nigeria health ict workforce and curricula assessment

| 1

Nigeria Health ICT Workforce and Curricula Assessment

Prepared by Excellence and Friends Management Consult (EFMC), on behalf of the United Nations Foundation in support of ICT4SOML

MARCH 2016

2 | NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

Table of Contents

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . 4

List of Acronyms and Abbreviations . . . . . . . . . . . 5

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . 8

Tables and figures . . . . . . . . . . . . . . . . . . . . . . . . . 10

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Purpose of the Assessment . . . . . . . . . . . . . . . . . . 14

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

assessment committee . . . . . . . . . . . . . . . . . . . . 15

assessment design . . . . . . . . . . . . . . . . . . . . . . . 15

population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

sample size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

exclusion criteria . . . . . . . . . . . . . . . . . . . . . . . 17

data collection procedure . . . . . . . . . . . . . . . 17

data analysis plan . . . . . . . . . . . . . . . . . . . . . . . 18

ethical concerns . . . . . . . . . . . . . . . . . . . . . . . . 18

quality assurance . . . . . . . . . . . . . . . . . . . . . . . 18

Results: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

part a: quantitative studies . . . . . . . . . . . . . . 19

Knowledge of ICT Equipment and Tools . . . . . . . . . . . . . . 22

Skills in ICT Among the Health Workers . . . . . . . . . . . . . . 22

Use of ICT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ICT Skills and Experience . . . . . . . . . . . . . . . . . . . . . . . . 24

Areas of Improvement in ICT Knowledge, Skills and Expertise . . . . . . . . . . . . . . . . . . . . 25

Core ICT Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

part b: qualitative studies . . . . . . . . . . . . . . . 27

Infrastructures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Training, Personnel and Management Commitment . . . . . . . . . . . . . . . . . . . . . . . . 30

Challenges of ICT Knowledge in Health . . . . . . . . . . . . . . . 34

Prospects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Synthesis of Findings of Assessment . . . . . . . . . . 35

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . 38

minimum ict knowledge and skills . . . . . . . . . 38

Basic ICT Knowledge and Exposure per person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Basic ICT use by users and support staff . . . . . . . . . . . . . . 38

Basic ICT Use per Establishment . . . . . . . . . . . . . . . . . . . . 39

health ict skill set upscale logic model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

learning stages . . . . . . . . . . . . . . . . . . . . . . . . . 41

training matrix . . . . . . . . . . . . . . . . . . . . . . . . . 42

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Appendix 1: Institutions and People interviewed . . . . . . . . . . . . . . . . . . . . . . . . 46

Appendix 2: Project Team . . . . . . . . . . . . . . . . . . 49


Acknowledgements

This assessment of the health ICT workforce capacity was developed and produced by the United Nations Foundation as a product of the Information and Communications Technology for Saving One Million Lives (ICT4SOML) initiative under the leadership of the Federal Ministry of Health and Federal Ministry of Communication Technology with funding support from the Norwegian Agency for Development Cooperation (Norad).

Special thanks to the ICT4SOML team: Olasupo Oyedepo, Emeka Chukwu, Salama Ashiya Achi, Dr. Patricia Mechael, Carolyn Florey and Abigail Manz. Many thanks also to all interviewees who contributed their time to this report as listed in Appendix 1. Special thanks to Honourable Minister of Health, Professor Isaac Adewole, Permanent Secretary of Health, Dr. Amina Shamaki, and Director of Planning Research and Statistics, Dr. NRC Azodoh for their support to make this assessment a success.

We would also like to express our gratitude to Excellence and Friends Management Consult (EFMC), specifically Dr. Obinna Oleribe, for his contributions to this document.

| 5

List of Acronyms and Abbreviations

B2B Business to Business

C2C Customer to Customer

CHEW Community Health Extension Worker

CHO Community Health Officer

CMD Chief Medical Director

DHIS District Health Information Software

EFMC Excellence and Friends Management Consult

EHR Electronic Health Record

EMR Electronic Medical Record

FCT Federal Capital Territory

FMCT Federal Ministry of Communication Technology

FMOH Federal Ministry of Health

GCE General Certificate of Education

GIS Geographic Information System

GPRS General Package Radio Service

GSM Global System for Mobile Communication

GSMA Groupe Speciale Mobile Association

HIMS Health Information Management Systems

HTML Hyper Text Markup Language

ICT Information Communication Technology

ICT4SOML Information and Communications Technology for Saving One Million Lives

IRB Institutional Review Board

IT Information Technology

ITU International Telecommunications Union

KII Key Informant Interviews

LGA Local Government Area

MDCN Medical and Dental Council of Nigeria

M&E Monitoring and Evaluation

MIS Management Information System

NCC Nigeria Communication Commission

NGO Non-governmental Organization

NHIMS National Health Information Management System

NHIS National Health Insurance Scheme

NHREC National Health Research Ethics Committee of Nigeria

NORAD Norwegian Agency for Development Cooperation

PCIS Patient Care Information Systems

PHC Primary Health Care

SAS Special Air Service

SMOH State Ministry of Health

SMS Short Message Service

SOML Saving One Million Lives

SPSS Statistical Package for Social Sciences


STATA Statistics and data

TWG Technical Working Group

UN United Nations

UNF United Nations Foundation

USB Universal Serial Bus

WASC West African School Certificates

WHO World Health Organization


Executive Summary

The Information and Communications Technology for Saving One Million Lives (ICT4SOML) initiative was established through the collaborative efforts of the Federal Ministries of Health (FMOH) and Communication Technology (FMCT), with technical support from United Nations Foundation (UNF) through the Norwegian Agency for Development Cooperation (Norad). This partnership leveraged the use of Information and Communications Technology (ICTs) to improve health outcomes for women and children through the Saving One Million Lives Initiative (SOML). Former President Goodluck Ebele Jonathan launched the SOML initiative in October 2012.

To achieve this objective, ICT4SOML designed a staged research process to assess the enabling environment in Nigeria before developing a National Health ICT Framework. In August 2014, the first phase was a review of the current ICT enabling environment in Nigeria guided by the WHO/ITU eHealth Strategy Toolkit that recommends components to examine: strategy and investment; legislation, policy and compliance; standards and interoperability; workforce; infrastructure; and services and applications.1 The review identified the strengths and weaknesses of the current health ICT environment in Nigeria.

The second phase was a field assessment conducted at the national level with a focus on six states: Akwa Ibom, Bauchi, Imo, Kano, Lagos, Sokoto, and the Federal Capital Territory (FCT) to evaluate the current state of relevant health ICT implementations and user experience. Findings from the field assessment showed that health ICT infrastructure is sufficiently available at the federal, state and local government levels but inadequate at the facility level. Infrastructure improvement was recommended as a key priority.

This assessment is designed to examine the development, training, deployment and management of ICT human resources in health. The purpose is to identify, map and review the current ICT curricula for health care workers (HCWs) and health ICT professionals; identify the current skill sets of different cadres of HCWs; and develop plans for up-skilling existing workforce and improving the training of new ones. Additionally, the assessment aims to map health ICT professionals within the health system and provide recommendations for the optimal cadre of professionals and career paths.

For the survey, a multistage sampling technique was used to select two local government areas (LGAs) (one rural and one urban) in six states in Nigeria, one state per geopolitical zone. The rural LGAs were randomly selected while the state capitals served as urban examples. Primary, secondary and tertiary health facilities as well as health training institutions were selected for the study. At the facility level, health workers were randomly selected and the structured questionnaires administered to them by the assessors. However, facility heads and/or ICT leads were purposefully sought after for the key informant interviews (KII). A total of 232 respondents were assessed in the six states/ geo-political zones. Each state team had at least two persons from EFMC, one from the Federal Ministry of Health and one from the State Ministry of Health. The personnel from FMOH served as the quality assurance for the entire exercise.

The findings from the survey reveal that most training institutions have some form of ICT curricula; however, these are not health specific, but rather a component of the general ICT curricula in use. Additionally, the ICT training is not a requirement for graduation and eventual certification of health professionals, which results in more casual attitudes of both trainers and trainees regarding the curriculum. There was no ICT-ready health worker curricula for health ICT or public health/biomedical informatics. Infrastructure and human resources for health ICT were found to be inadequate in most institutions.

