Health
The State of E-Health in Nigeria: A Journalistic Exploration of Growth and Challenges
“When we first introduced electronic medical records (EMR) in the hospital, there was serious resentment by the staff, to the extent there were even attempts to burn down the system.
”That was the Clinical Director of Garki Hospital, Abuja, Nigeria, Dr.
Kenneth Ityoh, recalling the initial challenges that the Management faced when a new order of doing things was introduced.Those who tried to burn down the server to circumvent the deployment of the EMR system were “among those that were benefitting from the existing loopholes to steal the hospital’s funds.
Some staff were printing cash receipts and collecting money without remitting same to the hospital’s account,” he explained in an interview last week.Ityoh, a renowned Orthopedic Consultant, also recalled that within the first month of the introduction of the EMR, the hospital’s overhead cost dropped by about 80% because through the system, lots of costs were saved, as most of the financial leakages were blocked.
Benue State University Teaching Hospital, Makurdi
Investigation by NATIONAL ACCORD revealed that corruption among Nigerian health workers – both in the public and private sectors – constitutes one of the major challenges affecting the full-scale adoption of electronic delivery of health care services (also known as e-health) in the country.
Igbo Gabriel Alobo of the Mental Health Department, Jhpiego (an affiliate of John Hopkins University, Nigeria field office) and 5 others (Tolulope Soyannwo, Godwin Ukponwan, Simon Akogu, Abubakar Matthew Akpa and Kazeem Ayankola) had last year, studied perspectives on the pioneering work of Electronic Health Recording (EHR) system in Nigeria with the objective to determine health workers perception, challenges, motivation and satisfaction with EHR.
Although the evolution of this healthcare practice that is supported by electronic processes and communication dates back to 1999, according to Vincenzo Della Mea (a Professor of Medical Informatics at the University of Udine, Italy), it was only in October 2013 that Lagoon Hospitals made news as the first health institution in Nigeria to invest in an electronic system for keeping patients’ medical records.
According to findings, while the EMR system, which Lagoon hospitals deployed in 2013 can be regarded as a hospital and clinic management software that makes it possible to run core financial, clinical, and operational processes, the term “e-Health” refers not only to “Internet medicine” but also almost every activity related to computers and medicine.
Chief Operating Officer (COO) of the hospital, Dr. Naseem Mohammed, said during the launch of the system in 2013 that the EMR would allow Lagoon Hospitals to “create a unique database of all patient’s medical and critical information such as medical history, future appointments, current medications and allergies.”
Kogi State Specialist Hospital is one of the few health centers in Nigeria operating an integrated electronic health record system. The system makes it possible for ongoing consultations to be accessed by other sectors of the hospital, real-time. Kogi State Ministry of Health (SMOH) which regulates health practice in the state has an objective of strengthening the Health Management Information System (HMIS).
At the Garki Hospital Abuja, both Dr. Ityoh and the Head, Information Technology Unit, Mr. Stephen Ayoola Ojokuku, told NATIONAL ACCORD that e-Health was deployed in phases due to the high cost.
The National Hospital Abuja, touted as the best equipped medical facility in Nigeria, has also deployed an IT-based system to enhance operations. It is called health in a box, according to the hospital’s Chief Information Officer, Muhammad Gidado.
“We have the health in the box application which is good. It cuts across all major aspects of the hospital such as record visit, consultation, laboratory investigations and results and prescriptions, “Gidado told NATIONAL ACCORD this week.
In Benue State, Middle Belt region of Nigeria, both the state government and Benue State University Teaching Hospital (BSUTH), Makurdi have integrated ICT into health service delivery.
Commissioner for Health in the state, Dr Joseph Ngbea, told NATIONAL ACCORD last week that they have developed software and deployed health personnel to the local governments, provided them with laptops and tablets to enable them monitor and report some of the common health issues like cholera, Covid-19 and any outbreak in those localities to their Central Collecting System in Makurdi. “We have done so for other ailments including HIV/AIDS”, he said.
