Did the HIFA2015 Save HINARI?

Alongwith a multitude of other health bloggers, I blogged about publishers pulling out nearly 2500 titles from the HINARI. You can read more about that here.

Now, it was followed by an article in the BMJ which raised a storm in the email discussion forum called HIFA 2015 (Health Information for All by 2015). Now before I move in to discuss how this uproar helped restore the journals back into the HINARI, let me give a short introduction to the HIFA 2015.

It is an endeavor which aims to provide every human being with access to a well-informed healthcare professional by 2015. So, in effect it implies the dual effects of:

  • Providing every person with access to healthcare facilities and healthcare professionals
  • Providing every healthcare professional with the cutting edge information in his/her field of expertise

Now, this group mainly functions through an email list which is moderated by Dr. Neil Pakenham-Walsh. I have also been a member of the list for the past few months. Now, one of the objectives of the email discussion is to analyze the available best evidence and adapt it to suit a specified condition/setting. Since a lot of the people involved in the discussion are from the developing world, the focus on developing a strategy that works in the resource deprived situations is more intense than on developing the best possible, ideal settings.

The group ran a discussion following the publication of an article (1) in the BMJ (which, ironically, was initially not open access itself), which drew the attention of the world to the plight of the healthcare workers and researchers and students in the developing world when it came to the issue of access to healthcare information following the pulling out of nearly 2500 journals from the HINARI repositories. Almost immediately, the buzz on the HIFA 2015 was palpable. Most noteworthy was the contributions of Dr. Richard Smith, who set the ball rolling by sending off queries to different publishing houses enquiring about the nature of the call back. It appeared that the South East Asia (specifically Bangladesh) and Africa (specifically Tanzania) were hit the worst.

As more and more members started venting their ire over the group, rapid responses and blogs started to build up around the BMJ news article, which soon became freely available to all. As the voice of dissent rose, the editors of The Lancet realized that they were also no longer on the HINARI list. Having had a pretty rough ride over the last few days centering the MMR-Autism issue perpetrated by Wakefield, The Lancet decided to make its stand clear as it published a brace of articles ( claiming that they themselves were in the dark regarding the pull out of the journals from the HINARI.

While this raises serious questions regarding the method of withdrawal and the intentions behind the decision, those are not the focus of this post.

However, as the week dragged on, the replies from the publishing houses started to trickle back in. It appeared that under fire from the medical research world, most of the retracted journals were reinstated. This stems the rot for the time being, but the question is, for how long? The very fact that the journals are pulling out indicates that the system is not sustainable. Free or subsidized articles are available to the developing world through some other methods, but the importance of the HINARI is undeniable in this aspect.

The best, and possibly only way, is to encourage more and more publications going to the Open Access players. As I have spoken time and again, taking out all research in the open is the best way to disseminate the information. While many esteemed journals like the BMJ and the NEJM run a tight ship with the subscription model, yet they allow all of their original research articles to be in open access. Also, sometimes, when some articles become very popular, they take them over to the OA side of the field.

Which is all very good. But in the developing world, sometimes (and this I say from my personal experiences), healthcare workers need reviews and more explanatory articles rather than basic research, which may be inapplicable in the best of the settings anyways. That is the reason, the best option is to shift the whole business onto the open access players.

Whilst some may contend that I may be overestimating the role of the HIFA 2015 in having the HINARI resuscitated (at least for the time being), its importance is undobubted. It is more important now than ever before that such active cyber advocacy goes on. If you are a healthcare worker, a doctor, a nurse, a technician, a student, or even a patient in search of more discerning healthcare related information, go, JOIN THE HIFA 2015. Its a worthy cause.



1. Zosia Kmietowicz. Publishers withdraw 2500 journals from free access scheme in Bangladesh. BMJ 342:doi:10.1136/bmj.d196 (Published 11 January 2011)

2. Editorial. Bad Decisions for Global Health. The Lancet. Published Online January 18, 2011. DOI:10.1016/S0140-6736(11)60066-4

3. Koehlmoos T & Smith R. Big publishers cut access to journals in poor countries. Published online January 18, 2011 DOI:10.1016/S0140-6736(11)60067-6

4 thoughts on “Did the HIFA2015 Save HINARI?

  1. Hello everyone,

    Many thanks Dr Skeptic, for your generous comments about HIFA2015, of which I am coordinator.

    1. I think HIFA2015 has helped, but I think the credit goes to (HIFA members) Tracey Koehlmoos, Richard Smith and Richard Horton for persuading Elsevier to reverse their decision to withdraw from HINARI in Bangladesh.

    2. The goal of HIFA2015 is ambitious, but not quite as ambitious as Dr Skeptic suggests above. The HIFA members define the goal as ‘By 2015, every person will have access to an informed healthcare provider’, and we emphasise that we include mothers and family caregivers in this definition of ‘healthcare provider’. It’s worth remembering that up to 80% of child deaths in Africa occur in the home, before reaching a health facility, and many of these deaths could have been avoided by simple measures in the home. The main thrust of HIFA2015 is that, by 2015, the lack of availability of appropriate healthcare information at the point of care will no longer be a major contributing factor to avoidable death and suffering. An example of how this can be achieved is provided by mobile phones, which are fast becoming ubiquitous: Imagine, for example, if every new mobile phone were preloaded with basic, appropriate health information in the local language.

    To join HIFA2015 (it’s free):

    Neil Pakenham-Walsh
    HIFA2015 Coordinator


    1. Thanks for caring to stop by and comment.

      I must say that the individuals who came together to save HINARI for the time being could not have done it had they not been united by the HIFA2015. It shows that the power of cyber advocacy is immense. I would like to applaud you for running the group so efficiently.

      Also, I have been following the mobile phone with healthcare information issue with some interest. I believe with mobile telephones becoming ubiquitous, it would be a great way to serve healthcare information at the point of care.

      I find it to be a matter of great privilege to be a member of this group. Thanks.


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