indian Rupees t o 1 US Dol la r has been appl ied f o r ob l i ga t i ons t h a t w i l l have t o be met i n t h e Indian currency.

The budgetary es t imates a r e made on t h e b a s i s of average cos t s f o r s t a f f , short- term consu l tan t s and fel lowships . However, f o r UNDP a c t i v i t i e s t h e e s t ab l i shed s tandard cos t s of UNDP have been used; and f o r UNFPA a c t u a l es t imates .

I n May 1976, t h e Director-General decided t o change t h e b a s i s f o r ob l i ga t i ng funds under t he regula r budget f o r fe l lowships . The new system w i l l be introduced from 1977. It is evident t h a t adjustments i n t h e adminis t ra t ion and budget ing f o r f u t u r e fe l lowships w i l l have t o be made. This has , however, no t been r e f l e c t e d i n t h i s document, s i n c e t he f i n a l arrangements have not ye t been worked ou t . ,

The est imated ob l i ga t i ons t o be met from the regula r budget and o t h e r sources a r e i d e n t i f i e d i n Annexes 1 and 2 by t he fol lowing abbrev ia t ions :

Code Fund - - RB Regular Budget

DP United Nations Development Programne

FP United Nations Fund f o r Populat ion A c t i v i t i e s

LA Standard L e t t e r of Agreement

FT Funds i n T rus t

Various Spec ia l Accounts under t he Voluntary Fund f o r Heal th Promotion:

V D Miscellaneous Designated Contr ibut ions (Other)

Medical Research (Specif ied) -

VG Other (General)

VL Leprosy

VS Smallpox

W Yaws Programme

A l l p ro j ec t numbers a r e i n accordance wi th t h e l a t e s t programme s t r u c t u r e . The p ro j ec t t i t l e should be used f o r i d e n t i f i c a t i o n of p r o j e c t s appearing i n e a r l i e r documents.

I n t he budgetary country and inter-country schedules of Annex 1, the column "Number of Posts" i n d i c a t e s t h e number of s t a f f , consu l t an t s o r f e l l o v s h i p s , as t h e case may b e , and the t o t a l number of man-months.

REGIONAL DIRECTOR'S PROGRAM@? STATEMENT

The years 1978-1979 cons t i tu te the f i r s t bienniwn of the S i x th General Prograwne of Work and the corresponding Medium-ten Progirme, which haue been based on our past experiences o f achievements and fai lures and which r e f l e c t our future hopes and expectations for the whole period 1978-1983.

The pmbkms now causing mqjor concern i n South-East Asia hare been wi th us for many years. Lack of primary heal th care f a c i l i t i e s for major sect ions of the population, malnutrit ion, high i n fan t and maternal morbidity and mortal i ty , comnunicable diseases , lack o f bas ic sani tat ion, and dearth o f trained hea l th manpcwer, especial ly i n the rural areas, a l l pose serious challenges t o our endeavours t o improve the health of the people i n the Region.

As a r e su l t o f health development e f f o r t s which governments hare undertaken &ring the past years, and i n which WHO has collaborated, the expectation of l i f e a t b i r t h has increased; morbidity i n general has decreased, and a t l ea s t one dangerous c o m n i c a b l e disease - smallpox - has been eliminated. The heal th and well-being of the people of the Region have, on the whole, improved but are s t i l l nowhere near the standard which has been achieved i n the &veZoped countries.

I n most o f the countries i n the Region, the expectation o f l i f e a t b i r t h ranges from between 46 and 67 years, whereas i n the developed countries i t i s between 60 and 75 years. The general mortal i ty ra te , especial ly m n g vulnemble groups, i s qu i te high, and i n fan t mortal i ty rates range from 27 t o 149 per 1000. Health services i n general are too inadequate t o reach the majority of the population. Excepting i n the DPRK and Mongolia, coverage of primary heal th care i n rural areas i s s t i l l far too inadequate i n countn'es o f the Region, ranging from as low as 7.6% i n the Maldives t o 70% i n S r i Lanka, even though these rural areas account for about 85% of the population. Hospital-bed f a c i l i t i e s are highly i n s u f f i c i e n t i n most of the countries, the r a t i o of hospi tal beds t o popuZation rmging f m m I : 6000 t o I : 1000, except i n the DPRK, Mongolia (where it i s I : 1001 and i n S r i Lanka (where it i s I : 3001. The provision of rural areas with sa fe water supply i s s t i l l far from sa t i s f ac to ry , (1.3% i n Nepal and Indonesia; 26% i n Bangladesh). To add t o the gravi ty of the problems, the population g r m t h ra te i n most of the countries continues t o be as high as 2-3%, nu l l i f y i ng the hard- e m e d gains obtained through deueZopment e f f o r t s i n the heal th sec tor and i n the en t i r e socio- economic f i e l d .

Although the spectacular success achieved i n reaching zem-incidence o f smallpox i n the Region represents a s t r i k i ng e x m p l e of what can be done by deterwined e f f o r t s t o wipe out a preventable commmicable disease, the onslaught o f other c o r n n i m b l e diseases continues t o take a heavy t o l l , both i n human l i v e s and i n deb i l i ta t ion .

A t the t h e t ha t the S i x th General P m g m e o f Work for the Region was being d m up, t h e Regional Of f ice made a thorough r e v i m of the ex i s t i ng heal th s i tua t ions and future trends i n the countries o f the Region. Health and health-related problems were analysed, and on the bas i s o f t h i s analysis p r io r i t i e s for act ion were i d e n t i f i e d , and the targets t o be achieved were defined and quant i f ied as far as pmct icable , i n consul tat ion wi th the Regional Conunittee and govermnents of Member countries. The Mediwn-ten Prograwne has thus been given a s o l i d base and should pmvide present and future p m g ~ m m e a c t i v i t i e s wi th a de f i n i t e d i rec t ion towards the attainment o f a b e t t e r qual i t y of l i f e i n the Region.

Among the major ob jec t ives expected t o be achieved through implementation of the Medium-ten Programne i n the Region during the period 1978-1983 are:

(11 Appreciable improvement i n the coverage of rural and under-served populations by primary hea l th care serv ices , wi th a vim t o ra i s ing t h e general s t a t e o f hea l th o f the people.

(21 Improvement o f the disease survei l lance systems and further reduction i n the incidence of c o m m i c a b k diseases,espeeiaZZy maZam.a, tlrberculosis, leprosy and dengue haemorrhagic fever.

(31 firther extension o f bas i c environmental hea l th services t o the rural and under-served populations.

(41 An increase i n the r a t e o f t ra in ing o f task-oriented, heal th manpower corresponding t o the needs o f the hea l th services .

( 5 1 Establishment of a sound mechanism for the co-ordination and promotion of biomedical research i n priority problem areas.

(61 Improvement o f systems o f health planning and management aimed a t the be t ter u t i l iaat ion o f scarce resources to solve priority health problems.

Cur progrme proposals for 1978-1979, the f i r s t biennium of the Medium-ten h . o g r m , have been f o m l a t e d as the f i r s t phase of ac t i v i t i e s to achieve the above objectives.

The recent trend i n countries of the Region t o improve the i r health planning e f for t s by means of country health programing and project formuZation technique8 has remzrka3Zy impmved national health plans and progrmes wherever these techniques hare been applied. Three countries i n the Region - BangZadesh, Nepal and Thailand - hare already completed country health p m g r d n g ; Burma has made a s tar t , and Wngolia, S r i Lanka and Indonesia are expected t o undertake th i s ac t i v i t y i n the near f i ture.

As the WHO progrannne for collaboration i s aimed a t meeting the needs of countries and i s based on the ir national priori t ies i n the health f ie ld , the improvements i n health planning, programming ond management a t the nationat Zevel obtained through country health progrmming shoutd also lead to be t ter WHO progrming and more e f fec t ive use of WHO inputs. Simultaneous development o f the new WHO Information System, which has already been started i n the Region, should further improve pmglmnne monitoring rmd delivery.

Moreover, the bui l t - in component of monitoring, systemai.io, periodic evaluation and feed-back, which are a part of country health pmgramning and pmject f o m l a t i o n , should resul t i n be t ter management during the implementation of projects and programmes. Also, the plmning of health sector p i w g m e s i n the context o f to ta l socio-economic development place8 national health development e f fo r t s i n true perspective, enhrmces the i r importance and strengthens the rationale for greater allocations t o th i s sector. Govement expenditures on health are, however, s t i l l too low when one considers the enormity o f the e x k t i n g problems.

A recent analysis of the expenditure on health services i n the countries of the Region (except i n the DPRK and Mongolia) shows that per capita health expenditure ranges f m m US$ 0.2 t o US$ 3.8 per annum. In fact, i n three countries i t i s Zess than two dollars, i n one country Zess than a dollar rmd i n three countries even less than half a dollar. This lm rate of annual expenditure on health services would seem t o indicate that the majority of the governments i n our region give very Zar priority t o investments i n the health sector. I should, therefore, Plke to stress the need for urgent measures by governments not only t o give higher priori ty t o health as an important component of t he i r socio-economic development but also t o ensure the allocation of adequate resources t o sa t i s f y the basic health needs of the people. To th is end, we are trying t o establish the Charter for Health Development- which, it i s hoped, w i l l provide a mechanism for a t tmc t ing investment from both internal and external sources for health development i n the countries o f the Region.

The programme proposals for 1978-1979 are based on: the above considerations, previous programme allocations and the i r u t i l i za t ion , evatuative assessments of on-going progrmwnes, pressing demands for developing nar p r o g m e s o f high priori ty , and the valuable comnents o f governments during the r e v i m of the progrme proposals a t sessions of the Regional Comnittee. The resul t has been, i n general, substantial increases i n the allocations t o Meder countries. Simultaneously, inter-country pmjects have been thoroughly reviewed, modified and streamlined i n order t o serve the speci f ic requirements of the Region and to provide meaningful support t o WHO-assisted country ac t i v i t i e s . WHO assistance wi l l thus continue t o play i t s due role i n the development of health care i n the countries of the Region.

The major thrust i n the 1978-1979 progrme w i l t be tajards extending minimal health care to the rural and under-served population, with the simuttaneous development of a suitable referral system. I n t h i s endeavour, the resul t s of ear l ier o p e r a t i o ~ l studies on integrated rural health services pmvided within the m e w o f national resources w i l l form one of the bases for further action. Hence an exchange among countries of technical in fomat ion on the resul t s o f various studies w i l l be pmmoted. Special at tention w i l l be given t o the development of sound infrastructures manned by health workers having task-oriented training i n actual work situations. The development of essential laboratory services and attainment of sel f-suf f iciency i n prophy- lac t i c vaccines should f ir ther improve the health services and the surveillance and control o f cmun icab le diseases.

Rapid population grmth and high nntemaZ and in fant mortality rates remain problems which point t o the importmce of continuing f&ly health pmgrananes i n the Region. Efforts t o

improve maternal and child health services, including fmLly planning (wherever accepted as national pol icy) , w i l l be pursued further through the already established process o f i n t e g m t i o n in to the general health services.

The main emphasis i n the f ie ld of nu tr i t ion w i l l be on the development of national nu tr i t ion policies and progranunes as a m l t i - s ec tora l e f f o r t . The health wmponents of the nutr i t ion progmnone, particularly i t s operational and training aspects, w i l l a lso be supplemented through integration in to the general health services as far as pnzcticable.

I t has becme increasingly clear t ha t mt only the act ive co-operation bu t a l so the actual participation of the c~omcnity i n devetoping health f m i l i t i e s and i n ensuring t h e i r proper u t i l i z a t i o n i s a necessary element i n making the health services e f f ec t i ve . Health education progrmes for the years 1978-1979 w i l l be further strengthened and oriented twards t h i s end.

Conrmunicable diseases are s t i l l the prime concern o f most o f the countries i n the Region. The memorable achievements i n smallpox have been mentioned. llze ear l ier successes i n the control of malaria have now, however, been overtaken by a rather alaming s i tua t ion with increasing numbers o f cases and deaths due t o m y factors including the development of vector resistance to DDT and other insec t ic ides , the emergence o f r e s i s tan t s t ra ins of malaria parasites t o comonly used anti-mataria drugs and inadequate funds t o meet the r i s ing costs of insec t ic ides and anti-malarials. Tuberculosis and leprosy s t i l l e x i s t as priori ty problems. Dengue haemorrhagic fever i s gmduaZly spreading and i s threatening t o become one of Regim-wide mncern. Diarrhoea1 diseases s t i l l cause a high rate o f morbidity m d mortal i ty , especial ly among children. The solut ion t o mmy o f these problems w i l l require not only the strengthening of appropriate health pmgranmes but also the i n t ens i f i ca t ion of multi-sectoral and multi-dimen- sional e f f o r t s o f ten outside the d irec t scope o f the heal th sector. A mult i -sectoml approach has been the trend during the past far years, which i s expected t o increase, along with the application by the heaZth sector o f measures for prevention and control. WHO w i l l continue to play i t s co-ordinating rote i n t h i s respect. During the years 1978-1979, the programnes for the controZ o f maluria, tuberculosis, leprosy, dengue haemorrhagic fever and diarrhoea2 diseases w i l l receive special a t ten t ion , and surveitlance o f c o m n i c a b l e diseases w i Z Z be further strengthened t o make the disease control programnes more e f f e c t i v e .

The IWenty-seventh World Health Assembly urged governments t o develop expanded pmgranmes for i m n i z a t i o n , with particular reference t o diphtheria, tetanus, pertussis , poliomyelitis, tuberculosis and smallpox. Most of the countries o f our Region have carried out systematic i m n i z a t i o n p r o g r m e s against tuberculosis end smallpox, some of which are s t i l l continuing. Large-scaZe programmes for routine inmunizat im against the remaining diseases have, however, seldom been taken up on a continuing basis even though these diseases are widespread i n m s t o f our countries and e f f e c t i v e i m n i z a t i m procedures a2.e available against them. The in ter - country Seminar on Expanded I m n i z a t i o n Frogrmes , held i n the Regional Off ice during February o f t h i s year, provided vatuable guidelines, and WHO w i l l collaborate i n devetoping and implementing such programnes i n the countries o f the Region.

Some mn-comnunicable diseases are now showing a tendency t o emerge as priori ty problems i n South-East Asia. Cardiovascular diseases and cancer have been a t t rac t ing the a t ten t ion o f governments for some time, and mental diseases and drug abuse are showing a r i s ing trend i n some countries. To tackle these emerging problems, appropriate measures are being taken by the governments concerned. WRO w i l l continue t o pmvide necessary technical support.

The problem o f visual impairment and blindness i s of sucii proportions that it has been considered by the Regional Committee as one requiring pm'ority. Accordingly, during the years 1978-1979, assistance w i l l be ~ m v i d e d t o a number o f governments i n implementing preventive, curative and rehabi l i ta t ive measures t o tackle t h i s problem.

Since lack of basic sani tat ion, especial ly o f safe water supply has been one of the major e w e s of the persistence o f a nwnber o f c o m n i c a b l e dineases i n the Region, governments have been attaching high priori ty t o p m g r m e s for improving basic sani tat ion. A major p a r t o f the WHO assistance t o the environmental health programnes during 1978-1979 w i l l be directed tmards promoting safe water supply t o the c o m i t y , especial ly i n rural areas. In addition, a t ten t ion w i l l be given t o the improvement of sewerage, drainage and prevention o f environmental hazards due t o poZ2ution. Assistance w i l l a l so be continued i n developing an appropriate infrastructure for basic sani tat ion services and i n training both professional m d non-profes- s i m l categories o f environmental heal th manpower.

For improving e n v i r m e n t a t health i n the Region, it i s essent ial and urgent t o have in t e r - sectoral co-operation and co-ordination within each country. There i s aZso a mntinued need for strengthening the co-ordinating ro l e of WHO i n channelling the a c t i v i t i e s o f the i n t e r - national and b i la tera l agencies working i n the environmental heal th f i e ld , with t h e i r f u l l co-operation. I t i s expected tha t WHO's co-operation with other aid-giving agencies i n such progrmes w i l l be further strengthened during the years 1978-1979, but i n t h i s co-operative e f f o r t the countries concerned must play the key ro le .

WHO's a c t i v i t i e s i n health manpower development during 1978-1978 w i l l fu l ly support the development o f the general health services. The educational objectives i n training a22 categories o f health workers w i l l thus need t o be adapted t o actual health needs. Our assistance i n health manpower development w i l l a m a t bringing about a balance between needs and production, with a view t o arriving at a proper mix, including doctors, nurses and auxi l iar ies , t o rmn the health seruiceo a t a l l levels . Emphasis w i l l be placed on multi-disciplinary health terns , trained to work i n h m o n y , for the delivery o f health care at d i f ferent levels o f the heal th services. Particular s t ress w i l l be laid on the training o f peripheral multipurpose health workers and intermediate-level auxi l iaries , such as, medical assis tanta. In view o f the rapid a c c m l a t i o n of na , knowledge and experience, technical support t o continuing education for a l l categories of health manpower w i l l a lso be pmvided. krXO w i l l further support the development of teaching and training in s t i t u t i ons , f a c i l i t i e s , methods, and evaluation and feed-back systems o f teaching and training programnes. Consideration w i l l a b o be given t o the production and u t i l i z a t i o n of c o m n i t y health workers. Training o f tradi t ional healers, b i r t h attendants and v i l lage volunteers and t h e i r integrat ion i n t o the hea2th services, wherever feasible, w i l l also be encouraged.

The need for continued research t o enhance the quali ty and quantity of health services i n a l l i t s facets i s undeniable. As the responsibi l i ty for developing biomedical research a c t i v i t i e s i s bsing increasingly decentralized t o the regions, the research p r o g r m e s i n priority problem areas w i l l be organized and m-ordinated a t the regional leve l . A Regional Advisory Connittee on Medical Research lR4CM.Q) for South-East Asia has been const i tuted, and has already iden t i f i ed the priori ty areas for research a c t i v i t i e s t o be undertaken during the coming years. Collection and dissemination o f research information and t m i n i n g of research manpcwer w i t 2 a l so be undertaken.

With a v i a , t o providing a mechanism for financing WHO's colZoboration t o meet special needs o f the countries i n t h i s Region arising outside the bu@et cycle , a "Regional Director's Development Progrme" has been established and provision for t h i s purpose m d e i n 1978 and 1979. !Phis w i l l introduce f l e x i b i l i t y i n t o p r o g r m e budgeting so as t o enable implementation of n m ideas and provide for developments t ha t may take place a f t e r the f inal izat ion of the p r o g r m e budget, and w i l l pmvide a limited amount of finds t o be used as a f lex ib le ins t rument for meeting unexpected needs.

I t i s considered that the proposed p r o g m e a c t i v i t i e s w i l l lay a so l id foundation for future p r o g r m e s to be launched during the subsequent bienniwns uf the Mediwn-term Pmgrmnne. For the successful implementation of the proposed biennial programne, e f f ec t i ve co-ordination and mutual co-operation among our countries, WHO and international and b i la tera l agencies w i l l , however, be indhpensable.

SUMNARY OF REGIONAL HEALTH PROGRAMME:

BY SOURCE OF FUNDS

Regu la r budge t

O t h e r S o u r c e s

V o l u n t a r y Fund f o r H e a l t h Promot ion

U n i t e d N a t i o n s Development Programme

U n i t e d N a t i o n s Fund f o r P o p u l a t i o n A c t i v i t i e s

Funds i n T r u s t

T o t a l - O t h e r S o u r c e s

T o t a l

(Expre s sed

Rev i sed E s t i m a t e s

=I= I t h o u s a n d s o f US 2

P r o p o s a l s

I rnLIcY ORGANS

1.1 Organizational Meetings

1.1.3 Regional Committee

2. GENERAL MMGEIIENT, CO- ORDIMTION AND DEVELOPMENT

2.1 Executive Hanagemenr

2 1 . 3 Office O F the Regional Director

2.2 co-ordination

2.2.2 co-ordination with other organizations

2.3 General Programe Development

2.3.2 Research Promtion and Development

2.3.4 Regional Director's Develaprnent programme

3. DEVELORaNT Of CU4PREHENSIVE HEUTH SERVICES

3.1 General Health Services

3.1.1 Programme Planning and ~ e n e r a l Activities


3.1.3 Primary Health Care and Rural Development

R e v i s e d E s f i , . i : e s

Irrplrrrru LC, " 0 uurldrr,

" r - O o n l 5

1 9 7 6

~ e g ~ l a r Budaer

8 500

1 9 7 7 1 9 7 8

Repular Budget

25 000

Budget

10 O w

1 9 7 9

ofher Sources

~egular Budzec

30 WO 8 S W

ofher Sources

other Sources

Total

25 000 lo WO

other Sources ,

30 WO

3.2 Family Healrh

3.2.2 mrernal and child Health

3.2.3 Human Reproduction

3.2.4 xurririon

3.2.5 Health Education

4. HEALTH M N W E R DEVELOF'MENT

4.1 ~ealch Manpower Development

5. DISEASE PREVENTION AND CONTROL

5.1 C-vnicable Direare reve en ti an and control

5.1.2 Epidemiolagical surver11ance

5.1.3 Malaria and Other Parasitic Diseases

5.1.4 Smallpox Eradication and ~xpanded Programme of Imunirafion

5.1.5 Bacterial and virus Diseases

5 1 . 6 veterinary Public Healrh

5.1.7 vector Biology and conrro1

5 1 . 9 Prevention ui Blindness

(Expressed in 11s Dollars)

R e v i s e d

1 9 7 6

Regular Budpef

E s t i m a t e s

1 9 7 7

Other I Total Sources 1

R ~ G u ~ = = Budget

357 800

160 000

238 600

756 400

P r o p o s a l s

Regular Budget

565 W O

235 300

378 4W

1 178 700

2 W 1 3 W

691 900

1 265 400

336 500

514 B W

34 500

259 100

102 WO

3 208 200

Other Sources

1 582 100

156 900

93 900

175 800

2 008 700

907 300

380 800

360 900

1 649 WO

2 670 100

772 000

1 380 2 W

375 5 W

644 500

36 500

350 3 W

604 400

4 163 400

Regular Budzet

413 300

I 245 200 ' 278 400

976 900

1 994 900

755 ?00

1 380 200

288 100

594 100

j b 500

350 300

140 700

3 546 100

I ~ I 1 1 939 900

lib 900

253 9 W

414 4 W

2 765 100

1 901 400, 2 473 6 W I

1 9 7 9

Other Sources

454 W O

135 600

82 500

672 100

675 200

15 800

87 400

50 400

463 7 W

617 3 m

289 400

148 100

182 500

620 000

1 657 O W

j2& OW

1 241 9 W

793 8W

244 900

69 700

27 200

34 600 -

2 936 LOO

1 9 7 8

Other Sources I

I

452 900 1 017 900 i I

4 375 WO

206 200

89 4W

748 S W

1 121 400

410 300

87 400

104 300

78 300

463 7 W

1 144 W0

441 500

467 800

1 927 200

3 122 700

' 1 106 200

1 265 400

423 900

619 100

34 5 W

337 400

565 700

4 352 200

1 538 700 ' 1 828 100 I 435 000 435 W O I

92 100 240 800

416 600' 599 100

2 483 O W

1 408 500,

i I

3 103 W O

3 065 5 W

965 500

1 333 4 W

3 756 800

488 200

1 279 900

1 014 800

L5b 300

53 500

2 742 000

!

1

1 178 700 ! 702 700

50 7 W I 292 600

4 300 000, 5 093 8W

255 7 W 500 b W

i loo I

94 8 W 1 122 000

1 34 600

194 900

30 300

326 800

31 300

3 366 200 4 879 900 7 816 000

/ 157 100 352 000 1 30 3 W

121 900

387 500

3 918 300

448 700

418 800

7 284 500

•

5.2 Non-Comunicable ~iseaoe Prevention and control

5 2 . 1 ~ r o g r a w e ~lanning and General Activiries

5.2.2 Cancer

5.2.3 Cardiovascular Diseases

5.2.4 Other Chronic Non- communicable Diseases

5.2.5 Oral Health

5.2.6 Mental Health

5.2.7 Bio-medical Aspects of Radiation

5.2.9 Immunology

5.2.10 Health of Working ~opularions

5.3 Praphylactic, Dlagnosric and Therapeutic Substances

5.3.3 Pharmaceuticals

5.3.4 Biologicals

5.3.5 Health Laboratory Technology

6. PROMOTION OF ENVIRONMENTAL HEALTH

6.1 Promotion of Environmental Health

6.1.1 Programme Planning and General Activities

6.1.2 Provision of Basic sanitary Measures

6.1.3 Pre-inverfoen~ Planning for Basic Sanitary Services

(Expressed in US Dollars)

Revised

1 9 7 6

~egvlar Budget

E s t i m a t e s

1 9 7 7

ofher Sources

Regular Budaer

P r o p o s a l s

1 9 7 8

Regular other Budnei 1 Sources !

I

I

Other Sources

1 9 7 9

51 400

198 500

110 700

uegular : other B u d ~ e f ! Sources

1 51 400

198 500

110 700

44 300

243 200

44 800

35 400

105 700

162 500

206 200

7 O W

97 400

946 500

125 000

231 200

405 000

761 ZOO

81 600

Total

I 1

44 300

159 200

44 800

35 400

105 700

162 500

149 100

7 000

91 500

799 500

124 000

72 M O

403 900

600 400

81 600

! !

47 1 47 700

84 000

57 100

5 900

147 000

1 000

158 700

1 100

160 800

56 200 56 200 I

115 100 :

174 200 j 174 200 I : 86 300:

14 500 I :f z: 29 300 88 900 I I18 200

836 200 88 900 , 925 100

138 700 138 700 i

109 400 i 142 700

33 300 I 561 200 82 000 643 200

880 900

55 100 1 55 100

227 700

87 300

44 000

113 100

160 300

199 600

19 500

172 000

1 071 200

145 300

254 700

473 O W

873 000

87 800

986 400

1 726 500

2:; 1 ,

I

25 rn 1 905 i m

714 300 71L J00

I

210 300

160 600 !

$7 500,

181 7W 1 186 900

2, 48 000 ' I

1 007 200

172 400,

155 600

620 500, 129 000

948 500 129 000

1

101 700 I I

953 l w , 518 200

44 000 )

73 500

160 300

122 000

19 M O

70 200

852 200

145 300

68 700

444 600

658 600

87 800

891 600

924 600 809 300

210 300

160 600

47 500

181 700

186 900

102 600

14 500

48 000

1 007 200

172 400

155 600

749 500

1 077 500

101 700

1 471 300

39 600

77 600

101 800

219 O W

186 O W

28 400

214 400

94 800

1 725 500

I

1 j

i 94 700

94 7* I 891 boo 860 wo 1 751 600

I

! I

I ( 710 800 1 iZ0 800

I

115 300

' ! ! 1

Pollu~ion and Hazards

6.1.5 Establishment and Strengthening o f Environmental Health Services and Instit"-

6.1.6 Food Safety Programme

. HEALTH INFORUAIION AND

LITERATURE

7.1 Health Stati~rics

7.1.1 Rograme Planning and General Acrivifies

7.1.2 Health Statiarical Herhadology

7.1.4 Development of Health Scatistical Services

7.2 Healrh Literature Services

7.3 WHO Publications

7.4 ~ealch ~nfarmarion of ~ublic

9. SUPPORT TO REGIONAL PROGRAHPZES

9.1 Regional Programme Planning and General Activities

9 . 2 ~ssistance co Country

9.3 Regional General Support

9.4 ~ e g i o n a l Conrman Services

r r a n l ~otal

SIW4ARY BY MAJOR P R O G M AND ORGANIZATlOW LEYEL - 0 ,- \

1.1 Organizational Meetings

Regional country Infer-country

2.1 Executive Uanagemenf

Regional country lnrer-country

2.2 Co-ordination

Regional Country Infer-cmnfry

2.3 General Programe Development

Regional country Inter-country


Regional Counrry ~nter-country

I L X D r C J S e O 1" us uollarr,

R e v i s e d

Regular nudger

8 500

8 YX)

99 000

99 MO

5 200

5 200

80 600

80 600

1 970 900 618 600

2 589 500

E s t i m a t e s P r o 7 o s a l r

25 000

25 000

105 100

105 100

5 700

35 MX)

41 300

148 1 W

148 100

2 642 200 870 900

3 513 100

Regular 8vdget

lo OW I

10 000

114 400 !

114 400

6 500

6 500

242 000 328 000

570 O W

2 520 000 505 800

3 025 800

1 9 7 9 1 9 7 7

Regular I Other Budget sources

I

! 25 OW 1

25 000

I

i 105 100

1 9 7 6

Ocher / sovrces 1

!

i 8 500

8 500

1

99 MX)

99 000

5 200

Regular Orher Budget smvrces

105 100

5 700.

5 700

148 1 W

148 100

32 900

32 900

Total

1 9 7 8

Ocher Total sources I

10 000

35 600

35 600

I

32 900

38 100

80 600

80 600

!

1 2 414 000 168 200

563 300 ! 307 600 1

3 037 JW 1 475 800

202 9 W 2 173 800 188 OW 806 600

390 9 W : 2 980 400

! i

30 000 1 30 MO

10 000

I 114 400

114 400

! 6 500

I 38 000 1 38 000

I 38 000 1 44 500

I

1 i 242

328 000

570 000

i

248 800 1 2 768 800 439 200 945 000

688 000 1 3 713 800

30030

122 300

122 300

7 500

40 600 - 48 100

337 MO 491 800

829 100

3 089 804 740 BW

3 830 MM

I

30 000 : !

122 300 I i

122 300 : i

7 500

7 500

40 600

40 600

I ::: i 829 100

2 877 200 511 900

3 389 100

212 600 228 900

441 500

3.2 Family Health

Regional c o u n t r y Inter-country

4.1 ~ealth "anpower Development

Regional C o u n t r y Inter-country

5.1 C-unicable Disease Prevention and Control

Regional C o u n t r y Inter-country

5.2 Non-Cm~nicable Disease prevention and Control

Regional Country Infer-country

5.3 Prophylact~c, Diagnostic and ~herapeutic Substances

Regional Councry inter-country

*


n e w i r e d

1 9 7 6

Regular I Other Budgei Sources 1

I

406 700 2 135 900 ' 2 542 600 213 3 W 347 Lo0 5bO 400

620 000: 2 483 O W 3 103 OW

~ s r i m a t e s

1 9 1 7

Regular other Budget I Sources !

1 ~ 540 200 ; 1 754 200 1 2 294 400

1 358 900 298 100

. 1 657 000

P r o p o s a l s

1 9 7 8

216 2 W

756 400

1 593 400 308 WO

1 901 400

2 724 000 642 200

3 366 200

753 2 W 99 000

852 200

i 1 290 3 0 , 2 649 200 118 200 416 3 W

1 408 500 1 3 065 500

~egular Budget

~egular Budget

740 300 236 600

976 900

1 568 900 426 OW

1 994 900

2 756 500 789 600

3 546 100

859 900 147 300

l 007 200

i

!

2 348 800 4 879 900 1 7 228 700

587 300 1 1 587 3 W

2 936 1 0 0 4 879 900 : 7 816 WO I ! i I i i

721 100 147 O M : 868 100 78 400 i 78 400

! 799 500 1 147 000 946 500

i I I

! 560 400. 160 800 : 721 200

40 000 j 40 000 I

bnci 4ao 1 1 8 7bl 200

Other Toral Sources

! 254 500

2 008 700

2 431 200 42 400

2 473 600

3 530 800 387 500

3 918 300

219 OW

219 OW

1 9 7 9

Orher Sources

58 400 613 700

672 100

450 100 225 100

675 200

66 200 551 LOO

617 300

470 700

2 165 1 W

4 024 M)O 350 400

4 375 W O

6 254 800 1 029 7 W

7 284 500

972 200 99 000

1071 2 W

;:: , 214 400

S u ?ii boo

Total

798 100 850 300

1 649 wo

2 019 O W 651 100

2 670 100

2 822 700 1 340 700

4 163 400

859 900 147 300

1 0 0 7 200

830 I00 42 900

873 000

I 914 500 i 126 200 1 040 700 264 200 ! 622 3 W 886 500

!

1 004 700 72 800

1 077 500

-

1 178 700

1 592 400 408 9 W

2 001 300

2 499 400 708 800

3 208 200

718 100 118 100

836 200

740 900 68 400

SO9 100

i

i 748 500' 1 927 200

I

765 5 W 2 357 900 355 900 7% 800

I 1 121 4 W ' 3 122 7 W

592 900 3 092 300 551 1 W 1 259 900

1 144 000 4 352 200

88 9 W 807 O W 118 1 W

88 900 925 LW

I 115 3 W 856 200

68 400 !

115 lo0 924 600

875 700 72 800

948 500

129 MH)

129 000

7.1 Health Statistics

~nter -country

7.2 Healch Literature Services

7.3 WHO Publications

~nrer-country

7.a Health Infarmarion of public

Inter-country

9 . 1 Regional Programme Planning and General i l c t , v i i i e s

9.2 Assistance to Country

Inter-country

9 . 3 Regional General Support s e r v i c e s

9 . 4 Regional c-on s e r v i c e s

Infer-COunLIy

T o t a l : Regional

Infer-country

Grand T o t a l

REGULAR BUDGET ESTIMATES 1976-1979 BY APPROPRIATION SECTION WITH TENTATIVE PROJECTIONS FOR 1980 AND 1981


Appropriation Section

1

2

3

4

5

6

7

9

Purpose of Expenditure

Policy Organs

General Management, Co-ordination and Development

Development of Comprehensive Health Services

Health Manpower Development

Disease Prevention and Control

Promotion of Environmental Health

Health Information and Literature

Support to Regional Programmes

Total

Revised Estimates

1976

8 500

184 800

3 209 500

1 657 000

4 336 000

1 258 000

408 800

2 117 700

13 180 300

1977

25 000

258 900

3 793 700

1 901 400

4 877 000

1 310 400

273 700

2 280 600

14 720 700

Proposals

1978

10 000

690 900

4 204 500

2 001 300

4 853 700

1 409 600

388 500

2 486 100

16 044 600

Tentative Projections

1979

30 000

958 900

4 366 000

1 994 900

5 501 800

1 518 900

405 700

2 712 400

17 488 600

1980

12 000

1 058 000

4 809 500

2 195 000

6 059 700

1 673 700

446 300

2 983 800

19 238 000

1981

30 000

1 163 800

5 290 500

2 412 400

6 657 500

1 841 000

486 700

3 280 100

21 162 000

-

PROGRAMME ANALYSES

Major Programme/ Programme T i t l e

Regional Cornnittee

Executive Management

Co-ordination with Other Organizations

General Programme Development

Research Promotion and Development

Regional D i r e c t o r ' s Development Programme


Programme Planning and General A c t i v i t i e s

Health Services Development

Primary Health Care and Rural Development

Family Health

Maternal and Child Heal th

Human Reproduction

N u t r i t i o n

Health Education


Cowunicable Disease Prevention and Control

Epidemiological Surve i l l ance

Malaria and Other P a r a s i t i c Diseases

Smallpox Erad ica t ion and Expanded Programme of Immunization

B a c t e r i a l and Virus Diseases

Veterinary Pub l ic Health

Vector Biology and Control

Prevention of Blindness

Non-Communicable Disease Prevent ion and Control


Cancer

Cardiovascular Diseases

Other Chronic Non-Communicable Diseases

Oral Health

Malor Programme1 Programme

5 . 2 . 6

T i t l e

Mental Health

Biomedical Aspects of Radiation

Imnuunology

Heal th of Working Populations

Prophylact ic Diagnost ic and Therapeutic Substances

Pharmaceuticals

Bio log ica l s

Health Laboratory Technology


Rograrmne Planning and General A c t i v i t i e s

Provis ion of Basic San i ta ry Measures

Pre-investment Planning f o r Basic San i ta ry Services

Control of Environmental P o l l u t i o n and Hazards

Establishment and Strengthening of Environmental Health Serv ices and I n s t i t u t i o n s

Food Safety Programme

Health S t a t l a t i c s


Heal th S t a t i s t i c a l Methodology

Development of Heal th S t a t i s t i c a l Se rv ices

Health L i t e r a t u r e S e r v i c e s

WHO Publ ica t ions

Health Information of Pub l ic

Regional P rograme Planning and General A c t i v i t i e s

Assis tance t o Country Programes

Regional General Support Se rv ices

Regional Common Serv ices

W O E P R O G R . 1.1 ORGANIZATIONAL HEETlNCS

PPOGRAWllE 1.1.3 REGIONAL COHHITTEE

Ihe Regional C o d t t e e i s composed of r ep resen ta t ives of Hember S t a t e s assigned t o the South-East Asia Region. It n o r r s l l y nee t s once a year e i t h e r i n t h e regional headquarters or elsewhere i n the Region as it m y decide i n advance.

The func t iom of t h e Regional Cormittee are t o fo rnu la te p o l i c i e s covering u t t e r s of an exclusively regional character and t o supervise the a c t i v i t i e s of WHO i n t h e Region. The C-ittee revievs the proposed regional progr- .nd budget es t imates and makes suggestions regarding t h e implementation of hea l th a c t i v i t i e s of common i n t e r e s t t o U d e r Sta tes . I t a l s o provides guidance t o the Regional Director i n mat ters concernin8 co-operation a t t h e r eg iona l l e v e l between the United Nations and t h e Specia l ized Agencies and with o the r regional in t e r - na t iona l organizat ions having i n t e r e s t s i n co-n with t h e Organization. F u r t h e m r e , i t can advise the Organization, through the Regional Director and the Director-General, on i n t e r n a t i o n a l hea l th mat ters vhich have wider than reg iona l s ignif icance. I h e Regional C o d t t e e may a l s o give preliminary considerat ion t o questions l i k e l y t o be t ako l up by t h e following World Health A s s d l y and sessiona of t h e Executive Board.

The e ~ t h t e s provide for annual m e t i n g e o f t h e Regional C-ittee far t h e South-Eaet Asia Region.

1976 Regional

country

Inter-country

Total

1977 Regional - country

Inter-country

Total

1978 Prgiomal - Country

Inter-country

Total

1979 Regional - Country

Inter-country

Tom1

Estimated Obligations

Regular Budget

Number o f Posts

Regular Other I Budget 1 Sources /

I ~ I i

I

1 I

I I

~ I

I

I I

I I

1

I

Other Sources

I

Total

US$ I US$

8 500

I

US$

' 8 500

;;--t-t . % 0 : 25 OW 25 000

~ I

25 000

10 000 I

25 WO 4

10 000

i I

I

10 000

I

, 10 000

30 000 1 M 000 !

30 000 30 000 .

MAJOR PROGRAMME 2.1 EXECllTIVE MANAGEMENT

The Regional Director is the chief technical and administrative officer of the Regionsl Office and, subject to the general authority of the Director<eoeral of the Organization, has the overall responsibility for the planning, erecution and evaluation of WHO'S programme at the regions1 level ss well as far the management of the supparting administrative services. He is the secretary of the Regional Cornittee, and consults directly with governments of the Member States of the Region. He takes decisions on regional policy mattere and ensures co-ordination with WHO Headquarters, with local or regional offices of other international or national governmental and non-governmental organizations and institutions, and with other international organizations of regional scope. He keeps the Director-General informed of major developments affecting the health situation in the Region,and participates in Organizationvide discussions and consultations on policy matters affecting the work of WHO. The Regional Director also provides technical and policy guidance ta all etaff in the Region.

The estimates relate to the Regional Director's office and duty travel to attend meetings, visit countries and WHO-assisted projects in the Region, as required.

1976 Regional

Country

Inter-country

Total


Inter-country

1978 Regional

Inter-country

1979 Regional

Inter-wuntry

Number of Posts

Regular Budget

5


Regular Budget

US$

99 000

99 000

105 100

Other Sources Total

5 1

I

5

5

Other Sources

US$

5

5

Total

US$

99 000

99 000

105 100

PROGRAMME 2 . 2 . 2 CO-ORDINATION W I M OTtlER ORGANIZATIONS

Objectives

To:

- eo-ordina te wi th a l l s p e c i a l i z e d agencies i n the UN System, World dank and h i a n DeveloplnenL Hank as w e l l as va r ious non-gavernnentnl , n a t i o n a l and i n t e rna t i o r l a l o rgan i za t i ons i n I t rn l th and r e l a t e d prograrmoes;

- co-ordinate wi th b i l a t e r a l a i d agenc i e s ;

- develop count ry and in ter -count ry p r o j e c t s f o r execut ion by WHO from UNDP and UNFPA funds ;

- r ev i ev , i n consu l t a t i on v i t h t e c h n i c a l u n i t s , programmes of various s p e c i a l i z e d agencies and t o ensure t h a t h e a l t h and r e l a t e d a s p e c t s are provided app rop r i a t e priority;

- ensure t h a t p r o j e c t s funded by UNDP and UNFPA are implemented as per schedule , arid

- a c t as f o c a l po in t far t e c h n i c a l co-operation among Developlug Countr ies .

Approaches

my:

- i d e n t i f y l a g areas where co-ordina t ion and c o l l a b o r a t i o n can be s t r eng thened , in c o n s u l t a t i o n v i t h t e c h n i c a l u n i t s ;

- mainta in ing l i a i s o n with WHO Krp re sen t a t i ve s and app rop r i a t e Unit., i n Headquarters;

- formula t ing app rop r i a t e p r o j e c t s and prngraonnes;

- mainta in ing l i a i s o n wi th UNDP Resident Representa t ives and, i f necessary , wi th m i n i s t r i e s , for t h e development of p r o j e c t s as w e l l as t h e i r implementation;

- implementing p r o j e c t s by moni tor ing and ensur ing t h e necessary noii- technical o p e r a t i o n a l a c t i v i t i e s , aod

- reviewing p r o j e c t s and rephas ing programmes i n c o n s u l t a t i o n wi th v s r i o u s u n i t s .

A Co-ordination Unit has been s e t up i n t h e Regional Of f i ce i n i t i a l l y t o a c t as a f o c a l po in t f o r UNPPA-assisted p r o j e c t s and prograomes. Gradually the func t ions of t h e Uni t were enlarged t o i nc lude vark connected wi th W P - a s s i s t e d p r o j e c t s and co-ordina t ion w i th va r ious m u l t i l a t e r a l end b i l a t e r a l o rgan i z s t i ohs . Emphasis on co- o r d i n a t i o n w i th va r ious agenc i e s i s a consequence of v a r i o u s r e s o l u t i o n s adapted i n World Health Assemblies as w e l l as due t o the i nc r ea s ing r e c o g n i t i o n t h a t t h e development of programmes i n t h e h e a l t h s e c t o r requires a m u l t i s e c t o r a l and i n t e g r a t e d approach.

Asels tance has been provided t o c o u n t r i e s i n developing p r o j e c t r equcs t s f o r a e s l s t a o c e from m u l t i l a t e r a l sources, i n implementing f u l l y p r o j e c t s a s e i s t e d by UNDP and UNFPA, and i n ca r ry ing out o t h e r a d m i n i s t r a t i v e work connected w i th t h e s e p r o j e c t s . P r o ~ e c t requeers were drawn up f o r a s s i s t a n c e from b i l a t e r a l and mul t i - l a t e r a l sources, such as DANIDA and UNDP, f o r in ter -count ry o r o f e c t s .

ProposaZs fo r 1378-1979

It is expected t o achieve st i l l b e t t e r and f u l l e r co-ordina t ion wi th o t h e r b i l a t e r a l and m u l t i l a t e r a l agencies and f u l l e r implementation of p r o j e c t 8 funded from sources o t h e r than Regular budget. I t i s a l s o expected t h a t i t w i l l b e p o s s i b l e t o promote l a r g e r funding of n a t i o n a l p r o j r r t s i n t h e f t e l d o f h e a l t h and a l l i e d sub j ec t s .

1976 Regional

Inter-country

Inter-country


Inter-country

Total


Inter-country

Total

I I 6 500

6 500

7 500

1

2

3

1

2

3

i 2

I i 6 90

1

1

1

Y) OW

38 000 2

2

2

38 WO

14 M O

7 500

40 600

48 100

I i 40 6W

7 500 40 600

MAJOR PROGRAMME 2.3 GENERAL PROGRAMME DEVELOPMENT

Objectives

- develop WHO p r o g r a m s f o r co l l abora t ion with the governments of Member countr ies of t h e Region i n t h e i r e f f o r t s t o improve hea l th and provide hea l th care t o t h e maximum number of people;

- s t rengthen WHO's d i r e c t i n g and co-ordinating r o l e i n t h e f i e l d of hea l th development a t t h e regional and country l e v e l ;

- promote, co l l abora te and co-ordinate biomedical and hea l th se rv ices research i n t h e Region with a view to supporting heal th development a c t i v i t i e s ;

- develop and s t reamline WHO'S information system f o r t h e b e t t e r implementation and monitoring of WHO's co l l abora t ive e f f o r t s f o r hea l th development, and

- provide a mechanism f o r f inancing WHO's co l l abora t ion to meet s p e c i a l needs of the Member coun t r i e s of the Region a r i s i n g ou t s ide the budget cyc le , so allowing f l e x i b i l i t y i n progranme budgeting.

Approaches

By:

- ensuring t h a t WHO's programme f o r co l l abora t ive a c t i v i t i e s conforms with the Sixth General Programme of Work and medium-term programme of WHO, the p r i o r i t i e s i n which have been formulated i n c lose consu l t a t ion with the Member countr ies ;

s t rengthening WHO'S co l l abora t ion i n biomedical research a c t i v i t i e s , wi th t h e major emphasis on the applica- t ion of research f indings t o improve t h e hea l th of the people i n t h e Region;

- developing and s t reamlining t h e WHO information and repor t ing system i n c lose co l l abora t ion wi th the na t iona l a u t h o r i t i e s , so as t o improve planning, programming, implementation, monitoring and evaluat ion of the WHO co l l abora t ive a c t i v i t i e s , and

- es tab l i sh ing the Regional Di rec to r ' s development programme so as t o provide f a r f l e l t i b i l i t y i n programme budgeting t o meet s p e c i a l needs of t h e Member coun t r i e s , as appropr ia t e , a r i s i n g a f t e r f i n a l i z a t i o n of the programme budget.

The Sixth General P r o g r a m of Work (which has been approved by t h e 29th World Health Assembly), the Medium-Term Programme and the na t iona l p r i o r i t y goals i d e n t i f i e d by t h e governments of Member coun t r i e s , provide t h e guide- l i n e s f o r developing t h e WHO co l l abora t ive programnee. I n t h e S ix th General P r o g r a m of Work, t h e programme ob jec t ives have been more c l e a r l y def ined than i n e a r l i e r programmes of work, p r i o r i t y a r e a s have been estab- l i s h e d , approaches and a c t i v i t i e s have been b e t t e r def ined, and an evaluat ion system of i t s programmes with output ind ica to r s has been b u i l t in . Various organs and l e v e l s of t h e Organization and governments themselves have pa r t i c ipa ted i n i t s preparat ion.

The s h i f t of emphasis to broad programme areas w i l l ensure more e f f e c t i v e and e f f i c i e n t management and a meaningful impact on t h e main hea l th problems. Moreover, the na t iona l hea l th p r i o r i t i e s have been i d e n t i f i e d by the governments through the na t iona l hea l th planning process and, i n some coun t r i e s , through country hea l th programming.

WHO a c t i v i t i e s i n research are based on A r t i c l e 2(a) of the Const i tu t ion which s t a t e s t h a t one of the funct ion of WHO i s "to promote and conduct research i n t h e f i e l d of health". Un t i l r e c e n t l y biomedical research was co-ordinated by Headquarters but w i t h t h e t r a n s f e r of t h i s r e s p o n s i b i l i t y t o the regions a number of a c t i v i t i e s has been generated i n the Regional Of f i ce . The Regional Director has e s t ab l i shed a Regional Advisory Committee on Medical Research (RACMR) t o advise him on the co-ordination of research i n Member coun t r i e s . The f i r s t meeting of the RACRR has i d e n t i f i e d the p r i o r i t i e s f o r biomedical research i n the Region: communicable d i seases (malaria, leprosy, tube rcu los i s , f i l a r i a s i s , denguelhaemrrhagic fever , d iarrhoea1 d i seases including cholera , and schis tosomiasis) ; n u t r i t i o n ; con t ro l of human f e r t i l i t y ; environmental h e a l t h ; de l ive ry of hea l th s e r v i c e s , and o the r s such as chronic d i seases including l i v e r cancer. Aleo a Research Development Committee has been formed which w i l l funct ion as an advisory body t o t h e Regional Director f o r t h e implementation of the research programme, through t h e newly es t ab l i shed Biomedical Research Unit i n t h e Regional Office.

For r a t i o n a l programme planning, implementation, management and evaluat ion, an adeqvate information system is e s s e n t i a l . A new WHO i n t e r n a l repor t ing system proposed by our Information System Development Working Group has been approved by the Director-General. I t w i l l s e rv ice t h e Organization's co l l abora t ive programmes with the Member coun t r i e s and provide f a r i n t e r n a t i o n a l exchange of information on heal th . It is a l r eady being implemented i n t h i s region. I n add i t ion , e f f o r t s are being increased t o s t reamline t h e hea l th information systems of t h e Member coun t r i e s .

I n order t o s t rengthen the Organizat ion 's d i r e c t i n g and co-ordinating r o l e a t t h e n a t i o n a l and the r eg iona l l e v e l and t o provide the Regional Director wi th the f l e x i b i l i t y t o respond adequately t o newly emerging problems, t o support promising innovative a c t i v i t i e s , and to respond t o Resolutions of t h e World Health Assembly, the Executive Board and t h e Regional Committee meetings, a new programme area has been es t ab l i shed : t h e Regional

Director's Development Programme. This w i l l a l s o in t roduce f l e x i b i l i t y i n t o t h e programme budgeting ao as t o enable implementation of programme a reas mentioned above a f t e r f i n a l i z a t i o n of t h e programme budget.

h.opooals for 1878-197s

A medium term programme w i l l be developed in t h e l i g h t of t h e Sixth General P r o g r a m of Work r e f l e c t i n g the p r i o r i t y needs of t h e Member countr ies .

Country (nat ional) hea l th programming, f o r p inpoint ing p r i o r i t y needs and f o r appropr ia t e p ro jec t and programme development, w i l l be supported.

Improved p ro jec t and programme management methods w i l l be developed, t ea ted and implemented t a ensure b e t t e r u t i l i z e t i o n of WHO'S co l l abora t ive a s s i s t ance .

National e f f o r t s a t developing biomedical research p r o g r a m s re l evan t t o t h e needs of the coun t r i e s and t h e Region w i l l be supported.

A mechanism f o r t h e co-ordination of biomedical research programmes i n t h e coun t r i e s of t h e Region w i l l be e s t ab l i shed through t h e co-operation of na t iona l organizat ions f o r t h e co-ordination of research.

A system f o r exchange of research information, both inter-country and inter- regional , w i l l be eetabl iahed with the aim of making b e t t e r use of research f ind ings , e t imula t ing f u r t h e r r e sea rch , and applying research f indings t o the improvement of the hea l th of the people of t h e Region.

Training of research workers to improve t h e q u a l i t y and quant i ty of biomedical research manpower w i l l be undertaken.

The i n t e r n a l r epor t ing system of WHO i n t h e Region w i l l b e s t reamlined through t h e establishment of p r o j e c t , programme and country p r o f i l e s which w i l l be used as t h e veh ic le f o r r epor t ing through pe r iod ic up-dating, i n co l l abora t ion wi th the Member countr ies .

Development. s t reamlining and f u r t h e r improvement of na t iona l h e a l t h information s y e t e m w i l l be undertaken with a view t o generat ing, c o l l a t i n g and enalysing re l evan t information f o r back-up eupport t o planning, programming and evaluat ing hea l th development e f f o r t s .

With a view t o providing f l e x i b i l i t y t o programme budgeting f a r meeting apec ia l needs of the eountr iea and f o r support ing innovat ive approaches even a f t e r t h e f i n a l i z e t i o n of t h e p r o g r a m budget a provis ion of $100 000 f o r each of t h e years 1978 and 1979 has been made under t h e "Regional Di rec to r ' s Development Proflame".

Inter-country

Inter-country

Inter-country

1979 Regional

Inter-country

PROGRAMME 2.3.2 RESEARCH PROMOTION AND DEVELOPMENT

Objectives

To develop, promote, collaborate in and co-ordinate bio-medical research in the Region with e view to making optimum use of the results of research in improving the state of health of the population.

Approaches

By:

- ca-ordinating research efforts in the Region with those of Headquarters and other Regions, working towards greater reliance at the regional level;

mobilizing and strengthening the research capacity of the countries of the Region and harnessing it, in order of priority, to national, regional and global needs;

- strengthening or assisting the establishment of national co-ordinating agencies for bio-medical and health practice research in order to establish or increase national capability and regional and inter-regional collaboration;

- identifying and supporting group research institutions, particularly those working an priority problems of common interest;

- setting up a Regional Advisory Council of Medical Research and an appropriate secretariat at he Regional Office far the co-ordination of activities;

- collecting and disseminating research information pertaining especially to the identified priority areas, to enable maltimum use of the results, both by scientists and deciaion-makers, and

- identifying relevant health problems and setting priorities for research in the Region (vith periodic revision).

Programne Review

The development of WHO'S activities in research is provided for in Article 2(a) of the Constitution, which states that one of the functions of WHO is "to promote and conduct research in the field of health". The guiding principles were that first priority should be given to reeeereh directly relating to the programmes of WHO. and that the Organization ahould support such research in existing institutions rather then establish international research institutions under its own auspices. In 1958 the Eleventh World Health Assembly adopted a resolution which resulted in a considerable expansion of reeearch activities. According to the plan vhich was evolved and adopted the following year, principlea and policies for these activities were laid down, vhich the Organization follared for many years.

The Fifth General Progrme of Work (1973-1977) extended research to cover more adequately such fields as education of health personnel and the planning and delivery of health services, thereby making clear the inclusion of the public health dimension in its research activities as well as bio-medical reseafch in its more conventionally conceived laboratory and clinical aspects.

Until very recently, WHO'S research activities were to a large extent focussed upon urgent technical problems connected vith global responsibilities in selected fields such as bio-medical standards, microbiology, nutrition. etc. The changed vorld scene, and especially the urgent needs of developing countries, required a shift of emphasis to take into account deficient or neglected areas of research, ""exploited potentials and the desirabi- lity of expanding research resources in developing countries and of rapidly applying existing ae well as emerging new knowledge to particular local conditions.

A Regional Advisory Committee on Medical Research was set up by the Regional Director in accordance with the deliberations at and resolutions of the sessions of the Regional Committee for South-East ksia, the Executive Board and the World Health Assembly.

The Committee first met in January 1976 and recommended the priority areas for bio-medical research in the Region, and other activities which ehauld take place in preparation for its second meeting in August 1976.

Although research activities have thus far been mainly the responsibility of Headquarter, eeveral on-going projects in the Region have had research components. With the establiehment of the Regional Advisory Committee on Medical Research and greater responsibility given to the Region, the trend towards development of research projects per se and inclusion of further research activities in the on-going and proposed projects in the Regions is expected - particularly in the priority areas identified. These priority areas consist of (1) communicable diseases (malaria, leprosy. tuberculosis, filariasis, dengue haemorrhagic fever, diarrhoea1 diseases, including cholera and schietosomiasis), (2) nutrition, (3) control of human fertility. ( 4 ) environmental health, and ( 5 ) delivery of health services, and others, such as chronic diseaaes including liver cancer.

Research into the adaptation and application of kn- results and new knowledge gained, has been stressed. The development of the institutional base for research, and research training of scientists was considered a priority.

A number of research p ro jec t s i n the f i e l d covering t h e m j o r progra- a r e a s of WHO a r e being conducted i n countr ies of t h e Region, through a s s i s t a n c e from Headquarters. These include an extensive research programre i n human reprcduct ion and research p ro jec t s i n vector c o n t r o l , t ube rcu los i s , leprosy, f i l a r i a s i a and h e a l t h p rac t i ce . These research p ro jec t s , conducted through Headquarters, con t r ibu te a t present t o t h e major e f f o r t s of bio-medical research i n t h e Region.

seve ra l p ra jec ta i n t h e Region have research camponent a l s o which cover a spec t s of n u t r i t i o n , communicable diseases including vector c o n t r o l , family h e a l t h , including neollatology, h o s p i t a l admin i s t r a t ion , occupational hea l th , den ta l h e a l t h and medical education. Research i n t o t h e development of m d e l s f o r evaluat ion, radiology, '

nuclear medicine, toxicology and h e a l t h p r a c t i c e has been promoted. Attempts have been m d e t o s t rengthen t h e i n s t i t u t i o n a l base f a r research through support f o r t h e t r a i n i n g of a c i e n t i s t e and t o research i n s t i t u t i o n s such as the National I n s t i t u t e of Medical Research i n Indonesia, and t h e Department of Medical Research i n Burma.

Proposats for 197e-1979

Strengthening of t h e research a c t i v i t i e s a t the Regional Office, including disseminat ion of s c i e n t i f i c info-- t ion , and of t h e information base on research.

Per iodic meetings of t h e Regional Advisory Council on Medical Research w i l l be held f o r review of the problem6 needing so lu t ion through research and r e f i x i n g of p r i o r i t y a r e a s f o r research.

The p o s s i b i l i t y of t r a i n i n g research a c i e n t i a t e i n i n s t i t u t i o n s i n the Region w i l l be explored and implemented, wherever f eas ib le .

Assistance t o research a c t i v i t i e s , including t echn ica l support , w i l l b e made a v a i l a b l e t m e r d s biomedical research a c t i v i t i e s i n countr ies of t h e Region, p a r t i c u l a r l y those pe r t a in ing t o t h e p r i o r i t y areas.

A modest beginning of p ro jec t s concerned with research a c t i v i t i e s per se w i l l be i n s t i t u t e d . The research s t u d i e s include i r o n def ic iency anaemia and hypovitaminosis A i n Thailand; whi le i n Ind ia t r a i n i n g of nurse educators i n research methods w i l l continue. The l a t t e r p ro jec t would con t r ibu te t o development of t h e research manpower a v a i l a b l e i n t h a t country.

Further s t u d i e s i n India pe r t a in ing t o occupat ional hea l th , toxicology, immunology end epidemiology of cancer have been proposed as na t iona l p r i o r i t i e s . The a s s i s t a n c e given t o e t rengthen t h e i n s t i t u t i o n a l capaci ty of the National I n s t i t u t e of Medical Research i n Indonesia and t h e Department of Medical Research in Burma w i l l continue.

I n view of t h e g rea te r r e s p o n s i b i l i t y i n bio-medical research being given t o t h e Region, i t ia proposed that na t iona l research and development committees be i n s t i t u t e d , wi th experience gained i n n a t i o n a l and regional progrannnee.

1976 Regional

Country

Inter-country

Total


Inter-country

Inter-country

Inter-country

Number of Posts

Regular Budget

2

2

2

Estimated Obl igat ions

Regular Budget

US$

80 600

80 600

148 100

Other Sources

Other Sources

US$

To ta l

2

2

2

Total

US$

80 600

80 600

148 100

PROGRAMME 2.3.4 REGIONAL DIRECTOR'S DEVELOPMENT PROGRAMME

lhis new programme has been described under t h e Regional Di rec to r ' s Programme Statement.

-


Inter-country

Total


Inter-country

Total


Inter-country

Total


Inter-country

To ta l

Nvmber of Posts

Regular Budget


Regular Budget

Other Sources

Other Sources Total To ta l

I

-

US$

100 OW

100 000

I

100 000

100 000

US$

I I

US$

1 1 I

1

100 000 / 1

100 000

I I

100 000

100 000

MAJOR PROGRAMME 3.1 GENERAL HEALTH SERVICES

- develop t h e h e a l t h planning process as an i n t e g r a l p a r t of general hea l th development progr-es through t h e in t roduc t ion of hea l th planning p r a c t i c e , formulation of hea l th plans and t r a i n i n g of personnel;

- f u r t h e r develop hea l th s e r v i c e s through research and demonstration p ro jec t s aiming a t the eventual eatebl ishment of comprehensive in teg ra ted hea l th s e r v i c e s ;

- improve se rv ices support ing or a s soc ia ted wi th medical care (such as nurs ing, r e h a b i l i t a t i o n , l a b o r a t o r i e s , medical r ecords , medical s t o r e s and equipment, e t c . ) , and

- a s s i s t i n t h e expansion of primary hea l th care.

- a s s i s t i n g i n the formulation of na t iona l p o l i c i e s f o r the development of h e a l t h s e r v i c e s ;

- e s t a b l i s h i n g and developing competence and e x p e r t i s e among the n a t i o n a l heal th adminis t ra t ions through t r a i n i n g and demonstration, i d e n t i f i c a t i o n of c o n s t r a i n t s and p r i o r i t i e s by country hea l th programming, g iving advice on measures f o r improvement, and t h e c rea t ion of an e f f e c t i v e working environment;

- providing t echn ica l support f o r t h e es tabl ishment and maintenance of va r ious s p e c i f i c components of hea l th s e r v i c e s ;

- explor ing innovative approaches and t h e prormting community p a r t i c i p a t i o n and co-ordination v i t h voluntary e f f o r t s i n the development of hea l th s e r v i c e s , and

- a s s i s t i n g wi th the es tabl ishment of hea l th s e r v i c e development i n s t i t u t e s and t h e promotion of e f f e c t i v e use of na t iona l resources f o r f u r t h e r development of hea l th s e r v i c e s , including planning end management, and t h e i r evaluat ion.

Recognizing the l imi ted s e r v i c e s a v a i l a b l e to r u r a l populat ions , an accepted pol icy of the government. is t o improve coverage by the es tabl ishment of hea l th cen t res which w i l l i nc reas ing ly provide promotive, preventive and c u r a t i v e s e r v i c e s , and t o i n t e g r a t e gradual ly the spec ia l i zed programmes i n t o the pe r iphe ra l hea l th se rv ices . This approach has s t imulated t h e i n t e r e s t of many internat ional . and o the r agencies , notably UNDP, UNICEF, IBRD and US A I D , who have been involved i n t h i s a c t i v i t y i n var ious ways.

Health i n f r a s t r u c t u r e s , with h o s p i t a l s , h e a l t h c e n t r e s , hea l th u n i t s or hea l th posts and sub-centres, s t a f f e d by doc to r s or a u x i l i a r i e s and a team of a u x i l i a r y h e a l t h workers covering standard populations are being es t ab l i shed i n a l l coun t r i e s of t h e Region. Under-ut i l iza t ion of hea l th f a c i l i t i e s , including law bed-occupancy. i n many pe r iphera l i n s t i t u t i o n s is being s tud ied t o f i n d ways of improvement.

Exercises i n country hea l th programming were undertaken i n Bangladesh (1973), Nepal (1974). Thailand (1975) and Burma (1976). As a r e s u l t , p ro jec t formulations were completed i n Nepal and Thailand. I t is expected t h a t Mongolia, Indonesia and S r i Lanka would adopt a s i m i l a r method of planning the development of t h e i r hea l th se rv ices i n the near fu tu re .

In a l l coun t r i e s of the Region, Governments have expressed wi l l ingness t o inc rease the hea l th coverage by e s t a b l i s h i n g an appropr ia t e i n f r a s t r u c t u r e f a r in t eg ra ted r u r a l hea l th care, including a family planning programme.

Medical care has been rece iv ing due emphasis. Depending upon the requirements of the coun t r i e s , var ious aspects of medical care, including support ing se rv ices , have been a s s i s t e d . A r eg iona l team an medical care, a f t e r having prepared some working manuals and conducted seminars, w i l l g ive a t t e n t i o n t o c e r t a i n a spec t s of medical care during i t s second phase. Another regional team is at tached t o t h e United Nations Aaian Development I n s t i t u t e i n Bangkok and the team, a c t i n g ae an i n t e g r a l p a r t of t h e I n s t i t u t e , has been p a r t i c i p a t i n g i o the t r a i n i n g and research i n hea l th a spec t s of general socio-economic development. The impact made by the th ree e a r l i e r r eg iona l courses on hea l th planning was assessed a t an in ter-country follow-up seminar f o r obta ining guidel ines f o r f u t u r e a c t i v i t i e s . A f u r t h e r in ter-country p ro jec t financed by UNDP, has been assess ing t h e needs of the coun t r i e s i n hea l th planning and i s conducting n a t i o n a l t r a i n i n g courses and v o r b h o p s a s required.

An in ter-country team c o n s i s t i n g of a phys ica l medicine exper t , an a r t h o t i c and p r o s t h e t i c s p e c i a l i s t and a physiotherapy t u t o r has been a s s i s t i n g the Rehab i l i t a t ion Centre i n Semarang. Indonesia. I n add i t ion t o organizat ion of r eg iona l group educat ional a c t i v i t i e s aimed a t promoting comprehensive in teg ra ted r e h a b i l i t a t i o n se rv ices wi th in t h e e x i s t i n g hea l th se rv ices , t h e se rv ices of t h e team members w i l l be made ava i l ab le t o H d e r S t a t e s f o r t r a t n i n g p rogrames and es tabl ishment of s e r v i c e f a c i l i t i e s .

By 1977 t h e r e s u l t s of e a r l i e r vork and of t h e opera t iona l s t u d i e s on i n t e ~ a t i a n of d i s e a s e c o n t r o l c a m p a i p w i l l have provided f u r t h e r impetw t o ensur ing b e t t e r q u a l i t y and coverage of t h e h e a l t h se rv ices . WllO w i l l

c o n t r i b u t e through the e x i s t i n g programmes by promutlng the exchange o f t e c h n i c a l informat ion among coun t r i e s an t h e r e s u l t s of va r ious s t u d i e s and exper iences . The emphasis w i l l con t inue t o b e on t h e improvement of p e r l - phera l and r u r a l l l e a l t h s e r v i c e s , wi th i nc rea s ing a t t e n t i o n t o r e f e r r a l mechanisms and primary hea l t i ) care, i n which c l o s e r c o l l a b o r a t i o n and a s s i s t a n c e is expected from United Nations and o t h e r agencies .

By 1977, i t i s hoped t h a t i n Bangladesh the development of i n t e g r a t e d h e a l t h s e r v i c e s through t h e thana h e a l t h complex w i l l b e w e l l advanced. S imi l a r a c t i v i t i e s i n Burma, Bhutan, Mongolia and Nepal w i l l a l s o be evalua ted and f u r t h e r a s s i s t a n c e provided. I n Ind i a , upgrading o f primary h e a l t h c e n t r e s and a s s i s t a n c e to the t r a i n i n g and u t i l i z a t i o n of mul t ipurpose workers w i l l be continued. I n Indones ia , nea r ly 1000 h e a l t h c e n t r e s w i l l be e s t a b l i s h e d a s a r e s u l t of h e a l t h c e n t r e programming by 1977. The e f f o r t s of WtlO i n Mongolia and t h e Democrati<. People ' s Repllblic o f Korea w i l l be concent ra ted on tile f u r t h e r expansion of comprehensive medical care i n r u r a l areas t o improve t h e q u a l i t y of t h e hea l t h care . In Thai land, primary h e a l t h care w i l l r e ce ive s p e c i a l a t t e n t i o n i n the r u r a l h e a l t h s e r v i c e s .

I n most c o u o t r i e s of the Region, t h e development of manpower i n h e a l t h - p a r t i c u l a r l y of nurs ing personnel , both p r a f e s s i o o a l and a u x i l i a r y , of mul t ipurpose h e a l t h workers and v i l l a g e vo lun t ee r s f o r running h e a l t h s e r v i c e s - w i l l cont inue t o b e emphasized. Ass i s t ance w i l l t h e r e f o r e be g iven t o developing n a t i o n a l h e a l t h manpower i nc lud ing r e g i s t r a t i o n aystems f o r mre e f f e c t i v e p lanning and u t i l i z a t i o n and f o r t h e c o l l e c t i o n of more a c c u r a t e informat ion on t h e a v a i l a b i l i t y of t r a i n e d manpower.

1976 Kegional

country

In ter -count ry

To ta l


In ter -count ry

T o t a l

1978 Keglonal -

Country

In ter -count ry

T o t a l


In ter -count ry

T o t a l i

Estimated Obl iga t ions

Kegular Budget

Number o f Posts

Regular O t h c r 1 - 'I'nLaI

MudseL I Sources ! 1 I I !

46 4 50

25 7 32

! - 7 1 ' 11 1 8 2

-. . ,

4 7 4 51

21 7 , 28 ! 1 l1 i 79

I 38 2 , 40

I

17 1 8 25

55 j 10 1 65

I I / Y l9 8 23 1 5

54

0 t her Sources T o t a l

US$ ~ IISS

1

9

US$

63

1 970 900 i 202 900 1 2 173 aw !

618 600 188 000 1 806 600 1

1 2 980 400

i 2 642 200 i

870 9M)

3 513 100

2 768 ROO

2 589 500 390 900

2 474 000 168 200

563 300 307 600

3 037 300 475 800

505 800 439 200 i 945 000

2 520 000 248 800

3 025 800 688 000 [ 3 713 800

1 I !

2 877 200 212 600 3 OR9 800

511 900

3 389 100

228 900 740 800 I I

441 500 I 3 830 600

PROGRAPME 3.1.1 PRN&\EME PLANNING AND GENERAL ACTIVITIES

Objectives

To s t rengthen planning and management of h e a l t h se rv ices .

Appmachea

By assisting i n s t r eng then ing h e s l t h planning u n i t s , developing planning and management c a p a b i l i t i e s , developing a s u i t a b l e h e a l t h i n f a r m t i o n system f o r planning, management, m n i t o r i n g and evaluat ion o f h e a l t h se rv ices , end conducting country hea l th programming exe rc i ses .

Propmnne Review

Since 1964, h e a l t h planning has been improved i n t h e coun t r i e s of t h e Region through meetings of h e a l t h adminis- t r a t o r s , organizing t h r e e r e g i o n a l courses in n a t i o n a l h e a l t h planning a t t h e Asian Deve lopen t I n s t i t u t e . Bangkok, and providing a s s i s t a n c e t o t r a i n i n g i n s t i t u t i o n s and n a t i o n a l planning and management courses. Assis tance is a l s o being provided through p r o j e c t s on h e a l t h planning on managemat i n Bangladesh, B u m , Ind ia , Indanesia. Mongolia, Nepal, S r i La& and Thailand. A number of f e l l a r s h i p s have been awarded i n t h i s f i e l d .

Country h e a l t h progrDlring h.e taken p lace i n Bpngladesh (1973). Nepal (1974). Thailand (1975) and Burme (1976). It v i l l be done i n l4mgolin i n 1977. This work was f o l l w e d up by formulat ion of p ro jec t s .

An in ter-country p r o j e c t , including a h e a l t h planner and an e c o n r r i s t , has been a s s i s t i n g v i t h t r a i n i n g i n h e a l t h planning e i n c e 1969. I h e p r o j e c t v i l l organize t h e four th r eg iona l course on h e a l t h planning i n 1976. Anather in ter-country p r o j e c t on s t rengthening of h e a l t h se rv ices through t r a i n i n g i n planning, launched i n 1975, a h t o develop n a t i o n a l c a p a b i l i t i e s i n h e a l t h planning and management, including i t s teaching i n t h e schools of publ ic hea l th . Both t h e p r o j e c t s are located a t t h e Asinn Development I n s t i t u t e i n Bangkok.

RopoeaLa for 1978-1979

Health planning v i l l be strengthened i n countr i - of t h e Region by country hea l th programming and through support t o n a t i o n a l p h i n g courses , o rgan iza t ion of r e g i o n a l seminars end vorkshops, a s s i s t a n c e t o p ro jec t s wi th t h e support of u p e r t i e e i n h e a l t h w g a e n t , s y s t e m a n a l y s i s and h e a l t h economics, and f e l l w e h i p s i n hea l th d r i u i s t r a t i o n md p h n a i n g .

Inter-country

Inter-country

Inter-country

1979 Regional

Inter-country

PROGRAMME 3.1.2 HEALTH SERVICES DEVELOPMENT

- p lan , e s t a b l i s h , s t r eng then and improve t h e management of h e a l t h s e r v i c e s through a network of h e a l t h insti- t u t i o n s and by i n t e g r n t j n g h e a l t h programmes i n t o h e a l t h s e r v i c e s , aiming a t maximum coverage and u t i l i z a t i o n . and

- a s s i s t suppor t i ng and r e f e r r a l s e r v i c e s f o r improved h e a l t h care.

/ppmuches

By:

- a s s i s t i n g the development and f u r t h e r s t r eng then ing o f h e a l t h s e r v i c e s , i nc lud ing supporting the e s t a b l i s h - ment and maintenance of va r ious s p e c i f i c components of h e a l t h services, and

- a S 6 i ~ t i n g i n e s t a b l i s h i n g i n s t i r u r i o m . f o r t h e developmenL o f hea l t h s e r v i c e s i n f i nd ing innovat ive approaches t o i nc rea s ing coverage.

The s t r eng then ing of h e a l t h s e r v i c e s and, i n p a r t i c u l a r , of i o t e g r a t e d h e a l t h s e r v i c e s i n r u r a l areas is being pursued i n a l l t h e c o u n t r i e s of t h e Region. Many c o u n t r i e s are e s t a b l i s h i n g h e a l t h u n i t s , each s t a f f e d by a doc to r and a team of a u x i l i a r y h e a l t h workers and covering an average popula t ion of 30 000 t o 100 000 wi th p e r i p h e r a l sub-cent res , each s t a f f e d by one o r two a u x i l i a r y h e a l t h workers cover ing popula t ions of 5000 t o 10 000. Cons t r a in t s i n t h e expansion and u t i l i z a t i o n of h e a l t h s e r v i c e s i nc lude : l a c k of manparer, inadequate supply of d r u g s , i n c f f e c t i v r two-way r e f e r r a l s e r v i c e s , lack of guidance and suppor t t o t h e p e r i p h e r a l h e a l t h worker, n o n - u t i l i z a t i o n i n the h e a l t h s e r v i c e s of t r a d i t i o n a l p r a c t i t i o n e r s , poor c o m u n i c a t i o n s , t h e low q u a l i t y o f services, t h e b r a y workload on i n d i v i d u a l h e a l t h workers, an inadequate concept of team work, l a ck of involvement of the community, and unwi l l ingness of doc to r s t o work i n r u r a l areas. For va r ious reasona. t h e r e i s , i n some c o u n t r i e s , u n d e r - u t i l i z a t i o n of r u r a l h e a l t h f a c i l i t i e s , i nc lud ing low bed-occupancy.

To c r e a t e a h e a l t h i n f r a s t r u c t u r e f o r an i n t e g r a t e d r u r a l h e a l t h and fami ly planning programme, a network of thana h e a l t h complexes and union sub-cent res is being e s t a b l i s h e d i n Bangladesh.

I n Burma, a p i l o t p r o j e c t on i n t e g r a t e d h e a l t h s e r v i c e s i n Kyaukse, cover ing four t o m s h i p s i n Handalay Divis ion , was launched i n 1973. I n t h i s p r o j e c t , the h e a l t h workers i n t h e malar ia . l ep rosy , t ube rcu los i e and trachoma programmes are pooled and, under r e g u l a r s u p e r v i s i o n , form a team of multipurpose h e a l t h workers who cover a de f ined popu la t i on , through v i s iLs t o t h e f a m i l i e s a t pe r iod i c i n t e r v a l s . Spec i a l a t t e n t i o n is paid t o occupa- t i o n a l h e a l t h and h e a l t h s e r v i c e s i n areas of socio-economic development.

In o rde r t o improve t h e e x i s t i n g h e a l t h s e r v i c e s i n I n d i a , a d i agnos t i c s t udy of d i s t r i c t h e a l t h s e r v i c e s has been completed, and consequent improvements a re being made at t h e l e v e l of t h e primary h e a l t h c e n t r e w i th u t i l i z a t i o n of mul t ipurpose h e a l t h workers. To s t r eng then t h e r u r a l h e a l t h s e r v i c e s , a s s i s t a n c e is being g iven t o t r a i n i n g p r a g r a m e s f o r medical o f f i c e r s and f o r t r a i n e r s of b a s i c h e a l t h worker, as w e l l as t o va r ious a s p e c t s of a d m i n i s t r a t i o n , plartning and eva lua t i on of t h e h e a l t h s e r v i c e s . A n a t i o n a l s t r a t e g y on the w e of mul t ipurpose h e a l t h workers tor r u r a l h e a l t h services has heen evolved.

In Indones ia , e x p e r t s i n systems a n a l y s i s , management s c i e n c e , and ope ra t i on r e sea rch are he lp ing t o s t r eng then the hea l t h s e r v i c e s . A Llevltli Centre Reference Manual, i n English and Bahase Indones ia , is under prepara t ion . and vork on a manual for matr rna l and c h i l d h e a l t h s e r v i c e s is i n p rog re s s . P rog raming of h e a l t h c e n t r e and o p e r a t i o n a l r e sea rch i n h e a l t h s e r v i c e s have rece ived p a r t i c u l a r a t t e n t i o n s i n c e 1374.

Progress i n t tea l th coverage is being made i n a l l c o u n t r i e s , p a r t i c u l a r l y i n r ega rd t o t h e s t a f f i n g of p e r i p h e r a l h e a l t h s e r v i c e s , and i t is expected t h a t by 1977 t h e r e s u l t s of t h e e a r l i e r work and o f the o p e r a t i o n a l a t u d i e e on i n t e g r a t i o n of d i s ea se -con t ro l campaigns i n t o genera: h e a l t h s e r v i c e s w i l l have provided f u r t h e r impetus t o ensur ing b e t t e r q u a l i t y and coverage of t h e h e a l t h services. To t h i s MI0 w i l l c o n t r i b u t e through t h e e x i s t i n g programms by promoting t h e exchange ,of t e c h n i c a l in tormat ion among c o u n t r i e s on t h e r e s u l t s o f va r ious s t u d i e s and exper iences . l'he emphasis w i l l con t inue t o be on improvement of p e r i p h e r a l and r u r a l h e a l t h s e r v i c e s . w i th i nc rea s ing a t t e n t i o n t o r e f e r r a l mechanisms and primary h e a l t h care.

By 1977, i t i s hoped t h a t , i n Bangladesh, t h e development of i n t e g r a t e d h e a l t h s e r v i c e s through t h e thana h e a l t h complex w i l l b e w e l l advanced. S imi l a r a c t i v i r i e s in Burma, Bhutan and Nepal w i l l b e evalua ted and f u r t h e r assistance provided. I n I n d i a , f a c i l i t i e s a t primary h e a l t h c e n t r e s v i l l be upgraded and expanded, and a s s i s t a n c e t o t h e t r a i n i n g and u t i l i z a t i o n of muitipurpose workers continued. In Indanes ia , by 1977, about a thousand h e a l t h c e n t r e s w i l l be e s t a b l i s h e d as a r e s u l t of t h e h e a l t h c e n t r e p rog raming . The e f f o r t s of WHO i n Mongolia and Democratic Peop le ' s Republic o f Korea w i l l be concent ra ted on t h e f u r t h e r expansion of comprehensive medical care i n p e r i p h e r a l and r u r a l areas t o improve t h e q u a l i t y of Lhe h e a l t h care.

1976 Regional

Inter-country

1 548 000 ! 168 200

Inter-country

country

Inter-country

Total

1 9 7 9 Regional - Country

Inter-country

Total

30 3 33

2 7 1 , 1 28 I

4 1 5

i I 1 567 200 212 600 1 1 779 800

174 500 78 800 ' 253 300

31

1 552 700 327 600

I

1 880 300

2 033 100 1 741 700 2 291 400 33

PROGlUMC 3.1.3 PRIMARY HEALTH CARE AND RURAL DEVELOPMENT

To expand primary h e a l t h care and co-ordina te w i th r u r a l development aimed a t t h e r e l i e f of pover ty and the improvement of t h e q u a l i t y of l i f e .

By a s s i s t i n g t h e p r o j e c t s having a primary h e a l t h care approach explor ing i nnova t ive approachee i n r u r a l h e a l t h s e r v i c e s , p r o m t i n g p a r t i c i p a t i o n and co-ordina t ion w i th voluntary e f f o r t s f o r primary hea l t h care , developing h e a l t h technology r e l a t e d to primary h e a l t h care. and t r a i n i n g and u t i l i z a t i o n of t r a d i t i o n a l p r a c t i t i o n e r s and v i l l a g e h e a l t h workers f o r i nc rea sed coverage.

F r o g r m e Review

The pub l i ca t i on and wide c i r c u l a t i o n o f t h e J o i n t WHO/UNICEF Study on A l t e r n a t i v e Approaches t o Meeting Basic Health Needs of Popula t ions i n Developing Countr ies ha s s t imu la t ed governments t o implerent primary h e a l t h care p rog rames .

lhe Government of Thai land is g iv ing h igh p r i o r i t y t o r u r a l h e a l t h s e r v i c e s and t o t h e primary h e a l t h care component i n i t , i t haa a l r eady undertaken an i nnova t ive approach by t r a i n i n g t r a d i t i o n a l h e a l t h workers ( t d o n doc to r s and midwives) wi th WHO a s s i s t a n c e i n 1974 and 1975 i n n ine provinces .

I n Indones ia s t u d i e s are under way an t h e r o l e of v i l l a g e h e a l t h promoters i n t h e ex t e rn ion of h e a l t h services t o r u r a l areas. Heet ings on a l t e r n a t i v e approaches t o t h e d e l i v e r y of h e a l t h s e r v i c e s , and on primary h e a l t h care have been held.

Rural h e a l t h s e r v i c e s and primary h e a l t h care are being s t rengthened in I n d i a by t h e use of mul t ipurpose h e a l t h workers (both male and female) .

t)oposaZs for 1978-1979

A s a fo l l a r -up t o count ry h e a l t h p rog raming e x e r c i s e s in Nepal, Thai land and Burma, p r o j e c t s have been formu- l a t e d on b a s i c h e a l t h s e r v i c e s , p r o v i n c i a l h e a l t h care and primary h e a l t h care r e s p e c t i v e l y . I n Nepal, l lear ly 500 a d d i t i o n a l h e a l t h p o s t s manned by a u x i l i a r y h e a l t h workers w i l l b e e s t a b l i s h e d du r ing t h e f i f t h f i v r y e a r p lan ending i n 1979-1980. In Thailand, du r ing t h e per iod of t h e f o u r t h f i v r y e a r p lan . ending 1980-1981, nea r ly 3000 tamban doc to r s , 8000 t r a d i t i o n a l midwives and 22 000 v i l l a g e h e a l t h vo lun t ee r s ( t o cover 50 per c m t of the v i l l a g e s ) w i l l b e t r a ined . I n Burma, a s s i s t a n c e w i l l b e g iven t o t h e t r a i n i n g of trriners of primary h e a l t h workers, t o t h e i n t r o d u c t i o n of a t ube rcu los i s c o n t r o l p r o g r a m e through primary h e a l t h worhrs m d t o t h e use of t r a d i t i o n a l medical p r a c t i t i o n e r s f a r primary h e a l t h care.

Rural h e a l t h s e r v i c e s w i l l b e expanded and improved i n Indones ia by t h e e r t e o e i o n of t h e h e a l t h c e n t r e progr l l l le and the use of primary h e a l t h nurses i n the progr- and, i n Ind i a , by t h e cont inued s t r eng then ing of r u r a l h e a l t h s e r v i c e s admin i s t r a t i on and t h e use of mul t ipurpose h e a l t h workers.


In t e r - coun t ry

T o t a l


In r e r - coun t ry

'Total

1978 R e g i o n a l -

Number of P o s t s

Country 591 500 I 591 500

Estimated Ob l iga t i ons

Inter-coutl tcy 60 900

l o r n 1 3 3 652 400 --

I

T o t a l Regular Budget

Regular Budget

US$

184 200

48 500

232 700

60 900

652 400

Other Sources

I

Other Sources

US$

20 700

20 700

l 1 1

1979 Krgionul - Country


Tot81 ,

T o t a l

US$

204 900

1 48 500

253 400

2 '

I 507 000 1 507 000

I

2

52 000

559 000 ppp

52 000

559 000

I

I I 1 1

!

2 1 1 3

I i

3 !

1

658 200 : 658 200 I

34 000 I 34 000

2

5

1 692 200

2

5

692 200

W O R PROGRAMME 3.2 FAMILY HEALTH

Objectives

To promote the hea l th of the family and improve the q u a l i t y of family l i f e by s t rengthening, as an in teg ra ted se rv ice , maternal and c h i l d hea l th and family planning se rv ices , including n u t r i t i o n , immunization and hea l th education, i n the context of t o t a l camuni ty hea l th services .

Approaches

By:

- a s s i s t i n g i n t h e development and s t rengthening of t h e maternal and c h i l d h e a l t h and family planning se rv ices as an i n t e g r a l pa r t of the general hea l th s e r v i c e s , with the focus on t h e primary care l e v e l ;

- developing of methods and formulation of guidel ines f o r s p e c i f i c a c t i v i t i e s i n family h e a l t h care using simple technology;

- promoting of hea l th manpower planning and t r a i n i n g i n t h e f i e l d of family hea l th ;

- a s s i s t i n g i n the c o l l e c t i o n and dissemination of information s p e c i f i c t o family h e a l t h , r e l evan t t o the care of mothers and ch i ld ren ;

- a s s i s t i n g i n iden t i fy ing and supporting p r i o r i t y areas of research i n family h e a l t h , and

- co l l abora t ing and co-ordinating with agencies and organizat ions i n t e r e s t e d i n the f i e l d of family hea l th .

Programna Review

The Regional programe a s s i s t s countr ies t o develop an in teg ra ted hea l th s e r v i c e capable of de l ive r ing family hea l th care. Comprehensive family hea l th programmes, supported by t h e United Nation8 Fund f o r Population A c t i v i t i e s co-ordinaced with other United Nations agencies , p a r t i c u l a r l y UNICEF, are being implemented i n Bangladeah, Ind ia , Indonesia, Nepal, S r i L a n b and Thailand. Care of the c h i l d and p a r t i c u l a r l y the school- ch i ld has been given increased a t t e n t i o n i n many countr ies .

~ e a l t h manpower planning and t r a i n i n g , t o ~ r o v i d e a s u f f i c i e n t number of adequately t r a ined hea l th personnel f o r family hea l th programmes, has received high p r i o r i t y . WHO has a s s i s t e d i n improving educat ional f a c i l i t i e s i n s t rengthening medical co l l eges and i n developing cu r r i cu la f o r undergraduate and post-graduate education i n f i e l d s of family hee l th . In co l l abora t ion with UNICEF, a s s i s t ance hae a l s o been given t o on-the-job t r a i n i n g and o r i e n t a t i o n courses for f i e l d workers as a preparat ion f o r f i e l d work i n family hea l th . I n S r i Lanka, in-service t r a i n i n g i n family h e a l t h is being introduced i n 1976 f o r p r a c t i t i o n e r s of Ayurvedic medicine as t h i s is a new approach.

Research i n human reproduction has been given emphasis mainly by support , f i n a n c i a l l y and t echn ica l ly , from WHO Headquarters. The e n t i r e range of research a c t i v i t i e s is being undertaken, but s p e c i a l r e fe rence should be made t o the c l i n i c a l research cen t res i n India and Thailand and t h e Research and R a i n i n g Centre i n the All-India I n s t i t u t e of Medical Sciences i n New Delhi, India , as one of t h e four global cen t res .

The s o l u t i o n of na t iona l problems, p a r t i c u l a r l y those wi th s p e c i a l relevance t o expectant mothers and chi ldren is a main concern of the h e a l t h adminis t ra tors . Col laborat ion i n t h e progFammes d i rec ted towards s p e c i a l problems, such as prote in-calor ie ma lnu t r i t ion , n u t r i t i o n a l anaemias, vitamin A def ic iency and g o i t r e continues. Supplementary feeding p r o g r a m s are common f ea tu res i n many countr ies though the degree of coverage end effec- t iveness v a r i e s very widely. Nu t r i t ion surveys , as base l ines for na t iona l programmes, have been conducted i n Indonesia, Nepal and Bhutan. I n Ind ia , t echn ica l guidance was given t o the UNICEF-assisted Specia l Child Rel ief Prograntme and l a t e r t o the Integrated Child Development Service , i n which n u t r i t i o n i s an important component. Recognizing t h e importance of n u t r i t i o n i n the region, t h e Regional Committee f o r South-East Asia decided t h a t t h e sub jec t f o r t echn ica l d iscuss ions during its twenty-ninth sess ion in 1976 w i l l be t h e "Development of na t iona l n u t r i t i o n programmes with s p e c i a l reference t o t h e vulnerable s e c t o r s of t h e population".

The main t h r u s t i n hea l th education i n a l l coun t r i e s is t h e development of h e a l t h manpower i n t h i s spec ia l ty . Apart from basic t r a i n i n g i n hea l th education i n many coun t r i e s , post-graduate t r a i n i n g i s nw a v a i l a b l e i n f i v e i n s t i t u t i o n s i n t h e region. One of the important f ac to re is t h e attempts i n the coun t r i ee t o i n t e g r a t e hea l th education i n t o the hea l th s e r v i c e s , r equ i r ing a l l hea l th workers t o include an educat ional approach i n t h e i r hea l th work. The endeavours to involve t h e community i n hea l th work i n planning as we l l as s e r v i c e are a l s o .. noteworthy.

Proposals for 1978-1979

~ ~ ~ ~ l ~ ~ ~ ~ ~ t of family hea l th se rv ices , e spec ia l ly a t t h e primary care l e v e l , as p a r t of a family hea l th care package, with support ing r e f e r r a l s e r v i c e s , t o provide maximum coverage t o t h e underprivileged population.

Development of a maternal and c h i l d heal th content i n bas ic and post-basic t r a i n i n g programmes, as wel l as t r a i n i n g i n s p e c i a l s k i l l s , such as medical termination of pregnancy, and a l s o the o r i e n t a t i o n t r a i n i n g of profess ionals and a u x i l i a r i e s .

Continuing on-the-job t r a i n i n g of hea l th s t a f f i s being promoted as a r egu la r f e a t u r e i n t h e t imetable of hea l th teams i n t h e region. This , i t i s bel ieved, w i l l have a more l a s t i n g impact on t h e q u a l i t y of t h e hea l th care than once-for-a1l"in-service" t r a i n i n g i n which h e a l t h s t a f f are taken ou t of t h e i r work s i t u a t i o n t o a t t end seminars, e t c .

An increasing preference i s evident f a r providing support t o fellowshipa i n maternal and ch i ld hea l th , which d i r e c t l y r e l a t e t o s e r v i c e needs, a t t r a i n i n g bases wi thin t h e Region or t h e country i t s e l f . Training cen t res a rc being developed f o r the purpose i n S r i L a t h and i n India.

Assistance w i l l be provided f o r t h e establishment and f u r t h e r development of programmes covering p e r i n a t a l care, the pre-school ch i ld and school heal th .

Continued ass i s t ance w i l l be given t o c o n t r o l programmes d i rec ted towards s p e c i f i c n u t r i t i o n problems; main emphasis would be an t h e development of na t iona l n u t r i t i o n a c t i v i t i e s ea an in teg ra ted progr-e, p a r t i c u l a r l y i n operat ional aepeets , t r a i n i n g and research.

In the f i e l d of hea l th education, the main focus w i l l b e on t h e func t iona l in t eg ra t ion of hea l th education i n t o the hea l th se rv ices covering broadly, research, education and t r a i n i n g , planning and se rv ice .

1976 Regional -

Country

Inter-country

Total

1971 Regional -

country

Inter-country

Total

1978 Regional -

Country

Inter-country

l o t a l

1272 Regional

Country

Inter-country

To ta l

Number of Posts

Regular Budget

Regular Budget

US$

406 700

213 300

620 000

540 ZOO

216 200

756 400

914 500

264 200

1 178 700

740 300

236 600

976 900

Other Sources


Other Sources

US$

2 135 900

347 100

2 483 000

1 754 200

254 500

2 008 700

126 200

622 300

748 500

58 400

613 700

672 100

To ta l To ta l

US$

2 542 600

560 400

3 103 000

2 294 400

470 700

2 765 100

1 040 700

886 500

1 927 200

798 700

850 100

1 649 000

11

17

28

1 3

15

28

10

16

26

8

16

24

3 ' 8

8 9 1

11 17

1

I

7 1 6 I

8 7 ! 1 5

9

8

17

7

8

15

13

1 I

8

9

1

8

9

PROGRAMME 3.2.2 MATERNAL AND CHILD HEALTH

a s s i s t Member countr ies i n t h e i r e f f o r t s t o reduce maternal, p e r i n a t a l , i n f a n t and childhood morbidity and mor ta l i ty ;

- a s s i s t i n organizing maternal and c h i l d hea l th s e r v i c e s , including family planning, as an i n t e g r a l pa r t of the general hea l th se rv ices (however maintaining i t s t echn ica l i d e n t i t y ) , and

- provide maternal and ch i ld hea l th care a t primary l e v e l t o t h e maximum number of the population.

- ~ r o v i d i n g t echn ica l guidance i n planning, implementing, monitoring and evaluat ing programmes of maternal and ch i ld heal th and family planning;

- developing of methods and guidel ines f a r s p e c i f i c a c t i v i t i e s i n maternal and c h i l d hea l th and family planning care, including the use of simple technology f o r maternal and ch i ld hea l th care a t t h e primary l e v e l ;

- promoting hea l th manpower planning and t r a i n i n g f o r maternal and c h i l d hea l th and family planning care, including school hea l th se rv ices , and

- promoting research i n the f i e l d of maternal and c h i l d hea l th and family planning o r i en ted to heal th problems, se rv ice and t r a in ing .

Pmgrwme Review

Taking i n t o considerat ion the p reva i l ing s t a t e of hea l th of mothers and ch i ld ren , the WHO Regional programme has i d e n t i f i e d the following p r i o r i t y areas:

(1) s t rengthening of maternal and ch i ld hea l th s e r v i c e s , including family planning, e spec ia l ly a t primary care l e v e l , wi th supporting r e f e r r a l s e r v i c e s ;

( 2 ) h e a l t h manpower planning and t r a i n i n g i n maternal and c h i l d h e a l t h care , including family planning;

( 3 ) s c t i v i t i e e r e l a t e d t o s p e c i f i c hea l th problems of mothers and chi ldren i n the Region, and

(4) research i n maternal and c h i l d hea l th and family planning as an i n t e g r a l pa r t of t h e t o t a l programme.

