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Health
Information Forum: Working together to improve access to reliable information for healthcare
workers in developing and transitional countries
Internet gateways for frontline healthcare workers in developing countries
Venue: British Medical Association, Tavistock Square, London, WC1H 9JR
Contact: Neil Pakenham-Walsh Telephone: 01865 248124 E-mail: [email protected]
BACKGROUND: An increasing minority of healthcare providers, students and researchers in the developing world are able to benefit from the Internet. In addition, access to the internet is becoming increasingly available to those in developing countries who are responsible for repackaging information to meet needs at national and local level: librarians, publishers, ministries of health, NGOs.
Internet gateways are a popular and useful method of helping Internet users to identify useful on-line resources. Selected links are organized and described in order to help users find what they need. But there is a surprising lack of health information gateways for developing countries.
OBJECTIVES:
1. To exchange experience of gateway development - at national, regional, and international level.
2. To explore priorities and options for the future.
3. To formulate a short list of action points: what needs to be done, who might do it, what needs to be done next?
PRESENTATION 1: Keneya blown: a possible model of medical portals for african countries
Abdrahamane Anne, Librarian, Faculty of Medicine, Bamako, Mali <[email protected]>
Ousmane Ly, medical doctor and coordinator, Kčnčya Blown project, Bamako, Mali <[email protected]>
INTRODUCTION TO HEALTH PORTALS
The Internet is a communication tool, a way of disseminating information, support of many services, a collection of information, and a source of information.
More and more attention is paid to the digital divide. The developing world could benefit from internet in many sectors such as health and education.
Health portals:
- are a way to organise web information
- provide a gateway to online information for a category of internet users
- present many useful and practical sources of information
- provide easy access to medical information on the net
Objectives of a health portal:
- Starting point to internet for a specific group
- Collect and classify medical information and news
- Inform about medical events and news
- Facilitate collaboration and sharing of experience among health workers
- Facilitate searching for medical information on the net
Types of portals
KENEYA BLOWN
http://www.keneya.org.ml
Keneya blown was initiated in Bamako, Mali, by Dr Ousmane Ly.
'Keneya' means 'health' in the Bamanan language, and 'Blown' means 'hall' (place where a visitor is met before entering the house) or 'meeting place'.
"Keneya Blown" is the hall where we plan to meet and fight diseases - unwelcome visitors. Thus we focus attention on prevention.
"Keneya blown" is the place where health professionals can discuss and share their experiences.
Current actors include: The Keneya Blown team; Mr Guy Olivier Segond (Switzerland); Pr Antoine Geissbuhler (Switzerland);SOTELMA (Mali); National Telecommunication company; International Institute for Communication and Development (IICD, Netherlands)
History of Keneya Blown:
1990 - MRTC uses email through Satellife network
1996 - first videoconference between Bamako and European Institute of Telemedicine in Toulouse
1996 - Internet is launched in Mali, thanks to Leyland Initiative
1999 - e.net is created
October 1999 the project document is written
November 1999 the project document is available online
February 2000 - Funds were found
2001 - A thesis is presented by Mr Ousmane
2002 Training of health workers on the use of ICTs
April 2002 - Round Table on "How to improve health quality by means of ICTs"
May 2002... To be continued
Keneya Blown has equipment installed in Bamako and Segou:
Hardware : servers and PC and connecting facilities
Software : web, mail and database servers, office 2000
Operating systems : Linux and windows 98
Keneya Blown activities
- Internet service provider for health services
- Medical portal
- Virtual library and access to bibliographic databases
- E-publishing : e-training, e-journals, continuing education
- Research : coordination and synthesis of practical research works
- Email : [email protected]
- Telemedicine applications :
- transmission of medical data and images
- e-monitoring
- tele-expertise
- Training on computer and internet use
- Videoconferences and online meetings
Keneya Blown as a portal
- for health workers:
- Access to medical databases
- Listservs
- Discussion groups
- Distance learning
- Online publishing
- for the general public:
- Directory of health centres and pharmacies
- E-trading
- Health education
- Weekly meeting with a specialist
- Range of information sources
Post doctoral education
Collaboration through health workers and practitioners
Medical news
A communication tool between ministry of health and its departments
A communication tool for health workers associations
Keneya blown also hosts the FMPOS database
URL : http://www.keneya.org.ml/fmpos/bd/fmpos.htm
This database has 1494 records and includes:
- theses presented at the Faculty of Medicine of Bamako
- statistics about medical publications about Mali
- selected Medline abstracts, eg parasitic diseases AND Mali
English : 57%
French : 34%
Russian, Italian, Bulgarian
As a conclusion
Different activities - be a provider, trainer, web hosting service, ...
