INFORMATION TECHNOLOGY-ASSISTED EDUCATION AND COMMUNICATION AT HSPH THE ROLE OF DISTANCE LEARNING

8/15/00 APPENDICES to the Report: INFORMATION TECHNOLOGY-ASSISTED EDUCATION AND COMMUNICATION AT HSPH: THE ROLE OF DISTANCE LEARNING Appendix A: Distance Learning Programs at Schools of Public Health Appendix B: Summary of Current DL/IT Capacity at HSPH Appendix C: Summary of DL/IT offered at Schools within Harvard University Appendix D: Report on HSPH Faculty Survey, Spring 2000 Appendix E: An Example of an International Center Appendix F: What Others Are Doing 8/15/00 Appendix A: Distance Learning Programs at Schools of Public Health 8/15/00 Distance Learning Programs at Schools of Public Health School of Public Health, University of Alabama at Birmingham The University of Alabama at Birmingham School of Public Health through its MidSouth Program for Public Health Practice (MSPPHP) offers a Certificate in Public Health Leadership in a distance learning format This program is primarily designed for public health professionals in Alabama, Indiana, or New Mexico For more information, visit http://www.uab.edu/PublicHealth/ School of Public Health, University of Albany SUNY The School of Public Health, University at Albany, State University of New York presently offers non-credit courses in a distance learning format The courses are mainly delivered through satellite broadcast to local health department employees, community-based organizations, and health care organizations The School is considering offering a Masters of Public Health (MPH) to be delivered by distance learning media, primarily the Internet The School is also considering the development of three certificate programs that could be taken singularly or, upon completion of all three, qualify as a MPH degree For more information, visit http://www.albany.edu/sph/ Joseph L Mailman School of Public Health, Columbia University The Joseph L Mailman School of Public Health, Columbia University, through its Division of Sociomedical Sciences, offers a Program in Health Promotion and Disease Prevention in a distance learning format The program is designed for employees of the New York Department of Health Distance education courses are taught on the Columbia University Health Sciences Campus and transmitted live via two-way audio/two-way visual teleconferencing technology Students in the distance education program take the same curriculum and complete the same requirements over the same period of time as the evening program in Health Promotion and Disease Prevention The MPH requires 45 credits (15 courses) Selected courses are augmented by using a variety of web-based materials For more information, visit http://cpmcnet.columbia.edu/dept/sph/ Rollins School of Public Health, Emory University The Rollins School of Public Health at Emory University offers two separate programs via distance learning: a Graduate Certificate Program and a Career MPH program Graduate Certificate Program (GCPE): Students in the GCPE attend seven on-campus, fiveday sessions over the course of a year During these sessions, students attend classes, seminars, and computer workshops Between on-campus sessions, students complete assignments and communicate with faculty and student colleagues via distance learning Credits can be applied towards a Master of Public Health degree at Rollins The program is 21-credit hours For more information, visit http://www.sph.emory.edu/gcphome.html Appendix A 8/15/00 Career MPH Program: The Rollins School of Public Health of Emory University offers a Career MPH Program for mid-career professionals who have to 10 years experience in public health or related fields The program began in the fall of 1999 The Career MPH is a 42 credit-hour program in which students participate in both traditional face-to-face instructional sessions and in a web-based learning environment The program is designed to allow working professionals to complete an MPH degree in approximately two and a half years Students in the CMPH program are required to attend on-campus sessions only twice per semester (Thursday through Sunday) Between the on-campus sessions, students will participate in courses via the web, receiving instruction and interacting with faculty and classmates Students can select the Prevention Science Option or Management Science Option For more information, visit http://www.sph.emory.edu/ School of Public Health and Health Sciences, George Washington University The George Washington University School of Public Health and Health Services (SPHHS) offers a Graduate Certificate Program through distance education Upon completion of the Certificate Program, all credit may be transferred, upon acceptance, to specific tracks and concentrations of the Master of Public Health program 15-credit hour program may be completed partially or entirely by distance education Students can select one of the three options to complete the Graduate Certificate Program: Community Oriented Primary Care (COPC) Option, MPH Core Courses Option, or Health Services Option For more information, visit http://www.gwumc.edu/sphhs/ School of Hygiene and Public Health, Johns Hopkins University The Johns Hopkins School of Hygiene and Public Health Distance Education Division and the School of Public Health offers two programs in distance learning format Graduate Certificate Program in Public Health The certificate program provides public health practitioners the opportunity to enhance their effectiveness in a rapidly changing health care environment through a flexible curriculum that combines distance education and traditional educational methodologies The certificate program requires 35 academic credit units and may be completed in 18 months Students who have earned the certificate and who also qualify for the MPH degree program may transfer all earned credits toward a MPH degree at JHU For more information, visit the School's web