Development of an in teg ra ted hea l th se rv ice capable of d e l i v e r i n g maternal and c h i l d hea l th and family planning care has been given high p r i o r i t y i n t h e coun t r i e s of t h i s Region. Assistance has been provided by t echn ica l advisory se rv ices by long-term s t a f f and t h e regional reaource group (Regional Family Health Team, ICP XCH 011). Fellowships have been provided, under country p r o j e c t s , f o r maternal and ch i ld hea l th planners. Two i n t e r - country group educat ional a c t i v i t i e s t h a t have relevance t o t h e in teg ra ted se rv ices are being planned in 1976. Group educat ional a c t i v i t i e s i n school h e a l t h se rv ices f o r those engaged i n school hea l th programmes have provided f u r t h e r development of these se rv ices .

Regarding h e a l t h manpower planning and t r a i n i n g t h e cu r ren t undergraduate and post-graduate paed ia t r i c c u r r i c u l a i n the coun t r i e s of the Region have been reviewed and i n some coun t r i e s s u i t a b l e cu r r i cu la developed.

In Ind ia , undergraduate and post-graduate c u r r i c u l a were remodelled with WHO a s s i s t a n c e , and demonstration centres f o r these new c u r r i c u l a have been s e t up t o be used as t r a i n i n g bases. A textbook on c h i l d care is a l s o being developed incorpa ra t ing these concepts.

Following the inter-country seminars, i t is planned t o set up a na t iona l committee on p a e d i a t r i c education i n 1976 i n Bangladesh with WHO as s i s t ance to i n i t i a t e f u r t h e r a c t i o n i n developing a s u i t a b l e undergraduate p a e d i a t r i c curriculum i n t h a t country.

The new emphasis placed on t h e de l ive ry of primary hea l th care by the twenty-seventh World Health Assembly ( r e so lu t ion WHA27.44) has been a g r e a t encouragement t o t h e UNICEFIWHO Course f a r Senior Teachers i n Child Health. F i f t y sen io r paed ia t r i c i ane from t h i s region have so f a r taken p a r t i n t h i s course.

As a r e s u l t of the t r a i n i n g programme i n rehydrat ion therapy, sponsored by WHO, f o r management of acu te d ia r - rhoeal d i seases i n i n f a n t s and ch i ld ren , seve ra l coun t r i e s have now es tab l i shed na t iona l campaigns t o s t rengthen rehydrat ion s e r v i c e s , including t r a i n i n g p r a g r m e s . Assis tance has s l e a been provided, both under country and inter-country programme, i n t h e teaching and p rac t i ce of neonatology.

The fallowing are t h e r eg iona l t a r g e t s f o r t h e reduct ion of i n f a n t and maternal mor ta l i ty r a t e s by 1983:

in fan t mor ta l i ty by 20% with a range of 10-50% ( i n cmpar i son with 1974), and maternal mor ta l i ty by 20% with a range of 10-30% ( i n comparison with 1974).

The main t h r u s t i n t h i s area would be t o provide a s s i s t a n c e t o develop t h e maternal and c h i l d hea l th programme ae p a r t of the general hea l th se rv ices , e spec ia l ly a t t h e primary care l e v e l , wi th the needed r e f e r r a l services . The maternal and ch i ld hea l th programme w i l l be developed wi th in the framework of o v e r a l l s o c i a l and economic development plans of t h e coun t r i e s concerned.

m e s p e c i f i c a c t i v i t i e s wi th in t h i s area would be provis ion of t echn ica l advieory se rv ices . Long-term spec ia l - ists i n maternal and c h i l d hea l th would b e provided f o r Bangladesh, Burma, Mongolia, Nepal. S r i L a n k and t o ma i l and .

Beeed on the f indings of the two s t u d i e s undertaken i n 1976-77 i n Burma and India on p e r i n a t a l morbidity and mor ta l i ty and low b i r t h weight, e se ie t ance w i l l be provided t o these coun t r i e s t o e s t a b l i s h guidel inee f o r the screening and care of t h e high-risk mother, foetue and newborn i n f a n t both i n t h e h o s p i t a l and i n t h e community, and t o develop in te rven t ion s t r a t e g i e s . A group educat ional a c t i v i t y i n t h i s f i e l d is proposed t o be held i n 1978.

Guidelines w i l l he formulated f o r t h e c a r e of t h e pre-schaol c h i l d i n t h e context of primary hea l th ca re , and guidel ines f o r the school hea l th se rv ices , which could be adapted t o l o c a l needs.

WHO maternal and c h i l d h e a l t h t echn ica l o f f i c e r s w i l l p a r t i c i p a t e i n country hea l th programming i n order t o def ine and implement i n t r a - and in te r - sec to ra l po l i c i ea and p r o g r m e s far t h e p ro tec t ion of mothers and children.

The main aim, the re fo re , of the Regional pragrimmue, w i l l b e i n providing a s s i s t a n c e i n teaching maternal and ch i ld heal th (both bas ic and poet-basic) a s s coherent e n t i t y both f o r p ro fess iona l s and a u x i l i a r i e s . With t h i s ob jec t ive i n view, a s s i s t a n c e w i l l be provided t o de f ine a curriculum and design a course f o r in t roducing the teaching of maternal and c h i l d hea l th i n t o t h e undergraduate curriculum and a l s o i n post-basic t r a i n i n g programmes.

In Ind ia , an experimental curriculum f o r teaching maternal end c h i l d hea l th a t undergraduate l e v e l and development of a p a r a l l e l textbook an maternal and c h i l d h e a l t h are being undertaken. A s i m i l a r m u l t i p l i e r e f f e c t has been planned for t h i s p r o j e c t by t h e development of demonstration t r a i n i n g centres .

In Bangladesh, a s s i s t ance w i l l be provided i n 1978-79 t o develop a diploma course i n maternal and c h i l d hea l th f o r physicians engaged i n maternal and ch i ld hea l th and family planning a c t i v i t i e s a t d i f f e r e n t levelrr.

I n keeping with t h e need t o t r a i n key personnel i n c h i l d hea l th i n t h i s Pegion, WHO/UNICEF Course f o r Senior Paed ia t r i c Teachers, e spec ia l ly wi th its never ob jec t ives , w i l l be supported.

Resulting from t h e t r a i n i n g courses i n rehydrat ian, na t iona l t r a i n i n g cen t res have nar been es t ab l i shed i n some of the member coun t r i e s . This work w i l l be continued in 1970-79.

I n 1978. WHO w i l l hold a seminar on t h e p red ic t ive value between high r i s k f a c t o r s and p e r i n a t a l events and i n f a n t heal th . I n the f o l l a r i n g year, a seminar w i l l be organized to plan end f u r t h e r develop p r a c t i c a l s t r a t e - g i e s f o r t imely in te rven t ion programmes for t h e prevention of ma lnu t r i t ion and common in fec t ious d i seases i n the pre-school chi ld .

PKDLIlAMHE 3.2.3 HUMAN REPRODUCTION

Objectives

To improve t h e q u a l i t y of family l i f e , i n view of t h e adverse impact on h e a l t h of t h e r i s i n g population wi th in the Repion, through ass i s t ance i n developing end implementing in teg ra ted family planning programmes.

,?pproui,hes

By:

- ca-ordinating t echn ica l support and co l l abora t ion i n t h e planning, management and evaluat ion of family planning as an i n t e g r a l component of hea l th se rv ices , including primary hea l th care wherever f e a s i b l e ;

- a t t a i n i n g and maintaining an ascending t rend i n the number of acceptors of family planning se rv ices ;

- educating and t r a i n i n g of hea l th personnel i n t h e p r inc ip les and techniques of f e r t i l i t y con t ro l , and

- a s s i s t i n g i n c l i n i c a l and operat ional s t u d i e s i n the f i e l d of human reproduct ion and the provis ion of family hea l th se rv ices .

The Government's programme for population con t ro l and family planning i n Bangladesh envisages a reduction of the r o t e of population growth by 0.2% by t h e end of the F i r s t Five-Year Plan (1978). Thi8 t a r g e t impl ies t h a t 1.1 mi l l ion b i r t h s r equ i re t o be prevented: consequently 1 506 000 couples need t o be e f f e c t i v e l y using contracept ive measures.

Assistance has been provided, under a UNFPA-funded p r o j e c t , t o the n a t i o n a l scheme t o improve t h e a c c e s s i b i l i t y of family planning se rv ices through two b a s i c approaches: f i r s t , a dooratep de l ive ry system, u t i l i z i n g v i l l age - baaed family welfare a s s i s t a n t s . and t h e second, which is complementary t o the f i r s t approach, is to s t rengthen the c l i n i c a l se rv ices so t h a t eventual ly every hea l th f a c i l i t y w i l l become an o u t l e t f o r t h e family planning se rv ice .

WHO has provided t echn ica l advisory se rv ices s i n c e January 1974, and t h e f i r s t phase of a s s i s t a n c e w i l l be completed i n mid-1976.

S t e r i l i z a t i o n has been def ined as one of t h e s t r a t e g i e s s i n c e most of t h e e a r l y acceptors are high p a r i t y couples with a completed family and e t e r i l i z a t i a n is consequently t h e optimal method.

I n India , t he re i s evidence of increasing demand f o r the new f a c i l i t i e s a v a i l a b l e under the country 's medical termination of pregnancy programme. Assistance has been given t o bu i ld ing up t h e n a t i o n a l t r a i n i n g base f a r t h i s programe. Training cen t res are being a ided with t echn ica l advice , equipment, and i n t e r n a t i o n a l fellowsh ips Far sen io r teaching s t a f f .

A meeting was arranged i n 1975 between h e a l t h adminis t ra tors from a l l regions and p ro fess iona l r ep resen ta t ives from the Indian Medical Association and Indian Federation of Obs te t r i c s and Gynaecological S a ~ i e t i e e t o discuss the na t iona l programe. A study tour was a l s o arranged f o r s e n i o r government hea l th officials t o observe the abor t ion programmes i n four other coun t r i e s .

I n Xepal, a s s i s t ance i s being provided to develop the family planning aspec t s of the in teg ra ted hea l th se rv ices i n two d i s t r i c t s i n t h e e a s t e r n region of t h e country. Pending f i n a l approval of the reviaed p ro jec t document f o r WHO/UNICEE/UNFPA assistance, UNFPA agreed, i n November 1975, t o provide fe l lowships t o Nepal i n 1975-76. Under the p ro jec t , a s s i s t ance w i l l be provided i n t h e farm of t echn ica l advisory s e r v i c e s , fe l lowships and study tour s . UNICEF w i l l provide supp l i e s and equipment.

In S r i Lanka, where the population growth r a t e , formerly 2.1% (1972), has f a l l e n t o 1.9%. a good response t o the family h e a l t h p ragrame i s repor ted by t h e ex te rna l review, undertaken i n 1975, of UNFPA-assisted p ro jec t s .

The in ten t ion is t o plan fo r a s t ronger field-based spacing programme.

The ob jec t ive of the na t iona l family planning programme of Thailand a t t h e end of the Fourth Five-Year Plan period (end 1981) is t o reduce t h e population growth from 2.5% t o 2.1%. This would mean providing family planning se rv ices t o 3 029 000 new acceptors and 1 630 107 cont inuing cases, and i t i s envisaged t h a t s i x m i l l i o n married couples w i l l be informed and motivated.

Assistance has been provided under UNFPA funded p r o j e c t s , f o r the expansion of t h e family planning se rv ices i n the Bangkok-Thonburi metropolis. t o make s t e r i l i z a t i o n se rv ices more r e a d i l y a v a i l a b l e wi th in the family hea l th s e r v i c e s , t o ensure t h a t s u f f i c i e n t h e a l t h personnel are appropr ia t e ly t r a ined t o man the na t iona l family planning programme, and f o r t h e extension of family planning and maternal and c h i l d hea l th se rv ices i n t o r u r a l areas i n four north-eastern provinces. I n Bangkok-Thanburi metropol is , the p ro jec t is t o demonstrate the u t i l i t y of the home v i s i t o r approach. The achievements i n t h e s t e r i l i z a t i o n p ro jec t continues t o exceed t a r g e t s .

wl iO has provided ass i s t ance t o Bangladesh t o develop a p ro jec t document f o r UNFPA a s s i s t a n c e f o r the s e t t i n g up of nine mobile s t e r i l i z a t i o n teams. This p ro jec t i s expected t o become opera t ive i n 1976, and continue through 1978.

In Nepal, prapoaals f o r t h e f u r t h e r development of t h e family planning programme within the o v e r a l l development plan f o r t h e F i f t h F iveYear Plan per iod, and t o i d e n t i f y WHOIUNFPA ass i s t ance required, w i l l be developed during 1976 and become opera t iona l i n 1977-1978-1979. ?he demographic t a r g e t f o r t h e F i f t h Five-Year Plan is t o reduce t h e crude b i r t h rate from t h e cu r ren t f i g u r e of 40 per thousand t o 38 per thousand.

In S r i Lanka, t h e emphasis w i l l be s h i f t e d , a f t e r 1976, t o in t roducing throughout t h e se rv ices , rou t ine , on- the-job, heal th- tern t r a i n i n g sess ions a t monthly i n t e r v a l s , using t h e newly developed maternel and c h i l d hea l th f i e l d manual as a b a s i s f o r t h i s a c t i v i t y . Training cen t res in S r i Lanka w i l l a l s o be b u i l t up t o serve as the base f o r an intra-country fe l lowship progrannne. Both of these a c t i v i t i e s are expected t o be f u l l y ope ra t iona l by the 1978-79 biennium.

The substance of the programme i n Thailand during t h e Paurth Five-Year Plan, commencing October 1976 w i l l be to inc rease the r a t e of in t roduc t ion an improvement of family planning se rv ices i n a r e a s with high b i r t h r a t e s , support the provieion of publ ic hea l th personnel a t l o c a l l e v e l , r e v i s e and expand family planning c u r r i c u l a , promote and expand the scope of dissemination of family planning information and publ ic r e l a t i o n s , e s t a b l i s h mobile family planning se rv ice t e a m , and s u p p r t research and t h e improvement of evaluat ion methods.

I t is envisaged i n 1978-79 t o provide a s s i s t ance i n maternal and ch i ld hea l th and family planning t o two pro jec t s , v i z . , the Development of Provincia l Health Care, and t h e Development of Urban Health P ro jec t .

- 1976 Regional

Country

~n te r -coun t ry

Total


Inter-country

Total

1978 Kegianal -

Country

Inter-country

Total


Inter-country

To ta l


Regular Budget

pppp

Regular Budget

Other Sources

Number of Poets

Other Sources Total

I US$

435 000

I , 435 000

1 156 900

156 900

US$

435 000

435 WO

156 900

156 900

i i I

I 1

I

PROGRAMME 3.2.4 NUTRITION

Objectives

To assist in improving the nutritional state of the population, and to aesist in the control of procein-calorie malnutrition and of specific nutritional deficiencies.

- promoting the nutritional activities as a fundamental component of basic health services, particularly those to be delivered through the mrternal and child health programmes:

- assisting the development and evaluation of programmea for the prevention of xerophthalmia, nutritional anaemias and endemic goitre;

- assisting the further development of nutrition component. in the training of medical and paramedical personnel and in poat-graduate training in nutrition;

- assisting the development of national food and nutrition policies and of national systems for nutritional surveillance, and

- assisting the development of programmes for nutritional rehabilitation.

P r c g r m e R e v i a

WHO has assisted nutrition programmes and activities since 1950, and has been instrmental in the eetablishment of nutrition units in the Directorates of Health Services in almat all the countries of the Region. Assi~tsnce haa been given towards the development of prevantive and curative measures against protein-calorie malnutrition, xerophthelmia, endemic goitre and nutritional anaemias - the major nutritional problem in the Region. Regional meetings have been held on endemic goitre (1967), xerophthalmia (1972), nutritional anaemias (1973) and protein- energy malnutrition (1975).

WHO has given assistance for the developent of nutrition cmrponents in the training of both medical and paramedical staff, and for the post-graduate training in nutrition.

~ r o p o s a ~ e for 1078-1970

Assistance to countries in dwvalopinp ard wl..pntinp nutritional activities as components of maternal and child health services.

Continuance of assistance and evaluation of methods a d programes to control xerophthalmia, nutritional anaemias and endemic goitre. The progress achieved in the control of the specific deficiencies will be evaluated in 1979.

Assistance to training programmes in nutrition will be continued. Particular attention will be paid to the training of paramedical and auxiliary personnel on how to give relevant health and nutrition education to the beneficiaries of maternal and child health programmes.

Co-ordingtion and assistance in the development of food and nutrition policies and nutrition services and also in further development of such activities in various fields of nutrition.


Inter-country

Total

1977 Regional

Country

I n t e r c o u n t r y

Inter-country

Inter-country

Number of Posts Estimated Obligations

Regular Budset

2

2

1

2

Regular Budget

US$

83 800

64 300

148 100

91 700

68 300

Other Sources

1

1

2

1

Other Sources

US$

49 800

42 900

92 700

93 900

To ta l

1

3

4

2

2

To ta l

US$

133 600

107 200

240 800 -

185 600

68 300

PROGKAIDlE 3.2.5 HEALTH EDUCATION

- st imulate , encourage and a s s i s t people t o adopt and sus ta in hea l th fu l l i f e p rac t ices , and

- to use judiciously and wisely the heal th services avai lable to them and t o make t h e i r wn decis ions, both individual ly and co l lec t ive ly , t o improve t h e s t a t e of t h e i r heal th and t h e i r environment.

Towarde the attaimnent of the above object ives the heal th education programme w i l l seek to a s s i s t the Member countries:

- to plan, develop, implement and evaluate the educational component of every heal th programme. including those of e l i n i c a l i n a t i t u t i o n s , heal th personnel employed i n each p r o p a m e assming responsibility f o r t h i s work;

- t o plan. develop end implement ax1 educational component i n health-related programmes, auch as those of nu t r i t ion and agr icu l tu re , and co-ordinate these e f f o r t s with those of the heal th workers;

- t o develop school heal th p r o g r a m , including heal th ine t ruc t lon i n primary and secondary schools, as an in tegra l par t of the cur r icu la o f theae i n s t i t u t i o n s ;

- t o develop or expand heal th education curr icula of t h e various pre-service t ra in ing p r o g r a m s f o r heal th professionals such as those f o r phyeicians, nurses, san i ta r ians , e tc . ;

- to carry out research relevant to the se rv ice aspects of heal th education a s wel l a s t o evaluate health education t o determine i t s effecr iveness;

- t o es tab l i sh , t o reorganize o r re-orient health education services st nat ionel , s t a t e , provincial and l o c a l levels of the administration i n order to m e t the needs of the above, and

- to educate an adequate cadre of heal th education s p e c i a l i s t s t o man hea l th education services a t nat ional , s t a t e , provincial or l o c a l l w e l s of the heal th administration and, t w a r d s t h i s end, t o develop, strengthen or re-orient i n s t i t u t i o n s i n the Region f o r the education of heal th education specialists and a l l i e d profes- s ionals .

Programme Review

The recognition of the need t o apply the educational approach i n the so lu t ion of heal th problem end the need to es tab l i sh a mechanism to ensure i t have led to the establishment of heal th education services i n a l l countries of t h i s region. In more recent years, the governments of several countr ies have increased the budget a l locat ions fo r heal th education and have reorganized the ex i s t ing heal th education services. Therefore heal th professionals have increasingly sought t o in tegra te heal th education i n t o the d i f f e r e n t services delivered by them. Experience over the past years has indicated t h a t community leaders should be involved i n the planning, implementation and evaluation of hea l th services from the ear ly s tage and t h e i r i n t e r e s t ~ h o u l d be maintained by appropriate and continuing educational meaeures. Greater emphasis on school heal th education programmes i n some countries of the Region i a e d i r e c t r e s u l t of the increased involvement of the community.

Studies and research programmee a r e i n progress i n d i f fe ren t aspects of family health education and camunica- t ion. Currently f i v e research pro jec t s , supported by grants from WHO Headquarters, a r e i n progress i n India, Indonesia and Thailand. I n addi t ion to these, several s tud ies were undertaken i n Indonesia and S r i Lanka as a part of the s c i e n t i f i c development of family heal th education. The r e s u l t e from these s tud ies have been used to improve programmes.

Past experience has shown tha t t ra in ing of heal th and a l l i e d personnel i n hea l th education should be baaed on spec i f ic descr ipt ions of d a i l y du t ies and respons ib i l i t i es . I n a l l the countr ies of the Region, analysis is being made of heal th workers' d u t i e s and reepone ib i l i t i es and de l inea t ing t h e i r educational components. Prac t ica l and f i e l d oriented t ra in ing progranmpes have been conducted and manuals have been prepared t o a s s i s t hes l th education work a t the f i e l d l e v e l i n India, Indonesia, Nepal and S r i Lanka. Thia approach w i l l be fu r ther tested and revised.

The r e s u l t s of previous a c t i v i t i e s a re such t h a t heal th planners have now recognized the need t o involve hea l th educators and behavioural s c i e n t i s t s i n planning heal th prograomps in an in tens i f ied e f f o r t to secure community par t i c ipa t ion i n the programmes concerned. To equip hea l th educators f o r these enhanced respone ib i l i t i ea , inter-country a c t i v i t i e s focussed on the t ra in ing of hea l th educators i n the methods of evaluation and s o c i a l science research, and on the review and rev is ion of learning resource mater ials used i n the t ra in ing of heal th edtLC3LOr8.

~ l l uf the countr ies of the Region have and a r e planning t o increase the required manpcver i n s p e c i a l t i e s auch as community hea l th education, family h e a l t h education. school hea l th and population educatioa, behavioural sciefices, mass communication, audio-visual education, indigenous media and educational technology. The f i v e

schools or i n s t i t u t i o n s of public heal th i n the Region providing post-graduate t ra in ing i n heal th education a r e n m a b l e t o educate manpower i n s w e of these spec ia l t i es .

Propoants fo r 1878-1078

Although a l l of t h e Member coun t r i e s of t h e Region have i n s t i t u t e d hea l th education i n support of hea l th programes and t o make it poss ib le e s t ab l i shed h e a l t h education s p e c i a l i s t s e r v i c e s , t h e progress made is not uniform i n a l l respects . Therefore t h e r e is a continuing need for WHO a s s i s t a n c e t o a l l coun t r i e s ; t h e emphasis of t h i s a s s i s t ance w i l l , hmever , vary from country t o country depending an t h e development of a p a r t i c u l a r aspect of hea l th education.

The main t h r u s t i n the f u t u r e is t o a s s i s t f u r t h e r i n t h e i n t e g r a t i o n of hea l th education, as an e s s e n t i a l p a r t of the hea l th programme, and t o u t i l i z e more adequate community p a r t i c i p a t o r y methods which w i l l encourage people t o adopt and s u s t a i n hea l th fu l ways of l i f e . I n support of t h i s t h r u s t , audio-visual and mass comunica- t i a n , and hea l th education s p e c i a l i s t s e rv icee should be re-or iented, o r reorganized. There is a l s o s need f o r g rea te r emphasis on the pre-service preparat ion of hea l th p ro fess i ane l s for t h e i r hea l th education re spons ib i l i - t i e s and a corresponding need f o r the t r a i n i n g of h e a l t h education f a c u l t y f o r t h e schools of hea l th prafes- s iona l s . The main ob jec t ive is t o make every h e a l t h worker a b e t t e r and more competent hea l th educator wi thin h i s profess ional f i e l d and t o have the hea l th education s p e c i a l i s t a s s i s t , guide and support him.

There is a l s o a need f a r g rea te r a s s i s t ance f o r the development of school hea l th education as a pa r t of the c u r r i c u l a of primary and secondary schools and of teachers ' co l l eges . I n providing such ass i s t ance , the co l l abora t ion of o ther agencies such as UNESCO and UNICEP w i l l be sought.

Assistance f o r research i n behavioural sc ience re l evan t t o h e a l t h education w i l l continue. Emphasis w i l l , however, be l a i d on operat ional research i n hea l th education i n c l i n i c a l i n s t i t u t i o n s , i n homes and i n communities. Research w i l l also focus on t h e organizat ion of h e a l t h education s p e c i a l i s t s e rv ices and appropr ia te ope ra t iona l procedures.

With these emphasis and continued support f o r hea l th education i t w i l l be poss ib le t o conso l ida te t h e progress i n hea l th education so f a r made i n t h e Region.

1976 Kegional

Inter-country

1977 Regional

Inter-country


Inter-country

Total

1979 Regional -

Country

Inter-country

Total

2

2

2

2

L

3

2

5

2

2

4

3

4

7

2

4

6

332 100

46 300 I

378 400

I

228 600

49 800

278 400

I

' 332 100 i 1 89 400

89 400

82 500

82 500

135 700

467 800

! 228 600

132 300

360 900

MAJOR PROCRAME 4 .1 HEALTH MANPOWER DNELOPMENT

Objectives

- a s s i s t t h e development of t h e ca tegor ie s and numbers of hea l th manpower needed t o provide h e a l t h s e r v i c e s t h a t are adequate and appropr ia t e t o t h e needs of t h e l a r g e s t poss ib le segment of t h e population;

- arrsiat i n planning f o r the t r a i n i n g of s u f f i c i e n t manpower wi th t h e proper knowledge, e k i l l s end a t t i t u d e s f o r the execution of n a t i o n a l hea l th plans and progra-s, including personnel f o r t h e provis ion of primary hea l th c a r e ;

- promate t h e i n t e g r a t i o n o f hea l th manpnrer planning, t r a i n i n g and u t i l i z a t i o n with n a t i o n a l hea l th plans and soeio-economic development, i n co l l abora t ion v i t h t h e general educat ional system;

- promote t h e optimum use of a v a i l a b l e h e a l t h manpower and t o reduce undesi rable migration of t r a ined manpower;

- p r a w t e t h e development and app l i ca t ion o f r e l evan t bas ic and cont inuing educat ional processes (planning, curriculum development, methodology and evaluat ion) f o r a l l ca tegor ie s of h e a l t h personnel;

- prepare t h e n a t i o n a l t o enable them t o apply a systemat ic approach t o educat ional procesees;

- o r i e n t teaching and t r a in ing programmes (basic as well as in-service) t o t h e agreed t a sks t h a t t h e members of t h e hea l th team are t o perform and, where appropr ia t e , t o develop multi-disciplinary t r a i n i n g , and

- promote continuing education i n t h e Region.

A p p ~ m c h e o

By: - promoting t h e concept of t h e i n t e g r a t i o n of h e a l t h manpower planning, ~ r o d u e t i o n and management, wi thin a

coherent system t h a t i s responsive t o n a t i o n a l needs;

- encouraging t h e i n t e g r a t i o n of hea l th manpower planning i n t o the o v e r a l l process of planning f o r socio- economic development;

- promoting t h e func t iona l i n t e g r a t i o n of t h e h e a l t h manpower process wi th t h e development of the h e a l t h s e r v i c e s , through a mechanism ensuring e f f i c i e n t co l l abora t ion and co-ordination between var ious agencies responsible f o r d i f f e r e n t a spec t s of t h e developmat of h e a l t h s e r v i c e s and h e a l t h manpower;

- p a r t i c i p a t i n g i n de f in ing balanced s t a f f i n g pa t t e rns f a r h e a l t h se rv ices a t a l l l e v e l s , including pa t t e rns f o r hea l th teams f o r a a t i a f y i n g the needs o f primary hea l th c a r e ;

- a s s i s t i n g i n t h e t r a i n i n g of teams f o r c m u n i t y - o r i e n t e d h e a l t h work based on t h e complementary na tu re of the r o l e s and funct ions of var ious h e s l t h workers and t h e members o f t h e community;

- promoting t h e s t r eng then ing of t h e manpower component of h e e l t h information systems t o maintain s u r v e i l l a n c e of t h e nu&ers and d i s t r i b u t i o n of h e a l t h personnel;

- preparing p r a c t i c a l gu ide l ines on t h e development of l ea rn ing o b j e c t i v e s , preparat ion of c u r r i c u l a and the development o f teaching programmes and methods f o r t h e h e a l t h personnel, according t o the immediate and long- term hea l th needs of t h e populat ion;

- s t rengthening t h e t r a i n i n g of teachers i n medical and a l l i e d eciences and co-ordinat ion between reg ione l and n a t i o n a l teacher t r a i n i n g c e n t r e s , and educat ional technology u n i t s , and developing a co-ordinated p rograme f o r t h e production, adap ta t ion and disseminat ion of l ea rn ing ma te r i a l s including s e l f - i n s t r u c t i o n e l ms te r i a l s , and teaching a i d s appropr ia t e t o l o c a l requirements;

- evaluat ing the fe l lowships progr-e and formulation of f u t u r e plans f o r fe l lowships t o meet t h e na t iona l p r i o r i t i e s f o r the hea l th and a l l i e d manpower needa, and

- ca-ordinat ing and co l l abora t ing v i t h o t h e r agencies f o r h e a l t h manpower development.

The need f o r a planned development and u t i l i z a t i o n of h e a l t h manpower, a s p a r t of t h e n a t i o n a l h e a l t h p lans , is ell recognized and t h e importance of cu r ren t and long-term planning f o r t h e t r a i n i n g of n a t i o n a l h e a l t h personnel , i n accordance wi th each country 's o b j e c t i v e s , needs and s o c i a l and economic resources , i s s t r e s sed . Support has been provided f o r h e a l t h planning and management p r a c t i c e s , and t h e country hea l th p rograming exercises which have been c a r r i e d ou t i n f o u r coun t r i e s of t h e Region and a n a t i o n a l hea l th manpower s tudy i n another country. It is planned t o undertake t h e country h e a l t h programming e x e r c i s e i n tw more coun t r i e s .

me organ iza t ion ' s a s s i s t a n c e t o t h e progralmne f o r h e a l t h manpower development support8 t h e development of general h e a l t h s e r v i c e s , implying adap ta t ion of educat ional o b j e c t i v e s t o hea l th needs. A team c o n s i s t i n g of s t a f f from WHO Headquarters and t h e Regional Of f i ce v i s i t e d two coun t r i e s of t h e Region to f o s t e r such a concept of i n t e g r a t e d h e a l t h s e r v i c e s and menpower development. This concept a l s o aims a t producing t h e r i g h t "mix" of h e a l t h personnel, both q u a l i t a t i v e l y and q u a n t i t a t i v e l y , f o r h e a l t h and o t h e r s e r v i c e s t h a t w i l l ensure f u l l h e a l t h coverage f o r t h e e n t i r e populat ion.

As an increas ing number and growing d i v e r s i t y of profess ionale , working together i n t e a m s , a r e required f o r hea l th promotion and maintenance, s t u d i e s are being encouraged on hea l th t e a m , including such aspects as t h e i r composition i n var ious l o c a l con tex t s , t h e i r b a s i c and continuing t r a i n i n g , promotion of co l l abora t ive team work between d i f f e r e n t types of hea l th personnel of d i f f e r e n t educat ional l e v e l s , and the impl icat ions f o r t h e i r career s t ruc tu re .

The process of converting t h e personnel of v e r t i c a l d isease-control programmes i n t o multipurpose a u x i l i a r y hea l th workers i s being stepped up i n the Region, so as t o provide coverage t o the population i n the r u r a l areas. I n order t o prepare such workers t o undertake t h e i r broader r e s p o n s i b i l i t i e s , task-based t r a i n i n g , both pre-service and in-service , is being organized.

considerat ion is a l s o being given t o t h e appropr ia te use of cornunity hea l th workers, as we l l as t h e t r a i n i n g of t r a d i t i o n a l hea le r s and b i r t h a t t endan t s , and t o t h e i r co l l abora t ion or i n t e g r a t i o n i n t o t h e hea l th service .

Fur ther , t o provide medical and hea l th care a t the pe r iphe ra l h e a l t h cen t res , and f o r providing supervisory l i n k s between t h e pe r iphe ra l multipurpose h e a l t h workers and t h e h e a l t h c e n t r e s , middle l e v e l workers are being t r a ined (or are planned t o be t r a ined) as medical a s s i s t a n t s .

E f fo r t s are a l s o undernay to r e s t r u c t u r e medical education i n order t o prepare t h e b e t t e r f u t u r e physicians f o r community-oriented work, and need-based c u r r i c u l a are being developed and t r a i n i n g i n the f i e l d p rac t i ce areas introduced.

I n the f i e l d of nursing educat ion, a t t e n t i o n has been paid t o t h e need f a r preparat ion of hea l th personnel i n community hea l th , family hea l th and primary care,and support provided f o r t h e establishment of post-basic nursing p r o g r a m s with the i n t e n t t o produce nurs ing t u t o r s , l eade r s and adminis t ra tors . Assistance has a l s o been provided f o r t h e preparat ion of t u t o r s of midwifery and f o r teaching of t h e a u x i l i a r y nurse midwives. In one country i n t h e Region, the e x i s t i n g nursing programmes are being converted i n t o a programme f o r t r a i n i n g of primary hea l th nurses, and an experimental programme i s being planned f o r the t r a i n i n g of nurses i n the commu- n i t y s e t t i n g , r a t h e r than i n the hosp i t a l .

P r i o r i t y has a l s o been given t o the education and t r a i n i n g of s a n i t a r y engineers , and a s s i s t a n c e provided f o r the preparat ion of c u r r i c u l a i n t h e newer f i e l d s , such as t h e treatment of i n d u s t r i a l wastes.

Recognition of the need f o r an educat ional approach t o t h e s o l u t i o n of h e a l t h problems has l e d t o the es tab- lishment of hea l th education se rv ices i n a l l the coun t r i e s , and h e a l t h p ro fess iona l s have inc reas ing ly sought t o encourage hea l th education as an i n t e g r a l p a r t of t h e var ious se rv ices they provided. Greater emphasis i s being given t o the h e a l t h education of t h e community, school h e a l t h education programmes, and family heal th education.

The two regional teacher t r a i n i n g cen t res i n Sri Lanlta and lba i l and continue t o play important r o l e s i n the development of cu r r i cu la and educat ional technology. The establishment of na t ions1 c e n t r e s f o r teacher t r a i n - ing , educat ional technology, and medical education i s being encouraged.

Specia l emphasis is being given to t h e teaching of humn reproduction, family planning and population dynamics i n medical i n s t i t u t i o n s .

Fur ther , group educat ional a c t i v i t i e s have been he ld t o supplement the development o f h e a l t h manpower, and these have provided continuing education and t r a i n i n g t o a l a r g e nuder of persons a t t ached t o n a t i o n a l hea l th se rv ices and na t iona l hea l th i n s t i t u t e s .

So f a r the t r a i n i n g of physicians has been t h e major concern of WHO'S fe l lowships programme. A study has been undertaken to assess the impact of t h e fe l lowships programme, and the r e s u l t s of t h e study w i l l he lp i n determining the f u t u r e pol icy f o r the award of fellowships according t o the hea l th manpwer needs of the coun t r i e s , including personnel o the r than physicians.

Proposats for 1978-1979

It i s proposed t o provide f o r :

- The i n t e g r a t i o n of h e a l t h manpower planning, production and management i n t o a coherent system responsive t o na t iona l needs, as r e f l e c t e d i n the requirements of hea l th se rv ices and development of appropr ia te mechanism f o r i t s app l i ca t ion .

- Health manpower aseessment and developing na t iona l hea l th manpower p o l i c i e s , plans and programmes based on the outcome of country hea l th programming.

- Formulation of s t a f f i n g pa t t e rns of h e a l t h se rv ices a t a l l l e v e l s , and promotion of a s u i t a b l e machinery f o r h e a l t h manpower development for t h e var ious ca tegor ie s i n t h e h e a l t h team.

- Def in i t ion of job pa t t e rns f o r the var ious types of hea l th workers, and development of guidel ines f o r task- o r i en ted educat ional programes f o r them, keeping i n view t h e f i e l d and p r a c t i c a l t r a i n i n g , team-training, and teacher- t ra ining.

- Development and app l i ca t ion of c r i t e r i a f o r assesement of competence and e f fec t iveness of t r a d i t i o n a l hea le r s and indigenous hea l th p r a c t i t i o n e r s and t h e i r t r a i n i n g f o r use as community h e a l t h workers f o r primary hea l th care.

- Assis tance i n developing t r a i n i n g programmes f o r middle l e v e l workers commensurate wi th t h e i r job requirements according t o the s p e c i f i c needs of t h e country.

- Reor i en t a t i on of the t r a i n i n g programmes f o r phys i c i ans t o make them more comun i ty -o r i en t ed and s u i t e d t o t h e needs of the count ry .

- Assis tance i n developing pos t -graduate and pas t -bas i c t r a i n i n g p r o g r a m , f o r s p e c i a l i s t s and t eache r s f o r a l l c a t ego r i e s of h e a l t h p r o f e s s i o n s , i n o rde r t o a t t a i n s e l f - s u f f i c i e n c y w i t h i n t h e coun t r i e s of the Region.

- Development o r s t r eng then ing , as necessary, of r eg iona l and n a t i o n a l t e ache r t r a i n i n g c e n t r e s , f o r provid ing t h e resources f o r t e ache r t r a i n i n g , advisory s e r v i c e s , t e c h n i c a l suppor t and educa t iona l research, and f o r e f f e c t i v e use of modem advances i n pedagogy and educa t iona l technology and t h e i r adap t a t i on t o l o c a l s i t u a - t i o n s .

- Tra in ing of managers f o r educa t iona l p lanning and p roces se s , management of educa t iona l system and eva lua t i on .

- Improvement of environmental h e a l t h manpower p lanning and development o f rrenuals, guides and o t h e r resources m a t e r i a l s f o r t r a i n i n g .

- Development o f a cadre of nurses as s e n i o r a d m i n i s t r a t o r s who could e f f e c t i v e l y p a r t i c i p a t e i n n a t i o n a l educa t iona l p lans . Ass i s t ance t o b a s i c nu r s ing educat ion , p r imar i l y i n t h e area of r e v i s i n g c u r r i c u l a t o prepare nurses f o r a r o l e more respons ive t o t h e needs of t h e country.

Reo r i en t a t i on o f t h e f e l l a r s h i p s programme t o meet t h e h e a l t h manpower needs of t h e c o u n t r i e s , wi th s p e c i a l emphasis on t h e award of g r e a t e r number of f e l l owsh ips f o r s t u d i e s w i t h i n the coun t r i e s and t h e Region.

Development of a system f a r moni tor ing t h e e f f e c t i v e n e s s and e f f i c i e n c y of h e a l t h workers , and s t r eng then ing t h e h e a l t h i n f a m a t i o n system, ensu r ing feedback of r e s u l t s of moni tor ing i n t o t h e p lanning end product ion elements of t h e h e a l t h manpower process.

1976 Regional

In ter -count ry

In ter -count ry

T o t a l


In ter -count ry

T o t a l

1979 Regional

Country


T o t a l

36

20

1 6

36

14

1 6

30

15

7

2

9

5

2

7

51

27

1 8

45

1 9

1 8

37

1 901 400

1 592 400

408 900

2 001 300

1 568 900

426 000

1 994 900

2 473 600

765 500

355 900

1 1 2 1 400

450 100

225 100

675 200

4 375 000

2 357 900

764 800

3 122 700

2 019 000

651 100

2 670 100

MAJOR PROGWE 5 . 1 COMMUNICABLE DISEASE PREVENTION AND CONTROL

Objectives

To:

- assist i n the development and s t rengthening of the epidemiological su rve i l l ance of communicable d i seases of publ ic hea l th importance;

- a s s i s t i n t h e development techniques and methods and f u r t h e r s t rengthening of those a v a i l a b l e to e l imina te those d i seases which can be eradicated eeononicelly, and t o reduce t h e morbidity and mor ta l i ty from o t h e r communicable d i seases t o the lowest poss ib le l e v e l s ;

- promote t h e i n t e g r a t i o n of communicable d i sease prograwea with t h e general h e a l t h s e r v i c e s ;

- a s s i e t i n t h e achievement of se l f - su f f i c i ency i n t h e production of vaccines by coun t r i e s i n the Region and t o promote t h e establishment of qua l i ty c o n t r o l of vaccines and pharmaceutical products;

- a s s i s t i n the development and s t rengthening of ve te r ina ry publ ic hea l th se rv ices f o r t h e con t ro l of zoonoees, and

- promote the acqu i s i t ion by a l l re levant hea l th personnel t o t h e necessary s k i l l s and knowledge f o r t h e preven- t i o n and con t ro l of communicable diseases .

Approaches

By:

- developing techniques for c o l l e c t i o n and ana lys i s of d a t e r e l a t i n g t o communicable d i seases ;

- developing systems of e a r l y d e t e c t i o n , prompt r epor t ing and e f f i c i e n t response t o outbreaks of communicable d i seases ;

- developing systemat ic techniques of planning and implementation of communicable d i sease con t ro l programmes with b u i l t - i n eva lua t ion ;

- improving t h e r e l i a b i l i t y of techniques of c l i n i c a l and laboratory diagnosis of communicable d i seases and development of s tandard gu ide l ines ;

- developing e f f e c t i v e co-operation and co l l abora t ion between d i f f e r e n t components of hea l th se rv ices i n the prevention and con t ro l of communicable d i seases ;

- s t rengthening of f a c i l i t i e s f o r t r a i n i n g a l l ca tegor ie s of h e a l t h personnel i n c a m n i c a b l e d i seases ;

- promoting na t iona l and i n t e r n a t i o n a l seminars, e t c . , and

developing n a t i o n a l expanded p r o g r a m s of immunization.

Programme Review

Communicable d i seases are still the g r e a t e s t concern of t h e Member coun t r i e s i n t h e Region and w i l l continue to be a p r i o r i t y area during the next decade. The g r e a t e s t success has been the achievement of "zero" s t a t u s f o r smallpox from the Indian sub-continent, s i n c e October 1975. The following are t h e p r i o r i t y areas i n communicable d i sease prevention and con t ro l :

(a) Epidemiological s u r v e i l l a n c e has been f u r t h e r strengthened by providing t echn ica l advice as we l l as i n t r a i n i n g of the na t iona l h e a l t h s t a f f . Prompt and accurate r epor t ing , being developed, w i l l be a good b a s i s for implementing s p e c i f i c prevention and con t ro l measures.

(b) There is a grave concern over t h e r i s i n g incidence of malaria i n the Region. There is a need t o develop a revised a t r e t egy - wi th in the l imi ted resources a v a i l a b l e - with emphasis on preventing mor ta l i ty from mala r i a , maintaining gaine achieved and p ro tec t ing t h e area f o r socio-economic development and concentra- t i o n of e f f o r t s i n problem areas.

(c) I n most coun t r i e s of the Region, tube rcu los i s programme has been in teg ra ted i n t o t h e general hea l th se rv ices with the tendency of combining the tuberculosis and l ep rosy programe. Systematic f i e l d t r i a l s have been c a r r i e d out i n leprosy t o develop t h e bes t poss ib le method f o r c o n t r o l and t o assess the bes t way f o r i n t e g r a t i n g the leprosy con t ro l programme i n t o t h e general hea l th se rv ices .

(d) Gas t ro -en te r i t i s i n f e c t i o n poses a se r ious problem with high r a t e o f mor ta l i ty and morbidity, e spec ia l ly among the ch i ld ren . There is a need t o i n t e n s i f y t h e e f f o r t i n reducing t h e case mor ta l i ty r a t e , f o r ins t ance , by making a v a i l a b l e rehydrat ion therapy up t o t h e pe r iphe ra l l e v e l s .

(e) Denguelhaemarrhagic fever is a s e r i o u s hea l th problem i n a t l e a s t t h r e e coun t r i e s of t h i e Region. Assis tance has been provided i n s t rengthening t h e n a t i o n a l su rve i l l ance programme, i n providing techni- c a l gu ide l ines f o r d iagnosis , t reatment , su rve i l l ance and con t ro l of t h e d i sease and i n e s t ab l i sh ing a research and t r a i n i n g cen t re f o r immunopathology.

( f ) Immunizetian programmes which ex l s t ed f o r one o r lmre d i seases need t o be strengthened i n l i n e wi th the [JHO Expanded Programe of Immunization.

ProposaLs fo r 1978-1379

Preparat ion f e a s i b i l i t y

gu ide l ines f a r a s sess ing t h e i r con t ro l measures.

r e l a t i v e importance Various communicable d i seases and fb)

Assistance i n planning and executing expanded programmes of immunization aga ins t se l ec ted communicable diseases : tuberculosis , d iph the r i a . te tanus , pe r tuas ia , smallpox, measles and pol iomyel i t i s .

Aesistance i n expansion of malar ia con t ro l / e rad ica t ion programme t o cover t h e e n t i r e population at r i s k and i n maintaining s u f f i c i e n t provis ion of a n t i - m l a r i a drugs.

Assistance i n s e l e c t i n g and applying appropr ia t e methods f o r c o n t r o l of vector-borne d i seases , wi th s p e c i a l reference t o malar ia , f i l a r i a s i s and dengue/haemorrhagic f eve r .

Assistance i n planning, implementing and evaluat ing of programmes for con t ro l of mycobacterial d i seaees , leprosy and tube rcu los i s , and o the r b a c t e r i a l d i seases , l i k e tetanu. neonatorum, venereal d i seases and treponematosis, v i r u s d i seases , l i k e denguelhaemorrhagic f eve r , trachoma and po l iomye l i t i s and p a r a s i t i c d i seases , l i k e f i l a r i a - sis and helminthias is .

P r o m t i o n of epidemiological su rve i l l ance of coormunicable dieeaaes , and entomological s u r v e i l l a n c e of vec to r s of important vector-borne diseases .

Promotion of ve te r ina ry publ ic h e a l t h se rv ices , e spec ia l ly for zoonoses.

Assistance i n t r a i n i n g workers i n r e l evan t f i e l d s , e spec ia l ly i n epidemiology and laboratory se rv ices .

Assistance i n biomedical r e sea rch , with p a r t i c u l a r r e fe rence t o t h e p r i o r i t y communicable diseaaee i n the Region.

Promotion of i n t e g r a t i o n of cormnunicable d i sease con t ro l programmes i n t o t h e general h e a l t h services.

Number of Posts

Regular Other Budget / Sources /


Inter-country

To ta l


Inter-country

To ta l


Inter-country

Total 1 58 1 11 1 69


Inter-country

Estimated O b l i g a t i o n s 7

Total 53

Other 1

7 60

PROGRAMME 5.1.2 EPIDEMIOLOGICAL SURVEILMCE

- a s s i s t the Hember coun t r i e s i n developing and s t rengthening t h e i r epidemiological se rv ices ;

- promote in te rna t iona l su rve i l l ance of connnunicable d i seases , e spec ia l ly cholera and smallpox, and

- administer the In te rna t iona l Health Regulations.

Approaciirs

By:

- es tab l i sh ing . maintaining and co-ordinating sources of information involving re l evan t u n i t s i n Member S t a t e s , country and inter-country p ro jec t s . SEAR0 and WHO Headquarters;

- a s s i s t i n g i n the in teg ra t ion of su rve i l l ance end con t ro l of communicable diseases with the general framework of publ ic hea l th se rv ieee ;

- preparing, and assess ing t h e usefulness o f , t echn ica l guides f o r the su rve i l l ance of communicable diseaees, and

- a s s i s t i n g wi th courses i n epidemiology and epidemiological su rve i l l ence aimed a t t h e formulation of a cadre of epidemiologists and the o r i e n t a t i o n of sen io r hea l th adminis t ra tors i n Member countr ies .

Programne Review

Since 1955, governments have been urged t o conso l ida te mass campaigns f o r d i sease con t ro l i n t o permanent h u l t h se rv ices a d s t rengthen the epidemiological se rv ices i n t h e i r d e p l r t l e n t s of hea l th a t e l l l eve l s .

Epidemiological ae rv ices have been receiving complementary i n t e n s i f i e d a s s i s t a n c e i n t h e form of t echn ica l exper t i se and supp l i e s and e q u i v n t and through annual t r a i n i n g courses i n epidemiology (Prague-Delhi), which are aimed a t t r a i n i n g epidemiologists from t h i s region and increasing t h e i r competence in the epidemiology and con t ro l of communicable diseases . A l l coun t r i e s of t h e Region, except t h e DPPX, have a WO-assisted p r o g r a m i n the s t rengthening of epidemiological se rv ices f o r improving e p i d d o l o g i c e l survei l lance. To mswa cc- ordinat ion d i r e c t t echn ica l a s s i s t a n c e , complemented by s p e c i a l i s t consul tant se rv ices has been given s i n c e 1970, through a Regional Epidemiological Survei l lance Tern .

Assistance has been provided t o the Member countr ies i n the improvement of port hea l th cervices, i n epidemio- l o g i c a l su rve i l l ance and i n t r a i n i n g na t iona l s t a f f i n t h e rout ine impl-ntatiao of the In te rna t iona l Health Regulations.

WHO has provided, through group educat ional a c t i v i t i e s , an opportunity f o r sen io r epidemiologists attached t o the epidemiological su rve i l l ance progr-s i n t h e Region, t o exchange experience and methodology with t h e i r colleagues from o the r coun t r i e s and t o acqu i re b a r l e d g e of t h e l a t e s t achievements in t h i s f i e l d .

A Regional Seminar on the Epidemiological Survei l lance of Comunicable Diseases ( Imuniza t ion Rogr-s) was held i n New Delhi i n November 1975 t o review the s i t u a t i o n of immunization i n the coun t r i e s of the Region and discussed the planning, implementation and evaluat ion of immunization programmes.

Assistance w i l l be continued i n developing:

(1) methods of su rve i l l ance and con t ro l of comunicable d i seases through the e x i s t i n g hea l th se rv ices ;

(2 ) methods and procedures f o r the study of epidemiological pa t t e rns of communicable dieeases wi thin the eocio-economic environment of coun t r i e s so as t o formulate prevention and con t ro l s t r a t e g i e s which can be appl ied by the e x i s t i n g hea l th se rv icee , with community p a r t i c i p a t i o n ;

( 3 ) c a p a b i l i t y and capaci ty to s t rengthen work i n the con t ro l and e rad ica t ion of those diseases which can be tackled wi thin na t iona l resources, using current techniques t o maximum e f f e c t , and

( 4 ) a system of b u i l t - i n eva lua t ion and assessment f o r d i s e a s e prevent ion and c o n t r o l

Inter-country

1977 Regional

Inter-country

Inter-country

Inter-country

PROGIUHHE 5.1.3 MAlARIA AND OTHER PARASITIC DISEASES

Objectives

Malaria

TO:

- assist countries in gaining increased control over malaria end eradicating it, where feesible;

- assist governments in the planning and implementation of malaria control/eradicatioo programmes and their evaluation;

- help countries in preventing the re-introduction of malaria in areas where the disease has been eradicated, and

- promote inter-country co-ordination of anti-malaria measures, operational research aimed at developing operational methods, and establishing of manufacturing plants far insecticides and anti-malarials.

Parasitic diseases other than Halaria

To:

- continue efforts at developing and improving filariasis control through the existing health services structure, and

- assist in control of other parasitic diseases, for example schistosdasie and leishmaniasis, and in assessing the magnitude of these problems.

- assessing the public health, social and economic importance of malaria and according to it the priority it deserves for its control/eradicatian;

- developing chemical, biological or other means and methode of control or eradicatioo leading to the interruption of transmission;

- identifying the most effective methods of control in relation to available financial and manparer resources, and of the level of control required where total interruption of trammission is not possible;

- promoting and cc-ordinating assistance from international organizations and bilateral agencies far anti- malaria progr-, field research projects and trials and the establisbnt of rsnufaeturing plants for insecticides and anti-malarials;

- training of the professional and auxiliary personnel required to met the recurring requirements for measures against malaria and other parasitic diseases;

- promoting active community participation in the implementation of anti-malaria programmes;

- stimulating end developing a health infrastructure for strengthening epidemiological surveillance to prevent the re-introduction of malaria to areas vhere the dieease has been eradicated, or to support anti-malaria programmes in progress, or for corrmencing anti-laria masurea in areas where such measures have not yet been begun;

- assieting and co-ordinating regular inter-country crmferences for eo-ordinating anti-malaria measures between neighbauring countries, and

- stimulating and organizing research to support the further development of operational and epidemiological methods.

Zhe spectacular results, in the early 19608, of the eradication p r o g r m of the countries in the Begion have, in recent years, been overtaken by a rising trend in the incidence of malaria. This trend continues, except in Indonesia where there has, since 1974, been a not too insignificant reduction in the n d e r of =laria cases detected.

mere has been no reduction in the difficulties experienced by malaria control and eradication progr-es. Technical limitations and operational constraints have also posed serious probleaa. Six of the welve main vectors have developed resietance to insecticides in use. The levels of resistance have increased and there has been spread of the resistant species to nev geographical areas. Resietance of Ptasmodium faLciparwn to 4-amlnoquinolines is fairly widespread in w o countries with pofkets of resistant atrains detected in three others. Ibe increasing costs of DDT and other inseeticides and their shortage in the wrld market have adversely affected the implementation of anti-malaria progra-s.

In view of technical, operational and financial constraints, e m governments ere now adopting a flexible, long- tern strategy of control operations to maintain the gains achieved and prevent further deterioration of the

malar ia s i t u a t i o n . The programmes i n Bangladesh, Ind ia , Nepal and Thailand a r e o f f i c i a l l y c l a s s i f i e d a s ersdi- ca t ion programmes, though t h e s t r a t e g y developed fo r India i s one of l o n e t e r m con t ro l . Burma. Indonesia, Maldives and S r i k n k a are geared t o con t ro l wi th t h e u l t ima te ob jec t ive of eradicat ion.

The o v e r a l l s t a t e of t h e programmes i n t h e Region is given below:

Number of malarious coun t r i e s in t h e Region 8

Total populat ion i n t h e Region 934 mi l l ion

Population i n o r i g i n a l l y malarious areas 864 mi l l ion

Population i n areas under e rad ica t ion : 119 m i l l i o n

(a) Maintenance Phase (b) Consolidation Phase ( c ) Attack Phase

31 mi l l ion 71 m i l l i o n 17 m i l l i o n

Population i n areas under con t ro l measures: 699 mi l l ion

(a) Protected by v ig i l ance a c t i v i t i e s 354 m i l l i o n (b) Protected by su rve i l l ance

a c t i v i t i e s 98 mi l l ion ( c ) Protected by extensive mosquito

c o n t r o l measures 235 m i l l i o n (d) Protected by organized e f f o r t

of drug treatment 1 2 m i l l i o n

Population i n areas with no s p e c i f i c ant i -malar ia measures 46 m i l l i o n

Since 1974, the malar ia programme i n Bangladesh has been i n t e g r a t e d wi th the genera l hea l th se rv ices , with 34 and 28 mi l l ion population being i n the maintenance and con.eolidation phases r e spec t ive ly and 9 mi l l ion i n areas of p e r s i s t e n t transmission under a t t a c k operat ions .

I n Burma, near ly 21 m i l l i o n , of a t o t a l population o f 30 m i l l i o n , are a t malaria r i s k , receiving p ro tec t ion by d i f f e r e n t an t i -ma la r i a measures, such as ex tens ive posqui to c o n t r o l wi th su rve i l l ance . case-detect ion, t r e a t - ment and f o c a l spraying, and t h e provis ion of anti-malaria drugs.

An in teg ra ted approach t o malar ia c a n t r o l is being developed i n Ind ia and i n the i s l ands of Java and Ba l i in Indonesia. Malathion and HCH are rep lac ing DDT i n I n d i a , &ere vec to r s are r e s i s t a n t to DDT. A planned extended urban malar ia c o n t r o l scheme i n Ind ia would cover 80 urban a r e a s , where l a r v i c i d a l and bio-environmental methods would be undertaken.

I n the o u t e r i s l a n d s of Indonesia, s e l e c t i v e c o n t r o l is ~ l a n n e d t o combat epidemics of malar ia i n areas o f aocio-economic importance and t ranemigret ion.

I n t h e Maldives, t h e programme i s planned t o cont inue as a c o n t r o l programme till t h e hea l th se rv ices are adequately developed f o r maintenance of e rad ica t ion , when i t would be converted t o an e rad ica t ion programme.

External a s s i s t a n c e t o t h e p r o g r a m i n Nepal from 1975, in t h e wake of se tbacks since 1971, would enahle the programme t o regain t h e l o s t ground and achieve an annual p a r a s i t e incidence of 0 .5 throughout the country by 1981.

In S r i L a k e , DDT spraying has become i n e f f e c t i v e over l a r g e a r e a s because of inc reas ing r e s i s t a n c e of t h e vector AnopheZes culicifacies t o DDT. This has necess i t a t ed replacement of DDT with malathion i n a r e a s of socio-economic importance and high incidence o f P. faleipa-. Prospects are b r i g h t of i n t e r r u p t i n g malaria t ransmiss ion through l a r g e s c a l e spraying of malathion.and i f e x t e r n a l a s s i s t a n c e is forthcoming, such spraying should b e underteken wi th e rad ica t ion as t h e ob jec t ive .

The progrsmme i n Thailand i s confronted wi th f i n a n c i a l and opera t iona l problems on the one hand and on the o the r , t echn ica l problems of outdoor r e s t i n g and b i t i n g h a b i t s of major vectors and widespread r e s i s t a n c e of P. foLciparwn throughout t h e country. The p r o g r m o b j e c t i v e is long-term c o n t r o l of the border and mountainous region covering 7 m i l l i o n population and e rad ica t ion as an u l t ima te goal i n the r e m i n i n g a reas .

The f i h r i a s i s m n t r o l pragra-s i n Burma and S r i Lanka have s i n c e been converted i n t o vector c o n t r o l a c t i v i - ties covering a l s o vec to r s o the r than CuZez pipiens fatigans. Detect ion and t reatment of f i l a r i a s i s cases are being taken up by t h e b a s i c hea l th se rv ices . Vector c o n t r o l a c t i v i t i e s have a s i g n i f i c a n t e f f e c t on the hea l th and economic s i t u a t i o n of t h e coun t r i e s .

WHO i a continuing t o a s s i s t Indonesia in a p r o g r m of echia tosomiasis c o n t r o l i n Svlawesi and t h i s a s s i s t a n c e w i l l be extended in t h e f u t u r e i n order t o develop a p r o g r m f o r t h e c o n t r o l of schiatosoniarris and t o prevent i t s spread t o o t h e r neighbouring a r m where t h e d i sease does not exist, bu t where eco log ica l condi t ions m y permit i ts t r a ~ r i s s l o n .


(1) Al l e i g h t coun t r i e s of t h e Region with problems of ma la r i a w i l l b e a s s i s t e d to develop long-term a n t i - malar ia programmes.

(2) Ass i s t ance w i l l be given wi th f i e l d t r i a l s of o p e r a t i o n a l methods of ma la r i a c o n t r o l s u i t a b l e t o i n d i v i d u a l coun t r i e s .

(3) Technica l guidance on t h e implementation of d i f f e r e n t types of an t i -ma la r i a ope ra t i ons w i l l be made a v a i l - a b l e t o a l l c o u n t r i e s .

(4) Ass i s t ance w i l l be g iven i n examining t h e p r e sen t t e c h n i c a l problems encountered i n t h e implementation af an t i -ma la r i a measures, i n o r d e r t o s t i m u l a t e p o s s i b l e s o l u t i o n s .

(5) Ass i s t ance w i l l be g iven t o develop n a t i o n a l manpower by provid ing f e l l owsh ips , and t o s u p p l i e s and t e c h n i c a l equipment and d i r e c t f i n a n c i a l suppor t w i l l be provided t o s t i m u l a t e o p e r a t i o n a l e f f i c i e n c y of the programme i n some or the c o u n t r i e s .

(6) Exchange of t e c h n i c a l i n fo rma t ion between c o u n t r i e s , s c i e n t i f i c t e c h n i c a l t r a i n i n g , and t e c h n i c a l co-ordi- n a t i o n between coun t r i e s w i th common borde r s w i l l be encouraged.

Ass i s t ance w i l l a l s o be provided i n f i l a r i a s i s c o n t r o l a c t i v i t i e s i n a l l t h e c o u n t r i e s of t h e Region and i n assessment of t h e magnitude o f t h e problems of s c h i s t o s o m i a s i s and l e i shman ia s i s .

1976 Regional -

Country


To ta l


In ter -count ry

T o t a l


In ter -count ry

To ta l


In ter -count ry

T o t a l ,


Regular

Number o f Pos t s

Other Regular Budget

Other Sources

To ta l

US$

! 1 097 200

195 400

1 292 600

1 106 600

T o t a l Budget Sources

US$ US5

27

10 !

37

25

9

34

2 1

9

30

19

9

28

1 046 500

195 400

26 1 1 I

10

36 1 1

I

2; 1 l

50 700

226 800

1 279 900

1 042 000

223 400

1 265 400

1 116 800

263 400

1 380 200

33

21

9

30

19

9

28

, 226 800

53 500 1 333 400 - ~

I

i 04' Oo0 223 400

I 1 1 265 400

1 116 800

1 263 400 I

1 380 200 -

1

I

, I

1 241 900 50 700

1 053 100 53 500

PROGWLMME 5.1.4 SMALLPOX ERADICATION AND EXPANDED PROGRAMME OF IMMINIZATION

- reduce t h e morbidity and mor ta l i ty of d i seases preventable by immunization, euch as d iph the r i a , pe r russ i e , te tanus , pol iomyel i t i s , measles and tuberculoeis t o t h e lowest poss ible l e v e l , and

- ensure the cont inuat ion of zero incidence of sml lpox .

Approaclies

By: - a s s i s t i n g coun t r i e s i n planning, implementing and evaluat ing t h e i r expanded programmes of i m u n i z s t i o n ;

- a s s i s t i n g those coun t r i e s where smallpox e rad ica t ion has not been c e r t i f i e d t o s t rengthen r h e i r su rve i l l ance programmes and assess t h e e rad ica t ion programea, including t h e f i n a l assessment to determine t h a t s m l l p o x i s eradicated from t h e Region;

- co-ordinating with t h e nati0n:il immunization programmes i n t h e Region, and

- assess ing the magnitude of thc d i seases preventable by immunization i n each country and i n each ares t o j u s t i f y an expanded p rograwe of immunization.

Progrme Review

With t h e exception of smallpox, which ha6 reached zero incidence in a l l coun t r i e s of t h e Region, and t h e tubercu los i s programme which is being c a r r i e d out t o a varying ex ten t , the e f f o r t t o immunize age ins t most o ther d i seases has been f a r from s u f f i c i e n t t o reduce s i g n i f i c a n t l y morbidity and mor ta l i ty .

Of the countr ies of the Region, Mongolia and t h e DPRK have a comprehensive and nationwide i m u n i z a t i o n programme. I n Indonesia, t r i a l s are undertaken t o determine an e f f i c i e n t and e f f e c t i v e methodology t o expand the e x i s t i n g smallpox/BCG vaccinat ion programme t o include vaccinat ion i n childhood aga ins t d iph the r i a , p e r t u s s i s and te tanus and vaccinat ion of pregnant women with t e t anus toxoid.

Burma i s planning a p r o g r a m of phased expansion, geographically and by including a d d i t i o n a l an t igens i n i t s e x i s t i n g immunization se rv ices . Several S t a t e s i n Iodia have embarked upon a s tarewide u s e immunization pro- g rames . Other coun t r i e s are inves t iga t ing t h e need f o r and f e a s i b i l i t y of expanding t h e i r fmuniza t ion services.

It i e expected t h a t by 1978 a l l coun t r i e s i n t h e Region w i l l have joined t h e expended programme of immunization.

The World Health Assembly i n 1974 reconmended ( re so lu t ion WHA27.57) t h a t "Member S ta te s develop o r maintain immunization and su rve i l l ance p r o g r m s against some or a l l of t h e following d i seases : d i p h t h e r i a , p e r t u s s i s , t e t anus , measles, po l iomye l i t i s , t ube rcu los i s , smallpox and o the r s , where app l i cab le , according t o the epidemio- l o g i c a l s i t u a t i o n i n t h e i r r e spec t ive countries". The Director-General was, i n t e r aZia, requested t o a s s i s t Member S ta te s .

Emphasis was l a i d by the Twenty-ninth World Health Assembly on high p r i o r i t y of the programme end i n v i t e d rhe Director-General t o work out t h e s t r a t egy on a sound s c i e n t i f i c b a s i s .

Assiqtance i n t h e preparat ion of plans of operat ion f a r expanding e x i s t i n g programes of imm~rtization t o meet the needs as demonstrated hy t h e i r evaluat ion.

Estimation of t h e requirements of such programmes and a s s i s t a n c e i n obta ining t h e means and resources t o f u l f i l those requirements.

Provision af f u r t h e r p ro fess iona l t r a i n i n g of na t iona l supervisory s t a f f .

Training o r r e t r a i n i n g of h e a l t h worker* i n s e rv ice condi t ions .

provis ion of guidel ines f o r the preparat ion of na t iona l ope ra t iona l and t r a i n i n g manuals.

Technical improvement of a l l l i nks i n cold-chsins , from t h e producer t o t h e f i e l d .

Assistance t o coun t r i e s i n co-ordinating t h e renources made a v a i l a b l e f o r immunization p ragrames .

Conduct of ope ra t iona l f e a s i b i l i t y s t u d i e s and improvement i n t echn ica l , l o g i s t i c end mangeris1 a c t i v i t i e s i n the f i e l d .

Conduct of ope ra t iona l Fr.*sit , i l i ty s t u d i e s dnd munituring of vaccine q u a l i t y a t producer and user l e v e l and assessment of immunologicsl i i f e c t i v e n e s s .

Evalui t ion of Lhc hea l th e f f e c t s and b e n e f i t s of the programe by initiating and s t rengthening d i sease surverl- lance and repor t ing, and

Bvaluutian of coverage, unit cubt and operational effectiveness with the necessary feedback to improve the service performance.

1976 Regional

Intcr-country

Intrr-country

1978 Kcgional

Inter-country

Inter-country

PROGRAMME 5.1.5 BACTERIAL AND VIRUS DISEASES

To a s s i s t i n the prevention and con t ro l of microbial d i seases of major publ ic h e a l t h importance i n t h e South- East Asia Region, f a r example: cholera , e n t e r i c in fec t ione , te tanue, d i p h t h e r i a , meningoeoccal meningi t is and plague; denguehaemorrhagic f eve r , po l iomye l i t i s , i n f luenza , trachoma end v i r a l h e p a t i t i s ; sexually-transmitted d i seases ; leprosy and tuberculosis.

- improving epidemiological su rve i l l ance and con t ro l of microbial d i seases ;

- con t ro l l ing outbreaks of epidemics of salmonelloses, sh ige l loses and o the r diarrhoea1 d i s e a s e s ;

- pxploring the f e a s i b i l i t y and poss ib le scope of expanding the e x i s t i n g n a t i o n a l programes t o cover more p inlulatinn:

- i I i v w l < p i n g a comprehensive programme for the preparat ion, t e s t i n g and d i s t r i b u t i o n of ant igens f o r virology laboratories;

- de-?loping and co-ordinating research on immunology and microbial d i seases ;

- atrengthening of t r a i n i n g programmes f o r var ious ca tegor ie s of workers, and

- promotitaa low-cost systems f o r r e g i s t r a t i o n , treatment end follow-up of cases of mycobacterial d i seases .

Bac te r i a l Diseases

The Regional Committee f o r Sauth-East A s i a , has paid s p e c i a l a t t e n t i o n t a t h e problem of c o n t r o l of b a c t e r i a l d i seases almost from i t s incept ion. There i s a se r ious problem of gast ro-enter ic i n f e c t i o n s wi th high morbidity and mor ta l i ty r a t e s e s p e c i a l l y among younger age-groups; t h i s problem was reviewed by t h e Regional Committee a t i t s twenty-f i rs t s e s s ion i n 1968.

I n pursuing a pol icy of cholera c o n t r o l and reducing c a s e - f a t a l i t y , a s s i s t a n c e has been provided i n developing a capaci ty f o r the production of rehydrat ion f l u i d s and i n t r a i n i n g i n prompt rehydrat ion through group educa- t i o n a l a c t i v i t i e s and fellowships. The caee - fa ta l i ty r a t e has been considerably reduced (a t present 8% i n the Region), and s t i l l f u r t h e r reduct ion is expected. Less favourable r e s u l t s have been achieved i n the prevention of cholera .

E f fec t ive means of c o n t r o l are a v a i l a b l e i n t h e Region aga ins t o the r b a c t e r i a l d i seases , t h a t i s , d iph the r i a , p e r t u s s i s and te tanus . While no l a r g e outbreaks of these d i seases have been repor ted, t h e i r ex i s t ence and occasional s e v e r i t y i n a l l coun t r i e s i n the Region have been confirmed. Assis tance has been given t o Mongolia i n inrroducing rou t ine immunization aga ins t these d i s e a s e s T r i a l s wi th d i f f e r e n t vaccines aga ins t cerebrospinal meningitis are being c a r r i e d out i n Mongolia. I n o the r coun t r i e s , rou t ine immunization, wi th high coverage, s t lou ld b e poss ible with gradual development of bas ic h e a l t h se rv ices . Inrmunizstion programnee using t h e t r i p l e ant igens (DPT) have been s t a r t e d i n i t i a l l y i n c i t i e s and around hea l th i n s t i t u t i o n a . Assistance has a l s o been provided i n the production of DPT vaccine i n Burma. Ind ia , Indonesia and Thailand. These th ree d i seases are covered i n group educat ional a c t i v i t i e s .

Specia l a t t e n t i o n has been given t o t h e problem of s u r v e i l l e n e e of plague i n some coun t r i e s of t h e Region. Of l a t i . Burma is t h e only country i n the Region repor t ing plague. Assistance i n s u r v e i l l a n c e of t h e dens i ty of r e s t l v o i r s and vec to r s , and t h e i r r e s i s t a n c e t o roden t i c ides and i n s e c t i c i d e s , and i n t h e t r a i n i n g of s t a f f concerned w i l l be continued i n areas where t h e r e are o r have been f o c i of plague.

Virus Diseases

Denguelhaemorrhagic fever has been repor ted f o r seve ra l years as a ser ioua problem i n Burma, Thailand and, more r ecen t ly , i n Indonesia, and as a l e s s e r one i n S r i Lankn and i n pa r t8 of India . WHO haa a s s i s t e d i n t h e eetablishment of na t iona l s u r v e i l l a n c e programmes r e s u l t i n g i n t h e d e t e c t i o n of a l a r g e number of cases end a reduc- t i o n i n f a t a l i t y r a t e s . As a r e s u l t of t h e two meetings of t h e Technical Advisory Corn i t t ee on Dengue/ Haemorrhagic Fever, sponsored by t h e Regional Of f i ces for South-East Asia, and Western P a c i f i c and WHO Head- quar t e r s which met i n Manila i n 1974 and i n Bangkok i n 1975, a research and t r a i n i n g c e n t r e f o r imnunopatholagy has been es t ab l i shed i n Bangkok. Technical guidel ines f o r t h e diagnosis , t reatment , su rve i l l ance , prevent ion and con t ro l of dengue haemorrhagic fever, have been widely d i s t r i b u t e d t o hea l th o f f i c e r s and physic ians dea l in8 with cases of denguelhaemorrhagic f eve r , and a Dengue Newsletter i s being brought out pe r iod ica l ly . j o i n t l y by SEAR0 and WPRO. Tnis is d i s t r i b u t e d throughout bath the Regions with a view t o drawing t h e a t t e n t i o n of hea l th workers and adminis t ra tors t o the l a t e s t information on denguelhaemorrhagic fever end i t s c o n t r o l , and keeping governments informed o f rhe dengue s i t u a t i o n and the con t ro l measures taken i n the coun t r i e s concerned as a b a s i s f o r ca-ordinated o r j o i n t ac t ion .

Inf luenza epidemics have been repor ted pe r iod ica l ly , and su rve i l l ance i s being undertaken through the in f luenza reference cen t res ( i n Boobay and Bangkok) and o t h e r l abora to r i e s .

The trachoma p r a g r m e e i n India and i n Thailand have now been in teg ra ted i n t o the hea l th se rv ices . Burma s t i l l maintains a na t iona l control p r o g r a m undertaking f i e l d t r ia ls of drug regimens and mass t reatment , a f t e r i n i t i a l case-finding, is done by t h e hea l th se rv ices . The Organization continued a c t i v e a s s i s t a n c e to the p ro jec t i n Burma p a r t i c u l a r l y i n programme evaluation.

Vira l h e p a t i t i s has been repor ted as a se r ious problem i n Mongolia and S r i Lanka. WHO ass i s t ance through consul tant se rv ices h a s been mainly towards treatment t o reduce complications.

Pol iomyel i t i s is becoming an important publ ic hea l th problem and has been repor ted from t h e large c i t i e s . p a r t i c u l a r l y from Jakar t a , Bangkok, Rangoon and Delhi. Ihe na t iona l hea l th se rv ices i n these coun t r i e s have included t h i s d i sease i n t h e i r su rve i l l ance programme and a r e proceeding with vaccinat ion of the suscep t ib le ch i ld population groups. WHO has a s s i s t e d t h e governments with t echn ica l advice i n the planning and execution of regular immunization programmes against pol iomyel i t i s and i n the development of vaccine production capaci ty , where technical ly and economically f e a s i b l e .

Sexually-Transmitted Diseases

Control of venereal d i seases was one of t h e ea r ly areas of WHO ass i s t ance , through t h e t r a i n i n g of s p e c i a l i s t s i n venereal d i sease con t ro l , the development of s u i t a b l e t r a i n i n g f a c i l i t i e s and ass i s t ance to na t iona l programes far control of treponematoses. Despite i n i t i a l successes i n reducing t h e incidence of venereal s y p h i l i s and gonorrhoea, i t has not been poss ible to maintain t h i s trend f o r var ious reasons - s o c i a l , economic and biological . With the change of people's a t t i t u d e s towards the danger from sexually-transmitted d i seases and consequent inadequate treatment and self-medicstion, res i r r taot s t r a i n s of gonococci have appeared end i t has been observed tha t cases of bath venereal s y p h i l i s and gonorrhoea are on t h e increase .

Evcobacterial Diseases

Leprosy con t ro l programores have been ca r r i ed out through s p e c i a l campaigns in almost a l l the coun t r i e s of t h e Region and these are gradual ly being in teg ra ted i n t o the bas ic hea l th se rv ices . Cese-finding and regu la r t r e a t - ment are the main con t ro l methods. WHO has aes i s t ed i n t h e t r a i n i n g of var ious ca tegor ie s of na t iona l s t a f f and i n hea l th education of the public. Assistance i n t h e f u t u r e w i l l be continued t o s t rengthen the con t ro l measures, t o provide t r a i n i n g and to u t i l i z e e f f e c t i v e l y drugs , supp l i e s end equipment. These p r o j e c t s have received support from UNICEF and other sources of funds. For t e n years leprosy/BCG t r i a l has been c a r r i e d out i n Mandslay, Burma and is going co continue f o r some time. A t an in ter-country consu l t a t ion on leprosy held i n the Regional Of f i ce i n December 1975 the s t r a t e g y of leprosy con t ro l t o be followed i n the f u t u r e was discussed.

Tuberculosis remains a se r ious publ ic hea l th problem i n a l l Member coun t r i e s i n t h e Reglon. Two WHO-assisted p ro jec t s developed a new s t r a t e g y f o r the con t ro l of tube rcu los i s , v a l i d not only f o r t h i s Region and developing countr ies but a l s o f o r developed countr ies . The s t u d i e s c a r r i e d out a t t h e Tuberculosis Chemotherapy Centre, Madras, India , with a s s i s t ance from WHO, UNDP, t h e B r i t i s h and t h e Indian Medical Research Councils, confirmed t h a t out-pat ient t r e a t m n t of tube rcu las i s cases was no t l e s s e f f e c t i v e than Qanatorium t reatment , from t h e point of v i m of bac te r io log ica l conversion. Operational s t u d i e s i n i t i a t e d by the WHO-assisted p ro jec t in the National Tuberculosis I n s t i t u t e i n Bangalore, Ind ia , on t h e opera t iona l a spec t s of t h e app l i ca t ion of these f indings developed a simple, non-expensive method s u i t a b l e f o r developing a na t iona l tube rcu los i s c o n t r o l programme i n the Region and elsewhere. In Burma, Bangladesh and t h e Maldives, the trenrl has been to carry out combined leprosy and tuberculosis con t ro l a c t i v i t i e s . me Regional Tuberculosis Training and Evaluation Team h a s , over the years , a s s i s t e d i n t r a i n i n g d i f f e r e n t ca tegor ie s of personnel engaged i n the tube rcu los i s con t ro l programmes i n same of t h e countr ies .

From p i l o t surveys of tube rcu los i s i n Member coun t r i e s , i t i s evident t h a t t h e d i sease is of wide prevalence in the Region and is considered t o a f f e c t se r ious ly the economic development.

WHO a s s i s t ance hae been i n t h e form of shor t and long-term s t a f f , fe l lowships and group educat ional a c t i v i t i e s f o r t r a in ing of na t iona l s , supp l i e s and equipment. The na t iona l tube rcu los i s c o n t r o l p rogrsmes a re g radua l ly being in teg ra ted i n t o t h e b a s i c hea l th se rv ices .

Proposals fo r 1978-1979

To expand and s t rengthen epidemiological su rve i l l ance of these d i seases .

Ass i s t i n expanding the nat ional programmes.

Prevent e n t e r i c in fec t ions through ass i s t ance i n promotion of s a f e water suppl ies and improvement of s a n i t a t i o n , e spec ia l ly i n r u r a l a reas .

Reduce mor ta l i ty due t o e n t e r i c in fec t ions by the development of o r a l rehydrat ion programes as an in teg ra l a c t i v i t y of b a s i c heal th services .

Strengthen laboratory se rv ices for b a c t e r i a l , v i r a l and sexual ly- t ransmit ted d i s e a s e s , and re l evan t t r a i n i n g p r o g r m e e .

Support the Expanded Programe of Immunization aga ins t b a c t e r i a l and v i r a l d i seases .

Provide t echn ica l advice and ass i s t ance i n t h e planning, implementation and evaluat ion of na t iona l hea l th programmes i n microbial d i seases .

PROGRAMME 5.1.6 VETERINARY PUBLIC HEALTH

Objectives

To:

- continue and i n t e n s i f y a s s i s t ance t o countr ies i n developing ve te r ina ry publ ic h e a l t h programes and competence i n t h i s f i e l d ;

- a e s i s t i n developing na t iona l roonoses su rve i l l ance end l e g i s l a t i o n ;

- a s s i s t with t h e implementation of food hygiene measures, and

- a s s i s t with t h e promotion of laboratory animal sc iences and primate medicine.

Approdches

By:

- c o l l e c t i n g , analyaing and disseminat ing information;

- a s s i s t i n g in zoonases contro1,foad hygiene, ve te r ina ry publ ic hea l th education and laboratory animal technology, through educat ional a c t i v i t i e s and t h e development of simple s tandardized methods of laboratory f i e l d work app l i cab le a t d i f f e r e n t l e v e l s of t h e community hea l th se rv ices , and

- a s s i s t i n g i n l abora to ry animal technology through t h e dissemination of information, t r a i n i n g , s tandardiza- t i o n , and t h e procurement of seed colonies .

P r o g r m e Review

Rabies and b r u c e l l o s i s ( e spec ia l ly i n Mongolia) continue to be prevalent i n coun t r i e s of t h e Region. WHO has a s s i s t e d governments i n e s t ab l i sh ing na t iona l r a b i e s su rve i l l ance and con t ro l programmes and i n increasing the capaci ty of r ab ies vaccine prcducing i n s t i t u t i o n s ( i n Burma, India , Indonesia, S r i Lanka and m a i l e n d ) . Several surveys c a r r i e d out i n Mongolia have helped t o de f ine t h e ex ten t of t h e prevalence of b r u c e l l o s i s among domestic animals and the danger of i t s transmission t o t h e human population. A r e l a t i v e l y l a r g e capaci ty f o r producing b ruce l l a vaccine f o r use i n domestic animals i s being es t ab l i shed i n Ulan Bator, w i th t echn ica l a s s i s t ance from WHO and f i n a n c i a l he lp from UNDP.

Other aspects of ve te r ina ry pub l i c hea l th , such as food hygiene, con t ro l of food of animal o r i g i n , con t ro l of s l augh te r houses and t r a i n i n g of s t a f f , have been taken up by governments as p r i o r i t y problems. WHO has provided consu l t an t s t o India . Indonesia. S r i Lanka and Thailand t o adviee on these problems. The f i r s t Regional Seminar an Veter inary Public Health s t imulated i n t e r e s t i n t h i s eubject . Two i n t e r - r eg iona l seminars i n 1973 and 1974 covered var ious a spec t s of zoonoses, food hygiene, environmental hea l th and organizat ion of these se rv ices wi th in t h e l imi ted resources of t h e p a r t i c i p a t i n g coun t r i e s . A twa-year Master 's degree course has been es t ab l i shed i n Calcut ta t o f a c i l i t a t e the t r a i n i n g of medical and ve te r ina ry personnel from coun t r i e s i n the Region, and WHO provided consul tants t o a s s i s t wi th i t i n t h e r ecen t years .

In laboratory animal technology support was provided f o r a reg iona l t r a i n i n g course f o r technicians sponsored by the ICMR; s tandards were d ra f t ed and models of cu r r i cu la f o r t h e t r a i n i n g of d i f f e r e n t ca tegor ie s of personnel were evolved a t an inter-country workshop of sen io r s t a f f on small laboratory animals, held i n Bombay i n 1975. Several f e l lmish ips were provided and t r a i n i n g g ran t s swarded f a r advanced t r a i n i n g i n gene t i c s , breeding and i n primate medicine. Assistance was provided by consu l t an t s t o Bangladesh, India . Indonesia, S r i Lanka and Thailand.


The c o l l e c t i o n of d a t a an t h e prevalence of zoonoses and use i t i n i n i t i a t i n g n a t i o n a l c o n t r o l programmes.

The t r a i n i n g and educat ional a c t i v i t i e s i n ve te r ina ry pub l i c hea l th through the provis ion of fe l lowshipa, the development of r eg iona l and na t iona l i n s t i t u t i o n s and consul tant se rv icea i n s p e c i a l areas.

The improvement of t h e q u a l i t y of an t i - r ab ies and an t i -bmce l l a vaccines and inc reas ing t h e i r production and u t i l i z a t i o n .

The improvement of na t iona l f a c i l i t i e s wi th respect t o breeding, SPP technology and primatalogy.

Intcr-country

1977 Xegional

Inter-country

1978 Regional 1 --- 1 ! Country

Inter-country

Total

19711 Kcgional -- Country

Inter-country

Total .

OoO ~ , 9 000

25 500

34 500 I

25 500

30 500

9 500 ! 9 500 I

27 000 j ' 27 000

36 500 36 500

PROGRAMME 5.1.7 VECTOR BIOLOGY AND CONTROL

Objectives

To provide advice and ass i s t ance on the ecology, biology and c o n t r o l of arthropod vec to r s and memmelian re se r - v o i r s of human d i seases and t o recommend how bes t t o adapt and implement appropr ia te con t ro l measures.

Approaches

By:

- s tudying t h e biology and ecology of vec to r s and rese rvo i r s end determining how appropr ia t e c o n t r o l measures might be appl ied, s e l e c t i v e l y a d economically;

- studying the d i s t r i b u t i o n of vectors and rese rvo i r s of d ieeases and r e l a t i n g t h i s t o epidemiological su rve i l l ance i n order t o e s t a b l i s h c r i t e r i a by which information on d i s t r i b u t i o n and d e n s i t i e s of vector and rese rvo i r may be used as an ind ica to r of high-risk areas;

- promoting a na t iona l system of vector su rve i l l ance which could be incorporated i n t o the o v e r a l l g lobal epidemiological su rve i l l ance of vector-borne d i seases and sdvieing the coun t r i e s as t o how such vector su rve i l l ance should be conducted according t o t h e i r p a r t i c u l a r s i t u a t i o n ;

- a s s i s t i n g i n surveying the d i s t r i b u t i o n of vector and rese rvo i r r e s i s t a n c e t o pes t i c ides , and cross- r e s i s t a n c e pa t t e rns which might develop, and ensuring t h a t t h e pes t i c ides u t i l i z e d i n c o n t r o l programmes are e f f e c t i v e replacements f o r those t o which r e s i s t a n c e has a l ready appeared i n the t a r g e t i n s e c t or rodent population;

- a s s i s t i n g i n def ining the magnitude of t h e problems, i n r e l a t i o n t o dengue, denguelhaemorrhagic fever . f i l a r i a s i s . Japanese B. encepha l i r i a end plague, wi th t h e assessment of e x i s t i n g and new methods of c o n t r o l , baeed on chemical, b io log ica l and environmental advances, and, based on t h e i r s u i t a b i l i t y t o implement them i n s p e c i f i c problem areas;

- disseminating information and documentation r e l a t e d t o e x i s t i n g methods f o r t h e c o n t r o l of vec to r s , in termediate hos t s and r e s e r v o i r s , which ere under development or being c a r r i e d ou t by WHOlfield research u n i t s i n vec to r biology and c o n t r o l , n a t i o n a l i n s t i t u t i o n s and research es tabl ishments i n t h e coun t r i e s of the Region;

- providing advice and a s s i s t a n c e i n t h e implementation of con t ro l (as emergency measure) during epidemics, and

- promoting and a s s i s t i n g i n research r e l a t e d t o vector biology and con t ro l , wi th p a r t i c u l a r reference to the so lu t ion of problems fac ing t h e coun t r i e s of t h e Region.


The vector biology and con t ro l u n i t was e s t ab l i shed i n the Regional Off ice from 1 Apr i l 1976.

With the change i n the general approach from malaria e rad ica t ion t o malar ia c o n t r o l , w i th emphasis on an in teg- r a t e d and f l e x i b l e s t r a t e g y , wi th t h e spread of dengue and denguelhaemorrhagic fever and Japanese B.encephaLi- c i s , wi th the increase i n the incidence of f i l a r i a s i a , both i n urban and r u r a l a r e a s , and t h e continued t h r e a t of the reappearance of plague i n t h e knam f o c i of t h e Region, the r ecen t ly e s t ab l i shed VBC u n i t w i l l be c a l l e d upon t o play en increasing r o l e i n the con t ro l of vector-borne d i seases .

I n recogni t ion of t h e importance of vec to r biology and c o n t r o l , s eve ra l coun t r i e s have recons t i tu t ed the p a t t e r n of entomological s t a f f i n g i n t h e hea l th m i n i s t r i e s by c r e a t i n g d i v i s i o n s o r departments of vec to r biology and c o n t r o l or vector-borne d i seases c o n t r o l , e i t h e r wi th in the malar ia programme o r sepa ra te ly .

The Government of Burma, following t h e recent country hea l th programming, s e t up a p ro jec t e n t i t l e d , "Vector- borne Dieeases Control", under which malar ia , denguelhaemorrhagic fever . Japanese B . encepha l i t i s and plague are being considered.

Thia t rcnd i s f u r t h e r i l l u s t r a t e d i n two o the r coun t r i e s , Thailand and Indonesia. In Thailand, t h e Government has , subsequent t o t h e i r country hea l th programming, formulated a p ro jec t "Malaria and Vector Control" which includes c o n t r o l of vectors of denguelhaemorrhagic f eve r , as an i n t e g r a l p a r t of the p ro jec t . In Indonesia, t h e Division of Communicable Diseases Control, under t h e Minis t ry of Health, has s e t up f i v e departments deal ing with ma la r i a , arbo-virus con t ro l , f i l a r i a s i s and schis tosamiasis , zoonoses c a n t r o l and vector biology c o n t r o l under the Sub-division "Vector-borne Diseases Control".

In t h e WHO-assisted p ro jec t s i n Bangladesh, vector biology and con t ro l has been in teg ra ted wi th "strengthening of epidemiological se rv ices" and "epidemiology and d i sease control" , i l l u s t r a t i n g t h e c lose r e l a t i o n s h i p of vector biology con t ro l with epidemiological su rve i l l ance . A UNDPIWHO misaion which v i s i t e d the country i n 1975 s t rong ly recommended the establishment of an Epidemiology and Vector Control I n e t i t u t e .

In other coun t r i e s of t h e Region, the re is recogni t ion of t h e p r i n c i p l e t h a t the va r ious vector con t ro l measures covering d i f f e r e n t vector-borne d i seases have many f e a t u r e s i n comon, as exemplified by the combined con t ro l operat ion f o r malar ia and urban f i l a r i a s i s i n Ind ia , launched through l a r v i c i d i n g opera t ions , and the c o n t r o l of vec to r s of dengue. denguelhaemorrhagic f eve r and f i l a r i a a i a through combined c o n t r o l operat ions i n t h e Maldives and S r i Lanka.

Proposots for 1978-1979

Attent ion needs t o be given, i n order of p r i o r i t y , t o t h e assessment of t h e magnitude of t h e problem of dengue and dengue/haemorrhagic fever , f i l a r i a a i a ; schis tosomiasis , Japaneee 8. e n c e p h a l i t i s , plague, l e i ~ h m a n i a s i s and Kala Azsr, wi th t h e development of con t ro l meaaures app l i cab le t o eech s p e c i f i c s i t u a t i o n .

It is proposed t h a t advisory se rv ices w i l l b e made a v a i l a b l e t o assess t h e e x i s t i n g e i t u a t i o n v i t h development of lona-term pragmatic con t ro l meaeures incorporat ing new technology wherever f e a s i b l e .

Survei l lance and determination of s u s c e p t i b i l i t y o r r e s i s t a n c e t o p e s t i c i d e s i n use i n the coun t r i e s of the Qegion is necessary to ensure t imely de tec t ion of t h e emergence of r e s i s t a n c e and ree i s t ance pat ter- af vectors and t h e i r r e se rvo i r i n order t o implement t imely con t ro l meaeures.

Inter-country group educat ional a c t i v i t i e s are proposed f o r sha r ing experience and t h e diesemination of knowledge i n recent advance* pe r t a in ing r o vector biology and con t ro l .

The eo-ordination and development of research a c t i v i t i e s would be undertaken with s p e c i a l r e fe rence t o p r i o r i t y a r ras recommended by t h e Regional Advisory Comnrittee on Medical Research and the n a t i o n a l needs of the countr ies . P r i o r i t y w i l l b e given t o ope ra t iona l research.

Inter-country

~ n t e r - c o u n t r y

lnter-country

1979 Kegional

Inter-country

PROCRAMHE 5.1.9 PREVENTION OF BLINDNESS

Objectives

To assist in reducing ocular morbidity resulting from preventable causes, restoring sight to the curably blind and rehabilitating the visually handicapped with a view to minimizing social dependancy and maximizing economic development.

Approaches

By:

- providing basic eye health services, as an integral part of the primary health care system at the peripheral level ;

- establishing camprehensive ophthalmic referral services at the intermediate level;

- promoting training of health and allied personnel for community-oriented public health ophthalmology, and

- mobilizing and co-ordinating community, voluntary, national, international and non-governmental resources fur education and training, services and research for the prevention of visual impairment and control of blindness.

Pmjrinru,!e Review

Infections, including trachoma, injuries, xerophthalmia, cataract and glaucoma account far a large percentage of visual impairment a d blindness. Hence consultancy services were provided to Bangladesh, Burma. India, Indoneeia, Sri Lanka and Thailand in the years 1974 to 1976 to assist in assessing the magnitude of the problems, evaluating exieting facilities far community-oriented, public health ophthalmic services and training facilities, and advising on the establishment of eye health care as an integral part of the existing health system.

In 1976, a regional consultative meeting of senior public health administrators and ophthalmologi~te was held to assess the magnitude of the problem in order to formulate strategies, to evaluate existing facilities for community-oriented eye care services, to recommend measures for training and mobilizing resources for establishing servlces in public health ophthalmology and for co-ordinating regional and national activities for the prevention of visual impairment and blindness in the countriee of the Region. Technical assistance was provided for training of health and allied personnel in community-oriented, eye health care services, end for the establishment of training and service facilities at the national, intermediate and peripheral levels.

Pr7r.op~~als for 1.978-1979

Technical assistance will be continued far in-service training of health and allied personnel and strengthening of the undergraduate and post-graduate training curriculum in public health ophthalmology, aimed at providing basic eye health services as an integral part of the existing medical services. Assistance will be provided in exploring the availability of resources for the establishment of training, services and research in community- oriented activities for the prevention of visual impairment and control of blindness.

,


Inter-country

Tutal


Inter-country

'Total

1978 Kegional -

Country

Inter-country

Total

1979 Kegional - Country

Inter-country

Total

Number of Poets

Regular Budget


Regular Budget

US$

16 100

18 5CO

34 600

31530

31 300

Other Sources

Total

--

I

I

j 4

4

4 --- I I

i

4

4

Other Sources

US$

z

387 500

387 500

4

4

4

4

4

4

Total

US$

16 100

18 500

34 600

31 300

387 500

' 41R RIK,

1 I

71 000 I I

71 000

31 000 I 463 700 414 700

- 102 000 463 700 565 700

7 91 900 ! 1 I 91900

48 800 463 700 512 500

604 400 140 700 463 700

EWOR PROGRAMME 5.2 NON-COKWNICABLE DISEASE PREVENTION AND CONTROL

- develop and strengthen epidemiological studies and programmes at national, intermediate and local levels for the identification and the evaluation of mortality and morbidity due to non-comuniceble diseases and to assess its impact an aocio-economic development;

- develop specialized services integrated into the national health programmes far the prevention and control of non-communicable diseases;

- develop and strengthen camunity-oriented comprehensive health care for the prevention and control of non- communicable diseases;

- promote biomedical research and application of recent advances in basic immunologl and human genetics to the control and prevention of nan-communicable disease* of public health importance, and

promote and assist in the development of specialized training in the investigation, prevention and control of non-communicable diseases.

Approachas

By:

- assi~ting in the collection of precise epidemiological data for assessing the magnitude of health problems due to non-communicable diseases and the establishment of priorities for developing control end prevention progrmes;

- identifying national institutions and strengthening their facilities for training, services and epidemiological studies in non-communicable diseases;

- a~sisting in improving the training programmes for the specialized health and allied health personnel required to meet the needs of health services for controlling and preventing non-communicable diseases, as an integral part of the existing health services;

- assisting in establishing pilat-cum-demonstration training projects for the screening of high-risk groups, early detection, prevention and control of non-communicable diseases, including emergency and rehabilitation management procedures, and promoting standardized procedures;

- assisting in strengthening of health education for the prevention of non-cmunicable diseases;

- promoting regional and national co-ordination of these activities, and

- assisting in biomedical research to study the links between the pathogenesis and aetiology of non-colmnuni- cable diseases, various environmental factors and the way of living of the people.

