Why Nigeria needs a national e-Health policy strategy

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Knowhow Media International Reports-Asst Writer/Researher: MOSHOOD ABUBAKAR

One of the global milestones in medicine is e-Health – leveraging on ICT to deliver efficient health care services to citizens. In the developed world, the introduction of ICT to the health sector has helped to bridge the relationship between patients and health service providers, and improve the transmission of data from institution to institution and the communication between health professionals.

 

Unfortunately, Nigeria seems to slumber in embracing e-health to address the challenges in its healthcare system. The country loses more than N81 billion annually to medical tourism, according to recent reports. The gainers are India, South Africa, Dubai and some European countries where highly developed healthcare system integrated with ICT has helped to provide succor for many.

 

With poor physical infrastructures and scarce health practitioners, e-health has the potential to strengthen the country’s health service delivery once the right policy framework for ICT adoption in the health industry is adopted as it has been the case in countries like India, Rwanda, Kenya and Uganda.

 

Dr. Osahon Enabulele, president of the Nigeria Medical Association (NMA), blames limited funding and shortage of medical manpower skilled in ICT as major reasons e-health adoption has been slow. He said: “Whereas there is an overwhelming evidence that developing countries like India, Rwanda, Kenya and Uganda have greatly explored the potentials of e-health in transforming their health systems and economies, Nigeria is yet to enthrone a strategic policy for sustained utilisation of e-health in a way to maximize its alluring and undeniable benefits in strengthening Nigeria’s healthcare system, improving Nigerians’ access to healthcare services in the face of limited resources and chronic shortage of medical/health manpower, improving medical education and research, improving the quality and efficiency of healthcare services and therefore improving the health and development indices of Nigeria.”

 

Nigeria’s health sector is notoriously underfunded and the industry is routinely besieged with labour crises. As we write, medical doctors are on a stay at home strike. The sector is long on  poor funding, insufficient manpower, paucity of  health infrastructures and absence of clear cut universal health policy or disposal insurance schemes to cover costly medicare; and very short on deliverables.  There are four doctors for every 10,000 inhabitants in Nigeria. Medical statistics available have also shown that while 90% of ordinary citizens go to government hospitals for subsidized medical care, not more than 10% of practicing doctors are employed by these government health institutions. This implies a long waiting time to get medical attention and an urgent need to implement e-health.

 

“Thehuge crowd that is often seen at any of the out-patient clinics of public hospitals can be so scary to any doctor who means well and have planned to meet up with the demands of all his patients as much as possible on any normal day. This is because while he has to attend to the large number of sick patients, listen to each one of their complaints, diagnose their ailments and make good prescriptions, he has to contend with the cumbersome nature in which the healthcare services are carried out which often times are frustrating and stressful even to the best of doctors,” said Professor Olumuyiwa Odusanya, the Provost of the Lagos State College of Medicine (LASUCOM) during the Second Olikoye Memorial Lecture at the 53rd Annual General Conference and delegates meeting of the Nigeria Medical Association in Lagos.

This affects the performance of the doctors as it often leaves them brain-fatigued as they have to work assiduously, while they are grossly underpaid. A challenge that has forced large number of medical practitioners to migrate to developed countries with better health care system and where the skills earn better remunerations.

 

In 2012, the Nigerian House Committee on Diaspora, lamenting on the shortage of medical professionals in Nigeria, disclosed that 77 per cent of members of the Association of Black Doctors practising in the United States of America were Nigerians. To support this statistic, Dr. Osahon revealed in the media that last year that there is only one in three registered Nigerian doctors’ practices in the country, the other two-thirds have migrated abroad.

 

According to Osahon, out of the 71,740 doctors registered with Medical and Dental Council, only about 27,000 are practising in Nigeria, while others are practising outside the shores of this country. Up to 7,000 Nigerian doctors work in British and the American public health sectors, while some have left the medical profession on account of better working conditions. That number seems to be far- short of the World Health Organisation (WHO) standard of one doctor to 600 patients.

 

What this means for Nigeria’s healthcare system delivery is that patients are left in the hands of doctors, who are easily prone to medical errors due to long rigorous working hours, others are left unattended to, thus leading to their untimely death. Medical practitioners are only human after all. This also explains the high infant mortality rate. Going by the 2008 National Demographic Health Survey, the indicator is that infant mortality rate is 75 deaths per 1,000 live births, while the under-five mortality rate is 157 per 1,000 live births for the five-year period immediately preceding the survey. The neonatal mortality rate is 40 per 1,000 births. Thus, almost half of childhood deaths occurres during infancy, with one-quarter taking place during the first month of life.

 

The statistic shows that Nigeria’s infant mortality rate is better than only 13 other countries in the world. The number is alarming when compared to war ravaged Sudan’s 65 deaths in 1000 live births. It is also reported that Over 300,000 Nigerians die from malaria each year – more than in any other country. An estimated 250,000 are children younger than five. Currently, the Ebola Virus outbreak is crawling on the health sector but could have an explosive growth if not properly checked. Ebola has led to the death of many people in countries like Liberia, Guinea and Sierra Leone.

 

How can Nigeria leapfrog from this health dilemma? To Mr. Mustapha Danesi, Professor of Neurology, College of Medicine, University of Lagos, Nigeria, the only way is to incorporate the general use of Information Communications Technology systems in our day to day running of our health care systems.  He said: “Medical practice in many developed and developing countries are now in stage 4 healthcare development which is the health system of the 21st century. In stage 4 healthcare practice, healthcare organizations have the characteristics of high performing organizations and focus on the six aims for improvement: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity.  Patients have as much control as they want over treatment decisions and services are coordinated across practices, with generous use of Information Communications Technology systems.”

 

Going by his argument, Nigeria is currently practising 19th or 20th century health care system in which Information Communications Technology tools are entirely absent. Therefore healthcare delivery system is highly fragmented, where physicians, hospitals and other healthcare organizations function autonomously. Patients rely on physician’s training and experience for guidance and physicians rely on their own experience to make best decisions.  Patient’s role is passive and they have no control over treatment decisions.

 

According to Wikipedia, ‘e-Health covers the deployment of electronic/digital processes in health. While others use it in the narrower sense of healthcare practices using the internet, it can also include health applications and links on mobile phones, referred to as m-Health.’

The major advantage of e-Health is that it smoothen the communication of patients data between different health care professionals via electronic health records. It encourages treatment at a distance and real time monitoring of patients via telemedicine. It also includes the use of mobile devices in collecting patients’ health data to medical practitioners, researchers.


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