Table of Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Important Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
List of Figures and Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part I: Vision for Health ICT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
PART I. SECTION 1: Strategic Context For Health ICT . . . . . . . . . . . . . . . . 14
PART I. SECTION 2: Vision For Health ICT . . . . . . . . . . . . . . . . . . . . . . . . . . 16
PART I. SECTION 3: Foundations For Change . . . . . . . . . . . . . . . . . . . . . . . 21
Part II: Action Plan for Health ICT . . . . . . . . . . . . . . . . . . . . . . . . 29
PART II. SECTION 1: Health ICT Theory of Change . . . . . . . . . . . . . . . . . . . . 29
PART II. SECTION 2: Health ICT Action Plan . . . . . . . . . . . . . . . . . . . . . . . 30
Part III: Monitoring & Evaluation Plan for Health ICT . . . . . . . . 35
PART III. SECTION 1: Monitoring & Evaluation Plan . . . . . . . . . . . . . . . . . . . 35
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
APPENDIX 1: List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
APPENDIX 2: Health ICT Scenario Illustrating
Change and Impact on Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
APPENDIX 3: Recommended Nigeria Health ICT Architecture . . . . . . . . 39
APPENDIX 4: Proposed Governance Structure . . . . . . . . . . . . . . . . . . . . . 42
APPENDIX 5: Detailed Health ICT Action Plan . . . . . . . . . . . . . . . . . . . . . . 44
APPENDIX 6: Health ICT M&E Framework . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
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Acronyms and Abbreviations
AIDS
Acquired Immunodeficiency Syndrome
CCT
Conditional Cash Transfer
CDC
Center for Disease Control and Prevention
CHAI
Clinton Health Access Initiative
CMD
Center for Management Development
CR
Client Registry
CRSV
Civil Registration and Vital Statistics
DBI
Digital Bridge Institute
DPRS
Department for Planning Research and Statistics
EMPI
Enterprise Master Patient Index
EMR
Electronic Medical Record
FCTA
Federal Capital Territory Administration
FMCT
Federal Ministry of Communication Technology
FMF
Federal Ministry of Finance
FMOH
Federal Ministry of Health
FR
Facility Registry
GBB
Galaxy Backbone
GSMA
Groupe Speciale Mobile Association
HDCC
Health Data Consultative Committee
HDGC
Health Data Governance Committee
HIA
Health in Africa
HIE
Health Information Exchange
HIS
Health Information System
HISP
Health Information Systems Program
HIV
Human Immunodeficiency Virus
HRH
Human Resources for Health
HRIS
Human Resource Management Information Systems
HWR
Health Worker Registry
ICT
Information and Communication Technology
ICT4SOML
ICT for Saving One Million Lives
6!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
IFC
International Finance Cooperation
IHE
Integrating the Health Enterprise
IL
Interoperability Layer
ITU
International Telecommunications Union
IVR
Interactive Voice Response
JSI
John Snow International
LGA
Local Government Area
LMIS
Logistic Management Information System
M&E
Monitoring and Evaluation
MAMA
Mobile Alliance for Maternal Action
MCCT
Mobile Conditional Cash Transfer
MCH
Maternal and Child Health
MDCN
Medical and Dental Council of Nigeria
MDA
Ministries, Departments and Agencies
MDG
Millennium Development Goal
MEMS
Monitoring and Evaluation Management Services
MSH
Management Sciences for Health
NACA
National Agency for Control of AIDS
NAFDAC
National Agency for Food and Drugs Administration and Control
NASCP
National AIDS Control and Prevention Programme
NCC
Nigeria Communications Commission
NCH
National Council on Health
NCS
Nigeria Computer Society
NDST
Network Data Services and Technology Ltd.
NHIS
National Health Insurance Scheme
NHMIS
National Health Management Information System
NIGCOMSAT
Nigeria Communications Satellite
NIMC
National Identity Management Commission
NIMS
National Identity Management System
NIN
National Identification Number
NITDA
National Information Technology Development Agency
NORAD
Norwegian Agency for Development Cooperation
NPHCDA
National Primary Health Care Development Agency
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!7
NPSCMP
National Product Supply Chain Management Programme
NTBLCP
National Tuberculosis and Leprosy Control Programme
NUC
National Universities Commission
OPENHIE
Open Health Information Exchange
PHC
Primary Health Care
POS
Point-of-Service
RH
Reproductive Health
SCMS
Supply Chain Management System
SDG
Sustainable Development Goal
SHR
Shared Health Record
SMS
Short Message Service
SOML
Saving One Million Lives
SON
School of Nursing
SURE-P
Subsidy Reinvestment and Empowerment Program
TS
Terminology Service
TWG
Technical Working Group
UHC
Universal Health Coverage
UN
United Nations
USAID
United States Agency for International Development
USD
United States Dollar
USPF
Universal Service Provision Fund
WHO
World Health Organization
8!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Important Definitions
Both Health Information and Communication Technology (Health ICT)
and electronic health (eHealth) refer to the use of information and communication technology (ICT) in support of health and health-related fields,
including health care services; health surveillance; health literature; and health
education, knowledge, and research. However, Health ICT is a more accessible
term and extends beyond ‘electronic’ to involve concepts and systems (e.g.,
architecture and information systems) and communication (e.g., phone calls,
bi-directional transfer of information) along with the necessary physical and
technology infrastructure. Health ICT is more than electronic health records;
it is applied across the health system and services to ensure continuity of
patient care across time. It includes mobile health (mHealth) services, telehealth, health research, consumer health informatics to support individuals in
health decision-making, and eLearning by health workers. In practical terms,
Health ICT is a means of ensuring that correct health information is provided in
a timely, coordinated and secure manner via electronic means for the purpose
of improving the quality and efficiency of delivery of health services and
prevention programs. mHealth services, in particular, focus on the application
of mobile and other wireless technologies for health systems strengthening.
A Health ICT Strategy can serve as an umbrella for planning and coordinating
different national Health ICT efforts while considering fundamental elements
in terms of regulatory, governance, standards, human capacity, financing and
policy contexts. An effective National Health ICT Strategy presents a set of
interventions that the health sector plans to use to facilitate the efficient and
effective delivery of services. Without an overarching national level strategy,
ICT initiatives are left at the hands of individual organizations without coordination and a guarantee that they are in the best interest of clients. A national
level Health ICT Strategy with sector-wide participation and ownership is an
effort to fill this gap.
Frameworks serve as guides, rules or well-defined approaches towards addressing a particular matter. A Health ICT framework is specifically concerned
with applying ICT in a health system. Different frameworks exist and can range
from being general, and providing comprehensive approaches to governing
the regulatory environment and guiding implementations within that context,
to being specific and focusing on a particular aspect of Health ICT, such as
data standards.
A roadmap is similar to a framework but is geared towards action. In a roadmap, goals and their corresponding activities are aligned in sequence to
achieve an overarching vision. Thus, roadmaps contain action plans, mechanisms to monitor progress and resource forecasts (i.e., time, human resources,
equipment, budget). Roadmaps are typically developed with stakeholders and
reflect consensus. Inputs include a vision, current state of affairs, barriers and
recommendations.
A health information system (HIS) is a system that collects, transmits, stores
and manages health-related data. The data can be patient-specific (or row-level
data) or aggregate. Reports can typically be generated from an HIS. If a system
is primarily being used to inform and support health management practices,
the system is referred to as a health management information system.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!9
An architecture is a conceptual framework that is used to inform data collection, transmission, storage and sharing. Architectures show the integration of
many components into a whole, as well as the interoperability that enables
these components work together. Interoperability is the ability of an application or platform to establish a data exchange with another application or platform. For interoperability to occur, both services must use the same standards
[for communication].
Standards serve as rules or guidelines that ensure consistency in the context
in which they are applied. Standards can be used to align data, processes
and systems. The standards development process is variable (e.g., government-mandated versus stakeholder-based). As such, it is possible for multiple
standards to exist. Accordingly, formal alignment among the different standards is necessary.
These definitions were adapted from “Assessing the Enabling Environment for
ICTs for Health in Nigeria: A Review of Policies.” 1
10!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
List of Figures and Tables
Figures
FIGURE 1. Current State of Nigeria’s Enabling Environment for Health ICT
FIGURE 2. Nigeria National Health ICT Vision
FIGURE 3. A National Health Information Architecture Drawing from
Existing Initiatives
FIGURE 4. Health ICT Governance Structure
FIGURE 5. Key Findings from Baseline Inventory Assessment on
Number of Health ICT Implementations by Program Area
FIGURE 6. Theory of Change for the Nigeria National Health ICT Vision
Tables
TABLE 1. Components of the Health ICT Enabling Environment
TABLE 2. Summary of Recommendations to Improve Health ICT
Enabling Environment
TABLE 3. Nigeria National Health ICT Vision Integrated Action
Plan 2015 - 2020
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!11
Executive Summary
Beginning in late 2014 and in the first half of 2015, the Nigerian Federal
Ministry of Health (FMOH) and Federal Ministry of Communication Technology
(FMCT) led the multi-sectoral and stakeholder development of the National
Health Information and Communication Technology (Health ICT) Strategic
Framework. This framework, which incorporates the effort and inputs of over
150 public and private health and technology sector stakeholders, is a threepart document that articulates the collective vision and necessary actions
of stakeholders involved in the health system in Nigeria. Borne out of the
recognition for the opportunities that ICT present to support health systems
strengthening and the achievement of health system goals, the National
Health ICT Strategic Framework positions Health ICT within the current context of the health system. This means addressing Universal Health Coverage
(UHC), one of the main priorities of the Federal Government of Nigeria.
Strategic Context
Nigeria is poised to become a major global powerhouse. Currently, Nigeria
is Africa’s largest economy and most populous nation. By 2050, Nigeria is
expected to be one of the ten largest economies in the world and is already
Africa’s most populous country. Despite these economic gains, close to half of
the population lives in poverty and life expectancy is projected to only increase
marginally. Accordingly, health needs and priorities, along with demographic
trends, must be considered to ensure the appropriate allocation of resources
and optimize strategies to address the issues.
The government is developing and implementing policies and programs to
strengthen the National Health System to support attainment of UHC. Initial
focus is on primary health care, and innovations including the use of Health
ICT to improve service delivery, access and coverage have been prioritized.
Health ICT must be in alignment with the clear, actionable goals of the health
system to help achieve UHC and improve service delivery.
Health ICT Vision
Subsequently, the National Health ICT Vision was established through an iterative stakeholder engagement process led by the FMOH and FMCT. With UHC
as a national health priority, the vision was articulated through the following
powerful statement:
“By 2020, health ICT will help enable and deliver universal
health coverage in Nigeria.”
To ensure that the vision can be achieved, the enabling environment components of the World Health Organization-International Telecommunications
Union eHealth Strategy Toolkit were used to structure and craft the
Health ICT Framework. The specific prioritized activities within Leadership
and Governance; Strategy and Investment; Architecture, Standards and
Interoperability; Legislation, Policy and Compliance; Capacity Building;
12!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Infrastructure and Solutions (Services and Applications) reflect the current
state and needs of the Nigerian health system as well as stakeholder recommendations on the appropriate Health ICT response.
Action and M&E Plans
Drawing from the recommendations for Health ICT to support the achievement of UHC and other health system goals and activities, an action plan was
developed. A Theory of Change included as part of this plan articulates the
pathway to change from Health ICT enablers to prioritized ICT-related actions
to health system priorities and the achievement of UHC. The action plan
forms the basis for the roadmap and orients the implementation of prioritized
activities. It informs the steps that those governing and involved with the
achievement of the Health ICT vision will need to make. The monitoring and
evaluation (M&E) plan and budget build on activities outlined in the action
plan. The M&E plan provides a link between the vision, action plan and desired
results and the budget estimates the resources needed to attain the vision.
The indicators captured in the M&E plan reflect short- and long-term activities
as guided by the Theory of Change.
The overall approach is separated into three phases over a five-year time period.
PHASE 1: Set-up (Year 1)
PHASE 2: Deploy, Maintain and Support (Year 2 and Year 3)
PHASE 3: Consolidate and Continuous Review (Year 4 and Year 5)
Over the next five years, the National Council on Health, as owners of the
Health ICT vision, will oversee the activities according to the action plan. The
council will be guided and supported by the Health ICT Steering Committee,
Project Management Office and Technical Working Group. Working collaboratively, the vision of Health ICT can be achieved.
This Nigerian National Health ICT Strategic Framework provides a vision and
guide for alignment of current investments in technology within the health
system towards a digitized health system that will help Nigeria achieve UHC
by 2020.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!13
Part I: Vision for Health ICT
PART I. SECTION 1:
STRATEGIC CONTEXT FOR HEALTH ICT
With a growing population and economy, Nigeria is emerging as a major
global powerhouse. To maintain the path to prosperity, improvements in the
health system are needed to ensure and optimize the health and wellbeing of
the country’s citizens. The Government of Nigeria recognizes that a healthy
population is important for socio-economic development.
As Africa’s largest economy and most populous nation, Nigeria is experiencing
substantial economic expansion, yet the country’s health system is strained.
The country’s economy is growing at an average annual rate of 7% and is
expected to be among the ten largest economies by 2050. 2,3 Despite the
country’s economic gains, the overall health status of the Nigerian population
is poor (as defined by the 2013 Nigeria Demographic and Health Survey);4
infectious and non-communicable diseases remain among the leading causes
of morbidity and mortality,5,6,7,8 continuing to take their toll on the health and
survival of Nigerians; and health coverage and financing remains low.9,10,11
Population and health status
•#Over 46% of the population continues to live in poverty (2010 estimate)2,3
•#Rural-urban divide is projected to increase 2,3
•#Maternal and under-five mortality rates remain high at 576 deaths per
100,000 live births and 201 deaths per 1,000 live births, respectively 4
•#Life expectancy at birth is projected to only increase marginally from
54.2 years to 56.2 years over the next 10 years (2015-2025) 2,3
Burden of infectious and non-communicable diseases
•#Nigeria is second to South Africa in the number of people living with
HIV/AIDs worldwide. This represent 9% of Global burden of the disease”
and a declining prevalence rate of 4.1 as of 2010. (NDHS 2013, page 224)
•#Malaria is the leading cause of infant and child mortality 7
•#Diseases such as hypertension, diabetes and coronary heart disease
also represent an increasing share of Nigerians’ burden of disease 4
Low health coverage and financing
•#As of 2013, fewer than 5% of the population were insured 4
•#Nigeria is among the 23 African nations that spends more than USD44
per capita on health care, however, the government expenditure on
health is 6.1% of the gross domestic product — which is below the
Abuja Declaration’s target of 15% 7, 9
14!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Despite the health challenges, Nigeria’s rising telecommunications and information and communication (ICT) sectors and the global proliferation of ICT for
health (Health ICT) are creating new opportunities to strengthen the health system and improve the overall delivery of health services. Accordingly, Health ICT
can be used to generate demand, increase access to and improve the quality
of health services. Furthermore, Health ICT addresses the critical need to coordinate information and resources across the health system in a timely manner.
As a result of these opportunities and the Government of Nigeria’s commitment to ICT, an assessment of the enabling environment for Health ICT was
conducted in 2014. The report, Assessing the Enabling Environment for ICTs
for Health in Nigeria, identified the need for a coordinated Health ICT Strategy.
In addition, the report concluded that Nigeria is transitioning from ‘experimentation and early adoption’ to ‘developing and building up’ (see Figure 1).12
In order to advance the enabling environment and support scale-up of initiatives, a unifying Health ICT Strategic Framework is required. A Health ICT
Strategy will enable Nigeria to leverage current and future ICT investments
to build an integrated national health information infrastructure and help
enable Universal Health Coverage (UHC) by 2020.
FIGURE 1. Current State of Nigeria’s Enabling Environment for Health ICT
13
ESTABLISHED ICT
ENVIRONMENT
MAINSTREAMING
SCALE UP
DEVELOPING &
BUILDING UP
EMERGING
ENABLING
ENVIRONMENT
FOR eHEALTH
II.
EARLY
ADOPTION
III.
I.
ESTABLISHED
ENABLING
ENVIRONMENT
FOR eHEALTH
EXPERIMENTATION
CURRENT STATUS
OF NIGERIA ICT
EMERGING ICT
ENVIRONMENT
COMPLETED TRAJECTORY
OF NIGERIA ICT
DESIRED TRAJECTORY
OF NIGERIA ICT
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!15
Identifying the potentials of Health ICT, the Government of Nigeria has
begun to prepare and introduce the necessary building blocks to facilitate
the digitization of the health system. The Federal Ministry of Health (FMOH)
and the Federal Ministry of Communication Technology (FMCT) have collaboratively led an inclusive effort to set-up this strategic framework for Health
ICT as well as a guiding architecture, health information exchange (HIE)
and supportive policies, plans and budgets to improve health and wellbeing
for all citizens through technological advancements and innovation. This
document, the National Health ICT Strategic Framework, is meant to guide
the deliberate and judicious use of ICT within the health system to enable
the delivery of quality, affordable and equitable health services to all citizens.
This National Health ICT Strategic Framework will facilitate the identification,
prioritization and implementation of appropriate technologies that can
potentially lead to a strengthened national health system.
PART I. SECTION 2:
VISION FOR HEALTH ICT
The FMOH, in collaboration with the FMCT and other Government of Nigeria
Ministries, Departments and Agencies (MDAs); donors; and implementing
partners, (see Appendix 1) has developed, through an inclusive and iterative
process, a collective vision for the use of Health ICTs in Nigeria.
“By 2020, health ICT will help enable and deliver universal
health coverage in Nigeria.”
UHC attainment will ensure that all Nigerians have access to the services they
need without incurring financial risks. Specifically, UHC means health insurance becomes economical, whereby the cost of care is not a burden. It means
equitable access to affordable and quality health services. It also means that
the health system must be functional to ensure that supply meets the needs
specified by demand. It is because of this last point that the value of Health
ICT is so substantial. With its ability to support health systems strengthening,
Health ICT can be used to improve the health system and ensure its adequacy
for scaling up health insurance and health coverage over the next five years.