Progrme Review

The extent of the problem, and morbidity and mortality trende of non-cowunicable diseases are receiving the attention of Member States. Precise data on their prevalence are being collected. Comprehensive services for non-communiceble diseases, integrated with the existing general health services, are being developed with e view to reducing morbidity and mortality. The concept of the prevention and control of non-eomunicable diseases is being incorporated into the curriculum for the training of health and allied personnel to enable them to participate in epidemiological investigations, health education, early diagnosis, treatment and rehabilitation.

WHO is promoting the development and strengthening of national health ssevicces for the prevention and control of nan-communicable diseases through 31 country projects end six inter-country projects. This assistance is offered for: epidemiological investigations, incidence surveys, planning of control activities, establishment of pilot-cum-demonstration centres, review of training programs and restructuring of curricula. The diseases dealt with include cancer, cardiovascular diseases,chronic respiratory disorders. blindness and visual impaix- ment, deafness, mental illness and drug abuse. The identification of high-risk groups, the early detection of these diseaaea, emergency treatment, management of the chronic state, rehabilitation and health education are the areas where assistance will reduce morbidity and late disability. Inter-country projects provide for advisory services to Member States and also for group educational activities far administrators, planners, health service pereonnel and professional educators.

A study of the magnitude of the problem has been made. An assessment of the existing facilities in health services for training of health and allied personnel hae been made. Epidemiological investigations have been carried out. Subsequently, group educational activitiee were arpnized in 1973, 1974 a d 1'175 and will be organized in 1'176 and 1977. These aim to stimulate the planning of programmes in cardiovascular diseases, cancer, mental health and control of drug abwe. Vieuel impairment, juvenile diabetes and deafness are some of the other health problems which will receive attention.

The basic strategy for WHO-assisted programnee for control of non-comunicable diseases includes: formulation of national policies; definition of objectives; preparation of mediunr and long-term plans; co-ordination of

a c t i v i t i e s a t t h e inter-country and country l eve l s ; pooling of i n t e r n e l as wel l a s ex te rna l resources, and pa r t i c ipa t ion by t h e community.


l tsaistance f a r developing comprehensive cancer con t ro l a c t i v i t i e s w i l l be continued t o many coun t r i e s i n t h e Region. Areas se lec ted f o r assistance i n prevention and con t ro l of cardiovascular d iseaaee a re : rheumatic fever and hea r t d i sease , treatment of myocardial i n f a r c t i o n and r e h a b i l i t a t i o n of p a t i e n t s , hypertension and s t roke , end chronic r e sp i ra to ry d i so rde r s . Consultant se rv ices w i l l b e given t o epidemiological inves t iga t ion and the t r a i n i n g of hea l th personnel i n the prevention a d c o n t r o l a€ o t h e r non-comnunieable diseaeelr, such as v i s u a l impairment, deafness, b ronch i t i s and asthma. An assessment of t h e magnitude of the mental hea l th problem, t r a in ing of t h e required psych ia t r i c personnel and organizat ion of community-oriented mencal hea l th se rv ices w i l l be promoted through country projects . Programmes w i l l be developed f o r t h e prevention and con t ro l of alcoholism and drug dependence and abuee in B u m , Ind ia , Indonesia and Thailand. With a view t o s t imulat ing na t iona l programes for s t rengthening measures for the c o n t r o l and prevention of some common non- communicable diseases , t h e study and management of p e r i p h e r a l v a a c u l a r d i seases and of immunology in diagnosis and treatment of l i v e r cancer, have been se lec ted f o r group educat ional a c t i v i t i e s and s t imula t ing biomedical research.


Inter-country

Total


Inter-country

Inter-country

1979 Regional

Inter-country

Number of Posts

Regular Budget

1

3

4

2

3


Regular Budget

USS

721 100

78 400

799 500

753 200

99 000

Other Sources

Total

1

3

4

2

3

Other Sources

US$

147 000

147 000

219 000

To ta l

US$

868 100

78 400

946 500 -

972 200

99 000

PROGRAMME 5.2.1 PROGRAMME PLANNING AND GENERAL ACTIVITIES

Objectives

- promote epidemiological and demographic studies for the identification and assessment of the problem of non- communicable diseases;

- assist in the development of health manpower required for promoting comprehensive prevention and control programmes integrated with the existing health service system;

- improve registration, early diagnosis through screeniag risk groups, fadlitlea for treatment, rehabilitation and follow-up aystem, and

- mobilize community participation, through health education, for the prevention and control of non-communicable diseases identified for priority public health action by governments.

Approaches

By:

- promoting a system far registration, based on informstion from hospitals and other sources, ultimately leading to the establishment of national registries far non-communicable diseases of national importance:

- standardizing criteria for diagnosis, treatment and epidemiological investigation;

- providing advice on and assistance with the introduction of the International Classification of Diseases and common forms or protocole developed for collaborative epidemiological and control studies;

- ~roviding information on recent advances in the field through documentation services to institutions developing research service and training programme;

- identifying risk groups, screening for early diagnosis, developing patterns of compreheneive community- oriented control measures integrated into the existing health measures, evaluating with provision for feedback, organizing services, training health and allied health personnel, planning and administration of medium and long-term programes for control and prevention and provision of an adequate infor=tion system for the prevention of non-communicable diseases:

- identifying national institutions and their strengthening to pronote leadership, training, development of patterns of service, construction of curricula for training epecialized health personnel and co-ordination of biomedical research in non-communicable diseases;

- establishing a clearing house for information an a regional basis for the dissemination and exchange of information on chronic and degenerative diseases of regional importance, and

- co-ordinating activities at the national level for enhancing performance, through pooling of resources from the community, national, international and non-governmental agencies.

Progrmrrie; Review

Cancer, cardiovascular diseases, visual impairment and blindness due to malnutrition, infection and cataract, psychiatric disorders including drug dependence, juvenile diabetes, rheumatoid arthritis, asthma, bronchitis, tropical eosinophilis, allergy, nephritis and deafness are some of the merging health problems identified under non-communicable diseases for public health action for their control and prevention.

Proposals f o r 1378-1973

kssistanee will be given for the development of progranrmes in cancer, cardiovascular diseases, chronic respiratory disorders, mental health, drug abuse and visual impairment and blindness, and deafness, through the establishment of pilot projects, the strengthening of national institutions for the training of specialized health personnel, the establishment of systems of registration for assessing the magnitude of the problems, promoting biomedical research and improvement of community-oriented health care service for prevention, treatment, rehabilitation and health education.


Inter-country

Total

1977 Kegional --

Country

Inter-country

Total


Inter-country

Total


Inter-country

'Total

Eotimated Obligations

Total

US$

44 300

44 300 -

47 700

47 700

2

2

2

2

2

2

2

2

Regular Budget

US$

44 300

44 300

47 700

47 700

Number of Posts

Other Sources

US$

Regular Budget

2

2

Other Sources

I

i i

2 1 2

2

2

2

2

51 400 i 51 400

i 1

55 100

55 100

51 400

51 400

I

55 100

55 100

PROGRAMME 5.2.2 CANCER

Dbjectiues

TO:

- assess the magnitude of the problem and the morbidity and mortality trends in cancer;

- assist countries in the formulation of national cancer control plans;

- strengthen general health services for comprehensive and integrated activities for health education, early detection, registration, diagnosis, treatment, follow-up and rehabilitation, based on experience gained in cancer control pilot projects, and

- assist in the development of specialized health and allied health manpower for services, training and research in cancer.

By: - providing technical guidance in the development of cancer control programmes, with special reference to

early detection and new methods of treatment;

assisting in the identification of high-risk groups within the population and in promoting the development of methods far monitoring such groups;

assisting in prevention, through educating the medical and allied health personnel and the public in cancer control;

- promoting epidemiological investigations and the establishment of cancer registries;

assisting in the development and application of new methods of diagnosis and treatment of cancer and precancerous conditions;

- establishing regional collaboration, exchange of information and co-ordination of activities with relevant bilateral and international programmes in the field of cancer control and research;

- establishing national and regional oncologicel training centres, and

- developing teaching aids and manuals.

An inter-country seminar on the epidemiology of cancer with special reference to countries in South-East Asia was held in 1973, under the joint auspices of the Indian Council of Medical Research, the International Agency for Research in Cancer and WHO. The seminar discussed strategies for cancer control, formulated certain recommendations and evolved guidelines for WHO assistance. One of the recommendations of the seminar vas that countries selected for cancer control projects in the first phase should be those with no organized or internally-assisted cancer prograinme at national level, and that during the second phase WHO-assisted activities should cover all countries in the Region; a regional training course fo-c registration and an early detection programme were also recommended.

An IAEAIWHO seminar on Afterloading Techniques in Radiotherapy Particularly Related to the Treatment of Cancer of the Uterus was held in Hyderabad, lndia in February 1975. In October 1975, in collaboration with the Indian Council of Medical Research, a regional symposium was held on chronic liver diseases, including liver cancer, in countries of South-East Asia. The importance of public health measures in the prevention of infective hepatitis and fungal contamination of food was highlighted.

Cancer control activities are being assisted in Bangladesh. Burma, DPRK, India. Indonesia. Mongolia and Sri Lanka. In Burma and Indonesia, training programmes for cytorechnicians, cytotechnologists and cytopathologists have been developed. In India, assistance to the cancer control pilot project in Kancheepuram, Tamil Nadu, has been provided, and further WHO support will be given to the establishment of regional cancer centres, as recornended in the report of the Cancer Assessment Committee. In Mongolia, the Oncalogical Centre in Ulan Bator is being strengthened and epidemiological studies on liver cancer are being supported. Bangladesh, DPRK, Nepal and Sri Lanka ere to be assisted in developing integrated and comprehensive cancer cantrol programmes.

F r o p ~ a Z a for 1978-1979

Oropharyngeal and cervical cancer is seen in most of the countries of the Region. Establishment of a training centre for the management of oropharyngeal cancer and possibly for cervical cancer with assistance from DANIDA and SIDA is being explored. An institution will be identified to train cancer epidemiologists and another strengthened to demonstrate early detection and management of cervical cancer and assisted in strengthening this programme. Through inter-country, group edcuatianal activities, it is planned to stimulate cancer prevention and treatment and evaluation of national cancer control activities, including management aspects of the programme Biomedical research on liver cancer and cirrhosis, and studies on osophagealcancer will be promoted.

Consultants will be provided and fellowships awarded for training in oncology, to Bangladesh, Bur=, DPRK, India, Indonesia, Mongolia and Sri Lanka to assist with the development of comprehensive cancer control activities within the existing health services. Pilot demonstration-cumtraining projects will be assisted. Bational institutions will be strengthened so that they can conduct epidemiological investigations, train specialist

hea l th personnel and develop p a t t e r n s of c o n t r o l f o r t h e commonly seen types of cancer. Asaietance w i l l be continued i n e s t ab l i sh ing cancer r e g i s t r i e s , measures f o r t h e e a r l y d e t e c t i o n of cases and s t andard iza t ion of treatment with chemotherapy and radiotherapy. Health education f o r t h e prevention end c o n t r o l of cancer w i l l b e promoted.

Resources f o r cancer con t ro l , r e c e n t developments in cancer , management aapects of cancer c o n t r o l prosramme, early de tec t ion o f cancer, immunology of cancer and treatment o f c e r v i c a l cancer are the top ics se l ec ted f o r group educat ional a c t i v i t i e s i n 1978-1979.

1976 Regional

Country

Inter-country

Total


Inter-country

1978 Regional

Inter-country

1979 Regional

Inter-country


Regular Budget

US$

159 200

159 200

227 700

Number of Posta

Regular Budget

o the r Soutees

US$

84 000

84 000

Ocher sources ' Tota l

US$

243 200

243 200 -

227 700

Inter-country

1977 Regional

Inter-country

Inter-country

1979 Regional

Inter-country

PROGRAMME 5.2.4 OTHER CHRONIC NON-COMWNICABLE DISEASES

Ob jectivee

- i d e n t i f y and assess hea l th p rob lem due t o non-communicable d i seases of publ ic hea l th importance o t h e r than cancer, cardiovascular d i seases and mental h e a l t h , and prepare comunity-based publ ic hea l th con t ro l programmes, f o r example, e i r r h o e i s of t h e l i v e r , d i abe tes , deafness , u r a l i t h i a e i s and rheumatoid a r t h r i t i s ;

- promote the inc lus ion of community-oriented publ ic hea l th concepts i n t h e t r a i n i n g of h e a l t h and a l l i e d hea l th personnel and a s s i s t i n evaluat ing t h e r e a u l t s of t h e t r a i n i n g , and

- a s s i s t i n the formulation of na t iona l p o l i c i e s and l e g i s l a t i o n , and i n t h e co-ordination of na t iona l and i n t e r n a t i o n a l resources.

Approaches

By:

- promoting epidemiological and c l i n i c a l inves t iga t ions i n non-communicable d i seasee of n a t i o n a l hea l th importance with s p e c i a l r e fe rence t o e thn ic , s o e i a l , c u l t u r a l and economic condi t ions i n the country;

- s t imula t ing t h e exchange of r ecen t f indings and experience i n the f i e l d s of epidemiology, prevent ion, treatment and s p e c i a l s e r v i c e s ;

- a s s i s t i n g i n t h e es tabl ishment of comprehensive and progress ive comuni ty-or iented b a s i c h e a l t h care se rv ices a t t h e ~ e r i ~ h e r a l l e v e l and comprehensive r e f e r r a l se rv ices a t the in te rmed ia te and c e n t r a l l e v e l , and

- promoting the t r a i n i n g of hea l th and a l l i e d personnel and development of hea l th education f o r the community.

Programme R e v i a

A Regional Symposium on Vesical Calculus was held i n Bangkok i n 1972 t o review t h e occurrence of b ladder s tone d i sease i n the coun t r i e s of t h e Region, d i scuss approaches f o r in t roducing prevent ive measures and s t i m u l a t e epidemiological and b a s i c s t u d i e s on u r o l i t h i a s i s .

A second symposium on u r o l i t h i a s i s was j o i n t l y sponsored by WHO and t h e Fogarty I n t e r n a t i o n a l Centre. National I n s t i t u t e of Health, Bethesda, USA t o develop plans f o r research aimed a t prevention. P a r t i c i p a n t e i n the symposium included rep resen ta t ives from South-East Asia coun t r i e s .

iroposoli; fofor 1978-1979

Epidemiological i n v e s t i g a t i o n s on b ronch i t i s , asthma and t r o p i c a l eos inoph i l i a w i l l be a s s i s t e d . Services f o r the management of r e s p i r a t o r y , emergencies and r e h a b i l i t a t i o n of chronic pulmonary d i so rde r s of a non-infective nature w i l l b e s t rengthened.

The prevent ion of deafness and treatment and r e h a b i l i t a t i o n of deaf p a t i e n t s w i l l be a s s i s t e d through school hea l th s e r v i c e s and community-oriented s c t i v i t i e a f o r t h e c o n t r o l of noise .

WHO a s s i s t a n c e w i l l a l s o b e a v a i l a b l e f o r epidemiological inves t iga t ion of d i a b e t e s i n t h e young due t o c a l c i f i c p a n c r e a t i t i s occurr ing i n aome coun t r i e s of t h e Region.

Renal and bladder s t a n e damage t o t h e kidney i s seen i n a number of coun t r i e s i n t h e Region and s t u d i e s of the pathogenesis and measures f o r prevent ion w i l l r ece ive a s s i s t ance .

h s i s t a n c e w i l l be provided f o r t h e s tudy and prevention of chronic l i v e r d i s e a s e s due t o i n f e c t i v e h e p a t i t i s , mycotoxicosis and o t h e r tox ie f ac to r s .

The study of environmental pathology i n r e l a t i o n t o t h e prevalence of non-communicable d i s e a s e s w i l l be promoted through group educat ional a c t i v i t i e s .


I n t e r - c o u n t r y

T o t a l

1977 Keglanal -

Country


T o t a l

1978 Regiona l - Country

I n t e r - c o o n t r y

T o t a l

1979 I < ~ g i r l o ; l l -- Cuunrry


T o t a l -

Nu&er of P o a t a I Egt ims ted O b l i g a t i o n s

T o t a l

US$

3 5 400

3 5 400

Other S o u r c e s

US$

Regula r Budget

US$

3 5 400

35 400

44 000

44 000

I ' 56 200 I i J

'

1 I I I

T o t a l Regula r Budget

44 000

44 000

56 200

56 200

Other Sources

1

I 56 200

I

i 1

47 500 1 47 5oo

! I

47 500 47 500

PROGRAHWE 5.2.5 ORAL HEALTH

- assist i n t h e development, promotion and implementation of e f f e c t i v e den ta l pub l i c hea l th programmes f o r t h e prevention and c o n t r o l of o r a l and d e n t a l d i s e a s e s , and

s t r eng then den ta l hea l th educat ion, t r a i n i n g , se rv ices and research.

Appmachea

By:

- a s s i s t i n g i n s t rengthening den ta l h e a l t h manpower and se rv ices f o r ~ r e v e n t i v e d e n t a l h e a l t h s e r v i c e s , and

- promoting epidemiological s t u d i e s r e l a t e d t o o r a l and den ta l h e a l t h problems.


The need for more d e n t a l heal th care and s e r v i c e s w i l l continue i n most coun t r i e s i n the Region f o r a consider- ab le time t o come. E f f o r t s t o develop se rv ices i n accordance wi th the a v a i l a b l e resources and d i rec ted towards the main problems i n o r a l and den ta l hea l th w i l l continue t o r ece ive a t t e n t i o n . Assis tance w i l l continue t o concentra te on the development o f s u i t a b l e d e n t a l h e a l t h manpower i n Burma, Indonesia, Mongolia and S r i Lanka. A n a t i o n a l seminar on pub l i c h e a l t h d e n t i s t r y was conducted i n India i n 1975 f o r prepar ing c u r r i c u l a f o r t r a i n - ing of den ta l and a l l i e d personnel i n publ ic hea l th den t i s t ry . In Burma, the a u x i l i a r y personnel were t r a ined to undertake prevent ive and c u r a t i v e se rv ices . A den ta l equipment engineer t r a ined s t a f f in the r e p a i r and maintenance of d e n t a l equipment.


kss i s t ance f o r t h e development, s t rengthening, implementation and evaluat ion of programmes f o r prevention and con t ro l of orodental d i seaees .

Assistance for prevent ion and e f f i c i e n t methods f o r an orodental h e a l t h de l ive ry system.

Training of d e n t a l personnel , including a u x i l i a r i e s , f o r undertaking prevent ive and c u r a t i v e d e n t a l se rv ices .

Assis tance f o r t h e maintenance of d e n t a l equipment.

*

1976 R e g ~ o n a l - Country

Inter-country

loca l


Inter-country

To ta l

1978 Regional - ~ o u n t r y

Inter-country

To ta l


Inter-country

T o t a l .

Number of Posts >

Regular Budget

I

Tocal

US$

I

105 700

1 105 700

113 100

113 100

' 115 100

115 100

I 181 700


Other Sources

Regular Budgec

US$

To ta l

1

1

1 I

1

1

1

1

1

1

Other Sources

US$

1

1

1

1

1

1

1 181 700

105 700 1

105 700

I

73 500 39 600

73 500 39 600

loo I 115 100

181 700

181 700

PROGHAI.I?lE 5.2.6 MENTAL HEALTH

- promote mental hea l th , including prevention and treatment of alcoholism and drug dependence;

- reduce mental end neurological morbidity and i t s consequences, and

- a n s i e t i n developing na t iona l community mental hes l th se rv ices through b e t t e r u t i l i z a t i o n of mental h e s l t h resources and exper t i se .

Appr~,i::hes

By:

- promoting the n a t i o n a l co l l ec t ion and ana lys i s of mental heal th informat ion;

- disseminating recent f indings and s t imula t ing exchange of experience on: the e t io logy , prevention and t r r a t - ment of mental i l l n e s s end problems associa ted with t h e non-medical use of dependence-producing drugs; the planning, organizet ion, adminis t ra t ion and evaluat ion of mental hea l th i lervicee; and t h e t r a i n i n g of r e l e - vent personnel;

- a s s i s t i n g countr ies i n formulating n a t i o n a l plane and p o l i c i e s f o r mental h e a l t h and i n designing the o rgan iza t iona l , admin i s t r a t ive and advisory s t r u c t u r e s appropr ia t e t o t h e i r execution;

- a s s i s t i n g coun t r i e s t o improve co-ordination between mental and general hea l th , s o c i a l v e r l f a r e , education, and penal aervices and voluntary agencies;

- a s s i s t i n g i n t h e design of t r a i n i n g methods f o r t h e provis ion of b a s i c mental h e a l t h ca re by non-specia l is t workers, by enabl ing them t o recognize and manage conspicuous psych ia t r i c morbidity i n general medical and hea l th activities a t community l e v e l , wi th s p e c i a l regard t o high-risk groups;

- a ~ ~ i s t i n p i n the s tudy of the f e a s i b i l i t y of in t roducing b a s i c mental hea l th se rv ices i n t o primary h e s l t h care a c t i v i t i e s and of t h e organizat ional and admin i s t r a t ive impl icat ions and t h e manpover t r a i n i n g requirements;

- promoting the etudy of t h e d i s t r i b u t i o n , n a t u r a l h i s t o r y and outcome of mental d i so rde r s wi thin the Region, end t h e r o l e of s p e c i f i c c u l t u r a l and psycho-social e t i o l o g i c a l f a c t o r s ;

- promoting modifications t o e x i s t i n g mental h e a l t h l e g i s l a t i o n and t h e in t roduc t ion of new l e g i s l a t i o n t o e f f e c t b e t t e r r e h a b i l i t a t i o n , s o c i a l support and welfare f o r ch ron ica l ly disabled s u f f e r e r s ;

- promoting t h e c o l l e c t i o n of d a t a on t h e pa t t e rns of a lcohol-re la ted d i s a b i l i t i e s i n the Region and of the medico-social problems associa ted wi th t h e non-medical use of psychoactive and dependence-producing drugs , and by providing t echn ica l a s s i s t ance t o develop progre-s of c o n t r o l and r e h a b i l i t a t i o n , and

- a a s i e t i n g i n the s t rengthening of teaching of psych ia t r i c educators , admin i s t r a to r s and c l i n i c a l s p e c i a l i s t s .

F,,,,imme Review

The prevalence of mental d i so rde r s i n t h e Region is no t diminishing; t o the major psychoses e r e added new forms of i l l n e s s barn of mounting psycho-social s t r e s s , i nc reas ing longevi ty and ia t rogenesie . The burden of chronic s i c k grows l a r g e r and i e supported l e s s because of urbanizat ion and i n d u s t r i a l i z a t i o n .

The cos t t o co rnun i t i e s of mental i l l n e s s has y e t t o be defined i n terms of medical care and maintenance, family e t r e s s and l a s s of s t a t u s and r o l e on t h e p a r t of t h e a f f l i c t e d . Specia l ized f a c i l i t i e s i n t h e Region t o meet the needs are sca rce , unevenly d i s t r i b u t e d and under-provisioned i n resources and equipment. Developments a r e hampered by profess ional a t t i t u d e s which o f t en a r e based on e s i n c e r e b e l i e f e i t h e r t h a t p s y e h i s t r i c treatment a s i t has evolved i n t h e developed nationa has l i t t l e t o o f f e r o r t h a t developing e o c i e t i e s a r e less prone t o mental i l l - h e a l t h . I n e f f i c i e n t screening systems, uncer ta in provis ion of drugs and inadequate record-keeping a r e added problems. There a r e , i n add i t ion , c e r t a i n e x t e r n a l r e t e - l imi t ing c o n s t r a i n t s : the harsh r e a l i t i e s of pes t i l ence , hunger and poverty; l i m i t a t i o n s on t h e use of equipment and drugs r equ i r ing s k i l l e d maintenance, c o n t r o l and de l ive ry systems; the problem of recrui tment , t r a i n i n g and u t i l i z a t i o n of e p e c i a l i s t manpower.

Pi,opgsals fo r 1978-1979

(1) Hental Health Manpower Development

(a) Short-term consu l t an t s w i l l be provided i n B u m , Bangladesh, Indonesia, Ind ia , S r i Lanka and Mongolia to cooperate with n a t i o n a l s t a f f i n the design and development of post-basic courses f o r psych ia t r i c educators and c l i n i c a l medical and nursing s p e c i a l i s t s . They w i l l a l a a adv i se on the adminis t ra t ion of p s y c h i a t r i c educa- t i o n a l programmes i n b a s i c medicine and nurse teaching, t o promote in-service and r e f r e s h e r t r a i n i n g end the design of appropr ia te educat ional ma te r i a l s ; e tudy t h e f e a s i b i l i t y of teaching of eimple mental hea l th p r inc ip les to we l fa re , educat ional , penal and c m u n i t y workers, and a s s i s t i n the development of spec ia l i zed teaching a reas , such as, behevioural therapy end psychopathology.

(b) I n 1977, s s h o r t course on t h e a p p l i c a t i o n of ep idemiologica l methods i n r e l a t i o n t o p sych i a t ry w i l l be he ld i n SEARO. I n 1978, a s i m i l a r course i n psychopharmacology i n r e l a t i o n t o needs of developing coun t r i e s is planned and i n 1979, s r e p e t i t i o n o f t h e 1977 course.

( c ) Fe l lovsh ips f a r f u r t h e r t r a i n i n g i n c l i n i c a l p sych i a t ry , c l i n i c a l psychology, p s y c h i a t r i c s o c i a l work and p s y c h i a t r i c nurse t u t o r t r a i n i n g w i l l b e awarded.

(2) S t rengthening of Mental Health Se rv i ce s

An adequate i n f r a s t r u c t u r e of mental h e a l t h s e r v i c e s w i l l be promoted. Visits t o c o u n t r i e s by t h e Regional Adviser w i l l be followed by t h e appointment o f shor t - te rm c o n s u l t a n t s and, i n t h e case of Bangladesh, a long- term s t a f f member i n 1978-1979 t o adv i se on: t h e o rgan i za t i on and a d m i n i s t r a t i o n of s e r v i c e s , t h e development of mental h e a l t h informat ion sys tems, a l t e r n a t i v e s t o t r a d i t i o n a l hospi ta l -based c a r e f o r ou t -pa t i en t s i n t h e i r own community s e t t i n % , menta l h e a l t h l e g i s l a t i o n and other r e l a t e d problems.

Communities w i l l b e n e f i t from b e t t e r d i s t r i b u t e d , b e t t e r p rov i s ioned , more a c c e s s i b l e and l e s s t h e r a p e u t i c a l l y r e s t r i c t i v e care f a c i l i t i e s .

(3) Drug Abuse Contro l

The e x t e n t and p a t t e r n of psychot ropic and n a r c o t i c drug abuse, and t h e development of c o n t r o l programmes involv ing c rop - subs t i t u t i on , t r ea tmen t , r e h a b i l i t a t i o n , s o c i a l l e g i s l a t i o n and h e a l t h educat ion w i l l cont inue t o r e c e i v e suppor t i n Burma and Thai land w i t h t h e assistance of t h e Uni ted Nat ions Fund for Drug Abuse Con t ro l (UNFDAC). In I n d i a and Indones ia suppor t from IJHO HQs OMH f o r s t u d i e s on t h e long-term e f f e c t s of cannabis and opium, t h e s i d e - e f f e c t s and pharmacological a c t i o n of c o m n l y used psychot ropic drugs and t h e development of ins t ruments f o r r e p o r t i n g of drug dependency and t r ea tmen t programmes w i l l con t inue .

(4) Alcohol-Related D i s a b i l i t i e s

In 1976, a c o n s u l t a n t w i l l v i s i t I n d i a t o adv i se on n a t i o n a l moni tor ing and p reven t ive a c t i o n i n t h e f i e l d of alcoholism. In 1977 and 1978, consu l t an t s w i l l v i s i t c o u n t r i e s i n the Region t o a d v i s e on t rea tment and manage- meat of s p e c i a l problem groups and n a t i o n a l control p o l i c i e s . I n 1979, a symposium on t h e s e a r e a s u i l l he h e l d .

(5) Research S t u d i e s

S tud i e s of t h e p sycho log i ca l s i d e - e f f e c t s of f e r t i l i t y r e g u l a t i o n , p i l o t s t u d i e s of community care of out - p a t i e n t s by non - spec i a l i s t h e a l t h personnel and long-term s t u d i e s i n s ch i zophren i a and dep re s s ive i l l n e s s w i l l con t inue i n t h e Post-graduate I n s t i t u t e a t Chandigarh w i t h a s s i s t a n c e from OMHIHQ.



Tocal


In ter -count ry

T o t a l


In ter -count ry

T o t a l


In ter -count ry

T o t a l

Regular Budget

US$

128 400

34 100

162 500

123 500

36 800

160 300

134 500

39 700

174 200

144 500

42 400

186 900


T o t a l

1

1

1

1

2

1

1

2

1

1

2

Number of Pos t s

Other Sources

US$

Regular Budget

T o t a l

US$

Other Sources

1 I

1

1

1

2 -

1

1

2

1

1

2

I 128 400

i I

34 100

162 500

123 500

36 800

160 300

I 134 500

39 700

174 200

I

144 500 1 42 400

I j 186 900

PROGrULMME 5.2.7 BIOMEDICAL ASPECTS OF RADIATION

Objectives

TO:

- assist in the establishment of regional and national radiation protection services and in the adoption of international standards in preventive and curative medicine through the improved use of ionizing radiations. including radioisotopes;

- promote the development of facilities for services, training and research in diagnostic radiology, radiotherapy, nuclear medicine and radiological physics;

- asist in establishing standards in radiation dosimetry;

- etimulate national interest in the investigation of biomedical aspects of radiation and the prevention of risks, and

- assist national authorities in legislation, organization and administration for the prevention and control of radioactive contamination of man and his environment.

Approaches

- promoting standards and assistance in the training of relevant personnel in monitoring and surveillance and in the maintenance and repair of radiological equipment;

- assiriting in the establishment of regional and national radiation protection services;

- establishing regional and national institutes or departments of radiological sciences, including centres for radiation dosimetry and nuclear medicine, in order to harmonize and improve the methods applied, promote new and more effective application of radiation in medicine and ensure comparability of results;

- providing advice and assistance to national authorities on legislative and administrative action to minimize radioactive contamination of man and his environment;

- assisting in the establishment of a national network for the collection and evaluation of data on national and regional levels of environmental radioactivity and the improvement and standardization of meaeuring methods;

- promoting collaboration in research in the field of radioactivity, radiation chemistry and radio-pharmaceuticals, end

- collaborating with International Atomic Energy Agency and bilateral agencies in promoting the use of nuclear science far peaceful uses in medical sciences.

Progrmme Review

The increasing use of ionizing radiation and radionucleides for medical, agricultural and industrial purposes and the production of nuclear parer necessitate ( 1 ) the organization of proper training facilities for health and ellied health personnel; (2) the standardization of techniques for practical diagnostic, therapeutic and research ectivities, and (3) the regular monitoring and surveillance of radiation workers and institutions, and the training of radiographers, radiological technicians and medical physicists. Training techniciana in the maintenance and repair of X-ray equipment, the establishment of radiation personnel dosimetry services, assisting in checking clinical applications through a postal, dose-inter-comparison programme, and the determination of Strontium-90 in human bones are the main activities being promoted by WHO in the Region, with UNDP assistance and an the basis of guidelines developed by WHO in collaboration with International Atomic Energy Agency. Film badge services are being developed in four countries in the Region with assistance from voluntary sources in the Federal Republic of Germany.

WHO is assisting in identifying national institutions, strengthening them for providing leadership and esteb- lishing the expertise required in radiological sciences.

currently, training programmes in radiological sciences are being aseieted in six countries of the Region (India, Indonesia, Mongolia, Nepal, Sri Lanka and Thailand), and the establishment of radiation health pratec- tian services are being supported in Burma, DPRK, Indonesia and Nepal; facilities for training technicians in the maintenance and repair of radiation equipment have been developed in Burma, India, Indonesia. Mongolia and sri ~~~k~ and assistance is being provided for the strengthening of nuclear medicine in Bangladesh, Burma, ~ndia and Indonesia. Assistance is being provided for an advanced course in radiological physic8 in India.

Propooals for 1978-1979

The establishment of national institutes of radiological sciences with modern facilities for undertaking training will be assisted with the objective of meeting their needs for manpower in these specialties. National pragra-s will be promoted for protecting the population againat genetic and somatic hazards through biomedical investigations an the biological aspects of ionizing radiation and radionucleides.

Assistance will be ~rovided to governments through support to institutions; the award of fellowships for the training of selected health and related personnel; the strengthening of national education programmes for the training of technicians in repair and maintenance of radiological equipment and the development of patterns of services and training in radiology, radiotherapy, nuclear medicine and radi~lagical physics. Biomedical research in ioniziug radiation will also be assisted.

1976 Regional

Inter-country

Inter-country

1978 Regional -

Country

Inter-country

Total


Inter-country

Total -

1 I l6 IoO 1 I 86 300

86 300 86 300

102 600

102 600

I 102 600

102 600

PROGRAMME 5.2.9 IMWJNOLOGi

- assiat in the application of new concepts and techniques in immunology to public health problem;

- assist in developing adequate competence in imunalogy to serve diagnostic, research and training purposes in the countries of the Region, and

- assist in the establishment of national and regional training-cum-research centres and to promote callabora- tion in training and research.

- assisting in the application of newly acquired knowledge in immunology to health problem of national importance;

- strengthening institutions in Meeber countries to help them develop competence in the field of immunology for providing expertiee and material;

- stimulating immunological investigations on problems of local health importance, and

- promoting inter-country collaboration for the exchange of information and distribution of references useful in clinical immunology.

Ionnunology has provided efficient methods for the prophylaxis, diagnosis and treatment of many diseases of public health importance. Recent advances have provided techniques for the diagnosis of cancer and of auto- immune diseasea as well as for treatment and for tissue transplantation.

Since 1968. WHO has organized and assisted with immunology workshops and in the establishment of training-cum- research centres. The pathogeneeie of denguelhaemorrhagic fever is not clearly understood. A WHO Collaborating Centre on DengueIHamrrhagic Fever has been established in 1975 in Bangkok, Thailand, to do research into the immunopatholagy of denguelhaemorrhagic fever. WHO has aleo helped the countries in the Region to organize meetings of immunologiets to diecuas special problems in imunological research.

Pmposats for 1978-1979

Assistance in the promotion of immunization services for the control of communicable and non-communicable diseases and in the study of the immunology of denguelhaemorrhagic fever and the application of results in the treatment of cases. Continued assistance to the WHO Collaborating Centre on DenguelHaemorrhagic Fever in Bangkok.

Continued support to programmes for the provision of facilities for training imunolagists, strengthening of institutional facilities for diagnoeis and treatment and collaborative research.

Assistance to research in the immunolagy of leprosy and malaria which may lead to effective preventive measures by vaccines.

Intar-country

IntePCoUntry

Inter-country

1979 Regional

Inter-country

Objeotivea

TO study the sa fe ty and heal th conditions in industry and agr icu l tu re , and i n mining and other trades and to pro- t e c t the workers against heal th hazards a r i s i n g out of t h e i r work o r from conditions i n the working environment.

Approaohes

By:

- providing assis tance i n strengthening the ex i s t ing I n s t i t u t e s or Departments of Occupational Health to enable them to t r a i n qual i f ied personnel, provide advice, a s necessary, and conduct surveys and research, and

- providing consultants t o a s s i s t i n conducting shor t courses for occupational heal th personnel.

Pmgramne R e v i a

Most of the Governrents of t h i s Region a r e a l i v e t o the need f o r improving the heal th of working populstions. In Bangladesh, the Government w i l l be ass i s ted in 1976 in the t ra in ing of qual i f ied technical personnel i n occupational heal th and sa fe ty and again i n 1977 in updating the leg i s la t ion . In 1976 and 1977, assis tance i s envisaged f o r the development of an o c c u p ~ t i o ~ l hea l th programme i n Burma. In India , a wo-week nat ional t ra in ing course on evaluation and control of i n d u s t r i a l environments was organized st the National I n s t i t u t e of Occupational Health i n Ahmedabad, i n order t o provide adequate knowledge t o the par t i c ipan ts f o r i n i t i a t i n g and developing i n d u s t r i a l hygiene programmes in industries. An i n s t i t u t e of occupational hes l th and regional centres has been establ ished i n Indonesia. In 1974-1975, for about a year s p e c i a l i e t i n occupational hygiene was assigned to t h i s I n s t i t u t e . Guidelines were prepared covering po ten t ia l topics i n s p e c i f i c areas of occupa- t iona l health. Eleven short-term courses and other t ra in ing a c t i v i t i e s covering d i f f e r e n t f i e l d s of occupa- t iona l heal th were conducted i n Indonesia and about 550 par t ic ipa ted i n these courses.

In S r i Lanka, an or ientat ion programe was conducted f o r p rac t i s ing nursee i n occupational heal th. Further assis tance t o S r i Lanka i n 1976 and 1977 i s envisaged on occupational heal th and sa fe ty problems i n agr icu l tu re and to iden t i fy n u t r i t i o n a l , heal th and socio-economic problems of the working women i n agricul ture.

PmpoaaZs for 1978-1979

It i s proposed t o provide short-term consultants and fellowships i n occupational heal th f a r Bangladesh, Burma, Indonesia and S r i Lanka.

Inter-country

Inter-country

1978 Regional

Inter-country

1979 Regional

Inter-country

MAJOR P R O G W 5.3 PRDPWLACTIC, DIAGNOSTIC AM) THERAPEUTIC SUBSTANCES

C%jectives

To:

- improve the q u a l i t y of prophylact ic , d i agnos t i c and the rapeu t i c substances;

- develop a na t iona l eystem f o r monitoring adverse r eac t ions ;

- s t rengthen t h e t r a i n i n g of pereonnel required f o r drug q u a l i t y c o n t r o l , and

- assist i n e s t a b l i s h i n g reg iona l and i n t e r n a t i o n a l co-operation for t h e production and s t andard iza t ion of prophylact ic , diagnostic and the rapeu t i c substances i n t h e coun t r i e s of t h e Region.

Approaches

By:

in t eg ra t ing na t iona l drug p o l i c i e s i n t o o v e r a l l hea l th p o l i c i e s and harmonizing them with i n d u s t r i a l , t r ade and f i n a n c i a l p o l i c i e s ;

- s t rengthening and updating t h e drug l e g i s l a t i o n ;

- s t rengthening and enhancing t h e p o t e n t i a l i t y of t h e na t iona l drug q u a l i t y c o n t r o l l a b o r a t o r i e s ;

- t r a i n i n g drug inspectors and drug ana lys t s ;

- promoting good p rac t i ces i n manufacture and qua l i ty con t ro l ;

- a e e i s t i n g i n t h e development of a n a t i o n a l system f o r d i s t r i b u t i o n and s t o r a s e , and

- promoting the production and a v a i l a b i l i t y of e s s e n t i a l drugs.

Progrme Review

As a r e s u l t of the growing awareness on t h e p a r t of t h e pub l i c , and t h e app l i ca t ion of research t o d i sease con t ro l , t h e use of p h a m c e u t i c a l s , d iagnost ic reagents and b io log ica l s has increased. To meet t h i s increased demand, the production i n and t h e import i n t o t h e coun t r i e s of t h e drugs have increased.

In the coun t r i e s of t h e Region, i t has proved d i f f i c u l t t o enforce and supervise s tandards , with the r e s u l t t ha t small drug manufacturing u n i t s have not been conforming t o acceptable s a f e s tandards i n t h e i r production and, as a r e s u l t , the drugs are of substandard q u a l i t y , i n e f f e c t i v e , and i n c e r t a i n cases even i n ju r ious . Extreme c l ima t i c condi t ions a l s o adversely a f f e c t the potency of c e r t a i n drugs.

h'H0 has a s s i s t e d wi th e i g h t p ro jec te i n the Region i n t h e f i e l d of q u a l i t y con t ro l of b io log ica l and pharma- c e u t i c a l products, and has a l s o organized th ree meetings on t h i s sub jec t in Bombay (1969), Bangkok (1971), and Jaka r t a (1973).

Proposa2s fo r 1978-1978

kssie tance w i l l be provided through consul tant s e r v i c e s , f e l l w e h i p s and n a t i o n a l group educat ional a c t i v i t i e s f o r promoting the d e f i n i t i o n of na t iona l drug p o l i c i e s , t e s t i n g and regu la r per iodic evaluat ion of drugs including re-evaluation, establishing a mechanism a t the na t iona l l e v e l t o r egu la r ly review the usefulness of p resen t ly ava i l ab le drugs i n r e l a t i o n t o t h e cu r ren t publ ic hea l th cond i t ions , s tudying r i s i n g c o s t s and the e f fec t iveness of p r i c e c o n t r o l measures, surveying d i f f e r e n t drug d i s t r i b u t i o n systems, iden t i fy ing l o c a l l y a v a i l a b l e medicinal p l an t s with a view t o use them thus reducing h e a l t h expenditure, and s t rengthening f a e i l i - t i e s f o r education and t r a i n i n g i n c l i n i c a l pharmacology, pharmacy, pharmaeognosy and pharmaceutical ana lys i s .

Inter-country

1977 Regional

Inter-country

Inter-country

1979 Reglonal

Inter-country

PROGRAMME 5 . 3 . 3 PHARHACEUTICALS

Ob jectiuee

To enhance t h e regional and na t iona l p o t e n t i a l f o r manufacturing of p h a n a c e u t i c a l s , employing l o c a l t a l e n t and making use af indigenous m a t e r i a l , and developing a d i s t r i b u t i o n system t o meet t h e requirements of hea l th se rv ices f o r pharmaceuticals.

Approaches

By:

- a s s i s t i n g i n iden t i fy ing t h e basic needs f o r pharmaceuticals in the coun t r i e s of t h e Region;

- advis ing and a s s i s t i n g i n planning t h e i n t e g r a t i o n , i n phased manner, i n t o t h e n a t i o n a l i n d u s t r i a l development of the manufacturing of e s s e n t i a l pharmaceuticals t ak ing i n t o considerat ion indigenous resources;

- a s s i ~ t i n g i n promoting good manufacturing p rac t i ces ;

- assisting i n promoting t h e development of e na t iona l system, based on i n t e r n a t i o n a l s tandards , For evaluating t h e s a f e t y and e f f i c a c y of drugs v i t h adequate p re -c l in ica l and c l i n i c a l t r i a l s :

- a s s i s t i n g i n s t rengthening reg iona l and na t iona l cen t res t o co l l abora te v i t h i n t e r n a t i o n a l s y s t e w f o r monitoring adverse r eac t ion t o drugs;

- a s s i s t i n g i n education and t r a i n i n g of personnel required f o r t h e manufacture and q u a l i t y control of phsrma- c e u t i c a l s , and

- a s s i s t i n g v i t h research by na t iona l pharmaceutical i n d u s t r i e s .

Progrme Review

With the increased emphasis on primary hea l th care and provis ion of prevent ive and c u r a t i v e servicea , the need for meeting t h e demands f o r pharmaceuticals from wi th in t h e country and t h e Region i s rece iv ing the p r i o r i t y considerat ion of Member S t a t e s . In t h i s con tex t , t echn ica l a s s i s t a n c e was provided f o r promoting the e s t ab l i sh - ment of a na t iona l pharmaceutical base f o r sc i ence and technology through advisory s e r v i c e s on good manufacturing p rac t i ces and q u a l i t y con t ro l of pharmaceuticals. Bangladesh, Burma, India , Indonesia, Mongolia, S r i Lanka and Thailand were provided t echn ica l assistance f o r t h i s purpose.


Assistance w i l l be provided f o r enhancing t h e manufacturing p o t e n t i a l of the coun t r i e s i n pharmaceuticals through consulcancy se rv ices and fe l lowships end by promotion of research.


Inter-country

Total


Inter-country

Inter-country

1974 Regional

Inter-country

Eetimsted Obli8ations Number of P o ~ t s

Total

US$

125 000

125 000

145 300

Regular nudger

1

1

1

Regular Budget

US$

124 000

124 000

145 300

Other Sources

US$

1 000

1 000

Other sources

1

1

1

PROGPAWC? 5.3.4 BIOLOGICALS

Ob jectivea

- advise on the production, supply and distribution of biologicals in general and vaccines, in particular, to meet the requirements of national immunization programs;

- establish and improve national requirements, standards and reference preparations for quality, safety and efficacy of prophylactic, diagnostic and therapeutic substances, end

- advise on and assist in the development and execution of national policies,

By:

- periodically surveying facilities;

- disseminating information;

- independently assessing biological preparations for potency and stability;

- individual and group training of preonnel concerned with production and control;

- specific problem-solving eonsultancies, and

- procuring reference preparations and standards.

PI.ogrme Review

WHO Win assistance in production and control technology enabled five countries in this region to develop their capacity, with respect to the requirements of the Expanded Program of Immunization: Burma (diphtheria. tetanus, smallpox). India (diphtheria, tetanus, pertussis, BCG, smallpox, polio), Indonesia (smallpox, diphtheria, tetanus, pertussis, BCG), Sri Lanka (smallpox), and Thailand (diphtheria, tetanus, pertussis, smallpox, BCG) . WHO-assiated country projects are in operation in Bangladesh, Burma, India, Indonesia, Sri Lanka and Thailand. In addition, assistance is being provided through an inter-country project as well as through courses conducted under inter-regional projects.

A group educational activity was held in 1976 in Delhi in the production and standardization of diagnostic antisera.

ProposaZs for 1978-1979

To assist Bangladesh and Sri Lanka in the production and control of DiphtheriaITetanus, Burma in Diphtheria, Pertussis, Tetanus, and to expand in India the production of Diphtheria, Pertussis, Tetanus and BCG vaccines.

Diagnostic anti-sera produced by national reference laboratories will be procured for collaborating laboratories, after these sera have been assessed independently in an international reference laboratory.

A course in standardization of vaccines is proposed to be held in 1979.

Inter-country

Inter-country

1978 Regional

Inter-country

Inter-country

Objectives

To improve the perfo-nce of hea l th l a b o r a t o r i e s w i t h regard t o t h e range o f t e s t s they can provide, the e impl i f i ea t ion of t h e t e s t a and t h e i r g rea te r accuracy.

Approaches

By:

- t r a i n i n g technician- ins t ructors i n teaching and t r a i n i n g methods;

- organizing bas ic , post-basic and re f reshe r courses f o r technicians;

- operat ing i n t e r n a l and e x t e r n a l q u a l i t y con t ro l schemes;

- developing and d i s t r i b u t i n g reference preparat ions and s tandards t o be used as c o n t r o l s ;

- d i s t r i b u t i n g information an new simple t e s t s , and

- i n i t i a t i o g research wi th a view t o developing simple a l t e r n a t i v e t e s t s t o be w e d a t d i s t r i c t and primary hea l th cen t res .

Each country has one or more schools f o r t r a i n i n g t echn ice l laboratory s t a f f . Some coun t r i e s have developed t h e i r t r a i n i n g p o t e n t i a l t o the e x t e n t of o f f e r i n g graduate and post-graduate courses i n medical laboratory technology.

The main t h r u s t of WHO a s s i s t ance i n t h e f i e l d of l abora to r i e s has been provided i n the area of communicable d i seases as t h i s was and a t i l l is a top p r i o r i t y i n t h e country programmes. To t h i s end microbiology, v i rolcgy and serology, both bae ic and advanced, have been strengthened a t c e n t r a l and intermediate l e v e l l abora to r i e s . Reference l a b o r a t o r i e s have been es t ab l i shed , both a t n a t i o n a l and reg iona l l e v e l s , t o provide e x p e r t i s e on e number of d i f f e r e n t bac te r i a . Reference l a b o r a t o r i e s i n Satmonetb phage typing, cholera , plague, l e p t o s p i r o s i s , S t r e p t o c o c m , smallpox, a rbov i rus , r a b i e s , i n f luenza , blood grouping and venerea l d i sease are examples of l abora to r i e s which provide r eg iona l as v e l l as n a t i o n a l reference se rv ices . Several of these reference labara- t o r i e s do produce and d i s t r i b u t e t h e reference reagents , f r e e of charge. t o help developing t h e p o t e n t i a l of na t iona l and intermediate l a b o r a t o r i e s a t country l e v e l .

I n mast coun t r i e s , the l a b o r a t o r i e s are not s u f f i c i e n t l y used and confidence i n t h e q u a l i t y of performance is yet to be e s t ab l i shed . Sk i l l ed laboratory personnel are i n shor t supply. I n s u f f i c i e n t l y t r a ined s t a f f , ere employed, as they become a v a i l a b l e from communicable d i sease c o n t r o l programmes t h a t have been in teg ra ted i n t o the hea l th se rv ices .

The absence of an adequate scheme f o r t h e maintenance and r e p a i r of laboratory equipment, t h e l a c k of uniformity in t echn ica l procedures, t h e running of d i f f e r e n t models and "makes" of instruments t h a t are hard t o maintain andlor r e p a i r and the absence of a programme f o r t h e preparat ion and d i s t r i b u t i o n of reagents , which most of the time have t o be imported, are among other important reasons which hamper t h e operat ion of laboratory services.

Proposals fo r 1978-1979

Assistance w i l l be given i n t r a i n i n g i n the use of recommended methods and s t andard iza t ion of reagents. i n securing support £row reference l a b o r a t o r i e s , and i n p a r t i c i p a t i o n in the in ter- laboratory evaluat ion end p ro f i c i ency t e s t i n g .

Manuals w i l l be developed f o r standard procedures i n h e a l t h laboratory p rac t i ce .

-


Inter-country

Total

1977 Regimal - country

Inter-country

Inter-country

Inter-country

Nuder of Poets Estimated Obligations

Regular Budget

8

2

10

6

2

Regular Budget

US$

363 900

40 000

403 900

401 700

42 900

Other Sources

Other Sources

US$

1 100

1 100

28 400

Total

8

2

10

6

2

Total

US$

365 000

40 000

405 000

430 100

42 900

MAJOR PROGRAMME 6.1 PROMOTION OF ENVIRONMEIWAL HEALTH

- promote environmental health in the community with special emphasis on basic sanitary measures in rural and urban fringe areas;

- strengthen environmental health manpower, end

- strengthen occupational health services in order to provide a better working environment end better protection ageinat occupational hazards, including protection againet radiation.

Approaches

By:

- assisting in the study of the prevailing environmental health situation and in planning and formulation of projects, management and evaluation of environmental health activities;

- promoting and initiating collaborative programmes undertaken jointly by national governments and WHO, and

- assisting in preparing basis for securing financial support from national, international and bilateral sources, lor the preparation and implementation of specific schemes for solving environmental health prob lens.


Since water-borne diseases continue to be one of the major public health problems in most of the countries of the Region, the national governments have been attaching high priority to the programmes for safe water supply to the community. A major part of WHO assistance in the field of environmental health has therefore been directed towards promoting community water supply programmes. In addition to this, appropriate attention has been given to sewerage and drainage, control of environmental pollution and the education and training af various categories of environmental health personnel, including professionals.

Pre-investment and sector studies an water supply and sewage disposal have been carried out in collaboration with UNDP and IBRD and these resulted in the preparation of project documents which enabled the government to prepare meaningful programme8 and also to attract eseistance from international and bilateral agencies for implementing the programmes.

General programmes for training environmental health manpower, in addition to the promotion of specialized courses, continued to receive WHO assistance.

Environmental health problems created by the rapid increase of population and unplanned urbanization, growth af industries leading to environmental pollution and ecological changes due to the changing use of land and water and irrigation practices are causing increasing concern to governments. More and more attention is, therefore, being given to the measures for tackling the existing and the emerging problems. Studies have been undertaken for the assessment of the situation in this regard in a number of countries and assistance has been provided by WHO through support for manpower development and environmental health research in strengthening of the environmental health services and relevant national institutions.

In the field of radiation health, WHO has been continuing with assistance to the Member States in the training of manpower, in develaping mrnitoring system and surveillance services and in establishing safety measures in institutions and establishments.

WHO alao provided technical suppart in developing occupational health services, especially by providing training to build up national expertise in this field and by providing advisory services in organizing national occupational health services.

WHO has assisted at least three countries to evaluate the existing laws and regulations on food hygiene. Aesistance was also given to strengthen laboratories dealing with food control and to train personnel.

As far hazards from pesticides, aseietance has been provided to train health workers in the laboratory techniques far detection of pesticide residues and to frame, or revise as necessary, legislative measures with a view to controlling pesticide hazards.

Assistance will be continued in the field of basic community sanitation to increase the coverage specially in rural and urban fringe areas. Cormnunity water supply end sanitation, education and training of personnel and support in planning and programming in environmental health services will receive foremost attention. In addition, support will be extended to monitoring and control of environmental pollution, the development of occupational health services, food control programes and the contra1 of hazards due to radiation and pesticides.


Inter-country

To ta l

1977 Regional - ~ o u n t r y

Inter-country

Inter-country

Inter-country

Emtimated Obligations Number of Posts

To ta l

US$

1 837 100

262 700

2 099 800

3 264 400

240 100

Regular Budget

US$

995 300

262 700

1 258 000

1 093 100

217 300

22

12

34

26

10

Other Sources

US$

841 800

841 800

2 171 300

22 800

Regular Budget

1 5

12

27

15

10

Other Sources

7

7

11

PROGRAMME 6.1.1 PROGRAMME PLANNING AND GENEUL ACTIVITIES

Objectives

To:

- assist in the planning and development of environmental health policies and programmes associated with economic and regional development policies, plans and projects, and

- co-ordinate all environmental health programmes, at country and Regional levels.

Appmochea

By:

assisting in formulating and implementing environmental health plans and programme; and in assessing the impact of development policies and programmes on environmental health, and

- collecting and dieeeminatinp of appropriate information on environmental health policies, services and methods far the assessment of their impact on environmental health.

Programne Review

The programme has continued to concentrate on four areas: the provision of basic sanitary services, education and training of environmental health personnel, the control of environmental pollution and hazards, and the establishment and strengthening of environmental health institutions and services. Primary importance is still attached by most countries of the Region to community water supply and sanitation. The subject of the technical discussions at the Twenty-seventh session of the Regional Committee held in 1974 was "Provision of Safe Water Supplies to Rural Communities", and the Committee adopted a resolution urging Member States to implement the recornendations made during the technical discussions, especially on the establishment of realistic national targets far rural water supply and sanitation programmes, setting priorities for their implementation, and assessing the financial, manpower and material needs of the plans. The Regional Director was asked to continue to accord high priority to providing technical assistance in making these studies, in programme formulation and implementation, and in identifying areas of specific needs qualifying for multilateral or bilateral assistance.

The planning of environmental health services was studied by senior engineers and administrators from seven countries who participated in an inter-country seminar in New Delhi in December 1974. The participants recognized that comprehensive planning of environmental health services must take into account all related governmental and other activities, and emphasized the need for a co-ordination mechanism and integrated planning. With the recommendations of this seminar in mind, environmental health staff both in the regional office and in the field have assisted in the collection and dissemination of data, the preparation of assessment studies, project formulation and evaluation, and general programme planning and development.


The programme will aim at the largest possible coverage by basic sanitary measures as a key to improving health, and accordingly will stimulate national, regional and international action benefiting underserved populations especially in rural and urban fringe areas. Community participation, the utilization of local resources, and the development of self-reliance will be given particular attention.

Accordingly. WHO assistance will focus on the follow up of country health programming and sector studies for formulation of projecte, investigation of investment sources and assistance in implementation and evaluation. Engineers in the field will be encouraged to assist further in programne development, these being confined to strict project limitations, and particular efforts will be made to co-ordinate the activities, of all agencies concerned with the field of environmental health, national as well as bilateral and multilateral.

Regional

Inter-country

Inter-country

Inter-country

Inter-country

6.1.2 PROVISION OF BASIC SANITARY WSURES

Objectives

To:

- improve basic community sanitation, particularly camunity water supply and disposal of wastes;

- prmote and assist the national planning of services for the provision of community water supplies and for the diepaaal of wastea;

- promote the application of knarledge on and methods of cornunity sanitation, and

- promote health aspects of housing.

Approaches

By:

- providing assistance in planning, project formulation, management and evaluation of cononunity water supplies end waste disposal;

- preparing appropriate guides and manuals, and

- co-ordinating and collaborating with the work of bilateral and multilateral agencies in their assistance to programea related to community vater supply and wastes disposal.

fiognurme Review

Sioee 1959, successive resolutions of the World Health Assembly and Regional Cmittee have impressed on the countries of the Region a aense of urgency about the need to provide basic sanitation as an essential to health aa well as to eocio-economic development. Furthermore the need to redress the imbalance arising out of the priority given to urban communities has led to a gradual shift in emphasis to the provision of rural cornunity water supplies.

In the years 1974 to 1976, data have been collected from all countries of the Region for the preparation of reports on the existing situation with regard to rural water supply, rural sanitation and urban water supply and sewerage. Countries have been encouraged and assisted to use these reports to enable them to set realistic targets for coverage of the urban and rural populations with safe water and sanitary excreta disposal services, bearing in mind the global targete accepted by WHO for the Second United Nations Development Decade. Efforts have been made to assese the needs in tetme of finance, manpower and equipment and to devise suitable strategiee for achieving these targets. This has made it possible for priorities to be set on which planning for the allocation of funds and mobilization of reeources can be based.

The Organization has provided direct assistance, in most cases in conjunction vith UNICEF, to nine countries of the Region in projects far community water supply and sanitation. Assistance has also been made available through inter-country projects. In those countries where national health programme exercises have been conducted, field staff have assisted in project formulation for environmental health programmes as part of national health and development planning. Assistance has also been given to sector studies on water supply and sanitation made or initiated in six countries of the Region through the IBRDfWHO Co-operative Progr-e.

ProposoLs for 1978-1979

While WHO'S assistance is changing from ad-hoc project support to that of stimulating and strengthening national programmes within the framework of national development plans, emphasis will continue to be placed in mast countries of the Region on assistance to governments in the planning, delivery and evaluation of basic sanitary measures. Io support of this, WHO'S role as a co-ordinacing agency mobilizing external assistance and promoting project formulation and implementation by Member countries is increasing.

In most countries of the Region, national progrennnes in community water supplies and sanitation vill be assisted by WHO sanitary engineera or hydrogeologiets. In e w e cases proposals for funding of these poste are t o be submitted by government for the consideration of UNDP. In most countries co-ordination of activities with UNICEF will continue.

Specifically, provision is proposed under the regular budget for sanitary engineer advisers through this period in Bangladesh, Indonesia. Maldives, Nepal and Sri Lanka. Proposals are being made for staff on projects in Burma, India. Mongolia. Sri Lanka and Thailand to be funded f r w other sources. In addition the regular budget provides for three sanitary engineers on an inter-country project for cornunity water supply and sanitation to be available for assistance in matters of a regional nature or far eo-ordination of activities. One of these engineers vill particularly work vith UNICEF South Ceotral Asia Regional Office. In total, it is expected that about twenty long-term staff will be serving countries of the Region in national programmes of provision of basic sanitary measures.

Several countries of the Region have adopted the global targets far the UN Second Development Decade as goals and are preparing phased programmes for their achievement. The targets for urban areas are: 60% population provided with piped water connections, 40% population with aeeess to public standpipes, and 30% population vith satisfactory excreta disposal facilities, and for rural areas: 25% population with reasonable access to safe water supplies, and 15% population with satisfactory excreta disposal facilities. It is expected that by 1980, at least two countries of the Region will have met the target for rural water supply coverage, and at least five will have established feasible plans for reaching all these goals.

1976 Reglonal - Country

Inter-country

Total


Inter-country

Total


Inter-country

Total


Inter-country

To ta l


Regular Budget

US$

711 800

169 100

880 900

762 100

129 500

891 600

Number of Poste

Regular Budget

14

8

22

1 4

6

20

Other SOUICLS

US$

25 000

25 000

94 800

94 800

Torel

US$

736 800

169 100

905 900

856 900

129 500

986 400

Other Sources

2

1 644 100

147 500

1 751 6M) -

1

Total

1 4

8

22

16

6

744 100 860 000

I 147 500

19

6

25

18

6

24

12 7

891 600

2

6

18

11

6

17

860 000

769 500 518 200 1 1 287 700

183 600 1 1 183 600 I

22

7

7

7

I

953 100 518 200 1 471 300

P R O C W E 6.1.3 PRE-INVESRIENT PLANNING FOR BASIC SANITARY SERVICES

Objectives

To:

- assist in the identification of projects that would qualify for international, bilateral and national investment in urban and rural community water supply, waste water disposal, solid wastes management and environmental pollution control systems, and

- assist in developing or strengthening of organizational, management and financial institutions to secure financial support.

Apprmches

By:

- making national sector studies on cmunity water supply and waste disposal, and

- assisting with planning and carrying out technical, institutional, economic, social and financial studies on the feasibility of apecific schemes for urban and rural community water supplies and waste disposal.


Sector studies have been undertaken through the IBRDIWHO Co-operative Pragr-e initiated in 1971. They have been instrumental in planning water supply and sanitation in the mainstream of national development plans and in identifying sector-vide needs and the potential roles of the different national agencies as well as WHO, UNDP, bilateral assistance organizations and lending agencies. Sector studies have involved the collection, analysis and evaluation of data and projections of future requirements. The joint participation of WHO and IBRD in the co-operative programme has ensured that health requirements are taken into account in IBRD lending decisions.

By 1976, sector studies had been made in Bangladeeh, Burma (preparatory mission), India (Rajastha" - preliminary studies - Madhya Pradesh and Uttar Pradesh), Indonesia, Nepal and Thailand. Proposals far studies in other countries or states are under consideration. As a result of the studies completed, a number of proposals have been prepared and same projects a i e being implemented by countries: an example is the massive rural water supply project in Uttar Pradesh, India, being implemented with IBRD loan assistance.

WHO'= pre-investment studies have been funded almost exclusively by the UNDP. Studies in reepect of water supply and sewerage syatema have been completed for the metropolitan area of Calcutta in India, for towns in the south-west coastal area in Sri Lanka, and for Greater Kathmandu and Bhaktapur in Nepal. Preparatory studies have been made in Male in the Maldives, and a study for sewerage and drainage of Jakarta, Indonesia, is to be completed in 1977. A water eupply and sewerage project for the metropolitan area of Madras, India, was started in early 1976. In addition, pre-investment studies for rural water supplies in East Java, Indonesia, were begun in 1975, and the Government of India ie planning to submit a proposal to UNDP in 1976 for assistance to its national rural water supply programme. Several other pre-investment planning projects are under consideration for implementation starting in 1976-1977 in Bangladesh, Burma, Indonesia, Mongolia and Sri Lanka.

I h e studies in India (Calcutta), Sri Lanka and Nepal have led to direct investment through loans and grants from the IBRD and bilateral agencies for the development of water supply and sewerage systems. In addition, the IBRD has expressed its interest in the projects in Jakarta and Madras.

ProposoZs for 1978-1979

Sector studies will be continued in order to provide countries with an overall picture of the existing situation and immediate needs and their relation to total development. Depending on the missions planned by the WHOIIBRD Co-operative Programme for the years 1976 and 1977, it is expected that by the end of 1979, sector studies would have been carried out in Sri Lanka, Mongolia and several states of India (other than those listed above). It is expected that the Regional Office will be more closely associated with these studies.

Ihese sector studies and pre-investment projects will, among other things, define health needs and identify health-related activities in the context of national planning; link up with inter-sectoral development progr-es and projects; be broadened to cover a wider range of environmental health improvements such as housing problems and programmes for the hygienic protection of special use areas; and include socia-economic studies on, for example, factors affecting investments of individual and community resources in the community.

Continued use will be made of expertise provided through the WHOIIBRD Co-operative Programme and through agreements made with other agencies such as the Asian Development Bank.


Inter-country

Total


Intercountry

1978 Regional

Inter-country

1979 Regional

Inter-country

Number of Posts Estimated Obligations

Regular Budget Total

US$

714 300

714 300

1 703 700

22 800

Other Sourcee

6

6

6

Regular Budget

US$

6

6

6

Other Sources

US1

714 300

714 300

1 703 700

22 800

PROGRAMME 6.1.4 CONTROL OF ENVIRONMENTAL POLLUTION AND HAZARDS

Objectives

To:

- promote the development of programmes f o r the e a r l y de tec t ion and con t ro l of po l lu t ion i n the environment;

- evaluate the e f f e c t s of environmental f a c t o r s on h e a l t h , and

- promote and co-ordinate re levant research and t o f o s t e r t h e p r a c t i c a l app l i ca t ions of research f indings .

Approaches

By:

- a s s i s t i n g i n formulating l e g i s l a t i o n and in planning.implementing and evaluat ing programmes f o r t h e con t ro l of environmental po l lu t ion ;

- developing of methods f o r assess ing the impact of environmental po l lu t ion on hea l th and the economy;

- t r a in ing of personnel i n management and evaluat ion of environmental po l lu t ion control p rogrames , and

- promoting and co-ordinating of research.

Progrme Review

Consciousness of the complexity and ex ten t of po l lu t ion of t h e environment has become more apparent i n p r a c t i c a l l y a l l coun t r i e s of t h e Region, where problems of overcrowding i n urban slums, inadequate s a n i t a t i o n f a c i l i t i e s , t h e uncontrol led development of i n d u s t r i e s and t h e d i f f i c u l t y of enforcement of l e g i s l a t i o n , have increased. A mi les tone i n t h e con t ro l of env i romenta l po l lu t ion hae been t h e enactment i n India of the Water (Pol lut ion Prevention and Control) Act 1974, which has been followed by t h e establishment of water po l lu t ion con t ro l boards a t c e n t r a l and s t a t e l eve l s . WHO has a s s i s t e d i n advis ing on t h e organizat ion and t r a in ing and t h e drawing up of l is ts of equipment f o r l abora to r i e s . Also i n Ind ia , an Air Po l lu t ion Act i s expected t o be f i n a l i z e d i n 1976 and ass i s t ance is being provided by WHO i n ma t t e r s r e l a t i n g t o l e g i s l a t i o n and implementation.

Assistance has been provided t o o the r coun t r i e s through an inter-country p r o j e c t , and progress has been made i n c o l l e c t i n g d a t a f o r t h e preparat ion of an inventory f o r t h e Region of major p o t e n t i a l po l lu t ion sources. Pro jec t s have been i n i t i a t e d , wi th UNDP a s s i s t a n c e , i n Meharashtra S t a t e , India , and i n Bangladesh. In te r - country group educat ional a c t i v i t i e s have been held i n t h e f i e l d s of water po l lu t ion c o n t r o l , a i r po l lu t ion con t ro l and s o l i d wastes management. Assistance i n the promotion and co-ordination o f research i n environmental po l lu t ion c o n t r o l has been provided t o seve ra l i n s t i t u t i o n e , including t h e National Environmental Engineering Research I n s t i t u t e i n Nagpur, India ; Chulalongkorn Univers i ty , Bangkok, Thailand; Bangladesh University of Engineering and Technology, Dacca; t h e I n s t i t u t e of Technology, Rangoon, Burma; and t h e I n s t i t u t e of Technology, Bandung, Indonesia.

India , S r i Lanka and Thailand have pa r t i c ipa ted i n t h e WHO Environmental Health C r i t e r i a Programme, a s s i s t e d by the United Nations Environmental Progr-e (UNEP), which was e s t ab l i shed i n 1972. Substances of high publ ic hea l th s ign i f i cance have been i d e n t i f i e d , s e v e r a l rec-endations f o r de ta i l ed tox ico log ica l and epidemiological s t u d i e s have been made+ number of env i romente l hea l th documents have been prepared, end hazards a s soc ia ted wi th p a r t i c u l a r technological developments have been assessed.


The WHO Environmental Health C r i t e r i a Programme w i l l be continued, strengthened and expanded, wi th t h e support of UNEP, and coun t r i e s of t h e Region w i l l continue t o p a r t i c i p a t e i n t h e programe. Centres i n t h e Region w i l l be i d e n t i f i e d t o c o l l a b o r a t e wi th WHO Headquarters i n t h e Global Environmental Monitoring System (GMs).

Assistance through consul tants , w i l l b e made a v a i l a b l e t o coun t r i e s request ing advice on plannina, implementing and evaluat ing progrsmmea, as we l l as on ma t t e r s r e l a t e d t o l e g i s l a t i o n and its enforcement, and formulation of gu ide l ines f o r t h e e a r l y d e t e c t i o n of po l lu t ion and f o r r e c m e n d e d maximum permiseible l i m i t s of po l lu tan t s i n the environment. The Regional Inventory of P o t e n t i a l Major Po l lu t ion Sources w i l l be maintained and updated in 1978.

In 1978 and 1979 group educat ional a c t i v i t i e s w i l l be held i n Ind ia on var ious aspects of environmental po l lu t ion con t ro l . Research w i l l be encouraged and a s s i s t e d a t appropr ia te cen t res i n the Region, p a r t i - cu la r ly a t t h e National Environmental Engineering Research I n s t i t u t e , Nagpur, Ind ia , and ass i s t ance w i l l be given i n methods of adopting or adapting research f indings f o r t h e prevention and c o n t r o l of environmental po l lu t ion and h a z a r d s .

Inter-country

Inter-country

1978 Regional

Inter-country

Inter-country

P R O G R . 6.1.5 ESTABLISHMEKT AND STRENGTHENING OF ENVIRONHENTAL HEALTH SERVICES AND INSTITUTIONS

Objectives

TO:

- assist in the planning of environmental health services, and

- promote manpower planning and development, and management in the field of environmental health.

Approaches

By:

- assisting with the environmental component of comprehensive health planning in the context of total socia- economic development planning, through country health programming and other procedures;

- aasieting in formulating manpower policy in the field of environmental health on the basis of studies and in building of institutional framework for implementing the policy, and

- promoting and assisting national, regional and inter-regional training programmes.

P m g m s Review

UNDP and WBO country planning and the sector studies carried out under the WHOIIBRD co-operative programme have helped. in recent years, to foeus attention on priority problems and on the need for planned approach and direction. As a supporting service to activities mentioned in other programmes, WHO haa collaborated with all countries of the Region in the establishment and strengthening of services at national. state, or local level, in health and other ministries concerned, for the effective planning and management of environmental health progr-es. In s w e cases, sanitary engineers and sanitarians, as members of multidisciplinary health teams. have assisted in development projects related to general health services, especially in rural areas.

One of the important areas of collaboration has been in education and training, which has formed an essential element of all other projects in the promotion of environmental health. Sanitary engineering professors have been assigned as consultants to review, strengthen and advise on the curricula in institutions in Bangladesh, Burma. India, Indonesia and Thailand, and assistance may be provided to Sri Lanka from 1977.

A8 a part of the total health manpower development programme, WHO has promoted studies leading to manparer planning and development in environmental health, notably in Indonesia and Sri Lanka. Assistance has been given to strengthen the existing national and regional centres, and to hold inter-country group educational activities.

Pmpoeals for 1978-1979

In future, health agencies will work more closely and effectively with other government agencies responsible for programmes that impinge on environmental health. bphasis will be on: the assessment of environmental conditions and the analyaia of their impact on health, social and economic development; the elaboration of national policies an environmental quality; the planning and evaluation of national programmes that respond to the needs of the cmunity; the strengthening, management and co-ordination of environmental control programmes carried out by different national agencies, and on finance and legislation.

The future manparer programme will concentrate on the strengthening of national and regional training programmes in environmental health, and the establishment af new programmes to include training end research on emerging environmental health problems. WHO will collaborate with countries in the design of curricula, in providing teachers and, with the participation of national experts end institutions, in developing manuals for the courses offered. Studies already carried out in manpower planning will be extended to other countries with a view to developing practical working guidelines for the formulation of environmental health manpower and educational policies, and defining methods of manpower planning and development in environmental health. Maximum advantage will be taken of sector studies, pre-investment studies and country health programming for the purpose of =nalyaing and planning national needs for environmental manpower.

1976 Regional

Inter-country

Inter-country

Inter-country

1979 Regional

Inter-country

PROGRAnnE 6.1.6 FOOD SAFETY PROGRAMHE

Objectives

To assist in food safety and the application of proper principles and methods far the production, processing, storage and distribution of fonds.

Approaches

By assisting in training personnel in faod handling, in training faod inspectors and analysts, and in updating and formulating food control legislation.

Pmgrme Review

In most countries of the Region, food control programmes presently lack coverage and strict control. In manufacturing plants, restaurants and other eating establishents food is very often handled under unhygienic conditions. Meat and milk inspection, in keeping with existing regulations are not done often enough or are undertaken by inadequately trained personnel. Consequently, the health of the people is endangered, to a certain extent, through consumption of sub-standard and unhygienic fond. Food analysis for detecting adulteration and pesticide residues needs strengthening, and legislation on food control should be reviewed and revised and updated.

In 1975, a preparatory mission visited Burma for the preparation of a project document for assistance from UNDP. Indonesia was assisted in the evaluation of existing lave and regulations concerning food control and their operation in the organization of food control, and also in the evaluation of the work of the existing food control laboratories. Assistance was given to Sri Ianka in revising and updating the existing legislation in food control, in strengthening the Food Control Unit and in training courses for food inspectors and laboratory staff. In Thailand the Microbiological Unit of the Division of Food Analysis. Department of Medical Sciences, Ministry of Public Health, was strengthened and assistance provided in the training of staff in the field of faod microbiology, microbiological analysis of food samples and food hygiene.

Propoeats for 1978-1979

In 1978-1979 assistance in this field will continue to be in the farm of consultants, fellowships and supplies and equipment, and will be correlated with other relevant programmes.

Inter-country

1977 Regional

Inter-country

Inter-country

1979 Regional

Inter-country

MAJOR PROGRAMMI? 7 . 1 HEALTH STATISTICS

Object ives

- a s s i s t c o u n t r i e s t o improve t h e i r h e a l t h s t a t i s t i c a l s e r v i c e s s o t h a t r e l e v a n t i n fo rma t ion can be produced and used e f f e c t i v e l y f a r a s s e s s i n g and monitoring t h e h e a l t h s i t u a t i o n of t h e count ry and for the p lanning and eva lua t i on of h e a l t h s e r v i c e s , which would provide a b a s i s f o r more informed decision-making i n h e a l t h a d m i n i s t r a t i o n , and

- c o l l a b o r a t e i n t h e c o l l e c t i o n , a n a l y s i s and i n t e r p r e t a t i o n of d a t a t o i d e n t i f y h e a l t h needs and p r i o r i t i e s i n t h e Region.

Approaches

By:

- c o l l a b o r a t i n g w i th c o u n t r i e s i n country h e a l t h programming t o i d e n t i f y and formula te p lans f a r developing i n f o n o t i o n systems and sub-systems t o suppor t managerial f unc t i ons ;

- a s s e s s i n g and de termining the needs and p r i o r i t i e s o f coun t r i e s i n the development of n a t i o n a l h e a l t h i n fo rma t ion sys tems, and

- determining and making a v a i l a b l e t h e necessary WHO i n p u t s t o achieve t h e above o b j e c t i v e s .


WHO has p layed an impor tant r o l e i n suppor t i ng n a t i o n a l h e a l t h a u t h o r i t i e s i n p lanning t h e development of h e a l t h s e r v i c e s , t h e i r management, ope ra t i on and p e r i o d i c eva lua t i on . WHO'S c o l l a b o r a t i v e programme i n t h e f i e l d of v i t a l and h e a l t h s t a t i e t i c s is i n t e w o v e n wi th and o r i e n t e d t a r a r d s t h e s e a c t i v i t i e s .

The demand f o r a s s i s t a n c e i n h e a l t h s t a t i s t i c s has g r adua l ly s h i f t e d from t h e development of i n f r a s t r u c t u r e towards the s t r eng then ing o f h e a l t h i n fo rma t ion systems t o suppor t managerial f unc t i ons of h e a l t h programmes and towards s p e c i a l i z e d s t a t i s t i c a l s e r v i c e s , such as computer programming and p r e p a r a t i o n of epide ln io lagica l models. Thus WHO'S advisory r o l e i n h e a l t h s t a t i s t i c s now tends t o t a k e t h e form of t e c h n i c a l pa r tne r sh ip i n m u l t i d i ~ c i p l i n a l y teama, except i n a few s p e c i f i c i n s t a n c e s where s o p h i s t i c a t e d s t a t i s t i c a l techniques are r equ i r ed .

T ra in ing a t graduate l e v e l of p r o f e s s i o n a l s t o enab l e them t o work a t c e n t r a l h e e l t h s t a t i s t i c a l o rgan i za t i ons has been campletrented w i th suppor t given to t r a i n i n g i n s t i t u t i o n s i n medical record keeping and h e a l t h s t a t i a - t i c s f o r i n t e r m e d i a t e end p e r i p h e r a l l e v e l personnel .

D i r ec t a s s i s t a n c e has a l s o been given f o r t h e organiza t i r rn of departments of medical records i n medical i n a t i - t u t i o n s . A r e g i o n a l meeting has promoted i n t e r e s t on t h e p a r t of c o u n t r i e s i n developing nomenclature and c l a s s i f i c a t i o n of l a y r e p o r t s of cause o f dea ths and of d i s e a s e s .

P r o p ~ s n t a for IY78-I979

Ass i s t ance w i l l cont inue i n s t r e n g t h e n i n g the h e a l t h informat ion systems i n f r a s t r u c t u r e a t n a t i o n a l l e v e l . r n t e n s i f l e d e f f o r t s w i l l be made t o promote t h e use of h e a l t h s t a t i s t i c a l informat ion c o l l e c t e d i n t h e c o u n t r i e s o f t h e Region.

A r e g i o n a l t r a i n i n g course €0; coding i n s t r u c t o r s w i l l be organized i n 1978 i n t h e use of t h e Ninth Revision of t h e I r t t e rna t i ona l C l a s s i f i c a t i o n of Diseases (ICD) i n o rde r t o ensu re t h e uniform a p p l i c a t i o n of t h e ICD, and b e t t e r i n t e r n a t i o n a l comparabi l i ty of morbid i ty and m o r t a l i t y d a t a . I n 1979, e group educa t iona l a c t i v i t y i s planned t o be h e l d t o promote b e t t e r u t i l i z a t i o n of h e a l t h s t a t i s t i c a l and o t h e r h e a l t h I n f o m a t i a n f o r the ~ l a n n i n g and management of h e a l t h programmes.

PROGRAMME 7.1.1 P R O G W PLANNING AND GENERAL ACCIVITIES

Objectives

To:

- advise on t h e development of n a t i o n a l h e a l t h information s y s t e m ;

- maintain s t a t i s t i c a l consu l t a t ive s e w i e e e f o r b m b e r countr ies , and

- ea l l abora te i n t h e co l l ec t ion , ana lys i s and i n t e r p r e t a t i o n of d a t a required for planning and management of hea l th p ragrames .

Appmaches

By emphasizing the development of h e a l t h information system. t o support t h e planning, management and evalua- t i o n of hea l th se rv ices .

WHO has col laborated wi th n a t i o n a l organizat ions i n t h e development of na t iona l hea l th information s y s t e m or i en ted towards t h e information needed f o r planning, management, and evaluat ion.

Assistance w i l l continue i n t h e development of information systems a t t h e country l eve l .

1976 Regional

Inter-country

1977 Regional

I n t e r c o u n r r y

1978 Regional

Inter-country

1979 Regional

Inter-country

7.1.2 HEALTH STATISTICAL MelgOMLOCl

Objectives

TO:

- advise and a s s i s t i n t h e a p p l i c a t i o n of s t a t i s t i c a l methods i n t h e f i e l d o f h e a l t h , and

- a s s i s t i n developing knowledge o f , and s k i l l s i n , s t a t i s t i c a l methods and techniques .

Appmaches

By a s s i s t i n g t h e s t a t i s t i c a l methodolow of various h e a l t h programmes.

Progranne Review

Advice on and a s s i s t a n c e i n t h e a p p l i c a t i o n of s t a t i s t i c a l methods have been provided under a number of p r o j e c t s . I n a d d i t i o n t o s t u d i e s of s p e c i f i c h e a l t h problems, i n c r e a s i n g a t t e n t i o n has been given t o research on h e a l t h d e l i v e r y s y s t e m . Ass i s t ance haa been given t o s t a t i s t i c a l problems i n t h e eva lua t i on of p r o j e c t s and p r a g r a m e s , and i n t h e development of computer process ing of h e a l t h da t e .


In ter -count ry

T o t a l


In ter -count ry

T o t a l

1978 Regional -

Country

In ter -count ry

T o t a l



T o t a l

Regular Budget

US$

4 3 600

4 3 600

Regular Budget

2

2


Other Sources

US$

T o t a l

US$

4 3 600

4 3 600

Number of Poets

Other Sources

T o t a l

2

2

PROGRAEiME 7.1.4 DEVELOPmT OF HEALTH STATISTICAL SERVICES

Objaeti we

To:

- assist i n developing and s t rengthening the n a t i o n a l h e a l t h information systems as support f o r planning. mafiegement, and evaluat ion o f hea l th ae rv ices ;

- continue aes ie t ance i n developing t h e i n s t i t u t i o n a l framework f o r t h e c o l l e c t i o n , ana lys i s , and diesemi- n a t i m of hea l th e t a t i e t i c s i n countr ies of t h e Region, and

- assist wi th t h e organizat ion and conduct of r e l evan t t r a i n i n g progranmee.

Appmaches

By:

- a s s i s t i n g i n determining t h e information needs f o r t h e planning and management of h e a l t h se rv ice8 and t h e i r evaluat ion, end

- e s s i e t i n g i n determining t h e needs and p r i o r i t i e s i n t h e development of n a t i o n a l hea l th information systems.

Technical a s s i s t a n c e i n the area of h e a l t h s t a t i s t i c s information i e inc reas ing ly being provided through p ro jec t s i n cornunity h e a l t h and maternal and c h i l d hee l th , r a t h e r than as separa te h e a l t h s t a t i s t i c s p ro jec t s . There i s an inc reas ing arereness , p a r t i c u l a r l y i n countr ies vhich have conducted country hea l th programming t h a t h e a l t h s t a t i s t i c s m u s t be t a i l o r e d t o the requirements of ~ l a n n i n g , management, and evaluat ion of hea l th e e d c e s and t h a t t h i s r equ i res a team approach.


A t t e o t i m v i l l be given t o t h e development end s t rengthening of ne t ione l hea l th information syeteur end s u b - systems. E f f o r t s v i l l b e d i r e c t e d t o the formulation of guidel ines and procedures f o r t h e planning,operation and evaluat ion o f these systems and sub-system. A review of experien-will be undertaken i n countr ies vhich have s t a r t e d bu i ld ing up h e a l t h information eyeterns o r eub-systems v i t h a view t o evolving e f f e c t i v e systems s u i t a b l e f o r t h e condi t ions and resources of t h e region. I n add i t ion , support v i l l b e provided t o t h e development of manpwer t o operate such eyet- and s&-aystem.

I n t h e development of h e a l t h s t a t i s t i c a l ae rv ices , s ea i s t ance v i l l continue t o be given t o p ro jec t s r e l a t i n g t o t r a d i t i o n a l aspect. of v i t a l and h e a l t h s t a t i s t i c s , as v e l l as t o those t h a t are support ive of o t h e r sub-programen, v i t h p a r t i c u l a r emphasis on p r a c t i c a l adaptat ion t o the changing p a t t e r n and needs of l o c a l hea l th e e d c e s .


Inter-country

Total


Intercountry

1978 Regional

Inter-country

Inter-country

Estimated Obligations Nuder of Poets

Total

US$

113 500

35 200

148 700

38 000

Regular Budget

US$

111 800

35 200

147 000

38 000

Regular Budget

3

3

3

Other Sources

US$

1 700

1 700

Other Sources Total

3

3

3

W O R PROGRAMME 7.2 HEALTH LITERATURB SERVICBS

Objcctivea

To:

- c o l l e c t and disseminate information on h e a l t h and t o provide h e s l t h l i t e r a t u r e t o WHO s t a f f , governments, research i n s t i t u t i o n s , and workers;

- a s s i s t i n t h e production of teaching and l ea rn ing ma te r i a l f o r h e a l t h teams, and

- puhlish annotated bibl iographies

A ~ , ~ l V , z , . / - < , #

BI :

- . I ss is t ing i n providing reference and docmentat ion se rv ices t o t h e na t iona l hea l th adminis t ra t ions and h r . ~ l t h i n s t i t u t i o n s ;

- c o l l e c t i n g information about hea l th sc ience l i b r a r i e s i n t h e countr iee of the Region and assisting them by providing advisory s e r v i c e s , reference se rv ices and l i t e r a t u r e , end

- conducting a survey of the needs and resources f o r teaching and l ea rn ing ma te r i a l f o r use by hea l th personnel i n t h e countr ies of the Region and t o a s s i s t i n and ca-ordinate t h e production of such l i t e r a t u r e .


The l i b r a r y has co l l ec ted and disseminated information on h e a l t h l i t e r a t u r e t o governments, research i n s t i t u - t ions and workers i n the countr ies o f t h e Region, ee we l l a s t o WHO s t a f f f o r t h e i r continuing p ro fess iona l education. It has a l s o provided MEDLINEIHEDLARS b ib l iograph ica l se rv ices t o t h e n a t i o n a l hea l th a d m i n i ~ t r a - t i o n s , i n s t i t u t i o n s and research workers i n t h e f i e l d . Photocopies of se l ec ted references have a l s o been provided. F a c i l i t i e s f o r t r a i n i n g and consu l t a t ion se rv ices have been provided t o Member countr iee .

I n view of t h e shor tage of medical l i t e r a t u r e fo r use by s tuden t s aa revealed by a survey, four teen s tudent loan l i b r a r i e s have been es t ab l i shed i n medical col leges i n Bangladesh, Burma, Ind ia , Indoneela, Mongolia, S r i Lanka and Thailand. Under t h i s scheme, mul t ip le copies of paper-back e d i t i o n s of medical textbooks are suppl ied ta the medical school l i b r a r i e s f a r loan t o etudenee.

A study has a l so been c a r r i e d ou t on the use of h e a l t h l i t e r a t u r e published i n t h e coun t r i e s of t h e Ragion; t h i s has revealed t h a t only t en pe r cen t of such l i t e r a t u r e is covered i n the Index Medicus. on which the MEDLINEIMEDLARS system is based. Consideration i s being given t o the development of an Index t o Medical Pe r iod ica l s of t h e Countries of t h i s Region.

The Regional Documentation Centre on Human Reproduction, Family Planning and Population oynemlcs, e s t ab l i shed i n the Regional Of f i ce , has been prepar ing and d i s t r i b u t i n g annotated b ib l iograph ies , including such s p e c i a l top ics as s t e r o i d contracept ion, family planning progr-es, male reproduction and f e r t i l i t y c o n t r o l , i n t r a - u te r ine contracept ive devices , female reproductive biology and male and female s t e r i l i z a t i o n .

FroposaZs for 1978-1970

kvelopment of hea l th l i t e r a t u r e i n t h e Region and t o p a r t i c i p a t e a c t i v e l y i n t h e Headquartera Health L i t e r a t u r e Programme.

Based on informat ion co l l ec ted es a r e s u l t of t h e survey of h e a l t h sc ience l i b r a r i e s , eee i s t ance t o Member Governments w i l l be provided. Addi t ional s tuden t loan l i b r a r i e s are proposed t o be e s t ab l i shed . K3DLINEI MEDLARS s e r v i c e s w i l l be extended t o c e r t a i n o t h e r ca tegor ie s which are not a t present covered.

Annotated b ib l iograph ies of published and unpublished mate r i a l , produced by t h e Regional Documentation Centre on Human Reproduction, Family Planning and Population Dynamics, w i l l b e i s sued more f requent ly .

Plans have a l s o been made, i n t h e d i f f e r e n t countr ies of t h e Region, f o r making e r e a l i s t i c e s t ima te of the needs f o r l ea rn ing ma te r i a l s f o r a l l ca tegor ies of hea l th s t a f f a t var ious l e v e l s , and t h i s is expected t o he lp i n working ou t a long-term plan f o r undertaking e h e a l t h l ea rn ing ma te r i a l s production programme.


1977 Regiona l


1978 Regiona l - Country


T o t a l

1979 Regional - c o u n t r y


T o t a l -

I I I i 3

3

3

6

3

3

6

3

3

3

3

3

3

25 300

42 000

67 300

1 25 300

I 5 3 900 I 95 900

55 900 121 200

28 lrn I 28 700

42 000 59 000 101 000 -

129 700 70 700 59 000

MAJOR PROCRANHG 7.3 WHO PUBLICATIONS

Objectives

- supplement Headquarters' e f f o r t s i n f u l f i l l i n g t h e object ives of t h e WHO publ icat ions pragr-e, e spec ia l ly with reference t o geeing t h a t these publ ics t iona reach t h e persons and i n s t i t u t i o n s f o r whom they ere intended, t h a t l a , p lacing them within easy access of h e a l t h workers and i n a t i t u t i o n e i n the Region and ensuring e f f e c t i v e d i s t r i b u t i o n and s a l e a , and

- i s s u e appropr ia te t echn ica l documents and s p e c i a l regional publ icat ions of p a r t i c u l a r i n t e r e e t t o countr ies of the Region.

Approaches

- supplementing Headquarters' d i s t r i b u t i o n of docments and publ icat ions and d i s t r i b u t i n g Regional Off ice ma te r i a l t o those i n t e r e s t e d as wel l as t o the s t a f f ;

- reviewing pe r iod ica l ly the mailing lists t o ensure t h a t WHO publ icat ions and documente reach a l l those t o whom they w i l l be use fu l ;

- c i r c u l a t i n g information on new WHO publ icat ions and on a l l WHO and SEAR0 publ icat ions t h a t a r e ava i l ab le f o r s a l e ;

- undertaking a d i r e c t s a l e s p r o g r a m f o r a l l WHO publ icat ions and SEARO pub l i ca t ions , by o f fe r ing these publ icat ions st 50% discount and a t s p e c i a l reduced r a t e e of subsc r ip t ion and accept ing payment i n the l o c a l currencies of the countries, i n co-operation with t h e WHO Representa t ives ;

- arranging f o r exh ib i t ions of publ ics t iana a t important meeting*;

- adver t i s ing WHO publ icat ions i n se l ec ted medical and paramedical journals;

- bringing ou t regional publ icat ions t o meet s p e c i f i c needs, such as guides f o r aux i l i a ry nurses, orldwives, e t c . , and placing them on s a l e a t very lov p r i ces ;

- producing and d i s t r i b u t i n g repor t s on p ro jec t a c t i v i t i e s , guides and manuals, and

- providing support t o p ro jec t s f o r the production of guides and manuals i n l o c a l languages.

The need for ensur ing wider d i s t r i b u t i o n of WHO publ icat ions was f e l t as ea r ly as t h e second ha l f of the nineteen f i f t i e s , and a regional scheme (by which publ icat ions could be made ava i l ab le a t low cos t ) was worked out with Headquarters, SEARO a c t i n g as s a l e s agent. At t h a t time, t h e problem of space prevented t h e s tocking of publ icat ions i n t h e Regional Of f i ce , b u t t h e scheme became a ful l - f ledged s a l e s progrannoe i n 1963, when t h e Regional Of f i ce moved i n t o i t s new premises. Coverage ha8 g r e a t l y improved, end t h e s a l e s have been inc reas ing progress ively , the amount f o r 1975 being US$36 396 (520 subsc r ip t ions were r eg i s t e red o r renewed during t h e year , and 1447 orders f o r r e t a i l purchases complied wi th ) .

With more p u b l i c i t y , i t should be poss ible t a make a s u b s t a n t i a l inc rease i n s a l e s and d i s t r i b u t i o n .

Assignment r epor t s , f i n a l r e p o r t s , and repor t s on group educat ional a c t i v i t i e s have been e d i t e d , i ssued as o f f i c i a l documents and d i s t r i b u t e d t o governments and i n s t i t u t i o n s concerned as wel l as t o i n t e r e s t e d workers on the b a s i s of e s t ab l i shed mai l ing l is ts o r on request. The Regional Di rec to r ' s Annual Report and other Regional Committee documents, including t h e minutes and f i n a l repor t of t h e sess ions , have been produced and d i s t r i b u t e d each year . Guides and manuals f o r t h e use of h e a l t h workers a r e a l s o prepared and d i s t r i b u t e d widely.

At tent ion has a l s o been given by t h e Regional Off ice and by f i e l d p ro jec t s t o l o c a l production of manuals i n na t iona l languages. I n Thailand ass i s t ance was given t o t h e publ icat ions of a nurs ing textbook i n the Thai language ( t r a n s l a t i o n from English).

"An Aid t o t h e Teaching of Huhlan Reproduction, Family Planning and Population Dynamics", which was f i r s t produced i n 1972, has been updated and widely distributed.

r


Inter-country

Total


Inter-country

1978 Regional

Inter-country

Inter-country

Nuher of Posts

Regular Budget

10

Eatimated Obligations

Other Source. 1

10

Regular Budget

US$

96 900

96 900

104 900

Other Sources

US$

10

10

Tocal

US$

96 900

96 900

104 900

10

10

Ob jectivea

To:

- keep t h e publ ic informed of the a c t i v i t i e s of WHO i n general and i n the South-East Asia Region i n p a r t i c u l a r ;

- make the publ ic mare of major hea l th problems and of some of the ways i n which they can he lp t o resolve them, and

- s t imula te t h e production, by ou t s ide sources , of information ma te r i a l about general na t iona l heal th a c t i v i t i e s and WHO'S p a r t i c i p a t i o n i n these a c t i v i t i e s .

Appmachee

By :

- providing a va r i e ty of se rv ices and f a c i l i t i e e t o j o u r n a l i s t e , radio and t e l e v i s i o n repor te r s and f i l m makers ;

- producing mate r i a l s i n t h e Publ ic Information Unit i n t h e Regional Off ice f o r d i r e c t d i f fus ion through the -8 media;

- encouraging production of fi lm8 and a r t i c l e s by outa ide producers, and

- approaching the publ ic d i r e c t l y through var ious publ icat ions , v i s i t o r s ' s e r v i c e s , l e c t u r e s and exh ib i t ions .

P r o g r m Review

Information ma te r i a l received from Headquarters a s we l l as produced i n the Regional Off ice , takes a va r i e ty of f a r w .

Presa re leases : These cover a wide range of top ics dea l ing wi th na t iona l and regional hea l th progr-es. new developmente i n research and technology and p a r t i c u l a r l y s i g n i f i c a n t meetings and seminars. Fie ld v i e i t s are made t o prepare s p e c i a l f ea tu res f o r WorZd Health, regional f ea tu res and press re leases .