site at http://www.distance.jhsph.edu/certificate Internet-based Master of Public Health Program: Beginning in 1999, the School will offer its Master of Public Health via the Internet Completion of the Internet-based program requires 80 credit units, with a maximum of 60 earned via the Internet The remaining 20 credits must be earned in a face-to-face environment For more information, visit the school's web site at: http://www.jhsph.edu/SASS/admiss/ Appendix A 8/15/00 School of Public Health, University of Illinois at Chicago The UIC at Chicago School of Public Health offers a number of courses that utilize the Internet There are a number of fully online credit courses and many courses that have associated web sites Currently, up to 12 semester hours can be taken in a credit non-degree status and applied toward a degree at UIC-SPH if accepted into their program The UIC School of Public Health, through its Great Lakes Center for Occupational and Environmental Safety and Health, offers continuing education courses to occupational and environmental health and safety professionals For more information, visit http://www.uic.edu/sph/ School of Public Health, University of North Carolina The University of North Carolina School of Public Health distance learning degree programs are designed for health professionals currently employed, and unable to enroll in a degree program at the Chapel Hill campus The UNC School of Public Health through its Distance Learning department offers the following degree programs: Executive Masters Program in Health Administration: The Executive Master's Program (EMP) is designed to provide the skills and competencies critical for leadership in upper-level management positions in all areas of health services It is open to professionals with at least years of prior experience in health administration or a health profession or holds a prior academic or professional doctoral-level degree in an appropriate field There are two variations of EMP: The National Program: The National Program is designed for working professionals from across the nation International students also frequently enroll in this Program The structure of the Program is limited to 35 new executive students each year The expanded Distance Learning format of this program will begin in May 2000 The format will consist of three eight-day sessions in Chapel Hill over a 12-month period with the bulk of the work performed via the WWW The North Carolina Program: The North Carolina Program was designed to serve working public health and health care professionals who are within commuting distance to program sites located in the western and eastern parts of the state The North Carolina Program is a joint effort of the Department of Health Policy and Administration and the Area Health Education Centers (AHEC) Programs are offered in AHEC facilities one day a week (typically Fridays) Students attend class every Friday for the fall and spring semesters, completing eight courses over two years Students take distance learning courses and summer institute courses to complete the requirements for a MPH or MHA Masters Program in Public Health Leadership: The distance learning MPH degree in Public Health Leadership is a 39-credit hour program The distance learning program is designed to be completed in three years Course contents are delivered over the Internet, using two-way videoconferencing, self-paced CD-ROMS, videotaped presentations, and programmed selfinstructional modules For more information, visit http://www.sph.unc.edu/ Appendix A 8/15/00 College of Public Health, University of South Florida The purpose of the distance learning program at the University of South Florida is to build capacity for providing essential public health services, community by community Masters of Public Health in Public Health Practice: Offered via satellite technology, using a television receive only (TVRO, or one-way video, two-way audio) format The MPH is offered at host sites throughout the state of Florida and other certified host sites in the nation and internationally In fall 1998, the College graduated its first graduates from this program For more information, visit: http://www.hsc.usf.edu/PUBHEALTH/DLP The College also offers an Executive MPH Program for health professionals For more information about the Executive program, visit: http://www.hsc.usf.edu/PUBHEALTH/exmphsum.htm School of Public Health, University of Texas-Houston The University of Texas-Houston School of Public Health offers two different distance learning programs Certificate Program offered through the Outreach Education Program: Courses are offered using a variety of electronic delivery media, including video, Internet, CD-rom and video tapes, as well as print-based materials Currently being offered only to the public health professionals who are employed by state and local health departments in Texas A certificate is issued on successful completion of five core courses For the second distance learning program, the UT-Houston SPH and its campuses in San Antonio, El Paso and Dallas deliver courses to students using the University of Texas system-wide videoconference network For more information, visit http://www.sph.uth.tmc.edu/ School of Public Health and Tropical Medicine, Tulane University The Tulane University School of Public Health and Tropical Medicine offers two programs in distance learning format Internet-based MPH program in Occupational Health and Safety Management through its Center for Applied Environmental Public Health (CAEPH) This program is targeted towards mid-career working professionals who traditionally not have the opportunity for advanced professional education and who need additional education for job advancement, to stay abreast of new knowledge and developments in public health and to meet professional demands and challenges Many of the distance learning programs offered at