The long-term objectives of the World Health Organisation in Europe endorsed b y the Regional Committee at its third session have assisted materially in the orderly development of an organizational structure of the Regional Office and in initiating programmes suited to the particular needs of Europe. Many difficulties in detail were encountered, and some will be mentioned in this report but, on the whole, progress during the first six months of 1953 was satisfactory.
In 1953 the following Members or Associate Members have participated in the work of the Region : Austria, Belgium, Denmark, Finland, France, Germany (Federal Republic), Greece, Iceland, Ireland, Italy, Luxembourg, Monaco, Morocco (French Protectorate), Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Tunisia, Turkey, the United Kingdom of Great Britain and Northern Ireland, and Yugoslavia. It must be recorded with regret that the following countries have not yet resumed participation in the work of the Region : Albania, Bulgaria, Byelorussian SSR, Czechoslovakia, Hungary, Poland, Roumania, the Ukrainian SSR, and the U. S. S. R.
This section of the Report is restricted to activities actually carried on inside each country during the first half of 1953 ; the participation of Governments in the inter-country programmes is recorded in Table I and will not necessarily be recorded again in this section. Inter-country activities which are to take place during the second half of 1953 are listed in Table II. The number of fellowships awarded or approved is shown in Table III.
The comprehensive programme of World Health Organisation Assistance* in Tuberculosis Control, Venereal Disease Control, Environmental Sanitation, Serum and Vaccine Production has now been implemented. Plans for improvement of post-graduate training for medical officers of the Public Health Training School of Vienna* are advancing, and the visit of a World Health Organisation consultant is contemplated in the near future. It is also expected that a World Health Organisation consultant will visit Austria within the next few months, in connexion with the Tuberculosis Control Programme.
A tripartite (W. H. O./U. N. I. C. E. F./Austrian Government) Plan of Operations for a serum and vaccine* project has been approved by World Health Organisation and U. N. I. C. E. F. and is in the process of being studied by the Austrian Government. This project involves upgrading of serum and vaccine production, especially diphtheria and pertussis, and a mass campaign for diphtheria immunisation throughout Austria. This was started in 1953 by the Government, and UNICEF equipment for the production laboratories'has been ordered and partially delivered. The World Health Organisation Regional Health officer visited each provincial Office in connexion with this programme.
Ten fellowships* have been awarded, or are in the process of being awarded, under TÀ programmes for study in Public Health Administration, Tuberculosis, Venereal Diseases Control and Environmental Sanitation.
A plan of operations has been worked out with U. N. I. C. E. F. for the programme for handicapped children and submitted to the Austrian Government for signature. This plan includes the establishment of a Rehabilitation Centre at Wiener Neustadt to which U. N. I. C. E. F. will provide the necessary supplies and equipment. World Health Organisation is to provide a consultant in physiotherapy for a period of six months, to start in November, 1953, and a fellowship in the field of poliorehabilitation has been approved.
A World Health Organisation consultant visited the diagnostic centre for Juvenile Epilepsy which was recently established in the University Psychiatric-Neurological Clinic in Vienna, partly equipped b y U. N. I. C. E. F. with advice and training facilities provided by World Health Organisation. Two fellowships in Mental Health have been awarded in connexion with this project.
The participation of Austria in the inter-country programmes is shown in Table I.
The Government of Belgium agreed to act as Host country for the Study Group on Problems of the Peri-Natal Period which is to take place in Brussels in September. This group will deal with causes and means to reduce mortality of the foetus and the new-born during gestation, delivery and in the neo-natal period.
Three individual fellowships were awarded to Belgium under the Regular Programme in the field of mental health, maternal and child health and endemo-epidemic diseases. A fourth fellowship in nursing is also planned.
Belgium also participated in the intercountry programmes as shown in Table I.
World Health Organisation and the Rockefeller Foundation continued to assist the Government of Denmark in carrying out a morbidity survey plan which is now in its second year, and it is expected that the nationwide morbidity survey will be able to reveal important results which will be of interest to other countries. A World Health Organisation statistician-consultant spent 2 1/2 months in Denmark to assist the Danish statistical section in setting up plans and methods for analysis of the data how becoming available. A small amount of supplies has been ordered and a fellowship for an assistant statistician in the National Health Service of Denmark is under discussion.
The Anaesthesiology Training Centre in Copenhagen is now in its fourth year. The fourth basic course began on 8 June and is attended by 8 ROE trainees, trainees sponsored by the' Danish Government and fellows from World Health Organisation regions other than Europe. Teaching responsibilities are assumed by eight Danish instructors supported by international lecturers and instructors provided by World Health Organisation. One of the Danish instructors is to be sent b y the Regional Office to the U. S. A. for a period of three months for further training in anaesthesiology. Five of the most promising ROE trainees who attended the third basic course were granted an extension of fellowship for study in the United Kingdom.
The World Health Organisation is to assist a National Training Course in Psychiatry which will take place from August to October, 1953 in Copenhagen and Aarhus, by providing two lecturers for one month each. Arrangements have been made to secure the services of such lecturers.
Nineteen Senior School Health Officers from the European Region and seven from the Eastern Mediterranean Region, visited Denmark in April to discuss school health services. Most of the time was spent in Copenhagen where a number of lectures were given and discussions held in connexion with visits to schools and institutions for normal and handicapped children. A Danish Group Leader prepared the programme in Denmark in collaboration with World Health Organisation and acted as discussion leader. The Group later visited The Netherlands.
Denmark participated in the Inter- Country programme summarised in Table I and was awarded four individual fellowships for a study in surgery and maternal and child health.