Radio: Tapes a re received from Headquarters and d i s t r i b u t e d i n t h e Region. Interviewe v i t h WHO or n a t i o n a l - hea l th s t a f f a r e recorded i n s tud ios and used l o c a l l y o r through Headquarters. I n add i t ion , consul tant se rv ices a r e provided f o r p r o g r a m s deal ing wi th h e a l t h prepared by n a t i o n a l r ad io and t e l ev i s ion networks.

Photographs: Photographs on a va r i e ty of hea l th themes are produced i n o rde r t o i l l u s t r a t e p ress f e a t u r e s , a r t i c l e s f o r VorZd Health and o the r WHO publ icat ions , including t h e Regional Di rec to r ' s and Director-Generel'a Annual Reports. They a r e a l s o d i s t r i b u t e d f o r use i n exh ib i t ions and suppl ied t o free-lance w r i t e r s t o i l l u s t r a t e a r t i c l e s i o various publ icat ions - including scho la r ly works.

Films: Films suppl ied by Headquarters are d i s t r i b u t e d , and advice i s given t o na t iona l organizat ions making filma on hea l th topics i n t h e Region. Films are a l s o produced, independently of Headquertem, on regional topics f o r use wi thin t h e Region.

World Health Dax: This occasion has , over t h e yea r s , been increasingly u t i l i z e d f o r e review of the achieue- mente i n e p e c i f i c f i e l d s of h e a l t h and t o l ay emphasis on t h e f u t u r e plane and programmes of the na t iona l hea l th services . It a l so provides an opportunity f o r WHO t o lay s t r e s s on p a r t i c u l a r and top ica l problem of hea l th and t o he lp b r i n g about an increased awareness among t h e peoples i n t h e Regim. Services f o r reproducing and translating t h e s p e c i a l ma te r i a l received from Headquarters i n var ious coun t r i e s continue t o be provided.

Spec ia l a c t i v i t i e s : During 1975, Asia was declared f r e e o f smallpox. Spec ia l commemorative a c t i v i t i e s were arranged in Ind ia which, only e year e a r l i e r , had witneeeed e widespread epidemic of t h e dieeeae. The a l l -ou t dr ive , which achieved tremendous succesa, aroused a great deal of i n t e r e s t among a l l forme of t h e mass media. both n a t i o n a l and in te rna t fons l . The Regional Off ice acted as t h e f o c a l po in t f o r b r i e f i n g the media with i n f o m t i m , end i n d i c a t i n g p lans and approachee us ing f i lms , radio in terviews o r f e a t u r e a r t i c l e s could be bes t c a r r i e d ou t .

General enqu i r i e s : A l a r g e nrsnber of enqu i r i e s about WHO'S a c t i v i t i e e and t h e general h e a l t h a i t u e t i o n i n countr ies continue t o be received and rep l i ed to .


Emphasis w i l l continue t o be given t o t h e production of w r i t t e n and v ieua l ma te r i a l ( p a r t i c u l a r l y fi lms) on top ice of regional importance. Tne resurgence of malar ia i n t h e Region, primary h e a l t h care, and Immunization w i l l receive s p e c i a l a t t e n t i o n bile producing i t e m f o r mass c i rcu la t ion .


Inter-country

Total


Inter-country

Inter-country

1979 Regional

Inter-country

1 Eetimd Led Obligations Number of Posts

Total

USS

54 200

54 200

58 500

Regular Budget

USS

54 200

54 200

58 500

Total

3

3

3

Other Sources

USS

Regular Budget

3

3

3

Other Sources

Objectives

To a s s i s t t h e Regional Director i n t h e formulation, implementation, con t ro l and evaluat ion of WHO programe of a s s i s t ance i n t h e Region.

- preparing the Sixth General Programme of Work r e l a t i n g t o t h e Region, and medium-term programmes i n accordance with the guidel ines e s t ab l i shed b y the World Health Assembly, R e g i a a l Committee, e t c . ;

- programme budgeting f o r b ienn ia l per iods through e f f e c t i v e hea l th programming, p r o j e c t formulation and management;

- reviewing and evaluat ing the medium-term and b i e n n i a l p rogrames ;

- developing methods for programme and p ro jec t evaluat ion;

- es tab l i sh ing and developing a comprehensive ipformation system with s p e c i a l emphasis on s p r o g r m e and p ro jec t information system i n t h e Regional Off ice , and

- applying economic analysis and h e a l t h ope ra t iona l research.

For t h e attainment of t h e above ob jec t ives , the Regional Director i s a s s i s t e d by t h e Director of Health Services , and four Ass i s t an t Directors of Health Services and t h e Chief, Administration and Finance.

The Assis tant Directors of Health Services , a s s i s t e d by t h e Regional Advisers - who provide the t echn ica l exper t i se - are responsible f o r the formulation of regional p m g r a m e s , based on the proposals i n i t i a t e d by t h e WHO Representatives a f t e r discuseions wi th n a t i o n a l a u t h o r i t i e s .

The Programme Support and Co-ordination Uni t , headed by one of t h e Ass i s t an t Di rec to r s of Health Services , provides support i n planning, programming and evaluat ion of regional p r o g r a m s , based on t h e competence of a mul t id i sc ip l ina ry team and information from t h e P r o j e c t Management Information System.

A P ro jec t Management Information System has been developed t o monitor t h e inpu t s i n t o p r o j e c t s end t h e outputs expressed i n terms of achievement of in termediate ob jec t ives (milestones).

Several t r a i n i n g a c t i v i t i e s have been conducted i n o rde r to d i f f u s e t h e managerial know-how throughout the Region - consu l t a t ive se rv ices i n management of hea l th semfces were p r w i d e d t o Nepal.

Praposais f o r 1978-1979

It is expected t h a t adequate methods w i l l be developed f a r country h e a l t h p rograming and t h e s e l e c t i o n , formulation, con t ro l and evaluat ion of programmes and projects .

The revised programme and p r o j e c t management i n f o m t i o n system, wi th in t h e o v e r a l l WHO Information System. t h a t w i l l be e s t ab l i shed w i l l conta in adequate i n f o m t i o n as a b a s i s f a r f u t u r e planning, p rograming , budgeting and control .

Inter-country

1977 Regional

Inter-country

Inter-country

Inter-country

MAJOR PROGRAMME 9.2 ASSISTANCE TO COUNTRY PROCRII(WES

To s t rengthen t h e planning, programming, con t ro l and evaluat ion of WHO country progr-es.

Approaches

- a s s i s t i n g i n : programme and p ro jec t formulation, monitoring and evaluat ion;

- developing methods f o r country hea l th programming, p ro jec t formulation end management;

- planning, conducting and analysing q u a n t i t a t i v e and hea l th ope ra t iona l s tud ies ;

- t r a i n i n g i n management of hea l th progr-ea, and

- t h e in t roduct ion of economic eoncepte i n hea l th planning.

Progmmne Rauiew

WHO Representatives t o coun t r i e s funct ion a s managers of the country programmes and p r o j e c t s and as adv i se r s t o t h e Regional Director i n providing aeaiscance. In t h e formulation and nanagement of t h e country p r a g r m e s and individual p ro jec t s they draw on t h e t echn ica l competence of Regional Of f i ce occasional ly Headquarters t echn ica l s t a f f .

An exe rc i se i n country hea l th programming was conducted i n Bangladesh towards t h e end of 1973, another i n Nepal in 1974 and one i n Thailand i n 1975. These exe rc i ses have s h w n t h e v a l i d i t y of new approaches t o hea l th planning a t country l e v e l by which i t ia dovetai led i n t o t h e o v e r a l l planning a c t i v i t i e s f o r eocio-economic development. Similar exe rc i ses are planned f o r Burma, S r i Lanlur, Indonesia and Mongolia during 1976-1978.

ProposaZe for 1978-1979

It is expected t h a t t h e WHO Representatives i n t h e coun t r i e s assume g r e a t e r r e s p o n s i b i l i t y f o r t h e management of country programmes and p ro jec t s , wi th support from d i f f e r e n t echelons i n t h e Organization.

With continuing n a t i o n a l e f f o r t s i n medium and long-term hea l th planning, supporting s e r v i c e s w i l l continue t o be provided.

Inter-country

1977 Regional

Inter-country

Inter-country

Inter-country

W O R P R O G W 9.3 REGIONU GENERAL SUPPORT SERVICES

This program* provides t h e f u l l range of support se rv ices t o t h e Regional Director and t h e t echn ica l s t a f f , a t regional , country and inter-country l e v e l , e i t h e r on a continuing b a s i s or i n response t o s p e c i f i c needs or requeste .

It cons i s t s of pol icy and admin i s t r a t ive guidance i n t h e planning and development of the r eg iona l programen. support t o all programmes i n f i n a n c i a l , budgetary, l e g a l and c o n s t i t u t i o n a l ma t t e r s and t h e provis ion of personnel, supplies, conference, reproduction, eamunica t ion , t r a v e l , o f f i c e apace and o the r general se rv ices .

-


Inter-country

Total


Inter-country

Inter-country

Inter-country

Estimated Obl igat ions Number of Posts

Total

US$

670 500

670 500 - 730 500

Regular Budget

US$

661 300

661 300

720 900

Regular Budget

73

73

73

Other Sources

US$

9 200

9 200

9 600

Other Sources

2

2

2

Total

75

75

75

MAJOR PROGRAMME 9.4 REGIONAL C W O N SERVICES

This progrme covers the c m o n services required for the operation of the Regional Office and the physical support necessary for the staff working in the office. These provisions include building maintenance; utilities; acquisition, repair and operation, as appropriate, of office furniture, equipment and transport; communication services of all kinds; expendable materials; library books; contractual services, and other related expenditures.

Allowance hes to be made for bath increased demands on theee services and for the continuing inflationary trends in the cost of various commoditiee, utilities and services.

-

1976 Reg~onal - Country

Inter-country

Total


Inter-country

1978 Regional

Inter-country

Inter-country

Estimated Obligations Number of Posts

Total

US$

376 700

376 700

402 000

Regular Budget

US$

369 200

369 200

394 000

Regular Budget

\ I

Other Sources

US$

7 500

7 500

8 000

Other Sources

I I

SUKMARY OF DIRECT TECHNICAL COOPERATIOX WITH, AND SERVICES TO, GOVERNMENTS

Bangladesh

Bhutan

Burma

Democratic P e o p l e ' s Republ ic o f Korea

I n d i a

Indones ia

Maldives

Mongolia

Nepal

S r i Lanka

Tha i l and

l n t e r - c o u n t r y

T o t a l -

~ -. . - - - - - - - . . - - - - - - - - - ,

1978

1 272 000

1 002 100

373 300

2 537 200

2 013 100

248 300

590 100

1 101 600

911 000

1 222 500

2 803 300

14 074 500

79

30

11

7

32

5

27

9

14

82

225

R E G U L A R B U D G E T

Proposa l s

1979

1 469 400

1 111 500

396 900

2 753 300

2 139 700

261 100

601 200

1 212 100

964 800

1 292 600

3 117 3M)

15 319 900

No.

76

9

2

6

14

9

3

6

5

1

23

78

Revised

1976

910 200

781 800

319 800

2 079 400

1 700 300

201 500

530 400

888 900

757 600

1 047 800

2 304 700

11 522 400

P a s t s

78

32

12

8

32

5

7 6 8 8

30

9

19

84

239

76

30

7

23

37

5

31

12

22

100

274

E s t i m a t e s

1977

1 127 900

965 400

339 9DO

2 401 700

1 816 200

235 500

579 200

1 070 700

900 600

1 151 400

2 325 000

12 913 500

of

77

13

2

6

1 3

9

3

6

3

2

24

8 1

No. o f

77

32

10

23

34

5

30

1 0

21

89

260

O T H E R S O U R C E S

1978

1 166 800

411 700

1 584 1M)

256 300

123 800

122 400

1 3 600

78 300

2 060 400

5 817 400

Revised

1976

3 440 700

160 400

584 800

3 221 200

597 800

224 900

469 800

63 100

588 200

309 400

742 000

10 402 300

Posts

78

11

4

10

2

2

3

1

28

61

Proposa l s

1979

421 100

315 500

518 200

96 300

83 400

1 718 400

3 152 900

Es t imates

1977

4 355 400

44 500

901 900

3 000 100

815 300

263 200

625 100

31 000

319 500

I33 I00

1 103 500

11 592 600

79

5

3

7

1

1

28

45

ANNEX 1

Regional O f f i c e

Bangladesh

Bhutan

Burma

Democratic p e o p l e ' s Republic of Korea

I n d i a

Indonesia

Maldives

Mongolia

Nepal

S r i Lanka

Thai land

In te r -coun t ry

R E G I O N A L O F F I C E

REGIONAL OFFICE

2.1 Executive Management

Regional Director Administrative officer Secretary Secretary Clerk-typist

Duty travel I

2.2 Programme Co-ordination

2.2.2 CO-ordimtion with other organizations I

I Secretary I 7.2 Health Literature Services , Library assistant Clerk Clerk-typist

Library books

7.3 WHO Publication

Reports officer 1 P4 Editor Reports assistant Administrative assistant Technical information assistant

Clerk Clerk-stenographers Stores clerk Clerk-typist

ND5 ND4 ND4 ND? ND?

Number of Posts Reviaed Estimates

l j l 1 1 1 1 1 1 1 1 1 1 - - - - 3 3 3 3 - - - -

Proposals

1978 1979

6500 X R B

9 800 11 300 5 300 6 100 4 200 4 800 - - 19 300 22 ZOO

6 000 6 500 - -

l I 1

1 1 1

1 1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 2 2 2 2 1 1 1 1

10 -

10 -

1

1 1

10 -

1 1 - - - -

10 -

127

(Ezpreased in US Do2lorsi

0 - 9 REGIONAL OFFICE

7.4

Proposals Revised

1976

43 500

1978

38 700 8 400 4 200

Health Information of Public

Public information officer Information assistant ND6 1 1 1 Clerk-typist

- - - - 3 1 3 3 3

~stimates

1977

36 000 7 300 3 700

47 000

1979

41 200 9 600 4 800

-

Number of Posts

3 000 i - - - -

Duty travel Public informtion material

I

i 9.1 i Re~io-1 Programme Plaming

1 and General Activities

Director, health services Assistant directors, health 1 services

Planning officer P5 1 1 1 1 Conference officer 1 Technical officer (programming) P2 1 t '

Administrative assistante jND7 2 2 2 2 Technical assistant ND7 1 1 1 1 Assistants N D 6 4 4 4 4 Assistant ND5 1 1 Clerk-stenographers Clerk-typis t

2 200 8 500

54 200

321400

22 000

343 400

55 600

1976

2 500 9 000

58 500

36 000

144 000 36 000 26 200 26 200 17 000 8 500 29 200 5 700 13 800 3 700

346300

24 500

370 800

36 000

36 000 8 500 5 700 4 600

36 000 4 600

12 200 8 500 7 300 5 700 9 200 3 700

RE

- I - !

I

Duty travel

9.3 ReRional General Support i Services

Administration and Finance

Administration and flnance 1 officer P5

Administration and finance 1 officer

Administrative assistant N D 7 Secretary ND5 Clerk-stenographer ~ D i 1

i Budget and Finance

Budget end finance officer Clerk-stenographer IND4

1 1977

38 700

154 800 38 700 28 000 28 000 19 600 9 800 33 600 6 500 15 900 4 200

---- 377800

26 000 ----

403 800 ----

38 700

38 700 9 800 6 500 5 300

38 700 5 300

14 100 9 800 8 400 6 500 10 600 4 200 .

41 200

164 800 41 200

' 29 700 29 700 22 600 11 300 38 400 7 500

/ 18 300 4 800

409500

27 500

437 000

41 200

41 ZOO 11 300 7 500 6 100

41 200 6 100

16 200 11 300 9 600 7 500 12 200 4 800

20 120

1978

20 - - - -

1

1 1 1

1 1

1 1 1 1 2 1

1

1

1 1 1 1 2 1

Special assistant 1 N D X 1 Administrative assistant IND7

1979

20

1

1 1 1 1

1

1 1 2 1

1

P 4 1 1 1 1 1 1

1

P 4 1 1 1 1 1 1

1 1

1 1 2 1

Assistant accountant Assistant accountant Accounts clerks Clerk-typist

ND6 ND5 ND4 ND3

128

IEzpreseed in US Dollars)

REGIONAL OFFICE

Finance

Special assistant Administrative aesistant Finance aasiatsnt

Number of Posts

NDX ND7 ND6

1976

1 1

Cashier 1 1 Assistant accountants Accounts clerks ND4 2 2 2 Clerk Clerk-typists 2 2

Personnel

Personnel officer Pereonnel officer Adminietrative assistants Senior assistants Clerks ND4 2 2 Clinical nurse Clerk-typist ND3 1 I 1

I

! Supply Services

Supply officer P3 1 1 1 Administrative assistant ND7 : I 1 1 1 Supply assistant 1 1 Clerk-stenographer Clerk-typists ND3 3 3 3

Administrative Services I

i Administrative services

officer Administrative assistant

Travel clerk ND5 1 1 1 Assistant air-conditioning operator

Clerk-stenographer Clerk 1 1 Mail clerk Registry clerk.

7 300 28 500 9 200 4 600

36 000 26 200 14 600 22 800 9 200 4 600 3 700

/ 26 200 8 500 7 300 4 600 11 100

26 200 8 500

14 600 7 300 5 700 5 700

4 600 4 600 I L 690 4 600 9 200 1 4 600 3 700 3 700

Revised Eetimates

Machine operator Telephone operator

1977

1 1 1 1

1976

ND3 1 1 1 1 1 1 1 1

RB

FP

G? 1)

3 1977

12 200 8 500 7 300

8 400 32 500 10 600 5 300

Proposals

Receptionist Clerk-typists

Custodial staff Temporary assistance Duty travel

UNFPA Infrastructure

Budget assistant Administrative assistant

(personnel)

1978

1 1

9 600 37 500 12 200 6 100

1978

14 100 9 8 0 0 8 400

1979

1 1 1 1

1979

16 200 11300 9 600

1 1 1 3 700 4 200 4 800 ND3 9 9 9 9 33 300 37 800 43 200

9 600

38 700 41 200 28 000 29 700 16 800 19 200 26 000 , 30 000 10 600 12 200 I 300 1 6 100

ND6

4 200

28 000 9 800 8 400 5 300

12 600

28 000 9 800

16 800 8 400 6 500 6 500

5 300 5 300 5 300 5 300 10 600 5 300 4 200

4 800

I 29 700 11 300 9 600 6 100 14 400

29 730 11 300 19 200 9 600 7 500 7 500

6 100 6 100 6 100 6 100

12 ZOO 6 100 4 80C

4 200 4 600

73

1

-

73 - - - -

1

2 2 2 2

-

' 73

1

N U 6 1 1 1 1

- - - -

-

73

1

-

534 200

83 500 35 010 8 600 - 661 300

- 9 200 -

( 582 400

92 000 37 000 9 500 - 720 900

5 000

4 600

- 9 600

-

651 300

105 800 39 000 9 500

--

805 600 ----

5 300

4 800

- 10 100

-

727 700

121 700 41 000 10 000 - 900 400

5 500

5 100

- 10 600

-

HL*9 006 Development of Procedures and S ta f f Tra in ing

To a s s i s t i n the (1) development of procedural manuala an p r i o r i t y hea l th se rv ice programme which have been i d e n t i f i e d by country hea l th progr-ing; (2) t r a i n i n g and reo r i en ta t ion of b a s i c hea l th se rv ice s t a f f i n carrying out t h e new tasks i n primary hea l th care and b e s i c hea l th s e r v i c e s , vector-borne d i sease c o n t r o l , family h e a l t h , expanded immunization and environmental s a n i t a t i o n , and (3) accelera- t i o n of t r a i n i n g programmes f o r midwives, lady hea l th v i s i t o r s and nurses i n t h e i r new r o l e s f o r multipurpose hea l th work and supervis ion of primary hea l th workers.

The country heal th programming exe rc i se c a r r i e d out i n 1976 f o r t h e planning period 1977-1982 has pinpointed the development of procedures and s t a f f t r a i n i n g as the c r i t i c a l support s t r a t e g y f o r the success of the se rv ice programmes iden t i f i ed . This p ro jec t is designed t o provide such c r i t i c a l eupport with t h e following inputs from WHO: A nurse educator w i l l a s s i s t i n developing the syl labus fo r the t r a i n i n g of nurses. lady hea l th v i s i t o r s and midwives during 1977 end 1978. A subsidy v i l l be provided f o r the p a r t i c i p a t i o n of t r a inees i n the midwifery and nursing t u t o r t r a i n i n g programme during the three-year period. A subsidy w i l l a l s o be given f o r the development of procedures which w i l l be undertaken by a group of 1 3 s p e c i a l i s t s who w i l l be entrus ted wi th the t a sk of developing procedure manuals on p r i o r i t y hea l th a c t i v i t i e s i n 1977. This support w i l l be repeated i n 1979, when the procedure manuals w i l l be reviewed i n the l i g h t of t h e experience gained i n applying the manuele i n 1977 and 1978. Another programe which w i l l receive a subsidy w i l l be t h e t r a i n i n g of teaching s t a f f st c e n t r a l , d iv ie i an and t a m s h i p l e v e l s who w i l l be involved i n teaching b a s i c hea l th se rv ice s t a f f i n t h e new procedure manuals. The t r a i n i n g of b a s i c hea l th se rv ice s t a f f t o acquaint them with the new procedure manuala w i l l be supported dur ing 1977, 1978 and 1979. Further support w i l l be given to the t r a i n i n g of midwives and nursing s t a f f through the provis ion of a subsidy f a r procuring necessary s t a t ione ry . I n 1977, two mini buses are proposed t o be procured f o r the midwifery and nursing tu to r course.

ESD 001 Strengthening (HeQlthP BUR/69/003)

To a s s i s t i n e s t ab l i sh ing epidemiological u n i t s i n a l l the admin i s t r a t ive d iv i s ions by converting the ex i s t ing disease-control teams i n t o such u n i t s ; i n organizing epidemiological su rve i l l ance of d i seases of publ ic hea l th importance i n addi t ion t o those sub jec t t o t h e In te rna t iona l Health Regulations, and i n i n i t i a t i n g planning and implementation of t h e na t iona l immunization programme with t h e aim of covering t h e e l i g i b l e c h i l d population wi th vaccinat ions sga ine t smallpox, tubercu- l o s i s , d iph the r i a , t e t anus , p e r t u s s i s and po l iomye l i t i s , through the bas ic hea l th services .

WHO'S support t o t h i s p ro jec t began i n 1961, with the assignment of an epidemiologist; a microbiologiet was l a t e r provided. Assistance was given i n laboratory d iagnos t i c methods and procedures a t t h e Rangoon and Mendalay l abora to r i e s . Consultants were provided ( in 1968, 1969 and 1970) t o he lp i n t h e f u r t h e r development of t h e Centra l Epidemiological Unit. I n 1969, a microbiologis t joined t h e p ro jec t t o a s s i s t i n t h e p a r a l l e l development of l abora to ry se rv ices and i n the organizat ion and conduct of various epidemiological su rve i l l ance a c t i v i t i e s ; i n 1972, a f u r t h e r consul tant assessed t h e d e v e l o p ment of t h e epidemiological se rv ices , and i n 1973, a consul tant evaluated t h e s t a t u s of the recogni t ion, d iagnosis , t reatment , prevention and con t ro l of haemorrhagic f eve r s caused by arthropod-borne v i ruses i n Burma as we l l as of research on t h i s subject . A WHO microbiologis t who joined t h e p ro jec t i n December 1973 has a s s i e t ed i n the epidemiological inves t igs t ione of Salmonella typhi D2 phsge-type. I n April-May 1974, a consul tant was aseigned t o a s s i s t the National Health Laboratory i n Rangoon.

A consul tant was assigned t o a s s i s t i n t h e epidemiological su rve i l l ance of communicable d i seases , s t rengthening of t h e Centra l Epidemiology Uni t , and t h e t r a i n i n g of na t iona l epidemiologists.

Another consul tant a s s i s t e d t h e p r o j e c t f a r one month during August 1975 i n organizing and conducting a couree on teaching methods f o r i n s t r u c t o r s of laboratory technicians .

Assistance is exoected t o continue till 1977.

ESD 002 Prevention. Control and Surveillance of Communicable Diseases

To assist the Government in the development, organization and assessment of surveillance and control of communicable diseases (trachoma, venereal diseases. cholera and enteric infections, plague and filariasis).

The assistance will consist of consultante, fellowships, supplies end equipment end training.

The project is a result of the merger of six projects for improved co-ordination and management in this field - (1) "Trachoma Control" (Burma 0069), which started in 1966 with case-finding services and domiciliary treatment in the framework of the health services; (2) "Epidemiology and Control of Cholera and Enteric Infections (Bum 0104); (3) "Pilariesia Control" (Burma 0087). which etarted in Rangoon as a follow-up of the "Filarinsis Research Unit" (IR 0271); (4) "Virtu Dieease Control" (Burma 0098). where assistance has been given in epidemiological studies and in the control of virus diseases; (5) "Plague Control" (Burma 0078). which el80 started in 1966, and (6) "Venereal Diseases and Treponematoses Control" (Burma 0105).

In 1976, a consultant will be aesigned to assist with the epidemiological surveillance of ealmrmnicable diseases. Supporting fellowships, national group educational activities and supplies and equipment will also be provided.

ESD 003 Expaneion of Eoidaiological Surveillance in Comunitx Health Services (UNDP BURl741053)

To improve the effectiveness of the health services through the application of epidemiological methods in the prevention and control of communicable and non-communicable diseases. The immediate objectives are to (a) establish the necessary competence in the National Health Laboratory in Rangoon; (b) improve the effectiveness of surveillance of communicable diseases ac peripheral levels; (c) train the staff of epidemiological services in public health microbiology and, conversely, train laboratory staff in epidemiology, and (d) conduct pre- and post-immunization studies.

In 1976, fellowships, supplies and equipment will be provided. In 1977, it is proposed to provide assistance by way of consultants in microbiology, virology, vaccine production and toxicology, fellowships and supplies and equipment.

In 1978, it is also proposed to provide assistance by way of consultants and eupplies and equipment.

MPD 001 Malaria Eradication

This project will merge with BUR VBC 001 from 1977.

SF1 001 Expanded Programme on Immuni~ation

To assist in the (1) planning, implementation end evaluation of the expanded programme of immunization and ( 2 ) training af the national staff engaged in the expanded immunization programme.

The immunization programme has always been carried out by the staff of the baric health services or vertical programmes such as the emallpox eradication and tuberculosis control programe. The country health progradng exerciee which was carried out in 1976 for the period from 1977 to 1982 has identified the expanded programme of hunization as a priority health programme which will need special development efforts.

In 1977, 1978 and 1979, a consultant will assist in the planning, implementation and evaluation of the expanded programme of immunization. A study tour will be conducted for cvo health workers in order to observe expanded immunization programmes in selected countries within or outside the South- East Asia Region. UNICEF will assist this progrmme by procuring necessary eupplies, including cold chains, vaccines end transportation.

Assistance is expected to continue for some years.

BURMA

BVD 001 Tuberculosis Control (UNDP BUR/68/018)

TO a s s i s t i n developing community-oriented tube rcu los i s c o n t r o l se rv ices .

Assistance was provided from 1951 t o 1954 under p r o j e c t Burma 0003, "Tuberculosie Control Demonetra- t i o n and Training, Rangoon" and from 1954 t o 1957 under Burma 0018, "Tuberculosis Control and Training Centre. Mandalay", i n establishing demonstration and t r a i n i n g c e n t r e s i n Rangoon end Msndalay.

I n 1964, when a s s i s t a n c e was resumed under t h i s consolidated p r o j e c t , co-nity-oriented p i l o t p ro jec t s i n tuberculosis con t ro l were s t a r t e d based a t t h e above two centres . s i n c e then t h i s p a t t e r n has spread t o cover t h e North-western Diviaion i n 1967-68 end t h e Eastern and S o u t h v e s t e r n Divis ions i n 1969-1970. Coverage of the South-eastern Division s t a r t e d i n 1971 and t h e operat ions i n the Centra l Division i n 1972.

The coverage by BCG vaccinat ion has considerably improved s i n c e t h e in t roduc t ion of the d i r e c t vaceina- t i o n technique. An eveluet ion vae undertaken In 1971, and, based on the f ind ings , a plan f o r t h e f u t u r e development of t h e programme was prepared. I n 1972, a b a s e l i n e tube rcu los i s survey was c a r r i e d out. F e l l m a h i p s and supp l i e s and equipment have been provided. I n 1974-75, the a s s i s t ance provided included fe l lowships and supp l i e s and equipment.

In 1976, a conaul tsnt a se ia t ed t h e Government i n t r a i n i n g the newly es t ab l i shed Tuberculoais Assessment Team f o r the comprehensive assessment of t h e na t iona l tube rcu los i s programme and i n i n i t i a t i n g opera- t i o n a l research f o r chemotherapy s tud ies .

I n 1977 and 1978, the aas ie t ance w i l l be i n t h e form of consul tants , fe l lowships and supp l i e s and equipment.

Aasistsnce t o the p ro jec t i s expected to continue up t o 1978.

BVD 002 Mycobacterial Diseases

To a s s i s t i n s t rengthening t h e leprosy and tuberculosis con t ro l programes in teg ra ted i n t o the general hea l th se rv ices .

Assistance is being provided f o r research and t r a i n i n g .

This p ro jec t is t h e r e s u l t of t h e merger of N o p ro jec t s - "Tuberculosis Control" (Bur- 0065), and "Leprosy Control" (Burma 0017). Community-oriented p i l o t p ro jec t s in tubercu los i s , s t a r t e d i n 1964, have so f a r covered the N o r t h r e e t e r n , Eastern , S o u t h u e e t e r n . South-eastern and Centra l Divisions. The coverage by BCG vaccinat ion has improved considerably s i n c e the i n t roduc t ion of t h e direct vaccinat ion technique; e l ao , a b a s e l i n e tube rcu los i s survey hae been c a r r i e d out. Assistance by WHO and UNICEF through t h e leprosy c o n t r o l p r o j e c t ( B u m 0017) s t a r t e d i n 1952, supported by th ree voluntary agencies , emphasis being placed on i n t e g r a t i n g t h e p r o j e c t a c t i v i t i e s i n t o t h e hea l th se rv ice8 and on t r a i n i n g s t a f f . An assessment of t h e leprosy con t ro l progr-e was made by th ree consul tants assigned during November 1972-April 1973. This p ro jec t includes a BCG t r i a l of ch i ld ren aga ins t leprosy and a c l i n i c a l t r i a l on r i fampicin f a r leprosy p a t i e n t s .

In 1976, a consul tant a s s i s t e d i n t h e evaluat ion o f t h e BCG t r i a l aga ins t leprosy, end another v i l l he lp t h e Government t o develop a research design f o r t h e r i f a m p i c i n l c l i n i c a l trial. Fellowships, auppl ies and equipment are a l s o provided.

This p ro jec t w i l l merge wi th p r o j e c t BUR PHC 001 i n 1977.

BVD 003 L e ~ r o s y Control

TO a s s i s t i n in t ens i fy ing t h e l ep rosy c o n t r o l programme, i n extending it t o cover a l l t h e endemic a reas , and i n t r a i n i n g personnel. .

Assistance from WHO and UNICEP a t a r t e d i n 1952, when a l e p r o l o g i s t was assigned. The p ro jec t is being supported by three voluntary agencies (Order of Malta. Emmaus Suiese and Deutsches Aussatzigen Hilfswerk). Expansion i n a l l 30 p r o j e c t a r e a s ha8 proceeded s a t i s f a c t o r i l y . Emphasis has a l s o been placed on i n t e g r a t i n g t h e p ro jec t a c t i v i t i e s i n t o t h e h e a l t h se rv ices and on t h e t r a i n i n g of s t a f f . Tvo t r i a l s for t h i s purpose have been c a r r i e d ou t i n t h e d i s t r i c t s of Hlegu Province. An assessment ca r r i ed ou t i n Apr i l 1973, ahowed very s a t i s f a c t o r y development. The WHO l e p r o l o g i s t completed h i e assignment i n Apr i l 1'374. The p r o j e c t has succeeded i n r e g i s t e r i n g almost e l l t h e leprosy cases i n the country and i n covering a l l t h e a r e a s of Burma. It w i l l s e rve a s a good t r a i n i n g and dwons t ra - t i o n cen t re f o r all coun t r i e s and a l l p r o f i l e s of h e a l t h workers involved i n leprosy con t ro l .

It i s expected t h a t , a t t h e end of 1976, t h i s p r o j e c t w i l l be merged with the p ro jec t BUR PHC 001.

182

BURMA

VBC 001 Vector-borne Diseases Control

To a a s i e t i n planning, implerenta t ion and e v d u a t i o n of wmprehemive c o n t r o l a c t i v i t i s a q a i M t malaria, danguclhaemorrhagic f eve r , f i l a r i u i m , Japmese encepha l i t i a and plague, by developing one coherent vector-borne d i sease c o n t r o l programme by mobiliaing e x i s t i n g resources a v a i l a b l e i n ind iv idua l p ro jec t s r e l a t e d t o vector-borne d i sease c o n t r o l , and s t a f f development f o r c o m p r e h a ~ i v e vector-borne d i sease con t ro l programme.

Since 1951, WHO a s s i s t ance hes been provided f o r t h e c o n t r o l of malar ia which had been etepped up eventual ly t o an e rad ica t ion progreame. This a s s i s t ance has been j o i n t l y provided with UNICEF u n t i l 1962, a f t e r which WHO as s i s t ance wsa l imi ted t o t h e award of f e l l a r s h i p s , technics1 advice and provi- s ion of suppl ies and equipment. The government has ca r r i ed ou t c o n t r o l a c t i v i t i e s a g a i m t f i l a r i a s i s , dengue/haemorrhagic fever and plague by e s t a b l i s h i n g sepa ra te c o n t r o l un i t a i n t h e Depar twnt of Health. WHO provided a s s i s t a n c e f o r f i l e r i s s i s c o n t r o l s i n c e 1969, plague con t ro l s i n c e 1966, dengue1 haemorrhagic fever con t ro l s i n c e 1974. The country hea l th programme i n 1976 haa i d e n t i f i e d the vector- borne d i sease con t ro l programme a s r equ i r ing in tens ive development e f f o r t s i n order t o ca r ry ou t these important a c t i v i t i e s ns a coherent vector-borne d i s e a s e c o n t r o l prograame f o r t h e period from 1977 t o 1982.

The vector-borne d i sease c o n t r o l t equ i rce h u v y r e s i s t a n c e i n supply and equipment component i n view of the s i g n i f i c a n t inc rease i n incidence of vector-borne d i s e a s e s i n Burme. I n t e r n a t i o n a l a s s i s t ance from o the r donor agencies v i l l be sought.

During t h e years 1977. 1978 and 1979, a s s i s t a n c e v i l l be provided through consul tancies by awarding fellowships and organizing s tudy tour s and by providing supp l i e s and equipment.

ORH 001 Dental Health Services

To a s s i s t i n s t rengthening and expanding t r a i n i n g f a c i l i t i e s f o r den ta l a u x i l i a r y personnel, i n planning the gradual expansion of e x i s t i n g end new d e n t a l h e a l t h s e r v i c e s , and i n e s t a b l i s h i n g and ensuring gradual implementation of p r o g r a m s t o provide prevent ive and curacive d e n t a l services.

A Consultant i n dentistry was provided i n 1967-68 (under p ro jec t Burma 0083). In 1971 end 1972, two consul tants helped t o draw up a d r a f t request f o r a s s i s t a n c e under UNDP. I n 1975, s d e n t a l t u t o r was assigned t o review the c u r r i c u l a of t h e d e n t a l nurs ing course being o f fe red a t t h e I n s t i t u t e of Dental Medicine, t o organize r e f r e s h e r w u r s e s and give p r a c t i c a l demonstration t o na t iona l d e n t a l a u x i l i a r y personnel f o r organizing prevent ive and c u r a t i v e d e n t a l se rv ices .

I n 1976, i t i s proposed t o a s s ign two consu l t an t s (a d e n t i s t and a d e n t a l equipment engineer) t o a s s i s t i n t h e t r a i n i n g of d e n t a l s t a f f i n t h e maintenance and r e p a i r of d e n t a l equipment.

l h i e p ro jec t v i l l merge with BUR PHC 001 i n 1977.

MNH 001 Nental Health Training and Services

This p ro jec t terminates i n 1976.

RAD 001 U d i a t i o n Health

This p r o j e c t terminates i n 1976.

BURMA


To assist in strengthening occupational health services, in revising legislation and in training personnel.

In 1975, an expert in occupational health visited Burma for three months to assist in strengthening the occupational health unit at the Ministry of Health. He also advised the authorities on formulating legislation on occupational health and organizing courses in this field. Pellwships related to occupational health were awarded and assistance was given for the procurement of supplies and equip- men t . In 1976 also, a fellowship and supplies and equipment will be provided.

BLG J02 Uevelopment of Pruduction and Quality Control of Hialogicsl end Pharmaceutical Producta

To assist in the production and control of biological producte, such as vaccines and sera, which ere produced by Burma Pharmaceutical Induatry (BPI), and in staff development for biological production of BPI.

In 1968 and 1969, consultants advised on quality control of biological and pharmaceutical products in BPI. In 1973, a consultant pharmaceutical chemist was assigned to Burma to evaluate the progress. In 1975, another consultant assi~ted in surveying the existing policies for quality assay and standardization of DPT vaccine production. In 1976, a team consisting of a vaccine expert, a biological standardization expert and an economist will carry out a feasibility study for development of a comprehensive plan in improving production and quality control of biological products.

In 1977, an expert on DPT vaccine will assist in further improving the quality of the DPT vaccine in order to meet international standards. Pellwships will be awarded to technical staff in BPI for training in production end quality control of biologicals. Provision has been made for limited eupplies and equipment in order to enhance production potential for biological products to meet the demands of the priority health programmes in immunization.

Assistance to the project will continue fot some more years.

LAB 001 Strengthening of Laboratory Services

This project terminates in 1976.

LAB 002 ~oad and Drug Quality Control Laboratory (UNDP BURl741027)

With B view to support a developing Food and Drug Administration, the project aims at establishiw and operating e multi-dieciplinary laboratory to implement the enforcement of the Burms Public Health Act, 1972.

Augmentation of existing testing facilities and manpower in food analytical unit of the National Health Laboratory and establishment of improved facilities, with personnel end equipment, for testing pharmaceutical and immono-biological products in the three existing buildings occupied by the National Health Laboratory at Rangoon.

In February 1975, a WHO preparatory mission visited Rangoon to make a thorough study of the existing situation with regard to food end drug quality control services in the country. In consultation with the national counterparts, a project document was prepared and submitted to the Government of Burma for clearance end onward transmission to UNDP for approval.

The project is expected to become operative in 1978 when the recruitment of a project manager will be made and fellowships in varioue disciplines will be awarded and assistance will be given far the procurement of supplies and equipment.

The project is expected to continue up to end 1981.

186

BURMA

BSM 002 Environmental Sanitation

To assist in planning, implementation and evaluation of community water supply and sanitation programme, and in staff development for community water supply and sanitation programe in urban and rural areas.

The rural water supply programme is carried out by the Ministry of Agriculture and urban water supply is provided by the municipalities in Burma. The Ministry of Health has played relatively marginal role as far ae water supply programme is concerned. The country health programme conducted in 1976 has identified environmental sanitation, with emphasis on community water supply and aanitation, as s priority programme from 1977 to 1982. The environmental sanitation programme will be carried out by the ministries concerned, with necessary international assistance.

Assistance will be provided through technical advice by a sanitary engineer and a short-term consultant in 1977, 1978 and 1979. Fellownhip will be awarded to develop the local leadership in environmental sanitation for a past-graduate training programme in Delft. Netherlands, which will be followed by an observation programme in India and Thailand. Practical training programme will be provided to the water eupply engineers by sending them to suitable countries such as Japan end Australia. In 1977, an observation study tour will be organized for the chief engineers in the rural water supply unit of the Ministry of Agriculture. An observation study tour will be conducted for workers in community water supply scheme in order to observe the progr-s in suitable countries witbia the Region. The mvlrom- mental sanitation programme will be supported by other donor agencies, in collaboration with WHO.

DHS 002 Department of Medical Research


DHS 003 Development of Health Infarmstion Services

To assist in building up co-ordinated health information cervices.

Beginning 1954, aseistance has been provided, through project (Burma 0022) for the establishment of a division of vital and health statistics in the Directorate of Health Services, improvement of the procedures related to disease notification, development of a hospital statistical syatem and organiea- tion and development of health statistical services. It is now proposed to eo-ordinate the various information outlets to provide an integrated health fnfo-Cion service to help develop health plans. In 1974, a consultant (under Burma 0022) etudied the various aspects of vital and health etatietical services and made recommendations for improvement. From December 1975 to February 1976, another consultent followed up the proposals made in 1974, and especially assisted in the development of a national health information ayetem. Fellowships under the project are related to training in medical records and statistical methods as applied to medical records.

BURMA

9.2 Assistance t o Country Programnes

Office of t h e WHO Representative

Medical o f f i c e r P5 Medical o f f i c e r SRP Secre ta r i a l a s s i s t a n t RN6 S e c r e t a r i a l a s s i s t a n t RN5

Custodial s taff l temporary aes is tance

Cornon services

Total - BURMA

Of which: Regular budget Other sources

in US

.A TI

. "

R8

1976

1/12 1/12 1/12 1/12

4

13 ---- 7 6

DoZtars)

Pro jec t No.

ASE 001

h

Number

1977

1/12 1/12 1/12 1/12

4

16 .I--

10 6

Revised

1976

72 200

4 400 13 000

89 600

1 366 600 11.-.----

781 800 584 800 -

Estimates

1977

41 800 28 600 4 000 2 800

77 200

5 100 22 000

104 300

1 867 300 --.------ 965 400 901 900 -

1978

44 800 30 400 4 600 3 200

83 000

6 000 24 000

---- 113 000

----

1 413 800

1 002 100 411 700

of Posts

1978

1/12 1/12 1/12 1/12

---- 4

----

---- 16 ---- 12 4

----

(&pressed

Proposals

1979

47 600 32 100 5 200 3 700

88 600

7 000 19 000

114 600

1 427 000 ----...I. 1 111 500

315 500

1979

1/12 1/12 1/12 1/12

4

14 1---

11 3

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

GENERAL

The Government of Democratic People ' s Republic of Kores, on t h e b a s i s of t h e Juche i d e a , cons ide r ing t h a t the wor ld ' s most prec ious possess ion is man, and f i rmly mainta in ing t h e p rophy lac t i c l i n e i n medicine f o r t h e prevent ion of d i s e a s e s be fo re t h e i r appearance, s t r i v e s t a r a r d s t h e continuous s t r e n g t h and development of t h e h e a l t h s e r v i c e s and medical s c i ence .

The Government i s respons ib le f o r and manages i n f u l l , a l l medical i n s t i t u t i o n s , which are r a t i o n a l l y d i s t r i - buted a l l over the country.

Ae aga ins t only 9 h o s p i t a l s i n 1944, t h e r e are now more than 6400.

The S t a t e has c a r r i e d out t h e Six-Year Plan (1971-1976) f a r n a t i o n a l economic development, a year and h a l f ahead of schedule . During t h e per iod of t h e p l an t h e S t a t e t r a i n e d more medical workers, i nc r ea sed t h e production of medicament and medical ins t ruments and, i n p a r t i c u l a r , r e in fo rced t h e county and ma te rn i t y h o s p i t a l s and t h e c h i l d r e n ' s wards and completed t h e work of conver t ing t h e r u r a l c l i n i c s i n t o h o s p i t a l s . The medical s e r v i c e s t o r u r a l popula t ion were thus improved remarkably.

The S t a t e has drawn up t h e p lan f o r d iminish ing e f f e c t i v e l y t h e d i s p a r i t i e s i n t h e q u a l i t y of medical serv ice between the urban and r u r a l areas i n t h e near f u t u r e and s t r i v e s towards i t s r e a l i z a t i o n .

General Health Se rv i ce s

Consonant w i th t h e p r i o r i t y a t t a ched t o medical s e r v i c e s , e s p e c i a l l y i n t h e f i e l d of maternal and c h i l d h e a l t h , the S t a t e is e n t i r e l y r e spons ib l e f o r t h e h e a l t h of a l l people. c

I n the Democratic People ' s Republic of Korea, t h e system of complete and u n i v e r s a l f r e e medical care has been put i n t o e f f e c t many years ago and h e a l t h s e r v i c e s con t inue t o develop and expand under the " sec t i on medical S ~ I V ~ C B S ~ ' system.

The county h o s p i t a l s are being conver ted i n t o i n t e g r a t e d h o s p i t a l s and a l l r u r a l c l i n i c s i n t o h o s p i t a l s ; thus r a i s i n g the l e v e l of s p e c i a l i z e d s e r v i c e s remarkably.

WHO'S c o l l a b o r a t i o n i n t h i s f i e l d s t a r t e d i n 1974 and w i l l con t inue i n t h e yea r s t o come. Emphasis is being placed on the development of h e a l t h manpower, geared towards p rov i s ion of s p e c i a l i z e d medical care t o t h e e n t i r e popula t ion through the h o s p i t a l network.

Health I*npower Uevelopment

Under the execut ive and tec i ln ica l guidance of t h e Min i s t ry of Pub l i c i l e a l t h , t h e t r a i n i n g of doctorq , pharma- c i s t s , middle l e v e l workers and n u r s e s is undertaken i n each province .

WHO is suppor t ing a p r o g r a m f o r t h e p r epa ra t i on of t h e p ro fe s s iona l s f o r t h e i n t e r n a t i o n a l s c i e n t i f i c comu- n i t y and a l s o w i l l c o l l a b o r a t e i n i t i a l l y i n r e i n f o r c i n g t h e medical l i b r a r i e s and documentation c e n t r e s .

Disease Prevent ion

In the Delnocratic People ' s Republic of Korea, t h e mafor comun icab l e d i s e a s e s have been completely e r ad i ca t ed many years ago as a r e s u l t of the f i rm adopt ion of p rophy lac t i c measures i n medicine through publ ic h e a l t h s e r v i c e s .

I n c o l l a b o r a t i o n w i th WHO, the Government i s implementing programmes r e l a t e d t o non-corn-nunicable d i s ea se s p a r t i c u l a r l y i n t h e f i e l d s of cancer and ca rd iovascu l a r d i s e a s e s .

I n f u t u r e , the Government w i l l concen t r a t e on o t h e r f i e l d s such as endocrinology, haematology, a l l e r g i e s and g e n e t i c s .

The comprehensive cancer p r o j e c t embraces a wide range of s u b j e c t s i n t h e f i e l d of cancer ranging from epidemiologica l i n v e s t i g a t i o n s , e a r l y d e t e c t i o n and d i agnos i s t o t h e t r a i n i n g o f h e a l t h personnel f o r management, provis ion of equipment, r t c .


I n view of t h e r ap id development of i n d u s t r y and a g r i c u l t u r e i n t h e Democratic People ' s Republic of Korea, WHO w i l l c o l l a b o r a t e i n a c t i v i t i e s f o r t h e improvement of t h e h e a l t h of t h e working people who are engaged i n t h i s f i e l d .

Ass i s t ance w i l l a l s o b e provided t o programmes f o r t h e improvement of genera l environmental hygiene e s p e c i a l l y i n the f i e l d s of school hygiene, i n d u s t r i a l hygiene and food hygiene; ae wel l as i n t h e q u a l i t y c o n t r o l of drugs , w i th p a r t i c u l a r r e f e r e n c e t o v i tamins and a n t i b i o t i c s .

HSD 001 Strengthening of Medical Care Servicea

To e s e i e t , i n general , i n the s t rengthening of hea l th se rv ices , and. i n p a r t i c u l a r , spec ia l i zed medical care i n the county h o s p i t a l s , a s we l l as i n the t r a i n i n g of hea l th personnel i n the planning and adminis t ra t ion of h o s p i t a l s e rv ices and var ious medical s p e c i a l t i e e .

I n 1974, a two-month group v i s i t f o r f i v e o f f i c i a l s was arranged and, i n 1975-76, some fe l lmish ips have been awarded i n hea l th care management. Consultants w i l l be provided i n 1976, 1977 and 1979 t o s t rengthen the medical c a r e se rv ices . Fellowship8 w i l l be awarded f o r t r a i n i n g i n t h e planning and management of comprehensive ae rv ices and i n var ious c l i n i c a l s p e c i a l t i e s . Suppl ies and equipment w i l l a l s o be provided.

From 1978 onwards the p ro jec t w i l l cover su rve i l l ance a c t i v i t i e s which were formerly under p ro jec t KRD ESD 001.

HMD 001 Strengthening of Health Manpower Development

TO a s s i s t i n t h e t r a i n i n g and continuing education of hea l th manparer needed by the country.

Suf f i c i en t numbers of doctors , pharmacists end nurses are al ready being t r a ined i n t h e country 's t en medical co l l eges and one pharmaceutical co l l ege as wel l a s i n high medical echoole. Research i n s t i t u t e s a r e a t tached t o t h e Academy of Medical Sciences. Support w i l l be provided mainly f o r the strengthening of medical l i b r a r i e s and doc~nnentation cen t res and, a f t e r 1976, f o r r e in fo rc ing teaching equipment.

A consultant each w i l l b e provided i n 1976, 1977 and 1979 f o r t h e f u r t h e r formulation of the project . Fellowships t o enable doctors t o l e a r n languages and f o r t h e t r a i n i n g of librarians have been provided s ince 1974. I n add i t ion , fellowshipa i n c e r t a i n defined s p e c i a l t i e s , including group v i s i t s , as neces- sa ry , to aome of t h e medical education c e n t r e s and medical l i b r a r i e s , a r e being awarded from 1975 through 1979. Suppliea and equipment w i l l a l s o be provided f o r the development of the p ro jec t .

ESD 001 Ep idemio l~g ica l Svrvei l lance

TO a s s i s t i n t r a i n i n g i n r ecen t developments r e l a t e d t o epidemiological su rve i l l ance and c o n t r o l methods i n se l ec ted countr ies . For t h i s purpose, fe l lowships f o r s t u d i e s r e l a t e d t o the epidemiologi- c a l su rve i l l ance progremes, as well a s supp l i e s end equipment, are provided.

From 1978 onwards, t h e laboratory a spec t s of t h i s p ro jec t w i l l be merged with p ro jec t KRD LAB 001 and the aervice aspects with KRD HSD 001.

CAN 001 Cancer Control

To a s s i s t i n etrengthening t h e publ ic h e a l t h se rv ice system f o r t h e de l ive ry of oncological se rv ices . t r a i n i n g hea l th and a l l i e d personnel i n cancer con t ro l , and i n promoting bio-medical research i n cancer.

I n 1974, a team of s p e c i a l i s t s t a f f members from Headquarters and the Regional Of f i ce v i s i t e d t h e country, assessed the e x i s t i n g f a c i l i t i e s and developed a plan of operat ion f o r cancer con t ro l . Supplies and equipment were made a v a i l a b l e i n 1975-76 f o r bio-medical research i n cancer. I n ea r ly 1976, a Broup of oncologists was awarded f e l l o w h i p a t o v i s i t such c e n t r e s i n Europe f o r observing the l a t e s t t rends i n the management of cancer. Similar provis ion has been made f o r supp l i e s and equipment, fellowehips and conaultsncy se rv ices an request i n spec ia l i zed a reas of oncology i n 1977.

A consul tant w i l l be provided i n 1978 t o a s s i s t i n e s t ab l i sh ing chemotherapy se rv ices f a r cancer. F e l l w s h i p s w i l l be awarded f a r sen io r anco log i s t s t o observe r e c e n t t r ends i n cancer management and for junior members t o g e t t r a i n i n g i n d i f f e r e n t d i s c i p l i n e s of oncology. I n 1979, e consul tant w i l l a s s i s t i n t h e development of cancer immunology. Provis ion has been made f o r t r a i n i n g i n cancer se rv ices and research and f o r equipping oncological cen t res .

0

2

RB

RB

€3

RB

Project NO.

HSD 001

HMD 001

ESD 001

CAN 001

DWOCRATIC PEOPLE'S REPUBLIC OF KOREA

3.1 General Health Service8


Strengthening of Medical Care Services

Short-term consul tants Eellawships Supplies and equipment

4.1 Health Manpower Development

Strengthening of Health Manpower Development

Short-term coneul tsnts P e l l w s h i p e Supplies and equipment

5.1 Communicable Disease Prevention and Control

5.1.2 Epidemiological Survei l lance

Epidemiological Survei l lance

F e l l w s h i p e Supplies and equipment

5.2 Non-Communicable Disease Prevention and Control

5.2.2 Cancer

Cancer Control

Short-term consul tants Fellowships Supplies and equipment

--

Prop08818

1978

84 200 10 000

94 200

36 400 8 000

44 400

12 000 34 600 82 000

---- 128 600

----

-

1979

4 500 86 800 10 000

-- 101 300

--

4 500 38 000 6 000

48 500

4 500 26 400 85 000

115 900

Revised

1976

3 000 52 600

8 000

63 600 -

3 000 31 600 8 100

42 700

-

7 800 1 000

8 800

6 000 47 400 48 000

101 400

Estimates

1977

3 500 51 400 10 000

64 900 -

3 500 26 400

8 500

38 400

5 000

5 000

21 000 51 200 59 000

131 200

Number of Posts

1978

6/96

I

4/48

11 3 8/42

I

1976

11 1 5/84

1979

I/ 1 6/96

i

11 1 4/48

11 1 4/30

1977

11 1 6/96

1 11 1 4/48

2/12

11 2 8/84

11 1 4/48

21 6 11/84

DEMOCRATIC PEOPLE'S REPLIBLIC OF KOREA

To a s s i s t i n the s t rengthening of se rv ices i n the publ ic healch de l ive ry oyetem, t h e t r a i n i n g of heal th and a l l i e d personnel, and the p r o m t i o n of research f o r the prevent ion and c o n t r o l of cardiovascular d iseases .

I n 1974, a team of s p e c i a l i s t s t a f f members from Headquarters and t h e Regional Off ice v i s i t e d the country, observed t h e e x i s t i n g f a c i l i t i e s end developed a plan of act ion. I n 1975, supp l i e s and equipment were provided f o r ce rd io thorae ic se rv ices . I n 1976, f e l l a r s h i p s were awarded t o a group of senior c a r d i o l o g i s t s t o observe r ecen t developments i n cardiology. Similar t echn ica l a s s i s t a n c e w i l l b e provided i n 1977 f o r the t r a i n i n g of sen io r and junior c a r d i o l o g i s t s .

I n 1978, provision has been made f a r t h e t r a i n i n g of cardiologists i n spec ia l i zed a res8 of the management of cardiovascular d ieeases and f o r suppl ies and equipment f o r the Cardiovascular I n s t i t u t e . A consul tant i n s t r ep tococca l microbiology w i l l be provided in 1979 and fellowehips awarded f o r the t r a i n i n g of s p e c i a l i s t s i n cardiovascular d iseases . Provis ion has a l s o been made f o r l imi ted suppl ies and equipment.

IMM 001 General I m m u n o l o ~

TO a a s i s t i n t h e development and improvement of f a c i l i t i e s i n immunology. Provision i s made i n 1976 f o r fellowships f o r t h e t r a i n i n g of na t iona l s t a f f i n se l ec ted t r a i n i n g and research cen t res and, i n 1976 and 1977, f o r supp l i e s and equipment. From 1978 onwards t h i s p ro jec t w i l l be merged with p ro jec t KRD LAB 001.

PHA 001 Drug Quality Control

To s t rengthen l abora to r i e s and t r a i n hea l th and a l l i e d personnel for t h e q u a l i t y con t ro l of drugs produced l o c a l l y o r imported.

In 1976, fellowships were awarded for t r a i n i n g two candidates i n t h e l a t e s t methods of q u a l i t y con t ro l of drugs. A consul tant w i l l be provided i n 1977 t o a s s i s t i n the development of f a c i l i t i e s f a r drug qua l i ty control .

Fellowships w i l l be awarded i n 1978 f o r t r a i n i n g i n t h i s spec ia l i zed area. Provis ion has been made i n 1979 f a r cansultancy s e r v i c e s , t r a i n i n g and t h e supply of equipment.

LAB 001 Laboratory Sciences and Techniques

To s t rengthen t h e competence of na t iona l se rv ice8 i n advanced laboratory methods.

It is propoeed t o provide fe l lowships i n 1976-77 t o acquaint n a t i o n a l personnel wi th the l a t e s t developments i n laboratory technlquea and t o enable e c i e n t i s t s t o s p e c i a l i z e i n se l ec ted sub jec t s .

Supplies and equipment w i l l be provided t o support t h e development of se rv ices on r e t u r n of t h e fe l lows from t ra in ing .

The p ro jec t s KRD ESD 001 and KRD IMM 0 0 1 w i l l be merged with t h i s p ro jec t e f f e c t i v e 1978.

198

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

CEP 001 Enviromental Henlth

TO a e s i s t i n t h e t r a i n i n g of personnel f o r t h e study of problems r e l a t e d t o environmental pol lut ion.

Provision i s made f o r sen io r hyg ien i s t s and s c i e n t i s t s t o study var ious a spec t s of environmental hygiene i n 1976, 1977, 1978 and 1979 through fe l lowahips i n se l ec ted sub jec t s , e.g., a i r po l lu t ion , i n d u e t r i a l toxicology, noiae c o n t r o l , s i l i c o s i s and water q u a l i t y con t ro l . Provis ion is a l s o m d e f o r suppl ies and equipment.

FSP 001 Food Hygiene

To a s s i s t i n t h e s t rengthening of t h e National Food Control Administration and i n the t r a i n i n g of s t a f f .

Provision i s made f o r a consul tant i n 1978 and f o r f e l l w s h i p s i n 1976, 1977. 1978 and 1979 i n se lec ted sub jee te and a l a o fo r euppliea and e q u i p e n t i n 1977. 1978 and 1979.

' p r o j e c t NO.

ASE 0 0 1

BLG 0 0 1

BLG 002

BLC 003

BSM 002

BSM 003

BSM 004

BSM 005

BVD W 1

BM 002

BVD 0 0 3

BVD 004

BVD 005

BVD 006

CAN 001

CAN 002

CAN 006

CEP 0 0 1

CEP 002

CEP 0 0 3

CEP 005

CEP 006

CVD 002

DHS 001

DHS 002

ESD 0 0 1

ESD 002

FSP 002

HED 0 0 1

* P r o j e c t


H e a l t h E d u c a t i o n

H e a l t h E d u c a t i o n i n S c h o o l s i n c l u d - i n g Family L i f e E d u c a t i o n

Development of N a t i o n a l Hea l th E d u c a t i o n S e r v i c e s

Medicla1 E d u c a t i o n

P o s t - b a s i c N u r s i n g E d u c a t i o n

P h y s i o t h e r a p y S c h o o l , Baroda

T r a i n i n g of B a s i c H e a l t h Workers

Research i n N u r s i n g

Seminars and Workshops on Medica l E d u c a t i o n

T r a i n i n g of Medica l E d u c a t o r s

Medica l L i b r a r i a n s h i p s

N a t i o n a l Medica l T e a c h e r T r a i n i n g C e n t r e

N u r s i n g Development

M e d i c a l E d u c a t i o n and T r a i n i n g

S t r e n g t h e n i n g o f Teach ing of Human R e p r o d u c t i o n , Family P l a n n i n g and P o p u l a t i o n Dynamics i n Medica l C o l l e g e s

Medica l R e h a b i l i t a t i o n (SHS 002)*

N a t i o n a l I n s t i t u t e of H e a l t h A d m i n i s t r a t i o n and E d u c a t i o n (SHS 005)*

N u r s i n g i n C l i n i c a l S p e c i a l t i e s (SHS 006)*

Development of Community H e a l t h Nurs ing S e r v i c e s (SHS 007)*

O c c u p a t i o n a l H e a l t h

Promotion o f ~ e a l t h ~ a b o r a t ~ r y S e r v i c e s and H e a l t h L a b o r a t o r y Technology

L a b o r a t o r y Q u a l i t y C o n t r o l and S t a n d a r d i z a t i o n

Blood T r a n s f u s i o n

V i r o l o g i c a l Techn iques (VIR 001)*

S t r e n g t h e n i n g of Depar tments of P a e d i a t r i c s , O b s t e t r i c s and P r e v e n t i v e and S o c i a l Medic ine i n I n d i a n M e d i c a l C o l l e g e s

I n t e g r a t i o n o f M a t e r n a l and C h i l d H e a l t h S e r v i c e s i n c l u d i n g Family P l a n n i n g S e r v i c e s i n t o G e n e r a l H e a l t h S e r v i c e s

S t r e n g t h e n i n g of M a t e r n a l and C h i l d H e a l t h S e r v i c e s


Country S t a t e m e n t

O f f i c e of t h e WHO R e p r e s e n t a t i v e

P r o d u c t i o n of F r e e z e - d r i e d Smallpox Vacc ine (ISB 001)*

P r o d u c t i o n of F r e e z e - d r i e d BCG Vacc ine (ISB 002)*

I n d u s t r i a l Technology i n DPT Vacc ine P r o d u c t i o n (BAC 001)*

V i l l a g e Water Supply

S o l i d Wastes D i s p o s a l

R u r a l Water Supply

Connuunity Water Supply and S a n i t a t i o n

Leprosy C o n t r o l (MBD 001)*

T u b e r c u l o s i s Chemotherapy C e n t r e , Madras (MBD 002)*

N a t i o n a l T u b e r c u l o s i s Progr-e (KBD 003)*

T u b e r c u l o s i s Research C e n t r e . Madras (MBD 004)"

T u b e r c u l o s i s C o n t r o l (MBD 005)*

V e n e r e a l D i s e a s e s C o n t r o l Programme ( M T 001)*

Cancer C o n t r o l P i l o t P r o j e c t , Tamil Nadu

E s t a b l i s h m e n t o f Cancer C e n t r e s i n S t a t e s

Cancer C o n t r o l and P r e v e n t i o n

P r e v e n t i o n and C o n t r o l of Wate r P o l l u t i o n

C o n t r o l o f A i r P o l l u t i o n

Medical Toxico logy U n i t

P o l l u t i o n I n v e s t i g a t i o n and C o n t r o l , M a h a r a s h t r a

Envi ronmenta l P o l l u t i o n C o n t r o l

C a r d i o v a s c u l a r D i s e a s e s C o n t r o l

I n d i a n C o u n c i l o f Medica l Research ( S t a t i s t i c s )

S t r e n g t h e n i n g of H e a l t h S t a t i s t i c a l S e r v i c e s

A s s i s t a n c e t o N a t i o n a l I n s t i t u t e of C o m u n i c a b l e D i s e a s e s

S t r e n g t h e n i n g o f H e a l t h S e r v i c e s (Ep idemio logy)

Food S t a n d a r d s Progrannne

T r a i n i n g i n H e a l t h E d u c a t i o n

number p r i o r t o t h e c u r r e n t programme

201

Page

214

214

216

216

216

216

216

2 18

218

218

218

218

218

220,413

212

208

20 8

208

210

230

234

234

236

236

210

210

212

INDIA

203

247

232

232

234

238

238

238

240

222

222

224

224

224

224

226

226

226

240

242

242

242

242

228

244

246

220

220

244

214

s t r u c t u r e .

- Index

P r o j e c t N O .

HED 0 0 3

HED 004

HED 005

HMD 0 0 1

HMD 002

HMO 005

HMD 006

HMD 007

HEm 008

HMD 009

HhD 0 1 1

HMD 012

HW 0 1 3

HMD 014

HRP 0 0 1

HSD W 1

HSD 002

HSD 003

HSD 004

HWP 0 0 1

LAB 002

LAB 003

LAB 004

LAB 005

MCH 0 0 1

MCH 002

MCH 003

202 INDIA - Index

P ro j ec t T i t l e Page

I

+

Heal th Economics and Management (SHS 001)* 1 201

. Pro j ec t

NO.

M N H 002

MNH 003

MPD 001

NUT 001

NUT 003

N U T 005

ORH 002

PBi 001

PHA 001

PHA 002

PHC 001

*p ro j ec t

Tamil Nadu Water Supply and Sewerage Pre-investment S t u d i e s - Madras Me t ropo l i t an Area

Radia t ion Medicine Cent re , Bombay 1 230

240

Advanced Courses i n Radiologica l Phys ics 1 230


Mental Health

Fellowships (Drug Addic t ion)

Malar ia E rad i ca t i on

Applied N u t r i t i o n P r o g r a m e

N u t r i t i o n T ra in ing

Nu t r i t i on Programmes

Oral Health (DNH 002)*

Prevent ion of V i sua l Impairment and Contro l of Bl indness (OCD 002)*

Drug Laboratory Techniques and B io log i ca l S t anda rd i za t i on (SQP 001)*

q u a l i t y Contro l of Pharmaceuticals (SUP 002)*

St rengthening of Hea l th Administra- t i o n (Rural) i nc lud ing Planning and Evaluat ion (SHS 008)*

number p r i o r t o t h e c u r r e n t p r o g r a m e

Biomedical Research 1 204

Ass is tance t o Na t iona l Environ- mental Engineer ing Research I n s t i t u t e I 214

228

228

220,413

212

212

214

228

226

232

232

210

s t r u c t u r e .

P u b l i c Health Engineer ing Education 1 244

P r o j e c t NO.

PIP 001

PPS 001

RAD 002

W 004

RPD 001

SES 001

SES 003

SPI 001

VPH 001

Nat ional Smallpox Erad i ca t i on Programme (sm 001) '< 1 222

I N D I A

GENERAL

Considerable importance continues t o be attached t o hea l th i n r u r a l areas and t o t h e control of comunicable diseases , of which malaria causes p a r t i c u l a r concern. Family welfare planning has been conceived as an i n t e g r a l p a r t of the s t r a t egy f o r rapid socio-economic development. The na t iona l programe f o r prevention and con t ro l of v i sua l impairment and blindness w i l l r e s u l t i n s t rengthening of ophthalmic se rv ices based on a community approach. The Government places much emphasis an the a v a i l a b i l i t y of s u f f i c i e n t quant i ty of drugs. e spec ia l ly i n r u r a l areas . Recognizing the necess i ty of b e t t e r fusion of ancient , non-ellopathic medicine with achievements i n the f i e l d of modem medical sc iences , are a l s o br ing encouraged.


The f i f t h five-year plan (1974-1979 l ays emphasis on h e a l t h se rv ices i n r u r a l areas and t h e i r del ivery i n an in tegrated manner. The programe of Minimum Needs s t r e s s e a hea l th care i n r u r a l areaa,uhere 80% of the country's population l i v e i n some 575 thousand v i l l a g e s under unfavourable hea l th conditions. In tensive e f f o r t s are being made t o enable primary hea l th centres and t h e i r network of sub-centres t o become f o c a l points f o r t h e provision of community hea l th se rv ices . The multipurpose hea l th workers' scheme has been accepted as a cornerstone i n the country's new hea l th s t r a t egy i n which a l so t h e r o l e of v i l l a g e volunteers has been given a s i g n i f i c a n t place.

The work done under the National Family Planning Programme has succeeded up t o m r e h 1975, i n aver t ing 20.6 mil l ion b i r ths . By 1997, i t i s expected t o increase t h i s number t o 47.6 mil l ions . The b i r t h r a t e i n India has declined from 41.7 i n 1961 t o 36.6 per thousand i n 1972. I n the course of the present plan per iod, i t is expected t o achieve f u l l e r in t eg ra t ion of hea l th , family planning and n u t r i t i o n a l programmes a t a11 l eve l s .

WHO Assistance. Assistance i s provided i n s t rengthening the h e a l t h admiu$stration. P a r t i c u l a r emphasis i s placed on management i n hea l th and hea l th economics. WHO continue8 t o assist t h e Governrent i n s e t t i n g up, throughout t h e country, an e f f i c i e n t network of hea l th laboratory services . A s i zeab le input i n support of the family planning programme is made ava i l ab le t o the country through WHO, e spec ia l ly i n the f i e l d of research.

Other Assistance. WHO co-operates wi th UNICEF and the WPP on supplementary and r e l i e f feeding programmes which aim a t the improvement of the n u t r i t i o n a l s t a t e of a l a r g e number of vulnerable chi ldren and mothers. I t pa r t i c ipa tes a l s o i n promotion of the WFP Food-for-Work p ro jec t s which t o t a l over 20 mil l ion do l l a r s and w i l l contr ibute e f fec t ive ly t o the improvement of the i r r i g a t i o n i n f r a s t r u c t u r e i n drought-prone areas.

Close co-ordination i s es t ab l i shed with UNICEF i n the f i e l d of a s s i s t ance t o hea l th se rv ices , improvement of v i l l a g e water supp l i e s , t r a i n i n g of hea l th personnel, maternal and ch i ld hea l th , n u t r i t i o n , school heal th education and s o c i a l welfare.

Health Manpover Development

I n order t o c r e a t e a viable model of nat ional hea l th s e r v i c e s , t h e Government has improved the education of heal th personnel. It has been a constant concern of Government t o induce innovations i n the t r a i n i n g of medical undergraduatea. A new category of hea l th a s s i s t a n t e has a l s o been created. Al l prospective hea l th workers have to be b e t t e r acquainted with community hea l th problems, n u t r i t i o n , family planning and family welfare , hea l th education and o the r na t iona l p r i o r i t y problems.

WHO Assistance. Assistance i n t h i s area covers a number of d i s c i p l i n e s , ranging from t h e t r a i n i n g of bas ic hea l th workera t o t h a t of medical post-graduates and includes t h e development of new methods of t r a i n i n g and assessment of the acquired knowledge. Training of t r a i n e r s i n t h e oar multipurpose workers scheme continues t o be one of the Gcvernmet~t's major i n t e r e s t s f o r WHO ass i s t ance . Individual fe l lovahips are provided f o r t r a i n i n g of profess ionals i n and outs ide the country. WHO'S programme of a s s i s t ance includes a l s o en increased number of group educat ional a c t i v i t i e s .


Dramatic progress i n co-nicable-disease control w a s recorded whensin July 1975, t h e incidence of smallpox i n India was brought t o zero l e v e l , bu t the resurgence of malar ia cauees much concern. The i m e d i a t e object ive af t h e Government i s t o regain an e f f i c i e n t con t ro l over malar ia which would ul t imately l ead t o eradicat ion.

Of the t o t a l estimated population of 604 mi l l ions , acme 372 mi l l ion people are exposed t o the r i s k of leprosy. So f a r s population of 154 mil l ions have been covered by the National Leprosy Control P r a g r m e which is nar being given p r i o r i t y .

Other important, unsolved hea l th problem and t h e i r r e l a t ed control programmes, such as tuberculosis , f i l a r i a s i e and venereal d i seases , receive increasing a t t en t ion .

High p r i o r i t y has been given t o bl indness , where eo-ardinsted e f f o r t s are made t o achieve the required l e v e l of prevention.

WHO Assistance. Assistance continues t o be given t o various na t iona l c m n i c a b l e - d i s e a s e control programmes. An inter-agency co-operation has been es t ab l i shed t o assist t h e Government i n the expanded p r o g r a m of imrmni- zat ion. WHO has been requested t o engage, as much as possible of i t s resources and co-ardinating capaci ty i n support of a na t iona l programme f o r bl indness prevention, con t ro l and r e h a b i l i t a t i o n .


The promotion of environmental hea l th receives an increasing importance i n t h e Government's development plans. The main emphasis has been an r u r a l water supply, s ince i n t h e country the re are s t i l l more than 160 thousand v i l l ages without s a f e sources of drinking water. The ~ r o b l e m of a i r po l lu t ion connected with i n d u s t r i a l development, t h e managepent of s o l i d wsstes and water po l lu t ion are a l s o receiving inc reas ing a t t en t ion .

WHO Assistance. I n t h e f i e l d of enviro-ntel h e a l t h , c lose col laborat ion has been es t ab l i shed between UNICEF, IMDP, WHO and the Government. Surveys and s tudicn of t h e enviro-ntal conditions and t h e i r r e l a t ionsh ip t o diseases are c a r r i e d b u t , u wel l as planning f o r ~ e r v l c e s and i t is expected t h a t these would lead t o control of po l lu tan t s i n t h e hum" environment.

204

I N D I A

RPD 001 Biomedical Research

To a s s i s t p r i o r i t y a reas i n biomedical research; t o s t rengthen the i n s t i t u t i o n s t h a t conduct research and t o support app l i ca t ion of t h e r e s u l t s obtained; t o provide necessary supp l i e s and equipment as well as e s e e n t i a l spa re pa r t a i n order t o ensure uninterrupted progress.

I n 1978 and 1979, s t a f f t r a i n i n g i n h u n o p r o p h y l a x i s and medical e n t m l o g y w i l l be given a t the Virus Research Centre, Poona.

me Indian Regis t ry of Pathology ( I R P ) , New Delhi, w i l l be provided with advisory s e r v i c e s i n t i s s u e pathology research r e l a t e d t o t h e use of t h e e l ec t ron microscope. S ta f f w i l l be t r a ined i n advanced educat ional technologies such se t h e use of c losed c i r c u i t t e l e v i e i o n , as wel l as i n r ecen t advances i n immunopathology and other se l ec ted f i e l d s .

A t t h e Indian Council of Medics1 Research, a s s i s t a n c e t o the construct ion of epidemiological models t o study t h e prognaaia of d i seases , and with t r a i n i n g i n the l a t e s t methods of ope ra t iona l research, w i l l be given.

Imunohaematologiml s t u d i e s w i l l be promoted a t t h e Blood Group Reference Centre, Bombay, through advisory se rv ices i n a p e c i f i c a spec t s of haemaglobinopathy and t r a i n i n g i n these procedures aa used i n blood banking.

Assistance t o the I n s t i t u t e of Reproductive Research, Bombay, w i l l be i n i t i a t e d and advice on and t r a i n i n g of s t a f f i n t h e techniques of f luo rescen t antibcdy methodology, immune complex d i sease de tec t ion , r ad io receptor assay end con t racep t ive a c c e p t a b i l i t y w i l l be provided.

Workshops on research top ics have been planned.

Rare chemicals and l abe l l ed compounds w i l l b e suppl ied f a r research purposes.

206

INDIA

PPS 001 Health Economics and Management

To promote a b e t t e r underetanding and t h e importance of t h e economic impl icat ions of i l l - h e a l t h and d i sease which would r e s u l t i n a systematic s o l u t i o n of hea l th problems through b e t t e r planning and management.

I n 1978 and 1979, WHO w i l l a s s i s t t h e p ro jec t wi th consul tants . Workshops w i l l be organized a l s o for o f f i c e r s at the S t a t e l e v e l responsible f a r the planning end management of hea l th se rv ices .

Supplies w i l l be provided f a r improvinp t h e s to rage and r e t r i e v a l of da ta .

The a c t i v i t i e s w i l l be c r ra rd ina ted wi th those of I N D SHS 008 and I N D HMD 006.

I N D I A

HSD 001 Medical Rehab i l i t a t ion

To a s s i s t i n expanding nedicel r e h e b i l i t a t i o n se rv ices and i n establishing t r a i n i n g schools i n the various d i sc ip l ines .

Assistance t o t h i s p ro jec t began i n 1963 with t h e provis ion of a r e h a b i l i t a t i o n s p e c i a l i s t and consul tants i n t h e manufacture of p ros the t i c and o r t h o t i c appliances. I n 1973, a course i n lower extremity p ros the t i c s and o r t h o t i c s was organized with WHO as s i s t ance .

ID 1976, the National I n s t i t u t e of P ros the t i c s and Or tho t i c s w i l l r ece ive a s s i s t a n c e i n t h e conduct of a nat ional course on t h e management aspects of o r t h o t i c and p r o s t h e t i c workshops i n r e l a t i o n t o r e h a b i l i t a t i o n of t h e physical ly handicapped.

I n 1978, fellowships w i l l be provided t o enable a physical medicine exper t , two p ros the t i c expert8 and one physiotherapy t u t o r t o receive advanced t r a i n i n g i n r ecen t developments i n these d i s c i p l i n e s .

In 1979, provis ion has been made f o r t h e award of f e l l w s h i p s f o r s imi la r t r a in ing .

Provision has a l s o been made f o r a l imi ted supply of audio-visual equipment f o r t r a in ing .

Aesistance i s expected t o continue f o r some years .

HSD 002 National I n e t i t u t e of Health Administration and Education

To a s s i s t i n the conduct of s t u d i e s on d i s t r i c t hea l th adminis t ra t ion and multi-purpose hea l th workers as we l l as i n the promotion and planning of cmprehensive hea l th care se rv ices a t t h e d i s t r i c t and per ipheral l e v e l s and i n t h e formulatian of research and teaching p r o g r a m s , s t u d i e s and research i n the f i e l d of hosp i t a l administrati 'n.

WHO ass i s t ance began i n 1965 and, i n 1970, a publ ic hea l th adminis t ra tor and s h o s p i t a l adminis t ra tor were provided t o t h e I n s t i t u t e . In 1971, a consu l t an t reviewed the p r o j e c t , and s i n c e 1973, e publ ic hea l th adminis t ra tor has been i n p a i t i o n .

Ihe a c t i v i t i e s i n ope ra t iona l research a t t h e pe r iphe ra l l e v e l and h o s p i t a l adminis t ra t ion w i l l continue u n t i l the end of 1977. A grant w i l l a l so continue t o be provided t o meet t h e c a s t of research.

It i s expected t h a t the p ro jec t w i l l continue u n t i l 1977. From 1978, a s s i s t ance is envisaged under a new ~ r ~ j e c t , I N D PPS 001, "Health Economics and Management", f o r follow-up work.

HSD 003 Nursing i n C l i n i c a l Spec ia l t i e s

To a s s i s t i n improving c l i n i c a l nursing p r a c t i c e i n se l ec ted s p e c i a l t i e s .

The programes include in-service education and shor t coursee f o r nurses as we l l as courses with multi- d i s c i p l i n a r y pa r t i c ipa t ion .

This p ro jec t s t a r t e d i n 1972. Provision f o r two nurse educators and consul tants continues i n 1976 and 1977. Consultants w i l l b e provided i n var ious f i e l d s of c l i n i c a l nursing.

From 1978 onrards, i t is proposed t o merge t h i s p ro jec t with a new p r o j e c t , I N D HMD 013, "Nursing Development".

INDIA

HSD 004 Develoment of Cmnuaity Health Nursing Scrvicea

To strengthen t h e provis ion aad development of p a t t e r n s of pub l i c h e a l t h nurs ing se rv ices i n se l ec ted S t a t e s i n India.

Beginning 1975, a publ ic h e a l t h nurse wan u s i g n a d t o H.harashtra and i n u r l y 1976 another t o West Bengal, t o a s s i s t i n t h e establishment of competence i n pub l i c h e a l t h nursing and i n the development of e f f e c t i v e managerial techniques and in-service educat ion p r o g r m s for pub l i c hea l th nurses , with s p e c i a l emphasis on organizing supervisory and r e f e r r a l system. i n t h e de l ive ry of r u r a l publ ic hea l th nursing services . It i a envisaged t h a t o ther S t a t e s v i l l a l s o be a a s i s t e d by t h i s p ro jec t .

Assistance is expected t o continue till 1977.

PHC 001 Strengtheninp. of Health Administration (Rural) including Plannin8 and Bvaluation

TO assist t h e hea l th adminis t ra t ion i n the planning, implementation and evaluat ion, including the developnent and s t rengthening, of a hea l th information system, and i n t h e s t rengthening of r u r a l hea l th se rv ices .

Assistance will b e given i n t h e form of a g r a n t and supp l i e s t o support t r a i n i n g progremes.

From 1978, the a c t i v i t i e s w i l l b e c lose ly co-ordinated w i t h a new p r o j e c t , I N D PPS 001, "Health Economics and Management".

HCH 001 S t ren~ theo inp , of Departments of Paed ia t r i c s . Obatet r ice and Preventive and Socia l Medicine i n Indian Medical Colleges

This p r o j e c t , a s s i s t e d by WHO and UNICEF, has t h e fundamental aim of expanding and improving uoder- graduate teaching of maternal, c h i l d and family c a r e , and undergraduate teaching of paed ia t r i ce , i n order t o s t rengthen maternal, c h i l d hea l th and family planning a t t h e community l e v e l .

The in t ra-country fe l lowship programme is based on t h r e e se lec ted demcnstration p e d i a t r i c teaching departments of medical co l l eges through which t h e pre- tes t ing, demonstration and dieeemJostion of a new curriculum i n maternal, c h i l d h e a l t h and family planning as an in teg ra ted sub jec t w i l l be ca r r i ed out a t undergraduate and in te rnsh ip l eve l s .

Hmdbwks on maternal and c h i l d hea l th , including family planning, and on c h i l d care, f o r t h e use of undergraduate s tuden t s and general p r a c t i t i o n e r s w i l l a l s o be developed.

% i s p ro jec t w i l l terminate ac t h e end of 1977.

From 1978 onwards, i t i s proposed to merge t h i s p ro jec t with a new pro jec t , I N D MCH 003, "Strengthening of Maternal and Child Heal th Services".

MCH 002 In teg ra t ion of Maternal and Child Health Services including Family Planning Services i n t o Gcneral Health Services (UNFPA INDl711P06)

This p ro jec t terminates wi th 1976 ass i s t ance .

INDIA

MCH 003 Strengthening of Maternal a d Child Health Services

The aim of t h e p ro jec t is t o continue t o develop, d e t a n s t r a t e and disseminate t h e new cur r i cu la a t undergraduate and in te rnsh ip l e v e l s i n maternal and c h i l d heal th/ family planning, and i n t h e teaching of ch i ld ca re , and t o develop, pre- tes t and e d i t companion handbook8 on maternal and c h i l d hea l th1 family planning and c h i l d care f o r the w e of undereraduatea and p rac t i t i cne ra . S t a r t i n g i n 1978- 1979, the p ro jec t w i l l begin t o a s s i s t i n developing school hea l th se rv ices as wel l as i n reviving workshops i n neonatology.

In 1978, a consul tant w i l l review and prepare a repor t on t h e s t a t u s of school hea l th c a r e i n India. This r epor t w i l l be discussed a t a na t iona l workshop t o be attended by S ta te - l eve l school hea l th o f f i c e r s and co-ordinated by a WHO temporary adviser .

Two workshops i n neonatology and one f o r Sta te- level maternal and c h i l d h e a l t h o f f i c e r s w i l l a l e a be held during the year , the former being a s s i s t e d by a consul tant and the l a t t e r by a WHO temporary adviser .

I n 1979, th ree regional- level workehops on school hea l th se rv ices w i l l be held , a s s i s t e d by e WHO temporary adviser .

A consul tant and a temporary adviser w i l l a s s i s t i n organizing two f u r t h e r workshops on neonatology.

HRP 001 5trengthenin.z of Teechlng of Human Reproduction. Paaily Plennin n This project terminates i n 1976.

NUT 001 Applied Nutr i t ion Progrerme

To a s s i s t i n improving the hea l th component of the Applied Nutr i t ion Progranrme a s s i s t e d by FA0 and UNICEF.

Assistance w i l l be given t o meetings of S t a t e Nutr i t ion Of f i ce r s i n Ind ia t o b e held i n 1976 and 1977. I n fellowships w i l l be awarded f o r t r a i n i n g personnel i n t h e hea l th aspects of n u t r i t i o n .

Assistance i s expected t o continue u n t i l t h e end of 1977, when t h e p ro jec t w i l l be amlgamated with the new p r o j e c t , IND NUT 005. "Nutr i t ion Programmes", s t a r t i n g i n 1978.

NUT 003 Nutr i t ion Training

To support the National I n s t i t u t e o f Nutr i t ion. Hyderabad, i n p a r t i c u l a r , and o the r i n e t i t u t i o n a i n general.

Supplies and equipment were provided and t r a i n i n g , through WHO f e l l a r s h i p s , arranged f o r some of the teaching and research s t a f f . Guest l e c t u r e r s were assigned f o r a s s i s t i n g i n t h e c e r t i f i c a t e and degree COUISBB i n n u t r i t i o n . Similar a s s i s t a n c e w i l l continue t o be provided till 1977, when the p ro jec t w i l l be amalgamated with the new pro jec t . IND NUT 005, "Nutrit ion Programmesqt, s t a r t i n g i n 1978

INDIA

NUT 005 Nutr i t ion Programmes

To a a s i s t i n improving t h e n u t r i t i o n component of b a s i c h e a l t h se rv ices and t o support t h e National I n e t i t u t e of Nut r i t ion (Hydersbad) and o the r i n s t i t u t i o m t h a t provide the necessary t r a ined personnel.

Th,s new pro jec t combines t h e a c t i v i t i e s previously c a r r i e d out under two p r o j e c t s , IND NUT 001, "Applied Nut r i t ion Programme", and MD MIT 003. "Nutr i t ion Training".

In 1978 and 1979, i t is proposed t o award f e l l a r e h i p s t o the teaching and research s t a f f of t h e National I n s t i t u t e of Nutr i t ion t o study sub jec t s of s p e c i a l i n t e r e s t such as n u t r i t i o n su rve i l l ance , evaluat ion of noxious substances i n food and n u t r i t i o n a l d isorders . Two guest l e c t u r e r s w i l l b e provided each year t o a s s i s t i n the c e r t i f i c a t e and degree courses i n n u t r i t i o n . Technical meetings i n n u t r i t i o n i n b a s i c hea l th se rv ices w i l l be held i n 1978 and 1979. Pe l l eash ips v i l l be awarded f o r the t r a i n i n g of personnel i n t h e hea l th a spec t s of n u t r i t i o n .

The a c t i v i t i e s of t h i s p ro jec t w i l l be co-ordinated with those of "Nutr i t ion Teaching in Educational I n s t i t u t i o n s for Health Personnel" (SE ICP NUT 002). and with the UNICEP and PA0 programmes i n t h i s f i e l d .

The p ro jec t is expected t o continue u n t i l t h e end of 1981

HED 001 Training i n Health Education

TO a s s i s t i n e s t ab l i sh ing and developing th ree post-graduate hea l th education t r a i n i n g centres with r u r a l and urban f i e l d p rac t i ce areas.

me project s t a r t e d i n 1969, when f a c i l i t i e s ava i l ab le f o r poet-graduate t r a i n i n g i n heal th education were reviewed. Consultants a s s i s t e d i n t h e development of poet-graduate curriculum i n h e a l t h education.

I n 1976, a consul tant and i n 1977, temporary adv i se r s w i l l assist with group educat ional a c t i v i t i e s and i n the evaluat ion of t h e a c t i v i t i e s c a r r i e d out.

me pro jec t is expected t o continue u n t i l 1977.

From 1978 omrarde, i t i s proposed t o merge t h i s p ro jec t with a new pro jec t , I N D HED 005, "Development of National Health Education Services".

HED 003 Health Education (UNDP IND/68/OM)

To a s s i s t i n the establishment and development of s t a t e hea l th education bureaux, t o a s s i s t i n the f u r t h e r in t eg ra t ion i n t o and co-ordination of h e a l t h education a c t i v i t i e s of t h e general hea l th aervices with those of the family planning programme a t d i f f e r e n t l e v e l s of the hea l th adminis t ra t ion, and t o a s s i s t i n the development of h e a l t h education i n primary and secondary schools and teachers ' col leges .

WO hea l th educators were ass igned t o a number of S t a t e s i n India. These hea l th educators reviewed t h e s t a t u s and funct ions of t h e s t a t e hea l th education bureaux a d a s s i s t e d i n reorganizing end s t rengthening them. I n add i t ion , two long-term h e a l t h education s p e c i a l i s t s have been provided t o the Centra l Health Education Bureau t o a a s i s t that Bureau i n deve lopbg na t iona l hea l th education eerrrices.

I n 1978, t h e a c t i v i t i e s of t h i s p ro jec t w i l l be incorporated i n a new pro jec t IND HED 005. "Development of National Health Education Services".

BED 004 Health Education i n Schools including Family L i f e Education (UHPPA IM1171/P02)

lhis pro jec t terminates i n 1976.

I N D I A

HED 005 Development of National Health Education Services

To a s s i s t t h e Central Health Education Bureau i n ( i ) organizing and expanding i t s s e r v i c e , t r a i n i n g and research funct ions f u r t h e r i n r e l a t i o n t o such bureaux i n t h e S ta te s and Union T e r r i t o r i e s ; (11) developing post-graduate t r a i n i n g i n h e a l t h education; ( i i i ) s t rengthening pre-service prepars- t ion i n hea l th education f o r hea l th p ro fess iona l s , and ( iv) developing school heal th education.

This p ro jec t incorporates p ro jec t I N D NED 002, and. from 1978,projects I N D HED 001 and I N D HED 003.

Assistance w i l l be given f o r t h e organizat ion of r e f re she r courses i n hea l th education f a r s t a f f of hea l th education bureaux i n the S t a t e s and Union T e r r i t o r i e s , study and observat ian tour s f o r sen io r hea l th education personnel, courses an research methodology, and conferences on school hea l th educa- t ion . Grants w i l l be provided for t h e production of ma te r i a l s and fo r a c t i o n research an hea l th education.

These a c t i v i t i e s w i l l consol idate and extend those ca r r i ed out previously under hea l th education p ro jec t .

The p ro jec t i s expected t o continue through 1983.

HMD 001 Medical Education

To a s s i s t medical col leges i n developing educat ianal object ives and t o improve s tudent evaluat ion; t o arrsist i n research methodology and t o t r a i n na t iona l s t a f f i n various medical and pub l i c hea l th f i e l d s .

The a c t i v i t i e s of the p ro jec t are co-ordinated wi th those of I N D HMD 009. "Training of Medical Educators". Fram 1974 onwards, only fe l lowships are being provided through t h i s p ro jec t .

From 1978 onwards, t h i s p ro jec t is being merged with a new IND HHD 014, "Medical Education and Training".

HMD 002 Post-basic Nurstnp Education

To a s s i s t i n expanding post-basic nurs ing education, with i n i t i a l emphasis on post-basic degree programmes usual ly o f fe r ing p ro fess iona l s p e c i a l i z a t i o n i n teaching, adminis t ra t ion. publ ic hea l th o r one of t h e c l i n i c a l s p e c i a l t i e s .

Evaluation of post-basic nurs ing education programmes i n t h e co l l eges s t a r t e d i n 1974.

lko nurse educators are being provided i n 1976 and 1977. Consultants w i l l a s s i s t i n s p e c i a l areas of teaching i n the post-basic nurs ing i n s t i t u t i o n s .

Assistance i s expected t o continue u n t i l t h e end of 1977.

Fram 1978, t h i s p ro jec t w i l l be amalgamated with a new p r o j e c t , IND HMD 013, "Nursing Development"

KMD 005 Physiotherapy School, Baroda

To a s s i s t with t h e t r a i n i n g of physiotherapis ts up t o t h e degree s t andard , "Bachelor a f Science (Physiotherapy)", a t t h e Physiotherapy School i n S.S.G. Hospi ta l , Baroda, over a three-year period.

Between 1968 and 1975, a WHO consul tant was assigned t o the p ro jec t . Fellawships w i l l continue t o be awarded i n 1976, when t h e p ro jec t w i l l terminate.

HMO 006 Training of Basic Health Workers

To s t rengthen t h e r u r a l hea l th se rv ices by t r a i n i n g hea l th s t a f f , p a r t i c u l a r l y doc to r s and t r a i n e r s of b a s i c hea l th workers, a u x i l i a r y nurse-midwives, h e a l t h a s s i s t a n t s (family planning) and o t h e r monovs- l e n t h e a l t h workers, t o become multi-purpose workers.

The p r o j e c t i a a cont inuat ion of pro jec t Ind ia 0185, "Strengthening of Health Services" modified according to present needs.

The main a c t i v i t i e s of the p ro jec t are re l a t ed to t h e courses, t h e i r c u r r i c u l a and the development of manuals.

Assistance i s expected to continue till 1979.

I N D I A

HMD 007 Research i n Nursing

TO a s s i s t co l l eges of nursing end i n s t i t u t i o n s i n t h e design and conduct of ope ra t iona l / ac t ion d tud ies i n t h e broad areas of nursing education and c l i n i c a l nursing p r a c t i c e , including community healch nursing, and t o conduct workshops/seminars on research methodology f o r t h e f a c u l t i e s of var ious co l l eges of nursing and s e n i o r nurses working i n c l i n i c a l areas and cornuni ty hea l th cen t res .

One nurse researcher w i l l be based a t t h e College of Nursing, New Delhi, and w i l l be ava i l ab le , upon requeat , t o a l l o ther col leges of nursing and i n s t i t u t i o n s i n t h e country request ing as s i s t ance i n the conduct of nurs ing s tud ies .

Assistance t o t h e p ro jec t i s expected t a continue till 1977. From 1978, t h i s p ro jec t w i l l b e merged i n t o a new p r o j e c t , I N D HMD 013, "Nursing Development".

HMD 008 Seminars and Workshops on Medical Education

To a s s i s t , i n co l l abora t ion with the Indian Academy of Medical Sciences, i n f u r t h e r developing medical teaching through seminars and workshops i n spec ia l i zed f i e l d s .

In 1976, consul tant s e r v i c e s , grant and suppl ies w i l l be provided f o r e seminar on p a e d i a t r i c surgery t o be held a t t h e All-India I n s t i t u t e of Medical Sciences, New Delhi.

HMD 009 Training of Medical Educator8 (UNDP IND/71/034)

To a s s i s t i n the f u r t h e r t r a i n i n g of na t iona l medical educators.

Fellowships were awarded From 1968. I n a l l , f i f t e e n fe l lowships have so f a r been given t o medical educators o f var ious medical co l l eges i n India .

HMD 011 Medical L i b r a r i a n a h i t

To t r a i n medical l i b r a r i a n s .

IWD 012 National Medical Teacher Training Centre

To a s s i e t i n e s t ab l i sh ing a n a t i o n a l teacher t r a i n i n g cen t re f o r h e a l t h personnel

The Centre w i l l t r a i n medical and o the r h e a l t h personnel i n modern pedagogical methods and t h e use of audio-visual ma te r i a l s i n teaching t h e hea l th sc iences . Training w i l l be given i n t h e development of a task-based curriculum, establishment of i n s t r u c t i o n a l ob jec t ives and l ea rn ing exper iencee, and evaluat ion of s tudent performance. The proposed Centre w i l l i n v e s t i g a t e t h e problems i n medical education and the education of o the r hea l th personnel i n India. Poss ib le f i e l d s of i n v e s t i g a t i o n w i l l be t h e study of t h e development of h e a l t h manpower i n t h e country appropr ia t e to the n a t i o n a l needs. From 1978, t h i s p r o j e c t is being merged with a new pro jec t , IND HMD 014, "Medical Education and Training".

