OCHA Situation Report
DPR Korea
August - September 2005
28 October 2005


Source: UN Office for the Coordination of Humanitarian Affairs

HEALTH AND NUTRITION SECTOR
WHO - TB Control Programme Review

>From 28 August to 10 September, the Global Drug Facility (GDF) and a 
WHO joint mission visited DPRK for a review of the national TB programme 
as part of the requirements for countries which have applied to the 
"Stop TB Partnerships" programme. GDF agreed to a grant in kind of 
anti-tuberculosis drugs for an additional period of three years. The GDF 
is an initiative to increase access to high quality tuberculosis (TB) 
drugs for DOTS implementation, a TB control strategy. It is managed by 
the Stop TB Partnership Secretariat in WHO Headquarters, Geneva. GDF has 
supported anti-tuberculosis drugs to DPRK for the last three years 
(2002-2005).

The main findings from the mission report were:

    The vertical structure of the programme should be maintained. The
    DOTS programme has shown successful results from the beginning and
    during the expansion of the programme.

    A new protocol for laboratory quality assurance has been elaborated
    with the assistance of a WHO consultant. It is scientifically
    advanced, and in line with the most recent international
    recommendations.

    Training courses at various levels have taken place on a regular
    basis.  Key programme staff have benefited from training abroad.
    Staff are well acquainted with the procedures and requirements of the
    DOTS programme.

    In order to prevent anti-tuberculosis drug resistance, the Government
    has issued a decree for zero use of streptomycin for conditions other
    than tuberculosis.

    There is good drug management at the peripheral level, but
    strengthening of drug management is needed at the central level.

    Supervision is taking place at regular intervals. Supervision reports
    are routinely prepared and available at the higher level. Use of
    supervisory check lists is recommended.


One of the most important issues, among many challenges and 
recommendations mentioned in the report, was financial sustainability 
which is very precarious in the medium term. The Canadian CIDA grant may 
well cover the needs up to the middle of 2006, but there are no further 
external donor commitments beyond this time. It was recommended that the 
Government should increase its efforts in allocating additional domestic 
resources for TB control.

The Government, Ministry of Public Health (MOPH) or NTP should actively 
engage with donors to pursue continued financial and technical support. 
WHO has consistently played a constructive role in this regard.

For the same period, from 20 September to 1 October 2005, a WHO 
technical expert visited DPR Korea to assist national authorities in 
development of a plan to strengthen data management of the national TB 
programme. A four day training course was held for28 personnel from each 
of the 10 provinces and from the national level. The training consisted 
of principles of basic and applied epidemiology; concepts of 
surveillance, including recording and reporting; and on data management 
and analysis using Excel-based tools for TB data and based on quarterly 
reports.

WHO - Obstetrics and Gynaecology Training

A specialist on Obstetrics Gynaecology from Papua New Guinea visited 
DPRK at WHO's invitation from 28th May to 28th June 2005. The purpose of 
this assignment was to review, in co0llaboration with the Ministry of 
Public Health (MOPH), the national Reproductive Health Clinical 
Guidelines and conduct a one week workshop on Obstetrics and Gynaecology 
with local specialists from county and central levels. The specialist 
also refined clinical guidelines through an interactive process of 
discussion and integrated inputs provided by participants. The revision 
of the Guidelines was enlarged to include:

    Common gynaecology topics for ri and county level health personnel;

    Non-emergency obstetric issues;

    Routine care of the newborn, and neonatal resuscitation.


On the penultimate day, a briefing was organised at the WHO Office and a 
presentation of the findings, lessons learned, and recommendations, were 
made by the specialist. This was attended by interested UN agencies' 
staff and NGOs. This initiative was part of the WHO/UNFPA joint 
collaborative programme

WHO - Regional Consultations on Traditional Medicine

Regional Consultations on the Development of Traditional Medicine were 
successfully held in Pyongyang from 22-24 June 2005. This was hosted by 
the government of DPR Korea, with participation from all regional 
countries (except Timor Leste). Since traditional medicines are widely 
used in DPRK, these regional consultations paved the way for a better 
understanding of this medication and their use in other countries of the 
region. The participants were taken on a field trip by Koryo Medicine 
focusing on traditional medicine as part of the Health System at the 
primary, secondary and tertiary health care levels.

UNICEF - Nutrition and Care Programme

During the second half of September 2005, a group of officials from the 
Ministry of Public Health visited different types of care institutions 
in three countries, which included foster parenting care, drop?in 
centres and orphanages in China; day-care centres and training 
institutions in the Regional Training Resource Centre in Singapore; and 
community-based care centres, Baby Friendly Hospitals and the Mahidol 
University in Thailand. These visits were part of ongoing capacity 
building activities for government officials, aimed at enhancing their 
understanding on issues related to early childhood development and 
effective collaboration between research/training and programme 
implementation. It is expected that this visit will contribute to the 
improved management of care institutions for the prevention of 
malnutrition among young children.

The rehabilitation of Yonsan nursery has been completed. Rehabilitation 
included the replacement of windows and doors, electrical wiring and 
painting, and forms part of the input towards developing model care 
institutions supported by UNICEF in the focus counties. The 
rehabilitation of Unryul nursery has started.

