Nigeria's health sector ties reform agenda to IT

His left legs were swollen when he was admitted that
night at one of the federal government hospitals in
Kaduna back in 2002. They could not find his medical
file, though he had been admitted twice at that same
hospital in the last one year. Yusuph Hamza had a history of Osteomylitis, a wasting disease of the bones. But there was no record for the doctor to work on that night neither was there any evidence to show that he had been treated for the same health condition at no less than four private hospitals and three government health institutions apart from the one into which he was admitted that night.

 

In fact that admission would be his fifth. But there was no record to prove this. The medical team that worked on him had to depend on the oral testimony of
Hamza with his family. He was operated on in the early hours of the morning to free his muscle of pus. That surgery would be the fifth and the only evidence were
the scars of earlier operations. And even then, they could not tell more than the physical eyes could see. Yusuph had no medical history that could be regarded
as authentic.

His story is not an isolated case. It is the norm in
Nigeria’s health sector plagued by a mix of factors
including absence of support infrastructures, a
depleting bank of medical experts, inadequate drug
supply as well as abundance of fake drugs,
insufficient funding further undermined by
multi-digits inflation, and little usage of IT.

But that would soon become history. That is if the
reform agenda woven round the deployment of IT in the
health sector is fully implemented. Work is to begin
within six months.

Under the new deal, tagged ‘Health Sector Reform
Agenda’ are plans to have a single databank for all
public health institutions in which case information
on patients like Hamza could be retrieved and acted on
in Port Harcourt, over 900 kilometers away, by just a
simple mouse click. The data would include texts and
graphical images such as X-ray and real life pictures.

The same IT structure would facilitate video
conferencing within the health sector, between
Nigerian medical experts and their foreign
counterparts, and telemedicine to enable serious
health cases to be addressed locally using foreign
technical resource, particularly in remote areas where
medical expertise is lacking.

The health sector, which had suffered neglect for
decades, has been undergoing a lot of reforms since
Nigeria’s civilian government took over power in 1999.
But the blueprint for access and uses of IT would
radically impact on it more than any other plans that
have been drawn up by the government.

The health reform agenda for IT deployment was adopted
last year in Yenagoa, capital of Bayelsa State by the
national Council of Health (NCH). It is to go before
the Federal Executive Council (FEC) this year. Once
approved by the FEC, it is entitled to budgeting from
government and external funding sources. [Related
report on Lagos State in print version]

Funding
The project is expected to consume over 100 million
euro at the first instance. Government would offer
financial support but the bulk of the expenses is
coming from external sources notably from the World
Bank, Canadian International Development Agency (CIDA)
and the German Aid Cooperation agency (GTZ) all from
which the ministry has been exploring potential for
support for its IT blueprint.

Funding would be channeled through The Health Systems Development Project (HSDP), a financing instrument, co-financed by the World Bank and the African Development Bank (ADB), to assist the Nigerian health authorities in their efforts to redress the serious deterioration in the delivery of basic health care services following decades of neglect.

Part of the objectives of the HSDP aims at building the national health systems capacities to respond to existing weaknesses, challenges, and opportunities that could significantly improve performance of the health system at all levels. The IT initiative falls within this bracket and has been enthusiastically received by most senior health officials.

It is envisaged that a new data flow would be put in place to collapse, streamline and consolidate the existing flow patterns and provide a clear mechanism for shared access. The new scheme is designed to create information crossing points that would support the National Health Management Information System (NHMIS), e-learning centre, e-hospital and eventually telemedicine.

The Architecture
 

The project is broken into three broad components namely the software components, the hardware components and the capacity building components. The key focus areas for the software, applications and resources components include business processes; back-end applications; front-end applications; ICT capacity; workflow; licences and usages; support; and security. The software component would drive the FMOH administration processes including e-Messaging, human resources and administration, payroll & accounting, and supplies/assets management among others.

The software infrastructure is designed to support the business processes within the FMOH and replace the existing tradition of information interchange carried out on a hard copy basis using files and memos. All the seven departments and five independent units within the FMOH interchange information on a daily basis. Once the LAN-enabled software solutions are deployed, data interchanged would become software driven enabling faster decision-making process within the ministry.

The departments include finance and supplies, personnel management, health planning and research, public health, community development and population activities, hospital services department, and food and drug services. The units are internal audit, public relations, legal federal vaccine production laboratory division, and special projects.

The FMOH is particularly keen to introduce a telemedicine programme, in some locations, that would span pre-diagnosis to online prescription. The key goal of the telemedicine project is to provide cost effective and timely medical care through strategic application of telecommunications and e-Health technologies particularly top remote locations where physical presence of a medical team seems most unlikely. Nigeria’s over 957,000 sq kilometres landmass is still an unconquered terrain to health workers.

The telemedicine scheme envisages the use of telecommunication technologies to transfer CT scan, MRI, Ultrasound images, Pathology reports, endoscopic video images and other procedures. The process would encompass patient live interviews and examinations, consultation with medical specialists, health care and educational activities through video conferencing.

In all, the telemedicine solution would offer capabilities that include tele consultation, tele diagnosis, tele education, tele training, tele monitoring and tele support built on the physical telecom links of a LAN, VSAT, ISDN, leased lines and Internet.

Training
The revolution in health care information management would of necessity entail the training of over 100,000 health workers in the country’s health sector. Health care information systems are complex and process changes at one point may have unexpected complications at another. Therefore, training is considered very important. Part of the implementation process includes capacity training for all categories of staff to be done in phases. Targets include the minister, overall boss of the sector, the permanent secretary, and director generals among others. Training is to be streamlined in accordance with the specific work schedules of the staff.

Specifically, identified members of staff would be required to train in the selected application package. Training rooms would be networked and have access to a training “dummy” database with test data. This process, as stated in a draft by the ICT Committee set up to draw up an IT implementation blueprint “has, in our experience, been invaluable not only in the areas of user education – but to test and refine the HMIS software.” The donor agencies are expected to feature prominently in this area. The CIDA had, for instance, provided initial training support through the SIMP programme to articulate a workplan for ICT deployment in the health ministry. The Canadian agency has been more forward in expressing its commitment to reform initiatives in the health.

Print version available in July/August 2004 edition of IT Edge Magazine…..

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