Is HINARI appropriate for medical students in ... - Wiley Online Library

Tropical Medicine and International Health

doi:10.1111/j.1365-3156.2011.02938.x

volume 17 no 4 pp 406–408 april 2012

Viewpoint

Is HINARI appropriate for medical students in the developing world? Caleb Van Essen1, Peter Cartledge2, Patrick Kyamanywa3 and Achille Manirakiza3 1 University of Colorado Denver, Aurora, CO, USA 2 Fellow on the THET Imperial College London – Rwanda Health Partnership, London, UK 3 Faculty of Medicine, National University of Rwanda, Rwanda

Abstract

The Health InterNetwork Access to Research Initiative (HINARI), which arose in response to medical literature needs in developing countries, gives online access to scientific information to a variety of institutions throughout the world. This is a great resource; however, little research has been performed on the effectiveness and usefulness of HINARI, specifically to medical schools. Our study sought to find out whether the textbooks (e-books) available on HINARI could form a virtual library that would cover the curriculum of a medical school. After categorising and reviewing the medically relevant e-books on HINARI, we found that they were insufficient in providing adequate subject material relevant to medical school curricula from Rwanda, the United Kingdom and the United States. This literature gap could be closed by additional medical textbooks being made available from contributing publishers. An increase of only 14% in HINARI e-book resources would provide material for the entire medical school curriculum. keywords literature, publications, Africa, students, medical, information dissemination

Introduction There are many challenges facing the education of health professionals in developing countries, such as physical infrastructure, accreditation systems, student selection and faculty recruitment, retention, and development (Supe & Burdick 2006; Burdick 2007). Access to medical literature is also a challenge; so much so that some have said, ‘universal access to information for health professionals is a prerequisite for meeting the Millennium Development Goals and achieving Health for All’ (Godlee et al. 2004). The Health InterNetwork Access to Research Initiative (HINARI) arose in response to these information needs and was introduced by the United Nations’ Secretary General Kofi Annan at the UN Millennium Summit in 2000. Led by the World Health Organisation (WHO), HINARI aims to strengthen public health services by providing public health workers, researchers and policymakers access to highquality, relevant and timely health information, via the internet (WHO 2010). Two sister programs also emerged, which give access to a broader range of disciplines. Access to Global Online Research in Agriculture (AGORA) and Online Access to Research in the Environment (OARE) cover a variety of topics related to agriculture, 406

food, ecology, environmental science and policy (AGORA 2011). More than 4500 institutions in 109 eligible countries, areas and territories are registered for HINARI (Figure 1). In 2009, users at these institutions downloaded more than 7-m articles (WHO 2010). The value for this resource to health practitioners in the developing world is enormous. However, very little research has been performed as to where, how and whether HINARI is being used in preservice medical professionals’ training and whether it is being used effectively. We were particularly interested to see whether HINARI is appropriate for undergraduate medical students. Medical teaching in developing countries still tends to focus on accumulation of facts, within a rigid curriculum, which means that ‘seeking out new information’ is often discouraged (Gituma et al. 2009). While a wave of change towards more student-directed and student-centred learning is sweeping across many universities, textbooks continue to be the most important source of information for medical students and postgraduate trainees. Students often find that journal articles are not relevant to their level of training, and so medical textbooks would be more appropriate. Currently, 447 e-books and 7961 journals are available on HINARI, which are both related to medicine

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C. Van Essen et al. Viewpoint: Literature access for medical students

Institutions registered with HINARI *

Institutions registered

* Data of Kosovo are included in the data of Serbia

Country bands 1 2

1–10 11–50 51–75 76–100 >100 Country eligible but no registration Country not eligible

Figure 1 Global distribution of Health InterNetwork Access to Research Initiative access (WHO 2011b).

