proposed programme and budget estimates for 197611977

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH-EAST ASIA

PROPOSED PROGRAMME AND

BUDGET ESTIMATES

FOR 197611977

NEW DELHI, JULY 1974

Explanatory Notes

Regional Director's Programme Statement

Summary of Regional Health Programme by Source of Funds

Summary by Programme and Source of Funds

Summary by Programme and Organizational Level

Programme and Budget Estimates for 1974 to 1977 by appropriation section, with a tentative projection for 1978 and 1979

Programme Analyses (See i n d e z for p r o g r m c s rmd sub-proyranones on page 151

Summary of Services and Assistance to Governments

Information Annexes:

Annex 1 (Regional Office, Regional Advisers, WHO Representatives and individual country statements with tabulations)

(Zee i n d e x on page 1571

Annex 2 (Additional Projects) (See i n d e z on page 4631

iii

1

5

6

10

EXPLANATORY NOTES

1. General

The Regional Director has the honour to present to the Regional Committee the Proposed Programe and Budget Estimates for 1976 and 1977 for the South-East Asia Region.

These have been prepared, as last year, in accordance with the new form of presentation approved by the Twenty-fifth World Health Assembly in its resolution WHA25.23. However, in accordance with resolution WHA26.38, the budget estimates include the two financial years fallowing 1975, instead of one year as hitherto.

The Regional Director's programe statement on pages 1 to 4, is followed by various summaries indicating the estimated obligations for 1974, 1975, 1976 and 1977, both under the Regular budget and other sources of funds. These are further broken down into appropriation sections, programmes and sub-programmes.

The programme analyses are given on pages 17 to 154 and include a textual statement for each programme and sub-programme followed by a schedule showing the number of posts and the estimated obligations under the Regular budget and other sources for each of the years 1974, 1975, 1976 and 1977, broken down into regional, country and inter- country levels.

A summary of services and assistance to governments appears on 155.

Two information annexes follow this summary. Annex 1 begins with the posts and budget for the Regional Office, Regional Advisers and WHO Representatives, and continues with those for each country (with the country programme statement) followed by individual project descriptions and budget tabulations, which also show the number and duration of posts, consultants and fellowships. Annex 1 concludes with similar details for inter- country projects.

Annex 2 contains requests from governments for assistance which could not be accomnodated within the planning allocation established for the Region by the Director- General under the Regular budget.

2 . Form of Presentation of the Programme and Budget Estimates

The programme proposals and budget estimates are presented within the framework of the new prograrnne classification structure introduced last year. This classification consists of nine appropriation sections, each consisting of programmes and sub-programmes end is based, as far as technical programmes are concerned, on WHO'S Fifth General Programe of Work Covering a Specific Period (1973-1977), adopted by the Twenty-fourth World Health Assembly (resolution WHA24.58).

The "Summary by Programme and Source of Funds" appearing on pages 6 to 9 of this document sets out the programme classification structure as applicable to the Region.

The Regional Director's programme statement describes the main health problems of the Region and the objectives of WHO'S assistance, and summarizes the progress already made and expected to be made towards the achievement of these objectives. It further relates the proposals being presented under all funds to the Fifth General Programme of Work and the regional programme of work, as well as to the policies and decisions adopted by the Regional Committee from time to time.

3. Re~ular Budget

The proposals are within the Director-General's planning allocation for the Region and have been developed in consultation with Member Governments.

4. Other Sources

The estimated obligations to be met from the United Nations Development Programme, the United Nations Fund for Population Activities, Voluntary Fund for Health Promotion, and other funds are shown under "other sources" and are identified under the country and inter-country tabulations.

The abbreviations used to identify the various funds in Annexes 1 and 2 are as follows:

United Nations Development Programme . . . . DP

United Nations Fund for Population Activities . . . . FP

Fund of the United Nations for the Development of West Irian

Standard Letter of Agreement . . . . LA

Various Special Accounts under the Voluntary Fund for Health Promotion:

Medical Research (Specified) - General . . . . VG

Miscellaneous Designated Contributions (DANIDA).. . . VK

Community Water Supply . . . . VW

Malaria Eradication . . . . VM

Smallpox . . . . VS

Leprosy . . . . VL

Cholera . . . . VC

It will be recalled that last year only those UNDP projects and components were included for which financing was reasonably assured. The resulting Lack of both balance and realism was remarked by the Regional Committee at its twenty-sixth session and by the Executive Board as well as the Health Assembly. Consequently, the present document includes all UNDP projects for which financing may reasonably be expected, even if final approval has not yet been received o r if negotiations have not been completed. However, it must be pointed out that the current planning period of the United Nations Development Programme will be terminating in 1976, and new Indicative Planning Figures have yet to be established for 1977/1981. Pending the establishment of these new figures, of neces- sity, no requests have been received from Governments for assistance in 1977 under the United Nations Development Programme. Nevertheless, in certain cases costings have been provided in the 1977 column for United Nations Development Programme projects; these represent either UNDP's forward commitments far approved projects or carry overs of allocations made during the current planning period.

Finally, expected assistance in the health field from the United Nations Children's Fund (UNICEF) has also been shown, to the extent that auch information is available; this information is given without commitment, and merely to supplement, so far as possible, the overall picture of international assistance.

5. Pro lect Numbers

All projects have again been numbered in accordance with the programme classification structure, the old numbers being shown in brackets.

REGIONAL DIRECTOR'S PROGRME STATEMENT

The year 1977 wiZl mark the completion of the s p e c i f i c period covering the F i f th General P r o g r m e of Work. In the meantime, ac t i ve prepara- t ions have been i n i t i a t e d for establishing principles for the development o f long-term planning and m e d i m - t e n p r o g r m i n g .

In conformity w i t h the aims, pr ior i t i e s and approaches of national health plans and the principles la id down wi th in the F i f t h General P r o g r m e of Work, the Regional Of f ice for Sou th -~as t Asia has already established strategy gui&Wnes for planning country health programmes for the period 1975-1980.

In addit ion, most countries undertaking national health planning have ,set oirt the i r s p e c i f i c national five-year plans i n the perspective of long- tern planning. Sonic of these perspective plans are being projected up t o the end of the present century. WHO long-tern and medium-term p r o g r m e planning, therefore, i s being formulated wi th in national long-term perspec- t i v e plans.

However, Government expenditures on health are s t i l l low. They represent between 1 . 5 and 9 .1 per cent of the national budget, and wi th some exceptions (Mongolia, S r i Lanka and Thailand), s t i l l l e s s than $1 per capi ta per year. Such a low investment on health i s unl ike ly t o change by 1976-2977 and these resources are obviously inadequate t o meet the requirements of national pr ior i ty health problems. Moreover, even these l imited funds are not being adequately u t i l i z e d .

A t the twenty-sixth session of the Regional Committee for South-East Asia the following four areas were recommended as deserving high regional pr ior i ty for the establishment of targets for the Asian Nealth Chmter:

Commurzicab Ze disease control Family health Nutri t ion Provision and maintenance of water supply and drainage.

Thereby, a regional bas is for medium-tern p r o g r m i n g i n the contest o f long-term planning has already been established.

Country health p r o g r m i n g exercises haue been completed i n Bangla- desh and Nepal and w i l l a lso be undertaken i n Indonesia and Thailand. By 1977 most Member Governments i n the Region w i l l have undertaken country health p r o g r m i n g i n the context of the preparation of future national health plans. In addit ion, the p r o g r m e management i n f o n a t i o n system, established i n the Regional Off ice i n 1972, has been reviewed and sui tably modified and i s expected t o continue t o provide a tool for e f f e c t i v e project management a t both country and regional l eve l s . Preliminary s t eps t o evolve an evaluation system have been i n i t i a t e d , and further developments are expected. By 1977, it i s hoped that an e f f e c t i v e information system u i l l be firmly established wi th in the Region, and preliminmy exerc ises t o review reporting and information co l l ec t ion and analys is have been started with HQ s t a f f w i t h respect t o s p e c i f i c programme i n selected countries.

Operational a c t i v i t i e s for improved project formulation have a lso been undertaken.

All these e f f o r t s should provide a bas is for more e f f e c t i v e mediun- L e n p r o g r m i n g and improved implementation, by the end of the period covered by the F i f t h General P r o g r m e of Work.

In establishing programne proposals for 1976-1977, account has been taken o f the u t i l i z a t i o n of previous p r o g r m e al locations, the r e s u l t s o f evaluation, the increasing demand for newer services and for the expansion of exis t ing ones, and, f i n a l l y , the need for developing programme o f high pr ior i ty i n the m n t e x t of e x i s t i n g national socio-economic conditions. I n addition, comments by governments during the review of p r o g r m e proposals a t sessions of the Regional Committee have been considered. As a r e s u l t , the ex i s t ing programne proposals provide, i n general, subs tant ia l increases i n WHO assistance t o Member countries; concomitantly, inter-country programme proposals have been reviewed and sui tably streamlined i n order t o cover s p e c i f i c requirements wi th in the Region, as wel l as t o supplement WHO- supported country a c t i u i t i e s .

Amongst the achievements expected by the end of the F i f t h General Progranune of Work period i s the eradication of smallpox wi th in the Region; a considerabk decrease i n mortal i ty ra tes fran cholera, a soundly based OPT and p o l i o ~ e l i t i s i m n i z a t i o n programne, improved epidemiological surveillance and more e f f e c t i v e foZZow-up of disease control measures, i n addit ion t o sound pknning practice and more e f f e c t i v e implementation o f plans through improved administrative practice.

Based on the a c t i v i t i e s outl ined above and the proposals tha t follow, WHO assistance i n the development of health care w i l l continue t o be o f major importance t o our countries.

Increasing a t t en t ion w i l l continue t o be paid t o the development of rural health services for de l ivery o f e s sen t ia l health services wi th in national resources.

Studies aimed a t undertaking new and innovative methods o f de l ivery o f health services, now under way, are l i k e l y t o provide a further bas is for the earpansion of health services i n areas a t present grossLy under- served. The deveZopment of an adequate network of heal th laboratory ser- v ices and a t t a i m e n t o f se l f - su f f i c i ency i n the production of e s sen t ia l vaccines w i l l further support the development of heal th services and the contro 2 o f prevalent connnunicab Ze diseases.

The high b i r t h r a t e s and high maternal and i n f a n t mortal i ty ra tes emphasize the importance and need for high pr ior i ty o f family heal th i n the Region.

In 1976-1977, maternal and chi ld heal th serv ices , including family planning (wherever accepted as a national pol icy) w i l l b e further integrated i n t o the general health serv ices . Similarly, current programmes such as smallpox eradication, anti- tuberculosis campaigns, leprosy control and trachoma control w i l l continue being integrated i n t o the comprehensive rural

h e a l t h care p r o g r m e i n a phased manner. The d i ccc rn ib l e t rend t o move i n t h i s d i r e c t i o n , w i l l be f u r the r accelerated by i n s t i t u t i n g p rac t i ca l and f i e ld -or ien ted in-seruice t r a i n i n g o f the "hea l th t a m " . The e f f e c t i v e n e s s o f the t ra in ing p r o g r m e w i l l be assessed by bu i l d ing approprziate eualua- t i o n a c t i v i t i e s i n t o it , a t tempt ing t o improve the educational methodology and technology.

The programme proposed for 1976 and 1977 inc ludes h e a l t h measures i n t h e con tro l o f c e r t a i n condi t ions o f ma lnu t r i t i on which are h igh l y prevalent i n many coun t r i e s . The multi-purapose heaZth worker-s a t the f i e l d l e v e l w i 2 2 r e c e i v e adequate t ra in ing to enable them t o d e l i v e r the semj ices and he lp prevent such condi t ions .

Health educat ion o f the people and t h e i r inuolvement i n t h e development o f cornuni ty hea l t h care, n u t r i t i o n , prevent ion and con t ro l o f communi- c d l e and o the r d i seases and proniotioiz o f envirownental hea l t h , m d t h e i r a c t i v e p a r t i c i p a t i o n i n carrying ou t d i f f e r e n t hea7th a c t i v i t i e s i 1 1 i Z Z

r e ce i ve g rea t e r a t t e n t i o n i n t he se proposals.

I t has been es t imated t h a t more than 60% of the r o s t o f healbh resources r epre sen t s h e a l t h manpower i n t h e r le l ivery o f h e a l t h s e r v i c e s . S tud i e s carr ied o u t i n the Region have shown, apart from shortage o f h e a l t h manpower, a maZdis t r ibu t ion and under -u t i l i za t i on o f the e x i s t i n g manpower resources . Further e f f o r t s w i Z Z be made t o d e f i n e the r o t e o f d i f f e r e n t ca tegor iee o f h e a l t h manpower i n t h e na t iona l h e a l t h o rgan i za t i ons and t o ensure t h a t the educat ion and t ra in ing o f t h e manpower i s task-based. W r i c u t a , teaching a id s , fieLd prac t ice areas , teacher t r a i n i n g , prepara- t i o n o f manuals and guides , and assessment o f t,he impact. o f traaining w i l l be gemzed t o t h e p r i o r i t y h e a l t h needs and progrwnnnes o f thp c o u n t r i e s concerned.

Cornunicable d i s ease s are s t i l l the leading causes o f h o s p i t a l out- p a t i e n t and i n -pa t i en t morb id i ty and a l s o o f m o r t a l i t y i n almost a12 the coun t r i e s o f t h e Region. Resurgence o f maLnrzia i n c e r t a i n c o u n t r i e s , the spread o f cholera and the h igh incideniae o f i n f e c t i m s t ubercu lo s i s i n d i c a t c the need for cont inued support t o communicable-.disease c o n t r o l p r o g r m e s , a s we l l as for more e f f e c t i v e measures aga ins t d e t e r i o r a t i n g erivirownenta2 cond i t i ons , which are t h e m u s e o f much o f the previ l i l ing pre iwnt ib le morbi- d i t y and m o r t a l i t y i n t h e Region.

I n s p i t e of t h e expected global success i n sriiallpor e rad i ca t i on , t h i s d i s ease w i l l s t i l l requ ire i n t e n s i v e surwei l lance f o r a number o f years i n t h i s region. Cholera, typhoid and other, e n t e r i c irij 'ections w i l l , u n t i l e f f e c t i v e preven t ive t echnolog ies ore d i scovered , cont inue t o be publ ic h e a l t h problems, and t h e a t t ack on these problems requ ires a m u l t i - d i s c i p l i - nary and mu l t i - s ec to ra l approach; the t rend t ha t has been i n i t i a t e d i n th past few years should gain momentwn i n f ind ing s o l u i i o n s .

1 t i s expected t h a t the non-cortmrunic& l e d i s ense s i , l i l l ,~eed more a t t e n t i o n during 1978-1979 and subsequent years . 2'0 deal w i t h cancer, cardiovascular d i s ease s , denta L h ea l t h , mental heal l h and &ug abuse, i r i -

creasing budgetary a l t o c a t i o n s may be needed. The measures taken i n 1976- 1977 ,and i n previous years should provide adequate in formation on d i f f e r e n t

aspects of these problems, which w i l l make it possible t o formuZate con- cre te and practicable p r o g r m e s towards t h e i r so lu t ion during the period o f the S ix th General P r o g m e of Work.

?he percentage o f population wi th access t o safe water supplies varies from 5 t o 26 per cent i n d i f f e r e n t countries; i n urLan areas from 10 t o 75 per cent and i n m r a t areas from 0 to 25 per cent . This d i f ference i s re f l ec ted i n the incidence of cholera and other water-borne diseases.

Community water supply and sanitat ion, the monitoring of environmen- ta l pol lu t ion , education and training of environmental health personnel and planning environmental health services w i l l receive further emphasis i n 1976 and 7 9 7 7 . Fora work on environmental health, not only close co-opera- t i o n between the international and b i l a t e r a l funding agencies but a lso the sound development of the co-ordinating r o l e o f WHO are indispensable. I f W H O ' S co-ordinative function i s t o be e f f e c t i v e , Member countries must p Z q a key ro le . I t i.? hoped tha t the present co-operation of WHO w i th UNICEF, IB'ARD, the ADR and other agencies w i l l be further strengthetred during the next two yeaizs.

All these programmes w i l l naturally depend upon the compZetion o f country health programing i n the Region by the end o f the F i f t h General P r o g r m e of Work. I t i s hoped tha t governments w i l l a l so , by tha t time, have gained s u f f i c i e n t expcperience i n the u t i l i z a t i o n o f modern management techniques and s k i l l s i n the de l ivery of d i f f e r e n t p r o g r m e s , i n monitoring the information required for ~ . e p r o g r m i n g , wherever necessary, and i n evaluating the outcome.

It i s considered that the p r o g r m e proposed i n t h i s document for t h i peraiod 1976-1977 w i l l lay a so l id foundation and w i l l cons t i tu te ade- qualc~ preparation for. the launching of the S ix th General Frogranone of Work. The Sirategy Guidelines, which are under review annually, should help governments not only t o meet t h e i r current health needs and pr ior i ty pro- g r m e s but a l so t o take f i r m s teps towards the achievement o f lag - t e rm objec t ives . Further, there should be c o n t i ~ u o u s and concerted act ion on the further strengthening o f health services, on the development o f heal th manpower and on rlea2ir.g wi th cer ta in health problems l i k e malaria, f i l a r i a , dengue/haemorrhagic fever, leprosy and tuberculosis , ohich w i l l require a t t e n t i o n i n the S i r t h General P r o g r m e of Work and perhaps i i z the subsequent ones.

SUMMARY OF REGIONAL HEALTH PROGRAMME:

ESTIMATED OBLIGATIONS BY SOURCE OF FUNDS

(in thousunds of US $)

1.1 Organ iza r i ana l meet ings

1 . 1 . 3 Regional C a m i t t e e

2 . 1 Execut ive Management

2 .1 .3 O f f i c e of che Regional DirecLor

3 . 1 . 2 S t reng then ing of Hea l th Services

3 . 1 . 3 Heal th Laborarory S e r v i c e s

3 .2 Family Healrh

3 . 2 . 1 Programme Planning and General A c t i v i t i e s

3.2.2 n a t e r n a l and Chi ld

3 . 2 . 3 nvman ~ e ~ r o d ~ c r i o n

3 . 2 . 4 NuLriCion

3 .2 .5 Hea l th Educat ion

1 9 7 4

Regular Budper US S

23 500

1 9 7 5

Other S O Y T E ~ S

US $

Regvlaz nudge t

US S

18 000

US $

23 500

1 9 7 6

Other source^ US $

Regular n u d ~ e t

CS $

10 MH)

1 9 7 7

Tafal

us S

18 000

Regular Budset

Other sources

US $

Total

US 5

10 OW

Other s o ~ r c e e

T o t a l

US $

25 WO

US S us $

25 000

5 . 1 Communicable D i s e a s e P r e v e n f ~ o n and c o n t r o l

5 . 1 . 2 Epidemiological Surveillance of C-unlcable D i s e a s e s

5 . 1 . 3 H a l a r i a and O t h e r Paras i t i c D i s e a s e s

5 . 1 4 S m a l l p o x E r a d i c a t i o n

5 . 1 . 5 B a c t e r i a l D i s e a s e s

5 . 1 . 6 Mycabacter ia l D i s e a s e s

5 . 1 , 7 V i r u s D i s e a s e s

5 . 1 . 8 V e n e r e a l D i s e a s e s and l r e p o n e m a r o s e s

5 . 1 . 9 v e t e r i n a r y P u b l i c H e a l t h

5 . 1 . 1 0 VecLor B i o l o g y and C o n r r o l

5 . 2 N a n - c o m ~ n i c s b l e ise ease P r e v e n t i o n a n d C o n t r o l

5 . 2 . 1 Programme P l a n n i n g and ~ e n e r a l A c i i v i c i e s

5 . 2 . 2 Cancer

5 . 2 . 3 C a r d l o v a s c u l a r D i s e a s e s

5 . 2 . 4 O t h e r C h r o n i c Non- c o w u n l c a b l e D i s e a s e s

5 . 2 . 5 D e n t a l i l e a l r h

5 . 2 . 6 b len ta l ~ e a l t h

5 . 2 . 7 p r e v e n t i o n and c o n t r o l of A l c o h o l i s m and Drug Dependence a n d Abuse

5 . 2 . 9 Lmnunology

I i i 7 5 I

l o c a l

U S 5

531 995

1 1 1 7 210

8 8 3 780

192 670

8 850

21 0 0 0

LO 0 0 0

2 765 505

4 7 610

225 925

9 4 0 0 0

3 i 350

49 b0O

210 030

16 500

2 8 400

709 415

~ ~p

I ' . ; a 1 9 7 7

R e g u l a r 1 O f h e r ~ ~ d ~ e t sources

Us 1 Us I

I i

431 b50 : 129 0 0 0

Regular B u d ~ e t us S

326 385

1 027 1 4 5

i 328 200

59 9 7 0

?&3 245

h 3 550

3b 850

102 550

3 167 8 9 5

US 5

5 6 0 650

- R e g u l a r 1 Other budpel , Sources

,US i I US S

I

531 995

1 117 210

758 9 0 0 124 880

192 670

8 850 I

21 0 0 0

1 0 WO

2 630 625 134 880

47 610

225 925

I 9 4 0 0 0 !

37 3 5 0 ; 49 600 !

? 1 0 03U

16 500 1 2 8 :

I 709 415 ;

1

R e g u l a r l i u d g e ~

C S s I i'S . ' US $

I 1 497 8 6 0 ) 25 0 0 0 522 860

18 4 0 0 1 116 0 2 0 1 097 120 ' 546 8 9 0 i l b 8LO 663 730

178 570 ; 34 190 212 760

19 LOO

l Y loo I I 1

28 200 2 8 200

10 1700 ' 30 000 ' 1 2 367 740 224 9 3 0 2 592 670

i *> 0 4 0 45 040

i , 1 6 8 750 168 750

1 9 7 4

58 0 0 0

iil 1 5 0

9 6 250

117 4511

1 1 250

33 4 0 0

631 290

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

US 5

1 072 630 i 35 600 / 1 LO8 230

6 J 6 795 ' 1 295 1100 1 931 79: 1 184 790 68 320 253 110

1 I I

58 0 0 0

I 4 1 150

: 9 6 250

177 450

1 11 250

33 4011

\ 631 290

1 -

Tota l

US i

2, 1 5 0

42 1Oi>

1 9 6 3 5 5

2 393 215 : L 624 275

~ 1

!a@ 2°C

14' 600 1 50 OoO I 5 3 b00

i 7 440

127 275 1 I

21 300 1 29 b(K2

541 015 I

I

25 250

42 1 0 0

9 6 355

4 0 1 7 490

i \

i 0 200

1 4 3 bOO

50 000

5 3 bCC

1 77 440

I 2 7 275

21 300

2 4 600

523 U L i --

38 410

216 511

63 9 0 0

27 210

134 763

155 800

23 9011

i l 5OU

b72 134 -

38 450

I 2 8 9 0 0

63 9 0 0

2 550

62 415

155 800

23 9 0 0

11 5 0 0

a 8 7 415

I

I I

146 630 1 4 7 3 015 1 I

44 lZ9 1 O7I 274 1 174 149 3 102 3ir9

! 5 9 9 7 0

250 378 ; 493 623

43 550

! 1 3 6 8 5 0 i

1

87 671

24 700

72 348

184 ;lY

1 3 0 150

2 345 43b

1 0 2 550

130 1 5 0

5 513 331

5 . 3 P r?phy lac t i c and The rapeu t i c Subs t ances

5 .3 .1 P r o g r a m e Planning and General A c t i v i t i e s

5 3 . 2 S p e c i f i c a t i o n s and Q u a l i t y Con t ro l of Pha rmaceu t i ca l p r e p a r a t i o n s

6 . 1 Promotion o f Environmental H e a l t h

6 .1 .1 Programme Planning and General h c t i v i c i e s

6 . 1 . 2 P r a v i s l o n o f Bas i c S a n i t a r y ~ e a s u r e s

6 . 1 . 3 Pre-Investment p lan- n i n g far ~ a s i c S a n i t a r y S e r v i c e s

6 . 1 . 4 Con t ro l o f Environ- men ta l P o l l u t i o n and Hazards

6 .1 .5 H e a l t h o f working P o p u l a t i o n s

6 . 1 . 6 Biomedical and Environ- men ta l H e a l t h Aspec t s o f I o n i r i n i Radiation

6 .1 .7 E o r a b l i s h r n f and S t r e n g t h e n i n g of Environmental h e a l t h S e r v i c e s and insti- c u t i o n s

6 .1 .8 Food S tanda rds P r o g r a m e

.

1 9 7 5

Regular ' Other Budqec / Sources ,

us $ us $ US s

I 36 310 ; ' 36 310 I

i 146 665 1 146 665

182 975

1 9 7 5

I 182 975

Begular ' Orher Cudget Sources

CS S US s Tota l

us 9

1 9 : b

Regular I o t h e r B u d ~ ~ t 1 Sources ;

US S US $ i L ' S S

i 4 3 040 43 040 i

1

i 74 700 74 700

562 080 155 441 , 717 521

546 351 546 351 i 1 2 7 8 3 0

11 850 830 , i 249 250 321 1 W

118 9 w 37 954 156 854

! I !

134 920 72 717 2C7 637

1 9 7 7

159 04C

202 080

33 900

Regular Budeer

i 39 800 I 39 800

159 040

202 080

33 900

186 240 ! I

226 040

I

I 84 080 84 080

1 783 2bO 793 WO , 1 576 260

1 290 100 290 100

125 910 125 910

98 950 12 5W ! 111 450

I ! 117 050 I 117 050

i 107 620 I 107 620

61 600 61 600 i

1 378 470 1 1 095 6 W 8 2 474 070 P

I !

1 124 180 1 1 061 713 2 185 893

I I

Orher Sources

186 240

226 040

T o t a l

US $ I US S

!

1 45 410 i

1 171 390 1

i

i 216 M)O

I

1

88 720 ~ !

738 900 137 500

I

' 1 7 3 0 0 1 I

us S

45 410

171 390

216 800

I

88 720

876 400

17 3 M

I i

77 9@0 77 900

I 629 910 1 0 0 7 000 1 636 910

i 458 250 1 458 250

1 6 1 3 0 0 1 1 6 0

102 250 7 1 0 5 0 1 173 300

81 WO 9 526 90 526

: 126 430 15 000

i

38 150 1

I 216 91" 1 1 560 826

j

I

162 020 I 162 020

95 800 1 9 5 X W

141 430

38 150

2 777 766

143 750

166 170

59 350

I 6Q9 510

143 750 I i

166 170 ;

59 350

1 454 710 1 154 800

7.1 Health Statistics

7.1.1 Progr-e Planning and General Activirleh

7.1.2 Health Statistical Hefhodoiogy

7.1.4 Development of Health ~ralistical services

7.2 ~ ~ ~ ~ r h Literature Services

7.3 WHO Publications

7.4 Health Information oi Public

9.1 Regional Programe Planning and ~eneral Activities

9.2 ~ ~ ~ i s t a n c e t o country 8 559 37

9.3 Regional General Support

9.4 Rrgiunal Common Services

Grand Total

1 9 7 4

~egular Budget

US $

36 950

18 230

163 740

1 9 7 5

Regular B u d ~ e ~

US S

Other Source.

Total

I 9 7 6

Other Sources us $ US S I US $

I

I 1 36 950

I 1 18 230

8 748 \ 172 488

Regular Budget

US $

41 640

67 810

1 9 7 7

US S

38 500 1

49 400 .

139 100

Other Total

Sources 1 IS I us

I

1 41 640 I 1

67 810

Regular Other Budget 1 Sources

I 44 010 38 500

49 400

139100 897601 89 760

To'a1

US 5

I 55 970 :

I

9a 070 1

44 010

5 5 970

98 070

S U m Y BY PRCGRAHHE AhD ORGANIZATIONAL LEVEL - 0

2 . 1 E X ~ C U Z ~ Y ~ Management

Inter-country

3.1 Strengthening of Health

Inter-country

3.2 Family Health

~nter-country

4.1 Xealrh Manpower Development

5 . 1 C m n u n i r a b l e Dlseasc Prevention axid c o n r r u 1

5 . 2 Non-communicable nlseasc Prevention and c a n t r u l

inter-country

5.3 Prophylactic and ~herapeutic Substances

Inter-country


Intrr-country

1.2 Heal th Literature Serv ices

7.3 WHO P~blicallons

Inter-'OuaLry

7 . 4 Health Informailon of

1nter-country

9.1 Regional P r o g r a m r Planning end Direction

9 . 2 A s s i s r a n c e t o Country ~rogr-es

9 . 3 Regional General Support

9.4 Regional Comon Services

Total: Regional

inter-country

PROGRAMME AND BUDGET ESTIMATES 1974-1977 BY APPROPRIATION SECTION WITH A TENTATIVE

PROJECTION FOR 1978 AND 1979

Appropr ia t ion S e c t i o n

1

2

3

4

5

6

7

9

T e n t a t i v e

1978

10 000

102 200

4 374 600

2 060 400

4 065 700

1 601 300

451 100

2 167 700

14 833 000

Purpose of Expenditure

Po l i cy Organs

General Management and Co-ordination

S t reng then ing of Heal th Se rv ices

Hea l th Manpower Development

Disease P reven t ion and Control

Promotion of Environmental Health

Heal th Informat ion and L i t e r a t u r e

Regional S e r v i c e and Support Programme

T o t a l

P r o j e c t i o n -

1979

25 000

106 300

4 601 200

2 298 800

4 450 300

1 800 400

460 600

2 277 400

16 020 000

1974

23 500

66 768

3 085 735

1 541 435

3 838 285

1 124 180

358 370

1 524 275

11 562 548

Obl iga t ions

1976

10 000

94 146

4 040 010

1 672 660

3 201 110

1 3 7 8 470

411 070

1 909 580

12 717 046

Estimated

1975

18 000

86 558

3 772 155

1 6 1 3 000

3 162 270

1 216 940

416 400

1 731 760

12 017 083

1977

25 000

98 290

4 275 800

1 839 525

3 556 840

1 454 710

425 830

2 058 080

13 734 075

PROGRMIE ANALYSES

Prograormel Sub-programme

1.1.3

2 .1 .3

3 . 1

3.1.2

3.1.3

3.2

T i t l e

Kegional Committee

O f f i c e of t h e Regional D i r e c t o r

S t r eng then ing of Healtli S e r v i c e s

S t r eng then ing of Heal th S e r v i c e s

Healtlr Labora tory S e r v i c e s

Family l l e a l t h

P r o g r a m e Planning and Genera l A c t f i r i t i e s

Materna l and Ct,ild Heal th

Human Ksproduction

N u t r i t i o n

Heal th Education

Heal th IIanpaver Development

Communicable Disease P reven t ion and Corl trol

Epidemiologica l Su rve i l l ance of Communicable D i sea se s

k la la r id and Ot11e.r P a r a s i t i c D i s e a s e s

Smallpox L r a d i c a t i o n

B a c t e r i a l U i sea se s

Mycobncter ia l Diseases

Virus I l i s ea se s

Venfrca l Uiseascs and l 'reponematoses

Ve te r ina ry P u b l i c Heal th

Vector Biology and Cont ro l

iion-Comunicable D i s e a s e P r e v e n t i o n and C o n t r o l

Programme Planning and Genera l A c t i v i t i e s

Cancer

Ca rd iovascu l a r D i sea se s

Other Chronic Won-Camtunicable D i s e a s e s

Denta l l l e a l t h

Mental Heal th

Programme1 Sub-programme T i t l e

P reven t ion and Con t ro l of Alcoholism and Drug Dependence and Abuse

Imnunology

P r o p h y l a c t i c and The rapeu t i c Subs tance

Programme Planning and Gene ra l A c t i v i t i e s

S p e c i f i c a t i o n s and Q u a l i t y Con t ro l of Pharmaceut ica l P r e p a r a t i o n s

Promotion of Environmental Heal th


P r o v i s i o n of Bas ic S a n i t a r y Measures

Pre-investment P lanning f o r Bas i c S a n i t a r y S e r v i c e s

Con t ro l of Environmental P o l l u t i o n and Hazards

Hea l th of Working Popu la t i ons

Biomedical and Environmental Hea l th Aspects of I o n i z i n g Rad ia t i on

Es t ab l i shmen t and S t r eng then ing o f Environ- men ta l Hea l th S e r v i c e s and I n s t i t u t i o n s

Food S t anda rds Programme

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


H e a l t h S t a t i s t i c a l Methodology

Development of Hea l th S t a t i s t i c a l S e r v i c e s

Heal th L i t e r a t u r e S e r v i c e s

WHO P u b l i c a t i o n s

Hea l th I n f o m a t i o n of P u b l i c

Regional Programme Planning and Genera l A c t i v i t i e s

A s s i s t a n c e t o Country Programmes

Regional Genera l Suppor t S e r v i c e s

Regional Common S e r v i c e s

APPROPRIATION SECTION 1 POLICY ORGANS

PROGRAMME 1.1 ORGANIZATIONAL MEETINGS

SLIB-PROGRAMME 1 . 1 . 3 REGIONAL COMMITTEE

The Regional C o m i t t e e i s composed of r e p r e s e n t a t i v e s of Member S t a t e s assigned t o t h e South-East Asia Region. The funct ions of the Regional Committee, which normally meets once a yea r e i t h e r i n t h e r eg iona l headquar ters o r elsewhere i n t h e Region as i t may decide i n advance, a r e t o formulate p o l i c i e s covering ma t t e r s of an exc lus ive ly r eg iona l c h a r a c t e r and t o supe rv i se t h e a c t i v i t i e s of t h e Regional Off ice . The Commit- t e e reviews t h e proposed reg iona l programme and budget e s t ima tes and makes suggest ions regarding implementation of h e a l t h a c t i v i t i e s of common i n t e r e s t t o t h e Member S t a t e s . It a l s o guides t h e Regional Di rec to r i n ma t t e r s l ead ing t o co-operation a t t h e regional l e v e l among t h e United Nations and t h e s p e c i a l i z e d agencies and wi th o t h e r r eg iona l i n t e r n a t i o n a l o rgan iza t ions having i n t e r e s t s i n common wi th t h e Organizat ion. Fur the r , i t may adv i se t h e Organizat ion, through t h e Director-General , an i n t e r n a t i o n a l h e a l t h mat ters which have wider than r eg iona l s i g n i f i c a n c e . The Regional Committee may a l s o g ive pre l iminary cons ide ra t ion t o ques t ions l i k e l y t o come up before the folloiqing World Health Assembly and ses s ions of t h e Executive Board.

PROGRAMME 1.1 ORGANIZATIONAL MEETINGS

SUB-PROGRAMME 1 . 1 . 3 REGIONAL COMMITTEE

Schedule A - Estimated Obliltationa

1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Estimated Obligations

Regular Budget

us $

23 500

23 500

W b e r of Posta

0 t her Sources

us $

Total Regular Budget

Total

us $

23 500

23 500

Other Sources

APPROPRIATION SECTION 2 GENERAL MANAGEMENT AND CO-ORDINATION

PROGRAMME 2.1 EXECUTIVE MANAGEMENT

SUB-PROGRAMME 2.1.3 OFFICE OF THE REGIONAL DIRECTOR

The Regional Di rec to r is t h e chief t e c h n i c a l and a d m i n i s t r a t i v e o f f i c e r of t h e Regional O f f i c e and, s u b j e c t t o t h e gene ra l a u t h o r i t y of t h e Director-General o f t h e Organizat ion, has t h e o v e r a l l r e s p o n s i b i l i t y f o r t h e p lanning, execut ion and eva lua t ion of WHO'S programme a t t h e r eg iona l l e v e l as w e l l as f o r t h e management of t h e suppor t - ing a d m i n i s t r a t i v e s e r v i c e s . He i s t h e s e c r e t a r y of t h e Regional Committee, and con- s u l t s d i r e c t l y wi th governments of t h e Member S t a t e s of t h e Region. He t akes dec i s ions on r eg iona l po l i cy ma t t e r s and ensures co-ordination wi th WHO Headquarters, w i th l o c a l o r r e g i o n a l o f f i c e s of o t h e r i n t e r n a t i o n a l o r n a t i o n a l governmental and non-governmental o rgan iza t ions and i n s t i t u t i o n s , and wi th o t h e r i n t e r n a t i o n a l o rgan iza t ions of r eg iona l scope. He keeps t h e Director-General informed of major developments a f f e c t i n g t h e h e a l t h s i t u a t i o n i n t h e Region, and p a r t i c i p a t e s i n Organization-wide d i scuss ions and consu l t a t ions on po l i cy ma t t e r s a f f e c t i n g t h e work of WHO. The Regional Di rec to r a l s o provides t e c h n i c a l and po l i cy guidance t o a l l s t a f f i n t h e Region.

P R O G W 2 . 1 EXECUTIVE MWUAGEMENT

SUB-PROGRAMME 2 . 1 . 3 OFFICE OF THE REGIONAL DIRECTOR

Schedule A - Estimated Obligations

- - - - t

- 1974 -

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Number of Posts

Regular Budget

5

5

Estimated Obligatione

Regular Budget

us $

66 768

66 768

Other Sources Total

5

5

Other Sources

us $

Total

us $

66 768

66 768

APPROPRIATION SECTION 3 STRENGTHENING OF HEALTH SERVICES

PROGRAMME 3 .1 STRENGTHENING OF HEALTH SERVICES

Objectives

To a s s i s t w i t h t h e f u r t h e r development o f t h e h e a l t h p lanning p roces s a s an i n t e - g r a l p a r t o f g e n e r a l h e a l t h development p r o g r a m e s through t h e i n t r o d u c t i o n of h e a l t h p lanning p r a c t i c e s , f o rmu la t i on of h e a l t h p l a n s and t r a i n i n g of t h e r e q u i r e d pe r sonne l ;

t o a s s i s t w i t h t h e f u r t h e r development of h e a l t h s e r v i c e s through h e a l t h s e r v i c e demonst ra t ion p r o j e c t s and r e s e a r c h i n h e a l t h p r a c t i c e , w i t h p a r t i c u l a r emphasis on i n t e g r a t i o n o f s p e c i a l i z e d h e a l t h programmes i n t o comprehensive h e a l t h s e r v i c e s ;

t o a s s i s t i n t h e improvement of s e r v i c e s s u p p o r t i n g o r a s s o c i a t e d w i t h medical c a r e systems (such a s t h e f u n c t i o n a l d e s i g n i n g of h o s p i t a l s , h e a l t h c e n t r e s , e t c . , nurs - i n g p r a c t i c e , h e a l t h r e c o r d s and s t a t i s t i c s , h e a l t h l a b o r a t o r i e s , medica l r e h a b i l i t a t i o n , medica l s t a r e s management and maintenance and r e p a i r o f medical equipment ) , and

t o a s s i s t w i t h t h e expansion of h e a l t h s e r v i c e s f o r w ide r coverage t o meet t h e b a s i c needs o f t h e community through development of e x p e r t i s e i n management, a p p l i c a t i o n of knowledge ga ined from s t u d i e s from p i l o t demonst ra t ion p r o j e c t s and implementat ion through i n t e r - d i s c i p l i n a r y teams.

Approach

- The development and s t r e n g t h e n i n g o f h e a l t h p l ann ing by a s s i g n i n g long-term s t a f f and sho r t - t e rm c o n s u l t a n t s and p rov id ing f e l l o w s h i p s f o r t r a i n i n g abroad w i t h a view t o improve t h e d e l i v e r y o f h e a l t h c a r e w i t h i n t h e e x i s t i n g f i n a n c i a l and manpower r e sou rces .

- Del ivery o f h e a l t h c a r e t o r e c e i v e g r e a t e r emphasis i n t h e y e a r s t o come, w i t h p r i o r i t y f o r s t r e n g t h e n i n g t h e c a p a b i l i t y o f n a t i o n a l h e a l t h i n s t i t u t i o n s .

- Emphasis on t h e development o f i n t e g r a t e d comprehensive h e a l i h s e r v i c e s i n o rde r t o p rov ide b a s i c h e a l t h c a r e t o t h e maximum p o s s i b l e p o p u l a t i o n , i n l i n e w i t h t h e p o l i c i e s of governments of t h e Region. S i m i l a r l y , t h e n u r s i n g component of t h e h e a l t h s e r v i c e s t o be developed by means o f count ry and i n t e r - coun t ry p r o j e c t s .

- High p r i o r i t y t o b a s i c , pos t -ba s i c and c o ~ ~ t i n u i l l g education p r o g r n ~ m e s f o r n u r s i n g and a l l i e d h e a l t h pe r sonne l .

I n t e r e s t i n t h e f i e l d of h e a l t h p l ann ing has cont inued t o grow, and i n almost every count ry h e a l t h p l ann ing u n i t s have been s t r eng thened . The n a t i o n a l h e a l t h p l an - n i n g u n i t s i n Bangladesh, I ndones i a , S r i Lanka and Thai land , i n p a r t i c u l a r , have been o p e r a t i n g i n a s t r u c t u r e d sys tem, and a p lanning u n i t has been e s t a b l i s h e d i n Nepal.

I n many c o u n t r i e s , d i r e c t a s s i s t a n c e was provided f o r t h e e s t a b l i s h m e n t of adequate h e a l t h p l ann ing o r g a n i z a t i o n s . I n Bangladesh, t h e p u b l i c h e a l t h a d m i n i s t r a t o r a s s igned t o t h e WHO-assisted h e a l t h p l ann ing p r o j e c t a l s o co -o rd ina t e s t h e a c t i v i t i e s of t h e n u r s i n g and h e a l t h a d m i n i s t r a t i o n p r o j e c t s . I n S r i Lanka, where a n a t i o n a l h e a l t h manpower s t u d y ( c o n s i s t i n g of e l even sub - s tud i e s ) was i n i t i a t e d i n 1971 and s u c c e s s f u l l y concluded a t t h e end of 1973, t h e emphasis is on i d e n t i f y i n g t h e needs of t h e count ry and t he reby f u r t h e r d e f i n i n g and enhancing t h e scope of t h e work of t h e h e a l t h p l ann ing u n i t . The H e a l t h P l ann ing D iv i s ion i n Tha i l and , a s s i s t e d by WHO s t a f f ( i n c l u d i n g a s e n i o r p u b l i c h e a l t h a d m i n i s t r a t o r and a s t a t i s t i c i a n ) , i s g a i n i n g expe r i - ence. The D iv j s ion has been c l o s e l y a s s o c i a t e d w i t h , and involved i n , t h e t r a n s f e r and developn,ent of t h e p r o j e c t system a n a l y s i s methodology and its country-wide a p p l i c a - t i o n ; t h e D iv i s ion a l s o r e c e i v e s a s s i s t a n c e , th rough c o n s u l t a n t s and f e l l o w s h i p s , i n t h e o r g a n i z a t i o n of t r a i n i n g cou r se s and seminars .

I n Indonesia , s i n c e 1970 a mul t i -d i sc ip l ina ry team has been a s s i s t i n g t h e Govern- ment i n s t r eng then ing t h e h e a l t h s e r v i c e s . The team is being r e s t r u c t u r e d t o enable i t t o provide t e c h n i c a l a s s i s t a n c e t o t h e Planning Bureau, t o t h e r e sea rch and development a c t i v i t i e s of t h e Nat ional I n s t i t u t e s of Medical Research and Hea l th , and t o t h e p e r i - phera l h e a l t h s e r v i c e s of t h e Minis t ry of Health.

A Health Planning Ce l l was e s t a b l i s h e d in Nepal, i n t h e Of f i ce o f t h e S e c r e t a r y , Minis t ry of Health. The WHO s t a f f a t tached t o t h e developnlent of h e a l t h s e r v i c e s p r o j e c t is a s s i s t i n g t h e Government i n formulat ing t h e f i f t h lrvalth p lan (1975-1980) by analys ing t h e r e s u l t s of p i l o t s t u d i e s on t h e func t ions and c a p a b i l i t i e s of h e a l t h s e r v i c e s and making surveys of h e a l t h manpower and f u t u r e p ro jec t ions on t h e needs of t h e country , based on such s t u d i e s .

The main emphasis i n a l l t h e coun t r i e s is on developing an in t eg ra ted h e a l t h s e r v i c e which would o f f e r adequate b a s i c h e a l t h c a r e t o a g r e a t e r number of people. Pending t h e r e s u l t s of t h e a n a l y s i s of d a t a c o l l e c t e d from t h e va r ious s t u d i e s , the;* i s an inc reas ing t rend towards e s t a b l i s h i n g a r e f e r r a l system among e x i s t i n g h e a l t h i n s t i t u t i o n s and toward t h e phased i n t e g r a t i o n of v e r t i c a l programmes i n t o t h e genera l h e a l t h s e r v i c e s . I n a d d i t i o n t o t h e ope ra t iona l and a c t i v i t y s t u d i e s being undertaken, a l l t h e c o u n t r i e s have e s t a b l i s h e d a b a s i c p e r i p h e r a l u n i t , which, i n most cases , con- s is ts of a h e a l t h c e n t r e s t a f f e d by a team o f f e r i n g minimum e s s e n t i a l h e a l t h s e r v i c e s . A l l coun t r i e s a r e cont inuing t o improve t h e s e r v i c e s of such p e r i p h e r a l u n i t s by analysing and reo rgan iz ing t h e d e l i v e r y system and, on t h e b a s i s of exper ience de r ived from va r ious s t u d i e s , by d e f i n i n g more c l e a r l y t h e r e s p o n s i b i l i t i e s of t h e i r s t a f f and drawing up o p e r a t i o n a l manuals.

I n r ecen t yea r s , coun t r i e s have been inf luenced by many changes i n hea l th ca re de l ive ry , and t h e nur s ing p ro fess ion i s prepar ing i t s e l f t o meet t h e growing needs and demands f o r h e a l t h c a r e . High p r i o r i t y has been given t o s t r eng then ing t h e b a s i c , pos t -has ic and cont inuing educat ion p rogrames f o r nurses i n o rde r t o improve t h e planning and d e l i v e r y of h e a l t h ca re .

A t t h e r eg iona l l e v e l , t h e a c t i v i t i e s have been co-ordinated wi th a number of p r u j u r . 1 ~ which come under t h e purview of development and planning of h e a l t h s e r v i c e s .

Closer co-operation is being e s t a b l i s h e d between l a b o r a t o r i e s i n t h e var ious coun t r i e s and i n t e r n a t i o n a l o r r eg iona l r e fe rence l a b o r a t o r i e s . Regional co-operation is promoted by WHO, which co-ordinates and promotes mutual suppor t among l a b a r a t o r i e s . bn I0 cont inues t o a s s i s t i n t h e s t r eng then ing of h e a l t h l abora to ry s e r v i c e s and i n t h e i r iixtension t o r u r a l a r e a s , e s p e c i a l l y i n Burma, I n d i a , Indonesia , and Nepal. Vaccine product ion, p a r t i c u l a r l y product ion of smallpox, DPT and r a b i e s vaccines , w i l l r ece ive tcchnir:al advice and a s s i s t a n c e f o r some yea r s t o come. Improvement i n blood t r a n s - l u s j o n f a c i l i t i e s has a l so been rece iv ing suppor t .

Following a r eg iona l meeting of s e n i o r h e a l t h admin i s t r a to r s on t h e sub jec t of medical ca re and as a follow-up of t h e t e c h n i c a l d i scuss ions a t t h e twenty-sixth s e s s i o n of t h e Regional Committee and i n t h e Sub-Committee on Programmes and Budget a t t h e same s i s s i a n , g r e a t e r emphasis is being l a i d on explor ing and evolving b e t t e r techniques of medical ca re and improving d e l i v e r y .

At its twenty-sixth s e s s i o n , i n 1973 , t h e Regional Committee adopted a r e s o l u t i o n , r eques t ing t h e Regional Di rec to r t o cont inue e f f o r t s i n t h e implementation of t h e recommendations of t h e s p e c i a l sub-committee, which i t appointed t o a s s i s t i n developing a h e a l t h c h a r t e r ; t h e recommendations of t h e sub-committee were aimed a t s ecur ing f e a s i b l e commitments from i n d i v i d u a l govermnents and a i d agencies to inc rease resources required f a r n a t i o n a l h e a l t h programmes based on a r e g i o n a l medium-term plan wi th spec i - f i c h e a l t h o b j e c t i v e s and t a r g e t s . It is proposed t o co-ordinate e f f o r t s on t h e develop- mi,nt of a h e a l t h c h a r t e r wi th country h e a l t h programming a c t i v i t i e s i n 1974 and wi th rhosc on aedium-term p r o g r a m i n g i n 1975.

Proposak for 1976-1977

The n a t i o n a l h e a l t h p lanning u n i t s which have been e s t a b l i s h e d by Governments i n t h e Region a r e expected t o acqu i re t h e competence and e x p e r t i s e necessary t o enable than t o f u l f i l t h e i r r e s p o n s i b i l i t i e s . Fur ther a s s i s t a n c e i n t h i s important f i e l d i n 1976 and onwards w i l l h e i n s p e c i a l a s p e c t s of p lanning, i n t h e implementation of h e a l t h programmes which are being formulated, and i n t h e achievement of n a t i o n a l " se l f s u f f i - ciency" i n meeting b a s i c t r a i n i n g needs .

It is hoped t h a t t h e Heal th Planning C e l l i n Nepal, i n c o l l a b o r a t i o n wi th and supported by WHO, w i l l have developed adequate competency by 1976-1977 t o t ake on t h e r e s p o n s i b i l i t y f o r p repa r ing t h e S i x t h Five-Year Plan (1980-1985).

I n I n d i a , t h e h e a l t h informat ion c o l l e c t i o n mechanism w i l l b e supported a t s t a t e and d i s t r i c t l e v e l s t o s t r e n g t h e n f u r t h e r t h e h e a l t h p lanning process i n t h e country.

By 1976, a UNDP-supported Regional Team on Heal th Se rv ices Adminis t ra t ion and Training i n Planning is expected t o p a r t i c i p a t e i n appropr i a t e h e a l t h planning and s e r v i c e a c t i v i t i e s , i n o rde r t o a s s i s t n a t i o n a l i n s t i t u t i o n s i n t r a i n i n g i n h e a l t h planning and r e l a t e d methodologies and f o r ope ra t ions research.

WHO-assisted programmes i n r e h a b i l i t a t i o n a r e designed t o assist i n t h e development of r e h a b i l i t a t i o n s e r v i c e s and t r a i n i n g , and fo l lowing assessments made by consul- t a n t s i n 1973, a r e expected t o develop i n t o comprehensive r e h a b i l i t a t i o n p rogrames t o meet t h e needs of t h e va r ious coun t r i e s .

A mul t i -d i sc ip l ina ry Regional Team on Medical Care w i l l provide a s s i s t a n c e i n t h i s f i e l d through 1976 and 1977, l i nked wi th t h e r e h a b i l i t a t i o n programme. Regional prograrmws i n h e a l t h economics and f o r q u a n t i t a t i v e h e a l t h s e r v i c e s t u d i e s a r e expected t o develop gu ide l ines f o r e f f e c t i v e eva lua t ion f o r t h e use of h e a l t h admin i s t r a to r s .

PROGRAMME 3.1 STRENGTHENING OF HEALTH SERVICES

Schedule A - Estimated Obliuations

r

. -. . - .,

1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Number of Posts

Regular Budget

10

53

18

8 1


Other Sources

1 4

4

18

Total

us $

153 430

2 548 738

642 385

3 344 553

Regular Budget

us $

153 430

1 905 355

435 955

2 494 740

Total

10

67

2 2

9 9

Other Sources

us $

643 383

206 430

849 813

SUB-PROGRAMME 3.1.2 STRENGTHWING OF HEALTH SERVICES

.?h ject ives

To p lan , e s t a b l i s h and s t r e n g t h e n h e a l t h s e r v i c e s through a network of h e a l t h i n s t i t u t i o n s and by i n t e g r a t i n g h e a l t h programmes i n t o h e a l t h s e r v i c e s aiming a t maximum coverage, p a r t i c u l a r l y i n r u r a l a r e a s ;

t o t r a i n p u b l i c h e a l t h admin i s t r a to r s - i n p lanning, admin i s t r a t ion and management of h e a l t h s e r v i c e s - and as soc ia t ed h e a l t h personnel , p a r t i c u l a r l y t o convert uni-purpose s t a f f i n t o multi-purpose workers, and

t o develop p i l o t s tudy a reas and demonstration models of h e a l t h s e r v i c e s t o form a b a s i s f o r f u t u r e expansion of t h e s e r v i c e s .

- Establishment and development of competence and e x p e r t i s e among t h e n a t i o n a l hea l th admin i s t r a t ions by t r a i n i n g , demonstration and i d e n t i f i c a t i o n of c o n s t r a i n t s , by advice an measures f o r improvement and by c r e a t i o n of an e f f e c t i v e working environment.

The s t r e n g t h m i n g of h e a l t h s e r v i c e s and, i n p a r t i c u l a r , of i n t e g r a t e d h e a l t h s e r v i c e s i n r u r a l a r e a s is being pursued i n a l l t h e coun t r i e s of t h e Region. Though t h e coverage of r u r a l popula t ions is s t i l l very l i m i t e d , t h e es tabl ishment of h e a l t h cen t re s inc reas ing ly providing promotive, p reven t ive and c u r a t i v e s e r v i c e s and g radua l ly i n t e g r a t i n g t h e s p e c i a l i z e d programmes i n t o t h e p e r i p h e r a l h e a l t h s e r v i c e s is an accepted po l i cy of governments. Many coun t r i e s a r e e s t a b l i s h i n g h e a l t h c e n t r e s , h e a l t h u n i t s o r h e a l t h p o s t s , each s t a f f e d by a doctor or an a u x i l i a r y and a team of a u x i l i a r y h e a l t h workers and cover ing, on an average , popula t ions of 30 000 t o 100 000, wi th p e r i p h e r a l sub-centres , each s t a f f e d by a number of a u x i l i a r y h e a l t h workers covering popula t ions O F 5 000 t o 10 000. Cons t ra in t s i n t h e expansion and u t i l i z a t i o n of h e a l t h s e r v i c e s inc lude lack of h e a l t h manpower, inadequate drug supply , poor communications, t h e low q u a l i t y of s e r v i c e s , t h e heavy workload on i n d i v i d u a l h e a l t h workers, an inadequate concept of team work, l ack of involvement of t h e connnunity, and unwil l ingness of doc to r s t o work i n r u r a l a r e a s . For va r ious reasons , t h e r e is, i n some c o u n t r i e s , u n d e r - u t i l i z a t i o n of r u r a l h e a l t h f a c i l i t i e s , i nc lud ing low bed occupancy.

Exerc ises i n country h e a l t h p r o g r a m i n g were undertaken i n Bangladesh i n 1973, and i n Nepal i n 1974. I t is expected t h a t more and more coun t r i e s w i l l adopt a s i m i l a r methodology i n developing t h e i r h e a l t h s e r v i c e s i n a planned and sys temat i c way. To c r e a t e a h e a l t h i n f r a s t r u c t u r e f o r an i n t e g r a t e d r u r a l h e a l t h and family planning programme, a network of thana h e a l t h complexes and union sub-centres is being e s t a b l i s h e d i n Bangladesh.

I n Burma, a p i l o t p r o j e c t on i n t e g r a t e d h e a l t h s e r v i c e s i n Kyaukse, covering four townships i n Mandalay Divis ion, was launched i n 1973. I n t h i s p r o j e c t , t h e h e a l t h workers i n t h e ma la r i a , l ep rosy , tube rcu los i s and trachoma programmes a r e pooled to- ge the r and, under r e g u l a r supe rv i s ion , form a team of multi-purpose h e a l t h workers who cover a def ined popula t ion, through v i s i t s t o t h e f a m i l i e s a t p e r i o d i c i n t e r v a l s . S p e c i a l a t t e n t i o n w i l l be paid t o occupat ional h e a l t h and h e a l t h s e r v i c e s i n a r e a s of socio-economic development.

I n o rde r t o improve t h e e x i s t i n g h e a l t h s e r v i c e s i n I n d i a , a d i a g n o s t i c s tudy of d i s t r i c t h e a l t h s e r v i c e s h a s been undertaken, and consequent improvements a r e be ing made a t t h e l e v e l of t h e primary h e a l t h cen t re . To s t r eng then t h e r u r a l h e a l t h s e r v i c e s , t r a i n i n g pKOgKaUimeS f o r medical o f f i c e r s and f o r b a s i c h e a l t h worker t r a i n e e s , a s we l l as var ious a spec t s of a d m i n i s t r a t i o n , planning and eva lua t ion of t h e h e a l t h s e r v i c e s a r e r ece iv ing a s s i s t a n c e .

In Indonesia , expe r t s i n systems a n a l y s i s , management s c i e n c e , and opera t ions research a r e he lp ing t o s t r eng then t h e h e a l t h s e r v i c e s . A Heal th Centre Reference Manual was prepared i n 1973, and work on a manual f o r maternal and c h i l d h e a l t h s e r v i c e s i s i n progress .

I n Thai land, t h e f i n d i n g s of t h e p r o j e c t systems a n a l y s i s methodology i n 1972 i n one province a re being implemented a t d i s t r i c t l e v e l . To i n c r e a s e t h e q u a l i t y and quan t i ty of p e r i p h e r a l h e a l t h s e r v i c e s , major emphasis w i l l be l a i d on t h e development of r u r a l h e a l t l ~ s e r v i c e s .

Medical c a r e has been rece iv ing due emphasis. A paper was prepared on m d i c a l ca re f o r d e t a i l e d examination by t h e Sub-Committee on Programme and Budget a t t h e twenty-sixth s e s s i o n of t h e Regional Committee. An in ter -country Seminar on Funct ional Progranming of Hosp i t a l Se rv ices was organized i n Bandung i n November 1973. Also, two guidrs - one on t h e f u n c t i o n a l programming of h o s p i t a l f a c i l i t i e s and t h e o t h e r an t h e development o f h o s p i t a l design and f a c i l i t i e s f o r nu r ses - were being prepared. Fellow- ships have been awarded f o r t r a i n i n g i n pub l i c h e a l t h admin i s t r a t ion , and WHO was a s s i s t - , i n 1973, n ineteen country and t h r e e in ter -country p r o j e c t s , i nc lud ing one on medical c a r e , which were involved i n s t r eng then ing t h e o rgan iza t ion and d e l i v e r y of h e a l t h c a r e and t h e development of h e a l t h s e r v i c e s informat ion systems.

Real progress has been achieved i n t h i s f i e l d dur ing recent y e a r s , p a r t i c u l a r l y i n regard t o t h e s t a f f i n g o f p e r i p h e r a l h e a l t h se rv ices , and i t i s expected t h a t by 1975 the r e s u l t s of e a r l i e r work and of t h e o p e r a t i o n a l s t u d i e s on i n t e g r a t i o n of d i sease - con t ro l campaigns w i l l have provided f u r t h e r impetus t o ensur ing b e t t e r q u a l i t y and coverage of t h e h e a l t h s e r v i c e s , t o which WHO w i l l c o n t r i b u t e through t h e e x i s t i n g programmes by promoting t h e exchange of t e c h n i c a l informat ion among c o u n t r i e s on t h e r e s u l t s of var ious s t u d i e s and exper iences . The emphasis w i l l cont inue t o be on improvement of p e r i p h e r a l and r u r a l h e a l t h s e r v i c e s , w i th inc reas ing a t t e n t i o n t o r e f e r r a l mechanisms.

By 1976, i t i s hoped t h a t i n Bangladesh t h e development of i n t e g r a t e d h e a l t h s e r v i c e s through t h e thana hea l th complex w i l l be w e l l advanced. S imi la r a c t i v i t i e s i n liurma, Maldives, Mongolia and Nepal w i l l a l s o l ~ e evaluated and f u r t h e r a s s i s t a n c e provided. I n I n d i a , f a c i l i t i e s a t primary h e a l t h cen t re s w i l l be upgraded and expanded, and a s s i s t a n c e t o t t le t r a i n i n g and u t i l i z a t i o n o f rnulti-purpose workers continued. The e f f o r t s o f WHO i n Mongolia and Democratic People ' s Republic of Korea w i l l be concen- t r a t e d on t h e f u r t h e r expansion of comprehensive medical care i n p e r i p h e r a l and r u r a l a reas .

I n mast coun t r i e s o f tire Region, I o r some t ime t o come, inadequate numbers of ~ i u r s i n g personnel , both p ro fess jona l and a u x i l i a r y , f o r t h e development of h e a l t h scrvices w i l l cont inue t o be a problem.

Assist:lnce w i l l b e given t o developing n a t i o n a l nu r s ing personnel and r e g i s t r a - t i o n systems f o r more e f f e c t i v e planning and u t i l i z a t i o n of nu r ses , and f o r t h e col lec-- t i o n of more accura te informat ion on t h e a v a i l a b i l i t y of t r a i n e d manpower.

An in ter -country p r o j e c t w i th a comprehensive approach t o medical r e h a b i l i t a t i o n , c,LdrLed i n 1974, w i l l a s s i s t i n t r a i n i n g n a t i o n a l teams and i n e s t a b l i s h i n g n a t i o n a l t r a i n i n g c e n t r e s .

A n i n t e r -coun t ry p r o j e c t i n medical s t o r e s management w i l l cont inue t o provide a s s i s t a n c e i n t h i s f i e l d as an i n t e g r a l p a r t of country p r o j e c t s i n t h e s t r eng then ing of h e a l t h s e r v i c e s .

SLIB-PROGRAMME 3 . 1 . 2 STRENGTHENING OF HEALTH SERVICES

Schedule A - Estimated Obli~ations

1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

+ Estimated Obligations Number of Posts

Total

us $

117 280

1 849 978

578 285

2 545 543

Regular Budget

8

42

17

6 7

Regular Budget

us $

117 280

1 453 330

371 855

1 942 465

Other Sources

us $

396 648

206 430

603 078

Other Sources

11

4

15

Total

8

53

21

82

SUB-PROGRAMME 3.1.3 HEALTH LABORATOW SERVICES

Objectives

To suppor t t h e community h e a l t h s e r v i c e s and t h e s u r v e i l l a n c e of comunicab le d i seases through an in t e r - l inked system of l a b o r a t o r i e s which would provide a r e l i a b l e s e r v i c e and func t ion a s an i n t e g r a l component of t h e n a t i o n a l h e a l t h s e r v i c e s ;

t o help t h e coun t r i e s o f t h e Region achieve s e l f - s u f f i c i e n c y i n t h e manufacture and q u a l i t y c o n t r o l of vacc ines , s e r a and b i o l o g i c a l s i n suppor t of n a t i o n a l h e a l t h programmes, and

t o e s t a b l i s h t h e capac i ty wi th in t h e Region t o meet t h e requirements f o r i n f u s i o n f l u i d s n e c e s s l t a t e d by outbreaks of cho le ra and o t h e r e n t e r i c d i s e a s e s .

- Advice i n p lanning, organiz ing and management o f h e a l t h l abora to ry s e r v i c e s i n t h e c o u n t r i e s of South-East Asia Region.

- Assis tance i n t r a i n i n g of l a b o r a t o r y personnel .

- Assis tance i n developing and e s t a b l i s h i n g s t andard p repa ra t ions and techniques and i n q u a l i t y c o n t r o l i n c l i n i c a l , p u b l i c h e a l t h and vaccine product ion l a b o r a t o r i e s .

Programme lfeuieu

The l a b o r , ~ t o r i e s a r e organized a s i n t e g r a l p a r t of g e n e r a l h e a l t h s e r v i c e s i n accordance wi th t h e views expressed by t h e t e c h n i c a l d i scuss ions group ( a t t h e n ine- t een th s e s s i o n of t h e Regional Committee, 1966) and t h e in ter -country Meeting of Health Laboratory Adminis t ra tors (1970). Inadequate r e sources , shor t age of t r a i n e d s t a f f , lack of supe rv i s ion , equipment, and r e p a i r i n g f a c i l i t i e s cont inue t o hamper development.

By 1975, i t i s expected t h a t each country i n t h e Region w i l l have b u i l t u p t h e necessary competence t o develop i t s n a t i o n a l h e a l t h l abora to ry s e r v i c e , wi th canlpetenl c e n t r a l management and q l i ~ ~ l i f i e d p r o f e s s i o n a l s t a f f providing guidance i n planning t i :c

s e r v i c i and cnsur ing e f f i c i e n t funct ioning of its d i f f e r e n t components. By 19711-1977 t h e l a b o r a t o r i e s a t c e n t r a l l e v c l in each country a r e expected t o provirle s p e c i a l i z e d and re fe rence d i a g n o s t i c s e r v i c e s i n e n t e r o b a c t e r i a e , cho le ra , s t r ep tococcus , diph- t h e r i a , p e r t u s s i s and t ~ t a n u s , smallpox, denguefhaemorrhagic f e v e r and in f luenza . Expansion of s e r v i c e s t o r u r a l pe r iphe ra l h e a l t h i n s t i t u t i o n s ( e .g . h e ~ l t h c e n t r e s ) w i l l have been i n i t i a t e d . The l a b o r a t o r i e s w i l l a l s o be a s soc ia t ed i n surveil1anc.e of communicable d i s e a s e s , inc luding ma la r i a and t u b e r c u l o s i s , i n s e l e c t e d a reas . Through in t e r -coun t ry courses , f e l lowsh ips and p r o j e c t s , s k i l l s and competence have developed i n maintenance o f equipment.

With UNICEF a s s i s t a n c e , i n t e rmed ia te and f i e l d l a b o r a t o r i e s i n a number of coun- t r i e s have been expanded and suppl ied w i t h t h e necessary equipment.

T ra in ing of l abora to ry manpower has been accorded high p r i o r i t y . Within a v a i l a b l e r e sources , NHO a s s i s t a n c e has emphasized t h e t r a i n i n g o f t h e l abora to ry s t a f f through t h e e s t ab l i shment of courses f o r t echn ic i ans a t d i f f e r e n t l e v e l s . Schools f o r t r a i n i n g t echn ic i ans of d i f f e r e n t l e v e l s have been e s t a b l i s h e d i n a l l c o u n t r i e s and t u t o r technj . c i a n s were t r a i n e d i n t each ing methodology. Regional manuals a r e being developed t o s u i t l o c a l cond i t ions i n I n d i a , Indonesia , S r i Lanka and Thailand.

Ass is tance has a l s o been provided i n t h e product ion of vacc ines , such as f reeze- d r i e d smallpox and BCG, d i p h t h e r i a , p e r t u s s i s , t e t a n u s and r a b i e s vacc ines .

I n d i a and Indonesia a r e expected t o b e s e l f - s u f f i c i e n t i n f reeze-dr ied BCG vaccine product ion; o the r s w i l l have taken s t e p s t o improve t h e an t i - r ab ies vaccines us ing BPL i n s t e a d of phenol; egg vacc ine w i l l be produced i n s i g n i f i c a n t q u a n t i t y i n I n d i a and S r i Lanka and t i s s u e c u l t u r e vaccines would be e s t a b l i s h e d i n Thailand. In Mongolia, t h e BrucelZa vaccine product ion p r o j e c t s t a r t e d i n 1973.

The r eg iona l needs f o r in fus ion f l u i d s have been reviewed and assessed. Countries wi th exper ience i n t h e product ion of such f l u i d s have been a b l e t o expand t h e i r capac i ty t o meet increased requirements. I n o t h e r coun t r i e s , t h e necessary technology has been in t roduced, and, w i t h advice from WHO and m a t e r i a l a s s i s t a n c e f r w UNICEF, production has been e s t a b l i s h e d . With a s s i s t a n c e from UNICEF, WHO and t h e United Nations Rel ief Operations i n Bangladesh, a p l a n t has been i n s t a l l e d i n Bangladesh f o r t h e product ion of in t ravenous f l u i d s and is func t ion ing .

I n d i a produces intravenous f l u i d s t o meet i ts requirements. By 1975-1976 Bangla- desh and Mongolia w i l l have increased t h e i r i n s t a l l e d capac i ty t o meet about 50 pe r cent of t h e i r es t imated needs. Decen t ra l i za t ion of product ion w i l l b e e f f e c t e d i n d iv iBiona1 h o s p i t a l s i n Burma. Nepal has p lans , wi th UNICEF a s s i s t a n c e , t o produce adequate i n t r a - venous f l u i d s f o r t h e h o s p i t a l s i n t h e Kathmandu Valley.

Emphasis i s being l a i d on t h e s t r eng then ing of q u a l i t y c o n t r o l i n both t h e h e a l t h l a b o r a t o r y p r o g r a m e s and programmes f o r t h e development of vaccines and b i o l o g i c a l s . A b a s e l i n e survey of vaccine production i n t h e coun t r i e s of t h e Region is being undertaken i n 1974; suppor t f o r development of q u a l i t y c o n t r o l l a b o r a t o r i e s both a t manufac- t u r e r and n a t i o n a l l e v e l s has been provided.

Support i s provided t o e s t a b l i s h c e n t r a l blood t r a n s f u s i o n s e r v i c e based on a f r e e blood donat ion s e r v i c e and t o r a i s e s t andards of blood banks and develop an i n t e - g ra t ed system of blood banks. A model s e r v i c e is a l r eady i n ope ra t ion i n S r i Lanka and es tabl ishment of such s e r v i c e s a r e expected i n Burma, Thailand and i n some S t a t e s i n Ind ia . A c l o s e r e l a t i o n s h i p between n a t i o n a l and reg iona l l a b o r a t o r i e s i n blood group- ing w i l l b e e s t a b l i s h e d and n a t i o n a l l a b o r a t o r i e s w i l l be s t imula ted t o meet t h e r equ i re - ments of blood banks f o r reagents t o meet t h e i r d a i l y needs.

ProposaLs for 1976-1977

Ass i s t ance i n upgrading t h e c e n t r a l n a t i o n a l l a b o r a t o r i e s t o be a b l e t o provide s p e c i a l i z e d and re fe rence s e r v i c e s i n e n t e r o b a c t e r i a e , cho le ra , s t r ep tococcus , diph- t h e r i a , p e r t u s s i s , denguelhaemorrhagic f e v e r , t e t a n u s , smallpox and in f luenza .

Ass is tance i n e s t a b l i s h i n g workshops f o r t h e r e p a i r of l abora to ry instrumenrs i n some c o u n t r i e s o f South-East Asia Region.

In co-operation wi th UNICEF, f u r t h e r expansion of t h e network of h e a l t h labora- t o r i e s a t i n t e rmed ia te l e v e l .

Ass is tance i n development of t each ing and in - se rv ice t r a i n i n g f a c i l i t i e s i n Member coun t r i e s .

A t t a in ing s e l f - s u f f i c i e n c y i n f reeze-dr ied smallpox vaccine product ion i n Burma, I n d i a , Indonesia and Thailand; i n c r e a s e i n DPT vaccine product ion i n I n d i a up t o 40 m i l l i o n doses.

Ass is tance t o i n c r e a s e f u r t h e r t h e production of Brucella vacc ine i n &ngo l i a t o reach an annual t a r g e t of 3 .5 m i l l i o n doses.

Ass is tance i n s t r eng then ing of q u a l i t y c o n t r o l l a b o r a t o r i e s i n Member S t a t e s

SUB-PROGRAMKE 3 . 1 . 3 HEALTH LABORATORY SERVICES

Schedule A - Estimated Oblisetions

PROGRAMME 3 . 2 FAMILY HEALTH

Objectives

To a s s i s t i n reducing maternal and c h i l d mor ta l i ty and morbidity and t o promote the q u a l i t y of l i f e , through development of r e l evan t family h e a l t h programmes as an i n t e g r a l func t ion of hea l th s e r v i c e s .

Approach

- Assis tance t o governments t o develop an i n t e g r a t e d h e a l t h s e r v i c e capable of d e l i v e r i n g family h e a l t h care ; de terminat ion of the types of o p e r a t i o n a l s t u d i e s t o f a c i l i t a t e the i n t e g r a t i o n process .

- Development of s u i t a b l e educa t iona l and t r a i n i n g programmes f o r h e a l t h person- n e l , community l e a d e r s , members of o t h e r p ro fess ions concerned and f o r t h e educat ion of t h e pub l i c .

- Assis tance i n c o l l e c t i o n , exchange and a p p l i c a t i o n of informat ion i n t h e f i e l d of family h e a l t h ; s t imula t ions , i n i t i a t i o n and co-ordinat ion of r e sea rch .

Programe Review

While maintaining a cons tan t and cont inuing i n t e r e s t i n the h e a l t h of the mother and the c h i l d i n a l l c o u n t r i e s , family planning, as an i n t e g r a l component of h e a l t h ca re i s rece iv ing s p e c i a l a t t e n t i o n i n some. Comprehensive family h e a l t h p r o g r a m e s , inc lud ing c l i n i c a l , pub l i c h e a l t h and t r a i n i n g a spec t s , supported by the United Nations Fund f o r Popula t ion A c t i v i t i e s , with co-ordination of United Nations agenc ies , p a r t i - c u l a r l y UNICEF, were launched i n Indonesia , Thailand and S r i Lanka. S imi la r programmes were being planned i n Ind ia , Bangladesh and Nepal. A t t h e r e g i o n a l l e v e l , t h e t r a i n i n g and teaching i n p a e d i a t r i c s , o b s t e t r i c s and gynaecology, were given emphasis; bu t i n coun t r i e s where t h e r e is growing i n t e r e s t i n family planning, human reproduct ion, family planning and demography were given s p e c i a l a t t e n t i o n through p r o j e c t s i n teaching and group educa t i ana l a c t i v i t i e s .

A s p e c i a l programme has been i n i t i a t e d i n some coun t r i e s wi th WHO and UNICEF c o l l a b o r a t i o n f o r t h e development of t h e "maternity-centred approach" t o family plan- n ing which aims a t improving t h e h e a l t h of the family by providing q u a l i f i e d maternal and c h i l d h e a l t h c a r e , educa t iona l counse l l ing , n u t r i t i o n a l advice , a long wi th advice on and p rov i s ion of con t racep t ive dev ices , proper supe rv i s ion of the use of f e r t i l i t y - r egu la t ing methods, t r a i n i n g and informat ion on t h e management of s i d e - e f f e c t s and complications.

Another a r e a i n t h e f i e l d of family h e a l t h t h a t has received and w i l l cont inue t o r ece ive h igh p r i o r i t y is educat ion and t r a i n i n g t o provide manpower f o r family hea l th . WHO has a s s i s t e d i n improving educa t iona l f a c i l i t i e s , i n s t r eng then ing medical co l l eges and schools f o r a u x i l i a r y nur s ing and midwifery personnel and i n curriculum development f o r undergraduate and post-graduate courses. WHO and UNICEF a r e c l o s e l y c o l l a b o r a t i n g i n these p r o g r a m s which a r e being acce le ra t ed .

A c t i v i t i e s i n t h e f i e l d of n u t r i t i o n a r e r e l a t e d t o t r a i n i n g i n suppor t of plan- n ing and o rgan iza t ion of n u t r i t i o n programmes i n the c o u n t r i e s , and implementation of app l i ed n u t r i t i o n programmes. Progrannnes a r e developed f o r s t u d i e s on growth and aevelopment of c h i l d r e n i n Burma and vi tamin A de f i c i ency i n Bangladesh.

Go i t r e i s a problem i n many coun t r i e s , and i n I n d i a , Burma, Nepal and Indonesia , n a t i o n a l g o i t r e c o n t r o l programmes a r e being a s s i s t e d i n c o l l a b o r a t i o n wi th UNICEF.

Studies i n h e a l t h behaviour, socio-anthropological a spec t s and t r a i n i n g of hea l th

educa to r s and eva lua t ion were developed and a s s i s t e d . Development of post-graduate courses i n h e a l t h educat ion is being a s s i s t e d i n Ind ia , Indonesia and Thailand. I n

Burma, Nepal and S r i Lanka, t h e emphasis is on t h e s t r eng then ing of h e a l t h educat ion s e r v i c e s and t h e p repa ra t ion of t h e n a t i o n a l s t a f f .

ProposaZs for 1976-1977

Development of community h e a l t h s e r v i c e s t o provide comprehensive family h e a l t h ca re t o t h e popula t ion, using t h e a v a i l a b l e r e sources of h e a l t h i n s t i t u t i o n s a s w e l l as ma te rn i ty ca re s e r v i c e s loca ted i n r u r a l p e r i p h e r a l a reas .

Developing s k i l l s i n a r e a s e s s e n t i a l t o sound long-term family h e a l t h p r o g r a m e s , e.g. , demography, management, o p e r a t i o n a l s t u d i e s , documentation and re fe rence f a c i l i t i e s .

PROGRAMME 3.2 FAMILY HEALTH

Schedule A - Estimated O b l i g a t i o n s

1974

Regional

Country

In t e r - coun t ry

T o t a l

I n t e r - coun t ry


In t e r - cuun t ry

, Estimated Ob l iga t i ons Number of P o s t s

Regular Budget

us $

114 800

414 195

62 000

590 995

Regular Budget

8

4

- 12 -

Other Sources

us $

15 540

2 805 656

248 060

3 069 256

Other Sources

2

1 3

9

2 4

T o t a l

us $

130 340

3 219 851

310 060

3 660 251

10

1 7

9

36

SUB-PROGRAMME 3.2 .1 PROGRAMME PLANNING AND GENERAL ACTIVITIES

To p l an , implement and manage t h e f ami ly h e a l t h programmes i n suppor t of and i n co-ord ina t ion wi th r e l a t e d programme and p r o j e c t s i n t h e c o u n t r i e s .

Approach

- Ass i s t ance t o develop p l ann ing and o r g a n i z a t i o n of f ami ly h e a l t h programmes.

- Prov i s ion of o p p o r t u n i t i e s , through p e r i o d i c workshops, f o r b r i n g i n g t o g e t h e r s e n i o r h e a l t h a d m i n i s t r a t o r s t o review and recommend t o governments t h e i n t e g r a t i o n o f fami ly p lanning and ma te rna l and c h i l d h e a l t h i n t o t h e g e n e r a l h e a l t h s e r v i c e s .

- Education a c t i v i t i e s f o r fami ly p l ann ing and ma te rna l and c h i l d h e a l t h adminis- t r a t i o n .

- Promotion of r e l e v a n t o p e r a t i o n a l s t u d i e s .

Programe Review

The World Heal th O r g a n i z a t i o n ' s p o l i c y of promoting t h e i n t e g r a t i o n a[ mate rna l and c h i l d h e a l t h and fami ly p l ann ing s e r v i c e s i n t o t h e g e n e r a l h e a l t h s e r v i c e s ha s h i t h e r t o been implemented by means o f :

( I ) o rgan i z ing i n t e r - c o u n t r y courses i n h e a l t h p l ann ing f o r ma te rna l and c h i l d h e a l t h and fami ly p l ann ing a d m i n i s t r a t o r s ;

( 2 ) ho ld ing p e r i o d i c workshops ( Ind i a ) t o b r i n g t o g e t h e r groups o f s e n i o r h e a l t h a d m i n i s t r a t o r s t o cons ide r and sugges t t o t h e government ways and means by which c l o s e r i n t e g r a t i o n o f t h e s e s e r v i c e s can be achieved , and

(3 ) making a v a i l a b l e t h e s e r v i c e s of c o n s u l t a n t s and long-term s t a f f i n h e a l t h p l ann ing , n u r s i n g educa t i on and demography t o a d v i s e and a s s i s t n a t i o n a l h e a l t h a d m i n i s t r a t i o n s i n p l ann ing and implementa t ion of n a t i o n a l programmes i n f a m i l y h e a l t h . ( I n Bangladesh, two c o n s u l t a n t s a s s i s t e d the Government i n drawing up f a m i l y h e a l t h programmes f o r p o s s i b l e a s s f s - t ance from UNFPA.)

While the programmes i n S r i Lanka and Tha i l and w i l l become w e l l e s t a b l i s h e d by 1974, i n I n d i a i t is expected t h a t t h e p lanning s t a g e f o r two mu tua l l y s u p p o r t i v e programmes i n f ami ly h e a l t h i n r u r a l and semi-urban a r e a s and medica l t e r m i n a t i o n of pregnancy w i l l b e completed and implementa t ion commenced. I n Nepal, w i th WHO, UNFPA and b i l a t e r a l a s s i s t a n c e , programmes w i l l b e i n i t i a t e d i n t r a i n i n g t h e r e l e v a n t h e a l t h s t a f f and i n expanding p h y s i c a l f a c i l i t i e s .

ProposaZs f o r 1976-1977

In view of the magnitude of t h e fami ly h e a l t h programmes i n I n d i a , Indones ia , S r i Lanka and Thai land , and o f t h e planned programmes i n Bangladesh and Nepal, t o g e t h e r wi th \4l4O1s r o l e a s t h e Execut ing Agency f o r UNFPA programmes, t h e Organ i za t i on w i l l con t inue t o m a i n t a i n d u r i n g 1976-1977:

(1) a c o n t i n u i n g c a p a c i t y a t t h e r e g i o n a l l e v e l and w i t h i n t h e s e c o u n t r i e s , t o moni tor and e v a l u a t e t h e implementa t ion of t h e n a t i o n a l programmes and t o p rov ide r e sou rce pe r sonne l ;

( 2 ) con t inu ing s u p p o r t th rough n a t i o n a l and i n t e r - c o u n t r y cou r se s f o r materna l and c h i l d h e a l t h and f ami ly p l ann ing s p e c i a l i s t s and a d m i n i s t r a t o r s ;

( 3 ) the p rov i s ion of f e l l m s h i p s f o r t h e t r a i n i n g o f maternal and c h i l d h e a l t h admin i s t r a to r s and planners i n maternal and c h i l d hea l rh f fami ly p lanning admin i s t r a t ion and h e a l t h planning;

( 4 ) suppor t t o s t r eng then n a t i o n a l i n s t i t u t e s f a r t h e teaching of h e a l t h admin i s t r a t ion , and

( 5 ) a mechanism f a r reviewing the pol icy , admin i s t r a t ion and s e r v i c e s f o r t h e i n t e g r a t i o n of family hea l th f fami ly p lanningfmaternal and c h i l d h e a l t h programmes i n t h e e x i s t i n g p u b l i c h e a l t h d e l i v e r y systems i n t h e coun t r i e s of t h e Region.

,UII-PRUGMMt 3 . 2 . 1 P R 0 G W ~ PLANNING AtVD GENEKAL ACTIVITIES

Sctredule A - Estimated O b l i ~ a t i o n s

F

1914 -

Regional

Country

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

T o t a l

1975 - h g i o n a l

I . r t ln t t -y

I ~ l t s r - c o u n t r y

T o t a l

1976

1:cgional

Coitntry


T o t a l

1977

Rcgional

Country

In t e r - caunc ry

T o t a l .

Estimated Ob l iga t i ons

Regular Budget

us $

Number of P o s t s

Regular Budget

Other Sources

Other Sources

us $

T o t a l

- us $

I 15 l i d 15 540 1 i I

1

1 2 1 2

15 540 2

2

2

2

2

2

2

- 1 5 540 2

2

2

2

2

2

2

i 27 500 27 500

27 500 , 27 500

I

I 30 280

30 280

32 720

32 720

I

10 280

- 30 280

32 720

32 720

SUB-PROGRAMME 3.2.2 MATERNAL AND CHILD HEALTH

Objectives

To a s s i s t i n organiz ing maternal and c h i l d h e a l t h s e r v i c e s , i nc lud ing family p lanning, a s an i n t e g r a l p a r t of b a s i c h e a l t h s e r v i c e s ;

t o provide appropr i a t e educat ion and t r a i n i n g f o r h e a l t h personnel;

t o a s s i s t i n reducing p e r i n a t a l and i n f a n t and maternal morbidity and mor ta l i ty ;

t o ensure ca re of the pre-school c h i l d , and

t o s t r eng then school h e a l t h s e r v i c e s .

Approach

- Provis ion of t e c h n i c a l guidance and t r a i n i n g o p p o r t u n i t i e s i n planning, implementation and managerial s k i l l s with a view t o organiz ing maternal and c h i l d h e a l t h s e r v i c e s , i nc lud ing family p lanning, a s an i n t e g r a l p a r t of b a s i c h e a l t h s e r v i c e s , t o inc reas ing coverage and improving q u a l i t y of maternal and c h i l d ca re t o t h e community.

- Development of methods and p rov i s ion of gu ide l ines f o r a c t i v i t i e s concerned with maternal and c h i l d care , and disseminat ion of informat ion among the h e a l t h person- n e l r e spons ib le f o r maternal and c h i l d care s e r v i c e s and t r a i n i n g .

- Promotion of and a s s i s t a n c e i n developing h e a l t h manpower i n the f i e l d of maternal and c h i l d h e a l t h , i nc lud ing family p lanning, i n o rde r t o s t r eng then and expand the family h e a l t h s e r v i c e s .

- Review and disseminat ion of r ecen t developments i n s c i e n t i f i c knowledge i n the f i e l d o f family h e a l t h .

- Promotion of and a s s i s t a n c e i n s p e c i a l s t u d i e s i n t h e f i e l d of family hea l th .

Programne Review

Assis tance was provided f o r the es tabl ishment of u n i t s of maternal and c h i l d h e a l t h i n h e a l t h d i r e c t o r a t e s , s t r eng then ing the managerial s k i l l s i n maternal and c h i l d hea l th / f ami ly planning a t a l l l e v e l s of the h e a l t h admin i s t r a t ion , and f o r the es tabl ishment and improvement of we l l co-ordinated maternal and c h i l d hea l th l f ami ly planning p rogrames i n t e g r a t e d i n t o community h e a l t h s e r v i c e s . With a view t o a s s i s t - i ng t h e c o u n t r i e s i n t h e i n t e g r a t e d approach, a s e r i e s of workshops and seminars a t country and in ter -country l e v e l s were held.

The c u r r e n t undergraduate p a e d i a t r i c teaching curriculum i n t h e medical co l l eges of t h e Region was reviewed, and a curriculum s u i t a b l e f o r t h e coun t r i e s of t h e Region was formulated t o be t r i e d o u t i n t h e medical co l l eges .

I n Ind ia , t h e remodelled undergraduate l e v e l curriculum proposed by a n a t i o n a l committee on p a e d i a t r i c educat ion i s being p re - t e s t ed i n two medical co l l eges , and a review i n i t i a t e d of needs a t i n t e r n s h i p l e v e l and f o r post-graduate s t u d i e s . A UNICEF/ WHO-sponsored Course f o r Senior Teachers i n Child Health has con t r ibu ted towards s t rengthening t h e teaching i n departments of p a e d i a t r i c s i n some of t h e medical co l l eges i n t h e Region. Ass is tance w a s g iven towards improving t h e teaching and p r a c t i c e of neonatology a t i n s t i t u t i o n a l and domic i l i a ry l e v e l s .

The t r a i n i n g programme on rehydrat ion therapy, a s an in ter -country a c t i v i t y , f o r p a e d i a t r i c i a n s and o t h e r medical o f f i c e r s engaged i n rehydrat ion therapy has encouraged t h e s e t t i n g up of rehydrat ion cen t re s i n c h i l d r e n ' s h o s p i t a l s and o t h e r h e a l t h i n s t i t u t i o n s .

Group educa t iona l a c t i v i t i e s i n schoo l h e a l t h s e r v i c e s f o r schoo l h e a l t h o f f i - c e r s , publ ic hea l th admin i s t r a to r s and maternal and c h i l d h e a l t h o f f i c e r s have provided oppor tun i t i e s f o r the improvement of schoo l h e a l t h s e r v i c e s , wi th in t h e f i n a n c i a l , phy- s i c a l and manpower resources .

Technical advisory s e r v i c e s and t r a i n i n g f a c i l i t i e s f o r improving managerial s k i l l s i n maternal and c h i l d h e a l t h a t a l l l e v e l s of the h e a l t h adminis t ra t ion.

By 1976, recommendations f o r remodelled p a e d i a t r i c c u r r i c u l a , from undergraduate to doc to ra l l e v e l , w i l l have been pre- tes ted under t h e cond i t ions e x i s t i n g i n average Indian teaching i n s t i t u t i o n s and s t e p s taken f o r t h e i r adoption i n teaching i n s t i t u - t i o n s . A p a r a l l e l a c t i v i t y w i l l have been i n i t i a t e d t o develop recommendations f o r the t r a i n i n g of s o c i a l o b s t e t r i c s .

A programme f o r the app l i ca t ion of t h e revised undergraduate p a e d i a t r i c c u r r i - ~ u l d ai,d post-gradoate s tudy i n p a e d i a t r i c s i n medical co l l eges w i l l be implemented, and ass i s t ance for the t r a i n i n g of s e n i o r teachers i n c h i l d h e a l t h w i l l continue.

Assistance w i l l continue i n the f i e l d of a p p l i c a t i o n of recent advances i n neonatology, the formulation of guidel ines on t rea tment and management of childhood diarrhoea i n rehydrat ion c e n t r e s and h o s p i t a l wards and o t h e r a s soc ia ted a c t i v i t i e s r e l a t e d t o maternal and c h i l d h e a l t h through country and in ter-country programes.

Assis tance i n developing h e a l t h i n s t i t u t i o n s , t o g e t h e r with f i e l d p r a c t i c e areas , f a r the proper o r i e n t a t i o n of a l l c a t e g o r i e s of h e a l t h personnel f o r r u r a l maternal and c h i l d h e a l t h work. These programmes w i l l be co-ordinated wi th UNICEF through provis ion o f equipment and supp l i e s t o s e l e c t e d l a r g e r i n s t i t u t i o n s , and es tabl ishment of a two- way r e f e r r a l system f o r maternal and c h i l d h e a l t h programmes. E f f o r t s w i l l continue, i n co l l abora t ion with UNICEF, t o organize in-service t r a i n i n g f o r the "heal th team", f o r the de l ive ry of maternal and c h i l d h e a l t h s e r v i c e s wi th in t h e genera l h e a l t h se rv ices .

Assistance w i l l a l s o be continued i n the assessment of the magnitude of the problems of low b i r t h weight bab ies and i t s importance i n con t r ibu t ing t o p e r i n a t a l morbidity and m o r t a l i t y , and t o provide adequate h e a l t h ca re t o the r u r a l pre-school population, a s w e l l a s i n the s t r eng then ing of school h e a l t h component of t h e in teg - r a t e d h e a l t h s e r v i c e s .

SUB-PROGRANHE 3.2.2 MATERNAL AND CHILD HEALTH

Schedule A - Estimated Obl iga t ions

1974

Regional

Country

Inter-country

T o t a l

In ter -country

In ter -country

In ter -country

Number of P o s t s

Regular Budget

4

1

5

Estimated Obl igat ions

Regular Budget

us $

73 000

118 845

47 900

239 745

Other Sources

7

8

15

Total

4

8

8

20

0 t her Sources

us $

947 962

118 110

1 066 072

- Tota l

us $

73 000

1 066 807

166 010

1 305 817

SUB-PROGRAMME 3 . 2 . 3 HUMAN REPRODUCTION

01, jcc t i u d s

To injpravr the q u a l i t y of family l i f e , i n view of t h e adverse impact of r i s i n g population wi th in the Region on the h e a l t h and values o f s o c i e t y as a whole, through a s s i s t a n c e i n the development and implementation of i n t e g r a t e d family planning programmes.

- Assis tance i n developing i n t e g r a t e d h e a l t h s e r v i c e s t o meet t h e chal lenge and demand of the popula t ion f o r family planning s e r v i c e s .

- Education and t r a i n i n g of h e a l t h and o t h e r r e l a t e d personnel i n p r i n c i p l e s and t ec l~n iques of f e r t i l i t y c o n t r o l methods.

- Col lec t ion , a n a l y s i s and disseminat ion o f informat ion p e r t a i n i n g t o popula t ion dynamics and human reproduction.

- Assis tance i n planning and conducting c l i n i c a l , demographic, epidemiological , behavioura l and o p e r a t i o n a l s t u d i e s i n the f i e l d of human reproduct ion and popula t ion dynamics.

Na t iona l family planning s e r v i c e s i n some Member c o u n t r i e s s t a r t e d as e a r l y a s 1960 wi th a s s i s t a n c e mainly from b i l a t e r a l sources , and WHO a s s i s t a n c e i n t h i s f i e l d s t a r t e d i n 1970.

I n S r i Lnnka, t h e i n i t i a t i o n i n 1966 of a n a t i o n a l family planning programme wi th Swedish a s s i s t a n c e and a l s o the v i s i t , i n .lanuary 1971, of a United Nations Inter-agency Family Planning Evaluation Mission, l e d t o proposals f o r the development of an expanded n a t i o n a l family h e a l t h programme, with UNFPA a s s i s t a n c e and WHO a c t i n g a s t h e Executing Agency.

I n Indonesia,WHO a s s i s t a n c e s t a r t e d i n 1970 concurrent ly wi th t h e a c t i v i t i e s o f t h e IBRD and of a j o i n t IDA/UNFPA a p p r a i s a l mission and p r o j e c t proposal . The programmes a r e a t p resen t i n t h e implementation s t a g e and, by 1975, w i l l be we l l es tab- l i shed . I n 1975 an e x t e r n a l review of the family h e a l t h p r o j e c t w i l l be c a r r i e d o u t followed by a f i n a l p r o j e c t review a t the end of 1976.

In I n d i a i t is expected t h a t a n a t i o n a l planning c e l l and task fo rce , w i th WHO a s s i s t a n c e , W i l l complete p repa ra t ion o f p l ans f o r a country-wide maternity-centred family planning p r o j e c t t o b e funded by UNFPA. Ass is tance i s a l s o being given i n promoting medical te rminat ion of pregnancy under a new l i b e r a l i s e d abor t ion law through a programme of i n t e r n a t i o n a l fe l lowships f o r n a t i o n a l l eade r s , followed by suppor t f o r the deve lopwnt of a number of t r a i n i n g c e n t r e s throughout t h e country i n techniques of pregnancy terminat ion, This programme, i n i t i a t e d i n 1974, w i l l expand i n 1975 and subsequent yea r s , and w i l l co-ordinate wi th the materni ty-centred family planning pro- j e c t which is a t p resen t i n t h e planning s t age .

pre l iminary planning f o r a WHO-assisted family p lanning p r o g r a m e i n Maldives is expected t o be i n i t i a t e d i n 1975.

I n Thailand s i x p r o j e c t s have been i n ope ra t ion s i n c e 1973. Of these , one has been completed. Four p r o j e c t s w i l l be evaluated i n 197411975 f o r con t inua t ion of ope ra t ions . A p r o j e c t reques t covering con t inua t ion o f the f i f t h p r o j e c t is under submission by t h e Government t o U N P A .

I n Bangladesh t h e f a m i l y h e a l t h programme, t o be funded by UNFPA, was s c h e d u l e d t o come i n t o o p e r a t i o n by mid-1974.

I n Nepa l , a fami ly h e a l t h programme, w i t h UNFPA s u p p o r t , i s e x p e c t e d t o become o p e r a t i v e i n 1974, f o l l o w i n g t h e v i s i t o f a j o i n t WHOIUNFPA M i s s i o n .

I n a d d i t i o n t o a s s i s t i n g i n t h e m o n i t o r i n g and implementa t ion of n a t i o n a l fami ly h e a l t h p r o g r a m s , t h e O r g a n i z a t i o n , through n a t i o n a l and i n t e r - c o u n t r y e d u c a t i o n a l a c t i v i t i e s , c o n t i n u e s t o promote s e r v i c e , t e a c h i n g and r e s e a r c h a s p e c t s i n human repro- d u c t i o n , f a m i l y h e a l t h and p o p u l a t i o n dynamics, p a e d i a t r i c s and f a m i l y h e a l t h , and o p e r a t i o n a l s t u d i e s i n i n t e g r a t e d m a t e r n a l and c h i l d h e a l t h l f a m i l y p l a n n i n g .

Country group e d u c a t i o n a l a c t i v i t i e s i n S r i Lanka i n c l u d e t r a i n i n g c o u r s e s f a r h o s p i t a l a t t e n d a n t s , pa ramedica l and a u x i l i a r y h e a l t h p e r s o n n e l i n v o l v e d i n t h e f a m i l y p l a n n i n g programme, and r e f r e s h e r i n - s e r v i c e t r a i n i n g c o u r s e s f o r t r a i n e r s , t h e t r a i n i n g of medica l o f f i c e r s and a s s i s t a n t medica l p r a c t i t i o n e r s , p u b l i c h e a l t h i n s p e c t o r s , nur- s e s and o t h e r s i n v o l v e d i n t i le fami ly h e a l t h programme.

I n T h a i l a n d , a t t h e end of 1974, a review w i l l b e c a r r i e d o u t , w i t h p a r t i c u l a r r e f e r e n c e t o t h e t r a i n i n g c o u r s e s t o be h e l d i n 1975, of t h e c u r r i c u l a f o r t h e t r a i n i n g c o u r s e s and any m o d i f i c a t i o n s t h a t a r e r e q u i r e d i n t h e t r a i n i n g s c h e d u l e and c o n t e n t o f t h e c o u r s e s .

To s u p p o r t and p r o v i d e a pool of r e s o u r c e p e r s o n n e l f o r c o u n t r y and i n t e r - c o u n t r y a c t i v i t i e s f o r s e r v i c e , t r a i n i n g , e v a l u a t i o n and r e s e a r c h i n fami ly h e a l t h , an i n t e r - c o u n t r y team, e s t a b l i s h e d e a r l y i n 1971 and r e c o n s t i t u t e d i n 1973 t o i n c l u d e m a t e r n i t y - c e n t r e d f a m i l y p l a n n i n g a c t i v i t i e s i n t h e Region, w i l l be m a i n t a i n e d .

Proposals for 1976-1977

F u r t h e r a s s i s t a n c e w i l l b e p r o v i d e d i n s t r e n g t h e n i n g of community h e a l t h s e r v i c e s , and i n t r a i n i n g of n a t i o n a l h e a l t h workers c a p a b l e o f d e l i v e r i n g f a m i l y h e a l t h s e r v i c e s .

I n co-opera t ion w i t h LNFPA, IBW and i n t e r n a t i o n a l and b i l a t e r a l a g e n c i e s , governments w i l l b e a s s i s t e d i n promoting and expanding t h e m a t e r n i t y - c e n t r e d f a m i l y p l a n n i n g programmes.

A s s i s t a n c e w i l l b e g i v e n t o t r a i n i n g , r e f r e s h e r and c o n t i n u i n g e d u c a t i o n programmes, t e a c h i n g of human r e p r o d u c t i o n , p o p u l a t i o n dynamics, demography and f a m i l y p l a n n i n g t e c h n i q u e s a c c e p t a b l e by t h e c o u n t r i e s .

SUB-PROGRAMME 3.2.3 HUMAN REPRODUCTION


SUB-PROGFIAWE 3 . 2 . 4 NUTRITION

Object ives

To a s s i s t i n improving the n u t r i t i o n a l s t a t u s of the popula t ion and i n con t ro l - l i n g major farms of ma lnu t r i t i on .

Approach

- Assis tance i n developing n a t i o n a l food and n u t r i t i o n a l p o l i c i e s .

- Assis tance i n f u r t h e r developing n u t r i t i o n components i n t h e t r a i n i n g c u r r i c u l a f o r medical and a l l i e d h e a l t h personnel , and i n post-graduate t r a i n i n g i n n u t r i t i o n .

- Development of e f f e c t i v e programmes f o r the prevent ion of xerophthalmia, n u t r i - t i o n a l anaemia and endemic g o i t r e .

Programme Revim

Since 1949, the s i g n i f i c a n c e of n u t r i t i o n a l problems i n t h e Region received t h e a t t e n t i o n of the Regional Committee. A t the twenty-sixth s e s s i o n , the Regional Com- m i t t e e endorsed t h e recommendation of t h e Spec ia l Sub-Committee of the Regional Com- m i t t e e t o inc lude ma lnu t r i t i on a s one of the four major p r i o r i t y h e a l t h problems f o r development i n t h e proposed Asian Health Char ter .

P r a t e i n - c a l o r i e ma lnu t r i t i on , n u t r i t i o n a l anaemias, v i tamin A def i c i ency and g o i t r e continue t o be the major n u t r i t i o n a l problems i n t h e Region.

WHO has a s s i s t e d i n the developrent of measures f o r the prevention and t rea tment of n u t r i t i o n a l d i seases , through c o l l a b o r a t i v e s t u d i e s and research g ran t s from Head- q u a r t e r s and through p r o j e c t s t o s t r eng then prevent ive and c u r a t i v e measures by t h e h e a l t h s e r v i c e s .

A r eg iona l seminar on endemic g o i t r e was he ld i n 1967 and reg iona l meetings on xerophthalmia and n u t r i t i o n a l anaemia i n 1972 and 1973, r e spec t ive ly . I n 1975, i t is planned t o organize a meeting on modem methods f o r t h e con t ro l of p ro te in -ca lo r i e mal- n u t r i t i o n and o t h e r forms of ma lnu t r i t i on .

Proposals f o r 1976-1977

Assis tance t o c o u n t r i e s t o implement measures a g a i n s t n u t r i t i o n a l d i seases a s p a r t of t h e r e g u l a r work of the h e a l t h s e r v i c e s t a f f .

Ass is tance wi th t r a i n i n g programmes t o he lp develop e x p e r t i s e a t d i r e c t o r a t e l e v e l and i n t r a i n i n g i n s t i t u t i o n s .

Ass is tance i n s t r eng then ing measures aga ins t var ious forms of ma lnu t r i t i on through t h e maternal and c h i l d h e a l t h and genera l h e a l t h s e r v i c e s .

Regional workshops w i l l be conducted on the teaching of n u t r i t i o n i n nledical schools and i n t r a i n i n g i n s t i t u t i o n s f o r o t h e r ca t egor i e s of h e a l t h personnel .

SUB-PROGRAMME 3.2.4 NUTRITION


SUB-PROGUMME 3 .2 .5 HEALTH EDUCATION

Ob jectiues

To promote h e a l t h educat ion a c t i v i t i e s a t t h e c o m u n i t y and re l evan t i n s t i t u - t i o n a l l e v e l s ;

t o a s s i s t i n p lanning and implementation of h e a l t h educat ion programmes as i n t e g r a l components of n a t i o n a l h e a l t h programmes, and

t o assist i n t h e conduct of s p e c i f i c s t u d i e s t o i d e n t i f y and eva lua te t h e speci - f i c c o n t r i b u t i o n of h e a l t h educat ion t o t h e promotion of h e a l t h s t a t u s of t h e popula t ion.

Approach

- Provis ion of t echn ica l guidance i n po l i cy formulat ion, p lanning, implementation and eva lua t ion of comprehensive h e a l t h educat ion programme a t a l l a d m i n i s t r a t i v e l e v e l s of t h e h e a l t h s e r v i c e s .

- Support and co-ordinat ion of mul t i -d i sc ip l ina ry s t u d i e s and re sea rch i n t h e behavioura l s c i ences , a s a b a s i s f o r development of s u i t a b l e educa t iona l programmes.

- Assis tance i n i n t e g r a t i n g h e a l t h educat ion a t a l l Levels of n a t i o n a l h e a l t h programmes; a s s i s t a n c e i n de f in ing r e s p o n s i b i l i t i e s and t a sks of h e a l t h workers and i n t h e development of t r a i n i n g and superv i so ry programmes.

- Exchange of r e l e v a n t t e c h n i c a l and a d m i n i s t r a t i v e informat ion and exper ience and follow-up a c t i v i t i e s r e s u l t i n g from such meetings.

- Provis ion of s e l e c t e d key h e a l t h personnel and teacher educators wi th opportuni- t i e s f o r advanced s p e c i a l i z e d educat ion.

The u l t ima te aim of h e a l t h educat ion programme is t o b r ing about d e s i r e d h e a l t h behaviour i n i n d i v i d u a l s , f a m i l i e s and communities. Health educat ion a c t i v i t i e s were s t rengthened among the p r i o r i t y groups of popula t ion, t o c r e a t e awareness about t h e p r e v a i l i n g h e a l t h problems and on-going h e a l t h programmes and t o enable e f f e c t i v e and a c t i v e community p a r t i c i p a t i o n i n the programmes. The e f f e c t i v e n e s s of t h e educa t iona l approach i n the s o l u t i o n of h e a l t h p r o b l e m , u t i l i z i n g l o c a l r e sources , have l a i d a f i r m foundation f o r extending h e a l t h educat ion i n an organized manner i n t h e f u t u r e . As a r e s u l t of t hese programmes, governments of s e v e r a l coun t r i e s have increased t h e budget a l l o c a t i o n s f o r h e a l t h educat ion and have reorganized t h e e x i s t i n g h e a l t h educat ion s t r u c t u r e s . The major l e s son of t h e s e p r o j e c t s , t h a t comuni ty l eade r s should be involved from t h e e a r l y planning s t a g e and t h e i r i n t e r e s t should be maintained by appropr i a t e educa t iona l measures, repeated r e g u l a r l y a t t h e a p p r o p r i a t e time i s t h e b a s i s t o improve e x i s t i n g p rogrames and f o r f u t u r e planning. Greater emphasis on school h e a l t h educat ion programmes i n S r i Lanka, I n d i a , Nepal, B u m and Thailand is a d i r e c t r e s u l t of increased c o m u n i t y involvement.

S tudies and research p r o g r a w e s a r e i n progress i n d i f f e r e n t a spec t s of family h e a l t h educat ion and communications. Five r e sea rch p r o j e c t s , supported by g r a n t s from WHO Headquarters, a r e i n progress i n I n d i a and Indonesia . Seve ra l s t u d i e s were undertaken i n Indonesia and S r i Lanka a s a p a r t of s c i e n t i f i c development of family h e a l t h educat ion. The r e s u l t s from these s t u d i e s have been u t i l i z e d t o improve programmes.

Pas t exper ience has shown t h a t t r a i n i n g of h e a l t h and a l l i e d personnel i n h e a l t h educat ion should be based on s p e c i f i c job d e s c r i p t i o n s of d a i l y d u t i e s and responsibi - l i t i e s . I n a l l t h e c o u n t r i e s af the r eg ion , a n a l y s i s is being made of h e a l t h workers '

d u t i e s and r e s p o n s i b i l i t i e s and d e l i n e a t i n g t h e i r educa t iona l components. P r a c t i c a l and f i e ld -o r i en ted t r a i n i n g programmes have been conducted and manuals have been prepared t o a s s i s t h e a l t h educat ion work a t t h e f i e l d l e v e l i n Ind ia , Indonesia and S r i Lanka, t o equip s t a f f t o undertake t h e i r h e a l t h educat ional r e s p o n s i b i l i t i e s e f f e c t i v e l y . This approach w i l l be f u r t h e r t e s t e d and rev i sed .

The r e s u l t of previous a c t i v i t i e s i s t h a t h e a l t h p lanner s working wi th p a e d i a t r i - c i ans and h e a l t h educators have agreed on t h e value of a s s o c i a t i n g h e a l t h educators and beliavioural s c i e n t i s t s i n planning h e a l t h programmes, i n o rde r t o u t i l i z e l o c a l f o r c e s i n e f f e c t i v e programme implementation. Involvement of m u l t i - d i s c i p l i n a r y groups i n t h e planning process was considered e s s e n t i a l . In ter -country a c t i v i t i e s focussed on (1) t h e t r a i n i n g of h e a l t h educators i n t h e methods of eva lua t ion and s o c i a l s c i ence researc l j and ( 2 ) the examination and r e v i s i o n of m a t e r i a l s and re sources used i n the t r a i n i n g of h e a l t h educators t o make t h e con ten t of such m a t e r i a l s more r e l evan t t o t h e c o u n t r i e s of t h e Region.

A l l t h e c o u n t r i e s of t h e Region have been planning t o expand t h e r equ i red manpower i n s p e c i a l t i e s such a s community h e a l t h educat ion, family h e a l t h educat ion, school h e a l t h and popula t ion educat ion, behavioura l s c i ences , mass communication, audio-visual educa- t i on , indigenous media and educa t iona l technology. Five schools o r i n s t i t u t i o n s of p u b l i c h e a l t h i n the Region pruviding post-graduate t r a i n i n g i n h e a l t h education would be a b l e t o develop adequate manpower needs i n some of these s p e c i a l t i e s by 197611977. The Health Education Manpower Development Programme i n Indonesia was implemented s u c c e s s f u l l y according t o schedule, and t h e n a t i o n a l post-graduate course s t a r t e d i n 1974. Pre l iminary p repa ra t ions have been i n i t i a t e d f o r t h e p o s s i b l e development of post-graduate t r a i n i n g courses i n family h e a l t h educat ion i n S r i Lanka dur ing 197611977. It is envisaged t h a t t h e s e courses w i l l be a p a r t of t h e u n i v e r s i t y graduate course i n community h e a l t h .

Expansion of h e a l t h educat ion p r o g r a m e s i n a l l c o u n t r i e s of t h e Region and developing a model programme i n each country i l l u s t r a t i n g t h e methods, techniques and advantages of cornuni ty involvement and suppor t .

Expansion of e x i s t i n g behavioura l s t u d i e s wi th t h e aim of developing b a s i c informa- t i o n fo r h e a l t h educat ion p rograming and f o r developing a corps of experienced re sea rch workers i n Burma, Thailand and o the r c o u n t r i e s a s f e a s i b l e .

P re - t e s t ing and r e v i s i o n of d r a f t manuals f o r conducting h e a l t h educat ion a t the f i e l d l e v e l a s necessary .

P repa ra t ion of a d d i t i o n a l r e sources us ing r e g i o n a l informat ion, f o r teaching h e a l t h educat ion and behavioura l s c i ences i n t h e t r a i n i n g programmes of t h e c o u n t r i e s ; suppor t t o n a t i o n a l t r a i n i n g progranmes i n s o c i a l s c i e n c e r e sea rch methods; a concerted e f f o r t t o fo l low up, e v a l u a t e and f u r t h e r a s s i s t o t h e r progrannnes and a c t i v i t i e s which have developed a t t h e country l e v e l as a r e s u l t of WHO a s s i s t a n c e .

Provis ion of a d d i t i o n a l t e c h n i c a l a s s i s t a n c e t o develop post-graduate h e a l t h educa- t i o n progranrmes.

SUP-PROGRAMME 3.2.5 HEALTH EDUCATION


1974 - Regional

Country

Inter- country

Total

Inter-country

Inter-country

Inter-country

Number of Posts 1


Regular Budget

2

3

- 5

- Total

US $

12 750

1 209 976

57 640

1 280 366

Regular Budget

us $

12 750

179 200

8 000

199 950

Other Sources

5

I

6

Other Sources

us $

1 030 776

49 640

1 080 416

Total

2

8

1

11

APPROPRIATION SECTION 4 HEALTH MANPOWER DEVELOPMENT

PROGRAMME 4.1 HEALTH MANPOWER DEVELOPElENT

Objectives

To develop and apply relevant methodology for comprehensive health manpower development and utilization and to assist in establishing a system of recruitment, training and utilization of health manpower, both in terms of quantity and quality to meet the existing and projected needs and demands of national health services;

to identify and specify the functions ti~at each health worker has to perform, including family health activities, and to determine the lines of communication in interaction, supervision and referral;

to promote the recognition and identification of the contributions and the role of auxiliary health personnel in the delivery of health services;

to orient teaching and training programmes (basic as well as in-service) to the agreed tasks that the members of the "health team" are to perform and, where appropriate, to develop multi-disciplinary training;

to strengthen effective involvement of the community in health activities and to include, in the training of health personnel, the ways and methods of approaching the community to enlist its participation;

to promote application of innovative teaching methodology, including aids to learning, particularly in teacher training programmes;

to assist countries in the development and application of systematic evaluation of educational and training programmes, and

to promote continuing education in the Region

Approach

- Assistance in relevant health manpower studies and collection of basic infonna- tion needed for health manpower planning, development and utilization. Results of completed studies to be used in the planning for improved quality and expanding the coverage of health care provided to rural and urban communities and through proper deployment of the staff, and defining lines of communication and supervision.

- Training and retraining of allied health workers at peripheral and intermediate levels, with effective education methods and media; both practical and field training to be adapted to local needs.

- Further strengthening of the training of teachers in medical and allied health sciences; also co-ordination with national teacher training centres, education technology units and developing locally appropriate teaching aids and training of teachers to use them effectively.

- Determination of cost effectiveness of diEferent educational and traininq activities suitable for various categories and levels of health and allied personnel.

- Critical study of the fellowships programe and formulation of future plans on fellowships to meet national priority health and allied manpower needs. Training, as far as possible, the required personnel within the country or in countries with similar socio-economic and cultural background. Fellowships for acquiring advanced knowledge and sophisticated skills as and when essential.

- Appropriate inter-disciplinary group educational activities.

P r o g r m e Review

Shortage of appropriately trained health personnel is a major obstacle to expanding and improving the delivery of health care to urban and rural populations. This is further aggravated by emigration of highly qualified health personnel and maldistribution of available manpower and imbalances between various categories of health personnel. The urgent need for a planned development and utilization of health manpower as a part of the national health plans and country health programing has been recognized by all Mem- ber countries.

Support has been given to include health planning and management practices in training curricula to ensure better administrative capabilities and delivery of health care at all levels of health services. Centres for the development of and training in educational planning and technology have been started in three countries. It is planned to expand these activities to other countries.

National health manpower studies undertaken in some countries of the P.egion have now provided data on the utilization of the health personnel and the tasks performed by them. It is important to utilize these data in the development of instructional ohjec- tives and build them into the medical and nursing curricula.

To ensure maximum utilization of limited teaching and training resources, a suitable machinery for co-ordinating all major activities of health manpower development, undertaken either within or outside the health ministries, is being established to ensure effective utilization of assistance from United Nations, bilateral and other agencies.

The development of comprehensive health programmes delivered through multi-purpose workers in the field has required increased attention to developing, training, organizing, and supervising this category of health workers. Studies have been initiated relating to identifying and standardizing the function, role and status of each level of health worker, for service in peripheral and intermediate level institutions. Such studies conducted in Nepal and India have already yielded useful data which will be utilized in developing job- and field-oriented training programmes. Training of trainers of these workers and the development of work manuals and teaching resource materials, will continue to receive emphasis.

There is also an increasing need for well-trained epidemiologists in the countries of the Region. Such epidemiologists could not only apply epidemiological methodology in the control of communicable diseases, but also in the field of non-communicable diseases as well as provide leadership and support for programmes in the "maintenance" phase. Improvement in the quality of training in epidemiology is continuously taking place as in the case of training of personnel required for health laboratories and statistical and other relevant public health programmes.

The effective utilization of the services and promotion of individual family and community health requires the active participation of people. Priority has been given to train health education specialists to assist in such training programmes and to provide necessary supervision and guidance in the educational efforts of the field workers.

The objectives of continuing education activities are aimed at creating an interest in, stimulating and assisting in the utilization of the latest knowledge and techniques in various fields. Refresher courses held in the previous years are being evaluated.

As programmes of medical teacher training, continuing education, training in the teaching of family planning, human reproduction and population dynamics, and community medicine progress, they would increasingly utilize latest developments in medical pedagogy and education technology; expanded use of regional medical teacher training centres

would also contribute to increasing utilization of such modern developments.

The shortage of qualified nurses in teaching and administrative positions, lack or inadequacy of planning for development of nursing resources, education and training, lack of nursing structure that would enhance planning for nursing development, inflexi- ble systems of education and outdated programmes of nursing education, poor recruitment and selection practices, and inadequate facilities for teaching both in the classroom and in the field are hindering development of essential nursing manpower.

Assistance would be focused on generating innovative approaches to educating nurses, as well as meeting the increasing demands for the preparation of basic educational materials in local languages.

Seminars have been held on training and utilization of sanitary personnel and on education and training in sanitary engineering and action taken to implement recomenda- tions arising out of these educational activities. A study of environmental health manpower, to be undertaken in 1974, is expected to provide the required data for developing programmes for improvement of environmental health manpower planning and needs in the Region.

Although the impact of educational and training programmes are being reviewed, it has been realized that there is an urgent need for systematic, co-ordinated evaluation of different activities undertaken in health manpower development. Suitable evaluation methods, tools and criteria for evaluation are to be developed, tested and standardized.

It is proposed to explore the possibility of making a study of the relative effectiveness and cost of various teaching-learning methods employed in medical schools and institutions teaching nurses.

Such studies will be undertaken in the Regional Medical Teacher Training Centres a t Peradeniya (Sri Lanka) and Bangkok.


Manpower assessment,planning and development,utilizing sound management techniques in personnel adrninistration,for efficient utilization of the available manpower as well as for improvement of the quality of statistics relating to health manpower.

Establishment and promotion of a suitable machinery for co-ordinating major activities for health manpower development, especially in strengthening the field and practical training, team training, teacher training and development of curricula and teaching aids.

Definition of the duties and responsibilities of health and allied workers ac peripheral and intermediate levels, improvement of the systems of communication and, supervision and identification of the workload, activities and skills required to deliver minimum essential cornunity health services.

Development of teaching models for common use and evaluation of training methodologies suitable for different disciplines.

Promotion of teaching of human reproduction, family planning and population dynamics in medical colleges, nursing institutions and other training centres in the countries within the on-going or planned national family health programme.

Further development of the programme of medical teacher training and education technology for effective utilization of modern advances in pedagogy.

Development of appropriate training programmes of a multi-disciplinary nature to prepare auxiliary health personnel to meet adequately the national health care needs; preparation of work manuals in local languages.

Integration of the teaching of health education into the training programmes of different categories of health and allied personnel and training of health education specialists needed to man selected key positions.

Improvement of environmental health manpower planning; development of manuals, guides and other resource material for the training of different categories of sanitation and environmental health personnel.

Strengthening of on-going training programmes to meet the manpower needs of the programmes for prevention, control and surveillance of communicable diseases.

Further promotion of continuing education for the health personnel of all categories of service.

Development of a cadre of nurses in senior administrative positions who could effectively participate in the development of health plans.

Strengthening of education fcr nursing midwifery personnel at all levels - from the indigenous midwives to the post-graduate level - including preparation of texts, manuals, guidebooks and educational materials in local languages.

Planning, co-ordination, evaluation and follow-up of group educational activities will be further systematized and the resources of the national institutions will be utilized more and more for conducting these activities.

In the changing socio-economic conditions of the developing countries, a dynamic and co-ordinated approach will be pursued for health manpower development aiming at the optimum utilization of existing resources with in-built evaluation and follow-up procedures. The results of studies in needs, job and task definitions of various categories of health and allied personnel in different local situations will be applied to curricula construction, training programmes and continuing education. It is expected that a multi-disciplinary approach in manpower training will help in creating health teams which could produce positive impact on the programmes.

PROGRAMME 4.1 HEALTH MANPOWER DEVELOPMENT

Schedule A - E s t i m a t e d O b l i g a t i o n s

APPROPRIATION SECTION 5 DISEASE PREVENTION AND CONTROL

PROGRAMME 5.1 COMMUNICABLE DISEASE PREVENTION AND CONTROL

Objectives

To assist in the development and strengthening of the epidemiological surveillance of communicable diseases of public health importance;

to assist in the development of programmes for the prevention and control of communicable diseases, with particular reference to comprehensive immunization procedures, and

to promote the integration of such programmes into the general health services.

