Connectivity Providers Database

From: NRobinson@p22.f1.n761.z5.fidonet.org (NRobinson) To: randy@psg.com Date: Mon, 12 Jul 92 10:14:02 PST Dear Antonia, I'm really sorry it's taken so long but at last below you'll find a copy of the pilot project proposal as promised all ready to be further modified and improved at our next HealthNet planning meeting. I've copied in all committee members so they can look at it and come up with their own comments and recommendations in time for that meeting. I've also sent a copy to Julia at Satellife, but the international e-mail system still seems to be misbehaving so I'm not sure if my message has got through. I was missing the minutes of the last meeting so feel sure I must have left out some of the points that we covered when discussing your first version. In particular I seem to be short of precise budgetry requirements in terms of quantities and costs so the very last section still needs substantial expansion. I also need to think about the qualities required in the research assistant. I guess we're now ready for our next meeting. Obviously I shall be busy this week with Suzanne's visit, and am away from Sunday until Wednesday (22nd), but any time after that will suit me. After the long delay in producing this the sooner the better! I look forward to hearing from you, and any reactions from other members of the committee, soon. Best Wishes, Neil ------------------------------------------------------------ PROPOSAL FOR HEALTHNET EXPANSION IN ZAMBIA PROPOSAL NAME: Healthnet Expansion in Zambia: Pilot Project BACKGROUND AND JUSTIFICATION HealthNet in Zambia Today: In a world in which 90% of data on Africa is thought to reside on databases in the West, information poverty clearly contributes to the economic and political disadvantages that Africn countries face. When economies run into trouble the effects on basic health care are often severe, and are compounded by a poor communications infrastructure and the lack of the very information that the medical sector needs to tackle the problems it faces. Medical journals and books are beyond the budgets of most institutions even if the foreign exchange that they require were available. Internationally Healthnet has been developed to address this issue by giving countries in the 'South' access to satellite facilities which link them to medical information repositories (libraries, health institutions and universities) in the 'North', as well as to their neighbours with whom they share common problems and goals. In Africa at an international level telephone systems tend to be poor and the costs set artificially high in order to dissuade outgoing calls which incur international carrier charges in foreign exchange. Thus, while international email links have been established between the University of Zambia and the rest of the world, Healthnet provides a cheaper and more reliable alternative using satellite technology. In Zambia a groundstation has been installed at the University of Zambia. This uses relatively cheap antennae, an amateur radio transceiver and a radio modem to transfer messages between a personal computer at the UNZA Computer Centre and a low-orbit sun-synchronous satellite which passes over Lusaka four times a day. Zambia was the first country to get an official licence from the PTT to operate this system and so has the valuable support and involvement of the Post and Telecommunications Corporation (PTC). The system was commissioned on March 20th when Queen Elizabeth and President Chiluba exchanged messages. Since then messages have been exchanged through this medium with medical schools in Mozambique, Kenya and Tanzania, with AFRO (WHO Regional Headquarters) in the Congo, and with Canada and the United Kingdom. For communication within Zambia a terrestrial email network (UNZANET) has been established successfully at the University of Zambia. This uses standard micro-computers, modems and telephone lines for inter-departmental communication, and, through a gateway provided by Rhodes University in South Africa, for international communication with academics in Europe, North America, Australia and Japan, as well as within the Southern African region. With a view to developing Healthnet within Zambia a core of five health institutions have also been given 'points' on UNZANET. These are: the Medical Library and Teaching Resource Unit at the School of Medicine (located at the University Teaching Hospital); the Planning Unit and Deputy Minister at the Ministry of Health, the WHO offices in Lusaka, TDRC (Tropical Diseases Research Centre) in Ndola, and the Nkana Mines Hospital in Kitwe. In addition the groundstation computer is itself a point. Thus these institutions are able to submit messages for transmission to the satellite and to receive messages indirectly from the satellite, in addition to being able to use more conventional international terrestrial email. So far such international communication has been used primarily for obtaining literature from libraries and information services in the 'West' notably the United States, although there has been some consultation between Zambia and Mozambique over clinical issues, and between Zambia and Kenya relating to the organization of conferences. The Need for Healthnet Within Zambia: In 1990 the population of Zambia was 8.09 million and currently is estimated to be growing at 3.2% per annum. While approximately half of that population live in urban areas the rest are spread over an area of some 752,600 square kilometres. Virtually all health promotion and health care is carried out by the Government through the Ministry of Health, together with Mission Hospitals aided by the Churches Medical Association of Zambia (CMAZ). At present health services are administered from the Ministry of Health through Provincial Health Offices to Districts. However, current Government policy is to decentralise the administration and to provide a considerable degree of autonomy to the districts. While technical support will be provided by the Provincial Offices, the District Hospital, which is already a key point in the district health service, will become the major administrative and service point and the 'nerve centre' of the district services. Clearly the decentralisation process will be dependent upon strong communication. Current means of communication within Zambia are expensive, or unreliable, or both. The telephone network is extensive but often overloaded or unavailable at peak times. Fax and telex are