Do not reinvent the wheel - build on the work done by others
Do not work alone - necessary to cooperate in the national, regional and international scale
Choose adaptable technology - use free software and, if available, open source software.
PRESENTATION 2: A system to support knowledge management in the health sector - the South African National Health Knowledge Network
Professor Koos Louw, Executive Director, Informatics and Knowledge Management, Medical Research Council, Tygerberg, South Africa <[email protected]>
www.sahealthinfo.org
- Access to unique local and indigenous content
- Gateway to relevant international knowledge sources
- Collaboration services for communities of practice
The aim of a knowledge network is to build and organise a network of local and global knowledge resources of relevance to the particular community of members and users, with access to quality-controlled and evidence-based health research information.
Furthermore it enables the players in the system to interact with each other and with remote suppliers of knowledge sources for the purpose of collaborative action and goal achievement.
The purpose of the information portal is to deliver comprehensive and unified access to a heterogeneous collection of information sources through a secure access layer.
Specific functionality includes:
- Personalisation and notification - allowing users to select and receive information relevant to their interests and roles.
- Searching - the ability to search for information buried across multiple formats and sources.
- Unified access - organizing and disseminating information assets, whether structured (databases, spreadsheets) or unstructured (e.g. documents, web pages).
- Strict security models - ensuring various levels of security to ensure information is accessible yet protected.
- Content submission and sharing - allowing collaborators to share valuable information in a simple, effective manner.
- Intelligent classification - allowing the subject matter to be organized according to certain standards and taxonomies.
- Common terminology - the portal provides a medium to establish a common metadata repository, ensuring consistency in understanding of information.
Portals have evolved over the last few years based on three standard concepts:
- personalization
- aggregation
- integration
Portals resemble standard corporate home pages. They display aggregated information in a single Web interface and allow users to customize the content.
A portal is a personalised secure web environment. It allows an organisation to aggregate and share content - information, services, and applications -- with customers, partners, employees and suppliers. A portal can bring together technology, business processes, and business partners, enabling the organisation to exchange information inside and outside the firewall. A portal allows an organisation to employ a single URL through which users receive customised and even personalised information, as well as vital business applications.
SAHealthInfo is a one-stop interactive forum/resource, for quality-controlled and evidence-based health research information, to a wide spectrum of users, at various levels of aggregation, with the necessary security arrangements and facilities for interaction among users to promote explicit (codified) and tacit knowledge flow. It takes into account the principles of knowledge management and the drivers of a system of innovation.
SAHealthInfo provides access to its own unique databases and static information in HTML format, as well as acting as a gateway to external trusted sources of health information.
Methodology
Key theoretical drivers:
1. The information society as a driver
Furthering the information society is viewed as an essential challenge for SA HealthInfo. One of the original driving forces was the Information Society and Development Conference (ISAD) held in South Africa in May 1996, where the United Nations Economic Commission for Africa (UNECA) launched the African Information Society Initiative (AISI).
The AISI action framework identified specific goals in terms of the way in which ICT can be used to achieve more efficient and affordable health care.
2. The dynamics of innovation:
We thought that it was necessary to take cognisance of the dynamics of various factors impacting on the innovation process - some examples are:
National System of Innovation (NSI)
Reciprocal feedback between scientific research, technical development and production (implementation)
A domain approach is necessary for collective problem-solving processes (communities of practice/ networks of co-operation)
The existence of a substructure and a superstructure
Coded and tacit knowledge flow
The South African National System of Innovation aimed at health solutions.
