Field Study: Electronic Networking for Health in Zimbabwe

Field Study: Electronic Networking for Health in Zimbabwe

Kerry Gallivan
Field Study: Electronic Networking for Health in Zimbabwe
Final Report
Advisor: Alan Hodson


FromSeptember 1993 to January 1994 I was able to work with the HealthNet community in Zimbabwe as part of my undergraduate studies at the School for International Training in Vermont, USA. As an intern at MANGO (Microcomputer Access for Non-Governmental Organizations), I assisted Dr. Rob Borland, MANGO system operator and Chairperson at the University of Zimbabwe's Computer Science Department, in the operations of the public access FidoNet 'node'. MANGO also serves as the HealthNet 'node' for Zimbabwe.

Although Zimbabwe was one of the first countries in Africa to have a groundstation installed (located at the University of Zimbabwe Medical Library), it was not until August 1993 that the local telecommunications authorities agreed to licensing the system. As a result, MANGO has served as the basis for HealthNet Zimbabwe.

Located at the offices of the Southern African Research and Documentation Centre (SARDC), MANGO is the center of both domestic and international computer networking in Zimbabwe. Three times a day a connection is made to the international gateway at WorkNet in Johannesburg, South Africa where electronic conference and personal mail is exchanged.


The majority of my activities dealt with installing MANGO system software and hardware, software training and providing on-going technical support to the various users.

Installation and training: The installation of a new user account or 'point' would generally consist of configuring the modem's internal settings and MANGO software (ie username, password, etc.) and wiring the local environment to allow direct access to the outside telephone network.

After making a successful connection with the host computer (ie MANGO), thus confirming that the system is functioning properly, I would proceed with a basic tutorial on operating the system. The topics covered are the following:

1) The Basic Computer Networking
2) Creating a message
3) Saving the message
4) Sending a message

This was generally the extent to which I could train the users of the system. Since it was likely that configuring the hardware and software took anywhere from 45 to 90 minutes, training time was inevidentablly sacrificed as a result.

Technical support: The technical support generally consisted of a series electronic mail correspondences or phone conversations answering basic questions. The majority of the problems resulted from either the MANGO software or the modems. Since documentation was unavailable to the users, myself or Rob were generally the only means of assistance in answering questions. Modems seemed to be a never-ending problem as a result of there general lack of durability and the varying degree of quality.


The majority of the information contain in this report is the result of a series of interviews which I conducted. These not only enabled me to develop a sense of the current status of the system but also allowed me to understand the.history of HealthNet Zimbabwe. The following individuals were interviewed:

Borland, Rob - Chairman of the Computer Department, University of Zimbabwe
  and MANGO sysop
Patrikios, Helga - Head Librarian, University of Zimbabwe Medical Library,
  University of Zimbabwe
ten Ham, Peter - Director of Disease Control and Epidemiology, Ministry of
  Health, Zimbabwe
von Hombergh, Dr. Henri - acting Provincial Medical Director (PMD),
  Midlands Province, Ministry of Health, Zimbabwe
Neuvians, Dieter - director of GTZ's Health Systems Research for Southern
  Africa project (GTZ-HSR)

The highlight of my activities with the HealthNet Zimbabwe occured when I was asked by the acting Midlands Provincial Medical Officer to travel to each of the district hospitals to install and training various health workers with the usage of electronic mail and the MANGO system. This consisted of two seperate visits to the Midlands Province both totaling eight full day of work. During this time, I acquired the bulk of my data for this project.


HealthNet groundstation

A satellite groundstation was installed over two and a half years ago but only until recently has the PTC (the governmental telecommunications organization) allowed sending of information. Upon arriving in Zimbabwe in September 93, myself and Rob Borland installed a "bazooka" omni-driectional antenna which I had brought with me during the journey. We were never sucess in making a connection with the satellite. A steerable antenna has cleared customs and is waiting to be installed. The NEC computer supplied by SatelLife currently has Version 2.0 (beta release) of the groundstation software, problems were encountered while installing the software and it is unclear whether or not it is properly installed.

Access to roof remains a problem, especially for larger equipment such as the steerable antenna kit. There is no direct means of getting on top of the library and a sizable latter remained unavailable. The times in which I did go on top of the roof, we needed to balance a ten foot latter on the arm-rest of a two story high cement stairwell - at least a twenty foot latter is need to assure safe and easy access.