The World Health Organisation continued to assist Finland in their comprehensive programme* in many aspects of communicable diseases control, "public health, nursing, environmental sanitation, social and occupational health maternal and child health and education and training. Eight fellowships were awarded (or are being awarded) in the field of tuberculosis, venereal diseases, maternal and child health and education and training. X-ray and laboratory supplies were delivered to the Pori area where a concentrated tuberculosis control programme* is carried on.
A World Health Organisation consultant* visited Helsinki to advise the National Institute of Occupational Health on the problem of silicosis. He also gave a few lectures at the above Institute.
UNICEF's equipmont was delivered to institutions caring for physically handicapped children. An alectro-encephalograph for the children's Clinic in Helsinki is being ordered.
Finland contributed an export in sanitary engineering to the ad hoc Advisory Committee which met in Geneva in April for discussions on the technical questions to be debated at the Fourth Seminar for European sanitary engineers envisaged for 1954. Finland participated in the inter-country programmes as shown in Table I and was awarded one individual fellowship under the World Health Organisation Regular Budget for the study of otolaryngology.
An expansion of the Premature Infant Programme, with supplementary equipment to be provided through the remaining UNICEF funds, is under discussion. A fellowship for study of the care of premature infants has been awarded to a paediatric nurse, thus bringing to six the number of fellowships granted to France in connexion with this programme.
The Regional Health Officer in Maternal and Child Health paid a visit to the French authorities in order to discuss tentative plans for the development of a Rehabilitation .Centre for children near Paris.
The Deputy Regional Director and the responsible Regional Health Officers visited the demonstration and training area in rural public health of Soissons to discuss the further development of the area in various fields of health including sanitary engineering. Two fellowships have been awarded to members of the staff of the area. Preparation for training courses in rural public health, intended for various types of health personnel, is proceeding.
An advance training course in Anaesthesiology, 'organised by the Director of the Anaesthesiology Training Centre with the assistance of a World Health Organisation consultant, started at the University of Paris in May. Four World Health Organisation fellows from the European Region are attending this course in addition to the sixteen French trainees who were already studying.
Technical aspects of the study of the health and welfare needs of the family unit, for which facilities have been provided since 1951 b y France and the United Kingdom, have been discussed with the World Health Organisation Technical Adviser of the study. The final report from France has been received, and it is expected that the survey for Great Britain will be completed by the end of the year.
The World Health Organisation continued to collaborate closely with the International Children's Centre to ensure the co-ordination of work, particularly in training. World Health Organisation provided 14 fellowships for attendance at the Training Courses on Prevention of Tuberculosis in Children, Re-adaptation of Handicapped Children and Social Paediatrics.
À French expert took part in the discussions of an ad hoe Committee which met in Geneva to advise on the programme on the Fourth Seminar for European Sanitary Engineers scheduled for 1954.
Studies on the effects of child development arising from separation from the mother are being carried out simultaneously in France and the United Kingdom under the sponsorship of the International Children's Centre and the World Health Organisation. At a meeting held in Paris in June, practical recommendations were made in order to avoid separations which are not absolutely necessary or to minimise their effects. The possibility of continuing the study on a long-term basis is under discussion.
France participated in the intercountry programmes set out in Table I. In addition, 12 individual fellowships were awarded for study in tuberculosis, maternal and child health, environmental sanitation, public health administration, nutrition, rehabilitation and hospital organisation.
Delivery of UNICEF equipment to institutions caring for physically handicapped children was completed in February, 1953.
A German expert in sanitary engineering took part in the discussions of an ad hoc Advisory Committee which met in Geneva in April last to make recommendations in connexion with the Fourth Seminar for European Sanitary Engineers scheduled for 1954.
The Federal Republic of Germany participated in the inter-country programmes as shown in Table I. In addition four individual fellowships were awarded for study of public health administration, communicable diseases and cancerology.
Discussion is also proceeding on the preparation of a Regional Conference on Vaccisination against Communicable Diseases to be held in Germany next year.
The Deputy Regional Director visited Greece for general discussions on programmes under both Regular and TA Budgets.
A tripartite (W. H. O./U. N. I. C. E. F./Greek Government) plan of operations for a project on rehabilitation of handicapped children has been signed. The programme will be centred around the Voula Rehabilitation Centre outside Athens, for which U. N. I. C. E. F. is procuring supplies and equipment. The World Health Organisation is to provide two consultants, one medical director for the Centre and one orthopaedic nurse. Fellowships were awarded by U. N., I. L. 0 . and World Health Organisation for training as a team, to persons selected b y the Greek Government to take up work on this programme upon their return to Greece in early autumn.
A plan of operations for a Maternal and Child Health* project finalised in a tripartite agreement and was signed b y the interested parties—the Greek Government, U. N. I. C. E. F. and the World Health Organisation. This programme is intended to strengthen the MCH Services in the Thessaly Region by upgrading MCH centres and introducing 10 mobile units based on them. A World Health Consultant in social paediatrics is to take up duty in Greece at the time UNICEF supplies are about to arrive.
The original plan of operations for the Tuberculosis Control project* called for simultaneous development of five districts where tuberculosis control activities were to be concentrated. It has been agreed, however, with the Greek Government that only two areas are to be implemented in 1953. Emphasis is placed on developing the Athens Chest Institute as a national training centre for Greek tuberculosis workers. Supplies for the Athens Chest Institute and the Regional Dispensary at Xanthi have been ordered. The World Health Organisation is also to provide the services of a full-time public-health TB consultant and a public-health nurse, who are now being recruited.
Two fellowships* were awarded for the study of animal brucellosis and colloidal chemistry of the cell.