HMD 013 Nursing Development

The aim of t h e p ro jec t is t o e s t a b l i s h regional cen t res for cont inuing education and t h e development of educat ional ma te r i a l s .

It w i l l a l s o he lp i n in t roducing a c t i o n research ae a problem-solving technique f o r t h e improvement of nurs ing se rv ice8 i n h o s p i t a l s and c o m u n i t i e s .

National nurses w i l l be prepared f o r Leaching and adminis t ra t ion i n nurs ing s p e c i a l t i e s such as neuro- l o g i c a l nurs ing, in t ens ive care and psych ia t r i c nursing.

Consultation s e r v i c e s i n planning, research and t r a i n i n g i n spec ia l i zed f i e l d s of nurs ing w i l l be provided as wel l as ahor t courses and o t h e r group educat ional a c t i v i t i e s . Fellowships, equipment and supp l i e s w i l l a l s o b e provided.

This p ro jec t replaces t h r e e nureing p ro jec te which end i n 1977, namely, I N D HMD 002. "Post-besic Nureing Education", IND HMD 007. "Research i n Nursing", and IND SHS 006, "Nursing i n c l i n i c a l Specia l t ies" .

Assis tance i s expected to continue through 1983,

I N D I A

HMD 014 Medical Education and Training

To a s s i s t i n t h e f u r t h e r development of medical education through b e t t e r planning and improvement of educat ional processes so as t o meet n a t i o n a l ob jec t ives and the country 's h e a l t h p r o g r a m needs.

I n 1978 and 1979. fe l lowships w i l l be o f fe red f o r t r a i n i n g i n Computer Library Science. Some e s s e n t i a l ~ u p p l i e e f o r t h e computer and automatic zerox machine w i l l be provided.

This p ro jec t includes re levant elements from e a r l i e r p ro jec t s i n medical education, IN0 HMD 001, "Medical Education", I N D HMD 011, "Medical Librarianship", and IND BMO 012, "National Medical Teacher Training Centre".

Assistance i a envisaged through 1983.

ESD 001 Assistance t o National I n s t i t u t e of Communicable Diseases

To a s s i s t the National I n s t i t u t e of Comunicable Diseases. Delhi, i n the conduct of na t iona l and in te r - na t iona l t r a i n i n g courses i n t h e epidemiology and c o n t r o l of communicable diseases ; to a s s i s t the I n s t i t u t e i n s t rengthening i t s f a c u l t y i n order t o improve f u r t h e r the t r a i n i n g and reeearch a c t i v i t i e s .

Since 1967, W O h a s been a s s i e t i n g the institute with a grant-in-aid t o permit the employment of s u i t - a b l e exper ts and teachers i n epidemiology i n connexion with t h e Delhi Chapter of the Prague-Delhi Course (WHO Inter-Regional Training Course in t h e Epidemiology and Control of Comunicable Diseases). It is proposed t o continue t h i s a s s i s t a n c e in 1976-1977. I n add i t ion , four medical o f f i c e r e w i l l v i s i t countr ies i n the Region t o observe f i l a r i a s i s con t ro l programmes. The p ro jec t IND MPD 002, " F i l a r i a e i a Control", has been merged with t h i s p ro jec t .

In 1978 and 1979, i n add i t ion t o t r a i n i n g , emphasis w i l l be l a i d on research and on s p e c i a l f i e l d s such as roonosee. mycology, plague eu rve i l l ance , immunology and t h e biochemistry of important communicable diseases .

The project is expected t o continue through 1983.

ESD 002 Strengthening of Health Services ( E ~ i d e m i a l o ~ y ) ((IMDP INDl681029)

This p ro jec t terminates i n 1976,

MPD 001 Malaria Eradicat ion

To a s s i s t the anti-malaria program=.

The National Malaria Eradicat ion Programme, a s s i s t e d by USAID end WO, was s t a r t e d i n 1958. Good progress was made up t o 196311964. Thereaf ter the malar ia s i t u a t i o n continued t o d e t e r i o r a t e progres- s i v e l y necess i t a t ing reve r s ion of areas t o a t t a c k measures. An evaluat ion i n 1970 ind ica ted t h e non- feas ib i l i ty of e rad ica t ion i n some hard-core areas with p e r s i s t e n t transmission. In 1974, e consu l t a t ive committee of exper ts supported the rec-endstion of another evaluat ion t o de fe r the cauntry-wide e rad ica t ion s t r a t e g y i n favour of e f f e c t i v e c o n t r o l of t h e disease . An experimental study i n Jodhpur Ci ty using t h e LEO-ULV machine t o combat urban malar ia was concluded i n 1974.

It i s envisaged t h a t t h e ant i -malar ia a c t i v i t i e s from 1976 onwards w i l l be baaed on l imi ted con t ro l on the l i n e s of s e l e c t i v e c o n t a i m e n t s t r a t egy . WHO a s s i s t a n c e inc ludes provis ion of a number of ahor t - term f e l l w e h i p s , suppl ies and equipment, and l o c a l c o s t subeidy for t r a i n i n g i n 197611977. Aaeietence f o r t h e t r a i n i n g of var ious ca tegor ie s of personnel a t t h e Nat ional I n s t i t u t e of Communicable Diseaees, Delhi, w i l l continue t o r ece ive p r i o r i t y i n 1976 and 1977. I n 197811979, provis ion has been made f o r fellowships and supp l i e s and equipment.

Assistance t o t h e p ro jec t is expected t o continue f o r some years.

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INDIA

SPI 001 Nat ional Smellp~!x E rad i ca t i on Programme

To achieve t o t a l e r a d i c a t i o n of smallpox i n t h e count ry by 1977.

The p r o j e c t s t a r t e d i n 1967, when a j o i n t Government/WHO team made an assessment o f t h e programme i n t h e va r ious regions of t h e count ry . I n t h e autumn of 1973, an i n t e n s i f i e d campaign was s t a r t e d w i th the main s t r , l t ~ g y of a c t i v e l y s ea rch ing f o r smallpox cases f a l l oved by containment of the outbreaks dc t r c t ed . ?l i , r i rhan 40 epl r iemia logis ts , approximately ha l f of them r e c r u i t e d from witliitr tiir coun t ry , a s s i s t e d in L ~ I V a r g a n i z a t i n n end supe rv i s ion of t h e campaign. S ince 1974, funds have a l s o been made av i i i l ab l e hv S l l M f o r t h e p r a g r a m e , t h e a s s i s t a n c e being mainly i n tile fom of a d d i t i o n a l epidemiolo- p,i*Ls, subs idy f o r m s u r i n g mob i l i t y of t h e d i f f e r e n t c a t e g o r i e s o f s t a f f and supply of va r ious rnnte- r i a l s and o q u i p m v n l .

1 7 , May 1975 zero Incidence of smallpox was achieved.

In 1976 and 1977, ep idemio log i s t s w i l l o rgan i ze and carry ou t s u r v e i l l a n c e a c t i v i t i e s mainly i n those areas previous ly heav i ly i n f ec t ed . It is expecred t h a t a n I n t e r n a t i o n a l Commission w i l l v i s i t I nd i a i n 1977 t o make a f i n a l a p p r a i s a l of t h e p r o g r a m e , when i t is expected t h a t the count ry w i l l b e o f f i c i a l l y dec l a r ed smallpox-free. As and when t h i s is done, t h e p rov i s ion f o r 1978 and 1979 w i l l b e reprogrammed i n t o a new p r o j e c t f o r immunization.

The a c t i v i t i e s are co-ordinated by t h e s t a f f of t h e incer -count ry p r o j e c t , ICP SPI 001, "Smallpox Eradica t ion" .

BVD 001 Leprosy Contro l

To a s s i s t i n dcvf loprng an t i - l ep rosy work through t h e t r a i n i n g of manpower and o p e r a t i o n a l s t u d i e s , c o n t r i b u t i n g t o an f l l t e n s i f i e d l ep rosy c o n t r o l programme i n o rde r t o reduce t h e prevalence of leprosy and t h e r e s u l t i o p i l is: ,bi l i ty.

Ass is tance was giver! LO two l ep rosy c o n t r o l p i l o t c e n t r e s i n Andhra Pradesh which were eupported by t h e Danish "Save the Children" Organiza t ion . Between 1961 and 1971, WHO l e p r o l o g i s t s have a s s i s t e d i n t h e t r a i n i n g of leprosy workers. Two s t a t i s t i c i a n s were ass igned i n 1970 i n connexion w i th a longi - t u d i n a l s t udy f o r t h e e x p l o i t a t i o n of l ep rosy c o n t r o l d a t a . UNICEF has provided s u p p l i e s and equipment.

I n the c u r r e n t phase, only f e l l a r s h i p s are be ing provided t o t r a i n n a t i o n a l s t a f f b u t , from 1978, g r e a t e r involvement is envisaged. Consu l t an t s w i l l b e provided i n t h e epidemiology of leprosy and r e sea rch and group educa t iona l a c t i v i t i e s w i l l be organized t o s t udy t h e p r a c t i c a l a s p e c t s of l ep rosy c o n t r o l . I nd iv idua l f e l l owsh ips w i l l be provided for t r a i n i n g i n c o r r e c t i v e su rge ry and rehab i l i ta t ion , bac t e r io logy and dermatology. The work w i l l be co-ordina ted w i th t h e aim of mobi l iz ing r equ i r ed resources. Exchange of ep idemiologica l d a t a w i t h i n t h e count ry w i l l be improved.

Suppl ies i n t h e form of equipment f a r r e s e a r c h i n s t i t u t e s , t e ach ing m a t e r i a l s , microscopes and veh i c l e s w i l l be provided.

The p r o j e c t is expected t o con t inue through 1983.

BVD 002 Tuberculos is Chemotherapy Cent re , Madraa (UNDP INDl681027)

This p r o j e c t t e rmina t e s i n 1976.

INDIA

BVD 003 National Tuberculosis Pro~ranme (UNDP 1N0/68/026)


BVD 004 Tuberculoeis Research Centre. Madras

To a s s i s t i n control led t r i a l e t o evolve simple, e f f e c t i v e and inexpensive methods of tuberculosis con t ro l through domici l iary and ambulatory chemotherapy, and i n carrying out r e l a t e d research.

Project IND BVD 002, "Tuberculosis Chemotherapy Centre, Madras", a s s i s t e d by WHO i n co-operation with the Government of Ind ia , t h e S t a t e Gave-nt of Tamil Nadu, t h e Indian Council of Medical Research and the Br i t i sh Medical Research Council, was s t a r t e d i n 1955 and a s e r i e s of inves t iga t ions on ambulatory and domiciliary chemotherapy have been c a r r i e d out. Since 1970, when regu la r WHO s t a f f were wi thdram, a s s i s t ance t o t h e Centre has been contillued through consul tant v i s i t s , fellowships and the provis ion of suppl ies and equipment. The new pro jec t is being a s s i s t e d s i n c e 1976, with broader ob jec t ives and under an i n s t i t u t i o n a l base. I n January 1976, a consultant reviewed t h e progress of s tud ies cu r ren t ly being ca r r i ed out a t the Centre.

It is proposed t o merge t h i s i n t o a new p r o j e c t , IND BVD 005, "Tuberculosis Control", s t a r t i n g i n 1978.

BM 005 Tuberculosis Control

To a s s i s t i n progressively reducing t h e transmission of tuberculosis i n t h e community, through b e t t e r i d e n t i f i c a t i o n of sources of i n f e c t i o n and by rendering p a t i e n t s non-infective by means of e f f e c t i v e ambulatory therapy.

% i s new pro jec t incorporates elements of e a r l i e r UHO and UNDP-assisted p ro jec t s IND MBD 002, IND MBD 003 end IM, MBD 004.

Consultant se rv ices w i l l be provided f o r s t u d i e s i n t h e microbiology, biochemistry and pharmacology of chemotherapeutics.

Fellowships v i l l be given f a r s t u d i e s i n immunology, metabolism of chemotherapeutic drugs and study of tuberculosis control p r o g r a m . and t h e i r achievements i n o the r countr ies .

Supplies and equipment, including consumable chemicals and media, w i l l b e provided, and g ran t s v i l l be made f o r the replacement of e s s e n t i a l equipment.

BM 006 Venereal Diseases Control Prosranme

To reduce t h e spread of sexually-transmitted d i seases through the development of adequate su rve i l l ance and control measures.

WHO assistance i n the past has been provided through p ro jec t s India 0003, "Venereal-Disease Control and Demonstration, Simla". India 0025, "Assistance t o t h e Venereal-Disease Department of the Government General Hospi ta l , Madras", Ind ia 0024 and 0217, "Yaws Control, Madhya Prsdesh, Andhra Pradesh and Oriasa", India 0033, "Serological Conference, Nev Delhi", India 0219, 'Yenereal-Disease Control", India 0015. "Cardiolipin Production, A l l Ind ia I n s t i t u t e of Hygiene and Publ ic Health, Calcutta", and Ind ia 0017, "Ant ibiot ics R a d u c t i o n Plant".

This p ro jec t v i l l o f f e r f e l lovsh ips f o r t r a i n i n g i n serolagy and i n the c l i n i c a l a spec t s of sexually- transmitted diseases .

Group educat ional a c t i v i t i e s i n epidemiology, immunology, therapeut ic0 and the s o c i a l a spec t s of eexually-transmitted d i seases v i l l be organized.

Supplies w i l l be provided f o r t h e establishment end improvement of f luorescen t microscopy techniques.

WH 001 Training i n Veterinary Publ ic Health

TO a88i.t i n promoting post-graduate t r a i n i n g i n ve te r ina ry pub l i c heal th .

Fol lar ing a seminar on ve te r ina ry publ ic hea l th held i n 1970, a s s i s t a n c e was given i n s t rengthening the f acu l ty f o r the newly es t ab l i shed course i n ve te r ina ry publ ic h e a l t h a t t h e All-India I n s t i t u t e of Hygiene and Publ ic Health, Calcutta. In 1971, 1972, 1974 and 1975, consu l t an t s a s s i s t e d i n reviewing the t r a i n i n g and research a c t i v i t i e s of t h e Department of Veterinary Publ ic Health of t h e I n s t i t u t e . Similar a s s i s t ance w i l l be provided a l a o i n 1976. Fellovahips w i l l be awarded i n 1977.

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INDIA

PBL 001 Prevention of Visual Impairment and Control of Blindness

Following the adoption of a reeolution by the Joint Council of Health and Family Planning, the Government has formulated a national policy on the prevention of visual impairment end blindness for a comprehensive programme on community-oriented ophthalmic services. A project document for UNDP assistance was prepared by the Government in 1975.

WHO assistance will be provided in 1978 for the training of ophthalmologists in community eye health eervicee and of health and allied persoanel in the delivery of basic eye health services in the peri- phery and comprehensive referral ophthalmic services at the intermediate and central levels. Supplies and equipment will be provided for training progremea in cornunity ophthalmic services.

In 1979, similar assistance will be provided for the training abroad of specialists in recent advances in eye health services and for national training pragreamee; educational and training material will also be supplied.

CAN 001 Cancer Control Pilot Prolect, Tamil Nadu !

To assist in training health personnel in early detection, diagnosis, health education and epidemiological investigations at the Arignar Anna Memorial Cancer Institute; to assist in the organization and strengthening of facilities for training, service8 and research st the Arignar Anna Cancer Hospital (Regional Cancer Centre) in Kancheepuram.

Assistance to this project started in 1967.

In 1976-1977, consultants and fellowships in epidemiology and other related subjecte will be provided. The project is also supported by the Norwegian Agency for International Development.

From 1978 onwards, it is proposed to merge this project with a new project, IND CAN 006, "Cancer Control and reve en ti on".

CAN 002 Establishment of Cancer Centres in States

To assist in the organization of national cancer control programmes, through the strengthening of training, services and epidemialogieel investigations, and in co-ordinating training and epidemiological research in the regional cancer centres.

In 1976, two consultents will assist in cancer epidemiology and control. In 1977, fellowships will be awarded to senior staff members of the regional cancer centres for studying the organization of ancological services and recent trends in the radiotherapy and chemotherapy of cancer.

From 1978 onwards, it is proposed to merge this project with a new project, IND CAN 006, "Cancer Control and Prevention".

CAN 006 Cancer Control and Prevention

TO promote the establishment of a system of cancer control through prevention, early detection and effective methods of treatment; to assist in the promotion of basic, clinical, experimental and epidemiological research.

In 1978 and 1979, fellovships will be provided for studying recent advances in anti-tumour druga and new methods of diagnosis and treatment.

Provision has been made for the supply of special equipment not produced in the country.

From 1978 onwards, projects IND CAN 001 and IND CAN 002 will be merged with this project.

INDIA

CVD 002 Cardiovascular Diseases Cantrol

To aesist (1) in the development of cardiac resuscitation and rehabilitation services, integrated into the existing public health delivery system; (ii) in the training of health and allied health workers in the management of the cardiac emergencies, and (iii) in the organization of health education for the prevention and control of eerdloveseular diseases.

From 1976, project IND CVD 001 has been merged into this project.

In 1976-1977, fellowships will be awarded for the training of physicians in the prevention and control of cardiovascular diseases.

In 1978, a national seminar on community-oriented p~evention of rheumatic fever as part of the existing public health and school health servicea will be organized for public health personnel and administrators of educational institutions. Fellowships will be awarded for training in streptococcal microbiology and in the prevention and control of cardiovascular diseases. Technical assistance will be provided for conducting a short course on streptococcal typing and laboratory quality control.

In 1979, provision has been made for assistance for holding a national seminar on peripheral acculusive vascular diseases and for training cerdiologiete in recent developments in community-oriented control progr-es in cardiovascular diseases. A course in streptococcal microbiology will also be supported.

Assistance is expected to continue through 1983.

ORH 002 Oral Health

TO stimulate the development, promotion and implementation of effective public health measures far the prevention of oral and dental diseases; to assiat in the training of dental health personnel.

In earlier years assistance to this project was provided through the WDP-assisted project IN71 ORB 001.

In 1978, asaistance will be given for conducting a seminar on the management of dental schools. Fellowships will be offered for training in dental specialties end public health dentiatry. In 1979, a seminar on orsl precancerous lesions will be assisted. Provision has also been made for giving training in recent advances in orsl diagnosis and treatment. Supplies and equipment will be made available for training in public health dentistry, dental health education and school dental health services.

MNH 002 Mental Health

TO assist the All-India Institute of Mental Health and Neurosciences. Bangalore, in the planning and delivery of socio-culturally relevant training progralmnes for specialist mental health personnel. Appropriate community-oriented field ambulatory units demonetrating ways and means of promoting interest, awareness and therapeutic and preventive skills of non-epecialiet health and cornunity personnel will be utilized in the training.

In 1976, a psychiatric teacher will be assigned to Bangalore, and short-term fellowships for advanced training will be awarded to senior teachers of psychiatry from other psychiatric teaching centres in India. Specialist teaching in psychiatry and related disciplines will continue to be supported in 1977, 1978 and 1979. The project ie expected to continue until 1983.

MNH 003 Fellowships (Drug Addiction)

To assist with training in the epidemiology, prevention and treatment of drug ebuae and rehabilitation of drug addicts.

In 1975, a six-month fellowship was awarded for study in centres in the European, Eastern Mediterranean and South-East Asia Regions.

In 1976, two further fellowships will be awarded.

Assistance will continue until 1977.

RhD 002 Radiation Medicine Centre. Bombay

To a s s i s t i n organizing t h e t r a i n i n g of nuclear medicine s p e c i a l i s t s , i n s t rengthening se rv ices and research, and i n t h e radiophamaceut ical production a c t i v i t i e s of t h e Radiation Medicine Centre, Bombay.

Since 1963, consul tants have a s s i s t e d t h e Radiation Medicine Centre i n Bombay i n the development of var ious s p e c i a l t i e s , e.g., computer ana lys i s of p r o t e i n metabolism, radioisotope screening i n r e l a t i o n t o pro te in metabolism i n t r o p i c a l sprue, thyroid metabolism, i n s t a l l a t i o n and s t andard iza t ion of a new scanner, radiorespirometry s tud ies , radioisotope methodology f o r t h e diagnoale of r e n a l d iseasee . hormone imunoassay i n endocrine d i so rde r s and a g o i t r e survey among echo01 chi ldren.

In 1976 and 1977, coneul tante and a fe l lawship i n nuclear medicine w i l l be provided. Short observat ion fellowships w i l l a l s o be awarded t o enable s e n i o r s t a f f t o v i s i t var ious advanced cen t res .

In 1978, a consul tant v i l l a s s i s t i n t h e t r a i n i n g of a p e c i a l i s t s i n nuclear medicine and of f a c u l t y members i n recent advances i n r a d i a t i o n medicine. Similar a s s i s t ance f o r t r a i n i n g and fe l lowships v i l l b e provided i n 1979 f o r s t rengthening t h e f a c i l i t i e s i n r a d i a t i o n medicine t o enable t h e cen t re to funct ion as a reg iona l t r a i n i n g c e n t r e as wel l f o r promoting t h e development of new radiopharma- c e u t i c a l s f o r diagnosis and treatment. Suppliee and equipment w i l l be made a v a i l a b l e f o r t h e t r a i n i n g programmes.

Assistance is expected t o continue u n t i l 1983.

RAD 004 Advanced Courses in Radiological Physics

To a s s i s t t h e Division of Radiological R o t e c t i o n a t t h e Bhabhs Atomic Research Centre, Bombay, with the corduct of t h e M.Se. course i n r ad io log ica l physics and with t h e development of r ad io log ica l protect ion services .

This course r ep laces t h e one i n hosp i t a l physics ( e a r l i e r p ro jec t IND RAD 003).

From 1975 orwards, e consul tant has been provided annually f o r a s s i s t ance i n the t r a i n i n g of candidates f a r the advanced course i n r ad io log ica l physice; a grant has been provided t o cover t h e cos t of the course. I n 1977, another consul tant w i l l a s s i s t i n the eva lua t ion of t h e t r a i n i n g programme. l k o f e l l a r s h i p s are awarded every year f o r advanced t r a i n i n g of s t a f f members from t h e Division of Radiolo- g i c a l Physics of t h e Centre.

Assistance w i l l continue till 1977.


To a s s i s t with courses i n occupat ional h e a l t h r e l a t e d t o s p e c i f i c hazards found i n industries, and t o advise on s t u d i e s an such hazards.

Assistance was provided t o t h e National I n s t i t u t e of Occupational Health, Ahmedabad, i n organizing t r a i n i n g i n occupat ional hea l th . Short-term consu l t an t s a r e being provided i n 1976 and 1977.

Fellowships i n var ious important sub jec t s , such as thermal physiology and a i r po l lu t ion , w i l l be avarded.

The p ro jec t is expected t o continue through 1977, a f t e r which i t w i l l be merged wi th a new pro jec t . I N D RPD 001. "Biomedical Research".

INDIA

5.2.7 Biomedical Aspects of Radiation

Radiation Medicine Centre, Bombay

Short-term consul tants Fe l lweh ips Supplies and equipment

Advanced Course i n Radiological Physics

Short-term consul tants F e l l w s h i p s Grant Supplies and equipment

5.2.10 Health of Working Populations

Occupational Health

Short-term consul tants F e l l w s h i p s Pa r t i c ipan t s Supplies and equipment

1976

11 3 21 9

11 2 2/24

11 2 4/39

Number

1977

11 3 2/15

21 4 2/24

11 2 5/40

Revised

1976

9 000 8 200 4 900 - 22 100

6 000 1 3 200 15 000 1 000 - 35 200

6 000 22 400 3 100

500

- 32 000 -

Estimates

1977

1 0 500 9 200 4 000

23 700

14 000 1 3 200 15 000 1 000 - 43 200

7 000 24 000

2 500 500 - 34 000 -

of Posts

1978

11 3 2/15

1978

12 000 21 200 9 000

42 200

-

.A

2

RE

RE

RE

1979

11 3 2/15

Proposals

1979

1 3 500 22 600 9 000

45 100 -

Project NO.

RAD 002

RAD 004

HWP 001

232

I N D I A

PHA 001 Urug Laboratory Techniques and Biological Standardizat ion

To a s s i s t i n the development of t h e se rv ices concerned with the qua l i ty con t ro l of pharmaceutical and b io log ica l preparat ions , and i n the t r a i n i n g of s t a f f .

I n 1967, a coneultant v i s i t e d various l abora to r i e s and i n s t i t u t i o n s and co l l ec ted background mater ia l f o r the formulation of a plan. I n 1970 and 1971, two consul tants a s s i s t e d i n the formulation of the plan and prepared a d r a f t document.

Fellovshipe have been given i n the past and a few mare f e l l a r s h i p s w i l l be awarded i n 1976-1977 to o f f i c e r s i n charge of S ta te con t ro l l abora to r i e s i n advanced laboratory techniques and t h e use of s tandards f o r control .

F r w 1978. the p ro jec t w i l l be followed up by the n w pro jec t . IND PHA 002, "Quality Control o f Pharmaceuticals".

PHA 002 q u a l i t y Control of Pharmaceuticals

TO a s s i s t i n the strengthening of drug con t ro l se rv ices .

The project w i l l provide technical a s s i s t ance with e view to s t rengthening the se rv icea es tabl ished a t the Centre and i n the S ta te s i n such areas as: organizat ion and adminis t ra t ion, drug atandsrda, t h e i r formulation and use; screening of drugs; advanced mthode f a r drug ana lys i s and operat ion of a scheme f o r the con t ro l of t h e l abora to r i e s involved i n drug control . I n 1978-1979 fellowships w i l l be provided i n drug adminis t ra t ion, drug ana lys i s and screening of new drugs.

Suppl ies and equipment w i l l be ~ r o c u r e d t o enable t h e Centra l Drug Control Laboratory t o provide reference se rv ices and t o produce and d i s t r i b u t e reference preparations t o other c o n t r o l laborator iee .

BLG 001 Production of Freeze-dried Smallpox Vaccine

To a s s i s t i n a t t a i n i n g sel f -suff ic iency i n the production of freeze-dried smallpox vaccine of standard qua l i ty .

Assistance has been provided i n reviewing t h e methodology of freeze-drying and qua l i ty con t ro l of smallpox vaccine. Assistance was a l s o given f o r s tepping up the production capaci ty .

The p ro jec t w i l l complete i n 1976.

BLG 002 Production of Freeze-dried BCG Vaccine

To a s s i s t i n t h e production of freeze-dried BCG vaccine of standard qua l i ty .

In 1968 and 1970, consu l t an t s advised on t h e production of freeze-dried vaccine, and fe l lowships were awarded i n r e l a t e d sub jec t s . I n 1972, a f u r t h e r consul tant m d e a follow-up v i s i t , and, i n 1973-1974. t h e same consul tant commissioned an automatic sea l ing machine supplied by UNICEF and l a i d plans fo r the s t rengthening of a na t iona l c o n t r o l laboratory a t the Nations1 I n s t i t u t e o f Communicable Diseases. Delhi.

Subs tan t i a l a s s i s t ance is being provided, by way of short-term consu l t an t s , fe l lowships , suppl ies and equipment, i n order t o s t e p up t h e production t o meet t h e requirements of the na t iona l tuberculosis con t ro l programme.

From 1976 through 1983, a s s i s t ance , by way of consu l t an t s and fe l lowships , w i l l focus an vaccine con t ro l and t h e s tandardizat ion of t h e BCG vaccine produced i n India . Concentrated vaccine w i l l a l s o be produced to s tudy t h e f e a s i b i l i t y o f a l t e r n a t i v e methods of vaccinat ion.

Assistance t o the p ro jec t is expected t o continue u n t i l 1983.

INDIA

5.3 Prophylactic. Diagnostic and Therapeutic Substances


Drug Laboratory Techniques and Biological Standardiza- tion - Fellowships Supplies and equipment

Quality Control of Pharmaceuticals

Fellowships Supplies and equipment

5.3.4 Biologicals

Production of Freeze-dried Smallpox Vaccine

Supplies and equipment

Production of Freeze-dried BCG Vaccine

Short-term consultants Fellowships Supplies and equipment

1976

4/15

Number

1977

5/30

11 2

rn

RB

RB

RB

RB

Revised

1976

12 900 2 000

14 900

4 000

8 000

8 000 -

Project

PHA 001

PHA 002

BLG 001

BLG 002

of Posts

1978

4/18

11 6

Eetimates

1977

19 500 2 000

21 500

7 000

2 000

9 000 -

1978

17 000 7 000

24 000

5 200 9 500

14 700 -

1979

4/18

11 2 11 6

Proposals

1979

18 600 20 000

38 600

9 000 5 600 13 000

27 600 -

INDIA

BLG 003 I n d u s t r i a l Technology i n DPT Vaccine Production

TO introduce advanced technology t o enable t h e s tepping up of t h e production of DPT vaccine i n t h e cen t ra l l abora to r i e s , i n order t o meet the demands of t h e National Immunization Programme.

To t h i s e f f e c t , two c o n s ~ l t a n t a - an engineer and a vaccine exper t - w i l l advise the Centra l Research I n s t i t u t e . Kaaauli, and other l abora to r i e s designated by t h e Government of India with regard t o the planning and i n s t a l l a t i o n of t h e equipment, operat ion of t h e p lan t s and qua l i ty con t ro l of DPT vaccine.

Staff w i l l be t r a ined i n advanced methods of production.

A6 and when required, suppl ies and equipment w i l l be provided t o meet contingencies.

kas is tance t o t h i s p ro jec t w i l l s t a r t i n 1976 and w i l l continue f o r some yeare.

LAB 002 Promotion of Health Laboratory Services and Health Laboratory Technology

To s t rengthen the laboratory se rv ices so as t o provide a more e f f e c t i v e support to t h e hea l th and disease-survei l lance progra-s i n t h e d i f f e r e n t S ta t e s .

Basic laboratory se rv ices w i l l be etrengthened and advanced techniques w i l l be introduced i n support of p r i o r i t y hea l th a c t i v i t i e s such as hea l th care, b a s i c hea l th se rv ices , comunicable-disease su rve i l l ance , food and water c o n t r o l and hoep i t a l hygiene. Exis t ing na t iona l reference laboratories w i l l continue t o receive eupport and t echn ica l aas i s t snce w i l l be extended f o r the establishment of newer ones as p a r t of s network i n support of t h e epidemiological su rve i l l ance of c m u n i c a b l e diseases. The project w i l l develop t h e technology with regard t o the care and breeding of l sbora to ry animals, including n o n - h w n primates, t h e maintenance and care of l abora to ry instruments, processing of laboratory d a t a and other general se rv ices of a l o g i s t i c na tu re which w i l l improve the work of a laboratory system.

A team cons i s t ing of a microbiologis t and a t echn ica l o f f i c e r , e a r l i e r under p ro jec t IND LAB W1, w i l l a s s i s t S t a t e d i r e c t o r a t e s i n improving t h e l abora to r i e s i n t h e i r r e spec t ive Sta tes . Consultsnts w i l l advise reference l abora to r i e s on s tandards and research and he lp i n so lv ing s p e c i f i c problems. National courses w i l l be organized by t h e reference l abora to r i e s i n order t o promote t h e i r respect ive sub jec t s .

Fellowships w i l l be awarded t o enable qua l i f i ed t u t o r s t o t r a i n technicians and to s p e c i a l i z e i n laboratory sc iences; s p e c i a l i s t s i n charge of reference cen t res w i l l be provided fellowships i n advanced s tud ies . Also, workshops w i l l be held i n advanced l abora to ry technology. Supplies and equipment not a v a i l a b l e l o c a l l y w i l l be procured t o support t h e a c t i v i t i e s of the p ro jec t and those of the reference l abora to r i e s .

Assistance t o the p ro jec t is expected t o continue u n t i l 1983.

LAB 003 Laboratory Quality Control and Standardizat ion

To improve the accuracy of diagnosis i n laboratory p rac t i ce .

With t h i s aim i n view, t h e p ro jec t proposes t o e s t a b l i s h c a p a b i l i t y f o r t h e preparat ion of s tandards and reference ma te r i a l s . Also, i t w i l l he lp operate a n a t i o n a l scheme f o r t h e ex te rna l qua l i ty con t ro l of laboratory workers. t h e t e s t i n g of t h e i r prof ic iency, t h e accuracy of methods used i n laboratory p rac t i ce , and of the r e l i a b i l i t y of reagents . I n 1978-1979, a s s i s t a n c e w i l l be provided i n order to develop standarde i n c l i n i c a l chemistry and microbiology.

In 1979, a two-week workshop i n q u a l i t y con t ro l w i l l be organized f o r t e n p a r t i c i p a n t s who a r e i n charge of c l i n i c a l chemistry l a b o r a t o r i e s p a r t i c i p a t i n g i n the na t iona l echeme.

F e l l w s h i p s w i l l be awarded i n laboratory s t andard iza t ion , q u a l i t y c o n t r o l and automation of se rv ices . Supplies and equipment w i l l be provided t o t h e n a t i o n a l r e fe rence laboratory f o r t h e freeze-drying of reference preparat ions .

Assistance t o t h i s p r o j e c t i e expected t o cont inue u n t i l 1983.

INDIA

LAB 004 Blood Transfusion

To support the national effort in providing guidance to the States far the promotion of blood transfusion services.

The project proposed to help develop good standards for practice in blood banking, preparation of blood components and plasma fractions; to promote studies an the health hazards consequent an the use of traded blood; also, to strengthen the role of institutions such as blood banks, the Past-graduate Institute of Medical Education and Research, Chandigarh, and the Blood Group Reference Centre. Bombay, with regard to training and research in immunohaematology, le-cytes typing and tissue typing and quality control; to assist these and similar institutions in exchanging information. material on blood services end rare types with other specialized international institutions abroad. Every year a one-week workshop will be held on 'how to organize voluntary donations and provide safe blood to the community - needs and probleme". In 1978-1979, fellowships will be awarded for studying the latest developments in blood banking techniques and the organization of blood transfusion services. Supplies, including cryogenic equipment, will be provided in order to support research.

Assistance to the project is expected to continue through 1983.

LAB 005 Virological Techniques

To assist in the development of laboratory capacity for the diagnosis and surveillance of viral diseases; to assist in the production of live poliomyelitis vaccine and ita neuravirulence testing (Nn) st the National Institute of Comunicable Diseases (NICD). Delhi.

In 1969, a eonaultant reviewed the procedure for the manufacture of live polio vaccine in Coonoor. In 1970, a cossultantlneuropathologist advised on the design and planning of the NV'l unit at the NICD and provided a protocol for the procedures to be followed in testing poliomyelitis vaccine; a pathologist was trained in NVT in the consultant's laboratory in the United Kingdom. In 1972, a neuropathologist consultant reviewed the work of the NVT unit and assessed its capability far aeaaying poliomyelitis vaccine.

Subsequently, a team of experts assessed the eligibility of the Haffkine Institute. Bombay, to produce polio vaccine. In 1974, a consultant advised the Virus Research Centre, Poona, in the development of a rickettesial laboratory, and a team of experts advised on stepping up the production af polio vaccine at the Caonoor and Haffkine Institutes.

Fellovships have been provided in the past in polio vaccine production, neuropathology in the control of polio vaccine, rickettsiology, general virology and virus diseaaee of laboratory animals. From 1976 onwards, fellowships will be awarded for training laboratory staff from the Haffkine Institute in polio vaccine and in the control and surveillance of viral diseases.

Supplies and equipment will be provided to support the activities of the reference virology laboratories.

Assistance to the project is expected to continue till the end of 1983.

INDIA

Blood Transfusion

Fellarships Grant Supplies and equipment

Virological Techniques


1976

11 1 4/20

Revised

1976

3 000 15 400 5 000

23 400

-

Number

1977

11 1 21 9

I

Estimates

1977

3 500 6 500

10 000

Proposals

1978

6 600 1 500 2 000

10 100

-

6 600 6 500

13 100

of Posts

1978

21 6

2/ 6

I

m a

RE

RE

1979

7 400 2 000 8 000

17 400 -

7 400 10 000

17 400

-

1979

2 1 6

2/ 6

I

Project No.

LAB 004

LAB 005

I I

238

INDIA

BSM 002 Village Water Supply

To assist in planning and co-ordinating the development of community water supplies in rural areas, including the well-drilling programme in areas where hard rock presents special problems and in those where water is scarce; to train professional and drilling ataff.

lhis project is a continuation end expansion of assistance provided earlier under India 0227. "Rural Water Supplies3', and India 0125, "Community Development Areas - Cowunity Water Supplies". In 1971, a sanitary engineer was assigned to assist the programe in eix southern States of India, and another was assigned in 1973 to provide similar assistence to the northern States. These engineers were transferred in 1975 and plans made to replace them with e hydrogeologist and a master driller in 1976 and 1977.

Fellowships for field training will be related to different specialties.

UNICEF is providing assistance in the form of materials and equipment.

From 1978. activities under this project will be covered under a new project. IND BSM 005, "Cornunity Water Supply and Sanitation".

BSM 003 Solid Wastes Disposal

To assist in studying the problems of solid wastee in urban cormunities and to advise on planning the management of solid wastes.

Four fellowships were awarded in 1973. In 1974, a eoneultant advised on solid wastes disposal problem in Bangalore and Delhi, and in 1975 in several other cities of India. Assistance was given in holding a national workshop in Ahmedabad in October 1975.

In 1976, a consultant will follow up on earlier recommendations and prepare a guideline for solid wastes management in India; fellowships will be provided for field training.

From 1978, this project will be merged into a new ~roject, IND CEP 006, "Environmental Pollution Control".

BSM 004 Rural Water Supply (UNDP INDl741016)

To assist in providing protected water sources to the difficult and probleln villages; to train hard- rock drilling crews, supervisors and water prospectors; to assist in establishing operational and maintenance procedures, internal monitoring and evaluation system and promoting the development of rural water supply surveillance and health education of the people.

The WHO consultant, aesigned in 1975 far a period of three months, reviewed the existing situation of rural water supply in the country and prepared a request for assistance from UNDP for the rural water supply programme in India.

Full project activities were scheduled to start in early 1976, but due to UNDP financial situation, it is now expected that the project would commence from 1978, though in a revised form, subject to approval by UNDP, and continue up to 1982.

INDIA

BSM 005 Community Water Supply and San i t a t ion

TO 8 6 8 i ~ t i n planning and co-ordinating t h e development of cornunity water euppl iee and s a n i t a t i o n i n r u r a l and urban area-.

This p ro jec t absorbs, from 1978, t h e a c t i v i t i e s undertaken under p ro jec t I N D BSM 002, "Village Water Supply". While t h e emphasis w i l l continue t o be on the provis ion of t echn ica l advice f o r the well- d r i l l i n g programme i n hard-rock areas and those where water i s scarce, a t t e n t i o n w i l l a l s o be paid t o piped water supp l i e s , t o improved s a n i t a t i o n and t o t h e provis ion of se rv ices t o urban c c m u n i t i e s . A hydrogeologistlmaster d r i l l e r w i l l b e continued i n 1978 and consu l t an t s w i l l be provided t o advise on spec ia l i zed aspec t s of t h e programme. Fellowships w i l l be made a v a i l a b l e f o r study abroad.

Assistance t o t h i s p ro jec t is expected t o continue u n t i l 1983.

P I P 001 T d l Nadu Uater Sunply and Sewerage Re-inveetment Studies - Madras Metroplican Arc. (UNDP INDl751008)

TO a s s i s t i n t h e preparat ion of s master p lan , covering a l l aspecte of water supply, drainage and sewerage f o r t h e Madras Metropolitan Area.

A WHOlIBRD mission made a survey of the water supply and sewerage s i t u a t i o n i n t h e Madras Metropolitan Area i n February 1975 and a s e i s t e d i n t h e preparat ion of p ro jec t document. A s a n i t a r y engineer took up h i s assignment as a p ro jec t manager in January 1976. The major work w i l l be entruered t o Wo sub- con t rac to r s under two sepa ra te sub-contracts, one f o r engineering s t u d i e s and the other f o r organiza- t i o n , f inance and management s tud ies . Local consul t ing f i rms w i l l a l e o co l l abora te with foreign firms i n these s tudies .

The p ro jec t document was signed i n February 1976 and a s s i s t a n c e t o t h e p ro jec t w i l l continue u n t i l the middle o f 1978.

CEP 001 Prevention and Control of Water Po l lu t ion

To provide t echn ica l advice on o rgan iza t iona l and o t h e r ma t t e r s r e l a t e d t a t h e abatement and con t ro l of water po l lu t ion .

In 1969, two consul tante s tudied t h e water po l lu t ion problems i n t h e S t a t e of Maharashtre and advised on the establishment and f u n c t i o n b g of a water po l lu t ion c o n t r o l board. I n 1971, a t h i r d consul tant advised on organizat ional , l a g i a l a t i v e and o the r mat tere r e l a t e d t o a water po l lu t ion con t ro l programme. Another consul tant , assigned i n 1972, advised on t h e prevention and con t ro l of water po l lu t ion , and espec ia l ly on t h e use of a n a l y t i c a l techniques i n t h i s f i e l d . Consultant se rv ices were provided i n 1974 and 1975 f o r a s s i s t ance i n t h e development of water po l lu t ion c o n t r o l boards and l abora to r i e s a t c e n t r a l and S t a t e l e v e l s .

I n 1976-1977, consul tant advice i s planned in water po l lu t ion c o n t r o l monitoring programmes and a n a l y t i c a l techniques; f e l lovsh ipa for f i e l d t r a i n i n g w i l l a l s o be provided. From 1978 t h i s p ro jec t w i l l be merged i n t o a new p r o j e c t , IND CEP 006, "Environmental Po l lu t ion Control".

INDIA

Community Water Supply and Sanitation

Hydrogeologiat P4

Short-term consultants Fellowships Participants Supplies and equipment

6.1.3 Pre-investment Planning for Basic Sanitary Services

Tamil Nadu Water Supply and Sewerage Pre-investment Studies - Madras Metropoli- tan Area IND/75/008

Project manager P5 Administrative assistant ND6 Clerk-stenographer ND4

Short-term consultants Temporary advisers Administrative support personnel

Fellowships Sub-contracts Supplies and equipment including vehicles

Miscellaneous

6.1.4 Control of Environmental Pollution and Hazards

Prevention and Control of Water Pollution

Short-term consultants Fellovships Supplies and equipment

Proposals

1978

39 400

8 000 52 200 5 000 2 000 -

I I 106 600 -

13 58 6 3 -

81 -

1976

1/12 11 9 1/12 -

11 3 13/39

Revised

1976

53 600

1 800

198 000

83 500 500 -

337 400

9 000 33 800 2 000

44 800

Estimates

1977

47 400 5 400 2 700

55 500

30 400 18 000

2 000 19 800

1 159 000

68 600 7 500

--

1 360 800

21 000 26 000 3 000

50 000

Number

1977

!

1/12 1112 1/12 -

3 3 3 ---

41 8

1 3 / 1 8 i

21 6 10130

of Posts

1978

1/12 - 1 -

11 2 12/36

11 7 11 7 11 7

- I

11 2

I #

1979

11 3 12/36

!

I N D I A

CEP 002 Control of A i r Po l lu t ion

To a s s i s t i n studying t h e problems of a i r po l lu t ion connected wi th i n d u s t r i a l development, and i n promoting e c o n t r o l programme.

Since 1971. WHO a s s i s t ance through consul tant se rv ices and fellowships has continued i n var ious a spec t s of a i r po l lu t ion control . I n 1976-1977. consul tant se rv ices w i l l be made ava i l ab le t o a s s i s t the Central Government i n e s t ab l i sh ing r u l e s and regu la t ions v i t h r e fe rence t o l e g i s l a t i o n for con t ro l l ing a i r pol lut ion. Fellowshipa w i l l be provided for f i e l d t r a in ing .

From 1978, t h i s p ro jec t w i l l be rnerged i n t o a new pro jec t , IND CEP 006, "Environmental Po l lu t ion Control".

CEP 003 Medical Toxicology Unit

To a s s i s t i n s tud iee on t h e e f f e c t of a i r po l lu tan t s and organo-chlorine pes t i c ides i n man.

This p ro jec t s t a r t e d i n 1972. ' Consultants a s s i s t e d i n e s t ab l i sh ing an epidemiological u n i t a t the I n d u s t r i a l Toxicology Research Centre, Lucknow, and i n t r a i n i n g s t a f f i n pes t i c ides de tec t ion , end a l s o gave advice on research p ro jec t s r e l a t i n g t o medical toxicology. Assistance was a l s o provided Ear the In te rna t iona l Symposium on industrial Toxicology held i n November 1975.

A consul tant in epidemiology w i l l be provided i n 1977 and provis ion i s made f o r f e l l w e h i p s i n 1976-1977.

In 1978, t h i s p ro jec t w i l l merge wi th a new p r o j e c t , I N D RPD 001. "Biomedical ~ e s e a r c h " .

CEP 005 Po l lu t ion Inves t iga t ion and Control. Mahsraahtra ( W P INDl751044)

TO a s s i s t i n the c o n t r o l of v a t e r po l lu t ion from municipal and indumtr ia l vsa tc . i n Mdharaahtra S ta t e .

The p ro jec t document covering UNDP a s s i s t a n c e t o t h i s p ro jec t was signed i n October 1975.

A consul tant w i l l be provided i n 1976 for two months t o advise on t h e implementation and enforcement of water po l lu t ion laws and admin i s t r a t ive regulat ions .

It i s proposed t o provide one consul tant i n 1977, t o a s s i e t i n carrying out eyetematic surveys of t h e r i v e r , streams and of t h e po l lu t ing i n d u s t r i e s t o d e l i n e a t e v s t e r po l lu t ion prevention areaa i n t h e S ta te .

CEP 006 Environmental Po l lu t ion Control

To provide t echn ica l advice and ass i s t ance i n s t u d i e s , da ta c o l l e c t i o n and research on var ious a spec t s of t h e prevention and con t ro l of environmental pol lut ion.

This p ro jec t i s being formed from 1978 by combining p ro jec t s I N D CEP 001, "Prevention and Control af Water Pollution", IND CEP 002. "Control of A i r Pol lut ion" , and I N D BSM 003, "Solid Wastes D i s p ~ s a l " .

In 1979, a san i t a ry eng inee r l sc ien t i a t w i l l be assigned t o give a s s i s t ance i n the development of i n s t i t u t i o n s and programmes of po l lu t ion c o n t r o l , and t o advise on the organizat ion and management of c e n t r a l and S t a t e water po l lu t ion and a i r po l lu t ion c o n t r o l b o a r d s . Consultant se rv ices w i l l be provided i n 1978 and 1979 on s p e c i f i c a spec t s of water , air and land po l lu t ion con t ro l , o rgan i ra t ion , enforcement, f inancing, monitoring, e t c . , Fel lovships f o r f i e l d t r a i n i n g abroad w i l l be awarded. It 16 proposed t o conduct na t iona l eeminaralworkshcps i n a i r po l lu t ion con t ro l measures and i n a s p e c i f i c f i e l d of water po l lu t ion c o n t r o l still t o be determined.

Aesistanee t o t h i s p ro jec t w i l l continue u n t i l 1983.

244

INDIA

SES 001 As8is tmce t o National Environmental EngineerinR Research I n s t i t u t e

To a s s i s t i n developing t h e I n s t i t u t e aa a major research and t r a i n i n g cen t re f o r environmental h e a l t h problems and for co-ordinating research prograrrmes.

The I n s t i t u t e received ass i s t ance from t h e United Nations Development Programme (Special Fund) from 1961 to 1967 i n the form of supp l i e s and equipment. WHO has provided consul tants t o a s s i s t i n the development of research programmes i n var ious spec ia l i zed f i e l d e of environmental heal th . Consultants i n 1976 and 1977 are t o be assigned t o advise on a n a l y t i c a l methods i n water and a i r po l lu t ion c o n t r o l , water treatment, environmental microbiology, r ecyc l ing of water , e t c . I n 1978 and 1979, t e n t a t i v e proposals are being made f o r Consultants t o advise on a i r po l lu t ion con t ro l , monitoring of water pol lut ion and development of information systems. A na t iona l workshop on research i n environmental engineering v i l l be held i n 1979.

Assistance under t h i s p ro jec t i s expected t o cont inue a t l e a s t u n t i l 1980, wi th consultants and fellowships provided according t o t h e needs of t h e research programmes.

SES 003 Public Health Engineering Education (UNDP INDl681033)

To a s s i s t i n the education and t r a in ing of s a n i t a r y engineers and i n the development of advanced courses i n the design of community water supply programee.

I n 1967 and 1968. two consul tants were provided t o t h e Vic to r i a J u b i l e e Technical I n s t i t u t e , Bombay. From 1973 t o 1975 fellowships were awarded.

In 1976, i t is proposed t o award f u r t h e r fe l lowships i n publ ic hea l th engineering education.

Subject to a v a i l a b i l i t y of UNDP funda, i t is expected t h a t i n 1977 and 1978 ass i s t ance w i l l be provided to t h i s p ro jec t by way of eonsu l t sn t s and f e l l m e h i p s .

ESP 002 Food Standards Programme

To improve the srandards of food handling i n processing p lan t s and ea t ing establishments.

WHO a s s i s t ance w i l l cons i s t of the award of fe l lowships f o r s t u d i e s of new laboratory techniques applied i n the con t ro l of food add i t ives and tox ic substances.

Specia l laboratory equipment not produced i n India v i l l a l s o be suppl ied.

From 1977, project I N D FSP 001, "Study i n Food Legis la t ion" , w i l l be merged i n t o th ia p ro jec t .

DHS 001 Indian Council of Medical Research ( S t a t i s t i c s )


I N D I A

DHs 002 Strengthenins of Health S t a t i s t i c a l Services

To advise on and a s s i s t with the f u r t h e r development of t h e h e e l t h e t a t i s t i c s system; t o a 8 e i s t i n the review and development of h o s p i t a l a t s t i e t i c a and medical recorde; t o he lp i n t h e development of cu r r i cu la for courses f o r medical records techniciene; t a help i n the organizat ion and conduct of t r a i n i n g programmes.

Beginning i n Ju ly 1970, a s s i s t ance was provided t o t h e Model V i t a l and Health S t a t i s t i c s Training Unit, Nagpur, i n e f f e c t i n g changes i n t h e curriculum f o r courses f o r medical records technicians necess i t a t ed by t h e e igh th r e v i s i o n of t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases (ICD). I n 1973, e c o n a u l t m t a s s i s t e d the t r a i n i n g course f o r medical record technicians held i n New Delhi , and another made an assessment of t h e h o s p i t a l records and s t a t i s t i c a l r epor t ing systems i n Punjab, Heryana and Maharashtra.

In 1975, e ight fellowships i n hea l th s t a t i s t i c s were awarded and supp l i e s and equipment were provided.

A consul tant w i l l be provided i n 1976 f o r t h r e e months t o a s s i s t i n t h e f i e l d of medical record* and t o prepare a a t r a t egy for t h e development of h o s p i t a l s t a t i s t i c s wi th s p e c i a l reference to Rosp i t a l morbidity.

Assistance w i l l be continued i n t h e gradual implementation of t h e hea l th information system u n t i l i t is capable of generat ing s a t i e f a c t o r i l y t h e d a t a needed f o r t h e planning and management of h e a l t h services . I n 1978, a consul tant w i l l advise on t h e establishment of a node1 h e a l t h information eystem i n Bihar S ta t e .

I n 1979, another consul tant w i l l evaluate t h e implementation of t h e design of a model hee l th informs- t i o n system and advise on s u i t a b l e modif icat ions , i f neceseary.

Revised Estimates

Dollars)

Project No.

DHS 002

ASE 001

, b.

249 INWNESIA - Index

P r o j e c t NO.

ASE 001

BLG 0 0 1

BSM 001

BVD 001

BVD 002

BVD 003

CAN 001

CEP 001

DHS 001

ESD 002

ESD 003

HED 003

HMD 001

HMD 002

HMO 003

HMD 008

HSD 001

HSD 002

*rrajecc


Country Statement

O f f i c e of t h e WHO Repre sen t a t i ve

Vaccine and Se ra Product ion (LAB 002)*

Na t i ona l Cornunity wa t e r supp ly and S a n i t a t i o n

Tube rcu lo s i s Con t ro l (MBD 001)*

Leprosy Con t ro l (MBD 002)*

Campaign f o r Cont ro l of Y a w s i n Sub-Dis t r ic t of North Morotai (VDT 001)*

Cancer Cont ro l

Hazards to Man from P e s t i c i d e s

Medical Records

Research i n Communicable Diseases Ecology

S t r eng then ing of Epidemiolr>gical S u r v e i l l a n c e and Control

Development of Heal th Education i n Family Heal th

Medical Education

Nursing Education and Se rv i ce s

Pos t -graduate Education i n P v b l i c Heal th

Resources f o r Family Heal th

S t r eng then ing of Nat iona l Heal th S e r v i c e s (SHS 001)*

Medical R e h a b i l i t a t i o n (SHS 002)*

ilumbcr p r i o r t o t h e c u r r e n t programme

Page

251

275

268

270

262

262

264

264

272

413

260

260

256

256

258

258

258

252

254

s t r u c t u r e .

~~ ~~ ~ ~~


S t r eng then ing of Heal th Se rv i ce s (Province of I r i a n Jaya) (SHS 006)*

Development of Cen t r a l and Regional Occupat iona l Heal th and I n d u s t r i a l Hygiene Labo ra to r i e s

Labora tory Se rv i ce s

School Heal th

Medical Se rv i ce s f o r Family Heal th

Mental Heal th

Malar ia E rad i ca t i on

Ma la r i a Cont ro l (Province of I r i a n Jaya)

N u t r i t i o n

Ora l Heal th (DNH 001)*

Qua l i t y Cont ro l of Food and Drugs (SqP 001)*

J a k a r t a Sewerage Master P lan

Rural Water Supply P r o j e c t , Ea s t Java Province

Rad i a t i on Heal th

T ra in ing of X-ray and E l ec t ro - medical Technic ians

T r a i n i n g i n S a n i t a r y Engineer ing

Immunization Se rv i ce s ( I nc lud ing Smallpox) (ESD 004)*

Ve t e r i na ry P u b l i c Heal th

- P r o j e c t

NO.

HSD 003

HW 001

LAB 001

MCH 001

MCH 003

MNH 001

MPD 001

MPD 002

NUT 003

ORH 001

PHA 001

PIP 002

PIP 003

RAD 001

RAD 002

SES 001

SPI 001

VPH 001

- Page

254

268

270

254

256

266

260

262

256

264

268

270

27 2

266

266

272

262

264

.

INWNESIA

GENERAL - The second f ive-year p l an w i l l end on 3 1 March 1979, du r ing which p e r i o d t h e t a s k s of the h e a l t h sector are t o improve h e a l t h , p a r t i c u l a r l y i n t h e f i e l d s of eomun icab l e d i s ea se s and n u t r i t i o n ; t o provide h e a l t h and s a n i t a r y f a c i l i t i e s according t o needs; t o s t i m u l a t e h e a l t h awareness i n t h e people , and t o promote fami ly h e a l t h .

P r i o r i t y is t o b e given t o r u r a l and developmental areas and t o those i n t h e p roduc t ive and younger age-groups. Out-pa t ient and p reven t ive a s p e c t s of pe r sona l a e r v i c e s are t o b e s t r e s s e d , as w e l l as environmental s a n i t a t i o n . The f r o n t - l i n e l e v e l of h e a l t h care is t o b e consol ida ted around t h e h e a l t h c e n t r e s .

General Heal th Se rv i ce s

Within t h e Department of Heal th , a Bureau f a r Health Planning, a Direc tora te-Genera l f o r Community Heal th , a Research and Development Wing, and a Centre f o r Education and Tra in ing have been e s t a b l i s h e d . P r i o r i t y a t t e n - t i o n is given t o t h e p r o g r a m f o r de l i ve ry of h e a l t h services through h e a l t h c e n t r e s , of which t h e r e w i l l be one i n eve ry s u b - d i s t r i c t , and f o r t h e educat ion and t r a i n i n g of t h e a s soc i a t ed manpower. The concept of primary h e a l t h care w i l l b e f u r t h e r developed. Research on t h e d e l i v e r y of h e a l t h s e r v i c e s cont inue .

WHO Ass is tance . The mu l t i -d i s c ip l i na ry team a s s i s t i n g t h e h e a l t h s e r v i c e s w i th p lanning, r e sea rch and development, management and e v a l u a t i o n , w i l l b e g r adua l ly reduced as t h e needs are met. Nursing s e r v i c e s w i l l b e s t r eng thened and a d d i t i o n a l a s s i s t a n c e w i l l b e provided t o fami ly h e a l t h through t h e p rov i s ion of medical f e l l owsh ips . The l abo ra to ry s e r v i c e w i l l cont inue t o b e supported.

Heal th Manpower Development

The p rov i s ion of competent m a n p ~ v t r t r a i n e d t o meet t h e needs of t h e count ry and, as f a r as p o s s i b l e , w i th in t h e country o r t h e region , cont inues t o b e t h e p a l i c y of t h e Government. Whilst i n some in s t ances t h e r e i s a need f o r g r e a t e r numbers, t o which a t t e n t i o n is d i r e c t e d , t h e major e f f o r t s are d i r e c t e d towards b e t t e r q u a l i t y .

WHO Ass is tance . Reorgeniza t ion of t r a i n i n g of nurses and t h e i n t r o d u c t i o n of t h e primary h e a l t h nurse w i l l r ece ive g r e a t e r a s s i s t a n c e . Ass i s t ance t o undergraduate medical educat ion w i l l cont inue , b u t w i th emphasis on teaching methods and management r a t h e r than an i n d i v i d u a l d i s c i p l i n e s . Ass i s t ance t o t h e Post-Graduate Facul ty of P u b l i c Health and t o the Bandung I n s t i t u t e of Technology w i l l be continued.

Disease Prevent ion and Con t ro l

?.-

With t h e e r a d i c a t i o n of smallpox, i nc r ea sed a t t e n t i o n has been given t o an expanded p r o g r a m of immunization. Tetanus and p o l i o m y e l i t i s are be ing inc luded i n the programme. The BCG vacc ina t i on p r o g r a m e is maintained. The a v a i l a b i l i t y of DDT, through a loan from US AID, enabled s t r e n g t h e n i n g and expans ion of the ma la r i a c o n t r o l a c t i v i t i e s . The l ep rosy programme, a s s i s t e d by t h e Danish Save the Ch i ld r en ' s Organiza t ion , cont inues t o expand both s e r v i c e s end t r a i n i n g . Su rve i l l ance of denguefhaemorrhagic f e v e r and o t h e r epidemic d i s e a s e s i s continued.

I nc rea s ing a t t e n t i o n i s be ing given t o nan-comunicable d i s e a s e s such as cancer , c a rd iovascu l a r a f f l i c t i o n s , mental h e a l t h , o r a l h e a l t h and drug abuse and dependence. Research, as a p p r o p r i a t e , is encouraged i n both comun icab l e and non-communicable d i s ea se s .

WHO Ass i s t ance . Support f o r s p e c i f i c p r even t ive and c o n t r o l programtee w i l l b e cont inued, though on a s l i g h t l y reduced s c a l e . I nc rea sed a s s i s t a n c e w i l l b e g iven to r e s e a r c h and development, d e n t a l h e a l t h and, f o r the f i r s t t i m e , t o cancer c o n t r o l . Short-term consu l t an t e w i l l b e used i n g r e a t e r numbers.

Promotion of Environmental Heal th

Inc rea s ing a t t e n t i o n cont inues t o b e given t o envi ronmenta l h e a l t h , p a r t i c u l a r l y wa te r s u p p l i e s , r u r a l and urban, and e x c r e t a d i sposa l . The main emphasis has been on r u r a l wa te r supply and t h e programme, which has d i r e c t suppor t from t h e P re s iden t , is a l s o suppor ted by b i l a t e r a l donors ( t h e Nether lands and West Germany) t oge the r w i th UNDP and UNICEF. Urban wa te r supply cont inues t o b e developed and e x t e r n a l a s s i s t a n c e comes from Japan, the USA, A u s t r a l i a , France. t h e UK. t h e Nether lands and Swi tzer land. The I n t e r n a t i o n a l Bank f o r Recons t ruc t ion and Development h a s a s s i s t e d w i th p r o j e c t s i n s e v e r a l c i t i e s . UNDP i s p rov id ing a s s i s t a n c e t o a p r o j e c t on sewerage and s to rmvs t e r d r a inage i n J a k a r t a .

WHO Ass is tance . Ass i s t ance provided i n t h e p a s t t o t h e M i n i s t r i e s of Heal th and P u b l i c Works and E l e c t r i c Power i n t h e form of long-term s t a f f and f e l l owsh ips w i l l b e continued.

HSD 001 Strengthening of National Health Services

To a e e i s t i n planning, programing, monitoring and eva lua t ing hea l th services; i n s s t a b l i s h i n g s reaearch and development progr- concerning h e a l t h care del ivery; i n co-ardinat ing and i n t e g r a t i n g hes l th eervices and improving t h e i r e f fec t iveness and e f f i c i e n c y ; i n s t andard iz ing and i n t e n s i f y i n g t r a i n l n g a c t i v i t i e s f o r h a a l t h s t a f f , and i n p r o m r i n g reviews of pub l i c h e a l t h p r a c t i c e and organizat ion intended t o l ead to t h e optimal de l ive ry of h e a l t h care.

Since 1969, when a master p lan of operat ion wae signed, long-term ~ t e f f and eonmultanta have a s s i s t e d i n s wide range of a c t i v i t i e s , i nc lud ing t h e p repa ra t ion of t h e syllabur, f o r o r i e n t a t i o n couracm i n developing e n a t i o n a l hea l th planning Byate., t r a i n i n g of s e n i o r s t a f f a t both e a n t r s l and p rov inc ia l l eve l s i n hea l th manegemeat and hea l th planning, review of research sub jec t# i n pub l i c heal th , development of protocols f o r s t u d i e s , including b i o m d i e a l s t u d i e s , t o be undertaken by t h e Nat ional Inmt i tu te of Health. Surabaya, preparat ion of t h e h a a l t h component of t h e Second Five-Year Development Plan. and reorganizat ion and s t rengthening of t h e h e a l t h services a t r u e t u r e , including t h e derrelopnent of the Bureau of Neslth Planning. The UHO team w u s t rengthened and re-s t ructured i n 1974 v i t h th ree components inder i t , viz . . h e s l t h planning, research and development, and h e a l t h ca re de l ive ry system - each l ed by a s e n i o r publ ic h e a l t h a d m i n i ~ t r a t o r . This change was accomplished by merging p r o j e c t s Indonesia 0086, "Strengtheninp of Nat ional Health Services", and Indonesia 0126, "National Ins t i tu t . of Publ ic Health. Surabaya", and a plan of operat ion incorporat ing theas changes v u f i n a l i z e d i n November 1974. Assis tance w u a l l 0 given i n t h e e s t ab l i ahaen t of s Health Service. Devalopmnt I n s t i t u t e a t Surabaya. Also i n 1974, two consu l t an t s m a i n r e d i n t h e e s t a b l i a h n n t and s t rengthening of the Bureau of Health Planning and i n t h e preparat ion of a study deaign f o r the developmat of hea l th services .

In 1975, consul tants were provided i n t h e f i e l d s of pub l i c h e a l t h a b i n i s t r a t i o n , h o s p i t a l adminintrr- t i on , haa l th p l a n i n g and evaluat ion; fe l lowships i n pub l i c hea l th , h o s p i t a l adminis t ra t ion and a d i c a l m t a t i s t i c s were a l s o awarded. I n add i t ion , es.istanee was given i n the organizat ion o f courses i n haa l th planning, h e a l t h i n f o n a t i o n eystem, hee l th management and operat ion r.se.rd/aysteme analysis .

I n 1976 snd 1977 consultants i n h e a l t h planning, h e a l t h information aystem, opera t iona l research, e t c . , and fellowshipa i n hea l th planning, h e a l t h n t a t i a t i e s and h o s p i t a l adminis t ra t ion w i l l be provided. Aseistance w i l l a l s o be given i n the organiaat ion of n a t i o n a l courses aiming a t t h e daveloplunt of comprehensive hea l th se rv ices .

I n 1978 and 1979 s i m i l a r aes i s t ance w i l l continue t o be given, bu t t h e n u d e r of long-term staff w i l l be reduced.

INDONESIA


3.1.2 Health Service8 Development

Strengthening of National Health Services

(a) Health Planning

Senior public health administrator P5

Statistician P4 Systems analyst P4 Health economist P4 Clerk-stenographer DJ5


(b) Research and Develo~ment


Systems analyst P4 Management expert P4 Clerk-typist 054


( c ) Health Care Delivery Sygrem


Education apecialist P4 Public health nuree P3 Clerk-typist DJ4


Revised

1976

109 400

9 000 2 600 11 500 2 500

135 000

- 131 000

Prop08als

1978

50 800 50 800

50 800 3 600

---- 156 000

8 000 13 400 4 500 2 500

---- 184 400

----

46 800 46 800

2 400

96 000

8 000 13 300 20 000 2 500

-- 139 800

---

50 800

35 700 2 400

88 900

28 000 22 400 4 500 2 500

---- 146 300 ---- - 470 500

in US

m ri

'

RB

Estimates

1977

48 100 48 100 32 100 48 100 3 100

179 500

10 500 6 600 2 300 2 500

201 400

44 100 44 100 36 100 2 100

126 400

1 500

127 900

(Ezpressed

1979

53 300 53 300

53 300 4 100

164 000

9 000 14 400 4 500 2 500

194 400

49 300 49 300

2 800 --

101 400

9 000 14 500 20 000 2 500

I - 147 400

53 300

37 400 2 800

93 500

31 500 23 900 4 500 2 500

155 900

- 497 700 -

Number of Posts

253

UullrirsJ

Project NO.

HSD 001

1976

1/12 1/12 1/12 1/12 1/12

- 125 600

4 500 2 500

132 600

- 398 600 -

1977

1/12 1/12 11 8 1/12 1/12

48 100

33 900 2 100 - 84 100

10 500 6 600 4 500 2 500

108 200

- 437 500 -

1978

1/12 1/12

1/12 1/12

- ! -

1979

1/12 1/12

1/12 1/12

4 _ 11 2 2/14

1/12 1/12

1/12

3

11 2 2/14

1/12

1/12 1/12

3

31 7 3/26

10

5

11 3 11 3

1/12 1/12 1/12 1/12

4

1/12 1/12 1/12 1/12

4

13

--

4 - 11 2 2/14

1/12 1/12

1/12

3

11 2 2/14

1/12

1/12 1/12

3

31 7 3/26

10

5

- 1 - 11 3 1/12

1/12 1/12 11 9 1/12

---- 4

----

1/12

1/12 1/12

---- 3

---- 11 3 1/12

---- 12

----

INDONESIA

HSD 002 Medical R e h a b i l i t a t i o n

'To a s s i s t i n t h e development of cammunity-oriented i n t e g r a t e d mediee l r e h a b i l i t a t i o n s e r v i c e s end i n t h e t r a i n i n g of t h e necessary h e a l t h and a l l i e d personnel .

A physiotherapy t u t o r was as s igned t o t h e School of Physio.therepy. Solo , from 1963 u n t i l t h e end of 1965 under p r o j e c t Indones ia 0065. A c o n s u l t a n t v i s i t e d Solo i n 1967 and aga in i n 1968 t o e v a l u a t e t h e t r a i n i n g programmes. A f u r t h e r c o n s u l t a n t , provided i n 1968 under SEhRO 0174. " R e h a b i l i t a t i o n of Handicapped Children", s t u d i e d t h e h e a l t h f a c i l i t i e s f a r p h y s i c a l l y handicapped ch i ld r en . I n 1971. ano the r consultant v i s i t e d va r ious i n s t i t u t i o n s a s s o c i a t e d w i t h medica l r e h a b i l i t a t i o n and, i n 1973, a team of t h r e e consu l t an t s (under SEAR0 0174) v l e i t e d Indones i a t o demonst ra te i n t e g r a t e d regimes of t rea tment and s e r v i c e s . S ince 1974, f e l l owsh ips have been awarded f o r t h e t r a i n i n g of n a t i o n a l s t a f f .

Ass is tance under t h i s p r o j e c t , which s t a r t e d i n 1974, was co-ordinated w i t h t h e a c t i v i t i e s of SEARO 0226. "Medical Rehab i l i t a t i on" .

Ass is tance under t h e p r o j e c t i s expected t o cont inue u n t i l t h e end of 1977.

HSD 003 :Strengthening of Heal th Se rv i ce s (Province of I r i a n J aya ) (IMDP INS/731010)

'Yo promote t h e h e a l t h of t h e popu la t i on through t h e development of i n t e g r a t e d h e a l t h s e r v i c e s a t a l l l eve l s as p o r t of t h e socio-economic development of t h e province , w i th p a r t i c u l a r emphasis on the clevelapment of a more e f f e c t i v e and e f f i c i e n t a d m i n i s t r a t i o n of h e a l t h s e r v i c e s i n the province .

This p r o j e c t i s i n con t inua t ion of t h e p r o j e c t wliich had been developed i n 1970, based on t h e reeom- mendations of a consu l t an t i n p u b l i c h e a l t h , who was a member of t h e FUNDWI/UNDP Survey Miasion which v i s i t e d I r i a n Jaya i n 1967. Under t h i s p r o j e c t , s e v e r a l shor t - te rm c o n s u l t a n t s , no t ab ly f o r t h e es tabl i shment of h e a l t h c e n t r e s nu r s ing educa t ion , l abo ra to ry s e r v i c e s , g o i t r e c o n t r o l and urban wa te r supply, v i s i t e d I r i a n J a y a and made r e c o m e n d a t i o n s . A n u r s i n g educa to r and admin i e t r a to r were ass igned from May 1971 t o A p r i l 1973 under p r o j e c t Indones ia 0084, "Nursing Education and Tra in ing ,Province of I r i a n Jaya". A p u b l i c h e a l t h o f f i c e r was as s igned to p r o j e c t Indonesia 0072. "Establishment of Hea l th [:entree, Province of I r i a n Jaya", from June 1972 to June 1973.

S t a f f i n t h e f i e l d s of envi ronmenta l s a n i t a t i o n and r u r a l wa te r supply and h e a l t h educa t ion were provided and a f e l l owsh ip i n t h e f i e l d of p u b l i c h e a l t h a d m i n i s t r a t i o n was awarded. A s s i s t a n c e by way of a San i t a ry Engineer and f e l l owsh ips were provided i n 1975. The p r o j e c t had t o be i n t e r r u p t e d a t the end of Apr i l 1976 due t o l a c k of funds , and i t is hoped t h e p r o j e c t a c t i v i t i e s w i l l r e c o m n c e from 1977.

MCH 001 School Heal th

TO a s s i s t i n developing s choo l h e a l t h s e r v i c e s .

In 1969, a consu l t an t (under SEAR0 0175, "School Health") reviewed t h e s choo l h e a l t h a c t i v i t i e s i n Indonesia. Another ~ o n s u l t a n t , provided i n 1975, a s s i s t e d i n s t r e n g t h e n i n g t h e h e a l t h con t en t ( Inc luding school hea l t h ) of t h e c u r r i c u l a of t e ache r t r a i n i n g c o l l e g e s and schools . A n a t i o n a l workshop on school h e a l t h was h e l d e a r l y i n 1976. The p r o j e c t i e suppor ted by e f e l l owsh ip compa- nen t f o r t r a i n i n g i n d i f f e r e n t a s p e c t s of s choo l h e a l t h .

INWNESIA

Medical R e h a b i l i t a t i o n

Fellowships

S t r eng then ing of Heal th Se rv i ce s (Province of I r i a n Jaya) INS/73/010

Semi t a r y engineer P4 Heal th educa to r P4

Fe l lowships Miscellaneous

3.2 Family Heal th

3.2.2 Materna l and Chi ld Heal th

School Heal th

Short- term c o n s u l t a n t F e l l w s h i p s Grant Supp l i e s and equipment

1976

3/18

1 / 4

11 5

1 /12

Revised

1976

11 700 -

- 15 800

5 500 500

21 800

6 600 800 500 -

7 900 -

Proposa l s

1978

47 400

47 400

69 300 2 000

118 700

1 2 000 9 100

21 100

. ..

e,

3

RB

DP

RB

Est imates

1977

39 500 47 400

86 900

36 300 500

--- 123 700

---

6 600

500

7 100

-- .....- .

- 1979

45 100 800 - 45 900 -

9 500

9 500

Number

1977

1 /24

1 /10 1 /12

--- 1 2 1 ---

4/33

1 /12

- . ~

P r o j e c t NO.

HSD 002

HSD 003

MCH 001

of P a s t s

1978

1 /12

6/63

11 3 1 /12

1979

1

4/41

1 /12

MCH 003 Medical Se rv i ce s f o r Family Hea l th

To a s s i s t i n s t r eng then ing t h e development of an i n t e g r a t e d approach t o t h e de l i ve ry of family h e a l t h s e r v i c e s , w i t h s p e c i a l r e f e r e n c e t o t h e provinces o u t s i d e Java and B a l l .

Provis ion has been made f o r award of annual t r a i n i n g f e l l owsh ips f o r f i v e key p r o v i n c i a l - l e v e l maternal and c h i l d h e a l t h a d m i n i s t r a t o r s from o u t s i d e J a v a I B a l i , who w i l l proceed i n 1976 an a regional obse rva t i on t ou r of J a v a / B a l i , Malays ia , Thai land, P h i l i p p i n e s and Singapore . On t h e i r r e t u r n , they w i l l conduct and co-ordina te a workshop i n Surabaya f o r 20 s e n i o r a d m i n i e t r a t o r s i n which they w i l l d i s c u s s and share t h e i r obse rva t i o s and expe r i ences w i t h t h e i r co l l eagues .

NUT 001 N u t r i t i o n

To a s s i s t i n developing e f f e c t i v e c o n t r o l programmes and i n s t r eng then ing and expanding t h e n u t r i t i o n a spec t s of h e a l t h servlces and t h e t r a i n i n g of s t a f f .

Ass is tance has been provided under Indones ia 0125, "Applied N u t r i t i o n Progr-", in c o l l a b o r a t i o n wi th PAO. UNICEF and WFP. I n l a t e 1973. a team of c o n s u l t a n t s from t h e Maesachusette Institute of Technology, USA, was a s s igned on a c o n t r a c t u a l b a s i s to s tudy t h e p o s s i b i l i t y of developing a n a t i o n a l food and n u t r i t i o n po l i cy .

Ass is tance t o t h e g o i t r e c o n t r o l p r o g r a m i n West I r i a n was provided under Indones ia 0088. "Goi t re Control", and Indones ia 0086.02. "St rengthening of Hea l th Se rv i ce s i n West I r i an" .

Consul tant s e r v i c e s t o improve t h e n u t r i t i o n a l a s p e c t s of t h e p u b l i c h e a l t h programmes w i l l be provided i n 1976. Fe l lowships i n 1976-1977 w i l l b e r e l a t e d t o t h e t r a i n i n g o f n u t r i t i o n i s t s engaged i n hea l th s e r v i c e s ar i n t e ach ing i n medical c o l l e g e s . P rov i s ion f o r c o n s u l t a n t s and f e l l owsh ips is provided i n 1978 and 1979 t o supplement a s s i s t a n c e expected from IBRD.

The p r o j e c t i s expected t o cont inue u n t i l end 1980.

HED 003 Developmnt o f Hea l th Educat ion i n Family Heal th (UNFPA INS171lPO8)

To a e a i s t i n developing h e a l t h educa t ion i n fami ly h e a l t h , i n c l u d i n g cervices, manpover developmant, s t u d i e s , m a t e r i a l and media for h e a l t h educa t ion and o t h e r components of t h e p rog rame , such ae ache01 h e a l t h and fami ly l i f e educat ion .

In 1971, a h e a l t h educat ion consu l t an t a s s i s t e d i n reviewing h e a l t h educa t ion s e r v i c e s a t v a r i o u s l e v e l s of t h e a d m i n i s t r a t i o n and formula ted a p l an f o r t h e f u r t h e r developrent of h e a l t h educa t ion s e r v i c e s t o meet t h e needs of t h e fami ly h e a l t h p r o g r a m . Another c o n s u l t a n t reviewed t h e s t a t u s of h e a l t h educa t ion i n t r a i n i n g p r o g r a m s f o r h e a l t h p r o f e s s i o n a l s . I n each of t h e y e a r s 1971 and 1972, two o t h e r c o n s u l t a n t s reviewed h e a l t h behav iou r - r e l a t ed s t u d i e s so f a r completed w i t h a view t o implement t h e f i n d i n g s . During t h e y e a r s 1972 and 1973, a h e a l t h educa t ion s p e c i a l i a t a s e i s t e d the Health Education Manpower Development P r o j e c t . to develop t h e work expe r i ence and h e a l t h educa- t i o n demonst ra t ion p r o j e c t , p r o v i n c i a l h e a l t h educat ion u n i t e and t h e mH degree p r o g r a m i n h e a l t h educat ion i n t h e School of P u b l i c Heal th , Un ive r s i t y of Indones ia . I n a d d i t i o n , h e he lped t o f u r t h e r develop h e a l t h educa t ion s e r v i c e s a t t h e Min i s t ry of Heal th . I n 1973, two shor t - te rm c o n s u l t a n t s were a l s o provided t o behav iou ra l s t u d i e s and t r a i n i n g programmes r e s p e c t i v e l y . I n 1975-1976. a s o c i a l s c i e n t i s t a s s i s t e d i n t h e f u r t h e r development of behav iau ra l s c i e n c e a s p e c t s of t h e h e a l t h educat ion programme.

In 1976 and 1977, a long-term h e a l t h educa t ion s p e c i a l i s t w i l l a s s i s t t h e Heal th Educat ion D i r e c t o r a t e t o develop f u r t h e r t h e n a t i o n a l h e a l t h educa t ion programme and t o e e t a b l i s h h e a l t h educat ion bureaux i n t h e provinces .

Ass i s t ance t o t h e p r o j e c t i s expected t o t e rmina t e i n 1977.

HMO 001 Medical Education

To a s e i s t i n developing t h e t e ach ing programmes of t h e medical f a c u l t i e s i n keeping w i t h t h e n a t i o n a l needs and t h e p rog re s s of t h e e d u c a t i o n a l sciences.

The p r o j e c t s t a r t e d i n 1964 wi th t h e p rov i s ion o f a v i s i t i n g p r o f e s s o r of physiology t o one of t h e medical f a c u l t i e s . Subsequent ly , v i s i t i n g p r o f e s s o r s i n phyaiology, pharmacology, h i s t o l o g y and embryology and c o n s u l t a n t s i n p r e v e n t i v e and ~ o c i a l medicine, pa thology, p s e d i a t r i c e , o b s t e t r i c s and gynaecolagy were as s igned t o v a r i o u s medica l college-. Fe l lowahips were a l s o provided.

In 1973, a v i s i t i n g p r o f e s s o r of pharmacology was ass igned t o Medan, and, i n 1975, a consu l t an t a s s i s t e d t h e Facu l ty of Medicine of t h e Un ive r s i t y of Indones ia i n curr iculum development. Two long- term p o s t s of medical educa to r s , t o a s s i s t t h e Government w i t h t h e broader a s p e c t s of medica l educa- t i on , i nc lud ing p lanning, w i l l con t inue i n 1976 and 1977, and aga in i n 1978 and 1979.

Ass i s t ance is expected t o cont inue f o r a number of yea r s .

HMD 002 Nursing E d ~ e a t i o n and Services

To develop a funct ional nurs ing se rv ice organizat ion and t o design, demonstrate and eva lua te a nurs ing educat ional system vhich i e responsive t o t h e f e l t needa f o r these se rv ices a t ne:ional and l o c a l level .

Assistance to t h i s p ro jec t s t a r t e d i n 1967 with the award of f e l l a r e h i p s . E a r l i e r . WHO had helped i n the c rea t ion of n nursing d iv ie i an i n t h e Ministry of Health and a l s o wi th educat ional prograrmaes. A fu l l - t ime nurse educator vse ass igned i n Apr i l 1971, s ince vhen the emphasis has been on i d e n t i f y i n g and es t ab l i sh ing a r a t i o n a l nurs ing personnel eystem t h a t served as a guide for the future d e v e l o p ~ n t and u t i l i z a t i o n of nurs ing manparer, improvement and expansion of teaching i n s t i t u t i o n s f o r nurse teachers and the improvement of c u r r i c u l a f o r a l l l e v e l s of nurs ing peraonnel. A revised plan of opera- t ion vas signed i n November/Deeember 1975 which included e t e n t a t i v e p ro jec t ion of a c t i v i t i e s up t o 1980.

I n 197411975, act ion was i n i t i a t e d for conver t ing s e v e r a l e x i s t i n g nurs ing education programen a t t h e aux i l i a ry l e v e l i n t o one progr-, 1 .e . . t r a i n i n g of t h e primary hea l th nurse. Assis tance v i t h o t h e r aspects of nursing education and manpower development continued, and t h e number of long-term educators was increased f rom one to two.

In 197811979, an add i t iona l nurse educator v i l l be assigned t o a s s i s t i n t h e planning, implementation and evaluat ion of t h e large-scale changes i n nurs ing education and se rv ices which w i l l take place during t h i s biennium. Short-term consu l t an t s w i l l be provided f o r s p e c i a l s t u d i e s and formulation of methods, and f e l l a r s h i p s v i l l be provided f o r advanced preparat ion of n a t i o n a l nuraes t o take over the work of the WHO nurse educators.

Assistance to t h i e p r o j e c t i a expected t o continue u n t i l 1980.

HMD 003 Post-graduate Education i n Publ ic Heal th

TO a s a i e t i n f u r t h e r developing t h e teaching and t r a i n i n g p r o g r a m s conducted by t h e School of Publ ic Health. University af Indonesia.

A medical educator i n t h e f i e l d of medical s t a t i s t i c s and epidemiology under Indonemie 0062 (IN0 HW 001). "Medical Education", was assigned t o vark with the Univers i ty of Indoneaia (Faculty of Uedicine) i n the beginning of 1974.

Fellovships were provided f a r t h e teaching s t a f f of t h e Faculty of Publ ic Health t o v i s i t i n s t i t u t i o n s outs ide Indonesia.

In 1975 a consul tant a s s i s t e d the Facul ty of Pub l i c Health i n curriculum improvement and i n the t r a i n - ing of s tudents i n a course majoring i n hea l th education. Another eonaul tant i n h o s p i t a l adminis t ra t ion vaa assigned t a ra rds t h e end of 1975.

In 1976 w d 1977 fe l lovsh ips have been provided f a r s t u d i e s i n Aus t ra l i a . Similar f e l l w a h i p s have been proposed i n 1978-1979.

Proposals have a l s o been made f o r provieion of t h e long-term post of medical educator (publ ic heal th) i n 197811979 and f o r provis ion of consu l t an t s from 1976 through 1979.

Assistance is expected to continue f o r a rider of years .

HMD 008 Resources f o r Family Health (UNFPA INSl71lP08)

This p ro jec t w i l l terminate i n 1976.

260

INDONESIA

ESD 002 Reeearch i n Communicable Diseases Ecolag)!

To a s s i s t i n t h e design, organizat ion and analyaie of biomedical s tud ies .

Since 1974, an eco log i s t has been a s s i s t i n g wi th t h e design of s t u d i e s t o i n v e s t i g a t e the impact of changing pa t t e rns in the community on hea l th . S t e t i t l t i c a l se rv ices were provided from IN0 SHS 001 u n t i l s s t a t i s t i c i a n was provided t o t h e p r o j e c t i n e a r l y 1976.

Provision f o r consul tants and fe l lowships has been made i n 1976 and 1977, and these are continued through 1978 and 1979. The two long-term s t a f f members are continued through 1979.

ESD 003 Strengthening of Epidemiological Survei l lance end Control

To a s s i s t i n the development, organizat ion, impl rmnte t ion and aseesement of the s u r v e i l l a n e s and control of communicable d i seases .

This p m j e c t is t h e r e e u l t of t h e merger of Indonesia 0091, "Strengthening of Epidemiological Servicel", and Indonesia 0099. "Plague Epidemiology". Under the former p r a j e c t , an epidemiologist, a s t s t i s t i c i s n and consul tants a a s i s t e d i n conducting n a t i o n a l seminars on epidemiological su rve i l l ance . developing s t a t i s t i c a l f a c i l i t i e s , and i n s p e c i f i c f i e l d s such as epidemiology, su rve i l l ance and t ra ining,epideaio- logy and con t ro l of cho le ra , schia tosomiaais con t ro l , yaws e rad ica t ion , evaluat ion of lung-diseaaes programme and denguelhaemorrhagic f eve r con t ro l . Also, f e l loush ips and supp l i e s and equipment have been provided t o s t rengthen the a c t i v i t i e s . Under the l a t t e r p r o j e c t , consul tants and an animal ecalo- g i s t a s s i s t e d i n a t rengthening su rve i l l ance and i n s tudying t h e environmental and eco log ica l condition@ i n t h e plague-affected areas, and i o s e c t i c i d e a and equipment have been provided. In 1975 t h e epidenio- l o g i e t from Indonesia 0091 was t r ane fe r red t o t h i s p ro jec t .

I n 1976 and 1977 consul tants w i l l a s s i s t i n s p e c i f i c f i e l d s , including plague epidemiology, and Eellou- ships w i l l be provided i n these s p e c i a l t i e s . I n 1978 and 1979 an entomologist w i l l be provided; The p ro jec t w i l l absorb p r o j e c t ESD 004. "Immunization Services , including Smallpox", end VPH 001, Veteri- nary Publ ic Health", from 1978 onwards.


To a s a i s t i n t h e con t ro l of malaria i o t h e e n t i r e country and its eventual e rad ica t ion , wi th s p e c i a l emphasis on Java and Bali and p r i o r i t y areas of socio-economic importance aa we l l aa on t ransmigrat ion p ro jec t s i n o the r i e l ands as an i n t e g r a t e d a c t i v i t y of t h e general h e a l t h se rv ices .

WHO ass i s t ance to malar ia con t ro l began i n 1951 and was extended to t h e e rad ica t ion programe, which was launched i n 1959. Sa t i e fac to ry progress waa made i n Java and Bel i up t o 1964. In 1965. the melar ia s i t u a t i o n de te r io ra ted on account of t h e diecontinuance of US AID ass i s t ance and o t h e r reasons. The Ministry of Health was reorganized i n 1967 and i n t e g r a t i o n of t h e malar ia programme with t h e general hea l th se rv ices i n t h e province8 was completed i n 1968. An assessment was c a r r i e d out by e j o i n t WHO1 US AID team i n 1972. US AID aae i s t ance was made a v a i l a b l e from 1975 f o r a period of f i v e years.

In 1976 and 1977 WHO s t a f f f o r t h e p r o j e c t cons i s t s of a ma la r io log i s t , two malsriologietslepidemia- l o g i a t s , two entoroologiats, and a t r a n s l a t o r - t y p i s t . Provis ion haa a l s o been made f o r f e l lovsh ips . supp l i e s and equipment and subsidy.

I n 1978 and 1979, the WHO s t a f f w i l l be reduced to four - a m a l a r i o l u g i s t , an epidemiologis t , an entomologist and s t r a n s l a t a r - t y p i e t - with provis ion f a r fellowships and supp l i e s and equipment.

INDONESIA

MPD 002 Malaria Control (Province of I r i a n Jaya) (UNDP INS/73/009)

To a s s i s t i n the con t ro l of malaria i n I r i e n Jaya, with s p e c i a l emphasis i n and e romd urban development centres .

A FLRIDWI/LlNLIP Survey Mission i n l9h7 recognized t h e importance of r eac t iva t ion of malaria con t ro l programme in the province. A WHO/FUNDWI ass i e t ance team v i s i t e d I r i a n Jaye i n 1970 and on Its reconmendation t h e con t ro l programme was reorganized and reac t iva ted . PUNDWI a a s i s t a d t h e programre with suppl ies and equipment up to 197311974,

Under an Agreemnt between t h e Government and UNDP, signed i n 1974, WHO, as t h e execut ing agency. assigned a team t o aasees t h e malar ia con t ro l a c t i v i t i e s and advise on t h e f u t u r e plan of work.

Assistance t o the proJcct cons i s t s of a t echn ica l o f f i c e r , aesignad i n 1975, and provis ion for fellowahips and supp l i e s and equipment.

SPI 001 llmnuniaation Services ( Including Smallpox)

To i n i t i a t e and develop gradual ly i m u n i z a t i a n se rv ices against d iph the r i a , t e t anus , per tusdin and pol iomyel i t i s according t o na t iona l p r i o r i t t e e i n addi t ion t o t h e e x i s t i n g progreJI.0 a g a i n r t amallpox and tuberculoaie .

Irmnunisstion w i l l s t a r t i n areas where t h e l o c a l a u t h a r i t i e s a re w i l l i n g t o bear t h e l o c a l cas t s . vaccine and t echn ica l guidance being provided by t h e Centra l Government. Trained s t a f f of the emallpox e rad ica t ion and BCG campaigns w i l l a s s i s t the programme, which w i l l be gradual ly extended; o t h e r heal th s t a f f w i l l be used ae appropr ia te . Pellowships and one consul tant are provided i n 1976 and 1977. Assistance from UNICEF and US AID i s expected. From 1978 onwards the p ro jec t w i l l merge wi th ESD 003, "Strengthening of Epidemiological Survei l lance and Control".

B V D 001 Tuberculosis Control

TO a s s i s t i n t h e i n t e g r a t i o n o f BCG vaccinat ion v i t h o u t p r i o r tubercul in t e s t i n g i n t o t h e work of the maternal and c h i l d h e a l t h c l i n i c s and regency po lyc l in ic s , i n t r a i n i n g a t a f f engaged i n case-findine by micraeeopie sputum examination, and i n providing a h u l a t o r y treatment.

Assistance began i n 1961. An urban p i l o t a r e a p r o j e c t i n Jog jaka r t a van gradual ly extended as a service programme t o cover t h e whale of t h e c i t y . In 1964, a s i m i l a r p r o g r a m ma. i n i t i s t a d i n Surabeya m d a r u r a l p i l o t p r o j e c t was s t a r t e d i n Halsng, East Java. A seminar i n tube rcu los i s con t ro l was held i n 1969 and, i n 1970, a consul tant i n pub l i c hea l th nurs ing a s s i s t e d wfth a t r a i n i n g pm- g r a m i n BCG vaccinat ion. Also, a medical consultant wan assigned i n 1970, 1971 and 1972-1973. I n addi t ion to a s s i s t i n g n a t i o n a l seminars i n 1971 and 1973, t h i a consul tant reviewed t h e BCG vaccinat ion progranrme and advised on its f u t u r e planning and organizat ion. Similar consul tant s e r v i c e s were provided i n 1974 and are continued i n 1976 and 1977. Pellowehips ere provided t o n a t i o n a l e t a f f t o a t t e n d t r a in ing courses. Prom 1978 a s s i s t a n c e may be provided under ESD 003,"Strengthening of Epidamioloaie.1 Survei l lance and Control".

BM 002 Leprosy Control

To a s a i e t i n organizing a training-cum-demonstration a rea i n leprosy con t ro l .

Assistance hes been given m d e r t h i s p r o j e c t i n 1955, 1956-1967 and 1969-1970. I n 1974, wi th t h e help of t h e Danish "Save t h e Children" Fund, t h e Governuent i n i t i a t e d a p r o g r w f o r devaloping a t r a in lng- cum-demonstration a rea f o r t h e t r a i n i n g of n a t i o n a l a t a f f i n leproay c o n t r o l techniques. One long-term l e p r a l o g i a t has been provided from 1974 t o 1976 and again from 1978 onwards.

Assistance t o t h i s p r o j e c t is expected t o continue f o r some years.

INDONESIA ~ . . . ,. . . . . 8 . , . ~~. . . . ..

B M 003 Campaign f o r Control of Yaws i n Sub-District of North Horotai

Unobligsted balance a v a i l a b l e f a r 1976 out of voluntary fund f o r Health Promotion Allocat ion.

VPH 001 Veterinary Publ ic Health

To a a s i a t i n t h e study of major zoonases and i n the t r a i n i n g of ve te r ina ry pub l i c hea l th off icsrm.

The pro jec t i a a fol lar-up of assistance provided under t h e in ter-country p r o j e c t SEAR0 0168,"Training i n Veterinary Publ ic Health and P r o m t i o n of Veterinary Publ ic Heal th Services". I n 1972 and 1973, consul tants a s s i s t e d i n launching, expanding and s t rengthening t h e n a t i o n a l ve te r ina ry pub l i c hea l th pragrmme. Similar a s s i s t ance is t o be provided i n 1977. Fellowships w i l l be awarded durinn 1976 and 1977. From 1978 a s s i a t m c e may be provided under IN0 ESD 003.

CM 001 Cancer Control

To a a s i s t i n organizing a na t iona l cancer con t ro l programme, i n t r a i n i n g h e a l t h and a l l i e d paraonnel i n cancer con t ro l , i n s t rengthening t h e se rv ices f o r t h e e a r l y de tec t ion , diagnaaia, treatment and r e h a b i l i t a t i o n of cancer p a t i e n t s , and i n epidemiological inves t iga t ions and h e a l t h education t a r the prevention of cancer.

I n 1977, two consul tants w i l l a s s i s t i n t h e conduct of a n a t i o n a l vorkshap on t h e epidemiolopy of cancer and cancer con t ro l . Fel lovshipe w i l l be awarded f o r aen io r surgeons. phyaieians m d patha- 10gi.t. t o observe r ecen t t r ends i n t h e management of cancer. S imi la r a sa ia t anea w i l l continue Ulrouh 1978 and 1979.

ORH 001 Oral Health (UNDP INSl681038)

To a s s i s t i n planning f u r t h e r d e n t a l a c t i v i t i e s , i n s t rengthening den ta l hea l th se rv ices v i t h i n t h e framework of t h e hea l th se rv ices , and i n promoting den ta l hea l th research.

