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 Niger State Private Health Facilities Agency (NiSPHFA) has sealed 12 unregistered Islamic medicine stores in Minna and a health facility in Katcha Local Government Area (LGA).
The Executive Chairman of NiSPHFA, Dr.
Abdullahi Suleiman, disclosed this while receiving members of the Islamic and Prophetic Medicine Practitioners’ Association of Nigeria (IPMPAN) in Minna.The enforcement is part of the agency’s renewed efforts to protect residents from unsafe healthcare practices and ensure compliance with minimum standards.
Suleiman said the facilities were sealed over alleged non-compliance with regulatory standards.
According to him, the enforcement is not aimed at persecuting healthcare providers but at ensuring residents have access to safe, quality, and standard-compliant healthcare services.
“Our responsibility is to protect the people by ensuring that anyone providing healthcare services operates within the required standards,” he said.
He urged genuine alternative medicine practitioners to register with NiSPHFA, saying registration would enable the agency to identify operators, monitor their activities, and protect residents from unsafe products and practices.
Suleiman also announced plans to organise a trade fair for verified alternative medicine practitioners to promote legitimate practices and improve public confidence in alternative healthcare.
He emphasised the need for practitioners to maintain minimum standards of hygiene, sanitation, safe preparation and storage of medicines, proper packaging, and infection prevention.
“Practitioners should refer patients whose conditions are beyond their capacity to appropriate health facilities. Such referrals will help reduce avoidable health risks,” he said.
The chairman said sustained enforcement, stakeholder collaboration, and improved compliance would enable NiSPHFA to safeguard residents and promote a safer, more accountable, and quality-driven healthcare system across the state.
He said the NiSPHFA enforcement team inspected 10 health facilities in Katcha local government and identified various irregularities requiring improvement.
Suleiman said the affected facilities were issued 21-day notices to correct the identified deficiencies.
“One of the facilities inspected was sealed for non-compliance with established standards,” he said.
He added that the agency also secured the support of the local government area in identifying and addressing facilities operating with irregularities.
IPMPAN Chairman, Abdullahi Haske, commended the state government for establishing NiSPHFA.
He pledged the association’s cooperation in ensuring that its members complied with regulatory requirements.
Stakeholders have called for improved implementation, tracking and accountability of health sector budgets to strengthen healthcare delivery and advance Universal Health Coverage (UHC) in Kaduna State.
They made the call during an engagement on strengthening participatory budget processes, health budget tracking and advocacy on Saturday in Kaduna, with emphasis on the 2027 budget process and implementation of the Annual Operational Plan (AOP) for the health sector.
Seth Luke, a Civil Society Coach on strengthening participatory budget processes under the Open Government Partnership (OGP) Kaduna, said the engagement was aimed at strengthening the capacity of OGP Technical Working Groups and state and local government accountability mechanisms to effectively participate in budget processes and advocacy.
Seth said the engagement was particularly focused on the health sector, including tracking the implementation of the Annual Operational Plan as the state commenced preparations for the 2027 budget.
“We want to see how we can track the implementation of the Annual Operational Plan for the health sector and, from our findings, bring out recommendations around improving funding and other areas that require attention,” he said.
He said the government needed to prioritise health financing beyond budgetary allocation by ensuring effective implementation of approved programmes and projects.
According to him, budget allocation represents government plans based on expected revenue, but available resources should be prioritised toward activities capable of improving healthcare and service delivery at the grassroots.
Seth urged participants to use the knowledge and findings from the engagement to engage relevant government stakeholders on improving health financing and budget implementation.
He also encouraged them to extend the knowledge gained to other sectors and continuously engage government on budgeting, accountability and service delivery.
Similarly, Garba Mohammed, Co-Chair of the Kaduna Maternal Accountability Mechanism (KADMAM), said the engagement was aimed at reviewing health budget performance against key indicators linked to maternal mortality reduction and child survival.
Mohammed said participants examined first and second quarter performance, particularly in areas such as family planning, Maternal, Newborn and Child Health (MNCAH), nutrition, malaria, immunisation and essential medicines.
