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close this bookBridge Builders: African Experiences with Information & Communication (BOSTID, 1996, 304 p.)
close this folderCase studies on the introduction of cd-rom to university libraries
View the document(introduction...)
View the documentThe CD-ROM Service for the University of Dar es Salaam
View the documentCD-ROM for Health Information in Zimbabwe
View the documentBackground Summary: The African Index Medicus (AIM) Project
View the documentCommunications for Better Health Project in Zambia


CD-ROM (Compact Disc, Read-only Memory) is a high density storage medium on which electronic data are etched by laser onto a compact disc master. A single CD-ROM can hold still images, motion video, audio, and digital data. With its vast storage capacity (a single CD-ROM can store as much data as 1,500 floppy disks or 200,000 printed pages of text), ease of mailing, and tolerance of harsh environmental conditions, CD-ROM offers a practical solution to the information isolation experienced by researchers, information professionals, and scientists in many developing countries.

These case study authors live in areas where high costs and technical difficulties deter online access and searching. They demonstrate that CD-ROM can bring the following gains:
· user-friendly, interactive online searching of databases by library staff and end-users;· current citations, with abstracts that often provide sufficient information to negate the need for source documents;· selected citations and abstracts that can be used for national digests of relevant material;· an enhanced image of library staff due to their dramatically improved ability to deliver current information and to demonstrate computer skills; and· demystification of microcomputer technology for staff and end-users.

CD-ROM has proven appropriate to these authors because it reduces the need for online links and it operates under difficult conditions, such as heat, humidity, dust, and unstable power supply. The authors did find' however, that while there is a relatively low capital cost for the equipment, the cost of sustaining the subscriptions to the databases is still a problem.

These case study authors demonstrate how they have used CD-ROM as a powerful tool to develop local computer literacy by providing the opportunity for hands-on use of a sophisticated system. They also describe how CD-ROM has been used to develop both local and pan-African databases and digests of relevant information.

The CD-ROM Service for the University of Dar es Salaam

by John M. Newa

Dr. John Newa is Director of Library Services at the University of Dar es Salaam He has worked on the promotion and development of information centers in Tanzania. Since 1990, he has been concerned with the introduction and applications of information technologies in libraries.


The University of Dar es Salaam was the first university for Tanzania. The United Republic of Tanzania was the outcome of the political union in 1964 between the former British Protectorates of Tanganyika (independent in 1961) and Zanzibar (independent in 1964 following a bloody revolt against the Arab Sultan). It is located on the Indian Ocean between Kenya and Uganda in the north, Burundi, Rwanda and Zaire in the west, Zambia and Mozambique in the south. The country has a population of about 27 million and is growing at the rate of 3.1 percent (1991).' People use Kiswahili as the national language. English is a second language and the language used in institutions of higher learning.

Tanzania is ranked second from the bottom worldwide in terms of its gross domestic product and its economy is mainly agricultural-based. It was reportedly growing at the rate of 3.6 percent in 1992. The industrial sector is increasing and accounts for 40 percent of the national economy. Through the International Monetary Fund's policies of structural adjustment, the economy is said to be improving, although the man on the street says life is getting more difficult.

The country recorded a literacy rate of over 80 percent in the late 1980s. The policy of Universal Primary Education - introduced in the early 1970s and calling for all girls and boys to have a basic seven years of primary education - is in place.

Yet the total number of children enrolled in secondary schools is less than 10 percent of primary school graduates, and the number of those who struggle and make it to the universities hardly reaches 0.05 percent. In recent years deliberate efforts have been made to increase the amount of science and technology in the curriculum at all levels of education.

Scientific and technological training is given more emphasis in the Teachers and Technical Colleges, as well as in the several vocational institutes spread all over the country. The government, through the Ministry of Science, Technology and Higher Education, is making deliberate efforts to prepare the country for the 21st century when scientific and technological information developments will be critical for national socioeconomic development.

At the national level, the Commission for Science and Technology (COSTECH) is responsible for the adoption, development, and dissemination of scientific and technological information. The target of the Ministry of Science, Technology and Higher Education is to raise the national expenditure on research and development (R&D) from the present 0.2 percent to 1 percent by the year 2000. Besides creating the scientific and technological infrastructure in R&D institutions, COSTECH is in the process of creating three databases: a directory of scientists and technologists; a directory of scientific and technological institutions, and an inventory of scientific and technological equipment.

The need for adequate scientific and technological information (STI) is felt in the research institutes of all sectors, including agriculture, forestry, health, industry, wildlife, and fisheries. However, I feel that the greatest need for the provision of STI is in the institutions of higher learning, especially the universities that are expected to support teaching, research, and consultancy activities.

When the CD-ROM project was first being prepared in 1991, the STI infrastructure at the University of Dar es Salaam (UDSM) and throughout the country was still underdeveloped. There were only a few international vendor agencies for STI hardware and software in the country: among them, IBM, International Computers Limited (JCL) and Wang. There were two electronic mail nodes: one at the Medical Library in connection with the HealthNet Project and another at COSTECH. At the UDSM, besides the University Computer Centre, there were personal computers in only some departments. The library had two computers. There was also a ground station for communication using a low-earth orbiting (LEO) satellite connection between the Department of Electrical Engineering and Essex University, in England. As far as CD-ROM services are concerned there was one CD-ROM workstation each at the United States Information Center Library (for the Books in Print database), at the British Council Library (for the British Books in Print database), at the Demographic Unit of the University of Dar es Salaam (for the POPLINE database), and in the Department of Crop Science at the Sokoine University of Agriculture (for a few databases from the Commonwealth Agricultural Bureaux).

As the CD-ROM Service project was getting under way in 1993, an electronic mail node was installed at the University Computer Centre, with connections to various departments of the University. For a variety of reasons, including the lack of email technicians and the need for a secure location to place the equipment, the library did not get its email connection until May 1995. Until then the University Library used the Medical Library and Computer Centre email nodes for sending and receiving messages. The University Computer Centre expected to install an Internet connection via leased line to South Africa in November 1995, however that proved too expensive and the Computer Centre is currently waiting for the arrival a satellite dish that they will use to connect to the Internet.

At this point the University of Dar es Salaam is in the process of adopting a technology information policy that will encompass the various university operations, including administration, student administration, finance, and the automation of the library.


The University of Dar es Salaam academic community was facing the problem of availability of and access to current information for its teaching, learning, and research activities. Our scholars and researchers were isolated from their colleagues in the region and overseas. Limited resources made it difficult to acquire and provide current information resources, including the maintenance of adequate periodical subscriptions. The lack of information technology resources and the poor telecommunication infrastructure ruled out online connections with information databases in the region and abroad.

For all of these reasons, we decided to introduce CD-ROM service to the University. We had heard about the successful introduction of CD-ROM at the medical library in Zimbabwe and wanted to provide our own library users with the same benefits: especially convenient and relatively inexpensive access to current scientific, technological, and socioeconomic information.

The financial support provided by the Carnegie Corporation of New York allowed for the purchase of two CD-ROM workstations, their accessories, a laser printer, and initial subscriptions to two CD-ROM databases. The Institute of Scientific Information's (ISI) Science Citation Index and the Social Science Citation Index were selected for their breadth in providing for the teaching, learning, and research needs of a large section of the university academic community. We hoped that this broad appeal would give the new service good publicity.

The CD-ROM service started operation with two donated engineering databases provided by American Association for the Advancement of Science (AAAS) Engineering Index Page One and Compendex Plus - and the Distance Education Database from the International Centre for Distance Learning (ICDL), donated by the Commonwealth Association for Distance Education. The Library also decided to acquire two additional databases, ERIC and TROPAG, which we believed to be of more general interest to the larger section of the academic and research community at the university and in other R&D institutions in the country.

Within its interlibrary loan program, the library had provision for document delivery through coupons purchased from the British Library Lending Division in Boston Spa. This provision enabled the Library to provide a modest document delivery service emanating from the CD-ROM database searches. In order to cope with the increasing demand from the CD-ROM service, the document delivery financial allocation had to be more than doubled.

The library was also maintaining a total of about 800 current journal subscriptions, 40 percent of which came through the assistance of the Swedish Agency for Research and Economic Cooperation (SAREC), 20 percent through AAAS's support within the sub-Saharan Africa program, and 40 percent from the library's own resources. The photocopying service of the library was also improved by the purchase of additional heavy-duty machines. The photocopying machines had been purchased with funds from SAREC within its Library Support to Tanzania Libraries Programme.

As originally intended, the CD-ROM service has provided the academic and research community at the university, in particular, and in Tanzania, in general, access to current information and has relieved the isolation of scholars and scientists in the region and abroad. In brief, the service provides scholars and researchers with the capacity of 15 different and updated CD-ROM databases in their subjects of interest and provides document delivery to most items requested. The databases include subjects in Science and Applied Technology, Social Science and the Humanities, and Law. Document requests from database searches were met by services from the British Lending Library and recently from the Massachusetts Institute of Technology through the AAAS. Our assessment is that the document delivery service, in terms of documents requested and time it takes to get the documents, has not been found satisfactory by our CD-ROM service users.

When we acquired the CD-ROM service, the only other operational service I knew about was at the Medical Library, which was part of the HealthNet project. My visit to the Department of Crop Science at the Sokoine University of Agriculture in the company of a team of experts from BOSTID indicated that the facility was not being used. I am also informed that about 1993 a CD-ROM facility was introduced at the Uyole Ministry of Agriculture, Research and Training Institute. It is not known which databases were donated to the Institute but I guess these might be products of the Commonwealth Agricultural Bureaux. Again the state of its functionality and extent of use is not known.

COSTECH acquired one CD-ROM workstation about 1993, which became operational in the same year, using patent databases from the U.S. Patent and Trademark Office and the European Patent Application Bibliography. When I visited the facility recently, the CD-ROM drive was out of order. The Ministry of Trade and Industry Registry Office is also reported to have one CD-ROM workstation.

The Office has also received a wide range of patent CD-ROM databases. However the facility is not yet operational awaiting the training of staff. So as far as the general academic and research community is concerned' the CD-ROM at the University Library was the first facility with a reasonable degree of usage.

Since our CD-ROM facility has been operational, there has been keen interest to spread the technology to other institutions in the country. As seen above the CD-ROM; service has since been introduced in other information institutions in the country. The UDSM Library service has built upon the library's and the university's interest to acquire more personal computers. Since then the Library has acquired six computers, which are used in a variety of operations, including the creation of three local databases, in education, environment, and biodiversity. Under the UDSM Library's coordinating role for the SAREC Library Support Programme to Tanzania, we have also acquired four personal computers for other universities and research institutes. As will be seen below, the tempo generated is now helping us make a credible case for the library's partial or complete automation.

