A l l t h e c o u n t r i e s i n . t h i s r e g i o n of South Zast
Asia a r e i n
2
s t a t e of vigorous forwayd movement.
The r e c e n t
achievement by many of them of complete n a t i o n a l independence,
combined w i t h t h e dramatic p o s s i b i l . i t i s s o f r e r e d by modern
s c i e n t i f i c development foi' t h e purpose of e c o n o ~ i cbetterment,
l u v e produced a s t a t e of l n t e n s e a c t i v i t y i n a l l d i r e c t i o n s
of s o c i a l improvement.
them quiclri;r.
People want big t h i n g s and t h e y want
The ~ a t i b n a la d n i n i s - L r . t i v e machineries si'e
n o t y e t f u l l y geared t o h,andle a d e q u a t e l y t h e enormous
a d d i t i o n a l s o c i a l and p h y s i c a l cha3r;e.s t h a t a r e involved.
But t h e urge t o do big t h i n z s i s stron," and b i g t h i n g s a r e
being a t t e m ~ t e dsome-ki.1~~
;iith inadequate resources i n men
and m a t e ~ i a l s . This s t r o n g p u b l i c demand f o r s o c i a l change
i s a l s o r e f l e c t e d i n t h e f i e l d of p u b l i c h e a r t h by t h e
f i e s i r e t o undertake a l a r g e v a r i e t y of p ~ o j e c t swhich sometimes r e s u l t s i n d i s p e r s i o n of e f f o r t over a v i d e f r o n t
t h a t i a c k s adequate st::ength a t v u l n e r a b l e p o i n t s .
For e::ample,
heavy f i e l d commitments a r e undei-taken without adequate
s t r e n g t h e n i n g of t h e b a s i c healtin a d m i n i s t r a t i o n structure
a t t h e c e n t r a l and provincial. l e v e l s and some s p e c i a l i s e d
c a m p a i ~ n sa r e g e t t i n g s t a r t e d i n :.dvance of b a s i c s e r v i c e s .
However, t h e genel-al t r e n d of t h e forward movement i s i n
the r i g h t direction.
I n t h e 'fo?swor7d' t o t h e l a s l y e a r ' s r e p o r t a
p l e a was made f0.r s h i f t i n ? ; of eaqphasis towai'ds b a s i c needs
such a s im>roverne?t 01 s a n i t a t i o n , h e a l t h education and much
more i n t e n s i v e t r a i n i n ; of personnel, s p e c i a l l y a u x i l - i a r y
personnel.
The Regional C o m i t t e e a ~ p r o v c dt h i s through a
Torma.1 r e s o l u t i o n a t i t s s i x t h s e s s i o n ; and s i n c e t h e n
~ o v e r n n e n t a lr e q u e s t s have been s t e a d i l y coming Corward f o r
WHO a s s i s t a n c e i n t h e s e b e s i c p u b l i c h e a l t h f i e l d s .
i s encouz.r:ing
Tilts
3s i t s:-~ows t h z t governments a r e a l i v e t o
t,a2se prob?.ems.
J-.
V?~.ati s needed now i s t o a c h i e v e s b ~ e n ~ t h e n -
i.ng ol t h e pul,lic h e a l t h d i r e c t i n g s t a f f
2.;
t h e c n n t r a l and
p r o v i c c i a l l e v e l s i n order t o ensure that (1) g a i n s a l r e a d y
made a r e c o n s o l i d a t e d ; ( 2 ) major e f f o r t is r e s t r i c t e d
towards a f e v carefully- s e l e c t e d p r i o r i t i e s ; and (3) iirsangements f o r pz'oducing adequately t r n i n e d p e r s o n n e l a r e
i n t e n s i i i e d and t h e i r u t i : c i z a t i o n assured.
N a t i o n a l planning f o r economic development i s
g r a d u c l l y assuming a concreto s:?a;~e i n nnny c o u ; l t r i e s .
Although h e a l t h does n o t a7.ways f i n d an i m p o r t a n t enough
';llcce i n n a t i o n a l p l a n s , t h e h e a l t h bud:,ets a r c sloxily and
steadily rising.
I t i s necessz.ry t o e n s u l e th:l.t t h i s s m a l l
rise i s n o t rlispepsed widely and thr,t a d i s p r o y o r t i o n a t c
m o u n t does n o t Zind i t s way i n t o h o s ~ i t n l sand idispenseries
i n proi'ei.snce t o schemes f o r safe-diiinking water s u p 2 l i e s
and elementary s a n i t a t i o n ,
L i a i s o n between d i f f w e n t department.: o f zovernments
needs g r e a t e r improvement es f o r exanple, between iieaLth
departments, education departments and a g r i c u l t u r a l d e p a r t ments.
This need 123s become ve?y appa?ent i n t h e f i e l d
of a e d i c a l e d u c a t i o n and h e a l t h e d u c a t i o n of t h e p u b l i c .
Mass campaigns i n conmunicable d i s e a s e c o n t r o l a r e
s t i l l a major f e a t u r e of p u b l i c h e a l t h e f f o r t and w i l l
continue t o be s o f o r some time u ~ t i tlh e s i z e of -the p u b l i c
.is
t
h e a l t l l problem i s s u P f i c i e n t l y reduced.
Howevers t h e
porio1.1 of co:2solidation shocld now bogin i n o r d e r t h a t
t h e s j ~ i ? c t a c ~ l . ag2a i n s achieved by mass campaigns become
an integi';;.l p a r t ' of t h . j gene:.-al. p u b l i c h e ~ l t hs e r v i c e s .
Some mi".t h e r.;t..ss c m p a i e n s a s f o r e x a ~ l p l emz.laria, p7:rs
and 3CCi have a l r e a d y 3.i.rived a t a s t a g e where they should
b e s i n t o be absorbed i n t o t h e :r?i?eral p u b l i c hea1,th
senices.
While i n inost c o u n t r i e s l a r g e n a t i o n a l campaigns
have al-eady developwJ. i n r e s p e c t or" m a l a r i a , yaws and
BCG, i n tile f i e l d of riatei'nal. and c h i l d h e a l t h and
g e n e i a l t u b e r c u l o s i s c o n t r o l bmg a s s i s t a n c e i s still
l a r g e l y i n t h e s t a g e 02 demonstration and t r a i n i n g p r o j e c t s .
The t r e n d , howevsr, 1 s s t o ? . d i l y developi'ng of
g i v i n g d i r e c t adviso-y s e r v i c e s a t c e a t r a l and p o v i n c i a l
l . e v e l i n ;;ref s e n c e Lo a e t u z l T i e l d iiemonstratio;..~. I n
nursin:;, on t h e o t h e r ban.:, most of ow a c t i v i t i e s a r e i n
t h e f i e l d o:f t r a i n i n g
,.ti?
'
this h a s bean one of t h e major
p o i n t s o r s w c e s s in t h o South S a s t Asia pro?;rawx.
The
big n a t i o n a l campaign f o r h a l a r i a con<-ol i n I n d i a h a s
become we1.i-established covering almost 100 liiilllon people
a t . t h e end of 19%.
Ceylon i s >?:oposing a b i g d r i v e f o r
t u b e i ~ c u l o s i r :conti'ol tl;rou:,.h t h e e s t a b l i s h m e n t of numerous
provincial clinics6
The a s s i s t a n c e t o u n d e r p a d u a t e medics1 educntion
has been continued but t h e p o s i t i o n with regan3 t o n a t i o n a l
c o u n t e r p a r t s i s some7,rhat discourazing.
Governnents s t i l l
expect WHO and o t h e r ouJiside a y e n c i e s to: " f i l l vacancies"
i n t h e i ? n a t i o n a l 2 u b l l c h e a l t h se-vices ins'lead of e x p l o i t i n g
o u t s i d e e x p e r t s f o r t h e purpose of t e a c h i n g and t r a i n i h g .
I t n i g h t be a d v i s a b l e t o give h i g h e r p r i o r i t y f o r WHO a i d
t o the development of f u l l time p u b l i c h e a l t h d e p a r t n e n t s
i n medicel s c h o o l s than t o providing p r o f e s s o r s i n a
v a r i e t y of s u b j e c t s I
A p r e l i m i n a r y survey of medical
e?ucation needs, developzd w i t h t h e h e l p of WHO h e a d q u a r t e r s
from t h e d a t a provided by t h e f o u r v i s i t i n g teams of medical
s c i e n t i s t s i;o t h e d i f f e r e n t c o u n t ~ i e si n t h e r e g i o n , i s t h e
s u b j e c t of a s e p a r a t e item on t h e agenda.
The Regioilal
Committee i s r e q u e s t e d f o r s u i d a n c e w i t h r e g a r d t o t h e
n e x t a 2 p r o p r i a t e s t e p t h a t should be t a k e n by WHO i n 'chis
important f i e l d .
The Government of I n d i a and t h e Boclcefeller
Foundation nave a l r e a d y taker? some i n i t i a l s t e p s i n this
direction,
Some p l a n s f o r environmental s a n i t a t i o n have
developed i n almost a l l c o u n t r i e s of t h e region.
Much work
howev;.r l i e s ahead :?or trainin[: of s a n i t a r y e n g i n e e r s and
auxiliaries.