The Chief Medical Director of BSUTH, Dr Terrumun Swende, however, describes what the teaching hospital has for now as rudimentary. “For instance, in the NHIS clinic, we have deployed some of that. That is what we are using for our complex billing and a whole lot of things. If you come to our finance, we have some of those ICT solutions that help us in certain areas” he told NATIONAL ACCORD two weeks ago.
“With the Nigerian government’s declaration that the nation cannot afford one doctor to 600 patients’ ratio, many believe that only e-Health can come to the rescue, given its immense potentials as highlighted by experts”
According to the Minister of Labour and Employment, Chris Ngige, Nigeria is unlikely to meet the recommendation of the UN and WHO ratio of one doctor to 600 patients.
In the area of drugs, Aligs Pharmacy & Stores, Abuja, has introduced technology to its business to change the way people receive their medications by ensuring that residents of Nigeria’s capital do not have the need to be physically present at a pharmacy before they can get their drugs or consult a pharmacist or even see a doctor.
Managing Director of the venture, Mrs. Ngozi James, told NATIONAL ACCORD the objective was to expand the role of the pharmacy as a primary care provider by giving Abuja residents easy access to drugs through online shopping and online drug information services.
This is, however, coming 10 years after the Lagos University Teaching Hospital (LUTH), in collaboration with Pfizer, introduced e-Pharmacy services in Nigeria with an installed Health Information System (HIS).
Country Manager, Pfizer, Dr. Enrico Liggeri, had explained during the official launch of the facility in 2011 that Nigeria was selected as the target country for the e-Pharmacy pilot project given the concentration of the largest high-risk patient populations as well as its complex and overstretched healthcare system.
At the Princess Medical Centre, Port Harcourt, Rivers State, South-south Nigeria, where e-health is practiced, the Founder and Chairman, Princess Medical Centre, Dr Emi Membere-Otaji, told NATIONAL ACCORD, “we have automated systems that connect to some of the best medical centres in the world especially Dubai and the UK. This way, our patients get same standards they would have got if they flew out.”
Benefits of E-Health
ICT has had a very positive development in most sectors of human endeavors, including the health sector, and as observed by Dr Swende of BSUTH, Makurdi, there is a wide range of applications of ICT that can enhance healthcare delivery.
For instance, he said, “if we were in a more developed country, booking to see a doctor can be done online as long as it is not an emergency situation. When you come to the hospital setting proper, one of the major advantages of ICT is what is called EMR where people can walk into the hospital just the way you walk into a bank and transact their business using credit/debit card or ATM card. This can also be done in the hospital too when you come in, as far as you are registered, you do not need to join long queues to get the physical paper records.”
According to Ojokuku, the analysis of data from an EMR can alert the medical personnel of rise of communicable disease cases based on demographics and if residential address of patients they are seeing come from high-risk areas.
Gidado of the National Hospital Abuja says e-Health has been very beneficial in the sense that “the system protects the hospital from losing money from likely corrupt practices and it helps the patients from getting victimized also.”
Dr. Swende believes that if the entire country is running with ICT or e-records, when one travels to any part of the country, such person’s medical records can be easily accessed on demand.
Yet another benefit of e-Health can be found in the aspect of e-consultations, where the patient is in a distant town and the medic is giving treatment from a very different location through video conference call.
Garki Hospital Abuja is a good example of how e-Health can enhance efficiency in any aspect of the hospital with proper deployment of ICT software, including management of human resources and also payment of salaries, all of which can be very simple and straightforward, instead of the long tedious method they deploy presently.
The inventory management in stores can also be made easy with e-Health. As both Dr. Ityoh and Dr Swende explained to NATIONAL ACCORD, as you buy like 3000 drugs, you save them up in the system and so with each one you dispense, the system tells you what is left until you reach a critical level where the computer will remind you that this drug will be out of stock soon hence, you have to re-order. The same software can help you take note of expiry dates of each drug you have over the counter like some of these big hospitals.
