The Nigerian health information system policy review of 2014 : the need, content, expectations and progress

Current status of digital health interventions in the health system in Burkina Faso

BACKGROUND

Digital health is being used as an accelerator to improve the traditional healthcare system, aiding countries in achieving their sustainable development goals. Burkina Faso aims to harmonize its digital health interventions to guide its digital health strategy for the coming years. The current assessment represents upstream work to steer the development of this strategic plan.

METHODS

This was a quantitative, descriptive study conducted between September 2022 and April 2023. It involved a two-part survey: a self-administered questionnaire distributed to healthcare information managers in facilities, and direct interviews conducted with software developers. This was complemented by a documentary review of the country's strategic and standards documents on digital transformation.

RESULTS

Burkina Faso possesses a relatively comprehensive collection of governance documents pertaining to digital transformation. The study identified a total of 35 digital health interventions. Analysis showed that 89% of funding originated from technical and financial partners as well as the private sector. While the use of open-source technologies for the development of the applications, software, or platforms used to implement these digital health interventions is well established (77%), there remains a deficiency in the integration of data from different platforms. Furthermore, the classification of digital health interventions revealed an uneven distribution between the different elements across domains: the health system, the classification of digital health interventions (DHI), and the subsystems of the National Health Information System (NHIS). Most digital health intervention projects are still in the pilot phase (66%), with isolated electronic patient record initiatives remaining incomplete. Within the public sector, these records typically take the form of electronic registers or isolated specialty records in a hospital. Within the private sector, tool implementation varies based on expressed needs. Challenges persist in adhering to interoperability norms and standards during tool design, with minimal utilization of the data generated by the implemented tools.

CONCLUSION

This study provides an insightful overview of the digital health environment in Burkina Faso and highlights significant challenges regarding intervention strategies. The findings serve as a foundational resource for developing the digital health strategic plan. By addressing the identified shortcomings, this plan will provide a framework for guiding future digital health initiatives effectively.

Risk communication during health emergencies in Nigeria: What are its challenges?

Although globalization has been advantageous in facilitating the free movement of people, goods, and services, the ease of movement of cross-border pathogens has increased the risk of international public health emergencies in recent years. Risk communication is an integral part of every country's response during public health emergencies such as the coronavirus disease (COVID-19) pandemic. To effectively increase adherence to guidelines during health emergencies, it is essential to understand the impact of social, cultural, political, and environmental factors on people's behaviours and lifestyles in any given context, as well as how these factors influence people's perception of risks. During the recent response to the COVID-19 pandemic in Nigeria, the need to comprehend these influences was pronounced, and these influences ultimately shaped risk communication in Nigeria. We have identified risk communication challenges in Nigeria based on sociocultural diversity, the complexity of the health system, the impact of social media on communications, and other contextual factors surrounding multisectoral partnerships. To achieve global health security, these challenges must be addressed in resourceconstrained countries like Nigeria. In this paper, we emphasize the need to contextualize risk communication strategies in order to improve their effectiveness during health emergencies. In addition, we urge increased country commitment to a multi-hazard and multisectoral effort, deliberate investment in subnational risk communication systems, and investments in capacity building for risk communication activities.

Geographical and time trends of measles incidence and measles vaccination coverage and their correlation in Nigeria

Nigeria has one of the highest measles burdens in the world. While measles-containing vaccine is proven to be effective in reducing measles cases, empirical studies on the correlation between measles incidence and measles vaccine coverage in Nigeria has been limited. The aim of this study was to conduct a detailed analysis on measles incidence, measles vaccine coverage, and their correlation between 2012 and 2021. A retrospective observational study was conducted based on the Integrated Disease Surveillance and Response (IDSR) data for the measles incidence in each Nigerian state over time, District Health Information System, V.2 (DHIS2) and Nigeria Demographic and Health Survey (DHS) for the coverage of the first dose of measles containing vaccine (MCV1) over time (2012-2021). We observed the trend of measles incidence and measles vaccine coverage, as well as their correlation. Out of the study period from 2012 to 2021, we found that the majority of measles outbreaks occurred in the northeastern states in recent years after 2019, especially in Borno state, where Boko Haram insurgency has negatively impacted health service delivery, including routine vaccination. We observed a significant negative correlation between measles incidence and measles vaccine coverage across Nigerian states. However, there was no sudden drop in measles vaccine coverage before the recent outbreak in Borno state in 2019, which could be due to various factors other than the overall vaccine coverage.