Tulane are unique in providing educational opportunities for those with the greatest potential to influence worker health and safety, implement health and safety programs, and advance occupational and environmental public health policy Courses are delivered using Video Conferencing and Internet For more information, visit http://www.caeph.tulane.edu/ Appendix A 8/15/00 Graduate Certificate Program (GCP) in Public Health Provides a strong academic foundation in public health theory, research, and practice via on-site classes and through distance-based computer technology Three on-campus experiences during a 15-month period Students earn 21 graduate credits Credits are applicable to degree programs in public health at Tulane For more information, visit their web site at http://www.tulane.edu/~cdctrain/ School of Public Health and Community Medicine, University of Washington The University of Washington School of Public Health and Community Medicine offers a Graduate Certificate Program in Public Health for public health professionals who wish to gain additional expertise in their field Graduate Certificate Program (GCP) in Public Health The program is a 15-month graduate credit program delivered through 4-1/2 weeks of intensive onsite instruction on the UW campus, and through distance learning Students include CDC field assignees, state and local public health agencies and others wishing to advance in public health Students earn 33 graduate credits, a majority of which can be applied toward the Master's in Public Health Courses utilize variety of distance-learning modalities, including self-study, email, telephone, print media and the World Wide Web The Department of Health Services in the School of Public Health and Community Medicine offers a three-year, part-time program delivered through a combination of intensive four-week summer sessions on the UW campus, directed independent study, and intensive weekend seminars during the academic year For more information, http://www.extension.washington.edu/extinfo/certprog/pht Appendix A 8/15/00 Appendix B: Summary of Current DL/IT Capacity at HSPH 8/15/00 CURRENT CAPACITY AT SPH FOR DL/IT: 1) Computer/Video projection systems Built-in units in Auditoriums: Kresge G-1, FXB G-11, G-12, G-13 Portable units: Infocus LP750, Infocus LP425Z ElmoEV500AF Document Camera system 2) Audio Systems Built-in Audio cassette recording systems in Auditoriums: Kresge G-2, FXB G-11, G-12, G-13 Portable units: (4) pro quality audio cassette recorders, (2) Shure audio mixers 3) Video Production Equipment Parkervision Cameraman: built-in auto-tracking camera system in FXB G-11 JVC pro quality analog video camera JVC VHS camcorder Panasonic AG 2510 VHS VCR Panasonic AG 1300 VHS VCR (2) Digital Capture cards Cannon XL-1 Digital Camcorder Panasonic Digital Video VCR 4) Video Conferencing Equipment Two Intel TeamStation video conferencing units 5) Audio/Video Streaming RealNetworks' Basic Server (25 simultaneous streams) installed in HSPH web server box Space and stream capacity suitable for small communications pieces (public service announcements, audio press conferences, etc.) at bandwidths of up to 80 Kbps AV server is currently underutilized, serving 100 streams per week Higher bandwidth productions, longer pieces, and higher volume productions (such as video taping a class a week for a course) requires more server hard disk space, upgraded software, and likely a dedicated server Web Site with streaming AV demonstrations: http://www.hsph.harvard.edu/video 6) Courseware CoureInfo 3.0 by BlackBoard.com is currently available to all faculty Software is installed in HSPH web server box Software allows faculty members to create and manage course web sites from an intuitive web browser interface The software allows faculty members to create web pages, upload files, create links to external sites, control access, create quizzes, add bulletin board/chat features, send email to class, etc Training and coordination with the Registrar's Office is led by the Instructional Computing Group of the IT Department Web Site: http://www.hsph.harvard.edu/courses Appendix B 8/15/00 7) Video Uplink/Downlink Currently able to downlink via the University’s satellite dish in Cambridge to the SPH internal video network at $100 per hour, with a 2-hour minimum charge This signal can be sent to multiple internal SPH locations to provide audio and video of the transmission, however without provision for interaction with the transmission Uplinks from SPH are not currently possible without the use of an outside vendor truck for a remote satellite feed The SPH video network is currently limited to the following locations in the Kresge building: Auditoriums: G-1, G-2, G-3; Cafeteria; All second floor classrooms and Room 502 8) Computer Servers Web Server: Sun Enterprise 250, with 18 GB disk space, running Solaris and Apache web server There are roughly 100 users with web accounts representing units of the school (departments, centers, student groups, faculty research projects, etc.) Mail Server: Sun Enterprise 5500 Majordomo Listserver ILS Server 9) Network Infrastructure Designed to be video ready Entire data network has been upgraded to 10/100 MB Ethernet Cisco switches in all wiring closets Core network backbone is Gigabit Ethernet between all buildings SPH network connection to LMAnet is 100mb Ethernet LMAnet connection to Harvard Cambridge campus (HSDN) is 45mb Ethernet (T-3) Harvard’s HSDN has multiple redundant Internet feeds, including ATT, MediaOne, and Internet2 10) The Intel Multimedia Grant is providing us with the following equipment: Two Intel TeamStation conference room video conferencing units (2) Intel ProShare desktop video conferencing system (30) Matrox RT2000 digital video capture boards, bundled with Adobe Premier (3) Intel Graphic Video Editing workstations (3) Intel Web servers (2) for web and ILS function Intel Video Server (1) Intel Curriculum Development workstations (3) Macromedia Director software (3) for the curriculum development workstations 11) Human Resources: We currently have only FTE’s to fulfill all AV/Media services functions throughout the school The school has FTE’s for the functions of webmaster and graphics designer FTE from the microlab staff is primarily responsible for working with faculty members on the webbased Blackboard Course Info software, as well as doing the first pass at digitizing video clips to pass on to the webmaster for posting on the school’s web site Appendix B The opportunity to expand the number of students taught was not an important motivational factor for most faculty; just over 40% ranked it “not important,” while only 20% ranked this factor as “very important.” Section III • • How HSPH Faculty feel HSPH should increase participation in IT Ancillary Concerns and Cautions How HSPH Faculty feel HSPH should increase participation in IT In our survey, we dedicated one section of our questionnaire to determine in what areas of Information Technology Faculty-Members at HSPH feel the Harvard School of Public Health should increase With respect to the development and integration of IT at HSPH, this question is especially important because “faculty members committed to teaching should have the first and last say on any issue regarding pedagogy.” The literature reviewed on the implementation and success of IT at universities indicates that, without faculty support, the results of IT- integration efforts would be dismal 1-2 The rest of this page was intentionally left blank Appendix D 14 Table VI: How HSPH Faculty Believe HSPH Should Increase IT (In Order of Priorities) Continuing Ed, NonProfessional Doctoral & HSPH MPH, MS Research & Off - Site Fellows Students Invest in IT Classroom Equipment Low Priority Medium Priority High Priority Increase Technical Support Staff for Classroom Help Low Priority Medium Priority High Priority Increase Technical Staff for Development of IT-Methods Low Priority Medium Priority High Priority Increase Videoconferencing and Internet Tools for Teaching Non-Resident, Off-Site HSPH Students Low Priority Medium Priority High Priority Increase Videoconferencing and Internet Tools for Off-Site Non-HSPH Students Low Priority Medium Priority High Priority Joint Ventures with Commercial Companies to Package Online Courses Low Priority Medium Priority High Priority Joint Ventures with Commercial Companies to Package & Market Online Courses Low Priority Medium Priority High Priority Appendix D 7% 35% 54% 7% 36% 54% 7% 31% 60% 7% 39% 50% 11% 39% 46% 14% 33% 50% 17% 30% 44% 21% 30% 41% 21% 36% 38% 26% 35% 30% 25% 34% 31% 33% 31% 31% 39% 26% 22% 34% 28% 23% 40% 26% 24% 59% 26% 4% 61% 25% 5% 69% 19% 5% 63% 24% 4% 62% 25% 5% 69% 21% 5% 15 The highest priority, regardless of type of student taught or teaching style, is to improve the onsite classroom environment for IT-assisted learning Roughly 90% of faculty surveyed supported as either a high or medium priority increased investment in equipment and employing support staff to assist faculty in the classroom (Of interest, in a study conducted at UCLA, an institute that actually mandated that all faculty employ IT methodology, the most common problem and complaint cited by UCLA faculty in using the technology was “technical problems due to inadequate technical support and computer skills.”) Not far behind in priority was the need to increase technical staff to develop other IT-Teaching Modalities The faculty ranked considerably lower as a priority increasing Video and Internet tools for offsite learning, although for those teaching lecture-style, the priority was higher Across all groups, faculty showed very little interest in entering into any kind of joint venture with commercial companies to produce materials or whole courses using IT-assisted methods Roughly 2/3 of faculty indicated that this should be a low priority at HSPH Ancillary Concerns and Cautions: Over the past ten years there has been a flurry of activity around developing new kinds of Information Technology not only for the purpose of enhancing the quality of teaching, but also to penetrate the Education Online Course market Although this action toward development and implementation has been greeted with optimism and support, not everyone believes that Information Technology, specifically online instruction, will be the pedagogical panacea that many IT- advocates claim it will be Positioned at the frontline of online opposition, historian David F Nobel stands tall In his fourpart series, “Digital Diploma Mills,” Nobel passionately trumpets concern over what he calls, “The commercialization of higher education That is, the recognition of intellectual activity into intellectual capital…forming courses into courseware that [turns] the activity of instruction itself into commercially viable proprietary products that can be owned and bought and sold in the market.” Appendix D 16 In addition to his belief that the era of Information Technology will transform education into industry, Nobel also cites these other concerns: (1) Academic deprofessionalization: Nobel’s concern is that “once the faculty converts its courses into courseware, their services are no longer required.” In essence, if faculty were to acquiesce to the transformation of classroom education into an Information Technology market, the need and value of teachers would become obsolete (2) The conflict of interest between business and scholarship: This concern embraces two parts The first is a concern that the implementation of IT may sacrifice pedagogy for technology The second concern is that the development and implementation of IT creates a significant and potentially hostile division between faculty and students with university administrators and their IT-business associates In a 1999 article written by Andrew Feenberg of San