Health Policy
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United Nations Millennium Action Plan: Health InterNetwork

The world today is divided between those who have access to health services and those who do not. A similar divide affects the flow of information and communications. To attain health equity, relevant information - and the technologies to deliver it - must be widely available and effectively used. New technologies hold great potential for improving health care, primarily by increasing the quality, relevance and delivery of information to health personnel. Unfortunately, this potential is far from being realised in many countries, partly because of the financial, technological and infrastructure challenges of the "digital divide", but also because the real and greatly varying needs of the users are often overlooked.

In September 2000 the Secretary-General of the United Nations launched a public-private initiative to bridge the digital divide in health. Spearheaded by the World Health Organization (WHO), the Health InterNetwork brings together international agencies, the private sector, foundations, non-governmental organizations and country partners under the principle of ensuring equitable access to health information. It aims to improve public health by facilitating the flow of health information, using the Internet. The core elements of the project are content, Internet connectivity and capacity building.

Content: to deliver effective public health services

As a key component of the project, the Health InterNetwork portal provides a vast library of the latest and best information on public health. Users can access more than 1,000 scientific publications, as well as statistical data and information for health policy and practice - essential information for research, and health services delivery. The portal will also make available information technology health applications such as geographical information systems and epidemiological tools, plus courses and training offered through distance learning.

Country needs are the basis for content development and selection; for example, publishing local and regional public health information that is currently unavailable electronically is given special attention. A content advisory group guides the selection of core public health content and the process for making it available. The academic and private sectors, along with local partners are contributing their knowledge and experience in developing and publishing information as well as contributing content.

Connectivity: for information and communication

The Health InterNetwork seeks to establish or upgrade thousands of Internet-connected sites in public and not-for-profit institutions in developing countries. Guided by a technology advisory group, foundations, development agencies, non-governmental organizations and corporate and local private sector partners are involved in specifying, providing and supporting hardware, software and Internet connectivity to pilot sites. More partners will be needed at the local and international level as these pilot projects roll-out to a broader scale.

Capacity building: to create an information environment

Health InterNetwork training concentrates on building the skills needed to put information into action: information access and use in daily work, basic computer and Internet skills, and hands-on training to use specialized public health information, literature and tools. A training advisory group is being established to guide the development and delivery of training courses, adapted to fit the needs of institutions with different information environments.

From concept to programs on the ground
The first year's planning phase focused on concept, strategy and initial partnerships. During this phase, a Health InterNetwork implementation task force was created at WHO with start-up work supported by a UN Foundation planning grant. A UN working group was established with participation from United Nations Development Program, UN Fund for International Partnerships, United Nations Population Fund, Unicef, United Nations Educational, Scientific and Cultural Organization, UN Volunteers, International Telecommunications Union and the World Bank to agree the project concept and strategy. Collaboration and support was secured from academic and governmental and inter-governmental agencies, foundations and the private sector.

The Health InterNetwork steering committee, still to be finalized, will guide the work of the implementation task force. Government representatives will be drawn from members of the newly-created UN Information and Communication Technology (ICT) Task Force to ensure coordination of UN ICT initiatives related to health.the private sector, foundations and non-governmental organizations will also be represented.

During the first year the Health InterNetwork achieved a major breakthrough on provision of health content. Starting in January 2002, the world's six biggest biomedical journal publishers have agreed to provide access to more than 1,000 of their scientific publications for free or at deeply-reduced rates to medical schools, research institutions and government offices in developing countries. Many other publishers are interested in joining this initiative as it expands.

Exemplifying the principle of equitable access to information, the "Access to Research" initiative enables accredited universities, medical schools, research centers and other public institutions in the developing countries to gain access to the wealth of scientific information contained in more than 1000 different biomedical journals produced by the six publishers. Until now, subscriptions to these journals, both electronic and print, have been priced uniformly for such institutions, irrespective of geographical location. Many key titles cost more than US$1500 per year, and the average subscription costs several hundred dollars, putting the journals beyond the reach of the large majority of health and research institutions in the poorest countries.