Approach

- Early detection of outbreaks of comunicahle diseases, prompt reporting and prompt establishment of control measures.

- Improvement of quality of clinical and laboratory diagnosis of communicable diseases in all areas.

- Improvement of co-operation amongst health services units in different areas in order to enable collaborative action to be taken for the prevention of spread of communicable diseases.

- Constant attention to the technical competence of staff responsible for diagnosis, treatment and control and surveillance of communicable diseases.

- Promotion of and support to national and international seminars to discuss experiences and ways of overcoming various constraints in the implementation of communicable disease control activities.

- Initiation and successful conducting of immunization programmes to cover at least 80% of the total eligible child population.

Infectious diseases are still of greatest concern to Member States of the South- East Asia Region. According to the information available, the following are the priority areas in communicable diseases of public health Importance:

(a) Notification, registration and surveillance of communicable diseases are unsatisfactory in the majority of the countries.

(b) Eradication of smallpox. Though smallpox and malaria programmes have satisfactory registration and fair surveillance and control services, out of four countries in the world where smallpox is still endemic, two are in this region.

(c) On the basis of studies in the countries of this Region, assisted by WHO, it was possible to estimate the prevalence and incidence of tuberculosis for all countries of the Region. A rough estimation of the leprosy problem in the countries has been made.

(d) In most of the countries data on tetanus, poliomyelitis, diphtheria, gastro-enteric infections and their late sequelae are limited.

( e ) I m n i z a t i o n programmes a r e i n t he development s tage i n the majori ty of the countries. Inrmunization programmes aga ins t tuberculosis with BCG vaccine have been r e l a t i v e l y b e t t e r developed i n the majority of the countr ies and t he estimated coverage i n 1970 among school chi ldren was i n the range of 5 t o 40 per cent. In some countr ies of the Region, attempts were made t o introduce mul t ip le immunization programmes on an integrated ba s i s ( S r i Lanka) or to combine smallpox and BCG vaccina- t ions i n t o a s i ng l e programme (Indonesia).

( f ) Active cholera outbreak occurred i n 1959 i n one of the countr ies of South-East Asia Region, and two countr ies i n the Region a r e recognized a s endemic a r ea s of cholera i n the world. I n two countr ies of the Region, research undertaken regarding various aspects of the spread, prevention and treatment of cholera with WHO ass i s tance contributed basic knowledge and experience for t ack l ing global outbreaks.


Assistance t o Member S t a t e s i n cmuni ty-wide appl ica t ion of the ava i lab le simple heal th techniques, l i k e vaccination, immunization and chemotherapy t o con t ro l of ccnnmuni- cable diseases .

In co-operation with environmental hea l th programmes, ass i s tance i n the control of some bac t e r i a l and vector-borne diseases , e.g. salmonella, dengue, f i l a r i a s i s .

Assistance i n t he control of zoonoses, i n c lose co-operation with ve te r inary services .

EROGRAMHE 5.1 COW4UNICABLE DISEASE PREVENTION AND CONTROL


SUB-PROGRAMME 5.1.2 EPIDEMIOLOGICAL SURVEILLANCE OF COMENNICABLE DISEASES

Objectives

To assist the Member countries in developing and strengthening their epidemiological services;

to promote international surveillance of communicable diseases, especially cholera and smallpox, and

to administer the International Health Regulations.

Approach

- Collection, verification, consolidation and dissemination of epidemiological information to assist in national decision making for t h z control of communicable diseases 1

- Establishment, maintenance and co-ordination of sources of information involving relevant units in Member States, country and inter-country projects, SEAR0 and WHO Headquarters.

- Assistance in the integration of surveillance and control of communicable diseases into the general framework of public health services.

- Preparation and assessment of the usefulness of technical guides for the surveillance of communicable diseases.

- Assistance in designing and conducting courses in epidemiology and epidemiological surveillance aimed at the formulation of a cadre of epidemiologists and orientation of senior health administrators in Member countries.

In 1955, at its eighth session, the Regional Committee considered the need for consolidating mass campaigns for disease control into permanent health services.

The Regional Cornittee, in 1958, recommended that governments in the Region set up epidemiological units in their public health directorates, and, in 1968, noted the developments that took place since 1958 and urged governments to strengthen the epidemiological services in their departments of health at all levels.

Epidemiological services have been receiving complementary intensified assistance in the form of technical expertise and supplies and equipment and through annual training courses in epidemiology (Prague-Delhi) which are aimed at training epidemiologists from this Region and increasing their competence in epidemiology and control of communicable diseases. All countries of the Region have WHO-assisted programmes in the strengthening of epidemiological services for improving epidemiological surveillance. Direct technical assistance, complemented by specialist consultant services, has been given through a Regional Epidemiological Surveillance Team,established in 1970, to ensure co-ordination.

Assistance has been provided to Burma, Indonesia, Sri Lanka and Thailand in the improvement of port health services (both at airports and seaports), in epidemiological surveillance and in training national staff in the routine implementation of the Inter- national Health Regulations, and its further strengthening, particularly regarding technical measures.

WHO has provided, through regional seminars, an opportunity to senior epidemiologists attached to epidemiological surveillance programmes in the Region, to exchange experiences and methodology with their colleagues from other countries and to acquire knowledge of latest achievements in epidemiological surveillance.


Assistance will be given in developing (1) methodologies for surveillance and control of communicable diseases through the existing health services, (2) methods and procedures for the study of epidemiological patterns of communicable diseases within the socio-economic environment of the particular countries so as to formulate feasible prevention and control strategies applicable through the existing health services with active community participation, (3) capability and capacity to strengthen their work in the control and eradication of those diseases which can be tackled within their resources, using current techniques to maximum effect and (4) a system of built-in evaluation and assessment for disease prevention and control.

SUB-PROGRAMME 5.1.2 EPIDEMIOLOGICAL SURVEILLANCE OF COMENNICABLE DISEASES


SUB-PROGRAMME 5.1.3 MALARIA AND OTHER PARASITIC DISEASES

Objectives

Malaria

To assist in eliminating malaria in areaslcountries wherever eradication is possible and in reducing the incidence of malaria to a point where it is no longer a public health problem, where elimination of the diseases is not feasible;

to assist in the integration of anti-malaria activities into the general health services, wherever possible;

to help in the assessment of anti-malaria programmes and, wherever needed, to improve anti-malaria activities, and

to promote inter-country co-ordination of anti-malaria measures.

Parasitic diseases other than malaria

To continue efforts in developing and improving filariasis control through the existing health services structure, and

to assist in surveying the existence of other parasitic diseases, e.g., schistosomiasis and leisbaniasis, and in assessing the magnitude of the problems.

Approach

- Development of techniques for epidemiological investigations, with emphasis on the definition and the quantitative evaluation of epidemiological methods.

- Development of means and methods of eradication or control leading to the interruption of transmission by chemical, biological or other means.

- Stimulation and organization of research, to support further the development of operational and epidemiological methodology.

- Training of professional and auxiliary personnel required for meeting the recur- ring requirements to undertake measures against malaria and other parasitic diseases. Assistance includes setting up of training centres and organizing courses for this specific purpose.

Progrannne Review

Of the ten countries in the Region, eight have anti-malaria programes. Bangladesh, India, Nepal, Sri Lanka and Thailand have formal malaria eradication programmes. Burma, Indonesia and the Maldives are engaged in control programmes with eradication as the ulti- mate objective. It is expected that by 1976, Maldives will have converted its control programme into an eradication one.

Out of a total population of 871.7 million in South-East Asia, 822.3 million (96%) are at malaria risk. Of the population at risk, 678.4 million (82.5%) are covered by eradication programmes. Of those covered by eradication activities, 361.2 million (43.9%) are in the maintenance phase, 166.2 million (20.2%) in the consolidation phase and 163.7 million (19.9%) in the attack phase. Of the remaining population at risk, 88.4 million (10.8%) are covered by malaria control measures and only 42.8 million (5.2%) are in areas with no specific anti-malaria measures.

The cont ro l operations i n Burma and Indonesia and fu r t he r expansion with the ul t imate aim of achieving eradicat ion. In Indonesia, only port ions of the i s lands of Java and Bal i (present population: 77 mi l l ion) may be f i t f o r maintenance by 1980. In the other i s lands of Indonesia, control measures w i l l be carr ied out f o r the present and i t is expected t ha t , by 1976, a population of 3 mi l l ion , out of the present 43 mi l l ion , w i l l be under protect ion of res idua l insec t ic ide spraying and the remaining population w i l l receive anti-malaria drug administration. In Burma, by 1980, a population of 11.4 mil l ion is ant ic ipated t o be f i t t o go i n to the maintenance phase. The t a rge t of the control operations w i l l he t o reduce t he pa r a s i t e r a t e t o a l eve l of l e s s than 2%.

WHO w i l l continue t o a s s i s t Bangladesh, India and Nepal t o assess annually t h e i r programmes. I n India, by 1976, a fu r ther 92 mil l ion may be f i t f o r en t ry i n t o maintenance, provided adequate programme support is made avai lable . I t is ant ic ipated t h a t by 1976, 59 mil l ion population i n Bangladesh and 5 mill ion i n Nepal w i l l he ready f o r maintenance. In S r i Lanka and i n Thailand, the present t rends ind ica te the continuance of malaria a c t i v i t i e s beyond 1977. In view of the development of res i s tance of vectors t o i n sec t i c i de s i n severa l countr ies , t he an t i -mala r ia programmes w i l l be adjusted according to loca l s i t ua t i ons . The danger of chloroquine r e s i s t a n t P. fazciparum spread- ing t o wider areas of d i f f e r en t count r ies has now t o be faced i n the progranme, s ince Burma, India , Indonesia, Nepal and Thailand have reported cases of such res i s tance .

The f i l a r i a s i s con t ro l programnes which were i n operation i n Burma and S r i Lanka have been gradually converted i n t o vector control a c t i v i t i e s covering a l so vectors other than Cules p. f a t i g a s . Detection and treatment of f i l a r i a s i s cases have been taken up by the basic heal th services . This s t ep has been taken a s a r e s u l t of experience acquired i n Burma - a su f f i c i en t l y good coverage of an area with vector con t ro l measures resu l t ing i n reduction of vec tors by 95% a l s o leads t o in te r rup t ion of transmission by vectors . Vector con t ro l a c t i v i t i e s have l a rge r aspects and impact on heal th and economic s i t ua t i on of the country.

WHO ass i s ted Indonesia i n a programe of schistosomiasis control i n Sulawesi and t h i s ass i s tance w i l l continue i n developing a p r o g r m e f o r control of schistosomiasis i n t h i s area and i n prevention of i ts spread t o other neighbouring areas where the d i sease does not e x i s t , but where ecological conditions may permit its transmission.

Assistance i n expanding fu r t he r the malaria control operat ions i n Burma and Indonesia and Maldives with the ul t imate aim of achieving eradicat ion.

Assistance i n assessing the malaria eradicat ion programmes i n Bangladesh, India and Nepal.

Assistance t o S r i Lanka and Thailand i n t h e i r malaria eradicat ion programmes.

Assistance i n inves t iga t ing the spread of a l l r e s i s t a n t vectors .

Assistance i n de tec t ing cases of P. f d c i p a m u n r e s i s t a n t t o chloroquine and i n s t i t u t i o n of measures t o control the spread of such pa r a s i t e s i n Burma, India , Indo- nes ia , Nepal and Thailand.

Assistance i n f i l a r i a s i s control a c t i v i t i e s i n a l l the count r ies of the Region.

Assistance i n assessment of the magnitude of the problems of s c h i s t o s m i a s i s and le ishmaniasis .

SUB-PROGRAMME 5 . 1 . 3 MALARIA AND OTHER PARASITIC DISEASES

Schedule A - Estimated Obliltatfons

<

1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Number of Posts

Regular Budget

10

27

1

38

4


Regular Budget

us $

121 410

847 995

57 740

1 027 145

I

Other Sourcee

1

1

10

28

1

39

Other sources

us $

44 129

44 129

Total

us $

121 410

892 124

57 740

1 071 274 -

S U B - P R O G M 5.1.4 SMALLPOX ERADICATION

Objective

To achieve total eradication of smallpox in the Region in a time-limited programme.

Approach

- Development of an effective reporting network at all levels.

- Establishment of specially trained surveillance teams at national and State/ zone, and in some areas, lower levels.

- Carrying out periodic active searches for undetected smallpox cases, both in endemic and in apparently smallpox-free areas.

- Systematic vaccination of the population (priority being given to primary vaccination) so as to raise the population immunity and retard transmission of the disease.

- Combining, wherever feasible, the immunization activities with those against other communicable diseases.

The WHO-assisted smallpox programmes are continuing in four countries of the Region - Bangladesh, India, Indonesia and Nepal - in addition to the continuation of an inter-country project. The implementation of the two main components of the programme, surveillance and systematic vaccination, have given encouraging results. In Indonesia, which as recently as 1970 reported more than one-third of all cases in Asia, the last known cases of smallpox occurred in West Java in January 1972. In this country WHO will continue to assist the surveillance programme of search for cases, as well as the implementation of a simultaneous BCG-smallpox vaccination programme. Following an appraisal of the smallpox situation by an international assessment team in April 1974, the country was officially declared smallpox-free.

In India, considerable progress towards the goal has been achieved, especially in the western region of the country, since 1970, when programme co-ordination between WHO and the Government was expanded. The main foci of the disease are in the States of Bihar, Uttar Pradesh, West Bengal and Madhya Pradesh, which accounted for 94% of all cases in India in 1973. An intensified campaign was started in highly endemic and other states in which health personnel of all categories participated each month in a week-long systematic search tor smallpox cases in all villages and towns. Containment activities were strengthened to arrest the spread of the disease from the numerous outbreaks discovered by the searchers. In order to achieve interruption of smallpox transmission by the end of 1974, further efforts will be made to improve and expand surveillance activities at all levels.

In Bangladesh, following a period of 18 months during which no smallpox cases had been recorded, major outbreaks were reported in early 1972. In addition to the emergency measures taken, assistance was given in the implementation of a well-organized national programme. Following the spread of the disease practically throughout the country, the programme was strengthened by the recruitment of national and WHO epidemiologists as well as by a five-fold increase of surveillance teams. At the beginning of 1974, extensively infected areas were few and localized. Plans have been developed to employ health workers in special search operations throughout the country in February 1974. By the strengthening of the surveillance component of the programme, it is expected that interruption of transmission will be achieved in 1974.

By t h e s t r eng then ing of s u r v e i l l a n c e measures and t h e i n t r o d u c t i o n of a new vacc ina t ion schedule throughout t h e country , Nepal h a s achieved a non-endemic s t a t u s s i n c e mid-1972.

Proposuls for 1976-1077

Surve i l l ance and vacc ina t ion programmes w i l l cont inue throughout the c o u n t r i e s mentioned above so a s t o (a) br ing t o l i g h t any f o c i undetected , unrecognized o r un- r epor t ed i n 1974 and 1975, and (b) ensure adequate vacc ina t ion coverage of t h e popula- t i o n . The smallpox d i a g n o s t i c l a b o r a t o r i e s w i l l be s t rengthened.

An a p p r a i s a l of t h e smallpox s i t u a t i o n i n I n d i a , Bangladesh and Nepal w i l l be c a r r i e d out i n 1977 by i n t e r n a t i o n a l assessment teams. It is expected t h a t i n t h a t yea r , smallpox w i l l be o f f i c i a l l y dec la red e rad ica ted from t h e s e coun t r i e s .

SUB-PROGRAMME 5.1.4 SMALLPOX ERADICATION

Schedule A - Estimated O b l i ~ a t i o n s

1974

Regional

Country

Inter-country

T o t a l

I nter-country

In ter -country

In ter -country

Number of P o s t s

Regular Budget

1 8

6

24

4


Other Sources

4

4

To ta l -

us $

2 939 804

162 545

3 102 349

Regular Budget

us $

1 175 420

152 780

1 328 200

Total

22

6

28

Other Sources

us $

1 764 384

9 765

1 774 149

SUB-PROGRAMME 5.1.5 BACTERIAL DISEASES

Objectives

To assist in the prevention and control of acute enteric, respiratory and other bacterial diseases of major public health importance in South-East Asia Region, especially cholera, enteric infections, tetanus, diphtheria and pertussis and plague.

Approach

- Development and improvement of methods of isolation and identification of causa- tive agents for epidemiological sumeillance at national and regional level.

- Provision of assistance in the control of cholera, particularly through preparation of strategic plans of action; establishment of laboratory diagnosis and treatment methods; development of the capacity of cholera-endemic countries to be self-sufficient in production of rehydration fluids.

- Study of the magnitude of the problem of diphtheria, tetanus and pertussis and developing a methodology for their prevention through routine ionrmnization.

- Control of outbreaks of salmonelloses, shigelloses and other diarrhoea1 diseases, one of the main causes of child mortality.

- Development of surveillance and containment of plague in countries with active endemic foci.

- Promotion and co-ordination of research and training in control of bacterial diseases.

The Regional Committee for South-East Asia Region paid special attention to the problem of control of bacterial diseases almost from the inception of WHO activity. The Regional Committee at its second session paid special attention to the research activities in cholera by the Indian Research Fund Association. In 1960, at its thirteenth session, the Regional Committee for South-East Asia, noting the great importance of the enteric group of diseases as a public health problem in the Region, requested the Regional Director to initiate a suitable pilot study area with a view to formulating measures for the effective control of these diseases.

It has been stressed that the immunization schedule for children, which has been recommended for South-East Asia, should include the schedule for immunization against typhoid fever.

There is a serious problem of gastro-enteric infections with high morbidity and mortality rates especially among younger age-groups; this problem was reviewed by the Regional Committee at its twenty-first session in 1968.

Cholera is endemic in Bangladesh, B u m , India and Indonesia, and occasionally in Nepal. Some cases were reported in Sri Lanka and Thailand in 1973. In pursuing a policy of cholera control and reducing case fatality, assistance has been provided in developing capacity for the production of rehydration fluids,and in training in prompt rehydration, through seminars, training courses and fellowships; information on oral rehydration has been widely diffused. Case fatality has been reduced considerably (15% for the Region), ranging from 5% in Burma to 16.5% in Indonesia, and still further reduction is expected. Less favourable results have been achieved in the prevention of cholera.

Effective means of control are available in the Region against the other bacterial diseases, i.e., diphtheria, tetanus and pertussis. While no large outbreaks of these diseases have been reported, their existence and occasional severity in all countries in the Region have been confirmed. Assistance has been given to Mongolia in introducing routine immunization against these diseases; the programme has resulted in high coverage and epidemiological success, so that now the number of cases has been remark- ably reduced. In other countries, routine imnization with high coverage does not seem to be possible yet, even in urban areas, due to the insufficient development of coverage by basic health services. Imnization programmes using the triple antigen (DPT) have been started initially in cities and around health institutions. Assistance has also been provided in the production of DPT vaccine in Burma, India, Indonesia and Thailand. All three diseases are regularly covered in national and regional training activities; other diseases such as enteric infections are also under surveillance in Burma, Maldives and Mongolia.

Plague has been dormant in all the known endemic foci in India, Indonesia and Nepal; sporadic cases of human plague have been reported from time to time only. Special attention has been given to the problem of surveillance of plague in some countries of the Region. In plague control, assistance in surveillance of the density of reservoirs and vectors and their resistance to rodenticides and insecticides, and in the training of the staff concerned will be continued in areas where there are or have been foci.


Expansion and strengthening of epidemiological surveillance of bacterial diseases, especially of cholera and other entero-bacterial diseases; tetanus, diphtheria and pertussis.

Organization of regular immunization programmes with triple vaccine against tetanus, diphtheria and pertussis.

Preventian of bacterial and other enteric infections through assistance in promotion of safe water supply and improvement of sanitation, especially in rural areas.

Reduction of mortality due to enteric bacterial infections, including cholera, by the development, in majority of the countries in the Region, of rehydration programmes as an integral activity of basic health services.

S W - P R O G W 5 . 1 . 5 EACTERIAL DISEASES


-

1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Incer-country

- Estimated Obligations Number of Posts

Total

us $

5 9 970

59 970

Regular Budget

us $

59 970

59 970

Regular Budget

1

1 -

Other Sources

us $

0 ther Sources Total

1

1

SUB-PROGRAMME 5.1.6 MYCOBACTERIAL DISEASES

Leprosy

Objective

To reduce progressively the prevalence of leprosy, with a consequent reduction of associated disabilities.

Approach

- Promotion of surveillance of leprosy by strengthening leprosy control measures in endemic and hyper-endemic areas.

- Development of national leprosy control programmes, wherever possible integrated into general health services, based on identification of leprosy cases in their early stage by active clinical and bacteriological screening of high risk groups or sections of population.

- Promotion of low-cost systems for registration, treatment and follow-up with priority for bacteriologically positive cases on an ambulatory, non-institutional basis.

- Development of case-finding and treatment activities within general health institutions.

Programme Review

Leprosy control programnes have been carried out through special disease campaigns in almost all the countries of the Region. Case-finding and regular treatment are the main control methods. The Organization has assisted in the training of various categories of national staff and in health education of the public. The projects in Burma, Nepal and Thailand have been evaluated, and are being gradually integrated into the general health services. These programmes, as well as those in Bangladesh, India, Indonesia, Maldives and Sri Lanka, will be continued with WHO assistance in order to strengthen the control measures, to provide training, and to utilize effectively drugs, supplies and equipment. These projects have received support from UNICEF and other sources of funds.

iJroposaZs for 1976-1977

Assistance in assessing the leprosy problem and in evaluating measures taken for the control of the disease.

Expansion of leprosy control programmes so as to cover effectively areas of high endemicity in the countries of the Region.

Development of integrated curricula in leprosy and tuberculosis institutes fo, training of medical and paramedical staff working in community health services.

Review of the results of BCG vaccination trials in Burma and in south of Indi't, and application of promising results in the prevention of leprosy.

In co-operation with the Burmese Government, assessing the system cf having case- detection, registration and therapy as a single integrated service, and evolving of recommendatio~~s fur an effective low-cost system.

Tuberculosis

Objective

To reduce progress ively the transmission of i n f e c t i o n by Mycobacterium tuberculosis and a l s o the prevalence of t h e d i sease i n t h e population.

Approach

- Reduction of s u s c e p t i b i l i t y t o tubercu los i s by achieving and maintaining a high r a t e of coverage of the e l i g i b l e population with BCG vaccination.

- Continuous provis ion, i n t h e f i e l d , of heat-s table freeze-dried BCG vaccine of approved s tandards i n s u f f i c i e n t quant i ty .

- To undertake, where f e a s i b l e , an in tegra ted immunization scheme with a s u i t a b l e combination of the following ant igens: BCG, smallpox and DPT (d iph ther ia , p e r t u s s i s and t e tanus ) .

- I d e n t i f i c a t i o n of t h e sources of i n f e c t i o n by d i r e c t sputum smear microscopy and rendering them non-infectious by e f f e c t i v e chemotherapy on an ambulatory bas i s .

- Application of the above con t ro l measures on a nation-wide b a s i s considering epidemiological, soc io log ica l and economical f a c t o r s and manpower cons t ra in t s .

Prograwne Review

The estimated prevalence v a r i e s from 240 t o 660 per 100 000 population and the annual incidence between 70 t o 200 per 100 000 population. The v a r i a t i o n s were not considerable from country t o country. Tuberculosis remains a se r ious pub l ic h e a l t h problem i n a l l Member S t a t e s i n t h e Region.

Two WHO-assisted p r o j e c t s developed a new approach t o s t r a t e g y f o r con t ro l of tubercu los i s v a l i d not only f o r South-East Asia Region and developing coun t r i es but a l s o f o r developed countr ies . The s t u d i e s c a r r i e d out a t t h e Tuberculosis Chemotherapy Centre, Madras ( India) , with a s s i s t a n c e from W, UNDP, t h e B r i t i s h Medical Research Council and the ICMR, confirmed t h a t ambulatory treatment of tubercu los i s cases was not l e s s e f f e c t i v e than sanatorium t reatment , from t h e point of view of b a c t e r i o l o g i c a l conversion. Opera- t i o n a l s t u d i e s i n i t i a t e d by t h e WHO-assisted p r o j e c t i n National Tuberculosis I n s t i t u t e i n Bangalore ( India) on the opera t iona l a spec t s of t h e a p p l i c a t i o n of these f ind ings developed a simple non-expensive methodology s u i t a b l e f o r developing a n a t i o n a l tubercu los i s con t ro l progrannne i n t h e Region and elsewhere.

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


Technical advice and a s s i s t a n c e w i l l be provided i n t h e planning, implementation and evaluat ion of tubercu los i s c o n t r o l a s an i n t e g r a l p a r t of h e a l t h programmes, g iving p r i o r i t y to BCG vaccinat ion a s the con t ro l measure of choice.

The t r a i n i n g of top- level key personnel and sen io r pub l ic h e a l t h o f f i c e r s through na t iona l and inter-country courses and seminars i n tubercu los i s c o n t r o l w i l l r ece ive s p e c i a l emphasis.

Assistance w i l l be provided i n highly spec ia l i zed s u b j e c t s such a s production of freeze-dried BCG vaccine.

Applied research a c t i v i t i e s , such as epidemiological survei l lance ( i n co-operation with the International Union Against Tuberculosis) and chemotherapy t r i a l s t o develop further su i tab le treatment regime.

Elaboration of integrated immunization programmes including BCG vaccine, i n order t o achieve, by 1977, a minimum 50% of the coverage of e l i g i b l e population.

SUB-PROGRAMME 5.1.6 MYCOBACTERIAL DISEASES


1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country


Regular Budget

us $

126 745

116 500

243 245

Number of Posts

Other Sources

us $

250 378

250 378

Total

6

5

11

Regular Budget

5

5

10

Total

us $

377 123

116 500

493 623

Other Sources

1

1

SUB-PROGRAMME 5.1.7 VIRUS DISEASES

Objectives

TO promote surveillance, prevention and control of virus diseases of public health importance in the Member States of the Region.

Approach

- Collection, analysis and dissemination of information on the distribution of viruses and virus diseases.

- Improvement of epidemiological surveillance of denguelhaemorrhagic fever and diagnosis and treatment of cases with shock-syndrome manifestations.

- Development of a comprehensive programme for the preparation and testing and distribution of reagents for virology laboratories.

- Training of workers for diagnostic and research laboratories.

- Control of trachoma in the countries of the Region where this disease exists.

- Surveillance and control of poliomyelitis.

Progrme Review

Denguelhaemorrhagic fever has been reported for several years as a serious problem in Burma and Thailand, and more recently, in Indonesia, and as a lesser one in Sri Lanka and in parts of India. WHO has assisted in the establishment of national surveillance programmes resulting in the detection of a large number of cases and a reduction in fatality rates. WHO has prepared and distributed technical instructions for clinical diagnosis, vector(Aede6 aegypti) surveillance and control. A Technical Advisory Committee sponsored by SEARO, WPRO and WHO Headquarters met in Manila in 1974, reviewed the present knowledge and status of surveillance of denguelhaemorrhagic fever and revised the technical instructions related to measures for control and treatment.

Influenza epidemics have been reported periodically,and surveillance is being undertaken through the influenza reference centres (in Bombay and Bangkok) and other laboratories.

The trachoma programme in India, the largest in the world, and the one in Thailand, which were in operation as special campaigns for some years, have now been integrated into the health services. Burma still maintains a national control programme undertaking field trials of drug regimens and mass treatment, after initial case-finding is made by the health services. The Organization continued active assistance to the project in Burma, particularly in progrme evaluation.

Viral hepatitis has been reported as a serious problem in Mongolia and Sri Lanka. WHO assistance through consultant services has been mainly towards treatment to reduce complications.

Poliomyelitis is gradually becoming an important public health problem and has been reported from the large cities - particularly from Jakarta, Bangkok, Rangoon and Dellxi. The national health services in all the countries concerned have included this disease in their surveillance programmes, and are planning to vaccinate the susceptible child population groups. WHO has assisted the governments with technical advice in the planning and execution of regular immunization programmes against poliomyelitis and in the development of vaccine production capacity,where technically and economically feasible.


Development and strengthening of the surveillance, prevention and control of virus diseases, and relevant training programmes.

Organization and evaluation of vaccine programmes against poliomyelitis.

Distribution of the available information on denguelhaemorrhagic fever and review of the application of recent findings.

SUB-PR0GRAt-M 5.1.7 V I R U S DISEjISES

Schedule A - Estimated 0b l iga t io r . s

-

1974 - Kegional

Country

In ter -country

To ta l

1975 - Regional

Country


T o t a l

1976 -- i:cgir;n.?l

i : ~ l l l l t r ~


To ta l

1977 - Regional

Country

In t c r - cuun t ry

To ta l

Regular Budget

Estimated Ob l iga t ions -

i

Nunbrr of P a s t s

Regular Other Sources

Other Total

! I

Budget . Sources To ta l

us $ us $ 1 us $ I

4 3 550

4 3 550

4 3 550

4 3 550

I

!

25 250

25 250

1y I(10

19 100

8 850

R 850

1

I 25 250

25 ?50

1 9 loo

1 9 100

8 8;0

8 850

SUB-PROGRAMME 5.1.8 VENEREAL DISEASES AND TREPONENATOSES

Objectives

To assist in strengthening the epidemiological surveillance of the major venereal diseases (syphilis and gonorrhoea) and endemic treponematoses of childhood, and

to improve laboratory diagnosis and treatment methods.

Approach

- Appraisal of the status of venereal diseases and treponematoses by means of data collection and assessment, to be able to advise governments on their national programmes.

- Continued assistance in the surveillance and control of venereal diseases with the co-operation of camunity health services.

- Eradication of yaws in the Region

Frogranone Review

Control of venereal diseases was one of the early areas of WHO assistance, through the training of specialists in venereal disease control, the development of suitable training facilities and assistance to national programmes for treponematoses control.

Despite initial successes in reducing the incidence of venereal syphilis and gonorrhoea, it has not been possible to maintain this trend for various reasons - social, economical and biological. With the change of people's attitudes towards the danger from venereal diseases and consequent inadequate treatment and self-medication, resistant strains of gonococci have appeared, and it has been observed that cases of both venereal syphilis and gonorrhoea are on the increase.

Elimination of the remaining foci of endemic treponematoses by assisting in carrying out sero-epidemiological surveys, reactivating control programmes and utilizing the resources of community health services, including health laboratory services and health education of the public and those at risk.

Survey of the sensitivity to antibiotics of gonococcus strains isolated in different countries of the Region, with a view to elaborating appropriate and effective treatment schedules.

Standardization of serological tests af syphilis and endemic treponematoses by expanding the proficiency testing programe through the existing regional and international centres.

SUB-PROGWE 5.1.8 VENEREAL DISEASES AND TREPONEMATOSES


r

1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

, Estimated Obligations Number of Posts

Regular Budget Total

us $

36 850

36 850

Regular Budget

us $

36 850

36 850

Other Sources

Other Sources

us $

Total

SUB-PROGRAMME 5.1.9 VETERINARY PUBLIC HEALTH

Objectiues

To continue and intensify assistance to countries in developing veterinary public health programes and competence in this field;

to assist in developing national zoonoses surveillance and legislation, and

to assist with the implementation of food hygiene measures.

Approach

- Collection, analysis and dissemination of information.

- Assistance in zoonoses control, food hygiene and veterinary public health education, by arranging educational activities and developing simple standardized methods of laboratory field work, applicable at different levels of the community health services.

Rabies and brucellosis (especially in Mongolia) continue to be prevalent in countries of the Region. WHO has assisted governments in establishing national rabies surveillance and control programmes and in increasing the capacity of rabiesvaccine producing institutions (in Burma, India, Indonesia, Sri Lanka and Thailand). Several surveys carried out in Mongolia have helped to define the extent of the prevalence of brucellosis among domestic animals and danger of its transmission to tht human population. A rela- tively large capacity for producing brucella vaccine for use in domestic animals is being established in Ulan Bator, with technical assistance from h!O and financial help from UNDP .

Other aspects of veterinary public health, such as fosd hygiene, control of food of animal origin, control of slaughter houses and training of staff, have been taken up by governments as priority problems. WHO has provided consultants to India, Indonesia, Sri Lanka and Thailand to advise on these problems. The first Regional Seminar on Veterinary Public Health stimulated interest in this subject. An inter-regional seminar was held in Bangkok, in 1973, which covered various aspects of zoonoses control. A rwo- year Master's degree course has been established in Calcutta to facilitate the training of medical and veterinary personnel from countries in the Region.

Proposals fo? 1976-1977

Collection of data on prevalence of zoonoses and its utilization in initiating national control programmes.

Training and educational activities in veterinary public health through provieion of fellowships, development of regional and national institutions and consultant services in special areas.

Improvement of the quality of anti-rabies and anti-brucella vaccines, expansion of their production and utilization.

SUB-PROGKAMEfE 5.1.9 VETERINARY PUBLIC HEALTH

Schfdule A - Estimated Obl iga t ions

19/11 - Regional

Country

Inter-country

T o t a l

1975 - Reg'mdl

Country

~ n t e r - c ~ t t ~ n t z y

Tota l

1576

Ilcglonal

Country

Inter-cotintry

To ta l

1977 - Regioaal

Country

In ter -cuxntry

To ta l *

R ~ g u l a r Budget

us $

82 550

20 000

102 550

31 400

10 I IK~

42 100

28 200

28 200

21 000

21 000

Regular Eudge:

Estimated Obl iga t ions

0 t her Sources

us $

T o t a l

us $

82 550

20 000

102 550

31 GOP

I O /oo

42 100

28 200

- 28 200

2 1 000

21 000

N,mber of

Other Sources

P o s t s

Total

SUB-PROGRAMME 5.1.10 VECTOR BIOLOGY AND CONTROL

Objectives

To assist with studies of the ecology and control of the arthropod vectors and manrmalian reservoirs of human diseases and with the implementation of control measures and also with trials for adapting vector control methods to local conditions.

Approach

- Surveillance of the distribution and density of pest arthropods and mammals to determine where control is warranted.

- Surveillance of the biology and ecology of vectors and reservoirs to determine suitable control methods.

Assesment of ~uethod* of control - biological, chemical or genetic - to deter- Ine their suitability for use under local conditions.


Haemorrha~ic Fever and Aedes aeqypt i . The control or eradication of Aedes aegypti has, for many years, been a problem in this region, although, in many countries in other parts of the world, the vector has disappeared during routine spraying of DDT in malaria programmes. This problem will continue to be given high priority till the methods of control now available are implemented and new and better ones developed.

A WO-assisted pilot project in the Region for the control of A. aegypti to combat haemorrhagic fever was set up in Thailand in 1966. Even at that time there was an indi- cation that high doses of DDT were required to control the vector. Since combined peri- focal and residual spraying is extremely difficult in large cities, newer techniques, e.g., the use of abate and ULV spraying, have been experimented in Thailand, India and Indonesia. Methods of genetic control of Aedes mosquitoes are still in an experimental phase and, when developed, are expected to contribute to its control.

a. Specific studies on the hionomics of A. batabacensis and A. m in ims and the role of these species in the persistent transmission of malaria are being conducted in Bangladesh, Burma, India and Thailand.

Filariasis. One of the mosquito species which has shown the greatest and most consistent resistance to insecticide is C. fatigans, the main vector of filariasis in this region. The bionomics of this mosquito have been intensively studied throughout the world and, in particular, in Burma, India and Sri Lanka, where there has been a considerable increase both in W. bancrof t i and B. nalayi filariasis. There are other vector species involved, but the attack measures have so far concentrated on C. fatigans, which, to date, has remained sensitive to fenthion. The main problems continue to be poor environmental conditions (lack of drainage, unhygienic disposal of water and failure to reduce breeding sites). Insecticides are a poor substitute for proper town planning and drainage. Elimination of breeding places and reduction of larvae and adult mosquitoes have shown to affect directly the transmission of filariasis and, over a period of time, to result in its disappearance.

Proposats for 1976-1977

Development of relevant programmes for improvement of environmental health and mobilization of community health resources in the application of suitable measures for vector control.

Evaluation of operating projects and their revision or evolution of new prolects, as necessary.

Organization of national courses and seminars on the epidemiological, laboratory, entomological, virological and parasitological aspects of vector-borne diseases.

Assistance with further relevant studies and trials and the application of the results to control programmes.

SUB-PROGRAMME 5.1.10 VECTOR BIOLOGY AND CONTROL

Schedule A - Estimated Obl ixa t ions

*

1974

Regional

Country

In ter -country

To ta l

1975

Regional

Country

In ter -cuuntry

T o t a l

1976

Rcgional

Country

In ter -country

To ta l

p7J

Rcgional

Country

In ter -country

T o t a l

4

Estimated Obl igat ions Number

Regular Budget

To ta l

us $

130 150

133 150

Regular Budget

us $

0 t her Sources

us $

130 150

130 150

of

Other Sources

2

2

2

2

1

1

1

1

Pos t s

Total

2

2

2

2

1

1

1

1

96 i 96 355

96 355

30 001)

30 000

10 OIX)

1 0 000

1 96 355

30 000

30 000

i 0 030

10 000

PROGRAMME 5.2 NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL

Objectives

To develop and s t rengthen epidemiological s t u d i e s and programmes a t n a t i o n a l , in termediate and l o c a l l e v e l s f o r i d e n t i f i c a t i o n and t h e evaluat ion of mor ta l i ty and morbidity due t o non-communicable d i seases and t o assess i ts impact on socio-economic development ;

t o develop n a t i o n a l h e a l t h programmes f o r the prevention and con t ro l of oon- communicable d i seases ;

t o develop and s t rengthen community-oriented comprehensive h e a l t h care f o r prevent ion and con t ro l of non-communicable d i seases , and

t o promote app l ica t ion of recent advances i n b a s i c immunology and human genet ics to the con t ro l and prevention of non-communicable d i seases of pub l ic h e a l t h importance.

Approach

- Assistance i n t h e c o l l e c t i o n of p rec i se epidemiological da ta f o r assess ing the magnitude of hea l th problems due t o prevalence of non-communicable d i seases and establishment of p r i o r i t i e s f o r developing con t ro l and prevention programmes.

- I d e n t i f i c a t i o n of na t iona l i n s t i t u t i o n s and s t rengthening t h e i r f a c i l i t i e s f o r t r a i n i n g , s e r v i c e s and epidemiological s t u d i e s i n non-communicable d i seases .

- Assistance i n improving the t r a i n i n g programmes f o r spec ia l i zed hea l th and a l l i e d hea l th personnel required t o meet the needs of h e a l t h s e r v i c e s f o r con t ro l and prevention of non-communicable d i seases , a s i n t e g r a l p a r t of the e x i s t i n g hea l th se rv ices .

- Assistance i n es tab l i sh ing pilot-cum-demonstration t r a i n i n g p r o j e c t s f o r the prevention and con t ro l of non-communicable diseases .

- Assis tance i n s t rengthening of h e a l t h education component f o r the prevention of "on-communicable diseases .

- Promotion of regional and na t iona l co-ordination of these a c t i v i t i e s .

The ex ten t of tlrc prohlem and morbidity and mor ta l i ty t rends of "on-communicable discnses are re rc iv ing the a t t c n l i a n of Member S t a t e s . Precise da ta on t h e i r prevalence are being co l l ec ted f o r the promotion of prevent ive and con t ro l measures. In tegra ted comprehensive se rv ices f o r non-communicable d i seases , wi th in the e x i s t i n g general hea l th se rv ices , a r e under development with a view t o decreasing morbidity and mor ta l i ty . The concept of prevention and con t ro l of non-comunicable d i seases is being incorporated i n the curriculum f o r t h e t r a i n i n g of h e a l t h and a l l i e d h e a l t h personnel t o enable them t o p a r t i c i p a t e i n epidemiological i n v e s t i g a t i o n s , hea l th educat ion, e a r l y diagnosis , t r e a t - ment and r e h a b i l i t a t i o n .

WHO is promoting development and s t rengthening of n a t i o n a l h e a l t h s e r v i c e s f o r prevention and con t ro l of non-communicable d i seases through 17 country p r o j e c t s and f i v e in ter-country p r o j e c t s . This a s s i s t a n c e i s o f fe red f o r epidemiological i n v e s t i g a t i o n s , incidence surveys, planning of con t ro l a c t i v i t i e s , es tabl ishment of pilot-cum-demonstra- t i o n cen t res , review of t r a i n i n g programmes and r e s t r u c t u r i n g of c u r r i c u l a f o r meeting the general h e a l t h s e r v i c e needs of the coun t r i es f o r management o f cancer, cardiovascular d i seases , b l indness and v i s u a l impairment, mental h e a l t h and con t ro l of drug abuse. I d e n t i f i c a t i o n of high r i s k groups, e a r l y de tec t ion of these d i seases , emergency t reatment , management of chronic s t a t e , r e h a b i l i t a t i o n and h e a l t h education a r e the

areas f o r a s s i s t a n c e t o reduce morbidity and l a t e d i s a b i l i t y . Inter-country p r o j e c t s provide f o r advisory s e r v i c e s t o Member S t a t e s and a l s o f o r conduct of group educat ional a c t i v i t i e s f o r admin i s t ra to r s , p lanners , h e a l t h s e r v i c e personnel and p rofess iona l educa to r s f o r the development of in tegra ted comprehensive con t ro l programmes i n non-comuoi- cable diseases .

Following the s tudy of t h e magnitude of the problem, an assessment of the e x i s t i n g f a c i l i t i e s i n h e a l t h se rv ices f o r management, t r a i n i n g of h e a l t h and a l l i e d personnel and epidemiological inves t iga t ions , group educat ional a c t i v i t i e s were organized i n 1973 and w i l l be organized i n 1974 and 1975 t o s t imula te n a t i o n a l hea l th planning a c t i v i t i e s f o r programmes i n cardiovascular d i seases , cancer, mental hea l th and con t ro l of drug abuse. Visual impairment, juven i le d iabe tes and deafness a r e some of the o the r hea l th problems which would rece ive a t t e n t i o n .

Formulation of n a t i o n a l p o l i c i e s , d e f i n i t i o n of ob jec t ives , preparat ion of medium- and long-term p lans , co-ordination of a c t i v i t i e s a t the inter-country and country l e v e l s , pooling of i n t e r n a l a s w e l l a s ex te rna l resources and p a r t i c i p a t i o n by the community would form the b a s i s f o r s t r a t e g y f o r WHO a s s i s t e d progranrmes f o r con t ro l of non-communicable diseases .


Assistance f o r de7eloping comprehensive cancer con t ro l a c t i v i t i e s w i l l be provided t o many countr ies i n the Region. Rheumatic fever and h e a r t d i sease , treatment of myocar- d i a l i n f a r c t i o n and r e h a b i l i t a t i o n of p a t i e n t s , hypertension and s t r o k e a re the a reas se lec ted f o r a ss i s t ance i n prevention and con t ro l of cardiovascular d iseases . Consultant se rv ices w i l l be given t o epidemiological inves t iga t ion and t r a i n i n g of h e a l t h personnel i n t h e prevention and con t ro l of o the r non-communicable d i seases , such a s v i s u a l impairment, deafness , b r o n c h i t i s and asthma i n Bangladesh, Burma and India . An assessment of the magnitude of t h e mental h e a l t h ~ r o b l e m , t r a i n i n g of t h e required p s y c h i a t r i c personnel and organizat ion of community-oriented mental h e a l t h se rv ices w i l l be promoted through country p ro jec t s . Programes w i l l be developed f o r the prevention and c o n t r a l of alcohol- i s m and drug dependence and abuse i n Burma, I n d i a , Indonesia and Thailand. With a view t o s t imula t ing country programmes f o r s t rengthening hea l th measures f o r c o n t r a l and prevention of some comon non-commuuicable d i seases , s tudy and management of pe r iphera l vascular d i seases and immunology i n diagnosis and treatment of l i v e r cancer , have been se lec ted f o r developing group educat ional a c t i v i t i e s .

PROGRAMME 5.2 NON-COhWNICABLE DISEASE PREVENTION AND CONTROL


1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Estimated Obligations Number of Posts

Regular Budget

us $

38 450

385 065

63 900

487 415

Total

2

1

3

0 t her Source8

us $

184 719

184 719

Regular Budget

2

1

3

Total

us $

38 450

569 784

63 900

672 134

Other Sources

SUB-PROGRAMME 5.2.1 PROGRAMME PLANNING AND GENERAL ACTIVITIES

Objectives

To pramote epidemiological and demographic studies for the identification and assessment of the problem of non-communicable diseases;

to assist in the development of health manpower required for promoting comprehensive prevention and control programnes integrated into the existing health service system;

to improve registration, early diagnosis through screening risk groups, facilities for treatment, rehabilitation and follow-up system, and

to mobilize community participation, through health education, for the prevention and control of non-communicable diseases identified for priority public health action by governments.

Approach

- Promotion of a system for registration, based on information from hospitals and other sources, ultimately leading to the establishment of national registries for non- communicable diseases of national importance.

- Standardization of criteria for diagnosis, treatment and epidemiological investigation.

- Advice and assistance in the introduction of the International Classification of Diseases and common forms or protocols developed for collaborative epidemiological and control studies.

- Provision of information on recent advances in the field through documentation services to institutions developing research service and training programmes.

- Identification of risk groups, screening for early diagcosis, developing patterns of comprehensive community-oriented control measures integrated into the existing health measures, evaluation with provision for feed-back, organization of services, training of health and allied health personnel, planning and administration of medium- and long-term programes for control and prevention, and provision of adequate information systems for the prevention of non-communicable diseases.

- Identification of national institutions and their strengthening to promote leadership, training, development of patterns of service, curricula construction for training specialized health personnel and co-ordination of bio-medical research in non-comunicable diseases.

- Establishment of a clearing house for information on a regional basis for dissemination and exchange of information on chronic and degenerative diseases of regional importance.

P m g m e Review

Cancer, cardiovascular diseases, visual impairment and blindness due to malnutri- tion, infection and cataract, psychiatric disorders including drug dependence, juvenile diabetes, rheumatoid arthritis, asthma, bronchitis, tropical eosinophilia, allergy, neph- ritis and deafness are some of the emerging health problems identified under non-comunicable diseases for public health action for their control and prevention.

Assistance will be given for the development of programmes in cancer, cardiovascular diseases, mental health, drug abuse and visual impairment and blindness through the establishment of pilot projects, strengthening of national institutions for the training of specialized health personnel, establishment of systems of registration for assessing the magnitude of the problems, and improvement of community-oriented health care service for prevention, treatment, rehabilitation and health education.

SUB-PROGRAMME 5.2.1 PROGRAMME PLANNING AND GENFRAL ACTIVITIES

Sctiedule A - Estimated Obl iga t ions

1914 - Regional

Country

In ter -country

To ta l

1975 - Regional

Collntry

In ter -country

Tota l

1976 - 1:egional

Country

In te r -coun t ry

Tot a 1

1977 - Regional

Country

In ter -country

T o t a l

1

Regular Budget

2

2

2

2

2

-- 2

2

2

Regular Budget

us $

38 450

38 450

40 200

40 200

45 040

45 040

47 610

47 610

Number of

Other Sources

P o s t s

2

2

2

2

2

2

2

2

E-~;&d'.ed Obl igat ions

Other Sourcen

us $

I

Total

us $

38 450

18 450

' 40 200

40 200 -- --

45 040

45 040 -

47 610

47 610

SUB-PROGRAMME 5.2.2 CANCER

Objectives

To assess t h e magnitude of t h e problem and t h e morbidity and m o r t a l i t y t r ends i n cancer ;

t o s t r eng then gene ra l h e a l t h s e r v i c e s f o r comprehensive and i n t e g r a t e d a c t i v i t i e s f o r h e a l t h educat ion, e a r l y d e t e c t i o n , r e g i s t r a t i o n , d i agnos i s , t rea tment , follow-up and r e h a b i l i t a t i o n , baaed on exper ience gained i n cancer c o n t r o l p i l o t p r o j e c t s ;

t o assist i n t h e development of s p e c i a l i z e d h e a l t h and a l l i e d h e a l t h manpower f o r s e r v i c e s , t r a i n i n g and research i n cancer , and

t o a s s i s t coun t r i e s i n t h e formulat ion of n a t i o n a l cancer c o n t r o l p lans .

Approach

- Provis ion of t e c h n i c a l guidance i n t h e development of cancer c o n t r o l programmes, with s p e c i a l r e fe rence t o prevent ion, e a r l y d e t e c t i o n and new methods of treatment.

- Assis tance i n i d e n t i f i c a t i o n of h igh-r isk groups wi th in t h e popula t ion and i n promoting t h e development of methods f o r monitoring such groups.

- Assis tance i n prevent ion, through educating t h e medical and a l l i e d h e a l t h personnel and t h e p u b l i c i n cancer c o n t r o l .

- Promotion of epidemiological i n v e s t i g a t i o n s and es tabl ishment of cancer r eg i s - t r i e s .

- Assis tance i n t h e development and a p p l i c a t i o n of new methods of d iagnosis and t rea tment of cancer and pre-cancerous cond i t ions .

- Establishment of c o l l a b o r a t i o n wi th r e l evan t b i l a t e r a l and i n t e r n a t i o n a l p rogrames i n t h e f i e l d of cancer c o n t r o l .

Programme Review

An in te r -coun t ry seminar an the epidemiology of cancer wi th s p e c i a l r e fe rence t o coun t r i e s i n South-East Asia was he ld i n 1973 , under t h e j o i n t auspices of the Indian Council of Medical Research, t h e I n t e r n a t i o n a l Agency f o r Research i n Cancer and WHO. The seminar d iscussed s t r a t e g i e s £or cancer c o n t r o l , formulated c e r t a i n recommendations and evolved gu ide l ines f o r WHO a s s i s t ance . One of the r ecomenda t ions of the seminar was t h a t coun t r i e s s e l e c t e d f o r cancer c o n t r o l p r o j e c t s i n t h e f i r s t phase should be those with no organized o r i n t e r n a l l y - a s s i s t e d cancer programme a t n a t i o n a l l e v e l , and t h a t during t h e second phase WHO-assisted a c t i v i t i e s should cover a l l coun t r i e s i n the Region; a reg iona l t r a i n i n g course f a r r e g i s t r a t i o n and e a r l y d e t e c t i o n programme w a s a l s o recommended.

Cancer c o n t r o l a c t i v i t i e s a r e being a s s i s t e d i n Buma, I n d i a , Indonesia and Mongolia. In Burma and Indonesia , t r a i n i n g programmes f o r cy to techn ic i ans , cytotechno- l o g i s t s and cy topa tho log i s t s have been developed. In Ind ia , a s s i s t a n c e t o t h e cancer c o n t r o l p i l o t p r o j e c t i n Kancheepuram, Tamil Nadu, has been provided, and f u r t h e r WHO suppor t w i l l be given t o t h e es tabl ishment of r eg iona l cancer c e n t r e s , as recommended i n t h e r e p o r t of t h e Cancer Assessment Committee. I n Mongolia, t h e Ontological Centre i n Ulan Bator is being s t rengthened and epidemiological s t u d i e s on l i v e r cancer a r e being supported. Bangladesh, DPRK, Nepal and S r i Lanka a r e t o be a s s i s t e d i n developing i n t e g ~ a t e d and comprehensive cancer c o n t r o l programmes.

Oropharyngeal and c e r v i c a l cancer is seen i n most of t h e coun t r i e s of t h e Region. Establishment of a t r a i n i n g c e n t r e f o r t h e management of oropharyngeal cancer and poss ib ly f o r c e r v i c a l cancer wi th a s s i s t a n c e from DANIDA is being explored. An i n s t i t u t i o n w i l l be

i d en t i f i ed t o t r a i n cancer epidemiologists and ass i s ted i n strengthening t h i s programme. Through inter-country group educational a c t i v i t i e s , it is planned t o s t imula te cancer prevention and treatment and evaluation of na t iona l cancer control a c t i v i t i e s .

PmposaZs for 1976-1977

Consultants w i l l be provided t o Bangladesh, Burma, DPRK, Ind ia , Indonesia, Mongolia and S r i Lanka t o a s s i s t with the development of cmprehensive cancer control a c t i v i t i e s within the ex i s t i ng publ ic hea l th del ivery system. Demonstcation-cum-training p i l o t p ro jec t s w i l l be a s s i s t ed . National i n s t i t u t i o n s w i l l be strengthened so t ha t they can conduct epidemiological inves t iga t ions , t r a i n s p e c i a l i s t hea l th personnel and develop pa t te rns of control f o r the commonly seen types of cancer. Assistance w i l l be continued i n es tab l i sh ing cancer r e g i s t r i e s , measures f o r the ea r l y detect ion of cases and s tandardizat ion of treatment with chemotherapy and radiotherapy. Health education f o r the prevention and control of cancer w i l l be promoted.

Resources fo r cancer control and recent developments i n cancer management a r e the topics selected f o r group educational a c t i v i t i e s i n 1976 and 1977.

SUB-PROGRAMME 5.2.2 CANCER


1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

1


Regular Budget

us $

128 900

128 900

Number of Posts

Regular Budget

Other Sources

us $

87 671

87 671

Total

us $

216 571

216 571

Other Sources Total

SUB-PROGWE 5.2.3 CARDIOVASCULAR DISEASES

Objective

To a s s i s t i n t h e prevention and con t ro l of cardiovascular d i seases and i n t h e r e h a b i l i t a t i o n of p a t i e n t s .

Approach

- Assis tance i n epidemiological s t u d i e s and surveys of cardiovascular d i seases , and i n i d e n t i f i c a t i o n of high-risk groups.

- Promotion of t r a i n i n g i n t h i s a rea , u t i l i z i n g methods of cardiovascular d i sease con t ro l app l icab le f o r the e n t i r e community and in tegra ted i n t o the general hea l th se rv ices .

- Promotion of h e a l t h education f o r t h e prevention of cardiovascular d iseases .

?rugrimone Review

Following t h e v i s i t s of consul tants i n 1973 and t h e organizat ion of a course f o r con t ro l of s t r o k e and management of s t r o k e p a t i e n t s i n 1974, the re have been increasing awareness and concern on t h e p a r t of Member S t a t e s about r i s i n g t rends i n morbidity and mor ta l i ty due t o cardiovascular d i seases . Rheumatic fever and i t s cardiovascular compli- ca t ions , ischaemic h e a r t d i seases , hypertension and cerebrovascular acc iden t s , thrombo- embolic l e s i o n s of a r t e r i e s and veins and cor putmonate a r e being i d e n t i f i e d a s pub l ic hea l th problems i n urban, semi-urban and r u r a l communities. National hea l th planning f o r spec ia l i zed hea l th and a l l i e d h e a l t h personnel, pilot-cm-demonstration p r o j e c t s f o r c o n t r o l , organizat ion of emergency s e r v i c e s , r e h a b i l i t a t i o n , eva lua t ion of con t ro l measures, in tegra ted h e a l t h education i n school h e a l t h and a system of r e g i s t r a t i o n with follow-up machinery a r e the a reas f o r WHO a s s i s t a n c e .

A c t i v i t i e s f o r con t ro l of rheumatic fever a r e being promoted i n Ind ia and Mongolia. F a c i l i t i e s f o r t h e management of ischaemic h e a r t d i seases through the es tabl ishment of coronary ca re u n i t s a r e being strengthened i n India , Nepal and Mongolia.

Prevention of rheumatic fever and hypertension, treatment and r e h a b i l i t a t i o n of myocardial i n f a r c t i o n and s t r o k e p a t i e n t s , es tabl ishment of r e g i s t r i e s f o r these condi- t i o n s , and epidemiological inves t iga t ions w i l l be promoted i n the coun t r i es of t h e Region through group educat ional a c t i v i t i e s , t r a i n i n g , and consultancy se rv ices f o r e s tab l i sh ing pilot-cum-demonstration cen t res on a regional o r na t iona l b a s i s .

Pulmonary hypertension and thrombo-embolic condi t ions of pe r iphera l blood v e s s e l s have been i d e n t i f i e d a s two cardiovascular problems which requ i re epidemiological and e t i o l o g i c a l s t u d i e s i n depth, and WHO a s s i s t a n c e w i l l be made a v a i l a b l e f o r promoting such s t u d i e s .

Regional co l l abora t ion w i l l be s t imulated i n epidemiological i n v e s t i g a t i o n , t r a in - i n g of personnel and preparat ion of medium- and long-term p lans f o r t h e promotion of t h e cardiovascular h e a l t h of communities.

SUB-PROGRAMME 5.2.3 CARDIOVASCULAR DISEASES


1974 - Regional

Country

Inter-country

Total

1975 - Regional

Country

Inter-country

Total

1976 - Regional

Country

Inter-country

Total

1977 - Regional

Country

Inter-country

Total

Total

us $

45 800

18 100

63 900

32 600

17 400

50 000

43 000

L5 000

58 000

78 500

15 500

94 000 -

Regular Budget

us $

45 800

18 100

63 900

32 600

17 400

50 000

43 000

15 000

58 000

78 500

15 5 W

94 000

Regular Budget

-


Other Sources

us $

Number of

Other Sources

Posts

Total

SUB-PROGRAMME 5 .2 .4 OTHER CHRONIC NON-COMMUNICABLE DISEASES

Objectives

To iden t i f y and assess hea l th problems due t o non-communicable diseases of publ ic hea l th importance and prepare community-based publ ic hea l th control programmes;

to promote the inclusion of connnunity-oriented publ ic hea l th concepts i n the t ra in - ing of hea l th and a l l i e d hea l th personnel and a s s i s t i n evaluat ing the r e s u l t s of the t ra in ing , and

t o a s s i s t i n the formulation of na t iona l po l i c i e s , l e g i s l a t i o n and co-ordination of na t iona l and i n t e rna t i ona l resources.

Approach

- Promotion of epidemiological and c l i n i c a l inves t iga t ions i n non-communicable diseases of na t iona l hea l th importance with spec i a l reference t o e t hn i c , soc i a l , cu l t u r a l and economic conditions i n the country.

- Stimulation of the exchange of recent f indings and experience i n the f i e l d s of epidemiology, prevention, treatment and spec i a l se rv ices .

- Assistance i n the establishment of comprehensive and progressive community- based hea l th care s e rv i ce s , and promotion of the t r a i n ing of hea l th and a l l i e d personnel.

Programne Review

The problem of v i sua l impairment and blindness due t o trachoma, xerophthalmia, c a t a r ac t and glaucoma requires p r i o r i t y consideration from na t i ona l , i n t e rna t i ona l , voluntary and other non-governmental agencies. This problem was s tudied by a consultant assigned t o Bangladesh, Burma and India i n 1973. He emphasized the need f o r the formula- t ion of na t iona l po l i c i e s , co-ordination of a c t i v i t i e s , t r a i n ing of special ized personnel, organization of se rv ices , inves t iga t ion of epidemiology and e t io logy , hea l th education and mobilization of cornunity pa r t i c i pa t i on f o r prevention and control . I n addi t ion, he recommended the establishment of na t iona l i n s t i t u t e s of publ ic hea l th ophthalmology.

PmposaZs for 1976-1977

Assistance w i l l be continued f o r epidemiological surveys, t r a i n ing of s p e c i a l i s t s i n publ ic hea l th ophthalmology, co-ordination of governmental, voluntary, i n t e rna t i ona l and other non-governmental a c t i v i t i e s and resources , and evaluat ion of con t ro l a c t i v i t i e s .

Epidemiological inves t iga t ions on b ronch i t i s , asthma and t r o p i c a l eos inophi l i a w i l l be ass i s ted . Services fo r the management of resp i ra tory emergencies and rehabi l i t a - t i o n of chronic pulmonary disorders of a non-infective na ture w i l l be strengthened.

Prevention of deafness and treatment and r e h a b i l i t a t i o n of deaf pa t i en t s w i l l be a s s i s t ed through school hea l th and community-oriented a c t i v i t i e s f o r the cont ro l of noise.

WHO ass i s tance w i l l a l s o be ava i l ab l e f o r epidemiological inves t iga t ion of diabetes i n the young due t o ca lc i fy ing p a n c r e a t i t i s occurring i n some count r ies of the Region.

The study of environmental pathology i n r e l a t i o n t o t he prevalence of non-communicable diseases w i l l be promoted through group educat ional a c t i v i t i e s .

SUB-PROGRAMME 5.2.4 OTHER CHRONIC NON-COHMMICABLE DISEASES


1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country


Total

us $

27 250

27 250

Regular Budget

us $

2 550

2 550

Other Sources

us $

24 700

24 700


Other Sources

SUB-PROGRAMME 5.2.5 DENTAL HFALTH

Objectives

To a s s i s t i n the development, promotion and implementation of e f f e c t i v e pub l ic hea l th measures f o r t h e prevention and con t ro l of o r a l and d e n t a l d i seases , and

to improve the o r a l h e a l t h of t h e population i n t h e coun t r i es of t h e Region.

Approach

- Promotion of comprehensive d e n t a l h e a l t h c a r e in tegra ted i n t o the e x i s t i n g pub l ic h e a l t h de l ive ry system.

- Strengthening of education and t r a i n i n g programmes f o r d e n t a l hea l th personnel, including a u x i l i a r i e s .

- Assistance i n t h e planning, organizat ion, de l ive ry and evaluat ion of dental hea l th se rv ices .

- Promotion of d e n t a l hea l th education through school hea l th .

- Stimulation of epidemiological inves t iga t ions i n o r a l and den ta l d iseases .


WHO ass i s t ance has concentrated on t h e development of den ta l hea l th manpower i n Burma, Ind ia , Indonesia, Mongolia, Maldives, S r i Lanka and Thailand. Stomatological se rv ices have a l s o been strengthened i n Mongolia. Other a reas of a s s i s t a n c e have included the t r a i n i n g of school d e n t a l nurses and promotion of d e n t a l l e g i s l a t i o n .


Assistauce w i l l continue t o be given i n the planning and evaluat ion of den ta l hea l th se rv ices , s o a s t o b r ing about t h e most e f f i c i e n t u t i l i z a t i o n of the a v a i l a b l e d e n t a l hea l th manpower, and a l s o i n t h e p r a c t i c a l aspects of implementing d e n t a l programmes. E f f o r t s w i l l be concentrated on the development of d e n t a l h e a l t h manpower, including a u x i l i a r i e s , i n Burma, Indonesia, Mongolia, S r i Lanka and Thailand.

A workshop on the use of d e n t a l a u x i l i a r i e s i n prevent ive d e n t i s t r y i s planned t o be organized i n S r i Lanka. I n Burma, a WHO den ta l a u x i l i a r y t u t o r w i l l a s s i s t i n organizing courses f o r d e n t a l a u x i l i a r y s t a f f . At tent ion w i l l a l s o be paid t o the t r a i n i n g of s t a f f i n the maintenance and r e p a i r o f d e n t a l equipment, both e l e c t r i c a l ;,nil mechanical.

SUB-PROGRAMME 5.2.5 DENTAL HEALTH

Schedule A - Estimated Obli~ationa

SUB-PROGRAMME 5.2.6 MENTAL HEALTH

Objectives

To a s s e s s the magnitude and n a t u r e of menta l , neuro log ica l and psychological problems, i n o rde r t o a s s i s t i n planning n a t i o n a l comuni ty mental h e a l t h p rogrxmes , and

t o s t r eng then f a c i l i t i e s and t o i n t e g r a t e t rea tment and r e h a b i l i t a t i o n programmes f o r p s y c h i a t r i c p a t i e n t s i n t o t h e e x i s t i n g gene ra l h e a l t h s e r v i c e s .

Approach

- Promotion of t h e p s y c h i a t r i c t r a i n i n g of medical undergraduates and post - graduates and a l l i e d h e a l t h personnel , i nc lud ing a u x i l i a r i e s , and in t roduc t ion of t h e concepts of psych ia t ry i n t o t h e curriculum content .

- St imulat ion of community p a r t i c i p a t i o n and t h e t r a i n i n g of community l eade r s i n mental h e a l t h a spec t s and promotion of t h e genera l educat ion of t h e publ ic .

- Study of methods f o r t h e t r a i n i n g and u t i l i z a t i o n of t r a d i t i o n a l h e a l e r s i n providing p s y c h i a t r i c c a r e s e r v i c e s t o t h e communities i n p e r i p h e r a l and remote a reas .

- Promotion of epidemiological i n v e s t i g a t i o n i n t o mental d i s o r d e r s , wi th s p e c i a l emphasis on the c u l t u r a l a spec t s and socio-economic development.

Frogranone Review

Progress i n t h e f i e l d of psych ia t ry , i n t roduc t ion of psychotropic drugs and advances i n t h e r a p e u t i c techniques have v a s t l y improved t h e prognosis f o r mental p a t i e n t s . The gene ra l h e a l t h s e r v i c e s r e q u i r e s t r eng then ing f o r t h e a p p l i c a t i o n of r ecen t advances i n mental h e a l t h ca re . Health and a l l i e d h e a l t h personnel r e q u i r e adequate t r a i n i n g i n comuni ty-or iented mental h e a l t h care . C u l t u r a l va lues and s o c i a l f a c t o r s leading t o p o s i t i v e mental h e a l t h development should be s t u d i e d , and e x i s t i n g f a c i l i t i e s s t rengthened. Nat ional i n s t i t u t i o n s w i l l be i d e n t i f i e d and a s s i s t e d s o t h a t they can provide the necessary l eade r sh ip i n formulat ing n a t i o n a l p l ans , t r a i n i n g programmes, s e r v i c e p a t t e r n s and c o l l a b o r a t i v e e x e r c i s e s f o r t h e development of r e sea rch i n psychia t ry .

Since 1968 th ree in ter -country seminars have been he ld t o s t i m u l a t e n a t i o n a l a c t i v i t i e s f o r improving p s y c h i a t r i c medical educat ion and promoting h e a l t h manpower development f o r p s y c h i a t r i c s e r v i c e s . I n 1973, a consu l t an t under an i n t e r - r e g i o n a l p r o j e c t v i s i t e d coun t r i e s i n t h e Region, evaluated t h e c u r r e n t s t a t u s and t h e need f o r p u b l i c h e a l t h s e r v i c e s i n mental h e a l t h , and formulated recommendations f o r medium- and long-term plans f o r WHO a s s i s t a n c e . An in ter -country seminar on community a c t i o n f o r mental h e a l t h ca re he ld i n Bangalore ( Ind ia ) i n 1973 i d e n t i f i e d t h e need f o r a s sess ing the magnitude of t h e problem and made recommendations f o r t h e s t r eng then ing of h e a l t h s e r v i c e s f o r a comuni ty-or iented mental h e a l t h programme.

WHO i s a s s i s t i n g , through country p r o j e c t s , mental h e a l t h programmes i n Bangladesh, Burma, Ind ia , Indonesia , Mongolia, S r i Lanka and Thailand.


Assis tance w i l l he provided f o r t h e formulat ion and implementation of mental h e a l t h l e g i s l a t i o n on modern l i n e s . Development of a n a t i o n a l s t r a t e g y f o r administra- t i o n , o rgan iza t ion , t r a i n i n g , s e r v i c e s and re sea rch , taking i n t o cons ide ra t ion the needs of t h e community, a v a i l a b l e l eade r sh ip and community r e sources , w i l l be promoted through a s s i s t a n c e t o p i l o t p r o j e c t s a t d i f f e r e n t l e v e l s of care . S t rengthening of f a c i l i t i e s i n mental h e a l t h i n s t i t u t i o n s , medical c o l l e g e s , nurs ing schoo l s , d i s t r i c t h o s p i t a l s and primary h e a l t h cen t re s f o r t r a i n i n g , s e r v i c e s and re sea rch w i l l a l s o r ece ive suppor t ; i t i s a l s o proposed t o a s s i s t r e h a b i l i t a t i o n programmes f o r long-term p a t i e n t s i n mental h o s p i t a l s , youth guidance and c h i l d psych ia t ry .

Other a spec t s w i t h which WHO w i l l cont inue t o a s s i s t a re : the development of p s y c h i a t r i c f a c u l t i e s i n medical schoo l s , t h e t r a i n i n g of h e a l t h and a l l i e d h e a l t h personnel f o r teaching and s e r v i c e s , t h e o rgan iza t ion of community-oriented mental h e a l t h ca re programmes, i n v e s t i g a t i o n s i n t o t h e epidemiological a s p e c t s of mental d i s o r d e r s , and development of r e h a b i l i t a t i o n s e r v i c e s and promotion of mental h e a l t h educat ion. Regional c o l l a b o r a t i o n i n r e sea rch and t r a i n i n g w i l l be emphasized, and informat ion on procedures f o r s t andard iz ing p s y c h i a t r i c d i agnos i s , c l a s s i f i c a t i o n and s t a t i s t i c s w i l l be made a v a i l a b l e t o Member c o u n t r i e s .

SUB-PBOGRIIlME 5.2.6 HENTAL HEALTH

Schedule A - Estimated Oblinations

SUB-PROGRAMME 5.2.7 PREVENTION AND CONTROL OF ALCOHOLISM, DRUG DEPENDENCE AND ABUSE

Objectives

To a s s i s t with the development of an improved p reven t ion , t rea tment and r e h a b i l i - t a t i o n p r o g r m e f o r the c o n t r o l of drug abuse and a lcohol ism;

t o assist wi th t h e epidemiological i n v e s t i g a t i o n s of drug dependence;

t o assist i n t h e eva lua t ion of p reven t ion and c o n t r o l measures;

t o s t r e n g t h e n c o m u n i t y o rgan iza t ions f o r h e a l t h educat ion and youth guidance a g a i n s t drug abuse, and

t o a s s i s t i n t h e co-ordinat ion of a c t i v i t i e s of n a t i o n a l a u t h o r i t i e s i n t h e c o n t r o l of drug abuse by providing t e c h n i c a l a s s i s t a n c e .

Approach

- Col lec t ion of d a t a on medical and s o c i a l problems a s s o c i a t e d with the thera- p e u t i c and non-medical use of psychoact ive , dependence-producing drugs, and dissemina- t i o n of informat ion about these t o h e a l t h and o t h e r a u t h o r i t i e s concerned wi th the c o n t r o l of drug abuse.

- Promotion of epidemiological i n v e s t i g a t i o n s and a i t h e t r a i n i n g of required h e a l t h and a l l i e d personnel f o r programmes r e l a t e d t o drug dependence.

- Promotion of s e r v i c e s f o r t h e prevent ion of drug dependence and t r ea tmen t , i nc lud ing r e h a b i l i t a t i o n of drug-dependent persons .


Opium and cannabis a r e t r a d i t i o n a l l y used i n many c o u n t r i e s of the Region. Increased use of t h e s e drugs , r e s u l t i n g i n dependency amongst youth and ado lescen t s , obta ined through i l l i c i t drug t r a f f i c , and t h e spread of t h i s problem on a g lobal s c a l e due t o tourism and u n r e s t r i c t e d movement of youth a r e being i d e n t i f i e d as socio-economic problems i n many c o u n t r i e s i n t h e Region. The e x t e n t and p a t t e r n of drug abuse a r e being s t u d i e d wi th a s s i s t a n c e from t h e United Nations Fund f o r Drug Abuse Control (UNFDAC) and WHO. Crop s u b s t i t u t i o n , t rea tment and r e h a b i l i t a t i o n programmes a r e being developed i n Burma and Thailand, and o t h e r c o u n t r i e s a r e being helped t o p repa re r eques t s f o r p o s s i b l e a s s i s t a n c e from UNFDAC.

Following a WHO c o n s u l t a n t ' s v i s i t t o Burma, Indonesia and S r i Lanka i n 1973, an in t e r -coun t ry seminar on t h e epidemiology and c o n t r o l of drug abuse and r e h a b i l i t a - t i o n of drug dependents w i l l be organized i n Indonesia towards t h e end of 1974. I n 1975, consu l t an t s w i l l v i s i t va r ious c o u n t r i e s t o a s s e s s t h e p rogress of a c t i v i t i e s aimed a t the c o n t r o l of drug abuse.


Technical a s s i s t a n c e w i l l be continued (1) i n t h e e s t ab l i shment of h e a l t h s e r - v i c e s f o r t rea tment and r e h a b i l i t a t i o n of drug dependents independent of p s y c h i a t r i c h o s p i t a l s , (2) i n the promotion of h e a l t h educat ion based on exper ience gained through c a r e f u l l y organized p i l o t p r o j e c t s , and (3) i n t h e eva lua t ion of c o n t r o l measures. The long-term e f f e c t s of cannabis and opium use w i l l be s t u d i e d wi th s p e c i a l r e fe rence t o withdrawal and maintenance a s p e c t s . Ass i s t ance w i l l b e g iven i n i n t r o d u c i n g measures f o r t h e prevent ion and c o n t r o l of o t h e r psycho t rop ic drugs i n t h e c o u n t r i e s of the Region. Soc io -cu l tu ra l f a c t o r s p r o h i b i t i n g drug abuse w i l l be s tud ied f o r p o s s i b l e a p p l i c a t i o n i n country programmes. Epidemiological i n v e s t i g a t i o n s w i l l be a s s i s t e d .

SUB-PROORAMME 5 . 2 . 7 PREVENTION AND CONTROL OF ALCOHOLISM AND DRUG DEPWDENCE AND ABUSE


r

1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country


Regular Budget

us $

3 900

20 000

23 900

Number of Posts

Regular Budget

0 t her Sources

us $

Total

us $

3 900

20 000

23 900

Other Sourcea Total

I

SUB-PROGRAMME 5.2 .9 IMMUNOLOGY

Object ives

To assist i n t h e a p p l i c a t i o n of new concepts and techniques i n immunology t o p u b l i c h e a l t h problems;

t o a s s i s t i n developing adequate competence i n immunology t o se rve d i a g n o s t i c , r e sea rch and t r a i n i n g purposes i n t h e c o u n t r i e s of t h e Region, and

t o assist i n t h e es tabl ishment of n a t i o n a l and r e g i o n a l training-cum-research c e n t r e s and t o promote c o l l a b o r a t i o n i n t r a i n i n g and re sea rch .

Approach

- Assis tance i n the a p p l i c a t i o n of newly acquired knowledge i n immunology t o h e a l t h problems of n a t i o n a l importance.

- Strengthening of i n s t i t u t i o n s i n Member c o u n t r i e s t o he lp them develop compe- t ence i n t h e f i e l d of immunology f o r providing e x p e r t i s e and m a t e r i a l .

- St imulat ion of immunological i n v e s t i g a t i o n s on problems of l o c a l h e a l t h impor- t ance .

- Promotion of in ter -country c o l l a b o r a t i o n f o r t h e exchange of informat ion and d i s t r i b u t i o n of r e fe rences u s e f u l i n c l i n i c a l imunology.

Programme Review

Iwaunolog). has provided e f f i c i e n t methods f o r t h e prophylaxis , d i agnos i s and t rea tment of many d i s e a s e s of p u b l i c h e a l t h importance. Recent advances have provided techniques f o r t h e d iagnos i s of cancer and ;.f auto-immune d i s e a s e s a s w e l l a s f o r t r e a t - ment, and f o r t i s s u e t r a n s p l a n t a t i o n .

Sin22 1968, WHO has organized and a s s i s t e d wi th immunology workshops and i n t h e es tabl ishment of t ra in ing-cum-resear~l l c e n t r e s , and has a l s o helped t o o rgan ize meetings of i m u n o l o g i s t s t o d i scuss s p e c i a l problems i n immunological r e sea rch .

Ass i s t ance i n the pron~cLic,n of ii,.munization s e r v i c e s f o r t h e c o n t r o l of communi- c a b l e and non-comm~~nicshje d i s e a s e s , arcd i n the s tudy of t h e im.unology cf dengue/haernar- r h a g i c f e v e r and L l ~ c a p p l i c a t i o n of r e s u l t s i n t h e treatment of cases .

Continued suppor t t o progranmes f o r t h e provis ion of f a c i l i t i e s f o r t r a i n i ~ g i m u n o l o g i s t s , s t r eng then ing of i n s t i t u t i o n a l f a c i l i t i e s f o r d i ~ g n o ~ i s and ti-satrrer,t and c o l l a b o r a t i v e r ? sz ;~ rch .


PROGRAMME 5.3 PROPHYLACTIC AND THERAPEUTIC SUBSTANCES

To improve t h e q u a l i t y of p rophy lac t i c and t h e r a p e u t i c substances , and

t o i n c r e a s e t h e t r a i n i n g of personnel i n drug q u a l i t y c o n t r o l .

- Strengthening of t h e n a t i o n a l drug q u a l i t y c o n t r o l l a b o r a t o r i e s .

- Training of drug i n s p e c t o r s and drug a n a l y s t s .

- Strengthening and updating the drug l e g i s l a t i o n .

As a rrsu:t of t h e growing awareness on t h e p a r t of t h e p u b l i c and t h e a p p l i c a t i o n of r e sea rch t o d i s e a s e c o n t r o l , t h e use of drugs has increased. To meet t h i s increased demand, t h e production i n and t h e import i n t o t h e c o u n t r i e s of the drugs have increased.

In the c o u n t r i e s of t h e Region, i t has proved d i f f i c u l t t o en fo rce and superv i se s t a n d a r d s , with t h e r e s u l t the smal l drug manufacturing u n i t s have not been conforming t o accep tab le s a f e s t andards i n t h e i r production and, as a r e s u l t , t h e drugs a r e of sub- s t andard q u a l i t y , i n e f f e c t i v e , and i n c e r t a i n cases even i n j u r i o u s . Extreme c l i m a t i c cond i t ions a l s o adverse ly a f f e c t c e r t a i n drugs.

WHO has a s s i s t e d wi th e i g h t p r o j e c t s ir. t h e Region i n t h e f i e l d of q u a l i t y contr r l l of b i o l o g i c a l and pharmaceutical p roduc t s , and has a l s o organized t h r e e seminars/worksl,~~p:; on t h i s s u b j e c t i n Bombay (1969), Bangkok (1971) and J a k a r t a (1973).

ProposaZs fo r 1976-1977

Prov i s ion of consultant scrv iscs , fe l lowsl l ips and scminars i n drug q u a l i t y c a n t r u l .

PROGRAHME 5.3 PROPHYLACTIC AND THERAPEUTIC SUBSTANCES


1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

Number of Posts .


Regular Budget

2

2

4

Regular Budget

us $

36 310

146 665

182 975

Other Sources Total

2

2

4

Other Sources

us $

Total

us $

36 310

146 665

182 975

SUB-PROGRAMME 5.3 .1 P R O G W E PLANNING AND DIRECTION

Objective

To a s s i s t i n planning and d i r e c t i o n of a c t i v i t i e s r e l a t i n g t o q u a l i t y c o n t r o l of p rophy lac t i c and t h e r a p e u t i c substances .

Approach

- Assis tance i n prepar ing p lans f o r e s t a b l i s h i n g o r s t r eng then ing q u a l i t y c o n t r o l u n i t s by us ing p r o j e c t formulat ion methods, and i n monitoring progress .


A number of p r o j e c t s and an in t e r -coun t ry p r o j e c t concerning t h i s s u b j e c t a r e i n ope ra t ion i n most of the coun t r i e s i n t h e Region. A few of these p r o j e c t s a r e l inked w i t h t h e o b j e c t i v e t o improve s t o r a g e and d i s t r i b u t i o n of p r o p h y l a c t i c and t h e r a p e u t i c substances ( see Sec t ion 3.1.2 f o r medical s t o r e s management).

Pi.~posaZs for 1976-1977

Assis tance i n updating drug l e g i s l a t i o n and s t r eng then ing t h e n a t i o n a l drug q u a l i t y c o n t r o l l a b o r a t o r i e s .

SUB-PROGRAMNE 5.3.1 PROGRAHME PLANNING AND GENERAL ACTIVITIES


.

1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country


Regular Budget

us $

36 310

36 310

Number of Post8

Other Sources

us $

Total

2

2

Regular Budget

2

2

Total

us $

36 310

36 310

Other Sources

SUB-PROGRAMME 5.3.2 SPECIFICATIONS AND QUALITY COhTROL OF PHARMACEUTICAL PREPARATIONS

Objectives

To improve the q u a l i t y c o n t r o l of pharmaceutical substances and t o i n c r e a s e t r a i n - ing of personnel i n charge of a c t i v i t i e s i n t h e f i e l d .

Approach

- Tra in ing drug a n a l y s t s and drug i n s p e c t o r s i n n a t i o n a l i n s t i t u t i o n s i n the country.

- Prov i s ion of necessary advice f o r updating t h e e x i s t i n g drug l e g i s l a t i o n and t o meet o t h e r requirements.

Progrmme Review

Governments a r e taking necessary s t e p s t o e s t a b l i s h n a t i o n a l drug q u a l i t y c o n t r o l l a b o r a t o r i e s o r t o s t r eng then t h e e x i s t i n g ones. The drug manufacturing es tabl ishments a r e being inspected more r e g u l a r l y and provided wi th guidance i n t h e implementation of t h e code of good manufacturing p r a c t i c e s at p l a n t l e v e l . T ra in ing a c t i v i t i e s have expanded o r have been i n i t i a t e d a t s u i t a b l e i n s t i t u t i o n s , which have been s t rengthened wi th WHO a s s i s t a n c e .

Seven c o u n t r i e s have WHO-assisted country p r o j e c t s .


Assis tance i n s t r eng then ing drug l e g i s l a t i o n and i n s t r eng then ing n a t i o n a l drug q u a l i t y c o n t r o l l a b o r a t o r i e s .

SUE+PROGRAMME 5.3.2 SPECIFICATIONS AND QUALITY CONTROL OF PHARMACEWI'IWLL PREPARATIONS


1974

Regional

Country

Inter-country

Total

Irrter-country

Inter-country

Inter-country

M b e r of Posts

Regular Budget

2

2

>


Regular Budget

us $

146 665

146 665

Other Sources Total

2

2

Other Sources

us $

Total

us $

146 665

146 665

APPROPRIATION SECTION 6 PROMOTION OF ENVIRONMENTAL HEALTH

PROGRAMME 6 .1 PRQMOTION OF ENVIIUNMENTAL HEALTH

Object ives

To promote community environmental h e a l t h ;

t o s t r eng then environmental h e a l t h manpower, and

t o s t r eng then f u r t h e r t h e occupat ional h e a l t h s e r v i c e s i n o rde r t o provide t h e working popula t ion wi th b e t t e r p r o t e c t i o n a g a i n s t hazards from the working environment, i nc lud ing r a d i a t i o n p ro tec t ion .

Approach

- Assis tance i n the s tudy and a n a l y s i s of t h e cond i t ions of environmental h e a l t h e x i s t i n g i n c o u n t r i e s of t h e Region.

- Promotion and i n i t i a t i o n of c o l l a b o r a t i v e programmes undertaken j o i n t l y by n a t i o n a l governments and WHO.

- Development of b a s i s f o r secur ing f i n a n c i a l suppor t from n a t i o n a l , i n t e r - n a t i o n a l and b i l a t e r a l sources f o r t h e cons t ruc t ion of s p e c i f i c schemes.

- Review and eva lua t ion of progress achieved.

The high incidence of water-borne d i s e a s e s cont inue t o be one of the major p u b l i c h e a l t h problems i n a l l c o u n t r i e s of t h e Region. An es t ima te of the impact which communi- cab le d i s e a s e s r e s u l t i n g fram unsafe environment have on h e a l t h i n one country of the Region can i l l u s t r a t e t h e magnitude of t h e problem:

Percentage of man-years l o s t from dea ths caused by environment-related communicable d i s e a s e s was es t imated a t 21% of t h e t o t a l ;

Percentage of morbidity from t h e s a m e cause: 14%. and

Percentage of h e a l t h expendi ture on enviranmmt-re la ted communicable d i seases : 17%.

Because of t h e p r i o r i t y g iven by t h e governments, p rov i s ion of community water supply i s t h e main a rea of a c t i v i t y f a r WHO a s s i s t a n c e f o r t h e promotion of environmental h e a l t h ; o t h e r f i e l d s such as sewerage and d ra inage , educat ion and t r a i n i n g of environmen- t a l h e a l t h personnel and environmental p o l l u t i o n c o n t r o l a l s o r ece ive a t t e n t i o n . The community water supply programmes were redef ined t o cover p r o j e c t s f o r d i s p o s a l of e x c r e t a and o t h e r wastes a l s o . With UNDP a s s i s t a n c e , pre-investment s t u d i e s on water supply and sewerage were undertaken. Under t h e WHO/IBRD Co-operative Programme, s e c t o r s t u d i e s on water supply and s a n i t a t i o n were c a r r i e d out and p r o j e c t documents prepared; t h e s e enabled t h e governments i n p lanning t h e i r programmes t o o b t a i n maximum b e n e f i t w i t h i n t h e a v a i l a b l e resources and a l s o i n a t t r a c t i n g a s s i s t a n c e fram i n t e r n a t i o n a l and b i l a t e r a l resources f o r t h e development of these p r o j e c t s and f o r t h e t r a i n i n g of personnel .

Undergraduate and post-graduate t r a i n i n g programmes i n environmental h e a l t h continued t o r e c e i v e WHO a s s i s t a n c e i n a d d i t i o n t o t h e promotion of s p e c i a l i z e d courses i n va r ious d i s c i p l i n e s . Group educa t iona l a c t i v i t i e s on t h e educat ion and t r a i n i n g of environmental h e a l t h personnel were organized which provided o p p o r t u n i t i e s t o d i scuss c o l l e c t i v e l y t h e common problems and t o b e n e f i t from an exchange of mutual exper iences . Manpower development i n t h e f i e l d of environmental h e a l t h has been c l o s e l y a s soc ia t ed wi th the development of o t h e r c a t e g o r i e s of h e a l t h personnel .

The problems of p o l l u t i o n , which a r e becoming more complex i n na tu re and a r e mul t ip lying with t h e r a p i d inc rease i n population, t h e development of new unplanned urban se t t l ements , growth i n i n d u s t r i e s and changes i n land use and i r r i g a t i o n p r a c t i c e s a r e causing grave concern t o governments which a r e eager t o take s t e p s f o r the abatement and con t ro l of environmental po l lu t ion . This s i t u a t i o n was assessed, and, on the b a s i s of the f indings , WHO a s s i s t a n c e was provided f o r t h e development of po l lu t ion con t ro l measures, through the s t rengthening of environmental h e a l t h s e r v i c e s and assoc ia ted na t iona l i n s t i t u t i o n s f o r t r a i n i n g and research.

WHO a s s i s t a n c e t o the bio-medical and environmental hea l th aspec t s of ion iz ing r a d i a t i o n has included the t r a i n i n g of radiographers and e lect ro-medical technicians , development of monitoring and s u r v e i l l a n c e s e r v i c e s , es tabl ishment of s a f e t y measures i n atomic energy i n s t a l l a t i o n s , a g r i c u l t u r a l and i n d u s t r i a l operat ions and promotion of research.

Assistance was provided i n t r a i n i n g personnel required f o r the development and ~Lreng then ing of i n s t i t u t e s of occupational hea l th and the s t rengthening of hea l th se rv ices f o r the working population.

Two count r i es were a s s i s t e d wi th food con t ro l measures, and th ree wi th improving the s tandards of hygiene i n food-processing p l a n t s and e a t i n g es tabl ishments .

A s regards hazards from p e s t i c i d e s , a s s i s t a n c e has been provided i n the form of t r a i n i n g personnel f o r the de tec t ion of p e s t i c i d e res idues and i n framing o r r ev i s ing p e s t i c i d e l e g i s l a t i o n .


Assistance w i l l be continued i n t h e f i e l d s of community water supply and s a n i t a t i o n , education and t r a i n i n g of environmental h e a l t h personnel, monitoring and con t ro l of environmental p o l l u t i o n and planning of environmental h e a l t h s e r v i c e s . Continued a s s i s t a n c e w i l l be given t o occupational h e a l t h s e r v i c e s and t o food con t ro l and hazards from p e s t i c i d e s .

PROGRAMME 6 . 1 PROElOTION OF ENVIRONMENTAL HEALTH


1974

Regional

country

~nter-country

Total

Inter-country

Inter-country

Inter-country

4


Total

us $

74 700

1 900 6 7 3

210 520

2 1 8 5 8 9 3

Regular Budget

us $

74 700

8 6 1 460

1 8 8 020

1 1 2 4 180

Regular Budget

4

1 4

8

26

Other Sources

us $

1 039 213

22 500

1 0 6 1 713

Other Sources

7

7

Total

4

2 1

8

33

SUB-PROGRAMME 6.1.1 PROGRAMME PLANNING AND GENERAL PLANNING

Objectives

To develop long-term and medium programmes f o r WHO a s s i s t a n c e i n the f i e l d of environmental h e a l t h ;

t o ensure an i n t e g r a t e d approach t o the promotion of environmental h e a l t h with due regard t o the m u l t i p l i c i t y of the needs and f a c t o r s involved, and

t o co-ordinate a l l environmental hea l th progranrmes both a t country and reg iona l l e v e l s .

Approach

- Review of e x i s t i n g environmental h e a l t h programmes i n the countr ies of the Region.

- Study of means f o r developing programmes within the e x i s t i n g economic, s o c i a l and i n s t i t u t i o n a l cons t ra in t s .

- Strengthening of educat ional and t r a i n i n g f a c i l i t i e s and i n s t i t u t i o n s t o meet t h e need f o r q u a l i f i e d environmental h e a l t h personnel.

Progrmnme Review

The WHO programme f o r t h e promotion of environmental hea l th i n the Region a t p resen t concentra tes on four a reas ; namely, provis ion of b a s i c s a n i t a r y s e r v i c e s , education and t r a i n i n g of environmental h e a l t h personnel, con t ro l of environmental p o l l u t i o n and hazards , and es tabl ishment and s t rengthening of environmental h e a l t h s e r v i c e s and i n s t i t u t i o n s . Assis tance i n the development of these a r e a s i s being provided through country and inter-country p ro jec t s . I n the planning of the environmental h e a l t h programme f o r a country t h e f i e l d s t a f f a s s i s t i n compiling and analysing d a t a o n country' a environmental h e a l t h plans , i d e n t i f y i n g d e f i c i e n c i e s , developing a reas of WHO inpu t s , and co-ordinating a c t i v i t i e s with r e l a t e d agencies. Thus, i n the planning and d i r e c t i o n of a s s i s t a n c e p rogrames f o r t h e promotion of environmental h e a l t h , c lose co-ordination of a c t i v i t i e s is maintained amongst t h e WHO s t a f f a t var ious l e v e l s .


Support t o country h e a l t h pKOgKaJme planning i n environmental h e a l t h w i l l cont i - nue i n 1976 and 1977 i n the context of country hea l th p rograming , through t h e provis ion of s a n i t a r y engineers a s resource personnel f o r WHO Representat ives i n the d i f f e r e n t coun t r i es . Environmental h e a l t h programmes w i l l be guided by a c t i v i t i e s i n o the r p r io - r i t y a reas of h e a l t h , such a s communicable d i sease con t ro l , s t rengthening of h e a l t h s e r v i c e s , e t c .

SUB-PROGRAMME 6.1.1 PROGRAMME PLANNING AND GENERAL ACTIVITIES


SUB-PROGRAMME 6.1.2 PROVISION OF BASIC SANITARY MEASURES

Objectives

To a s s i s t countr ies i n achieving na t iona l t a rge t s i n t h i s area f o r the Second United Nations Development Decade;

t o prevent and control water-borne and fil th-borne d i seases , and

t o promote physical, mental and s o d a 1 well-being by the provision of s a f e and adequate water suppl ies , san i ta ry co l lec t ion and d i sposa l of excreta and of l i qu id and s o l i d wastes and i n the provision of healthy housing condi t ions, and by the proper appl icat ion of san i ta ry pr inc ip les f o r the production, processing and d i s t r i bu t i on of food.

Approach

- Assistance i n the planning, implementation and evaluat ion of water supply, sewerage and waste d i sposa l programmes, i n the t ra in ing of s an i t a ry personnel, i n t he preparation of guidel ines and manuals, i n the development of operat ion and maintenance schemes, i n es tab l i sh ing water qua l i t y con t ro l , and i n i den t i f i c a t i on of p r i o r i t i e s based on epidemiological c r i t e r i a .

Basic s an i t a ry services , such as s a f e water supply and s an i t a ry disposal of excreta and o ther wastes i n urban and r u r a l communities, continue t o be a matter of primary concern i n environmental hea l th programmes, a t both country and regional l eve l s . National community water supply programmes werz redefined t o cover the provision of s an i t a t i on f a c i l i t i e s a l so , hut t h e i r development h~ not been ab le t o keep pace with the needs of ever-increasing populations, owing mainly t o idadequate f i nanc i a l resources and lack of e f f ec t i ve organizat ional set-up, t ra ined personnel and mater ia l . A t the twexty-sixth sess ion the Regional Committee, one of the inter im p r i o r i t i e s adopted when considering prdposale f o r the development of a heal th char te r wae the provision and maintenance of water supply and drainage. It is estimated t h a t , i n 1970, only 33% of the urban population and 10% of the r u r a l population received comunity water supply. This s i t u a t i o n shows t h a t much remains t o be done by governments t o a t t a i n the proposed t a rge t s f o r t he Second United Nations Development Decade, namely, t o provide 60% of a l l the urban population with water supply i n the houses and 40% with water supply from publ ic s tandpoi ts and 27% of a l l the urban population with s an i t a ry sewer se rv ices ; s im i l a r l y , 25% of the r u r a l population should have reasonable access t o s a f e water and 10% should be provided with f a c i l i t i e s f o r the s an i t a ry disposal of excreta.

The Organization, i n c lose col laborat ion with UNICEF by way of ma t e r i a l and f i nanc i a l a i d , has been a s s i s t i n g seven pro jec t s i n the Region and is ac t ing a s the Executing Agency f o r one pro jec t with funds from UNDP. In addi t ion, a s s i s t ance continues t o be provided through inter-country pro jec t s . Plans have been prepared t o assess the comunity water supply programmes i n the Region with a view t o determining fu r t he r WHO ass i s tance i n acce le ra t ing the development and implementation of the programmes i n t e r m of na t iona l t a rge t s f o r the Second United Nations Development Decade and i n co l lec t ing da ta f o r the preparation of manuals, guidel ines and standard drawings f o r use i n these pro jec t s . F ie ld s t ud i e s on the development of a handpump f o r use i n these programmes have been i n progress i n India and Bangladesh.

An inter-country seminar on s o l i d wastes management is scheduled t o be held i n Bangkok during the l a s t quar te r of 1974. A regional seminar on r u r a l water supply is planned i n Ind ia f o r 1975 as a follow-up of the one he ld i n 1970.

Proposals fo r 1976-1977

Approximately 20 san i ta ry engineers, 4 s an i t a r i an s and a number of short-term consul tants i n s eve ra l s p e c i a l t i e s w i l l provide the ass i s tance proposed f o r 1976-1977.

UNICEF w i l l con t inue t o provide f i n a n c i a l and m a t e r i a l a i d . The emphasis i n WHO and UNICEF a c t i v i t i e s w i l l cont inue t o be on a s s i s t a n c e t o country-wide programmes t o produce r e a l impact.

WHO w i l l cont inue t o co-operate f u l l y wi th t h e World Bank, t h e Asian Development Bank and o t h e r i n t e r n a t i o n a l and b i l a t e r a l lending agencies i n t h e i r a c t i v i t i e s i n t h i s f i e l d , and e f f o r t s a r e being made t o secure t h e i r f u r t h e r a s s i s t a n c e i n the development of community water supply and s a n i t a t i o n programmes.

SUB-PROGRAMME 6.1.2 PROVISION OF BASIC SANITARY MEASURES


SUB-PROGRAMME 6.1.3 PRE-INVESTMENT PLANNING FOR BASIC SANITARY SERVICES

Objectives

To a s s i s t i n p r e p a r i n g and implementing n a t i o n a l p l a n s f o r urban and r u r a l commu- n i t y wa te r s u p p l i e s and was te d i s p o s a l , and

t o develop t h e b a s i s f o r s e c u r i n g f i n a n c i a l suppor t from n a t i o n a l , i n t e r n a t i o n a l and b i l a t e r a l s o u r c e s f o r t h e c o n s t r u c t i o n of s p e c i f i c schemes.

Approach

- P r e p a r a t i o n of g u i d e l i n e s f o r t h e p l ann ing and o p e r a t i o n of n a t i o n a l and l o c a l programmes and p r o j e c t s .

- Conduct of n a t i o n a l s e c t o r s t u d i e s on community water supply and was te d i s p o s a l .

- A s s i s t a n c e i n p lanning and c a r r y i n g o u t t e c h n i c a l , i n s t i t u t i o n a l , economic, s o c i a l and f i n a n c i a l s t u d i e s on t h e f e a s i b i l i t y of s p e c i f i c schemes f o r urban and r u r a l community water s u p p l i e s and was te d i s p o s a l .

Progrannne Review

The funds made a v a i l a b l e by UNDP i n t h e p a s t have been v a l u a b l e t o t h e c o u n t r i e s i n pre- inves tment a c t i v i t i e s . Three pre-investment s t u d i e s i n r e s p e c t of water supply and sewerage f a c i l i t i e s have been completed f o r t h e m e t r o p o l i t a n a r e a of C a l c u t t a i n I n d i a , f o r towns o f t h e south-west c o a s t a l a r e a i n S r i Lanka and f o r G r e a t e r Kathmandu and Bhaktapur i n Nepal. S i m i l a r s t u d i e s on wa te r supply and s a n i t a t i o n a r e i n p r o g r e s s i n Indones i a and Maldives , and p r e p a r a t i o n s a r e under way f o r pre-investment s t u d i e s i n r u r a l w a t e r supp ly i n Eas t J ava i n Indones ia .

Apart from i ts l e n d i n g a c t i v i t i e s , t h e IBRD has of l a t e been t a k i n g more i n t e r c s t i n s e c t o r s t u d i e s i n water supply and was te d i s p o s a l i n o rde r t o a s s i s t governments i n assembl ing , a n a l y s i n g and e v a l u a t i n g d a t a and i n fo rma t ion s o t h a t they can p r e s e n t soundly conceived and well-documented p l a n s t o economic development p l a n n e r s . The Bank e a r l i e r conducted s e c t o r s t u d i e s i n water supply i n Indones ia and Thai land and c a r r i e d ou t p r e l i - minary i n v e s t i g a t i o n s i n t h e S t a t e of Rajas than and a wa te r supply and sewerage s t u d y i n U t t a r Pradesh i n I n d i a and s e c t o r s t u d i e s on water supply and s a n i t a t i o n i n Bangladesh and Burma. These s t u d i e s have y i e l d e d e s s e n t i a l i n fo rma t ion on which t o ba se p l ann ing and decision-making f o r wa te r supply and was t e d i s p o s a l programmes by governmental o p e r a t i n g a g e n c i e s and n a t i o n a l economic development bod i e s , a s w e l l a s f o r UNDP coun t ry programming

The Bank has shown i t s i n t e r e s t i n t h e UNDPIWHO-assisted p r o j e c t Nepal 0025, "Development of Water Supply and Sewerage i n G r e a t e r Kathmandu and Bhaktapur" and I D A c r e d i t was made a v a i l a b l e f o r t h e c o n s t r u c t i o n of t h e " F i r s t s t a g e programme of works" p r epa red under t h i s p r o j e c t . Schemes f o r wa te r supply and sewerage of Dacca and wa te r supply f o r Chi t tagong i n Bangladesh a r e be ing executed w i t h t h e a s s i s t a n c e of t h e Bank.


For t h e achievement o f t h e n a t i o n a l g o a l s f o r t h e Second United Nat ions Develop- ment Decade, WHO w i l l p rov ide a s s i s t a n c e t o governments t o e n a b l e them ( a ) t o c r e a t e o r s t r e n g t h e n p r o g r a m e s f o r t h e p l ann ing , execu t ion and u l t i m a t e o p e r a t i o n o f t h e r e q u i r e d f a c i l i t i e s ; (b) t o s t i m u l a t e i n c r e a s i n g l y t h e e f f e c t i v e u s e of r e s o u r c e s i n a d d i t i o n t o t h e i r own; ( c ) t o focus i n t e r n a t i o n a l a t t e n t i o n on p r i o r i t y h e a l t h problems, and (d) t o h e l p governments o b t a i n and u s e a p p r o p r i a t e b i l a t e r a l o r m u l t i - l a t e r a l a i d f o r t h e so lu - t i o n of t h e s e problems.

New p r o j e c t s f o r d e l i v e r i n g b a s i c s a n i t a r y s e r v i c e s t o r u r a l p o p u l a t i o n s , h i t h e r t o w i thou t r ea sonab le a c c e s s t o s a f e wa te r s u p p l i e s , w i l l be s t a r t e d i n S r i Lanka and Thai land . These p r o j e c t s may a t t r a c t i n v e s t m e n t / c a p i t a l from o t h e r i n t e r n a t i o n a l or b i l a t e r a l agenc i e s .

SUB-PROGRAMME 6.1.3 PRE-INVESTMENT PLANNING FOR BASIC SANITARY SERVImS


.--

1974 - Regional

Country

In ter -country

To ta l

In ter -country

In ter -cotmtry

In ter -country

Estimated Obl iga t ions Number of P o s t s

To ta l

us $

523 851

22 500

- 546 351

Regular Budget

us $

Regular Budget

Other Sources

us $

523 851

22 500

546 351

Other Sources

3

3

Total

3

3

SUB-PROGRAMME 6.1 .4 CONTROL OF ENVIRONMENTAL POLLUTION AND HAZARDS

Objective

To a s s i s t i n reducing environmental p o l l u t i o n and hazards t o l e v e l s t h a t w i l l permit opt imal economic development wi thout endangering h e a l t h o r d i s t u r b i n g e c o l o g i c a l systems.

Approach

- Study of t h e causes of environmental p o l l u t i o n and a s s i s t a n c e i n t h e development of s u r v e i l l a n c e and c o n t r o l s e r v i c e s .

- Prepara t ion and maintenance of an inventory of sources of p o l l u t i a n i n each country .

- Assis tance i n the es tabl ishment a f s t andards and l e g i s l a t i o n .

- Promotion of r e sea rch a c t i v i t i e s .

Progrmme He iii ew

A l l coun t r i e s of t h e Region a r e f ac ing problems of p o l l u t i o n r e s u l t i n g from inadequate s a n i t a r y f a c i l i t i e s . These problems a r e now becoming more complex i n n a t u r e and a r e i n c r e a s i n g wi th t h e r ap id i n c r e a s e of popu la t ion , development of new unplanned urban s e t t l e m e n t s , growth of i n d u s t r i e s and changes i n land u s e and i r r i g a t i o n p r a c t i c e s . This s i t u a t i o n has caused grave concern t o governments, which a r e eager t o t ake neces- s a r y s t e p s f o r t h e abatement and con t ro l of environmental p o l l u t i o n .

So f a r , WHO a c t i v i t i e s i n t h i s f i e l d have covered a s s i s t a n c e t o water p o l l u t i o n c o n t r o l programmes i n I n d i a and Thailand and t o the d r a f t i n g of l e g i s l a t i o n on a i r p o l l u t i o n c o n t r o l i n India . A r e g i o n a l seminar on a i r p o l l u t i o n con t ro l was conducced i n I n d i a i n 1972 and has s t imula ted the i n t e r e s t of governments i n the Region.

I n 1973, a consu l t an t s tud ied t h e environmental p o l l u t i o n problems i n v a r i o u s c o u n t r i e s and made recommendations f o r use a s a b a s i s f a r WHO'S p r o g r m e of a s s i s t a n c e . Provis ion has been made f o r the recrui tment of a s a n i t a r y engineer t o s tudy and survey t h e environmental p o l l u t i o n problems and t h e i r causes , adv i se on s u i t a b l e c o n t r o l measures, a s s i s t i n the t r a i n i n g of technical s t a f f and ca r ry o u t eva lua t ion s t u d i e s .

By the end of 1974, i t is proposed t o produce an inventory of p o l l u t i o n sources i n the Region.


The background d a t a w i l l be updated p e r i o d i c a l l y , and a c o n s u l t a n t w i l l assist i n p repa r ing a second r e p o r t i n 1976. It i s planned t h a t a c o n s u l t a n t should a l s o fo l low up t h e recommendations of t h e 1974 seminar on s o l i d wastes management and p repa re g u i d e l i n e s . An i n t e r - r e g i o n a l group educa t iona l a c t i v i t y on water p o l l u t i o n c o n t r o 1 , t o be held i n c o l l a b o r a t i o n wi th WPRO and the Asian T n s t i t u t e of Technology, Bangkok, is under cons ide ra t ion .

The programme envisaged f o r 1977 inc ludes continued advice t o governments on m a t t e r s r e l a t e d t o environmental p o l l u t i o n c o n t r o l , through s a n i t a r y eng inee r s and shor t - term c o n s u l t a n t s , supported by educa t iona l activities on t h e economic re-use of sewage.

SUB-PROGm 6.1.4 CONTROL OF ENVIRONMENTAL POLLUTION m WARDS


1974

Regional

Country

In ter -country

T o t a l

1975

Regional

Country

In ter -country

T o t a l

1976 - Regional

Country

In ter -country

T o t a l

1977 - Regional

Country

In ter -country

To ta l

Number

Regular Budget

2

2

2

2

2

2

2

2

Regular Budget

us $

93 600

34 230

127 830

115 400

45 900

161 300

72 250

53 660

125 910

100 800

6 1 220

162 020

of

Other Sources

P o s t s

Total

2

2

2

2

2

2

2

2

Estimated Obl iga t ions

0 t her Sources

us $

T o t a l

us $

9 3 600

34 230

127 830

115 400

45 900

161 300

72 250

53 660

125 910

100 800

6 1 220 -

162 020

SUB-PROGRAMME 6.1.5 HEALTH OF WORKING POPULATIONS

Objective

To p r o t e c t the workers aga ins t h e a l t h Ilazards a r i s i n g ou t of t h e i r work o r from i i lnd i t ions i n t h e working environment.

- Assis tance i n s t r eng then ing e x i s t i n g i n s t i t u t e s of occupat ional h e a l t h t o enable them t o t r a i n q u a l i f i e d personnel , provide advice a s necessary , and conduct su r - veys and re sea rch .

- Prov i s ion of consu l t an t s t o a s s i s t i n conducting s h o r t courses f o r oCCupati0nal Ileal tll personnel o r l abora to ry personnel i n charge of p e s t i c i d e s d e t e c t i o n .

- Assis tance i n formulat ing p e s t i c i d e l e g i s l a t i o n .

h ..di~G'lime Review

Governments have provided inc reas ing funds f o r t h e implementation of s e r v i c e s . I n 1970, I n d i a e s t a b l i s h e d a Nat ional I n s t i t u t e of Occupational Health t o organize occu- p a t i o n a l h e a l t h courses , conduct research and t r a i n s t a f f f o r p r i v a t e and p u b l i c i n s t i - t u t i o n s . An i n s t i t u t e of occupat ional h e a l t h and reg iona l cen t re s a r e being e s t a b l i s h e d i n Indones ia , w i th t h e a s s i s t a n c e from UNDP.

WHO-assisted p r o j e c t s have been s e t up i n f i v e coun t r i e s , and another country has an occupa t iona l h e a l t h p r o j e c t being a s s i s t e d by ILO. Tra ining of occupa t iona l h e a l t h personnel is being conducted i n a few coun t r i e s wi th t h e a s s i s t a n c e of a consul- t a n t . S r i Lanka was a s s i s t e d i n organiz ing a course f a r h e a l t h o f f i c e r s , and t h e Government of Burma has undertaken the t r a i n i n g of i t s h e a l t h o f f i c e r s .

There h a s been i n c r e a s i n g use of p e s t i c i d e s i n a g r i c u l t u r e and governments have became more acu te ly conscious of t h e hazards a r i s i n g from the t r a n s p o r t , s t o r a g e and use of p e s t i c i d e s f o r t h i s purpose.

Indonesia has a WHO-assisted p r o j e c t concerned wi th hazards from p e s t i c i d e s , and four o t h e r c o u n t r i e s have received a s s i s t a n c e through an in t e r -coun t ry p r o j e c t .

A d r a f t UNDP reques t i s under p repa ra t ion a t Headquarters f o r a s s i s t a n c e i n t h i s f i e i d t o Bangladesh, Burma, Indonesia , S r i Lanka and Ttlailand.

I n regard t o occupa t iona l h e a l t h , a long-term s t a f f ."ember w i l l be ass igned t o Indonesia , and p rov i s ion w i l l be made f o r short- term consu l t an t s and fe l lowsh ips f a r Bangladesh, Burma, I n d i a , Indonesia , S r i Lanka and Thailand.

I n t h e f i e l d of hazards from p e s c i c i d e s , shor t - term c o n s u l t a n t s and fe l lowsh ips w i l l be provided t o Bangladesh, Burma, Indonesia , S r i Lanka and Thailand.

SUB-PROGRAMME 6.1.6 BIOMEDICAL AND ENVIRONMENTAL HEALTH ASPECTS OF I O N I Z I N G RADIATION

Objectives

To a s s i s t i n t h e es tabl ishment of r eg iona l and n a t i o n a l r a d i a t i o n p r o t e c t i o n se r - v i c e s through t h e improved use of r a d i a t i o n and rad io i so topes and i n che adopt ion of i n t e r n a t i o n a l s t andards i n p reven t ive and c u r a t i v e medicine;

t o promote t h e development of f a c i l i t i e s f o r s e r v i c e s , t r a i n i n g and re sea rch i n d i a g n o s t i c radiology, radiotherapy, nuc lea r medicine and medical physics ;

t o a s s i s t i n e s t a b l i s h i n g s t andards i n r a d i a t i o n dosimetry;

t o s t i m u l a t e n a t i o n a l i n t e r e s t i n t h e i n v e s t i g a t i o n of biomedical a s p e c t s of radia- t i o n and prevent ion of r i s k s , and

t o assist n a t i o n a l a u t h o r i t i e s i n l e g i s l a t i o n , o rgan iza t ion and admin i s t r a t ion f o r t h e prevent ion and c o n t r o l of r a d i o a c t i v e contamination of man and h i s environment.

Approach

- Promotion of s t andards and a s s i s t a n c e i n t h e t r a i n i n g of r e l e v a n t personnel i n monitoring and s u r v e i l l a n c e and i n t h e maintenance and r e p a i r of r a d i o l o g i c a l equipment.

- Establishment of r e g i o n a l and n a t i o n a l i n s t i t u t e s o r departments of r a d i o l o g i c a l s c i e n c e s , i nc lud ing c e n t r e s f o r r a d i a t i o n dosimetry and nuclear medicine, i n o rde r t o harmonize and improve t h e methods app l i ed , promote new and mare e f f e c t i v e a p p l i c a t i o n of r a d i a t i o n i n medicine and ensure comparabi l i ty of r e s u l t s .

- Assis tance i n the es tabl ishment of r eg iona l and n a t i o n a l r a d i a t i o n p r o t e c t i o n s e r v i c e s .

- Assis tance i n t h e l e g a l a s p e c t s of r a d i a t i o n p r o t e c t i o n .

- Assis tance i n t h e es tabl ishment of a n a t i o n a l network f o r t h e c o l l e c t i o n and eva lua t ion of d a t a on n a t i o n a l and reg iona l l e v e l s of environmental r a d i o a c t i v i t y and improvement and s t a n d a r d i z a t i o n of measuring methods.

- Advice t o n a t i o n a l a u t h o r i t i e s on l e g i s l a t i v e and a d m i n i s t r a t i v e a c t i o n t o minimize r a d i o a c t i v e contamination of man and h i s environment.

Programme Review

Inc reas ing use of i o n i z i n g r a d i a t i o n and rad ianuc le ides f o r medical , a g r i c u l t u r a l and o t h e r i n d u s t r i a l purposes and product ion of nuclear power n e c e s s i t a t e (1) t h e organi- z a t i o n of proper t r a i n i n g f a c i l i t i e s f o r h e a l t h and a l l i e d healch personnel , ( 2 ) s t andar - d i z a t i o n of techniques f o r p r a c t i c a l d i a g n o s t i c , t h e r a p e u t i c and re sea rch a c t i v i t i e s , and (3) r e g u l a r monitoring and s u r v e i l l a n c e of r a d i a t i o n workers and i n s t i t u t i o n s . T ra in ing of r ad iographer s , r a d i o l o g i c a l t echn ic i ans and medical p h y s i c i s t s , t r a i n i n g of t e c h n i c i a n s i n t h e maintenance and r e p a i r of X-ray equipment, es tabl ishment of r a d i a t i o n personnel dosimetry s e r v i c e s , a s s i s t i n g i n checking c l i n i c a l a p p l i c a t i o n s through a p o s t a l dose- inter-comparison programme, and determinat ion of Strontium-90 i n human bones a r e the main a c t i v i t i e s being promoted by WHO i n t h e Region, wi th UNDP a s s i s t a n c e and on t h e b a s i s of g u i d e l i n e s developed by WHO i n c o l l a b o r a t i o n wi th I n t e r n a t i o n a l Atomic Energy Agency. Film badge s e r v i c e s a r e being developed i n two c o u n t r i e s i n t h e Region wi th a s s i s t a n c e from vo lun ta ry sources i n t h e Federal Kepublic of Germany.

WHO i s a s s i s t i n g i n i d e n t i f y i n g n a t i o n a l i n s t i t u t i o n s , s t r eng then ing them f o r pro- v id ing l eade r sh ip and e s t a b l i s h i n g the e x p e r t i s e r equ i red i n r a d i o l o g i c a l sc iences . Establishment of n a t i o n a l i n s t i t u t e s of r a d i o l o g i c a l s c i ences wi th modern f a c i l i t i e s f o r undertaking t r a i n i n g w i l l be a s s i s t e d wi th t h e o b j e c t i v e of meeting t h e i r needs f o r manpower i n t h e s e s p e c i a l t i e s . Nat ional programmes w i l l be promoted f o r p r o t e c t i n g the popula t ion a g a i n s t g e n e t i c and somatic hazards through biomedical i n v e s t i g a t i o n s on the b i o l o g i c a l a s p e c t s of i o n i z i n g r a d i a t i o n and rad ionuc le ides .

Currently, training programmes in radiological sciences are being assisted in five countries of the Region (India, Indonesia, Mongolia, Sri Lanka and Thailand), and the establishment of radiation health protection services are being supported in Burma, Indonesia and Nepal; facilities for training technicians in the maintenance and repair of radiation equipment have been developed in Burma, India, Indonesia, Mongolia and Sri Lanka, and assistance is being provided for the strengthening of the discipline of nuclear medicine in Bangladesh, Burma, India and Indonesia. Assistance is being provided for an advanced course in medical physics in India.


Assistance will be provided to governments through support to institutions, the training of selected health and related personnel, the strengthening of national education programmes, the training of technicians in repair and maintenance of radiological equipment and the development of patterns of services and training and stimulation of biomedical research in ionizing radiation.

SUB-PROGRAMME 6.1.6 BIOMEDICAL AND ENVIRONMENTAL HEALTH ASPECTS OF IONIZING RADIATION


Inter-country

1975

Regional

Country

Inter-country

Total

1976 - Regional

Country

Inter-country

Total

1977 - Regional

Country

Inter-country

Total

70 200

10 800

81 000

101 850

15 200

117 050

115 350

28 400

143 750

9 526

9 526

79 726

10 800

90 526

101 850

15 200

117 050

115 350

28 400

- 143 750

A

SUB-PROGRAMME 6.1.7 ESTABLISHXENT AND STRENGTHENING OF ENVIRON- MENTAL HEALTH SERVICES AND INSTITUTIONS

Objectives

To a s s i s t i n t he strengthening of governmental hea l th ca re i n f r a s t ruc tu r e and of i n s t i t u t i o n s capable of e f f ec t i ve planning and management of environmental hea l th programmes and of in tegra t ing them i n t o na t iona l plans and po l i c i e s f o r hea l th and general development.

Approach

- Review of the present s i t u a t i o n of the environmental component of community hea l th se rv ices and i n s t i t u t i o n s .

- Assistance i n the planning, adminis t ra t ion and evaluation of environmental heal th a c t i v i t i e s .

- Support f o r the development and strengthening of t r a i n ing programmes.

- Assistance i n improving environmental hea l th se rv ices through fu r t he r development of manpower and appl ica t ion of more e f f e c t i v e methodology.

Programe Review

The environmental hea l th services and the needs of each country vary considerably i n regard t o t echnica l manpower, organizat ional s t r uc tu r e , functions and r e spons ib i l i t i e s . The ava i lab le resources i n ind iv idua l countr ies a r e i n general inadequate t o cope with the ever-increasing environmental hea l th problems resu l t ing from the rapid growth of population, with concomitant unplanned urbanization and i ndus t r i a l i z a t i on . Some count- r i e s have taken ac t ion t o review the s i t ua t i on , and have i n i t i a t e d measures t o s t rengthen and reorganize ex i s t i ng environmental hea l th se rv ices o r f o r creat ing new agencies t o deal with these problems. I n December 1974 a regional seminar on the planning of environ- mc~rtal hea l th se rv ices w i l l be organized for high-level planners and adminis t ra tors from d i f f e r en t countr ies of t he Region. I n preparation f o r t h i s a c t i v i t y , two consul tants w i l l v i s i t var ious countr ies t o study the anvironmental hea l th se rv ices and c o l l e c t background data . I n 1975 i t is planned for two consul tants t o review the environmental heal th se rv ices and t o a s s i s t i n the development of na t iona l plans i n environmental heal th ser- v ices within the na t iona l hea l th se rv ices .

FroposaZs for 1976-1977

Consultant se rv ices w i l l a l s o be provided i n 1976 and 1977. I t is proposed t o compile a manual on the planning of environmental hea l th se rv ices i n the Region, based on the recommendations of the consul tants .

SUB-PROGRAMME 6.1.7 ESTABLISHMENT AND STRENGTHENING OF ENVIRON- MENTAL HEALTH SERVICES AND INSTITUTIONS


1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country


Total

us $

186 637

21 000

207 637

Regular Budget

us $

113 920

21 000

134 920

Regular Budget

1

1

Other Sources

us $

72 717

72 717

Other Sources

1

1

Total

2

2

SUB-PROGRAMME 6.1.8 FOOD STANDARDS PROGRAMME

Objectives

To a s s i s t i n food s a f e t y and t h e app l ica t ion of proper p r i n c i p l e s and methods f o r t h e production, process ing, s to rage and d i s t r i b u t i o n of foods.

Approach

- A8sistance i n t r a i n i n g personnel i n food handling, i n t r a i n i n g food inspec to rs and ana lys t s , and i n updating and formulating food con t ro l l e g i s l a t i o n .

Programme Review

In r e s t a u r a n t s and smal l e a t i n g places food i s very o f ten handled under unhygie- n i c condi t ions . Meat and milk inspec t ion , i n keeping with e x i s t i n g regu la t ions , a re no t done o f ten enough or a r e undertaken by inadequately t r a ined s t a f f . The condi t ions i n t h e l a r g e r food-processing p l a n t s a r e more s a t i s f a c t o r y . Food ana lys i s f o r de tec t ing a d u l t e r a t i o n and p e s t i c i d e res idues needs s t rengthening, and l e g i s l a t i o n on food con t ro l should be reviewed and revised and updated.