BOX 1 The Art of Proposal Writing

The personal contacts who gave us information on the technology - and where and how to get it - made a large difference in the quality of our proposal. The library had earlier contacted Dr. Patricia Rosenfield at the carnegie corporation of New York. She suggested that we meet with Wendy White of the U.S. National Research Council, who was scheduled to visit Tanzania in 1991 as a guest of COSTECH. The project proposal for the CD-ROM service was revised with her help and expertise before we submitted it to Carnegie. When you are new to proposal writing like we were, it is very helpful to have someone come along and help you compose answers to the reviewers, criticisms! For example, we thought that we had to address the reviewers" comments by changing our proposal to agree with them. We didn't know that we could challenge the reviewer by giving our justification for why we proposed to do things in a certain way or to use a certain product vendor.


Correct decisions concerning how to go about writing an acceptable and externally-funded project proposal, the handling of the grant, and the acquisition of hardware, software, and databases have been critical to the effective and efficient operation of the CD-ROM service. The story of how we learned about the technology, what it could do for us, and how and from whom to acquire it has been given above and in Box 1. Because we had little expertise and experience at the UDSM Library on appropriate equipment and databases, contacts with other African librarians in the region and individuals abroad at meetings organized by the AAAS and the U.S. National Research Council were very helpful. Still, our lack of experience resulted in heavy reliance on vendor recommendations for hardware and software and little control over the versions and price paid.

We decided to use the ICL local agent as a vendor for the hardware and software, so as to ensure the availability of spare parts, service, and consumables. Lengthy and cumbersome customs procedures were avoided by asking the Carnegie Corporation to make direct purchases from the vendor's parent company in London. A two-year service contract with the local vendor at the time of purchase solved the problem of installation and maintenance. The local back-up service has proved to be critical to the smooth operation of the service. Yet I have heard criticism from the Director. AAAS Library Program for sub-Saharan Africa, that the price paid for the UDSM's CD-ROM hardware was the highest in Africa. I swear that it was not caused by the Library Director's demand for kick-backs! It could be a factor of international and local vendors' price mark-ups, or a result of the country's customs duty structure for computer products imported into the country. The first two CD-ROM workstations were actually bought directly by the donor from ICL London and sent to the UDSM Library.

We faced a number of problems before the service got under way. First, the cost of the entire package from the local vendor was comparatively high. Then, the installation of the facility took longer than our donor could understand. We had peculiar local problems of security and high humidity. It took about six months for the Estates Department of the University to fix security grills and provide air conditioning for the CD-ROM facility. That was to ensure that the equipment was safe from possible theft and could not be damaged by the high Dar es Salaam humidity. So, although it took us longer than expected to become operational, we have had no serious problems in the safety and operation of the facility.

The purchase of CD-ROM database subscriptions has also been problematic from the outset. First of all, the CD-ROM databases selected were very expensive by our standards. In addition, financial transactions with database dealers overseas were long and difficult to execute, partly because of financial regulations at home and partly because of some irksome conditions set by the vendors. For example, the vendors required that we sign lease agreements before purchase and delivery. The database vendors contacted would not accept UNESCO coupons. Because of that initial experience, we have in subsequent years paid our database subscriptions through a London-based book agent who accepts payment in UNESCO coupons. We also learned that, in some cases, the CD-ROM databases actually belong to the publisher and were only being leased to us: we would have to return one disc before an update would be issued or if we had to cancel the subscription at a future date.

From the beginning we realized that it was our responsibility to have a few database subscriptions that were rather popular, rather than rely completely on the grant. We chose a department with high visibility - Reference - to house the CD-ROM service. This department was fortunately headed by a very able, effective, and efficient scholar and professional who had great personal drive. This has proved to be an asset to the service.

Effective March 1994, we formed a CD-ROM Service committee whose membership includes two end-users (people of senior academic ranks in the faculties of Engineering and Science) and four library professionals (the Director and the Heads of the Reference, Periodicals, and Readers Services departments).

In a concrete way, the university teaching and research community have reacted very positively to the project. (See Box 2.) Since the CD-ROM service became operational more and more users have turned up. The CD-ROM service is now the most important part of the library for teaching staff and postgraduate students and researchers. The library's 1994/95 Annual Report indicates that there has been an average of 53 searches per month and a total of 1,540 since the service started in October 1993.

The image of the library staff has also been significantly boosted among university professors, students, and committees. The CD-ROM service has frequently been cited by the Higher Degrees Committee as reason for academic staff and postgraduate students to enroll in the university. Since the CD-ROM service became operational, the Appointments Committee for Academic Staff no longer accepts complaints about lack of access to scholarly publications. Everyone on campus is expected to use the new service to improve their own scholarship.

BOX 2 The Benefits of CD-ROM

"Now that we have an efficient CDROM Service in the Library, there is no valid excuse for one not to register for a Ph.D. locally nor to produce scholarly publications, or go overseas for literature review."
Chairperson, Appointments Committee for Academic Staff at the UDSM, June 1993

Promotion and Publicity for the CD-ROM Services

We widely publicized the CD-ROM service within the university community and outside. We initially announced the service in various university committees, including faculty boards and the Senate. We sent circular letters to all heads of departments within the university and to all academic staff members, and we posted notices on all bulletin boards. We sent similar letters announcing and explaining the service to other universities and research institutes. We prepared special publicity leaflets and spread them all over the campus and outside. The 1993/94 Library Guide and University Prospectus and subsequent annual editions have included a sizable section on the CD-ROM service.

Word of mouth still plays a very important part in African communication channels. Since the 1993/94 academic year the service has featured prominently in all freshman and postgraduate orientation programs. I have spoken about the service in various forums, including the Senate, the Committee of Deans, Faculty Boards, and other academic gatherings to both announce and explain the service and its benefit for teaching, learning, and research.

The Library CD-ROM Committee took part in a number of departmental seminars as well as in postgraduate research seminar programs. So far the library has organized two Exposition Days for the CD-ROM service that were very well attended by both the university and external community. We organized the first Exposition Day when the service was just getting under way. We held the second Exposition Day during the university's Silver Jubilee week in July 1995; it was officiated by the former President and Chancellor of the University, Mwalimu J.K. Nyerere. The mass media, including newspapers and television, widely covered the event. Recently we decided to place one of the three CD-ROM workstations in the public area near the public catalog. The visibility of the facility may attract more users. We trust that these marketing and promotional efforts will improve and increase the use of the CD-ROM service.

Outreach Activities

In fact we are already providing outreach service to users in sister universities and research institutes. We have given access to a number of external users. In connection with other Library Current Awareness Services, we provide searches for users from outside the University. We have desktop publishing equipment on order that will allow us to produce and disseminate an information bulletin to users in the university and outside. The major limitation that we are facing now is poor and slow communication with institutions that do not have email or other telecommunication facilities. Thus in addition to providing traditional library products and services, such as bibliographies and newsletters, we plan to use the CDROM service as a launching pad for direct and aggressive services, directed at answering specific needs of S&T practitioners and researchers. This will include SDI (selective dissemination of information), retrospective searches, assistance in question formulation, bibliographies on demand, question and answer services, referral, photocopying, and citation tracing. These are in addition to the document delivery service.


We put a monitoring system in place when the service was launched. We keep records for users and their particulars, as well as records of searches. We are in the process of installing a system that can do that automatically. Currently all is done on daily record sheets which are cumulated weekly, monthly and yearly. Table I shows usage according to the broad categories of staff, postgraduate and undergraduate students, and others. Table 2 shows the number of searches requested according to the database.

TABLE 1 Usage Statistics, 1993-1995
























Since May 1995, the library has embarked on a project to evaluate the CDROM service, particularly the various CD-ROM databases held by the library. We identified senior academics and postgraduate students who had used the service and asked them to evaluate the databases in their various aspects, including the amount of information and its usefulness, relevance, currency, and coverage of the Africa region. From this evaluation and others to be conducted in the future, we will determine whether or not the CD-ROM service is having the desired effect. Unfortunately because of a change of the Librarian in charge of the CD-ROM service in the Library, this important report is not yet out.

We are bearing in mind Erick Baard's injunction that: "A correct assessment of an information technology innovation should include an examination of its requirements as regards physical and social infrastructure, its possible effects on new environments, and finally the nature of the limitations to information utilization which it is designed to alleviate."

TABLE 2 Searches by Database





Compendex Plus




Social Science Citation Index




Science Citation Index




Tropag and Rural Economy




Educational Resources Information Center








Arts and Humanities




International Centre for Distance Learning-



Public Affairs Information services




Life Sciences




Social Science Index








Applied Sciences




Current Citation




Current Contents













We have also taken serious steps to take care of the training aspect for both library staff and users. We expect staff to have basic computer skills and some ability in trouble-shooting, in case of minor operating problems. In order to undertake database searches effectively, CD-ROM operators need knowledge and experience in information retrieval techniques. So far all this has been only partially accomplished because, although professional staff had some exposure in their professional training, the rest of it, especially for the support staff, has been done on the job. Many academic staff members have had some database searching experience during their studies overseas. The bigger problem is with those who trained locally. The training of this group, together with that of students, is done by the library staff during their early database search sessions. The library has persuaded some teaching staff to have demonstrations in their classes or during seminars. The problem has always been whether to take the equipment to the class or to bring the group to the library CD-ROM facility. We have also used the Exposition Days as an opportunity to train both teaching and research staff and students in conducting database searches. We are still struggling to get training in trouble-shooting for our staff, but opportunities in the region and abroad have not presented themselves.


In hindsight we can say what went right:

· It was critical to have a good and acceptable CD-ROM project proposal and we were lucky that somebody happened to be there at the right time.
· We consulted and got the support of the university authorities before we sent out our project proposal. That support has been very critical in a number of ways, including provision of adequate local funding, and in publicizing the service.
· The decision to choose that particular vendor for the purchase of the equipment was also right. Back-up service has been very critical and the local ICL agent has generally not let us down.

There is no doubt that the CD-ROM service technology has done a wonderful job in alleviating our problems of availability of and access to current information. It is definitely a technology that we can afford. In implementing the technological innovation at the Dar es Salaam University, we did our level best to make the right decisions, and some of the problems are beyond our control.

So far our user statistics are still low. We should have made the CD-ROM service accessible to undergraduate students. That should have boosted our user statistics to an optimal level. We are discussing that issue in the CD-ROM Service Committee and the idea is likely to be accepted and adopted. We are also experimenting with various ways of making the document delivery service easier and cheaper for users.

