Adam Lewis

Doctors, Researchers – Tear Down this Paywall: Paving a new road to research-based action in global development

Last month, the world received some encouraging news: Liberia was declared Ebola-free. After a 14-month battle with the virus that claimed nearly 5,000 Liberian lives and brought the country to its knees, the World Health Organization announced that the devastating epidemic was over (Guinea and Sierra Leone, however, are still experiencing new cases).

As Liberia recovered from the outbreak and began the long, uphill process of rebuilding its health system for other ongoing and future health challenges, some of its leaders reflected on what could have been done to prevent the Ebola outbreak. In a New York Times editorial written about a month before the epidemic’s conclusion, Bernice Dahn, Vera Mussah and Cameron Nutt discuss a troubling reality: that European researchers knew about latent Ebola antibodies in Liberian blood samples as long as 30 years ago, positioning Liberia in the Ebola endemic zone. Yet, like many studies conducted by Western researchers, the findings sat atop the proverbial ivory tower, out of reach of the Liberian doctors and policymakers who could have acted to prevent the eventual outbreak.

This disconnect between development research and the communities it studies is an all-too-common trend in an international development community that hosts a Healthcare in Africa Summit in London and discusses poverty reduction strategies fresh off private jets. Mike Powell, director of IKM Emergent – a think tank that examines knowledge-management practices in the development sector – has noticed this trend for years. “The amount of research that is getting in the hands of local people in a useable format to make decisions is a minuscule fraction,” he said in a recent phone conversation. “We pour massive amounts of money into development research with no sense of how it will be practically applied.”

The intuitive reason for this disconnect is cost of access. Only about 17 percent of scholarly journal literature is open-access, with roughly 42 percent of journal articles published and paywalled by the three leading commercial publishers (Elsevier, Springer and Wiley). The Center for Global Development recently conducted an analysis to determine the average cost of published research, and found that book-based references cost approximately $34 (USD) and journal articles nearly $18 (including both fee-based references and those available for free online). To researchers, health workers and policymakers in the developing world, these prices can be prohibitive. In fact, as CGDev notes, “one of the earliest articles on Ebola in Liberia seems to cost $31.50 to download,” far too steep for a Liberian medical professional making only a few hundred dollars a month.

Fortunately, there are efforts under way to bridge this divide and make published research available for readers and organizations in low- and middle-income countries. Research4Life is a platform that offers peer-reviewed literature for free or discounted prices to institutions based in countries meeting certain eligibility criteria. It collates content from resources like HINARI, AGORA, OARE and ARDI, which enable access to articles in the health, agriculture, environmental and innovation fields, respectively. Likewise, Highwire compiles a list of journals that offer free online access to users in developing countries, complete with an advanced search function to navigate its more than seven million articles. Major funders of research like the Gates Foundation and National Institutes of Health now require articles to be made available public within 12 months of publication. And, in 2013, The Lancet established The Lancet Global Health, an open access journal focused on middle- and low-income countries.

However, price is just the tip of the iceberg. Format, according to Powell, is perhaps even more critical in terms of research actually resonating with the communities it studies. “What is this process really about?” Powell wonders. “Who is this knowledge for? Is it for the experts to tell people what to do or is it meant to empower people to improve their own lives?” As Powell alludes to, academic research is typically formatted by and for academic researchers – and rarely does this format inform the implementation of development strategies, which is exactly the problem. “All knowledge must be adapted to be useful. And that adaption has to be a two-way process.”

A good example of this type of adaption comes from social anthropologist Martha Chinouya, currently a professor at London Metropolitan University. When she was commissioned to lead an ethnographic research project on HIV in Zimbabwe (her home country), she decided to take a participatory approach with the community she was studying. She enlisted community members to help her develop the research proposal, determine the study methods and even name the project. And when it came time to disseminate the findings, she learned quickly that a traditional research paper wouldn’t suffice. As one elderly woman told her, “If you bring us reports we will use them to start fires to cook porridge for the children.” Instead, the community requested (and eventually wrote) a play to dramatize the results and translate them in a way that was real and useful to the research population.

In the aforementioned editorial, Dahn, Mussah and Nutt cite an old public health adage in relation to the Ebola data they so tragically lacked: “The road to inaction is paved with research papers.” Open access or not, maybe the traditional peer-reviewed research paper format is not the most effective way to capture and communicate important development studies. Maybe the road to action is instead paved with research informed by and therefore accessible to the communities it comprises, who are then in a position to put it to use. After all, if a study is published and no one is able to access, understand or apply it, does it make an impact?

Adam Lewis is a senior associate at Rabin Martin, a global health strategy firm in New York.

Education, Health Care