Effect of Information Technology Policy on Nigerian Health Sector. 1. Hassan Omowunmi .... health care centres are connected to the Internet and the information ...
Volume 2 No.6, JUNE 2011
Journal of Emerging Trends in Computing and Information Sciences
ISSN 2079-8407
©2010-11 CIS Journal. All rights reserved. http://www.cisjournal.org
Effect of Information Technology Policy on Nigerian Health Sector 1
Hassan Omowunmi M, 2Siyanbola Willie O, 3Oyebisi T.O. 1, 2
National Centre for Technology Management and 3 Technology Planning and Development Unit, Obafemi Awolowo University Ile-Ife, Nigeria.
ABSTRACT Information Technology (IT) is gaining ground in all areas of life and developing nations are taking advantage of this opportunity in various sectors including the development of health care systems. This paper presents a study on the assessment of the effect of implementation of IT policy on Nigeria’s health sector. It further examines the effects by assessing the issues on health in the policy, the adoption of policy objectives in the health sector, its implementation and use. The evaluation utilized questionnaires to collect information from purposively selected teaching hospitals in three geopolitical zones of Nigeria. Data collected were analysed using descriptive and inferential statistics. Keywords: Information technology, IT, Information and Communication Technology, ICT,
1. INTRODUCTION World population now exceeds six billion of which more than 4.7 billion reside in the developing world [7]. As the population is increasing there is a need to find ways of improving efficiency and quality of health care delivery systems in developing countries. Information and Communication Technology (ICT) has been identified as a vehicle with the potential to improve the quality of health care systems as well as the efficiency of the health workers both in the developed and developing countries. Information and communication technologies have changed the face of the world we live in. ICT enables people to communicate with family, friends and colleagues around the world instantaneously, gain access to global libraries, information resources, and numerous other opportunities. ICT may also bring an improvement in health care delivery systems. So, we may define ICT as one of the driving forces of globalization ICT encompasses the broad spectrum of communication technologies from radio, film, television, press, and telephone along with more participatory forms such as theatre, video or storytelling. It also focuses on the electronic end of the spectrum such as e-mail, the Internet, mobile phones and digital video. ICT came into existence in most of the African countries through research institutions, educational institutions, or international organizations like the World Bank, UNDP, USAID, WHO, etc [8]. In 1993 most provinces, Aimaks in Mongolia were provided with personal computers funded by the WHO with the goal to support the health services in the country [1]. In Nigeria, the history of the Internet in universities can be traced to the joint project handled by the International Centre for Theoretical Physics (ICTP), Trieste, Italy and Obafemi Awolowo University, in 1999. Also the inception of ICT into Nigerian teaching hospitals came into introduced as a result of the INDEHELA project by the Computing Centre of the University of Kuopio, Finland, Obafemi Awolowo University and Obafemi Awolowo University Teaching hospital in the late 80s. In
Africa, South Africa is ranked among the top 20 countries in the world with regard to the number of Internet nodes and it is 30 times larger than any other country in Africa. [5] The study presented in this paper will help the ministry of health and Nigerian government to instigate policies in the Nigerian health sector. The use of ICT Nigerian teaching hospitals will help all patients including the ones in life threatening situations. Since the year 2001, there has been a revolutionary growth in the telephony industry in Nigeria [3]. This is expected to have permeated the health care institutions with significant positive impact on health care delivery. Two years after the introduction of GSM in Nigeria, [3] conducted an interview among medical practitioners in some Nigerian teaching hospitals to find out the current level of utilization of telephones for health care delivery. They noted that medical experts use their personal mobile phones to facilitate patient care at their own expense. Neither the government nor hospital management had taken up the responsibility. Currently, the number of GSM service providers in the country has increased significantly and all of them keep rolling out several service options or packages including internet services with varying benefits to attract customers. Although, A GSM based referral system was developed, validated and recommended for use in the primary health care centres. The extent to which the growth in telecommunication has impacted tertiary health care and how far this has enhanced the development of an ICT – driven health care practice in Nigeria is still to be known.
