Health Libraries and Information Services in Tanzania: A Strategic Assessment

Abstract

Objective

To identify the current status and local impact of health sciences libraries and the perception of these libraries by their users, as a pre-requisite to the development of a competence-based curriculum for health information science training in Tanzania.

Methodology

A needs assessment was carried out using a convenience sample of local respondents, including librarians, trainers, academicians, students, health care providers and patients and families, drawn from national, referral, regional, district hospitals, health training institutions, and Universities from both government and non-government entities in Tanzania. A focus group approach was used to gather data from respondents.

Results

Results from this assessment revealed that health science libraries in Tanzania are faced with the challenges of insufficient infrastructure, old technology, limited facilities and furniture, inadequate and incompetent library staff, lack of health sciences librarians, outdated and insufficient resources, as well as low knowledge and use of information technologies by library clients. Most respondents would prefer to have both physical and electronic libraries, as well as librarians with specialized health information science skills, to cope with changing nature of the medical field.

Conclusion

The findings obtained from this assessment are strong enough to guide the development of a curriculum and training strategy and an operational plan and training packages for health information professionals. The development of a training curriculum for health information science professionals will mean better health information service delivery for Tanzania.

Introduction

The nation of Tanzania has begun implementing health sector reforms to improve equitable access to health information, as well as improve the quality of information received by all user communities. The need for timely and quality-filtered information at the moment in health care is universal. The overwhelming amount of health information, and the absence of time and expertise on the part of physicians and other health professionals to find, assess, and apply health information in their daily decision making. It has created an opportunity for information science specialists to play a major role in (i) storage (ii) retrieval, (iii) appraisal, (iv) management, (v) summarizing, and (vi) delivery of timely and reliable health information at the point of health settings ^1,2. While there are some relatively recent studies of information needs and behaviours of health-related users in other countries in sub-Saharan Africa ^3-11, there are few specific studies on health information practices in Tanzania ^12-14.

An understanding of the training needs for medical librarians will help the Tanzanian Ministry of Health and Social Welfare (hereafter cited as the MoHSW) improve the operations of Ministry-sponsored, Faith-Based Organisations (FBO) and private health science libraries, as well as those in clinical and educational units across the nation. Information specialists need to become more effective and efficient in the provision of health information services to their users, by acquiring the relevant information necessary by the health professionals and providing that information in a cost-effective and efficient manner that will enhance the provision of high-quality health services in Tanzania.

The MoHSW conducted a needs assessment project aimed at identifying the current situational of the medical/health libraries in the country and assessing the health information training requirements for librarians. The project was required to initiate a national health information science program at health training institutions, to produce health information specialists who would then be in all clinical areas, hospitals, health higher learning institutions, nursing and allied health sciences schools for both public, FBO, and private entities in the country. The needs assessment project was expected to guide subsequent activities, such as the development of a budget for ongoing training and operational planning, competencies and curriculum development, and possible continuing education training modules for medical librarians at diploma, bachelor and master achievement levels. A follow-up meeting was held with video conference between participants in Tanzania and colleagues who were gathered at the National Library of Medicine in the US.

Related Work

Current Competencies of Practicing Librarians in Health Sciences Libraries in Tanzania

"The health sciences librarian believes that knowledge is the sine qua non of informed decisions in healthcare and the health sciences librarian serves society, clients, and the institution, by working to ensure that informed decisions can be made" ¹⁵. It was noted that access to accurate and appropriate information is a prerequisite to good health ¹⁶. Ultimately, services provided by health sciences librarians at many health organizations requires them to act as full members of the health workforce ^17,18. Unfortunately, the health science information systems and services in Tanzania are not well organized to provide an opportunity for health librarians work in close collaboration with clinicians. Its existing health information centres include University libraries serving medical and allied health faculties and students, health training institution libraries operated by the MoHSW, a central MoHSW medical library, as well as national, referral, regional and district hospital libraries and libraries in some public and private health-related organizations. Many hospital/health facilities do not have health sciences libraries or health information resource centres. However, most of the librarians in Tanzania do not possess appropriate knowledge and skills to provide quality health information services in a timely and accurate manner ^12,14,19.

