W O R L D H E A L T H ~ W I *' +I ORGANISATION MONDIALE ORGANIZATION DE LA SANTE

REGIONAL OFFICE FOR THE BUREAU REGIONAL DE LA EASTERN MEDITERUNEAN MEDITERRANEE ORIENTALE

I?XIONC;L CCW1ITT%E FOR THE E A S ~ ~ m~~.:.nirniv

Twelfth Session

SLIB-CCRNITTEE A

E M / R c ~ ~ A / P ~ o ~ .$kin. 2 December 1962

ORIGIM!L: ENGLISH

SUB-DTVISION ON PRCG-

M D i F E S OF THF, SECOND IEFPRJG

Held a t Z?.hret e l Shark Hotel. Riyad on Tuesd-ay, g ,pctober 1962, a t 9.00 a.m.

CONTENTS

(d) lmprovenent of V i t d 2nd He?lth S t s t i s t i c s i n the Countries of t h e &stern Mediterrlnezn Region

(e) Tinea C2.piti.s and its Control GI t he Light of Experiences gained with Griseofulvin

(f) k r a l Health and C o m i t y Development in the Eastern Mediterranean Region: Results of nn h q u i r y

Representatives

Government

CYPRUS

ETHIOPIA

FRANCE

IRAN

JORDAN

KUWAIT

I E W O N

LIBYA

PAKISTAN

SOrnLIA

SUihN

SYfrIAN iBkB REPUBLIC

TUNISIA

UNITED KIMPCllII

Represent?.tive, ( ~ l t e r n a t e or Adviser

3r. V. Vassilopoulos

Mr. Hailu Sebsebie

Dr. M.H. Xorshed

D r . Khalid S h a d

Mr. Abdel Moshin A 1 Matrook Dr . Kamal E l Borai

Dr. Husni J a l l ou l

Mr. Hameda Z l i t n i

Brigadier M.S. Haque fir. A l i Nawab Khan

Dr. Abdel Aziz E l Mudarris Dr. Youssef E l Humeidan Dr. Omar Zawawi Dr. llohruned !min &qim D r . Hashem Dabbagh Dr. Elwi J e f f r i G r . Youssef E l I i a j i r i

I*. Adan Farah Abrar

Dr . Mohamned Zaki Etustafa

Dr. hassan Jallad

Ur. M. Taoufik ihghfous

Dr. !.].A. Glynn

'~Jorld Heal th Or jan iza t ion

Ssc re t a ry t o the Sub-Committee D r . A.H. Taba, Regional D i r e c t o r

Ass i s t an t D i r e c t o ~ l ~ n e r a l D r . F. .;rundy

Lkputy Sec re t a ry t o th Sub-Committee Dr. A.A. E l Balarnni , ikputy Re ; ional Director

Public Health A d m i ~ s t r a t o r (Health Or:.) D r . A.11. Zaki

Reyional l ~ d v i s d r on Heal th S t a t i s t i c s Mr . J. Nielsen

WIiO Consultant of F a w s Cont ro l Dr. E. s r in

United Nations and Spec ia l i zed Azencies

UNITF,iI NATIONS CHILDKEN'S FUNI) (UNICEF) M r . Fuad liwas

UNITE3 NATIONS R?LIEF f.ND WURKS i.&NCY Dr. S. F lache FCR PAUSTLNE REFU&ZS (UNRlqA)

FOOL) AND A J&ICULTURE ORGANIZRTION OF Miss Mona Doss TILE TITED :iATIONS (FAO)

Representatives and Observers of International Non-Governmental, Inter-ciovernnental and Nat ional O r g a n i z a t i ~ n s - INTS;RMI~TIONX STILTISTICAL EEiKTCiiTION CENTR'S Mr. F a i z F1 Khuri (Observer) ZZiRiiT (ISEC)

IIFi?22NATIOKiA COJ'MITT'IZ ON MILITLFtY Dr. S e i f E l K n Shishakly ~Pizi)iCIbX .&D ?IillWtCY (Representat ive)

Br igadier M.S. Haqw (%presenta t ive)

1. TECHNICAL M&TTEltS: A:<enda item 10

(d) Improvenent of Vital.and Heal*. Stat is . r jcs i n the -ublic He?lth Services of the E?stern Mediterranean Rezi-n: (Uocument F.f!/?T12/7,

Mr. NDLSEN, Regioiml Adviser on S t a t i s t i c s , said tha t i t wolild be rea!ily

recognized t h a t unless re l iab le da ta on population, b i r t h s and deaths, prevail ins

i l l ne s ses and medical resources were available, it was d i f f i c u l t t n describe thi2

heal th problems of a c5untry o r assess t he efficacy of i t s heal th programmes.

The overal l scarc i ty of v i t a l andhea l th s t a t i s t i c a l information was q e c i a l l y

pronounced i n t,he ccuntries of t h i s Region. Althoulh many of the countries

of the Region had recently carr ied out a population ce-nsus, e ta- t is t ics gn b i r th s

and deaths =re almost non-existent. The document before the committee

described the a c t i v i t i e s i n i t i a t e j . by IdHO since 1.750 i n the f i e l d of s t a t i s t i c s .

These included a trainin: centre i n Cairo i n 1 9 9 , the provision of 10ir

fellon~sksilips, t he provision of an adviser on s t a t i s t i c s i n the Reqional Office,

tne establishment of an epidemio1o;ical and s t a t i s t i c a l centre 3s an in t e r - coun t r~

project , a number of f i e l d projects ass i s ted by s$.a t is t ical consultants and an

Arabic version of the I n t e r n a t i o m l Classi f icat ion of Diseases vhich rms i n

course of compilation.

The s t a t i s t i c a l a c t i v i t i e s of t he countries of the. P.e?e:ion included ~opuLtt,ic:i

census, new or improved l eg i s l a t i on re,:arding r e yis t ra t inn and s t a t i o t i c a l

reportin: of no t i f i ab l e diseases, imy~rovement of the s t a t i s t i c a l services i n the

? a n i s t r i e s of Health and othcr health acencies and s % a t i s t i c a l m e t i n ~ s a r r a p e d

by the Lea:?ue of Arab States. Handbnoks and s tud ies on methodoloiy had been

issued by the United Nations and specialize-! a:encies, t he Internat ional

S t a t i s t i c a l Education Centre had been e s t ab l i she j i n Beirut i n 1353 and a

United Nations t r a i n i n ? centre i n Addis Ababa i n 1361.

The recommendations made i n theregor t towards the fu r the r improvement of

v i t a l and health s t a t i s t i c s included the establishment of n a t i o m l cormnittees

on v i t a l a d nealth s t a t i s t i c s t o deal with the subjsc t , t r a in in? of s ta t is t ic3.1

workers and s t a t i s t i c a l t ra in ing of a l l future physicians and other health

markers, more seminars and meetiny. I n t e r n a t i o m l e f f o r t s t o improve health

s t a t i s t i c s muld, however, be unavailing unless each country real ized the

necessity f o r accurate s t a t i s t i c a l ,data and took posit ive steps t o improve

i t s ex i s t i ng systems o r to c rea te new s t a t i s t i c a l services. R 6roup itleetin-.

on V i t a l and Healt'n S t a t i s t i c s f o r the countries of the Re2ion was envisared f o r

1363; t h i s would give health administrators and s t a t i s t i c i a n s an opportunity

t o evaluate prog-ess, the ac tua l posit ion and future needs, t o exchnqe

information and t o plan f o r future development.