both considerably more expensive in terms of telephone charges than email. They consume more paper, involve more human intervention for collection and delivery of messages, and without expensive scanning equipment, do not allow for messages to be reprocessed by computer (e.g. by incorporating in other reports or documents). The surface mail service in Zambia is very slow indeed. Even within the capital letters can take a week to reach their destination, and sometimes can disappear completely. Many institutions have resorted to using their own road transport to deliver documents and messages! For communication that isn't critically urgent email has the potential to overcome all of these problems and to save in communication expenditure. Email has the added advantage that the equipment it uses (the micro- computer and telephone line) are only required when the user chooses to call in to send or collect mail. At all other times they can be used for other work. Improved communications can be expected to increase the efficiency of the health services and of health training wherever they extend. Uses for HealthNet in Zambia: Many areas have been identified within which the use of electronic mail through HealthNet will be beneficial. The system has the potential to greatly improve access to people and information residing outside of Zambia, as well as improving national communication on administrative, professional and educational matters. No doubt other areas will be discovered once the system is being fully utilised by health workers throughout Zambia. At an international level the links provided through the network's host computer, both those of a terrestrial nature and the satellite facility, will give health workers in the field access to the same contacts, information and data that HealthNet points in Lusaka and the Copperbelt currently enjoy. Thus they will be able to access the wealth of health literature stored in health science libraries and information centres in Europe and America thereby improving both motivation and medical competence. (They will also be able to access information stored electronically in 'local' libraries e.g. the Medical Library at the University Teaching Hospital) In addition they will be able to receive accurate, up-to-date and relevant epidemiological data for the Southern African region. These advantages will be supplemented by a greater ability to communicate with fellow health workers in adjacent countries, e.g. Mozambique and Tanzania, using the satellite link, thus enabling better clinical consultation and cooperation within Southern Africa. Under the new National Health policy improved communication between the Ministry of Health Headquarters and peripheral health service and management units, and between the semi-autonomous peripheral units themselves, will be very important. Much of this communication will be administrative involving: the exchange of planning, budgeting, accounting and manpower data; the provision of regular health statistics, returns and reports, and the redistribution of these reports; and the ordering and co- rordination of distribution of drugs, vehicle parts and other supplies. Electronic mail has the potential to significantly improve communication on professional matters. Improved clinical consultation will be possible between district hospitals, and between centrally based specialist and peripheral doctors enabling greatly enhanced patient care, especially in those district hospitals previously remote and 'inaccessible'. There will be more efficient disbursal of information regarding treatment facility and clinical management policy changes, while advance warning of referrals and consultation visits will enable better management and preparation within the receiving hospital. It will also be possible to gather clinical and epidemiological data from the periphery more quickly, to analyse this data electronically and then equally quickly to distribute it to interested parties. For training the use of email for distance learning and maintaining contact with masters students working as District Medical Officers will prove invaluable to the School of Medicine at UTH. In addition it will be possible to provide expanded education directed at all cadres of health worker, including undergraduate students, working in the districts. Such continuing education is currently inadequate and largely concerned with medical graduates. PROJECT OBJECTIVE It is clear that the international component of Healthnet works. In addition telephone and therefore email communication within Lusaka, and between urban centres such as Lusaka and the Copperbelt, has proved to be reliable. The long term aim is to link in all 60 district hospitals and 11 general, central and special hospitals around Zambia. However before this can be embarked upon it is clearly important to establish the technical feasibility of electronic mail and the problems that will need to be overcome when dealing with remote locations in a rural setting. Thus this proposal is for a pilot project to be carried out within just one province (Southern Province), its aim being to install electronic mail in seven out of the eleven district hospitals, and then over a six month period to monitor closely the performance and uses of email in those hospitals. The seven target hospitals are: Choma General Hospital, Macha Mission Hospital (Choma District), Livingstone General Hospital, Chikankata Hospital (Mazabuka District), Mazabuka District Hospital, Monze District Hospital, Siavonga District Hospital. A single province was selected to promote as much realistic To: MBennett@gn.apc.org interaction between the participants as possible. However it is important that links with regular contacts in Lusaka should also be in place. While the Ministry of Health, the School of Medicine at UTH, WHO Lusaka and UNICEF all have email, part of the project will involve the identification of other of these Lusaka-based contacts. While district hospitals outside of Southern Province who already have the required equipment (computer, modem and adjacent telephone line), in particular those involved in the New National Health Policy Pilot Project, will also be encouraged to participate in HealthNet, during this project these districts will not necessarily receive the same level of support accorded to the seven target hospitals. The project objective can be broken down into four main areas: the determination of material requirements; an assessment of the technical support needed; an analysis of the user skills involved; and the monitoring of usage. 