The successful use of Health ICTs to achieve UHC in Nigeria will achieve:
•#Improved access to health services through the effective use of telemedicine and other ICTs for health worker training and support
•#Improved coverage of health services through the effective use of Civil
Registration and Vital Statistics (CRVS), National Identity Management
System (NIMS), Human Resource Management Information Systems
(HRIS), National Health Management Information System (NHMIS) and
Logistic Management Information System (LMIS) for tracking demand
and supply of health services and commodities
•#Increased uptake of health services through the effective use of mobile
messaging and cash transfer incentives for demand creation
•#Improved quality of care through the effective use of ICT for decision
support within the continuum of care
16!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
•#Increased financial coverage for health care services through the effective use of ICT for the national health insurance scheme (NHIS) and
other health-related financial transactions
•#Increased equity in access to and quality of health services, information, and financing through the effective use of ICTs for delivering
appropriate health services for those who need them
Figure 2 depicts the Nigeria National Health ICT Vision, mapping the goal of
UHC with Health ICT outcomes and the long-term ICT output. The National
Health ICT Vision embodies the development goals of the Government of
Nigeria and provides a concrete target for stepwise, long-term investments
into nationally scaled and integrated Health ICT services and applications. This
would all be supported by a national Health Information Exchange (HIE), and
implemented with appropriate governance, funding, infrastructure & equipment, training and policies.
FIGURE 2. Nigeria National Health ICT Vision
NIGERIA
NATIONAL HEALTH
ICT VISION
UHC OUTCOMES
HEALTH ICT
OUTCOMES
LONG-TERM
ICT OUTPUTS
By 2020, Health ICT will help deliver and enable universal health coverage — whereby
Nigerians will have access to the services they need without incurring financial risk.
Improved
access to
health
services
Effective use of
telemedicine
and use of ICT
for health
worker training
and support
Increased
coverage of
health
services
Effective use of
CRVS, HRIS,
NHMIS & LMIS
for tracking
demand and
supply of health
services and
commodities
Increased
uptake of
health
services
Effective use
of mobile
messaging &
cash transfers
for demand
creation
Improved
quality of care
Increased
financial
coverage for
health care
Increased
equity in,
access to, and
quality of
health services,
information,
and financing.
Effective use of
ICT for decision
support &
within the
continuum
of care
Effective use
of ICT for
health
insurance &
other
health-related
financial
transactions
Effective use
of ICTs for
delivering
appropriate
health services
for those who
need them
most based on
epidemiology
and ability
to pay
Nationally scaled integrated Health ICT services and applications supported by
Nigerian Health Information Exchange implemented with appropriate funding,
infrastructure & equipment, training & policies.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!17
In recognition of the significant Health ICT investments already underway in
Nigeria, this Health ICT Strategic Framework draws from and seeks to coordinate existing projects. As a part of this, an architecture that focuses on the
long-term impact of Health ICT will be established. Such a forward-looking
architecture will enable the achievement of the vision, while also setting the
stage for the sustainable use of Health ICTs across the entire health system.
Figure 3 provides an example of what the integration of several key information
systems (private and public sectors) in Nigeria could look like within an overarching architecture. Existing and planned digital point of care tools, such as
insurance registration and claims systems, Electronic Medical Records (EMRs),
laboratory and hospital information systems, mobile health (mHealth) solutions
and Monitoring and Evaluation (M&E) applications could leverage shared health
information services.
Building on both the Vision (with its Health ICT outputs) and architecture, the
following scenario illustrates the crosscutting impact that could be possible
FIGURE 3. A National Health Information Architecture Based on Some Existing Initiatives
Existing Institutional
Initiatives
Existing Shared Health
Information Services
M&E-DPRS
NHIS + NIMC
M&E-DPRS
Registry of
Health
Facilities
Registry of
Clients
National
Health
Management
Information
System
(NHMIS)
NACA +
NPHCDA
NAFDAC
HRH-DPRS
Shared Health
Records
Terminology
Service
Registry of
Health
Workers
Interoperability Layer
SECURITY + INTEROPERABILITY Not yet in development
Point Of Care Systems
M&E
Applications
Mobile
Applications
18!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Clinical Record
Systems
Hospital
Information
Systems
Laboratory
Information
Systems
with an integrated ICT-enabled health system. It describes a collection of Health
ICT advances that are not currently deployed across the three tiers of the
Nigerian health system. (See Appendix 2 for the entire scenario and Appendix
3 for information on the Health ICT Architecture.)
While the scenario presented is aspirational, it identifies several capabilities of
an ICT-enabled health system, such as the following:
•#Ability to capture and exchange patient-level healthcare information
•#Ability to exchange and report aggregate healthcare information
•#Ability to enroll, pay for health insurance and verify coverage
•#Ability to send appointment and care alerts to patients and
health workers
•#Ability for patients to send alerts to health care facilities
•#Availability of electronic training and reference materials
TABLE 1. Components of the Health ICT Enabling Environment
COMPONENT
DESCRIPTION
Leadership and Governance
Focuses on the oversight and coordination of Health ICT activities at the federal, state and
local levels, ensuring alignment with national health goals and priorities
Strategy and Investment
Describes the planning for, engagement of and alignment with all stakeholders involved in
Health ICT activities and procurement of financing for Health ICT. It also outlines strategies to
mobilize ICT in positioning health as an investment with good return to Nigeria economy.
Legislation, Policy and
Compliance
Covers national policies and legislation for Health ICT in terms of development, alignment and
regular review
Architecture, Standards and
Interoperability
Describes the development and use of enterprise architecture and standards for enhanced
interoperability, integration and health information exchange
Capacity Building
Details the empowerment of the health and ICT workforce to develop, use and maintain
Health ICT through education and training programs
Infrastructure
Refers to the physical facilities and related assets that forms the foundation for Health
ICT implementations
Solutions (Services and
Applications)
Reports on devices and tools utilized by end users to collect, transmit, access and maintain
health information
Adapted from the 2012 WHO-ITU eHealth Strategy Toolkit,15 Table 4
First printed in the report, “Assessing the Enabling Environment for ICTs for
Health in Nigeria: A Review of Policies” 16
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!19
SCENARIO: THE HEALTH ICT VISION IN PRACTICE — IMPACT ON STAKEHOLDERS
A few months ago, Fatima enrolled with the NHIS*. Now, Fatima was expecting and due at any
time. When she first learned that she was pregnant, she decided to sign up for weekly SMS*
notifications about her pregnancy and to receive appointment reminders and pregnancy-care
health information. When Fatima felt contractions, her family members texted the local clinic
and called a taxi. Fatima proceeded to the clinic.
Mary arrived at work right on time. She was excited for the day. During shift hand-over, she
and her co-worker huddled over one of the clinic’s tablets going through the different cases of
clients present at the clinic. They prioritized the cases and she got to work. Shortly thereafter,
Mary saw that a woman in labor was making her way to the clinic.
When Fatima arrived, she and her husband realized they had left the NHIS card at home in
the hurry. But they were lucky, her NIN* was stored in her husband’s phone contact. With the
cross-reference she was triaged. During her assessment of Fatima, Mary observed that the baby
was in a breech position. When she had a break, she read up on breech deliveries using the clinic
tablet. After reading, Mary decided to review Fatima’s chart again through the EMR* system
accessible using the tablet. Mary retrieved Fatima’s shared health record and learned that her
first baby had been breech and did not survive. To be safe, Mary requested a brief consult with
the obstetrics/gynecology department at the referral hospital. After speaking with the on-call
physician, Mary was instructed to contact the physician through phone or videoconference if any
complications arose. Mary felt confident going in to the delivery and provided support to Fatima.
After a successful delivery, Mary updated Fatima’s EMR, and updates were automatically sent
from the EMR system to the Civil Registration and Vital Statistics database, NHIS database for
facility reimbursement, the facility’s LMIS* to account for supplies used during the birth and the
NHMIS* for health services planning. The local government M&E* officer was reviewing aggregate electronic NHMIS reports and supply requests from each of the LGAs*; he was pleased to
see the decline in maternal and neonatal mortality continue.
Meanwhile, mum and baby were doing fine.
* EMR = Electronic Medical Record
LGA = Local Government Area
LMIS = Logistic Management Information System
NHIS = National Health Insurance Scheme
NHMIS = National Health Management Information System
NIN= National Identification Number
M&E = Monitoring and Evaluation
SMS = Short Message Service (or text)
20!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
PART I. SECTION 3:
FOUNDATIONS FOR CHANGE
The Foundations for Change for the successful application of Health ICT in
Nigeria draws from the World Health Organization (WHO) and International
Telecommunications Union (ITU) National eHealth Strategy Toolkit. The WHOITU components of an enabling environment (see Table 1) are used to provide
a strategic and policy-oriented framework to help realize the Nigeria National
Health ICT Vision, address critical gaps and track progress.14 The Foundations
for Change ensure that investments in Health ICT will help enable and deliver
UHC, while setting the stage for the sustainable and effective use of Health
ICT across the entire health system.
In this section on Foundations for Change, the current status, critical opportunities and gaps, and recommendations for short- and long-term outputs for
each framework component are discussed. Table 2 provides a summary of the
recommendations. The recommendations were iteratively developed through
an extensive stakeholder engagement process. The Action Plan in Part II
builds off of the recommendations and identifies specific inputs and activities
required to achieve the desired outcomes.
3.1 Leadership and Governance
Effective leadership and governance of Health ICT activities at all levels is essential to ensure coordination, sustainability and alignment with national health
priorities. While the National Council on Health (NCH) supports the strategic
leadership of the FMOH in collaboration with the FMCT, there is currently no
national governance structure in place for Health ICTs and to facilitate coordination across MDAs, with development partners and the private sector.
Therefore, it is essential for Nigeria to establish a National Health ICT Steering
Committee and supporting structure. The Steering Committee will be responsible for overseeing Health ICT planning, implementation, coordination,
governance and evaluation to the achievement of the Health ICT Vision.
Specifically, the National Health ICT Governance Committee will be responsible for the following:
•#Oversight of the implementation of the National Health ICT
Framework and Strategy
•#Ongoing coordination of Health ICTs across MDAs and with
development partners and the private sector
•#Alignment of Health ICT investments and activities with health
system priorities
•#Promoting awareness of Health ICT policies, regulations and best
practices, and encouraging, incentivizing or mandating adoption of
nationally-supported Health ICT services
•#Oversight of Health ICT strategic planning, including integration of
Health ICT into new health programs and workflows and evolution
of the National Health ICT Architecture
•#Implement National Health ICT Monitoring and Evaluation Plan to
ensure delivery of expected outcomes
•#Support and facilitate required change across MDAs
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!21
TABLE 2. Summary of Recommendations to Improve Health ICT Enabling Environment
COMPONENT
RECOMMENDATIONS
Leadership and
Governance
• Establish a National Health ICT Steering Committee and supporting structure to oversee Health ICT
planning, implementation, coordination, governance and evaluation
• Engage in broad stakeholder engagement beyond the Federal Government to involve State
governments, private sector and development partners
Strategy and
Investment
• Develop and periodically review the National Health ICT Strategy
• Secure sustainable funding to further develop and operationalize the National Health ICT environment,
align existing projects and investments and explore incentives and additional sources of both traditional
and catalytic funding
• Set up structures and processes to ensure proper investment and management of allocated funds at
the National and State levels
• Leverage existing information systems, including the Health Finance Information System
Legislation,
Policy and
Compliance
• Conduct an extensive review of policies relevant to Health ICT and develop recommendations in
collaboration with other ministries to harmonize existing policies and to address current and future
policy gaps, including privacy and security of personal health information
• Establish a mechanism for regular review of Health ICT policies, implementation guidance and best
practices
• Address key policy and regulatory gaps (i.e., privacy and security or standards and interoperability)
Architecture,
Standards and
Interoperability
• Define and implement a National Health ICT Architecture that defines high-level nationally-supported
health information services, while harvesting from existing projects, supporting long-term meaningful
use of ICTs within the health system
• Implement and harmonize digital registries, data collection instruments and reporting indicators that
meet the needs of UHC and other prioritized services and applications
• Establish guidelines, minimum functional requirements, and interoperability standards that allow for the
consistent and accurate collection and exchange of health information across the health system
Capacity
building
• Establish a system for Health ICT workforce monitoring and evaluation, readiness, adoption and
practices
• Develop incentive mechanisms to encourage workforce development of Health ICT skills and
competencies, leveraging the FMOH Collaborative Center Training Program and other existing
mechanisms where possible
• Establish methodology for accreditation and revision of Health ICT training Curriculum
• Establish special Health ICT education, training and career path development programs
• Develop and implement a strategy for the training and recruitment of a cadre of professionals into
government positions to design, implement and maintain Health ICT systems
Infrastructure
• Reinforce existing strategies for ongoing funding and investment in power provision, acquisition,
installation and maintenance at all health facilities throughout the country, including exploring
mechanisms (i.e. regulatory) for promoting distribution of alternate power
• Define minimum infrastructure and computing requirements for each type of health facility and health
administrative office and link to accreditation and assessment
• Develop and introduce a basic ICT and related equipment package for health facilities based on
prioritized services and application needs that encourages local ownership and capacity building
• Strengthen local and regional support programs, such as the Rural Information Technology Centers, to
ensure ongoing support for infrastructure development and maintenance
• Install and maintain Internet and/or broadband connectivity for all tertiary and secondary along with
prioritized primary health facilities as well as State and LGA level health administrative offices
• Develop incentive mechanism for Health ICT infrastructure improvement
Solutions
(Services and
Applications)
• Develop and implement services and applications to enable and deliver UHC, including at minimum
digital beneficiary enrolment, premium payment, coverage verification, and recording of encounters
• Select additional priority Health ICT services and applications for scale-up based on need, strategic
alignment with Health and Health ICT priorities, preparedness and evidence
• Gather and disseminate best practices for the implementation of Health ICT services and applications
22!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
The National Health ICT Steering Committee and supporting structure will
direct the application of ICTs to achieve the Health ICT Vision. The Steering
Committee will report to the National Council on Health, which will own the
Health ICT Vision and approve periodic updates. The Steering Committee
will set up a Health ICT Technical Working Group to coordinate technical and
operational inputs. A Health ICT Project Management team will be established
to carry out the implementation of the Health ICT Vision in support of the
Steering Committee and Technical Working Group (TWG). The National
Monitoring and Evaluation (M&E) Advisory Group will facilitate M&E and
linkages to the NHMIS. The recommended Health ICT governance structure is
depicted in Figure 4. Refer to Appendix 4 for a detailed description of each
entity in the governance structure.
3.2 Strategy and Investment
The Health ICT Vision requires sufficient funding, sustainable financing
mechanisms, incentives and accountability structures to support priority
Health ICT activities. The combination of the strategy and investments
ensures the development of a responsive plan and approach for improving
the Health ICT environment and securing financing for sustained activities.
Accordingly, four recommendations were provided that address current
gaps in strategy and investment:
•#Develop and periodically review the National Health ICT Strategy
FIGURE 4. Health ICT Governance Structure, State Health ICT Governance
Health Sector Leadership
State Steering Committee
National Council on Health
HCoH & HCCT
Oversee activities and own the vision
State eHealth Steering Committee
Health ICT Steering Committee
HMoH & HMCT
Provide strategic management
Health ICT Project
Management
Health ICT Technical
Working Group
Provide operational management
Provide technical inputs and also
responsible for standards and guidelines
HMoH – Honorable Minister of Health
HMCT – Honorable Minister of
Communication Technology
ICT – Information and Communication
Technology
M&E – Monitoring and Evaluation
NHMIS – National Health Management
Information System
HCoH – Honourable
Commissioner of Health
HCCT – Honourable
Commissioner of Communication
Technology
Note: in some states, the lead
inTechnology is a Special Adviser
to the Governor or the Head (DG
or ES) of a State Agency for ICT
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!23
•#Secure sustainable funding to further develop and operationalize the
National Health ICT environment, align existing projects and investments and explore incentives and additional sources of both traditional
and catalytic funding
•#Set up structures and processes to ensure proper investment and management of allocated funds at the National and State levels
•#Leverage existing information systems, including the Health Finance
Information System
By drawing from existing health information systems and ongoing and planned
activities, such as the Health Finance Information System, NHMIS, Human
Resources for Health’s (HRH’s) Health Worker Registry and the National
Health Insurance Scheme, the National Health ICT Strategy can leverage
current investments in lowering overall costs while maximizing downstream
value and providing direction to ensure achievement of the National Health
ICT Vision. The National Health ICT Strategy can also capitalize on current
funding sources.15 Creative means of funding — catalytic funding, incentives
for entrepreneurs and developers — may also be explored for their viability
in addition to existing funding sources (e.g., donors and external funders and
private sector investments). A recommendation has been made to establish
a trust fund for Health ICT to pool government and development partner
resources to simplify the management and investment of funds and promote
transparency and accountability.
