•• I \.oIt •• ~J , .;!..J, WORLD HEALTH .., -- oy" ORGANISATION MONDIALE ORGANIZATION s ~..u' DE LA SANT£

~.JI'...-:-' 1J,:,J "" .JI' ~, REGIONAL OFFICE FOR THE BUREAU RmlONAL DE LA

EASTERN MEDITERRANEAN M~DITERRAN~E ORIENTALE

IGGlOtrAL COiil'1ITTEE FOR THE EN/RC12/9 ';AS'YSRlI LEDITERRANEAN 15 June 1962

I'weU'tll Sec sion ORIGINAL: ENOL IS!:

Agenda item 10 (f)

RURAL HEALTH AND CONMUNITY DEVELOPMENT

IN THE

EASTERN MEDITERRANEAN REGION

Resu1 ts of an Enquiry

TABLE OF CONTENTS

I INTRODUCTION

II POPULATION AND VITAL STATISTICS

III HOUSING

IV ENVIRONMENTAL SANITATION

1. Water supplies

2. Excreta disposal

3. Food control (including milk)

4. General information on waste disposal

EMjRC12/9 page i

5. General information on measures, so far undertaken for the purpose of sanitation

V HORBIDITY

1. Notifiable diseases

2. Total number of persons suffering from blindness and deafness

3. Disease vectors and vector control

VI GENERAL INFORMATION ON RURAL AREAS AND RURAL ECONCMY

1. Definition used for distinguishing between urban

1

2

3

3

7

7 8

10

10

11

13

and rural areas 14

2. Number of rural communities, their average population and dispersion pattern 14

3. Types of agricul-rure and common crops l.!lcluding the relative importance of the various types 17

4. General state of nutrition in rural areas 21

5. The types of irrigation in the c amtry with particular lIlention of their possible influence on incidence of endemic diseases

6. Types of hcusing especially in relation to sanitation

22

in rural areas 26

VII GOVERNMENT ACTIVITIES ON THE NATIONAL LEVEL AIMING AT PROHOTION OF RURAL HEALTH

1, Special Ministry for Hunicipal and Rural Affairs

2. Special Agency dealing with rural health in the Ministry of Public Health

3. Cooperation in rural health of departments of other Ministries with the l-unistry of Public Health

4. Commi ttee for coordinating the work of various governmen tal agencies for promoting rural health

27

28

29

29

EM;1w12!9 page ii

TABLE OF CONTENTS (cont' d)

VIII VILIJ.GE HElJ.TH COOPERl.TIVE SJCIETIFS

IX HEAL'IH UNITS IN RURAL AREAS

Aden Protectorate French Somaliland Iran Israel Jordan Kuwait Lebanon East Pakistan West Pakistan Saudi Arabia Sudan Syrian Iwab Republic United Arab Republic

X SOCIAL CENTRES

French Somaliland Iran Jordan Kuwait Lebanon vlest Pakistan Saudi llrabia Syrian Arab Republic United Iwab RepUblic

XI BASIC EDUCATION AND SCHOOL HEALTH IN RURAL AREAS

31

31 32 33 33 34 36 37 39 40 43 43 44 45

50 50 50 51 51 52 52 52 53

1. Number of schools and school children 56 2. School health services and their influence on rural

health in general 56

XII HEALTH EDUCATION OF '!HE PUBLIC 62

XIII COMBINED UNITS 65

XIV COMl'IUNITY DEVELOPMENT SCHEMES 66

xv INTERNATIONAL ASSISTANCE 69

ANN E X - QUESTIONNAIRE ON RURAL HEALTH AND COMMUNITY DEVELOPMENT

I INTRODUCTION

EMtRC12/9 page 1

In view of the need for more information on rural health and community

development projects in the countries of the Region, the Regional Office

fer the Eastern Mediterranean, by circular letter of 4 April 1961 sent a

d8tailed Questionnaire on Rural Health and Community Development to all the

countries of the Region.

The questionnaire is annexed. It was designed with a view to

facilitating the description of the probl~ and to indicate the particular

subjects on which information was elicited.

The question" of rural health and community development is of great

concern in almost all countries of the Region as well as in countries O1,lt­

side the Region and particularly for countries at the development stage.

At the eleventh session of the Regional Committee for the Eastern

Nediterranean the question of rural health was one of the technical matters

discussed and a document on the subject was presented to the Committee. l )

Answers to the questionnaire were received from tbe following countries

and territories:

Aden Colony Aden Protectorate French Somaliland Iran Iraq Israel Jordan Kuwait Lebanon Pakistan Saudi Arabia Sudan Syrian Arab Republic United Arab Republic

It will be seen that answers were received fran the majority of the

countries of the Region. The Regional Office wishes to express its thanks

to the Governments for submitting replies to the lengthy Questionnaire.

l)Rural Health. Document EMtRCll/l3, 26 July 1961.

EMtRC12/9 page 2

In addition to the data received from the Governments, information

from other sources has been included in this document. These sources

comprise the statistical publications of the United Nations and its

specialized agencies such as "Statistical Yearbook 1960", "Demographic

Ye"rbook 1960", "Production Yearbook 1960 Vol. 14, FAO", "Annual

Epidemiological and Vital Statistics 1958", issued by the World Health

Organization and material available at the Regional Office.

The following analysis of the answers to the questionnaire has been

made separately for each of the fourteen r.hapters of the questionnaire.

II POPULATION AND VITAL STATISTICS (Item 1 of questiennaire)

In Table 1 is given a summary of the available population and vi tal

~tatistics for countries in the Region. It is a well known fact that the

degree of availability and reliability of vital and health statistics for

the Eastern Hedi terranean countries in general is low. In Table. 1 for the

purpose of the present study, the emphasis has been placed on giving

figures separately for urban and rural areas. This introduces a further

element of unreliability and the figures in Table 1 should therefore be

used with great caution. For some of the countries there is no well

defined distinction between urban and rural areas. This problem is dealt

with in more detail under chapter VI in page 14. With these precautions

it is seen from Table 1 that the countries which have answered the question-

naire are predominantly rural. Nore than two thirds of the total populo.tion

of Aden Protectorate, Iran, Pakistan, Saudi Arabia, Sudan and the United

Arab Republic live in rural areas. In Jordan, Kuwait and the Syrian Arab

Jiepublic at least one half of the population is rural.

regarded as having an exclusively urban population.

Aden Colony is

Birth and death rates and infant mortality rates are available with

spocification for urban and rural areas for only a very few countries.

These countries show in general higher birth and doath rates in the rural

areas than in the cities.

From Table 1 it is seen that the United Arab Republic is an exception

to this r.ule. However, it is generally believed that also in the United

EM/RC12/9 page 3

~ab Republic birth and death rates are highest in the rural areas but on

accounto~ under-registration ~ vital events the comp~ted rates ~or the

cities with more complete registration are the highest.

The extent o~ nomadism is large in French Somaliland, Somalia and the

Sudan, considerable in Iran, Kuwait, Libya and Saudi Arabia but o~ no

~pprec~able importance in Lebanon, Pakistan and the United Arab Republic.

III HOUSING (Item 2 o~ questionnaire)

The questionnaire asked for the building material usually used

separately for urban and rural areas.

in Table 2.

The information given is summarized

IV ENVIRONMENTAL SANITATION (Item 3 of questionnaire)

Under environmental sanitation, questions wP~o osked concerning water

supplies, excreta disposal, food control (including milk) ,general

information on wastE' disposal and general information on measures so far

Ill'\dertaken fort he purpos e of sani ta tion.

1. Water supplies

Table 3 summarizes the information on water supplies. The table

clearly indicates that water s~pplies are considerably more common in the

oi ties than in the rural areas. Only a small minority of the rural

population of French Somaliland, Iran and Saudi Arabia have any water

supply system.

For a number of countries this information is not available.

TABLE 1 - Population and Vitail. Statistics

Population in 1,000 Average size of Live Births per Deaths per Infant .ueatha per

% famUv 1000 pop. 1000 pop. 10f") 11 ve births htent Country Year Total of ...,

nomadism Urb. Rur Total Urb. Rur. Total Urb. Rur. Total Urb. Rur. l'otal Urb. Rur.

Aden Colony 1960 155 100 0 39.6 39.6 12.8 12.8 128.1 128.1 Nil Aden Protectora,te 1960 660 6 94 Bahrain 1960 147 Cyprus 1961 581 Ethiopia. 1960 20,000 French Somali1and 1960 67 36.0 li.1 Very large Iraa 1961 20,678 31 69 4.4 4.0 4.6 37.4 20 40 18.0 71.0 ~6-2l 10% Iraq 1960 7,085 2~-45 Isra.el 1961 2,114 77 23 3.9 27.1 5.7 5.7 5.6 26.7 24,395nom~ Jordan 1960 1,695 40 60 46,3 7·1 56.2 Kuw;.dt 1960 223 47 53 5 5 5 49 505 32.9 17, 747nomad Lebanon 1960 1,649 5 25.6 4.5 15.4 Of little

t:Unportance Libya 1;;60 1,195 25% }fus~at &' Oman 1960 560 Pakistan, East 1961 50,840 5.4 94.6 5;6 5.8 5.4 20.5 15.7 20·7 9;4 8.7 9.5 72.3 ","70.2 69.4 !Negligible Pakistan, West 1961 42,880 14.7 85.3 6.0 - - 25.9 32.5 24.6 11.3 ]Q .1 p.J..> lO6 . 86 102 Some Palestine, Gaza Stri 1960 377 Qatar 1960 45 Saudi Arabin 1959 6';036 20 80 5 4.), 5.1 39 37 42 30 28 31 250 220 270 15% Somal~':\ 1959 1,990

~pprox.80% Sudan 1961 12;109 9 91 5 51.9 . 23.7 1185.9 Large ~ian Ar3b Repub1i 1960 4,555 43 57 31.1 5.7 Trucial Oman 1960 . 86 Tunisia 1960 4,168 46.8 20' 173 JAR 1960 26,080 33 67 40.2 52.0 34.4 17.6 121.8 5.6 136 ~65 ~ Very smaU [elllen 1960 5.000 .

TABLE 2 - Housipg

Building Material

usually used Country

Urban Rural

Aden Colony Stone

Aden Protectorate Mud, Stone, Tents, Thatch.

French Somaliland Stone, Mud, Wooden cabins Tents

Iran I Bricks, 1'1u.d, stone, Wood

I Concrete , I Israel , Stone, Stone,

I Concrete Concrete

Kuwait I Cement, Cement,

I Iron bars, Iron bars,

! Bricks Bricks

, Lebanon stone, stone, I Concrete Concrete ! I

! Paldstan, West Brick & l10rtar Mud, I Brick & Cement Brick & Mortar , Cement & Stone & Mortar ! Concrete I I Paldstan, East Bricks lfud,

Bamboo , Tin i , i Saudi Arabia Cement, lfud I Stone , I j Sudan Mud Grass

l):Estimate.

2)Hore than one family per dwelling unit.

EMjRC12/9 page 5

Average number of rooms

per dwelling unit

Urban Rural

2.51 )

3 52)

3 3

5 1-5

1,81 ) 1.71)

5.5 4.7

3 3

I i

! ,

! i

EH/RC12/9 page 6

Country

Aden Colony

Aden Protectoratel )

French Somaliland

Iran

Israel

Jordan

Kuwait

Lebanon

Pakistan East6 ) ,lest

Saudi Arabia

Syrian Arab Republic

United Arab Republic7 )

TABLE 3 - Water SUpplies

Number of Supplies

Urban I Rural

2

1 5

119 5170

78 805

28 600002 )

13 ) 34) 3 3

4 17

9 610

88 1739

I Percentage uf population

I covered

Urban Rural % %

100

65 10

40 6

99 93

58 42

100 100

80 40 I

56 S)

30 10 I , 73 33 I 95 I 85 I

l)The vast majority of the Pr6tec1;orate popULat.1on relies on shallow and deep wells for its water supply. In a few of the larger towns, e.g. l'lukalla, tho water is piped some three miles to water points wi thin the town. Pollution of this pipeline to Hukalla resulte~ in an epidemic of typhoid in 1960. It was adequately controlled by chlorination but this is not a standard procedure.

2)Private wells and cisterns.

3)Water distribution through pipes into homes and at public places.

4)Water supplies through wells, tube-wells and reserve tanks.

5) 56 %. of urban population is provided with water piped into houses, and the remaining population with wells and hand-pumps.

6) .. b . IJr an Areas: Piped into houses, community and private wells and hand PU171.0S. Rural Areas. Community and private wells, hand-pumps and ponds.

n In 1960, 49 of the supplies in urban areas were wells and 39 piped water. Only six out of the 1739 supplies in rural areas are by piped water. Of the population covered by water supplies, this system in the cities sup;::li,;cl piped water into homes for 90;g and water distribution through public fowJi;a:'.ns for 10%; in rural areas the corresponding percentages were 5% and 95%.

2. Excreta disposal

EMjRC12/9 page 7

Information concerning systems of excreta disposal has been supplied

by the Aden Protectorate, French Somaliland, Israel, Jordan, Kuwait and

Pakistan.

No system of water borne sanitation exists anywhere in Aden Protectorate.

Random deposit and privy middens are the standard systems of excreta disposal.

In some towns municipal sweepers attempt to clear away the faecal deposits.

In the Wadi Hadhramaut human excreta is used extensively as fertilizer and

this results in a high incidence of infection witn pathogenic amoebae and

ascaris.

In French Sornaliland there are three excreta disposal systems in

Djibouti and none in the rural areas.

Israel reports that a number of 78 &lystems exist in the urban areas and

649 in. tile rural areas.

Jordan states that for 67% of the urban population an excreta disposal

system exists, namely for 6% through community sewerage systems and for 61%

through individual installations and that for 31% of the rural population

individual installations ~septic tanks, latrines, etc.) are used.

Kuwait reports that 95% of the urban and 80% of the rural p~pulation is

covered by two excreta disposal systems.

Lebanon reports that a number of systems are designed but not yet in

operation.

East Pakistan reports that three systems exist in the urban areas,

namely: 1) sewerage system; 2) septic tank; 3) hand clervice latrines,

and three in the rural areas: 1) septic tank; 2) pit privies; 3) bore­

hole latrines.

West Pakistan reports that two excreta disposal systems, viz. sewerage

and latrines exist in urban areas whereas in rural areas open fields are used

eXClusively. 10% of the urban population is served with sewerage system and

the rest have latrine system.

3. Food control (including milk)

Information concerning food control supplied by the countries is

tabulated in Table 4. It is seen that food control is carried out on a

EM,AlC12/9 page 8

very limited scale and exclusively for the urban areas with the exception

of Israel, Kuwait and Lebanon.

4. General information on waste disposal

Below is the information received.

Aden Colony Vehicular collection, tipping and burning.

Aden Protectorate Garbage is sometimes collected and deposited in one area

outside the settlements but the organization of refuse

disposal is hapharzard.

incinerate their garbage,

Some enlightened townships

French Somaliland In the urban areas and the main centres of the territory,

refuse is carried to sewage farms, where it is either

incinerated or left on the spot to be subsequently crushed

and then buried.

Iran

Kuwait

Lebanon

Pakistan, East

Pakistan, West

Saudi Arabia

Sudan

In rural areas, no refuse disposal service exists.

This is left to the numerous small savage carnivores

and birds of prey.

Human excreta is disposed of in pit privies; there is

no treatment of industrial wastes.

There are two means of waste disposall a) Dumping

b) Incineration

Dumped in sea or open air.

In urban areas refuse in disposal is by dumping or

filling low-land. In rural areas it is used as manure

apd for filling law-land.

Ordinarily the household refuse is thrown in the streets

and is used as manure in the fields.

Undertaken in urban areas only, covering about 40% of th,

urban population.

In towns wast is collected twice per week.

TABLE 4 - Food Control (including milk)

N111Ilber of staff ~gaged in control

activities Country

EM/RC12/9 page 9

Percentage of population

covered "-

Urban Rural Urban RurnJ %

Aden Colony 61 )

Aden Protectorate2 ) 0 0 0

French SomalilandJ ) 100

Iran 100 0

Israel 4 8 85

Jordan 280 0 87

Kuwait 150 3 100

Lebanon 13 22 90

Pakistan East 4094 ) 545 )'

Pakistan West 162 416 )

Saudi Arabia 30 0 aO Sudan 150 100

l)Part time

2) Health ordinances empower doctors and health st.llf to inspect shops.

