HLG Nursing Bulletin Vol. 39 (1)
by Shane Godbolt and Lucy Reid*
Abstract
This article describes the setting up and development of a library partnership between the United Kingdom (UK) and Tanzania over some 10 years. At its core is the passion of the partners to make a difference and improve health in Tanzania by improving public access to health information in one of the world’s poorest nations. In the current phase of this partnership, two young Tanzanian librarians are in the UK for three months on Commonwealth Professional Fellowships to consolidate the partnership’s achievements and develop improved governance, management and staff training tools to implement on their return.
How it all began
History is fascinating! What can grow from seemingly chance and insignificant beginnings! A young Tanzanian, Alli Mcharazo, consumed from childhood with a great love of books, was sponsored by the then Overseas Development Administration (forerunner of the Department for International Development) to study for a BA Information Management at Ealing College of Higher Education (predecessor to Thames Valley University and now the University of West London) in 1991. Graduating in 1994 with a first class degree, he stayed on to complete both an MA and then a doctorate at Thames Valley University (TVU) with a thesis on Aspects of distance education and its implications in information provision. To help fund his postgraduate studies, Alli was a part-time lecturer with the department and during this time a strong friendship was forged with his supervisor and mentor, Dr Tony Olden. The young Dr Mcharazo returned home in 1997 to become a Principal Librarian, a senior role within the Tanzania Library Service Board (TLSB). In 2000 he moved to the higher education sector as Librarian at the University College of Lands & Architectural Studies before joining the health sector as Librarian to the prestigious Muhimbili University of Health and Allied Sciences (MUHAS) in 2004. The University faced many challenges not least the knowledge and skills gap amongst the profession in the provision of information services in the electronic information age. In Tanzania as in the UK, there was a need to move a traditional medical library into an era undergoing a paradigm shift in access to information with information and communications technologies (ICTs) that redefined the role of librarians and library service development. Health librarians are crucial to providing access and training for users as their institutions develop infrastructure to open windows on the world of electronic information beckoning their users. Alli settled into his new role with great energy and enthusiasm, tapping into his well-established networks of UK friends and colleagues.
Partnerships in Health Information (Phi) is a UK charity, founded in 1992, which works in Africa to promote partnership working and development projects. In the mid-2000s, Phi was expanding its work having appointed a full time, salaried Programmes Officer in 2006 through a generous grant from the Sir Halley Stewart Trust. Tony Olden was an expert on aspects of information, education and development in Africa and was a member of Phi’s Board. Through Tony, Alli expressed an interest in forming partnership links with UK organisations to share knowledge and expertise. Around this time, Lucy Reid also expressed an interest in establishing professional links through Phi. Lucy had recently been appointed Head of Information Services at the Royal College of Obstetricians and Gynaecologists (RCOG) and, inspired by a Phi presentation at a Health Libraries Group conference, thought that such a partnership would be in keeping with the College’s strong international development agenda.
Forming the partnership
The challenges of partnership cannot be underestimated. Nancy Kamau, Chair of Ken-AHILA and President of the Association of Health Information & Libraries in Africa (AHILA) 2006-2008, spoke from experience about the Kenya/UK partnership which had evolved since 2004. In a co-authored paper, presented in Brisbane at ICML 2009, she identified the following factors:
- Finding the right partners
- Cultivating mutual trust and understanding
- Coming up with mutually agreed work programmes
- Bringing all the partners to the same level of interest
- Effective Information communication technology
In 2006 Phi put Alli (MUHAS) in touch with Lucy (RCOG) and our experience certainly reflected the challenges identified by Nancy with the notable exception that from the outset bringing all partners up to the same interest was not an issue. We were all equally committed and in no doubt the partners were right but building the understanding of the local need, of the how Phi might contribute and of the roles each partner would play took time. MUHAS urgently needed a computer laboratory and at one meeting we spent some time discussing an excellent submission setting out the requirements and budget for this (25k) and explaining that Phi UK has always been focused on capacity building, advocacy and coordination. It was and still is not a grant giving body!