Security at the Medical Library remains a questionable issue. Throughout my visits the groundstation, I was never once questioned by unfamilar staff and had no problem accessing the facilities unattended. On the other hand I would have to check-in with the guard at the main office, put my bag in a locker, and enter the library area with only a notebook, pen and diskettes.

With these and several other issues considered, Rob Borland and I both felt that the groundstation would be better situated at the University of Zimbabwe Computer Center.


MANGO is used as the "boss" or HealthNet "node" for Zimbabwe. This is a computer mail service established for the local NGO community here in Zimbabwe, with users in Mozambique and Malawi. MANGO uses FidoNet technology to transfer electronic mail messages. This technology has proven to be the best for African countries because of it's effectiveness against poor telephone lines. HealthNet users operate MANGO-supplied communications software in order to connect to the host.

Technical Specs

The following is a list of software and hardware used at MANGO:

FrontDoor 2.02          mailer
GEcho 1.0               tosser-scanner
RemoteAccess 2.01+      interactive BBS
BNU 1.70                FOSSIL driver
QEMM 6.03               extended memory manager
NetMgr 0.95             FidoNet redirection utility

MS-DOS 5.0
TeleBit T2500           modem

A TeleBit WorldBlazer was received by SatelLife in September 93 but Rob ran into a problem where by the modem would not successfully disconnect a caller and it would be "hung" indefinately, unable to allow other calllers to connect, for an indefinated amount of time. At first it appeared this was a problem which was unique to the TeleBit WorldBlazer but before I left Zimbabwe the same problem had occurred with the TeleBit T2500 at least once. I now think it maybe a software related problem, not a modem configuration problem.

Point software

The points of MANGO are currently using:

BinkleyTerm 2.56      mailer
Squish                tosser-scanner
Golded                editor


MANGO currently makes available a limited number of electronic conferences to it's users, of these several have been setup for the HealthNet community. The following is a list of medical-related ones:

 africa.netnews           News from systems in Africa
 aml.bulletin             African Medical Librarians Bulletin           HealthNet news bulletins from SatelLife
 healthnet.zimbabwe       HealthNet Zimbabwe private conference
 mango.aids               AIDS Daily news summary from Columbia University

HealthNet Zimbabwe: Whos Using It?

There are currently 37 registered HealthNet users throughout Zimbabwe (of which 24 are estimated to be active), including the Ministry of Health, University of Zimbabwe Medical Library, Community Medicine Department and the six students in the Masters in Public Health degree program, UNICEF, the German Agency for Technical Cooperation's (GTZ) Health Systems Research Programme, and seven rural hospitals in Midlands Province. NOTE: In determining who used HealthNet I referred to the user logs recorded at MANGO. I define an active user as someone who has dialed into HealthNet at least once in a one week period.

HealthNet Zimbabwe Point List

Rob Borland is the system operator and can be reached at

Name/Organization                                Fido Address

Dan Peterson, UZ Community Medicine            5:7211/1.3
Cathy Tsikirayi, UZ Medical Rural Coord        5:7211/1.5
Richard Laing, UZ Community Medicine           5:7211/1.7
Helga Patrikios, UZ Medical Library            5:7211/1.15
Dieter Neuvians, GTZ                           5:7211/1.19
Chas Todd, UZ Community Medicine               5:7211/1.28
Glyn Chapman, UZ Community Medicine            5:7211/1.31
Amanda le Grand, WHO                           5:7211/1.33
Sabelo Mapasure, UZ Medical Library            5:7211/1.60
Archibald Gumiro, MoH, Harare                  5:7211/1.61
Bothwell Mutandiro, MoH, Blair                 5:7211/1.63
Mary  Bassett, UZ Community Medicine           5:7211/1.64
Smockie Dube, MoH, Bulawayo                    5:7211/1.65
Peter ten Ham, MoH, Harare                     5:7211/1.66
PMDs Office, MoH, Gweru                       5:7211/1.67
Henri van den Hombergh, MoH, Gweru             5:7211/1.68
Pierpaiolo deColombani, MoH, Chinhoyi          5:7211/1.69
Shepard Mashayamombe, UZ MPH Program           5:7211/1.91
Standford Chigumira, UZ MPH Program            5:7211/1.92
Cephas Dzuda, UZ MPH Program                   5:7211/1.93
David Matanhire, UZ MPH Program                5:7211/1.94
Kevin Mwenye, UZ MPH Program                   5:7211/1.95
Sue Grady, UZ Community Medicine               5:7211/1.96
Godfrey Woelk, UZ Community Medicine           5:7211/1.100
Kwekwe District Hospital, MP                   5:7211/1.115
Mvuma District Hospital, MP                    5:7211/1.116
Zvishavane District Hospital, MP               5:7211/1.117
Gokwe  District Hospital, MP                   5:7211/1.118
Mberengwa  District Hospital, MP               5:7211/1.119
Shurugwi District Hospital, MP                 5:7211/1.120
Aad van Geldermalsen, MoH Rusape               5:7211/1.129
Alesandro Loretti, WHO                         5:7211/1.136
Vikram Patel, UZ Psychaitry                    5:7211/1.139

