The Health Internetwork Access to Research Initiative (HINARI) aims to reduce financial and legal barriers to scholarship by providing Internet access to full–text biomedical and health research articles for scholars in economically developing countries. In this study, citation data was used to evaluate if HINARI journals have had greater use since the initiation of the program in eligible American countries. Also considered was if a relationship exists between the use of HINARI journals and Internet user statistics. While an increase of journal use is apparent in two of three sub–regions (Caribbean America and Central America), only one of three sub–regions (South America) suggests a correlation between Internet use and HINARI citation frequency. The benefits, challenges and future considerations for HINARI are discussed, as they pertain to scholars and program administrators.
Advances in technology transform the creation and sharing of scholarship among researchers globally. However, the promotion of scholarly communication among researchers in economically developing nations is a particular challenge, as these scholars encounter unique barriers to participation. The Health Internetwork Access to Research Initiative (HINARI) addresses this challenge by attempting to reduce financial and legal barriers to scholarship. It is a collaborative effort between the World Health Organization (WHO) and leading publishers of scientific journals to bring the full text of biomedical and health research articles to scholars in economically developing countries through the Internet.
While HINARI is a tremendous advance toward increasing inclusivity within global scholarly dialogue, researchers and practitioners in the least economically developed countries face a broad array of challenges that reach beyond the cost and legal use of high–quality health and life science journals. The realities of economic and political instability impact the ability of researchers to access HINARI journals, as do language differences and local cultures of scholarship. One of the most obvious barriers to use is the slow development of the telecommunications infrastructures in these countries, which would facilitate not only obtaining journals through the Internet, but also contributing to them.
This study explores the relationship between the scholarly use of life science journals by researchers in economically developing countries in the Americas and two factors: the initiation of the HINARI program and telecommunications capacity. The following research questions were considered.
Have researchers from eligible American countries made greater scholarly use of the journals available through the HINARI program since its conception?
Are changes in the scholarly use of the journals available through HINARI by researchers from eligible American countries related to Internet use in those countries?
The scholarly use of journals was determined by the frequency and rate of change in frequency of citations made to HINARI journals over a nine–year period. These data were extracted from a comprehensive study conducted by Ross (2009; 2008), which surveyed citation behavior of all eligible countries with respect to HINARI and Access to Global Online Resources in Agriculture (AGORA) from 2000 to 2008. For the present investigation, only American countries eligible to participate in the HINARI program in 2006 were considered; their eligibility was based on 2001 World Bank figures for Gross National Income (GNI) per capita. Internet use data was derived from World Telecommunication/Information and Communication Technology (ICT) Indicators Data, compiled and published by the International Telecommunications Union (ITU).
The international imbalance of access to scientific information is a pressing issue. Nevertheless, public health organizations are optimistic regarding the capability of scientific journals to improve health in poorer nations. Spiegel, et al. (2008) contend that the ability of countries to train medical professionals could be addressed by improved journal access. HINARI exists to improve journal access by removing two of the most prevalent barriers for economically developing countries: cost and copyright restrictions.
Proponents of HINARI have identified several benefits of the journal access program (Katikireddi, 2004). Among these is abundant access to authoritative resources, which “help[s] stop or slow the ‘brain drain’ of scientists from the developing world to the developed world” . One intention of the World Health Organization in initiating HINARI was to empower local scholars and professionals with access to high–quality research so that the least economically developed countries might more effectively retain healthcare workers. However, retention continues to be a problem with “more than 23,000 healthcare workers migrat[ing] from Africa each year” . This trend results in a ratio of 0.02 to 0.74 physicians per 1,000 inhabitants in low–income countries, as compared to 2.6 in the United States (Spiegel, et al., 2008). Factors contributing to this migration include but are not limited to “insufficient remuneration, poor working conditions and/or inadequate resources, the political climate, discrimination, and even persecution” .
