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P A R T 111

A C T I V I T I E S U N D E R T A K E N BY G O V E R N M E N T S

W I T H THE H E L P O F WHO

S~A/Rc20/2 Page 71

PROJECT LIST

This part of the report contains a list of the projects for which WHO has given assistance during the whole or part of the period under review, listed by country. A short review of health developments duiing the year is dlso given for each country. Inter-country and inter-regional projects are listed at the end.

In general, projects for which no active assistance, in the form of field staff, fellowships or supplies, was given during the period covered are not included. Also omitted from the list are projects for which technical advice from the Regional Office or Headquarters was the only assistance given, and projects assisted only by grants-in-aid.

In the firet column (under IfProject No., Source of Funds, Co-operating Agencies") "R" means the Regular budget; UM)P(TA) and UNDP(SF) mean the Technical Assistance Fund and the Special Fund respectively of the United Nations Development Programme; "UNICEF" the United Nations Children's Fund, and "USADll the United States Agency for International 3evelopment. Names of co-operating agencies, except for UMCEF, whether or not they have contributed funds, are given in parentheses. In tbe second column, under the title of the project, the starting and, where relevant, finishing dates are shown within brackets.

The "Aim of the project" states the purpose for which it was undertaken by the government concerned, and is not related to the form or extent of WHO'S assistance.

Projects entitled l'FeUowshipsu list those which do not form part of assistance to a larger project; other fellowships are shown under the projects concerned.

It should also be noted that there are a number of projects not included in the list for which UNICEF is furnishing suppltes and WHO technical advice only (with no special personnel being provided).

An epidemiological survey for diphtheria in Kabul. One of the functions of the Public Health lnstitute i s t o help identify and define the epidemiological patterns of the prevailing communicable diseases.

+

Media preparation in the microbiological department of the Public Health Institute, Kabul. The epidemiological, microbiological and statistical sections of the Institute work closely together on investigatory and advisory services and for the training of health workers.

AFGHANISTAN

t f t;~inimg of nurses 8 2 tha Shararah Hcs~pita1 for Women in Kahui,

Smrllpm vaccinab~orl In tlic 91112~e o i DarnritdJ)811~ near' Kabul. car-r~ed out as pzrt of the n.~rion;ri smatlpnw rradirafior: propra inme,

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The trend towards more intensive economic development has emphasized the urgent need for a much more rapid development of integrated health services, which are still very inadequate. Plans for industrial expansion are paralleled by others for increasing agriculture, and several extensive irrigation schemes are under preparation. There has been a continued rise in the provision for general education, and several hundred new schools have been opened. The expansion of heath services has not received proportionate attention.

The Government is giving consideration to the nationalization of health services. Newly qualified doctors have been exempted from military service on condition that they serve in the national health services for an equivalent period. This should considerably facilitate the supply of urgently needed doctors for work in rural areas.

The nursing profession has gained in prestige, and, both qualitatively and quantitatively, entry into the profession has improved. Nursing administration has been strengthened with the establishment of the Nursing Division in the Niinistry of Health and the creation of an advisory Nursing Board.

For the year 1967-1968, just over 109 million afghanis were budgetted for health development and 91 million for recurrent expenditure of health services.

A number of difficulties have continued to hamper the progress of the malaria eradication programme. Lack of parallel development of the basic health services has delayed entry of some areas into the maintenance phase, and in other areas epidemiological conditions demanded that the attack phase be continued beyond the period earlier estimated. In addition, an accurate delineation of malarious areas and better geographical reconnaissance have yet to be completed. These set-backs have inevitably increased the estimated cost of the programme.

No cases of cholera were reported during the year. The difficulties encountered in the smallpox control programme, including shortage of staft and resultant poor supervision, inadequate financial provision and the inaccessibility of the female population due to lack of female vaccinators prevented the attainment of an adequate level of successful vaccination coverage. The tuberculosis control programme developed successfully in Kabul and some rural areas and was extended to include military recruits through the co-operation of the Xinistry of Defence. There was some evidence that the incidence of poliomyelitis has increased.

Some 92 doctors graduated from Kabul Medical College this year. As part of an agreement for cultural co-operation the Government of France is assisting this college.

In Jalalabad, a new polyclinic, under the administration of the Medical College, was opened and will be used for teaching. Construction of buildings for five new hospitals, ranging from 20 to 73 beds, was started in various provinces. A new hospital was opened in Gardez (Paktia Province).

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It has been recognized that the relatively elaborate pattern of rural health centres which the Rural Development Department has developed a s part of community development projects is too expensive and too demanding of staff to be suitable for country-wide extension. Instead, it has been agreed by the Ministry of Health and the Ministry of the Interior to adopt a system of simple health sub- centres manned by auxiliary staff, as recommended by WHO, and to extend this pattern throughout the country a s quickly a s possible.

Further plans have been made for international assistance in improving and extending the water supply and sewerage services in Kabul, under the Central Authority for Housing and Town Planning, and for the continued development of rural water supplies, under the Rural Development Department.

PROJECT LIST

P r o j e c t No.

Source of Funds

Co-operating

P.genciEs T i t l e -

U h a n i s t a n 0011 r a l a r i a Eradica-

R (Aug. 1956 - ) ONICSP

A i m of the p r o j e c t . To e r a d i c a t e r ra lar ia and t o prevent t h e re-es tabl ishment of

endemicity.

Ass is tance provided by WHO dur inq the yea r . ( a ) Three i i .a lar io logis ts . an entomologis t ,

t h r e e s a n i t a r i a n s , t h ree l a b o r a t o r y t e c h n i c i a n s , a sec re t a ry - s t enographer and two c l e rk -

t y p i s t s ; ( b ) a five-week fe l lowship f o r s tudy i n the Ph i l ipp ines and I n d i a ; ( c ) supp l i e s

equipment and f o u r t r a n s p o r t v e h i c l e s .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970. --

Work done dur ing t h e yea r . E rad ica t ion ope ra t ions were cont inued: s u r v e i l l a n c e

a c t i v i t i e s showed improvement; geographical reconnaissance continued t o be c a r r i e d o u t ,

and entomological work was expanded.

The Headquarters o f the National Malaria Organization was s t rengthened and

s t r i c t e r supe rv i s ion emphasized through t r a i n i n g and o r i e n t a t i o n of key personnel . New

u n i t s were c r e a t e d . A c o n s u l t a n t ma la r io log i s t and an entomologist of t h e Regional

Assessment Team on Malaria Erad ica t ion (SEAR0 0007) c a r r i e d out an assessment of the

programme i n the f o u r t h S u a r t e r of 1766; they have recommended an o v e r - a l l improvement

of the programme.

Some l imi t ed outbreaks of malar ia occurred i n Kunduz and ifhuajalghar u n i t s and

i n Kandahar c i t y . E f f o r t s have been i n t e n s i f i e d t o e l imina te these f o c i .

By J u l y 1967, a popula t ion of 5.845 mi l l ion had come under t h e a t t a c k phase , and

the popula t ion i n the conso l ida t ion phase had been increased t o 1.599 m i l l i o n . A u n i t

w l th 249 000 people is scheduled t o e n t e r the maintenance phase dur ing the second ha l f

of 1767.

Afghanistan 0013 Medical Education

n ( Jan . - AUK. 1952: Sep t . 1953 - )

A i m of t h e p r o j e c t . To s t r eng then departments of t h e F a c u l t i e s o f Medicine of

the U n l v e r s i t i e s Of Kabul and Nangarhar and t o t r a i n s t a f f .

Ass i s t ance provided by WHO d u r i n g t h e y e a r . ( a ) A p r o f e s s o r o f pa tho logy ; ( b ) a twelve-month f e l l o w s h i p for , s t u d y i n Sweden, two one-month I 'e l lowships f o r s t u d y

i n I r a n and a ten-day fellowship f o r a t t e n d i n g t h e seminar on t h e n u t r i t i o n a l

problems o f mothers 2nd c h i l d r e n . he ld i n Hyderabad ( I n d i a ) ; ( c ) s u p p l i e s and

equipment.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1770

Work done du r ing the " e a r . The WHO p r o f e s s o r of pa thology cont inued t o a s s i s t i n

t h e t e ach ing and t r a i n i n g programmes and i n the s e r v i c e s which t h e Pathology

Department of ttle F a c u l t y a t Kabul U n i v e r s i t y is g i v i n g t o h o s p i t a l s . More l e c t u r e

n o t e s were t r a n s l a t e d i n t o t h e n a t i o n a l language f o r unde rg radua t e c o u r s e s i n h i s t o l o g y and pa thology. A programmed course on i n j u r i e s by chemical a g e n t s was drawn up t o f a m i l i a r i z e s t u d e n t s w i t h t h i s modern t e a c h i n g a i d . Ob jec t i ve - type

examinat ion papers were i n t roduced i n t o t h e f i n a l examinat ions .

The s y s t e m a t i c t r a i n i n g of t e ach ing s t a f f of t h e Department was con t inued .

A f i e l d s t udy o f t h e geographic and e t h n i c i nc idence of c e r t a i n t ypes of cance r

was c a r r i e d ou t by a s s i s t a n t s of t h e Department, under t h e guidance of t h e WHO

p r o f e s s o r and i n co -ope ra t i on w i th t h e r e s e a r c h c e n t r e o f t h e U n i v e r s i t y of Kabul.

~n a n a l y s i s was made of t h e f i r s t y e a r o f t h e Tumour R e g i s t r y s t a r t e d by

the p r o f e s s o r , and t h e r e s u l t s were d i s c u s s e d w i t h v i s i t i n g s t a f f members from

t h e Cancer Unit a t WHO Headquar te rs .

The pa thology museum was r eo rgan i zed . New specimens were added and o l d

ones remounted and p r o p e r l y l a b e l l e d w i t h comprehensive d e s c r i p t i o n s .

A s s i s t a n c e t o t h e Pathology Department o f t h e F a c u l t y o f Medicine i n

J a l a l a b a d con t inued . The t e a c h e r of pa tho logy , who was p r e v i o u s l y t r a i n e d i n

Kabul , h e l d c o n s t a n t c o n s u l t a t i o n s w i th t h e WHO p r o f e s s o r and sought h i s adv i ce

on t h e t e ach ing . S p e c i a l a t t e n t i o n was pa id t o i n t e g r a t i n g t h e t e a c h i n g of

h i s t o l o g y w i th thaL of g r o s s anatomy and the t c ach ing o f pa thology w i t h t h a t o f

c l i n i c a l s u b j e c t s ; t h e s e problems a l s o were d i s c u s s e d w i th f o r e i g n t e a c h e r s

working i n J a l a l a b a d . The Pa thology Department i n Kabul s u p p l i e d s e t s of micro-

s cop i c s l i d e s of p a t h o l o g i c a l l e s i o n s t o the Department i n J a l a l a b a d .

P r e p a r a t i o n s were s t a r t e d f o r t h e assignment of a WHO team Of t h r e e

medical educa to r s t o J a l a l a b a d . A consulLant t o a d v i s e on t h e s t r e n g t h e n i n g

of s o c i a l p a e d i a t r i c s i n t e ach ing programmes i s under r e c r u i t m e n t .

Afghanis tan 0024 Hea l th Education

R (0c t .1958 - S e p t . 1959: May 1962 - Nov. 1766)

A i m of t h e p r o j e c t . To develop h e a l t h educa t i on s e r v i c e s ; t o p r o m t e h e a l t h

educa t i on i n t t - a che r - t r a in ing e s t a b l i s h m e n t s ; t o t r a i n h e a l t h s t a f f i n h e a l t h

e d u c a t i o n , and t o e s t a b l i s h and develop a h e a l t h educa t i on s e c t i o n .

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e y e a r . A h e a l t h e d u c i t o r .

Work d o n e . 'Ti-,? WHO !i,:aitti ~~.'.hc-iro7~ r:oxyl.:Lrd !lli woi'k and 1;fL t h e r:'o.j'~zL

in N C ~ V m'n. r ;76,/6. , I . c o : ~ . : ; ~ or' h:b as., Lgnrn.-ni a H e a l i h Educa t ion

S e c t i o n was es tab l i sYled i n t h e I n s t i t u t e of P u b l i c Hea l t i i t o s e r v c a l l t h e programmes

under t h e Directorate of H e a l t h 3 e r v l c e s . T!re S c c t i o n was ixpanded and a v i s u a l a i d s

u n i t added. T r a i n i n g i n h e a l t h e d u c a t i o n was g i v e n t o v a r i o u s c a t e g o r i e s of h e a l t h

p e r s o n n e l , i n c l u d i n g t h o s e a t t a c h e d t o s p e c i a l programmes, and t o s t u d e n t t e a c h e r s ;

t h e s e c l a s s e s a r e b c i n g c o n t i n u e d by t h e s t a f f of t h e r e s p e c t i v e t r a i n i n g programmes,

i n c o l l a b o r a t i o n w l t i i t h e h e a l t h e d i l c a t i o n p e r s o n n e l . The p r o j e c t s t a f f co-opera ted

w i t h UNESCO and USAII) i n s t r e n g t h e n i n g t h e hi.ilt11 e d u c a t i o n component of t e a c h e r -

t r a i n i n g p r o j e c t s and w i t h UNESCO i n r c v i s i n g t h e h e a l t h e d u c a t i o n a s p e c t s of i ~ i e n c e

t e x t b o o k s . P r e l i m i n a r y work was done on a p l a n f o r e s t a b l i s h i n g h e a l t h e d u c a t i o n

s e r v i c e s a t p r o v i n c i a l l e v e l s a s p a r t o f t h e g e n e r a l h e a l t h s e r v i c e s .

H e a l t h education work h a s been c o n s i d e r a b l y deve loped and a n awareness of i t s

impor tance c r c d t c d . There i s , however , 3 need fo:' fo l low-up a c t i o n , 3nd f u r t h e r

c o n s u l t a n t s e r v i c e s t o t h ~ p r o j e c t a r c p lanned f o r 1967 and 1968 .

A f g h a n i s t a n 0026 R u r a l H e a l t h

UNDP[TA) ( A p r l l 1956 - )

UNICEF

A i m o f t h e p r o j e c t . To f u r t h e r ' t h e rit:veiopment o f r u r a l h e a l t h s e r v i c e s . i n which

c u r a t i v e and l r r e v c n t i v ~ r ie rv ices .,re in teg l . a te i i ? t :111 l . .v . . ls ;nd ,cf?.-::lvt-ly

d i r e c t e d and s u p e r v i s e d ; t o t r a i n p e r s o n n e l .

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h c y e a r . [ a : A p u b l i c h e a l t h o f f i c e r , a

s a n i t a r i a n and a p u b l i c h e a l t h n u r s e ; ( b ) s u p p l i r s and equipment .

Probable d u r n t i o n of AS. - i s tanc i : . U n t i l tire cnd of 1970 .

Work done d u r i n g t h c year , . During '.!; Thi rd Five-Year P l a n ( 1 9 6 6 - 1 9 7 1 ) , t h e R u r a l

Development Department of t h e M i n i s t r y of I n t e r i o r p l a n s t o s e t up twenty a d d i t i o n a l

r u r a l development p r o j e c t s r v e r y y e a r g i v i n g due weigh t t o h e a l t h a s p e c t s . The

development of h e a l t h s e r v i c e s i n r u r a l developm,znt a r e a s w i l l be based on t h e

e s t a b l i s h m e n t of h e l l t h s u b - c e n t r c s , under t h e t e c h n i c a l s u p e r v i s i o n of t h e M i n i s t r y

of H e a l t h , p r l o r i t y b e i n g g l v e n t o a r c a s which e n t e r t h e main tenance phase of t h e

m a l a r i a e r a d i c a t i o n programme d u r i n g t h i s pc:riod. The work of t h i s p r o j e c t i s

c l o s e l y c o - o r d i n a t c d w i t h t h a t cf t h e p r o j e c t "Development of B a s i c H e a l t h S e r v i c e s "

( A f g h a n i s t a n 0 0 5 9 ) .

The appoin tment o f a s e n i o r m e d i c a l o f f i c e r t o t h e Shewaki h e a l t h c e n t r e

was a n i m p o r t 3 n t s t c g towardr improving t h i f u n c t i o n of t h i s h e a l t h c e n t r e a s a

s u i t a b l e t r h i n i n g f i e l d f o r h e a l t h s t a f f . F i e l d t r a i n i n g of m e d i c a l s t u d e n t s ;it

Shewaki was c o n t i n u e d , and t h c c u n t r e ' s t u b e r c u l o s i s programme showed f u r t h e r .

p r o g r e s s .

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The Ministry of I n t e r i o r asreed t h a t medical o f f i c e r s should be given

o r i e n t a t i o n t r a i n i n g before being appointed t o r u r a l h e a l t h c e n t r e s , and e igh t medical o f f i c e r s from two h o s p i t a l s were given a two-day b r i e f i n g on r u r a l hea l th .

A syl labus on hea l th and s a n i t a t i o n was drawn up f o r t r a i n i n g a new group

of 9th grade s tuden t s a t Gulzar.

The s a n i t a t i o n component of the p r o j e c t continued t o progress . With the

a r r i v a l of UNICEF supp l ies , t h e cons t ruc t ion of the Sahak and Daragi water

supply systems i s being completed.

Afghanistan 0031.1 I n s t i t u t e of Public Health, Kabul

R ( A p r i l - May 1956; Nov. - Dec. 1958; March - UNICEF play 1961; May 1962; ~ u g . 1962 - )

A i m of the p r o j e c t . To develop the I n s t i t u t e of Public Health f o r s e r v i c e , f o r

r esea rch and f o r the t r a i n i w of publ ic hea l th workers.

Assistance provided by WHO during the year . ( a ) A publ ic h e a l t h o f f i c e r , a micro-

b i o l o g i s t , a s t a t i s t i c i a n and a laboratory technician; ( b ) a three-month fe l lowship

f o r study i n Ind ia ; ( c ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h c end of 1970.

Work done dur ing the year . The Professor of Microbiology of the Medical Facul ty ,

Kabul, was appointed a s Pres ident of the I n s t i t u t e from 1 February 1967. A d i r e c t o r

of hea l th laboratory se rv ices and a head of the Epidemiological Department were a l s o

appointed.

A multi-purpose se ro log ica l survey was c a r r i e d out with the aim of de tec t ing

t h e p r o f i l e of immunity of the population i n Kabul aga ins t c e r t a i n i n f e c t i o u s

d i seases . It i s planned t o extend t h i s survey t o o the r p laces .

A reorganizat ion of p rov inc ia l hea l th l abora to ry se rv ices has been undertaken,

with a con t ro l un i t a t the I n s t i t u t e . To t h i s end na t iona l and WHO s t a f f of t h e

Ins tL tu te v i s i t e d nine provinces and assessed e x i s t i n g l abora to ry f a c i l i t i e s .

Standard methods and workitq manuals f o r t h e diagnosis of communicable d i seases

(cho le ra , d i p h t h e r i a , sa lmonel los is , s h i g e l l o s i s and t u b e r c u l o s i s ) , and b a c t e r i o l o g i c a l

con t ro l of water , foods and b io log ica l s were introduced. Training of laboratory

a s s i s t a n t s , which was s t a r t e d i n April 1966, continued; the s t a f f t r a i n e d w l l l be

posted t o c e n t r a l and p rov inc ia l l a b o r z t o r i e s . The co-operation of pub l ic h e a l t h

and c l i n i c a l se rv ices i n the u t i l i z a t i o n of t h e f a c i l i t i e s offered by the laboratory

se rv ices has improved.

The Health Statistics Scction of the Minlstry of Public Health h3s been

unified with the H~alth Statistics Section it tile Institutc. The tabulation of

in-patient diagnosis, by Ige 2nd s e x . far the Stiamsi year 1341 (1962-63) was

completed; the tabulation, by diagnosis, nl:x arld r.r.eion, was continued.

Assistance was given in the preparation of the protocol for the multi-purpose

serological survey, and t!le backlog of material on in-patient morbidity statistics

was reduced by processing a 20% systematic sample. Assistance was also given to

basic health services in developing a records and reports system to be tested in

the Pul-e-Khumri area. For the years 1962-1966 a report zrtitled "Hospital In-patients

in Afghanistan, Shams1 years 1341-1144" wris prepared from a 10% sample of individual

discharge reports and is being distributed to provincial health officers and heads of

larger hospitals. Preparation of a national index of health establishments was

initiated. In collaboration with other WHO-assisted projects, the Health Statistics

Section prepared a draft table showing the existiw rediral and health facilities in

the country.

Visits to the Institut, were pdid by a WHO short-term cinsultant, to assess

the feasibility of producing rehydration fluids for the treatment of cases of

cholera and cholera-like conditions, and by two consultants from WHO Headquarters

to collect information on thc incidence of cancer in the country.

The dspects reldtcd to public health engineering are described below (see

Afghanistan 0031.2 ) .

Afghanistan 0031.2 Institutc of Public Health, Kabul

R (Training in Sanitary Engineering)

UNICEF (July 1966 - )

Aim of the project. To r~inforce the telchirlg of' sanitary tngincering subjects in

the civil engineering course st tht, undcrgraduste level.

Assistance provided by WHO during the year. A zanitary engineer

Probable duration of assistance. Until the end of 1969.

Work done during the year. The WHO sanitary engineer continued to assist with the

teaching of sanitary enginucring subjects at the University of Kabul. The Dean of

the Engineering Faculty is acting as his counterpart. "Sanitary engineering" now

occupies n drfined place in thc civil engineerlng curriculum. Elghteen students

completed courses in water supply and sewerage: of thc.se, thirteen graduated as

civil engineers.

Plans are under way to give qdvanced training through fellowships in sanitary

engineering to some of the graduatcs so c1S to cnablc them to take up teaching

assignments on their return to Kabul.

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Other a c t i v i t i e s included a s tudy of r i v e r p o l l u t i o n i n Kabul and operat ion

of the sewage treatment p l a n t on t h ~ Univers i ty campus.

Thc s a n i t a r y engineer has workcd c l o s e l y with thc o the r WHO s t a f f members

assigned t o the I n s t i t u t e of Public Health i n helping t o solve problems r e l a t e d

t o publ ic h e a l t h engineering.

Afghanistan 0033 Tuberculos is Advisory Services

UNDP( TA ) (June - Dec. 1958; June - J u l y 1961;

UNICEF N O V . 1962 - March 1964; March 1965 - )

Aim of the p r o j e c t . To expand tubercu los i s c o n t r o l s e r v i c c s i n Kabul and i t s environs;

t o organize t u b e r c u l o s i s control. i n the provinces a s p a r t of t h e developing bas ic

h e a l t h se rv iccs i n t h e country , and t o t r a i n h e a l t h personnel i n the techniques of

in teg ra ted tubercu los i s c o n t r o l .

Assistance provided by WHO dur ing the year . [ a ) A medical o f f i c e r ; ( b ) a th ree -

month fe l lowship f o r s tudy i n Ind ia ; ( c ) supp l i e s and equipment.

Probable d u r a t i o n of a s s i s t a n c e . Unt i l t h e end of 1974.

Work donc dur ing the y e a r . Di rec t BCG vacc ina t ion has been accepted a s a r o u t i n e

f o r persons up t o 14 yea r s of agc , both i n Kabul and i n r u r a l d i s t r i c t s . BCO

vacc ina t ion of ncwborns was undertaken i n the Kabul materni ty home, and i n f a n t s were

vlccin.ited i n matcrnal and c h i l d h r a l t h centr -s The wholix schoolgoing population i n

Kahul has been lmmuinzed wl th BCO, and rou t lne BCC vacc ina t ion of a l l school e n t r a n t s

and l eavers has been introduced.

The BCG vacc ina t ion team from the Chainan R i b e r r u l o s ~ s Centre i n Kabul v i s i t e d

Uruzgan, Bamiynn, Baghlan, rarwan and Nangarhar Provinces and gave d i r e c t P N t o t h e

schoo l -ch i ld r rn . The t r a i n i n g of provinci.11 h e a l t h s t a f f i n the techniques of

d i r e c t BCQ vdccinat ion was undertaken. Training i n BCG techniques was a l s o given t o

smallpox vacc ina to r s s o t h a t simultaneous BCG and smallpox vacc ina t ion may subse-

quently be done. Simultaneous vacc ina t ion with a sys temat ic house-to-house approach,

was i n i t i a t e d i n Parwan and Nangarhar Provinces, and i n the r u r a l a rea surrounding

G b u l .

Plans were made t o s e t up two check-posts f o r g iv ing concurrent ly d i r e c t

BCO vaccinat ions t o persons up t o 2 0 years of age and smallpox vaccination t o

nomads.

BCG vacc ina t ion was introduced f o r army r e c r u i t s , 3s we l l a s i n s e l e c t e d

f a c t o r i e s i n and around Kabul and i n p r i sons .

SEA/RC~ 0/2

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Tuberculosis c o n t r o l ?.s an i n t e g r a l >ar t of the e x i s t i n g and developing

bas ic h e a l t h and maternal and c h i l d h ~ c l t h sc rv ices i n r u r a l nreas has expanded.

Rural hea l th and m t c r n a l and c h i l d h e a l t h workers i n Parwan 2nd Nmgarhar

rrovir.i:es hzve bcin t r a ined i n sputum collection from symptomatic p a t i e n t s ,

microscopical smear examination and ambulatory t rea tment of newly de tec ted cases .

UNICEF s u p p l i ~ s f o r tubercu los i s Control w i l l be g iven through thc m t e r n a l

and ch i ld h e a l t h and bas ic h e a l t h s e r v i c e s , which w i l l r ece ive t e c h n i c a l guidance

from t h e Chaman Tuberculos is Centre .

Afghanistan 0035 Nursing Advisory Services

UNDP ( TA 1 (June 1957 - 1

Aim of t h e p r o j e c t . To s t r eng then nurs ing admin i s t r a t ion and develop nursing and

midwifery t r a i n i n g and t o co-ordinate and expand nurs ing educat ion and the nursing

s e r v i c e s .

Assistance provided by WHO dur ing the yea r . ( a ) A nurs ing adv i se r and t h r e e nurse

educators ; ( b ) two twelve-month fe l lowships f o r study i n Lebanon; ( 0 ) supp l i e s and

equipment.

Probable dura t ion of a s s i s t ance . , Unt i l t he end of 1971.

Work done dur ing the year . There was f u r t h e r development of the Division of Nursing.

A Board of Nurses t o advise the Divis ion of Nursing and the Ministry of Health was

e s t a b l i s h e d . A Committee on Nursing Education, the membership of which includes

r ep resen ta t ives of the Ministries of Health and Education drew up c r i t e r i a and

regu la t ions f o r e s t a b l i s h i n g new schools of nurs ing and f o r the conduct of those

a l r eady e x i s t i n g . U system f o r r e g i s t r a t i o n of nurs ing personnel was es t ab l i shed .

One of the WHO nurse educators conducted : six-week coursc on ward adminis t ra-

t i o n f o r head nurses from Kibul and the p r o v i n c ~ s .

The nurs ing education programme of Sharzrah School f o r nurse-midwives continued

t o prGgress wel l . The one-year nurs ing programme f o r s e n i o r midwives was repeated,

thus completing the q u a l i f i c a t i o n of most of t h e s e n i o r midwives i n Kabul a s nurse-

midwives. The nurse f a c u l t y of the Sharnrah School h l s taken the r e s p o n s i b i l i t y f o r

planning and teachlng an a u x i l i a r y nursc-midwife coursc a t Wazir &bar Khan Xospi ta l

and f o r supervis ing the c l i n i c a l experience of thr,se s tuden t s .

Notable improvement was e f f e c t e d i n thc c l i n i c a l experience of s tuden t s of

Allabad School f o r men nurses .

SEA/Rc20/2 Page 82

Assistance was given t o the teaching of a u x i l i a r y nurse courses i n the provinces , and a WHO nurse conducted a midwifery course f o r a u x i l i a r y nurses i n one province. I t was planned t o repeat the course i n o the r provinces.

WHO nurses have a l s o a s s i s t e d i n t r a i n i n g supervisors of basic h e a l t h workers i n the provinces.

With t h e need f o r mare nurses and a u x i l i a r y nurse-midwives, the nurs ing schools a r e increasing t h e i r enrolment, and a u x i l i a r y nurse-midwife courses w i l l be continued f o r some time. Plans a r e a l s o being made f o r e s t a b l i s h i n g a new school of nursing i n Ja la labad .

A f ~ h a n i s t a n 0044 Trachoma Control R (May - June 1958; Sept . - Oct. 1962;

J u l y 1963; Apri l - May 1964; June 1965 - May 1967; - )

A i m o r t h e p ro jec t . To s tudy t h e epidemiology of trachoma i n Herat Province: t o i n i t i a t e con t ro l a c t i v i t i e s ; t o develop a programme of hea l th education i n communi- cable eye d i s e a s e s , and t o t r a i n s t a f f .

Assistance Drovided by WHO during the year. A medical o f f i c e r ( t r achomato log i s t ) .

Probable dura t ion of a s s i s t a n c e . Unt i l 1969.

Work done during the year . The programme i n Herat Province was operated a s a demonstration and t r a i n i n g c e n t r e f a r n a t i o n a l personnel employed i n trachoma con t ro l a c t i v i t i e s elsewhere i n the country. A t the same time, con t ro l a c t i v i t i e s were ca r r i ed out i n Herat and I n j e e l D i s t r i c t s , t r e a t i n g mainly the c h i l d popula- t i o n . The t o t a l nwnber of ch i ld ren t r e a t e d i n Herat Province f o r the year 1966 and January 1967 was 40 315. amounting t o about 9% of the e x i s t i n g c h l l d popula- t i o n . In I n j e e l D i s t r i c t , 28 622 ch i ld ren (more than 9C$ of t h e t o t a l c h i l d populat ion) were t r e a t e d from Apri l 1966 t o February 1967.

Lecturos on trachoma an8 i t s c o n t r o l were given i n 42 v i l l a g e s , and t en l e c t u r e s were given i n t h e schools.

Treatment of the chi ld populat ion groups was good both i n coverage and i n cure r a t e . The number of sources of infection was considerably reduced, and f u r t h e r s t e p s must now be undertaken by the na t iona l s t a f f and the community t o ensure maintenance of r e s u l t s achieved. A s bas ic h e a l t h se rv ices a r e not y e t developed. the in tegra t ion of trachoma c o n t r o l a c t i v i t i e s has not been poss ib le .

The WHO medical o f f i c e r completed h i s assignment i n May 1967, and t h e p ro jec t w i l l be c a r r i e d on by na t iona l s t a f f , with fe l lowships and consu l t an t s t o be provided by WHO.

Afghanis tan 0051 Tra in ing of Radiographers

R (Nov. 1965 - Feb. 19671

A i m of t h e p r o j e c t . Ta t r z i n r ad iog raphe r s and r a d i o l o g i c a l t e c h n i c i a n s .

Ass is tance provided by WHO du r ing t h c y e a r . ( a ) A radiography t u t o r ; ( b ) s u p p l i e s

and equipment.

Work donc . The, WHO radiogr-phy t u t o r completed h i s assignmcn'; w i th t h s

School f o r Train!ni: oi' Aadiog!,apli?rs, Kabul, i n Pebruar). 1967. During t h e coura.5

of h i s a s s ignnen t t h i o r e t i c r ? l t e ach ing w?s g iven t o f i f t e e n f i r s t - y e a r znd e l even

second-year s t u d e n t s i n phys i c s . appa ra tus c o n s t r u c t i o n , f i r s t - a i d and p a t i e n t c a r e ,

X-ray t echn iques and rzdiography. The s t anda rd achieved by some s t u d e n t s was low;

l a c k of t e c h n i c a l terminology i n t h e n a t i o n a l language and of a c c u r a t e : r a n s l a t i o n

handicapped t h e t each ing . P r a c t i c a l t r a i n i n g could no t be g i v e n f o r want of zdequate

f a c i l i t i e s . The Government has planned t o cons t r ,uc t 3 new X-ray S e c t i o n i n Avicenna

H o s p i t a l . and f u r t h e r WHO a s s i s t a n c e t o t he p r o j c c c may be cons idered a f i . e r t h i s

u n i t becomes 2vai l -b l i . f o r t cach ing purposes.

In the l r s t week of December 1965 two t e c h n i c i a n s were awarded WHO fellowships

(under SEAR0 0200) f o r t r a i n i n g i n t h e maintenance and r e p a i r of X-ray equipment

i n Colombo. They completed t h i s t r a i n i n g and r e tu rned t o Afghanis tan i n January

1967.

Afghanis tan 0054 Communicable-Disease Con t ro l (Smallpox Contro l )*

UNDP(TA) ( J u l y 1964 - )

A i m of t h e p r o j e c t . To develop a smallpox c o n t r o l programme; t o p l z n f i e l d e p i -

demio log ica l i n v e s t l g z t i o n s of t h e major p r e v a i l i n g communicable d i s e a s e s o t h e r

t h a n smal lpox, and t o t r a i n p e r s o n n ~ . l i n f i e l d epidemiology and c o m u n i c a b l e -

d i s e a s e c o n t r o l .

Ass i s t ance provided by WHO du r ing the y e a r . ( a ) A medical o f f i c e r ; ( b ) s u p p l i e s

ai-d equipment.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1966.

Work done du r ing t h e y e a r . Thc provinces of Kapissn. Badakshan. Samangan, i radghis ,

Takhar, Lashmar:, Kunduz, Chakansoor, Ghor, Herat and Baghlan were covered by

v a c c i n a t i o n toams. and more t h a n two m i l l i o n vacc ind t ions were performed. However,

coverage was no t equa l i n a l l age-groups and segments of t h e popu la t ion ; t h e b e s t

coverage wns achievcd zmong Pre-school and schoo l - ch i ld ren . The fcmale popu la t ion

was no t sufficlcntl!! covurcd.

* I n 1%9 t h i s p r o j e c t w i l l bc amalparnated wi th Afghanis tan 0064.

SEA/RCZO/:

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On about 800 ch i ld ren 3 t r i a l of a j e t i n j e c t o r was c a r r i e d out using a s p e c i a l l y prepared vaccine f o r the purpose. The r e s u l t s were encouraging a s l a r

a s the mechanical soundness of the apparatus was concerned, but a poor percentage

Of " takes" pointed t o low potency of the vaccine, a sample of which was s e n t f o r

t e s t i n g .

A- Provincia l Maternal and Child Health UNDP(TA) Services and Tra in ing

UNICEF [Apr i l 1966 - )

A i m of t h e p r o j e c t . To develop maternal and c h i l d h e a l t h se rv ices and the t r a i n i n g

of a u x i l i a r y nurse-midwives i n the provinces .

Assistance provided by WHO during t h e year . [ a ) A maternal and c h i l d h e a l t h o f f i c e r ;

a pub l ic h e a l t h nurse assigned t o the p r o j e c t "Rural Health" [Afghanistan 0026) a l s o a s s i s t e d t h i s p r o j e c t ; ( b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done dur ing the year . The establishment of a Maternal and Child Health Unit In the Ministry of Public Health gave impetus t o the development of maternal and c h i l d hea l th se rv ices wi thin t h e framework of general h e a l t h se rv ices i n the country.

Project a c t i v i t i e s were d i r e c t e d towards improvement and expansion of p a e d i a t r i c and o b s t e t r i c h o s p i t a l u n i t s and towards the s t rengthening of maternal

and c h i l d h e a l t h se rv ices and of a u x i l i a r y nurse and a u x i l i a r y nurse-midwifery

t r a i n i n g programmes i n t h e major p rov inc ia l c e n t r e s . A t Nangarhar, a t t e n t i o n was paid t o the provis ion of p a e d i a t r i c and o b s t e t r i c h o s p i t a l f a c i l i t i e s and per'.uheral maternal and c h i l d h e a l t h p r a c t i c e a reas complementary t o those e x i s t i n g a t the

teaching h o s p i t a l i n t h e Nangarhar medical school. To t h i s end the C i v i l Hospi ta l

of the if lr . istry of Public Health was recons t ruc ted , and s i x h e a l t h pos t s Were c l ~ a t e d i n thc p r o v l n c ~ s . A Norwegian dona t i o n under UNICEF t r u s t e e s h i p provided funds

f o r suppl ies and equipment. However, s c a r c i t y of mate r ia l resources and manpower

hampered the speedy expansion of t h i s development.

The WHO team, i n co l l abora t ion with na t iona l col leagues , a s s i s t e d i n o r ien ta -

t l o n courses f o r sen io r p rov inc ia l h e a l t h personnel and bas ic h e a l t h worKers.

A b i l a t e r a l agreement aiming a t the improvement of h e a l t h and s o c i a l welfare

se rv ices f o r mothers and ch i ld ren included t h e p rov i s ion of a materni ty h o s p i t a l

and a c h i l d r e n ' s h o s p i t a l , each with 100 beds, and f o r expansion of day-care s e r v l c = = f o r pre-school ch i ld ren and t r a i n i n g of kindergar ten t eachers .

For the purpose of s t rengthening p a e d i a t r i c se rv ices i n the provinces, bMO

awarded four fe l lowships t o medical o f f i ce r s fo r a t t end ing a four-month paed ia t r i c

r e f r e s h e r course i n Ind ia ( s e e Afghanistan 0200).

~ f ~ h a n i s t a n 0052 Development of B a s i c H e a l t h S e r v i c e s R ( A p r i l - May 1965; March 1766 - ) UNICEF

A i m o f t h e p r o j e c t . To e s t a b l i s h b a s i c h e a l t h s e r v i c e s th roughout t h e c o u n t r y , I n i t i a l l y th rough t h e m a l a r l a e r a d i c a t i o n s e r v i c e s and i n c o - o r d i n a t i o n w i t h r u r a l

h e a l t h s e r v i c e s ( s e e A f g h a n i s t a n 0 0 2 6 ) .

A s s i s t a n c e p r o v i d e d by WHO d u r i n ~ t h e y e a r . ( a ) A p u b l i c h e a l t h o f f i c e r ; ( b ) s u p p l i e s , equipment and a t r a r i s p o r t v e h i c l e .

Probable d u r a t l o n of a s s i s t a n c e . U n t i l t i le end 07 1775.

Work dgne d u r i n ~ t h e y e a r . I n t h e Thi rd Five-Year P l a n (1766-1971) s p e c i f i c p r o v i s i o n s

have been made f o r t h e development of h e a l t h s u b - c e n t r e s . In o r d e r t o inp lement t h e s e

p r o v i s i o n s more e f f e c t i v e l y and t o s e c u r e b e t t e r c o - o r d i n a t i o n of a l l h e a l t h work i n

t h e c o u n t r y , a f u n c t i o n a l r e o r g a n i z a t i o n o f t h e M i n i s t r y was u n d e r t a k e n . A p r o t o c o l was s i g n e d between t h e M i n i s t r y of H e a l t h and t h e Governor -Genera l of Baghlan P r o v i n c e ,

a c c o r d i n g t o whlcls t h e p e o p l e o f t h e a r e a have t e e n made r e s p o n s i b l e f o r t h e c o n s t r u c -

t i o n o f t h e h e a l t h s u b - c e n t r e s which t h e M i n i s t r y o f H e a l t h w i l l e q u i p a s and when

t h e y a r e conipleted.