3)FOod control was carried out in Djibouti town in 1960 under the Ruper­vision of the Veterinary Inspector assisted by a biologist, a chemist, and qualified national staff.

4) Urban: One sanitary Inspector for each municipality.

5)Rural: One sanitary Inspector for eaCh Thana health circle.

6)These are responsible for both urban and rural areas.

%

0

0

85

0

100

30

0

I

El1/RC12/9 page 10

5. General information on measures, so far undertaken for the purpose ot sam.titIon

Inrormation was received from the following countries:

Aden Protectorate. In Mukalla attempts have been made to fly-proof

the privy middens which lie in the walls of the houses.

French Somaliland. Intensification of research to allow for increasec

water supply. Insect control, mainly flies and mosquitoes (particula.rly

culex), and housing control.

Sanitary engineering work at Djibouti filling up areas where rain-water

is liable to stagnate.

Kuwait. Periodical medical examination of food handlers. Control of

slau~~ter houses, spraying of residues to control flies and other insects.

Health education of the public by distribution of hygiene leaflets and

posters.

Lebanon. Action is taken by physicians and sanitaTians to improve the

sani tary situation in rural areas.

East Pakistan. In the rural areas bushes and jungles are cut and tanks

and ponds are cleared.

West Pakistan. A separate pUblic health engineering Department has been

established to design, plan and construct water supply drainage and environ­

mental sanitation work. A sum of Rs. 135 million has been earmarked in the

Second Five Year Plan (1960 - 65) for improvement of urban and rural water

supply and sanitation.

V MORBIDITY (Item h of questionnaire)

1. Notifiable diseases

!.:II the countries answering the Questionnaire have given detailed

information on the number of reported cases of various infectious diseases.

This information is reproduced in Table 5.

It is a well known fact that reporting of diseases is generally in­

complete and that the degree of incompleteness varies from country to

country and within each country for the various geographical sub-divisions

of the country and that it also differs for the various diseases. The

information contained in Table 5 should therefore be interpreted with great

cClution.

EM,tRC12/9 page 11

Most of the countries reporting have been able to give information

covering the entire country without specification as to urban or rural

area. Such a specification is reported only from Jordan, West Pakistan,

the Syrian Arab Republic and the United Arab Republic. For further

details reference is made to Table 5.

Information concerning legislation and administrative arrangement for

the reporting of communicable diseases has been supplied by several

countries. This information is not reproduced here.

2. Total number of persons suffering from blindness and deafness

This information is generally not available in the countries included

in the study. From Saudi Arabia an estimate on the prevalence of blindness

is reported. This estimate is 2% of the urban population and 4% of the

rural population.

From Aden Protectorate the prevalence of blindness is reported as

very high, while the prevalence of deafness is not alarming.

From a survey of blindness, conducted in late 1961, the numbers of

blind persons were reported. The percentage of these numbers to the total

population of the country is also given:

Ethiopia

Iran

Israel

Syrian Arab Republic

Tunisia

United Arab Republic

Number of blind persons

90,000

280,000

4,500

4,154

18,000

37,179

In per cent of total population

0.45

1.39

0.21

0.09

0.43

0.14

EM,tRC12/S page 12

Saudi 10) Sudan Syrian Arab Republic United Arab Republic13)

Arabia

10191

754

829 0 0

168 3228 160

30

0 0 0 4

47 6571

0 5il)

0 9297

~2)

10017

87

Total Urban Rural Totail. ~ountry Cu<llltry

10808 73-36 531 234 287

127378 806 526 280

763 1290 538 752 14835

3 1 2 14 929 218 98 120 1167

24841 546 285 261 1807 1457 44 18 26 406

1263 22 2 20 179

6 45155

328 52 21 31 865 8

316 46360 1016 452 564 11707

120 20 46

259244

151 566134 137 32 105 1654

555 262

15178612 155125 64973 90152 182961

47345 755 35 720 1455546 12587 301182 1281 50000

982177

9)Including Bacillary dysentery and Amoebiasis 10)Figures relate to 1959

Urban Rurllll.

5281 2055

12658 2177

13 1 826 341

1073 734 339 67

27 152

762 103

13158 4549

34 12

52 99 878 776 141 414

475395 980151 115814 185368

5000 45000 395098 587079

11)rt is estimated that 95% of the population suffer from Trachoma 12)Includes Amoebiasis also

13)Figures relate to year 1955, except figures for Schistosomiasis, Ankylostomiasis, Filariasis and AsCariasis, which refer to year 1960

14)The figures givens against "7YJ>hoid" relate to "enteric group of fevers"

15)~ dysentery is a notifiable infectious disease. Separate figures from "BaCillary Dysentery" and "Amoebiasis II not available.

Total. ountry

i098

9

1308

11 150 la5 81

10

51

85

2943

1 76148

306

1293

7

TABLE 5 - Reported Number of cases of various diseases 1960

Jordan Kuwait

Urban Rural

855 243

4 5 845

4 644 644 182

9 2 7 108 42 15 243 172 478 69 12 16

0 10 2

21 13 38 0

0 0

48 )7 14 0 0

763 2180 995

1 24693 51455

0 266 40 38

576 889 404 561

7 171

West Pakistan Lebanon Total [Jrban R1l:i:'aJ.

3do ,1.5365 :;>;>65

)13 126114) 1267 6704 4516 2188

14 5 5 156 28 28

399 358 liL 22 2 2

9 7 7

0 0

198 3 )

688 274 414 404 404

0 0 3

102

0 0 0 11

I

26-112 304361$ 3043~ 1, ) (15)

*)Tota: cases'

l)Infected outside Colony

2)Al1 forms of dysenterY

3)Admissions to hospitals only

4) Is endemic in area

5)Cases of Ibejel seen near Saudi Arabia border

6)Imported cases

7)positive seroloay

East Pakistan

TotaJ..

24610*

9280*

27810 8856 686

)827 18790 )137 3060* 1969

8146 0 0

775 0

1086 15843

0 13497*

6313

7.39* 1333437

I 0 223752

79600 238400

0 27218 5756

8)From 1955-1960 a total of 6525 cases of 'bejel

I Aden Aden French I

eolollY Protec- Somali Iran Iraq Israel

torate land

Tuberculosis, all forms. (i) ••• 884 i 9904 11588 802 ~uberculosis, all formsl (ii) 980 2014 5231 I 1903 yphilis and its sequelae (i) 57 365 • 211597) 135 4 ~yphilis and its sequelae (11) 391 ••• L 174548)

3497 299 [ryphoid fever 96 781 6 1605 339 ~holera 0 0 0 I 0 Scarlet fever 0 0 0 I 1040 83 1995 , Diphtheria 2 °4) 0 • 3389 1171 243 Whooping cough 6 20 19621 10483 4547 1eningococcal infections 21 ° 2 391 493 22

Wlague 0 0 °6) 5 Leprosy: (i) 2 2 489 117 5 !Leprosy: (ii) ••• 207 2517 !Relapsing fever .3 05) 0 42 lYawsl (i) 1 0 lYaws: (ii) " ... 0

Poliomyelitis 16 ••• 22 117 129 38 Infectious encephalitis 3 0 ••• 30 34 Smallpox 8 54) 0 373 M8asles 3 45 35717 2.3540 5967 tyellow fever ° 0 0 IRabies in man 0 °4) 0 33 1 Trachoma. (i) .. ~ 57534 Trachoma: (ii) ... 55 ... ~3269710 Typhus 1 0 0 15 2 144 Nalaria. (i) 0 1 4381 23 Malaria. (ii) recurrent cases 4951) 2662 15 12185 9

Trypanosomiasis 0 04) ° " Diarrhooal diseases among children ••• 2) 822,99 4,32697

4) Bacillary dysentery 24713) 4)

525 Amoebiasis 433) 4093 Schistosomiasis 413) 308 0 ... 16916 Ankylostomiasis 2) 0 ... 8542 filariasis ••• ., .. 48

Ascariasis 4) ~94266

Symbols used. (i) new cases (ii) total known cases ••• Data not available

If no information is given, space is left empty.

!

,

3. Disease vectors and vector control

EMjRC12/9 page 13

The questionnaire asked for information on the vectors of Nalaria,

Leishmaniasis, Filariasis and Bilharziasis. The information to this point

of the questionnaire is swnmarized in Table 6. The answers relate evidently

to the whole territory of the country. Specification on urban and rural

areas was not received from any of the countries.

en measures so far undertaken in vector control, Iran reports that

antianophelin residual spraying is under way as well as focal control

programmes against other vectors and Lebanon reports that fly and mosquito

control programmes are being undertaken.

In Pakistan anti-malaria measures consisting of intensive and systematic

insecticidal spraying of selected areas in most of the districts of the

country are adopted. A scheme for eradicatiCll of malaria has been

formulated in collaboration with WHO and the eradication programme has

started. The total cost of the scheme is estimated at Ra. 540 million

and the programme is expected to be completed within fifteen years.

From the United Arab Republic the fOllowing information has been

received concerning vectOl' control measures:

a) Mollusc1cides are applied to sites in which snails infected with

cercaria are discovered,and whenever more molluscicide is available, it

is applied to streams infested with snails wi thin a radius of 500 metres

around villages.

b) Snail control by engineering methods - In cooperation with the

Irrigation Department (Hin1stry of Public WOl'ks) measures are taken to

render water-ways unsuitable for snails.

c) Health education, directed to encourage the people to keep their

water-ways clear of vegetation and to arouse their interest so as to

cooperate with the programmes.

d) For malaria, larviciding and house spraying are carried rut.

EM/RC12/9 page 14

VI GENERAL INFORMATION ON RURAL AREAS AND RURAL. ECONOMY (Item 5 of questionnaire)

1. Defini tion used for distinguishing between urban and rural areas,

In Iran an urban area is defined as any community having a popULation

of 5,000 or mare, other areas are considered rural.

Aden Colony is regarded as an exclusively urban area.

In Israel an urban population includes all localities with a population

exceeding 5,000 of whom less than 50% earn their living by agriculture, or

with a population of 2,000 - 5,000 of whom less than a third earn their

living by agriculture.

"Rural Population" includes all other localities.

In Pakistan a village generally means any area for which a separate

record of rights exists, or which has been separately assessed to land

revenue or which may be especially declared to be an "estate"i.e. a

village by Government.

For other countries in the Region, no specific definition exists for

distinguishing between urban and .rural areas, but a listing is made of all

ci ties and towns which are considered urban, and areas outside these

communities are regarded as rural.

2. Number of rural communities, their average population and dispersion pattern,

Information in this subject is summarized in Table 7." It is seen

that the structure and settlemmt p<lttern differs widely fran country to

country and also within the country. In the United .Arab Republic and in

Kuwait the villages are generally large with popUlations averaging

4 - 5,000 and in the United .Arab Republic they are located within short

distances of each other. In the Syrian Arab Republic and particularly

~ the villages are generally much smaller with a population of a .few

hundred, and are more scattered. In the Arabian Peninsula the villages

have an average population of about 1,500.

Aden Protectorate

Iran

Lebanon

Pakistan, East & .vest

Pakistan, East West

United Arab Republic

TAllLf; 6 - Vectors and Intermediate Hoste of Disease

Malaria

A. gambiae A. sergenti A. dthali

A. culicifacies A. fiuviatus A. maculipennis A. superpictus

complex

A. sacharovi, A.stephensi

A. superpictus A. sacharovi

A. culicifacies A. stephensi A. superpictus A. fiuviatus

. A. pharoensis A. sergenti

Leishmaniasis

Unknown

Ph. papataci Ph. perniciosus Ph. caucasicus several others

Phlebodomus Sp •

Ph. papatasii

Filariasis

\vuchereria bancrofti

(Draconculosis) Cyclops coronatus Cyclops locarti several others

Mosquito Culex

Bilharziasis

B. contortus B. forskalii

Bulinus truncatus

EN,tRC12/9 page 16

TABLE 7 - Nwnber of rural COInml.Uli ties, their average population and dispersion pattern

Aden Protectorate

French Somali land

Iran

Israel

Jordan

Kuwait

Lebanon

Pakistan East West

Saudi Arabia

Syrian Arab Republic

United Arab Republic

Nwnber of rural com­munities

50,000

827

23

2500

61424 35412

3600

6100

4000

Average population

300-3000

500

250

450 Jewish 1700 Arab

5000

200

783 782

1500

500

4000

Dispersion pattern

In certain ''Wadis'' (e.g. the Hadhramhaut) villages may be only a mile apart whilst in less fertile areas the distances may be as great as 20 to 30 miles.

Villages are located at inter-sections of caravan routes and connected through roads and trails, the le:1gth of which are difficult to estimate.

Average 15 - 20 Ians.

In Western and Northern districts, distances between villages are 5 - 10 kms, in Southern districts villages are more dispersed.

Average 10 Ians.

About 5 kms.

Average 1 mile. Varies greatly.

Average 10 - 15 kms.

About 3 kms.

~/RC12/9 page 11

3. Type ... of agriculture and common crops including the relative importance of the various types

Information under this item has been calculated from figures published

in the l'roduction Yearbook, 1960, Vol. 14; FAO.

In Table 8 is given the total area for each of the countries in the

Region and the relative distribution of total areas on the various forms of

land use. The table should be interpreted with care since there may be

wide vari.at;i.ons· among the reporting countries in defining the various forms

of land use.

"Arable land and laRd·under ·tree- crops", includes land with crops

(double cropped areas are counted only once), land temporarily fallow,

temporary meadows for mowing or pasture, land with market and kitchen

gardens (including cultivation under glass), and land with fruit trees,

vines. shrubs. and rubber plantations.

"Meadows and pastures II refers to land with herbaceous forage crops,

other than rotation grasses and clovers.

"Forested land" includes all land~ with natural or planted stands

of treea of present or potential value.

"Unused but potentially productive": In most cases this is subject­

ively determined by the reporting governments and represents anything from

land being at present reclaimed to land which may in the future be put to

agricultural use or 1:)e us.ed for forests.

"Built-on area, wasteland, and other "includes land occupied by

buildings, parks and ornamental gardens, roads or lanes., barren land,

wasteland, land under bodies of water.

Table 9 gives information on the area used for production of the

various kinds of cereals and in Table 10 is given the livestock population

for the countries for which information is available.

Country Year

Aden Colony 1955 Aden Protectorate 1956 Bahrain 1959 Cyprus 1958 Ethiopia 1959 French SomalUand 1959 Iran 1950 Iraq 1955 Israel 1959 Jordan 1954 Kuwait 1949 Lebanon 1959 Libya 1959

Cyrenaica 1957 Tripolitania 1959 Fezzan 1959

Muscat & Oman 1948 Pakistan 1957 Qatar 1947 Saudi Arabia 1952 Somalia

Ex _Iritish 1956 Ex-Italian 1957

Sudan 1954 Syr1a~ Arab Republic 1959 Trucial Onan 1947 Tunisia 1957 United Arab Republic 1957 Yemen 1947

TABLE 8 - Total Areas and their Relative Distribution on VariOUs Forms of Land Use ----- ------'=-----

-Total Area Percentage Distributjecn of total area

jArablc land Meadows Forested Unused but 1luil t-on area 1000 hectares and and land potentially wasteland

tree~rops Pastures !productive and other -% % % % %

21 - - - ••• 100.0 29,008 0.4 62.1 ••• 0.0 37.5

60 •• • ••• - ... 100.0 925 46.9 10.1 18.5 3.3 21.2

118,432 9.7 49.6 3.7 7.3 29.7 2,200 - n.1 5.5 ••• 83.4

163,000 10.3 6.1 11. 7 20.2 51.7 44,444 12.3 2.0 4.0 27.2 54.5

2,070 19.4 38.6 3.5 ••• 38.5 9,661 9.2 7.7 5.4 4.2 73.5 1,554 ... • •• ,H ••• 100.0 1,040 26.7 '" 8.9 35.0 29.4

175,954 1.7 4.5 0.3 ... 93.5 85,554 0.6 0.6 0.5 ... 98.3 25,000 10.0 30.0 0.0 ... 60.0 65,400 0.1 - - ... 99.9 21,238 ... ... 0.4 ••• 99.6 94,625 26.2 ••• 2.7 11.3 59.8

2,201 ... ... ••• ... 100.0 160,000 0.1 58.0 0.3 ... 41.6

17,612 0.5 48.8 46.3 ... 4.4 46,154 1.9 25.9 13.5 37.1 21.6

250,582 2.8 9.6 36.5 16.0 35.1 18,448 29.8 29.1 2.4 16.6 22.1

8,360 ••• ... .. .. ... 100.0 12,518 39.3 0.8 7.8 24.0 28.1

100,000 2.6 - 0.0 0.5 96.9 19,500 ... . .. 0.8 ... 99.2

~

~ Total ~

% 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 ],.00.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

--

Country

Aden Protectorate

Cyprus

Ethiopia

Iran

Iraq

Israel

Jordan I

EMJRC12/9 page 19

TABLE 9 - Area for Production of Cereals 1959/60 -1000 hectares

--

Wheat Barley Oats 11aize M.S. Rice (paddy )

3 2 - - T 28 -••• 61 • •• - - -171 321 ... 121 T 171,2 -... • •• - ... M • •• 259

1,490 1,091 4 M 5 63 - 8 8

62 57 1 3 523 ... 260 80 - - S ••• -

I Lebanon 66 18 ... 10 8 3 • ••

,

Libya: Cyrenaica 125 145 - -Tripolitania 58 286 - 1 Fezzan - - - -

Pakistan 4,921 217 - 485

Somalia 2x.British Some - - - -Ex. Italian Som. - - - 80

SJl'lan Arab Republic 1,422 727 5 9

'runisia 1,328 789 18 -'ni teci Arab Republic 620 59 - 781

Hotes I lEri trea only.

