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PART 111

ACTIVITIES UNDJBTAKEN BY GOVERNMENTS WITH THE HELP OF WHO

PROJECP LIST

This part of the report contains a l i s t of the projects fo r which WHO has given assistance during the whole or part of the period under review, l i s t e d by country. A short review of health developnents during the year i s a l so given f o r each country t o which the Regional Office has assigned an Area Representative o r FubUc Health Adviser. Inter-country and inter-regional projects a rc given a t the end.

Projects (even though mentioned i n l a s t year 's r e p r t and planned t o continue i n future years) fo r which no active assistance, e i ther i n the form of f i e l d s ta f f , fellowships or supplies, was given during the period covered a re not included. Also omitted f romthe l ist are projects fo r which technical advice fronl the Regional Office or Headquarters was the only assistance given a d ~ o m c projects ass i s ted only by grants-in-aid.

In the first c o l m (under "Project No., Source of Funds, Co- operating Agencies") "R" mans the Regular budget; "TAW means Technical Assistance funds; "UNICEF" the United Nations Children's Fund, and "MESA" the mlaria Eradication Special Account. Nancs of co-operating agencies except f o r UNICEF, whether or not they have contributed funds, a re given i n psrentheses.

The "Aim of the project" s t a t e s the purpose fo r which it was undertaken by the government concerned, and i s not re la ted t o the f o m or extent of WHO'S assistance.

The "Probable duration of assistance" cannot, of course, always be accurately stated, par t icular ly i n t h e case of scrme progranrnes which have t o be f i t t e d i n with governments' national plans for developnent but i n many cases may continue lorger than or iginal ly planned.

Projects en t i t l ed "Fellowships" a r e thosc i n which fellowships arc considered as projects inthcmselves; other fellowships are sham under the t i t l e of the project of which they f o m a part.

It should a l so be noted that there a re a rider of projects for which UNICEF i s furnishing supplies and WHO technical advice only (with no special personnel being provided). Exwples of such projects a re rkentioned in Chapter 5 of Part I1 of t h i s report. Advice of t h i s type continues t o be a growing responsibility of the R c g i o ~ l Office.

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M EDICAL services go drep into Afghanistan to bring aid to rer

MIDWIFE (right) and auxiliary nurse-midwives a t A work in a rural health centre near Kabul. WHO has been assisting with the organization and devel-

opment or nurse and midwifery training programmes in this area since 1957.

1. AFGHANISTAN

The Government c o n t i n u e d t o d i rec t a major e f f o r t t o t h e malaria eradica t ion programme. During t h e year, 14 u n i t s were created. Each un i t has a doctor and a s t a f f of 24, and i s responsible f o r spraying operations and surveil lance i n an area with a population o r 200 000.

An outbreak of cholera i n c e r t a i n areas (~andahar , Jalalabad and ~ a b u l ) l a s t year l a i d s t r e s s on the need f o r con t ro l measures. The Govern- ment has now launched a large-scale vaccination programme t o vaccinate about th ree mi l l ion people agains t cholera.

There has been appreciable improvement i n some aspects of maternal and c h i l d hea l th services,following b e t t e r s t a l f i n g and service pat terns. Seven centres now have ful l- t ime s t a f f , including a doctar, and a l l a r e now provided with water, e l e c t r i c i t y and other f a c i l i t i e s . A new fea tu res i s a bi-monthly meeting of t h e doctors and midwives t o discuss cammon problems - a most hopeful development. Two new c l i n i c s , a t Ala-u-din and Bel i Maru, were opened on t h e outskirts of Kabul.

Nursing education, although su f fe r ing rrom lack of s u f f i c i e n t r ec ru i t s , made good progress. There i s increasing awareness on t h e par t of t h e a u t h o r i t i e s of t h e def ic iencies i n nursing services. An encouraging development i n t h i s connection was the decision of t h e Ministry of Education t o designate sixth-grade female students a s nursing students and r e t a i n them i n t h e schools u n t i l they reach t h e n in th grade, when it w i l l be obligatory f o r them t o become nursing students . This i s an advance on t h e previous posi t ion, when t h e only way t o get niilth-grade f e h l e nursing students was t o assign sixth-grade students t o nursing schools, where t h e y had t o spend t h e f i r s t th ree years i n general education.

Rural hea l th u n i t s a r e being developed a s an i n t e g r a l par t of t h e Rural kvelopment Department's plans f o r cammunity development. In addi t ion t o t h e p i l o t projec t , s i x extension p ro jec t s a r e i n operation, each with a hea l th u n i t component. A major d i f f i c u l t y has been t h e non-avai labi l i ty of midwives and a u x i l i a r y nurse-midwives f o r service outside Kabul. Recrui'cs f o r t r a i n i n g as a u x i l i a r y nurse-midwives from the rural d i s t r i c t s , where extension projec ts a r e planned, a r e of ten nut avai lable , primeri ly because of t h e l ack of schools f o r girls. Enviroimen-La1 san i t a t ion aspects of -the programme progressed well, though i n t h i s f i e l d l i t t l e advance ms achieved elsewhere i n the country. Health education aspects have been s t r e s sed by aU categories of heal th s t a f f , ::ocial workers an& teachers.

Construction of t h e new Public Health I n s t i t u t e is nearing completion.

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PROJECT LIST

Public Health Advlser ov. 1951 -

Aim of the project. To improve public health administration and services; t o t r a i n medical and paramedical personnel; t o co-ordinate national and internationally-assisted health programmes.

Assistance provided by WHO during the year. (a) A public health off icer and an arlministrative assis tant ; 6) supplies and equipment.

Probable duration of assistance. Indefinite.

Work done during the year. During the year, continued assistance was given towards the general improvement of public health administra- t ion and health services i n the country. Plans were made for an intensification of campaigns against major communicable disease6 and i n particular, for an intensive cholera and smallpox vacclmtion programmes.

The public health advlser and other WHO staff gave every assistance t o the Ministry of Public Health i n the or&nization and carrying out of control measures against cholera, which broke out i n epidemic form i n August 1960 i n Kandahar and Jalalabad, and l a t e r spread t o Kabul.

A successful refresher course on chi ld health, attended by a large number of medical officers and nurses, demonstrated the ident i ty of purpose and ef for t by the Ministry of Public Health and the Faculty of Medicine. There has been an increased awareness of the deficiencies i n nursing services and t h e need for more nursing students. The Nursing Affairs Colmnittee has played a very useful role i n this connection.

The considerable shortage of qualified personnel consti tutes a major obstacle t o the development of eff ic ient services throughout Afghanistan. A large part of the ac t iv i t i e s of the project was d e ~ t e d t o problems of education and training.

Continued ef for t s were made t o a s s i s t i n developing the Ins t i tu te of Public Health, which is scheduled t o be completed i n mid-1961.

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Afghanistan 11 Malaria Eradication MESA XAug. 1956 - ) UNICEF

Aim of the 'project . To eradicate m l a r i a &om the en t i re country.

Assistance provided by kX0 during t ~ l e year. (a) Three mlar io log is t s , an entomolonist, a sanitarian, two laboratory technicians and three - ,

secretary-stenographers; (b) s ix fellowships-- two for two months and three for two and a half months for study i n India, and one for f ive mnths for study i n Jnmnica and India; (c) supplies, equipment and a transport vehiclc: . Probable duration of assistance. Until the end of 1968.

Work done during the year. In 1960, more sys tcmt ic planning and intensified e f for t s t o carry out the prograrmae according t o plan resulted i n sow improvement despite cer ta in d i f f i cu l t i e s i n obtaining supervisory personnel. One of the significant features of the campaign was thd timely completion of spraying operations (DDT) i n almost a l l areas without undue prolongation in to the transmission season: a s against a target of 2.77 million people, nearly 2.68 million were protected. In addition, about half a million people received protection by ant i - larval measures i n Kahul, Kandahar and PuUWlumri. Surveillance proeeduros were carr ied out i n seven provinces. Pre- eradication surveys mde i n t h s various provinces revealed several malarious pockets, especially i n Badakshan.

The 1961 spraying operations, whicn s ta r ted i n Wy, aim a t protecting 3.18 million people. It i s proposed t o withdraw spraying from a few smsll a x a s i n l'langarhar Provinc~ involving a population of 86 000.

Othcr ac t iv i t i e s included geographical reconnaissance, special blood-check survew, entomological studies and t ra ining of nationals a t mrious centres.

The programme continues t o receive supplies from UNICEF. ~inanc ia l ' a s s i s t ance has a l so been secured by the Government from P.L. 480 funds t o meet certain loca l costs.

Afghanistan Q Assistance t o Faculty of Medicine, Kabul University R (Jan. - Aug. 1952; Sept. 1953 - )

Aim of the project . To build up the Departments of Anatomy, Physiology, Preventive N:dicine, Internal Mcdicine and Paediatrics a t the Faculty of Medicine and t o t r a i n national counterparts t o the v i s i t ing profeocors.

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Assistance provided 'cy WHO during the year. A professor of preventive and s o c i a l medicine.

Probable duration of cosistance. Unt i l the end of 1964.

Work done during the year. With a break from December 1960 t o February 1961, the v i s i t i n g professor of preventive and s o c i a l medicine continucd h i s teaching a c t i v i t i e s . HE organized t h e Department of Preventive and Socia l Medicine i n the new building provided by the B c u l t y , and gave l ec tu res and demonstrations t o th i rd , fourth, f i f t h and sixth-year students. Sixth-year students were sent t o Shcwaki i n groups f o r p r a c t i c a l t r a i n i n g i n rural public health.

An a s s i s t a n t professor of t h e ~cpartmeint i s being sent f o r advanced t r a i n i n g at the Harvard School of Public Health.

The v i s i t i n g professor took p r t i n a ref resher course on ch i ld heal th fo r government medical o f f i ce r s , organized jo in t ly byh'H0 and the Ministry of Fublic Health, by giving two lec tures , taking pa r t i c ipan t s on home v i s i t s and holding discussions on the s o c i a l aspects of i l l n e s s and measures t o be taken t o correc t various adverse fac to r s (see a l s o Afghanistan 48).

Be attended sr. cmcrgency meeting a t the Ministry of Public Health on t h ~ cholera s i t u a t i o n i n Kpndahar and on measures t o be taken t o prevent i t s spread t o other pads of t h e country, and prepared a note on the c l i n i c a l and laboratory diagnosis of cholera and i ts treatment.

Afghanistan 20 Vaccine Production, Xabul TA (Jsn. 1955 - Nov. 1960; Ju ly 1961 - ) UNICEF

Aim of the project . To rcorganizc, e x p n d and improve f a c i l i t i e s f o r vaccine production f o r the nat ional heal th programmes; t o t r a i n l o c a l personnel i n the production of b io logicalsubstances .

Assistance provided by WHO during the year. A laboratory s p e c i a l i s t bacteriologist).

Probable duration of ass is tance . Unt i l the end of 1963.

Work done during t h e E a r . The productiod of TAB, cholera, a n t i - rabic and smallpox vaccines continued. Ey mobilizing a l l i t s resources the Vaccine Centre was able t o mnuf8eture 50 000 cc of cholera vaccine pcr week t o meet the emergency caused by a cholera outbreak i n Kandahar Province. The production of smallpox mccine a l s o was continucd on the required scale.

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A group of r c c r u i t s f o r appointment zs vaccinators completed t h e i r -training, which was s t a r t e d i n June 1960; they were given p r a c t i c a l ins t ruc t ion i n prL.ventive measures against cpidemic diseases (smallpox, cllolera and t h ~ en te r i c fevers) , with specia l emphasis on mccin:~tion. The new double storeyed bui ld ing fo r the Centre has been complcted.

Since the departure of the WHO bacter io logis t i n November 1960, on completion of h i s assignment, the projec t has been experiencing d i f i ' i cu l t i e s through lack of .i;echnical guidance, Therefore the bacteriologist hiis b , : ~ reassigned fo r a period of two months from the middle of July.

Afghanistan 22 Environmental Sanitat ion, KBbul Municipality TA Nov. - Dm. 1935; March 1956 - Dec. 1557;

i p r i l - s e p t . 1960)

A i m of the p ro jec t . To d ~ v e l o p a san i t a t ion sect ion i h Knbul Municipality; t o plan and carry out a p r o g r a m of sani ta t ion , including t h e design, operation and maintenarlce of sani tary ins ta l l a t ions ; t o t r a i n san i t a t ion personnel.

Assistance providcd by WHO during the year. A san i t a r i an f o r six months, who was latsr t ransferred t o the Rural Health and Training Unit, Gulzar, and ass is tance from the san i t a ry engineer working with t h e l a t t e r projec t .

Work done. WHO ass is tance t o the projec t wus terminated i n September 1960, whe;? ' n c san i t a r i an was t ransferred t o the School f o r Sani tar ians (Afgtx~nistal~ 28).

Afghanistan 22 A s s i s t ~ n c e t o Public Health Laboratory, Kabul TA (my 1956 - Nov. 1960)

Aim of the p ro jec t . To consolidate the worlc of the public heal th laboratory at Xabul; t o givu fur ther t r a i n i n g t o laboratory technicians.

Assistance provided by WHO during the year. ( a ) A laboratory technician; (b) supplies and equipment.

Work done. This projec t was s t a r t e d nine years ago i n 1951 as part of t h e maternal and ch i ld health/venereal-disease con t ro l programme. It was in ter rupted i n 1954, when in ternat ional ass is tance was withdrawn. A Lnhoratory technician was ass iu led from Msy 1956 t o Apri l 1958, but during t h i s period it was possible t o achieve only moderate success.

The pr0jec.t r e a l l y got under way i n February 1959 with the appointment cf (1 sur:c,:ssor t o t h ~ laboratory Lcchnician. Hc was a b l e t o achisve conoiclcrablc success both i n the reorganization of

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the laboratory and i n the t ra ining of students. The i n i t i a l standard of qual i f icat ion required of t ra inees for admission had t o be lowered, a s suff ic ient numbers of higher-grade students were not available.

Bacteriology and Serology Sections were reorganized. The laboratory technician undertook a cer ta in amount of research work i n (a) enteric pathogens; and (b) chronic gonorrhoea re la ted t o s t e r i l i t y . Other a c t i v i t i e s included lecturcs a t the School f o r Sanitarians, the School for Midwives, the School for Dentists and t o several groups of medical students. He a l so ass i s ted during the outbreak of cholera I n 1960.

By the time of h i s withdrawal fran the project, i n November 1960, 14 laboratory technicians had obtained the Diploma of Iaboratory Technicians.

Evaluation. The national s ta f f a r e now capable of carrying on with the present work, including theoret ical teaching ac t iv i t i es , but international assistance may be necessaryto advlse on the future expansion of the laboratory services and the prac t ica l side of the teaching programme. The courses have yielded good resu l t s by producing capable technical ass is tants , many of whom a re now working i n different laboratories i n Afghanistan.

Afghanistan 26 Rural Health and Training Unit, Gulzar I1A 7 A w r i l 1956 - . - - - UNICEF

Aim of the project . To establ ish a r u r a l health t ra in ing unit ; t o develop a rura l health and environmental sanitation programme; t o promote health education work.

Assistance provided by WHO during the year. (a ) A public health officer, a public health nurse, a sanitary engineer and a sanitarian; (b) supplies and equipment. -. Probable duration of assistance. Until 1963.

Work done during the year. The co-ordination of a l l conmhlnity development work continues t o be the responsibi l i ty of the Rural Develonment Department. Co-operation between the Department and project s ta f f has been good. ,-

Expansion of the health programme in to r u r a l extension areas made steady progress. UNICEF has now agreed. t o a s s i s t with the development of seven r u r a l extension areas.

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Training was a c t i v e l y maintained. In addi t ion t o o r i en ta t ion courses f o r medical o f f i c e r s dest ined t o work i n r u r a l s i tua t ions , f i e l d t r a i n i n g was given t o medical s tudents , midwives, fundamental education organizers and v i l l a g s l e v e l worirers. The p i l o t projec t a rea was used a s a f i e l d p rac t i ce area f o r s tudents from t h e School f o r Sani tar ians , and environmental san i t a t ion staff of t h e projec t a s s i s t e d i n t h e teaching i n t h e school.

With a view t o providing s t a f f f o r r u r a l heal th c e n t r ~ s , in-service t r a i r ~ l n g of l o c a l candidates f o r aux i l i a ry nurse midwivus was undertaken. B~cause of her g rea te r adap tab i l i ty t o t h e r u r a l environment, t h e a u x i l i a r y nurse midwife has advantages over t h e filly t ra ined midwife.

A l a rge cholera imuniza t ion programme was undertaken, and no case of cholera was reported i n t h e p i l o t area. Immunization programmes agains t smallpox and typhoid were a l s o undertaken, and t h e occurrence of :J f G w cases of typhus was t h e s i g n a l f o r an extensive dusting campaign, which was combined with a resurvey of v i l l ages i n the p i l o t a rea ; t h e introduction of house numbering has f a c i l i t a t e d s a n i t a r y control .

The r u r a l water supply and l a t r i n e programme mdc good progress. It was combined with a heal th education approach, and a high l e v e l of community acceptance was secured.

School f o r Sani tar ians , Wbul ( J u l y 1955 -

Aim of t h e projec t . To t r a i n san i t a r i ans f o r community hea l th services.

Assistance providea by WHO during the year. (a ) Two sani tar ians ; (b) supplies and iquipment . Probable durat ion of s s s i s t ance . Unt i l the end of 1963.

Work done during t h c ycar. Entry of students from widely spread l o c a l i t i e s i n t o t h e se l~oo l was sa t i s fac to ry , and t r a i n i n n aroceeded smoothly. It has become apparent t h a t san i i a r i ans q u a l i f i e d by t h e school were ~ . q u i p p ~ f l t o mect the demands made upon them by t h e i r dut ies , but equ~. l ly i t i s recognized tint they need support and guidance i n t h e i r i ' iz ld posts .

The nat ional counterparts i n the projec t took an increas ingly a c t i v e p a r t i n teaching a c t i v i t i e s . Fu l l use was m d e of t h e opportunit ies prc?sc~ltcd by t i e Rural Health and T r a i n i ~ g Unit, Gulzar (Afghanistan 26) f o r f i e l d t ra in ing.

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Preparations were made Sor the t ransfer of the school from i t s present r e s t r i c t ed premises t o the Public Health Ins t i tu te , when completed.

One sanitarian ms transferred t o t,he Public Health Programme, Punjab (1ndia 107) i n December l a s t year.

Afghanistan 3 1 Assistance t o Ins t i tu te of Public Health, Kabul TA April - May 1956; Nov. - Dec. 1958; b r c h -

L y 1961; - )

Aim of the project . To establ ish an in s t i t u t e of public health for investigations, research and the t ra in ing of public health workers.

Assistance provided by WHO during the year. (a) A medical consultant for two months; (b) a two-month fellowship f o r study i n India.

Probable duration of assistance. Unt i l 1968. -- Work ?me during the year. A medical consultant was assigned t o - - --- - . 'Jg,m~&,an f o r two months t o advise on the functional u t i l l za t ion of the building of the In s t i t u t e of Public Health, (which is now under con;t:~ction), the organizational set-up and the nature and type of equipment required for bhe laboratories of the Ins t i tu te . His report ir- bcing sent t o the Government.

Afghenistan 35 - .. .>;ursine Advisory Services* TA ,June 1 9 7 - 1

P.im of the ?ro.]ect. To develop the t ra in ing of m l e and female -- ..-.-a

r1urs,-b a::.: o- r!id~rives; t o plan f o r meeting the country's needs i n nursing ocrviecs.

.4ssist,nnce provided by WHO during the year. (a) A nursing adviser, ---- ---.. --. a piiclic hsai>a nurse and three nurse tutors; .(b) supplies, equipment end a trans2ort vehicle.

Probahle duration of assislcance. Until the end of 1964. -.- ------ .--.-.

Work done c?vr in~ the year. The Ministry of Public Health has opened .-- --- t..io ncl: ci .nicr on the outskir ts of Kabul city, t o which midwives were appointed for servlce; a day-time domiciliary servlce was in t ro&~ced i n 22ch area,

e+.uce+,ion progr'unme a t the School for Male Nurses continued, with the national counterparts taking a larger par t i n both cUss rom and c l in i ca l t,cnching. Six nurses qual i f ied during the year were a p ~ o i n t e d t o the cc!lool, the hospital and the ru ra l health t ra ining centi-c. A rev class of nineteen students was admitted i n April. The s tnior n t i .o ra1 counterpart l e f t on a WHO fellowship i n February.

--- *Prev,ous T i t l i : I;.i?sing Education

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The School f o r Female Nurses of hbstoorat Hospital was s h i f t e d t o new premises, of fer ing b z t t e r f a c i l i t i e s . Innovations m d e fo r ro ta t ion of s tudcnts r c s u l ~ e d i n b e t t e r c l i ~ i i c a l experience and pat ient-care. WIL curriculum was revised; a student progress evaluation form was introduced i n t h e hospi ta l , and an in-service education course i n nursing techniques for cliploma nurses was conducted,

Fif teen studcnts completed t h e programme a t t h e Midwifery School of t h e Shararah Hospital and received t h e i r diplomas, and a new class of f i f t e e n wns cnrollcd i n January. Deta i l s of course- ou t l ines i n some subjec ts wcre reviewed; f r e s h notes were prepared, and a course i n precuture baby care was arranged f o r t e n member6 of t h e graduate s t a f f . An ahd i t iona l teaching midwife was appointed t o t h e school.

There has been an encouraging increase of co-operation between s t a f f concerned with nursing and midwifery programnes. On severa l occasions during the year t h e s t a f f of t h e t h r e e schools and hosp i t a l s have met t o g e t k r t o discuss matters of common i n t e r e s t . Also, the sub-committe~s of t h e Nursing Affa i rs Committee have played t h e r o l e of a c t i v e and usef'ul working p a r t i e s . Metters considered included a revised cur r i cu luwout l inc f o r nurse/midwif'ery t r a in ing , adequate s t ipends f o r student nurses, functions of nurses i n hosp i t a l s and an ou t l ine guide f o r nursing services.

Guidelines f o r a comprehensive s a l a r y sca le and f o r emoluments f o r nursing and midwifery s t a f f and students were produced, and a standard form fo r admission of s t u d ~ n t s t o nursing schools ~ 8 s evolved.

Recruitment of nurse studcnts i n su f f i c i en t numbers continues, however, t o be a matter of grave concern. To st imulate i n t e r e s t i n nursing education, some rad io programms and meetings with high-school teachers and heal th and education a u t h o r i t i e s wcre arranged; schools i n Kabul were v i s i t ed , and mater ia l was provided f o r publication.

Afghanistan 36 Fellowships R

San i t a t ion : A twelvc-month fellowship f o r s tudy i n Lebanon.

A twclvc-month rellowship fo r s tudy i n t h e United S t a t e s %ica. Bacteriology: A twelve-month fellowship f o r s tudy i n France.

Preventive and Soc ia l Medicine: A twelve-month fellowship f o r study i n t h e United S ta te - o f America.

Afghanistan 37 TA

Fellowships

Medical Radiology: Two t~~clve-month fellowships for . study i n the Union of Soviet Social is t Republics.

Pfst and Insect Control: A one-month fellowship f o r study i n the Union of Soviet Sociali'st Republics.

Afghanistan 48 Orientation Course i n Public Hcalth R (6 - 27 July 1960)

Qim of thc project. To provide refresher t ra ining for medical off icers i n government service.

Assistance provided by WHO during the ycm. ( a ) A secretarial ass i s tan t : nssistance f r o r ~ WHO f i e l d s ta f f in Kabul and a public health o f k c e r from thc Regional mf lce ; (b) half t he cost-of t r ave l and maintenance expenses of seven medical off icers from outside Kabul; (c) textbooks.

Work done. A three-week course i n modern advances i n p e d i a t r i c s and child health was conducted i n Kabul. WHO f i e l d s taff in Kabul and a public health of f icer f r m the Regional Office ass is ted with the course.

The course, which was a joint endeavour of the Ministry of Public Health and the Faculty of Medicine, University of Kabul, was drawn up by the Professor of Obstetrics. It oonsisted of lectures, seminars and dcnonstrations. Seventeen medical officers, including seven fraw the provinces, participated. The nunbrr of those interested and taking part i n pr r t s of the course only mounted t o f i f t y or sixty. From the discussions hcld during the course it may bc concluded tha t the course f i l l e d an exist ing need.

" W 110 has been assistiny in the expansion of the leprosy control srrvirr in Burma a n d in the t ra in ins of per- \onnrl. I n thr pholr,ympIi a lrprovy insprctor

is rr:~rrrininy rhilclrcn in a villaxr school.

iven tr, l3~

fi I

A I D i; heins;? of . mirlwil . . tl1tol.s t o r n .,....... ...... ...,....... ; mlcl!l-~lrr s . 'I'lli.; t r ;~ininx inrluilrs tot;il r ;~l-r o l t l r

mntcrnity patirnt . A rni~lwifr. \nl<u wives l i l t . ;r p<,st-nal;~l \.irit li,ll,,\ring

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2. BURMA

A s i n other p a r t s of che Region, the m o s ~ important a c t i v i t y i n the f i e l d of public health i n Buma i s the malaria ~ r a d i c a t i o n programroe. Leprosy a l s o continues as one o i the major public health problems. The progress i n both nularia and leprosy programmes i s described elsewhere.

Tuberculosis c l i n i c s i l l Rangoon and Elandalay and t h e Tuberculosis Ward i n t h e Rangoon Gfneral Hospital a r e functioning s a t i s f a c t o r i l y .

Since t h c compldtion of the nat ional -BCG e ~ i g n , i n which 4.5 mi l l ion chi ldren were t e s t e d by -the end of 1957, the aim has been t o in tegra te BCG work i n t o the health szrvices of t h e country. Ten BCG teams a r e now i n posi t ion; f i v e o f t h e m a r e continuing with t h e work of m%ss t e s t i n g and vaccination, and the other f ive cngngcdin t r a i n i n g heal th centre s t a f f t o t ake over BCG work a s pa r t of t h e i r normal du t i es .

I n thf venereal-diseasc control programme, 22 f i e l d teams haw been working,' s i x i n Rangoon a n d . t h ~ others at d i s t r i c t headquarters. StafYing d i f f i c u l t i e s have hampered expansion of the progr;rammc.

. . Control of other infect ious diseases, especia l ly cholera and s~Bl l -

pox, has been undertaken by thc public heal th skaff with t h e - h e l p o f t e n mobile epidemic teams, each scrving four d i s t r i c t s . During the non-epidemic season th;. mobile teams ca r ry out vaccination and san i t a t ion programmes. The problem of f i l a r i a s i s i n Rangoon has received increased a t t en t ion , and an addi t ional sum of kyats 500'000 has been sanctioned f o r controlmeasures.