D r . BORAI (Kuwait) sa id t h a t i n t e r e s t i n the development of reg is t ra t ion

systems and compilation of v i t a l s t a t i s t i c s f o r national and in te rna t iona l

gurposes had considerably increased i n Kuwait i n recent yesrs . The system

now i n fo rce included the 1ei;al r q i s t r a t i o n of l i ve bir ths , deaths, f o e t a l

deaths, marriages, divorces, etc. and t h e s t a t i s t i c a l compilation and analysis

of the events so registered. I n the f i e l d of health, s t a t i s t i c s were beirg

collected on morbidity of trachoma and from t u b ~ r c u l o s i s surveys; no t i f iab le

diseases, leprosy, venereal diseases, m n t a l cases and blind person? were a lso

recorded. Accurate s t a t i s t i c s were available on w d i c a l resmrces , on hospi ta l

admissions and treatment and on health centre ac t iv i t i e s . His ;overnment

was f u l l y awal= of the need f o r cor re la t ion between and p a r a l l e l developm~nt i

v i t a l s t a t i s t i c s and morbidivy s t a t i s t i c s ancj was, therefore, makinq every e:'f?r-'

t c adopt t he pr',nciples f o r a v i t a l s t a t i s t i c s sjstem as l a i d down by the

United Nations.

Two fac to r s were of great importance i n t h e f i e l d of health s t a t i s t i c s :

f i r s t , the standardization of def in i t ions and, second, s t a t i s t i c a l training.

i:L-IO had made a g rea t contribution by publishin- i t s Internat ional c l a s s i f i ca t ion

.;i' diseases and medical p rac t i t ioners should be induced t o conform with t h i s

wprk when issuing death ce r t i f i ca t e s . A basic course i n medical s t a t i s t i c s

should be ob l iga tor j f o r a l l merlical students and optional f o r diploma stitdents

wi th a s p e c i a l i n t e r e s t i n s t a t i s t i c s and epiJemiol3 .y . Fundamnta l ly , h~r$ev;lr,

t h e g r e a t e s t problem rgas to ensuA% t h e cooperation of tlio . x r s o n s supolyin:; t h e

s t a t i s t i c a l d a t a and t o o b t a i n a v ide a p p r e c i s t i c n of thc va lue <and s ign i f i cance

of he3 l t ; . s t a t i s t i c s . The comprehens i~e rrr,port mnle by the Kcsinn?l i idviser

cn 3 t a t i s t i c s . a f t e r iiis v i s i t to Ku.m%t would be :iven the c l o s e s t a t t e n t i q n 2nd

i t s rccor,mendations wou1:i be implemented a s p rac t i cab le .

Bri::adier Ii::QUE (palcistan) s a i d t h a t plannin,. on a country-vide b a s i s was

a lmcs t impossible wi thout b a s i c v i t a l s t a t i s t i c a l d a t a , y e t i f f i c u l t y i n

communications made t h e c o l l e c t i o n of such da ta extremely d i f f i c u l t i n Pakistan.

Lack of t r a i n e d s t a t i s t i c a l s t a f f was ano ths r drawback an3, a1 thru :h a ',ti0

a d v i s e r was he lp ing t o e s t a b l i s h a s t a t i s t i c a l s e c t i o n i n the H i n i s t l y of H a l t h

and a deplr tment of vital s t a t i s t i c s a l r eady e x i s t e d , t h e t r a i n i n : nf personnel was

;oin,; t o p r e s e n t a v e v r e a l problem. He hoped t h a t ?alcistan w ~ u l d have the

b e n e f i t c f t h e advice o f tnc kc:;ional Ldviszr a s t o th6 b e s t means of developin?

i t s s t a t i s t i c a l scr-yicas.

Dr. MOF(SilE0 ( I r a n ) s a i d t h a t i t i w a s h e s t encoura:inq t o hecar of the a c + i i L 1 7 - -

of tile R ~ c i o m l Of f i ce i n t h i s f i e l d and espc:cial ly 3s re-:arded t r a i n i n - . . 1.n

e v a l u a t ~ o n ~f tho s i tua t2xn of v i t a l anJ ' l ea l th ? t a t i s t i c s i n I r a n ha.' ic ;n

prepered and w7.s i e i n ; c i r c u l a t e d .

3r. VIISSILO?C.!ZOS (Cyprus) s a i d t;:at, s t a t i s t i c a l s e r v i c e s i n Cyprus,

t i isorganizcd d u r i n i t h c emerzency, n2d no-L j e t r e tu rned t o f u l l nnrmal opcratj.qn;

conscqi~ently-, s t a t i s t i c s h%d t o t e ob ta in id f o r the time b e i p : by t h o c s t imz t ion

rmthois, based on t h e three-year period p r i o r t o the cmerlency r.~h-.n r e l a t i v e v

c:mplete h e a l t h and v i t a l s t a t i s t i c s ha3 becn r eeo r l ed .

FiiIZ EL KBURI, D i rec to r , In t e rna t io7 -a1 S t a t i s t i c a l Education Centre, Bei ru t ,

s ~ a k i n z a t the i n l r i t a t ~ o n of t h e Chairimn, s a i d t h a t he ha3 ha:{ the p r i v i l e ? ~

of a t t e n d i n - trm ses s ions of t h e 1te;:ional Committee, i n 1,758 an3 t h i s year, a t

which t h e ques t ion of v i t a l a n l nea l th s t a t i ~ t i c s [:a3 be .n discussed. He nnted

with agprec ia t ion t h e development i n the s t z t i s t i c a l s e r v i c e s of the various

coun t r i e s of the Re ;icn. He f e l t t h a t t h e r ecomenda t ion i n the r e p o r t

re;:ardi~t: the e s t a b l i s h m n t o r stron:themin:of z a t i ? n a l committees on v i t a l

and h e a t h statistics was extremePy important. Such a comrnittec ha3 been

e s t a b l i s h e d i n Lebanon ~LJ i th most s a t i s f a c t o r y r e s u l b . Reyardin: s t a t i s t . i c a 1

t r a in in ; , he be l ieved t h a t un ive r s i ty t r a i n i n f o r s t a t i s t i c i a n s a n t r a i n i n ' 5.n

ItmO c e n t r e s f o r s t a t i s t i c a l o f f i c e r s s h ~ l d be supglementii by elementar:{ c-,lr-:es

5i;ren i n those centres . Se a l s o t h o u ~ h t t h e t it %mu13 be valiuable t o have 7

manual f o r use i n a l l such c e n t r e s and of fered t h e c o o ~ e r a t i o n of h i s I n s ' , i t u t c ,

lJilish had a l r eady prep-zed t m manuals, one on h e a l t h s t a t i s t i c s an? t h e o the r rn

v i t a l s t a t i s t i c s , should !IHO wieh t o implement t h i s suggest ion. I n v i e n of

t.ie undo.ibted value of seminars f o r tilt? exchan- of information and tec'lniques,

h i s i n s t i t u t e intended t o hold a r e f re she r cgurse ofapproximately one month

i r r i t s y-adul tes ; t1l;s p a r t i c i p a t i o n of o t h e r s t a t i s t i c a l of f i c e s could be

a r r a n ed i f WHO wished t o cooperate. Thc s t r e y t h e n i n r ; of s t a t i s t i c a l s e r v i c e s

roquired both a coordinated 1on:-term programme, sv over 2 ~ e r i o l l of f i v e

y e w s , an3 a d c q i ~ t e r a t e s gf ;my f o r personnel. I n t h e l a t t e r c i , inec t ion ,