As a specialized field, education for medical librarianship needs special courses and lectures; medicine has its own subject classification systems, different from that used by librarians in non-medical information. Tanzania is among the developing countries with no academic library science programs for medical librarianship. Some colleges and universities in Tanzania do offer library, information management, and information science courses at general levels; these diploma/degree/masters programs cover general library/information science concepts and competence, and graduates are prepared primarily for work in the academic and public library sectors. Thus, a specialized curriculum in medical librarianship is needed to prepare information professionals who can deliver health information services that will make a difference in health care services and clinical research. A thorough investigation of contemporary medical information needs in Tanzania is necessary to inform medical librarian curriculum development, and this understanding must be based on an understanding of users’ needs.

Basic Health Information Needs of Health Sciences Library Users

There are a handful of studies on information needs, practices, behaviours, and provision of health information in Africa’s developing countries, primarily focused on the needs of health professionals and a few patient groups. For example, information needs by practicing nurses may include the needs for information on causes, patterns, and physical signs of disease and managing locally common presenting signs and symptoms. Patients’ information needs range from the needs of information on aging and hypertension, sexual functions and the roles of doctors, test results, treatments, cardiac rehabilitation, and how their families could support their lifestyle changes. They need information on “symptomatology and greater self-efficacy, healthcare satisfaction, and preventive health behaviours” ²⁰.

Studies on the information needs of health practitioners have identified various sources of information that are relevant to meet their information needs. These sources include external databases, research reports and research findings, meta-analyses and systematic reviews, and up-to-date information that is filtered, summarized, and synthesized from authoritative content ²¹.

Appropriate Curricula for Health Information Professionals (including health librarians)

Unlike general librarianship, health librarianship is more concerned with evidence-based digital information which supports the ever-changing health-related information needs of the digital medical generation ²². Health information science courses should include information skills, literature search, and evidence-based medicine resources training programs ²³. Health information professionals require training in (1) information science and medical informatics, (2) including the electronic medical record, (3) knowledge-based information and digital libraries, (4) digital imaging systems, (5) telemedicine, (6) clinical decision support, and (7) evidence-based medicine (EBM) focused on developing tools to access and apply the best evidence for decision-making for patient care ^24,25.

Infrastructure, Facilities and Environment for Health Information Sciences Programs in Developing Countries

The continued use of physical facilities and print-on-paper information resources in health sciences settings is gradually being replaced by the use of virtual libraries of electronic health information resources and services. However, the availability of appropriate infrastructure, facilities and the favourable environment in developing countries is plagued with poor, widely scattered, difficult to locate information resources that often become difficult to use ²⁶.

Methodology

This study employed focus group discussion as a research method, due to the fact that it provided the opportunity to include a large number of participants, also to engage them and gather information about their experiences in an open-structured focus group discussion. The focus group discussion was guided with developed and structured protocol aimed at discussing the following research objectives:

RO1: To assess current health information practices of potential clients in a health sciences libraries

RO2: To find out health information needs of health sciences library users

RO3: To identify desirable levels of competence and entry qualifications for students in a training program in health information sciences

The Fact-Finding Activities

An understanding of stakeholder information needs, practices, and behaviours is crucial to planning educational strategies for training health information workers for Tanzania. To that end, the MoHSW organized a fact-finding mission to solicit stakeholders’ opinions on the current status and impact of health sciences libraries, and their own information needs. Input from a variety of interested individuals--physicians, nurses, librarians, trainers, academicians, students, patients, and families--was seen as pre-requisite to the development of a competence-based curriculum for training Tanzania’s first generation of the health information specialists.

Two US-based consultants were invited to Tanzania, to meet with a team of local experts to plan a systematic investigation of stakeholder requirements that could support the development of training for health information sciences. The project was charged with identifying the stakeholder communities, the challenges to their access and use of health information, and their current information needs and practices. This descriptive, cross-sectional needs assessment was conducted using a participatory qualitative method. Invited stakeholders were selected on the basis of their experience in different aspects of health care system.