With a view t o d e v e l o p i n g a r e a l i s t i c p a t t e r n of b a s i c h e a l t h s e r v i c e s w i t h i n

t h e r e s o u r c e s a v a i l a b l e , a p l a n of a c t i o n was p r e p a r e d i n i t i a l l y f o r s u c h a s e r v i c e i n t h e Pul-e-Khumrl malar , la u n i t a r e a , t h e f i r s t a r e a e x p e c t e d t o e n t e r t h e m a i n t e -

nance p h a s e of t h e m a l a r i a e r a d i c a t i o n programme. The p l a n p r o v i d e s f o r a s u b - c e n t r e t y p e o f s e r v i c e w i t h g u i d a n c e and s u p e r v i s i o n from a s t r e n g t h e n e d p r o v i n c i a l head- q u a r t e r s . The Pul-e-Khumri m a l a r i a u n i t a r e a i n c l u d e s Baghlan P r o v i n c e and t h e

n o r t h - e a s t e r n p o r t i o n of Bamiyan P r o v i n c e , t h e l a t t e r b e i n g deve loped by t h e M i n i s t r y

of I n t e r i o r th rough i t s r u r a l development p r o j e c t s . I n t h i s a r e a , p r o v i n c i a l s u p e r v i s o r y s t a f f and s e n i o r and j u n i o r m a l a r i a i n s p e c t o r s were g i v e n o r i e n t a t i o n

t r a i n i n g i n t h e new t a s k s a s s i g n e d t o them, and t w t , new s u b - c e n t r e s were e s t a b l i s h e d . Thus , f o r t h e f i r s t t i m e , a m r i f o m p a t t e r n of b a s l 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

was e s t a b l i s h e d , which , i t i s e n v i s a g e d , w i l l be f o l l o w e d i n a l l r u r a l a r e a s , a s

t h e y e n t e r t h e main tenance phase .

A f ~ h a n i s t a n 0061 C e n t r a l A u t h o r i t y for ' Housing and

UNDP(SF) Town F l z n n i n g . Kabul

R ( J a n . 1967 - )

A i m o f t h e p r o . i e c t . To a s s i s t i n s ; i n i t a r y r n g l n e e l , l n g a s p e c t s of t h e work of t h e

C e n t r a l A u t h o r i t y f u r Housing and Town Planning .

A s s i s t a n c e ~ r o v i d e d by WHO during. t h e y e a r . ( a ) A s a n i t a r y e n g i n e e r ; ( b ) a t w e l v e -

month f e l l o w s h i p f o r s t u d y i n I n d i a ; ( c j a t r a n s p o r t v e h i c l e .

SEA/RCZO/Z

page 86

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done d u r l q _ t h e year . From i t s i n i t i a l s t a g e s of development, the WHO

s a n i t a r y engineer (provided under Afehanistan 0031.2) has been giving par t - t ime

a s s i s t a n c e t o the p r o j e c t . I n view of the increased r e s p o n s i b i l i t i e s . WHO

assigned a f u l l - t i m e s a n i t a r y engineer i n January 1967. He i s working wi th the

Housing and Town Plannin8 Author i ty , and i s engaged i n a survey of the e x i s t i n g

environmental s i t u a t i o n i n metropol i tan Kabul with a view t o making proposals

f o r i t s lr3.provement. Hc i s a l s o a s s i s t i n g i n the p repara t ion of a sys temat ic

water q u a l i t y con t ro l prograrrme f o r Kabul c i t y .

Afghanistan 0065 Furvey of I r r i g a t i o n P o s s i b i l i t i e s i n the - -- UNDP(SF1 Hwi-Rud and Upper Kabul River Basins - ( F A O ) (June - Sep t . 1966)

A i m of the p r o j e c t . To a s s i s t i n the f u r t h e r study 2nd development of r u r a l water

supp l i e s and s a n i t a t i o n programmes and t o advise on the prevent ion of h e a l t h hazards

which may be r e l a t e d t o t h e i r r i g a t i o n p r o j e c t .

Assistance provided by.,y.3H0 dur ing t h e y e a r . Two consu l t an t s .

Work done. A tram oC two WHO consu l t an t s - an epidemiologis t and a s a n i t a r y

rng in re r - visit,r-d Afghanistan fro" June t o September 1766 t o stlldy the

h e a l t h impl icat ions of i r r i g a t i o n development r e l a t e d t o t h i s survey. The r e p o r t

of t h i s team,which included broad recommendations on h e a l t h measures, has been

t r ansmi t t ed t o FAO, the executing agency f o r the p r o j e c t .

Afghanistan 0046 - Smallpox . Erad ica t ion

R (March 1967 - )

A i m of the p r o j e c t . To develop a n a t i o n a l smallpox e r a d i c a t i o n programme and t o . .- t r a i n personnel .

Assistance provided by W:i3_-during t h e yea r . Suppl ies , equipment and s i x t r a n s p o r t

v e h l c l e s .

Probable dura t ion of ass j . s tance . I n d e f i n i t e .

Work dons d u r i n s t h e y i , l r . I n 1766, one v i s i t was paid by a WHO Headqudrters

consul tant and another by a consul tant under an in te r -coun t ry p r o j e c t (SEARO 01361

t o review the smallpox c o n t r o l programme and t o advise on f u r t h e r extension of the

a c t i v i t i e s necessary f o r developing a smallpox e r a d i c a t i o n programme. The f e a s i -

b i l i t y of launching such a programme was f u r t h e r s tudied by the Regional Off ice and

the WHO Smallpox Eradicat ion and Epidemiological Advisory Team (SEARO 0 0 j 0 ) .

Afghanis tan 0066

H

Rura l Water Supply

(Nov. 1966 - )

A i m of t h e p r o j e c t . To f u r t h e r s t u d y , develop and implement r u r a l water s u p p l i e s

and s a n i t a t i o n programmes.

Ass i s t ance provided by WHO d u r i n g t h e y e a r . ( a ) h s a n i t a r y eng inee r ; ( b ) a t r a n s p o r t

v e h i c l e .

Probable d u r a t i o n of s s s i s t z n c e . U n t i l t h e end of 1970.

Work done du r ing t h e y e a r . A WHO s a n i t a r y eng inee r jo ined t h e p r o j e c t i n November

1966. Under t h i s p r o J e c t t h e e s t2b l i shmen t of a n Environmental Hea l th Unit i n t h e

M i n i s t r y of Heal th is being a s s i s t e d , and t h e a c t i v i t i e s of t h e p r o j e c t a r e c l o s e l y

co -o rd ina t ed Wizh t hose ox' t h e pr~o, tezcs "Rcra; Health1 ' (Afghanis tan 0026) .and "Develop-

m?nt of A a s i c Heal th S P I ~ V ~ C * ~ ' ~ (Afghanis tan N 5 9 ) . A n:mtcr of w l t e r supply schemes

under taken by t h e Rura l Development Department a r c be ing completed, and a programme

of new schemes i s under p r e p a r a t i o n . The WHO s a n i t a r y eng inee r i s h e l p i n g bo th t h e

Rura l Devclopmcnt Department and t h e M i n i s t r y of Heal th i n the development of r u m 1

water s u p p l i e s .

Afghanis t sn 0200 Rcl lowships

R

Tube rcu los i s Cor l t ro l . Two two-wuek f r l l o w s h i p s f o r s tudy i n I n d i a .

Rad io log i ca l Hea l th . A s ix-week f e l l owsh ip f o r s t u d y i n t h e United S t a t e s of America.

Blood Transfus ion . A s i x month f e l l o w s h i p f o r s t u d y i n Hungary.

P a e d i a t r i c s . Four four-month f e l l o w s h i p s f o r s t udy i n I n d i a .

Afghanis tan 0201 Fel lowshlps

UNDP ( TA )

Anatomy. A twelve-month f e l l owsh ip f o r s t u d y i n t h e United IUngdom. - Pa tho logz . A twelve-month f e l l owsh ip f o r s t u d y i n t h e United S t a t e s of Amerlca.

Bac t e r io logy . A twelve-month f e l l o w s h i p f o r s t udy i n ihc UniCrd Kingdom

Epidemiology. A nine-month f e l l owsh ip f o r s t u d y i n Czechoslovakia and I n d i a .

SEA/RC20/2 Page 88

Iaboratory Diagnosis of Communicable Diseases. A twelve-month fellowship for study in the United Kingdom.

Iaboratory Technoloa. A twelve-month fellowship for study in Ceylon.

Vaccine Production. Two six-month fellowships for study in India.

Trachoma Control. Two three-month fellowships - one for study in India and one for study in India and Burma.

Vaccine Production (Iaboratory Techniques). A six-month fellowship for study in Iran.

Diagnostic Radiology. A twelve-month fellowship for study in Germany.

Sanitation. A twelve-month fellowship for study in New Zealand.

A health assistant i s helping to glve curatlve ana prevenrlve servlces aternal and child health clinic of Zigon.

The health Committee ot Taw r a ~ t v~liage meets in tront of the dispensary to discuss with the health assistant (bottom left) the implementation of a programme of new wells.

SEA/kC20/2 Page 89

2. BURMA

The allocation made for health services in the national budget has shown a progressive increase in successive years. The estimates for the fiscal year 1966-1967 represented a rise of about 12 per cent over the figure for the previous year. The provision for recurrent expenditure on social services amounts to over 29 per cent of the total budget. Of this, 6.5 per cent is devoted to health, 15.5 per cent to education and nearly 3.5 per cent to social welfare. At the same time, more health needs have been revealed with the extension of services, or have ariaen a s a natural consequence of changing circumstances. The steady increase in the number of health centres and other health facilities has been maintained.

Shortage of trained manpower, particularly doctors, has tended to limit adequate expansion and operational efficiency. The Government has therefore placed much emphasis on medical education and training. (h qualifying, medical graduates are immediately absorbed into the national service. There has also been a marked increase in the training facilities for personnel of all categories working in the health field - refresher courses for township medical officers and nurses and training courses for health assistants, opticians, pharmacists, laboratory technicians, physiotherapists and many others. Post-graduate training in public health was started when the first one-year DPm course was initiated on 1 November 1966. The Government has also established a dental school offering a four-year course for professional dentists.

Assistance to medical education has been provided by WHO, the Colombo Plan and from bilateral sources. A seminar on recent advances in cardiology was sponsored by USAID and the Government.

Recognizing the important problem posed by virus diseases, the authorities have decided to take steps to establish a virus laboratory. Preparations are also being made to intensify the trachoma programme. The smallpox programme will be further strengthened by the local production of freeze-dried vaccine in a pro- gramme assisted by UNICEF and WHO. Other diseases are also receiving more and more attention: studies of plague are under way, and the leprosy oontrol programme has been further extended. A five-year tuberculosis control programme has been launched, and the country-wide BCG vaccination programme continues. The Wlrrna Medical Research Institute is conducting a survey of goitre as a first step towards developing a goitre control project.

Burma is now operating an efficient hospital and medical statistics service, and in 1966 it acted as host country for a WHO-sponsored inter-country training course for medical records officers.

Mental health care has been improved by in-service training programmes for the nursing staff of mental hospitals.

SEA/RC20/2

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PROJECT LIST

Project No.

Source of Funds

Co-operating Agencies - T i t l e

Burma 0017 Leprosy Control R (Apri l 1960 - ) UNICEF

Aim of the p r o j e c t . To expand and i n t e n s i f y the l eprosy con t ro l programme t o cover

a l l endemic a reas of t h e country , and t o t r a i n personnel f o r t h e purpose.

Assistance provided by WHO d u r i w t h e year . Two l e p r o l o g i s t s .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1970,

Work done dur ing the year . Four add i t iona l d i s t r i c t s i n the southern pa r t of Burma were included i n t h e p ro jec t a r e a , l eav ing eleven a f f e c t e d d i s t r i c t s s t i l l t o be covered. The number of cases under treatment increased from 144 670 t o 160 093,

p a r t l y due t o expansion of t h e area of operat ion and p a r t l y because of increased case d e t e c t i o n i n the o r i g i n a l con t ro l a rea . During t h e period under review,

in tens ive e f f o r t s were pursued t o s t rengthen t h e i n f r a s t r u c t u r e i n t h e e x i s t i n g con t ro l a rea . These a c t i v i t i e s included many shor t r e f r e s h e r courses f o r f i e l d

workers. Bac te r io log ica l con t ro l was f u r t h e r improved by t r a i n i n g .

I n add i t ion t o r e f r e s h e r courses , two t r a i n i n g courses f o r junior leprosy workers were h e l d , f o r which the s t ipends were provided by t h e t h r e e voluntary organizat ions - Order of Malta, Enuy1u.5 Suisse and Deutsches Hilfswerk. After t h i s t r a i n i n g a l l t h e 50 junior l ep rosy workers were added t o t h e l e p r o s y con t ro l s t a f f t o r e l i e v e t h e over-burdened leprosy workers and thus b r ing the caseload per worker

down t o a more manageable l e v e l . During 1968 and 1969 t h e gradual expansion w i l l be continued and s t rengthening of bac te r io log ica l con t ro l w i l l be maintained.

Burma 0022

R

V i t a l and Health S t a t i s t i c s , Rangoon

(Dec. 1955 - June 1961; Jan. 1962 - )

A i m of the Dro.lect. To develop a system of repor t ing and recording h e a l t h s t a t i s t i c a l d a t a and improve t h e i r process ing, and t o t r a i n s t a f f i n s t a t i s t i c a l methods.

Assistance provided by WHO durin,? the year. ( a ) A h e a l t h s t a t i s t i c i a n and a medical records o f f i c e r ; ( b ) a twelve-month fe l lowship f o r study i n Canada; ( c ) supp l ies and equipment.

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Probable d u r a t i o n of a s s i s t a n c e . Un t i l t h e end of 1969.

Work done dur ing the yea r . The WHO s t a t i s t i c i a n completed h i s assignment i n December

1966, and h i s r epor t was sen t t o t h e Oovernment. Addit ional n a t i o n a l s t a f f was posted

t o t h e Health S t a t i s t i c s Divis ion of t h e Health Di rec to ra t e and t o h o s p i t a l s having

medical record systems.

The medical record systems i n s i x Rangoon h o s p i t a l s continued t o func t ion

snwothly, and f u r t h e r in~provrments were in t roduced. Storage of r ecords was f a c i l i -

t a t e d by the i n s t a l l a L i o n of a d d i t i o n a l s t e e l racks .

The h o s p i t a l s t a t i s t i c s system was extended t o inc lude the Communicable Diseases

Hosp i t a l , Rangoon. A Hospital Adminis t ra t ive S t a t i s t i c s Report f o r 1965, covering

303 h o s p i t a l s , was published. Processing of h o s p i t a l morbidity s t a t i s t i c s was f a c i l i t a t e d by the provis ion of a d d i t i o n a l da ta-process ing equipment.

A cons ide rab le amount of t h e t i m e of the p ro jec t s t a f f was spent on planning,

d i r e c t i n g and teaching t h e course f o r medical records o f f i c e r s ( see SEAR0 0061.2).

Burma 0028 I n s t i t u t e of Medicine I , Rangoon*

UNDP(TA) (Feb. 1955 - Feb. 1959; Feb. 1961;

Sept . 1963 ; Aug. 1966 - Jan. 1967; - )

A i m of t h e [ I ro jec t . To s t r eng then s e l e c t e d departments i n I n s t i t u t e of Medicine I ,

Rangoon; t o improve undergraduate t each ing , and t o promote r e sea rch and pos t -

graduate s tudy.

Ass is tance vrovided by WHO dur ing t h e yea r . A p ro fesso r of biochemistry.

Probable d u r a t i o n of a s s i s t a n c e . Unt i l the end of 1968**.

Work done d u r ' i n ~ the y e a r . Tile WHO p ro fesso r of biochemistry worked a t t h e I n s t i t u t e

from August 1966 t o January 1967. He reviewed the teaching p r o g r a m s and emphasized

t h e development of p r a c t i c a l i n s t r u c t i o n i n the l abora to ry . New experiments were

added t o t h e undergraduate c o u r s e , and t h e Jun io r s t a f f of t h e Department of

Physiology were t r a i n e d i n t h e r e l evan t techniques t o enable them t o a c t a s

i n s t r u c t o r s . They were a l s o introduced t o elementary r e sea rch methods, and seve ra l

small research p r o j e c t s were s t a r t e d .

The WHO p ro fesso r took p a r t i n meetings of the heads of t h e Physiology Depart-

ments of t h e t h r e e I n s t i t u t e s of Medicine i n Burma and a s s i s t e d i n t h e d r a f t i n g of

a new uniform s y l l a b u s f o r undergraduate courses i n b iochemis t ry . He v i s i t e d

*Previous t i t l e : Medical Facu l ty , Rangoon.

**In 1969 t h i s p r o j e c t will. b e amalgamated with Burma 0079.

SEA/RC20/2 Page 92

I n s t i t u t e of Medicine I I , Mingaladon, and the I n s t i t u t e o f Medicine, Mandalay, where he advised on possible improvements i n t h e teaching programmes and gave l e c t u r e s .

He a l s o contr ibuted t o seminars arranged f o r a r e f r e s h e r course f o r physicians.

In h i s assignment repvr t he s t rong ly recommended the separa t ion of biochemistry

from physiology a s an independent department, adequately s t a f f e d and equipped.

A WHO professor of physiology is under recruitment

@ma 0031 Malaria Eradicat ion

R (Feb. 1957 -

A i m of t h e p r o j e c t . To e r a d i c a t e malaria i n progress ive s t ages

Assistance provided by WHO dur ing t h e year . TWO fe i lowships - one f o r twelve imntha

and one f o r nine and a h a l f months - f o r study i n the United Kingdom, Ind ia and

Thailand.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1968.

Work done dur ing the year . Spraying and surve i l l ance operat ions were continued. Because of delays i n t h e a r r i v a l of DDT and the e a r l y onset of r a i n s , only 6@ of t h e population scheduled t o be protected was covered i n 1966. It was decided t o discont inue voluntary labour and employ paid workers throughout the programme i n

1966-1967.

The general h e a l t h s t a f f i n r u r a l a reas p a r t i c i p a t e d a c t i v e l y i n su rve i l l ance operat ions . In a reas t h a t were not being covered by the general publ ic h e a l t h workers, t h e i n t e r v a l between house v i s i t s by a c t i v e case d e t e c t i o n agents was

approximately a month: i t was longer i n a reas t h a t were covered by the general

h e a l t h s t a f f . There were no major changes i n the phasing of the programme.

Burma 0037

R Mental Health, RanKOon

(Oct. - Dec. 1955; April 2965 - )

A i m of t h e o r o l e c t . To develop basic and post-basic educat ion programmes i n mental nurs ing , and in - se rv ice t r a i n i w t o improve nursing c a r e i n psych ia t r i c h o s p i t a l s .

BJsis tance Drovided by WHO durinp: the Year. ( a ) A psych ia t r i c nurse t u t o r ; (b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l Apri l 1968

sEA/RC2 0/2

Page 93

Work done during the year. The in-service education proeramme f o r nurses which began

i n March 1966 ended i n November 1966; the re were 1 6 nurses who p a r t i c i p a t e d .

The p i l o t p ro jec t on s t a f f i n g and adminis t ra t ion was completed on 31 December 1966 a f t e r having been i n operat ion f o r one year . It succeeded i n demonstrating t h a t

pa t i en t care could be improved i f personnel d i r e c t l y responsible f o r t h e ca re of p a t i e n t s r e m i n e d i n one un i t f o r a long period.

A p i l o t p ro jec t or. organizat ion and iranagement, which aimed a t demonstrating

t h a t pa t i en t ca re could be improved through teamwork, was s t a r t e d i n October 1966.

Ear ly i n 1767 a six-week "remotivation t r a i n i n g course" was conducted, i n which na t iona l nurses were shown how t o teach techniques t o o the r gmups of nurses

and a t t endan t s . Eleven nurses attended t h e e n t i r e course and f i v e observers were

present f o r a p a r t of the time.

The development of a r egu la r post-basic course i n psych ia t r i c nurs ing was delayed because of the l ack of nurses prepared t o teach i n such a programme. E f f o r t s

a re being made t o t r a i n nurse t u t o r s through fe l lowships .

Burma 0060 R

Health Education i n schools (Aug. 1966 - )

A i m of the p ro jec t . To develop hea l th education i n t eacher - t ra in ing i n s t i t u t i o n s and schools .

Assistance provided by WHO dur ina t h e year . Two fe l lowships of two and a half m n t h s f o r s tudy i n Ind ia .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1968.

Burma 0065 UNDP(TA)

UNICE?

Tuberculosis Control (Jan. 1964 - )

A i m of t h e p ro jec t . TO develop c o m n i t y - o r i e n t e d tubercu los i s s e r v i c e s , s t a r t i n g i n Rangoon and b d a l a y , a s t r a i n i n g and p i l o t a r e a s , and t o expand tubercu los i s

control t o o the r p a r t s of the country.

Assistance provided by WHO during the year . ( a ) A medical o f f i c e r and four

consu l t an t s - one i n s t a t i s t i c s , one i n l abora to ry techniques , one i n BCG vaccina-

t i o n and one i n radiography; ( b ) two three-week fe l lowships f o r s tudy i n Ind ia and Thailand; ( c ) c l i n i c a l ca rds .

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Page 94

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during the year . A f ive-year na t iona l tubercu los i s con t ro l programme

providing f o r preventive and cura t ive c o n t r o l , opera t ing through t h e basic h e a l t h

se rv ices and gradual ly t o be extended t o the whole country , has been approved. The methodology of in tegra ted tubercu los i s con t ro l is being worked ou t i n the p i l o t

p ro jec t i n Rangoon, which has recen t ly been expanded t o Upper Burma, with head-

q u a r t e r s i n Mandalay. Emphasis has been placed on t r a i n i n g d i f f e r e n t ca tegor ies

of h e a l t h s t a f f . WHO shor t - term consu l tan t s i n l abora to ry techniques , tubercu los i s record keeping and r e p o r t i n g , treatment o rgan iza t ion , home v i s i t i n g and radiography

have helped i n evolving t r a i n i n g programmes, which a r e being supervised by a na t iona l

t r a i n i n g o f f i c e r .

A tubercu los i s chemotherapy committee was formed, t o guide an i n v e s t i g a t i o n of the a c c e p t a b i l i t y and t o x i c i t y of INH plus th iacetazone. The committee a l s o

recommended t h a t second-line drugs and i n s t i t u t i o n a l treatment should be l iml ted t o cases which the committee approved.

A review of t h e one-year ambulatory chemtherapy p r o g r a m organized under

the Greater Rangoon Health Scheme showed t h a t of 882 cases of t u b e r c u l o s i s , 91 pe r

cent had become b a c t e r i o l o g i c a l l y quiescent . A t t h e end of February 1967 a l t o g e t h e r 2 464 cases of tubercu los i s were on treatment i n a l l t h e h e a l t h cen t res of t h e

Greater Rangoon Health Scheme, and another 3 821 p a t i e n t s suspected t o be s u f f e r i n g

from tubercu los i s were taken on presumptive t reatment : t h i s i s almost double the number of proven tubercu los i s cases .

With t h e experience gained i n Rangoon and Mandalay t h e in tegra ted tubercu los i s con t ro l programme is being extended t o t h e North-Western Divis ion of the country.

A t r i a l of d i r e c t BCO vaccinat ion f o r newborns was c a r r i e d out i n t h r e e maternity

homes i n Rangoon and proved the harmlessness of the m t h o d , which has a l s o been introduced i n o t h e r materni ty homes. A d i r e c t BCQ vaccinat ion t r i a l a m n g o l d e r

c h i l d r e n , including school-chi ldren, was s t a r t e d .

The Deputy Di rec to r and the Ass i s t an t Di rec to r of the Di rec to ra te of Health Services v i s i t e d India and Thailand on WHO fe l lowsh ips , t o study rou t ine d i r e c t BCG vaccinat ion.

A BCa mass campaign was s t a r t e d i n the Shan S t a t e s , and i n t e g r a t e d BCQ work was undertaken i n t h e c e n t r a l pa r t of the country.

The f i e l d repor t ing system i n BCC vaccinat ion work was reviewed with a view t o ensur ing t h a t i t provides information r e q u i s i t e f o r the admin i s t ra t ive eva lua t ion

of the programme, including d a t a on t h e coverage achieved. A s t a t i s t i c a l assessment of the BCG vaccinat ion p r o g r a m was made i n the Pegu a r e a , where f reeze-dr ied BCll

SEA/RCZ 0/2

Page 95

had been in t roduced i n 1963-1964. Tubercul in was given t o 741 111 persons , bu t of

these i t was poss ib le t o read t h e r e a c t i o n s only i n 75 p e r c e n t ; the r e s t were not

a v a i l a b l e f o r readine . Coverage of persons found e l i g i b l e f o r BCO vacc ina t ion ,

however, reached 96.7 p e r cen t .

Burma 0066

R

Health Education

(NOV. 1966 - )

A i m of t h e p r o j e c t . To organize t r a i n i n g courses i n h e a l t h educat ion f o r s t a f f

from f a c u l t i e s of t eache r - t r a in ing i n s t i t u t i o n s and f o r those holding key pos t s i n

t h e school o rgan iza t ion and i n t h e genera l h e a l t h s e r v i c e s .

Ass is tance provided by WHO dur ing t h e year. Ass is tance by t h e Regional Adviser i n

Health Education, and payment of s t ipends t o t h e l e c t u r e r s and inspec to r s of schools

who a t tended the course .

Probable d u r a t i o n of a s s i s t a n c e . Unt i l t h e end of 1969.

Work done dur ing t h e yea r . From 4 t o 17 November 1966, a h e a l t h educat ion t r a i n i n g

course was held i n Rangoon, f o r l e c t u r e r s from every t e a c h e r - t r a i n i n g i n s t i t u t i o n i n

t h e coun t ry , female inspec to r s of schools and a s s i s t a n t h e a l t h educat ion o f f i c e r s

working i n t h e a rea of these i n s t i t u t i o n s . The course was arranged through t h e

j o i n t e f f o r t s of t h e Minis t ry of Education and t h e Minis t ry of Heal th , and was conducted by t h e s t a f f of the Health Education Bureau. There were t h i r t y p a r t i c i p a n t s ,

who were provided with b a s i c h e a l t h informat ion and an oppor tuni ty f o r prepar ing p lans

f o r i n t e g r a t i n g t h i s new information i n t o t h e i r r e g u l a r work. The Regional Adviser

i n Health Education a s s i s t e d i n t h e p lanning and conduct of t h e course.

The course was wel l o rgan ized , and t h e e v a l u a t i m made by t h e p a r t i c i p a n t s

themselves ind ica ted t h a t i t had been v e r y much apprec ia t ed a s being of va lue .

It is proposed t o conduct s i m i l a r courses annual ly i n Burma.

Burma 0061

R UNICEF

P a e d i a t r i c Education

(June 1964 - June 1966; Sept. 1966; - )

A i m of t h e p r o j e c t . To s t r eng then the departments of p a e d i a t r i c s i n the t h r e e medical

c o l l e g e s of the country and t o improve t h e teaching of p a e d i a t r i c s , p a r t i c u l a r l y t h e

prevent ive a s p e c t s , by developing pe r iphe ra l s e r v i c e s f o r t r a i n i n g .

Ass is tance provided by WHO dur ing t h e yea r . An eleven-month f e l lowsh ip f o r s tudy i n

Sweden, t h e United Kingdom, Canada and Thailand.

Probable d u r a t i o n of a s s i s t a n c e . Un t i l t h e end of 1968.

Burm 0 6 9 Trachoma Control

UNDP(TA) (March 1966 ; Sept . 1966 : - )

A i m of the pro jec t . TO develop a trachoma control programme.

Assistance Drovided by WHO during the Year. Two three-month fellowships f o r study i n India.

Probable durat ion of ass i s tance . Until 1969.

Strengthening of Laboratory Services

(June 1967 ; - )

A i m of the pro jec t . To s t rengthen laboratory se rv ices .

Assistance Dmvided by WHO d u r i w the year . A nine-wnth fellowship f o r study i n Czechoslovakia and India.

Probable durat ion of ass i s tance . Until the end of 1970.

School of Preventive and TroDical Medicine* (Oct. 1964; Sept. 1965; Feb. 1967 - )

pim of the Drolect. 5% e s t ab l i sh a school of preventive and t rop ica l medicine.

Assistance Dmvided by WHO durinn the Year. A professor of public hea l th adminis t ra t ion.

J-e. Unti l the end of 1970.

Work Qone. A WHO professor of public hea l th adminis t ra t ion took up h i s assignment a t the School i n February 1967. He took Part i n the teaching a c t i v i t i e s , reviewed the p r o g r a m f o r the f i r s t diploma course i n preventive and

t rop ica l medicine, which had s t a r t ed i n November 1966,and made recommendations f o r

e f fec t ing necessary changes.

Recruitment of a WHO professor of epidemiology was i n i t i a t e d .

prma 0078 Plague Control R (Deo. 1966)

Aim of the ~ r o l e c t . To assess t he f a c to r s responsible f o r the pers is tence of plague f o c i and t o t r a i n personnel i n the epidemiology and control of the disease.

'Previous t i t l e : School of Public Health and Tropical Medicine.

Assistance provided by WHO dur ing the year . A consul tant f o r two weeks.

Work done. In December 1966 a WHO consul tant s tudied the endemic focus of plague

along the Irrawaddy River between Magwe and Wingyan. He a l s o v i s i t e d Mandalay and

the port area of Rangoon. H i s observations ind ica ted t h a t r i s k of import of plague

i n t o t h e Rangoon a rea was more l i k e l y from t h e upstream endemic focus than from

ou t s ide t h e country. He emqhasized t h e importance of e a r l y repor t ing of r a t f a l l s

and suspected cases of plague.

In February 1967 small outbreaks of p lagueoccur red in Mandalay and along the

Irrawaddy River. Plans have been made t o ass ign WHO consul tants t o a s s i s t i n making

a thorough inves t iga t ion of the extent and c h a r a c t e r i s t i c s of t h e endemic focus and

i n s t rengthening the repor t ing and control system.

Burma 0079 Medical Education

R (Dec. 1364 - peb. 1965; March 1966 - Jan. 1967 ; - )

A i m of the p r o j e c t . To improve undergraduate and post-graduate medical edvcat ion;

t o t r a i n teaching s t a f f ; t o develop the c u r r i c u l a i n keeping with modern concepts ,

and t o i n i t i a t e , encourage and guide research.

Assistance provided by WHO dur ing the year . ( a ) A professor of pathology; ( b ) two

twelve-month fe l lowships f o r s tudy i n the United Kingdom.

Probable dura t ion of a ss i s t ance . Until the end of 1970.

york done during the year . The WHO professor of pathology continued t o a s s i s t

I n s t i t u t e of Medicine 11, Mingaladon, u n t i l January 1967. when h i s term of assignment

ended. He p a r t i c i p a t e d i n the t h e o r e t i c a l and p r a c t i c a l courses f o r undergraduate

s tuden t s . F a c i l i t i e s f o r these courses were improved by enlarging the autopsy room

used f o r demonstrations, and c o l l e c t i o n of specimens i n t h e museum was a l s o enlarged.

At tent ion was given t o t h e t r a i n i n g of junior teaching s t a f f i n t h e techniques of

g iv ing l abora to ry i n s t r u c t i o n to undergraduates.

The WHO professor v i s i t e d I n s t i t u t e of Medicine I , Rangoon, and the I n s t i t u t e

of Medicine, Mandalay, and advised on possible improvements i n the teaching p r o g r a m s

and on d e s i r a b l e acqu i s i t ions of equipment. He a l s o drew up a syl labus f o r under-

graduate courses i n general and spec ia l pathology aimtng a t a one-year programme i n

l i e u of t h a t spread out over two years i n t h e present curriculum.

Fur ther WHO ass i s t ance t o the p ro jec t is planned

Burma 0080

R

Smallpox Eradicat ion

( Jan . 1967 - )

A i m of the p r o j e c t . To a s s i s t With the smallpox e r a d i c a t i o n programme and i n the establishment of a maintenance Programme and a su rve i l l ance system.

Assistance p r o v i d e d W H 0 during the year. Suppl les of f reeze-dr ied smallpox vaccine.

Probable dura t ion of a ss i s t ance . I n d e f i n i t e .

Work done durinR the year . A second three-year round of smallpox vaccinat;ion has been s t a r t e d by t h e Government i n a reas where e r a d i c a t i o n operat ions a re i n Progress i n o rder t o re in force the l e v e l of immunity i n the population.

Burma 0583 Education i n D e n t i s t r x

UNDP(TA) (Jan. 1967; - )

A i m of t h e ~ r o . l e c t . To improve and s t rengthen d e n t a l education i n the country.

Assistance provided by WHO dur ing t h e year . A temporary adv i se r .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1969.

Work done dur ing the year . A WHO temporary adv i se r i n den ta l education v i s i t e d

Rangoon from 2 t o 11 January 1967. H i s r epor t was forwarded t o the Government. FollOWing h i s recommendations, a p lan of operat ion covering f u r t h e r t echn ica l a s s i s t a n c e was prepared and is under considerat ion by t h e na t iona l a u t h o r i t i e s .

Burm 0200 Fellowships

R

Community Water Supply and Sewage Disposal. A twelve-month fe l lowship f o r s tudy i n t h e Netherlands.

R a d i o l o ~ i c a l Health. A six-week fe l lowship f o r study i n the United S t a t e s of America.

Blood Transfusion. A six-month fe l lowship f o r s tudy i n Hungary

Production of Smallpox Vaccine. A four-month fe l lowship f o r s tudy i n Hungary and Denmark.

Production of DPT Vaccine. Two th ree -mnth fe l lowships f o r s tudy i n Europe, and two fe l lowships - one of two m n t h s and one of th ree months - f o r study i n Hungary

Burma 0201 Bellowships UNDPlTA)

Bacterioloa. A twelve-month fellowship for st~dy in the United Kingdom.

Comnity Water SuPP1.y. A twelve-month fellowship for study in the Netherlands.

&Plied Parasitology and Entomolo~. A ten-mnth fellowship for study in the United Kingdom.

Blectro-encephalography. A six-month fellowship for study in the United Kingdom.

Mental Health (Nursing). A twelve-month fellowship for study in Canada.

Mental Health [EEG Techniquel. A six-month fellowship for study in India.

Dentistry. A twelve-month fellowship for study in the United Kingdom.

Radiology. A twelve-month fellowship for study in the United Kingdom.

CEYLON

Ocntal auxl l iark~ providing a school dental service in the provinces.

Gaity painted panels are used by the health educator to Illbskktc? safe water supply m a class of primary schoal pupils in a small tawn of Ceylo:~.

Children receiving oral polio vaccine as part of the national poliomyelitis immunization programme.

Nursing students from the Post-Basic School of Nursing in Colombo visit a ward at the Lady Ridgeway Children's Hospital.

SEA/'RC20/2 Page 101

Economic progress in Ceylon was hindered by adverse trade balances, making it necessary to impose severe import restrictions. Major floods devast- ated the South and South-Western Provinces, damaging large tracts of arable land and causing considerable loss of life and property. Failure of imports caused some rice shortage, and a massive food production drive was launched by the Government.

During the year, all the health units in the island were provided with medically qualified staff. As a result, there were 105 medical officers of health in the 89 health units in the whole island. A phased plan has been worked out to enable all these officials to obtain post-graduate qualifications in public health. Administration has been improved and simplified by the amalgamation of the Health Department and the Ministry of Health.

The budget estimate for the Health Department and the Ministry for the year 1966-1967 amounted to Rs. 171 790 567, forming 5.8 per cent of the total national budget and representing an increase of nearly 8 per cent over the previous year.

A family planning programme, integrated with maternal and child health services, is being promoted. CARE started its eleventh year of operation in Ceylon. Some two million school-children benefitted from feeding programmes, and milk was provided for child welfare centres and social service institutions.

The malaria eradication programme suffered a set-back when the occurrence of outbreaks of P. falciuarum infection, confined previously to the Eastern Sector, spread to localities in the north, and localized scattered foci of P. malariae infection were detected.

The tuberculosis control programme functioned well, and the pilot control project in the North-Western Province, aiming at the integration of tuberculosis control into the general health services, made good progress.

During the year, 174 new leprosy cases were registered, bringing the total known cases to 4 279. There was an increase in the number of recorded cases of venereal diseases. The filariasis infection rate of the population of control areas showed a decline, but surveys have suggested an extension of endemic areas. A third mass poliomyelitis vaccination campaign was carried out in Colombo and its municipal areas, following an increase in the incidence of infection mainly in young children. Better coverage was secured than in previous campaigns.

Expansion of epidemiological services with the setting up of a number of epidemiological units in outstations was initiated, and measures to improve the laboratory services and to expand virological work have been taken.

SEA/RCZO/Z Page 102

Substantial progress was made in the field of environmental sanitation. A request for UNDP assistance for the development of a community water supply and sewerage programme for the densely populated south-western coastal area was submitted and favourably considered.

A mental health committee has been appointed, and following its recom- mendations, a number of mental health units were established in provincial centres. This extension of mental health care will lighten the load on mental hospitals.

sEA/RCZ 0/2 Page 103

PROJECT LIST

Project No. Source of Punds co-operating Agencies

Ceylon OOCJf UNDP (TA )

Title -

Maternal and Child Health (Sept.1955 - Nov. 1963; Dec.1966)

Aim of the project. To improve and expand maternal and child health services.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United States of America.

Ceylon 0005.2 Venereal-Disease Control (Fluorescent A Laboratory Techniques in VDT)

UNICER (Sept.1964; Sept. 1966; - 1

Aim of the project. To develop laboratory diagnostic facilities for the national venereal-disease control programme.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Klngdom.

Probable duration of assistance. Until 1969.

Ceylon 003Z A

Mental Health (NOV. 1955 - Jan. 1956; AW. 1960; Nov. - Dec. 1961; Jan. - May 1963; June - July 1966; March 1967; - 1

Aim of the project. Second phase*: To strengthen the teaching of mental health in medical colleges.

Assistance provided by WHO during the year. A six-month fellowship for study in New Zealand.

Probable duration of assistance. Until the end of 1970.

*The first phase completed in May 1963

SEA/RCZ 0/2

Page 104

Ceylon 0038 R

Strengthening of Health Services (Epidemiology)

(Feb. 1956 - Sept . 1960; Feb. - March 1962;

Aug. 1962; Aug. - Nov. 1964; June 1967; - )

A i m of t h e p r o j e c t . To e s t a b l i s h an epidemiological u n i t i n the Di rec to ra te of

Health Services,and t o t r a i n personnel i n epidemiology.

Assistance provided by WHO dur ing the year . A twelve-month fe l lowship f o r study i n the United Kingdom.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1969.

Ceylon 0045

UNDP (TA )

Health S t a t i s t i c s [Apr. 1957 - Dec. 1961; Sept . 1964 - )

A i m of the p r o j e c t . To r e v i s e the system of records and r e p o r t s i n the h e a l t h

se rv ices and t o t r a i n personnel i n the design of documents, processing of s t a t i s .

t i c a l d a t a and o the r advanced techniques i n medical and h e a l t h s t a t i s t i c s .

Assistance provided by WHO during the year . ( a ) A medical records o f f i c e r , and ass i s t ance from the s t a t i s t i c i a n a t t ached t o the in ter . .country p r o j e c t SEARO 0072

(Hosp i ta l S t a t i s t i o s ) ; ( b ) a three-month fellowship f o r s tudy i n Burma and Thailand;

( c ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done dur ing t h e year . The WHO medical records o f f i c e r completed he r assignment i n December 1966. and her r e p o r t was s e n t t o t h e Government.

The improved Medical Record Department of Colombo South Hospi ta l began t o operate on a l imi ted s c a l e from January 1967, when a l l equipment and p a r t of the

proposed s t a f f were i n p o s i t i o n . Re-designed medical record forms were introduced.

The p ro jeo t worked i n c lose co-operation with the in te r -coun t ry h o s p i t a l

s t a t i s t i c s p r o j e c t (SEARO 0072), and t h e WHO s t a t i s t i c i a n and the medical records o f f i c e r a t tached t o t h a t p r o j e c t v i s i t e d Ceylon during March/April 1967 t o review

the p o s i t i o n and p lan f o r f u r t h e r development.

Ceylon 0041 R

UNICEF

Medical Education

(Nov. 1963 - April 1964; Oct. 1964 - Dec.1965; Sept. 1966; - I

Aim of t h e p r o j e c t . To s t reng then teaching i n se lec ted sub jec t s i n the Facu l t i e s

of Medicine of the University of Ceylon a t Colombo and Peradeniya.