There is little that we can do about the high cost of hardware and the ISI database products. We wished we had started with cheaper products. We could also have shortened the period of waiting for the purchase and the delivery of the equipment. That might have required us to use the services of another local agent, other than the ICL agent. But then that might have meant compromising on the back-up service. Unfortunately practically all hardware and software has to be ordered from overseas, and not locally or in the region. We had to resort to using personal contacts in the region and abroad from the beginning to the implementation stage of the project in order to obtain all the equipment and programs we needed.

At this point we have managed to convince our major CD-ROM database dealers, ISI and Silver Platter, to accept payment in UNESCO coupons. By this method, we have managed to bypass the cumbersome bank transfer procedures.

The application of information and communication technology (ICT), however, raises some old problems: if not used properly, ICT could perpetuate the dependency syndrome of the poorer African countries on the western countries. Of course this is a controversial issue like "appropriate technology" or "aid" in both the North and the South. As other case studies have shown, however, the technology can also be used to Africa's advantage. For instance, cataloging and capturing locally-produced material for distribution on CD-ROM will be of great benefit to Africa. Dissemination of local information databases to the North can provide a give and take situation between the South and the North.

The sustainability issue is very critical. The donor agency and the university have raised it on numerous occasions. The library and the university must have the necessary resources to carry on the project, when the donor's project period comes to an end. Here the need to make provision for local resources is critical. The local contribution is actually important throughout the functional operation of the project.

We have made significant efforts to cultivate individuals, departments, and research institutes inside and outside the university to contribute to the sustainability of the CD-ROM service. We have indicated that all users of the service must contribute to the cost of the service in one way or another. During the initial and launching period everything has been provided free-of-charge; however, as the service becomes critical to users, the users will be requested to pay at least a nominal cost for printing. We also ask users to pay for photocopies of documents delivered. We charge outside users a small user fee.

Teaching departments of the university are requested to consider subscribing to CD-ROM databases in their respective subjects within their link agreements with overseas universities or include the databases within their documentation components when presenting proposals to donor agencies. The faculties of Education and Engineering, for example, will take up subscriptions to ERIC and Engineering

Index, respectively, should the Library fail to pay for those subscriptions. The Faculty of Science will take up databases in the sciences. Recently the Faculty of Law consulted the Library on the acquisition of hardware and software, including databases in law. Some departments also have arrangements to pay for the cost of document delivery for their staff and postgraduate students.

It is also important to think about twinning arrangements with other projects going on in the Library. This ensures the successful implementation and mutual support of the projects. For the University of Dar es Salaam Library this has included project support from SAREC, the AAAS Journal Donation Program, and the UNO/RAF/006/GEF Biodiversity Project. One project seems to have a multiplier effect on others. It is after you have one project running smoothly that you attract other, related information technology projects. Since we started the CDROM service project in 1993, we have had two other local database creation projects.


The introduction of the CD-ROM service technology has solved a critical information problem for the UDSM and Tanzania. But there are several challenges, beyond the issue of sustainability. Recognizing that the UDSM Library cannot afford to ignore the CD-ROM technology - for fear of being left further behind - we have some concerns about whether the CD-ROM technology can be technically maintained. Do we have enough local expertise to repair and replace the technology, for example? So far we have depended on back-up service from the vendor. So the problem of maintenance is not difficult in the country, but it could be cheaper and faster if we had the qualified personnel at the University or in the Library.

The CD-ROM databases we have from overseas cannot meet all of our STI needs. For development purposes, Tanzania's scientists need to have access to local and regional information resources, as well. There is considerable information in the form of grey literature - unpublished or unindexed reports, studies, and surveys by government and R&D institutions. A start has been made by the UDSM Library to create databases of local literature on environment, education, and biodiversity. The next important step is to create regional and continent-wide databases. This effort should be coupled with a campaign to convince scholars, scientists and practitioners to publish locally. Although the UDSM Library is one of the African University Libraries participating in the evaluation of international databases, the outcome of that evaluation is not yet complete at our University, and results from other African universities are not yet out.

As stated above, CD-ROM database information providers and vendors set conditions that are difficult to meet in developing countries. Should we, for example, cancel subscriptions to print indexes and rely on their compact disc equivalents? If we do, what will happen if we cancel the CD-ROM subscription and we are asked to return the discs?

This technological innovation also gives STI workers in the Third World an opportunity to think seriously about the development of appropriate STI technologies in the South and the adaptation of STI technologies from the North. It is our hope that our friends in the North will support this noble endeavor.

It is important to operate a project in accordance with the agreement and expectations of the donor agency. We tried as much as possible to keep to these conditions. We are convinced that because of this, besides the growing user demand for the service, the Carnegie Corporation accepted our application for the extension of the project by supplying an additional CD-ROM workstation and two CD-ROM database subscriptions, a desk-top publishing facility, and support to outreach activities.


1. Statistical data in this report is taken from Jamhuri ya Muungano wa Tanzania. Hotuba ya Waziri wa Nchi katika Ofisi ya Rais na Makamu Mwenyekiti wa Tume ya Mipango, Mh. S.A.Kibona(Mbunge) wakati akiwakilisha Bungeni Taarifa ya Uchumi wa Taifa ya Mwaka 1992 na Mapendekezo ya Mpango wa Bajeti (Rolling Plan and Forward Budget) kwakipindicha 1993/94-1995/96, tarehe 17 Julai, 1993. Dar es Salaam: Government Printer, 1993.

2. We have since learned that this is a problem faced around the world - in both developed and developing countries.

3. Baard, Erick (1982) Appropriate Information Technology: A Cross-Cultural Perspective, UJISLAA, 4(4):263-268.

CD-ROM for Health Information in Zimbabwe

by Helga Patrikios

Helga Patrikios went to school in New York and Belfast, and to university at Trinity College Dublin, where she read French and Italian language and literature. She worked as a TV documentaries researcher, teacher and editor until her marriage to a Rhodesian brought her to Harare (then Salisbury) in 1972. She took a Higher Diploma in Library, Science by correspondence with the University of South Africa in 1978, and has worked ever since at the Library of the University of Zimbabwe. She has been Medical Librarian since 1985, and has published and presented many papers on her work there. She was appointed Deputy University Librarian in 1994.


In recent decades, throughout sub-Saharan Africa, academics, scientists and researchers have seen the decline of once flourishing institutes and universities as economic conditions worsened, and inflation and devaluation of local currencies exacerbated the chronic shortage of hard currencies. The deficiencies in traditional information sources, arising from economic, geographical and cultural factors, have worsened perceptibly in the past two decades. And while the information explosion in the North is fueled by dramatic developments in information technologies, the South must watch the gap between its own information sources and those available in the industrialized countries grow ever wider. Can that gap be narrowed or even bridged, or will the poorer countries be further marginalized in terms of technology and information access?

Fortunately, in many African countries, the advent of the personal computer has enabled libraries to leapfrog two decades of development in information technology, and move straight into effective and appropriate solutions to some of the problems of information storage and retrieval. Institutions and private companies which had never seen a mainframe or minicomputer began in the mid-1980s to acquire microcomputers - often initially only for word processing, but increasingly for compiling databases and other specific applications.

In Zimbabwe, at the Medical Library of the University of Zimbabwe (UZML), the process began with CD-ROM. This case study will describe how and how that process was set in motion, and its immediate and longer-term effects on the services of the library and on its staff and users.

Zimbabwe has a population of 11 million people, 70 percent of whom are based in the rural areas. Independence from the illegal white minority rule of Ian Smith's Rhodesia was achieved in 1980; by 1990 Zimbabwe's development programs were well advanced, particularly in the fields of education and the health services.

The colonial legacy included a centralized health service, with a concentration of sophisticated curative services for a minority in the urban centers. (See Box 1.) The goal of the new Ministry of Health was to create an extensive network of primary health care outlets in the rural areas, reallocating existing resources to establish new clinics and upgrade general and district hospitals. The success of their policies was seen in a steady improvement in health status indicators during the middle and late 1980s, including maternal and child morbidity and mortality; nutritional status; and expanded immunization programs.

Harare, the capital, is the home of the University of Zimbabwe, established in 1958, which includes the country's only Medical School - added in 1963. As well as the 500 medical students, the Faculty has departments of Nursing Science, Pharmacy and Rehabilitation, and the School is a regional center for postgraduate programs in the medical specialties. The present total of students approaches 1,000, and student intakes continue to grow.

The Medical Library was well planned from the outset, with a good collection of journals and textbooks, and a current awareness service for academics. As the country's only medical library it was in principle accessible to members of the health professions outside the University; but since it was situated in the main University Library on the campus in an outlying suburb, it was little used other than by staff and students of the Faculty. In 1978 the library moved to the spacious premises of the new medical school and teaching hospital close to the city center, where more non-university health workers began to make use of it.

In 1983, following recommendations from a World Health Organization-sponsored workshop in Tanzania, the UZML, as the only major medical library in Zimbabwe, was designated National Focal Point for Health Sciences Information Services, by both the Ministry and the University. An outreach librarian was appointed to deliver services to health workers in provincial and rural hospitals and health centers. In 1984, we carried out a survey of their information needs and priorities.1

Anecdotal evidence from rural health professionals of a dire lack of access to information - an absence of current textbooks and journals, or indeed any considerable hospital library - had prompted the survey, which had a 74 percent response rate; this evidence was emphatically confirmed by the 63 doctors and 10 senior nurses who responded. Their expressed priorities were to have core collections of books and journals at their workplaces, and 90 percent considered the lack of current medical information to be a serious difficulty or disadvantage.

Some of these needs were addressed by a Joint Health Information Committee, which we established with the Ministry of Health for this purpose - core collections of 40 textbooks and 13 manuals were provided by a Scandinavian donor for all hospitals and clinics. Adequate journal collections could not be provided to all hospitals, so we compiled instead a digest of MEDLINE abstracts on Zimbabwe's health issues, Current Health Information Zimbabwe (CHIZ), a free update for all Zimbabwe's health professionals. The abstracts were provided for us by the World Health Organization (WHO) in Geneva, who sent us the monthly MEDLINE printouts produced by the Swiss host Datastar. Datastar ran searches using a profile of Zimbabwe's major health problems, compiled with advice from former district medical officers.

We tried, in the mid- 1980s, to gain access to the online databases of the U.S. National Library of Medicine and to MEDLINE in particular - the index, with abstracts, to over 3,700 of the world's major biomedical journals, with over 8 million records. The obstacles - high and unpredictable costs in scarce foreign currency (for passwords, telecommunications, connect time and printouts) - were too great. A further disincentive were the complex command syntaxes of the databases, and the need for considerable familiarity with the medical terminology.

A less demanding more user-friendly medium was needed to access MEDLINE. In 1988, while visiting a London medical school library, we saw it - in the shape of CD-ROM, in full-color action - a technology based on laser discs that was just then beginning to penetrate European markets. The advantages of CD-ROM were immediately obvious: the powerful laser discs, used in conjunction with an ultra-friendly search engine, mounted in the homely personal computer, bringing international bibliographic databases into the most remote centers - and at a predictable cost. Unlimited online searching and training time, unlimited information retrieval, unlimited access to the almost mythical databases of the world's most advanced scientific institutions - these were suddenly within our reach.

BOX 1 Pre-Independence Health Services

Pre-Independence health services had neglected information support; medical and nursing education were historically centralized, and the only other sources of information and educational material lay in the small collections at the nursing schools. The library at the Ministry was a dusty storeroom piled high with government reports. The achievement of Independence made rapid growth and change possible not only for the health services but for health information too.


In mid-1988, a project proposal went off to the Carnegie Corporation of New York - for the acquisition of CD-ROM equipment with a subscription to the MEDLINE database. The general objective of the project was to improve the health information service at the UZML, with the specific objective of providing users in the Medical School and throughout Zimbabwe with MEDLINE literature searches.

The Medical Library had three professional (graduate) staff, three diplomats, and adequate secretarial and other support staff. The reference librarian had nursing training behind her, as well as her library qualifications. Most of her working hours hitherto were spent scanning the latest journal issues for individuals requiring current awareness updates - a Selective Dissemination of Information (SDI) service. We did not yet know that this task could be reduced to some minutes a month. All of us were excited by the prospect of introducing a computerized service into the Library at last.

Neither I nor any of my colleagues had ever laid hands on a computer. No one in the University Library had computer skills. Many of us were conscious of being left behind while libraries in the North were forging ahead with newer and better computer applications for information storage and retrieval, and library housekeeping systems. Among the major benefits of the project would be the familiarization of library staff with microcomputer technology.

We also counted on providing our own MEDLINE searches for CHIZ, and relieving WHO's Library in Geneva of that expensive burden. We could also revise our search strategy at will without incurring further expense or trouble for WHO.

The response from Carnegie was rapid and positive - we received a discretionary grant for a feasibility study of a MEDLENE on CD-ROM search service. The grant also enabled us to buy a personal computer, the two drives needed to search the current five-year MEDLINE file, and a two-year subscription to the MEDLINE database.


What were our problems, errors, and successes in implementing the three phases of our project?


Our initial choice of hardware was poor. Since we did not even know which questions to ask, we were guided by earlier advice from another donor's program officer, which stressed the importance of securing reliable local (IBM) maintenance. We ordered the smallest cheapest IBM: a PS2 Model 30. We were guided by excessive thrift, rather than by criteria of power and speed, of which we then knew nothing except what we learned from the conflicting advice given by local computer experts. They in turn knew nothing of the rapidly growing exigencies of CD-ROM - an unknown technology in Zimbabwe in 1988.

In reality the Harare private sector offered more than enough microcomputer support to go round; furthermore, a snippet of local lore that we absorbed has proved to be well founded: in Harare's temperate and relatively dust-free climatic conditions microcomputers, even the cheaper IBM clones, generally give little trouble. We rightly did not budget or contract for an expensive maintenance agreement with the local IBM agents - a hefty 10 percent of the equipment's cost per year, the local standard charge. (The high cost of equipment in Africa shocks buyers in the North - the addition of transport and duties almost double prices of any imported goods.)

Instead we allowed in our budget for (lower) maintenance costs and have always spent less than was budgeted on hardware and software problems. A piece of late news: recent extensive building operations next to our library have created a reddish-grey dust - clay and cement - which now thickly coats the edges and insides of our drives. They are giving occasional trouble now.

The pioneer personal computer' within three years of purchase, was unable to process the burgeoning MEDLINE database. We ran out of space on the 20 megabyte hard disk before the end of the first phase of the project - there was barely room for MEDLINE software (13 megabyte) and word processing software, and ultimately everything but MEDLINE had to be deleted. When MEDLINE needed 28 megabytes of disk space and at least one megabyte of RAM, and we found the machine's hard disk and RAM could not be upgraded, it was relegated to word processing use.

Clearly, as novices, we should have sought and found more expert advice outside Zimbabwe before deciding what to buy. (See Box 2.) It was a colleague in New York who discovered that the drives we had ordered were incompatible with the personal computer - just in time to prevent their shipment; it took several months to rectify that error; and when the equipment was all finally assembled, we found that the driver extension software was superseded, so that more weeks passed while we awaited the current version.

Professional advice provided by Carnegie, and first-hand experience, helped us in making better decisions on equipment in later phases of the project. Four years later, for instance, we were encouraged by a local supplier - and were very tempted - to network existing and new personal computers so that all workstations in the library could access all CD-ROMs. We learned, though, that not only would the proprietary networking costs of our database vendors have been beyond our long-term means, but also the absence of expertise in the library system needed to maintain the network would have left me with that responsibility. We knew that neither I nor my colleagues could muster the time or skills needed.

As time passed our local suppliers learned much more about CD-ROM; we too learned, as personal computers became cheaper, faster and more powerful in terms of clock speed, disk and memory size, that we needed to allow for rapid growth in the number and size of databases, for much more RAM, for Windows software for the databases which would' before long, be available only in Windows; for anti-virus packages to check the diskettes on which our users increasingly needed to download their search results.

Our initial choice of a vendor for the MEDLINE database (from a product range of eight competing companies) was based on advice from a large medical library in Milwaukee, which had closely examined all the options, and on journal articles which rigorously evaluated the search features of the different versions. Our chosen vendor, Ovid Technologies (formerly CD Plus), has prospered, multiplied and improved its products, and supported us with discounts. CD Plus responded, though not always promptly, to the software difficulties that arose from time to time as new features were developed. We learned to correct some of them by the simple expedient of reinstalling the software. Other software failures needed input from our suppliers. The only personal computer in which we failed to install the recent much larger DOS version of Ovid's MEDLINE is an IBM PS2 Model 70; it accepts only the Windows version of MEDLINE.

BOX 2 Relative Speed of Equipment

When, before ordering, I contacted the MEDLINE vendors in New York to ask whether our choice of equipment was appropriate for their database software, they said it would be fine, but warned that its performance would be a bit sluggish. l responded, quite seriously, that was just fine, since we too were sluggish .... It turned out that we could go off and brew tea during some of the lengthier search processes, and still find the search in progress on our return.


Our greatest frustrations came from the delays that held up the first phase by one year. There were delays in obtaining the correct drives and software; it took more time to cajole duty free certificates and import permits from the State's then ponderous bureaucratic machinery. The wasted year, 1988-1989, nonetheless saw a degree of progress in STI at UZML. We learned word processing on the personal computer, which was delivered within only a few months. Once the library had at least one functioning workstation (and by the second phase of support we had three) and could keep our search service going, we could tolerate subsequent delays. The cliff-hanging saga of the supplier who held us up in the third phase of the project by converting funds for equipment to his own use must be documented elsewhere; he delivered our goods in the end, but a year later than planned.


What have CD-ROM technology and the microcomputer - the availability of in-house biomedical and health databases - brought to the library, to the Medical School, its staff and students, and to the country's health workers? Who uses MEDLINE most? Why do they want MEDLINE searches? The data gathered from our search request forms give some answers.

Numbers of MEDLINE Searches Made

The average number of searches rose from 80 searches per month (1989-1990) to 450 per month in 1995 (November). (See Figure 1.) In March 1995 a record 700 individual searches and monthly updates (SDIs) were recorded.

Figure 1: Monthly average of CD-ROM searches conducted, January 1990 to November 1995

Categories of Search Requesters

Undergraduate and postgraduate students represented 36 percent and 15 percent, respectively, of all searchers in a 6-month sample of 1,660 search request forms in 1994. (The 58 monthly SDIs that are automatically generated as updates for individuals were not categorized.) Other searchers were academic staff, nonacademic staff, or government workers, or from NGOs, parastatals, or the private sector. (See Figure 2.)

Figure 2: MEDLINE searches by user categories.

Purpose of Searches

In the same six-month period, research and assignments (in which there may be overlap) accounted for 41 percent and 13 percent, respectively; teaching 4 percent; updates and SDIs 20 percent; patient care 8 percent; publications 2 percent; in 12 percent no purpose was given. (n = 2008 searches including SDIs.)

Survey on the Use of MEDLINE and Its Abstracts

In March 1995 we carried out a survey on the use of MEDLINE by staff and students of the Medical Faculty. A questionnaire sent to 252 staff and undergraduates sought to gain information on:
· numbers of MEDLINE users and non-users;· frequency of use;· the value of searches and of abstracts;· the number of end users and the need for training in end user searching; and· reasons for non-use of MEDLINE.

We had a response rate of 50 percent (n = 252). Of 122 academic staff to whom we sent questionnaires, 49 responded. Of the 130 final-year students to whom we sent questionnaires, 67 responded. Of the total 126 respondents, 119 used MEDLINE and only seven had never used MEDLINE. (See Table 1.)

We can surmise that those who have used MEDLINE are much more likely to respond to a questionnaire on its use than those who have not used it; thus a much greater proportion of the 50 percent who did not respond may have been non-users. The reasons given by respondents who had never used the service were lack of knowledge about it and lack of time to use it. Additional survey results are given in Tables 2-5.

TABLE 1 MEDLINE Users/Non-users





(n = 54) 92%

(n = 65) 97%

MEDLINE Non-users

(n= 5) 8%

(n = 2) 3%

TABLE 2 Frequency of Use of MEDLINE

Use of MEDLINE per month

(n = 114)


Use it oflen (5 times or more)



Use it regularly (2-3 times)



Use it occasionally (once)



Use it rarely (less than once)



TABLE 3 Value of Search Results

Search results satisfactory

(n = 117)














TABLE 4 Usefulness of Abstracts

Abstracts as a source of information

(n = 116)


Very useful



Moderately useful



Not useful



TABLE 5 Completeness of Information in Abstracts

Abstracts provide information complete in itself:

(n= 117)














Training in MEDLINE Searching

The library has periodically offered training in MEDLINE searching to users: 49 percent of respondents had received some training. Most of these were students: only 17 (31 percent) academic staff had received training.

The survey showed that most staff and students did searches assisted by a librarian; only 25 percent of respondents (n = 29) were able or willing to do their own searches, although half had received some training. Training was thus deficient in some way for half the participants. Ninety percent (n = 87) were interested in receiving training from library staff and/or the MEDLINE tutorial program.

It is important that we enable more end users to make searches independently of library staff. Because few of our staff have a strong grasp of medical terminology we are concerned that the quality of more complex searches may be uneven. The more end users with search skills, the higher the potential relevance of search results, and the more staff time saved.