The situational analysis was held in four regions which were randomly selected from a list of health facilities in the Tanzanian mainland. The team conducted field visits in four study areas: Dar Es Salaam, Kilimanjaro, Mwanza, and Njombe. See Appendix 1 Map of Tanzania. Each study area had three field visitors for data collection who carried out their investigation in the national, referral, regional, district hospitals and health training institutions from both government and non-government entities. Within the study area. See Appendix 2 for lists the sites and institutions in which the field visits took place.

A three-day orientation workshop and planning session was conducted in the town of Morogoro to create a tool for facilitators and note-taker teams on how to conduct the investigation and collect information through focused group discussions at a series of multi-disciplinary sites.

Focused group discussions are made up of people with a particular experience or knowledge about the subject of the research, and the discussions enable researchers to collect a lot of data quickly to facilitate the identification and exploration of beliefs, ideas, or opinions specific to the research topic. The workshop participants were able to develop a data collection tool, identify data collection sites, identify types and number of the key informants at each site, and establish a systematic approach for the focus group discussions. The group of specialists panel worked together to develop a set of guiding questions to use with the stakeholder discussions, and also had several workshop sessions on current trends in health information practices.

As this research was totally carried out in Tanzania, an American-style IRB permission was not required, but the participants were advised in advance of each meetings that the discussions would be used without individual attribution, that their confidentiality would be honoured, and that any tape recordings of the discussions would only be used as confidential documentation of the content of the discussions themselves and would not made public in any way that would identify the speakers. Data collection teams agreed that the sessions would be conducted in both Kiswahili and English, but in order to ensure better understanding and active participation on the issues, primary language for the majority of the discussions was in Kiswahili, the two US investigators were not involved directly in the discussions, and any photographs used in publications do not specifically identify individual participants.

At each site, the overall project goals and purpose for each focus group discussions were presented first in a plenary session by a representative from each group. After the presentation, all participants then contributed by sharing their own experiences and thoughts, leading to active discussions that were recorded by note takers. The individuals at the four sites formed a convenience sample of local respondents. A total of 280 Tanzanian stakeholders participated in the 24 focus groups; each group had from 8 to 12 participants.

3.2. Data analysis

The qualitative data gathered through focus groups discussion was initially analysed by the facilitators and the note-takers involved in conducting the focus group discussions. After completion of the focus group discussions, MoHSW staff was able to compile the evidence into a data matrix form according to themes ²⁷. The themes were:

Theme 1: Current health information practices of potential clients in a health sciences libraries

Theme 2: Health information needs of health sciences library users

Theme 3: Desirable levels of competence and entry qualifications for students in a training program in health information sciences

Prior visits to four study sites were undertaken, a list of themes, guiding questions, and terms of reference (TOR) for the project were developed by a multi-disciplinary group of experts from the MoHSW, National Council for Technical Education (NACTE), and representatives from institutions that provided training for a variety of stakeholder groups, as well as the two US consultants. See acknowledgement section for lists of members of the expert team. Each research theme (protocol) had several research questions that guided facilitators and participants in discussion and shared their ideas related to health information services ^27,28. At each of the four sites, focus group had a facilitator and two note takers, all of whom were participants in the orientation sessions. The facilitator led the discussion using guiding questions (protocol) to gather in-depth information; the note-takers recorded the matters arising from the discussion. Recorded conversation was transcribed and later on thematic analysis were used to analyse collected data ²⁸. The entire data matrix is available as supplemental material, as a PDF electronic file.

Findings

A summary of findings with representative comments from participants is organized around the three themes. The results offer a compelling snapshot of the health information behaviours and practices of various user communities who will be served by Tanzanian health information specialists.

THEME 1: Current Health Information Practices of Potential Clients in a health sciences libraries

Question: What methods are currently used to locate, store and retrieve health information?

Participants mentioned ways of locating, storing and retrieving health information such as shelves and cabinets, computers, use of a drop box, searching for labelling, indexing and bibliographic tools, using storage gadgets such flash drives/disks, CDs, external hard drives, downloading and saving, printing and storing hard copies, presentations, databases and other search tools like HINARI and PubMed.