WHO has a s s i s t e d Thailadd i n improving i ts Food Control Administration. Another country i n t h e Region has requested a s s i s t a n c e f o r a p r o j e c t i n food hygiene. A request f o r a s s i s t a n c e on food l e g i s l a t i o n and food hygiene is being met.

ProposaLa fo r 1976-1977

I n 1976 and 1977 a s s i s t a n c e i n t h i s f i e l d w i l l continue t o be i n the form of consl l l tants and fe l lowships and w i l l be cor re la ted with programmes f o r the c o n t r o l of b a c t e r i a l d i seases .

SUB-PROGRANHE 6 .1 .8 FOOD STANDARDS PROGRANME

Schedule A - Estimated Obl i~at ions

1974

Regional

Country

Inter-country

Total

Inter-country

Inter-country

Inter-country

1 Estimated Obligations Number of Posts

Total

us $

33 900

33 900

Regular Budget

us $

33 900

33 900

Other Sources

us $


Other Sources

APPROPRIATION SECTION 7 HEALTH INFORMATION AND LITERATURE

PROGRAMME 7.1 HEALTH STATISTICS

Objectives

To help develop and s t rengthen h e a l t h information systems i n the coun t r i es of the region a s support f o r planning of h e a l t h programmes, management and eva lua t ion of va r ious h e a l t h programnes, and

t o promote and support a c t i v i t i e s i n the var ious sub-programmes: h e a l t h s t a t i s - t i c a l methodology, dissemination of s t a t i s t i c a l information, development of h e a l t h s t a t i s t i c a l s e r v i c e s and i n t e r n a t i o n a l c l a s s i f i c a t i o n of diseases .

Approach

- Assessing and determining by mutual d iscuss ions the needs and p r i o r i t i e s of coun t r i es i n t h e development of h e a l t h s t a t i s t i c a l s e r v i c e s .

- Determining and making ava i l ab le t h e necessary WHO inpu t s t o achieve t h e above ob jec t ives .

WHO has t r a d i t i o n a l l y played an important support ing r o l e i n planning hea l th programmes, t h e i r management and operat ion, and i n t h e i r pe r iod ic evaluat ion. WHO'S programme i n t h e f i e l d of v i t a l and h e a l t h s t a t i s t i c s is i n t e w o v e n with and o r ien ted towards t h i s work.

A t t h e p resen t s t a g e of development of hea l th s t a t i s t i c s s e r v i c e s , the demand i s gradual ly s h i f t i n g towards t h e provis ion of advice and ass i s t ance i n r a t h e r s p e c i a l i z e d f i e l d s such as sample surveys , demography, and e l e c t r o n i c d a t a process ing, r a t h e r than i n genera l p r o j e c t s on v i t a l and h e a l t h s t a t i s t i c s . Thus WHO'S advisory se rv ices now tend t o take the form of mul t i -d i sc ip l ina ry teams and inter-country p r o j e c t s having these s p e c i a l i s t components.

Zhe h e a l t h s t a t i s t i c s output i n t h e Region, i n terms of published d a t a , s t i l l cannot be viewed wi th much s a t i s f a c t i o n . Nor, f o r the most p a r t , a r e these d a t a very u s e f u l t o h e a l t h adminis t ra t ions i n formulating h e a l t h p o l i c i e s , o r planning and eva lua t ing t h e i r a c t i v i t i e s . Assistance i n t h i s f i e l d has been focussed on strengthen- i n g t h e d a t a c o l l e c t i o n , a n a l y s i s and dissemination as w e l l a s i n organizing ad hoe exerc i ses on d a t a co l l ec t ion .

A major por t ion of WHO'S a s s i s t a n c e t o countr ies of t h e Region was d i r e c t e d i n the p a s t , through long-range s t a t i s t i c a l p r o j e c t s , t o the t r a i n i n g of t h e s e n i o r h e a l t h and v i t a l s t a t i s t i c s s t a f f t o man t h e s t a t i s t i c a l un i t s .

This s t a g e was followed by the development of the v i t a l and hea l th s t a t i s t i c s organizat ion, pr imari ly by e s t a b l i s h i n g o r s t rengthening h e a l t h s t a t i s t i c s u n i t s a t the c e n t r a l and per iphera l l eve l s , such a s s t a t e , province o r c i t y , and def in ing t h e i r func- t i o n s and in te r - re la t ionsh ips . This l e d gradual ly t o t h e t h i r d s t a g e a t which a s s i s t a n c e has been given t o the development of s p e c i f i c a spec t s of the s e r v i c e s of hea l th s t a t i s - t i c s , such a s h o s p i t a l records and repor t s systems o r development of r u r a l h e a l t h records and repor t s . Training programmes a r e con t inua l ly c a r r i e d out , mainly through fe l lowships , pe rmi t t ing s t a f f from one country t o study the ob jec t ives , procedures and r e s u l t s of s i m i l a r s t a t i s t i c a l s e r v i c e s i n o the r coun t r i es .

Assis tance has been given i n such mat ters as i n organizing medical record depar t - ments, organizing and promoting seminars and t r a i n i n g courses i n medical coding and i n in t roducing the medical c e r t i f i c a t i o n of cause of death.


Increased a t t e n t i o n is expected t o be given t o such f i e l d s as sample survey methodology, e l e c t r o n i c da ta processing, epidemiological mathematical models and t o the

t r a i n i n g of personnel i n these s p e c i a l t i e s . The o b j e c t i v e s of an in ter -country p r o j e c t i n h e a l t h s t a t i s t i c s were reformulated dur ing 1973 t o provide scope f o r t h i s new empha- s is .

At t en t ion w i l l be given t o t h e development and s t r eng then ing of h e a l t h informa- t i o n systems. Care w i l l a l s o be taken t o make use of sample surveys , ad hoe e n q u i r i e s and s t u d i e s t o f i l l informat ion gaps and t o s t r eng then t h e d a t a base f o r e f f e c t i v e h e a l t h planning, monitoring and eva lua t ion .

I n the development of h e a l t h s t a t i s t i c a l s e r v i c e s , a s s i s t a n c e w i l l cont inue t o be given t o p r o j e c t s which concern t r a d i t i o n a l a spec t s of v i t a l and h e a l t h s t a t i s t i c s as w e l l a s t o those t h a t a r e suppor t ive t o o t h e r sub-programmes.

Tra ining programmes w i l l be organized t o f a m i l i a r i z e the h e a l t h admin i s t r a to r s wi th the p r i n c i p l e s and p r a c t i c a l a p p l i c a t i o n s of t h e new r e v i s i o n of t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases.

PROGRAMME 7 1 HEALTH STATISTICS

Schedule A - Estimated O b l i ~ a t i o n s

I

1974

Regional

Country

Inter-country

To ta l

Inter-country

Inter-country

Inter-country

Number of P o s t s 1


Total

5

1

2

8

Pegular Budget

5

1

2

8

Regular Budget

us $

69 650

131 040

1 8 230

218 920

Other Sources

Other Sources

us $

8 748

8 748

To ta l

us $

69 650

139 788

18 230

227 668

SUB-PROGIWI4ME 7 . 1 . 1 PROGRAMME PLANNING AND GENERAL ACTIVITIES

d~ jec tines

To adv i se an t h e development of n a t i o n a l h e a l t h information systems;

t o maintain s t a t i s t i c a l c o n s u l t a t i v e s e r v i c e s f a r Member c o u n t r i e s ;

t o a s s i s t i n the planning and eva lua t ion of f i e l d p r o j e c t a c t i v i t i e s , and

t o organize and suppor t t r a i n i n g programmes i n v i t a l and h e a l t h s t a t i s t i c s .

Approach

- Emphasis an the fo rmt~ la t ion of a s t r a t e g y f o r developing a h e a l t h i n f o m a t i u n sys tcm t h a t could provide the d a t a needed f a r h e a l t h p lanning, and f o r t h e adminis t r a - t i o n and eva lua t ion of t h e e f f e c t i v e n e s s of p reven t ive and c u r a t i v e h e a l t h s e r v i c e s ; focus an t h e need t o s t r eng then t h e v i t a l and h e a l t h s t a t i s t i c s system respons ib le f o r genera t ing b a s i c v i t a l and h e a l t h s t a t i s t i c a l da ta .

Progrmnne Review

I n p repa ra t ion f o r the formulat ion of t h e Asian Health Char ter some a v a i l a b l e b a s i c d a t a i n c e r t a i n h e a l t h f i e l d s were c o l l e c t e d and a r e being supplemented.

I n 1974, a s s i s t a n c e t o Member c o u n t r i e s i s rendered through 21 country and in ter -country p r o j e c t s . There i s an inc reas ing demand f o r t echn ica l a s s i s t a n c e i n h ighly s p e c i a l i z e d branches of s t a t i s t i c s . A r e source group of s t a t i s t i c i a n s of v a r i o u s s p e c i a l t i e s a r e ass igned t o t h e Regional Of f i ce and t o some coun t r i e s .

I n 1973 s e v e r a l workshops and conferences were h e l d . These and the f e l lowsh ips i n p u b l i c h e a l t h s t a t i s t i c s , epidemiology, demography, b i o s t a t i s t i c s and medical documentation a r e expected t o have an impor tant impact on the development of h e a l t h informa- t i o n systems i n Member coun t r i e s .

SUB-PROGRAHME 7 . 1 . 1 PROGRANMX PLANNING AND GENERAL ACTIVITIES


SUB-PROGRAMME 7.1.2 HEALTH STATISTICAL METHODOLOGY

Object ives

To adv i se and a s s i s t i n the a p p l i c a t i o n of s t a t i s t i c a l methods i n the f i e l d of h e a l t h , and

t o a s s i s t i n developing knowledge o f , and s k i l l s i n , s t a t i s t i c a l methods and techniques.

Approach

- Promotion and a s s i s t a n c e i n the organizat ion and conduct of seminars and t r a i n - ing programmes i n the a p p l i c a t i o n of s t a t i s t i c a l methods t o hea l th problems.

- Assis tance with the s t a t i s t i c a l methodological a s p e c t s af var ious h e a l t h pro- j e c t s .

The Organizat ion 's p rograme of a s s i s t a n c e t o governments i n t h e f i e l d of h e a l t h s t a t i s t i c s has always been concerned l a r g e l y with the development and s t r eng then ing of systems of v i t a l s t a t i s t i c s s e r v i c e s . Advice and a s s i s t a n c e i n the a p p l i c a t i o n of s t a - t i s t i c a l p r i n c i p l e s and methods t o s p e c i f i c h e a l t h p r o j e c t s and problems have been given con t inua l ly i n such f i e l d s as leprosy c o n t r o l and BCG vacctnat ion t r i a l s , assessment of tube rcu los i s l e v e l , cho le ra vaccine t r i a l s , va r ious a spec t s of ma la r i a f i e l d programmes, and f i l a r i a s i s research p r o j e c t s . I n S r i Lanka, ex tens ive s t a t i s t i c a l a s s i s t a n c e was provided i n developing p ro toco l s , des igning sampling schemes f a r , and i n analys ing the r e s u l t s from a comprehensive h e a l t h manpower s tudy. Ass is tance was a l s o given i n the p lanning and conduct of a tube rcu los i s base l ine survey i n r u r a l and urban a r e a s , and i s c u r r e n t l y being provided t o a family h e a l t h p r o j e c t . I n Indonesia and Thai land, WHO s t a t i s t i c i a n s advise on the a p p l i c a t i o n of s t a t i s t i c a l techniques t o var ious prohlems i n the h e a l t h f i e l d . In Nepal, a s t a f f member from the R e ~ o n a l O f f i c e i s s i s t e d with an e x e r c i s e on country h e a l t h programming.

I n December 1973 an i n t e r - r e g i o n a l seminar on sample survey methods i n h e a l t h was he ld i n the Regional O f f i c e wi th p a r t i c i p a n t s from n ine coun t r i e s .


I t i s expected t h a t demands w i l l i nc rease f o r advice an s p e c i a l i z e d s u h j e c t s s~ lc l , as popula t ion sc i ence , a p p l i c a t i o n of mathematical models, e l e c t r o n i c d a t a process ing and sample survey methods. In a n t i c i p a t i o n of such demands, the ob jec t ives of an i n t e r - country p r o j e c t on "Development of Health S t a t i s t i c s Services" (now Health S t a t i s t i c a l Methodology) were reformulated. I t is planned t o a s sess t h e p resen t s t a t u s and f u t u r e needs of e l e c t r o n i c d a t a process ing f a c i l i t i e s i n the h e a l t h f i e l d i n Member c o u n t r i e s . I t is a l s o proposed t o promote the increased use of sampling techniques f o r the provi- s i o n of r e l i a b l e b a s i c v i t a l and h e a l t h s t a t i s t i c s da ta and i n o t h e r f i e l d s of s p e c i a l a p p l i c a t i o n . I t is proposed t o a s s ign a consu l t an t i n 1974 t o t h e Indian Council of Medical Research t o adv i se on t h e development of mathematical models f a r c e r t a i n rommuni- cable d i sease problems.

SUB-PROGRAMME 7.1.2 HEALTH STATISTICAL METHODOLOGY


SUB-PROGRAMME 7.1.4 DEVELOPMENT OF HEALTH STATISTICS SERVICES

Objectives

TO a s s i s t f u r t h e r wi th t h e o rgan iza t ion of n a t i o n a l v i t a l and h e a l t h s t a t i s t i c a l s e r v i c e s i n the context of a comprehensive h e a l t h informat ion system;

t o co-ordinate v i t a l and h e a l t h s t a t i s t i c a l s e r v i c e s wi th n a t i o n a l s t a t i s t i c a l s e r v i c e s , and

t o a s s i s t wi th the o rgan iza t ion and conduct of r e l evan t t r a i n i n g programmes.

Approach

- Assis tance i n determining the a r e a s which need s t r eng then ing and increased emphasis i n t h e o rgan iza t ion of v i t a l and h e a l t h s t a t i s t i c s .

- Provis ion of s u i t a b l e a s s i s t a n c e i n p a r t i c u l a r f i e l d s of a p p l i c a t i o n of s t a t i s - t i c s .

WHO a s s i s t a n c e has s o f a r been provided through 21 s t a t i s t i c a l p r o j e c t s o r pro- j e c t components aiming a t developing o r s t r eng then ing h e a l t h s t a t i s t i c a l s e r v i c e s . I n some of t h e s e , a h e a l t h s t a t i s t i c i a n is a member of a mul t i -d i sc ip l ina ry h e a l t h team.

T r a d i t i o n a l concepts of a s s i s t a n c e i n t h e f i e l d of v i t a l and h e a l t h s t a t i s t i c s a r e only now o u t l i v i n g t h e i r u t i l i t y . The s i t u a t i o n where a country i s s a t i s f i e d wi th t h e b u i l d i n g up of only a b a s i c v i t a l and h e a l t h s t a t i s t i c s o rgan iza t ion o r i n s t i t u t i n g b a s i c l e g a l p rov i s ions is seldom found. It is r a t h e r t h a t p a r t i c u l a r a s p e c t s of an e x i s t i n g s e r v i c e need t o be f u r t h e r developed t o keep pace with the l a t e s t developments o r t h a t advice i s needed on more s p e c i a l f i e l d s of a p p l i c a t i o n of s t a t i s t i c s such as demography, mathematical a n a l y s i s , e l e c t r o n i c da ta process ing, econometrics, e t c .


The development o f f u t u r e a c t i v i t i e s is c l o s e l y t i e d t o the needs of r e l a t e d programmes of h e a l t h s t a t i s t i c s . Thus, t h e need t o produce r e l i a b l e informat ion f o r h e a l t h planning and f o r monitoring and eva lua t ing p rogress , w i l l r e q u i r e a s s i s t a n c e t o r e l e v a n t p a r t s of t h e h e a l t h s e r v i c e s . Ass is tance t o p r o j e c t s i n h o s p i t a l s t a t i s t i c s and medical records a t the country l e v e l , and f o r bu i ld ing up a d a t a base f o r e x e r c i s e s l i k e che Asian Health Char ter and country h e a l t h programming w i l l be continued and f u r t h e r developed. I n a d d i t i o n , a s s i s t a n c e w i l l be given t o p r o j e c t s on p a r t i c u l a r a spec t s of h e a l t h s t a t i s t i c a l s e r v i c e s , such as s t r eng then ing of t r a d i t i o n a l v i t a l and h e a l t h s t a - t i s t i c a l systems and b u i l d i n g up appropr i a t e s e r v i c e s r e l e v a n t t o the planned in t roduc- t i o n of e l e c t r o n i c d a t a process ing systems.

SUB-PROGRAMME 7.1.4 DEVELOPMENT OF HEALTH STATISTICS SERVICES

Schedule A - Estimated Obl igat ions

1974 - Regional

Country

In ter -country

T o t a l

In ter -country

In ter -country

In ter -country

Number of Pos t s Estimated Obl igat ions

Regular Budget

3

1

2

6

-

T o t a l

us $

32 700

139 788

18 230

190 718

Other Sources

Regular Budget

us $

32 700

131 040

1 8 230

181 970

Total

3

1

2

6

Other Sourcea

us $

8 748

8 748

PROGRAMME 7.2 HEALTH LITERATURE SERVICES

Objectives

To c o l l e c t and disseminate informat ion on h e a l t h t o WHO s t a f f , governments, research i n s t i t u t i o n s and workers.

Approach

- The Regional Of f i ce Library provides r e fe rence and documentation s e r v i c e s , a s s i s t s wi th t h e improvement of n a t i o n a l l i b r a r y s e r v i c e s and makes a v a i l a b l e b i b l i o - g raph ica l s e r v i c e s t o t h e n a t i o n a l h e a l t h admin i s t r a t ions and h e a l t h i n s t i t u t i o n s .

The Library has t r a i n e d fe l lows from coun t r i e s of the Region i n medical l i b r a r y work and a l s o provided consu l t an t advice. A new scheme f o r e s t a b l i s h i n g s t u d e n t l o a n l i b r a r i e s , w i t h i n t h e medical school l i b r a r i e s , i n coun t r i e s of the Region has been in t roduced. I n t h i s scheme, t e n copies of each of t h e 41 t i t l e s i n paperback e d i t i o n s a r e provided, f o r loan t o s t u d e n t s a t a nominal f e e , t h e proceeds be ing u t i l i z e d t o purchase new books. Three such l i b r a r i e s have a l r eady been s e t up i n S r i t anka and Thailand.

When the WHO Headquarters Library i n Geneva became a MEDLARS (Medical L i t e r a t u r e Analys is and R e t r i e v a l System) Centre i n 1972 t h e Regional Of f i ce L ib ra ry undertook t o handle r eques t s of governments and i n s t i t u t i o n s i n t h i s Region f o r MEDLARS sea rches .

A Regional Documentation Centre on Human Reproduction, Family Planning and Popu- l a t i o n Dynamics has been e s t a b l i s h e d i n conjunction wi th the Library . Its purpose i s t o c o l l e c t publ ished and unpublished l i t e r a t u r e on t h e above s u b j e c t s and t o d isseminate t h i s informat ion w i t h i n t h e Region and t o c e n t r e s a c t i v e i n the same f i e l d elsewhere. Three b i b l i o g r a p h i e s were produced and d i s t r i b u t e d i n 1973.

"An Aid t o the Teaching of Human Reproduction, Family Planning and Popula t ion Dynamics" - an annotated c r i t i c a l s e l e c t i o n of world l i t e r a t u r e - t o be amended and updated annual ly has been f i r s t produced i n 1972 and d i s t r i b u t e d t o a l l t each ing i n s t i - t u t i o n s f o r h e a l t h personnel i n t h i s Region. The f i r s t r e v i s i o n was publ ished i n 1973.

ProposaZs fo r 1976-1977

The Library w i l l expand i ts a c t i v i t i e s by t h e es tabl ishment of a d d i t i o n a l s t u d e n t loan l i b r a r i e s and in t roduc t ion of a new s e r v i c e c a l l e d MEDLINE (MEDLARS on Line) which w i l l r ep lace MEDLARS. The Regional Documentation Centre w i l l cont inue t o prepare reviews and annota ted b i b l i o g r a p h i e s on s p e c i a l t o p i c s i n t h i s f i e l d .

PBOG- 7.2 HEALTH LITERATURE SERVICES

Schedule A - Estimated Oblirtat ions

1974

Regional

Country

Inter-country

To ta l

Inter-country

Inter-country

Inter-country

Number of P o s t s Estimated Obl igat ions

Regular Budget

3

3

Total

us $

10 240

2 570

146 340

159 150

Regular Budget

us $

1 0 240

12 000

22 240

Other Sources

3

3

Other Sources

us $

2 570

134 340

136 910

Total

3

3

6

PROGRAMME 7.3 WHO PUBLICATIONS

Objectives

To supplement Headquar te rs ' e f f o r t s i n f u l f i l l i n g t h e o b j e c t i v e s of t h e WHO p u b l i - c a t i o n s programme, e s p e c i a l l y w i t h r e f e r e n c e t o s e e i n g t h a t t h e s e p ~ b l i c a t i o n s r e a c h t h e persons and i n s t i t u t i o n s f o r whom they a r e i n t ended , i . e . , p l ac ing them w i t h i n ea sy a c c e s s of h e a l t h workers and i n s t i t u t i o n s i n t h e Region and e n s u r i n g e f f e c t i v e d i s t r i b u - t i o n and s a l e s , and

t o i s s u e a p p r o p r i a t e t e c h n i c a l documents and s p e c i a l r e g i o n a l p u b l i c a t i o n s o f p a r t i c u l a r i n t e r e s t t o c o u n t r i e s of t h e Region.

- Supplementing Headquar te rs ' d i s t r i b u t i o n of documents and p u b l i c a t i o n s and d i s t r i b u t i n g Regional O f f i c e m a t e r i a l t o t hose i n t e r e s t e d as w e l l a s t o t h e s t a f f .

- C i r c u l a t i n g i n fo rma t ion an new WHO p u b l i c a t i o n s and on a l l WHO and SEARO pub l i - c a t i o n s t h a t a r e a v a i l a b l e f o r s a l e .

- Under tak ing a d i r e c t s a l e s programme f a r a l l WHO p u b l i c a t i o n s and SEARO p u b l i - c a t i o n s , by o f f e r i n g t h e s e p u b l i c a t i o n s a t 50% d i s c o u n t and a t s p e c i a l reduced r a t e s of s u b s c r i p t i o n and a c c e p t i n g payment i n t h e l o c a l c u r r e n c i e s of t h e c o u n t r i e s .

- Arranging of e x h i b i t i o n s a t impor tan t meet ings hc ld i n (and o c c a s i o n a l l y out - s i d e ) Delh i .

- Bringing o u t r e g i a n a l p u b l i c a t i o n s t o meet s p e c i f i c needs , such a s gu ides f o r a u x i l i a r y n u r s e s , midwives, e t c . , and p l a c i n g them on s a l e a t v e r y low p r i c e s .

- Producing and d i s t r i b u t i n g r e p o r t s on p r o j e c t a c t i v i t i e s , gu ides and manudls .

- Prov id ing suppor t t o p r o j e c t s f o r t h e p roduc t ion of gu ides and manuals i n l o c a l languages .

T l ~ e need f o r ensu r ing wider d i s t r i b u t i o n of I*HO p u b l i c a t i o n s was f e l t a s e a r l y a s t h e second h a l f of t h e 1950-60 decade , and a r e g i o n a l scheme (by which p u b l i c a t i o n s could be made a v a i l a b l e a t law c o s t ) was worked ou t w i t h Headquar te rs , SEARO a c t i n g a s s a l e s agent . A t t h a t t ime, t h e problem of space prevented t h e s t a c k i n g of p u b l i c a t i o n s i n t h e Regional O f f i c e , bu t t h e scheme became a fu l l - f l edged s a l e s programme i n 1963, when t h e Regional O f f i c e moved i n t o i t s new premises . Coverage has g r e a t l y improved, and t h e s a l e s have been i n c r e a s i n g p r o g r e s s i v e l y , t h e amount f a r 1973 be ing $27 094 (572 s u b s c r i p t i o n s were r e g i s t e r e d or renewed du r ing t h e yea r and 1 398 o r d e r s f o r r e t a i l pu rchase s c ~ m p l i e d w i t h ) .

With a l i t t l e more p u b l i c i t y , i t should be p o s s i b l e t o make s u b s t a n t i a l i n c r e a s e i n s a l e s and d i s t r i b u t i o n . A d d i t i o n a l s t o r a g e space is needed t o meet o r d e r s promptly.

From 1961 t o 1969, s i x r e g i o n a l p u b l i c a t i o n s ( i n i t i a l l y wide ly d i s t r i b u t e d f r e e of c o s t and then s o l d ) were brought o u t , some of them i n s e v e r a l e d i t i o n s and one i n Hindi . Far v a r i o u s r ea sons , t h i s programme has been d i s c o n t i n u e d f o r t h e p a s t few y e a r s bu t w i l l be resumed.

Techn ica l i n fo rma t ion c i r c u l a r s on s u b j e c t s such a s communicable d i s e a s e s , h e a l t h educa t i on , e t c . have been pub l i shed and wide ly d i s t r i b u t e d .

The t h i r d e d i t i o n of t h e "Manual of P a e d i a t r i c s " by Rabinson and Wal lgren , was pub l i shed i n 1973. Th i s i s a p u b l i c a t i o n sponsored by WHO, t h e f i r s t e d i t i o n be ing pub l i shed i n 1959 a s a text-book f o r medica l c o l l e g e s i n t h e Region. The Government of l n d i a was g i v e n t h e permiss ion t o p u b l i s h a t r a n s l a t i o n i n Hindi .

Assignment r e p o r t s , f i n a l r e p o r t s , and r e p o r t s on group e d u c a t i o n a l a c t i v i t i e s have been e d i t e d , i s s u e d a s o f f i c i a l documents and d i s t r i b u t e d t o governments and i n s t i - t u t i o n s concerned a s w e l l a s t o i n t e r e s t e d workers on t h e b a s i s o f e s t a b l i s h e d m a i l i n g l i s t s o r on r e q u e s t . The Regional D i r e c t o r ' s Annual Report and o t h e r Regional Committee Documents, i n c l u d i n g t h e minutes and f i n a l r e p o r t of t h e s e s s i o n s , have been produced and d i s t r i b u t e d each yea r . Guides and manuals f o r t h e u s e of h e a l t h workers a r e a l s o p r epa red and d i s t r i b u t e d widely.

A t t e n t i o n h a s a l s o been g iven by t h e Regional O f f i c e and by f i e l d p r o j e c t s t o l o c a l p roduc t ion of manuals i n n a t i o n a l languages . I n Indones i a , a m u l t i - d i s c i p l i n a r y team, made up of WHO s t a f f , ha s been a s s i s t i n g t h e Government i n t h i s a r e a .


It is planned t o con t inue and i f p o s s i b l e expand t h e s a l e s a s we l l a s t h e f r e e d i s t r i b u t i o n p r o g r a m d u r i n g 1976 and 1977. A s s i s t a n c e w i l l b e provided f o r p roduc t ion of manuals i n l o c a l languages and i n s u b s i d i z i n g t h e c o s t of t r a n s l a t i o n of c e r t a i n tex tbooks .

PROGRAMME 7.3 WHO PUBLICATIONS


1974 - Regional

Country

Inter-country

Total

Inter-country

Inter-country

~nter-country

Number of Posts Estimated Obligations

Regular Budget

9

9

Regular Budget

us $

74 600

74 600

Other Sources

Other Sources

us $

Total

9

9

Total

us $

74 600

74 600

PROGRAMME 7.4 HEALTH INFORMATION OF PUBLIC

Object ives

To keep t h e publ ic informed of the most important a c t i v i t i e s of WHO i n general and South-East Asia Region, i n p a r t i c u l a r ;

throu6h such in fo rmat ion , t o make t h e p u b l i c aware of major h e a l t h problem* and of some of t h e ways i n which they can he lp t o r e s o l v e them, and

t o s t i m u l a t e t h e product ion, by o u t s i d e sources , of informat ion m a t e r i a l about gene ra l healch a c c i v i t i e s and WHO'S p a r t i c i p a t i o n i n these a c t i v i t i e s .

Approach

To achieve these o b j e c t i v e s a v a r i e t y of s e r v i c e s and f a c i l i t i e s a r e t o j o u r n a l i s t s , r ad io and t e l e v i s i o n r e p o r t e r s and f i l m makers. I n a d d i t i o n , m a t e r i a l s a r e produced by t h e Pub l i c Informat ion Uni t i n t h e Regional Of f i ce f o r d i r e c t d i f f u s i o n through the mss media. Production of f i l m s and a r t i c l e s by o u t s i d e producers is a l s o encouraged. The p u b l i c is approached d i r e c t l y through va r ious p u b l i c a t i o n s , v i s i t o r s ' s e r v i c e s , l e c t u r e s and e x h i b i t i o n s .

Informat ion m a t e r i a l received from Headquarters a s w e l l as produced i n the Regional Of f i ce , takes a v a r i e t y of forms.

P ress r e l e a s e s : These cover a wide range of top ics dea l ing wi th n a t i o n a l and reg iona l h e a l t h programmes, new developments i n research and technology and p a r t i c u l a r l y s i g n i f i c a n t meetings and seminars. F ie ld v i s i t s a r e made t o prepare s p e c i a l f e a t u r e s f o r World Heal th , r eg iona l f e a t u r e s and p r e s s r e l e a s e s .

Radio: Tapes a r e received from Headquarters and d i s t r i b u t e d i n the Region. I n - a d d i t i o n , consu l t an t s e r v i c e s a r e provided f o r programmes dea l ing with h e a l t h prepared by n a t i o n a l r a d i o and t e l e v i s i o n networks.

Photographs: Photographs on a v a r i e t y of h e a l t h themes a r e con t rac ted f a r and produced i n o rde r t o i l l u s t r a t e p r e s s f e a t u r e s , a r t i c l e s f o r World Health and o t h e r WHO p u b l i c a t i o n s , i nc lud ing t h e Regional D i r e c t o r ' s and Director-Genera l ' s Annual Reports. They a r e a l s o d i s t r i b u t e d f o r use i n e x h i b i t i o n s and supp l i ed t o f ree- lance w r i t e r s t o

i l l u s t r a t e a r t i c l e s i n va r ious p u b l i c a t i o n s - i nc lud ing s c h o l a r l y works.

Films: Films suppl ied by Headquarters a r e d i s t r i b u t e d , and advice i s given t o n a t i o n a z a n i z a t i o n s making f i l m s on h e a l t h t o p i c s i n t h e Region.

World Health Day: This occas ion has over t h e yea r s been inc reas ing ly u t i l i z e d f o r a review of t h e achievements i n s p e c i f i c f i e l d s o f h e a l t h and t o l ay emphasis on t h e f u t u r e p lans and programmes of t h e n a t i o n a l h e a l t h s e r v i c e s . It a l s o provides an oppor tun i ty f o r WHO t o l a y s t r e s s on p a r t i c u l a r and t o p i c a l problems of h e a l t h and t o h e l p b r i n g about an increased awareness among t h e peoples i n t h e Region. Se rv ices f o r reproducing and t r a n s l a t i n k t h e s p e c i a l m a t e r i a l received from Headquarters i n va r ious c o u n t r i e s cont inue t o be provided.

S p e c i a l a c t i v i t i e s : I n r e l a t i o n t o World Popula t ion Year 1974 , a three-day seminar on "Press and Population" w a s organized j o i n t l y by UNICEF and WHO i n New Delhi . Sen io r J o u r n a l i s t s i n Engl ish and t h e ve rnacu la r p r e s s from Afghanistan, Bangladesh, ~ ~ d i a , Indonesia , Nepal, S r i Lanka and Thailand were i n v i t e d t o t ake p a r t . The Seminar provided them with an oppor tuni ty t o exchange i d e a s and exper iences r e l a t i n g t o family p lann ing and t h e r o l e of t h e p r e s s i n d isseminat ing informat ion on t h e s u b j e c t : a r t i c l e s and f e a t u r e s were subsequent ly w r i t t e n by p a r t i c i p a n t s i n t h e r e g i o n a l p res s .

General enqu i r i e s : A l a r g e number of e n q u i r i e s about WHO'S a c t i v i t i e s and t h e genera l h e a l t h s i t u a t i o n i n count+ies cont inues t o be received and r e p l i e d t o .


Future p lans inc lude g r e a t e r emphasis on f i l m s and r a d i o work, o f t e n i n c o l l a - bo ra t ion wi th UNICEF. A r a d i o s e r i a l o r f i l m s f o r use on t e l e v i s i o n can be prepared incorpora t ing important m a t e r i a l concerning family h e a l t h . In a d d i t i o n , when necessary , s p e c i a l p u b l i c a t i o n s w i l l be prepared and i s sued . A workshop f o r working j o u r n a l i s t s i s planned t o be he ld t o cons ide r how t h e h e a l t h message can be conveyed t o t h e p u b l i c by means of mass media.

PROGRAMME 7.4 HEALTU INFORMATION OF PUBLIC

Schedule A - Estimated Obl igat ions

r

1974

Regional

Country

In ter -country

To ta l

1975 -- Regional

Country

In ter -country

Tota l

1976

Itcgional

Country

In ter -country

Tot.il

1977

Regional

Country

In ter -country

Tots1

Regular Budget

4

4

4

4

4

4

4

4

Regular Budget

us $

42 610

42 610

62 000

18 900

80 900

68 090

24 800

92 890

73 040

26 850

99 890

Number of

Other Sources

Estimated Obl igat ions Pos t s

Total

4

4

4

4

4

4

4

4

Other Sources

us $

Tota l

us $

42 610

-t 42 610

62 000

18 900

80 900

68 090

24 ROO

52 890

73 040

26 850

99 890

APPROPRIATION SECTION 9 SWPORT TO REGIONAL PROGRAMMES

PROGRAMME 9.1 REGIONAL PROGRAMME PLANNING AM, GENERAL ACTIVITIES

Objectives

To a s s i s t t h e Regional Di rec to r i n formulat ion, c o n t r o l and eva lua t ion of p l ans and programmes i n t h e Region.

Approach

- Prepara t ion of medium-term programmes based on country h e a l t h programmes wi th a s s i s t a n c e from WHO Headquarters, and i n accordance wi th g u i d e l i n e s e s t a b l i s h e d by the World Health Assembly, Regional Committee, e t c . , and t h e i r pe r iod ic review and eva lua t ion .

- Programe budgeting r e l a t e d t o country needs, through e f f e c t i v e h e a l t h programming, p r o j e c t formulat ion and management, and medium-tern planning.

- Development of p r o g r a m e and p r o j e c t eva lua t ion methodology.

- Establishment of a programme and p r o j e c t informat ion system i n t h e Regional Of f i ce .

- Appl ica t ion of economic a n a l y s i s and h e a l t h o p e r a t i o n a l research.

Bogramme Review

To assist i n t h e a t ta inment of t h e above o b j e c t i v e , t h e Regional Di rec to r is a s s i s t e d by t h e Di rec to r of Health Se rv ices , and four A s s i s t a n t D i r e c t o r s of Health Se rv ices and t h e Chief , Administrat ion 6 Finance.

The Ass i s t an t Di rec to r s of Health Se rv ices , a s s i s t e d by t h e Regional Advisers - who provide t h e t echn ica l e x p e r t i s e , a r e r e spons ib le f o r t h e formulat ion of r eg iona l programmes and sub-programmes, on t h e b a s i s of proposals i n i t i a t e d by t h e WHO Representa- t i v e s i n d i scuss ions with n a t i o n a l a u t h o r i t i e s .

The Programme Support and Co-ordination Uni t , headed by one of t h e Ass i s t an t Di rec to r s of Health Se rv ices provides suppor t i n p lanning, p rograming and eva lua t ion of r eg iona l programmes and s u b - p r o g r m e s , based on t h e competence of a mul t i -d i sc ip l ina ry team and information from t h e P r o j e c t Management Information System.

A P r o j e c t Management Information System bas been developed t o monitor t h e i n p ~ t s i n t o p r o j e c t s and t h e oll tputs expressed i n terms of achievement of in t e rmed ia te objec- t i v e s (mi les tones) .

Seve ra l t r a i n i n g a c t i v i t i e s have been conducted i n o rde r t o d i f f u s e t h e managerial know-how throughout t h e region - a Seminar an t h e Appl ica t ion of Operat ional S tud ies i n Health and i n Education £ o r Health P ro fess ions , a Meeting on Health Economics; a Seminar on t h e Q u a n t i t a t i v e S tud ies i n Heal th .

Consultative s e r v i c e s i n management of h e a l t h s e r v i c e s was provided t o Thailand and Indonesia.


It i s expected t h a t adequate methodologies w i l l be developed regarding country h e a l t h p r o g r a m i n g and t h e s e l e c t i o n , formulat ion, c o n t r o l and eva lua t ion of programmes and p r o j e c t s .

The programme and p r o j e c t management informat ion system w i l l be w e l l e s t a b l i s h e d and w i l l con ta in adequate informat ion as a b a s i s f o r f u t u r e p lanning, programming, budgeting and c o n t r o l .

PROGRAMME 9 .1 REGIONAL PROGRAMME PLANNING AND GENERAL ACTIVITIES

Schedule A - Est imated O b l i ~ a t i o n s

1974

Regional

Country


T o t a l

1975

Regional

Country


T o t a l

1976

Regional

Country


T o t a l

1977 - Regional

Country

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

T o t a l

Regular Budget

2 1

21

2 1

7

21

2 1

2 1

21

21

Regular Budget

US $

270 820

270 820

329 500

329 500

357 110

357 110

379 170

379 170

Number of

Other Sources

P o s t s

Total

2 1

21

21

2 1

2 1

21

21

2 1

Est imated Ob l iga t i ons

0 t he r Sources

US $

T o t a l

US $

270 820

270 820

329 500

329 500

357 110

357 110

379 170

379 170

PROGRAMME 9.2 ASSISTANCE TO COUNTRY PROGRAMMES

To develop and s t r eng then the p lanning, c o n t r o l and eva lua t ion of WHO country programmes.

- Assis tance t o WHO Representa t ives i n country h e a l t h programming, p r o j e c t formulat ion and management.

- Assis tance i n developing methodology f o r country programme and p r o j e c t evalua- t i o n .

- Assis tance i n planning, conducting and a n a l y s i s of q u a n t i t a t i v e s t u d i e s and h e a l t h o p e r a t i o n a l s t u d i e s .

- Assis tance to c o u n t r i e s i n t r a i n i n g i n management techniques and providing c o n s u l t a t i v e s e r v i c e s i n management of h e a l t h .

Progrannne Review

WHO Representa t ives t o c o u n t r i e s func t ion a s managers of t h e country programmes and p r o j e c t s and a s a d v i s e r s t o t h e Regional Di rec to r i n providing a s s i s t a n c e . I n fornu- l a t i n g and management of t h e country programmes and i n d i v i d u a l p r o j e c t s they draw on t h e t e c h n i c a l competence of Regional Of f i ce t e c h n i c a l s t a f f .

A country h e a l t h programming e x e r c i s e conducted i n Bangladesh towards t h e end of 1973 has shown t h e high p o t e n t i a l of t h i s approach i n a s s i s t i n g governments i n t h e formulat ion of t h e i r h e a l t h p lans i n t h e context of t h e i r n a t i o n a l planning a c t i v i t i e s f o r socio-economic development. S imi la r e x e r c i s e s a r e t o be conducted dur ing 1974-75 i n Nepal, Thailand and Indonesia .

It i s expected t h a t t h e WHO Representa t ives i n t h e c o u n t r i e s w i l l be completely r e spons ib le f o r t h e management of country programmes and p r o j e c t s , w i th suppor t from d i f f e r e n t Echelons i n t h e Organizat ion.

With cont inuing n a t i o n a l e f f o r t s i n medium- and long-term h e a l t h p lanning, suppor t ing s e r v i c e s w i l l cont inue t o be provided.

PROGRAMME 9.2 ASSISTANCE TO COUNTRY PROGRAMMES


PROGRAMME 9 .3 REGIONAL GENERAL SUPPORT SERVICES

To p rov ide t h e Regional D i r e c t o r and t e c h n i c a l s t a f f w i t h p o l i c y and admin i s t r a - t i v e adv i ce and guidance i n programme and 0 th t . r impor t an t r e g i o n a l m a t t e r s ; t o suppor t a l l programmes and sub-programmes i n f i n a n c i a l , budgetary , l e g a l and c o n s t i t u t i o n a l m a t t e r s , a s w e l l as t o p rov ide pe r sonne l , s u p p l i e s , con fe r ence , r e p r o d u c t i o n , communica- t i o n , t r a v e l , o f f i c e space and o t h e r g e n e r a l s e r v i c e s .

Appropr ia te suppor t i s g iven a t r e g i o n a l , coun t ry and i n t e r - c o u n t r y l e v e l t o o f f i c e s , programmes and p r o j e c t s , and t o s t a f f i n t h e Region a s r e q u i r e d , e i t h e r on a con t inu ing b a s i s o r i n r e sponse t o s p e c i f i c needs o r r e q u e s t s .

PROXfA?? 9 .3 REGIONAL GENERAL SUPPORT SERVICES

Schedule A - Es t ina ted Ob1iRatior.s

1974

Regior~al

C3untry

In ter -cauntry

To ta l

1975

Regional

Country

In tcr -country

Td ta l

1976

Regional

Country

In ter -country

To ta l

1977 - Regional

Country

In ter -country

To ta l

F o s t s

Total

75

75

I

75

75

75

75

75

75

Regular Budget

us $

522 725

522 725

590 600

590 600

6 5 1 100

651 100

707 630

707 630

Regular Budget

73

73

73

73

7 3

73

73

73

Number of

Other Sources

2

2

2

2

2

2

2

2

Es t iua ted Obl iga t ions

Other Sources

us $

10 000

10 000

12 500

12 GOO

Tc t a l

us $

532 725

532 725

602 600

602 600

I I I I

1 3 200 664 300 I

13 200

11 500

1 4 5 W

' 664 300

722 130

722 133

PROGRAMME 9.4 REGIONAL COMMON SERVICES

To provide t h e c o s t of common s e r v i c e s f o r t h e ope ra t ion of t h e Regional Of f i ce i t s e l f and t h e phys ica l suppor t r equ i red by t h e s t a f f working i n t h e o f f i c e . These provis ions inc lude bu i ld ing maintenance; u t i l i t i e s ; a c q u i s i t i o n , r e p a i r and o p e r a t i o n , as appropr i a t e , of o f f i c e equipment and t r a n s p o r t ; communication s e r v i c e s of a l l k inds ; expendable m a t e r i a l s ; l i b r a r y books; c o n t r a c t u a l s e r v i c e s , and o t h e r r e l a t e d expendi- t u r e s .

Allowance has t o be made f o r both increased demands on t h e s e s e r v i c e s and f o r i n f l a t i o n a r y t r ends i n t h e c o s t of va r ious commodities, u t i l i t i e s and s e r v i c e s .

PROGRAMME 9.4 REGIONAL COMMON SERVICES


SUNXMY OF SERVICES AND ASSISTANCE TO GOVERNMENTS

f P m n o c c o r i i n !IS nn77-a I

Bangladesh

Bhutan

Burma

Democratic People ' s Republic of Korea

I n d i a

Indones ia

Maldives 176 200 143 700

Mongolia

Nepal

S r i Lanka

Thai land

In te r -coun t ry

T o t a l L98 L82 179 181 9 020 415 9 111 165 9 497 700 1 0 269 245 82 74 5 8 34 9 598 125 7 830 261 4 762 608 2 058 088

.llr-lllll "."l""I"--I

R E G U L A R B U D G E T O T H E R S O U R C E S

No. of Pos t s

74

20

No. of P o s t s Estimated Expenditure

76

7

Estimated Expenditure

75

19

1974

688 190

75

7

1977

516 918

1974

1 332 496

1975

699 435

1976

748 620

76

2 1

1977

886 040

77

2 1

76

5

1975

1 690 483

77

1

1976

1 382 831

INFORMATION ANNEXES

ANNEX 1:

Regional Off ice

Regional Advisers

WHO Representatives

Country Statements and Tabulations:

Bangladesh

Bhutan

Burma

Democratic People's Republic of Korea

India

Indonesia

Maldives

Mongolia

Nepal

S r i Lanka

Thailand

Inter-country

ANNEX 2:

Additional Projects

REGIONAL OFFICE, REGIONAL ADVISERS AND WHO REPRESENTATIVES

(Expressed i n US D o l l s r n l

R E G U L A R B U D G E T O T H E R S O ! R C E S - Number oi P a r t s E s t i m a t e d O b l i g a t i o n s KEGIOEAL OFFICE Number of Posts Err i rnared O b l i % a c i o n r > -3 2 c _ l i 3 -

2. GENERAL MANAGE ME^ AND CO-ORDINATION

2 . 1 Execufive Manaqement ! I !

I 2 . 1 . 1 o f f i c e of t h e ~ ~ ~ i a n a l D ~ ~ ~ C L O ~ I

! I 4 3 558 47 066 i 4 1 320 ~ e g i o n a l D i r e c t o r UG 1 8 500 20 180 21 410 Conference oiiicer P2

8 1 0 1 0 0 11 100 12 200 Special assisrant mx I XD 5 9 400 1 0 300 , 1 1 300 S e c r e L a r i e s I - I- I -

62 268 81558 88 666 92 220

I 6 W 0 !

Duty t r a v e l

I i

66 768 / 8 6 558 , 94 146 1 I - ' - , - I I

! 4 . HEALTH HANPWER DEV€LOPPLENI I i I !

I I 4 . 1 u e s l c h Manpower Development

I 7 OW , 7 700 ! 8 500 ~ d m i n i s r r a t i u e aisxrtant ND7 4 7 W 5 150 5 650 ~ e c h n i c a l assistant ND5

2 7 6 W 8 400 9 200 C l e r k s EDL 3 WO 3 300 3 6 5 0 clerk-typist iiD3 I I I

I - - - - (-

- I

i 7. HEALTH I N F W T I O N AND

i !

LITERATURE I

7.2 H e a l t h L i t e r a t u r e Services

! i ;

~ i b r a i y ssrlsrant ND7 1 ,

i C i r r k ND4 C l e r k - s t e n o g r a p h e r h46

I ----

3 , 3 J 3 j i

i I I

R E G U L A R B U D G E T

(Expressed in US Dollarsl

Number of posts

1 4 7 0 0 ' 5 150 ! 5 650 1 3 8 0 0 ; 4 2 0 0 1 4 6 0 2

1 3 800 4 200 4 600 3 0% 3 300 3 650

I I 1 25 800 28 760 30 710

18 500 20 180 1 21 410 4 7 W 1 5 1 5 0 5 650 I 3 0 0 0 3 3 0 0 1 3 6 5 0 - - -

8 0 0 0 , 8000 8 5 0 0 ' 9 0 M - - ,

I I I

i !

'i !

I ! I i I i

i i I

I I

! !

1974

I .

Estimated obligations REGIONAL OFFICE

7.3 WHO Publicstion

Reports officer Ediror ~ e p a r f s assistant Administrative assistant Technical information assisrant Clerk Clerk-stenographer SLOres clerk

- . a u w e h 2

$, 1975

1

1977

30 770 30 770 7 250

1974

P4 P3 ND6 ND6 N D ~ Nn4 NDL ND 3

I

I

! i

I i j

i I I I

I

i 1 j

i 1 I

i !

' 6 C C 6 6 0 0 7 2 5 0

O T H E R

Number of Posts

clerk-typist

7.L Health Information of Public

Public information officer Information officer Informarion asrlrtant clerk-typist

DULY travel public infarnation material

1976

1 1 1 1 1 1 1 1 1 1 1 1

1

1975 1974

S O U R C E S


1977

1

1976

P4 P1

ND5 tm3

25 800 2 8 760 25 800 1 28 760 6 CC 6 600

1975 19711

i I I

I975 1976

I

I I

1976 1977-

!

1971

! I

!

1 I I

i I

I (Expressed in US Dollars

I I - R E G U L A R B U D G E T O T H E R S O I ! R C F S m

w

services Planning m d evaluation officer Progr-e rrmnagemenr officer Technical officer (programing) Abiniarrative assistant Assislancs Technical assistant P r a g m m e analyst Secretaries Clerk-stenographer. Clerk-typist

9.3 Reaional General S u ~ ~ o r r services

Mminisfrati.~ and Finance

Number of Posts

Administration and finance

1974

Estimated Obligations REGIONAL OFFICE

officer Administration and finance

officer

1974

9. SUPPWT TO REGIONAL PRffiUmSS

9.1 Reaional Progr- Planning and General Accivifie.

Director, health services Assistant directors, health

Administrative assisrent Secretary clerk-stenographer

1975

Number of Posts

02

Budget and Finance

I ; I 4

1975 1974


BvdgeL and finance officer senior assistant (health

insurance) Clerk-srenogrspher

1976

! I

I I i i

/ 38 100 40 320 ! 131 200 1 141 360

1974 1977

1 1 4

!

41 430 148 040

1976 1975

1 4

1977 1975 1976 1976 1977

i

(Expressed in US Doll-r~L

O I H E R S O U R C E S R E G U L A R

REGIONAL OFFLCE

1974

2

- 73

120

B U D G E T

Estimated Obli%ationa N u d e r of Posts

Administrative services

Adminil)trative services officer Adminietretive assistant Administrative aeaismnts ~ir-canditimiog operator *Il8irrant air-cor~ditioning

operetor Clerk-stenographer Typing pool supervisor Clerk Travel clerk Hail clerk Registry clerks Hachine operator (maintenance) Hachine operator Telephone operator ~teeeptionist Clerk-typists

Custodial sraff Temporary asaisfance m t y travel

9.4 ~exional common Services

General operacing expenses supplies and material ~cquiairion of furniture and

equipment

Total - REGIONAL OFEICE

1974

P3 No7 ND6 NDS

1104 1104 ND4 1104 ND4 1104 1104 1104 N D ~ H03 ND3 ND3

=_

- 0 v Y r " > 9 u.

2 w

Nvmbcr

1975

1 1

1 1 1 1

2

- 73

120

- 2

- 2

--==

1974

Elcimatrd Obli%acion%

1975 1976 1974

____

1977

30 770 8 500

of Posts

1976

1 1 1 1 1 1 1 1 2 2 2 2

1 1 1 1

1 1 1 1 1 1 1 1 1 1 1 1

2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9 9 9 9 -

73 ----

120

1975

25 800 7 000

1977

I

- 2 2 2 --- l-

- -

j

14 500 5 650 4 600

4 600 4 600 4 600 46QO 4 6 0 3 9 200 46QO 3 650 3 650 3 650

32 850 -

1977

1 1

1 1 1 1

2

- 73

120

1976

28 760 7 700

12 MO! i 4 700 1 3 8 W

' 3 8 W 3 800 1 3 8 0 0 3 8 0 0 3 8 0 0

3 8 0 0 3 m o 3 000 3 OW

1

I 1

1975

- 2 ---- .___

13 200 5 150 4 200

4 200 4 200 4 200 4 2 W 4 2 W 8 4 W 4 Z W 3300 3 300 3 300

1976

"6 725 4; a: 524 WO 569 130 I

83 5 w 92 OW 69 W O )

i

._==-==== =i==F=_.= I

1977

-

=-=-=.=-

27 WO 1 29 7 W -8 -

37 mo 9 500

707 630 -

176 5 W 152 WO 48 500

377 WO -

30 O W 32 WO 35 am 7 800 8 600 ----

52: , I 590 600 i 651 100

10 O W 4 W O 1 O W

-

145 OW 76 5 W 33 500

255 W O PP

PO

10 OW 1 11 500 12 500

- - , - - 15 WO 15 MX 18 000 20 OOO

1 261 313

5 OW :"i 1 5 W

_ _ I -

i 150 O W 167 W O 6 000 1 5 W

100 500 39 500

290 W O

- 2

.-=- 1 477 458 1 643 966

141 000 34 000

---- 342 W O

- 25 WO ----.-

- 2 .-- 1 778 020

I - - 27 MO ---- - 31 200 ===-..

- 34 500

R E G U L A R B C D G E T

Number o f posrs KEGIOSIIL AL'J I IEKS

IExpressed in US DollarsL

1974


3. STRENGTHEYING OF HEALTH SERVICES

3.1 Strensihening of Health services

3.1.2 Strenarheninp. of Health Services

Community health services Nursing Clerk-stenographers

DULY travel

3.1.3 Health Laboratory Services

Health laboratory services

Clerk-stenographer

Duty crave1

3.2 Faily Health

3.1.1 Prosramme Plannrn~ and General Activities

Administrative officer ~dminisfrarive assistanr

Duty travel

1974 1 1975 ) 1976

P5 P4

ND4

P5 ND4

P2 ND 6

I 1975 1977

Number of Ports

8 '

i I

i I

I , 65 600 70 680 ' 74 020

51 b W 57 520 ) 61 540 15 2 W 16 800 18 4 W

- 1 - _ _ , -

' 7 T t i E K S O l ' R L E S

m Estimated Obligations urn " C' L. >

8 ---

---- ----

8 / 8 107 480 132 400 145 000 1 I53 960

9 8 W , 10 600 11 O W 1 11 5 W

1976 1975 ; 19i7 I374 1974

1 1 1 1 1 1 1 1

2 2 2 2

i I

1

i I

1977

1 I

I ; i

1 i I I !

I

I

1975

PP

- - - , -

I I !

1 W O 1 100 1 2 W 1 300

- I - - - 36 150 37 7 W 40 740 1 2

- 1 , - - 1

i 1 i I !

i ! I I

i

I

18 500 ' 20 180 6 O W 6 600

- # - 24 500 ' 26 780

3 000 3 500 - , -

15 540 ' 27 500 30 280

- I - _ _ I !

I

I

i I

I , I I

!

i I i ! !

I i

! I

I I

i 1 I

i 1

1975

21 470 7 250 -

28 720

4 mo - 32 720 -

1976

I R E G U L A R B U D G E T I I O T H E R 1 5 Number of Post. Estimated Obligarione

1974 1975 1976 1977 1974 1975 1976 1977

I I I I I I

RECIMAL ADVISERS

3.2.2 Plrlrmnal and Child Health

Maternal and child health Clerk-.tenographers

htty travel

Nutrition Clerk-otenographer

htty tr.ve1

3.2.5 Health Education

Health education Clerk-mtmograpber

R E G U L * R B U D G E T

1974

- 6

2 1

2 2

10

REGIONAL ADVISERS

4. HEALTH IZANPWER DEVELOPHENT

4.1 Health Uan~over DevelomenC

Educarion and training Fellowship officer clerk-stenographers

DULY rravel

5. DISEASE PREVEMION AND c m n o ~

5.1 communicable ~ioease PTevention end cwrrol

5.1.2 Epidemioloxical Surveillance of Co-nicable Disenaes

Cararmnicable diseases Clerk-s~enographera

Duty crave1

5.1.3 Malaria and Other Parasitic Diseases

Senior melaria adviser MalarialogisLs Entomalogist ~dminiscrative assistant sfatisrical assistant clerk-stenographers Clerk-typists

~ u f y crave1

F

0. -

1977

74 020 30 770 13 800 -

118 590

5 500 - 124 090

74 020 9 200 - 83 220

6 WO

37 010 61 540 30 770 7 250 5 650 9 200 7 300 -

158 720 13 500

172 220

Number

1975

- 6 ----

_ - - _

1 1 2

2 2 ---- 10 ----

1974

- 93 640

4 100 - 97 740

- 70 300

4 800 - 15 100

- ill 510 9 9 w

121 410

P5 P4

NQ4

P5 ND4

P5 P4 P4

m 6 NI5 ND4 ND3

u - Y C b 2 > u. - of Ports

1976

2 2 2 2 1 1 1 1 3 3 3 3 -

6

2 2 2 2 2 2 2 2

4 4 4 4 ----

2 1 1

1 1 1 1 1 1 1 1

2 2

10

O T H E R

Number oE Ports Estimated obligations

1 1975 ( 1976

I I

! !

1977

- 6

1 1 2 1

2 2

10

1974

S O U R C E S

Estimated Obl~gafionr

65 600 25 800 11 400 -

102 800

4 500 I 107 300

1975 11916 1177 1974

70 680 28 760 12 600 -

112 040

5 O W - 117 040 ----

, ! I !

~ !

I I

~ i

1 I i ! 1 I I

I

1 I

I

1975 1976

I , :

I I I

65 MI) / 70 680 7 600 8 400

- 1 - 79 080

73 5 200 200 1 5 _ - 78 400 84

1977

1

32 800 51 600 25 800

6 W 0 4 700 7 600 6 WO -

134 MO 10 700

145 200

I

1 I 1 i

j i i i 1 ~ 1 i

1 1 I i !

- - - -

35 340 57 520 28 760 6 600 5 150 8 400 6 600 -

148 370

12 WO ---- 160 370 ----

- R E G U L A R

Number of Posts

1974

B C D C E I - Estimated Obligations REGICNAL ADVISERS

(Expressed in US Doller8k

I 1974 19-5 ' 1976

4

!

I

5.2 Nan-Communicable Disease ?revention and Control

5.2.1 Proxrsone Planning and General ~cfiviries

NO"-coolrmnicable diseases Clerk-8tenographer

nvty travel

5.2.6 Henla1 Health

mental Health

w r y travel

5.3 Prophylactic and Therapeutic Substances

5.3.1 Prozr-e Plsnninp. and General *crivities

Pvblic health officer Clerk-stenographer

mty travel

1975 / 1976 1977

PS ND4

PS

PI nn4

1977

Number of Ports

1974

I

i

I !

35 340 ! 37 010

! I

500 1 800 - , - 35 840 37 810 - -

!

! 1 32 , 35 340 '! 37 O1o

3 500

m - u C b 2 3 ... $ u.

-

O T H E R S O U R C E S

Eorimated Obligariona

i

1 1 1 1 1 1 1 1

2 2 2 2

- --

1 1 1 1 1 1 1 1

2

!

I

2

1 - 36 310 , 39 803

- ' -

1

1975 1974

1 1 - 1 1

2

i

---- ----

---- 2 ----

1976 ,1977

I !

!

I 1 !

!

I I

43 040 -

! I

1

I

i I i

I ! I I I I I

1975

I

- - 45 410 -

! !

i ~ I

1976 1977

R E G U L A R

Number of Polre

1974

3

B U D G E T - ~atimated Obligations WHO REPRESENTATIVES

iExoresaed in US Dallarsl

1974

9. SUPPLIB? TO REGIONAL P R f f i W S

9.2 Aasisrsnce ro Covnrry Progrsmeh

Medical officers medical officers &dmictisrra~i~e officer Admini~tralive nfficer Administrative aaaistant Clerk-stenographer Senior administrative ensiscant ~dminie~rarive asaisrant Clerk-afenographei clerk-stenographers Senior nssirtant Clerk-lleno$repher Clerk-stenographer Administrative assistant Senior nssietant Clerk-stenographer clerk-stenogmpher secretarial assistant Administrative aasistent Clerk-~tcn~grapher

Custodial srnff ~enparary assistance Duty travel

common Services

General operating expenses Supplies and mateiial ~ ~ ~ ~ i ~ i t i o n of furniture and

equipment

Torel - WE0 RePRESWTATIVES

1975

P6 PI P3 P2

819 BK8

CDLY COL7 COL6 DAC5 DJI DJ5 KA7 ND6 m 5 ND4 RN6 RN5 UBS UB4

1975 1974

5 5 5 106 100 l7L 950

I 30 360 21 900

8 640 6 180 3 960 3 060 2 520 4 8 W 2 580 2 580 2 400 6 WO 4 7 W 3 S W 3 240

I 2 280 I 550 1 B 560 - -

1976

3 d 3

27

27 __==

m

ly u II s b- 3 3 u.

r 1976

Number of posts

1977

3


Estimated obli%aciona

1977

109 900 185 430 33 440 21 740 9 500 6 800 4 360 3 370 2 770 5 280 2 840 2 840 2 640 6 600 5 150 4 2 W 3 570 2 510 6 110

; 5 020 -

1975 1974

1 1

1 1

1 1 1 1 1 1

1 1

---- 27

---- 21

113 940 194 280 35 310 24 530 10 450 7 480 4 800 3 710 3 050 5 8~ 3 120 3 120 2 900 7 250 5 650 i 6 W 3 750 2 760 6 730 5 550 -

13 000

40 W O 10 W O IS 000

- 475730

===

1

!

j i

I

1976

I 1 i

! I

I I 1

I

i ! I

I 1

i I

! 1

j

i i

i

1975 1976

1 1 1 1 1 1 1 1

I l l 1

2 2 2 2

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

1 1 1 1 1 1 1 1

27 ----

27

1977 1977

1 1

1 1

1 1 1 1 1 1

1 1

27

27 I===

19 OW

44 OW 13 O W 22 O W

- 594280 =====PI

15 OW 1 17 O W

I

42 OW 10 WO 17 OW

- 521660 ==-=-==

43 OW 12 O W 20 000

- 559370 111=11-

Country Statement

and Social Medicine

Vector Control

Nutrition

Planning and Hospital Adminis-

Study, Dacca

toses Control and Family Planning including Maternal and Child Health Based Family Planning in Medical

Education in Public Health and Colleges with the Establishment of Field Practice Areas

Planning Clinical Programme

Technicians with Special Emphasis on Maternal and Child Health

Production

The populat ion of Bangladesh is now 77 mi l l i on and the growth r a t e i s 3.1% per annum. Most of t h e people (85%) l i v e i n 64 493 v i l l a g e s and the r e s t i n 68 tovns and c i t i e s . Almost ha l f of the population (46%) is under f i f t e e n years of age. The populat ion dens i ty is 1 360 per sq. mile.

The Government is working towards decen t r a l i z a t i on of the hea l t h s e r v i c e s s o t h a t people i n r u r a l a reas w i l l rece ive the b e n e f i t s of modern medical f a c i l i t i e s . I t proposes t o a l l o c a t e adequate resources i n order Lo provide t o t a l hea l t h ca r e f o r the e n t i r e populat ion. The hea l t h s t ruc - t u r e , from the Ministry of Health and Family Planning t o the l o c a l l e v e l , i s being re-organized.

I n the f ive-year n a t i o n a l development p lan (1973-74 to 1977-78) the Minis t ry of Health and Family Planning w i l l be spending 2 700 mi l l i on takasZ and i n the cu r r en t yea r 350 mi l l i on takas. I n 1971. 0.85 takas pe r c a p i t a were spent on hea l t h .

I n 1973-1974, the f i r s t year of the plan, the Government appropriated 4.5% of the revenue budget expenditure and 6.1% of the development budget expenditure f o r hea l t h and family planning s e rv i ce s .

Zhe b i r t h and dea th r a t e s i n 1970 were 47 and 17 pe r 1 000 populat ion r e spec t i ve ly . The i n f a n t mor t a l i t y r a t e was 149 pe r 1 000 l i v e b i r t h s and the maternal mor t a l i t y r a t e 30 per 1 000 l i v e b i r t h s .

A populat ion census was s t a r t e d i n February 1974; the r e s u l t s are being awaited.

WHO a s s i s t ance . WHO continues t o a s s i s t with s p e c i f i c disease- c o n t r o l prograumes and i n co-ardinat ing b i l a t e r a l and voluntary a s s i s t ance in the recons t ruc t ion and expansion of the hea l t h services. Fur ther e f f o r t s i n programre formulat ion a r e planned t o t r y t o ensure the optimum b e n e f i t from the a s s i s t a n c e of WHO and o t h e r organiza t ions i n the development of t h e hea l t h s e rv i ce s .

Other a s s i s t ance . Throughout 1973,WHO a s s i s t e d i n the work of var ious United Nations missions t o Bangladesh, and the programmes of work of UNICEF, UNFPA, World Bank, US AID and o t h e r agencies were defined and co-ordinated. Thus the agencies have achieved g r e a t e r understanding of t h e i r r e spec t i ve r o l e s , and s t e p s a r e being taken toward f u r t h e r development of h e a l t h i n Bangladesh, on the b a s i s of p r i o r i t y programmes f o r support .

Strengthening of h e a l t h s e rv i ce s

I n the n a t i o n a l f ive-year sacio-economic plan, which has been pub- l i s h e d , t h e ob j ec t i ve of the hea l t h s e c t o r development is t o c r e a t e a h e a l t h i n f r a s t r u c t u r e a t the periphery f o r t h e provis ion of e s s e n t i a l

.ADESH + .J w

h e a l t h s e rv i ce s , e spec i a l l y i n the r u r a l a reas . The main t h r u s t is toward the provision of preventive s e rv i ce s and a balanced progr-e of medical s e rv i ce s through h o s p i t a l s , spec i a l i z ed i n s t i t u t i o n s and t h e thana hea l t h complex, which inc ludes thana hea l t h cent res and union sub-centres.

Implementation of the comunity-oriented i n t eg ra t ed r u r a l hea l t h cen t r e s i s now i n progress, through a r egu l a r home-visiting programme of t h e r e t r a i n e d workers of the v e r t i c a l programmes, such a s malar ia , smallpox, leprosy and tuberculos is , t o car ry out comprehensive hea l t h a c t i v i t i e s , under t h e superv is ion of the thana hea l t h adminis t ra tors and supervisory teams of a l l i e d hea l t h personnel . These a c t i v i t i e s a r e con t ro l l ed by s t a f f of d i s t r i c t personnel d r a m from family planning and genera l hea l t h s e rv i ce s . The Secre ta ry of Health and Family Plan- ning d i r e c t s the execut ion of t h e i n t eg ra t ed programme through t h e Cent ra l Implementation Committee, which, wi th the Secretary of Health as Chairman and the Direc tors of the Health Serv ices . inc lvdinr those - from malar ia and family planning a s members, were respons ib le f o r reorganiza t ion wi th in the Ministry of Health.

A r eo r i en t a t i on programme f o r the hea l t h workers was i n i t i a t e d and has helped t o develop i n t eg ra t ed b a s i c hea l t h s e rv i ce s throughout the country.

The Planning C e l l i n the Ministry of Health has been e s t ab l i shed , under t h e Chairmanship of t h e J o i n t Secre ta ry . I t is envisaged t h a t t h i s s e c t i o n of the Minis t ry w i l l be s trengthened by the conduct of t r a i n i n g courses i n h e a l t h planning f o r the s t a f f , as we l l as by s t u d i e s r e l a t ed t o h e a l t h manpower development. The s t a t i s t i c a l and epidemialogical s e rv i ce s have been f u r t h e r expanded, and ac t i on has been i n i t i a t e d t o develop the hea l t h information s e rv i ce s on a systema- t i c b a s i s .

A j o i n t group of WHO s t a f f and high ranking o f f i c i a l s of the Government pa r t i c ipa t ed i n a workshop i n mid-1973 as p a r t of a country h e a l t h programming exe rc i s e t o i d e n t i f y the f e a s i b i l i t y of the hea l t h component of the Five-Year Plan 1973-1978 and t o determine t h e p r i a r i - t i e s .

The Bureau of Health Education i n the Ministry of Bealth, as wel l a s co-ordinat ing the h e a l t h education a c t i v i t i e s of var ious min i s t r i e s , i s developing a j o i n t programme f o r family hea l t h education and family planning educators , f o r educators i n the malar ia e r ad i ca t i on programme and f o r those i n the Department of Publ ic Health Engineering.

The network of pub l i c hea l t h labora tory s e rv i ce s with hea l t h l a b o r a t o r i e s being e s t ab l i shed i n a l l d i s t r i c t s with d i s t r i c t genera l

*l taka = US $0.13

BANGLADESH

o r medical c o l l e g e h o s p i t a l s , under t h e I n s t i t u t e of P u b l i c Hea l th , w i l l form t h e b a s i s of n a t i o n a l ep idemio log ica l s u r v e i l l a n c e and c o n t r o l of communicable d i s e a s e s , based on the c e n t r a l n a t i o n a l i n s t i t u t e .

WHO a s s i s t m c e . I n t h e o r g a n i z a t i o n of h e a l t h s e r v i c e s , n u r s i n g , h e a l t h l a b o r a t o r y s e r v i c e s and h e a l t h educa t ion , WHO w i l l cont inue to g ive co-ordinated t e c h n i c a l a s s i s t a n c e t o s t r e n g t h e n t h e Government's e f f o r t s , inc lud ing a s s i s t a n c e i n planning, programming and e v a l u a t i o n .

Other a s s i s t a n c e . Ass i s tance t o the Government w i l l be maintained i n ca -ord ina t ing a l l the h e a l t h programmes and p r o j e c t s being supported by many i n t e r n a t i o n a l and b i l a t e r a l agencies (such as US AID, CUSO, DANIDA, UNICEF, CIDA and SIDA, s t imula ted by t h e United Nations Re l ie f Operat ions i n Bangladesh).

Heal th manpower development

The r a t i o of 1 doc tor t o 10 000 people and t h e d o c t o r / n u r s e r a t i o of l e s s than 10 : l remain t h e same, with 8 052 phys ic ians p r a c t i s i n g i n t h e country (only 3 500 of whom a r e government employees) and 900 r e g i s t e r e d nurses , two t h i r d s of whom are p r a c t i s i n g . There a r e 703 midwives, 634 lady h e a l t h v i s i t o r s / l a d y family p lanning v i s i t o r s and 670 s a n i t a r y i n s p e c t o r s .

There a r e e i g h t medical c o l l e g e s , one nurs ing c o l l e g e , n ine teen nurs ing s c h o o l s and one I n s t i t u t e of Past-graduate Medicine. The annual ou tpu t of d o c t o r s was increased from 250 i n 1970 t o 580 i n 1973. Although t h e annual enrolment of nurses f a r t r a i n i n g has been r a t h e r low, i t is hoped t o reach the t a r g e t of a t o t a l of 5 000 nurses i n the country by 1978.

To r a i s e t h e s tandard of medical educa t ion , the i n t e r n s h i p t r a i n i n g programme was, i n 1971, increased t o two y e a r s - one year i n h o s p i t a l and one i n a r u r a l h e a l t h c e n t r e - and t h e r e are f u r t h e r p lans t o b u i l d up t h e s t u d e n t s ' subsequent c a r e e r s , inc lud ing s p e c i a l i z a t i o n w i t h i n the country. Attempts w i l l b e made t o ensure t h a t a l l a v a i l a b l e h e a l t h manpower is f u l l y u t i l i z e d i n t h e b e s t p u b l i c i n t e r e s t . Doctors are being t r a i n e d f o r work i n t h e i n t e g r a t e d r h a a h e a l t h and family planning scheme, w i t h 356 p o s t s of thana h e a l t h a d m i n i s t r a t o r s c r e a t e d . The phased t raining-cum-intern s e r v i c e course f o r n u r s e t u t o r s which has been developed i n t h e Nursing College of Bangladesh, should he lp t o meet the need f o r expanded nurs ing educa t ion and s e r v i c e programmes.

Various i n t e n s i v e t r a i n i n g p r o g r m e s f o r a l l c a t e g o r i e s of h e a l t h workers a t vary ing l e v e l s have been e s t a b l i s h e d i n suppor t o f the i n t e g - r a t e d h e a l t h and family planning s e r v i c e s i n r u r a l areas. They have

included fe l lowships f o r s e n i o r h e a l t h o f f i c i a l s and seminars f o r h e a l t h personnel i n community-oriented r u r a l h e a l t h and on t h e develapment of comprehensive h e a l t h s e r v i c e s . By 1973, 300 i n t e r n s had completed t h e i r o r i e n t a t i o n i n r u r a l h e a l t h s e r v i c e s , and 12 ODD h e a l t h and family planning workers had been r e t r a i n e d as multi-purpose workers f o r t h e b a s i c h e a l t h s e r v i c e s i n r u r a l a r e a s . Furthermore, t o overcome t h e a c u t e shor tage of n u r s e s , a t r a i n i n g programme f o r 5 000 family h e a l t h v i s i t o r s func t ion ing a s a s s i s t a n t nurses or midwives is t o be e s t a b l i s h e d by 1978; a l s o , 175 nurses w i l l be r e t r a i n e d as p u b l i c h e a l t h nurses . To meet the t o t a l needs of the i n t e g r a t e d thana h e a l t h programmes, t r a i n i n g programmes f o r a l l i e d personnel have a l s o been i n t e n s i f i e d ; t o provide a malelfemale team of family wel fa re workers t o improve coverage, a f u r t h e r 8 000 lady family wel fa re workers are ca be r e c r u i t e d and t r a i n e d .

VHG a s s i s t m c e . I n a d d i t i o n t o suppor t ing t r a i n i n g courses f a r nurse t b t o r s t o meet a p r i o r i t y need, and r e t r a i n i n g seminars a t d i v i s i o n a l , d i s t r i c t and thana l e v e l s organized with the a s s i s t a n c e of WHO p r o j e c t s t a f f , WHO is a s s i s t i n g w i t h t r a i n i n g programmes f o r a l l i e d h e a l t h personne l and t h e development of model community p r a c t i c e f o r medical c o l l e g e s . Emphasis is p laced on s t r e n g t h e n i n g departments of p revent ive and s o c i a l medicine i n medical c o l l e g e s and e s t a b l i s h i n g a c e n t r a l n a t i o n a l i n s t i t u t e of p revent ive and s o c i a l medicine, wi th UNDP suppor t .

Other a s s i s t a n c e . WHO h a s continued t o a s s i s t t h e Government i n t h e co-ordinat ion of a s s i s t a n c e from b i l a t e r a l and vo lun ta ry agenc ies , which have provided equipment, s u p p l i e s , t r a n s p o r t , t each ing a i d s and l i t e r a t u r e .

Disease c o n t r o l and prevent ion

Considerable epidemiological impact h a s been achieved wi th d i s e a s e s l i k e smallpox, which is being e r a d i c a t e d , m a l a r i a , vhich is l i m i t e d t o the border b e l t , and c h o l e r a , which was under c o n t r o l i n 1972. S t i l l , t u b e r c u l o s i s , water-borne d i s e a s e , he lmin th ic i n f e s t a t i o n ( e s p e c i a l l y hookworm and amoebias i s ) , l e p r o s y , f i l a r i a s i s and venerea l d i s e a s e s are es t imated t o r e p r e s e n t 50% of the t o t a l h e a l t h problems.

An i n t e g r a t e d l a b o r a t o r y s e r v i c e is being organized and implemented and s u p p o r t of t h e p roduc t ion and d i s t r i b u t i o n of rehydra t ion f l u i d con t inues .

A f ive-year p lan has been prepared by t h e Planning Commission t o s h i f t the p r i o r i t y from c u r a t i v e t o p revent ive s e r v i c e s and t o in teg- r a t e t h e s p e c i a l i z e d s e r v i c e s i n t o those f o r b a s i c h e a l t h care.

BANGLADESH

With the measures f o r achieving a sound se rv i ce f o r epidemiological su rve i l l ance f o r communicable-disease cont ro l , t he r e is a l s o increas ing awareness of the impact of non-communicable d iseases .

WHO ass i s tmce . Apart from a s s i s t a n c e t o s p e c i f i c progr-es f o r smallpox, malar ia , l eprosy and t ube rcu los i s , emphasis w i l l he placed on ca-ordinat ion of WHO a s s i s t ance through the development of a v ig i l ance and su rve i l l ance system f o r epidemic cont ro l , t r a in ing , immunization, h e a l t h education, and the evolu t ion of a comprehensive i n t eg ra t ed hea l t h service, inc luding the o r i e n t a t i o n and r e t r a i n i n g of hea l t h workers.

WHO w i l l a l s o suppor t prevention and cont ro l programmes i n the f i e l d s of mental hea l t h , card iovascular d i seases , cancer , medical r e h a b i l i t a t i o n and r a d i a t i o n hea l t h .

Other ass i s tmce . Many d i f f e r e n t voluntary agencies are a s s i s t i n g i n the s t rengthening of cu ra t i ve and preventive s e rv i ce s . Their a c t i v i - t i e s a r e being co-ordinated with those of WHO, UNICEF and the Government.

Promotion of environmental hea l t h

The provis ion of piped water supply and sewerage t o the urban popu- l a t i o n has been f a r from s a t i s f a c t o r y , b u t the number of people i n the r u r a l a r ea s who have been provided wi th s a f e water have been indeed impressive. The t a r g e t i n the f i r s t five-year plan (1973-1978) is t o provide one handpump/tubewell f o r every 150-200 persons.

The on-going massive UNICEF/WHO-assisted programe f o r cons t ruc t ing 160 000 shal low tubewells , scheduled f o r completion by t h e end of 1974, is t o be supplemented by another 100 000 shallow wel l s and 30 000 deep tubewells by 1978, wi th a i d from UNICEF and technica l guidance from WHO. Proposals a r e under way t o motivate community p a r t i c i p a t i o n i n r e spec t a£ both cons t ruc t i on and maintenance of these w e l l s through t h e recent ly cons t i t u t ed 4 285 e l ec t ed union councils .

A Water Supply and Sewerage Sec tor Study of Bangladesh was ca r r i ed ou t j o i n t l y i n October 1973 by an IBRD/IDA and WHO team. The team's recommendations a r e s t i l l awaited.

To meet t h e requirements f o r s u i t a b l y qua l i f i ed s a n i t a r y engineers , the Government has accepted t h e recommendations of WHO f o r t h e development of post-graduate t r a i n i n g i n pub l i c h e a l t h engineering i n t h e Bangladesh Univers i ty of Engineering and Technology. They recommended s e t t i n g up of a Cent ra l Publ ic Health Engineering Research I n s t i t u t e and of fou r r eg iona l l a b o r a t o r i e s has a l s o been accepted and included i n the f ive-year plan.

There is an increas ing awareness of the hea l t h problems assoc ia ted with increas ing i n d u s t r i a l i z a t i o n .

WHO assistance. WHO and UNICEF w i l l continue t o a s s i s t t h e environmental hea l t h programme s p e c i f i c a l l y i n regard t o developing i nd i - genous capacity i n a l l a l l i e d f i e l d s , inc luding water q u a l i t y con t ro l , hea l t h education, t r a in ing , superv is ion and maintenance.

Assistance from WHO s t a f f is a l s o envisaged i n guiding the implementation of the proposed major v i l l a g e s a n i t a t i o n programme, i n 620 v i l l a g e s , a s p a r t of t h e i n t eg ra t ed r u r a l hea l t h complex proposals .

Under UNDP funds, WHO w i l l help t o prepare a f e a s i b i l i t y s tudy of garbage d i sposa l f o r Dacca and t o improve s a n i t a r y condi t ions i n o ld Dacca c i t y by convert ing t h e dry p r i v i e s i n t o a water-borne system.

The a s s i s t a n c e t o be given i n occupational hea l t h and t o the reorganiza t ion of the s e rv i ce s necessary f o r a good occupational hea l t h s e r v i c e , i n order t o provide the co r r ec t s i t u a t i o n f o r man i n h i s wark- ing environment i n Bangladesh, has been defined.

I n consul ta t ion wi th UNICEF, l ists of suppl ies and equipment f o r t h e water supply and s a n i t a t i o n programmes, a s w e l l as of matexia l and t r anspo r t needed f o r h e a l t h education, a r e being prepared.

Other assistrmce. UNDP, UNICEF and the IBRD a r e all a s s i s t i n g wi th these programmes, as mentioned.

Jrquni*~ri:n u f i l e a l t h S e r v i c e s . Plannini, s : ~ d i : :c . , r ta . A d r i n i s t r l l r o r ,

STR 001 (Bangladesh 0009)

To a s s i s t i n e s t a b l i s h i n g and s t r eng then ing a sound o r g a n i z a t i o n f o r h e a l t h p l ann ing i n the M i n i s t r y o f Hea l th , i n t r a i n i n g personnel i n h e a l t h p lan- n ing , i n developing a h e a l t h i n fo rma t ion system, i n c l u d i n g e v a l u a t i o n , i n plan- n i n g e f f i c i e n t i n t e g r a t e d r u r a l h e a l t h s e r v i c e s , i nc lud ing development of a r e f e r r a l sys tem, and i n p lanning h e a l t h and manpower s t u d i e s w i th the aim of improving the d e l i v e r y of medica l care w i t h emphas is on r u r a l areas. From 1974 onwards, t o deve lop a s u i t a b l e p l ann ing methodology i n accordance w i t h t h e long- te rm n a t i o n a l development p l a n , and a s u i t a b l e i n fo rma t ion system f o r f u r r h e r h e a l t h p l ann ing and e v a l u a t i o n of i n t e g r a t e d h e a l t h s e r v i c e s and fami ly plan- n ing .

A f t e r a review, i n 1973, of the s e r v i c e s i n v i t a l and h e a l t h s t a t i s t i c s by a c o n s u l t a n t (SEAR0 0220) and a Regional O f f i c e s t a f f member, and adv ice from a f u r t h e r c o n s u l t a n t on t h e development o f a h e a l t h i n fo rma t ion system and the co- o r d i n a t i o n of s t a t i s t i c a l and ep idemio log i ca l a c t i v i t i e s , p l a n s were made f o r t h e f u t u r e programme. A WHO t a s k f o r c e he lped t o conduct a workshop on count ry h e a l t h progr-ing, and seminars and t r a i n i n g a c t i v i t i e s f o r n a t i o n a l s t a f f were c a r r i e d ou t .

I n 1974 t h e a c t i v i t i e s w i l l be r e l a t e d t o h e a l t h manpower s t u d i e s , t h e fo rmu la t i on o f a p l ann ing methodology, and the t r a i n i n g of personnel f a r plan- n i n g l h e a l t h i n fo rma t ion . I n 1976-1977, f e l l owsh ips f o r s t u d i e s on h e a l t h plan- n i n g w i l l b e provided.

Development of Heal th S e r v i c e s . Educat ion i n ST8 002 R t b l i c Hea l th and Trainini: of Medical A s s i s t a n t s (Bangladesh 0018)

To a s s i s t i n f u r t h e r developing and s t r e n g t h e n i n g of i n t e g r a t e d h e a l t h programmes fo r r u r a l areas ( t hana h e a l t h c e n t r e s , e t c . ) , by p lanning, implemen- t a t i o n and e v a l u a t i o n of t r a i n i n g and r e o r i e n t a t i o n p r a g r a m e s £or p r o f e s s i o n a l a u x i l i a r y h e a l t h a l l i e d workers.

I n 1972-1973, 12 000 unipurpose workers were conver ted a f t e r t r a i n i n g i n t o multi-purpose workers and 300 phys i c i ans t r a i n e d as thana h e a l t h admin i s t r a to r s . A h o s p i t a l a r c h i t e c t advised on t h e p lans f o r thana h e a l t h complexes. Hea l th a d m i n i s t r a t o r s and p l anne r s v i s i t e d the U.S.S.R. t o obse rve t h e organization of gene ra l h e a l t h s e r v i c e s .

During 1974 and 1975 t h e a c t i v i t i e s f o r t r a i n i n g w i l l con t inue , b u t much more emphasis w i l l be p laced on the o p e r a t i o n a l and l o g i s t i c s a s p e c t s of t h e p r o g r a m e i n o r d e r t o reach a t o t a l coverage and provide b a s i c and comprehen- s i v e h e a l t h care. I n 1976-1977 bes ides improving the con t inu ing a c t i v i t i e s by e v a l u a t i o n and prompt feedback WHO w i l l h e l p t o deve lop v a r i o u s manuals and l o c a l teaching resource m a t e r i a l s .

I t i s expected t h a t t h e p r o j e c t w i l l cont inue f o r a number o f years .

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

R E G L ! L , \ R B L O G E T

BAYCUDESH

3. STRENGTHENING OF HEALTH SERVICES

3.1 Srren~Lhenin~ o f Health Se~vices

3.1.2 Strenqfheninp of Health Services

Orsanizafion of Health Services, Planninp, and Hospiral ~dminir- fration

Public health administrator1 planner P5

Statisticlan P4 Secretarial assistant OAC4

Short-term consultant Fellowships Subsidy Supplies and equipment

~evelooment of ~ealth Services, Education in Public Health and Trainins of Medical Assistants

Medical officer P5 Auxiliary health training

officer P4 Medical officer P4 Public health nurse educacor P3 ~ecrerarial assistant DAC4

Short-term consultants Fellowships Supplies and equipment

Sumber of P o r t s

1974 1975 '1976 1977


1974 1975 , 1976 / 19771

i I !

! !

P r o ~ e c r xo.

SIR 001 (way)

STR ~2 (W18)

i I I

1 i

i ! 39 270 , 39 940 i 42 610

---- 6 600 ( 6 6 W

2 WO 10003 10003 10003

i x p r e i s e d :r :' :':!lrrl I' T

!umber of 711:s

1974 '1975 ! 1976 19::

i

I

I

i

I

: i

!

1/12 1/12 -

I / 2

- - - 1 - 58 110 I 96 540 91 010 ! 91 980

- 1 - - , -

I i I 1 39 020 39 940 42 360

1 30 320 33 100 34 650

32 600 34 650 I 30 320 32 850 34 650

1 750 ! 1 930 ' 2 120

! - I - 4 420 I48 430

I 4 WO / 13 2 W : 13 Z W , 10 800 I 10 800

5 W O / I 0 0 3 7 0 0 0 i 7003

Xi E i; C O I R C L S

Eriimaied Obli~ationr

1974 I 1975 ) 1976 ~ 197:

! I

i I

! !

I !

I

I !

i

I

I ,

I

I I

1 /

1/12 1/12 1/12 -

4 4 1 5

6/36

1/12 1/12 -

---- I/ 6 2/24

: 2 . z * - ? -

1/12 1/12 1/12 -

6/36

- 166 230

- , - , -

! .

1 W 450 134 810 158 220 ----

? BANGLADESH ..J

01

Workshop f a r Electro-medical Technicians STR 003 (Bangladesh 0020)

To a s s i s t i n s t r eng then ing the c e n t r a l workshop f a r the r e p a i r o f e l ec t ro - medical equipment, Dacca, i n e s t a b l i s h i n g vorkshops a t zonal l e v e l and i n t r a in - i n g t h e s t a f f .

A consu l t an t ass igned under p r o j e c t Bangladesh 0011 "Pharmaceutical Services" i n 1972 a l s o a s sessed the e x i s t i n g s i t u a t i o n regarding maintenance and r e p a i r o f electro-medical equipment and recommended s t rengthening the c e n t r a l vorkshop and e s t a b l i s h i n g zonal workshops.

A consu l t an t e lect ro-medical engineer w i l l be ass igned f o r four weeks i n 1975 t o prepare and conduct a seminar on t h e maintenance and r e p a i r of e l ec t ro - medical and e l e c t r o n i c equipment and X-ray un i t s . I h e seminar w i l l be a t tended by s t a f f members i n charge o f t h i s work from the Minis t ry o f Health, h o s p i t a l s , medical co l l eges and l abora to r i e s .

Development of Cowuni ty Medicine sm 004 (Bangladesh 0021)

To a s s i s t i n the t r a i n i n g of medical graduates i n cormunity medicine and thus make medical educat ion mare "need based".

Medical graduates need t r a i n i n g i n order t o funct ion as "basic medical doctors" , t o provide e f f e c t i v e , comprehensive and i n t e g r a t e d prevent ive , proma- t i v e and c u r a t i v e h e a l t h care t o the c-unity. A s such, t h e i r t r a i n i n g i s to be o r i e n t e d wi th mare emphasis on comvni ty medicine and h e a l t h care.

A short-term consu l t an t , with experience i n planning and conducting t r a in - ing courses i n cornuni ty o r i e n t e d medical educat ion, w i l l be provided i n 1975 f a r curriculum planning and t o review and advise on reorganizing medical eduea- t ion.

The p r o j e c t i s expected to continue u n t i l the end of 1975.

Production of Rehydration Fluid HLS 001 (Bangladesh 0017)

To develop the resources f o r the production of in t ravenous e l e c t r o l y t e s o l u t i o n s a t t h e I n s t i c u t e o f Publ ic Heal th , Dacca, so as t o enable the country t o become s e l f - s u f f i c i e n t i n i t s day-to-day requirements and self-dependent i n meeting emergency s i t u a t i o n s such as cholera and others .

Publ ic Heal th , Dacca, v i t h an annual turn-over capac i ty o f 300 cu. met res of e l e c t r o l y t i c so lu t ions . I t includes a sub-system f a r the manufacture o f WC con ta ine r s f o r infusion f l u i d s and f o r the manufacture o f g iving s e t s .

I n 1971 a WHO consu l t an t from VIFOR (Switzer land) conducted a f e a s i b i l i t y study. I n 1972, implementation vas s t a r t e d and from 1973 Wo c o n s u l t a n t s have svpervised the d i f f e r e n t s tages o f implementation: supervis ion o f c o n s t r u c t i o n , i n s t a l l a t i o n of equipment, t r a i n i n g of the s t a f f , e t c . Zhe p l a n t vas f i n a l l y comnissioned f o r production i n November 1973. Apar t from l o c a l t r a i n i n g , i n t e r - na t iona l f e l lovsh ips were provided i n 1973-74 t o enable the sen io r s t a f f t o s tudy d i f f e r e n t a spec t s such as maintenance technology, operat ion methodology and q u a l i t y con t ro l .

A consu l t an t v i l l follov-up the progress of t h e p r o j e c t i n 1975, vhen a s s i s t a n c e t o the p r o j e c t w i l l be completed.

Development of Publ ic Heal th Laborator ies Inc lud ing Vaccine Production

BLS 003 (Bangladesh 0022)

To a s s i s t i n s t rengthening t h e I n s t i t u t e o f Publ ic Health t o enab le i t t o funct ion as a c e n t r a l l abora to ry and extend the resources of t h e I n s t i t u t e f a r the es tabl ishment of in termediate l a b o r a t o r i e s vhich v i l l funct ion a t d i s t r i c t l e v e l ; t o a s s i s t i n t h e development of vacc ines , i n t h e improvement of the present vaccines by e s t a b l i s h i n g q u a l i t y con t ro l and s tandards , and i n t h e development of c a p a b i l i t y for new vaccines l i k e DPT and betapropiolactone i n a c t i v a t e d r a b i e s vaccines; a l s o to s tudy the f e a s i b i l i t y o f e s t a b l i s h i n g f a c i - l i t i e s f o r s p e c i a l vaccines, such as f reeze-dr ied BCG vaccine.

I h e p r o j e c t w i l l begin v i t h the assignment o f a consu l t an t i n 1975, t o draw up a d e t a i l e d plan f o r the long-tern development o f the l a b o r a t o r y s e r v i - ces. In 19761977 the p r o j e c t v i l l be d i r e c t l y a s s i s t e d by a pub l i c h e a l t h laboratory s p e c i a l i s t . Fe l lovsh ips v i l l b e awarded i n r e l e v a n t fields related to the development of the l a b o r a t o r i e s including vaccines . Suppl ies and equipment, v i l l be provided during the i n i t i a l s t a g e and f o r the smooth opera t ion o f the p r o j e c t .

With ma te r i a l a s s i s t a n c e provided by UNROD and UhTCEF and t echn ica l a s s i s - tance from WHO, an i n d u s t r i a l p l an t has been cornmisstoned a t the I n s t i t u t e of

BANGLADESH

Workshop for Electra-medical Technicians

Short-term con0v1iant Supplies and equipment

Development of coolnuniry

nedicine

Short-term consulfanf Subeidy

3.1.3 Health Laboraiary Services

P~aducrion of Rehydration Fluid

Short-term cansuitant Pellouship. Supplies and e q u i p e n r

Deveio enc of Pubiic Health LaboraEries Includins, vaccine Production

Public health laboratory mpecia1iot PI

Short-term consultant Pellourhips Supplies and equipmenr

R E G U L A R

Number of Ports

1914

B O D G E T

Estimated Obligations Project NO.

STR 003 (0020)

STR 004 (W21)

nL5 001 (0017)

HIS M I (0022)

1974 1975

l i x p r e s s e d 1" L b UoLLaIs1

1971

I

I

I

1976

6 MI0 1 ! 3 W O i

I i I

1 - 1 i 9 600

I

I

I i

16 300 34 650

8 800 7 8 0 0 ( 9 1 5 0 9 150

1977

I

I !

1976

3 T

Number O f P o r t s

2/12

-

1977 1974

I/ 6

-- -- 2/15

I/ 3

I/ 1 I/ 2

I/ 4 2112

- 43 800

500

a rn u c k 3

il E R S O V K C E S

Estimated Obligarionr

1/12

1 1

2/15

i - 17 1 W

1974 I 1975 / 1976

i i

1975 ( 1976 1977

- 25 450 - - -

1971

1

1 i

I

I ;

I 1 ;

i

I , ! i i I

I I i !

I I !

i I

I

i : I 1

i 1 ! I

I I i I

i , I !

I

I

I

j ,

Training of Health Personnel i n Family Planning (UNFPA BGD/74/P07)

MCH 002 (Bangladesh 0037)

To a s s i s t i n the development and implementation of a t r a i n i n g programe f o r a new category o f multi-purpose h e a l t h worker, t e n t a t i v e l y c a l l e d the family h e a l t h v i s i t o r , who w i l l work i n r u r a l areas.

Assis tance w i l l begin i n 1974 with the assignment of a WHO nurselmidwife educator , who w i l l work i n c lose r e l a t i o n s h i p wi th the sen io r nurse adviser i n P r o j e c t Bangladesh 0013, "Nursing Advisory Services and Training". The plan o f a c t i o n f o r Bangladesh 0013 incorporates the a c t i v i t i e s to be c a r r i e d ou t under t h i s p ro jec t .

Suppl ies and equipment w i l l be provided.

Assis tance t o the p r o j e c t i s expected t o continue u n c i l 1978 sub jec t to a v a i l a b i l i t y of funds under UNFPA.

BANGLADESH F m 0

HCH 003 (Bangladesh 0039)

To a s s i s t i n the development of the c l i n i c a l programme i n family h e a l t h i n a phased manner, wi th s p e c i a l emphasis on maternal and c h i l d hea l th based family planning.

Services i n maternal and c h i l d h e a l t h and family planning w i l l be made a v a i l a b l e on an i n t eg ra ted bas i s to medical i n s t i t v t i o n s a t a l l l eve l s . Assis- tance w i l l be provided i n the form of t echn ica l advisory s e r v i c e s i n plsnning, execution of preparatory a c t i v i t i e s , implementation o f the c l i n i c a l progr-e, t r a i n i n g of e x i s t i n g h e a l t h personnel by means of n a t i o n a l seminars and study tours , in-service t r a in ing , on-the-job cont inuing educat ion; eva lua t ion , and suppl ies and equipment, including t r anspor t .

?he a c t i v i t i e s w i l l be c l o s e l y co-ordinated wi th those of Bangladesh 0037, "Training of Heal th Personnel i n Family Planning" and Bangladesh 0038,"Teachhg of Human Reproduction, Population Dynamics, Demography and Family Planning, Including Maternal and Child Health Based Family Planning i n Medical Colleges".

Teaching o f Human Reproduction. Populat ion Dynamics, HRP 001

.- BANGLADESH g

D- graph^ and Family Planning Including Materna17nd (Bangladesh 0038) Chi ld Heal th Based Family Planning i n Medical Colleges With the Establ ishment of F ie ld P rac t i ce Areas (UNFPA BGD/74/P08)

To provide a comprehensive t r a i n i n g programe i n i n t e g r a t e d family planning and healch care ( family h e a l t h ) f o r medical undergraduates to enable them t o perform i n r u r a l and urban areas e f f e c t i v e l y and with the competence neces- s a r y t o achieve na t iona l a s p i r a t i o n s .

Provis ion of consu l t an t s e r v i c e s f o r curriculum develapment, s tudy tour s and s u p p l i e s and equipment are envisaged.

The p r o j e c t i s expected t o become operat ive from J u l y 1974 and w i l l continue up t o 1977, sub jec t t o a v a i l a b i l i t y of UNFPA funds.

I n s t i t u t e o f Pvbl ic Health N u t r i t i o n (UNDP B60173I075)

NLlT 002 (Bangladesh 0031)

(Long-range) To a s s i s t i n br inging about a change i n the p resen t t rend o f ma lnu t r i t ion l ead ing towards a heaLthier populat ion i n the country, i n ==eat- ing an i n s t i t u t i o n for the continuous s tudy of the n u t r i t z o n a l a s p e c t s o f h e a l t h , w i th a view t o a s s i s t i n g the Government to develop i t s n u t r i t i o n programmes, and i n developing manpower i n n u t r i t i o n . ( I tmed ia te ) To develop an i n s t i t u t i o n capable of i d e n t i f y i n g the n u t r i t i o n a l problems i n t h e country , t o advise and a s s i s t the Minis t ry of Heal th and Family Planning and o t h e r r e l e - vant M i n i s t r i e s i n programes f o r the improvement o f t h e n u t r i t i o n a l s t a t u s o f the population, and to t r a i n h e a l t h personnel i n the pub l i c h e a l t h a s p e c t s o f n u t r i t i o n .

Assis tance to t h i s p ro jec t w i l l s t a r t i n 1974. A pub l i c hea l rh n u r r i - r i o n i s t , fe l lowships , and supp l i e s and equipment w i l l be provided. The e x i s t - ing n u t r i t i o n laboratory w i l l be expanded i n t o a n Institute of Publ ic Heal th Nut r i t ion wi th in the I n s t i t u t e o f Publ ic Heal th .

The p r o j e c t w i l l be a s s i s t e d f o r th ree years i n che f i r s t ins tance.

3.2.3 Human Reproducrion

Teachinp of Human Reproduction, Po~ulation Dynamics, Demography and family Planoina Including natelnal and Child Health Based Family Plannins, in Medical co11ezes With the Establishment of Field Practice Areas

BGD/74/P08

R E G U L A R

Number of Poats

Shoir-term consultant Administrative support personnel Pellovrhipo Grovp training Subsidy Supplies a d equipment

(including vehicles)

1974

B U D G E T


Instiruce of Public Health NYTriLiO" uGD/73/075

1974

Public health nutritionist P4

I I I

11 3 2/24

I I

1975 1975 , 1976

1 ! I I

Fellowships Supplies and equipment


Public Health Education

1976

I

I 1 i j I 1 i ! I I

I i

I I i I

i i j ~ I

I 1

Short-term conaultmc Felloushipo Supplies and equipment

1977

6 08 13 200 6 08 - 25 200 -

- project NO.

1 i

1 I

I

(Expreored in i $ uvllnr

O T H E R S O C R C E S

BANGLADESH & 4-

ealth Education NED 002 (Bangladesh 0023)

TO assist in developing health education, including services, manparer, raining studies, methods, materials and media and other component= of the rograme such as school health and family life education.

In 1973, the status of health education in the country was reviewed and eorganization and expansion of the current services were proposed. In 1975, t is planned to develop an adequate and viable health education service as an ntegral part of the thana health and family planning complex. A long-term ealth education specialist will be provided in 1975, and a consultant in 1977 ill review the project.

The progrannne during 1976-1977 will also include the provision of fellar- hips and supplies and equipment.

The activities of the project will be co-ordinated with those of the pro- ased project: Health Education in Family Health Programmes (UNFPA).

Assistance will continue through 1985.

urrinp, Advisory Services and Training HWD 001 (Bangladesh 0013)

TO assist in the develop men^ of the nursing component of national health are delivery services and with the development of educational programmes in

and midwifery essent~al to the preparation of the necessary nursing ersonnel.

Assistance began in 1972, with the assignment of a WHO nurse adviser at the ational level to advise and assist the Superintendent of Nursing Services. A ublic health nurse educator was assigned later to assist in developing post- asic education programes ro prepare nurse teachers, administrators and clinical pecialists. An additional nurse educator will be added in 1974-1975 (subject o availability of UNPPA funds - Bangladesh 0037) for the education of the amily health visitor.

A plan of action was dram up, which is designed to develop, by 1980, a nursing college granting a past-basic degree to educate nurses for leadership positions, to set up and implement a programe for the training of auxiliary nursing personnel, to develop a central index system of all nursing personnel and to support the Government's planning in an advisory capacity.

Consultants on hospital nursing, fellowships and group educational activities will be provided in 1976 and 1977. The design of the group educational activities will be determined later.

Assistance to the project is expected to continue until 1980.

Training of Medical Assistants (L'NDP BGD/73/072)

HWD 003 (Bangladesh 0028)

To increase the quantity and improve the quality of health services at the level of the union health centres, 1 068 of which are planned to be completed by the end of 1978,by training a new category of middle-level health care worker to be called "medical assistant". This project is expected to have a direct bearing on the physical fitness of the rural population and on its productivity, economic and social stability, in addition to improving the efficiency of the health services at sub-centres levels. The medical assistants, who will be trained in special schools for two years followed by one year's field training, will compensate for the shortage of medical officers in rural areas and thus increase the range of health services at union health centres by providing routine medical services which do not require the medical o f f i c e r ' s level of competence. They will also provide referral level services between the basic health workers in the villages and medical officers located at thana health centres.

Assistance to this project is to start i n 1974. A m e d i c a L officer w i t h public health and teaching experience will organize and supervise the training programme in co-ordination with the national project officer. Fellowships for the training of teachers for the training schools and supplies and equipment for these schools will be provided.

The duration of this project, in the first instance, will be three years.


BANGLADESH

HealLh Education

Health education specialist P4

Short-term consulrant Fellowships Assistance to national course supplies and equipment

4. HEALTH HANPNER DEVELOlWENl

4.1 Health nanpover Develooment

Nursing Advisory Services and

Nurse adviser P4 Public health nurse educator I3 secretarial assistant DAC4

Short-ferm consul fan^^ Fellowahips Participants Supplies and equipment

raini in^ o f nedical ~sristanrs BGDl731072

Medical officer P4

Fellowships Supplier end eqv lpment niscrilaneous

Number of Ports project NO.

HED 002 (W23)

M U 001 (0013)

mw 043 (W28)

1974

Estimated Obligaciona

1974

I 1 11 6 1/12 1 1/12 1 15 160 32 6 W I 34 650 I

1/ b

I 5 000 5 om

i

IExpressed in US Oollsrs~

1975

I! 9 1/12

4 /40

I

I i

1975

!

1

1976

Number o f Posr f

1/12 1/12

---- ----

2113

1977

i

I

1'476 1974

i

rn u r n " c .. 3 :- w -

DP

1977

O T H E R S O I ' R C E S

Estimated Obligariono

i

I

1/12 1/12 1/12

2 2 3 3

11 6 2/24

1975 1974 1975 1 1916

I 1 I

I !

1977

1/12 1112 1/12

11 b 2124

I I I

I

I !

I

i I

- - _ ! _

I976

i 30 320 32 850 34 650

i 1 930 I 2 120 - . - - 1 - 49 915 60 640 67 380 1 71 420

14 400 1 14 4 W 3 8~ 6 000 6 000

6 000 2 O W 5 W O 5 000

I

-- 8148

1977

I ! !

I I I I !

I 1 I

I ! I

- l- 8/48 :

i I

10 000

5 000 - 15 MO

I

i I I I

I I 30 OW 30 O W I I

! 2 8 O W I 28000 1 105 603 45 400

100 3 ' 6 m / 6 0 W - 109 403 - - - -

- , - 6 000 169 b W

National I n s t i t u t e of Prevent ive and Socia l Medicine (WDP B0/73/073)

HMD 004 (Bangladesh 0029)

BANGLADESH b, 0.

To develop an i n s t i t u t i o n i n the country w h ~ c h w i l l provide post-graduate t r a i n i n g and r e f r e s h e r covrses i n t h e d i s c i p l i n e s of prevent ive and s o c i a l medicine. Such t r a i n i n g vill prepare the manpower required f o r h e a l t h administra- t i o n and o t h e r publ ic hea l th se rv ices . The i n s t i t u t e w i l l a l s o undertake re sea rch a c t i v i t i e s i n prevent ive and s o c i a l medicine and pub l i c hea l th , w i l l provide the h e a l t h department wi th advisory se rv ices i n developing h e a l t h programnes, and v i l l co-ordinate t r a i n i n g and research i n the f i e l d of pub l i c heal*

A p ro fesso r of pub l i c h e a l t h admin i s t r a t ion having p ro fess iona l and teaching experience w i l l a c t as coun te rpa r t to the na t iona l d i r e c t o r o f the i n s t i t u t e . Fellowships for t r a i n i n g t eacher s f a r the i n s t i t u t e and supp l i e s and equipment w i l l be provided.

The dura t ion o f t h i s p r o j e c t is th ree years i n t h e f i r s t ins tance.

S t reng then in r of Epidemiological Se rv ices esn ooi (Bangladesh 0006)

To a s s i s t i n improving and s t r eng then ing o f the su rve i l l ance and con t ro l o f cmaun icab le d i seases i n the i n t e g r a t e d general h e a l t h services.

WHO a s s i s t a n c e s t a r t e d i n J u l y 1973 with t h e assignment of a WHO v i r o l o - g i s t , who has been a s s i s t i n g i n the o rgan iza t ion , p repa ra t ion and s t rengthen- i n g of the v i r o l o g i c a l l abora to ry f a r t h e s u r v e i l l a n c e o f s e l e c t e d v i r a l d i sea - ses of publ ic h e a l t h importance. I n January 1974, a WHO epidemiologis t was assigned. Fellowships and c e r t a i n supp l i e s and equipment have a l s o been provided.

The a c t i v i t i e s of the p r o j e c t v i l l be co-ordinated wi th those of Bangla- desh 0030 " I n s t i t u t e of Epidemiology and Vector Control".

The p r o j e c t i s expected t o cont inue f o r a number of years.

+. BANGLADESH m m

I n s t i t u t e of Epidemiology and Vector Control (UNDP BGD1731074)

ESD 002 (Bangladesh 0030)

(Long-ranse) To a s s i s t the Government i n developing a network of epidemio- l o g i c a l c e n t r e s to con t ro l a l l the i n f e c t i o u s and p a r a s i t i c d i seases of publ ic h e a l t h importance. (Immediate) To a s s i s t the Government i n reviewing, planning and prepar ing the p r o g r m e f o r organizing the epidemiological s e r v i c e i n the country; to a s s i s t i n t h e o rgan iza t ion o f the I n s t i t u t e o f Epidemiology and Vector Control Research ( t h e f i r s t n a t i o n a l epidemiological c e n t r e i n Bangladesh) which w i l l t r a i n t echn ica l personnel and give consu l t a t ions on t echn ica l mat ters , and t o a s s i s t i n improving the o rgan iza t ion o f su rve i l l ance and con t ro l o f communicable d i s e a s e s i n i n t e g r a t e d hea l th se rv ices .

Assis tance t o t h i s p r o j e c t s t a r t e d i n 1973. A WHO epidemiologis t w i l l a s s i s t i n the o rgan iza t ion o f epidemiological se rv ices a t the c e n t r a l and i n t e r - mediate l e v e l s and i n the p repa ra t ion of na t iona l epidemiological s u r v e i l l a n c e programe. A WHO v i r o l o g i s t (genera l ) , wi th spec ia l experience i n arbovirology, w i l l a s s i s t the Government both i n the es tabl ishment of general v i r o l o g i c a l techniques and l abora to ry competence i n t h e arboviruses .

The dura t ion of t h i s p r o j e c t w i l l be four years i n the f i r s t ins tance.

Mala r i a Erad ica t ion HeD 001 (Bangladesh W 1 )

To a s s i s t i n the e r a d i c a t i o n of malar ia from the e n t i r e country and to prevent t h e re-establishment o f endemicity.

I n E a s t Pakis tan (now Bangladesh), the malar ia control demonstration p r o j e c t , which was s t a r t e d i n 1959 with WHOlUNICEF ass i s t ance , c l e a r l y brought t o l i g h t the f e a s i b i l i t y a£ mala r i a e rad ica t ion . A f u l l - s c a l e e r a d i c a t i o n pro- g r m e wi th WHOlUSAID a s s i s t a n c e was s t a r t e d i n 1961. Since 1972, WHO a s s i s - tance has included short-term consu l t an t s , fe l lowships , and supp l i e s and equipment. The Government has i n i t i a t e d phased i n t e g r a t i o n of the malar ia progr-e wi th t h e general h e a l t h s e r v i c e s i n t h e consol idat ion areas as we l l as i n those recormended f a r maintenance. I n areas with a t o t a l population of 77 m i l l i o n , a l l of which are exposed to ma la r i a r i s k , those wi th 29.4 m i l l i o n are ready f o r maintenance, wi th 32.2 m i l l i o n i n the consol idat ion phase and 7.7 m i l l i o n i n the a t t a c k phase. I t i s expected t h a t by 1976, a population of 59 m i l l i o n w i l l be i n the maintenance phase. A plan of ope ra t ion has been developed f o r the f u t u r e conduct of t h e progr-e.

During 1976 and 1977, a s s i s t a n c e i s v i s u a l i z e d i n the form of consu l t an t s (ma la r io log i s t s ) , fe l lowships (var ious a s p e c t s of ma la r i a e r a d i c a t i o n ) and supp l i e r and equipment. Ihe p r o j e c t i s expected t o continue f a r some years.

Smallpox Erad ica t ion sm 001 (Bangladesh 0003)

To achieve t o t a l e rad ica t ion of smallpox i n the country by 1977.

The p r o j e c t (previously Pakis tan 0041), was o r i g i n a l l y s t a r t e d i n 1961 and was r e a c t i v a t e d i n 1967. Following a period of e igh teen m n t h s dur ing which no smallpox cases were repor ted i n the country, major outbreaks occurred i n e a r l y 1972. WHO a s s i s t e d i n the implementation of the programme throughout the country. From 1972 t o 1974, WHO s t e a d i l y inc reased i t s support mainly i n the provis ion o f both epidemiologis ts , subs id ies and supp l i e s and equipment. I n 1974, funds were made a v a i l a b l e t o the programme by SIDA. During t h e f i r s t q u a r t e r of 1974, a l l s t r a t e g i c and problem areas were under the soperv i s ion o f both n a t i o n a l and WHO epidemiologis ts , and 25 n a t i o n a l su rve i l l ance teams were i n ope ra t ion , a s s i s t i n g the l o c a l s t a f f . WHO s t a f f consis ted o f four long- term medical o f f i c e r s , one long-term opera t ions o f f i c e r and f i v e consul tants .

Following the successful implementation o f the su rve i l l ance and vaccina- t i o n progr-es by mid-1974, the incidence o f smallpox had considerably decreased and problem areas were mainly r e s t r i c t e d to the d i s t r i c t s of Hymen- s ingh, Rangpur and Rajshahi. During 1976-1977, t h e s t r eng then ing o f s u r v e i l - lance measures throughout the country as we l l as the vaccinat ion of the popu- l a t i o n w i l l continue, p r i o r i t y being given t o primary vaccinat ions .

Assis tance t o the p r o j e c t i s expected to continue up t o 1977, when consu l t an t s , as p a r t o f the i n t e r n a t i o n a l assessment team, w i l l c a r r y o u t the f i n a l appra i sa l of the programme, vhich i s expected t o be declared smallpax- free.

BANGLADESH

nvcobac te r i a l Disease Control HBD 0 0 3 (Bangladesh 0041)

To a s s i s t i n t h e development, o rgan iza t ion , implementation and assessment o f s u r v e i l l a n c e and concrol o f mycobacterial d iseases .

YRO has a s s i s t e d the Government wi th tuberculosis con t ro l from t ime t o t ime s i n c e 1951. I n 1973 and 1974, under t h e in ter-country p r o j e c t SEAR0 0113, " lbbe rcu los i s Tra in ing and Evaluat ion Team", ass i s t ance has been provided i n conducting a n a t i o n a l sample survey f o r es t imat ion of t h e size of tube rcu los i s problem i n t h e country and i n s e t t i n g up a na t iona l tube rcu los i s i n s t i t u t e .

I n the f i e l d of leprosy, a s s i s t a n c e s t a r t e d i n 1961. A survey conducted e s p e c i a l l y i n hyperendemic areas of the country provided h e a l t h a u t h o r i t i e s w i t h b a s i c informat ion regarding t h e s i r e of t h e leprosy and necessary o p e r a t i o n a l da ta f o r caee-f inding and treatment a c t i v i t y .

f i e p r o j e c t s " T u b e r c u l o s i ~ Control" (Bangladesh 0 0 0 2 ) and "Leprosy Control" ( h g L a d e s h 0004) are now being merged.

I n 1976 and 1977, long-term medical o f f i c e r s (one i n tube rcu los i s and a l e p r o l o g i s t ) v i l l be ass igned; short-term consul tants v i l l a l s o be provided, and group educat ional a c t i v i t i e s held.

Cancer - CAN 001 (Bangladesh 0 0 3 2 )

To a s s i s t i n the fo rmu la t i on o f a n a t i o n a l p r o g r m e f o r che prevent ion and c o n t r o l o f cancer i n t e g r a t e d w i t h i n the e x i s t i n g p u b l i c h e a l t h d e l i v e r y sys tem; i n t h e t r a i n i n g of h e a l t h and a l l i e d manpower f o r s e r v i c e s , t r a i n i n g and r e s e a r c h ; i n t h e o r g a n i z a t i o n o f a p a r t e r n of s e r v i c e s a t t h e c e n t r a l , i n t e r m e d i a t e and p e r i p h e r a l l e v e l s for e a r l y d e t e c t i o n , d i a g n o s i s , t rea tment and r e h a b i l i t a t i o n of cancer p a t i e n t s and i n the epidemiologica l i n v e s t i g a t i o n of cance r i n Bangladesh.

I n 1977, a n a t i o n a l workshop of two weeks' du ra t i on w i l l be h e l d w i th t en p a r t i c i p a n t s ( p u b l i c h e a l t h a d m i n i s t r a t o r s , surgeons, phys i c i ans , r a d i o t h e r a - p i s t s , r a d i o l o g i s t s and p a t h o l o g i s t s ) t o prepare d e t a i l s of d e s i r a b l e services, t r a i n i n g and r e s e a r c h on t h e p r even t ion and c o n t r o l o f cancer.

Card iovascu l a r D i sea se s CVD 001 (Bangladesh 0033)

To a s s i s t i n a s s e s s i n g the morb id i t y and m o r t a l i t y due t o c a r d i o v a s c u l a r d i s e a s e s ; i n t r a i n i n g s p e c i a l i z e d h e a l t h and a l l i e d manpower r e q u i r e d for pre- v e n t i o n c o n t r o l and r e h a b i l i t a t i o n programmes; i n e s t a b l i s h i n g services f o r c a r d i o v a s c u l a r d i s e a s e s , i n c l u d i n g h e a l t h educa t ion , and i n t h e ep idemio log i ca l i n v e s t i g a t i o n of ca rd iovascu l a r d i s e a s e s .

I n 1977, a n a t i o n a l workshop o f Oro weeks' d u r a t i o n w i l l be conducted f o r h e a l t h a d m i n i s t r a t o r s , surgeons , phys i c i ans and medica l e d u c a t o r s t o

develop progranrmes fo r s e r v i c e s , t r a i n i n g and r e s e a r c h on c a r d i o v a s c u l a r d i s ea - ses.

-

I

BANGLADESH

5.1.8 Venereal Diseases and Treponematoaes

venereal Diseases and T I ~ D O ~ W E ~ L O S ~ E con~ral

Short-term consultant Supplies and equipment

5.2 Non-Cmunicable Disease prevention and conrroi

5.2.2 Cancer

cancer

shoTt-teTm consaltant Fellovahip Parcicipancs

5.2.3 Cardiovascular Dlseares

Cardiovascular Diseases

Sbarr-term conrulranr Fellowship Parricipanrs

5 . 2 . ~ otner chronic ~oa-cnomunicabie Disease5

Fellowship:, (Non-Communicable Diseases;

! !

R E G U L A R

Number of Posts

I !

1974 11975

B U D G E T

Estimated Obligations project NO.

(0015)

(0032) Y M 1

C M 001 (call)

CCD 002 (02001

1974 1975 1976 1976 1917

IExpreosed in US Dollars

1977

I !

I i 1 ! I

I 4 000 ' 500 i - I

! I - : , 4 500 ! I I ! ~ i 1

i i i I

i 1 i 1 1 2 M

I ! 1 ;% i I ! - i ' 10 750

i - I

1 I i

i I : 7 2 W

i 2 550

i I lorn

I I - i 10 750 - i i

I 1 i i

- i !

I I

I I I I

I ! ; 1 : I (

I i I I

Number of Porrr

11 3 11 3

I / ] 11 3

I

1/ 2 I 1 1

!

1974

i

I I

w - " b c 2

2 z

O T L i E R S O C R C E 5

Eaiimaied Obligsfiono

I

i i I I i I 1

1 ! I I ! i i ! ; I

1 1 1 I

i i

i i I i 1 ' i

! I j i

1975 1974

I 1 I

I 1 / 3 1 1

1 1 I I i

1976 ( 1977

i 1975 1976 ,977

i I ! I

i i

I 1 1 I

I 1 1 1

I i 1 i i

I ! I I

i 1 I

I I

I

1

I I'

!

I

! I I i

I ! !

M n t a l Heal th MNH 001 (Bangladesh 0027)

To a s s i s t i n t r a i n i n g medical, nurs ing and a l l i e d h e a l t h workers f o r c o m n i t y - o r i e n t e d mental h e a l t h care, i n s t rengthening comprehensive mental h e a l t h care services i n t e g r a t e d wi th in t h e pub l i c h e a l t h d e l i v e r y system and i n t h e epidemiological i n v e s t i g a t i o n of mental i l l n e s s .

I n 1973, a consu l t an t (under p r o j e c t SEAR0 0172, "Mental Health") reviewed t h e s t a t u s o f mental h e a l t h services. Further a s s i s t a n c e under t h i s i n t e r - country p r o j e c t i s l i k e l y t o continue.

I n 1977, consu l t an t s w i l l a s s i s t i n the development of a psych ia t r i c t r a i n i n g programe i n the I n s t i t u t e of Post-graduate Medicine, Dacca, w i l l adv i se on p s y c h i a t r i c teaching i n the medical co l l eges and i n the College o f Nursing and schools o f nurs ing, and w i l l help to e s t a b l i s h pilot-cum-demonstra- t i o n a r e a s for the t r a i n i n g of h e a l t h workers i n comnunity-oriented mental h e a l t h care.

Fellowships w i l l be awarded f o r t r a i n i n g teachers i n psychiat ry and for observing recen t developments i n p s y c h i a t r i c t r a i n i n g and research. A group educa t iona l a c t i v i t y i s proposed i n 1977 t o plan menial hea l th s e r v i c e s and t o t r a i n p s y c h i a t r i c personnel.

Pharmaceutical and Bio:o~ical Qua l i ty Control SQP 001 (Bangladesh 0011)

TO a s s i s t i n the s t rengthening of drug q u a l i t y con t ro l l a b o r a t o r i e s a t c e n t r a l and zonal l e v e l and t o t r a i n t echn ica l s t a f f .

