Executive Summary

Over the past 30 years, the Latin American and Caribbean System on Health Sciences Information (Regional System) and BIREME have successfully developed the capacity of countries in the Region to create and operate national scientific and technical information systems in tandem with the emergence of new organizational, and information management paradigms. In recent years, the demand for technical cooperation with respect to Internet-based products and services has required new changes in BIREME and the Regional System.

The obsolescence of the current model coincided with the establishment of the BIREME External Evaluation Commission by the Director of PAHO in July and August 1997, which in its report stated that BIREME had shifted away from its mission as the Coordinating Center of the Regional System. Nevertheless, it recognized the fundamental role that BIREME has played and recommended that its leadership in promoting technical cooperation be strengthened.

The proposal to create and implement the Virtual Health Library (VHL) under the leadership of BIREME, represents the adoption of a new organizational and information management paradigm that will consistently respond to the recommendations of the External Evaluation Commission and to the new demand for technical cooperation.

The VHL represents an expansion of the current technical cooperation model, since it promotes decentralized production and operation of multimedia information sources, connected through networks with direct and universal access, exempt of geographical or scheduling restrictions.

BIREME has established a plan of action to implement the VHL based on 5 lines of action: promotion and marketing; realignment of traditional products and services; production of electronic publications; development of tools for integrating and locating information; and development of other VHL components. The plan of action will be implemented within a three-year period between April 1998 and March 2001.

BIREME and the Regional System: 30 Years of Evolution

The Latin American and Caribbean Region (LAC) is notable for the high degree of development it has achieved in the area of scientific and technical health information.

This development can be measured, along the past 30 years, by the constant and steady increase in the flow of information at the national and regional levels. This, in turn, is the result of the enhancement of the countries' ability to create and operate library systems and documentation centers with increasingly advanced information products and services.

The decentralized and cooperative production of the LILACS database system, which references the scientific literature on health generated in the Latin American and Caribbean countries, constitutes the best example of the remarkable progress made by the Region in information management. The LILACS/CD-ROM compact disk, which integrates and publishes the results of this cooperative effort, has been updated and published regularly three times a year since it was launched nine years ago, which is a significant achievement.

Also worthy of attention are the countless national and international electronic health information products that the countries of the Region have been developing, acquiring, operating, and disseminating in recent years, thus, significantly expanding the availability of information for the community of health professionals. The vast majority of libraries and information centers are already fully connected to the Internet or will be in the next two years.

This ongoing development is, undoubtedly, the result of a coordinated policy between PAHO and the countries of the Region. Jointly and cooperatively, they have mobilized significant investments and efficiently applied them toward training of human resources and updating of collections of information sources and infrastructure of information technology in an environment characterized by limited resources and economic crisis.

PAHO has played a key role in this development, chiefly through the ongoing action of BIREME, which has become PAHO's operational arm for technical cooperation in scientific and technical information.

BIREME's activity in the Region, in general, may be divided into three stages, each lasting approximately 10 years. Each stage has been characterized by a principal orientation in the promotion of technical cooperation, in keeping with the current organizational and management information paradigms.

Thus, in the first stage, between 1967 and 1976, BIREME's activity was centered on the operation of regional medical library services with a view to responding, on a priority basis, to the needs of the medical libraries of the Region for access to scientific literature.

In the second stage, between 1977 and 1986, BIREME's activity was directed toward the creation and implementation of a network of libraries in the Region, in pursuit of efficient organization and the shared use of their collections. At the same time, bibliographic control of the Latin American journals found in the publication Index Medicus Latinoamericano was implemented through centralized processing. The expansion and enrichment of BIREME's role beyond that of a library was reflected in the change, in 1982, of its original name, from Regional Library of Medicine to Latin American and Caribbean Center on Health Sciences Information.

In the third stage, during the past 10 years, BIREME's activity has been geared toward the creation and implementation of the Latin American and Caribbean System on Health Sciences Information, with active participation of libraries and information centers. In the second half of the 1980s, BIREME brought extraordinary progress with the creation and dissemination of the LILACS methodology to decentralize management of scientific literature; the creation of Descriptors in Health Sciences vocabulary in three languages; the mass introduction of information technologies; and, particularly, the LILACS/CD-ROM project, and the operation of LILACS and MEDLINE on BIREME's own computers. To expand the coverage and efficiency of the Regional System's operation, BIREME encouraged the creation and implementation of specialized systems in different areas of the health sciences. This progress was consolidated in the 1990s. It should be noted that BIREME's Internet connection and the celebration of regional Congresses, together with the mass participation of health information professionals of the Region and the developed countries, have contributed to an extraordinary exchange of information and sharing of experiences.

Meanwhile, in the past 3 years, with the growing prevalence of the Internet and its WWW service as a means to organize and disseminate information, the operational model of BIREME and the Regional System have been proven progressively unable to sustain the rate of development of information products and services in the Region as achieved in the late 1980s and early 1990s.

It is true that information methodologies, products, and services created by BIREME at the end of the last decade and related mainly to the scientific and technical literature published in hard copy, are still valid. However, the countries currently demand a new type of technical cooperation revolving around the creation and operation of decentralized information sources through the Internet. This type of cooperation, broader in scope and multimedia in nature, with more value added to serve the needs of specific groups of users and with less mediation through interfaces, makes the direct interaction of users with information sources a viable undertaking.