!le bzlie-red t h a t t h e sc)lut ion adopted by Lebanon of payin;. t echn ica l allowances

Lo it.s q u a l i f i e d s t a t i s t i c a l s t a f f considerably reduced the l o s s of e f f i c i e n c y

coneequcnt upon t h e depar ture of $ r a i ~ J s t a f f . He conc lu l td by recomendivf +,nr;

pol icy adopted by thz Food and !i.?riculture O r ~ a l i z a t i o n of hol.iin: r- s ta t ic t :c ;? ;

commission a t re u l ir i n t e r v a l s ?n t,hs btist ncans of inprovin? a:ricult;~xal

s t a t i s t i c s and by con r a t u l a t i n ; the Rc:iow-1 Advis-r on h i s r e p o r t .

3r. J m R I ( ~ a u d i Arabia) s a i d t h a t h i s !;07Jernment a t t a c h 3 :reat import-nco

t o t h e s u b j e c t of r i t a l 2nd hea l th s t a t i s t , i c s an3 t o t..hc development of

s t : , t i s t i c a l serv ices . Le : i s l a t i o n had a l r ea .@ h:cn pass.zj re?a;-iln; t h e

r c i s t r a t i o n if b i r t h s 3rd deaths and the st<?i'f of h e a l t h i n s t i t u t e s were bein.:

t r a i n e d i n s t a t i s t i c a l procedures but a : r ea t ?oa l of sup'.rort an3 a s s i s t a n c e

w-uld b c needed to. k v e l o p the programme s a t i s f a c t ori* .

Lr. Jm@IL ( ~ e b a n o n j thanked. t h e ;2eprdsentative of the In ternc l t icna l

s t a t ' i s t i c a l Pducat ion Centre f o r h i s kind remarks re a r 3 i n some ?.spects

tk o r 5 m i z a t i o n of t h e : s t a t i s t i c a l s e r v i c e s i n Lebanon. ?roblums i n o? ;:.-.in-

such s e r v i c e s rrarjed ~ r e a t l y from c r u n t r y t o c ~ ~ i n t r y ; i n Lebanon, qnr: ?i tLc

chief d i f l ' i c u l t i e s was t h ; t rt: . i s t r a t i " n of , v i t a l s t a t i s t i c s was a f u n c t i o n

of 'he )&.linistry of the I n t e r i o r and t h e ,data obtained wfs n o t r e a d i l y a c c e c s i b l ~

t o the 1.linistry of Haaltn. Tiu:? .>roblem had now been sol . rei by m i c r o - f i l m i y

the r e l e v a n t d a t a f o r use i n tiie NinistSy of Health. ; l i t h re:ard t o t h e

Arabic t r a n s l a t i o n of t o 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 n t i of ,Diseases an3 Causes

of Death, he hoped it wouW be b r r n e i n mind that terminology was n o t t h e

same i n a l l ,kabic-speaking c o ~ u n t r i e s and t h a t r e p r e s e n t a t i w s of cach c n u n t ~ y

mi,;ht be i n v i t e d t o a s s i s t i n a r e v i s i o n of the complete.-l t e x t . He f i r m l y

be l ieved i n t h e valuc of na t iow.1 com~nittees 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 Lebanon, t h e committee, r"r..ic,' included t,hc . J i r e c t o r of t h e I n t e r n a t i o n a l

S t a t i s t i c a l Educat ion Centr.: and many o t h e r c o m ~ t e n t gerssns i n t e r e s t e d i n

s t a t i s t i c s , had been puccess fu l i n drawin ]up a uni f ied l i s t of n n t i f i - r b l e

d i s e a s e s out of t h e .divew,ent l i s ts promul'!ated by t h o Ki i - i s t ry of Hzal th

and t h e Municipal i ty of Beirub; it had a l s o e lnbora ted forms f o r b i r t h an1

dea th c e r t i f i c a t e s a d o t h e r s t a t i s t i c a l r e t u r n s . He f e l t t h a t it was

p r t i c u l a r l y important t i z t a na t iona l committee should inc lude i n t e r e s t e d

p r s o n s f r ~ m va r ious bodies.

Sr. JLLUiL) (Syr i a ) s a i d t h a t a s t a t i s t i c a l o f f i c e had been e s t ab l i shed

f i v e y e a r s previous ly i n Syr ia with 1filAO ass i s tance ; s e n i o r s t a f f had b:,en

t r a i n e d abroad o r i n Be i ru t , while a u x i l i a r y p:?rsonnel had been t r a i n e d i n

iiamascus; s t a t i s t i c a l machinery was now bein*. i n s t a l l e d .

Ijr. SHilMI (Jordan) sa id t h a t one of t h e main problems i n obta in in? s t a t i s t i c a l

da t a was t h e unwillin,:ness of t h e popula t ion t n cooperate. This :ms p - r t l y

due t o i,:ncrance - it d i d not seem necessary, f o r i m t a ~ c e , to r c y i s k r

t he b i r t h o r dea th of a c h i l d wt!ich l i v e d only a couple of dqrs - and . -ar t ly,

pcrhaps, t o the unnccessazy complexity of b i r t h and ioa th c c r t i f i c a t c s . It

was poss ib le t h a t a pester masul'c sf c c o p r a t i , - n w-uld be achieved i f s impl i f ied

c t r t i f i c a t e s c w i ; rie devised. iid was :lot i n favnur of s e t t i n - : up a n a t i ~ n a l

covmittce on r e a l t h and v i t a l s t a t i s t i c s u n t i l such tin? 3s s t a t i s t i c a l i e r v i c e s

were f a i r l y wel l e s t ab l i shed .

2r. tiRWiiiY, A s s i s t a n t iErcctor- s i i z r a l , s a i d . t l i x t t h e s ~ ? c e s t i ? n s which

had emerzed from thc s t imulat ir l . d i s c u , s ign on tho r c p o r t wouli be noted and

taken i n t o account i n thc formula t ion of ijolicy a t Headquarters. He was

y a t e f u l t o t h e d i r e c t o r of t h e In te rcnLdona l S t a t i s t i c a l Tducation Cent,= :or

h i s o f f e r of cooperat ion i n t h e p r o d u c t i m of a manw.1 f o r i n s t a t i s t i c a l

t r a i n i n g c e n t r e s and wcltll.3 c e r t a i n l y bea r i t i n rni.n3. As ?'i :ar:3s the Arabic

~ r s i o . 1 of the I n t e r n a t i o r ~ a l C l a s s i f i c a t i o n ~f Causes of Disease a n l e a t h , hc

f u l l r e a l i z i d the d i f f i c u l t y c a u s ~ d b; d i f f e r e n c e s i n tzrmin~lo~::;., which tns

not confined t o the 2.1-aoic version :ilone, m d won.jere3 whether a s o l u t i o n mizht

be found i n a e n c r a l a:;reement t o adopt the broader hea j inqs of the c h . s s i f i c a t i o n ,

lca-ring the d e t a i l e d headin<s t o l o c a l 1lsa.y. He r a s s u r e t h a t the ~Erircctrrr-

~ n e r a l wmld bt. g r a t k f i e d t o l e a r n of t h e i n t e n s e and c o n s t r u c t i r e i n t e r e s t

i n t h i s slibject.

