Lack of access to information for health workers in resource-poor settings is a major obstacle to achieving the 2015 millennium goals for global health

A Public Health article published online today (9 July 2004) highlights how a lack of access to health information for health workers in resource-poor settings is a major obstacle to achieving the 2015 millennium goals for global health.

Authors of the article call on WHO to take the lead in championing the goal of 'Universal access to essential health-care information by 2015' or 'Health Information for All'.

Fiona Godlee (Editor of BMJ Clinical Evidence) and colleagues say there is little evidence that the majority of health professionals in the developing world (especially those in primary health care) are any better informed than they were 10 years ago. They cite a lack of physical access (absent, slow, or unreliable internet connectivity, expensive paper, and high subscription costs of products) as being the major barrier to knowledge-based health care in developing countries. Other barriers include lack of awareness of what is available, irrelevance of available information, no time and incentives to access information, few interpretive skills, and a lack of demand due in part to the poor quality of much of the available information.

The authors say that the “knowledge system”—by which reliable, relevant, useable information should be developed—is not working at the moment because it is poorly understood, unmanaged, and under-resourced. The system requires cooperation among a wide range of professionals including healthcare providers, policy makers, researchers, publishers, information professionals, indexers, and systematic reviewers.

A proposal for action is outlined: ‘As a framework for taking things forward, we propose that WHO takes the lead in championing the goal of “Universal access to essential health-care information by 2015” or “Health information for All”. We suggest that WHO and its partners establish an international collaborative group along the lines of the Global Fund for AIDS, TB, and Malaria, which is coordinated by the UN, or the Global AIDS Vaccine Initiative coordinated by the Rockefeller Foundation. We envision that this group, which should include representatives of the major global funders, would create a pot of money—like a lottery fund—to be allocated to initiatives on a competitive basis in line with an overall strategy to achieve health information for all. This strategy could include calls for research into information needs and barriers to use of information; evaluation and replication of successful initiatives; support for local information cycles and communities of practice; and the formulation and establishment of national public policies on health information’.

Dr Godlee adds: “We call upon WHO and other organisations to commit to universal access to essential health-care information by 2015. We believe such access is a prerequisite to meeting the Millennium Development Goals and achieving Health for All; moreover, it is now, for the first time, realistically achievable”.

Christopher Bailey and Tikki Pang from WHO respond to the article in an accompanying commentary, stating: ‘Health information for all by 2015 is an admirable goal, as long as we realise that the health-knowledge space is not static, just as health needs are always evolving and vary by local conditions and behaviours. Establishing just what is essential health information for particular communities and making sure that information is not only evidence-based but usable, useful, and applied would be a great accomplishment. And this can only be done by breaking free of the linear relation between the developed world and the developing world, and recognising that knowledge systems must be true networks, locally owned and driven, with each point of equal value. Ultimately in public health, we are moving from issues of access to knowledge, to the management and use of knowledge. This change may prove to have as positive an impact on peoples’ health as evidence-based medicine had after its introduction 100 years ago.’

Note to Editors: A meeting (Global Review On Access To Health Information In Developing Countries) will take place between 1400–1800 H Monday 12 July at the British Medical Association, Tavistock Square, London WC1H 9JR, UK. Chair: Dr Richard Smith (Editor, BMJ); Keynote: Dr Tikki Pang (Director of Research Policy and Coordination, WHO).

This paper is adapted from a discussion paper commissioned by WHO in preparation for the Mexico Summit on Health Research in November, 2004.

Publication in The Lancet coincides with the launch of the Global Review of Access to Health Information in Developing Countries. Building on a series of existing conferences worldwide in 2004-05, the review will bring together people from all stages of knowledge creation and dissemination, to understand more about what is involved, lessons learned, and ways forward.