A t the end of 1960, the re were 473 rural heal th centres i n Burma. The programme of r u r a l health iiclvelopment w i l l c-nd Furthdr as more heal th a s s i s t a n t s become available. The supervision of the rural h~!alth centres has been improved with Lhc'appbintment of 23 a s s i s t a n t d i s t r i c t hea l th o f f i ce r s .

There have been no major c b n g e s i n t h e operation of the maternal and c h i l d heal th and school. heal th services. Ef fo r t s a r e being made t o include the pre-school ch i ld within the matcrnzl and c h i l d heal th services.

I n the f i e l d of nu t r i t ion , i n addi t ion t o d i e t surveys, s tudies of e a r l y f a i l u r e of l a c t a t i o n i n nursing mothcrs nnd o i anaemia i n pregnancy have been taken up by t h e Nutri t ion Division oP tiic Health Directorate.

A l a rge number of h e a l ~ h exh ib i t s wcre held at f a i r s and f e s t i v a l s . The Production Section of the Bcalth Euucation Bureau has produced a number of Blides on d i f fe ren t subjects, and *he Burem. i s now engaged i n preparing a s e r i e s of handbooks on differen-L heal th projects .

The heal th budget of Burm f o r 1960-1961 worls out t o 3.9% of t h c t o t a l na t ional budget. This i s about 36 h k h s more than last year's allotment.

Lcproay Control l ~ p r i l 1960 - 1

UNICEF

Aim of the project , To expand and intensify the leprosy control programme t o cover a l l endemic areas of the country and t o t r a i n personnel for t h i s purpose.

Assistance provided by WHO during the year, Two leprologlsts.

Probable duration of assistance, U n t i l the cnd of 1965.

Work done during the year. The leprosy control project i n Burma i s very popular and well accepted by the peoplc.

The programme of case-finding, contact-tracing and treatment was act ively continued during the year, Tolerance t o DIS therapy i s generally good, and the number of serious reactions s m l l . Expansion of the control progranrme during 1961-62 t o five new areas (Sagaing, Mndalay-Qautse, Yamethin, Meiktils and par t of ~akokku) b s been sanctioned by the Government; a draf t addendum t o the p b n of operations i s under negotiation. The f i e l d work has proceeded sa t i s f ac to r i l y i n the f ive p i lo t areas; special a t tent ion was paid t o bacteriological examination, t o school surveys, and t o recording and class i f icat ion of t h e disease. A complcte survey of a l l schoolchildren was carried out i n the Mogwe area, and out of 56 619, there were 2 498 cases of leprosy detected (44 per thousand).

Team leaders, leprosy inspectors and junior leprosy workers were given prac t ica l instruction and demonstrations of leprosy case-finding, diagnosis, treatment and contact tracing.

The t o t a l number of rcgistcred cases i n Burma up t o the end of %rch 1961 was 77 815, of whom 67 413 were under treatment.

Burma 22 Vital and Health S t a t i s t i c s , Rangoon R 7-C. 1955 - )

Aim of the project. To establ ish machinery for prompt not i f icat ion of s t a t i s t i c a l data; t o improve processing of thc information and t o t r a i n s t a f f i n s t a t i s t i c a l methods.

Assistance provided by WHO during the year. ( a ) A s p e c i a l i s t i n v i t a l s t a t i s t i c s ; (b) supplies and equipment.

Probable duration 01' ass is tancc . Unt i l t hc end of 1963.

Work done during tnc y a r . Cabinet approval and f i n a n c i a l sanction were obtained f o r 'arrying out t h e f i r s t s tage of the new v i t a l

~ -

r e g i s t r a t i o n systcm i n Rangoon and Inse in areas . Detailed cos t e s t i n c t e s i n respect o f t h e new system i n subsequent years were p r e p a n d and submit,t~cl f o r inclusiori i n t h e na t ional budget. Forms and documents f o r usc under the new systcm were drafted, pr in ted and d i s t r ibu ted among t h e s t a f f concerned. Tile new medical c e r t i f i c a t e forms, incorporat ing t h e In te rna t iona l Form of Medical Cer t i f i ca te of Cause of Death and ins t ruc t ions on t h e use of the new form, were semi t o a l l medicalprcrctitioners i n the area and arrangements made f o r co l l ec t ing t h e completed forms through reg i s t r a - t i o n o f f i ces s c t u p i n various p a r t s of t h e area and f o r replacing the stocks whenever rcquircd. The s t a f f were *"rained i n processing t h e c e r t i f i c a t e s , coding medical diagnoses and o-Lher r e b t e d du t i e s .

A t t h e request of the Health Directorate, t h e projec t s t a f f compiled v i t a l s t a t i s t i c s data and a s e r i e s o i t a b l e s i n connection with Burma's contr ibution t o the Second Reporb on t h e World Health S i tua t ion .

The national. counterpart t o t h ~ WHO s t a t i s t i c i a n at tended a t r a i n i n g course i i i vital s t a t i s t i c s held i n bbnila under t h e jo in t sponsorship of the U~l i tcd Nations and WHO.

Thc WHO s t a t i s t i c i a n l e f t t h e projec t i n June 1961 at t h e end of h i s c o n t r x t . Action i s being taken t o post a fu r the r heal th s t a t i s t i c i a n t o t h i s projec t .

Post.-graduate School of Nursing, Rangoon i~il::. -. Nov. 1955; Aug. 1956 - )

Aim of t h t projec t . To give post-graduate t r a i n i n g t o nurse tu to r s , public heal th nursLs and midwife t u t o r s , t o meet t h e requirements of the in tegra ted hca l th services.

Assistance provided by WHO Guring the year. A midwife t u t o r .

Probable durat ion of a s s i s t ance . Unt i l the end of 1961.

Work done during t h e year. The f i r s t midwife t u t o r s ' course was completed and t h e f i n a l examination held a t t h e cnd of January. Eight out of twelvc students were successful .

S E A / R C ~ ~ / ~ Page 72

The course containcd a number of new subjec ts . C l i n i c a l experience, both domiciliary and hospi ta l , was appreciated and d id much t o develop an awareness fo r c l i n i c a l teaching. Throughout the course, very good co-operation and ass is tance from aLLied f i e l d s were received.

The students and s t a f f of t h e Post-graduate School were inv i t ed t o a meeting of senior medical and nursing s t a f f a t Dufferin Hospital t o o f fe r suggestions f o r improvements i n nursing. The s tudents made a number of sound proposals, p a r t i c u l a r l y i n regard t o t r a in ing .

The second course f o r midwife t u t o r s s t a r t e d on 1 June with t h i r t e e n students from dif ferent p a r t s of Burma i n attendance.

Assistance t o Mcdical College, Rangoon (Fcb. 1955 - Feb. 1959; Feb. 1961 - )

A i m of t h e projec t . To upgrade t h e Departments of Pharmcology, Physiology and Preventivc Medicine i n t h e Eaedical College of Rangoon University, a s p a r t of a long-term programme f o r upgrading t h e medical f a c u l t y a s a whole.

Assistance provided by WHO during t h e year. ( a ) Advice from a denta l o f f i ce r ; (bJ two twelve-month fellowships fo r s tudy i n Aust ra l ia .

Probable duration of ass is tance . u n t i l the end of 1965.

Work done during t h e year. For t h e purpose of advising on the establishment of a Dental Faculty i n the k d i c a l College, Rangoon, the Chief Dental Officer , WHO Headquarters, v i s i t e d Burma i n February 1961. H i s reporc, with important recommendations, has been forwarded t o t h e Government .

Two fellowships ham been awarded f o r advanced t r a i n i n g i n physiology and biochemistry i n Aust ra l ia .

B u m 3 1 MESA

Malaria Eradicat ion T ~ e b . 1957 - 1

TA UNICEF

Aim of t h e projec t . To eradica te malaria throughout t h e country i n progressive stages.

Assistance provided by WHO during t h e year. ( a ) Two malar io logis ts , an entomologist, a san i t a ry engineer, a s a n i t a r i a n and an administrative "

off i c c r ; (b) supplies and equipment.

Probable duration of a:;sistance. U i l t i l the end of 197.3.

Work done durlny t h ~ jear. The 1960 spraying operations afi'orded protection t o over 1.4 million people by Dm and nearly 0.8 million by dieldrin; a coverzcc o i a l i t t l e over 60% wao recorded. In 1961, about 10.5 million peoplc w i l l r ecc iw protection under the a t tack phase - 9 million by DDT and 1.5 n i l l l on by dieldrin. The spraying capaign, which s ta r ted ear ly i n 1 9 6 1 , ~ s completed i n April i n most areas and cvcry effor t was ma2 t o provide thorough coverage; spraying chta rcceived up t o mid-April showed that over 7.2 million people had been protectud.

Surveillance work, t ra ining of various categories of national s ta f f and entomological observations werc continued. The resul ts of surveillance worlr carried out i n 1960 i n the pre-withdrawal areas i nd ica t ed tha t it was possible t o interrupt spraying i n an area with a population of 3.5 million and t o enter in to the consoliclation phase. Surveimnce work i s continuing i n t h i s arca.

As a resu l t of a close study o; the programme during a numbfr of v i s i t s by Regional Office s t a f f , it was Oecidcd ear ly i n 1961 t o strengthen the WHO Staff by the acldltion of a seconC rmlariologist and a malaria engineer. The WHO administrative off icer i n Kathmandu was deputed t o B u m in August 1960 for two crccks t o study i n d e t a i l the administrative problems of t he programmc,and a fuU*timc odministmtive officer was rccruitcd and assigned in July. The possibiLity of assigning a short-term consultant t o mlcc an independent evaluation of the programe i s b u n g explored.

Strcn~thening of Environmental Sanitation (M3rch 1956 - )

UNICEF

A i m of t he project . To establ ish i n the Aung Scn Myo area a p i l o t demonstration arca where ru ra l water supplies and excreta disposal w i l l be improved; t o devise simple, pract ical and cheap scherws for r u r a l water supplg and l a t r i ne construction; t o provlde services and f a c i l i t i e s for extending sani ta t ion t o a l l r u ra l areas; t o t r a i n sani ta t ion personnel.

Assistance provided by WHO during the year. (a) A sanitarian; 7b) supplies and equipment, including a transport vehicle.

Probable dun t ion of assistance. Until March 1963.

Work done during the year. The programme of l a t r i ne construction and well-sinldng i n vil lages continued t o malre some progress. Plans were evolved for axtending of the work beyond the p i lo t project area. However, bacteriological and chemical examination of water from covered wells indicrlted recent prcsumptivc faccal pollution i n a

number of samples and called for a higher standard of protection* Over 46% cf samples from 1 636 wells showed an iron content of above 1 p.p.m. Efforts were i n i t i a t e d t o determine pract ical measures t o reduce t h i s figure. Effluent from dylng works, discharged in to soakage p i t s , was apparently causing contamination of some shallow wells. Methods of purifying the effluent a r e n a r under exmination.

The project provided a f i e l d t ra ining area for health ass i s tan t students. I n addition, the WHO sanitarian co-operated in the teaching of students i n the Health Assistants' School. Dis t r ic t health off icers and public health inspectors were given in-service training; and a short course of p rac t ica l f i e ld sanitation was arranged f o r fourth- year medical students.

Fublic Health Administration, Rangoon T%rch - Oct. 1955: April - Nov. 1956:

A i m of the project. To strengthen the administration of the Directorate of Health Services; t o assess health problems, and t o co-ordinate the planning of health services.

A C . A public health adviser.

Work done. WNO assistance t o t he project ceased a t the end of 1960, but it was arranged tha t advice on a l l aspects of public health administration would continue t o be given a s required by the Area Representative.

During the course of h i s assignment the public health adviser made a continuing study of the organization and administration of health services and thc pattern of international assistance. He examined generally problems of r u r a l health services and t ra ining and supervision of health s t a f f and advised on the control of communicable diseases, including plans for a smllpox eradication scheme, the national malaria eradication programme, a f i l a r i a s i s control scheme and preparation of n review on imunization against disease. Advice was a l so given i n the f ie lds of medical education, health education and nutri t ion, a s well a s on the t ra ining a c t i v i t i e s carried out a t the Aung San Myo Health Demonstration Centre.

The public health adviser took par t i n discussions on the prewrat ion of a four-year plan f o r the development of the hcalth . services. He made recommendations on the organization and operation of maternal and chi ld health services, part icipated i n the work of an inter-departmental committee on v i t a l s t a t i s t i c s and registration, and proposed a revision of the system of office routine and methods i n the Health Directoratc.

Evaluation. During the course of t h i s project , some improvement was effected i n the office routine of the Directorate of Health Services. There was a rea l i za t ion of the d e s i r a b i l i t y of gearing health planning i n terms of estimated resources. It was r e c o e i z e d that the effect ive- ness of heal th services based l a rge ly upon a u x i l i a r y personnel i s dependent upon adequate supervision.

Burma 40 R

Nursing Refresher Courses 15 Dec. 1955 - 15 Wrch 1956; ! Mrch - 31 Nyy 1$1; - )

Aim of t h e p ro jec t . To provide ref resher courses i n various aspects of nursing and midwifery.

Assistance provided by WHO during the year. (a) Half the cost of t r a v e l and mintenance expenses of nine par t ic ipants ; (b) ass is tance from the WHO nursing adviser at tached t o the nursing advisory services project i n Rangoon.

Probable duration of ass is tance . Further courses w i l l be held i n 1962 and 1963.

Work done during the year. A three-month ref resher course i n w e d i a t r i c nursing was held a t Rangoon General Hospital from t h e beginning of ~ r c h 1961. The WHO r:ursing adviser (BW 56) a s s i s t e d i n organizing and conducting t h e course, which was attended by nine pa r t i c ipan t s from d i f fe ren t p a r t s of Burma.

Comunicablc-Di ease Control (Epidemiology) (Jan. 1961 - )

Aim of the projec t . To es tab l i sh an epidemiological un i t i n the Directorate of Health Scrvices, Rangoon, with a view t o developing an epidemiological service throughout B u m f o r providing prompt and accurate information on epidemic and endemic diseases; t o define the pa t t e rn of epidemic and endemic diseascs i n order t o be ab le t o es tab l i sh communicable-disease controlmeasurcs i n order of p r i o r i t y .

Assistance provided by WHO during the year. (a) An epidemiologist; l b ) a t ranspor t vehicle.

Probable duration of ass is tancc . Unt i l the end of 1965.

Work done during t h e year. The epidemiologist was assigned t o t h i s projec t towards the end of January 1961. Hc immediately took s t eps t o es tab l i sh close co-operation with the V i t a l and Hsalth S t a t i s t i c s Service and t o plan an i n i t i a l programme of work, with a view t o

studying the s t a t i s t i c c l data and the epidemiological s i tuat ion i n the country. iic v i s i ted c l i n i ca l and laboratory ine t i tu t ions which Lical wlth cozmunicable diseases t o a s s i s t with necessary improvements and -to s t i m l a t e the establishment of a public health laboratory service i n the country.

B u m 54 Fellowships R

F i l a r i a s i s Control: Two three-month fellowships f o r study i n India.

Environmental Sanitation: A twelve-month fellowship for study i n Lebanon.

Malaria Control: A ten-week fellowship for study i n Ceylon, Europe, the United States of America and Brazil .

B~~ 55 Fellowships TA

Maternal an2 Child Hcalth: An eight-week fellowship f o r study i n the Union of Soviet Soc ia l i s t Republics.

Health Education: 12 one-month fellowship f o r study i n the Union of Soviet Soc ia l i s t Republics.

Nursing Advisory Services TMarch 1959 - )

A i m of the project. To a s s i s t the Division of Nursing of the Health Directorati in upgrading nursing and midwifery t ra in ing schools, par t icular ly thc schools i n d i s t r i c t hospitals.

Assistunce provided by WHO during the year. ( a ) A nursing adviser; (b) two four-month fellowships f o r study i n New Zealand.

Probable duration of assistance. Unt i l the end of 1963.

Work done during the p a r . Reorganization of .the Nursing D i v i ~ i o n received much at tent ion during the year. A sub-committee of independent observers studied the available material on the fbnctions of the Division and prepared a report, a f t e r study of which, tho Board of Directors of the Health Directorate agreedtha t t he Division should be the channel for a l l matters pertaining t o nurses and tha t the Nursing Chief should ac t a s a l i n k between it and the Hospital Division. It was decided that the Division or Nursing should maintain records of c l l nurses u n d e r t ruining and i n service.

s E A / R c ~ ~ / ~ Page 77

The nursing education programme i n Rangoon General Hospital continued. The s tu& j -ky system operated. s a t i s f a c t o r i l y with addi t ional graduatc nurser. appointed t o mlre t h i s educational pa t t e rn possible. Thcre m s h r t h e r improvement i n the number and qua l i ty of appl icants f o r general nursing t m i n i n g .

The s i x t h r s i r e s h e r course f o r hea l th v i s i t o r s , with UNICEF ass is tance , was held from 1 October t o 3 1 kcember i n Rangoon General Hospital under t h e guidUnce and supervision of na t ional nurses. Eighteen nurses from di f ferent p a r t s of the country attended t h e course.

k number of d i s t r i c t hosp i t a l s and. schools of nursing were v i s i t e d and reconlmcnclations m d e fo r changes i n s t a f f i n g pa t t e rns and curriculum planning. The number of graduate nursing s t a f f was increased i n seven of the small d i s t r i c t hospi ta ls undertaking nursing o r midwifery t r a in ing . In ~ n d a l a y e. study-chy method, t a i l o r e d t o t k ~ needs of t h e hospi ta l , W3s outl ined.

The h-puty Nursing Chief (counterpart t o t h e WHO nursing adviser ) went t o New Zealand i n M3rch on a WHO fellowship i n nursing administration, and. a similar fellowship was awarded t o t h e W t r o n of a teaching hospi ta l .

Assistance t o Medical College, Mandala 7 ~ o . i . 1959 - Wrch l9M); Oct. - Apr i l f961; - )

A i m of t h e p ro jec t . T'o upgacic c e r t a i n departments of t h e Medical College, Msndalay.

Assistance povided. by WHO (during the year. ( a ) A professor of pathology f o r s i x c~onths; (b) essential equipment, supplies and medical l i t e r a t u r e .

Probable duration of ass is tance . U n t i l 1965.

Work done during the year. k professor of pathology was assigned f o r six months i n October 1960, t o t sach pathology t o undergraduate s tudents and t o a s s i s t i n t h e development of t h e teaching curriculum i n pathology and of t h e Dewrtment of Pathology as a whole. Th? procedures with respect t o autopsies were reorganized; a manual of histopnthology was compiled, and h is topathologica l specimens were continuously prepared. A l i s t of urgent requirements i n t h e nature of microscopes, photographs of gross specimens and projec tors f o r micro-slides was prepared. Because of shortage of s t a f f it was almost inposoible t o organize any research, but a beginning was mde i n s t a r t i n g inves t i rn t ions on an important problem - t h e probable nature of chronic valvular l e s ions observed i n almost a l l t h e hear ts a t t h s autopsy tublc . The professor a l s o took a f u l l share of t h c teacl~illi : load, giving academic lec tures , t u t o r i a l s and p r a c t i c a l c lasses .

s E A / R c ~ ~ / ~ Page 78

He made recommendations f o r t h e strengthening of the staff, t h e in t eg ra t ion of th ree scrv ices of t h e h o s p i t a l - (a) i n pathology, (b) i n bacter iology and parasi tology, and ( c ) i n cl lnical-pathology - and t h e formstion of a committee o r t h e holdlng of a conference on medical education t o discuss t h i s proposed in t eg ra t ion a s w e l l a s other urgent changes needed i n t h e medical curriculum.

Further assignment of t h e professor of pathology is under consideration.

h v i s i t i n g professor of anatomy i s a l s o being recru i ted .

<- '-I

o r li con :" ,

A l ~ l 1 , A I ~ ~ A S l S ins[wrtor look^ liw rno%q~~i to l:irv;~r in t l ~ r . cr,it.-~o;tkit~g pot~d* 01' ii c o r ~ n l r t ~ t . ~ v r . 310t.c :tnrl morc nttrntirnn i r l ~ c i r , ~ ~ i v r n to tlre prolrlrm

11ari;r~iq. arrd \VHO has vercntly provided a sho1.t-tcrm rolt;rnt to assem the natu1.r and extent oC this problem

.,L devI<~n.

S E A / R C ~ ~ / ~ Page 79

3 . CEYLON

The Government of C ~ y l o n has s e t up a D~par'brnent of Foreign Aid, t o deal with a l l aspects of in tc rna l iona l and biln.;erizl aid, and a D ~ p r t m z n t of National. Planning, t o deal w i i h t h e work donc by t h r planning s e c r e t a r i a t and matters connected with economic a f f a i r s . Tiic grovis ional a l loca t ion f o r public heal th i s proposed 2 0 bc increased ~ r a d u a l l y from 28 mil l ion rupees i n 1959 t o 63 mi l l ion in 1968, A t prescni; Ccylon is spending 11% of her rzvenue on heal th services.

Except f o r a s t e a d i l y increizsing number of deaths caused by polio- mye l i t i s (from 34 i n 1949 t o 132 i n 1958), the pcrttern of endemic c o m n i c - ab le disease i n Ceylon r e m i n d unchanged. An Advisory Committse f o r Communicable Diseases was fomcd i n January t h i s year.

The nat ional m l a r i a eradica t ion p r o g r m c . h a s progressed wel l and i s described elsewhere. The Gov,-rnment i s con-bi~~uing t o 2xplore ways of a t t ack ing the problem of f i l a r i a s i s . Th< Curricillum Revision Connnittee appointed by the Medical Faculty has compl-ted i t s dcl ibcra t ions and submitted i t s report . Ths Government i s zstablis l l ing a second medical collegc a t Peradiniy",; t h ~ cons-Lruction of the ilcccsssry buildings has begun. Under orders issued by -the Govcrment, 211 medical graduates, s t a r t i n g with thosi. who graduated i n m r c h t h i s year, a r c requircd t o guarantee t o serve t h e Government f o r a period oi' f i v e years.

The Ministry of Hdalth has decided t o defer i h e implementation of t h e repor t on the grading of s p e c i a l i s t s and theil . s a l a r i e s and allowances, pending t h e reconrmenhtions of 'chi Su la r i c s uncl Cadrcs Commission, which i s now examining it.

A three-month ref resher course f o r a p o t n x a r i e s was s t a r t e d i n January t h i s year under t h e d i rec t ion of the Superintendent of Health Services, Kurunegala.

S teps a r e being taken by the Govcrment t o s e t up an in te rna t iona l ayurvedic research cent re near Colombo. It w i l l bc ca l l ed the "Bandaranaik; 1ni;ernational Ayurvedic Ccntre". Ayurvcdic dispensaries have a l s o been planned f o r every town, and f a c i l i t i e s a t out -s ta t ion hosp i t a l s a r e being improved.

A three-day seminar on scllool henlih was llcld a t Mztale i n D;:ccmber last year; school-teachers and o f f i c i a l s of t h c Departments of Education and H,salth participated. MOB% of i;ix itiscussions were r e l a t e d t o unvironm~ntal san i t a t ion i n schools.

A Nursing Education OSficer has been appoint22 i n t h e Eepartment of H a l t h . She i s responsible f o r planning, organizat ion and supervision of teaching i n a l l schools of nursing and aux i l i a ry . i ~ u r s i n g and a l s o fo r advising on nursing education.

The Ceylon Mental Health Association complcbcd a country-wide survGy of t h e incidence of mcntal diseases i n thc country by means of a simple questionnaire, which was complc t~d by over 3 000 v i l l age headmen.

An Inter-Departm~ntal Conmittre on Accident Prevention has becn formed, cons is t ing of representa t ivus of t h e Departmen-ts of Health, Police, Rural Dzvelopment, Local Government. Motnr T.-nmc---.- - ,

S E A / R C ~ ~ / ~ Page 80

PROJECT LIST

Ti t le - Ceylon 4

Th UNICEF

Aim of the project. In the f i r s t instance, t o upgrade the Children's Demrtment of the Kalutara Health Unit Hospital; t o integrate tile

and curative aspects of child care a t the hospital and in the f ie ld; t o improve public health nursing in the Health Unit, and t o t r a i n various cstegories of health personnel; when these objectives have been achieved, t o upgrade child health services i n a nwnber of provincial hospitals and t o l i nk child care ac t iv i t i e s in ru ra l areas with those i n the hospitals.

Assistance provided by WHO during the year. A p e d i a t r i c i a n and a ~ e d i a t r i c nurse.

Probable duration of assistance. Until Wrch 1963.

Work done during the year. The project has now been renamed "Maternal and Child Health. cevlonW'. w i t h headquarters i n Colcinbo, and w i l l be concerned w i t h the develo&nts of maternal and child hkalth services and paediatric and obstetric wards of provincial hospitals throughout the country.

O f the i n i t i a l l y ass is ted s i x psediatric departments i n provincial hospitals, a l l have achieved a higher grade of service, and sane have succeeded i n establishing a consultative service for peripheral health uni ts . A firm basis has been l a i d for a nation-wide development.

Ceylon 25 Tuberculosis Control and Training Centre, rr]n Colombo (Welisara

May 1953 - Aug:f957; N w . 1957 - Jan. 1958; bil 1959 - Oct. 1960)

Aim of the project. ( a ) To sc t up a model tuberculosis service and 'LO t r a i n medical and paramedical personnel for t h i s service; (b) t o revise the system of records and reports i n tuberculosis ins t i tut ions and t o es tabl ish n central tuberculosis regis ter .

S E A / H C ~ ~ / ; ~ Page 81

Assistance provided by WHO during the year. ( a ) A s t a t i s t i c i an ; 75) three one-month fe l larships for study i n India.

Work done. A s t a t i s t i c i an was provided by WHO -to t h i s project from Novembcr 1959 t o October 1960. It ass is ted w i t h the organizatim of the s t a t i s t i c a l work i n chcst c l inics , chcst hospitals, and i n the records and s t a t i s t i c s branch of the tuberculosis campaign. Quarterly report forms were workcd out and introduced i n chest c l in ics and chest hospitalc .

The Rccords and S ta t i s t i c s Branch of the 'iuberculosis campaign was ass is ted in preparing quarterly surmnarics of the tuberculosis instizutions and i n preparing s t a t i s t i c a l reports of the national BCG assessment team.

In the Records and S t a t i s t i c s Branch of the %ubcrculosis campaign, the notifications of tuberculosis cases for 1959 were mechanically processed and tabulated.

Plans were pripared for a simplified system of .not i f icat ion and invest imtion of tuberculosis cases. The system w i l l a l so f a c i l i t a t e the reporting of t ransfer of cases from one medical ins t i tu t ion t o anothzr, as well a s the f i n a l discharge from surveillance of the tuberculosis control system.

R plan f o r an annual inventory of known tuberculosis cases through chest c l in ics and hospitals was worked out.

Local tuberculosis prevalence surveys were visualized a s part of the project ac t iv i t i e s a t a l a t e r stage. This stage was not reached during the assignmen, of the s t a t i s t i c i an , who was fu l ly occupied in the above-mentioned ac t iv i t i e s .

