Providing access to evidence-based information in reproductive health: the WHO Reproductive Health Library for developing countries

Lack of access to up-to-date, reliable and comprehensive medicaI information is one of the biggest problems health care workers in developing countries .face. This problem is even more irnportant when the effecti veness of health care interventions are considered. W~thout this information being accessible to the majority of health workers, the removal of ineffective practices and instatement of beneficiaI practices will depend largel y on ad hoc incidental events such as conferences, meetings and visits to other countries. Having continuous access to good quality up-to-date infórmation on the effectiveness ofhealth care interventions may prove to be a more cost-effective way of improving the health status of populationsI. For developing countries, most subscription journals are not only expensive and delivered late and erratically, but also lack the systematically reviewed, comprehensive infonnation to influence practices in a specific topic or speciality. The reviews published in these journals are usually narrative and traditionally prone to the bias of the authors. Our experience with both narrative2 and systematic reviews3,4,5, and also the emphasis placed by others6,7 on the importance of systematic approaches to reviewing the effects of health care, have convinced us to take systematic reviews as the gold standard in reviewing health care interventions. In recent years systematic reviewing has become an efficient tool for providing such comprehensive information. The Cochrane Collaboration, founded in Oxford in 1993, is an international network of individuaIs around the world aiming to help people make well-informed decisions about health care by preparing, maintaining and ensuring the accessibility of systematic reviews of the effects of health care interventions8• . Cochrane reviews are systematic' reviews using rigorous, explicit methodology,. with thorough search for relevant st.udies, and are updated as new evidence becomes av~lilable. Hence, they are increasingly acknowledged as a reliable source of information on effecti veness of health care interventions9•


AL A Metin Gülmezoglu, José Vil/ar
Providing access to evidence-based information in reproductive health: the WHO Reproductive Health Library for developing countries L ack of access to up-to-date, reliable and comprehensive medicaI information is one of the biggest problems health care workers in developing countries .face.This problem is even more irnportant when the effecti veness of health care interventions are considered.W~thout this information being accessible to the majority of health workers, the removal of ineffective practices and instatement of beneficiaI practices will depend largel y on ad hoc incidental events such as conferences, meetings and visits to other countries.Having continuous access to good quality up-to-date infórmation on the effectiveness ofhealth care interventions may prove to be a more cost-effective way of improving the health status of populations I .
For developing countries, most subscription journals are not only expensive and delivered late and erratically, but also lack the systematically reviewed, comprehensive infonnation to influence practices in a specific topic or speciality.The reviews published in these journals are usually narrative and traditionally prone to the bias of the authors.
Our experience with both narrative 2 and systematic reviews 3 ,4,5, and also the emphasis placed by others 6 ,7 on the importance of systematic approaches to reviewing the effects of health care, have convinced us to take systematic reviews as the gold standard in reviewing health care interventions.
In recent years systematic reviewing has become an efficient tool for providing such comprehensive information.The Cochrane Collaboration, founded in Oxford in 1993, is an international network of individuaIs around the world aiming to help people make well-informed decisions about health care by preparing, maintaining and ensuring the accessibility of systematic reviews of the effects of health care interventions The World Health Organization has taken the lead in disseminating up-to-date reliable lnformation on the effectiveness of reproductive health interventions based on Cochrane review's to all regions, by embarking on the WHO Reproductive Health L~brary project for developing countries 10.The project is a collaborative activity between WHO, the Cochrane Collaboration and health workers in Latin America, Africa and South-East Asia, represented by an editorial board.The first issue of the WHO Reproductive Health Library contains, on one floppy diskette, 27 Cochrane reviews on topics of high priority for developing countries.The special feature of the WHO Reproductive Health Library is the commentaries on the relevance of review findings to developing countries.These commentaries and a corresponding section on practical management have been written by health workers in developing countries or by peopIe with experience of living and working there.Although these commentaries reflect the views of a small group of individuaIs, they clearly call attention to relevant issues relating to the reality of services in developing countries.They are all peer reviewed before being accepted for publication.
The WHO Reproductive Health Library will be published annually by WHO and will be distributed on a free subscription basis to health workers in developing countries.The first issue will be published only in EngIish, although active efforts to provide translations into major widely-spoken Ianguages are currentIy underway.
The dissemination of the WHO Reproductive Health Library will be made through several routes to ensure that health workers who would like to use it are accessed.WHO regional and international networks 11 ,12, collaborating centres, medicaI libraries in developing countries, and collaborators in multicentre international triaIs of importance to developing countries, will participate in dissemination.
Assistance from Cochrane Centres in Brazil and South Africa will be extremely vaIuabIe in this respect.This project was initiated and took shape in a reIativeIy short period (less than one year) due to the willingness and commitment of heaIth workers in many deveIoping countries, from Thailand to Brazil, Zimbabwe to Indonesia.However, the real success of the programme will only be measurable in terms of its impact in practice, which will be evaluated by appropriately designed studies.We look forward to fruitful collaboration with colleagues in Brazil in order to reach BraziIian health workers who would be interested in using the WHO Reproductive Health Library.
We also look forward to comments and criticisms from the users that will be crucial for the improvement of the programme.
Belizan JM, Carroli G. Multicentre randomized controlled trials in developing countries: The experience ,of the Latin American Network for Perinatal and Reproductive Research (LANPER).Archives of Public Health, 1996; 53: 134.12. Villar J, Ezcurra E, Perez-Palacios G, Hogue C, Gurtner de la Fuente V. Expanding research capacities to improve reproductive health in the Americas.World Health Organization.WHO/HRPIRFR 1994, Geneva, 1994.