Intended for healthcare professionals

Editor's Choice Editor's choice

How not to do things

BMJ 2007; 335 doi: (Published 09 August 2007) Cite this as: BMJ 2007;335:0
  1. Rajendra Kale, senior clinical editor
  1. rkale{at}

    The only thing I don't like about HINARI is its name. HINARI stands for Health InterNetwork Access to Research Initiative. I can't tell from the name that it is about meeting the information needs of researchers in developing countries. Notwithstanding its name HINARI is a success story that surprised even its organisers (doi: 10.1136/bmj.39293.711088.DE). It has inspired the world's leading publishers, the World Health Organization, Microsoft, Yale University, two individuals (Maurice Long and Barbara Aronson), and others to form a network in 113 poor countries and 2500 institutions that provides free access in these countries to 80% of Medline articles. Interestingly there are no contracts between publishers and WHO, and HINARI's diffuse network thrives on goodwill. HINARI's critics will list predictable shortcomings—access to information is not everything; information needs to be relevant to local needs; most Medline articles are not about the developing world, and so on. But health professionals in developing countries can judge for themselves what the take home message is in any article. To think otherwise is to be condescending.

    For example, this issue of the BMJ contains many articles that are not about the developing world but which might have useful messages—mostly warnings—for health professionals working there. If they want to fast track patients with breast cancer to specialist services they will find out that a “two week wait rule” introduced to reduce waiting times is failing many patients with cancer in the United Kingdom (doi: 10.1136/bmj.39258.688553.55). This would warn them to be careful in planning a similar fast track service in their own country.

    Doctors in the developing world will also find out how and why the health service in rich England is failing its children too (doi: 10.1136/bmj.39282.492801.80). England lags behind many other European countries in the services it provides to infants and children with cancer and diabetes. Alan Craft attributes this to managers being distracted by high profile targets, such as emergency waiting times and surgical waiting lists, and lack of extra money and specific targets for health professionals and managers. Research by Tracy E Roberts and colleagues will warn them that most published economic evaluations, which indicate that screening for Chlamydia trachomatis is cost effective, could be wrong (doi: 10.1136/bmj.39262.683345.AE). This is because these evaluations used static rather than dynamic models.

    Finally, planners from the developing world may want to organise postgraduate education and training and have a system to decide how they allocate jobs to doctors. Here too they can learn a lot from UK's Postgraduate Medical Education and Training Board (PMETB) and its medical training application service (MTAS). Sadly what they will learn most is how not to do things. As Nigel Hawkes says about MTAS, “Failure is an orphan, they say, but seldom such a threadbare and friendless waif as this” (doi: 10.1136/bmj.39297.609421.94). And his charges against friendless PMETB include a lack of cooperation with the royal colleges, inefficient management, high handedness, steep fees, and lengthy and complex application forms. All very avoidable.

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