Evaluation. Th? project succeeded in training the personnel of the chest c l inics , chest hospitals and par t icular ly the Rccords and S ta t i s t i c s Branch in recording and reporting proccduree.

Ceylon 26 R

y o s y c r t r o 1 July 195 - June 1957; Aug. - Oct,. 1960)

Aim of the project. To a.scss the idprosy problem and plan the further development of the control programme.

Assistance provided by WHO during the year. A consultant for two months

Work done. Sincc 1957, a f t e r the withdrawal of WHO assistance, which had been given since 1954, cllz control p r o g r a m has been continued by the national s t a f f . Information supplied t o the Regional Office indicated that there were about 3 500 leprosy patients i n Ceylon, a l l of whom wme undcr treatment, and tha t luprosy was no longer

s~.A@214/2 Page 82

a serious public health problem. The ccae-finding programme for the l a s t two years has therefore been concerned mcinly with treatment of p . t i cn ts and surveillance of contacts. A few surveys of schools and several small d i s t r i c t s were undertaken. In most areas, public health inspectors of the general Public Health Department were responsible for treatment of out-patients and undertook contact- tracing, ass is ted and supervised by lzprosy servicc s tc f f .

A WHO short-term consultant m s assigned for two months t o review the organization of lcprosy control, t o as:jess whcther leprosy s t i l l constituted a public health problem requiring s p c c i a l i z ~ d leprosy control service, t o study cxist ing arrangements for the physical and economic rehabi l i ta t ion of leprosy patients with deformities and t o advise on the fbrthcr devclopncnt of control and relmbili tat ion services.

The consultant's rcport shows tha t the r e a l extent of the disease i n the island i s not yet known, but according t o h i s estimates -the true number of leprosy patients i s not l ess t'mn twice that of those registered. The high proportion of dcformitics mong newly discovered patients suggests tlut mny must hc?ve been hiding the i r disease i n the ear ly stages. The leprosy inc id~nce is , however, low i n children. As compared with 1957, when the f i v e wns 2 685, the number of registered patients i n 1960 m s 3 629; of these about 25s ?.re segregated i n leprosy institutj.ons. After 1957, intensive surveys of large groups of population were not carried out. The steady intakc of new p?.tients, occasional discovery of new foci, high lcpromtous and deformity ra tes in newly admitted cases - a l l indicate tha t leprosy i s s t i l l a problcm in Ceylon and that there i s more than hzs been recorded. A t o t a l of 6 000 would not be an over-?stinate of the number of patients;of thcsc, about 2 000 niust be suffering from d i sab i l i t i e s of varying degree. The consultant estimated tha t it w i l l continue t o be a problem for 2.t l c a s t 12 t o 15 years.

Emluation. The type of leprosy seen i n Ceylon i s severe, w i t h a tendency t o reaction and neuri t is , which prolongs the time of treatment. Specialized surgery such as repair and restoration of the function of hands and fee t by tendon transplantation i s not being done a t present; special training i n these operative procedures i s needed. The method of providing treatment for caszs not t reated a t c l in ics and inst i tut ions i s unsatisfactory; most of the public health inspectors who dis t r ibute the drug ham no special t ra ining i n leprosy or i t s treatment. The nccd for be t te r t ra ining and supervision of t h e i r work by leprosy medical officers i s indicated.

It i s reasonable t o expect t h a t , through a suitably organized programme, leprosy can bc controlled i n and eradicated from Ceylon.

Ceylon 35 m

Envirorm:ntcl Sanitation, Kupuncgzh Tb~arch 1955 - February 1961)

UNICEF

Aim of the projcct , To se t up p i lo t projccts in ru ra l nrcas t o improve m t c r s u p p l i ~ s ant! ~ x c r c t a disposal ax! t o t r a i n personnel in environmental ;-nitation; t o build up a ncalth education programiie ','it w i l l sscure tk co-opcrai-ion of the peoplc; t o use t h i s experience in the national progmnme . iissistancc provld;.d by WIT0 during thc year. :. sanitarian.

Work donc. WHO a id i n thi: cstablishmnt of a rura l m t c r supply and l a t r i ne p r o g r m in a pi lot area, m.s completed i n 1959 and m s reviewed in thz Eleventh i m u a l Report. This year, assistance was given with the t ra ining in the School for Public Hczlth Inspectors. Work in the two sphcrcs was l i n k 6 so tlmt the pi lot area provided a training f i e l d f o r student public k a l t h inspectors.

Annuzlly, sincd the project bi.e,rin, groups of public health inspectors have becn trained i n the sci~ool. Two national tutors worked with the WflO sanitarian, and onc of then was awarded a WHO fellavship t o study envirmficntal sanitation in Beirut. In addition, medical officers, hcclth v i s i to rs and other catcgories. of health workers were trained i n the school. Refresher courses, on the l ines of the basic syllabus, wcrc arranged for public health inspectors. Health education teacixing was integrated into the -training course for public health inspertors, and rcfrushdr courscs i n hcalth education w r e given.

WHO assistance mded i n February 1961, when the sanitarian was assigned t o anothcr proj ic t . Evaluation. Although progress was i n i t i a l l y slow, the ru ra l water supply ancl la t r ind programe i n thd p i lo t area ultimately secured wide coveragc and a f a i r measure of public acceptance. h pattern of work suitable for extcnsior~ t o othcr d i s t r i c t s was evolved.

Basic t ra ining of public health inspectors was, within the l imitations of a nine-month course, successfully developed, and a pract ical syllabus cvolvcd. Rcfreshcr courses for health inspectors proved usefhl. Tilz principlc that rcfreshcr courses should be under- talcen a f t e r ten yezrs' service was acccptcd, but implcmentation m s sometimes hamxred by administrative d i f f i c u l ~ i e s . An average of

~ s s r a t e was attained in basic courses, indicating both a sat isfactory stanaard of student intake and adequate teaching. Training courses for hcalth v i s i to rs and othcr lx,alth s t a f f were u s e m .

S E A / R C ~ ~ / ~ Page 84

Ceylon 37 - Mental Health, Colombo (iuov. 1955 - Jan. 1956; Aug. 1960 - )

A i m of the project. To t r a i n a s m l l cadre of psychiatric nurses for supervisory posts and a s ta f f of ass is tant mental health nurses for the care of patients in mental hospitals.

Assistance provided by WHO during the year. A twelve-month fellowship for study i n Canada.

Probable duration of assistance. Until the end of 1963.

Ceylon 38 24

Assistance in Epiaemiology t o Health Directorate IPeb. 1956 - Sept. 1960; -

Aim of the project. To establ ish an epidemiological uni t i n the Directorate of Health Services, Colombo; t o make epidemiological surveys of disease distribution in Ceylon; t o t r a in undergraduate and post-graduate students and a counterpart; t o plan future work on veterinary public health, par t icular ly on the zoonoses and t h e i r control.

Assistance provided by WHO during the year. ( a ) A spec ia l i s t i n in fec t ims diseases; {b) a twclve-month fellowship f o r study i n the United Kingdcm.


Work done during the year. h c h improvement has been effected, par t icular ly in simplifying and rendering more e f f ic ien t the recording and reporting procedures introduced in October 1960. Since tha t t i m e , 98 d i s t r i c t s of the country have been sending t h e i r weekly reports d i rec t ly t o the Epidemiological Unit, where, a f t e r being processed by the S t a t i s t i c a l Unit, they are analysed. This procedure has proved t o be e f f ic ien t and useful, The WHO epidemiologist l e f t the project in September 1960 on completion of his assignment.

The Epidemiological Unit i s continuing investigations of typhoid fever and pyrexias of unknown origin and i s a lso advising and directing f i t l d investigations wherever indicated. The laboratory examinations necdcd for the various investigations being carried out by the Unit arc usually conducted by the Medical Research Inst i tute . This collaboration has a l so proved uscf i l .

A WHO consultant on veterinary public health is expected t o arr ive in September.

Ceylon 39 R

Assistance t o Health Directorat? (Nursing ~ d v i s e r ) I3uly 1957 - hug. 1960)

A i m of the project. To advise the Directorate of Health Services on nursing organization, education, administration and legislation, and on the development of co-ordinated supervisory services, t o ensure uniformly high nursing standards within the national health programe . Assistance provided by WHO during the year. !L nursing adviser.

Work done. \XI0 assistance t o t h i s project extended from July 1957 t o August 1960. During t h i s period the nursing adviser ass is ted i n the co-ordination of nursing services and nursing education and advised on the reorganization of nursing administration and enactment of requis i te legislation.

Assistance wcls a lso g i w n in planning nursing education programmes and in preparing teaching f ie lds both for basic progmmes and for post-gmdunte training.

A detailed pattern of nursing administration and s tcff ing ms evolved. Recomnendations were mde concerning the use and constitution of advisory bodies.

Evaluation. The rccomendations made are being carried out. ?I

Nursing Education Officer responsible for pbnning, implement in@ and supervising teaching p r o g r a m s i n nursing and auxil iary nursing schools and for overall advice on nursing educction was appointed i n the Deprtment of Health i n January 1960. A cami t t ee was appointed t o review the system of emminations, and advisory bmrds were established for a l l nursing schools. Satisfactory programmes for nursing and a u x i l i ~ r y nurse t ra ining have been established.

Ceylon 45 TA

Health S t a t i s t i c s 7tlpril 1957 - )

Aim of the project. To revise the system of records and reports i n the health services; t o t r a i n wrsonnel in the design of documents, the conduct af surveys r~nd other s t a t i s t i c a l techniques; t o s e t up a permanent s t a t i s t i c ? l service in the Ministry of Health.

Assistance provided by WHO during the yeor. (a) A health s t a t i s t i c i an ; 7b) supplies an& c q u i p ~ n t .


Work done during the year. The National Conmittcc on Vital and Health S t a t i s t i c s considered and accopted the recamendations of i t s sub- committee rdgarding the introduction of md ica l cer t i f ica te of cause of denth. Thesc rrrc i n l inc with the recomncndations of thd Regional

S E A / R C ~ ~ / ~ Page 86

Semhar on Certif ication ~.nd Classification of Mortality and Morbidity (SEAR0 17) held i n New Delhi i n 1958, and provide for cer t i f ica t ion on the International Form of Medical Csr t i f ica tc of Cause of Death of a l l ins t i tu t iona l deaths and cases t rected by privnte medical practitioners, and separate tabulation of a l l deaths thus cer t i f ied.

A new scheme for not i f icat ion of infectious diseases i n Ceylon was introduced a f t e r a short t r i a l use of various forms containing instructions designed for the purpose. The returns received i n the S t a t i s t i c s Branch during 1960 were processed ona the resu l t s made ami lab le t o the Superintendents of Health Scrviccs. An accident- reporting system was also introduced in to all government hospitals.

Work continued on the revision of the m t e m n l md child health records system. aoblems i n the reorganization of the work of midwives and of t he i r records were discussed with national off ic ia ls , and n new s y s t m was evolved, which has been introduced i n four areas on a t r i a l basis.

The records system i n use of the Mtrhuraguw Cdncer Ins t i tu te was studied and recommendations for its reorganization were submitted. The project s ta f f a lso assistc.d i n examining the records system of the Colombo General Hospital and i n submitting recommendutions for improvement.

Two lectures on s t a t i s t i c a l methods were given i n connection with a course for health educators attended by f i f t een tminees. A WHO fellow from Indonesia m s shown record systems designed for use of m s s cLwpsi@;ns.

Ceylon 50 Fellows hips R

Venereal-Disease Control: A three-month f e l l w s h i p for study in the United States of h e r i c a . the United Kinadm and the Union of - Soviet Social is t Republics.

Medical Stores &nagement: A six-month fellowship for study in the United Kingdom and Europe.

Ceylon 51 rn

Fellowships

Health Education: A onc-month fellowship for study in the Union of Soviet Social is t Republics,

Ceylon 53 R

Nursing Advisory Services X J ~ Y 1960 - 1

Aim of the project. To es tabl ish a post-basic school of nursing.

S E A / R C ~ ~ / ~ Page 87

Assistance proviclcd by WHO during the year. A nursing education adviser and a IIWEL' educator.


Work done during the year. A WHO nurse educator m s assigned t o the project in July and a senior nursing education adviser i n Nwember 1960.

Discussions were held t o consider th, background and t o give direction t o the project. The ac t iv i t i e s kavc been divided into three f a i r l y well-dcf ined f i e lds : assistance t o post-basic nursing education, assistance t o the officz of the nursing education officer, and assistance t o the rapidly developing progrcme of nurse-aide training.

The establishment of a post-basic school of nursing as an autonomous educatiorml insti tution, f ree t o scek' c l i n i ca l practice f ie lds under contract, w.s accepted i n pr inc ipk . This p h m s p r t i n l l y implemcntccl by thc appointmnt of a senior t u to r as principal of the schosl. Detailed planning for the establishment of a m y operational school was started. The current twelve-month course for preparation of tutors, which opened on 1 September with f i f teen students, mde good progress, with increased and enthusiastic participation by the students as the course developed.

The mtimcl nursing education off icer was given responsibil i ty for the administration of a11 government nursing education programs.

i~ post of co-ordinator of auxi l iary nursing education was created in the office of the nursing education off icer t o s u p r v i s e programmes for the education of auxil iary nursing personnel. A workshop m s organized in h r c h for tutors, natrons, principals and staff nurses concerned with the education of nursing nuxiliaries,and a course offering specialization in p e d i a t r i c nursing was s tar ted on 17 April with twelve students.

Advice was given t o the Faculty of the Colombo School of Nursing, which was ?Is0 ass is ted in i n i t i a t i ng an in-service education progmme .

Ceylon 54 TA

Training of Laboratory Technicians (April 1959 - March 1961)

Aim of the project. To organize c prognme for t ra ining laboratory technicians required for the hborntor ies in Ceylon.

Assistancc provided by WHO during the year. ( a ) A laboratory technician; (b) supplizs mil equipment.

sEA/~c14/2 Page 8s

Work done. This project s ta r te? i n Apri l 1959 with the assignment of a WHO laboratory technician LO a s s i s t the Government In establishing a training progrm.me for student nedical bboratory technologists and t o t r a i n four national counterpr t s . No complete organized curriculum in basic medical Llboratory technology had a t t ha t time bcen established. Courses of instruction were given by medical s ta f f for a period of s i x months but no syl21bus was being follawed, and frequently no lectures were given i n any one week.

The School of Medics1 Laboratory Technology, offering a one- year course of studies, was opened on 2 October 199 in the Department of Pathology of the Children's Hospital, Colombo. In 1960 t h i s coursc wns changed t o s two-year course, the second year en t i re ly one of internship i n mrious laboratories. aim of the School has been t o t r a i n some 25 t o 30 students annually. Twenty-three students completed the 1959-1960 course, and a new group of 28 students i a now undergoing the two-year course.

The School has four competent local laboratory technologists as tutors .

Evaluation. A reasonably high standard has been achieved in the training, which includes bacteriology, biochemistry, hematology, blood-bank, serology, c l i n i ca l techniques and prasi tology. The three m i n objectives of the project, i .c. (1) training four selected tcchnolo@;ists as tutors in t he i r specific subjects, (2) evolving a t ra ining scheme t o enbrace completely thc syllabus submitted and (3) establishing s school of medical laboratory technology t o t r a in students up t o the standard la18 down in the syllabus i n both theory and practice, have been accomplished.

Ceylon 55 R

School of Physiotherapy, Colmbo ' (k t . 1958 - 1

Aim of thc project. To t r a i n physiotherapists for physical nedicine and rehabi l i ta t ion services.

Assistance provided by WHO during the year. (a) Two physiotherapy tutors ; (b) a two-year fellowship for study i n the United Kingdom; ( c ) supplies and equipmnt . Probable duration of assistance. Until June 1963.

Work done during the year. So fc"r the school has been able t o produce 37 well trained and qualif ied physiotherapists; another 40 are under t ra ining 23 of whom s a t for the f i n a l examination i n June. These t m i n i ~ x ac t iv i t i e s have cnablcd new physiotherapy uni ts t o be opened a t the following ins t i tu t ions : Rstnapura thomc i c ) Galle ; Hendab Leprosy Hospital; Colombo Leprosy Clinic part-time); Neurosurgical Depcrrtmcnt, General Hospital, Colombo; De SOYSO Wterni ty Hospital (v i s i t ing physiotherapist ); Castle Street Mitcrnity Hospital; and Thoracic Unit No.2, General Hospital, Colanbo.

S E A / R C ~ ~ / ~ Page 89

Two m t i o m l coun te rp r t s nre now i n the United Kingdon studying for thc physiothcnpy tu tor cer t i f ica te . One reserve c o u n t e m r t has been appointcd by thc Govcrncnt .

The school i s s t i l l han&icc.ppcd by inndcqunte acconnodotion for tcaching. The equipment supplied by WHO h s in o large nensure remedied other handicaps prcvimsly expericnccd.

Ceylon 56 R

F i l n r i ~ s i s Control I ~ e c . 1959 - July 1961)

Aim of the project. To assess thc mture and cxtcnt of the f i l n r i a s i s pr&lem and t o explore ~ f f c c t i v c and practicable control measures.

Assislxmce provided by WHO d u r i w the yecr. R nedical consultant for three months.

Work done, Following thc s m r d of a t ravc l fellowship l a s t year t o enable a medical a f f iccr t o observe control ucnsures in other countries, o short-tern consultant ms assigned o t thc end of April 1961, t o cnrry out a survey of the f i l s r i a s i s s i tuat ion i n Ceylon. His report i s amitcd.

~ e y l o n 58 Malaria Eradication MESA nug. 1960 - 1 (IU)

A h of the project. To cmdicatc m l c r i a f ron the en t i re country.

Assistance provided by WHO during the year. ( a ) A oalariologist , an entmologist , n lnborctory tcchnician and an administrntive officer; (b ) transport vchiclis (including motor cycles, and bicycles ), office and laboratory cquipn~nt ; (c) prt pyrlcnt of governnent expenditure m national s ta f f .

Probable duration of ilssi~.La11ce. Until the end of 1963.

Work done during the year. Malaria erndication scems t o be ncarcr in Ceylon than anywhere e l s e i n the Region. In 1960, i n the nntionnl progame, assistccl by ICA, only 467 rn lnr ia positives were dctccted as against 1 596 in thc previous year. Although a plan of operations covering MiO-nssis.tancc f o r an expanded surveillttnce p r o g r a m m s concluded with the Govcrnncnt i n fiugust 1960, there was some delay in i t s implementstion. Harever, the Govement i s now taking steps t o appoint the additional s t a f f p rovid~d for under t h i s agreement.

A WHO odninistmtivc off icer m s ossirnccl t o the project frm December 1960 t o May 1961. Shc assisted thc Superintendent, Rnti- m l n r i a Cnnpaip, i n orgnniznt i o m l and adninistrative m t t e r s . In order t o strengtixn tlre prog- fur ther , a ~ . n h r i o l o a i s t . an - . - , entmologist and 2 laboratory technicinn were assigped i n the second quarter of 1961.

4. INDIA

The national health authori t ies b v e devoted considerable e f for t t o the prepra t ion of proposals for the Health Section of the Government of India's Third Five-Year Plsn 11961-1966). It is now l ike ly that a sum of Rs.345 crores (i.e. s l igh t ly l e s s than 446 of the t o t a l plsn outlay) w i l l be available for provision of health services, including ru ra l and urban water supply and sanitation; primary health centres, hospitals, and dispensaries; control of cgmrmnlcable diseases; education and training, family planning, and other schemes,

In the f i e l d of cizfmmicabla diseases, the largest item is the national malaria eradication prcgraxne, which began in 1955. The organization s e t up by the Gwenuuent now covers the whole country. Its ef for t s a re backed by supplies of MYP frcm the country's own production p h t s a t Delhi and Alwaye erala la s t a t e ) .

Other outstanding ac t iv i t i e s have been in the f i e l d of tuberculosis control; the work of the Xaational Tuberculosis Ins t i tu te a t Bangalore and of the Madras Chemotheraw Centre is described elsewhere.

There was a serious outbreak of poliomyelitis i n Andhra ePradesh in February-March t h i s year; the areas worst affected were Krishna, Guntw and Masuliptam. It was rapidly brought under control.

Progress with respect t o the control of other commnicable diseases i s mentioned in Part I, Section 1.5.

An important development in relat ion t o an overall epidemiological approach t o the health problems of India uas the creation of a s p c i a l unit, under an Assistant Director, t o deal with t h i s subject i n the Directorate-General of Health Services.

The Government continued t o devote at tent ion t o means of becoming self-sufficient in vaccine productfon, p r t i c u l a r l y in respect of smsllpox vaccine required fo r the proposed country-wide smallpox eradication camprign, and l a i d plans for establishing a m j o r an t ib ia t ics prduct ion factory.

Vital and health s t a t i s t i c s are receiving increasing at tent ion i n a number of States i n Indin. More adequately trained s t a t i s t i c a l personnel a re nar available a s a resu l t of the a l l - M i a t ra ining programme conducted in Nagpur.

The commnlty development programme i n India has made further progress. This p r o g r a m now covers 3 68 200 villages, with an aggregate population of 203 millions. As in $he past, the greatest handicap t o expansion has been the severe shortage of a l l categories of health workers.

The Central Bureau of Health Education has c~np le t ed its fourth year and has.moved into a new building. Its School Health Section, in co-operation with the Ministry of Education, undertakes developnent of teachirig in health education in teacher-training in s t i t u t e s and schools.

The. Food Deprrtment of -the Ministry of Food and Agriculture of the Central Government has se t up a special Nutrition Division,and a Rational Nutrition Advisory C m i t t e e has been created.

India has become one of t h e mJor prcducers of radioisotopes.

OS.1'-qradrlat? mcdiral stndents receiving training in h tn l l l~ (fix the lliploma rrf Chilrl Hml th ) Irarn

t l l r sp~.rializrrl c;lrr 01' tllr nrw-l~r,~.n a t t l l s KinS r 1~1<)~~litill , Vis;tkhapatnnm, lo \vhicl~ Wl-IO ha.; Sivrn ;~~r i r t nn rc .

PRaSECT LIST

T i t l e - India 53

TA Tuberculosis Chemotherapy Centre, Wdras (Dec. 1955 - )

A i m of the projec-t . ( a ) To study the e f f e c t s on p a t i e n t s and t h e i r contac ts of t h e chemotherapy of p a t i e n t s i n t h e i r homes and i n hospi ta l ; (b ) t o compare the e f f e c t s and value i n domici l iary t r e a t - ment of drugs u e i ~ alone and i n combination, with t h e objec t of f inding cheap and cif 'ectivc therapy; ( c ) t o study the e f f e c t s on t h e commur~ity of -<ride-spread chemotherapy of' ambrlant pa t i en t s ; (d ) t o assess the impoi--Lance of n u t r i t i o n a s a fac-tor; ( e ) t o provide for training. i n research methods.

Assistance provide& by IJHO during the year. ( a ) Two medical o f f i ce r s , a bac te r io log i s t , a labora tory technician, a public h e a l t h nurse, an adminis t ra t ive o f f i c e r and an administrat ive a s s i s t a n t ; (b) a shor t - term consul tant ; ( c ) a twelve-month fel.lowship f o r study i n the United Kingdom, and another twelve-mon-tn felloT.rship f o r study i n Ne:! Zealand (awarded ur~der India 110); (d ) suppl ies and equipment and a t r anspor t vehicle .

Probable dura t ion of ass i s tance . Until. the end of 1965.

Work done d u r i n ~ - t l ~ year . The work of the i s r e fe r r ed t o i n Sec t ions 1.2 and 9.2 of Par t I of t h i s repor t . During the year under revieir t he same Ili,:h standard of performance a s i n previous years has been maintained so t h a t of a l l t h e p a t i e n t s and t h e i r contac ts admitted t o t h e research s tuu ie s from 1956 onwards the Centre i s s t i l l i n touch with 868 (98%) of the p a t i e n t s and 2 860 (93%) of t h e i r contac-ts.

The senior lEIO medical o f f i c e r :rho has been with t h e p ro jec t s ince i t s beginning i n 1955 l e f t i n January 1361 t o r e tu rn t o h i s irork with the B r i t i s h Medical Research Council; h i s successor a r r ived i n October 1960 so t h a t an ef 'ficien-t t r a n s f e r of r e s p o n s i b i l i t y f o r important research s tud ie s was achieved. Unfortunately ne i the r of the key posts of a na t iona l d i r e c t o r o i 'the Centre nor of a chief f o r t h e bac te r io log ica l s ec t ion has y e t been f i l l e d . The NHO adminis t ra t ive o f f i c e r l e f t t h e p ro jec t i n J u l y 1960 and a na t iona l adminis t ra t ive o f f i c e r Loolc up the c i l~ t ies i n December 1960. TVo of t h e senior na t iona l :"?orkers, a b a ~ i e ~ i o l o g i s t and a s t a t i s t i c i a n , l e f t on \THO ie1lo~:isilips f o r s p e c i a l s tudy overseas, and the senior na t iona l bacterio3.ozist returned t o h i s substant ive post with t h e Cznt ra l Research I n s t i t u t e , Kasouli.

Up t o the end of June 1961, nineteen papers describing the resu l t s of the studies a t the Centre had been published,and many more prepared (see annex 6). A l l the patients included i n the f i r s t study of a comparison of home and hospital treatment have completed the t h i rd year under observation. The continuing follow-up of both the patients and the i r family contacts has confirmed the e a r l i e r findings tha t w i t h adequate chemotherapy the resu l t s of domiciliary treatment, even under the most adverse environmental and diet ry circumstances, are no worse than the resu l t s of similar therapy i n hospital, and tha t the attack ra te of tuberculosis among contacts is no greater. It would appear t ha t the major r i sk t o the contacts i n t h i s study resulted from exposure t o the index case before diagnosis and treatment.

Many other important studies designed t o discover an optimum chemotherapeutic re~imen f o r use i n cowtr ies lacking ample resources and t o c l a r i fy the effects of the domiciliary chemotherapy of patients on tuberculosis control i n the community have been in i t i a ted and are continuing; among these are most interesting studies re la t ing t o the question of drug-resistant bacteria and t h e i r virulence.

Several doctors, nurses and technicians from the countries of t h i s and other regions have been given training and experience i n t h i s project; up t o the end of April 1961, thi r ty-f ive trainees from eleven countries had spent varying periods a t t h i s research centre.

India 77 TA

Public Health Engineering, University of Madras ' ( ~ u g . 1955 - April 1959; July 1960 - )

Aim of the project. ( a ) To establ ish a department of public health engineering a t the University of Madras and t o organize post-graduate courses and f i e l d t ra ining i n public health engineering a t the University; t o t r a i n counterparts t o take over from the professors provided by WHO; (b) l a t e r , t o develop and organize courses i n chemistry, bacteriology and biology i n the post-graduate course i n sanitary engineering and t o help in the teaching of these subjects.