Question: What do you know about the use of electronic tools (databases, PubMed, HINARI, NLM, MeSH, Search engines and Library catalogues)?

Only a few respondents reporting knowledge or use of PubMed and HINARI, while most of them reported having knowledge or use of other library search engines and catalogue. None of them reported any knowledge or use of MeSH and NLM.

Question: What methods are used to communicate health information?

Respondents cited a variety of means to communicate health information: e-mail, meetings, and conferences, interpersonal communications, presentations, Web2.0 technology, written texts, quarterly reports, morning clinical report calls, brochures, flyers, collateral media.

• “Communication is made through meetings, debriefings, management meetings, general meetings and training” (Clinician).

• “We communicate health information through presentation, quarterly report, morning clinical report, written text and email” (Clinician)

Question: What about the existence of functional library and usage skills?

All of the respondents from training institutions/organizations reported that they had functional libraries, but only one university reported having a repository, and only one clinical institution reported having a medical library, though without any skilled medical library staff. A majority of respondents said that they had skills in using a library and that they gained that experience in their professional training in sites where there was a formal library.

• “There are orientation sessions where users are oriented on how to use library services” (Student)

• “There is a system of orientation on how to use library; however, skills on how to access online information is a problem for the majority of students” (Student)

• “I always go to library to remind myself and gain new knowledge, but while in school it was necessary to go to library for assignment completion” (Clinician)

However, when asked about colleagues’ information practices, a majority commented that they were not sure about their colleagues because of there was no library facility in their institutions, while others rated their colleagues as having poor skills in the use of the library.

• “Because here we do not have library facility, it is difficult to know if other colleagues have skills of using library or not” (Clinician)

• “Some students have skills but the majority of them do not have enough knowledge” (Academician).

Question: What about the Capability to use Information Communication Technologies?

A majority reported that they had basic Information and Communication Technologies (ICTs) application skills, while a few of the participants said they were capable of higher-level ICTs skills. Some participants, however, misinterpreted the meaning of ICTs to mean very narrow sense of Information Computer Technologies instead of Information and Communication Technologies. A majority of the health professional participants said that they had active email addresses; few patients or consumers reported having active e-mail addresses.

Question: What about the existence of a trained health sciences librarian?

Most of the respondents from training institutions reported having no trained health sciences librarians; rather they have general trained librarians. Apart from that, surprisingly, only one hospital had a library.

Question: What is your perception of the roles of a health sciences librarian in an electronic environment?

Participants were able to describe some roles for a medical librarian in electronic environment, including the ability to ensure availability of relevant and current health information; to guide customers on how to find books and related health information resources; to facilitate health information literacy training; to communicate with other health information resource centres; to develop online catalogues; to promote use of library; and to manage the library.

Question: What are your views on developing a health sciences librarian specialty?

All participants strongly agreed on the establishment of a health information specialty, because having health information specialists can help them to get current information on the right time and cope with changes taking place rapidly in the health field.

• “This specialty is highly needed and prioritized; it should start with diploma level” (Academician)

• “A medical librarianship specialty is extremely important because it will help those undertaking distance learning to access health learning materials” (Clinician)

Question: What is your preference between a physical and an online library?

There was a wide variation in preferences among respondents; a majority preferred both an online and a physical library because of internet problems with very slow, or no, connectivity. Some preferred only an online library because it could provide easily accessible and updated information. However, most respondents reported that they do not have skills for using online information and report problems with network connections.

Question: How frequently do you visit a physical library?

Those with no library facility obviously do not visit a physical library, and those with a library facility rarely visit, usually only when they have an assignment; they perceive that the existing libraries have outdated materials that do not suit nature of their activities.

• “We only use the library during examination periods, and when we have assignments, in that period, you find most of the students visit the library” (Student).

• “The higher one goes in the education ladders, the lesser time one visits the library, as most times they are busy in clinics attending to patients” (Academician & Clinician)

Question: How frequently are you utilizing online health information?

Respondents had different opinions on how often they utilize online health information; those with connectivity utilize online health information daily, with some reporting that they visit online information 1-3 times per week. In some places, online information could not be obtained in a timely way due to poor internet connections.

