In the years following the formation of The Cochrane Collaboration many people within the organisation were voicing their unease about the inaccessibility of the crucial evidence-based knowledge contained in The Cochrane Library among healthcare professionals in low- and middle-income countries (LMICs). In 1996, three staff members of the World Health Organization (WHO), with the help of many outside partners, embarked on a project that sought to overcome this problem, at least in the area of sexual and reproductive health. These efforts culminated in the launch in 1998 of The WHO Reproductive Health Library (RHL), a free-of-charge electronic journal based on Cochrane Reviews and endorsed by The Cochrane Collaboration.
The first issue of RHL, published on a single 3.5-inch diskette, contained 27 Cochrane Reviews and corresponding expert commentaries on pregnancy and childbirth topics. These reviews had been carefully selected by the RHL team (WHO staff members and six regional editors) to ensure that the topics were relevant to maternal health care in under-resourced settings. The commentaries, authored by individuals with experience of delivery of maternal health care in such settings, sought to present the complex science in the systematic reviews in a language and format that healthcare professionals could easily relate to and apply to their practice.
The RHL diskette was initially mailed to individuals and institutions listed in the various mailing lists of the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP; www.who.int/hrp), based at the WHO Headquarters in Geneva, Switzerland. Issues of RHL were disseminated via all available channels, including distribution at scientific conferences and similar events. Gradually, a subscription list was developed and, as content increased, RHL began to be published on CD-ROMs. Dissemination was also undertaken with the help of 'RHL Champions', who included the regional editors and specially appointed country focal points. The champions also promoted the use of RHL in educational activities (including continuing medical education for clinicians) in their home institutions in LMICs. RHL has also been vital for WHO's own normative work. Since 2007, WHO has used RHL to develop evidence-based guidelines in the area of sexual and reproductive health.
RHL has come a long way since it was first distributed by post to about 15,000 addresses. One measure of its impact is the steadily rising numbers of visits to the RHL website (apps.who.int/rhl). In 2011 and 2012, the website had over 2 million visits, with the number of page views rising from about 10 million in 2012 to nearly 14 million in 2013. Over the last 17 years, RHL has evolved not only in terms of its expanded content, but also in terms of the language of communication, which was seen at the outset as a key barrier to accessibility of knowledge. Today, in addition to Cochrane Reviews and corresponding commentaries, RHL includes educational videos, WHO guidelines, and selected literature on the principles and practice of evidence-based medicine. Moreover, RHL content is translated and published in six additional languages: Arabic, Chinese, French, Russian, Spanish, and Vietnamese.
Since the launch of RHL, the HINARI project (www.who.int/hinari) and the open access movement have changed the health information landscape in LMICs. More recently, The Cochrane Collaboration has revised its publication arrangements such that Cochrane Reviews will now be available free of charge globally after 12 months. The exponential growth of the Internet and its use worldwide, particularly access to scholarly health information via mobile and hand-held devices, are driving rapid evolution of global information dissemination strategies. RHL is adapting its publication format and style in order to continue to serve as an important resource. The RHL team is strengthening the focus on evidence-based information by highlighting key recommendations from WHO guidelines, adding new audio-visual material to facilitate the implementation of such recommendations, and presenting important research findings (from HRP and other institutions) that are likely to have an impact on policies and programmes. RHL is also gearing up to take advantage of social media to reach healthcare professionals who use such information channels. With the aim of expanding access to non-English language versions of RHL, the RHL team is seeking to build partnerships with WHO collaborating centres.
Expansion in the availability of Cochrane Reviews via RHL in many diverse settings has had significant spin-offs. For example, many healthcare professionals who have used RHL in their work have become Cochrane Review authors, editors or referees. Workshops on RHL conducted by WHO and its partners since the late 1990s provided impetus for the formation of the Thai Cochrane Network (tcn.cochrane.org), which currently includes over 100 authors contributing to 64 Cochrane Reviews. In South Africa, the distribution of the first issue of RHL to obstetricians, midwives, neonatologists, and neonatal nurses at the Annual Priorities in Perinatal Care conferences served as the first introduction to Cochrane Reviews for those healthcare professionals. Since 2001, WHO-sponsored annual research methods courses at the Effective Care Research Unit in East London, Eastern Cape, South Africa, have used RHL to introduce researchers from the WHO Africa region to Cochrane Reviews. A number those researchers went on to become Cochrane authors. The collaboration between WHO and Cochrane is at the heart of the success of RHL. This ground-breaking and long-standing partnership has benefitted not only the two organisations but also scores of healthcare professionals and their patients.
A Metin Gülmezoglu1, João Paulo Souza2, Jitendra Khanna3, Guillermo Carroli4, G Justus Hofmeyr5, Jean-José Wolomby-Molombo6, Suneeta Mittal7, Pisake Lumbiganon8, Linan Cheng9
1A Metin Gülmezoglu (firstname.lastname@example.org), Co-ordinating Editor, WHO Reproductive Health Library, WHO, Geneva, Switzerland; 2João Paulo Souza, Associate Co-ordinating Editor, WHO Reproductive Health Library, WHO, Geneva, Switzerland; 3Jitendra Khanna (email@example.com), Technical Editor, WHO Reproductive Health Library, WHO, Geneva, Switzerland; 4Guillermo Carroli, Rosarinian Centre for Perinatal Studies, Rosario, Argentina; 5G Justus Hofmeyr, Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; 6Jean-José Wolomby-Molondo, Department of Gynaecology and Obstetrics, University Clinics of Kinshasa, Democratic Republic of the Congo; 7Suneeta Mittal, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India; 8Pisake Lumbiganon, Department of Obstetrics/Gynaecology, Khon Kaen University, Khon Kaen, Thailand; 9Linan Cheng, Centre for Clinical Research and Training, Shanghai Institute of Planned Parenthood Research, Shanghai, China.
How to cite: Gülmezoglu AM, Souza JP, Khanna J, Carroli G, Hofmeyr GJ, Wolomby-Molondo JJ, Mittal S, Lumbiganon P, Cheng L. The WHO Reproductive Health Library: a Cochrane window on sexual and reproductive health [editorial]. Cochrane Database of Systematic Reviews 2013;(10):ED000070. dx.doi.org/10.1002/14651858.ED000070.
1. World Health Organization. WHO's new electronic journal promotes evidence-based reproductive health care in developing countries. www.who.int/inf-pr-1998/en/pr98-27.html (accessed 22 October 2013).
2. The Cochrane Collaboration. Cochrane Editorial and Publishing Policy Resource: Open access. www.cochrane.org/editorial-and-publishing-policy-resource/open-access (accessed 16 September 2013)
Competing interests: The authors declare that they have no conflcits of interest.
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Image credit: World Health Organization