Assistance provided by WHO during the year. A professor of chemistry and microbiology of water and s5wage.

Probable duration o i assistance. Until the middle of 1962.

Work done during the year. Following -the withdrawal of the ImO professor of public health engineering i n 1959, a f t e r the f i r s t aim of the project had been achieved, a professor of chemistry and microbiology of rra-ter and sewage was assigned i n July 1960 t o a s s i s t i n the more specialized aspects of t h c vork. The University has offered a post-graduatc course i n public health engineering and short course i n sanitary en:;ineering f o r cnginccrs and engineering subordi- nates, but the l a t t e r t ra ining has norr,unfortunately, been discontinued.

The WHO professor undertook thc teachin@; of bacteriology with a v iev t o preparing fu ture teachers. The Professor of Bc tc r io logy , Madras Mcdical Collep;~, assis.i;ci with khc course on a part-time bas i s . A bacteriology dcrnonstrator was appointed, but the sanctioned pos-t of l ec tu ru r i n bcc-Lcriology was not f i l l e d .

The FrHO professor a s s i s t e d the projec t i n drawing up plans f o r the organization and equipment of a bacteriology h b o r a t o r y . A considerable amount of equipment was rcccivcd from t h e National Water Supply and Sani'cation Programme.

India 81 R

Leprosy Control (Jan. 1961 -

UNICEF

Aim of the projec t . To develop a country-wide programme f o r leprosy control .

Assistance provided by WHO during the year. A leprosy consultant.

Probable dura t ion of assistance. Unt i l the end of 1965.

Work done during the year. The consultant '.ho ar r ived i n January, held discussions v i t h ?ovcrnment au-thori-Lies and undertook i.ntensive - tours t o v i s i t leprosy i n s t i t u t i ~ n s , both governmental and voluntary, i n t h e variovs Sta-Les of India. By the cnd of July, t h e S ta tes of Tripura, Manipur, Assam, West Bengal, Gujerat, Andhra Pradesh, Madras, Kerala and Mysore had been v i s i t ed . Some of h i s repor ts have been d i s t r ibu ted , and ot~-:rs a r e under preparation.

India 84 TA

Environmental Sanitat ion, Uttar Pradesh '(March 1958 - )

Aim of the project . To s e t up i n a r u r a l a rea a p i l o t projec t f o r improving water supplies and excreta disposal : t o plan and carry out a san i t a t ion pEbgramme inc lud im th&desi@;n, operation and maintenance of simple, p r a c t i c a l and cheap san i t a ry i n s t a l l a t i o n s ; t o organize a programme of heal th education; t o t r a i n technicians, san i t a r i ans and other personnel.

Assistance provided by WHO during the year. ( a ) A san i t a ry engineer and a sani tar ian; (b) supplies and equipment.

Probable dura t ion of assistance. Unt i l -the end of 1962.

Work done during the year. Latrine construction made s a t i s f a c t o r y progress' ana a wide masure of community acceptance was secured. Although d i f f i c u l t i e s rrere caused by abnormally heavy r a i n s and serious f loods, consider8ble extension of the projec-t was ef fec ted

i n Chinhat and Meerut areas and i n ncarly 200 community development blocks. The projec t has successfully pointed the way t o R r u r a l l a t r i n e proe)ramme covering the whole S ta te and has evolved sa t i s fac to ry types of l a t r i n e s adapted t o r u r a l circumstances.

Less subs tan t i a l progress was madc with the programme fo r protected water supplies. Ef fo r t s were made t o concentrate the a c t i v i t i e s of the projec t more strongly on t h i s aspect. A t r i a l construction of wells by the j e t t i n e me-thod and without casing shonred sa t i s fac to ry r e s u l t s and promised t o lead t o both an accelera t ion of the construc-Lion r a t e and a reduction of cost .

The project continued t o f u l f i l i t s t r a in ing ro le . The s t a f f co-operated i n the er~vironmental san i t a t ion aspects of or ienta t ion courses f o r medical of f icers ; courses vere arranged f o r sani tary inspectors and overseers of community development blocks; regular monthly courses i n construction of l a t r i n e p a r t s and t h e i r i n s t a l - l a t i o n were held fol- d i s t r i c t masons rrom a l l pa r t s of the S ta te , and courses, giving a major emphasis t o health education, were held f o r 84 v i l l age soc ia l workers.

India 85 Health Education (Miniscry of Health in Co-operation TA with Ministry of Education)

7 ~ c . 1957 - )

Aim of the project . To develop t r a in ing and prepare experimental curr icula f o r heal th education i n one or more teacher-trainzng i n s t i t u t i o n s i n Delhi.

Assistance provided by WHO during the year. (a) A heal th educator; (b) a twelve-month fellowship f o r study i n the United S ta tes of

Probable durat ion of assistance. Unt i l the end of 1361.

Work done during the year. This p ro jec t , located i n t h e Central Health Education Bureau, continued t o develop sa- t i s fac tor i ly . Ac t iv i t i e s were focussed upon the goal of providing a framework f o r and leadership i n hea l th education i n schools and teacher-training i n s t i t u t e s . Seminars and workshops were arranged f o r p r i m a n schoo l teachers and education off icers . Subsequently the teachers were v i s i t e d i n t h e i r schools with the ob,ject of reinforcing the e f f e c t of the seminars. Assistance was a l s o given t o a seminar f o r secondary-school teachers organized by the Extension Service Division of the Central I n s t i t u t e of Education with the aim of improving heal th p rac t i ces of students and studying the bes~t use of "Good Health Week" celebrations.

The School Health Education Seccion of the Central Health Education Bureau co-operated with t h c School Health Committee, was able t o guide i t s delibemtions and conclusions and undertook follow-up work after the meetings.

The preparation of a heal th education syllabus was considererl a t a meeting of pr incipals of teacher t r a in ing colleges. Health education programmes f o r the age-groups 6-11, 11-14, 14-17 and f o r teacher t r a in ing were drawn up and issued, and the f i r s t syllabus was t r ans la ted i n t o Hindi. I n f l u e n t i a l speakers a t the opening of the new Central Health Education Bureau premises i n May 1961, underlined the necessi ty f o r heal th education mater ia l i n loca l languages.

A t the Central Health Education Bureau ass is tance was given t o the school heal th education phase of programmes fo r heal th education students and f o r student public heal th nurses a t the Lady Reading Health School. Advice was given t o heal th education bureaux of S t a t e s on the formation of school health education sections.Health education students from the All-India I n s t i t u t e of Hygiene and Public Health, Calcutta, v i s i t e d the project . The College of Physical Educa- t ion , Gwalior and the Training I n s t i t u t e , Bombay, were provided with materials and guidance.

A considerable volume of work was undertaken i n connection with the Fourteenth World Health Assembly with respect t o a Health Progress Exhibition, planned and i n s t a l l e d by the Central Bureau of Health Education. A study guide t o the exhibit ion was prepared and d i s t r ibu ted t o schools, colleges and other educational ins t i tu t ions .

India 90 TA

V i t a l and Health S t a t i s t i c s , Nagpur 7 ~ a r c h 1956 - J u l y 1960)

Aim of the project . To s e t up i n an urban a rea a demonstration cmd t ra in inn uni t which w i l l serve as a model health s t a t i s t i c a l servicc; t o t r a i n pe'rsonnel i n heal th s t a t i s t i c s .

Assistance provided by WHO during the year. A health s t a t i s t i c i a n .

Work done. A modern systcm o i vltal and heal th s t a t i s t i c s ms established I n the Nagpur Corporation Health Offlce. Individual not i1 ica t ion f o m f o r biri;hs, deaths and f o e t e l deaUls were i,ltroduced according t o in te rna t iona l r e c m e n d a t l o n s . The death no t i f i ca t ion form incorporates the In ternat ional Form of Medwal C e r t i f i c a t e of Cause of Death.

Studies weremade on the incidence of death from diseases such a s smallpox, infect ious h e p a t i t i s end encephali t is and from f a t a l in ju r i es . The se r i es of epidemiological reports published by the projec t and s tudies on diagnostic repor ts from dispensaries material ly added t o the information on healah conditions available t o the ~ l c i p l i t y . Closc re la t ions liere established with the City Health Officer. Assistance was given i n the preparntion of a model annual v i t a l s t a t i s t i c s repor t .

The project conducted zeveral training courses for dif ferent categories of health personnel. There has been a continuous demand for training courses for s t a t i s t c i a l css is tants and medical coders and also for a repetii;ion of the refresher course for health off icers , Besides trainees from various Indian States, WHO fellows from other areas v i s i ted the project for t ra ining and orientation.

Evaluation: The two objectijs,.s of the project, m l y , establishment of a modern v i t a l and health s t a t i s t i c s unit in the Corporation Health Office and training of various categories of health s t a t i s t i c s personnel were achieved. The various epidemiological and diagnostic report, and especially the annual reports contain a great deal of information on the health conditions i n the municipal area which w i l l be of great value i n planning future health ac t iv i t i es . The project could not, however, carry oi~t.sample health surveys as envisaged i n the plan of operations, par t ly f o r technical reasons and par t ly because of the heavy workload on 1.he s t a f f .

India 91 TA

Traini- i n Preventive -. .- and Social Medicine* ( F e b . - c c . 1957; Nmch 1939 - Sept. 1960; -)

Aim of the progec-L. To develop the departments of preventive and social medicine i n selected medical colleges, incorporating preventive medicine into the general curriculum and organizing courses in preventive and social. medicine for undergraduates; t o es tabl ish centres for practice1 training; t o t r a i n national counterparts t o take over from the WHO professors.

Assistance provided by WHO during the year. (a) A professor of preventive and socia1,medicine a t King George Medical College, Lucknow; (b) a twelve-month fellowship f o r study i n the United States of America and a five-month fellowship fo r studf in the United Kingdom, Yugoslavia q d Lcbui~on.


Work done during the year. The professor of preventive and social medicine assigned t o the King George Medical College, Lucknow, completed his-sssi-ent a t the end of September 1966 and submitted - - his report.

Teachine i n preventive and social medicine which was ea r l i e r given only i n the fourth year has now been extended t o four of the f ive years of the M.B.B.S. course. The number of hours of formal teaching have been reduced t o allow more time for f i e ld demonstrations, i n which, hodever, d i f f i cu l t i e s are being experienced because of the limited number of ~eaching s ta f f and the pressurc of too many students.

*previous t i t l e : Prof :st;oi.s i n Preventive a1-d Social Medicine

A c t i v i t i e s :!ere a l s o d i r e c t e c io~ in rds the development of l>c,s,-- graduate t r c i n i n s . Research srork 013 problems of immediate ~ u b l i c hea l th importmcc t o India was star-tkd. and seve ra l s tud ie s were completed.

The establishment of zn urban hezli;h t r a i n i n g cent re , ic addi t ion t o En a l ready funct ioning r u r a l hea l th t r a i n i n g cent re , has been included i n t h e Third Five-Year Plan cs p a r t of a course f o r t h e Diplorn i n Public Health, scheduled t o s t a r t i n 196:.

A one-year' fe l lowship was i.t.~~.rded t o t h e s t n t i s t i c l a n - l e c t u r e r of t h e Department f o r s'cudy i n Unii.ed S t a t e s of m e r i c a .

It i s plcnned t o reass ign t h e ',,NO professor on a short-term consul tantship i n 1363 t o assess the fvrthcr development of the Department and t o i ~ e l p i n introducing t h e course f o r t h e Diploma i n Public Health.

The p ro jec t :~cs been a success and the Department i s functioning s a t i s f a c t o r i l y , but needs f u r t h e r consolidation.

Tndia QR Refresher Courses r"or Nurses, Visakhapatnam (27 Oct. - 21 k c . 1960) New Delhi (1 - 30 Nov. 1960)

Aim of t h e p r o j e c t , To planand conductshori, r e f r e she r courses i o r nurses incorporat ing heo ore tical ana practical i n s t r u c t i o n edapced t o l o c a l conditions.

Assistance providcd by WHO dwing the year. ( a ) Half t h e cos t of t r a v e l and maintenance expenses of 19 s i s t e r t u t o r s and 21 nursing superintendents from d i f f e r e n t p c r t s of Indin; (b ) a s s i s t ance from WHO nurses workiq; on f i e l d pro jec ts .

Probable dura t ion of ass i s tance . Further courses ; r i l l be .given i n 1962 and 1963.

Work done during t h e year. An 811-India cou-:-se f o r s i s t e r tu tors was held a t t h e King George HospitcJ, Visakhapat.n~un, from 27 October t o 21 December 1960. ' i i t h a s s i s t ance :rom the 1 0 n~l rs inf i team s tn t ioned - , a t Visakhapatnam. IL was attended by 19 t u t o r s from t c n S ta t e s .

An a l l - I n d i a re f resher course f o r nursing superintendents was held a t t h e Lady Hardinge Medical College and Hospitnl, New Delhi, f o r one month from t h e beginning of November 1960. The WHO nursing adviser at tached t o t h e Directorate of Heelth Services, Mrdhya Pradesh (under projccl; Indir;. ].lo), a s s i s t e d i n organizing and conduct in^ the course. It was aiiended by 21 part iciparr ls From u i f f e r e n t par-Ls of India.

Reports of both courses have been issued.

India 99 TA

Nursiii,: Eclucation (Public Health In tegra t ion) (Sept. 1957 - )

Aim of the projecL. To in tegra te t r a in ing i n public heal th i n t o the bas ic t r a in ing of inrses; t o provide s ~ ~ p e r v i s e d p r a c t i c a l observation and experience f o r s-tiudent nurses i n -three selected undergraduate schools of nursing.

Assistance provided by WHO during the year. (a) Tvo public heal th nurses and a nurse t u t o r . two t;!elve-month fellowships f o r s t d y i n New Zealand; (c) &!plies and equipment.

Probable dura-Lion of assistance. Unt i l the end of 1963.

Vork done during -the year. Cuttack: The r u r a l and urban health programme was developed and continued sa t i s fac~Lori lg , although it was concerned almost e n t i r e l y rrith maternal and child- health. m he c ~ r r i c u l u m has been developed t o in tegra te thc public health concep-t i n t o a l l courses, and the students have.gained a good knowledge of general public heal th concepts.

A neTr pro:;reme r j f classroom iilstruc-Lion was s t a r t e d on 1 January. It i s planned t o continue the ins t ruc t ion throughout the three-year periou of general nursi. t r a in ing instead of giving it f o r n fell months only a t the end of Lhc f i r s t and t h i r d years.

A large numbcr of nursing s t t i f i and student nurses attended the All-India Tuberc:ulosisChest Workers' Conference held a t the Medical Colle,l;e Hospital, Cuttack, irm 31 January t o 3 February 1961. Two nurses took par-i i n a penal discussion.

e: The -duca'tional programme tit Nagp~u' has been improved. A blo,:k system of ins t ruc t ion vas devcloped with good p r m i s c . This makes a s s i ~ m n - t of s tuden t s ' in to t h c pcblic heal th f i e l d more cer ta in .

Co-ordination betireen the nursing service and the teaching facul ty vhich i s being brought about -through monthly meetings of the combined nursing services and teaching 'staff i s good.

A nevr c lass of Z 5 students !(as ~cuni t ted i n November 1960, bringing the i o t a 1 nvmber of general inrs ing students t o 175.

Simla: A WHO pvklic health nurse has becn recrui ted and i s e x p f c ~ e d - t o be i n pos i t ion i n S M a by the end of July.

India 100 R

Dental H ~ ~ l t h ( j u l y - ~ u g . 1956; March 1960 - )

Aim of the projecx. To improve the stcndard of teaching i n denta l colleges.

Assistance provided by I.BO during the year. - TGro twelve-month fellowships - one f o r s tudyin Austral ia and New Lealand and the other - f o r study i n Aus.iralia.

Probable durat ion 02 assistance. Un-ti1 the cmple t ion of the fellowships.

India 101 R

Trachoma P i l o t Project ( ~ e b . - m y 1956; Oct. 1956 - )

Aim of the project . ( a ) To develop an i n i t i a l programme f o r a mass campaign against communicable eye disecnes, through primary heal th centres and sub-centres, i n S t a t e s illere these diseases present a major public healch problem; ( b ) t o give add i t iona l t r a in ing i n con-irol measures t o ophthalmologists, general physicians and nurses, i n order t o s-rdize meLhods of e m i n a t i o n , Ciagonosis and treatment; ( c ) t o introduce a-i a l l l eve l s ?. progressive programme of heal'ih education, and (d) t o plan fu r the r prcc-Licoble expansion of the project .

Assistance provided by t.BO during the year. ( a ) A trachomatologist; (b) two three-month fellowships f o r study i n the United Kingdom, . , France, Algeria, Tunisia and Egypt; ( c ) supplies and e q u i p e n t .

Probabld durat ion of zssistance. Un-ti1 the middle of 1962.

Work done during the year. Alrter there had been considerable dclnys i n c a r r y i w out the plans f o r e;:pcndiny; t h i s programme, chief ly due - - t o administrative d ik f icu l t i e s , f i e l d nct iv i - t ies rrere s t a r t e d i n f i v e S ta tes i.e., Rajas-then, Punjab, Uttar Pradesh, Bihar end Madhp Pradesh. I n aadit ion, con-trol c lc t iv i t ics i n three community development blocks of the StaLc of Gu;erct, were s t a r t ed . A t the f i f t h meetine of the Advisory Commit-teefor t h e p r o j e c t held i n May i n Chandigarh it was recommended t h a t -the Central and S ta te G o v e r m n t s should z l l o t addi t ional funds from t h e i r budgets -to expand the a c t i v i t i e s so t h a t they might cover, during the Third Five-Year Plan period, a population of abouh 1.3 mil l ion i n the areas mos-i affected.

s E A / R c ~ ~ / ~ Page 100

India 103 Nationcl Tuberculosis Programme TA 10ct . 1956 - Oct. 1957; Nov. 1957 - ) UNICEF

A i m of the project . To st 'dy,glm and carry out from the National mberculosis Inst i tute , model urban and rura l tuberculosis control programme suitable for application throughout India and based on epidemiological findings and f i e l d research; t o t r a in personnel for the control programmes t o be s e t up i n each of the f i f t een States and 380 Dist r ic ts of India.

Assistance provided by WHO during the year. ( a ) Four medical officers, a sociologist, a laboratory scient is t , an x-ray engineer, two s t a t i s - t ic ians and three public health nurses; (b) a short-term consultant;

an eight-month fellowship for study i n Czechoslovakia; supplies and equipment.


Work done during the year. The National Tuberculosis Ins t i tu te was inaugurated (by the Prime Minister of 1ndia) on 16 September 1960, by vhich time a l l sections of the Inst i tute , except bacteriological section, were i n working order. The f i e ld arms of the In s t i t u t e had been undertaking f o r mny months the work planned for them.

It i s d i f f i c u l t i n a short annual rcport of t h i s nature t o do justice t o the work of t h i s uroject, which compi-ises several individual programmes, each onc scparate but co-ordinate. %e mutual objective i s that of finding and proving the m s t e f f ic ien t and economical approach to tuberculosis control under the exist ing conditions and within the mai lab le resources of India and t o t r a in a l l categories of he:lth personnel needed for the key posts i n a country-wide programme.

Thus, within t h i s project i s

( a ) an epidemiological programme, i n which two national epide~niological teams for survey work have already been trained. The epidemiological un i t provides the essent ia l basic knowledge and periodic assessment needed f o r guiding and tes t ing the f i e l d apparatus. During the year the uni t has completed a baseline suyvey of 34 792 persons for the rura l p r o g r m e ; it has finished a resurvey of f i f t een vil lages which had been covered eai-lier by the Nztional Sample Survey of 1956 and a longitudinal survey of a population of 80 000 in three taluks, s tar ted i n May 1961 :

S E A / R C ~ ~ / ~ Page 101

(b) a m r a l control j?rogxmue, in which the opera- t ional components of various approaches t o case- finding and of dif ferent methods of providing t reat- ment services can b t systematically tested 2nd assessed. Welve protocols were prepared t o guide the work, and by the end of the year undc;" review the case-finding p r o g r m s r r i l l have covered a population of about 120 000,

(c) an urban control proBramne, with a model "State Tdberculosis Control Centre", which s ta r tcd t o function in November 1960; the urban p r o g r m e studying opera- t ional methods in an urbm cornunity i s s teadi ly expanding, and, with the co-operation of the Bangalore Municipal Corporation, f ivc sub-centres for case- finding and treatment wi-re opened i n the c i t y i n May 1961;

(d) a sociological studies programme, which i s closely linked with thc ru ra l and urban control progranunes. The sociological uni t hes completed studies on conimuity and individual awarencss of tuberculosis, on causes of defaulting from tiizatnent, on drug acceptabil i ty and on the economic effccts of tuberculosis,

( e ) a BCG assessment programme, the all-India BCG assessment team completed the work of re tes t ing the - -

mass cnnrpaign-vaccinated groups in four States, made a two-year follow-up study of tuberculin a l lergy i n vaccinated and unvaccinated schoolchildren, trained 36 technicians from ni.ie States, and carried out a comparative study of stock solutions of RT 23 nnd RT 22.

Serving a l l these programmes are the S t a t i s t i c a l Section, the Bacteriological Section and the X-Ray Engineering Unit of the National lUberculosis Ins t i tu te . The Statistical Unit has the responsibil i ty for processing and analysing a l l the material from the f i e l d programmes and has produced several most valuable reports; a f i r s t d ra f t of an cpidemetric node1 t o depict the epidemiological s i tuat ion of kberculosis a lso was prepared. After considerable delay the laboratory of thc Ins t i tu te has been provided with a l l essent ia l services, md sincc March 1961 the Becteriological Section has been able t o accept a l l the work required of it.

Since i t s establishrent i n 1959, the Ins t i tu te has provided training for various categories of pcrsomel, but the long planned fo rm1 training courses for d i s t r i c t tuberculosis control teams i n a l l the States throughout Iildia s ta r ted only i n May 1961 as soon es the necessary hostel accormnodation had been provided. The f i r s t course w i l l l a s t s i x months.

SEA/~c14/2 Fage 102

The seniol- TXO of f i ce r l e f t tilc projec t i n Janaury 1961 on another assi,-nmcnt; 3f the th reepub l ic healthnurses, one resi[;ncd i n January and clnot;:zr most unfortuna.lcly died i n January 1961. Recruitment f o r thcsc: posts i s undcr way.

India 106 Public Hcnlth Programme, Rzjasthnn 7 I m r c h 1.959 - March 1961)

UNICEF

A i m of the projcc-L. To expand hcalth servi e s i n community development nrec,s and t o t r a i n personnel; t o organi . :~ ot,her r e la ted r u r a l heal th services f o r integr8.tion in to t h e community dcvelopmen-t programme undcr the Second Five-Year Plan.

Assistance providcd by i.0 during the year, A public heal-bh oi'ficcr and a public heal th nurs?.

Work done. 'The WHO projec-t s-i~iff , with headcI&ers i n J ~ i p w , zontinued t o a s s i s t t l l e Health Directorate i n the d e v e l o p n t of the programme ;.nti in the upgrading ox' i n s t i t u t i o n s se lec ted fo r UNICEF ass is tance undcr the subsidiary plan of operations. Assistance was given t o the Department of Freventivc and Socia l Medicine, J a i p r Medical College, i n the betterment of heal th services and t o the Nnila r u r a l t r a in ing centre i n the improvement of f a c i l i t i e s . Thc team co-operated j.n the organization of an or ienta t ion t r a i n i n c coursc fo r primary hcnlbh centre mcdicnl o f f i c e r s which was p l ~ n n e d t o s t a r t i n August 1361.

The public heal th nurse a s s i s t e d i n t h e organization and conduct of or ienta t ion t r a in ing cour:;es f o r nurse-midwives, 2nd i n the t r a in ing proGrmi? a t Jaipur f o r amil - iary nurse-midwives.

A s s i s t a n c ~ -Lo ih i s projec t was tenainated on j l Markch 1951, and the two FmO team members were re-assigned t o o ther posts.

Evaluation: During the period of the team's assignment the re grew up e c lec rc r understanding of t i x aims and objects of the proe; rme including the need f o r the cst~.blishment of c, proper1.y integrnted heal-th service anu i t s requirements. Thc recruitmen'c of medical, pare-mcdica1,cuxiliary nursing arid other personnel a l s o gained - and is s t i l l gaining - momentum.

S F A / R C ~ ~ / ~ Page 103

Indiz 107 Fublic Health P r o g r m c , Punjab R ~ R C . 1958 - ) UNICEF

Aim of the projec t ; To expand heal th services i n community development areas and t o t r a i n personnel; t o organize other r e l a t ed r u r a l heal th services fo r in tcgra t ion i n t o t h e community development programme under the Second Five-Year Plan.

Assistance providcd by "H0 during t h e year. A public heal th of f icer , a public heal th nurse and n snni tar icn .

Probable durat ion of assistnnce. Unt i l the end of 1962.

:iork done during the yeer. Considerable progress rlns again made i n t h i s projec t during the year under review. The IJHO team, s ta t ioned i n chandigarh, a f t e r having moved from P a t i a l e i n ~ebruaiy 1960 ass i s t ed i n the development, organization rnc' conduct of or ienta t ion t r a in ing courses f o r primary heal th cent rs medical o f f i c e r s which w c r c s t a r t e d i n November 1960 a t t h e Bhadson, Verka and Nilokheri t r a i n i n g centres.

The public heal th nurse helped t o conduct t r a i n i n g courses f o r t e 2 C h i n ~ s t e f f e L a u x i l i r r y nurse-midwife t r a i n i n g schools. Five new schools have bczn opencd. She a l s o a s s i s t i d with the in tegra t ion of public hecl th i n t o the bcs ic nurse t r a i n i n g programme a t Rajendra Medical Colleg, Hospi-tal.

A IN0 san i t a r i an joined the t c m i n Jonunry 1961. Hc xras primari ly concerned - r i th thc training o r sani-cnry inspectors 2nd a l s o with public hea l th o r i en ta t ion t r a i n i n g of primary heal th cent re medical o f f i ce r s . The school f o r sen i t a ry inspectors a t lGzrnal was t ransfer red t o Chondigrrh.

The WHO public heal th o f f i c ~ r completed h i s work cnd rras t ransfer red from Punjab i n May 1961 on o spec ia l a s s i g m n t t o the Regional Office.

India 108 Health Education, S ta tes of Bombay, U t t e r Pradesh, TA Bihar and Two S t n t ~ s Undesignated

(Mnrch 1958 - )

Aim of the projdct . To bui ld up t h c heal th education bureau i n thc S t a t e Directorates of Public Health m d p i l o t demonstration cad f i e l d t r a in ing areas; t o teach heal th education t o public hea l th personnel and others.

Assistance provided by FRO d u r i n ~ thc ycar. ( a ) Two heal th educators - 'one f o r t h e S t a t e of Ut tar Pradesh and one f o r Bihor: (b) a twclve- , , , month fellowship fo r study i n t h e United S t a t e s of America; (c) supplies and equipment.