2Including "teff" (Eragrostis abyssinice.)

3Including Maize M = Millet S- Sorghum

-T 3 T 1

M 805 '8 456

T ... T 305

T 58

S 163

S 196

T = Millet and Sorghum

---

9,763

--1

-306

Total

33

... 234

.., 2,661

146

. ..

. .. 270 348 -

16,647

• •• 385

2,222

2,151

1,962

I

ri'/LBLE 10 - T.!ivestock £.Zpula.t.;ion j,n 10l.:0 of l10c..diJ --- - --- --- .-------------

'B~ ------ ---.-- ._-- ._ .. -- ------ ~~

0

Kin d 25~

Country Year ~ ----.- -- ~---.----

Mules &-ASS~~l:--Cattle Sheep Horses Hens - 1------ -- .. -- -- -- .-.,-~-.--

Cyprus 1959 394

Ethiopia1 1957 23,070 21,755 1,170 4,610

Iran 1954 5,000 17,750 370 1,393 41.0 •••

Iraq 1956 9,221 492 200 •••

Jordan 1958 689

Libya 1959 1,225

Pakistan 1959 23,820 6,662 595 999 454 11,345

Sudan 1958 7,247 7,846 574

Syrian Arab Republic 1959 5,91.2 97 304 76 2,973

Tunisia 1957 544 3,026 82 250 266 6,000

United Arab Republic 1957 1,390 1,259 45 961 162 60,785

--_ .• __ . ---- _._n" __

lExcluding Eritrea

E}ltRC12/9 page 21

4. General state of nutrition in rural areas:

The general state of nutrition is summarized by the various countries

as followsl

Aden Protectorate

French Somali­land

Iran

Jordan

Kuwait

Lebanon

School children in rural areas are underweight but rarely

show florid signs of avitaminosis.

is unknown.

Classical kwashiorkor

The general standard of nutrition is mediocre (milk products,

maize, and very rarely meat).

Poor in general.

Good, except in the Southern areas where the nomadic tribes

live. Good climate compensates for inadequate nutrition.

Fish constitutes the staple diet together with some bread

or rice, milk and dates. Sheep and camel meat are consumed

more than beef or goat meat. Fruit and vegetables are

scarce and are imported from neighbouring countries.

Carbohydrate consumptionl Cereals from wheat grain "Borghul",

is an outstanding staple national constituer.t of food.

Consumption of bread is high as is the usual pattern in the

Eastern world, this is especially the case in rural areas.

Rice is also very common.

Animal proteins I the consumption of milk products especiall:T

the Lebanese white cheese, "lebna" and "yoghort", is common.

They form an important constituent of food allover the

country, and sUbstitute milk consumption to a certain extent

especially in rural areas. Consumption of meat is higher

in urban areas. Mutton, followed by beef are the most

common. Meat is also eaten raw as "raw Kibba". Pork

meat is limited. Poultry and eggs are consumed in rural

areas; consumption of the latter is high. Fish is

available in coastal areas but is relatively expensive,

thus limiting its consumption. The mass production of

fruit constitutes an important supplenentary food.

EN"RCl2/9 page 22

Pal<:l.st,an, J>ast

West

Saudi Arabia

Syrian Arab Republic

~I Animal fat, butter, and olive oil are the main

sources of fat. Hydrogenated oils are becoming more and

more in common use.

The level of nutrition is good and deficiency diseases are

not as common as in other countries of the Region. Early

in 1961, a nutrition survey was carried. out in Lebanon but

the results have not yet been published.

UnsatisfactorY.

Generally fair. The staple food is wheat and other cereals

such as maize and millet.

Poor in general.

The ordinary diet in the rural areas is quite rich as it is

usually composed of broad, meat, cereals, milk and its

products, vegetables and some fruit.

Information on net food supplies is available from the Statistical

Yearbook of the United Nations for some of the countries in the Region,

namely Cyprus, Israel, Libya, Pakistan and the United Arab Republic. This

information is reproduced in Table 11.

5. The types of irrigation in the country with particular mention of their possible influence on incidence of endemic diseases

In Table 12 is shown the area under irrigation in 1000 hectares as

contained in the 1960 Production Yearbook of FAa.

This area has been compared with total area of arable land and land

under tree crops, Table 8 and the area under irrigation in percent of total

arable land has been calculated.

It is seen that all the agricultural area in the United Arab Republic

is irrigated. In Iraq half of' the agricultural area is under irrigation

and in Israel, Pakistan and Sudan, about one third of the agricultural area

is under irrigation.

Irrigation is also important in Cyprus, Lebanon and Somalia.

For each of the countries reporting the following information on

irrigation was given in the questionnaire.

TABLE 11 - !'let Food Supplies per Capita

Country Year

Cereals Po (as flour)

Fats Calories I'rotein tatoes Sugar Pulses l1eat

liilk and etc. (refined) and nuts oils

Fat Protein Per day _ .. , I""

K ilogrammes Per Year Total % r:>'::l fEnm. ori- mcs ein

Cyprus 1955 149 36 16 13 28 2 2 13 2,590 13 65

Israel 1957/58 124 45 27 9 26 5 5 16 2,750 17 84

Libya, Cyrenaica 1958 109 8 33 6 8 6 5 5 2,090 16 55

Pakistan 1958/59 139 3 14 7 4 2 2 4 1;810 9 43

United Arab Republic 1957/58 188 10 12 12 14 3 2 5 2,640 7 78

---

I

EM,lRC12/9 rage 24

TABLE 12 - Area under Irrigation and the Areal irrigated in percent of total arable land

Area under Irrigation

Country Year Total 1000 In percent of hectares total arable

land %

Cyprus 1958 80 18.4

Ethiopia 1958 48 0.4

Iran 19.5.5 1,600 9.5

Iraq 1956 2,800 .51.3

Israel 19.59 126 31.4

Jordan 19.5.5 32 3.6

Lebanon 1959 71 25.5

Libya, Cyrenaica 1958 2 0.4 Tripoli tania 1959 100 4.0

Pakistan 19.58 10,036 40.4

Somalia, Ex-Italian 1957 146 17.0

Sudan 19.55 2,409 33.9

qyrian Arab Republic 1959 476 8.7

United Arab Republic 1957 2,610 100.0

I I I

Aden Protec tora te

French Somali­land

Iran

Jordan

Kuwait

Lebanon

PD.kistan, East

EM,Al.C12/9 page 25

Irrigation is by means of flood water and wells. The

former is utilized by means of primitive dams and in the

Abyan cotton area the system of dams is permanent and

highly organized.

mechanical pumps.

Well water is drawn by animals or

No irrigation due to scarcity of water.

Ghanat.

Crops depend on rain-fall in the main part of the country.

In the Jordan valley and plains, growth of vegetables

depends on irrigation.

No irrigation.

Generally irrigation deoends onl 1) rivers. 2) rain

water, 3) wells.

Since 1940 a study of some irrigation projects on a large

scale started. These are,

a - Li tani Iliver project

b - Kasmeya project

c - Lake Yammoune, in Bekaa

d - Irrigation project of Akkar plane, from Elbarid river.

In other parts of the country irrigation projects are

usually small depending on water from wells and rivers.

With this state of irrigation Bilharziasis does not yet

constitute a problem to the country though some workers

have found Bulinus snails in localized areas and cases

of Bilharziasis among the Palestinian refugees. During

1961, a few caSeS of Bilharziasis have been reported from

the South - in Sarafand village and vicinity. The

situation is under investigation.

Irrigation is by means of rain, river and canal water.

This often leads to mosquito-breeding. A big irrigation

scheme is under construction in the districts of Kustia

and Jessore.

EM;RCl2/9 page 26

Pakistan, West

Syrian Arab Republic

United Arab Republic

Canals, wells and ponds are used for irrigation. Water

collections form breeding places for vectors of malaria.

Intestinal infections are prevalent in canal irrigated

areas.

Irrigation in the north of the country is being practised

by means of water from the rivers increasing the spreading

of bilharziasis. Anopheles breed in the rice fields.

Another main problem of irrigation in relation to the

endemic intestinal diseases exists in the villages

surrounding Damascus, Homs and Hama, due to the pollution

of the main rivers used for irrigation of vegetables.

Perennial irrigation is the predominant type of irrigation;

basin irrigation only in sollle Governorates. Perennial

irrigation to be extended after the exccution of the High

Dam project, with consequept probable increase in infection

with schistosomiasis (especially the mansonian type) and

ankylostomiasis.

6. Types of housing especially in relation to sanitation in rural areas I

Information on relationship between housing and sanitation was received

from the Syrian Arab Republic and West Pakistan only.

In the Syrian Arab Republic houses in rural areas consist mostly of

walls and floors made from mud and ceilings made from wood and thatched

branChes of trees.

and for rodents.

This type of house is a favourable place for insects

These houses are generally poorly ventilated and lighted, they lack

sanitary facilities, and improprer disposal of human excreta is common.

In West Pakistan the population live in mud-houses, huts and other

similar structures. Most of the dwellings are one roomed and no water

carriage system exists.

VII GOVERNl'lENT ACTIVITIES ON THE NATIONAL LEVEL AIMING AT PROMOTION OF RURAL HEALTH (Item 6 of questionnaire)

EM/RC12/9 page 27

The specific questions under this chapter apd the amount of· information

received are listed in Table 13. Countries having answered "Yes" or having

r;iven further information are lndicated by the sign "+" while the answer

"No" is indicated by the sign "_,, and in case of no information the space

is left empty.

1. Special Ministry for Municipal and Rural Affairs:

Such a Ministry exists in the majority of the countries.

the Ministry of Interior under a Central Development Council is responsible

for planning and implementation of rural community welfare development

projects under village councils. The work is done through specially

trained "Dehyars".

In Israel there is no special Hinistry for Municipal Rural Affairs.

The Division of Local Government at the Ministry of Interior deals with

both urban and rural areas.

In Jor4an responsibility for municipal affairs rests with the Ministry

of Interior. Rural Affairs are part of the Ninistry of Agriculture with

a special section for community development.

In· Kuwait the Department of Municipality is responsible for rural

affairs, and collaborates with the Public Health Department in some. sanitary

services.

In Pakistan Municipalities or small Disctrict Boards deal with problemc

of General sanitation of the area.

In the Syrian Arab Republic a special Ministry exists for municipal

and rural affairs with the following four technical departments.

a) Municipal Department: dealing wi th-- ci ty and village sani taticL, public gardens, traffic, etc.

b) Sanitary Engineering Department.

c) Planning and Housing Department.

d) Nechanical and Electrical Department.

EM;RC12/9 page 28

The functions of the Ministry are in the fields of planning and super-

vlsion. The achievements are mainly in the fields of water supplies and

electricity in rural areas. Housing pro.iects are still under development.

2. Special Agency dealing with rural health in the l1inistry of Public Health

In French Somaliland a Public Health Division under the Ninistry of

Health is in charge of rural health problems. This division collaborates

closely with the various administrative authorities of the territory .•

In Israel the Division of Regional Services Administration at the

flinistry deals WLth health matters in both urban and rural areas.

In Kuwait a preventive health division of the department of public

health deals particularly with rural health.

In Lebanon the medical care for the rural areas is under the Directorate

of Medical Care of the l'linistry of Health. Preventive Services (Qada Health

Departments) are under the Directorate of Preventive Medicine. Both

departments are under the Director General of the l1i.nistry, through the

provincial Health Office as a step towards decentralization.

In West Pakistan the promotion of rural health is through the agency

of Basic Democracies (Union Coun~il, Tehsil Councils and District Councils)

and through the West Pakistan Sanitary Board. The Sanitary Board is

responsible for the development of water supplies and drainage systems.

In Saudi Arabia the environmental sanitation department with the advice

of a WHO expert of an environmental sanitation field project deals with

rural health problems.

In the Syrian Arab RepubliE, the rural health department of the l'linistry

of Health is responsible for development and promotion of health services

in thirteen villages in El Guita Charkia. The rural health department

has integrated all activities in this area which include medical care,

o maternal and child health, health education, environmental sanitation,

training of health personnel, laboratory services, and vital and health

statistics.

In the United Arab Republic the general administration of rural health

or the Ministry of Health is composed of the following two administrations;

EM~C12/9 page 29

a) Health Centres adQinistration, responsible for the technical

supervision of the health centres in all the governorates and for study of

the means of promotion of all services provided.

b) Sarli tary Engineering administration, responsible for setting

up the programme of environmental sanitation in rural areas by means of

uni tes to generalize the installation of sanitary rural privies, Provision

of potable water and the technical supervision of these programmes.

3. Cooperation in rural health of departments of other Ninistries with the Ministry of Public Health I

Such cooperation exists in practically all the responding countries.

This cooperation takes place pa.rticularl¥ with the Ministries of AgricUlture

Education and Social Affairs.

4. Committee for coordinating the work of various governmental agencies for promoting rural healthl

Such a committee exists in Iran, in Jordan, in West Pakistan and in Saudi Arabia.

In Iran a Rural Development Council has been created in the. Ministry

of Interior.

In Jordan committees have been created conSisting of a head of

administration, a medical officer, a district engineer and a member of the

Community Development Department.

In Lebanon no committees have been developed for coordination of work

with other governmental agencies at central level. However, cooperation

with the Qaimmekams (Administrators) of the Qadas of the local level is

intimate.

In West Pakistan coordination is carried out through the Divisional

Councils farmed under Basic Democracies Order 1959.

In Saudi Arabia a Higher Board for Environmental Sanitation Projects

is undertaking these activities.

'J!>lBLE 13 - Government activities on the national level aiming at promotion of rural health'

~S n

~ ~ I (JJ ii1 ii1 S' i c... H "if VOl-'

[ 0 a "l ON

p: p: 0' '1 (\) ~ a Ii:' III

~ ::s is .... '" '" ::s ....

::s &' ~ §

.,.. P' io" C1l ~ ~ '1

~ go .. .. i 0' t:' ~ ~ ~ i :;0 '" '" (I) ci- ci-

l [ I-' I-' .... .... (.I n

1. Special Ministry for Municipal and Rural Affairs. + + + + + + + + Are organization and functions described? - + + + + +

2. Special agency of Ministry of Health dealing with rural heal th. + + + + + + + Are composition and functions described? + + + + + + +

3. l~e other ministries cooperating with the Ministry of Health? + + + + + + + + + Information on extent of cooperation. + + + + + + + + +

4. Coordinating Committoe for rural health. + + + + Are composition and functions described? + + +

EM/RCl2/9 page 31

VIn VILLAGE HEALTH COOffiRATIVE SOC::'ETIES (Item 7 of questionnaire)

Health Cooperative Societies are reported to exist in \'est Pakistan

and in the United Arab Republic.

West Pakistan reports that the number of health cooperative societies

is 98 and tjJ.e percentage of rural papulation covered is 0.3%. These

societies which run charitable dispensaries are supported by the Health

Department which provides a subsidy of Rs, 600,000 per annum. Part-time

doctors are employed and drugs are distributed free of charge,

In the United Arab Republic the number of societies is 17, but plans

are underway to extend village cooperative societies to all villages three

kilometres or more from a health unit and with a population of Dbout 5000.