The p ro jec t s t a r t e d i n 1968, when a consul tant reviewed den ta l education and den ta l hea l th servicea . I n 1970-1971, another consul tant a s s i s t e d i n t h e teaching of pub l i c h e a l t h and s o c i a l d e n t i l t r y a t t h e Dental Faculty i n Bandlmg. I n 1971-1972,s f u r t h e r consul tant advised on t h e planning of a n a t i o n a l system of den ta l educat ion, and i n 1972, t h e same consul tant helped with t h e f u r t h e r t r a i n i n g of den ta l personnel and i n t h e improvement of d e n t a l education. I n 1973, t h e development and teaching of periodontology i n den ta l institutions received ass i s t ance from a f u r t h e r conaul tant . The next year. a team a f consul tants helped with t h e p repa ra t ion of a long-term programme f o r t h e s t rengthening of den ta l h e a l t h se rv ices and t h e promotion of epidemiological research. In 1976, consul tant se rv ices w i l l be provided t o a s s i s t with t h e var ious aspects of d e n t a l education and den ta l h e a l t h se rv icea wi thin the framework of t h e h e a l t h se rv ices . I n 1977, fe l lowships w i l l b e awarded i n r e l a t e d spec ia l - t i e s . These are continued through 1978 and 1979.

INDONESIA

MIH 001 Mental Health

To a s a i a t i n t r a in ing medical, nurs ing and a l l i e d h e a l t h personnel f o r community-oriented rmntal hea l th se rv ices wi thin t h e framework of comprehensive h e a l t h ae rv icea , i n s t rengthening psychiatry se rv ices , including r e h a b i l i t a t i o n , and i n epidemiological i n v e s t i g a t i o n s of mental i l l n e s s .

In 1973, a consul tant under an in te r - reg iona l p r o j e c t (0308) v i a i t e d Indonesia t o assess the s t a t u s of r e n t a l hea l th . I n 1974, fellowships were provided f o r t h e t r a i n i n g of p s y c h i a t r i c teachers and adminis t ra tors . Fel lovships w i l l be awarded t o j m i o r ~ p e c i a l i s t a f o r f u r t h e r t r a i n i n g i n sub- s p e c i a l t i e s and a consul tant w i l l advise an t h e development of delegated armbulatory ca re by nuraes and a u x i l i a r i e s working i n r u r a l arena. In 1977, t h e f u r t h e r development of community-based c a r s and manpower t r a i n i n g w i l l be a s s i s t e d by the award of fe l lovahipa and provis ion of s conmultant wi th experience i n s e v e r a l spec ia l i zed ares.. including c h i l d psychiat ry and mental r e t a rda t ion , psycho- therapy and behaviour therapy, and alcohaliam and drug dependency. This programme of support w i l l continuc through 1978 end 1979 with t h e f u r t h e r aim of promoting in-service and re f reshe r t r a in ing , and t h e teaching of simple mental h e a l t h p r i n c i p l e s t o ~ p e r m d i c a l and o t h e r cornuni ty workers.

The project i e expected t o continue f o r a number of yeara.

RAD 001 Radiation Health

To e a s i e r in developing a n a t i o n a l r ad io log ica l h e a l t h p ro tec t ion s e r v i c e ; i n e s t a b l i s h i n g a n a t i o n a l r e d i c a l physics se rv ice and i n s t rengthening t r a i n i n g s e r v i c e s and raaearch i n r ad io log ica l sc iences i n medical f a c u l t i e s and r e l a t e d h e a l t h i n s t i t u t i o n s .

I n 1972, auppl ies and equipment were provided f a r i n i t i a t i n g a f i l m badge monitoring se rv ice . I n 1973. a consul tant under SEARO 0042, "Radiation Health", a s s i s t e d i n organizing a p i l o t f i l m badge se rv ice i n Jaka r t a . Another consul tant assisted, i n 1974, i n f u r t h e r developing r a d i a t i o n p ro tec t ion se rv ices .

I n 1975 and 1976, fe l lowships were provided f o r t r a i n i n g i n r ad io log ica l physics , radiotherapy, radia- t ion p ro tec t ion and nuc lea r medicine. A consultant i n r ad io log ica l h e a l t h p ro tec t ion and nuclear medicine v i l l be assigned i n 1977. Assistance w i l l a l s o be provided i n 1978 and 1979 through fe l lovships and eonsultaney se rv ices .

RAD 002 Training of X-ray and Electro-medical Technician (UNDP INS/72/029)

To a s s i s t i n t r a i n i n g radiographers and e lect ra-medical technieiana i n t h e i n s t a l l a t i o n , uae, maintenance and r e p a i r of electro-medical equipment.

I n 1962, e consul tant under SEARO 0041, "Training of X-ray Technicians", a s s i s t e d wi th Qlana f o r e s t a b l i s h i n g a school f o r X-ray technicians . The school was s e t up i n 1966 and an X-ray engineer was assigned. A school f o r t h e t r a i n i n g of radiographers was s e t up i n 1970, and a t u t o r radiographer has been assigned s i n c e t h a t year . An eleetro-medical engineer a l l 0 a s s i s t e d i n the es tab- lishment of B school f o r the t r a i n i n g of electro-medical techniciane.

In 1974, the t u t o r radiographer and t h e electro-medical engineer continued t o he lp wi th t h e t r a i n i n g of radiographers and electro-medical t echn ic ians i n t h e r e spec t ive academies. Pel lovshipe ue re awarded f o r t h e t r a i n i n g of t u t o r s from t h e academies.

In 1975, f e l l w s h i p provis ion was continued i n o rde r to enable t h e candidates t o complete t h e i r t r a i n i n g abroad.

UNDP sae i s t ance t enn ina tes i n 1977.

268

INDONESIA

HUP 001 Developmmc of Centra l and Repiunsl Occupational Health and Indus t r i a l Hygiene Laborator ies (UNDP INS/72/028)

To a s s i s t with the f u r t h e r development of t h e National Institute of Occupational Health. J aka r t a , and regional centres .

A consultant was provided f o r t h r e e weeks i n Apr i l 1970 to undertake a f e a s i b i l i t y study of a p r o j e c t i n occupational heal th . Another consul tant was assigned i n September 1970 f o r a per iod of s i x months t o a s s i s t the Government i n f u r t h e r s t rengthening t h e country 's occupat ional hea l th se rv ices and i n preparing e request to t h e UNDP f o r t h e development of a p r o j e c t i n t h i a f i e l d . A consul tant a s s i s t e k the project i n March 1973 i n the f i n a l i z a t i o n of t h e p ro jec t request .

In 1974 and 1975, the P ro jec t Manager (occupational hyg ien i s t ) aaa i s t ed i n s t rengthening the National I n s t i t u t e of Occupational Health. J a k a r t a , and i t s regional cen t res and i n conducting courses f o r d i f f e r e n t groups of personnel. For t h e personnel working a t t h e National I n s t i t u t e and t h e r eg iona l centres f e l l m s h i p a have been provided i n t h e f i e l d a of occupational h e a l t h and hygiene, industrial hygiene chemistry, occupat ional and mine s a f e t y , occupat ional hea l th nurs ing and ins t rumentat ion. ILO has been designated as Associated Agency f o r implementation of occupat ional s a f e t y aapects of t h e p ro jec t ( i . e . , a long-term post and none fe l lowships) .

Assistance t o t h e p ro jec t is expected t o continue u n t i l 1978.

PHA 001 g u s l i t y Control of Food end Drugs

To a s a i s t in dra f t ing l e g i s l a t i o n t o cover t h e q u a l i t y con t ro l of food and drugs; t o advise on t h e impravemant of t h e c e n t r a l q u a l i t y con t ro l l abora to ry , and t o t r a i n personnel.

I n 1969. two consul tanta , a pharmaceutical chemist and a mierobiologia t (provided under SEAR0 0154. "Quality Control of Biological and Pharmaceutical Products"), reviewed t h e e x i s t i n g l e g i s l a t i o n and laboratory competence i n q u a l i t y con t ro l . I n 1973, a pharmaceutical chemist a e s i s t e d with s h o r t coursea f o r drug inspectors . I t i s planned t o provide consu l t an t s t o s t rengthen q u a l i t y con t ro l l abora to r i e s fu r the r , t o t r a i n personnel and t o review end rev i se the l e g i a l e t i o n as necessary. Fe l l a r sh ips w i l l be provided t o cover the f i e l d a of chemical ana lys i s . chromatography and drug qua l i ty control . This a s s i s t ance is continued t h r o u a 1978 and 1979.

BLG 001 Vaccine and Sera Production (UNDP INSI681036)

To a s a i s t i n improving methods of producing b a c t e r i a l and v i r a l vaccines, ant i - toxins and to ro ids and a l s o t o a s s i ~ t i n developing c a p a b i l i t y i n t h e q u a l i t y con t ro l of vaccines and s e r a .

In 1970, a consul tant a s s i s t e d t h e Biofarma. Bandung, i n changing i t s DPT vaccine production methodology by the use of a batch fermentor "Bilthoven Unit". Also, a consul tant and a f e l l a r e h i p were provided t o study t h e f e a s i b i l i t y of producing freeze-dried BCG vaccine and i t s q u a l i t y con t ro l . I n 1971, m o t h e r consul tant engineer helped c o d s s i o n i n g a large-volume cen t r i fuge provided by UNICEF and a biomedical consul tant i n 1972, a s s i s t e d i n c o d a s i o n i n g the fermentor f o r t h e r egu la r produc- t ion of DPT and o t h e r b a c t e r i a l vaccines.

In 1973, following upon the e e s e s e m n t of s consul tant t h e p r o j e c t r e v i s i o n wan f i n a l i z e d i n Apr i l 1974, providing f o r increased UNDP inpu t s f o r developing t h e capaci ty of t h e Biofarma I n s t i t u t e i n the production of freeze-dried BCG vaccine. The rev ia ion a l s o provided t h e b a s i s f o r the development of v i r a l vaccines. I n 1974 a consul tant advised on t h e f e a s i b i l i t y of condi t ioning o r a l p o l i o vaccine from bulk aupp l i e s imported i n concentra ted form and i n 1975 through a r epea t v i s i t of t h e consul tant , consistency was e s t ab l i shed i n t h e production of f reeze-dr ied BCG vaccines.

The a c t i v i t i e s of t h e p r o j e c t have been co-ordinsted wi th the r e l a t e d country and inter-count ty p ro jec t s .

The p r o j e c t continues up t o 1977.

UB 001 Laboratory Services

To a s s i s t i n s t rengthening hea l th laboratory se rv ices .

As.istance t o t h e p r o j e c t a t a r t e d i n 1967. I n 1968, a consul tant a s s i s t e d i n planning t h e r e h a b i l i t a - t i on of p rov inc ia l l abora to r i e s and t h e es tabl ishment of pe r iphe ra l l abora to r i e s . A microbiolagie t and a laboratory technician were ass igned i n 1970 end a v i r o l o g i s t from 1971. In 1972-1973, bacterio- logy and virology departments were e s t ab l i shed i n t h e Cen t ra l Pub l i c Health Laboratory, Jaka r t a . I n 1974, aaais tance was given i n t h e design and operat ion of a r e f e r r a l laboratory s e r v i c e f o r work on the su rve i l l ance of s p e c i f i c communicable diseases. The p r o j e c t , which haa provided eupport t o t h e e tud ies of plague m d e r Indonesia 0099. "Plague Epidemiology". a l s o co-ordinarea i t s a c t i v i t i e s wi th Indoneais 0081, "Smallpox Eradication", Indonesia 0091, "Strengthening of Epidemiological Services", and the inter-country p r o j e c t SEAR0 0159. "Health Laboratory Services".

UWICEP provides suppl ies and equipment t o p rov inc ia l and kabupaten l abora to r i e s .

In 1974, 1975, 1976 and 1977, t h e fe l lowships have been r e l a t e d t o the t r a i n i n g of t u t o r technicians , advanced t r a i n i n g i n laboratory technology and pub l i c hea l th microbiology.

In 1976-1977, t h e p r o j e c t w i l l b e a s a i s t e d by a laboratory t echn ic ian and a food b a c t e r i o l o g i s t . In 1977, f i v e n a t i o n a l courses, each of th ree veeke' du ra t ion , w i l l be conducted f o r t r a i n i n g technician. i n r u r a l l abora to r i aa . I n 1978 and 1979 provis ion ha. been made only f o r t h e tvo long-term pasta . together with consultancy s e r v i c e s and f e l l w a h i p a .

BSH 001 National Cornunity Water Supply and S a n i t a t i o n

To a s s i s t i n providing community water supply and s a n i t a t i o n f a c i l i t i e s i n both r u r a l and urban areas and i n the t r a i n i n g of personnel.

A s a n i t a r y engineer was assigned i n 1969 to he lp i n the developllrnt of a r u r a l water supply and sani- t a t i o n p r o g r a m ; m o t h e r was appointed i n 1973 t o help wi th t h e development of urban water supply and s a n i t a t i o n . A s a n i t a r i a n was ass igned i n 1974. The provis ion of t h e two s a n i t a r y engineer0 and one s e n i t a r i a n continues i n 1976-1977. I n add i t ion , short-term consu l t an t s i n food s a n i t a t i o n and r u r a l water supply design w i l l b e provided i n 1976 and i n 1977 f o r t h e review and evaluat ion of r u r a l end urban water supply a. wel l as environmental poplut ion programnee. Fs l l avah ips i n p o r t h e a l t h were provided i n 1974 and f a r post-graduate s t u d i e s and shor t o b ~ e r v a t i o n tour s i n environmental hea l th w i l l be swarded i n 1976-1977. Similar aas i s t anee is continued through 1978 and 1979.

The programme receives considerable support from UNICEF end b i l a t e r a l donors.

PIP 002 Jaka r t a Sewerage Uaster Plan (UWDP INS1721068)

To a s s i s t i n t h e preparat ion of a master p lan, covering a l l aspecta of sewerage, dra inage and s m i t a - t i o n i n Jaka r t a , and t o develop a t r a i n i n g pragranae for personnel concerned wi th the technical . management and f i n a n c i a l aapecte of sewerage i n Jaka r t a .

I n October 1972, two s t a f f nmbers from WHO Headquarters v i s i t e d Indonesia t o study end sasesa t h e sewerage situation i n t h e c i t y of J a k a r t a and its environs , and t o a s a i s t t h e Governmnt i n prepar ing a p ro jec t document for UNDP a s s i s t a n c e i n t h e drawing up of a master p lan and t h e f i r s t s t a g e pro- g r a m f o r severage and s a n i t a t i o n .

A s a n i t a r y engineer i s assigned t o a c t a s a p ro jec t manager. The major engineer ing work is e n t r u s t e d t o a consul tant engineer ing firm. Training of n a t i o n a l counterpar ts is a major component of t h e p ro jec t .

INDONESIA

PIP 003 Rural Water Supply Pro jec t . East Java Province (UNDP INS/73/003)

To a s a i s t i n t h e development and implerenta t ion of a planned r u r a l water eupply progrecnne f o r the Eaat Java Province.

I n 1973, a preparatory a s s i s t ance requeet to UNDP was prepared i n order t o formulate, i n d e t a i l , a p ro jec t d o c w n t . A preparatory a s s i s t ance tealn consisting of s a n i t a r y engineers and short-term consul tants i n economice and hydrogealogy i s provided i n order t o prepare t h e document and to provide a nucleus of e x p e r t i s e f o r en eventual f u l l - s c a l e p r o j e c t , s u b j e c t t o a v a i l a b i l i t y of funds.

The preparatory work was commenced i n 1975 and i s expected t o l a s t till e a r l y 1977.

CEP 001 Hazards to Man fram Pes t i c ides

To 888is t i n formulating l e g l a l a t i o n on hazards t o man from p e s t i c i d e s i n use i n a g r i c u l t u r e ; t o t r a i n laboratory workers i n determining cho l ines te rase l e v e l s ; t o a a s i a t f u r t h e r s t u d i e s t o determine the s i z e of t h e problem.

Following a preliminary broad study of t h e s i t u a t i o n i n 1969 by a consul tant , two f u r t h e r consul tants were provided i n 1970 - one t o a s a i s t w i th the t r a i n i n g of laboratory s t a f f and another wi th the pre- pa ra t ion of l e g i s l a t i o n . I n 1973, a consul tant v i s i t e d appropr ia te l abora to r l ea t o a a n i s t i n strengthening pes t i c ide p ro tec t ion teams and i n guiding t h e members of t h e P e s t i c i d e s Co-ordination Comrtttee i n the enforcement of t h e Gowrnmente' decree on p e s t i c i d e s . Fur ther coneul tant s e r v i c e s are planned f a r 1978, together with fellowehips and supp l i e s and equipment i n 197811979, The p r o j e c t a l s o receives a s s i s t ance fram US AID.

SES 001 Training i n San i t a ry Engineering

To provide, on request , a s s i s t ance i n s a n i t a r y engineer ing t r a i n i n g t o t h e I n s t i t u t e of Technology, Bandung, end t o o the r i n a t i t u t i o n a .

A consul tant was provided i n 1968 and another i n 1970-1971. Between 1972 and 1975, e profeaeor of s a n i t a r y engineer ing a s s i s t e d the Institute i n the development o f s regular training progranw i n thia f i e l d . Since then, t h e I n s t i t u t e has needed only consul tant aervicea t o develop coursea i n a p e e i a l i r e d d i s c i p l i n e s of ean i t a ry engineering. Accordingly, ahart-term v i a i t i o g professors i n s p e c i a l s u b j e c t s w i l l be provided i n 1976-1977 and fe l lovsh ipa w i l l be offered f o r post-graduate atudy i n food san i t a - t ion as wel l as f o r s h o r t observation s t u d i e s for teaching e t s f f .

The p ro jec t w i l l continue u n t i l t h e end of 1977.

273

IEcpreased in US Dollars)

0

DP

RB

RB

-

Project NO.

PIP 003

CEP 001

SES 001

, INDONESIA

Rural Water Supply Pro jec t , East Java Province

INS/73/003

Project manager P4 Sani tary engineer P4

Short-term consul tant Supplies and equipment Miscellaneous

6.1.4 Control of Environmental Pol lut ion and Hazards

Hazards t o Man from Pest ic ides

Short-term consultant Fe l lwsh ipe Supplies and equipment

6.1.5 Establishment and Streng- thening of Environmental Health Services and I n s t i t u t i o n s

Training i n Sani tary Engineering

Short-term consul tants Pellovships Supplies and equipment

Proposals

1978

12 000 5 200 1 000

1 8 200

1979

5 600 1 000

6 600

Revised

1976

94 800

9 100 12 800

116 700 -

5 200 1 000 -

6 200

-

27 000 16 300 1 000

44 300 -

Number of Posts Estimates

1977

5 100 31 200

36 300

2 200 1 800

40 300 -

31 500 16 300 1 000

48 800 -

1979 1976

1/12 1/12

2

1/ 2

2/ 6

3/ 9 3/22

1977

11 1 1/ 8

-- 2

--

1978

3/ 9 3/22

, 1/ 3 1/ 6 11 6

27 7

MALDIVES - Index

Male, the cap i ta l of the country. has m e hospi tal with 52 beds and e heal th cen t re which provides iPlnunization services and out-patient c l i n i c s . The Allied Health Training Centre gives t raining courses f o r community heal th workers, nurse aide rmd t r a d i t i o n a l midwives (fool-). Male based heal th services a r e provided to the a t o l l s i n the f i e l d of f i l e r i n s i s , tuberculaais and leprosy control. Health centres have been established i n a t o l l s with heal th easis tante i n charge of the servicee.

There are only f i v e medical o f f i c e r s s tat ioned in Male f o r the e n t i r e population and there a r e no qual i f ied medical o f f ice rs i n the a t o l l s .

strengthening of Health Services

WHO assis ted in providing coneultants in d i f fe ren t spec ia l t i es . So f a r a s p e c i a l i s t paed ia t r ic im, a team of surgeons and an anaeathet is t , a pathologist, heal th educator and s p e c i a l i s t s on leprosy, tuberculosis, den t i s t ry , dermatology, e tc . heve v i s i t e d Maldives. Long-term s t a f f members have a l so been assigned t o a s s i s t with the health services. There e r e a f e w qual i f ied nuraes working i n the hosp i ta l and aeassieting the t ra in ing of nurse aides and camunity heal th workers. Health ass i s tan te (present s t rength: 31) man the heal th centrea i n a t o l l s ; the only aux i l i a ry s ta f f working outside Male.

Health Manpower Develoment

WHO ass i s ted i n the t ra in ing of nuraes end auxi l iary health pereonnel (comnunity heal th workers end nurse aids) .


Anti-malaria a c t i v i t i e s have been responsible f o r the successful control of spreading of the disease, which is now reduced t o a few c l i n i c a l cases.

Crude death and infant mortal i ty r a t e s are high. s ince the population is exposed t o a variety of endemic diseases. Diarrhoeal d i s u s e s , tubarculoair , leprosy, f i l a r i a s i s , te tanus, dsnsue /haru l r rha~ic fever , p o l i e myeli t is , in fec t ive hepat icia , meesles and chicken-pox a r e camonly seen. Diarrhoea1 diseases a r e very c-n and b r e d out i n epidemic form. Typhoid is widespread, but diagnosis is d i f f i c u l t due t o lack of laboratory f a c i l i t i e s .

WHO provides personnel and supplies f o r malaria eradicat ion and a s s i s t s i n the con t ro l of highly prevalent cmmmicable diseases.

Malnutrition amongst children is one of the chief causes of diseases due to vitamin B deficiency and of i ron deficiency anaemia.


Environmental conditions contr ibute to a la rge extent t o the prevalence of en te r ic diseases. Excreta disposal d i r e c t l y i n t o the s o i l , i n a s p e c i a l t o i l e t i n the house cmpound where the welle are a t c lose proximity, leads t o contamination of ground water.

Assistance i a being provided by UNDP-funded WHO pro jec t s f o r s a f e water and severage disposal i n Male and i n the a t o l l s . Maldives water and san i ta t ion au thor i t i es have been ass i s ted in management services.

Maldives a t present receive assis tance from WHO, UNDP, UNICEF and other b i l a t e r a l sources f o r strengthening the heal th delivery system.

280

MALDIVES

HSD 001 Publ ic Health Mmin i s t r a t ion

TO a s s i s t i n developing comprehensive h e a l t h se rv ices , i n promoting manpower development and i n s t rengthenin@ medical ca re se rv ices , wi th p a r t i c u l a r enphasis on the c o n t r o l of endemic d i seases of s o c i a l and economic importance.

Since 1959. a team coneie t ing of a publ ic hea l th o f f i c e r (up t o 1975). a nurse (up t o 1969). a sani- t a r i a n and a laboratory technician hse been provided, end a number of consul tants have given advice i n the f i e l d s of malar ia , t ube rcu los i s , f i l a r i a s i s , leprosy, environmental hea l th , s a n i t a r y engineering, hea l th education, entomology and physiotherapy, as we l l as on t h e t r a in ing of community hea l th workers. I n most of these f i e l d s . t he re have been follov-up v i s i t s by o the r coneul tante . During 1974. 1975 and 1976 consu l t an t s were assigned i n var ious r e l a t e d f i e l d s : hea l th education, leprosy, malar ia , physiotherapy, i n s t a l l a t i o n of X-ray u n i t , surgery, anaesthesiolagy, laboratory technology, s k i n diseases . ENT and paed ia t r i c s .

The p r o j e c t w i l l be developed through (a) t h e i d e n t i f i c a t i o n and phased planning of the a c t i v i t i e s t h a t would lead t o t h e development of h e a l t h s e r v i c e s , (b) t h e development of manpover, (c) t h e development of a demonstration a rea i n one of t h e a t o l l s , and (d) cornunity pa r t i c ipa t ion .

The a c t i v i t i e s w i l l be co-ordinated with those of pro jec t s "Training of Auxiliary Health Personnel", MAY HMD 001, and '%la r i a Control", MAV WD 001.

I h i s p ro jec t i e expected t o cont inue for a number of years.

HMD 001 Training of Auxi l iary Health Personnel ( W P MOV/70/002)

. *' To a s e i s t i n t h e es tabl ishment of a school f o r the t r a i n i n g of a u x i l i a r y hea l th personnel.

Since 1971, t h i s p ro jec t has covered t h e a c t i v i t i e s c a r r i e d out under p r o j e c t Maldivee 0008, "Nursing Services and Education". I n 1973, s publ ic h e a l t h nurse educator and a consul tant were provided and courses f o r a u x i l i a r y hea l th personnel were s t a r t e d . A publ ic hea l th nurse educator joined t h e p r o j e c t i n 1975 end a publ ic h e a l t h o f f i c e r i n February 1976. The publ ic h e a l t h o f f i c e r co-ordinates a l l t h e WHO pro jec t s i n t h e Maldives, i n add i t ion t o being responsible , together wi th the publ ic hea l th nurse educator , for t h e t r a i n i n g programmes f o r a u x i l i a r y hea l th personnel.

The budget provides f o r a publ ic h e a l t h o f f i c e r and a pub l i c hea l th nurse educator. I n add i t ion , the re i s provis ion f o r fe l lowships as wel l as supp l i e s and equipment.

HMD 002 Eellowehips (Medical Education) (UNDP MDV/70/003)

To a s s i s t i n bu i ld ing up a n a t i o n a l carps of h e a l t h personnel. Far t h i s purpose, fe l lowships ere being provided under t h i e p ro jec t .

WU 103 Pellawsltips (Medlcd Education - Non-comunicable Disease Prevention and Control) (LMDP HDV/73/004)

To a s s i s t i n bu i ld ing up a na t iona l corps of h e a l t h personnel. For th i8 purpose fe l lowships are being provided under t h i s p ro jec t .

282

MALDIVES

MPD 001 Malaria Control

To a s s i e t i n the c o n t r o l of malar ia i n t h e e n t i r e country , leading t o its eventual e rad ica t ion .

S t a r t i n g i n 1951, ant i -malar ia a c t i v i t i e s formed an i n t e g r a l p a r t of p r o j e c t Maldives W05, "Public Health Administration". A study of t h e prevalence of malar ia was made i n 1964. In 1966, i t was observed t h a t e s i n g l e round of spraying with DDT r e su l t ed i n t h e v i r t u a l disappearance of anophelinet i n the sprayed a t o l l s . Since 1971, a sepa ra te malar ia c o n t r o l p r o j e c t has been i n Operation with WHO a s s i s t ance .

By the end of 1974, DDT spraying had been completed i n a l l the houses on the i s l a a d s i n 1 9 a t o l l s . During t h e second ha l f of 1974, a d e t a i l e d study was c a r r i e d ou t by a WHO team t o determine t h e t echn ica l , ope ra t iona l , f i n a n c i a l and admin i s t r a t ive f e a s i b i l i t y of conver t ing t h e malaria c o n t r o l progr-e i n t o an e rad ica t ion programme, taking i n t o cons ide ra t ion t h e condi t ions prevalent end the f a c i l i t i e s a v a i l a b l e i n the country. Though e rad ica t ion is t echn ica l ly f e a s i b l e , t h e maintenance of the r e s u l t s of e rad ica t ion may no t be poss ib le u n t i l t he re is a wel l - funct ioning hea l th infrastructure in the a t o l l s , and hence t h e con t ro l p rograme i e being continued.

WHO as s i s t ance i n 1976-1977 w i l l include t h e provis ion of a s a n i t a r i a n , fellowshipa i n t h e f i e l d of m a l a r i a / f i l a r i a s i s , subsidy t o cover t h e running c o s t s o f veh ic le s and the payment of a l lovances to nat ional s t a f f . as we l l as supp l i e s and equipment. Thie a s s i s t a n c e w i l l cont inue i n 1978-1979.

BVD 001 Leprosy and Tuberculosis Control Programme

To con t ro l t h e spread of tube rcu los i s and leprosy by means of reducing sources of i n f e c t i o n and increasing immunity among the populat ion suscep t ib le t o these d i seases ( t reatment and fallow-up of cases and BCG immunization of the suscep t ib le groups).

Leprosy and tuberculosis are chronic communicable dieeases whose prevalence i s r e l a t i v e l y high among the population of the Maldives. I t i s estimated t h a t the t o t a l number of cases of leprosy is about 2000, of which about one t h i r d i s in fec t ioue . The estimated number of in fec t ioue tube rcu los i s caaes i s about 550, wi th about 180 new cases occurr ing every year.

Consultants were ass igned in March-April 1972 t o a s sess and a s s i s t an t i - tube rcu los i s a c t i v i t i e s and t r a i n the na t iona l s t a f f .

From June t o September 1974, a consu l t an t a s s i s t e d with leprosy surveys i n t h r e e a t o l l s and i n Male. The eame consul tant waa assigned aga in f o r s i x months from October 1975.

This p ro jec t i s supported by t h e Danish "Scouts Help" Organization through WHO and is a a s i s t i n g the Government i n carrying ou t complete surveys f o r a l l inhabi ted i s l ende of the Maldives i n order t o d e t e c t most of t h e cases of leprosy and tube rcu loe i s and g ive them appropr ia t e long-term treatment and follow-up. BCG and DPT vaccinat ion a f a l l the e l i g i b l e population w i l l be performed dur ing t h e survey periods. Training and fe l lowehips a r e provided f a r the n a t i o n a l h e a l t h workers. Suppl ies end equipment t o be used f o r t h e a c t i v i t i e s of t h e p r a j e c t a r e expected t o be provided by UNICEF and the Danish Scouts Help.

Thie p ro jec t is expected t o cont inue f o r some years .

284

MALDIVES

BSH 001 Water Suplrly and San i t a t ion

To advise on developing water supply and s a n i t a t i o n syst- i n Male and o the r a t o l l s ; t o a s s i s t i n t r a in ing personnel.

Following seve ra l v i s i t s by short-term consu l t an t s , a long-term s a n i t a r y engineer has been ass i f l ed t( the p ro jec t s i n c e 1974. A c t i v i t i e s t o p ro tec t w e l l w a t e r s u p p l i e s i n Hale were i n i t i a t e d i n 1974 end a r e continuing. UNICEF haa s s s i a t e d wi th t h e provis ion of supp l i e s and equipment f o r the improvement of water supply, p a r t i c u l a r l y i n i s l a n d s o the r than Male. I n 1975. WHO provided a grant f o r t h e construct ion of an i n t e r c e p t o r sewer and pump-set t o a l l e v i a t e the problem of po l lu t ion on the Yarine Drive i n Wale; these are expected to be opera t iona l i n 1976.

I n 1978 end 1979, t h e a c t i v i t i e s w i l l be c a r r i e d ou t i n Male and o t h e r i s l ands . The p r o j e c t i s expected t o continue a t l e a s t u n t i l 1981.

PIP 001 Water Supply and Sewerage, Male (UNDP EmY/72/007)

To a e s i s t i n improvement of water supply and exc re ta d i sposa l syetenvl i n ELlle.

In 1974, under UNDP preparatory a s s i s t a n c e , a sub-contractor s tud ied the f e a s i b i l i t y of providing s a f e water and sewerage t o Hale, and t h e f i n a l r epor t W 8 6 submitted t o the Government i n 1975.

A pro jec t request f o r UNDP a s s i s t a n c e f o r f u l l a c t i v i t i e s under t h i s p r o j e c t , aimed towards improving the v a t e r supply and s a n i t a t i o n f a c i l i t i e s i n Male, is being discussed between WHO, UNDP and the Government.

Subject t o a v a i l a b i l i t y of UNDP funds, t h e p r o j e c t a c t i v i t i e s w i l l e t a r t i n 1977, end it is expected t h a t UNDP a se i s t ance t o t h i s p r o j e c t v i l l cont inue f a r some years .

Fellowships f o r t r a i n i n g of engineers and a n accountant were s t a r t e d in 1974 and are expected t o be completed by the end of 1978.

287

MONGOLIA - Index

Page

298

298

29 2

296

296

290

29 6

300

.


Rehydration Therapy (Product ion and Cont ro l )

Modern Heal th Labora tory Technology

M a t e n ~ a l and Chi ld Heal th

Contri l l of Non-Comunicable Diseases

@ a l l r y Con t ro l of Drugs and B i o l o g i c a l s (SQP 001)*

Management of Heal th Se rv i ce s (SHS 005)*

S t r eng then ing of Rad io log i ca l Se rv i ce s and Maintenance of Electro-medical Equipment

S t r eng then ing of Environmental Heal th Se rv i ce s

P ro j ec t NO.

ASE 001

BLG 001

ESD 001

HED 001

HMD 003

HMD 004

HSD 001

HSD 002

LAB 001

*pro jec t

289

301

298

294

292

294

294

290

290

298

s t r u c t u r e .


Country S ta tement

Of f i c e o f t he WHO Rep re sen t a t i ve

B r u c e l l a Vaccine Product ion (VPH 001)*

Epidemiologica l Se rv i ce s and S u r v e i l l a n c e

Heal th Education

Ass i s t ance t o t he S t a t e Medical I n s t i t u t e , Ulan Bator

T ra in ing of Heal th Manpower

R e h a b i l i t a t i o n Se rv i ce s (SHS 003)*

S t r eng then ing of Emergency Health Se rv i ce s (SHS 004)*

P u b l i c Health Laboratory Se rv i ce s

number p r i o r t o t he c u r r e n t programme

p r o j e c t NO.

LAB 002

LAB 003

MCH 002

OCD 001

PHA 001

PPS 001

RAD 001

SES 001

MONGOLIA

GENERAL - The b i e n n i m 1978-1979 coincides with t h e t h i r d and four th years of the Sixth National Plan (1976-1980) and t h i s period is considered a dec i s ive one f o r reaching t h e planned t a r g e t s . The country w i l l make b e t t e r use of i t s r i ch n a t u r a l resources and complex measures w i l l be appl ied f o r t h e f u r t h e r improvement of husbandry and agr i cu l tu re . One of t h e b a s i c object ives of t h e National Plan remains the f u r t h e r betterment of t h e l i v i n g s tandards of t h e population, including hea l th , education, housing, cornunity cervices, e t c .

HEALTH POLICY

The Government's hea l th pol icy w i l l cen t re around upgrading the q u s l i t y of medical and hea l th care, and expanding the coverage of t h e r u r a l popularion with both primary and q u a l i f i e d h e a l t h care. Comprehensive survei l lance, prophylaxes and treatment f a r t h e whole population during the period v i l l be s t a r t e d . The S t a t e ' s annual hea l th budget w i l l b e mare than 300 mil l ion tughriks and t h e planned c a p i t a l investments w i l l be about 40 mi l l ion tughriks.

PROGRAMHE AREAS


A new computer-baaed na t iona l information system and, as an i n t e g r a l p a r t of i t , a new hea l th information. pat ient-or iented system w i l l be designed and p a r t l y put i n t o operat ion. A h e a l t h se rv ices management research centre w i l l be es tabl ished. The new National Health Act i s t o b e f i n a l i z e d and approved by t h e Pacliament. Ind iv idua l designs are t o be prepared f o r ten republican hea l th i n s t i t u t i o n s , including a p a e d i a t r i c hosp i t a l , an infectious diseases hosp i t a l , a maternity home. an environmental h e a l t h p ro tec t ion centre , a s tudents ' hos te l , and also s tandard designs f o r inter-eomon and eomon hea l th centres , creches, e t e . An in tens ive bui lding p r o g r a m f o r heal th f a c i l i t i e s i s t o be proper ly supervised by the hea l th a u t h o r i t i e s . In a l l these programmes, the maternal and chi ld hea l th se rv ices and the emergency heal t i ) s e rv ices w i l l receive the Government's utmost a t t e n t i o n .

WHO A s s i 8 t a n ~ e . A WHO a r c h i t e c t w i l l a s s i s t i n carrying out t h e Government plans i n these f i e l d s , taking p a r t i n the work of the designers ' group es t ab l i shed by t h e Ministry of Health i n 1976. A s o c i a l paed ie t r i c i an w i l l co-ordinate the contr ibut ions i n maternal and ch i ld heal th . Several consul tants v i l l support the designing of hea l th information systems and modernization of t h e emergency hea l th se rv ices . Fellowships and e s s e n t i a l equipment a l s o v i l l be provided.


Emphasis w i l l be placed on inc reas ing the number of f r o n t l i n e hea l th personnel: r u r a l and d i s t r i c t physicians, fe ldshers , midwives, nurses, e tc . . and a l s o on t h e i r post-graduate, post-basic and continuing t r a in ing . Each year. 350 doctors and 300 middle-grade s t a f f should follow past-graduate and post-basic courses, and 350 new medical e tudents and about 1000 middle-grade hea l th s tuden t s w i l l b e admitted t o teaching i n s t i t u t i o n s every year. Eventually one d i s t r i c t paed ia t r i c i an should se rve not more than 900 chi ldren.

WHO Assistance. The f i r s t phase of t h e large-scale UNDP financed p r o j e c t , "Assistance to t h e S t a t e Medical Ins t i tu t e" , v i l l be completed and the second phase, to include a l l ca tegor ies of hea l th workers and t o place t h e accent on post-graduate, post-basic and a l so pub l i c h e a l t h t r a i n i n g should begin. A WHO educator w i l l continue t o a s s i s t i n t h e f i e l d of b a s i c and past -basic education of middle-grade hea l th personnel. 0


The Government is planning new comprehensive measures aga ins t meningococcal meningi t is , i n fec t ious h e p a t i t i s , pe r tuss i s . inf luenza and o the r v i r u s diseases . Rheumatic f eve r cen t res , cardiovascular d i seases un i t s , cancer dispeneer ies and centres are t o be opened. The hea l th laboratory se rv ices are t o be f u r t h e r in t eg ra ted and c e n t r a l l abora to r i e s f o r t h e con t ro l of environmental hea l th , i n human genet ics , i n radiology, e t c . w i l l be e s t ab l i shed .

WHO Assistance. A WHO epidemiologiet v i l l a s s i s t i n s t rengthening t h e con t ro l of the most important comunicable diseases . Several consul tants w i l l advise t h e Government i n the f i e l d of "on-comunieable diaeases control , the f u r t h e r improvement of laboratory se rv ices , t h e q u a l i t y con t ro l of druga and t h e r a d i a t i o n protec- t ion se rv ices . Aeeistsnce w i l l be continued f o r maintenance and r e p a i r of medical equipment. Essen t i a l reagents, d iagnost ic too l s , instruments, e t c . , w i l l be provided.


The Government's in t e r -min i s t e r i a l programme f o r environmental p ro tec t ion and promotion v i l l be f u r t h e r ca r r i ed on and t h e publ ic h e a l t h se rv ices should play an ac t ive r o l e i n t h i s process. A new bu i ld ing f o r environmental hea l th l abora to r i e s i s planned and t h e san i t a ry se rv ices vill be strengthened.

WHO Assistance. A WHO s a n i t a r y engineer v i l l a s s i s t i n ca-ordination of a l l the e f f o r t s t o improve the environmental hea l th se rv ices and t o prepare the ground f o r o the r sources of assistance. Training of na t iona l s i n key f i e l d s v i l l be provided together with some b a s i c equipment.

CO-ORDINATION

In addi t ion t o the na t iona l and WHO resources, s u b s t a n t i a l b i l a t e r a l a i d i n t h e f i e l d of h e a l t h i s expected. A nev UNFPA population p ro jec t and a UNEP-assisted environmental p ro tec t ion p r o j e c t are l i k e l y t o be s t a r t e d .

290

MONGOLIA

PPS 001 Planagerent of Health Services

TO a e s i s t i n the development of i n t e g r a t e d h e a l t h s e r v i c e s i n a l l a spec t s of comwraity h e a l t h servieee . including hea l th planning and h e a l t h s y s t e m management; i n t h e development of a computer-based hea l th information system; i n developing h e a l t h s e r v i c e s management and opera t iona l research, and i n t r a in ing hea l th personnel i n t h e r e l a t e d f i e l d s .

I n 1975, a t e r n of two consul tants was provided t o a s s i s t i n t h e development of a computer-based hea l th information aystem. This team w i l l b e provided again i n 1976 t o he lp s t rengthen the computer-based hea l th information system and h e a l t h mansgeaant. The p r o j e c t w i l l be strengthened by t h e a s s ignmnt of s long-term h o a p i t a l a r c h i t e c t i n 1978 who w i l l he lp i n developing func t iona l designs of h o s p l t a l services . In addi t ion, a s s i s t ance by way of assignment of e x p e r t s i n t h e r e l a t e d f i e l d s w i l l c o ~ ~ t i n u r i n 1977 and 1978. Fellowships w i l l b e provided and courses organized i n t h e f i e l d s of hea l th planning. hea l th eye tem management, h e a l t h information Bystem, opera t iona l research, and a l l i e d f i e l d s . Aesiat- ance t o t h i s p r o j e c t i e t o continue f o r s e v e r a l years.

HSD 001 Rehab i l i t a t ion Services

To a s s i s t i n developing medical r e h a b i l i t a t i o n ae rv ices and i n t r a i n i n g t h e necessary personnel.

In 1972, a medical r e h a b i l i t a t i o n s p e c i a l i s t from Poland v i a i t e d the country for two weeks under s b i l a t e r a l arrangement t o a s sess t h e e x i s t i n g s e r v i c e s i n t h i s f i e l d . I n 1973, a con8ultant submitted proposals f o r reorganiaing t h e medical r e h a b i l i t a t i o n se rv ices and prepared a curriculum f o r the t r a i n i n g of r e h a b i l i t a t i o n peraonnel. A team of consu l t an t s was provided i n 1975-1976. I n 1977 e consul tant w i l l pay a fol lar-up visit f o r eva lua t ing t h e progress of t h e p r o j e c t .

Assistance is expected to continue up t o 1977.

, HSD 002 Strengthening of Emer~ency Health Se rv ices

TO a s e i s t i n t h e development, planning and management of emergency h e a l t h care ae rv ices , including the conduct of continuing education on new t r ends i n emergency care .

I n 1975, a coneultent i n toxicology was ass igned f o r 1k months. I n 1976. 1977, 1978 and 1979, con- s u l t a n t s w i l l be provided t o examine t h e a x i a t i n g emergency ca re s e r v i c e s , conduct cont inuing education program=zs i n the development of emergency ca re f o r t h e l o c a l s t a f f . and a l s o t o a s s i s t i n r e l a t e d management, surgery, trsumatology, b u m s treatment and toxicology. Fellowshipa w i l l a l s o be warded i n these f i e l d s .

Aasistsnce t o t h e p r o j e c t w i l l continue till 1980.

HM 002 Maternal and Child Health

To a s s i s t i n the f u r t h e r improvement of maternal and ch i ld care , including n u t r i t i o n , wi th emphasis on t h e development of spec ia l i zed ae rv iees f a r t h e care of mothera and chi ldren.

P r o j e c t s Mongolia 0004, "Maternal and Child Health", Mongolia 0023, "Nutrit ion", and Mongolia 0200, "Fellowshipe (Nutr i t ion)" , have been merged i n t o t h i s p r a j e c t .

Assistance provided e inee 1965 j o i n t l y by WHO and UNICEF (Mongolia 0004) has enabled t h e a t rengthening of the adminis t ra t ion of maternal and c h i l d h e a l t h se rv ices a t a l l l e v e l e , and t h e reorganizat ion and expsnsian of t h e i n s t i t u t i o n a l end cornunity hea l th se rv ices f a r mothers and chi ldren throughout the country. WHO provided t echn ica l advisory se rv ices i n t h e form of long-term s t a f f and consul tants and a l s o awarded fe l lowships for t refning. Supporting s e r v i c e s have included a v ide range o f t r a i n i n g and hea l th education a c t i v i t i e s . UNICEF provided supp l i e s and equipment.

Future a c t i v i t i e s w i l l aim a t improving t h e q u a l i t y of the se rv ices provided by developing t h e spec ia l i zed aspects of t h e m t e r n a l and ch i ld hea l th programme.

Assistance t o n u t r i t i o n a c t i v i t i e s s t a r t e d i n 1974 (Mongolia 0023). when a team of nutritionists helped i n iden t i fy ing problems r e l a t e d t o the n u t r i t i o n a l s t a t u s and n u t r i e n t in t akes .

I n 1975, a s s i s t ance through long-term and short-term s t a f f was given i n organizing the o b r r t c t d e ,and gynaeeological se rv icee and t r a in ing . I n 1976 coneultanta w i l l be provided, f o r reviewing t h e cu r ren t n u t r i t i o n a l s t a t u s of mothera and ch i ld ren i n order t o advise on planning and s e t t i n g up a s u i t a b l e n u t r i t i o n programme, as we l l as fo r advis ing on t h e s t rengthening of p a e d i a t r i c ear, nose and t h r o a t se rv ices . Fellowships w i l l be provided i n d i f f e r e n t f i e l d s of maternal and c h i l d hea l th . UNICEF w i l l support the p r o j e c t u n t i l mid-1976.

In 1977. 1978 and 1979, asaia tanee w i l l be provided by the assignment of a p r o j e c t co-ordinator ( s o c i a l paed i s t r i c i an ) . Consultant se rv ices i n t h e f i e l d a of p a e d i s t r i c nephrology, neonatology and o b s t e t r i c s and gyneecolagy w i l l be provided. P e l l a r s h i p s W i l l be awarded t o s e n i o r a d n i n i a t r a t o r s and se rv ice a t a f f i n the f i e l d of maternal and c h i l d hea l th and n u t r i t i o n .


To a s s i s t i n reorganizing and developing hea l th education se rv ices ; i n developing, implementing and evaluat ing hea l th educat ion a s an i n t e g r a l p a r t of each h e a l t h programme; i n t r a i n i n g t h e manpwer needed f o r key pos i t ion8 i n h e a l t h education.

In 1971, a consul tant s tud ied t h e e x i s t i n g hea l th education s e r v i c e s and msde recommandationa f o r the f u r t h e r development of these se rv ices . The same consu l t an t , assigned i n 1973, reviewed the ac t ion taken on h i s previous recommendations and made a number of add i t iona l propoasla, which were accepted by t h e Government. I t i s proposed t o ass ign a short-term consul tant t o a a s i s t t h e Government i n heal th education research i n 1976 and a e i m i l a r consul tant i n 1977 t o a s s i s t wi th t h e development of the hea l th education component of d isease-control pragra-e. Fellowships and equipment and supp l i e s a re provided under t h e p ro jec t .

Assistance w i l l continue through 1977.

HMD 003 Aseistanee t o t h e S t a t e Medical I n s t i t u t e . Ulan Bator (UNDP HDN/72/004)

To a s a i s t i n t h e proper development and i w r o v e m n t of medical education i n Mongolia by rev i s ing t h e cu r r i cu la and teaching evaluat ion p r a c t i c e s as wel l as by developing a corps of teachers competent i n d i f f e r e n t branchea of medicine and a b l e t o apply modern teaching technology.

The p ro jec t vas financed from regu la r funds up to 1973. A p r o j e c t manager has been assigned s i n c e 1974 and is being a s s i s t e d by a paed ia t r i c i an . I n 1975, a number of short-term consul tants i n var ious d i s c i p l i n e s a s s i s t e d the p ro jec t . A l a r g e component of funds has been used f o r supp l i e s and equ ipmnt .

The p ro jec t provides f o r the pas t of a P r o j e c t Manager up t o mid-1978 and consul tants i n 1976, 1977 and 1978. Suppliea and equipment and fe l lowships w i l l a l s o be provided during these years .

HMD 004 Training of Health Manpower

TO s e s i e t with t h e development of e comprehensive and nation-wide aystem of t r a i n i n g and continuing education f a r a l l ca tegor ies of middle-level h e a l t h personnel. P r i o r i t y w i l l be given t o t h e develop- r e n t of post-basic educat ional pragra-s f a r t h e p repa ra t ion of teachers. supervisors and adminis- t r a t o r s i n t h e r e spec t ive h e a l t h f i e l d a . A cen t re f o r post -basic t r a i n i n g i s t o b e e s t ab l i shed i n Ulan Betor.

Aasietance i n hea l th manpower development has been provided over s per iod of years i n the f i e l d a of pub l i c hea l th laboratory s e r v i c e s , r e h a b i l i t a t i o n , den ta l hea l th and nursing. Nursing education programmes have received ass i e t enee under MOG HUB 001, "Nursing Services and Education", and two long-term nurae educstora (one from 1968 and another from 1970) were i n pos i t ion m t i l December 1975. Since 1972, consul tants have a s s i s t a d i n t h e organizat ion and development of teaching and remearch i n var ious f i e l d s of dentistry under p r o j e c t MOG DNH 001,"Dental Health Services". These two p r o j e c t s have been merged from 1976 under t h e t i t l e "Training of Health Manparer" - MOG HHD 004.

The poet of nurse educator w i l l continue through 1978 and 1979. Fellowships v i l l be awarded t o various categor ies of h e a l t h personnel and some equipment w i l l b e provided.

A ~ s i s t a n ~ e w i l l continue u n t i l the end of 1985.

ESD 001 Epidemiolopical Services and Survei l lance

To a s s i s t i n the f u r t h e r development of epidemiological su rve i l l ance of disease. represent ing major publ ic hea l th problems, and i n the f u r t h e r s t rengthening of h e a l t h l abora to ry #ervicas i n t h e country.

From 1963 t o 1972, a s s i a t anee i n epidemiological servicea and surveillance wan provided through Mongolia 0001,"Strcngthening of Health Services (Epidemiology)". Consultant se rv ices and fe l lowships have been provided t o assist i n epidemiology (designing f i e l d t r i a l s ) and i n t h e c o n t r o l of some i n f e c t i a u a diseases . Under p r o j e c t Mongolia 0002. a s s i s t ance has been given i n undertaking a campre- henaive country-wide appra i sa l of t h e laboratory se rv ices .

The Chief of t h e B a c t e r i a l Diseases Unit from WHO Headquarters and a consul tant v i s i t e d Mongolia i n 1974 i n connerion v i t h t h e organizat ion and conduct of a vaccinat ion t r i a l against cerebrospinal meningitis v i t h t h e A group of vaccine. Two consul tanto and a medical o f f i c e r from W O Headquarters v i s i t e d Mongolia i n J u l y 1975 t o assess t h e r e s u l t s of the immunizations a l ready given.

In 1976-1977, consul tante w i l l be sseigned i n t h e f i e l d s of i n f e c t i o u s h e p a t i t i s , epidemiological prog- nos i s and immunology. I n 1978, a long-term pos t of epidemialogistlspecialist i n d i s i n f e c t i o n v i l l be es tabl iahed. Fel larehipa w i l l cover t r a i n i n g i n t h e con t ro l of meningococcal i n f e c t i o n s , i n f e c t i o u s h e p a t i t i s , e t c . Supplies ( including vaccine) and equipment v i l l be provided.

Assistance t o t h e p r o j e c t w i l l continue f o r some years .

0CD 001 Control of Nan-Communicable Diseases

TO a s s i s t i n iden t i fy ing h e a l t h problems due t o non-communicable d i seases , i n epidemiological i n v e s t i - gat ions and hea l th education f a r prevent ion and con t ro l , and i n the t r a i n i n g of h e a l t h and a l l i e d personnel f o r ea r ly de tec t ion , d iagnosis and treatment se rv ices , including biomedical research.

Since 1967, cansultancy se rv ices have been provided under p ro jec t s Mongolia 0010. "Cardiovascular Diseases", Mongolia 0011. "Cancer Control". and Mongolia 0021, "Mental Health",for s t rengthening eervicee i n cardiovaacular d iseasee (rhewmtism) and hypertension, cancer (chemotherqg, radiothempy, Liver oacer epidemiotogy). and advis ing on psych ia t r i c se rv ices . Since 1975, a c t i v i t i e s f o r t h e prevention and con t ro l of non-cornmicable diseasee have been consol idated under t h i n project . In 1976, c o n s u l t w t s are being assigned end fe l lowships awarded f o r t r a i n i n g i n epidemiology, psychiat ry , r e h a b i l i t a t i o n and management of n a n - c o m n i c a b l e diseases . Assistance i n 1977 w i l l cover t h e f i e l d s of mcosurgery, r eeusc i t a t ion and out-pat ient psych ia t r i c eervicea . During 1978 and 1979 ass i e t anee w i l l be given f o r f u r t h e r s t rengthening t r a i n i n g and se rv ices i n t h e management of cancer con t ro l , cardiovaacular d ieeases , and prevent ion of mental i l l - h e a l t h through t h e assignment of consu l t an t s , award of fellowships t r a i n i n g hea l th personne1,and the provis ion of e s s e n t i a l auppl iee end equipment.

RM 001 Strengthening of Radiological Services and Maintenance uf E l e c t r a - e d i r a l Equipment -- To a s s i s t i n t r a i n i n g technicians i n t h e r e p a i r and maintenance of electro-medical equipment, i n s t rengthening repa i r and maintenance se rv ices f o r h o s p i t a l equipment through the organizat ion of a cen t ra l and a s e r i e s of s a t e l l i t e workshops, and i n promoting rad ia t ion p ro tec t ion p rac t i ces i n hea l th i n s t i t u t i o n s .

I n 1968. two consul tants a s s i s t e d i n the i n s t a l l a t i o n of X-ray uni te . Since 1971. an electra-medical engineer has been helping with t h e t r a i n i n g of na t iona l s t a f f and the organizat ion of maintenance and repa i r se rv ices f a r electro-medical equipment. A consul tant was assigned i n 1974 t o a s s i s t i n the development of e l e c t r o n i c se rv ices i n h o s p i t a l s , and i n 1975, a f u r t h e r consul tant s s a i a t e d i n the r epa i r and maintenance of s t e r i l i z a t i o n apparatus. Fellowships were provided for t r a i n i n g i n the r e p a i r and maintenance of StOmatolOgiCal and i so tope equipmenr. In 1976, a consul tant reviewed the progress , and two fe l lovsh ips were awarded f o r t r a i n i n g i n r a d i a t i o n h e a l t h and r e p a i r se rv ices . I n 1977, provision has been made f a r a consul tant i n r a d i a t i o n p r o t e c t i o n and two fe l lowships i n r ad ia t ion p ro tec t ion and repa i r and maintenance se rv ices .

In 1978 a consul tant (electro-medical engineer) w i l l b e provided t o a s s i s t i n t h e development of t h e p ro jec t and to advise t h e newly t r a ined l o c a l engineer on t h e organizat ion of t r a i n i n g and ee rv iees f a r the maintenance and r e p a i r of electro-medical equipment. I n 1979, provis ion has been made f o r eonaultants i n r a d i a t i o n p ro tec t ion , including s t rengthening of t h e r a d i a t i o n p ro tec t ion laboratory. F e l l m s h i p s w i l l be awarded for t r a i n i n g i n these areas end l imi ted auppl ies and equipment made ava i l ab le .

PHA 001 q u a l i t y Control o f Drugs and Bio log ica l s

To s s e i s t i n the f u r t h e r development of t h e manufacture of pharmaceutical products and i n t h e upgrsd- ing of servicea associa ted wi th t h e i r q u a l i t y c o n t r o l ; t o a s s i s t i n t r a i n i n g a t a f f .

I n 1971, two consul tants s tud ied t h e s i t u a t i o n and made recommendations. Another c o n s u l t m t , provided i n 1973, t r a ined a n a l y s t s i n s p e c i f i c methods and i n t h e u t i l i z a t i o n of modern a n a l y t i c a l i n a t r u m t m . I n 1974, a f u r t h e r consul tant was ass igned and fe l lowships were awarded i n t h e f i e l d of q u a l i t y control . I n 1976 a s p e c i a l i s t advised on t h e q u a l i t y con t ro l of hornones, and m o t h e r consul tant w i l l advise on t h e q u a l i t y con t ro l of vitamins i n 1977. In 1978 and 1979, a d d i t i o n a l t echn ica l e r p c r t i e e and fe l lovshipa w i l l be provided, i n b i o l o g i c a l s t andard iza t ion wi th a view t o completing t h e b u i l d up of na t iona l competence i n q u a l i t y c a n t r o l .

The p ro jec t s a c t i v i t i e s w i l l be co-ordinated wi th K)G BLG 001, "Brucella Vaccine Production".

MONGOLIA

BLG 001 Brucel la Vaccine Production (UNDP HON1711511)

To a s s i s t i n producing freeze-dried Bmoetta vaccine and i n e s t a b l i s h i n g laboratory f a c i l i t i e a f a r i t a tea t ing.

As a r e s u l t of t h e recornendations made by a consul tant who v i s i t e d Mongolia, i n 1968, under p r o j e c t , Mongolia 0001. "Strengthening of Heal th Services (Epidemiology)", i t was decided t o s t a r t the production of BmoeZta vaccine. F ie ld t r i a l s i n Mongolia proved t h e r e l a t i v e e f f i cacy of the Rev.1 vaccine i n reducing the frequency of b r u c e l l o s i s i n animala.

The economic impact of preventing abor t ion i n l ivea tock end the pub l i c h e a l t h advantages of preventing b ruce l los i s i n man were conaidered moat important by t h e Government, and, i n 1970, s WHO team s s a i s t e d i n t h e preparat ion of a request t o UNDP.

In 1971, a consul tant a s s i s t e d i n f i n a l i z i n g the p ro jec t documnt. A b a c t e r i o l o g i s t has been assisting aince 1973, and a p r o j e c t manager s i n c e 1974.

In 1974 and 1975 consul tants ve re asaigned i n vaccine con t ro l , b r u c e l l o s i s con t ro l and f r eeze drying technology. In 1976 a consul tant advised on t h e microbiological aspects of su rve i l l ance and con t ro l of b ruce l los i e i n man and mimale .

W 001 Public Health Laboratory Services (UNDP HDN1681005)


LAB 002 Rehydratim Therapy (Production and Control)

TO a a s i e t i n producing rehydrat ion f l u i d s and i n t r a i n i n g p a e d i s t r i c i a n s i n the p r a c t i c e of o r a l and p r r e n t e r a l rehydrat ion therapy.

In 1971. a e o n ~ u l t a n t (provided under SEIRO 0144. "Rehydration Therapy") recommended t h e f e a s i b i l i t y of producing p a r s n t e r a l f l u i d s l o c a l l y . Under t h e same p r o j e c t , two consu l t an t s , i n 1972, prepared the b luepr in t i n respect of two s spec ta , v i z . , production and therapy. I n 1973. a consul tant aas i a t ed i n organizing tvo n a t i o n a l t r a i n i n g courses i n rehydrat ion therapy.

During 1974-1976 a pharmacist (production manager) and a e c i e n t i e t (qua l i ty con t ro l ) hsve a s s i s t e d with the impleoentation of t h e p r o j e c t and t h e conmiasionins of t h e p lan t i n Ulan Bator f o r the

I production of p s r e n t c r a l f l u i d s .

Several fellowahips hsve been provided through 1975 t o t r a i n n a t i o n a l s t a f f i n t h e teehnolo&y of production of intravenous f l u i d s and i n t h e i r t e a t i n g f o r q u a l i t y control .

A manual, protocols f o r production and laboratory i n s t r u c t i o n no tes f o r t e s t i n p have been made ava i l - able. LlNICEF has procured the p l a n t from Czechaslovakia and suppl ied equipment t o two h o s p i t a l cen t res where resuscitation therapy i a be ing provided t o newborns and vhich are rued f o r t r a i n i n g as well .

Assiatenee to t h e p r o j e c t ended i n Apr i l 1976. The a c t i v i t i e s v i l l be f o l l w e d up under p r o j e c t UCH 002, "Maternal and Child Health", as and when f u r t h e r assistance becomes ncecssary.

LAB 003 Modern Health Laboratory Technology

To bu i ld up n a t i o n a l competence i n advanced laboratory medicine.

Thla p r o j e c t is re1at.d t o the e a r l i e r UNDP p r o j e c t , UDN LAB 001, of vhieh i t is a new developrent v i t h cmpha~i s on t h e development of advanced f a c i l i t i e s i n support of c l i n i c a l u td epid..iologieal se rv ices .

The p m j e c t propose. t o develop eoopetence i n such f i e l d s as virolopy, imwmology, including a l l e rgo- logy, genetic8 and advanced c l i n i c a l chemistry; a l s o t o he lp operate reference marvices m d promote the accuracy of r e s u l t s repor ted by t h e laboratory aervicea through schema vhich w i l l a n i t o r the q u a l i t y of t e a t s and check t h e prof ic iency of laboratory performer. am w e l l as use standard. and reference preparation..

A conmultent i m u n o l o g i s t and s consul tant v i r o l o g i n t , both t o be provided i n 1978, and s g e n e t i c i s t t o be assigned i n 1979, v i l l a s s i s t i n developing t h e above a c t i v i t i e s . F e l l w a h i p s i n f i e l d a r e l a t e d t o t h e work of t h e consultants v i l l a l a o be provided.

SES 001 Strengthening of Environmntal Health Services

TO a a a i s t i n s t rengthening t h e s a n i t a r y c o n t r o l s e r v i c e s and i n the f u r t h e r development of the comu- n i t y water supply and a a n i t a t i o n programme.

A consultant, assigned i n 1974, s tud ied t h e environmental h e a l t h p rob lem i n Ulsn Betor end d ra f t ed e prapoeal f a r the establishment of a n a t i o n a l environmental h e a l t h cen t re . The proposal ha8 been general ly accepted by t h e Government and i a na r under review by UNDP and UNEP f o r poas ib le anBimtmcC.

In 1976. th ree consul tants - one on cornunity water supply design and two i n t h e f i e l d of a i r pol lu- t i o n control - were asmigned t o provide f u r t h e r a s s i s t ance .

A s a n i t a r y engineer w i l l be assigned from mid-1976 u n t i l t h e end of 1979 t o he lp i n s t rengthening s a n i t a r y con t ro l s e r v i c e s end t h e coolnunicy water aupply and s a n i t a t i o n p r o g r a m .

Fellowahips to enable n a t i o n a l n t e f f t o a t t e n d s h o r t courses and make abaervat ion s tud iee have been provided; some supp l i e s and equipment have a l s o been provided.

Similar s se ia t ance w i l l be continued t i l l the end of t h e p r o j e c t i n 1980.

NEPAL - Index . Project

. q U.

ASE 001

BSM 001

BVD 001

BVD 002

HED 001

HW 001

HND 003

HSD 001

*project

Project T i t l e

Country Statement

Office of t h e WHO Representative

Cornunity Water Supply and San i t a t ion

Leprosy Control (KBD 001)*

Tuberculosis Control (MBD 002)*

Health Education

Training of Health Manparer

Fellowships (Nursing)

Development of Health Services (SHS 001)'

n d e r p r i o r t o the current programwe

Project T i t l e

Family Health Aspects of Integrate ' Health Services , Si raha and Sapfer i D i s t r i c t s , Nepal

Strengthening of Family Health Services

Malaria Eradicat ion

Nutrition

Development of Water Supply and Sewerage i n Greater Kathmandu and Bhaktapur

Health Planning and Programming (SHS 005)*

Smallpox Eradicat ion (SME 001)*

304

317

316

314

314

310

312

312

308

Project NO.

MCH 001

MCH 002

HPD 001

NUT 003

PIP 001

PPS 001

SPI 001

NEPAL

GENERAL

The popula t ion of Nepal was approximately 12.5 m i l l i o n i n 1975 (40.4% being under 15 y e a r s of age) , w i t h 15 major e t h n i c groups speaking d i f f e r e n t languages and d i a l e c t s ; 96.2% of t h e popula t ion l i v e i n r u r a l ereas and 61.74 i n h i l l s and mountains, The crude b i r t h r a t e is 42 per 1000, crude dea th rate 2 0 per 1000, iafanr m o r t a l i t y r a t e 183 p e r 1000 and n a t u r a l i n c r e a s e of popula t ion 2.2% pe r annum. L i f e expectancy a t b i r t h i a 42 years f a r males and 45 y e a r s f o r females. I n r ecen t yea r s t h e r e ha s been a cons ide rab l e movement of popu- l a t i o n t o c u l t i v a t e land i n t h e Te ra i and a long t h e newly cons t ruc t ed roads. The d e n s i t y of popula t ion i e 80 per sq. km. over t h e count ry and 579 pe r sq. !a. of c u l t i v a t e d land. .Iccess t o piped water is a v a i l a b l e t o 7 % of t h e popula t ion and t h e per cnpitn gros s n a t i o n a l product i n 1974 was US590-100.

Comunica t ions over t h e whole country are d i f f i c u l t al though t h e r e has been a l a r g e i n c r e a s e i n t h e network of paved, g r ave l and ea r th - su r f ace roads from 660 kms i n 1955 t o 3173 kms i n 1974. This is i n c r e a s i n g r ap id ly .

Nepal ' s economic g r m t h over t h e l a s t n i n e y e a r s has been slow, from 1965-1974 t h e average annual r a t e of g r m t h i n g ros s domestic product (GDP) be ing 2.2% i n r e a l terms. During t h e same pe r iod , the popula t ion i nc rea sed a t a r a t e of over 2%. There was t h e r e f o r e ha rd ly any improvement i n per cnpito GDP. Agr i cu l tu r e accounts f o r about two-thirds of t h e GDP, f a r 80L of expo r t e a rn ings and provides employment t o 94K of t h e popola t ion .

The F i l t h Plan , covering 1975-1980, c o s t s approximately USS500 m i l l i o n , and envisages a balanced development of t h e f o u r Regions of t h e country, t h e Far Western, Western, C e n t r a l and Eas tern regions . The Plan has given p r i o r i t y t o a g r i c u l t u r e (upproximately 30%). The s o c i a l s e c t o r has been a l l o c a t e d approximately 25% of the t o t a l budget, of which 28% has been earmarked f o r h e a l t h , thus g iv ing 7% of t h e t o t a l p l a n ou t l ay t o hea l t h . Health and d r ink ing wa te r account f o r 11% of t h e budget. The h e a l t h s e c t o r a lone w i l l co s t approximately US538 m i l l i o n over the 5-year pe r iod .

HEALTli POLICY

The long-term o b j e c t i v e of t h e h e a l t h s e c t o r is t o expand t h e h e a l t h s e r v i c e s w i th community involvement. The p r i o r i t i e s of t h e plan are t o develop i n t e g r a t e d b a s i c h e a l t h e e r v i c e s i n o rde r t o provide h e a l t h s e r v i c e s t o t h e v i l l a g e people as soon a s pos s ib l e ; t o implement t h e country-wide fami ly p lanning and maternal and c h i l d h e a l t h programme i n o r d e r to c o n t r o l t h e growth of t h e popula t ion and mainta in the balance of economic develap- ment, and t o s t r eng then and expand t h e programme t o e r a d i c a t e and c o n t r o l communicable d i s e a s e s such as malar ia , smallpox, t ube rcu los i s and leprosy .

The major h e a l t h concerns i d e n t i f i e d by t h e cormtry h e a l t h p r o g r a m i n g e x e r c i s e (1974) are ma la r i a , h igh m o r t a l i t y and morbidity i n ch i l d r en m d e r 5 yea r s , t u b e r c u l o s i s , h igh f e r t i l i t y , d i a r rhoea1 d i eease s , l a ck of s a f e water and sewage d i sposa l , smallpox, h igh maternal morbid i ty and m o r t a l i t y , l ep rosy , g o i t r e , i n t e s t i n a l p a r a s i t i c i n f e c t i o n s , p ro t e in - ca lo r i e de f i c i ency , measles, t e t anua , r e s p i r a t o r y d i s ea se s , a c c i d e n t s , s k i n d inease s and geni to-ur inary d i s ea se s .

The Government has c a r r i e d out p r o j e c t formula t ions i n ma la r i a , t u b e r c u l o s i s , l ep rosy , water supply and sewerage, n u t r i t i o n and g o i t r e , h e a l t h educat ion , h e a l t h informat ion s e r v i c e s , b a s i c h e a l t h s e r v i c e s and h e a l t h l abo ra to ry s e rv i ce s . Based on these Formulations, WHO i s fo rmu la t i ng i t s p r o j e c t s t o d o v e t a i l them i n t o t h e p l ans of t h e Government. These are be ing co-ordinated w i t h o t h e r agencies . The h e a l t h t a r g e t s which t h e country would l i k e t o achieve dur ing t h e f i f t h p l an pe r iod are:

(1) Inc rea s ing the t o t a l numher of h e a l t h pos t s up t o 810 from t h e p re sen t 351.

( 2 ) Establishment of 15-bed hosp i t31s i n 15-24 d i s t r i c t s which are a t p r e sen t wi thout h o s p i t a l s .

(3) Reduction in t h e b i r t h r a t e f rom 40 t o 38 pe r 1000. I n f a n t m o r t a l i t y r a t e t o be brought down t o 150 from 200 per 1000 by improving c h i l d r e n ' s h e a l t h .

(4) Out of 7 253 000 people i n the malar ious area, b r ing ing 6 303 000 i n t o the maintenance phase and 950 000 i n t o t h e a t t a c k phase.

(5) Carry ing out t ube rcu los i s c o n t r o l p r o g r a m s and BCG vacc ina t i on t o c h i l d r e n of 0-14 y e a r s i n each drvelopment region dur ing the p l an per iod .

( 6 ) Extension of t h e l ep rosy c o n t r o l programme t o more areas and t o c a r r y ou t a survey o f f o u r m i l l i o n people f u r leprosy .

(7) Es tabl i shment of fou r Regional Hea l th O f f i c e s and 41 D i s t r i c t Heal th O f f i c e s on t h e b a s i s of popula t ion dens i t y and geographica l s i t u a t i o n .

WHO programme a s s i s t a n c e fo l l ows ve ry c l o s e l y t h e n a t i o n a l p r i o r i t i e s i n development of t h e b a s i c h e a l t h s e r v i c e s , h e a l t h p lanning and p r o g r a m i n g and h e a l t h manpower development as w e l l as communicable-disease c o n t r o l , community wa te r supply and s a n i t a t i o n .

General Health Se rv l ce s

A Planning Unit was e s t a b l i s h e d i n t h e Min i s t ry of Heal th i n 1973, and t h e Gove rnmnt ' e p lan is t o develop a h e a l t h care system based on "minimum h e a l t h care t o t h e maximum n u d e r of people". The p i l o t p r o j e c t areas have been eva lua t ed and i t has been shown t h a t t h e I n t e g r a t e d Healrh Se rv i ce d e l i v e r s more d i r e c t h e a l t h care

se rv ices pe r rupee f o r a l l major p r o g r a m areas (family planninglmaternal and ch i ld hea l th , smallpox, curat ive and malaria i n t h a t order) than comparable "on-integrated d i s t r i c t s , the reason being a s h i f t i n the expendi- t u r e s from adminis t ra t ive funct ions to supervisoly end d i r e c t hea l th care ee rv ice a c t i v i t i e s . WHO a s s i s t e d with planning, implementation and evaluat ion. It has a l s o a s s i s t e d i n t r a i n i n g hea l th personnel i n t h e services . Other WHO inpu t s are i n hea l th laboratory se rv ices , medical records and maintenance of electro-medical equipment. S t a r t i n g i n 1976; the Planning Unit w i l l be a s s i s t e d wi th a h e a l t h planner. A seminar on hea l th planning had received ass i s t ance .

Health Manpwer Development

A t the present time, the I n s t i t u t e of Medicine (es tabl ished i n 1972) of Tribhuvan Univereity is t r a i n i n g nurses, hea l th a s s i s t a n t s , hea l th inspectors , aux i l i a ry nurse-midwives and aux i l i a ry hea l th workers, laboratory technicians and radiographer technicians a t c e r t i f i c a t e l eve l . From 1977 a Diploma Course i n Medical Services , General Medicine, of 3-112 yea r s ' duration w i l l be s t a r t e d i n order t o produce " C o m n i t y Physicians". A t r a in ing course f a r radiographers has a l s o been prepared.

WHO has a s s i s t e d i n 1975176 with a radiographer t u t o r , a medical educator i n curriculum development and a nurse educator i n bas ic and poet-basic midwifery. Planned inputs w i l l support the new p r o g r a m , emphasis being placed on t r a i n i n g t o meet the needs of the comprehensive hea l th care system.


During the period 1972-74, a steady increase i n malar ia incidence has been observed i n Nepal. I n 1975, i t appeared t h a t a l e v e l l i n g of incidence occurred i n t o t a l numbers, but the reasons f o r t h i s l e v e l l i n g muat be reviewed ca re fu l ly as large areae had incomplete su rve i l l ance . The bas ic , t echn ica l planned p r o g r a m i s t o l w e r the incidence of malar ia t o approximately 500 cases per mi l l ion population over the next f i v e years . J o i n t a c t i v i t i e s by the government wi th WH0,US A I D and UNDP w i l l enable the government to receive the required programme ass i s t ance with technical s t a f f , t r a in ing , and suppl ies and equipment.

The l a s t case of smallpox occurred i n Apr i l 1975 and WHO ass i s t ance w i l l continue u n t i l the end of 1977. An i n t e r n a t i o n a l smallpox aseeesment team w i l l i nves t iga te the s t a t u s of smallpox i n Nepal i n May 1977, two years a f t e r the l a s t ease had been reported.

Tuberculosis and leprosy control are being supported along the l i n e s of the p r o j e c t formulations.


The development of water supply and sewerage i n Greater Kathmandu and Bhaktapur i s proceeding; the re i s no se r ious current problem a f f e c t i n g the funding and progrese of t h e p ro jec t .

The community water supply and s a n i t a t i o n programme i n t h e r u r a l areas, with the a s s i s t ance of WHO and UNICEF, i s making progrese.

WHO provides long-term a t a f f t o a s s i s t the Department of Local Development, under the Ministry of Panchayat, and a l s o the Department of Water Supply and Sewerage, which is responsible f o r urban water supply and san i t a t ion . In addi t ion, fellowships are being provided.

CO-ORDINATION

WHO is co-ordinating i t s programme with UNDP. UNICEF, the World Food P r a g r m e and the World Bank. In add i t ion , WHO is f u l l y eo-operating with var ious b i l a t e r a l and m u l t i l a t e r a l agencies.

306

NEPAL

PPS 001 Health Planning and Prosramming

To a s s i s t i n n a t i o n a l hea l th planning, programming and hea l th adminis t ra t ion on e broad baa i s , inc lud ing the heal th information system and h e a l t h mansgemnt a spec t s , w i th emphasis on t h e phased i n t e g r a t i o n of v e r t i c a l hea l th programmes, t h e system of adminis t ra t ion, l o g i s t i c s and information, eventual ly leading t o the development of b a s i c in t eg ra ted hea l th s e r v i c e s i n t h e country and a s t rong n a t i o n a l hea l th se rv ice i n f r a s t r u c t u r e .

A publ ic hea l th planner and a s t a t i a t i c i s n w i l l b e aasigned t o the p r o j e c t i n 1976. A na t iona l hea l th planning course w i l l be held with a s s i s t a n c e from in ter-country p r o j e c t ICP PPS 002, and an in-service t r a in ing workahop on planning, management and evaluat ion w i l l be organized i n 1977. The h e a l t h planner and the s t a t i s t i c i a n w i l l continue t o a s s i s t the p r o j e c t i n 1977, 1978 and 1979 i n s t rengthening the hea l th planning process and the h e a l t h in fo rna t ion syatem so ar t o b u i l d a competent bane f o r h e a l t h planning and management.

Supplies and equipment w i l l a l s o be provided.

Assistance t o t h e p ro jec t is expected t o continue f o r a number of years .

308

NEPAL

HSD 001 Development of Health Services

To organize, plan and manage the evolut ionary development of in t eg ra ted hea l th se rv ices through hea l th posts and d i s t r i c t hea l th o f f i c e s and t h e i r support ing l a b o r a t o r i e s a t d i s t r i c t . zonal and regional l e v e l s , and develop medical records; t o a s s i s t i n developing h e a l t h laboratory se rv ices ; t o s t rengthen medical s t o r e s managemnt and maintenance of electro-medical equipment; t o ee tab l i eh a s a n i t a t i o n u n i t within the Community Health and In teg ra t ion Sect ion of the Di rec to ra te of Health Services; to develop indigenous capaci ty f a r t h e t r a i n i n g of middle and lower-level personnel and t o provide necessary t r a in ing f a c i l i t i e s f a r h igher- level pereonnel; t o conduct ope ra t iona l research i n h e a l t h se rv ices i n col laborat ion with the Planning Ce l l : t o e s t a b l i s h , extend and operate a network of pe r iphe ra l labora- t o r i e s i n those regions where t h e h e a l t h se rv ices have developed and, i n p a r t i c u l a r i n those d i s t r i c t s where the malaria a c t i v i t i e s have been in teg ra ted i n t o t h e b a s i c h e a l t h se rv ices .

In 1968, a consultant a sa ia t ed i n prepar ing a five-year plan f o r in t eg ra ted hea l th se rv ices . Assistance t o t h i s p ro jec t was given up t o 1970 by t h e pub l i c hea l th o f f i c e r a t tached t o Nepal 0003,"Strengthening of Health Services". A pub l i c hea l th o f f i c e r and e pub l i c hea l th nurse have been i n p o s i t i o n aince 1971 and a medical records o f f i c e r s i n c e 1973. I n 1971, two consul tants advised on the design and a r c h i t e c t u r a l a spec t s of t h e construct ion of h o s p i t a l s and hea l th pos t s and a t h i r d a s e i s t e d wi th plans for t h e establishment of a medical records system i n t h e b a s i c h e a l t h aervices . Two consul tants , provided i n 1973, reepect ively a s s i s t e d wi th t h e development of h e a l t h manpower and h e a l t h planning and assessed the p o s s i b i l i t y of t r a i n i n g a n a e s t h e t i a t s wi thin t h e country. Assis tance was a l s o given i n evolving guidel ines f o r t h e development of occupat ional hea l th s e r v i c e s as an i n t e g r a l p a r t of the general hea l th se rv ices . I n 1975, an e l e c t r a - r d i c a l engineer joined t h e p r o j e c t and e consul tant ( a rch i t ec t ) advised on t h e formulat ion of guidel ines f o r designing plans and drawings f o r t h e conetruc- t ion of hoap i t a l s and hea l th centres. Also i n 1975, two f u r t h e r consul tants were provided - one a s s i s t e d with the development of t h e Nat ional Health Planning Unit i n t h e Minis t ry of Health and the other advised t h e I n e t i t u t e of Medicine, Tribhuvan Univers i ty , on the teaching of anaesthesiology.

P i l o t s t u d i e s on t h e i n t e g r a t i o n of b a s i c hea l th se rv ices i n Bara and Kaski d i s t r i c t s were completed i n 1974 w d the recommendations s r i a i n g nut of an independent assessment of t h i s p i l o t p r o j e c t are under implementation. A country h e a l t h p rograming exe rc i se was undertaken i n 1974 and a p r o j e c t on bas ic hea l th se rv ices was formulated i n 1975. P ro jec t NEP LAB 001 has been merged with t h i s p r o j e c t with e f f e c t from 1976. During 1978 and 1979 ass i s t ance w i l l continue t a be given t o the development of i n t eg ra ted bas ic hea l th s e r v i c e s , laboratory ae rv ices , medical records and s t o r e s management.

Fe l l a r sh ips w i l l cover t h e f i e l d s of pub l i c h e a l t h adminis t ra t ion f o r medical and non-medical o f f i c e r s , nursing and t r a i n i n g i n re levant s p e c i a l t i e s . In-service t r a i n i n g f o r n a t i o n a l s t a f f i s a l s o planned i n 1976, covering the f i e l d s of i n t e g r a t i o n of bae ic hea l th s e r v i c e s and electro-medical equipment.

Assistance i n t h e f i e l d of l a b o r a t o r i e s has been provided s i n c e 1967 under p r o j e c t Nepal 0010. A Centra l Health Laboratory was es tab l i shed i n Kathmandu. as wel l as severa l d i s t r i c t l abora to r i e s . A two-year t r a i n i n g course f a r laboratory e s a i s t s n t s has received regu la r a sa i s t anee and technolo- g i s t s have been t r a ined under t h e WHO fel lowship p r o g r a m .

In 1976, following p r o j e c t formulation, i t was proposed, wi th a s s i s t ance from WHO and UNICEF, t o in t eg ra te t h e l abora to r i e s i n t o t h e e x i s t i n g hea l th se rv ices . The programme envisaged s e t t i n g r i g h t the regional imbalance i n t h e d i s t r i b u t i o n of l a b o r a t o r i e s i n order t o provide a minimum package of se rv ices t o medical and h e a l t h care through t h e operat ion of a t h r e e - t i e r laboratory eervice . To t h i e e f f e c t , a laboratory t echn ica l o f f i c e r w i l l b e i n pos i t ion from 1978 and courses w i l l be held by t h e Centra l Health Laboratory f o r t h e development of t h e t echn ica l manpower.

Assistance t o t h e p r o j e c t i s expected t o continue f a r a number of years .

MCH 001 Family Health Aspects of In ten ra ted Health Services , Si raha and S a p t a r i D i s t r i c t s . Nepal (UNFPA NEP/74/P02)

To a s s i s t i n s t rengthening t h e family planning aspec t s of t h e in teg ra ted hea l th services i n the d i s t r i c t s of Siraha w d Sap ta r i .

For t h i s purpose i n 1976, fe l lowships w i l l be awarded f a r t r a i n i n g i n management of McH/FP ee rv ices wi thin t h e context of general h e a l t h s e r v i c e s , and s study tour t o observe i n t e g r a t e d de l ive ry of MCHIFP se rv ices wi thin t h e baa ic h e a l t h services.

I n 1977, th ree fe l lowships and i n 1978 one fe l lowship f o r post-basic t r a i n i n g i n UCHlFP w i l l be awarded.

NEPAL

MCH 002 Strengthening of Family Health Services

To s t rengthen t h e maternal and ch i ld hea l th aspects of the family h e a l t h programme within t h e in te - gra ted heal th se rv ice del ivery system.

This p ro jec t w i l l operate in c lose co-ordination wi th p ro jec t s NEP HSD 001 and NEP MCH 001 (UNFPA),and w i l l a s s i s t i n r e in fo rc ing t h e development of the family hea l th pragrarmne i n an i n t eg ra ted manner.

There is a need, t o continue t echn ica l advisory se rv ices on a long-term b a s i s t o s t rengthen t h e maternal w d ch i ld hea l th se rv ices , including tho development of r e f e r r a l se rv ices i n maternal and chi ld hea l th i n support of pe r iphe ra l h e a l t h se rv ices . Therefore, a maternal and e h i l d hea l th s p e c i a l i s t w i l l be assigned f o r a per iod of two yea r s c o m n c i n g i n 1978.

Provision has been made f a r r eg iona l fe l lowships i n 1978 and 1979 f a r se rv ice personnel i n t h e maternal and ch i ld hea l th programme. These fe l lowships w i l l be i n areas of family hea l th o the r than family planning.

NUT 003 Nutr i t ion

TO a s s i s t i n organizing a Nut r i t ion C e l l i n the Department of Health Services and i n developing plans f o r n u t r i t i o n a l p r o g r a m s and a c t i v i t i e s .

This is a new pro jec t which follows up t h e recommendations made as a r e s u l t of I C P NUT 001, "Nutr i t ion Training and Advisory Services". Provis ion has been made f o r a long-term medical n u t r i t i a n i a t , who w i l l l i a i s e with UNICEF's programme of co-ordinated se rv ices f o r ch i ld ren , which provides a s s i s t ance to n u t r i t i o n and ch i ld care,primary education and b a s i c hea l th se rv ices a t d i a t r i c t and v i l l a g e I eve l s .

This p r o j e c t i s expected to continue f o r a number of years .

NED 001 Health Education

To a s s i s t with the development of h e a l t h education se rv ices a t t h e Centra l and o the r l e v e l s of the hea l th adminis t ra t ion as an i n t e g r a l p a r t of h e a l t h programmes. I n add i t ion , t o develop school hea l th education i n p r i m r y and secondary schools and teachers ' col leges .

Assistance s t a r t e d i n 1967, when a consul tant made recommendations f o r the f u r t h e r development of hea l th education se rv ices . In 1968-1969, another consul tant reviewed hea l th education i n school8 and i n teacher-trafning i n s t i t u t i o n s and suggested measures f o r e f f e c t i v e co-ordination. A s a f a l l m up o f the in ter-country workshop on school hea l th education (1970). a consultant assisted with a national workshop fo r key teaching and hea l th personnel i n 1970-1971. Fur ther consul tant s e r v i c e s were provided i n 1971 and 1972. I n 1974, a long-term h e a l t h education s p e c i a l i s t was provided and i n 1975 e shor t - term consul tant f a r s i x months.

WHO a s s i s t ance has r e su l t ed i n a plan f o r t h e development of expanded h e a l t h education s e r v i c e s and a c t i v i t i e s i n d i f f e r e n t programmes. To a s s i s t these , a long-tern hea l th education s p e c i a l i s t f o r two years is proposed from 1977 and provis ion f o r f e l l a r s h i p s t o t r a i n hea l th educat ion manpower i n the country is made i n 1976, 1977 and 1978. Funds are a l s o provided i n 1977-1979 f o r group educat ional a c t i v i t i e s and supp l i e s and equipment.

The p ro jec t is expected t o continue u n t i l 1983.

HMD 001 Training of Health Manpower

To a s s i s t i n the t r a i n i n g of hea l th manpower needed f o r the comprehensive hea l th care syatem.

Recognizing the urgency of promoting t h e development of hea l th manpower, the Government e s t ab l i shed t h e I n s t i t u t e of Medicine under Tribhuvan Univers i ty i n 1972. In t h e i n i t i a l s t ages , t h e I n s t i t u t e concentrated an the t r a i n i n g of nurses and some categor ies of a u x i l i a r y personnel, eapec ia l ly hea l th a s s i s t a n t s , s en io r aux i l i a ry hea l th workers, a u x i l i a r y hea l th workers, a u x i l i a r y nurse-midwives. laboratory technicians , radiographer technicians , e t c .

A nurse-midwife educator joined t h e p r o j e c t i n 1975. I n add i t ion , consul tants i n medical education have been provided s ince 1975 to help i n developing t r a i n i n g p r o g r a m s f o r d i f f e r e n t l e v e l s of hea l th workers. In 1976, e radiographer t u t o r and consultants i n the f i e l d s of curriculum development, cornunity medicine and c l i n i c e l sc i ences w i l l be provided.

I t is planned to a t a r t pre-medical t r a i n i n g i n 1977 and p re -c l in ica l and c l i n i c a l t r a i n i n g a f t e r 1978. A new diploma course i n medical sc i ences , general medicine, of 3% yea r s ' durat ion is scheduled t o s t a r t i n 1977. This course should produce "cornunity phvsicians" to s u i t t h e s i t u a t i o n i n Nepal - l m e r i n s t a t u s and t r a i n i n g than an MBBS bu t wi th a t r a i n i n g s p e c i f i c a l l y geared t o meet the s i tua - t ion and needs i n remote areas. Assis tance t o the teaching of nurs ing, b a s i c medical eciencea and community medicine w i l l continue wi th the provieion of long-term and short-term consql tanta i n 1978 and 1979. These consul tants are a l s o expected to be experienced i n educat ional sc iences .

In add i t ion , fellowships f o r the t r a i n i n g of hea l th workers i n d i f f e r e n t f i e l d e w i l l be provided

The p ro jec t i s expected to continue f a r a number of yea r s .

HMO 003 Fellawehips (Nursing) (UNDP NEPl751034)

To a s s i s t i n t h e improvement of nurs ing education and se rv ice through the preparat ion of we l l q u a l i f i e d nursing leaders .

The p ro jec t is f o r a 24 month f e l l o w s l ~ i ~ i n USA for study toward a Master's degree , 1976-1978.

NPD 001 Malaria Eradicat ion

To a s s i s t the malar ia e rad ica t ion p r o g r a m

The malaria con t ro l p i l o t p r o j e c t wi th WHO a s s i s t ance , s t a r t e d i n 1954, l ed t o the development of the malaria e rad ica t ion p r o g r a m , which c o m n c e d i n 1958 with US AID ass i s t ance . The progranrme progressed s a t i s f a c t o r i l y till 1970, when only 2500 malar ia cases were recorded. The progranrme underwent s revi- s i o n i n 197011971. A s t r a t e g y review recommended minimum requirements of t h e p rograme t o maintain the gains achieved and t h e development of i n t e g r a t e d h e a l t h s e r v i c e s . US AID a s a i s t m e e wae a v a i l a b l e t i l l 1973.

There was an increaee i n the incidence of malaria i n 1973 and 1974, though the re was a s l i g h t dec l lne i n the number of cases i n 1975. WHO and UNDP a s s i s t e d wi th t h e provis ion of DDI i n 1974. A " s i t u a t i o n anelyeis" was ca r r i ed out j o i n t l y by s GovernmentlWHOIUS AID team i n 1975 which l e d t o US AID and UNDP ass i s t ance f o r t h e programme f o r f i v e years . A review of t h e ant i -malar ia a c t i v i t i e s i n 1975 was ca r r i ed out j o i n t l y by the Government, WHO and US AID e a r l y i n 1976.

Out of a t o t a l ~ o p u l a t i o n of 12.56 mi l l ion , 7.27 mi l l ion of which l i v e s i n malarious areas, t h e programme covers 6.63 mi l l ion .

WHO a s s i s t ance i n 1976 w i l l be t h e same as i n 1975, wi th increased supp l i e s and equipment, but i n 1977 w i l l include an entomologist i n add i t ion to the long-term s t a f f provided i n 1976. In 197811979 support t o the entomological ae rv ices of t h e p r o g r a m w i l l continue. Assistance f o r supp l i e s and equipment i n 1978 and 1979 w i l l be a t a reduced l e v e l .

314

NEPAI

SP1 001 Smallpox Eradicat ion

To achieve t o t a l e rad ica t ion of smallpox i n the country by 1977.

A p i l o t smallpox p ro jec t was s t a r t e d i n Kathmandu Valley i n 1962, and s ince 1970, WHO has provided a publ ic hea l th o f f i c e r , an operat ions o f f i c e r , fe l lowships , subsidy and supp l i e s and equipment. I n 1972, a second operat ions o f f i c e r vas added. The pub l i e h e a l t h o f f i c e r continued up t o mid-April 1976. By 1973, the programme had been implemented throughout t h e 75 d i s t r i c t s i n Nepal. A c t i v i t i e s included conduct of r egu la r t r a i n i n g courses f a r t h e l o c a l s t a f f , c rea t ion of su rve i l l ance teams, and weekly repor t ing from a l l d i s t r i c t s . Changes were made i n t h e organizat ion and schedule of rou t ine vsccina- t i ans . Transport facilities were made ava i l ab le . The s teady s t rengthening of t h e eu rve i l l ance and vaccinetion programmes during t h e l a s t few yeara has r e su l t ed i n Nepal a t t a i n i n g a nan-endemic s t a t u s i n 1973 and i n e f f e c t i v e l y combating t h e numerous importa t ions i n t o the country.

The l a s t case i n Nepal occurred an 6 Apr i l 1975: s ince t h a t da te su rve i l l ance measures u t i l i z i n g heal th workers have been implemented i n a l l areas of the country. Each v i l l a g e is v i s i t e d a t l e a s t once every th ree months and enqu i r i e s are made.

I t i e proposed t h a t s ahort-term c o n s u l t w t v i s i t Nepal from 1 August 1976 f o r 6-8 weeks and again i n the spr ing of 1977 f o r a s i m i l a r per iod, t o a s s i s t i n prepar ing t h e docurenta t ion of the p ro jec t .

I t is proposed t h a t t h e present l e v e l of su rve i l l ance be maintained u n t i l the v i s i t of the Commission which is scheduled f o r Apr i l 1977.

The p ro jec t w i l l end i n Deceuber 1977,

BM 001 Leprosy Control

To e s s i e t i n t h e development and expansion of t h e leprosy con t ro l p ragrame and i n the t r a i n i n g of na t iona l s t a f f .

I n 1965. leprosy con t ro l a c t i v i t i e s s t a r t e d i n c o d i n a t i o n wi th p r o j e c t Nepal 0016. "Tuberculosis Control". The p r o j e c t i t a e l f s t a r t e d i n 1967, end a review was undertaken i n 1969 through consul tants provided under SEAR0 0138, "Seminars and Training Courses i n Leprosy Control Methadology". I n 1972- 1973, a consul tant a s s i s t e d i n organizing a course i n leprosy con t ro l . A leprosy con t ro l o f f i c e r was provided i n 1974-1975 and t h i s provis ion w i l l be continued u n t i l 1978.

Leprosy con t ro l a c t i v i t i e e have been expanded to the d i s t r i c t l e v e l i n conformity with t h e F i f t h Five- Year Development Plan (1975-1976 - 1979-1980) of t h e Government. I n 1976 a consul tant w i l l review and assess t h e con t ro l programme and a s e i e t i n a t r a i n i n g course i n leprosy control . I n 1978, a cansu l t rn t w i l l a s s i s t i n evolving guidel ines f o r t h e development of t h e leprosy p r o g r a m as an i n t e g r a l p a r t of t h a general h e a l t h se rv ices and i n t r a i n i n g the r e f e r r a l r eg iona l medical o f f i c e r s ( leprosy) .

BM 002 Tuberculosis Control

To a s s i s t i n developing a tube rcu los i s con t ro l programme as p a r t of the b a s i c h e a l t h s e r v i c e s , and i n t r a i n i n g personnel.

The p ro jec t s t a r t e d i n 1965, and a medical o f f i c e r (1965-1967) and a pub l i c h e a l t h nurse (1965-1970) were provided. BCG vaccinat ion is c a r r i e d out sys temat i ca l ly i n Kathmandu Valley through maternal and ch i ld h e a l t h and r u r a l hea l th cen t res ; mobile teams have been operat ing i n o t h e r p a r t s of t h e country. B ~ c t e r i o l a g i c a l case-finding and ambulatory t reatment a r e c a r r i e d out from the Tuberculosis Centre i n Kathmandu and a few cen t res e l s e h e r e . I n 1973, a medical o f f i c e r was appointed to a s s i s t With t h e development of t h e programme.

The Government's F i f t h Five-Year Plan and t h e d r a f t p r o j e c t formulation docunent envieage BCC vaccina- t ion of the e l i g i b l e populat ion i n t h e whole country; maintenance of BCG vaccinat ion; es tabl ishment of four regional p ro jec t o f f i c e s - one i n each development region and csse-f inding and treatment through t h e e x i s t i n g and developing b a s i c h e a l t h se rv ices .

A medical o f f i c e r has been a s s i s t i n g t h e p ro jec t s i n c e 1974-1975 and w i l l continue i n 1976. A con- s u l t a n t a l s o w i l l be assigned i n 1977, 1978 and 1979.

Fellowships were provided i n 1974-1975 and v i l l be provided i n f u t u r e years up t o 1979.

Assistance to t h e p r o j e c t i s expected t o continue f o r some years .