1. United Nation Foundation in support of ICT4SOML. (2014a). Accessing the enabling environment for ICTs for health in Nigeria; A landscape and survey. http://www.health.gov.ng/doc/nigeria-Health-ICT-landscape-report.pdf

| 9

Also, there was a general poor showing in knowledge and skills amongst the health workers assessed as the majority were trained during week long conferences or workshops. Others received on-the-job training without a defined curriculum. There is little post-training practice of ICT curricula, leading to poorly translated knowledge and skill transfer in the field. However, there is the general agreement for a specific curriculum for ICT-ready healthcare workers, and specialized training courses to both sensitize and improve their skills. These gaps provide excellent opportunities for the training of both core and non-core health ICT workforce. Pre-service and in-service health ICT trainings are recommended as a professional development requirement for health workers.

The penetration of ICT into the Nigerian health system is still very low despite the eagerness and willingness of health workers to learn and use the technology. A significant knowledge gap among health workers still exists regarding the utilization of technology to advance and enable their work. The absence of good ICT infrastructure, health-specific ICT curriculum and qualified and motivated ICT trainers were further hindrances to ICT use and adoption in the health system.

To ameliorate these problems and improve the uptake of ICT expertise in the Nigerian health system for better health outcomes, the following recommendations are made:

1. Inauguration of a Health ICT workforce Technical Working Group/Committee

2. Establishment of Health ICT workforce improvement fund

3. Development of a health specific ICT curriculum for health worker trainings

4. Development of Health ICT infrastructure to support regular capacity building

5. Development of Health ICT strategic and operational plans to bolster the skills of Health ICT professionals

6. Bridging the capacity gap by training healthcare workers on ICT as is required for their job

7. Establishment of professional cadre and career path for health ICT professionals


Tables and figures

tables:

table 1: states visited for ict assessment and number of participants enrolled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

table 2: age distribution of participants in the ict assessment exercise in six states . . . . . . . . . . . . . . . . . . . . . . . . 19

table 3: level and type of health facilities where participants were working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

table 4: professions of participants in the ict assessment study . . . . . . 21

table 5: level of care of practice of ict trained healthcare workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

table 6: age of ict practitioners who participated in the ict assessment from six geo-political regions of nigeria . . . . . . . . . 24

table 7: location of primary assignment of core ict staff . . . . . . . . . . . 26

table 8: curriculum present and accounted for at sites visited . . . . . . .28

table 9: types of trainings in institutions visited . . . . . . . . . . . . . . . . . . 30

table 10: proposed ict courses and class of healthcare workers/duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

figures:

figure 1: sample selection for ict assessment flow chart . . . . . . . . . . . 16

figure 2: gender distribution of participants in the ict study in nigeria, december 2015 . . . . . . . . . . . . . . . . . . . . . . . . . .19

figure 3: Distribution of total participants according to rural vs . urban regions of the states according to their work places, December 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

figure 4: participants living areas: rural vs . urban . . . . . . . . . . . . . . . . . 20

figure 5: health ict improvement logic model . . . . . . . . . . . . . . . . . . . . . 40

figure 6: health ict learning stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

figure 7: health ict training matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42


Introduction

Launched in October 2012 by President Goodluck Jonathan, the Saving One Million Lives (SOML) initiative aimed to prevent the deaths of one million women and children by the end of 2015 by improving access to essential primary health care services and commodities in order to achieve Millennium Development Goals 5 and 6 (MDGs). SOML has since scaled up primary healthcare to meet the basic and essential needs of maternal and child health, engage the private sector and effectively manage data.2

In January 2013, Information and Communications Technology for Saving One Million Lives (ICT4SOML) was launched as a multi-sectoral, multi-stakeholder partnership by the Federal Ministry of Health (FMOH) and Federal Ministry of Communication Technology (FMCT) to leverage the power and proliferation of mobile and other information and communications technology (ICTs), to achieve SOML targets and support the enabling environment for ICT for health. In partnership with the United Nations Foundation (UNF), GSMA and Intel, with support from Norad, ICT4SOML has two primary objectives:

1. Strengthening the enabling environment for the use of ICTs for health through the development of an ICT strategy to support long-term sustainability and coordination, to address capacity, financing and policy gaps, and to promote accountability, performance monitoring and evaluation.

2. Supporting the scale up and institutionalization of high priority ICT-based programs.

To achieve its objectives, ICT4SOML developed a multi-tiered review process to assess the Nigerian ecosystem across policy, health ICT inventory and landscape, and field assessment. The policy review examined existing policies to enable a National Health ICT Framework. Further, the health ICT inventory and landscape reviewed the current status of existing health ICT implementations across the country. The final review was a field assessment across the Federal, State, LGA and facility levels to assess the current state of ICT infrastructure, services and applications and accompanying support structures, including workforce capacity, standards and interoperability, and funding availability. All research adhered to the eHealth component structure as articulated by the World Health Organization (WHO)/International Telecommunications Union (ITU) eHealth Strategy Toolkit and examined the environment according to this format.

The first phase, conducted in August 2014, sought to identify key areas of engagement, preparedness, and synchronization within the existing health system and establish the parameters within the Nigerian context. It also aimed at understanding the current health ICT enabling environment in Nigeria in relation to legislation, policy and compliance. This review examined strategy and investment; legislation, policy and compliance; standards and interoperability; workforce; infrastructure; and services and applications. Inter-ministerial involvement in, and commitment to health ICT, acknowledgement of infrastructure and regulatory gaps, and numerous ongoing implementation initiatives were identified as strengths of the current health ICT environment. However, a lack of harmonization, lack of strategic long-term financing mechanisms, and inadequate policy and regulatory environment hindered appropriate progress and growth in achieving sustained and effective ICT for health.3

The second phase field assessment evaluated the current state of relevant health ICT implementations and user experience. It also identified opportunities and weaknesses in ICT infrastructure, resources, and capacity across the federal, state, local government

2. United Nation Foundation in support of ICT4SOML. (2015). Nigeria health ICT phase 2 field assessment findings. http://www.health.gov.ng/doc/FieldAssessment.pdf

3. United Nation Foundation in support of ICT4SOML. (2014a). Accessing the enabling environment for ICTs for health in Nigeria; A landscape and survey. http://www.health.gov.ng/doc/nigeria-Health-ICT-landscape-report.pdf

| 13

areas (LGAs), and facility levels. This assessment focused on five components of the WHO/ITU framework: infrastructure, services and applications, workforce, standards and interoperability, strategy and investment, and was carried out using key informant interviews and surveys. The survey was conducted at the national level with a focus on six states (Akwa Ibom, Bauchi, Imo, Kano, Lagos, and Sokoto) and the Federal Capital Territory (FCT).

Findings from the field assessment revealed that infrastructure, including electricity, connectivity and ICT equipment (i.e. computers, mobile phones/telephones, printers) are sufficiently available at the federal, state and LGA levels, but inadequate at the facility level. While a primary source of electricity is available across the health system, frequent interruption in power is common, combined with poor network coverage impacting Internet connectivity. Improving infrastructure was recommended as a key priority to ensure that investments in health ICT services and applications and workforce capacity were not wasted due to limited uptake and poor user experience.

Following these assessments of landscape, inventory and policies, ICT4SOML is conducting a series of deeper dives into specific topic areas. The first was a review of the privacy and security that outlined Nigeria’s need to establish legal frameworks to facilitate the lawful processing of patient information in order to meet SOML goals and achieve universal health coverage.4 The second topic-specific deep dive is this report, which is designed to examine the development, training, deployment and management of health ICT human resources. While the aforementioned assessments focused on the components of the WHO/ITU eHealth Toolkit, this review will provide specific and detailed guidance on the capacity building component only.

4. United Nations Foundation in support of ICT4SOML (2015). “Keeping Personal Health Information Safe and Secure: A Guide to Privacy and Data Security Laws in Nigeria.” http://www.unfoundation.org/assets/pdf/keeping-personal-health.PDF


Purpose of the Assessment

The purpose of this assessment is to review current curricula and training for the health workforce in the use of ICT as well as for health ICT professionals. The assessment is also designed to provide baseline information on ICT capacity and existing curricula and training. Specifically, the assessment will identify, map, and review the following:

• Current ICT-related curricula and training opportunities for physicians, nurses, community health workers, administrators/officers, etc.

