Geneva Health Forum Roundtable: Improving the availability and use of health research information in LMICs (12)

25 February, 2020

AS WE APPROACH GHF 2020 HIFA ROUND TABLES: Access to and use of Health Research/Multilingualism/Libraries and Billions

I wish to add to my previous comment on Q4 of the Round Table on Access to and Use of Health Information:

Q4. What other steps (other than open access) are needed to increase the availability and use of health research information?

On HIFA forum we have discussed quite a few topics on the advantages of Open Access and some obstacles that beset the model and which hinders achieving access to information especially for stakeholders in LMICs. I don’t recall our discussing one particular hindrance: access to citations in publications. Meanwhile to make Open Access even more open, researchers and clinicians, policy-makers and implementers should be able to access references (citations), but often these citations are not available because they are behind pay walls. This challenge to availability and access of information has been extensively discussed and solutions are still being sought especially for LMICs, in other forums, including:

a) Trish Groves - Access to References in WAME-L@LIST.NIH.GOV 1 May 2018

Citations are the most important vehicle for the discovery, dissemination, and evaluation of all scholarly knowledge. But ‘the present scholarly communication system inadequately exposes the knowledge networks that already exist within our literature. Data are not usually freely available to access, they are often subject to inconsistent, hard-to-parse licenses, and they are usually not machine-readable. The Initiative for Open Citations (I4OC) is a collaboration between scholarly publishers, researchers, and other interested parties to promote the unrestricted availability of scholarly citation data. These are exactly the reasons behind the Initiative for Open Citations (i4OC), which many publishers have joined in the past year or so, including BMJ, PLOS, F1000 Research, and Springer.

b) Barry Pless - Access to references in WAME-L@LIST.NIH.GOV 29 April, 2018

I decided to quote rather than paraphrase Pless’s contribution to the debate so as not to lose the main point: ‘’I have a perplexing question. I was completing a review for a prestigious journal and found a reference I needed to check. It turned out to be behind a pay-wall of another equally reputable journal. To read the full paper I would either have to become a subscriber for $184 US (online only), or pay $31.50 to read the article for 24 hours. I asked an editor of the journal for which I was doing the review why it was not their policy to advise authors not to cite key references that readers could not easily access. The fact that I could do so through my university affiliation seemed irrelevant. An average reader, especially a clinician, rarely has access to a medical school library. I believe part of a reviewer's job is to serve as the readers' advocate, on matters such as this (access to references) and for clarity. Am I off base? Or, if what I say makes sense, what policies should enlightened journal editors adopt? If forbidding the use of inaccessible references is impossible (and I am not yet convinced it is), could reviewers ask an author to provide a PDF of any such reference Or, if doing so is viewed as a violation of a 'blinding" policy, could the journal be obliged to provide the reference? If asking for a copy of a reference behind a pay wall seems too demanding, could a reviewer require the author to provide full details of any such citation? Finally, it occurs to me if what I believe was the 'old rule' were re-established, i.e., that references that were not accessible were forbidden, journals that use pay walls would be punished by having their impact factor diminished. Maybe this could remedy the problem and combat the greed that drives this unfair practice’’.

c) HK Burd. Contributing to Access to references in WAME-L@LIST.NIH.GOV 29 April, 2018.

This OA challenge is not a new problem but one we could do without. Several suggested solutions have been suggested, but none has enjoyed universal acceptance. They include that because ‘paywalls are an anachronism’ they must be discouraged and eliminated as they have no place in contemporary science. Others have advocated excluding references from Journals which use paywalls as that would bring down the number of citations and thus their Impact Factor (IF) and the consequences of that. Yet others suggest that ‘where a journal insists on accepting papers with references that are not freely or easily accessible they must provide the full copy of the papers for the peer reviewers’, at least. Another suggestion is that ‘the author provides the pdf of all papers cited’. This last suggestion was explored in a British surgical journal (name withheld) before the days of the internet. It did not last too long as a policy because of the mass of paper involved’.

The most held suggestion is that Journals and Publishers that operate behind paywalls need to embrace the emerging new order and business model adapt to change their business model because the old traditional publishing model is no longer an option.

In the HIFA Round Table we should note these suggestions, add our own, and try to build concensus around what option / combination of options may work based on the experience of the participants at the meeting.

Joseph Ana.


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Standards and Quality of Care Monitor and Assessor

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and Periodicals.

Nigeria: 8 Amaku Street, State Housing & 20 Eta Agbor Road, Calabar.

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT