Enhancing Access to Health Information in Africa: A Librarian's Perspective

Abstract

In recent years, tremendous progress has been made toward providing health information in Africa, in part because of technological advancements. Nevertheless, ensuring that information is accessible, comprehensible, and usable remains problematic, and there remain needs in many settings to address issues such as computer skills, literacy, and the infrastructure to access information. To determine how librarians might play a more strategic role in meeting information needs of health professionals in Africa, the author reviewed key components of information systems pertinent to knowledge management for the health sector, including access to global online resources, capacity to use computer technology for information retrieval, information literacy, and the potential for professional networks to play a role in improving access to and use of information. The author concluded that, in regions that lack adequate information systems, librarians could apply their knowledge and skills to facilitate access and use by information seekers. Ensuring access to and use of health information can also be achieved by engaging organizations and associations working to enhance access to health information, such as the Association for Health Information and Libraries in Africa. These groups can provide assistance through training, dissemination, information repackaging, and other approaches known to improve information literacy.

Information is a prerequisite to the development of any nation and is a driving force for development, whether economic, social, or political. Information is also an indispensable contributor to good health outcomes, and a critical element of well-functioning health systems. For these reasons, universal access to health information is a prerequisite for achieving the Millenium Development Goals (Godlee et al., 2004). However, challenges to ensuring a coherent approach to the information needs of health workers and poor attention to knowledge management components of health systems pose a major hindrance to achieving the Millenium Development Goals. In addition, basic determinants of information use will need to be addressed, as getting people to use information remains a challenge (Kapadia-Kundu & Sullivan, 2011).

It is important to note that, for information to be used, it must be available, accessible, and usable, and absorbed by the recipients of the information (Wagacha, 2007). In regions that lack adequate information systems, librarians can play a role facilitating access and use by information seekers, because they are (a) aware of the needs of users, (b) familiar with new information and communication technologies to meet local needs, and (c) skilled in techniques of information retrieval. Many librarians who support institutions working in health have access to at least some current sources of evidence-based information, and as information professionals they are committed to information sharing and to providing access to information for members of the health community (Coghlan, 1993).

To determine how librarians might play a more strategic role in meeting the information needs of health professionals in Africa, I reviewed some of the key components of information systems pertinent to knowledge management for the health sector, including access to global online resources, capacity to use computer technology for information retrieval, information literacy, and the potential for professional networks of librarians to play a role in improving access to and use of information. The results of my analysis will be used to advise donors, universities, public health organizations, and professional associations involved in knowledge management in the region.

Improving Access

The world is experiencing a technological revolution with the advent of the Internet, increased use of computers and mobile phones, and greater access to growing volumes of information. Nevertheless, only 5.7% of the world's 2 billion Internet users are in Africa (Internet World Statistics, 2011).

In sub-Saharan Africa, tremendous progress has been made in the availability in electronic formats of health information for those in the health sector, from policymaking to service delivery levels. For example, a number of countries in the region have been extremely privileged to be beneficiaries of initiatives such as the Health Internetwork Access to Research Initiative (HINARI). The HINARI database, a WHO initiative, provides access to more than 8,000 information resources free of charge to users in eligible countries. It is an invaluable source of health information for health care providers in developing countries, providing access to current and up-to-date information otherwise only available by subscription to peer-reviewed journals. Such access by researchers, students, and health professionals should ultimately translate to better health care.

Even with the availability of such valuable resources, however, the issues of proper access and usability need to be critically addressed. There remains a gap in ensuring equitable access to health information in rural and urban settings (Godlee et al., 2004). Access to the Internet in many rural areas, for example, is contingent on the availability of electricity and related infrastructure.

The Internet, Language Barriers, and Computer Skills

A second factor affecting accessibility is language. Language is a major issue and challenge that needs to be considered in order to increase the use of the Internet, which is dominated by English-language materials. In a continent such as Africa, with 54 countries and thousands of languages and dialects, the predominance of English-language materials on the Internet limits access to many users. While many websites published by global health organizations such as WHO provide some translated materials, translation is largely from English into other major languages such as French, Spanish, Arabic, Spanish, and Portuguese. This leaves access to much evidence-based material on health unattainable for people who can only communicate using local languages, or those with low literacy in any language. One way to increase use of the Internet and ensure greater access to health information in Africa would be to facilitate and support more posting of material on health in local and ethnic languages. Third, the technological revolution not only brings opportunities for greater access to health information resources but challenges. For example, the Internet requires basic computer skills to access and use effectively, and many health workers do not yet have such experience.