GTZ     German Agency for Technical Cooperation
MPH     Masters in Public Health degree program
MP      Midlands Province
MoH     Ministry of Health
NUST    National University of Science and Technology (Bulawayo)
UZ      University of Zimbabwe


Midlands Province

Of the various HealthNet users in Zimbabwe, the recent additional of the seven district hospitals in the Midlands Province deserves a special mention. With the help of Dr. Henri van den Hombergh, Medical Officer of Health - Epidemiology and Disease Control (MOH-EDC), each of the seven district hospitals was supplied with a personal computer, printer and modem.

With this equipment, health workers at each of the district hospitals are able to enter data into the custom-made T5 epidemiology software program. The data is exported as a DBase file and sent via HealthNet Zimbabwe to the Provincial Medical Director's (PMO) office as an electronic mail message with an 'attached file.' The MOH-EDC analyzes the data and a report sent back via HealthNet. As a result, the Midlands Province has been enabled to significantly increase it's monitoring capabilities of cholera and malaria in the region.

University of Zimbabwe Medical Library

On the average 2 requests per month are made via HealthNet for books or periodicals at the University of Zimbabwe Medical Library. These are mainly from Master's of Public Health students who are in the rural areas completing their studies. A few of the Midlands District hospitals have also begun making literature requests via electronic mail, namely the Mnene Mission Hospital which is located 32 km from a main road and serves as the District Hospital for the Mberengwa region.

University of Zimbabwe's Masters of Public Health Without Walls

Sponsored by the Rockefeller Foundation in New York with assistance from the Center for Disease Control in Altanta, this is a two year program in public health with an emphasis on epidemiology. The program arose from the philosophy that public health programs were becoming too acedemic and there was a fundamental need to be to able reality-based training. Students are therefore required to do there studies 'in the field' at various health centers. As a result, the students have remained in contact with their adivors and program councilors via HealthNet.


With electronic mail comes an increased access to information, this increase is not always welcomed by the governments of less-developed countries. As a result, several 'political issues' came to light during my work in Zimbabwe regarding HealthNet and electronic mail in general. Licensing: The satellite groundstation license was not received until several years after the intial installation. For the most part, the Zimbabwe government is still very concerned about the "free flow" of information to the general population. Although "not as much as South Africa" (Rob Borland), Zimbabwe's government continues to have a very restrictive policy towards electronic mail usage. This is most obvious with it's policy for modem usage witin the country.

A person wanting to use a modem in Zimbabwe has two options, purchase a PTC-made modem or pay a usage fee to use a third party modem. If the user purchases a modem from the PTC, speeds up to 2400 bps are only available and it's very likely that it won't work. Third party modems must be registered, this includes having it sent to Harare in order to be "certified," and installed by the PTC. Once registered, monthly usage fees must be paid to compensate the PTC for the right to connect the modem to it's telephone system.

While working at the district hospitals in the Midlands Province, several times the District Medical Officer (DMO) needed to lie to the local PTC authorities by telling them he needed a modification in the PTC-owned switchboard to allow access to a direct line from an extension. The reason given was so that the health worker working with the computer would be able to call the PMD's office at any time to report vital health data. In fact, it was so the computer could call the HealthNet node in Harare to transmitt and recieve medical information, not the person.