• Optimal training and curricula for ICT-ready health workers and develop a plan for how to build the capacity and skills of existing health workers and improve training of new health workers

• Current ICT skill set of the health workforce cadre

• Curricula and training in Health ICT, public health/biomedical informatics, and computer science that might be able to support increased demand for IT skills within the health system

• Optimal training and curricula for Health ICT, public health/biomedical informatics, and computer science and develop a plan for how to up-skill existing professionals and improve training of new cadres of professionals

• Health ICT professionals within the health system and provide recommendations for the optimal cadre of professionals and career path

| 15

Methodology

This section describes the assessment team, state selection process, study design, and selection of participants for the ICT assessment. It also explains the inclusion/exclusion criteria, data collection technique, data analysis, and ethical considerations.

assessment committee

An assessment committee was convened to inform the overall design and ensure quality delivery of this project. It was comprised of EFMC, ICT4SOML, and representatives of FMOH. Following initiation and planning meetings held at the Federal Ministry of Health to review the research design, approach, sampling, and instruments, all parties participated in a pre-field meeting on December 4, 2015.

During the pre-field meeting, the nature of field activities, completion of questionnaires and the role of federal and state government personnel were discussed. The study tools were also extensively discussed and relevant amendments were made. Teams took turns to discuss and finalize their field visit logistics plans.

assessment design

This survey used a non-controlled cross-sectional study design executed in December 2015. The four levels of measurement (nominal, ordinal, interval and ratio) were used as appropriate.


population

At the federal level, representatives from the majority of the health workforce regulatory agencies were interviewed. This included the regulatory bodies and federal ministries, departments and agencies.

At the state level, key academic institutions and associations, state level health directors, M&E officers, ICT directors and administrators, ICT for health program implementers (NGOs/private sector), and other relevant stakeholders were included in the study. At the LGA level, key academic institutions and associations, LGA-level health directors, M&E officers, ICT directors and administrators, ICT for health program implementers (NGOs/private sector), and other relevant stakeholders were enlisted and interviewed.

sampling

A multi-staged sampling technique was used. Simple random sampling was used to select six states from the six geopolitical zones as shown below in Figure 1.

Six States(one from each geopolitical zone)

Random selection of available healthcare workers within the selected heath facilities for general questionnaire study

Purposeful selection of facility head or ICT lead/manager for KII

National (identification of six geopolitical zones)

Selection of one primary, secondary and tertiary health Care facilities and training intuitions within the LGA

Targeted selection of six urban LGAs (State Capitals) – one per state

Random selection of six rural LGAs – one per state

figure 1: Sample selection for ICT assessment flow chart

| 17

Anambra (South East), Taraba (North East), Niger (North Central), Kaduna (North West), Cross Rivers State (South South), and Ondo (South West) were randomly selected. However, because of the Annual Festival in Cross Rivers, the state was substituted with Akwa Ibom State.

Between 37 and 40 participants were enlisted per state as seen in Table 1 below.

Participants were drawn from tertiary (60 participants, 25.9% of total participants), secondary (61, 26.3%), primary (94, 40.5%), and training institutions (17, 7.3%). Four (1.7%) participants classified under primary were from private health facilities within the LGA.

In the last stage, Key Informant Interviews (KII) for health administrators and IT leads in selected facilities, regulatory bodies, national agencies, health worker training institutions, and SMOH were conducted. At least one KII was done in each selected organization.

sample size

A total of 232 persons participated in this study, drawn from the six geopolitical zones of Nigeria.

exclusion criteria

Seven states were initially excluded from the study because of previous exposure to an ICT study by the funders. These states included Lagos, Imo, Kano, Sokoto, Akwa Ibom, Bauchi, and FCT.

data collection procedure

Interviewer-administered questionnaires and structured KIIs were used in this study (see Appendices 1 and 2). Six groups of four field workers were formed – EFMC (2), FMOH (1), and SMOH (1). The six teams worked concurrently at the six geopolitical zones for a total of five days (December 7-11, 2015).

table 1: States visited for ICT assessment and number of participants enrolled

STATENUMBER OF

PARTICIPANTSPERCENTAGE

OF TOTAL

Akwa Ibom 37 15.9%

Anambra 39 16.8%

Kaduna 39 16.8%

Niger 39 16.8%

Ondo 40 17.2%

Taraba 38 16.4%


data analysis plan

Data were collected, collated, cleaned and entered into SPSS Version 21 (IBM, 2012). A double entry technique was used to improve the accuracy and validity of the data. All data underwent descriptive analysis and frequencies were developed. Graphs (bar chart, histogram and pie chart) were developed to give visual dimension to the findings. Mean, mode and standard deviation were calculated along with range and 95% confidence intervals for interval and ratio measurements. In addition, simple percentages and proportions were computed.

ethical concerns

Institutional Review Board (IRB) approval was obtained from the National Health Research Ethics Committee of Nigeria (NHREC) of the Federal Ministry of Health (NHREC Protocol Number: NHREC/01/01/2007-18-11-2015; NHREC Approval Number: NHREC/01/01/2007-26/11/2015).

The FMOH also produced letters of introduction to the states, LGAs and facilities to support the assessment. In addition, individual oral consent was obtained following full explanation of the nature, content and purpose of the assessment from participating health workers using the introduction to the study tool as a guide.

quality assurance

FMOH personnel served as the national quality assurance team. Review meetings and discussions on the tools helped ensure that quality was maintained throughout the assessment. All data collectors were extensively trained on the use of the data tools and on data gathering exercises. Data entry was double checked to ensure accuracy and completeness.

| 19

Results

Quantitative and qualitative study results are presented in this section, beginning with the quantitative study results. Socio-demographic details of the participants, knowledge, skills, and use of ICTs are also reported. Finally, the qualitative training curriculum, proposed trainings, and prospects are recorded.

part a: quantitative studies

A total of 232 persons were surveyed in six states (Akwa Ibom, Anambra, Kaduna, Niger, Ondo and Taraba). The figure below depicts the gender distribution and location of the participants.

A majority of the participants (63.3%) were between 20 and 49 years old (Table 2).

figure 2: Gender distribution of participants in the ICT study in Nigeria, December 2015

table 2: Age distribution of participants in the ICT assessment exercise in six states

AGE RANGE TOTAL NUMBER PERCENT

>59 3 1.3%

20 - 29 43 18.5%

30 - 39 74 31.9%

40 - 49 73 31.5%

50 -59 38 16.4%

Total 232 100.0%

Male

45.26%Female

54.74%


figure 4: Participants living areas: rural vs . urbanfigure 3: Distribution of total participants according to rural vs . urban regions of the states according to their work places, December 2015

Urban

51.29%(119)

Rural

48.71%(113)

37.93%(88)

62.07%(144)

0

50

100

150

UrbanRural

Fre

que

ncy

Where Do You Live

| 21

Although 113 (48.7%) work in rural areas, only 88 (37.9%) live in rural areas.

Of the 232 participants, 122 (52.8%) were working in either tertiary or secondary facilities. The rest were working in primary or secondary facilities (Table 3).

A total of 100 participants (45.1%) had at least a Bachelor’s degree, while the rest were either holders of WASC/GCE or other certifications. Over 29% were either doctors or nurses. The rest were drawn from other professions (Table 4).

table 3: Level and type of health facilities where participants were working

FREQUENCY NUMBER PERCENT

Others 16 6.9%

Primary 94 4.5%

Secondary 61 26.3%

Tertiary 61 26.3%

Total 232 100.0%

Note: Four (4) private facilities were assessed and classified as primary.

table 4: Professions of participants in the ICT assessment study

NUMBER PERCENTCUMULATIVE

PERCENT

Accountant 6 2.6% 2.6%

Administrator 5 2.2% 4.7%

CHO/CHEW 52 22.4% 27.2%

Data Clerk 4 1.7% 28.9%

Doctor 25 10.8% 39.7%

Health Educator 1 .4% 40.1%

Information Officer

21 9.1% 49.1%

Laboratory Personnel

22 9.5% 58.6%

Nurse 43 18.5% 77.2%

Others 40 17.2% 94.4%

Pharmacist 13 5.6% 100.0%

Total 232 100.0%

Key Message: 58.2% have had one form of training training; however, 98.7% (229) of all participants indicated that they needed trainings in computer software.


All participants have and use mobile phone(s), the majority of which were self-purchased (218, 94%). Of those that use mobile phones, 4.7% use mobile phones purchased by their office and 3.9% had multiple phones purchased by different funders (self and office).

155 (66.8%) participants use computers, of which 75 (32.3%) are self-purchased, 29 (12.5%) were purchased by their offices with 31 (13.4%) having computers from both sources. Among those that completed this question, desktops were the most common type of computer used (57.5%) followed by laptops (28.8%). However, most personal computers were laptops (103, 44.4%), followed by desktops (5.2%) and tablets (1.7%).