Diego State University entitled “Distance Learning: Promise or Threat?” Feenberg writes It is not faculty who are in the forefront of the movement to network education Instead politicians, university administrations, computer, and telecommunications companies have decided that there is money in it To exemplify the detrimental effects of this conflict, Nobel cites an experience of UCLA, an institution that tried to enact an “Information Enticement Initiative” that mandated web sites for all 3800 arts and sciences courses in 1998 Nobel explains, Several dozen faculty actively resisted the Initiative and the way it had been unilaterally inspired and implemented…and at the end of the academic year, only 30% of the faculty had put any of their course material on line (We note that only one third of our surveyed faculty use our course web page software – although the implementation environment was neither mandatory nor unilateral) (3) Course Ownership: The issue of course ownership is a presently volatile and sensitive Although “there may be legitimate circumstances under which the quality of academic work and the shared maintenance of creative vitality is best assured when the University has some share in copyright…the highest quality of online materials is usually assured when faculty members are in control of the material.” 1-2 At the present, there is no clear protocol for online course ownership There is, however, clear indication that many faculty are not going to be willing to surrender their rights to ownership At UCLA, for example, instructors made it clear that they would refuse to assign any of their rights to their course materials The stage is set The outcome on course ownership, however, is yet to be determined (4) Cost: the need for small class size in order to achieve high-quality online teaching implies high cost perhaps an even higher cost than the cost for traditional instruction 1-2 Appendix D 17 Nobel passionately argues this point in several of his articles where he states that increases in cost incurred by IT will be translated into increased tuition for students—an unfair consequence considering the present climate of student and faculty resistance to IT In the end, Nobel states, The infrastructional expense for online courses exceeds the overhead for correspondence courses by an order of magnitude—a technological tapeworm that lives in the guts of higher education…and it is the faculty and students who will ultimately suffer from [this] effect of the Digital Diploma Mill Section IV In this report, the current capacity and application of IT has been discussed, as well as the application of that discussion to the investigation of further developing IT at the Harvard School of Public Health Several ancillary cautions and concerns regarding IT were also reviewed Summary of Key Points Regarding IT and HSPH: In general, the HSPH faculty is interested in increasing IT-Method learning The greatest motivational priority for increasing use of IT-Methods is to increase the quality of teaching in the classroom Across all types of students taught and across the type of teaching method employed, faculty demonstrate interest in increasing (a) the use of the internet as a source of information and (b) the use of the HSPH “Blackboard” and Web Page Email is already in wide use Across all groups there was considerably less interest was demonstrated in expanding the use CDs and videoconferencing for teaching purposes The area of IT-expansion that received the least amount of interest was teaching totally on line Of note, however, faculty who teach continuing education students demonstrated the greatest amount of interest in developing this area Appendix D 18 RECOMMENDATIONS The top priority of HSPH should be to the following: • • Equip classrooms with the appropriate Information Technology Provide technical support in the classroom Of note, this recommendation is consistent with the conclusion reached from the 1999 Harvard University Working Group Discussion, a group of faculty and administrators across the University who were brought together to discuss opportunities in enhancing teaching programs, reaching new markets, and technology platforms and infrastructure The conclusion reached by this group was that the promotion of faculty growth and education, and leveraging infrastructure and expertise were, overall, top priorities Developing the capacity for videoconferencing that is specifically targeted for use by off-site HSPH students is of interest, although of lower priority The school should proceed with extreme caution with respect to engaging in joint ventures with commercial companies If such ventures seem desirable for other reasons, the faculty will need to discuss the issues and feel comfortable with the professional and commercial implications before they will be willing to support and participate in this type of activity REFERENCES University of Illinois Faculty Seminar, Teaching at an Internet Distance: the Pedagogy of Online Teaching and Learning The Report of a 1998-1999 University of Illinois Faculty Seminar, University of Illinois, 1999 pp 1-52 Nobel, David F, Digital Diploma Mills, Part I-IV 1997-1999 pp 1-42 Drazen, Hess, & Rogers, Opportunities for Harvard in Distance Learning: Provost Report on Distance Education at Harvard Draft, March 1999, pp 1-11 Appendix D 19 8/15/00 Appendix E: An Example of an International Center 8/15/00 (1) Collaboration between Harvard University and Muhimbili University, Tanzania: Below is a brief write-up on the collaboration between Harvard University and Muhimbili University College of Health Sciences in Dar es Salaam Our efforts have focused on addressing maternal and child health problems in Tanzania from angles: training, services and advocacy, and research Training: Through a training grant that we have from the Fogarty International Center at the National Institutes of Health (Max Essex, PI), a number of Tanzanians have been to Boston for degree (Master's and doctoral) and nondegree training programs related to HIV infection We were recently funded for a second Fogarty grant to provide training in the broader area of maternal and child health (Wafaie Fawzi, PI) In the latter grant, we will focus on the following disciplines: (a) nutrition and its role in perinatal outcomes (fetal losses, low birthweight, prematurity), maternal mortality and morbidity including preeclampsia; gestational diabetes, and infections during the perinatal period and beyond (b) infectious disease, including diarrhea, ARI, malaria in childhood and pregnancy outcomes; HIV; TB; vaccines; (c) behavioral sciences including psychosocial stressors, breast feeding, sexual practices, alcohol, smoking, and drug abuse, and (d) child development including motor and cognitive development Trainees are mentored by faculty from Harvard School of Public Health, Harvard Institute for International Development, Harvard Medical School, and Children's Hospital In addition to training Tanzanian fellows, the collaboration continues to be an excellent training ground for several Harvard students and post-doctoral fellows who are based in Boston or in Dar es Salaam Advocacy and service: As part of our research programs, we provide clinical services to all patients enrolled In collaboration with our Tanzanian colleagues, we also plan to undertake a series of workshops in Dar es Salaam to disseminate results from our research and discuss the policy implications of these findings The first workshop was held in the period May 30-June 1, 2000 The workshop was attended by more than 100 senior members of academia and senior policy makers from the Ministry of Health and district medical officers from Dar es Salaam and other districts in Tanzania The workshop was focused on perinatal health including the role of anti-retrovirals, micronutrients, and breastfeeding among HIV-infected women and their children Several Harvard faculty participated in the workshop We are about to start a new program entitled "Training and Study of Effectiveness of Services for Prevention of Vertical Transmission of HIV-1 in Tanzania" This program aims to develop a curriculum and manual for training HIV counselors in antenatal care settings, and to test these training materials through the implementation of an HIV counseling and testing program in Dar es Salaam In addition, we propose to evaluate key implementation issues Appendix E 8/15/00 involved in such a targeted intervention by administering a treatment intervention which includes nevirapine, multivitamins and a breastfeeding counseling/health education component After this project is completed, the training curriculum and manual developed will be useful to government and non-government programs in reducing vertical transmission, a set of trainers in “vertical transmission prevention” counseling will be valuable resources to such future programs, and the experience of having implemented a small-scale supplementation and follow-up program at the district level will inform policymakers for future national programs or larger initiatives This program is funded by the World AIDS Foundation Research: There has been longstanding collaboration between Harvard University and Muhimbili Medical Center in Dar-es-Salaam for the past 20 years The two institutions have collaborated on a number of research projects Over the last years, we have initiated several large epidemiologic studies focusing on nutrition, perinatal health, and infectious diseases To address basic and epidemiologic aspects of various public health problems, our research team is multi-disciplinary both at Harvard and at Muhimbili Harvard colleagues are based at the School of Public Health in the Departments of Nutrition, Epidemiology, Biostatistics, Immunology and Infectious Diseases, Population and International Health; at the Medical School and affiliated hospitals in Infectious Diseases; Social Medicine, Immunology, Virology, Histopathology, Clinical Chemistry, and Child Development We have also recently started a collaborative effort with the Nutrition and Immunology group at Tufts University Our collaborators in Tanzania are based at Muhimbili University College of Health Sciences in the Departments of Community Health, Paediatrics and Child Health, Obstetrics and Gynecology, Psychiatry, Microbiology and Immunology Internal Medicine, Histopathology and Morbid Anatomy, and at the Tanzania Food and Nutrition Center Most of our research projects are NIH funded, but several were funded by foundations including the Thrasher Research Fund, Rockefeller Foundation, the International Development Research Center, and the World AIDS Foundation Potential role for IT: IT could be instrumental in strengthening the collaboration that we have with Tanzanian institutions leading to a stronger capacity of these institutions to independently address the national public health agenda Our research program would benefit from improved means communication between Dar es Salaam and Boston For example, we have weekly telephone conference calls and several daily email contacts between the two sites to discuss progress on all aspects of the research activities Having video communication would improve the means of communication on all aspects Improved links between the sites are also likely to be beneficial for trainingrelated activities, including linking our faculty, postdoctoal fellows, and Appendix E 8/15/00 students who are in the field with Boston Regular virtual seminars could be held between the sites These could include making the regular seminars that are held in Boston available to an audience in Dar es Salaam Noting the time difference of hours, a lunch time seminar in Boston would be held at pm Dar time, which is possible Alternatively, special seminars to be held at more convenient times (say am Boston time) could be arranged The special seminars could be on monthly-basis to start with, and possibly switched to become weekly with time The seminars would be led by speakers from Tanzania and Boston Topics would center around issues that are relevant to Tanzania, for example policy and management issues related to vertical transmission of HIV or the latest findings on the role of micronutrients in maternal and child health The audience in all cases would include policy makers at the Ministry of Health and members of academia Degree and non-degree programs could be part of the DL activities If the idea of partial DL-degree programs were to be implemented (as Marcello Pagano envisioned during the meetings), the class could work on their own throughout the week, and then meet with the instructor on Saturdays from the Center at Muhimbili In discussion with the leadership at Muhimbili, they would like to see the institution contributing to enhanced communication in the health sector This would include providing current information to health personnel country-wide by establishing a national electronic network linking the Ministry of Health, the main national hospitals, and universities in Tanzania That effort could be aided by strengthening the IT infrastructure at Muhimbili and other institutions and putting in place qualified technical staff to maintain such a system HSPH could support the effort scientifically by contributing the latest findings on issues pertaining to public health including basic sciences, policy and management, and epidemiology in several areas including nutrition, infectious diseases, and maternal and child health In summary, we have a long standing collaboration with Muhimbili University College in Dar es Salaam in the areas of research, training, as well as services Our collaboration has the seed to develop into a regional center of excellence in public health IT would certainly improve that potential (2) IT infrastructure at Muhimbili and the College's goals I had discussions with several people in assessing the IT infrastructure in Tanzania including Professor Jacob Mtabaji, Principal of Muhimbili University College of Health Sciences (MUCHS), Professor Andrew Swai, Director of Postgraduate Studies and Research at MUCHS, Dr Gernard Msamanga, Senior Lecturer of Community Health, and Dr Sylvia Kaaya, Senior Lecturer of Appendix E 8/15/00 Psychiatry All that is described below is based on a write-up that they gave to me The University of Dar es Salaam Five-Year Rolling Strategic Plan attaches great importance to the use of Information Technology (IT) in the way the University delivers its mission The challenge the University faces now is to apply IT in order to revolutionize teaching, research, consultancy, library services, administration and management To this end the University established a university-wide network inter-linking all academic buildings, the central administration building, the library and the computing centre by a high capacity fibre optic cable Already the University has a Financial Information System (FIS in position, an Academic Register Information System (ARIS) and a Library Information System (LIBIS) in their final stages of implementation However the two campuses still lag behind, although they are currently connected to main campus by a mbps wireless link External Internet connection: As stated earlier MUCHS is connected to the main campus via a wireless link Although this mode provides a fast transmission it requires a line of site and therefore has a number of limitations including the distance from one point to another Initially MUCHS had a direct link with the main campus because it has a line of site To accommodate other interests, however, with time transmission has been rerouted through other institutions initially in Sinza, then Mikocheni and currently in town making the service unreliable because of unanticipated interruptions on route There is therefore need to strengthen the connection between MUCHS and University of Dar es Salaam (UDSM) to be able to support the expanded service at the College A satellite dish might provide an enhanced connection to UDSM as well as an alternative/backup service through another provider Local Area Network: MUCHS has a local area electronic network connecting all main buildings by coaxial cables Two buildings (Mwaisella Block and the Central Pathology) are connected by wireless links to a central building (the Multipurpose Laboratory) which is in turn connected by a wireless link to the UDSM network External access is through the UDSM link, which is connected by a satellite dish to a service provider in the USA backbone The internal wiring is by UTP cables Computing Services: Two central servers (one using Windows NT and the other using UNIX) provide the Email/Internet Service link for the College from the College Computing Centre The Computing Centre has a cafe with 15 computers (funded through Sida/SAREC) serving postgraduate students and the bulk of members of academic staff Currently only Deans and Directors and Heads of Departments are directly linked to the computing centre on College funds The library has another local area network with 15 computers, funded through Sida/SAREC, serving Undergraduate students and students in the Appendix E 8/15/00 Institute of Allied Health Sciences The College is very far from realizing the target of one computer for every 10 students Dial up connection: The central server is connected to a pool of modems Each modem is connected to a direct telephone line One of Muhimbili's objectives is to apply IT in the delivery of the mission of the College in order to revolutionize teaching, research, consultancy, library services, administration and management in the College including: • Strengthen the link between the Main Campus and the College • Strengthen the network infrastructure linking all