It is clear that one can only expect 'innovation' as an output of such a system if the necessary interaction and information flow between the various players happens at a sophisticated level.
This is where MRC's role as a 'linking organisation' comes into play:
providing for the necessary links between diverse bodies of knowledge, competencies and techniques, thereby creating a convergence of interdependent and complementary action within the innovation community.
3. Capitalising on modern ICT:
Modern ICT offers a major advantage, but the digital divide should not be ignored.
Number of Internet hosts as an indicator of the 'digital divide'
The number of Internet hosts per capita increased 29 percent in Sub Saharan Africa in 1997-99, compared to 87 percent in OECD countries. (World Bank)
Therefore we welcome the UN Millenium Summit Declaration:
"To ensure that the benefits of new technologies, especially information and communication technologies...are available to all." (September 2000)
Where land-based telecommunication infrastructure is not sufficient, consider satellite downloads.
4. Using a knowledge management approach:
Processes that seek a synergistic combination of the data and information processing capacity of information technologies, and the creative and innovative capacity of human beings
Catering for knowledge production and diffusion
5. The specific requirements of the health system:
The International Conference on Health Research for Development, held 10-13 October 2000 in Bangkok, underlined the importance of knowledge creation and appropriate knowledge management in the health system.
Health status is the result of a complex system, involving various players. Interaction among these players, involving researchers, health services, industry, health policy makers and communities in an iterative process, is also the basis for the Essential National Health Research (ENHR) approach.
For ENHR to succeed it must be supported by efficient knowledge management.
In an effort to investigate the role of information in the process of decision-making, in depth interviews were conducted by the MRC Burden of Disease Unit with programme and district managers in the Department of Health in one of the provinces in South Africa (Mbananga and Sekoktia, HST report 2002).
The study has shown that managers are well aware of their information needs but that the information system generally does not meet their needs. The quality of health management information (available) is described as inaccurate, incomplete and inadequate in informing all the decisions. In particular, the inadequacy of routine, data and the inappropriate level of aggregation appear to be constraints. That are taking place in province and in the country.
A new kind of 'animal' is needed:
Traditional relational databases
HTML files
Linking remote sources - indexed by robot
Modern front end
Customised by end-user
Currently the following modules are available on SAHealthInfo:
- Alcohol and drug abuse
- Bioinformatics
- Chronic diseases of lifestyle
- Ethics in health research
- Evidence-based medicine
- HIV/AIDS
- Malaria
- Medical Inventions
- Mental Health
- Nutrition
- Traditional Medicine
- Tuberculosis
- Violence and injury surveillance
The users?
A study by Elizabeth Gummerson, Center for International Development at Harvard University, "Assessing the Global Audience for Health Care Web Sites"
Are development health web sites actually being accessed by users in developing nations? Development health sites do not to appear to be any more successful than their non-development counterparts at reaching audiences in the developing world. Locally managed health sites may be an exception.
Thoughts/Questions:
- Why is usage of apparently useable sites so poor in developing countries?
-Is content irrelevant? Would it help to "focus group" content for developing country consumers?
-Is connectivity poor? How would the data look if normalized to total national bandwidth?
-Is there simply less demand than we imagined?
Expected exponential growth of eHealth
Linking the health care sector with the educational and research sector - must be a high priority
It is important to ensure that the health care sector does not develop information systems in isolation or ignoring the necessary interfacing with the valuable information resources in the educational and research sector - and vice versa.
Challenges
Articulation: People can describe their information needs:
- Understand and communicate intended use of information.
- Direct information requests appropriately.
Awareness: People know where to find knowledge resources:
- Provide signposts: directories, Yellow Pages, and maps.
- Use communities of practice to cast a spotlight on organisational knowledge.
Access: People have the (ICT) tools they need to find and capture information:
- Balance push and pull technologies.
- Involve the user in tailoring navigation and capture tools.
Guidance: New organisational roles support information seekers:
- Convert librarians into cybrarians.
- Create a new role: the knowledge manager.
- Use experts as information filters.
Completeness: The knowledge infrastructure is comprehensive and well-organised:
- Provide access to both centrally managed and self-published information.