Availability of Full-text Articles

MEDLINE citations carry a note if the journal cited is held by our library, and most users reported making some effort, sometimes, to locate such journal articles. But less than half of our users attempt to obtain articles through the Library's Inter-Library Loans (ILL) service. There had been a boom in ILL requests, almost matching the growth in the numbers of searches, from 1990 to mid-1994. The service then declined sharply when ILL funds ran out.

Users have little confidence in the library's runs of journals, which are broken by frequent temporary or permanent stoppages of subscriptions; they are unwilling, too, to depend on the unreliable and very slow ILL service. When its funds run out we are dependent on the goodwill of two or three South African libraries, which cannot, of course, meet all our needs. In response to the library's attempts to improve ILL services, the University has recently approved, in principle, the introduction of realistic (almost full cost-recovery) charges, as opposed to highly subsidized minimal charges for ILL documents. While students will continue to be subsidized to some extent, researchers (academic staff) will be expected to pay for ILL services.

Immediate and Long-term Outcomes of the Service: Products and Spinoffs


MEDLINE now produces over 380 individual searches each month, as well as 58 monthly updates for individual researchers and clinicians; it also produces the monthly printouts of abstracts for our national digest Current Health Information Zimbabwe (CHIZ).

Journal selection

CD-ROM (used with the bibliographic database management program Papyrus) enables us to use MEDLINE in bibliometric studies to identify those journals which most frequently publish articles of relevance to Zimbabwe's health problems - the citations selected for CHIZ and those selected for printing out by our users. The most frequently cited titles are included in a revised core collection of most-needed journal titles.

The Bradford's Law of Scatter (illustrated in many studies including one at the National Library of Medicine, where it was found that only 300 titles of its 22,000 periodicals satisfied 70 percent of all requests reinforces the benefits of accessing journals through a document delivery service, rather than "owning" expensive subscriptions to little-used journals. The "ownership versus access" algorithm we have developed4 can be brought to bear on the selection process now that lists of most frequently cited titles can be built on objective criteria rather than relying solely on manual analyses of inter-library loans, or on the possibly idiosyncratic or unrepresentative demands of often transient specialists and other academics.


The survey demonstrates the dissatisfaction of users with our journal collection and inter-library loans service, and a considerable - and certainly lamentable - dependence on abstracts rather than on full-text articles, with 73 percent "usually" or "sometimes" making do with abstracts alone. How valuable can abstracts be, how complete the information they contain? No clinician, researcher, or librarian would advocate total dependence on abstracts. Many of them do not accurately reflect the main findings or conclusions of their full papers, and rarely (except in terms of the unassailable reputation of the source publication) enable a critical evaluation of a paper's real worth in terms of methodology and other criteria. A recent study on the reliability of reviews of abstracts for scientific meetings found that reviewers disagreed substantially when evaluating the same abstracts and that structured review criteria were needed.5 The proportion of structured abstracts in the medical literature is increasing, however, and enhances the value and usefulness of bibliographic databases. (See Box 3.)

Outcomes for health professionals, patients?

While published data demonstrate the impact of MEDLINE on patient outcomes in the USA6,7,8 we are not able in Zimbabwe to quantify what the direct and indirect benefits of CD-ROM databases and their abstracts are, in terms of improved efficacy of health professionals, or improved health status indicators, for instance. There were considerable gains in the health status indicators of Zimbabwe's people after the country won its Independence in 1980, but these are now being rapidly eroded by the combined effects of the AIDS pandemic, and of the economic structural adjustment programs being implemented in recent years in many African countries.

In a 1993 snap survey of opinions of senior academic staff on MEDLINE's effects the following were among their comments: "its comprehensiveness and currency [make it] revolutionary"; "it makes life so easy . . . very helpful for research and teaching"; "it plays a very important role in teaching Med students enabling them to keep up with the latest information . . . is invaluable for their clinical presentations"; "it helps me keep up with appropriate management of clinical problems"; "it is indispensable for research protocols and write ups of research projects"; "in the recent meningitis epidemic it provided essential epidemiological and serotyping data for appropriate measures for prevention, control and management"; "it plays a major role for me as a consultant teaching juniors."

Some examples (from the 1995 survey) of respondents' reactions to a question on the effects on their work of NOT having access to MEDLINE: "dramatic - my research and teaching capability would collapse without it"; one urologist declared he "would scream"; others spoke of "catastrophic", "devastating" and "drastic" effects, and "the end of the road."

BOX 3 The Importance of Abstracts

We have learned anecdotally too that our users find that abstracts can and do provide critical information in a crisis - our Drug and Toxicology Information Service, for example, inevitably has to rely on abstracts in emergencies. Abstracts inform policy and assist planning. They have had to satisfy our users for information on management of diseases and poisoning cases for decisions on drug prescribing and dosages, for literature reviews, for preparing lectures, for updating practical knowledge and skills - because the back-up of full texts is not available quickly enough. It may be deplorable but it is also true that in many contexts, including our own, the back-up texts will never be available, or will arrive too late. It must be recognized that in the poorer countries of the world an abstract is likely to be all the reader will ever see of journal articles.

Promotion of the CD-ROM Literature Search Service

We promoted the service initially only to Medical School staff and not to students, anticipating an unmanageable demand on our single workstation. Only two members of staff (out of over 100 in 21 departments to whose chairmen we sent promotional circulars) appeared at our MEDLINE open day. We assume that initially news of MEDLINE and POPLINE spread largely by word of mouth, since there was a steady increase in use after the first few weeks.

After a formal presentation of the first workstation, involving the United States Information Service (USIS), the small paragraph on the event which appeared in the daily paper showed a total lack of understanding of the technology on the part of the reporter. Our handout about CD-ROM was beyond his comprehension - we realized how important it is to recognize the impenetrability of new technologies to those who have no experience of them, and to learn how to communicate their capabilities in the simplest possible way.

We reinforced our initial low-key circulars and notices only when we had acquired two more workstations in the second phase of the project, by promotional demonstrations of MEDLINE (using a Datashow projector we acquired in the second phase of the project) at professional meetings of interest groups (such as pharmacists, physiotherapists, primary care physicians). To provide these demonstrations our reference librarian, with help sometimes from me or another colleague, had to load her car with a personal computer, four drives and a printer, drive to the meeting venue and reassemble the workstation there - a considerable undertaking. From follow-up visits and search requests from those sectors we knew the demonstrations made an impact - seeing is believing. (Recently staff in our Main Library took CD-ROM to individual faculties, and they too found that an immediate increase in use of the databases resulted.)

Demonstrations of CD-ROM searches get the most attention in our library orientation sessions for students; post-graduate students are given a longer introduction than undergraduates, and are strongly encouraged to read database tutorials and take the training which is always available from our staff. However, offers to academic staff and students of training for individuals or small groups have had little response thus far. The lack of interest in our offers of training is not surprising - very few students and staff have had the opportunity to acquire computer skills, and most still have no access to any computer other than ours. They will have to start by learning basic computer skills, and only then attempt to use the (relatively user-friendly) interface software.

Training is more likely to be accepted if it is informally given, by way of explanations to a search requestor as he helps a librarian make his search. Our understanding of the problem of low uptake of training is that, unless users practice and enlarge on newly acquired search skills on a regular basis, they forget them between visits and have to start again. Many of our users have very little spare time for acquiring new skills outside their daily work schedule.

The Medical School is constructing a new Health Sciences building and plans to incorporate considerable computer-aided learning facilities in the building. Easy access to computers will then no longer be limited to the library's CD-ROM facilities.

BOX 4 The African Index Medicus Project

Our database, Utano (the Shona word for Health), provides records for us to contribute to Who's recent database initiative, the African Index Medicus (AIM). The innovative AIM project assembles (at WHO headquarters in Brazzaville) abstracts of mainly unpublished "grey', literature collected from a growing number of African countries. WHO produces and circulates regular printed updates to libraries in Africa, and to subscribers in African institutes throughout the United States and Europe.

Other Uses of Microcomputers in the Medical Library

A database of local health literature

This project to create and compile a database of local unpublished health literature was funded by IDRC and implemented in 1991-1992, concurrently with our expanding CD-ROM service. (See Box 4.) The contract staff, the training in database use (UNESCO's Micro CDS/ISIS) and the hardware brought to the library by the project reinforced our understanding and appreciation of the potential and value of computerization, and has since offered continuing opportunities to all our professional staff to widen their computer skills. The database, after the expiry of the contracts of project staff, has continued its slow but steady growth, as two of our staff members gradually master the complexities of the ISIS software.

Email: local and international access to information

Email now enables health workers outside the capital to get access to MEDLINE searches and other material from the Harare library and beyond. In our third year of reliable email access, we now operate through Zimbabwe's upgraded telephone system, through SatelLife's local HealthNet node in Harare, which links us with other major international email networks as well as with the HealthNet users in provincial medical directorates and many of the district offices. The number of MEDLINE search requests emailed to our outreach librarian from the provinces doubled last year. We download and return search results to users by email, and can at last scan and email photocopies of articles in the library instead of mailing photocopies (which may take a week to deliver). The main limiting factor in the use of email is the still small number of health professionals with easy access to and familiarity with personal computers; but the time taken to scan and run an Optical Character Recognition program against the copy is also something of a deterrent.

Moves to bring us online into the Internet may bear fruit in the next year or two. Meanwhile email and the Grateful Med search interface give us easy and low-cost access to the MEDLARS databases of the National Library of Medicine, through the BITNIS program,9 which enables a turn-around time of 24-48 hours. The costs of our email services are modest: each of our two stations costs about $7.00 per month, less than the cost of one five-page fax.

The impact of microcomputer technologies on library staff

Many libraries in Africa, including our own, have become shelters for dwindling and aging printed resources. The effects on library staff of acquiring computer skills and delivering computerized and very current information are all the more positive in this context. The image of traditionally low-status professionals has been subtly but unquestionably enhanced by their new capabilities - doctors and nurses now request appointments for searches with library staff. . . who have something valuable to offer at last. This empowerment of librarians increases their morale at a time when economic forces have a contrary effect on the work force; computers make the job more fun for the majority of staff who enthusiastically embrace the new technologies.

The growing use of personal computers in our library imposes on us the need to re-examine our management structure; lines of authority have to be redefined. There is need for greater flexibility in job descriptions and responsibilities, need for recognition and monitoring by senior management of any radical increases or reductions in workloads brought about by automation, need for rewarding exceptional skills and providing opportunities for the development of those skills to those who show aptitude. If sustained progress in use of the new technologies is to be made, the old rigid and hierarchical structures of libraries must bend and expand to allow for new patterns and areas of growth. The application of performance indicators to services and processes is one obvious method of planning and managing the changes which automation inevitably brings in its wake.


