[e-drug] Better access to information

[Valeria Frighi <valeria.frighi@dtu.ox.ac.uk>]

E-drug: Better access to information
---------------------------------------------

[copied as fair use]

Closing the digital divide
Remarkable progress is being made
BMJ 2003;326:238 ( 1 February )

Editorials

As recently as September 2000 a scientist from the World Health
Organization wrote that global inequity in access to the internet was 
greater than any other inequity.1 Less than three years later more 
than 100 health institutions in the developing world have free 
electronic access to over 2000 journal saccess that is equal, and 
sometimes better, than in institutions in New York, London, and 
Paris. This week access is being extended beyond the 68 countries 
with incomes of less than $1000 (£612; 922) a head to 42 countries 
with incomes between $1000 and $3000 a head.

Until very recently health institutions in low income countries had
almost no access to international journals, and the few textbooks 
available were often years out of date. 2 3 These institutions simply 
couldn't afford the journals. Many small organisations worked hard to 
try to provide information, but international organisations such as 
the World Health Organization and the World Bank did not give high 
priority to improving access to information. Access to drugs, 
supplies, and technical support seemed to be more important.

But this is the information age, and we have all understood increasingly
that access to information is essential for development and 
improvement in health services.4 WHO decided a few years ago to give 
higher priority to improving access to information.

In July 2001 Gro Harlem Brundtland, the director general of WHO,
announced the launch of HINARI (Health Internetwork Access to 
Research Initiative, www.healthinternetwork.org).5 This is a 
voluntary partnership between WHO and 28 publishers to provide free 
or nominally priced access to health information to institutions in 
the developing world.

The first phase launched on 31 January 2001, supplying 68 countries 
with free access to 1400 journals. A total of 438 institutions in 56 
countries have registered, and more than 100 institutions are 
accessing the journals regularly. The number of institutions 
accessing material is growing, and the number of journals has 
increased to over 2000 since 18 further publishers have joined the 
programme. All the major weekly medical and scientific journals can 
be accessed for free.

On 31 January 2003 access was extended to another 42 middle income
countries. Institutions in these countries must pay $1000 for access 
to all the journals (which would buy subscriptions to about three 
journals at normal prices), but the publishers are donating the 
revenue to WHO to use for training librarians in using HINARI. In 
future HINARI should include electronic books, bibliographical 
databases, and continuing education programmes.
There is also a plan to copy the programme for information on 
agriculture and the environment.

HINARI has transformed information access in a very short time, but it
is no panacea. Access to the internet in the developing world is 
still limited, expensive, and far from robust although it is 
increasing exponentially in many poor countries. HINARI is aimed at 
researchers and policy makers. Further steps perhaps using paper need 
to be taken to reach front line health workers. Librarians and others 
need training in how to find the best information. Ironically, some 
in the developing world are now suffering from the information 
paradox familiar in the developed world drowning in information, much 
of it irrelevant, and
yet being unable to find answers to the questions that arise all the
time in health care.

The programme is also primarily about supplying information from the
rich world to the poor world. It's equally important to increase the 
flow of information in the developing world and from the poor world 
to the rich world. Most important of all is to create cultures of 
reading, questioning, debating, researching, and publishing. An 
improved information supply is a necessary but not sufficient 
condition for creating such cultures.

Richard Smith, editor.

BMJ

Footnotes
Competing interest: The BMJ has played a leading part in creating
HINARI. Partly because bmj.com has been free to everybody since it 
was launched, I was approached by WHO to serve as a link with 
commercial publishers. I explained that many commercial publishers 
think me odd and suggested that one of our staff, Maurice Long, would 
do the job much better. Maurice knows everybody and is widely liked 
and respected. The BMJ Publishing Group (and so the BMA) has paid for 
Maurice's time while he has worked on this project. Meanwhile, the 
electronic version of the BMJ and all the BMJ journals are not only 
part of HINARI but also remain free to individuals as well as 
institutions in the 100 poorest countries in the world.

1.
    Tan-Torres Edejer T. Disseminating health information in developing
countries: the role of the internet. BMJ 2000; 321:
    797-800[Free Full Text].
  2.
    Godlee F, Horton R, Smith R. Global information flow. BMJ 2000; 321:
776-777[Free Full Text].
  3.
    Kale R. Health information for the developing world. BMJ 1994; 309:
939-942[Free Full Text].
  4.
    World Health Organization. Macroeconomics and health: investing in
health for economic development. Report of
    the commission on macroeconomics and health. Geneva: WHO, 2001.
  5.
    Kmietowicz Z. Deal allows developing countries free access to
journals. BMJ 2001; 323: 65[Free Full Text].
-- 
Dr. Valeria Frighi
Diabetes Trials Unit
Radcliffe Infirmary
Woodstock Road
Oxford OX2 6HE
UK
tel. -44-1865-228422
fax -44-1865-224584
e-mail valeria.frighi@dtu.ox.ac.uk
--
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