Editorial
Gut 2001; 49:1 (July)

Getting our journals to developing countries

For some years now it has been our policy to give gratis subscriptions to our journals to applicants from countries in the developing world. However, in practice this has had its difficulties. Many developing countries have either poor or non-existent postal services and granting a print subscription can often be problematic and expensive. The marginal cost of sending Gut to Africa is around GBP 25 each year. An editorial in the BMJ sets out the arguments very clearly.[1]

We know that the gap between the rich and poor countries is widening. Whilst those of us in the developed world have information overload, the developing countries have bare library shelves. The internet gives us the opportunity to narrow the gap. The marginal cost of giving access to the electronic edition of Gut is close to zero. What is more, those in resource poor countries can access electronic journals at exactly the same time as those in the developed world. Even better, they can access what is relevant rather than what is provided, much of which isn't relevant. Best of all, they can participate in the debate using the rapid response facility on the web site in a way that was almost impossible with the slowness of print distribution.

Access to the electronic edition of Gut will be provided free automatically to those from countries defined as poor under the human development indexes of the United Nations and the World Bank. The BMA and the British Society of Gastroenterology have made funds available for the installation of 'Digital Island' on all our journal web sites. This clever piece of software recognises where the user is coming from and will give unrestricted access to the whole web site to users from those developing countries we choose to designate.

BMJ.com will continue to be free to those in the developing world whatever happens in the developed world. The income that we get from resource poor countries is minimal; and facilitating information supply should encourage development, improvement in health care, and eventually create a market.

The problem with this vision is the lack of access to the world wide web in the developing world. While tens of millions of people have access in the United States, it is only thousands in most African countries; and access in Africa is often painfully slow, intermittent, and hugely expensive relative to access in the United States (where it's often free). Power cuts happen every day in many resource poor countries.

Yet there's every reason to expect that access should increase dramatically. India currently has a million people with internet access, but this is expected to rise to 40 million within five years. Similarly dramatic increases are expected in Nigeria. Technological developments like access to radio and the proliferation of satellites will render irrelevant the many problems of telephone access in Africa. Rapid progress will also be made because many international organisations such as Unesco, the British government, the World Bank, and the Bill and Melissa Gates Foundation are increasingly interested in helping improve information access in resource poor countries.

The challenge will be sustainability. It is easy for donors to invest money and reap the rewards of short term success. But enhancing information flow will make no impact on health if projects continue only as long as their funding lasts. Information cannot be separated from the capacity of a healthcare system to work effectively over time.

How is it possible to influence the context within which information will flow, the apparently intractable political, economic, and organisational constraints that disable rather than enable information to work for people? Publishers in the rich world have a part to play, and we hope that by making access to Gut on line free to those in the developing world, we are making our own small contribution.

Michael J G Farthing
Editor
Alex Williamson
Publishing Director

References:

[1] Godlee F, Horton R, Smith R. Global information flow.
BMJ 2000;321:776-777

Countries with Free Access The following countries are entitled to free access to our sites. This list is compiled of countries defined by the World Bank as "Low Income Economies". Potential subscribers should follow the standard subscription procedure as our subscription system will automatically recognise the origin of access; countries in the list below will automatically qualify for free access. For further details on this policy, please refer to the relevant editorial in each journal.

The following electronic editions of journals are freely available on the net: eAnnals of the Rheumatic Diseases
eArchives of Disease in Childhood
bmj.com
eBritish Journal of Ophthalmology
eBritish Journal of Sports Medicine
eEmergency Medicine Journal
Evidence-Based Medicine
Evidence-Based Mental Health
Evidence-Based Nursing
eGut
eHeart
eJournal of Clinical Pathology
eJournal of Epidemiology & Community Health
eJournal of Medical Ethics
eJournal of Medical Genetics
eJournal of Neurology, Neurosurgery, & Psychiatry
eMedical Humanities
eMolecular Pathology
eOccupational and Environmental Medicine
ePostgraduate Medical Journal
eQuality in Health Care
eSexually Transmitted Infections
eThorax
eTobacco Control
eWestern Journal of Medicine