- Create frameworks and processes that promote knowledge reuse.
Information waystations / staging posts / telecentres :
Information Waystations (Iws) are local points of access to health information received electronically. They have a PC, CD-ROM & databases, printer, modem, reliable satellite, land telephone, or cellular-phone communication links, and Internet access. The aim is to link the network of other Iws, and share information with other Iws in a two-way flow. This could potentially be integrated into existing telecentres. Iws will also allow for telemedicine referrals.
IWS will hopefully evolve into Staging Posts, which will act as 'relay stations', translating and adapting information materials in order to make them locally appropriate. They will distribute information rapidly and widely, linked to health and education initiatives. They will make use of appropriate external information sources, particularly prototype publications provided electronically, as well as sharing local information, both formal and non-formal/indigenous, in a two-way flow.
Summary
The knowledge network, SA HealthInfo, will facilitate and enable interaction and iterative information flow among players in the health system (researchers, health services, industry, health policy-makers and communities).
Such action is essential to drive innovation processes and improved decision making for finding solutions for the southern African region's health problems.
An underlying principle is that the knowledge network provides a trusted single entry-point resource for quality-controlled and evidence-based information.
Without doubt there is a need to provide relevant information to front-line health workers who are fighting the burden of disease.
We have to use relevant technology, appropriately, and plan access to to portals, gateways and repositories in such a way that rural areas are included.
Developing-world national portals and gateways must be complementary to global initiatives, but they would logically have `tentacles' into each other.
National portals and gateways should:
- Create an enabling IT environment, with capacity building
- Create momentum in developing new information resources and unlocking existing disparate sources
- Provide a secure environment for health information
- Adhere to the legislative framework
- Link with projects aimed at roll-out of waystations or telecentres for Internet under-serviced areas
- Not ignore the human element and need for personal interaction, and should therefore plan for:
- the role of librarians and knowledge officers, as information filters
- a physical call centre
- services such as document provision
Questions
Q: Can you say more about the role of local knowledge in national and regional portal development?
A: National and regional portals such as the AfroAIDS portal can help to unlock indigenous knowledge sources and serve as a channel for dissemination of local research. Local content has an important contribution to make to 'global' content. Development of national and regional health portals also empowers people.
International activities can help to stimulate regional initiatives. For example, the Cochrane Collaboration, an international activity, has stimulated the development of the African Trials Database.
Q: In southern Africa, there are two main levels of healthcare: public and private. In the public sector, which is responsible for the majority of the population, healthcare workers have very few resources available and they require different types of information that is appropriate to their level of education and available diagnostic and treatment facilities. Will SA HealthInfo take into account the need for information that is appropriate to these frontline public-sector healthcare workers?
A: The primary end-user groups of SAHealthInfo are biomedical researchers, policy makers and patients. It is not the main information source for public sector healthcare services. The ministry of health in South Africa is developing a gateway for public sector workers and we aim to work with them. SAHealthInfo is keen to link and partner with public and private sector initiatives.
Q: SAHealthInfo is provided free for the present, but worldwide we are seeing the introduction of user charges for web resources that were previously free of charge.
A: I agree, this is a major problem.
PRESENTATION 3: The INASP Health Links gateway
<http://www.inasp.info/links/health/>
Lenny Rhine, Assistant Director for Collection Management, Health Science Center Library of the University of Florida, U.S. <[email protected]>
Lenny started by saying he felt inspired to be in a room with such a large number of professionals who shared a commitment to exploring ways to improve access to information for health workers in developing countries.
He opened with two quotations:
"Although physicians in the developed countries may feel overwhelmed by the volume of available information..., most doctors in developing countries would never understand such a complaint. The concern in the developing countries, where at least two-thirds of future physicians are being educated, is the lack of access to current scientific data to help in medical decision-making."
Haddad, H and MacLoud, S. Access to medical and health information in the developing world: an essential tool for change in medical education. Journal of the Canadian Medical Association: 1999 Jan 12; 160:1: 63
"Internet connectivity and its abundant databases, reference material, journals online and library-search programs hold promise for the information starved countries."