Following the recommendations of a World Health Organisation consultant who visited Greece in 1952, the Greek Government has approached the Regional Office for possible assistance on the establishment of a National School of Anaesthesiology in Athens.
Greece also participated in the intercountry programmes summarised in Table I.
Iceland participated in the intercountry programmes listed in Table I. In addition, two individual fellowships were awarded for the study of nursing and physio-therapy of poliomyelitis patients.
A World Health Organisation consultant assisted the authorities in Ireland in selecting two candidates for the posts of psychiatrist and child psychologist for a Child Guidance Clinic which is to be established in Dublin. World Health Organisation fellowships were granted to these candidates to enable them to undergo suitable training in the U. S. A. prior to their assignment to the Clinic.
* Ireland also took part in the intercountry programmes shown in Table I. In addition, four individual fellowships were awarded for the study of public health administration.
World Health Organisation fellowships on UNICEF funds were awarded to two physicians to be connected with the Don Gnocchi Rehabilitation Centres for children in Rome and Parma. A World Health Organisation consultant in physiotherapy is to visit these centres towards the end of the year to train the nursing personnel and advise on the use of UNICEF equipment.
The U. N. I. C. E. F./W. Ii. 0 . programme for the care of premature infants started in five of the seven centres equipped with UNICEF supplies. The Regional Health Officer in Maternal and Child Health visited all seven centres to investigate the need for possible supplementary equipment to be provided by U. N. I. C. E. F.
Teaching equipment has been delivered to a new school of public health in Rome. Further assistance, in the form of visiting lecturers and fellowships for members of the teaching staff, will be provided when a request is received.
World Health Organisation assistance has been requested by the Government of Italy for the further development of a health education project in Perugia. A visit of World Health Organisation staff members is planned for the near future.
A group training course on diseases transmitted by insects started in May at the Istituto Superiore di Sanità in Rome. World Health Organisation fellowships were awarded to ten candidates from the European Region for attendance at this course. The programme of the course provides for one month of theoretical lectures and laboratory demonstrations and for a second month to be devoted entirely to field work and visits to areas in Italy where insect control operations are being carried out.
The Italian Government has accepted the invitation to act as host country for the European Seminar on Occupational Health which is to be held in September at the Institute for Occupational Health " Luigi Devoto " in Milan. This seminar is organised b y the World Health Organisation in collaboration with the Italian authorities and I. L. 0.
A symposium on the control of insect vectors of disease is to be held in Rome in co-operation with the Istituto Superiore di Sanità and the Division of Environmental Sanitation of World Health Organisation Headquarters. This symposium is scheduled for the end of October.
Italy contributed one professor in sanitary engineering to an ad hoc Advisory Committee which met in Geneva in April to advise on the choice of technical subjects to be discussed at the Fourth Session for European Sanitary Engineers which is to take place in 1954.
Information on the participation of Italy in the inter-country programmes is contained in Table I. In addition, three individual fellowships were awarded for studies in the fields of poliomyelitis, venereal diseases and bovine tuberculosis.
Luxembourg took part in the travelling study group of senior school health officers who visited Denmark and The Netherlands (Table I).
Participants from Luxembourg will attend the Seminar on Occupational Health in Milan and the Conference of Public Health Nurses in Switzerland which are to take place in the second half of 1953 (Table II).
A fellowship was awarded to Luxembourg for participation in the postgraduate course in the fundamentals of thoracic clinical science and surgery given at the University of Groningen in May.
A plan of operations for a project in trachoma control* to be carried out with the joint assistance of the World Health Organisation and U. N. I. C. E. F. was signed by the three parties involved (W. H. O./U. N. I. C. E. F./Govt. of Morocco). This project involves mass treatment of seasonal acute infectious eye diseases and trachoma with modern antibiotics, and is to be conducted with the assistance of two World Health Organisation full-time consultants.
At the request of the Government, a World Health Organisation consultant visited Morocco to conduct a survey of the venereal disease* problem in the country and prepared a provisional plan of operations to combat this major public-health problem with the joint assistance of the World Health Organisation and U. N. I. C. E. F. The plan of operations is under discussion with the Government.
The French Protectorate of Morocco also participated in the inter-country programmes as shown in Table I.
A first training course in English will start in September at the Rotterdam port demonstration and training centre, for a duration of 12 weeks, and will deal with all the various aspects of venereal disease control which are particularly applicable to maritime populations. Students from maritime nations of World Health Organisation Regions (including Europe) have been awarded fellowships for attendance at the course.
The World Health Organisation continued to give assistance to the Institute of Preventive Medicine in Leyden in the form of books and teaching equipment.. Courses in public health and tropical medicine during the academic year 1953-54 are being organised jointly by the Institute for Preventive Medicine in Leyden, the Institute for Tropical Hygiene in Amsterdam and the Institute for Tropical Medicine in Leyden; the World Health Organisation is to provide the services of a consultant to advise on further development in public-health training. A fellowship has been approved for a staff member of the Institute for Tropical Hygiene in Amsterdam to study tropical diseases in Africa.
A Dutch group leader was assigned by the Government to conduct the Study Group on School Health Services during their stay in The Netherlands. Visits to rural and urban school health services, as well as to specialised institutions, were followed by several days of discussion.
Two World Health Organisation lecturers assisted the University of Groningen for the third postgraduate course in the fundamentals of thoracic clinical science and surgery which took place in May. World Health Organisation fellowships were granted to twelve European trainees who attended the course.
A Dutch expert in sanitary engineering assisted the ad hoc Advisory Committee which met in April in Geneva, in its recommendations for the fourth Seminar for European Sanitary Engineers which is to be held in 1954.
