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
The Joint Health Sector Unions (JOHESU), University College Hospital (UCH), Ibadan,has suspended the strike it embarked on Oct. 25.The workers resumed work on Friday morning.The seven-day nationwide warning industrial action embarked upon by the unions was to press home their demands ofadjustment of Consolidated Health Salary Structure as was done with the Consolidated Medical Salary Structure sinceJan.
2, 2014 and implementation of consultant cadre for pharmacists in federal health institutions. Others are upward review in the retirement age from 60 to 65 years for health workers and 70 years for consultants, andpayment of outstanding salaries of JOHESU members in professional regulatory councils.The UCH JOHESU Chairman, Mr Oladayo Olabampe, said that the strike was suspended as directed by the national body.He explained that “the suspension followed an MoU signed between JOHESU national leadership and Federal Government.“The Federal Government asked for a maximum of six weeks counting from Oct. 31, to meet our demands.“Based on the MoU signed, the JOHESU National Executive Council met and resolved that the strike be suspended on Fridaynationwide.”According to him, JOHESU UCH is obeying the order, and workers have resumed work.Olabampe said that if the demands were not met after the six weeks, they would embark on an indefinite strike. (NAN)
By Laide Akinboade, Abuja
The Federal Capital Territory Administration, FCTA, on Wednesday, kicked starts the screening of over 250,000 Abuja residents on diabetes and hypertension, and also do referrals.Dr Adedolapo Fasawe the Mandate secretary of Federal Capital Territory Health and Environmental Services Secretariat (FCT-HESS, while declaring the one week screening open, in Abuja.
She raised alarm at the rate at which people slump and die of high blood pressure and diabetes, adding that these unnecessary deaths can be prevented by regularly checking your sugar level and your blood pressure. She lamented that diabetes and hypertension are two silent killers and noted that, North central has one of the highest number of diabetes and hypertension. And 40% didn’t know they have hypertension until they came across a program like this.According to her, “So, this is an initiative of all commissioners for Health in Nigeria; 36 states plus the FCT. I am happy to say here in the FCT, we have had several programmes similar to this. We had a medical palliative program whereby we gave people medicines for free, for whatever their ailments is for one month. So that the money they would have used to buy medicines, they would use for other things. And we encourage the Health Insurance Scheme, whereby you pay a token, if you can afford it and your healthcare is free for the year. Or if you are considered vulnerable or poor, you are registered for free.”Now, what motivated this, we started noticing that people were slumping and dying. The rate of non-communicable diseases is going high. We were focusing a lot on HIV, malaria, and tuberculosis. But all of a sudden, people are dropping dead, and older people who were otherwise healthy in the morning would slump in the afternoon. At post-mortem, we were realising that people had undiagnosed heart diseases, which is a complication of undiagnosed hypertension. Hypertension is a very treatable disease if caught early. Diabetes is a very treatable disease if caught early. Treatable in the sense that if you adhere to your doctor’s instructions, and take your medication, you will live a normal life”.She continued, “Out of every 27 Nigerians, one person is hypertensive, this is recorded. Now, we are trying to look for all these people, educate them, and give them medication, so that your quality of life, your output at work, and in the end, the GDP of the nation would be improved. Because with this RHA, we constantly look for ways to reach the people and touch them. And the essence of this program also is that people find it hard to leave their workplace where they get money, their markets, and their farms, to go to the hospital to check. “We are taking this project 10 million to the doorstep of people, where they live, where they work, where they play. We will be in every Area council, we will be in most chiefdoms and palaces, we will be in markets, we will be in places like this where most people aggregate, and the good news is, it will run for one week. If you can’t make it today, you will make it tomorrow. And I believe at the end of this, the saying ‘health is wealth’ will truly be understood. Without good health, we cannot enjoy the beautiful infrastructure that the FCT is putting up daily”.”This program is not only for those who are suffering from hypertension or diabetes. It is also for people who we find their results to be normal. When we find their results to be normal, our screening tool has some questions; do you smoke? Do you exercise? What is your diet like, what is your lifestyle like? If the result is normal, we will encourage you and teach you how to keep it normal. That means you have been doing something good.”For people we have found to have normal readings, we encourage them and teach them how to keep it normal. They are also a very integral part of this program. It’s called health promotion. Prevention is better than cure. We can learn from them what they have been doing, we can teach them to teach their neighbours how to keep their blood pressure and blood sugar normal. And if indeed within this secretariat, we are finding normal readings, the risk factors for high blood pressure include stress, sleeplessness, obesity, family history, and sedentary lifestyle. What it then means is that most of us here, do not fall into that. If you work for Barrister Nyesom Wike, it is not likely that you have a sedentary lifestyle”.The Acting Director of the FCT Health Insurance Scheme, Dr Salma Lawal Belgore also announced that the FCT will undertake the cost of health services for a pregnant woman, Mrs Esther Omojo, until a year after the birth of her baby. She explained that the insurance will cover medical consultations, drugs, delivery and even surgery.“Our patient will benefit from medical consultation, lab investigations, her drugs, her delivery and even if she has to have surgery, it is all covered by the health insurance scheme, at no cost to her. The FCT Administration is enrolling her under the health insurance scheme, as well as all FCT residents. With the unborn baby, and a year after the baby is born, the baby is also going to be covered under the health insurance scheme, and will access medicines, medical consultations, and lab investigations at no cost to the mother or the baby”, she said.Health
Consumption of Sugar-sweetened Beverages Capable of Causing Diabetes, other Diseases – Minister
The Federal Government has discouraged the consumption of Sugar-Sweetened Beverages (SSB) because it is capable of causing diabetes and other Non- Communicable Diseases (NCDs), an official has said.