A majority of office-owned computers were from the state government (35.0%). Other major sources of ownership included facility (23.8%) and donor (11.3%). The rest were from implementing partners (8.8%), LGAs (2.5%) and other undefined sources (18.8%).

135 (58.2%) of participants have had one form of computer-related training. A majority of these trainings took place in a computer training center (25.4%), followed by a university (11.2%). Other common training centers were the office/place of work (8.2%) and conferences (5.6%). Of those who said they have had trainings, 69.9% were issued training certificates, with a majority of these certificates being either Certificate of Attendance (21.5%), Certificate of Proficiency (20.6%) or Diploma (28.0%). Only 5.6% and 0.9% had Bachelor’s and Master’s degrees, respectively. All of the trainings were completed based on a documented curriculum, and most of the participants (95.0%) found the trainings to be useful. However, 98.7% (229) of all participants indicated that they needed trainings in computer software; however, they did not specify a particular software. Of the three who did not need trainings, one said he/she was already very proficient in ICT, and the other said it was an unnecessary burden.

83 (40.1%) participants used their computers three to five times a week with 29.3% using theirs daily. However, on self-computer skill ratings, 107 (46.1%) had never used a computer (40, 17.2%) before or functioned at a beginner level (67, 28.9%).

Knowledge of ICT Equipment and Tools

An assessment of the level of participant knowledge was the most revealing. Of the 186 that claimed to be computer literate, 94 (50.5%) were able to correctly identify an output device (e.g. computer monitor); 159 (85.5%) correctly identified a portable storage device (e.g. USB drive); 68 (36.6%) identified the icon for attaching a file to an e-mail; and 139 (74.7%) knew that search engines (such as Google) could be used to find specific information on the Internet.

On whether it was “safe to shop online”, 48 (25.8%) of the 186 did not respond as they were not sure. However, among those that responded, 68 (49.3%) were of the view that it was not safe. On which button on the toolbar a user would click to save a document, only 86 (46.2%) identified the right icon (diskette icon). Only 48 (25.8%) knew how to auto sum numbers in a spreadsheet, as well as knew the button that will enable a change of text color in an MS Word document. 116 (62.4%) correctly identified an image/picture file, 159 (85.5%) knew the benefits of a digital camera over a film camera, 166 (89.2%) knew the use of an MP3 player, and 182 (97.8%) could appropriately read system messages on their mobile phone.

Skills in ICT Among the Health Workers

Skills were assessed based on self-reports. Of the 232 participants, 121 (52.2%) of the participants could not sufficiently identify the main parts of a computer, 134 (57.8%) could not identify the types of storage devices, 120 (51.7%) could not create e-mails using a computer, and 128 (55.2%) did not know how to use search engines. Furthermore, 156 (67.2%) did not know how to prevent their computers from becoming infected with viruses, 167 (72.0%) did not know how to shop online, 113 (48.7%) could not save a document

Key Message: Knowledge of ICT for recreational activities (MP3, camera and text messages) were a lot higher than core business process ICT operational knowledge.

| 23

Key Message: ICT skills lagged behind ICT knowledge as more than 50% of all participants were unskilled in the most basic ICT activities.

using a computer, 165 (71.1%) could not do basic calculation on numbers in a spreadsheet, 137 (59.1%) could not do basic editing of a document and 144 (62.1%) found it difficult to identify different file types. Moreover, 147 (63.4%) did not know the advantages and disadvantages of a digital camera, and 132 (56.9%) could not explain the use of an MP3 player. However, only 27 (11.6%) could not send text messages on a mobile phone.

Use of ICT

There were 156 (67.2%) valid responses from participants for this question. The responses were classified into eight (8) different groups for analysis, classified as ICT for:

1. Communication (i.e. calls, SMS, e-mail, skype, social media)

2. Medical logistics and records (i.e. stock taking/management, medical commodity inventory, patients’ medical records and histories)

3. E-medicine (i.e. consultations, prescription, prescription review and dispensing, diagnosis, laboratory investigations, billing prescription)

RX

4. Documentation and report writing (i.e. typing of various documents, registrations, document review and editing, report submission, reporting on DHIS and NHIS)

5. Data management (i.e. data storage, analysis and retrieval, database management)

6. E-learning (i.e. internet surfing, PowerPoint presentations, research, current information, online registrations)

7. E-commerce and finance (i.e. budgeting, online shopping, bank transactions, staff salaries)

8. Entertainment (i.e. music, photography, editing)

A majority of the respondents used ICT primarily for E-learning (123, 78.8%). The other major uses of ICT were for documentation and report writing (94, 60.3%), communication (88, 56.4%), and data management (69, 44.2). 29 (18.6%), 21 (13.5%) and 16 (10.3%) used ICT for medical logistics and record-keeping, E-commerce and E-Medicine, respectively. The use of ICT for entertainment had the lowest score of 7 (4.49%).


ICT Skills and Experience

This section assessed the skills of core ICT experts (or individuals who thought they had sufficient ICT knowledge). Of the 232 participants, 26 (7.2%) responded to these core ICT questions. Of these, 16 (62.0%) respondents had Bachelor’s degrees (B.Sc, B-Eng or HND), 3 (12.0%) had a Diploma (ND, Diploma in Nursing and Midwifery), 3 (11.2%) had Master’s degrees, and 1 (3.8%) had an M.B.B.S. Only one candidate (3.8%) had just a WASC/GCE certification.

Of the 26 ICT-savvy participants, 18 (69.2%) were males; and a majority (73.1%) were from the state health care systems and younger than 40 years old (see Tables 5 and 6 below).

All, except the doctors and the nurses, were either heads of ICT units, data processing officers or working as monitoring and evaluation officers. Of the 26, 15 (57.5%) had less than 4 years of experience working in their respective organizations, while 3 (11.5%) had over 10 years of experience.

76.9% (20) of participants had an IT department in their establishment with zero to eight trained IT personnel in each department. 65.4% (17) of the establishments assessed use computers for data entry into an EMR/EHR/NHIS/DHIS2; and 42.3% (11) of establishments use mobile devices in collecting data. 24 (92.3%) staff had a positive/open (20, 76.9%) or very positive/open (4, 15.4%) attitude to the use of computers for data entry.

table 5: Level of care of practice of ICT trained healthcare workers

NUMBER PERCENT

Tertiary 4 15.4%

Primary 3 11.5%

Secondary 19 73.1%

Total 26 100.0%

table 6: Age of ICT practitioners who participated in the ICT assessment from six geo-political regions of Nigeria

AGE RANGE TOTAL NUMBER PERCENTAGE

20 – 29 7 26.9%

30 – 39 10 38.5%

40 – 49 7 26.9%

50 - 59 2 7.7%

Total 26 100.0%

Key Message: A majority of the participants did not see phone calls and text messaging as a core ICT activity, thus the low percentage levels for communication.

| 25

Twelve organizations (46.2%) have an EMR/NHIS/DHIS2 support unit. A majority (15, 57.7%) had no idea of the programming language that was used in developing the EMR/NHIS/DHIS2. Others mentioned Google Chrome, Internet Services, Microsoft Server 2003, Mysol, HTML and Open Source OS, Software System, Windows 8, Windows OS, and/or Windows/Linux O.S. Moreover, 15 (57.7%) of the facilities using Open Source OS were encouraged to adopt it by ICT personnel, with 13 (50.0%) being at least open to the suggestion.

On whether the organizations have a stable power supply to run all the ICT equipment available, 18 (69.2%) affirmed the presence of adequate power supply.

To ensure proper training and skills in the evolving ICT world, we wanted to know how often the ICT staff attended additional trainings. 10 (38.5%) noted that this never happened, 5 (19%) were not sure, while 10 (38.5%) were trained at least once a year.

Areas of Improvement in ICT Knowledge, Skills and Expertise

Regarding core areas of improvement, participants identified networking (14), programming (13), MS techniques and presentation (12), database capturing and management (13), computer appreciation and utilization (5), electronic medical records (EMR) and DHIS (4), use of Internet (4), graphics and Corel draw (4), E-learning (3), accounting software and revenue tracking (2), GIS and GPRS (2), and maintenance of computer hardware (2). Other identified areas include research, web design, server management, information security management, documentation and report writing, social media, SPSS, Epi Info, use of Internet; use of multimedia aids in student training; E-Mails; health informatics, and MIS.