Conceptualizing and implementing a health workforce registry in Nigeria

BACKGROUND

Nigeria's health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries.

CASE PRESENTATION

In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry.

CONCLUSION

In establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries

Background

Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands.

Methods

In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services.

Result

Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker.

Conclusions

PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06652-5.

Death registration in Nigeria: a systematic literature review of its performance and challenges

Background

Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria.

Objective

This paper describes the performance of death registration in Nigeria and factors that may affect its performance.

Methods

We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration.

Results

Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance.

Conclusions

We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.

Child Electronic Growth Monitoring System: An innovative and sustainable approach for establishing the Kaduna Infant Development (KID) Study in Nigeria

BACKGROUND

Developing countries bear the burden of childhood stunting but lack resources for cohort studies to develop preventive strategies. To enable future prospective studies, we designed and tested the Child Electronic Growth Monitoring System (CEGROMS) using a readily available electronic data capture platform, the Research Electronic Data Capture (REDCap).

OBJECTIVES

To demonstrate the feasibility of using CEGROMS for data collection for a pilot study for the Kaduna Infant Development (KID) Birth Cohort Study in Nigeria.

METHODS

CEGROMS consists of the data capture form for growth monitoring, a central cloud server, electronic tablets, and desktop computer. We implemented the pilot study in 2017-2019 at the Barau Dikko Teaching Hospital, Kaduna, Nigeria. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for completeness of baseline data (relative to individuals with incomplete data) and completion of follow-up at different time points (relative to individuals with no follow-up visit) by the participant characteristics. Complete data were defined as date of birth, sex, and birthweight recorded at recruitment.

RESULTS

Among 3152 infant records in CEGROMS, 2789 (88.5%) had complete data. Of these, 1905 (68.3%) had at least one follow-up visit. The main determinants of data completeness were health facility delivery (OR 19.17, 95% CI 13.65, 26.92) and tertiary education (OR 3.54, 95% CI 2.69, 4.67). Follow-up was greater for women with tertiary education (OR 1.33, 95% CI 1.06, 1.51 for at least one visit). Maternal education is associated with completeness and follow-up (following adjustments for parity and employment).

CONCLUSIONS

The CEGROMS electronic data collection system enables complete and consistent data collection. The data will enable design of strategies to improve follow-up in the future implementation of the birth cohort study.

Compliance with disease surveillance and notification by private health providers in South-West Nigeria

Introduction

Private health facilities are important contributors to health service delivery across several low and middle income countries. In Nigeria, they make up 33% of the health facilities, account for more than 70% of healthcare spending and over 60% of healthcare contacts are estimated to take place within them However, their level of participation in the disease surveillance system has been questioned.

Methods

We conducted a cross-sectional survey of 507 private health facilities in South-West Nigeria to investigate the level of compliance with disease surveillance reporting and the factors that affect their participation.

Results

We found only 40% of the private health facilities to be complying with routine disease surveillance reporting which ranged from 17% to 60% across the six states in the region. Thirty-four percent of the private health facilities had the requisite data collection tools, 49% had designated professionals assigned to health records management and only 7% of the clinicians could properly identify the three data collection tools for disease surveillance. Some important factors such as awareness of a law on disease surveillance (OR=1.55 95% CI=1.08-2.24), availability of reporting tools (OR=13.69, 95% CI=8.85-21.62), availability of a designated health records officer (OR=3.9, 95% CI=2.68-5.73), and health records officers (OR=10.51, 95%CI=2.86-67.70) and clinicians (OR=2.49, 95% CI=1.22-5.25) with knowledge of disease surveillance system were important predictive factors to compliance with disease surveillance participation.

Conclusion

Private health facilities are poorly compliant with disease surveillance in Nigeria resulting in missed opportunities for prompt identification and response to threats of infectious disease outbreaks.

Peer review processes at the Health Information and Libraries Journal

Responding to referee comments, the Health Information and Libraries Journal Editorial Advisory Board has been engaged in a large-scale project to review and revise local peer review processes. What has emerged is a review process which enables referees to provide a more nuanced review to the editorial team and authors. The revised processes have now been implemented in the ScholarOne Manuscripts submission system. Thank you to everyone who has contributed to peer reviewing for the Health Information and Libraries Journal in 2018.