Practitioner Commentary on: Hoppenbrouwer, J. & Kanyengo, C.W. Current access to health information in Zambia: a survey of selected health institutions. Health Information and Libraries Journal 2007, 24, 246–256

Introduction and background

In Zambia 65% of the population lives on < $1 per day.¹ It is ranked 173 out of 209 in the World Development Indicators for Gross National Income.² Almost all of sub-Saharan Africa is in the low-income category of the World Bank. Partnerships in Health Information (Phi) are concerned with capacity building for those involved in health information flow in a number of African countries. Working through partnership links between libraries in the UK and partner countries Phi seeks to facilitate professional development and raise the profile of the profession and its contribution to promoting the health of the people of Africa and other developing countries. Across Africa where Phi is involved in supporting and promoting partnership projects the information environment in health facilities outside the major towns and cities is similar to that described in this article.

A 1986 article by Chisanga³ provides a baseline against which to assess changes in the health information scene in Zambia. Chisanga was largely concerned with the difficulties of doing a Medline search at a time when the search strategy had to be devised and sent by e-mail to another library to perform the search and provide the printout of results. This situation has certainly changed for the better. Chisanga also reported that the Tropical Diseases Research Centre Library had an up to date collection including 212 journal subscriptions. Access to subscription journals dropped to almost nil in the early 1990s throughout sub-Saharan Africa as economic conditions deteriorated. The end of the last century was therefore a grim one for science libraries in Africa.

Medline on CD-ROM was a blessing for health libraries, but students, researchers and practitioners had to rely mainly on abstracts, not the full text, until the launch of the Health InterNetwork Access to Research Initiative (HINARI <http://www.who.int/hinari/en/>) in 2000. This has made over 3000 mainstream journals available online to libraries and non commercial institutions in low-income countries—available but not necessarily accessible even in the capital and impossibly expensive outside major urban centres.

Chisanga also noted the lack of opportunities for continuing or specialist professional development and this situation has not changed much. A longstanding supporter of the African Association of Health Information and Libraries (AHILA) Dr Lenny Rhine from the University of Florida has been working with the University of Zambia's Medical Library from about 1994 onwards and in this respect Zambia has been luckier than many other African countries. Specialized health workshops (mainly on the use of different databases and electronic resources) have averaged about one per year from 2000 onwards.

Reaction

We have to thank Joost Hoppenbrouwer and Christine Wamunyima Kanyengo⁴ for their survey of libraries in government health facilities, particularly those serving rural areas. Acquiring such data requires finance and ingenuity in breaking through many barriers to its collection such as poor communications, staff overload, and a perceived lack of urgency at the receiving end. There is, for instance, little information about the facilities available at training colleges outside the capital in Zambia and their relationship, if any, to their local hospital. Only one, Chainama College of Health Sciences (for the training of clinical officers (diploma level medicine), mental health nurses, and professions allied to medicine), is on the list of institutions eligible to receive WHO publications when these arrive in sufficient quantities for distribution. It has an identifiable library with an active librarian and has invested in a broadband connection ($1000 a month 2005 prices!).⁵ In Kenya a medical training college visited by Phi in 2006⁶ employed a librarian, but there was no budget for new material and no donations had been received for 2 years. The UK end of the Kenya partnership has raised a small sum for the purchase of up-to-date textbooks.

Cooperative arrangements between teaching institutions under the Ministry of Education and the health facilities under the Ministry of Health are similar to those in the UK and reflect similar issues. Unfortunately the Ministry of Health hospitals make no contribution to the libraries funded through the Ministry of Education at the University of Zambia Medical Library or Chainama College of Health Sciences. Both these libraries serve nearby hospitals—in the former case the national referral hospital and in the latter the only mental health hospital in Zambia.

With rare exceptions, hospital information resources, online or print, are very poor, lacking practical and easy-to-read material relevant to the situations in which Zambian health professionals operate. A range of publications on HIV/AIDS are published through the financial backing of numerous wealthy donors and distributed to resource centres/outlets in public libraries and community organizations, but little reaches hospitals and health facilities outside Lusaka. Although ‘lack of a reading culture’ may be given as a reason for low use and a low perception of the usefulness of library/knowledge facilities, it is difficult to imagine why short-handed health workers should feel there is any benefit in reading out-of-date material with little relevance to the work in hand.

Reflection

The lack of an information policy from the Ministry of Health is one of the more serious hindrances in improving knowledge provision. But an information policy which lacks recommendations on staffing libraries will simply perpetuate the inefficiencies already demonstrated by Hoppenbrouwer and Kanyengo. Relevant material exists in print—some free, some at modest cost,⁷ but without a professional librarian somewhere in the system there is no one to make the case for its acquisition. The coming of cheaper broadband (as the high speed backbones are developed in Eastern and Southern Africa) is bound to impact on the situation. However, Internet access without guidance and information literacy training is just as likely to be a threat as an opportunity; and the full benefit of such technological investments is at risk of being lost.

The importance of specialist information in the health sciences is becoming increasingly apparent as better internet access feeds the information explosion on a global scale. Continuing and rapid change in information management requires more and specialist opportunities for in-service professional development, opportunities which currently rely heavily on international, rather than national, agencies. Phi-facilitated partnerships aim to support local health information professionals to expand their skills in providing the health information so desperately needed within their communities. Technology is an important, but by no means sole, focus in adding value to the partnership experience. Of crucial importance are the relationships and shared professional vision, powerful drivers for change especially as opportunities open up for physical libraries in developing countries to move to e-libraries and e-library services.

Our Zambian colleagues have identified the need to exchange expertise and work cooperatively through the creation of a body to represent the interests of health librarians, their users, and producers of health information.⁵ Creation of such a body, especially with support from a Phi partnership, could address some of the issues raised by the Hoppenbrouwer and Kanyengo article thereby providing a focus for professional development.

Conflicts of interest

JGS & SG have declared no conflicts.