These societies are supported by the Ministry of Health. A part-time

doctor is enployed and drugs are distributed at reduced rates,

IX HEADTH UNITS IN RURAL AREAS (Item 8 of questionnaire)

Under this chapter of the qre stioIlIlcure ini'or,nation was requested on

all the di1'1"erent types of health units in the country, a descl'l.pvion of

the staffing and of the activities of rural health units, their integration

in the general public health structure, their equipment and their income

and expenditure patterns.

liith the e::ception of Saudi Arabia detailed replies were received from

all the responding count,'ies.

by country.

:These replies are summarized belOW', country

Aden Protectorate

Health units "''VB been stal1.dardized throughout the Protectorate and

uS'.lally consist of three rooms. One is reserved for women and children,

one for men and the t!1ird is uy,d as a store and simple laboratory.

These units may be constructed of mud, stone or hollow concrete blocks,

J'here is nCM an increasing tendency to build new health units from hollow

concrete blocks.

Rural health units are sbffed by one health assistant. It is hoped

thp.t in tho future, units serving 2.!'8a8 with large populations will have

tMO health assistants, thus el'.ab.Line one to be constantly on tour.

EM/RC1219 page 32

The more important units should be staffed with three assistants, two

males and one female, but at present this is not feasible.

The health assistants are "general dutY" and are responsible for all

aspects of health within their area. They treat the sick, imnunize the

school children, control epidemics and advise the local administrative

staff on environmental hygiene. All units are within easy reach of military

radio transmitters and whenever a problem beyond their capabilities arises

they signal for assistance. The signals are received by the Protectorate

Health Service Headquarters, which is in Aden. Assistance in diagposis is

given and if a case warrants evacuation to Aden, permisSion is granted for

the case to be sent by air. The case may either travel by routine internal

flights of Aden Airways or by special charter provided by the Royal Air Force.

Rural health units are supplied with drugs, UNICEF milk, vitamins and

drug supplements, sterilizer, primus stove, microscope, hand cerrtrigue,

dental farceps, syringes, baby scales, scalpels and dissecting and dressing

forceps. Drugs c anprise suJphonamides (including the long acting variety

suJphsmethoxy-pyridazine), penicillin, streptanycin and pasinah (for

tuberculosis only), suJphones (leprosy) eye cintment, (chloramphenicol) iron,

(ferrous sulphate) vitamins, morphia, pethidine etc.

Expenditure patterns for ruml health units are difficult to estimate.

French Somaliland

Rural health is the responsibility of the various medical centres out-

side Djibouti. These centres are directed or supervised by a physician with

the assistance of a local nurse. Each separate community has a medical post

or a dispensary constructed of bricks and technically equipped for treatment

and isolation of patierrts.

There are

areas. These

eight dispensaries and two medical out-posts in the rural

undertake smallpox vaccination which is obligatory, BeG

vaccination, and health and sanitation activities. Curative medicine and

maternal and child health are the basic activities of the rural health unit.

In addition there are mobile units, each directed by a physician, and

active in social and occupational health, basic health education, nutritional

services and ethnological research.

EH/RC12/9 page 33

The basis of the public health structure of the terri tory is the

territorial hosnital in Diibouti from where all specialized services are

carried out in collaboration with the Directorate of Public Health.

The rural health centres are equipped with basic material such as

a~?aratuses for pulverization, for spraying of aerosol, stocks of insect­

icides and disinfectants.

Provisions are received at request from the territorial health services.

All services are carried out without payment and it is difficult to estimate

the costs which vary considerably fram year to year.

Iran

In 1959 a total of 953 health units existed in the country. Of these

598 are run by the Ministry of Health and the remaining 355 by other agencies,

such as Red Lion and Sun or other voluntary agencies.

The work of these units is chiefly curative in nature and they are

mostly located in rural areas.

There are also 29 health centres mostly located in towns. The work of

these centres is mainly preventive such as immunizations, m8.ternal and child

health, nursing, tuberculosis control, venereal diseases contr~, communicable

diseases control. environment.al health and public health laboratory oorvices,

Host of these centres are relatively well staffed wi th tr:4ned people.

Some of them are used for training and danonstration purposes.

The general objective for the future is to develop the present health

units into comprehensive ,)reventive, diagnostiC, trea"bnent and rehabilitation

centres. It is planned to develop al,J.. health facilities into a territorial

hierachry of general purpose type.

Israel

About 80% of the total population and 90% - 100% of the rural population

are covered by voluntary health insurance schemes (including hospitalization).

Uni ts include vi llage dispensaries, local and district clinics and health

centres with integrated service. The health insurance agencies are concerneC.

mainly with curative services, while preventive medicine and immunization,

,.'.o"l;her and child health, tuberculo,sis, venereal diseases and vector control

are dealt with by Goverr.ment services.

Erl/RC12/9 page 34

Jordan

The Hashemite Kingdom of the Jordan is divided into seven districts,

Each district is headed by a Senior Hedical Officer. who controls the sub­

districts, hospitals and rural health units.

Urban areas are provided with hospital facilities, general clinics,

maternal and child health centres and sanitary inspection.

The following table shows the number and types of Government clinics:-

General Clinic£ l1aternal and Child Health Centres Mobi;Le Units

Urban

33 16

Rural

86 13

1

119 29 1

The maj ori ty of rural clinics and centres are rented by the Ministry

of Health, A few are operated by local councils or villages. A few new

stone-built clinics are being constructed by the Community Development

Department,

Staffing:

Rural health units are staffed as follows:-

a, Rural general clinics: A visiting physician once or twice a week.

One permanent "Tamurgi" and a cleaner. A nurse is posted" in larger clinics.

b, Natemal and Child Health Centres: One or two qualified midwives

and one servant are posted permanently.

centres once or twice a week.

A medical officer visits these

c. Mobile unit: A mobile unit aets in distant rural areas, staff8d

by a medical officer, a qualified midwife and an aid,

A special lady Medical Officer supervises all maternal and child healt:]

centres,

All staff working in these clinics are given special training for

field work,

The policy of the }\inistry of Health is to widen and extend rural

hee.lth services year after year as provisions are made available.

Activities I

EMjRC12/9 page 35

a. Specially trained sanitary inspectors are posted to discover

communicable diseases in rural areas and to vaccinate against smallpox

and other diseases.

b. Sanitation is carried out l:ly a special section (environmental

sanitation division) with its own inspectors.

c. Endemic diseases are taken care of by the medical officers each

in his own district.

the whole country.

A special tuberculosis campaign is under way in

d. Curative medicine is carried out in a large chain of clinics where

medical care is rendered and drugs are distributed free of charge.

e. ~laternity and child health are coped with on the spot.

cases are referred to maternity hospitals.

Difficult

f. Tuberculosis surveys have been carried out in the country, posi ti ve

cases are recorded and looked after medioally and socially.

Venereal diseases are not common and are becoming unimportant after

penicillin has been widely ~istered.

Communicable eye diseases will soon be under control under a new

scheme which is about to be enforced.

regular treatment.

Patients attend village clinics for

g. Vector control is carried out where necessary.

h. About 95% of the population of the country are served by the variou:

health units.

A malaria eradication project is functioning under a special well

staffed department conjointly with WHO and UNICEF.

Facilities for rE)ferral to hospitals and laboratories are extended to

village clinics free of charge.

Each rural health clinic is supplied with necessary drugs, dressings,

and equipment sufficient to deal with urgent casei!.

As services are extended free of charge, there is no income in rural

clinics. The annual expenditure is estimated at roughly 600 Dinars per

clinic.

EE/:aC12/9 page 36

Kuwait

Number and types of health units in rural areas:

General dispensaries 11

Preventive health centres 5 Haternal and child health centres 6

Veterinary centres 3

Quarantine stations 4 Dental care 3

Total 32

In view of the fact that the government undertakes to build all health

units, the trend in constructing these units is to provide better and more

extensive services to the rural areas, regardless of cost.

Rural health units are s-taffed with nurses and male attendants, full­

time or part-tinie physicians as -the necessity calls in main villages and,! or

hospitals, sanitary inspGctors, veterinary inspectors and dentis-ts. There

are 47 physicians, 4 dentists and 3 veterinarians. The estimated ratio of

nurses and male a-ttendan~s is 4 per 1,000 populaticn. The approximate ratio

of working physicians to -the population is one physician per 1,000 population.

Activities:

a. Preventive i:B w.cine and immunization: There are five health units

responsible fo~ birth a:ld death registration, for immunization against

smallpox, diphther'.a and poliomyelitis and for control of patien-ts, contacts

and immedia-te envi::'orunent.

b, The en7i:!'onlllental sa'li ta-tion section unrertakes to educate the

pu"Jlic as to mode of sp:::'8ad a'1d control of diseases, protection and

purifyinr: ;late:!' supplies and sending samples for analysis.

Health uni""s in rural areas are· attached to tteirrespective divisicns,

and may refer certain cuI'ati VB and! or analytic cases to hospitals and/ 01'

J.abora-tories, alttwSh a minor number of these units have their special

labo:!'atories, or a hocpital which is loca-ted in the rural areas for some

9rellOnti V3 0:''' cu:-:ati va healtJ;. purposes.

Equipment:

EMJRC12/9 page 37

Health units of rural areas are in most easp~ equipped with stretchers.

aQbulances, DDT sprayers, baby balances, etc.

Finance I

Health services are provided to all pat.ient.s I"ree 01" charge.

Lebanon

a. There are nine rural hospitals with the following staffing I

Functions I

2 medical officers

1 nurse

2 practical nurses

1 midwife

1 cook

3 attendants

Out-patient medical care, first aid, in-patients, paediatrics and

deliverY Aervicp,s.

b. gada Health Departmentsl The nwnber of units is 24 out of which

12 are operated by part-time health officers (i.e. three days a week).

staffing I

1 medical officer

1 nurse or midwife

1 sani tariar

1 attendant

l~ctionsl To provide preventive services.

c. Rural Dispensaries I Nwnber-2$

Staffingl

1 medical officer (the Qada health officer acting)

1 nurse or midwife (the Qada nurse acting)

1 assistant nurse

1 attendant (the Qada attendant acting)

Ei'!/RC12/9 page 38

Functions I To provide medical care.

d. Mobile Health Unitsl

These are still at the pianning stage.

F1mctionsl To provide medical care during visits to the villages.

e. Rural Health Project (Halba Centre) I

A programme of constitution of rural health centres for providing

basic health services throughout the country was initiated by establishing

the first centre of this type in Halba, Akkar.This project, run by the

Lebanese Government, is receiving the technical assistance of WHO. The

main objective of this project is to demonstrate the op&ration of rural

health services and to train personnel required not only for carrying out

these services in one area but in all rural areas of Lebanon.

The extension of this project depends on its progress. The pattern

envisaged for this project consists of the establishment of health centres

in the head towns of each Qada and sub-centres according to the geographical

conditions and distribution of population. All these units are run in

rented private property. Generally they are built with concrete blocks

all of which are plastered and white-washed.

f or building.

j'hereare no special patterns

Rent of each unit varies between three and six thousand Lebanese

Pounds. according to size, location and condition of the building.

Due to the short distances between villages and the availability of

houses that could be arranged to meet the needs, no steps have been taken

in the past to build health units in a standard w~.

Provisions in the proposed· budget for 1962 for allocation of funds to

build ten dispensaries has been requel'lwd. If approved, plans will be

developed in such a way as to allow future expansion and transformation

of buildings into rural health centrel!.

Cases from local health units needing specialized services are

referred to the provincial hospitals (which are five in number, one in

each province). Laboratory services are available to the health units

in the laboratories located in the capitals of the five governorates

(districts) •

EM/RC12/9 page 39

Equipments At present the health units are supplied with various

equipment according to their needs. The Ministry of Health is intending

to seek the help of WHO tn standardizing this equipment and purchasing it

through the Organization.

Expenditures I For each rurql hospital L.L. 100,000 is allocated for

the first year (50,000 for initial equipping and 50,000 for running expenses),

L.L. 50,000 is allocated for each successive year of operation. For

dispensaries, supplies are provided by the central stores of the Ministry.

110 separate budget for each dispensary or Qada Health Department exists.

Expenditures for staffing and other expenses (equipment, supplies, etc. for

Qada departments) are provided as part of the general budget of the Ministry

of Heslth.

East Pakistan

There are 409 rural health circles in the Province. In addition,

there are 110 four-bedded thana dispensaries.

puce a buildings and some in tin sheds.

Some units are located in

There are also 48 government or government aided maternal and child

health institutions in the Province. The rural population is generally

poor; low-cost buildings are constructed to suit the economy of the rural

areas.

Staffings

The starf of each rural health circle consists of one sanitary inspector,

two health assistants and one menial. Each thana dispensary has one medical

officer, one compounder and one menial. One training centre at Dacca for

training health staff, one health staff for each union or per ten thousand

people will he the ideal. Rural hlalth centres are planned to start in

the Province.

Expenditures I Collection of tax from the local people is the source

of income. All expenditures for maintenance of the 110 thana dispensaries

a"() borne by the Government. The rural health oentres have not yet

started functioning.

EH/RC12/9 page 40

West Pakistan

At present hospitals, dispensaries and maternal and child health

centres are catering to the needs of the rural population. The munber

of existing units in the rural area is given beloW I

Hospitals 92

Dispensaries 898

Maternal and !lhild health centres 106

In addition, the preventive health field staff consisting of sanitary

inspectors, sanitary supervisors, vaccinators, etc., is also emplqyedto

look after the needs of the population on the preventive side.

The material used in the construction of the buildings for

accommodatine these units, is mostly bricks and mortar.

A new fifteen year Hastern Plan has recently been designed. The

plan envisages the setting up of 1000 primary health units to cover rural

West Pakistan. Each unit will on the average serve a population of about

50,000. Each primary health unit will comprise one primary health centre

and three sub-centres. The unit will provide an integrated curative and

preventive health coverage to the population.

It will take care of all the preventive work such as maternal and

child welfare, vaccination and immunization programme, tuberculosis and

malaria control measures and control of other infectious diseases. The

unit will also be responsible for all sanitation and environmental hygiene

measures as well as school health and health education in its area.

Besides this preventive work the primary health un:l.t will pTOVide curative

medical care for the population. From the operational point of view, it

is preferred to have such comprehensive rural health centres as detailed

above.

The trend is to improve the existing dispensaries which were

primarily first aid centres to the present concept of rural health centres.

No research and training on low-cost building is being done.

staffing,

EM,/RC12/9 page 41

In the new primary health centres and sub-centres, the following

staff will be employed.

Centres, -

Medical Officers

Health Technician

Lady Health Visitor

Dispensers and Dressers

Laboratory Technician

Clerk

Midwife

Sanitary Patrol

Driver, Fitter and Peon

Sub-centres, -

Health Technician

Midw:i f'e

Sanitary Patrol

2

I

I

3

I

I

I

I

I

I

1

I

(one male and one female)

each

Ten field training and demonstration rural health centres are to be

opened, six of which have already started functioning and four others are

nearing completicn. In addition to the duties as primary health centres

these will serve as training grounds for nurses, midwives and dayas, etc.

It is contemplated to start two health techn~c~ans training institutes,

one at Bahawalpur and one at C;;wtta to train the health technicians required

for the rural health work in the primary centres and sub~qentres. The

staff earmarked for the ten demonstration and field training health units

was given are-orientation cour,se at the Institute of Hygiene and

P~eventive MediCine, Lahore.

The )r.]dical colleges a..,d schools will provide the necessary number

of medical offi~ers required for the primary health centres. The public

health ~ursing schro:s at Lahore, Peshawar and Hyderabad will provide the

necessary number of lady heal't'l visitors.

The staff earmarked for one primary health centre and its three sub­

ecn+,res is expec'~ed to be sufficient for the population is is required

to serve.

EI'I;RC12/9 page 42

Activities

The field staff working in the rural areas is responsible for carrying

out smallpox vaccination, anti-cholera and TAB inocculations in case of

localized out-breaks of cholera and typhoid. They also take antifly and

anti-mosquito measures and chlorinate open shallow wells meant for drinking

water. Anti-malaria measures are also taken in the form of intensive and

systematic insecticidal spraying.

by field staff.

Anti-malaria drugs are also distributed

The hospitals and dispensaries provide facilities for free treatment

of actual cases suffering from various ailments.