Probable durat ion of assistance. About -t-vro years f o r each Sta te .

Work done d u r i m the year. Bombay: WHO assis-tance t o t h e S ta te of Bombay rras completed a-t t h e - end of January 1960. The S t a t e Health Education Bureau continued t o function i n Nagpur, which, a f t e r the b i furca t ion of Bombay S ta te , i s included i n t h e new S t a t e of Maharasli-Lra.

Uttar Pradesh: I n i t i a l l y t h e work 0.1 -:he WHO hea l th educator i n Uttar Pradesh vras divided between the Pl-anning, Research and Action I n s t i t u t e and the S t a t e Health Education Bu-eau u n t i l experience d ic ta t ed t h a t it was preferable t o concentrate ass is tance on t h e Bureau.

V i s i t s riere made t o various t r a i n i n g centres t o a s sess the methods used, and a study of heal th education programmes i n a l l public hea l th d i s t r i c t s was undertaken with t h e aim of obtaining a f a c t u a l bas i s f o r p l a n n i q . It was a-t-tempted t o gear t h e work towards the a t t a i i m n t of long-term object ives. Assistance was given i n the use of heal th education approaches i n a p i l o t smallpox e r ~ d i c a t i o n pro jec i , and heal th education '.ms included i n a f our-veek t r a i n i n g course f o r vaccinators. Subsequen-Lly, an evaluat ion of heal th education me-thods i n the smallpox eradica t ion projec t was attempted.

Training of a l l categories of health workers i n heal th education was ~ i v e n major a t t en t ion : the inclusion of hea l th education i n o r i en ta t ion cowses f o r medical o f f i ce r s of primary heal th centres, the development o; a health education manual f o r r u r a l workers, and f i r s t s t eps toward the in tegra t ion oi' heal th educa'cion i n t o the undergraduate niedical curriculum of -the K.G. Medical College, Lucknor<.

A Projec-t Ad-visory Committee, composed of representa t ives of the Health Dircc Lorate, Planning, Research and Act ion I n s t i t u t c , K.G. Medical Collc::~, Department of Education, and the Health Education Bureau was crcil-keel and forms 3 usefl~l . mechlism f o r co-ordinating heal th education work. The establishment o r t h e Bureau i n accordance with the reconm~cnda~,ions of the Ccn.t~:ol Health Education Bureau has been sanctioned, bi>-i recruitincnt -to a l l . Lhc vacant technica l posi;s has not been comnleteii.

As v i t h o-ciie~. i ~ c a l t h education ~!r.iLs, the Bure nu d i rec ted much e f f o r t t o the planniri:; and c::hibiti,:>n ol" clisplays i n conr~cction rrith the Fourteenth Wor1.i: IIcalth Assemb:.y.

Bihar: A WHO heal-tl. ducator was assigned -to tho Health Education - Bureau i n B i h a r e a r l y i n 1961. The Head of the Bureau was appointed. a s na t ional covnterpnrt. Recruitment -Lo br ing the s taf f of the Bureau t o =nctioned s t rength i s i n t r a i n .

Work was l a r z c l y devoted t o constructing t r a i n i n g prozr~ammes fo r various categories of health and s o c i a l workers. An in-service t r a in ing course f o r malaria off icers ms arrcnged. Discussions were held with a view t o including health education i n the undergraduate medical curricuJm. The d e s i r a b i l i t y o i undertaking heal th education of the community a t the peripheral l e v c l through general public heolth s t a f f , r a t h e r than through special ized :rorkers performing no other service, was stressed.

Effor ts .lere made t o producc health education material and t o prepare f o r exhibit ions and heal th weeks. The Bureau a l s o contributed t o displays i n associat ion with the Fourteenth World Health Assembly.

India 110 Nursing Advisers t o S t a t e s (Madhya Pradesh, Madras and TA Funjab

P C 1 9 5 7 - )

Aim of the project . To organize and expand nursing education and nursing services i n the three s t a t e s <and t o co-ordinate supervisory services so as t o ensure uniformly high s-t,andards of nursing and midwifery i n t h e i r heal th programmes.

Assistance provided by !.THO during the ycar. (a) Two nursing advisers; '(b) two twelve-month fellowships f o r study i n New Zealand.

Probable durat ion 0.1 assistance. About three years f o r each State.

Work done durin;: the year. Madhya Pradesh: Encouraging progress rms made i n t h i s programme. The public heal th in tezra t ion and short--tcim teaching courses progressed sn.l;isfac.torily i n most d i s t r i c t s . ~ u r s i n g education programmes i c r c rcviewed. The pr inciple of having nursing education committees i n n l l schools of nursing was acccpted and such comrnl-t-tccs have received d i ' i c i a l support.

The WHO nursing adviser assisLed the nursing s t a f f of the lady Hardinge Medical College and Hospital, New Delhi, i n o r g a n i z i x and conducting an a l l - Ind ia refresher course f o r nursing superintendents i n November (see India 98).

Madras: Progress has been qui te s,?-Lisfactory. On re tu rn from study =the nat ional countcrpart t o t h c 'dHO nursing adviser was appointed Assistant Director of Health Services ( ~ u r s i n g ) .

Duties and respons ib i l i t i e s f o r nursing posi t ions have been defined and aeli.::atcd. The managememi; of a l l nursing matters ;?as vested i n the Ass i s t a r t Director, Health Services (~ursir~g).

Ten new matrons were appointed i o vacant posi t ions i n the nursing service of Madras Sta te .

India 111 R

Medical Education i n Non-clinical Subjects (Dec. 1958 - )

Aim of the project. To improve the teaching of non-clinical subjects i n the medical courses of the rapidly expandingCmedical colleges i n India by providing experienced professors and by awarding fellowships t o enable teachers t o widen t h e i r knowledge and experience.

Assistance provided by WHO during thc year. Two twelve-month fellowships - one for stud!, i n the United Kin~dom and the other for study i n & m e , the unite; Kingdom and the ~ G i t e d States of I ~ ~ c r l c n .

Probable duration of assistance. Until 1963.

India 114 Pacdiatric Education and Services* R TAW. 1956 - Aug. 1959; May 1961 - ) UNICEF

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics i n a number of medical colleges.

Assistance provile3 by !a0 during t h c year. A professor of pacdiatrics for9arojiniNaidu Medical Collcge, Agra.


Work done during the year. I n s p i t i of the absence of international s ta f f i n the Paediatric Department of Tri'ciandrm Medical College,

7 ,

the project has developed sat isfactor i ly .

In Agra, the Government has made a l l appointments t o which they were committed, and some of the peripheral paediatric centres were upgraded pr ior t o the a r r iva l o r the WHO v i s i t ing professor of paediatrics i n May 1961.

Since joining the project, the WHO professor has made good progress i n establishing working relationships with loca l personnel, with whom problems confronting the Paediatric Department have been discussed a t length. He has also made recommendations t o the appropriate authori t ies for furthering the objectives of the project.

India 11> R

Fellovships

Nutrition: A three-month fellowship for study i n the United States of America, Japan, ;iols Koly: and the Plilippincs.

*Previous t i t l e : Pacdiatric Education

Health Education: A six-month fellowship for study in the United States of America.

Nursing: An eight-month fellowship for study i n New Zealand and Australia.

Biochemistry: An eleven-month fellowship for study i n the United States of America, the United Kingdom, France and Belgium.

Leprosy Control; Three fellowships of f ive and a half months for study i n Nigeria, Uganda, the Philippines, Hang Kong and Thailand.

Health S t a t i s t i c s : A four-month fellowship for study i n the United Kingdom.

Anatomy: A twelve-month fellowship for study i n the United Kingdom.

Ph siology: A twelve-month fellowship f o r study i n the United * Sanitary Engineering: A twelve-month fellowship for study i n the United States of America.

Production of ficczc-r:alcd Sr~?.LI.pox \r?rr:cchc: .A two-nonth fcllowsllil> - - * -

f-ed Kingdom.

Dentistry: A nine-month fellowship fo r study i n Australia.

Pharmacology: A twelve-month fellowship for study i n the United States of America.

Neuropotholcgy: A five-uonthfellowship for study i n the United Kingdom and Europe.

India 116 F~i!.r-,-.-:lips TA

Sanitary Engineering: An eight-month fellowship for study i n the United States of Amcrica.

Public Health Administration: Two seven-week fellowships f o r study i n the Union of Soviet Social is t Republics, Yugoslavia and dest Germany.

Paediatrics: A four-month fellowship for study i n Australia.

Vital and Health S t a t i s t i c s : A twelve-month fellowship f o r study in h e United States of America.

S E A / R C ~ ~ / ~ Page 108

Epidemiology: Two twelve-month fellowships f o r study i n the United Kingdom.

Health Education: A one-month fellowship f o r study i n the Union of Soviet S o c i a l i s t Republics.

Pest and Insect Control: Two one-month fellowships f o r study i n the Union of Soviet S o c i a l i s t Republics.

India 119 R

Bi lha rz ias i s Control, Bmbay (Jan. - March 1961)

Aim of t h e projec t . To study the nature and extent of t h e problem of b i l h a r z i a s i s i n t h e endemic foci i n Ra-Ldgiri Dis t r i c t , Maharashtra Sta te , and t o recornend con t ro l measures.

Assistance provided by WHO during the year. A consultant f o r s i x weeks.

Work done. The consult an^ s t a r t e d h i s survey i n Gimvi, Ratnagiri D i s t r i c t , i n January 1961. He completed h i s assignment by e a r l y March. The r e s u l t s of h i s survey indicate t h a t t h e disease is probably not confined t o one a rea only but it may occur i n a number of other foc i In India. He has submitted spec i f i c recommendations on.the epidemio- l o g i c a l s tudies t o be made i n the f i e l d and i n laboratory. The findings of h i s survey, along with the recommendations f o r fur ther s tudies and control measures, have been forwarded t o o he Government.

India I20 R

Health Educa-'ion C e r t i f i c a t e course, All-India I n s t i t u t e of Hygiene and Public Health, Calcutta ' ( ~ u n e 1 9 9 - )

A i m of the projec t . To teach heal th education principles, methods and pract ices i n order t o prepare s p e c i a l i s t s i n heal th education f o r key . - - - posts i n the country.

Assistance provided by WHO during the year. ( a ) A heal th education consultant f o r two months*; (b) f o r t y percent or" t r a v e l and subsistence allowance of s i x pa r t i c ipan t s i n the course.

Work done. I n order t o a s s i s t i n the second heal th education c e r t i f i - ca te course and t o follow-up the recommendations of previous WHO spec ia l i s t s , a heal th education consultant was assigned e a r l y

"Phis was o r i g i n a l l y provicled f o r under project India 118 "Health Education - All-India I n s t i t u t e of Hygiene and Public Health, Calcutta", which i s now being considered a s having been completed i n March 1960

i n 1961. She found tha t thc cdrtificc-be coui-se had devclopcd on sound l i nes and thc t the I n s t i t u t ~ had admirable practice f a c i l i t i e s and potcn t ia l i t i es for the further divelopmerit of health <ducation teaching. Conversion of the certifico.tc coursc t o a diploma course was under consideration, but t h i s advance Ins contemplated with due caution, It appeared tha t some strengthening of the teaching s tcff of the Ins t i tu te would be demanded beforc a f u l l diploma course could be tackled.

The consultant dr?w at tent ion t o Lhc possibly excessive demands on the academic s ta f f mdc by supervision of the production of health education m t e r i a l fo r use outside the Ins t i tu te and i n connection v i th a museum of limited valuc.

India 122 ,Issistance t o Specialized Depr tmnt s of Medical R Inst i tut ions

' (~ep t . - Nov. 1960; - )

Aim of the project. To demonstrate modern nethods of integrated teaching in selected medical colleges i n India.

Assistance provided by WHO during the year. :L team of three short- term consultants.

Probable duration of assistance. Until t he end of 1964.

Work done during the year. This p r o g r m e was carried out by a team of three short-term consultants in physiology, preventive and social rncdicine and therapeutics, Two centres were selected f o r t h e i r demonstrations - Osmanh Medical College, i n Hyderabad, and Calcutta Medical College. Demonstrations wdre a lso given a t neighbouring medical colleges i n Kurnool and Guntur i n Andhra Pradfsh, a t the N.R. Sirknr, R.G. Kar Mcdical Colleges, a t the National Medical Ins t i tu te , Calcutta.

Two types of integrated teaching were demonstrated: combined s taff presentation and studsnt-staff discussions. Discussions were held on co-ordination of teaching programmes.

The demonstrctions were much appreciated by students and s taff . The staff of thc Osmnia Medical College intend t o have further meetings t o make detailed arrangements for integrated teaching. I n Calcutta, the Vice-Chcincellor of the University indicated h i s readiness t o co-opcrate i n the introduction of integrated teaching in to the ntfdical colleges. Members of the s ta f f of one of the medical colleges i n Calcuttn have already h w n up a provisional programme .

Considering tk impact on studcnts and s ta f f of the midical colleges visi ted.by the WHO team, t h i s prograrmne was a success, although f i n a l judgement must be withheld u n t i l it i s known t o what extent the methods demonstrated and discussed are adopted.

SEA/Rc14/2 Page 110

India 131 T ~ L

Vita l and Health S ta t i s t i cs , West Bengal (Jan. - March 1960; m y 1961; -1

Aim of the ~ r o j e c t . To improve v i t a l and health s t a t i s t i c s scrviccs i n West Bengal by introducing techniques t o ensure thc accuracy and completeness of reporting, and by training personnel in the use of the new system, including coding of medic& diagnoses.

A A r . S t a t i s t i c t i equipment.

Probable duration of assistance. Until the car1 of 1964.

!?ark done d u r i q t he yeur. The Regional 'Wviocr in Health S t a t i s t i c s v i s i ted the project meL discussed problems in cod&l,n and processing of individual Uscharge fans, and in om3ysing and presentation of data.

A short-tern consultan$ is under rocru i tmnt for asslgrmcnt t o the project towards th, clla of 1961.

S t a t i s t i c a l equipxnt, consisting of ;~.cxhrzxLcc3 punches, v e r i t y p r , verifiers and t x > c plates was s u p p ~ c d i n ~ a y 1961.

India 133 Public ~ i a l t h P rog rmc , Orissa R (Fcb. 1961 - } mcEF

Aim of the project. To expand health services i n community development areas and t o t r a i n personnel; t o organize other re la ted -1 health services for integration in to the commmity devclopmcnt programme under the Second Five-Year P h .

Assistance provided by WHO during thc year. A public health off icer ' r @ a c health nurse.

Probable duration af assistance. Until the end of 1963.

Work done during the year. The public health officer and nurse arrived in Bhubanesr~~r during the f i r s t quurter of 1961. They have bcen engnged i n fcwil iar iz ing thcmsclves with the overall progr;unmc! and in selecting a suitable primary health centre for the development of public health or icntnt io:~ courses fo r prb~wy health centre uedicN officers.

M i a 135 Assistance t o the &wrtmnts of Paediatrics of R thc Three Medical Colleges i n Bonbax UNICEF -(my 1959 - )

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics a t the three medical colleges rant, S.G.S. in the K.E.M. Hospital and Topiwala) in Bombay.

SEA/RC14/2 Eage lll

Assistance provided by WHO during the year. Two paediatric nurses.


Work done during the-. After the departure, i n m y 1960, of the p e d i t r i c i a n formerly assigned t o t h i s project, a second paedictric nurse was assigned in September 1960.

Development a t the Grant Medical Collegc, including the establishment of a home v i s i t i y , service has been satisfactory, but in the other two colleges progress hns been slow for lack of sat isfactory accommodation f o r child patients.

I n April 1961 national counterparts for the two paedintric nurses were praridcd; three national public health nurses were a lso appointed t o strengthen three of the selected ten peripheral child health centres. The f i r s t of these peripheral centres began t o function from b y .

India U7 Assistance t o the All-India Ins t i tu te of mgiene and TA Public Health, Calcutta (Exchange of Professors1

( b y 1959; NOV. 1960; - 1

Aim of the project. To ra i se the stzndard of teaching in the Ins t i tu te .

Assistance provided by WHO during the year. A consultant i n public health f o r one week.


Work done durinc: the year. I n November 1960, a short-term consultant in public health spent a week a t thc Ins t i tu te and ass is ted i n thc course for senior public health administrators. Further consultant services and fellowships w i l l be provided.

India 142 Assistance t o the Dfpartment of Paediatrics, R Osmnnia Medical College erabbad U'NTCEF (Feb. - April 1939; ~ul; h 6 0 )

AJm of the pro,lect. To expand, upgrade and rqorient the teaching of p e d i a t r i c s a t Osmania Medical College, Hyderabad.

Assistance provided by WHO during the year. A short-term consultant i n biochemistry.

Work done. Most of the. xc t iv i t i es duriix the yc~m were conccn- t r t e d on the construction of z new lnrg- buil- t o house the o u t p t i e n t s ' d c p r h ~ n t , l ec ture r m s , 11~71th education s e r v i c ~

?.n& quarters for housc p l l y ~ i c i ~ n r . The b u i l i k q will be completad a d put i n to use bdforL t : ~ a d of the y ~ ? r .

A WHO consultant in biochemistry was provided f o r a period of three and a half months from the l a s t week of July 1960. She was successful i n establishing the f i r s t and only p e d i a t r i c biochemical laboratory i n the Region. Work, a f t e r her departure, continues sat isfactor i ly .

India 145 -R

Public Health Programme, B i h r (Jan. 1956 - )

UNICEF

Aim of the project. To expand health services i n community develop- 111ent areas and t o t r a i n personnel; t o organize other re la ted rural health services for integration in to the community d e v e l o p n t program2 under the Second Five-Year Plan.

Assistance provided by WHO during the ycar. A public health officer.


Work done during the year. The public health officer, i n Patna, ass i s ted i n the upgrading of ru ra l health services, and on the es tabl ishtent of primary health centres, r e f e r r a l hospitals and labaratories, and made proposals f o r the improvement of the s taff ing pattern of r e f e r r a l hospitals, which havc been accepted by the Government. He made asscssment of the s taff ing pattern, functions and working of the Bihar type of primary health centre in selected ccmmmity development blocks i n co-operation with the Health Dlrectarate.

He l e f t Bihnr on repatr ia t ion i n April 1961; h i s replacement a s well as a public health nurse arc under recruitment.

India 146 R

Public Health Programme, Uttar Pradesh (Jan. 1960 - )

Aim of the project. To expand henlth serviccs i n community develop- llaent areas and t o t r a i n personncl; t o organize other re la ted rural health services for integration into the community developnrnt programme under the Second Five-Year Plan.

Assistance provided by WHO during the ycar. A public hcalth off icer and a public hcalth nurse.

Probable duration of i s s i r t -ncur Until the )of 1963.

Work done during the year. T ~ L WHO t e r n continued the i r work on the r u r a l health services. the ~ u b l i c health nurse undertakjng studics -

i f auxil iary nursc midwifk tra&ng in various schools. A t 'a conference of ass i s tan t superintendents of these schools administrative and teachbg problems were considered. The team assisted with a seminar on ml health services f o r d i s t r i c t medical off icers of health of the ALlahabad region, and in the develapmnt of the Gosaingmj primary health centre f o r apprenticeship t ra ining of various categories of health personnel. Assistance was a lso given in public health orientation courses for primary health centre medical officers a t Sarojininagar near Lucknow. During the l a s t quarter of 1960 progress was seriously interrupted by the severe floods which inundated Lucknow and dislocated the work of the Directorate of Health Services.

The public health officcr w s repatr ia ted in Decenber 1960 3nd was replaced in April 1961. The emphasis of WHO assistance was al tered t o give pr ior i ty t o the development of a second public health orienta- t i o n training centre f o r primary health centre medical officers. An amendment t o the plan of operations giving effect t o t h i s has been submitted t o the Government of India.

Mia 147 R

Public Health ProgrMrrnE ,Kcrala [June 1960 - )

Aim of the project. To expand health scrvices in community development areas and t o t r a i n personnel: t o organize other re la ted ru ra l health services for integ&ition in to the conmiunity development programme under the Second Five-Year Plan.

Assistance provided by WHO during the year. (a) A public health officer, a public health nurse and a sanitarian; (b) supplies and e q u i p n t . Probable duration of assistance. Until the e d of 1963.

Work done during the year. After making n prelimim$ry study of the ru ra l health services i n the State, the team, loceted in 'Pivandrum, continued t o a s s i s t the Government i n preparing of plans for the developmnt of a public health nursing school. The public health nurse took part in a committee which w a s established t o prepare a SylLabu6 f o r the school. The public health off icer and the sanitarian helped with the t ra ining of vil lage leve l workers i n environmental sanitation a t the Greenfield centre, where groups of 25 workers were given one month's training.

The WO team continued t o a s s i s t with the estnblishmcnt of primary health centres and i n the upgrading of hospitals and labora- t o r i e s for r e f e r r a l purposes.

& April a decision was made t o use the Neyattinkara a c c o n b n health centre a s an orientation train- centre for primary health centre medical officers, and the WHO team assis ted in the development of the centre for t h i s purpose.

Public Health Prograrmne, lQsare (Jm. 1958 - )

Aim of the project. To expand health services in community development areas a d t o t m i n personnel; t o organize other related ru ra l health services f o r integration into the community developmnt pmgrmmr: under the Second Five-Year Plan.

Assistance provided by WHO during the year. and a public health nurse.

A public health officer

Probable duration of assistance. U a thc end of 1963.

Work done during the year. The public health nurse was assigned t o the project with headquarters i n Bangulore, i n December 1958. The public health officer joined in July 1960 and mde a preliminary study of the rura l health services. They ass is ted the Government i n the developmnt of t ra ining f n c i l i t i e s in the State and i n planning the development of Shimoga Demonstration Dist r ic t .

Eight schools f o r t ra in ing auxil iary nurse-midwives and a second t ra ining school for sanitary inspectors were established during the F a r . Orientation t ra ining courses f o r prinary health centre medical off icers were held ear ly in 1961.

Staff shortagcs, however, hindered thc imp1emcnta;tion of the objectives of the project.

India 149 Public Health Programme, Madhya Pradesh R (WY 19% - 1 -JNICEF

A i m of the project. To expand health services in community development areas and t o t r a i n personnel; t o o r s n i z e other reluted ru ra l health services f o r integration into the cornunity development p r o g r w under Second Five-Year Plm.

Assistance provided by WHO during the year. A public health off icer , a public health nurse, a public health nurse midwife and a sanituricm.

Probable duration uf assistance. Until the end of 1963.

S E A / R C ~ ~ / ~ Page 115

Work done during t h ~ year. Progress during the year ms m i n l y i n the f i e l d s of nursing and environmental san i t a t ion and i n t h e establishnen'c of p r i m r y heal th centres. Public health or ienta t ion courses Tor nurse-midwives wcrc continued a t Gwalior, where the WHO nurses a l s o ass i s t ed i n the domiciliary and f i i l d t r a in ing of aux i l i a ry nurse- midwives and ref resher t r a i n i n g of midwives. They a l s o advised the Curriculum Phnn- Committee on the work of in tegra t ing public heal th i n t o the basic nurse t r a in ing syllabus a t Gwalior, and on the development of the t r a in ing p r o g r m e .

The public heal th off icer located i n Indore, helped the p r i n c l g l s and professors of preventive and s o c i a l medicine of the medical colleges a t Bhopal, Jabalpur and Indore i n planning the development of t h e i r respective f i e ld - t ra in ing areas.

The t r a i n 3 . I ~ schools f o r san i t a ry inspfctors a t Rewa and Gwalior continued t o work s a t i s f a c t o r i l y w i t h the help of the WHO sani tar ian , who a l s o ass i s t ed in the development of a f i e l d t r a in ing arca f o r the Rcwa school and i n the planning of a l a t r i n e construction programme in selected community development blocks.

India 150 Public Health Programme, Maharashtra* TA 7 ~ a n . 1958 - ) UNICEF

Aim of the project . To expand health s e r v i c i s i n the community development areas and t o t r a i n personnel; t o organize other r e la ted r u r a l health services fo r in tegra t ion in to the community development programme under the Second Fivc-Year Plan.

Assistance provided by WHO during the ycar. A public heal th o f f i ce r and a public heal th nurse-midwife.

Probable durat ion of assistance. Unt i l t h i end of 1961.

Work done during the year. Bombay S ta tc was b i furcated i n t o Maharashtra and Gujerat S ta tes on 1 May 1960. The WHO team, stat ioned i n Poona, continued t o work mainly i n the new Maharashtra Sta tc , but during the l a t t c r part, of t h ~ ycar arrangements were made f o r them t o v i s i t Gujcrat Sta te , a s an interim measure, pending the assignment of a separate Leam f o r t h a t S ta te .

Orientation t r a in ing courses f o r primary heal th centre medical o f f i c e r s continued a t Nagpur. Progress was achieved in or ienta t ion t r a i n 3 . I ~ of nurse-midwives, t r a i n i n g of aux i l i a ry nurse-midwives and ref resher t r a in ing and or ienta t ion of midwives. Field t r a in ing of public heal th nurse students continued sa t i s fac to r i ly .

*Previous t i t l e : Public Hcalth P r o g r m e , Bombay

sEA/~c14/2 page l l 6

Shortage of medical off icers t o man primary health centres and other public hcalth services i n Maharashtra State bccame more pronounced during tnc l a t t e r pa r t of 1960, and the Government decided t o appoint Ayurvedic pract i t ioners and l icen t ia tes not holding qualif ications recognized by the Indian Medical Council t o primary health centres, including some which have received UNICEF assistance.

The public health office? continued t o a s s i s t t he Government with the upgrading of r e f e r r a l hospitals and laboratories.

India 151 R UNICEF

hibl ic Health P r c g ~ a z ~ e , Andhra Prsdesh -.- -(~an. 19% - Mrch 15)bl; - )

Aim of the project. To cxpa~d health services i n community development areas and t o t r a i n person,?l ; to organize other related ru ra l health services f o r integration in to chc cornunity development programme under the Second Five-Year Plan.

Assistance provided by WHO during the Far . A public health officer, -- a public health nursc, a public ncalth nurse-midwife and a midwife tutor .

Probable duration of assistacse. Until the end of 1963. -- Work done during t h e ~ . The public health officer, stationed i n Werabad, continued t o a s s i s t the G o w m n t with the general development of the programe . -

In August 1960 a course leading t o the Diploma in Public Health was star ted a t Osmania Medical College, Hyderabad, with twelve post- graduate s t d e n t s . Plans were a l so developed f o r the establishment i n Hyderabad of a diploma cmvsc i n public health nursing.

The WHO nursing team a t 'Jisakhapatnam continued the i r assistance t o the integration of public h ~ l t h in to the basic nurse t ra ining programe, the teaching of nidwiCery t o studeht nurses and the training of auxil iary nurse midwives. A fourth all-India s i s t e r turors ' course on the integration of public he-1th into the basic nursing prograrmne was conducted a t Visakhapai;rL,am (see India 98).

