Tropical Doctor, October I977
JOINT TRAINING COURSES
I 189
Community Medicine
Joint training courses in
nutrition, public and tropical medicine for work in Third World countries H. v. Holst Senior Medical Officer, Planning Department of the National Board of Health and Welfare, Stockholm, Sweden
Y. Hofvander Associate Professor of Pediatrics, Uppsala University, Uppsala, Sweden
B. Vahlquist Emeritus Professor of Pediatrics, Uppsala University, Uppsala, Sweden
TROPICAL DOCTOR,
1977,7,189-192
------
The tasks meeting expatriate health personnel undertaking work in Third World countries will in many ways differ fundamentally from those encountered in their countries of origin. These differences have become even more evident in recent years when the main emphasis in many countries, and indeed in WHO, is laid on the development of appropriate health delivery systems in rural areas with training concentrated on auxiliaries - "health by the people" (King 1966; Newell 1975). Community health care surpasses in importance medical care on the individual level (Morley 1973; Williams and [elliffe 1972), even though the latter must still be given very great attention. Many Third World countries have become convinced of the need to liberate themselves from dependence on western culture, not least in the organization and practice of health care. One example should be sufficient to illustrate the absurdity of the health care approach which prevailed all too long. In most developing countries children below 15 years of age represent 45-50% of the total population. Yet, not until the last 10-15 years has the importance of mother and child health care and appropriate training of personnel in this field been recognized (Nordberg et al. 1975). It seems obvious that the training needed by expatriate doctors and nurses to equip them for meaningful work in Third World countries goes far beyond
the fields of communicable diseases and "tropical medicine". Obviously a basic knowledge of these subjects is still of great importance (Bengtsson 1972), but thorough knowledge is also needed in a number of other fields, for example social anthropology, nutrition, maternal and child health, family planning, training of health personnel ("teaching the teachers"), health education, health planning, administration and management, and disaster relief. Obviously also some knowledge of the local language is a necessity. It is of paramount importance that the expatriate personnel, by their knowledge, behaviour, and philosophy, fit into the general local pattern for health care (Vahlquist 1971). To this end, after some preparatory work (Bengtsson et al. 1971), a training course once a year, along the lines referred to above, was started in Sweden in 1973 (v. Holst I974a, I974b). It has now been extended from one to two courses per year. The idea of arranging a joint programme for doctors and nurses was first suggested by the Swedish International Development Authority (SIDA) in I97I. With the incorporation of some necessary preparatory training for the nurses (see below), this arrangement has worked out very well. * Now looking back on our experience of seven consecutive courses, we consider that certain features of the course arrangements, as well as of the balance of representation of different topics in the curriculum, might be of some interest to the international community. OBJECTIVES
The objectives of the course are "to communicate such knowledge of assistance and disaster relief services within the fields of public health and medicine as will enable the trainees to carry out their public health and medical duties, including planning, administration, training, and information at health 'In the early 1960s Professor E. Bengtsson, Head of the Department of Infectious Diseases, Roslagstull Hospital, Stockholm, started six-week annual courses in tropical medicine for physicians working or intending to work in departments of infectious diseases of paediatrics, for example. Since completing the course, some of the former participants have taken up work in Third World countries. The experience gained from these courses has been of great value in the planning of the new type of courses described in this paper and intended for physicians and registered nurses contracted for work in various Third World countries through the sponsorships of different Swedish assistance organizations.
190
I JOINT TRAINING COURSES
Tropical Doctor, October I977
clinics of various levels and at district hospitals. These tasks often have to be carried out under difficult circumstances and with inadequate resources." The training underlines the importance of all activities being conducted in close co-operation with the public health authorities of the country concerned and with the participation of national health personnel. Emphasis should be placed on the fact that all assistance activities are intended as "help towards self-help". ORGANIZATION
The training course is organized by the Swedish National Board of Health and Welfare. It is run jointly by university institutions in Uppsala and Stockholm, being backed mainly by the Department of Pediatrics and the Institution of Nutrition, Uppsala, and the Department of Infectious Diseases at Roslagstull Hospital, Stockholm. It is financed chiefly by the Swedish International Development Authority (SIDA), the Swedish National Board of Health and Welfare, and several voluntary assistance organizations (missions, Red Cross, Save the Children).
Table
I.