At that time, Alli was visiting the UK on average twice a year so we were able to build the partnership through face to face meetings. Opportunity knocked on our open door when, in 2006, the British Council announced the Development Partnerships in Higher Education (DelPHE) programme which offered funding for higher education institutions in Africa and Asia. This aimed at building capacity in institutions and was focused on achieving the United Nations’ Millennium Development Goals (MDGs). We decided to focus on 3 key strands:
- Development of MUHAS library
- Delivery of good quality health information to members of the public in Tanzania
- Supporting the improvement of health across the country as a whole
The UNESCO statement Access to relevant information is crucial to the economic, political, and social well-being of any community was useful in building a case as well as highlighting the health needs in Tanzania evidenced in the statistics below.
- Maternal death = 6 women/1,000 live births (NBS 2007). Lifetime risk = 1/24
- HIV/AIDS prevalence = 6 % (15-49 year olds)
- Malaria, cholera and TB affect significant numbers of people
We also knew that while there was some access to health information in urban areas it was very poor in rural areas. We were convinced that we could make a strong case for the value of reliable health information and the role of librarians and their services in contributing in partnerships to deliver this. Developing the proposal was hard and time consuming work. We met several times over many months. All partners recognised the key role that Emma Stanley, Phi Programmes Officer, played. The British Council locally in Dar es Salaam referred back the first DelPHE application but with the useful feedback they gave we were able to improve on this for the following round and were successful.
In summary the objective of the project proposed was the improvement of health in Tanzania focusing on maternal and reproductive health and communicable diseases including HIV/AIDS, TB, malaria and cholera. To achieve this, the project would deliver a programme of work over three years which would involve:
- Embedding information skills training in the MUHAS curriculum
- Developing a health information module for library students at the School of Library, Archives & Documentation Services (SLADS)
- Developing a network of Health Information Corners for members of the public to access good quality health information through the public library network in Tanzania.
In 2007 the project received a huge boost when Alli was appointed Director-General of Tanzania’s public library system, the Tanzania Library Services Board (TLSB). This enabled us to expand the scope of the partnership to include public libraries formally – a huge bonus, especially for goals 2 and 3 above. A further opportunity arose when the Commonwealth Scholarship Commission offered the developing country partner involved in a DelPHE programme the possibility of a split site scholarship enabling a member of the partnership, registered for a PhD in their home country, the chance of UK study for one year provided a suitable candidate could be identified and both universities were in agreement. The new Director of MUHAS Library, Rehema Chande-Mallya was accepted for a scholarship and this enriched the whole project.
Delivering the project; the partners
Partnership working is complex. Good communication is essential and co-ordination is vital. The partners now formally engaged in a funded partnership were:
- For Tanzania
- MUHAS – a public medical university delivering education and training for doctors, nurses and allied health professionals and holds the national medical collection.
- TLSB – a network of public libraries in major towns providing a mechanism for delivering library services to members of the public. TLSB also hosted SLADS, training librarians to certificate and diploma level.
- For the UK
- Phi – supports and co-ordinates the partnership and drives funding applications.
- RCOG – a UK-based professional body with an international membership of doctors specialising in women’s and reproductive health, delivering information services internationally through its library.