The maternal and child health centres aim at promoting the health,

well-being and happiness of mothers and children and prolonging their livGS

by preventing disease and disability through early diagnosis and prompt

treatment of illness. These objectives are attained by 1) providing

health supervision to expectant and nursing mothers and their children at

the centres and at their homes. 2) educating the families in healthy

living. The maternal and child health centres provide antenatal and

post-natal facilities to the rural population.

The population is given BCG vaccination to protect them from

tuberculosis. Mobile teams for BCG vaccinaticn are doing this work in

various areas of the province.

en some of the hospitals and dispensaries penicillin is supplied for

the free treatment of venereal diseases patients.

Anti-typhus measures are organized in districts of D.G. Khan, D.r. Khan, Hazara and Quetta Division. Forty-seven delousing teams are working

in these control projects aided by UNICEF. As a result of extensive

measures, the province is now free of t,yphus.

Extensive anti-malaria measures consisting of systematic insecticidal

spraying are adopted by the anti -malaria field staff. A scheme f or the

eradication of malaria has been formulated in collaboration with the

;<{orld Health Organization. The eradication programme has started in

Sheikhupura and Sialkot districts. It is expected that the programme

of malaria eradication will be completed by 1975.

EM;1l.C12/9 pag" 43

The primary health centres wiL. be backed by a graded hospital service,

beginning with a Tehsil headquarters hospital and going through the district

headquarters hospi tal to the ~arge centres of specialist medical relief

attached to the major medical teaching centres.

Equipment I All the necessary basic equipment for the primary health

centres will be provided through UNICEF aid. In addition to the UNICEF

assistance, equipment, worth Rs. 21,000 is to be provided locally.

Expendi tures I The source of income will be from the public revenue

and the pattern of the expenditure of a; primary health unit (one primary

health centre plus three SUb-centres) will be as followsl

l~ Pay and allowances of staff Rs. 44,000

2. Hedicines and drugs Rs. 25,000

3. Die'~ of patients Rs. 4,000

4. Insecticides and vaccines Rs, 5,000

5. Transport Rs. 1,500

6. Other exPenditure Rs. 2,000

Total I Rso 81,500 =================

Saudi Arabia

No information on health units in rural areas was received,from

this country.

Sudan -The different types of health units existing in t.he country arel-

HospitBls 66

Dispensaries 448

Dressing stations 489

Heal th centres 37 Total 1040

Number of personnel a~ployed in rural health workl-

J100ical assistants 509

Nurses 120

11idw:i_.v8s 901

Health vIsitors 28

Total 1558

EM,tRC12/9 page 44

Syrian Arab Republic

There is only one rural health unit in the country. It was

established in 1958 with WHO assistance in the Nahya El Ghuta Charkia.

This unit has a main centre in Sakba and three sub-centres.

The premises of the main centre and the sub-centres are rented by

the Government.

staffing:

The national staff consists of:

Two medical officers, one chief nurse-midwife, four nurse-midwives,

five health visitors, two nurse-aides, two laboratory technicians, one

chief clerk, one storekeeper and two drivera.

Training:

The in-service training of the project personnel and the training

of the midwives (dayas) of the village is the only work achieved in this

field. It is hoped that in the future, training will be afforded to all

categories of health personnel engaged in rural health work.

In addition to the presont number of personnel assigned to rural

health, two sanitarians and one health educator will be needed.

Activities:

The following activities are carried out:

a. Preventive medicine and immunization. Routine vaccination of

DPT, smallpox and poliomyelitis is being carried out regularly and according

to need.

b. Medical care is rendered to the population of the project area

through the different clinics in the main centre and sub-centres.

c. Maternal and child health and nursing are carried out within

the limited facilities.

The population of the project area is about 25,000 in 14 villages.

Equipment: The main centre and the three sub-centres have laboratory,

sanitation and clinical equipment, visual aids and supplies for demonstr:_,ticn

purposes, drugs and chemicals and two vehicles.

FM/RJ:12/9 page 45

Finance: The annual budget ·for. rural health is 190,000 Syrim.

P01Ulds and the last year eJiPElndi tures were about 124~OOO including salaries

of personnel.

United Arab Republic

Number of health units in rural areas:-

Rural health centres 254

Canbined units 250

Social centres 105

Village health cooperative societies 17

Canprehensive mass treatment units 168

Total. 794

Building material used is generally red brick and concrete for rural.

health centres and combined units and red brick for social centres and

village health cooperative societies.

Cost of construction:

Rural health centre £ 20,000,fQr s~lified l'Ilral heal.th centre £ 4000

Canbined unit £ 35,000

Social centre £ 10,000

Village health cooperative society - rented house or.as a donation.

Staffing:

Rural health centre:

1 physician in some cases two, full-tine

1 sanitarian

1 clerk

1 laboratory technician

1 qualified nurse-midwife (a senior assistant nurse or assistant midwife may replace her)

2 or more assistant midwi.ws

1 assistant nurse

Orderlies

EM/RfJl2/9 page 46

Rural healtp centre, Sub-ceIltre:

1 physician - periodic visits

2 assistant midwives

Orderlies

Canb:ined unit - Health unit

1 full-time physician

1 nurse midwii'e

2 assistant midwives

1 assistant nurse

1 sanitarian

2 sanitary aides

1 laboratory technician

Orderlies

Social centre:

1 socio-agricultural e:xpert

1 full-time physician

1 quali.fied health visitor midwive

1 laboratory technician

1 clerk

Orderlies

CQ!!J>rehensive mass treatment units:

1 full-time physician

1 clerk

1 laboratory technician

1 assistant adninistrator

vector control labourers

Orderlies

Village health cooperative societies:

1 physician

2 assistant midwives

1 laboratory tectmician

OrdBrll.es

Tra'-'- • oUL.LUg.

EM/RCl2./9 page 47

As regards the rural health centres there are training centres in

Shubrament and Talbia Centres as well as three other proposed centres at

Sirs-El-Layyan, Abis and Kouta in which practical training of all the

sta:tf of the rural health centre takes place, with the exception of the

orderlies. In addition theoretical lectures are given in the train:lng

centre at Fam-El-Khalig. By the end of the training period (usually

six weeks) an examination is held for evalllation.

There are training centres :In SOlIe cOllbined units and social centres

for train:!ng of all the new staff required. In-service training for

shorter periOds takes place regular~ in these train:\ng centres.

Activities:

Preventive medicine and inDmmization:

a. Registration of births and deaths and notifiable diseases.

undertaldng of all necessary measures.

b. Examination of deaths for measures to be taken in case of

increase over average number of deaths within previous &J days; deaths

from canmimicab16 diseases.

c. Canimunicable disease control, diagnosis of cases; isolation;

investigation of source of inf-ect:\.onj_QPservatil..Qtl:ot .. cootac:\;B;dIi!'iinfection

and inmunization of contacts.

d. Maternal and child health services.

e. Heal th education.

Immunization programmes:

a. £mallpax for infants under four months of age.

b •.. Diphtheria between 6 - 8.months.

c. Im!m.mization of pilgr:i:ms aga:!nst smallpox •. typhoid. cholera.

d. other vaccinations when ~ired.

FM/RC12./9 page 48

Sanitation:

a, FOGd inspection.

b, Water sampling,

c, General cleanlj.ness, :r;'6ITIoval of heaps of dung and manure,

do. Housing modification, installation of latrines.

e, Supervision of public baths, laundries, latrines, slaughter places and markets,

Endemic and parasitic diseases:

a, Comprehensive examination and treatment for these diseases in

villages related. to the health control as well as routl.ne examination o:t:

new out-patients aged 5 - 60 years,

b, Snail control,

c. Health education,

Curative medicine:

a. Out"'Patients, minor surgery, tirst-aid services,

b, In-patient services for advanced cases of endemic diseases,

maternal and child health, medical cases, limited operations,

Maternal and child health and nursing:

a, Pre-natal care,

b, Natal care,

c, Post-natal care,

do. Lactating mothers care,

e, Care o:t: children up to 6 years,

Tuberculosis, venereal diseases, camnmicable eye diseases control:

a, TUberculosis:

Referral of suspected cases to nearest dispensary,

Supervision of domiciliary treatment cases in too territory of

the health centre,

Health educaticn,

b. Venereal diseases:

Detection of cases.

Treatment of cases.

Health. education.

c. Canmunicable eye diseases controll

Treatment of cases.

Health education.

Fly control.

Vector control:

EM/FWl2/9 page Ie

Larviciding and house spraying against mosquito borne diseases.

Intept1.on of heaJLh units in the general public health structure:

Cases are referred to district hospitals, general hospitals, fever

hospitals, skin and venereal diseases hospitals, eye-diseases hospitals etc.

Equipment: The rural health centre canprises the following sections:

out-patient, matemal am child health, laboratory, in-patient and

health office. Each unit is equipped 1d.th the necessary ecp.ipment.

Finance: The annual running eJPenses of the rural health centre is

about" 5150. SOcial centres have annual runn:ing expenses of about" 2400 of which" 500 - f, 2000 are paid by the Goven:unent, the rest being collected

from the inhabitants.

Canbined units have annual running eXpP.nses canprising for the health

unit" .5200, the social unit" 2700, and the school f, 6000.

Canprehensive mass treatment units have annual running elP enses of

about £ 1500.

Qalyub Demonstration and Training Centre has running eJq)enses for the

rural health unit (general service unit, e.g •. Tanan) £ 13,000. The sub­

centre £ 1100 - 1300.

EM/RC12/9 page 50

X SOCIAL CENTRES (Item 9 of questionnaire)

Under this chapter of the questionnaire info:rnJ8.tion was asked on any

type of organization for specific activities by the Ministry of Social

Affairs for increasing the standard of living of the rural population,

and in the affi:rnJ8.tive the functions and organization of such centres and

any medical and health work included in tlEir activities. Most.of the

countries have reported that such activities are undertaken.

French Somaliland

In French Samaliland a medical social centre exists in Djibouti.

otherwise social centres have not yet been created, but the problem is

under study.

Iran

It 1:1 only rooen:J:.ly- that a special Social Welfare Department has been

eS1;atllished in the Ministry of Labwr with thepltlpo:oe of creating social

welfare activit:i.es in rural areas. Hitherto social service aptivities

have been carried out by voluntary organizations.

In health centres some social work is done through trained public

health nurses and other health personnel.

Jordan

The cooperative movement in Jordan is initiated by the Goverrunent and

sponsored by the Department of Cooperative Development of the Ministry of

Social Affairs. The movement aims to raise the socio-economic standards

of the population particularly in the rural communities. Out of the 290

cooperati ve societies, 230 with about 4,000 members are located in the

rural areas. Most of these societies provide credit to fanners in order

to increase their incane.

Social centres, as the term ilTIplies, do not exist, but the Ministry

of Social Affairs has realized its obligations towards the Jordanian

society as' a WIlole, as embraced within the Social Affairs Law, No. (14)

for the year 1956, Which called for the establiShment of ·adequate services

to promote the social standard of the people on the one hand, and to

combat delinquency amongst children and adultl$ and social problems arising

from the rapid growth of population in the country, on the other.

Kuwait

EM/RCJ2./9 page 51

The Departments of Education and Social Affairs have contributed

towards the execution of vital projects a:imi.ng at the trainmg of adults

and their instruction in different crafts which prepare them to realize

a better standard of living. The most important of these projects are:

a) The vocational training projects - aiming at raising the standard

of technical qualifications among Kuwaiti worlrers and iJrrproving their

e:xperience in worl<:s and sJdlls demanied by the modern mdustrialization.

b) Girls Trainmg Institute which aims at giving an opportunity to

the Kuwaiti girls to gam e:xperience m danestic worl<:, alimentary matters,

child welfare, nursing, needle work and embroidery. The Institute alBo

aims at providmg girls with general !lnd speciali red knowledge on modem

SOCiology, eccnany and secreterial work to increase their effectiveness in

the society by understanding its circumstances, customs, problems and needs,

preparing them for opportunity of field work which comcides with the needs

of the society.

The fundamental education centres undertake to broaden social and

health consciousness among their nenibers and to this etfect organize audio­

visual programmes, exhibiting healtl>l!lldsocial guidanc.e fiJr.w and

organizing lectures and meetings reviewmg the problP!lls and inducing members

to contribute to solving them and suggest solutions,

The following figures show the activities by January 1960:

Number of fundamental education centres

Nunber of candidates

Nuniber of instructors and superviscrs

lebanon

17 3559

153

The Ministry of Social Affairs used to take care of social services

and community development in rural areas until 1959, well a special semi

governmental agency called "Department of Community Deve1opment" was

created for that pUIpose. Plans are still under consideration by the

Gove:mment and the Ministry of Health has no definite information on

this matter at this stage.

EM/Rcl.2/9 page 52

West Pakistan

The Ministry of Social Affairs contributes to raising the standard

of living through an agriculture extension programme.

The Social Welfare Department has organized some SOCl.a.L cent;res out;

these are located in urban areas. These centres help various groups to

i'unction fully through organization and through use of democratic methods

with the formation of area committees.

Saudi Arabia

Special activities for increasing the standard of living are deployed

through community development projects. Their functions are promotion of

health and of social and ecmomic standards.

The number of projects in the country is six and eight sre cialists are

attached to each centre. The health staff of each project comprises a

doctor, a nurse; a sanitarian and a health visitor.

Syrian Arab Republic

Social centres ex!.st and are composed of the following units:

a) The social unit (specialist in social work and a case worker)

b) The agricultural tmit (expert in agriculture and a veterinarian)

c) The health unit (physician, midwife, health visitor and a

sanitarian)

d) The construction tmit (exrert in building construction)

There are four social centres in the Region, namely:

Haran El Awamid

Salkhad

Al Shareia

Goubat Al Birghal

Mohafazat of Damascus

Mohafazat of Suida

l10hafazat of Edlib

Mohafazat of Lattekia

The Ministry intends to establish ane main centre in each of the

eleven Mohafazats of the country and plans also to encourage the inhabitants

to contribute and assist in establiBhing one social sub-centre for every

20,000 population.

EM/RCJ2/9 page 53

The function of the~e centre~ is mainly to raise the educationaJ.,

econanical social and health standards of the country.

United Arab Republic

There is a special service in the Ministry of Social Affairs to look

after the famer's affairs. This service has undertaken the study of

rural reform projects in foreign countries and the results of '!he experiments

done in Egypt itself for village reform. The social centres project started

in May 1941 with five centres, expanded till 1953 when the number of social

centres was 170. Each centre has been deSigned to serve a populatian of

about 10,000. After the establishment of the Pennanent Council of Public

Welfare Services in 1953, the combined units project started and s~ of

the social centres have been converted into combined units. There are nOw

105 social centres.

other agencies in the Ministry of SociB.l Affairs working in the fie ld

of health in the rural communities are the rural ref om societies and the

cooperative societies. S~ of these non~official societies have

established free out-patient clinics, served by dootors practising in the

locality.

The social centres project was based upon three fundamental princiPles:

(1) Participation of the inhabitants after being convinced of the

value and benefits of the social centre in the service of the village.

The social centre would be set up upon request by the inhabitants and

implement the projects which it was desired to carry out.

(2) The social centre services were supposed to comprise all the

phases of village life, economically, hygienically, culturally and socially

at the same time as they influence each otheT.

(3) The premises of the social centre should be silnple and

econanica:uy built.

The functions of the social centres areas folloWS:

Sanitary and I12dical servicesl

Sanitation such as construction of underground water s~, the

establishment of sanitary latrines in houses and mosques, the general

EWRC12/9 page 54

cJ.eanllness and village illumination. Medical services, medical care for

the sick in the out-patient clinics, first and preventive aid and minor

operations (that need local anaestheSia), campaign against endemic diseases,

maternal and child health services, school health and heaJLh education.

Programmes similar to rural health centres with the following exceptionsl

(1) The work of the health office is lacking.

(2) No in-patient wards in sOcial centres (except a few materni ty beds)

(3) Treatment of OIlt-patients is Pt'escribed and dispensed. for a few

piasters.

(4) The midwife works with the help of the native midwife (village

illiterate midwl.fe) since there are no assistant midwives in the social

centres.

Economic and a¢cultural services:

(1) Teaching the farmers how to improve their crops by canbating

blights, followlngmodern technicques of agriculture fertilization,

cultivation and plougnfng of land.

