Assignment Report RP/l979-1980/5/lO.l/O3 Advisory services for the planning design, development and evaluation of national information systems and services

FOR INTERNAL USE NOT FOR GENERAL DISTRIBUTION

K E N T A

ESTABLISHMENT OF A TUBERCULOSIS RESEARCH DATA BANK AND INFORMATION SERVICE

by S. Schwarz

ARCHIVES PGI

United Nations Educational, Scientific and Cultural Organization

Paris, June 1980

Serial No. FMR/PGl/80/lSl

. • \

Fffi^PGl/80/lSl(Schwarz) 30 June 1980

TABLE OF CONTENTS P a S e

1. Local background 1

l.A The Kenya Tuberculosis Investigation Centre (KTIC) 1

l.B The Kenya Association for the Prevention of Tuberculosis 1 (KAPT)

l.C Libraries ?

l.C. i KTIC "library" *t i

l .C.2 University of Nairobi Faculty of Medicine Library ;

l.C.3 The Wellcome Library (National Public Health Service) <

l.C.4 Medical Training Centre Library 5

l.C.5 ILRAD Library 3

2. The International Union Against Tuberculosis (IUAT) 6

3. The World Health Organization ( W H O , Geneva) 7

3.1 Tuberculosis and Respiratory Infections Unit (within 7 Division of Communicable Diseases) ,

3.2 The W H O Information Systems Programme 8

3.3 The W H O library 9

4. Journal literature, computerized services and other 10 sources of information

5. Objectives for information services at KTIC 1?

6. Strategies for creation of information services at KTIC 13

7. Staffing 16

8. Consultants 17

References 19

Visits related to the KTIC mission 20

PREFACE

At the request of the Government of the Republic of Kenya, the Director

General of Unesco arranged, under the Organization's Regular Programme

for 1979-1980, for a consultant to visit that country from 3 September 1979

to 17 October 1979 to advise on the development of scientific and

technological information systems. As one task of the mission, which is the

subject of the present report, the consultant was required to provide

approximately one week of advisory services to the Kenya Ministry of

Health, leading to a preliminary study of the feasibility of establishing a

tuberculosis research data bank and information service, and detailed

proposals for its establishment.

1. LOCAL B A C K G R O U N D

l.A THE KENYA TUBERCULOSIS INVESTIGATION CENTRE (KTIC)

The KTIC was created in the mid fifties as a co-ordinating centre for

surveys and clinical follow-up projects on occurrence of tuberculosis in

Kenya and the effect of various therapeutic measures. The centre has some

laboratory facilities but a very limited professional staff including at

present about 5 researchers at the M D level. This capacity is not available

full time for studies carried out at the centre since staff members have

educational and clinical obligations and other part-time commitments.

There are five well defined areas of interest:

1 Case finding and community studies 2 Chemotherapy of tuberculosis 3 Epidemiological studies k B C G vaccination** 5 Immunology

The Centre was involved in a major tuberculosis survey conducted by W H O

in 1958-1959, including tuberculosis testing, bacteriological examination and

chest X-ray examination (of 8,500 persons in 17 groups of 500). Since then

there has been a continuous follow-up of test groups. Data are analysed in

the United Kingdom in co-operation with the British Medical Research

Council (Tuberculosis and Chest Disease Unit, Brompton Hospital, London).

A new national survey is now in an advanced stage of planning.

1. B THE K E N Y A ASSOCIATION F O R THE PREVENTION O F T U B E R C U L O ­

SIS (KAPT)

This -organization was founded in 1959 as a national counterpart to the

International Union Against Tuberculosis (IUAT, founded in Paris in 1920).

The aim is to improve measures against the disease by extending the system

of activities outside the medical and health service professions into a

popular movement of voluntary contributions (in terms of financial support

and practical work in the field). The objectives of the K A P T have been

formulated as follows:

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To assist in every way possible in the prevention and control of tuberculosis in Kenya with a view to its ultimate eradication and particularly (but without in any way limiting the generality of the foregoing) in the following ways:

a) By fostering the interest of the people of Kenya in all measures con­sidered necessary to combat tuberculosis, by enlisting their active co­operation in implementing such measures and by acting as a centre for prevention and control of tuberculosis.