Unquestionably CD-ROM databases, MEDLINE in particular, have brought about a radical change in the information seeking behavior of our users: unprecedented rapid and easy access to current and archival journal literature; and an increased awareness and documented increased use of the journal literature. We believe, however, that the most significant and valuable outcome of this service has been the growing awareness in its users of a range, literally a world of other

wise unknown information sources. It has been by far the greatest force for progress in information access that our users have experienced.

However, while the advent of CD-ROM has been a dramatic success in our library, and while email is the cheapest known method' pro rata, for the speedy transmission of data, there are funding and technical issues that cannot be ignored. We have learned - painlessly so far, thanks to the generosity and flexibility of our donors - that one-time set-up costs are not a reality.

Planners must face and meet the costs of maintaining and updating expensive hardware to keep pace with changes in database sizes and interfaces; they must have access to expert and unbiased information on the new technologies to avoid costly mistakes in purchasing inappropriate equipment. They must allow for the relentless growth of RAM requirements; the need for multiple workstations when multiple users want access to databases; the need for the more expensive laser printers when printing out images from full-text CD-ROMs or other electronic sources such as World Wide Web. The Internet has come to neighboring countries and is likely to reach us too before very long, with further implications for hardware, training and other costs. Growth and development in the technologies are inevitable and expensive. Institutional support and involvement become increasingly vital if the technologies are to survive and prosper in the long term in Africa.

The lack of concern of institutional planners for information supply may be attributable to negative experiences and low expectations in the libraries they have known, as much as to the failure of educational systems to include information retrieval skills in their curricula. We expect MEDLINE to break that cycle in Zimbabwe, by sensitizing students - the planners of the future - to the existence of vast and formerly unknown resources. The cost of introducing and maintaining a MEDLINE search service, represented as a proportion of the budget of a Medical School or a Health Ministry, would be insignificant. That cost calculated as a percentage of the salary of each health professional in government service would be negligible; its cost effectiveness in terms of the development of human resources and services would be obvious.

Our survey, made after five years of use of MEDLINE, shows that this database has become essential to the work of many of our academic staff: eighty per cent of respondents stated that they would elect that the library cancel ten journal subscriptions rather than the MEDLINE subscription. We are likely to have to make just such a substitute in the near future. As a first step it is essential to expose present and future generations of planners, teachers and practitioners to these databases. The fact that the library has been able to offer four or five workstations providing MEDLINE and other databases to all comers has meant quick, easy, and free access to vast quantities of medical literature, which would otherwise be inaccessible.


We have realized to a considerable extent the potential of CD-ROM technology at the UZML. The primary effects of the medium have been a vastly increased access to and use of current health information sources, whether in the form of abstracts or full-text journal articles or segments from constantly updated textbooks; and along with this increase there have been very significant changes in the information seeking behavior of large proportions of academic staff and students in the Medical Faculty and of health professionals in government service and the private sector. There is evidence elsewhere, and we must to a great extent assume, that the increased use of the literature and the resulting increased knowledge base of health professionals must produce the secondary and most important benefits of improved health services in general and better patient care in particular.

Our experiences in providing CD-ROM literature search services suggest that increased and more effective use would be made of the databases, and of other computer technologies such as email and eventually the Internet, if more of our present and potential users had been previously exposed to computers, or had some computer training. Economic circumstances in Zimbabwe have hitherto prevented all but the most privileged sections of our present and potential user community from owning or having easy access to computers. However, the rate of growth in the computer industry, and growing awareness among members of the health care community of the immeasurable benefits of personal computers - to which our project has made a major contribution - suggest that a critical mass of computer users will have been reached in the longer term.

Once this critical mass has been achieved, the question of sustainability will cease to be such a worrisome issue. Institutions, health services, and individuals will have their own strong motivation to supply the material and human resources necessary to exploit and develop the new technologies.


1. Patrikios, H.M. (1985) Socio-economic changes in developing countries: the concern of the medical librarian? In: Medical Libraries, One World: Resources, Cooperation,Services. Proceedings of the Fifth International Congress on Medical Librarianship. Tokyo: Keio University Medical Library.

2. Patrikios, M.M. (1995) Effects of MEDLINE abstracts on information use in an African medical Library. Paper presented at 7th International Congress on Medical Librarianship: Health Information for the Global Village, Washington, D.C.

3. Warren, K. (1987) The evolution of selective biomedical libraries and their use in the developing world. Journal of the American Medical Association 257(19):2628-9.

4. Patrikios, H.M. (1994, 1996) A minimal acquisitions policy for journals at the University of Zimbabwe Medical Library. In: Survival strategies in African university libraries. American Association for the Advancement of Science.

5. Rubin, H.R. et al. (1993) How reliable is peer review of scientific abstracts? Looking back at the 1991 Annual Meeting of the Society of General Internal Medicine. Journal of General Internal Medicine 8(5)255-8.

6. Lindberg, D.A., et al (1993) Use of MEDLINE by physicians for clinical problem solving. Journal of the American Medical Association 269(24):3129.

7. Wilson, S.R., et al. ( 1989) Use of the Critical Incident Technique to evaluate the impact of MEDLINE: Final report. Palo Alto, CA: American Institutes for Research.

8. Klein, M.S. et al. ( 1994) Effect of on-line literature searching on length of stay and patient care costs. Academic Medicine 69(6)489-95.

9. Search costs are currently being funded by SatelLife, Cambridge, Massachusetts.

10. Patrikios, H.M. ( 1993) A minimal acquisitions policy for journals at the University of Zimbabwe Medical Library. In: Survival Strategies in African University Libraries: New Technologies in the Service of Information. American Association for the Advancement of Science, Washington, D.C., p. 96.

Background Summary: The African Index Medicus (AIM) Project

The need for improved access to bibliographic and other information related to health issues of African countries has long been felt by researchers, development agents, health administrators, and planners both inside and outside the continent. Very few African health and biomedical information sources are included in the world's leading bibliographic databases. Thus, access to information on health and medical research in the region is inadequate and, unless researchers publish in non-African journals, their work may be overlooked or duplicated. Further, there is a wealth of untapped information in books, reports and studies from international development agencies, non-governmental organizations and local institutions.

The African Index Medicus (AIM) was initiated by the Association for Health Information and Libraries in Africa (AHILA) to provide improved access to health information published in or related to Africa. At its consultative meeting in January 1993, in Accra, Ghana, AHILA members made decisions regarding contents, standard data-input format, methods of exchange of database records, and training needs. Participants at this meeting included AHILA committee members, potential pilot-site librarians from Ghana, Kenya, Nigeria, Zambia, and Zimbabwe, and technical support staff from the World Health Organization. With sponsorship from the Health Foundation (New York), WHO has recently completed training of librarians in Cameroon, Ethiopia, Ghana, Kenya, Nigeria, Tanzania, and Uganda.

With technical assistance from the World Health Organization (WHO) and support in the form of training and equipment from the Health Foundation and other agencies, the project is steadily growing with the motivation and hard work of the African health librarians. Indeed, Regina Shakakata, one of the contributors to AIM, calls the project "the pride of Africa because it developed with the efforts of AHILA members." Ms. Shakakata says that, in Zambia, the AIM project means that the local literature created by health professionals is indexed and disseminated widely using the printed media intra-nationally and the Internet gophers internationally. As a spin-off-service, her Medical Library collects the full text articles of the indexed items and integrates them into the University of Zambia Medical Library collection.

The project is a decentralized one that gives participating institutions greater bibliographic control of their national health information materials. Databases of bibliographic records of local health materials are created at the national level, using CDS-ISIS software. They are then merged with records relating to health in Africa emanating from other international databases, such as WHO's WHOLIS, POPLINE, and others. The bibliographic database is only one of the components of the project. AIM also intends to create files on health-related research, health information experts, and health information resources and services. Seven issues of AIM have appeared. Input centers are in anglophone and lusophone countries and francophone countries have been encouraged to join in the project.

A sample file from the database is available on the Internet from the WHO gopher ( in order to give visibility to the project in developed countries. Through increased visibility, WHO and the AIM participants hope to garner support for AHILA's efforts by encouraging people and institutions to become affiliated members in order to receive the latest print version of AIM. AHILA's existence depends on its membership. Many of the AIM participants have pointed out the difficulty of getting such a project off the ground with little or no funding. They encourage other African countries to join the AIM project and welcome partnerships with bilateral agencies and others interested in this unique grassroots, south-south project.

The success of the African Index Medicus Project is due, in large part, to the efforts of Dr. Deborah Avriel, who joined WHO in 1984 and was Chief Librarian from 1987 until her death in June 1995. Dr. Avriel's global vision consistently emphasized the importance of library and information services for health professionals in the developing world. Her enthusiasm and commitment to the cause of health information in the poorer countries motivated and encouraged her colleagues even at a distance. As a vocal supporter and untiring friend of Africa, she gave vigorous backing to the launching of the AIM Project.

Communications for Better Health Project in Zambia

by Regina Shakokata

Regina Shakokata is Medical Librarian at the University of Zambia Medical Library. She is Coordinator for the Communications for Better Health project and the National Coordinator for Healthnet. She has managed the Medical Library since 1986.


Zambia has an area of 752,600 square kilometers and a population of 8.09 million people ( 1990 census). It has a national average density of 10.8 per square kilometer. Children under 15 years and women of child bearing age (15-49) constitute almost 75 percent of the population in any given year.

The country has a fairly good health service infrastructure and a reasonable cadre of health professionals, at least by standards of the developing world. The health system is heavily biased in favor of curative services rather than in preventive medicine and, even then, it favors urban population over rural populations.

Health resources and status are influenced by the economic development of the country. The consequences of the economic crisis in Zambia include among others the following:
· Erosion of the health infrastructure;· A decline in the quantity and quality of access to health services;· An increase in the cases of malnutrition;· An inadequate supply of drugs; · An unsatisfactory rate of infant mortality;· Poor staff morale due to unfavorable working conditions; and· The neglect of health information provision in national programs.

The University of Zambia (UNZA)

The link between the University of Zambia and the Ministry of Health (MOM) is the School of Medicine. When the School of Medicine was established in 1970, it had a book collection which was housed at the then Oppenheimer College of Social Services. The years that followed the establishment of the Medical Library saw a steady growth of health information at the library, with a book stock of 25,000 volumes of books and 781 periodical titles on the current subscriptions list in 1985 (Stock-taking report, 1985). Although the proportion of the books and periodicals budget which was given to the Medical Library was not rationally divided, the Medical Library was able to purchase all the recommended books and to pay for the periodicals on the current subscriptions list in any given year. (See Box 1.)