The Government of the Netherlands has agreed to act as host country for the Seminar on Mental Health Aspects in Public Health Practice which will take place in Amsterdam in July. The purpose of this Seminar is to review, by lectures and group discussions, the application of mental health principles in several fields of public health practice.
The Netherlands participated in the inter-country programmes described in Table I, and, in addition, was awarded five individual fellowships for studies in nursing, mental health, geriatrics and environmental sanitation.
Information on the participation of Norway in the inter-country programmes is contained in Table I.
Two individual fellowships were awarded to Norway for study in dental prophylactics and rural health.
Portugal's participation in the intercountry programmes is described in Table I.
Five individual fellowships have been granted to Portugal for study in epidemiology and prophylaxis of infectious diseases, organisation of port and airport sanitation services, public health administration and biochemistry of nutrition.
A Regional Health Officer visited Spain in connexion with the Technical Assistance programme which concentrated in 1952 on the control of zoonoses. It was agreed not to limit assistance to that particular field but to incorporate it in a general programme of communicable diseases control.
A World Health Organisation consultant visited the rice fields of Spain to advise on lepstospirosis*, and assisted the Spanish workers in improving control methods which will lead to an increase in available manpower.
Fellowships* were awarded to two Spanish trainees to enable them to attend the Trachoma Course which was held in Giza (Egypt) in February, under the sponsorship of the World Health Organisation Regional Office for the Eastern Mediterranean. Another fellowship* was awarded for the study of the pathology of laboratory animals.
Spain also participated in the intercountry programmes as shown in Table I, and is in the process of being allocated a fellowship under Regular Budget for study in maternal and child health.
As a result of the decisions taken by an inter-governmental Committee which met in Copenhagen and Gôteborg in 1952, a first course in public health will be given in Gôteborg in July and August, 1953. This course will concentrate on epidemiology, statistics and environmental sanitation. Fellowships have been awarded to twenty Scandinavian health officers who are invited to attend. World Health Organisation will also contribute lecturers.
A Conference on postgraduate training in hygiene, preventive and social medicine is also to be held in Goteborg in July, 1953. It will bring together professors of hygiene and medical administrators from European countries. This conference is the second of a series of regular meetings planned to enable European professors of hygiene and Directors of Schools of Public Health to examine training methods in relation to present needs. The first conference was held in Nancy in 1952 where undergraduate training in hygiene, preventive and social medicine was discussed. The Government of Sweden has agreed to act as host to a Conference on Relations between Paediatricians and Child Psychiatrists which will be held at Stockholm, probably in September, 1954. Pursuant to the recommendations made by an ad hoc Committee composed of ten participants from France, Portugal, Denmark, Sweden, the United Kingdom and the U. S. A. •— which met in Geneva in February — a first planning meeting for the Conference was held in Stockholm in June between the Swedish authorities and World Health Organisation representatives.
Sweden participated in the intercountry programmes shown in Table I. In additions, five individual fellowships were awarded for studies in Mental Health, Public Health Nursing and Environmental Sanitation.
Switzerland will act as host for the Conference of Public Health Nurses, scheduled to take place in Mont Pèlerin s/Vevey in October, 1953. The purpose of the conference is to bring together hospital nurses and public health nurses from all European countries to discuss problems of co-ordination of nursing services in and outside the hospital, and of nursing education.
A Swiss expert took part in the work of the ad hoc Advisory Committee which met in Geneva in April, 1953 to advise on the questions to be discussed at the Fourth Seminar for European Sanitary Engineers scheduled for 1954.
The inter-country programmes in which Switzerland took part are shown in Table 1. In addition, four fellowships were awarded for study in maternal and child health, nursing, mental health and environmental sanitation.
As a continuation of the fellowship programme for Trieste* which started in 1952, three candidates have been approved for 1953 for study in tuberculosis and maternal and child health.
A basic agreement for provision of technical assistance to the Government of Tunisia has been signed.
A plan of operations for a joint WHO/UN ICEF Project in Trachoma control* is in the process of being signed. A field study of the relationship between fly control and the incidence of acute eye diseases is to be conducted with the assistance of World Health Organisation consultants. U. N. I. C. E. F. is to provide supplies.
Tunisia's participation in the intercountry programme is described in Table I. Moreover, an individual fellowship was awarded under Regular Budget for study in tuberculosis.
Upon recommendations made by the World Health Organisation Regional Health Officer in Maternal and Child Health, who visited Turkey in February, U. N. I. C. E. F. approved a supply programme which aims at equipping 90 Health Centres in various parts of the country. Provision has been made for supplies, such as fish liver oil capsules, etc and for 5-10 vehicles for mobile units (based on Health Centres and Maternity Clinics) to operate in rural districts. Teaching equipment for 10 schools for nurses and midwives is also included in the programme. A World Health Organisation team will provide assistance to the urban demonstration and training centre in maternal and child health now being established in Ankara*.
Post-graduate courses for nurses* are given in Ankara under the supervision of two World Health Organisation nursing advisers.
A World Health Organisation consultant visited Turkey in June to advise with the Government on measures of leprosy control.
The World Health Organisation consultant on public-health administration assisted in drawing up a programme for refresher courses for medical officers and sanitarians to be given at the School of Public Health in Ankara. He also submitted a report to the Government containing recommendations for establishing a pilot region which would serve as a model for the extension of health services in the country. The consultant in publichealth engineering made a survey of the sewerage disposal facilities for the city of Ankara and advised local authorities on various problems related to environmental sanitation. Two fellowships for study of public health administration were awarded in connexion with this programme*.