The first stage will make more than 1,000 journals available free or at significantly reduced charges to institutions in those countries. A second stage will involve similar access at significantly reduced prices for institutions in the other countries. WHO and the publishers will also work with the Open Society Institute of the Soros foundation network and other public and private partners to extend the initiative; for example, through training for research staff, and improving Internet connectivity. The initiative is expected to last for at least three years, while being monitored for progress. Decisions about how to proceed with further developments will grow from the precedent it sets, and will be informed by the working relationships which have evolved among the publishers and participating institutions.

Currently, the Health InterNetwork pilot phase is under way to test concept validity and feasibility. Major tasks during this phase include:
  • Building the Health InterNetwork portal, based on needs assessments and stressing priority public health programs.
  • Conducting a strategic review of similar initiatives to identify potential synergy among UN system and other partners.
  • Expanding working arrangements with private sector, foundations, governments, agencies and technical partners to mobilize skills, resources and support.
  • Working with technical development programs internationally and locally to ensure project support, in the context of UN Millennium development goals.
  • Conducting country situation analyses and implementing pilot studies, to guide overall project planning, implementation and evaluation.

The following are examples of major pilots studies in progress:

The Research Network pilot operates in 9 WHO Collaborating Centers in 8 countries in Africa, Central Asia and Eastern Europe. Sponsored by the Open Society Institute of the Soros Foundation network and major scientific publishers, the project will support researchers with electronic access to scientific journals and databases as negotiated with the publishers (see above). The collaborating centers will receive upgrades to connectivity such as computer hardware and access to the Internet, as well as training. They will participate in an in-depth evaluation to study the impact of the investment. In particular this pilot will review the cost and logistics of establishing or upgrading connectivity as well as the impact of better access to health information, for future expansion to other research centers.

The India pilot (http://www.hin.org.in/) aims to support tuberculosis and tobacco control programs throughout the country. An initial health information needs assessment was carried out in seven districts to give a broad overview of health information needs. Developed in India by a core team consisting of government, private sector and technical program staff, the project will contribute to filling gaps in the health research information system, support electronic publishing of related Indian journals and reports, and facilitate the network of medical libraries. The pilot study is supported through a grant from the Bill and Melinda Gates Foundation matching the initial UNF planning grant.

Pilot projects in other WHO Regions include the Caribbean Islands pilot to test the cost, logistics and feasibility of providing public health distance education in 5 sites; a pilot in Bolivia to address major health problems of childhood pneumonia and Chagas' disease, and a joint project with UNAIDS in countries with high HIV/Aids prevalence. Each pilot study is outlined through a document detailing objectives, milestones, expected outcomes (impact on indicators) and supporting budget. The cost for each pilot implementation, covering Internet connectivity installation and support, training, and local content publishing, one-year operation and evaluation is budgeted at between US$750,000-$1M, subject to the local capacity of the host authorities and the private sector.

The impact of Health InterNetwork
Already the Health InterNetwork has become a model for other sectors. The success of the Health InterNetwork Access to Research initiative has engaged other UN agencies, in extending the cooperation with publishers to other sectors such as agriculture and education. Key partners are universities and foundations. Plans are under way to expand the initiative with access to other scientific journals in related fields, based on WHO's experience.

In addition, the Health InterNetwork is a strong advocate of health equity through its work to ensure affordable, available information for better health. The initiative has been cited at the recent publishers' meetings, as well as by the WHO Executive Board as an exciting and promising public-private partnership, using the outreach of the UN in making available global public goods.

But the Health InterNetwork's most important contribution is in meeting country needs. This excerpt from a letter from Bibliotheque Sanitaire, Bukavu, Democratic Republic of the Congo, shows how severe those needs are: "Let us begin to admit that in Bukavu town and its immediate neighborhood live many health professionals, many health institutions, schools and universities which organize different medical teachings. Unfortunately, none among them do not own truly a … library but, just something constituted of old publications. Unfortunately for us, those technologies remain not only inaccessible…for the local university institutions but also very expensive at any places where we have it: 5$US for 30 minutes of visit."

The Health InterNetwork was created with one single purpose: to bridge the digital divide in health. Towards that end, health information - relevant, timely and appropriate - must become unrestricted and affordable worldwide, so that all communities can benefit from this global public good.