b) By disseminating knowledge concerning the causes, treatment and prevention of tuberculosis by any means deemed expedient (including leaflets, films, radio and other talks and press publicity).

c) By providing facilities for and assistance to patients and/or their dependants to ensure their continuous care and rehabilitation.

d) By raising funds and receiving donations, endowments, legacies and gifts or other property, materials or equipment of any kind offered as gifts.

e) By adopting such other measures as may from time to time be deemed advisable or expedient for the attainment of the objects set forth above.

f) To supplement and support Government's efforts, particularly health authorities, in all schemes. (Ref. 5)

It can be observed that the .information needed for most of these activities

is on a non-scientific level, although "it is partly concerned with practical

applications of research results (partly just with general education in

hygiene, nutrition, housing, etc). Only item e), formulated in general terms,

may be considered to include high-level information.

"The Association has been dormant since its inception" (Ref. 5), and has only

recently revived into an active state. The content of its activities is,

however, still undetermined, but it is likely that the popularization of

information concerned with health care and community health schemes will

form an important part.

1. C LIBRARIES

The main libraries of interest are the following:

a)*University of Nairobi - Medical Faculty Library, Kenyatta Hospital,

b) University of Nairobi, Science Faculty Library, Chiromo.

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c) University oí Nairobi, Faculty of Agriculture and Veterinary Medicine Library, Kabete.

d) University of Nairobi, Main Campus Library.

e) Kenyatta University College Library.

f) Kenya t ta Veterinary Research Institute Library, M u g u g a .

g ) * I L R A D Library (International Laboratory for Research o n A n i m a l Disease.

h) ICIPE Library (International Cent re for Insect Physiology and Ecology) .

i) * National Public Health Laboratory Service - W e l l c o m e Library.

j) * Medical Training Cen t re Library.

T h e libraries i) and j) are very close to K T I C . Only libraries m a r k e d ( * ) are

directly relevant to medical research.

T h e research library sys tem in K e n y a , as in m a n y developing countries,

generally reflects the prob lem of the small research sys tem: only f e w active

users of research literature in any particular field require a full spect rum of

journals and m o n o g r a p h s . H o w e v ç r , the funding for acquisitions, in K e n y a n

research libraries is better than in m a n y other countries with research

syetems of comparab le size. Priority should be given to the finalizing (and

continued updating and publication) of a union catalogue of current

periodicals in the m a i n research libraries. H o w e v e r , for easy access to the

material an efficient sys tem (i.e. with fast response) of interlibrary loans

with f ew restrictions to provision of photocopies in lieu of actual loans has

to be established.

T w o m a i n problems reside in the attitudes towards this kind of very p r o m p t

service: the staffing prob lem (dependent o n library m a n a g e m e n t priorities)

and the lack of photocopying e q u i p m e n t . This latter factor is related to the,

as yet, not fully recognized importance of photocopies for the efficient use

of the costly library collections. For e x a m p l e , although the user c o m m u n i t y

might be m u c h better served by renouncing several peripheral journal

subscriptions in favour of reasonably priced and rapid photocopying service,

the necessary transfer of funds is not allowed by the budgetary rules of m o s t

libraries.

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One further problem in the present situation is a direct consequence of the

pricing policies of the British Library Lending Division (BLLD) for overseas

photocopy service, which has now become very expensive, - at the same

time the British Council grants for research literature and B L L D coupons

seem to be being phased out.

The use of computerized search services is relatively little known, and is not

publicized. Some researchers obtain such services through personal contacts

(e.g. in engineering, entomology) and some service is given for searchers on

Medline.

The joint holdings of Kenyan research libraries, if effectively co-ordinated

by a c o m m o n policy, could within presently available means, present a good

set of core journals in all disciplines of on-going research. In conjunction

with a bi-lateral working arrangement for provision of computerized current

awareness (SDI) services to a number of projects, and a reasonably

subsidized back-up service of photocopies, the needs for research literature

in science and technology could be satisfied at marginal cost.

Some details are given here for a number of libraries of interest to KTIC:

l.C.l KTIC "library"

The KTIC subscribes to a limited number of periodicals, but the collection is

not organized as a formal library. Presumably the budget available for

subscriptions would be sufficient only for a core set of journals and

monographs and one has to rely heavily on other libraries, both for journals,

monographs, reports and similar publications and of course, for access to

index medicals.

The main libraries of interest are the following:

1.C.2 University of Nairobi Faculty of Medicine Library

Services to Medical Faculty and students. Annual budget for literature

approximately 200,000 Ks. Number of current journals approximately 390.

No library photocopying equipment, but Xerox 3600 in the office of the Dean

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can be used sometimes. British Council offers free Medline searches (since

March 1979).

Staff: 1 librarian, U library assistants, 2 other staff members.

1.C.3 The Wellcome Library (National Public Health Service)

Library established in 1910. Annual budget for literature approximately

100,000 Ks. Number of current journals about 350 (including Index Medicus;

small overlap with University of Nairobi Medical Library; no list of current

periodicals available). Relatively long suites of back-numbers (for Kenyan

situation). N o photo-copying equipment available.

Staff: 1 librarian, 6 library assistants, 2 other staff.

1.C.4 Medical Training Centre Library

Library established in 1962. Serves 17 schools in Kenya with ^ ,000 pupils

(nurses, health technicians, medical laboratory technicians). Annual budget

for literature (1979): 130,000 Ks (plus grant from British Council). Collection

oriented towards training for non-academic lines of work.

Staff: 1 librarian, 9 other staff including library assistants.

1.C.5 I L R A D Library

Library established in 1973. Serves mainly I L R A D projects and projects in

veterinary medicine in Muguga and Kabete. Annual budget for literature

about 785,000 Ks (quoted figure is US$ 112,000. Number of current perio­

dicals (1979) about 250 (including a number of important abstract journals;

the number of periodicals is increasing). Relatively large utilization of B L L D

copies. TeJex available. Xerox 7000, ca 400,000 copies (1978), ca 700,000-

800,000 (1979). Some contacts with University of Zambia Medical Library.

The collection at Makerere University (established in 1902) not available

since break-up of East African Community in 1977. Some experience of

computerized literature searches through CAB-services and through co­

operation with Batelle (Geneva) using Lockheed (Dialog) services.

Staff: 1 librarian, 6 other staff, including library assistants.

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2. THE INTERNATIONAL UNION AGAINST TUBERCULOSIS (IUAT)

The IUAT, formed in 1920, is a federation of national associations against

tuberculosis and certain governmental agencies and health service organi­

zations in 95 countries (1977). In 1973 the scope was enlarged to include

other respiratory infections and community health service. The Union

operates by several modes of action (Refs 1,2):

a) Dissemination of scientific information, by publication of the important "Bulletin of the IUAT" (now k issues per year in English, French and Spanish with a total circulation of 14,000 copies (1978)); the popularizing journal " T " (3 issues per year), bibliographies and other compilations, including W H O material.

b) Encouraging personal contacts, by organizing world conferences (the 24th in 1978) and annual conferences, national and regional seminars, courses, working groups, etc.

c) Applied research and evaluations towards development and acceptance of simplified efficient technology. This is implemented through a number of scientific committees, viz. on "epidemiology and statistics", "bacteriolo­gy and immunology", "case finding and diagnostic methods", "treatment", "prophylaxis", "respiratory diseases", and a "tuberculosis surveillance unit".

"The Scientific Committees review recent discoveries on specific items. They aim at the uniformisation of criteria, at the simplification and standardization of methods. They prepare technical guides (on bacteriology -direct smear examinations; culture; establishment of laboratories -on treatment - regimens; monitoring of treatment). They carry out applied research and cooperative international studies and trials (on chemotherapy, on chemoprophylaxis by INH, on B C G , on X-ray examination, on tuberculin testing).

Over the years, the Scientific Committees have tackled more than 200 items and the reports of their work constitute several thousand pages of the Bulletin of the Union, including the report of 6 recent international cooperative studies.

The Scientific Committees gather presently 250 experts from some 60 countries.

Field projects are carried out under the Mutual Assistance Programme, started in 1961, through which affluent member countries and various donor organizations support and strengthen the field activities of the Union and complement the efforts of less privileged member organizations and countries.

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In cooperation with the World Health Organization, the Union is increasingly helping countries formulate, prepare and launch national tuberculosis control programmes. The help is aimed at improving the delivery of preventive, diagnostic and therapeutic measures against tuberculosis within the frame­work of the general health services, thus contributing to up-grade the work of these services. Projects also include the training of personnel and aim to obtain community participation.

Increasing importance is given to evaluation (in terms of coverage, quality of delivery of services, epidemiological impact and cost/benefit analysis) as a means of assessing progress, reorientating activities and motivating the personnel and the public.

Beside fulfilling this technical advisory role and participating in training, the Union also provides assistance which may include antituberculous drugs and vaccines, medical equipment, means of transportation, salaries of permanent officers of newly founded voluntary associations.

A great number of projects have been carried out or are under way in 19 countries. In 1977 help was given to Bangladesh, Benin, Guatemala, Indonesia, Kenya, Mali, Pakistan, Peru, Sierra Leone, Sri Lanka, Tanzania and Upper Volta."

(Quoted from the back cover of ref. 1)

3. THE W O R L D H E A L T H ORGANIZATION (WHO, GENEVA)

3.1 Tuberculosis and Respiratory Infections Unit (within Division of C o m -

municable Diseases).

This used to be a relatively large operation with headquarters in Geneva,

including specialists for each region plus consultants for field projects. N o w

are only only two medical officers and one scientist. The Unit is involved in

setting up field projects (surveys and studies), co-ordinating certain

activities and providing experts.

A number of projects are directly financed by W H O . The Unit stays in close

contact with IUAT and its committees, and with organizations like the

International Tuberculosis Surveillance Centre, The Hague.

Discussions at the Unit revealed that the total research activity in tuber­

culosis is relatively small at present. Results are mainly published in a

handful of professional medical journals. Only some 10 reports from W H O

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projects are published per year in this area. The unit now puts some effort

into an information service on "the tuberculosis aspect of general medicine".

3.2 The W H O Information Systems Programme

"The W H O Information System is an umbrella title for a number of existing and planned information systems which, though they differ in purpose, users and operation, are all related in that they service these two main functions: the countries/WHO programmes of technical cooperation and the central international exchange of health information." (Ref. 14)

" . . . the W H O Information System would have to comprise a programme management information system and a number of special-purpose (mainly scientific and technical) information systems. The latter mainly form the very support for information transfer and, in terms of volume of data/infor­mation, is the larger." (Ref. 14)

The programme information system is based on standardized profiles for

programme descriptions-containing ten components, viz:

Identifier Policy basis Objectives & targets Description Monitoring & control Participating persons, groups & institutions Essential reports, documents <5c publications Related programmes & projects Analysis & evaluation Cross-references to special-purpose information systems (Ref. 14)

To this system is linked a class of special purpose information subsystems in

support of certain objectives identified as follows:

a) Health Situation Determination b) Monitoring and Surveillance c) Research and Research Support/Promotion d) Programme and Project Management e) Information'Transfer f) Promotion of Standardization g) General Support Services (Ref. 15)

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A total of 290 subsystems have been defined within the W H O sphere.

The complexity of the anti-tuberculosis strategies necessary to obtain a

lasting effect, involving not only medical factors but also (and of the same

importance) socio-economic factors related to nutrition, general hygiene,

housing etc. would indicate the usefulness of a large number of the

subsystems, not only those directly related to the Tuberculosis and

Respiratory Infections Unit. If the information of these subsystems can be

systematically and regularly updated and made retrievable from the aspect

of relevance to this particular application, the impact of information

concerning the W H O overall efforts in improvement of public health may be

enhanced considerably. O n the other hand these subsystems, being limited

to W H O activities, will necessarily cover only a fraction of the total

material that should potentially be relevant.

Since it must be assumed that world expertise in the area of particular

interest here, at least theoretically, is inter-linked within an informal

communication network through the IUAT, this organization might -if it

could be operative to its full potential - constitute a much more,

comprehensive and naturally updated source of relevant information, where

W H O activities and experiences are included as an important component.

3.3 The W H O library

The library is operated as a first priority for the needs of W H O staff and

programmes. It is oriented towards the area of Health Planning and Health

Management in general, and towards research and clinical material in

special areas of W H O priority. It has large collections of monographs (some

t+0,000 volumes), about 2,500 current periodicals and serials, some 250,000

documents from W H O and other U N agencies, some 25,000 governmental or

non-governmental reports. The staff - and acquisitions budget - was

drastically cut by some 50% in 1977, reducing the staff to 8 professional

and 12 non-professional and significantly curtailing the service capacity of

the unit. (Ref. 10).

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A free MEDLINE search service has been operational through the W H O

library for institutions in developing countries and is channelled through the

regional W H O centres. The searches have been performed at the Swiss

Medical Centre in Bern (and subsidised by the Swiss Government). Before

1977 the annual number of searches was about 5,000, and is now reduced to

about 2,500. At present the service is not encouraged by W H O . The W H O

library has given some back-up service of photocopies - now about 3,500

articles per year - using also other libraries to complement its own holdings.

An agreement with the National Library of Medicine (Bethesda, Md.) has

now been negotiated, under which W H O will fund MEDLINE searches and

photocopies for developing countries, except for the American region which

is searched from Sao Paulo. A total number of 2,000 searches per year are

foreseen.

4. J O U R N A L LITERATURE, COMPUTERIZED SERVICES A N D O T H E R

SOURCES OF INFORMATION

The literature on Tuberculosis Research is to a large extent concentrated in

a small number of specialized journals such as:

a) The Bulletin of the International Union Against Tuberculosis ( IUAT, Paris)

b) Tubercle (Edinburgh) c) American Review of Respiratory Diseases (Baltimore) d) Revue française des Maladies Respiratoires (Paris)

The Bulletin of I U A T publishes the proceedings of the Union's World

Conferences, and also the reports from its Scientific Committees . There are

of course articles directly relevant to tuberculosis research in m a n y other

medical journals. These would to a large extent be found in reference

instruments like Index Medicus and the section 15 on Chest Diseases in

Excerpta Medica.

The whole spectrum of medical and socio-medical aspects of tuberculosis

can be searched through the computer-based networks that give access to

the main bibliographic databases:

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1 Medline (co-produced with Index Medicus) 2 Excerpta Medica 3 Pascal (co-produced with Bulletin Signalétique) 4 Science Citation Index 5 Social Science Citation Index and some other more specialized bibliographic databases.

Since the total research activity in the area of tuberculosis is relatively

limited, this must also be the case for the rate of production of medical

research literature relevant to the area. However, there are some major

problems in access:

1 The interdisciplinary character of the public health aspect of tuber­culosis, which makes it difficult to retrieve relevant material compre­hensively.

2 The large bibliographic instruments are based on core sets of journals which exclude many local medical journals (with little international circulation) and other local material of particular interest to the situation of developing countries in the tropical zone.

3 Even if references were found to such journals it would be difficult to get access to the text (in many cases also through problems of language in addition to the problem of physical access) since the material is rarely found in libraries outside the country of publication.

»

4 A large part of relevant work is reported in "grey literature" (i.e. reports from institutions, ministries and government agencies) or is available only in "manuscript" form as the basis of a brief presentation at some conference. Some of these materials may be quite important even for users outside its immediate target groups, but the identification and access to the material depends largely on personal contacts.

5 The essential problem of case finding and therapy and of the more general public health aspect of tuberculosis in developing countries (including B C G vaccination of children) seems to a large extent not to be research-dependent but rather a matter of training a large cadre of health technicians, and managing a major nationwide operation based on well known and relatively simple procedures. The "extension" literature needed is not on the research level, nor dependent on recent research developments, but is rather a matter for the local medical training schools and national health service and education programmes. The international research literature will be of little help in this context. A comparative -study and evaluation of textbook materials and audiovisual aids for appropriate low-level training programmes (particularly in developing countries in the tropical zone) should be of direct importance.

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5. OBJECTIVES F O R I N F O R M A T I O N SERVICES A T KTIC

In order to define objectives for an information service at KTIC it is

necessary to decide what kind of information is to be handled. Research

documentation services normally deal specifically with bibliographic infor­

mation, giving pointers to the scientific literature. It is then a problem for

library services to give access to the full text of the material supposed to be

relevant in a particular context. A n immediate objective for an information

service at KTIC would be to provide such bibliographic searches giving

access not only to the material easily available in the international

literature (e.g. through Excerpta Medica and Index Medicus), but also to the

"grey literature" of local reports and publications, in particular those

produced in developing countries in the tropical zone. This is a relatively

straightforward and well-defined task for which actions can be defined and a

programme be set up.