The BCG campaign, which started in 1952, continued to develop in various provinces of Turkey where the total population was examined. A World Health Organisation team, composed of two physicians and two nurses, is assisting national experts in the extensive vaccination programme. Results obtained by retest and examination of vaccination lesions have been very satisfactory. A fellowship was awarded to the Deputy-Director of the campaign for further training in BCG.
Refresher courses will be given in July and August at the School of Public Health in Ankara, to which World Health Organisation will contribute two short-term consultants, who will lecture on epidemiology and health education of the public.
At the request of the Government, World Health Organisation sent three shortterm consultants (an architect, an installation engineer and a medical expert) to Ankara, to advise the Turkish Workers' Medical Insurance on the construction of two 500 bed hospitals*. A second visit of these experts is planned for the last quarter of 1953.
A plan of operations was signed in June between the Government of Turkey, U. N., î. L. 0., and World Health Organisation for a programme of assistance in Vital and Health Statistics*. World Health Organisation is providing the services of a vital and health statistician for a period of one year
A fellowship* was awarded to a Turkish trainee to attend the course on Trachoma Control which was given in Cairo under the sponsorship of the Regional Office for the Eastern Mediterranean.
Turkey also participated in the intercountry programmes described in Table I.
The study of the health and welfare needs of the family unit, for which the Government has been providing facilities since 1951, is progressing, and it is expected that the survey will be completed by the end of the year. This study is co-ordinated with a similar one in France.
The United Kingdom continued to offer training facilities for both individual studies and for group training. A course in industrial hygiene was organised at the University of Manchester (Nuffield Department of Occupational Health) and at the Roffey Park Rehabilitation Centre, Horsham, and attended by ten World Health Organisation fellows from as many European countries.
The first Conference on Health Education of the Public was held in London, with fifty-seven participants representing eighteen European countries and the Secretariat from World Health Organisation. Its primary objective was to identify the constituents of a total programme of health education of the public, and to plan towards expansion of health education within countries and the European region as a whole.
A study on the effects of child development arising from separation from the mother is being carried out simultaneously in England and France under the sponsorship of the International Children's Centre and World Health Organisation. According to the first results obtained, the possibility of establishing the study on . a longer-tern basis is under discussion.
A British expert took part in the ad hoc Advisory Committee which met in Geneva in April with a view to making recommendations for the fourth Seminar for European Sanitary Engineers scheduled to take place in 1954.
The participation of the United Kingdom in the inter-country programmes is shown in Table I. In addition four individual fellowships were awarded or approved for studies in tuberculosis, bacteriophage, public-health administration and public-health nursing.
The comprehensive programme of World Health Organisation Assistance*, which was completed b y the end of 1952, has been extended for a further two years with the inclusion of new elements such as tuberculosis control.
A World Health'Organisation consultant will visit Zagreb in September to work with Yugoslav experts in the diphteria and pertussis prophylactic producing laboratories, for which a considerable amount of U. N. I. C. E. F. and World Health Organisation equipment was previously furnished.*
A social paediatrician and a publichealth nurse visited Yugoslavia in June to work out a detailed plan of operations for training institutions for nurses and assistance to Homes for Health and Maternity Dispensaries) as well as to establish a list of supplies and equipment to be provided b y U. N. I. C. E. F.*
Trachoma in Yugoslavia has been a problem for many centuries and is a leading cause of loss of vision. A revised plan of operations for a joint WHO/UNICEF project, aiming at treating trachoma with modern antibiotics after an intensive house to house survey to find cases, is under discussion with the Government. UNICEF supplies and equipment, especially antibiotics, have been ordered. Two World Health Organisation fellowships were awarded for attendance at the Trachoma Course of Giza (Egypt); one of these fellowships was extended by three months for further study in France.*
Three other fellowships were awarded or approved for study in tuberculosis, bacteriology and occupational diseases.*
World Health Organisation and U. N. I. C. E. F. assisted in a project aiming at economic production of penicillin in Yugoslavia. The last of the UNICEF equipment for the penicillin plant was delivered and three consultants visited the plant to assist the local workers in bringing it into production. As from 1 July, this project will be transferred to U.N.T.A.A.
In February, the Blood Transfusion Institute in Belgrade (the plasma and gamma globulin plant) was put into operation in the presence of a team of three UNICEF representatives who checked the equipment provided by U. N. I. C. E. F. A World Health Organisation consultant also paid a visit in March. The gamma globulin produced will be used only for maternal and child health, primarily in control of measles.
A World Health Organisation expert visited Yugoslavia in March to lecture at a course in anaesthesiology organised at the Zagreb School of Public Health by a former World Health Organisation sponsored trainee of the Copenhagen Anaesthesiology Centre.
An invitation from the Yugoslav Government to act as host country to the Fourth Seminar for European Sanitary Engineers, scheduled for 1954, has been accepted. A Yugoslav expert took part in the ad hoc Advisory Committee which met in Geneva in April for discussion on the forthcoming seminar.
Five fellowships under the Regular Budget were awarded (or approved) to members of Faculties of Medicine for study in haematology, thoracic surgery, biochemistry and drug control.
Yugoslavia also participated in the inter-country programmes set out in Table I.
The major programme trend in 1953 is still focussed towards the broad fields of exchange of information and professional education and training. While there appears no reason to doubt the value of the activities in Europe it is evident that a preliminary study of health problems or services is often needed before a really valuable conference, seminar discussion or training course can be arranged. A greater proportion of time and effort will need to be devoted to these studies in future.
