Open Access Highly Accessed Research article

Access to electronic health knowledge in five countries in Africa: a descriptive study

Helen Smith1*, Hasifa Bukirwa2, Oscar Mukasa3, Paul Snell4, Sylvester Adeh-Nsoh5, Selemani Mbuyita3, Masanja Honorati3, Bright Orji6 and Paul Garner1

Author affiliations

1 International Health Group, Liverpool School of Tropical Medicine, UK

2 Malaria Research Group, Makarere University, Uganda

3 Ifakara Health Research & Development Centre, Tanzania

4 Medical Research Council Laboratories, Banjul, The Gambia

5 Holy Trinity Development Foundation, Holy Trinity Foundation Hospital, Cameroon

6 Department of Health Promotion and Education, College of Medicine, University of Ibadan, Nigeria

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Citation and License

BMC Health Services Research 2007, 7:72  doi:10.1186/1472-6963-7-72

Published: 17 May 2007



Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives.


Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use.


In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet caf├ęs were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords.


Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.