He said family planning interventions largely involved commodities at the primary healthcare level, while MNCAH activities remained largely donor-dependent.
Mohammed commended the Kaduna State Government for meeting the Abuja Declaration benchmark of allocating at least 15 per cent of its annual budget to health.
He, however, expressed concern over gaps in the implementation of some critical health budget lines, stressing that allocation alone was not enough to improve health outcomes.
“We have looked at the budget allocation, and Kaduna State has met the 15 per cent Abuja Declaration benchmark. We commend the state for that. However, there are still issues around budget performance in critical health indicators,” he said.
He said the findings would be used to identify advocacy priorities and engage key government decision-makers, including the Ministry of Health, Planning and Budget Commission, Ministry of Finance and other relevant authorities.
Mohammed said participants were expected to understand the relevant health budget lines and their implementation status and use the knowledge to undertake evidence-based advocacy in their respective organisations.
Meanwhile, Yusuf Guje, Executive Director, Civic Impact for Sustainable Development Foundation (CISDF), and a participant at the programme, told the News Agency of Nigeria (NAN) that the engagement was timely in strengthening the capacity of civil society and accountability mechanisms.
Guje said the programme would deepen participants’ capacity in budget tracking, project monitoring and social auditing, particularly within the health sector.
He described the health sector as a critical pillar of development, saying civil society organisations had an important role to play in complementing government efforts through effective monitoring and accountability.
He said CSOs needed to strengthen their ability to analyse budgets, track expenditure and visit healthcare facilities to determine whether appropriated and released funds were being properly utilised.
“Civil society needs to really improve on how effectively we analyse the budget, how we track the spending, and go down to the various facilities to see how well the money appropriated and released is being utilised,” Guje said.
He said effective monitoring would help determine the extent to which communities benefited from government investments in healthcare.
According to him, Kaduna State’s commitment to Universal Health Coverage could only be strengthened through sustainable health financing and effective accountability mechanisms.
Guje described CSOs as representatives of communities that often lacked the knowledge, skills and platforms required to engage government on public policies and resource allocation.
He therefore urged civil society actors to continuously strengthen their capacity to represent citizens effectively, particularly in health financing advocacy and accountability.
“As civil society, we need to remain committed to holding the government accountable where necessary and tracking the entire health financing process,” he said.
Guje said the ultimate objective of budget tracking and social accountability was to ensure value for money in public expenditure on health.
He added that effective monitoring of public finances would contribute to improved healthcare delivery and better health outcomes at the grassroots. (NAN)
Cross River Government has made enrolment in the state Health Insurance Scheme compulsory for all civil and public servants in the state.
The Head of Service, Bassey Okon, announced this in a circular dated Sept.
3, following the official relaunch of the Formal Sector Enrolment Programme of the Cross River State Health Insurance Agency.According to the circular in Calabar, at the weekend, the directive takes immediate effect.
Okon stated that the policy was meant to ensure that all the civil and public servants had access to affordable, quality, and timely healthcare services, while strengthening the welfare and productivity of the state workforce.
He directed all the civil and public servants to enroll in the scheme and comply with the registration and documentation requirements of the agency.
The circular also introduced a mandatory requirement for officers to attach valid health insurance enrolment cards to official correspondences relating to personnel matters.
“Correspondences concerning promotion, confirmation of appointment, loan applications, study leave, training or sponsorship, transfer or secondment, as well as other personnel-related requests or benefits, would not be processed without the attachment of a valid health insurance enrolment card,” it stated.
To facilitate the enrolment process, the government established enrolment points at the Office of the Head of Service, New Secretariat, Calabar, and the Ministry of Health, Old Secretariat, Calabar.
Okon directed all Heads of Ministries, Departments, and Agencies (MDAs) to ensure that officers under their supervision were duly informed about the circular and made to comply with the enrolment requirement without delay.
He also urged concerned officers to take advantage of the designated enrolment points for guidance and assistance and to complete their enrolment as required.
He further directed all the heads of the MDAs to bring the contents of the circular to the attention of all civil and public servants under their supervision. (NAN)
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