NEPAL

5.1.4 Smallpox Eradication end Expanded Programme of Immunization

Smallpox Eradication

Public health officer P4 Operations officer P2

Short-term consultants Fellowships Participants Subsidy Supplies and equipment

5.1.5 Bacterial and Virus Diseases

Leprosy Control

Leprosy control officer P2


Tuberculosis Control

Medical officer P4

Short-term coneultants Fellowships Supplies and equipment

1976

11 4 1/12

2

11 3 21 6

1/12

-- 11 3 11 3

11 9 - 1 - 4/12

Revised

1976

- 39 300

9 000 2 400 4 000 51 000 12 000

117 700

26 900

9 000 1 200 600

1 000 - 38 700

27 800

4 800 500

33 100

1979

Number

1977

1/12 --

1 --

11 3 21 6

1/12 --- 1 1

Estimates

1977

28 500 - 28 500

10 500 2 400 14 000 64 000 9 800

-- 129 200

--

28 500

1 200 600

1 000

31 300

10 500 7 200 6 000

23 700

of Poets

1978

1/12

1

Propoaala

s "

RB

RB

RB

11 3

1/ 3 6/18

1978

-

project NO.

SPI 001

BYD 001

B M 002

11 3 - I 21 6 21 6

11 3 1/ 3 8/22 6/18

1979

30 300

12 000 3 200 800

1 000

47 300

12 000 12 200

24 200 -

3 800 800

1 000

5 600

13 500 11 400 6 000

30 900 -

316

NEPAL

%SM 001 Co-nity Water Supply and San i t a t ion

To a s e i s t i n t h e planning, organizat ion and implementation of a long-term, comprehensive n a t i o n a l p ros reme of cornunity water aupply and waste disposal.

The p ro jec t s t a r t e d i n 1971 with t h e assignment of a s a n l t a r y engineer , and a second aan i t a ry ensineer was assigned i n 1975 t o provide advisory se rv ices t o t h e Department of Local DevelopMnt, HinistIY of Home and Panchayat, which is responsible f o r r u r a l water supply and s a n i t a t i o n , on mattarm r e l a t i n g to the development of t h e progrrume. I n add i t ion , fe l larahipm f o r poor-graduate o tud ias i n publ ic hea l th engineering and fa r s h o r t observat ion tour s of water supply and ani it at ion syatemn w i l l a l a o be provided i n 1976-1979.

During the 1975-1980 plan per iod, 35 p r o j e c t s pe r year a r e expected t o be constructed and campissionad.

UNICEF is providing auppl iea end equipment.

Assistance t o t h e p r o j e c t i a expected t o continuo u n t i l 1980.

PIP 001 Developn~nt of Water Supply and Sewerape i n Greater Karh-du and Bhaktspur (UNDP NEP1701508)

This p r o j e c t w i l l te rminate i n 1976.

319 SRI WLNKA - Index

Project No.

ASE 001

BLG 001

BSH 002

CAN 001

CVD 001

DHS 001

ESD 002

ESP 001

HED 001

HED 002

HMD 001

HMD 002

HMD 004

HMD 005

HMD 006

HMD 007

HMD 008

HMD 009

*Project

Project T i t l e

Country Statement

Off ice of the WHO Representative

Production of Improved Vaccines (LAB 002)*

Provision of Basic Sani tary Services

Cancer Epidemiology and Research

Cardiovascular Disekses

Health S t a t i s t i c s

Strengthening of Survei l lance and Control of Comunicahle Diseases

Food Hygiene

Health Education

Health Education i n Family Health

Medical Education

Nursing Adviaory Services

Post-graduate Scholarships f a r Training Univers i ty Probationary Ass i s t an t Lecturers

Health Manpower Study

Strengthening of N ~ r s i n ~ l M i d v i f e r y Education

Teaching of Human Reproduction, Family Planning and Population Dynamics t o Medical Students

Post-graduate Teaching of Coonnunity Medicine

Training i n Publ ic Health

number p r i o r t o t h e cu r ren t programe

320

345

340

342

334,414

336

344

332

342

326

328

328,414

328.414

328

330

330

330

330

330

s t r u c t u r e .

Project No.

HSD 001

HSD 002

HSD 003

HSD 004

HSD 005

HWP 001

LAB 001

M 0 1 001

HNH 001

MPD 001

MPD 002

N U l 001

OM 001

PHA 001

PPS 001

RAD 001

SES 001

VPH 001

WC 001

Project T i t l e

Medical Rehab i l i t a t ion (SHS 001)*

P a r t Health Services (SHS 002)*

Strengthening of Electro-medical Division (SHS 004)*

Training of Anaesthesiologis ts (SHS 005)*

Medical Stores Managernent(SHS 007)*

Occupational Health and I n d u s t r i a l Hygiene

Strengthening of Laboratory Services

Family Health

Mental Health

Malaria Eradicat ion

F i l a r i a s i s Control

Publ ic Health Nut r i t ion

Oral Health (DNH 001)*

Qual i ty Control of Biologicale and Pharmaceutical Products(SQP 001)*

National Health Planning (SHS 003)*

Radiation Health

Undergraduate Training i n Publ ic Health Engineering

Veterinary Publ ic Health - Control of Rabies i n S r i Lanka

Vector Control

Page

322

322

324

324

324

338

340

324

336

332

332

326

336

338

322

338

342

334

334

SRI LANU

GENERAL - The Republic of S r i Lanka, with a population of 13.5 mi l l ion , has declared i t s i n t e n t i o n t o broaden t h e pol icy of o v e r a l l economic development under which populat ion and hea l th care se rv ices receive p r i o r i t y . The objec- t i v e s of t h e Government are t o achieve complete i n t e g r a t i o n , improve h e a l t h coverage and environmental hea l th and s t rengthen hea l th manpower requirements.

There i s a grar ing awareness of t h e need f o r t echn ica l knowledge, manpower and appropr ia te planning and co- ordinat ion of the above progr-s f o r more e f f e c t i v e del ivery of hea l th care throughout t h e country.

The F i r s t Five-Year Plan (1972-1976). i n which most emphasis ha8 been placed on prevention. h e a l t h education, improvement of hea l th se rv ices and broader coverage wi th baa ic h e a l t h s e r v i c e s , i s now expected t o t u r n towards emphaeining E m i l y hea l th , the e x p a d e d p r o g r a m of immunization, development of hea l th manpover f a c i l i t i e s a t post-graduate l e v e l , and provis ion of and g r e a t e r coverage wi th b a s i c s a n i t a r y measures.


The Planning Unit of t h e Ministry of Heal th i s responsible f o r co-ordinsting plans f o r fu tu re h e a l t h a c t i v i t i e s .

The Govemmnt has placed high p r i o r i t y on expanding t h e indigenous ayurvedic se rv ices and a gradual co-ordination and col laborat ion wi th the Western medical system.

The family hea l th programme i s one of t h e major programmes of t h e Minis t ry of Health and a l l t h e a c t i v i t i e s are aimed a t broader maternal and ch i ld care, improved family n u t r i t i o n , i m u n i z a t i a n of i n f a n t s and chi ldren, improvement of t h e home environment, h e a l t h educat ion, school h e a l t h and family planning. This programme is expected t o receive considerable a s s i s t ance from SIDA and LNFPA. The se rv ices programme is conducted through a network of c l i n i c s s c a t t e r e d a l l Over t h e i s l a n d and Some form of family planning method is w e d by 44% of married womn of reproductive age so t h a t t h e b i r t h r a t e , over 1000 which was 30.1 i n 1973. f e l l t o 27.3 i n 1974. The r a t e of na tu ra l inc rease var ied from 2 .2% i n 1971 t o 1.8% i n 1974. After the mid-term review of the LNFPA-aseisted p r o j e c t s , in addi t ion to increased coverage, In tens ive Implementation D i s t r i c t s w i l l be developed, which would, i n the next five-year programme, se rve t o demonstrate in t ens ive implementation of family hea l th and maternal and ch i ld hea l th se rv ices . They would a l s o serve for opera t iona l research and the study of methods f o r the t r a i n i n g of var ious categor ies of hea l th personnel i n family hea l th p rac t i ces .

The Ministry of Heal th ' s l a r g e s t in t e rven t ion p r o g r a m i s t h e "Tripasha" programme, wi th in t h e family h e a l t h programme. "Triposha" is a pre-cooked, f o r t i f i e d weaning food mainly composed of a wheat-aoye blend. The control of n u t r i t i o n a l anaemias i n about 160 000 pregnant mothers w i l l b e by provis ion of i r o n t a b l e t s through maternal and chi ld hea l th network.

WHO Assistance. The Organization continues t o a s s i s t the hea l th planning and programming a c t i v i t i e s . By means of a c ross - s t ruc tu ra l p ro jec t , embracing medical, nurs ing and hea l th education and the s t rengthening of hea l th se rv ices , and i n co l l abora t ion with UNICEF, i t w i l l he lp t o develop t h e n a t i o n a l p r o g r a m through consul tant se rv ices , fellowships, and supp l i e s and equipment in var ious f i e l d s , such as medical r e h a b i l i t a t i o n , h e a l t h s t a t i s t i c s , n u t r i t i o n , hea l th education, e t c .

Health Hanpawer Development

The Government has been taking measures t o expand r a t i o n a l l y t h e hea l th manpower development. A n a t i o n a l committee of exper ts was s e t up t o analyse and u t i l i z e the r e s u l t s of t h e hea l th manpower study f a r fu r the r developing pa t t e rns f o r manpower u t i l i z a t i o n of exper t s .

Undergraduate medical t r a i n i n g i n S r i Lanka is provided by t h e two Facu l t i e s of Medicine of the University of S r i Lanka, i n Colombo and Peradeniya.

The most important development has been the es tabl ishment , i n February 1976, of t h e I n s t i t u t e of Post-graduate Medicine, t o provide post-graduate s p e c i a l i s t t r a i n i n g i n medicine, paed ia t r i c s , surgery, gynaecology, obate t - r i c s , radiology and anaesthesialogy during t h e f i r s t planning period 197611977. and l a t e r i n microbiology, pathology, ophthalmology and d e n t i s t r y . This t r a i n i n g programme i a designed t o enable l o c a l graduates t o have higher t r a i n i n g within the country.

The Government does not in tend t o develop a new category of primary hea l th worker a8 i t i s convinced t h a t the task of the primary heal th worker could b e developed by a midwife whose t r a i n i n g w i l l be appropr ia t e ly e t rengthened and supplemented.

WHO Assistance. WHO w i l l continue t o a s s i s t i n t h e t r a i n i n g of medical undergraduates and past-graduates, including t r a i n i n g i n se l ec ted specialties and w i l l continue i t s support t o the f a c i l i t i e e of t h e Medical Teachers' Training Centre a t Peradeniya and t o t h e i r me on a r eg iona l bas i s . Continued ass i s t ance w i l l a l s o be given f o r t h e development o f nurs ing and midwifery education and i n the organizat ion o f courses i n nurs ing education by providing consul tants end fe l lowships . The development of i n t e g r a t e d c u r r i c u l a f a r the teaching of human reproduction, family planning, populat ion dynamics and psychiat ry i n medical schools w i l l be f u r t h e r supported.


Malaria continues t o b e t h e main ~ r o b l e m i n most p a r t s of t h e country. Increased d e n s i t i e s of Anophelew cutici- faciee, t h e only e s t ab l i shed vec to r of t h e d i sease , are assoc ia ted wi th drought condi t ions , t h e p re fe r red breeding places being pools remaining i n t h e d r i e d up r i v e r beds.

In 1975, 400 000 cases of malar ia have been reg i s t e red and i t i s bel ieved t h a t t h i s i s only ha l f the ac tua l number. A " s i tua t ion analysis ' ' c a r r i e d ou t by e WHOfGovernment J o i n t Team has suggested t h a t t h e Government change the i n s e c t i c i d e from DDT t o malathion spraying and launch an in tens ive programme within t h e next f i v e years, under which t h e d i sease should b e brought under complete control . At t h e same time, recommendations were made t h a t DDT spraying aa we l l as malathion should be abolished f o r use i n ag r i cu l tu re . It has also been recommended t h a t reorganizat ion of t h e machinery f o r t h e con t ro l p r o g r a m and s t rengthening of t h e geagraphi- c a l su rve i l l ance should b e ca r r i ed out wi thin t h e f i r s t Wo years of t h e five-year programme.

I n the f i e l d of f i l a r i a e i s , which i s endemic i n the south-west coas ta l b e l t , about 2.5 mil l ion people are a t r i sk . Through t h e F i l a r i a s i s Control Programme, t h e in fec t ion r a t e has nov been brought d m t o 0.49% and the measures used i n the control are di rected both against the vector as wel l a s t h e pa rae i t e .

The Tuberculosis Control Programme, which i s ca r r i ed out as a s p e c i a l campaign, has e ighteen cheat c l i n i c s and twenty-one chest v i s i t i n g c l i n i c s , and these have a t o t a l of 2150 beds. This programme has been in teg ra ted with t h e general medical care se rv ices a l l over the i s l a n d and 71% of t h e cases under treatment have been bac te r io log ica l ly confirmed. The prevalence of bac te r io log ica l ly confirmed cases i s 2.3 per thousand.

WHO Assistance. WHO'S main e f f o r t s are directed towards malaria e rad ica t ion ; f u r t h e r assistance w i l l be given i n s t rengthening epidemiological su rve i l l ance , i n general, and laboratory se rv ices , i n p a r t i c u l a r , i n support of conmunicable disease control . A vector con t ro l programme i a being ca r r i ed out wi th WHO and LNDP ass i s t ance . The control and prevention of cardiovaecular d iseases and cancer w i l l b e supported.


The Government is keenly aware of t h e environmental h e a l t h p rob lem b e s e t t i n g t h e country.

The most important development i n the f i e l d of environmental h e a l t h has been t h e cont inuat ion of t h e rural water supply schemes. Twelve water schemes have been completed out of 55 and 39 are expected t o be completed within the next two years. I n addi t ion, a t e n t a t i v e time schedule has been completed f a r progremee expected to be generated by t h e National Plan f o r provis ion of access t o s a f e water and s a n i t a r y exc re ta dieposal f o r the e n t i r e population of S r i Lanka by the year 2001.

WHO Assistance. WHO w i l l a s s i s t t h e programme through a s a n i t a r y engineer. The na t iona l endeavour to provide access t o safe water and s a f e exc re ta d i sposa l syetema f o r t h e e n t i r e r u r a l population i s being supported.

Assistance w i l l a l so be given i n s t rengthening occupational hea l th se rv ices , i n the development of food hygiene and control measures, and i n a review of t h e e x i s t i n g organizat ional s t r u c t u r e and operat ional procedures, by providing consul tants , and fellowships f o r s p e c i a l t r a i n i n g of sen io r personnel engaged i n food production, food handling, e t c . , w i l l be awarded. Assistance to r ad ia t ion hea l th se rv ices , radiology, radiotherapy and nuclear m d i c i n e , which has been given i n the paet , w i l l be continued.

WS 001 National Health Planning

To a s s i s t i n t h e es tabl ishment and s t rengthening of a h e a l t h planning u n i t i n t h e Minis t ry a f Health, and i n t h e t r a i n i n g of s t a f f .

I n 1970, two consul tants were provided t o study t h e p o t e n t i a l development of t h e h e a l t h planning u n i t , and two members of t h e planning u n i t a t tended t h e regional course on h e a l t h planning under SEARO 0178, "National Health Planning and Manpower Studies". I n 1971, f u r t h e r preliminary s tud iaa were undertaken under SEARO 0148. "Strengthening and Development of Health Services". S r i Lanka 0101, "Health Manpower Study", and in te r - reg iona l p r o j e c t s NHP 0001, "Co-ordination of Manpower Surveys", and MS 0004, "Ut i l i za t ion and Training of Manpower", and e consul tant a s a i s t e d i n t h e f u r t h e r development o f t h e h e a l t h planning un i t . In 1972, a pub l i c h e a l t h adminis t ra tor a s s i s t e d wi th s- components of t h e n a t i o n a l h e a l t h manpaver study.

In 1974, a eonsul tant a s s i s t e d in s t r eng then ing t h e n a t i o n a l h e a l t h planning funct ion of t h e M i n i s t r y of Health and s t imulated and guided decia ions f o r implementation. Health o r i e n t a t i o n courses f o r h o s p i t a l adminiet ra tors were organized in 1975 and 1976.

The National Health Manpower Study was completed in 1975. I n 1976 and 1977, a consul tant w i l l review t h e hea l th de l ive ry system i n t h e l i g h t of medium-term h e a l t h planning. I n 1977 and 1978. i n co l l a - borat ion with in ter-country p m j e c t SE ICP PPS 002, "Strengthening of Health Services Administration Through Training in Planning", a s s i s t ance w i l l be provided in t h e conduct of n a t i o n a l courses on h e a l t h systems management. Short observat ion fe l lowships f o r sen io r s t a f f and a fe l lowship each in 1977, 1978 and 1979 f o r DPR majoring in h e a l t h planning w i l l be awarded.

The p ro jec t is l i k e l y t o continue f o r some years.

HSD 001 Medical Rehab i l i t a t ion

To a s a i a t i n t r a i n i n g personnel and s t rengthening f a c i l i t i e s f o r community-riented r e h a b i l i t a t i o n services .

In 1968 and 1970, a consul tant advised on t h e manufacture of appl iances end on t h e management of the orthopaedic workshop a t t h e General Hospi ta l . Colombo. He a l s o a s s i s t e d i n t h e t r a i n i n g of p r o s t h e t i c and o r t h o t i c technicians . A review of t h e p r o j e c t was undertaken i n 1971. and i n 1972, a consul tant a s s i s t e d i n t h e development of medical r e h a b i l i t a t i o n services and reviewed t h e c u r r i c u l a i n t h e f i e l d of medical r e h a b i l i t a t i o n . In 1973, an occupat ional therapy t u t o r a s a i s t e d i n a s sess ing t h e e x i s t i n g e i t u a t i a n of occupat ional therapy se rv ices i n t h e h o s p i t a l s and i n drawing up a curriculum f o r a School f a r Occupational Therapy. I n 1974, fe l lowships were awarded f o r t r a i n i n g i n medical r e h a b i l i t a t i o n .

In 1975, e consul tant v i s i t e d t h e r e h a b i l i t a t i o n cen t res i n S r i Lanka, demonstrated t h e uae of simple dev ices l s ids made from indigenous m a t e r i a l f o r o r t h o t i c and p r o s t h e t i c purposes and advised on t h e optimum use of e x i s t i n g r e h a b i l i t a t i o n f a c i l i t i e s . H e a l s o a s s i s t e d i n t h e t r a i n i n g of t echn ic ians and hea l th personnel.

In 1978 and 1979 short-term fe l lowships w i l l be awarded f o r t h e t r a i n i n g of t echn ic ians i n medical r e h a b i l i t a t i o n . Technical a s s i s t ance w i l l be provided f a r t h e t r a i n i n g o f middle-level personnel in new a reas of medical r e h a b i l i t a t i o n work.

The p ro jec t i s expected t o continue u n t i l 1979.

HSD 002 Por t Health Services

TO a s s i s t i n s t rengthening por t h e a l t h s e r v i c e s .

The p ro jec t was operated i n co-ordination wi th t h e in ter-country p ro jec t SEARO 0169, "Port Health Services", under which WHO provided a consul tant in 1969. Fellowships ere being awarded each year. Consultant a s s i s t ance h a s been provided i n 1973 i n t h e f i e l d s of epidemiology o f quarant inable d i m e a r s , improvement of por t environmental h e a l t h condi t ions and t h e d i s i n f e c t i o n of container.. In 1974, a consul tant advised on por t h e a l t h meaeures ou t s ide Colombo; t h r e e fellowshipa and supp l i e s and equipment were a l s o provided. During t h e yea r s 1976-1979 fe l lowshipe w i l l be awarded f o r DPHhPH and f o r s a n i t a r y inspec to r s t o s tudy new techniques.


SRI LANKA

HSD 003 Strengtheninp of Electra-medical Division

TO advise on and a s s i s t i n t h e t r a i n i n g of electro-dice1 r e p a i r t echn ic ians and t h e improvement of maintenance workshops t o underteke r e p a i r s t o X-ray equipment and o t h e r types of e l e c t r i c a l and e l e c t r o n i c instruments i n h e a l t h i n s t i t u t i o n s .

In 1972. a consultant was assigned t o t r a i n t echn ic ians . In September 1974, a long-term e l e c t r o - medical engineer was provided t o the p ro jec t t o t r a i n n a t i o n a l s t a f f and t o a s s i s t t h e Government in t h e development o f a t r a i n i n g p r a g r m e . Fellowships f o r e l e c t r o n i c engineers and t e c h n i c i w e w i l l continue t o be provided.

The project i s expected t o continue u n t i l 1980.

HSD 004 Training of Anaesthesiolagis ta

To a s s i s t i n e s t a b l i s h i n g a na t iona l t r a i n i n g cen t re in anaestheaiolagy.

In 1969, two sen io r consul tants from t h e Anaeathesialogy Centre, Copenhagen, v i e i t e d S r i Lanka and p lans were made t o r e -es t ab l i sh the diploma course. A consul tant . aaaigned i n 1971 (under SRL HnD 001, 'Wedieal Education"), advised an t h e development of t h i s spec ia l ty . It i s proposed t o ass ign s consul tant each i n 1976 and 1977 to a e s i s t in t h e development o f a post-graduate t r a i n i n g programme. Similar assistance is planned i n 1978 and 1979 f a r t h e organizat ion and conduct of t r a i n i n g courses, and for evaluat ion.

The p ro jec t is expected t o continue u n t i l 1979.

HSD 005 Medical Stores Management

TO a s s i s t i n t h e s t rengthening and expansion of medical s t o r e s and aupply se rv ices .

I n 1965, a consul tant , assigned m d e r p ro jec t Ceylon 0023, assessed t h e s i t u a t i o n i n t h e f i e l d of medical s t o r e s and advised on t h e improvement and decen t ra l i za t ion of t h e s t o r e s . I n October 1973, t h e same consul tant v i s i t e d S r i Lanka under p ro jec t SEAR0 0143, " P h a m c e u t i c a l and Medical S to res Management", as a follow-up of h i a previous assignment. Fellowships and suppl ies and equipment w i l l be provided t o s t rengthen t h i s a c t i v i t y f u r t h e r .

Aesiatence to the p r o j e c t i s eltpected t o continue u n t i l t h e end o f 1980.

MM 001 Family Health (UNFPA SRLI72lP04)

To a s s i s t i n promoting family h e a l t h as an i n t e g r a l p a r t of t h e general h e a l t h se rv ices

S t a r t i n g with a fe l lowship p rograms i n 1971, t h e UNFPA-assisted p r o j e c t has t h e ob jec t ives of s t rengthening t h e adminis t ra t ive organizat ion responsible f o r t h e n a t i o n a l family h e a l t h programme; in - se rv ice t r a i n i n g and o r i e n t a t i o n of h e a l t h personnel of d i f f e r e n t ca tegor ie s , including s fel lowehip and study tour pragr-e f o r doctore , nu r ses , and administrators; improving t h e q u a l i t y o f family hea l th se rv ices wi th bu i ld ing and equipment inpu t s and replanning of s e r v i c e rou t ines , and on-going programme evaluat ion and research.

An advisory team cons i s t ing of a medical o f f i c e r , a nurse and a s t a t i s t i c i a n i s assigned t o t h e p ro jec t . From the l a s t q u a r t e r of 1976, only t h e medical o f f i c e r w i l l remain i n t h e p ro jec t . Although t h e p ro jec t was o r i g i n a l l y planned for completion i n 1976. i t was extended up t o 1977. A proposal t o continue t h e p ro jec t up t o 1981 is under formulation i n consu l t a t ion wi th t h e Government and UNFPA.

326

SRI LANKA

NUT 001 Publ ic Health Nutr i t ion

To a s s i s t in developing n u t r i t i o n a l a c t i v i t i e s wi thin t h e h e a l t h se rv ices and i n t r a i n i n g na t iona l s t a f f i n f i e l d s r e l a t e d t o n u t r i t i o n i n pub l i c hea l th .

The pragrame s t a r t e d i n 1969 with a p i l o t p r o j e c t on t h e con t ro l of n u t r i t i o n a l anaemia i n pregnant women and fellowships f o r laboratory technicians . A consul tant was provided i n 1971-1972 t o develop programes against n u t r i t i o n a l anaemias and i n 1975 another consul tant was assigned t o eva lua te n u t r i t i o n programmes i n pub l i c h e a l t h and t o recommend measures t o s t rengthen them.

In 1976, 1977 and 1979 consu l t an t s w i l l be provided t o follow up on t h e recommendations made i n 1975 and t o plan f o r f u r t h e r n u t r i t i o n a l a c t i v i t i e s i n the pub l i c h e a l t h n u t r i t i o n p r o g r a m s . Fellowships f a r 1978 and 1979 w i l l concentra te on t h e t r a i n i n g of DPHB majoring i n n u t r i t i o n .

The p ro jec t i s expected t o continue u n t i l t h e end of 1979.


To a s s i s t in s t rengthening h e a l t h education s e r v i c e s , including school h e a l t h educat ion, and i n evalua- t i n g hea l th education a c t i v i t i e s ; t o a s s i s t i n s t r eng then ing hea l th education teaching i n medical co l l eges , i n schools f o r o t h e r hea l th profeseionala , teacher t r a i n i n g i n s t i t u t i o n s and i n o t h e r t r a i n i n g cen t res .

In 1966, 1967 and 1969, coneul tants reviewed hea l th education programmes and advised on t h e reorganiza t ion and s t rengthening of t h e s e r v i c e s a t d i f f e r e n t l e v e l s of t h e h e a l t h adminis t ra t ion. As a follow- up of t h e in ter-country workstop he ld i n 1970, a school h e a l t h education s p e c i a l i s t a s s i s t e d , i n 1971, i n conducting a n a t i o n a l workshop f a r educat ional admin i s t r a to r s , teacher educators and school h e e l t h o f f i c e r s . A h e a l t h education s p e c i a l i s t has been assigned s ince 1972. A consul tant a s s i e t ed i n developing the teacher t r a i n i n g programme in 1973. Pram 1977 t o 1979 consu l t an t s w i l l be assigned t o a e s i s t i n t h e development of h e a l t h education cu r r i cu la f o r medical schoo l s , schools f o r o the r h e a l t h p ro fess iona l s and o the r s and t o develop the necessary l ea rn ing resource mate r i a l . Workshope w i l l a l s o be organized. Fellowships w i l l be provided f o r post-graduate t r a i n i n g i n hea l th education wi thin t h e Region as wel l as f o r shor t observat ion toura f o r s e n i o r h e a l t h education personnel.

The p r o j e c t ' s a c t i v i t i e s are c o a r d i n a t e d wi th those of SRL HED 002, 'Wealth Education i n Family Health".

Assistance t o t h e p ro jec t i s expected t o continue u n t i l t h e end of 1983.

m

% 3 '

RE

RE

SRI LANKA

3.2.4 N u t r i t i o n

P u b l i c Heal th N u t r i t i o n

Short- term c o n s u l t a n t s Fe l lowships S u p p l i e s and equipment

3.2.5 Heal th Educa t ion

Heal th Educa t ion

Heal th e d u c a t o r P4

Short- term c o n s u l t a n t s Fe l lowships P a r t ~ c i p a n t s S u p p l i e s and equipment

P r o j e c t NO.

NUT 001

HED 001

Revised

1976

6 000 2 600 1 000

9 600

34 500

3 000 2 000

39 500 -

1976

11 2 11 3

1 /12 -

1 -

1/12

Proposa l8

1978

9 100

9 1 0 0 -

32 000 9 600 2 000 1 000

44 600 -

E s t i m a t e s

1977

7 000 2 400 1 000

1 0 400

3 500 2 400

200

h 1 0 0 -

1979

9 000 9 500

1 8 500 -

9 000 10 000 4 000

500 - 23 500 -

Number

1977

11 2 21 6

11 1 21 6

of P o s t s

1978

1 / 1 2

21 8 2/24

1979

1/ 2 1 /12

11 2 2/24

SRI LANKA

HED 002 Health Education i n Family Health (UNFPA SRL/72/P01)

To promote family hea l th through h e a l t h educat ion; t o support family hea l th education a c t i v i t i e s with audio-visual and mass comunicat ion media; t o t r a i n h e a l t h p ro fess iona l s f o r h e a l t h education r e s p o n s i b i l i t i e s i n t h e f i e l d of family h e a l t h , and t o undertake research t o provide d i r e c t i o n s f o r h e a l t h education a c t i v i t i e s end t o eva lua te e f fec t iveness of euch a c t i v i t i e s .

Fallowing t h e recormendations of t h e United Nations/UNESCO/WHO Family Planning Evaluation Mission t o s r i Lanka, i t was proposed t o s t rengthen h e a l t h education i n t h e family h e a l t h programme, inc lud ing assesssen t of present hea l th education se rv ices , research, and c o r n m i c a t i o n media. The earlier p r o j e c t s S r i Lanlca 0098, "Behavioural Studies" , S r i Lanka 0099, "Assessment and Strengthening of Health Education in Family Health" and S r i Lanka 0100, "Health Education i n Family Heal th Teaching Programmes" were incorporated i n t h e present p ro jec t . In add i t ion , t h e p r o j e c t was c lose ly r e l a t e d t o S r i Lanka W72, "Development of Health Education", and wi th t h e a c t i v i t i e s of o t h e r UNWA-eupparted programea in S r i Lanka.

I n 1971, two consul tanta under p r o j e c t S r i Lanka 0099 reviewed h e a l t h education se rv ices i n t h e country. S imi la r ly , another consul tant a s s i s t e d , i n 1971, under p r o j e c t S r i Lanka 0072, i n f u r t h e r developing school hea l th and populat ion education i n the educat ional system of t h e country.

In 1972, two coneul tants were provided t o a s s i s t i n s t u d i e s r e l a t e d t o t h e development of a s o m d educat ional s t r a t e g y f o r r e a l i z i n g t h e goa l s of family hea l th . In 1973, a team of two consu l t an t s a s s i s t e d in t h e h e a l t h behaviour s t u d i e s and one i n t r a i n i n g . I n 1974, a consul tant a s s i s t e d i n reorganizing Health Education Media Production Unit i n o rde r t o be ab le t o produce b e t t e r and d i e t r i b u t e pr inted and other a i d s t o support hea l th education a c t i v i t i e s . Two o t h e r consul tants i n t h e f i e l d of beheviaural sc iences a s s i s t e d , i n 1974 and 1975. A number of fe l lowshipe, equipment and suppl ies were a l s o provided.

In 1976 and 1977, f u r t h e r a s s i s t ance w i l l be provided f o r t h e i n t e g r a t i o n of hea l th education i n t h e family hea l th programme, behaviaural s t u d i e s , mass communication and audio-visual a ids , hea l th education dermnstration and s tudy p r o j e c t s and f o r t r a i n i n g i n h e a l t h education.

The p ro jec t i s expected t o terminate i n 1977.

IMD 001 Medical Education

To a s s i s t i n f u r t h e r developing t h e undergraduate and past-graduate teaching programmes and t o a s s i s t teacher t r a i n i n g a t t h e tw f a c u l t i e a of medicine i n S r i Lanka.

From 1963 onwards, consu l t an t s and v i s i t i n g p ro fesso r s have been provided t o a s s i s t wi th t h e teaching of p re -c l in ica l and c l i n i c a l s u b j e c t s and a l e o wi th sub jec t s r e l a t e d t o pub l i c hea l th .

In 1972-1973. consul tants a s s i s t e d i n var ious d i s c i p l i n e s r e l a t e d t o medical teacher t r a i n i n g , post- graduate education and i n areaa shown by t h e h e a l t h manpower study t o be i n need o f a s s i s t ance . Such aeeis tance continued i n 1975.

Assistance t o t h i e p ro jec t i s expected t o continue till 1979.

HHD 002 Nursing Advisory Services

To a s s i s t in developing nurs ing and midwifery education and s e r v i c e s .

WHO has aes ie t ed t h e Past-Basic School of Nursing i n Colombo s ince 1960 with a s e r i e e of shor t courses and workshops. I n 1971, a consul tant a s s i s t e d i n s tudying t h e f u r t h e r development of poat-basie educat ion. I n 1972, a shor t course i n t h e adminiet ra t ian of nur s ing se rv ices i n hospitals was asa ia t ed and a sequent ia l l ea rn ing a c t i v i t y i n p a e d i a t r i c c a r e was s t a r t e d . The l a t t e r a c t i v i t y was completed i n 1974. The following shor t courses have been given: "Strengthening t h e i n t e g r a t i o n of Community Health in Basic Curriculum" (1973). "Cl in ica l Teaching'' (1974) and "Surgical P a t i e n t Care" (1975).

Beginning i n 1976, wi th t h e f u l l concurrence of t h e Government, s t rengthening of t h e Post-Basic School of Nursing w i l l be pursued with r enewd vigour.

Consultants, fellowahips and supp l i e s end equipment w i l l be d i r ec ted toward t h i s goal.

Assietance t o t h i s p ro jec t w i l l continue u n t i l 1979.

IMD 004 Pos t -~ redua te Scholarships f o r Training Univerei te Probationary Assietant Lecturers (LTDP SR1.1721058)


L

SRI LANKA

Eealth Education in Family Health SRLI7ZIPOl

Short-term consultants Fellowships Subsidy Supplies and equipment Miscellaneous

4.1 Health Manpower Development

Medical Education

Short-term coneultants Fellowships Supplies and equipment

Nurs~ng Advisory Services

Short-term consultants Temporary adv~aers Fellowsh~ps Participants Supplies and equipment

Post-graduate Scholarships for Training Universit~ Probationary kssistant Lecturers SRLl721058

Fellowshzp

1976

8124 6124

Proposals

1978

Revised

1976

62 300 16 800 1 500 18 900 1 400

100 900

-

rn

p

FP

1979

11 6 9/31

11 2

13/11615/12

11 4

Number of Posts Estimates

1977

8 000

8 000

Project NO.

HED 002

1977

11 3

RB

RB

DP

I

18 000 36 000 5 000 -

59 000

27 000 1 500

27 800 3 000 2 000

61 300 -

1978

18 000 21 700 3 500 - 43 200 -

6 000

31 500 2 500 1 000 - 41 000 -

21 4 8136

11 6 116w 5/54

1

I I

I

I

I

i I HMD 001

HMO 002

HMD 004

1979

21 4 5/24

11 6

I I

14 000 14 200 4 000 - 32 200 -

21 000

34 200 2 500 1 000 - 58 700

21 4 8/36

11 6 116w 5/54

16 000 32 700 5 000 - 53 700

24 000 1 500

26 400 3 000 2 001,

56 900

SRI LANKA

HMD 005 Health Yanparer Study (UNFPA SRLI71lP02)

lhis p ro jec t terminates i n 1976.

HMD 006 Strengthening of Nursinghfidvifery Education (UNFPA SRL172/P02)

Assistance t o t h i s p ro jec t terminates i n 1976, except f o r cont inuing fe l lowships i n 1977.

mo 001 Teachlng of lluman Rrproducclon, Family Plannlnp and Population Dynamics t o Xedlcel Students (L t ikTA SRLIl3IPO3)

To a s s i s t in s t rengthening t h e teaching of hman reproduction, family planning and population dynamics i n medical schools .

A s per r e c o m e n d a t i m s of t h e United Nations Tnter-agency Family Planning Mission t o S r i Lanka i n 1971, teams of short-term consu l t an t s have been provided t o t h e f a c u l t i e s a t Colombo and Peradeniya t o give support t o undergraduates and past-graduatee and t o a s s i s t w i th s e r v i c e programes and research. I n 1975, consul tants were provided in t h e d i s c i p l i n e s of s t a t i s t i c s , maternal m d c h i l d hea l th , behavioural sc iences , demography and populat ion dynamics.

A na t iona l workshop on teaching of human repraduct ion, family planning and population dynamics was held i n 1975. This was a s s i s t e d by a In10 consul tant .

Consultancy se rv ices w i l l be provided i n 1976 t o f u r t h e r a s s i s t t h e f a c u l t i e s a t Peredeniys end Colombo i n s t rengthening t h e t each ing of behavioural sc i ences . Provis ion has a l s o been made f o r suppl iee and equipment, f e l l a r s h i p e end group t r a i n i n g .

Aseietance t o t h e p ro jec t i e planned u n t i l 1977.

R4D 008 Poet-graduate Teachin& of Cornunity Medicine

To a s s i s t i n i n i t i a t i n g and s t r eng then ing a past-graduate course i n community medicine.

Following t h e in t roduc t ion of a course i n community medicine i n 1975 with WHO support , fe l lowships were provided f a r f i e l d t r i p s . A consul tant i n sociology/epidemiology w i l l be provided i n 1976 and EM f u r t h e r consul tants w i l l be ass igned i n 1977 i n the f i e l d of medical s t a t i s t i c s h e a l t h adminis t ra t ion f o r e i x mmths each. Similar a s s i s t a n c e i s planned i n 1978 and 1979.

Aes i s tmce t o t h i s p ro jec t i s expected t o continue till 1979.

HMD 009 Training i n Publ ic Health (UNDP SRLl741041)


ESD 002 S t r e n ~ t h e n i n g of Survei l lance and Con tml of Communicable Diseases

To a s s i s t t h e Government i n s t rengthening t h e su rve i l l ance and con t ro l of communicable d i seases .

The p ro jec t is t h e outcome of t h e amalgamation a f two p ro jec t s . "Strengthening of Epidemialogicel Servicee" ( S r i La& 0078). and "Veterinary Publ ic Health Services ' ' (S r i LanL. 0093). t h e l a t t e r p m j e c t being concerned v i t h t h e c o n t m l and e rad ica t ion of r a b i e s (VPH 001).

In 1967, s consul tant under p r o j e c t S r i L e h 0078 reviewed t h e organizat ion and work of t h e epidemio- l o g i c a l se rv ices . The a c t i v i t i e s of p r o j e c t s ICP ESD 002, "Epidemiolagicel Survei l lance and Training". and S r i Lanka 0066, "Strengthening of Laboratory Services", are c o a r d i n a t e d v i t h t h i s p r o j e c t .

In 1975, consul tante were provided t o a s s i s t in t h e epidemiology of chronic degenerat ive d ieeases and i n t h e production of r a b i e s vaccine. I n 1976-1978 consultants are being provided t o a s a i a t i n t h e epideniology of chronic d i seases and in ve te r ina ry publ ic hea l th . Fellowships w i l l be awarded f o r DPH with s p e c i a l t r a i n i n g in epidemiology. Short-term fe l lowships w i l l be provided f o r a t tendance a t the regional courses.

A s s i s t w c e is expected to continue u n t i l t h e end of 1980.


To a a e i s t t h e anti-malaria programme

WHO aseis tance t o t h i s p ro jec t d a t e s back t o 1960. I n 1966, a consul tant s tud ied t h e outbreak8 of malar ia which occurred in p a r t s of t h e previously hyperendemic areas and recommended necessary remedial measures. I n 1968, a WHO team a s s i s t e d t h e Government i n formulating emergency measures t o dea l v i t h t h e is land-wide malar ia epidemic and i n drawing up long-term plans . WHO s t a f f was ~ t r e n g t h e n e d and a n a t i o n a l malar ia e rad ica t ion t r a i n i n g cen t re t o meet t h e t r a i n i n g needs o f t h e progr- was es tab- l i s h e d in 1971. In aesessm?nt of t h e p r o g r m e was c a r r i e d out i n 1972 by a j o i n t Gavernnmnt/WR) team. The number of cases diminished progress ively till 1972, but s i n c e 1973 t h e r e has been sn i nc reas ing incidence of malar ia wi th an alarming spread o f P. fnZcipammr i n areas of a g r i c u l t u r a l production in 197411975.

A ' s i t u a t i o n ana lys i s ' was ca r r i ed out by a j o i n t GovernmentlWHOlUS A I D team e a r l y i n 1976 as a s t e p fo r obta ining b i l a t e r a l a s s i s t ance f a r t h e progranrme. In 1975, nut of a t o t a l population of 13.95 mi l l ion , the population e t malar ia r i s k was 10.37 mi l l ion , of which 5.28 mi l l ion are under a t t a c k measures and 5.09 mi l l ion are being protected v i t h ant i -malar ia drugs and f o c a l spraying.

I n 1976, WHO ass i s t ance t o the programme includes long-term s t a f f - a mala r io log i s t , a p a r a s i t o l o g i e t , an e n t w o l o g i a t and a s a n i t a r i a n - wi th provis ion f o r fe l lowships end s u p p l i e s a d equipment.

With t h e p a r a s i t o l o g i s t completing h i s assignment a t t h e end of 1976, WHO a s s i s t ance £tom 1977 t o 1979 w i l l include th ree long-term s t a f f - a mala r io log i s t , an entonologiet and a s a n i t a r i a n , i n add i t ion t o fe l lowships and supp l i e s and equipment.

MPD 002 P i l a r i a s i e Control (UNDP SRLl681007)

Assistance t o t h i s p ro jec t t e rmina tes i n 1976 except f o r a cont inuing fe l lowsh ip in 1977.

Number of Posts SRI LANKA

Colnnunicable Disease Prevention and Control I l l 5.1.2 Epidemiological Surveillance


5.1.3 Malaria and Other Parasitic Diseases I / Malaria Eradication I I Malariologist P4 Parasitologist P4 Entomologi8t P3 Sanitarian P2 Clerk-stenographer COL6

Short-term consultants 21 2 Fellowships 6/30 Supplies and equipment

Filariasis Control SRL/68/007

Revised Estimates

334

SRI LANKA

WH 001 Veterinary Publ ic Health - Control. o f Rabies i n S r i Lanka

To a s s i a t i n developing se rv ices f o r t h e con t ro l of r a b i e s .

Aaeistance w i l l be given t o enable t h e Government t o carry ou t a p ro jec t f o r t h e con t ro l of r ab ies i n domestic animals. Pet animals w i l l be vaccinated and unlicensed ones w i l l be destroyed. These measures w i l l involve s t r i c t e r enforcement of e x i s t i n g l e g i s l a t i o n f o r the con t ro l of r a b i e s and t h e carrying out of su rve i l l ance f o r t h e continuous monitoring of r ab ies in t h e country. I n i t i a l l y t h e Govem-t w i l l import t h e chick embryo freeze-dried vaccine i n s u f f i c i e n t q u a n t i t i e s t o meet t h e requirements of t h e p ro jec t dur ing t h e f i r s t t h r e e yea r s of i t s operat ion. WHD w i l l a s s i e t t h e Veterinary Research Laboratory a t Peradeniya i n developing i t s capaci ty t o produce t h e vaccine l o c a l l y , and, by 197811979, i t is hoped t h a t t h e l abora to ry w i l l have stepped up i t s production t o 200 thousand doses per year. Of t h e n i n e provinces in t h e country, t h e western, c e n t r i l , nor th-western and southern provinces account f o r t h e major i ty of cases. lhese provinces w i l l be covered by t h e opera t ions of t h i s project by 198011981, by which time t h e incidence of human rab ies i n the i s l and would have been reduced t o t e n per cent of t h e annual average of 246 deaths during the period 1963-1970.

A consul tant has a s s i s t e d i n e s t a b l i s h i n g t echn ica l know-how a t Peradeniya and has a l s o developed a seed l o t . A p ro jec t o f f i c e r has been t r a ined i n r ab ies con t ro l . I n 1976, one more fe l lowehip w i l l be provided f o r t r a i n i n g i n methods of improving laboratory animals. I n 1977, 1978 and 1979 c m s u l t a n t e w i l l be ~ r o v i d e d t o fol low up t h e a c t i v i t i e s and assess progress . Assistance i e expected t o continue u n t i l t h e end of 1979.

W C 001 Vector Control (UNDP SRLI721039)

To a s s i s t t h e government in t h e con t ro l of f i l a r i a s i s ; and t h e s tudy and con t ro l of dengue, Japanese B encepha l i t i s and o the r arthropod-borne diseases .

This p ro jec t was formulated in 1972 to study and implement e f f e c t i v e measures f o r t h e con t ro l of f i l a r i a s i s , dengue, dengue heemorrhagic fever and Japanese B encepha l i t i s . An entomalogiet wae assigned t o t h e p ro jec t s i n c e 1975 and an epidemiolagie t joined the p ra jec t i n March 1976.

I n 1977,a consul tant w i l l be provided f o r t h e assessment of t h e a n t i - f i l a r i a s i s programme; f o r t h e planning and development of n a t i o n a l a c t i v i t i e s f o r t h e s tudy and con t ro l of dengue, dengue haemrr- rhagic fever, Japanese B e n c e p h a l i t i s and o the r vector-borne d i seases .

I n 1978, tw fel lowships i n t h e f i e l d of medical entomology and vec to r con t ro l , and t h r e e f e l l o w s N p s f o r study t o u r s are expected t o be awarded.

Assistance t o t h e p ro jec t i 8 expected t o continue up t o 1978.

CAN 001 Cancer Epidemiololpr and Research

To a s s i s t i n t h e epidemiological i n v e s t i g a t i o n of cancer, i n t h e es tabl ishment of cancer r e g i s t r a t i o n , i n t h e t r a i n i n g of hea l th personnel i n e a r l y de tec t ion , d iagnosis , t reatment and r e h a b i l i t a t i o n , and i n t h e development of h e a l t h educat ion on cancer.

I n 1977, a consul tant w i l l a s s i e t i n t h e t r a i n i n g of publ ic h e a l t h personnel i n t h e methodology of epidemiological investigations of cancer. Fellowships w i l l be awarded f o r a s e n i o r surgeon, a physi- c ian and a r ad io the rap i s t t o v i s i t ontological cen t res abroad for observing recent t r ends i n oncolo- g i c a l services.

In 1978, a f u r t h e r consul tant w i l l be provided f o r organizing a n a t i o n a l course on cancer management and advis ing on epidemiological i n v e s t i g a t i o n s . Fellowships w i l l be awarded f a r t r a i n i n g aen io r h e a l t h personnel i n chemotherapy, d iagnosis and nuclear medicine f a r t h e treatment of cancer. Selected candi- d a t e s w i l l be awarded fe l lowships f o r t r a i n i n g i n s p e c i a l a spec t s of oncology.

S imi la r fe l lowships f o r t r a i n i n g i n oncology w i l l be awarded in 1979.

Provis ion has been made f a r a l imi ted amount of supp l i e s f o r education and t r a i n i n g i n oncology.

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C M 001 Cardiovascular Diseases

To a s a i s t i n the epidemiological inves t iga t ion of cardiovascular d i seases , e t rengthening o f f a c i l i t i e s f o r t h e prevention and con t ro l of cardiovascular d i seases , t r a i n i n g of h e a l t h personnel i n diagnosis , t reatment , r e h a b i l i t a t i o n and research i n t h i s s p e c i a l t y , and i n t h e development of h e a l t h education f o r t h e prevention of cardiovascular d i seases .

In 1977, a consultant w i l l a s s i s t in t r a i n i n g h e a l t h personnel i n epidemiological research i n cardia- vascular d iseases . Fellowships w i l l be awarded t a s e n i o r c a r d i o l o g i s t s f o r v i s i t i n g c a r d i o l o g i c s l centres and observing t h e l a t e s t developments i n t h i s s p e c i a l t y .

I n 1978, the se rv ices of a f u r t h e r consul tant w i l l be made ava i l ab le f o r advis ing an the development of t ho rac ic surgery. Fellowships w i l l be awarded f o r t r a i n i n g c a r d i o l o g i s t s and ca rd iac surgeons i n s p e c i a l areas f o r t h e prevention and con t ro l of cardiovascular d i seases .

In 1979, fe l lowships w i l l be provided f o r t r a i n i n g i n ca rd io thorac ic surgery, cardiopulmonary re susc i - t a t i o n and r e h a b i l i t a t i o n ,

OUH 001 Oral Health

To a s s i s t in f u r t h e r developing teaching and t r a i n i n g p r o g r m e s , e spec ia l ly those concerned with prevent ive d e n t i s t r y , and i n expanding den ta l h e a l t h se rv ices as p a r t of t h e general h e a l t h se rv ices .

Under t h i s programne, which began i n 1970, consul tants have been provided i n den ta l mechanics (1970, 1971 and 1972) and i n prevent ive d e n t i s t r y (1974). S imi la r a s s i s t ance w i l l be provided i n ch i ld d e n t i s t r y i n 1977.

In 1976,a workshop on t h e r o l e of den ta l a u x i l i a r i e s i n prevent ive d e n t i s t ~ has been planned. The fe l lowships planned f o r 1978 and 1979 w i l l mainly be f o r prevent ive d e n t i s t r y .



To a s s i s t i n t h e t r a i n i n g i n psychiat ry of undergraduates and post-graduates i n medicine, of nu r ses and o the r hea l th personnel, i n t h e development of community-oriented mental h e a l t h care se rv ices in t eg ra ted i n t o the e x i s t i n g pub l i c h e a l t h de l ive ry system, i n t h e in t roduc t ion of innovat ive approaches i n mental h e a l t h care, and i n t h e epidemiological i n v e s t i g a t i o n of mental i l l n e s s .

Consultants were provided on mental hea l th services and p s y c h i a t r i c education i n 1961, 1966, 1969, 1970, 1972 and 1973. I n 1974 and 1975 spec ia l i zed areas of t r a i n i n g were eupported. I n 1976 e long- term fellowship was awarded for t r a i n i n g i n psych ia t r i c s o c i a l work education. I n 1977, a consul tant w i l l a s s i s t i n t h e development o f t r a i n i n g courses i n psychopathology a t t h e Colombo Campus and in behaviour therapy a t Peradeniya. I n 1978, f u r t h e r a s s i s t ance w i l l be given f o r t h e development o f a na t iona l p r o g r a m f o r t h e t r a i n i n g of s p e c i a l i s t p s y c h i a t r i c educators , admin i s t r a to r s and c l i n i c i a n s . A eansu l t an t i n 1978 w i l l give advice i n t h i s a rea , and i n bo th 1978 and 1979 fe l lowships f o r j r o i o r l e c t u r e r s i n psychiat ry w i l l be awarded wi th a view t o developing i n S r i Lsnks a comprehensive cadre of t eacher s .

' h e pro jec t i s expected t o continue f o r a number of yea r s .

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RAD 001 Radiation Health

To a s s i s t i n s t rengthening rad io log ica l h e a l t h p ro tec t ion e e r v i c e s , i n t r a i n i n g r a d i o l o g i s t , radio- t h e r a p i s t s , radiographers, nuclear medicine s p e c i a l i s t s and medical p h y s i c i s t s , and i n promoting t h e development of r ad io log ica l se rv ices and science, including nuclear medicine.

Two consul tants were assigned in 1966 t o help in conducting a one-month course i n r ad ia t ion p ro tec t ion f o r t h e s t a f f of X-ray departments. S imi la r courses were held i n 1969 and 1971 f o r s tuden t radiographers. In 1973, fe l lawships were awarded f o r t r a i n i n g s e n i o r radiographers in recent advances i n t h i s apee ia l ty . I n 1974, a consul tant advised on t h e development of r ad io the rapeu t i c se rv ices and t h e s t rengthening of r ad ia t ion hea l th p ro tec t ion se rv ices .

I n 1976 and 1977 consul tants w i l l be provided f o r a s s i s t i n g i n t h e t r a i n i n g of r a d i a t i o n phye ic ia t s and i n conducting re f reshe r t r a i n i n g courses on rad io log ica l h e a l t h p ro tec t ion se rv ices .

Fellowships w i l l be awarded t a senior s t a f f t o undergo r e f r e s h e r t r a i n i n g .

Assistance t o t h e p ro jec t w i l l be continued till 1977.

HWP 001 Occupational Health and I n d u s t r i a l H y ~ i e n e

To a s a i s t in c o n t r o l l i n g h e a l t h hazards i n indus t ry .

The p ro jec t s t a r t e d i n 1968 with t h e award of f e l l o r s h i p s . I n 1969. a consul tant reviewed t h e s t a t u s of occupational b a l t h i n industry . In 1973, another consul tant advised on t h e development of an i n d u s t r i a l hygiene u n i t i n t h e Department 'of Labour and a l e o as s i e t ed i n conducting a t r a i n i n g course f o r hea l th o f f i c e r s . ?he s m e consul tant was a l s o assigned i n 1974 t o the Department of Labour t o a s s i s t in preparing p lans of operat ion f o r a j o i n t DANIDA/IIl)/WHO-assisted pro jec t i n the f i e l d o f sa fe ty . hea l th and env i ran ren t s l po l lu t ion . During 1976. 1977. 1978 and 1979 consu l t an t s w i l l be provided i n se l ec ted sub jec t s ( a g r i c u l t u r e , i n d u s t r i a l e f f l u e n t s , a i r po l lu t ion c o n t r o l , e t c . ) of occupational heal th . Group educat ional a c t i v i t i e s are a l s o planned every year. Pellovshipa i n i n d u s t r i a l h e a l t h , a i r po l lu t ion and recent techniques i n i n d u s t r i a l hea l th a r e planned f o r 1976-1979.

Assistance t o the p r o j e c t is expected t o continue f o r some years .

PHA 001 g u a l i t y Control of Biologicals and Pharmaceutical Products

To a s s i s t i n s t rengthening t h e q u a l i t y con t ro l of pharmaceutical and b io log ica l p repa ra t ions , and in t r a i n i n g .

In 1966. two consul tants advised on t h e es tabl ishment of a q u a l i t y c o n t r o l laboratory. Two consultants, provided i n 1969 under p ro jec t SEAR0 0154, "Qual i ty Control of Druge", made f u r t h e r recommendations, including t h e organizat ion o f a diploma course. In 1971, a consul tant s tudied the manpower reqvire-ts and made d e t a i l e d reeammendatians on c u r r i c u l a . A phermsceutical chemist wae assigned f o r s i x months in 1973, t o t r a i n t h e l abora to ry s t a f f i n s p e c i f i e d methods of ana lye i s and in t h e use of m d e r n a n a l y t i c a l i n s t r m e n t s . A f u r t h e r consu l t an t , provided i n 1974, a s s i s t e d i n t r a i n i n g ana lya t s f o r ti-e q u a l i t y con t ro l of p h a m c e u t i c a l s and teaching techniques of analyaia us ing rmdern a n a l y t i c a l ins t ruments .

I n 1975, a pharmaceutical chemist a s s i s t e d i n t h e development of a q u a l i t y con t ro l system i n t h e manu- f a c t u r i n g u n i t s and i n t h e t r a i n i n g of drug inspec to r s .

In 1977, e consul tant i n b io log ica l s t andard iza t ion w i l l be provided.

I h e Government i e a l s o receiving a ~ s i e t a n c e from o t h e r aourcea f o r t h e improvemet of t h e q u a l i t y c a n t r o l laboratory.

Assistance t o t h e p r o j e c t i s expected t o continue u n t i l 1979.

BLG 001 Production of Improved Vaccines

To a s s i s t in t h e production of freeze-dried smallpox and o the r vaccines .

In 1967. m d e r p ro jec t SEAR0 0038, "Production of Freere-Dried Smallpox Vaccine", a consul tant advieed on t h e production of freeze-dried smallpox vaccine. I n 1969, another consul tant , under t h e same i n t e r - country p r o j e c t , suggested t h e freeze-drying of smallpox and rab ies vaccines . lo 1971, a f u r t h e r consultant advised on t h e sequen t i a l production of both vaccines and provided a b luepr in t f o r t h e development of t h e p r o j e c t . In 1974. 1975 and 1976 consu l t an t s have helped i n implementing the d i f f e r e n t aspects of t h e p ro jec t and fellowahipa were provided t o t r a i n na t iona l s t a f f i n r e l a t e d f i e l d s . In 1977 and 1979 consul tants w i l l advise an DT vaccines and t h e i r s t andard iza t ion .

Assistance t o t h i s p ro jec t w i l l continue through 1979 by way of consu l t an t s and fellowshipe i n the areas r e l a t ed t o vaccine production and q u a l i t y con t ro l .

UNICEF has supplied t h e equipmnt f o r t h e production of f reeze-dr ied vaccine and w i l l supply bulk t e t anus and d iph the r i a vaccines to be conditioned l o c a l l y .

LAB 001 S t r e n ~ t h ~ n i n g of Laboratory Services

To a s s i s t f u r t h e r i n developing spec ia l i zed d iagnos t i c and reference funct ions i n support o f co rnmi - csble-disease con t ro l and prevent ion, and t o t r a i n e t a f f .

~ o l l o w i n g an assessment of d iarrhoea1 d i seases , t h e p r o j e c t s t a r t e d i n 1963 with a study of the p a t t e r n of e n t e r i c diseases . In 1966, a s s i s t ance was given in Organizing bac te r io log ica l d i agnos t i c f a c i l i t i e e f o r e n t e r i c i n f e c t i o n s i n t h e p r i n c i p a l h o s p i t a l l a b o r a t o r i e s i n Colombo and i n t h e provinces. Help was provided t o t h e Medical Research I n s t i t u t e i n developing competence in the serology of heemorrhagic fever and i n fluorescence microscopy f o r t h e diagnosis of r a b i e s . Since 1970 t h e p r o j e c t ' s aim has been t o give fu r the r a s s i s t ance in developing spec ia l i zed funct ions f o r t h e prevention and con t ro l of conmunicsble d i seases and i n bu i ld ing up a country-wide reference se rv ice f o r the support of epidemio- l o g i c a l a c t i v i t i e s i n cholera , dengue/heemorrhegic f eve r and smallpox. Assistance continued t o be given t o t h e t r a i n i n g of e t a f f .

Between 1972 and 1975. WHO has supported a one-month n a t i o n a l course i n pub l i c h e a l t h microbiology f o r p rov inc ia l pa tho log i s t s . From 1973 d i f f e r e n t consu l t an t s have been a s s i s t i n g t h e Medical Research I n s t i t u t e off and an i n developing virology reference a c t i v i t i e s i n arbovirus , en te rov i rus and Inf luenza v i rus d i seases .

The activities of t h e p r o j e c t are c o a r d i n a t e d wi th those of SRL ESD 001. "Strengthening of Epidemio- l o g i c a l Services", and SE ICP LAB 001, "Health Laboratory Services".

Fellowships have been provided throughout f a r t h e t r a i n i n g o f b a c t e r i o l o g i s t s and spec ia l i zed t r a i n i n s of t e c h i c i a n s i n s p e c i f i c s k i l l s ; ahort-term fe l lowships uere a l s o awarded t o enable sen io r s t a f f t o acquire f u r t h e r experience.

The p r o j e c t i s expected t o continue u n t i l 1979.

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891 002 Provisiom of Basic San i t a ry Services

To a s s i s t in t h e provis ion of s a f e water supp l i e s and exc re ta d i sposa l in r u r a l and urban communities throughout t h e country.

This p ro jec t has replaced t h e e a r l i e r p r o j e c t , SRL BSM 001. "Cornunity Water Supply and Sani ta t ion" , which was pr imari ly concerned with t h e development of piped water supp l i e s , wi th UNICEF ass i s t ance , as a p i l o t p ro jec t for l a r g e r r u r a l c o w u n i t i e s . Separate plans of ac t ion w i l l cover t h e provis ion of piped water supp l i e s , s a n i t a r y we l l s , deep w e l l s , water-seal l a t r i n e s , improvements t o e x i s t i n g i n s t a l l a t i o n s , and o t h e r sub-programmes, farming p a r t of t h e National Plan f a r Water Supply and Drainage f o r S r i Lanka.

The p ro jec t i s a s s i s t e d through long-term s t a f f t a provide t echn ica l advice i n planning, implementation and t r a i n i n g , through consul tant se rv ices i n p ro jec t proposal development i n 1976, and through fellawships . A s a n i t a r y engineer w i l l continue through 1976-1979 and consul tants w i l l advise on t h e development of i n d u s t r i a l support f a r t h e programme and on hydrogeology. Fellowships w i l l be awarded f o r post-graduate san i t a ry engineer ing and management s t u d i e s , and f o r s h o r t e r per iods f a r observat ion v i s i t s an rural water supp l i e s . well-sinking and d r i l l i n g .

I t i s hoped t h a t a d d i t i o n a l funds from o the r sources w i l l be made a v a i l a b l e t o t h i s p r o j e c t t o cover t h e sasignment of add i t iona l long-term s t a f f , t o t e s t and develop technology new t o S r i Lan*e, and t o a s s i s t t h e Governnent i n i n i t i a t i n g sub-projects i n new a g r i c u l t u r a l se t t l emen t s and i n o t h e r spheres o f a c t i v i t y .

Assistance w i l l continue a t l e a s t u n t i l 1981.

SFS 001 Under~raduate Training in Publ ic Heal th Engineering

To a s s i s t i n t h e t r a i n i n g of f a c u l t y members of t h e Univers i ty of S r i Lanka t o enable them t o develop s u i t a b l e c u r r i c u l a i n publ ic h e a l t h engineer ing, and t o a s s i s t i n s e t t i n g up s a n i t a r y engineer ing teaching l abora to r i e s and research f a c i l i t i e s .

This p r o j e c t , s t a r t i n g i n 1977 with t h e sward of a f e l l o m h i p f o r post-graduate study f o r a f acu l ty member and sane euppl ies and equipment, w i l l continue i n 1978 and 1979 with t h e assignment of consul t - a n t s t o a s s i s t i n the i n s t a l l a t i o n and c o m i s s i o n i n g of l abora to ry equipment provided under t h e p ro jec t .

Assistance is expected t o continue u n t i l 1981

FSP 001 Food Hygiene

To a s s i s t i n e s t a b l i e h i n g a na t iona l food con t ro l adminis t ra t ion and i n t r a i n i n g s t a f f f o r va r ious branches of food con t ro l .

I n 1974, a consul tant was assigned t o a s s i s t i n e s t a b l i s h i n g a food c a n t r o l u n i t a t c e n t r a l l e v e l , i n r ev i s ing e x i s t i n g food l e g i s l a t i o n , and i n t r a i n i n g personnel engaged i n food production and handling. I n 1975, t h e se rv ices of a consul tant were provided f o r s t rengthening t h e food c o n t r o l u n i t and i n r ev i s ing t h e e x i s t i n g l e g i s l a t i o n on food con t ro l . Fellowships w i l l be awarded f o r t h e t r a i n i n g o f food inspec to r s , and supp l i e s and equipment w i l l a l s o be provided.

Aesistance i s e x ~ e c t e d t o continue u n t i l t h e end of 1980.

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DHS 001 Health Statistics (UNDP SRL/68/006)


347 THAILAND - Index

THAILAND

GENERAL - Thailand, wi th an area of 514 000 sq.km., has a popu la t i on of approximately 42 m i l l i o n , ove r 85% of whom l i v e i n r u r a l areae. The n a t i o n a l per capita income is about USS230 p e r yea r , b u t t h e r e are wide v a r i a t i o n s between regions . The economic and s o c i a l p o l i c y of t h e count ry i s d i r e c t e d towards i n c r e a s e d inves tment and a more equal d i s t r i b u t i o n of goods and s e r v i c e s throughout t h e count ry , w i th s p e c i a l emphasis on unde rp r iv i l eged r u r a l areas.

HEALTH POLICY

In 1975, t h e Minis t ry of Health prepared a development p l an f o r the Fourth Socio-economic Five-Year Plan. Na t iona l Health Programming, a n a t i o n a l p roces s sponsored by t h e Na t iona l Economic and S o c i a l Development Board and a s s i s t e d by WHO, adapted count ry h e a l t h p r o g r w i n g methods t o n a t i o n a l p o l i t i c a l , o r g a n i z a t i o n a l and admin i s t r a t i ve r e a l i t y . Act ive p a r t i c i p a t i o n of n a t i o n a l decision-making bod ie s and r e l e v a n t s e c t o r s was assured .

P r i o r i t y is given t o the improvement o f t h e h e a l t h o f people i n r u r a l and urban slum areas. Genera l goa l s were s e t for: r educ t ion i n popu la t i on growth, maternal and c h i l d h e a l t h , n u t r i t i o n , comun icab l e d i eease s , envi ron- mental h e a l t h hazards , f ree medica l care f o r the poor, e n l i s t i n g of v i l l a g e h e a l t h vo lun t ee re , p lanning, and management and informat ion system. The fo l l owing are the t a r g e t s f o r reducing p r i o r i t y h e a l t h p r o b l e m : wa te r and food-borne d i s ea se s by 50%, ma la r i a and dengue haemorrhagic f eve r by 50%. r educ t ion of popu la t i on growth t o 2.1% p e r yea r by 1981 ( a g a i n s t 2.6% i n 1976). i n f a n t m o r t a l i t y by 20% and ma te rna l m o r t a l i t y by 20%.

Some o t h e r t a r g e t s s e t f o r achievement dur ing t h e p e r i o d 1977 t o 1981 are: i n c r e a s e i n medica l coverage by 50% of the r u r a l popula t ion; s a f e d e l i v e r y f o r 50% of pregnant women; p r o t e i n supplements t o 15% of c h i l d r e n aged 1-4; p rov i s ion of safe wa te r t o 25% of t h e r u r a l and 50% of t h e urban popu la t i on ; con t inu ing uaers of fami ly planning. 1.5 m i l l i o n and new accep to r s , 3 m i l l i o n ; c o n ~ t r u c t i o n of 19 400 wa te r supply s y s t e m and 2.3b m i l l i o n water -sea led l a t r i n e s : immunization a g a i n s t DPT 15 m i l l i o n , smallpox 1 8 m i l l i o n , DCG 8 m i l l i o n and t e t anus 18 mi l l i on ; cons t ruc t i on o f 2000 midwifery c e n t r e s , 600 h e a l t h c e n t r e s , and 25 t h i r t y -bed and 15 s ix ty-bed d i s t r i c t h o s p i t a l s ; p rov i s ion of 11 410 h o s p i t a l beds a t r e g i o n a l and p r o v i n c i a l l e v e l s ; i n - s e rv i ce t r a i n i n g fo r 500 phys i c i ans , 6100 h e a l t h workers, 10 000 nurses and p r a c t i c a l nurses, 7500 midwives and 1400 nurses t o became nurse p r a c t i t i o n e r s ; and t r a i n i n g of 22 400 v i l l a g e h e a l t h v o l u n t e e r s , 200 000 h e a l t h communicators, 8000 granny-midwives and 5000 tambon doctors .

These t a r g e t e cover the 16 n a t i o n a l development p r o g r a m e s and are l i a b l e t o be modified as the Four th P l an is f i n a l i z e d . S t r a t e g i e s were e l a b o r a t e d t o reduce i d e n t i f i e d h e a l t h problems.

WHO Co-operation. Following Na t iona l Heal th Programming, i n o rde r t o conform wi th n a t i o n a l and WHO p o l i c i e s and p r i o r i t i e s , the 1976-77 programme was replanned, t h e o v e r a l l rep lanning and p l ann ing p roces s a c t u a l l y cover ing the per iod 1976-1981.

WHO a s s i s t a n c e w i l l c o n t r i b u t e p r imar i l y t o t h e r educ t ion o f p r i o r i t y h e a l t h problems among the more under- p r i v i l e g e d groups, s p e c i f i c a l l y the r u r a l popu la t i on . An e v a l u a t i o n mechanism w i l l permi t measuring, i n q u a n t i f i e d terms, the achievements of t h e programme. Other expected b e n e f i t s w i l l be t h e r educ t ion of soe io- economic d i s p a r i t i e s , i nc r ea sed p r o d u c t i v i t y , popu la t i on s a t i s f a c t i o n and p rog re s s towards r u r a l community development and s e l f - r e l i a n c e .

PROGRAMME AREAS

Out of the n ine teen n a t i o n a l development p r o j e c t s t h a t were formula ted , s e l e c t i o n c r i t e r i a were a p p l i e d f o r t h e i d e n t i f i c a t i o n of t en WHO-assisted p r o j e c t s .

General Health Se rv i ce s i

Six p r o j e c t s come under t h i s programme. The main emphasis, i n t h e p r o v i n c i a l h e a l t h care p r o j e c t , i e on the development of a primary h e a l t h care system cover ing 50% of t h e v i l l a g e s du r ing t h e p l a n pe r iod . Ass i s t ance is a l s o g iven t o urban h e a l t h care (cover ing 126 m u n i c i p a l i t i e s ) ; n u t r i t i o n t r a i n i n g and s t u d i e s ; h e a l t h educa t ion , suppor t i ng core p r i o r i t y p r o j e c t s ; h e a l t h l a b o r a t o r y s e r v i c e s ; and p lanning, management and informat ion system wi th mechanisms f o r c o n t r o l , moni tor ing , e v a l u a t i o n and r ep l ann ing t h e whole programme.


Ass i s t ance is provided t o the p r o j e c t , "Facul ty of P u b l i c Health", f o r promatian of t h i s I n s t i t u t i o n and the t r a i n i n g of t u t o r s f a r t h e p r o v i n c i a l h e a l t h care p r o j e c t , and t o t h e h e a l t h manpower development p r o j e c t fo r t r a i n i n g of a l l c a t e g o r i e s of s t a f f , e s p e c i a l l y t h e primary h e a l t h care workers.

Disease Prevent ion and Con t ro l

One p r o j e c t cont inues t o a s s i s t ma la r i a c o n t r o l and e r a d i c a t i o n i n r e l e v a n t a r e a s and a s a i e t i n t h e c o n t r o l of o t h e r v e c t o r s , mainly Aedes Aegypti .

Promotion of Environmental Hea l th

One p r o j e c t w i l l a s s i s t i n the improvement of food and drug q u a l i t y . S i g n i f i c a n t UNDP i n p u t i s expected t o m a t e r i a l i z e t o suppor t wa te r supply and s a n i t a t i o n i n o r d e r t o reach t h e n a t i o n a l p l a n t a r g e t s .

Tvo s p e c i f i c aepects of t h i s programme are: (1) i n t eg ra t ion of co rnmicab le disease (except malaria) and maternal and chi ld h e a l t h l f m i l y planning with p rov inc ia l and urban hea l th care p ro jec t s (however, the na t iona l family planning p ro jec t w i l l continue s p e c i f i c t echn ica l a c t i v i t i e e ) , and (2) emphasis on f e l l w s h i p s i n nat ional i n s t i t u t i o n s , in-country courses and g ran t s f o r primary hea l th csre vorkers t r a in ing .

CO-ORDINATION

UNDP, UNFPA. UNICEF, IBRD and USOM were involved i n National Health P r o g r a d n g through a co-ordination mechanism es tab l i shed by the Governrent and WHO. The amamt and nature of poss ib le co-ordinsted as s i s t ance from these agencies v i l l be known i n 1977. P r i o r i t y areas f o r j o i n t m s i a t a n c e wi th WHO or f o r p r o j e c t s i n vhich WHO vould be t h e executing agency during 1977-1981 are: primary hea l th csre; maternal and ch i ld hea l th1 family planning; promotion of environmental hea l th , and extension of the cornunity v a t e r supply p ro jec t . In 1975 and 1976. UNDP, UNFPA, UNICEF and USOM provided ass is t rmce t o p ro jec t s i n these f i e l d s . USOM and WHO were j o i n t l y involved i n the development of primary hea l th care.

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THAILAND

PPS 001 P lannin~ . Manaecmnt and Informacian Svstem

To a s s i s t i n nat ional heal th planning and i n heal th administration.

Following the merger of Thailand 0002. "Strengthening of Health Services". Thailand 0051, "Hllospital Administration", Thailand 0069, "Urban Public Health Administration", Thailand 0087, "Administrative Aspccte of Health Services" and mai land 0091, "Health Hanpwer Study" with t h i s project the sc t iv i - t i e s cover a l l these subjects plus the in tegra t ion of heal th services and heal th information s y s t e m , with emphash on the implementation, monitoring. control , evaluation and replanning of the nat ional davelopnunt pr0grsP.l f o r the hesl th sec tor . This project a l s o co-ordinate. the a c t i v i t i s e of other WHO-~sisred project. i n the country.

I n 1970, i n addition ti, contractual services , a public heal th administratar and e s t a t i s t i c i a n ass i s ted respectively w i t h the in tegra t ion of general heal th services d a heal th -parer study. In 1972, a public health adminiatrator helped es tab l i sh a heal th planning un i t i n the Xinis try of Public Health. I n 1974, a consultant helped develop a heal th info-tion system. Grants were given t w a r d the costa of a National S a i n a r on Health Economics and a t ra in ing p r o g r a n r f o r chief provincial medical o f f ice rs .

The p r o j r c t was strangthenod by the addi t ion of a management o f f i c e r i n 1976. Another s p e c i a l l e t w i l l be added in 1978. Short-term consul tants i n heal th manpower planning, s t a t i s t i c s , epidemiology. health i n f o r u t i o n r y s t - and hea l th insurance. ana fel lovships i n planning and l a n s g a r a t , operations research and planning of compoter services w i l l be pmvided i n 1977. 1978 and 1979, Mao a subsidy w i l l be provided f o r devrloping and tea t ing forms f a r na t iona l information symtem.

The t ra in ing aspects of +he project w i l l w r k closely with the projects THA HW 003 (Faculty of Public Health), ICP PPS 001, ICP PPS 002 ( i n the Asian Developrent 1a.tltutc). IW PHC 001 and 'nlA HW 011.

Assistance t o the project is expected t o continue f o r a number of years.

HSD 001 yrbam Hwl th Care DLv.loment

Ta assist in the develo-t of comprehensive heal th se rv ices f o r the urban slum population In Bangkok Metropolim and 126 h n i c i p d i t i u of Thailand m an i n t e g r a l p a r t of tma planning d urbm management; from thr conceptual s tage. with emphasis on preventive anpects of hea l th , primarily i n respect of envizonwutal heal th, end the o r g a n i z a t i w of family planning and imuniza t ion propratmu.

A ahort-term c o n m u l t ~ t (Urban Public Health Administrator) w i l l be provided i n 1977. 1978 and 1979. FeIlwships i n epidemiology, hosp i ta l a r a t i s t i c s , hosp i ta l Maagarrat and admin is t ra t im. hosp i ta l accountancy and i n h o a p i t s l p s r s m e l nana&ement, and study tours f o r sen ior o f f i c i a l s of the Ministry of I n t e r i o r i n the f i e l d s of slum upgrading, urban s a n i t a t i o n and family heal th w i l l be provided. In addition. l o c a l courses i n Wit, Unrsing. Urban Health M n i n i a t r a t i c n and flauning and f o r t ra in ing schoel teachers i n urban heal th and municipal administration w i l l be aubaidired.

Assiatsncc t o the proJect . in expected to continue f o r a number of years.

THAILAND

PHC 001 Development of Provincia l Health Care

To a s s i s t i n s t rengthening in teg ra ted r u r a l hea l th se rv ices . I t i s proposed t o inc rease the coverage of the hea l th s e r v i c e s , t o t r a i n h e a l t h personnel, including development of c u r r i c u l a and a method f a r the evaluat ion of t r a i n i n g and i n t e g r a t i o n of t r a d i t i o n a l hea l th workers i n l o c a l h e a l t h services.

This p ro jec t with THA HMD 011, covers t h e p r i o r i t y problems i d e n t i f i e d dur ing n a t i o n a l hea l th programming, and p r a c t i c a l l y a l l the t a r g e t s . The mo p r o j e c t s w i l l provide primary h e a l t h ca re including family planning, hea l th education through t h e h e a l t h education development p ro jec t and bas ic environmental hea l th . The p r o j e c t a l s o w i l l provide the necessary c e n t r a l support t o primary hea l th care.

The p ro jec t began i n 1974, wi th a grant f o r t r a i n i n g t r a d i t i o n a l h e a l t h workers and tambol doctors i n th ree provinces. The programme of t r a i n i n g indigenous midwives, tambol doctors , e t c . , was extended t o more provinces i n 1975. I n 1976, a management o f f i c e r has been provided t o he lp plan and monitor the p r o j e c t t o ensure t h a t ob jec t ives are achieved i n time with t h e minimum use of resources. Subsidies w i l l continue t o be provided f o r eva lua t ion , f o r ope ra t iona l s t u d i e s and f o r t r a i n i n g of primary hea l th care workers and o the r r e l evan t categor ies of personnel. Consultants w i l l a s s i s t i n publ ic hea l th and nurs ing s e r v i c e adminis t ra t ion. Fellowships w i l l be r e l a t e d t o these f i e l d s .

The p ro jec t is expected t o continue for a number of years .

MIX 001 Bangkok Municipality Familv Planning F ie ld Workers Pro jec t

Assistance t o t h i e p r o j e c t terminates i n 1976 except f o r cont inuing fe l lowships .

YM h)2 Accelerated Development of Maternal and C h i l d Health and Family P l a n n i n ~ Serv ices


HRP 001 Expanded S t e r i l i z a t i o n Proxramme


NUT 003 Nutr i t ion train in^ and Studies . Faod Harketink and Dis t r ibu t ion

To a88iSt i n the t r a i n i n g of medical and a u x i l i a r y h e a l t h personnel i n n u t r i t i o n and i n problems r e l a t e d t o the marketing, d i s t r i b u t i o n and s a f e t y of food, e s p e c i a l l y of high p ro te in foods.

The p ro jec t , t o s t a r t i n 1977, combines and expands t h e scope of two previous p ro jec t s : I n s t i t u t e of Nutr i t ion and Faod Sciences a t Ranathibodi (THA NUT W1) and Nut r i t ion Training - Fellowships (THA NUT 002), which ended i n 1974 and 1975 respec t ive ly .

The na t iona l food and n u t r i t i o n p r o j e c t , formulated through t h e National Health Programme, aims a t improving the n u t r i t i o n a l s t a t e of t h e population a t r i s k , e s t a b l i s h e s p ragrames t o cover t h e most disadvantaged populations and f i x e s t a r g e t s f o r the reduct ion of i n f a n t and c h i l d morbidity and mor ta l i ty . To help implement these p r o g r m e s and t o meet the t a r g e t s , courees i n publ ic h e a l t h n u t r i t i o n f o r doctors and nurses , and n u t r i t i o n t r a i n i n g a c t i v i t i e s f o r nur ses , midwives and day care cen t re a t t endan t s , w i l l be held year ly s t a r t i n g i n 1977. A t a higher l e v e l of t r a i n i n g , provis ion has been made f o r a two-year fe l lowship t o study Nut r i t ion Education.

A consul tant w i l l be provided i n 1978 t o a s s i s t i n t h e d i s t r i b u t i o n and marketing of high p ro te in foods and a two-year fe l lowship on food s a f e t y evaluat ion w i l l be awarded i n 1979.

Assistance t o the p r o j e c t is expected t o continue f o r a number of years .

HED 001 Development of Health Education

To a s s i s t i n the development of h e a l t h education se rv ices i n support of hea l th programmes i n the regions and the provinces.

A consul tant was provided i n 1966 t o review hea l th education t r a i n i n g i n t h e country and another consul tant i n 1975 t o review the present s t a t e of hea l th education and t o prepare proposals t o extend these se rv ices , Limited s u p p l i e s and equipment were also provided. The previous sseistaace t o the country, the country h e a l t h programming exe rc i se and the p r o j e c t Formulation t h a t followed has r e su l t ed i n an expanded programme of WHO ass i s t ance t o Thailand.

A short-term s o c i a l s c i e n t i s t w i l l be assigned i n 1978. A short-term consu l t an t i n h e a l t h education w i l l review t h e progress of t h e p r o j e c t i n 1978. Fellowships w i l l be provided f o r t r a i n i n g na t iona l hea l th educators i n 1976, 1977 and 1979 whi le study tour s w i l l be organized f a r Chiefe of Sect ions of the Health Education Bureaux i n 1977, 1978 and 1979. Suppliee and equipment including t r anspor t w i l l b e provided from 1976 t o 1979.

Assistance is expected to cont inue u n t i l 1983

HElD 003 Faculty of Publ ic Health

To a s s i s t the Faculty of Pub l i c Heal th i n Mahidol Univers i ty i n f u r t h e r developing i t s teaching and t r a i n i n g programmes i n hea l th planning and management. It i s now intended t o provide t h e Faculty wi th a s i z a b l e a s s i s t ance i n order t o meet Wa ob jec t ives ae under:

(1) the upgrading of the Faculty t o i n t e r n a t i o n a l s tandards , and

(2) t o s t rengthen t h e involvement of the Faculty of Publ ic Heal th i n the development of manpower f o r the Ministry of Publ ic Health i n r e l a t i o n t o t h e outcome of National Heal th Programming. This w i l l involve t h e t r a i n i n g of t u t o r s f o r primary h e a l t h care and var ious echelone of h e a l t h s e r v i c e s ' s t a f f , and, j o i n t l y wi th t h e Minis t ry , t r a i n i n g i n planning, management and h o s p i t a l adminis t ra t ion f o r pe r iphe ra l hea l th o f f i c e r s .

I n 1975, a consul tant i n hea l th education helped prepare t h e curriculum f o r t h e MPH degree i n h e a l t h education. From 1976 t o 1978 an education e p e c i a l i s t and a pub l i c hea l th nurse educator w l I L be provided. I n add i t ion , a short-term consul tant i n h e a l t h manpower planning i n 1978 and a consul tant i n hea l th education (MW) i n 1979 w i l l be made ava i l ab le . A number of fe l lowships w i l l be o f fe red . Vehicles, audio-visual a ids and var ious i tems of supp l i e s and equipment w i l l be provided. Provis ion has been made f o r subsidy t o cover the c o s t of n a t i o n a l courses. The p r o j e c t i s expected t o continue f o r a number of years .

THAILAND

HMD 004 Medical Education and Trainine.

TO a s s i s t i n f u r t h e r developing t h e t e ach ing and t r a i n i n g programmes of t h e fou r medical f a c u l t i e s a t Chiengmai. Chulalongkorn and Mahidol U n i v e r s i t i e s , I nc lud ing the l a t t e r ' s Facul ty of Pas t -graduate S tud i e s and t o a s s i s t i n p lanning t h e F a c u l t i e s of Medicine a t P r i n c e of Songkhla and Khon Kaen Un ive r s i t i e s .

I n 1973, consu l t an t s i n emergency s e r v i c e s and i n epidemiology were ass igned r e s p e c t i v e l y t o S i r i r a j Medical School and the Facul ty of Pub l i c Heal th of Mahidol Un ive r s i t y . S ince 1973, g r a n t s Ilave been provided t o cover t h e c o s t of s t u d i e s a t Mahidol Un ive r s i t y , Facul ty of Graduate S t u d i e s , f a r s t a f f des ignated f o r t h e two new schoo l s of medicine a t Songkhla and Khon Kaen. In 1974, a c o n s u l t a n t i n n u t r i t i o n a l pathology was provided t o Ramathibodi Medical School; a c o n s u l t a n t i n curr iculum development had a l s o been a s s igned , and h i s a c t i v i t i e s covered t h e t r a i n i n g of t h e proposed new ca tegory of h e a l t h a s s i s t a n t s . I n 1975, a consu l t an t was as s igned , as a follow-up of an e a r l i e r assignment i n 1972-73, t o adv i se f u r t h e r on d e t a i l e d p lans f u r t h e h e a l t h s c i e n c e s c e n t r e a t t h e P r ince of Songkhla Univers i ty and a nurse educator was a l s o provided.

A medical educa to r w i l l be provided i n 1976 and 1977 a t t h e Khon Kaen Univers i ty for t r a i n i n g same new c a t e g o r i e s of s t a f f . A g r a n t t o t h e Facul ty of Graduate S t u d i e s i n 1976 and 1977 w i l l be used f o r t r a i n i n g t eache r s i n b a s i c medica l s c i e n c e s f o r Songkhla and Khon Kaen U n i v e r s i t i e s . Fellowships w i l l b e r e l a t e d t o medical educa t ion , i nc lud ing b a s i c medica l s c i e n c e s , c l i n i c a l teaching , nu r s ing educat lnn and community h e a l t h .

HMD 011 Heal th Manpower Development (Min i s t ry of P u b l i c Heal th)

This p r o j e c t r e p r e s e n t s the manpower component of the P r o j e c t on P r o v i n c i a l Heal th Care Development. It w i l l t r a i n a l l r e l e v a n t c a t e g o r i e s of s t a f f w i t h i n - se rv i ce t r a i n i n g , or s p e c i a l t r a i n i n g as i n the case of t h e primary h e a l t h care workers. The p r o j e c t l a y s emphasis on t h e t r a i n i n g o f primary h e a l t h care workers and t h e i r a d v i s e r s such as midwives, p r a c t i c a l nurses and h e a l t h workers who w i l l a l s o be t r a i n e d i n s imp le medical care. The p r o j e c t w i l l a l s o suppor t the t r a i n i n g o f t h e nurse p r a c t i t i o n e r s who may be s u b s t i t u t i n g f o r doc to r s i n d i s t r i c t h e a l t h c e n t r e s , whenever a doc to r is n o t a v a i l a b l e .

Beginning i n 1976, a n u r s e educa to r w i l l b e ass igned t o a s s i s t w i t h t h e t r a i n i n g programmes and t h e p r epa ra t i on of teaching m a t e r i a l s . Subs id i e s w i l l be g iven f o r t r a i n i n g s t a f f from t h e Min i s t ry o f l l e a l t h and t u t o r s of paramedical personnel i n t h e medical educa t ion u n i t i n Chulalongkorn Un ive r s i t y and f o r t r a i n i n g s a n i t a r i a n s i n t h e Facul ty o f P u b l i c Hea l th , Mahidol Un ive r s i t y . A g r a n t w i l l be made f o r t h e development of t e ach ing m a t e r i a l s and f e l l owsh ips w i l l b e given f a r s t udy t o u r s and f o r a t t e n d i n g t h e UNICEFlWHO course i n c h i l d h e a l t h i n t h e UK. Ass i s t ance w i l l con t inue f o r a number of years .

MPD 001 Malar ia and Vector Contro l

To a s s i s t t h e programmes f a r c o n t r o l of ma la r i a i n t h e bo rde r and mountainous r eg ion ( cove r ing approxi - mately 7 m i l l i o n popula t ion) and i ts u l t i m a t e e r a d i c a t i o n i n t h e remaining areas; and f o r c o n t r o l of Aedes mosquitoes and t h e r educ t ion and prevent ion of outbreaks of dengue haemorrhagic f eve r .

S ince the an t i -ma la r i a programme began i n 1949, i t has been v a r i o u s l y a ided by WHO, UNICEF and US AID. With t h e withdrawal of US A I D a s s i s t a n c e i n 1970, t h e Government developed a r ev i s ed s ix-year p l an of a c t i o n f o r 1971 t o 1976. An independent assessment of t h e programme was undertaken by t h e Government i n c o l l a b o r a t i o n w i t h WHO and US A I D i n 1974. S t u d i e s on t h e r o l e of Anopheles b. ba l abacens i s i n ma la r i a t ransmiss ion which began i n 1972 were concluded i n 1974.

The WHO-assisted n a t i o n a l h e a l t h programming i n 1975 i d e n t i f i e d ma la r i a , a long w i t h denguelhaemorrhagic fever , as impor tant h e a l t h problems and a p r o j e c t , ">la lar ia and Vector Contro l" was formula ted , With emphasis be ing g iven t o developing a network o f h e a l t h s e r v i c e s , t h e involvement of primary h e a l t h care workers i n ma la r i a ca se -de t ec t i on and t h e promotional e f f o r t t o ensu re ma la r i a s u r v e i l l a n c e through t h e b a s i c h e a l t h s e r v i c e s , i t i s hoped t h a t , by t h e end of t h e p lan pe r iod , t h e e n t i r e populs- t i a n now i n conso l ida t i on phase can b e s h i f t e d t o t h e b a s i c h e a l t h s e r v i c e s .

The Nat iona l Malar ia E r a d i c a t i o n T ra in ing Cent re a t Prabudhabat con t inues t o b e a s s i s t e d by WHO. I n 1976,1977 and 1978, WHO a s s i s t a n c e i nc ludes a m a l a r i o l o g i s t , an ep idemio log i s t , an entomologis t , two s a n i t a r i a n s (one t e rmina t ing i n 1977, t h e o t h e r i n 1978) and a c l e r k - t y p i s t , w i t h f e l l owsh ipa f o r t r a i n i n g i n ma la r i a epidemiology and entomology, and s u p p l i e s and equipment. I n a d d i t i o n , du r ing 1978 and 1979 f e l l owsh ips w i l l b e provided f a r an M.Sc. i n entomology and f o r HPH courses and there w i l l be a subs idy f o r n a t i o n a l d r i v e r s . The WHO a s s i s t a n c e f a r t h i s p r o j e c t w i l l con t inue f o r a number of yea r s .

OIM 001 Oral Health

To a s s i s t i n the development of d e n t a l hea l th se rv ices and i n the t r a i n i n g of d e n t a l hea l th personnel.

The p ro jec t began i n 1967. the i n i t i a l years being devoted t o a s s i s t ance in t h e t r a i n i n g of school den ta l nurses through the provis ion of fe l lowships and of a den ta l nurse i n s t r u c t o r f o r two years (1969 and 1970). Consultants reviewed the p r o j e c t i n 1972 end i n 1974 and i n 1975 t h e a s s i s t ance given was mainly i n the form of f e l l m e h i p s .

Provisions have been made i n 1976 f a r a two-year fe l lowship t o t r a i n a p ro fess iona l i n ope ra t ive d e n t i a t r y , who w i l l teach t h i s s p e c i a l t y a t t h e Phya Thai School of Dent is t ry . I n 1976 and 1977 consul tants w i l l be provided t o eva lua te t h e p r o j e c t and t o develop a n a t i o n a l d e n t a l h e a l t h survey. Assistance to t h e p r o j e c t w i l l continue u n t i l 1977.

V3H 001 Mental Health

To a s s i s t i n t r a i n i n g undergraduates and post-graduates i n psychiat ry , i n developing comuni ty- or iented mental hea l th se rv ices wi th in the general medical s e r v i c e s , and i n conducting epidemiological inves t iga t ions i n t o mental i l l n e s s .

Consultants were provided i n 1972, 1973 end 1974. I n 1975, a f e l l n r s h i p waa awarded f o r t r a i n i n g i n c l i n i c a l psychology. I n 1976, the Regional Adviser w i l l review t h e p r o j e c t and w i l l a s s i s t i n implementing a co l l abora t ive p ro jec t wi th WHO Headquarters t o develop an i n f a m a t i o n system f o r monitoring the use of resources and the need fo r mental h e a l t h care. The f e a s i b i l i t y and impl icat ions of t h e use of a u x i l i a r i e s i n e a r l y de tec t ion and out-pat ient treatment w i l l a l s o be s tud ied i n r e l a t i o n t o the goals of na t iona l hea l th programming. Fellowship for occupat ional therapy and t r a i n i n g of t u t o r s i n ~ o c i s l work w i l l be awarded.

The p ro jec t i n i t e present farm w i l l be discontinued i n 1976.

RAD 003 School f a r Medical P h y s i c i s t s (UNDP THA1701033)


PHA 001 Q u a l i t y Control of Pharmaceutical Preparat ions

This p ro jec t terminates i n 1976. 2

i i

THAILAND

LA3 001 St rengthenin# of Laboratory Techno lo~y

To a s e i s t i n o rgan i z ing n a t i o n a l h e a l t h l abo ra to ry s e r v i c e s , i n s t r eng then ing the t e ach ing of l sbora- tory s c i e n c e s , and i n t r a i n i n g i n medical l a b o r a t o r y technology.

(1) Department of Nedical Sc iences

Early a s s i s t a n c e t o t h i s p r o j e c t was extended from Thai land W 4 2 , "Tuberculos is Control". U n t i l 1972 prepara tory a s s i s t a n c e was provided by shor t - te rm consultants f o r p lanning t h e p r o j e c t . A microbiologist was ass igned i n 1972 t o h e l p r eo rgan i ze h e a l t h l a b o r s t o r y s e r v i c e s a t c e n t r a l , p r o v i n c i a l and d i s t r i c t l e v e l s . Consul tants v i s i t e d t h e p r o j e c t i n 1972 and 1974 t o develop t h e l abo ra to ry aepecte of ep idemio log i ca l s u r v e i l l a n c e .

In 1974-75 consu l t an t e have advised on s p e c i f i c f i e l d s i n c l i n i c a l pathology; s u r v e i l l a n c e of communi- cab l e d i s e a s e s ; equipment maintenance; b i o l o g i c a l s t a n d a r d i z a t i o n and r a b i e s vacc ine and t i s s u e c u l t u r e . P rov i s ion is made f a r payment of a g r a n t t o meet t h e c o s t of a n a t i o n a l cou r se f o r c l i n i c a l p a t h o l o g i s t s i n 1976-77.

The p r o j e c t has been i d e n t i f i e d du r ing n a t i o n a l h e a l t h programming as an impor tant s u p p o r t i v e p r i o r i t y and i s connected w i t h the s t r e n g t h e n i n g of h e a l t h l a b a r a t o r y s e r v i c e s a t a l l l e v e l s of t h e h e a l t h s e r v i c e s , n a r i nc lud ing side-roam l a b o r a t o r i e s i n t h e r u r a l areaa. The p r o j e c t is connected w i t h t h e improvement of c l i n i c a l work a t a l l l e v e l s , w i t h epidemiologica l s u r v e i l l a n c e , and acco rd ing ly , w i t h informat ion system development, cons ide rab l e emphasis i s l n l d on t h e t r a i n i n g of n a t i o n a l s t a f f i n t h e count ry and in t h e o rgan i za t i on of t h e l a b o r a t o r y s e r v i c e s network.

( 2 ) Univers i ty I n s t i t u t i o n s

Assistance w i l l be provided t o s t r e n g t h e n t h e t e ach ing of l a b o r a t o r y s c i ences .

(a) Chien~mai Medical Col lege - A f e l l owsh ip was provided i n 1974 i n medica l microbiology and phama- cology. Fellowships i n sero logy and i n toxicology w i l l be awarded i n 1976 and i n 1977 r e s p e c t i v e l y .

(b) Ramsthibodi Medical Col lege - I n 1974, a c o n s u l t a n t i n haematology was provided.

(c) Mahidol Univers i ty (Facu l ty of Medical Technology) - A c o n s u l t a n t reviewed, i n 1970, t h e four- yea r degree and one-year c e r t i f i c a t e courses f o r l a b o r a t o r y t echn ic i ans , recommended t h e r eo rgan i za t i on of t h e curr iculum f o r c l i n i c a l chemis t ry , i n c l u d i n g automated chemis t ry , and sugges ted updat ing t h e methods o f t e ach ing , t r a i n i n g and examination. I n 1974, a f e l l owsh ip was provided i n microbio logy.

Fellowahips i n 1975, have been provided f o r t r a i n i n g i n pathology.

LAB 003 Nat ional Laboratory Animal Cent re (UNDP THA/72/004)

To e s t a b l i s h a n a t i o n a l l abo ra to ry animal c e n t r e f o r provid ing sma l l l a b o r a t o r y animals of a s t anda rd q u a l i t y t o t h e t e ach ing and r e s e a r c h i n s t i t u t i o n s as w e l l as b i o l o g i c a l l a b o r a t o r i e s .