1. Material Requirements: While considerable experience of the use of computers and modems for electronic mail already exists at the University of Zambia and its reliability in an urban setting has been ascertained, it will be necessary to monitor closely the performance of this equipment in a more remote situation to identify any special requirements in such an environment. The reliability of the local electricity supply and telephone service will need to be ascertained for each district, and methods of overcoming any weaknesses determined. Close liaison with the PTC will be particularly valuable in this venture. The software used for email communication will be dictated by that used at the central host computer. Currently this is the FrontDoor program running under the DOS operating system. 2. Technical Support Requirements: Clearly once users are depending upon email for a large part of their daily communication the reliability of the system and thus the availability of technical support will be critical. 2.1 Materials It will be necessary to determine the quantity and nature of spare computer components and additional modems that will need to be stocked in order to maintain the system in the event of hardware failure. The need for backup telephone lines and the cost of providing them will also need to be assessed. 2.2 Support Staff (Quality) The level and nature of the skills required by technical support personnel will need to be determined. A recruitment source in terms of existing qualifications required for these personnel will need to be identified, and the content and duration of any training provision decided upon. 2.3 Support Staff (Quantity) The number of trained technical support staff required for a given area will need to be determined. 2.4 Location The best location in terms of access to supplies and ability to provide service will need to be chosen. It should then be possible to extrapolate the criteria used in determining that location to the rest of the country. 3. User Skills: In any given institution it will be necessary to determine which members of staff will be using the system directly, the skills required by those users, and the training method, content and duration required in order to provide those skills. 4. Usage: It will be important to identify the nature, frequency, reliability, information value and cost efficacy of email usage with regard to communication between the centre (Lusaka) and the periphery, communication within the Province, and international usage. In addition the accessibility of the email facility to staff within an institution will need to be monitored. For each type of communication (inter-provincial, intra- provincial and international) the volume of usage will need to be further broken down into subject area (e.g. health management and administration; monthly returns; clinical consultation; training; access to medical literature etc.) To maintain confidentiality usage by subject area will have to be recorded manually by the users themselves. PROJECT IMPLEMENTATION AND TIME-FRAME 1. Personnel: Personnel will be required for each stage of the pilot project. While staff at the University of Zambia Computer Centre will be able to provide a degree technical support and training, it will be necessary to recruit a full-time co-ordinating research assistant to manage the pilot project. This person will need to be provided with a salary, accommodation, and in view of the geographical spread of hospitals within the province and the nature of the work involved, transport and fuel in order to carry out the work effectively. 2. Stages: 1. Procurement of equipment and personnel. 2. Survey of the current situation regarding infrastructure (availability of electricity supply and telephone lines), security, size of operation (staff numbers, patient statistics etc.), and current lines of communication (nature, cost and problems) of each of the target hospitals. 3. Installation of equipment and software in seven district hospitals. 4. User training: the development of a course and documentation for such training, and its provision on site (at time of installation). 5. Monitoring, both of usage using manual and automatic methods, and of the technical support requirement to maintain the system. 6. Assessment of technical support: the identification of a source for trainees; the development of a course and documentation for technical support staff training; and the identification of the best geographical base and the logistics required to support it. 7. Evaluation of HealthNet in a 'remote' location in terms of the extra requirements for providing an effective service, and its cost-efficacy. 8. Preparation of project report. It is estimated that stages 2 to 7 should be completed within a period of six months. However obviously the procurement of personnel and equipment will be initially dependent on the availability of funds. 3. Next Phase: On successful completion of the project and the publishing of the project report, and obviously depending upon the content of that report, the next phase will be the development of a proposal for national expansion. BUDGET LINES AND ESTIMATES 1. Equipment Requirements (Capital Items): To service seven hospitals within Southern Province, plus UTH, and to provide testing facilities and backup the following will be required: 9 IBM compatible PCs (preferably 386s), with 60MB+ hard disk running on 220 volts (for 7 hospitals + 2 spare). 9 narrow carriage dot matrix impact printers (one for each computer specified above). 1 IBM compatible 386 PC with 120MB hard disk running on 200 volts (for UTH hub). 1 IBM compatible 386 notebook computer with internal modem (for travelling, setup, troubleshooting and testing around the districts). 15 tested internal modems (2400 baud) 1 9600 baud Telebit modem (for UTH) 1 UPS (for the UTH PC) A supply of spare parts for servicing of ten PCs. RJ11 telephone cable, plugs and sockets, line tester, installation tools etc. DOS (latest version) for all computers. Mailing software (FrontDoor) for all computers. 2. Recurrent Expenditure: Salary of full-time Co-ordinating Research Assistant. Consumables (stationery, diskettes, printer ribbons etc.) Transport and fuel. Per Diem costs. Note: More precise details and the cost of these items is still to be determined. -- uucp: uunet!m2xenix!puddle!5!761!1.22!NRobinson Internet: NRobinson@p22.f1.n761.z5.fidonet.org