3.3 Legislation, Policy & Compliance
This component of the enabling environment addresses the legal and regulatory measures, public policy, and observance of rules and regulations related
to Health ICT initiatives. There is a special focus on ensuring privacy and security of personal health information. To maintain and strengthen trust between
consumers, the private sector and the health system, use of Heath ICTs must
support and improve the safe, effective, efficient, equitable and timely delivery
of care. In addition, policy and regulatory guidance must be clear. Three legislation, policy and compliance recommendations were suggested:
•#Conduct an extensive review of policies relevant to Health ICT and develop recommendations in collaboration with other ministries to harmonize
existing policies and to address current and future policy gaps, with a
particular focus on privacy and security of personal health information
•#Establish a mechanism for regular review of Health ICT policies, implementation guidance and best practices
•#Develop and put in place systems of accountability and compliance
mechanisms for key measures of the Health ICT Framework
There are existing privacy and security policies that are applicable to Health
ICT, including Nigeria’s Medical Code of Ethics, Constitution of the Federal
Republic of Nigeria and National Health Law 2014. The Code of Ethics contains
a special telemedicine provision. The provision covers the safety and maintenance of personal health information when that information is stored; sent;
or received by fax, computer, e-mail or other electronic means.17 Sections 37,
45 and 46 of the Constitution establish a general right of privacy for Nigerian
citizens, which can be applied to health.17 The National Health Law 2014 also
provided for authorized access and storage of patient records.18 Awareness
24!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
of these provisions is limited, and education and capacity building in how to
apply them to the use of Health ICT is needed.19
3.4 Architecture, Standards and Interoperability
The architecture, standards and interoperability component of the enabling
environment addresses the development of a blueprint of nationally supported digital services, such as the NHMIS and Health Worker Registry and
their interactions, and the adoption of standards to maximize the meaningful
use and sharing of health information. This is of particular importance given
the federal structure of Nigeria’s health system and diversity of systems and
actors involved in the delivery and administration of health services.
A National Health ICT Architecture, that builds off of existing Health ICT solutions in Nigeria and best practices from other countries, was proposed in Part I,
Section 2. The architecture defines the high-level structure of systems that the
Nigeria FMOH is already supporting. With strategic coordination, the systems
could support a broad set of health system use cases, in addition to enabling
and delivering UHC by 2020. Proposed nationally-supported architectural
components include the NHMIS; a digital facility registry based on the FMOH
Department for Planning Research and Statistics (DPRS) registry; a digital
health worker registry based on the FMOH HRH Health Worker Registry; a
terminology service building off of the National Agency for Food and Drugs
Administration and Control (NAFDAC) drug formulary; a registry of clients
leveraging NHIS and the National Identity Management Commission (NIMC)
and a shared digital patient record building off existing EMR implementations by the National Primary Health Care Development Agency (NPHCDA),
National Agency for Control of AIDS (NACA) and others. In a heterogeneous
environment with incompatible software projects and limited data and security
standards, setting up a standards-based and interoperable National Health ICT
Architecture is a prerequisite to a coordinated and connected health system.
Standards define how information is stored in Health ICT systems and how it
is transferred between them, enabling interoperability. The absence of mandated Health ICT standards and interoperability requirements and guidelines
has exacerbated fragmentation, limited scale-up and increased market risk.
Establishing interoperability, data and software functionality standards and
requirements will allow for consistent and accurate collection and exchange of
health information across health systems and services.
Recommendations within Architecture, Standards and Interoperability are
as follows:
•#Define and implement a National Health ICT Architecture that defines
high-level nationally-supported health information services, while aligning existing projects, supporting long-term meaningful use of ICTs
within the health system and helping enable and deliver UHC by 2020
•#Implement and harmonize digital registries, data collection instruments
and reporting indicators that meet the needs of UHC and other prioritized services and applications
•#Establish guidelines, minimum functional requirements and interoperability standards that allow for the consistent and accurate collection
and exchange of health information across the health system. Outputs
may include guidelines for use of Health ICT within public facilities and
requirements for electronic reporting of health data and indicators
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!25
3.5 Capacity Building
Skilled and empowered health and ICT workforces are needed to design,
develop, maintain, govern and use the services and applications critical to
meeting the National Health ICT Vision. Recent estimates put the density of
doctors and nurses/midwives in Nigeria at 4 and 16 per 10,000 populations,
respectively.20, 21 However, there are significant urban-rural and regional differences in health worker distribution. Health ICT training is limited and there are
no career paths available to specialize in Health ICTs in Nigeria. Additionally,
no incentive schemes exist for the adoption of ICTs in health service delivery.
A recent baseline field assessment of Health ICT implementations across
Nigeria’s six geopolitical zones found that 32% of Local Government Area
(LGA) M&E Officers interviewed and fewer facility-level health workers had
been trained on the use of the widely implemented and adopted NHMIS.22
In response to challenges with managing the health workforce, the FMOH
designed and developed an electronic health workforce registry (eRegistry)
that has improved the management of a subset of the health workforce and
enabled the tracking of capacity building activities and health worker competencies. In addition to incorporating Health ICT training into standardized
curricula, the eRegistry and other Health ICT services and applications present
an opportunity for a nationally scaled health workforce registry and digitally
supported health and ICT workforce education and training.
Specific recommendations for the Capacity Building component are as follows:
•#Establish a system for Health ICT workforce monitoring and evaluation,
readiness, adoption and use
•#Establish special Health ICT education, training and career path development programs, leveraging the FMOH Collaborative Center Training
Program and other mechanisms where possible
•#Develop incentive mechanisms to encourage workforce development
of Health ICT skills and competencies
•#Establish methodology for accreditation and revision of Health ICT
training curricula
•#Develop and implement a strategy for the training and recruitment of a
cadre of professionals into government positions to design, implement
and maintain Health ICT systems
3.6 Infrastructure
Infrastructure refers to the physical facility and related assets that form the
foundation for Health ICT implementations, consisting of reliable electricity,
cellular and Internet connectivity, and ICT equipment (e.g., computers, servers
and data warehouses). Currently, infrastructure is inadequate to scale up
Health ICT systems nationally, especially in under-served areas of the country.
Given the magnitude of the gap, infrastructure investments should be coordinated to ensure that they are in step with Health ICT and health system
priorities (e.g., to enable UHC by 2020). Existing programs, like the Rural
Information Technology Centers and the Universal Service Provision Fund’s
Community Resource Centers, may be leveraged.
Specific infrastructure recommendations include the following:
26!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
•#Establish a workable strategy for ongoing funding and investment in
electrical power provision, acquisition, installation and maintenance at
all health facilities throughout the country, including exploring other
mechanisms (i.e., regulatory) for promoting distribution of power
•#Define minimum infrastructure and computing requirements for each
type of health facility and health administrative office and link to accreditation and assessment
•#Develop and introduce a basic equipment package for health facilities
based on prioritized services and application needs that encourages
local ownership and capacity building
•#Strengthen local and regional support programs, such as the Rural
Information Technology Centers, to ensure ongoing support for infrastructure development and maintenance
•#Install and maintain Internet and/or broadband connectivity for all
tertiary and secondary along with prioritized primary health facilities as
well as State and LGA level health administrative offices
•#Develop incentive mechanism for further Health ICT infrastructure
improvements
FIGURE 5. Key Findings from Baseline Inventory Assessment on Number of
Health ICT Implementations by Program Area (UNF Assessment Report)
Nutrition
Immunizations
12
20
Essential
Commodoties
Maternal, Newborn
& Child Health
16
63
eMTCT
22
Malaria
11
In 2014, when the baseline assessment was conducted, 84 Health ICT projects were identified and included in the
inventory. 28% of those initiatives were pilots and 24% were in the process of scaling up from pilot implementations.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!27
3.7 Services and Applications
Services and applications provide the tangible means for end users to derive
benefits from the application of ICTs to health. They facilitate service delivery
and provide access to the information required for health planning and administration. Examples range from electronic medical records and laboratory
information systems to mobile applications for health insurance enrolment,
premium payment and verification. The focus of the services and applications
component is to facilitate selection of a small number of Health ICT solutions,
building off of existing projects where possible, that align with national health
system priorities, have sufficient preparedness and evidence for national
scale-up and simultaneously drive strategic investments into the National
Health ICT Architecture.
Although health services delivery in Nigeria is primarily based on traditional
or paper-based approaches, there are numerous Health ICT tools at varying
degrees of maturity implemented throughout the country. Prevalent cellular
coverage and mobile subscriptions throughout Nigeria has encouraged experimentation with mHealth or mobile-supported interventions, especially within
maternal and child health. An opportunity remains to integrate mHealth into
national health programming, especially in underserved regions. Patient and
supply-chain information systems, though at their infancy, are being adopted
for health services delivery, as well. NHMIS is the most prevalent Health ICT
application in the health system, but routine data is generally still collected
manually on paper forms and then entered electronically at the LGAs.23
Specific recommendations for the services and applications component are:
•#Develop and implement services and applications to enable and delivery UHC, including at minimum digital beneficiary enrolment, premium
payment, coverage verification, and recording of patient encounters
•#Select additional priority Health ICT services and applications for scaleup based on need, strategic alignment with Health and Health ICT
priorities, preparedness and evidence
•#Gather and disseminate best practices for the implementation of Health
ICT services and applications
28!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Part II: Action Plan
for Health ICT
PART II. SECTION 1:
HEALTH ICT THEORY OF CHANGE
ICT is well positioned to help achieve the key UHC outcomes of improved
equity, access, service and financial coverage, uptake, and quality. 25 Each of
these aspects of UHC can be supported by ICT services and applications that
contribute to its accelerated achievement. The elements required to achieve
the vision of Health ICT in the delivery of UHC have been layered on to the
National Health ICT Vision, UHC outcomes, Health ICT outcomes and long-term
ICT outputs to form the Theory of Change (see Figure 6). The set of interconnected elements are presented in a graphical form and illustrate the pathway of
change from the Health ICT enablers, short- and long-term ICT-related outputs
and Health ICT outcomes as they align with UHC outcomes. The Health ICT
enablers, directly and indirectly support activities that make other more direct
outputs and outcomes possible, ensuring that there is a career path within the
health sector for technology professionals; there is also a requirement that
appropriate governance structures are in place to make informed decisions and
FIGURE 6. Theory of Change for the Nigeria National Health ICT Vision
NIGERIA
NATIONAL HEALTH
ICT VISION
UHC OUTCOMES
HEALTH ICT
OUTCOMES
LONG-TERM
ICT OUTPUTS
SHORT-TERM
OUTPUTS
(1 YEAR)
HEALTH ICT
ENABLERS
By 2020, Health ICT will help deliver and enable universal health coverage — whereby
Nigerians will have access to the services they need without incurring financial risk.
Improved
access to
health
services
Increased
coverage of
health
services
Effective use of
telemedicine
and use of ICT
for health
worker training
and support
Effective use of
CRVS, HRIS,
NHMIS & LMIS
for tracking
demand and
supply of health
services and
commodities
Increased
uptake of
health
services
Effective use
of mobile
messaging &
cash transfers
for demand
creation
Improved
quality of care
Increased
financial
coverage for
health care
Increased
equity in,
access to, and
quality of
health services,
information,
and financing.
Effective use of
ICT for decision
support &
within the
continuum
of care
Effective use
of ICT for
health
insurance &
other
health-related
financial
transactions
Effective use
of ICTs for
delivering
appropriate
health services
for those who
need them
most based on
epidemiology
and ability
to pay
Nationally scaled integrated Health ICT services and applications supported by
Nigerian Health Information Exchange implemented with appropriate funding,
infrastructure & equipment, training & policies.
Strategic
framework,
governance
structure &
Health ICT Fund
established
Guidance on
existing
policies & gaps
identified
Review and
adoption /
adaptation of
prioritized
standards
Health ICT
assessment,
curriculum
developed,
career path
developed
Define
minimum
package &
plan for
connectivity,
power &
equipment
Prioritized
services &
applications
identified &
requirements
gathered
Leadership,
governance,
strategy &
investment
Legislation,
policy, and
compliance
Standards &
Interoperability
Capacity
building
Infrastructure
Solutions
(services &
applications)
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!29
investments in technology. The enablers are based on the WHO-ITU eHealth
Strategy Toolkit14 and highlight the importance of investing in the enabling environment in addition to the implementation of ICT services and applications. The
Health ICT outcomes include the use of ICT to facilitate and track the coverage
and delivery of health services and commodities through digitized CRVS, HRIS,
LMIS, health service delivery and timely decision-making (through NHMIS) as
well as enrollment, claims and reimbursement software for managing financial
transactions within the health system (particularly in relation to insurance).26
The long-term outputs of nationally scaled integrated Health ICT services
and applications are the bridge that maps and aligns key Health ICT enablers
and short-term outputs with the achievement of UHC. This is supported by a
Nigerian Architecture implemented with appropriate funding, infrastructure,
equipment, training and policies. Targeted outputs detailed in this National
Health ICT Strategic Framework serve as catalysts towards creating the appropriate combination of governance, strategy, financing, workforce ICT-readiness,
infrastructure, policy, standards and prioritized services and applications that
will ultimately inform and generate the enabling environment needed for Nigeria
to move towards nationally scaled integrated digital health systems that contribute to improved health outcomes and greater well-being.
PART II. SECTION 2:
HEALTH ICT ACTION PLAN
A detailed action plan was developed using the Theory of Change along with the
stakeholder-generated recommendations from Part I, Section 3. Reflective of the
key stakeholders’ inputs and needs, the action plan will be used to direct implementation for the realization of the Health ICT vision (including development of
the budget), and the M&E plan will be used to track and assess progress.
The vision recommendations, categorized by the seven components of the
enabling Health ICT environment, were converted into an actionable, measurable form in the detailed action plan (see Appendix 5). Each recommendation
has a set of steps that informs how the recommendation will be achieved. The
steps have been organized into activities and sub-activities, with dependencies noted. The persons or entities responsible for carrying out each of the
activities are clearly identified in the plan, as well. The following integrated
action plan is a high-level summary of the detailed action plan (see Table 3).
Based on the Theory of Change, the recommendations are connected along a
logical pathway of activities with short- and long-term impact. The activities
reflect a five-year process, separated into three phases, to support the attainment of UHC. The phases are:
PHASE 1: Set-up (Year 1)
PHASE 2: Deploy, Maintain and Support (Year 2 and Year 3)
PHASE 3: Consolidate and Continuous Review (Year 4 and Year 5)
Set-up and preparation will take place in year 1. During years 2 and 3, activities
that reflect Deploy, Maintain and Support to help meet the vision will be carried
out. The final two years (years 4 and 5) will be focused on Consolidate and
Continuous Review activities and reviews of progress. The initial phase will be
front-loaded as important foundational structures and activities will need to be
established. As time advances, there will be opportunities to assess the status of
progress and revisit the action plan.
30!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Some activities are longitudinal and will span the entire course of the timeframe, while others may be more discrete. All are captured in the action plan,
including the timeframe needed to meet or sustain each recommendation.
Revisiting the action plan will be important to ensure the continued alignment
of the activities with achieving UHC.
The members of the NCH, as owners of the Health ICT vision, will oversee
the action plan with guidance and support from the Health ICT Steering
Committee, Technical Working Group and Project Management Office.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!31
32!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Compliance
Policy &
Legislation,
Interoperability
Standards &
Investment
Strategy &
Governance
Leadership &
PHASES
TIME/
SEQUENCE
Q3
Health ICT PMO
& TWG capacity
strengthening
Establish
Nigerian
Health
Information
Exchange
(HIE)
Training and
capacity building on
Health ICT standards
& interoperability
Review existing
national and international standards
Establish special purpose Health
ICT Fund
Q1
Establish catalytic
funding
Q4
Q3
Q1
Q2
YEAR 3
Q3
Q4
Q1
Ongoing review and update of national standards and requirements
Scale-up the Nigerian HIE
Ongoing on-the-job Health ICT mentoring
Q4
Develop and approve standards for secure messaging, high-priority health information, terminologies and data dictionaries
Establish & implement compliance mechanisms
Review and update of policies
Q1
Q2
YEAR 5
Review and re-explore sources of Health ICT funds
Q3
Advocacy, communication and education to decision makers and end users to ensure support for Health ICT standards application
Establish incentive mechanisms
Q2
YEAR 4
Q3
Q4
PHASE 3 – CONSOLIDATE AND CONTINUOUS REVIEW (YEAR 4 AND YEAR 5)
Framework adoption and ongoing broad stakeholder engagement
Q4
Link policies with Health ICT Framework
Q2
YEAR 2
PHASE 2 – DEPLOY, MAINTAIN AND SUPPORT (YEAR 2 AND YEAR 3)
Develop, adapt or
adopt high-level
requirements and
design for foundational
Health ICT services
State Engagement / Governance
Q2
Setup
Fund coorInvestment
dination
management
mechanism
structure
Q1
YEAR 1
Explore source of funds & align with
framework
Establish
SC,
TWG &
PMO
Framework
Endorsement
Q4
YEAR 0
PHASE 1 – SETUP
TABLE 3. Nigeria National Health ICT Vision Integrated Action Plan 2015 - 2020
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!33
Building
Capacity
PHASES
TIME/
SEQUENCE
Q1
Q2
Q3
Q4
Define professional
practice standards
YEAR 1
Define
new
accreditation
requirements
Design targeted
stakeholder
reference and
working group
Develop Design M&E
Health ICT framework
for
awareness
campaign measuring
effectivestrategy
and
ness of
roll-out
engagement
Establish National Health ICT knowledge
repository
Identify
education
and training
course
changes
Develop
standard
Health ICT
competency
framework
Develop and Roll-out inventive schemes for
Health ICT adoption
Assess Health
ICT readiness of
stakeholders
Q4
YEAR 0
PHASE 1 – SETUP
Q3
Q4
Develop strategy for continued
Health ICT skills and competency
acquisition
Q2
Monitor
effectiveness of
Health ICT
use and
adoption
Implement specialized Health ICT courses
Establish specialized Health ICT qualifications
and certification track
Implement education and training course
changes
Review FMoH collaborative programs to
include health informatics
Implement
new accreditation
requirements
Q1
YEAR 2
Q2
Q3
Q4
Q1
Engage and consult with stakeholder reference and working groups
Q2
YEAR 4
Q3
Q4
Q1
Q2
YEAR 5
Q3
Q4
PHASE 3 – CONSOLIDATE AND CONTINUOUS REVIEW (YEAR 4 AND YEAR 5)
Monitor Health ICT adoption
Design Health ICT skills and
competencies career progression
plan
Q1
YEAR 3
PHASE 2 – DEPLOY, MAINTAIN AND SUPPORT (YEAR 2 AND YEAR 3)
TABLE 3. Nigeria National Health ICT Vision Integrated Action Plan 2015 - 2020 continued
34!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Applications)
(Services &
Solutions
Infrastructure
PHASES
TIME/
SEQUENCE
Q2
YEAR 1
Q3
Identify priority
services and/or
applications
Select implementation
partners to
develop data
connectivity
infrastructure
Q4
Identify resources
to support the
expansion and
development of
identified services &
applications
Q1
Develop/implement collaboration portal
Develop/revise
requirements and
design for identified services &
applications
Advocate for priority infrastructure
Link health
organization
providers’ Health
ICT acceditation to
meet minimum health
facility computing
infrastructure
Develop data connectivity
implementation and design plan
Q1
Define minimum
computing, power
and connectivity
infrastructure
requirements
for health
implementation
Identify
and assess
ongoing
infrastructure
projects in
underserved
areas
Identify
underserved
areas
Q4
YEAR 0
PHASE 1 – SETUP
Q2
Q3
Q4
Q1
Q2
YEAR 3
Q3
Q4
Q1
Q2
YEAR 4
Q3
Q4
Q1
Identify best practices in Health ICT and disseminate widely
Ongoing scale-up of priority services and application
Promote research and development of priority Health ICT solutions
Foster continuous upgrades of implemented high priority Health ICT solutions
Operate, support and sustain priority Health ICT services and application
Build/deploy/scale identified priority National Health ICT services and/or applications
Q2
YEAR 5
Q3
Q4
PHASE 3 – CONSOLIDATE AND CONTINUOUS REVIEW (YEAR 4 AND YEAR 5)
Local participation of communities in support, maintenance and use of Health ICT services and applications
Deploy data connectivity infrastructure for underserved areas
YEAR 2
PHASE 2 – DEPLOY, MAINTAIN AND SUPPORT (YEAR 2 AND YEAR 3)
TABLE 3. Nigeria National Health ICT Vision Integrated Action Plan 2015 - 2020 continued
Part III: Monitoring &
Evaluation Plan for Health ICT
PART III. SECTION 1:
MONITORING & EVALUATION PLAN
The M&E plan provides a link between the vision, action plan and desired
results (see Appendix 6). The M&E plan draws from the Theory of Change to
define the relationship between the inputs, activities, outputs, outcomes and
impact. Its contents are measurable and presented in the form of indicators.