It is further evident that programmes and particularly inter-country programmes in Europe are scattered over too many fields. This point has emerged in several of the consultations with individual Governments on the Programme for 1955 and the view is fully shared by the staff of the Regional Office. The need for more detailed preparation, the necessary elaboration of techniques for a conference, seminar or training course and the whole question of national follow-up, all these emphasise for the future the desirable objective of fewer and better programmes.
Table I sets out in summary form the inter-country programmes carried out in the first six months of 1953, a textual description of which is elaborated in connexion with the host country or countries in which the activity took place. Table II features the inter-country programmes to be carried out in the second half of 1953. A summary of fellowships awards in the first six months of 1953 (Table III) appears to indicate a programme advancing at a slower rate than in the previous year.
In 1952, a total of 592 fellowships were awarded in Europe compared with 169 fellowships for the first six months of 1953. This reflects to some extent the reduction in Technical Assistance funds available to Europe in 1953 compared with 1952. However, the two years are not strictly comparable, since the tables for 1952 in the Director-General's Annual Report included under " fellowships " the attendance of " participants " at Seminars and similar activities, whereas such attendance in 1953 is not to be included in the fellowship figures. Another related factor was the slowing down of Technical Assistance programmes during the early part of 1953 owing to financial uncertainties. It is probable, therefore, that some levelling up will take place in the second half of 1953.
The participation of certain European countries in the Expanded Programme has been much influenced by economic retardation due to war. Furthermore, these countries in Europe were ready to absorb technical assistance in the early phases of the Expanded Programme. These two factors were reflected in comparatively large technical assistance programmes in Europe in 1952. As economic development improves in Europe and as the more underdeveloped countries of the world increase their absorptive capacity, it is clear that Europe must expect to receive a decreasing proportion of technical assistance funds. This was already evident in 1953, and led to considerable redesign of the programmes. By a combination of deferment of programmes, transfer from technical assistance to regular programme, and emergency assistance from U. N. I. C. E. F., a degree of stability has now been achieved, but necessarily at the expense of some of the programmes which participating Governments had planned for 1953. Similar adjustments are in hand for 1954, but precise planning even with a system of priorities is extremely difficult without knowing the extent to which, technical assistance funds will be available in 1954. In Europe, where the outlook for technical assistance funds is perhaps less certain than in other regions of World Health Organisation, the future appears to depend largely on the technical and financial possibilities for the Organisation to absorb the most important of the activities in the individual countries within the regular programme.
Each year sees progress towards smoother working relationships with other agencies with interests in Europe related to the work of the World Health Organisation. Indeed, there is little reason why this should not happen in Europe where no great distances are involved to prevent the personal contacts on which really effective co-operation depends. The meetings of Secretariat members in the course of duty travel in Paris, Rome, Geneva and Strasbourg is not difficult to arrange when the desire exists on both sides. The real turning-point in a co-operative and practical arrangement is when both sides appreciate the importance of mutual consultation in the planning phase of an activity since adjustments are often very difficult to make later when the two agencies have somewhat different structures and a different system of finances. Table I indicates the end product of some of the close relationships established with agencies in Europe, and the individual country section of the Report outlines the particular activities undertaken jointly with U. N. I. C. E. F.
Joint planning U. N. I. C. E. F. is now a routine procedure and works extremely well. Ever since the establishment of the International Children's Centre.working relations with the Regional Office have been excellent. The Centre provides a valuable additional training resource in maternal and child health, and the staff of the Regional Office regularly partcipate in discussions on the future programme trends of the International Children's Centre. A well-established co-operation with the Rockefeller Foundation in Europe has continued not only on specific programmes, but in many other matters in which the long experience of the Foundation has been made fully available to the Regional Office at any time it was requested. UNESCO participated in the Conference of Health Educators in London, assisted in the planning of regional work on medical libraries, and shares in the preliminary study of terminology in sanitary engineering. Specific co-operation is established with the I. L. 0 . including recent regional activities in occupational health, and similar instances of joint effort could be cited in relations with F. A. 0 . and U. N. T. A. A
A working arrangement established with the Council of Europe in the autumn of 1952 has been followed by regular exchanges of information and attendance at meetings during which subjects of mutual interest such as social and medical assistance were discussed.
In the development stage, the proximity to Headquarters has been of the greatest possible benefit to the Regional Office for Europe, particularly through the contacts established between each newly appointed Regional Health Officer and the appropriate Technical Section at Headquarters. 1953 is the second full year of operation of the Regional Organisation for Europe. If there be added the three previous years of preparation by the Special Office for Europe, five years of experience have already been gained in operating a progressively decentralised Regional Organisation. No doubt at all the maintenance of technical contacts with Headquarters will continue to have value, but this would never be difficult to secure in any reasonably central area of Europe, and will always be a relatively trivial problem compared to that facing some of the other Regional Offices of the World Health Organisation. On the other hand, the maintenance of the intimacies of contact of a Regional Office with decentralised responsibilities in the same section of the same building raises problems all its own. The day-today work of the Office becomes increasingly impeded by efforts, to disentangle the respective rôles of the Headquarters and the Regional Office for Europe. To the occasional visitor to the World Health Organisation in Geneva, and these constitute the majority, it is almost impossible to grasp the difference in function of a group of offices occupying the same stretch of corridor; for the regular visitor the task is somewhat easier, but even in the case of the World Health Organisation Secretariat there is frequently a confusion of rôles and, with the best will in the world towards a contrary result, some overlapping.