In recent years it has been suggested the effectiveness of HINARI has declined, with fewer journals available for use (Villafuerte–Gálvez, et al., 2007). According to Aronson (2002), at its launch in January 2002 HINARI offered 1500 titles from five publishers. Participating publishers agreed to offer access directly to eligible institutions for a minimum of three to five years. By the end of April 2002, more than 20 publishers had joined with hundreds of additional titles (Aronson, 2002). However, Villafuerte–Gálvez, et al. found in a 2007 survey of the 150 highest impact journals initially offered by the partner publishers (via the Science Citation Index) that many of those highly ranked were inaccessible, including journals from publishers Macmillan (publishers of Nature), Elsevier–Science Direct, Blackwell, Oxford Press University, Lippincott Williams and Wilkins, and Wiley and Sons (Villafuerte–Gálvez, et al., 2007).
From correspondence with scholars at Universidad Peruana Cayetano Heredia, it was found the aforementioned inaccessible journals represented 57 percent of the HINARI collection, leaving 43 percent accessible, which largely consisted of open access journals. Villafuerte–Gálvez, et al. emphasizes the need for these journals, as they ensure the capacity “to practice evidence–based healthcare and conduct high–quality research” . In response to a related concern, Parker (2009), Program Manager of HINARI, clarified that HINARI content is chosen based on merit, rather than simply availability by publishers.
Other significant challenges for HINARI users involve support resources. Surveying institutions in five African countries, Smith, et al. (2007) found respondents rarely accessed full–text articles. Hardware, Internet connections, computing facilities, and power supply were noted as the most pervasive hardships. Obtaining passwords was often cited as problematic, as were downloading and opening large PDF files and the inability to print. Brown (2007) found “many users have Internet connection speeds so slow that downloading a single article can absorb an entire afternoon” . To summarize, some users simply had difficulty “making HINARI work” (Smith, et al., 2007). In a survey of ICTs in African nations, Alemneh and Hastings (2006) found that the pricing strategies of telecommunications providers and the restrictive policies for information exchange and use are among the more inhibiting factors in the expansion of connectivity, leading to a slow development of effective ICT in Africa.
Ross (2008) suggested that if the average rate of citations to HINARI journals is not higher after the program’s initiation, other barriers must exist that are not addressed by HINARI. Issues of access to HINARI journals and the capacity to make scholarly use of the journals may affect the success of the program. The number of Internet users in eligible countries is one indicator of access and capacity. If the rate of Internet users rises and falls in concert with the citation rate, all else being equal, it suggests the telecommunications capacity is a primary enabler or barrier, respectively, for researchers in economically developing countries.
The bulk of the data used in this study was extracted from an extensive survey of HINARI and AGORA citation patterns for eligible countries (Ross, 2009; 2008). The HINARI data for researchers in eligible American countries was isolated for this study. These data were examined to determine if citation rates were greater after the initiation of the HINARI program. Recognizing that free access to life science journals may not be the only enabler of scholarly use of HINARI journals, but that Internet infrastructure is also a critical component for researchers, this study identified data that describe Internet use at the national level. These data were then compared with the citation behavior of scholars from eligible American countries.
The American countries considered in this analysis were eligible to participate in the HINARI program in 2006 and are listed in Table 1. Their eligibility is based on 2001 World Bank figures for GNI per capita. Institutions in countries with GNI below US$1,250 were considered Band 1 and eligible for free access. Institutions in countries with GNI per capita between US$1,250 and US$3,500 were considered Band 2 and paid a fee of US$1,000 per year per institution. Eligibility parameters were updated from the 2001 World Bank figures to those of 2006 in 2008.
Table 1: American countries eligible to participate in HINARI. Sub–region Country Band Caribbean America Cuba 2 Caribbean America Dominican Republic 2 Caribbean America Haiti 1 Caribbean America Jamaica 2 Central America El Salvador 2 Central America Guatemala 2 Central America Honduras 1 Central America Nicaragua 1 South America Bolivia 1 South America Ecuador 2 South America Guyana 1 South America Paraguay 1 South America Peru 2 South America Suriname 2
There are several methods for discerning journal use. Among these are studies that examine article download statistics (Lwoga, et al., 2007). However, these data do not speak to the scholarly nature of this journal use. While not evidence that an article has been read, citations to a journal article are a better indication that the article has been used for scholarly purposes than the number of times it has been downloaded. The method, used by Ross (2009; 2008) to determine the scholarly use of articles in HINARI journals, was described by Egghe and Rousseau (1990) in their guide to informetrics as “the use of local journal collections as measured by citations in theses and local study projects” . Many librarians have used this technique to inform collection development efforts. Todorov and Glänzel (1988) demonstrated that citations used in this manner are valid indicators of scholarly journal use by specific populations.