SEA/RC20/2 Page 105

Assis tance provided by WHO durinu the year. A twelve-month fe l lowship f o r s tudy i n Ind ia and the United S t a t z s of America, and two ten-day fe l lowships f o r a t t end ing t h e seminar on n u t r i t i o n a l problems of mothers and ch i ld ren , held i n Hyderabad ( I n d i a ) .

Probable dura t ion of a ss i s t ance . U n t i l the end of 1970.

Work done during the year. Action was i n i t i a t e d t o r e c r u i t a WHO professor of micro- biology and a consul tant i n p a e d i a t r i c s .

Ceylon 0051 Nursinu Advisory Services R ( J u l y 1560 - Peb. 1966; Aug. - Oct. 1966; - )

A i m of the Dro.lect. To develop a l l a spec t s of bas ic and post-basic nursing education through the Nursing Unit i n t h e Department of Health and t o s t rengthen the paed ia t r i c nurs ing programmes.

Assistance ~ r o v i d e d by WHO durinu the year. ( a ) A consul tant i n nurs ing education f o r three months; ( b ) a twelve-month fellowship f o r s tudy i n New Zealand.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done during the year. The WHO consul tant i n nursing education conducted a s e r i e s of workshops on implementation of the new curriculum f o r bas ic nurs ing schools i n Ceylon. A l l the t u t o r s i n the e igh t nursing schools of the country a t tended one o r the o t h e r of these two-week worlcshops. The response was good, and follow-up i s planned by providing a short-term consul tant i n 1967 who w i l l v i s i t t h e schools and a s s e s s the r e s u l t s of the workshops by making a n evaluat ion of the performance of the t u t o r s .

Ceylon 0056 B i l a r i a s i s Control UNDP( TA) (Dec. 1959; Apri l - J u l y 1761: Sept . 1961:

Aug. - Sept. 1963; June 1965 - )

A i m of the Drolect . To study t h e problem of f i l a r i a s i s con t ro l : t o s t rengthen the f i l a r i a s i s con t ro l programme, and to in t roduce such new con t ro l methods a s may be ind ica ted .

Assis tance Drovided by WHO during the year . An epidemiologist and a n entomologist.

Probable dura t ion of a s s i s t a n c e . Unt i l 1970.

Work done during the year. The r e s u l t s of t h e study t o evaluate Baytex emulsion f o r l a r v a l con t ro l led t o i t s s u b s t i t u t i o n f o r malathion i n o i l i n the con t ro l a rea . Important r e s u l t s of t h i s change i s a considerable reduct ion i n t h e c o s t s of con t ro l measures and increased e f f i cacy . The WHO team a l s o a s s i s t e d i n reconnaissance surveys ou t s ide t h e area so f a r considered t o be highly endemic. These surveys have indicated t h a t t o some extent f i l a r i a s i s In fec t ion is moving inland from the c o a s t a l b e l t .

SEA/RCZ 0/2 Page 106

Occasional night blood surveys carried out among university students revealed incidental cases of filaraemia which constitute a focus for further infection. It is hoped that also in the larval control measures in the city of Colombo, the change from malathion in oil to Baytex emulsion will soon be made.

Further studies on the epidemiology of filariasis are necessary, to enable the

planning of effective control measures over a considerable period.

Ceylon 0058 R

i USAID)

Malaria Eradication (Aug. 1960 - )

Aim of the project. To eradicate malaria and to prevent the re-establishment of

endemicity.

Assistance provided by WHO during the year. Four two-week fellowships for study in India and one six-week fellowship for a study tour in Greece, Iran, Romania and

Turkey.

Probable duration of assistance. Vntil the end of 1969.

Work done during the year. The continued occurrence of malaria outbreaks in Eastern North-Central. North-Western and Uva Provinces required the resumption of attack operations to cover a population of 0.45 million in 1966 as compared with 0.15 million in 1965. The outbreaks have not yet been brought under control: the number of cases detected in 1966 was 501 as against 242 in the previous year. The rest of the country

is either in the consolidation or maintenance phase. Steps are being taken to improve active surveillance and field supervision, to decentralize laboratory work by establishing field branches in the areas affected by the outbreaks and to divide the

regions into smaller zones. By these measures as well as by implementing certain recommendations made by WHO, it should be possible to cope with the situation.

Ceylon 0063 UNDP(TA)

Medical Rehabllitation (Poliomyelitis) (April 1962 - Sept.1964; Nov. - Dec.1966)

Aim of the project. To organize a physiotherapy service for poliomyelitis patients and train physiotherapists and nursing staff in the treatment and rehabilitation of patients affected with poliomyelitis.

Assistance provided by WHO during the year. Two consultants (a medical officer and

a nurse) for one month.

Work done. A WHO team,consisting of a medical consultant and a nurse.

visited Ceylon for six weeks during November-December 1966 to advise

SEA/RC20/2

Page 107

t h e Government on t h e care and treatment of cases of t e t anus and po l iomyel i t i s wi th r e s p i r a t o r y involvement, and t o a s s i s t i n conducting a one-month demonstration and t r a i n i n g course f o r na t iona l medical o f f i c e r s and nurses i n t h e techniques necessary f o r the treatment and ca re of such cases . The course was held a t t h e

Chi ldren 's Hospi ta l , Colombo, and was attended by one res iden t physic ian, six

r e g i s t e r e d paed ia t r i c ians from the Children's Hospital and one p a e d i a t r i c i a n from Badullah. The nurse t r a i n e e s consis ted of four s i s t e r s and twelve t r a ined nurses.

The r e p o r t of the consul tants has been forwarded t o t h e Government

Ceylon 0064 R

A i m of t h e p r o j e c t . To develop piped water suppl ies i n major towns and o the r community a reas .

Assistance provided by WHO dur ing the year . ( a ) A s a n i t a r y engineer and a consul tant ; ( b ) a twelve-month fellowship f o r study i n the Netherlands; ( c ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done dur ing the year . The Department of Water Supply and Drainage has been merged i n t h e Ministry of Local Dovcrnment a s thc "Division of Water Supply, Drainage, and I a c a l Qovcrnment Works".

As s t a t e d i n Sect ion 6.4 of Par t I of t h i s r e p o r t . t h e UNDP(SF) has approved the Government's request f o r a s s i s t a n c e i n prel iminary operat ions f o r carrying out pre-investment s tud ies of h igh p r i o r i t y water supply and sewerage schemes f o r the south-west c o a s t a l a rea . UNDP(SF) w i l l make provis ion f o r a f i r m of consul t ing engineers and s a n i t a r y engineering consul tants i n sewerage and water supply a s well a s exper t s i n management and f inance. WHO has becn designated a s the executing agency f o r the p r o j e c t . Thc WHO s a n i t a r y engineer has a s s i s t e d t h e Division i n t h e c o l l e c t i o n of d a t a , deputat ion of l o c a l s t a f f , e t c . , ncccssary f a r the implementation of the projected programme. It i s encouraging t h a t t h e l o c a l a u t h o r i t i e s have agreed t o meet the c o s t s of water treatment and d i s t r i b u t i o n and a l s o the loan charges.

The in t roduc t ion of improved techniques has contr ibuted t o r a i s i n g the s tandards of management of water supp l ies , and the l o c a l a u t h o r i t i e s have been encouraged t o e s t a b l i s h and maintain e s s e n t i a l records and s t a t i s t i c s .

A water r a t e s tudy prepared f o r Negombo with the ass i s t ance of the WHO s a n i t a r y engineer has been issued a s a Division document. The s a n i t a r y engineer a l s o helped i n thc p repara t ion of an o u t l l n c f o r a r a t e study f o r t h e "Towns South of Colombo" p r c j e c t . The Divis ion a l s o planned f e a s i b i l i t y surveys, including " r a t e studlcs%f high p r i o r i t y p r o j e c t s .

SEA/RC2 0/2

Page 108

Tho responsibility f o r the development of r u r a l water supp l ies now r e s t s with t h e Divis ion, and a s u i t a b l e scheme i s under y r e p a r a t i ~ n f o r UNICEF supp i r t

on the advice of WHO.

A WHO consul tant was assigned i n Apri l 1967 f o r a per iod of f i v e weeks. He s tudied t h e requirements of t echn ica l s t a f f a t var ious l e v e l s , f o r the

implementation of the water supply programme i n t h e country and advised on t h e i r

t r a i n i n g .

Ceylon 0066.3

R

Strengthening of Laboratory Services (Aug. 1966 - )

A i m of t h e p r o j e c t . To study t h e epidemiology and con t ro l of d ia r rhoea l d i seases

and t o develop bac te r io log ica l d iagnos t i c f a c i l i t i e s f o r e n t e r i c d i seases i n the p r i n c i p a l h o s p i t a l s and i n the f i e l d ; a l s o t o s t reng then l abora to ry s e r v i c e s throughout the country.

Assistance provided by WHO dur ing the year . ( a ) A microbiologis t and a VlrOlogis t ; ( b ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l 1969.

Work done during the year . The scope of t h e four l abora to r ies previously developed

i n connection wi th diarrhoea1 d i seases was widened t o include d iagnos t i c t e s t s f o r o ther b a c t e r i a l d i seases ( d i g h t h e r i a , typhoid, l e p t o s p i r o s i s , e t c . ) and s a n i t a r y

bacter iology. A t Ratnapura Hospi ta l a s tudy was c a r r i e d out on pyrexias of unknown or ig in : i n one quar te r ( t h e P i r s t q u a r t e r of 1966) a s many a s 278 cases of l e p t o s p i r a l

i n f e c t i o n s were confirmed by microscop:r or by c u l t u r e .

A t Lady Ridgeway Hospi ta l comparative s t u d i e s were c a r r i e d out on virulence t e s t s f o r d iph ther ia . The Elek technique was found l e s s s e n s i t i v e than t h e i n t r a -

dermal technique, but t h e r e s u l t s from both techniques corresponded i n 82.2% of the s t r a i n s t e s t e d .

A Survey of Q f ever by complement f i x a t i o n t e s t was c a r r i e d out on 520 human s e r a co l l ec ted from d i f f e r e n t d i s t r i c t s . The r e s u l t s indicated t h a t t h i s d i sease

was not a s i g n i f i c a n t problem i n Ceylon. A survey of arboviruses was a l s o c a r r i e d

ou t , and the da ta co l l ec ted a r e being processed.

A p lan f o r remoCelling the laboratory of South Colombo Hospi ta l was prepared

i n order t o make i t s u i t a b l e a s a v i r u s l abora to ry . A p lan f o r t h e animal house,

which is t o be b u i l t f o r t h e same labora to ry , was a l s o drawn up. The procedure f o r t h e preparat ion of a n t i - r a b i e s vaccine was revised and t h e an t i - rab ies s e c t i o n

of t h e laboratory remcan ized . Following these changes, a n t i - r a b i e s vaccine i s now

being produced I n s u f f i c i e n t quan t i ty f o r the needs of t h e country. The potency and sa fe ty t e s t s c t the vacclne gave s a t i s f a c t o r y r e s u l t s .

SEA/RC2 0/2 Page 109

Lectures were given to medical officers and physicians on various subjects, including control of hospital cross-infection, laboratory management of diarrhoea1 diseases, bacteriological investigation of food poisoning, and clinical bacteriology.

Assistance was given to the Maldive Islands in controlling an outbreak of typhoid fever.

Ceylon 0071 rnP(TA)

Radiation Protection Course (21 Nov. - 6 Dec. 1966; 7-17 Dec. 1966)

Aim of the project. To organize a course in radiation protection for the staff concerned with the operation of radiological equipment.

Assistance provided by WHO durin~ the year. (a) Two consultant Lecturers and a

secretary-stenographer; (b) cost of attendance of 17 participants in the first course and 16 in the second course.

Work done. Two identical courses were held in 1966 for two groups of students - one from 21 November to 6 December, uith 32 participants, and the other from 7 to 17 December, uith 33 participants. The participants ineluded'radiologists, radiotherapists, medical officers, radiographers and others concerned from the (teneral Hospital, Colombo, and the Cancer Hospital, - EPtharagalM, and also some student radiographers. The courses made a successful impact, but their value was limited, as participants were not able to attend full-time.

Ceylon 0072 R

Health Education (Nov. 1966 - Peb. 1967)

Aim of the project. To evaluate the health education programme and further strengthen the health education services.

Assistance prcvided by WHO duriw the year. A consultant in health education for three months.

Work done. A WHO consultant undertook an extensive programme of visits to various parts of the country to study the work of the existing health education services. Concurrently she held discussions uith staff in the institutions and services visited.

On the basis of her findings, recommendations were made for further strengthening health education in the training programmes for all workers and in in-service training for those already on the job. To accomplish this and to meet other health education needs, including planning, evaluation and research. it

SEA/RC20/2 Page 110

was suggested that the health education services should be further strengthened by upgrading the Health Education Unit in the Ministry, posting personnel with higher qualifications and training in health education to strategic posts in the general health services and raising the level of health education services generally.

The report of the consultant, containing her findings and recommendations, has been forwarded to the (iovernment.

Ceylon 007'k UNDP(TA)

Institute of Hygiene, Kalutara (July . Sept. 1964; Feb. 1967 - )

A i m of the project. To develop the Institute as a centre for training and orienta- tion of public health staff; to improve and integrate the services planned; to develop a provincial-type health laboratory at the Institute and also to upgrade the district hospital laboratories in the area assigned to the laboratory of the Institute.

Assistance provLded by WHO during the year. A bacteriologist.

Probable duration of assistance. Until the end of 1969.

Work done during the year. The new building for the Institute of Hygiene was opened during the year and the service and training activities of the former Kalutara health unit were undertaken by the Institute. A WHO b a c t e r i o l o g i s t - c w - c l M c a 1 pathologist was appointed in February 1967. He is asslting in (1) setting up the laboratory services on a provincial laboratory pattern, ( 2 ) strengthening laboratories in district hospitals which are in the area covered by the Institute's laboratory and (3) developing referral services between diitrict hospitals, peripheral health units and the laboratory at the Institute.

Ceylon 0075

R UNICEF

Tuberculosis Control (Jan. 1966 - )

Aim of the project. To organize a community-oriented tuberculosls control programme on a pilot basis in an area of the North-Western Province; to continue and expand the BCG vaccination programme to cover the whole country, and to secure the eventual integration of tuberculosis control into the general health

services.

Assistance provided by WHO during the year. (a) A medical officer; (b) two fellowships - one of three weeks and one of three months .. for study in India; ( c ) supplies and equipment.

sEA/RCZO/~ Page 111

Probable duration of assistance. Until the end of 1969.

Work done during the year. A pilot provincial tuberculosis control programme was launched in the North-Western Province after training national key personnel. Ninety-three health centres and health posts in the Province are participating in the programme.

Sputum was collected from symptomatic persons in all the participating health units, but microscopical examination was undertaken only at the provincial tuberculosis centre and two other laboratories in the Province; referral examinations were also carried out only in the latter places. On receipt of bacteriological confirmation, newly detected cases were treated at the health units nearest the patients' homes. The treatment of cholce was the supervised, intermittent (twice. weekly) regimen with streptomycin and INH in high doses.

Regularity of ambulatory treatment of newly diagnosed cases was about 90 per cent, but case-finding operations through sputum examination need improvement. For

this purpose, a WHO laboratory technician is being assigned.

Integration of BCG vaccination activities is in progress in the pilot area. A special training programme was established through which health and hospital Staff were trained in the method of integrated tuberculosis control and BCO vaccination of newborns and infants.

A direct BCG vaccination trial was completed, and no adverse side effects were observed, but the direct vaccination method has not yet been Officially introduced.

Ceylon 0071 Quality Control of Pharmaceutical Preparations R (March 1966: Sept. 1966; - )

Aim of the project. To strengthen the quality control of pharmaceutical prepa- rations.

Assistance provided by WHO during the year. A consultant for one week.

Probable duration of assistance. Until 1969.

Work done during the yes. A WHO consultant visitcd Ceylon in September 1966 to advise the Government on the design of a quality Control laboratory and its requirements. His report has been sent to the Government.

RITther consultant service 1s planned.

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Ceylon 0080 UNDP(SP) Hydro-power Survey

(Aw. - Oct. 1966)

Aim of the project. To assist in carrying out a detailed study of health and public health engineering implications of the irrigation project and to make recommendations for their inclusion in the over-all development Programme.

Assistance provided by WHO during the year. Two consultants.

Work done. A team consisting of two WHO consultants - an epidemiologist and a sanitary engineer - visited Ceylon between August and October 1966 and made a preliminary survey of the health implications involved in the project. The report of the team, containing broad recommendations on desirable health developments, has been transmitted to PAO, the executing agency Of the project.

Ceylon 0200 R

Fellowships

I-ledical Scrvlces Administration. Three three-month fellowships for study in the United Kingdom and a further three-month fellowship for study in the United Kingdom and Yugoslavia.

Radiological Health. A six-week fellowship for study in the United States of America.

Management of Smallpox. A slxteen-day fellowship for study in India.

Ceylon 0201 Fellowships UNDP(TA)

Public Health Administration. Three fellowships - two of ten and a half months for study in the United Kingdom and India, and one of ten months for study in the United Kingdom.

Public Health Administration and Epidemiology. A fifteen-month fellowship for study in the United Kingdom.

Epidemiology. A nine-month fellowship for study in Czechoslovakia and India.

Bacterlolog~. A twelve-month fellowship for study in the United Kingdom.

Iaboratory Technology. A twelve-month fellowship for study in the United Klngdom.

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Ccneral Medicine. A three-month fellowship for study in the United Kingdom and

India.

Dentistry. A six-month fellowship for study in the United Kingdom.

Transport Medicine. A three-month fellowship for study in the United flngdom.

Sanitary Engineering. A twelve-month fellowship for study in the United States of

America.

Water Supply and Scwage Treatment. A nine-month fellowship for study in the Unitcd States of America.

Medical Stores Administration. Two fellowships - one of three months and one of one month - for study in Sudan and mprus.

INDIA

u n e of the 15000 Auxiliary nurse midwives now serving in India is making a house visit on one of her daily rounds in the Punjab.

A medical records officer at work. The quality of morbidity statistics i s gradually being improved through the strengthening of medical records departments i n hospitals.

Under the national tuberculosis programme, a health visitor in Mysore State goes from house t o hut in a village t o enquire into attitudes towards health and symptoms such as the presence of chronic cough.

Ptovlslen at a simple bnfe wgter gupplr in rural fnd~a.

Thcr nutwhnidwifo show& women in an 1nd:an village trdu* rn prepare haby tend.

Prers~nr~unr.uem drylng gmsllp~~x freeze-d~ied

vaccine in phials- Thir proccss in btinz arr ied out a t tke King inrtitutc. Madras. WP. vt t l r ~ loirr cm1:res ~ 1 : pr-*sent prod~clf ig rhmmosnble fr.eozr-drle#l gmallpor v r r c i n ~ fqr t+ic natiorlal smal 'par eedicrt iun programme.

SEA/RC20/2 Page 115

As a result of vigorous action on the part of the Government and generous aid from a number of countries and from international and voluntary agencies, the severe food scarcity in 1966 was surmounted without major disaster. However, there was again widespread failure of the monsoon rains, affecting mainly the State of Bihar and the eastern part of Uttar Pradesh; difficult conditions were also experienced in West 3engal and A'iaharashtra. Bihar also suffered from floods, and, finally, unseasonal rains in the spring of 1967 interfered with the harvesting of the winter wheat crop. It was estimated that upwards of 75 million people were likely to be gravely affected as a result of the drought conditions.

The draft outline of the Fourth Five-Year Plan was presented to Parliament at the end of August 1966. The Plan gives high priority to agricultural develop- ment, promotion of exports, stabilization of prices, industrial advance and family planning. An increase of health laboratory facilities a s well as drug quality control and accelerated development of urban and rural water supplies are envisaged.

Progress in health services was affected by the devaluation of the rupee. Devaluation also caused some rise in the cost of indigenous a s well a s imported commodities.

In lgovember 1966, Punjab State was bifurcated into two States (Punjab and Haryana), and the city of Chandigarh serves as the capital of both States. The health directorates of both are located in the capital, but the Institute of Post- Graduate Medical Education and Research in Chandigarh has become a national institute.

The national malaria eradication programme continued a s a model of effective planning, vigorous implementation and sound administration. Areas now in the maintenance phase contain 60 per cent of the population originally at malaria risk. Some anxiety was caused by a resurgence of malaria in some areas under the maintenance phase, mainly in Uttar Pradesh, and it was necessary to resume spraying operations to cover a population of up to three million.

The reduction in the incidence of smallpox which had been observed in the past two years was not maintained. Outbreaks were reported from many districts throughout the country. Cases were mainly in infants and young children.

The Indian Council of Medical Research has assumed responsibility for the scientific direction of the research programme of the Tuberculosis Chemotherapy Centre, Madras. The national tuberculosis control programme was further extended and staffed with key personnel trained a t the National Tuberculosis Institute, Bangalore. Direct BCG vaccination up to the age of 20 years has been adopted in thirteen States and Union Territories.

SEA/RC20/2 Page 116

The Calcutta Metropolitan Water and Sanitation Authority came into being in October 1966. Good progress was made by the supplementary engineering services in the design and construction of interim water and drainage schemes co-ordinated with the master plan scheme.

There was a further increase in the number of medical colleges, which now number 90, but the scarcity of medical teachers persisted. However, five post-graduate teaching institutions were in operation, and post-graduate study facilities were available in 56 medical colleges.

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PRWECT LIST

ProJect No.

Source of Funds

Co-operating

AJencies T i t l e -

Ind ia Tuberculosis Chemotherapy Centre , Madras

UNDP(TA) (Dec. 1965 - )

(BMRC 1 ( I C M R )

A i m of t h e p ro jec t . To undertake con t ro l l ed t r i a l s t o f ind simple, e f f e c t i v e and

inexpensive methods of tubercu los i s con t ro l through domici l iary chemotherapy of

ambulant p a t i e n t s , and t o c a r r y out r e l a t e d research.

Assistance provided by WHO d u r i w the year . ( a ) A l abora to ry technician and two

shor t - term consu l tan t s ; ( b ) suppl ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1971.

Work done during the Year. This p ro jec t has continued t o funct ion well and has

extended i t s research l i n e s .

Theencouraging r e s u l t s o f t h e f u l l y supervised twice-weekly treatment regimen

With Streptomycin and high doses of INH (wi th pyridoxine, t o prevent toxic s i d e

e f f e c t s of INH) suggested the p o s s i b i l i t y of longer i n t e r v a l s between t h e doses and

l ed t o a s tudy of once-weekly i n t e r m i t t e n t treatment regimens with various drug

combinations. It was found t h a t once-weekly treatment with streptomycin and INH was not robust enough, as i t s the rapeu t ic e f f i c a c y i s influenced by a p a t i e n t ' s

being a rapid o r a slow IMI i n a c t i v a t o r . In heavier p a t i e n t s , t h e r e l a t i v e l y

lower dose of t h e drugs per kilogram of body-weight l imi ted t h e e f f i c a c y of the

once-weekly regimen when f l a t standard doses were administered. However. t h i s

u n s a t i s f a c t o r y outcome does not n e c e s s a r i l y imply t h a t a once-weekly regimen has

n o therapeut ic p o t e n t i a l i t i e s . Preliminary r e s u l t s of cur ren t s t u d i e s suggest

t h a t the add i t ion of a t h i r d drug i n an i n i t i a l shor t course of d a i l y chemtherapy

enhances i t s e f f i c a c y . Studies have t h e r e f o r e been designed and s t a r t e d t o

i n v e s t i g a t e these f a c t o r s .

Before i n i t i a t i n g major chemotherapy t r i a l s , p i l o t s tud ies were c a r r i e d out

t o determine t h e maximum dose of ethionamide f o r i n t e r m i t t e n t regimens and t h e

p robab i l i ty of acute t o x i c i t y when INH i s given t o p a t i e n t s i n such high doses a s

17 mg per kilogram of body weight.

S E A / R C ~ O / ~ Page 118

Intermit tency i n t h e a p p l i c a t i o n of chemoprophylactic an t i - tubercu los i s drugs

i s a l s o t h e sub jec t of a s p e c i a l s tudy i n which INH is given i n t e r m i t t e n t l y , under superv i s ion , t o c lose family con tac t s (under 5 years of age) of p a t i e n t s with

b a c i l l a r y tubercu los i s .

Although 306 p a t i e n t s have been taken f o r t h e re lapse s tudy i n which they w i l l be followed up f o r a period of four years a f t e r receiving chemotherapy f o r one year

and a t t a i n i n g b a c t e r i o l o g i c a l quiescence. In t h i s s t u d y , r e lapse r a t e s i n t h e

subsequent years a r e being inves t iga ted and inexpensive regimens of maintenance

chemtherapy t e s t e d t o prevent r e lapses .

It i s important t o s tudy reserve regimens under ambulatory cond i t ions , s i n c e

p a t i e n t s i n whom i n i t i a l o r f i r s t - l i n e regimens have f a i l e d and a l s o some p a t i e n t s

a t t end ing tubercu los i s cen t res f o r the f i r s t t i m e , wi th o r without a h i s t o r y Of previous t r ea tment , may have tubercu los i s b a c i l l i r e s i s t e n t t o one o r more of t h e

standard drugs. The in take of p a t i e n t s f o r a s tudy , which is a con t ro l l ed

comparison of cycloser ine plus ethionamide and cyc lose r ine plus ethionamide plus

pyrazinamide, is continuing,as the number of p a t i e n t s s u i t a b l e f o r admission t o t h e s tudy i s not y e t s u f f i c i e n t f o r computation of s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t s .

The l abora to ry inves t iga ted ( 1 ) t h e r e l a t i v e s u i t a b i l i t y of four d i f f e r e n t mthods of c u l t u r i n g tuberc le b a c i l l i from sputum, ( 2 ) t h e s u i t a b i l i t y of t h e

proport ion s e n s i t i v i t y t e s t f o r PAS and ethionamide ( s i n c e t h e s tandard s e n s i t i v i t y

t e s t has proved unsa t i s fac to ry f o r these two d r u g s ) , ( 3 ) degradation of ethionamide

i n b l o o d and t i s s u e homogenates of experimental animals, (4 ) i n t e r m i t t e n t chemo-

therapy of experimental tubercu los i s i n guinea-pigs and mice, ( 5 ) s u s c e p t i b i l i t y of Madras s t r a i n s of tuberc le b a c i l l i t o c e r t a i n an t i - tubercu los i s drugs and t h e i r s u i t a b i l i t y f o r purpose of i d e n t i f i c a t i o n , ( 6 ) biochemical c h a r a c t e r i s t i c s

of Indian tuberc le b a c i l l i , ( 7 ) metabolism and i n a c t i v a t i o n of an t i - tubercu los i s

drugs and ( 8 ) methods f o r de tec t ion and es t imat lon of a n t i - t u b e r c u l o s i s drug.. and/or t h e i r metabol i tes i n serum and u r ine . The l abora to ry has continued t o

p a r t i c i p a t e i n t h e drug-res is tance survey being c a r r i e d out by the Indian Council of Modical Research, which has entered i ts second and t h i r d phase. A simple t e s t ,

s u i t a b l e f o r f i e l d u s e , f o r the de tec t ion of d e t e r i o r a t i o n of cycloser ine t a b l e t s end capsu les , was evolved.

h l r i n g the year , 420 biochemical e s t imat ions , 496 assays of an t i - tubercu los i s drugs , 540 haematological examinations, 19 926 sputum examinations. 20 318 c u l t u r e s ,

5 558 s e n s i t i v i t y t e s t s . and 9 122 u r ine examinations were c a r r i e d ou t . The Centre had a t o t a l attendance of 36 884, including those who came f o r re-examination;

7 138 X-ray p ic tu res were t aken , and 1 013 tomograms made.

WHO fe l lows from count r i es of t h e South-East Asia and o t h e r Regions v i s i t e d t h e Centre f o r Various periods of t r a i n i n g . Two WHO consul tants from t h e B r i t i s h Medical Research Council v i s i t e d the Centre.

Publ icat ions prepared by the Centre dur ing the year a r e l i s t e d i n Annex 2.

SEA/RC20/2 Page 119

Ind ia 0081.1 Leprosy control (National P r o g r a m e l

R (Jan. 1961 - ) UNICEF

A i m of the prcJ&. To develop a programme of l ep rosy con t ro l .

Assistance provided by WHO during the year . ( a ) A l e p r o l o g i s t ; ( b ) a six-month

fe l lowship f o r a s tudy t o u r i n Thailand, Burma, Nigeria and Ghana.

Probable durat ion of a ss i s t ance . Unt i l the end of 1970,

Work done durinu the year. The WHO l e p r o l o g i s t completed h i s assignment i n August

1966, and h i s replacenient took up h i s d u t i e s i n May 1967. He w i l l concentra te h i s

work p r imar i ly i n Andhra Pradesh i n a co-ordinated programme of t r a i n i n g and a l s o w i l l supervise the t r a i n i n g ard d e m n s t r a t i o n a rea of t h e l eprosy con t ro l project

i n Srikakulam D i s t r i c t supported by the Danish "Save the Children" Organization, WHO and UNICEF. A revised plan of operat ion was submitted t o t h e Oovernmnt which

projected t h e recent new p a t t e r n of leprosy c o n t r o l i n t h e revised "Operational Guide f o r the National Leprosy Control Programme" issued by the Government. An

important aspect of the recent change i s t h e g r e a t e r emphasis now placed on h e a l t h education and p a t i e n t mot ivat ion, t h e value of which as being more e f f e c t i v e than

mass surveys has been demonstrated by the Srikakulam p r o j e c t . Fur ther a s s i s t a n c e

t o programmes w i l l be based on the plan of a c t i o n of individual S t a t e s .

Of t h e t o t a l estimated two and a half mi l l ion l e p m s y cases i n India no t more than 600 000 a r e repor ted t o be under t r ea tment , and considerat ion i s being given

t o ways of u t i l i z i n g such resources a s a r e a v a i l a b l e wi th maximum e f f i c a c y t o cope with t h i s very l a r g e problem.

UNICEF continued t o support the con t ro l a c t i v i t i e s with supp l ies and equ ipmnt .

India 0081.2 . I ~ D F O S Y Control , Srikakulam R ( Jan . 1962 - ) UNICEF

A i m of the p ro jec t . To provide technical d i r e c t i o n f o r a leprosy control project supported by the Danish "Save the chi ldren" Organization, and t o t r a i n l eprosy

a u x i l i a r y personnel a t a l l l e v e l s .

Assistance DrOVided by WHO d u r i w t h e year . A l e p r o l o g i s t .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done dur ing the year . The WHO l e p r o l o g i s t completed h i s assignment i n

December 1966. and h i s replacement assumed duty i n April 1967. The assignment repor t

S E A / R C ~ O / Z

Page 120

of t h e l e p r o l o g i s t has c l e a r l y shown the e f f i c a c y of t h e con t ro l methodology advised by WHO and applied i n t h i s p ro jec t . Remarkable r e s u l t s were achieved i n coverage of

c a s e s , a s evaluated through smal l -scale mass surveys , i n the treatment r e g u l a r i t y secured and a l s o i n t h e e f f i c a c y of t reatment . I f these r e s u l t s i n de tec t ion and

treatment of l e p m s y p a t i e n t s can be maintained, t h i s p ro jec t may demonstrate t h a t control on a mass s c a l e i n a highly endemic a rea i s poss ible a t a cos t of roughly

Rs.24 pe r p a t i e n t . This sum includes provis ion f o r a c t i v e su rve i l l ance by examina-

t i o n of con tac t s and school-chi ldren twice a year and f o r some physiotherapy and recons t ruc t ive surgery i n a neighbouring i n s t i t u t i o n .

The t o t a l number of cases repor ted i n Pogir i increased from 31 000 t o 35 000 i n a population of one and a ha l f mil l ion. When t h e a rea of expanded a c t i v i t i e s i n

Orissa i s brought under c o n t r o l , t h e t o t a l population covered under t h i s p ro jec t w i l l be over two and a h a l f mil l ion.

The new WHO l e p r o l o g i s t who took up h i s d u t i e s i n April 1967 was assigned

t o t h e expansion a rea i n (ianjam D i s t r i c t of Orissa S t a t e , where a l ready more than

2 000 l ep rosy p a t i e n t s had been r e g i s t e r e d f o r treatment s i n c e t h e S t a r t of opera- t i o n s i n t h i s a rea i n the second half of 1966.

UNICBF continued t o support t h e p ro jec t with supp l ies and t r a n s w r t .

M i a 0098 Short Oourses f o r Nursing Personnel

H ( J u l y 1957 - Dec. 1966)

A i m of the Droject. To t r a i n nurses i n the o rgan iza t ion , conduct and evaluat ion

of shor t courses f o r nurs ing personnel and t o in t roduce them t o modern nurs ing

concepts and p rac t i ces which were not a pa r t of t h e i r previous education.

Assistance provided by WHO dur ing the year . ( a ) A nurse educator ; (b) equipment.

Work done. Up t o t h e end of 1966 t h i s p ro jec t was confined t o India . In January 1967 i t was converted t o an in te r -coun t ry programme (SEAR0 0139). and courses were planned i n severa l coun t r i es of t h e Region. Before January and wi th in t h e period

covered by t h i s r e p o r t , two one-month courses were held - one i n Chandigarh and

one i n Bombay. The t o p i c of the course i n Chandigarh was t h e teaching of t h e

physical and s o c i a l sc iences i n t h e bas ic curriculum, and i n Bombay, ln - se rv ice education. A t o t a l of 40 nurses attended these courses , which were well received. The need f o r a cont inuing programme of t h i s type has been well e s tab l i shed .

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India 0099 Nursing Education (Public Health Integration): Assistance to States*

India 0099.5 Nursing Education (Public Health Integration), Ooa

UNDP(TA1 (Sept. 1963 - 1

Aim of the project. To establish professional and auxiliary nursing education

programmes in accordance with the pattern laid down by the Indian Nursing Council;

to arrange in-service training in all teaching hospitals, and to improve methods

of administration of the nursing component of all health services.

Assistance provided by WHO during the year. (a) i. nurse educator; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1967

Work done during the year. Project development was slowed by administrative factors. However, advances made in previous years were consolidated. Both classroom and

clinical teaching were improved in the schools in Margoa. Plans were made for the

development of public health nursing services, and the auxiliary nurse-midwives in

the first group trained in Goa were assigned to posts in the public health programme. A full-time public health nurse was appointed in the Health Directorate.

In-service education programmes were started in the teaching hospitals, and

further advances were made in filling senior nursing posts with qualified nurses.

India 0099.6 Nursing Education (Public Health Integrati~n)~ UNDP(TA) Punjab

(July 1965 - May 1967)

Aim of the project. To assist basic nursing schools being used as teaching centres for post-basic nursing education, to improve the over-alladministration of the

educational programme and to provide sound experiences for student teachers and administrators.

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

Work done. The project achieved the upgrading of the basic nursing education

programme conducted by the Post-graduate Institute of Medical Sciences. Chandigarh.

The WHO nurse educator conducted several field tests of the methodology of a

*The project started in September 1957 and 1s expected to continue until the

end of 1967.

SEA/RC2 0/2 Page 122

study of nursing activities, and subsequently completed the "cuide to the Study of

Nursing Activities in Hospitals and Out-patient Denartments" (see India 0223).

In the School of Nursing at the Post-graduate Institute, the proJect achieved

the following: (1) re-organization of the curriculum, including preparation of

course outlines, and assistance to indlvidual tutors in the preparation of lesson

plans; (2) better planning for and better patterns of school administration; (3) a master plan for rotation of students through the clinical field; (4) development of clinical supervision and teaching by the staff of the School (this is an area which

needs much attention and which will not improve further until the appointment of

an adequate number of tutors); (5) organization and utilization of the School's

library facilities, and (6) the development of public health field training.

The WHO nurse educator assisted in the education programmes conducted by the

College of Nursing at the University of Punjab, Chandigarh. She also taught in the

School and helped with the clinical supervision of post-basic students.

In the area of nursing service administration, she worked closely with the Matron of the Post-graduate Institute to develop better patterns of nursing care

in the hospital.

Evaluation. The accomplishments of the project include an improved pattern of

basic nurse education, 2s well as improvement of nursing administration in the

hospital. The development of better basic nursing education has led to a better

practice field for the nurses studying nursing education in the post-basic courses

at the College of Nursing. Although improved hospital housekeeping and an increased awareness of the importance of environmental sanitation have been secondary, they

are the most useful results of the project.

India 0101 National Trachoma Control Programme R (Feb. - May 1956; Oct. 1956 - Feb. 1960;

UNICEF June 1960 - May 1965; March 1966 - )

Aim of the project. To assist with the national trachoma control programme.

Assistanceprovided. Assistance from one of the WHO medical officers under project SEAR0 0030.

Probable duration of assistance. Until 1968.

Work done during the year. The trachoma control programme has ceased to be under-

taken as a special campaign. The teams were dissolved, and some trachoma workers from theteams were trained as basic health workers and each of them was entrusted

with the task of covering a population of 10 000 and operating within the framework

SEA/RC20/2 Page 123

of the basic health services. Since these workers will remain indeflnltely in their

respective areas, it is expected that this arrangement will give better treatment

results and also reduce the cost of the programme.

One of the WHO medical officers attached to the Smallpox Eradication and

Epidemiology Advisory Team (SEAR0 0030) visited the programme in March 1967 and

reviewed the activities carried out through an integrated approach. Several

discussions on the future development of the programme were held with the national

authorities.

UNICEF continued to assist the programme by providing antibiotic ointment.

India 0103 National Tuberculosis Programme muDP(TA1 (Oct. 1956 - Oct. 1957; NOV. 1957 - )

UNICEF

Aim of the project. To develop a national control programme by providing technical guidance, based on model rural and urban tuberculosis control programmes, epidemio-

logical findings and operational research; to train sufficient public health workers

of various categories for the tuberculosis control centres at district and state

levels, and to develop adequate methods and procedures for assessment of the

programme.

Assistance provided by WHO during the year. (a) A medical officer and three consultants; (b) a four-month fellowship for study in the United Klngdom, the

Netherlands and the Federal Republic of Germany.

Probable duration of assistance. Until the end of 1971.

Work done during the year. The programme was substantially expanded. Up to April

1967. 135 district pr'grammes had been established with UNICEF support, and a UNICEF vehicle, required to organize peripheral activities in rural health centres, was

provided to each of 107 districts. Comprehensive programmes were operating in 78 districts, and in 53 districts BCG teams were integrated into the district programme.

Out of 198 BCG teams in India only 163 were in operation during the year, and of these, 90 were working on a house-to-house basis, concentrating on direct vaccina- tion of the age group 0-20 years.

During the year, the National Tuberculosis Institute trained 52 medical

officers, 61 treatment organizers, 56 laboratory technicians, 46 X-ray technicians, 55 statistical assistants, and 33 BCG team leaders for key posts in district programmes.

SEA/RCZO/Z Page 124

Altogether, 1 459 persons have been traincd since the inception of the trainlng course in 1961.

Twenty-one delegates from India participated in the Sixth Tuberculosis Control

Seminar held at the Institute in January 1967. They included senior health adminis- trators. university teachers and key personnel of state tuberculosis programmes.

There were also six observers from other countries of the Region.

Nine WHO fellows from various countries who had participated in the Inter. national Training Course in Epidemiology and Control of Tuberculosis at Prague visited the Institute for four weeks for practical training and also visited the

tuberculosis institutions in Madras and Madanapalle.

An important document on "Function and Responsibilities of State Tuberculosis

Control centres" was prepared by the Institute for discussion with responsible officers of State Oovernments and the Directorate General of Health Services.

The Institute's Epidemiological Seotion continued longitudinal surveys in rural areas. In co-operation with the Bacteriological Section, it collected data

on the prevalence of resistant strains in a rural community, which are now ready for analysis. The Sociological Section and the Control Section are engaged in studies on (1) the milieu of tuberculosis cases as well as their "fate"; (2) the baclrpround and changing pattern of patients who present themselves for diagnosis at tuberculosis centres, and ( 3 ) the extension of operational research to the district tuberculosis programme. The Statistical Section provided assistance to all sections in designing protocols and analysing data.