The Medical Library collection was supplemented by generous donations from friends of the University of Zambia, mainly from abroad and through gifts and exchange programs within and outside Africa. The only technology that was available at the Medical library was an audio/visual collection, which was composed of slides, microfiche, microfilm, filmstrips, reel-to-reel tapes, and texts. This collection was not easily accessible because the library did not have, and still does not have, the hardware with which to view the collection. The collection was and is still only usable with the help of the equipment from the UNZA Medical Illustrations Unit of the School of Medicine.

The Medical library struggled to survive through all the economic turmoil that Zambia faced from 1985 to 1990. Health information provision at the Medical Library suffered much since 1985. The last regular subscriptions to periodicals was in 1984. The book budgets were last fulfilled at about the same time. There was near total dependency on donor support to acquire current health literature. The World Health Organization (WHO) played a major role to sustain subscriptions to critical journal titles in the Medical Library. Initially, the total number of periodicals subscribed to by WHO was 50, which was reduced to 15 in 1987 and which has remained at that level to date. The book collections were slowly becoming redundant as new acquisitions diminished in number year after year. The academic and research programs were dependent upon the ingenuity of the medical librarians and the goodwill of their partners outside the country. The host institution did not have the funding required to support the library services.

In this situation of real information poverty, genuine financial support was sought to try and alleviate or reduce the lack of information to less destructive levels. It was not possible to seek assistance in-country because the entire nation existed in an information poverty trap. Neighboring states were in no better situation either, except in the case of the University of Zimbabwe Medical Library, which survived the scourge of the rash economies of developing countries due to late independence.

The Carnegie Corporation of New York, the International Development Research Centre of Canada (IDRC), the Commonwealth of Learning, WHO, the Ford Foundation, and others have, at one time or another, sponsored meetings that brought together African medical librarians and persons working in the area of science and technology information systems and communication technologies to discuss access to information and other professional developments. Other groups also provided expert assistance and moral support. These include the American Association for the Advancement of Science (AAAS), The Health Foundation of New York (THF), SatelLife of Cambridge, Office of International Affairs of the U.S. National Research Council, and the African Regional Centre for Technology (ARCT). Most important of all resources, however, are the individuals and groups of people who initiated moves to organize these meetings.

Zambia, like any other developing country, has no time to walk - it must run to keep up with the developments of industrialized countries in all fields. In health information provision in particular, the need to focus on the 1978 Declaration of Alma Alta, which stated that primary health care was the key to attaining health-for-all and the recognition that health-for-all could not be attained without a well coordinated health information system, became critical to Zambia's aspirations to improve health information provision.

BOX 1 The UNZA Medical Library

The economic conditions that prevailed in the country due to extensive mining activities at the time of the inception of the Medical Library made it possible for the UNZA to be very well supported financially. The UNZA in turn gave 5 percent of its budget to the UNZA Library. As the local book industry was not developed and is still not developed, all required medical books and periodicals were obtained from either the United Kingdom or the United States, with less than 5 percent coming from Africa and other parts of the world (annual reports, 1970-1985).


The AHILA conferences (see Box 2) provided the platform for Zambia to review its performance in the provision of health information. The result was that when the first partners offered to help to solve the problems, the Medical Library took the opportunity and worked to use the resources that were extended to it to increase health information provision. There have been six major developments since 1991 offering solutions aimed at getting Zambia out of the information poverty trap:

· Installation of a HealthNet ground station at the UNZA Computer Centre in April 1991 by SatelLife and the subsequent installation of a Fidonet email point at the Medical Library.
· Installation of the CD-ROM technology by the Health Foundation in 1992.
· Establishment of a Zambia national and Africa regional African Index Medicus (AIM) data base in 1993.
· Initiation of a quarterly publication called the Zambia Health Information Digest (ZHID).
· Installation of an Internet connection at the UNZA Computer Centre and the subsequent installation of an Internet point at the Medical Library in January 1995.
· Formation of a National Aids Resource Centre (NARC) in February 1995 ( see Box 4).

All the initiatives tell one story: that Zambia wanted to solve her health information poverty problems which dated back to the 1964 pre-independence era. While I have been involved in some way in all of these initiatives and while I see them as very synergistic, for the purpose of this case study I will focus on the Communications for Better Health program, which encompasses the CD-ROM and the ZHID projects.

One initiative listed above' the African Index Medicus, is important to both me and Helga Patrikios and it has been described in detail on page 45 of this volume. Another initiative, that of bringing Internet connectivity to Zambia, is covered in detail in Neil Robinson's case study on page 191 of this volume.

BOX 2 The Value of Professional Associations

In certain instances, limitations to accessing health information from neighboring countries were caused by uncompromising political policies that were put in place by the nation towards the pre-independent Zimbabwe and South Africa. What were solvable health information problems became entangled in factors beyond the librarians' boundaries. This situation could easily have lead to professional skills redundancy had it not been checked by the existence of professional meetings at Africa regional level under the Association for Health Information and Libraries in Africa (AHILA) and the Medical Library Association (MLA).


CD-ROM Databases

In 1992, we made major progress in the delivery of health information by installing CD-ROM technologies. The library received a total of 12 CD-ROM databases from THF and AAAS, some of which have full text articles, on such subjects as AIDS. One CD-ROM database, called Popline, is a donation from the John Hopkins University, whereas the Infectious Diseases database was installed by the CAB International. The usage of the databases is illustrated in Tables I and 2.

Please note that even though the AIM and Infectious Diseases databases are not CD-ROM databases, their statistics have been included because they are searchable databases. The Popline database was first received after the first quarter of 1995, hence the low statistics. The statistics on the Infectious Diseases database were lower than expected because the contents of the database overlapped with those of the databases that have existed longer in the Library. The database comes with coupons for full text articles donated by the CAB International. Some of the databases were a one-time donation, whereas those that continued to be received periodically were MEDLINE, Popline and AIDS. We update the AIM database regularly.

The University of Florida Health Sciences Center Library continued to provide photocopies of full text articles. Tables 4-8 provide some statistics of the reprints that have been provided with help from THF since the project started in 1992. The statistics are disaggregated by type of request, subject, distribution by numbers, distribution by percentage, distribution by geographical location, and method of distribution. The total number of reprints received by the Medical Library by April 1995 was 1,172. Another 234 reprints were received in May 1995, bringing the total to 1,406 reprints. In terms of distribution of reprints' there were times when they were distributed multiple times, thereby pushing the statistics high.

TABLE 1 Literature Search Statistics (1994)


Yearly Total



British Medical Journal




New England Journal of Medicine






Morbidity and Mortality Weekly Report


Viral Hepatitis


Year Books


American Journal of Public Health


Family Physician






TABLE 2 Literature Search Statistics (January-June 1995)


6 Months Statistics



British Medical Journal




New England Journal of Medicine






Morbidity and Mortality Weekly Report


Viral Hepatitis


Year Books


American Journal of Public Health


Family Physician






Infectious Diseases


TABLE 3 Categories of Reprints for Medical Library (September 1992-April 1995)

Category of Reprints

Number of Reprints

Topic requests from UNZA Med. Lib.


Special requests from UNZA Med. Lib.


Clinical information file, UNZA Med. Lib.


TABLE 4 Reprints by Broad Subject Category


Number of Reprints

















Maternal & child health/nutrition








Sexually transmitted diseases






TABLE 5 Distribution of Reprints

User category

Number of Reprints

University of Zambia


University Teaching Hospital


Health practitioners


TABLE 6 Percentage Distribution of Reprints

User category

Percentage distribution

University of Zambia


University Teaching Hospital


Health practitioners


TABLE 7 Health Practitioners Distribution of Reprints

Geographical location

Number of reprints

Within Lusaka


Outside Lusaka


TABLE 8 Method of Reprint Distribution outside of Lusaka


Number of reprints





The email provided an avenue to request and transmit literature search requests. Furthermore, both the email and post were used to distribute reprints to users outside Lusaka. Our vision is to provide access to the CD-ROM databases to health care workers outside the university by using a leased line. The greatest need for this service is at the periphery health facilities and yet most, if not all, of the databases cannot be networked over a wide area because of the copyright rules that govern them. Serious thought should be given to waiving some copyright regulations to third world countries if information is to be shared equally among all health care workers.

Zambia Health Information Digest (ZHID)

The ZHID is a creation of the Medical Library and the Ministry of Health (MOH), with a grant from THF and IBM International Foundation. It is an offspring of the CD-ROM technology component of the Communications for Better Health Project. The first issue was launched on 1 February 1995 at a ceremony held at the Medical Library. Its contents include appropriate and relevant health information designed for all levels of health care workers (presented in the form of abstracts culled from the Ovid MEDLINE and AIM databases), articles on the management of common medical conditions, feature articles on other medical conditions, and institutional profiles.

The digest is produced quarterly and circulated to 1200 health facilities and institutions throughout the country. The MOH plays an important role in the distribution of the digest. The digest is also distributed on the Internet using the ZAMNET gopher. It is our intention to distribute it locally using the local Fidonet email system as well. The launching issue of the digest attracted positive comments from the local readers and from as far away places as Brazzaville, Columbia University and Geneva. The hardware on which the digest is being produced came from a cooperative grant between THF and IBM International Foundation. The launching attracted dignitaries from Zambia, the United States, the Republic of South Africa and received positive media attention.

The University of Florida Health Sciences Center Library provides full text articles of the Ovid MEDLINE abstracts that are included in each issue of the digest. The provision of the full text articles by the University of Florida is a continuation of the aid which is being given to the UNZA Medical Library.

The CD-ROM project did not start in a vacuum rather, it built upon the HealthNet project that had just been introduced to the UNZA Medical Library. Part of the technology (a 286 Olystar Computer) had already been installed by SatelLife. THF added on a CD-ROM player, providing one work station for CD-ROM activities. This took place in July, 1992. The pressure on the one computer, which was used for both email and CD-ROM activities, mounted as more and more people became aware of the improved health information services being provided by the UNZA Medical Library.

Efforts to get more equipment from donors met with some hitches as we failed to provide convincing justification for the acquisition of additional equipment. This did not surprise us because statistics maintenance was poor at that time. After a lengthy two years of negotiating with donors, THF working in collaboration with the IBM International Foundation, donated two 486 IBM file servers, each with a 540 megabyte hard disk; one laser printer; one dot matrix printer and color monitors.

With the availability of this equipment, we ventured into publishing the ZHID. This project went on smoothly because all that was required to be done was a few lessons in the use of Wordperfect 6.0 and how to use the graphics, both programs that we had acquired with the arrival of the file servers. The project proved a great success and is still running strong. The cooperation from the Ministry of Heath, THF, and the IBM International Foundation motivated us to such an extent that we aimed to do everything as correctly as possible.