The possibility of an PTC engineer discovering an unregistered modem remians a constant concern to electronic mail users in Zimbabwe. If a such a modem is discovered, it is possibel that it will be taken away by the PTC. Although it remain unlikely, this was the case for one organization which I connected to the network. As a result, internal modem are preferred by the general user for the reason that they are less likely to be "discovered" by the PTC. For a technical view point, internal modems are consistantly not as duriable and are discouraged.


The lack of general computer knowledge remains the single greatest social obstacled related to computer networking in Zimbabwe, so few people are exposed to computers. For example, upon leaving UNICEF offices in Harare I was asked by the security guard how he can get involved with computers, he originally wanted learn about them, not be a security but there was no way - how can he? While my answers were to get involved with the university, night-classes maybe, I sensed these were suggestions which were not possible for him. I suspect it is largely a result of the cost and limitedness need of education, specially higher education/technical degrees, in Zimbabwe.

Simiarly, the motivation among employees who have access to computers is very low. The people I spoke with felt this is because health workers are paid so little, there is not much desire to spend extra time learning computer applications.


Medical students

They [Zambian physicians] thought that it was important to encourage post graduates to use the system more. If students got used to using it and understood the benefits, they might be more likely to use it when they graduate. Antonia was going to look into putting HealthNet into the curriculum. For example, they might require all students to do one medline search or a consultation over the system. He said that he believes HealthNet will be an important aspect of the post-graduate course that they are creating, the objective of which is to train Zambian doctors to stay in Zambia. E-mail will be an important component because it will help them not feel so isolated in rural areas.

Internet Resourses

* Accessing databases of the national library of medicine through electronic mail - BITNIS. BITNIS it is a new mechanism for accessing all databases of the National Library of Medicine (NLM) in Bethesda, Maryland. This method involves use of GRATEFUL MED, BITNET, internet, UUCP, FIDONET, and a software called SMED.

* CANCHID-CUCHID/CSIH - Canadian University Consortium on Health in International Development Bulletin Board.


A sense of community it doesn't appear to exist among the HealthNet users in Zimbabwe. For example, "healthnet.zimbabwe" (a private electronic conference on MANGO) was never used during my stay. This was orginally setup to provide a forum of exchange among HealthNet users in Zimbabwe and issues relating specifical to them. In fact, the only exchange which occurs among users is 'point-to-point' rather than group discussions. There are several possible reasons for this. People do not have a clear sense of what HealthNet. For example, to many of the users HealthNet consists of the daily AIDS bulletins which are received at MANGO, nothing more. There is a really need for SatelLife to clear articulate it's vision of HealthNet and to promoted it in places such as Zimbabwe.


Many of the health workers I've worked with have only been exposed to computers with the year so that many of the concepts and terms which I take for granted are unclear to them. This requires that I am very conscious about what terms I use and concepts I choose not to explain. Others like Peter ten Ham at the Ministry of Health require very little time before their up and running with the system, of course Peter is from Denmark and has been exposed to computers for sometime now.


"One has to be prepared to do hardware with communications.", says Dr. Henri von Hombergh. This is quote "says it all." The majority of installations which I've done or assisted with have required working on the telephone wiring system. As a result, I've slowly become familiar will the workings of the average telephone connections and how to alter them when needed.

I've also had to become more familiar with the internal configuration of modems. These are the various Hayes Command Sets which determine the details of a modem's functions. These settings are important because the phone lines here in Zimbabwe and throughout most of Africa are very poor so that particular settings are required in order for the modem to work properly. This usually isn't the case in the US or Europe because the phone lines are so good, compared to Africa, had any setting will allow the modem to function properly.

While the groundstation's hardware and software are updated, MANGO will continue to serve as HealthNet Zimbabwe's 'node'. It has developed into a cooperative relationship, one of the many which exists among computer networks in Africa, and will help to strengthen the system as a whole.

From: "Arthur R. McGee" 
---------- Forwarded message ----------
Date: Thu, 4 Aug 1994 10:58:35 -0400 (EDT)
From: Kerry Gallivan 
Subject: paper #1

Editor: Ali B. Ali-Dinar
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