Dr. T!.BI:, Re:r$.onal Direc tor , expressed h i s apprec ia t ioq f o r t,h.z e v i l e n t

endorsement of 'JHO programme>smd a s s i s t a n c e i n t h e f i e l d of v t t a l m i i :?a l th

s t a t i s t i c s . The importance of this f i e 1 3 was obvious s ince an , - v z l u a t i ~ n of

the work of WifO could only be bnsed on adequate s ? a t i s t i c a i 32ta. ..s r e .?.ri;.

tiie ..rabic ve r s ion ef t h e I n t e r n a t i o n a l Class i f ic2 , t inn of ; l iscnscs and of C:iu,,es

of jeath, i t would bc rsmembercd t h z t aL the o r e - i a u s s.:ssion ?f the Sub-Conrritt;~.?

i;ne d r a f t t c x t i lal been c i r c u l a t e d .with tho r e q w st, t;l?.t a v e r m e n t s sh3uld

i'orrrard t h e i r comments. The t z x t ha: been comoiled wi th the a s s i s t a n c e of

,.rl.b mc.dical Ten, ..rabic l a n ;ua;e a u t h o r i t i e s CW! the meiical department o f the

;,rzb l e a ;ue, but, a f t e r the c mments of . iovernncnts ha3 bt~; n rce:.:i-re!, it miyht be

gossible t o arranze f o r a mall committee t o make a f i n a l revision. I f such

wele the case, he h o p d t h a t the r-presentative of Lebanon, who was an authori ty

on the lirabic lan,'lza;e, and '.he representative of Syria, where medicine had

beentaught in Arabic f o r many years, m i h t be wil l ing t o serve.

I*. NIELSEN, Re :ional Adviser on S t a t i s t i c s , s a i f t h a t there was every

cause t o hope f o r a very ~ a l improvement i n the !walth an' v i t a l s t a t i s t i c s

of th-. countries of the Iie:ion. The woup Iket ing i n 1563 w ~ u l d provide an

excel lent opportunity t o 3iscuss fu r the r the various topics which ha3. a r i s en

durinz the debate.

The CIi4~IRMtUi submitted the fol lowin. d r a f t resolution:

H a m , studied the document on Improvement of V i t a l an? Health S t a t i s t i c s i n the Countries of tho ,astorn $IeLiterranean Re-ion (EM/RC12/7) ;

Considerin., the basic importance t o public hiialth administration of the de velopment and eAmen;thenin : of systematic procejurcs f o r e n s w i n a d e ~ u a t e v i t a l and health s t a t i s t i c s ;

Notin, t h a t the ex is t ing data an? not suf f ic ien t t o allow f o r a quant i ta t ive evaluation o i the health s i tua t ion i n t h e Ke:iln o r comparisons betmcn countries;

Notins:; t h a t a major obstacle t o the impro rement of v i t a l an3 health s t a t i s t i c s i s the s n o r t a ~ e of trained s t a t i s t i c a l p3rsonne1,

1. Etii!SS 1::ember S ta tes t o pursue t h c i r ~ f f o r t s i n the f i e l d of v i t a l and hoalth s t a t i s t i c s par t icu la r ly by unrlertakin: ~ e r i o d i c population censuses; improvin.: t ho i r legislation on reg is t ra t ion nnd. reportin. of v i t a l events an3 develo$ment of the various f i e l d s of health s t a t i s t i c s ; establishin,:, i f they h2ve not alrea* done so, national committees on v i t a l and heal th s t a t i s t i c s ; o r ~ a n i s i n seminars and meetin:js on the subject; stimulatin:!: the trainin: o f s t a t i s t i c a l p2rsonnel;

2. FtF::UESTS the Regional A r e c t o r t o continue t o pmvide f e l l o t sh ips and teachin.: i n health s t a t i s t i c s .m J t o ren3:-r inc-easing s t a t i s t i c a l assistance and advice on s t a t i s t i c a l or:anization an? dcvclopmnt t o countries reque stin!: it.

h c i s i o n : The d r a f t resolut ion was adopted !EM/ttC12L/R.8)

( e ) Tinca G a p i t i s an3 i t s Contro l i n tk Liyht of Txperiences 1;ained w i t h iris<.of ulvin: (Document EM*I/RC12/8)

The RE jI Ol';I,L DIli XTOR sa id t h t Tinea C a p i t i s was a ~ ' l b l i c he 31th problem

t,or~ards the s o l u t i c n of which W.0 had i n ihe p a s t : i ven a j v i c e and a s s i s t a n c e

es;>ecially a s ~ s g a r d s t,he use of s u p : r f i c i a l ra3iotherany. Dr. Grin, the

.~~ , rdliO short-term c ~ n s u l t a n t Dn ' t i n e 2 c a g i t i s , would be visi tin.: a numbr of

c o u n t r i e s i n t h e Re . icn wi2ic:i kla.3 asked f o r f u r t h e r a tv ice ; i f any o ther

c o u n t r i e s rnshcd t o a v a i l themselves of h i s przsencc i n the Rs?;ion, it m i ~ h t

be poss ib le t o arranSe f o r him t o crisit them a s well.

h. I W N , : L O consu l t an t on t i n e a c a p i t i s , s a i d t h a t the most c m o n

,iycotic d i seascs rrc7s t'he i r f e c t i o n s of t h c s k i n and i t s appenda::eswd, amon':

these, t i n c a c a ? i t i s i n f e c t i o n s caused by s e v e r a l knotin spec ies of dermatophytcs

were of major pub l i c h*:alth importance. Frcm f r a ~ m e n t a r y d a t a ava i l ab le , it

appeared t 'nat i n sorE a reas of tho world, ria-worm nf t h e s c a l p alone a f fec ted

2% or nore zf tkie school ch i ld ren , r h i l e the g l o b a l number of cases of t i noa

c a p i t i s was est imated a t not l e s s than 1~,000,000. Tinca c a p i t i s was n~a in ly

found i n endemic form amon:, r u r a l popualt ions with low h y ; i en ic and socio-econni:ic

s tandards; tile i n f e c t i o n h a l a l l t h e c :ha rac te r i s t i c s nf a h o u s c h o l disea.;, . . o f t e n producin: s i m u l t a ~ e o s i n f e c t i o n s i n the family. It was of , z r t i c u l

e p i d e r i o l o g i c a l importance t o r e a l i z e t h a t the i n f c c t e j fami ly was the m i n

source of i n f e c t i o n of c h i l d r e n r a t h e r than tk schonl. The h ighes t prevriloncc

of t i n c a c a p i t i s occurred i n c h i l d r e n but , i h ~ r c the disease r,ms cause j by the

t r lchophyton s p e c i , ? , i n f e c t i q n was founJ among adu l t s , p a r t i c u l a r l y amonz

wc:nen, a l t h o u .h t'ne d i sease caus,;d by tAs s;?ccics had a ten lency- t o spontanenus

C ;; lo a f t c r puberty. I n consequence of these f i n r l i v ; ~ , it was obvious t h z t a

carq,sai<n a:ainst t i n e a c a p i t i s must be planned to take i n the bihcle populat ion

and not j u s t a s e l e c t e d age-group.