The concept of "tuberculosis research data", however, might be taken to

include also categories like

a) primary (raw) data from laboratory research b) clinical data from medical practice c) statistical data d) demographic, data • e) empirical data from social research, etc, etc.

This kind of material is extremely difficult to handle out of its context and

without reference to a larger conceptual framework. It is advisable not to

attempt to handle it other than in form of extremely well-defined, narrrow

pilot studies. An obvious example of manageable data sets of this kind is

given by statistical data specifically used for wider circulation, e.g. for

national or regional surveys. Even in such limited and well-defined cases the

maintenance of up-to-date files and the preparation of input in a consistent

and unambigous way is a difficulty that should be considered seriously before

regular information service commitments are made. More generally, the

information produced and needed by the health service delivery system, the

social research system and the social service delivery system, is extremely

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difficult to define and handle in terms of comprehensive information and

documentation services. As long as the information output or input is

explicitely related to "tuberculosis research", the material can in principle

be included in a documentation service specifically oriented towards this

area. The information needs will, however, in most cases be much wider and

could probably not be catered for completely by such a specialized

information service.

It is, therefore, advisable to study the information needs of user communi­

ties potentially interested in such for information services in order to get a

sufficient back-ground for proposals of services outside the medical

literature proper. Such studies, therefore, are clearly within the objectives

and information service at KTIC. A third group of objectives is to provide

training in the use of information services, thereby also marketing the

services set up by the centre and creating a broader base for continued

activities.

6. STRATEGIES F O R C R E A T I O N O F I N F O R M A T I O N SERVICES A T KTIC

The "research data bank" concept'is here (except for studies suggested)

limited to bibliographic documentation services related to the area of

tuberculosis research. A mixed strategy of using conventional and compute­

rized techniques can be employed, whereby different levels of activities can

be achieved depending on the resources made available. When discussing the

resource level, one has to remember that tuberculosis research is a very

narrow field, and that services to be created should be seen as complemen­

tary to services given by other I&D centres, for example university libraries.

6.1 An important prerequisite of information services is an updated union

list of journals in relevant fields, held by the main libraries in Kenya.

(Appropriate measures should be taken to speed up the process of publishing

at least a partial list for the medical field from the material already

assembled.)

- ]A -

6.2 KTIC will need a formalized library to maintain a small specialized

collection. This will include somewhat extended subscription to main

journals in the field of tuberculosis research and a systematic collection of

"grey literature" in the area. This includes establishment of international

contacts with main research centres in the world concerned with tuberculo­

sis research and particularly with centres in developing countries in the

tropical zone. Material required for the library should be indexed and

possibly abstracted to provide a searchable file to be used in documentation

work.

6.3 This special library should provide back-up services for the documen­

tation services attempted, involving

a) photo-copy service from its own holdings

b) establishment of inter-library loans service, also with centres abroad, and providing photo copies, reprints or original documents of material not available at KTIC.

6.4 In parallel with this development of library services proper a

documentation service can be gradually established. This documentation,

service can provide manual searches in the literature, and computer-based

searches in major data bases, in particular Medline and,Excerpta Medica. As

long as direct on-Jine searches are not possible, this service can be provided

through an intermediary organization by means of bi-lateral agreement.

6.5 Since documentation services can be made viable through an intense

user training activity, this bi-lateral agreement should be extended to

include also development of user training programmes and techniques for

obtaining feed-back from users to guide further development of services.

6.6 Retrieval services should be both of the retrospective type and of the

current awareness type. The latter ones can take on various forms to be

developed according to the perceived needs. For example a simple and

effective method to disseminate information on recent journal articles is to

circulate photocopies of tables of content of the most important journals to

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users who do not have easy access to appropriate library collections.

Another method is to put up standard profiles to be searched on the main

data bases, and to produce small editions of the print-outs. A third method

is to produce specialized bibliographies with current updates.

6.7 A further service is to produce a newsletter giving different kinds of

information, for example news items on events, institutional activities,

research results, etc, acquisition lists for the KJIC library and other

bibliographic information of general interest. Such a newsletter should, of

course ,be oriented specifically to the local needs, perhaps later to be

addressed to the entire region of the developing countries in the tropical

zone. The production of such a newsletter should not overlap with the

information given in the publications of the IUAT, which must be assumed to

reach the entire community of users of tuberculosis and research informa­

tion. (This assumption must, of course, be verified!)