Challenges of E-Health in Nigeria
While Alobo identified the challenges faced in the deployment of e-Health in Nigeria as low manpower, infrastructure, inadequate financing, inadequate political will and poor knowledge of computers and IT for health recording, there are other little but highly significant obstacles to the spread of e-Health practice in the country.
Doctors and other Health Workers
Dr. Ngbea believes that the challenges currently being faced in the deployment of e-Health in Nigeria are surmountable with time, there are, however, several challenges, the first being even where the ICT solution is on ground, not many doctors and other health workers are able to access or apply them.
Outlining the challenges of e-Health, Alobo said that electronic health record “falls short of being accepted by all cadres of the medical profession,” adding that one of these is “the charting of patients’ information by nurses and the inability to describe peculiar clinical findings on ready-made templates.”
Finance
Findings by NATIONAL ACCORD showed that most of the challenges facing e-Health in Nigeria border on finance because the whole process is capital-intensive.
For instance, after installing the EMR software, the management of BSUTH Makurdi realized that most of the staff on ground were not ICT compliant and it meant doing a lot of training to get them on board.
“We needed to make substantial expenses especially at the initial stage to be able to move,” according to Dr. Swende, who mentioned the need to deploy “either tablets, desk tops or laptops at every point pen and paper were used, and they come with a huge cost”.
Garki Hospital Abuja, as learnt, invested about N30 million (about $72,000) for software development or licenses and support, then probably between close to N15million (about $36,000) for the infrastructure.
This explains the inability of the Federal Medical Centre, Makurdi to start consultation with its patients on the portal it created, according to the Chief Medical Director, Dr Peteru Suega Inunduh.
Poor Internet Connectivity
While Alobo was the first to identify internet services and power outages as some of the problems encountered in the attempt to use the electronic health record, Dr Inunduh of the FMC, Makurdi also expressed concern about the poor connectivity.
Manpower
One of the major challenges faced by National Hospital Abuja was manpower. According to Gidado, “it was pretty difficult getting the right manpower and deploying relevant system in an organization.”
Benue State, according to Dr. Ngbea, also faced the same challenge as National Hospital. “First, many of the health personnel we have are not computer literate. So embracing ICT has been a challenge” said the Commissioner for Health.
The story is the same at the BSUTH Makurdi where Dr. Swende recalled that after managing to install the EMR software, the hospital got stuck. “Part of the challenges we had was one, most of the staff on ground were not ICT compliant”.
“FMC too has the challenge of low ICT compliance level by staff. However, we are carrying regular in-house training for practitioners to address the challenge,” said Dr Inunduh.
Corruption
Another challenge is that of stealing. In a number of the healthcare centres visited, there were complaints that when the needed tools for e-health are provided, some people use it for themselves like selling the gadgets or use it for other personal purposes.
A staff in the Accounts unit of one of the Federal Medical Centres who spoke on condition of anonymity for fear of victimization, intimated NATIONAL ACCORD last week that funds budgeted every year for deployment of EMR and other e-Health components have always been “diverted and shared by certain people in this hospital” It was not clear how many government health institutions are in this same mess.
Epileptic Power Supply
Power outages in Nigeria have remained one major problem encountered by many sectors in the country, particularly manufacturing, health and food processing.
Disposition of Patients
The disposition of patients was another challenge encountered by National Hospital Abuja when the IT-based system was deployed. As Gidado recalls, it was initially not easy “getting the target audience to accept the new system.”
Possible Solutions
Dr. Ngbea suggests that two things need to be done, one of which Benue State is already doing. The first step is “constant training and retraining of staff” while the other is “public enlightenment so that people will change their disposition towards government property because as the Commissioner, I cannot always be on ground to effectively monitor the situation”
The training, according to the Chairman of the Medical Advisory Committee (CMAC) of the hospital, Dr Sa’id Abubakar, was to make them be compliant with the electronic health (e-health) practice for service delivery.
