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The Hesperian Digital Commons: Field-testing & the Nonprofit Publisher

There are almost as many ways of doing nonprofit publishing as there are nonprofit publishers. One nonprofit publisher, Hesperian Health Guides, recently launched its new Digital Commons, and while this project has challenges of its own, Lizzie LaCroix explains the ways in which the Commons are just the logical extention of Hesperian’s commitment to being connected with–and listening to–its audience at every stage of content-creation.

by Lizzie LaCroix


Chances are if you find yourself in an emergency medical situation, the first
thing you do is call 911. But what if you lived somewhere 911 wasn’t an option? Where the only hospital—or even clinic—was hours away by foot? For many people the world over, medical care is far away, prohibitively expensive (insert joke about American health care here), or simply inadequate. In such places, having knowledge about how to diagnose, treat, and prevent common medical conditions can mean the difference between life and death.

Since the early 1970s, Hesperian Health Guides has been developing, publishing, and distributing books in English and Spanish for this kind of primary health care. Starting with our flagship book Where There Is No Doctor, Hesperian has created a library of titles that include information on dentistry, maternal health, midwifery, the health of disabled women and children, and environmental health.

There are many unique ways in which Hesperian approaches publishing. First, as a nonprofit, Hesperian is entirely mission-oriented. Our resources are not only meant to inform—they are meant to empower and inspire action. In addition to solving their own or their families’ health problems, Hesperian readers are also encouraged to understand and address the social and economic root causes of poor health.  Although there are challenges to funding this mission (some of which will be mentioned later), the effectiveness of Hesperian’s publications is measured solely by the extent to which they empower individuals to act on their right to health.

The effectiveness of Hesperian materials is due to an extensive process of global field testing, in addition to verification of medical information: each chapter of each book is sent to community health groups in different parts of the world for comments and review. Because the end users are included in the book development process, it ensures that the content is understandable and relevant to the needs of the poorest, most marginalized, and most rural populations.

Sometimes the feedback is linguistic: “we don’t talk like that, nobody will understand what you mean.” Sometimes it is medical: “we have another solution to malnutrition in my village: people eat beetles for protein.”  Sometimes it is critical of the text and presents new philosophical angles. Comments are collected by Hesperian writers and editors, and the text is revised to reflect this new information.

Second of all, our open copyright policy means that our books can be freely copied and adapted in any region of the world. We have a network of translation partners who translate books into local languages, and often also adapt the illustrations to be more relevant to the community around them.

An example image from Hesperian Images

The first truly global field testing experience happened in the late 1990s, when Hesperian expanded upon its method of “field testing” during the book development process of Where Women Have No Doctor.  Chapters of this book were mailed (by post!) around the world for feedback.  All communication was done by letter.  Jane Maxwell, the lead on that project and currently the editor of Hesperian’s book A Community Guide to Women’s and Girls’ Health and Empowerment, often marvels aloud at how much field testing processes have changed since then. Today, she e-mails chapters of A Community Guide to countries as far-flung as Pakistan, Mongolia, Lebanon, Guatemala, and Zambia, and sometimes receives answers within a few hours!

As the twenty-first century  hurtles onward, Hesperian has taken our “open copyright” to the next level in the digital age. All of Hesperian’s titles are available for free download on our website, and we are currently in the process of making many of our translated materials available as well.  Currently there is information in 26 languages, including 10 pages that can be navigated bilingually (several of which feature both left-to-right and right-to-left languages on one page, a technical feat that took a lot of time and effort). The Hesperian Digital Commons also includes a tool for editing and adapting Hesperian source text, and the Hesperian Image Library, where users can search and download from among Hesperian’s 10,000 unique images.

Additionally, we are proud to have a pilot of a mobile phone application featuring information for maternal health, which we plan to use as an example of how to turn book content into navigable mobile phone All of this innovation raises some interesting challenges for Hesperian. How can we continue to make this information available for free, while still being able to afford to develop new books? As a nonprofit, we benefit from fundraised income, but since the launch of the Hesperian Digital Commons, book sales have faced significant challenges. The question is not a new one: why would people pay for content that they can access for free? Because of Hesperian’s mission to get health information to everyone who needs it, a simple pay wall won’t solve the problem. This vital information must be available for free to people who cannot afford it.

Hesperian’s advantage is specialized, very high-quality content. The extensive field testing that goes into the development of our resources mean that they stand out from other primary health care information because they are designed by the very people who need and will use it. Although we face challenges in creating a revenue stream for our digital tools, the multi-lingual, user-developed content that we make available via flexible digital platforms is one example of how a publisher can stay relevant to the needs and expectations of modern readers.


Lizzie LaCroix

Lizzie LaCroix graduated from Pomona College with a degree in Asian Studies. She works at Hesperian in Berkeley, California, doing fundraising and communications. For personal reading, she prefers her books in hard copy, but as an amateur linguist she gets great enjoyment out of scrolling through Hesperian’s multi-lingual resources (even ones she can’t read).

One Trackback

  1. […] HarperOne, an imprint of HarperCollins that focuses on health, wellness, and spirituality, has their office in San Francisco’s financial district, just a few blocks from the Bay. Ignatius Press, publisher of popes and Catholic theologians, is based in an area of San Francisco known as Inner Richmond, right next to the northeast corner of Golden Gate Park. Just across the Bay in Berkeley, next to the Marina, is Counterpoint Press, a combination of three independent presses: Counterpoint, Shoemaker & Hoard, and Soft Skull Press. All imprints publish fiction and nonfiction, and Soft Skull also publishes graphic novels. Hesperian Health Guides is a nonprofit that’s been working for 40 years to commission, translate, and distribute health-education books and print/digital media for areas of the world with limited healthcare access… […]

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