Expanding developing-world access

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Research4Life, the programme to provide developing-world access to scholarly resources, recently celebrated its tenth birthday. Case studies reveal some of its achievements

Building a viable research culture in developing countries takes more than just access; it calls for training in how to find and use scientific resources, sufficient bandwidth, author workshops and much more.

But access certainly forms a critical foundation on which to build. In mid May, Research4Life announced that the content available through its collaborative public-private partnership has dramatically increased since 2011 to 17,000 peer-reviewed scientific journals, books and databases. Thanks to this rise, more than 6,000 institutions in more than 100 developing countries now have free or low cost access to peer-reviewed online content.

Research4Life involves four UN agencies, four discipline-specific programmes (HINARI, AGORA, OARE, ARDI), 150 publishers and technology partners such as Microsoft. It recently celebrated its tenth anniversary by holding a competition for the best stories from the field. The resulting case study book, Making a Difference, maps the evolution of research cultures in 10 different countries. Below is an extract from one of the articles it contains. Dr Arun Neopane in Nepal shares how access to Research4Life enabled him to transform his annual hospital publication into a peer-reviewed scientific journal.

Research out of reach

In his role as a paediatrician at Kathmandu’s Shree Birendra Hospital, Nepal, Arun Neopane is a voracious consumer of journal papers. This passion led to his appointment in 2003 as the hospital’s officer in charge and editor of the Journal of Shree Birendra Hospital (JSBH). Over the next few years, Neopane led the conversion of JSBH from an annual publication with news, views and hospital updates to a biannual peer-reviewed scientific journal – with original papers, review articles and case reports – and made it available electronically through Nepal Journals OnLine (NepJOL).

Despite having subscriptions to a small number of international journals, the hospital was desperately short of the up-to-date medical literature that doctors need to maintain and upgrade their skills and knowledge. As is the case in other low-income countries, university libraries and research organisations in Nepal do not have the budgets to pay for important peer-reviewed journals. In 2007 Neopane and his team convinced the hospital administration to invest in an internet connection. This unblocked the window to the wider world of medical research, but, without access to journals, a key component remained locked. The hospital staff could now read abstracts via the PubMed database, but the complete papers – crucial for the understanding required to incorporate research results into practice – remained out of reach.

It was the new internet connection that led Neopane to Research4Life’s HINARI programme. The institution was granted access to HINARI in February 2008 and it hasn’t looked back since.

The most concrete result of the hospital’s access to HINARI is better clinical treatment and this has directly improved patient health. For example, research published in Pediatrics (the journal of the American Academy of Pediatrics) showed that zinc is essential in treating diarrheal diseases in children, mitigating illness and even saving lives. Ironically, although some of this research had been performed in Nepal, Nepalese institutions could not afford the subscriptions to the journal and the country’s doctors did not have access to the results. Using HINARI, Nepalese paediatricians discovered the information and changed their treatment of diarrhoea, saving many lives and improving the quality of life of many sick children.

Beyond better clinical practice based on others’ research, HINARI has transformed the way that medical research is performed, not only at Shree Birendra Hospital but also for the Nepalese medical community as a whole. And it was because of HINARI that Neopane was able to advance his own research. In March 2007, he was appointed editor-in-chief of the Journal of Nepal Paediatric Society (JNPS), the oldest specialty journal in the country. Launched in 1981 and published annually, JNPS had struggled as a credible scientific publication. However, with a small editorial team and lessons learned from the leading journals they now had access to, Neopane has transformed it into a thrice-yearly, internationally recognised, peer-reviewed journal with its own website.

Neopane’s achievements were further recognised with his appointment as general secretary of the recently-established Nepal Association of Medical Editors. He describes Nepal’s medical research as still in its infancy, but he is confident that it will progress from the current work, which mostly comprises clinical features and epidemiology, to more complex work based on molecular biology and genetics.

HINARI has fundamentally changed the research landscape in Nepal, with five national journals now indexed in PubMed and many more aspiring to this (including JNPS, which was considered for PubMed in February 2012). Internationally-renowned journals such as BMJ, the New England Journal of Medicine and The Lancet occasionally publish articles by Nepalese researchers. Without HINARI, such achievements would have remained a dream.

The case study is an excerpt from Making a Difference. Additional writing by Ylann Schemm, who is corporate relations manager at Elsevier and manages the company’s corporate responsibility and partnerships programme