While one person said that his staff needed training in all areas of programming, another noted that the staff needed no additional trainings.

The assessment also inquired about areas of training for professional capacity development. Areas noted include computer programming and networking (16); programming (9); data management and analysis (6), MS office tools (6); database creation and use; website design (2); graphics and Coral draw (2), and information security management (2). Other identified areas of improvement include, but are not limited to, computer maintenance and troubleshooting, data capturing, data processing and calculations, website design and hosting, health informatics, software project management, programming, GIS and GPRS, web applications, EMR, SPSS, Epi Info, SAS, STATA, and the use of the Internet.

Core ICT Professionals

Of the 232 respondents, only 18 (7.8%) were comfortable enough to complete this section of the questionnaire. These are drawn from facilities as depicted in Table 7 below.

7 (38.9%) had knowledge and experience on information security strategy development; 6 (33.3%) on education and training provision, relationship management, and process improvement; 5 (27.8%) on ICT quality management and information security management; and 4 (22.2%) on purchasing, contract management, personnel development, information and knowledge management, and business change management. In addition, 3 (16.7%) had knowledge and experience on ICT quality strategy development, risk management, and IT governance. However, only 1 (5.6%) participant had both knowledge and experience on project and portfolio management.


table 7: Location of primary assignment of core ICT staff

NUMBER INSTITUTION LEVEL OF CARE STATE

1 School of Nursing Anua Training Institute Akwa Ibom

2 St Luke’s Hospital Anua Secondary Akwa Ibom

3 School of Midwifery Anua Training Institute Akwa Ibom

4 University of Uyo Teaching Hospital Tertiary Akwa Ibom

5 ABU Zaria Tertiary Kaduna

6 Arakale CPHC, Akure Primary Ondo

7 Mother and Child Hospital, Akure Secondary Ondo

8 School of Nursing, Akure Secondary Ondo

9 Federal Medical Centre Tertiary Taraba

10 Taraba state specialist Hospital Tertiary Taraba

11 IBB Specialist Hospital, Minna Tertiary Niger

12 General Hospital, Minna Secondary Niger

13 School of Health Technology, Minna Tertiary Niger

14 School of Midwifery, Minna Tertiary Niger

15Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (Formerly ANSUTH)

Tertiary Anambra

16College of Medicine, Chukwuemeka Odumegwu Ojukwu University (Formerly ANSUTH)

Training Institute Anambra

16 Anambra State School of Nursing and Midwifery, Nkpor Training Institute Anambra

18 Anambra State College of Health Technology, Obosi Training Institute Anambra

| 27

part b: qualitative studies

To understand the basis of the quantitative findings, a qualitative study was done using key informant interviews (KII). ICT focal persons or institutional leads were purposefully selected to participate in this KII. A total of 29 KIIs were conducted in the six states visited covering the six geopolitical zones of Nigeria.

In the participating states, we visited facilities in rural and urban areas, where the head or ICT focal persons were interviewed. Findings were approximately the same across all facilities as there exists a large digital divide between the rural health workers/facilities and their counterparts in urban areas. Although there is a high level of interest in ICT practice and ICT-related trainings among most participants, trainings were infrequent. All health training institutions used ICT curricula. However, these curricula were not health specific, but part of the general ICT training for all students.

Recently, government at various levels had taken steps to improve ICT knowledge and practice in some locations. In Kaduna State, the state government recently developed a policy that tied all subsequent promotions to computer literacy levels and certifications. In Akwa Ibom State, the FMOH initiated a laptop and desktop program to provide computers to health care workers at subsidized rates. However, the actual provision of computers has not been uniform across the state. About five years ago, the Nigeria Communications Commission (NCC) intervened in Kaduna State by training some staff and selling computers to them at a subsidized cost. Similar support may have been seen in other states, but this was not explored in this study.

However, qualified trainers were scarce as most surveyed schools reported inadequately qualified ICT lecturers. Also, ICT courses were not offered as a requirement for graduation, resulting in a lack of seriousness on the part of the students compared to other courses in their institutions. In most surveyed institutions, ICT lecturers were needed, and current curricula needed to be revised and enriched. Among students in training, we discovered that their level of ICT skills were still rudimentary and limited to memorization of content solely for examination purposes.

These findings were worst at the LGA level where the PHC workforce were almost ignorant of ICT and had little or no official ICT exposure. A majority of healthcare workers trained in ICT were trained during week-long ICT workshops which culminated in certificates of attendance for participants. However, it was found that degree program students at both the graduate and undergraduate levels generally had better ICT skills than the rest of the participants.

Infrastructure

There is gross inadequacy of infrastructure for ICT training and skills acquisition across all states visited. For example, in one state it was learned that two years ago, FMOH gave out forms to schools with regard to laptops/desktops at subsidized prices and at the time of this assessment, nothing had been heard about the project. However, an institution in the South-South Zone recently received equipment to commence ICT training and is expecting all staff to become computer literate, a requirement for staff employment. This has led to the inclusion of ICT in their 2015 curriculum which was still under review at the time of this assessment. The personnel department has already commenced ICT trainings while awaiting the curriculum approval.

The absence of ICT training and infrastructure is more prevelant in North East than in other zones, as ICT equipment is lacking in most centers and none of the visited centers had Internet connectivity at the time of the assessment. Finally, apart from Ondo State where some institutions were said to have an adequate number of computers, most visited centers did not have a sufficient number of computers or ICT equipment.

Key Message: Government at various levels had taken steps to improve ICT knowledge and practice in some locations. In Kaduna State, the state government recently developed a policy that tied all subsequent promotions to computer literacy levels and certifications.


These deficiencies are similar to what previous assessments reported. Previous assessments and surveys identified the following characteristics and ICT gaps frequently observed in many facilities, with more issues found in rural areas:

• inadequate or lacking ICT equipment at many facilities,

• poor or no Internet connectivity,

• frequent interruption in power supply,

• inadequate knowledge or training on the use of ICT equipment,

• lack of accountability mechanisms in place,

• lack of uniform standards or clinical documentation requirements,

• variable experience and capacity to use ICT for health amongst health workers,

• absence of national health management information systems,

• absence of mobile conditional cash transfer,

• absence of mobile supply chain management, and

• inadequate demand generation.

Curriculum

The findings from KII are as shown below:

table 8: Curriculum present and accounted for at sites visited

NUMBER SITE VISITED CURRICULUM PRESENTSIGHTED/NOT SIGHTED

COMPREHENSIVE

1 Anambra4 centers visited Curriculum present in 2

Sighted– 0 Not sighted- 2

Comprehensive- None

2 Akwa-Ibom6 centers visited Curriculum present in 6


Comprehensive- 3 Not comprehensive- 3

3 Kaduna5 centers visited Curriculum present in 2


Comprehensive- None

4 Niger5 centers visited Curriculum present in 2


Comprehensive- None

5 Ondo5 centers visited Curriculum present in 3


Comprehensive- 3

6 Taraba5 centers visited Curriculum present in 3


Comprehensive- None

Key Message: Currently, there are ICT related curricula in all participating health institutions. However, these curricula were not health specific, but just a component of general ICT curricula in use

| 29

Most training institutions had curricula, but these were general in nature and content, and not health ICT specific. Where there were some forms of curricula, the majority were not sighted at the time of the assessment. The sighted curricula were part of a larger curriculum for the entire school used mostly to train students on basic computer appreciation. Moreover, available curricula needed to be updated to meet the changing availability and use of ICT. For example, in one center where there was a curriculum, a participant said:

“The curriculum is for basic computer appreciation and not sufficient for wider application in health.”

Furthermore, in institutions where there was “adequate” curricula (as defined by the participants), they were not being fully and properly implemented. There is, therefore, a need to have health specific curricula that covers health related issues for a more holistic approach to health ICT training.


Training, Personnel and Management Commitment

Human resources for ICT training and use were found to be grossly inadequate at all levels of the health institution and facilities visited. Available human resources were neither adequate to meet the needs of ICT training in schools, nor mentoring in facilities. Most trainers in institutions were not always available, as one participant noted:

“A permanent lecturer in ICT is needed for there to be great improvement in the training.”