• “Almost every day as medical life requires regular access to the Internet” (Clinician)

• “If I go to internet café or use my modem, I can get the online information that I need, but some days the internet can be very slow in the daytime but in the evening it can be very fast” (Librarian).

Question: What about the provision of specific instructions to library users?

Librarians reported providing assistance occasionally to those who are in need, while some instruction is provided by academicians in the classroom. However, some librarian said that they did not have enough knowledge to provide specific instruction, especially in an electronic environment.

• “It depends on those who are borrowing books, some of them are knowledgeable but some they do not even know the type of books they want, they just tell you I have this assignment then you have to assist” (Librarian)

• “Mostly to postgraduates and not very regularly to undergraduates” (Academician)

Question: What do you think is the contribution of health information resources to your duties?

Participants mentioned different ways in which health information contributed to achievement of their duties: keeping health care providers abreast of the current knowledge in their sphere of interest, improving quality of health services provided, supporting evidence-based medicine, facilitating learning process and research development, improving access and use of research findings, and serving as a health information source to patients and public at large. Additionally, participants were able to mention challenges encountered in areas of responsible and ethical use of health information resources such as subscription fee to access online health information, plagiarism, the authenticity of information, misuse of information resources, and mutilation of library resources.

Question: What about the provision of distance-learning courses?

Individuals from some of the training institutions provide both on-site and distance learning courses, but none of the organizations provides online library courses.

Question: What information is available about library operating hours and its reliability?

The three university libraries which were visited operate for 14 hours during weekdays and 8 hours on weekends, including the services of a generalist librarian. Other institutions indicated that the operating hours were the official working hours (7:30am-3:30 pm) but noted dissatisfaction with these operating hours and wanted additional service time. Most of the libraries were not equipped with ICT facilities and up-to-date health materials. There were an inadequate number of computers compared to the number of users, unreliable internet connectivity, and no e-resources. In two of the university sites, wireless internet connections were only available from within the library premises.

• “wireless internet connection is only within library premises; it could be better to have wireless in our residence halls so as to have access to health information twenty-four seven” (Student)

THEME 2: Health Information Needs of Health Sciences Library Users

Question: What is your current access to health information?

Participants mentioned accessing books, journals, articles, research findings, published and unpublished government reports, libraries, databases, search engines, collateral media, leaflets, flyers, brochures, websites, and portals, as sourced from information necessary for health sciences.

• “The information resources necessary for our work are books, journals, modules and ministerial policies and guidelines” (Clinician)

• “The needed information for our work are subscribed electronic resources such as EBSCOhost, updated library books and book bank materials “(Librarian)

Question: What are the challenges encountered in communicating health information?

Respondents indicated that the challenges they faced in communicating health information within their institutions were the misinterpretation of information, delays in information delivery, a lack of public awareness about health information, a lack of timely feedback mechanisms, incomplete information, and information sharing barriers. Furthermore, participants mentioned the challenges faced in utilizing library services were outdated books, the shortage of library staff, library size as compared to number of users, misuse of library structures, misappropriation of library facilities, a low regard for library services, inadequate learning materials, the lack of e-resources, and the lack of reliable internet connectivity.

Question: How do you see the way forward in improving health information services?

Participants proposed a wide variety of ways to improve health information services, including the establishment of health information sciences programs, improved health sciences library operating hours, the introduction of electronic libraries, the expansion of library physical infrastructures to take on an increased number of users, updating library stock, increasing number of skilled health sciences library staff, establishment of health information resource centres at each organization or institution, special set-aside funds for subscription fees, and a prohibition on misuse of libraries.