In addition, the process of using existing services at Headquarters has inevitably given rise to a difficulty when for example a staff member has had to be added to cope with the work. Headquarters is, naturally, inclined to incorporate such a recruit within the structure of the section and express services to the Region in terms of the part-time services of a number of officers totalling in all one staff member. This has created a situation which cannot be regarded as satisfactory from the Regional Office viewpoint, since the new recruit is neither responsible to the Regional Director nor is he integrated within the team work of the Office. Many of these difficulties are minor in themselves, some of them can be tided over by one ad hoc arrangement, or the other, but the net result is towards the development of a situation in which the essential rôle of the Regional Office is maintained only with the expenditure of much time and effort which would much more usefully be devoted to programme. As time passes, and from now on, it will become not more easy, but more difficult to effect a separation of the Regional Office from Headquarters. Despite some loss in personal contacts and despite some initial additional costs this separation yet appears essential to the full development of World Health Organisation's work in Europe. The Regional Committee will be devoting particular attention to this problem in the course of the current session.
| DESCRIPTION of Programme | DURATION | GOVERNMENT(S) principally concerned | OTHER PARTICIPATING countries | PARTICIPANTS or fellows | PARTICIPATING AGENCIES and rôle of Regional Office |
|---|---|---|---|---|---|
| Alcoholism. Establishment of Abstract Archives of Alcohol Literature in selected libraries in Europe. | 2 years 1952-54 | Belgium - Denmark - Finland - France - German Federal Republic - Ireland - Norway - Sweden - Switzerland - Yugoslavia | Regional Office continued to provide in 1953 current abstracts from University of Yale for initial period of 2 years started in course of 1952. | ||
| Anaesthesiology. [a] Further basic postgraduate cour se for anaesthesiologists held at the Anaesthesiology Centre, Copenhagen. | 1 year June, 1953 May, 1954 | Danemark | Austria - German Federal Republic - Italy - Norway - Spain | 7 | University of Copenhagen and Regional Office which provided outside lecturers and some teaching equipment. |
| Anaesthesiology. (b) Training Course for Anaesthesiologists, held at the Anaesthesiology Centre, Paris. | 1 year May, 1953 April, 1954 | Franco | German, Federal Republic - Greece - Spain - Switzerland | 4 | University of Paris and Reg. Office which provided technical adviser, an outside lecturer, and some teaching equipment. |
| Environmental Sanitation. An ad hoc Committee to advise on the next meeting of sanitary engineers in Europe (in 1954) and on the choice of technical subjects to be discussed; held in Geneva. | 2 days | WHO Headquarters and R. O. E. which financed attendance at ad hoc Committee. | |||
| A Study of Sanitary Engineering Terms in Europe aiming at the development of an accepted termino logy of sanitary engineering terms in French and Eng- | lish languages in Europe. | 2 years | UNESCO and R. 0 . E. which contributes to the costs of the study. | |||
| Handicapped Children. A Group Training Course on the Rehabilitation of Handicapped Children, for social workers and specialists ; held in Paris. | 6 weeks | Franco | Spaii - Yugoslavia | 2 | International Children's Centre. |
| Health Education. A Conference on Health Education for medical and public health administrators and persons actively engaged in health education work, held in London. | 10 days | United Kingdom | Austria - Belgium - Denmark - Finland - France - Germany - Greece Ireland - Italy - Netherlands - Norway - Spain - Sweden - Switzerland - Portugal - Turkey - Yugoslavia | WHO Headquarters, and Regional Office, which provided Conference Organizer and five Discussion Leaders (UNESCO participated in the Conference) | |
| Health Visitors. Continuation of the Pilot Study to determine the kind of worker best suited to meet family health and welfare needs. | 3 years 1951-53 | France - United Kingdom | Rockefeller Foundation and Regional Office which provided the technical adviser and the services for the Technical Advisory Committee. | ||
| Insect Control. A Group Training Course, on diseases ' transmitted by insects, for medical and auxiliary personnel; held in Rome. | 2 months | Italy | France (Algeria Morocco - Portugal - Spain - Tunisia - Turkey - Yugoslavia | 10 | Istituto Superiore di Sa-> nità of Rome and the • Regional Office. |
| Mental Health in Childhood. An ad hoc Committee to advise on the most appropriate way to undertake a Seminar Discussion on relations between Paediatricians and child psychiatrists; held in Geneva. | 3 days | WHO Headquarters and Regional Office which financed attendance at ad hoc Committee. | |||
| Morbidity Survey. Continuation of the survey carried on in Denmark since 1951, with the object of publishing results of international interest. | years 1953-54 | Danomark | Rockefeller Foundation and Regional Office which provided statistical advisory services and some supplies. | ||
| Mother/Child Separation Study. A study of the effects on child development arising from separation from the mother in the early years of life. | To be determined | Franee - United Kingdom | International Children's Centre and Regional Office which contributes to the. cost of the Study Teams working in France and England. | ||