I n 1972, a consu l t an t was provided to s tudy the p resen t methods for t h e purchase, s to rage and d i s t r i b u t i o n of drugs, medical supp l i e s and equipment, and t o advise on any reorganizat ion t h a t might be considered necessa ry i n the management o f the medical s to res . I n 1973, and 1974 another consu l t an t assisted i n s t rengthening the n a t i o n a l drug q u a l i t y con t ro l laboratory. A lang- term s t a f f member w i l l be provided f o r several yea r s s t a r t i n g from 1975 to i n t e n s i f y the a s s i s t a n c e .

The p r o j e c t i s expected to continue up to 1982

Assis tance t o t h i s p r o j e c t v i l l continue up t o 1985.

B A N G W E S H

5.2.6 Mental Health

n e n w nealth

Short-term consultants Fellouship Participants supplies and equiment

5.3 Proohvlactic aod Therapeutic Substance.

5.3.2 SoecificaCions and Qualitr Control of Pharmaceutical Preparation.

Pha-cevrical and Bialopical quality control

Pharnaceurical analyst P3

Fellwshipa Supplies and equipment

R E G U L A R

1974

I/ 5

B U D G E T - EstIma~ed Obligarions

Project NO.

mn WI ( W 2 7 )

SQP W l ( W 1 1 )

1974

Number

1975

1/12 ---- ----

1/12

(Expressed in US oolla..~

1975

of Posts

1976

1/12

1 1 1 1

1/12

28 800 6 600 1 MO

i 1

1

1977

2/12 1/12

1/12

1/12

1976

O T H E R

Number of Pooca

11 675

1977

1 I

i 29 960 1 32 240

I 6 6 m / 6 6 W 6 6 W

- rn

" c . , 1974

S O U R C E S

Esfimaled Obligations

i 1 I

I 1

1 !

i

I

I

1975 1976 1974

10 MO 10 000 10 WO

11 675 46 560 48 840 50 890

1977

-

1 ! !

I 1

i

I I j i I

1975 1976

- -

1977

-

i

Community Water Supply and Sanitation BSH 001 (Bangladesh W07)

To assist in the planning, organization and administration of a national environmental health programe and, more specifically, to provide technical advice and guidance in the expansion of the national cmunity water supply and other environmental health Programes.

In 1972 two consultants, one in public health engineering laboratory service and one in education and training in sanitary engineering, were provided. A sanitary engineer was assigned to the Department of Public Health Engineering in 1973 and a sanitarian in 1974. It is planned to continue these posts through 1976-1977 and to provide fellowships for short observation study in water supply and sanitation in neighhauring countries.

UNICEF is providing materials and equipment.

Assistance to the project is expected to continue uncil 1980.

Occupational Health HWP 001 (Bangladesh W08

TO assist in controlling health hazards in industr)

Polloving a reviev of the sratvs of occupational health in indvstry made in 1973 by a consultant, who also advised an the development of an industrial hygiene unit at the central level, other consultants will assist the project in 1974, 1975, 1976 and 1977, in strengthening the occupational health services and updating the legislation.

Assistance to the project is expected to continue up to 1983.

The Kingdom of Bhutan, knovn as the "Dragon Land", is situated in the heart of the Himalayas and has an area of about 46 000 s q . kms. According to an ad hoe census conducted in 196'3, the population of Bhutan was one million, of which the urban population would be about 30 000. The population density i s roughly 22 per sq. km.

The whole country can be conveniently divided into three zones - Southern, Central and Northern. The main valleys, in vhich the population is concentrated, are Thimphu, Paro, Punakha. Ha. Chirang. Bumthane . . . . and Tashigang. The capital is~located it Thimphu, vhich has a popula-u tion of 10 000.

Bhutan's economy is based mainly on agriculture and animal husbandry. The area under cultivation constitutes about 9% of the total area. About 70% of the total area is under dense forests.

Bhutan is in the midst of its third five-year plan, launched in April 1971. It is following a system of annual plans which enables it to review the progress of various schemes and shift the priorities where necessary. A high-powered Planning Commission, presided over by the King, was set up in 1971. The major beads of development in the third plan are (1) an agricultural programme, including co-operation ( 2 ) power (3) industry and mining ( 4 ) transport and communications ( 5 ) social services and (6) miscellaneous. The total outlay for the third plan ar the start of the plan was RB 355 million, of vhich the provision for social services (including health) vas Rs 108.55 million. Health is recognized as an essential component of overall socio-economic development in Bhutan and finds an important place in the development plans. Nearly 8% of the total outlay in the third five-year plan is for health.

Strengthening of health services

There is a nucleus of health services under the Directorate, which provfdes mainly medical relief from five zonal hospitals, three leprosy hospitals, and a network of 46 dispensaries covering even the areas remote from the capital. All dispensaries have at least a compounder; five have medical officers and seventeen have a smallpox vaccinator. In 1973 there was a rota1 a£ 262 hospital beds, general and others.

Preventive activities have been confined to malaria eradication programme and, smallPox vaccination and BCG mass campaign (since 1966) through a BCG team. The important diseases affecting the population are infectious and parasitic diseases and those of nutritional disorders.

With international assistance, the Government of Bhutan is developing rural health services, the provision of rural drinking water and work on nutrition. Tuberculosis control will be carried out as an integral part of the general health services. The rural health services are being strengthened through the establishment of basic health units in place of the existing dispensaries, to be manned by teams with a minimum of three members, viz., a health assistant, a basic health worker and an auxiliary nurse-midwife. The main functions of these units are medical care, maternal and child health and family planning, immunization, health and nutrition education and environmental sanitation. Special attentfon is being given to the development of health manpower by training the three types of health workers to man these units at the Health School located in the General Hospital, Thimphu.

N40/LhVDP assistance. The Organization, through the project for development of health services financed by UNDP, in collaboration vith other international agencies (such as UNICEF and the WFP) will be assisting the Government specifically to establish basic health units, provide integrated curative and preventive healrh services, vith special emphasis on maternal and child health and the control of tuberculosis, train health manpower for the basic health units, ensure quality control of drinking water and advise on the improvement of the nutrition of the population.

Development of Hea l th Services (UNDP BHU1721W6)

STR W l Two long-term s t a f f - a p u b l i c h e a l t h a d m i n i s t r a t o r and a p u b l i c h e a l t h (Bhutan 0001) nu r se educator - were provided i n 1974.

To a s s i s t i n t h e development of i n t e g r a t e d h e a l t h s e r v i c e s a t a l l l e v e l s , There i s p rov i s ion f o r a sho r t - t e rm c o n s u l t a n t i n n u t r i t i o n i n 1974 and as p a r t of t h e socio-economic development, w i t h p a r t i c u l a r emphasis on t h e f o r another i n 1975. development of e f f e c t i v e and e f f i c i e n t h e a l t h s e r v i c e s for t h e r u r a l popula t ion .

The p r o j e c t i s expected t o con t inue upto December 1976 i n t h e f i r s t As a r e s u l t of t h e f i r s t UNDP reconna i s sance miss ion , March-April 1972, i n s t a n c e , and i s l i k e l y to be extended t h e r e a f t e r s u b j e c t to a v a i l a b i l i t y o f

o u t of a t o t a l of t e n s p e c i f i c p r o j e c t r e q u e s t s , one was concerned wi th n a t i o n a l UNDP funds . t u b e r c u l o s i s c o n t r o l . A f r e r f u r t h e r v i s i t s and a s e r i e s o f meet ings w i th in the Uni ted Na t ions agenc i e s and w i t h government o f f i c i a l s , i t was decided t h a t the h i g h e s t p r i o r i t y should be g iven t o t h e development o f h e a l t h s e r v i c e s concerned w i t h t u b e r c u l o s i s c o n t r o l and w i t h maternal and c h i l d h e a l t h and t o the t r a i n i n g of paramedica l ( a u x i l i a r y ) workers to man the b a s i c r u r a l h e a l t h s e r v i c e s . Conse- q u e n t l y the p r o j e c t "Development of Heal th Services" was prepared and becomes o p e r a t i v e i n July 1974, i n c o l l a b o r a t i o n w i th U N I C E F ' s p r o j e c t e n t i f l e d "Develop- ment of Co-ordina ted Services for Chi ld ren i n Bhutan" a n d the p r o j e c t s of the World Food Programme.


Number of Posts Estimated Obligations BHmlUI

--- 3. STRENGTHENING OF H W T H SERVICES

3.1 Stren~fhening of Health services

3.1.2 Strenztheninil of Healrh Services

Develoment of ~ealth Services BHU172iW6

Public health administrator P4 Public health nuroe educator P3

Short-term eonsuliant Supplies and equipment nisce11aneou.

Total - BHUTAN

I L

Projecr No.

STR m i (WO1)

* 0 . -

(Exorersed in CS Dollar%&

- u - " c ,. 3 3 * 2 u.

DP

D T H E R S O U R C E S

Number of Posts Estimated Obligation.

1974 1915

I i I / 2 ,1112 11/10 11 2 , 1112 ! 1/10 - 1- -

2 1 2 ~ 2 - ,- 1- ll1 2 1

i I I '

I i

i !

1 :

i

!

i

i

I

10 mo 60 mo so 000 i

5 M O ' j 46 wo

100 1 I W 5 W - - , - 10 100 1 112 1 W 50 5W -

- 1 - - 10 I W 1 112 100 50 5 W !

i I

I I

! i

I

i !

1971 0

I 1976 1977

i

- I

1 I

Project No. Old I New

I

I Country Statement

I

Maternal and Child Health Leprosy Control Vital and Health Statistics Institute of Medicine I, and School of Preventive and Tropical Medicine, Rangoon

Malaria Eradication Strengthening of Health Services

(Epidemiology) Nursing Advisory Services Tuberculosis Control Health Education Trachoma Control Strengthening oE Laboratory

Services Burma Pharmaceutical Industry

(Production of Biologicals! PLague Cantrol Filariasis Control Rehabilitation of the Handicapped institute of Technology, Rangoon Dental Health Services Radiation Health Nutrition Services Planning and Strengthening o: Health Services

Department of Medical Research

MCH 001 MBD 001 DHS 001 HMD 003

MPD 001 ESD 001

HMD 001 H8D 002 HED 001 VIR 001 HLS 001

HLS 002

BAC 001 MPD 002 STR 001 HMD 004 DNH 001 RAD 001 NUT 001 STR 002

DHS 002

1 212, 473 1 RlAddl.

Project Title

0097 STR 003 I I

Page Funds

0102 / HWP 001 0103 MCH 002 0104 BAC 002

0109 MBD 003 0110 CAN 001 0111 SQP 002

I


0113 1 INF 001 / I I

0096 SQP 001 ] Quality Control of Biological I I I and Pharrnaceut~cal Products 22 i I 1 R

Project Title Page Funds

R R

RIAddl.

DP RIAddl. R

R

R RIAddl.

R/Addl.

RlAddl. ~ I ~ d d l . R

RIAddl.

/~/Spl.~cc.

RIAddl.

Maintenance and Repair Workshop for Health Equipment

I Virus Disease Control Mental Health Training and

Services Education and Training of Health Manpower

Occupational Health School Health Services Epidemiology and Control of 1 Cholera and Enteric Infections

Venereal Diseases and Trepanema- toses Control

Hospital Services Management Development of Family and Child Health

Prevention, Control and Surveil- lance of Communicable Diseases

Mycobacteriai Diseases Cancer Control Development of Production and Quality Control of Biological and Phermaceutical Products

Community Water Supply and Sanitation

Development of Health Informa- tion Services

210 225

226, 474

218 228, 475 215

223

225 212, 473

214, 473

220. 474 222, 474 226

228, 474

228. 475

232. 475

I n accordance wi th the overwhelming r e s u l t s of the Nat iona l Referendum h e l d i n December 1973, the Union of Burma h a s now become the S o c i a l i s t Republic of t h e Union of Burma.

A p o p u l a t i o n census was taken i n A p r i l 1973, v i t h t h e suppor t (equipment and t e c h n i c a l advice) of UNEPA. The t o t a l popula t ion of Burma a s on 31 March 1973 was 28 885 867, which was very c l o s e t o t h e popula t ion e s t i m a t e s f o r 1972 i.e. 28 874 000. F u l l d e t a i l s of the census are n o t y e t complete and are being analysed by the computer c e n t r e e s t a b l i s h e d a t the I n s t i t u t e of Economics, wi th the a s s i s t a n c e of UNDP .

The Government's development p l a n cont inues t o g ive h igh p r i o r i t y t o t h e p roduc t ive s e c t o r s , wi th emphasis on mining, o i l d r i l l i n g , c o n s t r u c t i o n of dams, and i r r i g a t i o n schemes. S o c i a l s e r v i c e s , a l s o r e c e i v e a t t e n t i o n , and among them e d u c a t i o n a l f a c i l i t i e s a t a l l l e v e l s A s s i s t a n c e f o r economic development from b i l a t e r a l a g e n c i e s , such a s the Colombo P l a n ( e s p e c i a l l y from Japan, t h e United Kingdom, A u s t r a l i a and Canada) is on t h e i n c r e a s e .

The f i r s t f o u r y e a r p lan , which s t a r t e d i n October 1971, was te rmina ted a t the end of March 1974, thus covering a s h o r t e r per iod than foreseen . The second four-year p l a n s t a r t e d i n A p r i l 1974, c o i n c i d i n g w i t h t h e nev f i s c a l y e a r now running from 1 A p r i l t o 31 March i n s t e a d of from 1 October t o 30 September. Accordingly, a second four- y e a r h e a l t h development p l a n i s mder p r e p a r a t i o n . The Divis ion of Planning, Finance, Adminis t ra t ion and Tra in ing is now being s trengthene: by t h e a d d i t i o n of a "Planning Cel l" , t o which, e v e n t u a l l y , a medical economist v i l l be ass igned .

Medical educa t ion h a s nor- become t h e r e s p o n s i b i l i t y o: the U i n i s t r y of Heal th, and a Department of Xedica l Education, headed by a Directo:- General , h a s been e s t a b l i s h e d , thus f a c i l i t a t i n g the understanding of t h e "producer" and t h e "consumer".

The Government of Burma h a s accepted i n p r i n c i p l e a s s i s t a n c e f r o = t h e United Nations Fund f o r Drug Abuse Cont ro l (UNFDAC! f o r a f ive-vear p r o j e c t , t h e d e t a i l s of which a r e be ing developed. Meanwhile, with, WHO a s s i s t a n c e , t r i a l s a r e b e i n g uodertaken t o s tudy t h e most e f f e c t i v e t rea tment of drug a d d i c t s .

The p r i o r i t i e s e s t a b l i s h e d by t h e Min is t ry of Heal th i n deve1ooir.g t h e i r h e a l t h s e r v i c e s are f o r those a c t i v i t i e s f a l l i n g under the appro- p r i a t i o n headings o f : (1) Programne Planning and D i r e c t i o n ; (?) Community Hea l th ; ( 3 ) Heaitn Laboratory S e r v i c e s ; (4) S p e c i a l i z e d Medical Care, and (5) Research.

BURMA w 0 m

Health s e r v i c e development is centred on t h r e e main o b j e c t i v e s , i . e . , the b u i l d i n g up of a rura; h e a l t h n e w a r k , the t r a i n i n g of manpower f o r s t a f f i n g t h e s e r v i c e s , and t h e prevent ion of communicable d i s e a s e s . The Government i s a l s o endeavouring t o develop s p e c i a l i z e d s e r v i c e s such as those f o r i n t e n s i v e care, neurosurgery, cardio- t h o r a c i c surgery and nephralogy. E f f o r t s being made t o carry out t h i s programme are w e l l d e p i c t e d by the cont inuously expanding budget of t h e Heal th Min is t ry .

A s i g n i f i c a n t s h i f t has been the acceptance of "cornunity medi- c ine" , which has become t h e common denominator f o r a i l a c t i v i t i e s , i n c l u d i n g undergraduate and post-graduate t each ing .

VB'ii; cissistance. The o v e r a l l programme of WHO a s s i s t a n c e cont inues t o r e f l e c t a g radua l swi tch from s p e c i a l i z e d d i sease-cont ro l programmes t o an i n t e g r a t e d p r a g r m e s t r e s s i n g h e a l t h manpower development and a s s i s t a n c e t o t h e s t r e n g t h e n i n g of h e a l t h s e r v i c e s ( v i t a l and h e a l t h s t a t i s t i c s , l a b o r a t o r y s e r v i c e s , t h e maintenance and r e p a i r of equipment, community water supply and s a n i t a t i o n ) .

The Minis t ry of Heal th h a s shown an i n t e r e s t i n WHO-assisted p r o j e c t s f o r s t r e n g t h e n i n g the h e a l t h s e r v i c e s of areas undergoing economic development, which comprise a number of heavy i n d u s t r i e s .

Szher nssistance. A r e q u e s t f a r $5.8 m i l l i o n t o s u p p o r t the development of h e a l t h s e r v i c e s dur ing the per iod 1975-1979 f o r which WHO t e c h n i c a l advice and suppor t has been provided, was be ing submit ted t o t h e UNICEF Board of May 1974.

S t rengthen ing of Heal th Serv ices

The number of h o s p i t a i s con t inues t o increase . In 1973 t h e r e were, a l l over t h e count ry , 411 h o s p i t a l s , d i s t r i b u t e d as follows: 104 s t a t i o n h o s p i t a l s and 150 township h o s p i t a l s (each with 16 beds) ; 128 township h o s p i t a l s (53 wi th 25 beds , 33 wi th 50 beds, 3 1 with 100 beds and 11 wi th 150 b e d s ) ; 5 d i v i s i o n a l h o s p i t a l s wi th 200 beds; 8 g e n e r a l h o s p i t a l s , and 16 s p e c i a l i z e d h o s p i t a l s . I n a d d i t i o n , t h e r e were, i n a l l , 1 0 1 3 r u r a l h e a l t h c e n t r e s , 266 mate rna l and c h i l d h e a l t h c e n t r e s , and 46 urban h e a l t h c e n t r e s .

S p e c i a l i z e d mass campaigns are st i l l being i n t e g r a t e d i n t o t h e r u r a l h e a l t h s e r v i c e s on an exper imenta l b a s i s . The r e s u l t s s o f a r obtained are most encouraging, and t h e r e - t r a i n i n g of s p e c i a l i z e d personne l t o t ake up the d u t i e s of g e n e r a l purpose h e a l t h workers ha. been s u c c e s s f u l i n t r i a l a r e a s .

Health educa t ion , environmental s a n i t a t i o n , p revent ion o f communi- cab le d i s e a s e s , maintenance of b a s i c h e a l t h s t a t i s t i c s , mate rna l and c h i l d h e a l t h , n u t r i t i o n and medical care remain the main a c t i v i t i e s being c a r r i e d o u t a t the p e r i p h e r a l l e v e l through the j o i n t e f f o r t s of the Peasan ts ' Council and the Heal th Serv ices .

WHO a s s i s t m c e . The WHO p r o j e c t f o r t h e s t r e n g t h e n i n g of h e a l t h s e r v i c e s w i l l p rov ide a s s i s t a n c e s p e c i f i c a l l y i n h e a l t h l a b o r a t o r y ser- v i c e s , mate rna l and c h i l d h e a l t h , n u t r i t i o n , h e a l t h educa t ion , r e h a b i l i - t a t i o n of t h e handicapped, mental h e a l t h , d e n t a l h e a l t h s e r v i c e s , h o s p i t a l s e r v i c e s management and medical research . I n t h e c o n t r o l of n a r c o t i c drug abuse t h e Organizat ion w i l l g i v e a s s i s t a n c e through funds from the Regular budget and the UNFDAC.

Hea l th manparer development

I n c r e a s i n g numbers of post-graduate medical s tudy courses have been conducted l o c a l l y ; i n 1973 t h e r e were f a c i l i t i e s f o r f i f t e e n .

WHO fe l lowship f a c i l i t i e s a r e being u t i l i z e d f o r only those s p e c i a l - ties which have n o t y e t been developed a t country l e v e l and e s p e c i a l l y f o r t h e t r a i n i n g of medical t eachers . The th ree i n s t i t u t e s of medicine, a n d post-graduate t r a i n i n g , a s w e l l as t h e t r a i n i n g of n u r s e s and of h e a l t h workers, are being a s s i s t e d by a WHOILINDP p r o j e c t . Graduates from t h e I n s t i t u t e of Dental Medicine, now r e c e i v i n g suppor t from t h e United Kingdom and Japan s e c t o r s of t h e Colombo Plan, a r e he ing u t i l i z e d t o develop d e n t a l s e r v i c e s a t the p e r i p h e r a l l e v e l . The I n s t i t u t e of Paramedical Sciences p rov ides t r a i n i n g f o r pharmacis t s , h e a l t h a s s i s t a n t s , medical t e c h n o l o g i s t s , p h y s i o t h e r a p i s t s and rad iographers .

WHO a s s i s t a r c e . The Organiza t ion w i l l cont inue t o a s s i s t i n improving t h e undergraduate and post-graduate t each ing i n e x i s t i n g medical i n s t i t u t e s and a l s o i n t h e educa t ion and t r a i n i n g of n u r s e s , midwives and a u x i l i a r y h e a l t h personne l , by s t r e n g t h e n i n g the teaching and by prov id ing teach ing and s e r v i c e equipment t o t h e schools . F i e l d p r a c t i c e a r e a s f o r d i f f e r e n t c a t e g o r i e s of h e a l t h personne l a r e being developed as j o i n t t r a i n i n g areas.

Disease prevent ion and c o n t r o l

me Government cont inues i ts d i sease-cont ro l programmes and c o n t r o l of c o m u n i c a h l e d i s e a s e s such a s m a l a r i a , trachoma, v e n e r e a l d i s e a s e s , l e p r o s y and t u b e r c u l o s i s . Smallpox has been v i r t u a l l y e r a d i c a t e d . Epi- demio log ica l s u r v e i l l a n c e a c t i v i t i e s are c a r r i e d o u t i n r e s p e c t of d i s e a s e s s u b j e c t t o t h e I n t e r n a t i o n a l Heal th Regulat ions, and a l so f o r o the r d i s e a s e s l i k e d i p h t h e r i a , whooping cough, m e n i n g i t i s , typhoid, para typhoid , d i a r r h o e a , amoebic dysentery, b a c i l l a r y dysen te ry , p a l i o m y e l i t i s , t e t a n u s , measles and i n f l u e n z a .

I n the f i e l d of nan-communicable d i s e a s e s i t is worth mentioning t h a t the i o d i z e d s a l t programre has proved s u c c e s s f u l i n those endemic g o i t r e a r e a s which a r e e a s i l y a c c e s s i b l e and t h a t the h e a l t h a u t h o r i - ties have s h a m an i n t e r e s t i n developing f a c i l i t i e s for e x f o l i a t i v e cytology and o t h e r measures f o r cancer c o n t r o l .

WHO a s s i s t a n c e . WHO w i l l cont inue t o a s s i s t s ~ e c i a l i z e d mass campaigns with t e c h n i c a l advice i n epidemiology and c o n t r o l measures, e v a l u a t i o n of programmes and the p r e p a r a t i o n of p lans . Local courses f o r t h e t r a i n i n g of n a t i o n a l personnel are a l s o supported.

The Organizat ion w i l l a l s o cont inue t o a s s i s t the Burma Pharma- c e u t i c a l I n d u s t r y i n developing b i o l o g i c a l s (vaccines and s e r a ) and i n the q u a l i t y c o n t r o l of both b i o l o g i c a l s and pharmaceuticals .

I n the f i e l d of endemic g o i t r e i t is planned t o in t roduce t h e use of long-act ing iod ized o i l i n those a r e a s where communications a r e d i f f i c u l t . WHO a s s i s t a n c e i n extending cancer c o n t r o l a c t i v i t i e s and e x f o l i a t i v e cytology s e r v i c e s i n urban a r e a s o t h e r than Rangoon w i l l be maintained.

Promotion o f environmental h e a l t h

Environmental h e a l t h and cornuni ty water supply, both urban and r u r a l , have i n t h e p a s t been r e l e g a t e d t o r e s t r i c t e d a c t i o n , mainly because of t h e magnitude of the problem. Under the aeg is of t h e M i n i s t r y of A g r i c u l t u r e and F o r e s t s , a r u r a l community wate r supply programme is endeavouring t o p rov ide about 200 wel l s p e r year , from which approximately 100 000 persons w i l l b e n e f i t . UNDP a s s i s t a n c e is provided under the "Three Reservoir P r o j e c t " scheme and t h e Water Resources Hanagement and Development P r o j e c t .

The r a d i a t i o n h e a l t h programme has progressed s a t i s f a c t o r i l y , now being a b l e t o screen personne l i n a f i lm badge se rv ice .

A f t e r having become a member af t h e Asian Development Bank, Burma has ob ta ined a s u b s t a n t i a l loan from t h i s i n t e r n a t i o n a l o r g a n i z a t i o n f o r the development of urban water resources .

VHG a s s i s z a n c e . WHO a s s i s t a n c e w i l l now focus on: (a ) community w a t e r supply and s a n i t a t i o n , which w i l l a l s o cover the s o l i d was te d i s p o s a l progr-e of Rangoon; occupa t iona l h e a l t h p r o g r m e s , i n c l u d i n g s p e c i a l i z e d f i e l d s , which, with the development of i n d u s t r i a l a r e a s , are beginning to be of immense i n t e r e s t , and r a d i a t i o n h e a l t h , w i t h the f u r t h e r development o f the personal f i lm badge s e r v i c e , t o cover a l l w

workers i n t h e country who are exposed to r a d i a t i o n r i s k . 0 .c

BURMA

Rehabilitation of the Handicapped STR 001 (Burma 0088)

To assist, at the central and peripheral levels, in the expansion of medical rehabilitation services and in improving workshop facilities for the manufacture of orthotic and prosthetic appliances.

In 1968, under project SEAR0 0174, "Rehabilitation of Handicapped Children", a consultant advised on this subject. In 1969, another consultant assisted in evaluating the rehabilitation services with particular reference to those injured in light industry and agriculture, amputees and cases of paralytic poliomyelitis. In 1971 a further consultant assisted in organizing a workshop on prosthetic and orthotic appliances and on the training of staff. In 1972 ar orthotist-prosthe- tist was assigned for a year to upgrade the prosthetic workshop at the Hospital for the Disabled in Rangoon and to strengthen the training of the staff. An occupational therapy tutor assisted in 1973, assessed the existing situation and advised on the establishment of a school for occupational therapy; also, a three-member team was assigned to conduct two courses on management skills for the total care of the disabled.

It is planned to assign an occupational therapy tutor in 1974 and 1975 to assist in teachine at the School. In 1976-1977, consultants will assist in - upgrading the training programme, in conducting training courses and in the evaluation of existing facilities. Fellowships awarded will be related to the care of the neurologically disabled

The project is expected to continue until the end of 1982

Planning and Strenxthenin,q of Health Services STR 002 (Burma 0094)

TO assiet in the planning and strengthening of health services, with particular emphasis on the development of a comprehensive health care; in the implementation of a national health plan, and in the training of health personnel for basic health services, particularly auxiliary personnel.

In 1969, a plan of operation was prepared which stressed the development of a phased comprehensive pragrame. In 1970, a consultant assisted in conducting a refresher course for health assistants, and a master plan of operation was signed in 1972. In 1973-1974 a consultant assisted in the planning and development of health services and the evaluation of the results of UNICEF assistance.

In 1974, consultants will assist in strengthening the Health Assistants' Training School and in developing a UNDP-assisted project for the development of health services with particular reference to areas of socio-economic importance. In 1976-1977 further consultants will help to plan and evaluate the development of health services, as well as UNICEF assistance, and to conduct training and refresher courses at the Health Workers' Raining School. Fellowships in medical social work and short study tours will also be arranged.

The project is expected to continue up to the end of 1979.

Maintenance and Repair Workshop for Health Equipment

STR 003 (Burma 0097)

TO assist in establishing workshops and in training staff in the maintenance and repair of equipment used in health institutions.

A consultant assisted the project in 1969, 1970 and 1971, under project Burma 0085, "Training of Electro-medical Technicians". A training progr-e for hospital equipment repair technicians was started at the Cenrral Medical Stores Depot. Equipment was provided by UNICEF and WHO.

Since 1971, an engineer has been advising on the expansion of the programme. The fellowships are related to the repair of optical apparatus, medical electronics and maintenance and repair of dental equipment.

The project is expected to continue until 1977.

pro,ecr BO.

SIR W 1 (0088)

STR W 2 (cG-34)

STR W3

SLRXA

3. STRENGTHEXISG OF HEALTH SERVICES

3.1 Strenqrhenin~ of Health Services

3.1.2 Srrenarhening of Health Services

Rehabilitatlan of Chz Handicapped

Occupar~ona1 therapy r u t o r P2

Short-term consultants Fellowships S~pplles and equipment


:Expressed m LS Dollars1

Number o f Posts

- - planning and Strenarhening o f

Health services

ShocT-term conrulLancs 21 3 7 200 7 2 W Fellowships

7 OW Supplies and equipment

- I - - Maintenance and Repair Workshop

i for Health Equipment

! ~leccra-medical engrneer P4 2 , 1/12 1/12 2 26 070 - ,- - -

1 1 I 1 1

3/36 2/24 3/76 1/12 ! I Frllowshipr supplies and equrprnenr

i I

I I

! i

I 19 510

I i 14 400

1 W k y d 1:;: 5 ow 5 OW 5 o w

Estimated Obligsiionr

1974

! :

' ;

> = - : b z

2 - % -

I

I

1 1

i

0 t.

Number of Ports

1977 1974 1975 '1916

48 070

. .~ it j , I I R C E S

irrLmared Obligations

1974 1975 1976 1977 1974 1975 ! 1976

I !

- - - - 46 390 53 370 - - - -

I

1917

i

I I

1975

48 790

1976 19:.

!

I

i

!

!

I

i

H08pifB1 Services Management STR 004 (Burma 0106)

TO assist in hospital administration and management, jncluding the planning and development of facilities for the diagnosis, treatment, care and rehsbilita- tion of the sick.

In 1975, a team of consultants will be assigned to advise on the management of the new orthopaedic hospital. In 1976 and 1977, further teams will be assigned to advise on the improvement in hospital administration for West Bangoon General Hospital and on the administration of the Children's Hospital. Also a consultant will assist the course on hospital administration to be conducted for senior medical officers. A fellowship to be awarded in 1977 will be related to hospital administration.

Strengthening of Laboratory Services M S 001 (Burma W74j

To assist in strengthening laboratory services and to promote their development at central and peripheral levels.

Consultants were assigned in 1967 and 1968 and proposals made for the reorganization of the National Health Laboratory, Rangoon. During 1969-70, a microbiologist from project Burma 0044, "Strengthening of Health Services (Epidemiology)", assisted in upgrading the services in several units of the Laboratory and introduced modern laboratory techniques, such as fluorescence microscopy. In 1971-72, a consultant advised on the serology of venereal diseases and the breeding of small animals. From 1972, a technologist has been assisting in building up the capacity in virus serology and media preparation, and in 1974 a technologist was assigned to assist in developing specialized clinical microbiology, including virology and virus serology. A further consultant (microbiologist) (SEARO 0159) was assigned for six-months in 1973-74 to esaist in planning and developing a food control bacteriology laboratory, and another WHO consultant was assigned to plan the development of the fwd chemistry laboratory and pesticides control laboratory.

In 1975-76, consultants for food chemistry and analysis of drugs, and for Setting up a leprospirosis unit will be provided. In 1977, a long-term scientist is to be assigned, subject to availability of funds.

UNICEF has provided supplies and equipment to divisionalldistrict laboratories as well as to the School for Laboratory Technicians of the National Health Laboratory.

The activities of the project are co-ardinated with those of Burma 0044. ~ -

"Strengthening of Health Services (Epidemiology)", and of SEARO 0159, "Hmlth Laboratory Services".

The project is expected to continue until 1977

B U M

Hos~ital Services Management

Short-term consultants Fellowships supplies and equipment


Srrenxrhening of Laboratory Services

Virology technologist P3

Shorr-term consultants Pellovrhipo supplies and equipment

Burma Pharmaceutical Industry (Production oi Bioloxicals)

Short-term consultant Fellowships Supplies and equipment

3.2 Family Health

3.2.2 Maternal and Child Healrh

Uafernal and Child Health

Supplier and equipment


Estimated Obligarions P r o j e c t

NO.

STR 004 (0106)

HLS 001 (0014)

HLS 002 (_17)

UCH W l (0006)

umber

1974

of p o s t s

1976

2 1 6

11 8 2/24

1974

iExpressed in us oollarrl

1976 1975 1977

;$;

3/36

1975 1977

i 8 B W 14 4W 14 4 W

umber of ~ u r r r

1 2 1 4

1974

I

1/12 - 1 -

11 3 3/27

I/ 1 3/27

u v " c 8- 5

2 : -

O T l i E R S O U R C E S


11 6 2/24

I 2 550

4 0 W i 5 W 0

-221 10 8 W ~ I - , - - I : I

1 1 I

i I

I i

i

1 1

I ~ : I

i : I 1 i ! !

1 I

i I

1975 1914

26 070

6 WO 15 750 7 WO -

54 820

2 WO 10 150 5 WO - 17 150 -

5 500

1976

I I

1 i !

I

I i 1 ~ I

I I

!

i

~ I i I

1975

!

~ !

I I I 1 I

13 200 19 2 W 13 200 ) 13 200 ! 19 800

7 W O 5 0 0 0 5 0 0 0

1917

- 1 -

33 400 ! 37 400 - - - -

1976

- 24 8 W

1971

! I ! !

I

i I I

i

1 i I

I

Development of Family and Child Health HCH 003 (Burma 0107)

To assist in the further development of maternal and child health, including school health services, as part of the general health services.

The projects "Family Health" (Burma 0006) and "School Health Services" (Burma 0103) will be merged into this project from 1975.

Emphasis will be placed on providing adequate training and orientation for health workers in maternal and child health (including school health) and on developing an adequate referral systan in support of the peripheral health services. The training programme under this project will supplement activities under related projects.

Assistance so far provided has helped to strengthen the training programme at the nursing school, the Health Visitors' Training Centre st Rangoon, and the paediatric training programme at the Institute of Medicine in Rangoon and Elandalay .

In 1969, a WHO consultant (under project S W O 0175) reviewed the school health services in Burma. In 1974, two national courses are to be conducted with the assistance of a WHO consultant for school health teams (Burma 0103) and in 1974 and 1975 study tours outside the country are to be arranged for school health medical officers to study the organization of school health services in both developing and developed countries.

In 1970, a consultant advised on the strengthening of maternal and child health services (Burma 0006) and in 1973, fellowships were awarded to paediatricians and nurses in the field of child health, including neonatology. In 1975, it is planned to assist in the establishment of a neonatal unit at the Institute of Medicine, Mandalay, by providing a consultant and supplies and equipment. A fellowship is to be provided for training in the field of neonatology.

In 1976-1977,consultants will review the existing maternal and child health services, will assist in strengthening the neonatal services (institutional and domiciliary) and will evaluate t k school health services. Fellowshipe will be awarded in the field of neonatology, to study integrated maternal and child health programmes, and school health services.

Assistance to this project is expected to continue for several years.

Nutrition Services NUT 001 (Burma 0093)

L assisting the Nutrition Unit of the Directorate General of Health in developing : models and in its programme of in-service orientation courses for medical personnel.

In 1971, the Regional Adviser m Nutrition assisted in establishing a pilot nutrition rehabilitation centre in Rangoon. In 1971-1972, a consultant (under Burma 0086) helped to devise a methodology for the evaluation of the goitre control programme. In 1972 and 1974 consultants helped in conducting arienta- tion courses for senior health officers and for paediatricians.

In 1975 and 1976, assistance will be provided in the conduct of orientation courses in nutrition for township medical officers. In 1976 and 1977 s consultant will also assist in the assessment of the project and will recommend measures for further expansion. Fellowships will continue to be provided for the training of key personnel in nutrition.

The project is expected to continue until the end of 1980.

Health Education HED 001 (Burma 0066)

To assist in the development af health education services and in giving training in health edvcation to teachers and those holding key posts in the school organization and in the general health services; to assist in the development of the health education manpower needed for services and training programmes, and of the educational materials required for health education services and training programmes.

In 1966 and 1968, assistance was given in organizing courses for various categories of teachers and health educators. In 1971, a workshop on health education in schools was held as a follov-up of the inter-country workshop on health education in schools, held in Bangkok in 1970. Also in 1971, a consultant assisted with a training course, and in 1972, another consultant assisted in reviewing the health education activities. This review was followed by three training courses held in 1973 for township health officers and for ~tsff of the Medical Institute and of the Teacher Training College.

Three training courses are planned in 1974 and one in 1975. The consultants in 1974, 1975 and 1976 will help with the training, whilst the consultant in 1977 will assist in research in health education. The long-term fellovships are for training health educators (MPH) with emphasis on curriculum development and on the planning and evaluation of health educatim activities.

The project is expected to continue through 1982.

TO assist in strengthening nutrition activities of health services by

B m

School Health Services

Short-term consultant Fellrmshipr sarficipanrs Suppliea and equipment

Development of Family and Child Healfh


3.2.4 NuLrifion

Nutrition servrcer

short-term consu1rantr Temporary adviser Fellouships Supplies and equipment

3.2.5 Health Edvcatron

Health Educairan

Short-term consultants Temporary advisers Fellavship. participants Supplies and equipment

R E G U L A R

Number of Posts

1974

B U D G E T

Eatimared Obligariona Prolecr NO.

BCH 002 (0103)

BCH 003 (0107)

NLT 001 (0093)

1974

4 WO 5 100 6 5 W 2 500 - 18 100 -

(Expressed in US Dollrrsl

1977 1975 1975

I

1976

I

i 6 b W 1 4 800 1 9 b W 11 700 7 500 10 200 3 500 ' 5 500 I 6 5 W

- , - - 2 1 8 0 0 . 1 7 8 0 0 ) 2 6 3 W

- , - - I , i

4 ow 1 6 b w 4 800 500

12 750 I 22 100 3 500 ( 4 O W -

1 - - 1 - 13 700 j 26 600 21 050 30 900 - -

i -

8 000 7 Z W 3 0 0 0 1 3 0 0 0 , ' 8 7%

.a - u

i

HED 001

i

!

1976

- Number of port.

I/ 3

4125

I

1 4 1 3 41 3 !4/ 3 4127 4 / 3 0

I I

12 5 W 5 9 W 2 WO - 31 400

i !

1

I I

1977 1974

11 3 ' /4/27 14 000 13 400

1 700 4 b w 4 000 4 WO - - 8 - 29 9 W 24 600 1 19 950 - - - -

I

. u " c b. 3

2


Ertimafed Obligarions

1 !

i

i i

i , , i

1975 1974 1976 1976 1975 1977 1977-

i I I I

I

i

I I

I I !

i I I I

! I

1

I

I !

Nursing Advisory Se rv ices m 001 (Burma 0056)

To assist i n t h e development of nurs ing and midwifery education and se rv ices .

Ass i s t ance t o t h e p r o j e c t s t a r t e d i n 1959, with the assignment of a WHO p a e d i a t r i c nur se , and cont inued u n t i l 1966. Subsequently, through fe l lowships and s h o r t courses, emphasis has been placed on the education of q u a l i f i e d nursing and midwifery personnel f o r spec ia l i zed s e r v i c e s and on the improvement of b a s i c and pos t -bas ic programmes. I n 1971, courses i n neurological and eye, ear, nose and t h r o a t (EENT) nurs ing were held . I n 1972, the re was one course on t h e care of s u r g i c a l p a t i e n t s and another on the care of orthopaedic p a t i e n t s was organized. I n 1973, t h r e e courses were a s s i s t e d , i . e . , i n neonata l nu r s ing care, nurs ing care of s u r g i c a l p a t i e n t s and methods of teaching re spec t ive ly . I n 1974, provis ion was made f o r four courses: on teaching i n schoo l s of nur s ing , neonata l nurs ing care, neurological p a t i e n t care, and or thapaedie nurs ing care. Three courses are planned f o r 1975. Similar courses w i l l be a s s i s t e d i n 1976 and 1977. The s h o r t fe l lowship w i l l be for observa- t i o n of post -graduate courses, whereas the twelve-month fe l lowships w i l l be f o r nur s ing t u t o r s ro a t t e n d courser leading to a diploma.

P r o j e c t SEAR0 0139, "Short Courses f o r Nvrses and Health Personnel", w i l l be co-ardinated wi th t h i s p r o j e c t .

Assis tance i s expected to continue for a number of years

I n s t i t u t e of Medicine I and School of Prevent ive and Tropical Medicine, Rangoon (WDP BUR168IO20)

m 003 (Burma 0028)

To a s s i s t I n s t i t u t e of Medicine I i n improving undergraduate teaching and t o promote r e sea rch i n post-graduate s t u d i e s ; t o a s s i s t the School of Prevent ive and Tropical Medicine i n developing a diploma course i n the academic and f i e l d t r a i n i n g a r e a s .

A professor of pub l i c h e a l t h admin i s t r a t ion was ass igned in 1967 and a p ro fesso r o f epidemiology i n 1968. Since 1966, a one-year diploma course i n p reven t ive end t r o p i c a l medicine has been conducted; a professor of s a n i t a r y engineer ing, ass igned under p r o j e c t Burma 0089, " I n s t i t u t e of Technology, Rangoon", has taken p a r t i n t h e teaching. The professor of publ ic hea l th admin i s t r a t ion completed h i s assignment i n 1971. I n 1972 and 1973, a v i s i t i n g p ro fesso r of p a e d i a t r i c s and a t echn ic ian t u t o r i n anatomy a s s i s t e d the p ro jec t . The professo r of epidemiology cont inues h i s work under the UNDP-assisted p r o j e c t mentioned below.

A l a rge - sca le p r o j e c t f o r a s s i s t a n c e i n t h e educat ion and t r a i n i n g o f hea l th manpower (Burma 0100, BUR/71/520) has been approved by UNDP. P r o j e c t s Burma 0028 and Burma 0079, "Medical Education", are being merged i n t h i s comprehensive new p r o j e c t .

I n 1974, a professor of human gene t i c s w i l l be ass igned f a r fou r months from the carry-over of u n u t i l i z e d funds from 1973, a f t e r which t h i s p r o j e c t w i l l be terminated.

I n s t i t u t e of Technology, Rangoon (UNDP BURI70lW8)

IW) 004 (Burma 0089)

T O a s s i s t the Department of C i v i l Engineering, I n s t i t u t e of Technology, i n t h e teaching of s a n i t a r y engineer ing.

A v i s i t i n g professor of s a n i t a r y engineer ing was ass igned t o t h e I n s t i t u t e from May 1969 to the end of 1971 to help wi th t h e development of t r a i n i n g prograrmnes i n s a n i t a r y engineering. Another p ro fesso r was provided i n May 1973 but was a b l e m continue only up t o August of t h a t year; s i n c e then e f f o r t s have been made to r e c r u i t a replacement. I n a d d i t i o n , eonsu l t en t s e r v i c e s were provided i n 1971 and 1972 t o he lp i n s p e c i f i c f i e l d s , and fe l lowsh ips were awarded to teaching s t a f f f o r post -graduate study i n pub l i c h e a l t h engineering and shor t observat ion study i n teaching and general s a n i t a t i o n .

Assistance to t h e p r o j e c t i s now expected t o cont inue u n t i l t h e end of 1975, when t h i s p r o j e c t w i l l be merged v i t h Burma 0100, "Education and T r a i n i n g of Health Manpower" (WDP No.BUR/71/520).

Education and Training of Heal th Manpower (UNDP BUR/71/520)

HW W 5 (Burma 0100)

To s t r eng then undergraduate and post-graduate education i n t h e t h r e e e x i s t - i ng medical i n s t i t u t e s i n Burma, as a l s o t h e educat ion and t r a i n i n g o f nur ses , midwives, lady h e a l t h v i s i t o r s and var ious c a t e g o r i e s of a u x i l i a r y h e a l t h person- n e l , and to a s s i s t i n t h e expansion and s t rengthening of t h e Hlegu Rural Heal th Demonstration Area as the camon t r a i n i n g area f o r a l l manbers of t h e h e a l t h team.

The p r o j e c t was approved i n March 1973. A p r o j e c t manager, a p ro fesso r of maternal and c h i l d h e a l t h , and a nurse educator were appointed. A p ro fesso r of epidemiology and s i x consu l t an t s , i n the f i e l d s o f b i o s t a t i s t i c s , bac te r io logy , o p e r a t i o n a l r e sea rch i n medical education, imunohaemotology, c l i n i c a l pathology and pharmacology are to be r e c r u i t e d for 1974. I n 1975, i t i s planned to a s s ign t h i r t e e n consu l t an t s i n t h e f i e l d s of imunohaemotology, c l i n i c a l pathology, pharmacology, o b s t e t r i c s and gynaecology, c l i n i c a l biochemistry, physiology, medicine ( c h e s t ) , surgery ( c h e s t ) , medicine (gas t roen te ro logy) , surgery (gas t r a - enterology),imunofluorescence, and cy togene t i c s . I n 1976-1977, fou r consul- t a n t s i n t h e f i e l d s of medicine (gas t roen te ro logy) , surgery (gast roenterology) , immunofluorescence and cy togene t i c s are expected to be assigned.

A number of fe l lowships a re planned to g ive support t o appropr ia t e depar t - ments.

Assis tance to t h e o r o i e c t i s exoected to cont inue t i l l 1977

B U M h + D

n l o ' s support t o t h i s p r o j e c t began i n 1961, v i t h the assignment o f an epidemiologis t ; a mic rob io log i s t va8 l a t e r provided. Ass i s t ance was given i n l abora to ry d iagnos t i c methods and procedures a t the Rangoon and Mandalay l a b o r a t o r i e s . Consul tants were provided ( i n 1968, 1969 and 1970) t o h e l p i n the f u r t h e r development o f t h e Cen t ra l Epidemiological Uni t . I n 1969, a mic rob io log i s t joined t h e p r o j e c t t o a s s i s t i n t h e p a r a l l e l development of l abora to ry se rv ices and i n t h e o rgan iza t ion and conduct of va r ious epidemio- l o g i c a l su rve i l l ance a c t i v i t i e s ; i n 1972, a f u r t h e r consu l t an t a s sessed t h e development o f the epidemiological s e r v i c e s , and i n 1973, a c o n s u l t a n t evaluated the s t a t u s of the r ecogn i t ion , d i agnos i s , t reatment , prevent ion and con t ro l o f haemorrhagic f eve r s caused by arthropcd-borne v i r u s e s i n Burma a s we l l as of r e sea rch on thze s u b j e c t . A WHO mic rob io log i s t who joined the p r o j e c t i n December 1973 has a s s i s t e d i n t h e epidemiological i n v e s t i g a t i o n s of Salmonella typhi D2 phage-type. I n April-May 1974, a consu l t an t was ass igned to a s s i s t t h e National Heal th Laboratory i n Rangoon, especially i n regard to s y p h i l i s serology and t h e bac te r io logy o f gonorrhoea, end to assess the progress made i n the implementation of t h e recommendations made by the e a r l i e r consu l t an t s .

An immunization programme i s planned to be s t a r t e d from 1975, a t f i r s t around the e x i s t i n g r u r a l h e a l t h cen t res . By t h e end of 1977, t h e coverage of the c h i l d populat ion i n Rangoon and Mandalay i s expected to be a t l e a s t 75% and i n o t h e r towns and r u r a l areas, a t l e a s t M7.. The p r o j e c t i s a good t r a i n i n g area f o r epidemiological s u r v e i l l a n c e and c o n t r o l of outbreaks and could be used f o r both n a t i o n a l and i n t e r n a t i o n a l fe l lows.

Strenatheninp, of Heal th Services (Epidemiology) (UNDP BW/69/W3)

Future WHO a s s i s t a n c e w i l l be provided through a mic rob io log i s t , fellow- ESD W 1 sh ips , supp l i e s and equipment.

(Burma 0344)

To a s s i s t i n e s t a b l i s h i n g epidemiological u n i t s i n a l l the admin i s t r a t ive d i v i s i o n s by conver t ing t h e e x i s t i n g d i sease -con t ro l teams i n t o such u n i t s ; i n organizing epidemiological s u r v e i l l a n c e of d i seases of publ ic h e a l t h importance i n a d d i t i o n t o those s u b j e c t to t h e I n t e r n a t i o n a l Health Regulations, and i n i n i t i a t i n g planning and implementation of t h e na t iona l immunization progr-e v i t h the aim of covering t h e e l i g i b l e c h i l d populat ion v i t h vaccinat ions a g a i n s t smallpox, tube rcu los i s , d i p h t h e r i a , t e t anus , p e r t u s s i s and po l iomye l i t i s , through the b a s i c h e a l t h s e r v i c e s .

Prevention Control and Surve i l l ance o i C-unicable Disease*

ESD 002 (Burma 0108)

To a s s i s t the Government i n t h e development, organizat ion and assessment of s u r v e i l l a n c e and c o n t r o l of comunicab le d i seases (trachoma, venereal d i seases , cho le ra and e n t e r i c i n f e c t i o n s , p lague and f i l a r i a s i s ) .

The a s s i s t a n c e w i l l c o n s i s t of consu l t an t s and he lp i n t r a i n i n g .

The p r o j e c t i s a r e s u l t of t h e merger of s i x country p r o j e c t s f a r improved eo-ordinat ion and management i n t h i s f i e l d : - (1) "Trachoma Control" (Burma 0069), which s t a r t e d i n 1966 with case-f inding s e r v i c e s and domici l iary t reatment i n t h e framework of t h e h e a l t h s e r v i c e s ; (2) "Epidemiology and Control of Cholera and E n t e r i c In fec t ions" (Burma 0104); (3 ) " F i l a r i a a i s Control" (8urma 0087), which s t a r t e d i n 1969 i n Rangoon as a follow-up of the " F i l a r i a s i s Research Unit" (IR 0271); (4) "Virus Diseases Control' ' (Burma 0098), where a s s i s t a n c e has been given i n epidemiological s t u d i e s and i n the con t ro l of v i r u s d i seases ; ( 5 ) "Plague Control" ( B u m 0078), which a l s o s t a r t e d i n 1966, end (6) "Venereal Diseases and Treponematoses Control" (Burma 0105).

I n 1976-1977 consu l t an t s w i l l be ass igned for trachoma c o n t r o l , r e s p i r a t o r y v i r u s d i s e a s e s , venerea l d i seases c o n t r o l , con t ro l of e n t e r i c i n f e c t i o n s o the r than cho le ra , f i l a r i a s i s c o n t r o l and c o n t r o l of na tu ra l f o c i of in fec t ions . Support ing fe l lowsh ips and supp l i e s and equipment w i l l a l s o be provided.

Assis tance i s expected t o be provided f o r some years.

Hala r i a Erad ica t ion urn 001 (Burma 0031)

To a s s i s t i n the con t ro l of malar ia i n c e r t a i n areas, wi th t h e u l t i m a t e goal of e r a d i c a t i n g malar ia from the e n t i r e country and t o prevent t h e re- es tabl ishment of endemicity.

This p r o j e c t , developed from a demonstration p r o j e c t , s t a r t e d i n 1951 i n Upper Burma. I t was j o i n t l y a s s i s t e d by WHO and UNICEF u n t i l 1962, a f t e r which WHO a s s i s t a n c e to t h e p rograme was l imi ted t o the award of fe l lowships and t echn ica l advice .

I n 1970-71, a laboratory s p e c i a l i s t was provided. Since 1970 c o n s u l t a n t s , fe l lowships , he lp i n t r a i n i n g and supp l i e s and equipment have been provided. Owing t o va r ious d i f f i c u l t i e s the programme has no t been a b l e t o make s u f f i - c i e n t headway; however, by 1980, a populat ion of 11.4 m i l l i o n i s expected t o e n t e r t h e maintenance phase. A p lan of ope ra t ion was signed e a r l y i n 1973. The con t ro l ope ra t ions a t p resen t being c a r r i e d o u t w i l l have t o be cont inued f o r a number of years . I n 1973, two consu l t an t s a s s i s t e d i n t r a i n i n g a c t i v i - t i e s and i n the implementation of the programme.

I n 1974 and 1975 consv l t an t s (an entomologis t , a s t a t i s t i c i a n and a s a n i t a r i a n ) w i l l be provided, and i n 1976-77 f u r t h e r consu l t an t s (malario- l o g i s t s and s a n i t a r i a n s ) w i l l be ass igned; fe l lowships i n va r ious f i e l d s ( inc lud ing malar ia s t a t i s t i c s , b a s i c malariology entomology, general epidemiology, e t c . ) awarded and supp l i e s and equipment provided.

Assis tance t o t h e p r o j e c t i s expected t o cont inue f a r a number of yea r s .

h h

BURMA b

Leprosy Control MBD 001 (Burma 0017)

To a s s i s t i n i n t e n s i f y i n g t h e leprosy con t ro l programme, i n extending i t t o cover a l l t h e endemic areas, and i n t r a i n i n g personnel.

Ass i s t ance from WHO and UNICEF s t a r t e d i n 1952, when a l e p r o l o g i s t was ass igned. The p r o j e c t i s being supported by t h r e e voluntary agencies (Order o f m l t a , E m u s Suisse and Deutsches Aussatzigen Hilfswerk). Expansion i n a l l 30 p r o j e c t areas has proceeded s a t i s f a c t o r i l y . Emphasis has a l s o been placed on i n t e g r a t i n g t h e p r o j e c t a c t i v i t i e s i n t o the h e a l t h s e r v i c e s and on t h e t r a i n i n g o f s t a f f . TM t r i a l s f o r t h i s purpose have been c a r r i e d out i n t h e d i s t r i c t s of Hlegu Province. An assessment c a r r i e d ou t i n Apr i l 1973, showed very s a t i s f a c t o r y development. The WHO l e p r o l o g i s t completed h i s assignment i n Apr i l 1974. The p r o j e c t has succeeded i n r e g i s t e r i n g almost a l l t h e leprosy eases i n t h e country and i n cover ing a l l t h e areas of Burma. It w i l l s e rve as a good t r a i n i n g end demonstration c e n t r e for a l l coun t r i e s and a l l p r o f i l e s of h e a l t h workers involved i n l ep rosy con t ro l .

Ass i s t ance w i l l be continued i n 1975 through a consu l t an t , fe l lowships , supp l i e s and equipment, a f t e r which i t w i l l be merged i n t o Burma 0109, "Myco- b a c t e r i a l Diseases".

Tuberculosis Control (UNDP BURl681018)

MBD 002 (Burma 0065)

TO a s s i s t i n developing community-oriented tube rcu los i s con t ro l se rv ices .

Assis tance was provided from 1951 to 1954 under p r o j e c t Burma 0003, "Tuberculosis Control Demonstration and Training, Rangoon" and from 1954 t o 1957 under p r o j e c t Burma 0018, "Tuberculosis Control and Training Centre , mnda lay" , t o e s t a b l i s h demonstration and t r a i n i n g cen t res i n Rangoon and m n d a l e y .

I n 1964, when a s s i s t a n c e was resumed under t h i s consol idated p r o j e c t , c-unity-oriented p i l o t p r o j e c t s i n tube rcv los i s con t ro l were s t a r t e d based on t h e above two cen t res . Since then t h i s pa t t e rn has spread to cover t h e North- v e s t e r n Divis ion i n 1967-1968, t h e Eastern Division i n 1969-1970 and t h e South- v e s t e r n Divis ion i n 1969-1970. Coverage of the South-eastern Divis ion s t a r t e d i n 1971 and t h e opera t ions i n t h e Centra l Division s t a r t e d i n 1972.

The coverage by BCG vacc ina t ion has considerably improved s i n c e t h e i n t r o - duct ion of the d i r e c t vacc ina t ion technique. An eva lua t ion was undertaken i n 1971, and, based on the f ind ings , a plan f o r f u t u r e development of t h e programme was prepared. I n 1972, a b a s e l i n e tube rcu los i s survey was c a r r i e d out . Fellowships and supp l i e s and equipment have been provided.

Assis tance t o t h e p r o j e c t i s expected t o cont inue up t o 1975.

Mycobacteriel Diseases MUD 003 (Burma 0109)

TO a s s i s t i n s t r eng then ing t h e leprosy and tube rcu los i s c o n t r o l progr-es i n t e g r a t e d i n t o t h e general h e a l t h se rv ices .

The a s s i s t a n c e w i l l be provided f o r r e sea rch and t r a i n i n g .

The p r o j e c t i s t h e r e s u l t of a merger o f Wo p r o j e c t s - "Tuberculosis Control" (Burma 0065) and "Leprosy Control" (Burma 0017). Community-oriented p i l o t p r o j e c t s i n tube rcu los i s were s t a r t e d i n 1964. Since then, t h e North- western , Eastern , South-western, South-eastern and Cen t ra l Div i s ions have been covered. The coverage by the BCG vaccinat ion has considerably improved s i n c e the in t roduc t ion of t h e d i r e c t vacc ina t ion technique. A b a s e l i n e t u b e r c u l o s i s survey has been c a r r i e d ou t . Assis tance through t h e l ep rosy con t ro l p r o j e c t (Burma 0017) by WHO and UNICEF s t a r t e d i n 1952 supported by t h r e e vo lun ta ry agencies . Emphasis has been placed on i n t e g r a t i n g t h e p r o j e c t a c t i v i t i e s i n t o t h e h e a l t h se rv ices and on t h e t r a i n i n g of s t a f f . An assessment of t h e l ep rosy con t ro l programme i n Burma was made by t h r e e c o n s u l t a n t s a s s i e e d t o t h e p r o j e c t dur ing November 1972 - Apr i l 1973. I t i s expected t h a t t h i s p r o j e c t , including a BCG t r i a l of ch i ld ren a g a i n s t l ep rosy , vill cont inue t o be supported through b i l a t e r a l agreements.

I n 1976-1977, a consu l t an t w i l l a s s i s t i n t h e eva lua t ion o f t h e tuber- c u l o s i s and leprosy aspec t s of t h e p r o j e c t . The f e l lowsh ips f o r l ep rosy are f o r a study tour by na t iona l s t a f f of the p r o j e c t , and one i s f o r s tudy of c l i n i c a l leprology and dermatology. The fe l lowships i n tube rcu los i s is f o r a diploma course. The p r o j e c t w i l l a l s o support t h e a c t i v i t i e s o f t h e l ep rosy1 BCG t r i a l .

Assis tance i s expected t o continue f a r some y e a r s .

B U R ?

E~idemiology and Control of Cholera and E n t e r l c in fec t ions

Short-term consultant Fellovrhips Suppliee and equipment

5.1.6 Mycobacterial Diseases

Leprosy C o n t r o l

Leprologirc P4

Short-term con~ultanis Fellourhrpr Subsidy Supplier and equipmenr

~uberculosir control BUR1681018

Short-term consultant Fellovships Supplies and equ~pmenr Miscellaneous

PLy~oba~teri.l Diseases

s h o r t - t e r m consulranrs Fellovrhrps supplier and equipment

R E G U L A R

umber of posts

1974

B U D G E T - ~stimated obligatiuna project

N O .

BAC 002 (0104)

U8D 001 10017)

UBD 002 (0065)

MBD 003 (0109)

1974

6 W O

1975

(Expressed in US Dollersl

I/ 3 1 3/12

I

1975 j 1976

i 1976 1977

i 4 200 1 5 OW , - 15 2 W

! I

u m u c .. > 3 .. 0 -

VL

DP

1977

I I

i ~

8 690

6 O W 8 050

I

0 T

Number of P o r t s

I

i

6 600 11 850 ~

I

l i E R S O L R C E S

Errlmared Obligarione

1

21 5 4126

i ~ '

1976 I1977 1974 1974 1975 ! 1976 I , I ~ i i I i !

L 500 i L wo - - i 24 240 i 19 450 - - ~ ~

I I i ~

I 1 i I I

~ 1 ~

I

~ 1 / 3 1 1 9/87 15/48

I

~ ~ I 1 !

1975 1977

11 3 2/21

1/ 4

1 - I/ 3 3/17

I ; 7 2 W

11 850 1 000

, -

20 050 8 -

I

I ! i i i ~

i 1

76 615 10 000 I i

P I ~ -~ 76 615 . 10 000 - -

! I

i I 1 5 W 1 I 44 024 26 600 1 2 622

610

i 54 506 27 210

2~ -

- 1 - : I I

1 i

1/ 3 2/21

12 O W 13 300 2 5 w - 27 B W -

I

Cancer Control CAN 001 (Burma 0110)

TO a s s i s t i n the t ra in ing of cytopathologists and eytoteehnieiana, i n the establishment of a t ra in ing cen t re f o r the e a r l y detect ion, diagnosis and management of cancer i n Rangoon and i n the epidemiological invest igat ion and reg is t ra - t ion of cancer i n Burma.

I n 1973 No consul tants under p ro jec t SEAR0 0215, "Advisory Services", a s s i s t e d i n an assessment of the magnitude of the cancer problem and advised on the organizat ion of r e g i s t r a t i o n and t ra in ing of personnel f o r cancer control and i t s prevention. Another consultant advised on the t ra in ing of cytopathola- g i s t s and cytotechnicians, on the establishment of a t ra in ing cen t re i n Rangoon and on the organization of e x f o l i e t i v e cytological services i n Rangoon and Uandalay. I n 1974, a consul tant w i l l a s s i s t i n developing a nat ional plan fo r cancer control , and i n organizing bio-medical research i n cancer and advise on resources for cancer cont ro l a c t i v i t i e s .

I n 1977, consul tants w i l l be provided for cytopatholagical laboratory se rv ices and for a na t iona l r e g i s t r y and control o f cancer. Observation fel lovsh ips w i l l be offered t o a medical o f f i c e r and a technician.

The pro jec t i s expected to continue u n t i l the end of 1980.

rd w L"

BW

5.1.7 Virus Diseases

Trachoma Control

Short-perm c~naultants Temporary advisers Supplies and equipment

Virus Disease Control

short-rerm canaulfant Pellovrhipa supplies and equipmenr

5.1.8 Venereal Direasea and Trepanemataseo

Venereal Diseases and ~reponemaroser control

short-term conrvlranr Fellwahipa supplies and equipment

5.2 NO"-c-unicable Disease Prevention and Control

5.2.2 Cancer

cancer Control

Short-term con.ultanL. fellovshipa supplies and equipment


project No.

VIR 001 (0069

VIP. W 2 tCQ98)

Ym 001 (0105)

CAN W 1 (Oi10)

1974

8 000 3 000 2 500 - 13 500 -

6 000 6 450 1 500 - 13 950 -

6 000 7 800 7 om -

20 800 -

1974

21 4 21 3

I 1 3 2 1 9

11 3 2/12

umber

1975

of ~ o r r s

1976

~ ~ x p r e a a e d in US DollrrlL

~sfinafed obligations

1977

21 2 21 8

1975

m a v " c ,. 2 2 - 2 -

O T H E R

1976 1974

S O U R C E S

1977

I I I

i i I I

I I I

4 800 6 000 8 000 - 18 800 -

1977

umber o f ?oats

1975

Obligarions

1976 1974

Esrimared

1975

I I i 1

i

! ! !

I

i I

i

1976 1977

1 i I I

Dental Health Services DNH 001 (Burma 0090)

To assist in strengthening and expanding training facilities far dental auxiliary personnel, in planning the gradual expansion of existing and new dental health services and in establishing and ensuring gradual implementation of programes to provide preventive and curative dental services.

A consultant in dentistry vas provided in 1967-1968 (under project Burma 0083). In 1971 and 1972, two consultants helped to draw up a draft request for assistance under UNDP. In 1974, a dental tutor vill assist with the training of dental auxiliary personnel and in the training of dental staff in maintenance and repair of dental equipment. In 1976, a consultant (dental equipment engineer) will be provided, and in 1977, another consultant will assist in developing dental services at regional and township levels.


Mental Health Trainini: and Services HNH 001 (Burma 0099)

To assist in ( 1 ) training psychiatrists and health workers in mental health, including prevention and control of drug abuse (2) the epidemiological investigation of the problem of drug dependence, and (3) strengthening facilities for psychiatric services, including rehabilitation.

In 1967 and 1968 WHO provided a psychiatric nurse tutor and supplies and equipment under Burma 0037, 'Uental Health, Rangoon". In 1971, a fellowship was awarded under Burma 0079 "Medical Education". In 1973, a consultant advised on methadone treatment. Fellowship assistance during 1972-1974 related to control of drug abuse, training in thin-layer chromatography, clinical psychology, psychological medicine and occupational therapy. In 1975, a consvltant vill evaluate the results of the comparative drug treatment study; in 1976, he will assist in the control of drug abuse, and in 1977, in psychiatry. Eellawshipa vill be provided in 1975-1977 in preventive psychiatry and psychiatric medicine.

Assistance will be continued up to 1980.

Development of Production and Qualrty C~ntrol ~r Biological and Pharmaceutical Products

SQP 002 (Burma 0111)

To advise on legislation end procedures to control ths quality of biological and pharmaceutical preparations, to assist in modernizing methods for the production and assay of bacterial and viral vaccines and anti-sera preparations as well as in developing new vaccines.

In 1968 and 1969, consultant8 advised on the quality control of biologicals and pharmaceuticals under project SEAR0 0154, "Quality Control of Biological and Pharmaceutical Products". Fellowships were awarded in 1970 under Burma 0092, "Quality Control of Drugs". In 1973, a pharmaceutical chemist was assigned far two months to follow up the assignments in 1968 and 1969. In 1974 a consultant will assist in the control of biologicals under Burma 0096. Another consultant will be assigned in 1976 for project evaluation.

Originally assistance in production of vaccines was given under inter- country projects, followed by assistance under the project B u m 0077. From 1975, the projects Burma 0096, "quality Control of Biological and Pharmaceutical Products" and Burma 0077, "Burma Pharmaceutical Industry" have been merged into this project.

Cornunity Water Supply and Sanitation Bsn 001 (Burma 0112)

TO assist in c-unity water supply in rural areas and the training of personnel.

This project is expected to be initiated in 1977 with a view to develping village water supply schemes in rural areas, more specifically in water scarcity and technically difficult areas, during the period 1977-1980. Also, subject to availability of funds, the project will be assisted by a long-term sanitary engineer, who will give technical advice in planning and implementation of the schemes, and by means of fellowships.

Occupational Health

To assist in strengthening occupational health services, revising legislation and training personnel.

An occupational health specialist from I M assisted in assessing the existing situation during 1970. In 1971, a WHO consultant assisted in preparing a UNDP request for short and long-term assistance.

In 1974, the consultants will assist in developing occupational health services, in organizing an occupational health laboratory and in conducting local training courses. They will also advise on the epidemiological aspects of occupational health. The fellowships (in the drug observation visits in developing and developed countries) will be related to the above project components.

The project is expected to continue for a number of years.

Assistance will continue until 1980

Radiation Health RAD 001 (Burma 0091)

To assist in radiation protection services in Rangoon and Mandalay, in establishing facilities for training perhonnel for radiological services, including physics and in strengthening services in radiation, radiotherapy and nuclear medicine.

In 1968, 1970, 1972 and 1973, consultants assisted the existing radiation protection services. In 1974, a consultant will help with the organization of radiological, radiotherapeutic, nuclear medicine and radiological health protection services and training facilities. A further consultant wlll also advise in 1975 on national radiation safety standards and introduction of clinical dosimetry services

In 1976-1977, consultants will review the progress of radiation health services in Burma and will assist in the further development o f this project.

Fellowships will be related to training in medical physics and prevention of hazards from nuclear enargy.

N " BURMA 0

Department of Medical Research DHS 0 0 2 (Burma 0095)

To assist in strengthening the units of the Medical Research Department.

In 1972 a consultant advised on the of a study on growth and development. In 1973 WHO helped to strengthen the statistical unit and to organize the Department of Imunology. In 1974 assistance will be given in planning a study on growth, development and physical fitness.

In 1975 it is proposed to assist with the establishment of a division for the breeding of small laboratory animals. Also a consultant will be provided for goitre control.

In 1976 assistance will be given for a follow-up of the previous study and in clinical research on mal-absorption, and in 1977 (a) in strengthening the Departments of Immunology and Epidemiology, (b) in carrying out a study of liver pathology, end ( c ) in complete programing for medical research.

The project is expected to last until 1980.



BIIRI(A

6.1.6 Biomedical and Environmental Health A s p e c t s of Ionizing Radiaf ion

Radiation Health

Short-term conrvltantr Fellovahipr supplies and equipment

7. HEALTH INFORMATION AND LITEMTURE

7.1 ~ealth starintics

7.1.4 Develoment of Health sratirtica1 services

Viral and Health Statistics

- Number of Posts

project NO.

R*D W l (0091)

DHS m l

(Ex~resoed in US Dollarsl

1974


short-cerm consvlranr Fellowships Svpplier and equipmenr

Department of nedical Research


1974

I !

I

5 0 0 0 ! 8000' 8 0 0 0 1 0 O W - - I -

; 1975

umber of ~ o a r r

I/ 1 2/21

11 3 6/37

DHS W 2

I

!

i i i 1

1975

! I 1

i I

!

I I

i i I

m 0 - " c ., 3 - $ - 1976 1974


Eotimared Obligation8

1977 1976 1975 1976 1974

21 4 3/36

I

1977 1977

I !

4/11 5/36

31 9 3/30

I

I i !

i ~

!

, 1975

i ! :

I

i I

2 000 11 850 5 5~ - 19 350 -

6 000 17 450

i

1976 1971

I I I

i 1 !

I

8 800 / 21 600

3 500 4 m 7 m

26 4 W

26 950 -

22 000 ' 17 1 W 22 2 W

33 800 42 7 W - 1 -

! i !

55 6 W -

Development of Heal th Informat ion Se rv ices INF 001 (Burma 0113)

To a s s i s t i n bu i ld ing co-ordinated h e a l t h informat ion se rv ices .

Beginning 1954, a s s i s t a n c e has been provided, through a p r o j e c t (Burma 0022) on v i t a l and h e a l t h s t a t i s t i c s , i n e s t a b l i s h i n g a d i v i s i o n of v i t a l and h e a l t h s t a t i s t i c s i n t h e D i r e c t o r a t e of Heal th Se rv ices , improving t h e procedures r e l a t e d t o d i s e a s e n o t i f i c a t i o n , developing a hoap i t a l s t a t i s t i c a l system and o rgan iz ing and developing h e a l t h s t a t i s t i c a l services . I t i s nov proposed to co -o rd ina te t h e v a r i o u s informat ion o u t l e t s t o provide an i n t e g r a t e d hea l th informat ion s e r v i c e t o he lp develop h e a l t h plans. I n 1974, a consu l t an t (Burma 0022) s tud ied t h e e x i s t i n g s t a t u s of the v i t a l and h e a l t h s c a t i s t i c a l se rv ices i n i t s var ious a s p e c t s and made recommendations f o r i t s improvement. I n 1975- 1977, i t i s proposed to follov-up the proposals made i n 1974 e s p e c i a l l y i n r e l a t i o n to t h e development of a h e a l t h information system. A senior s t a t i s - t i c a l o f f i c e r v i l l observe the o rgan iza t ion of hea l th and h o s p i t a l s t a t i s t i c s i n o t h e r c o u n t r i e s , and the f e l l a v s h i p s v i l l be r e l a t e d to t r a i n i n g i n medical r ecords and e l e c t r o n i c d a t a process ing. A course for medical record techni- c i a n s v i l l be he ld i n 1974.

AssisLance i s expected t o be continued f o r some years.

Merged wi th p r o j e c t Burma 0113, "Development of Heal th Information System" from 1975.

project No.

INF W 1 (0113)

B U M

7.4 ~ealth Information of Public

Development of Health ~nformerion Services

Short-term conrultanfs Fellowships Supplier and equipment

Total - BURMA

~xpecred direct inputs f r w UNICEF I" the health field

R E G U L A R

umber of ~ o r r s

( E x p r e s s e d in US O~llarrl


1974

B U D G E T

Eacimaied Obligations

1976

rn u m " c .. 2 s - 6 - 1975

~"rnber of p o r t s

I ;

8 800 ! 9 600

3 5 W 5 000 6 000 8 - , - I -

18 900 24 8 W ' 26 850 - - - I ~

- , - - - 1 571 440 910 i 647 185 ======= l _=====i ii=ii=i =======

i

1 I I I

I i

I I

i

i

~

!

1975

~srimated Obligation.

1974

1 1 4 3/25

====

I

1

I

1976

i

! I l / l / 3 1/12 3 / 2 8

- - , - - - -

i

I

i

I

1974 1 1975 1 1976 I

1975 1976 1977

I

1976

i

1977

=_.=

I

1 ! i i

1

1977

i ;

1

1977

I ! I

! i i

!

1

I i

i

I I

I

----

I

i

i

I

i

i i

1

DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA

I D.P.R. KOREA

OF KOREA (D.P.R.K.) w Ld 0.

The D.P.R.K. Government cons iders t h a t " the wor ld ' s mast precious possess ion is man", and devotes g r e a t a t t e n t i o n t o p u b l i c h e a l t h s e r v i c e s f o r t h e p r o t e c t i o n of l i f e and t h e improvement of h e a l t h .

The Government c a r r i e s o u t measures f o r the p revent ion of d i s e a s e s b e f o r e t h e i r appearance, and, i n a system of f r e e medical care f o r a l l t h e people , in t roduced i n 1953, p rov ides them with high q u a l i t y medical s e r v i c e a v a i l a b l e a t a l l t i m e s and i n a l l p laces .

Also, t h e S t a t e is s t r i v i n g tovard the continuous improvement of t h e s c i e n t i f i c and t e c h n i c a l l e v e l of the h e a l t h s e r v i c e s through the r a p i d development of t h e medical s c i e n c e s , i n conformity wi th t h e a c t u a l c o n d i t i o n s i n t h e count ry , by i t s rn e f f o r t s and by r e i n f o r c i n g the i d e o l o g i c a l educa t ion of h e a l t h workers so t h a t they w i l l devote them- s e l v e s f u l l y t o t h e care of p a t i e n t s .

The S t a t e is r e s p o n s i b l e f a r managing a l l medical i n s t i t u t i o n s , which a r e r a t i o n a l l y d i s t r i b u t e d a l l over t h e country. As a g a i n s t only 9 h o s p i t a l s and c l i n i c s i n 1944, t h e r e i s nav a t o t a l of 6 300.

The s ix -year p lan (1971-1976) f o r n a t i o n a l economic development i s n w i n p rogress . During the p lan per iod t h e Government in tends t o s e t up more h o s p i t a l s and t r a i n more medical workers, as w e l l as t o expand t h e produc t ion of medicaments and medical ins t ruments . I n p a r t i c u l a r , t h e S t a t e p lans t o improve t h e medical s e r v i c e s a v a i l a b l e t o the r u r a l popula t ion by r e i n f o r c i n g the county and mate rn i ty h o s p i t a l s , convert ing r u r a l c l i n i c s i n t o h o s p i t a l s and expanding the c h i l d r e n ' s wards, as w e l l a s e f f e c t i v e l y diminishing t h e d i f f e r e n c e s i n t h e q u a l i t y of medical s e r v i c e between the urban and r u r a l areas.

St rengthen ing of h e a l t h services

me Government con t inues t o a t t a c h p r i o r i t y t o p u b l i c h e a l t h , encompass ing medical c a r e and maternal and c h i l d hea l th . A l l c h i l d r e n a t t e n d n u r s e r i e s and k i n d e r g a r t e n s , which numbered 37 275 a t the end of 1972.

Paid m a t e r n i t y l eave and a s s i s t a n c e i n d e l i v e r y f o r a l l pregnant women have been in t roduced i n the country. A scheme f o r advanced "sec t ion medical s e r v i c e s " is a l s o i n f o r c e , under which t h e d o c t o r s are respons i - b l e f o r t h e h e a l t h of t h e people of t h e i r s e c t i o n . These h e a l t h s e r v i c e s con t inue t o develop and expand.

I n t h e programme f o r b u i l d i n g and s t reng then ing h o s p i t a l s e r v i c e s , i t is planned t h a t t h e number of t h e r a p e u t i c and p r o p h y l a c t i c u n i t s w i l l be r a i s e d t o more than 10 000 during t h e s ix-year plan period.

WPG a s s i s t a n c e . With WHO'S c o l l a b o r a t i o n i n t h i s f i e l d , s t a r t i n g i n 1974, emphasis w i l l be p laced on the development of h e a l t h manpower, p a r t i c u l a r l y f o r p rov id ing s p e c i a l i z e d medical care through t h e hospi- t a l s .


Medical r e s e a r c h i n s t i t u t e s a r e a t t a c h e d t o the Academy of Medical Sciences. I n each prov ince , i . e . , i n t e n medical c o l l e g e s , one pharma- c e u t i c a l c o l l e g e and a l a r g e number of high medical schools , d o c t o r s , pharmacists and nurses a r e being t r a i n e d .

YHC a s s i s t a n c e . WHO and t h e Government w i l l co-aoerate i n t h e t r a i n i n g and cont inuing educa t ion of the n a t i o n a l s t a f f needed f o r expanding i n s t i t u t i o n s . WHO w i l l c o l l a b o r a t e i n i t i a l l y i n r e i n f o r c i n g t h e medical l i b r a r i e s and documentation c e n t r e s .


The major communicable d i s e a s e s were e r a d i c a t e d many y e a r s ago, a s a r e s u l t of p revent ive measures through p u b l i c h e a l t h s e r v i c e s .

WHO a s s i s t a n c e . I n the f i r s t i n s t a n c e , WHO w i l l a s s i s t i n p lanning f o r a c t i v i t i e s r e l a t e d t o non-communicable d i s e a s e s , p a r t i c u l a r l y i n t h e f i e l d s of cancer and card iovascu la r d i s e a s e s , and w i l l a l s o a s s i s t i n t h e development and expansion of programmes i n endocrinology, haematology , a l l e r g i e s , inmunology and g e n e t i c s .

The comprehensive cancer p r o j e c t is t o embrace a broad spectrum of s u b j e c t s i n t h e f i e l d , ranging from ep idemio log ica l i n v e s t i g a t i o n s , e a r l y d e t e c t i o n and d i a g n o s i s , t o the t r a i n i n g of h e a l t h personne l f o r management, p rov is ion of equipment, e t c .

Promotion of environmental h e a l t h

The Government cont inues t o g ive p r i o r i t y t o i n d u s t r y and a g r i c u l - tu re .

WHO a s s i s t a n c e . WHO w i l l c o l l a b o r a t e i n c u r r e n t a c t i v i t i e s for t h e improvement of the h e a l t h of the working popula t ion .

Ass i s tance w i l l a l s o be provided t o p r o g r m e s i n improvement of g e n e r a l environmental hygiene, e s p e c i a l l y i n the f i e l d s o f s c h o o l hygiene, i n d u s t r i a l hygiene and food hygiene, as w e l l a s i n t h e q u a l i t y c o n t r o l of drugs wi th p a r t i c u l a r r e f e r e n c e t o v i tamins and a n t i b i o t i c s .

Country Statement Education

Biological Standardization

Pollution Paediatrics, Obstetrics and Preventive and Social Medicine in Indian Medical Colleges

Tamil Nadu

tics Services

cable Diseases

Human Reproduction, Family Planning and Population Dyna- mics in Medical Colleges

N P 0

Pro: Old

0277

0278

0279 0280

0284

0285

0286 0287 0288

Project Title

Strengthening of Teaching of Human Reproduction, Population Dynamics and Family Planning in Nursing and Midwifery Education

Integration of Maternal and Child Health Services, including Family Planning Services, into the General Health Services

Medical Toxicology Unit Training Programme for Medical Officers and Trainers a f Basic Health Workers

Development of Cornunity Health Nursing Services

Strengthening of Health Adminis- tration (Rural) including Planning and Evaluation

Research in Nursing Filaria Control Establishment of Regional Cancer Centres

ec t No. New

HMD 010

MCH 002

CEP 003 HMD 006

STR 007

STR 008

HMD 007 MPD 002 CAN 002

Page

261

251 2 74

258, 478

246, 476

246, 476 258, 478 262, 479

268

!

Funds

FP

FP R

R/Addl.

RIAddl.

RIAddl. RIAddl. RIAddl.

R

I

Project Old

0289 0290

0291 0292

0293 0294

0295

0296

0297 0298 0299 0200 0200 0200 0200 0200

Project Title

Mental Health Advance Course in Radiological Physics

Study in Food Legislation Blindness Prevention and Rehabilitation

Medical Librarianship Prevention and Control of Cardiovascular Diseases

Tuberculosis Research Centre, Madras

National Medical Teacher Training Centre

Rural Water Supply Environmental Health National Goitre Control Programme Port Quarantine Medical Librarianship Cardiovascular Diseases Mental Health Drug Addiction

No. New

MNH 002 BAD 004

FSP 001 VIR 002

HMD 011 CVD 002

MBD 004

HMD 012

BSM 004 CEP 004 NUT 004 STR 003 XED 003 C M 001 MNH 001 ADA 001

Page

270, 479

2 78 278, 481

479 260, 478

268, 479

266

260, 478 2 74 481 477 244 257 268, 479 269 270, 480

Funds

RIAddl.

R RIAddl.

Addl. RIAddl.

RIAddl.

R

RIAddl. DP Addl. Addl. R R RIAddl. R RIAddl.

INDIA

I n I n d i a , t h e r e are 2 641 towns and tm agglomerat ions, and 576 000 v i l l a g e s , as p e r t h e 1971 census, according t o which t h e popula- t i o n of t h e country amounts t o 547 949 809. 20% of the populat ion is urban and 80% r u r a l . The decennia l growth r a t e during the per iod 1961- 1971 was 24.8 p e r cent . The average expectancy of l i f e dur ing 1966-70 was 48.2 y e a r s f o r males and 46.8 y e a r s f o r females.

I n 1971, t h e b i r t h r a t e was 36.9 per thousand, t h e death r a t e 14.9 p e r thousand populat ion, and t h e i n f a n t m o r t a l i t y r a t e 122 p e r thousand l i v e b i r t h s . The mate rna l m o r t a l i t y r a t e p e r 1 0 0 0 l i v e b i r t h s was 5.7 i n 1968.

The p e r c a p i t a expendi tu re on h e a l t h s e r v i c e s through government sources dur ing 1969-70 was Rs. 6.50. During the F i r s t Plan per iod (1951- 5 6 ) , t h e h e a l t h o u t l a y was 5.93 per cent of t h e t o t a l government budget. Although dur ing the f o u r t h p lan (1969-74) t h i s percentage increased t o 7.27%, naw, a t the beginning of t h e f i f t h f ive-year p l a n (Apr i l 1974- March 1979). a cumulative percen tage of 4.85 of the t o t a l o u t l a y f o r t h e above programmes is earmarked f o r h e a l t h .

By September 1972 t h e r e were 5 195 primary h e a l t h c e n t r e s , each aimed a t covering a popula t ion of 87 000, and 32 218 sub-centres aiming a t covering a popula t ion of 282.4 m i l l i o n . The number of ou t -pa t ien t s v i s i t s t o 5 131 primary h e a l t h c e n t r e s and 27 929 sub-centres i n 1971 was e s t i m a t e d 327.7 m i l l i o n .

Although h e a l t h programmes are p r i m a r i l y the r e s p o n s i b i l i t y of the S t a t e governments, t h e Union Government has, under t h e p l a n s , supported major schemes f o r improving the s tandard of h e a l t h of the na t ion . The broad o b j e c t i v e s of t h e h e a l t h programmes during t h e l a s t decade have been t o c o n t r o l and, where p o s s i b l e , e r a d i c a t e communicable d i s e a s e s , t o p rov ide c u r a t i v e and prevent ive h e a l t h s e r v i c e s i n r u r a l areas through the e s t a b l i s h m e n t of primary h e a l t h c e n t r e s and to augment t h e t r a i n i n g p r o g r a m s f o r medical and p a r m e d i c a l personnel.

I h e primary o b j e c t i v e during the f i f t h f ive-year plan i s t o provide minimum p u b l i c h e a l t h f a c i l i t i e s t o g e t h e r wi th the i n t e g r a t e d family h e a l t h and n u t r i t i o n s e r v i c e s f o r t h e vu lnerab le groups.

WHO a s s i s t m c e . The major WHO input is s t i l l i n t h e s t reng then ing of h e a l t h s e r v i c e s , which i s aimed a t increas ing coverage f o r minimum, b u t e s s e n t i a l h e a l t h s e r v i c e s . Ass i s tance t o d i s e a s e c o n t r o l and preven- t i o n cont inues t o fol low t h e g e n e r a l s h i f t of emphasis tovards chronic and degenera t ive d i s e a s e s . The suppor t given i n t h e development of h e a l t h manpower covers a wide range, from t r a i n i n g of a u x i l i a r i e s and

paramedical5 up t o post-graduate and research l e v e l h e a l t h workers. Cowuni ty wate r supply and p o l l u t i o n c o n t r o l w i l l cont inue t o b e major s u b j e c t s f a r WHO a s s i s t a n c e i n the f i e l d of environmental h e a l t h .

Other a s s i s t a n c e . The World Food P r o g r a m e is c u r r e n t l y supply ing about $56 m i l l i o n (420 m i l l i o n rupees) worth of milk powder and b u t t e r o i l over a f ive-year per iod . UNICEF is spending about $10 m i l l i o n annua l ly on development a c t i v i t i e s i n such f i e l d s a s h e a l t h s e r v i c e s , improvement of v i l l a g e wate r s u p p l i e s through v a s t w e l l - d r i l l i n g progranmes, t r a i n i n g of n u r s e s , e t c . . maternal and c h i l d h e a l t h c a r e , n u t r i t i o n , sc ience educat ion i n secondary schools , and s o c i a l w e l f a r e . I n d i a i s also r e c e i v i n g a s s i s t a n c e from such sources as FAO's Freedom From Hunger Campaign.

S t rengthen ing of h e a l t h s e r v i c e s

Under t h e mas te r p l a n f o r p rov id ing h e a l t h s e r v i c e s i n t h e r u r a l a r e a s , t h e main aim is sti l l t o provide, by 1979, every primary h e a l t h c e n t r e wi th two d o c t o r s , an a u x i l i a r y nurse-midwife and a b a s i c h e a l t h worker f o r every 5 000 people , and t o supply a t l e a s t one o u t of every f i v e primary h e a l t h c e n t r e s wi th a 25-30 bed h o s p i t a l and s p e c i a l l y t r a i n e d d o c t o r s i n medicine, s u r g e r y , a n a e s t h e s i a and o b s t e t r i c s . Rura l h o s p i t a l s and d i s p e n s a r i e s , inc lud ing family planning/maternal and c h i l d h e a l t h s e r v i c e s , are be ing involved. The n a t i o n a l fami ly planning s e r v i c e s are be ing i n t e g r a t e d i n t o the g e n e r a l h e a l t h s e r v i c e s , and s p e c i a l a t t e n t i o n i s being g iven t o t h e problems of m a l n u t r i t i o n , care of pregnant women and l a c t a t i n g mothers and c a r e of pre-school c h i l d r e n i n t h e l w e r economic groups. Feeding programmes a r e b e i n g combined w i t h h e a l t h ca re , immunization and n u t r i t i o n educa t ion .

kiHO a s s i s t m c e . WHO is d i r e c t i n g i ts a s s i s t a n c e mainly toward the development o f t h e h e a l t h i n f r a s t r u c t u r e , and p a r t i c u l a r l y toward t h e r u r a l h e a l t h s e r v i c e s , through the promotion of s t u d i e s , experiments . and t r a i n i n g and demonstrat ion p r o j e c t s . By 1975, r e s u l t s a r e expec ted f a r feedback t o h e a l t h planning and manpower development. More group e d u c a t i o n a l meetings i n I n d i a w i l l be arranged f o r medical and paramedical personne l engaged i n the h e a l t h programmes. The h e a l t h s e r v i c e s w i l l b e f u r t h e r s t reng thened by t h e development and promotion of e f f e c t i v e planning a t the Centre , supported by the appointment of t h e a p p r o p r i a t e s t a f f a t both S t a t e and d i s t r i c t l e v e l s . Heal th l a b o r a t o r y s e r v i c e s are being a s s i s t e d both i n o r g a n i z a t i o n a l and tech- n i c a l a s p e c t s .

Other a s s i s t m c e . The family planning programme cont inues t o b e c a r r i e d o u t wi th WHO'S t e c h n i c a l a s s i s t a n c e a s a family planning s e r v i c e and a s i z a b l e UNF'PA i n p u t i n t o family planning, channe l led

INDIA

through UHO. This programme is unfolding i n t o a broad-based family hea l t h p r o g r m e as an i n t e g r a l p a r t of the general hea l t h s e rv i ce s

Health manpower development

Expansion of h e a l t h manpower development s t i l l occupies a key place i n the f i f th f ive-year p lan .

mere a r e now 100 medical co l l eges , with an admission capacity of more than 12 500 s tudents . By March 1974, approximately 49 300 new doctors had q u a l i f i e d i n var ious medical co l leges , making a t o t a l of 137 930, tak ing a t t r i t i o n i n t o account.

I n 1969 t h e d e n t i s t s numbered 7 000, and the 15 den t a l co l leges i n t h e country now have an annual admissions of 680 students . About 6 300 nurses q u a l i f y year ly from the e x i s t i o g 253 nursing schools. I n 1972-197 the r a t i o of nurses t o populat ion was 1:6 930; by 1974, i t i s s t i l l hoped t o reach a r a t i o o f 1 :6 400 approximately, which w i l l s t i l l be lower than the doc tor /popula t ion r a t i o .

With 311 a u x i l i a r y nurse-midwifery schools , about 40 000 aux i l i a ry nurse-rnidvives and 20 000 midwives and t r a ined dais should h e ava i l ab l e by t h e end of March 1974. I n Ut ta r Pradesh, Bihar and Or issa , new schools f o r t r a i n i n g t h i s category of personnel a r e being e s t ab l i shed wi th WHO and UNICEF as s i s t ance . Most of t h e o ther S t a t e s should a t t a i n an adequate capac i ty i n the t r a i n i n g of a u x i l i a r y nurse-midwives by 1974.

The ma la r i a workers who, i n the u n i t s which a r e en t e r ing the malar ia maintenance phase, a r e being converted i n t o multi-purpose hea l t h workers; they should soon c o n s t i t u t e the main f r o n t l i n e hea l t h workers i n the de l i ve ry of h e a l t h ca r e i n the country.

WBO as s i s t ance . Assistance w i l l he given t o t r a in ing p r o g r m e s , a t b a s i c and post-basic l e v e l i n nursing, medical education, pub l i c hea l t h , and s a n i t a r y s e rv i ce s and f a r the t r a in ing of a u x i l i a r y hea l t h workers as w e l l as f o r in-serv ice and on-the-job t r a i n i n g of medical and paramedical workers. Fellowships w i l l h e of fered t o candidates f o r p ro fe s s iona l and post-graduate t r a i n i n g abroad; group educa t iona l a c t i - v i t i e s , geared tovards meeting the h e a l t h manpwer requirements, w i l l he organized and a s s i s t a n c e given i n the developing educational technology, medical pedagogy and teacher t r a i n i n g cent res .

A programne f o r t r a i n i n g multi-purpose hea l t h warkers, including the prepara t ion of t h e i r teachers, w i l l c o n s t i t u t e one of the majar e f f o r t s of the Government with WHO a s s i s t ance .

Disease prevention and con t ro l

Due emphasis continues t o be placed on the con t ro l and e r ad i ca t i on of coormunicable d i s ea se s , and the p lan f o r a phased scheme f o r t h e i n t e g r a t i o n of these programmes i n t o the hea l t h s e rv i ce s is being implemented; wi th a t a r g e t da t e of 1975-1976. Other important hea l t h programmes f o r tuberculos is , l eprosy and f i l a r i a s i s cont ro l , e t c . , a r e a l s o rece iv ing increas ing a t t en t i on . The f i f t h five-year p l an provides f o r subs id i e s and grants- in-aid t o S t a t e Governments for the e f f e c t i v e implementation of these progr-es .

National immunization pragr-e and the production of va r ious vaccines have been f u r t h e r s trengthened wi th a view t o achieving s e l f - su f f i c i ency i n support of I nd i a ' s am h e a l t h programmes and a t the same time export ing s i z a b l e q u a n t i t i e s of vaccines t o he lp m e e t t h e needs

3 , of neighbouring count r ies . Great emphasis is placed on the e r ad i ca t i on of smallpox, which i s planned t o achieve zero incidence by 1975.

WHO ass i s tmtce . WHO w i l l provide s t a f f , assessment teams f o r disease-control programmes ( including, i n 1975, f i l a r i a s i s cont ro l ) . fe l lowships , grants-in-aid and supp l i e s and equipment.


Increas ing importance is a t tached by t h e Government t o the enviroomental problems fac ing t h e country, inc luding the l a ck of adequa te and pro tec ted water supply and sewerage systems.

Up t o 31 March 1973, out of a t o t a l of 2 921 tams, 1 450 had p a r t i a l o r f u l l water supply, and 186 p a r t i a l sewerage f a c i l i t i e s . Out of 576 000 v i l l a g e s , only about 28 650, with a populat ion of approximately 15 mi l l ion , had been provided w i th piped water suppl ies .

It has been es t imated t h a t about 120 000 v i l l a g e s out of a t o t a l of 576 000 s u f f e r from s c a r c i t y of dr inking water supply, hea l t h hazards, cholera o r s p e c i a l problems such as s a l i n i t y o r an excess of i r o n o r f l uo r ide s . The expenditure on r u r a l water supply i n the f i f t h p l an is the re fo re proposed t o he increased t o about Rs.5 730 mil l ion , as aga ins t l e s s than one fou r th of t h i s l e v e l i n t h e fou r th plan. l h e t o t a l all- ca t i on , covering urban water supply and sewerage, as wel l a s r u r a l water suppl ies and s a n i t a t i o n , i s appraximately Rs.10 200 mi l l ion . The Government in tends t o provide water supply t o all the d i f f i c u l t and problem v i l l a g e s during the P lan period.

Training i n pub l i c hea l t h engineering continues t o he given by the Cent ra l Publ ic Health Environmental and Engineering Organizat ion,

INDIA

New D e l h i , and t h e C e n t r a l P u b l i c Hea l th Eng inee r ing Research I n s t i t u t e , Nagpur, i n a s s o c i a t i o n w i t h u n i v e r s i t i e s , o t h e r t e a c h i n g i n s t i t u t i o n s and p u b l i c h e a l t h e n g i n e e r i n g depar tmen t s of S t a t e Governments, and r e s e a r c h on p u b l i c h e a l t h e n g i n e e r i n g i s c a r r i e d o u t by t h e S t a t e Governments as w e l l as i n t h e I n s t i t u t e a t Nagpur.

WHO a s s i s t m c e . The emphasis i n t h e WHO p r o g r m e i s on r u r a l w a t e r s u p p l y and s a n i t a t i o n , a s s i s t a n c e b e i n g g iven by p r o v i s i o n of s a n i t a r y e n g i n e e r s , s h o r t - t e r m c o n s u l t a n t s , temporary a d v i s e r s f o r group e d u c a t i o n a l a c t i v i t i e s , and f e l l o w s h i p s . Water p o l l u t i o n and a i r p o l l u - t i o n c o n t r o l are a l s o r e c e i v i n g i n c r e a s e d a s s i s t a n c e .

Othe r a s s i s t a n c e . For t h e f i v e - y e a r p r o g r m e 1972-77, UNDP h a s been asked t o p r o v i d e 1 . 9 m i l l i o n d o l l a r s mainly f o r r u r a l w a t e r supp ly schemes, which a r e a l s o r e c e i v i n g c o n s i d e r a b l e a s s i s t a n c e from UNICEF.

INDIA

Hedical Rehabilitation STR 002 (India 0194)

To assist in expanding medical rehabilitation services and in establishing training schools in the various disciplines.

Assistance began in 1963, when two WHO consvltants visited various centres in India and recornended a phased programme for a country-wide medical rehabili tation service for the physically handicapped. In 1967, a rehabilitation specialist was provided to the Department of Rehabiliration and Physical Medi- cine in the General Hospital, Madras. In 1969, a consultant reviewed the situation in medical rehabilitation and in the manufacture of prosthetic and orthotic appliances. A prosthetistlorthotist has been assigned since 1970 to Safdarjvng Hospital and the All-India Institute of Medical Sciences in New Delhi for two years to train instructors. In 1973, assistance was provided in the conduct of a course on lower extremity prosthetics and orthotics. Two other courses - one on upper extremity prosthetics, and the other on spinal orthotics and rehabilitation - will be conducted in 1974 and 1975 respec- cively. Assistance will continue in 1976 when the project will be terminated.

Fellowships (Port Quarantine) STR 003 (India 0200)

National Institute of Health Administration and Education

STR 005 (India 0218)

To assist in the candvct of studies in district health administration a s well as in the promotion and planning of comprehensive health care services at the district level and in the formulation of research and teaching programmes, studies and research, in the field of hospital administration.

WHO assistance to the project began in 1965. During 1970, a public health administrator and a hospital administrator were provided to the Institute. In 1971, a consultant reviewed the project and since 1973 a public health administrator has been assigned. A hospital administrator will again be provided from 1974.

The activities in the field of operational research at the district level and hospital administration will continue until the end of 1977 with the help of long and short-term staff (including staff in health education and economics). A grant will also continue to be provided to meet the cast of social investigators.

It is expected that the project will continue until 1977.

To assist in the training of national staff.

~rojecr NO.

STR 002 (0194)

m 3 (0200)

S n W (0212)

STR cQ5 (0218)

INDIA


3.1 SfrengChenin~ of Health Services

3.1.2 Strewtheninp, of Health Services

Medical Rehabilirnrion

Short-term consultan~s Fellovrhips Supplies and equipment Grant

~ e l l w s h i p s (port Quarantine)

Nvrlrinp Administration

~ u r s e administrator P3

Svpplies and equipment

National 1nstitvre of Health Administration and Edvcation

Rlblic health officer P5 ~ospical a&inirrrator P5

Short-Lem consultants Fellowshipa Grant Supplies and equipment

R E G U L A R

Number of P o a f s

(Expressed in US Dollarl~

B U D G E T

Esrlmated Obligations

1974 1974 1974 1975 1975

a a m " c ., 3 u.

u.

umber of ~ o s r r


Eltimared Obligations

1976

1 1 I i

!

i

1976 1975 1974 1977

1/12 1/12 ----

2 ---- 11 4 Z/ 6

11 3 3/18

21 6

1/12 - 1 -

1/12 11 3

2

2/ 8 3/13

6 W O i 11 700

500

- 18 200 - loa

25 150

500 - 25 650 -

- 40 570

16 WO 9 450 9 600

100

75 720

1977

1/12 1/12

2

21 6 21 6

11 3 2/12

21 6

1/12 1/12

2

21 8 21 7

j :

i I ~

!

I

I i ~

1

I

1976

I

1 1 1 I I

i I I i I

1975

:El 5 W O ! - 1 14 400 T&

1977

I

i I

1976

I

37 460 37 460 - 74 920

14 400 5 100 9 600

100

104 120

- 1 -

- 1 I !

i i I I i

1977

33 250 33 250 - 66 500

17 bW 5 550 9 600

100

99 350

35 790 35 790 - 71 580

9 600 5 100 9 600

100 - - - - 95 980 - - - -

Nursing in Clinical Specialties

INDIA ,a z. 01

SIR 006 Develo~ment of Community Health Nursing Services STR 007 (India 0269) (India 0284)

To assist in improving clinical practice in selected specialties

The programmes include in-service education and, on an all-India basis, short courses for nurses as well a s courses with multi-disciplinary professional participation. Some courses were carried out in collaboration with project SEAR0 0139, "Short Covrser for Nurses and Health Personnel".

A WHO consultant nurse educator in orthopaedic nursing was assigned for eleven months in 1972 to Safdarjung Hospital, New Delhi, to assist in developing the service and educational aspects of orthopaedic nursing. In 1972 and 1973, the two WHO nurse educators transferred from project India 0114, "Paedia- tric Education", assisted in maternal and child health nursing education and services in the medical college hospitals of Bikaner, Ajmer and Udaipur in Rajasthan, and in paediatric nursing at the All-India Institute of Medical Sciences, New Delhi, and K.E.M. Hospital, Bombay.

In early 1973, to continue through 1975, a WHO nurse educator in peychia- tric nursing was assigned to the All-India Institute of Mental Health and the Mental Hospital, Bangalore. In 1974, a WHO MCH nurse educator was eseigned to the JIIllER Hospital, Pondicherry, and from April 1974, a consultant in orthopaedic nursing is assisting the K.G. Medical College, Lucknow, and the Safdarjung Hospital, New Delhi.

Provision for two nurse educators and consultants will continue for a number of years. Consultants will be provided in the fields of cardiological nursing and neurological nursing at the All-India Institute of Medical Sciences, New Delhi, and paediatric nursing at K.E.M. Hospital, Bombay. Possible assistance might extend to the Mental Health Hospital in Rsnchi, Bihar .

To strengthen the provision of and development of patterns of public health nursing services in selected States in India.

Beginning 1975, two WHO public health nurses will be assigned, one to West Bengal and the other to Maharashtra, to assist, at State level, in the establishment of public health nursing competence and in the development of effective managerial techniques and in-service education programmes for public health nurses, with special emphasis on organizing supervisory and referral systems in the delivery of rural public health nursing services. It is envisaged that four other States will be assisted by this project, i.e., Uttar Pradesh, Mysore, Biher and Gujarat. The fellowship component of the project will be geared to the provision of fellowships for either district nursing supervisors or State-level public health nurses to undertake observational tours of rural public health nursing services.

Assistance to the project is expected to continue for some years

Strengthening of Health Administration (Rural), Including Plannins and Evaluation

TO assist the health administration, in planning, implementation and evaluation, including development and strengthening of a health information system, and strengthening of rural health services.

Consultants will be provided in 1975 in economics and systems analysis, and assistance will also be given in the form of grant and supplies to support the training programme.

It is expected that the project will continue till 1977.

Product ion of Freeze-dr ied Smallpox Vaccine HLS 001 ( Ind ia 0174)

To a s s i s t i n becoming s e l f - s u f f i c i e n t i n the production of f reeze-dr ied smallpox vaccine of s tandard q u a l i t y .

Since 1964, a s s i s t a n c e has been provided to t h i s p r o j e c t , as and when requ i red , i n reviewing the methodology of freeze-drying and with q u a l i t y con t ro l o f smallpox vaccine. By 1970, t h e four l a b o r a t o r i e s a t Patwadangar, Belgawn, Madras and Hyderabad had developed t h e capac i ty to produce a t o t a l o f 4.3 m i l l i o n ampoules (each containing .25 ml.) of f r eeze -d r i ed vaccine. I n 1972, a s s i s t a n c e was given to s t e p up t h e o v e r a l l capac i ty i n t h e four cen t res to 10.4 m i l l i o n ampoules per yea r , which i s the es t imated requirement of the n a t i o n a l smallpox e r a d i c a t i o n programme dur ing the cu r ren t Five-Year Plan. I n 1972, a consu l t an t a s s i s t e d i n the i n s t a l l a t i o n and opera t ion of the new equipment both a t Patwadangar and Belgaum as wel l as t r a i n t h e l aba ra to ry personnel. I n 1973, a consu l t an t undertook a technical review of t h e programme. Consul tants w i l l also be provided i n 1974 and 1976.

The p r o j e c t i s expected to cont inue up to the end of 1976.

Strengthening of Laboratory Services

TO a s s i s t i n s t rengthening h e a l t h l abora to ry service* i n Ind ia .

HLS 002 ( Ind ia 0188)

INDIA P 4 P m

WHO a s s i s t a n c e to the p r o j e c t began s i n c e 1965 when two courses for technicians have been es t ab l i shed . I n 1970, a th ree year course l ead ing t o an M.Sc. degree end a six-week r e f r e s h e r t r a i n i n g course was s t a r t e d i n Chandigarh. I n 1971, a consu l t an t introduced and s tandardized t h e procedures f o r the l abora to ry d iagnos i s o f s t reptococcus i n f e c t i o n a t t h e Lady Hardinge Medical Col lege, New Delhi. From 1974 onwards, a WHO team - one microbio- l o g i s t and a t echn ica l o f f i c e r w i l l a s s i s t the S t a t e h e a l t h s e r v i c e s i n s t rengthening the microbiology of camunicab le d i s e a s e s and of food, i n l i n k - ing up the l a b o r a t o r i e s a t pe r iphe ra l , d i s t r i c t and S t a t e l e v e l s , and i n t r a i n i n g manpower by in - se rv ice r e f r e s h e r courses. I n 1974, t h e team was located i n Kerala and from 1975 onwards i n o t h e r S t a t e s r epec t ive ly .

The p r o j e c t co-ordinates wi th SEAW) 0159, "Health Laboratory Services" i n t h e planning, evaluat ion and fallow-up as p a r t of a r eg iona l assessment.

I n 1976-77 a p a r t from the a s s i s t a n c e provided by t h e team, c o n s u l t a n t s w i l l be r e c r u i t e d to s t rengthen re fe rence s e r v i c e s i n bac te r io logy and virology i n se l ec ted c e n t r a l l a b o r a t o r i e s . Financia l g r a n t s v i l l be given i n 1974 and i n 1976-77 - t o support the c a s t of n a t i o n a l course f a r s t r eng then ing h e a l t h l abora to ry manpower. Fellowships w i l l be provided i n s p e c i a l i z e d sub jec t s f o r t h e r e fe rence l a b o r a t o r i e s and f o r the t r a i n i n g of t u t o r techni- c i a n s . Suppl ies and equipment w i l l be provided wi th in the budgetary l i m i t a - t i o n s to support the operat ion o f t h e p r o j e c t .

Assis tance t o the p r o j e c t i s expected to cont inue f o r s e v e r a l years till a t l e a s t 1979 (end of the F i f t h Pive-Year P lan ) .

project NO.

STR 010 (0199)

STR Oil (0276)

HLS W l (0174)

HLS 002 (0188)

ISDIA

School for Trainins of Technicians IND/68/032

Elecfro-med~cal engineer P3

Fellovshipr supplies and equipmenr Miscellaneous

- INDI71IPW

Strenxrhenins of F m i l y Planning Aspects a£ Nursing AdminiaL~a- tion

Supplier and equipment

3.1.3 Health Laboratory Service*

Production of Freeze-dried Smallpox Vaccine

sh~rt-term conauifanfs Fellowships Supplies and equipmenr

Strengthening of Laborator1 services

nicrabiolaginr P4 P2 Laboratory technician

short-term coneulcanrs Fellowships Grant Supplies and eqvipment

R I C I ' L A R

,Exore~red in US Dollsrll

1974

11 1 31 9

1/10 1/12 -

31 5 3/18

B U D G E T

Estimated Obligationr

1974

* u * " a u 3 5 ... 2 u

DP

PP

umber of p o r t s

1975

umber of ports

1977 1975 1974

11 8 - 1 -

2114


i i I

I I I

i i I !

, ' ~ I ! i !

i ! 2 wo i 1 2 4w 7 650 1

I 1 W O - 10 650 3 4W - ! , -

1976 1976

- 39 510

1 0 W O 11 700 2 625 2 000 -

65 835 -

i

1977

!

1 i

I ~ I ! i

~ : ! ;

I

1975 1977

1

~stimated Obligations

1/12 1/12 -

---- 31 5 2/12

i

1976 / 1977 1974

! I 1

I I

i ~ ! 1

i

26 250 18 950 - 45 2 W

11 000 7 8 W

3 000 - 67 000 -

3 509 2 0 w i 2 923 i I 1

552 I !

- 26 984 i ~

!

-~ i i

-"~

i !

i

i I 1 , 1

1

1975

11 I

1/12 1/12 -

2 2 2 2

31 5 2/12

1976

1/12 1/12 -

11 3 5/33

29 210 / 31 220 20 630 1 21 920 - 49 840

1 12 000 7 800 2 000 3 000 - 74 640 -

- 53 140

7 Z W 20 850 1 000 5 000 -

87 190 -

Production of ~reeze-dried BCG Vaccine HLS W 3 (India 0225)

To assist in the production of freeze-dried BCG vaccine of standard quality .

In 1968 and 1970, consultants advised on the production of freeze-dried vaccine, and fellowships were awarded in related subjects.

In 1972, a UHO consultant visited the project for follov-up. In 1973-74, the same UHO eoneultant commissioned an automatic sealing machine supplied by UNICEF,and laid plans for the strengthening of a national control laboratory at the NICD, Delhi.

Substantial assistance to the project has been provided by UNICEF and further assistance is due for the expansion of the freeze-dried vaccine production plans at Hadras.

In 1975 through 1977, the project will be further assisted by way of short-term consultants, fellowships. supplies and equipment - to step up production to meet the vaccine requirements of the national TB control pra- g r m e and to operate a national vaccine control laboratory.

INDIA h " C

Strengthening of Departments of Paedratrics. Obstetrics and Prevencrve and So;ial Ued~einc i n Indran Hed~c.1

MCH 001 (India 0114)

TO assist in strengthening the teaching and practice of social paediatrics, and social obstetrics in Indian medical institutions.

The scope of this project, which began in 1961 vith assistance to paediatric departments, was widened in 1965 and further enlarged in a new plan of operation (1973) to include social obstetrics. An & Coornittee on Paedia- tric Education, in 1970, framed a remodelled undergraduate curriculum, and pre- tested it in 1973-1974 with a view to developing a demonstration teaching centre. A parallel review of the obstetric curriculum started in 1973. With UNICEF assistance,trsining in maternal and child health is envisaged in 1977. Heenwhile, paediatric teaching at diploma and doctoral levels is being studied and assistance to national training courses continued.

As a response to inter-country projects SEARO 0144, "Rehydration Therapy" and SEAR0 0170, "Short Courses in Neonatology",national workshops in both these subjects have been provided for in 1976.

The project is expected to continue up to the end of 1977.


Strengthening of t h e Teaching of Human Reproduction, HRP 001 Family Planninx and Populat ion Dynamics i n ( I n d i a 0275) Medical Colleges (UNFPA IND/71/PO3)

To s t r eng then t h e s e r v i c e , teaching and research funct ions of t h e deparr- ments involved i n t h e teaching o f human reproduct ion, family planning and popu- l a t i o n dynamics i n medical c o l l e g e s .

A team of t h r e e consu l t an t s s tud ied the teaching of human reproduct ion, populat ion dyaamics and family planning i n 21 medical co l l eges i n Ind ia i n 1970. I n 1971, a meeting of leading medical educators was held and consultants a s s i s t e d i n the development of a plan of ope ra t ions f a r t h i s p r o j e c t . I n 1973,

c o n s u l t a n t s were ass igned to four medical co l l eges - i n Madurai, Hyderabad (Osmania), Nagpur and Gwalior. I n 1974, s i m i l a r a s s i s t a n c e was given t o the medical c o l l e g e s i n Ca lcu t t a , Banaraa and Cuttack.

I n 1975, i t i s proposed t h a t the e i g h t designated medical co l l eges w i l l each adopt th ree neighbouring medical co l l eges to implement the teaching programmes i n those s u b j e c t s , which have been e laborated and implemented by t h i s p r o j e c t . In a d d i t i o n , i t i s proposed t h a t a n a t i o n a l workshop w i l l be held .

I n 1976-1977, the programme w i l l be f u r t h e r expanded to o t h e r medical co l l eges , whi le on t h e o t h e r hand i t w i l l be reviewed and evaluated. I n t e r - n a t i o n a l a s s i s t a n c e to t h i s p r o j e c t w i l l depend on the a v a i l a b i l i t y of UHDPA funds.

Applied N u t r i t i o n Programme NUT 001 ( Ind ia 0181)

M

INDIA L" P J

A consu l t an t was provided i n 1964 and a pub l i c h e a l t h o f f i c e r i n 1966-67. A f u r t h e r pub l i c h e a l t h o f f i c e r was provided from 1971 to 1973. UNICEF has been a s s i s t i n g t h i s programme a l l these yea r s .

I n 1975, i t i s proposed to hold a meeting of S t a t e N u t r i t i o n O f f i c e r s i n Ind ia . This a c t i v i t y w i l l be repeated i n 1976 and 1977. I n add i t ion , fe l lowsh ips w i l l be awarded to t r a i n personnel i n t h e h e a l t h a spec t s o f n u t r i t i o n .

Assis tance i s expected to continue u n t i l t h e end of 1977

N u t r i t i o n Training NUT 003 ( I n d i a 0267)

TO support the National I n s t i t u t e of N u t r i t i o n , Hyderabad, i n p a r t i c u l a r , and o t h e r i n s t i t u t i o n s i n genera l .

I n 1971, 1972 and 1973, a s s i s t a n c e was given t o the I n s t i t u t e i n conduet- ing i t s courses i n n u t r i t i o n . Suppl ies and equipment were provided and t r a i n - i n g , through WHO fel lowships , arranged f o r some of t h e teaching and resea rch s t a f f . Similar a s s i s t a n c e w i l l cont inue to be provided during 1974, 1975 end 1976, when i t w i l l be terminated.

The a c t i v i t i e s of t h i s p r o j e c t w i l l cont inue t o be co-ordinated w i t h those of SEAR0 0097, "Nut r i t ion Training and Advieory Services" , up t o 1975, and w i t h those o f S U R O 0237, "Nut r i t ion Teaching i n Educational I n s t i t u t i o n s f o r Rea l th Personnel", t h e r e a f t e r .

To a s s i s t i n improving t h e h e a l t h component of the Applied Nut r i t ion Pro- gra-e a s s i s t e d by FA0 and UNICEF and i n the t r a i n i n g of h e a l t h personnel f o m e c t e d wi th t h e app l i ed n u t r i t i o n progranme.

r

w w "

LExpre~sed in US Dollars4

INDIA

3.2.3 Human Re~roducrion

Stren~chenin~ of the Teaching of Xvman Re~roduction, Family ~lanninz and Popularion ~ynamics in Medical Colleges IND/71lP03

short-term consultanrs Fellowships Supplies and equipment

3.2.4 Nvfririon

Applied Nutrition Proz.ranme

short-term consultant Fellowships rarricipanis Supplies and equipmenr

~ ~ e i n i n x of Dietitians

Fellovshipe

Nutrition raining

Short-term consu1Lanrs Temporary advisers Fellowships supplies and equipment

project NO.

R E G U L A R

Number of Post.

1974

B U D G E T

EILimfed Obligations


1975 1977 1974

m u m " c w 3 3 r.

2 r. I 1975 / 1976

I I XRP W l

(0275)

i

1976

Number of Posir

I I I

MIT W l (0181)

NUT 002 (0266)

NUT m 3 (02671

i 26 511 67 315 32 947

126 773 - - i

I

i !

I I I

1 IW I 10 800 7 650 ! 5 100 / 7 650 I 700 1 100 7 w

2 W 200 200 2 W - , - - 9 650 6 800 8 550 - - - 1 -

I i

i I

i 1 I 2 4W

14 250 13 200 14 250 12 000

1977

21 6

21 1

4/21

1974

Estimated ~bligatione

3/18

2/24

21 1 4/21

i , I i ! I i

i

i

i

! I !

i I

27 250 -

31 9

1974

1/2w 31 9

2 1 1 2124

I

14 Zoo ! 18 650

1975 1976 1977 1975 1977 1976

INDIA

Tra in ing i n Heal th Education HED M 1 ( Ind ia 0190)

To a s s i s t i n e s t a b l i s h i n g and developing th ree post-graduate h e a l t h educa t i o n t r a i n i n g c e n t r e s w i t h r u r a l and urban f i e l d p r a c t i c e areas.

I n 1969, two c o n s u l t a n t s reviewed the f a c i l i t i e s a v a i l a b l e for post-graduate t r a i n i n g i n h e a l t h educat ion. I n 1971, a consu l t an t a s s i s t e d i n reviewing t h e curr iculum of the past -graduate course i n hea?:h education provided by the Centra l Heal th Education Bureau under Delhi Unive r s i ty . I n 1973, N o consu l t an t s were provided to examine t h e c u r r i c u l a . I n 1974. th ree na t iona l group educat ional a c t i - v i t i e s w i l l be conducted. A number of f e i l o v s h ~ p s i n h e a l t h education a r e being provided.

I n 1976 and 1977, consu l t an t s v i l l a s s i s t wi th group educat ional a c t i v i t i e s and i n the eva lua t ion of a c t i v i t i e s c a r r i e d o u t .

The p r o j e c t i s expected to continue u n t i l 1977.

Cen t ra l Hea l th Education Bureau RED 002 ( Ind ia 0247)

TO a s s i s t t h e Cen t ra l Heal th Education Bureau i n s t rengthening var ious a s p e c t s of i t s work.

I n 1969, two c o n s u l t a n t s a s s i s t e d wi th the conduct of a conference on behavioural aciences he ld i n t h e Bureau, and a fe l lowship was awarded i n 1970. I n 1971, a c o n s u l t a n t advieed on t h e design of s t u d i e s . I n 1974, a consul tant v i l l a s s i s t the Bureau i n s t rengthening i t s funct ions r e l a t e d to research.

Heal th Education (ITNDP IND/68/030)

RED 003 ( I n d i a 0108)

To a s s i s t i n the es tabl ishment and development of S t a t e h e a l t h educat ion bureaux; to a s s i s t i n the in teg ra t ion /co-o rd ina t ion of h e a l t h educat ion a c t i - v i t i e s of the general h e a l t h s e r v i c e s wi th those o f t h e family planning programme a t d i f f e r e n t l e v e i s 05 t h e h e a l t h admin i s t r a t ion .

W O h e a l t h educators have been ass igned to the former Bombay S t a t e (1958), Ut t a r Pradesh (1966), Bihar (1961), Or i s sa (1964 and 1967), and Gujarat (1965 to 1968). I n 1971, a consu l t an t reviewed the c u r r e n t s t a t u s and func t ions of t h e S t a t e Heal th Education Bureau, Tamil Nadu. I n 1972, a consu l t an t was ass igned to Haharashtra .

From 1974, and i n 1974-1975, consu l t an t s w i l l be ass igned to d i f f e r e n t S t a t e s and N o long-term h e a l t h education s p e c i a l i s t s w i l l be provided.

The p r o j e c t which i s co-ordinated wi th Ind ia 0274, "Health Education i n Schools, Including Family L i f e Education", i s expected to cont inue f a r seve ra l yea r s , s u b j e c t to a v a i l a b i l i t y of funds.

me p r o j e c t i s expected to terminate a t the end of 1975.

INDIA


Trainins in Health Education

short-term consultant Temporary advisers Fellowships Participants supplies and equipment

ShDrL-rerm coo."lrants Temporary adviser. Felloviihips Perricipants supplies and equipmenr

Health educators

Sho~t-term consulLants Fellowships supplies and equipment uisce11eneoua

Medical Education HMD 001 (India 0111)

To assist medical colleges in developing the curriculum based on educational objectives and in improving student evaluation; to assist with research methodology, and to train national staff in various medical and public health fields.