Accordingly, progress towards achievement of the vision can be tracked and
evaluated and inform whether the implementation is yielding intended results
and outcomes. In line with the adopted result-based management approach27,
the M&E plan has three aspects: the indicators for the activities outlined in the
action plan, the baseline and target measures and the governance to oversee
and support progress.
The indicators developed for and used in the Health ICT M&E framework focus
on outcomes and health impact. The outcomes are related to the enabling environment and translate the recommendations and activities from the action
plan into a measurable form. The health impact reflects the national focus on
UHC and uses national indicators for health services access, delivery, coverage,
quality and equity. For each indicator, its scope or reach (e.g., National, State
or both) along with the data source, collection method and frequency of data
collection are articulated. The baseline measures will be obtained and target
measures for 2020 set by the leadership and supporting entities.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!35
Appendices
APPENDIX 1:
LIST OF CONTRIBUTING ORGANIZATIONS
ABT Associates - HS2020
Galaxy Backbone (GBB)
Ajimatics
Groupe Special Mobile
Association (GSMA)
ANADACH group
Bill and Melinda Gates
Foundation
Center for Management
Development (CMD)
Centers for Disease Control
and Prevention (CDC)
Health Finance and
Governance
Health in Africa (HIA)
Health Information Systems
Program (HISP) Nigeria
Nigeria Communications
Commission (NCC)
Nigeria Computer Society
(NCS)
Nigeria Telecommunications
Satellite (NIGCOMSAT)
Norwegian Agency
for Development and
Cooperation (Norad)
Computer Professionals
(Registration Council of
Nigeria)
Health Reform Foundation of
Nurses and Midwifery Council
Nigeria
of Nigeria
ICT for Saving One Million
Pathfinder International
Lives (ICT4SOML)
Praekelt Foundation
InStrat Global Health
Solutions
Private Sector Health Alliance
Digital Bridge Institute (DBI)
Intel
eHealth Nigeria
International Finance
Corporation (IFC)
Clinton Health Access
Initiative (CHAI)
Federal Capital Territory
Administration (FCTA)
Federal Civil Service
Federal Ministry of
Communication Technology
- Department of Planning
Research and Statistics
(FMCT-DPRS)
Federal Ministry of Health
- Budget
Federal Ministry of Health
- DPRS
John Snow Incorporated
(JSI)
Medical and Dental Council
of Nigeria
Millennium Development
Goals (MDGS) Nigeria
Mobile Alliance for Maternal
Action (MAMA)
National Agency for Control
of AIDS (NACA)
Federal Ministry of Health Family Health
National Agency for Food
and Drugs Administration
and Control (NAFDAC)
Federal Ministry of Health Food and Drugs
National Health Insurance
Scheme (NHIS)
Federal Ministry of Health Hospital Services
National Identity
Management Commission
(NIMC)
Federal Ministry of Health National AIDS Control and
Prevention Programme
(FMOH-NASCP)
Federal Ministry of Health
- National AIDS Control
and Prevention Programme
(FMOH-NPSCMP)
Federal Ministry of Health Public Health
FMCT- eGovernance
(FMCT-eGov)
Fortern Global Ltd
Futures Group
36!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
National Information
Technology and
Development Agency
(NITDA)
National Primary Health
Care Development Agency
(NPHCDA)
National Tuberculosis and
Leprosy Control Programme
(NTBLCP)
National Universities
Commission (NUC)
Network Data Services and
Technology Ltd. (NDST)
Saving One Million Lives
(SOML)
Standards organization of
Nigeria (SON)
State Ministries of Health
- DPRS
State Ministries
of Information/
Communication/Science
and Technology or Relevant
Agencies or designates
Subsidy Reinvestment and
Empowerment Program
Maternal and Child Health
(SURE-P MCH)
United Nations (UN)
Foundation
United States Agency for
International Development
(USAID)
Universal Service Provision
Fund (USPF)
USAID Monitoring and
Evaluation Management
Services (USAID/MEMS)
World Bank
World Health Organization
(WHO)
APPENDIX 2:
HEALTH ICT SCENARIO ILLUSTRATING
CHANGE AND IMPACT ON STAKEHOLDERS
SCENARIO: THE HEALTH ICT VISION IN PRACTICE
A few months ago, Fatima registered her children in the NHIS* through the Primary School
Enrollment Process. At that time, Fatima and her husband were also enrolled in the NHIS and they
were issued NHIS Cards that can be used for healthcare services.
Mary woke up early. She checked her phone. It was 6 AM. She had 30 minutes to get ready before
going to work. She scrolled through her apps to double check the shift calendar. Earlier on in the
week, she had received a request to swap shifts with one of her co-workers who was headed out
of town to attend to a family matter. She started getting ready.
Around the same time, Fatima was going about her day. She was expecting and due at any time.
She had developed a birth plan with the local midwife. When she first learned that she was pregnant, she decided to sign up for weekly SMS* notifications about her pregnancy and to receive
appointment reminders. She found the messages and pictures informative and even enjoyable,
and would often discuss them with her sisters. She was especially proud that she had not missed
a single appointment. This was unlike her previous pregnancies. She sighed as she recalled her
previous experiences. Back then, she did not know the importance of antenatal visits or setting up
a birth plan. Sometimes she would make appointments, but not show up. This time was different…
Fatima felt a contraction.
Mary arrived at work right on time. She was excited for the day. During shift hand-off, she and
her co-worker huddled over one of the clinic’s tablets going through the different cases of clients
present at the clinic. They prioritized the cases and she got to work.
Fatima notified her family members that she needed to be taken to the clinic. She then directed
one of her sisters to text the local clinic about the situation. A taxi was called and Fatima proceeded to the clinic.
[Alert.] Mary checked the clinic tablet. She read that a 33 year old female, G4P2 (Gravida of 4,
Parity of 2)*, in labor was headed to the clinic.
When Fatima arrived, she and her husband realized they had left the NHIS card at home in
the hurry. But they were lucky; her NIN* was stored in her husband’s phone contact. With the
cross-reference she was triaged and encouraged to relax or walk about until the contractions
came closer together.
During her assessment of Fatima, Mary observed that the baby was in a breech position. When she
had a break, she decided to read up on breech deliveries. She browsed the resources on the clinic
tablet and began reading. After reading, Mary decided to review Fatima’s chart again through the
EMR system accessible using the tablet. Fatima had mentioned a history of pregnancy complications, but Mary did not see that in the clinic’s system so she checked the Nigerian Health Exchange
to see if the records were there. Mary retrieved Fatima’s shared health record and learned that the
first baby had been breech and did not survive. It had been a home delivery in a different village.
To be safe, Mary decided to request a brief consult with the obstetrics/gynecology department
at the referral hospital. She sent off the request through the hospital tablet. Within a few short
minutes, she was on the phone with the on-call physician in that department.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!37
Fatima’s contractions shortened. Mary checked up on her and moved her to the delivery room.
Mary had instructions to contact the on-call physician her through phone or videoconference
if any complications arose. Mary felt confident going in to the delivery and provided support
to Fatima.
Fatima, G4P3, delivered a healthy baby boy weighing 3.4 kgs, 49.3 cm in length at 17h21 on... Mary
typed into the clinic computer, updating Fatima’s chart as she smiled. Through the chart update,
the baby was registered in the Civil Registration and Vital Statistics database. The data were also
automatically transmitted to the NHIS database for facility reimbursement, the facility’s LMIS* to
account for supplies used during the birth and the NHMIS* for health services planning. Meanwhile,
mum and baby were doing fine in the recovery unit.
One week later, Oye, the local government M&E* officer was reviewing aggregate electronic
NHMIS reports from each of the LGAs*. That week, the decline in maternal and neonatal mortality
continued. He concluded his day by emailing off performance reports to each of the supervisors in
his department and fulfilling supply requests and systems prompts.
* EMR = Electronic Medical Record
G = Gravida (number of pregnancies)
LGA = Local Government Area
LMIS = Logistic Management Information System
M&E = Monitoring and Evaluation
NHIS = National Health Insurance Scheme
NHMIS = National Health Management Information System
NIN= National Identification Number
P = Parity (number of successful births)
38!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
APPENDIX 3:
RECOMMENDED NIGERIA HEALTH ICT
ARCHITECTURE
In Health ICT projects, the architecture serves as the conceptual framework
that defines the high-level structure and behavior of the system components.
The recommended architectural approach is a components-based approach
that fosters collaboration and interoperability.
The architecture facilitates interoperability by creating a reusable framework
that is service oriented, maximally leverages health information standards,
enables flexible implementation and supports the interchangeability of individual components. Integrating the Health Enterprise (IHE) and other transaction standards form the basis for the interactions between the architecture
components and Point-of-Service (POS) applications. This architecture is
designed to build upon and amplify the health benefits of existing Nigerian
health and government initiatives.
Health Information
Exchange
Interoperability Layer
Point Of Service
Applications
Many of the components in the proposed architecture are already being
developed or can leverage existing projects or information. The following is
an overview of each of the proposed architecture components and some
examples of Nigerian projects or activities that could be leveraged in the
proposed architecture.
•#An enterprise master patient index (EMPI), or Client Registry (CR)
manages the unique identity of citizens receiving health services with
the country – “For whom”
The work that NIMC and NHIS are doing to link insurance beneficiaries
to unique patient identifiers can be leveraged to provide a strong
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!39
foundation for a client registry portion of a health information exchange
(HIE). The National Identification Number (NIN) could be considered as
a key, highly “discriminating”, attribute for identifying patients. To take
advantage of that, we recommend understanding the relationship between NIMC and NHIS and gaining a better understanding of how the
NIN relates to healthcare identification across the entire health system.
•#A Health Worker Registry (HWR) is the central authority for maintaining
the unique identities of health providers within the country – “By whom”
HRH has already created an OpenHIE-compatible Health Worker
Registry and they are in the process of working towards populating it.
To position the registry to be utilized outside of HRH, we recommend
that the team continue to expound upon the value that this data can
provide across the healthcare system.
•#A Health Facility Registry (FR) serves as a central authority to uniquely identify all places where health services are administered within the
country – “Where?”
Significant work has been done to collect facility registry information,
largely led by the FMOH DPRS. This information is valuable and can provide value across the public and private health system. For example, the
data can be used in supply chain planning and in verifying the location of
a patient’s clinical interaction. The FMOH is well positioned to move this
content toward a digital platform that can be more widely used and supported. We recommend further conversations around governance models.
•#A Health Management Information System (HMIS) is a repository
containing the normalized version of aggregate-level content created
within the community, after being validated against each of the previous registries. It is a collection of indicator-centric records for cohorts
with information in the exchange.
The FMOH Department of Planning, Research and Statistics (DPRS)
has selected DHIS2 as the HMIS platform and there are currently web
and paper data collection processes for reporting of primary health
indicators. DHIS2 is compliant with the proposed architecture.
•#A Shared Health Record (SHR) enables the collection and storage of
electronic health information about individual patients in a centralized
repository which is capable of being shared across different healthcare settings.
There are numerous point-of-care systems that are EMRs and capturing data about clinical encounters. Depending upon the initial health
priority that the team decides to pursue, many of these implementations could provide input on data standards and/or be positioned to
contribute to a shared health record.
•#A Terminology Service (TS) serves as a central authority to uniquely
identify the clinical activities that occur within the care delivery process
by maintaining a terminology set mapped to international standards
such as ICD10, LOINC, SNOMED, and others – “What?”
While no terminology service currently exists, some indicator, registry
and data definitions do exist. The initial health priority will help focus
the team on the terminology standards that need to be defined first.
40!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
•#A Health Interoperability Layer (IL) receives all communications from
point of service applications within a health geography, and orchestrates message processing among the point of service application and
the hosted infrastructure elements.
Because there currently is not an HIE, this component of the architecture does not currently exist in Nigeria.
•#Point of Service (POS), or point of care applications are a diverse
group of actors that leverage the health information exchange to improve the quality of care by using higher quality and more timely data
to support their activities. These systems include mobile messaging
tools [SMS/interactive voice response (IVR)], EMRs, laboratory or stock
management systems and monitoring and evaluation tools.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!41
APPENDIX 4:
PROPOSED GOVERNANCE STRUCTURE
Federal Level
The following table outlines the proposed Health ICT governance structure.
This table complements the governance structure illustration in Part I, section
3.1. The general functions and responsibilities are also included in the table.
ROLE
COMPOSITION
GENERAL FUNCTIONS AND
RESPONSIBILITIES
Health Sector Leadership
National Council on Health
Provide oversight and own the Health ICT vision
Health ICT Steering
Committee
Ministers of Health and Communication
Technology in addition to CEOs of
Government Departments/ Agencies as
may be identified by the two (2) Ministers.
Strategic direction and support
Health ICT Project
Management Office
This will be hosted by FMOH
Provide operational management through:
• General daily management and operation
• Facilitate design, implementation and maintenance of the strategic architecture
• In charge of logistics for meetings of the
steering committee
• Generate and coordinate reports and other
key documentation for Health ICT
• Stimulate stakeholders and private sector
involvement/investment in Health ICT
• Develop and help implement the Health ICT
Strategy and administrative funding
• Interface with the Health ICT Steering
Committee
Health ICT Technical
Working Group
• The Chair member will be appropriate
government ministry, department or
agency.
• Other members can be drawn from a
wide range of stakeholders ranging from
the private sectors, to development
partners to health ICT subject experts
• There may be several subject matter
specific working groups
42!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Coordinate technical consultation on appropriate subject matter:
• Produce subject-specific guidelines that will
inform the work of the Health ICT Program
Management Office
• holding monthly reviews meetings
State Level
The following table outlines the proposed Health ICT governance structure at
the states. This is meant as a guide to help states develop appropriate governance for health ICT. This recognizes that different states have varying priorities and varying degree of ICT governance. While some may have ministry of
science and technology, other have special advisers and some commissioners
embedded in contiguous ministries. The general functions and responsibilities
are also included in the table.
GENERAL FUNCTIONS AND
RESPONSIBILITIES
ROLE
COMPOSITION
State Health ICT
Committee
Commissioners of Health and
Communication Technology / Science and
Technology and heads of state government
agencies as identified by the two (2)
commissioners.
Strategic management and support within the
state
The secretary of this committee shall be
the appropriate as identified by SMOH
within the state. The State steering committee should also include other agencies
of SMOH.