2. ICT AS A WORKING INFRASTRUCTURE IN THE HEALTH SECTOR The production of quality health-care delivery in a country is guided by the level of the ICT infrastructure possessed and used by that country. A good ICT infrastructure, therefore, is a prerequisite for enhancing the well-being of a country. Gates (1999) reported that intraand interorganizational networks in some advanced
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Volume 2 No.6, JUNE 2011
Journal of Emerging Trends in Computing and Information Sciences
ISSN 2079-8407
©2010-11 CIS Journal. All rights reserved. http://www.cisjournal.org
countries function like a digital neural system of the organization. Thus, he inferred that communication for health purposes has shifted from the largely manual or physical documentary method to digital communication. He further stated that such access to ICTs has helped disseminate information to the rest of the world. American doctors are now able to collaborate as often and as quickly as they want with other medical doctors in other parts of the world through the use of ICTs. For example, while examining a patient, a medical doctor might be able to send an electronic x-ray of a patient to a leading expert in another country who could readily interpret and provide more details of the disease or condition, as well as send feedback to the medical doctor all within a few minutes. RHWs, in their research and application processes, can use the Internet to identify research issues, search literature databases, seek out information on surveys and clinical trials, and published research results [2]. Several studies have reported on ICT use among RHWs. [3] reported that while ICT capabilities (personal computers, mobile phones, Internet) were available in Nigerian teaching hospitals, mobile phones were spreading fast. Their findings also revealed that computers and mobile phones were in use in all the teaching hospitals but not much Internet connectivity was available, meaning that most of the medical experts used external (non hospital) Internet services, such as cybercafés, for even rudimentary Internet access, such as e-mail. They further explained that while just 1.4% of the medical staff did not use the Internet in any fashion, the vast majority (70.7%) of those using the Internet did so only for e-mail.
3. METHODOLOGY Samples for the study were selected mainly from Abuja, Lagos and three other states (Osun, Rivers and Nassarawa) in Nigeria. The research instruments used were questionnaires, personal interviews and observations. The evaluation utilised questionnaire as instrument to elicit information on the set objectives from a teaching hospital in each selected study area. A total of nine hospitals were purposively sampled and 60% response was obtained. Data collected were analysed using descriptive and inferential statistics.
4. RESULT AND DISCUSSION Policy Issues To use IT for: (i) (ii) (iii) (iv) (v)
the establishment of Health-care Information Systems (HIS), development of drug information, records and bibliographic records, the study and control of epidemics, as a research tool and means of disseminating information, for use in distance learning for medical professionals.
Adoption Adoption of IT into the mainstream of managing health system in the country is high, but the awareness of the IT policy is low just like in the education sector. The responses across sectors and especially in the health sector show that most Nigerians have keen interest in using ICTs for their various works and activities to enhance efficiency and productivity. The influx of the GSM into the country and its extensive impact have encouraged the adoption of IT, and most institutions, such as the health sector, would take every advantage of the internet for effective health delivery.
Implementation IT Literacy: It was observed that implementation of the policy at the health institutions is still at the early stages especially as regards IT knowledge. Most health workers can mainly use the computers for e-mailing, surfing the net and general word processing. The capacity to utilise HIS for health care is still lacking among health workers in Nigeria. The policy needs to be strengthened in this regard, so as to assist the hospitals, especially teaching hospitals, to deploy telemedicine to the rural areas especially.
Staff On-job Training: Most respondents said they have never been trained on information technology through the hospital training schemes, except for such training that relates to their duties. Some few hospital workers who have IT training are managers of the IT facilities within the system who obviously, are IT professionals. While a few others try to train themselves most others are comfortable using IT for e-mails services only. Few respondents have been encouraged to learn about IT but without any training commitment from the government or hospital management.