Fellowships were provided between 1958 and 1964. Since 1965, amall groups of consultants have been assigned to a nunber of medical colleges to advise on, and assist with, teaching prograomes and to encourage inter-disciplinary co- operation and integrated teaching with emphasis on modern teaching methods. Groups of consultants have made follow-up visits. In 1973, five consultants were provided in disciplines related to medical education to assist medical colleges.

The activities of the project are co-ordinated with India 0234, "Raining of Medical Educators". From 1974 onwards,feilowships only will be provided.

Assistance is expected to continue for a nunber of years.

Post-basic Nursing Education HKD 002 (India 0136)

w INDIA L r

m.

Starting in 1962, WHO has helped with post-basic prograrmnes in Delhi, Atmedabad, Bombay, Bangalare, Madras, Lucknaw and Kanpur. Since 1964, colleges of nursing with post-basic degree programmes have been established in Ahmedabad, Bombay, Chandigarh, Madras and Kanpur. Since 1969, WHO has assisted the College of Nursing, New Delhi, with emphasis on the Master of Nursing degree programme. From 1974, Wa WHO nurse educators will be stationed at New Delhi and Kanpur.

Beginning 1974, the WHO nurse educator will assist in the development of a Continuing Education Centre at the College of Nursing, New Delhi, to conduct continuing education programmes in colleges, institutions and other centres in the country upon request.

Evaluation of post-basic nursing education programmes in the colleges being assisted has been started in 1974. An evaluation design drafted at Headquarters will be field-tested in Ahedabad.

Posts of two nurse educators are being continued till end 1977. Cansul- rants will assist in special areas of teaching and educational administration of the post-basic nursing institutions. A fellovship in nursing education will be provided every year to cover different States.

Assistance is expected to continue until the end of 1977.

TO assist in expanding post-basic nursing education, with initial emphasis on post-basic degree programmes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

project NO.

NED 004 (0274)

m 001 (0111)

m W 2 (0136)

m 003 (0200)

INDIA

Health Educetion in Schools, Including Plmily Life Education

INDl71IP02

Health Educator P4

Fellowships Parficiplmrs Supplies and equiaenr

4. HEALTH W P C V E R DEWLORLENT

4.1 Heslrh Uanpwei Development

nedical Education

Pellarshipe supplie. and equipmenr

Past-b..ic NurBing Education

Nurse educa~ors p4 ~ u r a e educator P3

Short-term consultenra Fellwshipe Supplies and equipment

Fel1ovships (Medical Librarlanahi~)

R E G U L A R

umber of ~ o s t s

(Expressed in US Dollars4

1974

B C O G E T

~srirnaced obligations

1974

s a m " c .. 5 3 u

$ r

FP

a

1975

~ v m b e r of ports

1975 1976

!

1 I I I !

1974 1976 1977


Estimated obligations

i

28122512154

2/16 1/12

3

I/ 6 8/72

3 1 M

I !

1 I

I

i !

1977

I

1974

124 850 2 400 -

11 6 1 - 1 -

5/35

i !

I I

1

I

1975

38 7 W 50 400 ! 65 100

- - -

1915

161102

1/12 1112

2

11 6 1112

1/12 1/12 ----

2 ----

1/12

I

i 1

1976

I

j !

12 580

I

25 1 W 35 3 W 2 100 I

75 080 1 - I

15/72

1112 1/12

2

11 6 1/12

127 250 ! 38 700 i 50 400 i 65 100

1977

I

I

1916

- - -

I

i ~ ! I

I !

1977

-

- 58 680

12 000 55 200 2 000

127 880 -

15 600

26 250 29 210 31 220 26 250 29 210 31 220 - 52 500 1

i 14 400 / 14 LW

' 9 200 I 9 200 1 9 200 2 000 2 OW - - - - 63 700 84 020

- , - I

j

2 000

88 040 -

INDIA

Physiotherapy School, Baroda m 005 (India 0257)

To assist with training physiotherapists to degree standard, "Bachelor of Science (Physiotherapy)", at the Physiotherapy School in S.S.G. Hospital, Baroda, aver a three-year period.

A WHO consultant was assigned in 1968 to advise on improving the Physio- therapy Department and to assist in the preparation of an outline of the curriculum. Since Harch 1969, a WHO physiotherapy tutor has helped in finalizing the syllabus for a three-year degree course and has assisted in the organization and conduct of the training programme. In 1972, the first group of physiotherapists graduated from the School. It is proposed to continue the physiotherapy tutor in 1975 while fellovships will continue to be awarded until 1976 for the further training of national tutors.

Training Progr-e for Medical Officers and Trainers of Besic Health Workers

llMD 006 (India 0280)

TO strengthen the rural health services by training health staff, particularly doctors and trainers of basic health workers, auxiliary nurse-midwives, health assistants (family planning) and other monavalenc health workers to be converted into multi-purpose workers.

The main activities far 1974 and 1975 will be related to the courses, their curricula and development of manuals. In 1976-1977, observation tours will be for senior officers and teachers of training institutions.

Assistance is expected to continue far several years.

Research in Nursing HHD 007 (India 0286)

To assist colleges of nursing and institutions in the design and conduct of operationallaction studies in the broad areas of nursing education and clinical nursing practice, including c-unity health nursing and to conduct workshopslseminars on nursing methodology for the faculties of various colleges of nursing and senior nurses working in clinical areas of cornunity health centres.

Starting in 1975, one nurse researcher will be based at the College of Nursing, Delhi, who will be available upon request to all other colleges of nursing and institutions in the country requesting assistance in the conduct of nvrring studies.

Assistance to the project is expected to continue for five years.

The project is the eontinustion of project SEAR0 0185, "Strengthening of Health Services", modified according to the present needs in this field.

INDIA

Seminars and Workshops on Medical Education HND 008 National Xedical Teacher Training Centre ( Ind ia 0221)

To a s s i s t i n f u r t h e r developing medical teaching.

Seminars and workshops i n spec ia l i zed f i e l d s have been organized every year Since 1966, i n c o l l a b o r a t i o n wi th the Indian Academy o f Medical Sciences.covering va r ious t o p i c s .

Subject t o the concurrence of the Government of Ind ia , the top ic for the seminar t o be held i n 1975 w i l l be decided i n consu l t a t ion with the Indian Academy of Medical Sciences .

The p r o j e c t w i l l be terminated a t the end of 1975

Medical L i b r a r i e n s h i e

HHD 012 ( I n d i a 0296)

To a s s i s t i n e s t a b l i s h i n g s l a t i o n a l Teacher Training Centre f o r Heal th Personnel .

The purpose of the Cenrre would be to t r a i n medical and o t h e r h e a l r h personne l i n modern pedagogical methods and the use o f audio-visual m a t e r i a l s i n teaching of the healrh sc iences . Training would be given i n the development of task- based curr iculum, es tabl ishment of i n s t r u c t i o n a l o b j e c t i v e s and l ea rn ing exper iences , and evsluar ion of s tuden t performance. The proposed Cenrre would i n v e s t i g a t e the problems i n medical education and education of o the r h e a l r h personnel i n Ind ia . Poss ible f i e l d s o f i n v e s t i g a t i o n s would be the study of the development o f h e a l t h manpower i n the country appropr ia t e to t h e n a t i o n a l needs .

Km 011 ( I n d i a 0293)

To t r a i n medical l i b r a r i a n s

INDIA

Seminars and Warkaho~s on medical Education

Short-term consultants ~ e ~ p o i s r ~ advisers ~arricipanrn Grant supplies and equipment

Traininx of Medical Educators IND1711034

Fellowships Miscellaneous

Strengthening of Teaching of H u n Reproduction, Population Dynamics and family Planning in Nursinn and Miduifery Education INDi71/P05

Nurse educat~r P3

Short-term conrulcanf Temporary advisers Fellovahip. Participants supplies and equipment

medical Librarianship

Fellavshipa

National Medical Teacher train in^ Centre

Short-term consultant Fellowships svpplier and equipment

R E G U L A R

~vmber of oars

1974

31 3 3 1 3 ~

B U D G E T

Entimared nbligafiona project

NO.

HW 008 (0221)

HMD 009 (0234)

mu 010 (0277)

Dm oil (0293)

HW 012 (0296)

1974

6 000 750

5 loo

1975

21 2

(Expressed in US Dallsr8J

2/20

: 1975 1976

! 2 500 i 500 I 500 - -

12 350 1 7 400

- 1 - #

~ I 1 , '

!

I i

i I ~

i I I

1977

I i I

1 4 4W ; i I

i

1976 1974

4117

I/ 1 -

1 - 1/11 31 6 2112

I

i I 11 bW I 11 4W - - -

I i

1977

2/20 11 400

14 400 7 2 W 1 ow -

22 600 -

- 0 m " c w

3 2 - 2 -

DP

PP

umber of posts


Eatimared Obligarions

2/20

I/ 6 6/18

1975

1

1974

i I

!

I 1 ~ i I

i

1976 1975 1977

I

1976

I i !

I i

1977

5 253 - 160

5 413

i

- ,

2 100

i !

22 000 / i 6 CQO 1 1 15 2 W 8 850 9 720 - 63 870 -

i ~ I

National I n s t i t u t e of C m u n i c a b l e Diseases ESD 001 ( Ind ia 0259)

TO a s s i s t t h e Nat ional I n s t i t u t e of Cornnunicable Diseases, Delhi, i n the conduct of the WHO i n t e r - r e g i o n a l t r a i n i n g course i n the epidemiology and c o n t r o l o f communicable d i seases , he ld p e r t l y i n Prague and p a r t l y i n Delhi ; t o a s s i s t t h e i n s t i t u t e i n e t rengthening i t s f a c u l t y i n o rde r t o improve f u r t h e r t h e f i e l d t r a i n i n g of epidemiologis ts .

WHO has been conducting t h i s course f o r the p a s t seven years. About h a l f the number o f t h e p a r t i c i p a n t s i n t h e course are usua l ly from coun t r i e s i n the South-East Asia Region.

I n 1976-1977, t h e grant- in-a id meant f o r t h e above purpose w i l l continue.

I t i s expected t h a t t h i s course w i l l be continued f o r a few more years .

Ha la r i a Erad ica t ion

TO a s s i s t t h e malar ia e r a d i c a t i o n p r o g r a m .

WPD 001 ( Ind ia 0153)

The NaCioaal H a l a r i a Erad ica t ion Programme, a s s i s t e d by USAID and WR0,was starced i n 1958. Good progress was made up t o 1963-1964. b u t l a t e r . owing to r eve r s ion of many a r e a s t o a t t a c k phase, t h e programme vas reviewed and a nev s t r a t e g y proposed i n 1970. An experimental s tudy i n Jodhpur C i ty , us ing

N m.

INDIA w

LECO U-L-V machine, t o f i g h t urban malar ia has been i n ope ra t ion s i n c e 1973 and the r e s u l t s are encouraging. WHO a s s i s t a n c e wi th t h e t r a i n i n g of va r ious ca te - g o r i e s of n a t i o n a l personnel a t the Nationel I n s t i t u t e of Communicable Diseases , Delhi, cont inues t o r ece ive p r i o r i t y .

WHO a s s i s t a n c e i n 1976 and 1977 includes provis ion of short-term eansul- Cants f o r annual assessments, supp l i e s end equipment, fe l lowships i n t h e va r ious a s p e c t s o f ma la r i a and l o c a l c o s t subsidy f o r t r a i n i n g .

Assis tance t o t h e p r o j e c t i s expected t o cont inue f o r some years .

F i l a r i a Control

TO a s s i s t i n t h e t r a i n i n g of the sen io r medical and paramedical s t a f f i n the methodology o f con t ro l l ing f i l a r i a s i s .

The f i r s t t r a i n i n g course w i l l take p lace i n 1975, vhen a fe l lowship w i l l a l s o be awarded.

I n 1976-1977, four medical o f f i c e r s w i l l v i s i t coun t r i e s i n t h e r eg ion f o r observat ion o f f i l a r i a s i s con t ro l progracmes.

Projecr NO.

FSD 001 (0259

ESD 002 (0182)

m 001 (0153)

W D 002 (02871

INDIA

5. DISEASE PREVENTION ANLl CONTROL

5.1 C-unicable Diaeese Prevention and control

5.1.2 ~pidemiolosicnl Surveillance of Communicable Dieeases

~arional I n s t i ~ u r e of C-micable Diaenaes

Grant

Sfren(lthe"in~ OF Health Services INDl681029 (E~idemialaav)

short-term consulrsnr Fellowships supplies and equipment ni.ce11aneous

5.1.3 Halaria and other Parasitic

Malaria Eradication

short-term coneultants Pellmships Subsidy supplies and equipment

Fil-ria Control

Fellmshipa ~arricipencs

R E G U L A R

Number of Posfa - 1974

B U D G E T

EsfimaLed Obligations

. . . . .

m a v " c 8 - ,

DP

- ~ u n b e r of ~ o s r a

1975 1974

, . .. . -. . . . . . . . . . .

O T l i E R S O U R C E S

1974 1976 1975 1977 1976

I I

i 1 i 1 !

I !

I I - 1 212,

1977-

I

~ ; ::2: 1

i !

1 :

i ~ 1

i ;

i ~ !

! ~ ~ i 1

1975

Estimated Obligariona

1977

21 2 17/41

41 8

21 2 mi25

1974

21 2 ,7139

41 8

21 2 19/48

11 3

i

4 800 20 750 12 000 70 000

107 550

4 O W

- 4 000

1

I

1 , i ! 1

1976

1 300

-

1977

i I i i

I

!

I 15 W O 1 14 816

~ 314 ~ I

30 130 1 i

-~ ; ~ i

I i

I ~ !

! I ~ ! I I

1975

!

i !

i

I

1976

i 1 300 I - !

1

4 000 14 500 12 000 70 000

100 500

I

I 4 400 / 4 800

24 500 1 21 150 12 000 70 000

110 900

2 550 5 wo - 7 550

12 000 70 000 ----

107 950 ---- 4 000

- 4 MO - - -

INDIA

Smallpox Erad ica t ion SHE 001 ( Ind ia 0233)

To achieve t o t a l e rad ica t ion of smallpox i n the country by 1977

The p r o j e c t s t a r t e d i n 1967, when a j o i n t GovernmentlUHO team made an assessment of t h e programme i n t h e va r ious regions of t h e country. Since 1971, UHO epidemiologis ts ( 4 from 1971 and 8 from mid 1973) and consu l t an t s have been provided i n a d d i t i o n to subsidy, supp l i e s and equipment. Prom t h e beginning of the pro- g r a m e , emphasis has been placed on surveillance-cum-containment a c t i v i t i e s . S t r e s s i s a l s o l a i d on developing a uniform sroallpox repor t ing system. Tra in ing courses were he ld f o r s t a f f st a l l l e v e l s and s t a t e su rve i l l ance teams were c r e a t e d . In t h e autumn of 1973, an i n t e n s i f i e d campaign was s t a r t e d , focussed mainly on t h e four h igh ly endemic s t a t e s , i .e . B iha r , Hadhya Pradesh, U t t a r Pradesh and West Bengal, which accounted i n t h a t year f o r 94% of a l l cases i n I n d i a . More than 40 epidemiologis ts , approximately ha l f of them being r e c r u i t e d from wi th in t h e country , a s s i s t e d i n the o rgan iza t ion and supervis ion of t h e campaign.

I n 1974, inc reased suppar t by UHO w i l l be given mainly i n t h e form of a d d i t i o n a l shor t - term epidemiologis ts , subsidy and supp l i e s and equipment. Funds w i l l a l s o be made a v a i l a b l e by SIDA f o r the programme. A l l e f f o r t s w i l l be made t o ensure t h e mobi l i ty of t h e d i f f e r e n t ca tegor ie s of s t a f f . Surve i l l ance a c t i - v i t i e s i n t h e non-endemic S t a t e s and systemat ic vaccinat ion of t h e populat ion w i l l cont inue to be s t rengthened, p r i o r i t y being given t o primary vaccinat ion.

I n 1976, consultants w i l l be personal ly ca r ry ing o u t and organizing su rve i l - l ance a c t i v i t i e s , mainly i n those a r e a s previously heavi ly i n f e c t e d , and i n 1977, as p a r t of m i n t e r n a t i o n a l assessment team, they w i l l c a r r y ou t t h e f i n a l a p p r a i s a l a £ t h e programme, when i t i s expected t h a t t h e country w i l l be o f f i - c i a l l y dec la red smallpox-free.

The p r o j e c t i s co-ordinated by the s t a f f of in ter-country p r o j e c t SEAR0 0030, "Smallpox Erad ica t ion and Epidemiological Advisory Team".

Leprosy c o n t r o l HBD 001 ( Ind ia 0081)

To a s s i s t i n developing a leprosy con t ro l programme, mainly throvgh t r a i n - ing and manpower development i n leprosy con t ro l .

Assis tance was given t o p r o g r a w e s i n Andhra Pradesh i n two leprosy con t ro l p i l o t cen t res . The programmes were supported by the "Danish Save t h e Children" Organizat ion. Normal a s s i s t a n c e through provis ion of c o n s u l t a n t s , long-term s t a f f , e t c . , vhich s t a r t e d i n 1961, ended i n 1972. I n t h e c u r r e n t phase, fe l lowships are being provided to t r a i n n a t i o n a l s t a f f .

Assis tance i s expected to continue u n t i l 1977

w INDIA a

m

Tuberculosis Research Centre , Madras MBD 004 ( Ind ia 0295)

To a s s i s t i n c o n t r o l l e d t r i a l s to evolve simple, e f f e c t i v e and inexpensive methods of tube rcu los i s c o n t r o l through domic i l i a ry and arcbulatory chemotherapy, and i n ca r ry ing ou t r e l a t e d re sea rch .

P r o j e c t I n d i a 0053, "Tuberculosis Chemotherapy Centre , Madras" a s s i s t e d by WHO i n co-operation with the Government of I n d i a , the S t a t e Government of Tamil Nadu, t h e Indian Council of Wedical Research and the B r i t i s h Medical Research Council , was s t a r t e d i n 1955; s i n c e then a s e r i e s of i n v e s t i g a t i o n s on ambula- t o r y and domic i l i a ry chemotherapy has been c a r r i e d ou t . Since 1970, when regu la r WHO s t a f f were withdrawn, a s s i s t a n c e to the Centre has been continued through consu l t an t v i s i t s , fe l lowships and the provis ion of supp l i e s and equipment. I n 1972 and aga in in e a r l y 1974 shor t - term consu l t an t s proposed broadening of the s tudy o b j e c t i v e s of the Centre . From 1976, i t i s proposed t o a s s i s t a new p r o j e c t wi th broader o b j e c t i v e s and under i n s t i t u t i o n a l base .

V i r o l o ~ i c a l Techniques VIR mi ( Ind ia 0214)

To a s s i s t i n the development of laboratory capacicy for t h e diagnosis and s u r v e i l l a n c e of v i r a l d i s e a s e s ; t o a s s i s t i n the production of l i v e p o l i w y e - l i t i s vaccine and i t s neurovirulence t e s t i n g (NVT) a t the National I n s t i t u t e of Communicable Diseases (NICD), Delhi.

I n 1969, a consu l t an t reviewed the procedure f o r the manufacture of l i v e p o l i o vaccine i n Coonoor. I n 1970, a consul tanr neuropathologis t advised on the design and planning of the NVT u n i t of t h e NICD and provided a protocol f o r the procedures t o be followed i n t e s t i n g po l iomye l i t i s vaccine; a pa tho log i s t was t r a i n e d i n NVT i n the c o n s u l t a n t ' s laboratory i n t h e United Kingdom. I n 1972, t h e neuropathologis t consu l t an t reviewed the work of the NVT u n i t and assessed i t s c a p a b i l i t y f o r assaying po l iomye l i t i s vaccine.

I n 1973, a consu l t an t helped i n e s t a b l i s h i n g Streptococcal Reference Laboratory a t t h e Lady Hardinge Medical College; a team of WHO exper t s have as sessed t h e e l i g i b i l i t y of Haf£kine I n s t i t u t e , Bmbay, in r e l a t i o n to produc- t i o n of p o l i o vaccine. I n 1974, a consul tant w i l l advise t h e Virus Research Cen t re , Poona,in che development of R icke tes i a l Laboratory and a team of WHO e x p e r t s w i l l advise i n s tepping up production of po l io vaccine i n Coonoar.

I n 1975 through 1977 consu l t an t s and fe l lowships w i l l be provided i n s ~ e c i a l i s e d s u b j e c t s , wi th s v iev to s t rengthening the r e fe rence se rv ices provided by the Centra l Laborator ies i n vi rology, v i r u s serology and v i r u s vaccines . I n 1977 g r a n t i s earmarked to support the c o s t of na t iona l course i n vi rology.

Training i n Veter inary Publ ic Health WH 001 ( Ind ia 0244)

To a s s i s t i n developing f u r t h e r a post-graduate (Mas te r ' s degree) course i n v e t e r i n a r y pub l i c h e a l t h a t the Al l - India I n s t i t u t e of Hygiene and Pub l i c Heal th , Calcut ta .

I n 1970, the f i r s t WHO Regional Seminar on Veter inary Publ ic Heal th was held (under an in ter-country p r o j e c t ) . Assis tance was given i n s t r eng then ing t h e f a c u l t y fo r t h e newly es t ab l i shed course i n v e t e r i n a r y pub l i c h e a l t h a t the Al l - India I n s t i t u t e of Hygiene and Publ ic Heal th , Ca lcu t t a . I n 1971 and 1972, f u r t h e r a s s i s t a n c e was given through consu l t an t s (one of them provided under SEAR0 0168).

I t i n expected t h a t -XHO consu l t an t s w i l l v i s i r i n 1975-1976 the Department of Veterinary Publ ic Health a r the Al l - India I n s t i t u t e of Hygiene and Publ ic Heal th i n Ca lcu t t a and a s s i s t i n improving resea rch and t r a i n i n g a c t i v i t i e s .

The p r o j e c t i s expected to continue f o r a number of yea r s

Cancer Control P i l o t P r o j e c t , Tamil Nadu CAN 001 ( Ind ia 0238)

TO a s s i s t i n t r a i n i n g h e a l t h personnel i n e a r l y d e t e c t i o n , d i agnos i s , h e a l t h education and epidemiological i n v e s t i g a t i o n s a t t h e Arignar Anna Memo- r i a l Cancer I n s t i t u t e ; t o a s s i s t i n the o rgan iza t ion and s t r eng then ing o f f a c i l i t i e s f o r t r a i n i n g , se rv ices and research a t t h e Arignar Anna Cancer Hospi ta l (Regional Cancer Centre) i n Kancheepuram.

Af te r t h e v i s i t of a team i n 1967, WHO provided t h e s e r v i c e s of a d i r e c t o r , a s o c i a l s c i e n t i s t , a cy topa tho log i s t , a s t a t i s t i c i a n and a s o c i o l o g i s t . From January 1971 t o January 1973, a WHO programme d i r e c t o r was ass igned under p r o j e c t I R 0458, "Cancer Control". Grants were given i n 1968 and 1969 t o meet p a r t of the l o c a l c o s t s , whereas from 1970, t h e Gavelnment has r eques ted t h a t t h i s g ran t be used for purchasing equipment. I n 1974, one consu l t an t i s be ing provided to a s s i s t i n t h e o rgan iza t ion of s e r v i c e s i n t h e cancer h o s p i t a l and another i n the t r a i n i n g programme f o r t h e cy to techn ic ian a t t h e I n s t i t u t e . A consul tant w i l l a s s i s t i n 1975 i n t h e development of t h e epidemiological i n v e s t i g a t i o n s ir. oropheryngeal and s e r v i e a l cancer . A f e l lowsh ip w i l l be o f f e r e d fo r t r a i n i n g i n cancer treatment.

I n 1976-1977, consu l t an t s and fe l lowships i n epidemiology and o t h e r r e l a t e d sub jec t s w i l l be provided. The p r o j e c t i s a l s o supported by t h e Norwegian Agency f o r I n t e r n a t i o n a l Development.

Assis tance i s expected t o cont inue u n t i l t h e end o f 1978.

Assis tance to t h e p r o j e c t i s expected t o continue till the end of 1977

Establishment of Regional Cancer Centres CAN 002 (India 0288)

To assist in the organization of regional cancer control programmes, through the strengthening of training, service and epidemiological investigations, and in co-ordinating training and epidemiological research in the regional cancer centres.

In 1975, a consultant vill review the progress and advise and assist in the establishment of regional cancer centres. In 1976, W o consultants vill assist in cancer epidemiology and control and in 1977 fellowships in cancer therapy will be awarded.

Assistance will continue till 1985.

Fellowships (Cardiovascular Diseases) C M 001 (India 0200)

To assist in the training of national staff for strengthening services in cardiovascular diseases.

In 1968, a consultant explored the possibility of establishing coronary care units and recornended installation of such units in the collegiate hospitals in New Delhi Chandigarh, Bombay, Calcutta and Madras. In 1971, a seminar on rheumatic heart disease was organized under India 0221, "Seminars and Work- shops on Medical Education", for teachers in medicine, cardiology, surgery, paediatrics and microbiology and for other health personnel a t the All-India Institute of Medical Sciences, New Delhi. In 1972, advice was given to the Institute of Cardiology, under development in Madras, on the training progcaomes, services and research. The Institute was inaugurated in April 1972 vhen VHO assisted in the conduct of a scientific session.

m INDIA 0.

m

A number of urban hospitals in India are setting up coronary care units. WHO plans to assist in the training of the health teams in the management of cardiovascular diseases and in the organization of cardiac and stroke registries.

Prevention and Control of Cardiovascular Diseases C W 002 (India 0294)

To assist in the development of cardiac resuscitation and rehabilitation services, integrated into the existing public health delivery system, in training health and allied health workers in the management of cardiac emergencies and in the organization of health education for the prevention and control of cardiovascular diseases.

From 1976 project India 0200 (Cardiovascular Diseases) has been merged into this project.

In 1976-1977, fellowships vill be avarded to assist in training physicians, surgeons and cardiologists in recent advancer in cardiology, in epidemiology of cardiovascular diseases, in public health aspects for prevention and control of cardiovascular diseases,and for training in epidemiology, health education and management of peripheral vascular diseases.

Assistance is expected to continue till 1985.

In 1974 and 1975 fellowships have been provided to cardiologists, technicians and cardiac surgeons in various fields of cardiology.

R L G L L A K B C D C L T

INOLA

Establishment oi Re",ianal cancer c e n t r e s

Short-term consultants Fellowships supplies and equrpment

5.2.3 Cardiovascular Diseases

Frllowshrps (Cardiovascular

oiseaees)

~ r n v e n r i o n and control of Cardiovascular D~seases

Fellovshlps

5.2.5 Dental Health

lmprovwenc of Dental Educaiian IND/68/031

sho r t - t e rm conrulranir Fellowships Supplxes and equipment Miscellaneous

5.2.6 Mental Health

Fellowships (Mental Health)

Number n t P o i t i EsClllated Obligarions pro,ecr NO.

CAK 002 (0288)

C W 001 (0200)

cw 002 (0294)

DMi W1 (0208)

M N i 001 mm'

1974 1971 1 9 7 0 119:- 1 1974 1975 197b 197-

1 ~ !

11 2 21 4 4/24 ! &/I6

!

~ 8/32 j 3/20

8 I

I i

i I 1

I i

1 1 I

I

3/20 : !

i I !

I '

w G. O

E x p r e s s e d r n I T "ollarsl

I

I I

! :. 400 9 600

1 5 6 0 0 ' 12000 6 000 10 000 6 000 - - -

10 400 35 200 ! 18 M1O - - -

2 4 000 12 600 - - 1 !

~ I

1 n, I i

i

~ !

!

I

i 12 600 i

! ~ I 1

i I I

I' T

Number ili P a r l s

1974 11975 11976 , 19::

I

1 ! i

1 i

! I

3/13 8

2/15 1

i I

1 ~ !

I ~ ; i

~! : I

!

H t ii S l i ' E S

Crrlrnated :'bl~gacluus

1974 Iq:j 1976 1977

I ~ I

i I I I

I

! 32 5 W ' 7 300 1 2 335 !

619 ! - 42 754 ~ - ~ ~ I ~, !

!

a rn d c k >

3 L

2 -

DP

.

Mental Heal th MNH 002 ( I n d i a 0289)

TO a s s i s t the Al l - Ind ia I n s t i t u t e of Mental Health, Bangalore, i n the o rgan iza t ion of t r a i n i n g progr-es f o r psych ia t r i c personnel, i n the development of pilot-cum-demonstration f i e l d u n i t s f o r community-oriented mental h e a l t h ca re s e r v i c e s and i n epidemiological inves t iga t ions of mental i l l n e s s .

In 1975, a long-term s t a f f member w i l l be assigned to a s s i s t i n the organiza t ion of t r a i n i n g programmes f a r p s y c h i a t r i c personnel . Short-term fe l lovsh ips v i l l be awarded f o r senior t eacher s i n psychiat ry to v i s i t advanced cen t res and observe developments i n s e r v i c e s , t r a i n i n g and research. Similar a s s i s t ance v i l l be continued i n 1976-1977.

The p r o j e c t i s expected to cont inue till 1985

Fe l lovsh ips (Drug Addiction) ADA 001 ( Ind ia 0200)

To a s s i s t i n t r a i n i n g i n epidemiology of drug abuse; i n prevention, t r e a t - ment and r e h a b i l i t a t i o n of drug abuse, and i n hea l th education fo r the prevent ion and c o n t r o l of drug dependence.

Fellowships t o be awarded v i l l be r e l a t e d to the epidemiology of drug abuse and a l s o to t reatment and r e h a b i l i t a t i o n .

Drug Laboratory Techniques and Bio loa ica l Standardizat ion

SQP 001 ( I n d i a 0222)

To a s s i s t i n the development of the se rv ices concerned wi th t h e q u a l i t y con t ro l of pharmaceutical and b io log ica l p repa ra t ions , and i n the t r a i n i n g of s t a f f .

I n 1967, a consu l t an t v i s i t e d var ious l a b o r a t o r i e s and i n s t i t u t i o n s and c o l l e c t e d background matc r i e l for t h e formulation of a p l a n . I n 1970 and 1971 tm c o n s ~ l t a n t s a s s i s t e d i n the formulat ion of t h e plan and prepared a d r a f t document. Io 1972, a consu l t an t f i n a l i z e d t h i s document, which i s under consi- de ra t ion by the Government. I n the meantime, n a t i o n a l s t a f f are being t r a i n e d through fe l lowships .

Assis tance to the p r o j e c t v i l l cont inue u n t i l 1977

Ass i s t ance w i l l cont inue till 1980

- -

INDIA

Mental Health

Medical o f f i c e r P4

Fellovshlps supplies and equipment

5.2.7 Prevention and Control of Alcoholism and DruR Dependence and Abuse

Fellowships (nrup ~ddic~ion)

5.3 Prophylactic and Therapeutic Sub.tancei

5.3.2 Speciflcaflons and Qualife Control o f Pharmaceutical Preparations

~ r u ~ Laboratory ~ e c h n i s u e r and Biolopical Sfandardiza~ion

Fellowships Supplies end equipment

R E G U L A R

Number of P o r t s

1974

B C D G L T

Errrmared Obligations Prajecr No.

HMI 002 (0289)

ADA 001 tozoo)

5QP 001 (0222)

I 1974 1915 1976

!

1975 1977

31 220

(Expressed in US Dollars

1976 1977

I I

1 I 11 6 1 1 1 2 1/12

- 1 - I-

ii: , - l3 lZ5 29 210 i

I i

550 13 8 W i 13 8oo 1 500 1 W0 5 000 3 O W - - - - 1 500 I6 615 48 010 50 020

1 I I

'm ilia. ~ i

I

21 600 i 7 800 15 600 1 19 500 2 W 0 2 W O 2 O W 2 0 W

Number of Ports

4120 4/20

i

I

1 ! 1

21 9 r l a 11 6

- 1 - - fl -6" - 17600

!

I I I I i

1974

l/ 3

ilra

- - 215"

u Q " c k 3

1


irtlmated Ubligarions

6/36

I !

I

I I

I 1 ~ ~ 1 :

~ ~ ~ ~ 1 I

1 i

1

1975 1914 1 19.5 1976 1976 1977 1977'

I I 1 I

I i

i I

I

i i

~ i I I I ~ ~

I

!

1 i i

i ~ i

~ ~ I

1

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I

5/30

1 2112 4/24

I 1

I I

I I

INDIA

Village Water Supply BSH 002 (India 0268)

TO assist in planning and co-ordinating the development of comunitv water supplies in rural areas, including the well-drilling programme in areas where hard rock presents special problems and in those where water is scarce; to train professional and drilling staff.

This project is a continuation and expansion of the assistance formerly provided under India 0227, "Rural Water Supplies", and India 0125. "Community Development Areas - Community Water Supplies8'.

In 1971, a sanitary engineer was assigned to assist the programme in six southern States of India and another sanitary engineer was assigned in 1973 to provide similar assistance in the northern States. In 1974-1977, bath the sanitary engineers will continue. In 1975, consultants, including master drillers will be provided.

In 1976-1977, short-term consultants in drilling, operation and maintenance, and sanitation will be provided. Fellowships for field training will be related to different specialties.

UNICEF is providing assistance in the form of materials and equipment.

Solid Wastes Disposal B5W 003 (India 0272)

TO assist in studying the problems of solid wastes in urban communities and to advise on planning the management of solid wastes.

Your fellowships were awarded in 1973. In 1974, it is proposed to provide a consultant to advise on solid wastes disposal problems in Bangalore and Delhi. It is also planned to provide further consultant services in 1975 on solid wastes management.

In 1976, a consultant is proposed to advise on solid wastes collection and disposal methods in various urban centres, and fellowshipe will be provided for field training. Assistance to the project will cease at the end of 1976.

Assistance is expected to continue until 1980.

R E C ! L A R B r D C E T

I N D I A

6. PRMQTION OF ENVIRONHENTAL HEALTH

6.1 Promotion of tnvrronmenra1 Health

6.1.2 Pravrslan of Basrc Sanrrary neasures

Ground-water I r a r n l n ~ Course

Short-term conr4:tanf Fellowships Supplies end equ~pment

Villa~e water sum1y

Sanitary engineers P4

Short-term consultants Fellovrhipr Participanr~ supp~res and eqdipmenr

Solid wastes Disposal

short-term consultants ~ei~ovships Grant supplies and equlpmenr

Number oi r o r r s

1974 i 1975 11970 19;: Ertlns:ed Obllgeriuns

1976 I I975 l Y l b l i i

Project N O .

BSM 001 (0251)

BSU 0-32 (0268)

BSU 003 (0272)

1 , 1 I ~ 1

w 4 "

Lxpressed 1" I > OollarlL

i i !

1 / 3 / ~ 12/72 1 i

! i ~ i

2/24

2 -- 8/24

6 000 L1 WO , I 000 - -8 W O -

50 3 W 26 250 29 210 31 220

!

39 6 W 36 O W 14 4 W 28 000 30 600 35 700 30 600

6 O W 500 2 wo 10 wo 10 w o

- , - - - 78 800 LO4 rJ0 110 910 86 220 - - - -

1 8 W O ' 6 M O 7 200 34 300 I 25 500 25 500

2 5 W ! 1 000 9 w 5 ooo

- ! - -

,' T

Number 0 , P J a : i

I

I

1 1

1/12 1/12 1/12 --- ;- 1 ' 1 ; l

,- i- 4/18 5/13 121 b 12/36 14/42 12/36

i

43 300 -

1974

" z b. 3 3 -

2 , 1971 '197r ' 197:

li E 3 S O R C E S

isrrnarru lbllgarionr

1 ! I !

35 500 37 700

I

i i I

i

I

I

I : i

~~: I

1 I :

L97h ! 14.5 1976

- -

lY7i

I/ 3 W 3 0

I

21 4 9/54

1

!

i

1

i

I I

I

i

I

I ~ ! 1 i i I ~ ~ ! I

I

I I ~ I

I

I/ 3 IWIO

w INDIA Q z-

Rura l Water Supplv (UNDP INDl i r i O l S I

B s x m i ( I n d i a 0297)

To i n i t i a t a a p i l o t p r o j e c t u t i l i z i n g l a r g e d iameter deep d r i l l i n g r i g s i ~ r r u r a l wa te r sunply pragrammes.

I t i s proposed: t o c a r r y o u t i n v e s t i g a t i o n s and surveys and draw c? p l a n s and des igns neces sa ry f o r t h e s e l e c t i o n and p r e p a r a t i o n of va r ious water supply schemes; t o d r i l l approximate ly 1 500 tubewe l l s w i th capac i t y t o p rov ide water t o a t l e a s t two v i l l a g e s each , and t o t r a i n n a t i o n a l s t a f f .

The p r o j e c t i s expected t o con t inue up t o 1978, s u b j e c t t o a v a i l a b i l i t y o f funds.

P reven t ion and Con t ro l of Water P o l l u t i o n CEP 001 ( I n d i a 0226)

To p rov ide t e c h n i c a l adv i ce on o r g a n i z a t i o n a l and o t h e r m a t t e r s r e l a t e d to t h e abatement and c o n t r o l of water pollution.

I n 1969, two c o n s u l t a n t s s t u d i e d t h e water p o l l u t i o n problems i n t h e S t a t e of Maharasht ra and a d v i s e d on t h e e s t ab l i shmen t and func t ion ing of a water p o l l u t i o c c o n t r o l board. I n 1971, a c o n s u l t a n t advised on a r g a n i z a t i o n a l , l e g i s - l a t i v e and o t h e r macters r e l a t e d t o a water p o l l u t i o n c o n t r o l programme. A c o n s u l t e n t was a s s igned i n 1972 t o a d v i s e on t h e prevent ion and c o n t r o l of water p o l l u t i o n , and e s p e c i a l l y on t h e use o f a n a l y t i c a l techniques i n t h i s f i e l d . Consu l t an t s e r v i c e s a r e planned f o r 1974 and 1975 f o r a s s i s t a n c e i n t h e f u r t h e r development of p r e v e n t i v e measures.

I n 1976-1977, c o n s u l t a n t adv i ce w i l l be g iven i n p o l l u t i o n c o n t r o i , a n a l y t i - c a l t e chn iques and p r o j e c t e v a l u a t i o n , and f e l l owsh ips f o r f i e l d t r a i n i n g w i l l be p r o v i d e i .

Contro l of Air P o l l u t i o n CEP M? ( I n d i a 0270)

To a s s i s t i n s t udy ing t h e problems of a i r p o l l u t i o n connected w i t h i n d u s t r i a l development, an< i n promoting a c o n t r o l programme.

S ince 1971, WHO a s s i s t a n c e through c o n s u l t a n t services and f e l l o w s h i p s ha s cont inued i n v a r i o u s a s p e c t s of a i r p o l l u t i o n c o n t r o l , and s i m i l a r a s s i s - t a n c e i s planned for 1975. I n 1976-1977, c o n s u l t a n t s e r v i c e s w i l l be made a v a i l a b l e to s t udy and adv i se on h e a l t h a s p e c t s of a i r p o l l u t i o n , a n a l y t i c a l de t e rmina t ion of p o l l u t a n t s and development of r e s e a r c h . Fe l l owsh ips w i l l be r e l a t e d to t h e areas i n which t h e c o n s u l t a n t s would a s s i s t .

Ass i s t ance t o t h i s p r o j e c t i s expected t o con t inue a t l e a s t u n t i l 1980

Medical Toxicology Uni t CEP 003 ( I n d i a 0279)

To a s s i s t i n s t u d i e s on the e f f e c t of a i r p o l l u t a n t s and o rganoch lo r ine p e s t i c i d e s i n man.

I n 1972, a c o n s v l t a n t a s s i s t e d i n e s t a b l i s h i n g an ep idemio log i ca l u n i t a t t h e I n d u s t r i a l Toxicology Research Cen t r e , Lucknov. Another c o n s u l t a n t a s s i s t e d t h e Cent re f o r two months i n 1973 i n i n s t a l l i n g a gas chromatograph and i n t r a i n i n g s t a f f i n p e s t i c i d e s d e t e c t i o n . I t i s planned t o p rov ide i n 1974 a c o n s u l t a n t ro h e l p i n improving t h e l a b o r a t o r y procedures a t t h e Cen t r e . I n 1977, a c o n e u l t s n t i n pa thology and epidemiology v i l l be provided.

A s s i s t a n c e to the p r o j e c t i s expected t o con t inue u n t i l 1978

A s s i s t a n c e t 3 t h i s p r o j e c t w i l l con t inue u n t i l 1980


INDIA

Rural Wafer Supply IND17410lb

Short-term consultants Fellowships Svpplres and equrpment

6.1.4 control of Envrranmental Pollurlon and Hazards

Prevention and Control of water ~ollution

Short-term consultants Fellovshipr Suppl~es and equlpmen:

Control of Air Pollution

Short-term consulranis Fellovrhlps Grant supplies and equipment

Medical Toxico!oqy h i f

s h o r t - t e r n consvltanrs Fellovships Farric~pilnrr Supplies and equipment

Eafimared Oblxgarions

I 1974 1975 1Y7b 19;;

1 !

!

1

Number o f P o s t s Pro~ecr

N O .

BSU CWi (0297)

CEP WJl (0226)

CEP 002 (0270)

CEP W 3 (0279)

1974 I

1975 i 197b ( 1977

8 000 19 B W 14 400 14 400

500 4 500 5 000 5 O W - - - - 27 550 49 8 W 44 900 44 900 - - - -

9 600 9 600

2 5 W 2 4 w 2 000 2 000

6 0 ; >i 800 2I4 350 iu 350 - 1 - - -

i I

i 11 3 11 3 b 000 i ; 7 200

i

I

Expressed rn C ? Dollarr.

!

i

1/12 1/12 1 1 4 3/15 6 600 b 600 3 W O , LO 350 1 300 I

9 000 5 000 14 O W - - I 21 600 1 12 900

- I - i

! 1 I

a m " c L. 3 2 - 2 -

DP

i! E R 5 1 1 : B i E S

Ercrmaced Obiigaf~onr

1974 iUl5 iY7b I 1977

30 O W 15 O W 15 W O 35 W O 10 000 40 O W 937 W 0 --- I - 85000 9 8 7 W O 7 9 3 0 0 0 137500 --- I -

i ! I

! 1 I I !

I !

I

i

T

Number oi ?or:r

1974 1975 1970 ' 1977

I I 1 1

2112 11 b 11 6 11 6 2118 4142 1/12

1 i

I

1

INDIA

Occupational Health HhT 001 (India 0197)

To assist with courses in occupational health related to specific hazards found in industries, and to advise on studies on speciflc hazards.

Arsisrancr was provided in organizing a Symposium an Academic Education and Training in Occupational Health and Hygiene on the occasion of the inauguration of the Yational institute of Occupational Health, Ahzedabad, in November 1970. In 19iL. a rrainlng course for medical officersfscientists responsible for occupat;onal health will be held in Ahmedabad. Further courses, assisted by WHO short-term csnsultants, are planned for 1975, 1576 and 1977.

Tbt fellowships are for thermal physiology, air pollution and observation visits.

The project is expected to continue for some years.

Radiation Medicine Centre, Bombay WID 002 (India 0192)

To assist in the organization of training of nuclear medicine specialists, in the sirengthening o f services and research and in the radiopharmaceutical production activiries of the Radiation Medicine Centre, Bombay.

Since 1963, consultants have been assigned to the Radiation Medicine Centre in Bombay for the establisbent and organization of this centre. They covered various specialties, e.g. computer analysis of protein metabolism, development o l radioisotope screening in relation to protein metabolism in tropical ~prue, thyroid metabolism, installation and standardization of a new scanner, radiorespirometry studies, radioisotope methdology for diagnosis of renal diseases, hormone imunoassay in endocrine disorders and goitre surveb- amongst school children in Bombay.

In 1973, an organic chemist was assigned to assist in the training programme, preparation of radiopharmaceuticals and research methodology. In 1974 the organic chemist continued, and a consultant is being provided to advise and assist in cornputor technology in nuclear medicine. A consultanF in teaching of nuclear medicine will assist in 1975 in organizing the training programme. Two fellowships will be awarded £or the training of the staff members. In 1976 and 1977, consultants and a fellowship in nuclear medicine will be provided. Short observation fellowships will also be provided for senior staff to visit various advanced centres.

Assistance is expected to continue until 1980

ixprrrsed i n r i Dollars'

K L G V L A K B C O G E T

26 900 26 050 21 000 31 8 W - - - - ~ I i

6.1.6 Biomed~cal and Env~ronmental Health *epecr. of 1onrzing Radiation

T r a i n r n R of Radlaxraphers

Organic chemist

7 Zoo 7 2 w Short-term conrulranrs 9 150 i 9 150 ~ei~owrhlps 3 000 4 000 Supplier and equipment

course in Hosplfal Pnyrice

Short-tern conru1iant Supplres and equrprnenr

.J - -

lSD1A

6.1.5 Health ul Workrnp, Populations

Occu~arional Health

Short-term conrul~anrs Fellavshrpr ~arricipanri supplies and equipment

Esri-alrd Obligat~onr

1974 I 1975 1976 li::

4 000 2 200 ' 4 800 4 800 12 900 15 750 13 200 24 W O 2 500 3 100 2 500 2 500 7 500 5 wo 500 500

Nvmher o f Porrr P r o j e c t so .

WP 001 (0197)

- - - -

: 1' t. '3 s ( ' : " I E S

1974

5 m u c b

3 5 - 2 -

- Number a! P o r t s

I 1971 1975 ' 1970 1 V - 1

I

i i

l l 2 l l 1 l i 2 . 1 1 2 4118 3 1 2 7 2 1 2 4 5/40

1 ; i

1975 '1976 197:

I r:~xe:eo Obligarrons

I 197r lV7i 1976 1917

~ ~

INDIA p.7 * a

Advanced Course i n Rad io log i ca l Phys i c s RAD 004 ( I n d i a 0290)

To a s s i s t t h e D iv i s ion o f Rad io log i ca l P r o t e c t i o n a t the Bhabha Ato:nic '~3eai;h . - , n r r z , R,>?bsy ; i i rh the conduct of t h e M.Sc. course i n r a d i n l 3 g i i a l p h y s i c . wirh t h e development o i r a d i o l o g i c a l p r o t e c t i o n s e r v i c e s .

T h i s Lourre rep laces t h e c o u r s e i n h o s p i t a l phys i c s ( p r o j e c t I n d i a 0232).

Prom 1975,onrrards a c o n s u l t a n t w i l l be provided annua l ly f o r a s s i s t a n c e i n Lhe t r a i n i n g of c a n d i d a t e s f o r t h e advanced course i n r a d i o l o g i c a l p h y s i c s . A g r a n t w i l l be provided t o cover t h e c o s t of t h e course. In 1977, ano the r consul- t a n t w i l l a s s i s t i n e v a l u a t i o n of t h e t r a i n i n g programme. Two f e l l owsh ips w i l l be awarded every yea r f o r f i v e y e a r s f o r t h e h ighe r t r a i n i n g of s t a f f members from t h e D i v i s i o n of Rad io log i ca l Phys i c s , Bhabha Atomic Research Cent re .

A ~ s i ~ t a n c e w i l l con t inue till 1981.

SES 001 ( I n d i a 0176)

To a s s i s t i n developing t h e I n s t i t u t e as a major r e s e a r c h and t r a i n i n g c e n t r e for envi ronmenta l h e a l t h problems and f o r co -o rd ina t i ng r e s e a r c h programmes.

The I n s t i t u t e r e c e i v e d a s s i s t a n c e from t h e Uni ted Xarions Development Programme ( S p e c i a l Fund) Crom 1961 t o 1967 i n the iorm of supp l i e s and equipment. WHO has pr,-,vided c o n s u l t a n t s t o a s s i s t t h e I n s t i t u t e i n the develapment of research programmes i n va r ious s p e c i a l i z e d f i e l d s o f environmental h e a l t h . In 1974, i c i s planned to a s s i g n t h r e e c o n s u l t a n t s i n the f i e l d s o f marine o u t f a l l s , sewage t r ea tmen t and a i r p o l l u t i o n 2nd the same number o i c o n s u l t a n t s i s proposed f o r 1975. 1976 and 1977, i n f i e l d s as y e t unspec i f i ed .

A s s i s t a n c e under t h i s p r o j e c t i s expected t o c o n t i n u e a t l e a s t u n t i l 1980 wi th c o n s u l t a n t s and f e l l owsh ips provided according t o t h e needs o f t h e r e s e a r c h programmes.

Pub l i c Heal th Engineer ing Educarion (UNDP INDi6RiO33)

SES 003 ( I n d i a 0210)

To a s s i s t i n the educat ion and t r a i n i n g o f s a n i t a r y eng inee r s and i n t h e development of advanced courses i n t h e de s ign of community water supply programmes.

I n 1967 and 1968, two c o n s u l t a n t s were provided t o t h e V i c t o r i a J u b i l e e Technica l I n s t i t u t e , Bombay. In 1972-1973, f e l l owsh ips were awarded. The p r o j e c t was under review by the Government.

I n 1974 and 1975, a s a n i t a r y engineer and c o n s u l t a n t s w i l l a s s i s t i n c u r r i c u l a formula t ion and review. Fel lowships i n p u b l i c h e a l t h eng inee r ing educat ion w i l l a l s o be provided b e s i d e s some s u p p l i e s and equipment f o r t h e p r o j e c t .

Study i n Food L e ~ i s l a t i o n ESP W 1 ( I n d i a 0291)

To a s s i s t i n t h e s t udy of food l e g i s l a t i o n and i t s implementation.

I n 1975, a f e l l owsh ip of r h r e e months i n t h e f i e l d of l e g i s l a t i o n w i l l b e provided t o a s en io r o f f i c e r from t h e M i n i s t r y of Hea l th and Family Planning. A s i m i l a r f e l l owsh ip w i l l be provided i n 1977.

Ind ian Council o f Medical Research ( S t a t i s t i c s ) DHS 001 ( India 0121)

To h e l p i n the improvement of s t a t i s t i c a l procedures f o r planning, conduct and eva lua t ion of r e sea rch s t u d i e s i n medicine and publ ic heal th .

The p r o j e c t s t a r t e d i n 1962. Long-term s t a f f and consu l t an t s have a s s i s t e d t h e Council i n var ious ma t t e r s from rime t o time. I n 1972, a t r a i n i n g course was held on S t a t i s t i c a l Methods i n Medicine and Public Health. The S t a t i s t i c a l Un i t o f t h e Council was s t rengthened and converted i n t o a Divis ion of S t a t i s t i c s and Comunicat ions i n 1973. I n 1974, under an in ter-country p r o j e c t (SEAR0 0220) , a consu l t an t vill be provided t o advise on t h e use of mathematical models i n understanding c e r t a i n d i s e a s e processes . A programmable ca lcu la to r was supp l i ed t o the Divis ion i n 1974.

The p r o j e c t v i l l be terminated by 1975.

Strengthening of Health S t a t i s t i c s Services DHS 002 ( India 0255)

To adv i se on and a s s i s t wi th the f u r t h e r development of a h e a l t h s t a t i s t i c s system; t o a s s i s t in the review and development of h o s p i t a l s t a t i s t i c s and medical records; to help i n t h e development of c u r r i c u l a f o r courses for medical record t echn ic ians ; to he lp i n the o rgan iza t ion and conduct of t r a i n i n g programmes.

,4 INDIA m

0

Beginning i n J u l y 1970, a s s i s t a n c e was provided t o t h e Model V i t a l and Heal th S t a t i s t i c s Training Uni t , Nagpur, i n e f f e c t i n g changes i n t h e curr iculum f o r courses f o r medical record t echn ic ians n e c e s s i t a t e d by t h e e igh th r e v i s i o n of t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases (ICD). I n 1973, a consu l t an t a s s i s t e d the t r a i n i n g course f o r medical record t echn ic ians he ld i n Nev Delhi . Another consu l t an t made an assessment of t h e h o s p i t a l r ecords and s t a t i s t i c a l r epor t ing systems i n Punjab, Haryana and Maharashtra.

I n 1974, short-term consu l t an t s vill a s s i s t i n a review of t h e v i t a l and h e a l t h s t a t i s t i c s system and i n p repa ra t ions f o r t h e in t roduc t ion of t h e n e x t r e v i s i o n of t h e ICD. Provision has been made i n 1975 f o r two consu l t an t s , each f o r th ree months t o render f u r t h e r a s s i s t a n c e i n these f i e l d s . P rov i s ion has a l s o been made f o r t en f e l lovsh ips fo r a t o t a l per iod o f 93 man-months and f o r suppl ies and equipment amounting t o $12 500.

A short-term consu l t an t v i l l be provided i n 1976 f o r t h r e e months.

P r u j r r I so.

DHS 001 (0121)

DHS 002 (0255

)XU!.

7. HEALTH INTORn*'TIO\ AND

LITEMTUNE

7.1 Healch S r a t l s r l c -

7 . 1 . Develoylnenr oi ihi-airt sraLiirlinl S c r ' . I i c

lndlan Counc:l oi 'Led~cal R e s e a r c h ( S t s r l i t l c s l

Fellaushrps Supplies and equiylrenL

strengthenin4 .,i ~ e a l r i Statistics S e r u l ~ c s

Short-term conri1Lan:i Felluwin~ps supplies and eqirpnenr

iolai - INDIA

Expected d r r e c l 1nyu:i iron1

UNICEF I:, the nealth i i e l d

! k ( . l L A i i B I 1 r i : i I

Numhrr u i F o s r s Y s l l m a ~ e d Ohlig~liuni

'xp, r s s r d L i l l ! :i~.: : . I .

I - $ 4 i , t ,' , I. S

L m - < z = - ; _

- ..... .- 3 1 m h r : u t Pas:,

1 * 7 i 1973 8 1"" 19;; I

I 1974 1 iwi' ' 1 9 ; ~ ' 19.~ 197: 19:j 1976 I , - ;

. i < . I . , q ec: d!bI~&a:~dz>s

. .~ I,,;, , , , iui6 ! 1'41-

I

!

! !

- - - - -

......................................... ........ ............................. 1 iiii===

L 3 ; L 2 I F P

8 7 671

.........

I 7 973 000 I 7 661 000 , 8 582 000 ......... ! ========= =========

!

I

i

9 440 o w

2112 1 1 6

I !

! i

11 6 2 1 6 1 1 3 2iZ4 I816Y

!

!

6 O i l l i 3 900 2 W0 1 W0 - - ! 8 000 4 900 - -

I 12 000 ; 13 200 7 200 13 200 , 39 300 5 000 , 12 500 500 1

- , - - 30 200 65 000 7 700 - - -

.--- ... = = = = ! - - - - ................................... .... ....................................

1 I

! 1 1

1

I ! i

! !

i

Country Statement

Polyclinics, Irian Jaya

Supplies, Irian Jaya

medical Technicians

Public Health

- Pro Old

0105

0106

0107

0113

0114

0115

0116

0119

0121

0127

-

ect No. New

HWP 001

SQP 001

OCD 001

MCH 002

HM) 007

HLT 001

BAD 001

HID 008

HED 003

PIP 001

Project Title Page

Development of Central and Regional Occupational Health and Industrial Hygiene Laboratories

Quality Control of Food and Drugs

Establishment of Cytology Services and Training

Family Health Services

Strengthening of the Teaching of Human Reproduction, Family Planning and Population Dyna- mics in Medical Schools

Assistance to Libraries for Health Personnel

Radiation Health

Resources for Family Health

Development of Health Education in Family Health

Land and Water Resources Develop- ment in Southern Sumatra

INDONESIA - Index

Project Title

Jakarta Sewerage and Sanitation Project

Rural Water Supply Project, East Java Province

Medical Records

Nutrition Training

Cancer Control

Imunization Services (including Smallpox)

Strengthening of Epidemiological Surveillance

Strengthening of Health Services Irian Jaya

Nutrition Training

Page Funds

DP

DP

Add1 . RIAddl.

RIAddl.

RIAddl.

RIAddl.

DP

R

The e f f e c t s o f modest improvements i n commmications among t h e many s c a t t e r e d i s l a n d s of Indones ia , of family p lanning on the normally l a r g e i n c r e a s e of popula t ion and of t h e e f f o r t s and towards encouraging t r a n s - migra t ion t o o f f s e t t h e uneven d i s t r i b u t i o n of t h e popula t ion have, none of them, had much impact on the problems of communication and popula t ion , which have a s e r i o u s b e a r i n g on h e a l t h . A high b i r t h r a t e , undernut r i - t i o n , communicable d i s e a s e s , environmental p o l l u t i o n and the inadequacy of p o t a b l e wate r and s a n i t a r y e x c r e t a d i s p o s a l f a c i l i t i e s s t i l l remain i t e m of major concern.

From household and o t h e r surveys conducted d u r i n g 1972, the main causes o f m r b i d i t y a r e repor ted to be ( i ) d i s e a s e s of the r e s p i r a t o r y system ( i n c l u d i n g t u b e r c u l o s i s ) , ( i i ) s k i n d i s e a s e s , ( i i i ) gas t ro- i n t e s t i n a l i n f e c t i o n s , ( i v ) mala r ia , and (v) eye i n f e c t i o n s . The high- e s t inc idence of d i s e a s e is i n c h i l d r e n below t h e age of one month and t h e nex t h i g h e s t i n t h e one month t o faur-year age-group. The main causes of m r t a l i t y a r e ( i ) d i a r r h o e a i n c h i l d r e n , ( i i ) r e s p i r a t o r y i n f e c t i o n s and ( i i i ) g a s t r o - i n t e s t i n a l d i seases . About 44 p e r cen t of a l l dea ths are i n c h i l d r e n under f i v e years o f age. Populat ion d e n s i t y and t h e educa t ion l e v e l a r e con t r ibu tory f a c t o r s . The popula- t i o n d e n s i t y 1971 i n Java and Madura is 565lkm2, elsewhere 22lkm2. I n t h e p o p u l a t i o n over t e n years of age , l e s s than 1% r e c e i v e u n i v e r s i t y educa t ion , 6% secondary e d u c a t i o n , and on ly 19% complete elementary school .

I n A p r i l 1973, t h e l a s t y e a r of t h e f i r s t f ive-year p lan , the Government reviewed t h e p a s t and o u t l i n e d s t r a t e g i e s f o r t h e fu ture . The b a s i c under ly ing p r i n c i p l e is t o provide h e a l t h s e r v i c e s t o the g r e a t e s t number o f people mare evenly. A t t e n t i o n v i l l be s p e c i f i c a l l y d i r e c t e d t a r a r d s (a) t h e p r o v i s i o n of h e a l t h f a c i l i t i e s , (b) the f u r t h e r c o n t r o l o f colmrmnicable d i s e a s e s , (c) r a i s i n g the n u t r i t i o n a l s t a t u s of t h e popula t ion , (d) p r o v i s i o n of s a n i t a r y f a c i l i t i e s and (e) h e a l t h edu- c a t i o n of t h e p u b l i c .

WHO a s s i s t a n c e w i l l con t inue , as i n the p a s t , t o be i n t h e c o m n i - c a b l e d i s e a s e c o n t r o l , f ami ly h e a l t h , h e a l t h educa t icn and the t r a i n i n g of personne l . P a r t i c u l a r emphasis is, however, t o b e placed on the s t r e n g t h e n i n g of t h e h e a l t h s e r v i c e s through a s s i s t a n c e wi th planning. r e s e a r c h and development, m a g e m e n t and e d u c a t i o n a l technology, and a l s o on environmental h e a l t h , by suppor t ing the p r o v i s i o n of water sup- p l i e s , b o t h r u r a l and urban, and sewage d i s p o s a l .

S t reng then ing of h e a l t h s e r v i c e s

The p o l i c y of t h e Government cont inues t o be the prov is ion of b a s i c h e a l t h care through i n t e g r a t e d h e a l t h c e n t r e s . E f f o r t s a r e t o b e d i r e c - t e d towards an i n t e n s i f i c a t i o n of t h i s p o l i c y and t h e improvement of t h e r e f e r r a l system. The r a t i o of h o s p i t a l beds t o popula t ion , which averages 7.2 p e r 10 000 v a r i e s from 20 p e r 10 000 t o 2 p e r 10 000. At t h e end of the f i r s t f ive-year p lan t h e r e were 2 343 h e a l t h c e n t r e s , b y A p r i l 1975 it is planned t o have 2 843 and t h e cumulative t a r g e t by A p r i l 1979, t h e end a f second f ive-year p lan , is 3 400. I n Java and B a l i , more than h a l f the s u b - d i s t r i c t s have h e a l t h c e n t r e s , each s e r v i n g 40 000 - 100 000 people. Outside Java and B a l i about 65% of the s u b - d i s t r i c t s have a h e a l t h c e n t r e , b u t only a few a r e s t a f f e d by a d o c t o r . A popula t ion of 1 0 000 - 40 000 is se rved by each h e a l t h c e n t r e . For the a c c e l e r a t e d development of these p e r i p h e r a l h e a l t h s e r v i c e s , i n a d d i t i o n t o mult i - l a t e r a l a i d , a s s i s t a n c e is b e i n g provided by the Governments of t h e U.S.A. and the Netherlands. Funds f o r t h e h e a l t h c e n t r e programme have been augmented by a d i r e c t grant- in-aid from t h e P r e s i d e n t i n t h e amount of 2 750 m i l l l o n rupiahs. To p l a n , guide and d i r e c t t h e s e e f f o r t s . t h e Min is t ry has proposed e s t a b l i s h i n g a Bureau of Hea l th Planning and a Nat iona l Board f o r Hea l th Research and Development. Family p lanning a c t i v i t i e s cont inue t o be under t h e d i r e c t i o n of t h e C e n t r a l Family Plan- n ing Board, with the Min is t ry of Heal th p a r t i c i p a t i n g through t h e mater- n a l and c h i l d h e a l t h c e n t r e s and t h e h o s p i t a l post-partum p r o g r a m . The h e a l t h educa t ion p r o g r a m cont inues t o r e c e i v e high p r i o r i t y , and pro- v i n c i a l u n i t s w i l l s h o r t l y be s t r e n g t h e n e d by t h e appointment of gradu- a t e s t r a i n e d tmder the programme. N u t r i t i o n cont inues t o be the s u b j e c t of s p e c i a l concern, and c o n s i d e r a t i o n is be ing given t o t h e f e a s i b i l i t y of launching var ious food f o r t i f i c a t i o n programmes.

The p r o g r a m f o r t h e ex tens ion of t h e l a b o r a t o r y s e r v i c e s through t h e provinces w i l l cont inue through the second f ive-year p lan , as v i l l a l s o t h e r e h a b i l i t a t i o n of e x i s t i n g l a b o r a t o r i e s . Cons t ruc t ion of new l a b o r a t o r i e s w i l l h e permi t ted on ly i n p rov inces where t h e r e a r e no l a b o r a t o r i e s , where one l a b o r a t o r y (only) can be e s t a b l i s h e d t o suppor t and s e r v i c e a l l the programmes.

WHO assistmce. The Organizat ion w i l l cont inue t o p rov ide a l a r g e m u l t i - d i s c i p l i n a r y team and t a t r a i n n a t i o n a l s concerned w i t h p lanning , r e s e a r c h and development, management and eva lua t ion . With i n c r e a s i n g emphasis on i n t e g r a t e d h e a l t h s e r v i c e s , a s s i s t a n c e w i l l be con t inued f o r the development of managerial and planning s k i l l s and s t r u c t u r e s , a s w e l l as f o r the t r a i n i n g of personne l and development of i n t e g r a t e d h e a l t h c e n t r e s . Continuing suppor t w i l l be provided t o h e a l t h s e r v i c e d e l i v e r y

rn m Ln

INWNESIA

i n c l u d i n g consumer p a r t i c i p a t i o n i n the planning o f such s e r v i c e s . Nurs- i n g s e r v i c e s i n the v a r i o u s h e a l t h programmes w i l l cont inue to be s t r e n g - thened e s p e c i a l l y i n t h e mate rna l and c h i l d h e a l t h l f a m i l y planning programmes. The l a b o r a t o r y s e r v i c e programme w i l l be supported by one pro- j e c t a long t h e l i n e s envisaged i n t h e second f ive-year plan.

Hea l th manpower D e v e l o p s

The p o l i c y of t h e Government i n t h e new f i ~ e - ~ e ' a r p lan cont inues t o be t h e p r o v i s i o n of competent personne l i n s u f f i c i e n t numbers, The undergraduate and post-graduate t r a i n i n g of d o c t o r s , remains under constant review by the Consortium of Medical Sciences, t o ensure t h a t i t is r e l a t e d t o t h e needs of t h e country. A j o i n t Heal thIEducat ion Board was appointed i n 1973 t o ensure p roper co-ordinat ion between consumer and producer . The s t r e n g t h e n i n g of the Facu l ty o f P u b l i c Heal th, J a k a r t a , h a s provided a s u i t a b l e n a t i o n a l i n s t i t u t i o n f o r t h e MPH degree, though f o r c e r t a i n s p e c i a l t i e s , t h e r e w i l l s t i l l b e a need f o r t r a i n i n g abroad. T r a i n i n g programmes for h e a l t h personne l w i l l be upgraded a s w e l l as increased . F u r t h e r a t t e n t i o n w i l l be given t o having more t r a i n i n g f a c i l i t i e s i n t h e provinces and p a r t i c u l a r l y t o developing administra- t i v e and managerial competence.

The d o c t o d p o p u l a t i o n r a t i o averages 0.49 p e r 10 000 b u t v a r i e s widely from p l a c e t o p l a c e , from 2.5 t o 0.22 i n Java and from 0.64 t o 0.13 i n Sumatra. For paramedicals t h e r a t i o is 1.19 p e r 1 0 000 popula- t i o n w i t h , aga in , v i d e r e g i o n a l v a r i a t i o n s . From s t u d i e s c a r r i e d out i n h e a l t h c e n t r e s , an i n t e r e s t i n g observa t ion with i m p l i c a t i o n s f o r t r a i n i n g i s t h a t d o c t o r s a t t h e s e c e n t r e s spend 38% of t h e i r time on administra- t i v e work and midwives about 50% of t h e i r time on maternal and c h i l d h e a l t h a c t i v i t i e s .

The h e a l t h manpower survey conducted by t h e Heal th Min is t ry w i l l be completed i n t h e l a t t e r h a l f of 1974, and t h i s in format ion is t o be kep t con t inuous ly up-dated and t o form t h e b a s i s f o r more sys temat ic h e a l t h manpower planning and development.

WHO a s s i s t a n c e . WHO w i l l con t inue t o t r y t o a s s i s t i n ach iev ing t h e goa ls of h e a l t h manpower development i n t h e second f ive-year p lan . This a s s i s t a n c e w i l l encompass a l l l e v e l s o f educa t ion and many d i s c i p - l i n e s ; undergraduate medical educa t ion w i l l be supported through provi- s i o n of long-term e x p e r t s . Both formal courses and in -se rv ice t r a i n i n g f a r p r o f e s s i o n a l and a u x i l i a r y personnel w i l l be suppor ted , and t h i s s u p p o r t w i l l i nc lude a s s i s t a n c e by way of l o c a l fe l lowships f o r the MPH degree , i n conformity wi th t h e p o l i c y o f suppor t ing t r a i n i n g w i t h i n t h e country. In -se rv ice t r a i n i n g of paramedicals w i l l be provided i n a l l p r o j e c t s .


The l a s t case o f smallpox repor ted was i n January 1972, and a f t e r an a p p r a i s a l undertaken i n A p r i l 1974, an i n t e r n a t i o n a l assessment team i n A p r i l 1974 confirmed t h a t smallpox had been e r a d i c a t e d i n t h e country.

Malar ia programme has been expanded and i n t e n s i f i e d . S t rengthen ing of s u r v e i l l a n c e measures f a r a l l communicable d i s e a s e s has been emphasi- sed and s p e c i a l t eamslun i t s have been e s t a b l i s h e d a t v a r i o u s l e v e l s o f h e a l t h s e r v i c e s . Through the use of smallpox v a c c i n a t o r s , t h e BCG programme has continued t o progress . Leprosy c o n t r o l work has been con t i - nued and b e i n g i n t e g r a t e d i n t o the h e a l t h s e r v i c e s programme. A nev leprosy p r o j e c t with the aim of e s t a b l i s h i n g a t raining-cum-demnstra- t i a n area f o r v a r i o u s p r o f i l e s of h e a l t h workers has been s t a r t e d .

Based on epidemiological in format ion , f u t u r e a c t i v i t i e s w i l l be d i r e c t e d mainly a g a i n s t mala r ia , g a s t r o - e n t e r i t i s ( i n c l u d i n g chole ra ) , oulmonarv t u b e r c u l o s i s . and deneuelhaemorrhaeic f e v e r . which h a s recent- -- - l y become m r e preva len t . The immunization programmes, which have concent ra ted on smallpox and t u b e r c u l o s i s , v i l l g radua l ly be expanded the main emphasis a t f i r s t be ing p laced on d i p h t h e r i a , p o l i o n y e l i t i s and te tanus . The c o n t r o l of communicable d i s e a s e s w i l l be i n t e g r a t e d i n t o t h e a c t i v i t i e s of t h e h e a l t h c e n t r e s . A l a r g e p a r t o f t h e c o m n i - cab le -d i sease programme w i l l b e undertaken by t h e p r o v i n c i a l h e a l t h s e r v i c e s , b u t i ts f i n a n c i n g w i l l s t i l l be provided by t h e c e n t r a l autho- r i t y .

Non-communicable d i s e a s e s such as card iovascu la r d i s e a s e s , mental h e a l t h , cancer , d e n t a l h e a l t h and drug abuse and dependence, have been rece iv ing a t t e n t i o n . Programmes f o r t h e g radua l expansion of a c t i v i t i e s are being developed.

&TI0 a s s i s t m c e . Support f o r s p e c i f i c p revent ive and c o n t r o l pro- g r a m s f a r both co-nicable and non-comm~micable d i s e a s e s w i l l be cont inued. WHO w i l l a s s i s t i n t h e product ion and c o n t r o l of vacc ines f a r some more years. The programmes f o r immunization and t h e s t reng then ing and expansion of ep idemio log ica l s u r v e i l l a n c e w i l l l i k e - wise be supported.

P r o m t i o n of environmental h e a l t h

I n c r e a s i n g r e c o g n i t i o n is being given t o the importance of environmental h e a l t h . During t h e f i r s t f ive-year p l a n , ending i n March 1974, a t t e n t i o n was d i r e c t e d t o p r i m a r i l y water s u p p l i e s . These a c t i v i t i e s

INDONESIA

i n c l u d e d t h e i n i t i a t i o n o f a r u r a l w a t e r supp ly p i l o t p r o j e c t by t h e H e a l t h M i n i s t r y , w i t h t h e a s s i s t a n c e o f WHO and IJNICEF and t h e con t inua - t i o n o f t h e urban w a t e r supp ly programme through t h e M i n i s t r y o f P u b l i c Works and E l e c t r i c Power, t h e work b e i n g mainly r e l a t e d t o improvements o f and e x t e n s i o n s t o e x i s t i n g schemes. I n t h e second f i v e - y e a r p l a n , i n c r e a s e d emphasis is t o b e g i v e n t o r u r a l w a t e r supp ly . The budge t h a s been i n c r e a s e d t o 1 550 m i l l i o n r u p i a h s f o r 1974-75, as compared t o 150 m i l l i o n r u p i a h s i n t h e p r e v i o u s y e a r . It i s a n t i c i p a t e d t h a t a p o p u l a t i o n coverage of 5 m i l l i o n w i l l b e p rov ided . (The p o p u l a t i o n coverage d u r i n g t h e f i r s t f i v e - y e a r p l a n was approx imate ly 700 000) .

I n 1974, a WHO-UNDP r u r a l w a t e r supp ly p r o j e c t w i l l b e s t a r t e d i n s e l e c t e d areas w i t h i n t h e p rov ince of E a s t Java . I n West J a v a , a l s o s t a r t i n g i n 1974, an i n c r e a s e i n t h e volume of c o n s t r u c t i o n work on r u r a l w a t e r s u p p l y is schedu led i n some areas, which WHO he lped t o s t u d y i n e a r l y 1973 f o r p r o j e c t f o r m u l a t i o n based on systems a n a l y s i s .

The p r o v i s i o n of f a c i l i t i e s for t h e s a f e d i s p o s a l o f e x c r e t a , main- l y i n t h e r u r a l areas, w i l l b e i n i t i a t e d and emphasized d u r i n g t h e second f i v e - y e a r p l a n . P lanned a c t i v i t i e s w i l l b e g i n , f o r t h e f i r s t t ime , i n 1974, w i t h an a l l o c a t i o n o f 750 m i l l i o n r u p i a h s . V i l l a g e s a l r e a d y p rov ided w i t h w a t e r s u p p l y w i l l be g iven p r i o r i t y . It is expec- t e d t h a t by 1976 s u f f i c i e n t e x p e r i e n c e w i l l have been ga ined t o e n a b l e t h e programme t o p roceed w i t h i n c r e a s e d momentum. A c t i v i t i e s i n g e n e r a l s a n i t a t i o n a l s o w i l l b e i n i t i a t e d , and w i l l mainly i n c l u d e food s a n i t a - t i o n , s a n i t a t i o n i n p u b l i c p l a c e s and w a t e r q u a l i t y s u r v e i l l a n c e , w i t h p r imary a t t e n t i o n t o u rban areas.

a t p r e s e n t s u p p l i e d w i t h w a t e r through t h e p u b l i c sys tems , though t h e d e s i g n c a p a c i t y o f w a t e r p r o d u c t i o n a t t h e p l a n t r e l a t e s t o a much l a r g e r p o p u l a t i o n . When t h e p r e s e n t f e a s i b i l i t y s t u d i e s f o r w a t e r s u p p l i e s t o seven c i t i e s are completed,wi th t h e a s s i s t a n c e o f IBRD. c o n s t r u c t i o n work w i l l s t a r t (1976) , and similar s t u d i e s on a n o t h e r IBRLI-aided package w i l l b e under taken. I n a d d i t i o n t o t h e w a t e r s u p p l y p r o g r a m , t h e M i n i s t r y of P u b l i c Works is g i v i n g i n c r e a s i n g a t t e n t i o n t o w a s t e d i s p o s a l and p o l l u t i o n c o n t r o l . A f e a s i b i l i t y s t u d y on sever- age f o r J a k a r t a c i t y i s schedu led t o b e g i n i n 1974, as WHO/UNDP p r o j e c t , f o r a p e r i o d o f two and h a l f years. Th i s i s t h e f i r s t such s t u d y , b u t it i s expec ted t h a t s i m i l a r s t u d i e s i n about two more c i t i e s w i l l have been s t a r t e d by 1976. I n 1974, a garbage d i s p o s a l i s t h e s u b j e c t o f ? s t u d y by t h e M i n i s t r y i n t h r e e c i t i e s . A c t i v i t i e s i n p o l l u t i o n c o n t r o l , now main ly l i m i t e d t o J a k a r t a , was t h e s u b j e c t o f a 1974 seminar . F u r t h e r developments a re expec ted t o s t r e n g t h e n t h e co- o r d i n a t i o n a f p r e s e n t a c t i v i t i e s and t o evo lve a n a t i o n a l p r o g r a m e .

WHO assistonce. The O r g a n i z a t i o n w i l l c o n t i n u e t o assist t h e Government, mainly through t h e M i n i s t r i e s o f Hea l th and of P u b l i c Works and E l e c t r i c Pover . By 1974 two s a n i t a r y e n g i n e e r s and one s a n i t a r i a n were , i n p o s i t i o n , i n t h e WHO p r o j e c t "Na t iona l Community Water Supply and S a n i t a t i o n " . By 1976. i t is expec ted t h a t a t h i r d e n g i n e e r and a second s a n i t a r i a n w i l l b e a s s i g n e d . F u r t h e r a s s i s t a n c e , b e g i n n i n g i n 1974, i n c l u d e s s t a f f t o b e a s s i g n e d t o two UNDP-funded p r o j e c t s (sewerage and r u r a l w a t e r supply) for a two-year pe r iod . A s s i s t a n c e through f e l l o w s h i p s , i n c l u d i n g s h o r t t r a v e l f e l l o w s h i p s f o r s t u d y i n c o u n t r i e s w i t h s i m i l a r c o n d i t i o n s and p r o g r a m s , w i l l c o n t i n u e .

The M i n i s t r y o f P u b l i c Works and E l e c t r i c Power w i l l f u r t h e r s t r e n g t h e n and expand t h e w a t e r s u p p l y programme f o r t h e c i t i e s wi th e x i s t i n g l i m i t a t i o n s , mainly on t h e d i s t r i b u t i o n of w a t e r , i t is e s t i - mated t h a t n o t mre t h a n abou t f i v e m i l l i o n peop le i n urban a r e a s a r e

St r eng then ing of Na t iona l Hea l th Se rv i ce s STR W 1 ( Indones ia 0086)

To a s s i s t i n p l ann ing , programming, moni tor ing and eva lua t i on o f h e a l t h s e r v i c e s ; i n e s t a b l i s h i n g a r e s e a r c h and development programme concerning h e a l t h care d e l i v e r y ; i n co-ordinacing and i n t e g r a t i n g h e a l t h s e r v i c e s and improving t h e i r e f f e c t i v e n e s s and e f f i c i e n c y ; i n s t anda rd i z ing and i n t e n s i - f y i n g t r a i n i n g a c t i v i t i e s f o r h e a l t h s t a f f and i n promoting reviews of pub l i c h e a l t h p r a c t i c e and o r g a n i z a t i o n i n t ended t o l e ad to the opcimal d e l i v e r y of h e a l t h ca re .

A master p l a n of o p e r a t i o n was e s t a b l i s h e d i n 1969. S t a r t i n g from 1969, c o n e u l t a n t s a s s i s t e d i n p r epa r ing t h e s y l l a b u s f o r o r i e n t a t i o n courses i n developing a n a t i o n a l h e a l t h p lanning system, t r a i n i n g s e n i o r s t a f f of t h e M i n i s t r y o f Hea l th and p r o v i n c i a l d i r e c t o r a t e s i n h e a l t h management and h e a l t h p l ann ing , reviewing r e s e a r c h s u b j e c t s i n p u b l i c h e a l t h a t Surabaya, f u r t h e r developing mut l i -purpose a u x i l i a r y h e a l t h workers, developing proto- c o l s of s t u d i e s , i n c l u d i n g b iomedica l s t u d i e s , t o be under taken by the Na t iona l I n s t i t u t e of Hea l th , Surabaya, conduct ing and e v a l u a t i n g a workshop on h e a l t h management, f i n a l i z i n g h e a l t h component of t h e Second Five-Year Development P l an , and i n r e o r g a n i z i n g and s t r eng then ing t h e h e a l t h s e r v i c e s s t r u c t u r e , i n c l u d i n g the development of the Bureau of Hea l th Planning. The composi t ion o f t h e WHO team underwent a change i n 1973 and i t was s t r eng thened and r e - s t r u c t u r e d i n 1974 w i t h t h r e e components under i t , u i z . , h e a l t h p lanning,

w INWNESIA Cn

m

r e s e a r c h and development and h e a l t h care d e l i v e r y system - each having a s e n i o r p u b l i c h e a l t h a d m i n i s t r a t o r a s the team l e a d e r . This was sought t o be accamp- l i s h e d by merging t h r ee p r o j e c t s , v i z . , Indones ia 0086, "S t r eng then ing of Nat ional Hea l th Se rv i ce s " , I ndones i a 0098, "Nat ional I n s t i t u t e of Medical Research" , And Indones ia 0126, "Nat ional I n s t i t u t e of P u b l i c Hea l th , Surabaya". I n 1974, two c o n s u l t a n t s were as s igned to a s s i s t i n t h e e s t ab l i shmen t and s t r eng then ing o f the Bureau of Hea l th Planning and i n the p r e p a r a t i o n o f a s t udy des ign f o r the development of h e a l t h s e r v i c e s .

I n 1975, c o n s u l t a n t s i n che f i e l d s of p u b l i c h e a l t h a d m i n i s t r a t i o n , hosp i - t a l a d m i n i s t r a t i o n , h e a l t h p lanning and e v a l v a t i o n and f e l l o w s h i p s i n t h e f i e l d s of p u b l i c h e a l t h , h o s p i t a l a d m i n i s t r a t i o n and medica l s t a t i s t i c s w i l l b e pro- v ided . I n a d d i t i o n , a s s i s t a n c e w i l l be g iven i n t h e o r g a n i z a t i o n of courses i n h e a l t h p l ann ing , h e a l t h informat ion system and h e a l t h management.

In 1976, c o n s u l t a n t s i n h e a l t h p l ann ing , h e a l t h i n fo rma t ion sys tem, opera- t i o n a l r e s e a r c h , e t c . and f e l l owsh ips i n h e a l t h p lanning, h e a l t h s t a t i s t i c s and h o s p i t a l a d m i n i s t r a t i o n w i l l b e provided. A s s i s t a n c e w i l l a l s o b e g iven i n t h e o r g a n i z a t i o n of n a t i o n a l courses aiming a t t h e development o f comprehensive h e a l t h s e r v i c e s . S imi l a r a s s i s t a n c e w i l l a l s o be provided i n 1977.

A s s i s t a n c e t o t h e p r o j e c t i s expected t o con t inue till 1979

K E L ~ L A K B ~ D C L K

INOONES I*


3.1 Sfrengfhenmp. of Health Servrces

3.1.2 Strengthening of Health Servrces

stren~theninp. oi ~atlonal ~ealrh Services

( a ) Health Planning

Sr.pilP:rc nea1L I a l m ~ n r i r r i c o r PI SCarlsLiCLan P4 System analyst P4 Health econanlrt P4 clerk-stenographer DJS

Short-term consulfanrr Fellowships ~arcicrpanri Supplier and equ~pmeni

( b ) Research and Development

sr.~~biic nealfh adminlstiatar ~5 System anaiysr P L Management exper: P4 Medical sraclstic~ans P4 Human ecalag~sr P4

Short-term consulranrs Fellowships participants Supplies and equipment

( c ) Health Care Dellvery System

Sr.pub11c healrh adminrsrraror P5 Educat ion specialist 74 Public healih nurse P3 Clerk-typist 054

Short-term consulrants Fellavrhlpr Parficlpancs Supplies and equipment

Number n f P a r r s

1974 11975 11976 11977

I

Pro,ecL

s o .

SIR mi (0086)

Errinaced Obligalionr

1974 19:i 1976 I

35 250 41 910 43 580 31 110 34 190 36 260 31 110 J i 190 36 260 31 110 34 190 , 3b 260 2 580 2 840 3 120

19;-

r- u

w

ILxprrEsed in CS "oilars,

1

! i

7 0 445 135 160 147 320 155 480 6 0 0 0 7 200 7 200 6 600 6 600 6 600 1 500 4 500 2 250 2 250

5 -- 11 3 1/12

5 8 5 IZI* ! 1/12 1/12

- Number of P o r : i

11 9 1/12 1/12 I/ 5

-- 4

1/12 11 7 1/12 1/12 - 2 1 4 2/24

i T H L K ( I . ! R ! i s

L i r : n i : c d Obllgarlonr

ill& 1575 1976 / 1977

I ~ ! I

i I

I i i

!

I

I

! I

I

! 1

i

! I !

I I

1974

= - " G k 3 3 L

2 u. I

1975 ' 1976 1977

I & 5 W 4 500 ~ 4 500 I 2 500 2 500 2 500 2 500

8hi 130 133 000 , 119 O W

- - 1- - I

I -

2 500 2 500 2 500 2 500 I - - I 87 045 142 160 165 870

I !

1

1

I

I

i I

I

I I

36 "00 39 000 40 670 28 830 31 850 33 890 31 110 34 190 36 260 59 940 66 040 70 150 31 110 34 190 36 260

95 760 187 390 205 270 !

6 600 7 200 7 200 22 7 W 20 150 20 150

4 875 1 500 I 500 1 000 1 5 W 1 500 , 1 500

101 OJ> 118 190 235 620 2L7 580 --- I - - - - I

39 250 41 910 ; 43 580 31 110 34 190 I 36 260 31 110 34 190 , 36 260 1 740 1 910 2 100 - - -

87 165 103 210 112 200 118 200 R 000 13 200 7 200 7 200 13 200 ' 6 600 6 600 6 600

1/12 1 / 1 2 ill12 1/12 1/12 1/12 i 1/12 2/24 12/24 1/12 ' 1/12

6 / 6 11 3 11 3 5/36 14/33

1/12 1/12 2/24 1/12 6

11 3 4/33

1/12 1/12 1/12 1/12 - 1, 3 1/12

I

1/12 1/12 1/12 1/12 -

----

1/12 1/12 1/12 1/12 -

4 4 4 4 21 6 ,l/ 3 11/12 11/12

Medical Rehabilitation STR 002 (Indonesia 0093)

To assist in developing integrated medical rehabilitation services and in the training of the necessary personnel.

A physiotherapy tutor was assigned to the School of physiotherapy, Solo, from 1963 until the end of 1965 under Indonesia 0065. A consultant visited Sola in 1967 and again in 1968 to evaluate the training programmes. A further consultant was provided in 1968 under SEARO 0174, "Rehabilitation of Handi- capped Children", to study the health facilities for physically handicapped children. In 1971, another consultant visited various institutions associated with medical rehabilitation. A team of three consultants (under SEAR0 0174) visited Indonesia in 1973 to demonstrate integrated regimes of treatment and services. F r m 1974, fellowships will be awarded to train national staff.

Assistance under this project which will c-ence in 1974 will be co-ordinated with the activities of SEARO 0226, 'Uedical Rehabilitation".

Assistance is expected to be provided until the end of 1978.

x INDONESIA <

C

Training of X-ray and Electro-medical Technicians (UNDP INS/721029)

STR 003 (Indonesia 0069)

To assist in training radiographers and electro-medical technicians in the installation, use, maintenance and repair of electro-medical equipment.

In 1962, a consultant, under SEARO 0041, "Training of X-ray Technicians", assisted with plans for establishing a school for X-ray technicians. In 1966, the school was set up and a WHO X-ray engineer was assigned. A school for the training of radiographers was established in 1970, and a tutor radiographer has been assigned since that year. An electro-medical engineer also assisted in the establishment of a school for the training of electro-medical technicians.

In 1974, the tutor radiographer and the electro-medical engineer continued to assist in the training of radiographers and electro-medical technicians in the respective academies. Fellowships were awarded for the training of tutors from the academies.

In 1975, fellowship provisions are continued in order to enable the candidates to cmplete their training abroad.

R E G C L A R B U D G E T

INDONESIA

Medical Rehabilitation

Fellovrhips Supplies and equipment

Training of x-ray and Eiecrro- medical Technicians INSl721029

Tutor radiographer P2 Elecrro-medical engineer P2

Fellowships Supplies and equipment nisce11aneaus

Establishent of Health cenrres, ~ r i a n ~ a y a

Public health officer P4


~ehabilirafion of ~ospirals and ~olvclinicr, liian laya

Fellowships supplies and equipment

Number of Ports project NO.

STR 002 (W93)

s m m 3 (W69)

ST6 004 (0072)

STR W S (W87)

1974


1974 , 1971

I 1 I

i I 3 9 W

- -

(Ex~reared in LS Dollecs~

1971 11976 1976 1 1977 1977

I

I !

1 I I i I

i ~ I

i I I

I

i

I i /

I I

1974

1/12 1/12 -- 2 --

5/47

i/ 5 - 1 -

I

Number of P o r i r

O T R E R S O U R C E S

Errlmeted obligationr

I

1975 1974

m v " c M 3

I

3/36

2 u

0

DO

YI

YI

!

I i I

! I

I

1 1 1 i 1 I

I !

I/ 2

1

3116 i 1

1

I !

i

1976 1975

w %. -

197i

I

5 W O '

I

1976

I I

i I - 60 W O 1 5 O W !

I ~ 23 255 6 3 W 1 21 871 2 8W , - -

!

!

I I

24 600 22 366

46 966

- I

1977

INDONESIA

S t r e n g t h e n i n s of Hea l th S e r v i c e s . I r i a n J a y a (UNDP INS/73/010)

STR 006 ( Indones ia 0139)

To promote t h e h e a l t h of t h e popu la t i on through the development o f i n t e - g r a t e d h e a l t h s e r v i c e s a t a l l l e v e l s a s p a r t o f t h e socio-economic development of t h e p rov ince , w i t h p a r t i c u l a r emphasis on t h e development o i a more effei- t i v e a n d e f f i c i e n t a d m i n i s t r a t i o n of h e a l t h s e r v i c e s i n the province .

Th i s p r o j e c t i s i n c o n t i n u a t i o n of t h e p r o j e c t which had been developed i n 1970, based on t h e recommendations o f a cansu l ean t i n p u b l i c h e a l t h , who was a member of t h e FUNDWI/UNDP Survey Miss ion which v i s i t e d I r i a n J aya i n 1967. Under t h i s p r o j e c t . s e v e r a l s h o r t - t e r n c o n s u l t a n t s , norably f o r t h e e s t a b l i s h - ment of h e a l t h c e n t r e s n u r s i n g educa t ion , l abo ra to ry s e r v i c e s , g o i t r e c o n t r o l and urban wa te r supp ly , v i s i t e d I r i a n Jaya and made recommendations. A nu r s ing educa to r and a d m i n ~ s t r a t o r were a s s igned from May 1971 to A p r i l 1973 under pro- j e c t I ndones i a 0084. "Nursing Educat ion and T ra in ing Province o f I r i a n Jaya". A p u b l i c h e a l t h o f f i c e r was a s s igned t o p r o j e c t Indones ia 0072. "Es tabl i shment of Hea l th C e n t r e s , Province of I r i a n J a y a m ' , from J u n e 1972 t o June 1973.

S t a f f i n t h e f i e l d s of environmental s a n i t a t i o n and r u r a l water supply and h e a l t h educa t ion were provided and f e l l owsh ips i n the f i e l d s o f p u b l i c h e a l t h a d m i n i s t r a t i o n , h e a l t h p l ann ing , s t a t i s t i c s , environmental s a n i t a t i o n , h e a l t h educa t ion and n u r s i n g were awarded. Ass i s t ance by way of e x p e r t , and f e l l o w s h i p s w i l l be provided i n 1976.

Th i s p r o j e c t was scheduled t o s t a r t i n June 1976, s u b j e c t to approval by UNOP.

Labora to ry S e r v i c e s HLS 001 ( Indones i a 0060)

To a s s i s t i n s t r e n g t h e n i n g h e a l t h l abo ra to ry s e r v i c e s .

A s s i s t a n c e t o t h e p r o j e c t s t a r t e d i n 1967. In 1968, a c o n s u l t a n t a s s i s t e d i n p lanning t h e r e h a b i l i t a t i o n of p r o v i n c i a l l a b o r a t o r i e s and the e s t ab l i shmen t of p e r i p h e r a l l a b o r a t o r i e s . A m i c r o b i o l o g i s t and a l abo ra to ry t e c h n i c i a n have been a s s igned s i n c e 1970 and a v i r o l o g i s t s i n c e 1971. i n 1972-73, t h e p r o j e c t e s t a b l i s h e d t h e b a c t e r i o l o g y and v i ro logy depar tments i n t h e Cen t r a l Pub l i c Hea l th Labora to ry . J a k a r t a . The l a b o r a t o r y s t a f f of t h e c e n t r a l , p r o v i n c i a l and kabupaten l a b o r a t o r i e s w i l l b e t r a i n e d i n modern l a b o r a t o r y technology u s i n g t h e equipment provided through i n t e r n a t i o n a l a s s i s t a n c e . I n 1974, t h e p r o j e c t a s s i s t e d i n t h e des ign and ope ra r ion o f a r e f e r r a l l a b o r a t o r y s e r v i c e f o r work an t h e s u r v e i l l a n c e of s p e c i f i c comun icab l e d i s e a s e s , e . g . , c h o l e r a , smallpox, denple/haemorrhagic f e v e r and r a b i e s . A n a t i o n a l course i n the l a b o r a t o r y d i a g n o s i s o f smallpox was h e l d i n 1972 wi th the a s s i s t a n c e of a c o n s u l t a n t . Fe l lowships have been provided w i th a view ro e s t a b l i s h i n g b a s i c r e sources i n l a b o r a t o r i e s . I n 1973-74. one v i r o l o g i s t and one l a b o r a t o r y t e c h n i c i a n cdnt inued t o a s s i s t t h e p r o j e c t . The p r o j e c t p rov ides suppor t t o t h e s t u d i e s o f p l ague under Indones i a 0099, "Plague Epidemiology". I t a l s z co-

o r d i n a t e s i t s a c t i v i t i e s w i th p r o j e c t I ndones i a 0091, "S t r eng then ing of Epidemio- l o g i c a l Se rv i ce s " , and t h e i n t e r - c o u n t r y p r o j e c t SEAR0 0159, "Heal th Labora to ry Se rv i ce s " . I n a d d i t i o n , t h e p r o j e c t develops t h e l a b o r a t o r y a s p e c t s of smal lpox s u r v e i l l a n c e i n co -o rd ina t i on w i t h p r o j e c t Indones ia 0081, "Smallpox Eradica t ion" .

UNICEF p rov ides s u p p l i e s and equipment t o p r o v i n c i a l and kabupaten l abo ra - t o r i e s .

I n 1974, 1975, 1976 and 1977, t h e f e l l o w s h i p s w i l l b e r e l a t e d ro t v t o r t e c h n i c i a n t r a i n i n g , advanced t r a i n i n g i n l a b o r a t o r y technology and p u b l i c h e a l t h microbiology.

I n 1976-77, t h e p r o j e c t w i l l be a s s i s t e d by a v i r o l o g i s t and a food b a c t e r i o l o g i s t . I n 1977, f i v e n a t i o n a l courses each of three-weeks' d u r a t i o n w i l l be conducted f o r t r a i n i n g t e c h n i c i a n s i n r u r a l l a b o r a t o r i e s .

A s s i s t a n c e t o t h e p r o j e c t i s expected t o con t inue u n t i l t h e end of 1977.

Vaccine and Se ra Product ion (LWDP INSI681036)

HLS 002 ( Indones i a 0083)

To a s s i s t i n improving methods of producing b a c t e r i a l and v i r a l v a c c i n e s , a n t i - t o x i n s and t oxo ids and a l s o t o a s s i s t i n developing c a p a b i l i t y i n t h e q u a l i t y c o n t r o l o i vacc ines and s e r a .

I n 1970, a c o n s u l t a n t a s s i s t e d t h e Bio Farrna, Bandung, i n changing i t s DPT vaccine product ion methodology by t h e use of a ba t ch fermentor "Bi l thoven Uni t" . Also , a c o n s u l t a n t and a f e l l owsh ip were provided t o s tudy t h e f e a s i b i l i t y of producing f r eeze -d r i ed BCG vacc ine and i t s q u a l i t y c o n t r o l . I n 1971, a n o t h e r consu l t an t engineer he lped commissioning a large-volume c e n t r i f u g e provided by UNICEF and a biomedical c o n s u l t a n t i n 1972, a s s i s t e d i n commissioning t h e fermentor for t h e r e g u l a r product ion o f DPT and o t h e r b a c t e r i a l vacc ines .

I n 1973, fo l l owing upon t h e assessment of a c o n s u l t a n t t h e p r o j e c t r e v i s i o n was f i n a l i z e d i n Apr i l 1974, provid ing fo r i nc rea sed UNDP i n p u t s f o r developing the capac i t y of the Bio Farrna I n s t i t u t e i n t h e p roduc t ion o f f r e e z e - d r i e d BCG vacc ine . The r e v i s i o n a l s o provides the b a s i s f o r t h e development of v i r a l vacc ines f o r which f u r t h e r DNDP a s s i s t a n c e w i l l be r e q u i r e d . The BCG p r o j e c t a t Bio Farma a l s o r e c e i v e s a s s i s t a n c e from Colombo Plan and t h e Dutch Government.

The a c t i v i t i e s o f t h e p r o j e c t have been co -o rd ina t ed w i t h t h e r e l a t e d count ry and i n t e r - coun t ry p r o j e c t s .

The p r o j e c t w i l l con t inue up t o 1976.

INDONESIA

School Health

To assist in developing school health services

UCH OJl (Indonesia 0104)

In 1969, a consultant (under SEAR0 0175, "School Health") reviewed the school health activities in Indonesia. A consultant is expected to assist in strengthening the health content (including school health) of the curricula of teacher training colleges and schools followed by a national workshop on school health in 1975. The project is supported by a fellarship component for training in different aspects of achool health in 1976 and 1977.

Nutrition Training AUT 003 (Indonesia 0132)

To develop effective control progr-es and to assist in strengthening and upanding the nutrition aspects of health services and the training of staff.

Assistlllce to nutrition programes in Indonesia had been provided by P M , LIIACEF .nd YPP m d e r Indonesia 0125, "Applied Nutrition Progr-e". In late 1973, a team of consultants from the Massachusetts Institute of Technology, O.S.A., was assigned, m a contractual basis, to study the possibility of developing a national food and nutrition policy.

Assistance to the goitre control progr-e in West Irian was provided m d e r Indonesia 0088, "Goitre Control", and Indoneaia 0086.02, "Strengthening of Health Services in West Irian".

Consultant services to improve the nutritional aspects of the public health progr-es will be provided in 1976. Pelleaships in 1975-1977 will be related to training of nutritionists engaged in health services or in teaching in medical colleges.

The project is expected to continue until end 1980.

R E G U L R R B U D G E T

( E x p i r s s e d in us Duiiarsk

ISOONES~A

public ~ealth Laborarorv, lrian Java

Fellovrhrps

3.2 Family Health

3.2.2 narernal and child ~ealth

School Healrh

short-term consultants Fellowrhips Participants Supplies and equipment

Family Health Services INSI7OIPOB

nedrcai officer P5

Fellowship

3.2.h Nurririan

FelloushiDs (Nuirifion

TraininR)

~ellovships

Nvtriflon Trainlng

short-term consultants Fellowshipn supplies and equipment

pro,ect xo.

HLS ~3 (0089)

UCH W 1 (0104)

WCH W 2 (0113)

MPI 001 (0200)

NLPI W 3 (0132)

umber of p o s t s umber of p o r t s

1974

~rtinated obligations

1974

rn s m " c - 5 3 .. 2 -

WI

FP

1911 '1976 1971 1914 1975 1976

O T H E R S O r R T E S

11 3 11 3 b W o 1 b 600 6 6 W , 6 600 ! 6 600

750 1 i 500 , 500

- , - 7 100 1 100

! - - i i I

1977 1975

tir;nired obligations

1974 ~ 1975 ' 1916

!

2 575 , - 8

I

1 1

19 200

9 9 W I -1 29 100 i -

I I

i I

i !

i 1 i i i

I I i

I 1

i i

! I

i

1976 11977 ,

1977

I I 21 5 1

I

I

i

11 6 - 1 -

1/12

1 !

!

1 1/11 1

i

I

I

I 1

I

i

i i I

i i

I

I i i

1 I

14 400 j

I ,

1 7 000 6 600 1 800

i i

500 I - ' - 21 500

300 -

8 100 -

INDONESIA

Development of Health Education in Family Health NED 003 The activities of this project are co-ardinated with thoae of Indonesia (UNFPA INS1711FQ8) (Indonesia 0121) 0378, "Health Education".

TO assist the Government in developing health education in family health, Assistance to the project is expected to terminate in 1976. including services, manpower, training, studies, methods, material and media and other cmpanents of the programme such as school health and family life Medical Education TmU 001 education. (Indonesia 0062)

In 1971, a health education consultant assisted in reviewing health education services at various levels of the administration and formulated a plan for the further development of health education services to meet the needs of the family health prograome. Another consultant reviewed the status of health education in training programes for health professionals.

In each of the years 1971 and 1972, hro other consultants revieved health behaviaur related studies so far completed vith a viev to utilizing the findings. Since 1972, s health education specialist has assisted the Health Education Uanpover Development Project, in developing the vork experience and health education demonstration project, provincial health education -its and the MPH degree programme in health education in the School of Public Health, University of Indonesia. In addition, he has helped to develop further health education services at the Ministry of Health.

In 1973, the projects Indonesia 0120, 0121, and 0122 vere combined into one project Indonesia 0121. Tvo consultants vere provided in 1973 to assist in studies and training programnes respectively.

Health education specialiets ( tvo in 1974 and one in 1975-1976) will assist the Health Education Division in the Ministry of Health and the Health Education units in the provinces.

To assist in developing the teaching programmes of the medical faculties in keeping with national needs and the progress of the educational sciences.

The project was started in nay 1964 with the provision of a visiting professor of physiology to one of the medical faculties. In subsequent years, visiting professors in physiology, pharmacology, histology and embryology and consultants in preventive and social medicine, pathology, paediatrics, obstetrics and gynaecology were provided to various medical schools. A nunber of consultants Yere provided and fellowship8 awarded. This assistance has greatly helped in the development of the teaching of basic medical sciences end other spcciel- ties in the medical schools.

In 1973, a visiting professor of pharmacology vas assigned to Medan and a consultant in physiology, who had previously worked as a visiting professor, revisited some of the medical schools to assess the impact of the project on the teaching of physiology.

A large nllnber of fellowships have been provided .rretly for the training of teachers in Lnsic medical sciences.

Long-term posts (ore in 1974-1975 and three in 1976-1977) will continue.

Assistance ie expected to continue for a nuber of gears.

Nursing and Midwifery Education m 002 (Indonesia 0074)

To a a a i e t i n s t r eng then ing and f u r t h e r developing nurs ing and midwifery education.

Commencing i n 1957, WHO has helped i n t h e c rea t ion o f a nurs ing d iv i s ion i n t h e n i n i s t r y of Hea l th and h a s a s s i s t e d wi th educat ional p rogrames under p r o j e c t Indonesia 0041, "Nursing Education". Assis tance t o p r o j e c t Indonesia 0074 s t a r t e d i n 1967 v i t h t h e award o f a fe l lowship. The a c t i v i t i e s of pra- j e c t Indonesia 0041 were merged wi th t h i s p r o j e c t i n 1969.

S ince t h e appointment i n 1971 o f a WHO nurse educator , emphasis has been placed on i d e n t i f y i n g and e s t a b l i s h i n g a r a t i o n a l nursing personnel system t h a t w u l d se rve as a guide f o r t h e f u t u r e development and u t i l i z a t i o n of nursing manpower, improving and expanding teaching i n s t i t u t i o n s f o r nur se teachers and on general improvement of c u r r i c u l a f o r a l l l e v e l s of nurs ing personnel.

I n 1973, a d e t a i l e d p lan of a c t i o n f o r the period 1973-75 was d r a f t e d which included a t e n t a t i v e p r o j e c t i o n of a c t i v i t i e s fo r the per iod 1976-1980. The methods and a c t i v i t i e s as descr ibed are geared t o develop, by 1980, a func t iona l o rgan iza t ion o f nurs ing service and to design, demonstrate and eva lua te a nur s ing educat ional system which i s responsive t o t h e perceived needs f o r these s e r v i c e s a t n a t i o n a l and l o c a l l eve l .

Pram 1974, t h e number of long-term nurse educators i s being increased from one to two. Also consu l t an t and fe l lowsh ip a s s i s t a n c e w i l l continue i n 1976-1977 i n accordance wi th the emphasis i n the plan of a c t i o n on community h e a l t h educat ion.

w INDONESIA .r

ET

Post-graduate Education i n Publ ic Health K m 003 (Indonesia 0097)

TO a s s i s t i n f u r t h e r developing t h e teaching and t r a i n i n g programmes conducted by t h e School of Publ ic Heal th , Univers i ty of Indonesia.

I n 1972, two consu l t an t s under SEAR0 0096, "Medical Education" a s s i s t e d i n developing a plan of work f o r t h i s p r o j e c t and i n determining d i s c i p l i n e s i n which consu l t an t s w i l l be required.

A medical educator i n t h e f i e l d of medical s t a t i s t i c s and epidemiology under Indonesia 0062, 'Wedical Education'' has been ass igned to t h e Facu l ty o f Publ ic Heal th , Univers i ty of Indonesia , s i n c e t h e beginning of 1974. P rov i s ion has been made f o r a medical educator from 1975 onwards. Th i s medical educator and shor t - t e rn consu l t an t s i n t h e f i e l d of pub l i c h e a l t h admin i s t r a t ion and programmes i n publ ic h e a l t h . In 1977 a second medical educator w i l l be provided.

Fellowships have been provided f o r t h e t each ing s t a f f of t h e Facu l ty Of Publ ic Health t o v i s i t i n s t i t u t i o n s o u t s i d e Indonesia. Fur the r n a t i o n a l f e l l o v - s h i p s have been provided f o r post -graduate t r a i n i n g i n pub l i c h e a l t h a t t h e School of Publ ic Heal th , J aka r t a .

Assis tance i s expected to cont inue f o r a number of years .

Aesiscance t o the p r o j e c t i s expected t o continue u n t i l 1980.

INDONESIA

Nursin~ and Midwifery Education

Nurse educators P3

S l l u r L - t r r r c c n i u 1 t a n t s

Fellowships supplies and equipment

post-praduate Education in Public Health

Medical educators P4

short-ierm cixnsuiranis Fellovrhips Supplies and equipment

Nursing Education and Training, Irian Jaya

Fellowships

Strengthenins, of the Teaching of muman ~eoroduction, Family ~ l a n n i n ~ and ~opulation Dyna- mics in Medical Schools

INSI7IIP04

Medical officer P4


IExnrersed in US Dollars)

R E G U L A R

Number of Posts m

m v " G k 3 2 b.

iq .. 0

WI

FP

pro,ect NO.

IHU M 2 (W74)

tw) w 3 (0097)

IHU W 5 (0084)

IHU 007 (0114)

1974

B O D G E T

Errimared Obligations

1915 1977

10 150

1974 1975 1 1976

Number of Posrr

36 540 2/24

( I T H E R S O I Y i E S

t . s r ~ m a t e d Ohligsri~ns

1976 1974

I I

59 940 66 040

11 4

i 18 000 13 200 15 750 25 I W I wo 1 W0 -

1 -

1974 ! 1975 I 1976

I

i i

I i

1977

55 540 74 140 - - -

1917 1915 / 1976

1/12 ---- 1 1 ----

21 4 10/10012/115~/115

87 590 101 650

1 -

i j

!

I j I

I !

I i I I !

i I I ! i

i ; I !

1 744

! i

7 460

16 540 5 860 - 29 860 -

1977

1

I I

~ i

I I I !

I

1112 9 810

21 2

11 3 - 1 - 4128

2/24

1 2

21 6 111147

i 30 735 ! 33 815 1 11 770

I

I 1

1

I 1 14 400

3 ow - 1 - -

i i !

I i I i I

j

i !

!

i

I E x D r e s s e d In " 5 Uollarri

R E G U L A R B U O C E T O T H E R S O V R C E S

PrO,ecr Number of Posts Estimated O b l i g a t i o n s IWONESIA Number of P o s t s Esflmdted O h l l g a t i o n S u T N O . " c

- 5 2 - 1974 1975 1976 1977 1974 1975 1976 1977 1974 1975 1976 1977 1974 1975 1976 1977 2

Resources f a r Fami ly H e a l t h Wm 008 INSI71IYOb (0119)

~ e a l r h srarlrr~cran 19 930

1 - 1 7 514

5. DISEASE PREVENTION AMI CONTROL

5 .1 C-unicable D l s e a r e s Prevention and C o n t r o l

5 .1 .2 Epidemiolo.ica1 s u r v e r 1 1 a n c e of Communicable D i s e a s e s

E p i d e r n i o l a g l s i

s h o r i - t e r m c o n s u l r a n t s F e l l o v r h i p r Particijalfi s v p p 1 i e r and equlpmenr

Medica l s t a t i s t i c i a n numan e c o l o g i r r

s h o r i - t e r m c o n s u l t a n t F e l l o v s h i p s S u p p l i e r and tqurpment

Strengthening of Epidemiological Surveillance ESD 003 (Indonesia 0137)

To assist in the development, organization, implementation and assessment of the surveillance and control of communicable diseases.

This project is the result of the merger of projects Indonesia 0091, "Strengthening of Epidemiological Services", and Indonesia 0099, "Plague Epidemiology". Under the former project, an epidemiologist, a statistician and consultants assisted in conducting national seminars on epidemiological 8ur~eillan~e, developing statistical facilities, and in specific fields such as epidemiology, surveillance and training, epidemiology and control of cholera, schistosomissis control, yaws eradication, evaluation of lung-diseases programole and denguelhaemorrhagic fever control. Also, fellowships and supplies and equipment have been provided to strengthen the activities of the project. Under the latter project, consultants and an animal ecologist assisted in strengthening surveillance and in studying the environmental and ecological conditions in the affected area, and insecticides and equipment have been provided. After the completion of ecological studies of plague in the endemic focus of Bojolali District, a national plague surveillance pto- gr-e will be established, as a part of the general epidemiological surveillance programme in the country. From 1975, the epidemiologist from project Indonesia 0091, will be transferred to the project.

Malaria Eradication HPD 001 (Indonesia 0032)

Ta assist in the control of malaria in the entire country and its eventual eradication with special emphasis in Java and Bali and in the socio-economic areas of other islands as an integrated activity.

WHO assistance was first provided to malaria control activities in 1951 and vas extended, in 1959, to an eradication programme, which was also supported by USAID. Satisfactory progress was made in Java, Bali, South Sumatra and South-east Kalimantan. In 1965, the situation deteriorated owing to various reasons. In 1967, the Ministry of Health was re-organized and the provinces were made responsible for the malaria progr-e and integration of the progr-e into health services started. As a result of a review of the programe by a joint WHOlUSAID team in 1972, it is expected that bilateral assistance will become available from 1975 for a period of five years.

In 1976 and 1977, a team of six long-term staff members will continue to assist the programme.

Assistance to the project is expected to continue for a number of years.

In 1976 and 1977, consultants will assist in specific fields, including plague epidemiology, and provision of fellovships rill be related to these specialties.

!

P r o l e c r SO.

ESD 003 (0137)

MPD W 1 (0032)

INDOSESI;3

Strengrhenrny of Ejldemlo1op,ical Surveillance

~pidemiolvgisr P4

Short-term cclniullonfs Pelluwshlps Suppiles and equrpmenc

1.1.3 naiarra and Ocher Parasitic Dlsearer

Nrlaria Eradication

NalariolagrrL P5 Malarioiuglsrs!

epideniologlsrs P4 Sanitary e n g ~ n e e r P4 Enromolvg~rt P4 Entmologirt P3 Translaforltgplit 054

Fellowshlps Subsidy Supplies and equipment

R E C C L A R

lixprrased m US ".?llarr,

1974

1/12 2/24

1112 1/12 1/12 1/12

7

5/24

B U D G E T

Estimated Obligaciunr

1974 1975 1 1976

& rn " c b 3 z -

2 L.

-

i' :

Number a t P o s r i

1974 / 1975 197e 1977

!

~ I !

i

1 i I I I I

I

I N

I I I !

I

I !

1

Number of Ports

1977 1975

ii i K 1 & C E S

isllmrred Obii~aLions

! I

31 110 25 640

19800 21600 21600 20 7 W 19 350 19 350 2 W O 2 000 2 W O - - - 73 610 I 68 590 42 950 - - -

i I

! 39 625 42 285 ! 43 955 60 690 66 790 70 9 W

1 31 485 34 568 ' 36 635 31 485 34 565 36 635

1 29 205 32 225 34 265 1 910 ' 2 100 1 740 - - - - - - - -

187 100 194 230 212 340 224 590

11 400 i 800 i bllii 43 000 43 W O 43 000 ; 43 000

L97b 1975 1976 1976

9 0 0 0 ) 9 m O I O O W - , - - 250 500 246 230 1 270 140 - I - I -

I i !

!

~ i

1977 1977

I i

~ i 1/12 11 9 I

- I T ! 1 I

31 9 31 9 3 1 9 - I - ; 6/30 6/27 6/27

; I

1 D W a - 282 290 -

I

1 1 i

'I

I I

I I

I

i I

1/12 2/24

1112 1/12 1/12 1/12

7

Si12

I !

1/12 1/12 2/24 2124 I 1112 1112 i 1/12 1/12 1/12

7 ----

1/12 1/12 1/12

7

A/lZ

INDONESIA

Malaria Control, I r i a n Jaya tmroP InS/73/009)

HPD 0 0 2 (Indonesia 0076)

To control malaria i n I r i a n Jaya.

A m 0 Team v i s i t e d I r i a n Jaya i n 1970 and made recormendations for a control progr-. Assistance from PUMNI, by way of supplies and equipment, was given up to 1973-1974. I n June-July 1974, m 0 v i l l assign a team t o assess the present malaria control a c t i v i t i e s and t o advise on the future wrk. A long-term malariologist i s proposed to be assigned from 1974, subject to ava i l ab i l i t y of UNDP funde.

INWNESIA

Tuberculosis Control HBD 001 (Indonesia 0050)

To a s s i s t i n the i n t e g r a t i o n of BCG vaccinat ion without p r i o r tube rcu l in t e s t i n g i n t o the work of t h e maternal and c h i l d h e a l t h c l i n i c e and regency poly- c l i n i c s , i n t r a i n i n g s t a f f engaged i n case-f inding by microscopic sputum exami- na t ion , and i n providing ambulatory treatment.

Ass i s t ance began i n 1961. An urban p i l o t area p r o j e c t i n Jog jaka r t a was g radua l ly extended as a s e r v i c e programme to cover t h e whole of the c i t y . A s i m i l a r programme was i n i t i a t e d i n Surabaya i n 1964, and, a t t h e same time, a r u r a l p i l o t p r o j e c t was s t a r t e d i n Halang, Eas t Java. A seminar i n tube rcu los i s c o n t r o l was h e l d i n 1969. I n 1970, a consul tant i n pub l i c h e a l t h nurs ing a s s i s t e d b r i e f l y wi th a t r a i n i n g programme i n BCG vaccinat ion. Also, a medical consu l t an t was ass igned i n 1970, 1971 and 1972-1973. I n add i t ion to a s s i s t i n g n a t i o n a l seminars i n 1971 and 1973, t h i s consu l t an t reviewed t h e BCG vaccina- t i o n programne and advised on i t s f u t u r e planning and organizat ion. Similar consu l t an t s e r v i c e s w i l l be provided i n 1974, 1976 and 1977. Fellowships w i l l b e provided t o n a t i o n a l s t a f f t o a t t e n d t r a i n i n g courses.

Leprosy Control HBD 0 0 2 (Indonesia 0009)

Veter inary Publ ic Health vm 001 (Indonesia 0100)

To a s s i s t i n the study of major zoonoses and i n t h e t r a i n i n g of v e t e r i n a r y pub l i c h e a l t h o f f i c e r s .

The p r o j e c t i s a fallow-up of a s s i s t a n c e provided under t h e in te r -coun t ry p r o j e c t SEAR0 0168, "Training i n Veterinary Publ ic Heal th and Promotion of Veter inary Publ ic Health Services". I n 1972 and 1973, consu l t an t s have a s s i s t e d i n launching, expanding and s t rengthening t h e n a t i o n a l v e t e r i n a r y pub l i c h e a l t h programme.

It i s planned to cont inue s i m i l a r a s s i s t a n c e for some years.

Cancer Control CAN 0 1 ( Indonesia 0134)

To a s s i s t i n organizing a na t iona l cancer c o n t r o l programme, i n t r a i n i n g hea l th and a l l i e d personnel i n cancer con t ro l i n s t r eng then ing the s e r v i c e s f o r the e a r l y detect ion, d i agnos i s , t reatment and r e h a b i l i t a t i o n of cancer p a t i e n t s and i n epidemiological i n v e s t i g a t i o n s and h e a l t h educat ion f o r t h e prevent ion of cancer.

To a s s i s t i n organizing a t r a i n i n g cum demonstration area i n leprosy I n 1977, two consu l t an t s w i l l a s s i s t i n t h e conduct of a n a t i o n a l vorkshop con t ro l . on the epidemiology of cancer and cancer con t ro l i n Indonesia. Fellowships w i l l

be awarded f o r senior surgeons physic ians and p a t h o l o g i s t s t o observe r e c e n t I n t h e p a s t a s s i s t a n c e has been given under t h i s p r o j e c t i n 1955, 1956- t r ends i n t h e management of cancer.

1967 and 1969-1970. I n 1974, wi th t h e help of Danish Save the Children Fund, t h e Government has i n i t i a t e d a programme for developing a t r a i n i n g cum demonstratiao area f o r t r a i n i n g of na t iona l s t a f f working i n the hea l th se rv ices i n leprosy con t ro l techniques.

Assis tance to t h i s p r o j e c t i s expected to continue f o r some years .

INDONESIA


Tuberculosir Control

short-term consulfanrr Feliovsh~ps

Leprosy Control

Medical a f f r c e r P4

5.1.9 Veterinary Public Health

veterinary public ~ e a ~ t h

S ~ O T C - t e r m consulianrs Fellowships

5.2 Nun-Cmunicable oinease Prevenrion and control

5.2.2 Cancer

cancer control

short-term consvlranrs Fellowahips

R E G U L A R

Number of P a s t s

1974

B U D G E T

Estimated Obligations F'rojecr NO.

HBD 001 (0050)

M8D W 2 (WM)

WH WI (01W)

CAN 001 (0134)

1974 1975 1975

11 3

u 0 .,

1976

i I

! I

6 000 4 8 W 4 800 3 600 1 3 6 W 1 2 000 1 ? 000

- 1 - 1

i

i

6 OW i 6 6 W 4 800 4 800 ' 2 W O 2 0 0 0 I - 1 - - 6 WO G 6 8 0 0 6 S K I

- - : - ,

j - I

i

1917 1976 1974

11 8

11 3

1

I

1977

4 800 4 950 - 9 750 -

"~,.~-,

n % m " c L. 3 5 *

VL

-

Number or Ports

~ - A p . L o s = " A,, ..,

T H E R S i l l R C L S

LslLnated Obligalionr

I

11 2 21 4

1975 : 197b

11 2 21 4

21 2 3 1 3

1917 1977 1914 1 1975

1 ! 1

lil? 1/12 --- 1 1 1 ---

I

!

i

i

I

i I i

I

1

I

I

I

I

i !

1916

Dental Heal th (LJNDP INS/68/038)

DNH 001 (Indonesia 0079)

L. INDONESIA z

To a s s i s t i n planning f u r t h e r den ta l a c t i v i t i e s and i n s t rengthening den ta l h e a l t h s e r v i c e s wi th in t h e framework of h e a l t h se rv ices and i n promoting den ta l h e a l t h r e sea rch .

