A new open-access journal from South Africa offers a sustainable model to amplify research from low- and middle-income countries and rebalance global health knowledge.
More than 80% of the world’s population lives in low- and middle-income countries (LMICs). Yet high-income countries (HICs), that account for only 10% of the global disease burden, produce approximately 80% of medical research publications [1]. In 2016, only 3.2% of scientific research originated from Africa [2].
This imbalance has far-reaching consequences. It shapes which health problems are studied, whose questions are prioritised, how clinical guidelines are developed, how health systems are designed and ultimately how patient outcomes are improved, not only in LMICs but also in HICs.
South African specialist trainees are required to complete a Master of Medicine research dissertation as part of training. A minority of these dissertations are ultimately published [3]. This represents a major loss of locally generated knowledge and a missed opportunity to inform clinical practice, health policy and future research. Similar patterns are seen across many LMICs, where valuable clinical insights fail to reach the global literature.
"Without alternative funding models, open access publishing risks replacing one form of inequity with another, moving barriers from readers to authors and further marginalising research from most of the world"
Clinicians and researchers working in LMICs face multiple barriers to publishing their work. The Journal of the Colleges of Medicine of South Africa (JCMSA) was established to address this inequity and to provide a practical, sustainable model for equitable dissemination of research from LMICs.
Structural barriers to publishing from LMICs
Several barriers limit LMIC participation in global medical publishing. Editorial and geographic bias may frame LMIC research as of limited relevance to readers in HICs. This perception persists despite the reality that most medical journals are now accessed online using keyword searches and consequently have global readerships.
Open access publishing has transformed scientific communication by removing paywalls for readers, increasing visibility of research, and accelerating knowledge transfer. For clinicians, educators and trainees in LMICs, open access is often the only feasible way to access current literature. However, the shift to open access has transferred costs from readers to authors through article processing charges (APCs). In otolaryngology, APCs average around USD 2500, while some journals, such as Nature, charge APCs exceeding USD 12,000 [4]. These costs are prohibitive for trainees and academics in LMICs [5].
Without alternative funding models, open access publishing risks replacing one form of inequity with another, moving barriers from readers to authors and further marginalising research from most of the world. Addressing this paradox requires rethinking how journals are owned, funded and governed.
The CMSA and its mandate to share knowledge
The Colleges of Medicine of South Africa (CMSA) celebrated its 70th anniversary in 2025. It is the apex body for medical and dental specialists in South Africa, comprising a membership of more than 12,000 diplomates and specialists across all medical and dental disciplines. The CMSA operates as a non-profit organisation and conducts national unitary examinations, conferring approximately 3000 diplomas, fellowships and subspecialty certificates annually.
Beyond assessment and certification, the CMSA’s mission commits it to promoting excellence, ethical practice and professional conduct “for the benefit of humanity.” Embedded within this mandate is a responsibility to support the generation of research and, critically, to ensure that this research is shared globally.
Launch of JCMSA and early performance
Launched in July 2023, the Journal of the Colleges of Medicine of South Africa is a digital, fully open-access, peer-reviewed journal spanning all medical, surgical and dental specialties. It was established as a joint initiative between the CMSA and South African universities, with shared ownership between the CMSA and its publishing partner, AOSIS.
The aims of JCMSA are to showcase high-quality research from South Africa, Africa and other LMICs; provide a publication pathway for registrar MMed research; counter structural bias against LMIC scholarship; and expand global publishing capacity without reliance on commercial, profit-driven (predator) models.
The journal’s early performance has been notable. JCMSA is already listed in the Directory of Open Access Journals (DOAJ) and indexed in PubMed, confirming that its editorial governance, peer-review processes, and publishing standards meet internationally recognised benchmarks. For a young, LMIC-based, multispecialty journal, these milestones represent a significant achievement and have rapidly enhanced the journal’s credibility and visibility.
Articles published in JCMSA demonstrate strong download rates, with readership distributed across high-, middle- and low-income countries worldwide. This global reach highlights the journal’s role in enabling equitable access to clinically relevant research and amplifying LMIC voices within the international medical literature.
Challenging entrenched publishing paradigms
JCMSA questions several long-standing assumptions in academic publishing. While specialist and society journals remain influential, most clinicians now discover research through keyword-based searches using platforms such as Google Scholar rather than by browsing journal titles. In this environment, discoverability, accessibility and clinical relevance increasingly outweigh journal brand recognition.
"This global reach highlights the journal’s role in enabling equitable access to clinically relevant research and amplifying LMIC voices within the international medical literature"
Similarly, the dominance of journal impact factor as a proxy for quality is being reassessed. In the era of open access, the influence of research may be better evaluated using article-level metrics, download data, altmetrics, citation patterns and evidence of uptake into clinical practice and health policy, rather than reliance on impact factor alone.
Ownership and funding models
A defining feature of JCMSA is its shared ownership model. Unlike many established journals that are owned outright by large commercial publishers, JCMSA is jointly owned by the CMSA, a non-profit professional body, and its publishing partner, with shared control over editorial policy and APC structures.
JCMSA operates as a Diamond Open Access journal, ensuring that the ability to pay is never a barrier to publication, a matter of social justice. To support this model, the CMSA established an APC Waiver Fund with an initial endowment target of USD 1.2 million. Investment returns from this fund are intended to cover APCs for approximately 120 articles per year at no cost to authors. To date, USD 900,000 has been raised from industry partners, foundations and individual donors, providing a strong foundation for its long-term Diamond Open Access sustainability.
Supporting authors and building capacity
Recognising the limited access to research mentorship and writing support in many LMIC settings, JCMSA introduced an Author-Assist Program. This initiative pairs early-career authors with experienced researchers to strengthen manuscripts prior to peer review, while simultaneously building local research and publication capacity.
In addition, the CMSA established the Professor Bongani Mayosi Award, honouring his legacy of clinical excellence, leadership and commitment to Africa-focused research. Awarded annually for the best article led by a diplomate, registrar or subspecialist in training, the award reflects the journal’s commitment to nurturing the next generation of clinician-scientists.
Conclusion
The Journal of the Colleges of Medicine of South Africa demonstrates that equitable academic publishing is both possible and sustainable. By rethinking ownership, funding, metrics and mentorship, JCMSA offers a credible model that aligns scientific excellence with social responsibility.
In a world where most patients live in LMICs, the future of global health depends on ensuring that those closest to the burden of disease are central to generation and dissemination of research, not only as a matter of equity, but for meaningful and lasting health progress globally.
References
1. Yegros-Yegros A, van de Klippe W, Abad-Garcia MF, Rafols I. Exploring why global health needs are unmet by research efforts: the potential influences of geography, industry and publication incentives. Health Res Policy Syst 2020;18(1):47
2. Nabyonga-Orem J, Asamani JA, Olu O. Why are African researchers left behind in global scientific publications? – a viewpoint. Int J Health Policy Manag 2024;13:8149.
3. Grossman ES. Publication rate of 309 MMed dissertations submitted between 1996 and 2017: Can registrars fulfil HPCSA Form 57 MED amendments? S Afr Med J 2020;110(4):302–7.
4. Kim EK, Shrime MG. Cost of open access publishing in otolaryngology–head and neck surgery. World J Otorhinolaryngol Head Neck Surg 2022;9(4):352–6.
5. Seguya A, Salano V, Okerosi S, et al. Curr Opin Otolaryngol Head Neck Surg. 2023;31(3):202–7.
Declaration of competing interests: None declared.
Johan Fagan will be giving a keynote address on this topic at IFOS 2026 in Istanbul, Türkiye, in September. For further information visit: https://ifosistanbul2026.org/en/