(2) Giving attention and arousing interest in cultivation of special

crops such as vegetables, fruits and timber trees.

(3) Improving breeding stock of cattle and poultry and other veterinary

servi-ces.

(4) The introduction and generalization of heme and rural. i.ndustries

such as bee-keeping, weaving, "Klearn" and cazpet making and palm leave

stalk industry for which the r_ material is available.

Educational and Social Services:

(1) Reconciliation of fanrl.lies and combating crimes.

(2) Cultural education to combat superstition and had habits.

(3) Canbating illiteracy among adults.

(4) Establishment of rural clubs.

(5~ Establishment of day nurseries.

F1'l/Rcl2/ 9 page 56

XI BASIC EDUCATION AND SCHOOLllEALTH IN RURAL AREAS (Item 10 of questiormaire)

1. Number ei! schools and school children:

Information on number of schools and number of students was received

from only a few of the reporting countries and fer some of these countries

information was available covering a whole country only. In order to·

describe the situation in primary, seccndaryand higher institutions in

the various countries of the Region, information on educational institutions

is given in Table 14. This information has been extracted from the

Statistical Yearllook of the United Nations, The figures given :in Table ~

are subject to caution in inter-country conparisons, owing to variatiCXlB

in school systems, as well as differing criteria adopted in gathering and

presenting the data;.

2. School health services and treir influence on rural realth in general:

From Aden Protectorate it is reported that all school children are

examined at least once a year.

In French Somaliland school health services have not yet. been introduced

but plans for treir establishment are under way.

In Iran there are no ccmplete school health services :in rural areas.

However, there is a nation-wide nutrition, vaccination and health education

programme going on through local public health units with the cooperation

of the Ministry of Edllcation.

In Jordan school children are examined at the begirming at' each fiscal

year and the necessary advice and care are prescribed to the needy.

It is reported that the sanitary e("'cation of School children is

undoubtedly improving the standard of health of rural areas.

In Kuwait complete general and specialist services are provided to

all school children and students. They are physically examined twice a

year and :iJnmunized against diphtheria, pertussis and poliomyelities.

School health services are reported to have proved most valuable to rural

areas.

EM/RCl2/9 page 57

In Lebanon the Qada health officer accompanied by nurse and sanitarian

visits the schools periodically f(l[' medical examination, vaecinations and

sanitary inspection of premises, services which reflect on the general

health of the children.

In East Pakistan health examination of school children of the pIimary

schools of the rural areas has been found necessary. Sanitary inspectors

in charge of Thana h~alth circles keep a check on the health of the students

under the direct supervision of the District Health Officer.

There is indication that tb.e school health services in rural a:reas

have influenced rural health, as the people are becoming gradually health

conscious.

In Saudi Arabia school health services are reported to exist in rural

areas and to have influenced rural health in general.

In the United Arab Republic the school health services in rural areas

comprise I

a. Smallpox vacclnation for new attendants.

b. Booster'dose of d:i:phtheTi.a anatoxin lcc for new attendants in

primary schools.

c. Spotting of cOl!)llIUllicable diseases and isolation from school.

do Spotting of cOllimunicable skin diseases especially ring worm, favus,

scabies, impetigo and referral of cases to skin diseases units for treatment,

e. Comprehensive urine and stool eX2lllination for neW attendants and

treatment of bilharziasis or intestinal parasites.

f. Intake of water samples from the source of water for ~is

(fitness f(l[' human consumption).

g. ;';upervisi.on or the school bu;.1ding and sanitary premises.

h. Supervision of school feeding and clinical examination of

individuals responsible for transfer and delivery.

i. Transfer of tb.e sick to the nearest treating unit whether rura.1.

health centre, cumDined unit, social centre or other unit.

El"l/RCl2/9 page 58

Country

Aden Colony

Aden Protectorate

Bahrain2

CyPrus

Ethiopia

French Sanal.:iland

Iran7

Iraq

TABLE 14 - Educatiq~-!n~titutions

Year Type of Education

L958 Pr:ilnaryl. II Seconciar;yl " Technical. n Teacher-Training

1958 Pr:ilnary1

" Secondary1

" Teacher-Training

1959 Primary3 nil Secondary

" Technical.

" Teacher-Training

fL958 Pr:ilnary

" Secondary

" Technic~

" Teacher-Training " Special.

1'-958 Pr:ilnary " Secondary " Technical. " Teacher-Training

" Higher

1'-957 Primary

" Secondary " Technical.

958 Pre-schoo

" Primary

" Secondary " Technical. " Teacher- aining " Higher

~958 Pr:ilnary

" Secondary

" Technical. " Teacher-Trainin

" Higher

--_. Number

of chool

Teaching Staff

51 7 1 2

130 1 1

50

729 57

6 2 3

581 26

.

26) )

8

16 3 4

252 8,079 ,078

67 50

• ••

2,448 326 57 65 17

Total

422 65 39 12

330 ... ...

688

2,204 840

715 23 ...

) ) ) 4,723 ) I)

69 9

13

... 35,185

8.662

... 16,102

4,2l2 496 335 681

Females .

147 8 3 2

29 • •• • ••

•••

807 243

2 4 . .. ( (

644( ( (

n·

... ... • ••

1~,481 (

1,817( ( ...

4,991 1,064

183 114 114

Students Enrolled

Total. ""ernales - - ---

11,443 3,322 1,314 231

300 -41 15

12,617 901 22 -13 -

16,94& 5,4674 626 -171 -

86 -81,359 38,990 24,639 9,341

397 -424 124 145 32

158,005 32.794 4,496 318 2,544 9606 1,175

689 446

2,2l4 509 161 47 143 70

11,720 5,366 ,135,2l9 373,847 2l4,968 59,158

7,301 I 665 3,L,D4 , 395

14,439 ' 2,613

526,501 ,,33,907 98,559 18,416 8,443 3,577

11,050 3,050 8,334 1,784

,

Country

Israel

Jordan

Kuwa.it

Lebancin

Libya

. Pakista.n10

Qua~

F11/RC12/9 page 59

TABIE :14 - Educational IIlBtitutions (cont'd)

Year Type oJ: NUllIber Teaching Staff Studentf Education oJ: Enrollee

Schools Total Females- Total

1958 Pre-Sqhool 2,052 2,553 ••• 75,499 11 ·Primary 1,263 15,957 370,356 ... 11 Secondary 189 2,837 30,802 ••• 11 Technical 86 1,:148 13,888 ... 11 Teacher-Training 32 770 ... 6,J77

" Highe~ 12 11,300 • •• ... " Special 74 637 6,3939 ...

1957 Pre-School 15 86 19 9,480 n Primary 925 5,605 2,185 205,ll9 II Secondary 391 2,459 524 50,869 1\ Technical 10 90 - 846

" Teacner-Training 4 32 10 297

" Special 1 - 23 ... 1958 Pre-School 9 123 123 2,574

II Primary 86 1,625 652 28,648

" Secondary 2 122 38 1,270

" Techn;i.cal 1 ) 186

" .Teacher-Training 1 D 79 - 57

" Speci;1l. 1 D ... . .. 56

1958 Primary 1,939 ) 201,623 II ·Secondary 227 Il 9,569 ••• 53,666

1956 Techn;i.cal ... ... ... 756

" Higher 7 3,999 ... ... 1956 Pre-8chool 25 94 94 2,010 1957 Primary 502 3,061 ... 96,763 , " Secoljdary 53 525 6,886 ... " Technical 8 87 722 ... " Teacher-Training 4 131 ... 1,568

1958 Higher 1 41 ... 307

1957 p. 11 43,509 ,..17,014 9,030 ~,226,831 r:unary 11 " Secondary12 5,847 52,872 5,799 fl., 325, 563

" Technical 119 11,769 ... . .. " Teacher-Training 103 ... ... 9,485

1958 Higher ••• • e-. ... 9~,584 1957 Special 812 ... ... 37,268

1957 Pre-8chool 16

" Primary 3 ) ... ... 1,550

" Secondary 1 I)

Females

168,2259 16,5269

3, 809 5,117

2,5249

4,300 69,677 10,423 -102 -...

11,211 248 -

57 -... ... 374 849

1,026 19,776 . ..

,

I . .. 285 .. .

~92,398 ,..79,095

2,583 ... 9,588 . .. . ..

!

EM/PJJ12/9 page 60

Country

Saudi Arabia

I Somalia13 A, . Ex.British

B. Ex. Italian

. Sudan

Syrian Arab Republic

Trucial Oman

Tunisia

TABIE 14 -1:ducational Institutions (cont' d)

Year . Type of Number Teaching Staff Education of

Schools . Total Females

1958 Primary ••• 3,481 • •• I! Secondary ••• 420 • •• I! Technical ... 97 • •• I! Teacher-Training .... 134 ... I! Higher 1 ... ... II SpeciaJ 1 ... ...

1958 Primary 51 124 7

" Secondary 1 6 -I! Technical 1 6 -I! Teacher-Training 1 4 -

1958 Pre-5chool ) 181 624 143 I! Primary ) I! SecondzilrY 5 56 ... I! Technical 13 91 14 I! Teacher-Tra!nin~ 1 4 3 I! Higher 1 4 -

1958 Pre-SChool 24 ... • •• I! Primry 2,173 ... ... I! ::;econdary 253 ... ... I! Technical 11 196 -I! Teacher-Training ... ... . .. II \:I;i.gher 1 142 -

1957 Pre-School ... D, 11,685 4,390 I! Primary 2,989 I! Secondary 286 2,916 683 11 Technical 16 284 72 I! Teacher-Training 8 147 55

1958 Higher ••• ... • •• 1957 Special 1, 10 5

1957 Primary 8 ... . .. 1957 Primary ••• ... ...

II Secondary 76 ... • •• I! Technical 69 ••• • ••

1958 .Teacher-Training 7 ... ... II Higher 5 ... . ..

Students Enrolled

Total Females

75,595 ... 5,256 ...

641 ... 1,668 . ..

. .. ... 120 . ..

2,881 279 81 -71 -22 -

( 711 252 ( 16,485 4,070

7'0 65 964 ...

91 -33 1

2,154 ... 265,462 68,000

50,312 .., 1,443 ...

809 177 964 36

( 31,136 13,914 ( 358,434 103,371

54,842 12,582 2,693 708 1,231

14 441

8,695 1,52814

41 9

2,000 ... 303,106 100,478 31,202 7,858 12,816 4,724

979 ... 2,1)00 • ••

, ;

Country

FMjRCJ2/9 page 61

TABIE 14 - Educational Institutions (ccnt1d)

Year Type of ~er at Teaching Staff S1lldents Education ~chools Enrolled.

Total I Females Total \ Females

United Arab 1958 Pre-School 47 305 284 24,439 Republic 11 Primary15 7,436 62,372 2::>,070 2,340,146

11 Secondary15 1,094 27,318 5,948 385,251 " Technical 211 6,020 930 83,368 11 Teacher-Training 76 2,596 1,051 22,261 11 HigOOrl5 26 83,251 00' 000

YElm9n 1956 Primary 2,155 2,701 '0. 93.099 II Secondary 4 69 296 ••• II Technical 18 210 1,252 •••

" ~eacher-Trainin€ 1 16 50 •••

Notes

1) lntermediate schools are included under primary education.

2) Public schools only.

3) Including kindtlI'gartens.

4) Including guls enrolled in secondary education.

5) Including teachers in reform. schools.

6) InCluding girls in higher teacher-training.

7) In addition 336 Koranic SChools with 8034 pupils ..

8) At secondary level only.

9) Hebrew education only.

10) In addition a nUJllber of non-recognized schools exist; estimated nUJllber 2653 with 11662 teachers and 223,057 students.

11) Data on primary classes attached to secondary schools are included under seconclnry educati.on.

12) Excluding data on 107 Arabic schools with 4100 pupils.

13) AI former British SOllIB.lilandJ B, former Italian Somaliland.

14) Including 166 students enrolled in higher teaching faculties.

15) Excluding Al Azhar University, 17B9 teachers and 37,215 male pupils.

12,833 894,089 96,508 17,692 10,088 12,079

• •• • •• • • 0

• ••

EM/RC12/9 page 62

XII HEALTH EDUCATION OF TIE PUBLIC (Item 11 of questionnaire)

The following information was received:

Aden Protectorate

In Mukalla all the local midwives have been brought to the training

centre and mown a UNICEF film on the birth of a baby, The Protectorate

Matron. has instructed them on the elements of hygiene and has given them

issues of UNICEF soap.

a Sl..I.K screen nas oeen oruered and it is hoped soon to mass produce

health. posters for distribution throughout the Protectorate.

French. Samaliland

Basic health education is carried out by the physician attached to

the mobile te'amS with the assistance of the nurses from the dispensaries

ana 'tne medical out-posts.

The Health Education Division of the General D>lpartment of Public

Health through its regional health educators is. responsible· for the

execution of health education activities in the country. At present.

there are thirty-five such educato;r:s. The activities are either carried

out by these educators in copnexion wi '!lh such programmes as vaccination,

sanitation, malaria eradication, health centres etc, or with the

cooperation of other agencies working in fundamental education, . agribulture

extenSion, community development and others.

The methods employed are conferences, broadcasting, newspapers,

distribution of posters and pamphlets, eto. Also individual interviews,

group discussions specially with local leaders, demonstrations and field

work are used as methods of health education.

Jordan

Health education of the public is regularly carried out by sanitary

inspectors, who convene meetings in villages, display health films, give

talks to village school children with the special aim of promoting health

and proper sanitary habits.

Kuwait

EH.fflCl2/9 page 63

Health education programmes have been adopted by various graded

schools in rural areas as a part of the educational curriculum of the

Education Department. On the other hand, the newly created Division of

Health Education has started its extensive educational programme in the

url>an areas and is planning to extend the programme activities to rura],.

areas in the near future. Pamphlets and posters are distributed:in the

villages.

lebanon

The Department of Health Education of the Ministry of Health has one

mobile team, canposed of a health educator, a teclmician and a driver.

This unit visits rural areas, gives talks, demonstrations and exhibitions

and gives priority to school children. The depar"bnent prepares educational

material for publication, press material and for the broadcasting statim

and television. Health needs and problems are stressed. Staff of health

units al,so carry out health education as a basic element of their

activities. As a general pOlicy, the staff takes advantage of the

opportunities for health education during the outbreaks of epidelllics etc.

A great deal is still needed in this field, but the Ministry is fully

aware of the inportance of health education and its contribution in

combating d!.seases and prcmoting the health of the public.

East Pakistan

The Directorate of Health Services employs a Heal tp. EdUcati on Officer

for health propaganda work with posters, charts, leaflets etc.

West Pakistan

The field health staff give lectures on different topics on the

prevention and control of infectious diseases on their field visits to

·the public. In times of epidemiC, however, special arrangements are

made to d!.stribute posters, leaflets, and pamphlets etc., on the prevention

and control of such diseases. A Health Education Bureau has been set

up in West l:'akistan, flealth Directorate, Lahore. An Assistant Health

Education Off:icer has been awointed arid is working under the guidance of

a foreign adviser and has been entrusted with the production of health

education material.

EM/RCl2/9 page 64

Saudi Arabia

Medias used are radio broadcasting and pamphlets.

Syrian Arab Republic

The Health Education Section of the Ministry of Health participates

in the training of health personnel and makes publicity by distributing

posters and pamphlets and showing health fiJJns according to a regular

schedule.

United Arab Republic

It was felt that the public health programme executed by rural health

centres mould attain the active participation .of rural people in its

components in order to ensure its success. Hence, health education has

been included in every service rendered by 1!Ul'2.l health centres and is

considered an integral. part of the total programme.

Health education enters into the services of maternal and child health

and school health, which

patients of rural health

are parts of the rural health programme. Out­

centres and in-patients l.n the unit of the centre,

particularly those with endemic diseases, are advised about what to do

after treatment so as to avoid reinfection and to create a feeling of

resp cnsibility for safeguarding the rural community. Sick persons in

general are advised to cooperate in the sort of treatment they are given.

One of the services provided by rural heal th centres in the United

Arab Republic is environmental sanitation such as providing the people -with

sanitary latrines. Active participation on the part of people is achieved

by providing manual power and sharing the financing of installation of

latrines. They are being convinced of the benefit of such latrines through

health education and at the same time they are taught the proper way of

using the latrines

Health cOlllllittees are organized in every village served by rural health

centres, so that people participate through their leaders (governmental and

public) in the solution of local health problems. Methods of education

utilized are those which bring the people actively into the process of

health education either by personal 1nterviewing or discussion with small

grrups and utilizing every opportunity for health education.