The obsolescence of the BIREME and the Regional System's operational model coincided with the establishment by the Director of PAHO of the BIREME and Regional System External Evaluation Commission, whose work was carried out during July and August 1997. In its report, the Commission points out the key role that BIREME has played, mainly in the implementation of the Regional System. It recommends its consolidation and enhancement as the coordinating center for the Regional System, together with the strengthening of its leadership in promoting technical cooperation in scientific and technical information.

With the objective of analyzing and monitoring the recommendations of the BIREME External Evaluation Commission report, early in October 1997, a working group convened by HDP/PAHO prepared a document proposing the bases for a workplan for PAHO's technical cooperation in health information. This plan was based on the creation and implementation of the Virtual Health Library, originally proposed to the External Evaluation Commission during its examination of BIREME.

BIREME intends to adopt the Virtual Health Library proposal as the platform for the promotion of technical cooperation in information for the coming years, in harmony with the new organizational and information management paradigms established by the Internet. Thus, BIREME will continue to play a leadership role in the Region.

The creation and implementation of the Virtual Health Library is planned as the fourth stage in the BIREME and the Regional System evolution.

The Virtual Health Library for Latin America and the Caribbean

The creation and implementation of the Virtual Health Library (VHL) is the strategy that BIREME intends to adopt for the promotion of technical cooperation in information toward and among the countries of Latin America and the Caribbean. The objective is to provide an organized and efficient response to the emerging needs of the countries to produce and operate health information sources through the Internet.

The Virtual Health Library is envisioned as the broad of scientific and technical knowledge based in health-entered, organized, and stored in electronic format in the countries of the Region, universally accessible on the Internet and compatible with international databases.

The VHL is simulated in a virtual space on the Internet and consists of a collection or network of health information sources in the Region. Users from different levels and locations will be able to interact and navigate in the space of one or more information sources, regardless of their physical location. The information sources are generated, updated, stored, and manipulated on the Internet by producers, integrators, and intermediaries, in a decentralized manner using common methodologies for their integration into the VHL.

The VHL information sources include health information products and/or services, which are divided into six basic types:

These six types of VHL components constitute the basic models for information products and services to be provided by both the regional and national centers. Their scope will be able to cover local, national, and regional data and needs.

It will also be possible to enrich, schedule, reformulate, and/or translate the basic information sources into new information products and services, with value added, in order to meet more efficiently the information needs of users from specific communities, for example, scientific research and education, health authorities and administrators at the different levels, direct medical care in its different specialties, media, the general public, etc.

The VHL does not represent a break with, opposition to, or a negation of the information achievements, methodologies, products, and services currently operated by BIREME, the Regional System, and other national and regional entities. Nor does it represent the end of BIREME and the Regional System. On the contrary, the VHL represents the expansion of the entire infrastructure for the information already amassed in the Region. This expansion is not linear. It represents the gradual adoption of a new paradigm of information management that in a variety of ways solves unsolvable problems or problems with very expensive solutions in the current operating model of BIREME and the Regional System. The following are some of the main aspects of this expansion or change in paradigm:

Implementation of the VHL and its development until it reaches momentum will demand political mobilization and increased awareness from the health authorities and institutions of countries in the Region to ensure that the information initiatives and resources are directed toward the VHL on a priority basis.

Cooperation between the authorities and the PAHO leadership is indispensable for making this mobilization a reality. As an operational arm of PAHO/WHO information policy, BIREME will act as a leading center at the regional level in the promotion and implementation of the VHL, through the creation of strategic alliances and consortia.

Thus, technical cooperation provided by PAHO in regard to scientific and technical information, especially through the activities of BIREME, should be redirected toward implementation of the VHL. In particular, it will fall to BIREME to promote discussion and promotion of the VHL in the centers of the Regional System, so the national systems begin their transition as soon as possible toward the creation and operation of the VHL with local information products and services.

BIREME has established the following lines of action for the implementation of the VHL, in close cooperation with the countries and the PAHO programs:

c. Development of electronic publications in the Region utilizing a common methodology for their preparation, storage, dissemination, and evaluation, including, on a priority basis:

d. Development of the Health Information Locator, including:

e. Forging of alliances and development of consortia for establishing and implementing projects for the development of the other components of the Virtual Health Library, including:

Each of these lines of action involves different degrees of development and adaptation of the information methodologies and technologies appropriate to the Region, mobilization of institutions and professionals, training of human resources, and improvement of the national health information infrastructures.

Plan of Action for

This plan of action is on the lines of action established by BIREME for implementation of the Virtual Health Library.

The plan is centralized with respect to the actions considered essential for VHL implementation. It is not a question of an exclusive plan, since the VHL operation, at least in principle, is decentralized and autonomous. In this regard, the main objective of the plan is to implement the VHL and sustain its initial development until it acquires its own momentum.

This plan will be discussed within several PAHO entities and at the Regional System Meeting in Costa Rica, with a view to its improvement.

The plan is organized along five lines of action:

Each line of action is comprised of a series of related macro activities.

For their implementation, BIREME will group the activities of the plan into different projects that will each include a detailed timetable of activities, implementation methodology, and financial resources.

Implementation of the plan is expected within a three-year period, beginning in April 1998, after the Regional System Meeting in Costa Rica. By the end of the period 30 March 2001, the Virtual Health Library should be fully operational.

The following pages present the lines of action of the plan, including a description of the main actions and institutions involved.

The VHL implementation plan has already made progress and taken constructive preliminary steps that make it possible to anticipate a high degree of success in its implementation:

Finally, we should point out the ability of BIREME and the Regional System, demonstrated over the past 30 years, to promote the changes necessary for the adoption of new paradigms, as is the case with the creation and implementation of the VHL.