In her study, Ross collected the complete set of citation information for articles authored by scholars from HINARI–eligible countries from 2000 to 2008 from the Science Citation Index (SCI) and the Social Science Citation Index (SSCI) produced by Thomson Scientific. The indices contain article–level records for material published in certain journals and are indexed in such a manner as to allow retrieval according to the author’s nationality. The article–level records were retrieved in groups according to author nationality and year. The references made within these articles were included with each record. These citation data were then extracted from the article sets and grouped by author nationality and year. The extracted citation data were imported as a table into a Microsoft Access database designed to enable queries, matching citations with sets of journal titles.
Among the results of her study were the frequencies of citations to the HINARI journal set from 2000 to 2008 for each eligible American country, providing nine data points for each. Using these data, the percent change in citation frequency was then calculated for each year. Graphing the frequency of citation and the percent change in citation frequency over the nine–year period demonstrated journal use trends before and after the initiation of the HINARI program. Results were totaled by country and sub–region. Reviewing these trends was a necessary first step for exploring the relationship between changes in the scholarly use of the journals available through HINARI by researchers from eligible American countries and the Internet use in those countries.
The citation frequency and percent change in citation frequency to HINARI journals by eligible American researchers were compared to data from the World Telecommunication–ICT Indicators Data Set, compiled and published by the ITU. These data are collected directly from telecommunication regulatory agencies and/or ministries via an annual questionnaire, and subsequently verified, harmonized and complemented by ITU (2010). Data for Internet subscribers, Internet users, fixed telephone operation and access, and cellular telephone subscriptions can be found through the online database. Not all categories of data are complete for each country, however.
The use of HINARI journals would likely be impacted by the possibility of scholars accessing the Internet. Internet use statistics were examined against citation statistics for patterns. Within the Internet indicators, only one set of data was complete for all HINARI eligible countries in the Americas — the number of Internet users. For the data to more accurately represent Internet use in a given sub–region, the component countries’ Internet use data were weighted proportionally according to population. Then, the percent change in Internet users was calculated for comparison with the percent change in citations to HINARI journals, resulting in eight intervals for the nine–year period.
The data in Table 2 indicate that since the initiation of the HINARI program scholars in the America region as a whole have been citing its journals more often. Each of the three American sub–regions reveals an increase in citations to HINARI journals over the nine–year period. All experienced more than an 80 percent increase from citations made in 2000 to the citations made in 2008.
Table 2: Frequency of citations to HINARI journals by scholars in America. Year Caribbean America Central America South America Total America 2000 2328 560 2012 4900 2001 3663 617 2388 6668 2002 2692 459 3200 6351 2003 5849 645 3564 10058 2004 3534 647 3804 7985 2005 4019 1688 4906 10613 2006 4442 1032 5771 11245 2007 4041 842 7108 11991 2008 5205 1017 7660 13882
The same data is expressed in Figure 1, revealing the relative annual fluctuation of citations to HINARI journals by the three American sub–regions over the nine–year period.
Figure 1: Frequency of citations to HINARI journals by scholars in America.
The data charted in Figure 2 show that since the initiation of the HINARI program scholars in two American sub–regions, Caribbean America and Central America, have been citing its journals at a greater rate of change. Citations made by South American researchers, however, do not demonstrate greater average rate of change after the initiation of HINARI.
Figure 2: Average annual percent change in frequency of citations to HINARI journals before and after program initiation by sub–regions in America.
Having reviewed the citation patterns of the three American sub–regions with eligible countries, each has distinct characteristics. Some data suggest the HINARI program successfully impacted scholarship, as with Caribbean America. Other data suggest the HINARI program did not impact scholarship, as with South America. These trends are likely a result of more than one influence, however. Examining the percent change of citations to HINARI journals to the percent change in other factors may reveal additional relationships. A comparison with the percent change in Internet users over the nine–year period is presented below for each sub–region.