| Occupational Health. A Group Training Course in Industrial Hygiene, held at Manchester and Roffey Park, England. | 3 weeks | United Kingdom | Austria - Belgium - Denmark - German, Federal Republic. - Italy - Morocco - Spain - Sweden - Switzerland - Yugoslavia - Greece | 11 | British Council. |
| Public Health Administration Development of the demonstration and training area in rural public health in Soissons, | 3 years | France | |||
| Rockefeller Foundation and Regional Office which assisted in initial costs of establishing the area | |||||
| School Health Services'. A travelling Study Group for Senior School Health Officers, in Denmark and Holland. | 1 month | Denmark - Netherlands | Austria - Denmark - France - German Federal Republic - Netherlands - Norway - Spain - Sweden - Switzerland - Tunisia - Greece - Turkey - Iceland - United Kingdom - Ireland - Luxembourg - Yugoslavia - Morocco | 19 | Regional Office which provided two leaders for the travelling study group. |
| Social Paediatrics. A Group Train ing Course on Social Paediatrics; held in Paris. | 12 weeks | France | Belgium - Italy - German Federal Republic - Norway - Spain - Turkey - Ireland | 7 | International Children's Centre. |
| Thoracic Surgery. A Group Training Course on certain aspects of thoracic clinical science and surgery; held in Groningen | 3 weeks | Netherlands | Austria - Denmark - German Federal Republic - Luxembourg - Morocco - Norway - Spain - Sweden - Switzerland - Tunisia - United Kingdom - Yugoslavia | 12 | University of Groningen and ROE, which provided two lecturers |
| Tuberculosis in Children. A Group Training Course on the prevention of tuberculosis in children, for physicians and medical officers responsible for prevention of TB; held in Paris. | 6 weeks | France | Finland - Italy - Germany - Morocco - Greece | 5 | I International Children's Centre. |
| Veneral Diseases. (a) The future status of the intergovernmental Commission established to control venereal diseases among Rhine River boat men and their families is under discussion. | 4 years 1950-53 | Belgium - France - Germany, Fed. Republic - Netherlands - Switzerland | |||
| WHO Headquarters I. L. 0 . and R. 0 . E. | |||||
| (b) Continued work in the port demonstration and training centre situated in the Port of Rotterdam to deal with the control of venereal diseases, among seafarers, and preparatory work for the first training course to be given in September. | Netherlands | WHO Headquarters and Regional Office which continued to contribute to the operational costs of the centre and assisted in the preparation of the first training course. | |||
| Although thes European inter-country activities were open to participants from other Regions, only European Fellows and participants are recorded in the above Tables. |
| Activity | Place | Date |
|---|---|---|
| Symposium on Insect Control. | Rome | October |
| Ad hoc Advisory Committee of Medical Librarians | Geneva | July |
| Seminar on Mental Health Aspects of Public Health Practice | Amsterdam | July |
| Seminar on Occupational Health. | Milan | September |
| Seminar on the Peri-Natal Period. | Brussels | September |
| Training Course on Peri- Natal Problem (ICC). | Paris | October - November |
| Conference on Teaching (Post-graduate) of Preventive Medicine | Gôteborg | July |
| Scandinavian Public-health Training Course. | Gôteborg | August September |
| Conference on PH Nursing. | Mont-Pèlerins/ Vevey. | October |
| Training Course on Tuberculosis | Istanbul | Early October (tentative) |
| Training Course on Maritime Venereal Disease Control. | Rotterdam | September October November |
| Seminar on In-Service Training in Techniques of Working with Individuals (UNTAA). | Paris | July |
| Seminar on Services to Individuals and Families in Public and Voluntary Welfare Agencies (UNTAA). | Italy | July |
| European Study Group on November Water Standards. | Geneva | November |
| Training Course for Milk October Plant Operators (F.A.O.; U. N. I. C. E. F.). | Rome | October |
| COUNTRY OF ORIGIN | SOURCE OF FUNDS | TYPE OP FELLOWSHIP | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WHO 0. M. S. | UNICEF F.I.S.E. | Tech. Assist. | TOTAL | Inter Regional | Regional | Indiv. Trng. | Group Trng. | ||||||||||
| Austria. | 3 | 13 | 12 | 4 | 16 | 10 | 6 | ||||||||||
| .Belgium. | 2 | 3 | 5 | 5 | 5 | ||||||||||||
| .Danemark | 2 | 4 | 3 | 3 | 6 | 6 | |||||||||||
| .Finland. | 1 | 9 | 6 | 4 | 10 | 8 | 2 | ||||||||||
| France (incl. Algeria) | 1 | 15 | 13 | 3 | 16 | 1 | 15 | ||||||||||
| Germany (Fed. Rep.) | 7 | 4 | 11 | 11 | 11 | ||||||||||||
| .Greece. | 3 | 2 | 5 | 5 | 2 | 3 | |||||||||||
| . Iceland. | 2 | 2 | 2 | 2 | |||||||||||||
| .Irland. | 1 | 6 | 5 | 2 | 7 | 7 | |||||||||||
| .Italy. | 4 | 5 | 8 | 1 | 9 | 2 | 7 | ||||||||||
| .Luxembourg. | 1 | 1 | 1 | 1 | |||||||||||||
| .Monaco. | |||||||||||||||||
| MMorocco (French Protectorate) . | 4 | 4 | 4 | 4 | |||||||||||||
| . PayNetherlands | 6 | 4 | 2 | 6 | 6 | .Norway. | 3 | 2 | 5 | 5 | 5 | ||||||
| . Portugal. | 1 | 5 | 6 | 6 | 6 | ||||||||||||
| .SpainNote | 11 | 2 | 11 | 2 | 13 | 3 | 10 | ||||||||||
| Sweden | 2 | 5 | 7 | 7 | 7 | ||||||||||||
| Switzerland. | 3 | 4 | 7 | 7 | 7 | ||||||||||||
| .Trieste. | 3 | 3 | 3 | 3 | 3 | .Tunisia. | 2 | 1 | 3 | 3 | 3 | ||||||
| . TurkeyNote | 4 | 3 | 6 | 1 | 7 | 3 | 4 | ||||||||||
| . United Kingdom. | 1 | 4 | 2 | 3 | 5 | 5 | |||||||||||
| Yugoslavia.Note | 7 | 8 | 12 | 3 | 15 | 5 | 5 | ||||||||||
| 63 | 106 | 133 | 36 | 169 | 34 | 3 | 132 |