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!43
44!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Output Title
Output (Recommendation)
National Health ICT governance structure established State Government engaged State Government engaged 1.1 Governance Structure 1.2 State Government Engagement 1.2 State Government Engagement Output (Recommendation)
Funding for Health ICT operations secured Funding for Health ICT operations secured Motivation mechanism established Motivation mechanism established Output Title
2.1 Funding for Health ICT 2.1 Funding for Health ICT 2.2 Motivation 2.2 Motivation Component
2.0 Strategy and Investment 2.0 Strategy and Investment Output (Recommendation)
National Health ICT Framework developed, endorsed and periodically reviewed Broad stakeholder engagement achieved National Health ICT Framework integrated and linked with National health Act, NHP, National ICT policy and NSHDP National Health ICT Framework integrated and linked with National health Act, NHP, National ICT policy and NSHDP National Health ICT Framework developed, endorsed and periodically reviewed Output Title
1.5 Framework Adoption 1.5 Framework Adoption 1.4 Linked and Integrated Policies 1.4 Linked and Integrated Policies 1.3 Broad Stakeholder Engagement 1.3 Broad Stakeholder Engagement National Health ICT governance structure established 1.1 Governance Structure Broad stakeholder engagement achieved Output (Recommendation)
Output Title
Component
1.0 Leadership and Governance 1.0 Leadership and Governance Component DETAILED HEALTH ICT ACTION PLAN
Component APPENDIX
Appendix 5:
5: Detailed Health ICT Action Plan Appendix 5: Detailed Health ICT Action Plan Set up motivation mechanism A. Investment management structure Investment management to enable Set up msotivation mechanism C. Establish pecial purpose fund for Health ICT B. Establish catalytic funding C. Establish special purpose fund for Health ICT B. Establish catalytic funding A. Explore sources of Health ICT funds and align with Framework Activity
A. Explore sources of Health ICT funds and align with Framework Activity
Ensure endorsement, periodic review and adoption of National Health ICT Framework Ensure endorsement, periodic review and adoption of National Health ICT Framework Ensure inclusion of Health ICT during reviews of NHA, NHP, National ICT Policy and NHSDP. Ensure inclusion of Health ICT during reviews of NHA, NHP, National ICT Policy and NHSDP. Broad stakeholder engagement Broad stakeholder engagement Formalize governance interactions between Federal and States as well as between States and LGAs Formalize governance interactions between Federal and States as well as between States and LGAs Activity Establish National Health ICT Steering committee (SC), National Health ICT Technical Working Group (TWG) and National Health ICT Establish National H
CT Project Management Oealth ffice (IPMO) Steering committee (SC), National Health ICT Technical Working Group (TWG) and National Health ICT Project Management Office (PMO) Activity Establish motivation mechanism for Establish motivation mechanism for infrastructure development, entrepreneurs and developers Secure sustainable funding for the development and operation of the national Health ICT environment, making sure to explore the viability Secure sustainable funding funding for the of existing funds, catalytic development nd operation of the and aincentives national Health ICT environment, making sure to explore the viability of existing funds, catalytic funding and incentives Output Description
ICT Framework as a part of a larger Ensure the endorsement, adoption National Health Strategy and periodic review (at most every 5 years) of developed National Health ICT Framework as a part of a larger Output Description
National Health Strategy Establish mechanisms for ongoing broad stakeholder engagement beyond government to involve the private sector, development Establish echanisms or ocngoing partners, m
civil society afnd itizens broad stakeholder engagement beyond government to iFnvolve the Link National Health ICT ramework private ector, development with the msajor emerging National partners, civil tshe ociety and cHitizens policies (e.g., National ealth Act, National Strategic Health Link Development National Health I
CT F
ramework plan (NSHDP), with the Hmealth ajor ePmerging National olicy and NNational ational policies (e.g., t
he National Health ICT policy) Act, National Strategic Health Development plan (NSHDP), Ensure the endorsement, adoption National Health Policy National and periodic review (at amnd ost every 5 ICT p
olicy) years) of developed National Health Broad stakeholder engagement Support
ofgovernment state level to beyond the fsetup
ederal governance
as appropriate
involve the structure
state governments for maximum support and participation Broad stakeholder engagement beyond the federal government to involve the state governments for maximum support and participation Output Description Establish a national Health ICT governance structure to oversee Health ICT decision-­‐making, planning, implementation and Establish a national Health ICT monitoring/evaluation governance structure to oversee Health ICT decision-­‐making, planning, implementation and monitoring/evaluation Output Description Introduce a structure for planning and coordinating Health ICT budgets to improve prioritization, allocation Establish catalytic to A special speed urpose fund ffunding or Health innovation ICT will esupport nsure adequate funding for Health ICT innovation and implementations A special purpose fund for Health Establish motivation mechanism ICT will ensure adequate funding for infrastructure development, Health ICT innovation and entrepreneurs a
nd d
evelopers, implementations including providing enabling Establish motivation mechanism for environment for potential export and revenues from Health ICT Explore sources of Health ICT funds: Activity Description
revenue (National and States), development partners and external funders, including private-­‐sector Explore sources of Health ICT funds: investments revenue (National and States), development partners and external funders, including private-­‐sector Establish seed catalytic funding to investments support innovation strategic framework, but multi-­‐
sectoral adoption is critical, as is a Framework contributes system of 5-­‐yearly review tao nd establishing evaluation a National Health ICT strategic framework, but multi-­‐
sectoral adoption is critical, as is a Activity Description
system of 5-­‐yearly review and evaluation Beyond government MDAs, involve the private sector, development partners, civil society and citizens Advocate for a subsection on Health ICT within NSHDP, NHP, and other relevant and emerging institutional mechanisms. Advocate for a subsection on Health ICT within NSHDP, NHP, and other relevant and emerging institutional Framework contributes to mechanisms. establishing a National Health ICT partners, civil society and citizens clearly define how they will interact There will be nealth eed to identify and in relation to aH
ICT strategy, formalize the relationships with investment and coordination these governance functions and clearly define how they will interact in relation to Health M
ICT strategy, Beyond government DAs, involve investment and coordination the private sector, development Governs Health ICT planning, Activity Daescription implementation nd evaluation, as well as interoperability and integration requirements, funding, Governs Health ICT planning, clinical documentation implementation and evaluation, as requirements, architectural well as interoperability and guidelines, privacy, security, and integration requirements, funding, auditing requirements clinical documentation requirements, architectural Dedicated Health ICT governance guidelines, privacy, security, and functions will need to coexist with auditing requirements existing governance functions operating at Federal, and State Dedicated Health ICT governance levels functions will need to coexist with existing overnance unctions There will bge a need to fidentify and operating tahe t Frederal, and Sw
tate formalize elationships ith levels functions and these governance Activity Description FMOH, FMCT and TWG major funders development partners and private sector FMOH, FMCT, PSHAN, WB/IFC, FMOH, FMCT, PSHAN, WCC-­‐USPF, B/IFC, NHIS, NITDA, CBN, FMF, N
Development partners and the development partners private sector development partners FMOH, FMCT, PSHAN, USPF, WB/IFC and development partners NHIS, NITDA, CBN, FMF, NCC-­‐USPF, FMOH, FMCT, PSHAN, USPF, WB/IFC and development partners FMOH-­‐DPRS, Health Financing, FMF, FMCT, Private sector stakeholders Stakeholders
FMOH-­‐DPRS, Health Financing, FMF, FMCT, Private sector stakeholders Stakeholders
Steering Committee, TWG Steering Committee, TWG TWG, PMO, Civil society organizations, Patient health associations, private providers association, ICT providers TWG, PdMO, Civil society association, evelopment partners organizations, Patient health and professional societies associations, private providers association, ICT providers association, development partners FMOH, FMCT, National Health Act and professional societies sub committees, National M&E technical working group, and other relevant platforms. FMOH, FMCT, National Health Act sub committees, National M&E technical working group, and other relevant platforms. FMOH, FMCT, State Health and Technology ministries, State PHC boards and agencies FMOH, FMCT, State Health and Technology ministries, State PHC boards and agencies NCH, FMOH, FMCT plus parties listed in the governance table NCH, FMOH, FMCT plus parties listed in the governance table Stakeholders Stakeholders NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!45
.0 Standards and Interopera ility .0 Standards and Interopera ility .0 Standards and Interopera ility Component
Component
Component
3.3 Data Collection and Registries 3.3 Data Collection and Registries Standardized registries, instruments (data collection forms, reports etc.) and indicators Standardized registries, instruments (data collection forms, reports etc.) and indicators Standardized registries, instruments (data collection forms, reports etc.) and indicators Capacity built for ensuring standards and interoperability 3.2 Standards capacity building 3.3 Data Collection and Registries Capacity built for ensuring standards and interoperability Standards for Health ICT and health information exchange defined and established Standards for Health ICT and health information defined and Capacity built efxchange or ensuring standards and established interoperability 3.2 Standards capacity building 3.1 Established Standards 3.2 Standards capacity building 3.1 Established Standards Output (Recommendation)
information exchange defined and established Output Title
Output (Recommendation)
Standards for Health ICT and health Investment management plan established 2.3 Investment Output Title
Investment management plan established 2.3 Investment 3.1 Established Standards Output (Recommendation)
Investment management plan established Output Title
2.3 Investment Build on existing instruments to support key registries (health facility, patient, health workers, citizen etc.) foundational to health Build o
n existing instruments to information exchange support key registries (health facility, patient, health workers, citizen etc.) foundational to health information exchange facility, patient, health workers, citizen etc.) foundational to health information exchange Building on existing standards and requirements for some foundational Health ICT services Building on existing standards and requirements for some foundational Build on existing instruments to Health services support key rICT egistries (health Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives Capacity of esxisting takeholders built aand s Building on standards appropriate, tfo understand, define, requirements or some foundational review, aHealth pply and msanage standards ICT ervices in Health ICT initiatives Define and prioritize Health ICT and related data standards, as well as establish processes and infrastructure to facilitate safe Define and prioritize Health ICT aand nd secure exchange of haealth related data standards, s well as Capacity o
f s
takeholders b
uilt a
s information establish processes and appropriate, to to understand, define, infrastructure facilitate safe and review, apply and manage standards secure exchange of health in Health ICT initiatives information Investment management to enable proper allocation of Health ICT investment funding to priority Investment mprojects anagement to enable proper allocation of Health ICT investment funding to priority projects Define and prioritize Health ICT and Output Description
related data standards, as well as establish processes and infrastructure to facilitate safe and secure exchange of health Output Description
information Output Description
Investment management to enable proper allocation of Health ICT infrastructure development, investment funding o priority entrepreneurs and dtevelopers projects infrastructure development, entrepreneurs and developers B. Develop and approve standards for secure messaging, high-­‐priority health information, terminologies and daata ictionaries B. Develop nd adpprove standards for secure messaging, high-­‐priority health information, terminologies and data dictionaries A. Develop, adapt or adopt high-­‐
level requirements and design for foundational Health ICT services A. Develop, adapt or adopt high-­‐
level requirements and design for B. Develop and Haealth pprove foundational ICT sstandards ervices for secure messaging, high-­‐priority health information, terminologies and data dictionaries A. Partners provide training and
uilding in aH
ealth ICT job B. Rcapacity egular mbentoring nd on the training to sustain knowledge gained
A. Develop, adapt or adopt high-­‐
and ensure its application level requirements and design for B. foundational Regular mentoring n the job Health aInd CT oservices training to sustain knowledge gained
and ensure its application B. Establish a Nigerian Health
A. Information Partners provide training and
Exchange (HIE) capacity building in Health ICT B. RB. egular mentoring and oHn the job Establish a Nigerian ealth
training to sustain knowledge gained
Information Exchange (HIE) and ensure its application A. Review existing national and B. Establish a Nigerian Health
international standards and Define Information Exchange (HIE) Health ICT standards A. Review existing national and international standards and Define A. Partners training and
Health pIrovide CT standards capacity building in Health ICT Activity
Activity
A. Investment management structure B. Fund coordination mechanism A. Review existing national and international standards and Define Health ICT standards B. Fund coordination mechanism A. Investment management Activity
structure B. Fund coordination mechanism A. Investment management structure All must be properly authenticated and delivered to intended recipient Ensures that health information All must be properly authenticated exchanged between healthcare and delivered to intended recipient organizations and providers through a Ensures national that Health ICT ienformation nvironment health are appropriately defined and the exchanged between healthcare messages utilize standard organizations and providers through terminologies and remain private a national Health ICT environment and confidential. are appropriately defined and the messages utilize standard All must be properly authenticated terminologies and remain private and delivered o intended r ecipient and ctonfidential. A HIE system will facilitate international Health ICT and othe ther standards to odf etermine what can be exchange health information Regular mentoring and oan the job among stakeholders cross adopted training sustain kill nowledge gthe ained geographical awnd hfacilitate ealth-­‐sector A HIE to system and ensure its application boundaries ased oinformation n defined exchange of hbealth standards across among stakeholders Training and aCnd apacity Building geographical health-­‐sector provided by competent artners boundaries based on dpefined standards Implementation of foundation Health ICT asnd ervices (e.g., national Training Capacity Building health identifiers, national provided y competent Regular mb
entoring and opn artners the job authentication, health training to sustain eklectronic nowledge gained records, etc.), with and ensure its baegins pplication understanding t
he h
igh-­‐level Regular mentoring and on the job requirements for ktnowledge he service gaained nd training to sustain defining igh-­‐level esign for how and ae h
nsure its ad
pplication the service would be delivered for Implementation of foundation the country Health ICT services (e.g., national health identifiers, national authentication, electronic health Implementation of foundation records, etc.), begins ith Health ICT services (e.g., nwational Ensures that health understanding the information hnigh-­‐level health identifiers, ational exchanged between ealthcare requirements for the hservice and authentication, electronic health organizations pb
roviders hrough design or how defining a high-­‐level records, eand tc.), egins wftith a n
ational H
ealth I
CT e
nvironment the understanding service would tbhe e dhelivered igh-­‐level for are a
ppropriately d
efined a
nd he the fcor ountry requirements the service atnd messages utilize dsesign tandard defining a high-­‐level for how terminologies and bre emain private the service would delivered for and confidential. the country and coordinating Health ICT budgets to improve prioritization, allocation and release infrastructure development, entrepreneurs and developers, Establish pfund coordination including roviding enabling mechanisms to mp
itigate risks from environment for otential export infrastructure development, fragmented f
unding sealth tructure and revenues farom ICT entrepreneurs nd dHevelopers, including roviding feor nabling Introduce a sptructure planning environment for pealth otential and cActivity oordinating ICT ebxport udgets DHescription
revenues from Health ICT to iand mprove prioritization, allocation Process for aand reviewing, release Introduce dseveloping, tructure for planning approving and publishing national and coordinating Health ICT budgets Establish fund coordination Health ICT sptandards, and aw
hich is to improve rioritization, llocation mechanisms m
itigate r
isks from supported band y tto he h
ealth s
ector and release unding swtructure the fragmented Health ICT ifndustry ill need to be feund stablished Establish coordination mechanisms to mitigate risks from Activity D
escription
fragmented Review existing national and funding structure international Health ICT raeviewing, nd other Process for developing, standards to determine what can be approving and D
publishing national Activity escription
adopted Health ICT standards, and which is A HIE system wh
ill ealth facilitate the supported bd
y eveloping, the ector and Process for rseviewing, exchange of hindustry ealth information the Health IaCT will nnational eed to approving nd publishing among be stakeholders a
cross established Health ICT standards, and which is geographical and health-­‐sector supported by the health sector and boundaries b
ased o
n defined HRealth eview ICT existing national and to the industry will need standards international ealth ICT and other be eHstablished Training and Capacity wBhat uilding standards to determine can be provided competent partners adopted Review bey xisting national and FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and regulatory organizations e.g. MDCN, NMCN FMOH, FFMOH, MCT, NIMC, NITDA, NHIS, NPC, end-­‐users NPC, implementers, TWG, Professional and regulatory organizations e.g. MDCN, NMCN FMOH, NIMC, NITDA, NHIS, FMOH, NIMC, NITDA, eNnd-­‐users HIS, NPC, NPC, implementers, implementers, end-­‐users FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and FMOH, NITDA, FMCT regulatory organizations e.g. MDCN, NMCN FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, NITDA, FMCT FMOH, FMCT, NHIS, USPF, NIMC, NITDA, Galaxy Backbone, NBS FMOH, NITDA, FMCT FMOH, FMCT, NHIS, USPF, NIMC, NITDA, Galaxy Backbone, NBS FMOH, NITDA, FMCT, TWG FMOH, FMCT, NHIS, USPF, NIMC, FMOH, NITDA, FMCT, TWG NITDA, Galaxy Backbone, NBS Stakeholders
FMOH, FMCT and TWG major Stakeholders
funders development partners and private sector FMOH, FMCT and TWG major funders
evelopment partners and FMOH adnd TWG, major funders, private sector private sector and development partners FMOH, FMCT, TWG FMOH and NTITDA, WG, m
ajor funders, private sector and development Stakeholders
partners FMOH, FMCT and TWG major funders development partners and private sector Development partners and the private sector FMOH and TWG, major funders, private sector and development Development partners and the partners private sector 46!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
3.1 Established Standards Component
5.0 Change and Adoption (Capacity uilding) 5.1 System for Health ICT Adoption 5.1 System for Health ICT Adoption 5.1 System for Health ICT Adoption Output Title
Component
5.0 Change and Adoption (Capacity uilding) 5.0 Change and Adoption (Capacity uilding) Output Title
Component
3.3 Data Collection and Registries 5.1. Establish a system for Health ICT Readiness, M&E and best practices adoption 5.1. Establish a system for Health ICT Readiness, M&E and best practices adoption 5.1. Establish a system for Health ICT Readiness, M&E and best practices adoption Output (Recommendation)
Output (Recommendation)
Output (Recommendation)
4.1 Regulatory Framework Established .0 Legislation Policy and Compliance Output Title
Standardized registries, instruments (data collection forms, reports etc.) and indicators 4.1 Regulatory Framework Established .0 .0 Legislation Policy and Compliance Standards and Interopera ility Component
Empower National Health ICT PMO to support legislation, policy and compliance 4.1 Regulatory Framework Established Capacity built for ensuring standards and interoperability Empower National Health ICT PMO to support legislation, policy and compliance Empower National Health ICT PMO to support legislation, policy and compliance information exchange defined and Output (Recommendation)
established Standards for Health ICT and health Output (Recommendation)
Health ICT standards communicated and advocated Output (Recommendation)
Health ICT standards communicated and advocated Output (Recommendation)
.0 Legislation Policy and Compliance 3.2 Standards capacity building Output Title
Output Title
3.4 Communication Output Title
3.4 Communication Output Title
Health ICT standards communicated and advocated 3.4 Communication Component
Component
Component
Investment management plan established 2.3 Investment Establish a system for structured Output Description
assessment for Health ICT readiness among stakeholders. The system will support monitoring and Establish a system for structured evaluation ofor f HH
ealth ICT adoption. assessment ealth ICT readiness among stakeholders. The system will support monitoring and Establish ao sf ystem for structured evaluation Health ICT adoption. assessment for Health ICT readiness among stakeholders. The system will support monitoring and evaluation of Health ICT adoption. Build on existing instruments to support key D
registries (health Output escription
facility, patient, health workers, citizen etc.) foundational to health information exchange Output Description
Capacity of stakeholders built as appropriate, to understand, define, Develop or aind dentify a relevant review, apply manage standards regulatory framework (legislation, in Health ICT initiatives policy and compliance processes) to encourage nd incentivize Health Develop oar identify a relevant initiatives regulatory ICT framework (legislation, policy and compliance processes) to encourage and incentivize Health Develop ICT or iidentify a relevant nitiatives regulatory framework (legislation, policy and compliance processes) to encourage incentivize Health Building on aend xisting standards and ICT for initiatives requirements some foundational Health ICT services Investment management to enable proper allocation of Health ICT investment funding to priority Ensure that cprojects ommunications and information disseminated about Health ICT standards are appropriate to encourage the Ensure that communications and adoption and adpplication of aHbout ealth information isseminated Output D
escription
ICT s
tandards Health ICT standards are appropriate to encourage the Ensure that and adoption and caommunications pplication of Health information isseminated about Output escription
ICT dsD
tandards Health ICT standards are appropriate to encourage the adoption and aD
pplication of Health Output escription
Define and ICT prioritize Health ICT and standards related data standards, as well as establish processes and Output tD
infrastructure o escription
facilitate safe and secure exchange of health information B. Establish national Health ICT
knowledge repository B. Establish national Health ICT
knowledge repository A. Assess Health ICT readiness of
B. Establish national Health ICT
stakeholders knowledge repository A. Assess Health ICT readiness of
stakeholders Activity
A. Assess Health ICT readiness of
stakeholders A. Develop, adapt or adopt high-­‐
level requirements and design for foundational Health ICT services D. Ensure compliance of providers, services and applications with regulatory framework defined in the action line above D. Ensure compliance of providers, services and applications with regulatory framework defined in the action line above D. Ensure compliance of providers, services and applications with regulatory framework defined in the action line above B. Develop aActivity
nd approve standards for secure messaging, high-­‐priority health information, terminologies and dActivity
ata dictionaries C. Review and update policies C. Review and update policies B. Agree and adopt a nationally B. Regular mentoring and on the job consistent regulatory framework for training to sustain nowledge gained
