Nigeria Health ICT Workforce and Curricula Assessment

Transcription

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

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3 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 assessment design population sampling sample size exclusion criteria data collection procedure data analysis plan ethical concerns quality assurance Results:...19 part a: quantitative studies 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 part b: qualitative studies Infrastructures Curriculum...28 Training, Personnel and Management Commitment...30 Challenges of ICT Knowledge in Health Prospects...34 Synthesis of Findings of Assessment...35 Conclusion...37 Recommendations...38 minimum ict knowledge and skills Basic ICT Knowledge and Exposure per person Basic ICT use by users and support staff...38 Basic ICT Use per Establishment health ict skill set upscale logic model learning stages training matrix References...45 Appendix 1: Institutions and People interviewed...46 Appendix 2: Project Team...49

4 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. 4 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

5 List of Acronyms and Abbreviations B2B C2C CHEW CHO CMD DHIS EFMC EHR EMR FCT FMCT FMOH GCE GIS GPRS GSM GSMA HIMS HTML ICT ICT4SOML IRB IT ITU KII LGA MDCN M&E MIS NCC NGO NHIMS NHIS NHREC NORAD PCIS PHC SAS SMOH SMS SOML SPSS Business to Business Customer to Customer Community Health Extension Worker Community Health Officer Chief Medical Director District Health Information Software Excellence and Friends Management Consult Electronic Health Record Electronic Medical Record Federal Capital Territory Federal Ministry of Communication Technology Federal Ministry of Health General Certificate of Education Geographic Information System General Package Radio Service Global System for Mobile Communication Groupe Speciale Mobile Association Health Information Management Systems Hyper Text Markup Language Information Communication Technology Information and Communications Technology for Saving One Million Lives Institutional Review Board Information Technology International Telecommunications Union Key Informant Interviews Local Government Area Medical and Dental Council of Nigeria Monitoring and Evaluation Management Information System Nigeria Communication Commission Non-governmental Organization National Health Information Management System National Health Insurance Scheme National Health Research Ethics Committee of Nigeria Norwegian Agency for Development Cooperation Patient Care Information Systems Primary Health Care Special Air Service State Ministry of Health Short Message Service Saving One Million Lives Statistical Package for Social Sciences 5

6 STATA TWG UN UNF USB WASC WHO Statistics and data Technical Working Group United Nations United Nations Foundation Universal Serial Bus West African School Certificates World Health Organization 6 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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8 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 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. 8 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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 9

10 Tables and figures tables: table 1: states visited for ict assessment and number of participants enrolled table 2: age distribution of participants in the ict assessment exercise in six states table 3: level and type of health facilities where participants were working table 4: professions of participants in the ict assessment study table 5: level of care of practice of ict trained healthcare workers table 6: age of ict practitioners who participated in the ict assessment from six geo-political regions of nigeria table 7: location of primary assignment of core ict staff table 8: curriculum present and accounted for at sites visited table 9: types of trainings in institutions visited table 10: proposed ict courses and class of healthcare workers/duration figures: figure 1: sample selection for ict assessment flow chart figure 2: gender distribution of participants in the ict study in nigeria, december figure 3: Distribution of total participants according to rural vs. urban regions of the states according to their work places, December figure 4: participants living areas: rural vs. urban figure 5: health ict improvement logic model figure 6: health ict learning stages figure 7: health ict training matrix NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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12 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 United Nation Foundation in support of ICT4SOML. (2014a). Accessing the enabling environment for ICTs for health in Nigeria; A landscape and survey NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. keeping-personal-health.pdf 13

14 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 14 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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, 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 The four levels of measurement (nominal, ordinal, interval and ratio) were used as appropriate. 15

16 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. figure 1: Sample selection for ICT assessment flow chart National (identification of six geopolitical zones) Six States (one from each geopolitical zone) Random selection of six rural LGAs one per state Targeted selection of six urban LGAs (State Capitals) one per state Selection of one primary, secondary and tertiary health Care facilities and training intuitions within the LGA 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 16 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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 STATE NUMBER OF PARTICIPANTS PERCENTAGE OF TOTAL Akwa Ibom % Anambra % Kaduna % Niger % Ondo % Taraba % 17