6.8 One more important activity located at the information centre is to

give referral service to individuals and institutions when personal contacts

are needed for research or practice involving information which is not

covered by the literature.

6%.9 A number of studies will have to be performed both to decide on how to

develop information services and to evaluate the effectiveness of different

programmes. These will include studies of the various user communities

interested in the information services, their present information sources,

present and potential needs, etc. Such studies will be of particular

importance in the areas not covered by the medical research literature, i.e.

publications dealing with the social managerial and economic aspect, and all

kinds of data needed not only in research on tuberculosis, but also on all the

other non-research aspects associated with important social conditions and

health delivery systems present in developing countries in the tropical zone.

Since tuberculosis is only one aspect of many of these problems, studies

should be designed to demonstrate to what extent specialized information

services dealing with this particular aspect will be helpful, and what forms it

should take.

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6.10 The Nordic countries, in particular the northern parts of Sweden,

Finland and Norway, suffered from a widespread presence of

tuberculosis as recently as 50 years ago. It has been suggested to m e that

the situation in these areas at the time referred to in many important

respects can be said to be comparable to the present situation in rural areas

of many developing countries. A lot of experience has been gathered on the

process whereby the disease has been practically eradicated. It might be a

fruitful idea to include as one of the development studies for KTIC to solicit

(perhaps through IUAT) a study on this whole process with a view to transfer

some of the decisive experiences on managing case-finding, therapy and

health-educational programmes, even if social, environmental and climatic

conditions are different from the situation in the tropical zone. Since some

of the pioneers of these ventures have been involved in health service

programmes in India and other areas of the tropical zone much of this

experience has probably already been made available, although perhaps not

to its full potential.

It is advisable both in developing the depository of "grey literature" and in

establishing documentation ' and referral services to utilize at its full

potential'the network of institutions and individuals established by the IUAT.

7. STAFFING

7.1 One librarian with experience form university medical faculty libraries

and a back-ground in life sciences and appropriate library training.

This librarian should be trained externaly as a documentalist in order to be

able to conduct not only the development of the library collection, but also

the preliminary stages of development of documentation services (in co­

operation with a documentation consultant). The librarian will also be in

charge of marketing information services, investigating user needs of

scientific literature and organize user training courses for documentation

services.

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7.2 One assistant to be in charge of international and local correspon­

dence, maintenance of the contact network which provides external

retrieval services and an inflow of documents, and day-to-day contacts with

users.

7.3 One typist to assist in the correspondence and also to maintain the file

of documents held at the KTIC library (possibly as a computer edited

catalogue).

7A In the beginning there will be need for access to a photocopy operator,

and a driver for document delivery.

At a later stage as the services will develop, the staffing situation will have

to be reviewed.

8. CONSULTANTS

8.1 A six months' consultancy of a documentalist with experience of

computerized services in the medical field. This consultant should start up

documentation services, organize the bi-lateral agreement for computerized

service from abroad, design and organize user training programmes and

pursue studies of the structure and needs of the user community and on the

structure and character of the "grey literature" to be collected. The

consultant should specifically work towards making the KTIC librarian fit

for taking over responsibility.

8.2 A different kind of consultant will be needed to pursue studies on

potential information services related to the non-medical-research informa­

tion (literature, data etc), which would be needed for comprehensive

information services related to tuberculosis research and associated applica­

tions. In view of the experiences both of community health systems and of

the building up'and inter-relationship of specialized information services,

the W H O ought to be consulted both on how to recruit an expert for this task

and how to pursue this kind of studies. Likewise the IUAT should be involved

so that its world-wide network of expertise could be effectively included in

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the studies. From a documentation service point of view the social science

oriented aspects are very difficult to handle. Even a person experienced in

the social, managerial and economic problems of developing countries will

need considerable time to get an overview of the situation and design a

viable programme that brings some structure and specificity to information

services and some judgment on their importance and cost-effectiveness.

Only after these studies have been performed and evaluated is it possible to

embark on a practical programme to extend the basic documentation

services related to the scientific literature. The period of 6 months'

consultancy is probably a minimum for this kind of exploratory studies.