The p r o j e c t s t a r t e d i n 1968 with the assignment of a consu l t an t t o review d e n t a l educat ion and d e n t a l h e a l t h services. I n 1970-71, another consu l t an t a s s i s t e d i n t h e t each ing of p u b l i c h e a l t h and s o c i a l d e n t i s t r y a t t h e Dental Facul ty i n Bandung. I n 1971-72, a f u r t h e r consu l t an t advised on the planning of a n a t i o n a l system of d e n t a l education and a s s i s t e d i n t h e organizat ion of a den ta l workshop t o review t h e teaching i n den ta l schools i n r e l a t i o n to the d e n t a l care needs of t h e populat ion. I n 1972, t h e same consu l t an t helped with t h e f u r t h e r t r a i n i n g of t h e d e n t a l personnel and i n t h e improvement o f den ta l educat ion. I n 1973, a consu l t an t a s s i s t e d wi th the development and teaching of per idontology i n den ta l i n s t i t u t i o n s . I o 1974, a team of consu l t an t s helped wi th t h e p repa ra t ion of a long-term prograrmoe f o r t h e s t rengthening of den ta l h e a l t h s e r v i c e s and t h e promotion of epidemiological research. I n 1976,consul- t a n t s e r v i c e s w i l l be provided t o a s s i s t wi th t h e var ious a s p e c t s of the den ta l educat ion and d e n t a l h e a l t h se rv ices wi thin t h e general franevork of the h e a l t h s e r v i c e s . I n 1977, fe l lowships v i l l be awarded i n r e l a t e d s p e c i a l t i e s .

he p r o j e c t i s expected t o cont inue u n t i l t h e end of 1978.

Mental Heal th HNH 001 (Indonesia 0096)

To a s s i s t i n t r a i n i n g medical, nurs ing and a l l i e d hea l th personnel f o r community-oriented mental h e a l t h se rv ices v i t h i n the framework of comprehensive h e a l t h s e r v i c e s , i n s t r eng then ing psychiat ry services, including r e h a b i l i t a - t i o n , and i n epidemiological i n v e s t i g a t i o n s of mental i l l n e s s .

I n 1973,a consu l t an t under an in te r - reg iona l p r o j e c t (0308) v i s i t e d Indonesia to assess t h e s t a t u s of development i n mental hea l th . I n 1974 consul- t a n t s advised and a s s i s t e d i n t h e teaching, o rgan iza t ion and demonstration o f p s y c h i a t r i c services. I n 1974, fe l lowships were provided f o r t h e t r a i n i n g o f f a c u l t y members and o f f i c e r s from mental h e a l t h se rv ices .

I n 1976-1977, provis ion has been made f o r consu l t an t s i n b i o l o g i c a l psychiat ry and c h i l d psychiat ry . Fellowships w i l l be provided f o r t h e t r a i n i n g o f junior and s e n i o r psychiat ry t eacher s and government and mental h o s p i t a l medical o f f i c e r s .

WHO a s s i s t a n c e i s expected to cont inue u n t i l 1983

I m u n i r a t i o n Services ( inc lud ing Smallpox) nn 001 (Indonesia 0135)

TO i n i t i a t e and develop imnunization s e r v i c e s t o cover gradua l ly i m i z a - t i a n aga ins t smallpox, tube rcu los i s , d iph the r i a , t e t anus , p e r t u s s i s and po l io - m y e l i t i s , according t o n a t i o n a l p r i o r i t i e s .

Immunizations w i l l be s t a r t e d i n urban areas and then f u r t h e r extended t o r u r a l areas, t o begin wi th a t p l aces where h e a l t h c e n t r e s e x i s t . Af te r success- f u l completion of t h e slnallpox e rad ica t ion p r a g r a m e (Indonesia 00811, wel l - t r a i n e d and experienced na t iona l s t a f f w i l l be a t t ached t o , and w i l l cont inue t o work with , the above p r o j e c t .

INDONESIA

Q u a l i t y Control of Food and Druge SQP 001 (Indonesia 0106)

To a s s i s t i n d r a f t i n g l e g i s l a t i o n to cover the q u a l i t y con t ro l of food and drugs; t o adv i se and a s s i s t i n t h e improvement of t h e c e n t r a l q u a l i t y c o n t r o l l a b o r a t o r y , and to t r a i n personnel.

I n 1969, tm c o n s u l t a n t s , a pharmaceutical chemist and a miccobiologis t , provided under SEARO 0154, "Quality Control of Biological and Pharmaceutical Products", reviewed t h e e x i s t i n g l e g i s l a t i o n and l abora to ry competence i n q u a l i t y c o n t r o l . I n 1973, a pharmaceutical chemist a s s i s t e d wi th s h o r t courses f a r drug inspec to r s . It i s planned t o provide consu l t an t s t o s t rengthen f u r t h e r the q u a l i t y c o n t r o l l a b o r a t o r i e s t o t r a i n personnel and t o review end r e v i s e t h e l e g i a l a t i o n as necessary. Fellowships w i l l be provided t o cover t h e f i e l d s of chemical a n a l y s i s , chromatography and drug q u a l i t y con t ro l .

Ass i s t ance t o the p r o j e c t i s expected t o continue u n t i l 1978

National Comnunitv Water Supply and San i t a t ion BSI 001 (Indonesia 0071)

To a s s i s t i n providing community v a t e r supply and s a n i t a t i o n f a c i l i t i e s i n r u r a l and urban areas and i n the t r a i n i n g of personnel .

A s a n i t a r y engineer was ass igned i n 1969 t o help i n t h e development o f a r u r a l water supply and s a n i t a t i o n programme; another was appointed i n 1973 f o r providing a s s i s t a n c e i n the development of urban v a t e r supply and s a n i t a t i o n . It i s ~ r o p o s e d t o a s s ign a s a n i t a r i a n i n 1974. The provis ion of the tvo san i - t a ry engineers and one s a n i t a r i a n v i l l cont inue i n 1976-1977. Subject to a v a i l a b i l i t y of funds, s f u r t h e r s a n i t a r y engineer and a s a n i t a r i a n i s proposed to be provided from 1976. I n add i t ion , shor t - term consu l t an t s i n food san i - t a t i o n , s o l i d waste management and v a t e r supply in - se rv ice t r a i n i n g w i l l be provided i n 1976 and i n 1977 for review and evaluat ion of r u r a l and urban water supply as wel l as environmental po l lu t ion programmes. Fellowships for p o r t h e a l t h v i l l be provided i n 1974 and 1975 and f o r posr-graduate s t u d i e s and s h o r t observat ion tour s i n environmental h e a l t h i n 1976-1977.

UNICEF is providing a s s i s t a n c e i n the form of supp l i e s and equipment

Assis tance i s expected to cont inue u n t i l 1980.

Jakarta Sewerage and Sanitation Project (UNDP JNS172/068)

PIP 0 0 2 (Indonesia 0129)

INDONESIA

To assist in the preparation of a master plan, covering all aspects of sewerage, drainage and sanitation in Jakarta, and to develop a training programme for personnel concerned with the technical, management and financial aspects of sewerage in Jakerta.

In October 1972, two staff members from WHO Headquarters visited Indonesia to study and assess the sewerage situation in the city of Jakarta and its environs, and to assist the Government in preparing a project document for UNDP assistance in the drawing up of a master plan and the first stage progranmre for sewerage and sanitation

A sanitary engineer is assiwed to act as a project manager. The major engineering work will be entrusted to a consulting engineering firm. Training of national counterparts is a major component of the project.

Rural Water Supply Project, East Java Province (UNDP INS1731003)

PIP 003 (Indonesia 0130)

To assist in the development and implementation of a planned rural water supply programme for the East Java Province.

In 1973, a preparatory assistance request to UNDP was prepared in order to formulate, in detail, a project document. A preparatory assistance team consisting of sanitary engineers and short-term consultants in economics and hydrageology is therefore proposed in order to prepare the document and to provide a nucleus of expertise for an eventual full-scale project.

The preparatory work is expected to etsrt in July 1974 and is expected to last till 1976.

The project document was signed in December 1973 and assistance to the project vill continue for 30 months.

P r o j e c t so.

PIP 001 (01271

PIP 002 (01291

PIP 003 (0130)

IWONESIA

6.1.3 Pre-~nvestmenr Plannrng for 8asic sanlrary services

Land and Water Rerources Developmenr x n Southern Sumdicra INSIb9/518

Short-term consultant

Diskarta Seuera~e and Sanitation P r o l e c i INS1721068

Project manager P5

Short-term coniultant Sub-contracts Fellowships Supplies and equipment nrsce1ianeaur

Rural Water Supply Project, East Java Province 1~S1131W3

projecr manager P4 sanitary engineer P4

short-term consulfanri Sub-confracrs F ~ I I O W S ~ ~ P S

supplies and equipment nisce11aneour

I

B C D C E T


1974 I915 1916 ! 1977

I

I I ~ I

I I 1 i

I

I i

i I

I I

i

i ~ i

I I I I ~ !

i ! I

i I

! i

R E G U L A R

Number of P o e t s

! I 1 j I

l L x p r e E E e a i n r-. "u,laib,

1974

u v " L w ,

1 -

LA

DP

DP

! I 1 ~ 1 ' I 1 1 1

I

1975

Number of Porrr

1974

< m T H L H > O I H C E S

srirrred ObI~gaL~onr

1976 1974 1975 1976 1977 1975 1977 I

1976 1977

!

I

2 500 i ! !

15 000 30 000 30 O W

7 500 180 W O 230 000 50 000 14 400 ' 14 400 7 200 ~ 30 250 1 750 8

10 1 W , 16 300 6 100 - - - I 249 750 299 950 93 300 1 - - - I

I

30 WO 20 O W i 30 000 20 O W i - - -

20 O W 60 O W 40 W O I

15 000 7 5W I 100 000

10 300 11 000 15 OW , 18 000 1 000 1 O W 1 2 W - - - 47 000 83 500 169 500 - - -

I

1

I i

I/ 1

11 b 1/12 ! 1112 , /, ~, -I- i-

1 1 3 1 i !

4124 4124 2112 I !

1

11 4 11 4

2 -- 31 b

1112 '11 8 1112 , 11 8 --- 2 l 2

I - 31 3

1 I j 2/18 i I :

i ~ ~

Hazards t o Man from P e s t i c i d e s CEP 001 (Indonesia W90)

TO a s s i s t i n formulat ing l e g i s l a t i o n regarding hazards t o man from pes t i - c i d e s i n use i n a g r i c u l t u r e ; to t r a i n l abora to ry m r k e r s i n determining cho l i - n e s t e r a s e l e v e l s ; t o a s s i s t f u r t h e r s t u d i e s to determine the s i r e of t h e problem.

A consu l t an t undertook a prel iminary broad study of the s i t u a t i o n i n 1969. Tvo consu l t an t s were provided i n 1970 - one to a s s i s t v i t h t h e t r a in ing o f l abora to ry s t a f f , and another v i t h t h e preparat ion of l e g i s l a t i o n . I n 1973, a consu l t an t v i s i t e d appropr ia t e l a b o r a t o r i e s and a s s i s t e d i n s t rengthening t h e p e s t i c i d e s p ro tecc ioo teams and i n guiding the members of the Pes t i c ides Co-ordination Committee i n the enforcement of the government decree on pes t i - c i d e s . Fur ther consu l t an t s e r v i c e s have been provided f o r i n 1975.

The a c t i v i t i e s of t h e p r o j e c t are co-ordinated v i t h those of SEARO 0190, "Control o f Hazards to Man from Pes t i c ides r ' .

Development of Centra l and Regional Occuoational Heal th and I n d u s t r i a l Hygiene Labora to r i e s (UNDP INS/72/028)

HCTP 001 (Indonesia 0105)

To a s s i s t v i t h the f u r t h e r development of the National I n s t i t u t e of Occupa- t i o n a l Heal th , J a k a r t a , and reg iona l c e n t r e s .

A consu l t an t was provided f o r th ree weeks i n April 1970 to undertake a f e a s i b i l i t y study o f a p r o j e c t i n occupat ional h e a l t h . Another consu l t an t was ass igned i n September 1970 f o r e per iod of s i x months to a s s i s t the Government i n f u r t h e r s t r eng then ing the coun t ry ' s occupat ional h e a l t h s e r v i c e s and i n p repa r ing a r eques t t o t h e UNDP f o r t h e development of a p r o j e c t i n t h i s f i e l d . A consu l t an t a s s i s t e d t h e p r o j e c t i n March 1973 i n the f i n a l i z a t i o n of the p r o j e c t r eques t .

I n 1974 and 1975, the P r o j e c t Manager (occupat ional h y g i e n i s t ) w i l l a s s i s t i n s t rengthening the National I n s t i cute of Occupational Hea l th , J a k a r t a , and i t s reg iona l cen t res and i n conducting courses f a r d i f f e r e n t groups of personnel . Consul tants i n mine s a f e t y and a g r i c u l t u r a l h e a l t h and safey w i l l provide a s a i s - tance. Personnel working a t t h e Nat ional I n s t i t u t e and t h e r e g i o n a l c e n t r e s w i l l be awarded fe l lowships i n the f i e l d s of occupat ional h e a l t h and hygiene, indus- t r i a l hygiene chemistry, occupat ional and mine s a f e t y , occupat ional h e a l t h nurs ing and ins t rumentat ion. ILO has been designated as Associated Agency fo r implementa- t ion of occupat ional s a f e t y a spec t s of t h e p r o j e c t ( i . e . , a long-term p o s t and some fe l lowships) .

Assis tance to t h e p r o j e c t i s expected to cont inue u n t i l 1976.

Radiat ion Heal th RAD W 1 (Indonesia 0116)

To a s s i s t i n developing a na t iona l r a d i o l o g i c a l h e a l t h p r o t e c t i o n s e r v i c e ; i n e s t a b l i s h i n g a na t iona l medical physics se rv ice and i n s t r eng then ing t r a i n i n g se rv ices and resea rch i n r ad io log ica l sc i ences i n medical f a c u l t i e s and r e l a t e d h e a l t h i n s t i t u t i o n s .

I n 1972, supp l i e s and equipment were provided to a s s i s t i n i n i t i a t i n g a f i lm badge monitoring se rv ice . I n 1973, a consu l t an t under SEARO 0042, "Radia- t ion Health", a s s i s t e d i n organizing a p i l o t f i lm badge s e r v i c e i n J a k a r t a . Another consu l t an t a s s i s t e d , i n 1974, i n f u r t h e r developing r a d i a t i o n p r o t e c t i o n s e r v i c e s .

I n 1975 and 1976, fe l lowships are proposed f o r t r a i n i n g i n r ad io log ica l physics , radiotherapy, r a d ~ a t ~ o n protection and nuclear medicine. I n 1977, consu l t an t s w i l l be provided i n r a d i o l o g i c a l h e a l t h protection and nuc lea r medicine.

me p r o j e c t i s expected to cont inue t i l l 1980.

Projeer NO.

CEP 001 (0090)

W P W 1 (0105)

RAD 001 (0116)

INDONES lA

6.1.4 Control of Environmental Pollvflon and Hazards

~arards to "an f r m Perticidea

~ h ~ ~ i - t ~ ~ ~ consulrant Fellovrhipr Supplies and equlpmenr

6.1.5 ~ e s i ~ h of vork~ng Poouiations

~evelomenr of Central and ~eglon.1 Occuoa~~onal Health and Indurcrial Hygiene Laboratories INSIl2/028

occupational hygienlsf P4 ~~c~parronal safety engrneer ~4

Short-term con~ulrants Fellovrhipr supplies and equipment nisce11aneous

6.1.6 Bimedical and Environmental Health Aspec ts of Ionizing Radiation

Radiation Health

Short-term consul rant^ Fellovrhipr Supplier and equlpmenr

R E G U L A R

iixpressed In u, "oLlsrs4

-

1974

11 2

B C D G E T

Estimated Obligarionr u 0 c * 5 2 .. -

DP

1977

Number of P o r t s

1974

umber of ~orri

1975 1975 1 1976

O T i i E R S O I ' R C E S

1974

11 7 11 6

I I

I I I

500 1 O W

I

1976

4 000

- 4 000 -

1917

.timared obligations

2 1 2 2 ~ 14/86 6/49 : ;

i I I 1

I

! I

I I !

1915 1917

I !

1976 1975 1916 / 1977

i

1976

, i i

I I

I I 1

1/12 111 5 11 6

I/ 4 3118

: I/ 3 2/12

1/12 !

6 6 0 0 ' 1 1 l W 5 W 500 - 1 -

7 1 w 1 12 200 -

! i I

1

30 MO 1 12 5W

13 500

137 O W 1 O W

I

! I !

I I

21 6

3/18

9 600 11100 1 000 - 22 300 -

Tra in ing i n San i t a ry Engineering SFS 001 (Indonesia 0061)

To provide a s s i s t a n c e t o t h e I n s t i t u t e o f Technology, Bandung and t o o t h e r i n s t i t u t i o n s on r e q u e s t , i n s a n i t a r y engineer ing t r a i n i n g .

A c o n s u l t a n t was provided i n 1968 and another i n 1970-1971. A WKO professo r o f s a n i t a r y engineer ing was ass igned i n 1972 t o assist t h e I n s t i t u t e i n t h e development o f a r e g u l a r t r a i n i n g programme i n s a n i t a r y engineering. He w i l l complete h i s assignment st t h e end of 1975 and t h e r e a f t e r t h e I n s t i t u t e w i l l need only consu l t an t s e r v i c e s t o develop courses i n s p e c i a l i z e d d i s c i p l i n e s o f s a n i t a r y engineer ing. Accordingly, shor t - term v i s i t i n g p ro fesso r s i n s p e c i a l s u b j e c t s w i l l be provided i n 1976-1977 and fe l lowships w i l l be o f fe red f o r post -graduate s tudy i n food s a n i t a t i o n as we l l as f o r s h o r t observat ion s t u d i e s f o r teaching s t a f f .

The p r o j e c t i s erpecced t o cont inue u n t i l t h e end of 1977.

Pr0,ecf S O .

SES 001 (0061)

HLI 001 (0115)

INDONESIA

6.1.7 Errablishmenr and Stienzthening of Environmenial Health Services and Insrltutions

Trainrnp in Sanitary Enqineeiing

Sanitary engineer P4

Short-term consultants Fellovshi?i Supplies and equipment

7. HEALTH ISFORE(RTI0N AND LITERATURE

7.2 nealrh ~ ~ r e r a t u r e services

Assisrance to L l b r a r l e r f o r Health Personnel INsI~IIPO~

Fellovshrp Supplies and equrpment

Total - ISDOSLSIA

Expected direit input. from

l !

BUDGE^

Estimated Obllgalionr

1974 1 1975 1976 , 1977

I

I I

I

27 670 28 830

21 600 21 600 6 600 , 19 100 16 000 16 000 I 000 I O W 1 000 1 000

- - - 1 , -

! i

I i ! !

i

I- - -

R E C O L A R

Number o f P o r r r

UBICEF I" the health field ......... , ========= . . -. . . . . .

I

l i x p r e s r e d i n L ' Oallarr'

34 34 1 325 005 1 466 800 1 540 825 1 662 120

! I i ! I

1974 11975 ! 1976 1977

L - 9 c b.

3 3 - -

FP

DP FP WI VL LA

i I --

- Number o l P ; , r : i

1974 ! 1975 1976 I !9i7 I

I !

1

l i T H E 2 5 ! 1 I ? , I i S

itinitrd ~ d h l i p a r l o n s

I

-

I 1974 1'175 1976

I

I -

1977

!

. . . . .-. - . . . . . -. .

-- --

I I

- - - 722 370 421 130 3 200 - - - - - - - - - - - - - - = = = = = = = ...... ....--

603 350 353 150 3 ZOO 87 910 33 790

I1 110 14 190 2 500 1 - - - -

1 333 284 722 370 , 421 130 3 200 - - -

Project Old

0005

0007

0009

Project Title

Country Statement

Public Health Administration

Water Supply and Sanitation

Training of Auxiliary Health Personnel

No. New

STR 001

BSM 001

HMD 001

Page

320

322

324

322

I !

Funds

R

W Y 'D

Pro'ect Old

0010

0011

Project Title

Malaria Control

Water Supply and Sewerage,

No. 1 New

MPD 001

PIP 001 Ma16

Maternal and Child Health Services

Medical Education

MCH 001

HMD 002

R

DP

Page

0012

0201

Funds

324

326

487

322

I DP

Add I.

DP

MALDIVES

The t o t a l p o p u l a t i o n of t h e 190 i n h a b i t e d i s l a n d s ( o u t of t h e 1 273 i s l a n d s , grouped i n 19 a t o l l s , which make up t h e Republ ic of t h e Maldives) is 122 673 (1972 census ) and t h e c a p i t a l , X a l e , a l o n e h a s 1 5 750 i n h a b i t a n t s .

The a n n u a l p o p u l a t i o n growth was e s t i m a t e d t o be 3.6% over t h e p e r i o d 1965-1971 and 2.9% i n 1972.

I n f a n t m o r t a l i t y was e s t i m a t e d t o be 180 p e r 1 000 l i v e b i r t h s i n 1972, when d e a t h s among c h i l d r e n under one y e a r of age were 1 042 a g a i n s t 5 792 b i r t h s . lne m a t e r n a l m o r t a l i t y ra te p e r 1 UUO 11i.e b i r t h s was 11 .9 .

The Government c o n t i n u e s t o g i v e h i g h p r i o r i t y t o t h e development o f t h e h e a l t h s e r v i c e s and , p a r t i c u l a r l y , t o h e a l t h manpower development, env i ronmenta l s a n i t a t i o n , i n c l u d i n g s a f e w a t e r s u p p l i e s , and t h e c o n t r o l o f communicable d i s e a s e s .

WHO'S a s s i s t a n c e i s v e r y c l o s e l y t a i l o r e d t o t h e Government 's p r i o r i - t i e s and is p rov ided through long- term s t a f f , shor t - t e rm c o n s u l t a n t s , f e l l o w s h i p s , s u p p l i e s and equipment.

S t r e n g t h e n i n g o f h e a l t h s e r v i c e s

The P u b l i c H e a l t h D i v i s i o n i n t h e M i n i s t r y of Hea l th o r g a n i z e s and s u p e r v i s e s t h e a t o l l h e a l t h c e n t r e s . Of t h e 19 a t o l l s , 14 now have h e a l t h c e n t r e s , which are manned by h e a l t h a s s i s t a n t s , and Male h a s a h o s p i t a l w i t h 45 beds . I n a d r q u a t e i n t e r - a t o l l t r a n s p o r t s t i l l p r e v e n t s t h e Government from t a k i n g e f f e c t i v e measures f a r t h e d e l i v e r y of h e a l t h s e r v i c e s .

WHO assistance. The O r g a n i z a t i o n is h e l p i n g t o develop a compre- h e n s i v e h e a l t h s e r v i c e and t o s t r e n g t h e n medical care. For t h i s purpose , s u b j e c t t o a v a i l a b i l i t y o f UNDP funds , WHO p l a n s t o p r o v i d e t h e s e r v i c e s o f seven f u l l - t i m e s t a f f members, and t o c o n t i n u e t o a s s i g n shor t - t e rm c o n s u l t a n t s and award f e l l a r s l r i p s i n d i f f e r e n t d i s c i p l i n e s . The a c t i v i - t i e s w i l l b e c l o s e l y l i n k e d w i t h t h e a s s i s t a n c e i n t h e t r a i n i n g o f a u x i l i a r i e s and community h e a l t h workers .

H e a l t h manpower development

The implementa t ion of h e a l t h programmes requires more t r a i n e d p e r - s o n n e l , who a r e i n v e r y s h o r t s u p p l y i n t h e coun t ry (which h a s 3 n a t i o n a l q u a l i f i e d d o c t o r s , 5 g r a d u a t e n u r s e s , 31 h e a l t h a s s i s t a n t s , 24 n u r s i n g a i d e s and '30 ind igenous midwives). T r a i n i n g a c t i v i t i e s aimed a t making a n u c l e u s o f t r a i n e d a u x i l i a r y s t a f f a v a i l a b l e have

been e s t a b l i s h e d by t h e Government, which w i l l a l s o c o n t i n u e t o u t i l i z e t h e s e r v i c e s of t h e p h y s i c i a n s t r a i n e d w i t h WHO a s s i s t a n c e .

3 9 assistmce. A s s i s t a n c e w i l l c o n t i n u e t o b e p rov ided f o r t h e t r a i n i n g of a u x i l i a r y h e a l t h p e r s o n n e l . With funds from UNDP, t h e pro- j e c t f o r t h e t r a i n i n g o f community h e a l t h workers i s t o b e expanded. This programme, whereby community r e s o u r c e s f a r t h e p r o v i s i o n o f f r e e lodg ing and s u b s i s t e n c e are p rov ided a t Male f o r s t u d e n t s f rom o t h e r a t o l l s , p r e s e n t s an admirable example o f a w e l l o rgan ized t r a i n i n g programme f o r a u x i l i a r i e s on a s e l f - h e l p b a s i s , a s s i s t e d by WHO.

Disease p r e v e n t i o n and c o n t r o l

M a l a r i a , f i l a r i a s i s and t u b e r c u l o s i s c o n t i n u e t o b e p r e v a l e n t i n t h e c o u n t r y , and l e p r o s y , typho id , meas les , d i p h t h e r i a and t e t a n u s are a l s o i m p o r t a n t . G a s t r o - i n t e s t i n a l d i s e a s e s and n u t r i t i o n a l problems are wide ly p r e v a l e n t . As r e g a r d s t h e m a l a r i a c o n t r o l programme, i t is expec ted t h a t t o t a l s p r a y coverage i n a l l t h e i s l a n d s i n t h e 19 a t o l l s w i l l have been a c h i e v e d , and r a d i c a l t r e a t m e n t c a r r i e d o u t by t h e end o f 1974. Fol lowing an as sessment of t h e work done, a n d , i f f e a s i b l e and adequa te t r a n s p o r t f a c i l i t i e s a re a v a i l a b l e , i t i s p lanned t o i n i - t i a t e a m a l a r i a e r a d i c a t i o n programme from 1975. The Government h a s launched a house-to-house l e p r o s y s u r v e y throughout t h e a t o l l s . BCG v a c c i n a t i o n s were s t a r t e d i n a l l 19 a t o l l s a f t e r 1968; t h e f i r s t round was completed i n 1970, and t h e Government h a s under t aken t o carry o u t t h e subsequen t rounds a l s o . A l i m i t e d b a s e l i n e t u b e r c u l o s i s s u r v e y was under t aken and t r e a t m e n t o f p o s i t i v e cases i n i t i a t e d b o t h i n Male and i n t h e o t h e r a t o l l s .

V#O assistance. WHO w i l l p r o v i d e p e r s o n n e l and s u p p l i e s f a r m a l a r i a e r a d i c a t i o n and w i l l a l s o a s s i s t i n t h e i n t e g r a t i o n o f t h e m a l a r i a pro- g r a m e s i n t o t h e g e n e r a l h e a l t h s e r v i c e s . I t w i l l a l s o h e l p w i t h mea- s u r e s f a r t h e f u r t h e r c o n t r o l of o t h e r h i g h l y p r e v a l e n t communicable d i s e a s e s .

Promotion of Environmental Hea l th

E n v i r o n m n t a l c o n d i t i o n s i n Male and some o f t h e o t h e r more popu- l a t e d i s l a n d s are i n s a n i t a r y and c o n t r i b u t e t o t h e p r e v a l e n c e o f e n t e r i c d i s e a s e s on t h e s e i s l a n d s . The con tamina t ion of sources of f r e s h w a t e r by unhyg ien ic e x c r e t a d i s p o s a l and as a r e s u l t o f t h e overcrowding i n Male c o n s t i t u t e s one problem. The Government i s p r e p a r i n g t o p r o v i d e a s a f e w a t e r and sewage d i s p o s a l i n Xale and i s a l s o p o s s i b l y t o launch s i m i l a r schemes i n some of t h e o t h e r p r i n c i p a l i s l a n d s of t h e a t o l l s . These schpmeq s h o u l d reduce t h e i n c i d e n c e o f e a s t r a - i n t e s t i n a l d i s e a s e s .

MALDIVES

WHO assistance. The Organization will continue to provide technical services, fellowships and same supplies. In addition UNDP and U N I C E F assistance are expected to continue in respect of supplies and equipment for the development of water supply and excreta disposal systems in Male and other islands. It is expected that, as a result of the pre-investment study carried out in Male through funds provided by UNDP, construction work will start in 1976 with bilateral assistance.

Public Health Administration STR 001 (Maldives 0005)

u w

MALDIVES w

To assist in developing comprehensive health services, in promoting manpowe; development and in strengthening medical care services with particular eophasis on the control of endemic diseases of social and economic importance.

Since 1959, a team consisting of a public health officer, a nurse (up to 1969), a sanitarian and a laboratory technician has been provided and a number of consultants have given advice in the fields of malaria, tuberculosis, filariasis, leprosy, environmental health, sanitary engineering, health education, entomology and physiotherapy, a s well a s in training connunity health workers. In most of rhese fields, there have been follow-up visits by other consultants. During 1974 and 1975 consultant assistance will be provided in various related fields: epidemiology, tuberculosis, leprosy, iilariasis and sanitary engineering.

The project will be developed through ( a ) the identification and phased planning of the activities that would lead to the development of health services, (b) the development of manpower and ( c ) the development of a demonstration area in one of the atolls and community participation.

The activities of this project will be co-ordinated with those of "Training of Auxiliary Health Personnel", (Maldives 0009) and 'Ualaria Control", (Maldives 0010).

Training of Auxiliary Health Personnel (UNDP HDV/70/002)

HHD 001 (Maldives 0009)

TO assist in the establishment of a school for the training of auxiliary health personnel.

The project has covered, since 1971, the activities earlier conducted under Maldives 0008, "Nursing Services and Educationc'. In 1973, a public health nurse educator and a consultant were provided and courses for avxiliary health personnel were started. The project will carry out its activities in close co-ordination with project Maldives 0005, "Public Health Administration".

WHO assistance will continue in 1975 and 1976 subject to the availability of funds from UNDP.

Fellowships (Hedical Education) (UNDP MDV/70/W3 and MDVl731004)

To assist in building up a national cadre of physicians.

HHD 002 (Maldives 0201)

This project is expected to continue for a number of years.

~ i . n i , i r

E r r i ~ a c e d O b l i g . < i i i n s

I 1974 I 9 ; j I976 ! 19:;

26 560 29 640 11 560 18 880 20 670 21 860 18 880 20 9 7 0 21 860

1 350 L 350 1 150 - - - - 64 330 65 b70 72 610 78 630

20 000 1 7 600 19 200 I9 200 1 0 200 9 3 0 0 1 5 0 0 0 I 3 8 0 0

8 8 0 0 8 0 0 0 8 0 0 0 1 0 0 0 0 ---- 103 330 100 570 114 830 ; 119 610

- -

R F G ~ L A R

Number o f P c l r t b

m u

X A L D l i T S

1. SIKtPiGTtiESlKG OF IHEALIII SERVICES

3 . 1 S t r e i ~ g t o e n i n g o i HealCI? Servlcer

3.1.2 S t r m n f i f n r n ~ n g u i i i e s l t h Se rv i ce s

Publrc H e a l t h AdmlnirtraLion

P u b l i c h e a l t h uiilcer Pl. L a h o r a f o r y tec-zlcian P2 S d r i i l a r i a n 1'2 C l e r k - s r e : ~ a g r a p n e r C0L4

S i ~ o r t - i e r n c o n r u l t a o l i F e l l o v i h i p b S u p p l i e s arrd equrpmenr

. IIEALIH ~~IVI(POL'ER DEPELOPnENI

i . 1 H e a l t h Manpoiier D r v e ! u p m m t

Tra in , , ,& r l *url:lar? H e a l t h Persoll l lel XUV/701002

P u b l i c heeal l i a i i l c e r Y4 Yuoilc ~ C ~ L L I c u r i e e d u c a r o r P 3

short-term c i ~ x s 2 1 r a : ~ t s i c i l ~ ~ r s n ~ p s S u j i p i l r i dau s r j r l j l i : r >,~s'",~,3r.'2du~

l e l l "~ . .dsn . l s ( : :eCl 'a l i " i ' a t , o , l I >iDVi7OIOOJ MDYl7ii001

> c . 1,>,.<s,.,.;,s

1974 1975 ' 1 9 7 6 I 197'

P r , , l e c I

x u .

S I R W 1 (0005)

HE(D 001 (0009)

am 002 1 0 2 0 : )

I ; !

I ~ 1 / 1 2 1 1 1 2 1 / 1 2 1 ' 1 2 l i 1 2 , 1112 ' 1 / 1 2 ; 1 \ 1 2 1 / 1 2 1 / 1 2 1 / 1 2 1 / 1 2 I / 6 1 / 1 2 1 / 1 2 1 / 1 2

IT _ l - , - i - 6 1 1 0 , 41 8 , 41 8 4 1 8 5136 , 3/36 6 / 6 0 1,136 i

I i i

i ! i I ! ! 1 ' 1

I 1

1 i ; l l ~ I I ;

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I !

ixprrssrd i n C S O d l l a r s )

I ' :

Su-nher 0 , P , i r ; i

1974 1 4 7 i , 1 9 : ~ 19::

~ !

i 1 / 1 2 Li 7 1 / 1 2 1 / 1 2 I L1 ---

2 2 2 --- 11 6 5 ;l 3/27 " l a 8

1 4 $ 8 8

L m : 5 2 - i' _

i'C

UP

OP .

I! i H s h r ~ i i s

i r r ~ v r ~ e d O h l 1 & , 4 t i i l n i

I 1 9 i i LU:? , 1976 197:

I

I ~ !

400 - 400 1 -

!

I

1 !

I 0 0 0 0 I 7 500 1 30 0 0 0 30 0 0 0 !

- - ,

1 2 500 60 0 0 0 4 7 500 1 I 5 000 1 6 700

l 9 100 1 7 200 '

5 000 2 500 2 500 1 100 1 1 W - - - ,

80 100 72 700 67 200 - - - j

i - - - - 14 400 14 Lo0 14 400 1 4 400

Malaria Control MPD 001 (Maldives 0010)

MALDIVES K2 R

To assist in the control of malaria in the entire country leading to its eventual eradication.

Starting in 1951, anti-malaria activities formed an integral part of project Maldives 0005, "Public Health Administration". A study of the prevalence of malaria was made in 1964. In 1966, it was observed that a single round of spraying with DDT resulted in the virtual disappearance of anophelines in the sprayed atolls. Since 1971, a separate malaria control project has been in operation vith WHO assistance. It is expected that all the houses in all the islands in the 19 atolls vill have been sprayed by the end of 1974. During the second half of 1974, a feasibility study will be carried out by a WHO team to determine the technical, operational, administrative and socio-economic suitability of converting the present control programme into one of eradication.

In 1976 and 1977, WHO assistance will include the provision of a sanitarian, fellovships in the field of malarialfilariasis, subsidy to cover running costs of vehicles and partial payment of allowances to national staff a s well as supplies and equipment.

Assistance to the project is expected to continue for some years.

Ws ter Supply and Sanitation 8% 001 (Maldives 0007)

To advise on developing water supply and sanitation systems in Male and other atolls; to assist in training personnel.

The sanitary engineer, under recruitment in 1974, will assist in the development of a rural water supply and sanitation programme. A UNDP-funded project for water supply and sewerage for Male has been formulated and the sanitary engineer will act as project manager for that projecr,in addition to his regular duties.

Assistance has been given in this field from time to time under other projects. A team of surveyors visitedMale twice in 1972. In 1973, fellowships were given. In 1974, assistance vill be provided in the organization of accounting services.

In 1975, a consultant will advise the Maldives Water and Sanitation Authority on the organization of accounting services. The saaitary engineer will be continued in 1976-1977,and consultants in management and project evaluation vill be provided in addition to regional fellowships in engineering.

UNICEF is developing a pragr-e in the rural sector of water supply and vill assist in the supply of materials and equipment.


Project NO.

"PD 001 (0010)

BSM 001 (0007)

m L D l i Z S

5. DISEASE PREVEMION AND CONTROL

5 1 communicable ~ ~ s e a s e ~ r e v e n r i o n and c o n t r o l

5 .1 .3 n a i a r r a and o t h e r P a r a s i t i c Diseases

M a l a r i a c o n t r a 1

s a n i t a r i a n p2

F e l l o w s h i p s Subs idy s u p p l i e s and equipment

6. PROMdIOh OF ENVIRONMENTAL WALTH

6 . 1 ~ r o m a t ~ a n of Envlronmeil tal H e a l t h

6 . 1 . 2 ~ r o ~ i s i o n o i ~ a r i c s a n i r a r y measure9

water S ~ P P L V and s a n l r a i ~ o n

s a n i t a r y englnrer ~ 4

s h o r c - ~ e r m c o n s u l t a n t F e l l o w s h i p s

R E G U L A R

umber of P a s t s

s u p p l r e , and eyu1pnenr !

I

I

r r x p r e r s e a la L > u o ~ r a r s .

i 2 7 0 1 0 29 9 9 0 1 32 0 1 0

!

7 200 4 BOO

! 6 0 0 0

B U D C E T

~ s t i m a f e d O b l i g a t i o n s

1974

1 0 0 0 , 500 500 500 - - - I - 1 8 280 34 110

i

L T - number 01 P o r t s

1977 1974 1975

I i I

I I i

il i R S O I Y C E S

E r ~ i m i i r d O b l i g a t i o n s

I I 1974 lV75 1916 I 1977

i

I

I

I

i

I

i

i

7 890 19 330 , 21 020 22 310

I I

3 6W ' 2 400 3 600 7 500 5 wo - - -

I

i

!

!

1915 1976

1 !

j

1 5 1 / 1 2 1 / 1 2 1 / 1 2

3 1 9 2 1 6 31 9

i i

& w u c u 3 - . - -

i' 1976 , 1977 1974

I

I

1976

i

I

I i

!

I

I i

!

i

!

1975 1977

!

Water Supply and Sewerage, Male (IJNDP HDV172/007)

PIP 001 (Maldives 0011)

To advise on developing water supply and sewage disposal systems for Male.

This project, starting in 1974, is concerned with the preparation of an engineering feasibility report for water supply and sewerage for Male. It is expected that construction work will start in 1976 under bilateral aid.

The sanitary engineer assigned to Maldives m 7 , "Water Supply and Sanita- tion" will act a s project manager for this project.

R L G L L A K B L S G t T

MXLDIj-ES

6.11 Pre-investment Planninp, for Bas~c Sanlfary S e r v l c e r

Water Supply and Sewerage, Male MDVl72/007

Shori-term conrvlranfr Sub-contracts Fellowships S u p p l l e r and equipment Miscellaneous

Iofel - NLLDIES

Elflnaled Obligatiuns

1974 19.5 1976 197:

Number of Posts P r o j e c t No.

PIP W 1 (0011)

1974 I

1975 1976 j 1977

I I

I -- _ _ - __

!

!

i==i

c 2 w .d

(Expressed in US Dollars&

i

6 i = i E / ==== , ====

i I 1 i

I ! : ! I I 1 i I

!

i

Number of Porrr

145 600 161 010 I89 940 194 850 ======= , = = ======= , ------. - - - - - - -

I 1 !

I I !

I ! !

! I I

1974 11975

" c k 3 2 -

2 r. -

DF

DP VC

197s / 1977

3 T H E K S O l K C E S

ESflmaLed ObligaLion.

1974

!

I '

I I ;

2 1 2 ;

31 9 , 3/36 , 3136 3i36

!

1 I

1975 / 1976

- 2 . . . . ....

1977

5 000 65 000 43 8 W 3 600 LO 8 W ! 10 800 6 500 1 500 1 WO 1 000 : 5 W 5 W

- , - -

- I _

2 ~ 2 . . . . .... , _===

10 8 W 1 Ow 5 W -

- 1 - -

I i

1 ;

i

I

!

81 100 ' 56 600 12 300 1 12 3 m - , - - , -

!

- ! I - - 176 200 143 7 W 93 9 W ======= ======= ==_====

175 800 1 143 7 W 93 900 400

- I - 176 200 143 7 W

- 1 - -

I

I I

i

26 7 w ====_==

26 7 W

I __

Country Statement

Health Services

Personnel

0006

0007

0008

0010

0011

0012

0013

0014

0015

0016

HMD 003

DHS 001

HMD 001

C W 001

CAN 001

STR 001

HLS 004

HED 001

DNH 001

SQP 001

I

Water Supply)

Assistance to the State Medical Institute, Ulan Bator

Health Statistics

Nursing Services and Education


Cancer Control

Strengthening of Radiological Services and Maintenance of Electro-medical Equipment

Brucella Vaccine Production, Songino

Health Education

Dental Health Services

349

340

351

340, 488

345

345

332

336

340

R

R

DP

DP

R

RIAddl.

R

R

R

I 346 Quality Control of Drugs and Biologicals

0022

0023

0027

0028

0029

0030

0031

346

STR 002

NUT 001

HLS 002

STR 003

STR 004

STR 005

HMD 004

DP

R

OCD 001

MCH 002

NUT 002

0032

0033

0200

Community Health Services

Nutrition

Rehydration Therapy (Production and Control)

Rehabilitation Services

Strengthening of Emergency Health Services

Management of Health Services

Training of Health Manpower

Control of Non-Communicable Diseases

Maternal and Child Health

Nutrition Training

333

339, 488

336

332, 488

334

334, 488

342

R

RIAddl.

R

R/Addl.

R

RIAddl.

R

344, 489

338, 488

339

RIAddl.

RIAddl.

R

The y e a r 1976 i s t h e f i r s t year o f t h e Sixth Five-Year Plan of the Mongolian People ' s Republic. During 1976-1980. a g r i c u l t u r e , and p a r t i - c u l a r l y husbandry, w i l l cont inue t o p lay an e s s e n t i a l p a r t i n t h e c o u n t r y ' s economy. b u t the accen t w i l l be on i n d u s t r y . The r i c h n a t u r a l r e s o u r c e s and t h e massive f o r e i g n a i d w i l l permit a f u r t h e r a c c e l e r a t i o n of t h e i n d u s t r i a l development, wi th i ts m u l t i f a r i o u s i n f l u e n c e s on t h e t o t a l socio-economic development.

The o b j e c t i v e s of t h e s i x t h p l a n i n t h e h e a l t h f i e l d a re :

(1) f u r t h e r improvement of maternal and c h i l d h e a l t h , w i t h p a r t i - c u l a r s t r e s s a n pre-school and school-chi ld n u t r i t i o n through es tab- l i s h i n g of n a t i o n a l c h i l d food i n d u s t r y ; a l l the e f f o r t s o f h e a l t h s e r v i c e s , c e n t r a l and l o c a l , w i l l be d i r e c t e d towards c h i l d r e n ' s d i s e a s e s , mre e f f e c t i v e c o n t r o l , r educ t ion af the i n f a n t m o r t a l i t y r a t e , c o n t r o l of i n f e c t i o u s h e p a t i t i s , mening i t i s , e t c ;

(2 ) t h e s t r e n g t h e n i n g of p revent ive h e a l t h s e r v i c e s i n o r d e r t o a t t a i n b e t t e r c o n t r o l of t h e environmental changes l i k e l y t o a f f e c t t h e h e a l t h of t h e populat ion; more vil l be done i n t h e f i e l d of c a m u n i t y water supply, sewage d i s p o s a l , b e t t e r housing, e t c ; measures v i l l be taken t o reduce t h e absenteeism r a t e ;

(3) upgrading t h e q u a l i t y of medical and h e a l t h c a r e , extending t h e coverage of t h e r u r a l popula t ion by d o c t o r s and f r o n t - l i n e s e r v i c e s , ach iev ing comprehensive d i spensary s e r v i c e i n p a e d i a t r i c s and i n g e n e r a l t h e r a p e u t i c s ; f u r t h e r improvement of t h e c o n t r o l of non-communicable d i s e a s e s and s t r e n g t h e n i n g of t h e r e h a b i l i t a t i o n services;

(4) modernizat ion of t h e system of medical educa t ion and of t h e mnagement o f h e a l t h s e r v i c e s (planning, implementation, e v a l u a t i o n ) ;

(5) f u r t h e r development of the n a t i o n a l pharmaceutical indus t ry , and

( 6 ) i n c r e a s i n g t h e e f f e c t i v e n e s s o f t h e medical research .

The s t a t e h e a l t h budget w i l l be increased from 220 m i l l i o n t u g h r i k s i n 1975 t o about 360 m i l l i o n t u g h r i k s i n 1980. Each year the planned c a p i t a l investment f o r t h e c o n s t r u c t i o n of h e a l t h i n s t i t u t i o n bu i ld ings w i l l be 30 t o 40 m i l l i o n tughr iks , and about 5 000 000 t u g h r i k s w i l l be s p e n t y e a r l y f o r medical equipment.

Foreign a s s i s t a n c e is expected t o m k e new c o n t r i b u t i o n s t o t h e count ry ' s socio-economic development. It w i l l cont inue t o come mainly from t h e USSR and o t h e r s o c i a l i s t c o u n t r i e s . UNDP i n d i c a t i v e p lanning f i g u r e s a r e l i k e l y t o remain about US $ 2 000 000 y e a r l y . UNICEF w i l l cont inue t o c o n t r i b u t e US $ 90 000-100 000 annual ly. E f f o r t s a r e being made t o improve the co-ordinat ion of a l l f o r e i g n a s s i s t a n c e .

Strengthening of h e a l t h s e r v i c e s

Together wi th t h e f u r t h e r ex tens ion of t h e network of h e a l t h i n s t i t u t i o n s , which a l r e a d y covers t h e whole country, t h e Government w i l l s eek through t h e i n t r o d u c t i o n of m d e r n managerial t echniques and approaches, b e t t e r u t i l i z a t i o n of t h e r e s o u r c e s , improved q u a l i t y o f c a r e , i n t e g r a t i o n of s m a l l h e a l t h u n i t s , r easonable d i s t r i b u t i o n of s p e c i a l i z e d s e r v i c e s and t h e s t r e n g t h e n i n g of emergency c a r e s e r v i c e s . Maternal and c h i l d h e a l t h s e r v i c e s w i l l be f u r t h e r extended and improved, i n bath t h e i r b a s i c and t h e i r s p e c i a l i z e d a s p e c t s . New and more e f f e c t i v e methods and techniques i n h e a l t h educa t ion vill be sought . Operat ions r e s e a r c h i n h e a l t h s e r v i c e management, p lann ing , e v a l u a t i o n , and h e a l t h economics a r e t o be introduced. Beds s t a f f e d by phys ic ians a t a r a t i o of 10.03 p e r 1 000 popula t ion i n 1975 should reach 12.37 p e r 1 000 people i n 1980. The importance of p lanning b e t t e r h o s p i t a l plan- n ing and des ign becomes ev iden t from t h e s e f i g u r e s .

W O a s s i s t a n c e . This is t o be c e n t r e d around t h e new p r o j e c t on management of h e a l t h s e r v i c e s t h e main o b j e c t i v e of which is t o a s s i s t i n in t roduc ing new managerial methods and approaches. A s s i s t a n c e w i l l be given t o t h e f u r t h e r improvement of emergency c a r e s e r v i c e s , which a r e e s s e n t i a l f o r Mongolia, wi th its t e r r i t o r y of 1.56 m i l l i o n sq.km. Maternal and c h i l d h e a l t h , n u t r i t i o n and h e a l t h educa t ion w i l l a l s o rece ive srmuort . wi th t h e n a r t i c i u a t i o n of UNICEF and u o s s i b l v of UNDP .. . and FAO. The s u c c e s s f u l s t r e n g t h e n i n g of the r a d i o l o g i c a l s e r v i c e s and maintenance of e lectro-medical equipment w i l l r e c e i v e a d d i t i o n a l support .

Health manpwer development

Some of t h e t a r g e t s f o r h e a l t h manpower development as l a i d down

MONGOLIA

by t h e Government i n t h e s i x t h five-year plan are as follows:

The t a b l e shows t h a t more s tudents a r e t o be admitted t o the medical and nurs ing schools and technicurns and more teachers a r e t o be t r a ined . Increased a t t e n t i o n w i l l be paid t o post-graduate ( p a r t i c u l a r l y continuing) and post-basic education. The upgrading of t h e q u a l i t y of teaching and learn ing and of medical research w i l l be unceasingly sought.

Category of manpower

Physicians

Middle-level medical workers (nurses , f e l d s h e r s , l abora tory technic ians , midwives, e t c . )

Pharmacists (higher education)

P h a r m c i s t s (middle-level)

WHO as s i s t ance . Training of h e a l t h manpawer w i l l remain t h e main f i e l d of WHO a s s i s t a n c e t o Mongolia. A l l t h e WHO-assisted pro- j e c t s have s u b s t a n t i a l manpower development components. The la rge- s c a l e UNDP-funded p r o j e c t "Assistance t o t h e S t a t e Medical I n s t i t u t e , Ulan Bator" w i l l e n t e r its f i n a l s t a g e of implementation, and i t s ob j ec t i ve s of modernizing t h e whole medical education system should be a t t a i n e d . Within the hea l t h manpower development p ro j ec t under t h e r e g u l a r budget, a s s i s t ance i n t h i s f i e l d w i l l have an important impact on t h e whole medical care de l ivery system i n t h e country.

Disease prevention and con t ro l

Year/per 10 000 populat ion

The Government w i l l continue t o i nves t money and e f f o r t s i n t h e prevention and e l im ina t i on of some communicable d i s ea se s from t h e l i s t of major hea l t h problems. B ruce l l o s i s , i n f e c t i o u s h e p a t i t i s and meningi t i s w i l l be t h e main ob j ec t i ve s of a c t i v e epidemiological and o t h e r s t u d i e s and of p r a c t i c a l con t ro l measures. Due a t t e n t i o n will a l s o be given t o tuberculos is . A t the same time the non-communi- c ab l e d i s e a s e s w i l l undoubtedly come more t o the fo r e as publ ic

1975

21.1

70.0

1 .3

6.5

hea l t h problems, and t h e Government plans t o a l l o c a t e more funds f o r the e a r l y de t ec t i on , prevention, and treatment of these condi t ions and on r e h a b i l i t a t i o n . Laboratory s e rv i ce s i n t h i s connexion a r e t o be f u r the r extended and modernized.

1980

25.0

76.2

1.5

5.8

WHO as s i s t ance . WHO w i l l give s u b s t a n t i a l a s s i s t ance through two comprehensive p r o j e c t s , one on colmnunicable-disease con t ro l and t h e o ther on the con t ro l of non-communicable d iseases . The aims of both a r e t o s t imu la t e an i n t eg ra t ed approach t o t h e problems and t o i n t r o - duce the b e t t e r u t i l i z a t i o n of s t a f f , suppl ies and fel lowships. Assis- tance i n t h e f i e l d of qua l i t y con t ro l of drugs w i l l be continued. The la rge-sca le UNDP-funded Bruce t la vaccine production and con t ro l p r o j e c t should be almost completed, and an eva lua t ion w i l l be made of i t s e f f e c t on human and animal hea l t h . UNICEF w i l l continue t o support a number of p r o j e c t s i n t h i s group.


I n 1971 t h e Government approved a long-term programme f o r pre- se rv ing t h e human environment, and many government departments were asked t o p lay a r o l e i n implementing t h e programme. The h e a l t h s e rv i ce s should be b e t t e r equipped f o r t h e i r t e chn i ca l , consu l t a t i ve and supervisory functions in connexion with the p ro t ec t i on and promotion of environmental hea l t h . Rapid i n d u s t r i a l development and socio-economic changes w i l l l ead t o i n t e n s i f i c a t i o n of a l l k ind of human a c t i v i t y , a l t e r a t i o n s of t h e t r a d i t i o n a l n u t r i t i o n a l p a t t e r n s and environmental po l l u t i on of a l l k inds . This s i t u a t i o n w i l l have some repercussion, with changes i n t h e popula t ionlhea l th i nd i ce s ,bu t more research i s necessary t o c l a r i f y t h e e f f e c t s of t h e environmental changes on hea l t h . Research workers w i l l be t r a ined and l a b o r a t o r i e s e s t ab l i shed f a r t h i s task .

WHO as s i s t ance . During 1976-1977 WHO w i l l assist on a mare comprehensive b a s i s in indent i fy ing t h e environmental hea l t h problems, s trengthening environmental hea l t h s e rv i ce s w d t r a i n i n g n a t i o n a l manpower i n t h i s f i e l d .

SCrengt5enrn~ of Red~olvg~cal S e r v ~ c e s and Yaintenancc of Electro-medical Equrpmcnt

STR 001 (Mongolia 0012)

To assist in training technicians for the repair and maintenance of electro-medical equipment, in strengthening repair and maintenance service of hospital equipment throvgh the organization of a central and a series of satel- lite workshops and in promoting radiation protection practices in health institutions.

In 1968, two consultants assisted in the installation of X-ray units. Since 1971, an electro-medical engineer has been assisting in the training of national staff and organizing maintenance and repair services for electro- medical equipment. In 1974, a consultant is being assigned, subject to availability of funds. to assist in the development of electronic services in hospitals. In 1975, a consultant will assist in the repair and maintenance of sterilization apparatus in hospitals. Fellow~hips will be provided for training in the repair and maintenance of stomatological and isotopes equipment. In 1976, a consultant will reviev the progress and tvo fellovships vill be awarded for training in radiation health and repair services. In 1977, provision has been made for a consultant in radiation protection and two fellowships in radiation protection and repair and maintenance services.

LL

MONGOLIA LL w

Rehabilitation Services STR 003 (Mongolia 0028)

To assist in developing medical rehabilitation services and in training the necessary personnel.

In 1972, a medical rehabilitation specialist from Poland visited the country for two weeks on a bilateral basis to assess the existing services in this field. In 1973, a WHO consultant submitted proposals for reorganizing the medical rehabilitation services and prepared a curricvlum for the training of rehabilitation personnel. A team of consultants vill be provided in 1975-1976, and in 1977 a consultant vill pay a follow-up visit.

Assistance is expected to continue up to 1977.

Assistance is expected to continue up to 1980,

HOKCOLIA


3.1 Strenpthenrnq of Healrh Services

3.1.2 Strengthening a f ~ealih Services

Sfrenzthenin~ of Radiological Services and naintenance of Eleclro-medical Equipment

Elecrro-medrcal engineer P3

SiiarC-term cinivlianfr Fellovshipa Supplies and equipment

C-unity Health Services

S~OTL-term coniuifanl Fellavships Participants supplies and equipment

Rehabiliiarian Servlces

short-term conrulrancs Temporary advisers Fellovshipr supplies and equipment

R E C C L A R

Number of Posrr

1974

B U D G E T

Estimated Obligations ProJecr NO.

STR 001 (0012)

STR 002 (W22)

SIR W 3 (W28)

1974

2 000 I i 3 5 w 8

1975

I

2 2112 2/12

' i , ' !

; L x P r r s a r " i n L a uulldr,

1975 1976

' 1

1/12

71 900 - i

! i

1 19 8W 21 600 9 b W 1 000 15 6 W 7 800 7 800 5 wo 5 000 1 2 wo - -

414W 34 400 ! 19 400 8 - - 1 -

I

1976 1977

- I -

31 9

! 27 8 W ;

I

1977

Number of Ports

7 650 4 000 - 39 450 -

1974

11 4 11 3 8 800 7 200 7 200 7 650 10 500 , 10 500 1 5 W 5 W O 2 O W - - 17 950 22 700 i 19 700 - - I -

i

9 m u G - 3 3 - 1 -

O T i i i R S O L R C E S

?scimaced Obligations

11 3

I ! 6 O W 60 400 I

i

j

!

I I I

I

I I ; 1

: I

I ;

I

1 i

1 :

i i !

1975 I

1974! 1 9 7 5 1976

I

1

11 3 181104

1976 1 9 7 7 .

1977

1 ' !

I ; !

!

31 9 2/18 I

2/15

I

I I

i

1

I

I

i

u u

MONGOLIA *

St r eng then ing o f Emergency Hea l th S e r v i c e s STR 00; (!!unolia 0029:

TO a s s i s t i n t h e development, p l ann ing and management o f emergency h e a l t h care s e r v i c e s , i n c l u d i n g a s s i s t a n c e i n the conduct of con t inu ing educa t ion on new t r e n d s i n emergency care.

I n 1975, 1976 and 1977, c o n s u l t a n t s w i l l be provided t o examine t h e e x i s t - i n g emergency care ee rv i ce s , conduc t con t inu ing educa t ion i n emergency care development f a r t h e l o c a l s t a f f , and a l s o t o a s s i s t i n r e l a t e d management su rge ry end t ox i co logy . Fe l lowships w i l l a l s o be awarded i n t he se f i e l d s .

Ass i s r ance t o the p r o j e c t w i l l con t inue till 1980.

Nanagement of Hea l th Services STR 005 (>longolia 0030:

To a s s i s t i n t h e development of i n t e g r a r e d h e a l t h s e r v i c e s , i nc lud ing t h e t r a i n i n g of h e a l t h pe r sonne l i n a l l a s p e c t s of community h e a l t h s e r v i c e s ; ts a s s i s t i n developing a h e a l t h i n fo rma t ion sys tem, and i n t r a i n i n g h e a l t h s r a t i - s t i c a l pe r sonne l ; t o a s s i s t i n developing h e a l t h s e r v i c e s management and opera- t i o n a l r e s e a r c h .

P r o j e c t s Mongolia OW7, "Health S t a t i s t i c s " and Mongolia On??, "Camun i ty Heal th Se rv i ce s " have been merged i n t o t h i s p r o j e c t from 1975.

For a Dumber of y e a r s , WHO has a s s i s t e d i n t h e t r a i n i n g of p u b l i c h e a l t h a d m i n i s t r a t o r s through f e l l o w s h i p s . I n 1973, a c o n s u l t a n t (Mongolia 0022) adv i sed t h e Government on h e a l t h p o l l c y m a t t e r s .

I n 1967, a WHO s t a t i s t i c i a n reviewed t h e h e a l t h s t a t i s t i c s s e r v i c e s i n t h e coun t ry , and i n 1969 (Mongolia 0007) . a s t a t i s t i c a l c o n s u l t a n t adv i sed on developing a system of h o s p i t a l r e c o r d s and on o rgan i z ing t r a i n l n g courses i n h e a l t h s t a t i s t i c s and medica l coding. I n 1970, a Cen t r a l Data Process ing Un i t , equipped by WHO, was e s t a b l i s h e d i n t h e Min i s t ry o f ? u b l i c E e a l t h . I n 1971, 1972 and 1973, s t a t i s t i c a l c o n s u i t a n t s were provided ro a s s i s t i n t h e s t r e n g t h e n i n g of t h e Heal th S t a t i s t i c s Cni t i n t h e Miniscry o f Pub l i c Heal th . to establish ways of co -o rd ina t i on o f s t a t i s t i c a l activities c a r r i e d on by d i f f e r e n t h e a l t h i n s t i t u t i o n s and i n t r a i n i n g h e a l t h s t a t i s : i c a l pe r sonne l . A c o n s u l t a n t i n t h e maintenance and r e p a i r of d a t a process ing equipment was a s s i g n e d i n 1973.

I n 1975, c o n s u l t a n t s w i l l a s s i s t i n h e a l t h p lanning and in t h e development o f a h e a l t h i n i o r n a c i a n system. The f e l l owsh ips w i l l be r e l a t e d t o t h e s t udy of epidemiologica l methods and i o r t r a i n i n s i n v a r i o u s branches of h e a l t h care.

Tvo c o n s u l t a n t s - one s p e c i a l i s t i n h e a l t h i n fo rma t ion system and t h e o t h e r i n h e a l t h economics - w i l l be provided i n 1976 . Th i s p r o j e c t w i l l be s t r eng - thened f u r t h e r by t h e ass ignment o i a 10"s-tern s p e c i a l i s t i n h e a l t h i n fo rma t ion sys tems. Fe l lowships i n t h e i ~ e i d s of p u b l i c h e a l t h a d m i n i s t r a t i o n and h e a l t h s c a t i s t i c s ('ill be provided.

P u b l i c Health Labora tory S e r v i c e s ( W D ? >105/65'105:

HLS 001 (Mongolia 0002)

To assls: Fr. s t r eng then ing n e a l t i l a b o r a t o r y services and i n t r a i n i n g per - sonnel i n medical laboratory technology.

Followina a p re l imina ry s tudy by a consu l t an t i n 1964, a WHO m i c r o b i o l o g i s t a s s i s t e d , irom 1966 t o 1968, i n under taking a comprehensive country-wide app ra i - s a l a f t h e l abo ra to ry s e r v i c e s and recommended t h e e s t ab l i shmen t o f a c e n t r a l l a b o r a t o r y o r g a n i z a t i o n . S ince 1970, w i t h t h e guidance o f a WHO m i c r o b i o l o g i s t and a l a b o r a t o r y t e c h n i c i a n , t h e Cen t r a l B a c t e r i o l o g i c a l Labora tory has provided r e f e r r a l s e r v i c e s t o n i n e p o l y c l i n i c s , t h e In f ec t i ous -Di sease Hosp i t a l and t h e C h i l d r e n ' s Hospi ta l i n Ulan Bator . I n 1971, fo l lowing the r e o r g a n i z a t i o n o f t h e Labora tory Counci l , a d i r e c t o r was appointed t o look a f t e r t h e l a b o r a t o r y pro- g r a m e ; r e f e r r a l s e r v i c e s i n c l i n i c a l chemis t ry are being provided by t h e F i r s t C l i n i c Hosp i t a l l a b o r a t o r y ; i n t e g r a t i o n o f t h e s e r v i c e s rendered by aimak labo- r a t o r i e s i s being i n i t i a t e d . The p r o j e c t a s s i s t e d i n s t a n d a r d i z i n g t h e media and i n o rgan i z ing the t r a i n i n g of b a c t e r i o l o g i s t s from t h e aimak l a b o r a t o r i e s . The b a c t e r i o l o g y l a b o r a t o r i e s ar t h e I n s t i t u t e of Hygiene; Epidemiology and Microbiology (1HE.Y) were merged i n t o t h e Cen t r a l Labora tory .

Following the r e v i s i o n o f t h e p r o j e c t i n 1973, f r e s h i n p u t s by UNDP and t h e Government were made a v a i l a b l e , aimed a t ex tending t h e l a b o r a t o r y se rv ices t o s e l e c t e d aimaks and a t s t a r t i n g such ex t ens ion through a reference scheme which would i nvo lve specialized laboratories i n Elan B a t o r . Dvring t h e pe r iod 1973- 1975, a c l i n i c a l p a t h o l o g i s t and seven sho r t - t e rm c o n s u l t a n t s have been provided for f u r t h e r developing t h e l a b o r a t o r y programme i n t h e r e s p e c t i v e s p e c i a l t i e s and e l even f e l l owsh ips have been awarded.

Three c o n s u l t a n t s - a p u b l i c h e a l t h a d m i n i s t r a t o r . an a r c h i r e c t and an e x p e r t t o a d v i s e on a p p l i c a t i o n of e l e c t r o n i c d a t a process ing technrques i n t h e h e a l t h E i e ld and t o h e l p w i t h computer programmins - were a s s i ; n t t I" 13-1 .

?II'SGOLIA

Srrrnstheninr oi Emerqency Healti. Serv~cci

s ~ L ~ r : - c e r ;..:liulranfs Fellowsh~ps Supplier ano equlpmerf

Manareaeat of Health Servrcea

s;.ecralisr in health ~ n i o r ~ a t r a n iyscem Pb

i i o t r - c e r , cc-s~ltanrs Feliovships ~arcicipanrr Supplres a d <q.rpaeor

J.i.3 Health Laboratory Services

public ~eait3 ~ a ~ c r a r a r y Services UON/681005

Cllnlcal pathoiogirl P4

shari-term ccnrulranrs Fellaishrpr hlscellaneour

8 ; 3 C E L

irflrared Dhlipr~~ons

197'. 19:j 1Y7b ! 11..

6 6 m 12 ooc L L 000 b 000 7 800 i 800

10 000 5 000 - - - 12 600 29 800 l b d0U - -

15 970 J? 370

13 200 IL 400 - i 550 62 400 bz 400

1 2 000 5 O W 6 500 J 500 - - -

67 750 1 9 270 39 870 - - -

! ! I

R E G U L A R

Number ol 7 0 s f r

1974 1975 19:b 1377

I !

1

1 3 11 5 2 / 1 0 2 / 8 ?!I2 2/12

I

1 :

i I

21 6 2 1 6 i

13/71 u / i w ulloi,

I

I 1

! I

I ! :

i

I

Pri:ecf s o .

STR 004 (0029 1

STR 005 (0030)

HLS 001 (WO2)

i

8 Exprcssei! i r L S D.,llarsL

m u 7 " c L. > 2 .. l? -

DP

r , - Number of Poi:i

1971 19;s 19:a 19.-

I I : I 1 I

I

~ ! I I I

I

I

R L R S L ' U R L E S

E s r ~ m a r r d Obligarions

7/23

19iii ! , . ,-: , 19ib

3/18 I 1

1377

i I i

i

I

i

i

I

i i I i

i ! !

! i

i I I

2 7 5 0 0 12500 i I

45 000 , 35 W o 13 350 11 100

860 610 - 1 - 86 710 59 210 - -

1 1

Rehydratian Therapy (Production and Control) HLS 002 (Mongolia 0027)

LL

MONGOLIA u 0.

To assist in producing rehydratian fluids and in training paediatricians in the practice of oral and parenteral rehydration therapy.

In 1971, a consultant (provided under SEAR0 0144, "Rehydration Therapy"> recommended the feasibility of producing parenteral fluids locally. Under the same project, N o consultants, in 1972, prepared the blueprint in respect of tvo aspects, vie., production and therapy. In 1973, a consvltant assisted in organizing two national training courses in rehydration therapy.

In 1974-75, a pharmacist (production manager) and a scientist (quality control) will be in position to assist with the implementation of the project and the commissioning of the plant in Ulan Bator for the production of parenteral fluids.

Assistance to the project is expected to continue until 1975. The project a n be followed up under the project Mongolia 0030, 'Maternal and Child Health", as and vhen further assistance becomes necessary.

Brucella Vaccine Production, Songino (UNDP MON171/511>

M S 004 (Mongolia W13)

To assist in producing freeze-dried - Brucella vaccine and in establishing laboratory facilities for its testing.

As a resvlt of the recommendations made by a consultant who visited Mongolia in 1968, under project Mongolia 0001, "Strengthening of Health Services (Epidemiology)", a decision was taken to start production of Brucella vaccine. Field trials in Mongolia proved the relative efficacy of Rev.1 vaccine in reducing the frequency of brucellosis in animals.

The economic impact of preventing abortion in livestock and the public health advantages of preventing brvcellosis in man were considered most important by the Government, and in 1970, a WHO team assisted in the preparation of a request to UNDP.

In 1971, a consultant assisted in finalizing the project document. A bacteriologist was recruited in 1973 and the project manager is expected to be in position from 1974. Consultants will be assigned from 1974 through 1977 to advise on the different aspects of the project: vaccine production. Brucella bacteriology, vaccine control and standards, field trials and epizootiology. Fellowships to train national staff have been provided in 1973-1974 to cover areas in vhich the consultants will advise the project. Supplies will consist o t vaccine production equipment, refrigerators, vehicles and electrical appliances. FA0 has been designated as Associated Agency for the implemente- tion of some fellowships.

P r 0 , e c f NO.

HLS 002 (0027)

l y l

(wli)

MONGOLIA

Rehydratian Theraw (Producrlon and Control)

Pharmac~jr ( 2 r o d u c ~ i a n rnanager 1 P4

S C ~ ~ ~ ~ . S L (qual~fy control officer) P3

S!>nri-tern cansulranrr Temporary advisers ~ e l ~ o u s h ~ p r suppires and equipment

Brucella Vaccine Production, nos/7i/sil

~rojecr manager P5 Bacterialogirt P4

Administrative rvppart personnel Short-term consultants Fellowships Supplies m d eq;i?rent nirceilaneous

R E G U L A R

:Expressed in US Dollarsl

1974

11 6

l1

- 2 --

21 1 2112

B U D G E T


1974

m * m u c L. 5

DP

Number of Posts

1975 1 1976 I 1977

~ 28 890 I

1975

I 28 890

! - - 26 990 57 780

4 W O 1 L 400

:Ei 1 000

500 1 i 5W

- t - ,

40 290 i 63 680 - - i

I

1 I

I i

i

I I i

i

Number of Porrr

O T H E R S O L R C E S

Estimated Obligarlons

1974

~! 1/12

1112 1 - ! ! 2 I

1 / 2 1 1 2 1 1 21 1

I 1

1976 I I

1974 1975 1976

I

I

1977 1977

I

I ~ !

,

~ 11 8 1 1/12 1/12 1112 1/12 1 1112 i 1/12 1/11 _ 2 ' 2 1 2 2 ----

31 7 18/14 5/11 , I/ 2 4117 ' I/ 3 I

~ i i

i

i

1975 1976 i 1977

i

I

1

i i I

i 30 OW ' 30 W O 30 OW 30 W O _ _ I - -

50 W O 60 000 60 O W

30 W O 27 5 W - 57 500

4 8 W 4 800 4 8W 17 500 , 31 000 2; ;t 1 l 11 650 i 1 350

4 6 W - 78 300 -

30 000 20 WO 18 000 6 500 - 120 450 -

5 600 , 4 600 - , - 126 750 114 900

- , -

I !

Haternal and Child Health HCH 002 (Hongolia 0033)

- d

HONGOLIA 7.

To assist in the further improvement of maternal and child care, including nutrition, with emphasis on the development a£ specialized services for the care of mothers and children.

Mongolia 0004, "Maternal and Child Health", Mongolia 0023, "Nutrition" and Mongolia 0200, "Fellowships (Nutrition)", have been merged into this project.

Assistance provided since 1965 with WHO/ITNICEF collaboration (Mongolia CO04) has enabled the strengthening of the administration of maternal and child health services at all levels, and the reorganization and expansion o f the institutional and community health services for mothers and children throughout the country. WHO provided technical advisory services in the forr of long-term staff and consultants and also awarded training fellowships. Supporting services have included a wide range of training and health education activities. UNICEF provided supplies and equipment.

The future trend would be ro improve the quality of the services provided by developing specialized services in the maternal and child health programme.

Assistance to nutrition activities started in 1974 (Mongolia 00231, when a team of nutritionists assisted in identifying problems related to the nutritional status and nutrient intakes.

In 1975 obstetrician/gynaecologisL will remain in position. In 1976-1977 consultants will be provided to (i) advise on setting up intensive care services for children; (ii) review the current nutritional status of mothers end children; (iii) advise on planning and setting up a suitable nutritional programme and (iv) advise on investigating and managing respiratory disorders in childhood. Fellowships are provided for senior administrators and staff in the field of maternal and child health and nutrition.

Assistance to this project is expected to continue for a number of years.

MONGOLIA

3.2 Famlly Health

3.2.2 narernal and ch~ld ~ealth

Maternal and Child Health Services HON/68/007

Obefetricianigynaecologii~ P4

Short-term consulcant Temporary adviser Fellwshipr Supplier and equ~pment

maternal and child meaiih

obrretricianlgynaecologisi ~4

SIIOTC-term cunruliants Fellowahips supplies and equipment

3.2.4 Nurririon

Nutrition

Short-term consultants

Fellovahip. [Nutrltran

rraininn)

- R E G U L A R

i

B U D G E T

EstimaCed Obligations Project NO.

UCH WL (0004)

ncx w 2 (0033)

NUT W 1 (W23)

Nrn W 2 (OZW)

!

I I

Number

I 1974 ! 1975 1976

I ~ 1

1974

o f P o r t s

1976

2 1 9 4/29

I

1977

(Expressed in US Dul larsJ

1975 1977

I

21 8 6/42

i 15 745 :

I

I

b W O ! ! 2 300 I 12 800 j

500 -

Number of P v s t r

I 1 / 7 1

37 345

1974

- 1 - I/ 3 I/ 2 4/20

31 3

2/18

!

29 7 w

* 0 m " 6 u 2 2 -

DP


Earimaled Obligations

1/12 - 1 -

4/20

i 21 b00 , 19 2 W

I 13 8 W 17 850 : 26 1W I m I W O ! ~ W O

8 - - i - ! b4 5 W 40 450 ' 46 3 W - - -

I b O W ~ - 1

i 2 800 I I

i I

! I i

11 I 1

I : 1 I I

: : ~ ~ ~ ~ I i

i i

1975 1974 1976 , 1977

I 1 :

1

! i ! ~ !

I

!

1975 1976 1977

MONGOLIA Ld C- 0

Health Education HED 001 (Mongolia 0014)

To assist in reorganizing and developing health education services; in developing, implementing and evaluating health education as an integral part of each health programme; in training manpower needed for key positions in health education.

In 1971, a consultant studied the existing health education services and made recornendations for the further development o f these services. The same consultant returned in 1973 and reviewed action taken on his previous recommendations and made a number of additional proposals, which were accepted by the Government. Again, in 1974, the consultant will return to help implement the prograrmne. Consultant visits are proposed from 1975 onwards for evaluation and teaching programme. Emphasis will be placed on developing, implementing and evaluating education as an integral part of each health programme and on training the manpower needed for key positions.

Assistance will continue through 1982.

Nursing Services and Education

To assist in developing schools of nursing, in strengthening existing training programmes for nursing personnel, and in improving nursing services.

Following a survey of nursing education programmes and nursing services made by a consultant in 1966, a nurse educator was assigned to the project in 1968 and a second nurse educator from 1970.

Proposals were made for the co-ordinated development of nursing education. A syllabus and curriculum were prepared far the two-year nursing programme, which started in 1969, and supplemental courses were conducted for a variety of health personnel. Assistance was given in 1970 in preparing a five-year plan for the consolidation and development of institutions training nursing personnel at all levels. Assistance was also provided to nurse training schools. In 1971 and 1972, emphasis was given to the conduct of short training courses for qualified nursing staff in a variety o f clinical and functional subjects. In

1973. a second nurse educator was provided.

In 1973, short courses continued to be given for local teachers, feld- shers, tutor nurses and nurses in medical-surgical and pediatric wards. The first national poat-basic nursing course started in February 1974 with fifteen srudents. In 1974-1975, assistance will be towards continuing development of the post-basic course and implementation of new syllabus for the Nursing School, including the conduct of relevant refresher courses for nurses in Darchan, Selenge and Tov airnaks and in Ulan Bator.

Assistance to the project is expected to continue until the end of 1975. From 1976 this project will be merged into a new project, "Training of Health Manpower".

Assistance to the State Medical Institute, Ulan Batar (UNDP MON/72/004)

HPlD 003 (Mongolia 0006)

To assist in improving the medical education system by improving admission procedures, by revising the curricula, teaching and evaluation practices, and by developing a corps of teachers competent in different branches of medicine and able to apply modern teaching technology.

The project was financed from Regular funds till 1973. A group of cansul- tants studied the situation of the Medical Institute in 1970 and a number of consultants assisted the Institute. A project manager has been assigned since the beginning of 1974 and a preparatory work for the development of a large scale country UNDP project (1974-1978) has been completed.

It is expected that for 1974.1977, the project manager will be assisted by two long-term staff members ( a paediatrician later on an epidemiologist 1976.1977) along with a number of short-term consultants.

In 1976-1977, consultants in internal medicine, physiology,microbiology, experimental pathology and imunology will be provided. Fellowships will cover internal medicine, biophysics, analytical chemistry, cytochemistry, endoscopic diagnosis, paediatrics, medical statistics, general surgery, medical psychology, clinical pathology, clinical pharmacology and paediatrics and school medicine, etc.

P r u l e c t s o .

KEO 001 (001L)

HELD W 1 (00081

HELD 003 (00061

MOXCOLIA


Health Edvcarron

Snort-rer .1 r.,niulfanrs fellavrhips Supplies and equrpmenc

4. HEALTH W P M R OEYELOPt4ENT

4.1 Health Manpower Development

Nursing Servlcer and Education

Nurse educators P3

Temporary advisers Fellowships Svppl~er and equipment

~ r s l s t a n c e to the s t a r e ~edical ~ n s i l r u r e . ~ l a n s a t o r

MON1721004

project manager P5 Medical educators P4 Clerk-stenographer UB4

ShUi-L-tern ~onsulcants Fellowships supplies and equipmenr Miscellaneaui

R E G C L A R

Number o f Porrr

7 000 8 200 , 14 500 12 650

---

I I

itxpirrsed in US Uollair~

1974

B C D L E T

Estimated Obl~gatronr

1974

u m c .. 5 3 -

1 - 1975

- 1915 1976 1977

j 8 0 0 0 ' 6 600 , 7 200 7 2 W 4 200 ! 5 I00 , 1 9 M 6 900

2 000 3 000 2 500

- 1 - - - 12 200 8 13 7 W 14 LOO 16 600 - - - , -

I 55 6 W ! 29 7W 1

i

4 OW

200 I 1 WO - 1 - 59 800 1 43 1 W

- 1 -

I ~ !

Svmber of Pdr:s

I " 1 1 4 l l 3 l / 3 l l 3 21 4 21 6 : 11 6 2 / 1 0

1976 1974

( . I i i i R 5 0 : X C E S

Ertimafrd Obligations

2124 -- 2 -- 21 4

1977 1975 19:b 1%; 19i4 ! 19i5 1976

1/12

1

21 4 41 8

I

I I I ,

i !

i

I 1 I

1/12 I 1/12 . 1112 ' 1/12 - - - -

3 . 3 4 , 3 _

1977

1 i

I

30 000 30 000 30 000 35 W O 6 000 6 000

46 000 66 000 71 000

- - , -

30 OM)

15 W0 6 OW

51 O W

-

Training of Health mnpower

TO assist in teaching and training programes For health personnel to cater to national needs; to assist in improving the education and training of paramedical persmnel and, associated professions including revision of curricula and procedures ro be able to apply modern teaching technology.

Assistance to nursing education programmes has been provided under Mongolia O W 8 , "Nursing Services and Education", and long-tern nurse educators were provided - one i ron 1968 and another from 1970. Froh 1972, consultants assisted in the organization and development of teaching and research in various fields of dentistry under Mongolia 0015, "Dental Health Services". These two projects will be merged into this project from 1976.

Assistance to nursing education will be continued under this project through the assignment of a nurse educator from 1976. Consultants will be provided to assist in various aspects of nursing and dentistry.

The activities of this project will be ca-ordinated wich those of Mongolia 0006, "Assistance to the Stace Medical Institute, Ulan Bator".

MONGOLIA L-

A. w

Epideniological Services and Surveillance i s3 w1 (Mongolia 0018;

TO assist in the further developmen: of epidemiological surveillance of diseases representing major public health problems, and in the further rtreng- thening of health laboratory services in the country.

The Project Mongolia 0002. "Public Health Laboratory Services", has now been merged with this project. From 1963 to 1972, assistance in epidemiological services and surveillance was provided through Mongolia 0001, "Strengthening oi Health Services (Epidemiology)". Consultant services and fellowships have been provided to assist in epidemiology (designing field trials) and in the control o f some infectious diseases. Under project Mongolia 0002 assistance had been provided for undertaking a comprehensive country-wide appraisal of the laboratory services.

Consulrants in epidemiology and bronchaocopy will be provided in 1974-1975. In 1976-1977, assistance by way of consultants and fellovships will cover epidemiology and laboratory techniques.

Assistance cc the project is expected to continue For some years

Assistance will continue for a number of years

Control of Non-Communicable Diseases OCD 001 (Mongolia 0032)

lo assist in identifying health problems due to non-conrmunicable diseases. in epidemiological investigations and health education fo r prevention and control, and in the training of health and allied personnel for early detection. diagnosis and treament services, including bio-medical research.

Since 1967, consultancy services have been provided under project Mongolia 0010, "Cardiovascular Diseases", Mongolia 0011, "Cancer Control". Mongolia 0021, 'Ilental Health", for strengthening services in cardiovascular diseases (-- tism) and hypertensioo, cancer (chemotherapy, radiotherapy, liver cancer epi- - demiology), and advising on psychiatric services. It is proposed to consali- date these activities for the prevention and control of non-communicable diseases under a new project from 1975. In 1976, consultants and fellowships, will be provided in epidemiology, psychiatry, rehabilitation and management of non-communicable diseases. Provision has been made for the award of fellowships in these subjects. In 1977, assistance will be provided in oncosurger)., resuscitation, and out-patient psychiatric services.

Assistance to this project will continve till 1980.

MONGOLLA

5.2 Non-C-unicable Disease Prevention and Control

5.2.2 Cancer

cancer canrrol

Short-term consult an^ Fellourhips Supplies and equipment

5.2.3 Cardiovascular Diseases


Short-cerm consulrants Fellmrhips svppiier and equipment

5.2.4 Other Chronic Nan-Cmmmnicable Diseases

Control of N a n - C m u n i c a b l e Diseases

Short-cerm consultants Fellovships Supplies and equipment

R E G F L A R

Number of Posts

1974

B U D G E T

Estimared Obl~gatiune P r o j e c l NO.

cm w 1 (0011)

CMI W 1 (W10)

CCD 001 (0032)

1974 / 1975 ' 1976

I

1975 .

1977

" P L"

IExpresred in C S Dollarri

1976

I I

I

i

I

i ! I I

8 W O 8

"""I ,

1977

11 4 3/13

21 6 2/12

1 1

!

1 I ; 1

23 900 -

LI 1

Number of P a s r s

1

3/12 6/30

3/10 3119

I I I I ~

1974

i

2 1 6 4/27

w n u c 2 2 ".

2 -

12 000 1 7 8 M 1 2 000

- . 21 800 - ~

ii E K S O C R C E S

!:sc~zated Obliga~~ons

1974 1371 ! 197b ! 1977

!

~ I ~

' !

i !

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1 24 000 12 150 5 000

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To assist in strengthening dental health services. parricularl) the pardia- tric scamatology services, and in training dental health persooncl: co scud? the feasibility of having a fluoridation programme.

In 1970, a consultant reviewed the existlng fac~liries and resources and advised on plans for further development. In 1972, another consultant advised on the organization and development of Ceacning and research in the new Stama- tological Department. In 1972-1973 a consultant in orthopaedic stomatology assisted the project. In 1974 and 1975, consultants in the management of dental health services will be provided.

From 1976, the project will be merged i n t o Mongolla 0031. "Training o f Health Manpower".

Quality Control a i Drugs and Biologicals SQP 001 (Mongolia 0016)

TO assist in the further development of the manufacture of phalmacevtical products and in the vpgrading o f services associated with their quality control; to assist in training staff.

In 1971, two consultants studied the situation and made recommendations. In 1973, a consultant trained analysts in specific methods and utilization of modern analytical instruments. In 1974, a conrultant and fellowships are being provided in the field of quality control. A consultant in biological standardization vill be assigned in 1975. Assistance in the form of consultants and fellowships will continue in 1976-1977 in relation to quality control of drugs and biologicals and biological standardization,

The project activities vill be co-ordinated with Mongolia W 1 3 , "Brucella Vaccine Production".

The project is expected to continue till 1979.

Strengthening of Environmental Health Services SES 001 (Mongolia 0020)

TO a s s i s t i n eva lua t ing t h e s a n i t a r y con t ro l se rv ices and t o advise on t h e i r f u r t h e r development; t o improve the t r a i n i n g of personnel f a r the s t a t e s a n i t a r y inspec t ion s e r v i c e s ; t o help i n s t rengthening the publ ic hea l th chemi- c a l l a b o r a t o r i e s .

I n 1974, a consu l t an t w i l l a s s i s t i n studying environmental hea l th problems i n Ulan Bator . Fellowships w i l l be r e l a t e d t o shor t courses and observa- t i o n s tudy i n genera l s a n i t a t i o n . Similar a s s i s t ance i s planned for 1975.

A s a n i t a r y engineer w i l l be ass igned t o help i n the s t rengthening and development of t h e s a n i t a r y con t ro l se rv ices from mid-1976 onwards. I n 1976 and 1977, shor t - term consu l t an t i n a i r po l lu t ion and food s a n i t a t i o n and fe l lowsh ips s i m i l a r to those f o r 1974-1974 w i l l be provided again .

Ass i s t ance to t h i s p r o j e c t i s expected t o continue u n t i l the end o f 1978.

Country Statement Sanitation

Sewerage in Greater Kathmandu and Bhaktapur

I. _ NEPAL

Nepal is v igorous ly pursuing f o u r t h n a t i o n a l development p lan (1970-75). i n which p r i o r i t y is given t o b u i l d i n g up the necessary i n f r a s t r u c t u r e f o r s u s t a i n e d economic growth, i n c r e a s i n g a g r i c u l t u r a l p roduc t ion , s t e p p i n g up i n d u s t r i a l c a p a c i t y and s t r e n g t h e n i n g t h e a d m i n i s t r a t i v e and p lanning machinery. S teps have been taken toward t h e p r e p a r a t i o n of t h e f i f t h n a t i o n a l development p lan .

The t o t a l n a t i o n a l budget f a r t h e f i s c a l year 197311974 is Rs.1 547 488 000 ( t h e e q u i v a l e n t a f US$ 153 216 633) , which i s divided i n t o h . 5 0 5 749 000 f o r t h e r e g u l a r budget and R s . 1 041 739 000 f o r the development budget. Compared t o the budget f o r the f i s c a l y e a r 19721 1973, t h e r e h a s been, i n t h e t o t a l budget, a 51.7% i n c r e a s e , and i n the r e g u l a r and development budgets r e s p e c t i v e l y 25.6% and 68.6% i n c r e a s e s . The i n c r e a s e i n t h e development programme expendi tu re r e f l e c t s t h e Government's de te rmina t ion to c a r r y o u t i t s economic development p o l i c i e s . Although the f o r e i g n a i d t o t h e country has i n c r e a s e d i n volume, t h e p r o p o r t i o n of a v a i l a b l e f o r e i g n a i d t o the development e x p e n d i t u r e has decreased t o 322, as compared t o t h e p rev ious y e a r . This decrease was made p o s s i b l e by the new t a x revenue system, which aims a t g e n e r a t i n g f u l l y 55% of the development expendi- t u r e needed.

The t o t a l e s t i m a t e f o r t h e Heal th M i n i s t ~ y f o r the 197311974 f i s c a l y e a r r e p r e s e n t s 4.1% of the t o t a l n a t i o n a l budge t , wi th a per cnpita h e a l t h e x p e n d i t u r e of Rs.5.N (US $0.50). The d i s t r i b u t i o n among major h e a l t h programmes i n the 197311974 f i s c a l y e a r are a s follows:

Percentage of t o t a l Per capita Programmes h e a l t h es t imates expendi tu re

Cura t ive s e r v i c e s 30.1% Rs. 1.60 Malar ia e r a d i c a t i o n 23.8% Rs. 1.25 Heal th p o s t s 18.8% Re. 0.99 MCHIfamily planning 10.1% Re. 0.54 Smallpox e r a d i c a t i o n 3.6% Re. 0.19 Others 13.6% Re . 0.80

According t o t h e 1971 census , t h e t o t a l popula t ion of Nepal was 11 533 983. Based on t h i s f i g u r e and u s i n g n a t i o n a l h e a l t h survey e s t i m a t e s of 1966, t h e i n f a n t m o r t a l i t y r a t e is es t imated t o be 183 p e r thousand. The crude dea th r a t e is es t imated a t 20 p e r thousand; t h e e s t i m a t e d annua l crude b i r t h r a t e i n 1970 is 44.6 and l i f e expectancy a t b i r t h i n 1970 40.1 y e a r s f a r males and 43.2 y e a r s f o r females . The annual growth r a t e o f t h e popula t ion is 2.46%.

NEPAL u Ln P

For t h e per iod 1973-1975, the amount of WHO a s s i s t a n c e is i n the o r d e r o f $2 409 126. This a s s i s t a n c e c l o s e l y fol lows t h e o v e r a l l p r i o - r i t i e s of the n a t i o n a l p l a n . concent ra t ine on methods f o r t h e develoo- . . ment of h e a l t h s e r v i c e s which a r e s u i t a b l e to the count ry ' s geographica l and o t h e r c h a r a c t e r i s t i c s , h e a l t h manpower development, family h e a l t h , d i s e a s e c o n t r o l and var ious suppor t ing s e r v i c e s ,

The proposed p r o g r a m e and budget e s t i m a t e s f o r 1976 and 1977 are planned t o a s s i s t the p r i o r i t y h e a l t h progrHnmes of Nepal i n conformity wi th those of the e x i s t i n g n a t i o n a l h e a l t h p l a n s and of WHO'S F i f t h General Progranrme of Work. I n o r d e r t o ensure b e t t e r management of t h e p r o j e c t s and t o make g r e a t e r impact on lead ing h e a l t h problems, t h e aim i n 1976 and 1977 is t o r e s t r u c t u r e WHO-assisted programmes by aggregat- i n g r e l a t e d p r o j e c t s and by reducing the t o t a l number of p r o j e c t s . A country h e a l t h programming e x e r c i s e applying a WHO developed methodology was c a r r i e d o u t i n 1974. This e x e r c i s e and t h e p r o j e c t fo rmula t ion , management and implementation t h a t fol low should f a c i l i t a t e s p e e d i e r development of h e a l t h programmes i n Nepal.

S t reng then ing of h e a l t h s e r v i c e s

A p lanning mi t was e s t a b l i s h e d i n the Min is t ry of Heal th dur ing 1973. Ihe Government con t inues to emphasize on the development of h e a l t h s e r v i c e ? by means of e s t a b l i s h i n g a network of comprehensive h e a l t h c a r e systems. A p i l o t p r o j e c t f a r i n t e g r a t e d h e a l t h s e r v i c e s is progress ing i n two d i s t r i c t s , and t h e p a t t e r n being t r i e d o u t i n t h e p i l o t p r o j e c t a r e a s w i l l be extended t o s e v e r a l o t h e r d i s t r i c t s from 1974. The p l a n a l s o envisages t h e opening of a number of d i s t r i c t h e a l t h o f f i c e s and 225 h e a l t h p o s t s throughout the country. The mater- n a l and c h i l d h e a l t h f f a m i l ~ planning programme and o t h e r h e a l t h s e r v i c e s w i l l b e i n t e g r a t e d e v e n t u a l l y i n t o the h e a l t h s e r v i c e s . The p l a n c a l l s f o r t h e development and f u r t h e r improvement of s p e c i a l suppor t ing s e r v i c e s such a s h e a l t h l a b o r a t o r i e s , in format ion systems and medical s t o r e s management.

WHO assistance. WHO, through m u l t i - d i s c i p l i n a r y p r o j e c t s f o r the development of h e a l t h s e r v i c e s , assists v a r i o u s a s p e c t s of h e a l t h s e r v i c e development - s t u d i e s i n p i l o t a r e a s , demonstrat ion of methodology , n a t i o n a l h e a l t h p lanning , t h e h e a l t h in format ion system and t r a i n - i n g and p r e p a r a t i o n of n a t i o n a l s t a f f . Under t h e l e a d e r s h i p of a s e n i o r p u b l i c h e a l t h a d m i n i s t r a t o r a t t h e c e n t r a l l e v e l , t h e team i n c l u d e s a p u b l i c h e a l t h o f f i c e r , a p u b l i c h e a l t h nurse , a s t a t i s t i c i a n and a s a n i t a r i a n and co-ordinates a l l t h e o t h e r r e l a t e d WHO i n p u t s . Prom 1976, WHO w i l l cont inue t o a s s i s t t h e Government i n developing i t s h e a l t h planning and programming c a p a c i t i e s . WHO'S a s s i s t a n c e w i l l a l s o

NEPAL

continue i n the f i e l d of h e a l t h l a b o r a t o r y s e r v i c e s and o t h e r suppor t ing s e r v i c e s .


It i s r e a l i z e d t h a t s e r i o u s e f f o r t s a r e needed t o ensure the speedy development of h e a l t h manpower. I n t h e i n i t i a l s t a g e s the I n s t i t u t e of Medicine, e s t a b l i s h e d i n 1972 under Tribhuvan Univers i ty , is concent ra t - i n g on t h e t r a i n i n g of nurs ing and some c a t e g o r i e s of a u x i l i a r y personnel , p a r t i c u l a r l y h e a l t h a s s i s t a n t s , s e n i o r a u x i l i a r y h e a l t h workers, a u x i l i a r y h e a l t h workers , a u x i l i a r y nurse-midwives, l a b o r a t o r y t e c h n i c i a n s , radio- g rapher t e c h n i c i a n s and Ayurvedic phys ic ians .

WHO asaistmce. With long-term s t a f f and shor t - t e rm c o n s u l t a n t s , WHO is s u p p o r t i n g the con t inu ing t r a i n i n g programme f o r nurses and a u x i l i a r y personne l . ' h e plans to conso l ida te WHO i n p u t s i n the t r a i n i n g f i e l d and t o h e l p wi th the development of t h e I n s t i t u t e o f Medicine i n a composite educa t ion and t r a i n i n g programme, are geared t o meet needs f o r h e a l t h manpower t o suppor t the h e a l t h s e r v i c e s as a whole.

Disease p r e v e n t i o n and c o n t r o l

The c r i t i c a l s i t u a t i o n of t h e m a l a r i a e r a d i c a t i o n programme, the f i r s t and one of t h e mast e f f e c t i v e communicable-disease c o n t r o l programmes launched by t h e Government, i n which t h e r e is a r i s k t h a t the r e s u l t s a l r e a d y achieved may b e jeopard ized , con t inues , because of i n s u f f i c i e n t f i n a n c i a l resources and t h e l a r g e number of imported cases from neighbouring c o u n t r i e s . The n a t i o n a l a u t h o r i t i e s are s t i l l at tempt- i n g t o b r i d g e t h e gap. Smallpox, which was widely p r e v a l e n t f o r some t ime, i s d e c l i n i n g , and t h e e r a d i c a t i o n programme i s expected t o achieve i t s o b j e c t i v e s by 1975. Tubercu los i s and leprosy c o n t r o l programmes are i n t h e i r i n i t i a l s t a g e s , and r a b i e s and g a s t r o - i n t e s t i n a l i n f e c t i o n cont inue t o r e c e i v e s p e c i a l a t t e n t i o n .

WHO ass is tmzce . WHO w i l l d i r e c t i t s e f f o r t s t o communicable-disease c o n t r o l programmes which w i l l make up an es t imated expendi tu re o f 28.2% and 28.5% of the t o t a l amount of t o t a l WHO a s s i s t a n c e f o r t h e country f o r 1976 and 1977 r e s p e c t i v e l y . Ihe o b j e c t i v e s of the m a l a r i a programme continue t o be l i m i t e d t o r e t a i n i n g the ga ins s o f a r achieved, whereas the smallpox programme aims a t e r a d i c a t i o n ; both w i l l cont inue t o be suppor ted , as w i l l t he l eprosy and t u b e r c u l o s i s programmes, f o r which a s s i s t a n c e w i l l be channel led through long-term s t a f f , supported by c o n s u l t a n t s .


Environmental h e a l t h p r o j e c t s cont inue t o be l e a s t developed h e a l t h programmes i n the count ry , and a r e t h e r e f o r e being g iven s p e c i a l a t t e n t i o n by the Government. Tne f i r s t phase of the UNDP-funded Kath- mandu wate r supply and sewerage p r o j e c t was completed i n l a t e 1973, and t h e Government now p lans to implement the second phase of cons t ruc- t i o n immediately. The community wate r supply and s a n i t a t i o n programme s t a r t e d i n the r u r a l a r e a s , wi th the a s s i s t a n c e of WHO and UNICEF, is progress ing , and t h e Government is determined t o extend t h i s programme t o o t h e r areas as r a p i d l y as p o s s i b l e .

VHC a s ; i s t m c e . WHO w i l l p rov ide long-term s t a f f f o r the n a t i o n a l community water supply and s a n i t a t i o n programme, and f u r t h e r f e l l o w s h i p s t o n a t i o n a l s t a f f working i n environmental h e a l t h i n a con t inu ing t r a i n - i n g programme. WHO a s s i s t a n c e t o t h e development of h e a l t h s e r v i c e s and community wate r supply and s a n i t a t i o n i s aimed a t p r o g r e s s i v e l y s t reng then ing the s a n i t a t i o n programme and a t h e l p i n g t o develop the Environmental S a n i t a t i o n Unit w i t h i n the Department of Heal th.

Development of Heal th Se rv ices STR 001 (Nepal CO21)

To s t r eng then t h e development of an i n t e g r a t e d comprehensive h e a l t h care s e r v i c e ; i n conformity wi th t h e development plans of the Government, t o a s s i s t i n t h e conduct of h e a l t h surveys , h e a l t h manpower surveys and re l evan t s t u d i e s ; t o co-ordinate a s soc ia ted p r o j e c t s ope ra t ing i n the country.

I n 1968, a consu l t an t a s s i s t e d i n prepar ing a f ive-year plan f o r i n t e g r a t e d h e a l t h s e r v i c e s . Assis tance to t h i s p r o j e c t was given up t o 1970 by the pub l i c h e a l t h o f f i c e r a t t ached t o Nepal 0003, "Strengthening of Health Services" . Since 1971, a pub l i c h e a l t h o f f i c e r and a pub l i c h e a l t h nurse , have been ass igned. Also i n 1971, two consu l t an t s advised on t h e design and a r c h i t e c t u r a l a spec t s of h o s p i t a l admin i s t r a t ion f o r cons t ruc t ion o f h o s p i t a l s and h e a l t h p a s t s and another consu l t an t s t a t i s t i c i a n a s s i s t e d i n planning and prepar ing f o r the es tab- l i shment of a medical records system i n the b a s i c hea l th s e r v i c e s . I n 1973, a medical records o f f i c e r was r e c r u i t e d . A consu l t an t was assigned to a s s i s t i n t h e development o f h e a l t h manpower and a l s o h e a l t h planning i n Nepal. Another consu l t an t a s sessed t h e p o s s i b i l i t y of t r a i n i n g a n a e s t h e t i s t s i o the country . Ass i s t ance was a l s o provided i n evolving gu ide l ines fo r the development of occupat ional h e a l t h s e r v i c e s as an i n t e g r a l p a r t of general h e a l t h s e r v i c e s .

It has been planned t h a t the s t u d i e s c a r r i e d o u t i n Bara and Kaaki w i l l be completed and recornendat ions made a v a i l a b l e by June 1974.

Fellowships w i l l cover f i e l d s o f pub l i c h e a l t h adminis t ra t ion f o r non- medical o f f i c e r s , and nurs ing and observat ion tour s f o r team of a pvb l i e h e a l t h o f f i c e r , a pub l i c h e a l t h nurse and a h e a l t h inspec to r . In-service t r a i n i n g f o r n a t i o n a l s t a f f i s a l s o planned.

L NEPAL u

0

Medical S to res Management STR 002 (Nepal 0032)

To a s s i s t i n the development and expansion of medical s t o r e s and supply se rv ices .

I n 1968, s consul tant was provided under p r o j e c t SEAR0 0143, "Pharmaceuti- c a l and Medical Stores Management". A c t i v i t i e s w i l l be c l o s e l y eo-ordinated wi th Nepal 0021, "Development of Heal th Services" .

A consu l t an t i n medical s t o r e s management was ass igned f o r n i n e months from November 1972 to c o l l e c t da ta needed f o r the preparat ion of a d e t a i l e d plan of ope ra t ions . Since 1973, he has been appointed as a medical s t o r e s management o f f i c e r f o r two yeare u n t i l the end of 1975, when the p r o j e c t w i l l b e merged with Nepal 0021.

Assis tance t o t h e p r o j e c t i s expected to continue f o r a number o f years

NEPAL

Nursing Education and Services (UNDP NEPl681013)

STR 004 (Nepal 0002)

To assist the Directorate of Health Services in co-ordinating nursing activities; to assist in setting up a basic nursing school, in organizing courses far assistant nurse-midwives, in upgrading nursing services in Bir Hospital, in improving clinical facilities for student nurses and in developing public health nursing services which will provide practice fields for nursing and assistant nurse-midwife students.

Assistance to this project started in 1954. In 1966, a Nursing Section was set up in the Directorate of Health Services. In 1968, a consultant planned a public health nursing programme in Kathmandu Valley, and in 1965. the same consultant was assigned full-time a s a public health nurse.

In 1972, the School of Nursing was transferred to the Institute of Medicine, Tribhuvan University. In 1973, a short-term consultant was assigned to assist in the re-organization of nursing curricula, including the development of the credits system. Activities to strengthen the public health nursing component, both theory and practice, were intensified during 1974 in the light of new developments of health manpower requirements in the country.

WHO continues to assist with the development of the administration oi nursinglmidwifery services at national, zonal and institutional levels and of basic and auxiliary nursing-midwifery education. Short courses for nurses to update nursing practice and improved supervisory and managerial techniques were conducted by the project staff in 1974. This project is closely related with other WHO-assisted projects in Nepal, especially Nepal 0021, "Development of Health Services", and Nepal 0200, "Fellowships (Nursing)".

Assistance to the project will be terminated by the end of 1974 except that fellowships will complete their studies in 1975.

Health Planning and Programming STR 005 (Nepal 0039)

This is a new project starting from 1976. A health planner, a management expert and a statistician will be assigned in 1976-1977 to strengthen health planning programming and health administration. A consultant will also be provided ro assist in the management of hospital administration.

This assistance will continue for a number of years.

Health Laboratory Services HLS 001 (Nepal 0010)

TO assist in developing health laboratory services; to support an epidemiological unit and to assist in training personnel.

Assistance started in 1967 with the assignment of a laboratory technician. A central laboratory has been established, and from November 1967 to December 1971, a microbiologist helped to organize the different sections. In-service training and a two-year training course for laboratory assistants are being implemented. A laboratory technician tutor was provided from 1970 to 1972. Another laboratory technician is to be aesigned shortly to ageist the project with regard to both manpower training and expansion of laboratory services in zonal and district hospitals. During this period several fellowships have been awarded in specific subjects.

From 1975 through 1977 a number of fellowships will be provided for training in specialized subjects as well as the training of tutor technicians.

To assist in national health planning, programing and in health administration, on a broad basis, with primary emphasis on the phased integration of disease control and special health programes, eventually leading to the development of a comprehensive health care service in the country.

r

ProJecf NO.

ST8 W 4 (WO2)

STR 005 (00391

HLS W I (M101

N E P A l

Nursing Education and Services NEPlb81013

Nurse adviser P3 Public healrh nurse ?3

Fellavehrps supplies and equipment Hiscellaneaus

Health Plannin~ and ProRramminp,

nealch planner PS Management expert P4

P3 Statistician clerk-stenographer m b



Health Laboratory Service3

laboratory technician ruror P2


R E G U L A R

Number of Post.

'Lxc.'errea 1" u > "",La,,'

B U D G E T


1974 1974

1/12 1112 - 2 - 21lb

1974 1975 1976 1976 1975

1

I 1977

' 1

3 - u c b 3 2 L

2

DP

1 I ~ ~ ~ 1 ~

1

I I : 1 I I

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Number of Ports



1977

I/ 5 --

1 -- 2/18

I ! I

j I 1 ~ I I !

1 I

i

I 18 395 38 460

I 32 040 15 010 32 040

925 2 040

G I G

1 l4 12 jjy 900 1 8 200 - - 61 630 1 112 780

i I - 1 - 1

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1975 1974 1 1975

7 900

8 4 M ) 1 O W - 17 3 W -

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11 290

9 6 0 0 11400 ' 5 700 2 5 W 1 0 M 1 1 0 0 0 - I -

23 390 12 400 b 700 - 1 - -

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1 - 2120

!

!

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i

1976 1976

I

I/ 7

I

2/24

1977 1977

I 1 i

2 5 W ; - - 60 000 2 5 W

l4 800 l4 lW i 929 738 I

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76 467 16 600 - 8 - ,

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4

1/24

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Family Heal th (UNFPA) MCH 001 (Nepal 0038)

TO a s s i s t t h e Government i n i t s e f f o r t s t o improve t h e hea l th of mothers and c h i l d r e n , t o reduce t h e b i r t h r a t e , and t o promote t h e hea l th of the family by i n t e n s i f y i n g and extending t h e maternal and c h i l d hea l th f fami ly planning a c t i v i t i e s i n a phased manner, i n t h e Eastern Region, through the bas ic h e a l t h Services .

I n 1972, a team of t h r e e consu l t an t s (under p r o j e c t IR 1001) v i s i t e d Nepal, i n t e r a l i a , t o assess t h e maternal and c h i l d hea l th a c t i v i t i e s and t o advise on t h e development of t h e b a s i c h e a l t h se rv ices i n support of maternal and c h i l d h e a l t h l f a m i l y planning programmes and on appropr ia t e t r a i n i n g prograormes f o r n a t i o n a l h e a l t h personnel.

A p r o j e c t r eques t f o r UNFPA a s s i s t a n c e vas developed with t h e a s s i s t a n c e of s t a f f ass igned t o in te r -coun t ry p r o j e c t SEAR0 0219, "Development of Na te rn i ty - centered Aspects of Family Heal th Services" , i n 1973.

I n March 1974, a j o i n t WHOlUNFPA Mission v i s i t e d Nepal t o review the d r a f t r eques t prepared i n 1973 with t h e n a t i o n a l a u t h o r i t i e s . Following t h i s v i s i t , a r ev i sed d r a f t p r o j e c t r eques t vas prepared.

I n t h e f i r s t s t a g e of t h e programme, under t h i s p r o j e c t , f i v e d i s t r i c t s i n t h e Eas te rn Region w i l l be taken up for a s s i s t a n c e dur ing t h e f i r s t Wo years (mid 1974-mid 1976). Therea f t e r , beginning mid-1976, i t i s planned t o extend gradual ly t h e programme, a t t h e r a t e o f 2 t o 3 d i s t r i c t s pe r yea r , t o cover t h e remaining d i s t r i c t s i n t h e Eas te rn Region. Proposals for the second s t a g e of the p r o g r m e i d e n t i f y i n g f u t u r e UNFPAlWHO a s s i s t a n c e needed, vill be f i n a l i z e d and submitted to UNFPA towards t h e end of 1974.

Under t h i s p r o j e c t , a s s i s t a n c e w i l l be provided i n the farm of t echn ica l advisory se rv ices , s a l a r y suppor t , fe l lowships and study t o u r s , i n - se rv ice t r a i n i n g , construct ion of and renovat ions to h e a l t h "entree and o r i e n t a t i o n t r a i n i n g cen t res . UNICEF w i l l provide supp l i e s and equipment.

Heal th Education RED 001 (Nepal 0019)

To a s s i s t i n h e a l t h educat ion i n the b a s i c h e a l t h s e r v i c e s , i n s p e c i a l p r o j e c t s and i n schools and teacher t r a i n i n g i n s t i t u t i o n s .

Assis tance s t a r t e d i n 1967, when a consu l t an t made reconnnendations for the f u r t h e r development of h e a l t h education se rv ices . I n 1968-69, another consu l t an t revieved h e a l t h educat ion i n schools and i n t eacher - t r a in ing i n s t i t u t i o n s and suggested measures f o r e f f e c t i v e co-ordinat ion. As a follow- up of t h e in ter-country workshop i n school h e a l t h educat ion (1970), a consul- t a n t a s s i s t e d i n planning and conducting a n a t i o n a l vorkshop f o r key teaching and h e a l t h personnel i n 1970-71. Fur ther consu l t an t s e r v i c e s were provided i n 1971 and 1972. I n 1974, a workshop f o r h e a l t h educators end admin i s t r a to r s w i l l be held and a WHO h e a l t h educator w i l l be ass igned, who w i l l cont inue through 1975.

NEPAL

3.2 Family Health

3.2.2 naternal and Chrld Health

~arnily Health

Medical oifrcer (Maternal and child her.ch,famrl) !health) P4

Fellowships ~rovp rrainrng I , I -servl ie r r a 1 n r n g Subsidy Miscellaneous

1.2.4 Nviriiion

Feliovships (Aufrltion

Training)


Health Educatron

Health educator P4 Clerk-stenographer KA5

Fellowships Participants Supplies and equipment

R E G U L A R

Number o f Posts

1q74

B C D C E T

Esf~nrred Obligarivns

1911 '1976 1977 1974

L" e" P-

P r u , e c f NO.

UCH WI (0038)

N U I 002 (0200)

HED W l (0019)

1975 1976

i

1 I

! ~ I ; ; i

I !

1 ~ i I I

1 I

I ~ I I I 1 !

' 1 1

'Lxpresseo i n ua u o ~ l a r a ~

1977

3/12

I 1 1

~ !

4 Zoo

I ~ I

i I

27 040 1 200

- # - ~ 15 700 28 240

i 7 200 ~ I : I: 1 1

- - JO 700 28 250

I

I i

-

Number of Parrr

-

1974

I i i

0 rn " G L. 2

2 :

99

L J T H E R S O U R C E S

Estimated Obligation8

I

!

; ~

11 2 1/12 l i 6 - i- 1 1 1 1 - - ,-

6164 3/32 ~ I i

i

i ~ i I : 1 I

1 1 1

!

i !

1975 1974

i I ! !

11 7 I/ 7 -- -- 2/30

1976

i

1 I

i i 4 J20 27 040 , 15 010

1 I

48 400 23 200 / 26 600 26 600 18 883 23 161

I 3 124 7 041 3 520 4 063 17 284 11 040 - - -

57 390 ' 149 130 I 52 770 - - I i I

i ~ I

I i I

I ~ !

I

I I ~ I !

1975

1112 1/12

2 2

1977 1976 1977

NEPAL

Tra in ing of Heal th Manpower tW) 001 (Nepal 0037)

To a s s i s t i n the t r a i n i n g of h e a l t h manpower needed f o r the comprehensive h e a l t h care system.

Recognizing t h e urgency of promotillg t h e development of h e a l t h manpower, t h e Government e s t a b l i s h e d t h e I n s t i t u t e of Medicine under h i b h u v a n Univers i ty i n 1972. I n the i n i t i a l s t a g e s , t h i s i n s t i t u t e concentrated on t h e t r a i n i n g of nurses and some ca tegor ie s o f a u x i l i a r y personnel - espec ia l ly , h e a l t h a s s i s - t a n t s , s e n i o r a u x i l i a r y h e a l t h m r k e r s , a u x i l i a r y h e a l t h uorkers, a u x i l i a r y nurse-midwives, l abora to ry technicians , r a d i e ~ r a p h e r technicians , e t c . It i s planned t o s t a r t pre-medical t r a i n i n g i n 1975 and p r e - c l i n i c a l and c l i n i c a l t r a i n i n g a f t e r 1978.

A nurse educator (medico-surgical) from 1975 and pharmacist educator and radiographer t u t o r from 1976 w i l l be provided. I n add i t ion , short-term eonsul- Cants i n medical educat ion w i l l a l s o be provided from 1975 onwards t o he lp i n the development of t r a i n i n g programmes f o r d i f f e r e n t l e v e l s o f h e a l t h workers and to a s s i s t w i th the s t r eng then ing of the I n s t i t u t e of Medicine. I n add i t ion , f e l lowsh ips f o r the t r a i n i n g of h e a l t h workers i n d i f f e r e n t f i e l d s w i l l be provided.

Malar ia Eradicat ion MPD W 1 (Nepal 0001)

To a s s i s t i n the malar ia e rad ica t ion programme

The malar ia e rad ica t ion p rograme , s t a r t e d i n 1958 and a l s o a s s i s t e d by USAID, was developed from the e a r l i e r malar ia con t ro l compaign s t a r t e d i n t h e Rapt i Valley i n 1954. The programme made s i g n i f i c a n t progress till about 1970-71 and about 80 per cen t o f t h e o r i g i n a l l y malarious areas had en te red t h e conso l ida t ion phase by the end of 1973. However, t h e r e has been an inc reaae i n t h e incidence of malar ia i n 1973. I n 1974. UtlO has given subs- t a n t i a l a s s i s t a n c e towards the provis ion of DDT and o t h e r supp l i e s and equipment. A s t r a t e g y review of t h e programme was c a r r i e d o u t by the Government i n February 1974, i n co l l abora t ion wi th WHO and USAID.

I n 1975, 1976 and 1977. VRO a s s i s t a n c e w i l l be almost on t h e l e v e l as i n 1974, by way o f personnel , fe l lowships , s u p p l i e s end equipment.

Assi.tence to t h e p r o j e c t i s expected to cont inue f o r a number of years .

The p r o j e c t i s expected to cont inue f o r a number of years.

R E G U L X E : D ; F T

SEPAI.

4. HEALTH MANPOVER DEVELOPMENT

4.1 Healch Manpower Development

~ r a i n m ~ ci nealin nanpower

Pharmaclni educator P4 Nurse educa~or

(medica-srrg,cal) P 3 ~ a d ~ o g r a p n e ~ titor P3

Short-term consulLanfs Fellawshipr

Fellovships (Surs inq)

5. DISEASE PREm.vI1oN iVio CONTROL

5.1 ~ o ~ u n i c a b l e ~ l r e a s e Prevention and Control

5.1.3 Malaria and otner Parasitic Diseases

Malaria Eradlcarron

,, nalariologist Epidemialogrrr P4 Sanitarian PZ ~ransporf assistant KA7 Adxinisfrafive assistant KA6 Clerk-stenographer XA6

Fellovrhips Supplies and e q u ~ p m e n r

Number of Ports Erc:ma:ed Obligations Prolecl S O .

HMD 001 (W37)

HMD W 2 (0200)

KPD 001 (OWl)

1974

'xprrrsed in US Dollars;

1971

0 * v " c $- 5

2

- ? V S u I ? . . i

Number ai i d s r i ESfrmated Inilga:l,>ns I

1976

I I

1 1

1 ~ I 1 1112

I/ 6 1/12 1/12

1977

- 1974 'i 1175 1 197a i I 1974 1 1975 1976

T I/ 6 3/36

I

15 010 32 0dfl 13 520 30 020 , 32 040

I 15 010 , 16 020 - - 1 , - 13 520 60 040 ; 80 100

13 200 7 200 7 Z W I 19 800 ' 42 600 14 4 W ! - 8 - ! 46 520 109 840 101 7~ ! - I

25 500 1 I

i i ! !

I I , 27 280 30 260 32 280

27 280 30 260 32 280 1 19 6 W 21 290 , 22 580 2 400 1 2 640 ! 2 900 1 680 1 1 850 i 2 040

i 1 680 1 1 850 ' 2 040

I

- , - 8 -

79 920 88 150

I : 7,! 24 W O 25 OW 25 6 W - - - 101 150 i 112 720 , 113 750 -- _ _

! I

I!;. 1917

I

11 6 ! 11 6

T I T

I

j ~ !

! ! i

I ~

- 94 120

5 2 W 30 6 W

I - 129 920 -

1974 1975 1976

I ~ !

! i I I :

- - A

11 3 61104

I

~! I !

i 4/60

I : 1

11 3 3/60

I

1,

I

1

~

1/10 1/12 1/12 1/12 1/12 1/12

4/14

1 1/12 1/12 1/12 1/12 1/12 1/12 ----

---- 6/21

! I ! , \ i 1 1 1

! I I

i ~ ! 1 I

i I I

I

1 I

i

1 ! 1 I

i

i

1/12 1/12 1/12 1/12 1/12 1/12

6 6 6 6

1/12 1/12 1/12 1/12 1/12 1/12

4/14

I I

mallpox Erad ica t ion SME 001 (Nepal 0009)

To achieve t o t a l e r a d i c a t i o n o f smallpox i n the country by 1977.

A p i l o t smallpox p r o j e c t was s t a r t e d i n Kathmandu Valley i n 1962, and i n c e 1970, WHO has provided a pub l i c h e a l t h o f f i c e r , an opera t ions o f f i c e r , ellowshipa, subsidy and supp l i e s and equipment. I n 1972, a second opera t ions f f i c e r was added. By 1973, t h e programme had been implemented throughout the 5 d i s t r i c t s i n Nepal. T ra in ing courses f o r t h e l o c a l s t a f f were conducted egu la r ly , s u r v e i l l a n c e teams were c r e a t e d , and weekly r e p o r t i n g from a l l i s t r i c t s W 8 8 i n i t i a t e d . Changes v e r e made i n t h e o rgan iza t ion and ~ c h e d u l e f r o u t i n e vacc ina t ions . Transpor t f a c i l i t i e s v e r e made a v a i l a b l e . The s teady t rengthening of t h e s u r v e i l l a n c e and vacc ina t ion programmes dur ing the l a s t ew y e a r s has r e s u l t e d i n Nepal a t t a i n i n g a non-endemic s t a t u e i n 1973 and i n f f e c t i v e l y combating the n w e r o u s importa t ions i n t o the country. The pub l i c e a l t h o f f i c e r w i l l cont inue up to t h e end of 1975.

The s u r v e i l l a n c e and vacc ina t ion programmes w i l l cont inue up to 1977 a t h igh pace so as t o b r ing to l i g h t any f o c i undetected, unrecognized or

nrepor ted i n 1974 and 1975.

e p r a s ~ Control

To a s s i ~ t i n developing a l ep rosy c o n t r o l programne and i n t r a i n i n g h e a l t h e r s o n n e l i n the s u b j e c t .

I n 1965, l ep rosy c o n t r o l a c t i v i t i e s s t a r t e d i n combination wi th Nepal 0016, 'Tuberculosis Control". The p r o j e c t i t s e l f s t a r t e d i n 1967. A review vas under- :aken i n 1969 through consu l t an t s provided under p r o j e c t SEA6U 0138, "Seminars 1.d P a i n i n g Courses i n Leprosy Control Hethodology". I n 1972-73, a c o n ~ u l t a n t ~ s s i s t e d i n o rgan iz ing a course i n l ep rosy c o n t r o l . A l ep rosy c o n t r o l o f f i c e r r i l l b e provided i n 1974-75.

I n 1976-1977, consu l t an t l e p r o l o g i s t s w i l l a s s i s t i n a review and assess - ment o f the programme and i n the p repa ra t ion and conduct of a t r a i n i n g course i n leprosy c o n t r o l .

Assis tance to t h e p r o j e c t i s expected t o cont inue f o r some yea r s .

Tuberculosis Control MBD 002 (Nepal 0016)

To a s s i s t i n developing a tube rcu los i s c o n t r o l programroe as p a r t of the b a s i c h e a l t h s e r v i c e s and i n t r a i n i n g personnel .

The p r o j e c t s t a r t e d i n 1965, and a medical o f f i c e r (1965-67) and a pub l i c h e a l t h nurse (1965-1970) were provided. BCG vacc ina t ion is c a r r i e d o u t sys te - ma t i ca l ly i n Kathmandu Valley through maternal and c h i l d h e a l t h and r u r a l h e a l t h c e n t r e s . Mobile teams are now opera t ing i n o t h e r p a r t s of the country. Bac te r io log ica l caee-finding and ambulatory t reatment are c a r r i e d o u t from the Tuberculosis Centre i n Kathmandu and a t a few c e n t r e s elsewhere. I n 1973, a medical o f f i c e r was appointed to a s s i s t wi th the development of the programme.

I n 1975, 1976 and 1977, fe l lowships w i l l be provided to t r a i n tube rcu los i s teams a t t h e Nat ional Tuberculosis I n s t i t u t e i n Ind ia .