EM/RC12~/ProgrMin .2 page 12

Treatm:?nt nf t i n e a c a p i t i s , *ich had been f r a u rht with d i f f i c u l t i e s ,

was revolu t ionized by t h e i n t r o j u c t i o n of g r i s e o f u l v i n , an o r a l l y administered

a n t i b i o t i c . This d r u , which was fun : i s t a t i c , when taken o r a l l y became

incorporate:i i n tho newly f o m d kere t inous s t r u c t u r e , thus pro-lucin-: r e s i s t a n c e

t o a t t a c k by demhtophytes. i i r i seofulv in was r e l a t i v e l y c o s t l y bu t the

replacement o f t h e former 250 mg. t a b l e t s by 125 m;, t a b l e t s of equa l the rapeu t i c

value would effectiTrely reduce cos t of treatment. The e f f i c a c y of the d rus alone

had been convincingly e s t a b l i s h e d b u t it s e e m d t h a t a , : ld i t ional l o c a l t rea tment

increased t h e r a t e of recovery.

Even if i t should be consi.iercd t h a t dermat?phyte i n f e c t i n n s were n-t an

important neal t l l proolem, lt should be rem~mbered t h a t t i n e a c a p i t i s was found

only i n populat ions with low hy:ienic s t a n d a r l s and habi t s . Consequently,

zn e f f e c t i v e a n t i - v c o t i c campaign could be of the g r e a t e s t value as an example

of p r a c t i c a l h e a l t h education. The :<astern Mediterranean Z e ~ i ? n was t o be

cony-atulated on takin : t h e i n i t i a t i v e of inclu'3in: the problem of v c o t i c d i seases

i n i ts a c t i v i t i e s and of seeking t o c o n t r o l and eventual ly e r a d i c a t e t h e s e d iseases

.with t h e a s s i s t a n c e of new s c i e n t i f i c developments.

Or . BORAI (Kuwait) sa id t h a t , ; r iseofulvin had been use3 f o r the t rea tment c f

s u p r f i c i a l fungus i n f e c t i o n s , p a r t i c u l a r l y t i n e a c a p i t i s , s ince 1'60. Owin:

t o t h e l a c k of l a b o r a t o v f a c i l i t i e s , no d e f i n i t e 3 a t a could be : i v e n re .*ardin .

the c o n t r o l of t i n e a c a p i t i s by t h i s method, b u t it was hoped to complete a

survey by F e b r u a ~ y 1763 which would inc lude these d a t a a s w e l l a s s t a t i s t i c s

re , iardin: the inc idence of i n f e c t i o n and th3 preva i l in : types of funya. Such

information a s was a ~ i l a b l e silowad t h a t most cases achieved a c l i n i c a l cu? i n

e i ~ h t t o twelve weeks; a few cases showed recurrence gf the i n f e c t i o n &en

t rea tment was s t o p p d , b u t some LY? t hese resporded t o morc t rea tment , o thers

f a i l e d t o respond even when t h e t rea tment wns continlled f o r folw months.

C ~ s e s of rin,:worm showed b e t t e r responsc than favus and the r a t e of f a i lu -e rms

lower. cnly mecase of t r e a t m n t were the re any s i . j c -e f fec t s b u t i t was

necessary t o i n s t r u c t pa ren t s t o s t o p t rea tment if s ide-ef fec ts suoh a s f eve r ,

YP~/RCI~A/P~O:: .Min. 2 page 13

so re t h r o a t , cou,;h o r b o i l s , s h ~ l d appear. It seemed e s s e n t i a l t o i n s i s t

t h a t p a t i e n t s should have t h e i r b.air c l i p g e l s h o r t e.rery week s ince f a i l u r e

t o observe t h i s urecaut ion might ell cause f a i l u r e of Lie. 1;reatmcnt o r tray

r e - in fec t ion a f t c r the p a t i e n t had responrte t o t r sa tment . Re-infect ion

from o the r sources, p a r t i c u l a r l y witil in the family, ~ o s e d the qucs t inn of rrhcthsr

i t w-uld be j u s t i f i e d t o :ive - : r iseofulvin a s a prophylaxis t o suscea t ib l c

c o n t a c t s i n the family. To conclude, he had no doubt t h a t r i s e o f u l v i n

~ r a s a pod weapon w i t h which to comblt t i n e a c a p i t i s and t h a t i ts s ide -e f fec t s

:"rere i n no way comy.i?able with those d X-ray e p i l a t i o n combinc-d wi th t o p i c a l

t,rentment.

3ri;;adier ikC1UE (r 'akistan) s a i d t n n t t r ea tmen t of t i n e a c a p i t i s by X-ray

c p i l a t i o n was be in , replaced by r i s e o f u l v i n i n Pakistan. Treatment was

,iv,cn f o r 6-8 wecks rturin:: wm~ich t i m e the h a i r was c l ipped short . Resul t s

ha3 bccn vem s a t i s f a c t o r y .

:jr. &&FOI!S (Tunis ia) s a i d t h s t two g i l o t p r o j e c t s coverin 5'75 school

c h i l d r e n had bcen carci.33 nut t o determine whcther thc t rea tment nf t ine? .

c a p i t i s by : r i seofulv in was b e t t e r than by X-ray zp i l a t ion . I n a d f i t i o n t o

dosa ;e with the d r y , , t h e c h i l d r e n were made t o wash t h e i r h a i r each day acd

t o have it cl ipped each week. 90% of the p a t i e i l t s wcrc cured with no s i - n r f

r c - i n f e c t i o n a f t e r t h r e e months.

Dr. MORSFIFD ( I r a n ) asked whether t h e r e rms ?qr i nd ic - t ion t h l t c!?n-qc t o :!one

mi-mw could r e s u l t from t h e use c f : r i seofulv in .

Dr. JALLOUL (Lebanon) s a i d t h . t t he problem of t i n e a c a o i t i s e x i s t e l i n

Lebanon; the p a t i e n t s were t r e a t e d by mobile u n i t s and i n 4 ispensar ics . FL

s p e c i a l pro7ranmE t o combat th:: d i sease had b;?en rlrarm up t o opera te i n three

sta;es; the f i ~ s t s t a ; e rras a h c a l t : ;.ducation campaign; the second s t age

was s p c i a l trainin.; f o r a l l pm-sonnel tiho would be e n g a i e i i n t h e campainn;

t h c t h i r d s t a p wo Llld be thc a c t u a l f i e l d campaizn i n which d i a ~ n o s i s w-uld be

chcckcd by l abora to ry c o n f i r m t i o n before t rea tment was i n t t i a t e d .

Lie D e l i e n d t h a t 3 mass campaign i s the only m a n s qf eradica t in- t t h e

J i s e a s e b u t thou;ht t h n t t h e a s s i s t a n c e of the ' G O exper t m i :ht be necessary

i n imp1ementh-g the p ro jec t .