UNICEF - Central Medical Warehouse (CMW)

In August, the CMW distributed medicine kits to 448 Ri clinics/hospitals 
and 39 Provincial/county hospitals in N. Pyongan, S. Hamgyong and N. 
Hwanghae provinces. In September, the CMW distributed medicine kits to 
1258 Ri clinics/hospitals and 52 Provincial/county hospitals in S. 
Pyongan, Kangwon, Ryanggang and S. Hwanghae provinces.  During this 
period, 562 Section Doctor's Bags, funded by ECHO, arrived. The CMW is 
distributing them to 2 counties (Kosan and Chonnae) in Kangwon and Ranam 
districts in N. Hamgyong. The CMW finished the distribution of 
calculators and ledgers (funded by ECHO) to facilitate the maintenance 
of better records, thus contributing to an overall improvement in the 
management of essential medicines and the storage and distribution of 
these drugs. 120 metal racks also arrived during this period and will be 
distributed to the CMW and 8 PMWs.

UNFPA - Reproductive Health (RH) Survey 2004

UNFPA organized a technical briefing on the findings of the Reproductive 
Health Survey in August to collect comments from partner agencies. The 
preliminary findings of the survey concluded that improvements in the 
quality of services for maternal health care, especially EmOC, can still 
be made. Furthermore, widening the choice of contraceptives and 
providing informed choice and improved decision making on contraceptive 
methods, is essential to meet the unmet needs of the population for 
family planning.

UNFPA - Reproductive Health Clinical Guidelines With the support of a 
WHO consultant, the national guidelines on reproductive health were 
revised to fit the needs of service providers at county and ri level. 
The training manual based on the guidelines is being developed for 
follow-up training in 23 ri clinics and 9 county hospitals supported by 
UNFPA within this year.

UNFPA - Reproductive Health Commodity Security (RHCS)

In July 2005, at a request from UNFPA, WHO and UNICEF, the government 
established a steering committee to ensure coordination on RHCS. 
Consensus was reached on the following points:

    Government, WHO, UNICEF and UNFPA are committed to harmonize the
    logistics management for essential drugs in DPR Korea which goes
    beyond Reproductive Commodities. Other health partners including IFRC
    are welcome to join the process.

    A Logistics Management System will be introduced nationwide and
    computerized.

    UNICEF initiated a new stock card system in early 2005 and this will
    also be used by WHO and UNFPA.

    WHO is working with the Ministry of Public Health (MoPH) and
    international health partners to finalize the latest updates of the
    National Essential Drug List. This includes contraceptives.

    UNFPA will provide technical and financial support to adapt and
    develop an ELMIS software package based on the experiences from Laos.
    The system will be tested first in the Central Medical Warehouse in
    early 2006, before being expanded to all provinces.


Handicap International (HI) - Sijung Rehabilitation Treatment Centre

Beginning in July 2005, HI launched the second phase of the 
rehabilitation of the Sijung Rehabilitation Treatment Centre, located in 
Kangwon Province. This centre is one of the most important institutions 
in the medical rehabilitation of disabled people in the DPRK. Every 
year, around 1500 patients visit this centre for rehabilitation 
treatment after amputation surgery, chronic disease or side effects from 
surgical operations. Handicap's support is focused on the physical 
renovation of the main three buildings in the centre (the patients' 
dormitory, mud-treatment unit and physiotherapy unit) in order to 
improve the treatment conditions and the living conditions of the 
patients. This phase will be completed by the end of 2005, and as a next 
step, the upgrading of treatment methods and equipment is under 
consideration. ECHO and UN OCHA are funding this project.

Handicap International (HI) - Target Groups Expand

In mid-2004, the beneficiaries of HI programmes in the DPRK were solely 
amputees and patients of the Hamhung Orthopaedic hospital. Thanks to an 
ongoing collaboration with a local partner organization, the Korean 
Association for Supporting the Disabled (KASD), HI has subsequently been 
able to expand its target groups to include deaf children. There are 
eight schools for the deaf in the DPRK and by the end of 2005, HI and 
KASD plan to upgrade the overall standard, using the Wonsan Deaf School 
as an example. In Wonsan, the main building, the dormitory and a 
vocational training building have been rehabilitated thanks to support 
from ECHO, allowing the children to develop their capabilities in a 
favourable learning environment.

Following the conclusion of an assessment mission on hearing impairment 
conducted by a HI expert in November 2004, 1000 volumes of an upgraded 
sign language dictionary were printed. Previously, there were only 2 
books in a school of 130 students. Furthermore, 2,300 volumes of a 
reference book on sign language have been edited and printed for the 
parents and friends of the deaf children. These reference books aim to 
re-create the communication between the deaf children and their parents 
and friends, and ease the reintegration of these children back into the 
family cell. This reference book is a totally new concept in DPRK. ECHO 
and Caritas Hong Kong funded this joint KASD/HI project. With the 
additional support of the UK embassy in Pyongyang, further vocational 
training materials will be provided through KASD, allowing children to 
be trained in a specific profession, and the Australian Government has 
provided funding to improve the living conditions of the children by 
providing basic equipment such as mattresses, blankets, buckets and 
shoes.

Handicap International - Hamhung Physical Rehabilitation Centre

A delegation of EU parliamentarians visited the HI Physical 
Rehabilitation Centre (PRC) in Hamhung earlier in 2005 The EU, through 
ECHO, is the main donor for HI projects in the DPRK, and the Hamhung PRC 
is the largest project for HI.

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