Information Literacy

The availability of information and communication technologies is important for the development of any nation. However, in developing countries, barriers such as language, low literacy levels, and poor information literacy remain a challenge. Information literacy—the capacity to recognize when information is needed and to use the information effectively and in an ethical manner—is a critical component of information usage. If the population the technology is intended for cannot use and effectively manipulate the information, then it does not serve the purpose it is intended for. Sometimes information that is accessed and taken out of context is misinterpreted and can be detrimental. Basic literacy levels, information literacy, and the lack of comprehensible and usable information for health workers at every level need to be addressed if we are to achieve the Millennium Development Goals by 2015.

Role of Health Information Professionals

How can greater availability of information that responds to the specific needs of health workers at multiple levels in the health sector be achieved across Africa? How can persistent barriers to access—from infrastructure to language issues, information search and retrieval skills, and information literacy—be addressed? Health information professionals should take the lead in ensuring that health workers and the general population know how to retrieve the information and use it effectively and ethically. They have knowledge and skills in organization, retrieval, and dissemination of information and they can therefore take a central role in locating and filtering relevant information for personnel in the health sector, students at faculties of nursing and medicine, and other health stakeholders. Associations of professional health librarians can also play an important role, as their purpose is to promote and enhance access to health information. Such groups can provide needed assistance through training; selection, repackaging, and dissemination of relevant materials; and other approaches known to improve information literacy. The Association for Health Information and Libraries in Africa, for example, with members at information resources and libraries throughout the region, might be an ideal group.

Association for Health Information and Libraries in Africa

The Association for Health Information and Libraries in Africa, founded in 1984, is an association of health information professionals in Africa. It has grown steadily over the years and currently has members in 46 countries. The organization's vision is to be a “leader in promoting access and use of health information in Africa.” It aims to do the following:

	Improve the provision of up-to-date and relevant health information
	Encourage the professional development of health librarians
	Promote resource sharing in Africa and the exchange of experiences
	Promote the development, standardization, and exchange of health databases in Africa, such as the African Index Medicus

The engagement of health information professionals in so many countries across the region in the Association for Health Information and Libraries in Africa is an indication of the association's potential to transform the international response to health information needs in Africa. The Association for Health Information and Libraries in Africa could provide an effective structure to disseminate health information in the region. Country chapters could contribute to achieving shared health information objectives at the country level.

For example, in 2010 the Kenya local chapter of the Association for Health Information and Libraries in Africa, called KEN-AHILA, identified nurses as the largest group of healthcare providers who needed to have current evidence-based information for patient care. In collaboration with the National Nurses Association of Kenya, KEN-AHILA made an effort to train nurses on how to access health information from various databases. It implemented a series of training workshops for Kenyan nurses on information retrieval and how to use information ethically, without violating patients' rights. These efforts focused on the usability of the information for the intended users of the information and effective use of health information.

KEN-AHILA also identified a second group of health care personnel who provide critical services in rural areas, i.e., community health workers. It established an information resource center in a remote area of Kenya among the Maasai community in a pilot effort to disseminate health information to the rural area. With technical support from KEN-AHILA, the center has begun to provide health information in an audiovisual format to serve the needs of people in the region with low literacy levels. Such efforts could be replicated elsewhere if adequate resources were identified.

Conclusion

A number of strategies can address needs for health information in resource-poor settings. First, health information professionals in Africa have a big role to play in improving the health of society. Health information professionals should be invited to help develop and implement comprehensive knowledge management strategies for the health sector, with attention given to their unique role in promoting access to needed information. As Coghlan observed in 1993, for this to happen, policy makers and administrators must be convinced of the importance of health literature services, and such services should be integrated at the national level and be brought to the attention of the local health community as well as to the population at large.

Second, associations such as the Association for Health Information and Libraries with country chapters should be tapped to address specific information needs of groups currently not yet reached with comprehensible and usable information, and resources need to be identified to allow librarians to serve the most critical health information needs in their communities. To achieve the Millennium Development Goals, we will need the active involvement of health information professionals to ensure access among healthcare providers and consumers to accurate, relevant and up-to-date information.