academic buildings in the College • Provide computing facilities to all Heads of departments and other members of academic staff • Provide computing facilities to students aiming at attaining the one computer for every ten student target to enable the College to produce computer literate graduates Another problem in health care delivery in Tanzania is the relatively poor dissemination and utilization of research results MUCHS has decided to address that problem by repackaging the findings from all the research at the College, although in a summary form, and distribute these to research users in the form of a biannual College Research Bulletin MUCHS hopes to extend this endeavor to cover the whole of Tanzania For the same reason, the National Institute for Medical Research (NIMR) has embarked on a Bulletin for the dissemination of research results The two journals have to address the problems of producing the required paper copies and distributing the publications to all the districts and regions of Tanzania The last issue related to communication is the need for information, including health statistics, from the districts to the MOH and feedback from MOH to the districts Disease outbreaks and their progression, for example, need to be communicated to the MOH promptly Monthly health statistics are essential for health planning MOH has instituted a country wide Health Information System (MTUHA) through which standard information is collected by each district, analyzed at the district for their immediate use and transmitted on a diskette to MOH for compilation of national statistics Implementation of this system is nearly complete In this project, each region has been supplied with a computer and personnel are trained in the use of the system Data/information transfer would have been much quicker, easier and cheaper if a nation wide electronic network had been established Appendix E 8/15/00 The problem of communication is also apparent at the MOH headquarters Nearly each of the units there has one or more computers but there is no network to connect them for easy sharing of information or computer resources including printers and faxes Internal communication within the Ministry and outside is done by means of phone and messages on paper that are relatively expensive, time consuming and cumbersome, compared to electronic messaging MOH acknowledges the huge problem of communication and this has featured in the current Health Sector Reforms The goals of this project with the MOH is to improve the health status of people in Tanzania The purpose is to enhance communication in the health sector and provide current information to health personnel country wide Objectives of the project are: • To enhance communication between the major health units in the country • To establish a national electronic network linking the MOH, the main national hospitals, universities in Tanzania offering health related courses and research institutions • To enable medical personnel in Tanzania access medical information from MOH, MUCHS, NIMR and the WWW • To enhance data transfer in the MTUHA program • To enable MUCHS and other health related institutions to provide continuing education to health graduates working in Tanzania • To enable MUCHS, NIMR and other health research institutions disseminate research findings to research users in the country • To enable MUCHS and other consultant hospitals to counteract with colleagues in and outside Tanzania through Telemedicine Major project activities include: • Equip the MUCHS Computing Centre to act as the hub for the national electronic network and as a training centre for MUCHS students and staff • Equip and modernize the MUCHS Library to act as a national health information centre Appendix E 8/15/00 • Connect all the main health units including district hospitals, regional hospitals, health research institutions and the major departments in the MOH to the MUCHS electronic network • Train staff in the various health units in the use of computers for email and internet services • Equip the main departments in MUCHS for the preparation of continuing education material • Furnish and equip the MUCHS Institute of Continuing Education for the coordination of the continuing education activities at MUCHS • Strengthen the Directorate of Postgraduate Studies and Research for the repackaging of research findings for research users • Train staff in MUCHS in the preparation of HTML material for continuing education • Provide for initial subscriptions to selected electronic publications • Establish telemedicine facilities at MUCHS and some of the other consultant hospitals Other points: - I spoke with Dr Michael Reich about whether he know if the World Bank million dollar nodes included one in Tanzania He suggested that I enquire about this from Ms D Beattie (msbeattie@worldbank.org) I emailed her but have not heard from her - I learnt Ms Julia Royal at the National Library of Medicine (NLM) that the library is providing computers and internet connection to stations of the National Institute for Medical research in Tanzania They are considering linking up the Ministry of Health and another medical school (Kilimanjaro Christian Medical Center) to the web through an internet provider that has satellite links to a site in South Appendix E 1 ... investigate the current capacity and application of IT around the country; and to determine the level of interest and the need for Information Technology at the Harvard School of Public Health Of. .. Type of Training Transmission of knowledge; unilateral Education toward earning an undergraduate degree The training of the educated The training and mentorship of the educated For the purpose of. .. of Continuing Education for the coordination of the continuing education activities at MUCHS • Strengthen the Directorate of Postgraduate Studies and Research for the repackaging of research findings