In the oil producing Rivers State (Niger Delta region), the consulting firm, CINFORES, led by Ibifuro Asawo, working to automate the services of the Government in a scheme called e-Governance policy, told NATIONAL ACCORD last week that healthcare delivery would be automated, adding that the early stage is to get the transactions and financials captured on digital platforms.
The author is the Editor-in-Chief, National Accord
UNICEF has issued an urgent appeal for nearly $59 million to support efforts to halt the rapid spread of mpox in six African countries including Burundi, where youngsters have been impacted the most.UNICEF Regional Health Advisor for Eastern and Southern Africa,Dr Paul Ngwakum diclosed this to journalists in Geneva on Friday.
“Children in Burundi are bearing the brunt of the mpox outbreak with alarming rates of infection and health impacts. “Of the nearly 600 reported cases, two-thirds are children under 19 years old and the situation is escalating really rapidly with more than [a] 40 per cent increase in cases over the last three weeks,” he saidTo date in Burundi there have been more than 14,000 suspected cases but no reported deaths from mpox. Neighbouring Democratic Republic of the Congo, however, has seen nearly 21,900 suspected cases and 717 deaths. The UNICEF official insisted that with funding and prompt action in Burundi, “we have an opportunity to end this outbreak in a very short time period because the geographical area is kind of limited and with concerted effort from all partners.”I think, we can limit the spread; we can contain the virus so we can stop the outbreak without any loss of life.” Following the start of the school year earlier this week in Burundi, the UN agency remains concerned about the rise of mpox among children under five years of age, who represent 30 per cent of reported cases – as in DRC.To help teachers and parents understand the risks and minimisze disruption, the UN agency has supported the education authorities to implement health measures in schools.This is train staff to recognise early symptoms of mpox and reinforce hand hygiene. “Make no mistake, we don’t have all the answers. No one does. This is a rapidly evolving situation, with a new, infectious strain.”We are learning more every day about different modes of transmission.”And with more information, we update our messaging and our response,” Ngwakum said.The UNICEF appeal will also provide mental health support for parents and front-line workers who may face hostility from some communities in part.This is because of the association of mpox with sex, which is responsible for some transmission – but by no means all of it.He said, “Sex in Africa is not something that is spoken of on a daily basis. And if they think you are having a sexually transmitted disease, it stigmatizes you as well.“We try to explain that this is not the case. Most children have it from body-to-body contact or contact with animals or contact with infected materials, which is not having anything to do with human-to-human sexual contamination.”Communities also remain fearful of a repeat of previous serious health outbreaks such as Ebola or COVID-19, “so there is an important role we are playing to dispel myths, and calm fears”, the UNICEF official explained.Highlighting the stark contrast between the high number of suspected deaths from mpox in DRC and Burundi, Dr Margaret Harris from the UN World Health Organization (WHO) explained that this was likely owing to the longstanding humanitarian emergency in eastern DRC.“Many of the children whom we’ve seen horribly, sadly die in the Democratic Republic of Congo were very immuno-suppressed.”This was through being severely malnourished and having suffered the effects of conflict and perhaps also having other diseases at the same time,’’ she said (NAN)
As Mpox continues to devastate countries, especially in Africa, the WHO Africa Region says African countries are capable of diagnosing Mpox, thereby making for early detection.
Dr Abdou Gueye, Regional Emergency Director, World Health Organisation Africa Region (WHO AFRO), made the assertion in a virtual interview in Lagos.
Providing updates on WHO’s field efforts since the declaration of the mpox outbreak, Gueye said that WHO had been working effectively and collaborating with all entities to stem the public health emergency.
The Africa CDC declared Mpox a Public Health Emergency of Continental Security on Aug. 13.
On its heels, on Aug. 14, the WHO Director-General declared the resurgence of mpox to be a public health emergency of international concern (PHEIC), requiring a coordinated international response.