Infrastructure Deployment: Quite a number of teaching hospitals now have IT infrastructure, such as the Internet that can enable connectivity for various health services. Before now, [3] studied the three ICT indicators which are personal computers, mobile phones and Internet in some teaching hospitals in South-Western Nigeria. The study showed that out of the four hospitals visited, none was connected to the Internet as at then, as workers had to go to a cybercafé to access their e-mail boxes. For instance, the Obafemi Awolowo University been connected to the Internet since the late 90’s but the affiliated teaching hospital was not connected. It further revealed that a majority of the medical experts (including nurses) use external (non-hospital) Internet facilities. Almost one and a half percent (1.4%) of the medical experts are not using the Internet, 70.7% are using Internet for e-mail and 27.9% are using it for browsing. The study revealed that over 98% of the medical experts in the Nigerian teaching hospitals are using the Internet but not within the hospital as at 2003. Although personal computers, mobile phones and Internet facilities 297
Volume 2 No.6, JUNE 2011
Journal of Emerging Trends in Computing and Information Sciences
ISSN 2079-8407
©2010-11 CIS Journal. All rights reserved. http://www.cisjournal.org
are available in Nigerian Teaching hospitals, the mobile phones are the most efficient ICT tool mostly utilised. The mobile phones are used for communication between the wards, such as for patient referrals from one ward to another, reaching other Physicians, consultations and get materials or equipment into a particular ward or room. Nowadays, the story is changing, as most hospitals and health care centres are connected to the Internet and the information needs of the doctors, as well as other workers are met. However, studies have shown that most health workers use mobile phones more than the Internet and this device has been useful for health care services. Mobile phones with functionary internet facilities and camera can be useful for telemedicine, especially at the rural areas.
Uses Most of the health workers, especially the Doctors, use IT to surf the internet for e-mailing, journal and articles search, best medical practices and guide to making diagnosis among others. Others use IT for Research activities, especially those at the teaching hospital who combine academics with clinical services. Though access to computing facility is still a major challenge, as most hospitals do not have dedicated IT centres for staff use, most doctors, pharmacists and nurses interviewed have purchased personal computers or laptops to assist them.
Effects: First Level Effects Effectiveness: The level of knowledge, diagnosis and research exhibited by health workers in Nigeria has improved through the use of ICTs. Efficiency: The rate of information retrieval and expertise displayed by health workers shows a high level of IT utilisation. A lot still needs to be done in the aspect of patient’s record keeping and health information systems as a result of poor or inadequate infrastructure. Innovativeness: There is not much done in terms of innovation as IT deployment is still at the preliminary stage. More literacy and training needs to be done to create innovative opportunities within the sector.
Effect: Second Level Effects HIS has been developed by researchers for use in hospitals and this has in a way helped to keep some patients records but it is still at primitive stage in Nigeria’s health management. R&D in health has improved, as most doctors and other health workers are now able to access online journals, publications and health materials easily through the internet. Correspondence with other health institutions, locally and internationally has been facilitated and enhanced. More opportunities for telemedicine, HIS development to have local content and distance learning for medical professionals are equally progressing.