The All-India BCO Assessment Team has worked out simple methods for evaluation of direct BCP vaccination programmes and is studying concurrent smallpox and BCQ vaccination; the use of dermo-jet apparatus for BCO vaccination was also studied.

At the Twenty-second All-India Conference of Tuberculosis and Chest Diseases Workers, held in Hyderabad in February 1967, the Institute presented the following papers: "Economics in health", "Certain aspects of resistant mycobacteria found in a survey", "Methodology of the assessment of direct BCO vaccination", "Treatment default: administrative, organizational, and sociological considerations", and "Relationship between drug collection and drug intake under domiciliary treatment".

A list of other papers prepared by the Institute during the year is given in Annex 3.

The research activities of the Institute were critically reviewed by WHO short-term consultants, who also assisted in the analysis of data pending from

previous studies and, at sessions of the Institute's Technical Co-ordination Committee, discussed operational research, including predictive epidemiology.

SEA/FiC20/2 Page 125

M i a 0108 Heal th Education: Assistance t o Sta tes*

1ndia 0108.4 Health Education, a u j a r a t

UWDP(TA1 (December 1965 -

Aim of the p r o j e c t . To develop a Health Education Bureau i n the Di rec to ra te of

Health Services of t h e S t a t e on the l i n e s l a i d down by the Centra l Health Education Bureau; t o provide t r a i n i n g i n h e a l t h education f o r h e a l t h workers and t eachers , and

t o plan f o r h e a l t h education of the publ ic .

Assistance provided by WHO during t h e year . ( a ) A h e a l t h educator; ( b ) suppl ies

and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1967.

Work done dur ing the year . Fur ther e f f o r t s were made t o bu i ld up the Health Educa-

t i o n Bureau and t o s t reng then i t s work, p a r t i c u l a r l y i n regard t o t r a i n i n g and

extension of h e a l t h education throughout the S t a t e .

The Assis tant Director (Health Education) re turned from a WHO fellowship i n

t h e United S t a t e s of America and Jamaica. The o f f i c e r i n charge of school h e a l t h education i n the Bureau underwent a job-oriented t r a i n i n g course a t t h e Centra l

Health Education Bureau. New Delhi.

D i s t r i c t h e a l t h educators wete se lec ted and posted t o two d i s t r i c t s and

were given o r i e n t a t i o n t r a i n i n g .

The Bureau continued t o u t i l i z e and t o s t rengthen f u r t h e r i t s competence

i n the job-oriented f ie ld-based methods of t r a i n i n g . Various t r a i n i n g programmes were organized where t h i s method was app l ied , such a s t r a i n i n g f o r a s p e c i a l hea l th

educat ion team t o work i n the malaria e r a d i c a t i o n programme i n Kutch D i s t r i c t t o increase the spray-coverage; t r a i n i n g given by t h i s team t o malar ia workers and primary h e a l t h oentre s t a f f i n h e a l t h education methods: t r a i n i n g f o r u n i t malaria

o f f i c e r s and reg iona l malaria o f f i c e r s , and t r a i n i n g f o r extension educators a t

d i s t r i c t and block l e v e l s . A seminar was held f o r a l l f a c u l t y members i n one

school , and a r e p o r t was prepared.

I n co-operat ion with the Centra l Health Education Bureau a reg iona l workshop

on t r a i n i n g methods was held i n Ahmedabad; the p a r t i c i p a n t s included some from two

o ther S t a t e s a l s o .

Assistance was given i n providing f i e l d t r a i n i n g f o r s tuden t s taking the

diploma course i n hea l th educat ion a t the A l l - M i a I n s t i t u t e of Hygiene and Public

Health. Ca lcu t t a .

*The pro jec t s t a r t e d i n March 1958 and i s expected t o continue u n t l l the end of 1970.

SEA/RCZ 0/2 Page 126

The S t a t e Committee of the country working group f o r the proposed i n t e r . country workshop, on the Methodology of Planning, Implementation and Evaluation of Health Education (SEAR0 0130) c a r r i e d out a s tudy of the h e a l t h education se rv ices i n the S t a t e , and t h i s was followed by the formation of a sub-committee composed of a s s i s t a n t d i r e c t o r s a t the s t a t e l e v e l and medical o f f i c e r s of two d i s t r i c t s , t o make a more d e t a i l e d s tudy of h e a l t h educat ion i n t h e d i s t r i c t s concerned.

India 0108.5 Health Education, Orissa UNDP(TA1 ( J u l y 1964 . June 1965; June 1966;

Nov. 1966 - 1

A i m of the p r o j e c t . To develop a Health Education Bureau i n the Di rec to ra te of Health Services of the S t a t e on t h e l i n e s l a i d down by the Centra l Health Education Bureau; t o provide t r a i n i n g i n h e a l t h education f o r h e a l t h workers and t eachers , and t o plan f o r h e a l t h educat ion of the pub l ic .

Assistance provided by WHO during the year . ( a ) A h e a l t h educator; ( b ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1967.

Work done during the year . A WHO hea l th educator was assigned t o t h e S ta te a t the end of November 1966. He reviewed the e x i s t i n g s i t u a t i o n i n the Health Education Bureau and a l s o v i s i t e d var ious p a r t s of t h e country t o observe primary h e a l t h cen t res and other h e a l t h s e r v i c e s , p a r t i c u l a r l y the na t iona l malaria e r a d i c a t i o n programme, with a view t o assess ing the h e a l t h educat ion work i n operat ion. H i s o the r a c t i v i t i e s included a s s i s t a n c e t o t h e I n s t i t u t e of Education i n s t rengthening t h e h e a l t h education content i n courses f o r t eachers , t r a i n i n g i n h e a l t h education f o r malaria inspectors and d i s t r i c t s a n i t a r y inspec to rs and l e c t u r e s a t var ious t r a i n i n g courses.

E f f o r t s were made t o g e t the key pos t s i n the Bureau f i l l e d .

The Bureau maintained i t s regu la r work of prepar ing m a t e r i a l s f o r t r a i n i n g and mass d i s t r i b u t i o n and arranging f i l m shows, e x h i b i t s and other publ ic informa- t i o n a c t i v i t i e s .

Ind ia 0110 Nursing Advisers t o Sta tes*

Ind ia 0110.4 Nursing Adviser t o Orissa UNDP(TA1 (Oct. 1962 - Peb. 1967)

A i m of the p r o j e c t . To organize and expand nurs ing education and nursing se rv ices i n t h e S t a t e , and t o co-ordinate supervisory se rv ices s o a s t o ensure unilormly high standards of nursing and midwifery i n the h e a l t h programmes.

*The p ro jec t s t a r t e d i n December 1957 and is expected t o Continue U n t i l the end of 1970.

SEA/RCZO/Z Page 127

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

Work done. A WHO nursing adviser was assigned to Orissa from October 1962 to

February 1967. During this period the establishment of the office of Assistant

Director of Health Services (Nursing) was undertaken. Terms of reference for the

past were prepared; a survey of nursing needs a& resources in the State was

carried out; staff records were compiled; job descriptions for various categories of nursing personnel were prepared, and a regular pattern for field visits was

outlined and initiated. Effective day-to-day work of a nursing unit within a

Directorate of Health Services was demonstrated.

In-service education programmes were promoted in all the hospitals in the

State, and assistance was given to nursing staff undertaking these programmes.

Information material designed to provide the public with better and more regular information about nursing was introduced and distributed; and this included

descriptions of policies and procedures related to recruitment of student nurses

and auxiliary nurse-midwives at the state and national level.

The national counterpart was awarded a two-year WHO fellowship, to enable

her to complete a degree in nursing, including specialization in nursing

administration.

Evaluation. The project achieved the defined targets. The usefulness of a nursing unit at the Directorate was well demonstrated, and sound patterns for the conduct

of this unit were established.

lndia 0110.5 Nursing Adviser to Gujarat

UNBP(TA) (sept. 1963 . 1

Aim of the project. To organize and cxpand nursing education and nursing services

in the State, and to co-ordinate supervisorg services so as to ensure uniformly

high standards of nursing and midwifery in the health programmes.

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

Probable duration of assistance. Until the end of 1968.

Work done during the year. The project gained momentum during the year. A second post for a nurse in the Nursing Section of the Directorate of Health Services was

sanctioned and filled. This unit took on increased advisory and direct assistance

programmes. Further help was provided to hospitals in starting in-service educa-

tion and to hospital scho~ls introducln& the revised Indian Nursing CoUnCil Syllabus.

Regular state-wide tours were maintained and increased.

SEA/RCZO/Z Page 128

Further assist2nce was provided to nursing services and nursing education

in the Baroda Medical College Hospital. Advice was given on environmental s2nita.

tion in hospital wards and on the development of in-service training for domestic

staff.

Job descriptions for all categories of nursing personnel were prepared, and

short courses for qualified nursing staff conducted.

India 0110.7 Nursing Adviser to Bihar

UNDP(TA) (Oct. 1966 -

Aim of the project. To organize and expand nursing education and nursing services

in the State and to co-ordinate supervisory services so as to ensure unifo~mly high standards of nursing and midwifery in the health programmes.

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

Probable duration of assistance. Until the end of 1970.

Work done during the year. A WHO nursing adviser took up duty in Patna in

October 1966. Preliminary plans were made for the establishment of a nursing Unit

in the Directorate of Health Services. The post of Assistant Director Of Health

Services (Nursing) was advertised and a job description for the post prepared. A

survey of nursing needs and resources in the State was started. Regular visits

to institutions providing nursing service or nursing education were initiated.

India 0111 Medical Education

R (Dec. 1958 - Sept. 1961; Nov. - Dec. 1965; Aug. 1966 - )

Aim of the project. To strengthen selected medical colleges

Assistance provided by WHO during the year. (a) Pourteen consultants (professors

in various disciplines) and a temporary adviser; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. Groups of WHO consultants in medical education were

assigned to four selected medical colleges for periods ranging from five to twelve

weeks. Most of the groups consisted of three senior medical teachers from different disciplines. The colleges to which they were assigned and the disciplines they

represented were as follows: (1) Maulana Azad Medical College, New Delhi: biochemistry, medicine, and paediatrics; (2) Osmania and Oandhi Medical Colleges, Hyderabad: social

SEA/RC20/2 Page 129

and preventive medicine, psychiatry, medicine (cardiology), and paediatrics*; ( 3 ) College of Medical Sciences, Varanasi: psychiatry. anatomy, chemical pathology, paediatrics, obstetrics and gynaecology; (4) S.M.S. Medical College, Jaipur: physiology, bacteriology, and paediatrics.

The consultants studied the undergraduate and post graduate teaching pro-

grammesintheir respective disciplines, the relationships between their host departments and other related departments in respect of teaching and research. and

associated clinical and laboratory services.

Some observations of a general nature which were made by almost all the

consultants were: the exaggerated concern of the teachers to impart factuzl informa- tion by means of fc,rmal, non-interpretative methods; the lack of co-ordination in

time between theoretical and practical instruction; inflexibility of regulations

governing curricula and examinations; inadequate provision of modern teaching aids;

difficulties in the procurement and maintenance of equipment; shortage of experienced teaching staff, and excessive numbers of students. Overcrowding of hospital wards

and of out-patient services, cumbersome administrative practices and defective hygienic conditions also were found to be seriously impairing the quality of teaching and patient care.

Acting as a team rather than as individual representatives of their respective

disciplines, the WHO consultants, in consultation with the deans and the teaching

staff of the colleges concerned promoted (1) closer inter-departmental collaboration.

(2) the integration of teaching of various subjects and ( 3 ) the application of newer educational methods. Wherever applicable the community aspects of medicine werc

stressed, and advice was given on improvements of field training programmes.

Reconunendations were made on modernization of the course content and of pi-actical exercises, and all kinds of teaching activities were demonstrated. In many cases, the consultants also were able to advise on current research projects.

India 0114 Paediatric Training and Services: R

UNICEF Assistance to States** (August 1958 - )

Aim or the project. To strengthen thc paediatric departments of selected medical colleges and of non-tcaching and district hospitals.

Asslstanoe provided by WHO during the year. (a) A pacdiatric nurse; (b) a fellowship

of one month and twenty days for a study tour in the United Kingdom, France and Uganda.

*The consultant in paediatrics also visited the Collegeof Medical Sciences,Varanasi. **Previous title: Paediatric Education: Assistance to States.

SEA/UC20/2 Page 130

Probable dura t ion of a ss i s t ance . Unt i l the end of 1970.

Work done dur ing the year . The WHO p a e d i a t r i c nurse a s s i s t e d i n t h e planning and conduct of three-month supplemental p a e d i a t r i c nursing courses - one i n Indore and one i n Trivandrum.

E f f o r t s were made t o improve environmental hygiene, ward planning and manage- ment i n a l l the h o s p i t a l s p a r t i c i p a t i n g i n t h e p r o j e c t . The WHO nurse spent t h r e e weeks a t the Medical College Hospi ta l . Baroda, where she advised on the reconstruc- t i o n and f u t u r e use of t h e space a v a i l a b l e t o the Paed ia t r i c Department.

The need f o r b e t t e r domestic and laundry se rv ices and f o r such bas ic f a c i l i t i e s a s hand-washing basins , l a t r i n e s , s l u i c e rooms, work s inks and c leaning f a c i l i t i e s was t h e top ic of much discuss ion. E f f o r t s were made t o help h o s p i t a l a u t h o r i t i e s t o provide f o r b e t t e r organizat ion of domestic se rv ices and a b e t t e r understanding of the need f o r these bas ic s e r v i c e s .

The number of p a e d i a t r i c departments i n teaching h o s p i t a l s and p a e d i a t r i c u n i t s i n h o s p i t a l s associa ted with the p a e d i a t r i c departments and d i s t r i c t h o s p i t a l s i n Ind ia rose t o 6 1 and 74 respec t ive ly . I n two major teaching c e n t r e s , p a e d i a t r i c sec t ions of communicable-disease h o s p i t a l s were improved and l inked with medical co l l eges f o r teaching purposes, and plans were completed f o r t h i s l inkage t o be e f fec ted i n two f u r t h e r such c e n t r e s .

Pive p i l o t p r o j e c t s f o r t h e teaching of s o c i a l o b s t e t r i c s were s t a r t e d . The design included the development of comprehensive f i e l d p r a c t i c e a reas f o r under- graduate and post-graduate medical and nurs ing s tuden t s i n which they w i l l be taught by a team of sen io r teachers i n o b s t e t r i c s , p a e d i a t r i c s , prevent ive and s o c i a l medicine, and nursing. A WHO consul tant t o a s s i s t wi th t h i s development i s under recrui tment .

A1so.a WHO p a e d i a t r i c consul tant from a medical educat ion p r o j e c t (SEAR0 00%) was assigned t o s tudy t h e development of post-graduate p a e d i a t r i c educat ion i n Ind ia and t o advise on f u r t h e r progress , including WHOhlNICEF a s s i s t a n c e . H i s f indings indicated t h e value of WHO/~INICEP a s s i s t a n c e i n t h i s f i e l d and helped t o def ine the minimum c r i t e r i a necessary t o q u a l i f y f o r t h i s a ss i s t ance . Draf t p lans of operat ion f o r th ree p i l o t p r o j e c t s were submitted t o S t a t e Governments concerned. Preparat ions were advanced f o r a workshop i n p a e d i a t r i c pathology and f o r two courses i n neonatology f o r sen io r paed ia t r i c ians t o be held i n t h e second ha l f of

1967. WHO has arranged t o provide consul tants and s t ipends f o r p a r t i c i p a n t s .

Ind ia 0114.4 Paed ia t r i c Training and Services , Maharashtra R (Oct. 1963 - J u l y 1965; Sept . 1966 - )

UNICEF

A i m of t h e p r o j e c t . To expand, upgrade and r e - o r i e n t the teaching of p a e d i a t r i c s i n the medical and nursing co l l eges of the S t a t e .

3EA/RC2 0/2 Page 131

Assistance provided by WHO dur ing t h e year . ( a ) A p a e d i a t r i c nurse educator; ( b ) a six.month fellowship f o r study i n the United S t a t e s of America.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1967.

Work done during the year . A WHO p a e d i a t r i c nurse was assigned t o the p ro jec t i n September 1966.

Assistance was given t o the post-basic p a e d i a t r i c nursing course offered a t the J.J. Hospi ta l Bombay. Planning of the admin i s t ra t ive p o l i c i e s and content of t h e post -basic degree course which i s expected t o be s t a r t e d during 1967 was continued.

The development of nursing care and s tudent nurse teaching i n the Paed ia t r i c Department of J.J. Hosp i ta l was a l a o a s s i s t e d .

India 0114.6 Paed ia t r i c Training and Services , Punjab R (NOV. 1965 - )

Aim of t h e p r o j e c t . To plan and conduct a post -basic course i n maternal and c h i l d h e a l t h nursing i n the College of Nursing, I n s t i t u t e of Post-graduate Medical Education and Research, Chandigarh.

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

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done dur ing the year . Assistance t o the degree p r o g r a m i n maternal and c h i l d h e a l t h nursing continued a s planned. Course o u t l i n e s c l i n i c a l experience and a l s o publ ic h e a l t h nursing f i e l d s were f u r t h e r developed. Considerable tlme was spent i n helping t h e s t a f f of the p a e d i a t r i c u n i t t o improve both genera l admin i s t ra t ion and nurs lng procedures. The physical environment i n t h e wards, including envlron- mental s a n i t a t i o n , management of t r a f f i c i n the u n i t , i n s t a l l a t i o n of hand-washing f a c i l i t i e s and l o c a t i o n of the treatment rooms, n u r s e r i e s and i s o l a t i o n u n i t s required, received a t t e n t i o n . Regular meetings of medical and nursing s t a f f were encouraged, and jo in t planning of p a t i e n t ca re between doc to rs and nurses was promoted.

M i a 0121 Indian Council of Medical Research ( S t a t i s t i c s ~ R (Aw. 1962 - Feb. 1963; Dee. 1963 - June 1965; Aug. 1966 - )

A i m of t h e p roJec t . To a s s i s t the Indian Council of Medical Research i n s e t t i n g up a s t a t i s t i c a l u n i t a t i t s headquarters and i n organizing aml co-ordinating medical research.

SEA/RC~O/Z Page 132

Assistance providcd by WWO during the year. (a) A statistician-cum-epidemiologist:

(b) a twelve-month fellowship for study in ttm United States of America.

Probable duration of assistance. Until the end of 1970.

Work done during the year. Proposals for new and continuing research projects

submitted to the Indian Council of Medical Research for grants-in-aid were reviewed. About 630 projects were under consideration. These proposals were presented to

several ICMR expert groups/committees; at each of which at least one of the prOfeS- sional staff members attached to the project was present. Project staff also

advised the Scientific Advisory Board and the Governing Body of the ICMR on research proposals.

The Statistics Section started a permanent index of all research proposals submitted to the ICMR. It also assisted selected research projects with data processing. Several research projects were given statistical or epidemiological

advioe, and in this connection the project staff visited research centres in six

States of India.

India 0136 Post-basic Nursing Education: Assistance to States*

1ndia 0136.2 Post-basic Nursing Education. aujarat R (Jan. 1963 - Dcc. 1966; - )

Aim of the project. To expand post-basic nursing education and to upgrade public

health and institutional nursing services in the State.

Assistance provided by WHO during the year. A nurse educator.

~robable'duration of assistance. Until the end of 1970.

Work done during the year. WHO assistance to this project began in January 1963. when a WHO nurse educator helped to start a public health nursing course. In 1965

a nurse tutors' course was added and a Post-basic School of Nursing established.

During the year under review, plans were made to upgrade the School to the status of a Collcgc of Nursing associated with Gujarat University. A bachelor's degree in nursing will be awarded to nurses who SuCCessfully complete the two-year programme. Specialization in either public health nursing or teaching will be retained in the degree programme.

*The project started in January 1962 and is expected to continue Until the end of 1972.

SEA/RC20/2

Page 133

Ind ia 0136.3 - Post-basic Nursing Education, Punjab

R (March 1964 - )

A i m of the p r o j e c t . To s e t up a post -basic school of nursing a f f i l i a t e d t o a

u n i v e r s i t y .

Assistance provided by WHO dur ing t h e year . ( a ) Two nurse educators; (b) suppl ies

and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during the year . Tho Collegc of Nursing continued t o o f f e r degree courses

t o q u a l i f i e d nurses . Th i r t een new s tuden t s were admitted t o the regu la r course f o r

nurse teachers and admin i s t ra to r s , br inging the t o t a l enrolment t o 29. A degree

programme designed t o prepare nurses a s s p e c i a l i s t s i n maternal and c h i l d hea l th

nursing was s t a r t e d . Five s tuden t s were admitted t o t h i s programme.

C l i n i c a l teaching f i e l d s i n the h o s p i t a l , were strengthened and e f f o r t s were made t o develop f u r t h e r the urban and publ ic h e a l t h nursing programmes i n which

s tudents from the school receive experience.

The College o f f e r s advisory se rv ices i n nursing educat ion t o i n s t i t u t i o n s throughout the S t a t e and serves a s a cen t re f o r fellowship s tudy a d f i e l d p r a c t i c e

f o r nurses from o ther co l l eges i n India and abroad.

M i a 0136.5 Post-basic Nursing Education, Madras

R (June 1964 - )

A h of the p r c j e c t . To s e t up a post -basic school of nursing a f f i l i a t e d t o a u n i v e r s i t y .

Assistance provided by WHO during the year . ( a ) Two nurse educators; ( b ) supp l ies

and Equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1970.

Work done during thc yehr. The opening of the College of Nursing, which was o r i g i n a l l y scheduled f o r January 1367, had t o be postponcd. and thc c l a s s e s a r c now expected t o

s t a r t i n Ju ly . Assistance t o the p o s t b a s i c diploma course i n nursing was continued

a s was the regu la r development of o l i n i c a l and p r a c t i c e teaching f i e l d s .

Onc of the two WHO nurses was away from t h e p ro jec t from August t o October 1966 on a threc-month assignment t o Ceylon ( s e e p ro jec t Ceylon 0053).

s~A/RC20/2

Page 135

Ind ia 0170 Survey of Water Supply Resources of

i i Greater Calcut ta

W p ( S F ) ( o c t . - NOV. 1959; Sept. - Nov. 1961;

Feb. 1963 - June 1967)

Aim of t h e p r o j e c t . To inprove the water supply and drainage of Greater Calcut ta .

Assistance provided by WHO dur lng the year . A consul tant s a n i t a r y engineering

planner; two s a n i t a r y engineers .

Work done. The Calcut ta Metropolitan Water and S a n i t a t i o n Authority was es tab l i shed

on 2 October 1966 and th ree f u l l - t i m e Directors were appointed. Nomination of a l l the members t o the General Counoil has been completed.

A s i g n i f i c a n t development i n this p r o j e c t was t h e completion and submission t o the Governmentpin November 1966, of t h e Master Plan Report prepared by the

engineering consortium ( the "Consulting Engineer"], which began its work i n

February 1963. The repor t has been c leared by the Government f o r r e s t r i c t e d

d i s t r i b u t i o n .

The WHO consul tant s a n l t a r y engineering planner a s s i s t e d i n the p repara t ion

of t h e f i n a l r e p o r t on the p r o j e c t which i s being submitted t o the Government through

t h e UNDP. The two s a n i t a r y e q i n e e r s provided by t h e consortium (under i t s Supplementary Serv ices ) completed t h e i r work a t t h e end of March 1967 according t o schedule. This concluded successful ly the second phase of UNDP(SF)/~XO ass i s t ance

towards t h e s o l u t i o n of t h e water supply and sewerage and drainage problem of

Q r e a t e r Ca lcu t t a .

A p lan of operat ion f o r the t h i r d phase of t h e p r o j e c t i s under cons ide ra t ion

by t h e Government. This a l s o w i l l be a s s i s t e d by the UNDP(SF), and WHO w i l l a c t a s the executing agency and provide engineering and management consul tants t o t h e

Calcut ta Metropolitan Water a m S a n i t a t i o n Authority.

Fur ther a c t i v i t l e a w i l l be c a r r i e d out under a new p r o j e c t "Assistance t o

t h e Calcut ta Metropolitan Wate? and S a n i t a t i o n Authority" ( Ind ia 0240).

India 0173 Production of DPT Vaccine, Kasauli R ( Jan . - March 1961; Sept. 1961: URICEP March 1965; Dec. 1966; - )

A i m of the p r o j e c t . To develop the production of immunizing agents aga ins t d iph ther ia , p e r t u s s i s and t e tanus .

Assistance Provided by WHO durlng the year . A two-month fellowship f o r s tudy i n t h e Netherlands and Denmark and a twelve-month fellowship f o r s tudy i n t h e United W d o m and Czechoslovakia.

SWL/RC20/2 page 136

Probable duration of assistance. Until the end of 1970.

Work done during thc year. The production and UtlliZation of the triple vaccine

manufactuxed at the Central Research Institute, Kasauli were reviewed. With the

existing equipment, the Institute can produce 100 000 doses of triple vaccine per month. UNICEF has agreed to supply additional equipment and reagents to increase the production.

The Regional Office sent specimens of DPT vaccine produced to the State Institute for the Control of Medical Biological Preparations in Moscow for testing; the result was satisfactory.

India 0174 Production of Freeze-Dried Smallpox Vaccine

R (Sept. - Oct. 1964; June 1965 - March 1966; UNICEF Feb. 1967 - )

Aim of the project. To increase the production of freeze-dried smallpox vaccine.

Assistance provided by WHO during the year. (a) A consultant for s i x months; (b) a six-week travel fellowship in Europe (awarded under India 0201); (c) supplies and equipment.

Probable duration of assistance. End of 1967.

Work done during the year. The production of freeze-dried smallpox vaccine in the four centres set up with WHOmICEF assistance has reached about 50 million doses per year. When two shelf-driers recently supplied by WHO come into operation, production should go up to 65 million doses per year. The feasibility of increasing production to 200 million doses per year was studied by WHO Headquarters and the Regional Office. The Director of Vaccine Institute, Patwadangar, accompanied by a medical supply officer from WHO Headquarters, visited several production institutes in Europe on a six-week WHO fellowship. Based on these studies and visits it has been found advisable for India to adopt production on an industrial scale, and accordingly the production institutes in Belgaum and Patwadangar have been selected to undertake this. The equipment necessary has been selected for procurement byUNICEF, and it has been emphasized that the suppliers nust install the equipment and put it in worldng order; WHO will provide fellowships to train

staff for its maintenance and operation. Spare parts for the existing equipment are being supplied by WHO (centrifugal driers) and by UNICEF (shelf-driers).

A WHO consultant is assisting the National Institute of Communicable Diseases,

Delhi, in increasing the facilities for testing the vaccine.

SEA/RCZ 0/2 Page 137

1ndia 0176 Central Public Health Engineering

R Research Institute, Nagpur

UNDP(SF) (Feb. 1961 - )

Aim of the project. To develop the Institute as a major centre for research on

environmental sanitation problems; tu co-ordinate research prcgrammes, and to train

research workers.

Assistance provided by WHO during the year. (a) Three consultants; (b) supplies

and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. Assistance from the UNDP(SF), which consisted mainly of provision of research equipment to the Institute, ended on 31 December 1966. Except

for a few minor items, which are due to arrive soon, all the equipment has been

provided. In September 1966, a WHO consultant visited the Institute and its various

field centres to assist in the preparation of the executing agency report for the

UNDP component of the project. The report is being finalized. From its own budget

WHO provided two more short-term consultants, one in the field of industrial waste

and the other in the entero-viruses, who were assigned to the project in February

and March 1967 respectively. A consultant in composting is expected to join the

project in August.

India 0178 R

Production of Polio Vaccine (Jan. 1963; Oct. 1966; - )

Aim of the project. To produce attenuated live poliomyelitis virus vaccine and to

establish facilities for independent testing.

Assistance provided by WHO during the year. Supplies and equipment.

Probable duration of assistance. Until the end of 1969.

Work done during the year. The seed virus prepared at the Pasteur Institute at

Coonoor was tested at the National Institute of Medical Research. bndon, and found

satisfactory; virus fluids have subsequently been prepared and sent for testing to the State Institute for the Control of Medical Biological Preparations, Moscow. It

is expected that first batches of the vaccine will be ready for testing in the second

half of 1967.

Essential chemicals and some spare parts for the equipment have been provided

by m0. A WHO consultant to assess production procedures and to advise on the setting up of a national control laboratory 1s under recruitment.

SEA/RC20/2 Page 138

India 0180 Health Education i n Schools

R ( Ju ly 1964 - 1

A i m Of the pro jec t . To develop hea l th education i n basic teacher- t ra ining courses, --- t o be extended t o teacher.tra1ning i n s t l t u t l o n s throughout the country.

Assistance provided by WHO during the year . ( a ) A hea l th educator; ( b J suppl ies and eq~lipment . probable durat ion of ass i s tance . Until the end of Ju ly 1967.

Work done during the year . Concentrated work was car r ied out i n the Boys' Basic

Teacher Training I n s t i t u t e , Alipur, t o t e s t the d r a f t hea l th education s y l l a b i

developed j o in t l y by the I n s t i t u t e and the Central Health Education Bureau. This

has included work wlth the loca l primary hea l th cen t re and wlth the nine schools

used fo r pract lce- teaching by t h i s i n s t i t u t e . I n addi t ion, a thorough study was undcrtaken i n one of these schools selected f o r the purpose.

The pro jec t s t a f f , i n co-operation with the I n s t i t u t e s t a f f and the s t a f f

of the selected school, s tudied a t both the I n s t i t u t e and the school, the problem of e f fec t ive i n t eg ra t i on of hea l th education i n t o the cur r icu la f o r t r a i n ing both

primary teachers and school s tudents . I n i t i a l l y the s t a f f of the I n s t i t u t e and

the school co-operated wlth the pro jec t s t a f f i n assessing the ex i s t i ng s i t u a t i o n and reviewing (1) hea l th education top ics i n the ex i s t i ng curriculum and how they a r e taught. 2 1 the teachers ' t r a i n ing and experience i n hea l th education, ( 3 ) the

ex is t ing lolowlcdge, a t t l t u d e s aM p rac t i c e s of the s tudents and (4) the f a c i l i t i e s

f o r heal th p ro tec t ion and education, school organization and other resources.

Bascd on the information obtained, the standard s y l l a b i and the knowledge of

the hea l th problems i n the conununity, revised s y l l a b l were developed co-operatively

by the s t a f f of the p ro j ec t , the I n s t i t u t e and the school, and t en t a t i ve programmes f o r teaching according t o the sy l l ab i were drawn up. A t e s t was then

car r ied out t o determine i f the s y l l a b i could be taught within the time ava i lab le ,

t o ensure t ha t pa r t i cu l a r items could be included with other sub jec t s i n the

syl labus and t o assess how much more t r a i n ing , i f aiw, the teachers needed i n order t o do t he teaching. It was a l s o necessary t o def ine p r a c t i c a l ways of improving

the t ra in ing and teaching i n the ex i s t i ng s i t u a t i o n and the amount and kind of

superviaion and guidance required t o keep t he teacher on the t rack.

Detailed repor t s a s t o t he s teps taken, the methods used and the r e s u l t s

accrued i n t h i s e n t i r e p ro jec t were being prepared i n su l t ab l e form f o r wider

d i s t r i bu t i on .

Act iv i t i es were continued with the Jamia Mil l ia Teacher Training I n s t i t u t e and College t o strengthen hea l th education i n the diploma courses f o r primary

teachers , i n the B.W. cour3e and i n the M.Ed. programme.

m e programme of p r a c t i c a l p r o j e c t s i n h e a l t h education, s t a r t e d l a s t year a t t h e Iady I rwin Home Science College, was a l s o continued. Some of these p r o j e c t s prepared by B.Ed. s tudents were used f o r t h e expansion of a c t i v i t i e s t o o the r schools and f o r extension t o the community.

Follow-up a c t i v i t i e s i n schools used f o r p r a c t i c e of teaching by s tuden t s from Jamla Mi l l i a showed t h a t the teachers had ca r r i ed out. on the b a s i s of what they had l e a r n t e a r l i e r i n the p r o j e c t , h e a l t h observations of s tuden t s i n order t o d e t e c t s i e n s of d e f e c t s and dev ia t ion from the normal and had t abu la ted the r e s u l t s t o enable the r e f e r r a l of the s tuden t s concerned t o the hea l th se rv ices .

Under the jo in t Health Education - Nutr'iMon Education Committee of the Ministry of Education and Ministry of Health, a f i n a l r e v i s i o n of a d r a f t syl labus in h e a l t h educat ion f o r teacher t r a i n i n g i s being prepared f o r c i r c u l a t i o n throughout t h e country. I n co-operation with the Minis t ry of Education, the Centra l Health Education Bureau has done preliminary work on planning a "guide" f o r t h e teaching of hea l th educat ion.

Ind ia 0181 Applied Nut r i t ion Programme R (Oct . 1964 - )

UNICEF

(FA0

A i m of t h e p r o j e c t . To expand and improve the h e a l t h component of t h e Applied Nut r i t ion Programme, p a r t i c u l a r l y a s regards the h e a l t h and n u t r i t i o n of mothers and ch i ld ren .

Assistance provided by WHO during the year . ( a ) A publ ic h e a l t h o f f i c e r ; (b) a tuelve-month fe l lowship f o r study i n the United Klngdom and Nigeria.

Probable dura t ion of a s s i s t a n c e . Until t h e end of 2970.

Work done during the year . The appl ied n u t r i t i o n programme i n Ind ia continued t o expand. It has been agreed by the p a r t i c i p a t i n g agencies t o extend the v a l i d i t y of t h e Master Plan of Operation (which expired on 31 March 1967) f o r two years , and an addendum has becn prepared f o r considerat ion by the p a r t i e s concerned. Subsidiary plans of operat ion have been completed and signed f o r most of the major S t a t e s , except f o r Andhra Pradesh and Madras, the plans f o r which a r e being revised. Addenda t o the subs id ia ry plans of operat ion f o r var ious S t a t e s , f o r expansion of t h e programes during 1968, have a l s o been f i n a l i z e d o r a r e being negot ia ted, a s a r e plans f o r the development of c o a s t a l f i s h e r i e s and r u r a l d a i r i e s i n some States.

A s s t a t e d i n Sect ion 6.6 of Par t I, the programme now covers a t o t a l of 593 community development blocks i n seventeen S t a t e s and th ree Union T e r r i t o r i e s , with

a populat ion of over 40 mil l ion . It i s planned gradual ly t o extend it i n a phased manner t o other a reas .

SEA/RC20/2 Page 140

The Co-ordination Committee, consisting of representatives of the various

agencies concerned (including international and bilateral agencies and foreign

voluntary organizations) held several meetings at which the progress of the

programme and its future expansion were reviewed and discussed.

A WHO public health officer was assigned to the project from November 1966

to April 1967.

India 0182 Strengthening of Health Services (Epidemiology)

DNDP(TA) (March 1963 - )

Aim of the project. To establish or improve health intelligence units in health

directorates; to train staff in epidemiology, health statistics, microbiology and

communicable-disease control, and to develop the National Institute of Communicable

Diseases (NICD), Delhi.

Assistance provided by WHO during the year. (a) An epidemiologist, a bacteriologist

and a consultant epidemiologist; (b) two nine-month fellowships for study in

Czechoslovakia and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. The National Institute of Communicable Diseases, Delhi,

continued to develop as a training centre.

The three-month training course which was started at the Institute in September 1966 was assisted throughout by a WHO ConSUltant epidemiologist. The new group of participants in the combined nine-month Prague-Delhi training course, which

started in Prague in November 1966 and continued there up to 28 April 1967, is now undergoing the remaining part of the course in Delhi at the Institute.

The NICD continued to assist Indian States and municipal corporat4ons In

investigations of outbreaks of epidemics. In an epidemic of infective hepatitis

in Siliguri (Assam), some 2 265 cases of overt disease were recorded; more than half of these cases occurred among railway employees. It was found that the disease

had spread through contaminated water supply. Another epidemic of menlngococal

meningitis in Delhi was also studied.

An NICD team started investigations of an epidemic,in Nagpur.of a highly fatal disease showing symptoms of encephalitis.

A study of haemorrhagic fever in Jabalpur was also undertaken and revealed that in a current epidemic about 7% of the cases of dengue fever developed a haemorrhagic syndrome.

S E A ~ C ~ O / Z Page 141

The N I C D a l s o developed a laboratory f o r t e s t i n g t h e potency of smallpox vaccines. Preparations have been made f o r immunity s t u d i e s i n smallpox.

The WHO b a c t e r i o l o g i s t helped t o s t a r t s tud ies i n anaerobic bac te r i a with the aim of developing a laboratory f o r t h i s purpose a t the I n s t i t u t e .

Ind ia 0183 Medical Education, Oujarat S t a t e ONDP(TA) (Dec. 1962 -

A l m of the p r o j e c t . To develop medical education and medical r esea rch i n Baroda Medical College.

Assistance provided during the year . ( a ) Seven v i s i t i n g p rofessors , a laboratory technician, a consul tant phys io the rap i s t , two shor t - term consul tants and two temporary adv i se r s ; ( b ) th ree twelve-month fe l lowships - one f o r study i n Ceylon. one i n Europe and one i n the United Kingdom and Yugoslavia - and two fe l lowships of th ree and a half months each f o r study i n t h e United Kingdom; ( c ) supp l ies , equipment and a t r anspor t veh ic le .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1968.

Work done dur ing t h e year . The WHO professors of medicine and bacter iology completed t h e i r assignments i n December 1966 and June 1967 respec t ive ly . New assignments included: p ro fessors of o b s t e t r i c s and gynaecology, a n a e s t h e t i c s , orthopaedic surgery, and medicine, a laboratory t echn ic ian and shor t - term consul tants i n pharmacology and surgery. A professor of c h i l d h e a l t h i s expected t o jo in the WHO team by the end of June 1967 t o a s s i s t i n developing a community p a e d i a t r i c programme i n urban and r u r a l a reas .

A s temporary adv i se r s t h e Academic and Executive Deans of the Faculty of Medicine of Edinburgh University v i s i t e d t h e College i n December 1966 and reviewed progress wi th t h e co l l ege S t a f f , t h e WHO team, the s t a t e a u t h o r i t i e s and t h e Regional Off ice .

A major f e a t u r e of t h e y e a r ' s progress has been t h e in t roduc t ion of a well organized programme of post-graduate educat ion, Pollowing on t h e recommendations of a S tee r ing Committee on Post-graduate Training. The WHO v i s i t i n g s t a f f have a s s i s t e d i n t h e planning and implementation of the programme, which includes a common bas ic sc ience course f o r a l l post -graduate s tuden t s and a l s o provides f o r post-graduates t o g a i n experience under supervis ion of undergraduate teaching.

The WHO professors of medicine and bacter iology have promoted resea rch a c t i v i t i e s which enabled Junior s t a f f t o acquire resea rch s k i l l s i n bas ic physiological r esea rch , c l i n i c a l t r i a l s and community surveys.

S E A / F ~ C ~ O / Z Page 142

For t h e f i r s t t ime, members of t h e s t a f f of the Medical College - t h e PI'OfeSsCrs of medicine, surgery and o b s t e t r i c s - were e lec ted t o the Faculty 3 1

Medicine of the University of Baroda.

I n Deoember 1966 a WHO consul tant i n h o s p i t a l a r c h i t e c t u r e from pro jec t SEARO 0103 v i s i t e d Baroda t o s tudy t h e p o s s i b i l i t y of r e h a b i l i t a t i n g t h e old h o s p i t a l bu i ld ings . Following h i s advice, t h e Regional Office, wlth t h e agreement of the S t a t e Government, i s arranging t o a s s i g n a h o s p l t a l des ign team t o c a r r y out a design study and recommend a master p lan f o r t h e u t i l i z a t i o n of the h o s p i t a l a s a func t iona l teaching h o s p i t a l .

