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A total of 1043 institutions in 100 countries (of a total of 113 eligible countries) have registered for the program. Institutions 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 institutes, teaching hospitals, and government offices. All staff members and students are entitled to this access.
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HINARI has greatly improved access to information for these institutions, and the levels of use are growing steadily. In the first six months of 2003, HINARI users downloaded 34,680 articles 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, Sudan, and Vietnam, all of which are among the poorest countries in the world. The high cost of reliable Internet access, computer equipment, peripherals, and supplies (workstations, printers, 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 Internet access from their governments and from international donors.
In 2004, the HINARI team at WHO and our partners — the publishers, the Yale University Library, the National Library of Medicine, 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 particularly 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 Agriculture (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 improved 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 essential work on local problems and government offices that try to set effective policies. Warren Stevens of the Medical Research Council Laboratories in the Gambia has noted that intellectual isolation represents an important hindrance to the development of world-class researchers in African countries. Access 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.
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