The b i g g e s t p l a n , t h a t of: I n d i a , i s s t i l l . i n
t h e p r e p a r a t o r y stage.
Burma i s making a b i g e f f o r t i n r u a l medical
r e l i e f w i t h t h e t r a i n i n g o f h e a l t h a s s i s t a n t s an6 midwives
f o r t h e manning of over 60 r u r a l h-ralth u n i t s every yeer.
I n d i a hopes t o undertake a l a r g e s c a l e t r a i n i n g of auxiliary
h e a l t h p e r s o n n e l w i t h t h e same o b j e c t i v e ,
I n most c o u n t r i e s WHO-assisted p r o j e c t s have
a l r e a d y sp??ead o u t s i d e th? c a p i t a l s i n t o t h a p r o v i n c i a l
c e n t r e s aad t h e mass cm:>aigns have o:f coufse covered mostly
v i l l a g e populations.
I n Bums, we have a l r e a d y moved o u t
of the c a. p i t a l i:?to Manda?.ay, Lashio, Maymyo, e t c ,
,
In
Afghanistan, o u r e f f o r t s t o develop work o u t s i d e Kabul
have, w i t h t h e e x c e p t i o n of n a l a r i a and typhus c o n t r o l ,
n o t y e t succeeded.
I n I n d o n e s i a , work w i l l soon begin
t o nove o u t s i d e .of Java i n t o Sumatra and o t h e r b i g
islands.
I n Thailand, work ol;i;side Bangkok i s spreading
t h r o u ~ ht h e p r o v i n c e s and rurel a r e a s .
Some mention must be made of t h e d e g ~ e eof
l o c a l s u p p o r t given t o i n t e r n a t i o n a l l y a s s i s t e d p ? o j e c t s
i n general.
While l o c a l cooperation i s always a v a i l a b l e
i n p r i n c i p l e i t s t p a n s l a t i o n i n t o t h e t a n g i b l e shape of
b u i l d i n g s and. l o c a l s e r v i c e s , t r a n s p o r t f a c i l i t i e s and
maintenance, a d e q u a t e c l e r i c a l a s s i s t a n c e and above a l l
adequate n a t i o n a l p e r s o n n e l i s n o t always forthcoming.
The r e s u l t i s t h ~ t,he p r o j e c t s do n o t r e c e i v e C u l l v a l u e
from t h e investments ;lade botll by government and WHO.
T& some e x t e n t t h i s i s m a v o i d a b l e because l o c a l r e s o u r c e s
i n men and m a t e r i a l s a r e very l i m i t e d .
Our methods a r e
c o r r e c t and I a n s u r e t h a t i f governments would make a
st-onger e f f o r t t o p r o v i d e gi3eater i o c a l s u p p o r t e s p e c i a l l y
i n p e r s o n n e l a much b e t t e r s e r v i c e could be rendered by
WHO f i e l d s t a f f .
The experiment of r e c r u i t i n g some exper-Ls from
r l i t h i n t h e regioil, on beiielf of and a t t h e c o s t of governments a s recornended
being pursued.
t h e S i x t h Regional Committee, i s
So fa.1- ttro c o u n t r i e s (Ceylon and I n d o n e s i a )
have i n t i m a t e d t h e i r immediate needs.
be made t o f i n d s u i t a b l e candidates.
Every e f f o r t w i l l
R e l a t i o n s wit11 o t h e r agencies have continued t o
develop c l o s e l y during t h e year.
.I
Our a s s o c i a t i o n with
t h e United S t a t e s programmes, p a r t i c u l a r l y i n I n d i a and
Indonesia, has been v e r y c l o s e and c o r d i a l .
With t h e
help of WHO Area R e p r e s e n t a t i v e s we have come much c l o s e r
t o Colombo P l a n a c t i v i t i e s .
During t h e p a s t year i t has
been p o s s i b l e a c t i v e l y t o a s s i s t i n guiding a p p r o p r i a t e
governmental r e q u e s t s towards t h e Colombo P l a n i n r e s p e c t
of e x p e r t s , f e l l o w s h i p s and equipment.
One o f t h e Coloabo
P l a n c o u n t r i e s has very k i n d l y agreed t o provide s i x
n u r s e s t o c o l l a b o r a t e c l o s e l y i n a j o i n t WHO/UNICEF p r o j e c t
i n maternal and c h i l d h e a l t h i n India.
this association.
We ~ l a r m l yweieome
C o l l a b o r a t i o n with UN agencies, e.g.
FA0 and UNESCO i n some j o i n t p r o j e c t s has continued.