A public healch o r l e n t a t i ~ k course for primary health centre doctors was s tar ted a t Patanc:r.er-.I ru ra l training centre. Public health orientation training for nurses was stopped as national s ta f f were generally not available f o r ser-vice i n rura l areas.

Plans f o r demorst,ration ci is tnctf i a t Guntur and Kurnool were prepared and sent to the G a e r m n t During the first quarter of 1961 d i s t r i c t conferences on commun~t.y heaith development were held, and,

ar is ing out of the reports of these conferences, a stat-nt of general conclusions was prepared. This statement covered a l l aspects of the development of health servicrs i n c m u n i t y development areas.

In Mrch the Public Health Officer completed h i s contract and was repatriated, and the three nurses a l so l e f t Visakhapatnam, where t h i s part of the project was considered as terminated. Toward the end of June a public health nurse was assigned t o Hyderabad. A r e p h e r e n t f o r the public health off icer i s being recruited.

India 152 Public Health P r o g r m , Assam R (Jan. 1958 - 1 UNICEF

Aim of the project. To expand health services i n canmunity development areas and t o t r a i n personnel; t o organize other re la ted ru ra l health services for integration in to the community developmfnt programw under the Second Five-Year Plan.

Assistance provided by WHO during the year. A public health officer, two public health nurses and a smi t a r i an .


Work done during the year. The public health officer, stationed a t Shillong.continued t o a s s i s t the fur ther development of the programme. A t the jissam Medical College, Dibrwarh and a t the Rural ~ r a i n i & Centre, Chabua the nurses assisted i n the integration of public health into basic nurse training. Public health orientation t ra in& courses f o r medical officers, nurse-midwives and auxi l iary nurse-midwives were conducted a t the Chabua centre. The sanitarian cmtinued t o take part i n the t ra ining of sanitary inspfctors a t Chabua. The course wss extended t o cover one f u l l year with a rcvised syllabus of training.

Although there was no marked shortage of trained s t a f f , progress i n the development of the programme has been slow, largely because of the need t o provide adequate physical f a c i l i t i e s . Plans were made t o overcome the physical short-comings of the p rog rme .

Thirty-eight sanitary inspectors ccmpleted t h e i r t ra ining course i n September; of these only twenty-four graduated. A further c lass of 30 students s tar ted t ra ining i n April 1961.

India 153 MESA

Wla r i a Eradication ~ A W . 19% - 1

Aim of the project. To eradicate malaria from the whole country.

Assistance provided by WHO during the year. ( a ) Two assessment teams, consisting of two mlar io log is t s , an en-tomologist and four laboratory technicians; (b) payment of cost of t rave l and per diem of malaria workers attending the annual malaria conference held in Eiyderabad; ( c ) reimbursement of t r ave l and transportation charges of national personnel worbing i n int.er-state organizations; (d) two t rave l fellowships - one of two months for studies i n South American countries and the United States of America, and one of three months i n Ceylon, Greece, Romania and i n cer ta in South American countries; ( e ) supplies and equipment.

probable duration of assistance. Until the end of 1968.

Work done during the year. The malaria eradication programme i n India continues t o make sat isfactory proQ;ress. A l l 390 malaria units, . - - each responsible for the protection of a million people, are now functioning. In 1960-1961, the strength of f i e l d s ta f f for spraying operations was increased in a l l units . Surveillance operations have been s tar ted i n 340 units. Epidemiological data'have shown a considerable overall reduction i n spleen and parasite indices throughout the country, and the same applies t o the proportional case-rate of malaria, which has come down by 86$ during 1960-1961 as compared with 1953-1954. In Madras State, an examination of nearly 120 000 blood s l ides over a ten-month period shared the presence of malaria parasites only i n 12 cases; of these, only one was due t o loca l transmission.

In November 1960, a meeting of entomologists was held a t the Malaria Ins t i tu te of India, where, the problems ar is ing out of the reported resistance in A.culicifacies t o DDT in Gujerat and Maharashtra States were discussed and recommendations made t o deal with the si tuation.

With a view t o co-ordinating the a c t i v i t i e s in border areas, conferences were held between the national au-thorities i n charge of the programme and representatives of Pakistan, Burma and Nepal. Meetings were a l so he ldwi th the representatives of tea es ta tes , railways, and ccal-f ie lds t o provide be t te r co- ordination in the campaign, within the country. The annual meetings of malaria and f i l a r i a workers were held in Hyderabad during December 1960; WHO was represented by two officers from the Regional Office and some of the f i e l d s ta f f i n the country .

The t ra ining programes in the Malaria Ins t i tu te of India, regional co-ordinating organizations and s t a t e t ra ining centres have been very effective.

The two WHO Assessment Teams stationed in Bankura and Baroda have completed the i r assignments and have now been s p l i t up into malariological and entomological sub-units; the malariological uni ts are in position a t Darbhanga ( ~ i h a r S ta te ) and Belgaum ( ~ y s o r e s t a t e ) ; one of the entomological uni ts i s i n Gujcrat State, continuing furbher investigations on A.culicifacies, and the other w i l l be i n Margeritha (Assam s t a t e ) as soon as the entomologist recruited f o r t h i s unit arrives.

India 158 R

Teaching of Psychiatry in Medical Colleges (Dec. 1959 - March 1960; Dec. 1960 -

A i m of the project. To study the undergraduate teaching of psychiatry in selected medical collcges and t o recommend improvements.

Assistance provided by WHO during the year. A twelve-month fellowship for studv in the United Kinadom. (The fe l larshiu was amrded a t the .- - " - A

end of 1960, but thc fe l lau w i l l be able G O proceed for study only in September 1961).

Probable duration of assistance. Until the completion of the fellowship in September 1962.

India 159 Conference on Auxiliary Personnel in Sanitation, NewDelhi R 727 - 31 Dec. 1960)

Aim of the project. To bring together responsible public health of f ic ia l s i n charge of teaching and t ra inin2 of sanitation personnel from different parts of India t o analyse present developments in rura l and urban sanitation work and t o determine the basic needs in auxi l iary personnel for t h i s work i n future.

Assistance provided by Mi0 during the year. A consultant for three months.

Work done. This conference was held in New Delhi from 27 t o 31 December 1960, with the participation of delegates from fourteen States of India, the Central Directorate-General of Health Services, WHO environmental sanitation personnel, different ins t i tu t ions of India and b i h t e r a l agencies interested i n the problem of t ra ining and u t i l i za t ion of auxil iary sanitation pcrsonncl in the country. A consultant was provided by WHO t o a s s i s t w i t h the arrangements for the Conference.

The Conference attained i t s purpose and a se r ies of practicable recommendations was made.

The principal recommendations of the Conference were for :

(1) A uniform designation for f i e l d health workers;

2 An additional health inspector in svery primary health centre exclusively for environmental sanitation work;

(3) Establishment of fu l ly developed training ins t i tu tes in cvcry Sta-tc;

(4) A standard curriculum for training health inspectors i n the whole country;

(5) Training t o be extended t o a miniL~um duration of one calendar ycar, including three months of intensive pract ical training;

(6) ~ln adequate career service;

(7) Prwision af refresher courscs and in-service training;

(8) Enactment of sanitary legis la t ion i n each State, based on the Mdcl Public Health Act, 1955.

The repori: of the Conference has been widely distributed.

India 160 Radiation Protection 7 n o v . 1960; - 1

Aim of the project. To provide theoret ical and pract ical orientation i n t he hazards associated with x-ray insta l la t ions i n hospitals and other medical ins t i tut ions and i n the measures necessary for individual and public protection.

Assistance provided by WHO during thc year. (a ) Half the cost of t rave l and per dien of fourteen participants i n the course on radiation protectiar? held in Bombay.

Probable duration of assistance. U n t i l 1961.

Work done during the ycar. A WHO-assisted t ra ining course on radia- t i on protection, designed for medical administrators, was held i n Banbay a t the Atomic Energy Department from 7 t o 28 Nwember. It ms attended by fourteen medical administrators, radiologists and teachers frm different par t s of India.

The Regional Public Health Officer trttended the opcning session. The main part of thc instructions was undertaken by the s ta f f of the D e p a r t ~ n t . The Chicf, Radiation and Isotopcs, WHO Headqunrters, assisted during the l a s t week of the course. He also displayed a useful sound colour f i lm "Radiation: Physician and Patient" of 45 minutes running time.

It is proposed t o hold another course in the last quarter of 1961.

Prodoction of Diphtheria, Pertussis and Tetanus Vaccines 't~an. - March 1961: - I

Aim of the project: To establ ish a u n i t fo r the production of vaccines ldiphtheria, whooping cough and tetanus) a t the Central Research Inst i tute , kasauli.

SEA/Rc14/2 Page l.21

Assistance provided by WHO during thc ycar. ( a ) A consultant f o r six weeks; ( b ) two fellowships of one and a half months f o r study i n the United Kingdoln.

Probable durat ion of assistance. Unt i l 1962.

Work done during the year. The consultant took up h i s dut ies a t the Central Resecrch I n s t i t u t e , Kasauli, towards the.end of January. He worked c losely with t h e Director of the I n s t i t u t e and h i s s t a f f , with whom he discussed the production, t e s t ing , storage and applicat ion of the three separate vaccines and t h e i r combination as a t r i p l c ~ c c i n e . Hc dcmonstmted, i n d e t a i l , methods of vaccine production and drew up a list of equipment and chemicals necessary f o r production of diphtheria, pe r tuss i s and tetanus vaccine. H i s report has been sent t o the Govermwnt.

Steps a rc being taken t o arrcnge f o r a medical o f f i ce r of the I n s t i t u t e t o spend three months on a WHO fellowship, s t a r t i n g i n September 1961, c t an i n s t i t u t e where these methods a re i n use, and fu r the r consultant scrvice may be provided ncxt year.

India 175 Public Health Progranmc, Gujerat TA 7 ~ u l y 1961 - ) UNICEF

Aim of the project . To expand heal th services i n community development areas and t o t r a i n personnel; t o organize other r e la ted r u r a l heal th services f o r in tegra t ion i n t o the cornunity development p r o g r m e under the Second Five-Year Plan.

Assistance provided by WE0 during the year. A public health nurse.

Probable durat ion of nssistanci . Unt i l the end of 1963.

Work done during the ycar. The WHC public heal th nurse reported f o r duty only i n Ju ly 1961.

India 176 Assistance t o Central Public Hcalth Engineering R Rcsenrch I n s t i t u t e , Nagpur UNSF IFeb. 1961 - )

A h of the project . To develop the I n s t i t u t e ns a major research centre f o r cnvironnental san i t a t ion problems, t o co-ordinate resecrch prograrmoes and t o t r a i n research workers.

Assistance provided by WHO during the year. A short-term consultant f o r s i x wceks (financud by UNSF).

SEA/RCL&/~ Fage 122

Probable duration of a s s i s t anc~ . Until. the end of 1964.

Work done during the year. An Agreement was concluded between the Government. WHO and UNSF. bv which the Succial Fund w i l l ~ r w i d e , "

research eiuipmnt t o the amount of $;525-000 and WHO will 'act as the executing agzncy for the Special Fund i n carrylng out the project.

A short-term consultant was assigned ear ly i n 1961. He studied research ~~~~~~8, needs and potent ia l i t ies , advised on the organiza- t ion of the Ins t i tu te and prepared Q list of equipmnt with a phased schedule of supply for the Ins t i tu te and I t s f i e l d research units. His report has been sent t o the Government.

Recruitment of a WHO professor of sanitary engineering t o a s s i s t In the cvolution of a research pragramme md In the use and ins ta l la t ion o f the equipment provided by UNSF is in t ra in .

5 INDIA - FORMER FR3NCH SETTLEMENTS

Nothing t o report.

sEA/~c14/2 Page I23

6. INDONESIA

The economic s i t u a t i o n i n Indonesia mentioned i n last yea r ' s repor t improved t o some extent , but here was s t i l l shorbage of imported commoditizs.

The National Planning Cmmittee has formulated an eight-year developnent plan f o r t h e country, but t h e amount t e n t a t i v e l y apportioned f o r heal-ih is a very small percentage of tile t o t a l estimated outlay.

West and Central Java were ravaged by floods, which caused much.. damge t o crops, s tored foods and communications. The s i tua t ion was furthe:

.complicated by t h e recent zruption of t h e Merapi volcano, which necess i ta ted t h e evacuation of some 20 000 persons.

With respect t o communicable diseases, a cause f o r anxie ty was thc increased incidence of smallpox i n many a reas ol^ t he country. The nat ional yaws contro l programme was expanded t o include t h e outer is lands. To consider the malaria eradication programme, which w i l l now concentrate operations on t h e c e n t r a l group of is lands, a confcrcnce of provincia l inspectors of heal th i n Kalimantan and Nusa Teng@n B a r a t was convened i n Djakarta by t h e Minister of Hzalth, a t which time a l l ava i l ab le i n f o m t l o n was reviewed. The malaria prop&mme and t h e nat ional leprosy contro l progrannne a r e described elsewhere.

The problem of malnutr i t ion, e spec ia l ly i n Java, is becoming worse year a f t e r year, and t h e f lood havoc i n t h e beginning of 1961 brought matters t o a head. The National Nutr i t ion Board i s we l l aware of t h e inadequacies i n food supply. The help of a FA0 food expert was obtained t o ou t l ine a scheme f o r a food consumption survey i n Java end B a l l .

The c o n s t r ~ t i o n of Ibu Soekarno Hospital, on t h e o u t s k i r t s of Djabrta, has been cmplc ted . Although it was &s:gned as a p e d i a t r i c cen-bye, it i s now occupied by orthopaedic p a t i e n t s . Ii i s proposed t o bui ld a new h o s p i t a l of 200 beds south-east of Djakarta, w i t h a i d from t h e USSR.

LFRPROJECT LIST

Indonesia 9 lbprosy Controll R July - Sept. 1.955; Sept. 1956 - ) UNICEF

Aim of the project. To develop within the frarfle work of general health services a leprosy control programme i n a l l endemic areas of the country.

Assistance provided by WIfO d.uring the year. (a) A leprologist; ( b ) u three-month fellowship for study i n Thailand, India and Nigeria.

Probable duration of assistance. - Until the end of 1963.

Worlc done during the year. A plan of action based on the experience of the p i lo t project and an addendum t o the plan of operatiom t o provide f o r the expansion of the project t o other parts of the country were agreed t o by the Government, UNICEF and WHO. In 1961 it has been possible t o expand the ac t iv i t i e s t o even more areas than had been envisaged i n the plan of action; indeed, the project has mde good progress during the perlod under review. From the beginning of the project, i n 1936, u n t i l the cnc? of 1960, 1 009 516 persons had been examined and 2 767cases of leprosy detected. Iri some areas attendances f o r treatmerlt were r e p o ~ t cd as almost LOO$.

A study of thc progress of treatment i n the p i lo t area of Menganti showed very encouraging resu l t s : a f te r an average of two years of treatment, 86$ of the patients had markedly improved.

The t r a i n l w programme has been extensive; a large number of doctors, medical students, nurses and auxil iary workers i n a l l areas of Java were trained i n leprosy controlmethods. I n East Java a l l medical off icers ol' residencies, regencies and inunicipslities a lso received refresher training.

The agreed policy i s t o achieve as much integration as possible of the leprosy treatment programme in to the general public health services of the country.

Indonesia 29 Strengthening of Health Services (~pidemiology) TA (Dcc. 19% - )

Aim of the project. To se t u l ~ an epidemiological unit i n the Ministry of Health i n order t o ~Leterminc the prevaiEng disease pattern and plan control measur~:s; t o advise a l l branches 0.1 thc medical services on the use of epideroidlogical !nithods.

Assistance provided by WHO during the year. An epidemiologist.


Work done during the year. The WHO epidemiologist l e f t t h e project a t the end of September 1960 on completion of h i s contract, and h i s successor arrived towards the end of January 1961. The project has continued t o show satisfactory progress. In addition t o continuing i t s work on the improvement of the recording and reporting of comunicable diseases throughout the cowl-try, the Epidemiological Unit has contributed t o the control of a smallpox epidemic, which brolce out i n December 1960 i n Wonogiri District , Central Java.

Indonesia 32 Wlar i a Eradication MESA (my 1955 - 1

Aim of the project. To eradicate malaria throughout the country i n progressive stages, and completely before the end of 1969.

Assistance provided by WHO during the year. ( a ) Eight malariologists, s ix ass i s tan t malariologists, an epidemiologist, two entomologists, two sanitarians, a short-term consu!ltmt, an administrative of f icer and tvo secretary-stenographers , (b) supplies and equipment.


Work done during the year. By the end of 1960 eight addit ional zones were taken up f o r spraying, bringing the t o t a l number i n the a t tack - - phase t o tweive and-a half; For the preparation of new areas, preliminary investigations were carried out i n Kalimantan and i n the Province of West Nus8 Tenggarra; four zones i n West Java, s ix i n R n t r a l Java and f ive i n East Java are i n the preparatory phase. In order t o meet tile pqsonnel requirements of t h i s expansion, training f a c i l i t i e s i n the country were augmented; i n addition t o the t r a in i rg centres i n Surabap, semarang and Bandung, a central training centre has been se t up i n Djakarta t o t r a i n zone chiefs and training instructors.

Of the four WHO study t eam assigned t o the project, t h r e have been withdrawn; the fourth i s engaged i n tes t ing whether 1 gm/$ DDI? applied a t in tervals of s ix months w i l l effectively interrupt transmission i n a selected area. The findings of surveillance studies i n Central Java showed that only a small proportion of cases could be detected by the exclusive usc of viLlage voluntary aids. The surveys conducted by the study t e ~ w s i n Java a l so confirmed the ea r l i e r findings tha t prevalence i n many parts of Java had been reduced t o low levels by previous control measures.

During recent v i s i t s of the Director, Malaria Eradication Division, WHO Headquarters, and the ICA Chief mlar io log is t , Washington, decisions on the future dosage and frequency of ksecticide application were taken; as thc standard programme-phasing could not be applied t o a l l p r t s of the country alike, it was agreed tiiat amendments t o the plan of operations were necessary. ICA w i l l continue t o provide a l l equipment, insecticidca and transport f o r the p r o m .

Jndanesia 34 Assistance t o Medan Medical School R ' ( ~ e p t . 1956 - Nov. 1960)

A i m of the project. To improve the f a c i l i t i e s and standards of medical education, especially i n pre-clinical subjects, in the Medan Medical School.

Assistance provided by WHO during the year. ( a ) A professor of anatomy and a professor of physiology; (b ) supplies and equipment.

Work done. Star t ing i n 1956, WHO assigned a professor of anatomy and a professor of physiology t o the Medan Medical School for about four years. During t h i s time it was possible t o ra i se the teaching of anatomy t o a sat isfactory academic standard. Histological and photographic laboratories were s e t up t o provide material fo r histology classes; new laboratories were brought into use and training was given t o technical personnel required for the laboratories and t o student ass is tants , one of whom supervised the dai ly routine work i n the histological laboratory and s tar ted some minor research. The Deprtment of Anatomy i s now housed in a large new building.

In the Physiology Department, teaching wss organized i n divided courses for junior and senior students following a logical sequence. A system of t e s t s throughout the teaching years was established. Integration of tcncLinc was introduced a t the end of the senior course. A physiological c m r i m e n t a l laboratory was established, with equipment supplied by WHO; the laboratory course revised and laboratory guide notes and a laboratory manual were prepared.

Memoranda were submitted t o the Faculty with suggestions on: (1) the admission of students who had completed a part of t he i r studies i n other universit ies, (2) principles of selection and screening of candidates for admission, ( 3 ) the teaching of pre-cl inical subjects, (4) the conduct of C I I examinations, and (5) the organization of the Physiolo@;.f Department.

The main d i f f icu l ty experienced during the en t i re period of WHO assistance was shortage of s ta f f . Suitable national counterpr t s were not provided.

S E A / R C ~ ~ /2 Page 127

The professor of anstmy completed his assignment ear ly in September 1960 and the professor of physiology i n November 1960.

Evaluation. The project was only par t ly successful, because of inadequate support from the Faculty and ncln-provision of counterparts who could take over from the WHO professors.

Indonesia 4 1 Nursing Advisory Services* TA 70ct. 1977 - J U ~ Y 1929; NOV. 1950 - )

Aim of the project. To strengthen, e-nd and co-ordinate programmes for t ra ining a l l categories of nursing and midwifery s ta f f and t o es tabl ish a Division of Nursing.

Assistance provided by Mi0 during the year. A nursing adviser.


Work done during the year. Further WHO assistance t o the project s tar ted i n November 1960, when a nursing adviser was assigned. Her national counterpart has been in position since August 1960 following a two-year study course i n Cana0.a on a Colombo Plan fellowship.

The nursing adviser vis i ted a number of provincial hospitals and nursing and midwifery t ra ining schools t o study the education programes and services.

Assistance was given t o the Division of Education and Training with the preparation of an analysis of a questionnaire which had been f i l l e d out by auxi l ia r ies and t h e i r supervisors.

Meetings of government and UNICEF representatives were attended t o discuss UNICEF a i d t o t ra ining inst i tut ions; l i s t s of equipment f o r ass i s tan t midwives' schools, bcsic medical training schools and ass i s tan t b

nurses' schools were reviewed and modified.

The national ccunterpart was occupied with the work of two committees; one of which was concerned with the revision of the education programme for bidans (midwives), and the ather with examining the poss ib i l i t i es of organizing a nursing college.

A survey of hospital and public health nursing inst i tut ions was planned fo r future action.

R~revious t i t l e : Nursing Adviser

SE~/RC 14 /2 Page 128

Indonesia 48 Fellowships R

fellowship for study i n the United

Orthoptics : A ninc-rconth fellowship for study in Netherlands and Switzerland.

Dental Health: I: twelve-month fe l la rsh ip for study i n the United States of Amcricz.

Public Hudth Fvgineeriw: li 'mclvc-month fellowship for study i n the United States of America.

Vaccine Manufacture : A three-month fellowship for study i n the United Kingdom, West. Gfnrany and Yugoslavia.

Production of Frcezc-dried SPrrllpox Vaccine: for study i n Thailand.

Lndonesia 49 Fellowships Dl

Pest and Inscct Control: Union of Soviet Social is t

A one-month Republics.

fellowship

A two-month feLlowship

for study i n the

Indonesia 50 Tuberculosis Control R (July 1961 - 1

A i m of the project. To c r e ~ t e i n Jogjakarta a tuberculosis epidemiological centre and t o vstablish a model survey (:omunity case-finding and treatment program* which w i l l a l so serve as a t ra ining ground for national personnel; l e t c r t o develop a similar tuberculosis control programme i n a more rura l se t t ing i n another province.

Assistance provided by WHO during the year. (a ) A medical officer; (b) a t rave l fellowship of three itnd a half months i n India, Europe and Jcpan; (c) supplies equipment.


Work done during the year. After spending two months for orientation with tuberculosis projects i n India and Bangkok, the medical off icer proceeded t o Indonesia ear ly i n July 1961 t o take up his duties with t h i s project. The other s t a f f members ore under recruitment.

S E A / R C ~ ~ / Z Page 129

Indonesia 55 Strengthening of Lealth Services TA I sep t . 1959 - )

Aim of the project. To plan improvements t o the health services; t o evaluate health work, p r t i c u l a r l y a l l a s p c t s of the t ra ining of personnel; t o study staffinp; p t t e r n s and formulate administrative procedures.

Assistance provided by WHO during the year. ( a ) A public health off icer ; (b) assistance from the WHO Area Representative, who i s acting as the public health administrator t o t h i s project.


Work done during the year. A public health off icer m s assigned in October. The Area Representative who had ended his assignment i n August was replaced by another i n November. National counterparts t o both WHO s ta f f were appointed. They undertook a comprehensive review of the health services, which formed the basis for a plan of action. The study of health organizations throughout the country was continued.

Considerable e f for t was put i n by the WHO s ta f f on the organiza- t i on of measures t o control outbreaks of smallpox, par t icular ly i n Central Java. Attention was given t o health control of a i r t rave l a t Kemjoran Airport. Control of international t r a f f i c was found t o be thorough, but that of loca l t r a f f i c l e s s satisfactory. An investigation made by the malaria eradication staff fa i led t o confirm the presence of A. sundaicus a t the a i rport . However, DDT-resistant A. aegypti were found around t h ~ , a i rpor t .

The leprosy control programme for 1961 was examined in de ta i l .

Close l ia ison was maintained with the WHO ass is ted nursing project (Indonesia 41) and the epidemiology project (.Indonesia 29).

SEA./RC ilk / ii Page 130

7. MRLDIVE ISLANDS

PROJECT LIST

Project No. Source of Funds Co- operat ing

Agcnc ies - T i t 1 2

Maldive Islands 4 Fc1laws:;ips TA

Basic Nursing: i, two-yzar fellowship for study in India.

Maldive Island 5 Public Ficalth !,?ministration R -(kt. 1959 - )

A h of the project. To study the health s i tuat ion and t o t r a i n health ass i s tan ts for the future health service.

a r . (3) the. public h a l t h officzr, 2 zsn i tn r iw nnd 3. lnbor3Lory t.ecImi::lan; ( b ) suppliss and equipment.


Work done d u r i q the year. A fZrst t ra ining course f o r health ass is tants , with seven candidates, made good progress. Due weight was given t o t ra ining in environmental sanitation. A second group having a wider geographical dis t r ibut ion from different a to l l s , has been enrolled.

The Government of the United Kingdom i s providing a dispensary launch for service i n the a to l l s . It i s a l so planning t o build a 30-bed hospital in Male. Assistance t o the t ra ining of nursing and other s ta f f fo r the proposed hospital was given by the project staff.

Some study of health conditions throughout the archipelago was undertaken. ii sclleme for treatment of leprosy patients segregated on an island near mlc. was established, with a health ass is tant trainee i n charge. Early resu l t s were promising.

Advice was given t o the Government on the procurement of medical supplies.

The WHO sani tar ian wts repatriatcd i n February 1961 and a replacement is under recruitment. A laboratory technicinn w s assigned i n May.

RI I

SECOND-"ear s t ~ ~ d c n t in th? \%'I Assistants' School in Kathmandu A . :. board for 111s final ~xarnination.

UI'PLIES for NePilI's malaria eradication campaign portrrs ovrr mnuntain tracks to storage

1 ~ ~ n t ~ I" thr scnttrrrd vil la~rs. O u t of thr two nlilliorr pcnplr livinx in rnalariolts arear of the Central Xonr. morr tl~;ln 1,700,000 are now hring protected hy spr;tying operations

sEA/~C14/2 Page 131

8. NEPAL

The National Planning Council i s drawing up a three-year plan i n place of the Second Five-Year Plan previously prepared. During the year 1960-1961 the t o t a l national budget amounted t o 377 million rupees. Of t h i s sum, 18.5 million rupees were a l lo t ted t o health.