3r. SMlQ ( ~ o r d a n j sa id t h a t t i r e a c a p i t i s i s a f e f i n i t c problem i n Jor?an

bu t unfortunately t reatment with z r i s e o f i ~ l v i n was not achieving thc saw r e s u l t s

a s i n the experiments i n Sarajevo. Hz would be most : :ratoful i f the consu l t an t

could visit Jordan and &ivz them the bcnc f i t of h i s advice.

Dr. JilLLAD (Syr ia) s a i d Iik.t t ! !~ X-ray e p i l a t i o n mct;cd had been used

h i t h e r t o i n Syr i a b u t a chan .e-over t o :riseof u lv in during t h c p ? s t y e a r

had had very :pod r e s u l t s - d t h f e w s ide-ef fec ts . It had the re fo re been

decided t o extend t r e a t w n t with g r i sco fu lv in t o 3,000 cases.

Ih.. &XN, WHO consu l t an t on t i n e a c a p i t i s , s a i d t i la t l a0 was considering

t h e es tabl i shment of an ln t i i rna t iona l c s n t r c f o r t r a i n i n g personEl f o r

. . ;ris,>ofulvin campiens . The response t o t reatmcnt v a ? i ~ d co-nsilerably f mm

person t o person, thus shortening o r pro lonr in? the time of treatment; t hc re

would always be somi f a i l u E s bu t apparcnt f a i l u r e s mi:ht r e s ~ ~ n d t o t reatment

a t a subsequent t i m e because 'risooful*n was only -.ffcctive i f it s e n t t r a t x i

the kere t inous s t r u c t u r e riurin, the ,rowth of t h e k n i r - t he re fo re trcatmcni,

g iven when the h a i r was dead would f a i l but was l i lcely t o succeed when the

h a i r began to ?row a;ain. Cases o f favus were l i lcely t o ;t:spond more slo%rly

t o t rea tment because blood c i r c u l a t i o n w2s le:!: if there were s c a r t i s sue .

?rophylaxis d i t not appear to have s a t i ~ f a c t o r y r e s u l t s bu t a 7 3 i t i o n a l l o c a l

t reatment was J ~ s i r a b l e a s a means of p ~ v e n t i x =-infect ion. Re had no t

observed aqy se r ious s i d e - e f f e c t s r e s u l t i n ? from t h e w e of : r i s eo fu lv in

b u t recommended t h a t tk dosa:e b ;iven t h r e e t imes d a i l y + i c h r:.juced t h e

r i s k of s ide -e f f - c t s and maintainad t h e concon t ra t i n of the r u . Health

educat ion was a most Important f a c t o r i n mass campai-ns which werr: t h e only m y

t o achieve c o n t r o l of t ~ n e a c a p i t i s ; it must be remenbore t h a t such campai -ns

t c bc. e f f e c t i v e must inc lude t h e whole p o p d a t i o n s ince the y a v f s t r i s k of

r e - in fec t ion o f t en lay with t h e moth<,r -f the family.

The W, :IOh iL riT:3CTCR s a i d th2.t a r r a n rcments would be mads, i f possibl-e,

f o r dr. iris t o v i s i t Jordan a s requested.

The C:ii,Iki"ikN submitted t h e fol lowin; d r a f t r e so lu t ion :

"The Sub-committoe,

ilavin.; examined m e dncument o n Tinca Ca.pitis an1 i t s Cont ro l i n the L i , h t of Expsriences ~ a i n i d wi th - r i s e o f u l v i n ( 3 ~ h C 1 2 / 8 ) ;

3c;co:rnizin t h a t Tiriea C a i t i s i n f e c t i o n s . particu1nrl:f those - caused by Trichophyton violaceurn, and T. s c h o e n l i i n i i f a w s ) , a r e ~ J e l y j i s t r i b u t e d i n the Eas te rn !kd i t e r r anean Re :ion, a n 3 c o n s t i t u t e a s c r i o u s problem i n many c n u n t r i ~ s ;

Notin t h z t WHO-assistad f i e 1 3 t r i a l s on the e f f i c a c y n f ? r i s e o f u l v i n f o r m ~ s s t r ea tmen t of Tinca c a p i t i s -n encleric r u r a l a r cas , !?a:re >roved t h a t t'ne o r a l a d m i n i s t r a t i o n of t n i s i r u : i s t h e most e f f e c t i v e and the safcs'i, therapy f o r tb.5 j is . ;ase,

1. RECO:'!ivENUS that countries rrherc t h e j i s e a s c i s endemic should undertakc r z s s campai:qns f.or i t s c o ~ ~ t r u l usiru: s r i s e o f u l v i n the raw;

2. RE;!:XSTS the Re , ion31 Di rec to r t o g ive maximum poss ib l e a id t o 2o.ierqments vndor tnkin ; such pro?rm?.as, and t o a s s i s t i n any o t & r el)idemiolo , i c a l s t u d i e s and prophylac t ic ~1easu:-es t h a t may be necessary t o achieve t h e b e s t r e ~ a l t s .

Decision: The g r a f t r e s o l u t i o n was a d o p t ~ d (FJI/k~12h/R.3)

( f ) Rura l Hcal th an3 Community 26-rclopment i n th-. Vastern I*i~?iC,crranc.?~ Fte,:ion: Resu l t s ?f a n Enquiry (iIocwnents EPZ/R':12/3 an:] Add. 1)

13r. Zaki (WHO Rc , i s m 1 0 f f i c c ) s a i d t h a t r u r a l h e a l t h was of paramount

importance i n t h c economic and s o c i a l - ? i c lds i n connt,rics of t h e i ic . ion, an3 wzir

a s u b j e c t t h a t rec:ived sp ;c i a l a t t e n t i o n by t h o H;+.;ional Office, which 7:ras

awarc t t ia t a lmost a l l co i in t r ics of t h e Fce;ion wme deve1opin-j. p l ans f o r i t s

'rrmqtion. Tht, i i e ; i ? w l 0:fice tiad found i t use fu l t o compile i n a s inq le

document the d a t a on tha econo~nic, s o c i a l md cul t iura l c o n j i t i o n s i n c-untri::s

!i:~' t.hc &;ion z n l thc t, pc; cf o rzan iza t ion ant1 admin i s t r a t ion of h e a l t h s e r v i c e s

- r id ~ o c i a l p r o , r a w E s i n thi,f?ield of r u r a l conmunity 3 c v c l n p c n t . I n i t s

v i r c u k j r 1 - t t c r da ted ? p r i l 1761, the Ze-:ional Office ha3 sen t 1. j a t a i l e d

qucsi-ionnain, o n r u r a l ncaltt. anj community 36-~elopnent to a l l c n u n t r i e s of the

Eic,ion, and = p l i e s h a j brien r e c e i v e J f rorti thc i a j o r i Q and ins lude? i n the document,

summarized i n f o q t e e n s a r t s . I n f o m a t i o n drawn from s t a t i s t i c a l pub l i ca t ions

c f ';he Unitcd Nations and S p o c i d i z o d .?-f?cncies h c ! 2180 boon included, iir?

asked those countries wiio had n o t y e t done so t o reply t o t h e qaes t ignna i r e i n

o rde r t h a t t h e document could b e conipleted. Cnuntr5es t h a t had a l r eady ssc.nt

r e g l i e s m r e a l s o r c q u e s t e j t o provide fur t i1 , : r .~nforma~;ion on l a t e s t even t s t o

b r i n g t h e ioc l lmnt ui1 t o date .

