Free access to journals of BMJ Group
Gut 2001; 49:1 (July)
Getting our journals to developing countries
For some years now it has been our policy to give gratis subscrip-
tions to our journals to applicants from countries in the developing
world. However, in practice this has had its difficulties. Many de-
veloping countries have either poor or non-existent postal services
and granting a print subscription can often be problematic and expen-
sive. The marginal cost of sending Gut to Africa is around GBP 25
each year. An editorial in the BMJ sets out the arguments very
We know that the gap between the rich and poor countries is widening.
Whilst those of us in the developed world have information overload,
the developing countries have bare library shelves. The internet
gives us the opportunity to narrow the gap. The marginal cost of giv-
ing access to the electronic edition of Gut is close to zero. What is
more, those in resource poor countries can access electronic journals
at exactly the same time as those in the developed world. Even bet-
ter, they can access what is relevant rather than what is provided,
much of which isn't relevant. Best of all, they can participate in
the debate using the rapid response facility on the web site in a way
that was almost impossible with the slowness of print distribution.
Access to the electronic edition of Gut will be provided free auto-
matically to those from countries defined as poor under the human de-
velopment indexes of the United Nations and the World Bank
<http://www.worldbank.org/data/databytopic/class.htm>. The BMA and
the British Society of Gastroenterology have made funds available for
the installation of 'Digital Island' on all our journal web sites.
This clever piece of software recognises where the user is coming
from and will give unrestricted access to the whole web site to users
from those developing countries we choose to designate.
BMJ.com will continue to be free to those in the developing world
whatever happens in the developed world. The income that we get from
resource poor countries is minimal; and facilitating information sup-
ply should encourage development, improvement in health care, and
eventually create a market.
The problem with this vision is the lack of access to the world wide
web in the developing world. While tens of millions of people have
access in the United States, it is only thousands in most African
countries; and access in Africa is often painfully slow, intermit-
tent, and hugely expensive relative to access in the United States
(where it's often free). Power cuts happen every day in many resource
Yet there's every reason to expect that access should increase dra-
matically. India currently has a million people with internet access,
but this is expected to rise to 40 million within five years. Simi-
larly dramatic increases are expected in Nigeria. Technological de-
velopments like access to radio and the proliferation of satellites
will render irrelevant the many problems of telephone access in Af-
rica. Rapid progress will also be made because many international or-
ganisations such as Unesco, the British government, the World Bank,
and the Bill and Melissa Gates Foundation are increasingly interested
in helping improve information access in resource poor countries.
The challenge will be sustainability. It is easy for donors to invest
money and reap the rewards of short term success. But enhancing in-
formation flow will make no impact on health if projects continue
only as long as their funding lasts. Information cannot be separated
from the capacity of a healthcare system to work effectively over
How is it possible to influence the context within which information
will flow, the apparently intractable political, economic, and organ-
isational constraints that disable rather than enable information to
work for people? Publishers in the rich world have a part to play,
and we hope that by making access to Gut on line free to those in the
developing world, we are making our own small contribution.
Michael J G Farthing
 Godlee F, Horton R, Smith R. Global information flow.
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