8.3 Resources also have to be made available to hire computer soft-ware

personnel to design and construct the programmes necessary for the

computer applications found appropriate in the various stages of develop­

ing information services. This may include up-dating and retreival from

the file of "gfey literature", handling of profiles for current awareness

services, production of camera-ready manuscripts for special bibliographies

and simple products like automatic production of adhesive address labels for

different subsets of the user community.

> i

9. Funds should be made available for external training of the KTIC

librarian in modern documentation services and the use of computers in

library and documentation work. A stay- of about four months in an

advanced institution and a further period of two months for trips to several

major information centres (e.g. in the Netherlands, the United Kingdom and

the United States of America) and to W H O and IUAT should be foreseen.

10. Equipment. The centre will need certain basic equipment including two

modern typewriters and a plain paper photo-copying machine of the Xerox

3100 type or of comparable efficiency. For the library some regular

equipment (shelving, filing cabinets, etc) are needed. A connection to the

Nairobi University Computer should be established which involves purchase

of an appropriate terminal and a high-quality printer (e.g. of the daisy-wheel

type).

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REFERENCES

1 Bulletin of the International Union against Tuberculosis (53:4(1978)) (inçl. Proceedings of the 24th World Conference of the IUAT)

2 L'Union Internationale contre la Tuberculose (UICT) - En bref

3 The International Union against Tuberculosis (Circular letters on the 24th World Conference 1978 and on the Annual Meeting 1979)

4 The Kenya Association for the Prevention of Tuberculosis - Constitution (1979)

5 The Kenya Association for the Prevention of Tuberculosis - Presentation of Objectives (1979)

6 Kenya Tuberculosis Investigation Centre: Kenya Tuberculosis Survey -1979

7 Kenya Tuberculosis Investigation Centre: Kenya Tuberculosis Survey -1979. Protocol for B C G Scar Survey (Nairobi, May 1979)

8 Tuberculosis Research in Kenya (Letter from Dr 3.A. Aluoch, KTIC, to Chief Olu Ibukun, U N E S C O , Nairobi)

9 World Health Organization, Advisory Committee on Medical Research (Subcommittee on Information): W H O Programmes on the strengthening of National Health Libraries and the Development of Regional Medical Libraries and Regional Health Centres (1979)

10 Library Guide (World Health Organization Library, Geneva)

11 World Health Organization: list of Documents in the W H O / T B - series (Aug. 1977) (Formerly W H O / T N / T E C H N . INFORMATION) Series

12 World Health Organization (Tuberculosis and Respiratory Infections Unit - Division of Cummunicable Diseases): List of Currently Available Publications and Documents on Tuberculosis and Respiratory Infections

13 S.H. Mandil: A Survey of Special Purposes Information Subsystems (WHO - ISD/76/12, 1976)

14 S.H. Mandil: Towards a New W H O Information System (WHO ISD/76/13, 1976)

15 Boletin de Tuberculosis (Sept. 1976; issued by the Pan American Health Organization {WHO), Washington, DC)

16 P . N . D . Njagi: The Wellcome Research Library (National Public Health Laboratory Service, Nairobi)

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VISITS RELATED T O THE KTIC MISSION

W H O , Geneva

Mr D . Berg Dr B. Mansourian Dr F. Rodriguez-Alonzo Dr A . Pio

Mrs G . Bencze

Information Systems Development Research Promotion and Development Library and Health Literature Services Tuberculosis and Respiratory Infec­tions Unit Reporting and Information Services

Kenya Tuberculosis Investigation Centre (KTIC)

Dr J.A. Aluoch (Director) Dr F. Kamunvi Dr A . Dallas Mr E.A. Edwards

Medical Training Centre

Dr M . R . Migue (Director)

Wellcome Medical Library

Mr P. Njagi (Librarian)

University of Nairobi

Mr 3. Ndegwa (Director of Libraries) Mrs R . M . Kiathe (Librarian) Mr S. Durrani (Librarian)

Medical Faculty Library Faculty of Agriculture and Veterinary Medicine Library

ILRAD

Mr P. Imende (Librarian)

ICIPE

Mr D . R . Kigera (Librarian) Mrs R . Ortega (Documentalist)

Kenya Agrarian Research Institute Library, Muguga

Mr D . Njoroge (Librarian)

Medical Research Centre Department of Royal Tropical Insti­tute, Amsterdam

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