Use social media to strengthen health systems
Health scientists in developing countries can use social media to tackle research priorities, argue Alexander E. T. Finlayson and colleagues.
Building research capacity in developing countries is, perhaps appropriately, a relatively new aim for efforts to improve health systems and is not a prominent building block in the WHO framework for health systems strengthening.
Nonetheless, its importance is increasingly recognised by the WHO and organisations such as our own, MedicineAfrica. 
But how can health scientists in developing countries build networks and share the knowledge needed to make strategic progress towards strengthening health systems?
Perhaps the mobile-phone revolution provides a clue. With more than five billion subscriptions, mobile phones are now indispensable across the world. Mobile technology promises to transform global healthcare, especially in remote areas, by enabling direct interaction with patients, helping remote training of healthcare workers, and supporting the education of scientists.
The fledgling patchwork of electronic and mobile health is on the cusp of becoming an integrated global solution, either through a series of unifying enterprise architectures (blueprints for information technology management in organisations), or through the adoption of internationally accepted interoperability standards that enable diverse systems to work together.
We can make an analogy with healthcare: just as manufacturers' differing mobile handsets come with a frustratingly diverse range of incompatible chargers, Western healthcare has historically fallen victim to a closed-off system, with insufficient attention given to sharing lessons and information. This means that each patient's case needs to be approached afresh by every new doctor who has limited access to the patient history.
But just as many African countries have bypassed fixed telephone lines to embrace mobile-phone networks, so healthcare systems can skip having paper records.
It is highly likely that scientists in countries with limited resources will follow this pattern, perhaps bypassing traditional, and at times ineffective, research methodologies for more progressive approaches — including the use of social media — to addressing local priorities for biomedical research.
In a recent edition of Nature, we suggested the possibility of exploiting Twitter to facilitate collaboration between scientists in developing countries. 
To date there are 104 mentions of Twitter on PubMed, the primary research database for healthcare sciences. These range from using Twitter for monitoring outbreaks of H1N1 'swine flu' or for promoting sexual health, to helping senior healthcare professionals provide feedback for students.
The Cochrane Collaboration has published work reflecting on the potential of social media for disseminating the results of biomedical research and for providing up-to-date clinical information to healthcare providers. 
And some groups are exploring the use of social media in peer-reviewing research , based on their immediacy of interaction and potential to reduce costs.
There are lessons to be learned from other knowledge-generating, self-correcting communities, such as Wikipedia, regarding the mutually beneficial altruism and status that drives much social networking, and the transparency and accuracy created through visible, 'open' review.
But the positive, innovative uses of social media are not without drawbacks. They are open to abuse, as in the case of using Twitter to circumvent the traditional regulatory frameworks that aim to control direct-to-consumer advertising by pharmaceutical companies.
Better, faster, cheaper
One exciting step forward would be to exploit the connectedness of social media for crowd-sourcing solutions to biomedical research questions almost in real time.
Unnecessary duplication of research is widespread in Western science, and competition for funds and publications risks breeding a culture of secrecy between scientists eager to protect their ideas.
This is potentially problematic. But in developing countries, where resources are scarcer and research results are more critical to saving human lives, there should be even greater demand for a streamlined model of scientific cooperation.
Traditionally, we have had to wait for a meeting of national research councils to define research strategies. But if we could shift to decentralised decision-making through freely circulating information in a non-hierarchical network, the community could understand — and perhaps jointly set — research priorities with greater expediency.
Likewise, we often rely on a serendipitous meeting with like-minded researchers at a conference. Or worse still, a scientist may wait several years for the publication of their research only to discover that they have worked on the same questions as someone else, with the same results and the same shared problems.
But by leveraging the global nature of media such as Twitter, with a large audience and well-defined interest groups, individual scientists could find local collaborators working on similar problems with greater experience in specific areas of their work.
By eliminating reams of redundancy from the scientific process, scientists in developing countries may be able to conduct research that is faster, better targeted to real problems, and has less duplication. And in the end, they could disseminate their results more efficiently.
In his book Turning the World Upside Down, Nigel Crisp reflects on the extent to which Western healthcare systems with unwieldy bureaucracies can learn from the evolution of avant-garde healthcare systems in resource-poor settings where need begets innovation. Perhaps the same can be true of science.
Alexander E. T. Finlayson, Katherine E. M. Hudson and Faisal R. Ali are affiliated with MedicineAfrica, a social enterprise providing a platform for healthcare educational and research partnerships between Northern and Southern collaborators.
 WHO's role and responsibilities in health research — draft WHO strategy on research for health [108kB] (WHO, 2010)
 Ali, F. R. & Finlayson, A. E. T. Tweet to collaborate with poorer nations. Nature 475, 455 (2011). doi: 10.1038/475455d.
 Sud, V., Ejaz, K., Fedorowicz, Z., Mathew, M. & Sharma, A. Cochrane: spreading the message of research to students and juniors. Cochrane Database Syst. Rev. ED000026, doi:10.1002/14651858.ED000026.
 Mandavilli, A. Peer review: Trial by Twitter. Nature 469, 286 (2011). doi: 10.1038/469286a