EN~C12/9 page 65

Close cooperation with the rural schools ensures proper health

education in the schools and understanding by the teachers of their role

in the health education of the students and also as leaders of health

education in the rural community.

Audio-v:l.sual methods in the form of health films, posters and

pamphlets are used as aids to the local health education programme. These

audio-visual materials are supplied by the health education unit in every

governorate.

PhysiCians, midwives, assistant midwives, assistant nurses. laboratory

technicians and sanitarians working in rural health centres receive in­

service training, a constituent part of which is health education.

It is generally felt that the health education programme as a part of

the total public health progranrnes. applied in the United Arab RepubliC,

has resulted in better achievement of this programme.

XIII COl'JBINED UNITS (Item 12 of questionnaire)

A combined unit was in the questionnaire defined as a unit which

comprises rural health. basic education, social work and horticulture,

The existence of combined units was reported from the United Arab

Republic and from Jordan only. Plans for creating combined units have

been reported from Iran and Kuwait.

In Jordan the combined units from the ¥.inistry of Health. Education,

Social "elfare and Agriculture, work together and cover about 80% of the .

population,

Sanitary inspectors cooperate .with social welfare inspectors and

educational as well as agricultural visitors in IUral areas,

Existing plans are being extended on the above basis,

In the United Arab Republic a combined unit is defined as an organization

in which health. education, social and agricultural services in the area

served are integrated,

There is a number of 250 combined units in the country covering 21%

of the rural population. The combined units are administered by the

Ninistry of Local Government.

EMtRCl2/9 page 66

Within the five-year plan a further 500 combined units will be

established.

XIV COMMUNITY DEVELOPMENT SCHEMES (Item 13 of questionnaire)

The following conmunity development schemes were reported through the

questionnaire:

The Ministry of Interior under a Central Development Council is

responsible for planning and implementation of rural community welfare

development projects under village council.

speCially trained "Dehyars".

Kuwait

This work is done through

A long-term programme has been adopted by the Social Affairs Depart­

ment in collaboration with the Economic Department to survey the soc1a.l

and economic status of Kuwait. This programme includes, inter alia, the

collection of statistical information on various aspects of life which

relate to the socio-economic structure of the community.

In 1957, the Department of Social Affairs and Labour had conducted

its first census. As already stated both the Deparlment of Education

and the Deparlment of Social Affairs and Labour had initiated their plan

of Fundamental Education Centres for training Kuwaitis in different crafts.

lebanon

The Deparlment of Community Developnmt has its own plans which are

not yet officially approved and information has not yet been communicated

to the Ministry of Health.

East Pakistan

There are twenty-two urllan community development projects, five in

Dacca and one in each District Headquarter. Each urban community develop­

ment project consists of two officers, five mohalla level workers and two

organizers. They give training on a self-help basis on sanitation,

education, maternal and child welfare, gardening etc.

West Pakistan

EM/RC12/9 page 67

Under the Social Welfare Department forty-three urllan cOlllTlunity

development projects are to be opened under the second five year plan

(1960 - 65). Eleven of these projects have already been opened and eight

mora are beinlZ ooaned durinlZ 1961 - 62). Each project has the following

staff:

Social Welfare Organizers

Canmuni"t:Y \'lorkers

Clerks

Peons

Syrian Arab Republic

General:

2 (1 male and 1 female)

3 (2 males and 1 f:emale)

1 1

The Community Development progranrne in the Syriar. Arab Republic has

successfully passed through numerous vicissitudes and, thanks to the very

keen personal interest taken by three ministers in succession, is nQl( well

on the way to becaning a permanent and eJqlanding national programme.

During the last one year or so, it has made considerable progress.

A ten-year national programme for setting up 110 projects, including

seven projects to be launched during the first four years in the seven zones

of the Syrian Arab Republic, has been accepted in principle, and included

in the five-year plan. Funds have already been allocated for eight pilot

projects expected to cover a population of over 200,000 in eight nahias

(aaninistrative sub-divisions). One of these pilot proJects, HaranEl

Awamid, has been in operation for over two years and two other projects

atSalkhad and-Sheria for four months, The buildings for the fourth pilot

project, Jobet Burghal, are nearing completion and it is expected to be

launched in July 1961. The buildings for the fifth pilot project,

Kafferine, are under construction. The buildings for three projects at

Sheddadeh, Mayadin, and Abu Hureira, are being constructed durlllg 1961-62.

The ultimate obj ecti ve of Community Development is the same as laid

down by the United Nations in CCIJIIIWl1ty Development- and Related Services,

namely ba::Lanced development of the area in the light of local needs and

resources throulZh the use of modern technologj.cal and scientific aids and

EM,AiC12/9 page 68

introduction of an integrated approach, team relationship, administrative

coordination and people's participation in partnership with the government

on a self'help baSis.

The immediate objectives of Community Development are in terms of

increasing agricultural production, eradication ~r reduction of human,

cattle and crop Cll.seases and epidemics, up-grading cattle, improving

sanitation, expanding health, maternal and child welfare services, prOViding

more and better roads, water supply and other facilities, working with the

coopera'tive s'ocieties, youth clubs and village councils, expanding

educational facilities through primary and nursery schOOls and introducing

home and rural industry.

Administrative Set-up

Ten multi-purpose "village level workers", graduates of agr:l:elll"ture

secondary schools with six months' supplementary training in practical

agriculture, cooperatives, rural health, rudimentary civil engineering and

prinCiple and methods of ~ommunity development have been provided in each

project. Each "vill!lile level worker" is in charge of one or mare villages

with 500-800 families. The "village level workers" are guided, supervised,

and controlled by seven subject-matter specialists ins

agriculture, anlll1al husbandry and veterinary aid, public health and medical

aid, cooperatives) social education, home economicsl and civil works

(vacant). There is a director of the project to coordinate the entire

programme. One project area covers a population of 25,000-40,000.

Institutional Pattern

The necessary institutions, such as, a dispensary with maternal and

child welfare centre, a veterinary dispensary with an articicial insemination

sub-centre, a poultry unit, a nursery, a central library and an information

centre with a cinebibliobus, are provided at the Project headquarters.

Financial Implications

Excluding the over-head cost on account of the training of staff and

the Department of CommU¢1;y Development at the State headquarters, each

project costs about L.S. 300,000 for buildings, water supply and electriCity,

L.S. 80,000 for equipment, .furniture and transport, L.S. 1l1,000 per annum

for salaries and allowances for staff, L.S. 50,000 for recurring

EM,tRC12/9 page 69

contingencies, and L.S. 25,000 for grants-in-aid. In addition short­

tem loans of up to L. s. 150,000 are provided by the Agriculbura:1 Bank.

The totaJ estimated expenditure over the entire ten~year period is

L.S. 72,18 millions.

Results

Sig!iificant results were achieved in regard to increased agricultural

production through the use of improved seeds and chemical fertilizers on

wheat, (range of increase between 62.1% and 106.5% in demonstration pilot

areas in 1959-1960), cotton, vegetables and potato, control of cotton pests;

prophylactic inoculation of sheep, goats and poultry against epidemic

diseases; distribution of improved seedlings and plants and popularization

of horticulture, medical aid and maternal and child welfare service through

the health units, veterinary aid; organization and operation of cooperative

societies; hame economics; library service; nursery for young children;

training courses and study tours for fanners; cinema and some other aspects

of social education, and self-help works (schools and a canal).

Training Programme

Two six-month courses for training "village level workers" in the

principles and methods of cOlll11unity development, cocperatives, elements of

rural health, some aspects of civil engineering, and practical agriculture

and animal husbandry, have been organized and a third is in progress. The

minimum qualification for admission is a three-year diploma in agriculture.

A fellowmip has been provided by the United Na.tions and the candidate

has left for a six-month course. Two mare fellowmipshave been approved,

one for 1961 and the ather for 1962.

4. study tour for high level administrators, though approved by United

Nations could not be carried out so far, due to financial stringency.

xv INTERNATIONAL ASSISTANCE (Item 14 of questionnaire)

Und.E)r the poSsible scope of assistance from intema.tiona1organizations

in strengtllenine; tile various fields of activities COJ!¥lrised by the

questionnaire, the following countries Ilave indicated .need for such

assistance.

EM/RC12/9 page 70

Aden Protectorate

The Aden Protectorates are extremely backward and their natural

resources limited. Unless mineral deposits such as oil are discovered,

it is unlikely that they will even be able to finance health projects

which are essential to eradicate and control epidemic diseases, or to

supply medical services which should be the prerogative of all people.

British assistance through Community Development and Welfare f:unds

will not be adequate to bring about these changes, although their projects

for 1961-1963 will make a great difference to the present medical

organization. It has been the policy of the British not to initiate

services which could not be maintained by the individual States. This

has t.ended to limit development,

WHO and UNICEF must play an increasing part in the future health

schemes, but it should be borne in mind that recurrent expenses will

be a pennanent feature that cannot be supported by the indigenous economy

Vector disease surveys for malaria, bilharziafD-s ancLdraconiasis are

possible projects which, through a policy of eradication, could ease the

burden of the health services.

E.ducation for women is another essential step, if the infant

mortality rate is ever to be reduced to acceptable levels.

Communications are poor and evacuation of sick is mainly through

costly air transport, Highest priority should be given to roads, and

their development would result in greater security and stability in the

tribal areas,

All these projects are bound up with political advancement, which now

shows signs of rapid development,

French Samaliland

French Sanaliland has reported that financial aid from France within

the frame of F.I.D.E.S. for the moment suffices for the territory, and

that until now assistance from international organizations are not needed,

EM,.tRC12/9 page 71

The need for :further international assistance is warranted to carry

on expanding future programmes.

Jordan

There is need for cooperation with the international organizations

for raising the standards o:f living in the country.

Kuwait

Four specialized agencies FAO, WHO, IW and UNESCO provide their

consultative assistance to Kuwait through the Departments o:f Agriculture,

Public Health, Social Af:fairs and Labour and Education respectively,

Lebanon

WHO is already aSSisting the Lebanese Government through the operation

of a rural health unit as a model for other health centres in the country,

other WHO projects are contributing to improving health conditions in

rural areas a:fflicted by malaria and indirectly through training by

providing a prafessor in sanitary engineering to the American University

af Beirut.

The help o:f UNICEF in promoting health, particularly of children and

motbars in rural areas is anticipated in the :future, as there is a large

scope for assistance in these :fields.

East Pakistan

International assistance is being received in connexion with anti­

malaria work, school-health won:, BCG vaccination campaign, maternal and

child wel:fare centres.

West Pakistan

As there are many health problems in the country, which have to be

faced, cooperation from international agencies like ICA, WHO, UNICEF etc.

for solving them is needed.

ANNEX

ANNEX pagei

QUESTIONNAIRE ON RURAL HEALTH AND COMMUNITY DEVELOPMENT

1. Population and vital statistics

(Tables I and II of Questionnaire for Second Report on World Health Situation, extract enclosed)

I Year Total Urban Rural country areas areas

i

Population

Average size of family

Live births (per iooo populatio~

Deaths (per 1000 population)

Infant deaths (under ~)e year-per lOGO live births

What is the extent of the problelnof nomadiSll1

2. Housing

! Year Total Urban Rural ccw.try a::'''eas areas

Building material usually used

Average number of rooms per dwel~ unit

EM,IRC12/9 ANNEX page 1i

3. Environmental sanitation

(Table XI of Questionnaire for Second Report on World Health Situation, extract enclosed)

Year Total Urban Rural country areas areas

Water Supplies

Number of supplies

Percentage of total population served -%

Excreta disEosal

Number of systems

Percentage of total population served - %

Food control ~ including milk)

Number of staff (specify) engaged in control activities

Percentage of total popu1ation covered ... %

.

General information on waste disposal

General information on measures, so far under-taken for the purpose of sanitation

A.

4~ Mo!'bidity

EM;RCl2/9 ANNEX page iii

('l'abl& XIV of Questionnaire for Second Report on World Health Situation, ~act enclosed)

Total Urban Year country areas

Number of reported cases:

Tuberculosis, all forms: (i) new cases

tuberculosis. all forms: ~(ti) total known cases

Syphilis and its sequelae: (i) new cases

Syphilis and its sequelae: (ii) total known cases

Typhoid fever

Cholera

Scarlet fever

Diphtheria

Whooping cough

Mimingococcal infections

Plague

Leprosy: (i) new cases

LeproSy: (li) total known cases

R,elapSing fever

Yaws: ( (i) new cases

Yaws: (ii) total known cases

Poliomyelitis

Infectious encephalitis

Smallpox

Measles

Yellow fever

Rabies in man

Trachoma (i) new cases

Trachoma (ii) total knO"\lIl cases

Typhus

Malaria: (i) new C;1ses

Malaria: (ii) recurrent cases

Trypanosonuasis

Rural areas

B.

C.

EM;RC12/9 ANNEX page iv

Diarrhoeal diseases among childret_

Bacillary dysentery

Amoebiasis

Schistosomiasis

Ankylostonuasis

Filariasis

Other (spec11'y)

Total number of persons, suffering from:

Blindness

Deafness

Disease Vectors

Which are the vectors of:

Malaria

Leishmaniasis

Filariasis

Bilharziasis

Which measures haVe, so far, been undertaken in vector control

Year Total country

5. General information on rural areas and rural economy

Urban areas

5.1 Which definition is used in the country for distinguishing between urban and rural areas?

In case no definition exists, please list the cities or towns which are considered urban, as distinct from the rest of the country which is considered rural.

Rural areas

5.2 Number of rural communities (villages) in the country, _______ _

Ter,+,~tt"''' c'o."inition' A ~·u:r2.1 COIll!l!'JIlity is a non-urban ---"7,n-:;-·t--;;;:l"·'~h-l.· s -l':;'-;"~d "Y' 1"~al p"b' < ~ a.,t"'n~' +.y _, ..J.. , "'........ ... .. .... '-'"'-'_ u ... _ .,.'.... '-' ~__ ....... ,. __ ...... _,

.. BUCP as a mayor or chairman of community council. Please state your own definition when necessary.

5.3 Average population of rural communities (villages)

If exact infomation is not available, give an est:lmate.

EM;iW12/9 ANNEX page v

5.4 What is: The disperaion patterns of rural communities (villages), such as average distance between villages.

~"ho t:l<"?os c? ":-,,,~::_;:c:.:.ture a..,d comnon, crops in the country, including the relative importance of the various types.

The general state of nutrition in rural areas.

The types of irrigation in the country with pal't:;'('LLd.J.' il181ri;:WIl of tnair possioie influence on incidence of endemic diseases,

The types of housing especially in relation to sanitation in rural areas.

6. Govermnental activities on the national level aiming at promotion of rural health

6.1 Does a special Ministry for Municipal and Rural Affairs exist?

If yes, describe the administrative set-up, functions arid aChievements of this Ministry.

Yes No

DO 6.2 Is there a special agency in the Ministry of Public Health, Yes No

which deals with rural health? 0 0 If yes, please give the name and address and describe

the composition and functions of this agency; and also in relation to the Public Health Administration.

6.3 Are departments of other Ininistries cooperating with the Ministry of Public Health in rural :.aalth?

r:r yP~: r't"'\~.('O~ :; ...... ....., ..... -,....,~~ ""-:0 ':" •. ~_~~~ ~:-;c .. ::--::::C"::~:: :::l:'1~

describe the extent of cooperation.

Is there a committee for coordinating the work of various governmental agencie3 for promoting rural health?

If yes, describe composition of committee, its functions, activities and achievel1'.ents.

7. village health cooperative societies

7.1 Number of health cooperative societies

Percentage of rural population covered - %

-Are the health cooperative societies supported by public funds?

If yes, please indjcate from which government agency or agencies.

Yes No

DO

Yes No

OD

Yes No

DO

EM,1I.C12/9 .ANNEX page vi

7.3 Activities of village health cooperative societiesl Yes No

Employment of full-time doctor

Employment of part-time doctor

Distribution of drugs, free of charge

Distribution of drugs, at reduced rates

8. Health units in rural areas

DO DO

BB 8.1 Please list all the different types of health units existing

in your coiiiitry.

For each type please give the number of existing units, bllilding material used, cost of construction and attach blue-prints. It would also be useful to have a description of your pre£erence, from the operational point of view. regarding the various types now in use in your country. A map giving the location of the health units or centres in the country would also be appreciated.