The percent change in Internet users in South America increased each year from 2000 to 2008. The most significant increase of 120 percent was from 2000 to 2001. This sub–regional increase is influenced by its largest eligible country, Peru, which experienced a 146 percent increase in Internet users over the year. Since then, increases have hovered between 15 percent and 37 percent. Citations to HINARI journals also steadily increased each year during the study, with a rate of change in the percentage of citations between six percent and 34 percent. As illustrated in Figure 3, aside from the first set of data points, the percent change in Internet users and the percent change in HINARI citations tend to rise and fall together. These data suggest perhaps there is a relationship between Internet use and the patterns of citations to HIANRI journals.
Figure 3: Percent change in South American Internet users compared to the percent change in citations to HINARI journals by eligible South American scholars.
The Central American sub–region experienced consistent increases in Internet use during the nine–year period, though not at an increasing rate. The regional aggregation, however, masks the extreme variation in Internet use among the constituent countries. El Salvador, Honduras, and Nicaragua all show decreases in the percent change of Internet users, though not in the same years, which has the impact of leveling the aggregated regional data. Guatemala was the only Central American country to follow the regional pattern with increases each year of the study. HINARI citations by researchers in the Central American region, however, both increased and decreased during the nine–year period. Nicaragua experienced a dramatic rise in citations in 2005, explaining the percent increase of 2005 and decrease of 2006. Yet, the decrease in 2007 is not explained by the Nicaragua influence. Figure 4 does not demonstrate a relationship between Internet use and citations to the HINARI journals in Central America.
Figure 4: Percent change in Central American Internet users compared to the percent change in citations to HINARI journals by eligible Central American scholars.
While Cuba, the Dominican Republic, and Haiti all experienced modest increases in Internet users between 2000 and 2008, the data from Jamaica are impressive. From 2001 to 2002, Internet users in Jamaica rose from .6 percent of the population to eight percent, an increase of about 1,243 percent. While the population of Jamaica only accounts for about eight percent of the sub–region’s eligible population, the impact of this increase is evident in the aggregated data and distorts the remaining data points. Haiti likewise experienced an increase of 637 percent from 2003 to 2004. However, this only accounted for .009 percent and .07 percent of the sub–region’s eligible population and is imperceptible in the aggregate. From 2003 forward, Caribbean America demonstrates modest increases and two small decreases of .25 percent and two percent in 2006 and 2008, respectively. According to Figure 5, percent changes in citations to HINARI do not rise and fall with the percent change in Internet users in eligible Caribbean American countries.
Figure 5: Percent change in Caribbean American Internet users compared to the percent change in citations to HINARI journals by eligible Caribbean American scholars.
As several factors likely impact the scholarly use of life science journals, this study examined the relationship between two. The first was the HINARI program, which removes some barriers, most notably, cost and copyright restrictions. This factor was considered by comparing the rate of change in citations before and after the initiation of the program. The second was Internet capacity, in this case, the number of Internet users. This factor was considered by comparing the rate of change in citations to the rate of change in number of Internet users. The results demonstrated that both factors have impacted the scholarly use of life science journals by HINARI–eligible American researchers.
While all three American sub–regions revealed an increase in citations to HINARI journals over the nine–year period, the average annual increase in frequency of citations to the HINARI journals was greater after the program’s initiation for only two sub–regions, Central America and Caribbean America, indicating a positive impact by the program. There does not, however, seem to be a relationship between Internet use and citations to the HINARI program in Central America and Caribbean America. This strengthens the suggestion that the increased scholarly use of HINARI journals by these researchers resulted from the initiation of the program, rather than improved capacity, as gauged by number of Internet users.
The data for South American researchers does suggest the number of Internet users is related to the scholarly use of HINARI journals. While citations made by South American researchers did not demonstrate a greater average rate of change after the initiation of the program, this sub–region did demonstrate a relatively high degree of consistency between the citation data and Internet user data. The number of Internet users in the Americas, however, is only one variable that may impact the scholarly use of HINARI journals. It is extremely difficult to identify and isolate all of the potential variables that might impact the rate of citations to a set of journals. This is particularly challenging for the citations made by researchers in economically developing countries where instability and change is common.