A WHO medical records o f f i c e r (from inter-country p r o j e c t SEARO 0072) advised on t h e f u r t h e r development and funct ioning of the r e c e n t l y reorganized

Medical Records Department of t h e Medical College Hospi ta l .

A c t i v i t i e s of the var ious departments a s s i s t e d by WHO s t a f f a r e described below:

Medicine. The c r e a t i o n of a f i f t h u n i t i n t h e Department and the appointment of another professor of medicine permitted a smal ler grouping of s tuden t s f o r c l i n i c a l i n s t r u c t i o n .

The Department, wi th t h e co l l abora t ion of the Department of Education of t h e Univers i ty of Baroda, organized a two-day seminar on teaching and l ea rn ing . The WHO professors conducted weekly consul tant and teaching sess ions a t t h e r u r a l t r a i n i n g cen t re of the Department of Preventive and Soc ia l Medicine.

New resea rch a c t i v i t i e s undertaken included a resp i ra to ry-d i sease survey of h o s p i t a l admissions, a p i l o t s tudy preparatory t o i n s t i t u t i n g a BCO vaccinat ion programme f o r Baroda school-chi ldren, a c l i n i c a l t r i a l of chemotherapy and c o r t i - cos te ro ids i n t h e treatment of tuberculous meningi t is , and a n i n v e s t i g a t i o n of r e s p i r a t o r y funct ion i n hea l thy ind iv idua l s and i n cases of r e s p i r a t o r y d i seases .

Bacteriology. The WHO professor a s s i s t e d i n rearranging t h e sy l l abus . This has reduced t h e teaching load and improved co-ordinat ion between t h e o r e t i c a l and p r a c t i c a l courses. The virology content has been increased and medical mycology introduced. A new post-graduate course i n medical microbiology has a l s o been s t a r t e d .

Laboratory d iagnos t i c f a c i l i t i e s have been developed i n the tubercu los i s and infect ious-disease h o s p i t a l s t o supplement those s e t up I n the medical co l l ege a t an e a r l i e r s t age of the p r o j e c t . Assistance was a l s o given i n t h e t r a i n i n g of laboratory s t a f f i n bas ic l abora to ry techniques and i n v i r o l o g i c a l d iagnos t i c techniques.

Major resea rch s t u d i e s were undertaken, wl th the Department of Surgery, on t h e causes and prevent ion of s u r g i c a l s e p s i s , and, wl th the Department of Dermatology, on b a c t e r i a l co lon iza t ion and i n f e c t i o n of t h e skin . Studies on acute u r e t h r i t i s ,

S E A / R C ~ O / ~ Page 143

t h e d i s t r i b u t i o n of t e t anus b a c i l l i i n the h o s p i t a l compound, drug-res is tance i n

tuberc le b a c i l l i , and the ae t io logy of g a s t r o - e n t e r i t i s i n ch i ld ren were c a r r i e d ou t .

Obs te t r i c s and Oynaecolog~. The WHO professor of o b s t e t r i c s and gynaecology

was mainly concerned with the organizat ion of a community o b s t e t r i c s s e r v i c e t o provide a n appropr ia te s t r u c t u r e f o r teaching o b s t e t r i c s and improving the q u a l i t y

of o b s t e t r i c ca re . Teaching and p a t i e n t care have been extended from the main

teaching h o s p i t a l t o h e a l t h cen t res and subs id ia ry h o s p i t a l s i n urban and r u r a l

a r e a s . Thus, the undergraduate and post-graduate courses , h i t h e r t o excess ively

o r ien ted t o abnormal, emergency o b s t e t r i c s , w i l l henceforth give appropr la te

a t t e n t i o n t o normal and community o b s t e t r i c s . F ie ld s t u d i e s , epidemiological and

opera t iona l , as appl ied t o o b s t e t r i c s , w i l l a l s o be poss ib le .

I n November 1966 a two-day symposium on medical d i so rders of pregnancy was

held i n the College.

Pharmacolog~. The WHO consul tant i n pharmacology reviewed the teaching and

resea rch programmes and t h e admin i s t ra t ion of the Department of Pharmacology. H i s recornendations included reduct ion of the formal teaching load, provis ion Of resea rch equipment, t r a i n i n g f o r laboratory technicians i n workshop techniques and

bas ic e l e c t r o n i c s and the employment of non-medical teaching s t a f f i n p r e c l i n i c a l

departments. He took p a r t i n a seminar on physiological and p h a ~ C O l o g l C 9 1 top ics ,

organized by the College and a t tended by medical teachers from Q u j a r a t S t a t e a s wel l

a s v i s i t o r s from Bombay and Luchow.

Orthopaedic Surgery. I n add i t ion t o p a r t i c i p a t i n g i n teaching and aemonstratlng new s u r g i c a l techniques, t h e WHO professor of orthopaedic surgery advised on t h e

development of a n accident and emergency s e r v i c e , a c e n t r a l s t e r i l e supply department and t h e establishment of a school of physiotherapy based on t h e e x i s t i n g Physiotherapy

Department. A WHO physiotherapy tu to r ( f rom p r o j e c t Thailand 0073) was assigned f o r

t e n days t o advise on the f e a s i b i l i t y of e s t a b l i s h i n g t h i s school.

. The WHO consul tant i n surgery advised on t h e d i s p o s i t i o n Of teaching

and se rv ice f a c i l i t i e s i n the newly b u i l t h o s p i t a l u n i t . He a l s o reviewed the teaching courses i n surgery and gave advice on t h e use of new techniques i n gast ro- i n t e s t i n a l surgery.

Anaesthetics. The attainment of acceptable s tandards of anaes the t i c ca re and of teaching and t r a i n i n g i n anaes the t i cs has been rendered d i f f i c u l t by shor tages of

s t a f f and of modern equipment and drugs; t h e Expansion of s u r g i c a l se rv ices has

aggravated the de f ic ienc ies of the Department. Undergraduate s tuden t s have l i t t l e

opportunity t o acquire anaes the t i c s k i l l s . The WHO professor of anaes the t i cs prepared a post graduate t r a i n i n g course and a s s i s t e d i n the OrganiZatiOn of blocd

t rans fus ion and r e s u s c i t a t i o n se rv ices . He has submitted a r e p o r t on s t a f f i n g and

has recommended t h a t anaesthesia technicians be given t r a i n i n g . The P o s s i b i l i t y of

cons t ruc t ing simple e l e c t r i c v e n t i l a t o r s l o c a l l y i s being inves t iga ted .

SEA/RC2 0/2 Page 144

Ind ia 0185.1 Strengthening of Health Services . Jamnagar R ( Jan . 1964 - June 1967) UNICEF

A i m of t h e p r o j e c t . To s t reng then t h e na t iona l h e a l t h se rv ices a t d i s t r i c t and per iphera l l e v e l s , wi th emphasis on t r a i n i n g programmes of a l l hea l th s t a f f and on opera t iona l research.

Assistance provided by WHO dur ing the year. ( a ) A publ ic h e a l t h o f f i c e r , a public h e a l t h nurse and a s a n i t a r i a n ; ( b ) a six-week fe l lowship f o r s tudy i n Thailand and t h e Ph i l ipp ines .

Work done. The p r o j e c t a c t i v i t i e s s t a r t e d i n Jamnagar D i s t r i c t wi th t h e appointment of a WHO pub l ic h e a l t h o f f i c e r and a s a n i t a r i a n i n January 1964. A WHO nurse joined the p r o j e c t i n March 1964. A p l a n of operat ion f o r t h e development of t h i s p r o j e c t was signed by the Government and WHO i n February 1963, and a d e t a i l e d p lan of a c t i o n was prepared i n September 1964- based on discuss ions wi th t h e na t iona l h e a l t h s t a f f a s wel l a s on the f ind ings i n a survey of h e a l t h condi t ions c a r r i e d out by the WHO

s t a f f . Assistance t o t h e p ro jec t ended i n June 1967.

I n the t h r e e and a h a l f years i n which t h e p r o j e c t has been operat ing, many of the ob jec t ives have been achieved. The admin i s t ra t ion of t h e d i s t r i c t h e a l t h se rv ices was considerably improved; t h e post of t h e D i s t r i c t Health Officer was upgraded t o Class I , and those of medical o f f i c e r s i n charge of primary h e a l t h c e n t r e s were made Class 11. The appointment of a publ ic h e a l t h nurse t o t h e d i s t r i c t has considerably helped i n supervis ion and guidance of nurs ing personnel and i n thus increasing t h e i r output both i n quan t i ty and q u a l i t y . Of t h e t e n primary h e a l t h cen t res i n the D i s t r i c t , n ine were upgraded. Job desc r ip t ions were prepared f o r a l l h e a l t h s t a f f . The repor t ing system was s impl i f i ed , following t h e recommendations of a WHO consul tant i n s t a t i s t i c s made a v a i l a b l e f o r t h e purpose. The bulky monthly r e p o r t s of primary h e a l t h c e n t r e s and q u a r t e r l y repor t s being prepared f o r UNICEF have now been abol ished, and a more r e a l i s t i c and use fu l quar te r ly repor t form has been prepared and put i n t o use.

The laboratory a t Shah Medical College was considerably improved, and now se rves a s a r e f e r r a l l abora to ry f o r t h e d i s t r i c t . Regular in - se rv ice t r a i n i n g courses were given t o h e a l t h v i s i t o r s , a u x i l i a r y nurse-midwives and s a n i t a r y inspectors i n the D i s t r i c t .

I n t h e f i e l d of comunicable-disease con t ro l , the tubercu los i s con t ro l pro- gramme has been wel l e s tab l i shed , ard BCO vaccinat ion, a s a r o u t i n e f o r a l l newborns, has been introduced i n t h e Shah Medical College Hospi ta l . Even though the maintenance phase of t h e malaria e r a d i c a t i o n programme has not y e t been reached i n t h i s d i s t r i c t , t h e h e a l t h i n s t i t u t i o n s and the h e a l t h s t a f f a r e a s s i s t i n g with e r a d i c a t i o n a c t i v i t i e s .

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There is only one s a n i t a r y inspec to r f o r each t a l u k , covering a population of 60 000 t o 80 000, and the re fo re the progress made i n t h i s f i e l d has been very l i m i t e d . However, an i n i t i a l survey was c a r r i e d out t o assess the e x i s t i n g problems i n s a n i t a t i o n and hea l th , and i n defined a reas w a t e r - s e a l l a t r i n e s were i n s t a l l e d . Kalawad t a l a was se lec ted f o r t h e proposed WliOhNICEF-assisted :-ural w a t e r s u p p l y scheme. Plans a re ready t o implement a r u r a l water supply scheme i n Kalawad t a l a with WHO and UNICEF ass i s t ance .

Evaluation. The p r o j e c t has shown that it is possible t o increase the output , both I n quan t i ty and q u a l i t y , with t h e hea l th s t a f f a v a i l a b l e . This has been done by rev i s ing job d e s c r i p t i o n s , g iv ing in - se rv ice t r a i n i n g , and ensuring adequate supervis ion and guidance.

Strengthening of Health Serv ices , -- R Punjab and Haryana

UNICEF ( Jan . 1967 - 1

Aim of t h e p r o j e c t . To s t reng then na t iona l h e a l t h se rv ices a t s t a t e , d i s t r i c t and per iphera l l e v e l s , with emphasis on t r a i n i n g programmes f o r hea l th s t a f f , supervis ion of a u x i l i a r y s t a f f by the appropr ia te profess ional s t a f f and on opera t iona l studies.

Assistance provided by WHO during the year . [ a ) A publ ic h e a l t h o f f i c e r ( reass igned Rom p r o j e c t 0191) and a publ ic hea l th nurse .

Probable dura t ion of a s s i s t a n c e . Until e a r l y 1970.

Work done during t h e year . A study of t h e work of smallpox vaccinators was c a r r i e d out i n t e n v i l l a g e s of Karnal D i s t r i c t , and brought out a need t o t r a i n new vaccinators This t r a i n i n g w i l l not only be i n smallpox e r a d i c a t i o n but a l s o w i l l include top ics on malaria e rad ica t ion , hea l th education, f i r s t a i d , record keeping, s t a t i s t i c s and t h e organizat ion of hea l th s e r v i c e s . Xarnal D i s t r i c t has been se lec ted a s a p i l o t p ro jec t f o r such t r a i n i n g . The t r a i n i n g w i l l l a s t f o r s i x weeks.

A new type of family r e g i s t e r t o be used by t h e s t a f f of both t h e malaria and t h e smallpox e r a d i c a t i o n programmes has been prepared and i s being t r i e d out i n Karnal D i s t r i c t .

I abora to r ies have been es tab l i shed a t primary hea l th cen t res i n Karnal and Ambala D i s t r i c t s of Haryana and i n a l l the primary h e a l t h cen t res of Rupar D i s t r i c t . i n seven out of t e n primary hea l th cen t res of P a t i a l a D i s t r i c t and i n f i v e out of twelve primary h e a l t h cen t res I n Bhatinda D i s t r i c t of Punjab.

A WHO publ ic h e a l t h nurse assumed duty i n March l%7.

SEA/RC2 0/2 Page 146

Ind ia 0187 Training of Radiographers R (March 1967 - )

A i m of t h e p r o j e c t . To t r a i n radiographers

Assistance provided by WHO dur ing the year . A radiography t u t o r .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during the year . I n March 1967 a WHO radiography t u t o r was assigned t o the School f o r Tra l r ing of Technicians (Radiographers). located i n the I n s t i t u t e of Post-graduate Medical Education and Research a t Chandigarh. He has been engaged i n

reviewing f a c i l i t i e s and needs and a s s i s t i n g i n t h e design of a s u i t a b l e curriculum.

Ind ia 0188 Strengthening of laboratory Services

R (Feb. 1965 - )

A i m of the p r o j e c t . To s t rengthen hea l th l abora to ry se rv ices and t o improve t h e

t r a i n i n g of l abora to ry t echn ic ians .

Assistance provided by WHO dur ing t h e year . ( a ) Two labora to ry t echn ic ians (one s t a t ioned i n Trivandrum and one i n Chandigarh); ( b ) supp l ies and equipment.

Probable d u r a t i o n of a s s i s t a n c e . Unt i l e a r l y 1970.

Work done dur ing t h e year . I n Trivandrum, t h e second one-year course f o r l abora to ry a s s i s t a n t s , s t a r t e d i n September 1966, continued with 24 s tuden t s . I n t h e l i g h t of

the experience gained i n the f i r s t course , some modif icat ions were made i n the sy l l abus and curriculum. A higher course of two years was being planned. The Govern. ment has appointed a f u l l - t l m e o f f i c e r t o be i n charge of t h e t r a i n i n g school, and

two fu l l - t ime t u t o r s have been sanctioned and a r e under recrui tment .

I n connection with the planning and gradual expansion of l abora to ry se rv ices i n t h e S t a t e , the WHO laboratory t echn ic ian accompanied the Di rec to r of Health

Laboratory Services on v i s i t s t o t h e l a b o r a t o r i e s a t Cochin, Ernakulam, Ca l icu t ,

C a n t n o r e and Palghat. Exis t ing f a c i l i t i e s were reviewed and proposals made f o r a

phased programme f o r upgrading some of these l a b o r a t o r i e s .

The WHO l abora to ry t echn ic ian assigned t o the I n s t i t u t e of Post-graduate Medical Education and Research. Chandigarh, s t a r t e d work i n January 1967. The

e x i s t i n g one-year course f o r laboratory a s s i s t a n t s has been rev i sed , and discuss ions

were held on t h e organizat ion of a higher two-year course f o r t r a i n l n g l abora to ry

technicians and t u t o r s a s soon a s f e a s i b l e . Three n a t i o n a l t u t o r s have been appointed a rd two more a re under recrui tment .

SEA/RC20/2 Page 147

India 0191. Development of Health Services i n Community Development Areas (Dec. 1964 - Feb. 1965; Dec. 1965 - Dec. 1966)

A h of the p r o j e c t . To s t rengthen the development of r u r a l h e a l t h se rv ices and t o t r a i n s t a f f , including multi-purpose hea l th a u x i l i a r i e s .

Assistance provided by WHO during t h e year . ( a ) A publ ic h e a l t h o f f i c e r ;

( b ) suppl ies and equipment.

Work done. With a team from the Di rec to ra te of Health Services t h e WHO medical o f f i c e r v i s t ed some primary hea l th c e n t r e s i n Funjab and assessed the work of t h e s t a f f , i n order t o advise on a s a t i s f a c t o r y p lan of work f o r primary h e a l t h cen t res . The workload of bas ic h e a l t h workers was s t u d i e d , and t h e i r knowledge of malar ia , communicable d i seases and family planning assessed.

The primary h e a l t h cen t re i n (fharuan ( P a t l a l a D i s t r i c t ) was upgraded t o c a r r y out in - se rv ice t r a i n i n g of hea l th personnel i n Punjab S t a t e . The t r a i n i n g of laboratorytechniciansand microscopis ts from the na t iona l malar ia e r a d i c a t i o n Programme t o enable them t o man primary hea l th cen t re side-room labora to r ies i n Karnal D i s t r i c t was completed.

With the b i f u r c a t i o n of Punjab S t a t e i n November 1966, and t h e formotion of two S t a t e s , viz..Punjab and Haryana, separa te d r a f t p lans of operat ion were prepared f o r these S t a t e s under a revised t i t l e "Strengthening of Health Services", wi th p ro jec t numbers India 0185.2 f o r Punjab and Ind ia 0185.3 f o r tIarwm. However. a s both S t a t e s a re a t present being a s s i s t e d by a s i n g l e WHO team, the a c t i v i t i e s from t h e beginning of 1967 a r e repor ted under a j o i n t number, Ind ia 0189 .2h .

Ind ia 0192 Radiation Medicine Centre, Bombay R ( J a n . - Feb. 1963; March 1967 - )

A i m of t h e p r o j e c t . To s t rengthen the Radiation Medicine Centre, Bombay.

Assistance provided by WHO during the year . A consul tant f o r two months.

Probable d u r a t i o n of a s s i s t a n c e . Unt i l the end of 1969.

Work done during t h e year . A WHO consul tant was assigned t o t h i s cen t re i n t h e f i r s t week of March 1967, t o a s s i s t i n carrying out r esea rch i n p r o t e i n metabolism, including t h e use of r ad ioac t ive isotope turnover and computer a n a l y s i s of t h e da ta co l l ec ted . She completed her assignment i n May and her repor t i s under study. 'Ivo f u r t h e r consul tants a r e under recrui tment .

+ A t the beginning of 1967. the p r o j e c t was merged wi th India 0185.2h.

SEA/RC20/2 Page 148

India 0194 Medical Rehabilitation R (Nov. 1963 - Feb. 1964; April 1967 . ) UNICEF

Aim of the project. To expand medical rehabilitation services; to establish regional rehabilitation centres in some large cities and rehabilitation units in selected medical colleges, and to improve the facilities at the All-India Institute of Physical Medicine and Rehabilitation, Bombay.

Assistance provided by WHO during the year. A medical rehabilitation Specialist.

Probable duration of assistance. Until the end of 1970.

Work done during the year. In April 1967, a WHO medical rehabilitation specialist was assigned to the Department of Rehabilitation and Physical Medicine in the Govern- ment General Hospital, Madras, for a period of two months to assist with the training Of physiotherapists. An orthopaedic appliances technician is also being recruited.

A co-ordinated plan of action covering all aspects of medical, social and educational rehabilitation is under consideration.

India 019z R

Course in Radiological Physics, Bombaz (April 1962 - )

Aim of the project. To strengthen the training of radiological physicists.

Assistance provided by WHO during the year. (a) A short-term consultant; (b) a

twelve-month fellowship for study in the United States of America.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The fifth training course in radiological physlcs organized by the Bhaba Atomic Research Centre, Trombay (Bombay) started on

14 September 1966. In all. 25 candidates are attending the course. A WHO consultant to assist in the teaching progralme was assigned in June 1967.

Asslstance to the project has materially contributed to the improved status of X-ray radiation protection services in the country.

India 0200 Fellowships R

Epidemiology. Three nine-month fellowships for study in Czechoslovakia and Indla, and one three-month fellowship for study in Yugoslavia, Czechoslovakia and the United Kingdom.

SEA/RC20/2 Page 149

Epidemiology and Plague Control. A six-month fellowship for study in Tehran and the U.S.S.R.

Leprosy Control. A six-month fellowship for study in Thailand, Burma, Ghana and Nigeria.

Tuberculosis Control. A fellowship of four months and twenty-four days for study in Czechoslovakia, Denmark and Kenya, and a tuelve-month fellowship for study in the United States of America. Denmark, Czechoslovakia and Kenya.

Cancer. A twelve-month fellowship for study in the United States of America. - Embryology. A twelve-month fellowship for study in the United Kingdom.

International Quarantine. A three-month fellowship for study in the United Arab Republic and Italy.

Ophthalmology. hro fellowships - one of two months for study in the U.S.S.R. and one of three months and ten days for study in Switzerland, Prance and Spain.

Dentistry. A twelve-month fellowship for study in Australia.

Paediatric Surgery. A twelve-month fellowship for study in Canada, the United States of America and the United Kingdom.

Sanitary Engineering. A tuo-wcek fellowship for study in the United Kingdom.

Microbiology. A three-and-a-half-month fellowship for study in Europe and the U.S.S.R.

Neuro-surgery. A one-and-a-half-month fellowship for study in Sweden.

India 0201

UNDP( TA Pcllowships

Irprosy Control. Three six-month fellowships for study in Thailand, Burma, Nigeria and Ghana.

Tuberoulosis Control. A fellowship of four months and twenty-four days for study in Czechoslovakia, Denmark and Kenya.

Venereal-Disease Control. A six-month fellowship for study in Denmark and the United Kingdom.

SEA/RC20/2 Page 150

San i ta ry Engineering. A slx-month fellowship f o r s tudy i n the United S t a t e s of

America and tho United Kingdom.

Public Health Engineering. A six-month fe l lowship f o r s tudy i n t h e U.S.S.R., t h e Netherlands and the United Kingdom.

Nursing. Two fel lowships - one of two years (awarded under p r o j e c t Ind ia 0110) and

one of s i x months - f o r s tudy i n t h e United S t a t e s of America.

Food Adul tera t ion. A six-month fellowship f o r s tudy i n Denmark, t h e Netherlands and

the Federal Republic of Germany.

Freeze-dried Smallpox Vaccine Production. A three-month fellowship f o r s tudy i n t h e

United Kingdom and the Netherlands and a one-and-a-half-month fellowship f o r a s tudy

t o u r i n Europe and East Pakis tan.

ScrOlOgy. A twelve-month fellowship f o r s tudy i n Denmark, Sweden and the United Kingdom.

Blood Transfusion. A six-month fellowship f o r study i n Hungary.

Dental Surgery. A two-year fellowship f o r s tudy i n t h e United S t a t e s of America.

F a c i a l Surgery. A twelve-month fe l lowship f o r study i n Denmark and t h e United Kingdom.

Ind ia 0208

UNDP(TA)

Improvement of Dental Education ( J u l y - Dec. 1966; - )

A i m of the p r o j e c t . To improve and s t reng then d e n t a l education and resea rch i n a

se lec ted d e n t a l co l l ege .

Assistance provided by WHO dur ing t h e year. ( a 1 A teacher i n d e n t i s t r y f o r six months; ( b ) a twelve-month fellowship f o r s tudy i n the United S t a t e s of America and a t k e e -

month fellowship f o r study i n Denmark; ( c ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1969.

Work done during the year . The WHO teacher complctcd h i s assignment a t the (fovern- ment Dental College, Bangalore, a t thc end of Dccember 1966, and h i s r e p o r t has been

forwarded t o the Government. Considerable Improvement i n t h e p a t t e r n of the

curriculum has been e f fec ted , wi th emphasis g iven t o the s o c i a l and prevent ive

aspects of d e n t i s t r y .

A f u r t h e r teacher i n d e n t i s t r y i s under recrui tment . He i s expected t o take

up assignment i n J u l y 1967.

SEA/FtC20/2 Page 151

Ind ia 0211 Environmental Health: Assistance t o Sta tes*

EDP(TA) ( Jan . 1967 - )

A i m of t h c p r o j i c t . To dcvclop advanced t r a i n i n g programmes f o r senior s a n i t a r i a n s .

Assistance prcvided by WHO during t h e year . A s a n i t a r i a n f o r s i x months.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during thc-YE. A WHO s a n i t a r i a n joined the p r o j e c t i n January 1967. He

urdertook a s tudy of thc curriculum, and is now advis ing on t h e p r a c t i c a l t r a i n i n g

of senior s a n i t a r y inspectors, p a r t i c u l a r l y i n some of thc c e n t r a l l y sponsored

i n s t i t u t i o n s i n t h e country. At tent ion i s given t o the p o t e n t i a l supervisory

funct ions of these o f f i c i a l s .

India 0212 Yaws Eradicat ion Programme

Spec ia l Account (Dec. 1966 - )

f o r Yaws

Programme

A i m of t h e p r o j e c t . To assess the nature and extent of yaws and c a r r y out s y s t e m t i c

con t ro l measures i n the yaws endemic a reas .

Assistancc provided by WHO dur ing the year . A ytws consul tant f o r s i x months.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1967.

Work done during the year . A WHO consul tant took up h i s d u t i e s i n December 1966

and examined the endemic f o c i of Yaws i n the S t a t e s of Madhya Pradesh, Maharashtra,

Andhra Pradesh, Orissn and Madras. H i s f ind ings i n d i c a t e t h a t yaws i s s t i l l t ransmit ted i n i so l3 tcd v i l l a g e s and t h a t t h e con t ro l aCt iVi t ieS of some S t a t e

Governments h3ve bcen p r imar i ly d i r e c t c d t o treatment of the l a t e non-infectious

cases . WHO w i l l provide PAM t o the primary h e a l t h cen t res concerned, through the

S t a t e hea l th s e r v i c e s , f o r mass treatment of the remaining f o c i a s p ? r t l y revealed

i n t h e course of the c o n s u l t a n t ' s f i e l d t r i p s .

India 0218 National I n s t i t u t e of Health Administration R UNICEF

and Education, New Delhi

( s e p t . 1965 - )

A i m of t h e p r o j e c t . To a s s i s t i n t h e teaching of h o s p i t a l and h e a l t h admin i s t ra t ion

and t o promote planning of comprehensive h e a l t h se rv ices i n d i s t r i c t s .

- -

'States not ye t designated

SEA/RC20/2 Page 152

Assistance provided by WHO during the year. A medical o f f i c e r ( s p e c i a l i s t i n

hosp i t a l admin is t ra t ion) .

Probable dura t ion of ass i s tance . Until the end of 1970.

Work done during the year . A two-month s t a f f col lege course f o r senior d i s t r i c t

medical/health o f f i c e r s was held a t the I n s t i t u t e during August/September 1966. The

par t i c ipan ts had an opportunity t o make f i e l d v i s i t s t o hosp i ta l s and t o the WHO Regional Off ice , where a useful discussion was conducted on the subject "The need

t o s t rengthen d i s t r i c t hea l th adminis t ra t ions" . This was t h t t h i r d such course

conducted by the I n s t i t u t e .

A seminar on the ro l e of basic hea l th services and the ro le of basic hea l th

workers was held a t the I n s t i t u t e from 26 t o 29 October 1966 with the p l r t i c i p a t i o n

of the WHO Regional Office.

A f u r t he r a c t i v i t y of the I n s t i t u t e was the conducting of another seminar,

on hosp i ta l adminis t ra t ion. from 3 t o 15 April 1967, again with ass i s tance from WHO

Regional Office s t a f f and the UHO medical o f f ice r assigned t o the I n s t i t u t e . This

seminar was attended by 34 par t i c ipan ts from India and one each from Afghanistan,

Ceylon, Indonesia, Nepal and Thailand, WHO awarding fellowships t o t he par t i c ipan ts

from outs ide India ( see SEAR0 0200). This was the second seminar on t h i s subject

t o be organized by t he I n s t i t u t e - the f i r s t one was held from 11 t o 23 ~ u l y 1966.

India 0221 Seminars and Workshops on Medical Education R (Dcc. 1965 - ~ a y 1966; Jan. 1967 - )

A i m of the p ro j ec t . To a s s i s t with seminars i n special ized f i e l d s organized by the

Indian Academy of Medical Sciences, i n order t o s t rengthen medical teaching i n the country.

Assistance provided by WHO during the year. A temporary adviser , a consul tant , and

ass i s tance from the Regional Advisers inMedical Education,and Maternal and Child Health.

Probable dura t ion of ass i s tance . Until the end of 1970.

Work done during the year . A seminar on nu t r i t i ona l problems of mothers and ch i ld ren

i n developing countr ies , sponsored by the Indian Academy of Medical Sciences, with

assls tancc from WHO, was held a t Hyderabad f r w 16 t o 21 January 1967. There were

s ix teen pa r t i c i pan t s from India , including teachers of paed ia t r ics , obs t e t r i c s ,

preventive and s o c i a l medicine, and biochemistry. The Indian Academy of Medical

Sciences was responsible f o r t h e i r t r a v e l and subsis tence cos t s . I n addi t ion, WHO awarded fellowships t o two Par t ic ipan ts from Ceylon, and one each f run Afghanistan

and Thailand ( s ee pro jec t Afghanistan 0013, Ceylon 0047 and Thailand 0200). WHO a l s o

SEA/RC20/2

Page 153

provided tile fzculty, which consisted of 3 temporary advissr, a consultant and the

Reelanal Advisers in Medic31 Education snd Maternal and Child Health.

The seminar considered the content of nutrition teaching in the undergraduate

curriculum in the light of nutrition research in India. Discussions confirmed a

wide gap between the ascertainment of nutritional rc.search findings, their inclusion in undergraduate medical education, and their application in community maternal and

child health services.

Participants discussrd the organization of suitable nutrition training in

thc medical curriculum and thc methods by which the subject might be taught in association with biochemistry, pnedi3trics, obstetrics and preventive and social

medicine.

The Indian Acadcmy of Medicnl Sciences has planned a further workshop in evaluation methods in medical education to take place in New Delhi in September 1967, with assistance from WHO. Participants to be sponsored by the Academy will be

senior medical educators from India, and WHO will again award fellowships for medical

educators from other countries in the Region for pnrticipstion in the workshop and will again provide a faculty (threc consultants).

The Academy hzs recently introduced a post-graduate examimtion for membership

of the Indian Academy of Medical Sciences. WHO has initiated recruitment of a consultant to assist in organizing objcctive-type cxaminntions for this qualification

on an all-India basis.

India 0222 Drug Iabor?tory Ttchniqucs and

Biological Standardization

(June 1967 - )

Aim of thc project. To assist in quality control of drugs and training of pcrsomel.

Assistance providcd by WHO during the year. A twelve-month fellowship for study in the Unitcd Kingdom and one for eight months for study in Yugoslavia.

Probable duration of assistancc. Until the end of 1967.

Work done during the ye-.r. Plans were made to assign two WHO consultants (3 chemist

speclallzed in quality control of drugs and a laboratory specialist with experience in economics) to help in thc preparation of a preliminary request to the United Nations Development Programme (Special hind) for assistance in developing facilities for quality control of drugs.

SEA/RC20/2 Page 154

India 0223 R

Study of Nursing Services ( o c t . 1964 . )

A i m of the p r o j e c t . To introduce senior nurses t o the l a t e s t developments i n the

a p p l i c a t i o n of c e r t a i n managerial techniques t o nursing adminis t ra t ion, and t o prepare a guide f o r the s tudy of nursing a c t i v i t i e s i n hea l th s e r v i c e s .

Assistance provided by WHO during thc ycar . A nurse consu l t an t , and ass i s t ance from t h e WHO nurse educator a t tached t o p r o j e c t India 0099.6.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1967

Work done during t h e year . The " ~ u i d e t o t h e Study of Nursing A c t i v i t i e s i n Hospi ta ls and Out-patient Departments" was completed, and arrangements were made f o r printing.

Plans f o r t h e conduct of a s tudy of thc work of a u x i l i a r y nurse-midwives assigned t o primary h e a l t h cen t res 2nd sub-centres were a l s o completed. The f i r s t two phases of t h e study i n se lec ted cen t res i n Punjab and Gujarat S t a t e s ended, and the t h i r d phase, t o be conducted i n Gujarat , w i l l f i n l s h dur ing t h e t h i r d

Quarter of 1967.

Considerable time was spcnt i n discuss ions a t the Di rec to ra te General of Health

Services and i n the p a r t i c i p a t i n g S t a t e s i n attempts t o develop a p r a c t i c a l p lan of

a c t i o n and a methodology which w i l l produce sound r e s u l t s . Experience g'elned i n

conducting t h c s tudy, i n s e l e c t i n g and t r a i n i n g observers and i n the handling of

da ta should be of value t o o the rs i n the conduct of s i m i l a r s tud ies .

Ind ia 0228 R

Regis t ry of Pathology

(Nov. 1966 . March 1967)

A i m of tho p r o j e c t . To a s s i s t the Indian Regis t ry of Pathology i n organizing a pe r iphera l cen t re a t Orant Medical College, Bombay.

Assistance provided by WHO during thc year . ( a ) A consul tant i n pathology and a

l abora to ry technician; ( b ) supp l ies and equipment.

Work donc. I n November 1966, a WHO consul tant i n pathology made a prel iminary v i s i t

t o the proposed centre a t Grant Medical Collcge i n Bombay and prepared 3. l i s t of

equipment and supp l ies t o be provided. I n ~ e b r u a r y / k ? r c h 1967, he nnd a WHO laboratory t echn ic ian a s s i s t e d i n organizing the pe r iphera l cen t re a t t h e College.

The cen t re w i l l prepare gross psthology and histopathology teachlng mate r ia l a& d i s t r i b u t e i t t o medical co l l eges i n t h e Region. Nntional s t a f f were t r a ined i n

the necesjary techniques and hnvc s t a r t e d producing specimens a t the r a t e of 300

month. Arrangements were made f o r a system of d i s t r i b u t i o n of the m l t e r i a l by the

SEA/RC20/2

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Regis t ry of Pathology. WHO has provided the equipment needcd t o establish t h e

cen t re and supp l ies f o r one year - s operat ion.

Assistance t o the p ro jec t has becn completed, but an cvnlunt ion w i l l be

poss ible only i n 1968.

Ind ia 0246 Conference of S t a t e Engineers (Rural R WBter Suppl ies)

(27-28 Dee. 1966)

A l m of the p r o j e c t . To gather information regarding t h e s t age of development of UHO/%NICEF-assisted r u r a l water supply p r a j c c t s i n Ind ia ; t o br ing about an exchange

of ideas and a pooling of t h e experience gained, and t o f a c i l i t a t e t h e speeding up

of the programmes.

Assistance provided by WHO during t h c year . Cost of attendance of four teen

p a r t i c i p a n t s .

Work done. A conference sponsored by WHO and attended by chief engineers of t h e

Public Health Engineering Departments of t e n S t a t e s i n Ind ia was held i n the Regional Office on 27 and 28 December 1966. The chief engineers were from those S t a t e s i n

which a programme f o r the development of WHO/tiNICEF-assisted r u r a l water supply p r o j e c t s was e i t h e r i n operation or proposed. The Deputy Director-(ieneral of Health

Services (Publ lc Health Engineer ing) , the Director of the Centra l Health Education Bureau, and the Di rec to r o f the Planning, Research and Action I n s t i t u t e . Luchow,

a l s o pau t i c lpa ted .

The conference provided a useful review of programmes and progress i n t h i s

f i e l d and r e s u l t e d i n a number of p rac t i cab le recommendations f o r improved performance.

INDONESIA

A t Djakarta General Hospital- 5 4 a teaching hospital with

A 1500 beds-student nurses are dressing a child patient (above)

I ' . -.

and feeding a baby (right). i

* &!. a

A t the Sitanala Rehabilitation Centre in Tangerang, West Java, leprosy patients exercise in the yard in front of their ward (above) while others are shown in the physiotherapy room (below).

SEAhC20/2 Page 157

Reorganization of the Ministry of Health was undertaken in September 1966. A Secretary-General was appointed to the Ministry and three directors were placed in char@ of the Departments of Prevention and Eradication of Communi- cable Diseases, Public Health, and Pharmacy respectively. In October 1966, the Government resumed active membership of the United Nations and participation in the United Nations Development Programme. Membership of UNESCO and FA0 was also revived, and UNICEF support to WHO-assisted health programmes was resumed; this has facilitated the progress of technical assistance to health services and education.

In spite of a policy of economic retrenchment and reform instituted by the Government, the inflationary trend in the national economy has not yet been reversed, and the high cost of commodities and services continued to hamper the operation and expansion of health and other social programmes. The Government has decided that for the allocation of the limited resources, the maintenance and consolidation of existing health services should have priority over attempts at further development. The impact of economy imposed by the retrenchment policy was especially reflected in a considerable reduction in the funds available for central health services, but the relatively greater strength of the financial position at provincial and regency levels enabled the widespread decentralized health services to be largely maintained.

Training of all major categories of health staff continued, but there were difficulties due to scarcity of teachers and lack of equipment. The annual output of doctors from medical colleges is estimated to have reached over five hundred, but there is an undue concentration of health staff in towns and cities. Nine government medical colleges a re in operation, and these are reinforced by a few private medical colleges. There are also nearly a hundred schools for professional nurses and midwives and over a hundred for auxiliary nursing personnel. Considera- tion has been given to securing uniformity of nursing education programmes in Sumatra.

No major epidemic of communicable diseases was recorded. Limited out- breaks of malaria and smallpox were successfully contained. The malaria eradica- tion programme, although handicapped by shortage of supplies and transport, has been maintained. At the central level, the direction of malaria eradication operations and that of the prevention of other communicable diseases have been combined under a single head.

Increasing emphasis has been placed on BCG vaccination as the major means of tuberculosis control. n e r e has been further progress towards the integration of BCG vaccination into the general health services.

Some progress was achieved towards the goal of national self-sufficiency in the production of vaccines. Freeze-dried smallpox vaccine mandactured in the Bio Farrna Institute, Bandung, is of a standard acceptable to WHO. A considerable increase in the output of this vaccine is planned.

SEA/RC20/2 Page 158

PROJECT U S T

Projcct No. Source of Funds

Co-operating

Agencies

Indonesia 0009

R UNICEF

T i t l e -

Leprosy Control

( J u l y - Scpt.1955; Sep t . 1956 - )

ALm of the p r o j e c t . To develop a leprosy con t ro l programme, wi th in the framework

of the general h e a l t h s e r v i c e s , i n a l l the endemic a reas of the country, and t o t r a i n

personnel.

Assistance provided by WHO during t h e year . A l e p r o l o g i s t .

Probable dura t lon of a s s i s t a n c e . Unt i l t h e end of 1967.

Work done dur ing the y e a r . During the per iod under r e p o r t , a more comprehensive

review of the p r o j e c t was undertaken. The t o t a l repor ted caseload had increased

t o about 53 000. However, t h e r a t i o between lepromatous and non-lepromatous cases

indicated t h a t a considerable number of non-lepromatous p a t i e n t s had evaded de tec t ion .

Further s t rengthening of con t ro l a c t i v i t i e s r equ i res a programme of ln - se rv ice

t r a i n i n g of leprosy workers and po lyc l in ic nurses i n t h e diagnosis and treatment

of leprosy.

Indonesia 0032 R

Malaria Eradicat ion

(May 1955 - )

A i m of the p r o j e c t . To e r a d i c a t e malar ia i n s t ages

Assistance provided by WHO during t h e year . ( a ) Two mala r lo log i s t s and one t r a n s l a t o r -

t y p i s t ; (b) Seven fe l lowships - two f o r f i v e weeks f o r s tudy i n the Phi l ippines and

Ind ia , one f o r th ree weeks f o r study i n India and Ceylon, two f o r t h r e e weeks i n

the Ph i l ipp ines , and two f o r about two months each f o r study i n the Phi l ippines:

( c ) supply of a n t i - m a l a r i a l drugs and a t r a n s p o r t veh ic le .