THEME 3: Desirable Levels of Competence/Entry Qualifications for a Training Program in Health Information Sciences

A majority of respondents proposed that the entry qualifications for a training program in the health information sciences be the successful completion of a British-style Form Four or Form Six education, with passes in the science subjects (chemistry, biology, and physics) and passes in mathematics and English. Some suggested that a prospective trainee should also have a background in nursing, clinical medicine, health records, and other health related fields. The following quotes are illustrative:

• “It will be better for a person to have passed in science subjects like physics, chemistry, and biology, that will be very helpful even if a person need to know something s/he can help” (Clinician)

• “Not only science subjects but also s/he should have Certificate / Diploma in any health fields like clinical officers and nurse assistance” (Librarian)

• “People with librarian qualifications can also join the course” (Academician)

• “The Ministry should enrol current librarians who have certificate/diploma to undergo health information science programme as a capacity building (Librarian)

Discussion

This study sought to identify the current status and local impact of health sciences libraries and the perception of health information services by users. Collected data were regarded as a prerequisite to the establishment of the competence-based curriculum for health information science training. Results obtained from situational analysis, and the stakeholders identified several weaknesses and challenges in the current and potential workforce, including insufficient health information literacy skills and incompetence in health information search skills, and inadequate knowledge in biomedical and basic health sciences, as well as inadequate training in medical, legal and professional ethics. It was also found that poor communication skills, insufficient training in health information system management, information technology, management and leadership skills and research methodology posed a potential threat in developing a successful new curriculum. Similarly, the mentioned weakness and challenges were also identified in some prior studies ^{10,12-14,29-31}. It is crucial to overcoming the said problems in accessing health information in all healthcare settings that can support quality services delivery country wide.

The research finds that different types of health related information are required by users. However, the information need depends on the activities performed or problems need to be solved by information users. For instance, health professionals they need health-related information to perform the following policy and decision-making activities, including drugs and medication category, administration of patients, control of diseases, hospital management, training, and development, human resource for health, outbreak of infectious diseases, equipments and tools ¹². One hand, study conducted to assess health information needs and behaviour of health practitioners revealed that they sought information related to specific health information, general health information, health practice, information to support teaching and learning, and information for conducting research ¹³. On the other hand, health sciences students indicated they need information concerning their education project and activities including: for coursework and assignment, preparing for test and examinations, general reading to enhance lecture notes and for group discussion ³², information related to personal development, academic activities, and employment issues ³³. This information has been found in different sources that can be categorised into three: human, printed and electronic. However, this study indicated number of challenges related to access health information that encounters information users.

Desirable levels of competence and entry qualifications for students in a training program in health information sciences is one of important objective we addressed. In any educational program, the admission criteria for the potential prospective students and the duration of study have a substantial impact on the learning process and quality of the graduates. For example, a diploma in medical librarianship in the UK requires one to register for a course on information management and technology (abbreviated as IM&T) in the areas of medical sciences, and the course has to be studied within two to three years ³⁴. Health information specialist should be an individual with a good science background in his or her secondary school education. This suggestion is well supported by NACTE’s National Technical Award (NTA) learning systems. Most of Diploma program in health sciences courses the duration of study is three years, this program the duration of study must be determined by the course content to ensure that required competencies are covered. The advancements in ICTs, the worldwide information explosion and the unique nature of medical sciences requires health information specialists and medical librarians to be conscious of legal and ethical issues that are essential for building trust with medical practitioners and patients/consumers in the process of providing health information services ³⁵, competencies are outlined in Appendix 3.

Tanzanian health training institutions are at different stages of the accreditation process, but they typically have basic teaching and learning infrastructures such as teaching hospitals, classrooms, dormitories, computer laboratories and libraries. These institutional strengths can facilitate the establishment of a diploma program in health information sciences; one institution will be chosen to implement the course. The availability of skilled human resources, reliable infrastructure, modern medical facilities and support from medical councils have created a favourable environment for a successful launching of health information science programs in those countries ^31,36. Currently, there are issues of unavailable of qualified medical/health information specialists, and infrastructure issues such as dormitories, libraries and skills labs which need to be significantly renovated and improved. In some training institutions, students reported very limited access to ICT services including internet connections due to the presence of conflicting demands with institutional priorities and financial difficulties. To have a successful health information science program in a dynamic information technology environment, a stronger ICT infrastructure is of paramount significance ^37,38. A cadre of instructors—most likely from among those with an existing generalist library degree but who lack a health sciences and medical specialization, needs to be trained as teachers for the diploma program. This can best be done by having those proposed as librarian instructors earn their master’s degrees in Library and Information Science through an online graduate program with a specialization in health and medical information.