CURRICULUM
The curriculum comprises 10 weeks and includes a fairly wide range of subjects. There is a total of about 270 hours of teaching, demonstrations, and structured discussions, and 230 hours of group work, films, self assessment programmes, etc. The detailed curriculum is shown in Table I. COURSE MATERIAL
Three months in advance of the course each participant receives free of charge a set of pertinent literature, partly in English and partly in Swedish. The participants are encouraged to study this as much as possible in advance; most of it is intended for use both during the course and for reference during the following contract period in the field. During the course the trainees also receive a number of booklets, compendia, and similar material as well as a folder containing summaries of many of the lectures. A set of reading matter, comprising some 20 books, booklets, etc., is provided as a small reference library for group work during the course ~ one copy per five or six students. About 10% of the participants will be working in
Curriculum of the course Lectures (hours)
Medical socio-anthropology Nutrition Maternal health and family planning Child health, common diseases in children Practical laboratory training Hygiene (environmental and food) Health planning and administration Medical training and health information Emergency assistance Common infectious diseases (for nurses) Tropical infectious and parasitic diseases: Entomology Protozoal diseases Helminthic diseases Bacterial, viral, and rickettsial diseases Infections of the eye, ear, nose, throat, and skin Vaccinations Practical pharmacology Parasitological laboratory training Infectious and parasitic diseases - case studies Epidemiology and combat of tropical infections and parasitic diseases - Conclusions Special training (as required) Total
2 10 5 10
Demonstrations and structured discussions (hours)
Group work (hours)
3
15 5 5
15 5 10 3 5 5 2 6
6
8 5 2 1
5 10 7
15 5 1 6 6 5 5 1 1
15 10
15
15 20
100
170
230
Tropical Doctor, October I977
French- or Spanish-speaking countries. Attempts have been made to provide these students with literature in the appropriate language. PARTICIPANTS AND DIPLOMA
The number has been set at 30 per course, but on some courses this figure has been exceeded, In all, 224 health personnel have completed the course64 doctors and 160 registered nurses, and a few of other categories (nutritionists, laboratory assistants, etc.). Each course has included some participants from other Scandinavian countries. Before attending the course 80 participants (35°/.») had already been working for some years in developing countries, primarily in Africa and Asia. All participants of the last five courses had already been appointed. for assistance services starting within one year after completion of the course. Students who have passed the oral and written examinations are awarded a Diploma in "Nutrition, Public Health and Tropical Medicine". Those who have not taken the examination are given a course certificate. EVALUATION
At the end of each course the participants have had the opportunity of discussing and commenting in writing on the value of the course and the need for amendments and new approaches. The discussions have been frank, searching, constructive, and they have led to successive improvements. The fundamental principles, i.e. the joint training of physicians and nurses, the strong emphasis on prevention and public health aspects, and the prodigious application of group work as a technique have never been challenged. On several occasions doctors and nurses who have attended the course have since expressed their positive opinion about its value, in articles in Swedish medical journals (Andersson 1975; Boberg and Hylander 1975; Habib 1975). These authors had already worked for a number of years in developing countries before participating in the course, which gives added weight to their testimonies. The essence of their statements is that the course provides very useful complementary information even for those with earlier experience of field work in developing countries, that a relevant diploma should be looked upon as a more or less obligatory prerequisite for Swedish health personnel starting work in developing countries, and that efforts should be made to organize short refresher courses focusing especially on topics such as management, communication and evaluation and disaster relief.
JOINT TRAINING COURSES
I 191
Interviews with former course participants have also been carried out in the field by one of the authors (HvH) during a visit to Tanzania and Zambia in December 1975. In this context also, after confrontation with realities, the consensus was overwhelmingly positive - both with respect to the broad outline and content of the course and to the variety of practical knowledge it had provided. The coeducation of doctors and nurses has meant the breaking of new ground for Sweden. At the beginning it was regarded as an experiment, with some scepticism as to its feasibility. Very soon, however, it proved to be not only a practicable way of training but indeed a real advantage. With some extra training in general laboratory work and a special series of lectures on general infectious diseases for the nurses, the joint course has been successful. At the same time the combined training of doctors and nurses was a valuable exercise for later field work, when the medical staff has to be flexible and prepared to take up new roles as members of a team. PLANS FOR THE FUTURE
The idea is to integrate the different parts of the course as far as possible. In this process some further changes with respect to balance between different topics may prove necessary but on the whole the present outline should be preserved. There is no doubt that in its present shape and duration the course must be looked upon as a rather strenuous one - particularly so, perhaps, for the nurses. For this reason an extension from the present to-week course to 12 weeks has been discussed. However, for many participants even 10 weeks mean considerable problems with respect to leave ofabsence from their regular work. For the administration and financing of the course such an extension would mean added hardship. Thus, for the next few years an extended duration is not foreseen. There is a need to reach a greater stability in staff and at the same time to reduce the number ofteachers. For the time being over 30 teachers are involved, although the main burden falls on a group of eight to 10. The total number of participants should preferably be lowered from the present 30 to about 25. The proportion between doctors and nurses should, if possible, be at least I : 2, this proportion corresponding roughly to the present demand as expressed by various Swedish assistance agencies. So far, only a limited number of places in the course have been available to doctors and nurses from other Scandinavian countries. The co-operation between the Scandinavian countries will probably increase with time.
