Bulletin of the World Health Organization

Free access to journals gives Kenyan science a boost

A joint initiative between WHO and about 90 scientific publishers has transformed patient care at a university hospital in Kenya, where students and their teachers have Internet access to the latest research findings. The programme is benefiting a whole generation of scientists across the developing world.

Alex Maina Mwangi, librarian at the KEMRIWellcome Trust Research Programme, teaching colleagues how to use HINARI.
Alison Talbert
Alex Maina Mwangi teaching colleagues how to use HINARI.

Dr Hilary Rono shudders to think what life for him and his colleagues in the medical profession — particularly in developing countries — was like before the Internet. Rono is just about to complete his masters degree in ophthalmology at the University of Nairobi.

The Internet has been key to his studies, especially the Health InterNetwork Access to Research Initiative (HINARI). The WHO programme is a gift to academic institutions in developing countries, providing them with free online access to 3300 scientific journals. This gives researchers like Rono access to the most up-to-date information for research, but also information that can be used to improve clinical management of patients.

HINARI has transformed Rono’s ability to check the latest trends in the management of trachoma and other eye diseases: “It’s very easy for me to handle cases at the university hospital. … Because of HINARI, my colleagues and I are able to provide the latest medical care for our patients here in Nairobi, instead of having them taken to the developed world for treatment.”

The fact that the latest medical research is just a mouse click away is a major boon for practitioners in developing countries. Before HINARI, practitioners used to go to the library to refer to books and journals, most of which were way out of date. Dr Rono’s lecturer Dr Stephen Gichuhi recalls that as an undergraduate in the 1990s: “You were considered well read if you had seen a five-year-old copy of the New England Journal of Medicine”.

“It is often said that by the time a book rolls out of the press, the information is already outdated. But for those in the medical profession and practising in the developing world we were left with no option but to use such information,” said Gichuhi.

Gichuhi has just finished a Masters degree dissertation using HINARI and says many of his colleagues are also benefiting from the programme.

As a leading institution in East and Central Africa, the University of Nairobi receives students from across the African continent, some of whom are from countries with limited access to the online journals that are now needed for effective research and patient care.

However, thanks to HINARI, these students can work successfully at the university and later take the same knowledge back home with them. Gichuhi said students and doctors were able to follow some of the latest trends in medical care, such as evidence-based medicine, thanks to HINARI.

Coupled with this, some students, doctors and lecturers use the programme for general reading as well as planning and doing research. Some of them use HINARI in the office and — those who have Internet access — also from home. Since HINARI is relatively new, however, it is too early to say whether it is helping people publish papers more easily.

“It normally takes between six to eight months to publish and we were introduced to this programme only last year,” Gichuhi said, adding that the people who use HINARI are overwhelmed by the choice and range of journals to which they can submit work.

Before HINARI, most of them only targeted well-established journals that were unlikely to publish articles from developing countries.

With the expansion of the choice of journals available to students and staff at the university’s department of ophthalmology, usage has increased — a situation that has been helped by continuous in-house promotion by the university authorities.

Currently, users can access HINARI from four computers but Gichuhi said that at least 10 more “would be welcome”. The university also plans to offer wireless connections so that users can access HINARI from their laptops.

Gichuhi and Rono agreed that HINARI could be improved. Gichuhi said that the archiving of information online does not always include some diseases that are still a major problem in the developing world.

About an hour’s flight from Nairobi, in the coastal town of Kilifi, HINARI has made a quieter but no less significant impact. Established in 1989, a joint programme between the Kenya Medical Research Institute and the Wellcome Trust, the Kilifi unit is a research leader in Africa.

“We’re quite a different beast to most [institutions that] use HINARI in Africa in that we’re very well resourced,” said Dr Greg Fegan, the unit statistician.

Even before HINARI, the Kilifi library subscribed to 34 scientific journals in print and 11 others online. Fegan said that 80 scientific staff and students use the system regularly and that HINARI is one of their 10 most-visited websites. At Kilifi, they have over 100 computers on their network and about six networked laser printers.

Before HINARI, the system for obtaining articles in scientific journals at the institute was cumbersome and slow, according to librarian Alex Maina Mwangi.

But while access is no longer an issue with HINARI, institutions like the University of Nairobi and the Kilifi research centre are facing mounting costs for high-quality print-outs of articles containing vital information in colour-coded figures and micrographs.

Tom Osanjo, Nairobi

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"[in the 1990s] You were considered well read if you had seen a five-year-old copy of the New England Journal of Medicine”.
Dr Stephen Gichuhi