The following shows trainings and certifications present in the institutions visited:

table 9: Types of trainings in institutions visited

SITE NUMBER

SITE VISITED

DEGREES FOR TRAININGS PRESENT

TARGET POPULATION

DURATION OF TRAINING

GAPS AND AREAS FOR IMPROVEMENT

1 Anambra MBBS (1, in view-1)

Doctors 4-5 years, 4-6 years

General computer appreciation and specialized skills e.g. • PowerPoint and Excel • Basic computer

programming • Networking • E-conferencing • Funds • Provision of computers and

generatorsCertificates and diploma (2)

Doctors, Students and other Health Workers

6 months, 1 year, 3 years

2 Akwa-Ibom HND Certificate (1)

Nurses 3 years • Provision of computers; • Government tutors to teach

ICT in the school • Students pay • New curriculum to be used

has Microsoft word • Excel and Internet

operations included• Adequate Internet• Full time lecturersRegistered

Midwife (2)Student Midwives

18 months

Registered Nurse (1)

Nurses 3 years

Diploma HND (1)

Students of health information management

2 years

3 Kaduna Not stated Not stated Not stated Not stated

| 31

SITE NUMBER

SITE VISITED

DEGREES FOR TRAININGS PRESENT

TARGET POPULATION


GAPS AND AREAS FOR IMPROVEMENT

4 Niger Computer appreciation

Doctors, Nurses, Students, Pharmacists, CHEWs, CHOs

1-4 months • Better assimilation by the trainee; provision of computers

5 Ondo ICT trainings and workshops

Doctors, M&E officers, program focal persons

One week • More training for staff • Improve Internet usage

component of the curriculum.

Registered Midwife (RM)

Midwives 6 months, 15 hours lecture, 45 hour practical

Registered Nurse (RN)

Nurses 6 months, 30 hours lecture, 60 hour practical

Diploma, Certificates

Community Health Extension workers- Technologist and technicians

Range from 1 to 2 semesters

Patient care training

Doctors, Nurses, Pharms, Lab scientist, ICT personnel, Admin

Two weeks

6 Taraba Diploma Certificate

Everybody Diploma– 6 months, Certificate– 3 months

• Access to Internet • More training for all staff

Diploma All staff and students

Diploma– 6 months


This state of affairs was worsened by poor commitment to ICT resources and adoption by management. The assessors found states where the current government has made a number of promises towards the improvement of ICT knowledge and skills, but these promises were yet to be translated into expressions of reality in the lives and careers of health workers in the state.

Healthcare workers also mentioned the lack of opportunities to advance their ICT skills. Moreover, both infrastructure and human resources were limited. To improve skills and competence, the participants suggested the following trainings as documented in Table 9 below.

table 10: Proposed ICT courses and class of Healthcare Workers/Duration

SITE NUMBER

SITE VISITED

PROPOSED FUTURE TRAININGS FOR HEALTHCARE WORKERS

TARGET POPULATION


EXPECTED BENEFITS OF PROPOSED TRAININGS

1 Anambra Diploma and Certificates on ICT

Doctors and other health workers

6 months – 1 year

Capacity building and improved service delivery to staff and patients

Diploma and Certificate for Doctors

Doctors 1 - 2 years Improved capacity for E-consulting, prescriptions etc.

Higher Programming Language

Health information management technicians, CHEWS, medical lab technicians, and pharmaceutical technicals

4 months Help enlighten the students and build skills, get better job opportunities and help the school to grow

2

Akwa-Ibom Training of the staff workforce/more advanced training for the students.

Student midwives and midwife tutors

6 months Since technology is applied in everything it would be beneficial to the students in teaching, data storage and eHealth.

ICT system of filing and record-keeping/documentation. A proposal on this training has been discussed at management level.

Students of information management technology

2 years (embedded into their training.)

Training would benefit the patients by reducing waiting time. It will help in quick folder retrieval and archiving.

| 33

SITE NUMBER

SITE VISITED


TARGET POPULATION



3 Kaduna Integrated course in Diploma, Bachelors, Masters

Doctors and nurses

Not defined Improved access to skilled personnel

Diploma Midwives (students)

0.3 (one semester in a 3 years course)

• Shifting of staff • Improved ICT skills

4 Niger eSystem training Doctors, nurses, pharmacists, ICT/records unit staff

1 month • Easy consultations• Proper documentation

of patient’s records• Helps to monitor drugs

in the pharmacy

eSystem training Doctors and nurses

1 month • Maximum improvement in Record system

• Awards

Diploma in Computer science

Nurses 1 year Career improvement

Diploma in Computer Science just began

CHEWS 1 year Students are compliant to e-learning and global practice.

None Nurses, CHEWS, CHOs

1 month To help improve their job skills

5 Ondo Trainings are part of the curriculum

Midwives 6 months To be computer literate and be able to conduct research

Trainings are incorporated into existing curriculum

Nurses 6 months To be computer literate

Patient care training Doctors, nurses, pharmacists, lab scientists, ICT and administrative personnel

Two weeks Plans are on the way to have at least 50-60% of patient data in the hospital on software so all staff will be mandated to go through the training to learn to retrieve patient information


The general approach of healthcare workers and students is that ICT training is not central to their work, being a beneficial extracurricular activity but not the core focus of their jobs. It is important to note that this point of view will hinder future skill building required for the health sector to be more technologically fluent and advanced. Further, lack of proper, hands-on ICT training for the workforce, lack of ICT equipment in most of the facilities visited, shortage of qualified ICT staff, and erratic powers supply in PHCs inhibit comprehensive ICT development nationwide.

Challenges of ICT Knowledge in Health

Funding for training and acquiring ICT equipment appeared to be the major challenge facing ICT penetration in Nigeria. In addition, low ICT knowledge, relative scarcity of qualified ICT professionals in government employment, erratic power supply, absence of permanent lecturers and no Internet connectivity are other challenges faced.

Prospects

In one school in Ondo, the assessment team learned that there were a sufficient number of computers, but were occasionally challenged by Internet connectivity issues. The availability is a positive sign, and reveals that access to ICTs can be made a reality for every heathcare worker and student, but will require governmental commitment.

Key Message: Funding for training and ICT equipment appeared to be the major challenge of ICT penetration in Nigeria

SITE NUMBER

SITE VISITED


TARGET POPULATION



6 Taraba Certificate Doctors, nurses, pharmacists, lab scientists, data clerks, and administrative staff

3 months • Improved ICT knowledge

• Revenue tracking• Data security and

protection and improved information management

• Ease of work

Certificate and Diploma

Staff, students and local citizens

3 months, 6 months, and 1 year, respectively

Increased employability. The training will help them in their work after graduation.

Certificate All staff Two weeks else everyone will be tire

Improved data and information storage

Certificate All academic staff and student

Two weeks There will be proper use of ICT. More research will be done.

| 35

Synthesis of Findings of Assessment

Currently, there are ICT-related curricula in all health institutions that participated in the study. However, these curricula were not health specific, but just a component of general ICT curricula in use. A majority of the curricula were not sighted, but the few that were seen covered most aspects of general ICT. All institutions also offered some form of ICT training, but lacked the prerequisite infrastructure and regular trainers for effective training. ICT training as weighted by respondents was not a requirement for graduation as they were only components of school courses instead of there being an independent ICT course. There is also very little post-training practice of ICT, leading to poor skills in the field. These gaps provide an excellent opportunity for the training of both core and non-core ICT specialists including physicians, nurses, community health workers, and administrators/officers etc., using properly adapted curricula designed for core and non-core ICT healthcare workers.

In all institutions visited, there were neither specific ICT-ready health workers’ curricula nor training. Knowledge, attitude, and skills of healthcare workers are below average as the majority were trained during week long conferences or workshops. Others were trained in their places of work while on the job without a defined curriculum. However, there is general agreement for a specific curricula for ICT-ready healthcare workers, and specialized training courses to both sensitize and improve their skills. The proposed training should be executed immediately after graduation, but before National Youth Service for a period of six (6) months. This should be a diploma level course and made mandatory for all healthcare workers before the end of their service year and a prerequisite for employment into any public or multinational establishment. In addition, it is suggested that every healthcare worker should undergo a three- to four-week refresher course at least once every three years to update skills and knowledge on ICT developments in their respective field. This should be a prerequisite for promotion and career advancement.

This assessment revealed the absence of health ICT, and public health/biomedical informatics curricula in the schools and health institutions visited. The components of health ICT and public health/biomedical informatics seen were embedded into the general computer science courses within the institutions. Moving forward, there will be the need to tease out these sections of the curricula, expand them and ensure that all ICT professionals in the health industry are exposed to them and empowered to use health ICT infrastructure effectively and efficiently. This will support increased demand for IT skills within the health system.