C. Review and ukpdate policies health information and ensure its application A. B.
Concerted and focused advocacy, Fund coordination mechanism communication and education to decision makers and end users to ensure a support the application A. Concerted and ffor ocused advocacy, Activity
of standards communication and education to decision makers and end users to ensure a support for the application A. Concerted asnd focused advocacy, of tandards Activity
communication and education to decision makers and end users to A. Review existing ational and ensure a support for tnhe application A. Empower the Health ICT
Activity
international sstandards of tandards and Define governing body with the capacity to Health ICT standards oversee, review and harmonize policy, legislation, A. Empower the Hregulation ealth ICT
Activity
(including compliance) and to governing body with the capacity implementation f Hhealth ICT oversee, review aond armonize initiatives regulation policy, legislation, A.
Empower the Health aInd CT
(including compliance) governing body with capacity implementation otf he Health ICT to B. Establish a Nigerian Health
oversee, review and harmonize initiatives B.policy, Agree laegislation, nd adopt ar egulation nationally Information Exchange (HIE) consistent regulatory framework (including compliance) and for health information implementation of Health ICT B. Partners Agree and adopt taraining nationally A.
provide and
initiatives consistent capacity regulatory building in framework Health ICT for health information A. Investment management structure Establish fund coordination mechanisms to moitigate isks from Highlight benefits f the ardoption of fragmented structure Health ICT sfunding tandards while emphasizing the costs of non-­‐
adoption tbo enefits all relevant stakeholders Highlight of the adoption of Activity Description
Health ICT standards while emphasizing t
he c
osts of non-­‐
Process for developing, reviewing, adoption to aand ll relevant stakeholders approving publishing national Highlight benefits of the adoption of Activity Description
Health ICT standards, and which is Health ICT standards while supported by the health sector and emphasizing the costs of non-­‐
the Health ICT industry will need to adoption to all relevant stakeholders Activity Dgescription
be eICT stablished The Health overning body described under Leadership and Review esxisting ational and Governance hould bne empowered international ealth ICT maid-­‐wife nd boody ther to guide, influence and a The Health IHCT gescription
overning Activity D
standards tfo etermine wH
hat caan be regulatory ramework for ealth ICT described udnder Leadership nd adopted Governance sactivities hould be empowered to A gH
uide, influence nd mid-­‐wife IE system will afacilitate the a The Health CT gaoverning body ICT Ensuring pframework rivate nd information cfor onfidential regulatory Health exchange of Ih
ealth described nder Leadership and information exchange requires a activities among sutakeholders across Governance hould e reegulatory mpowered nationally csonsistent geographical and hbealth-­‐sector to g
uide, i
nfluence a
nd m
id-­‐wife framework for bhased ealth nformation boundaries defined a Ensuring private and ocin onfidential regulatory framework for Health IaCT protection standards information exchange requires nationally cactivities onsistent regulatory Training and Capacity Building This is often equirement where framework faor health information provided by c rompetent partners Ensuring private alegislation nd confidential data protection and protection information deiffer, xchange requires frameworks or conflict, at aa nationally ctate onsistent regulatory national, s
a
nd l
ocal l
evel This i
s o
ften a
r
equirement w
Regular mentoring and on the here job framework for health information data tpo rotection egislation nd training sustain klnowledge gaained protection Developing a
nd a
dopting s
uch frameworks d
iffer, o
r c
onflict, a
and ensure its application at a framework ensures hat dlevel ata national, state and ltocal This is often ap rivacy, requirement protection, access wahere nd data p
rotection l
egislation and a consent is approached and msuch anaged Developing and adopting frameworks d
iffer, o
r c
onflict, aat nd a consistently at ae nsures National, State framework that data Implementation ond f foundation national, Local state level laevel protection, privacy, alocal ccess and Health iIs CT services (e.g., ational consent approached and nm
anaged health identifiers, national Developing and dopting such aand consistently at a Naational, State authentication, e
lectronic h
framework ensures ata Local level that dealth records, e
tc.), b
egins w
ith protection, privacy, access and understanding the haigh-­‐level consent is approached nd managed Focusing on fcor ompliance with requirements the service and consistently at a National, State and established r
egulations (legislation defining a high-­‐level design for how Local level and p
olicy), t
he P
MO o
r T
WG w
the service would be delivered fill or promote, ethe ncourage and ew
nsure Focusing on ccountry ompliance ith established compliance regulations (legislation and policy), the PMO or TWG will promote, encourage and ensure Focusing compliance on compliance with Ensures that health information established regulations (legislation exchanged etween and policy), bthe PMO hoealthcare r TWG will organizations a
nd p
roviders hrough promote, encourage and etnsure a national Hcompliance ealth ICT environment Description
are aActivity ppropriately defined and the messages utilize standard Recognize p
riority stakeholder terminologies and remain private segments (consumer, care provider Activity Description
and confidential. and health-­‐care manager) that should be m
tRecognize argeted Health ICT adoption, priority takeholder All ust be pfor roperly asuthenticated assess their readiness to apdopt segments (consumer, care rovider and delivered to intended recipient Activity D
escription
specific Health solutions and health-­‐care mICT anager) that asnd hould opportunities to ab
uild be identify targeted for Health ICT doption, Recognize p
riority s
takeholder momentum f
or s
cale assess their readiness to adopt segments care provider specific H(consumer, ealth ICT solutions and and identify health-­‐care manager) tto hat should build Create ao npportunities ational, web-­‐based be targeted for Health ICT adoption, momentum for scale knowledge repository that captures assess their readiness to adopt Health ICT project successes and specific Health ICT solutions and enables sharing Create a nknowledge ational, web-­‐based identify opportunities to build knowledge repository that captures momentum for scale Health ICT project successes and enables knowledge sharing Create a national, web-­‐based knowledge repository that captures Health ICT project successes and enables knowledge sharing and coordinating Health ICT budgets to improve prioritization, allocation and release TWG, FMOH, FMCT, implementing partners, SMOH TWG, FMOH, FMCT, implementing partners, SMOH TWG, FMOH, FMCT, implementing TWG, FMOH partners, SMOH TWG, FMOH Stakeholders
TWG, FMOH Stakeholders
Stakeholders
FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, NITDA, FMCT, HERFON, NASS, Legal units FMOH, NITDA, FMCT, HERFON, NASS, Legal units FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and regulatory organizations e.g. MDCN, NMCN FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, NITDA, FMCT, HERFON, NASS, Legal units FMOH, NITDA, FMCT, HERFON, NASS, Legal Consultants and Partners FMOH, NITDA, FMCT, HERFON, NASS, Legal NCITDA, onsultants FMOH, FMCT and Partners FMOH, NITDA, FMCT, HERFON, NASS, Legal Consultants and Partners FMOH, FMCT, NHIS, USPF, NIMC, FMOH, NITDA, FMCT, HERFON, NITDA, alaxy Backbone, aNnd BS NASS, LGegal Consultants Partners FMOH, NITDA, FMCT, HERFON, NASS, Legal Consultants and Stakeholders
Partners FMOH, NITDA, FMCT, HERFON, NASS, Legal Consultants and Partners Stakeholders
FMOH, NITDA, FMCT, TWG FMOH, TWG Stakeholders
FMOH, TWG Stakeholders
FMOH and TWG, major funders, private sector and development partners FMOH, TWG FMOH, FMCT and TWG major funders development partners and private sector NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!47
.0 Standards and Interopera ility Component
Standardized registries, instruments (data collection forms, reports etc.) and indicators 5.3. Establish methodology for accreditation and revision of Health ICT Curriculum 3.3 Data Collection and Registries 5.3 Skills accreditation and curriculum review Capacity built for ensuring standards and interoperability 3.2 Standards capacity building 5.2. Develop and adopt Incentive mechanisms to encourage uptake of Health ICT skills and competencies Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives Standards for Health ICT and health information exchange defined and established 3.1 Established Standards 5.2 Incentivize skills uptake Define and prioritize Health ICT and related data standards, as well as establish processes and infrastructure to facilitate safe and secure exchange of health information Develop/review Health ICT curriculum in health, technology and relevant institutions Also support new accreditation regimes for regulatory organizations Build on existing instruments to support key registries (health facility, patient, health workers, citizen etc.) foundational to health information exchange Building on existing standards and Design and adopt structured requirements for some foundational incentive scheme financial Health ICT (sboth ervices and non-­‐financial) to encourage uptake and retention of Health ICT skills and competencies. Output Description
Output (Recommendation)
Investment management to enable proper allocation of Health ICT investment funding to priority projects Output Title
2.3 Investment Investment management plan established Disseminate incentive program B. Define new accreditation
requirements A. Identify education and training course changes B. Develop and approve standards for secure messaging, high-­‐priority D. Design Health ICT skills and
health information, terminologies competences areer progression plan and dcata dictionaries C. Develop strategy for continued
Health ICT skills and competency acquisition A. Develop, adapt or adopt high-­‐
level requirements and design for foundational Health ICT services B.
A.
Develop and Roll-­‐out B. Regular mentoring and foor n Hthe job incentive schemes ealth
training to sustain nowledge gained
ICT akdoption and ensure its application A. Partners provide training and
capacity building in Health ICT B. Establish a Nigerian Health
Information Exchange (HIE) D. Monitor Health ICT adoption
A. Review existing national and international standards paractice nd Define C. Define professional Health ICT standards standards Activity
B. Fund coordination mechanism structure Identify and define changes to existing professional accreditation programs for healthcare institutions and individual healthcare providers to include Health ICT All must be properly authenticated and delivered to intended recipient Determine changes that are required to existing education and training courses to ensure the development of Health ICT workforce capabilities Develop communication strategy and materials to publicize Implementation of ifncentives oundation and put in place mechanisms Health ICT nsecessary ervices (e.g., national to support including funding health tihis, dentifiers, national guidelines, information nd authentication, electronic haealth application forms with records, etc.), begins understanding the high-­‐level requirements for the service and defining a high-­‐level design for how the service would be delivered for country Develop a the strategy for on the job Health ICT skills improvement, training and retraining for relevant cadre of health workforce Ensures that health information exchanged between healthcare organizations and providers through a national Health ICT environment are appropriately defined and the Design and institutionalize Health ICT messages utilize standard skills and competencies progression terminologies and remain private plan through the federal civil service and confidential. and other related schemes of service Process for wdith eveloping, reviewing, Work cross-­‐sectoral approving and publishing stakeholders to guide ntational he Health I
CT s
tandards, a
nd which is development of a professional supported by the haealth sector and practice standards nd guidelines for the Health ICT industry will need to healthcare providers be established Define the expectations and Review eo
xisting national and obligations f these providers to international ealth ICT haigh-­‐quality nd other collect, store aHnd share standards tho determine what can bie electronic ealth-­‐care information n adopted and secure a timely, appropriate manner A HIE system will facilitate the exchange of health information among s
takeholders across of Monitor and review adoption geographical and h
ealth-­‐sector Health ICT solutions routinely among boundaries based on defined stakeholders standards Training and Capacity Building Design ibncentive programs to provided y competent partners encourage the adoption and use of Health ICT services and applications. This should include conditions of Regular mentoring and on the job funding, eligibility criteria, application training to sustain knowledge gained and approval processes, funding and ensure its application administration, and associated roles and responsibilities Activity Description
Establish fund coordination mechanisms to mitigate risks from fragmented funding structure to improve prioritization, allocation and release School of Medicine School of Health technology Nursing and others Health Informatics degree awarding Universities NUC, NBTE, NITDA FMOH, NIMC, NITDA, NHIS, NPC, CHPRB HRORBN MDCN implementers, end-­‐users NMCN PCN Environmental Health registration Board of Nigeria FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and regulatory organizations e.g. MDCN, Community and Health Practitioner NMCN FMOH, NIMC, NITDA, NHIS, Registration Board of Nigeria NPC, implementers, end-­‐users (CHPRBN) Health Records Officers Regulatory Board of Nigeria (HRORBN) Medical and Dental Council of Nigeria (MDCN) Medical Science Council of Nigeria Nursing and Midwifery council of Nigeria (NMCN) Pharmacists Council of Nigeria (PCN) Environmental Health Registration Board of Nigeria.and relevant professionals NCH, SMOH, TWG, FMOH FMOH, NITDA, FMCT FMOH, FMCT, NHIS, USPF, NIMC, NITDA, GTWG, alaxy BFackbone, MOH NBS FMOH, NITDA, FMCT, TWG TWG, FMOH, NITDA Stakeholders
FMOH and TWG, major funders, private sector and development partners funders development partners and private sector 48!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
.0 Standards and Interopera ility Component
5.4. Establish a plan for Health ICT awareness and stakeholder engagement 5.5. Establish Health ICT education and training programs 5.4 Awareness and stakeholder engagement 5.5 Health ICT Education and Training Capacity built for ensuring standards and interoperability 3.2 Standards capacity building Standardized registries, instruments (data collection forms, reports etc.) and indicators Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives Standards for Health ICT and health information exchange defined and established 3.1 Established Standards 3.3 Data Collection and Registries Define and prioritize Health ICT and related data standards, as well as establish processes and infrastructure to facilitate safe and secure exchange of health information Create new Health ICT education and training programs to support improved Health ICT skills and competencies among priority stakeholders (consumers, health providers, health care managers, citizen etc.) foundational to health information exchange Establish mechanism for Health ICT activities and targeted Build on aewareness xisting instruments to Health ICT stakeholder support key registries (health engagement. facility, patient, health workers, Building on existing standards and requirements for some foundational Health ICT services Output Description
Output (Recommendation)
Output Title
2.3 Investment Investment management plan established Investment management to enable proper allocation of Health ICT investment funding to priority projects Develop Health ICT awareness
campaign strategy A. Implement education and training course changes E. Engage and consult with
stakeholder reference and working groups reference and working groups B. Develop and approve standards for secure messaging, high-­‐priority health information, terminologies and dtargeted ata dictionaries D. Design stakeholder C. Design M&E framework for measuring effectiveness of engagement A. Develop, adapt or adopt high-­‐
level requirements and design for foundational Health ICT services B.
Rollout Health ICT awareness
campaigns A.
B. E.Regular mentoring and on the job Implement new accreditation
training to srequirements ustain knowledge gained
and ensure its application A. Partners provide training and
capacity building in Health ICT B. Establish a Nigerian Health
D. EInformation stablish specialized Health Exchange (HIE) ICT qualifications and certification track A. Develop Review estandard xisting national nd C.