192
I JOINT TRAINING COURSES
The course language has so far been Swedish, although several contributions are given in English. For the majority of the participants who are already contracted for work in the field, English will become their working language. Although quite a few are preparing for work in French- or Spanish-speaking countries, it has now been considered important to gradually introduce more English. This would give an opportunity in the future for medical personnel from Third World countries to participate in the course, which would mean a definite two-way benefit. Disaster relief will continue to be a subject of major importance in the course. Emphasis will be placed on the application of theoretical and practical knowledge in various simulated disaster situations. Many participants have expressed the opinion that the course should be a requirement for all Swedish health personnel before taking up work in Third World countries. This seems fair enough. In this case the need for reserving a large number of places for doctors and nurses who already have considerable experience of field work would no longer be pressing. More important then would be to establish a one to two-week refresher course as a complement to the present "basic" period, perhaps carried out in the field, and focusing primarily on a selected number of subjects such as health planning, management, administration, economics, communication, disaster relief, etc. In many Third World countries today the idea of self-reliance is growing fast. But for a number of years there will probably still be a need in developing countries for medical assistance from abroad, both for curative and preventive activity and for counselling in planning and administration. Access to appropriate training before taking up work in developing countries will become ofincreasing importance. A type of course such as that established in Sweden and outlined above would seem to be a logical way of meeting this legitimate demand. ADDENDUM
Since this paper was submitted for publication a major change in the organization of the course has
Tropical Doctor, October I977 taken place. Following a decree concerning regionalization of the activities of the Swedish universities which came into action on July I, 1977, and the establishment at Uppsala University of a personal professorship in International Child Health for one of the authors (YH), a decision has been made, in consultation with the National Board of Health and Welfare and SIDA, to transfer the course to Uppsala. At the same time the curriculum has undergone a revision, implying a more intimate integration of the different parts of the course. The new organization came into effect on July I, 1977.
ACKNOWLEDGEMENTS
The authors wish to express their thanks to those assistance organizations which have given their support to the course activities, mainly SIDA, the missionary organizations, the Swedish Red Cross, and the Swedish Save the Children Fund. Special thanks are due to Dr G. Wennstrom, chairman of the course committee and head of the Planning Department, National Board of Health and Welfare, Stockholm, and to Professor E. Bengtsson, head of the Department of Infectious Diseases, Roslagstull Hospital, Stockholm, and his staff. They have played a very important role in the successful realization of the training courses.
REFERENCES
Andersson, 1. (1975). T. Sverig. sjuhshiitersleor, 5, 54. Bengtsson, E., et al. (1971). Ldhartidn., 68, 5241. Bengtsson, E. (1972). Nord. Med., 87,185. Boberg, L., and Hylander, N-O. (1975). Ldkartidn., 72, 2367. Habib, Z. (1975). Ldkartidn., 72, 2533. V. Holst, H. E. (1974a). Ldkartidn., 71, 2889. v. Holst, H. E. (1974b). T. Sverig. sjukshoterskor, 14,4. King, M. (ed.) (1966). Medical care in developing countries. Nairobi: Oxford University Press. Morley, D. C. (1973). Paediatric priorities in the developing world. London: Butterworths. Newell, K. W. (1975). WHO Chron., 29, 161. Nordberg, 0., et al. (Eds) (1975). Actionfor children towards an optimum child care package in Africa. Uppsala: The Dag Hammarskjold Foundation. Vahlquist, B. (1971). Nord. Med., 86, 837. Williams, C. D., and jelliffe, D. B. (1972). Mother and child health: delivering the services. London: Oxford University Press.