General Remarks Though the policy has made provision for health development in Nigeria, the ability in terms of funding, staff training and infrastructure deployment by NITDA is not available. Local development of Health Information Systems is available in some tertiary institutions and companies and should be encouraged for utilization, so as to boost local content creation and software development. Nigeria is still behind in management of hospital information systems because of obstacles such as high cost of ICT equipment, power failure, and inadequate telecommunication facilities to the adoption and infusion of ICT in the hospitals. Moving away from the traditional, manual ways of delivering health care like other sectors such as banking, through adoption of ICT should be very easy. Until the mid-20th century for instance, the UK government was not involved in the delivery of health care; it was philanthropists and social reformers that offered free health facilities to the poor. Later, the government saw the need to provide a free quality health care system and on 5th July, 1948 the NHS (National Health Service) was established [5, 6]. In 2005, the Nigerian government embarked on a system similar to the UK NHS, which is called the National Health Insurance Scheme (NHIS). Arguably the establishment of the scheme ought to begin with the introduction of ICT in hospitals because ICT will reduce the cost of running the hospital and improve the delivery of healthcare system if fully implemented. In UK hospitals, all patients’ data are stored on a computer system which is updated each time the patients visit the hospital. In Nigeria, to find the number of patients that visited a particular hospital could take a while, because numerous files must be checked. Hospitals which are not research-based may not even keep proper records. Although few researchers in the universities [4] have developed systems to solve referral system in the hospitals, the system is yet to be implemented because the Nigerian government is yet to show interest in any direct ICT investment in any hospital. Some health information systems used in hospitals are purchased directly by the Directors of such hospitals. Online services, where authorised medical personnel (doctors, nurses and other clinical professionals) can access information about the latest health research and best practice, anytime the need arises are now available though in some hospitals but the physicians in the same hospital cannot share a patient’s file within the hospital and an electronic booking service is not available in any public or teaching hospital in Nigeria.
5. CONCLUSSION AND RECOMMENDATION The importance of the introduction of ICT in Nigerian health sector cannot be over emphasized. However the idea has brought rapid development both in the dissemination of information and health care delivery. Nigeria is still behind in management of hospital information systems because of obstacles such as high cost
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Volume 2 No.6, JUNE 2011
Journal of Emerging Trends in Computing and Information Sciences
ISSN 2079-8407
©2010-11 CIS Journal. All rights reserved. http://www.cisjournal.org
of ICT equipment, power failure, and inadequate telecommunication facilities, working policies to the adoption and infusion of ICT in the hospitals. Moving away from the traditional, manual ways of delivering health care like other sectors such as banking, through adoption of ICT. The extent to which the growth in telecommunication has impacted tertiary health care and how far this has enhanced the development of an ICT – driven health care practice in Nigeria is still to be known. We conclude that, the implementation of the 2001 IT policy in Nigeria did not have the so much of its desired results and that government needs to balance politics, flexibility and continuity with the vision and goals of the policy to effectively implement future policies.
ACKNOWLEDGEMENT The authors wish to appreciate the contributions of Mr. Patrick Itemgboye, a Scientific Officer of the National Centre of Technology Management, North-East office in putting together of this paper. The result of the research presented in this paper is from the PhD thesis of Dr. Hassan with the able supervision of the co-authors cited. Thanks you.
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http://www.jmir.org/2002/2/e13/doi: 10.2196/jmir.4.2.e13 PMID: 12554560 [3] Idowu, B., Ogunbodede, E., & Idewo, B. (2003). Information and Communication technology in Nigeria: The health sector experience. Journal of information Technology Impact 3 (2), 69-76 [4] Idowu, P.A., Adagunodo, E.R. Aderounmu, G. A. and Ogunbodede, E. O. (2004): Electronic Referral System for State Hospitals, Ife Journal of Science, Volume 6 (2), p.161-166. [5] Jensen, M. (1998). Africa Internet Connectivity: Information and Communication technologies (ICTs) Telecommunications, Internet and Computer Infrastructure in Africa.. Retrieved from The Association for Progressive Communications Web site: http://www3.sn.apc.org/africa/ [6] NHS, (2007): NHS in England online, Available from http://www.nhs.uk/England/AboutTheNhs/Hsitory/Be fore1948.cmsx [7] NHS, Bulletin (2007): New Guide and Tools to assist Implementation, NHS Bulletin,online Available from www.chooseandbook.nhs.uk/news/choose-and-bookbulletin-9 [8] United Nations Development Programme. (2000). World Development Report. Retrieved from http://www.undp.org/hdr200/english/HDR2000.html [9] US Census Bureau. (2000). World POPClock Projection. Retrieved from http://www.census.gov/ cgi-bin/popclock
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