Assis tance to the p r o j e c t i s expected t o cont inue f o r some yea r s

NEPAL

R e v e n t i o n of Rabies Vpg 001 (Nepal 0033)

To a s s i s t i n the prevent ion and con t ro l of r a b i e s

I n 1972, advisory s e r v i c e s were provided to a s s i s t i n p r o j e c t des ign and i n planning an e f f e c t i v e c o n t r o l p r o g r m e . A consu l t an t advised on r a b i e s vaccine production a t t h e Cen t ra l Veter inary Laboratory, Kathmandu; another c o n s u l t a n t advised on improving t h e l abora to ry animal resources which w i l l be used f o r t h e t e s t i n g of t h e vaccine. A d r a f t p lan of ope ra t ion for both t h e product ion of a n t i - r a b i e s vaccine and t h e c o n t r o l of r a b i e s has been prepared

Ass i s t ance has been provided by way of fe l lowships and supp l i e s and equipment t o the Cen t ra l Ve te r ina ry Laboratory i n t h e d iagnos i s of r a b i e s and i n t h e product ion and q u a l i t y c o n t r o l of the r a b i e s vaccine.

Ass i s t ance t o t h e p r o j e c t i s l i k e l y t o cont inue u n t i l t h e end of 1975.

Community Water Supplv and S a n i t a t i o n asn 001 (Nepal W29)

To a s s i s t i n t h e planning, o rgan iza t ion and implementation of a long-term comprehensive n a t i o n a l programme of cornuni ty water supply and waste d i sposa l .

The p r o j e c t s t a r t e d i n 1971 with the assignment of a s a n i t a r y engineer and a second s a n i t a r y engineer w i l l be ass igned i n 1974 to provide advisory s e r v i c e s to the Department of Local Development, Min i s t ry of Home and Panchayat, which i s respons ib le f o r r u r a l water supply and s a n i t a t i o n , on ma t t e r s r e l a t i n g t a t h e development of t h e programme. It i s proposed t o a s s ign a t h i r d s a n i t a r y engineer t o a s s i s t the Department of Water Supply and Sewerage, vhich i s respons ib le f a r urban water supply and s a n i t a t i o n , from 1976 o r 1977 s u b j e c t t o a v a i l a b i l i t y of funds. I n a d d i t i o n , f e l lowsh ips f o r post -graduate s t u d i e s i n pub l i c h e a l t h engineer ing and f o r s h o r t observation study i n water supply and s a n i t a t i o n w i l l a l s o be provided i n 1976-1977. The p r o j e c t is being implemented i n phases and i t i s expected t h a t i n t h e f i r s t four phases, 195 water supply schemes w i l l be completed and commissioned by t h e end of 1975.

UNICEF i s providing supp l i e s and equipment.

Assis tance t o t h e p r o j e c t is expected t o cont inue u n t i l 1980.

NEPAL

Development of Water Supply and Sewerage in Greater Kathmandu and Bhaktapur (LlNDP NEP1701508)

PIP 001 (Nepal 0025)

To assist in the preparation of a plan for the development of water supply and sewerage in Greater Kathmandu and Bhaktapur.

In 1970, a project manager (sanitary engineer) was appointed and an agreement was concluded with a consulting firm which started field operations in 1971. Additional work was undertaken in connexion with sector studies, production of adequate maps, and additional groundwater exploration.

The objective of the project was achieved in that a long-range plan for the development of piped water supplies and sewerage systems for the three largest cities in the country - Kathmandu, Lalitpur and Bhaktapur - was finalized and the draft detailed designs for immediate construction vere also produced. The reports called for under the project were submitted in draft form by the consulting firm and the final copies were printed. Pellouships, supplies and equipment were also provided.

Assistance to the projeet terminated by ihe last quarter of 1973, but provisions for sub-contracts and fellowships, etc. have been continued to meet the outstanding comitment .

- R E G U L A R B L D C I I

.... 1 ' ==== . . . . . . . !

I 2 1 182 926 19 800 i I DP

I 57 390 149 530 52 770 f P ! - - - !

240 316 169 330 52 770

i - - - i i Expected dlrec: inputs from

I UNICEF ~ r . the heairh field 1

I I i 418 900 12 100 . . . . . . . . . . . . . . ====== , ! I

I ! ! I

i i !

I : i i ! ; ! I

I I I i

I I i i i

j i

SirAL

6.1.3 Pre-lnves:>r:. I3:rnniny far mas>= samta;.. s c r i , l c e s

Developme::i c . 5 Va:er S u p p l ~ end Sewerage :r Zreafer Kathmandu a : ~ c Enakrapur

BEP!70!508

S u b - c o r r ~ i c ~

rel I~~~~~~~~ Hlrcrlrane

I u r l ! - SEPII.

Number of Ports

1974 11971 1 9 7 6 11977

Estimated Obligarions

1974 19-5 1976 19.-

P r o j e c t NO.

PIP 00: (W25)

i 1

(Ex~ressed in US Dollarr~


- - - -

Number of Ports

1974 / 1975 11976 j 1977 1

!

6r23 11 3 !

i -- ! -

3 2 1

- - - - 26 ' 27 26 2- ' 6li 090 731 5- ' 787 800 884 730 .... 8 .... .... ....

" c & 3 2 L

2

DP


1974

i

!

80 886 18 goo 3 200 6 673 : - - 106 459 3 2 W - -

- ! - , - 240 316 , 169 330

1978 1976 1977

Country Statement

Family Planning and Population Dynamics in Medical Schools

and Pharmaceutical Products

and Sewerage for the South- west Coastal Area and Control of Communicable

I n t h e Republic of S r i Lanka, wi th a popula t ion of 13.5 m i l l i o n (mid-1973 e s t i m a t e ) , t h e annua l r a t e of popula t ion growth i s 2.2% and t h e p o p u l a t i o n d e n s i t y 206 p e r sq. km. Nearly 41% of t h e t o t a l popu- l a t i o n is i n the 0-14 year age-group. I n 1971, t h e b i r t h and dea th r a t e s were es t imated t o be 29.4 and 7.9 p e r thousand popula t ion respec- t i v e l y . I n 1967, l i f e expectancy a t b i r t h was 64.8 years f o r males and 66.9 years f o r females ; maternal m o r t a l i t y and i n f a n t m o r t a l i t y were i n 1970 1.2 and 45 p e r thousand l i v e b i r t h s r e s p e c t i v e l y .

Some 50% of t h e l a b o u r f o r c e is engaged i n a g r i c u l t u r e . The l i t e r a c y r a t e is very h igh (80%).

To improve t h e n a t i o n a l economy, a f ive-year p l a n (1972-1976) is under way, under which, w i t h r e s p e c t t o the h e a l t h s e r v i c e s , t h e Govern- ment is c o n c e n t r a t i n g on t h r e e main o b j e c t i v e s , i . e . t h e f u r t h e r i n t e g r a t i o n of h e a l t h s e r v i c e s , the improvement of h e a l t h coverage and t h e s t r e n g t h e n i n g of t r a i n i n g programmes f o r h e a l t h personnel .

WO's programme of a s s i s t a n c e cont inues t o suppor t t h e Government's p r i o r i t i e s , p a r t i c u l a r l y i n l a y i n g t h e groundwork f o r i n c r e a s i n g i n t e g - r a t i o n and e f f e c t i v e n e s s of t h e h e a l t h s e r v i c e s through h e a l t h manpower development. A comprehensive h e a l t h manpower s t u d y , undertaken with t h e a s s i s t a n c e of WHO and UNFPA, h a s provided v a l u a b l e d a t a f o r t h e improvement of t h e h e a l t h d e l i v e r y system. Family h e a l t h programmes, medical and n u r s i n g educa t ion , r u r a l piped water supply and communicable d i s e a s e c o n t r o l , i n c l u d i n g v e c t o r c o n t r o l , a r e a l s o supported.

S t rene then ing of h e a l t h s e r v i c e s

The Planning Unit of che Minis t ry of Hea l th i s r e s p o n s i b l e f o r co- o r d i n a t i n g p lans f o r f u t u r e h e a l t h a c t i v i t i e s . The Government i s a l so working on improvements i n t h e h e a l t h information system, and the h e a l t h educa t ion s e r v i c e s a t n a t i o n a l l e v e l a r e being reorganized.

The bed s t r e n g t h i n t h e country is now 4 1 803 w i t h a bed r a t i o of (3.14 p e r 1 000 p o p u l a t i o n ) , and t h e government h e a l t h s e r v i c e s i n c l u d e 457 h o s p i t a l s . More is a comprehensive network of 798 medical care i n s t i t u t i o n s which prov ide medical coverage t o t h e popula t ion , and e f f o r t s are being made t o evolve a more e f f e c t i v e r e f e r r a l sys tem,and t o improve t h e q u a l i t y of medical c a r e i n r u r a l a r e a s .

The n a t i o n a l family h e a l t h programme, which has s t a r t e d i n 1966, had gained impetus wi th i n t e r n a t i o n a l a s s i s t a n c e . This programme, admin is te red by t h e Family Heal th Bureau i n t h e Min is t ry , p rov ides a t

p r e s e n t f o r the management o f the well-developed h e a l t h care i n f r a - s t r u c t u r e throughout the count ry , and fo r maternal and c h i l d care and family planning s e r v i c e s , i n t e g r a t e d i n t o the h e a l t h s e r v i c e s .

WHO assistance. The Organizat ion cont inues t o a s s i s t t h e h e a l t h planning and p r o g r a m i n g a c t i v i t i e s . By means of a c r o s s - s t r u c t u r a l p r o j e c t approach embracing medical , nurs ing and h e a l t h educa t ion and t h e s t r e n g t h e n i n g of h e a l t h s e r v i c e s , and i n c o l l a b o r a t i o n with UNICEF, i t w i l l h e l p t o develop t h e n a t i o n a l p r o g r a m e s through c o n s u l t a n t s e r v i c e s , fe l lowships , s u p p l i e s and equipment i n v a r i o u s f i e l d s such a s medical r e h a b i l i t a t i o n , h e a l t h s t a t i s t i c s , n u t r i t i o n , h e a l t h educa- t i o n , e t c .


I n 1973, t h e r e were 3 225 phys ic ians i n the country. The doc tor popula t ion r a t i o of those working i n d i r e c t p a t i e n t care was 4.12 p e r 1 000 popula t ion . I n 1974 t h e t o t a l number o f nurses and midwives was 8 522, o: medical a s s i s t a n t s , 1 118, of pharmacis t s , 398 and af d e n t i s t s , 192.

The Government is p lanning f u r t h e r measures t o expand manpower development r a t i o n a l l y . A n a t i o n a l c o m i c t e e of e x p e r t s has been e s t a b l i s h e d t o ana lyse and u t i l i s e t h e r e s u l t s of t h e h e a l t h manpower s tudy mentioned e a r l i e r f o r f u r t h e r developing p a t t e r n s f o r manpower u t i l i z a t i o n of e x p e r t s .

Undergraduate medical t r a i n i n g i n S r i Lanka is provided by t h e two F a c u l t i e s of Uedicine of the Univers i ty of S r i Lanka, i n Colombo and Peradeniya. The t o t a l y e a r l y ou tpu t of t h e two f a c u l t i e s i n 1971 was 251 gradua tes . Pos t -gra iua te educa t ion i n surgery and a n a e s t h e s i a , gynaecology and o b s t e t r i c s and medicine i s a l s o o f f e r e d i n t h e country. A post-graduate course i n cornuni ty medicine is being s t a r t e d i n 1974.

N a t i o n a l f a c i l i t i e s f o r post-graduate medical s t u d i e s are being expanded. The Government is e s t a b l i s h i n g a post-graduate programme f o r t h e t each ing of anaes thes io logy .

There are e i g h t b a s i c n u r s i n g schools (which are a l s o expected t o t r a i n midwives), one p s y c h i a t r i c n u r s i n g school and one post-basic school . It is proposed t o r e o r i e n t nurs ing and midwifery t r a i n i n g so t h a t t r a i n e e s w i l l be given a more balanced t r a i n i n g i n h o s p i t a l work, p u b l i c h e a l t h and community and family h e a l t h .

WHO assistance. WHO w i l l a s s i s t i n t h e t r a i n i n g of medical under- g r a d u a t e s and pos t -gradua tes , i n c l u d i n g t r a i n i n g i n s e l e c t e d s p e c i a l t i e s and w i l l con t inue i t s support t o the f a c i l i t i e s of t h e medical t e a c h e r s ' t r a i n i n g c e n t r e a t Peradeniya and t o t h e i r use on a reg iona l b a s i s . Continued a s s i s t a n c e w i l l a l s o be given f o r the development of nurs ing and midwifery educa t ion and i n t h e o r g a n i z a t i o n of courses i n nurs ing educa t ion by prov id ing c o n s u l t a n t s and fe l lowships . The development of i n t e g r a t e d c u r r i c u l a f o r the t each ing of human reproduc t ion , family planning, popula t ion dynamics and p s y c h i a t r y i n medical schools w i l l be f u r t h e r supported.


The p e r s i s t e n c e of mala r ia is s t i l l a problem, and t h e r e is an added danger i n the f a i l u r e t o e r a d i c a t e p. faZcipmvm i n f e c t i o n s from t h e sou th-eas te rn a r e a s of t h e i s l a n d . Spray coverage i s no t s u f f i c i e n t t o guaran tee i n t e r r u p t i o n of t ransmiss ion i n t h e whale i s l a n d .

The e r a d i c a t i o n of r a b i e s , which is a problem of p u b l i c h e a l t h importance, w i l l be one of t h e f u t u r e a c t i v i t i e s .

A b a s e l i n e survey revealed an o v e r a l l t u b e r c u l o s i s prevalence r a t e of 2 .3 f a r t h e country ( r u r a l 1.9 and urban 4.0 p e r 1 0 0 0 popula t ion) . BCG v a c c i n a t i o n is c a r r i e d o u t mainly through matern i ty h o s p i t a l s and i n r u r a l a r e a s among school -ch i ld ren . The i n t e g r a t i o n of t h e t u b e r c u l o s i s c o n t r o l programme i n t o t h e g e n e r a l h e a l t h s e r v i c e s , covering t h e e n t i r e count ry , con t inues .

The Governrent has i n s t i t u t e d a sys temat ic programme of i m u n i z a - t i o n a g a i n s t d i p h t h e r i a , whooping cough and te tanus . P o l i a m y e l i t i s c o n t i - nues t o occur a t a reduced l e v e l . I n October 1973, c h o l e r a E l Tor made its appearance i n t h e J a f f n a p e n i n s u l a i n t h e n o r t h and spread t o Colombo and o t h e r p a r t s of t h e country.

The Epidemiology Department of t h e Min is t ry of Heal th has shown an i n c r e a s e d i n t e r e s t i n t h e epidemiology of ca rd iovascu la r d i s e a s e , one of t h e l e a d i n g causes of dea th .

WHO assistance. In d i s e a s e prevent ion and c o n t r o l , WHO'S main e f f o r t s a r e d i r e c t e d towards m a l a r i a e r a d i c a t i o n ; f u r t h e r a s s i s t a n c e w i l l b e g iven i n s t r e n g t h e n i n g ep idemio log ica l s u r v e i l l a n c e i n g e n e r a l , and l a b o r a t o r y s e r v i c e s i n p a r t i c u l a r , i n suppor t of communicable- d i s e a s e c o n t r o l . A v e c t o r c o n t r o l programme has been c a r r i e d o u t with WHO and UNDP a s s i s t a n c e . The c o n t r o l and prevent ion of c a r i o v a s c u l a r d i s e a s e s and cancer w i l l be supported.


The Government is keenly aware of the environmental h e a l t h problems b e s e t t i n g the country. About 25% of t h e h o s p i t a l beds a r e occu- pied by p a t i e n t s s u f f e r i n g from e n t e r i c d i s e a s e s . Only about 23% of a l l households have a piped d r i d i n g water supply. Most o f the people (72%) a r e dependent on w e l l s and 5 per c e n t on r i v e r s and s treams f o r d r i n k i n g water .

Targe t s fo r t h e United Nations Second Development Decade have suggested access t a s a f e water by 50 p e r c e n t of t h e t o t a l popula t ion , i . e . , 100 p e r cen t of the urban and 33 per cen t of t h e r u r a l popu- l a t i o n , by t h e end of 1980. A Nat iona l Water Supply and Drainage Board has been e s t a b l i s h e d .

Untreated sewage and i n d u s t r i a l wastes are p o l l u t i n g r i v e r s , and i n urban a r e a s , s o l i d waste d i s p o s a l p r e s e n t s s e r i o u s p r o b l e m . Colombo and o t h e r t o m s are beginning t o experience a i r p o l l u t i o n . Occupat ional h e a l t h problems are i n c r e a s i n g , and food hygiene a l s o is becoming a p r i o r i t y concern.

W O assistance. The n a t i o n a l endeavour t o provide access t o s a f e water and s a f e e x c r e t a d i s p o s a l systems f o r t h e e n t i r e r u r a l popula t ion i s being supported.

Ass i s tance w i l l also be g iven i n s t r e n g t h e n i n g occupa t iona l h e a l t h s e r v i c e s , i n t h e development of food hygiene and c o n t r o l measures, and i n a review of t h e e x i s t i n g o r g a n i z a t i o n a l s t r u c t u r e and o p e r a t i o n a l procedures, by prov id ing c o n s u l t a n t s ; fe l lowships f o r s p e c i a l t r a i n i n g of s e n i o r personne l engaged i n food product ion, food handling, e t c . w i l l be awarded. Ass i s tance t o r a d i a t i o n h e a l t h s e r v i c e s , rad io logy , rad io therapy and n u c l e a r medicine,vhich h a s been given i n t h e p a s t , w i l l be cont inued.

w SRI LANKA * *

Medical Rehabilitation STR W 1 (Sri Lanka 0063)

To assist the medical rehabilitation service. and to train staff.

In 1968 and 1970, a consultant advised on the manufacture of appliances and on the management of the arthopaedic workshop at the General Hospital, Colombo. He also assisted in the training of prosthetic and orthatic teehni- cians. In 1971, a review of the project was undertaken. In 1972, a consultant assisted in the development of medical rehabilitation services and reviewed the curricula in the field of medical rehabilitation. In 1973, an occupational therapy tutor assisted in assessing the existing situation in the field of occupational therapy services at the hospitals and in drawing up a curriculum for a School for Occupational Therapy. In 1974 and 1975 further assistance will be provided through the services of consultants (a prosthetic tutor and a physiotherapist). Fellowships will continue to be related to the training of teachers far the School of Physiotherapists for Rehabilitation. In 1977, training will also be provided in special disciplines of rehabilitation by the assignment of a consultant.


Port Health Services STR 002 (Sri Lanka 0083)

TO assist in strengthening port health services.

The project was operated in co-ordination with the inter-country project SEARO 0169, "Port Health Services", under which WHO provided a consultant in 1969. Fellowships are being awarded each year. Consultant assistance has been provided in 1973 in the epidemiology of quarantinable diseases, on the improvement of port environmental health conditions and on the disinsection of containers. In 1974, a consultant will advise on port health measures outside Colombo, and, in 1977, a consultant will be provided for evaluation. Fellow- ships are intended mainly for studies leading to DPH or MPH, followed by orientation in port health and also for attendance at short training courses.

National Health Planning STR 003 (Sri Lanka M92)

To assist in the establishment and in the strengthening of a health planning unit in the Ministry of Health, and in training staff.

In 1970, two consultants were provided to study the potential development of the health planning unit, and two members of the planning unit attended the regional course on health planning under SEARO 0178, "National Health Planning and Manpower Studies". In 1971, further preliminary studies were undertaken under SEARO 0148, "Strengthening and Development of Health Services", Sri Lanka 0101, "Health Manpower Study", and inter-regional projects NHP CW1, "Co-ordination of Manpower Surveys", and CHS 0004, "Utilization and Training of Manpower", and a consultant assisted in the further development of the health planning unit. In 1972, a public health administrator assisted with some components of the national health manpower study.

In 1974-75, the Health Planning and Programing Unit at the Ministry of Health will be further strengthened and the health planning capacity at the intermediate level vill also be further developed with the help of the WHO public health administrator. Training of planners will also continue.

Activities of the projects Sri Lanka 0045, "Health Statistics" and Sri Lanka 0105, "Family Health" are co-ordinsted with this project.

In 1976 and 1977, consultants will be provided for training and evaluation. Short observation fellowships for senior staff and a twelve-month fellowship (DPH) will be provided. In 1976, a group educational activity in health planning and medical care administration will be assisted.

The project is likely to continue until 1978.

Assistance is expected to continue until the end of 1977


I

u -, u

SRl LANKA

3. STRENGTHENING OF HEALlH SERVICES

3.1 Strengthenins of Health Services

3.1.2 Strengthening of Health Services

Medical Rehabrlirarion

Short-term consulLanCs Fellovshipr supplies and equipment

port Health services

ShorL-Lerm ~onl~lcanfs Fellowrh~ps Suppl~es and equipment

National Heslih Planning

Public health admini~lrsfar P5

Short-term coneultant8 Eellawships ~ ~ ~ t i ~ ~ ~ ~ ~ t ~ supplies and equipmenr

Number of oars

1974

11 3 3/24

~stirnated obligations project NO.

SIR Wl (0063)

1974

I ! I

11 2 4 000 b 400 9 O W 9 W O

- i -

1975

11 5 -- -- 11 3 2/24

iExpressed in KS Dollsrsi


1 !

I I i I

I ! 1 !

I ! 6 000 ' 6 600 7 2 W 13 000 7 8W 1 7 650 , 7 650 2 ooo i w 2 0 0 0 2 w 0 - - - -

9 650 14 850 - -

1975 , 1976 1974 1977

STR w 2 (0083)

I I

I

i 1 I 1 :

I

i

! !

1/12

1 1

I/ 3 2/24

1977

umber of rortr

11 3 2/12

1974

3/ 9 31 9 111

11 3 5/10

i : I

I ! !

i I i i

! I I

I

i I I

i f !

i i !

m m " c b . ,

z z Estimated obligations

I

i I I

I I I i

1975 1974

1

11 2 3/16

I

1976 ! 1977

i i i

I I

I 6 000

I I W 1 wo - ,

38 780 I 53 700 I i4 ZOO 14 4 w

1

!

I

I I

I !

I !

1915 1 1976 1977

LANKA w .A rn

itrengthening of Electro-medical Division STR 004 (Sri Lanka 0094)

To advise and assist in the training of electro-medical repair technicians tnd in the improvement of maintenance workshops to undertake repairs to X-ray aquipment and other types of electrical and electronic intruments in health institutions.

In 1972, a consultant was assigned to train technicians. In 1974 and 1975, lonsultants will assist in strengthening and improving the Central Workshop of :he Electro-medical Division and the peripheral workshops, and in conducting short training courses for artisans and technicians. In 1976, a consultant will ,e provided for the management of workshops. Fellowships for electronic ~ngineers and technicians will continue to be provided.

The project is expected to continve until 1978.

rraining of Anaesthesiologists ST8 005 (Sri Lanka 0102)

To assist in establishing a national training centre in anaesthesiology

Consultants have been provided to assist in the training of anaesthesiologists, first in 1952 under project Ceylon 0016, "Visiting Team of Medical Scientists", and then from 1955 to 1956 under Ceylon 0027, "Training of hnaesthesiologists and Operating-room Nurses". At that time a one-year diploma course in anaesthesiology (DA) was introduced at Colombo General Hospital under the auspices of the University of Ceylon. This course was later discontinued and anaesthetists were trained mainly abroad.

In 1969, two senior consultants from the Anaesthesiology Centre, Copenhagen, visited Sri Lanka and plans were made to re-establish the diploma course. A consultant was also assigned in 1971 under Sri Lanka 0047, '%ediad Education", to advise on the development of this specialty.

In 1974, one consultant will assist in developing a training programme and another in conducting a course for technicians in this field. A consultant will evaluate these activities in 1975. In 1976, a consultant will assist in the development of post-graduate training and, in 1977, of a special topic. In 1976-1977, fellowships will be provided to post-graduates for gaining practical experience.

This project vill terminate at the end of 1977.

Medical Stores Management STR 007 (Sri Lanka 0113)

on the improvement and decentralization of the stores. In October 1973, the same consultant visited Sri Lanks under project SEAR0 0143, "Pharmaceutical and Medical Stores Management", as a follow-up of his previous assignment. Another consultant will be assigned for three months in 1975.

Assistance to the project is expected to continue until the end of 1978.

Strengthening of Laboratory Services HLS 001 (Sri Lanka 0066)

To assist further in developing specialized diagnostic end reference functions in support of camunicable-disease control and prevention, and to train staff.

Following an assessment of diarrhoea1 diseases, the project started in 1963 with a study of the pattern of enteric diseases. In 1966, assistance was given in organizing bacteriological diagnostic facilities for enteric infections in principal hospital laboratories in Colombo and in the provinces. Help was provided to the Medical Research Institute in developing competence in the serology of haemorrhagic fever and in fluorescence microscopy for the diagnosis of rabies. Since 1970 the project's aim has been to give further assistance in developing specialized fvnctions for the prevention and control of communicable diseases and in developing a country-wide reference service for the support of epidemiological activities in cholera, denguelhaemorrhagic fever and smallpox. Assistance continued to be given to the training of staff.

Since 1972, WHO has been supporting a one-month national course in public health microbiology for provincial pathologists; this assistance vill continue through 1975. From 1973 different consultants have been assisting and will continue to help until 1976, the Medical Research Institute in dOvelaping virology reference activities in arbovirus, enterovirus and influenza virus diseases.

The activities of the project are co-ordinated with those of Sri Lanka 0078, "Strengthening of Epidemiological Services", and SEAR0 0159, "Health Laboratory Services". Starting from 1973, the laboratory aspects of venereal disease control will be absorbed in this project.

Fellowships have been provided throughout for the training of bacteriolo- gist8 and specialized training of technicians in specific skills.


To assist in the strengthening and expansion of medical stores and supply services.

In 1965, a consultant, under project Ceylon 0023, was assigned for two months to assess the situation in the field of medical stores, and to advise

- , - - - I 317001 3 4 1 W 34550 27900 -. - - - I

I I

SRI UNKA

Stren~~hening of Electro- medical Division

short-ierm consulrancs Fellowships supplies and equipment

Traininz of Anaesthesiologists

Short-term consultants Fellowships supplie~ and equipment

Fellowships (Uedical Stores nanaaemenr

uedicai stares management

Shorr-term consvlfanf Fellov~hips Supplies and equipment



Short-term coneultant~ Fellavships Particip."LB supplie~ and equipment

R E G U L A R

Number o f Forts

1974

B U D G E T

Estimated Obligations P r o ~ e c r No.

STR 004 (W94)

STR W 5 (0102)

STR W 6 (02W)

STR WI (0113)

HLS W 1 (W66)

1974

22 000

1975

(Expressed in US DullarrL

1975

!

1/11 ' 11 3 11 3 1 6/27 1 3/24 3124 4136

1

1976

_ 17 100 1 14 400, 14 400 21 W O 2 wo ' 2 om 3 000 - 1 - , - -

1977

I I i

6 600 7 200

1976

Number of P o l r r

31 9 8124

2/12

5142

!

I

LO W 0

-

1977 1974

21 5

11 6

I/ 3 5/33

I I I !

13 2 W / 19 200 21 600 6 6 W 1 5 100 16 350 1 OW 3 000 , 2 500

P I , -

rn a " c &. 3

:- rn u.



i I

I

i i i I

i

i

i

1975

11 6 1/12

7 200 I 3 9 W 5 W

1974

21 8 21 6

4 3 9 W 11 600 I - 1 -

I ! I

I 7 200

22 350

1976 1975 1976

7 8 W -

24 9 W

1977 1977

I

I I I

1 !

I

I

11 6

11 3 4136

4 W O 2 500 2 5 w 5 wo 3 wo

; 11 6

11 3 4139

I

I

Production of Improved Vaccines

To assist in the production of freeze-dried smallpox and other vaccines

In 1967, under project SEAR0 0038, "Production of Freeze-dried Smallpox Vaccine", e consultant advised on the production of freeze-dried smallpox vaccine. In 1969, another consultant under the same inter-country project, suggested the freeze-drying of smallpox and rabies vaccines. In 1971, a furhter consultant advised on the sequential production of both vaccines and provided a blueprint for the development of the project. In 1974 and 1975, consultants vill help in implementing the different aspects of the project and fellowships will be provided to train national staff in related fields.

Assistance to this project vill continue through 1977 by way of consultants and fellavships in the areas related to vaccine production and quality control.

UNICEF will supply the equipment for the production of freeze-dried vaccine and will supply bulk vaccines to be conditioned locally.

Family Health (UHPPA SRL/72/P04)

MCB w 1 (Sri Lanka 0105)

To assist in promoting family health as an integral part of the general health services.

Starting with a fellowship progr-e in 1971, the UNFPA-assisted project has the objectives of strengthening the administrative organization responsible for the national family health programme; in-service training and orientation of 12 OW health personnel of different categories, including a fellowship and study tour progr-e for 255 doctors, nurses,and administrators; improving the quality of family health services with building and equipment inputs and replanning of service routines, and on-going progr-e evaluation and research.

An advisory team consisting of a medical officer, a nurse and a atatisti- eian is assigned to the project. Uhile the project was planned for completion in 1976, re-scheduling is now necessary because of initial delays. Further- mare, preparation of a submission for continuing assistance for 1977 and beyond is expected.

Public Health Nutrition NUT 001 (Sri Lanka 0085)

To assist in strengthening the public health nutrition programmes and to assist in training national staff in nutrition.

In 1969-70, a consultant helped in initiating a pilot project, end three fellowships were awarded for laboratory technicians. In 1971-72, a consultant assisted in draving up plans for developing a nation-wide prophylactic programme against nutritional anaemia and recomneoded investigations baaed on iron and folic acid therapy as prophylaxis. In 1974, a consultant will be provided. Another consultant will be aaaigned in 1976, to evaluate the public health nutrition programme and to recommend measures for its strengthening. In 1977, a consultant vill follow-up on the recommendations made in 1976.


SKI LANK4

Eraduction of Improved vaccine

Short-term consultants ~ e l ~ o ~ r h i p a Supplies and equipment

3.2 family Health

3.2.2 Hecernal and child ~ealrh

Family Health SRLI72IP04

Medical officer P5 Statistician P4 Public health nurse P3

Administrative support peraomel

Shorr-term consultants Temporary advisers Fellovahipa croup training Supplies and equipment Hiscellaneous

3.2.4 NuLriLi.n

public nealrh Nurririon

Short-term consultants Fellowshipa supplien and equipment

R E G U L A R

Number of Posrs

1974

B C O G E T

Estimated Obligarions P r o j e c t NO.

HLS 002 (0089 1

UCH W 1 (0105)

NLT WL (00851

1974 1975

IExpreased in CS OollarrL

1975

I

I/ 2 11 2 11 3 11 3 3/21 3/21 2/18 21 6 1 1 1

1976

I/ 3 5/22

I !

4 000 4 400 7 20d 1 7 200 10 350 10 350 i 10 5 w 1 5 IW - 500 500 1 - i - 1L 850 15 250 17 700 12 300 - - - ; -

I 1 !

i 1 i !

!

!

I I

i

!

1977 1976

Number of P o S r E

6 000 4 800 7 400 ! 1 I 200

1 1 000

14 400 - j !

1977 1974

I

11 2 11 3

4 800 2 400 1 MO - 8 200 -



11 2 21 6

1975 1974

m 0 m " c L.

5

1976 / 1977

PP

.

I

I I I I !

i

33 4 W 34 000 19 80.3 22 O W - - -

72 660 75 200 34 000

4 280 7 700 8 480 2 000 2 2 W 19 200 I 1 000 1 000 ! 000 ;

23 330 12 200 75 ZOO ' 50 200 2 550 5 430 1 310 680 1 - - -

186 450 ! 149 810 85 160 1 I - -

! !

I

! i

I I I 1

!

1975

u - .L

1/12 1112 11 7 _ 3

11 11 1 7148

I

1

1112 1/12 I

11 9 1 1/10 _ I _ 3 ! 1 ---

1il/ 1 , 3 1 8 ' 11 1 11 1 3/36 1/12

!

I

I i I !

1976 1977

w LANKA m 0

Heal th Education H D 001 ( S r i Lanka 0072)

TO a a s i s t i n s t r eng then ing h e a l t h education s e r v i c e s , i nc lud ing school h e a l t h educat ion, and i n eva lua t ing h e a l t h educat ion a c t i v i t i e s ; t o a s s i s t i n s t r eng then ing h e a l t h educat ion teaching i n medical c o l l e g e s , teacher t r a i n i n g i n s t i t u t i o n s and i n o t h e r t r a i n i n g cen t res .

I n 1966, 1967 and 1969, consu l t an t s reviewed hea l th educat ion programmes and advised on t h e r eo rgan iza t ion and s t r eng then ing of the s e r v i c e s a t the d i f f e r e n t l e v e l s . As a follow-up of t h e in te r -coun t ry workshop he ld i n 1970, a school h e a l t h educat ion s p e c i a l i s t a s s i s t e d , i n 1971, i n conducting a n a t i o n a l workshop f o r educat ional a d m i n i s t r a t o r s , teacher educators and school h e a l t h o f f i c e r s . A h e a l t h educator has been ass igned s ince 1972. A consu l t an t a s s i s - t e d i n developing teacher t r a i n i n g programme i n 1973. I n 1975, 1976 and 1977 caneu l t an ta w i l l be provided to teach h e a l t h education i n the undergraduate medical curr iculum. Fellowships w i l l be f o r Master ' s degree i n h e a l t h education (both medical and non-medical), f o r s h o r t courses i n n u t r i t i o n and f o r t r a i n i n g medical o f f i c e r s i n h e a l t h educat ion.

The p r o j e c t ' s a c t i v i t i e s a re co-ordinated wi th those of S r i Lanka 0104, "Health Education i n Family Health".

Assis tance to t h e p r o j e c t i s expected t o cont inue u n t i l t h e end of 1977.

Heal th Education i n Family Heal th ( W P A SRL/7Z/FU1)

HED 002 ( S r i Lanka 0104)

To promote family h e a l t h through h e a l t h education.

I n accordance w i t h t h e conclusions and recommendations of t h e United Nations/UNESCO/WHO Family Planning Evaluat ion Mission to S r i Lanka (19711, i t was proposed t o s t r eng then h e a l t h education i n the family h e a l t h programme, including assessment of p r e s e n t h e a l t h education se rv ices , r e sea rch , comuni- c a t i o n media and development of d e t a i l e d p lans to meet the educat ional needs of family h e a l t h programmes.

Th i s comprehensive p r o j e c t incorpora tes t h e proposals e a r l i e r presented under p r o j e c t s S r i Lanka 0098, "Behavioural Studies" , S r i Lanka 0099, "Assess- ment and Strengthening of Heal th Education i n Family Health0' ,and S r i Lanka 0100, "Health Education i n Family Heal th Teaching Programmes", and w i l l be c l o s e l y r e l a t e d to S r i Lanka 0072, "Development of Heal th Education", and wi th the a c t i v i t i e s i n family planning proposed by o t h e r United Nations agencies.

I n 1971, two consu l t an t s under p r o j e c t S r i Lanka 0099 reviewed h e a l t h educat ion s e r v i c e s i n t h e country. Their f ind ings were examined a t a meeting of a n a t i o n a l w r k i n g group a t t h e D i r e c t o r a t e of Health. S imi la r ly , another consu l t an t a s s i s t e d , i n 1971, under p r o j e c t S r i Lanka 5372, i n f u r t h e r developing school h e a l t h and populat ion educat ion i n the educat ional system of t h e country.

I n 1972, two consu l t an t s were provided t o a s s i s t i n s t u d i e s r e l a t e d t o t h e development o f a sound educat ional s t r a t e g y f o r r e a l i z i n g the goa l s of family hea l th . I n 1973, a team of two consu l t an t s a s s i s t e d i n t h e h e a l t h behaviour s t u d i e s and one i n t r a i n i n g . I n 1974, a consu l t an t a s s i s t e d i n reorganizing the programme of t h e Health Education Media Production Uni t and a l s o t h e equipment and f a c i l i t i e s a v a i l a b l e f o r t h e production of p r in ted and o the r a i d s f o r h e a l t h education work. Also w o more consu l t an t s w i l l be provided t o a s s i s t i n the h e a l t h behavioural s t u d i e s . I n 1975, th ree consu l t an t s w i l l be provided f o r d i f f e r e n t hea l th education a c t i v i t i e s .

A number of fe l lowships have been provided s i n c e the beginning of t h e p r o j e c t , and are planned to be continued. Likewise a nvmber of group educa- t i o n a l a c t i v i t i e s w i l l be continued.

Assis tance to the p r o j e c t i s expected t o cont inue u n t i l the end of 1976.

Medical Education 001 ( S r i Lanka 0047)

To a s s i s t i n f u r t h e r developing the undergraduate and post -graduate teaching p rogrames and t o a s s i s t teacher t r a i n i n g a t the wo f a c u l t i e s of medicine i n S r i Lanka.

From 1963 onwards, consu l t an t s and v i s i t i n g p ro fesso r s have been provided to a s s i s t wi th the teaching p r e - c l i n i c a l and c l i n i c a l sub jec t s end a l s o wi th s u b j e c t s r e l a t e d t o publ ic hea l th .

I n 1968, tw consu l t an t s a s s i s t e d i n t h e development of o b j e c t i v e exami- na t ion methods and i n the determination of education ob jec t ives . I n 1971, a team of consu l t an t s reviewed t h e progress made. I n the same year a consu l t an t advised on drawing up a p ro toco l for a study of t h e func t ions of physic ians and, i n 1972, helped i n t h e implementation of the s tudy, which i s p a r t of t h e na t iona l h e a l t h manpower study. A team of four consu l t an t s a l s o examined post - graduate medical education and made proposals f o r t h e development of such programmes.

I n 1972-73, consu l t an t s a s s i s t e d i n va r ious d i s c i p l i n e s r e l a t e d to medical teacher t r a i n i n g , post -graduate education and i n areas shown by t h e h e a l t h manpower s tudy t o be i n need of a s s i s t ance . I t i s proposed to cont inue such a s s i s t a n c e i n 1975, 1976 and 1977.

Fellowships f a r both F a c u l t i e s w i l l cover post-graduate s t u d i e s , o r i e n t a - t i o n t o u r s and s t u d i e s i n s p e c i a l i z e d s u b j e c t s f o r teaching s t a f f t o enable them t o improve t h e i r knowledge and techniques.

Assis tance i s envisaged t o l a s t u n t i l t h e end of 1977 and a nev plan of ope ra t ion f o r f u r t h e r a s s i s t a n c e i n t h e f i e l d of educat ion and t r a i n i n g f o r a l l ca tegor ie s of h e a l t h personnel w i l l be prepared.

SRI LANKA z Nursing Advisory Services HUD 002

(Sri Lanka 0053)

To assist in developing nursing and midvifery education and services.

WHO has assisted the Post-basic School of Nursing in Colombo since 1960. A series of courses and workshops has been held with particular attention to in- service and post-basic educational programmes for qualified nursing personnel.

In 1971, a consultant assisted in studying the further development of post- basic education. In 1972, a short course in the administration of nursing services in hospitals was assisted and a sequential learning activity in paediatric patient care was started. This activity will end in 1974. In addition, a consultant was provided in 1972 to assist with the development of midwifery training in schools of nursing. In 1973, assistance was given to a course on "Strengthening the Integration of Cormunity Health in Basic Curriculum". Nursing education courses are planned for 1974, 1975, 1976 and 1977. Consultants will be provided to strengthen nursing services and clinical instruction. Fellowships will be related to training of public health nurses, matrons of hospitals for attendance in degree and diploma and other short courses, and for short study tours in special areas.

The activities of this project are closely related to those of project SEAR0 0139, "Short Courses for Nurses and Health Personnel".

Strengtheninp, of Nursin~/Midwifery Education (UNFPA SRL/72/P02)

HUD 006 (Sri Lanka 0106)

To assist in strengthening the nursinglmidwifery education offered in eight basic schools of nursing, the Mulleriyava affiliation school and the Post- basic School of Nursing, Colombo, with emphasis on public health, midwifery and child care; to assist in producing nursing and midwifery texts and other reference material in the local languages.

Temporary assistance was given by a Regional Nursing Adviser in 1972 and a WHO nurse educator arrived in 1973. Work on renovation of schools of nursing was started. Assistance was given to project "Health Manpower Study'' (Sri Lanka 0101) related to nursing and midwifery education aspects. Assistance was also given at the national level in the strengthening of educational programmes preparing nurselmidwives and other nursing personnel.

Assistance to the project is expected to continue until 1976, subject to availability of UNFPA funds.

Assistance to the project is expected to continue uncil 1977,

Teaching of Human Reproduction, Family Planning lu4D 007 and Population Dynamics in Medical Schools (Sri Lanka 0107) CUEIFPA SRL/70/W3)

To assist in strengthening the teaching of human reproduction, family planning and population dynamics in medical schools.

In accordance with the recommendations of the United Nations Inter-agency Family Planning Mission to Sri Lanka in 1971, it is proposed to strengthen the teaching of these subjects in the two faculties of medicine at Colombo and Peradeniya. Teams of short-term consultants will be provided to work in each of these faculties, including field training areas, to give support to the teaching of undergraduates and post-graduates and to assist with service programmes and research. National personnel are being appointed in a temporary capacity for implementing this programme. Two national workshops will be held in 1974.

Assistance to the project is planned until 1977

Lz SRI LANKA rn

C

Post-graduate Teaching of Community Medicine HMD 008 (Sri Lanka 0114)

To assist in initiating and strengthening a post-graduate course in community medicine.

Under Project Ceylon 0074. "Institute of Hygiene, Kalutare" assistance was given since 1964 in the development of a centre at Kalutara for the training of public health staff. A consultant visited Sri Lanka in 1971 (SEAR0 W96) and made recommendations an the establishment of a diploma coulee in public health and community medicine. After starting a course in community medicine with WHO support in 1975 on local fellowships, a long-term teacher in cornunity medicine is expected to advise and participate in this programe from 1976. Fellowships will also be provided for field tripe and limited amount of supplies and equipment in 1976-77.

This project will be co-ordinated with Sri Lanka 0107, "Teaching of H-n Reproduction, Family Planning and Population Dynamics in Medical Schools".

SRI LANKA

ieachinp of Human Reproduction, Family Plannlnp and Population Dynamics in Hedrcal Schools

SRL1731P03

Admrnisrrative rupporr personnel Short-term conrultants fellawshrps <;roup rralnlng Granr Subsidy supplies and equipment

(1nc1"di"~ vehlcler) niscelianeo~r

Posr-graduate Ieachmg of Comunirv Mediclne

'teacher in cmuniry medicine P4

fellovships Supplies and equipment

R E G U L A R

Number of Poala

1974

B U D G E T

Estimated Obligations ~ r o j e r r No.

HMD 007 (0107)

HMD W 8 (0114)

1974 1975 1975 1976 / I977

I !

(Expressed in US Doilara~

1

I ! I i

~ 13 750 ; 28 700

1 13 200 , 14 700 13 650 3 0 W ! ; 3 O W

, - - -

I I

! I !

I 1 ! I

11 6 1/12

1976 1977

Number of Ports

1 1

8/24 2124

1974

-- 10130

!



4127 '3118 4121 10126 8124 6118

I I I

i i

i

1975 1914

0 rn " c k 3

1976 / 1977

FP

I

5 840 8 4 W ' 9 240 54 000 39 600 , 50 400

20 400 , 15 300 2i tz ~ 8 080 1 8 080 65 120 58 630 I 50 650 20 760 18 870 ! 9 440

54 383 6 574 3 574 1 5 091 ; 2 683 1 713 ---

235 874 163 237 148 397 I - - , -

! i

i 1 !

I !

I

I

1975

- m u

I I I 1

!

1

1976 1977

Strengthening of Surveillance and Control of Comunieable Diseases

ESD 002 (Sri Lanka 0117)

To assist the Government in strengthening the surveillance and control of communicable diseases.

The project is the result of combining two projects "Strengthening of Epidemiological Services" (Sei Lanka 0078) and "Veterinary Public Health Services'' (Sri Lanka W93), the latter project being for control and eradication of rabies.

In 1967, a consultant under Sri Lanka 0078 reviewed the organization and work of the epidemiological services. The activities of projects SEAR0 0193, "Epidemiological Services and Training'' and Sri Lanka 0066, "Strengthening of Laboratory Services" are co-ardinated with thiri project.

In 1975, consultants will be provided to assist in the epidemiology af chronic degenerative diseases and in the production of rabies vaccine. In 1976-77, consultents will assist in the epidemiology of chronic diseases end in veterinary public health. Fellowships will be for HPH or DPH with special training in epidemiology. The short-term fellowships will be for attendance at the regional courses.

Assistance is expected to continue until the end of 1980

Malaria Eradication HPD 001 (Sri Lanka 0058)

To assist the malaria eradication programme.

WHO assistance to this project dates back to 1960. In 1966, a UHO consultant studied the outbreaks of malaria which occurred in parts of the previously hyperendemic areas and recamended necessary remedial measures. In 1968, a WHO team assisted the Government in formulating emergency measures to deal with the island-wide malaria epidemic and in drawing up long-term plans. WHO staff was strengthened and a national malaria eradication training centre to meet the training needs of the programme was established in 1971.

The number of cases diminished progressively till 1972, but, in 1973, the incidence of malaria was on the increase as compared to previous years. Out of a total population of 13.3 million, 9.9 million are at malaria risk, of which 5.1 million are under attack measures and 4.8 million are being protected with anti-malarial drugs.

From 1974 to 1976, the project will be assisted by e team composed of a malariologist, a parasitologist, an entomologist and a sanitarian. The parasitologist will complete his assignment at the end of 1976. Regional fellowships in the field of malaria and international fellowahipe for courses in HPH or DPH, and equipment and supplies will continue to be provided.


SRI LANKA

Vector Control (UNDP SRL/72/039)

VBC 001 ( S r i Lanka 0103)

To c o n t r o l i n s e c t v e c t o r s of connnunicable d i seases of publ ic h e a l t h importance.

The a c t i v i t i e s o f t h e p r o j e c t s t a r t e d i n December 1972 with the r eass ignment of t h e WHO epidemiologis t and entomologist from p r o j e c t S r i Lanka 0056, " F i l a r i a a i s Control".

Routine blood surveys have been c a r r i e d ou t involving 1 500 000 blood smear examinations which gave a t o t a l p o s i t i v i t y r a t e of 0.57.. Spec ia l surveys were conducted i n newly organized conrmunities where people coming from d i f f e r e n t areas had s e t t l e d and i n a l l major c i t i e s border ing a l l c o n t r o l l e d areas. I n t h e hyperendemic areas, where t h e i n f e c t i o n r a t e was more than 27., mass treatment was provided. Artempts have been made t o extend t h e a c t i v i t i e s of vec to r c o n t r o l p r o g r a m e t o t h e municipal area of Colombo.

Assis tance t o t h e p r o j e c t i s expected t o cont inue upto 1976.

SRI IANKA

Filarissis Confiol SRL168/007

Fellowshlp Miscel1aneaua

5.1.9 veterinary Public Health

Veterinary Publ~c Health Services

Short-term conrulfsnf Fellowship Supplies and equipment

5.1.10 vector niology and ca~irol

Vector Control SRLl721039

Epidemiologist P4 Eniomologist P3

Short-term consultants Fellovships Supplies and equipment

R E G U L A R

umber of ~ontr

i

I 1974 ; 1975

B U D G E T


Miscellnneoua

~rolecr NO.

MPD wz (W561

VPH 001 (0093)

VBC W 1 (0103)

1 1974 ' 1975 1976

12 O W / 25 355 1 5 W !

I

1976 1977

I I - - 1 - -

I

I i I

:Lxpresbed m L, u u i l a r r L

O T H E R S O C 3 T F . S

1977

I

I

12 000 Z 550 2 100

-. 16 b50 -

i i !

i

i !

i

I

I i I

i

1 / 6 1 1 1

- Number of Posr.

1974 / 1975 1976 11977

i

11 3

i 1

I

I

- a. m b c b

5 3 - 2

Estimated Obllgarrons

DP

I

1974 1 1975 1 1976

1 1 6 ! 1 3 700 37

1917

i !

i :

I

-

!

!

I

1

30000

11/97

I 30 000 ' 30 000 - - ,w r a m i o m

5 W O 1 0 ~ 0 ~ 52 650 I

1 1 2 1 1 4 ' : I 1

10 000 - ,,,

Cancer Epidemiology and Research CAN 001 (Sri Lanka 0109)

To assist in the epidemiological investigation of cancer, in the establishment of cancer registration, in the training of health personnel in early detection, diagnosis, treatment and rehabilitation and in the development of cancer health education.

In 1977, a consultant will advise and assist in training cancer epidemiologists and participate in the conduct of a course in cancer epidemiology. Fellov- ships will be provided for senior staff from cancer hospitals to visit advanced ontological centres to observe latest trends in cancer control.

Assistance is expected to continue for ten years.

Cardiovascular Diseases CVD 001 (Sri Lanka 0110)

To assist in epidemiological investigation of cardiovascular diseases, strengthening facilities for the prevention and control of cardiovascular diseases, training health personnel in the diagnosis, treatment, rehabilitation end research in this specialty, and in developing health education far the prevention of cardiovsscular diseases.

In 1977, a consultant will assist in training health personnel in methodology of cardiovascular epidemiological investigation. Senior cardialo- gists will be awarded fellowships to visit advanced centres in cardiology for observing recent trends in the prevention and control of cardiovascular diseases.

Dental Health DNH 001 (Sri Lanka 0087)

To assist in further developing teaching and training programmes for dental personnel and in expanding dental health services a s part of the general health services.

A consultant (dental mechanic tutor) was assigned to the Dental School, University of Ceylon, Peradeniya, in 1970, and vas continued in 1971 and 1972.

In 1974 and 1975, consultants will assist in preventive dentistry and in orthodontics. In 1976 and 1977, similar assistance will cover child dentistry and special clinical areas. Io 1976, a group educational activity is planned, and fellovships planned for 1976-1977 vill be related to oral pathology.

Assistance is expected to continue until the end of 1977.

Mental Health NNH 001 (Sri Lanka 0037)

S R I LANKA u a w

To assist in the training in psychiatry of undergraduates and post-graduates in medicine, of nurses and other health personnel, in developing community- oriented mental health care services integrated into the existing public health delivery system,in introducing innovative approaches in mental health care and in the epidemiological investigation of mental illness.

Consultants were provided on mental health services, and psychiatric education in 1961, 1966, 1969, 1970, 1972 and 1973. In 1974, a consultant in behavioural sciences will assist the faculties of medicine in Colombo and Peradeniya in the undergraduate training prograrne. In 1975, consultants will be provided to assist in teaching special topics in mental health and also in strengthening mental health services. Fellowships have been awarded for training junior and senior faculty members in psychiatric education and services. These will be continued in 1976 and 1977.

In 1976-1977 consultants will be provided to assist in teaching special subjects in psychiatry, to advise on problems of juvenile delinquency and rehabilitation, to assist in the conduct of seminars an mental health, and to assist in the study of social, cultural and economic aspects of mental illness.

Quality Control of Biological and Pharmaceutical Products

SQP 031 (Sri Lanka 0077)

To assist in strengthening the quality control of pharmaceutical and biological preparations, and in training.

In 1966, two consultants advised on the establishment of a quality control laboratory. Two consultants, provided in 1969 under project SEAR0 0154, "Quality Control of Drugs", made further recornendations, including the organization of a diploma course. In 1971, a consultant studied the manpower requirements and made detailed recornendations on curricula. In 1973, a pharmaceutical chemist was assigned for six months to train the laboratory staff in specified methods of analysis and in the use of modern analytical instruments. In 1974 and 1975, it is planned to provide consultants to assist the quality control laboratory and in the training of pharmacy technicians and other students who follow the diploma course. In 1977, a consultant in biological standardization will be provided. The twelve-month fellowship will be awarded to a diploma holder for studies leading to graduation.

The Government is also receiving assistance from other sources for the improvement of the quality control laboratory.



Community Water Supply and S a n i t a t i o n BSM 001 ( S r i Lanka 0064)

To a s s i s t programmes of community wa te r supp ly , sewage d i s p o s a l , storm- wa te r d r a inage and gene ra l s a n i t a t i o n , and t o t r a i n pe r sonne l .

From 1963 t o 1968 a s a n i t a r y eng inee r a s s i s t e d i n water supply and sewage d i s p o s a l schemes and i n t r a i n i n g pe r sonne l . Consu l t an t s were a s s igned i n 1967 and 1968 i n connexion w i t h t h e t r a i n i n g of p r o f e s s i o n a l and sub -p ro fe s s iona l pe r sonne l concerned w i t h wa te r supply and sewage, and, i n 1969, t o h e l p w i t h t h e p r e p a r a t i o n of a government r e q u e s t f o r UNICEF a s s i s t a n c e .

I n 1970, ano the r s a n i t a r y eng inee r was provided t o a s s i s t i n developing wa te r supply schemes f o r a number of r u r a l communities. UNICEF has g iven a s s i r - t a n c e from 1970. I n 1971, t h e t r i p a r t i t e p l a n of o p e r a t i o n was concluded and p r e p a r a t o r y su rveys , de s igns and c o s t e s t i m a t e s were csmpleted f o r a f i r s t group of f i f t e e n communities. During t h e p e r i o d from 1972 ro 1975, t h e p r i n c i p a l a c t i v i t y r e l a t e s t o t h e p l ann ing and implementa t ion of one hundred p iped community wa te r supply schemes i n d i f f e r e n t p a r t s of t h e coun t ry , t o serve as a p i l o t development l e a d i n g t o a l a r g e - s c a l e programme o f r u r a l wa te r s u p p l i e s on a count ry-wide b a s i s .

A c o n s u l t a n t i s b r i n g provided i n 1974 t o a s s i s : i n o r g a n i z i n g and running a n a t i o n a l course on o p e r a t i o n and maintenance of water supply systems.

P rov i s ion of Bas i c S a n i t a r y S e r v i c e s BSH 002

( S r i Lanka 0111)

To a s s i s t i n t h e p r o v i s i o n of s a f e wa te r s u p p l i e s and e x c r e t a d i s p o s a l i n r u r a l communities throughout t h e coun t ry .

T h i s i s a new p r o j e c t r e p l a c i n g t h e p r o j e c t S r i Lanka 0064, "Community Water Supply and S a n i t a t i o n " , which has develoned abou t one hundred p iped r u r a l wa te r s u p p l i e s w i t h UNICEF a s s i s t a n c e . Separa:? p l a n s of a c t i o n w i l l cover t h e p r o v i s i o n t o r u r a l communities of p iped r u r a l wa te r s u p p l i e s , s a n i t a r y w e l l s , deep w e l l s , and wa te r - s ea l l a t r i n e s . The programmes w i l l form p a r t of t h e Na t iona l P l an f o r Water Supply and Drainage which w i l l be prepared i n 1974 and 1975 w i t h t h e a s s i s t a n c e of a WHO s a n i t a r y eng inee r .

The p r o j e c t w i l l b s a s s i s t e d through l o n g - r e r e s t a f f who w i l l p rov ide t e c h n i c a l a d v i c e i n p l ann ing , implementation and t r a i n i n g , through c o n s u l t a n t s e r v i c e s i n hydrogeology, and through f e l l owsh ips .

Tvo s a n i t a r y eng inee r s w i l l be provided i n 1976-1977 and a c o n s u l t a n t hyd rogeo log i s t w i l l a l s o a s s i s t t h e p r o j e c t . Fe l l owsh ips w i l l be awarded f o r pos t -g radua t e s a n i t a r y eng inee r ing , management and wa te r resources development s t u d i e s , and for s h o r t e r p e r i o d s f o r obse rva t i on v i s i t s on rura l wa te r s u p p l i e s , we l l - s i nk ing and d r i l l i n g .

A s s i s t a n c e w i l l con t inue u n t i l 1981. A s s i s t a n c e t o t h e p r o j e c t w i l l c o n t i n u e u p to t h e end of 1975; i t s a c t i v i -

t i e s w i l l t h e r e a f t e r be t r a n s f e r r e d t o p r o j e c t S r i Lanka 0111.

SRI LANKA

6. PRMOTION OF ENVIRONP(ENTAL HEALTH

6.1 Prnoorion of Envlionmental Health

6.1.2 Provision of Basic Sanitary neasures Community Water Supply and sanitation

sanitary engineer ~4

Short-term connulianis Fellowships Parricrpanrs Supplier and equipment

Provision of Basic Sanitary Services

Sanitary engineers ~4

Shot'L-tern consulranc Fellowships Supplies and equipment

R E G U L A R

~umber of Poare

1974

B U D G E T - E s f i r n a r e d Obligations

pro,ect NO.

BSM 001 (COW)

85N 002 (0111)

1974 1975

[Expressed i n U S Dollar.

:

I

25 300 26 400 I I

! I

1 7 W 8

1 5 W 1 5 0 0

I I

I

I

I

2 WO

_ _ - 1 78 300 81 800

! I !

!

I I

1975 1976

1 i i

I - I -

1976 19::

- , - 11 3 11 3 5/39 6/42 /

2/18 -- 2 --

1/ 3 7/28

1977

Number of Postr

2/24

2

7/39

1974

- m " c k 3

i z


E r f i m a r e d Obligarionr

!

;

I

! I

! 1 i

1

1975 1974 1975

j

1976

i I ! I

1

I I ! !

I

I I I i

i I

i

I !

I

I

1976 1Yi7 1977

Occupational Heal th and I n d u s t r i a l Hygiene HWP 001 ( S r i L a n k 0082)

To a s s i s t i n c o n t r o l l i n g h e a l t h hazards i n industry .

The p r o j e c t s t a r t e d i n 1968 wi th the award of fe l lowships . I n 1969, a consu l t an t reviewed the s t a t u s of occupat ional h e a l t h i n indus t ry . I n 1973, another consu l t an t advised on t h e development of an i n d u s t r i a l hygiene u n i t i n t h e Department of Labour and a l s o a s s i s t e d i n conducting a t r a i n i n g course f o r h e a l t h o f f i c e r s . The same consu l t an t was a l s o ass igned i n 1P74 to the Depart- ment of Labour m a s s i s t i n prepar ing p lans of ope ra t ion f o r a j o i n t DANIDA/ILO/ WHO-assisted p r o j e c t i n t h e f i e l d of s a f e t y , h e a l t h and environmental p o l l u t i o n . It i s planned to a s s ign consu l t an t s i n 1975, 1976 and 1977 i n s e l e c t e d s u b j e c t s of occupat ional hea l th . Group educat ional a c t i v i t i e s a re a l s o planned every year. Fellowships i n i n d u s t r i a l h e a l t h are planned f a r 1976-1977.

Ass i s t ance t o t h e p r o j e c t i s expected to cont inue f o r some years

SRI LANKA u 'D 01

Radiat ion Heal th BAD 001 ( S r i Lanka 0071)

To a s s i s t i n s t r eng then ing rad io log ica l h e a l t h p r o t e c t i o n s e r v i c e s , i n t r a i n i n g r a d i o l o g i s t s , r a d i o t h e r a p i s t s , radiographers , nuclear medicine specia- l i s t s and medical p h y s i c i s t s and i n promoting t h e development of r a d i o l o g i c a l s e r v i c e s and sc ience , including nvclear medicine.

Two consu l t an t s were ass igned i n 1966 to help i n conducting a one-month course i n r a d i a t i o n p ro tec t ion f o r t h e s t a f f of X-ray departments. S imi la r courses were held i n 1969 and 1971 f o r s tudent radiographers . I n 1973 fellow- s h i p s were awarded f a r t r a i n i n g sen io r radiographers i n r e c e n t advances i n t h e s p e c i a l t y . I n 1974 a consu l t an t w i l l advise on the development of r ad io - therapemtic se rv ices and the s t rengthening of r a d i a t i o n h e a l t h p r o t e c t i o n se rv ices . A s p e c i a l course i n r a d i a t i o n h e a l t h p ro tec t ion t o b e he ld i n 1975 w i l l b e a s s i s t e d by a consu l t an t .

I n 1976-1977, consu l t an t s w i l l b e provided f o r a s s i s t i n g i n the t r a i n i n g of r a d i a t i o n p h y s i c i s t s and i n conducting a r e f r e s h e r t r a i n i n g course on r s d i o l o g i - c a l h e a l t h p r o t e c t i o n services.

Also,= consul tant w i l l eva lua te t h e development of r ad io log ica l p r o t e c t i o n s e r v i c e s . Fellowships w i l l be awarded to senior s t a f f to undergo r e f r e s h e r t r a i n i n g .

Aesiscance t o the p r o j e c t w i l l b e continued till 1980.

Jnde rg radua t e train in^ i n P u b l i c Hea l th Engineer ing SES 001 ( S r i Lanka 0112)

To a s s i s t i n t h e t r a i n i n g o f f a c u l t y members of t h e U n i v e r s i t y of S r i Lanka to e n a b l e them t o develop s u i t a b l e c u r r i c u l a i n p u b l i c h e a l t h eng inee r ing , and t o a s s i s t i n s e t t i n g up s a n i t a r y eng inee r ing t each ing l a b o r a t o r i e s and r e s e a r c h f a c i l i t i e s .

P r o v i s i o n i s made i n 1976-1977 f o r t h e award of f e l l owsh ips f o r pos t - g r a d u a t e s t udy t o f a c u l t y members, and f o r s u p p l i e s and equipment f o r l a b o r a t o r y f a c i l i t i e s .

The p r o j e c t w i l l b e i n i t i a t e d i n 1976 and i s planned t o con t inue u n t i l 1979 i n t h e f i r s t i n s r a n c e .

u SRI LANKA a

m

Food Hygiene FSP 001 ( S r i Lanka 0108)

To a s s i s t i n e s t a b l i s h i n g a n a t i o n a l food c o n t r o l a d m i n i s t r a t i o n and i n t r a i n i n g s t a f f f o r v a r i o u s branches o f food c o n t r o l .

I n 1974, a c o n s u l t a n t i s being assigned t o a s s i s t i n e s t a b l i s h i n g a food c o n t r o l v n i t a t c e n t r a l l e v e l , i n r e v i s i n g e x i s t i n g food l e g i s l a t i o n and i n t r a i n i n g personnel engaged i n food p roduc t ion and hand l ing . I t i s p lanned t o p rov ide c o n s v l t a o t n i n 1975, 1976 and 1977 t o a s s i s t i n s p e c i a l a s p e c t s . Fe l lowships w i l l be provided i n food hygiene and drug c o n t r o l .

A s s i s t a n c e i s expected t o con t inue u n t i l t h e end of 1980.

SRI WiKA

b.i.7 Establishment and Srrenprhening of Environmental Health Services and ~nstirvrions

Underpr~du~re Traininp. in public Health ~n~ineerine

F ~ I ~ O W S ~ ~ P S

Supplies and equipmen:

6 1 . 6 Food Standards Programme

Food Hy~iene

Short-term canrulrancs Fellowships Participants Supplies and equipment

7. HEALTH INFORIULTION AKD LITERATURE

7.1 Health SraLisilcs

7.1..1 Develomenr of Healrh Scafisii- ce1 services

Health Statistics SRLlb81006

Fellowships Miscellaneous

Total - SRI LlViKA

B C D G E T


I 1974 1915 1976 1977 i

i

!

9 200 12 000 - 21 200 -

6 000 8 800 7 200 7 200 5 100 5 100 10 j00 il 2 W

700 700 1 000 500 200 2 w 500 500 - - - -

16 000 14 800 19 200 21 $0"

I

! ! - , - , - I -

R E G U L A R

Number of Ports

1974

Project NO.

SES 001 (0112)

FSP 001 (0108)

DHS 001 (001j)

i

1975

i

ltxpressed in C5 Dollarrl

O T l i E R S O C R C E S

i

1

i ! 1/12 I : ! i l : l

I i I

1976

11 4 11 4 21 6 21 6

1977

Number of P u s t i

i 11 3 I! 3 2/18 2124

Estimated Obligar~or!~

1974 1 1975 : 1976 / 1977

I I I

1974

1

! ! I I

~ j

I

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u m u c L. 2 5 .. - I

1915 ,1976 1 I971

DP

! i

I !

I I I

I !

i

I i i i I I

5! 9

i I ' 1

8 355 393 - 8 748 1

- . - __ -

Funds

R

DP

FP

R

DP

R/DP

RIDP

FP

FP

FP

R

RIAddl.

Page

414

424

414

419

408, 494

410

424

410

410

411

414

408, 494

Protect Old

0017

0037

0065

0066

0071

0075

0076

0079

0082

0086

0089

0090

0093

0095

0097

0098

No. New

MNH 001

DHS 001

MPD 001

FSP 001

RAD 002

HLS 001

HED 001

SQP 001

VDT 001

DNH 001

HMD 002

BSM 001

STR 001

HMD 003

HMD 004

STR 002

Project Title

National Institute of Dermata-

logy

School for Medical Physicists

Teaching of Human Reproduction, Family Planning and Population Dynamics in Medical Schools

Faculty a f Veterinary Sciences

National Laboratory Animal Centre

Institute of Nutrition and Food Science, Ramathibodi

Improvement of the Sanitary Engineering Department, Chulalongkorn University, Bangkok

Bangkok Municipality Family Planning Field Worker Project

Expanded Sterilization Project

Accelerated Development of Maternal and Child Health and Family Planning Services

Physician Assistant

Strengthening of Rural Health Services

Project Title

Country Statement

Mental Health

Vital and Health Statistics

Malaria Eradicatron

Food and Drug Control Adminis- tration

School for Medical Radiography


Development of Health Education

Quality Control of Pharmaceuti- cal Preparations

W Control

Dental Health

Nursing Education and Services

Community Water Supply


Faculty of Public Health

Medical Education and Training

Health Planning and Management

~ p ~ -

Page

402

420, 495

42 7

416, 495

426

425

408, 494

412, 494

420

419

418, 495

412, 494

422

406, 494

412, 494

414, 495

406, 494

No. New

HMD 005

RAD 003

HMD 008

VPH 001

HLS 003

NUT 001

SES 001

MCH 001

HRP 001

MCH 002

HMD 006

STR 006

Pro-ect Funds

Old

RIAddl.

R

~/spl.~cc.

R

0107

0109

0115

0117

DP

RIAddl.

RIAddl.

R

R

RIAddl.

RIAddl.

DP

RIAddl.

RIAddl.

0123

0125

0126

0127

0129

0130

0131

RIAddl.

RIAddl.

0132



0134 W P 001 Occupational Health I I

Project Title

Comnunity Water Supply and Sanitation

Nutrition

Radiation

Training

Health

Page Project Title

THAILAND

Following from Thai land ' s wel l-defined p o l i c y on socio-economic development and programmes f o r economic growth, d e f i c i e n c i e s such as d is - p a r i t i e s i n income, imbalance of s o c i a l s e r v i c e s and under-employment a r e t aken i n t o c o n s i d e r a t i o n i n the Third Five-Year Sacio-economic Development P lan (1972-1976). which is aimed a t c o r r e c t i n g t h e s e s o c i a l problems.

For 1972, t h e r e g i s t e r e d r a t e s f o r v i t a l even ts are: crude b i r t h r a t e 32.5%o,crude dea th r a t e 6.8Xo and i n f a n t m o r t a l i t y r a t e 24.4%0. It is g e n e r a l l y es t imated t h a t the popula t ion is growing a t t h e r a t e of about 3% p e r annum. A second survey of popula t ion change t o a s s e s s t h e degree of incompleteness i n v i t a l r e g i s t r a t i o n is t o t a k e p l a c e i n mid-1974. I n 1971, dea ths below t h e age of 5 r e p r e s e n t e d 22.5% of a l l dea ths . According t o the popula t ion census taken i n 1970, popula t ion below the age of 15 is 44.1% of t h e t o t a l popula t ion and 3.1% a r e 65 years and over .

The g r o s s n a t i o n a l product has been i n c r e a s i n g a t the r a t e of 7x p e r annum u n t i l 1972. However, u n o f f i c i a l e s t i m a t e s g ive a lower f i g u r e . The Government is t r y i n g very hard t o s u s t a i n t h e l e v e l of economic growth and a t t h e same t ime t o reduce t h e r a t e of popula t ion growth t o 2.5% p e r a n n m by 1976.

The country remains l a r g e l y r u r a l , wi th 85% of t h e people l i v i n g i n v i l l a g e s , around 10% i n Bangkok, t h e c a p i t a l , and 5% i n smal l towns. The s t a n d a r d of l i v i n g of the urban d v e l l e r s i s f a i r l y h igh .

While t h e Government's expendi tu res f o r h e a l t h have increased i n 1974 by 8.83 p e r cen t , t h e t o t a l government expendi tu res went up by 13.92 per c e n t f o r t h e same year . The budget of t h e Min is t ry of Hea l th , a l though i n c r e a s i n g , has represen ted a s m a l l e r p ropor t ion of the t o t a l budget s i n c e 1972: from 3.41% i n 1971 t o 3.09% in 1974. According t o t h e 1974 budget the Min is t ry of Heal th r e c e i v e s 64% of t h e t o t a l Government's expendi tu re f o r h e a l t h . Per capita government expendi tu res f o r h e a l t h are 27.91 b a h t s , e q u i v a l e n t t o US$ 1.40. It is es t imated t h a t about 75% of y e a r l y per capita expendi tu res f o r h e a l t h (which i s s e v e r a l times h igher than t h e Government per capita y e a r l y expendi tu res ) is s p e n t by t h e p u b l i c i n p r i - v a t e h e a l t h care. The Minis t ry h a s d i s t r i b u t e d i t s a l l o c a t i o n s among v a r i o u s types of s e r v i c e s as follows:

- General medical c a r e , i n c l u d i n g mental h e a l t h . .

- Disease prevent ion and c o n t r o l .. 16.49 21.14

- P u b l i c h e a l t h promotion . . 27.89 17.60

- Others . . 12.51 12.56

The d isease-cont ro l programmes have developed q u i t e s a t i s f a c t o r i l y . However, v e n e r e a l d i s e a s e s and t u b e r c u l o s i s are s t i l l important p u b l i c h e a l t h problems, though the s e r v i c e s t o c o n t r o l them have improved. The number of a c c i d e n t s of var ious types and poisonings con t inues t o i n c r e a s e a s w e l l as t h e demand f o r h e a l t h s e r v i c e s f o r d i s e a s e s of s k i n and sub- cutaneous t i s s u e s , a c u t e i n f e c t i o n s o f r e s p i r a t o r y organs and g a s t r o - i n t e s t i n a l condi t ions . M a l n u t r i t i o n , e s p e c i a l l y p r o t e i n d e f i c i e n c y , i s a major problem i n c h i l d r e n i n some a r e a s . P lans f o r d e n t a l h e a l t h and mental h e a l t h a r e under p r e p a r a t i o n , on a n a t i o n a l b a s i s . The development of r u r a l h e a l t h s e r v i c e s has rece ived a t t e n t i o n i n r e c e n t y e a r s . Emphasis has been p laced on mate rna l and c h i l d h e a l t h , family p lanning , environmental h e a l t h , n u t r i t i o n , and the c o n t r o l of non-communicable d i s e a s e s .

The s h o r t a g e and m a l d i s t r i b u t i o n of p r o f e s s i o n a l s t a f f c r e a t e problems which are aggravated by the t r e n d t o migra te from t h e count ry . To improve t h e s i t u a t i o n , r u r a l h e a l t h p o s t s have been e s t a b l i s h e d , a u x i l i a r y t r a i n i n g c e n t r e s expanded and new medical and nurs ing s c h o o l s opened i n the sou thern and nor th-eas t reg ions .

The 14-point programme i ssued by the Government i n 1973 (of which one p o i n t d e a l s w i t h h e a l t h ) has r e s u l t e d i n d e c i s i o n s of the new l e a d e r s h i p o f the Min is t ry of Hea l th to in t roduce r a p i d l y an i n t e g r a t e d r u r a l h e a l t h care d e l i v e r y system, us ing a l l a v a i l a b l e resources i n terms of manpower, f inance and e s p e c i a l l y mobi l iz ing community p a r t i c i p a - t i o n ; t o in t roduce a new approach i n t r a i n i n g of a l l types o f h e a l t h personne l , i n c l u d i n g medical d o c t o r s , aimed a t developing h e a l t h workers t r a i n e d and w i l l i n g t o serve i n r u r a l a reas , and t o undertake a re- o r g a n i z a t i o n of the M i n i s t r y o f Heal th on the b a s i s o f s p e c i f i c ob jec- t i v e - o r i e n t e d government programmes i n o r d e r t o improve e f f i c i e n c y .

VhO asszstarce. WHO i s c o n c e n t r a t i n g i t s a s s i s t a n c e on development of i n t e g r a t e d r u r a l h e a l t h s e r v i c e s and r e l a t e d t r a i n i n g of paramedica l l a u x i l i a r y h e a l t h personne l , on medical educa t ion , environmental h e a l t h ( s p e c i f i c a l l y r u r a l water s u p p l y ) , p lann ing and management t echniques and improving l a b o r a t o r y s e r v i c e s . Ass i s tance t o communicable d i s e a s e s a t h e r than t o m a l a r i a , v e n e r e a l d i s e a s e s and denguelhaemorrhagic f e v e r is gradua l ly phasing o u t . Disease i n t e l l i g e n c e w i l l b e s t reng thened . Ass i s tance t o family h e a l t h and t o h e a l t h manpower development i s be ing g iven by UNFPA and UNDP.

S t r e n ~ t h e n i n g of h e a l t h s e r v i c e s

Adminis t ra t ive h u r d l e s , i n c l u d i n g d i f f i c u l t i e s i n co-ord ina t ion and co-operat ion, con t inue t o be among t h e main problems i n t h e f i e l d of p u b l i c h e a l t h . The p o l i c y is t o concent ra te on e i g h t a r e a s , some S

c.3

of which a r e concerned w i t h the s t r e n g t h e n i n g of h e a l t h s e r v i c e s , mate rna l and c h i l d h e a l t h , family p lanning , medical c a r e , i n t e g r a t e d h e a l t h ser- v i c e s , community psychology and mental h e a l t h . A f u r t h e r d e c e n t r a l i z a t i o n of t h e Min is t ry of P u b l i c Heal th is be ing contemplated. I t is planned t h a t by t h e end of t h e Thi rd P lan (1976). t h e t o t a l number of h o s p i t a l bede w i l l b e increased by 10 500, and t h a t t h e r e w i l l be 80 a d d i t i o n a l f i r s t - c l a s s and 1 276 a d d i t i o n a l secand-class c e n t r e s , t h a t the family planning s e r v i c e s w i l l b e extended t o 2.6 m i l l i o n people and t h a t the expected r a t e of popula t ion growth w i l l b e reduced by a t l e a s t 0.5%. The l a b o r a t o r y s e r v i c e s a r e being s t reng thened and expanded.

WtiO a s s i s t a n c e . I n r e c e n t y e a r s WHO a s s i s t a n c e has been s h i f t e d t o h e a l t h p lanning and i n t e g r a t i o n of s p e c i a l programmes i n t o t h e h e a l t h s e r v i c e s and a l s o f o r t h e development of comprehensive r u r a l cammunity h e a l t h s e r v i c e s , inc lud ing mate rna l and c h i l d c a r e , n u t r i t i o n , and b a s i c s a n i t a t i o n d e l i v e r e d mainly through superv ised paramedical personnel , v i l l a g e h e a l t h workers wi th community p a r t i c i p a t i o n . The p r o j e c t w i l l b e f u l l y f u n c t i o n a l by 1976. I n 1974, i n t h r e e provinces t r a i n i n g and p r o v i s i o n of b a s i c equipment t o "tambol doctors" and indigenous midwives, o r i e n t a t i o n of h e a l t h personne l i n t h e i r e f f e c t i v e u t i l i z a t i o n w i l l b e i n i t i a t e d . WHO is a s s i s t i n g h e a l t h p lanning and management through prov id ing e x p e r t s , o rgan iz ing l o c a l t r a i n i n g courses , and awarding fel law- s h i p s . The family planning programne is being implemented by a wel l - e s t a b l i s h e d n a t i o n a l family p lanning s e r v i c e wi th t h e t e c h n i c a l a s s i s t a n c e of WHO i n programme formula t ion and e v a l u a t i o n , and wi th funds from WEPA. Four p r o j e c t s cover ing urban and r u r a l opera t ions i n t h e f i e l d s of MCHIEP have been e s t a b l i s h e d wi th UNICEF suppor t . WHO is a l s o a s s i s t i n g wi th t h e p r o v i n c i a l l a b o r a t o r y s e r v i c e s and t h e s t r e n g t h e n i n g of s p e c i a l i z e d l a b o r a t o r i e s a t t h e c e n t r a l l e v e l .

Hea l th manpower development

The Government h a s p laced g r e a t emphasis on educa t ion and t r a i n i n g , and by 1975, i t is expected t h a t 374 d o c t o r s , 1 408 n u r s e s , 1 0 0 0 p r a c t i - c a l nurses and 800 midwives w i l l be g radua t ing p e r y e a r , and t h a t t h e manpawer/population r a t i o w i l l thus b e improved, i f t h e r e is a d e c l i n e i n migra t ion and i n popula t ion growth. The t r a i n i n g of o t h e r h e a l t h workers and t e c h n o l o g i s t s w i l l a l s o b e s tepped up. The a u t h o r i t i e s s t r e s s t h e need f a r improving t h e des ign of t h e curr iculum conten t o f t r a i n i n g programmes and t h e d i s t r i b u t i o n , u t i l i z a t i o n and s u p e r v i s i o n of s t a f f .

WHO a s s i s t a n c e . A medical educa t ion and t r a i n i n g ~ r o i e c t is co- ~ ~~~ - . - ord ina ted w i t h p r o j e c t s on n u r s i n g educa t ion and l a b o r a t o r y s e r v i c e s . I n 1975-1977, i n p u t s w i l l move from Ramathibodi and S i r i r a j H o s p i t a l s and ~hulalongkorn-University t o t h e new P r i n c e of Songkhla U n i v e r s i t y and t h e new medical s c h o o l a t Khon Kaen. New c a t e g o r i e s of h e a l t h workers

f a r t h e r u r a l h e a l t h s e r v i c e s and community workers w i l l b e t r a i n e d . From 1976 a s s i s t a n c e w i l l b e given t o t h e Facu l ty of P u b l i c Heal th f o r t h e teaching of paramedical personne l and f o r l o c a l t r a i n i n g i n h o s p i t a l a d m i n i s t r a t i o n , h e a l t h planning and management. The UNDP i s p rov id ing a s s i s t a n c e t o t r a i n i n g of s e l e c t e d c a t e g o r i e s , s u c h as medical p h y s i c i s t s , r ad iographers and s a n i t a r y eng ineers .


The phased i n t e g r a t i o n of the d i sease-cont ro l programmes i n t o t h e b a s i c h e a l t h s e r v i c e s h a s proceeded s a t i s f a c t o r i l y . The yaws prograwne h a s a l ready been i n t e g r a t e d , and o t h e r s a r e i n v a r i o u s s t a g e s of i n t e g r a t i o n . BCG v a c c i n a t i o n is t o cover 80% of t h e e l i g i b l e popula- t i o n , i . e . , f i v e m i l l i o n c h i l d r e n i n t h e 0-7 y e a r age-group, and t h e l e p r o s y programme is t o be i n t e g r a t e d i n 60 o u t of the 72 provinces by 1975. I n the m a l a r i a programme. which i n f u t u r e w i l l c o n c e n t r a t e on maintenance of e f f e c t i v e c o n t r o l , e s tab l i shment of a t r a i n i n g c e n t r e and entomological research ; i t is expected t h a t by 1975, of t h e e s t i m a t e d popula t ion of 40 m i l l i o n , on ly 6 . 8 m i l l i o n w i l l remain i n the a t t a c k phase, t h e rest being i n e i t h e r t h e c o n s o l i d a t i o n o r t h e maintenance phase.

The ep idemio log ica l s u r v e i l l a n c e programmes a r e t o b e expanded.

WHO a s s i s t a n c e . Ass i s tance t o t h e m a l a r i a prograwne w i l l con t inue and s u p p o r t provided t o o t h e r progr-es,such as those f a r venereal- d i s e a s e and dengue haemorrhagic f e v e r con t ra1 ,as w e l l a s t o v e t e r i n a r y p u b l i c h e a l t h . Qual i ty c o n t r o l of drugs w i l l a l s o con t inue t o r e c e i v e a t t e n t i o n . WHO w i l l a l s o assist wi th progranrmes f o r t h e p revent ion and c o n t r o l of non-comunicable d i s e a s e s and f a r t h e s t r e n g t h e n i n g of d i s e a s e i n t e l l i g e n c e . UNICEF cont inues t o assist l e p r o s y , trachoma and t u b e r c u l o s i s programmes.


At p r e s e n t , s a f e water is a v a i l a b l e t o only 10% of t h e r u r a l popula t ion and 46% of t h e urban popula t ion . No sewerage f a c i l i t i e s e x i s t , t h e d i s p o s a l of was te being g e n e r a l l y through s e p t i c tanks. Execut ion of the sewerage plan f o r Bangkok, which has been prepared, i s s t i l l hampered because of l a c k o f f inance . The wate r - sea l l a t r i n e "se l f -he lp" programme i n r u r a l a r e a s con t inues t o make progress .

Zhe M i n i s t r y of P u b l i c Heal th i s r e s p o n s i b l e f o r t h e p r o w t i o n of environmental h e a l t h , b u t urban and r u r a l w a t e r supply programmes cont inue t o b e the j o i n t r e s p o n s i b i l i t y o f t h r e e m i n i s t r i e s and,under them, seven departments. Emphasis is i n c r e a s i n g l y being p laced on a

co-ordinated approach by t h e s e departments a l l o f which now have i n c r e a s e d a c t i v i t i e s i n the f i e l d of r u r a l w a t e r supply. For t h e Third Plan programme, a r e q u e s t f o r more UNICEF a s s i s t a n c e is s t i l l being considered. S t r e s s is being l a i d on an e x t e n s i v e s tudy of groundwater p o t e n t i a l .

A review of occupa t iona l h e a l t h s e r v i c e s is be ing undertaken f o r p o s s i b l e f u t u r e WHO a s s i s t a n c e .

WHO a s s i s t m c e . The connounity w a t e r supply programme, which is be ing funded by UNDP up t o 1975 and is a s s i s t e d by WHO/UNICEF is concent ra t ing on r u r a l w a t e r supply and w i l l cont inue t o r e c e i v e WHO s u p p o r t , and a s s i s - t ance t o urban areas is a l s o being provided. Environmental h e a l t h p r o g r m e s a r e being supported by r e g u l a r s t a f f , c o n s u l t a n t s and p a r t i c i - p a t i o n i n the t r a i n i n g p r o g r a m e s and r e f r e s h e r courses for the s t a f f concerned. UNDP i s s u p p o r t i n g the t r a i n i n g of s a n i t a r y eng ineers a t Chulalongkorn Univers i ty . This a s s i s t a n c e , i n 1 9 7 5 , w i l l b e focussed on wate r supply management, environmental p lann ing and g r o u n d r a t e r development and i n 1976 on expansion of the tube-well w a t e r supply scheme, t a p rov ide i n c r e a s i n g coverage of r u r a l a r e a s a t minimum c o s t . Food c o n t r o l a d m i n i s t r a t i o n and occupa t iona l h e a l t h s e r v i c e s w i l l a l s o be supported.

Xed ica l R~+cI1: :s : ; j : STR 001 (Thai lend 0093)

To a s s i r r i z ic;?lapint: r e h a 5 i l ; c a t i o n services i n s e l e c t e d h o s p i t a l s i n the provinces and i n Sangkok, and in t r a i n i n g s t a f f .

I n 1968. 2 physio therapy t u t o r , former ly a t t a c h e d to Thai land 0073, "Phys i ca l Therapy Tra in ing" , was a s s igned t o a s s i s t the Min i s t ry of Pvb l i c Hea l th i n p lanning t h e development of phys io therapy s e r v i c e s i n major provin- c i a l h o s p i t a l s . I n 1 9 i 1 , a Uni ted Nat ions P r o s t h e t i c Technic ian v i s i t e d Lerd- s i n H o s p i t a l and made r e c o m e n d a t i a n s f o r f u r t h e r improvement of t h e workshop. A c o n s u l t a n t was a s s igned i n 1973 to assess t h e e x i s t i n g s i t u a t i o n of occupa- t i o n a l t he r apy and medica l s o c i a l work i n h o s p i t a l s and r e h a b i l i t a t i o n c e n t r e s i n Bangkok and t h e p rov inces and t o co -o rd ina t e w i t h o t h e r e f f o r t s and forms of t he rapy . A c o n s u l t a n t i s being provided i n 1974 for an e v a l u a t i o n of t h e p r o j e c t . I n 1975, c o n s u l t a n t s w i l l a s s i s t i n t e ach ing and a l s o demonst ra te advanced t echn iques .

The p r o j e c t i s under t h e r e s p o n s i b i l i t y o f the O f f i c e of t h e Under-Secre- tar? of S t a t e f o r Pub l i c H e a l t h .

A s s i s t a n c e i s expected t o con t inue v n t i l 1975.

Hea l th Planning and Management STR 002 (Thai land 0098)

TO a s s i s t i n n a t i o n a l h e a l t h p lanning and i n h e a l t h a d m i n i s t r a t i o n , i n c l u - d ing h e a l t h i n fo rma t ion system and h e a l t h management a s p e c t s , w i t h emphasis on t h e phased i n t e g r a t i o n o f d i s e a s e - c o n r r o l and s p e c i a l h e a l t h programmes, even- t u a l l y l e ad ing t o t h e development and s t r eng then ing of s comprehensive h e a l t h care s e r v i c e i n t h e coun t ry .

Following t h e merger of Thai land 0002, "St rengthening of Hea l th Se rv i ce s " , Thai land 0051, "Hospi ta l Admin i s t r a t i on" , Thai land 0069, 'Vrhan P u b l i c Heal th A d n i n i s t r a t i o n " , Thai land 0087, "Adminis t ra t ive Aspects o f Hea l th Se rv i ce s " , and Thai land 0091, "Health Manpower Study" w i t h t h i s p r o j e c t , t h e a c t i v i t i e s cover t h e i n t e g r a t i o n of h e a l t h s e r v i c e s , h o s p i t a l a d m i n i s t r a t i o n , i nc lud ing h e a l t h i n fo rma t ioo system, u rban p u b l i c h e a l t h , a d m i n i s t r a t i v e a s p e c t s of h e a l t h s e r v i c e s and h e a l t h manpower s t u d i e s . Th i s p r o j e c t m-o rd i l l a t e s t h e a c t i v i t i e s o f o t h e r WHO-assisted p r o j e c t s i n t h e count ry and i s under t h e r e s p o n s i b i l i t y of t h e O f f i c e o f t h e Under-Secretary o f S t a r e f o r P u b l i c Hea l th .

I n 1970, i n a d d i t i o n t o c o n t r a c t u a l s e r v i c e s , a p u b l i c h e a l t h a d m i n i s t r a t o r and a s t a t i s t i c i a n were provided - t h e former t o a s s i s t w i t h t h e i n t e g r a t e d gene- r a l h e a l t h s e r v i c e s , and the l a t t e r f o r a h e a l t h manpower s t u d y . I n 1972, a h e a l t h p l anne r c o n s u l t a n t a s s i s t e d i n e s t a b l i s h i n g a h e a l t h p l ann ing u n i t i n t h e M i n i s t r y of P u b l i c Hea l th . I n 1974, a c o n s u l t a n t a s s i s t e d i n t h e development of a h e a l t h i n fo rma t ion system. A s s i s t a n c e was g iven by way of g r a n t s f o r t h e conduct of a Na t iona l Seminar on Hea l th Economics and a l s o fo r t h e o r g a n i z a t i o n o f a t r a i n i n g p r o g r a m e f o r c h i e f p r o v i n c i a l medica l o f f i c e r s .

A s t a t i s t ~ c i a n w i l l be added t o t h e p r o j e c t i n 1975, a management/operations r e s e a r c h s p e c i a l i s t i n 1976, and a h e a l t h economist i n 1977. Shor t - te rm consul - t a n t s i n epidemiology, h e a l t h i n fo rma t ion systems and h e a l t h economics and fe l low- s h i p s i n p lanning and management, o p e r a t i o n s r e s e a r c h , p lanning of computer s e r v i - ces and h o s p i t a l de s igns w i l l be provided i n 1976 and 1977. Also a subs idy w i l l be provided t o cover c o n t r a c t u a l s e r v i c e s (computer p r o g r a m i n g l r r a n s l a t o r ) .

Ass i s t ance t o t h e projec: i s expected t o con t inue f o r a number of y e a r s

trengthening of Rural Health Services STR 006 (Thailand 0132)

To aesist in strengthening integrated rural health services. It is pro- osed to increase the coverage of the peripheral health services, to train ealth personnel, including development of curricula for health workers and e ethodology for the evaluation of training and integration of traditional ealth vorkers in peripheral public health services.

The initial phase of the project vas started in 1974, by way of a grant or the training of traditional health workers and tambol doctors in three rovinces. This training will be extended to five more provinces in 1975. In 976-1977, this project will be strengthened by the assignment of a public ealth administntor, a social scientist and a public health nurse educator. onsuItants will assist in the fields of health educetian end school health. ellowships vill be related to health education and health practice research. ubsidy is intended ta cover local costs in respect of the national manpower eeded.


trengthening of Laboratory Services HLS 001 (Thailand 0075)

To assist in organizing national health laboratory services, in strengthen ng the teaching of laboratory sciences and with training in medical laboratory :echology .

Department of Medical Sciences

Early assistance to this project was extended from Thailand W42, "Tuber- :ulosis Control". A laboratory technician helped in converting the venereal- lisease laboratories into provincial health laboratories and in training tech- iicians. In 1968, a coneultant-microbiologist reviewed the training of laba- tatory technicians. In 1970, another consultant studied the status of labo- :.tory services as a part of e regional assessment under project SEAR0 0159, 'Health Laboratory Services". A microbiologist was assigned in 1972 to help in :he implementation of the national plan for the reorganization of health labo- :nary services at central, provincial and district levels. Consultants visited :he project in 1972 and 1974 to develop the laboratory aspects of epidemiologi- :a1 surveillance. From 1975 through 1977 consultants vill advise on specific fields in clioi-1 pathology and surveillance of communicable diseasee, equipment maintenance technology, biological standardization, rabies vaccine tissue tulture m d leptoepirosis. Provision is made far payment of a grant to meet the coet of a national course for clinical pathologists in 1976-1977.

Pellavahips vill be awarded in related fields.

LAND

11. University Institutions

Assistance will be provided to strengthen the teaching of laboratory sciences in the related departments.

( a ) Chienwi Medical College. A fellarship was provided in 1974 in medical microbiology and pharmacology. In 1976, a fellowship in serology and one in toxicology in 1977 will be awarded.

(b) Ramathibadi Medical College. In 1974, a consultant in haematology is being provided.

( c ) Mahidol Universitx. (Faculty of Medical Technology) A consultant reviewed, in 1970, the four-gear degree and one-year certificate courses for laboratory technicians, reconmended the re-organization of the curriculum for clinical chemistry, including automated chemistry, end suggested updating the methods of teaching, training and examination. In 1974, a fellowship was provided in microbiology.

Fellowships in 1975, 1976 and 1977 will be related to pathology and other specialized subjects.


National Laboratory Animal Centre (UNDP THA/72/W4)

ms 003 (Thailand 0123)

TO establish a national laboratory animal centre to provide small laboratory animals of a standard quality to the teaching and research institutions as well as biological laboratories.

Assistance originated in 1970 under project Thailand 0075. A consultant collected information on the demand for and the use made of small laboratory m i - mala in Bangkok. In 1971, another consultant surveyed the capability of breeding small laboratory animals and recommended the establishment of a central breeding unit, the production of laboratory animal diets and the training of technicians in animal sciences. The Government of Thailand established in 1972 a National Laboratory Animal Centre in Hahidol University, with aasiatance from UNDP. The Centre will breed and supply small laboratory animals to medical and bio-medical and health institutions and will provide adequate facilities for training qualified laboratory animal technicians. In early 1973, a consultant assisted the co- ordinating c-ittee with the detailed planning of the building and its lay-out as well as with the long-term plaming of the activities of the Centre. In 1974. a veterinarian was awarded a fellowship for training in laboratory animal technology breeding and management.

In 1975, it is hoped that a consultant will review the project and conduct II rr.inino rntlrae.

ans ick H u n l c l p a l ~ r y ? a r i l ~ P:acnln& . . :e:d Worker Pro:ec: I'VFPA T&\,7? PO8

MCH W 1 (Thailand 0127)

To a s s i s t i n the improvement and expansion of the family hea l th s e r v i c e s in Bangkok-Thonburi me t ropo l i s , as an i n t e g r a l p a r t of the general h e a l t h care i e r v i c e s provided a t t h e h e a l t h c e n t r e s .

The p lan of ope ra t ions was signed i n M r c h 1973 and a s s i s t a n c e was provi- ied i n developing s u i t a b l e c u r r i c u l a f o r t h e t r a i n i n g courses f o r family plan- l i n g f i e l d workers. Ass i s t ance included payment of s t ipends , s a l a r y supple- nents t o pub l i c h e a l t h nurse superv i so r s , s e s s i o n a l payments t o physic ians iorking p a r t time a t h e a l t h c e n t r e s , and a con t r ibu t ion towards the edminis t ra- t i v e c a s t s of h e a l t h c e n t r e s , and the Publ ic Heal th Bureau. Fellowships were warded t o key h e a l t h personnel i n h e a l t h cen t res wi th a view t o improving t h e family h e a l t h s e r v i c e s provided i n t h e metropol is . An eva lua t ion o f t h i s pro- j e c t i s t o be undertaken by Mahidol Univers i ty ia 1976. The P r o j e c t s Co-ordi- l a t i n g Corn i t t ee he ld a t t h e end of t h e f i r s t year a review meeting i n March 1974. The a c t i v i t i e s of t h e p r o j e c t are being c lose ly ca-ordinated wi th those ,f Thailand 0130, "Accelerated Development of Maternal and Child Health and Family Planning Services" .

Cont inuat ion of t h i s p r o j e c t beyond 1975 w i l l depend on the a v a i l a b i l i t y of LINFPA funds.

Expanded S t e r i l i z a t i o n P r o j e c t (UNFPA THA/72/P02)

HRP W 1 (Thailand 0129)

To make s t e r i l i z a t i o n s e r v i c e s more r e a d i l y a v a i l a b l e wi th in t h e E m i l y h e a l t h s e r v i c e s , as an i n t e g r a l p a r t of the general hea l th s e r v i c e s .

F inanc ia l a s s i s t a n c e was provided i n t h e form of a subsidy t o h o s p i t a l s , maternal and c h i l d h e a l t h cen t res and sub-centres , and h e a l t h c e n t r e s t h a t could provide male and female s t e r i l i z a t i o n s , i n o rde r t o make such s e r v i c e s more r e a d i l y a v a i l a b l e . During the four teen months o f ope ra t ion , f i f t y - f i v e per cen t of t h e t a r g e t s e t f o r a three-year pe r iod was achieved.

A review of the a c t i v i t i e s a t the end of t h e f i r s t year was undertaken by t h e P r o j e c t s Co-ordinating Committee i n Harch 1974.

The a c t i v i t i e s under t h i s p r o j e c t are being c l o s e l y co-ordineted wi th those of t h e p r o j e c t Thailand 0130, "Accelerated Development of Maternal and Child Health and Family Planning Services" .

con t inua t ion of t h i e p r o j e c t beyond 1975 w i l l depend on the a v a i l a b i l i t y of UNFPA funds.

I n s t i t u t e of Nut r i t ion and Food Science, Ramathibodi 0

NUT 001 (Thailand 0125)

To a s s i s t i n meeting t h e cont inuing need f o r t r a i n i n g medical and a u x i l i a r y h e a l t h personnel i n n u t r i t i o n , and i n s t rengthening medical r e sea rch and i n supporting research a c t i v i t i e s of the National I n s t i t u t e o f Food and Nut r i t ion .

I n 1972 and 1973, the p r o j e c t was a s s i s t e d wi th fe l lowships . I n 1974, a con- s u l t a n t w i l l help wi th the planning and mnagement of the p r o j e c t .

Fellowships w i l l be provided i n 1975 f o r t h e t r a i n i n g o f s t a f f .

The p lan of opera t ion was signed i n January 1973, a l though the p r o j e c t had become opera t ive i n November 1972.

D e v e l o m n t of Health Education Hm W1 I n 1972, a WHO nurse educator a s a i s t e d with the development of the p r a c t i c e (Thailand 0076) areas f o r basic nursing s tudents from the Faculty of Nursing, Khon Kaen Univer-

s i t y . A senior nurse educator w e asaigned i n 1973 t o a a ~ i e t v i t h the nor TO a s s i s t i n the development of heal th education personnel fo r both comnu- masters degree pragrame i n nursing administrat ion a t Chulalongkorn Universi ty ,

n i t y heal th education and t ra in ing i n heal th education; to a ~ s i s t i n developing as well as t o a s s i s t the Chief Nurse, Division of Nuraing, Hin is t ry of Public audio-visual mate r ia l s and to conduct research t o provide the bas ic data Health. I n the same year, the nurse educator moved from Khon Kaen to tho required f o r the development of heal th education a c t i v i t i e s . Division of Nursing to design an in-service progr-e f o r a11 chief nuraea of

Thailand t o begin i n 1974. Assistance *IS given in the t r a n s l a t i o n of e d u u t i o - A consul tant ms provided i n 1966 to review heal th education t ra in ing i n na l mater ials i n t o Thai. This ~ r o j e e t has been closely r e l a t e d with SPABO

the country. Pellovehips were a w r d e d i n order to develop the required hea l th 0139, "Short Courses for Nurses and B u l t h Faraomel", and SEAR0 0194, '7180- education manpower. Sponsored Training Centre f o r Nlrses, Wellington".

I n 1975, i t is proposed to ansign a consul tant to review the present s ta - t u s of hea l th education i n Thailand i n a11 i t s aspects and t o prepare proposals f o r the extension and expansion of these services . I n add i t ion , fellowships w i l l be provided f o r graduate t ra in ing i n hea l th education as well as for short- term observation of h e a l t h e d u u t i o n aervices i n selected countr ies . Supplies and equipment a r e a l s o provided for .

I n 1976, the p r o j e c t w i l l be merged i n t o the new pro jec t Thailand 0132, "Strengthening of Rural Health Services".

Nursing E d u ~ t i o n .nd Services

h e post of nurse educator i s dropped i n 1975 and the p r o j e c t w i l l be merged p a r t l y with the nev p r o j e c t p h e d f o r Thailand i n L976-1977, i . e . , "Strengthening of Rural Health Services" (Thailand 0132) and p a r t l y with p r o j e c t Thai lmd 0097, 'Uedical E d u u t i c o and Training".

Faculty of Public Health BLLD 003 (Thailand 0095)

To a s s i s t the Faculty of Puolie Health i n Whidol Univeraitv i n fu r ther developing i ts teaching and t ra in ing progrmmes f a r b e t t e r co-ordination and e f f e c t i v e support t o t h e h e a l t h se rv ices i n h e a l t h planning and ~ n a g s a n t .

Polloving the provision of consul tants i n - t e r m 1 and c h i l d hea l th and i n environmental hea l th under Thailand 0038. "School of Public Uemlth". consulunt . i n publ ic hea l th administrat ion, heal th education. n u t r i t i o n . n d occupa t ioml

To a s s i s t i n studying nursing nceda m d resources, i n strengthening nurs- heal th have been assigned s ince 1368. A consul tant i n epidemiology *IS asmigned ing aervicea and education, i n developing universi ty- level courses f o r nurses, i n 1974 and one i n occupational hea l th is t o be provided l a t e r i n the year. and i n org.nizing and cmducting s tud ies r e l a t e d to nursing services and edu- - cat ion. It i s proposed t o assign in i975.a consultant i n i n d u s t r i a l medicine, and

i n L976-1977, an education s p e c i a l i s t and a public h e a l t h nuxse educator. m e p r o j e c t s t a r t e d i n 1968 m d hall a s s i s t e d the Division of Nursing i n

s t r a g t h m i n g i ts f lmctions, p a r t i c u l a r l y in the management of nursing services I n 1977, a heal th manpower s p e c i a l i a t r i l l be added. m d e h l m t i o n .

I n 1970, the HE0 psychia t r ic nurse adviser v i t h p ro jec t m i l a n d 0017, "mental Wlth Education and Services", *IS trmnsferred t o t h i s p ro jec t .

The p ro jec t is expected to continue f o r s ae years.

THAI&VD


DevelowenL of Health Education

Short-term consult an^ Fellovnhipr Supplies and equipment

4. HEALTH MANPOVER DEVELOPMENT

4.1 Health Uan~ouer Development

Nursins Education and Services

Nurse educator 94 Nurse educator P3

Sharr-rerm canrulranr Eellovehips Supplier and equipment

Faculty of Public Health

Education specialist PS Health manpower specialist P4 Public health nurse educator P3 Clerk-typist BK b

shorr-term conrulrancs Fellowships Grsnt Supplies and equlpmenr

R E G U L A R

1974

1/12 1/12 -- 2 --

81120

11 1 1/18

B U D G E T

Estimated Obligations ~rajecr NO.

HED 001 (0076)

mn 002 (0089)

rn W 3 (0095)

1974

Number

1975

11 3 4/30

1/12

1

1/ 3 7/96

21 s

1975

m - -

(Exoreseed in US DollaraL

of Posts

1976

11 8

11 8 11 8 -- 3 --

5/15

18 1 1 3 6 0 0 , 1 - I 1 2 9 W O ; a -

i

52 080

1977

1/12 11 9 1/12 1/12

4

5/15

I

1 6 600 i

1976

6 8 W O 1 WO -

121080 -

1977 1974

6 600 8

5 7 W 1 l O m l - ! 9 1 7 W I - ,

I i 24 610 38 580 j 24 120

20 090 ! 32 160

a * " c b. 3

2 - rn u.

0

Number of Post.


Estimated Obligation.

I i i

1975 1974

2 250 - 46 950

I !

I i i

i /

i

i 1

1976

1

i j

i

i I

1 i

i I I

!

i

!

1975

3 7 W - 98 560

2 ow

1977

11 w o 1

!

1976

9 8 W 12 750 12 750 17000 17000

7 b W - ! - -

11 800 11 000 85 300 135 910

1977

Medical Education and Training HMD 004 (Thailand 0097)

To a s s i s t i n f u r t h e r developing t h e teaching and t r a i n i n g programmes of the e x i s t i n g four medical f a c u l t i e s a t Chiengmai, Chulalongkorn and Mahidol Uni- v e r s i t i e s , including the Facul ty of Post-graduate Studies of the l a t t e r , and ro a s s i s t i n planning the F a c u l t i e s of Medicine a t Pr ince of Songkhla and Khon Kaen U n i v e r s i t i e s .

Assis tance t o t h e former Unive r s i ty of Medical Sciences s t a r t e d i n 1960 under p r o j e c t Thailand 0062, "Medical Education" by the assignment of a WHO pro- f e s s o r of prevent ive and s o c i a l medicine. In add i t ion , a s s i s t a n c e vas given under Thailand 0038, "School of Publ ic Heal th , Bangkok", lhe i l and 0057, "Facul ty of Tropical Medicine", and Thailand 0058, "Paed ia t r i c and O b s t e t r i c Education and Services" , i n subsequent yea r s . Consul tants i n p a e d i a t r i c s , pathology, su r - gery, pharmacology, c l i n i c a l pathology and post-graduate res idency programmes have been ass igned s ince then and a workshop on teaching methods i n medical edu- c a t i o n and a seminar on the teaching of pathology vere held i n 1966 and 1969 r e s p e c t i v e l y (under in t e r -coun t ry p r o j e c t s ) . I n 1971, No consu l t an t s worked wi th a l l four F a c u l t i e s o f Medicine and conducted a na t iona l workshop on the s u b j e c t . I n 1972, an a r c h i t e c t (SWLW) 0104, "Organization and Administration of Hosp i t a l and Medical Care Services") s tud ied and completed the master plan fo r t h e Facul ty of Medicine and A l l i e d Health Sciences, Pr ince of Songkhla Uni- v e r s i t y Medical School. A consu l t an t v i r o l a g i s t was a l s o ass igned t o Chiengmai Unive r s i ty Medical School.

I n 1973, a consu l t an t on emergency se rv ices was ass igned to the S i r i r a j Medical School, Mahidal Unive r s i ty , and a consu l t an t i n epidemiology to the Facul ty of Publ ic Heal th , Mahidol Univers i ty . Since 1973,a g r a n t has been provided to cover the c o s t o f s t u d i e s a t Mahidol Univers i ty , Facul ty o f Graduate S tud ies , f o r s t a f f des ignated f o r t h e cvo new schools of medicine a t Songkhla and Khon Kaen.

I n 1974, a consu l t an t i n n u t r i t i o n a l pathology v i l l be provided to Ramathi- bodi Medical School; a consu l t an t i n curriculum development w i l l a l s o be ass igned, and h i s a c t i v i t i e s may cover the t r a i n i n g of the proposed new category o f h e a l t h a s s i s t a n t s .

From 1975, the p r o j e c t v i l l be r e s t r u c t u r e d , and a medical educator and a nurse educator v i l l be provided.

I n 1976 and 1977, f u r t h e r a s s i s t a n c e i s envisaged f o r the two new medical schools . A h e a l t h sc ience educator v i l l be added i n 19?7. While the ind iv idua l needs o f the d i f f e r e n t i n s t i t u t e s vary, i t is intended t h a t , wherever poss ib le , the s e r v i c e s of WHO consu l t an t s w i l l be shared. Fel lovship a s s i s t a n c e w i l l be r e l a t e d to medical educat ion, including bas ic medical sc i ences , c l i n i c a l teaching nvrs ing education and community h e a l t h . I n add i t ion , a s s i s t a n c e v i l l be given to the Minis t ry of Pvbl ic Health v i t h the nev curriculum f o r the " ru ra l physician".

.AM) f P

National I n s t i t u t e of Dermatology HND 005 (Thailand 0107)

TO a s s i s t i n e s t a b l i s h i n g a National I n s t i t u t e of Dermatology which w i l l provide f a c i l i t i e s f o r d iagnos i s , t reatment , research and t r a i n i n g . Three shor t - term consu l t an t s v e r e provided - one to review the general programmes i n dernato- logy and to prepare a plan f o r f u t u r e developmenr, t h e second to advise on patch t e s t mathodology for d iagnos i s of contact d e r m a t i t i s , and the t h i r d to advise on the development of d iagnosis of mycotic s k i n d i seases . The p r o j e c t w i l l cover a number of sk in d i seases (both i n f e c t i o u s and of o the r na tu re ) found i n Thailand. WHO a s s i s t a n c e w i l l be continued through consultants to in t roduce modern methodology and to p a r t i c i p a t e i n teaching the na t iona l s t a f f . Fel lovshipe v i l l be given to the s t a f f of the I n s t i t u t e t o v i s i t i n s t i t u t i o n s abroad to gain knowledge and experience i n dermatology.

The p r o j e c t i s expected to continue up to the end o f 1975

Physician Ass i s t an t HM) 006 (Thailand 0131)

To a s s i s t v i t h the t r a i n i n g of a new category of h e a l t h workers, tenta- t i v e l y c a l l e d "Physician Ass i s t an t s " . The physician a s s i s t a n t s w i l l be t r a ined f o r th ree to s i x months to be a b l e t o d e l i v e r s b a s i c u n i t of h e a l t h care, both prevent ive and c u r a t i v e . They v i l l be posted i n v i l l a g e s end supervised by h e a l t h cen te r s t a f f .

The fe l lowship provis ion under t h e p r o j e c t w i l l be u t i l i z e d to enable t h e t eacher s t r a i n e r s o f physic ian a s s i s t a n t s to proceed to coun t r i e s vhere t h i s category of h e a l t h vorke r s i s t r a i n e d , to study t h e progranole of t r a i n i n g , c u r r i - culum and l ea rn ing exper iences f o r such h e a l t h workers.

Supplies and equipment to be provided v i l l include teaching a i d s and books f o r the school for physic ian a s s i s t a n t s .

Teachins of llurran Reprod-crion, Fa?lly Pl.8nning and P o p u l a t ~ o n Dynanrzs r n Medical Schocls F A THA 7 1 W21

HHD 008 (Thailand 0115)

To impart appropr ia t e knowledge, a t t i t u d e and s k i l l s i n human reproduction. family planning and populat ion dynamics to sc ience, medical and o t h e r h e a l t h personnel , both undergraduate and post-graduate who, i t i s a n t i c i p a t e d , v i l l become the key personnel and l eade r s i n the n a t i o n a l prograones i n these f i e l d s .

I n 1970, a team of th ree consu l t an t s (under IR 0568, "Teaching on Humao Reproduction i n Medical Schools") reviewed, and advised on, the development of the p r o j e c t . A d r a f t p r o j e c t request has been developed and subjected to r e v i s i o n s . A f i n a l d r a f t i s expected to be a v a i l a b l e i n 1974.

Fur ther a s s i s t a n c e i s being planned sub jec t to a v a i l a b i l i t y of UNFPA funds

The p r o j e c t i s expected to cont inue for a number o f yea r s .


THAILANO


Medical educators P4 Nurse educator P4 Health science educator P4

Short-term ~~nsulLanLr Fellovships Grant supplies and equipment

National Institute of Dermatology

Short-term c~nsvltanr~ Fellowships Supplies and equipment

Physician Arsirfanc

Fellovshlps Supplies and equlpmenr

Teachimp Of Human Reproduction, Family Planning and PapvlaLian Dy"amics in Medical Schools

THAI71IPOZ

Fellovrhrpr

Number of Posts project No.

m 004 (0097)

HMD 005 (0107)

006 (0131)

m 008 (0115)

1974


1974 1975

21 3 1/12


1977

1/12

11 6

1975

1/12 1/12

1976

I

11 1 1/12

4/24

I

1976

2/21 1/12

---

1977

Nvlnber of P o r t s

i

I 1

1974

27 160 52 745 27 160 30 140

I - - - I

!

I !

6 WO 2 200 6 6 0 0 I _ , 1 000 1 o W i - - # I 13 600 9 8W

a v " c - 3 9 * 0 L

FP


32 160

16 080

!

1 15 600 '

j 8 W O

1975

54 320 82 885 48 240

i

- 1977

~sfirnafed Obligations

2/18

1

!

!

1976 1974 1911 1975 1976

I

1 !

i I

I 11 943 ' 5 218 - -

1

i !

I

!

I

!

!

I I

I i

I i

I !

I i

I I I

I I

!

11 3 I ! I

i !

I ; I 1

Strengthening of Epidemiological Surveillance ESD 002 (Thailand 0133)

TO assist in the further development, organization and implementation of the control of cwmvnicable diseases by improving the surveillance services starting from the periphery.

Assistance was provided to the Epidemiological Unit in the Division of Coolnunicable Disease Control and the Department of Health in the form of consub tants, fellowships and supplies and equipment, under project Thailand 0059, "Epidemiology", which was financed through Regular and UNDP funds.

Assistance to the project will be directed towards the development of a model system of svrveillance service which will be applied throughout the country by stages. In 1976, two consultants in epidemiology and statistics and, in 1977, an epidemiologist and a statistician will be provided. Fellow- ships in the above subjects will also be provided in 1977.

Malaria Eradication HPD 00i (Thailand 0065)

To assist with the malaria eradication programe.

From 1949 to 1961, malaria control activities were assisted by UNICEF AND USAID. The programe was converted into one of eradication in 1961. Indepen- dent assessments of the programme were carried out by joint WHOIUSAID teams in 1963 and 1968; a comprehensive evaluation was carried out in 1969.

In 1971, the Government developed a revised six-year plan of action. USAID assistance was terminated in 1972 when a WHO malariologist/epidemiologist was added to the team. The National Malaria Eradication Training Centre at Prabu- dhabat, assisted by WHO, continues to cater for the training needs of national personnel. In 1974, WHO assistaoce included one malariologist, one epidemiologist, one entomologist, three sanitarians and a laborarory technician (nine months). The epidemiologist will complete his assignment at the end of 1975. The Government inrends to carry our an evaluation of the programme in collaboration vith WHOIUSAID in the second half of 1974. Studies an the role of A. balebacensis continued.

In 1976 and 1977, WHO assistance will include the continuation of one malariologist, one entomologist and three sanitarians and fellovships for attendance in M.Sc. entomology and M.P.H. courses, supplies and equipment.

The project is expected to continue for a nmber of years.

Dental Health DEN 001 Under p r o j e c t Thailand 0108, "Phythai School of Dent is t ry" , consu l t an t (Thailand 0086) s e r v i c e s were provided i n 1971 and 1973 f o r curriculum development and i n o r a l

surgery. TO a s s i s t i n improving d e n t a l s e r v i c e s and i n t r a i n i n g d e n t a l hea l th

personnel . I n 1975 and i n 1976 den ta l h e a l t h se rv ices w i l l be strengthened by t r s i n - ing na t iona l s t a f f and providing a consul tant .

The p r o j e c t s t a r t e d i n 1967 wi th the assignment of a consu l t an t who advised on the t r a i n i n g of school d e n t a l nu r ses . A d e n t a l nu r se t u t o r was Assis tance to the p r o j e c t is expected t o continue u n t i l 1976. aooigned i n 1969 and 1970. Another consu l t an t a s s i s t e d i n reviewing t h e p r o j e c t i n 1972. I n 1973, s h o r t fe l lowships were provided for t r a i n i n g of d e n t a l nurses . I n 1974, a eortsultant w i l l eva lua te the progress o f d e n t a l h e a l t h se rv ices .

Mental Health m 001 (Thailand 0017)

TO a s s i s t i n t r a i n i n g undergraduates and past -graduates i n p s y c h i a t r y , i n developing c-unity-oriented mental h e a l t h care se rv ices wi th in the general medical d e l i v e r y system and i n epidemiological i n v e s t i g a t i o n s i n mental illness .

I n 1972 a consu l t an t under S-0 0096, "Medical Teacher Training and Continuing Education", reviewed t h e educat ion and t r a i n i n g progr-e i n psy- c h i a t r y and reconmended res idency t r a i n i n g . A consu l t an t under IR 0308, "Epidemiology and Biology o f Mental Disorders", v i s i t e d Thailand i n 1973, reviewed the c u r r e n t s t a t u s of p s y c h i a t r i c se rv ices and advised on t h e s t r eng- thening of f a c i l i t i e s f a r mental h e a l t h care. I n 1974 a consu l t an t a s s i s t e d i n p s y c h i a t r i c t r a i n i n g and m o t h e r i n t h e development of mental h e a l t h care s e r v i c e s . Fellowships were awarded f o r t r a i n i n g i n fo rens ic psych ia t ry and and p s y c h i a t r i c nurs ing. I n 1975, fe l lowships w i l l be o f fe red f o r t r a i n i n g i n p s y c h i a t r i c educat ion and psychology.

I n 1976 a consu l t an t w i l l a s s i s t i n t h e development of community mental h e a l t h programme.

Q u a l i t y Control of Pharmaecutical Preparat ions SQP 001 (Thailand 0079)

To a s s i s t i n s t rengthening l e g i s l a t i o n and l abora to ry competence i n t h e q u a l i t y con t ro l o f pharmaceutical p repa ra t ions and i n t r a i n i n g drug a n a l y s t s and drug inspec to r s .

A p h a m e e u t i c a l chemist was provided i n 1970. The programme a l s o received support from p r o j e c t S-0 0154, "Qual i ty Control of Biological and Pharmaceutical Products". A consu l t an t has a s s i s t e d i n 1974 i n s p e c i f i c a spec t s of q u a l i t y c o n t r o l . The pharmaceutical chemist wi th the p r o j e c t w i l l c w p l e t e h i s assignment i n 1975 a f t e r which t h e p r o j e c t w i l l be merged i n t o Thailand 0066, "Food and Drug Control A b i n i s t r a t i a n " and f i n a l l y evaluated.

The p r o j e c t i s under t h e r e s p o n s i b i l i t y of t h e Department of Medical Sciences, Minis t ry of Public Health.

I n 1975-1976 fe l lowsh ips w i l l be awarded f o r t r a i n i n g i n c l i n i c a l psychia- t r y , sociology and f o r obse rva t ion o f c-unity mental h e a l t h care programmes.

Community Water Supplp (UNDP THA/72/016)

BSM 001 (Thailand 0090)

To assist in the planning and implementation of a national environmental health programme and, more specifically, to provide technical advice and guidance in the expansion of the national cornunity water supply and sanitation programmes.

The project commenced in 1967, with assistance under SEAR0 0064, "Develop- ment of Cornunity Water Supply Programme", and was assisted by UNDP in 1969. In addition to the assignment of a sanitary engineer, consultants were provided to assist in water supply and sewerage training, water pollution control, hydrogeological studies and training, training courses in community water supply and design, and groundwater engineering at Khon Kaen University; and in the preventive maintenance prograwe for cowunity water supply. UNDP assistance will continue until mid-1975, but it is planned that WHO will assist the programme until 1980, in the expanded programme, by providing technical advice in planning, research, and through consultant services and fellowships.

Community Water Supply and Sanitation BSM 002 (Thailand 0135)

To assist in the planning and implementation of the national environmental health prograwe, and, in particular, to promote the development of provision of safe water su~~lies to smaller communities by exploitation of nroundwater . . . . - sources or use of appropriate technology for water treatment; to co-ordinate the development of sanitation prograrmnes with provision of safe water supplies.

In 1976-1977, a sanitary engineer will be provided and consultants will advise on water pollution, hydrogeology, operation and maintenance, end sever- age systens. Subsidies will be provided for a social scientist, subject to availability of funds, to study water use habits and reactions to treated water supplies, and fellowships will be awarded for well-drilling and sanitary engineering studies.


Occupational Health WP 001 (Thailand 0134)

TO assist the Department of Health Promotion, Ministry of Public Health, in establishing an Occupational Health Unit at the central level for the co- ordination of the activities in preventing hazards to the working population and to train staff.

In 1966, ILO assisted the Government in establishing en occupational health project, which was located at Samrongthai, ao industrial area outside Bangkok. The assistance was continued for some years. In 1972, a consultant under project Thailand 0095, "Education in Public Health", was assigned to strengthen the teaching of occupational health at the Faculty of Public Realth, Mahidol University. From October 1973, another "Occupational Health and Safetf project is being assisted by UNDPIILO.

In 1977, a consultant will be provided to evaluate the progress and achievements.

Assistance to the project is expected to continue for same years. This project is the continuation of the UNDP-assisted project Thailand

0390, "National Cornunity Water Supplyq', which will terminate in 1975.