Include also any information on the trend regarding low cost· building of health units to suit the economy of rural areas and to extend the rural health services.

If research and training on low-cost building is made, give information on agencies promoting such research and training.

8.2 Give a detailed description of the staffing of rural. health units and their sub-units, including inf onnation on training of personnel in the health units and of training centres for personnel to be employed in rural health work. What would be considered as ideal types of personnel, and number in relation to population served?

8.3 Activities of health units and sub-units in the field of:

a) preventive mediCine and immunization

b) sanitation

c) endemic medicine and parasitic diseases

d) curative medicine

e) maternity and child health and nursing

f) tuberculosis, venereal diseases, communicable eye diseases control

g) vector control

h) population served, and number of visits to health units

8,,4 Integration of health units in the general public health structure, especially with regard to referral hospital and referral laboratories.

8.5 Give a description of the equipment of rural health units.

~.6 live a description of the general income and expenditure patterns of rural health units and sub-unitB.

EMfiiCl2/9 ANNEX page vii

9. Social centres

9.1 Does the M1.nistry o£ Social AffaiJ;'a (or other governmental agency) deploy specific activit;eil for the purpose of increasing the standard of liv:l.ng of the rural population.?

If yes, describe the type of organization for thia P1l1'Pose and the extent and results of such actiVities.

9.2 Give a general description of the functions of social centres, size of staff and geographical location.

9 • .3 Is medical and health work included in the activities of social centres?

If yes, give information on health staff, specifically number of medical doctors, nurses , sanitarians and technicians.

10. Basic education and school health in rural areas

10.1 Number of primary school in rural areas

Yes No

DO

Yes No

DD

Number of children attending primary schools __________ _

Percentage of children of sohool age attending, ___________________ __

schools - %

10.2 Give a description of the school health services in rural areas. Is there any indioation that the school health service has influenced rural health in general?

ll. Health education of the public

Describe any efforts made towards introducing health education of the public in rural areas and the various methods employed for such education.

12. Combined units

Definition: A canbined unit may be one which comprises:

rural health, basic education, social work and horticulture.

What is your definition of combined units?

12.1 Are canbined units existing in the country?

If yes, describe which governmental agency is administering such combined units, the:ir number and percentage of the population covered.

12.2 ~ exi.sting for the creation of oombined--units'?

If yes, describe BUCh plans.

Yes No

DO Yes No

DO

EMAiCJ.2/9 ANNEX page viii

13. Community development scheme!

Describe fully any colTllTlUIlity developnent schemes or training centres in the country, both already existing and, in the planning stage.

14. International assistance

Indicate the possible scope of assistance from international organizations such as WHO and UNICEF ill strengthening the various fields of activity enumerated under 1-13 above.

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN

REGIOl;'AL COMHITTEE FOR THE EASTERI'l MEDITERP.A.NEAII!

Twelfth Session

Agenda item 10 (f)

4:11.01, ~' ~,

~:V, -"'!' 'IJ.,.!J ~:,." ~, ORGANISATION MONDIALE

DE LA SANTE

BUREAU REGIONAL DE LA MEDITERRANEE ORIENTALE

EM/RC12/9 Add.l 18 September 1962

ORIGrnAL: FRENCH

RURAL HEALTH AIID CmIT'IUNITY DEVELOPMENT

TIl THE

EASTERN MEDITER..'lANEAN REGION

Results of an Enquiry

Tunisia

I JNTRODUGTION

The following is a 5U.ll1Ina.I'Y of the answers received frcan the Government of

TlUriSia to the Questionnaire on Rural Health and Community Development sent to

the countries of the Region by circular letter of L. A.pril 1961 from the

Regional Office.

II POPUlATION AND VITAL STATISTICS (Item 1 of the Questionnaire)

Separate vital statistics ~igures for urban and rural areas of Tunisia do

not ex;Lst. The average size of the fxnily for the total country is estimated

at 5.5, livebirths are 45 D6r 1000 population, and deaths are '>stimated to be

20 per 1000 population. Infant deC\ths are estimated to be about 170 per 1000

li vebirths.

Registration of births is almost complete, "While registration of deaths

is estimated to be in the neighbourhood of 50%. In the city of Tunis vital

statistics are fairly reliable.

III HOUSDlG (Item 2 of the Questionnaire)

Housing statistics are not available at present. The average number of

::.'o"ms per dwelling unit is e&timated to be 3.3 for the whole country.

Eh/RC12/9 Add.1 page 2

IV ENVIRONMENTAL SANITATION (Item 3 of the Questionnaire)

For the year 1961, the total number of water supplies in Tunisia was

50,000 of which h6,000 were in urban and h,OOO in rural areas. This corres-

ponds to a coverage of 50% of the urban and of 10% of the rural population.

The number of systems for excreta disposal is h, all urban and covering about

5% of the total urban population.

V IDRBIDITY (It,em h of ilie QU8st,j.onrmiro)

The following number of cases of various diseasos were reported for the

year 1960 for the mole country. It, bas not, yet, been possible t,o subdivide

t,he figures on urban and rural areasl

TB (total known cases)

SyphiliS (total known cases)

Typhoid fever

Diphteria

Honingococcal infections

Relapsing fever

PoliOll\YBlitis

Rabbies :in man

Typlms

Halaria (new casos)

Brucellosis

Blindness (total number of blind r:c rsons)

1. Tuberculosis

80,000

15-30% of population

282

113 25 1

77 1

6

57h 1

18,000

The figures concern;i.ng tuberclllo8is refer to pulmonary t,uberculosis only

and arc probably ninimum figun:;s. Roliablo figures on tuberculosis morbidity

are available only for the Region cf SOUS~lO "here an anti-tuberculosis

campaign has been carried out ane: "hen:; 97% of tho population has been exa;mjned.

About 4% of the population of this area is infected with tuberculosis, an

infection rate which is belieVDd to be ilie highest in the countrY

2. SYph:ilis

No eJalct figures are avail10ble at present. Between 15 and 30% of the

population are infected according to serological tests.

3. Trachoma

EM/RC12/9 Add.l page 3

Statistics covering the whole population are not available. A systematic

study among school ch:i.ldren has given the following rosul ts: 60-80% infected

in the south, 35--45% infected in the centre, in Sahel and Cap Bonl and 15--25% infected in tho big cities and in the north of the country.

4. Cro.J.dren1s diseases (whooping cough, mumps:, lIlOasles)

Since there is no obligatory notification of those diseases, the number

of cases notified is much below tho roal number and no reliable information

is available.

5. Bilharziasis

This disease seems to be very localized. A study in the Region of Gabes

has given the following percentacos of children infected by age:

Age ! 6 22 7 53 8 45 9 52

10 5'7 11 61 12 52 13 64 14 64 15 54

Total (age 6-15) 52.4

VI GENEBAL TI1FORt'1A.TION ON RURAL AREAS AND RURAL ECONOMY (Item 5 of the Quos tionna.ire )

There is no offichl definition of the term rural areas. All localities

c onsti tuti;:!g cOlllmunes may bo com)idcrod urban and other areas rural. A more

realistic, rut still arbitnry, lino of divisien is to regard communes with

more than 5,000 inhabitants as urban. This will give a rural population of

about 3.1 milliOE out of a total population of h.3 million, or about. 72%. The

number of villages with morothan 100 inhabitant.s i R R.hnllt. 1.000 with "n average population of about 3,000.

Tho most common crops are olives, dates, cereals, grapes and citrus

fruits.

EM/RCl2/9 Add.l page 4

General state of nutrition in rur2_1 areas

In March 1958, an enquiry on the standard of living was carried out.

Resul ts of tho enquiry are published in "Bulletin de Statistiques et d'Etudes

economiquos" J October-DecGmbor 1958 ~_nd April-Juno 1959.

According to this enquiry, the caloric consumption is in generaJ.

satisfactory and varies between daily averages of 201lh and )007 in the

Governorates studied.

po~'son per day.

The average weighed caloric intake was 250) per

!he protein consumption varied between 57,50 and 91,50 g, 01'-11-13% of

total calories. Protein of animal origin is very insufficient, varyinll:

ben-men 6 and 10 g per person per day.

The content of iron was found sufficient, but that o! caJ.cium much l'lsS

than required, never exceeding 460 mg per day in the rural areas.

Vitamin C consumption varied between ),40 and 28,47 mg per person per day

compared to the recommended amount of 75 mg.

It is believed that the nutritional status has improved conSiderably

since 1958 but more recent d:,ta ars not avoilable.

Irrigation syE~oms

The se'Gting-up of the, rCC1~J;l2ctiGn Gervicus (Enfidaville, Medjerda vaJ.ley,

ete) arouses health probl.ems rGzo.rding thair bearing on mdemic diseasesl

a) in respect of irrigo:tion systems "Which have often brought about

breeding places for vecters of endemic disenses;

b) through the movements of people suffering from anKYlostomiasis.

bill"larziasis, ete., which may result in the spread of diseases, hitherto

strictly localized.

This situation roq)liree prccautionary moasures through clOSe cooperation

botween the dGpartmonts concerned, particularly the Ministries of Agricul turo,

Public Health and Social Affairs and Public Works.

VII GOVER.m1ENT ACTIVITllS ON THE NATIONAL LEVEL AIMING AT PROMOTION OF RURAL HEALTH (Item 6 of the Questionnaire)

There is no speCial Ministry for Mmicipal and Rural Affairs in Tunisia,

but the Ministry of Health deals 1'ii th rna tters aiming at the promotion of rural

health in c ollabora tion wi th the Ministries of Agricul ture, National Education,

EIVRc12/9 Add.l page 5

There is no Special committee entrusted with coordinating the work of

these governmental agencies. The coordination on thc national level is

effected according to the special needs in committees where the various

govornmental agencies concerned are represented. On the local level a

de facto coordination exists, without any fomal agency.

VIII VIIJAGE HEA.LTH COOPERAJ:TVE SOCIETIES (Itom 7 of the Quostionnaire;

Such cooperative societies do not exist in Tunisia.

IX HEA.LTH UNITS n~ IDRAL AREAS (Hem 8 of the Quostionnaire)

1. There are at present 345 dlispensarios in tho rural areas, They

arc built in stone and oach dis~ensary consists of a consultation room and

one or two wai tine: rooms. Tho cost of :!onstruction is between 1 , °00 and

3,000 Dinars. Blue-prints for such dispensaries exist.

The Ministry of Public H-cal th and Social Welfare, on presentation of a

roport from the Regional Governor, invostigat0s the request for building a

dispensary and decides the assignment of the premises proposed after consulting

the local Public Works EnginoGr.

ProviSion is made to the Governor who, with the assistance of the

')opulation (organizations for combating under-developmont) undertakes the

construction of the dispensary, thus securing rathor reducod costs.

However, municipalities often take the initiativo in proposing premises

to the Hinistry of Public Health and Social Welfare.

2. Rural dispensary staff include a male nurse who is responsible for

the dispensaYJ and who is sometimes entrusted with viSiting douars and

neighbouring schools.

Thoro are further male nurs,cs, merely itiner:mt, mo carry out visits

of douars only, tho total of both c2,tcgories is 375 itinerant male nurses.

The latter are supervised by 16 ree;ionC'~ supervisors.

The Chief Public Health Medical Officer of ~, district proceeds to the

rural dispensaries at various intervals according 'GO the importance of the

local population.

The dispensary male nurse carries out common care and transfers urgent

caSGS to the aUxiliar,r hospital, under the authority of which falls the

EM/R012/9 Add.l page 6

dispensary. These nurses are generally qualified nurses (State diploma, or

attendants). A specialized training for itinerant male nurses has been

provided to young men of purely Arabic education (IIZi touniansll ) who were unable

to follow their studies for the State classical diploma (Professional School

of Public Health at Hamam-Ill'); they have a diploma of hygiene itinerant, eye

diseases, anti-tuberculosis, r.uX'sing, etc.

3. Rural dispensaries, through their regular medical consultations,

CQrry out the follCJloJing duties, preventive ,c;nd curative medecine; care and

dressing, sometimes specialized maternal and child welfare; care of

tuberculous patients. venereal diseases natients. and communicable eye

diseases control.

In 1960, 2,290,961 patients have been attended tp in the ,rural dispensaries.

The number of population visited by the itinerant inale nurses has not been

established so far.

4. Rural dispensaries are linked with the Regional hospital or aUXlliary

hospitals existing in the thirteen circumscriptions.

Patients may be transferred to these hospitals for hospitalization or

speCialized consultations, or to laboratories for examination,

5. Annual budget for rural dispensaries -

All consultations, care, etc., are free. Under e"Penditures are:

Nurse salllry 380 D

Drugs 125 D

Hiscellaneous 20 D

525 D

The Medical Officer of lIo:clth ,,1110 is a, State civil servant carries out

consul tc.tions.

These i'unctions are the responsibility of the 'hospital-Which supervises

the dispensary.

X SOOUL CENTRES (Item 9 of the Questionnaire)

1. Under the Ministry of Public Health and Social weilare, "the population

~,nd Social Action Department employs at present 122 rural sanitary and female

Locial leaders in all the Governorates. Their duties consist of inculcating

on women in the rural environment the awareness of the r61e they have to play

EM/RC12/9 Add.l page 7

in the new Tunisian community and comprise health education, family social

education and elementary home economics. It is a true basic education, very

realistic and efficient for the improvement of the standard of living of the

rural population.

2. Under the Ministry of Agricul ture the Enfida Office undertakes social

activities for community development.

XI PASIC EIDCATION AND SCHOOL llEAL'IH IN RURAL A.llEil.S (Item 10 of Questionnaire)

School health in rural areas is still precarious. The district medical

officer viSits, as a rule, each school twice a year. He is assisted by two

itinerant male nurses, who carry out systematic vaccinations.

It is expected that full time medical officers will be provided for rural

schools assisted qy male nurses and equipped with cars.

Heal th education in schools is undertaken qy health educators, periodical

campaigns, etc.

XII HEAIXH EDUCATION OF THE PUBLIC (Item 11 of the Questionnaire)

Each of the thirteen health regions of Tunisia has a regional centre :Cor

health education, equipped with audio-nsual aids.

Regional health educatcrs carry out an educative action in rural

environments qy means of periodical rounds including talks, pro;;'.ctien of

educational films, distribution of leaflets, etc., either in public or in the

premises of national organizations (Neo-Destour, U.N.F.T.,trade U11ionS or

agricul tural U11ions, etc.).

HeeJ. th education is also carried out in connection with national and

international prophylaxis campaigns (anti-tuberculosis, trachoma control,

fly control, etc.). Regional cuntros for health education cambine activities

with those of other organizations concerned and playa prominent r81e. A

village is chosen as seat for collective work for the improvement of health

conditions. After a thorough study of tho environment is carried out as a

preliminary measure, the programme is planned qy tho health educator in

cooperation with the local authorities.

EM,/Rc12/9 Add.l pago 8

un COMBlNED UNITS (Itom 12 of the Questionnaire)

Combined units do not exist in Tunisia.

The Tunisian Governmen t has, as tar back as 1956, undertaken a pilot

projoct for comprehensive communit,y dovelopment in Enfida area. In an area

of 25,000 hectares, characterized qy a marked state of destitution, and with

~ population of 35,000, the Government has undertaken, alongside agricultural

roclamation, education of the public and enrolment of the potential energy of

the population with a view to integrating it. in the new national context.

The objectives aimed at are the following:

- Reclamation with tho voluntary participation of the inhabitants and

their social progress.

- Promoting the potential enorgy of the public for various activities

connected with basic structure work, c~Cricultural reclamation, sotting-up of

rurcl. cOlnlTIUl1.i ties, etc.

- Arranging for both oporatj.ons to b8 achieved along the lines of a

genoral economic policy set by the GovCcrnmont.

- EnSuring, alongSide tho im~lcmentc,tion of this programme, a rational

oducation of the public with omph~sis on the coopc.r2tion aspect;

- Endoavouring to reduce capital invostment to the lowest possible level.

These changes require much care and should be carried out smoothly and

I.rithaut compulsion. Community development is adopted as a mean:; and a

preliminary step towards cooperation. Inhabitants of small isolaved places

should, as a first step, be brought together in villages. In each village,

an agricultural. cooperative association will be set up; it will progressively

[(ssumG variOliS acti vi tie s as the CXl mmuni ty develops.