Lown, B, Bukachi, F and Xavier, R. Health information in the developing world. Lancet 1998 Oct; 352: Suppl: su35-36
The priority is to increase access to relevant, reliable information for health professionals in developing and transitional countries.
Key variables for successful use of the Internet include: Cost effective, speedy and reliable access; and Training, education, re-education.
There is a vital role for health information providers to filter information and adapt for connected and unconnected end users.
Current limitations of Internet include:
- English language bias
- Industrialized country bias (North to South)
- Overwhelming and varying levels of information
- Problems of access
A Subject Gateway is "a web site that provides searchable and browsable access to online resources focused around a specific subject. Subject gateway resource descriptions are usually created manually rather than being generated via an automated process." IMesh Toolkit
Subject Gateways use human intervention for:
- Resource Selection - selection of appropriate Internet resources, usually according to criteria
- Collection Maintenance - regular maintenance of the collection occurs, including the removal of resources
- Resource Description - annotated by a human intermediary with a description of the resource.
- Subject Classification - use of a subject classification scheme to index all resources
University of Zambia Guide to Medical Resources
http://www.medguide.org.zm/
This gateway provides access to relevant health information that is available on the Internet. It has become a useful tool for UNZA students, faculty and researchers and the Ministry of Health and other institutions' personnel including NGO officers become a tool for disseminating information on health care developments within Zambia.
The Guide has successsfully applied new information technology to close the information gap; and it has been a prototype for the type of websites that could be created in developing and transitional countries.
'INASP Health Links' was created because there is:
1. A lack of a comparable international health gateway dedicated to health professionals in developing and transitional countries
2. An increasing number of individual websites focused on health issues for this population
3. An increasing level of access to the Internet in the principle cities in developing and transitional countries
Towards the end of 2001, Lenny Rhine approached INASP about adapting the UNZA Medical Library 'Guide to Medical Resources' to develop an international gateway as a collaborative effort of INASP, University of Zambia and the University of Florida. After considerable reorganization and addition of many new links, INASP Health Links was launched in January 2002. INASP Health Links now includes links to well over 500 recommended sites, with descriptions. The functionality of all links is checked every 6 weeks.
'INASP Health Links' is seen as an immediate contribution to help address the demand in developing and transitional countries for access to relevant and reliable information on the Internet. It is offered as a template for use by others to develop and customize their own gateways.
Limitations of 'INASP Health Links' include the fact that it has been produced with *minimal* resources, and this has precluded formal quality assessment of the content of each recommended site.
As with all internet resources, INASP Health Links is not directly accessible to all in developing countries. Use of the Internet is slow for most users in developing countries, and the Internet cannot be accessed at all by most frontline healthcare workers.
However, the Internet *is* increasingly accessible in developing and transitional countries to training institutions and medical libraries, Ministries of Health, NGOs, and the publishing industry. These institutions can repackage information into print and other formats for frontline healthcare workers.
There are increasing opportunities for international collaboration and communications to deliver quality-controlled, comprehensive Internet gateways and web-based tools for frontline healthcare workers. Coordination of international and national gateways is important so that projects are mutually reinforcing with minimal duplication.
Questions
Q: Most primary healthcare providers have no access to books, journals, or any other materials, let alone the internet. How can gateways address the needs of frontline health workers for practical information in printed and other non-IT formats?
A (from speaker and other participants): Info needs to be repackaged for use by frontline healthcare workers in developing countries. The priority is to develop capacities at the local level to produce locally relevant materials. These capacities include a need for easy access to relevant sources of information that are appropriate to healthcare with minimal resources, eg Where there is no doctor. More source information of this nature could be made more easily available, free of charge, to 'health information repackagers' - producers of health learning materials, trainers, lecturers, librarians - in developing countries. Support is needed for repackagers to adapt, translate and synthesize content with other sources. This would enable local repackagers to deliver reliable, relevant information to local healthcare workers. Local repackagers are in the best position to understand the information needs of local healthcare workers. There is also a great potential for supporting exchange of experience, ideas and publications among local repackagers around the world.
Q: Could we be underestimating the importance of gateways such as INASP Health Links? We need to be sure that future development of such gateways is adequate.