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1974.

Work done during t h e year . The programme, which remained confined t o t h e c e n t m l

group of i s l ands (Java. B a l l , Nadura and t h e southern t i p of South Sumatra), suffered from f i n a n c i a l and admin i s t ra t ive d l f f i o u l t i e s a s i n previous years .

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Spraying operations were carried out in epidemiologically "dangerous" areas, while surveillance was continued throughout the central group of islands. The epidemiological

situation in those areas where spraying had been withdrawn remained satisfactory,

and no major outbreaks of malaria were rcportcd. Malaria trnnsmission continued at

a low level along the south coast of West and East Java and part of Ball.

A reorganization of the Ministry of Health, which was effected during the year, led to the malaria eradication pragrme's becoming the responsibility of

the Directorate of Control 2nd Eradication of Communicable Diseases.

Indonesia W 0 R

UNICEF

Vaccine and Sera Production

(April 1959; June 1960; Peb. - March 1963; Sept. - Dec. 1963; Dec. 1964; Aug. 1965;

June 1966; Oct. 1966)

A i m of the project. To improve mcthods of production of vaccines, antitoxin and toxoids . Assistance provided by WHO during the year. (a) A three-and-a-half-month fellowship for study in Denmark and the Netherlands and a six-month fellowship for study in Yugoslavia; (b 1 supplies and equipment.

Work done during the year. WHO provided the Bio Parma Institute, Bandung, with equipment and chemicals, to increase and improve its production of DPT vaccine.

Additional equipment has been requested from UNICEF. W O also provided some

spare parts and chemicals to help the Institute in the production of freeze-dried

smallpox vaccine.

The feasibility of increasing production of freeze-dried smallpox vaccine to meet national needs was studied, and suitable equipment was recommended. A

WHO consultant is being recruited to advise on a phased programme for

procurement andlnstallation of this equipment. The vaccines produced at the Institute were sent to the State Serum Institute, Copenhagen, for independent testing. The "room-dried" vaccine has been found satisfactory as regards potency and stability, but its bacterial content was higher than the WHO standard. The

freeze-dried vaccine was satisfactory as regards bacterial content, but its potency was slightly below the WHO standard.

The activities will be continued under a new project, "Virus Diseases" (Indonesia 0083 ) .

Indonesia 0041

R Nursing Education

(Oct. 1957 - July 1959; Nov. 1960 - June 1967) Aim of the project. To upgrade and expand trainlng programmes for nurses and midwives.

SEA/RC20/2 Page 160

Assistance provided by (JXO during the year . A nurse educator .

Work done during t h e year . The work of the p r o j e c t was concentrated on the Academy

of Nursing, Djakar ta . A r egu la r schedule of a s s i s t a n c e t o the o l l n i c a l i n s t r u c t o r s

was maintained by the WHO nurse educator .

A number of nurs ing and midwifery schools were v i s i t e d t o a s s e s s t h e i r

programmes and needs. Based on t h i s assessment, a r e v i s i o n of the Curriculum f o r bas ic nursing schools was s t a r t e d .

The two-year post -basic programme i n Bandung f o r the p repara t ion of nurse

t eachers , midwife t eachers , and pub l ic h e a l t h nurses w i l l now lead t o a bachelor ' s

degree f o r those who complete t h e course.

The Ministry of Health has made plans t o provide i n var ious p a r t s of the csun t ry , s h o r t courses , f o r nurses i n charge of h e a l t h cen t res and po lyc l in ics

The a c t i v i t i e s w i l l be continued under a new p r o f e c t "Nursing Education and

Services" (Indonesia 00841.

I n d o n e s i . --- R

UNICEF

Tuberculosis Control

( J u l y 1961 - )

A i m of the prodect. To i n t e g r a t e d i r e c t BCG vacc ina t ion i n t o t h e widespread network

of maternal and c h i l d h e a l t h c l i n i c s and regency po lyc l in ics ; t o t r a i n s t a f f i n techniques of d i r e c t BCG vaccinat ion, and t o expand and i n t e g r a t e tubercu los i s

oase-finding by microsCopic sputum examination and ambulatory treatment of cases .

Assistance provided by WHO during t h e year . ( a ) A s t a t i s t i c i a n ; ( b ) two fe l lowships - of four months and t h r e e weeks each f o r s tudy i n Czechoslovakia and Ind ia and one

fellowship of one month f o r study i n Ind ia ; ( c ) supp l ies an3 equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1968, i n the f i r s t ins tance.

Work done during the y e a r . As i n Indonesia t h e r e i s a l ready a wel l developed network

of cen t res and p o l y c l i n i c s f o r maternal and ch i ld hea l th se rv ices , i n t e g r a t i o n

of BCG vaccinat ion i n t o these se rv ices i s t h e method of choice i n tubercu los i s

c o n t r o l , because by t h i s methad t h e most suscep t ib le c h i l d populat ion can be reached. A plan of a c t i o n was prepared, desc r ib ing the s t e p s necessary f o r t h e t r a i n i n g of

h e a l t h s t a f f of maternal and c h i l d h e a l t h c e n t r e s and p o l y c l i n i c s . Members of the former BCG teams w i l l be used t o give p r a c t i c a l t r a i n i n g .

SEA/RCZO/Z Page 161

Initiation of the proposed programme of integrated BCO vaccination was delayed far administrative reasons.

The WHO statistician completed her assignment in August 1966.

Indonesia 0060 Assistance to Laboratory Services R (June 1967; - )

A-t. To strengthen health laboratory services.

Assistance urovided by WHO duriw the year. (a) A twelve.month fellowship for study in Australia; (b) supplies and equipment.

Probable duration of assistance. Until 1969

Indonesia 0062 w e a l Education R (May 1364 - 1

Aim of the project. To assist selected departments of various faculties of medicine.

Assistance Drovided by WHO during the year. (a) A professor of physiology, a professor of pharmacology and a professor of histology and embryology; (b) a three-week fellowship for study in Denmark; (c) supplies, equipment and a transport vehicle.

Probable duration of assistance. Until the end of 1970.

Work done durina the year. The WHO professor of physiology continued his work at Oadjah W d a University. JogJakarta.

The'lecture syllabus for the new academic year (started in January 1967) was revised, and practical courses were reorganized so that groups of ten students could perform the same experiment simultaneously. New experiments and demonstrations were introduced with the aid of equipment supplied by WHO. The new laboratory premises for the Department of Physiology were completed. and the electro-physiological equipment supplied by WHO was put into full use. Post-graduate training was thus intensified through experimental work on a high scientific level.

Physicists from the Faculty of Science and physiology teachers from other medical faculties in the country participated as guests in seminars promoted by the WHO professor. He visited four other medical faculties, two in Java and two in Sulawesi, to discuss the teaching prograwnes with the local faculties and to give lectures and demonstrations on modern aspects of medical education.

SEA/RCZO/Z Page 162

The experimental phase of the research project which he started was

concluded, and the material for the study has been processed. The opportunity

was utilized to acquaint the staff of the department with methods of evaluating

experimental data. The material is being compiled for publication.

A WHO professor of pharmacology was assigned to the University in October 1966. He helped to reorganize the teaching Programme in pharmacology and stressed

the necessity to introduce laboratory work into the undergraduate course. He

assisted with seminars for the teaching staff in order to provide post-graduate

training and to prepare junior staff for their teaching duties.

Teaching of pharmacology is seriously hampered by inadequate accomnodation and staffing of the Department. The attention of the university authorities has

been drawn to this problem, and a new building has been allocated for the joint

use of the Departments of Physiology and of Pharmacology. Constructional work on the adaptation of the building for this purpose was under way.

A WHO professor of histology and embryology was assigned to the University in May 1967.

Indonesia 0065 R

School of Physiotherapy, Solo

(March 1963 - )

Aim of the project. To improve and expand the training of physical therapists and to develop physical medicine and rehabilitation services.

Assistance provided by WHO during the year. (a) A physiotherapy tutor from project Thailand 0073; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1967.

Work done during the year. The WHO physiotherapy tutor assigned to a project in

Thailand visited the project twice (from 19 October to 21 November 1966 and from 18 March to 23 April 1967) and assisted the national staff in the examination of students. He also conducted a brief course In physiotherapy teaohing methods and

discussed future plans with the national authorities.

The last group of fourteen assistant physiotherapist students completed

their training in December 1966. All of them were successful; thirteen are in general hospitals, and one works in a military hospital.

A newly recruited group of 30 students started training in January 1967.

SEA/RCZO/Z Page 163

Indonesia 0069 R

School f o r Training of Technicians i n Electro-medical Techniques

(March 1966 -

Aim of the p r o j e c t . To e s t a b l i s h a school f o r the t r a i n i n g of technicians i n the

maintenance and r e p a i r of X-ray and e lect ro-medical equipment.

Assistance provided by WHO during the year . ( a ) A s p e c i a l i s t i n electro-medical

techniques; ( b ) suppl ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done dur ing the year . The School, which i s i n the Oeneral Hospi ta l i n Djakarta.

continued t o t r a i n t echn ic ians , although the re were d i f f i c u l t i e s stemming from lack

of teaching l i t e r a t u r e and t echn ica l equipment. Some equipment supplied by WHO was

received and s to red i n t h e Ministry of Public Health pending the establishment of s u i t a b l e workshop premises. Tneorct ical t r a i n i n g of s tuden t s was s a t i s f a c t o r y .

The WHO s p e c i a l i s t i n e lect ro-medical techniques v i s i t e d h o s p i t a l s in Makasar, Ambon and Menando f o r th ree weeks during April-May 1967 t o a s s i s t i n the r e p a i r of

X-ray equipment.

Arrangements were i n i t i a t e d f o r a WHO p h y s i c i s t t o v i s i t Jog jakar ta , t o advise on (1) the planning of an elrctro-mcchanical workshop i n the School of

Medicine, ( 2 ) a s u i t a b l e t r a i n l n g programme f o r technicians t o be t r a ined l o c a l l y

o r abroad and ( 3 ) the need f o r equipment and o the r teaching mate r ia l .

Indonesia 0074 R

Education and Training of Public Health S ta f f

(June 1967; - )

A i m of the p r o j e c t . To t r a i n s t a f f , e s p e c i a l l y para-medical personnel, f o r the

pub l ic h e a l t h se rv iccs . Assistance provided by WHO during the year . A twelve-month fellowship f o r s tudy i n

t h e Netherlands and i n Ind ia .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1%9.

Indonesia 0082

UNDP(TA)

UNICEF

Paed ia t r i c Education and Services (Apr i l 1967 - )

A i m of t h e p r o j e c t . To cxpand. r e a r i e n t and improve the promotional, preventive

and c u r a t i v c c h i l d care content of the teaching given t o madical and nursing s tudents i n p a e d i a t r i c departments of medical schools .

SEA/RC20/2 page 164

Assistance provided by WHO during the year. A paed ia t r ic ian .

Probable durat ion of ass i s tance . Until the end of 1970.

Work done during the year . A WHO paed ia t r ic ian was assigned t o the Bandung Medical Faculty in May 1967. He has made a study of the ex i s t i ng services and current p rac t ice of paed ia t r ic education and has a s s i s t ed i n planning des i rab le changes,

more pa r t i cu l a r l y i n developing su i t ab l e f i e l d p rac t ice a r ea s , I n col laborat ion with the Departments of Obstetr ics and Preventive and Social Medicine. It was planned t ha t he would l a t e r make a study of paed ia t r ic se rv ices and education i n a l l the major paed ia t r ic departments of the country and advise on measures f o r Improvement.

A WHO paed ia t r ic nurse educator i s under recruitment

Under p ro jec t Indonesia 0200, a twelvemonth fellowship was awarded t o a

senior paed ia t r ic ian t o a t t end the London-Bombay paed ia t r ic teachers course from

January 1967.

Indonesia CQOO

R Fellowships

Epidemiology. A nine-month fellowship f o r study i n Czechoslovakia and India.

Anaesthesiolog~. A twelve-month course f o r study I n Denmark.

Pacdlatr ics . A twelve-month course i n the United Kingdom and India .

Public Health Administration. Three ten-month fellowships f o r study i n the Netherlands. - Blood Ti-ansfusion. A six-month fellowship f o r study i n Hungary.

San i ta ry Engineer iT . A twelve-month fellowship f o r study i n the Unitcd S t a t e s of America.

MALDIVE ISLAI

As part of the anti-malaria programme of Male Island, entomologists examine a well for mosquito larvae.

I F -

A malaria parasite survey is one of the public health activities being carried out among the islanders.

In preparation for DDT spraying, spraymen and field supervisors are >IIUWII

here a t an insecticide-mixing site on Male Island.

*

Administration of treatment in the health centre in Male, which provides for smallpox, DPT and typhoid vaccination and for the routine care of tuberculosis and leprosy patients.

SEA/RC20/2 Page 165

6 . RIALDIVE ISLANDS

Anti-malaria spraying was started during the year in Male Atoll after a period of preliminary surveys and of basic training of health assistants, domici- liary workers (for malaria mute) and spraymen. The first round of house spraying with DDT in the Atoll was completed and mass radical treatment was undertaken concurrently.

Trained nurse-aides underwent further training in elementary public health nursing in preparation for home visiting for maternal and child health work. In Male, a new hospital has now been built and equipped.

Investigations into an epidemic of typhoid fever in Addu Atoll, were carried out and were followed by a successful mass anti-typhoid vaccination programme. Primary vaccination and re-vaccination against smallpox were undertaken in the government schools in Male, and the immunization programme against diphtheria, whooping cough and tetanus was continued.

In 1966, a UNDP Mission undertook a general survey af the social and economic conditions of the Maldive Islands and their potential for development. In the economic sectors, attention was focussed on fisheries (by far the largest source of income); mechanization of existing craft and improvement of catching methods were recommended. In agriculture, more studies on soil and ground water a s well as on crops best suited for these areas were suggested. Means of improving transport and inter-atoll communication were considered, and problems of land reclamation and conservation and public administration were studied.

In the social sector, a review was made of educational requirements, housing, health and water supply. In health, WHO is already assisting in the development of basic health services and in the training of personnel, as mentioned elsewhere.

SEA/RC2 0/2 Page 166

PROJECT LIST

Pro jec t No.

Source of Funds

Co-operating

Agencies T i t l e -

Maldive Is lands 0005 Public Health Administration

R (Oct. 1959 - )

A i m of the p r o j e c t . To develop comprehensive basic h e a l t h se rv ices and t o t r a i n

personnel , including male and female h e a l t h a u x i l i a r i e s ; t o c a r r y ou t ante-malaria a c t i v i t i e s i n t h e i s l and of Male.

Assistance provided by WHO dur ing t h e year . ( a ) A public h e a l t h o f f i c e r , a public

h e a l t h nurse , a s a n i t a r i a n , a l abora to ry t echn ic ian , a n e n t o m l o g i s t and a consul tant

on water s u p p l i e s ; (b ) suppl ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1971.

Work done dur ing t h e year . Por t h e first time i n t h e h i s t o r y of t h e Maldive I s l ands ,

DDT spraying a s an ant i -malar ia measure was s tar t 'ed on 28 ~ u g u s t 1966 on f i v e , i s l ands of Male Ato l l . Six spraymen were r e c r u i t e d and t r a i n e d , and, wi th ass i s t ance from

t h e WHO s a n i t a r i a n and t h e entomologist , t h e h e a l t h a e s i s t a n t s supervised t h e spraying

operat ions . Entomological surveys c a r r i e d out a f t e r the f i r s t round could not d e t e c t

the known vectors of malar ia , A. subpictus and A. t e s s e l a t u s i n the a reas sprayed.

Training courses f o r nurse-aides and "foolumahs" (indigenous midwives) were

continued, but i t was found d i f f i c u l t t o r e c r u i t t r a i n e e s f o r the t h i r d nurse-aides '

course planned. Six q u a l i f i e d nurse-aides were given t r a i n i n g i n elementary public

h e a l t h nursing.

A c h i l d r e n ' s c l i n i c was opened a t the Government Hospital i n Hale. The clinic funct ions twice a week, and ch i ld ren up t o the age of f i v e years a r e given h e a l t h c a r e , which includes n u t r i t i o n a l c a r e , i m n i z a t i o n and treatment f o r worm i n f e s t a t i o n .

pollowing the repor t of the WHO microbiologis t who inves t iga ted an epidemic of typhoid i n Addu Atol l i n 1966, a successful mass i m n i z a t i o n campaign aga ins t typhoid was ca r r i ed out i n t h i s a t o l l as well a s i n Male Atol l .

A UNDP Mission v i s i t e d the Maldives during the year and c a r r i e d out a preliminary survey of t h e p reva i l ing socio-economic condi t ions and p o t e n t i a l f o r development. The

WHO p ro jec t s t a f f co-operated with the Mission.

A consul tant on water supp l ies was assigned t o the p ro jec t towards t h e end of May 1967 t o s tudy t h e l o c a l cond i t ions , p a r t i c u l a r l y i n respect of water supply, and

t o make recommendations f o r the provis ion of dr inking water f o r the i s l and of Male.

SEA/RCZO/Z Page 167

W d i v e Islands 0201 UNDP(TA)

Fellowships

m. A twelve-month fe l lowship f o r study i n India.

MONGOLIA

A regular check-up of children as part of the social paediatr~c services in Ulan Bator.

A doctor and nurse making domiciliary visits in the Gobi Desert.

Laboratory services in Ulan Bator and in the aimaks participate i national survey for brucellosis in man and animals.

n the

3EA/'R@20/2 Page 169

The year 1966 was the first year of the Mongolian Government 's new Five- Year Plan for socio-economic development in which the health services are receiving considerable attention. The expenditure on health services amcunted to approximately 10% of the total budget. All medical care, including treatment in hospitals and preventive services, is free of charge. Expenditure on institutions is high, but emphasis is being increasingly placed on preventive measures and health education for the general public and also for special groups of the population, such as factory workers, co-operative farm workers and mothers and children. In 1966, the number of doctors and of para-medical and auxiliary staff was respec- tively 14.5 and 54 per 10 000 population.

The birth rate continued to rise, and there was a steady decline in the death rate. The annual birth rate is estimated to be 40, and the death rate 9.7, giving a rate of natural increase of 3 per cent.

Further progress was made in the development of the administration of health services in Ulan Bator and in the aimaks (provinces), particularly through the training of health personnel and gradual integration of certain specialized health programmes into the general health services. Extensive programmes of orientation and training of general health service personnel were undertaken.

WIHO's programme of assistance has consisted of four projects: in epidemiology, the strengthening of public health laboratories, tuberculosis control and community water supply.

Epidemiological activities were directed principally towards problems of brucellosis in man and animals, including controlled Brucella vaccine field trials. Early in 1967 a systematic country-wide immunization programme against diphtheria, whooping cough and tetanus was started, as was a survey of the existing microbiological, public health and clinical laboratories, a s well as laboratories for production of vaccines and diagnostic reagents, in order to bring about a better use and co-ordination of laboratory facilities.

The Government has initiated a plan of action to introduce preventive services and ambulatory treatment for tuberculosis control a s part of the general health services. A successful start was made in systematic BCG vaccination.

The question of evolving a practicable and economical water supply scheme to provide piped water in the aimak towns and rural areas remained a difficult and complex problem because of the severe climatic conditions in the country.

In October 1966, an FAO/UlWEF survey was carried out to study the possibilities of establishing a milk conservancy project, which would provide about 1 000 tons of milk powder a year and thus meet the requirements of children who were receiving their milk through milk kitchens, cr8ches and kindergartens, and of the needy school children.

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In July 1966, the country suffered from heavy floods in and around Ulan Bator. The Government took measures to strengthen health services to deal with similar emergency situations in future. A team from the United Nations Department of Economic and Social Affairs, specially from the Water Resources Section, and from the Special Fund sector of the United Nations Development hograrnrne visited Ulan Bator in December 1966 to advise on prevention of future floods in Ulan Bator.

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PROJECT LIST

Project No.

Source of Funds Co-operatin&

ngencies T i t l e -

Mongolia 0001 Strengthening of Health Services (Bpidemiologyl

R (July 1963 - )

A i m of t h e p ro jec t . To undertake epidemiological surveys of p reva i l ing c o m n i c a b l e d i seases i n o rder t o p lan p r a c t i c a l con t ro l measures; t o advise a l l branches of t h e

medical and h e a l t h se rv ices on the use of epidemiological methods, and t o t r a i n

personnel.

Assistance provided by WHO dur1n.q the year . ( a ) An epidemiologis t , a ve te r ina ry

public h e a l t h o f f i c e r and a mic rob io log i s t ; ( b ) a nine-month fe l lowship f o r study i n Czechoslovakia and Ind ia and a twelve-nwnth fe l lowship f o r s tudy i n t h e USSR: ( c ) s u p p l i e s , equipment and two t ranspor t veh ic les .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1967.

Work done d u r i w the year. A multi-purpose se ro log ica l survey aiming a t t h e e s t a b l i s h -

ment of immunological age-specif ic p r o f i l e s f o r a number o f d i seases i n t h e human populat ion, a s a b a s i s f o r f u r t h e r planning of Public h e a l t h m a s u r e s , was completed.

Human s e r a were s e n t i n l i q u i d ni t rogen con ta ine rs , accompanied by ind iv idua l record

c a r d s , t o the WHO Serum Reference Ban!.f i n Prague. The comparative Brucel la vaccine

f i e l d t r i a l of two vaccines was completed, and the r e s u l t s a r e under evaluat ion. A

l a r g e Brucel la vaccine t r i a l i n small ruminants was s t a r t e d i n mid-1967.

The WHO epidemiological team a s s i s t e d i n combating an outbreak of d iph ther ia and i n t h e i n v e s t i g a t i o n of an epidemic of a v i r u s i n f e c t i o n . The team a l s o helped i n t h e

planning and t r a i n i n g of h e a l t h s t a f f f o r a nation-wide DPT vaccinat ion campaign,

s t a r t e d e a r l y i n 1967 and planned t o be completed dur ing the year. The maintenance of t h i s programme by vaccinat ion of newborns w i l l be continued by t h e na t iona l

a u t h o r i t i e s .

A second seminar on the epidemiology, epizootology and bacter iology of brucel- l o s i s , o r i g i n a l l y planned f o r 1966. was postponed and w i l l nnw be held i n October 1967.

The WHO team a s s i s t e d wi th a l a r g e number of seminars f o r h e a l t h s t a f f and with a seminar on ve te r ina ry medicine.

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Mongolia 0002 Public Health Laboratory Services

UNDP(TA) (May - Aug. 1964; Dec. 1964; Aug. 1965; Q c t . 1966 - ) UNICEF

A i m of the Pro jec t . To develop h e a l t h l abora to ry s e r v i c e s and t o t r a i n personnel i n hea l th l abora to ry work.

Assistance provided by WHO dur inn t h e year . ( a ) A microbiologis t ; ( b ) a six-month

fe l lowship f o r study i n Czechoslovakia; ( c ) a small supply of reagents .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970,in t h e f i r s t ins tance.

Work done d u r i m the year. The WHO microbiologis t s t a r t e d work i n October 1966 and s tudied the work being done by the l a b o r a t o r i e s i n Ulan Bator. While c l i n i c a l l abora to ry work i s f a i r l y well developed. bac te r io logy lagged behind.

Plans have been made t o reorganize t h e c e n t r a l l a b o r a t o r y s e r v i c e s , t o co- o rd ina te t h e work of t h e var ious e x i s t i n g l a b o r a t o r i e s and t o s t reng then bacter io-

l o g i c a l work. e s p e c i a l l y i n the diagnosis of communicable d i seases . Equipment f o r t h i s purpose i s under procurement by UNICEF. Additional equipment w i l l be needed

when t h e l abora to ry s e r v i c e s a re extended t o t h e aimaks.

Mongolia 0003 Tuberculosis Control

UNDP(TA) (Dec. 1963 - Jan. 1964; ~ u g . 1965 - ) UNICEF

A i m of the p r o j e c t . To s tudy the epidemiology of tubercu los i s and t o organize a na t iona l tubercu los i s con t ro l p r o g r a m .

Assistance provided by WHO durinu t h e year . ( a ) A medical o f f i c e r and a ~ c ~ / p u b l i c hea l th nurse; ( b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1970.

Work done dur ing the year. Systematic t r a i n i n g i n BCG vaccinat ion was given t o s t a f f from d i spensar ies of Ulan Ba tor , from t h e army and ra i lway h e a l t h se rv ices and from provincia l tubercu los i s d i s p e n s a r i e s , i n preparat ion f o r a n expanded vaccinat ion

programme. BCO vaccinat ion of newborns was introduced i n Ulan Bator (where about 9~7%

of t h e b i r t h s t a k e place i n materni ty homes) and a l so i n t h e materni ty homes of some aimaks.

Epidemiological d a t a c o l l e c t e d through tubercu l in t e s t i n g from d i f f e r e n t p a r t s of the Country by t h e na t iona l BCG team showed t h a t i n f e c t i o n with tubercu los i s i n the age group 0-8 years had occurred i n only about 6 per cent i n Ulan Ba tor , but the

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incidence increased t o 28 pe r cent i n the age group 9-18 years and reached 70 per cent i n t h e age group 19-29 years. Consequently.it was proposed t o launch a mass d i r e c t BCQ vaccinat ion campaign i n t h e c a p i t a l amongst ch i ld ren from 1 t o 8 years of age.

Systematic BCG vaccinat ion of t h e school population i n Ulan Bator was s t a r t e d a f t e r tubercu l in t e s t i n g , and p a t i e n t s with indurat ion diameters of 11 mm and more were

considered t o be " infected" and not i n need of BCa.

In t h e l i g h t of t h e prel iminary d a t a showing l e s s tuberculous i n f e c t i o n i n r u r a l a reas than i n the c a p i t a l , a comprehensive phased pmgramme was s t a r t e d f o r

vaccinat ing, before t h e end of 1968,the e n t i r e population of t h e country up t o

1 0 years of age; when t h i s has been completed, vaccinat ion w i l l be given only t o

newborns, school e n t r a n t s and school l e a v e r s . UNICBF support has been requested.

In ulan Bator , examinations t o determine the d i f f e r e n t i a l d iagnosis between

tubercu los i s of bones/joints and b r u c e l l o s i s of bones/joints were s t a r t e d . Ambulatory treatment o rgan iza t ion and symptom-motivated case-f inding i n Ulan Bator were under

considerat ion.

The Government has decided t o p a r t i c i p a t e i n a co-operative th iacetazone s ide -

e f f e c t s tudy being organized by the B r i t i s h Medical Research Council, and a l l necessary p repara t ions , such a s t r a n s l a t i o n of forms i n t o the Mongolian language,

and assignment and b r ie f ing of the responsible s t a f f , have been completed.

m n g o l i a 0004 Maternal and Child Health Services

UMOP[TA) (June - Sept. 1965; Nov. 1966; - ) UNICBP

J i m of the p r o j e c t . To develop maternal and c h i l d h e a l t h se rv ices and t o e s t a b l i s h

r e f e r r a l f a c i l i t i e s .

Assis tance Dmvided by WHO durinn t h e Year. Wo six-month fe l lowships - one f o r study i n the USSR and Bulgaria and one f o r s tudy i n the L5SR and Czechos1ovaMa.a twelve-month

fe l lowship f o r s tudy i n the USSR and a seven-and-a-half-month fe l lowship f o r s tudy i n India and the USSR.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1970.

Work done dur ina the year . The d r a f t plan of operat ion f o r t h i s p ro jec t was rev i sed , and emphasis was placed i n i t i a l l y on the f u r t h e r improvement of t h e Maternal and Child Health Division of the Ministry of Public Health, the s t rengthening of t h e p a e d i a t r i c ,

o b s t e t r i c and maternal and c h i l d h e a l t h se rv ices and the i n s t i t u t i o n of s a t i s f a c t o r y h e a l t h s tandards i n day-care se rv ices f o r young ch i ld ren i n the c a p i t a l . Strengthening of these se rv ices a t a i m k and o the r per ipheral l e v e l s was planned a s a phased

development p r o g r a m over a period of th ree years .

SEA/RC20/2 Page 174

Review of re levant s t a f f t r a i n i n g p r o g r a m s was i n progress.

WHO i s r e c r u i t i n g a maternal and c h i l d h e a l t h o f f i c e r f o r the p r o j e c t .

Monuolia 0005 E n v i r o m n t a l Health (Conurmnity Water Supplyl

UNDP(TA) [June 1966 - ) UNICEF

A i m of t h e p ro jec t . To develop water supp l ies and excre ta d i sposa l systems i n

provincia l towns and r u r a l a reas .

Assistance provided by WHO during the year . (a) A s a n i t a r y engineer ; ( b ) suppl ies

and equipment.

probable dura t ion of a ss i s t ance . Unt i l t h e end of 1970.

Work done durim? t h e year . WHO ass i s t ance t o t h i s p ro jec t s t a r t e d i n June 1966, with

t h e assignment of a s a n i t a r y engineer. Before t ak ing up h i s work i n Ulan Ba tor , he

v i s i t e d Zagreb ( I g o s l a v i a ) and the WHO-assisted rural h e a l t h p r o j e c t i n Afghanistan

t o s tudy t h e a c t i v i t i e s being c a r r i e d out i n t h e f i e l d of environmental s a n i t a t i o n ,

p a r t i c u l a r l y r u r a l water supp l ies .

TWO areas were se lec ted f o r the development of water s u p p l i e s , and a s t a r t

was made i n t h e c o l l e c t i o n of d a t a on s o i l and c l i m a t i c condi t ions . The s a n i t a r y

engineer is studying t h e p o s s i b i l i t i e s of us ing p l a s t i c pipes and o t h e r mater ia ls

f o r water supply under t h e severe weather condi t ions i n t h e country.

m n g o l i a 0008 Rursillg Services and Education R (Dec. 1966 - )

A i m of the DmJect . To develop a bas ic school of nurs ing; t o s t rengthen e x i s t i n g

t r a i n i n g programmes f o r nursing personnel, and t o improve nursing se rv ices .

Assistance provided by WHO dur ing t h e year . A consul tant i n nurs ing education f o r two weeks.

Probable dura t ion of a ss i s t ance . Unt i l t h e e M of 1972.

Work done dur ina t h e year . A WHO consul tant i n nursing education s tudied t h e nursing education programes and nurs ing se rv ices and made recommendations f o r t h e development

of a bas ic nursing school which would meet i n t e r n a t i o n a l s tandards . A WHO nurse educator w i l l be assigned t o t h i s p ro jec t l a t e r i n the year .

mwolia 0200 Pellowships

R

Public Health Administration. A seven-and-a-half-month fellowship for study in M i a

P?~~siolo~. A six-month fellowship for study in India and the U.S.S.R.

~m. A six-month course in the U.S.S.R.

Pharmacoloa. A tuelve-month course in the U.S.S.R.

Public Health Administration. A six-month fellowship for study in the U.S.S.R. llnd Czechoslovakia.

Adnrinistration of Medical Services. Three nlne-month fellowships for study in the U.S.S.R. and Czechoslovakia.

Anaesthesiologx. An eight-month fellowship for study in the U.S.S.R. and Czechoslovakia.

Cardiovascular Diseases and Gastro-enterolo~~. A six-month fellowship for study in the U.S.S.R.

NEPAL

A demonstration kitchen a t the Gokarna health post.

BCG vaccination of newborns i s part of the daily routine at the Bir Hospital in Kathmandu.

class in attendance the Auxiliary Health orkers' School.

The Chief of the National Malaria Eradication Organization indicates the areas and sub-areas of the programme.

In the malaria campaign, spraymen of Un i t Office No. 5 in Bhakular, near Bharatpur, are ahout t o complete their first spraying cycle in 1967.

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8. NEPAL

During the year important amendments to the Constitution were announced. Zonal panchayats were abolished, and the zonal chief executive officer will now be assisted by a zonal committee.

National budget estimates for the fiscal year (July 1966 - July 1987) envisaged an expenditure of Rs. 546 million - an increase of 19% over the previous year. The health budget for the year amamted to 4.6% of the national budget. Expenditure on communicable diseases, in particular the malaria eradication campaign, continued to account for about 56% of the health budget.

There was some reorganization in the Directorate of Health Services, with division of major responsibility between the Director, Deputy Director and six Assistant Directors. Some changes in the five-year plan for health have been considered. Three zonal health offices have been established in Biratnagar, Birganj and Nepalganj, and two more are planned for early 1968 at Butwal and Jaleswar.

The main problems confronting the Directorate in its efforts to provide basic health services continued to be recruitment and retention of auxiliary health workers and assistant nurse-midwives in the health services. Provision d adequate accommodation for these health workers posted in rural areas away from towns wss considered. Official figures of medically qualified and other health workers in government employment at the end of 1966 were: 182 doctors, 46 staff nurses, 29 assistant nurse-midwives and 59 auxiliary health workers. There were 143 medical undergraduates studying abroad. Some concern was felt at the failure of many doctors to return to Nepal after qualifying abroad. Negotiations for the establishment of a medical college in Kathmandu were continued bilaterally.

The School for Auxiliary Health Workers now has ample accommodation in its new building, with scope for further extension. The School of Nursing, despite shortage of tutorial staff, continued its good work. The training of nurses in Kathmandu progressed well as did that of assistant nurse-midwives in the schools in Kathmandu and Biratnagar; a new school for auxiliary nurse-midwives in Nepalganj was planned.

Further progress was made in the consolidation of the Maternal and Child Health Department of the Health Directorate. Attendances at maternal and child health sessions in the eight centres in Kathmandu Valley have increased.

A public health laboratory has been constructed in Kathmandu and is being equipped.

There was no change in the pattern of spray operations of the malaria eradication programme. In the programme, emphasis was placed on the training of a large number of personnel of different categories with a view to strengthening field activities and supervision. Survaillance operatbns - cnntinud in nentral and east zones.

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Systematic vaccination and revaccination against smallpox were intensified in and around Kathmandu Valley. Smallpox outbreaks were reported in the western (Bardia and Baitadi), central (Mahotari), and eastern (Skaha) parts of the country and on the Mia-Nepal border (Jhapa).

Direct BCG vaccination was continued on a methodical basis in Kathmaudu Valley; newborns were routinely vaccinated in the maternal and child health centres and in tbe maternity wards of Bir Hospital and the Women's Hospital.

In the programme of work of the Department d Irrigation and Water Supply, community water supply wae given the same importance as irrigation. A draft request to UNDP(SF) for assistance in the planning of water supply in Patan and Bhadgaon and sewerage in Kathmandu is being prepared.

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PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title -

Nepal 0001 Malaria Eradication R (June 1954 - )

( USAID

Aim of the project. To eradicate malaria in stages.

Assistance provided by WHO during the year. (a) Three malarlologlsts, an entomologist, an epidemiologist, a sanitary engineer. three sanitarians, a laboratory technician, an administrative officer, two administrative assistants, a transport assistant and a secretary-stenographer: (b) supplies, equipment and four transport vehicles.

Probable duration of assistance. Until the end of 1973.

Work done during the year. Geographical reconnaissance, spraying and surveillance Were continued. However, restriction in budgetary pnovdsion curtailed planned expansion of the programme.

The organizational structure of the programme was revised and supervisory tiers were increased to improve supervision and strengthen field activities. Tne frequency of house visits in hyperendemic areas was stepped up to twice a month. Mopping-up

teams have been formed and have operated successfully. A large training programme was undertaken, and 499 staff members of categories ranging from malaria inspectors to senior superintendents were trained.

Early in 1967 a USAID team reviewed the programme and its requirements.

One more sanitarian is expected to join the project shortly.

Nepal 0002 UNDP(TA)

Nursing Education and Services (Nov. 1954 - )

Aim of the project. To establish a Division of Nursing in the Directorate of Health Services to co-ordinate nursing activities in the country; to set up a basic nursing school to prepare qualified nurse-midwives for health services: to develop courses for the preparation of auxiliary nurse-midwives; to upgrade nursing services in Blr Hospital, and to improve the clinical field for student nurses.

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Assis tance provided by WHO dur ing the year . ( a ) A nurs ing adv i se r and a nursing education adminis t ra tor ; ( b ) a twelve-month fellowship f o r s tudy i n Lebanon; ( c ) a t r anspor t veh ic le .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1974.

Work done dur ing the year . A Nursing Sec t ion has been es tab l i shed in the Di rec to ra te of Health Services , and i t s func t ions have bcen determined. A s t a r t has been made i n c o l l e c t i n g da ta on nurses and a u x i l i a r y nurse-midwives i n government se rv ice .

The programmc of t h e School of Nursing has been handicapped t h i s year by dep le t ion of s t a f f i n both t h e School and t h e Bl r Hospi ta l nursing se rv ices . It is expoc ted tha t the s i t u a t i o n w i l l improve when f a c u l t y and nursing se rv ice personnel r e t u r n from t h e i r s t u d i e s abroad.

The curriculum of t h e a u x i l i a r y nurse-midwives' course has been revised and nar covers a per iod of e ighteen months. Courses have been s t a r t e d and a r e proceeding wel l i n Bharatpur and Bi ra tnagar , and plans a r e under way f o r e s t a b l i s h i n g add i t iona l courses elsewhere.

The Trained Nurses' Association of Nepal has revised i t s o o n s t i t u t i o n , which i s now i n l i n e wi th the requirements of the I n t e r n a t i o n a l Council of Nurses.

Nepal 0003 UNDP ( TA )

U2PICE.F

Strengthening of Health Services (June 1955 - Jan . 1962; Dec. 1962 - )

A i m of t h e p r o j e c t . To develop e f f e c t i v e l y d i r e c t e d and supervised h e a l t h se rv ices i n which cura t ive and preventive s e r v i c e s a r e in tegra ted a t a l l l e v e l s , and which a r e ab le t o provide adequate t e c h n i c a l guidance t o f i e l d a c t i v i t i e s and s t a f f and a l s o i n t h e t r a i n i n g o f h e a l t h s t a f f required t o man t h e bas ic h e a l t h se rv ices .

Assistance provided by WHO during the year . ( a ) Two pub l ic h e a l t h o f f i c e r s ; ( b ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1970.

Work done d u r i w the yaar . A s i g n i f i c a n t development was t h e appointment of t h e Deputy Director of Health a s na t iona l counterpar t t o t h e WHO pub l ic h e a l t h o f f i c e r . A second pub l ic hea l th o f f i c e r provided by WHO joined t h e p r o j e c t i n March 1967.

The new bu i ld ing f o r t h e Auxi l iary Heal th Workers' School was formally opened; a h o s t e l t o accommodate the t r a i n e e s was provided, and s t e p s were t&en t o ob ta in UNICEF a s s i s t a n c e in equipping t h e h o s t e l . St ipends f o r t h e t r a i n e e s were increased.

SEA/RCZO/~ Page 181

The Services of a US Peace Corps volunteer were secured for teaching English to the trainees. There are 100 first-year and 83 second-year students following the course.

The WHO staff, the national maternal and child health staff and the national nurse tutor continued to participate in training programmes for auxiliary health workers. The Cokarna health post was developed as a centre for integrated field

training of auxiliary health workers.

The plan of operation of the project calls for the development of health services on a zonal basis. Accordingly, a draft plan of action for 1967 for the development of basic health services in Kosi Zone was drawn up.

Nepal OOC8 R

UNICEF

Maternal and Child Health Services and Training (Dec. 1963 - )

Aim of the project. To develop maternal and child health services and to establish referral facilities.

Assistance providcd by WHO during the year. (a) A maternal and child health officer and a public health nurse; ( b ) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. The Maternal and Child Health Unit of the Health Directorate was reorganized and expanded to provide for an integrated maternal and child health and family planning programme. Activities of the maternal and child health units were progressively integrated into the general health services in Kathmandu Valley, at Bharatpur (Rapti Valley) and in Kosl, Narayana and Bheri Zones. Plans were finalized to extend the project to Janarnur and Lambini Zones. hro maternity homes and more nutrition demonstration kitchens were constructed in the vicinity of maternal and child health clinics in Kathmandu Valley. Close collaboration was maintained with the projects "Strengthening of Health Services" (Nepal 0003 I , "Nursing Education and Services" (Nepal 00021, "Smallpox Eradication and Control of Other Communicable Diseases" (Nepal 0009) and "Tuberculosis and Leprosy Control" (Nepal 0016 ) .