This was necessitated by the advice given by the International Health Regulations (2005) (IHR or Regulations) Emergency Committee regarding the upsurge of mpox 2024, during its first meeting held on Aug. 14.
It had noted that the ongoing upsurge of mpox in the Democratic Republic of the Congo and a growing number of countries in Africa, constituted a PHEIC under the provisions of the International Health Regulations.
Also, given the detection and rapid spread of a new clade of mpox in eastern Democratic Republic of the Congo, its detection in neighbouring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond.
Gueye emphasised the importance of early detection, robust health systems, and community engagement.
He said that some of WHO’s efforts included supporting diagnostic capabilities, treatment guidelines, and community engagement across African countries.
“All the African countries are capable of diagnosing mpox. Thanks to our work and collaboration with all the entities.
“We checked with all our countries. 45 countries out of the 47 were able to do the diagnostic and the genomic sequencing, and we were able to support the two additional countries.
“We also worked with the countries to develop guidelines on the treatment and the care about mpox, and also, we provided some reagents.
“ The treatment of mpox is very rare, but as soon as it is possible, we try to make it available to the African country
“In the framework of the Public Health Emergency of International Concern, we have raised the advocacy for all partners that are capable of donating or contributing to supporting countries, and are put in touch with countries that need it,’’ he added.
According to Gueye, WHO is also working to make sure that all manufacturers that can produce vaccine, diagnostic and therapeutic are being put in touch with those who can fund it.
This will enable enough production for Africa, particularly also for low and middle-income countries.
He said close collaboration was also ongoing with researchers, all to stop Mpox.
“We are working in close collaboration with researchers to make sure that all the vaccines, therapeutic and diagnostic that are in the pipeline will be accelerated.
“This is in order to diversify the possibility and the tools to fight against the disease,” he said
Giving an insight into the current outbreak, he explains Mpox to be a viral disease, previously known as monkeypox.
According to him, it traditionally existed in West and Central Africa, with two viruses that are slightly different.
“The one in West Africa was called the clade two, and the one in Central Africa was called the clade one in 2022.
“An outbreak occurred, and the virus went beyond the traditional border and went through to some countries where it was never seen before.
“It affected some particular communities, mainly men who have sex with men.
“And the outbreak was addressed by the international community, but also by the affected community, and it was controlled.
“What happened in 2024 is there is a new outbreak with a new strain that is different to the one that existed before, that usually was seen in DR Congo, but has a little mutation.
“That made it more contagious, but also more serious, because the mortality rate increased.’’
He said that the outbreak was localised initially in North Kivu and South Kivu in the Democratic Republic of Congo, spreading in Congo first but also in neighbouring countries, including Rwanda, Uganda and Kenya.
According to him, when the outbreak reached that level, the WHO D-G called for an emergency committee to advise him, and the emergency committee advised to raise the highest alert possible in public health.
“We say the public health emergency of international concern, which means to make sure that the international community will be mobilised.
“Also, the mobilisation will be coordinated in order to stop the outbreak before it becomes more difficult to control.’’
Report says that the multi-country outbreak of Mpox has led to 116 countries and territories in all WHO regions reporting 99,176 confirmed cases and 208 deaths between May 2022 and June 2024.
The latest global mpox rapid risk assessment at the beginning of August 2024, showed that mpox risk in eastern Democratic Republic of the Congo and neighbouring countries is high.
In Nigeria and other countries of West, Central and East Africa where mpox is endemic, it is moderate.
However, individual-level risk is largely dependent on individual factors such as exposure risk and immune status, regardless of geographic area, epidemiological context, biological sex, gender identity or sexual orientation. (NAN)
The Kaduna State Contributory Health Management Authority (KADCHMA) and the state chapter of the Nigerian Union of Pensioners (NUP), have signed a Memorandum of Understanding (MoU) on health insurance for its pensioners.