JOINT TRAINING COURSES
I 189
Community Medicine
Joint training courses in
nutrition, public and tropical medicine for work in Third World countries H. v. Holst Senior Medical Officer, Planning Department of the National Board of Health and Welfare, Stockholm, Sweden
Y. Hofvander Associate Professor of Pediatrics, Uppsala University, Uppsala, Sweden
B. Vahlquist Emeritus Professor of Pediatrics, Uppsala University, Uppsala, Sweden
TROPICAL DOCTOR,
1977,7,189-192
------
The tasks meeting expatriate health personnel undertaking work in Third World countries will in many ways differ fundamentally from those encountered in their countries of origin. These differences have become even more evident in recent years when the main emphasis in many countries, and indeed in WHO, is laid on the development of appropriate health delivery systems in rural areas with training concentrated on auxiliaries - "health by the people" (King 1966; Newell 1975). Community health care surpasses in importance medical care on the individual level (Morley 1973; Williams and [elliffe 1972), even though the latter must still be given very great attention. Many Third World countries have become convinced of the need to liberate themselves from dependence on western culture, not least in the organization and practice of health care. One example should be sufficient to illustrate the absurdity of the health care approach which prevailed all too long. In most developing countries children below 15 years of age represent 45-50% of the total population. Yet, not until the last 10-15 years has the importance of mother and child health care and appropriate training of personnel in this field been recognized (Nordberg et al. 1975). It seems obvious that the training needed by expatriate doctors and nurses to equip them for meaningful work in Third World countries goes far beyond
the fields of communicable diseases and "tropical medicine". Obviously a basic knowledge of these subjects is still of great importance (Bengtsson 1972), but thorough knowledge is also needed in a number of other fields, for example social anthropology, nutrition, maternal and child health, family planning, training of health personnel ("teaching the teachers"), health education, health planning, administration and management, and disaster relief. Obviously also some knowledge of the local language is a necessity. It is of paramount importance that the expatriate personnel, by their knowledge, behaviour, and philosophy, fit into the general local pattern for health care (Vahlquist 1971). To this end, after some preparatory work (Bengtsson et al. 1971), a training course once a year, along the lines referred to above, was started in Sweden in 1973 (v. Holst I974a, I974b). It has now been extended from one to two courses per year. The idea of arranging a joint programme for doctors and nurses was first suggested by the Swedish International Development Authority (SIDA) in I97I. With the incorporation of some necessary preparatory training for the nurses (see below), this arrangement has worked out very well. * Now looking back on our experience of seven consecutive courses, we consider that certain features of the course arrangements, as well as of the balance of representation of different topics in the curriculum, might be of some interest to the international community. OBJECTIVES
The objectives of the course are "to communicate such knowledge of assistance and disaster relief services within the fields of public health and medicine as will enable the trainees to carry out their public health and medical duties, including planning, administration, training, and information at health 'In the early 1960s Professor E. Bengtsson, Head of the Department of Infectious Diseases, Roslagstull Hospital, Stockholm, started six-week annual courses in tropical medicine for physicians working or intending to work in departments of infectious diseases of paediatrics, for example. Since completing the course, some of the former participants have taken up work in Third World countries. The experience gained from these courses has been of great value in the planning of the new type of courses described in this paper and intended for physicians and registered nurses contracted for work in various Third World countries through the sponsorships of different Swedish assistance organizations.
190
I JOINT TRAINING COURSES
Tropical Doctor, October I977
clinics of various levels and at district hospitals. These tasks often have to be carried out under difficult circumstances and with inadequate resources." The training underlines the importance of all activities being conducted in close co-operation with the public health authorities of the country concerned and with the participation of national health personnel. Emphasis should be placed on the fact that all assistance activities are intended as "help towards self-help". ORGANIZATION
The training course is organized by the Swedish National Board of Health and Welfare. It is run jointly by university institutions in Uppsala and Stockholm, being backed mainly by the Department of Pediatrics and the Institution of Nutrition, Uppsala, and the Department of Infectious Diseases at Roslagstull Hospital, Stockholm. It is financed chiefly by the Swedish International Development Authority (SIDA), the Swedish National Board of Health and Welfare, and several voluntary assistance organizations (missions, Red Cross, Save the Children).
Table
I.