Thc s u b j i c t of r u r a l h e a l t h heL< bc n nnc of the t e c h n i c a l s l ~ b j e c t s -!iscussed

a t the Eleventh Sess ion of the Re;ional Co!:mittne an4 a d o c m n t had bccn presi:nte,l

on xhc sub j sc t . Moreover, two r c y i o ~ a l a d v i s o r s i n p u b l i c h e a l t h p1annin.q and

com,~unity dcvclopment would s h o r t l y be a s s i :ncd t o t h e Re ,? i ,~ na l Off ice t o pro.ri3c

a s s i s t a n c e t o Henbzr S t a t e s ,at t h e i r r.:quest. He emphasized t h e i w ~ o r t a n c e of

makin; r u r a l h e a l t h and community flevelopment s c r v i c e s ava i l ab le an: e f f e c t i v e

w i t h i n t h c f r amwork of o v c r a l l s o c i a l and economic develo~mcnt , bear in : i n mind

t h a t bO t o 90 pe r c e n t of the @o~: i l a t io r i of the Rezion w a s l i v i n ? i n r u r a l a reas .

I n s p i t e of differing h e a l t h co i j i t i o n s , t21c na ture of t h e h e a l t h problcns

i n co i ln t r ies of t h e I ~ e ; i o n was more o r l e s s the same, and f u l l y justified t h e

cievelopmcnt of u n i t s t o @ l a 2 and imglemcnt hea l th se r - r i cus i n r u r a l i ~ c a l t h a reas .

He m n t i o n c d t h a t a wide v a r i e t y of skills and educa t iona l t cch 1iqut:s I ~ S

needed t o achicvc t h e s p s c i f i c ohj:;ctives of a l l ?ro;ramm.is l e a d i n ! t z t h ~ 'broad.,r

; o a k of m t i o t x l d c v c l o ~ m n t . Experi incc h e sh?%?rn the necccs i ty i n r u r a l n8:nlth

and communi.ty dcvc1o:)mcnt of e n l i s t i n , : t h e R C t i v o p a r t i c i p a t i o n of i n l i v i d u n l r

a!ld communities r n d of cncoura : i n , i n i t i a t i v e an3 snlf-hcl , . It was important

tlkt tile r u r a l h s a l t h ard community d e w l o j q ~ n t process should be ma3e an i n t e , ? r a l

p:wt of t i r : planri in~. and zx tens ion of b a s i c technical s c r v i c - s such as educat ion

an3 a ; r icu l ture , a s w e l l a s s t . rv i ccs anci t r a i o i n ? pro:ranancs i n h c a l t h an? o t h e r

bas i c f i o l d s .

On behalf of the He . i c : l a l D i ~ c t o r , he ex2rzssed thanks t o lhnbe r S t a t e s

f o r t h u i r e f f o r t s and the; i n t e r : . s t shown i n replyin: t o t h e lonz ques t ionnai re .

Dr. EL BOWd (Kmrait) emphasized t h e w e d f o r devo te j ~ ~ o r k c r s , f u l l y awaE

of t h e o b j s c t i v e s f o r which tAby were workin:, a n j s a i d t h a t needs var ie4 :?rea::-W

from one community t o another.

The people of h i s country enjoyed f r e e comprehensive medical se rv ices , i n

w.:ich t rea tment of a l l kinds, and prophylaxis, wero c l o s e l y l inkcd. h -:r.ea%

d e a l was be ing dow i n bui ld ing hosp i t a l s , s a n a t o r i a and o ther h e a l t h establ ishmcnts ,

and rural h e a l t h and environmental s m i t a t i n n continued t o rece ive t o p p r i o r i t y .

X i s Government a t tachod p a r t i c u l a r importance t o t h e need f o r inc luding i n water

supply p r o j e c t s schemes f o r sermraee and su r face 3raina:e.

A c l i n i c had been s e t up i n each vi1la::e of h i s country, of the same standard

a s t'klose e x i s t i n g i n urban areas , and the medical network was evenly d i s t r i b u t e d

throu;hout t h e country, adequately s t a f f e d by doc to r s an5 a u x i l i a r y s t a f f , and

provided with good equipment. k f i r m t e c h n i c a l b a s i s was thereby provided f o r

s ~ l v i n : t h e most se r ious publ ic h e a l t h problems, and t h e c l i n i c s wcr;: considered

i n h i s f i ~ u s t q i as thc nucleus of t h e c u r a t i v e e l e m n t . The bas ic s e r v i c c s

o f f e r e i i n them inc luded medical ca rc a s p a r t of a n i n t e q r a t s d r u r a l h e a l t h

pro : r m . The number of d o c t o r s employed i n them depended upon t h e populatieri

of the d i s t r i c t served. For a d i s t r i c t of 12,000 f o r example, f o u r doctor-

were employed.

The c l in icawere d i s t r i b u t e d t o enable coveraye of t h e whole ~ o p u l a t i o n ,

and t r a n s p o r t was f a c i l i t a t e d by a road -etwork cover in : t h e whole country.

Under the r e g i s t r a t i o n le; ; is lat ion now existing, measures had becn t a k e n t o ensure

t h a t p a t i e n t s at tended t h e c l i n i c n e a r e s t t o t h e i r home. The card i -sued t o each

p a t i e n t snowed tile blood group, t h e Rh f a c t o r , s e n s i t i v i t y , chronic d i s e a s e s

such as d i a b e t e s and h e a r t d iseases , s u s c e p t i v i l i t y t o praemia and o t h e r

important i tems.

A c e n t r a l c l i n i c had been chosen from among every t h r e e o r f o u r c l i n i c s t o

serve a s the coinbined h e a l t h u:.iit, of vhich t o n had been f om.:d and m m workin.:

24 hours a dqy, while t h e o t h r c l i n i c s workel a t d t a l ?f s ix hours a lav.

The b a s i c hca l th s e n r i c e s s f fered a t t he combined h::alth u n i t s i n c l u l e 3 an or-Jin'rj7

c l i n i c , maternal and c h i l d h e a l t h seririces, and communicable -1isease con t rq l

s e r v i c e s includin:; e n v i r o m n t a l saniLation a c t i v i t i e s .

k very c losd l i n k e x i s t e d ' bct,ween the c-mbin:.3 hea l th u n i t on the one hand

and h e a l t h and s o c i a l educat ion on the othcr. A l l elwrgency cases from any

p a r t nf the country were p r m i t t e d t o vis i t the u n i t s a f t e r du ty hours f o r f i r s t

a i d before being t r ans fe r red t o h o s p i t a l o r r e f e r r e d t o t h e i r o r i - r i n a l c l i n i c s .

Every combined h e a l t h u n i t had a f i r s t - a i d post f u l l y equipped with ins t ruments

and ambuhnces, ~ l i l e d i s t a n t c l i n i c s o r combined hea l th u n i t s were eq~tipped

+ n t h wire less .

It was hoped t h a t those m a s u r e s of r e g i s t r a t i o n w i t h c l i n i c s an3 combined

h e a l t h u n i t s would l e a d t o the f u l l u t i l i z a t i o n of modern environmental and

?ublic hea l th se rv ices includin.: medical ca re , d i rc jc te i towardsthe a t ta inment of

the h i ~ h e s t p o s s i b l e l e v e l of h e a l t h and happiness.