Dr Ali Pate, the Coordinating Minister of Health and Social Welfare, said this in Abuja on Tuesday at the National Conference on Sugar-Sweetened Beverages (SSB) Tax and Health Financing in Nigeria.
The theme of the conference titled “Health Tax as a Recipe for Improved Healthcare Financing”.
The minister was represented by Mrs Olubunmi Aribeana, the Director, Food and Drug Services Department, Ministry of Health and Social Welfare.
He recalled that the Federal Government introduced SSB tax in 2021 to reduce the consumption of SSB as well as reducing the prevalence of obesity, diabetes and other related diseases.
“Sugar-sweetened beverages (SSBs) are drinks that contain added natural sweeteners, such as table sugar, high-fructose corn syrup, or fruit juice concentrates, all of which have similar metabolic effects.
“The consumption of SSBs has been linked to numerous health risks, including obesity, heart disease, weight gain, type 2 diabetes, kidney diseases, non-alcoholic liver disease, tooth decay, cavities, and gout.
“The health burden of SSB consumption is particularly significant in low- and middle-income countries, where rates of obesity and related health problems are on the rise.”
The minister said the country faced a growing health crisis with SSB-related diseases such as obesity and diabetes, adding that the associated healthcare costs were escalating at an alarming rate.
“Recent reviews and meta-analyses by the International Diabetes Foundation (IDF) show that as of 2021, over 3.6 million people are diabetic with 53 per cent of these citizens undiagnosed; and this number is expected to rise to about five million by the year 2030.
“The cost of treating diabetes per person has surged from an average of N60,000 in 2011 to N800,000 in 2021, and it is projected to exceed N1 Million by 2030.”
According to him, the goal of the SSB tax is to reduce the consumption of these unhealthy beverages, ultimately preventing obesity and its related diseases.
“In 2021, Nigeria joined over 100 countries that have introduced taxes on sugar-sweetened beverages. This tax, embedded in the Finance Act of 2021, levies a N10 tax on each litre of all non-alcoholic, sweetened, and carbonated drinks.
“As we look to the future, we must view the SSB tax as a cornerstone of our strategy to improve public health and healthcare financing.
“By discouraging the consumption of sugar-laden beverages, we aim to reduce the prevalence of obesity and diabetes, and in turn, alleviate the financial burden on our healthcare system.”
According to the minister, this tax serves as a deterrent and generates essential revenue that can be reinvested into healthcare initiatives, particularly preventive measures and the treatment of non-communicable diseases.
“Our vision is a Nigeria where healthier choices are accessible and affordable for all citizens.
“We aspire to create an environment where nutritious alternatives are readily available, empowering individuals to make informed decisions about their diet and overall health.”
The minister called on food and beverage industry, healthcare providers, civil society organisations and other relevant stakeholders to strengthen their collaboration to promote healthier lifestyles and ensure the sustainability of the nation’s health systems.
He said in line with the government’s vision, the 2023 National Policy on Food Safety and Quality and its Implementation Plan also prioritised the consumption of healthy foods.
According to him, the plan specifically expects the government at every level to develop strategies for reducing the consumption of sugar, alcohol, and sodium as well as the elimination of Trans-Fatty Acids (TFAs) in Nigerian diets.
The minister restated the Federal Government’s commitment to ensure food supply chain supports the health and well-being of the population by minimising the risks associated with poor dietary choices.
In his remarks, Mr Akinbode Oluwafemi, Executive Director, Corporate Accountability and Public Participation Africa (CAPPA), said that the current SSB tax that imposed an excise duty of N10 per litre on all non-alcoholic and sweetened beverages did not meet global standards.
Oluwafemi said, “At N10 per liter, Nigeria’s current tax on SSBs falls short of the World Health Organisation’s recommendation and global best practice of a minimum of 20 per cent of total retail prices.
“In fact, the impact of our current tax rate has been largely eroded by escalating inflationary pressures, rendering it nearly ineffective, hence the need for a re-evaluation.
“This is why, last year, CAPPA in collaboration with the Centre for the Study of Economies of Africa, conducted a simulation study that examined the potential fiscal and public health effects of SSBs in Nigeria, to provide Nigeria-specific data and information to support a re-calibration of the SSB tax rate.
“Findings from this research not only underscored the urgent need to address the public health impact of excessive SSB consumption but also identified an effective tax rate of N130 per litre as the most sustainable peg for realising public health goals.
“After two years of implementing the SSB tax, we strongly advocate, based on available evidence evaluating its impacts, that the Nigerian government should activate all necessary policy measures to increase the tax from N10 to N130 per liter.
“Or government should implement a revised tax structure to 50 per cent of the total retail price rate of SSB products as recommended by the Global Tax Force for Health of which our honourabe minister is a member.
“This adjustment will not only align with the WHO recommendations but also with the 2024 Bloomberg report on effective health taxes.
“Additionally, this increment must be accompanied by a redefinition of SSBs to capture all products that fall within the categorisation, and a resolve to establish a legal framework for earmarking the tax for public health initiatives,” CAPPA boss said. (NAN)
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