Open, free access to health evidence: a new precedent for Africa

Clinicians can do their jobs better when they have quick, open access to scientifically rigorous research. Penn State/Flickr, CC BY-NC

When the World Health Organisation develops guidelines on the use of health care interventions, it turns to the Cochrane Library. This is a collection of databases containing high quality systemic reviews and other evidence to inform decisions about health care.

The problem is that access to these important databases costs money. In South Africa, universities and the South African Medical Research Council could access the Cochrane Library through institutional subscriptions with the library’s publishers.

But most of the country’s health care workers aren’t affiliated to universities. So the library has been inaccessible where it’s most needed – in clinical settings. Technical teams within the government and those responsible for creating policies were also left out.

Perhaps most importantly, consumers – patients who wanted to know more about medicines and possible treatments – could pay for a personal subscription. But most people can’t afford the subscription fee.

Now, thanks to funding from the South African Medical Research Council (SAMRC), that’s going to change.

One of the SAMRC units, Cochrane South Africa, has procured a national licence that provides “one-click” access to the Cochrane Library for everyone in South Africa. This will provide fair, equal – and free – access to evidence-based Cochrane Reviews for all. It’s a chance for practitioners, policymakers and patients to get up-to-date, scientifically rigorous information about health care.

This is the first time a country in Africa has bought a national licence of this kind, though other low or middle-income countries such as India have already gone this route.

A valuable asset for clinicians

Being able to access up-to-date, relevant evidence is good news for any health system. Access of this kind is key to improving treatment outcomes and reducing health care harms and sometimes even costs. It also boosts the chances of improved well being in a society.

Systematic reviews can guide decision makers in developing policies and clinical practice guidelines. We’ve experienced this first hand. In 2007 we published a Cochrane Review about the treatment of hypertension using medications known as beta blockers.

In the decade that followed, this review has been referenced in nearly all international hypertension guidelines. It has contributed to the phasing out of the traditional approach of recommending that doctors use beta blockers as first-line treatment for the management of hypertension.

Clinicians see patients suffering from a host of illnesses every day. To keep up with the literature it’s estimated that they must read 17 articles a day. A Cochrane Review helps by providing an up-to-date synthesis of all relevant research on a given topic. This reduces the risk of practitioners cherry-picking only the studies with whose results they agree. Cochrane Reviews provide the most reliable evidence on what works, what does not work, and what requires further research. Treatments based on this information are therefore more likely to improve health outcomes.

The national licence also provides access to Cochrane Clinical Answers. These are designed to be used at the point of care, which is especially valuable for many doctors and nurses working in South Africa’s rural and remote areas. The library works well on mobile devices, so even clinics that don’t have PCs can benefit.

The mobile responsiveness of the Cochrane Library would allow ready access to evidence-based information on smartphones and other mobile devices.

There are also huge benefits in allowing patients to access such reviews.

Patients benefit enormously

Increasingly, the rights of patients and consumers are being recognised. They experience a growing sense of autonomy when they are able to influence health care decisions using sound information.

Cochrane Reviews include plain language summaries which describe review results using accessible wording and style. Patients who are researching a newly diagnosed condition can empower themselves with knowledge about potential interventions, including outcomes and risks. They are therefore able to ask the right questions, discuss treatment with more insight and even draw their doctor’s attention to new discoveries.

The national licence will also help policymakers and researchers. Being able to access the Cochrane Library will ensure that any health policy or guideline is underpinned by a comprehensive search and synthesis of the available literature. It will also allow researchers to identify areas where more investigation is needed.

The national licence has been available since June and anyone in South Africa can access the library here.