In India, a woman enters a village health center and accesses a web page for information on how to better care for her baby. In Boston, a doctor at the Brigham and Women’s Hospital (BWH), one of the world’s most elite hospitals, pulls up the UpToDate website — an online medical information resource used by many clinicians to stay current with the latest clinical advances and practices — for information to help diagnose and treat a patient.

The World Wide Web has connected health care implementers with a vast sea of knowledge and experience. From mothers to doctors to architects to IT technicians to government policy makers, each of these actors faces daily challenges on how to deliver quality health care. Some are sitting in first-class hospitals in developed countries, while others are in isolated rural clinics in the poorest countries. Some are new to their role, while others have been in the field for as long as they can remember.

Unfortunately, many health care implementers are unable to access the information they need on the internet. Most online journals and medical information resources charge subscription service fees. Recognizing this financial barrier, there has been a strong drive to make access to scientific journals free for health care implementers in developing countries.

In 2002, the World Health Organization launched HINARI, a program to provide access to major scientific journals for public and non-profit institutions in developing countries. Other initiatives include the Global Information Full Text database and the Open Access movement by which some publishers, such as Biomed Central and PloS, make articles freely available on the internet.

However, there is no guarantee that the breadth of health implementers practicing in resource-limited settings are able to understand and utilize this new set of information — especially scholarly papers or resources not applicable to their point of care. Language barriers, computer and internet literacy issues, and information overload are a few other challenges that they face. The woman in the village may not necessarily be able to use the information she finds on the internet to improve her child’s health as “trying to get information from the Internet is like drinking from a fire hose.”

So how do health implementers access the most reliable, practical, and current information that is most applicable to their particular situation?

GHDonline.org — a platform where professionals from around the world engage in problem solving and share information resources to improve health outcomes in resource-limited settings — is one attempt to answer this question.

In June 2009, an infection control specialist from Swaziland posted on GHDonline.org’s TB Infection Control community asking for advice on how to design isolation rooms that maximize natural ventilation for multidrug-resistant TB patients. Within days, TB experts, architects, engineers, and other health care professionals from the US, the Netherlands, the UK, South Africa, and Italy — all members of the community — had responded with suggestions on room structure, software design programs, and literature references.

Instead of a one-way flow of information, this open platform facilitates a two-way flow wherein implementers on the ground access the most current and relevant information from peers and experts across the world, while at the same time sharing some of the issues they face in delivering health care.

As one architect describes, “We as architects are happy to listen in and get an insight on the subject matter and be able to relate with our area of expertise. Again thanks for your discussions we are able to understand the seriousness of the issues.”

Members can also discuss challenges and seek advice in their native languages, with several discussions having taken place in Spanish; for example, there has been a request for TB control guidelines in Colombia and a discussion about the 2009 Latin American Open Source Medical Informatics conference.

Additionally, following the HINARI model of partnering with publishers or “professional content makers,” resources like GHDonline.org can leverage partnerships to provide access to an increasing number of professional tools and content to its members at little or no cost. For example, a new international grant subscription program to UpToDate is now being offered on GHDonline.org to qualifying organizations and clinicians serving underserved communities.

While online tools such as GHDonline.org are important in sharing knowledge, electricity and internet access are prerequisites to accessing this information. Some off-line solutions have been developed for implementers in resource-limited settings, but these are makeshift options at best, as they do not address the need for up-to-date, context-relevant information. Furthermore, interactive exchanges, whether in person or online, allow for the advancement of knowledge and best practices in the field. In the context of providing access to life-saving health information, the provision of internet access is not a luxury, but a necessity.

 
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