No serious epidemics of communicable disease were reported. In A m s t 1960 an outbreak of gastro-enteri t is occurred in Bhutwal and Bhairawa,i,~ south-vest Nepal. There was sporadic cholera in Kathmandu, an6 a nwnber of cases of malaria occurred in the Rzpti Valley. The malaria progranrme i s described elsewhere. On the whole, the health s i tuat ion has been maintained a t a reasonably sat isfactory level.

A mass inoculation campaign against smallpox and cholera i s being launched.

The reorganization of the Health Department in i t i a ted in 1959 and the creation of a public health division a t the Directorate have helped t o improve the efficiency and smooth working of the health services. Orders have been issued for the amalgamation of the offices of the Ministry of Health and the Health Directorate.

The inauguration of a school for t ra ining in health s t a t i s t i c s and census operations by -:he Central Bureau of 'Sta t is t ics , with financial and technical assistance from ICA, FA0 and the Indian Aid Mission, has been a significant s tep forward, par t icular ly as there i s no section t o deal w i t h health s t a t i s t i c s a t present.

Improvement of environmental sanitation and provision of potable water supplies are urgent needs throughout Nepal. Arrangements are being made t o provide piped water supply t o Amlekganj, Pokhra, Sukka, Palambo and Biratnagar, and t o improve the quali ty and quantity of the water supply in Kathmandu.

There a r e now thir ty-f ive vil lage development blocks which a re ftnctioning, and another for ty are expected t o be in operation by 1963.

The Government has appointed a comi t tee t o study poss ib i l i t i es of establishing a medical college a t Kathmandu.

A 60-bed hospital has been constructed a t Birganj, almost the en t i re amount for i t s construction having been raised local ly by public subscriptions. The Government proposes t o meet the r e c u r r i n g c o s ~ s a s well as the non-recurring expenditure on equipment, furniture, e tc .

Construction of a new 250-bed hospital with ICA aid, replacing the 130-bed B i r Hospital a t Kathmandu, i s under planning, while a 50-bed general hospital with USSR a id i s under construction i n another part of Kathmsndu.

sEP./~c14/2 Page 132

PROJECT LIST

Nepal 1 R

Malaria Eradication ' (~une 1954 - 1

MESA ( ICA 1

A i m of the project. To eradicate malaria throughout-the country in progressive stages s t a r t i ng with the Central Zone.

Assistance provided by WHO during the year. (a) Three ~mlar io log is t s , three entomologists, a malaria engineer, two sanitarians, three auxi l iary personnel, an admin i s t r~ t ivc of f icer and three- secretary stenographers; (b) two regional fellowships of two and a half months for study in India; ( c ) supplies, equipment, including a transport vehicle,and l ining material end windows for pre-fabricated aluminium houses provided for WHO f i e ld s t a f f a t Amlekganj.


Work done during the year. Close collaboration has been msintained with ICA in the development of the programme.

Malaria eradication ac t iv i t i e s were rnainly confined t o the three sectors of the Central Zone. The 1960 spraying operations, which ended in July, afforded protection t o 246 664 people in the north sector, 258 813 in the middle sector and 1 224 005 in the south sector.

The 1961 spraying operations which s tar ted ear ly t h i s year, are in progress in the three sectors: those in the north sector a r e proceeding according t o plan and those in the middle sector are ahead of schedule; in the south sector where the operations are behind schedule, it i f i planned t o u t i l i z e 24 spray teams from the middle sector t o a s s i s t with the campaign.

To reinforce the administrative services, recruitment i s under way for a WHO administrative ass i s tan t and two supply ass is tants .

A survey was conducted in each sector with a view t o determining the habits of the people in replastering the w8Us of t he i r houses, rethatching of roofs and sleeping out of doors. Altitude surveys t o delimit the areas of malaria transmission have been completed, and the resu l t s seem t o indicate that it does not occur above 4 000 fee t .

Routine mlariometric surveys, entomological a c t i v i t i e s and t ra ining of nationals are being continued.

SEA/RC~~/~ Pcge 133

Nepal 2 TA

Nursing Education* ~ N O V . 1954 - )

A i m of the project. To t r a i n nurses for i n s t i t u t i oml , domiciliary and public health work,

Assistance provided by WHO during the year. ( a ) Three nurse tutors; l b ) a ten-month fellowship for study in M i a ; (c) supplies and equipment.

Probable duration of assistance, Until 1964.

Work done during the year. The nursing education programme continued as planned. A new class of twelve students was enrolled i n February. To encourage more active ~ r t i c i p a t i o n of students, project work was introduced for small groups, This innovation proved valuable, but time-consuming, For the f i r s t time, second-year students were assigned t o the c l i n i ca l f i e l d for supervised evening duty, which, in addition t o brcadening the i r experience and improving patient care, produced a be t t e r system of reporting. Thirtofn studcnts graclwtcd i n April.

One ward in the male section of the B i r Hospital was organized and equipped as a demonstration unit , Students gained experience i n t h i s ward and i n the children's ward of t h i s section. A well-baby c l in ic was s tar ted a t the Maternity Hospital, and mothercraft classes for mothers attending pre-natal c l in ics were introduced. A night duty programme for midwifery students was started; it has Increased the opportunities for students t o attend deliveries,

The record forms for instruction and c l in i ca l experience for students were revised with a view t o providing a more permanent document and simplifying office work in the school and hospital.

Proposals for a five-year development plan for nursing education, including suggestions for providing public health and domiciliary midwifery experience for students, were aade on request,

Training of Health i,ssistants, Kathmandu T ~ u n e 1955 - )

A i m of the project. To establ ish a school for health ass i s tan ts i n Kathimndu for theoret ical and pract ical training; t o plan a prograrmae of ru ra l health service; which w i l l make-the best use of the health ass is tants .

Assistance provided by WHO during the year. ( a ) A public health off icer and a sanitarian; (b] supplies and equipment, including a transport vehicle.


*Previous t i t l e : Trainim of N~~rscs . Kath-mdu

S E A / R C ~ ~ / ~ Page l34

Work done during thc year. The senior WtiO o f f icer and the sanitarian attached t o the pro.ject, a l o n ~ with the national Director of Public - - Health P roJec~s and the.WIIO public health advise'r in Kathmandu, vis i ted several ; i tcs with a view t o establishing a loca l practice f ie ld ; the areas of Poretol Dhobichour a d Budhe'nkhcl proposed by WHO have been approved by the Director of Health Services.

Final exruninations were held;- 17 out of 21 students were successful in t h 3 qualifying examinntion and 12 i n the promotion examination. The =luc of the course was enhanced by s i x weeks of pract ical t ra ining of l,ealth ass i s tan ts a t Bhamtpore Health Centre i n the Rnpti Valley. '

Lectures on nursing procedures were given by the WHO-.nurse '

working with the nursing education project. The students'were given an opportunity t o get in-service t ra ining during the Shivratr i Festival.

Thirty students w-re enrolled for the 1961-1962 course, fo r which training s t a r t e J on 115 February.

Assistance t o Central Health Directorate (Aw. 1957 - 1

Aim of the project. To organize the work of the Central Health Directowte and t o develop short-term and long-term health plans t o meet the country' n basic health and medical problems.

Assistance provided by WHO during the year. ( a ) A public health adviser and an administrative ass is tant ; (b ) supplies, a transport vehicle an4 spire parts.


Work done dur- thc ycar. DI view of the dccision of the National Planning Council t o ?raw up a three-year plan for Nepal i n place of the Second Pive-Year Plan, the WHO public hcnlth adviser ass is ted in a revision of the propo~als of the Health Department.

Advice imd been given -Lo the Government &-the des i rab i l i ty of amalgamation of the offices of the Health Wnistry and tha t of the Director of Health Scrviccs. m e proposal has now been f inal ized and amslgamtion e f f c c - t ~ i . . . ... . . . . . . . .

The public heal'rll adviser gum advice on the organization of a S t a t i s t i c s Division the Ministry of ~ e a l t h , suggesting that two s t a t i s t i c a l officers bc ,mployed t o form the nucleus of the Division. He a l so ass is ted i n pknhing a sanitation course for Qurkha army persame1 as par t of t i icir rehabi l i ta t ion t ra ining on re turn t o Nepal on discharge or rctircm-nt from service. Hc vis i ted the tube wells recently insta l led a t T h h i and Maharnjganj with assistance from ICA, which are report& t o bc capable of delivering approximately 400 000 and 300 000 gallons of water per day respxt ive ly .

Assistance was given in formulating a preliminary draft of the smllpox control ~ r o j c c t . Inter-departt l~ntal discussions on the subject indicate tkat the Government i s ackively considering s ta r t ing the scheme during t h i s year.

The public health adviser attended the meeting of the Bmrd for the Management of the Shri Bnch Indra Rajya L a m i Devi Elaternity Home and Child Welfare Centre and helped in revising the pay scales of technical and pra- technica l s t a f f .

The public h e a l ~ h adviser continued t o function as an adviser t o the Malaria Eradication Board and t o the Shri Panch Indra R o j p L a m i Devi Elaternicy How, and Child Welfare Centre.

9. WRTUGUESE INDIA

Portuguese India 6 F e l l w h i p s m

Public Health Adninistration: A six-month fellowship for study i n Puerto Rico and Brazil.

P o r t u p s e India 7 Nursing Education El (Oc i. 1959 - w t 1960 April - July 1961, - )

A i m of the project. To upgrade and expand the trninine; of nurses for ins t i tu t iona l and public health nursing services; t o es tabl ish - a central nurse t ra ining school.

Assistance provided by TvXO during the year. h consultant for three months.


Work done during the year. This project s tar ted with the award of a fellowship i n 1959. In April 1961, a short-term nursing consultant was provided t o carry out a survey of nursing and midwifery education progrnmmes and t o make recommendations for the catablishment of a central nuz-sing school. She vis i ted lhospitals, c l inics , health centres and the mining industry mfclical service t o assess t he i r volue and the practieabili-ty of t he i r use for pract ical experience of nursing and midwifery students. She completed her work i n July, a d her report i s under consiuei.ation.

'r IELD drmonstratron aurtn,q traininr u n l r > r > NIL L N L ~ L L F hca\?h sanitarians in yaws sill:vcillancr. Fifieen

provinces are at pve.;ent coverrd 1,y c(lnrrnl nrtivi- tie7 in Thailand's y:tn.s prosramrnc, \vltich is now \)rins intcrated into t1,r qznr.l.;tl rur;rl 11rnltll srrvicr5.

T L E is examined li,r s i ~ n s of infection with :pyosy. In Thailand's lep~.osy control programme, srlstcd by WHO, mare than 43,000 rases have been undrr rrratrnent. The proqramme is now king

,~nces. d to hvv. more

sEA/~c14/2 Page 13'1

The f i s c a l year i n TlmiUnd, which used t o bc t h c calendar year, has been changed t o 1 October t o 30 Szptember. Thebudget a l locat ion f o r healbh fo r the f i r s t nine months of t h e current year i s approximately 246 millioii bahts, which i s about 3.7% of the t o t a l na t ional budget. This compares favourably with the a l locat ion Tor 1960.

There was no m j o r outbreak of commun~cable a s c a s e s during the year. A large number of ;rflallpo>: vaccina-cions was p~rformed by the p w s teams operating i n the co~mlry .

An outbreak of hacmorrliagic disease i n chLldren occurred i n 1 9 0 . There were m n y cases,wltli a f a i r l y high r a t e nortal iby, but the cause was unknown. The Government of J a s n has now mad? a &rant of two mil l ion bahts t o invest igate t h e cause ci' tile disease.

Cholera, a f t z r being epidemic i n 1958 and 1959, was not reported. In the l a t t e r pa r t of 1m cases acute grtstrc-cn-Lcri-tic occurred., The Cholera Research Laboratory sct up by the Sduth-@st Asia Treaty Organizatidn conducted an inves t iga t i a l , and it was found t h a t the causative agent was paracholera EL TOR. This SFAT0 Laboratory has now been s h i f t e d t o Dacca (East Pakistan), and the cholera invest igat ion work i n Thailand w i l l be continued i n the laboratory of the Army School of Pathology.

A new Communicable-Disease Hospital has been opened on the ou t sk i r t s of Bangkok, and the coristruction of t h e new bui ld ing f o r tile School of Tropical Medicine and Endemic Diseases was completed.

The malaria, yaws , tuberculosis and leprosy control projec ts a r c described elsewhere i n t h i s report .

A p i l o t n u t r i t i o n survey was s t a r t e d i n t h e north-east province of Ubol among army personnel and c i v i l i a n s . In an invcst igat ion with t h e use of radio-active iodine conducted i n t h c go i t re aroa of Prac Province, it ~jns found t h a t t h e g o i t r i m s ilue t o iodinc deficiency.

T h r e has been some ~mprovemcnt i n the in tegra t ion of tile r u r a l health services, but one 0;' the primary needs is f o r improvements i n sanita.. t ion, including drainage, r.:fisc disposal, p i p d water supply, etc. With ass is tance from ICA a v i l l n ~ c health and san i t a t ion programme i s continuing.

b t e r n a l and ch i ld iiealtii services have been expanded, with t h e upgrading und increase i n t 1 1 ~ number of hcal th ccxtrcs. The Municiptllity of Bangkok has drcrwn up plans f o r a major expansion of maternal and c h i l d health services i n Bangkok, w i t i i ass is tance f r m UNICEF. In t h e r u r a l areas, 164 midwifery service ceiitres were opened. R~'freslic1" courses f o r midwives were continued; 159 midwives graduated from two midwifery schools, and p l m s have been made fo r tile establislrment of a t h i r d school.

A one-year nurse-aid course, sponsored by ICA, was s t a r t c d i n January this year i n the CChingmi Medical School.

A building f o r h o u s i ~ ~ g the atomic rvdc'cor i s bcing constructed a t Nngkhen near Bangkol:. The reac-lor w i l l supply radioisotopes f o r therapy, diagnosis and rcsearcil.

sEA/RC14/2 page 338

PRaTECT LIST

Project No. Source of Funds Co- owrat ing

Agencies T i t l e - Thailand 2 Yaws Control

ICA (May 1950 - . - UNICEF

Aim of the project. To carry out sys t emt i c control of yaws throughout the country; t o reduce the reservoir of infection t o a leve l a t which the disease can be controlled by ru ra l health authorit ies; t o train loca l personnel; t o incorporate yaws control in the permanent public health services.

Assistance provided by WHO during the year. ( a ) h yaws special is t , a medical officer, a laboratory technician and a c ta t i s t i c inn ; (b) two three-week fellowships for studies in 'J?aiwan, Hongkong and the Philippines; (c) supplies and equipment.

Probablc duration of assistance. Unt FL the end of 1963,

Work done during the ycar, The accomplishments of the mass campaign have been sat isfactory but the integration aspect i s lagging behind.

During the period from 1 June 1960 t o 31 May 1961, a t o t a l of 2 607 693 examinations were made, and 12 595 active cases, with only 248 infectious cases, recorded. In addition, routine smallpox vaccina- t ions continued t o be undertaken by the project s t a f f , integration supervisors and ru ra l health sanitarians ; over 180 000 primary vaccina- t ions and nearly two mill ion revaccinations were given.

Refresher courses were given t o proJect f i e l d s ta f f anrl t ra ining courses t o r u r a l health sanitary inspectors of the provinces. These courses were designed t o stimulate the overall a c t iv i t i e s , improve working standards and increase the howledge of the s t a f f involved.

Further emphasis was a l so placed on be t te r supervision and guidance a t various levels in order t o achieve s t i l l greater efficiency.

The incidence of infectious yaws has been found t o be generally very low, and it appcars t ha t most of the provinces are ready for integrationj the -1 health services gradually are being b u i l t up t o accept responsibil i ty far yaws surveillance.

The laboratory technician joined the project In January 1961.

The services of the s t a t i s t i c i a n attached t o t h i s project were len t temporarily t o the L'i-dponcrntoses ~:?.visoiy Tcm.1 workiw i.1

Thailand (see Inter-rc,;L m?l 51).

Thailand 21 Nursing Advisory Services* TA (April 1954 - Dec. 1957; Jan. 1938 - )

Aim of the project. To co-ordinate, expand and upgrade the undergraduate and post-graduate nursing education programes t o meet the needs of the country, and t o improve nursing services, par t icular ly in inst i tut ions that are used for teaching.

Aseistance provided by WHO during the year. ( a ) Two nurse educators; 7b) supplies and e q u i p n t .


Work done during the year. WHO assistance was extended t o two provincial hospitals and nursing schools in Korat and Pitsanuloke. The senior nurse educator spent considerable Lime a t each school ass i s t ing with thc revision of the curriculum and course outlines, the organization and carrying out of an in-service education programme, and ward administration and supervision. The revised curriculum, with increased emphasis on supervised pract ical experience and c l in i ca l teaching, met the needs of thc students and resulted i n improved nursing care and be t te r nursing education. TWO short courses were conducted a t each of these hospitals - one for head nurses and one for s ta f f nurses. A refresher course was a l so arranged a t each hospital for nurses from ru ra l hospitals.

A Chief Nurse and a Director of Nursing Education hnve been appointed a t Korat,with c l e x l y d ~ f i n u d md delegated dutics and responsibi l i t ies .

The number of students enrolled a t the Post-graduate School of Nursing in Bangkok increased from t h i r t y t o forty-five. Students were sent t o several ins t i tu tes in Bangkok for brcader pract ical experience.

An a f f i l i a t i on programme was introduced a t Cholburi Hospital fo r students of the Women's Hospital Nursing School, Bangkok, and considerable assistance was given in orienting the s t a f f and reorganizing the nursing service i n order t o prepare a practice f i e l d for the basic nurse t ra ining programme.

Assistance was given t o the Nursing Division i n conducting a refresher course for head nurses and supervisors a t Vajira Hospital.

%?2vious t i t l e : Nursing Education

Thailand 30 f;L~s;~;y;r;l R UNICEF

Aim of the projzct. Following the organization of a p i lo t project -.-.-- i n i(hon Kaen Province for demonstrating modern methods of leprosy control, with e q h a a i s on case-finding, domicilia'ry treatment and surveillance of contach, ( a ) t o t r a i n personnel and (b) t o extend the control progsa-!rn? t o a l l endemic areas of 'che country.

Assistancu .---- provilcti - - f.:; '1110 durinp; the' year. ( a ) Two leprologists and two leprosy controi officers; (b) four twelve-month fe l larships for s t u * ~ in india; (c j supplies and equipment. '

Probable durztion of assistance. Until the end of 1965. -. - ---- .-

Worlr done dul ing thc year. There are now four WHO f i e l d s ta f f members - .- two lcprologists and two Teprosy control off icers - a s s i ~ c d t o t M s projec-t. Vp t o thc cnd of February 1961, 43 550 patients (including

I, 195: un:,.r ccnditional rclcasc") had been brought under treatment i n -the nine provinces of' the project area i n the north-east of the country (Khon men, ?"lhaszrelcam, Kalasin, Roi-Et, Buriram, Surin, Srisaket, %rat ~ ~ 0 . l . j. A t h i rd addendum t o the plan of operations was prep?:?, ari. tlle j'roQ;ramme i s now being extended t o f ive more provinces (Udon, Cl,a:~;:1.~:~1, tT>.!dlon ?man, Sakon Nakhorn and Nongkai). A fourth ~ d d e n d . ~ , t o ~ : ; r l : ?e for e m s i o n t o the north-west of the country, i s unrlcr neC9ti.ation.

Tx the p 2 o t area of Khon Kaen, the phase of integration into the &en,-ral hcslth services was consolidated, and a t h i rd and f i n a l case-f ind:ir-.g surmy was hunched. iZ new mobile laboratory uni t was established z ~ ~ f c i f i c a l l y for e m i n a t i o n of disease-arrested pat ients prior t o t he i r release t o survei lhnce.

In V ~ ~ i . - i s n ~ k ; m and Roi-Et the i n i t i a l case-finding programme was coz~plc,:,?CI. In Ki:i:'.sin province, however, the covcrage achieved was unsc+T$f?cto~y, nri,?, further action was taken t b improve the work.

A check sura,: of the progrsrmne in the fivc provinces of Buriram, Surin, 2 % KO:%: and Ubol was undertaken and addit ional mobile and s t - t i c ircn.-bvcn; c ~ : ~ t r e s were opened. In some vil lages of Srisaket province o~c: t::;' c r rhc population was found t o be affected with leprosy. !. ;I. lot, survcy of Ubol City, the seccmd largest c i t y of Thailand, mq c ~ . p l e ' ; ~ ? d , with a population covcrage of over @€$, revealing a 1 -re-cleric,: ra te of f ive per thousand.

i n Che.L3uri Province, leprosy control servlccs were established thrmyh exjsllng ger.cr.iL1 health centres and with the general health s ta f f . A t tk~c end of January t h i s year 695 patients were under -treatment 'cy means of s mobilc uni t and i n eight treatment centres.

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The national Director of the Leprosy Control Division orfpnized a National Leprosy Relief Fund, which i s ass i s t ing the establishment of a leprosy control project in the Bangkok City area. Spccial skin c l in ics have been established i n f ive municipal m t e r n a l and child health centres and i n two heal-ch centres i n Bangkok; the doctors and nurses of these centres were given special training.

A fourth group of auxil iary leprosy s ta f f for assignmfnt t o the expanded control programme i n the north-east successfully cmpleted basic training a t the Phra Pra Daeng Leprosy School.

Four WHO fellowships have been awarded and two more are p b e d t o provide for t ra ining doctors and psrnmedical s ta f f in the physical rehabi l i ta t ion (reconstructive surgery and physiotherapy) of l e p o s y pstients, a t Vellore (h i t la)

m i l a n d 38 :.ssistnncc t o sc:,ua1 of ~ u b l i c Hczlth, w k o k R ?kc. 1955 - ~ r c h 1956; k c . 1956 - 16-;lch 1957;

July 1959 - )

A h of the project. To strengthen the School Of Public Health, Bangbok, by providing advice on various aspects of public health an(? on the teaching of cer ta in subjects.

Assistance provided by WHO during the year. (a) A professor of s 6 o r of public health f o r three months and a health education consultant for three months; (b) a three-month fellowship for studies in M i a , B-, ~ e y l o k and Afghanistan.

Probable duration of assistance. U n t i l March 1962.

Work done du r iw the year. Teaching ac t iv i t i e s a t the school continued t o follow the defined pattern.

Final examinations were held during the f i r s t quarter of 1961. Ten fourth-year sanitarians completed the requiremnts for the B.Sc. in Sanitary Science, and thir teen thlrd-year students (sanitarians) co;lpletcd t h e rc.quirL. ~ i l t s for tll,: Mplm-. i n sdtLwy Science. !I~wnty-eight n u r s ~ s finishcd the two-year courbL f o r the Diplorn In WaUc Hcalth Nursiw, and 25 c h t o r s the one-year MPlI course.

The professor of sanitary engineering gave instruction in food sanitation and industr ia l hygiene t o MPH students.

Plans have been mde for the construction of a workshop a t the f i r s t -c lass health centre in Bangken t o provide opportunities for pract ical work for the students and for thc developncnt of new techniques in sani ta t ion by thc s t a f f of the school.

The consultant (professor of public hcal'ch) who was appointed t o the school i n June 1960 for a period of thrcs months, made vcry valuable recommendations for the integration of public health in the teaching. His report has bcen sent t o the Government. On the conclusion of t h i s short assigmcnt, he was transferred t o thc University of Medical Sciences, Bnngkok, as v i s i t ing professor of preventive and social mdicinc (see Thailand 62).

A short-tcrm consultant i n health education was assigned t o the project i n DccembcT 1960. This assignment was a follow-up of, and was complemcntsry to, a similar assignment, in 1959, when a consultant had reconmended a p t t c r n of t ra ining in health education with cmphnsis on the developmcnt of f i e ld training. The consultant worked u n t i l the middle of February and appcars t o hnvc beon successful i n stimulat- ing and consolidating a programme of f ie ld t ra ining i n which a l l categories of health workers co-opcrate i n family health studies and plans for "family betterment programmes". Her report has a l so been sent t o the Government.

Thailand 42 National Tuberculosis P r o g r a m - Pilot Frojcct 7 (Oct. 1958 - May 1959; Dec. 1939 - 1

UNICEF

A i m of the projcct. To crcntc a tuberculosis epidemiological centre and t o carry out a c m i t y case-finding and treatmcnt programc i n a well-dclincatcd and congested area of Bangkok; l a t e r , t o develop a tuberculosis p r o g r w e outside Eangkok, the f i r s t stage of which w i l l be a p i lo t prevalence survcy i n one provincc; t o t r a i n national personnel for t h i s programme.

Assistance provid?d by WHO during the year. ( a ) iL meaical officer, a s ta t i s t i c ian , a public hcaltll nurse, n laboratory technician and an x-ray technician; (b) supplies and equipment.

Probable cluration of sssistancc. Until thc cnd of 1964.

Work done during the year. Iiith the ready support and co-operation of the government authorit ies, t h i s projcct b s continued t o develop very sat isfactor i ly . The high coverag;: required t o produce sound epidemiological resu l t s has 'occn achieved by -thc case-find- unit . In the f i r s t twenty sections of the project area, with a t o t a l population of 23 283 pGrsons, 21 355 (91.77&) werc ewmined; t h i s population included 9 213 Thais and U 730 Chinese, and the actual case ra tes for thcsc G W O comnu~itics were 5.88$ and 7.52% respectively.

Up t o 31 &arch 1961, 37 900 persons had been examined and 1 581 a l loca te~l t o treatment. The treatment unit i s serviced by f ive mobile treatment centres 7,nG. v i s i tcd regul?.rly by two t z w a of four horn v i s i to rs under tlic s~lpervision of a nurse-aide.

Thc radiological and laboratory services lmve been maintained a t a high standard. The t o t a l number of x-ray exposures taken i n connection w i t h the p i lo t pro,jcct up t o 31 Mar::h 1961 was .26 528; the average number of exposures pcr r o l l was 44, tllc cost per photofluorogram being 1.78 baht. A t the request. of the Tuberculosis Control Division, assistance was given in set t ing up a. programme for regular maintenance of a l l x-ray units ogerated by the Tuberculosis Control Division i n Bangkok and Chiengmai. A syllabus for a radiographers' training course was a lso drawn up.

In the laboratory, the number of spccintns cultured to ta l led 4 360,of which 158 were spot-sputum specimens, 1 638 collection- sputum specimens and 2 564 laryngeal swabs; the respective percentages for positives were 20.1$ from spot sputum, 10.7% from collection sputum and 7.3% from laryngeal swabs. The t o t a l number of micro- scopical e=inations was 1 824, with a pos i t iv i ty ra te of 5 . 8 .

The national BCG Assessment Team, consisting of two specially trained BCG technicians under the sup rv i s ion of a w d i c a l officcr, s tar ted f i e l d work i n Novenber 1960. To check the standard of tuberculin-test reading, somc of the technicians working with the BCG mass campaign in Bangkok co-operated with the WHO nurse in dual readings. In a special reporc on the BCG campaign in Thailand, suggestions and recommendations were mEde w i t h regard t o the approach t o pre-school-age children in 3angkok for vaccination and intensifica- t i on of BCG work. Tuberculin examinations of children i n Bangkok indicate the following infection ra tes : f i in 0-4 year age group, 2% in 5-9 year age group, and 66s in 10-14 year age group. Under the guidance of the WHO nurse, the BCG technicians of the hngkok teams are conducting house-to-house v i s i t s fo r vaccination of pre-school children and have been able t o zchiew an 8& coverage.

ThaFLand 43 Trachoma Control R -(July - Aug. 1959; Dec. 1960 - )

A h of the project. To deternine the nature of and seas01131 variation in bacter ia l infections of the conjunctiva and the i r re la t ion t o the incidence and severity of trachoma; t o study the minimum effective course of an t ib io t ic treatment of the type of trcchons. founa i n ~ i l n n d ; t o give addit ional t ra ining t o national personnel i n control measures for communica~olc eye diseases;t,o introduce, a t a l l levels, a progrcssiw programe of health education; t o plan a programme (of control activities oil ,,. lnreer-sc::lc in t he trachorn endemic region, and t o evolve economically e f f ec t iw proccdures for thc gradual expansion of treatment ac t iv i t i e s in schools and among family contacts ::o 2s t o rcducc t h c rcsfrvoir of iul"~c.Lion t o 3 levc l a t which communicable eyc diseases are no longer a public health problcm.

S E A / R C ~ ~ / ~ Page 144

Assistance provided by WHC during thc year. A three-month fellowship for study in India. (Another fellowship was avmrdcd under Thailand lit i )

Probable duration of assistance. Up t o Junc 1963, i n the f i r s t instance. - Work done during t h i year. iZn ophthalmologist and a s t a t i s t i c a l ass i s tan t h v e cornplcted t1u-c~ nionths' t ra ining in comnunicnble eye diseases control iil India on WdO fellowships. A plan of opcrations for z pi lot project has been prepared and agreed ' o by the Government, WHO and UNICEF, and a trachomatologist is now being recruited, who, it i s hoped, w i l l t-kc up his assigntwnt in Scpt~rqber 1961.

Thi lund 44 Hospital S t a t i s t i c s TA (Nov. 1957 - )

Aim of the project. 1'0 illlprove thc c o l l ~ c t i o n of hospital s t a t i s t i c s and t o develop trc.inln, mogramlcs for ncdical rccords off icers and s t a t i s t i c a l c l ~ r k ; .

fissistance providel Lg iiItO during thc year. A s t a t i s t i c i a n and a bil ingual typis t .

Probable duration of ?.s::istancs. Until the end of 1962.

Work done during the year. Ths in-patient rccorrls of thc Chi lbcn ' s Hosnital and Wonen's 1io:;oital were analvscd and quarterly and semi- - - . annual reports prcparLi; an m n m l report, usin;: an adaptation of the International h List, ilcsigned specif ical ly for the use of hospitals, i s under preparation. These reports arc based on new s m r y records ;lc;iped by the WHO s t a t i s t i c i a n and introduced on a t r i a l basis.

The senior s-tc.ff of thu Dcprt?.~ent of Medicine were given on- the-job t ra ining in the principles and u s ~ of the International Classification of Diseases, tllc International Fonn of Medical Ccrtif icatc of Causc of Death, tabulation of iliagnostic statements in rcports,nnJ n~tii02s of 'ledical s t a t i s t i c s . Similar training was a lso offered t o pcrsorlncl fron S i r i r a j Hospital.

T ~ I work of cxtcnding the project nct ivi t ien t,o mrious provincial and other eovern~~cnt hospitals i s proceeding. A phased p r o g r a m lzas been works? out and n cost c s t i m t c prepared for thc extension scheo~c, which has rcceivcd goveru~cnt approval. The Pr ies t s ' Hospital an.: Lest Sin Hospital i n Bangkok were selected for a t r i a l of tk~c propcscd systen.

The s t a t i s t i c i a ; i studiecl the r.ccords an(1 reports systen of the S i r i r a j 2nd Cl~uhlon~!.;orn IIospitals ani! n?dc rcco~~mendntions for t he i r rcorganizztion, T! a ' Lr . ,;,- ,. L annual ,,,:.~ii:i:; .'f ;;it<.

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Thailand Medical Association on thc subjdct of "Need for and Uscs of Hospitnl ~ t a t i s t i c s " , v is i ted th? WHO-assisted Hospital Records Project i n Penang, Maluyc. (Mahyn l5) , and discussed m t t c r s of nutual interest with thc project s t a f f .

m i l a n d 46 Fellowships R

Trachona. Control : A thrcc-nonth fc l la rsh ip for study i n Jndia.

Anatomy: A twelve-nonth fellowship for stu+y in Australia.

X-Ray Techniques: Two two-year fellowships for study i n Ceylon.

Electro-khysiology: k twelve-I-.lonth fellowship for study in the United States of lmcrica.

Thailand 47 Fellowships TA

Epideniology: A twelve-r;ontlr fi?llowship for study in the United Kingdm .

Thailand 57 Assistance t o Faculty of Tropic21 Medicilc and R Endemic Diseases

-(nug. - Sep-c. 1959; June 1961 - )

Aim of the project. (a) To a2vise on thc organization of a post- graduate School of Tropical Medicine an? Endemic Discases i n thc university of Medical sciences, Hangkolt, and t o a s s i s t in the prcpara- t ion of a curriculum; (b) a f t cmr r l s , t o assess the resu l t s of the assistance given by \THO and t o advise on further dcvclopr~ent.

Assistance provided by WHO during the year. 11 consultant professor of t rop ica l medicine for two an2 a half months.

Piobabk duration of assistance. Until the of 1964.

Work done during the year. After ttic f i r s t phase of the project had becn completed by the assignr~ent of a consultant professor t o advise on thc organization, cu&iculwn, etc., of the post-graduate School of Tropical Medicine an8 Endemic Diseases i n August-September 1959, the sane consultant (professor of t rop ica l ncdicine) s tar ted a seconcl assignment a t the School in June 1961 t o assess the resu l t s of thc assistance originally given, and t o nake recmendat ions for thc further clcvclopnent of tllc School.

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Thailand 61 Bijharzias is Survc R (March - April 196:; Oct. 1960)

A* of the project. To collec-t informtion on thc prcvalcncc of bi lharzias is and on the distribution and ecology of potent ia l inter- mediate host snai ls and animal reservoirs.

Assistance providd bj WHO during the ycar. A short-term consultant.

Work done. The WHO 2clnsultant who had f i r s t carried out a survey during March-April 1960, conducted a second survey for a fortnight i n October 1960, a t tb.e end of the rainy season. According t o his findings, bi lharzias is does not appear t o be a public health problem in Thailand. Nevertkelesr;, in view of the various i r r iga t ion schemes being carried out and tl?ose planned for thc future, t h i s subject has been given continued attention. Details of the f i r s t survey were given i n l a s t year's annual report.

A similar survey was carried out in the Mekong River Basin in Laos by a WHO Consultant (recruited for thc Wcstcrn F c i f i c R@oml Wfics). In tha t Zxea of E~os , prcmlencc of biLWzi;lsis ws found t o bc very low.

Thailand 62 Assistance t o University of Medical Sciences, Bangkok R 7sept. 1960 -. 1

Aim of the project. To develop the Departments of Social and Preventive Medicine i n the three Medical Faculties of t h i s University - those a t Chulalongkorn and S i r i r a j in Bangkok, and the one i n Chie-i.

Assistance provided by WHO during the year. A professor of preventive and social medicine.

Probable duration of assistance. Until t!lc cnd of 1964.

Work done during the year. 'The consultant professor of preventive and social medicine s tar ted his assignment on 1 September 1960. In consultation with his national counterparts, a t both Facult ies of Medicine i n E)angkok, he made a detailed ntudv of ihe contents and organization of a course in hygiene and public health and submitted a K - ~ U I I on the motivation, objectives, contents and methods of undergraduate teaching in pevent ive and social medicine.

The professor and his caunterparts have been successful i n outlining a course covering a l l four years of the curriculum, which is in keeping w i t h recent progress i n the sphere of medical education and i n accordance with the requirements of the practice of preventive medicine in Thailand. Support for the new curriculum and i t s implementation was a l so secured from the members of the Faculty.

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The Department which w i l l conduct t h i s course w i l l henceforth be ca l l ed the "Department of Preventive Medicine". In preparat ion of f i e l d t ra in ing , t o comence i n the academic year 1962-63, a survey of the fami l ies in the f i c l d t ra in ing a reas which a r e chosen f o r t h i s purpose is planned t o s t a r t a t the beginning of the academic year 1961-62 ( Ju ly 1961).

It has been indicated b:; the Direc tor of -ihe University of Medical Sciences t h a t the C;~icngmai Medical Faculty w i l l a l s o follow the same pa t t e rn of teachine; i n preventive medicine a s do the Bangkok schools .

The consultant professor completed h i s f i r s t assignment i n A p r i l 1961 and w i l l be re-assigned i n J u l y 1961 f o r a fu r the r period of t e n months.

In view of t h e s t i l l mcagre and comparatively inexperienced local stsff it i s plnnncc? t o continuc Iff10 c s 8 i s t r . n ~ ~ f o r oru: or t w o uarc yc~a-s.

11. I N T E R - C m Y

PROJECT LIST

T i t l e - Regional As.;cssmeni; Team on h l a r i a ~ m d i c n t i o n *

1959 - )

A i m o f t . To nake an incle3endent appraisal of the s ta tus of malaria eradication or of any syjecial aspect of it i n countries of the Region, as required.

Assistance provided by \NO dur iw the year. ( a ) A mlar io log is t , an entoiilologist and two technicicn~; (b) supplics ard equipnent.

Frobable duration of assistance. Until the end of 1963.

Wo'!: clone during the year. The tccri lms comgleted inde2endent CpprcioCl of the s ta tus of mlaric. eradication i n thc northern, southerh and north-eastern parts 0:; Thaihnd and submitted i t s reports. The findings a r e bein; used t o guide the r e - o r ~ n i z a t i o n of the programme.

.2t the: request o f ICA, th ?EO m.lariolc@st a l so gave technical advice t o the national p r o g m e from mid-June t o August 1960. The entonlologist and onc technician 1cT-c the p o j e c t during the second half or 1960 and the r e s t of the team completed i t s rrorlc i n IIFn;tiland i n June of t h i s ycar. The m1ar io lo~i : : t and one technician have been posted t o Belgaum (Y~::vI'I: s t a t e ) ::incc the b e g i d w of July.

S W O 38 R UNICEF

Production of Frcczc-Dried SmUpo:: Vaccine (Jan. 1958; Oct. - Nov. 1958; Feb. 1961; - )

Aim of the 2roject. To a s s i s t Member Governments i n the Region with the :>rociuction of a thermostable dried smallnox vaccine.

Assistance -9rovided by WHO d u r i n ~ the year. A medical concultant for two rrecl;?.

Frobable duration of assistance. Until the end of 1963.

Work done dui-ir21: the year. The frccze-dried small,m:: vaccine pro8uc- t i on centre i n E~ngkok, Thailand, s ta r ted t o function from April l a s t ycnr. I n ordcr t o give furthcr assistance i n bqrovlng production, a MI0 consultant ~ m s -rovidcd i n February 19G1 for about

*Previous t i t l e : AGvisory Team on bhibiarla. Eradication

S E A / R C ~ ~ / ~ Page 149

two weeks. He has submitted a report which contains important recomndations, including the change t o a new st ra in , now being used a t the Lister Ins t i tu te . Sheep a re being used instead of buffaloes, and the pulp collected from them on the f i f t h day a f t e r vaccination i s used i n the preparation of the elementary body suspension. The consultant demonstrated a simplified method of preparing t h i s suspension a s adopted a t the Lis ter Ins t i tu te . The present production of the centre i s 1 0 0 0 ampoules a week.

Preparations for the establishment of three other regional centres for the production of freeze-dried smallpox vaccine ( a t Patwadangar and Guindy i n India and a t Bandung i n ~ndonesia) are progressing sat isfactor i ly .

The bacteriologists from India, one engineer and one mechanic have completed t h e i r t ra ining a t the Lister Ins t i tu te under WHO fellowships.

Except for the air-conditioning units, a l l equipment t o be supplied by UNICEF f o r t he freeze-dried vaccine production centres i n Guindy and Patwadangar has arrived. It i s expected the t production w i l l s t a r t shortly.

A laboratory technician from the Pastcur Inst i tute , Bandung, completed his t ra ining i n freeze-dried vaccine production i n Bangkok under a WIiO fellowship. Most of the equipment for t h i s Ins t i tu te t o be supplied by UNICEF has arrived, and it i s expected tha t the vaccine producing centre, which w i l l be loczted there, w i l l s t a r t production towards the end of 1961.

SEAR0 40 k l a r i a Eradication (~xperimental MESA Study on Surveillance), Ceylon and

India (April 1959 - May 1961)

Aim of the project . To study the most practicable and eff ic ient methods and procedures for surveillance i n malaria eradication.

Assistance provided by WHO during the year. Ceylon: (a) A malariologist, two ass is tant malariologists, four laboratory technicians and f i f teen auxi l iary personnel; (b) reimbursement t o the Government of sa la r ies and allowances and t r ave l and per dien 'costs of national personnel; (c) supplies and equipment.

India: (a ) Two mla r io log i s t s and three laboratory technicians; (b)eimbursement t o the Government of salar ies and allowances and t r ave l and per diem costs of national personnel; (c) supplies and equipment.

S E A / R C ~ ~ / ~ Page 150

Work done. In 1953 W O imti tu- ted .;::o experimental programm~% - onc i n Ce;rlon 2nd one i n Mysore Stc.te (1ndia) - with a vierr t o studyini, the most practicable and e f f ic ien t methods of surveillnnce. The ac t iv i t i e s i n Ce;rlon rrere completed i n April 2nd those i n Mysorc i n May 1961.

I n Ceylon, the main cc t iv i t i e s included active and passive surveillance worlr, m s s blood surveys i n selected villnges and treatment ?.nd follow-u? of a l l m h r i a c-.ses found. Fifteen medical ins t i tu t ions took part i n the possivc detectisn ?rogr.nme - f ive on the ~eri:?hery and ten i n the :?reject area; blood smer.rs from f ive were e;:amincd by the cnti-malaria cmwign bbomtory znd those from the other ten by the project laboratory. In the act ive detec- t i on programme, surveillnnce v i s i t s vere mde a t fortnightly, monthly and two-monthly i n t e r v d s .

I n Wsore, fever cu rvc i l1 r .n~~ i n Krishmmjo.m.gcr Tal- was con t in~~ed by the national s t a f f , and blood s l ides received from the national authori t ies r.!cr.c examined by the WHO team. The mass blood surveys undertaken i n t h i s t z l u h r:erc discontinued from August 1960. Fever surveillance i n the WHO arc?. of Feriyapatm TnLW was continued a t i n t c n n l s of two, four, s i x and ei:;ht veeks; i n the Bhadra Reservoir Project Area, surveillance v i s i t s vere made a t intervals of two, six and eight M ~ S S b l o d survey; ricre conducted i n both areas. Early i n 1961, the team concentra.ted i t s studies i n the Bhndra Reservoir Project Area, rhere there had been evider~cci of loca l mlaric. transmission, i n orddr t o Letermine the influence of t h i s occurrence on vil lsges i n the immcdiete neighbourhoocl; a sub- hzadqmrtcrs wnc established a t BhadmLvcti f o r t h i s puqmsc, and entomologic3J. obscmt ions wen, carried out.

Early i n 1961, s taff from thc Fa0 Headquarterst &lar ia and Health S t a t i s t i c s Mvisions v i s i ted both the projects t o a s s i s t i n the yidemiological interpretation, s t a t i s t i c a l analysis and f iml presentztion of thc. technical d;lt- collected. The f i m l reports on both etudics a r e under prc?ara.tion. An evalmtion v i l l be given i n the next report.

+$ In?;~rovecent of X-Ray Services { ~ c b . 1959 - )

A i m of the project. To t r a i n x-rr,;r technicians from various countries i n thc Region i n ndiograi>hic tcchni,:~~:urs and i n t h ~ m.intenance of x-my equipment, and t o .:?sist thc School of Radlograjhy, Colombo, f o r t h i s Turpose.

Assistance provided by i f i O durirq the ycar. (c) An ::-rey engineer; ib) su:>j>lies and equipcnt .

Probable duration of -L-sistance. Un-l;il the end. of 19c.3.

m i o u s t i t l e : Wi* of X-R;y Tcchniciuns

Work done during the year. Teaching a t the School of Radiography omceeded sat isfactor i lv . Thirti-nire students s s t fo r the MR biplom examination i n hovember,"ard 31 were successflrl. A nev group of students has been selected for the next course.

The X-ray Department of the General H o s ~ i t a l , Colombo, where the school is functioning, has improvcd considerably cluring the year. Three new x-ray mchines havc been installed; the two dark- rooms have been redecorated, and new processing units installed. Rooms have been allocated f o r a second lecture hull, including a l ibrary. A s e p r a t e dark-room has been allocated for photographic work and the students are being taught enlurglng and printing. Additional premises f o r the school t o s e t up a physics laboratory have not yet been provided.

Additional space was mzde - n i b b l e i n the out-;%tients depnrtmcnt of the Eye Hospital, Colombo, for the use of the Division of Electro-Medical Engineering. The electronic section has been edarged and f a c i l i t i e s for t e s t i w high voltage and x-ray units have been 9rovided. The refrigerator6 supplied by WIIO suffered set- backs fmm burnt-out motors. These are now being sa t i s fac tor i ly rewound and put into operation.

In Febru?.ry 1961 tho r;ervices of the WHO x-ray engineer were made awilcble t o Afghanistan for about two months t o give advice on the repair and mintemnce of radiological ins ta l la t ions and on the measures and equipment necessary for increased protection against ionizing radiation. Before returnixg t o Ceylon, he also v i s i ted a number of d i s t r i c t tuberculosis centres i n India t o study the x-ray processing f a c i l i t i e s available i n those centres and recommerd r,aqsurec needing :,ction.

\.no-assistance t o the School of Radiography, Colombo, w i l l be com;,leted i n August 1961, and the x-ray engineer w i l l tour countries of the Region i n order t o t r a i n technicians t o provlde more effective mechanisms against radiation hazards and t o repair insteU*,tions.

Medical Education Study Tour (~iochcmlstry) (21 Nov. - 1 4 Dec. 1960)

A i m of the project. To enable a simll group of teachers of bio- c h e m i s t ~ from the countries of thc Region t o v i s i t medical colleges and rescerch inst i tut ions i n Thailand and India on a study tour.

Assistance provided by WHO durine; th? year. ( a ) A l~rofessor of biochcaistry for f ive weeks; (b) ti-?.vel costs and subsistence a l l o ~ ~ , n c e r f o r eight teachek from the countries of the Region.

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Worl: done. Thc fourth of an annual ser ies of medical education study tourr, under WIiO auspicer; was conducted from 21 November t o 1 4 December under the guidance of a professor of bioehcmi~try from m a , appointed for t h i s purpose. Eight teachers oi" biochemistry (one ccch from Afghanisten, B u m , Ceylon and Indic, two from Indonesia and two from m i l a n d ) v i s i ted ncdical colleges i n kngkok, Delhi, Lucknow, Bornby 2nd Eydercbild. They also attended some of the annual meetings of the Indian Council o: Medical Rccarch, which took ?lace a t Hyderr.bad. The object of t h i s study tour was t o focus a t tent ion on the stztus of biochcmi~t~ry i n thc rncdical curriculum, and it was f e l t t1p.t the purpose of thc tour :,~.-.n well achieved.

The team leader submitted n 'cport on completion of the tour, and the report has bcen distributed.

S M O 50 Reorganization of Rural Health Records and Reports R (Jan. 1961 - 1

Alm of the project. To or&wize a system of r u m l hcalth service records and reports a t selected centres and t o t m i n personnel i n the collection, processing and presentation of vital and health s t a t i s t i c s a t the ru ra l health centre level.

Assistance provided by WIIO du r iw the year. (a) A s ta t i s t i c ian ; (b) supplies and equipent .


Work done during the year. The project s ta r ted with the a r r iva l of the s t a t i s t i c i a n i n January 1961. b i t i a l l y , the project i s located a t the ruml health centre i n Saro.iiili Naaar. near Lucknow i n Uttar - - ,

Pradesh Stnte, India.

The q ta t i s t i c ian vis i ted threc other Indian States as well: Andhra Fradesh, Gujerat and Punjc-b. During these v i s i t s , she hcld discussions with of f ic ia l s on the i r reporting needs and studied the records systems b e i w follo?rcd. Much in te res t was shorn by everyone concerned i n the project's objective. There we= complaints of an cxccssive burden of pripLr vork. The s t a t i s t i c i a n studied the problems i n dc t a i l a t Sarojini Nagar and prepared a memrandum cnalysing two forrlt concerned with reporting m t c r n a l dentho. .

The out-patient records anl y c p ~ r t s i n Saroj ini Nagar were a lso studied and new forrnb: an?. an in s t ruc t ioml m n m l drafted. These draf ts were discussed by an zilvisory cormnittee, consisting of the Assistent Director (~~ idemio logy) , who i s a l so the WHO s t a t i s t i c i an ' s counterpart, the Professor of Preventive and Social Medicine and thc Special Officer i n charge of p r imry hcalth centre plannin& The fonm w i l l be printed and enough copics distributed f o r a t r i a l of the new system before a wider application i n the State and elsewhere i s recommended.

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Assistance t o Public Health Laboratories 7Ay. 1960 - )

Aim of the project. To review the administrative and technical structure of laboratories and 13bor2torv serviccs i n the Region: t o - . evaluate the work being performed, the iechniques and the type of eqxi~xi~cnt i n use, and the number 0;' l?.boratory personnel employed and ';:lc"ir standmd of t ra in iq ; ; t o ~iork out a plan oi^ organization and adninistration for a r e f e r r a l laboratory system and t o d raw up curl-icula for training.

Assistance provided by WHO durin;; the year. Two short-term consul; tants - one for Indonesia and one f o r India.

Probable duration of assistance. Until the end of 1963

Work done during the year. To help meet the need for developing public henlth laboratory services i n the countries of the Region, a consultant was assigned t o Indoncsic fo r three months i n 1960. I n his reyort, he has recommended the e n d u a l establishment of 8 f 'ull public health laboratory service i n tha t country. The Government has accepted his suggestions.

Another consultant h s been ~ s s i g n e d t o India for a period of t en months t o advise the Govcrnnent on the improvement and development of exist ing public health laboratory services a t d i s t r i c t , regional and s t a t e levels and c l in i ca l laboratory f a c i l i t i e s i n primary health centres, re fe r ra l hospitals and d i s t r i c t hospitals. So f c r he has v i s i ted seven States.

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12 mrER-REGIONAL

PROJECT LIST

Project No. Source of Funds Co-operating

Agencies T i t l e - Inter-regional 31 Advisory Tean

R

Aim of the p r g e c t .- ( ~ s reg:~rds Thailand). To assess the resu l t s of the Yaws Control Project; t o investigate the prevalence of yaws i n selected areas which have not yet been surveyed by the Yaws Control Project; t o consider meesures t o be undertaken t o ensure eradication . of Firs bnscd on the findings of the heponematosis Advisory Team.

A s s i s t a n ~ r o v i d e d - i y mIO during the year. (a) A He8dqmrters1 team - composed of ct medical officer, a male nurse ~dminis t ra tor and a laboratcry tri-hnicfcn; (b) tne WdO s t a t i s t i c i an attached t o the Yaws Contra?. ProJect (Tnciland 2); ( c ) supplies, equipment and transport vehicles.

Probable duration of assistance. Until ALIJ.~GL; 1961 i n TW.ih~d. -..-

Work done during the-. The team completed i t s survey i n the Southern Prot-inces o? Thailand durlng the l a s t quarter of 1960. As mentioned u-der toe Yaws Control Pro,ject (Thailind 2), t o help with the statistical analvris of the resu i t s of the surve?l, the services of the WE10 s ta t is t ic ; .m working w l t i l that project we& made available t o the tc,m.

The tzam i s n,m working i n the north-eastern par t of the country. It i s expected tht it w i l l complete i t s work i n Thailand in August of t h i s year.

Inter-regional ---- 7' Inter-rcvional Smallpox Conference, New Delhi R ~.4-1:&v-1963)

A i m of r2c project . v scudy the monwet3rnL md operztion of campaigns for sriCl?or er~Lica",icln ilnd to mnk,? 1ppropriate rccomendstions . Aasistance p ro~ idcd by WlIO during the year. ( a ) A consultant for one month (provided hy Headquarters); (b) t rave l costs and stipends for

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Work done. The conference was held in New Delhi from 14 to 19 November, with 18 participants from countries of the Eastern Mediterra- nean, Western Pacif1.c and South East Asia Regions. Various aspects of smallpox control m d eradication were reviewed, attention being paid to epidemiological considerations, organization, local and social aspects, and evaluation of eradication campaigns. In country statements the participants gave brief accounts of the past and present

'

activities in their countries as well as future plans. It war; stressed that priority should be given to smallpox eradication campaigns in countries where the disease is still present in epidemic form.

The report of the Conference has been distributed to all the Member States who sent participants as well as to the participants themselves.

Inter-regional 76 Symposium on the Use of Radioisotopes in the Studx R of Endemic and Tropical Diseases, Bongkok VlEA (12-16 Dec. 1960)

Aim of the project. To bring together e;rperts in the medical uses of isotopes and in the field of tropical medicine and to enable them to review the results so far achieved in the study of endemic and tropical diseases with radioisotopes, to enable tropical scientists to initiate or intensify clinical research work on problems in tropical medicine which might be successfully investigated with radioisotopes.

Assistance provided by WHO during the year. Technical and secretarial assistance. participation of technical staff from Headquarters, the Regional office for~llestern Pacific and the Regional Office for South East Asia.

Work done. Under the sponsorship of the International Atomic Ehergy Agency and the World 3calth Organization a symposium on the use of radioisotopes in the study of endemic and tropical diseases was held in Bangkok from 12 to 16 December 1960. Dclegates from 16 countries were present along .rith about -0 invited speakers.

From the South East Asia Region, Ceylon, India a d Thailand sent delegates. WHO Ins represented by two officers from Headquarters, two from the Western Pacific Regional Office, one from the South East Asia Regional Office m d the Arca Representative in Thailand.

Papers of high scientific interest, followed by useful discussions, were presented on nutrition (particularly haematology, endemic goitre and metabolism of electrolites) as well e.s on entomology and parasitology.

In addition to discussing the fundmental aspects of the use of radioisotopes in medicine, the symposium considered practical methods for studying scientific problems.

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