CURRICULUM
The curriculum comprises 10 weeks and includes a fairly wide range of subjects. There is a total of about 270 hours of teaching, demonstrations, and structured discussions, and 230 hours of group work, films, self assessment programmes, etc. The detailed curriculum is shown in Table I. COURSE MATERIAL
Three months in advance of the course each participant receives free of charge a set of pertinent literature, partly in English and partly in Swedish. The participants are encouraged to study this as much as possible in advance; most of it is intended for use both during the course and for reference during the following contract period in the field. During the course the trainees also receive a number of booklets, compendia, and similar material as well as a folder containing summaries of many of the lectures. A set of reading matter, comprising some 20 books, booklets, etc., is provided as a small reference library for group work during the course ~ one copy per five or six students. About 10% of the participants will be working in
Curriculum of the course Lectures (hours)
Medical socio-anthropology Nutrition Maternal health and family planning Child health, common diseases in children Practical laboratory training Hygiene (environmental and food) Health planning and administration Medical training and health information Emergency assistance Common infectious diseases (for nurses) Tropical infectious and parasitic diseases: Entomology Protozoal diseases Helminthic diseases Bacterial, viral, and rickettsial diseases Infections of the eye, ear, nose, throat, and skin Vaccinations Practical pharmacology Parasitological laboratory training Infectious and parasitic diseases - case studies Epidemiology and combat of tropical infections and parasitic diseases - Conclusions Special training (as required) Total
2 10 5 10
Demonstrations and structured discussions (hours)
Group work (hours)
3
15 5 5
15 5 10 3 5 5 2 6
6
8 5 2 1
5 10 7
15 5 1 6 6 5 5 1 1
15 10
15
15 20
100
170
230
Tropical Doctor, October I977
French- or Spanish-speaking countries. Attempts have been made to provide these students with literature in the appropriate language. PARTICIPANTS AND DIPLOMA
The number has been set at 30 per course, but on some courses this figure has been exceeded, In all, 224 health personnel have completed the course64 doctors and 160 registered nurses, and a few of other categories (nutritionists, laboratory assistants, etc.). Each course has included some participants from other Scandinavian countries. Before attending the course 80 participants (35°/.») had already been working for some years in developing countries, primarily in Africa and Asia. All participants of the last five courses had already been appointed. for assistance services starting within one year after completion of the course. Students who have passed the oral and written examinations are awarded a Diploma in "Nutrition, Public Health and Tropical Medicine". Those who have not taken the examination are given a course certificate. EVALUATION
At the end of each course the participants have had the opportunity of discussing and commenting in writing on the value of the course and the need for amendments and new approaches. The discussions have been frank, searching, constructive, and they have led to successive improvements. The fundamental principles, i.e. the joint training of physicians and nurses, the strong emphasis on prevention and public health aspects, and the prodigious application of group work as a technique have never been challenged. On several occasions doctors and nurses who have attended the course have since expressed their positive opinion about its value, in articles in Swedish medical journals (Andersson 1975; Boberg and Hylander 1975; Habib 1975). These authors had already worked for a number of years in developing countries before participating in the course, which gives added weight to their testimonies. The essence of their statements is that the course provides very useful complementary information even for those with earlier experience of field work in developing countries, that a relevant diploma should be looked upon as a more or less obligatory prerequisite for Swedish health personnel starting work in developing countries, and that efforts should be made to organize short refresher courses focusing especially on topics such as management, communication and evaluation and disaster relief.
JOINT TRAINING COURSES
I 191
Interviews with former course participants have also been carried out in the field by one of the authors (HvH) during a visit to Tanzania and Zambia in December 1975. In this context also, after confrontation with realities, the consensus was overwhelmingly positive - both with respect to the broad outline and content of the course and to the variety of practical knowledge it had provided. The coeducation of doctors and nurses has meant the breaking of new ground for Sweden. At the beginning it was regarded as an experiment, with some scepticism as to its feasibility. Very soon, however, it proved to be not only a practicable way of training but indeed a real advantage. With some extra training in general laboratory work and a special series of lectures on general infectious diseases for the nurses, the joint course has been successful. At the same time the combined training of doctors and nurses was a valuable exercise for later field work, when the medical staff has to be flexible and prepared to take up new roles as members of a team. PLANS FOR THE FUTURE
The idea is to integrate the different parts of the course as far as possible. In this process some further changes with respect to balance between different topics may prove necessary but on the whole the present outline should be preserved. There is no doubt that in its present shape and duration the course must be looked upon as a rather strenuous one - particularly so, perhaps, for the nurses. For this reason an extension from the present to-week course to 12 weeks has been discussed. However, for many participants even 10 weeks mean considerable problems with respect to leave ofabsence from their regular work. For the administration and financing of the course such an extension would mean added hardship. Thus, for the next few years an extended duration is not foreseen. There is a need to reach a greater stability in staff and at the same time to reduce the number ofteachers. For the time being over 30 teachers are involved, although the main burden falls on a group of eight to 10. The total number of participants should preferably be lowered from the present 30 to about 25. The proportion between doctors and nurses should, if possible, be at least I : 2, this proportion corresponding roughly to the present demand as expressed by various Swedish assistance agencies. So far, only a limited number of places in the course have been available to doctors and nurses from other Scandinavian countries. The co-operation between the Scandinavian countries will probably increase with time.
