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[afro-nets] Improving Online Access to Medical Information

  • Subject: [afro-nets] Improving Online Access to Medical Information
  • From: Dr Rana Jawad Asghar <jawad@alumni.washington.edu>
  • Date: Thu, 4 Mar 2004 11:57:59 +0500
  • Cc:

Improving Online Access to Medical Information for Low-Income Countries

NEJM Volume 350:966-968 March 4, 2004 Number 10
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Download as Adobe PDF file (3 pp. 85 kB):

by Barbara Aronson

Over the past two years, the World Health Organization (WHO) has
worked with publishing partners (including the Journal) to im-
prove online access to scientific resources as a way of support-
ing health professionals, medical researchers, and academics in
developing countries. WHO helped to create the Health InterNet-
work Access to Research Initiative (HINARI,
http://www.healthinternetwork.org), which offers health and
medical institutions in 69 of the world's lowest-income coun-
tries free online access to a large library of important inter-
national journals. This initiative has been expanded to include
an additional 44 countries that qualify for access to the jour-
nals at a very low price. To date, 47 publishers from all
streams of scientific publishing have joined HINARI to offer ac-
cess to more than 2300 journals and other full-text resources.

A total of 1043 institutions in 100 countries (of a total of 113
eligible countries) have registered for the program. Institu-
tions in countries with a per-capita gross national product
(GNP) of less than $1,000 receive free access to the journals
(see Table). Institutions in countries with a per-capita GNP of
$1,000 to $3,000 pay $1,000 per year. These institutions include
national universities, professional schools, research insti-
tutes, teaching hospitals, and government offices. All staff
members and students are entitled to this access.

HINARI was created after a study by WHO found that researchers
and academics in developing countries identified access to the
"priced literature" (i.e., journals) as their most pressing in-
formation problem. In the lowest-income countries, 56 percent of
the institutions had no current subscriptions to international
journals and 21 percent had an average of only two journal sub-
scriptions. In the tier with the next-lowest incomes, 34 percent
of institutions had no current subscriptions, and 34 percent had
two to five journal subscriptions. HINARI complements efforts by
some of the major Web publishers to offer free, direct access to
biomedical journals for users in the lowest-income countries.
(The Journal also participates in the free-access program of
HighWire Press and offers unrestricted access to all users from
these 113 countries.)

HINARI has greatly improved access to information for these in-
stitutions, and the levels of use are growing steadily. In the
first six months of 2003, HINARI users downloaded 34,680 arti-
cles from the 214 journals offered by Blackwell Publishing, and
during the next six months, the number jumped by 113 percent, to
73,734 articles downloaded. Usage levels seem to depend more on
good connectivity than on the relative economic strength of the
country. Some of the biggest users are in Ethiopia, Nepal, Su-
dan, and Vietnam, all of which are among the poorest countries
in the world. The high cost of reliable Internet access, com-
puter equipment, peripherals, and supplies (workstations, print-
ers, paper, toner, and electric generators for backup supply) is
a major limiting factor, but access to equipment and to the
Internet is growing throughout the developing world. And some
participating institutions indicate that they are using their
HINARI eligibility to leverage funding for equipment and Inter-
net access from their governments and from international donors.

In 2004, the HINARI team at WHO and our partners - the publish-
ers, the Yale University Library, the National Library of Medi-
cine, and the Special Program for Research and Training in
Tropical Diseases (cosponsored by the United Nations Development
Program, the World Bank, and WHO) - will be focusing particu-
larly on user training. The publishers have donated the fees
they have collected through the program in order to fund in-
country training workshops. Training is closely coordinated with
HINARI's sister program, Access to Global Online Research in Ag-
riculture (AGORA), which is administered by the United Nations
Food and Agriculture Organization.

Will improved online access have an effect on health in low-
income countries? It is probably impossible to show a direct
connection either between the lack of access to information and
poor health or between improved access to information and im-
proved health. There are many other reasons why health in these
countries is poor and will not improve quickly. These include
poor health services infrastructure, poor nutrition, lack of
clean water, and poor sanitation, as well as war, drought, and
political corruption. Most global health and medical research
remains focused on the problems of wealthy nations. But low-
income countries also have medical schools and universities.
They have researchers and research institutes that carry out es-
sential work on local problems and government offices that try
to set effective policies. Warren Stevens of the Medical Re-
search Council Laboratories in the Gambia has noted that intel-
lectual isolation represents an important hindrance to the de-
velopment of world-class researchers in African countries. Ac-
cess to timely, relevant, high-quality scientific information
represents a substantial gain for the researchers, students,
teachers, and policymakers in low-income countries. Can this be
called anything but progress?

Source Information:
From the HINARI Program, World Health Organization, Geneva.