The reaction of the clientele to both the CD-ROM and the ZHID projects was amazing. Initially the Library staff took advantage of the visit of Dr. Leonard Rhine, Medical Librarian at the University of Florida Health Sciences Center Library1, to market the CD-ROM services. In October 1992, he conducted three half-day seminars on Automated literature searching at the Library. The participants in the seminars were drawn from among medical students, the University Teaching Hospital (UTH) health care workers, and research and teaching staff from both the School of Medicine and the University's Great East Campus. The UNZA Medical Library and Main Library staff were also active participants in the seminars.

The publicity leaflets for the seminars were put up before the arrival of Dr. Rhine. From that time onwards, most of the Medical Library clientele became aware of the new technology in the library. They were booked for thirty minutes each to do literature searches, but they complained that time was too short. The time allocation provided for a maximum of 15 searches a day. Some requests for literature searches arrived by email from the periphery hospitals - even though the technology was not adequately marketed outside of Lusaka. However, my involvement in the evaluation of the HealthNet project provided an opportunity to introduce the CD-ROM activities in the Southern Province of Zambia.

The comments from the readers of the digest both from the printed copy and from the Internet were full of praise for the initiative taken and for the quality and usefulness of the publication in promoting health information provision. (See Box 3.) Some comments were made against the UNZA Medical Library for excluding some departments of the MOH and other health institutions. Another indicator of the success of the digest was reflected by the number of local and international researchers who brought their reports to be published in the digest. The impact of the digest on the Medical Journal of Zambia is that the editors have been motivated by the progress made on the digest to such an extent that they have regrouped and are working out new strategies for reactivating the publication.

Publicity of the ZHID was done in grand style with the Deputy Minister of Health, Dr. Katele Kalumba, officiating at the launching ceremony of the digest. The occasion attracted media coverage that lasted more than one week. The launching was followed by a workshop on Problem Solving For Better Health (PSBH), which took place in Ndola, the Copperbelt Provincial capital. The participants in the workshop came from all over the country, thereby giving an opportunity for the digest to be introduced across the country. The method of disseminating the digest to all health facilities, using the MOH, provided yet another form of publicity. In short, the digest was self-selling.

It has not been easy to measure the impact of the CD-ROM services in the absence of carrying out an impact assessment survey addressed from the point of view of the student performance from the time of the introduction of the service. The other way of measuring impact would be to find out the increase in medical research and publishing activities among health care professionals in the School of Medicine and the UTH. However, the Post Basic Nursing student projects have greatly improved in quality in the past two years. The 1994 projects were even applauded by the Research and Ethics Committee of the School of Medicine after a seminar at which they were presented to the School. As the UNZA Medical Librarian, I give yearly lectures to the Post Basic Nursing students on library services and literature search strategies. Recently, I started to do the same for the School of Nursing students at the UTH.

BOX 3 Some Comments on the Inaugural Issue of ZHID

The introduction of the ZHID is highly welcome and commended in that it will not only keep health workers abreast with new developments in health but will also instill the spirit to do some research. (Clinical Officer in Kasama)

I wish to congratulate you for the introduction of ZHID. Surely it will go a long way in changing some attitudes and methods in the manner clients are treated and thereby improve the health standards of Zambian citizens. (Health worker in Samfya)

I wish to congratulate you most warmly on the first issue of ZHID. it is most impressive and I particularly like the variety of information included: the institutional profile is an excellent idea, which I hope will be picked up by other countries. (WHO Librarian, Geneva)

I was so impressed with your educative material, especially for health workers in remote health centers of the country. Please keep it up. (Environmental Health Technician, Nakonde)


The main constraints we faced in implementing the project were the poor staffing levels at the professional ranks and the lack of appropriately trained persons to manage the projects. I, as coordinator of the project, had to learn computer skills as a matter of urgency in order to get going with the activities. In addition, the support staff were requested to work with me to move the projects forward. This on the job training worked for our library but I would suggest that it is better to start with the training before implementing the projects.

One lesson learned from this experience is that it pays to include support staff in traditionally professional projects. We found that many of the medical library staff had a natural instinct for the technology. For instance, the fastest learner we had was a library attendant. Once this person was trained, she then went on to train others, including the library users, to do their own CD-ROM searches.

If I were to start this project again, I would probably not do it much differently. The idea that intrigued me most was the need to be able to build on the existing projects instead of re-inventing the wheel. (See Box 4.) The other thing that I found useful was the use of relatively low budgets in implementing all the projects. In some cases, the projects were parasitic in the sense that they had no budgets at all, but relied totally on the existence of the other projects. An example of this is the AIM project which has no budget of its own and is dependent on the CD-ROM project for sustainability.

We were also able to build on the electronic communications initiatives of the University's Computer Center. In 1991, through the Computer Centre, we got hooked to a Fidonet system and installed a HealthNet satellite ground station. We started using electronic communications for the following purposes:

Library Partnership Program

The first use we made of email was to request literature searches. To do this, we found a partner in the United States - the University of Florida Health Sciences Center Library - to carry out the searches on our behalf. SatelLife facilitated the partnership. In June 1991 the first request (for information on meningitis) was sent to Florida late one afternoon. By the following morning, we had received a long list of citations, complete with abstracts. Dean Kopano Mukelabai of the School of Medicine at the University of Zambia acknowledged this giant breakthrough in the provision of health information by inviting me to address a meeting of the Eastern and Southern African Chairmen of Paediatrics Departments, in August 1991.

HealthNet News

SatelLife introduced an electronic newsletter that we disseminated to health care workers linked to the Fidonet system. A snap survey on the impact of the HealthNet News in 1993 showed that it was not widely read by users largely because of the busy schedules of the health care workers at whom the publication was targeted.

Literature Searches

We used the HealthNet communication system to receive and transmit literature search requests from the health care workers within the country. This aspect of SatelLife's information services was slow to be fully used because the health care workers were not fully aware of the information facilities that were at the Library. By 1994, SatelLife paid for a Grateful Med account to the National Library of Medicine with access to Toxinet, Cancerlit, AIDS, and Alert.

The HealthNet Communication Service

At the national level, the Library was linked to the Fidonet system but, at global level, communication was limited by Healthsat to those collaborators who were hooked to the HealthNet communications system. Most of the communication was centered on literature searches and to a lesser extent on other non-specific consultations with health care workers and medical librarians.

In January 1995, we received an Internet account from ZAMNET (see Neil Robinson's case study in this volume.) This development further enhanced access to and provision of our health information services. Some of the things we are able to do with the Internet are listed below:

Access to Health Information Databases

Through the Internet, the Library can access many unrestricted databases, such as the WHO Library database in Geneva. Because a subscription is needed to access some databases, the Medical Library still needs some assistance to support these charges.

Access to the ZAMNET Gopher

We have installed the AIDS Bibliography on the ZAMNET gopher. A pointer to ZHID was opened on the Zambia's Worldwide Web homepage in November 1995, and it is accessible to all Internet users around the world. We have plans to have more health information on the Internet as more is generated.

Access to Other Databases

The world of information both related and unrelated to health opened to the Medical Library users with the installation of our Internet node. We have access to multidisciplinary information through the Internet.

BOX 4 National AIDS Resource Centre (NARC)

This latest project is still in its infancy. In spite of the fact that the proposal is still under consideration by donors, some local HIV/AIDS literature was pulled from the UNZA Medical Library and UNICEF databases and put on the ZAMNET gopher. The Tropical Disease Research Centre (TDRC) Library has also prepared some abstracts that are still to be installed. The NARC coordinating center is the UNZA Medical Library and the TDRC Library is a satellite center. The participating centers are the HIV/AIDS information producing institutions which are on the email. Data collection will be done by email, whereas the AIDS database will be resident at the UNZA Medical Library. The ZAMNET gopher will be updated regularly.


Good programs have been brought to the Medical Library and implemented to the best of our ability. What we have been doing is just the beginning of a long road to providing health information for problem solving. Although HealthNet became a household name in health information transmission, the project failed because it failed to attract funding after the pilot phase. There is no more health information being transmitted by Healthsat because the ground station was moved from Zambia to a more needy site.

In another vein, the Fidonet system which spread all over the country is, in some cases, being replaced by the interactive Internet. Progress and technology are playing a major role in the development of a better health information system. Neil Robinson's case study describes this progression from Fidonet to Internet and explains how ZAMNET is providing service to all levels of users in Zambia.

Although CD-ROM usage statistics have shown a steady increase since 1992, the use of the databases outside Lusaka has not improved much. The most frequently used databases continue to attract more and more users, while the less popular databases continue to be underused. The Popline database is proving to be very popular.

The AIM database is regularly consulted, too. The collection of data outside the School of Medicine and the UTH has proved to be slow because of the time and personnel factors. The first NARC HIV/AIDS bibliographies were culled from the AIM database. Since the database is accessible on the Internet, it has a wide circulation, but we have not yet devised a method to monitor usage at the national level. The only statistics available are collected from users who use the database from the library. On average, there are eleven clients who use the AIM database per week, and seven of these requests are made by readers of the digest.

Although only two issues of the digest have been released, the feedback from the readers in form of comments and requests for full text articles has been good. The usage and comments on the usefulness of the digest will be monitored continuously through a feedback mechanism built into the publication.

The Medical Library will continue to need support from partners to develop these programs that improve information provision to health care workers. The devastating effects of the structural adjustment program on the development of health information and literature can only be alleviated through the sort of assistance we have received and hopefully will continue to receive until the national economy strengthens. In view of the above concerns, I suggest the following:

· We need to network the CD-ROM for greater accessibility to databases by health care workers who cannot easily come to the library.· We need to subscribe to key CD-ROM databases not only for the Medical Library clientele but for other health care workers who depend on us for information services.· There are eight other health sciences libraries in Zambia that should be linked to Zambia's Internet service.· We need to market CD-ROM databases and other health information services outside Lusaka.· We need to purchase a portable CD-ROM workstation that we can use for demonstrations.· In order to confer on issues relating to health information provision, Zambian medical librarians should meet at least once a year.· We need to continue to improve the coverage and frequency of publication of the ZHID. · We need to send medical librarians to all AHILA meetings where much of the professional sharing takes place.· We need to subscribe to more databases on the Internet, for example, MEDLINE.

The issues that haunt the UNZA Medical Library hinge on whether health information and literature provision will develop at the same pace as health provision - which is attracting reasonable funding from both the government and donors. Or will these efforts collapse soon after the current crop of Library staff disappear from the institution?

I would like to wrap up this story with the following: partnership, intelligent use of available resources, marketing of health information, and willingness not to give up are very important factors in the provision of health information. Better health information leads to better health care. Lastly, our philosophy has been to access information - not to OWN it. Collaboration with others, regardless of geographical or political boundaries, and acceptance of the changing information and communication technologies is the way forward.


1. The Florida Health Sciences Library has a twinning arrangement with the University of Zambia Medical Library.