192
I JOINT TRAINING COURSES
The course language has so far been Swedish, although several contributions are given in English. For the majority of the participants who are already contracted for work in the field, English will become their working language. Although quite a few are preparing for work in French- or Spanish-speaking countries, it has now been considered important to gradually introduce more English. This would give an opportunity in the future for medical personnel from Third World countries to participate in the course, which would mean a definite two-way benefit. Disaster relief will continue to be a subject of major importance in the course. Emphasis will be placed on the application of theoretical and practical knowledge in various simulated disaster situations. Many participants have expressed the opinion that the course should be a requirement for all Swedish health personnel before taking up work in Third World countries. This seems fair enough. In this case the need for reserving a large number of places for doctors and nurses who already have considerable experience of field work would no longer be pressing. More important then would be to establish a one to two-week refresher course as a complement to the present "basic" period, perhaps carried out in the field, and focusing primarily on a selected number of subjects such as health planning, management, administration, economics, communication, disaster relief, etc. In many Third World countries today the idea of self-reliance is growing fast. But for a number of years there will probably still be a need in developing countries for medical assistance from abroad, both for curative and preventive activity and for counselling in planning and administration. Access to appropriate training before taking up work in developing countries will become ofincreasing importance. A type of course such as that established in Sweden and outlined above would seem to be a logical way of meeting this legitimate demand. ADDENDUM
Since this paper was submitted for publication a major change in the organization of the course has
Tropical Doctor, October I977 taken place. Following a decree concerning regionalization of the activities of the Swedish universities which came into action on July I, 1977, and the establishment at Uppsala University of a personal professorship in International Child Health for one of the authors (YH), a decision has been made, in consultation with the National Board of Health and Welfare and SIDA, to transfer the course to Uppsala. At the same time the curriculum has undergone a revision, implying a more intimate integration of the different parts of the course. The new organization came into effect on July I, 1977.
ACKNOWLEDGEMENTS
The authors wish to express their thanks to those assistance organizations which have given their support to the course activities, mainly SIDA, the missionary organizations, the Swedish Red Cross, and the Swedish Save the Children Fund. Special thanks are due to Dr G. Wennstrom, chairman of the course committee and head of the Planning Department, National Board of Health and Welfare, Stockholm, and to Professor E. Bengtsson, head of the Department of Infectious Diseases, Roslagstull Hospital, Stockholm, and his staff. They have played a very important role in the successful realization of the training courses.
REFERENCES
Andersson, 1. (1975). T. Sverig. sjuhshiitersleor, 5, 54. Bengtsson, E., et al. (1971). Ldhartidn., 68, 5241. Bengtsson, E. (1972). Nord. Med., 87,185. Boberg, L., and Hylander, N-O. (1975). Ldkartidn., 72, 2367. Habib, Z. (1975). Ldkartidn., 72, 2533. V. Holst, H. E. (1974a). Ldkartidn., 71, 2889. v. Holst, H. E. (1974b). T. Sverig. sjukshoterskor, 14,4. King, M. (ed.) (1966). Medical care in developing countries. Nairobi: Oxford University Press. Morley, D. C. (1973). Paediatric priorities in the developing world. London: Butterworths. Newell, K. W. (1975). WHO Chron., 29, 161. Nordberg, 0., et al. (Eds) (1975). Actionfor children towards an optimum child care package in Africa. Uppsala: The Dag Hammarskjold Foundation. Vahlquist, B. (1971). Nord. Med., 86, 837. Williams, C. D., and jelliffe, D. B. (1972). Mother and child health: delivering the services. London: Oxford University Press.