18 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/ ; NHREC Approval Number: NHREC/01/01/ /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. 18 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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 Female 54.74% Male 45.26% table 2: Age distribution of participants in the ICT assessment exercise in six states AGE RANGE TOTAL NUMBER PERCENT > % % % % % Total % 19

20 figure 3: Distribution of total participants according to rural vs. urban regions of the states according to their work places, December 2015 figure 4: Participants living areas: rural vs. urban % (144) Urban 51.29% (119) Rural 48.71% (113) Frequency % (88) 50 0 Rural Urban Where Do You Live 20 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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 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. FREQUENCY NUMBER PERCENT Others % Primary % Secondary % Tertiary % Total % Note: Four (4) private facilities were assessed and classified as primary. table 4: Professions of participants in the ICT assessment study NUMBER PERCENT CUMULATIVE PERCENT Accountant 6 2.6% 2.6% Administrator 5 2.2% 4.7% CHO/CHEW % 27.2% Data Clerk 4 1.7% 28.9% Doctor % 39.7% Health Educator 1.4% 40.1% Information Officer Laboratory Personnel % 49.1% % 58.6% Nurse % 77.2% Others % 94.4% Pharmacist % 100.0% Total % 21

22 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%). Key Message: Knowledge of ICT for recreational activities (MP3, camera and text messages) were a lot higher than core business process ICT operational knowledge. 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 ; 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 s 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 22 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

23 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: Key Message: ICT skills lagged behind ICT knowledge as more than 50% of all participants were unskilled in the most basic ICT activities. 1. Communication (i.e. calls, SMS, , 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) R X 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%). 23

24 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. 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 % Primary % Secondary % Total % table 6: Age of ICT practitioners who participated in the ICT assessment from six geo-political regions of Nigeria AGE RANGE TOTAL NUMBER PERCENTAGE % % % % Total % 24 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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; s; 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. 25

26 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 15 Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (Formerly ANSUTH) Tertiary Anambra 16 College 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 26 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. 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. 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. 27

28 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 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 PRESENT SIGHTED/NOT SIGHTED COMPREHENSIVE 1 Anambra 4 centers visited Curriculum present in 2 Sighted 0 Not sighted- 2 Comprehensive- None 2 Akwa-Ibom 6 centers visited Curriculum present in 6 Sighted 6 Not sighted- 0 Comprehensive- 3 Not comprehensive- 3 3 Kaduna 5 centers visited Curriculum present in 2 Sighted 1 Not sighted- 1 Comprehensive- None 4 Niger 5 centers visited Curriculum present in 2 Sighted 2 Not sighted- 0 Comprehensive- None 5 Ondo 5 centers visited Curriculum present in 3 Sighted 2 Not sighted- 1 Comprehensive- 3 6 Taraba 5 centers visited Curriculum present in 3 Sighted 1 Not sighted- 2 Comprehensive- None 28 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. 29

30 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) Certificates and diploma (2) Doctors Doctors, Students and other Health Workers 4-5 years, 4-6 years 6 months, 1 year, 3 years General computer appreciation and specialized skills e.g. PowerPoint and Excel Basic computer programming Networking E-conferencing Funds Provision of computers and generators 2 Akwa-Ibom HND Certificate (1) Registered Midwife (2) 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 Student Midwives 18 months Adequate Internet Full time lecturers 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 30 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

31 SITE NUMBER SITE VISITED DEGREES FOR TRAININGS PRESENT TARGET POPULATION DURATION OF TRAINING 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 31

32 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 DURATION OF TRAINING 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. 32 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

33 SITE NUMBER SITE VISITED PROPOSED FUTURE TRAININGS FOR HEALTHCARE WORKERS TARGET POPULATION DURATION OF TRAINING EXPECTED BENEFITS OF PROPOSED TRAININGS 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 Trainings are incorporated into existing curriculum Midwives 6 months To be computer literate and be able to conduct research 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 33

34 SITE NUMBER SITE VISITED PROPOSED FUTURE TRAININGS FOR HEALTHCARE WORKERS TARGET POPULATION DURATION OF TRAINING EXPECTED BENEFITS OF PROPOSED TRAININGS 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. 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. Key Message: Funding for training and ICT equipment appeared to be the major challenge of ICT penetration in Nigeria 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. 34 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. 35

