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Why Nigeria needs a National eHealth strategy

BY Chioma Obinna

Mr. Job Agbo, not (real name) recently visited his doctor with chronic kneel pain. The condition was not severe enough to require a visit to the emergency department, but it kept him awake all night and interfered with his daily activities. He was given a hand-written referral to review previous films and treat according to recommendation in the report”

He took his hand -written referral and booked for an “urgent kneel procedure” with the Radiology staff of the hospital. He came few days after for the procedure. But no one could trace his previous films or reports. The situation was compounded as no one knew where the previous films or reports were.

Efforts to contact his doctor proved abortive as he was said to have gone on vacation. Job was unable to have the procedure done because no one knew the details of his current clinical problem and there was no referral to perform any sort of repeat x-ray or CT scan to determine the type of treatment to alleviate his symptoms.

Many patients are faced with similar problem in Nigeria today. Advancement in medicine have shown that Electronic Health, eHealth, would have made a significant difference to this real life situation. With eHealth, the doctor would have been able to submit the request electronically and the Radiology reception staff would be able to retrieve Mr. Job’s electronic health record instantaneously, including the previous reports.

Instead of spending the whole day at the health facility, an estimated 20 minutes would have been enough for the required procedure. Findings have shown that availability of electronic health and mobile health services plays a major role in the delivery of public health services around the world.

In Nigeria today, cases of negligence in the course of healthcare service provision in most hospitals abounds. Medical tourism has become the order of the day.  Reports have it that no fewer than N78 billion are spent by Nigerians annually on medical tourism. While countries like India earn about $260 million from medical tourism.

No thanks to the fact that most Nigerians have lost confidence in the country’s healthcare system.  The situation is so bad that many Nigerians travel to countries like India and Ghana even for common illnesses like malaria.  Unconfirmed reports revealed that no fewer than 3000 Nigerians travel to India annually for various medical reasons.

To strengthen the country’s health system as well as make the country a medical tourism destination of choice, Health Watchers say paying more attention to e-health and telemedicine by developing a national eHealth Strategy will ensure that Nigerians get the right treatment and the right medication in the right place and time. The story of Job aptly describes the difference eHealth will make to patients and  providers.

Health Minister, Onyebuchi Chukwu
Health Minister, Onyebuchi Chukwu

The World Health Organisation, WHO, has identified eHealth as a veritable tool to deliver health information for health professionals and health consumers, through the Internet and telecommunications as well as using Information Technology, IT, to improve public health services through education and training of health workers.

Critical observers are of the view that eHealth has not only helped health economists focus on a host of inexpensive clinical applications such as tele-neonatology, tele-paediatrics, it has become an essential tool to administer healthcare needs in developed nations.

In the views of a Senior Strategic Advisor, International Development Research Centre/Nigeria Evidence-Base Health Systems Strengthening Initiative, Dr. Muhammed Lecky, there have been worldwide recognition and interest in eHealth as an enabler of national health systems.

According to Lecky, although Nigerian Government has sought to pay more attention to this important emerging field, every attempt to achieve coherence in the form of an articulated policy framework regarding telemedicine and eHealth in Nigeria had hitherto proven abortive.

This may not be unconnected with the absence of a national e-health strategy to facilitate a systematic, coherent and sustainable implementation of telemedicine and eHealth in the country. With some medical institutions in the country embracing eHealth, the absence of the national e-health policy has made the development of eHealth and integration into the nation’s healthcare delivery system difficult.

Experts are of the view that telemedicine and eHealth should be integrated into the curriculum of medical/health training institutions in the country, they believe that the Federal Government should promote advocacy to get the three tiers of government involved in the development of eHealth strategy, with active participation of all major stakeholders — private sector academia/universities, NGOs in health, development partners, professional bodies and associations, etc.

At the 17th International Conference on Telemedicine and eHealth (ISfTeH), organised by Society for Telemedicine and eHealth in Nigeria (SfTeHIN), the National Representative member of ISfTeH, in Abuja recently, Prof. Eyitayo Lambo, former Minister of Health, admitted that the implementation of eHealth in the country has been largely piecemeal and uncoordinated as existing pilots were rarely scaled-up.”

Lambo who regretted the absence of a comprehensive national eHealth strategy, identified lack of policy and an eHealth legislative framework, power problems, lack of political will, absence of a robust ICT infrastructure, poor funding of the health sector as major challenges.

“eHealth would provide efficient and cost effective healthcare services for people in remote areas through early diagnostics, logistics and supplies as well as help individuals to make informed decisions about their health. Beneficiaries of eHealth include patients, healthcare professionals and providers, government bodies, policymakers, healthcare educators and students.”

He explained that the National Health Policy and the National Strategic Health Development Plan Framework (2009 – 2015), developed by the Federal Ministry of Health were key documents upon which any work towards developing the eHealth policy should be based upon.

Lambo explained that developing a national eHealth Strategy involves a multi stakeholder participatory approach and a credible strategy development process, by which the eHealth strategy would be aligned to the strategic priorities of the health sector.

“The Federal Ministry of Health should facilitate a coherent and sustainable implementation of eHealth in Nigeria, get every level of government involved and provide enabling environment for implementation with a national eHealth steering committee.

Available information have shown that until 1999, ICT use in Nigeria was next to nothing until development of ICT policies for the telecommunications sector in 2000 and the establishment of the National Information Technology Development Agency (NITDA) to formulate a National Policy for ICT in Nigeria in 2003.

With the adoption of District Health Information System (DHIS) as a national tool for reporting aggregate data from the lowest to the highest levels, the need for a comprehensive situational analysis as a precondition for the development of a comprehensive national eHealth strategy cannot be overemphasised.

President, SfTeHIN, Mr. Olajide Adebola, “A comprehensive situational analysis of the implementation of telemedicine and eHealth initiatives should be undertaken to identify the strengths, weaknesses, opportunities and threats of the current efforts. The eHealth strategy should address local needs and should involve locally driven solutions.”

He called for the upgrade of the National Telemedicine Programme to a national eHealth programme with secretariat under the ICT Department in the Federal Ministry of Health. “A National eHealth Committee should be constituted, possibly under the purview of the National Council on Health with membership drawn from all major stakeholder groups.

and this body should be charged with the responsibility of providing policy advice to the government on telemedicine and eHealth matters.

He added that the programme should be strengthened and adequately utilised, and similar desks established at the various State Ministries of Health.


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