Ass i s t ance o r i g i n a t e d i n 1970 under p r o j e c t Thai land 0075. A c o n s u l t a n t c o l l e c t e d informat ion on t h e demand f o r and t h e use made of sma l l l a b o r a t o r y animals i n Bangkok. In 1971, ano the r consu l t an t surveyed t h e capac i t y of i n s t i t u t i o n s f o r b r eed ing sma l l l a b o r a t o r y animals and recornended t h e e s t a - blishment of a c e n t r e 1 breeding u n i t , the product ion of l a b o r a t o r y animal d i e t s and the training of t e chn ic i ans i n animal s e i eneea . The Government of Thai land e s t a b l i s h e d i n 1972 a Na t iona l Laboratory Animal Centre i n Mahidol Un ive r s i t y , w i t h a s s i s t a n c e from UNDP. The Centre w i l l breed and supply sma l l l abo ra to ry animals t o medical and b iomedica l and h e a l t h i n s t i t u t i o n s and w i l l provide adequate f a c i l i t i e s f o r t r a i n i n g q u a l i f i e d l a b a r a t o r y animal t e chn ic i ans . I n e a r l y 1973, e c o n s u l t a n t a s e i s t e d t h e co-ordina t ing c o r n i t t e e w i t h t h e d e t a i l e d p lanning o f t h e b u i l d i n g and its lay-out as w e l l as w i t h t h e long-term planning of t h e a c t i v i t i e s of t h e Centre; i n 1974, a v e t e r i n a r i a n was awarded a fellow- s h i p f o r t r a i n i n g i n l abo ra to ry animal technology b reed ing and management.

In e a r l y 1975, a WHO c o n s u l t a n t v i s i t e d t h e p r o j e c t t o review d i f f e r e n t problems r e l a t e d t o h e a l t h l abo ra to ry s e r v i c e s and s p e c i f i c a l l y l abo ra to ry animal c e n t r e s . b e t o nan-completion of t h e b u i l d i n g where t h e n a t i o n a l l abo ra to ry animal c e n t r e is t o b e housed, t h e p r o j e c t d id not make much headway.

I n 1977, a WHO c o n s u l t a n t w i l l be a s s igned t o adv i se i n s c i e n t i f i c and t e c h n i c a l problems.

THAILAND

5.3.5 Health Laboratory Techno lou

Strengthening of Laboratory Technolow

Microbiologist P4

Short-term consul tants Fellovships Subsidy Supplies and equipment

National Laboratory Animal Centre THA/72/004

Short-term consul tant Supplies and equipment Miscellaneous

m v 9

BE

DP

--

Project NO.

LAB 001

LAB 003

--

Propoeala

1978

42 400

12 000 8 700

12 600 5 000

80 700

1979

44 900

27 000

12 600 5 000

89 500 -

I

1976

1112

2113

Revised

1976

37 300

8 300 6 600 5 000

57 200

Estimates

1977

39 700

9 200 12 600

5 000

66 500

7 600 20 000

800

- 28 400 -

1979

1/12

21 6

Number

1977

1112

2/15

11 2

of Posts

1978

1112 ----

1 1 1 1 ----

11 3 21 6

THAILAND

BSM 001 Community Water Supply (UNDP 211A/72/016)

This p r o j e c t t e rmina t e s i n 1976.

BSM o0L Community Water Supply and S a n i t a t i o n (UNDP THA/75/W6)

TO a s s i s t i n t he p lanning and implementation of t he n a t i o n a l envi ronmenta l h e a l t h programme. I n p a r t i c u l a r , t o promote t h e p rov i s i on of s a f e wa t e r s u p p l i e s t o s m a l l e r communities by t h e e x p l o i t a t i o n of groundwater sources or t h e use of a p p r o p r i a t e technology f a r wa t e r t r e a tmen t and t o ca-ord ina te t he development of s a n i t a t i o n programmes w i th p rov i s i on of sa fe wa t e r s u p p l i e s .

This p r o j e c t i s t he follow-up t o t he UNDP-assisted p r o j e c t Thai land 0090, "Nat iona l Community Water Supply", which ended i n 1975.

I n 1976, a s a n i t a r y eng inee r and a hyd rogeo log i s t have been provided from r e g u l a r budget funds , and ano the r s a n i t a r y eng inee r has been funded on an i n t e r - coun t ry p r o j e c t . I n view of t h e n o n - a v a i l a b i l i t y of a n t i c i p a t e d UNDP funds , some d e l a y s i n f u l l implementa t ion of i n t e r n a t i o n a l a s s i s t a n c e may, however, t ake p l a c e . It i s hoped t h a t t h e p o s i t i o n w i l l improve i n 1977 when t h e s a n i t a r y eng inee r under t h e r egu l a r budget w i l l con t i nue and c o n s u l t a n t s w i l l be provided on wa t e r q u a l i t y c o n t r o l and s a n i t a t i o n . A p r o j e c t proposa l based on n a t i o n a l h e a l t h programming, is under p r e p a r a t i o n f o r t h e pe r i od 1977-1981, cor responding wi th t he Four th Na t i ona l P lan per iod . I t is expected t h a t i n t e r n a t i o n a l a s s i s t a n c e t o t he p r o j e c t w i l l be e n t i r e l y funded by UNDP and UNICEF from 1978 onwards.

SES 001 S t r e n ~ t h e n i n p , of t he Department of S a n i t a r y Engineer in%, Chulalonakorn Un ive r s i t y

To a s s i s t i n s t r e n g t h e n i n g t he Department of S a n i t a r y Engineer ing a t Chulalongkorn Un ive r s i t y .

In 1971-72, a c o n s u l t a n t was a s s igned t o t h e Un ive r s i t y under p r o j e c t Thai land 0120, "Bio-environmental Engineering", t o a s s i s t i n t h e f u r t h e r improvement of t r a i n i n g and r e s e a r c h i n t h a t f i e l d . Ass i s t ance was provided f o r t h e development of t r a i n i n g and r e s e a r c h i n envi ronmenta l p lanning and i n d u s t r i a l was t e s t rea tment i n 1974 and 1975. Fu r the r a s s i s t a n c e is proposed fo r 1976-1977 i n s t r e n g t h e n i n g s a n i t a r y eng inee r i ng t r a i n i n g and r e s e a r c h by p rov id ing c o n s u l t a n t s t o review the e x i s t i n g programme and t o adv i s e on a i r p o l l u t i o n c o n t r o l . Fe l lowships f o r f a c u l t y members t o s t udy t e ach ing methods i n wa t e r and was te t r e a tmen t . envi ronmenta l h e a l t h , p u b l i c h e a l t h eng inee r i ng and envi ronmenta l chemis t ry w i l l be provided.

Ass i s t ance is expected t o t e rmina t e a t t h e end of 1977,

FSP 001 Food and Drug Control

To a s s i s t i n e s t a b l i s h i n g a n a t i o n a l food and drug con t ro l adminis t ra t ion and i n t r a i n i n g s t a f f .

A consultant i n food con t ro l l e g i s l a t i o n was provided i n 1971. Further consul tants were provided i n 1974 and 1975 to t r a i n mare food-handlers and f o r s t rengthening t h e microbiological u n i t of t h e Food Analysis Section. I n 1976, a ehort-term consul tant i n food chemistry w i l l be provided t o a s s i s t i n a n a l y t i c a l methods and chemical ana lys i s . Assis tance is aleo expected t o be provided t o develop t e s t i n g methods far screening of foods, drugs and cosmetics. Fellowehips w i l l be provided i n d i f f e r e n t f i e l d s of food control .

The p ro jec t is expected t o continue f o r a number of years.

367 INTER-COIMTRY - Index

Page P r o j e c t NO.

BSM 001

CEP W2

DHS 100 Development of Health S t a t i s t i c a l I I Serv i ce s 1 406

I I P r o j e c t T i t l e

CM 001

cWO 100

DGP 001

ESD W 1 Dengue Haemorrhagic Fever I I Surve i l l ance and Contro l 1 390

Community Water Supply and S a n i t a t i o n

Environmental P o l l u t i o n Contro l

402

404,415

Cardiovascular Diseases

Co-ordination wi th o t h e r Organiza t ions

Regional ~ i r e c t o r ' s Development Programme

HED 003 Development of Health Education i n I I Family Heal th Programme 1 382

400

368

368

ESD 003

ESD 100

XED 100 Health Education I I 1 382

HLT 001 Health L i t e r a t u r e and Teaching I I Mater ia l8 1 406

Epidemiological S u r v e i l l a n c e and Nat ional Health I n t e l l i g e n c e systems Development

Epidemiologica l Su rve i l l ance

HLT 003 Regional Centre f o r Documentation I I on Human Reproduction, Family Planning and Popula t ion Dynamics 408

390

39 2

HMD 001 Continuing Education f o r Nurses I I 1 382

Education and T ra in ing i n Community Health 1 384

HMD 008 Medical Education i n Human Repro- I I d u c t i a n , Family Planning and Popula t ion Dynamics 1 384

I HMD 005

HMD 006

KW 009 Medical Teacher T ra in ing and I ! Continuing Education,Phase I1 1 386

P a r t i c i p a t i o n i n Meetings

Educat ional Technology

Development of Nat ional Post- graduate T ra in ing Centres 1 386

HMD 011 Continuing Education fo r Heal th I I Workers 388,415

HSD 001 Heal th Research and Development I I (SHS 006)* 372,415

I HMD 012

HMD 100

HSD 002 Advisory Se rv i ce s (SHS 009)*

HSD 003 Medical R e h a b i l i t a t i o n (SHS 011)* I 1 HSD 004 Repair and Maintenance of Biomedical 1 1 E l e c t r i c and E l e c t r o n i c Equipment 374

Medical Teacher T ra in ing and Continuing Education,Phase 111

Heal th Manpower Development

HSM 001 Heal th S t a t i s t i c a l Methodology I I 406,415

388

390

*Pro j ec t number p r i o r t o t h e c u r r e n t programme s t r u e r u t

P ro j ec t

IMM 001 -c I LAB 004

LAB 100

MCH 002

MCH 003

I MCH 010

I I MCH O l 1 I MCH 012

MCH 100 I

MNH 100

MPD 001

MPD 003

MPD 10C

NUT 002

NUT 003

NUT 004

N l n 10C

PBL 001

PHC 001

PIP 001

PPE 10(

PPH 10(

PPN 10(

PPS 00:

PPS 00:

PPS 101

RPD 00

RPD 101

SPI 00

SPI 00

VBC 10

VPH 00 -

Pro j ec t T i t l e

T ra in ing i n Immunology

S t anda rd i za t i on of Diagnos t ic Ma te r i a l and Labora tory P r a c t i c e

Health Laboratory Technology

Course f o r Sen io r Teachers i n Chile Health

Education and S tud i e s i n Maternal and Child Heal th

Education and S tud i e s i n Chi ld Health

Regional Team on Family Health

Regional Maternal and Child Health T ra in ing Programme

Maternal and Chi ld Health

Mental Health

Advisory Team on Anti-Malaria A c t i v i t i e s

Meetings on Anti-Malaria Operation:

Malar ia and Other P a r a s i t i c Disease

N u t r i t i o n Teaching i n Educat ional I n s t i t u t i o n s f o r Health Persanne:

Study on I n t e r n a t i o n a l Megalo- b l a s t i c Anaemias

N u t r i t i o n Programme

Prevent ion of Blindness and Visual Impairment (OCD 002)*

Organiza t ion and Adminis t ra t ion o f Primary Heal th Care (SHS 002)*

P u b l i c Heal th Advisory S e r v i c e s , Mekong (Phase IV)


P r o g r m e Planning and General A c t i v i t i e s


Asian I n s t i t u t e f o r Economic ~ ~ " e l o p m e n t and Planning(SHS 001

S t r eng then ing of Health Se rv i ce s Adminis t ra t ion through Tra in ing i n Planning (SHS 012)*

programme Planning and General A c t i v i t i e s

Biomedical Research

Research Promotion and Development

Sn~al lpox E rad i ca t i on (SME 001)*

Expanded Programme on Immunization

v e c t o r Biology and Con t ro l

raining i n Ve te r ina ry P u b l i c Heal th

- Page - 400

402

402

376

376

378

378

378

380

400

39 2

392

39 4

380

380

380

380

398

376

,04

40 2

404

398

370

370

372

368

368

39 4

39 6

396

39 6 -

368

INTER-COUNTRY

CWll 100 Co-ordination wi th l l ther Organiza t ions

I n f r a s t r u c t u r e .

WII 001 !liomedical Research

r u s t r eng then r e sea rch c a p a b i l i t i e s i n Member c o u n t r i e s and t o p r o m t e t h e a p p l i c a t i o n of e x i s t i n g and ,new s c i e n t i f i c knowledge and r e s e a r c h methodology t o problems r e l a t e d to t h e s t a t e d p r i o r i t i e s of the IJ rganiza t ion; t h e main ins t rument of implementing t h e p r o g r a m e is t h e Regional Advisory Committee on ?ledical Research, the f u n c t i o n i n g of which would b e t h e main a c t i v i t y of t h i s p r o j e c t .

rile implementation of r e sea rch on t h e whole w i l l be co-ard ina ted and suppor ted by t hose of Headquarters Kcsearch. Promotion and Development, a d m i n i s t r a t i v e l y , f i n a n c i a l l y and t e c h n i c a l l y .

RPU 100 IUrsearch Promotion and Development

Regional Advisory Services.

DGP 001 Kegional D i r e c t o r ' s Development P r o g r m e

With a view t o provid ing a mechanism for f i nanc ing WHO'S c o l l a b o r a t i o n t o meet s p e c i a l neede of the c o u n t r i e s i n t h i s r eg ion a r i s i n g o u t s i d e t h e budget c y c l e , a "Regional D i r e c t o r ' s Development Programme" has been e s t a b l i s h e d and p rov i s ion f a r t h i s purpose nade i n 1978 and 1979. This w i l l I n t roduce f l e x i b i l i t y i n t o p r o g r a m e budget ing so as t o enab l e implementation of new i d e a s and provide f o r developments t h a t may t a k e p l a c e a f t e r t h e f i n a l i z a t i o n of t h e programme budget and w i l l provide a l i m i t e d source of funds t o b e used as a p o s e i b l e i n s t rumen t f a r meeting unexpected needs.

370

INTER'COUNTRY

PPS 001 Asian Institute f o r Efanamie Development and Planning

TO a s s i s t t h e f acu l ty of t h e Asian Development I n s t i t u t e , Bangkok, wi th the hea l th component of t r a i n - ing courses and o the r a l l i e d a c t i v i t i e s of t h e I n s t i t u t e . Assis tance to t h e p r o j e c t s t a r t e d i n 1964, s i n c e when a publ ic hea l th admin i s t r a to r and a t echn ica l o f f i c e r (economist) have helped t h e I n s t i t u t e with i t s var ious courses, laying emphasis on the h e a l t h component; a s s i a t e d i n the organizat ion, conduct and evaluat ion of th ree r eg iona l courses and two country- level courses i n n a t i o n a l hea l th planning; a s s i s t e d i n country hea l th programing exe rc i ses and conducted s f i e l d study f o r c o l l e c t i n g teaching mate r i a l i n the na t iona l h e a l t h planning course.

During 1978-1979, i n add i t ion t o a s s i s t i n g t h e I n s t i t u t e i n i t s a c t i v i t i e s , among which is t h e important sub-theme designated as ' de l ive ry of s o c i a l se rv ices including primary hea l th c a r e and family p lann ing ' , i t is proposed t o he lp i n conducting t h e I n s t i t u t e ' s r eg iona l t r a i n i n g courses aimed a t t h e development of eompreheneive planning f o r h e a l t h , i n in t roducing and improving t h e hea l th planning approach i n eocio-economic development, i n s t rengthening t h e hea l th planning a c t i v i - t i e s of the Region and i n t h e development of t h e planning, programming and p r o j e c t formulat ion l e v e l s of the hea l th planning proceas.

PPS 002 Strengthening of *Services Adminisrratlon throueh Trainlnp, in Planning (UNDP RAS/73/027)

To a s s i s t i n developing and s t rengthening hea l th planning, as an i n t e g r a l p a r t of h e a l t h se rv ices systemsladminis t ra t ion of coun t r i e s , t o meet more e f f e c t i v e l y and e f f i c i e n t l y t h e hea l th needs of the people wi thin the framework of t h e i r s o c i a l and economic development by p r o m t i n g n a t i o n a l a e l f - su f f i c i ency i n hea l th planning and h e a l t h aystems management t o s t rengthen h e a l t h se rv ices sdn in i s t r a - t i a n .

The p ro jec t was i n i t i a t e d i n 1969 under t h e WHO Regular budget wi th the t i t l e "National Health Plan- ning" when a meeting of r ep resen ta t ives from the coun t r i e s of t h e Region on hea l th planning waa supported. Assistance was provided t o S r i Lanka i n hea l th planning and t o Thailand i n the devalopment of a manpower s tudy, and a r eg iona l s h o r t courae i n h e a l t h planning was conducted f o r p s r t i c i p a n t a from f i v e countr ies .

In 1970, UNDP s t a r t e d a s s i s t i n g t h e p r o j e c t under t h e t i t l e "National Health Planning and Manpower Studies". In the same year t h e p ro jec t supported a meeting on hea l th planning i n Bangkok which was attended by senior o f f i c i a l s of m i n i s t r i e s of h e a l t h i n t h e coun t r i e s of t h e Region, and provided short-term s p e c i a l i s t a s s i s t a n c e (publ ic hea l th adminiat re t ion and hea l th s t a t i e t i c s ) t o t h e Government of S r i Lank8 f o r the es tabl ishment of a h e a l t h planning u n i t .

In 1971-1972, two mare regional ahor t courses i n h e a l t h planning were held i n Bangkok. The p ro jec t a s s i s t e d t h e Governments of Indonesia, S r i Lanka end Thailand i n s t u d i e s of h e a l t h manpower; the Governments of India and Thailand i n hea l th planning t r a i n i n g ; and t h e Government of Mongolia i n hea l th economies. Health planning courses were held i n Burma, Thailand and Indonesia.

In 1973, a s s i s t ance was provided i n t h e conduct of e n o r i e n t a t i o n course i n hea l th planning and management i n Thailand.

In 1975, ahor t t r a i n i n g courses a t n a t i o n a l l e v e l , i n n a t i o n a l hea l th planning and h e a l t h ayetems management f a r sen io r ca tegor ie s of h e a l t h admin i s t r a to r s and h e a l t h planning t r a i n e r s were conducted i n Indonesia and India . Similar t r a i n i n g courses i n t h e coun t r i e s of the region a r e planned f o r 1976 throilgh 1978. A regional seminar f o r hea l th planners and admin i s t r a to r s and hea l th planning and management educators each i n 1976, 1977 end 1978 is planned. Besides. f e l l m s h i p s e r e planned t o be provided t o f a c u l t y members of na t iona l t r a i n i n g i n s t i t u t i o n s and coneu l t an t s w i l l a s s i a t i n s t rengthening t h e teaching i n s t i t u t i o n s .

Project NO.

PPS 001

PPS 002

.

rn

$

RB

DP

, INTER-COUNTRY


3.1.1 Programe Planning and General A c t i v i t i e s

him I n s t i t u t e f o r Economic Development and Planning

Public h e a l t h adminis t ra tor P5

Economist P4 Clerk-stenographer BK7


Strengthening of Health Services Administration through Training i n Planning RASl731027

Pro jec t manager P5 Management exper t P4 Nuroe adrninietrstor P4 S e c r e t a r i a l a s s i s t a n t s BK7 S e c r e t a r i a l a s s i s t a n t ND4 Clerk- typis t BK5

Short-term consul tante Temporary advisers Adminiatratlve suppor t

personnel Fellowships Group t r a i n ~ n g Supplies and equipment Miscellaneous

1976

1/12 1/12 1/12

3

1/12 1/12 11 4 2/24 1/12 1/12

-- 7

11 4

-

I

Number

1977

I 1/12 1/12 1/12

1/12 1/12 1/12 2/24 1/12 1/12

7

2/10 ,

-

11 1 1

5/60

I i

Revised

1976

- 82 000

2 500

- 84 500 -

- 125 000

15 200

1 200

32 000 7 000 7 600

188 000

Proposals

1978

43 400 43 400 6 900 -

93 700

1 000

94 700

47 400 47 400 47 400

9 000 4 100 2 700

- 158 000

26 600

1 600 138 600

19 000 2 600

1 0 000 ---- 360 400

----

Estimetrs

1977

40 700 40 700

6 000 - 87 400

1 000 - 88 400 -

47 400 47 400 47 400

8 600 3 900 2 600

- 157 300

38 000 3 800

1 500 66 000 23 000 4 000

1 4 000

307 600

1979

45 900 45 900

7 900 - 99 700

1 000 --

100 700 --

47 400 15 800 47 400

9 600 4 300 2 900 - 127 400

7 600

1 700

1 000 1 2 400

150 100

I I

of Posts

1978

1/12 1/12

1979

1/12 1/12

1/12 ----

1 3 1 3

----

1/12 1/12 1/12 2/24 1/12 1/12

- 1 -

1 1/12

3

1/12 1/ 4 1/12 2/24 1/12 1/12

7 7

21 7 -1, l l / l Z b

INTER-COUNTRY

PPS 100 Profiramme Planning a d General A c t i v i t i e s

Regional Advisory Services .

HSD 001 Health Research and Devela~mannt

The ob jec t ives of the p r o j e c t are t h e development and s t rengthening of mechanisms f a r programme development end euppar t , both i n the Regional Off ice and i n t h e coun t r i e s of the Region and these w i l l be achieved through euppart t o t h e Progr-a Support a d Co-ordination Unit (PSC) i n t h e Regional Off ice i n carrying ou t i ts main func t ions , v i z . , country h e a l t h programming (CUP), p ro jec t formulation and management (PPbM) , medim-term progr-ing (KCP) , programme budgeting (PB), development of programme evaluat ion methodology (DPEV), p m g r a m e l p r o j e c t information system (PPIS) and consul tant se rv ices t o countries.

The project app l i e s q u a n t i t a t i v e methods of research and ana lys i s .

A t the time i t was s t a r t e d , the p ro jec t got involved i n var ious a c t i v i t i e s piecemeal, without a c l e a r perspective of i t s proper r o l e i n the r eg iona l WHO system. Its ob jec t ives were re-defined i n 1974, and i t became abviaua t h a t t h e p r o j e c t could work meaningfully only i n the context of the working programme of PSC, as a resource group. Its a t a f f were involved i n e l l t h e a c t i v i t i e s of PSC, and t h e e f f i c i ency of the p ro jec t can b e evaluated only i n t h e context of the a c t i v i t i e s of PSC.

The pro jec t w i l l continue t o func t ion aa resource group of PSC. I n a d d i t i o n , s p e c i a l a t t e n t i o n w i l l be given t o the promotion bf hea l th s e r v i c e s research, i n t h e context of t h e improvement of planning end management of hea l th se rv ices i n the va r ious coun t r i e s and i n the Regional Office.

HSD 002 Advisory Services

To provide consul tant s e r v i c e s i n regard t o emerging h e a l t h problems such as road t r a f f i c acc iden t s a d g e r i a t r i c s upon s p e c i f i c , ad hoc r eques t s of governments; a l s o t o provide support t o a c t i v i t i e s cu r ren t ly financed under in t e r - reg iona l p r o j e c t s and s u i t a b l e f o r implementation i n t h i s region.

Assistance t o the p ro jec t i s expected t o continue u n t i l 1980.

INTER-COUNTRY

HSD 003 Medical Rehabilitation

To assist in: (1) assessing the pattern of disability; (ii) investigating the causes and promoting measures for the prevention of disabilities; (iii) evaluating existing facilities for rahabilitation of the disabled; (iv) promoting the training of health and allied menparer, organization of services and research for rehabilitation of the disabled aa an integral part of the existing public health, social welfare and educational services in the countries of the Region; (v) establishing facilities for consulting and training in vocational aspects of rehabilitation.

Under SEAR0 0174, "Rehabilitation of Handicspped Children", a consultant visited India. Indonesia, Sri Lanka and Thailand in 1968 ta study the available health facilities for physically handicapped children. In 1970, the same consultant visited Sri Lanka and also paid a second visit to Thailand to work out details for the establishment of a comprehensive assesement centre for handicapped children. In 1971, a further consultant visited medical rehabilitation institutions in B u m . India, Indonesia, Sri Lanka and Thailand. In 1973, a team of three consultants (a medical officer, a physiotherapy tutor and s prostheticlorthotic tutor) (under SEABO 0174) conducted e courae on management skills for the total care of the disabled in Indonesia, and assisted with the formulation of a project.

In 1975 and 1976, a team of three eteff members (a medical officer, a physiotherapiet and a prosthetic1 orthatic tutor) assisted with the community-oriented disability prevention and rehabilitation prograe in Semarang as a regional training centre in collaboration with rehabilitation training and service activities in Solo and at the Patmewati Hospital in Jakarta. The team also provided assistance to other centres in the Region.

In 1976, an inter-country warkehop was held for participant8 from Bangladesh. Burma, India, Indonesia, Sri Lanka and Thailand to demonstrate community-oriented disability surveys. development of integrated comprehensive rehabilitation services within the existing health and aocial wslfare services, education and training in rehabilitation, and the development of research specially directed towards the promotion of local talents and use of locally available material for vocational training.

In 1977, an inter-country seminar on rehabilitation of crippled children will be organized.

Assistance on the present ecale will be continued for same years.

HSD 004 Repair and Maintenance of Bimedical Electric and Electronic Equipment

To assist in strengthening national organization for training uf technicians in repair end maintenance of biomedical electric and electronic equipment and establishment of s syatem of hospital workshops.

Repair end maintenance of electric and electro-medical equipment in hospitals is a specialized area which requires development of a national system and establishment of theae services in the countries of the Region. It is proposed to aet up a regional training centre in Sri Lanka for training of technicians in repair and maintenance of hospital equipment and nanapenent of hmpital workshops. Provision has been made, subject to availability of funda, for a full-time biomedical engineer. traininp fellowships end limited supply end equipment.

PHC 001 OrRanization a d Administration of Primery Health Care

To e a s i e t i n the development of regional ized hea l th se rv icee i n t h e organizat ion of systems of a e d i c a l care , and i n hosp i t a l admin i s t r a t ion , including t h e planning and development of facilities f o r the diagnosis , t reatment , care and r e h a b i l i t a t i o n of t h e s i c k , and i n t h e development of uniform a y a t e m of record keeping and repor t ing , including support t o a h o s p i t a l and h e a l t h c e n t r e r e f e r r a l s e r v i c e s y s t m ; t o a s s i s t i n t r a i n i n g s t a f f a t var ious l e v e l s of operat ion.

Pol lar ing t h e organizat ion af an in ter-country course i n h o s p i t a l admin i s t r a t ion i n 1968, two consult- an t s prepared, i n 1970, a d r a f t guide on the func t iona l programing of h o s p i t a l s ; a seminar on t h i s sub jec t was held i n 1971. I n 1972. Nepal received a s s i s t a n c e from two consu l t an t s i n the designing of hosp i t a l8 and of a hea l th post , and a coneul tant a r c h i t e c t advised the Thai Haepi ta l Deeign C o m i t t e e on the Pr ince of Songkhla Univers i ty . A seminar on t h e f u n c t i o t u l programing of h o s p i t a l s i n r e l a t i o n to bas ic hea l th se rv ices was held i n Bandung, Indonesia, i n 1973 f o l l w c d , i n 1974, by another on t h e organizat ion of medical care i n r e l a t i o n t o genera l h o s p i t a l s , which took p lace i n Sr inagar ( Ind ia ) . A h o s p i t a l adminis t ra tor and a medical records o f f i c e r were assigned t o the p ro jec t i n 1974. I n 1975. s seminar on pe r iphe ra l medical c a r e s e r v i c e s was held i n Bangkok and Chiengmai ( m a i l a n d ) . Bangladesh and Indonesia received a s s i s t a n c e i n t h e f i e l d of medical records , and f u r t h e r a s s i s t a n c e w i l l be provided to coun t r i e s i n t h e Region. I n 1976, a seminar an app l i ca t ion of ways end approaches r e s u l t - ing from e a r l i e r s t u d i e s t o achieve increased coverage by h e a l t h c a r e de l ive ry p r o g r a m s was held i n the Regional Off ice . In 1977. a seminar on primary hea l th c a r e is proposed t o be held. I n 1978 and 1979 f u r t h e r a s s i s t a n c e w i l l be given i n t h e f i e l d s of medical r ecords , f i n a n c i a l management of hosp i t a l s (coat aceouoteney), h o s p i t a l a r c h i t e c t u r e , e t c .

b s i s t a n c e to the p ro jec t w i l l cont inue f o r a number o f years .

HCH 002 Course f o r Senior Teachers i n Child Health

To provide advanced t r a i n i n g f o r sen io r t eacher s i n c h i l d hea l th i n developing coun t r i ee wi th the object of improving education i n c h i l d hea l th i n these coun t r i e s .

Assistance has been provided t o t h e UNICEPIWHO t r a i n i n g p r o g r a m f o r sen io r teachers i n c h i l d heal th . I n 1970, a consul tant a s s i s t e d i n t h e conduct of a f i e l d education study a t Hyderabad ( India) t o be undertaken by t h e p a r t i c i p a n t s . Another consu l t an t c a r r i e d o u t , i n t h e same year , an eva lua t ion of t h e course by interviewing fe l lows from t h e South-Eest Asia Region. I n 1972 and 1974, t h e Director of t h e course i n Hyderabod was s e n t t o t h e United K i n g d a and Bast Afr ica t o take p a r t in the teaching progr-s. In 1973, the f i r s t reunion meeting of t h e p a r t i c i p a n t s i n the previous courses (1967 and 1968) was held i n the Regional Of f i ce as a means of f u r t h e r evaluat ion and follov-up of the course. and a similar meeting was organized i n 1975 f o r t h e fe l lows of t h e 1969 and 1970 courses. A t h i r d such meeting is planned f o r 1977 aa a form of cont inuing evaluat ion.

Provision haa a180 been m d e i n 1977 and 1978 t o support the p a r t i c i p a t i o n of some fe l lows from countriem of the Region.

HCH 003 Education and Studies i n Maternal and Child Health

To assist i n f u r t h e r developing t h e educat ional and s e r v i c e p r o g r w , including s p e c i a l s t u d i e s , i n p r i o r i t y areas i n t h e f i e l d of maternal and c h i l d h e a l t h , i n support of pe r iphe ra l h e a l t h se rv ices .

Thia p ro jee t is an expansion of t h e a c t i v i t i e s under p ro jec t ICP HCH 010.

I n 1978. two workshops w i l l be held - one on "Teaching of Maternal and Child Health" and the o t h e r on "Predic t ive Value Between High-risk Pactore and P e r i n a t a l Events and I n f a n t Health" - with a view t o developing se rv ice gu ide l ines .

The two group educat ional a c t i v i t i e s t o be held i n 1979 ere a "Symposiun t o draw up Guidelines f o r School Health Servicea" and a seminar on "Delivery of Service t o Pre-School Child i n the Context of Primary Health Care".

This p ro jec t has been developed i n o rde r t o u t i l i z e t h e d a t a from t h e p e r i n e t a l s t u d i e s a8 a feedback to the maternal and c h i l d hea l th programw 80 t h a t maternal h e a l t h aspect8 could a l s o be included. I n view of the s t r e a s on maternal and c h i l d hea l th i n t h e h e a l t h plans of copn t r i e s i n t h e Region, i t is appropr ia te t h a t t h i s s u b j e c t be developed as a more coherent e n t i t y wi thin t h e t r a i n i n g p r o g r a m f o r hea l th personnel. Data from p e r i n a t a l s t u d i e s supported by t h i s programme w i l l be u t i l i z e d for fr-ing s e r v i c e r e f e r r a l p o l i c i e s (guidel ines f a r h i e - r i s k cases) wi th in the context of pe r iphe ra l hea l th se rv ices . I n view of t h e growing importance of achool hea l th s e r v i c e s t o formulate gu ide l ines f o r these s e r v i c e s and f o r framing s e r v i t e r e f e r r a l p o l i c i e s f o r t h e pre-school c h i l d .

INTER-COUNTRY

MCH 010 Education a n d Studies i n Child Health

To a s s i s t i n f u r t h e r developing t h e education and s e r v i c e programmes, including s p e c i a l s t u d l e a , i n p r i o r i t y areas i n t h e f i e l d of c h i l d hea l th .

The a c t i v i t i e s of p ro jec t SEARO 0170, "Short Courses i n Neonatology", SEaRO 0196, "Education i n Paediat r ics" , SEARO 0197, "Seminar on Health Aspecte of Care of Normal Children i n Day-care Centres and I m t i t u t i a n s " , and SEARO 0230, "Assessment of L w Birth-Weight Babies", were merged i n t o t h i s p ro jec t i n 1974.

1" 1974, a consul tant v i s i t e d four coun t r i e s (Burma, India . S r i Lanka and Thailand) t o study t h e magnitude of the problem of lw b i r t h weights and i t s importance i n con t r ibu t ing t o p e r i n e t s l m r b i d i t y and mor ta l i ty , and to a s s i s t i n drawing up a methodology f o r s tudying such morbidity and mor ta l i ty .

In 1975, i n s t i t u t i o n s f a r t h e study were i d e n t i f i e d ( i n Burma end Ind ia ) , and an in ter-country meeting was held i n Bangkok t o review t h e post-graduate p a e d i a t r i c c u r r i c u l a , including t h e i n t e r n s h i pmriod. I: In 1976, assistance w i l l be provided f o r a s sess ing t h e d a t a co l l ec ted during t h e " p i l o t phase of the p e r i n a t a l study i n Burma. A seminar an neonatology w i l l a l s o be he ld , sub jec t t o a v a i l a b i l i t y of funds.

MCH 011 Regional Team an Family Health

To support country end inter-country a c t i v i t i e s i n family hea l th wi th regard t o planning, s s rv iceo , t r a in ing , management, evaluat ion and research embracing family h e a l t h , including t h e maternity-centred approach.

The a c t i v i t i e s of the p r o j e c t s SEARO 0219. "Development of Maternity-Centred Aspect. of Family Health Services". SEAR0 0199. "Group Education i n Se rv ice , Teaching end Reaearch Aspects of Human Reproduc- t ion , Family Health a d Population Dynamics", and SEAR0 0209, "Course i n Health Planning f o r Uaternal and Child Health/Pamily Planning Adminiatration" were merged i n t o t h e p ro jec t i n 1974 and 1975 respec- t i v e l y .

The members of t h e team have a s s i s t e d i n t h e development of family hea l th p ro jec t8 i n S r i Lanka, Bangladesh and Nepal during 1972 and 1973. I n 1974, one of the medical o f f i c e r s hse been s t a t ioned i n Bangkok t o he lp t h e WHO Representa t ive i n t h e co-ordination of t h e IMPPA-financed p r o j e c t s i n t h a t country and a l s o t o provide a s s i a t a n e e t o some of the other countr ies . p a r t i c u l a r l y Bangladesh and Nepal. The team has been a s s i s t i n g i n a c t i v i t i e s ranging from d a t a gather ing, p r o j e c t formulation, group educat ional a c t i v i t i e s t o evaluat ion. The programme of work envisaged includes , a p a r t from ~ss i s t a11ce t o t h e ongoing country family h e a l t h p r o g r a m s , a s s i s t a n c e i n the formulat ion of p r o j e c t r eques t s , ca-ordination and support t o country p r o j e c t s , and r e s p o n s i b i l i t y f o r organizing and supporting some of t h e group educat ional a c t i v i t i e s t h a t are nar t o take p lace under t h i s p ro jec t .

In 1975, e group educat ional a c t i v i t y on "Seminar an Paed ia t r i c i ans and Family Herlth" was held i n New Delhi. Two group educat ional a c t i v i t i e s , one on "Symposium on F ie ld Operat ional Research" and the other on "Workshoo on Deliver" of Maternal and Child HealthlFamilv Plsnnins Services i n t h e Context of Primary Health bare", are pianned i n 1976. I n add i t ion , two group educs i iona l a c t i v i t i e . each i n 1977. 1978 and 1979 ere planned.

MCH 012 Regional Maternal and Child Health Training Programme

The ob jec t ive of t h i s p ro jec t is t o develop a r eg iona l c e n t r e f o r t r a i n i n g i n maternal and c h i l d hea l th as t h e springboard f o r a r eg iona l t r a i n i n g programme; i t is a l s o planned t o disseminate t h o l e concepts through t h e establishment of e a t e l l i t e t r a i n i n g programmes wi th in t h e coun t r i e s of t h e Region.

a Subs tan t i a l e f f o r t s are required t o provide balanced t r a i n i n g i n maternal and c h i l d h e a l t h c a r e ( including family planning) t o p ro fess iona l a s w e l l a s a u x i l i a r y personnel i n o rde r t o u t c h t h e a s s i s t ance a l ready being given through IME'PA t o t h e family planning component i n country f d l y hea l th programmes i n t h e Region. The p r o j e c t responds t o t h i s r eg iona l need.

The t r a i n i n g programme i s t o b e baaed on an a x i s between the Regional Training Centre proposed t o be developed and a maternal and c h i l d hea l th cen t re / cen t rea a f excel lence i n a developed country.

MCB 100 Matern41 and Child Health


NUT 002 Nutrition Teaching in Educations1 Institutions for Health Personnel

To strengthen the teaching in nutrition of health personnel and aseiet in developing problem and service-oriented training.

In 1976, it is proposed to hold a Seminar on the Organization of Nutrition Progre-s in the Health Services.

A Workshop on Programes to Control the Specific Nutritional Diseaees through the Health Servicee will be held in 1977. It is proposed to hold a Workshop in 1978 to examine the Organization of the Nutrition Activities at the Field Level, vith emphasis on the teaching of local health personnel involved in these activities and on nutrition education to the community.

In 1979, a consultant will viait the counrries in the Region to evaluate the programmes in the control of protein energy malnutrition.

The project is expected to continue for aome years.

NUT 003 Study on International Megaloblastic Ahsemias


NUT 004 Nutrition Programe

To assist the countries in the Region in defining end organizing the nutritional components of programmes end services in the health area.

Subject to availability of funda from UNDP the following activities are proposed.

In 1978, two consultants will examine the organization and administrative structure of nutritional activities end programmes within the health services of the countries of the Region. A regional aeminar for planners, health administrators end public health nutritionists will be held to discuss their findings.

In 1978, a regional seminar will be held to examine the role and responsibility of the health sector in the control of protein-energy malnutrition.

In 1979, a workshop for medical and paramedical personnel will be held to exmine the institutional and domiciliary treatment and rehabilitation of the malnourished child.

NUT 100 Nutrition

/ ' Regional Advisory Services.

HED 003 Development of Health Education i n Family Health Progr-es (LMFPA IUS/71/P07)

To a a a i e t i n developing, implementing and evaluat ing t h e s f fec t ivenese of t h e h e a l t h education component OF family hea l th programme; i n improving t h e quan t i ty and the q u a l i t y of information, educe- t i o n a l and teaching m t e r i a l s used f o r family h e a l t h education; i n providing con t inu ins educat ion t o s t a f f of t r a i n i n g institutions and key h e a l t h educat ion personnel i n d i f f e r e n t a spec t s of family healti . education; and i n developing research c a p a b i l i t i e s i n family hea l th education.

A mult i -disc ipl inary workehop held i n 1971, examined t h e e x i s t i n g programmes f o r t h e development of hea l th education media r e l a t e d t o family hea l th and f o r m l a t e d gu ide l ines f o r t h e co-ordinated production, u t i l i z a t i o n and evaluat ion of theae media a t d i f f e r e n t l e v e l s of t h e hea l th adminis t ra t ion. To help apply these guidel ines and t o determine add i t iona l e f f o r t s needed, a ahort-term consu l t an t v i s i t e d two coun t r i e s i n t h e following year. I n 1973, s t r a i n i n g course i n s o c i a l sc i ence research methodology was held , and i n e a r l y 1974, a working group meeting on teaching and t r a i n i n g reeaurca ma te r i a l s i n family h e a l t h education was held; t h e s e were followed by another seminar on t h e assessment of heal th education and mass communication media p rograms i n family hea l th i n 1975.

I n 1976, two inter-country workshops, one on h e a l t h education eervicea i n family hea l th end t h e o the r on the development of a manual f a r audio-visual and mass communication s t r a t e g i e s , w i l l be held . A na t iona l workshop i s a l s o proposed t o be held i n Ind ia on se l f - l ea rn ing ma te r i a l f a r family hea l th education.

hssilrtsnce t o be provided i n 1978 and 1979 w i l l be s imi la r t o those i n the preceding two yea r s , but group educat ional a c t i v i t i e s w i l l focus on d i f f e r e n t a spec t s of family h e a l t h education. The hea l th education s p e c i a l i s t w i l l be continued and supp l i e s and equipment and supporting se rv ices w i l l be provided.

The pro jec t is expected t o continue f o r a number of yea r s , sub jec t t o a v a i l a b i l i t y of UNPPA funds.

BED 100 Health Education


Hwo 001 Continuin8 Education f o r Nurses

To s t imula te and encourage Member coun t r i e s t o develop cont inuing education programmes f o r nurseal midwives; t o a s s i s t i n s t i t u t i o n s and hea l th cen t res i n t h e planning and o rgan i sa t ion of continuing education f o r nursinglmidwifery personnel on the b a s i s of l o c a l needs and demands; t o develop, ' compile and publ ish reference ma te r i a l s geared t o the needs of nurseslmidwives a t t h e primary hea l th care l e v e l , and t o encourage and promote t h e co l l ec r ion , exchange and evaluat ion of informat ion and s t u d i e s i n cont inuing education.

Since 1967, country and inter-country courses have been held i n var ious c o u n t r i e s , cover ing a w i d e range of sub jec t s and involving p a r t i c i p a n t s from a number of hea l th d i s c i p l i n e s . The aim of t h i s p ro jec t is t o provide e a s i a t s n c e , through short-term s t a f f assignments, i n conducting courses f o r nurseslmidwifery personnel i n both hoap i t e l e and h e a l t h cen t res d i r e c t l y concerned with render ing primary hea l th se rv ices . Spec ia l emphasis w i l l be l a i d on t h e development of technology and in teg ra ted teaching methoda re l evan t t o the needs and preparat ion o f nurseslmiduives involved in cornuni ty h e a l t h work, including family planning, e s p e c i a l l y i n r u r a l h e a l t h se rv ices . A c t i v i t i e a w i l l a l s o include development of r e fe rence ma te r i a l s , end eventual pub l i ca t ion of those t h a t may be use fu l f o r nurses ill Hember coun t r i e s , and a l s o t o develop a deposi tory o r d a t a bank pe r t inen t t o education and se rv ices use fu l t o the planning of nurs ing i n the Region.

In 1976, an in ter-country course on "Trends i n Educational Technology" f o r t u t o r s i n nurs inglmidvifsry programmes was held end i n 1977 a n in ter-country v o r b h o p on "Co.aunity Health-based Nursing Curricuhm" f o r s e n i o r nur se educators w i l l be conducted.

Prom 1918, t h i s p ro jec t w i l l be merged with t h e new p r o j e c t ICP Kl4U 011, "Continuing educat ion for Health Uorkere".

INTER-COUNTRY

HHD 003 Education and Training i n Cornunity Health

Different a spec t s of community h e a l t h i n medical education have been discussed i n seminars organized during 1972-1975. Realizing t h e importance of medical a s s i s t a n t s i n hea l th c a r e de l ive ry , s p n c l l l y i n r u r a l a reas , a seminar on medical a s s i s t a n t s was organized i n February 1976. This seminar has made c e r t a i n reconmendations f o r implementing t h e programme of t r a i n i n g and u t i l i z a t i o n of mcdical a sa ia t an t s . Since t h i s concept haa been accepted by almost a l l t h e coun t r i e s of the Region, i t i w necessary and important t h a t t h i s group educat ional a c t i v i t y is continued i n 1977, 1978 and 1979 t o discuss t h e sub jec t i n d e t a i l and t a k e concrete dec i s ions .

Provision has been made f o r holding t h i s group educat ional a c t i v i t y and f o r the assignment of consul tants i n 1977. 1978 and 1979.

HMD 005 P a r t i c i p a t i o n i n Meetings

l h i a p ro jec t terminates i n 1976.

HHD 006 Educational Technolorn

TO promote t h e establishment of e d u u t i o r w l technology cen t res i n the coun t r i e s of t h e Region f o r t h e l o c a l production of teaching m t e r i d ~ f o r educat ion and t h e t r a i n i n g , i n i t i a l l y , of medical teacher. and l a t e r on of o the r l e v e l s of h e a l t h work*rs; t o provide support t o t h e teacher t r a i n i n g centram i n d i f f e r e n t countries of t h e Region, and t o he lp i n t h e conduct of courees f o r na t iona l personnel concerned with the production of educat ional mater ia la .

W o Regional Hedical Teacher Training Centres a r e a l ready funct ioning i n the Region, and support i s being ~ r a v i d e d f o r s e t t i n g up medical teacher t r a i n i n g c e n t r e s i n o t h e r coun t r i e s . Cons ida ra t im i m almo being given t o the eetablishment of e comprehensive educat ional technology u n i t i n t h e Ikgion with a s s i s t ance from WHO Headquarters. This p ro jec t w i l l a s s i s t and support t h e activities of these cen t res and t h e u n i t and funct ion i n c lose co l l abora t ion wi th p r o j e c t s ICP HUD 009. "Medical Teacher Training and Continuing Education". ICP HMD 001, "Short Coursee f o r Nurses and Health Personnel", ICP HLT 003, "Regional Centre f o r Documentation on Human Reproduction. Pamily Planning and Population Dynamics", and ICP HMD 008. 'Uedical Education i n Human Reproduction. Family Planning and Population Dynamics".

During 1976, the educat ional technologis t w i l l func t ion as a resource person t o adviae the institutions i n the s e t t i n g up of educat ional technology u n i t s , i n t h e production of teaching . a t e r i a l a , i n t h e conduct of courses f o r n a t i o n a l p e r ~ o n n e l f o r t h e production of educat ional u t e r i a l s , and i n t h e conduct of group educat ional a c t i v i t i e s .

The sane consu l t an t w i l l h e l p i n t h e p r o m t i a n of educat ional technology u n i t s and t h e production of teachin% m t e r i s l s i n t h e Region.

I n 1977 and 1979, i t is planned t o hold one inter-country and two n a t i o n a l courses covering the broad aspecta of educat ional mcience, including educat ional technology.

HMD 008 Medical Education i n Human Reproduction, Family Planning and Population Dynamics (UNFPA RASJ71IPO5)

TO a s s i s t i n t h e planning, p repa ra t ion , conduct and eva lua t ion of s h o r t t r a i n i n g courses f o r sen io r medical educators i n order to improve f u r t h e r t h e teaching of human reproduct ion, family planning and population dynamics i n medical schools of t h e Region.

The f i r s t course was held i n 1972 a t t h e Nat ional I n s t i t u t e of Family Planning, New Delhi, t h e second i n Dacca, Bangladesh i n 1973, t h e t h i r d i n Denpasar, B e l i , Indonesia i n 1974 and t h e four th i n Bangkok, Thailand i n 1975. The f i f t h course is being p lamed t o be held i n t h e WHO Regional Off ice . New Delhi i n November-December 1976.

In 1975, gu ide l ines f o r t h e teaching of these sub jec t s have been developed and c i r c u l a t e d t o a11 the medical schools i n t h e Region. This programme is u t i l i z i n g modern pedagogical methods and audio-visual mater ia ls . Audio-visual ma te r i a l s i n t h e ahape of overhead p r o j e c t o r s and a c e t a t e s h e e t s were suppl ied to the 1 3 medical co l l eges i n Ind ia . I n 1976. i t has been propoaad t o provide s e t s of trarwparenciea t o a l l t h e medical col legea i n t h e Region on t h e mubject o f h-n reproduct ion, f l u i l y planning and population dynamics. A consu l t an t w i l l v i s i t i n s t i t u t i o n s which have a l ready p a r t i c i p a t e d i n e a r l i e r courses held under t h i e p ro jec t and asmist and advise i n t h e implementation of teaching of humn reproduction, family planning and populat ion dynamics end eva lua te t h e e f f e c t i v i t y of t h e i n t e g r a t e d teaching prograrme a s ou t l ined i n t h e guidel ines .

Similar a c t i v i t i e s are planned f o r 1978-1979 s u b j e c t t o t h e a v a i l a b i l i t y of UNFPA funds.

INTER-COUNTRY

HMD 009 Medical Teacher Trainiqq and Continuing Education,Phase I1 (UNDP RASl731028)


HMD 010 Development of National Post-graduate Training Centres

With t h e rapid expansion of educat ional programmes f o r t h e t r a i n i n g of var ious c a t e g o r i e s of h e a l t h personnel, t he re is an urgent need for encouraging t h e development of post-graduate t r a i n i n g c e n t r e s i n the coun t r i e s of t h e Region t o enable them t o t r a i n t eacher s f o r the d i f f e r e n t ca tegor ie s of h e a l t h profeesionals as v e l l as o the r s p e c i a l i s t s . Such a development w i l l not only improve the q u a l i t y and quan t i ty of educat ional progra-8 - both undergraduate as wel l as post-graduate - b u t w i l l a l s o be more economical, as a major i ty of t h e teachers and s p e c i a l i s t s required v i l l be t r a ined within the Region i t s e l f . This w i l l f u r t h e r improve t h e n a t i o n a l hea l th se rv ices .

Before undertaking a long-term p r o j e c t f o r t h e development of post-graduate t r a i n i n g cen t rea , during Phase I, a survey w i l l be conducted i n t h e d i f f e r e n t coun t r i e s of t h e Region by a aenior medical educator , a s s i e t e d by two short-term consu l t an t s , t o i d e n t i f y t h e following:

(a) Needs of post-graduate t r a i n i n g in d i f f e r e n t f i e l d s on a c o u n t r y r i s e b a s i e ;

(b) I n s t i t u t e s and departments i n t h e Region a t p resen t capable of providing post-graduate t r a i n i n g i n the hea l th profess ions;

(c ) I n s t i t u t e s and departments vhich have t h e p o t e n t i a l t o be converted i n t o poat-graduate t r a i n i n g c e n t r e s , and

(d) Steps t h a t may be taken by t h e coun t r i e s of t h e Region f o r t h e development of post-graduate centres/institutee/department8. and WHO'S con t r ibu t ion i n t h i s regard.

Furtiler,an inter-country Committee f o r Post-graduate Training Programe , cons i s t ing of experta from the Region, w i l l be s e t up t o review t h e v a r i a w aspec t s f o r t h e development of these post-graduate t r a i n i w centres .

Aa a r e s u l t of the a c t i v i t i e s undertaken i n Phase I, a d e t a i l e d programme w i l l b e worked out which w i l l form t h e b a s i s of t h e long-term p r o j e c t f a r t h e development of poat-graduate c e n t r e s i n d i f f e r e n t e p e c i a l t i e s i n coun t r i e s of t h i s Region.

INTER-COUNTRY

HMII Oil C s i n u i n g Educa t i on Fir I iea l th Igorkers

?lajor aims a re :

( I ) To a s s i s t coun t r i t . s i n t h c develr8pmenl 111 .i;jtiurial pl;nt~s and guidelines f o r tlxr co l l t inu ing educat ion of he;llLIi worlrrrb;

( 2 ) To promote t he arlnpr,>tiun and npp1ic;ll i c ~ u t o t p ~ i ~ ~ c i ~ 1 i . s and technique3 o i m<irIc,rn e d u c a t i o n a l ~ e c l ~ i ~ o l o g y ;

(3) To a s s i s t w i th t he deve lop i~~en t of Leaclking and l e a r n i n g modules des igned f u r l o c a l s i t u a t i o n s , p a r t i c u l a r l y For primary h e a l t h workers , ;ind

( 4 ) To prepare a c a d r e u f lienltll personnel i n 'lrmbrr c o u n t r i e s c apab l e uf assuming t he l e a d e r s h i p i n r h r p lanning and implementation o f cun t i on inp educa t i on programmes.

I t is proposed t o uc l~ i cv i , t h e s e aims b y :

( 1 ) Coiivening i n t e r - coun t ry cuurscs r e l e v a r ~ t t o t he aims O F t he p r o j e c t .

(2 ) Promoting cont inued c u l l a b o r a t i o n wi th n a l i n n a l and r e g i o n a l t e ache r t r a i n i n g i n s t i t u t i o n s , p a r t i c u l a r l y i n r e l a t i o n t o con t i nu ing educa t i on p r o g r a m s .

(3 ) Making u s e of s k i l l e d human r e s o u r c e s , i n c l u d i n g WI0 Headquar te rs , r e s i o n a l ;and f i e l d s t a f f as w e l l as n a t i o n a l s t a f f , a s resource pe r sons , t r a c h c r s , a d v i s e r s and a c t i v a t o r s , i n o r d e r t o maximize t he impact of t h e p r o j e c t .

( 4 ) Promoting researc l> a c t i v i t i e s aimed a t t he product ion oi e d u c a t i o n a l n u t e r i a l s , t e ach ing methods and t h r u v c r n l l eva l lwr ion o f con t i nu iog cdocn t i oa p r o g r a m e s .

This ~ r o j e c t r e p l a c e s t h e former i n t e r - coun t ry p r o j e c t ICP HMD 001 , "Continuing Education fo r Nurses". The main emphasis w i l l be on t he development of e f f e c t i v e con t i nu ing educa t i on programmes f o r primary h e a l t h workers.

IIMU 012 Medical 'Teuciler T r a i n i ~ s and Cont inuing EddcctiunUUi'1~aae I l l (UNDP)

'The p r o j e c t i n i t s second phase aims a t t r a i n i n g m d i c a l t e ache r s i n modern concepts and p r a c t i c e of educa t i ona l s c i e n c e , as a p p l i e d t o the teuc i~ inp , of Liie l leal t l i p r o f e s s i o n a l s , and a t a s s i s t i n g i n t he e s t ab l i shmen t of s y s t e m a t i c programmes f o r con t i nu ing e d u c i ~ t i o n .

In 1974 and 1975, two rsgiorhol t e a c h e r s ' t r a i n i n g courses and f o u r r e f r e s h e r courses were organized . In 1976, f o u r n a t i o n a l cou r se s i n e d u c a t i o n a l s c i e n c c f o r t e a c h e r s of 11enlth p r o f e s s i o n a l s w i l l b e organized i n Bangladesh, Rurma, I nd i a and Mongolia a n d each course w i l l b e a s s i s t e d by two shor t - te rm c o n s u l t a n t s . S o f a r f e l l owsh ip s il;lve been av:xrded t n 20 i n d i v i d u a l s fro. t h e d i f f e r e n t c o u n t r i e s of t h i s r eg ion .

During t h e p r o j e c t ' s t h i r d phase , t h e long-term o b j e c t i v e s w i l l h e t he fo rmu la t i on of n common po l i cy and p r a c t i c e s i n t he f i e l d of educa t i on of t e a c h e r s of h e a l t h p r o f e s s i o n a l s geared t o t h e needs and t he s p e c i f i c c o n d i t i o n s of t h e Region, co -o rd ina t i on of r e g i o n a l s t u d i e s , r e ~ e a r c h programmes and innova- t i o n s d i r e c t e d t o s o l v i n g common problems i n t l i r educa t i on of lhealth p r o f e s s i o n a l s , p r a v l s i o n of mutual suppor t i n t h e t e a c h i n g a c t i v i t i e s which w i l l c o n t r i b u t e t o a qu i cke r development and growth of t h e Nat iona l Teacher T ra in ing Cen t r e s and s i m i l a r i n s t i t u t i o n a l u n i t s , and promoting co -o rd ina t i on and co-opera t ion wi th o t h e r UN and government agenc i e s i n t h e f i e l d of h ighe r educa t i on and t e a c h e r s ' t r a i n i n g a t t h e f i r s t i n s t a n c e aL t h e r e g i o n a l l e v e l and l a t e r a t t h e i n t e r - r e g i o n a l l e v e l .

INTER-COUNTRY

HMD 100 Health Manparer Development


ESD 001 Dengue/Hsemorrhagic Fever Survei l lance and Control

To a s s i s t i n the na t iona l as we l l as r eg iona l s u r v e i l l a n c e and c o n t r o l programmes aga ins t dengue1 haemorrhagic fever (DHF).

In 1964, a seminar on DHF was held i n Bangkok. From 1967 t o 1975, consu l t an t s v i s i t e d coun t r i e s i n the Region t o observe and f o l l o v up t h e s t a t u s of t h e d i sease . The Technical Advisory Committee on DenguelHaemarrhagic Fever, sponsored by WHOIHQ, SEAR0 and WPRO, held i t s f i r s t meeting i n Manila i n 1974 and t h e second meeting i n Bangkok i n 1975.

Consultants w i l l v i s i t coun t r i e s every year t o a s s i s t i n the c o n t r o l activities and follow up of t h e pragralmnee. In 1977, a seminar i s propoeed t o be held along the l i n e s o f the one held i n 1964, t o be followed by another group educat ional a c t i v i t y i n 1979. The study tour s ere meant f o r nmdical o f f i c e r s employed i n DHF c o n t r o l end t reatment i n Member coun t r i e s i n o rde r t o exchange experiences with col leagues i n o the r coun t r i e s .

ESD 003 Epidemiological Survei l lance and National Health In te l l igence Systems Development

To a s s i s t i n the development and s t rengthening of informat ion systems a t a l l l e v e l s of t h e hea l th se rv ices f o r e f f i c i e n t and e f f e c t i v e planning, management and evaluat ion of h e a l t h programes. The pro jec t w i l l s e rve as s veh ic le t o provide d i r e c t a s s i s t a n c e and organize group educat ional a c t i v i t i e s , as we l l as s forum f o r the exchange of experience and co l l abora t ion among countries of the Region i n the f i e l d of hea l th information. and t o a s s i a t i n s t rengthening epidemiological su rve i l l ance programues d i rec ted towards p r i o r i t y d i seaees , i n in t roducing epidemiological su rve i l l ance a c t i v i t i e s i n t o the func t iom of l o c a l hea l th s e r v i c e s , and i n t r a i n i n g s t a f f .

The e x i s t i n g systems f o r d i sease s u r v e i l l a n c e and n o t i f i c a t i o n of communicable d i seases i n t h e context of the na t iona l hea l th information systems w i l l be s tud ied and reeommendetions aimed a t s t rengthening these systems w i l l be made.

Plans f o r a phased implementation of improvements i n t h e information s y s t e m w i l l be developed.

Assistance w i l l be provided t o coun t r i e s through v i s i t s by p ro jec t s t a f f as wel l as group educat ional a c t i v i t i e s .

In 1978, a t r a i n i n g course on t h e Ninth Revision of t h e I C D f o r coding i n s t r u c t o r s of morbidity and mor ta l i ty d a t a w i l l b e organized. The course aims pr imari ly a t f a m i l i a r i z i n g the participants with the changes, extensions and supplementary c l a e e i f i c a t i o n s t h a t have been introduced i n t o the Ninth Revision and w i l l d e a l with t h e var ious a p p l i c a t i o n s of t h e C l a s s i f i c a t i o n t o d a t a derived from d i f f e r e n t se rv ices l saurces . Also, e group educat ional a c t i v i t y on the su rve i l l ance of communicable d i seases w i l l be organized.

I n 1979, a group educat ional a c t i v i t y an the development of n a t i o n a l h e a l t h information systems w i l l be organized.

ESD 100 Epidenialogical Survei l lance


MPD 001 Advisory Team on Anti-Malaria A c t i v i t i e s

To advise coun t r i e s i n t h e Region on formulating plane f a r ant i -malar ia ope ra t ions , with emphasis on the in teg ra ted approach t o malaria c o n t r o l , i n undertaking f i e l d e tud ies and demonstrations, i n t r s i n - ing and i n progr-e evaluat ion.

This p r o j e c t , e a r l i e r e n t i t l e d as t h e "Assessment Team an Malaria Eradication", has been renamed a s "Advisory Team on Anti-Malaria A c t i v i t i e s r ' t o f a l l i n l i n e wi th i t s new funct ions . This advisory team, mul t i -disc ipl inary i n cha rac te r , w i l l c o n s i s t of a s a n i t a r y engineer and a laboratory s p e c i a l i s t . With the terminat ion of p ro jec t ICP MPD 002. "External Cross-checking of Blood Films", t h e laboratory s p e c i a l i s t assigned to t h a t p ro jec t w i l l b e absorbed i n t o p ro jec t IN0 MPD 001 t i l l 1976 and there- a f t e r i n p ro jec t ICP MPD 001.

The assessment team, t r ans fe r red from Headquarters t o t h i s Region i n 1959, worked i n Thailand u n t i l mid-1961. It was r econs t i tu t ed i n 1963 and c a r r i e d ou t assessments of t h e programmes i n S r i Lanka (1963) and Nepal (1965) and a l s o undertook a s tudy of t h e problem of chloroquine r e s i s t a n c e i n Thailand i n 1965. Reconstituted as necessary, i t has c a r r i e d ou t . s i n c e 1967. assessments and evaluat ions of t h e programme i n the Region. I n 1974, i t a s s i s t e d wi th an independent assessment of the Nepal malar ia p r o g r a m and with assessments of t h e programmes i n Indonesia ( I r i a n Jaya ) , Maldives end Thailand.

With the s h i f t i n g of the s t r a t e g y from time-limited e rad ica t ion t o 'long-term con t ro l ' by most coun t r i e s of the Region, t h i s p ro jec t w i l l cont inue f o r a number of years.

In 1978 and 1979. the re is provis ion f o r a s a n i t a r y engineer and a laboratory s p e c i a l i s t .

Assistance t o the p ro jec t is expected t o continue f a r a number of years.

MPD 003 Meetings on Anti-Malaria Operations

To hold, pe r iod ica l ly , seminars an ant i -malar ia ope ra t ions wi th a view t o exchanging information on the changing methodology of c o n t r o l operat ions .

This p r o j e c t , e a r l i e r e n t i t l e d "Seminar on Advanced Malaria Epidemiology", is now given e new t i t l e with the change i n s t r a t egy .

Following a s p e c i a l couree on advanced epidemiology, held i n New Delhi i n 1964, t h r e e seminars on t h e same s u b j e c t have been held - i n t h e Regional Of f i ce i n 1967, i n Colombo i n 1969 and i n Prabhudhabat (Thailand) i n 1973. The seminars organized i n t h e past have proved b e n e f i c i a l to the epidemiologis ts of malaria programmes i n exchanging t echn ica l informat ion, and it is planned t o organize a s i m i l a r seminar i n 1977 i n one of t h e coun t r i e s of t h e Region.

In 1978-1979, i t i e planned to promote in ter-country border malar ia co-ordination meetings and a l s o t o hold a reg iona l seminar on ant i -malar ia ope ra t ions , t o which pa r t i c ipan te from the malariaus coun t r i e s of t h e Region w i l l be inv i t ed .

INTER-COUNTRY

ELPD 100 Malaria and Other P a r a s i t i c Diseases

Regional Advisory Se rv i ce s .

SPI 001 S m l l p o x Erad i ca t i on

To achieve t o t a l e r a d i c a t i o n of smallpox i n t h i s r e g i o n by

(1) co-ordina t ing t h e n a t i o n a l smal lpox e r a d i c a t i o n programmes of t h e Region;

( 2 ) provid ing a s s i s t a n c e , when neces sa ry , t o a l l governments of t h e Region i n s t r eng then ing s u r v e i l l a n c e , and

( 3 ) a s s i s t i n g governments i n p r epa r ing t h e documentation necessary f o r t h e I n t e r n a t i o n a l C o m i ~ s i o n which w i l l v i s i t t h e Region i n 1977.

The p re sen t phase o f t h e p r o j e c t s t a r t e d i n 1966, s i n c e when a s s i s t a n c e h a s been provided t o most c o u n t r i e s of t l ie Region. The s t a f f a s s igned t o t h e p r o j e c t have he lped i n p r epa r ing p lans of o p e r a t i o n fo r smallpox programmes, p a r t i c i p a t e d i n assessments and conducted courses and seminars on smallpox s u r v e i l l a n c e .

The p r o j e c t co-ordina ted t h e i n t e r - coun t ry c r o s s - n o t i f i c a t i o n of smallpox eases and t h e implementation o f a uniform r epo r t i ng system. The r e g u l a r t e s t i n g o f the l o c a l l y produced vaccine by WHO r e f e r ence l a b o r a t o r i e s , as w e l l as t h e t e s t i n g of specimens from suspec t smallpox cases, was arranged. In 1970. a course f o r t e c h n i c i a n s i n t h e l a b o r a t o r y d i a g n o s i s of smallpox was he ld i n Indones i a , and t h e next year c o n s u l t a n t s pa id follow-up v i s i t s t o t h e amallpox d i a g n o s t i c l a b o r a t o r i e s i n t h e Region. I n 1972, a r eg iona l course on the l a b o r a t o r y d i a g n o s i s of smallpox was he ld i n Delhi .

I n 1972, s e v e r a l m i l l i o n s of t r a i n i n g a i d s , awareness p o s t e r s , r e p o r t i n g forms, c h a r t s , maps, e t c . , were produced and despatched t o c o u n t r i e s i n t h e Region.

S ince mid-1973, when an i n t e n s i f i e d smallpox campaign was s t a r t e d i n I n d i a and Bangladesh, the medica l o f f i c e r s of t h e p r o j e c t have p e r i o d i c a l l y organized and a t t ended smallpox p rog re s s meet ings a t c e n t r a l . S t a t e , r e g i o n a l and d i s t r i c t l e v e l s i n t h e m a j o r i t y o f t h e S t a t e s of I n d i a , and a s s i s t e d i n t h e t r a i n - i n g of S t a t e s u r v e i l l a n c e teams as w e l l as lower- level s t a f f . Pe r iod i c assessments of s t r a t e g i c areas have been made and, where necessary, a s s i s t a n c e g iven i n t h e f i e l d f o r t h e o r g a n i z a t i o n and implementa- t i o n of l o c a l programmes.

By 1974, the s t a f f a s s igned t o t h e p r o j e c t had been inc rea sed from two t o fou r medical o f f i c e r s . An admin i s t r a to r was as s igned , and a c o n s u l t a n t a s s i s t e d i n t h e a d m i n i s t r a t i v e a s p e c t s of t h e p r o j e c t i n 1974.

In 1975, t h e t h r e e p r ev ious ly endemic c o u n t r i e s - Bangladesh. I nd i a and Nepal - achieved zero inc idence of smallpox. The p r o j e c t , which i s a t p r e s e n t a s s i s t i n g i n o rgan i z ing and c a r r y i n g ou t s u r v e i l l a n c e a c t i v i t i e s i n t he se c o u n t r i e s , is expected t o t e rmina t e by t h e end of 1977 wi th t h e c e r t i f i c a t i o n by the I n t e r n a t i o n a l C o m i s s i o n t h a t smallpox has been e r a d i c a t e d .

INTER-COUNTRY

Malaria and Other Parasitic Diseases

Malaria adviser P5 Malariologists P4 Entomologist P4 Administrative assistant ND6 Technical assistant ND5 Clerk-stenographers ND4 Clerk-typist ND3

Proposals L, .rr 5 "

5.1.4 Smallpox Eradication and Expanded Programme of Imunization

Smallpox Eradication

Epidemiologists P5 Epidemiologist P4 Administrative officer P2 Clerk-stenographers ND4 Clerk-typist ND3

Short-term consultants Participants Supplies and equipment

1978

Number of Posts Project NO.

MPD IDC

RB

F 3

1979

Revised Eetimates

SPI 001

1979

1/12 2/24

1/12 2/24 1/12 -

1976

-

- 1976

1/12 2/24 11 3

1977

39 400 78 800

5 700 9 200 3 700

42 200 84 300

6 500 10 600 4 200

137 800 7 1 7

_ i _

1977

1/12 2/24

,

44 900 89 600

7 500 12 ZOO 4 800

- 9

_

1978

!

1/12 2/24

1

_

1/12 2/24 1/12 -

11 3 1/12 2/24 1/12 -

I I ! ~ i i

1 1 ! 1 I

2/24 2/24 1/12 11/12 1 1/12 11/12

159 000

1/12 2/24 1/12 -

136 800

--- 147 800

-1

1 ! ~ i ! !

2/24 2/24

143 900

6 000 14 500 6 100 - 170 500

1/12 - 7

11 2

I

75 400 37 700 27 900 9 200 3 700

-- 1 153 900

7 000 14 500 3 000 -- 178 400

--

11/12 I

7 --

11 2

i

I

I i i I

I ' !

i

i

i

SPI 002 Expanded Programme on Immunization

TO reduce morbidity and mor ta l i ty t o t h e lowest poss ib le l e v e l f a r d iseases such as d iph the r i a . p e r t u s s i s , s m l l p o x and tube rcu los ie , presumed t o be preventable by i m u n i r a t i o n . It is expected tha t p ro jec t ICP SPI 001 w i l l terminate dur ing 1977.

It is proposed t h a t dur ing 1976 and 1977, a s e r i e s of t r a i n i n g courses f a r planners end superviaore bc held i n the coun t r i e s where t h e expanded programme of immunization (EPI) is envisaged. A consul tant w i l l be r e c r u i t e d t o provide a s s i s t a n c e i n the b a s i c planning a t country l e v e l .

I n 1976-77, one ful l - t ime medical o f f i c e r w i l l be seconded from Smallpox Eradicat ion Pro jec t t o a s s i s t with f e a s i b i l i t y s t u d i e s , t h e planning of programme and t h e t r a i n i n g of n a t i o n a l s t a f f .

I n 1978-79, another medical o f f i c e r from pro jec t ICP SPI 001, wi th f u l l a d m i n i ~ t r e t i v e eupport, w i l l continue t o a s s i s t i n t r a i n i n g and i n t h e implementation of expanded immunization programmes, including the f u r t h e r development of su rve i l l ance and repor t ing systems, and the es tabl ishment of assessment techniques.

A second major f e a t u r e of the Programme w i l l be the establishment of l a b o r a t o r i e s capable o f : ( i ) producing c e r t a i n vaccines , ( i i ) p lacing bulk-purchased vaccine i n t o smal ler v i a l s , and ( i i i ) q u a l i t y con t ro l t e s t s of vaccine. The provis ion of b a s i c equipment t o allow such procedures

w i l l be an e a r l y p r i o r i t y of t h e Programme.

Subject to a v a i l a b i l i t y of UNDP funds , i t is a l s o an t i c ipa ted t h a t an exper t engineer w i l l be recrui ted in 197811979 t o a s s i s t i n t h e r e p a i r i n g of e x i s t i n g equipment and t h e t r a i n i n g of n a t i o n a l s t a f f t o maintain t h e cold chain.

VPH 001 Training i n Veterinary Publ ic Health

To a s s i s t i n t r a i n i n g ve te r ina ry publ ic hea l th o f f i c e r s .

Assistance s t a r t e d i n 1968. A two-year post-graduate course i n ve te r ina ry publ ic hea l th was s t a r t e d i n India i n 1970 and i n t h a t year a reg iona l seminar was held i n Mukteswar ( India) . In 1971, consu l t an t s v i s i t e d India and Thailand f a r follow-up on t h e Seminar. I n 1973 and 1974, seminars were held i n Thailand and India r e spec t ive ly . Similar group educat ional a c t i v i t i e s are planned f o r 1978 and 1979. In 1976 and 1978, consu l t an t s w i l l make f o l l w - u p v i s i t s and review t h e a c t i v i t i e s i n t h e f i e l d of veter inary publ ic hea l th i n coun t r i ee of t h e Region.

VBC 100 Vector Biology and Control


397

Dottarsi

project NO.

SPI 002

YPH 001

VBC 100

in US

4 2

RB

DP

RB

RE

INTER-COUNTRY

Expanded Programme on Immunization

Epidemiologist P5 Epidemiologist P4 Administrative officer P2 Senior assistant ND5 Clerk-stenographer ND4


Repair and maintenance engineer P4


5.1.6 Veterinary Public Health

Training in Veterinety Public Health


5.1.7 Vector Biology and Control

Vector Biology and Control

Scientist P5

Proposals

1978

40 400 40 400 29 700 6 500 5 300

122 300

8 000 14 500 3 000

--- 147 800

---

47 400

40 000

87 400

12 000 12 500 1 000

- 25 500

-

42 100

42 100

(Ezpreseed

1979

42 900 42 900 31 400 7 500 6 100

-- 130 800

9 000 14 500 3 000

157 300

47 400

40 000

87 400

13 500 12 500 1 000

- 27 000

-

44 800

44 800

1976

11 1

Revised

1976

3 000 14 500 3 000 - 20 500 -

9 000

1 000

- 10 000 -

27 200

- 27 200

Estimates

1977

3 500

3 500

39 300

39 300

1979

1/12 1/12 1/12 1/12 1/12

-- 5

-- 21 2

1/12 --

1 1 --

Number

1977

11 1

11 3

1/12

1

of Posts

1978

1/12 1/12 1112 1/12 1/12

5

21 2

1/12

11 3

1/12

1

I

!

11 3 I 1

I 11 9 1/12

---- I 1 ' 1

I

----

398

INTER-COUNTRY

PBL wl Prevention of Blindness and Visual Impairment

To a s s i s t i n promoting eetablishment of r eg iona l and n a t i o n a l t r a i n i n g cen t res i n pub l i c hea l th ophthelmlogy i n se lec ted medical c o l l e g e s i n t h e coun t r i e s of t h e Region; e s t a b l i s h i n g pilot-c- demonstration cen t res for t r a i n i n g i n comuni ty-or iented b a s i c eye hea l th ca re , as an i n t e g r a l p a r t of the e x i s t i n g publ ic hea l th d e l i v e r y system; organizing comprehensive ophthalmic r e f e r r a l eervicea a t the in termediate l e v e l and co-ordinating a c t i v i t i e s of na t iona l , i n t e r n a t i o n a l and non-governmental agencies for prevention and con t ro l o f b l indness and v i s u a l impairment.

In fec t ione , i n j u r i e s , n u t r i t i o n a l d i so rde r s (avitaminosis), c a t a r a c t and glauc- are the common causes of v i s u a l impairment and bl indness . I n 1976, a consu l t a t ion meeting of exper t s c o n s i s t i n g of sen io r adminis t ra tore and ophthalmologists was held i n SEAR0 t o a s s e s s t h e m e ~ i t u d e of t h e problem, t o develop e t r a t e g i e s f o r prevention and c o n t r o l and t o d i scuss ways and means of mobilizing resources f o r r eg iona l and n a t i o n a l a c t i v i t i e s for prevent ion of v i e u a l impairment and c o n t r o l of blindness. Consultancy ee rv ices were provided i n 1976-77 t o Bangladesh, Burma, Ind ia , Indonesia. Nepal, S r i Lanlra and m a i l a n d t o assess t h e problem of v i s u a l impairment and b l indness due to i n f e c t i o n , i n j u r i e s . ma lnu t r i t ion , c a t a r a c t and glaucoma. Subject t o a v a i l a b i l i t y of funds, se l ec ted medical co l l eges are proposed to be a s s i s t e d t o s t r eng then t h e i r p o t e n t i a l f o r t r a i n i n g i n publ ic h e a l t h ophthalmology with a p r a c t i c e f i e l d developed s p e c i a l l y t o demonstrate camnunity-oriented b a s i c eye h e a l t h se rv ices f o r the prevention and c o n t r o l of these common condi t ions . Regional t r a i n i n g c e n t r e s w i l l be developed f a r glaucoma i n Burma, for rerophthalmia i n Bangladesh, f o r c a t a r a c t i n Ind ia , and f o r r e h a b i l i t a t i o n of the b l ind i n S r i Lanka. I n a d d i t i o n t o t h e assignment of long-term s t a f f , short-term consu l t an t s w i l l be ass igned t o a s s i s t i n t h e conduct of r eg iona l t r a i n i n g programmes f o r h e a l t h and a l l i e d personnel i n t h e management of these ocu la r condi t ions . Provieion has been made f o r s t ipends , suppl iea end equipment f o r these spec ia l i zed t r a i n i n g a c t i v i t i e s .

PPN 100 Programme Planning and General A c t i v i t i e s

Non-communicable Diseases - Regional Advisory Services .

400

INTER-COUNTRY

CVD 001 Cardiovascular Diseases

To a e s i e t in: (1) iden t i fy ing t h e most common causes af cardiovascular morbidity and mor ta l i ty ; (2 ) a s sess ing t h e e x i s t i n g f a c i l i t i e s f a r s e r v i c e s , t r a i n i n g and research f o r prevent ion end manege- ment, including r e h a b i l i t a t i o n of p a t i e n t s wi th cardiovascular a i lmente; (3) developing, community- or iented programmes f o r education i n iden t i fy ing high-risk groupe end e a r l y diagnosis of rheumatism, hypertension, s t roke , ischaemic h e a r t d i s e a s e and pe r iphe ra l occlusive vascular d i s o r d e r s , and (4) s t rengthening f a c i l i t i e s wi th in t h e e x i s t i n g publ ic h e e l t h de l ive ry system f o r t h e management of cardiovascular d i seases .

Following v i s i t s of consu l t an t s t o a s s i s t coun t r i e s i n t h e o rgan iza t ion of se rv ices f o r the promotion of cardiovascular h e a l t h and t h e conduct of an in ter-country workshop on hypertension and s t r o k e i n 1974, a meeting was he ld l a t e i n 1975 t o s t imula te t h e development of ca rd iac r e s u s c i t a t i o n and r e h a b i l i t a t i o n se rv ices .

Assistance is being provided i n 1976 and 1977 from sources o the r than t h e r egu la r budget f o r t h e prevention and c o n t r o l of cardiovascular d i seases through award of f e l l a r s h i p s , provis ion of consul tants and l imi ted supp l i e s . Regional co l l abora t ion was promoted f o r t h e t r a i n i n g of apecia l - ists, exchange of information and epidemiological inves t iga t ions . An inter-country group educat ional a c t i v i t y was organized f o r t h e of rheumatic hea r t d isease .

In 1978, a consul tant w i l l v i s i t t h e coun t r i e s i n t h e Region, eseeas t h e problem of corpulmonale and advise on t h e development of f a c i l i t i e s f o r t h e management of chronic obs t ruc t ive pulmnary dieeases .

I n 1979, a seminar on pulmonary hypertension w i l l b e held and w i l l be a s s i s t e d by a c e r d i o l o g i s t , a ches t physician and an inha la t ion therapy s p e c i a l i s t . Teams cons i s t ing of een io r a p e c i a l i s t s i n these th ree d i s c i p l i n e s w i l l be i n v i t e d ae p a r t i c i p a n t s from Member coun t r i e s .



IhX 001 Training i n Immunoloa

To review t h e progress i n immunology, p a r t i c u l a r l y as r e l a t e d t o communicable d i seases , and t o con t r ibu te towards increasing t h e competence of n a t i o n a l immunologists.

After t h e holding of two workshops - one on t h e molecular b a s i s and t h e o the r an t h e c e l l u l a r b a s i s of the i m u n e response - i n Delhi i n 1968, two consu l t an t s paid follov-up v i s i t s i n 1969 under p ro jec t SEAR0 0166, "Workshope on C e l l u l a r and Molecular Baeia of t h e Immune Responseo'. In 1970, two consultants v i s i t e d var ious i n s t i t u t e s i n t h e Region i n o rde r t o explore the p o s s i b i l i t y of e s t ab l i ah - ing a WHO Regional Research and Training Centre i n Immunology. Assis tance was provided i n 1970 and 1971 i n s tudying t h e immunological a spec t s of denguelhaemorrhagic fever i n Thailand. I n 1972, t en fellowships were provided f o r a t tendance a t var ious immunological courses. An inter-country worksho~ on t h e immunology of cwmuniceble d i seases , held i n Bangkok i n 1972, reviewed developeents i n immunology and provided d e m n s t r a t i o n s of immunological techniques t o t h e p a r t i c i p a n t s . A meeting of inves t iga to r s of immunological problems i n leprosy re sea rch . organized by WHO Headquarters, was held i n t h e Regional Off ice i n 1972 and reviewed t h e a t s t u s of t h e r e s u l t s of research i n t h e eubject .

With support from WHO and DANIDA, a course on cell-mediated and humoral immune response with s p e c i a l reference t o ma lnu t r i t ion and i n f e c t i o u s d i s e a s e i n the t r o p i c s was held a t t h e WHO/ICHR Imunolcgy Centre, All-India I n s t i t u t e of Medical Sciences, New Delhi, i n 1974. The second DANIDAIWHO-supported course on humoral and ce l l -med ia ted immune responses wi th s p e c i a l r e fe rence t o p a r a s i c i c d i seases and reproduction was held a t t h e WHO/ICHR lormunology Centre, All-India I n s t i t u t e of Medical Sciences, New Delhi i n November 1975.

Such a c t i v i t i e s are proposed t o be continued i n t h e f u t u r e wi th a view t o inc reas ing the competence of na t iona l immunologists.

402

INTER-COUNTRY

LAB 004 Standardization of Diagnostic Material and Laboratory Practice

To help develop national standards for biological preparations (vaccines), chemical agents and diagnostic material as well as to develop related aspects of laboratory methods; also to promote and support the co-ordination of research, service and information between national laboratories and regional and inter-regional collaborating laboratories concerned with standards and quality control.

The project will help Member countries in the Region to upgrade and refine methods for the quality control of biological preparations; will provide guidelines adapted to regional requirements for the development of standardization of health laboratory methods and reagents; the co-ordination of development of standards for biological preparations, reagents and diagnostic material and their use, with special emphasis on quality control; to collaborate with national institutions within the Region in the co-ordination of efforts in standardization and research; to help countries to establish services for the quality control of diagnostic materials produced indigenously or imported.

LAB 100 Health Laboratory Technology


PPE 100 Progr-e Planning and General Activities

Environmental Health - Regional Advisory Services.

BSM 001 Community Water Supply and Sanitation

To assist in developing community water supplies and sanitation programmes and in the planning and management of environmental health services.

The project started in 1965. A fourth sanitary engineer, added to the project in 1975, has been assigned to the UNICEF Regional Office in New Delhi to assist in the rural water supply programme in India. The services of the other three sanitary engineers are utilized to deal with problems of water supply and sanitation on a regional basis and also to support country programmes, particularly in the assessment and collection of national data and fixing of national and regional targets a8 recommended by the World Health Assembly. The post which was established in Bangkok in 1971 to provide assistance to Burma end Thailand will be terminated by the end of 1976.

The services of consultants have been utilized in the past in specialized fields, and similar assistance is proposed for the future. In 1978 and 1979, con8ultanta will assist in the development of research in environmental health in the Region, in further follow-up on the special problems relating to community water supply and sanitation, and in conducting an inter-country seminar.

Assistance under this project is expected to continue until the end of 1980.

03

INTER-COUNTRY

5.3 Prophylactic, Diagnostic and Therapeutic Substances

5.3.5 Health Laboratory Technolopx

Standardization of Diagnos- tic Material and Laboratory Practice - Short-term consultants Temporary advisers Participants Supplies end equipment

Health Laboratory Technolo~y

Health laboratory technology adviser P5

Clerk-stenographer ND4

6.1 Promotion of Environmental Health

6.1.1 Programme Plannin~ and General Activities

Programme Planning and General Activities

Environmental health advisers P5

Clerk-stenographer ND5 Clerk-stenographer ND4

6.1.2 Provision of Basic Sanitary Measures

Cornunity Water Supply and Sanitation

Sanitary engineer P5 Sanitary engineers P4 Clerk-stenographers ND4 Clerk-typist ND3


---- 169 100 129 500 147 500 183 600

1978

8 000 1 000 13 500

500

23 000

40 100 5 300

45 400

82 900 6 500 5 300

94 700

40 400 83 800 10 600 4 200

- 139 000

8 000

500

Revised

1976

1 000

1 000

39 000

- 81 600

-

157 600

6 000

5 500

RE

in US

m v '

RB

RB

RB

(Ezpeseed

Proposals

1979

9 000 1 000 13 500

500 - 24 000

42 700 6 100

48 800 -

88 100 7 500 6 100

-- 101 700

42 900 88 800 12 200 4 800 - 148 700

22 500 11 900

500

Estimates

1977

1 000

1 000

37 300 4 600

41 900

77 500 5 700 4 600 - 87 800

37 700 78 400 9 200 3 700 - 129 000

500

1976

1/12 1/12

i

4

Doltors)

project NO.

LAB 004

LAB 100

PPE 100

BSH 001

1979

21 2 2/4w

~ 1112 1/12

Number

1977

I

1/12 1/12

----

I

2/24 1/12 1/12

i-

4 ' 4

1/12 2/24 2/24 1/12 - 6

21 5

of Posts

1978

21 2 2/4w

I

1/12 1/12

2 2 2 2 ----

2/24 1/12 1/12

1/12 2/24 2/24 1/12 -

6

11 2

2/24 1/12 1/12

4

1/12 3/36 3/36 1/12

- 8

i

2/24 1/12 1/12

--- 4

----

1/12 2/24 2/24 1/12

- 6

----

4 04

INTER-COUNTRY

PIP 001 Public Health Advisory Services , Mekong (Phase I V L (UNUPISLA UASl721078)

To provide t echn ica l advice t o the Committee f o r Co-ordination of Inveat igat iona of t h e Lower Mekong Basin, and t o advise on t h e prevention of communicable d i seases r e s u l t i n g from the changes i n environment due t o man-made lakes and o the r i r r i g a t i o n works.

I n 1968, a pub l i c hea l th adviser and a s a n i t a r y engineer were provided t o survey t h e hea l th problems i n t h e Lower Mekang Basin. From 1970 u n t i l l a t e 1972, a s a n i t a r y engineer was ass igned t o advise t h e S e c r e t a r i a t of the Mekong Committee on t h e poss ib le e f f e c t s on publ ic hea l th of the development of water resources i n t h e Lower Mekong Basin. I n 1973, a f u r t h e r s a n i t a r y engineer consul tant was provided to a s s i s t i n the development of pub l i c hea l th programes i n t h e area. During 1975 and 1976 a c t i v i t i e s of the p ro jec t were temporarily stopped due to unavoidable ex te rna l f a c t o r s . I t i e expected t h a t t h e a c t i v i t i e s o r i g i n a l l y scheduled w i l l continue i n 1977 with the provis ion of e consul tant i n publ ic hea l th engineering.

CEP 002 Environmental Po l lu t ion Control

To a s s i s t i n the con t ro l and abatement of environmental po l lu t ion end hazards.

The p ro jec t s t a r t e d i n 1973. I n 1974, a r eg iona l seminar on s o l i d wastes management was organized with the a s s i e t ance of two consul tante . Consultant se rv ices were used aga in i n 1975 t o ass i~ t i n preparing quest ionnaires t o be sen t t o governments, the f i r a t s t e p i n t h e preparat ion of an inventory of major p o t e n t i a l po l lu t ing sources i n t h e Region.

111 1976, consul tants w i l l review s t e p s taken by coun t r i e s t o implement t h e recommendations of t h e 1974 seminar, w i l l a s s i s t i n t h e preparat ion of t h e inventory of po l lu t ing sources, end w i l l advise on m d e l l e g i s l a t i o n f o r water po l lu t ion con t ro l .

A Regional Seminar an the Economic Reuse of Sewage is proposed f a r 1978, and i n 1979 coneu l t sn t s w i l l review the s t a t u s of environmental po l lu t ion c o n t r o l progremes i n coun t r i e s of the Region from t h e s tandpoint of l e g i s l a t i o n and monitoring coverage.

Assistance t o the p ro jec t is expected t o continue u n t i l the end of 1980

PPH 100 Programme Planning and General A c t i v i t i e s

Health S t a t i s t i c s - Regional Advisory Services

406

INTER-COUNTRY

HSM 001 Health S t a t i s t i c a l Methodology

TO provide assistance i n the app l i ca t ion of s t a t i s t i c a l methods t o coun t r i e s i n the Region, t o other WHO pro jec t s , and t o Regional Off ice un i t s .

l h i s p ro jec t , which was previously c a l l e d "Col lect ion and U t i l i z a t i o n of Health S t a t i e t i c s . Records and Reports", d e a l t with developing a uniform system of record keeping i n , and repor t ing from, h e a l t h cen t res end hosp i t a l s . It a l s o d e a l t with t h e c o l l e c t i o n , ana lys i s , i n t e r p r e t a t i o n and u t i l i z a t i o n of information derived from these systems. It was evolved by t h e merger af two e a r l i e r ones "Reorganiza- t i o n of Rural Health Records and Reports" (SEARO 0050), and "Hospital S t a t i s t i c s and Medical Records". which had s imi la r object ives . Beginning i n 1961, a s s i s t a n c e was given by these p ro jec t s i n the development of r u r a l h e a l t h records and repor t ing systems and i n the s t andard iza t ion of h o s p i t a l s t a t i s t i c s and medical records. I n 1972, a working group wae convened i n New Delhi t o consol idate the regional proposals f o r the Ninth Revieion of the I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases (ICD).

I n 1973, the ob jec t ives o f the p ro jec t were reformulated i n order t o cope wi th the inc reas ing demands f o r advice and he lp i n the app l i ca t ion of s t a t i s t i c a l methods.

A s t a t i s t i c i a n joined the p ro jec t i n 1974 and has provided support to a number of areas. In 1975, a consul tant a s s i s t e d t h e Indian Council of Medical Research f a r f i v e weeks i n the app l i ca t ion of mathematical models t o diseases .

In 1976, s Working Croup on Lay Reporting of Morbidity and l l o r t a l i t y w i l l be organized.

DHS 100 Develo~ment of Health S t a t i s t i c a l Services


HLT 001 Health L i t e ra tu re and Teaching h t e r i a l

To cover the supply of text-books a n d t h e production of regional publ icat ions f o r medical and a l l i e d hea l th workers and s tudents .

I n view of the acu te shor tage of medical l i t e r a t u r e i n t h e coun t r i e s of t h e Region, e igh t Student Loan L ib ra r i e s were es tab l i shed i n 1974 and 1975 i n Bangladesh, Burma. Indonesia and Thailand. During 1976, s i x sueh l i b r a r i e s are being es t ab l i shed i n Ind ia , Mongolia and S r i Lanka. It is proposed t o e s t a b l i s h seve ra l sueh l i b r a r i e s i n t h e coun t r i e s of the Region during the next few years .

In order t o overcome the shor t age of s u i t a b l e educat ional ma te r i a l f o r h e a l t h teams i n the countr ies of the Region, i t is proposed t o i n i t i a t e from 1978 t h e Regional Educational Publ ics t iong Pragraome under which production of s u i t a b l e pub l i ca t ions i n t h e ''WHO Regional Publ icat ions: SEARO Series", would be undertaken.

kss i s t ance under t h i s p ro jec t s t a r t e d in 1954 and is expected t o continue f o r a number of years

INTER-COWRY

HL'I OD3 Regional Centre for Uac-ntation on Human Reproduction, Family Planning and Population Dynamics (LMYPA RAS/70/P06)

To set up, in the Regional Office, a regional centre to reproduce basic reports and documentation on various aspects of human reproduction, family planning and population dynamics for wide distribution, particularly to schools for professional and auxiliary health workere, to the health services, to the main health institutions in the Region and to international documentation centres.

In 1970 and 1971. consultants prepared a plan for the development of the Centre. In 1973, a consultant documentation officer visited various countries of the Region to establish contacts vith workere in the field and to invite them to aend their published and unpublished material on family planning subjects far incorporation into the bibliographies published by the Centre. During 1973, three bibliographies of annotated articles and unpublished work in the South-East Aaia Region were issued covering the period January 1971 - September 1973. In 1974 and 1975, the scope of the bibliographies was enlarged and certain new features incorporated. Consultants were recruited to prepare annotated bibliographies on speciality topics vhich also included review of the current status of such subjects. A Seminar on documentation vas held in April- May 1975 vith participants from six countries. It recommended establishment of multl-channela of e~mmunication between the Regional Centre and the countries of the region nod development of nationel documentation centres.

In 1976, bath general and special bibliographies will continue to be published. Furthermore, it is planned to have a consultant to help establi~h a mechanism for preparing comprehensive monthly anna- rated bibliographies.

During 1977, bibliographies will be iasued on a monthly basia. A seminar on documentation will be held to review the progress achieved since the 1975 seminar and to make recormendations for future activities of the Regional Documentation Centre and development of national docuuentetion centres.

During 1978-79. in addition to monthly annotated bibliographies. a Newsletter would be issued. Assistance vould be provided for development of national documentation centres and for training documentation officers.

ANNEX 2

Bangladesh

India

Indonesia

Maldives

Nepal

S r i Lanka

Thailand

Inter-country

ADDITIONAL PROJECTS

BANGLADESH

5.3 P rophy lac t i c . Diagnos t ic and Therapeut ic Substances


Pharmaceutical and B io log i ca l Qua l i t y Contro l

Maintenance engineer P3

6 .1 Promotion of Environmental Heal th -

6.1.2 P r o v i s i ~ n of Bas i c S a n i t a r y Measures

Community Water S u v p l ~ and S a n i t a t i o n

Sen io r s a n i t a r y eng inee r P5

Sen io r s a n i t a r i a n P 3

T o t a l - BANGLADESH

INDIA

4.1 Health Manpower Deve lovmen t

Medical Education and T ra in ing

Fellowships

5 .1 Comunicab l e Disease Prevent ion and Con t ro l

5.1.3 M d a r i a and Other P a r a s i t i c Diseases

Malar ia E r a d i c a t i o n

Short-term c o n s u l t a n t s

T o t a l - INDIA

s t imated c o s t

30 300

42 200 30 300

- 72 500

ADDITIONAL PROJECTS

[NWNESIA

1 . 1 I e a l t h S t a t i s t i c s

1.1.4 )evelopment of Health i t a t i s t i c a l Se rv i ce s

3edica l Records

l e d i c a l r e c o r d s o f f i c e r P3

Fellowships

r o t a 1 - INWNESIA

3.2 Family Heal th

3.2.2 b t e r n a l and Chi ld Heal th

Maternal and Child Heal th

Medical o f f i c e r (MCH) P4 Nurse educa to r P3

Fellowships Suppl ies and equipment

T o t a l - MALDIVES

uoz zws - s t imated

c o s t -

35 700

36 400

PROPOSED PROGRAMME BUDGET FOR 1978 AND 1979

Documents