Breaking down the barriers to health information

18 World Health • SOth Year, No. 6, November-December 1997

Breaking down the barriers to health information

Neil Pakenham·Walsh & Carol Priestley

The library at the University Teaching Hospital in Brazzaville. a single half-empty bookshelf of outdated material. Photo WHO/N.Pakenham-Walsh

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However, health workers in countries with few resources do not have access to the basic information they require for training and clinical decision-making. This starvation of information inevitably limits profes- sional development and the quality of health care, contributing to unnec- essary suffering and death.

According to the late James Grant, former Executive Director of UNICEF, "the most urgent task before us is to get medical and health knowledge to those most in need of that knowledge. Of the approxi- mately 50 million people who were dying each year in the late 1980s, fully two-thirds could have been saved through the application of that knowledge."

Lack of information is seen at all levels of health care, from village health workers to national teaching hospitals. The contrast with devel- oped countries is striking. For exam- ple, the library at St George's Hospital, London, where one of the

authors (NP-W) trained, contains more than 30 OOO books and sub- scribes to 800 journals; the equiva- lent library at the University Teaching Hospital, Brazzaville, Congo, con- sists of a single half-empty bookshelf of outdated material.

Why do health workers continue to lack access to reliable informa- tion? It is not because of a shortage of enthusiasm or ingenuity. An increasing number of nongovern- mental organizations, international health agencies, health librarians, publishers, multimedia producers, and information technology consul- tants, among others, are striving to improve access to health information in developing countries. Individually, these health information providers have made important contributions, but their overall impact remains fragmented.

In 1994 leading figures of the health information provider commu- nity met in London to discuss ways in which health information provi- sion could be improved. This land- mark conference, 'Getting health information to developing countries',

identified the three-part barrier that restricts their activities.

First, there is a lack of coordina- tion and communication among the providers of health information themselves. Second, there is a lack of collective action to build a clear understanding of global health infor- mation needs and provision. And third, there is a lack of advocacy for political and financial commitment.

These three areas were reiterated by African health librarians at the 5th congress of the Association for Health Information and Libraries in Africa (Brazzaville 1996).

The challenge is to promote coordination, analysis, and advocacy so that they are no longer barriers but allies (see figure on page 19).

The London conference revealed a clear need for an initiative to ease the flow of health information. This mandate was accepted by the Interna-tional Network for the Availability of Scientific Publications (INASP), which launched the IN ASP-Health pro- gramme in April 1996. Founded in 1992 by the International Council of Scientific Unions, INASP is a non- profit, nongovemmental organization that promotes the exchange of infor- mation, both printed and electronic, between and within the developed and developing world. INASP- Health is supported by the United J(jngdom's Department for International Development and the British Medical Association. In addition, DANIDA (the Danish International Development Agency) has pledged a three-year contribution for the period 1998-2000.

World Health • SOth Year, No. 6, November-December 1997

Promoting coordination

There is a wide scope for enhanced coordination. There is no association of health information providers, nor is there any organization dedicated to serving them. Collaboration is often limited to ad hoe partnerships, with those involved being unaware of related activities.

INASP-Health's first aim is to promote collaboration and sharing of expertise and experience by building on INASP's recognized achieve- ments in cooperative networking.

INASP-Health's advisory and refer- ral network now serves more than 400 organizations and individuals, North and South, with an interest in providing health information to developing countries. The network advises on all aspects of health information provision, supported by in-house databases and the diverse expertise of network participants.

A key function is to facilitate contact between health libraries in develop- ing countries and organizations that can provide assistance. Participation is free and without obligation.

Promoting analysis

Much remains to be learned about the varied information needs of health workers and the most cost- effective methods of meeting those

HEALTH INFORMATION

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HEALTH INFORMATION

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The Library of St George's Hospital in London.·

a collection of more than 30 OOO books and 800 journals. Photo courtesy of St George's Hospital Medical School Library

needs. There is no central repository of material such as needs assess- ments, evaluations of different approaches to health information provision, and the complex links between information access, quality of health care, and morbidity and mortality.

INASP-Health is therefore intro- ducing a 'needs and provision' resource, with contributions from the mainstream literature and from network participants.

Promoting advocacy

Health information activities are chronically underfunded. IN ASP-

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Health will continue to lobby and work closely with others to put these needs high on the development agenda. It will also publicize spe- cific issues in response to the de- mands of its network participants.

Conclusion

Health information for all is essen- tial for health for all, and is poten- tially the most cost-effective approach to improve the quality of health care delivery in many of the less developed countries.

International health agencies have the opportunity to play an increasingly important leadership role, not only as providers of health information, but also as coordinators and partners with other organiza- tions. A wide collaborative process is needed to define priorities and set targets. Only then can we hope to develop a coherent framework that meets the varied needs of tomor- row's health care professionals. •

For further information, please contact Dr Neil Pokenhom-Wolsh, Programme Manager, INASP-Heolth, INASP, 27 Pork End Street, Oxford OX I I HU, England

(e-mail: I O 137 4. 36 I 5@compuseNe.com}.

Ms Carol Priestley is Director of INASP.

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Coordination, analysis and advocacy ore the facilitators towards universal access to health information. Graphics WHO/N Pokenhom-Wolsh