The methods used in this study have other limitations as well. While the data sets are large and comprehensive, the data points used to explore relationships are few, providing only a descriptive analysis rather than a more statistically oriented analysis. Also, because data are aggregated, potentially significant country–level detail is lost. Aggregated data has the impact of distorting sub–regional numbers due to the relative size of constituent countries; if a particularly large country experiences a trend opposite that of the other countries, the numbers cancel each other out. Finally, calculating change in percent, while a common practice, presents comparisons that are difficult to evaluate, as each data point is sensitive to the leading factor in the calculation.
Program administrators for international initiatives such as HINARI strive to find ways to evaluate and improve their programs. Identifying geographic areas that require targeted support, as well as the kind of support required, is an enormous task. Consulting international statistics for trends, paired with a more qualitative assessment of perceived barriers by the researchers themselves, should provide means to serve this end. However, international statistics for economically developing countries are often incomplete, as was discovered in this study. With more complete data, indices such as the Knowledge Economy Index, which usefully combines multiple economic and technological variables, would be a valuable tool for evaluating potential barriers to scholarly communication.
While cost, copyright restrictions and technology are obvious barriers to researchers in economically developing countries, other factors also exist and deserve further consideration. The information offered in the most authoritative life science journals tends not to address the local needs of many researchers and practitioners. Content relevancy is particularly important in the medical field. Medline, for example, grants access to 3,000 journals; 98 percent of these originate in economically developed countries. All of “Latin America accounted for 0.39 percent of the total number of articles referenced by Medline in 1996, down from a ‘high’ of 2.03 percent in 1966” . Moreover, much of the published research focuses on the application of newer technology in the medical environment, which is often not applicable to day–to–day care in economically developing nations (Brown, 2007). An additional barrier is created when journals are in a non–native language; journals are typically published in English, limiting understanding for those fluent in other languages (Brown, 2007). However, Kale (2007) suggests much of seemingly irrelevant information can be useful in a broader context, such as failures in medicine, as well as warnings for healthcare providers.
Supporting access to locally based research would improve practice and scholarship in economically developing countries. International publishing can foster the international community, lessening a sense of isolation for scholars. Training and teaching opportunities may arise from new findings. Publishing can improve the quality of journals and education via exchange and collaboration. Physicians in China, Thailand, India, Egypt, and Kenya were surveyed regarding their willingness to change clinical practice as a result of reading biomedical journals (Page, et al., 2003). Overall, physicians were most likely to alter clinical practice based on articles published in local journals, emphasizing the need for local information and research.
While researchers and practitioners in economically developing countries would benefit from access to locally based research, they face barriers to publishing their work. Editorial and peer review bias can be an impediment, as authors and institutions unknown to editors and peer reviewers may be overlooked (Aronson and Glover, 2005). The majority of funds available for biomedical research is financed by and directed to institutions in the wealthiest countries. The traditional cycle of funded scientific research and publication requires researchers to publish in major journals. Funded researchers with experience working in this cycle have an advantage when publishing research results. The recommendation of duplicate or parallel publishing in local journals, with translation of articles into local languages, has been voiced, although this practice has not been well received by the publishing community (Aronson and Glover, 2005).
About the authors
Sheri V. T. Ross is an Assistant Professor at St. Catherine University in the Library and Information Science program. Her research interests include non–resident library use, scholarly communication, information ownership and the academic library, and electronic resources management.
E–mail: svtross [at] stkate [dot] edu
Christina Buckles graduated from St. Catherine University’s Library and Information Science program in the spring of 2010. Currently she is a graduate student at the University of Iowa in the Department of Cinema and Comparative Literature.
E–mail: christina [dash] buckles [at] uiowa [dot] edu
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Received 19 July 2010; revised 14 June 2011; accepted 19 June 2011.
“The Health Internetwork Access to Research Initiative (HINARI) in eligible American countries: Benefits, challenges and relationship to Internet use” by Sheri V.T. Ross and Christina Buckles is licensed under a Creative Commons Attribution–NonCommercial–ShareAlike 3.0 Unported License.
The Health Internetwork Access to Research Initiative (HINARI) in eligible American countries: Benefits, challenges and relationship to Internet use
by Sheri V.T. Ross and Christina Buckles.
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