A promising feature of the programme was a rapid increase of paediatric attendance in contrast with less satisfactory progress in the registration of ante- natal cases. BCC and smallpox vaccinations were undertaken as routine functions of the maternal and child health staff. Measures for enhancing the smallpox vaccination programme were adopted. A revised system of records. registration and periodical reports was introduced with the help of the WHO-assisted project "Vital and Health Statistics" (Nepal 0017).

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The WHO public health nurse assisted in the establishment of a nurse- midwifery school at Biratnagar, preparations for an assistant nurse-midwifery school at Nepalganj and staff training programmes, including orientation training of lady medical officera and public health nurses and also in-servloe training programmes for assistant nurse-midwives and woman auxiliaries. The Chief of the Maternal and Child Health and Family Planning Unit. her deputy and

five lady medical officers attended family planning courses l n Korea and India.

Uapal 0009 R UNICEF

Smallpox Eradication and Control of Other Communicable Diaeases (Feb. 1962 - Dec. 1965; Aup. 1966 - )

Aim of the project. To start a smallpox control pilot project in Kathmandu Valley with a view to establishing an eradioatlon programme, and to develop the oonm!unlcable- disease control unit.

Assistance provided'by WHO during the year. (a) A public health officer; (b) two three-month fellowships for study in India; (c) supplies, equipment and four transport vehicles.

Probable duration of assistance. Indefinite.

Work done during the year. Vaccination programmes were continued by the national

staff: 36 000 primary and 221 000 revaccinations were performed,mostly in Kathmandu valley.

A WHO public health officer joined the projeot towards the end of August 1966.

A Headquarters consultant and, later, one under the inter-country project SEAR0 0136 visited the country, reviewed the project and made reconmendations for its extension and for starting a smallpox eradication programme in 1967.

A plan of operation was prepared, and activities in accordance with this plan were started in Bagmati and Kosi Zones. A number of government-employed vaccinators

and supervisors were recruited, and panchayat vaccinators from the area under operation were also employed. A recording system and methods Of supervlslon of the

work and results have been prepared and are being tested in the field.

Nepal 0010

WDP( TA) UNICEP

Health Iaboratory Services

(Hay 1967 - 1

Aim of the project. To develop health laboratory services in order to improve

diagnostic services and to support an epidemiological unit.

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Assistance provided by WHO during the year . ( a ) A l abora to ry t echn ic ian f o r six

months; ( b ) a one-month fellowship f o r s tudy i n Ind ia and Afghanistan.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during the year . A WHO laboratory t echn ic ian was assigned t o Nepal i n

May 1967, and i s a s s i s t i n g i n s e t t i n g up the new laboratory premises under construc- t i o n . She has put t h e equipment i n working order and has now s t a r t e d t o organize l abora to ry diagnosis f o r cho le ra .

Nepal 0013 R

Leprosy Control

(March 1967 - )

Aim of t h e p r o j e c t . To develop con t ro l se rv ices f o r leprosy i n Kathmandu Valley and

t o t r a i n h e a l t h personnel.

Assistance provided by WHO dur ing the year . A consul tant l e p r o l o g i s t f o r th ree weeks.

Probable dura t ion of a s s i s t ance . Unt i l the end of 1970.

Work done during the year . A WHO consul tant l e p r o l o g i s t reviewed t h e leprosy con t ro l p a r t of the previously combined p ro jec t "Tuberculosis and Leprosy ~ o n t r o l " ( s e e

Nepal 0016) and advised on a f u t u r e p a t t e r n f o r leprosy con t ro l .

Fur ther WHO ass i s t ance i s planned.

Nepal 0014 R UNICEF

Community Water Supply: (June 1964 - )

A i m of the p r o j e c t . To plan and co-ordinate t h e development of community water supp l ies .

Assistance provided by WHO dur ing t h e year . ( a ) A s a n i t a r y engineer; (b) suppl ies

and equipment.

Probable dura t ion of a s s i s t a n s . Unt i l the end of 1970.

Work done during the year . The request t o the UNDP(SF) f o r a ss i s t ance i n the plann-

ing of water supp l ies f o r Pa t t an and Bhadgaon, and sewerage f o r Kathmandu, whlch was

prepared e a r l i e r wi th t h e a s s i s t a n c e of a team of WHO consu l t an t s , has not y e t been submitted t o the Specia l Fund by the Government.

SEA/RC20/2 Page 184

The WHO sanitary engineer assisted In the survey and investigation which were carried out in order to determine the possibility of using the Pharping water source for the Ialitpur water supply.

A scheme for a WHO/tNICEF-assisted rural water supply project was prepared, with the assistance of the WHO sanitary engineer, and 1mICEF has started to prooure equipment and materials for the project.

The WHO sanitary engineer left the project in June 1967. and a replacement is under recruitment.

w a l 0016 R UNICEF

Tuberculosis Control* (March 1965 - 1

Aim of the project. To develop a tuberculosis control programme as part of the developing basic health services, starting with Kathmandu Valley, and to give requisite training to health personnel.

Assistance provided by WHO during the year. (a 1 A medical officer, a leprosy control officer and a BC(i/public health nurse; (b] four fellowships - three for three months and one for two weeks - for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1970.

Work done during the year. The programme of systematic direct BCQ VaCcinatiOn, successively covering the 0-14 year age-group in Kathmandu Valley, made good

progress. In some areas, the estimated coverage reached the 80 per cent level. In S a M u District, BCO vaccination was given along with smallpox immunization. on a house-to-house basis, but the numbers covered were limited.

BCG vaccination was given to newborns in all maternity hospitals In the Valley, including the maternity wards of Bir Hospital and the Wotnen's Hospital. The newborns and infants in four maternal and child health centres were also vaccinated, and auxiliary nurse-midwivcs were appropriately trained. The school vaccination teams started on their third round, giving BCG to all newly admitted students; BCG vaccination was more readily accepted by school-children and the teachers. Vaccination of older college students and army recruits was carried out after tuberculin testing, using 10 mm diameter induration or more as criterion for vaccination.

The Kathmandu Tuberculosis Centre's previous exclusively clinical approach

to diagnosis and treatment of tuberculosis was somewhatmodifled,towards one which

*Previous titlr. Tuberculoct- -nE Leprosy control

SEA/RCZO/Z Page 185

is more coamrunity-oriented. Greater emphasis was l a i d on microscopical examlnation of sputum from Symptomatic pa t i en t s and ambulatory treatment of the newly detected cases.

It was decided t ha t the leprosy component of the pro jec t should be separated from the tuberculosis con t ro l programme. Accordingly, a new pro jec t f o r leprosy control was i n i t i a t e d (see Nepal 0013 ).

The WHO medical o f f i c e r and the leprosy control o f f i c e r connpleted t h e i r asslgnments i n January and April 1967 respect ively. The public hea l th nurse continued t o a s s i s t with the Bca vaccination programno.

Nepal 0017 mnrP(TA)

Vi ta l and Health S t a t i s t i c s (NOV. 1965 - Peb. 1966; March 1 % ~ : - I

A i m of t he p ro j ec t . To arrange f o r the e f f i c i e n t co l lec t ion , processing alvl presentat ion of hosp i ta l s t a t i s t i c s ; t o organize hosp i t a l record departments. and t o t r a i n personnel.

Assistance provided by WHO during t he year . ( a ) A s t a t i s t i c i a n ; ( b ) suppl ies and equipment.

Probable durat ion of ass i s tance . Until the end of 1967.

Work done during the year. A WHO s t a t i s t i c i a n v i s i t e d Nepal i n March 1967 t o review project a c t i v i t i e s . His report has been sen t t o the Oovernment.

The o f f i c e r i n charge of the hosp i t a l s t a t i s t i c s programme went abroad f o r t ra in ing i n hea l th s t a t i s t i c s .

A nat ional index of hosp i ta l s was i n i t i a t e d . and a repor t containing diagnostic s t a t i s t i c s an3 adminis t ra t ive da ta f o r hosp i t a l s i n X a t b n d u Valley, f o r the year 1965-1966, was prepared.

The Medical Record Department of Bir Hospital continued t o operate on the l i n e s proposed by the pro jec t .

Nepal 0319 Health Education R (May 1967 - 1

Aim of the p ro j ec t . To plan hea l th education i n the basic hea l th services and special ized pro jec t s and t o strengthen fur ther the functioning of the ex i s t i ng hea l th education se rv ices .

SEA/RC2 0/2 Page 186

Assistance provided by WXO during the year . A consultant i n hea l t h education f o r t h r ee months.

Probable durat ion of ass i s tance . Until 1969.

Work done during the year. A WHO consultant i n hea l th education was assigned t o the pro jec t I n May 1967. She has made a study of the ex i s t i ng hca l th education services and t h e i r functioning i n the general hea l t h services and spec ia l p ro jec t s and of the a c t i v i t i e s of hea l th educators working with other programmes, such as teacher- t ra in ing . She a l s o helped i n the preparat ion of mater ia ls f o r teaching and t ra in ing and for the guidance of hea l th workers i n t h e i r day-to-day a c t i v i t i e s . Assistance was glven t o the na t iona l working groups f o r the proposed lnter-country Workshop on the Methodology of Planning, Implementation and Evaluation of Health Education (SEAR0 01301 i n t e s t i ng out procedures f o r planning.

Nepal 0200

R

Fellowships

Epidemiology. A nine-month fellowship f o r study i n Czechoslovakia and ind ia ,

Health Education. A four-month fellowship f o r study i n India .

Nepal 0201 Fellowships m e ( T A )

Operation and Management of Water Supplz. Three slx-month fellowships f o r study i n India .

THAILAND

Children being examined as part of a malaria survey near Chiengmai, North Thailand.

Elementary school pupils in North-East Thailand lunching at a demonstration school, where meals are prepared by the

/ children under the teacher's i guidance.

As part of the mental health services, A child is undergoing an intelligence test under the supervision of the director of the child guidance clinic.

SEA/RC20/2 Page 187

9. THAILAND

Thailand continued to enjoy relative financial stability. It was reported that growth of national output has risen from 5 per cent per annum some ten years ago to 6.5 per cent. Population growth is estimated at over 3 per cent annually, while the annual national income has been rising by about 7 per cent. However, the price trend of consumer goods showed a marked rise.

The Second National Economic and Social Development Plan 4967-1971) was started in October 19%: the addition of the word "social" to the title of the plan indicates its wider scope. Enphasis has been placed on social development, manpower development planning and accelerated development of rural areas.

Over 40 per cent of the budget d the Kinistry of Health for 1967 (excluding the expenditure on malaria eradication) is allocated to preventive and promo- tional services a s against some 30 per cent devoted to curative services. It is envisaged that the proportion of the resources available for preventive and promotional services will progressively show a slight r ise in future years.

Scarcity of medical and para-medical staff, particularly for service outside the capital, persisted. A modest increase in the health staff in relation to popula- tion growth between 1967 and 1 9 n has been planned.

Completely reliable statistical data on the incidence of communicable diseases are not yet available for the whole country. However, a number of useful epidemiological studies of tropical diseases have been undertaken, and efforts are being made to develop supporting laboratory and statistical services.

Practically the whole country is now covered by the malaria eradication programme, and there is a declining trend in the incidence of the disease. Some expansion of the national tuberculosis control programme has also been achieved, but some more time will be required to secure the integration of tuberculosis control into the general health services and to attain wider coverage.

Sporadic cases of cholera were reported from several provinces, but extensive spread of infection was prevented. The largest reported outbreak comprised 64 cases. No cases of smallpox have been notified since 19G3, but the routine vaccination programme fell far short of covering the estimated number of newborns, and the immunological state of the population is vulnerable to the introduction of the disease. In keeping with the pattern of two-yearly cyclical peals, the wer-all incidence of haemorrhagic fever in 1966 was relatively high; the disease was reported from five further provinces in which it had not previously been noted. However, the incidence in BaiigkoldThonburi was below that of 1964, and throughout the country the case fatality rate declined. An epidemiological study of poliomyelitis, assisted by a WH3 consultant, indicated that the disease constitutes a public health problem which can best be met by a carefully admin- istered programme of immunization of children against all communicable diseases for which effective immunizing agents are available.

SEA/RC20/2 Page 188

A gradual increase in the network of rural health uaits was maintained. An accelerated rural development programme, including health services, has been undertalcen in a few provinces.

The Division of Sanitary Engineering of the Department of Health has been reorganized, and its functions expanded. Four technical sections of the Division deal, respectively, with water supply and pollution control, environmental ssnita- tion, architectural design and construction, and research and analysis. A national phased programme designed to supply safe water to 50 000 villages was started.

In the three medical schools of Thailand there is an i n c r e a s e tendency to project teaching into a rural environment. There was a substantial increase in the numbers of students admitted to the medical schools, not, however, accompanied by a proportionate enlargement of teaching faculties. Progress was made in the organization of the new Ramatibodi School of Medicine, which is being assisted by the Rockefeller Fwdation. A new nursing school will be incorporated in the teaching hospital of the Ramatibodi School.

sEA/Rc20/2 Page 189

PROJECT LIST

Title -

Thailand 00U2 -2

UNDP( TA ) UNICEF

Strengthening of Health Services (Inte~ration of S~ecialized Programmes 1 (Jan. 1964 - )

Aim of the Project. To promote the integration of specialized communlcable-disease control programmes into the general health services and the further development and organization of rural health services.

Assistance Orovided by WHO durin~ the year. A public health officer and a public health nurse, and assistance from the laboratory technician (provided under project Thalland 0042) and the statistician (provided under project SEAR0 0050).

Probable duration of assistance. Until the end of 1970.

Work done during the year. The project continued to make satisfactory progress in three districts of Pitsanuloke Province, and it was planned to extend it to cover the other four districts of this province. The national and WHO project staff made an analysis of the activities carried out during the fiscal year 1965-1966 in Wat Bot District, the first district taken up for strengthening the health services.

The Provincial Health Officer, Pitsanuloke, was awarded a one-month WHO fellowship to observe rural health projects in India (see Thailand 0200).

A senior nurse-midwife was seconded to Pitsanuloke Province for three months for experience in supervisory duties. After completing this training she was appointed as an assistant to the provincial public health nurse supervisor. A supervisory guide was prepared for the use of the public health nurse in Wat Bot District.

The health educator appointed to the Pitsanuloke Provincial Health Office assisted in training programmes for tambol health workers.

A WHO statistician visited the project and assisted in the development of suitable records and returns for rural health services. These were under trial in the field.

It was planned to assist in assessing the project's activltiea and objectives in order to work out a methodology and future plan of work and lay down guidelines for drawing up annual plans of action.

SEA/RC20/2 Page 190

Six more provincial laboratories were upgraded and have started working. The laboratory at Lampang was moved to a new building, and some more laboratories will be shifted to new premises as soon as the buildings are completed. Laboratory trainees from the School for Laboratory Technicians in the Department of Medical Sciences, Bangkok, are attending practical classes in rotation in the Central Venereal Diseases laboratory, Bangkok. The WHO laboratory technician visited most of the provincial and tuberculosis laboratories and advised on the organization and management of the services; defective equipment was repaired and put into operation. Arrangements have been made in Mahasarakam for the collection of horse serum for preparation of media. A few batches bf the serum have already been prepared.

Thailand 0017.2 R

Mental Health Education and Services (June 1963; Dec. 1963 - Feb. 1964; Jan. 1965 - )

Aim of the orodect. To strengthen the basic nursing curriculum in respect to psychiatric nursing; to develop a post-basic programme in psychiatric nursing; to improve the mental health services.

Asslstance Drovided by WHO durlna the year. An adviser in psychiatric nursing.

Probable duration of assistance. Until September 1969.

Work done during the year. Progress was made in planning for the introduction of a psychiatric nursing component into the post-basic programme at Chulalongkorn University. All students taking this course will have experience in psychiatric nursing whether they specialize in this field or not. Those specializing in psychiatric nursing will have further advanced work. This part of the programme will start in October 1967.

The six-month programme of guided learning experience was continued at Somdet Chao Phraya Hospital for nurses working in psychiatric units of other hospitals or teaching in schools of nursing. So far 17 nurses have gained this experience. The results have been good. The in-service education programme for nursing personnel of the Hospital was continued.

Basic nursing schools were further assisted in developing the psychiatric nursing content and experience in the curriculum.

Psychiatric nurses participated in the annual meeting of the Division of Mental Hospitals held in February 1967. The needs in psychiatric nursing services and how these were being met as well as the educational programmes developed were presented and discussed.

Thailand 0021 UNDP(TA)

Nursing Advisory Services (April 1954 - Dec. 1957; Jan. 1958 - )

Aim of the orolect. To assist the Division of Nursing in the Ministry of Public Health in co-ordinating nursing activities and nursing education; to develop basio nursing education, and to establish a college of nursing to enable nurses to Qualify for a national degree.

SEA/RC2 0/2 Page 191

Assistance provided by WHO during the year. A nurse educator.

Probable duration of assistance. Until the end of 1968.

Work done durin~ the year. The WHO nurse educator helped in the initial development of the Southern School of Nursing opened in Songkhla in May 1966. Particular attention was given to the clinical practice area for students in Songkhla Hospital. Notable improvement was made. There has been a great deal of concern, however, about the comparatively small number of patients in that hospital in proportion to the students. Therefore, affiliation of the students with the nearby Haad Yai Hospital has been arranged, and plans have been made for the improvement of nursing services in that hospital.

A two-year post-basic programme for nurses, leading to a B.Ed. degree, n s started at Chulalongkorn University in June 1967. This programme provides for the preparation of nursing teachers and administrators in one of three areas; (1) medical- surgical nursing, (2) mother and child care and ( 3 ) psychiatric nursing. The WHO nurse educator was transferred from Songkhla to Bangkok on 1 July 1967 to help in developing the clinical experience part of the medical-surgical nursing course for post-basic students. The WHO adviser in psychiatric nursing (working with project Thailand 0017.2) also assisted the Nursing Division in planning and preparing for the total programe.

Thailand 0030 R UNICEF

Leprosy Control

(Oct. 1955 - )

Aim of the Drodect. To expand and intensify the leprosy control programme to cover all endemic areas and to train persomel.

Assistance provided by WHO during the year. (a) A senior consultant leprologist, a leprologist and two leprosy control officers; ( b ) a five-and-a-half-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1969.

Work done duriw the year. There has recently been a reduction in the number of cases detected by the control activities, but it is not yet clear whether this reduction is real or due to inadequacy of case-detection methods. The bacteriological control of lepromatous cases was further developed using the newly introduced record cards. Intensive reviews of the case registers of the project areas in the north-east revealed some misdiagnosis by leprosy auxiliary workers and rather poor treatment regularity. It is now planned to make a re-survey of the population investigated by WHO Leprosy Advisory Team in 1962. This will make it possible not only to evaluate the efficacy of control in discovering new cases among school-children but also to determine the over-all efficacy of case-detection.

S E A ~ C ~ O / ~ Page 192

Increased facilities for training leprosy auxiliary workers were arranged early in 1967, and it Is hoped that improved training standards will result in a higher level of performance. In-service training of supervisory staff was continued in the Korat area. The infrastructure of leprosy control in the north-eastern provinces requires further strengthening before the project can embark on a wider expansion to the central and southern provinces, where leprosy endemicity is fairly low.

Thailand 0038.2 School of Public Health, Bawkok*

R (Dec. 1966 - )

Aim of the DroJect. To plan nutrition training courses and to develop the maternal and child health component of the various courses of studies in the school.

Assistance Drovided by WHO during the year. A consultant in nutrition, and a consultant in paediatrics.

Probable duration of assistance. Until the end of 1967.

Work done duriw the year. In order to provide adequate training in nutrition to the staff of the community health services, the Government of Thailand has introduced a one-year degree course in nutrition at the Faculty of Public Health of the University of Medical Sciences. WHO provided a consultant for two months to advise on the nature and content of the course.

Various aspects of the training course, particularly field practice, were reviewed, and suggestions were made for effecting adjustments.

In June 1967, a consultant in maternal and child health was assigned to the School of Public Health for a period of three months. A study of relevant curricula and teaching methods is in progress.

Thailand 00112 UWDP(TA)

Tuberculosis Control (Oct. 1958 - May 1959; Dec. 1959 - )

UNICEF

Aim of the Droject. To develop an integrated national tuberculosis control programme based on the experience gainea in urban and rural pilot projects and to train health personnel in WHO-recommended tuberculosis control techniques.

Assistance urovided by WHO duriw the year. (a) A medical officer, a statistician and a laboratory technician; (b) five three-month fellowships for study in India.

*The first stage of this project ended in March 1962 under project number Thailand 0038.

SEA/RC~O/Z Page 193

Probable duration of assistance. Until the end of 1968.

Work done durin~ the year. Progress was made in integrating tuberculosis control

into the existing and developing basic health services. Integration of direct BCQ

vaccination was given prior attention. In-service training of the health staff

of provincial headquarters; including yaws inspectors, made progress in some provinces and reached about 95% of the targets set.

Integrated tuberculosis case-finding and ambulatory treatment have been introduced in 29 provinces, but supervision and output of work need to be improved. The rate of case-finding by microsco~ical sputum exarrlnation of symptomatic patients attending health centres was about 19 per cent. Of the cases detected, 86 per cent have started treatment.

While bacteriologically positive cases were detected through existing health services without additional cost, the regional tuberculosis centres and mobile X-ray units took a total of 271 173 X-ray pictures in 1966, with a diagnosis of 20 565 tuberculosis suspects. from whom 5 310 cases, i.e.,only 1.9 per cent of the number initially examined, were confirmed by culture examination. In the regional tuberculosis centre at Yala, where there are no culture facilities, patients with symptoms of tuberculosis (approximately 18 per cent of the total number examined) .were bacteriologically examined by sputum smear only, and more than 68 per cent were found to be excreting tubercle bacilli.

Regularity of treatment was secured in about 90 per cent of the cases during the first quarter of treatment; after six months, regularity of treatment decreased to 70 per cent, and was only 50 per cent at the end of one year. In Bangkok, mobile treatment units obtained a higher degree of regularity than at the Central Chest Clinic, confirming the desirability of bringing health services close to the patients' homes. In rural areas it is thus desirable to establish as many health centres as possible to provide community health services that can reach the periphery. The logistic and operational aspects of comprehensive rural health services are being tested, in close co-operation with project Thailand 0002.2 "Strengthening of Health Services (Integration of Specialized ~rogrammes)".

Thailand 0052 Faculty of Tropical Medicine* R (Aug. - Sept. 1959; June - Aug. 1961; June 1962 :

June - July 1963: Jan. - May 1964; June - Dec.1964; Jan. 1967; - )

Aim of the prolect. To strengthen the Post-graduate School of Tropical Medicine of the University of Medical Sciences, Bangkok.

Assistance provided by WHO during the year. A six-month fellowship for study in the United' Kingdom.

Probable duration of essistance. Until the end of 1969

*Previous title: Faculty of Tropical Medicine and Endemic Diseases.

SEA/RC20/2 Page 194

Work done during the year. Action was initiated to recruit a WHO consultant for the PaCulty's newly established Division of Tropical Nutrition.

Thailand 0052 UNDP(TA)

Strengthening of Health Services (E~idemiology) (Oct. 1966; Dec. 1966 - )

Aim of the ~roject. To establish an epidemiological unit in the Department of Health for defining prevailing disease patterns and planning control measures.

Assistance Provided by WHO during the year. (a) Two short-term consultants; (b) two nine-month fellowships for study in Czechoslovakia and India.

Probable duration of assistance. Until the end of 1970.

Work done durina the year. A WHO consultant was assigned to this project in December 1966. He reviewed the system of notifying, recording and reporting comunicable diseases and prepared a proposal for an improved system. He also trained a team, consisting of an epidemiologist, a microbiologist, a clinician and four technicians, in epidemiological field investigations and the control of epidemics.

A model immunization programme, based on the general health services, was prepared. It includes immunization against smallpox and other communicable diseases, including diphtheria, pertussis, tetanus and poliomyelitis.

Another WHO consultant visited Thailand in February/Plarch 1967 to study the problem of poliomyelitis and advise on control measures. He reconunended a general strengthening of childhood immunization programmes rather than mass campaigns against polio.

Thailand 0065 Malaria Eradication R (Jan. 1962 - ) ( USAID)

pim of the ~roject. To eradicate malaria from the entire country.

Assistance Provided by WHO durinR the year. (a) A malariologist, an entomologist, a sanitary engineer, five sanitarians and a translator-typist; (b) two seven-week fellowships for study in the Philippines and China; (c) supplies, equipment and two transport vehicles.

Probable duration of assistance. Until the end of 1972.

Work done durina the year. Field operations, including geographical reconnaissance, spraying and surveillance, carried out under strengthened supervision,have shorn improvement, resulting in a lower malaria incidence. The attack phase was extended to two addltional provinces, thereby increasing the population coverage in this phase

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to 22.9 million as against 22.0 million the previous year. Surveillance activities were also extended to cover a population of 14.6 million, compared with 12 million in 1965.

Large movements of population in developing areas in the fringe of heavy forested areas have created problems. In Packhong, a new settlement, it was necessary to carry out a third cycle of spraying and also to increase mopping-up operations in order to cope with problems of persistent malaria transmission.

The resistance of P.falcivarum to chloroquine, which is widespread in the country, has not, so far, caused any major difficulty in the progress of the programme.

Thailand 0061 Radiation Protection Services R (April - May 1963; Feb. - March 1965;

Nov. - Dec .I965 ; Dec. 1966 - Peb. 1967; - )

Aim of the oroject. To develop radiation protection measures and to establish a Division of Radiation Health Protection in the Ministry of Public Health; to organize a radiation protection course.

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

Probable duration of assistance. Until the end of 1969.

Work done during the year. In pursuance of the pattern of assistance established, a further WHO consultant visited Bangkok from December 1966 to February 1967 to assist the national authorities in the development of the Radiation Protection Division, and in particular to help in the consolidation and expansinn of radiation protection services.

Thailand 0070 Vector-Borne Disease Control R 1 Haemorrhaaic PeverL

(June 1963; June 1964; March - Kay 1965; June 1967)

Aim of the orodect. To study the epidemiological factors responsible for the persistence of haemorrhagic fever, and particularly the bionomics of the vectors, in order to take effective control measures.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United States of America.

Thailand 0071 School for Radiological Technology. Bangkok UM)P( TA) (Jan. 1965 - )

Aim of the project. To train radiographers.

SEA/RC20/2 Page 196

Assistance ~ r o v i d e d by WHO dur ing the year. A radiography tu to r .

Probable dura t ion of a ss i s t ance . V n t i l the end of 1968.

Work done dur ing the Year. The f i r s t (diploma) year of t h e two-year degree course i n X-ray technology was completed, and examinations were held i n February 1967. A l l t h e e leven s tuden t s were successful i n both the w r i t t e n and t h e p r a c t i c a l t e s t ; they obtained good marks and were granted a Diploma i n X-ray Technology.

The sy l l abus f o r t h e f i r s t year of the course was revised on t h e b a s i s of experience gained dur ing the School 's f i r s t year of operat ion. A s e r i e s of s l i d e s f o r teaching purposes was prepared f o r use i n the second year.

Arrangements were made t o procure a vehicle f o r the p r o j e c t t o f a c i l i t a t e t r anspor t .

A WHO fe l lowship f o r s tudy i n the United Kingdom was awarded (under ThaiLand 0201) t o the Assis tant Professor of Radiology, S i r i r a j Hospital Mediaal School.

Thailand 0073 P h y s i o t h e r a ~ y Tra in ing UNDP(TA 1 (Dec. 1965 - ) UNICEF

A i m of the Droject. To develop the t r a i n i n g of phys io the rap i s t s f o r t h e expansion of orthopaedic and r e h a b i l i t a t l o n se rv ices .

Assis tance provlded by WHO d u r i n ~ t h e year. ( a ) A physiotherapy t u t o r ; ( b ) supp l ies and equipment.

Probable d u r a t i o n of a ss i s t ance . Unt i l the end of 1968.

Work done during the year. The two-year course f o r s e n i o r s tuden t s i n physical therapy, which s t a r t e d i n May 1965, ended i n March 1967, and f i n a l examinations were held. Gut of seventeen s tuden t s , twelve were success fu l , and t h e remaining f i v e were r e f e r r e d f o r f u r t h e r t r a i n i n g f o r per iods of one t o s i x months before re-examination.

The r e s u l t s of the examinations r e f l e c t e d the s t u d e n t s ' general performance. The standard of p r a c t i c a l work was not so high a s would be d e s i r a b l e , but a n opportuni ty t o improve w i l l be provided by a proposed in te rnsh ip . After graduat ion a l l the newly q u a l i f i e d phys io the rap i s t s w i l l be required t o work f o r two months a t S i r i r a J Hospi ta l , t o consol idate t h e i r knowledge and p r a c t i c a l s k i l l before being appointed t o permanent duty s t a t i o n s .

Annual examinations were a l s o held f o r seven junior s tudents . S i x continued i n t o the second year and one wlthdrew from the course.

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A t en -sea te r microbus was supplied by UNICEF f o r the use of s tuden t s and t u t o r s . Textbooks and teaching a i d s a r e being used by t u t o r s and s tuden t s of both grades.

Thailand 0076 Health Education R (Dec. 1966)

A i m of the p ro jec t . To develop a course i n h e a l t h education a t the School of Public Health, Bangkok.

Assistance provided by WHO d u r i w the year. A consul tant i n h e a l t h education f o r cne month.

Work done. A WHO consul tant was assigned t o Thailand i n December 1966. She worked c l o s e l y wi th the h e a l t h education s t a f f a t t h e Facul ty of Eublic Health i n f u r t h e r developing the degree course i n h e a l t h education. I n p a r t i c u l a r , a s s i s t a n c e was provided i n improving teaching methods f o r hea l th education s tuden t s dest ined t o work i n schools and i n planning f o r t h e i r f i e l d t r a i n i n g . The manual f o r f i e l d t r a i n i n g developed by the Facul ty was r e v i s e d , and a s e c t i o n on f i e l d t r a i n i n g f o r school h e a l t h education s tudents was prepared and added. I n a l l , 73 s tudents were enro l l ed i n the one-year and two-year programmes, both leading t o the Bachelor 's Degree i n Health Education.

The repor t submitted by the consul tant was forwarded t o the Qovernment.

Thailand 0081 Water Po l lu t ion R (Dec. 1966 - Jan. 1967; - )

A i m of the p ro jec t . To provide t echn ica l advice on o rgan iza t iona l and o the r mat ters r e l a t e d t o the prevention and con t ro l of water po l lu t ion .

Assistance provided by WHO during the Year. A consul tant f o r one month.

Probable dura t ion of a ss i s t ance . Unt i l 1969.

Work done durinu the year. A WHO consul tant was assigned t o Thailand a t the end of December 1966. He advised the Oovernment on s u i t a b l e measures f o r water-control. including l e g i s l a t i o n . Fur ther a ss i s t ance t o the p ro jec t is being planned on the b a s i s of h i s recommendations.

Thailand 0082 Venereal-Disease Control R (Peb. 1967 - )

Aim of t h e p ro jec t . To organize a programme f o r the con t ro l of venereal d iseases .

Assistance provided by WHO durinu the year. A consul tant .

SEA/RC20/2 Page 198

Probable dura t ion of a ss i s t ance . Unt i l 1968.

Work done during t h e Year. I n February 1967,a WHO consul tant ( a s p e c i a l i s t i n c l i n i c a l

aspects and con t ro l methodology of venereal d i seases ) was assigned f o r s i x months t o Thailand. The Government was a c t i v e i n expanding the con t ro l a c t i v i t i e s , p r imar i ly by developing p rov inc ia l s e r o l o g i c a l l a b o r a t o r i e s , which now t o t a l 36. The consul tant a s s i s t e d the con t ro l a c t i v i t i e s by t r a i n i n g s t a f f i n a c t i v e case- f ind ing and p a r t i c u l a r l y i n con tac t - t r ac ing measures. It i s planned t o a s s i g n , i n t h e l a t t e r ha l f of 1967, a second consul tant t o a s s i s t i n s t rengthening laboratory s e r v i c e s , p a r t i c u l a r l y wi th regard t o reference procedures between p rov lnc la l se ro log ica l l a b o r a t o r i e s and the c e n t r a l l abora to ry i n Bangkok.

Thailand 0086 Dental f k a l t h R an. 1967)

A i m of t h e Drolect. To improve and s t rengthen d e n t a l education of both profess ional and a u x i l i a r y s t a f f a s wel l a s d e n t a l se rv ices .

Assistance ~ r o v i d e d by WHO dur ing t h e year. A temporary adv i se r .

Work done. A WHO temporary adv i se r v i s i t e d Thailand f o r t e n days i n January 1967. Hls recommendations included reorganizat ion of t h e t r a i n i n g of d e n t a l hyg ien i s t s and establishment of a new school f o r school d e n t a l nurses . His repor t has been Sent t o t h e Government.

Thailand 0200 R

Tuberculosis Control. A two-week fe l lowshig f o r study i n India .

Venereal-Disease Control. A three-week fe l lowship f o r s tudy i n Denmark.

Patholo=. A ten-month fellowship, f o r s tudy i n the United Kingdom.

Public Health Administration. p one-month fe l lowship f o r study i n India .

Administration of Medical Services . A one-month fe l lowship f o r a s tudy tour i n Switzer land, Denmark, Turkey and the United Arab Republic.

Health Education. Two fellowships of t h r e e months and twelve days f o r s tudy i n India .

Nutr i t ion. A ten-day fellowship f o r a t t end ing a seminar on n u t r i t i o n a l problems of mothers and ch i ld ren held i n Hyderabad ( I n d i a ) .

Preventive and Soc ia l Medicine. A ten-month fe l lowship f o r s tudy i n the United Kingdom.

Veter inary Public Health. A twelvemonth fe l lowship f o r s tudy i n the United S t a t e s of America.

Rural Health. Three two-month fe l lowships f o r s tudy i n India and Burma.

Thailand 0201 UNDP(TA)

Pellowshivs

Venereal-Disease Control. A twelve-month fellowship f o r study i n t h e United Kingdom.

C l i n i c a l and T r o ~ i c a l Medicine. A ten-month fe l lowship f o r study i n the United Kingdom.

Radiation and IsotoDes. A twelve-month fellowship f o r s tudy i n the United Kingdom.

Radioloaical Technolo~x. A twelve-month fe l lowship f o r s tudy i n the United Kingdom.

Radiat ion Protect ion. A two-month fellowship f o r s tudy i n New Zealand.

Nutr i t ion. A twelve-month fellowship f o r study i n I s r a e l .

Preventive and Soc ia l Medicine. A ten-month fellowship f o r study i n t h e United S t a t e s of America.

Production of DPT Vaccine. A twelve-month fe l lowship f o r s tudy i n Derunark, the United Kingdom and the Federal Republic of Gennany.

SEA/RCZO/Z Page 201

10. INTER-COUI{TRY

PROJECT LIST

Project No. Source of Fur.-; .- Co-operatirg

Agcnnlrs --

SEARO 0307 it:;,-ional Asszssmcnt Te;m on

Nalaria Eradication

( m y 1757 - Dcc. 1761; Nov. 1963 - )

E'm of th,? proJcc. To m~lki an indepenacnt appraisal of the status of malaria - eradication and of ar;y spcclal aspects of thc programme in countries of thc Rcgion.

Assistancc pr~vided 53. WHO during the gear. ( a ) An entomologist and a short term

consultant: supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work d o n ~ during the year. Thc tcam carried out an assessment of malaria eradication

prograrme in Afghanistin during thc list quartcr of 1966. The report was sent to

thc Government .

SEARO 00:O

L1IDP ( T!,

Smallpox Eradication and Epidemiologicrl

Ad7isory Team

(Oct. 1962 - )

Aim of tho projos. To assist thc countrifs of the Rcgion in smallpox eradication - and in the development of epidemiological services.

Assistance provided by WHO during the year. Two epidemiologists.

Probable duration of issistnncc. Until the cnd of 1970.

Work done during thc year. The WHO epidemiologists joined the projcct in December

1966 2nd p3rtici~atcd in the seminar on smallpox eradication held in the Regional

Office (sfe SEARO 0112). One of thcm alsn took part in the one-month leprosy

trainins coursc hc.l<' in Thailand, and the other re-ricwed the development of the

Indian national trachoma control programme.

Assistance was also givcn to the smallpox control programmes in Afghcnistan

and Nepal, and inform~tion is being collected for :an assessment of the Indian smallpox eradication prog-anmc.

SEADCZ O/2 Page 202

SEARO 0050 Reorganization of Rural Health Records and Reports (.Jan. 1961 - )

A i m of the ~ r o l e c t . To organize a system of r u r a l h e a l t h se rv ice records and r e p o r t s i n se lec ted cen t res and t o t r a i n personnel i n the c o l l e c t i o n , processing and p resen ta 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 a t the r u r a l hea l th cen t re l e v e l .

Assistance ~ r o v i d e d by WHO dur inp t h e year . ( a ) A s t a t i s t i c i a n ; ( b ) supp l ies and equipment.

probable durat ion of a ss i s t ance . Unt i l mid-196%

Work done during the year. The WHO s t a t i s t i c i a n reviewed r u r a l hea l th record and repor t ing systems i n Afghanistan, Nepal and Thailand. H i s r epor t s have been s e n t t o t h e respec t ive Governments.

In Ind ia , t h e record and repor t ing system developed by t h e p ro jec t was accepted f o r implementation i n Gujarat S t a t e . The WHO s t a t i s t i c i a n v i s i t e d t h e S t a t e s of Andhra Pradesh, Haryana, Maharashtra, Mysore, Punjab and West Bengal t o d i scuss wi th t h e Di rec to ra tes of Health Services the r ~ o r g a n i z a t i o n of t h e r u r a l h e a l t h record and repor t ing systems on the l i n e s developed i n Gujarat .

Co-ordination of record and repor t ing systems of the genera l h e a l t h s e r v i c e s wi th those of spec ia l i zed d i sease -con t ro l programmes was reviewed with t h e h e a l t h a u t h o r i t i e s concerned.

Based on observations i n s e v e r a l coun t r i es of the Region, gu ide l ines f o r r u r a l hea l th record and repor t ing systems were d r a f t e d .

~ E A R O 0061 .2~ Course f o r Medical Records 0i ' f lcers .Ran~oon R (Nov. 1966 - )

A i m of the p r o j e c t . To a s s i s t i n the t r a i n i n g of personnel t o work i n h o s p i t a l records and s t a t i s t i c s departments.

Assistance provided by WHO d u r i w the year . ( a ) Assistance from t h e h e a l t h s t a t i s t i c i a n and the medical records o f f i c e r a t tached t o t h e V i t a l and Health S t a t i s t i c s p r o j e c t , Burma 0022, and from the medical records o f f i c e r of t h e Hospi ta l S t a t i s t i c s p r o j e c t , SEARO 0072; ( b ) s i x fe l lowships - f i v e f o r t e n months and one f o r seven and a half months - f o r p a r t i c i p a n t s i n the course; ( c ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l September 1967.

*The f i rs t course was held i n Bangkok from 9 June 1964 t o 15 March 1965 under p r o j e c t number SEARO 0061.

SEA/RC20/2 Page 203

Work done during the Year. The second course f o r medical records o f f i c e r s began i n Rangoon i n November 1966. The course w i l l l a s t f o r t e n months. Eight t r a i n e e s from count r i es of the Region were admitted ( four from Burma, one from Ind ia , one from Indonesia and two from Tha i land) , and four medical records o f f i c e r s from Falaysia attended p a r t time.