To build the capacity and skills of the existing professionals and improve training of a new cadre of professionals, in-service health ICT trainings should be included as a professional development requirement, and required for annual renewal of practicing licenses. Additionally, all health workers should be required to attend at least a three-week course on ICT once every three years. All healthcare training centers should have adequate infrastructure for practical sessions. ICT infrastructure should also be made available at all healthcare facilities for effective practice during and after their trainings.


Moving forward, the Federal Ministry of Health (FMOH) should partner with the Federal Ministry of Education, relevant regulatory bodies, and other education stakeholders to design, develop, and implement a health specific ICT intensive curricula for health informatics and make it compulsory at all levels of education and mandatory for all health related institutions of learning. The same curricula should be used to re-train current health workforce involving all cadres as part of their continuous professional development programs. These trainings should be competency based, rather than didactic. The Nigerian Government should also design and develop a national policy that makes ICT literacy a requisite for employment and promotions, as is the case in Kaduna State. However, funding should be earmarked for provision of necessary infrastructures including electricity, ICT soft and hardware, and internet facilities.

| 37

Conclusion

There is a relatively low level of knowledge among the healthcare workers on ICT-related issues with over 50% deficiency in knowledge in most knowledge areas. The absence of good ICT infrastructure, healthcare specific ICT curriculum and qualified and motivated ICT trainers were some of the hindrances to ICT use and adoption in the health system.

The study also revealed that some participants were willing and eager to learn and use ICT. However, as ICT was not seen as a requisite for healthcare professional activity, nor a requirement for graduation and subsequent professional certification, there was poor translation of knowledge into practice.

These human and infrastructural challenges may be contributors to the low ICT penetration in the health system, low skill sets and capacity of healthcare workers and low use of available ICT infrastructure.


Recommendations

This section focuses on developing and harmonizing health ICT knowledge, skills and practice in Nigeria by proposing some minimum benchmark criteria for healthcare workers, logic models and training matrices.

minimum ict knowledge and skills

It is generally agreed that ICT knowledge, skills and expertise are important in health, but no benchmarks have been set on what is needed or optimal. As there are no minimum ICT standards yet in Nigeria, the following recommendations are suggested as either benchmarks, or foundations for the development of national minimum standards. The following guidelines are proposed.

Basic ICT Knowledge and Exposure per person

Every health worker should have a basic awareness and knowledge of the following ICT infrastructures and/or activities:

• E-communication (E-Mail, Instant Messaging, Video and Audio calls)

• Internet-based research

• Funds Transfer

• Outlook/Or other email clients

• Knowledge Sharing

• Customer Relationship Management (CRM)

• Enterprise Resources Planning (ERP)

• Computer Aided Designs (CAD)

• E-Procurement

• Intranet

• Portals

• Global Positioning Systems (GPS)/Geographical Information System (GIS)

Basic ICT use by users and support staff

This is classified into five different stages for all healthcare workers.

Every user should therefore be able to pass through a minimum of four levels of competence:

Level 1: Computer literacy shown by an individual’s self-described ability to use computers, including desktop, laptop, tablets or other ICT tools as well as properly identify an output device (computer monitor); a portable storage device (USB drive); the icon for attaching a file to an e-mail; as well as define proper use of search engines (such as Google).

Level 2: Proven ability to type with a computer, send emails, work with MS Office tools especially MS Word, MS Excel and MS PowerPoint.

| 39

Level 3: Proven ability to use MS Office tool including Access, Project and Outlook for planning, reports and scheduling.

Level 4: Proven ability to use Excel formulas, and other data management tools.

Basic ICT Use per Establishment

Every healthcare establishment should provide, at a minimum, the infrastructures for the following ICT related activities:

• E-Mail

• Websites

• E-Procurement

• Intranet

• Extranet

• CRM

• ERP

• Document sharing


health ict skill set upscale logic model

Poor ICT penetration in the health industry with resultant poor ICT trainings, knowledge and infrastructure

Observable improvement in health ICT knowledge penetration in healthcare services – knowledge, skills and infrastructure

Sustained improvement in knowledge, attitude, skills, and use of health ICT in health institutions and facilities

Universal Health Coverage as a result of health ICT enabled workforce

Health ICT training curriculum updated and distributed to all

health training institutions

Train the trainers program organized and implemented

pre- and in-service trainings conducted

Updated health ICT curriculum developed

and circulated

Health care workers trained using tailored health ICT curriculum

at various levels

Health ICT trainers identified and trained

SITUATION

INPUTS

SHORT TERMOUTCOMES

MEDUIM TERMOUTCOMES

LONG TERMOUTCOMES

IMPACTS

figure 5: Health ICT Improvement Logic Model

| 41

learning stages

Healthcare workers should be exposed in-service and pre-service to ICT following the schedule below.

figure 6: Health ICT learning Stages

STAFF TO STAFF (S2S)

STAFF TO BOSS (S2B)

STAFF TO CUSTOMERS (S2C)

STAFF TO INSTITUTION (S2I)

STAFF TO ALL (S2A)

Focus Communication, E-learning

Productivity, documentation and report learning

E-Medicine, CRM, improved outcomes

Procurement and Management, Medical logistics and records, and Data management

E-Commerce and Finance, E-entertainment

Systems Computers, Phones (Smart and Non)

Computers, Phones (Smart and Non), Productivity software

Computers, Phones (Smart and Non)



Processes One to one tutorial and intensive practical coaching

One to one tutorial and intensive practical coaching




Strategies • Active Learning

• Learner-Centered Teaching

• Lecture Strategies

• Teaching with Cases

• Collaborative/Cooperative Learning

• Active Learning





• Active Learning





• Active Learning





• Active Learning




1 2 3 4 5


training matrix

The training of healthcare workers in ICT should be guided by the following matrix.

figure 7: Health ICT training matrix

STAGE 1: ICT APPRECIATION

STAGE 2: ICT BASIC USE AND PROCESS MANAGEMENT

STAGE 3: ICT ADVANCED USE AND ANALYTICAL ANALYSIS

STAGE 4: ICT MANAGE-MENT AND MAINTENANCE

STAGE 5: ICT PROGRAM DEVELOP-MENT AND DESIGN

Primary Objective

Improve knowl-edge and access to ICT

Ability to use basic MS Office and other communications tools

Ability to use Excel analytical and other data management and planning tools

Ability to troubleshoot ICT challenges and solve sim-ple problems

Ability to design, develop and manage programs

Knowledge/Skills Focus

ICT software and hardware, websites, emails

Office tools and its operational-ization

Data man-agement and planning techniques

ICT basic and intermediate challenges and their management

Program initiation, devel-opment and deployment

Dominant Infrastructure

Communication tools including computers, telephones (GSM), etc

Work flow and output, CRM, computers, Internet, intranet and extranets,

Database and planning, process and product data, ERP knowledge networks

In-situ development and deploy-ment of new programs as the need arises

Logistic coordi-nation, supply chain manage-ment systems, procurement procedures and E-procurement, EMR devel-opment and deployment

Operational Focus

Staff access to ICT

Staff use of MS tools for enhanced performance

Proper staff management and planning

Maintenance culture and effective handling of ICT tools

Main process or Use

Computers, Smart Phones,

Internet, Websites and Networks

Data Systems –Excel, SPSS, Epi Info, Epi Data, SAS, etc.

CISCO (CCNA, CCNP,CCNE), MCSE, A+, Net-work+, Server+ etc…

Windows/ Linux O.S, HTML, PHP, MySQL, etc

| 43

To build an ICT compliant health system in Nigeria, the following eight (8) specific recommendations are proposed:

1. Health ICT Technical Working Group/Committee: Stakeholders across Nigeria — at both the national and state levels — with relevant partners, should implement the recommendations of the other assessments conducted as a part of the ICT4SOML initiative.

2. Health ICT Funds: To develop health ICT, adequate funds are needed. Thus, it is recommended to establish a health ICT fund. This shall be a source of funds for all health ICT activities. Partners who also desire to work in health ICT spaces should have a joint funding mechanism that funds the entire national health ICT development. This will prevent duplication of activities, parallel services and conflicts while enhancing better implementation of projects and improved outcomes.

3. Health Information Management Systems (HIMS): Building the capacity of relevant stakeholders on the National Health Information Management System (NHIMS), domiciled in Abuja, will help coordinate the health ICT activities and serve as a repository of information for health data. This will also work to triangulate all health data sets across the nation into a single database for information generation and decision making. The NHIMS will be a living system regularly updated and open to health data from all the states of Nigeria. In addition, this NHIMS will be linked to sub-HIMS located in all state capitals across Nigeria, as well as in all health-related parastatal agencies.