- TVU (now UWL) – was the university partner which hosted a one year PhD candidate for the Split Site Scholarship
Delivering the project; partnership activities
Year 1 – 2008/9
A baseline study was carried out which identified needs of library staff at TLSB. Resources available for Health Information Corners were also mapped. Exchange visits enabled:
• Sharing knowledge about local needs (staff and users) and facilities
• Learning from existing services with similar aims
• Workshops on delivering information to members of the public
• Training on health information skills
• Introductory presentation to library students at SLADS
• Developing a training manual for postgraduate students at MUHAS, SLADS and TLSB staff in information literacy skills
• Establishment of Health Information Corners at the pilot public libraries for easily accessing health information within the community for preventing communicable disease (malaria, HIV/AIDS, TB, cholera)
Year 2 – 2009/10
Exchange visits to the UK and Tanzania enabled:
- Developing information skills programmes for undergraduates and postgraduates at MUHAS
- Improving infrastructure at MUHAS
- Developing partnership working between MUHAS (appraising health information) and TLSB (network for dissemination)
- Split site scholarship PhD study on Effectiveness of communication channels in disseminating HIV/AIDS information
Welcome additional input to the project came via Phi’s partnership with the International Federation of Library Associations and Institutions (IFLA) Freedom of Access to Information and Freedom of Expression
(FAIFE) project. Following the success of IFLA/FAIFE’s Learning Materials for workshops on Access to information on HIV/AIDS through Libraries, FAIFE developed materials within a broader programme around health issues which provided learning materials for workshops for librarians on Public Access to Health Information (PAHI). As Phi was supporting active networks of health librarians with UK partners in East Africa we were invited to partner with FAIFE in the testing and refining of these materials. In Tanzania we were able to deliver the workshop within the framework of the existing DelPHE activities. The Dar es Salaam workshop was hosted by MUHAS, with planning and organisation also contributed by Alli on behalf of TLSB. Participants included librarians from the health sector and public libraries, health NGO (Non-Governmental Organisation) personnel, and lecturers form Departments of Library and Information Sciences at three universities.
Year 3 – 2010/12
The Project was extended by a further year due to personnel changes. Information literacy training was embedded as a mandatory component of the undergraduate curriculum at MUHAS. The curriculum for diploma students at SLADS was submitted for approval by the National Council for Technical Education. The first pilot Health Information Corners were established at MUHAS and the National Central Library (TLSB) as well as at its branches in Morogoro and Dodoma. There was a visit in 2010 by UK partners including Phi’s Programmes Officer, Emma, and Phi’s Chair, Nick Naftalin OBE, a Fellow of the RCOG and a senior clinician of national standing. Dr Tandi Lwoga, recently appointed Director at MUHAS and Dr Alli Mcharazo hosted this visit. The visitors were extremely impressed at the evidence-based practice training/information literacy embedded within the MUHAS curriculum.
What had we learnt?
The final Report concluded that
- Tanzania faces significant health challenges
- Access to health information for members of the public is difficult
- Libraries are ideally placed to deliver health information to members of the public
- Institutions working in partnership have resources and skills to deliver health information in a way that is suitable for members of the public
- Librarians need to re-package information and develop ways of disseminating it to the community
Sustainability
How to maintain momentum and ensure sustainability is the most challenging issue in international development. Health librarians in Tanzania had formed a country chapter of AHILA and were becoming more active professionally. At the AHILA Biennial Congress in Cape Verde in 2012, Phi & AHILA sponsored a PAHI workshop for all delegates co-ordinated by Phi. Rehema Chande-Mallya from MUHAS was elected Treasurer of AHILA and the General Assembly accepted the offer of hosting the 2014 Congress in Dar es Salaam. In 2013 Phi offered two small grants for improving Public Access to Health Information (PAHI). One of these was won by an attendee at the PAHI workshop of 2009 with a project for Promoting and Improving Public Access to Nutrition and health related Information in Health Facilities which was successfully delivered through a partnership of the local branch of AHILA with MUHAS and the Tanzanian Food & Nutrition Centre as part of the Ministry of Health & Social Welfare.
Commonwealth Professional Fellowships
The Partners agreed that the Commonwealth Professional Fellowships scheme offered a great opportunity to move PAHI in Tanzania into the next phase. A successful application was made in 2013 for two Fellows:
- Emily Meshack, from the National Central Library in Dar es Salaam who is Head of the Information Desk, which deals with all enquires including health
- Charles Marwa, who is Head of ICT and information literacy training at MUHAS).