The course was planned, d i r e c t e d and taught by the s t a f f of the v i t a l and h e a l t h s t a t i s t i c s p ro jec t (Burma 0022). and a s s i s t e d by the WHO medical records o f f i c e r a t tached t o the in te r -coun t ry h o s p i t a l s t a t i s t i c s p ro jec t (SEARO O072), and a number of guest l e c t u r e r s .

SEARO 0064 R

Develooment of Community Water S U D D ~ V Programme (Apr i l 1965 - )

A i m of the p r o l e c t . To provide governments of t h e Region with consul tant se rv ices f o r the development of t h e i r urban and r u r a l community water supply p ro jec t s .

Assistance Drovided by WHO during t h e year . Two s a n i t a r y engineers.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1971.

Work done during the year. A WHO s a n i t a r y engineer joined t h e p ro jec t i n December 1966. He has been engaged i n a s tudy of t h e programme of WHo/UNICEF a s s i s t a n c e t o the development of r u r a l water supply i n the var ious s t a t e s of I n d i a , v i s i t i n g severa l a reas of the p r o j e c t s a l ready developed o r those i n the process of development.

With a s s i s t a n c e from UNICEF, a demonstration of t h e i n s t a l l a t i o n of PVC pipes and o the r mate r ia l s was arranged i n one of the p r o j e c t a reas i n Roorkee from 13 t o 22 April 1967. An engineer provided by t h e manufacturers of these pipes which were supplied t o some of these p r o j e c t s , conducted the p r a c t i c a l p a r t of t h e demonstration. Students of Roorkee University a s wel l a s engineers from Uttar Pradesh S t a t e and from Afghanistan and Nepal and a l s o the environmental hea l th s t a f f of the Regional Office p a r t i c i p a t e d i n the demonstration. Lectures were given on various aspec t s of t h e use of PVC pipes i n r u r a l water suppl ies .

The p r o j e c t was strengthened by the assignment, i n May 1967, of another WHO s a n i t a r y engineer, who has s t a r t e d t o s tudy t h e various p r o j e c t s under the r u r a l and urban water supply programme i n the Region.

SEARO 0072 rnP(TA)

H o s ~ i t a l S t a t i s t i c s ( Jan . 1963 - )

A i m of t h e p r o j e c t . To help governments of the Region t o organize an e f f i c i e n t system f o r t h e maintenance and flow of records i n se lec ted hosp i t a l s : t o c o l l e c t , process and present h o s p i t a l s t a t i s t i c a l data e f f i c i e n t l y on a na t iona l sca le , and t o t r a i n medical records and h o s p i t a l s t a t i s t i c s personnel.

SEA/RC20/2 Page 204

Assistance provided by WHO d u r i w the year. ( a ) A s t a t i s t i c i a n and a medical

records o f f i c e r ; ( b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1968.

Work done durinR the year. I n Thailand, t h e WHO s t a t i s t i c i a n a s s i s t e d i n organizing t h e processing of ind iv idua l d iagnos t i c r e p o r t s from mental h o s p i t a l s and i n rev i s ing the procedures f o r processing morbidity s t a t i s t i c s from general h o s p i t a l s . He went

t o Manila a s a WHO consul tant t o the Third Regional Seminar on V i t a l and Health S t a t i s t i c s (Hospi ta l Medical Records and S t a t i s t i c s ) , organized by t h e Western

Pac i f i c Regional Office from 28 November t o 5 December 1766, where he presented a

paper on "Medical Records and Hospital S t a t i s t i c s " . He completed h i s assignment i n February 1967, and h i s post (wi th duty s t a t i o n now i n Da lh i ) was f i l l e d by the WHO s t a t i s t i c i a n who had been working i n Burma with the v i t a l and h e a l t h s t a t i s t i c s p r o j e c t . I n March he went t o Nepal a s a short-term consul tant ( s e e Nepal 0017).

The WHO medical records o f f i c e r s t a t ioned i n Delhi v i s i t e d Afghanistan i n

August 1966,and reviewed t h e h o s p i t a l medical record systems i n Kabul and Jala labad and organized workshops f o r t r a i n i n g of personnel a ssoc ia ted with the h o s p i t a l

records and s t a t i s t i c s system. She v i s i t e d Burma i n November 1966 t o a s s i s t i n planning and teaching the course f o r medical records o f f i c e r s ( s e e SEARO 0061.2).

Together, the WHO s t a t i s t i c i a n and WHO medical records o f f i c e r v i s i t e d

Ceylon t o review the progress made i n the establishment of a medical record depar t - ment i n Colombo South Hospital and advise on f u r t h e r development of h o s p i t a l

s t a t i s t i c s se rv ices . I n Ind ia , they v i s i t e d t h e I n s t i t u t e of Post-graduate Medical Education and Research i n Chandigarh and reviewed progress i n the development of

the Medical Record De~ar tment of the I n s t i t u t e .

The WHO medical records o f f i c e r a s s i s t e d i n the f u r t h e r development of

medical record departments of the Baroda Medical College Hospital and of Safdarjang

Hospi ta l , New Delh i , and a l s o i n the planning of a medical record department i n

Ramathibodhi Hospi ta l , Bangkok.

SEAR0 009q External Cross-Checkiw of Blood Films

R (June 1963 - Dec. 1966)

A i m of the p ro jec t . To provide f a c i l i t i e s f o r ex te rna l cross-checking of blood f i lms from malaria e rad ica t ion programmes i n t h e Region.

Assistance provided by WHO dur ing the year. A g ran t t o the Government of India t o meet the cos t of employment of na t iona l s t a f f and contingent expenses.

Work done. In order t o provide f a c i l i t i e s f a r the ex te rna l cross-checking of blood f i lms from malaria e rad ica t ion programmes i n the Region and I n pursuance of

Resolution SEA/RC14/R5 of the Regional Committee, a r e fe rence c e n t r e was es tab l i shed

SEA/RC20/2

Page 205

a t the Centra l Research I n s t i t u t e i n Kasauli ( I n d i a ) i n June 1963, i n co-operation

wi th the Government of Ind ia . The f a c i l i t i e s of the c e n t r e were u t i l i z e d by some

of the coun t r i e s i n the Region, e s p e c i a l l y by Ceylon. Prom t h e time when the cen t re was s t a r t e d , a t o t a l of 106 539 s l i d e s were rece ived ; of t h e s e , 8@ were

from Ceylon.

A s t h e r e was a dec l in ing t rend i n the use of t h i s c e n t r e , and a l s o because Ceylon,with the d e c e n t r a l i z a t i o n of i t s laboratory s e r v i c e s , now has adequate

f a c i l i t i e s f o r cross-checking wi thin the country , i t was decided t o c lose down

t h i s r eg iona l cen t re a t the end of 1966.

Medical Education (Nov. 1965 - Feb. 1966; J u l y 1966 - March 1967)

A i m of t h e o r o j e c t . To ass is t i n improving teaching methods i n medical co l l eges .

Assis tance urovided by WHO dur ing the year. A consul tant i n p a e d i a t r i c s and a consul tant i n the maintenance and r e p a i r of e lect ro-medical equipment.

Work done. I n J u l y 1966, a WHO consu l t an t i n p a e d i a t r i c s was ass igned t o India f o r e i g h t months t o advise on post -graduate t r a i n i n g . I n the course of t h i s assignment, he a l s o made a s tudy of WHO/UNICEP-assisted p a e d i a t r i c education programmes i n

India .

I n the evo lu t ion of post-graduate education i n p a e d i a t r i c s he recommended

development of l a r g e r u n i t s of o rgan iza t ion t o provide completely organized academic courses and more s a t i s f a c t o r y t r a i n i n g . I n support of pas t -graduate t r a i n i n g he

s t r e s s e d t h a t means should be found t o br ing toge the r a study group t o plan s u i t a b l e and p r a c t i c a l courses of undergraduate s t u d i e s i n p a e d i a t r i c s . He a l s o suggested

t h a t t h e following were i n need of c lose a t t e n t i o n : teaching of s o c i a l p a e d i a t r i c s ; development of s u i t a b l e f i e l d p r a c t i c e a r e a s , i n co-operation with d e p a r t m ~ n t s of

o b s t e t r i c s and prevent ive and s o c i a l medicine i n o rde r t o ensure t h a t post-graduate s tuden t s can p rac t i se prevent ive a s wel l a s c u r a t i v e p a e d i a t r i c s dur ing t h e i r

t r a i n i n g ; Kard and a u t - p a t i e n t admin i s t r a t ion and o rgan iza t ion ; a p p l i c a t i o n of micro- techniques t o p a e d i a t r i c b iochemist ry; p a e d i a t r i c pathology; neo-natology; study of teaching techniques and the use of v i s u a l and o the r a i d s , and p rov i s ion of necessary s t a f f f o r post-graduate p a e d i a t r i c t r a i n i n g .

The study of WHO and UNICEF-assisted p a e d i a t r i c programmes i n India ind ica ted t h a t WHO/UNICEF a i d had has tened, encouraged and supported the development of

p a e d i a t r i c s i n t o an independent d i s c i p l i n e . Teaching had been expanded, but develap- ment of the s o c i a l a spec t s had lagged behind. Se rv ice demands on departments were

heavy, and f u r t h e r improvement was necessary , e s p e c i a l l y i n h o s p i t a l cond i t ions , teaching methods, nurs ing s t r e n g t h , provis ion of teaching m a t e r i a l , and extra-mural teaching.

The r e p o r t s of t h e consul tant have been fomarded t o the Oovernment.

SEA/RC20/2 Page 206

I n February 1967, a WHO consul tant i n t h e maintenance and r e p a i r of electro-medical equipment was assigned t o Ceylon and Ind ia f a r one month. He v i s i t e d the workshops f o r maintenance and r e p a i r of e lect ro-medical equipment s i t u a t e d a t the Colombo General Hospital and the Bernard I n s t i t u t e of Radiology, Madras, assess ing t h e i r s u i t a b i l i t y f o r teaching purposes and a s t r a i n i n g cen t res f o r WHO fe l lows. His repor t s a r e being processed f o r submission t o t h e Governments concerned.

SEARO OW? R UNICEF

Nut r i t ion Tra in ing (Dec. 1963 - )

A i m of the p r o j e c t . To a s s i s t i n t r a i n i n g i n n u t r i t i o n and t o support t h e Nut r i t ion Research I a b o r a t o r i e s , Hyderabad ( I n d i a ) , i n carrying out t h e i r programme.

Assistance provided by WHO dur ing t h e year . ( a ) A g ran t - in -a id t o t h e Nut r i t ion Research Laborator ies , Hyderabad, and a twelve-month fe l lowship f o r an o f f i c e r of these l abora to r ies f o r study i n the United S t a t e s of America; ( b ) e i g h t three-month fe l lowships f o r candidates from Afghanistan, Ceylon, Indonesia and Thailand f o r p a r t i c i p a t i o n i n t h e t r a i n i n g course ( s t i p e n d s f o r twelve candidates from India were paid by UNICEF) ; ( c ) a guest l e c t u r e r .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1971.

Work done d u r i w t h e year . The f o u r t h c e r t i f i c a t e course i n n u t r i t i o n was held a t the Nut r i t ion Research Laborator ies , Hyderabad, from 1 December 1966 t o 28 February 1967. It was a t tended by 21 p a r t i c l p a n t s ( inc lud ing one from Afghanistan, th ree from Ceylon, twelve from Ind ia , two from Indonesia , two from Thailand and one from Korea) coming from the d i s c i p l i n e s of publ ic h e a l t h , biochemistry, p a e d i a t r i c s , prevent ive and s o c i a l medicine, and o b s t e t r i c s and gynaecology. P a r t i c i p a n t s from ou t s ide India were awarded WHO fe l lowships . The course consis ted of t h e o r e t i c a l work, v i s i t s t o a c l i n i c , f i e l d work i n the nearby v i l l a g e s and l abora to ry experience. An in tegra ted p i c t u r e of n u t r i t i o n problems and of the ways i n which d i f f e r e n t departments operated i n c l i n i c and f i e l d inves t iga t ions was provided i n varioue seminars and symposia. WHO provided a guest l e c t u r e r from Indonesia t o co-operate with the na t lona l s t a f f .

The Governing Body of the Indian Council of Medical Research has approved the proposal f o r a nine-month diploma course, which i s expected t o s t a r t i n 1968.

SEARO 0102 R UmP( SF ) ECAPE UNICEF

Asian I n s t i t u t e f o r Economic develop me^ and Plannin,?. Ban~kok ( Jan . 1964 - )

A i m of t h e pro.1ect. To s t rengthen the f a c u l t y of t h e Asian I n s t i t u t e f o r Economic Development and Planning, e s tab l i shed with the help of the United Nations Develop- ment Programme (Spec ia l Fund) and UNICEF, and t o a s s i s t wi th the t r a i n i n g i n hea l th aspec t s of planning and public hea l th admin i s t ra t ion .

SEA/RC20/2

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Assis tance provided by WHO dur ing the year. A consul tant i n publ ic h e a l t h adminis t ra-

t i o n (up t o October 1966) and a publ ic h e a l t h admin i s t r a to r .

Probable dura t ion of assistance. Unt i l t he end of 1971.

Work done dur ing t h e year . The t h i r d genera l course of the I n s t i t u t e , which had

s t a r t e d in February 1766 with 31 p a r t i c i p a n t s from different coun t r i e s , ended i n

A u g u s t 1966. A s a p a r t of t h i s course a country debate s e r i e s on t h e s t a t u s of

h e a l t h planning i n the o v e r - a l l development p lans of s e l e c t e d coun t r i e s i n the ECAPE Region was introduced. The f o u r t h genera l course , wi th 33 s tuden t s from

13 countries.was s t a r t e d on 1 Pebruary 1967, and h e a l t h a s p e c t s of economic and s o c i a l development were covered by the WHO s t a f f member i n a s e r i e s of in t roductory

l e c t u r e s .

A s f o r the 1966 "advanced course" , i t was held from August t o October, with

31 p a r t i c i p a n t s , the WHO consul tant conducting seminar sess ions on "The Health

Component i n National Plans f o r Economic and Soc ia l ~evelopment" "Development of Health ~anpower%nd "Development of Comprehensive Environmental ~ e r v i c e s " .

I n November-December, under the ausp ices of the I n s t i t u t e a six-week course an " ~ l a n n i n ~ f o r Development i n Nepalt' was conducted i n Kathmandu, and a s a p a r t of t h i s course a seminar on the elements of h e a l t h planning was he ld , the

WHO publ ic h e a l t h admin i s t r a to r g iving a l e c t u r e on h e a l t h planning. Another course

on human resources development was conducted i n Elanila i n January 1967, the hea l th

con ten t of which was provided by a h e a l t h admin i s t r a to r from the Western Pac i f i c

Regional Of f i ce .

The WHO consu l t an t i n publ ic h e a l t h admin i s t r a t ion completed h i s t h i r d assignment a t the I n s t i t u t e i n October 1966. H i s replacement, a publ ic h e a l t h

admin i s t r a to r , a r r i v e d dur ing the same month and has c a r r i e d on s i n c e t h a t time.

Hospi ta l Designs

(Oct . - Dec. 1966; - )

A i m of the p r o l e c t . To a s s i s t i n the p repara t ion of h o s p l t a l des igns .

Assis tance Provided by WHO dur ing t h e Year. A consul tant i n h o s p i t a l a r c h i t e c t u r e .

Probable dc ra t ion of a s s i s t a n c e . Unt i l 1969.

Work done dur ing t h e year. A WHO consu l t an t was ass igned t o Afghanistan i n October

1966 f o r a period of two months. He advised the Government on the des ign, planning

and cons t ruc t ion of h e a l t h u n i t s and h o s p i t a l s . His r e p o r t has been s e n t t o the

aovernment.

Similar a s s i s t a n c e i s planned i n Indonesia and Thailand dur ing 1967.

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SEARO 0110 UNDP(TA)

Seminar on the Teaching of Prevent ive

and S o c i a l Medicine. Colombo

( 3 0 Nov. - 8 Doc. 1966)

A i m of t h e orodect . To a s s i s t i n the improvement of teaching of prevent ive and s o c i a l medicine.

Ass is tance provided by WHO dur ing the yea r . A f a c u l t y c o n s i s t i n g of two consu l t an t s

( i n p reven t ive and s o c i a l medicine and s o c i a l p a e d i a t r i c s ) and t h e Regional Advisers i n Medical Education and Health Education: a s e c r c t a r y from t h e Regional Of f i ce , and

c o s t of a t tendance of p a r t i c i p a n t s .

Work done. A WHO-sponsored seminar on the teaching of p reven t ive and s o c i a l medicine

was held i n Colombo from 30 November t o 8 December 1966, a t t ended by 19 p a r t i c i p a n t s

(from Afghanistan, Burma, Ceylon, I n d i a , Indonesia and Thai land) and by a number

of observers .

The WHO f a c u l t y cons i s t ed of two c o n s u l t a n t s , i n p reven t ive and s o c i a l medicine and s o c i a l p a e d i a t r i c s r e s p e c t i v e l y , and the Regional Advisers i n Medical

Education and Health Education.

The Seminar d e a l t p a r t i c u l a r l y wi th t h e teaching of epidemiology and

s t a t i s t i c s , medical c a r e , medical sociology and h e a l t h educat ion p r a c t i c e .

Pour v a r j a t i a n s of i n t e g r a t e d teaching methods were demonstrated and

eva lua ted . The WHO consu l t an t s and t eache r s from the departments of p reven t ive

and s o c i a l medicine, p a e d i a t r i c s , medicine and pathology of t h e Facu l ty of

Medicine of the Univers i ty of Ceylon conducted t h e demonst ra t ions .

P r i n c i p l e s and methods of a s s e s s i n g s t u d e n t s ' progress were a l s o d iscussed

SEARO 0112

UNDP(TA)

Seminar an Smallpox Erad ica t ion

(12-16 Dec. 1966)

A i m of t h e Dro,iect. To exchange informatioil on ( 1 ) t h e epidemiological f a c t o r s r e spons ib le f o r t h e p e r s i s t e n c e of smallpox endemic a r e a s , ( 2 ) t h e methods and

p lans of a c t i o n i n ope ra t ion under t h e va r ious n a t i o n a l smallpox c a n t r o l / e r a d i c a t i o n programmes i n t h e Region, and ( 5 ) t h e requirements f o r s t rengthening these

programmes i n o rde r t o achieve e r a d i c a t i o n of t h e d i s e a s e .

Ass is tance provided by WHO dur ing t h e year . A consu l t an t f o r two weeks.

Work done. A seminar on smallpox e r a d i c a t i o n was held i n t h e Regional Off ice from

12 t o 16 December, wi th t h e p a r t i c i p a t i o n of t e n medical o f f i c e r s r e spons ib le f o r smallpox e r a d i c a t i o n programmes i n var ious coun t r i e s of t h e Region. The WHO medical o f f i c e r s a t t ached t o t h e in t e r -coun t ry p r o j e c t SEARO 0050 a l s o took p a r t .

SEA/RCZO/Z Page 203

The smallpox control/eradication programmes in operation were reviewed country by country, and discussions were concentrated on weak and fundamental points observed in the implementation of these programmes (see Section 1.3.1 of Part I).

Ty~hoid Immunization (Nov. 1966 - )

Aim of the project. To assist the governments in the Region in starting the produc- tion of acetone-dried typhoid vaccine, in order to facilitate systematic immunization programmes among the susceptible age-groups.

Assistance provided by WHO during the year. (a) A consultant for two weeks; ( b ) supplies and equipment.

Probable duration of assistance. Until 1969.

Work done durinu the year. Following technical advice, from WHO, experimental batches of acetone-dried typhoid vaccine were prepared at the Medical Research Institute, Colombo, the Haffkine Institute, Bombay, and the Central Research Institute, Kasauli. A WHO consultant vlsited the mffkine Institute and the Central Research Institute in November 1966 to advise on production procedures. The causes of some of the difficulties experienced were explored and suggestions made for modifying the procedures. Some addltional equipment was supplied by WHO to the Haffkine Institute to enable it to overcome the difficulties noted.

Stren~thening of Medical Education (April 1967 - )

Aim of the project. To strengthen selected departments of medical colleges and to introduce modern teaching methods.

Assistance DPovided by WHO duriw the year. A consultant in social paediatrics for five months.

Probable duration of assistance. Until the end of 1968.

Work done during the year. A WHO consultant in social paediatrics assisted in developing suitable field practice areas for medical colleges in Bombay in preparation for starting a course in tropical paediatrics for paediatric teachers, as part of the London-Bombay course sponsored by UNICEF in collaboration with WHO, (see Section 6.2 in Part I). Close collaboration was established between the Department of Paediatrics and the Departments of Preventive and Social Medicine and Obstetrics of the medical colleges participating in this course.

SEA/RC20/2 Page 210

SEAR0 0135 Global Smallpox Erad ica t ion Programme Spec ia l Account (Nov. - Dec. 1766)

f o r Smallpox Erad ica t ion

Ain of t h e p r o j e c t . To review smallpox c o n t r o l campaigns and t o adv i se on t h e

f e a s i b i l i t y of s t a r t i n g e r a d i c a t i o n programmes.

k s i s t a n c e provided by WHO dur ina t h e yea r . A consu l t an t f o r about s i x weeks.

/l13rIc done. A WHO consu l t an t v i s i t e d Afghanistan and Ncpal f o r the above purpose.

Hls r e p o r t s 3 r e under study.

Regional Tra ining Course on Leprosp

Control , Bangkok and Phrapradaeng

( 2 7 Dec. 1966 - 21 Jan . 1967)

A i m of t h e ~ r o j e c t . To review t h e p resen t p r a c t i c e of l ep rosy c o n t r o l i n t h e

c o u n t r i e s of t h e Region and t o cons ide r the adap ta t ion and s t a n d a r d i z a t i o n of

c o n t r o l methodology t o a more up- to-date understanding of l ep rosy epidemiology,

p a r t i c u l a r l y wi th regard t o eva lua t ion of c o n t r o l a c t i v i t i e s .

Ass is tance ~ r o v i d e d by WHO dur ing the yea r . Ass is tance from ( 1 ) t h e WHO medical

o f f i c e r s and s t a f f of t h e l ep rosy c o n t r o l p r o j e c t Thailand 0030, ( 2 ) one of t h e Reeional Advisers i n Communicable Diseases , ( 3 ) the WHO s e n i o r l e p r a l o g i s t of p r o j e c t Burma 0017, ( 4 ) t h e WHO l e p r o l a g i s t former ly wi th the l ep rosy c o n t r o l p r o j e c t i n Srikakulam, I n d i a , and ( 5 ) two s e c r e t a r i e s from t h e Regional Off ice .

Work done. This fou r week course was a t t ended by e igh teen p a r t i c i p a n t s from t h e South-East Asia and one from t h e Western P a c i f i c . The course included an i n t ~ n s i v e review of the c l i n i c a l a s p e c t s of l ep rosy , i t s epidemiology and c o n t r o l . P a r t i c i -

pan t s were mostly s e n i o r l e p r a l o g i s t s from s i x c o u n t r i e s of t h e Region. Consldera t lon

was g iven t o modern th ink ing on l ep rosy , i t s n a t u r a l course and epidemiology, and a c r i t i c a l assessment of l ep rosy c o n t r o l measures i n va r ious p a r t s of t h e Region

was undertaken. The r e s u l t s of t h e course can be evaluated on ly over a per iod of

t1T.c.

Shor t Courses f o r Nursing Personnel a an. 1967 - )

of t h e ~ r o j e c t . To a s s i s t educat ion programmes which provide f o r thc development of concepts and s k i l l s i n t h e o rgan iza t ion , conduct and eva lua t ion of s h o r t courses

f o r nu r s ing personnel .

Wince t h e beginning of 1967 tho activities of p r o j e c t Ind ia 98 have been

amalgamated wi th t h i s in t e r -coun t ry p r o j e c t .

SEA/RC20/2 Page 211

Assistance provided by WHO dur ing the year. Three nurse educators.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1970.

Work done during t h e year . Plans were made f o r the admin i s t ra t ion and conduct of shor t courses f o r q u a l i f i e d nurses on an inter-country bas i s . Three one-month courses were offered - one i n Ceylon, one i n Ind ia and one i n Nepal. The top ics covered concerned c l i n i o a l teaching and in - se rv ice education. Some nurses from India attended the Ceylonese course , and some from Afghanistan the course i n Nepal.

Reference mate r ia l s and o the r teaching a i d s were prepared.

Worksho~s i n Medical Education (7-18 Nav. 1966)

A i m of t h e ~ r o j e c t . To improve the standards of teaching i n medical i n s t i t u t i o n s .

Assis tance ~ r o v i d e d by WHO dur ing the year . A f a c u l t y cons i t ing of two consul tants and two temporary a d v i s e r s , and a s s i s t a n c e from the Regional Advisers i n Medical Education and two s e c r e t a r i e s from the Regional Off ice; cos t of attendance of p a r t i c i p a n t s .

Work done. Two workshops i n teaching methods i n medical education were held , one i n Rangoon and the o the r i n Bangkok from 7 t o 11 November and 14 t o 18 November 1966 respec t ive ly . They were conducted by the WHO f a c u l t y mentioned above. The Regional Advisers i n Medical Education a l s o a s s i s t e d .

Twenty s e n i o r teachers from the t h r e e I n s t i t u t e s of Medicine i n Burma took p a r t i n the workshop i n Rangoon, and twenty-two from the f o u r medical co l l eges i n Bangkok and Chiengmai and f i v e from Indonesia ,par t ic ipated i n the Bangkok workshop. There were a l s o some l o c a l observers.

The workshops d e a l t mainly with the app l ica t ion of educat ional r esea rch f indings t o c u r r i c u l a r design, medic31 teaching and evaluat ion of s tuden t s . Some commonly used teaching techniques were demonstrated and l a t e r evaluated c r i t i c a l l y by the p a r t i c i p a n t s . The possible r o l e of programmed i n s t r u c t i o n i n medical education was discussed. At tent ion was d i r e c t e d t o the p r i n c i p l e s t o be considered when designing and applying v a l i d , r e l i a b l e and ob jec t ive examinations, and some ob jec t lve - type examinations were demonstrated.

A t one of the sess ions i n the Bangkok workshop, the s t a f f of the UNESCO p i l o t p ro jec t f o r a chemistry teaching cen t re described the work of the cen t re i n developing audio-visual teaching a i d s , and demonstrated t h e use of the s i n g l e - concept loop f i l m f o r teaching.

SEA/RC20/2

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11. INTER-REGIONAL (PRWECTS WITHIN THE REGION)

Pro jec t No.

Source of Funds Co-operatinq

Agencies T i t l e

I n t e r - r e ~ i o n a l 0190 Leprosy/BCG T r i a l Team, Burma

R ( A p r i l 1964 - )

A i m of t h e ~ r o j e c t . To c a r r y ou t a t r i a l of BCa vaccinat ion i n t h e prevent ion of

l ep rosy .

Ass is tance ~ r o v i d e d by WHO dur ing t h e yea r . A l e p r o l o g i s t , a s t a t i s t i c i a n and a

shor t - term consu l t an t .

P1,obable dura t ion of a s s i s t a n c e . U n t i l t h e end of 1969.

Work done dur ing t h e yea r . I n 1966, ahead of t h e o r i g i n a l p l a n , t h e p r o j e c t completed

BCG vaccinat ion of t h e t r i a l popula t ion. The WHO l a b o r a t o r y t echn ic i an f i n i s h e d h e r assignment a t t h e end of 1966, and i n 1967 ano the r l abora to ry t echn ic i an and a l ep rosy

c o n t r o l o f f i c e r were r e c r u i t e d t o a s s i s t the work o f t h i s important i n v e s t i g a t i o n . I n the l a t t e r h a l f of 1966 and e a r l y i n 1967 a WHO consu l t an t l e p r o l o g i s t a s s i s t e d

I n an eva lua t ion of t h e team's diagnoses,according t o t h e s tudy p ro toco l . The

r e s u l t s of t h i s assessment a r e expected t o be a v a i l a b l e i n t h e near f u t u r e .

I n t e r - r e g i o n a l 0218.1 Cancer Advisory Team, Asia

R (Aug. 1963 -

A i m of the Droject . To s tudy t h e epidemiology of oropharyngeal tumaurs, and - p a r t i c u l a r l y t h e i r r e l a t i o n t o b e t e l and tobacco chewing and smoking h a b i t s .

Ass is tance provided by WHO dur ing t h e year . An epidemiologis t .

Probable d u r a t i o n of a s s i s t a n c e . I n d e f i n i t e .

Work done dur ina t h e yea r . The epidemiological s tudy of oropharyngeal tumours i n Malnpuri D i s t r i c t was cont inued, i n c o l l a b o r a t i o n wi th t h e Department of Pathology,

S.N. Medical Col lege , Agra. I n January 1967 t h e WHO epidemiologis t , accompanied by

a WHO s t a t i s t i c i a n from WHO Headquarters, v i s i t e d t h e epidemiological r e sea rch

p r o j e c t i n Neyyoor (South I n d i a ) , which i s being supported by WHO, t o s tudy t h e f e a s i b i l i t y of s t a r t i n g a n epidemiological s tudy of oropharyngeal tumours.

Analysis of t h e d a t a from t h e s tudy i n Mainpuri D i s t r i c t i s i n t r a i n .

SEA/RCZ 0/2 Page 215

In te r - reg iona l 0271' Research Unit f o r the Control of Mosquito Spec ia l Account Vectors of P i l a r i a s i s . Rangoon f o r Medical (Nov. 1962 - ) Research

A i m of t h e v r o j e c t . To c a r r y out r esea rch and f i e l d t r i a l s on the con t ro l of mosquitoes, p a r t i c u l a r l y the vectors of f i l a r i a s i s , using organo-phosphorus and o the r new i n s e c t i c i d e s , b io log ica l con t ro l procedures and o the r techniques not a t present employed.

Assistance provided by WHO during t h e year . Pour entomologists and f i v e consul tants .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1968.

Work done dur ing t h e year. Research on the mosquito vector of f i l a r i a s i s , wi th p a r t i c u l a r reference t o the ecology, bionomics, f l igh t - range , and s u s c e p t i b i l i t y t o i n s e c t i c i d e s , r e su l t ed i n the establishment of a small p i l o t a rea f o r the con t ro l of Culex pipiens fa t inans . I n t h i s a rea it was demonstrated t h a t t h e con t ro l of t h i s species by using anmgano-phosphorus compound a s l a r v i c i d e was no t only more e f f e c t i v e but a l s o more economical than malathion i n o i l . Towards t h e end of 1966 t h i s a rea was extended, and a f u r t h e r extension w i l l be considered towards t h e end of 1967, by which time the area w i l l cover about one f i f t e e n t h of the Rangoon c i t y a rea .

The e f f i c a c y of vector con t ro l f o r the con t ro l of f i l a r i a s i s was evaluated by a WHO consul tant us ing sk in t e s t i n g techniques. However, t h e e f f e c t of vector con t ro l on s k i n s e n s i t i v i t y i s bound t o be slow, and evaluat ion by t h i s method w i l l have to be repeated i n the f u t u r e . While various resea rch p r o j e c t s a r e engaged i n t h i s f i e l d , an i n v e s t i g a t i o n on the f e a s i b i l i t y of a n i n s e c t i c i d e o i l mixture f o r t h e con t ro l of Culex v i ~ i e n s f a t i n a n s i s necessary, t o determine the pe rs i s t ence of t h e i n s e c t i c i d e i n such breeding places a s s e p t i c tanks , e t c .

A study of the f e a s i b i l i t y of gene t i c con t ro l by the in t roduc t ion of males of a n incompatible s t r a i n was undertaken i n a v i l l a g e near Rangoon. This i n v e s t i - ga t ion was completed i n t h e second quar te r of 1966, and the r e s u l t s w i l l soon be ava i l ab le . However, con t ro l of Culex pipiens f a t i n a n s through e i t h e r gene t i c con t ro l o r by int roducing a n incompatible s t r a i n is l imi ted t o vector populations of r e l a t i v e l y small s i z e , and thus can be used only when t h e vector population has been reduced t o manageable proport ions through t r a d i t i o n a l con t ro l measures.

In te r - reg iona l 0276 Cholera Control Team UNDP( TA ) (Peb. 1965 - )

A i m of the p r o j e c t . To a s s i s t epidemiological s t u d i e s and measures f o r the con t ro l of cholera and promote na t iona l programmes f o r t h e s tudy and con t ro l of t h i s d i sease .

*Previously repor ted under p ro jec t SEAR0 0076, wi th the t i t l e "Studies on P i l a r i a s i s " .

SEA/RCZO/Z Page 216

Assistance Drovided by WHO duritu? the year. An epidemiologist, a microbiologist, a sanitary engineer and a consultant.

Probable duration of assistance. Until 1971.

Work done during the year. The WHO inter-regional team stationed in Calcutta continued its investigations on measures for the control of cholera, and demonstrated the presence of cholera excretors although there were no cholera patients in the population during the inter-epidemic period. The occurrence of cholera in house- hold contacts of cholera carriers was also demonstrated. The methodology of tracing cholera excretors through weekly investigations of latrines proved to be useful, but it became evident that a complete epidemiological picture of the role of cholera carriers required more complex investigations, which should be pursued in the future. The research being carried out by the West Bengal Government in co-operation with the WHO inter-regional team will continue to explore the potentialities of screening latrines. Investigations have also started to elucidate the measurement of infection by serological tests. These investigations are supported by the Indian Council of Medical Research, the West Bengal Government and WHO, and will probably continue for some time.

Inter-renional 0297 FAO/WHO Seminar on Planning and Evaluation UNDP(TA) of A ~ ~ l i e d Nutrition Pro~rammes in Asia

(FAO) and the Far East. New Delhi (30 Nov. - 10 Dec. 1966)

Aim of the DroJect. To discuss the methodology of evaluation of applied nutrition programmes in the South-East Asia and Western Pacific Regions, where there are a large number of applied nutrition projects being operated with international assistance.

Assistance ~rovided by WHO during the year. Three consultants and two members of the secretariat.

Work done. This seminar, jointly sponsored by FA0 and WHO, was held in New Delhi from 30 November to 10 December 1966. There were 26 participants from the 3isciplines of agriculture, education and health, from nine different countries with applied nutrition programmes. The general scope and objectives of the seminar were to provide an opportunity for those involved in applied nutrition programmes at the policy-making level or those holding key technical posts directly concerned with the planning and implementation of such programmes in Asia and the Far East to exchange experiences and to improve their techniques in the planning and evaluation of this type of programme.

The main items of discussion were: objectives of applied nutrition programmes; principles for the collection of baseline data; involvement of national institutions and local communities; progress evaluation, orientation and training of personnel. and problems of co-ordination and integration.

SEA/RCZO/Z Page 217

Inter -regional 0306 Research Unit for the Control of Special Account Aedes aegypti , Bangkok for Medical (April 1966 - ) Research

Aim of the DroJect. To carry out research and field trials on the control of Ardes aegypti.

Assistance provided by WHO during the year. A medical officer and an entomologist.

Probable duration of assistance. Indefinite.

Work done during the year. Investigations on the ecology and distribution of the AEdes aegypti were continued. Studies were also made an the resistance of A m a e m t i larvae to various insecticides, with the aim of developing a practical methodology for ABdes aegmti control.

The Chief of the Vector Control Unit, WHO Headquarters, visited the project in November 1966 and reviewed its activities.

Inter-renional 0446+ Seminars and train in^ Courses on UNDP(TA) Cholera Control

(24 April - 13 May 1967)

Aim of the project. To give advanced training to medically qualified workers who are actually dealing with cholera control work.

Assistance Drovided by WHO durinR the Year. (a) Three consultants and a temporary adviser; (b) cost of attendance of fifteen participants.

Work done. A n inter-regional training course on cholera control was organized at the School of mopical Medicine, Calcutta, from 24 April to 13 May 1967. It was conducted in close co-operation with the School, and was assisted by the WHO epidemiologist attached to the Inter-regional Cholera Control Team, stationed in Calcutta, two staff members from WHO Headquarters and one of the Regional Advisers in Communicable Diseases. Fifteen participants (nine from South-East Asia and six from the Eastern Mediterranean Regions) took part in the course.

+Previous number and title: Inter-regional 228, "Training Course on the Control of Cholera".

SEA/RC20/2 Page 218

1 INTER-REGIONAL (PROJECTS OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA ?5GION)

Project No. and Source of Funds

Title - No. of Partici~ants

Inter-re~ional OC70 - Malaria Eradication Study Tour in 1 from Afghanistan R Turkey and Pakistan (3-16 October 1966)

Inter-regional 0070 Malaria Eradication Study Tour in 2 from India R Iran and Iraq (12-30 November 1966)

Tinter-regional 0113.1 Course on the Epidemiology and Control 2 (1 from Ceylon and LIDP(TA) of Tuberculosis, Prague (27 April - 1 from India)

16 September 1967)

Inte-onal 0120.1 - Seventeenth Anaesthesiology Course, 2 (1 from Indonesia and UNDP( TA) Copenhagen (16 January - 15 December 1967) 1 from Thailand)

Inter-regional 0133.2 Advanced Training Course on the Use of 2 from India R Computers in Human Genetics, USA

(14-27 August 19661

Inter-regional 0137.2 Third Training Course in Human Genetics, 1 from India UNDP(TA) Copenhagen (30 August - 19 November 1966)

Inter-regional 0178 Training Course on Nursing Services 2 (1 from Ceylon and ;INDP(TA) Administration, Hillerd (Denmark) 1 from Nepal)

(26 August - 8 October 1966)

Inter-re~ional 0 s -- Travelling Seminar on the Organization of 4 (1 from Ceylon, IIM)P(TA) Epidemiological Services and Their Role 1 from India,

in the Control of Communicable Diseases, 1 from Mongolia and USSR (18 August - 8 September 1966) 1 from Thailand)

Inter-regional 020% Travelling Seminar on Nursing, USSR 3 (1 from Afghanistan, WID?( TA) (6-26 October 1966) 1 from Ceylon and

1 from India)

Inter-reqional 0285 Course for Clinical Instructors in 2 (1 from India and UNDP( TA ) Physical. Therapy, Copenhagen 1 from Indonesia)

( 1 September - 30 November 1966) Inter-re~ional 0287 Advanced Training Course in Diagnosis, 2 (1 from Thailand

UNDP(TA) Treatment and Prevention of Major and 1 from Burma) Cardiovascular Diseases, Copenhagen (15 November 1966 - 1 July 1967)

S E A / R C ~ O / ~ Page 219

Child Dental Health Course, Copenhagen (1 March - 31 May 1967)

Travel l ing Seminar on Plague, USSR (1-24 June 1967)

Trave l l ing Semimr on Preparat ion of Teachers f o r Medical Schools, USSR (15 September - 4 October 1966)

Trave l l ing Seminar on Cornunity Water Supply i n Regional Development, USSR (8-30 September 1966)

Training Course f o r Radiological Health Inspec to rs , Rockvi l le , USA (7-18 November

1966)

Symposium on Developmental Work i n Community Water Supply, Tehran (24 October - 3 November 1966)

Conference of Di rec to r s of Sohools of Public Health, Oeneva (29 August - 3 September 1966)

Travel l ing Seminar on t h e Organization of Medical Care i n t h e USSR (6-27 Apr i l 1967)

Travel l ing Seminar on Leishmaniasis, USSR

( 4 May - 10 June 1967)

Seminars and Training Courses on Cholera Control , Dacca (Pak i s tan) (12-21 December

1966 1

1 from Thailand

2 from Mongolia

3 ( 1 Prom Burma and 2 from I n d i a )

6 (2 from Burma, 2 from Ceylon, 1 from India and 1 from Nepal)

3 ( 1 from Afghanistan, 1 from Burma and 1 from Ceylon)

4 (1 from Ind ia , 1 from Indonesia and 2 from Thailand)

1 from India

2 ( 1 from Afghanistan and 1 from Ceylon)

1 from India

3 ( 1 from Indonesia, 1 from Nepal and 1 from Thailand)