D r . HAQUE (Pakis tan) s a i d t h a t the 1,900 dispensari i is and n a t e r n a l and

ch i ld h e a l t h c e n t r e s e x i s t i n ' ; i n h i s country had h:td c e r t a i n shor tcomin:~ .

They had, f o r =ample, no c l i n i c a l room a t t a c h e d t g them, and no accommcrdetinn

f o r doc to r s .and o t h e r s t a f f , so t h a t such workers had been r e l u c t a n t t o j g in

v i l l a s e d ispensar ios . A l a r l e - s m l e n a t i o n a l pro:ranme had recen t ly been

hunohed i n s0ch f i e l d s a s malaria , smallpox, leprosy am1 t r a c h o m , and i t

had been r e a l i z e d t h a t f o r the m i n t e k n c e phase an inter :rate3 p lan was necessary

t o se rve the whole country. The second f ive-year plan t 6 cover t h e y e a r s

1960-1365 envisa:;ed the establish-ment of 300 i n t e - r a t s d r u r a l c e n t r e s , of which

45 ?;re a l r e a d y funct ioning. Each ccintre would provide c u r a t i v e se rv ices ,

m a t o r m l and c h i l d h e a l t h s e r v i c ~ s , school h e a l t h se rv ices , vacc ina t ion ,

inocu la t ions a q a i n s t smallpox, cholera, typhoid, etc. , t u b e r c u l o s i s cont ro l ,

environmental sani ta t ion ac t iv i t i e s , collection and compilation of health

and v i t a l s t a t i s t i c s and health education. %ansport f a c i l i t i e s had a l s ?

been provided for.

The coun t r j was f o r t u m t e in having a great deal of educated manuower,

so t h a t there was no d i f f i cu l ty in r e c m i t i n g s ta f f well trained in basic

science. Five schools had been operled in East and blest Pakistan t o t r e i n

multi-purpose technicians, of whom a large number was needed.

With reference t o t h e question of self-help, emuhasized by Dr. Zaki,

an undertakine had been given t h a t a m r a l health centre would be urwided

t o every v i l l age will ing t o donate t h e land, end great competition had thus

been stimulated.

In endeavours t o improve health education, the question of water supuly

was often the nost d i f f i c u l t problem. Reports of outbreaks of choler^ had

sometimes been received which on investigation had uroved t o be fa lse , and

the explanation given had been t h a t submission of such reworts had been

made i n t he hope of obtaining clean water supuly.

It was hoped tha t t he 300 centres envisaged i n the second five-year

plan would help t o f i l l the gap, but t o cover t he &ole c o u n t ~ y about

2, aX) were needed.

Miss DOSS (FAO) said that those concerned with ru ra l welfare tended

t o emphasize t he pa r t i cu l a r need in which they had a s p ~ c i 2 l in te res t .

Agricul tur is ts regarded the primary need a s being r n increase in agr icu l tura l

productivity and r u r a l income and public health workers emphasize t he

importance of improved health, while educationists claimed tha t the f i r s t .

s t ep should be t h e provision of more schools. A l l those aspects must,

however, be tackled a t t he same t i m e . In order t o r a i s e the standard of

l iv ing i n any comnunity, i ts women and children must receive inst ruct ion

2nd care i n a l l matters re la t ing t o health and family l i f e , with par t icu la r

emphasis on simple nu t r i t ion educ=tion and homecrafts t o supplement Faril-r

income and improve home conditions.

FA0 had demo~strated i t s i n t e r e s t i n community development by i t s par t ic ipat ion

i n Training Centre f o r Community Development a t Sirs-el-Laman. Her Organizatio,i

bclieved t h a t heal th education a c t i v i t i e s should include the s ~ ~ v i c c s of a

worker h*o could give t o t he women i n the cononunity t ra in in? i n simple home

economics w i t h special emphasis on nut r i t ion education. It encnura~e?

the multi-purpose approach i n dealing with tha t question.

Dr. VASSILOPOULOS (Cyprus) said t h a t one of the 1on:-term pol ic ies of

h i s Ministry of Healtn was the advameilent of t h e scheme f o r impmvement and

extension of curat ive and pmventive health services i n ru ra l areas. The

scheme was aimed a t the gradual replacement of old-fashioned dispensaries by

more advanced and elaborate heal th cen t res with adequate personnel. It was

hoped thereby t o br ing th : health services within the reach of a l l l o p l e i n

ru ra l areas. There was a t present no special provision f o r health education, but

the subjec t f o m d one of the d u t i c s of every medical o f f i c e r a s well a s of

health v i s i t o r s and other workers. M-thers attendin7 ant i -natal c l i n i c s

wOri: ;iven advice on personal hy:iem and ch i ld care, while health education

also formod part of the curriculum i n elementary and secondary schools.

d i s t r ibu t ion of l e a f l e t s also playtd a part . It was : ra t i fyin? t o note

t ha t a fellowship had been granted t o enable a medical o f f icor t o t a k e a crursc

i n the United Sates.

Ur. SIlQlI (Jordan) said t ha t it was imprrtant to xovide i n i t i a l l y f o r

t ra ining of. personnel f o r the centres i n nursin;:, sanitation, health education

e t c . Onoe the i n h d i a t e needs of the population had been met, more specialize*

services c o u l d b e sought f o r the centres.

Dr. ZAKI thanked rep-esontatives f o r t h e i r statements and reminded them of

the n ~ e d f o r sending r ep l i e s t o the questionnaire.

The CIIIIIRWN introduced the followin: d r a f t rdsolution:

"The Sub-Conrmittce,

Having examined t.he docwnent on Rural Health and Community kvelopment (EM/RC12/9 and Add. 1 )

Notin: with i n t e r e s t t he r e s u l t s of an enquiry into the rura l health and co-ty developcent projects i n the Region, which are analyzed i n t he document,

1. IBITECiTES t h e importance of 'kmber s t a t e s or:';anizin : w i t h i n t h e i r K i n i s t r i e s of Hss l th a s p e c i a l department t o d e a l p a r t i c u l z r l y wi th planning f o r r u r a l h e a l t h and i t s in t e ; ; r a t ion wi th o the r t c c h n i c a l an3 s o c i a l s e r v i c c s includini : community development, and a iopt in : a pol icy of r e g i e n a l i z a t i o n of h e a l t h work;

2. UH 3s ~ i o v e r n m n t s who have n o t a r e a @ done so, t o serd r e p l i e s t o t h e Re:ional D i r e c t o r ' s q u e s t i o m a i r c on m r z l h e a l t h and comnunity development so t h a t i n f o r m t i ~ n on t h e s u b j e c t m y be complete an ! up t o d a t e f o r t h e wcole Re:ion;

3. REC!UESTS t h e Re.;ional X r e c t o r t o continuo t o a s s i s t Governments i n p l a n n i n ; an3 developin ; t h e i r r u r a l h e a l t h a c t i v i t i e s . "

Uccision: The d r a f t resolut, ion was approved (&4/RC12~@.10)

The meetin:? r o s e a t 4.b5 Arabio t i m e . (10.45 -.m.)