School for Nedical Physicists (UNDP THA/70/033)

RAD 033 Thailand 0109)

TO assist Mahidol University in teaching and training medical physicists.

Following preliminary assistance under the Colombo Plan to the training of medical physicists, a radiological physicist was appointed in 1971 to assist in organizing the School and in teaching.

In 1975, the total provision in this project is limited to a nine-month fellowship, which is a continuation of the one awarded in 1974.

This UNDP-assisted project is scheduled to terminate in 1975.

lmprovwent of the Sanitary Engineerins Department, Chulalongkorn University, Bangkok (REG and UNDP ?liA/72/022)

SES 001 (Thailand 0126)

TO assist in strengthening the Department of Sanitary Engineering at Chulalongkorn University.

In 1971-1972, a consultant was assigned to the University under project Thailand 0120, "Bio-environmental Engineering", to assist in the further improvement of training and research activities in bio-environmental engineering. Assistance will continue to be provided for the development of training and research programes in environmental planning and industrial wastes treatment in 1974 and 1975. Further assistance is proposed for 1976-1977 in strens- thening sanitary engineering rraining and research by providing consultants to review the existing progr-e and to advise on air pollution control work. Fellowships for faculty members to study teaching methods in water and waste treatment, environmental health, public health engineering and environmental chemistry will be provided.

Assistance is expected to terminate at the end of 1977.

Food and Drug Control Administration FSP 001 In 1976, the project Thailand 0079, "Quality Control of Pharmaceutical (Thailand 0066) Preparations", after final evaluation, will be merged into this project. In

1976-1977, consultants will assist in pesticide analysis, food technology1 To assist in establishing a national food and drug control administration chemistry and food sanitation. Fellowships will also be provided in these

and in training staff. fields and in the administration of food control, drug control and cosmetic control services.

A consultant in food control legislation was provided in 1971. Staff of the Department of Medical Sciences vill be trained in various aspects of food Assistance is expected until the end of 1977. analysis.

The project vill assist the Department of Medical Sciences and the Department of Public Health Promotion.

A consultant lmder project SEAR0 0190, "Control of Hazards to Man From Pesticides", assisted in training the staff in pesticides residue analysis in foodstuffs in 1972. A food chemist was assigned in 1973 to train food analysts, food inspectors and food handlers. Other consultants ia the field a£ food microbiology and pesticides analysis are proposed for 1974.

(Expressed i n US Dollar.:

THAILAND

6 .1 .8 Food S t a n d a r d s P r o p r m e

F O O ~ and D C U R c o n t r a 1 ~ d m i n i s t r a t i o n

s h o r t - t e r m c o n s u l r a n t s F e l l a v s h i p e s u p p l i e s and equipmenr

7. HEALTH INFOFNATION AND LITERATLIRE

7 .1 t i e a ~ r h s c a r i s t i c s

7.1.4 Development of H e a l t h S t ~ L i s C i ~ a l s e r v i c e s

V i t a l and H e a l t h S t a t i s t i c s

S t a t i s t i c i a n P4

F e l l o w s h i p s u p p l i e r and equipment

T o t a l - THAIL*ND

~ x p e c t e d d i r e c t i n p u t s from UNICEF in t h e h e a l t h f i e l d

P r o j e c t N O .

FSP w1 (0066)


~ s t i m a r e d o b l i g a t i o n s ~ v m b e r

1974 1 1 9 7 5

I

i i 21 6

I / 6 1 2 / 2 4 I

1977

O T H E R - Number of P a r t i

1974

of ~ o s r s

1

I

1 / 1 2 - 1

1 / 1 2

1 5

S O C R C E S m

Est imated O b l i g a t i o n s v

: i I

1 2 W O : 2 1 6 0 0 7 2 W 3 9 W ! 1 5 8 W I 16 8 W 22 2 W

i 4 w O 6 0 0 0 - ' - 1

- 1 5 W 4 2 4 0 0 !,YE _ _ - ! i

I !

i I i 1

I 26 010

i !

6 600 i 2 wo !

34 640

I

- -- 914 445 1 011 835

======= ======= t i = = = = = = = =

I

i i I

1974 1976

3 1 9 5 /24

1 5

I

DHS W 1

i

!

i 1 !

1975 / 1976 11977 1975 1977

1 1 3 5 /36

.... ....

-

I I

1976

=-==

I 1

- ,

1 1 ;

i I

1 i I i

I

I

i I - -

752 798 328 501 ======= , ======= !

752 798 328 501 -- i

!!+_"-7z ooo i ~ ~ z - g ~ p

1976 1974

I I

I

DP FP

i

- l - i ....... 1 iiiiiii

I

i I ! !

I

1975

u c L. 2

0 w *

---- 22

= = = = . = = = = = = = = = = =

I i

......

1

26

Pra'ect Old

0007

0025

0030

0038

0042

0064

0094

0096

0097

0102

0104

0113

0114

0116

0117

No. New

MPD 001

HLT 001

SME 001

HLS 001

RAD 001

BSM 001

MPD 002

HMD 007

NUT 001

STR 001

STR 002

MBD 001

MPD 003

STR 003

HLS 002

Project Title

Assessment Team on Malaria Eradication

Medical Literature and Teaching Equipment

Smallpox Eradication and Epidemiological Advisory Team

Production of Freeze-dried Small- pox Vaccine

Radiation Protection

Community Water Supply and Sanitation

External Cross-checking of Blood Films

Medical Teacher Training and Continuing Education Phase 11

Nutrition Training and Advisory Services

Asian Institute for Economic Development and Planning

Organization and Administration of Hospital and Medical Care Services

Tuberculosis Training and Evalua- tion Team

Seminar on Advanced Malaria Epidemiology

Inter-country Nursing Meetings

DPT Vaccine Production

-

Page

452, 497

464

454

439

462

460, 498

452

448

442

432

432, 496

455

454

432

438

Funds

R

R

RIAddl.

R

RIAddl.

RIAddl.

RIAddl.

R

R

R

R

R

R

R

RIAddl.

DP

--

Project Title

Trainingcourses in the Management of Infectious-disease Hospital

Seminar and Training Course Leprosy Control Methodology

Continuing Education for Nurses

Pharmaceutical and Medical Stores Management

Rehydration Therapy

Health Research and Development

Education and Training of Envi- ronmental Health Personnel

Training in Immunology

Quality Control of Biological and Pharmaceutical Products

Health Laboratory Services

Course for Senior Teachers in Child Health

Training in Veterinary Public Health and Promotion of Veteri- nary Public Health Services

Community Health Aspects o f Medical Education

Mental Health

Courses on Health Laboratory Techniques

Strengthening Health Services Administration Through Train- ing in Planning

No. New

STR 004

MBD 002

HMD 001

STR 005

MCH 001

STR 006

HMD 002

IMM 001

SQP 001

HLS 003

MCH 002

VPH 001

HMD 003

MNH 001

HLS 004

STK 012

Pro'ect Funds

Old Page

435

45 7

446, 497

435

440_ 496

434, 496

446, 497

458

458

438

440

456

44 7

456

438, 496

436

R/Spl.Acc.

R

R/S~~.ACC.

R

0128

0138

0139

0143

0144 K

R/Spl.Acc.

R

DP

R

R

~ I ~ d d l .

R

R

R

R

0148

0150

0153

0154

0159

0163

0168

0171

0172

0176

0178

INTER-COUNTRY - Index

Seminar on School Health

Proiect No. Old I New

Public Health Education

Control of Hazards to Man from Pesticides

Serum Reference Procedures

Project Title Old I New

Regional Team on Family Health

Page Project No. Funds

I

Epidemiological Surveillance and Training

WHO-sponsored Training Centre for Nurses (Wellington, New Zealand)

I

Regional Centre for Documenta- tion on Human Reproduction, Family Planning and Popula- tion Dynamics

Funds Project Title

I

Group Education in Service, Teaching and Research Aspects of Human Reproduction, Family Health and Population Dyna- mics

Page

Medical Education in Human Reproduction, Family Planning and Population Dynamics

Environmental Pollution Control

Public Health Advisory Services, Mekong (Phase IV)

0211

0213

0215

0216

0220

0225

0226

0227

0228

0233

Development of Health Education in Family Health Programme

PIP 001

HED 003

STR 009

HMD 005

HSM 001

SES 002

STR 011

ADA 001

CVD 001

CAN 001

I

Advisory Services

0234 MCH 010

0235 HMD 006 I 0236 / OCD CQl

I i

Participation in Meetings

Health Statistical Methodology

Planning of Environmental Health Services


Epidemiology and Control of Drug Abuse and Rehabilitation of Drug Dependants

Epidemiology, Control and Management of Cardiovascular Diseases

Cancer Control and Prevention

Education and Studies in Child Health

Educational Technology

Chronic and Degenerative Diseases

LA

FP

RIAddl.

RIAddl.

RIAddl.

R

~ I ~ d d l .

RIAddl.

RIAddl.

Addl.

I R/Addl.

RIAddl.

Add1 .

Funds Page Project Old

0237

0238

Project T i t l e

Nutri t ion Teaching i n Educational I n s t i t u t i o n s for Health Person- ne 1

Strengthening of Epidemiological Survei l lance and Control of Communicable Diseases

No. New

NUT 002

ESD 003

Page

444

452, 497

Project T i t l e Pro-ect Funds

Old

R

RIAddl.

No. New

INTER-COUNTRY u N

Asian Institute for Economic Development and Planning

STR 001 (SEAR0 0102)

TO assist the faculty of the Asian Institvte for Economic Development and Planning with the health component of training courses and other allied activities of the Institute.

Assistance to the project started in 1964. A public health administrator and a technical officer (economist) helped the Institute with its various courses, laying emphasis on the health component; assisted in the organization, conduct and evaluation of three regional courses and two country courses in national health planning; assisted in country health programing exercises end conducted a field study for collecting teaching material in the national health planning course.


STR 002 (SEAR0 0104)

Inter-country Nursing Meetings STR 0 0 3 (SEAR0 0116)

To hold biennial meetings for the purpose of studying problems in nursing that are of interest to all countries of the Region.

An inter-country meeting on "In-service Educatior, (Nursing)" was held in Bangkok in 1967 and another, on the "Control and Management of Nursing Compo- nent of Health Services", took place in the Regional Cfiice in 1969. A third, on the "Role of Operational Studies in Health Services", which was organized in Bangkok in 1972, contributed towards instilling in the participants a deeper appreciation of the role and value of the application of scientific methods in achieving the aims of the health services.

In late 1974, a course on "National Planning for Nursing Education and Services" is planned to bring together nurses in key positions from several countries of the Region.

To assist in the development of regionalized health services in the It is planned to have a meeting in 1976 on the assessment of the various organization of systems of medical care, and in hospital administration, includ- systems of nursing manpower development and utiliration, including a plan for ing the planning and development of facilities for the diagnosis, treatment, nursinglmidvifery education adapted to the needs and resources of the care and rehabilitation of the sick, and in the development of uniform systems countries. of record keeping and reporting, including support to a referral service system for hospitals and health centres; to assist in training staff at various levels of operation.

An inter-country course in hospital administration was organized in 1968. In 1970, two consultants prepared a draft guide on the fvnctional programming of hospitals; a seminar an this subject was held in 1971. In 1972, Nepal received assistance from Wo consultants in the designing of hospitals and of a health post, and a consultant architect advised the Thai Hospital Design Cornittee on the Prince of Songkhla University. In 1973, a seminar on the functional programing of hospitals in relation to basic health services was held in Bandung, Indonesia. In October 1974, it is planned to hold a seminar on the organization of medical fare in relation to general hospitals in Srinagar, Kashmir (India). A hospital administrator and a medical records officer were assigned to the project in 1974. In 1975, a follow-up seminar on the seminars held so far under the project will be held to review the impact not only on the educational aspects but also on the use the governments have made. Consultants in the fields of hospital abinistration and architecture will be provided in 1976 and 1977.

Assistance to the project will continue for a number of years

2 1 3 2 / 3 6 O W 7 200 Short-term consultants 1 10 600 11 000 ! ~arficxpanfs

2 000 : supplies and equ~pmenr i 1 000 - - . ! ! 17 600 i 20 200 :

! - , -- I I I ! I ! !

rroject NO.

STR m l (0102)

STR W 2 (01M)

SIR 003 (0116)

R E G U L A R

Number of P o r r a

B U D G E T

Estimated Obligations ! INTER-COUNTRY

(Expressed in US Dollarsl

1974

5 , STRENGTHENING OF HEALTH SERVICES

3.1 Screny~henins of Health Services

2 Sfrenychenin~ of Health Services

1974 1976 1975

- u v " G b 2

2 , 1977

I 1975

Number of P o s t s

I/ 3 1/12 1/12

3

11 7

11 5 I/ 8

- 3 / 7 i 2 / 2 216"

i ! i ~ 5 1 a n lnstiture far ~ c o n o ~ i c

Development and Planning i 35 350 37 910 39 56C public healch administrator ~5

37 910 39 580 ~conmis: ~5 5 430 5 984 Clerk-sienographer BK 7

1976 / 1977 1974

O l i L H S O r R C E S

Esrimared Obllgarlons

- 41 295

5 w - 47 795 -

I i ! j

i I

1974 / 1975 ! 1976

i I

I

1/12 1/12 1/12 - _ _ _ 3 ----

i

! 1 i : l 1 :

!

I I

' ,

1977

I

1975

-1 - -. 75 640 81 250 1 65 140

I 503 500 500

-1 - - 76 140 ' 81 750 85 640

- 8 -1 -

1

I i

I i i i

1 I

!

!

1/12 1/12 1/12

3

supplree and equipment

Organization and Adminisrrarion of Hoeoiral and Uedical Care services

30 360 ' 32 370

1 20 1 W 21 780 1 23 070 3 800 4 2 0 0 4 6 0 0

- ' - - , - 25 650 1 51 3 W ! 56 340 60 040

!

: 1

! I

i

I I

1976

1/12 1/12 1112

3

Medical hospital administrafor P4

Hedical records officer P2 Clerk-rrenographer NU4

1977

1/12

1/12 1/12

- 2 1 2 316"

i

!

I I

i

1/12

1/12 1/12 ----

,-

3/6w 1 4 400 14000 4 800 4 800 Short-term consultants

9 1 0 0 1 9 7 0 0 1 7 7 0 0 l l 7 U Participants 1 W O 1 1 000 1 W O 1 W O / Supplies and equipment

1/12

1/12 1/12

3 3 3 3 - 2 1 2 316"

- 1 - - 1 - 51 250 ' 67 900 81 340 85 040 -1 - , - ! -

Inter-sauntri Yurslng neerings

!

INTER-COUNTRY

Heal th Research and Development STR 0 0 6 (SEAR0 0148)

To provide support to the Programe Support and Co-ordination Uni t (PSC) i n t h e Regional O f f i c e i n t h e de l ive ry o f i t s main funct ions: v i z . , country h e a l t h p rograming (CHP), p r o j e c t formulation and management (PFW), medium- term programing (NTP), progr-e budgeting (PB), development of p rograme eva lua t ion methodology (DPEV), progr-e/project informat ion system (PPIS) and consu l t an t e e r v i c e s t o c o u n t r i e s on t h e i r r eques t .

The p r o j e c t w i l l be applying q u a n t i t a t i v e methods of research and ana lys i s .

The team was e s t a b l i s h e d i n 1970, cons i s t ing of one pub l i c h e a l t h a d m i n i s t r a t o r , one nurse admin i s t r a to r and one s t a t i s t i c i a n . By 1974, t h e team had become f u l l y s t a f f e d , v i t h t h e add i t ion of an economist and an opera- t i o n s r e sea rch s p e c i a l i s t . Assis tance vas provided v i t h t h e planning, conduct and a n a l y s i s of some opera t iona l s t u d i e s , e s p e c i a l l y the Nat ional Health Elan- power Study i n S r i Lanka. Members of t h e p r o j e c t took p a r t i n the t r a n s f e r o f t h e PSA methodology f o r p r o j e c t formulation and i n country hea l th planning e x e r c i s e s i n Nepal, Thai land, and Indonesia. I n co-operation v i t h o the r p r o j e c t s , seminars and meetings were organized an t h e ro l e of ope ra t iona l s t u d i e s i n h e a l t h s e r v i c e s and educat ion f o r these s e r v i c e s , on h e a l t h economics, and on q u a n t i t a t i v e s t u d i e s of h e a l t h se rv ices i n South-East Asia.

The team i s expected t o con t inue a s s i s t a n c e i n t h e above f i e l d s fo r a number of years .

INTER

Advisory Services

To provide consultant services in various disciplines upon specific & requests of Governments; also to provide support to activities currently financed under inter-regional projects, and suitable for implementation in this Region.

Consultants on the epidemiology and pathology of cancer vere provided to Bangladesh, Burma, Indonesia, Nepal, Sri Lanka and Thailand, to evaluate the pattern of cancer morbidity and mortality, and assess the facilities for epidemiological studies, prevention, early detection, treatment, training and research in cancer control. The impact of WHO assistance on medical care was reviewed.

Assistance to the project is expected to continve until 1980

Medical Rehabilitation STR 011 (SEAR0 0226)

To study (i) the problems of rehabilitating the physically handicapped and (ii) facilities available; to advise on the integration of various components of rehabilitation services into a unified pragrame.

Under SEARO 0174, "Rehabilitation of Handicapped Children", a consultan: visited India, Indonesia, Sri Lanka and Thailand in 1968 to study the available health facilities for physically handicapped children, especially those provided under WHO/UNICEF-assisted projects. In 1970, the same consultant visited Sri Lanka. He also paid a visit to Thailand again to work out details for the establishment of a comprehensive assessment centre far handicapped children. In 1971, a further consultant visited Burma, India, Indonesia, Sri Lanka and Thailand to see medical rehabilitation institutions. In 1973 a team of three consultants (medical officer, a physiotherapy tutor and a prostheticlorthotic tutor) under SEAR0 0174 visited Indonesia to conduct a course on Management Skills for the Total Care for the Disabled and assisted vith project formulation. A team of three staff members is being recruited for this project in 1974. It is proposed that the team consisting of a medical officer, a physiotherapist and a prosthetic1 orthotic tutor will initially assist vith the further development of an existing centre vhich, it is planned, will eventually become a regional training centre. The team will be available to give assistance to other centres in the Region.

In 1975 five national teams consisting of medical rehabilitation specialists, physiotherapists and prosthetists from Member countries vill be trained for one month in that centre. Assistance on the present scale vill be continued for some years.

Strengthening Health Servlces Adminlrrrarran through Tratn~ng I" Planning (UNDP FASl681769 and FASl681027)

STR 012 (SEARO 0178)

To assist in developing and strengthening health planning, as an integral part of health services systemsladministration of countries, to meet more effectively and efficiently the health needs of the people within the framevork of their social and economic development by promoting national self-sufficiency in health planning and health systems management to strengthen health services administration; in providing training in health planning methods and health systems management, including, where appropriate, practical field training; in developing a training capacity so as to provide national self-sufficiency in training as vell as in operations.

The project vas initiated in 1969 under the WHO Regular budget vith the title "National Health Planning". In 1969, the project supported a meeting of representatives from the countries of the Region on health planning. Assistance was provided to Sri Lanka in health planning and to Thailand in the development of a manpower study, and a regional short-course in health planning was conducted for participants from five c3untries.

In 1970, UNDP started assisting the project under the title "National Health Planning and Manpover Studies". In the same year the project supported a meeting on health planning in Bangkok vhich was attended by senior officials of ministries of health in the covntries of the Region, and provided short-term rpecial- ist assistance (public health administration and health statistics) to the Government of Sri Lanka for the establishment of a health planning unit.

In 1971-72, two more regional short-courses in health planning vere held in Bangkok. The project assisted the Governments of Indonesia, Sri Laoka and Thai- land in studies of health manpower; the Governments of India and Thailand in health planning training; and the Government of Mongolia in health economics. Health planning courses were held in Burma, Thailand and Indonesia.

In 1973, assistance was provided in the conduct of an orientation course in health planning and management in Thailand.

In 1974 and 1975, assistance is planned, subject to availability of funds, for the conduct of short training courses at national level for senior categories of health administrators and health planning trainers end for fellowships for faculty members of national training institutions. In 1976-1977, this assistance vill be continued and consultants provided to strengthen teaching inatitu- tions in health planning.

ISIER-COl'hTRY

Advisory Services

Short-term cansuitants


Hedical officer P4 Physiofherap~sr P3 OrrhoLisr pros~heri~c P3 Clerk-stenographer DJ4

Parcrclpanrs Supplies and equrpnent

Srrenlrheniny n r a l r > services Adminisrrarlcn Thr0up.h Train- in8 in Plannlng RAs/73/027

RAS1681769

public health admin~srrarar PS Economi~L P4 Management expert P4 Nurse adminisrraCor P4

Shorr-term consulrants Administrative support pereonne1 Fellowships Participants supplies and equipment Miscellaneous

R E G U L A R

1974

5\10

I) 3 11 5 1/11 11 5

B U D G E T

Estimated Obligations project so.

STR 009 (02151

STR Oil (02261

SIR 012 (01781

1974

20

i

Number n i Posts

, 1975 ' 1976 1 1977

I

! I

'

36

(Expressed in US Dollsrz

1975

29 680 32 700 i 34 740 29 680 32 700 1 34 740

1 29 680 32 700 1 34 740

1 740

I 12 O W 1 12 000 7 W O ! 5 0 0 0 5 O W 5 WO

q " s u 3

z .,

DP

1976

-

1977

Number of Po3:r

- 1 - ! -

7/15

I/1z 1/12 1/12 1/12

1974

5/10 7/15 ,

!

I

! !

I

! ! i

!

1

I

! i

O T H E R S O L R C E S

isrimaced Obligarionr

1974 1975 1976 1977

I

I

I

I 1 1 !

I 30 000 30 ooo I 30 WO 30 O W ! 30 000' 30 W O

30 O W , 30 W O 30 WO - - - , - 50 O W , 120 000, 120 O W , 120 WO

27 500 30 000 10 WO 16 320 12 000 12 W O 12 mo 75 570 57 600 1

1975 1 9 7 6 : 1977

I/1z 1/12

' 1/12 1/12 ----

----

24 650 i 46 MX, 29 300 Y 960 1 1 630 ' 1 600 2 430 2 400 1 900 - - , - - i 206 430 - 1 240 2 W - 194 800

I ! !

1112 1/12 1/12 1/12

4 4 4 4

56 3 W 1 6 0 0 2 m - - 201 9 W

1 I

11 5 11 5 11 5 11 5

1/12 i 1/12 1/12 1/12 1/12 , 1/12 1/12 1/12 11/12 1/12 1/12 1/12

, - - 4 4 4 - - 2112 , 21 4

I

1 1 i I

D

INTEB-COUNTRY c.2 - DiphtherialPertussis/Tetanus Vaccine Production HLS 002

(SEARO 0117)

TO assist in the production of DPT vaccine, consistent vith WHO minimum requirements.

The triple vaccine is being produced in Burma, India, Indonesia and Thai- land. In 1970, a consultant visited Burma and Thailand. Tvo consultants were provided in 1972-73 to reviev anti-tetanus serum production in Burma and advise the Government of India in expanding production st the Central Research Insti- tute, Kasauli. In 1974, s consultant in biological standardization is undertaking a reviev of the quality control of laboratories in South-East Asia and has strengthened the method used in these laboratories for the assay and standardization of DPT vaccine. Provision has been made for No consultants in 1975.


Health Laboratory Services HLS 003 (SEARO 0159)

To reviev the progress achieved in the re-organization of national health laboratory services; to consider the administrative and technical operation and management of these services; to determine ways of standardizing methods, equipment, teaching, recording and reporting in order to formulate guidelines for ED-ordination with recipient services such as epidemiological and health services, and to assist in the training of laboratory personnel.

In November 1970, a meeting of technical and administrative staff of health laboratory services was held to reviev the status of health laboratory services.

In 1972, a consultant specialist in health laboratories studied the progress made in India and Sri Lanka in response to the recommendations made by the meeting held in 1970. In 1973-74, a microbiologist assisted Burma in food hygiene microbiology, and has reported on the status of the training of technicians in selected States of India.

COurSe8 on Health Laboratory Techniques HLS 004 (SEARO 0176)

To assist in courses in health laboratory techniques.

The activities of this project started in April 1969, vhen a Seminar on Fluorescent Antibody Techniques in the Diagnosis of Rabies was held in Coonoor (India). This was followed by a consultant's visit in 1970. In 1971, a course an Imuno-Haematological Procedures in Blood Banking was held in Bombay. In 1972, the consultants in their follow-up visits to India, Indonesia, Nepal and Sri Lanka made a number of recomendatians to improve the blood banks and blood bank laboratories and drew up minimum requirements for the guidance of the governments. An inter-country course in public health virology was held in Poona (India) in November 1973. In September 1974, a seminar on rabies vaccine is to be held at Hsffkine Institute, Bombay. An inter-country Seminar on Small Laboratory Animals and Training of Animal Technicians is being planned for February 1975, also to be held in Bombay subject to availability of funds. In 1977, it is proposed to organize an inter-regional-cum-inter-country course on s tandardire tion of biologicals.

Serum Reference Procedures HLS 005 (SEARO 0191)

To build up competence in serum reference procedures in the countries of the Region.

The feasibility of the project was studied in 1971, when a consultant visited selected laboratories in India, Sri Lanka and Thailand. In 1974, a consultant will advise selected laboratories in India, Sri Lanka and Thailand vith a viev to building up experience and skill in short-term storage and the processing of serum for serological surveys. Provision has been made for a further consultant in 1976.

Assistance to the project i s expected to continue till the end of 1975.

INTER

Rehydration Therapy MCH 001 (SEARO 0144)

To a s s i s t i n producing rehydrat ion f l u i d and i n e s t a b l i s h i n g rehydrat ion c e n t r e s i n c h i l d r e n ' s h o s p i t a l s and a t pe r iphe ra l c e n t r e s , and to t r a i n s t a f f .

I n 1967, a consu l t an t v i s i t e d some coun t r i e s and s tud ied t h e f a c i l i t i e s knowledge, t echn ica l adequacy and capac i ty f o r producing rehydrat ion f l u i d s . I n 1970 and 1971, consu l t an t s were ass igned t o Burma, Indonesia , Mongolia and S r i Lanka. Rehydration therapy courses f o r sen io r p a e d i a t r i c i a n s and o the r medical o f f i c e r s engaged i n t h e teaching and/or management of d iarrhoea1 d i seases i n c h i l d r e n , were organized i n Indonesia (1971), I n d i a (1972), Bvrma (1973), and Bangladesh (1974). I n 1972, a consu l t an t a s s i s t e d Mongolia i n planning the production of r ehydra t ion f l u i d s .

I n 1973 and 1974, consu l t an t s paid follow-up v i s i t s t o Indonesia and Ind ia . I n 1974, a c t i o n i s being taken t o prepare gu ide l ines on the management of ch i ld - hood d ia r rhoea i n r ehydra t ion c e n t r e s and h o s p i t a l wards a p p l i c a b l e to the c o u n t r i e s i n the Region. I n 1975, a consu l t an t i n q u a l i t y c o n t r o l w i l l be provided. Also a course i n rehydrat ion therapy w i l l be he ld i n S r i Lanka. I n 1976, t h i s p r o j e c t w i l l be terminated a f t e r an evaluat ion by a consu l t an t , followed by a symposium on rehydra t ion therapy.

Course f o r Senior Teachers i n Chi ld Heal th MCH 002 (SEARO 0163)

To provide advance t r a i n i n g f o r s e n i o r t eacher s i n c h i l d h e a l t h i n developing coun t r i e s wi th t h e o b j e c t of improving educat ion i n c h i l d h e a l t h i n these coun t r i e s .

Assis tance was provided t o t h e UNICEFIWHO t r a i n i n g progranrme f o r senior t eacher s i n c h i l d h e a l t h . I n 1970, a consu l t an t a s s i s t e d i n t h e conduct of a f i e l d education s tudy a t Hyderabad ( Ind ia ) to be undertaken by t h e p a r t i c i p a n t s . Another consu l t an t c a r r i e d o u t , i n the same year , an eva lua t ion of t h e course by interviewing fe l lows from t h e South-East Asia Region. I n 1972, t h e t u t o r of t h e course i n Hyderabad was s e n t t o the United Kingdom and East Afr ica to take p a r t i n t h e teaching progr-e. I n 1973, a reunion meeting of t h e p a r t i c i p a n t s i n t h e previous courses (1967 and 1968) was held i n t h e Regional Of f i ce as a means of f v r t h e r eva lua t ion and follow-up of t h e course. I n 1974, the Di rec to r o f t h e Course i n Hyderabad v i l l take p a r t i n the teaching programme i n t h e United Kingdom and East Afr ica . S imi la r ly i n 1975, i t i s planned to send two co-ordinators a f t h e Indian course t o p a r t i c i p a t e i n t h e teaching i n the United Kingdom and Eas t Af r i ca .

The p r o j e c t i s expected t o continue up to 1975 a f t e r which i t w i l l be merged with p r o j e c t SEARO 0234, "Education end Studies i n Child Health".

Seminar on School Heal th UCH 005 (SEARO 0184)

To enable school h e a l t h o f f i c e r s , pub l i c h e a l t h and maternal and c h i l d h e a l t h planners t o examine methods f o r t h e f u r t h e r improvement of school h e a l t h se rv ices i n the Region.

An in te r -coun t ry seminar was held i n Rangoon i n 1971, and another i s t o be he ld i n Burma i n October 1974. I n 1975, a consu l t an t w i l l undertake a follow-up study of t h e work a l r eady undertaken under t h i s p ro jec t . Group educat ional a c t i - v i t i e s are planned f o r 1975 and 1976.

A c t i v i t i e s under t h i s p r o j e c t w i l l end i n 1976.

Education and Studies i n Child Heal th MCH 010 (SEARO 0234)

To a s s i s t i n f u r t h e r developing t h e education and s e r v i c e progr-es,including s p e c i a l s t u d i e s , i n p r i o r i t y areas i n the f i e l d of c h i l d h e a l t h .

E a r l i e r a s s i s t a n c e was provided f o r t h e UNICEPlWHO t r a i n i n g prograllme f o r sen io r t eacher s i n c h i l d h e a l t h under SEARO 0163.

The undergraduate p a e d i a t r i c c u r r i c u l a i n medical schools of the Region were reviewed i n 1973 under p r o j e c t SEARO 0196, "Education i n Paed ia t r i c s" .

I n 1974, consu l t an t s v i l l v i s i t s e l ec ted coun t r i e s of the Region t o s tudy the magnitude of the problem of l o v b i r t h weight and i t s importance i n c o n t r i - but ing t o p e r i n a t a l morbidity and mor ta l i ty , end to advise on a methodology f a r c o l l e c t i n g information for s t u d i e s t o be undertaken i n one or more of these c o u n t r i e s . I n 1975, based on the methodology recornended and i n s t i t u t i o n s i d e n t i - f i e d , f i n a n c i a l a s s i s t a n c e w i l l be provided f o r such s tud ies . Also, a meeting i s ~ l a n n e d to be held i n 1975, to review the post -graduate p a e d i a t r i c c u r r i c u l a , including the in te rnsh ip per iod. Also a seminar on Education i n P a e d i a t r i c s w i l l be h e l d , s u b j e c t t o a v a i l a b i l i t y of funds.

I n 1977, a group educat ional a c t i v i t y on s o c i a l p a e d i a t r i c and a symposium an p e r i n a t a l problems w i l l be h e l d .


; I I I -

I 1 ;

! 1 i i

INTER-COUNTRY

3.2 Familv Health

3.2.2 Maternal and Child Health

Rehydration Therapy

Short-term consultants Temporary advisers Participants supplies and equipment

C~urse for Senior Teachers in Child Healrh

Temporary advisers

Seminar an School Health

short-term consultan~s Temporary advisers Parficipanra supplies and eqvipmenr

Education and Studies ~n Child Health

Short-term cansvlranrs Temporary advisers Paxiicipanrs Supplies and equipment

Number of Ports p r o j e c t NO.

MCH W 1 (0144)

MCH W 2 (0163)

MCH W 5 (0184)

MCH 010 (0234)

1974


1974

112" i 500 I

4 000 2 5 w ;

- 1 - 9 000 16 750

1 - 1 I !

I1 2 21 2 2 W O - 2W0,

I I

i 11 1 2 m ; 4 4 W iI 8W

1 300 1 1 300 5 W 7 800 7 8W 7 800 ; 5 W 1 5 W 750

_ _ __ 11 600 15 WO 13 850 1

(Expressed in US DollarsA

I I

: I 1 1 1 1 / 3 !

1975 1975 1 1976 1977

I

i

3/3& 213w

i I I

2 000 I 7 200 i

1976

Number of Poirr

! 16 250

1977 1974

i I !

15 000 ' 8 800 1 7 200 710 500 500

9 W O I 7 S W 1 7 800 550 ! 1 WO 750

-

21 4 112v

rn rn 0 " c b. 3

2



21 3

i

I i 1 :

I

I

I

1975 1974

I

1976 11977

I !

!

1

I

I

i i i

! i

!

i

I

i

I i 1 i ! i 1 I

1975 1 1976 1977

INTER

Reqional Team on Family Heal th (UNFPA RASl711FQ3)

MCH 011 (SEARO 0192)

To support country and in te r -coun t ry a c t i v i t i e s i n family h e a l t h wi th r ega rd t o planning, services, t r a i n i n g , management, eva lua t ion and resea rch embracing family h e a l t h , i nc lud ing t h e materni ty-centred approach.

During 1972 and 1973 t h e members of t h e team have provided a s s i s t a n c e a s r equ i red i n the development of t h e family h e a l t h p r o j e c t s i n S r i Lanka, Bangla- desh and Nepal. Since March 1974, one of t h e medical o f f i c e r s of t h e team has been s t a t i o n e d i n Bangkok t o he lp the WHO Representa t ive i n t h e co-ordinat ion of the UNFPA-financed p r o j e c t s i n t h a t country and a l s o t o provide a s s i s t a n c e co same of t h e o the r c o u n t r i e s , p a r t i c u l a r l y Bangladesh and Nepal. Since 1974 t h e p r o j e c t SEARO 0219, "Development of Maternity-centred Aspects of Family Rea l th Servtces" has been merged i n t o t h i s p ro jec t .

From 1975, t h i s p r o j e c t w i l l be a comprehensive one wi th the merger i n t o i t of the o t h e r t~ r e l a t e d p r o j e c t s , SEARO 0199, "Group Education i n Se rv ice , Teaching and Research Aspects of Human Reproduction, Family Heal th and Popu- l a t i o n Dynamics", and SEARO 0209, "Course i n Health Planning f o r MCHlFamily Planning Administration".

The programme of work envisaged inc ludes , a p a r t from a s s i s t a n c e t o t h e on- going country family h e a l t h progranrmes, a s s i s t a n c e i n the formulat ion of p r o j e e t r eques t s and p lans of ope ra t ion f o r new p r o j e c t s , co-ordinat ion and support to country p r o j e c t s , and r e s p o n s i b i l i t y for organizing and support ing t h e group educat ional a c t i v i t i e s t h a t are now t o take p lace under t h i s p r o j e c t . A t t en t ion w i l l a l s o be paid to r e sea rch i n t o and t r a i n i n g i n t h e materni ty-centred approach.

Three group educat ional a c t i v i t i e s are planned for 1975 and two each f o r 1976 and 1977.

I n order t o cover a l l t hese a s p e c t s , and sub jec t to a v a i l a b i l i t y of funds, i t i s expected t h a t the p r o j e c t , a s from 1975, w i l l c o n s i s t of three medical o f f i c e r s , one h e a l t h education s p e c i a l i s t , one s t a t i s t i c i a n , one nurse and a l s o the necessary admin i s t r a t ive support personnel. Excepting the t h i r d post o f medical o f f i c e r , a l l the o the r poscs are continuing ones.

N u t r i t i o n Training and Advisory Services NUT 001 (SEARO 0097)

TO a s s i s t wi th t h e t r a i n i n g of h e a l t h personnel i n n u t r i t i o n and t o advise on pub l i c h e a l t h measures i n n u t r i t i o n .

WHO fel lowships have been awarded f o r a t tendance a t t h e c e r t i f i c a t e course i n n u t r i t i o n s i n c e 1963 and the M.Sc. course s i n c e 1968 a t the National I n s t i - t u t e of Nut r i t ion , Hyderebad ( I n d i a ) . Grants- in-a id have been paid to the i n s t i t u t e up to 1970. UNICEF paid s t ipends to Indian p a r t i c i p a n t s t i l l 1970. From 1971, a s s i s t a n c e to t h e I n s t i t u t e has been continued under p r o j e c t India 0267, "Nut r i t ion Training".

I n 1969. a consu l t an t provided under SEARO 0179. "Nut r i t ion Rehab i l i t a t ion and Rehydration Centres", s tudied t h e f e a s i b i l i t y of e s t a b l i s h i n g n u t r i t i o n a l r e h a b i l i t a t i o n c e n t r e s ; f u r t h e r a s s i s t a n c e i n t h i s regard was proposed to come under t h i s p r o j e c t .

I n 1972, a meeting of exper t s on the prevent ion of xerophthslmia war he ld a t the National I n s t i t u t e of N u t r i t i o n , Hyderabad. I n 1973, s Consul ta t ion on N u t r i t i o n a l Anaemia was held a t the A l l I nd ia I n s t i t u t e of Medical Sciences, New Delhi .

I n 1974, a consu l t an t a s s i s t e d the Government of Nepal i n a s sess ing n u t r i - t i o n a l problems and i n planning and developing a co-ordinated n u t r i t i o n programme f o r the F i f t h Five-Year Plan.

I n 1975, i t i s proposed to organize a Seminar on n u t r i t i o n a c t i v i t i e s i n h e a l t h s e r v i c e s , with emphasis on the prevent ion and treatment of prote in- c a l o r i e m a l n u t r i t i o n . Three consu l t an t s are to a s s i s t wi th the planning and conduct of the meeting.

With the rermination of t h i s p r o j e c t a t the end of 1975, a s s i s t a n c e v i l l be continued under SEAR0 0237, "Nut r i t ion Teaching i n Educational I n s t i t u t i o n s f o r Health Personnel".

INTER-COUmRI

Re~ional Team on Family Health RASl711P03

Senior medical officer P5 Medical officers P4 Health educator P4 statistician ~4 Nurse P4 Clerk-stenographer5 ND4 Cierk-typist hD 3

s h o r r - t e r m consulcanr. iimporarr adv:serr iart1ripan:r hppl1es and equ~pnenr ?Llscellanroui

3.2.3 Hman Reproduction

Grouo Education in Service, Teaching and Research Aspects of Human Reproducrion, Pwily Heelth and Papularlan Dynamics

RRSI~IIPO~

Short-terr consui ra i s imporary advisers Parc~cipanti Supplies and equipmen: Miscellanec~s

3.2.- Futririon

Nurriiion Iralning and Advisory services

Short-cerr cansulranrs participar.:s sop5ire5 anr *qui:,menr

I

R E G U L A R

Number of Posra

1974

B U D G E T

Estimated Obligations Projecr l ia.

UCH 011 (0192)

HRP W 1 (0199)

NLT 001 (0297)

1974 / 1975 ' 1976 1975 1977


O T H E R S O L ' R C E S

1 I

I ; I I I I

i I !

!

! ~ ! I

1 ~ I

i

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I

I 1

! ;

6 0 0 0 1 3 Z W ! 8 O W i

I - 1 G o - 1 -

I !

1 ~~! I

1 i

i 1

!

1 I : i l 1 I ~ i j

1 1 i

1 I I i 1 1 i ! l i 1 i 1 I

1976

l/ 3 3 1 6

1977

Number of Ports

I

1974

i

m u - 0 G b > 3 - I

1975 , 1976 1 1917

Estimated obligation.

PP

PP

I ! ! I

1/11 1/12 1/12 1/12 1/12 2/24 2124 1'12 1/12 ' 1/12 1/12 1112 I : 11 4 1/12 1/12 1/12 11 4 1/12 1/12 1/12 2/24 2/24 2/24 2124 11 5 1/12 1/12 1/12 - - _ _

1974 ~ I975 I 1976

8 9 9 8 1 113 110 191 260 205 630 , 184 990 ---- 19/18 6112 6/12 : 39 4 000 600 28 800 28 8W ' 2 1 4 2 1 3 2 / 3 1 3 000 1 3 000

1977

6i12 41 7

I I

! I

I

I I

36 3 W 37 870 39 540 56 460 61 620 1 32 160 29 300 1 31 480 ' 33 480 29 3 w 31 480 33 480 29 300 31 480 8 33 480 7 600 8 4W 9 2 W 3 W O 3 3 W 1 3 650

- - - 8 -

1 35 000 25 000 1 25 000 3 O W 7 500 5 500 5 500 2 O W 2 m 1 500 : 1 5 W ----

118 110 279 360 269 430 i 248 790 - - 1 -4 - I

i 24 WO 7 ow 39 310 7 W O 3 ow

- 1 80 310

I

j

i i

! ; i I

N u t r i t i o n Teaching i n Educat ional I n s t i t u t i o n s f o r Health Personnel

To s t r eng then the t each ing of n u t r i t i o n i n educat ional i n s t i t u t i o n s f o r h e a l t h personnel , and t o a s s i s t i n developing gu ide l ines f o r problem-oriented n u t r i t i o n t each ing i n c u r r i c u l a f o r h e a l t h personnel.

I n 1976, i t i s proposed t o organize a workshop on the teaching of n u t r i t i o n i n medical schools . I n 1977, t h i s i s t o be followed by a workshop on t h e teaching of n u t r i t i o n i n educat ional i n s t i t u t i o n s f o r non-medical h e a l t h workers.

Developmenr of Health E d u c o c i ~ n i n Yamilv Health Programe (UNFPA RASI71lP07)

To a s s i s t i n developing, implementing and eva lua t ing t h e e f fec t iveness of t h e h e a l t h educat ion component of family h e a l t h programmes; i n improving the q u a n t i t y and t h e q u a l i t y of informat ion, educat ional and teaching mate r i a l s used f o r family h e a l t h educat ion; i n providing cont inuing education to s t a f f o f t r a i n i n g i n s t i t u t i o n s and key h e a l t h education personnel i n d i f f e r e n t a s p e c t s of family h e a l t h educat ion; and i n developing resea rch c a p a b i l i t i e s i n family h e a l t h education.

A mul t i -d i sc ip l ina ry workshop held i n 1971 examined t h e e x i s t i n g progr-es f o r t h e development of h e a l t h educat ion media r e l a t e d to family h e a l t h and formulated gu ide l ines f o r the co-ordinated product ion, u t i l i z a t i o n and evalua- t i o n of media a t d i f f e r e n t l e v e l s of t h e h e a l t h admin i s t r a t ion . To help apply these gu ide l ines and to determine a d d i t i o n a l e f f o r t s needed,a short-term conaul- t a n t v i s i t e d tvo coun t r i e s i n t h e fa l lowing year . I n 1971, a workshop on t h e development of h e a l t h education media, wi th p a r t i c u l a r r e fe rence t o family h e a l t h was conducted. I n 1973, a t r a i n i n g course i n s o c i a l sc i ence re sea rch methodology was h e l d , and i n e a r l y 1974, a working group meeting on teaching and t r a i n i n g resource m a t e r i a l s i n family h e a l t h educat ion was held; these are to be fallowed by another seminar on t h e assessment of h e a l t h education and mass communication media programme i n family hea l th . The h e a l t h education s p e c i a l i s t and group educat ional a c t i v i t i e s w i l l be continued i n 1975.

Assis tance t o be provided i n 1976 and 1977 w i l l be s i m i l a r t o those i n the preceding N o years , bu t group educat ional a c t i v i t i e s w i l l focus an d i f f e r e n t a s p e c t s of family h e a l t h educat ion, family h e a l t h education and mass comuni- c a t i o n programmes, and new d i r e c t i o n s f o r h e a l t h educat ion a c t i v i t i e s t o support t h e adoption of family planning. The hea l th education s p e c i a l i s t w i l l be con t i - nued and supp l i e s and equipment and support ing se rv ices w i l l be provided.

The p r o j e c t i s expected t o cont inue f o r a number of years , sub jec t to a v a i l a b i l i t y of UNPPA funds.

INTER


To stimulate and encourage Member countries to develop continuing education programmes for nurses and assistant nurse-midwives; to assist institutions and health centres in the planning and organization of continuing education for nursing/midwifery ~ersonnel on the basis of local needs and demands; to develop, compile and publish reference materials geared to the needs of nurses/midwives at the primary health care level, and to encourage and promote the collection, exchange and evaluation of information and studies in continuing education.

Since 1967, country and inter-country courses have been held in various countries, covering a vide range of subjects and involving participants from a number of health disciplines. The aim of this project is to provide assistance, through short-term staff assignments, to conduct courses for nurses/midvifery personnel in both hospitals and health centres directly concerned with rendering primary health services. Special emphasis will be laid on the development of technology and integrated teaching methods, relevant to the needs and preparation of nurses/midwives involved in community health work, including family planning, especially in rural health services. Activities will also include development of reference materials, and eventually publication of pertinent materials, that may be useful for nurses in Member countries, and also to develop a depository or data bank pertinent to education and services useful to planning nursing in the Region.

In 1976, two inter-country courses will be held an Educational Technology for Tutors in Nursinghlidwifery Programmes, and Multi-professional Training in Community Health and in 1977, one inter-country course will be held on Develop- ment of Integrated Education in Nursing/Midvifery Schools.

Education and Trainrnn of Environmental Health Personnel

TO assist in the training and utilization of engineers and other personnel in various aspects of environmental health.

Assistance under this project started in 1970 when consultants were assigned to assist in the development of training programes. Io addition, two regional seminars were organized with the help of consultants - one in 1972 on air pollution control and the other on edveation end training in sanitary engineering in 1973.

In 1974, it is proposed to recruit two consultants to study, in selected countries of the Region, the manpower requirements and planning for environmental health personnel and to prepare on the basis of their findings, practical working guidelines for policy formulation and methodology in manpower planning. In 1975, it is planned to hold a regional workshop on manpower planning with the help of t m consultants, who, in addition, will assist the countries in the further development of Specialized education and training programmes in environmental health.

Assistance will be discontinued at the end of 1975.

UHO-spooe~red Training Centre for Nurses (Wellington, New Zealand)

To provide a training prograrmne for nurses from the Region who cannot obtain admission to other post-basic courses because of lack of secondary education and/or language skills required for admission.

The Centre was opened in January 1970. Eight students attended the first year's course, eleven took part in the second year, Nelve in the third year, and fourteen in the fourth year. Ten students have been enrolled in 1974. Pello~hips are provided under the respective country projects.

In early 1974, two faculty members of the Centre paid follow-up visits to meet the graduates in Indonesia, Thailand and Nepal co determine the relevance and suitability of the training received at the Centre.

Provision at the current level is continuing in 1976-1977

(Expressed in US Dollsrs~


i I !

I ! i

ConLinuin~ Education for Nurses HMD 001 (0139 1

I !

76 220 59 120 63 740 Nurse educators P3 i I 1 600 8 400 ! 9 200 Clerk-stenographers ND4 ! - I

- , - - ' , - I I

i Short-term consultants

i Temporary advisers Participants

2 0 0 0 ' 2 m supplies and equipment i , - ! :

j Education and Training of m m 2 i i Environmental Health Personnel (0150) I

I ! 12 000 8 800 Short-fern consultants

participants I ! Supplies and equipment i : I

- , - i 15 O W 20 4 W

I i ! 1 Connnun~ty Health Aspects of HHD W 3 ! !

I 1 Medical Education (0171) I i I

i 11 1 2 W O I Short-term consultant

I

l ParriclpanLs I ; I I

I Supplies and equipment

! I i 4 I

i ! i WHO-sponsored Tralninp. Centre lQlD 004

I for Nurses (Uell~naron, Liew (0194) I Zealand) 1 i I

20 W O 20 000 . 1 I - - Grant i ! I I i !

I

I i

INTER-COUNTRY

4. HEaLLTH HlUiPdJER DEVELOPPIENI


Liumber of port. Project NO.


1974 1 1975 1976 1974

O T H E R S O V R C E S

I i I 1 ! !

!

1976 1977 1975 1977

! I

umber of ~ o s r r

1974

m u v " c L.

5 3 u.

$ - 1975 1976 ; 1977

Erfimared Obl~gations

i

1977 1974

I i

!

1975 1 1976

INTER

P a r t i c i p a t i o n i n Meetings m 005 (SEARO 0216)

To provide f o r p a r t i c i p a t i o n of na t iona l s p e c i a l i s t s i n group educat ional a c t i v i t i e s and conferences i n d i f f e r e n t d i s c i p l i n e s ; a l s o t o provide support t o a c t i v i t i e s c u r r e n t l y a s s i s t e d under i n t e r - r e g i o n a l p r o j e c t s , and s u i t a b l e f o r implementation i n t h i s Region.

Provis ion f o r p a r t i c i p a n t s i s planned for a number of y e a r s

Educat ional Technolog1 HPlD 006 (SEARO 0235)

To promote t h e es tabl ishment of educat ional technology c e n t r e s i n the c o u n t r i e s of the Region f o r t h e l o c a l production of teaching m a t e r i a l s f o r educat ion and t h e t r a i n i n g , i n i t i a l l y , of medical t eacher s and l a t e r on of o the r l e v e l s of h e a l t h workers; t o provide support t o t h e teacher t r a i n i n g c e n t r e s i n d i f f e r e n t coun t r i e s of t h e Region, and t o he lp i n the conduct of courses f o r n a t i o n a l personnel concerned wi th t h e production of educat ional ma te r i a l s .

TWO Regional Medical Teacher Tra in ing Centres are a l r eady funct ioning i n t h e Region and support i s being provided f o r s e t t i n g up Medical Teacher Tra in ing Centres i n o t h e r c o u n t r i e s . Considerat ion i s a l s o being given to t h e e s t a b l i s h - ment of a comprehensive Educat ional Technology Uni t i n t h e Region wi th a s s i s t a n c e from WHO Headquarters. This p r o j e c t v i l l a s s i s t and support t h e a c t i v i t i e s of these c e n t r e s and t h e U n i t and func t ion i n c l o s e co l l abora t ion wi th p r o j e c t s SWLRO 0096, "Medical Teacher Tra in ing and Continuing Education", SEARO 0139, "Short Courses for Nurses and Heal th Personnel", SEARO 0198, "Regional Centre f o r Documentation on Human Reproduction, Family Planning and Populat ion Dynamics" and SEARO 0206, "Medical Education i n Human Reproduction, Family Planning and Populat ion Dynamics".

The educat ional t echno log i s t s v i l l func t ion as resource persons t o advise t h e i n s t i t u t i o n s i n t h e s e t t i n g up of educat ional technology u n i t s , i n t h e product ion of teaching m a t e r i a l s , i n the conduct of courses f o r n a t i o n a l person- n e l f o r the production of educat ional ma te r i a l and i n helping group educat ional a c t i v i t i e s .

I n 1975, a group educat ional a c t i v i t y on educat ional technology i s proposed to be held i n SEARO f o r hn, weeks. I n 1976-1977, an educat ional techno- l a g i s t consu l t an t w i l l be provided.

The p r o j e c t i s expected to continue f o r about 6 years .

Medical Teacher Tra in ing and Continuing Education, Phase I1 HMD 007 (UNDP US1681769 and USl731028) (SEAR0 0096)

The p r o j e c t i n i t s second phase aims a t t r a i n i n g medical t eacher s i n modern concepts and p r a c t i c e of educat ional sc i ence , as app l i ed t o teaching medicine, and a t a s s i s t i n g i n the es tabl ishment of sys temat ic programmes f o r cont inuing education.

The ob jec t ives w i l l be achieved by a s s i s t i n g i n :

(a) f u l l development t o s e l f - s u f f i c i e n c y of t h e two Regional Medical Teachers ' T ra in ing Centres ( i n Bangkok and Peradeniya), where medical educators and l e a d e r s of na t iona l medical education u n i t s w i l l be t r a ined ;

(b ) es tabl ishment o f n a t i o n a l medical education u n i t s i n Burma, Ind ia , Indonesia and Mongolia, and

( c ) demonstrating a method of c m t i n u o u s education by holding s h o r t r e f r e s h e r courses repeated by n a t i o n a l groups a t country l eve l .

I n 1974 and 1975, two regional t eacher s ' t r a i n i n g courses and four r e f r e s h e r courses w i l l be organized. Subsequently, tvo more regional teachers ' t r a i n i n g courses and four s h o r t r e f r e s h e r courses vill be organized. Also n a t i o n a l medical edvcat ion u n i t s i n Burma, I n d i a , Indonesia and Mongolia v i l l be s t a r t e d wi th WHO a s s i s t a n c e . One tvelve-month and two three-month f e l l o v s h i p s i n medical educat ion vill be avarded t o medical t eacher s each year.

Assis tance v i l l be reviewed i n 1975 f o r cont inuat ion of the p r o j e c t up t o 1977 sub jec t t a a v a i l a b i l i t y of UNDP funds.

INTER-

Medical 6:ducarian rn liuman Reprod~ctlon, Familx Planning and Populariun Dynaxics (LINTPA RASl7lIm5)

To assist in the planning, preparation, conduct and evaluation of short training courses for senior medical teachers in order to improve further the teaching of human reproduction, family planning and population dynamics in medical schools of the Region.

The first course was held in 1972 at the National Institute of Family Plan- ning, New Delhi. A second course was held in Dacca, Bangladesh, in 1973, and in 1974 a course is planned to be held in Denpasar, Indonesia. A course is planned to be held in Thailand in 1975.

Guidelines for the teaching of these subjects have been developed and,after validation,will be issued in a loose-leaf format. This programme is utilizing modern pedagogical methods and audio-visual materials. Sets of these materials will be provided to medical schools. It is proposed to evaluate these progranmes. The medical educator under this project will continue to develop and co-ordinate these activities in relation to country programmes.

Similar activities are planned for 1976-1977, subject to availability of UNFPA funds.

~idemiological Surveillance and Training ESD 002 (SEAR0 0193)

To assist in strengthening epidemiological surveillance programmes directed towards priority diseases, in introducing epidemiological surveillance activities into the functions of local health services, and in training staff.

The project is an expansion of an earlier project, SEARO 0146, "Regional Enteric Infections Team", and takes into account relevant resolutions.of the Regional Cornittee and the World Health Assembly. Emphasis has been laid on the development of methods of surveillance and aseessment of imnization progr-es.

lo 1971,the team consisting of a virologist and a bacteriologist,moved to the National Institute of Communicable Diseases, Delhi; it undertook a study of the incidence of various communicable diseases in the Region and completed the collection of baseline data in respect of the more important diseases.

In 1972, a WHO consultant reviewed the situation with regard to venereal diseases in Burma and made recommendations for further improvement.

A consultant epidemiologist (chief of epidemiological services in Sri Lanka) was assigned to the project as Team Leader from December 1972 to June 1973. He carried out a retrospective analysis and collected data on cholera in the countries of the Region. An analysis of data pertaining to haemorrhagic fever and poliomyelitis was also made. He also collected information from available reports concerning the organization of epidemiological surveillance progr-es in the Region.

Similarly, another consultant epidemiologist (chief of epidemiological services in Thailand) was assigned as team leader from August 1973 to February 1974. The Team, consisting of the epidemiologist and the microbiologist, compiled information regarding surveillance activities in the countries of the Region. In December 1973, the team visited Sri Lanka and provided assistance in fighting an outbreak of cholera. The Team Leader visited Indonesia in January 1974 end reviewed surveillance of various infectious diseases in that country. The microbiologist completed his assignment in December 1973.

The team has provided advice end assistance to Burma, India, Indonesia, the Maldives, Nepal and Sri Lanka in strengthening their epidemiological services and also in training activities, such se the Delhi part of the training of participants in the International Training Course on Epidemiology (Prague - Delhi), sminars on cholera control, etc. It has collected and dis- seminated data on diphtheria, pertussis, tetanus and polio which have been sent to countries in the Region.

In 1975, the project SWUM 0113, "Tuberculosis Training and Evaluation Team" vill be merged into this project and from 1976, the project (SEAR0 0193) will be merged into SEARO 0238, "Strengthening of Epidemiological Surveillance and Control of Comunicable Diseases".

4 WO Temporary advisers I 11 3 I Fellowship

i

i Supplies and equipment i

i I

I I 8 - i I

i I I

INTER-COUNTRY

Medical Educarion in Human Reproduction. Family Planning and Population Dynamics

RASI71IP05

Medical edvcarar P5 Cleik-stenographer ND4

Short-term conrulfanfs Temporary advisers Participants Sub-contiact Supplies and equipment Miscellaneous

5 DISEASE PREVENTION AND CONTROL

5.1 Comnicabie Direase Prevention and control

5.1.2 Epidemioloxical Surveillance of Camunlcable Diseases

Epidemiolagrcal Surveillance and Training

Epidemrolagxri Statistician P3 Laboratory rechnicran P3 Clerk-stenographer NO4 Clerk-stenographer COL6

Short-term c a n s ~ l ~ a n t ~

B P U L E T

Esrimared Obligariono

1974 1 1975 ' 1976 I 1977

I

!

i I

i 1 I

I ! 27 4 W 27 4 W 27 1.00 I 3 800 2 520

- 8 - 16 300 88 520

I

R E G U L A R

Number of Posts

4 000 I 4 400

1974

Frojecr No.

rW, 008 (0206)

ESD 002 (0193)

1975 11976

1Emresred in VS Dollarrl

O T 9 E R S O U K C E S

1977

!

I i

i

1 I

1 I

I 6

1/12

-- 2

m a m

" < b 2 3 .. $

1/12

1/12 1112

5

Number of P o r t r

--

I I !

! I

I I

1 ! I 1

1

1974

Esrimared Obligations

I i

1 1 I

1

I I

i i

1975 1976 ; 1917

1/12 1/12 8 1/12 1112 11 8 1/12 1/12 1/12 - - - - 2 2 2 2 ----

31 6 31 6 31 6 31 6 21 2 21 2 2; 2

1977 1974

1

3 800 4 2 W

i 34 550 36 120 : 37 790

4 6 W - - - - 35 850 ' 38 350 40 320 42 390

12 000 13 2 W 14 4 W 14 400 2 WO 2 0 W 2 W O

31 426 26 MX) 26 000 1 26 O W I 8 W O 7 0 0 0 6 0 W

4 500 13 WO 7 000 1 7 WO 2 500 2 500

I 1975 ! 1976

INTER.

Strengthenin8 of Epidemiolo~ical Surveillance and Control of Communicable Diseases

ESD 003 (SEARO 0238)

To assist in strengthening epidemiological surveillance and control of communicable diseases, both acute and chronic.

As a result o f a critical evaluation of inter-country projects concerning communicable diseases, a new comprehensive project has been formulated, to start in 1976, with the aim of improving its effectiveness and efficiency. This project will include, among other things, the activities so far carried out by projects SEARO 0113, "Tuberculosis Training and Evaluation Team", SEARO 0153, "Training in Immunology", SEARO 0168, "Training in Veterinary Public Health Services", and SEARO 0193, "Epidemiological Surveillance and Training".

The project is expected to continue for a number of years

Assessment Tram on ELalaria Eradication MPD 001 (SEARO 0007)

To make independent assessment of malaria controlleradication programmes, inclcding any special aspects, in countries of the Region.

The assessment team, transferred from Headquarters to this Region in 1959, worked in Thailand until mid-1961. It was reconstituted in 1963 and carried out an assessment of the progrmes in Sri Lanka (1963) and Nepal (1965). The team also undertook a study of the problem of chloroquine resistance in Thailand in 1965. Reconstituted as necessary, it has carried out, since 1967, assessments and evaluations of the progrmes in the Region. In 1974, it assisted in carrying out an independent assessment of the Nepal malaria programme. Assessments of the malaria programmes in Indooesir (Irian Jay=), Maldives and Thailand are planned during the remaining part of the year. As most of the programmes in the Region have still areas in the attack or consolidation phase, the need for periodic assessments to determine the readiness of areas for entry into the next phase continues to exist.

In 1976-1977, provision is, therefore, inclvded for short-term consultants, for inter-country border malaria co-ordination meetings and supplies and equipment.

Assistance to the project is expected to continue for a number of years

External Cross-check in^ of Blood Films Mm) W2 (SEARO 0094)

To assist in developing facilities in the countries of the Region for the independent cross-checking of blood films from malaria programmes.

Pursuant to a resolution adopted at the fourteenth session of the Regional Committee, a reference centre was established, in collaboration with the Government of India, at the Central Research Institute, Kasauli, in 1963. Assistance to this centre was continued up to the end of 1966. Following the recommendations of the Regional Committee at its twentieth session, a laboratory technician was provided from mid-1968 to make periodic visits to covntries and help in establishing independent cross-checking centres. This technician, who was stationed in Colombo, assisted the Anti-malaria Campaign in Sri Lanka in the setting up of cross-checking centres, and in laboratory aspects. He visited Burma in 1971 and Indonesia in 1971 and 1972, to render similar assistance. At the request of the Government of Indonesia, he was reassigned in 1972 to Jakarta, where he continues to render assistance in the laboratory aspects of the programme.

In 1976, the project will continue with one laboratory technician and a small amount of supplies and equipment, and from 1977 onwards, it is proposed to absorb this project into one of the country projects.

- (Ex~resred in US Dollnral

Srrenstheninp, of Eoidemiolo~ical ESD 003 I 1 Surveillaoce and Control of (0238)

Cmunicable Diseases

Epiderni~logi~f Clerk-stenographer - -

41 lk0 43 210

21600 21603 Short-term conaultanLs 6 000 , 6 O W Temporary advisers 9 000 ' 9 WO PBrLlcipBnT3 5 000 I 5 O W Supplies and equipment

5.1.3 Malaria and Other Parasitic

Eradication

ShmC-term conbuitant~ Participants Supplies and equipment

External Cross-checkins of Blood Films

~aboratory specialist

Supplies and eqvlpment

INTER-COUNlXY p r o j e c t

KO.

R E C K L A R B L ' D G E T

Number of Posrs

I 1974 , 1975 ! 1976 11977

Estimated Obllgarions

1974 1975 1976 ' 1977

U T R E R S O L ' R C E S

Number of Porrn

1974 11975 1976 '1977

m u m " c k 3 3 ... 2 -

Estimated Oblrgaclons

I 1974 1 1971 1976

I 1977

I

INTER.

Seminar on Advanced Malaria Epidemiology

To hold, periodically, seminars on advanced malaria epidemiology with a view to exchanging information on the changing epidemiological patterns of malaria in the Region.

Following a special course on advanced epidemiology, held in New Delhi in 1964, three seminars on the same subject were held - in the Regional Office in 1967, in Colombo in 1969 and in Prabudhabat (Thailand) in 1973. The seminars organized in the past have proved profitable to the epidemiologists of malaria programmes in exchanging technical information and it is planned to organize a similar seminar in 1977 in one of the countries of the Region. In 1975, it is proposed to organize the Seventh Asian PLalaria Canference.

In 1977, provision is included for short-term consultants, a temporary adviser, and participants together with a small amount for suppliea and equipment.

Smallpox Eradication and Epidemiological Advisory Team SHE 001 (SEAR0 0030)

To co-ordinate the national smallpox eradication progr-ea of the Region; to assist the remaining three countries of the Region which are still reporting mallpox cases, i.e. India Bangladesh and Nepal, to achieve smallpox eradication by 1977; to help, when necessary, the governments of the smallpox-free countries of the Region to strengthen their vaccination and surveillance progranmes so as to prevent re-establishment of the disease, should importation into the countries occur, and to assist the governments in the assessment of their smallpox eradication programmes, including the final assessment to determine the smallpox-free status of the Region.

The present phase of the project started in 1966, since when assistance has been provided to most countries of the Region. The staff assigned to the project have helped in preparing plans of operation of smallpox programmes, participated in assessments and conducted courses and seminars on smallpox surveillance.

By 1974, the staff assigned to the project had been increased from m to four medical officers. An administrator was assigned to the project as well as two additional clerklstenographers. A consultant assisted in the administrative aspects of the project in 1974.

Since 1972, several millions of training aids, awareness posters, reporting forms, charts, maps, etc. have been dram up, printed and despatched to the countries of t h Region.

Since mid-1973, when an intensified smallpox campaign was started in India and Bangladesh, the medical officers of the project have periodically organized and attended snvlllpox progress meetings at Central, State, regional and district levels in the majority of States of India, and assisted in the training of State surveillance teams as well as lower level staff. Periodic assessment of strategic areas was made and, where necessary, assistance given in the field for the organization and implementation of local programoes.

The project co-ardinated the inter-country cross-notification of smallpox cases and the implementation of s uniform reporting system. The regular testing of the locally produced vaccine by WHO reference laboratories, as well as the testing of specimens from suspect smallpox cases, was arranged. In 1970, a course for technicians in the laboratory diagnosis of smallpox was held in Indonesia; during 1971, consultants visited the smallpox diagnostic laboratories in the Region as a follow-up of the course. In 1972, a regional course on the laboratory diagnosis of smallpox was held in Delhi.

A monthly regional surveillance report was dram up and issued to all health workers at all levels in the countries reporting smallpox in the Region.

From 1975 to 1977, the above activities will be intensified, m d the project will organize the final assessment in India, Bangladesh and Nepal in 1977, vhen it is expected that these countries will be officially declared smallpox-free.

The project is expected to continue for several years.

1/12 1 Medical officer P4 1/12

I ~ I SLBfistician P3 I 1/12 ! Public health nurse PI ! 1/12 ! LaborPtocy technician P3 1/12 1 I Clerk-stenographer - COL6 - 5 100 900 1 - I

2, 2 1 4 W ~ i Short-term c~nrul~ancr 1/2u i 5 W Temporary advisers I

5 W O 1 Supplier and equipment ~

- 8

- ~ I 1 1 110 400 ! ! I

I

INTER-COUNTRY

Seminar on Advanced nalarie Epidemiolo~y

Short-term consultants Temporary advisers Participants Supplies and equipment

5.1.4 Smellpox eradication

smallpox ~~adication and Eoidemialor,ical Advisory Team

Medical officers P4 Medical officer P3 Administrative officer P2 Clerk-stenographers Nu4

Short-term consvlianra Supplier and equipment

5.1.6 Mycobacrerial m ire ares

Iuberculorir Trainln* and Evaluation T e w

R E G U L A R

1974

2/24 1/11 1 9 2/24 -

5/26

B U D G E T

EsLimared Obligarions Project NO.

KPD ~3 (0114)

sm w i (W30)

UBD 001 (0113)

1974

Number

1975

21 1 21 1

2/24 1/12 1/12 2/24 -

---- I/ 2

(Expressed in US DollsrQ

1975

of Posts

1976

i

2/24

2/24 - 6 6 4 4

11 2

1 1- 1 OOO - -

1 16300 16 500 8 - ~ -~

I

1977

21 1 21 1

2/24

2/24 -

11 2

1 !

2 2 W 2 4 W 1 MO 1 1 0 0 0 12 100 12 1 W

1 1976

Number of Posts

-

1977 1974

I I I

54 8 W I 60 720 64 740 27 400 20 1 W ) I

!

7 6 W 8 4 W ' 9 2 W - - , -

m u - " s ,. 2 > -

0

VS

O T H E R S O V R C E S

Estimated Obligation.

97 780 109 9 0 0 69 120 , 73 940

52 O W i 44W 4 800 4 8W I T 3 000 3 W O 3 Om --

-~ - 152 780 117 I@3 7b 920 81 740 - - - -

I I I

i I

I i

1 ~ I : i I ~ 1 i ~

I I #

i

1975 1974 1976 / 1977 I I

!

I

I i 1

i I

! I

! i I

;

i i

j I I

9 765 - ,

9 765 i - 8

I I

1975 1 1976 1977

Tra in ing i n Veter inary Publ ic Heal th and Promotion of Veter inary Publ ic Heal th Services

TO a s s i s t i n t r a i n i n g v e t e r i n a r y pub l i c h e a l t h o f f i c e r s .

INTER

WH 001 (SEARO 0168)

Assis tance s t a r t e d i n 1968, when a consu l t an t v i s i t e d t r a i n i n g i n s t i t u t i o n s i n I n d i a and developed a two-year post -graduate course i n ve te r ina ry publ ic h e a l t h , which s t a r t e d i n 1970. I n 1969, another consul tant advised on t h e development of animal d i sease i n t e l l i g e n c e se rv ices i n Ind ia and a l s o s tudied t h e s t a t u s of ve te r ina ry pub l i c h e a l t h and t r a i n i n g i n Indonesia and Thai land. I n Apr i l 1970, the f i r s t Regional Seminar on Veterinary Publ ic Heal th was held i n Ind ia . Consul tants v i s i t e d Ind ia and Thailand during 1971 to follow up on the recornendat ions of t h e seminar. Ear ly i n 1972, a WHO consu l t an t v i s i t e d C a l c u t t a and a s s i s t e d i n t h e conduct of the tuo-year Mas te r ' s degree programme i n v e t e r i n a r y pub l i c h e a l t h a t t h e Al l - India I n s t i t u t e of Hygiene and Publ ic Health. He a l s o went t o Thailand to advise on t h e problem of r a b i e s as wel l as on t h e production of r a b i e s vaccine i n t h a t country.

A consu l t an t v i s i t e d Thailand i n Apr i l 1973 t o a s s i s t wi th prel iminary arrangements f o r an in te r -coun t ry Seminar on Veterinary Publ ic Heal th (combined with i n t e r - r e g i o n a l Seminar on Epidemiological Survei l lance and Zoonoses) which was he ld i n Bangkok i n October 1973.

I t i s planned t o hold another combined seminar ( in t e r - reg iona l end i n t e r - country) on v e t e r i n a r y pub l i c h e a l t h i n New Delhi i n October 1974. I n 1975, another group educat ional a c t i v i t y i s planned.

From 1976, t h e p r o j e c t w i l l be merged with SEARO 0238, "Strengthening of Epidemiological Surve i l l ance and Control of Communicable Diseases".

E~ idemio logy , Control , and Management of Cardiovascular Diseases

CM 001 (SEARO 0228)

To a s s i s t i n conducting group educat ional a c t i v i t i e s f o r the evaluat ion of t h e magnitude of t h e cardiovascular d i seases ; t o a s s i s t i n a s sess ing the cu r ren t s t a t u s and promoting f a c i l i t i e s f o r e a r l y de tec t ion , d i agnos i s , t r e a t - ment and r e h a b i l i t a t i o n ; i n i n t e g r a t i n g t r a i n i n g and s p e c i a l i z e d s e r v i c e f a c i l i - t i e s i n t o the publ ic h e a l t h d e l i v e r y system and i n co-ardinat ing epidemiological i n v e s t i g a t i o n s on a reg iona l b a s i s .

-COUNTRY c b7 m.

I n 1974, th ree consu l t an t s a s s i s t e d i n the conduct of a Workshop on Stroke and Rehab i l i t a t ion of Stroke P a t i e n t s a t t h e I n s t i t u t e of Neurology, Madras ( I n d i a ) .

A consu l t an t i n cardiology v i l l a s s i s t i n t h e conduct of a seminar on ca rd iac r e s u s c i t a t i o n and r e h a b i l i t a t i o n i n 1975.

I n 1976-1977, i t i s proposed to a s s i s t wi th group educat ional a c t i v i t i e s .

Mental Heal th

TO a s s i s t i n evaluat ing t h e magnitude of mental h e a l t h problems; i n a s s e s s i n g t h e cv r ren t s t a t u s of p s y c h i a t r i c s e r v i c e s , t r a i n i n g and resea rch ; i n organizing group educat ional a c t i v i t i e s f o r t h e promotion o f community- o r i e n t e d mental h e a l t h care se rv ices ; i n co-ordinat ing on a reg iona l b a s i s , epidemiological i n v e s t i g a t i o n s of mental i l l n e s s , and i n s tudying the socio- economic aspec t s of mental h e a l t h .

A Seminar on the Teaching of Psychiat ry was he ld i n New Delhi i n 1970. I n 1971, provis ion was made for p a r t i c i p a t i o n i n t h e i n t e r - r e g i o n a l Seminar on P s y c h i a t r i c Diagnosis, C l a s s i f i c a t i o n and S t a t i s t i c s . A seminar on t h e Teach- ing o f Psychiat ry i n Medical Colleges was held i n Colombo i n 1972. I n 1973, a consu l t an t a s s i s t e d i n the conduct of a Seminar on Community Action f o r Mental Health Care held a t t h e Al l - Ind ia I n s t i t u t e of Mental Heal th i n Bangalore.

I n 1974, th ree consu l t an t s w i l l a s s i s t i n t h e organizat ion and conduct of the Seminar on Training of P s y c h i a t r i c Personnel f o r Community Oriented Hea l th Care i n Bangkok.

A seminar on the epidemiology and management of mental d i s e a s e s w i l l be held i n Indonesia i n 1975 and w i l l be a s s i s t e d by two consu l t an t s .

I n 1976, a team of two consu l t an t s w i l l a s s i s t a group educat ional a c t i v i t y , and i n 1977 a consul tant v i l l be provided.

The p r o j e c t i s expected t o cont inue t i l l the end of 1977.

I n 1973, tw consu l t an t s v i s i t e d Bangladesh, Burma, Nepal, Indonesia , S r i Lanka and Thailand t o review t h e cu r ren t s t a t u s of se rv ices for the prevent ion and c o n t r o l of cardiovascular d i seases and recommended epidemiological i n v e s t i - ga t ions .

- R E G C L A R B U D G E T

INTER-COUNTRY

Seminar and Traininx Course in Leprosy Control Methodology

Short-term coneulcanr Supplies and equipment

5.1.9 Veterinary Public Health

Training in Veterinary Public Health and Prwocion o f Veteri- nary Public Health Services

Shorr-term conrultants participants Supplies and equipment

5.2 Non-communicable Disease prevention and Control

5.Z.3 Cardlovascular Diseases

Epidemiology, Control and nanapement of Cardiovascular Diseases

Short-term ~anaulranrr Temporary advlrerr ~arricipants Supplies and equrpmen:

5.2.b Menial Healtn

Mental Health

Short-term coniulranfr Participants Supplies and eqirpmeni

Eotimared Obligarionr

I 1974 1975 1976 197:

I i 6 W O , i 1 W I

- 8

6 l W -

Number of Posts Pmjecr

No.

nBD W 2 (0138)

W H 001 (0168)

C M W l (0228)

NNH 001 (0172)

12 000 4 4 W ' 7 8W ! 5 8W

I 2 W 5 W - 1 - 20 W0 1 10 7 M I - , -

b 600 7 200 7 2 w 7 W 1 WO 5 W

8 400 7 800 7 8 W 7 8W 1 m 2 W O - - - -

i 18 LOO 17 100 is wo 15 jw - - - -

6 W O , i LW $ 800 i 200 7 8 W . 3900 11000 500 Z 000 1 M o , 1 000 - - - -

14 300 10 300 16 800 , 8 200 - - , - !

I 1974 1975 11976 1977

(Ex~ressed in C S Dollarsl

I I

I

! ; I

I

u - " c . L . 3 3 ". $ r. 1974



1974 1 1975 1975

I

! 4

i

I I 1

I

I I

i !

i I

i I

i I

1976

I I

i i I

I

I

!

! I ! i

1976 1977 1977

INTER

Epidemiology and Control of Drug Abuse and Rehabilitation of Drug Dependents

ADA D01 (SEAR0 0227)

To assist in evaluating the magnitude of the problem of drug abuse; to advise on strengthening the facilities for training and services for the control of drug abuse; to advise on the epidemiology of drug dependence; to assist in co-ordinating the activities concerning drug abuse, prevention and control on a regional basis and in developing health education for the control of drug abuse.

In 1973, hn, consultants visited Burma, Indonesia and Sri Lanka to assess the problem of drug abuse and advised on epidemiological investigatiane. In 1974, three consultants will assist in the conduct of a seminar on epidemiology of drug abuse in the countries of the Region.

Provision has been made in 1975 for a consultant to visit the countries and evaluate measures taken far the control of drug abuse as a follow-up measure. Consultants vill also be provided in 1976 and 1977.

Training in h u n o l o g ~

TO review the progress in inrmunology, particularly as related to communicable diseases, and to contribute towards increasing the competence of national immunologists.

After the holding of two workshops - one on the molecular basis and the other on the cellular basis of the immune response - in Delhi in 1968, two consultants paid follow-up visits in 1969 under project SEAR0 0166, "Workshops on Cellular and Molecular Basie of the Immune Response". In 1970, hn, consul- taut8 visited various institutes in the Region in order to explore the possibility of establishing a WHO Regional Research and Training Centre in Immmology. Assistance was provided in 1970 and 1971 in studying the imunological aspects of denguelhaem~rrha~ic fever in Thailand. In 1972, ten fellowships were provided for attendance at various hunological courses. An inter-country vorkshop covering the immmology of comunicable diseases was held in Bangkok in August- September 1972, reviewed developments in immunology and provided demonstrations of iormunologieal techniques to the participants. A WHO meeting of investigators of immunological problems in leprosy research, organized by WHO Headquarters, MS held in the Regional Office in November-December 1972, to reviev the status of the results of research in the subject.

The first inter-regional Course on I-nology is planned to be held in September-October 1974 at the IMRIWHO Inrmunology Research and Training Centre at the All-India Institute of Medical Sciences, New Delhi.

From 1976, the project vill be merged with SEARO 0238, "Strengthening of Epidemiological Surveillance and Control of Communicable Diseases".

Quality Control of Biological end Pharmaceutical Products

SQP 001 (SEARO 0154)

To assist countries of the Region in establishing or strengthening their quality control services and in improving laboratory competence,md to organize seminars on t k quality control of biological and pharnuceutical products.

The project began in 1968, and since then assistance has been given to most countries of the Region. Three seminars have been held - one in January 1969 (in India), one in January-February 1971 (in Thailand) and a third in June 1973 (in Indonesia). A fourth is planned for 1975 in India.


- 1 i I j 1 7 2 0 0 ~

1 -

i

I i ~

INTER-COWRY

5.2.7 Prevention and Control of Alcoholism and Drug Dependence and Abuse

Epidemialosy and Control of Drus Abuse and Rehabilitation of Drug Dependants

short-term consultants Temporary advisers Supplies and equipment

5.2.9 I m n a l o g y

Trainins in Imnalogx

Pnrricipanra Grant Supplies and equipmenr

5.3 Pro~hylacfic and Therapeutic S v b s ~ ~ n c e s

5.3.2 SpecificaLianr and Qvalitv Control of Pharmaceutical Preparations

Quality control of nio1opical and Pharmaceutical Products

Short-term consultants participants Supplies and equipmeni

R E G U L A R

1974

31 6 2015

B U D G E T

Estimated Obligarions Project NO.

ADA W 1 (0227)

IIM W 1 (0153)

SQP WI (0154)

1974

Number

1975

11 3

21 4

(Expressed in U S Dollsrsl

of Ponr.

1976

21 2

1977 1

I ! 6 600 ' 4 8 W / n 800 E ' I

1977

11 2

umber o f eorra

1975 1976 1976

- 4 800 -

I

! 3 WO 3 WO - , - -

m u v " c b.

3 > - 2 -



1 1 I ! !

I ! I ! !

i 1 i i i 1 8 8 W i 7 9 w i I

5 W :

20 O W -

7 WO 2 WO 2 500 -

I ! I I

i ~ ! i I ;

I !

i

1 ~ ; i 1 i ! I

/ : I I

I 1 ; ! : I i

1975 1974

9 b W 4 8 W

- i -

7 0 0 0 ~ I - I 5 W O ; -

11 5 W 13 000 '

-~ -~

1976 1977 1977

! I I ~

i I I

i

1 1 I 1

! !

j ~ i

I

j ~ I

i

1975

I

I

1976

Comnunity Water Supply and Sanitation

To assist in developing cornunity water supplies and sanitation facilities and in the planning and managemant of environmental health services.

The project started in 1965. Three sanitary engineers are assigned to this project. One of them is stationed in Bangkok to provide assistance to Burma and Thailand and the other fvo in the Regional Office. The services of these sanitary engineers are utilized primarily to deal with problems of water supply and sanitation on a regional basis and also to support country programes, particularly in the assessment and collection of national data and fixing of national and regional targets as recommended by the World Health Assembly.

Help of consultants has been availed of in the past on special problems and the same is proposed for the future. In 1974, it is planned to engage fovr consultants to study the regional problems on ground-water resources, water supply management, rural waste water drainage, end excreta disposal in non- severed urban areas. The same number of consultants is proposed for 1975 also: NO will assist in the regional seminar on rural water supply, after a necessary survey of the water supply situation and hydrogeological stvdy of the Region, and the other NO On rural excreta disposal and maintenance of handpumps.

In 1976 and 1977, consultants will review handpump water supply schemes, prepare manuals on handpump maintenance and rvral drainage systems, conduct a regional seminar on the financing and management of water supply end sewerage systems, and follow up on the 1975 inter-country seminar on rural water supply. In 1976, the third sanitary engineer will complete his assignment.

Assistance under this project is expected to continue untiI the end of 1980.

Public Health Advisory Services. Hekong (Phnse IV) PIP 001 (SEAR0 0211)

In 1968, a public health adviser and a sanitary engineer were provided to survey the health problems in the Lover Mekong Basin. From 1970 until late 1972,a sanitary engineer was assigned to work with the Secretariat of the Mekong Committee to advise on the possible effects on public health of the development of water resources in the Lower Mekong Basin. In 1973, a further sanitary engineer consultant was provided to assist in the development of public health programmes in the area.

Assistance has been continued during 1974.

Control of Hazards to Man from Pesticides CEP 001 (SEAR0 0190)

TO assist in assessing the problems relating to the importation, storage, transport, handling, labelling and sale of pesticides; to recommend measures to prevent or minimize hazards to man arising from the use of pesticides; to assist in preparing suitable legislation and to advise on the establishment of laboratory competence in this field; to develop studies to investigate this problem in depth.

A consultant visited Sri Lanka and Thailand for two months in 1970. In 1972, another consultant was assigned to Thailand to assist in the assessment of pesticide residues in foad-stuffs. In 1973, a consultant (a staff member from WHO Headquarters) visited Sri Lanka, Indonesia, Thailand, Burma and Bangladesh to assess the need for further assistance to these countries.

It is planned to provide consultants in 1974 and 1975 to aseist further those countries in training staff and updating their legislation. A draft request for UNDP assistance has been prepared and it is expected that the assistance will macrrialire in 1976.

To provide technical advice to the Committee for Co-ordination of Investi- gations of the Lover Mekong Basin, and to advise on the prevention of communicable diseases resulting from the changes in environment due to man-made lakes and other irrigation works.

Environmental Pollution Control

C- INTER-COUNTRY 01 ,+

CEP 002 (SEAR0 0210)

To assist in the control and abatement of environmental pollution and hazards.

The project started in 1973. It is proposed to assign a sanitary engineer in 1974 to assist with a regional study of the causes of environmental pollution, development of surveillance and control services, preparation and maintenance of en inventory of sources of pollution in each country, establishment of standards and legislation, and promotion of research activities. It i8 also proposed to engage two consultants for a Regional Seminar on Solid Wastes Management. Three consultants are proposed for 1975 to help with a Re~ional Seminar on Environ- mental Pathology.

In 1976 and 1977, consultants will follow up on the 1974 Seminar, prepare model water pollution control legislation for the Region, conduct a regional seminar on the economic reuse of sewage, and advise on specialized fields of environmental pollution control. Subject to availability of funds, a seminar, jointly sponsored by WHO and the Asian Institute of Technology, vill be held in Bangkok on a specific aspect of water pollution control.

Assistance under this project is expected to continue until the end of 1980.

Radiation Health

To assist in training personnel for radiation monitoring and surveillance, in developing radiological health protection services, in developing legislation against health hazards due to ionizing radiation, and in promoting radiological sciences as applied to human health.

Advice on raiiation protection was given to several countries in the Region in 1959-60 and 1963,to Burma in 1968, tc Nepal and Indonesia in 1969- 1970, to Nepal in 1970 and to Bur- and Indonesia in 1972.

In 1973, a consultant reviewed the status of radiological facilities io Bangladesh and recommended measures for their strengthening. Another consultant assisted Indonesia in the organization of personal film badge service for hospitals in Jakarta. In 1974, a consultant in radiation protection is to visit Indonesia to review the progress made in radiation protection and radiological sciences. Also, another consultant will assist Sri Lanka in the development of radiation protection services. Consultants vill be provided in 1975 for the development of training and services in radiotherapy and nuclear medicine in Bangladesh and Nepal.

In 1976 and 1977, consultants vill be provided to assist the countries of the Region. In 1977, an inter-country seminar on strengthening of radiation health protection services is planned.



I Planning aE Enviranmentai SES W 2

I Health Services (0225) ! I

12 000 ; i Short-term canrultant~ 8000' participants

i I

i 1 000 Supplies and eqsrpment

' , -

I I

I

INTER-COUNTRY

Environmental ~allvrion Control

Sanitary engineer P4 Clerk-stenographer ND4

Short-term consulcanrr Participants Supplier and equipment

6.1.6 Biomedical and Environmental Health Aspecrs of Ionizing Radiation

Radiation Protection

Short-term conrultanlr Temporary advisers ~arficipants Supplies and equlpmenc

6.1.7 Esrablinhmenr and Sfrenzrhening of Environmenral Health Services and ~nrrlrvtionr


1974 1975 ( 197b I 1911

I I

Ibumber of Purrs P r o ~ e r r NO.

CEP 002 (0210)

RAD W 1 (0042)

1974

! 1 27 400 30 360 I 32 370 1 3 800 4 200 4 500

I - 9 730 8 31 200 34 560 36 970

6 6 0 0 1 2 0 0 0 , 1 2 m 11 000 11 250

: 1 1 000 ' 1 O W 1 000 1 000 - - - , - 27 730 38 8W 47 560 , 51 220

I - - - 1 - !

I ! I 21 6 21 4 : 11 3 11 3 12 O W 8 800 7 2 W 7 2 0 0

!expressed in os ouliara2

I

~ 1975 / 1476

21 1

1977

1 000

i 11 700 500 2 OW 8 000 8 500 _ _ - -

10 8 W 15 200 i 28 400 - - - - I

- Number of Poirr

i l

1974

u m " c b. 3 2 u

2 u.



I I !

I I

! I ! I I 1 I 1

I I

!

1 1

1975 1974 I

1976 1 I977

1 I

I

!

!

!

! i

I I

j

1975 1 1975 1977

Health S t a t i s t i c s Methodology

To a s s i s t i n the development of knowledge and s k i l l s necessary f o r the app l ica t ion of s t a t i s t i c a l methods to problems i n the hea l th f i e l d i n the Region.

This p ro jec t which waa previously ca l led "Collection and U t i l i z a t i o n of Health S t a t i s t i c s , Records and Reports", d e a l t with developing a uniform system of record keeping i n , and report ing f r w , heal th centres and hospi tals . It a l so d e a l t with the c o l l e c t i o n , ana lys i s , i n t e r p r e t a t i o n and u t i l i z a t i o n Of i n f o r m - t i o n derived from theae systems. That p ro jec t i t s e l f was evolved by the merger of two e a r l i e r ones, "Reorganization of Rural Health Records and Reports" (SEAR0 WSO), and "Hospital S t a t i s t i c s and Medical Records", which had s imi la r objec- t i v e s . Beginning i n 1961, ass i s tance was given by these pro jec t s i n the development of r u r a l h e a l t h records and report ing systems and i n the s tandardizat ion of hosp i ta l s t a t i s t i c s and medical records. I n 1972, a working-group was convened i n N e w Delhi to consol idate the regi-1 proposals f o r the Ninth Revision of the In te rna t iona l Class i f i ca t ion of Diseases (ICD).

In 1973, the object ives of the p ro jec t were reformulated i n order to cope with the increasing demands for advice and help i n the appl icat ion of s t a t i s t i - c a l methods.

A s t a t i s t i c i a n i s expected to take up h i s du t ies i n 1974 to develop fur ther the a c t i v i t i e s under thin p ro jec t . For 1975, provision has been made f o r consul- t a n t s a s well as for meeting expenses of par t i c ipan ts i n coonexion w i t h . group education a c t i v i t y on data processing techniques.

I n 1976 and 1977, coneul tants w i l l a s s i s t i n matters connected v i t h the use of the Ninth Revision of the 10. I n addi t ion, there w i l l be a wrkshop i n 1976 for. f s m i l i e r i r i n g the p a r t i c i p a n t s with the use of the Ninth Revision. R o v i s i o n has also been made f o r supplies and equipment.

Medical L i t e r a t u r e and Teaching Equipment

To cover the supply of medical l i t e r a t u r e end teaching equipment and the exchange of technical informatioo.

I n view of the acute shortage of medical l i t e r a t u r e i n the count r ies of the Region, f i v e "Students Loan Libra r ies" , cons i s t ing of ten copies each of W textbooks, are being establ ished i n Burma, India and Thailand during 1974. It i s proposed to s e t up several such l i b r a r i e s i n the count r ies of the Region during the next few years.

Assistance under t h i s p ro jec t s t a r t e d i n 1954 end is expected to continue f o r a number of years.

Assistance to th in p ro jec t i s expected t o continue for a number of years.

INTER-COUNTRY

7. HEALTH INFORMTION hMI LITEMTIIRE

7.1 Health Srarisflcr

7.1.2 Healrh Starrsrlcal Merhodol~~y

Health Sratirtrcal Methodology

Health statistician P4 Clerk-stenographer ND4

Short-term consulrants Temporary advisers participants Supplies and equipment

7.2 Health Literature Services

Medical Literacure and ~ e a c h i n l : ~quiwent

Supplies and eqvipmenr

R E G U L A R

1974

11 3 1/12

11 3

B C D G E T

Errimared Obligarions Project NO.

HSM 001 (0220)

HLT W 1 (0025)

1974

Number

1975

1/12 1/12 ----

---- 21 4

(Expressed in US Oollars~

1975 1976

of P o r r s

1976

1/12 1/12

2 2 2 2

3/36, 31 9v

1977

1 27 400 , 30 360 i 32 370 ! 3 800 4 200 ' 4 600 - - , - I -

730 / 31 2CQ 34 560 1 31 970 I

8 800 18 000 18 000

1977

1112 1/12

3130u

Number of Ports

2 250 6 1 0 0 ! 9 m 0

2 500 2 600 4 000 I - ' -

1974

1 ma -



I i ! 1 I

I

I I i i ! I

i i

i

1

I

i

I

I

i

I

1975 1974

7 " c L. 2 3 -

!

I I

1976

I I I j I

!

i

1 !

! ! ! I I

I I

, i

1

1975

s L7

1977

I

I !

1976 1977

INTER-COUNTRY

Rc~ional Centre for Documentation on H-n Reproduction, HLT 003 Family Planning and Population Dynamics (SEAR0 0198) (IJNFPA RAS/70/H)6)

To set up, in the Regional Office, a regional centre to reproduce basic reports and documentation on various aspects of human reproduction, family planning and population dynamics for wide distribution, particularly to schools for professional and auxiliary health workers, to the health services, to the main health institutions in the Region and to international documentation centres.

In 1970 and 1971, consultants prepared a plan for the development of the Centre. In 1973, a consultant documentation officer visited various countries Of the Region to establish contacts with workers in the field and to invite them to send their published and unpublished material on family planning subjects for incorporation into the bibliographies published by the Centre. During 1973, three bibliographies of annotated articles and unpublished work in the South-East Asia Region were issued covering the period January 1971 - September 1973.

In 1974 and 1975 the services of this Centre will continue. A documentation officer, or specialists who are experts in the field of human reproduction, family planning and population dynamics will be recruited as consultants. They will prepare annotated bibliographies of literature available in the specialized fields. In addition, bibliographies of current material will be issued regularly.

In 1975, a Regional Conference an Dacmentetion and Family Kealth vill be held for one week with twenty participants.

The project is expected to continue for a number of years, subject to availability of funds under UNPPA.

R E G U L A R B V D C E T

INTER-COUMRY

Rexional Centre for Documenra- tion on numan Reproduction, Family Planning and Popularion

Dynamicp RAS/70lP06

Documentarion officer ~4 Documentation aoristant ND5 Clerk-typist NU3

Short-term consulfani~ Temporary advisers Participants S u b - ~ ~ n t r a ~ ~ Supplies and equipment Miscellaneous

Total - INTER-COCMRY

Number of Poata F r o l e c l No.

HLT 003 (0198)

1974

Estimated obligations

1974

I

48 44 38 36 1 351 925 1 313 640 1 267 970 1 232 950

I

i I !

j

i I

1975 1971 1 1976 197:

_=== = =

!

i I

i * 0. -

( E x ~ r e e r e d in TS oollar.l

i i I

I !

: I

I I i

Number of P o r f r

1 1974 1975 11974 11971

I

1 i l i

11 8 , 1112 1/12 1/12 11 4 1/12 1/12 1112 11 8 1/12 1/12 1/12

- I - - - 3 : 3 3 3 ----

11 1 11 1

I i

a I, ~T . . . . . . . .... , .... ==== =a==

5 ' 5 ! 5 5

1976

====

!

1971



1974 1975 I 1976 ! 1977

! !

! I

I

! 26 7 W ' 28 880 30 880 4 7 W 5 150 5 650 3 WO 3 300 3 650 - - - -

20 340 34 4 W 37 330 40 180

2 2 W ! 2 4W I OW 1 mo

10 OW 10 OW 1 5 W

107 500 23 000 23 WO ' 23 O W 5 W O 2 WO 2 O W 2 000

134 340 72 600 62 330 ! 78 580 - - - 1 - - , - - - 860 901 ~ 906 390 795 450 874 830 ======= , ======= ------- . . . . . . . , = = = = = = - 359 960 359 530 299 640 306 740

__==

a m " c ,. 2 5 b.

2 -

PP

DP

======_== ====_==== =========

I I I

!

I

i I

I i

I !

FP VS LA

i

14 468 676 531 860 480 810 563 090 9 765 22 500 15 000 15 000 5 O W

- - - , - ! i

I

i i

1

! !

I

Bangladesh

Burma

India

Indonesia

Naldives

Mongolia

Nepal

Sri Lanka

Thailand

Inter-Country

ANNEX 2

ADDITIONAL PROJECTS

ADDITIONAL PROJECTS

BANGLADESH


3.1 Strengthening of Health Services


Ornanization of Health Services, Planning and Hospital Administration

Short-term consultant Fellowships

Development of Health Services, Education in Public Health and Training of Medical Assistants

Health education specialist P4

Fellowships Subsidy Supplies and equipment

Development of Community Medicine

Medical officer P5

Project NO.

STR 001 (0009

STR 0 0 2 (wie)

STR 004 (0021)

BANGLADESH

1 ""I

Hospital Administration

Fellowships Participants


Development of Public Health Laboratories Including Vaccine Production


3 . 2 . 4 Nutrition

Nutrition

Short-term consultant 1 Fellowships

c. -4 w

US ~ollars)

Estimated cost

14 400 13 200 2 800 2 000 - 32 400 -

4 800 22 800 - 27 600 -

in

No.of posts

21 6 2/24

1/ 2 4/40

(Expressed

Project NO.

OCD 003 (0034)

HNH 001 (0027)

ADDITIONAL PROJECTS

No.of Posts

2/24

I 5/72

11 6

Estimated cost

Project No.

HED 002 (0023)

HPID 001 (0013)

MBD 001 (0002)

BANGLADESH

1

BANGLADESH

I

1 3.2.5 Health Education

Health Education

Fellowships

4. HEALTH MANPWER DEVELOEWENT


Nursing Advisory Services and Training

Fellowships

5. DISEASE PREVENTION AND CONTROL

5.1 Communicable Disease Prevention and Control


Tuberculosis Control


- 13 200

5.2 Non-Communicable Disease Prevention and Control

5.2.4 Other Chronic Non-Camnunicable Diseases

Other Non-Comunicable Diseases

Short-term consultants Fellwships Participants Supplies and equipment

24 500 - 5.2.6 Mental Health

Mental Health


- 14 400

i

r

ADDITIONAL PROJECTS - (Expressed in US Dollars)

BANGLADESH

5.3.2 Specifications and Quality Control of Pharmaceutical Preparations

Pharmaceutical and Biological Quality Control

Pharmaceutical production adviser P3

Fellowships

No.of Posts

/

1/12 - 1 - 6/72

Project No.

SQP 001 (0011)'

Supplies and equipment

Total - BANGLADESH

6. PROMOTION OF ENVIRONMENTAL HEALTH

6.1 Promotion of Environmental Health

6.1.5 Health of Working Populations

Occupational Health

Estimated Cost

32 240 ! I

39 600

i Short-term consultants Fellowships

I I I

- 3 ---- ----

583 580 - - - - - -- - - - -- --

C U N

BANGLADESH

6.1.6 Biomedical and Environmental Health Aspects of Ionizing Radiation

Radiation Health

Short-term consultants Fellowships

Project NO.

RAD 001 (0040)

No.of Posts

6/12 6/54

Estimated Cost

28 800 31 600 - 60 400 -

BURMA




Rehabilitation of the Handicapped

Fellowships

Planning and Strengthening of Health Services


Hospital Services Management



i Strenzthening of Laboratory Services

Scientist P


Project NO.

STR 001 (0088)

STR 002 (0094)

STR 004 (0106)

HLS 001 (0074)

ADDITIONAL PROJECTS (Expressed in US Dollars

I I I '

3.2 Family Health

3.2.2 Katernal and Child Health

No.af posts

Development of Family and Child Health

Fellowships

3.2.4 Nutrition

Nutrition Services

Fellowships

4. HEALTH &ANP(XJER DEVELOPUENT


Nursing Advisory Services

Estimaced cost

Fellowship

MCH 003 (0107)

NUT 001 (0093)

HHD 001 (0056)

BURMA Project No.

No.of Posts

Estimated cost

5. DISEASE PREVEmION AND CONTROL


5.1.2 Epidemiolo~ical Surveillance of C-unicable Diseases

Prevention, Control and Surveillance of Communicable Diseases

5.1.6 Uycobacterial Diseases

LeDrosy Control (VL)

Fellowship Subsidy

Mycobacterial Diseases


Project NO.

ESD 002 (0108)

MBD 001 (0017)

NBD 00: (0109:

-

NO. of posts

ADDITIONAL PROJECTS (Exore!

Estimated cost I BURMA Project I NO.

5.2 Non-Cmnicable Disease Prevention and Control

5.2.5 Dental Health


Fellowship

5.2.6 Mental Health

Mental Health Training and Services

Fellwship


5.3.2 Specification and Quality Control of Pharmaceutical Preparations

Development of Production and guality Control of Biological and Pharmaceutical Products

Fellovships

DNH 001 (0090)

PW1 001 (0099)

SQP 002 (0111)

;ed in US Dollars

posts

ADDITIONAL PROJECTS (Expressed in US ~ollars)

Estimated cost

24 000 13 200 - -

Supplies and equipment 37 200 - 7.4 Health Information of Public

6.1.5 Health of Working Populations Develoment of Health Information INF 001 Services (0113)

Occupational Health HWP 001 (0102) Fellowships 4/37 - 21 500

Fellowships 6/54 - Supplies and equipment Total - BURMA 2 414 690 ---- ---- -----= -----

No.of Posts

2/10 2/24

Project No.

DHS 002 (0095)

Estimated Cost

30 170

No.of Posts

1/12 - 1

BURMA

6. PUDnOTION OF ENVIRONlBNl'AL BEALTH

6.1 Prwotion of Environmental Health

6.1.2 Provision of Basic Sanitary Measures

Cmunity Water Supply and Sanitation (VW)


BURMA

7. HEALTH INFOFWATION AND LITERATURE


7.1.4 Development of Health Statistical Services

Department of Medical Research


Project No.

BSM 001 (0112)

INDIA





Grant

National Institute of Health Administration and Education

Short- term consultant

Nursing in Clinical Specialties


Development of Cmunity Health Nursing Services

Fellowship Supplies and equipment

Project NO.

STR 002 (0194)

STR 005 (0218)

STR 006 (0269)

STR 007 (0284)

ADDITIONAL PROJECTS

Estimated cost I INDIA

Strengthening of Health Administra- tion (Rural) Including Planning and Evaluation

Short-term consultants Supplies and equipment

School for Training of Technicians


I 3.1.3 Health Laboratory Services 28 800

Production of Freeze-dried Smallpox ""1 48 600 Vaccine (VS) -

(Expre

Project NO.


6 000 - 12 600 -

STR 002 (0285:

STR 01( (0199:

HLS 001 (0174:

HLS 00: (0225:

Production of Freeze-dried BCG Vaccine


ied in - N0.0f Posts

US Dollars

Estimated cost

INDIA

3.2 Family Health


Strengthening of Departments of Paediatrics, Obstetrics and Preven- tive and Social Medicine in Indian Medical Colleges

Fellowships

3.2.4 Nutrition

Applied Nutrition Roxramae

Fellowships

Nutrition Training


National Goitre Control Programe


Project No.of

f MCH 001 (0114)

NUT 001 (0181)

ADDITIONI

Estimated cost

5 100

14 250

28 500 23 000 - 51 500

INDIA


Training in Health Education

Short-term consultant Fellowships Participants Supplies and equipment

Central Health Education Bureau

Temporary advisers Fellowships Participants

HEALTH MANPOWER DEVELOFtlENT


Medical Education

I Fellowships

ADDITIONAL PROJECTS

INDIA Project No.of I No. I Posts I

Post-basic Nursing Education

Short-term consultants Fellowship

Physiotherapy School, Baroda

Physiotherapy tutor P3

Fellowships

Participants Supplies and equipment

Trainin~ Prograorme for Medical Officers and Trainers of Basic Health Workers

Research in Nursing


IMD 005 (0257)

HMD 006 (0280)

Estimated cost I

1/12 - 1 -

2/24

INDIA

Seminars and Workshops on Medical Education

Grant

Medical Librarianship


National Medical Teacher Training Centre

Short-term consultant Fellowship Supplies and equipment

1 5. DISEASE PREVENTION AND CONTROL 1 5.1 Communicable Disease Prevention and Control -

5.1.2 Epidemiological Surveillance of Cormmmicable Diseases

3 000

1

National Institute of Communicable Diseases

Fellowships

ADDITIONAL PROJECTS

I

1 INDIA !

5.1.3 Malaria and Other Parasitic Dis*

Malaria Eradication (VM)

~ Grant

I Filaria Control

Fellowships

5.1.5 Bacterial Diseases

Production of ~iphtheria/Pertussis/ Tetanus Vaccine, Kasauli


I 5.1.7 Virus Diseases

I Blindness Prevention and Rehabili- tation


Estimated cost I Project

NO.

HPD 001 (0153)

MPD 002 (0287)

BAC 001 (0173)

VIR 002 (0292)

INDIA No.of posts

8/16

11 3

3/12 6/45

I 5.1.9 Veterinary Public Health

Training of Veterinary Public Health I - ,,I Fellowships

I 5.2 Non-Comnunicable Diseases Prevention and Control

1 5.2.3 Cardiovascular Diseases

I Fellowship (Cardiovascular Diseases)

Prevention and Control of Cardio- vascular Diseases

Fellovships Supplies and equipment

5.2.6 Mental Health

Mental Health

Medical officer

27 450 Short-term consultant

Fellowships 56 250 Participants

US Dollars

Estimated Cost

15 750 -

- 6 600

60 600 27 000 - 87 600 -

29 210

7 20C 57 30C 5 00C 33 20C - 131 91C -

in

No.of Posts

3/27

1/12

16/92

1/12 - 1 -

11 3 14/90

I

(Expressed

Project No.

W H 001 (0244)

CVD 001 (0200)

CVD 002 (0294)

MNH 002 (0289)

ADDITIONAL PROJECTS

INDIA

5.2.7 Prevention and Control of Alcoholism and Drug Dependence and Abuse

Fellowships (Drug Addiction)


5.3.2 Specifications and Quality Control of Pharmaceutical Preparations

Drup. Laboratory Techniques and Biological Standardization

Fellowships

6. P R W I O N OF ENVIRONMENTAT. HEALTH



Village Water Supply (VW)


Project NO.

ADA 001 (0200)

SQP 001 (0222)

BSH 002 (0268)

No.of Estimated posts 1 cost INDIA

Solid Wastes Disposal


6.1.4 Control of Envirolrmental Pollution and Hazards

Prevention and Control of Water Pollution

Short-term consultants Fellavships Supplies and equipment

i Control of Air Pollution


INDIA

Environmental Health



Occupational Health



Training of Radiographers

Short-term consultant Fellowship


Project No.of NO. I Posts

CEP 004 (0298)

Estimated Cost

. PROJECTS

INDIA

6.1.8 Food Standards Progrme

Study in Food Legislation

Fellowship

7. HEALTH INFORMATION AND LITERATURE


7.1.4 Development of Health Statistical Services

Stren~thening of Health Statistics Services

Fellowships I Participants

I I Total - INDIA

(Expre

Project NO.

FSP 001 (0291:

DHS 00; (0255

;ed in US Dollars

posts

C US ~ollars)

Estimated Cost

- 15 600

15 600 16 875 - 32 475 -

- 33 000

- 20 700

in

No.of Posts

4/24

4/24

5/60

6/30

INDONESIA




Strengthening of National Health Services

( a ) Health Planning


(b) Research and Development


(c) Health Care Delivery System


7

No.of Posts

3/ 9 5/60

2/ 6 5/78

21 6 3/36

Project No.

STR 001 (0086)

ADDITIONAL PROJECTS (Expressed

Estimated Cost

INDONESIA Project No.

STR 002 (0093)

HLS 001 (0060)

MCH 001 (0104)

NUT 003 (0132)

21 600


Fellowships


Laboratory Services

Fellowships Participants

33 000 - 54 600 -

14 400

3.2 Family Health


42 600 - 57 000 -

14 400 19 800 - 34 200 - - 145 800

School Health

Fellowships

3.2.4 Nutrition

Nutrition Training

Fellowships

ADDITIONAL PROJECTS (Expressed in US Dollars)

HEALTH MANPdrlER DEVELOPMENT DISEASE PREVENTION AND CONTROL

4.1 Health Manpower Development 5.1 Camunicable Diseases Prevention and Control

Medical Education 5.1.2 Epidwiological Surveillance of

Comunicable Diseases



Nursing and Midwifery Education

Nurse educator 5.1.3 Malaria and Other Parasitic Diseases

Malaria Eradication (VM)

Short-term consultants Fellowships Fellowships - Supplies and equipment

- 5.1.6 Mycobacterial Diseases

Tuberculosis Control Short-term consultants Fellowships Supplies and equipment Short-term consultants

R m W

ADDITIONAL PROJECTS (c-",.""c"., ;" ,,< n*,,*-")

r C z INDONES 1.4

5.2 Non-Conarmnicable Disease Prevention and Control

5.2.2 Cancer

Cancer Control

Short-term consultant Participants Supplies and equipment

5.2.5 Dental Health

Dental Health

Fellowships

5.2.6 Mental Health

Mental Health


Praject No.

CAN 001 (0134)

DNH 001 (0079)

MNH 001 (0096)

No.of Posts

11 1

121126

11 4 2/24

I

,lA,,LC'aCY LL. ,," YV.-~.I,

Estimated Cost INDONES 1.4

No.of Posts

Project No.

Estimated Cost

1/12 - 1 -

11 3 7/42

IMn 001 (0135)

5.2.9 Imunology

- 23 270

7 200 12 600 - 19 800 -

1 I

Immunization Services (Including Smallpox)

Operations officer P2

5.3.2 Specification and Quality Control of Pharmaceutical Preparations I Quality Control of Food and Drugs

Short-term consultant - Fellowships

2 400 500 500 -

SQP 001 (0106)


I i

i

ADDITIONAL PROJECTS

6. PROMOTION OF ENVIRONNENTAL HEALTH

6.1 Prwotion of Environmental Health


National Cammunity Water Supply and Sanitation (VW)

Sanitary engineer P4 Sanitarian P3



6.1.4 Control of Environmental Pollution and Hazards

Estimated Cost

Hazards to Man from Pesticides

No.of Posts



Radiation Health

Estimated INDONESIA

Cost No.of Posts INDONESIA


Project No.

Project No.

6.1.7 Establlshmenc and Strengthening of Environmental Health Services and Institutions

Training in Sanitary Engineering

Short-term consultants Fellowship

RAD 001 (0116)

SES 001 (0061)


P (D

Project No.of Estimated cn

No. Posts cost

I I I I



Total - MALDIVES

-

11 3 1 200 500 - 22 820 -

- - 1 22 820

---- ---- ------ ------

I !

No.of Posts PWSIVES


3.2 Family Health


Maternal and Child Health Services

Nurse educator P2

Estimated Cost

Estimated Cost

Project No.

MCH 001 (0012)

21 120

MALDIVES No.of Posts

1/12 - 1

Project No.


s m

(0030) 4. HEALTH PUNPaWER DEVELORBNT I

6/42 26 100 4.1 Health Manpower Development

Fellowships Participants 2 000 Nursing Services and Education - HHD 001

28 100 (0008)

- Fellowships 6/32 21 600

Supplies and equipment 1 000 3.2 Family Health - 3.2.2 Maternal and Child Health

22 600 -

Maternal and Child Health MCH 002 (0033)

Short-term consultant I 1/ 3 - 7 200 I I I

1

Estimated Cost

14 400 6 900 2 000 - 23 300 -

Project No.

NUT 001 (0023)

MONGOLIA - 3. STRENGTHENING OF HEALTH SERVICES



Rehabilitation Services

Fellowship

Management of Health Services

No.of Posts

1/ 6 2/10

No.of Posts

1/ 6

Project No.

STR 003 (0028)

STR 005

Estimated Cost

- 3 900

MONGOLIA

3.2.4 Nutrition

Nutrition


ADDITIONAL PROJECTS

MONGOLIA 1 I 5 .

DISEASE F'REVEWION AND CONTROL

I 5.1 Cmunicable Disease Prevention and Control

I 5.1.2 Epidemiological Surveillance of Comunicable Diseases

Epidemiological Services and Surveillance

I 5.2.4 Other Chronic Non-Communicable Diseases

I Control of Non-Conmunicable Diseases

NEPAL Project I NO.

3. STRENGTHENING OF HEALTH SERVICES I 3.1 Strengthening of Health Services I 3.1.2 Strengthening of Health Services I

Development of Health Services

Short-term consultant Fellowships Participants Supplies and equipment

Medical Stores Management

Short-term consultant I 3.1.3 Health Laboratory Services I

Health Laboratory Services

Fellowship

STR 001 (0021)

STR 002 (0032:

N0.0f posts


1 *

Estimated cost I NEPAL

Project No.of Estimated 0 I No. I Posts I Cost I 3.2.5 Health Education

Health Education


4. HEALTH MANPOWER DEVELOFXENT


Training of Health Manpower

Fellowships


HED 001 (0019)

HPU) 001 (0037)

1 5.1.3 Malaria and Other Parasitic Diseases I I I

7 200 -

-I Malaria Eradication (W) 5 700


NEPAL

5.1.4 Smallpox Eradication

Smallpox Eradication (VS)

Operations officer P2

Fellowships Participants Supplies and equipment


Leprosy Control (VL)

Short-term consultanr Participants Supplies and equipment


PRCNOTION OF ENVIRONMENTAL HEALTH

6.1 Prolnotion of Environmental Health


Sanitary engineer


Total - NEPAL -- - -- - - --- ----

SRI LANKA




National Health Planning

Fellowships

Training of Anaesthesiologists

Fellowships


Strengtheninn of Laboratory Services

Fellowship

3.2 Family Health


Health Education

Fellowship

STR 003 (0092)

Project No.

STR 005 (0102)

No.ol Postr

ADDITIONAL PROJECTS

Estimated cost I SRI LANKA

I HEALTH MANPWER DEVELOFUEKP

4.1 Health Uanpower Development

Medical Education

I Fellowships

-I Nursing Advisory Services

I Temporary advisers

Post-graduate Teaching of Cmunity Medicine

Fellowships

1 5. DISEASE PREVENTION AND COKPROL

5.1.2 Epidemiological Surveillance of Cmnicable Diseases

6 600

Strengthening of Epidemiologid Services

5.1 Commnicable Disease Prevention and Control

Fellowship

US Dollarf

Estimatec Cost

19 10C -

- 3 00C

4 80C -

6 600

-

(Expressed

Project No.

m 001 (0047)

HHD 002 (0053)

m 008 (0114)

ESD 001 (0078)

in

No.of Posts

2136

21 3

4/12

1/12

SRI LANKA

5.2 Non-Cormunicable Disease Prevention and Control

5.2.5 Dental Health

Dental Health


6. PROnOTION OF ENVIRONNENTAL HEALTH



Cormunity Water Supply and Sanitation (VW)

Fellowship


Occuoational Health and Industrial Hvziene


Project NO.

DNH 001 (0087)

BSM 001 (0064)

HWP 001 (0082)

N0.0f POStS

ADDITIONAL PROJECTS (Exore

Estimated Cost I SRI LANKA Project I M.

6.1.7 Establishment and Strengthening of Enviro~ntal Health Services and Institutions

Undergraduate Training in Public Health Engineering


Total - SRI LANKA

SES 001 (0112 I

ed in US Dollars

posts

THAILAND

STRENGTHENING OF HEALTH SERVICES




Fellovship

Health Planning and Management

Short-term consultant Fellowship

Strengthening of Rural Health Services

Subsidy Supplies and equipment




Project No.of + STR 001 (0093)

STR 002 (0098)

STR 006 (0132)

ADDITIONAL PROJECTS (Expre:

I

11 3 11 6

HLS 001 (0075)

Estimated cost I

11 6 2/24

THAILAND Project 1 NO.

National Laboratory Animal Centre HLS 003 I (DP) THAI721004 (0123)

Short-term consultant Fellowship Supplies and equipment

3.2 Family Health


11 200

7 200

- 4. HEALTH MANPWR DEVELOPHEW I 4.1 Health Manpower Development

50 000 15 000

Nursing Education and Services


Development of Health Education

- I! 65 000 Fellowship - 11

HED 001 (0076)

R Faculty of Public Health

1 14 400 I 15 800 - 30 200 -


z- red in

No.of posts

11 3 11 6

11 3 21 6

1/24

11 6 2/36

US Dollars)

Est~mated cost

7 200 3 900 7 000 - 18 100 -

7 200 5 100 - 12 300 -

17 400 -

14 400 19 600 - 34 000 -

AUUlllUNAL PKUJLLlb

(Expressed in US Dollars)

Estimated Cost

- 33 400

Malaria Eradication (VM) Collrmunity Water Supply and Sanitation (VW)

5.2 Non-Conrmunicable Disease Prevention and Control

5.2.5 Dental Health

Dental Health Total - THAILAND -- - - - - - --- - - - -

Medical officer (public health

Fellowships

P

V

<

THAILAND


Fellowships


5.1 Comnunicable Disease Prevention and Control


No.of Posts

7/72

Project No.

HMD M)4 (0097)

Estimated Cost THAILAND

Project No.

- 43 400

No.of Posts

MNH 001 (001 7 )

5.2.6 Mental Health

Mental Health

Fellowships

6. PROMOTION OF ENVIRONMENTAL HEALTH

6.1 Promotion of Enviromental Health

3/64


C \O e.

in

No.of Posts

21 4 1/2w

21 4 316w

31 3 2/2w

(Expressed

Project NO.

HLS 004 (0176)

MCH 001 (0144)

MCH 010 (0234)

r US Dollars)

Estimated Cost

9 600 500

8 500 2 000 - 20 600 -

9 600 1 500 10 600 2 000 - 23 700 -

7 200 500

7 800 - 15 500 -

ADDITIONAL PROJECTS

INTER-COUNTRY INTER-COUPITRY No.of Posts

Project No.

Estimated Cost





Short-term consultants Participants

Health Research and Development


Advisorv Services


Nedical Rehabilitation

Short-term consultant Participants Supplies and equipment

4/ 8

11 3

6/18

11 6

STR 002 (0104)

STR 006 (0148)

STR 009 (0215)

STR 011 (0226)

19 200 8 O W -


Course on Health Laboratory Techniques

Short-term consultants Temporary adviser Participants Supplies and equipment

27

7 200 8 000 - 15 200 -

3.2 Family Health


Rehydration Therapy

Short-term consultants Temporary advisers Participants Supplies and equipment

Education and Studies in Child Health

Short-term consultants 14 400 12 O W 5 000 - 31 400 -

Temporary advisers Participants

C 10 *

US Dollars)

Estimated Cost

9 600 8 300 - 17 900 -

- 36 000

- 7 200

INTER-COUNTRY

4. HEALTH MANPCNER DEVELOPMENT




Education and Training of Environ- mental Health Personnel


Participation in Meetings

Participants

Educational Technology


I

AVVL I IULYAL TKVJLL15

Project No.

HMD 001 (0139)

HMD 002 (0150)

HMD 005 (0216)

HMD 006 (0235)

(Expressed

Project No.

ESD 002 (0193)

ESD 003 (0238)

MPD 001 (0007)

Estimated Cost

No.of Pasts

5/17

21 6

31 9

in

Na.of Pasts

21 4

5/15

11 3

IWER-COUNTRY

!

- 40 800



5.1.2 Epidemiological Surveillance of Communicable Diseases

Epidemiological Surveillance and Training

Short-term consultants 14 400 Participants 3 000 - 17 400 -

Strengthening of Epidemiological Surveillance and Control of Communicable Diseases

22 500 Short-term consultants


Assessment Team on Malaria 3 600 Eradication (vM) 5 000 - Short-term consultant 8 600 -

!

INTER-COUNTRY Project I NO.

5.2 K. .-Congpunicable Disease Prevention and Control

Cancer Control and Prevention

Short-term consultants Participants Grant Supplies and equipment

CAN 001 (0233)

5.2.3 Cardiovascular Diseases I Epidemiology Control and Management CVD 001 of Cardiovascular Diseases (0228)

Short-term consultant Fellowships Grant

5.2.4 Other Chronic Non-Communicable Diseases

Chronic and Degenerative Diseases


OCD 001 (0236)

ADDITIONAL PROJECTS

No.of Estimated posts I cost I INTER-COUNTRY

I 5.2.7 Prevention and Control of Alcoholism and Drug Dependence and Abuse

Epidemiology and Control of Drug Abuse and Rehabilitation of Drug Dependence

Participants Grant

6. PRCMOTION OF ENVIRWMENTAL HEALTH

I -I 6.1 Promotion of Environmental Health

I 1 6.1.2 Provision of Basic Sanitary Measures

C~mmunity Water Supply and Sanitation (VU)


Short-term consultant Participants

(Expre

Project NO.

ADA 001 (0227)

BSM 001 (0064:

JS Dollars

Estimated cost

ADDlTIONAL PROJECTS