Health IaCT
international standards and Define competency framework Health ICT standards Activity
B. Fund coordination mechanism A. Investment management structure Work with education institutions (e.g. universities, vocational training institutions, professional bodies) to insert Health ICT into their curricula were necessary. Groups will be involved in exploring particular issues and risks related to the development of the country s Health ICT environment, and the identification of acceptable solutions to these reference groups throughout the development of the Health ICT environment goals, objectives and deliverables All must be properly authenticated and d
elivered to intended recipient Engage/Involve stakeholder Define clear criteria and targets for Health ICT awareness and progress, and periodically measure actual Ensures that health information awareness programs against exchanged abnd etween healthcare these, to assess the effectiveness of organizations and providers through ICT change adoption a Health national Health ICT aend nvironment activities a
cross s
takeholders are appropriately defined and the messages utilize standard terminologies nd remain private Design a set of taargeted stakeholder and fcorums onfidential. engagement that h ave clear Develop awareness campaigns that Implementation of foundation utilize appropriate communication Health ICT services (e.g., national mechanisms and forums to promote health identifiers, national awareness of Health ICT, specific authentication, electronic health services and applications, and their records, etc.), begins with benefits understanding the high-­‐level Roll-­‐out awareness campaigns to requirements for the service and high-­‐priority change and adoption defining a high-­‐level design for how targets, and over time extend to the service would be delivered for broader health sector and public the country Process for developing, reviewing, approving publishing national Develop aand standard Health ICT Health ICT standards, and which is competency framework for health supported by Htealth he health ector and workers and ICT psractitioners the Health ICT industry will need to be established Framework should provide an understanding of required Health ICT R
eview e
xisting national and for knowledge, skills and attributes international ICT and groups other these various Hpealth rofessional standards to determine what can be adopted Identify and establish nationally A HIE system will facilitate the recognized t
ertiary qualifications exchange of health information in Health I
CT (
e.g. h
ealth i
nformatics among stakeholders across exchange) aand geographical nd implementing health-­‐sector formalized boundaries tbraining/education ased on defined programs designed to recognize and standards promote the spread of Health ICT Training and Capacity Building skills and expertise provided by competent partners Liaise with the appropriate professional bodies and working groups o agree tao nd changes Regular mtentoring on the tjo ob accreditation requirements nd training to sustain knowledge gaained implement these icts hanges throughout and ensure application segments of the health sector, and broader health sector Activity Description
Establish fund coordination mechanisms to mitigate risks from fragmented funding structure and coordinating Health ICT budgets to improve prioritization, allocation and release School of Medicine School of Health technology Health Informatics degree awarding Universities NUC, TWG TWG, FMOH TWG, FMOH FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users Nigeria Medical Association (NMA) DPRS-­‐FMOH SMOH FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and TWG, FMOH, Implementing regulatory organizations partners e.g. MDCN, NMCN FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, ITDA, F MCT School of MNedicine
School of Health Technology Health Informatics degree-­‐awarding universities NUC, FMOH FMOH, FMCT, NHIS, USPF, NIMC, NITDA, Galaxy Backbone, NBS FMOH, TWG, NUC, NBTE FMOH, TWG, NITDA FMOH, NITDA, FMCT, TWG Stakeholders
FMOH and TWG, major funders, private sector and development partners funders development partners and private sector NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!49
.1 Expanded Coverage .1 Expanded Coverage .0 In rastructure 3.3 Data Collection and Registries Output Title
3.2 Standards capacity building Connectivity coverage expanded and enhanced Connectivity coverage expanded and enhanced Standardized registries, instruments (data collection forms, reports etc.) and indicators Output (Recommendation)
Capacity built for ensuring standards and interoperability 3.1 Established Standards Output (Recommendation)
Standards for Health ICT and health information exchange defined and established 5.5 Health ICT Education and Training Output Title
Create new Health ICT education and training programs to support improved Health ICT skills and competencies among priority and health administrators) stakeholders (consumers, health providers, ealth care managers, Define and phrioritize Health ICT and 5.5. Establish Health ICT education and training programs Focusing and prioritizing interventions based on population density, disease prevalence, and providing adequate connectivity Focusing and prioritizing and supporting them ow
relevant interventions based n ith population policies a
nd e
nabling e
nvironments density, and Build on deisease xisting pirevalence, nstruments to providing connectivity support akdequate ey registries (health facility, patient, health workers, and supporting them with relevant policies nd efoundational nabling environments citizen eatc.) to health information exchange Building on existing standards and requirements for some foundational Health ICT services Capacity of stakeholders built as Output Description
appropriate, to understand, define, review, apply and manage standards in Health DICT initiatives Output escription
related ata standards, as well as and hdealth administrators) establish processes and infrastructure to facilitate safe and secure exchange of health information Output Description
Output (Recommendation)
Investment management plan established Output Title
.0 In rastructure .0 Standards and Interopera ility Component
Component
Component
2.3 Investment Investment management to enable proper allocation of Health ICT investment funding to priority projects D. Select implementation partners to
develop data connectivity infrastructure D. Select implementation partners to
develop data connectivity infrastructure B. Develop and approve standards C.for Assess infrastructure vailability of
secure messaging, haigh-­‐priority health facilities and programs health information, terminologies and data dictionaries C. Assess infrastructure availability of
health facilities and programs B. Local participation of communities in support, maintenance and use of infrastructure Health ICT services and
application Develop, adapt oor f acdopt high-­‐
B. A. Local participation ommunities level requirements and daesign for in support, maintenance nd use of foundational Health ICT services infrastructure Health ICT services and
application A. Identify underserved areas B. Regular mentoring and on the job Activity
training to sustain knowledge gained
ensure its application A.and Identify underserved areas Activity
B. REeview stablish a Nigerian Health
C. FMOH collaborative Information xchange (HIE) programs to Einclude health informatics C. Review FMOH collaborative A. programs Partners ptrovide training and
o include health capacity binformatics uilding in Health ICT B. Implement specialized Health ICT
courses A. Implement education and training course changes A. Review existing national and international standards and Define Health ICT standards B. Implement specialized Health ICT
courses Activity
E. Engage and consult with
stakeholder reference and working B. Fund coordination mechanism groups A. Investment management structure These could be private and/or public organizations enhanced, limited funds, htechnology-­‐wise ealth care facilities with the highest each in data The country will need tro select communities hould be identified and connectivity isnfrastructure providers technology-­‐wise and oenhanced, perators to assist in developing the required connectivity The country will dnata eed to select data infrastructure connectivity infrastructure providers and operators to assist in developing These be pdrivate and/or public the crould equired ata connectivity organizations infrastructure limited funds, ealth care facilities data chonnectivity All must be the properly authenticated with highest reach in and delivered teo intended recipient communities be identified and In order to aid should fficiency and optimize Regular mentoring and on the job Health Facilities nd communities. Activity Dakescription
training to sustain nowledge gained Services coverage will cover power, and ensure its application connectivity and computing infrastructure Health Facilities and ccoverage ommunities. Services coverage will cover power, connectivity and computing Implementation of cfoverage oundation infrastructure Ensure participation and Health ICT local services (e.g., national ownership f Health ICT projects and health oidentifiers, national equipment authentication, electronic health records, etc.), begins with Ensure local participation and understanding the high-­‐level ownership of Health ICT projects and Data connectivity is a key foundation requirements for the service and equipment for sharing electronic information defining a high-­‐level design for how between the service would be delivered for care pconnectivity roviders, and the provision Data is faor key foundation the country of shharing ealth-­‐care services through for electronic information electronic between channels (e.g. teleHealth ICT) care providers, and for the provision of health-­‐care services through Ensures that h
ealth i
nformation This activity n
eeds t
o i
dentify the electronic exchanged etween healthcare priority health-­‐care channels (be.g. teleHealth ICT) organizations and providers through provider segments and communities a This national Health ICT to environment that in fit tfhe or arequire ctivity ninvestment eeds identify are appropriately d
efined a
nd the purpose
priority health-­‐care messages u
tilize s
tandard connectivity provider sdata egments and communities terminologies and remain in private that require investment fit for and c
onfidential. optimize In order to aid purpose
efficiency and Establish fund coordination Groups will be involved in exploring mechanisms to mitigate risks from particular issues and risks related to fragmented funding structure the development of the country s Health ICT environment, and the identification of D
acceptable solutions Activity escription
to these Process for developing, reviewing, Work with eaducation institutions (e.g. approving nd publishing national universities, vocational raining Health ICT standards, and tw
hich is institutions, bodies) to supported by ptrofessional he health sector and Identify and eIstablish insert Health into tinternationally heir the Health ICT CT industry will cnurricula eed to recognized t
ertiary q
ualifications in were necessary. be established Health ICT (e.g. health informatics) and aind mplement formalized Identify stablish internationally Review eexisting national and training/education programs recognized tertiary international Health qIualifications CT and other in designed to (e.g. recognize aind promote Health I
CT h
ealth nformatics) standards to determine what can be the and spread of Health ICT skills and implement formalized adopted expertise programs training/education A HIE system will facilitate the designed to recognize and Hpealth romote Design and insert relevant ICT exchange of health information the sipread of Health ICT skills skills and and nformatics competency among stakeholders across expertise required to advance relevant skills geographical and health-­‐sector and competencies mongst Hm
anagers Design and insert raelevant ealth ICT boundaries based on defined in the FMOH collaborative center and informatics competency skills standards required to aprogram dvance relevant skills Training and Capacity Building and competencies amongst managers provided by competent partners in the FMOH collaborative center Activity Description
program and coordinating Health ICT budgets reference groups throughout the to idevelopment mprove prioritization, allocation of the Health ICT and r
elease environment FMCT, NCC, USPF, Mobile Telcoms, GBB, NGOs FMCT, NCC, USPF, Mobile Telcoms, GBB, NGOs FMOH, FMCT (eGovt), Galaxy Backbone (GBB), LGA and community leaders, Mobile Telcoms, NCC, NGOs, GUalaxy SPF FMOH, FMCT (eGovt), Backbone and FMOH, NIMC, N(GBB), ITDA, LNGA HIS, NPC, community leaders, Mobile implementers, end-­‐users Telcoms, NCC, NGOs, USPF FMOH, FMCT (eGovt), Galaxy Backbone (GBB), LGA and community leaders, Mobile FMOH, FMCT, NIMC, NITDA, NHIS, Telcoms, CC, N(GOs, USPF, NHIS NPC, TWG, Professional nd FMOH, FNMCT eGovt), Gaalaxy regulatory o
rganizations e
.g. M
Backbone (GBB), LGA and DCN, NMCN FMOH, NlIMC, NITDA, NHIS, community eaders, Mobile NPC, implementers, Telcoms, NCC, NGOs, eUnd-­‐users SPF, NHIS USPF, TWG, GBB, MGOs USPF, TWG, GBB, MGOs Stakeholders
FMOH, NITDA, FMCT Stakeholders
FMOH, Relevant Universities, TWG FMOH, FMCT, NHIS, USPF, NIMC, NITDA, Galaxy BUackbone, NBS FMOH, Relevant niversities, TWG School of Medicine School of Health technology Health Informatics degree awarding Universities NUC, TWG FMOH, NITDA, FMCT, TWG School of Medicine School of Health technology Health Informatics degree awarding Universities
NUC, N BTE, TWG School of Medicine
School of Health technology Health Informatics degree awarding Universities NUC, NBTE, TWG Stakeholders
FMOH and TWG, major funders, TWG, FMOH private sector and development partners FMOH, FMCT and TWG major funders development partners and private sector 50!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Capacity built for ensuring standards and interoperability 3.2 Standards capacity building .1 Prioritize Services and Applications .0 Solutions (Services and Applications) Core set of appropriate Health ICT services and Applications prioritized and deployed Output (Recommendation)
Minimum infrastructural requirements for e-­‐health implementation defined .3 Define Minimum Infrastructural Requirements Output Title
Standardized registries, instruments (data collection forms, reports etc.) and indicators 3.3 Data Collection and Registries Existing Infrastructure for Health ICT identified and assessed Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives Standards for Health ICT and health information exchange defined and established 3.1 Established Standards .2 Identify and assess existing infrastructure Define and prioritize Health ICT and related data standards, as well as establish processes and infrastructure to facilitate safe and secure exchange of health information Identify and prioritize services and applications that have scaled, or are scalable Output Description
This will give the general public some comfort that the healthcare facilities they attend has met certain Health ICT standards/ conditions/ requirements. Build on existing instruments to Once these equirements are support key rregistries (health defined, hatient, ealth facilities workers, ill simply facility, p
health w
Health tIo CT health citizen not etc.) initiate foundational implementations ithout meeting information w
exchange these requirements. By thinking through and agreeing upon what different health facilities at all levels will need, the FMOH can define the basic/ minimum requirements for Health ICT adoption. Existing infrastructure can be leveraged to support Health ICT initiatives alternative sources of power could also be explored Building on existing standards and NIPOST kiosks are an efxample of an requirements for some oundational organization Health infrastructure ICT services Others are Power, Connectivity and Equipment Output Description
Investment management to enable proper allocation of Health ICT investment funding to priority projects Output (Recommendation)
Investment management plan established Output Title
Component
.0 Standards and Interopera ility Component
2.3 Investment A. Identify services and/or applications for prioritization
Activity
B. Develop and approve standards for secure messaging, high-­‐priority health information, terminologies Link hand ealthcare rganization and data doictionaries provider e-­‐health accreditation to meeting minimum computing Infrastructure Define minimum computing, power and connectivity Infrastructure requirements for e-­‐health implementation Identify and assess ongoing infrastructural projects in A. Develop, adapt or adopt high-­‐
underserved areas level requirements and design for foundational Health ICT services F. Deploy data connectivity B. Regular mentoring and on the job infrastructure for underserved areas training to sustain knowledge gained
and ensure its application A. Partners provide training and
capacity building in Health ICT B. Establish a Nigerian Health
Information Exchange (HIE) A. Review existing national and international standards and Define Health ICT standards E. Develop data connectivity implementation design and plan
Activity
B. Fund coordination mechanism A. Investment management structure and revenues from Health ICT This would include identifying: -­‐ Existing scalable services and applications -­‐ Necessary services and applications for prioritization -­‐Services and application that have evidence for high impact Activity Description
Once standards have been established, it becomes easier to monitor and enforce, and reward compliance across organizations aspiration, such an activity can be All must e properly initial authenticated used to ebncourage investment and elivered intended recipient in Hdealth ICT tro elated infrastructure. This activity woill f efoundation xplore the Implementation possibility f leveraging ealth ICT Health ICT soervices (e.g., H
national initiatives n existing ninfrastructure health iodentifiers, ational such as RITCs, community authentication, electronic health connectivity and w
community records, perojects tc.), begins ith based power (solar/ wind etc.) understanding the high-­‐level requirements initiatives for the service and defining a high-­‐level design for how the service would be delivered for the country These are the minimum infrastructural requirements for health facilities to optimally deploy and implement Health ICT initiatives Ensures that health information exchanged between healthcare One potential method to drive organizations roviders hrough investments and in Hpealth ICT tis to link a national Health ICT environment their Health ICT accreditation to their are a
ppropriately d
efined a
nd the meeting of defined infrastructural messages u
tilize s
tandard requirements terminologies and remain private and Although it cis onfidential. typically a l ong-­‐term leveraged for Health ICT purposes Regular entoring and on the hjob Some gmovernment agencies ave training to sbustain gained already egun wknowledge ork on putting IT and ensure in its application infrastructure place. These can be Process for developing, reviewing, approving and national Investing in pdublishing ata connectivity Health ICT standards, which is infrastructure will be agnd uided a high-­‐
supported by tfhe sector and level design or hhealth ow improving or the H
ealth I
CT i
ndustry w
ill n
eed t
o providing data connectivity to priority be established care providers and communities can be achieved, and how this will be extended Review existing ational haealth nd to the bnroader international ICT and other sector Haealth nd population standards to determine what can be While some adopted government agencies already begun several A Hhave IE system will facilitate the initiatives, t
here still information remains a plan exchange of health to eamong ffectively link them tao cross Health ICT stakeholders geographical and health-­‐sector boundaries based on defined standards Training and Capacity Building Deployment would explore wired, provided by competent partners fixed wireless and mobile connectivity infrastructure Activity Description
Establish fund coordination mechanisms to mitigate risks from fragmented funding structure Introduce a structure for planning and coordinating Health ICT budgets to improve prioritization, allocation and release FMOH, NOTAP, NITDA, implementing partners in private sector Stakeholders
FMOH, SMOH, NITDA, NHIS FMOH, NIMC, NITDA, NHIS, NPC, implementers, end-­‐users FMOH, FMCT (eGovt), GBB, USPF, NITDA FMOH, FMCT (eGovt), USPF, GBB, community leaders, private organizations (especially telecoms) FMOH, FMCT, NIMC, NITDA, NHIS, NPC, TWG, Professional and Alternative power companies (solar regulatory organizations e.g. MDCN, generation, hydro, wind farms, NMCN FMOH, NIMC, NITDA, NHIS, inverters, etc.) NPC, implementers, end-­‐users FMOH, NITDA, FMCT FMOH, SMOH, USDF, FMCT, NCC, GBB, Telecoms FMOH, FMCT, NHIS, USPF, NIMC, NITDA, Galaxy Backbone, NBS FMCT, NCC, GBB FMOH, NITDA, FMCT, TWG Stakeholders
FMOH and TWG, major funders, private sector and development partners FMOH, FMCT and TWG major funders development partners and private sector NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!51
.1 Prioritize Services and Applications .0 Solutions (Services and Applications) .2 Share Best Practices Output Title
Component
Best practices in development and use of Health ICT documented and disseminated Core set of appropriate Health ICT services and Applications prioritized and deployed Output (Recommendation)
Assess and document Health ICT services and applications in the repository (change and adoption).