A: We see INASP Health Links as a short-term solution to an immediate need. In the long term, we hope that this will stimulate international collaboration among major players to ensure provision of more comprehensive information targeted to frontline healthcare workers in developing countries, and the local 'health information repackagers' who are responsible for meeting local information needs.
Comment: Much of the available content is unintelligible to many frontline healthcare workers. I would like to put the case for increased support for, and use of, publications with simple language, diagrams, and pictures.
PRESENTATION 4: Evaluation of quality of health web sites
Paula Manning, Services Manager, BIOME
BIOME was launched in 2000, built upon pre-existing OMNI (Organising Medical Networked Information) Gateway. It aims to bring together good quality resources for the UK community, and it is managed by the University of Nottingham, UK. It is part of a national initiative aiming to provide students, lecturers and researchers with access to high quality Internet resources (www.rdn.ac.uk/). It is not focused on developing countries, but is experienced in the evaluation of health-related web sites.
The BIOME Internet Service:
- Offers free searchable access to a collection of quality-filtered Internet resources on 'The Natural World'.
- Includes OMNI (Organizing Medical Network Information)
- Resources are hand-selected, evaluated using quality criteria, indexed and described.
- Designed for ease of use, including novice internet users. Guidelines are freely available on the BIOME web site and can be customized by others.
The OMNI Gateway was established in 1995 and now includes more than 6000 evaluated web sites.
http://omni.ac.uk/
OMNI is a gateway to quality medical resources on the Internet. It uses defined criteria relating to context, content and access, and thereby evaluates web sites to ensure that the resources it recommends to users are the best available.
Evaluation Guidelines - a brief history
- A Special Advisory Group on Evaluation (SAGE) developed the Evaluation Guidelines for OMNI in 1996.
http://biome.ac.uk/sage/
- The Guidelines were then reviewed and expanded in 1999 to take account of the new subject coverage in BIOME.
- The criteria are available at: http://biome.ac.uk/guidelines/eval/
Evaluation Criteria overview
3 broad elements of a resource are examined:
Evaluation criteria in detail I
Context
- Scope - what is the subject scope and is it relevant to the BIOME community?
- Audience - who is it intended for?
- Authority - who has produced it? What are their qualifications?
- Provenance - how long has the resource been available? Is it stable?
Evaluation criteria in detail II
Content
- Coverage - what is the subject coverage of the resource? Is it at a suitable level for the BIOME community?
- Accuracy - has there been an editorial process? Is there any evidence that the source maybe biased?
- Currency - is the information up-to-date? How frequently is it updated?
Evaluation criteria in detail III
Format
- Accessibility - are there any access restrictions or special requirements? Is there a charge for the service?
- Design and layout - is the resource well designed? Are images used appropriately? Is there any aids to navigation?
- Ease of use - is it easy to use? Is there help information and user support?
Comments and questions
Comment: Ahmad Risk has recently carried out a survey of quality initiatives on information on the internet. Also, a recent posting on HIF-net at WHO introduced 'Hi-quality', which provides guidelines that can be used in underresourced environments.
Q: What range of resources does OMNI evaluate?
A: OMNI evaluates web sites overall, books, journals and individual articles.
GENERAL DISCUSSION
End user groups need to be defined. A classification of 13 target end-user group was made by WHO in 1986, but this needs to be reviewed.
All the gateways presented had multiple target audiences. Different web sites are probably needed for different categories of end user. Biome has developed a specific resource for midwives.
Brain drain of health professionals is a major problem. The ratio of health professionals to population in developing countries is already much lower than in developed countries, and in some developing countries the ratio is continuing to decrease further.
Internal brain drain is a real problem also. In many countries in Africa, healthcare providers are posted to rural areas for up to 2 years. These healthcare providers report professional isolation and lack of opportunity for continued learning and professional development. As a result, most are eager to move to the cities as soon as they can. Rural healthcare workers are few in number, professionally isolated, have low morale, and few opportunities for learning and professional development.