and agriculture (AGORA 2011). In late 2010, HINARI announced that more e-books would be added to the programme, including the Oxford Handbook of Tropical Medicine and other Oxford University Press books, John Wiley & Sons’ Current Protocols series and 400 reference works and textbooks from Elsevier (WHO 2011a). We wanted to know whether the textbooks (e-books) available on HINARI could form a virtual library that would cover the curriculum of a medical school. Methods We accessed medical school curricula from the National University of Rwanda (NUR), Imperial College London (ICL) in the UK and the University of Colorado in Denver (UCD), USA. From these, we identified and summarised common subjects covered by the undergraduate curriculum in the three continents. We contacted the WHO to ascertain the number of e-books available, the proportion of these e-books that are medically related and the number of e-books accessed through HINARI in 2010. Unfortunately, there is no such categorisation of HINARI, and so these data were unavailable. Thus, we accessed HINARI, reviewed and categorised the available e-books to find


what proportion was relevant to the requirements of the curricula. Results We identified 31 (18 pre-clinical and 13 clinical) subjects common to all curricula. Of the 447 accessible e-books on HINARI, 281 (63%) contained medically relevant material. Only 4 (22%) of the pre-clinical curricular subjects and 2 (15%) of the clinical curricular subjects had e-books that would be appropriate to undergraduate medical students. Therefore, only 6 (19%) of the curricula’s 31 subjects had appropriate material available. The vast majority of the 447 accessible books were too specialised for undergraduate students. Discussion The lack of access to relevant, up-to-date textbooks is a significant challenge to medical students and professionals practicing in poor settings. Even though we found e-books containing material relevant to the specific curricular subjects, they did not cover topics encompassing the entire course subject matter. Thus, the current e-textbook

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C. Van Essen et al. Viewpoint: Literature access for medical students

collection available is insufficient in regard to coverage of undergraduate curricular material, making HINARI a less effective resource for medical students. The HINARI journal collection is invaluable and extensive; however, there is a great disparity between the number of journals and the small number of e-books. We would like to call on the publishers, who are already giving their valuable information resources, to consider providing medical e-books that cover the undergraduate curriculum in developing countries. It has already been stated that ‘publishers in the developed world are unlikely to incur significant financial loss by offering free or reduced price access to their online material’ (Katikireddi 2004). As more relevant texts become available on HINARI, and students spend more time accessing them, the hope would be that the use of medical journals would also increase. Increasing the access to appropriate literature would also allow medical teachers in developing countries to move away from fact accumulation and rigid curricula and encourage students to seek information in a more problem-based approach (Gituma et al. 2009) and then practice based on evidence. If this is to succeed, several challenges need to be met to facilitate access in poor settings: Enlarging awareness of HINARI by better signposting, providing easy access to passwords and ensuring availability of computers, constant electricity and internet access. Conclusion HINARI provides access to a wealth of scientific information to developing countries. However, the currently available e-books do not cover all subjects of medical

school curricula. This literature gap could be closed by a few additional medical textbooks being made available by publishers. Only 64 e-books (a mere 14% increase) would be required to allow two e-books for each subject in the undergraduate curriculum. More up-to-date literature would not only aid students, but would also help teachers develop a problem-based based curriculum.

References AGORA (2011) Leaflet. http: ⁄ ⁄ www.aginternetwork.org ⁄ en ⁄ (Accessed on 3 November 2011). Burdick W (2007) Challenges and issues in health professions education in Africa. Medical Teacher 29, 882–886. Gituma A, Masika M, Muchangi E et al. (2009) Access, sources and value of new medical information: views of final year medical students at the University of Nairobi. Tropical Medicine and International Health 14, 118–122. Godlee F, Pakenham-Walsh N, Ncayiyana D, Cohen B & Packer A (2004) Can we achieve health information for all by 2015? Lancet 364, 295–300. Katikireddi SV (2004) HINARI: bridging the global information divide. BMJ 328, 1190–1193. Supe A & Burdick WP (2006) Challenges and issues in medical education in India. Academic Medicine 81, 1076–1080. WHO (2010) HINARI Info Sheet. http: ⁄ ⁄ www.who.int ⁄ hinari ⁄ HINARI_INFOSHEET_ENGLISH_2010.pdf (Accessed on 15 July 2011). WHO (2011a) HINARI. http: ⁄ ⁄ www.who.int (Accessed on 15 July 2011). WHO (2011b) HINARI Country Breakdown. http: ⁄ ⁄ www.who.int ⁄ hinari ⁄ eligibility ⁄ en ⁄ (Accessed on 15 July 2011).

Corresponding Author Caleb Van Essen, 7117 S. Windermere Street, Littleton, CO 80120, USA. Tel.: +13039030735; E-mail: [email protected]

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