The new s t a t u s of UNICEF, on a more permanent
f o o t i n g , i s a welcome development axd if c a r e f u l l y a d j u s t e d
with r e g x d t o WHO r e s r ~ o n s i b i l i t i e sa s a t e c h n i c a l organiza-
t i o n , t h e mutual a s s o c i a t i o n should prove even more
p r o c i t a b l e than before.
There a r e some important p o i n t s
of r e l a t i o n s h i p and procedure vhich have been discussed by
t h e Seventh World H e a l t h Assembly.
Consul'tations a l s o
continue between t h e two headquarters.
A t the regional
l e v e l we w i l l continue t o :-:ive t h e utmost of our t e c h n i c a l
r e s p o n s i b i l i t y towazds UNICEF-assisted p r o j e c t s s o long a s
Ire a r e a b l e t o m i n t a i n the soundness of p u b l i c h e a l t h
p r i n c i p l e s and a n adequate balance between g e n e r a l WHO
a c t i v i t i e s and UNICEF a c t i v i t i e s .
The Seventh 'vlorld H e a l t h Assembly has decided that
we should develop t h e Technical Assistance programme
L
1I
vii
s e p a r a t e l y from our 3egularprogramme.
This d e c i s i o n i s
r e f l e c t e d i n my programme p r o p o s a l s placed b e f o r e t h e
Regional C o n n i t t e e i n r e s p e c t
of 1956.
The r e c e n t t r e n d s
i n t h e T e c h n i c a l A s s i s t a n c e Cormittee and t h e Technical
A s s i s t a n c e Board i n v o l v i n g t h e a b o l i t i o n of automatic
a l l o c a t i o n s t o S p e c i a l i z e d Agencies and t h e f o c u s s i n g of
country programnles tl-rough TAB Re2resentabives anrl
governments c r e a t e problems of programme re-adjustment on
which a s e p a r a t e d o c m e n t i s being p l a c e d b e f o r e t h e
Regional Committee.
This Report r e l a t e s t o t h e p e r i o d J u l y 1953 t o
J u l y 1954.
The u s u a l method OF j:~resentation has been
followed i n d e s c r i b i n g -the work by s u b j e c t s a s w e l i a s by
countries.
We have been f o r t u n a t e i n ~ e c e i v i n gt h e f u l l e s t
cooperation and understanding f r o n a l l c o u n t r i e s of t h e
r e g i o n and f o r t h i s continued suppoi-t I wish t o r e c o r d our
g r a t e f u l thanks.
I t i s w i t h a f e e l i n g of deep r e g r e t t h a t I h a ~ e
t o report t h e r e t i r e m e n t of t h e Dzputy D i r e c t o r of o u r
Regional O f f i c e a t t h e end of September t h i s year.
He
joined t h e Regional O f f i c e i n January 1949 almost a t i t s
commencement and shared w i t h t h e Regional D i r e c t o r t h e
d i f f i c u l t t a s k of b u i l d i n g t h e f i r s t WHO Regional Office.
IJith an e x c e l l e n t academic
background, e x t e n s i v e
e x p e r i e n c e of p u b l i c I i e a l t h a d m i n i s t r a t i o n a c q u i r e d through
many y e a r s of s e r v i c e a s head of t h e H e a l t h D i r e c t o r a t e i n
his country, coupled w i t h a good knowledge of h e a l t h ,
s o c i a l 2nd economic c o n d i t i o n s of most of t h e c o u n t r i e s of
t h i s r e g i o n , he has been of i n f i n i t e a s s i s t a n c e t o t h e
viii
Regional Office.
H i s e x t e i ~ s i v eknowledge and eirperience
of p u b l i c h e a l t h m a t t e r s have been of z r e a t he3.p i n our
d e l i b e r a t i o n s and d i s c u s s i o n s i n t h e s e annual meetings of
t h e Regional Comaittee and I am s u r e his absence i n s i m i l a r
meetings i n f u t u r e w i l l be keenly f e l t .
There i s a n o t h e r a s p e c t of h i s a c t i v i t i e s which
desei-ves s p e c i a l mention and t h a t i s his presirfentship of
of our s t a f f a s s o c i a t i o n .
I n s p i t e 02 heavy o f f i c i a l
d u t i e s he most w i l l i n g l y a c c e p t e d t h i s honorary p o s t f o r
over two yeai-s and guided t h e a c t i v i t i e s o f t h e S t a f f
S o c i e t y i n t o u s e f u l and p r o g r e s s i v e channels.
I ~ r i s ht o r e c o r d h e r e our high esteem and g r e a t
indebtedness t o Doctor Chellappah f o r h i s c o n t r i b u t i o n t o
t h e World H e a l t h Organization and i t s p r i n c i p l e s .
.-
C. MAN1
Regional D i r e c t o r