4. Health ICT Curriculum: Although there are various ICT curricula, there was no specific health ICT curriculum. The relevant TWG (including the relevant regulatory bodies) should work with partners and health institutions to develop a health specific ICT curriculum for basic, undergraduate and postgraduate trainings of health workers. This should also be updated as ICT evolves globally.

5. Health ICT Infrastructural development: This is critical for proper translation of health ICT training into practice. This will be developed in phases based on availability of policy, operational plans and resources. Also, this will be developed in such a way to ensure equity and fairness to all states and levels of healthcare in Nigeria. The development of these infrastructures may be supervised by the relevant TWG.

6. Health ICT strategic and operational plans: The proposed health ICT policy should be used to develop health ICT strategic and operational plans for the implementation of ICT scale up and scale-out across Nigeria.

7. Training of healthcare workers on ICT: Using the proposed curriculum, systematic in-service training for healthcare workers should be put in place. Similarly, pre-service trainings at basic, undergraduate and postgraduate levels should be developed and approved by relevant authorities of healthcare worker training institutions across Nigeria. Further, regulatory bodies should make trainings in health ICT compulsory for qualification and certifications of healthcare workers across all field of the health industry. Finally, certification and degree (Bachelors, Masters and even PhD) courses in health ICT should be established for healthcare workers.

8. Cadre of professionals and career path: ICT trained healthcare workers should be recognized as a functional line manager in the health industry. Individuals with these skills should have a professionalized, progressive career trajectory similar to other healthcare workers. Individuals with bachelor’s degrees and additional ICT certifications (like a diploma) should begin at Level 9 and move on progressively to higher levels. The ICT unit, because of the current Business to Business (B2B), Business to Customer (B2C), and Customer to Customer (C2C) relevance of ICT, should be identified and created as a separate department within the Ministry. Also, the ICT unit should be headed by an ICT Director. The use of big data, development of a national database, and regular update of the database should be part of their assignment. Furthermore, they should be mandated to ensure that all healthcare workers are properly trained in ICT and able to use ICT infrastructures, maintain current and future ICT infrastructures, develop and manage health industry social media and websites, and ensure appropriate and timely sharing of information with the public.

| 45

References

Federal Ministry of Health (FMOH) and Federal Ministry of Communication Technology (FMCT). (2015). National health ICT strategic framework 2015-2020. http://www.unfoundation.org/features/mhealth/national-health-ict-strategic.pdf

United Nations Foundation in support of ICT4SOML. (2015). Nigeria health ICT phase 2 field assessment findings. http://www.health.gov.ng/doc/FieldAssessment.pdf

United Nations Foundation in support of ICT4SOML. (2014a). Accessing the enabling environment for ICTs for health in Nigeria; A landscape and survey. http://www.health.gov.ng/doc/nigeria-Health-ICT-landscape-report.pdfUnited

United Nations Foundation in support of ICT4SOML. (2014b). Accessing the enabling environment for ICTs for health in Nigeria; A review of policies. http://www.health.gov.ng/doc/nigeria-Health-ICT-policy-report.pdf

United Nations Foundation in support of ICT4SOML (2015),. “Keeping Personal Health Information Safe and Secure: A Guide to Privacy and Data Security Laws in Nigeria.” October 2015. http://www.unfoundation.org/assets/pdf/keeping-personal-health.PDF


Appendix 1: Institutions and People interviewed

INDIVIDUALS INTERVIEWED NAME OF INSTITUTION VISITED DESIGNATION

North East (Taraba State)

Mr. Jellason Yuguda Taraba State Specialist Hospital Head ICT

Joseph Bright Federal Medical Centre, Jalingo Head ICT

Mr. Kiloh Nfor Taraba State College of Nursing and Midwifery

Principal

Mrs. Larai Maihankali Taraba State College of Health Technology

Deputy provost Academy

Mamman B Bawuru Taraba State College of Health Technology

Computer coordinator

South West (Ondo State)

Dr. Marius Adeniyi Ondo State Primary Healthcare Development Board

PHC coordinator

Mrs. Ibitoye Olabisi F. Ondo State School of Midwifery, Akure

V.P SMW

Mrs O. M. Iwaola, Ondo State School of Nursing, Akure

VP SON

Dr Olawoye Felix, Ondo State School of Health Technology

College provost

Mr. Foluso Israel Taiwo Federal medical Centre, Owo Senior Program Analyst

| 47


North Central (Niger State)

Dr Umar Isah A. IBB Specialist Hospital, Minna CMD

Dr, A bubakar Sani Bello General Hospital, Minna MD

Aisha Mekudi School of Midwifery, Minna Provost

Abdullahi D. Bello School of Health Technology, Minna Provost

Hadiza Aliyu Health Department Shiroro L.G.A. HOD Health

North West (Kaduna State)

Sanusi Rayyanu General Hospital Giwa Hospital Secretary

Adamu Ahmed Ahmadu Bello University Teaching Hospital Shika, Zaria

CMAC/Acting CMD

Dr Tijjani FG Yusuf Dantsoho Memorial Hospital Acting CMD

Shehu Danlami Kaduna state college of Midwifery Provost

Zainab Sabo Sambo Rigachikum PHC Nurse in-charge



South South (Akwa Ibom State)

Mrs Philomena Patrick Edem School of Nursing Anua, Uyo. Vice Principal Academics.

Mrs Ekaete U. Akpan School of Midwiffery Anua, Uyo. Principal

Ononokpono Mercy School of Health Information Management, University of Uyo Teaching Hospital, Uuth, Uyo.

School Secretary

Mrs Uduak Akang College of Health Sciences, University of Uyo.

Admin Secretary

Nyeneime Efiong Efiakedoho, School of Midwifery, Ituk Mbang, Uruan LGA

Principal

Mrs Mayen S. Ekanem School of Nursing Ituk Mbang, Uruan LGA.

Principal

South East (Anambra State)

Engr Tochukwu Onyeyili School of Nursing and Midwifery Anambra State University Teaching Hospital Nkpor

ICT Lead

Anaehobi Chizube Anambra State College of Health Technology, Obosi

ICT Lead

Dr Ejiofor O. S Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (Formerly ANSUTH)

Deputy CMAC

Dr Echezona E E C College of Medicine, Chukwuemeka Odumegwu Ojukwu University (Formerly ANSUTH)

Assist Dean

| 49

Appendix 2: Project Team

Consultant:

• Dr. Obinna Oleribe

ICT4SOML Team

• Olasupo Oyedepo

• Emeka Chukwu

• Salama Ashiya Achi

• Carolyn Florey

• Dr. Patricia Mechael

• Abigail Manz

STATE EFMC STAFF FMOH STAFF

North East– Taraba • Bright Amadi • Deborah Udofia

• Mr. Haruna Aminu Aliu

North West– Kaduna • Sagir Abubakar • Ann Enenche

• Mrs. Vashti Said

North Central– Niger • Princess Osita-Oleribe • Ugochinyere Okoro

• Dr. Tony Udoh

South East– Anambra • Paul Ezieme • Grace Iyalla

• Mr. Nwanka Lawrence

South West– Ondo • Patience Akinola • Ede Enenche

• Mr. Adeleke Balogun

South South– Akwa Ibom • Ekei Ekom • Solomon Nwabuzor

• Mrs. Ibiene Roberts • Dr. Emuren Doubra


PHOTO CREDITS

FRONT COVER: Adrian Brooks, Courtesy of PhotoshareINSIDE FRONT COVER: Akintunde Akinleye/NURHI, Courtesy of PhotosharePAGE 7: Akintunde Akinleye/NURHI, Courtesy of PhotosharePAGE 11: Akintunde Akinleye/NURHI, Courtesy of PhotosharePAGE 15: United Nations FoundationPAGE 18: eHealth Africa, Courtesy of PhotosharePAGE 20: United Nations FoundationPAGE 29: United Nations FoundationPAGE 37: Peter Roberts, Courtesy of PhotosharePAGE 43: United Nations FoundationINSIDE BACK COVER: Akintunde Akinleye/NURHI, Courtesy of Photoshare

52 | ASSESSING THE ENABLING ENVIRONMENT FOR ICTS FOR HEALTH IN NIGERIA

nigeria health ict workforce and curricula assessment

Documents