Emily and Charles are responsible for the development and management of the Health Information Corners programme in Tanzania and will be engaging with health libraries of national importance to broaden their experience of health information in the UK. Lucy, now Head of Library and e-Learning Services at South London and Maudsley NHS Foundation Trust (SLAM) is hosting their programme and they are based at SLAM where they are doing project work relevant to the purpose of their Fellowship.
Charles and Emily’s Fellowship programme focuses on three main activities. Most importantly, Charles and Emily have received invaluable leadership and strategic management mentoring from Ray Phillips. Ray is a very experienced health information professional who has previously worked as Head of Information Services at The King’s Fund and, prior to that, held senior roles in various National Health Service (NHS) organisations. Ray’s focus has been to help Charles and Emily review the current Health Information Corners, carrying out a Strengths Weaknesses Opportunities and Threats (SWOT) analysis, and draft a memorandum of understanding that will provide a formal grounding and mechanism for partnership working which will take Health Information Corners forwards towards a national roll-out across Tanzania.
Charles and Emily have also benefited from the excellent Critical Appraisal Skills Programme train the trainer course which is designed to give learners the knowledge to cascade critical appraisal training to their
organisations. For Charles, critical appraisal training is an important component of the information skills training offered to MUHAS students and staff. Critical appraisal is also essential for selecting good quality health information resources for members of the public so the skill set is important for Emily and her team at TLSB. In addition, Charles and Emily have been working with Ray on creating a local, Tanzanian implementation of the PAHI training package which will give all professional and para-professional staff of TLSB the knowledge of health information they need to be able to support users of the Health Information Corners.
The third element of the Fellowship programme is for Charles and Emily to contribute to the delivery of library services and consumer health information to the South London and Maudsley Recovery College. The recovery model in mental health care focuses not simply on symptom reduction but on rebuilding lives, including providing routes back into education. Recovery Colleges follow an educational model with classes aimed at service users, carers and staff providing a range of knowledge and skills linked with recovery from mental ill health. Access to information about mental health conditions is an important part of this model as individuals learn to manage and participate in their own care. During the Fellowship, Charles, Emily and the Reay House Library team at SLaM will be piloting a hands-on information literacy session for the Recovery College and developing ways of providing access to good quality printed literature on mental health conditions, both activities which have a direct relation to the Health Information Corners project in Tanzania.
“Commonwealth Professional Fellowships are highly regarded and the opportunity that we have been given will benefit our careers and impact on the development of health information services in Tanzania. The knowledge we gain through CASP
training, conferences, study tours to different health libraries, and our work with Ray will be invaluable. Our Fellowships have allowed us to gain experiences that would otherwise have been impossible and will increase our ability to influence and make changes at our work places.”
Charles Marwa and Emily Meshack
Conclusion
Through this partnership we will bring significant value to our library users and strong growth for TLSB and MUHAS Libraries. Also, it will improve the public health information infrastructure increasing the efficiency of health information
infrastructure and public health services delivery.”
Charles Marwa and Emily Meshack
Tanzania continues to face significant health challenges. Easily accessible reliable health information can make a difference and even save lives. Passion and commitment is an attribute of individuals. The difference individuals can make is immeasurably enhanced when they work in partnership; and can advocate successfully within their organisations for partnership. Of course their organisations are vital too but it is the individual in the organisation that makes the contribution. Margaret Mead the celebrated cultural anthropologist (1901 – 1978) said “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” We can all play our part and join in with others. The final word goes to Neil Pakenham-Walsh, founder of the Healthcare Information For All by 2015 campaign, “Let’s build a future where people are no longer dying for lack of healthcare knowledge”.
Thanks to Tony (Dr Anthony Olden), Charles Marwa and Emily Meshack for their input into this article.
This article was published in Focus on International Library and Information Work 45(2)in July 2014. The original version can be accessed at https://archive.cilip.org.uk/sites/default/files/documents/focus4522014.pdf
Health Libraries Group 