Speaking at the signing of the MoU on Monday in Kaduna, the Director-General (DG) of KADCHMA, Abubakar Hassan, said the benefits of the scheme for the pensioners were immense.
He explained that with the health insurance, pensioners would have access to health care services from any public or private health facility across the state without having to spend from their pockets.
With this, Hassan said, pensioners could receive the care they needed without worrying about the financial burden that often comes with accessing healthcare
services.
He disclosed that the annual premium for the health insurance scheme was N10,600, thereby making it affordable for the pensioners.
“This will facilitate access to quality healthcare to our pensioners, in line with the promises of governor Uba Sani’s administration to provide access to quality care through a state contributory health insurance scheme.
“As the State Health Insurance Manager, our objectives are clear. We aim to enroll more residents into the scheme to make healthcare more affordable and secure a
sustainable funding basis for our health facilities.
“We also seek to extend health insurance cover to poor and vulnerable citizens through the basic health care
provision fund, as well as enroll persons employed in the informal sector into the contributory health insurance scheme.
“Our ultimate goal is to build consensus
across the state for adopting contributory health insurance as the most affordable way to access healthcare in public facilities,”Hassan said.
He thanked the State’s Pension Bureau and the state chapter of NUP for embracing the scheme.
He urged other organisations, associations and bodies to follow suit and enroll their members in the social insurance scheme.
Also, the Chairman of NUP, Kaduna Chapter, Mr Aboman Ladan, said the MoU signing marked a significant milestone in their efforts towards ensuring that their members have access to quality healthcare without financial burdens.
“We believe that our pensioners deserve the best, and this scheme will go a long way in improving their overall well-being,”he said.
Ladan commended KADCHMA for their commitment to making healthcare affordable and accessible to all, while urging their members to take advantage of the scheme and enroll in the health insurance program.
Doing so, he said, the pensioners would live healthy and fulfilling lives, free from the worry of medical expenses.
Also, the National representative of the NUP, Ahmed Garzali, described pensioners as the most vulnerable, who were affected most by fuel subsidy removal.
He said the health insurance for their members in the state is a step toward addressing their out-of-pocket spending on health, while calling for sincerity of purpose and full implementation of the MoU.
Earlier, the state’s Commissioner for Health, Hajiya Umma Ahmed, said the collaboration between KADCHMA and the NUP marked a monumental step in the state government’s collective efforts towards ensuring the health and well-being of its pensioners.
Ahmed added that Sani’s leadership was instrumental in advancing healthcare initiatives that prioritise the well-being of every citizen, particularly senior citizens who have served the state with distinction.
She also said that Kaduna State Government recognised that the health of every citizen was a priority, which extended especially to its pensioners who have dedicated their lives to serving the state and nation.
By enrolling pensioners into the State Contributory Health Scheme, the commissioner said, they were taking proactive steps to safeguard the pensioners health and enhance their quality of life in retirement.
According to her, the contributory health scheme plays a critical role in reducing the financial burden of medical expenses, particularly for those in their later years who are often more vulnerable to health challenges.
“The Kaduna State Health Insurance Scheme is designed to provide comprehensive and affordable healthcare coverage, ensuring that no one, regardless of age or economic status, is left behind.
“The partnership between KADCHMA and the NUP is a strategic initiative that aligns with our vision of universal health coverage for all residents of Kaduna State.
“This MoU is more than just a document; it is a covenant that reaffirms our shared commitment to upholding the dignity and well-being of our pensioners.
”It symbolises our dedication to creating a health system that is inclusive, equitable, and responsive to the needs of every citizen,” she said.
She assured the pensioners that the government would implement the agreement effectively, while ensuring that the enrollment process is seamless, transparent, and accessible to all eligible pensioners.
“By doing so, we will not only fulfill our promise of providing quality healthcare but also demonstrate our commitment to the values of empathy, respect, and service,”Ahmed said.(NAN)
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