Ousmane Ly and Abdrahamane Anne pointed out that internal brain drain can be reversed by improving access to information and providing distance learning opportunities. Recent introduction of internet-based continued medical education in the remote town of Timbuktou has made a huge difference in morale for healthcare providers in the area. It is expected such learning opportunities will encourage healthcare providers to provide long-term services in rural areas.
Many of the current international access initiatives seem to be targeted to researchers in developing countries. But researchers represent a very small percentage of health professionals in developing countries.
A second, larger group - those in training institutions: lecturers, medical students, nursing students - their information needs are comparable with lecturers and students worldwide - they need access to a range of standard textbooks and journals.
The third and arguably most important group are the doctors, nurses and other healthcare providers who are working in district and primary-level healthcare in developing countries. They have different needs - information that is appropriate to their level of resources and medical education. Currently, these healthcare workers often have no access at all to reliable, relevant information of any kind.
One participant pointed to the importance of user surveys to assess the use of health gateways. AIDSMap, for example, has learned a great deal from such feedback.
Professionals in developing countries need financial support and training to produce materials that are relevant and reliable for local, primary healthcare workers. They also need access to the full range of source information, both national and international.
One participant raised a plea for more primary and secondary education.
Jean Shaw referred users to a PhD study by Maria Musoke, who looked at health information needs in rural Uganda. (see INASP Health section at <http://www.inasp.info/newslet/may01.html>).
Participants pointed out the need for further increases in international collaboration and exchange of experience.
Participants pointed out the relative lack of support for infomediaries in developing countries, who were crucial players in access to health information.
In particular, the electronic-print chain ('Staging Posts') required strengthening, so that local infomediaries could be supported to access source information (local and international), repackage and adapt this, and provide for health workers at local and national level. Similar chains were possible between electronic and other media. Expertise existing in developing countries should be used to achieve this, with training as necessary in medical writing, editing, production, and other skills.
There is also a need to support south-south collaboration and exchange of experience, and particularly south-south collaboration among regional, national and local infomediaries based in developing countries.
Maurice Long announced that the Health InterNetwork Access to Research Initiative would be making 200 to 300 extra journals available to developing countries on Friday 24 May 2002, including New England Journal of Medicine, JAMA (J of the American Medical Association), and Annals of Internal Medicine. This would include everyone except for non-profit institutions. He expressed confidence that the electronic journals provided by HINARI would be permanently free to all countries with a GNP less than 1000 dollars per year. He also commented that it is now a priority to persuade internet service providers and others to facilitate internet connectivity for health professionals in developing countries.
CONCLUSIONS
Health professionals and health information services in developing countries require comprehensive and quality-controlled gateway services that are relevant to their information needs. Such services need to be developed in consultation with end-users.
WORLDSPACE DEMO
After the meeting, Alistair Bolt (Medicines Information Pharmacist at the Norfolk & Norwich Hospital, UK) demonstrated the WorldSpace receiver, receiving live audio broadcast from the Africa satellite. WorldSpace HQ is in Washington, running three WorldSpace satellites, others covering Latin America and Asia. Several radio channels are available, crystal-clear in Africa. It is also possible to download a large amount of HTML content through the Africa Learning Channel multimedia service, from the satellite to the hard drive. This content includes health information selected by SatelLife, including BMJ reviews, Cochrane, and health news.
One participant noted that at present there is no upload capacity, and pointed out the importance of inclusion of local content.
Harry McConnell (International e-Health Association) announced that IeHA had recently been appointed to run the Medical Education channel of WorldSpace. This had exciting possibilities and he invited potential contributors and collaborators to contact him <[email protected]>.
ACKNOWLEDGEMENTS: Thanks to the BMA and Exchange for sponsorship of the meeting, and to the International Institute for Communication and Development for enabling attendance of Ousmane Ly and Abdrahamane Anne.
The Health Information Forum is run as an activity of
INASP-Health, a cooperative network for organizations and
individuals working timprove access treliable information
for healthcare workers in developing and transitional
countries. Participation is free of charge and without
obligation. INASP-Health is supported by the BMA, Danida,
ICSU-Press, and WHO. INASP is a programme of the
International Council for Science (ICSU).
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