36 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. 36 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. 37

38 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 ( , Instant Messaging, Video and Audio calls) Internet-based research Funds Transfer Outlook/Or other 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 ; as well as define proper use of search engines (such as Google). Level 2: Proven ability to type with a computer, send s, work with MS Office tools especially MS Word, MS Excel and MS PowerPoint. 38 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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: Websites E-Procurement Intranet Extranet CRM ERP Document sharing 39

40 health ict skill set upscale logic model figure 5: Health ICT Improvement Logic Model SITUATION Poor ICT penetration in the health industry with resultant poor ICT trainings, knowledge and infrastructure INPUTS 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 SHORT TERM OUTCOMES Updated health ICT curriculum developed and circulated Health ICT trainers identified and trained Health care workers trained using tailored health ICT curriculum at various levels MEDUIM TERM OUTCOMES Observable improvement in health ICT knowledge penetration in healthcare services knowledge, skills and infrastructure LONG TERM OUTCOMES Sustained improvement in knowledge, attitude, skills, and use of health ICT in health institutions and facilities IMPACTS Universal Health Coverage as a result of health ICT enabled workforce 40 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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) Computers, Phones (Smart and Non) Computers, Phones (Smart and Non) Processes One to one tutorial and intensive practical coaching One to one tutorial and intensive practical coaching One to one tutorial and intensive practical coaching One to one tutorial and intensive practical coaching One to one tutorial and intensive practical coaching Strategies Active Learning Learner- Centered Teaching Collaborative/ Cooperative Learning Active Learning Collaborative/ Cooperative Learning Active Learning Collaborative/ Cooperative Learning Active Learning Collaborative/ Cooperative Learning Active Learning Lecture Strategies Teaching with Cases Learner- Centered Teaching Lecture Strategies Learner- Centered Teaching Lecture Strategies Learner- Centered Teaching Lecture Strategies Learner- Centered Teaching Lecture Strategies Teaching with Cases Teaching with Cases Teaching with Cases Teaching with Cases 41

42 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 knowledge 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 simple problems Ability to design, develop and manage programs Knowledge/ Skills Focus ICT software and hardware, websites, s Office tools and its operationalization Data management and planning techniques ICT basic and intermediate challenges and their management Program initiation, development 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 deployment of new programs as the need arises Logistic coordination, supply chain management systems, procurement procedures and E-procurement, EMR development 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+, Network+, Server+ etc Windows/ Linux O.S, HTML, PHP, MySQL, etc 42 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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. 43

44 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. 44 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

45 References Federal Ministry of Health (FMOH) and Federal Ministry of Communication Technology (FMCT). (2015). National health ICT strategic framework United Nations Foundation in support of ICT4SOML. (2015). Nigeria health ICT phase 2 field assessment findings. United Nations Foundation in support of ICT4SOML. (2014a). Accessing the enabling environment for ICTs for health in Nigeria; A landscape and survey. United Nations Foundation in support of ICT4SOML. (2014b). Accessing the enabling environment for ICTs for health in Nigeria; A review of policies. 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

46 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 46 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

47 INDIVIDUALS INTERVIEWED NAME OF INSTITUTION VISITED DESIGNATION 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 47

48 INDIVIDUALS INTERVIEWED NAME OF INSTITUTION VISITED DESIGNATION 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 48 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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 49

50 PHOTO CREDITS FRONT COVER: Adrian Brooks, Courtesy of Photoshare INSIDE FRONT COVER: Akintunde Akinleye/NURHI, Courtesy of Photoshare PAGE 7: Akintunde Akinleye/NURHI, Courtesy of Photoshare PAGE 11: Akintunde Akinleye/NURHI, Courtesy of Photoshare PAGE 15: United Nations Foundation PAGE 18: ehealth Africa, Courtesy of Photoshare PAGE 20: United Nations Foundation PAGE 29: United Nations Foundation PAGE 37: Peter Roberts, Courtesy of Photoshare PAGE 43: United Nations Foundation INSIDE BACK COVER: Akintunde Akinleye/NURHI, Courtesy of Photoshare 50 NIGERIA HEALTH ICT WORKFORCE AND CURRICULA ASSESSMENT

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