Conclusion and Future Work

The results of this situational analysis are helpful in identifying the current status and local impact of health sciences libraries and in assessing the health information training needs for medical librarians and health information specialists in Tanzania. The findings obtained from this assessment are strong enough to guide activities involved in the development of curriculum, training strategy, operational plans and training packages for health information professionals in the country. The results of the needs assessment research provide the evidence and basic information for the development of a training curriculum for health information sciences and subsequently for the actual training that can translate to better health information service delivery for the nation.

Appendix 1.

Map of Tanzania

Appendix 2.

Lists of the sites and institutions in which the field visits took place.

Study Area	Study units
Dar Es Salaam	Muhimbili University of Health and Allied Sciences (MUHAS) -Muhimbili University Library Muhimbili Institute of Health and Allied sciences -Muhimbili school of Medical Laboratory Sciences -Muhimbili School of Assistant Dental Officers -Mumbili School of Hygiene -Muhimbili School of Radiography -Muhimbili School of Nurse Tutors -Muhimbili School of Midwifery -Muhimbili School of Dental Laboratory Technology -Muhimbili School of Pharmaceutical Sciences -Muhimbili School of Nursing Muhimbili National Hospital Muhimbili Cardiac Surgery and Training Center -Muhimbili Orthopedic Institute (MOI) Ocean Road Cancer Institute
Kilimanjaro	Kilimanjaro Christian Medical University College(KCMUCo) Kilimanjaro Christian Medical Centre (KCMC) - KCMC Medical Library KCMC School of Physiotherapy Kilimanjaro School of Pharmacy KCMC Assistant Medical Officer Anesthesia KCMC Health Records KCMC Assistant Medical Officer Ophthalmology KCMC Ophthalmic Nursing School KCMC Assistant Medical Officer Radiology KCMC School of Nursing KCMC School of Pediatric Nursing KCMC Regional Dermatology Centre KCMC Occupational Therapy KCMC School of Optometric KCMC AMO General Tanzania Training Centre for Orthopedic Technology
Mwanza	Bugando Medical Centre (BMC) Catholic University of Health and Allied Sciences (CUHAS) Bugando Medical Centre Library Bugando School of Nursing Bugando School of Pharmacy Bugando School of Radiography Bugando School of Nurse Tutors Bugando School of Laboratory Technology Bugando Assistant Medical Officer Training School Sengerema Clinical Officer Training college ○ Sengerema Medical Library Sengerema School of Nursing ○ Sengerema School of Nursing Library
Njombe	Njombe Regional Hospital (Kibena) Njombe District Hospital Njombe School of Nursing Ilembula School of Nursing Ilembula Referral Hospital

Appendix 3.

Proposed Competencies for the Diploma in HIS program

Year 1	Year 2	Year 3
HEALTH AND MEDICINE Anatomy & physiology with associated terminology Essential medical terminology the healthcare environment basic medical and clinical awareness standards of care/clinical processes introduction to common public health community issues Health statistics common medical issues in Tanzania Library users information behaviour of medical and health personnel types of clients/patrons/users for health and medical information Transfer to column 2 Ethical interaction with users* and confidentiality of patient records Evidence-based healthcare Basic computing skills (Software and hardware) Communication and presentation skills Clinical practical	MEDICAL AND HEALTH LIBRARIANSHIP Types of health information Literature search/retrieval Organization of knowledge (classification, cataloguing, indexing of health/medical information) digital and hard-copy collections management specialized technology & applications public and technical services Consumer health issues; customer relations/users support/public service Marketing information services HIV/AIDS and TB information Disaster information management Environmental health information health promotion- Database management Library internship/practice Evaluation of online information	HEALTH RECORDS MANAGEMENT Schemes and tools technical requirements privacy and security concerns legal aspects Healthcare management information systems Medical office procedures Research methods Scholarly writing, referencing, and plagiarism Electronic health records Disease classification & coding Medical information technology Leadership and managerial skills; Medical office management Internship elective Repositories, records management and archives administration, conservation, and preservation Advanced metadata, medical informatics pedagogical skills clinical practical research work Quality Assurance