Identify and prioritize services and applications that have scaled, or are scalable Output Description
This will give the general public some comfort that the healthcare facilities they attend has met certain Health ICT standards/ conditions/ requirements. Identify best practices in Health ICT and disseminate widely H. Promote research and
development of priority Health ICT solutions G. Foster continuous upgrades of implemented high priority Health ICT
solutions
F. Ongoing scale-­‐up of prioritized
services and application D. Build and Deploy identified priority national Health ICT services and/or applications
E. Operate, support and sustain
developed priority Health ICT services and application C. Identify resources to support the expansion and development of identified services and applications B. Develop/revise high level requirements and design for identified national Health ICT service and/or application A. Identify services and/or applications for prioritization
Activity
meeting minimum computing Infrastructure A dynamic portal for text, documents and audiovisuals resource materials This will focus on supporting identified priority services and application. (e.g., DHIS2) Technology is dynamic, therefore system reviews and updates are mandatory for long-­‐term implementations This would include identifying: -­‐ Existing scalable services and applications -­‐ Necessary services and applications for prioritization -­‐Services and application that have evidence for high impact -­‐Solutions with potential for ease of This involves he cdost evelopment scale and atre effective of requirements for priority services and -­‐Reliable solutions
applications to meet identified business process needs of the Nigerian Health ICT eco-­‐space This involves identifying, evaluating and selection of resources (within public and private sectors) to undertake the detailed design and implementation or expansion of national Health ICT services or applications that adhere to the high-­‐
level requirements and design This involves working with selected implementation partners to execute, needed programs at scale Activity Description
aspiration, such an activity can be used to encourage initial investment in Health ICT related infrastructure. Once standards have been established, it becomes easier to monitor and enforce, and reward compliance across organizations FMOH, NITDA, implementing partners in private sector, MDCN, NUC, various medical bodies FMOH, NOTAP, NITDA, implementing partners in private sector Stakeholders
FMOH, SMOH, NITDA, NHIS 52!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
rame ork Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome No. of stakeholder groups represented at meetings No. of national policy documents released/reviewed in the preceding year with subsections for of identified key stakeholder groups engaged of national policy documents released/reviewed in the preceding year with subsections for Health ICT 1.2 State Government engaged 3 States of Nigeria No. of states with state strategies, plans and budgets No. of national policy documents released/reviewed in the preceding year Identified stakeholder groups 3 States of Nigeria No. of states with functional TWGs N/A Policy documents released/re
viewed National/St
ate PMO State PMO State PMO PMO PMO N/A No. of meetings held within the reporting period PMO N/A PMO PMO No. of planned meeting for within reporting period Denominator Data Sources N/A N/A N/A 1. road stakeholder engagement achieved 1. ational Health ICT rame ork integrated and linked ith ational Health Act and umerator Indicator De inition National Health ICT Steering Committee ( /N) National Health ICT TWG/committee ( /N) National Health ICT project management office (PMO) ( /N) Percentage ( ) of meetings held by the National TWG in a year (with outputs and resolutions) State Health ICT TWGs established ( /N) of states in Nigeria with functional state level TWGs (functional -­‐defined a meeting per quarter) of states in Nigeria with state strategy, plan and budget Number (No.) of Health ICT initiatives led by key stakeholders in government -­‐ National and State Technical Working Groups (TWGs) Health ICT policy changes adopted and enacted es/No ( /N) Indicator 1.1 ational Health ICT governance structure esta lished 1.0 sta lished sustaina le governance structure Proximal Outcome Output Health ICT na lers HEALTH ICT M&E FRAMEWORK
APPENDIX
Appendix 6:
: Health ICT Policy document review Reports of meetings Data Collection ethod early uarterly uarterly uarterly Bi-­‐Annual re uency o Data PMO State PMO, SMOH, FMOH PMO State PMO, SMOH, FMOH TWGs -­‐ National and State, FMOH FMOH, PMO Responsi
ility Nation
al Nation
al/Stat
e State State Nation
al Nation
al, State Scope TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2015 ase
line TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
et NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!53
Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome .1 Standards or .0 Standards and Interopera ility 2.2 Incentives 1. road mechanism stakeholder esta lished engagement achieved 1. ational Health ICT rame ork integrated and 2.
Investment linked ith ational management plan Health Act and esta lished 1.2 State Government engaged 2.1 unding or Health ICT operations secured 1.1 ational Health 2.0 Increased unding or ICT governance Health e
ICT structure sta lished 1.5 ational Health ICT rame ork developed endorsed and periodically revie ed 1.0SHDP sta alished nd others sustaina le governance structure Proximal Outcome Output Health ICT na lers No. of Interoperable Health ICT applications available in Nigerian Health ICT space Standards for Health ICT and of states with established state fund coordinating mechanisms National fund coordinating mechanism established ( /N) No of incentive of identified key programs/structures and stakeholder groups engaged mechanism established No of companies/organizations of national policy utilizing incentive documents mechanisms/scheme released/reviewed in the Framework for planning and preceding yHear with coordinating ealth ICT subsections for Health ICT budgets developed ( /N) Number (No.) of Health ICT initiatives led by key stakeholders in government -­‐ National and State Technical Working Groups (TWGs) National ealth ICT Health ICT pH
olicy changes framework ( /N) adopted eandorsed nd enacted es/No ( /N) National Health ICT framework reviewed after 5 ( /N) National years Health ICT Steering Resources committed Committee ( /N) to Health ICT implementation National Health ICT and scale-­‐up from partners, TWG/committee ( /N) donors aHnd other National ealth ICT sptake-­‐
roject holders (financial and (iPMO) n-­‐kind management office contributions) ( /N) Total NGN Percentage ( ) soecured f meetings held by the National TWG in H
CT budget secured a ealth year (Iwith outputs and resolutions) State Health oIf CT TWGs Total amount seed fund established ( /N) ICT disbursed to Health of states in Nigeria with initiatives functional state level bTudget WGs of statutory health (functional defined a allocated for -­‐H
ealth ICT meeting per quarter) states in hNealth igeria with o f osf tatutory budget state strategy, plan aICT nd released for Health budget Indicator PMO PMO N/A N/A No. of states with established state fund coordinating mechanisms N/A N/A Total no. of states in Nigeria N/A No. of national policy No. of national policy documents documents released/reviewed in N/A released/reviewed in the preceding year the preceding year with subsections for TWG/PMO TWG/PMO reports TWG/PMO reports TWG/PMO reports Policy document review TWG/PMO TWG/PMO reports Policy documents released/re
TWG/PMO viewed reports TBD TWG/PMO reports TWG/PMO reports reports TWG/PMO reports Seed funds reports State fPunds MO Seed reports TWG/PMO National/St
reports ate PMO Audit report Report of review Report oof f Reports review meetings Data Collection ethod Audit report State PMO Fund raised Budget PMO document PMO FMOH
PMO s annual report PMO Data Sources N/A A A N/A N/A Denominator No. of meetings held N/A No. of planned within the reporting meeting for within Amount secured for Annual Health ICT period reporting period Health ICT budget Amount disbursed N/A Amount of seed fund for Health ICT allocated for Health No. of states with 3 States of Nigeria ICT functional hTealth WGs Statutory Statutory health budget allocated for budget Health ICT No. of states with 3 Statutory States of hN
igeria Statutory health ealth state sreleased trategies, budget for budget plans and bIudgets Health CT N/A No. of stakeholder Identified stakeholder groups represented groups at meetings N/A Health ICT umerator Indicator De inition TBD TBD TBD PMO FMOH FMOH FMOH TBD TBD PMO FMOH State FMOH PMO, SMOH, FMOH FMOH PMO early TBD TBD uarterly uarterly TBD TBD State FMOH PMO, SMOH, FMOH FMOH FMOH TBD uarterly TBD FMOH FMOH -­‐ TWGs DPRS National and FMOH State, FMOH FMOH, PMO Responsi
ility TBD 5 yearly One-­‐off Bi-­‐Annual re uency o Data Nation
Nation
al Nation
al Nation
al al Nation
al Nation
Nation
al al/Stat
e Nation
State Nation
al Nation
al State Nation
al Nation
Nation
al al, State Nation
al Nation
al Scope TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
et TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2015 ase
line 54!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome Health ICT na
Health Act and .1 Legislation
policy and compliance supported y ational Health ICT P O 5.0 Change and Adoption (Capacity uilding) engagement . achieved Health ICT Standards 1. ational Health advocated or ICT rame ork .0 Legislation
Policy and integrated and Compliance linked ith ational . Registries instruments (data collection orms reports etc.) and indicators
1. road standardi
ed stakeholder 1.2 State Government engaged 1.1 ational Health ICT governance structure esta lished .2 Capacity uilt or ensuring standards and interopera ility 1.0 S tandards sta lished .0
and sustaina
le governance Interopera
ility structure .1 Standards or Health ICT and health in ormation exchange de ined and esta lished Proximal Outcome Output 2. Investment lers management plan esta lished 1. of consumers, care providers and health-­‐care managers using Health ICT
solutions/innovations compliance supported by National Health ICT PMO ( /N) documents Health ICT policy changes released/reviewed in the adopted and eynacted ( /N) preceding ear with subsections f
or H
ealth ICT Legislation, policy and Health ICT Standards advocated for p( olicy /N) of national of identified key stakeholder groups engaged Number (No.) of Health ICT No. of Interoperable Health led by key in ICT ainitiatives pplications available Nigerian Health ICT space -­‐ stakeholders in government National and Technical Standards for SHtate ealth ICT and Working Groups (eTWGs) health information xchange Health ICT policy changes defined ( /N) adopted and enacted Standards es/No for Health ( /N) ICT and health information exchange disseminated ( /N) of defined Health and National Health ICT SICT teering Committee ( /N) HIE disseminated National Health ICT ( /N) TWG/committee of individuals trained to provide or H
ealth National support Health IfCT project ICT standardization and management office (PMO) interoperability to other key ( /N) stakeholders Percentage ( ) of meetings held by the National TWG in a year (with outputs and of organizations trained to resolutions) provide support for TH
ealth State H
ealth ICT WGs ICT established standardization and ( /N) interoperability other key of states in Nto igeria with stakeholders functional state level TWGs (functional -­‐defined a meeting per quarter) o of f rsegistries, tates in Ninstruments igeria with and indicators standardized state strategy, plan and in line with tbudget he agreed Health ICT framework of states with established state fund coordinating mechanisms mechanisms/scheme Framework for planning and coordinating Health ICT budgets developed ( /N) National fund coordinating Indicator mechanism established ( /N) 1. No. of consumers,
care providers and health-­‐care managers using 1. No. of consumers,
care providers and health-­‐care managers reached with Health No. of national policy No. of national policy documents documents released/reviewed in N/A released/reviewed in the preceding year the preceding year with subsections for N/A TWG/PMO reports documents TWG/PMO released/re
reports viewed TWG/PMO reports Policy National/St
ate PMO TWG/PMO State PMO reports State PMO Periodic Review document review Monthly Reports Policy Registries of instruments and standardized instruments Bi-­‐Annual early Monthly uarterly Bi-­‐Annual uarterly uarterly uarterly PMO PMO FMOH SMOH, FMOH PMO FMOH/P
State MO PMO, PMO State PMO, SMOH, FMOH PMO Nation
al , State Nation
al/Stat
e Nation
al, Nation
State al Nation
State al State Nation
al, State Nation
al, State Nation
al Nation
al Nation
al, Nation
State al Nation
al Nation
Scope al Nation
al TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
TBD et TBD TBD TBD TBD TBD TBD TBD 2015 ase
TBD line TBD TBD TBD Training registers Registered targets uarterly Training registers Registered targets TWGs -­‐ National PMO and State, FMOH PMO FMOH, PMO PMO FMOH Responsi
ility FMOH FMOH TWG/PMO reports TBD TBD TBD Bi-­‐Annual TBD TBD TBD re uency o TBD Data TBD TBD TWG/PMO PMO reports PMO TWG/PMO reports PMO Total disseminated N/A Total no. of defined Health ICT standards and HIE N/A No. of individuals Total No. of targeted trained to provide N/A individuals to be trained support for Health ICT standardization and ointeroperability No. f meetings held No. of planned to otther key within he reporting meeting for within stakeholders period reporting period No. of organizations Total no. of targeted trained to provide N/A organizations to be trained support for Health ICT s
tandardization No. of states with 3 States of Nigeria and interoperability functional TWGs to other key stakeholders No. oof f srtates egistries, Total o. of orf egistries, No. with 3 Sn
tates Nigeria instruments and instruments and state strategies, indicators indicators in use by plans and budgets standardized in line health programs line with approved with the satakeholder pproved No. otf he stakeholder Identified Health ICT Health ICT framework groups represented groups framework at meetings N/A Reports of meetings TBD TBD TWG/PMO Data reports Collection TWG/PMO ethod reports TWG/PMO reports PMO TWG/PMO reports TWG/PMO reports PMO reports N/A N/A N/A N/A Denominator Total no. of states in Nigeria TWG/PMO Data reports Sources TWG/PMO N/A Indicator De inition No. of states with established state fund umerator coordinating mechanisms TWG/PMO reports N/A NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!55
Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome Health ICT na
5.1 System or Health ICT readiness and adoption o est practices esta
1.2 Slished tate 5.2
Incentive Government mechanisms engaged to encourage uptake o Health ICT skills and competencies esta lished 5. ethodology or accreditation and revision o Health ICT 1. training road curriculum stakeholder esta lished engagement 5. Pachieved lan or Health areness and 1.ICT a ational Health stakeholder ICT rame ork engagement integrated and estaith lished linked ational 5.5 Health CT Health Act aInd education and training programs esta lished .0 In rastructure 1.1 ational Health ICT governance structure esta lished .1 Legislation policy and Proximal compliance Outcome
Output y supported ational Health ICT P O sta
lished 5.0 C1.0
hange and Adoption sustaina
le governance (Capacity uilding) structure Standards advocated or .0 Legislation Policy and lers Compliance Denominator TWG/PMO Data reports Sources Periodic Data Review Collection ethod Reports National/St
ate PMO No. of stakeholder groups represented at meetings No of health providers with access to electronic health information No of healthcare of health providers with increased access to electronic health information of healthcare consultations No of health providers reach with electronic health information interventions No of health N/A No. of national policy No. of national policy documents documents released/reviewed in released/reviewed in the preceding year the preceding year with subsections for N/A FMCT FMCT Annual Surveys/TB
D documents released/re
viewed Workforce TWG Workforce TWG Policy State PMO Workforce TWG No. of states with 3 States of Nigeria state strategies, N/A plans and budgets Identified stakeholder groups Workforce TWG State PMO N/A Workforce PMO TWG PMO No of incentive 3 Smechanisms tates of Nigeria developed No of incentive mechanisms No. of states with adopted functional TWGs No. of meetings held N/A No. of planned within the reporting meeting for within period reporting period N/A TBD TBD Periodic Review Periodic Review Policy document review Periodic Review Periodic Review Periodic Review 1. No. of consumers, N/A 1. No. of consumers,
care providers and care providers and health-­‐care health-­‐care managers managers using reached with Health ICT Health ICT solutions/innovation N/A solution/innovation PMO Reports of s interventions meetings 2. No. of consumers, 2. No. of consumers,
care provider and care providers and health-­‐care health-­‐care managers managers satisfied N/A reached with Health PMO with using Health ICT
ICT solutions/innovation N/A solution/innovation PMO s interventions umerator N/A Indicator De inition Plan for Health ICT awareness and stakeholder engagement of national policy established(
documents /N) released/reviewed in the preceding year with No of Health fIor CT Heealth ducation subsections ICT programs established stakeholder groups engaged National Health ICT Steering Committee ( /N) National Health ICT TWG/committee ( /N) National Health ICT project management office (PMO) ( /N) 1. Health (ICT Percentage ) oreadiness
f meetings assessment completed ( /N) held by the N
ational TWG in Health ICT readiness a 2. year (with outputs and system resolutions) established ( /N)
State Health ICT TWGs 1. No of incentive
established ( /N) mechanisms eveloped of states in Ndigeria with 2. of incentive echanisms
functional state m
level TWGs adopted (functional -­‐defined a meeting per quarter) of states in Nigeria with Methodology for and state strategy, plan accreditation and revision of budget Health ICT training curriculum established of identified key ( /N) Number of Health ICT 1. of (cNo.) onsumers, care initiatives led by key providers and health-­‐care stakeholders in government managers using Health ICT -­‐ National and State Technical solutions/innovations Working Groups (TWGs) 2. of consumers, care provider and health-­‐care
Health ICT policy changes managers atisfied with adopted asnd enacted using Health ICT es/No ( /N) solutions/innovations Legislation, policy and Indicator compliance supported by National Health ICT PMO ( /N) TWG/PMO reports Health ICT policy changes adopted and enacted ( /N) N/A reports advocated for ( /N) TBD TBD uarterly Bi-­‐Annual early uarterly uarterly Annually uarterly Bi-­‐Annual Annually Bi-­‐Annual Bi-­‐Annual re uency o Data FMCT FMCT PMO PMO PMO State PMO PMO, SMOH, FMOH PMO State PMO PMO, SMOH, FMOH PMO TWGs -­‐ National and State, FMOH FMOH, PMO PMO Responsi
ility Nation
Nation
al Nation
al al Nation
al/Stat
e Nation
al Nation
State Nation
al Nation
al , State State Nation
al Nation
al Nation
al, State Nation
Scope al , State al, State TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
et TBD TBD TBD TBD TBD 2015 ase
line TBD 56!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
.2 xisting In rastructure 1.2 State or Health ICT identi ied Government and assessed engaged . inimum in rastructural re uirements or Health ICT in rastructure de ined .0 Solutions (Services and Applications) 1. road stakeholder .1
Core set o engagement appropriate Health ICT sachieved ervices and 1. Applications ational Health ICT rame
prioriti
ed aork nd integrated and deployed linked ith ational Health Act and .2 est practices in development and use o Health ICT documented and disseminated. .1 Connectivity 1.1
ational Health coverage expanded ICT and geovernance nhanced structure esta lished Health ICT Outcomesi Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome Health ICT na
esta lished 5. Plan or Health lers ICT a areness and stakeholder engagement esta lished Proximal 5.5 Health ICT Outcome Output education and training programs esta lished 1.0 In sta
lished .0
rastructure sustaina le governance structure of national policy with adocuments ppropriate Health released/reviewed the ICT solution amongst in target preceding year with population subsections for Health ICT Best practices in development and use of Health ICT documented and disseminated. ( /N) solution deployed of identified key stakeholder groups engaged of innovative Health ICT 1. of communities/ health
National Health ICT Sw
teering facilities supplied ith Committee ( /N) connectivity hardware infrastructure National Health ICT TWG/committee ( /N) National Health ICT project management office (PMO) of communities/health ( /N) facilities connected to an ISP Percentage ( ) of m
eetings held by the National TWG in a year (with outputs and resolutions) of health facilities with needs assessment completed State Health ICT TWGs established ( /N) of states in Nigeria with Minimum sitate nfrastructural functional level TWGs requirements Health aI CT (functional f-­‐or defined infrastructure defined ( /N) meeting per quarter) of states in Nigeria with state strategy, plan and budget Number (No.) of Health ICT of health providers with initiatives by ktey ccess o increased laed stakeholders in government electronic health information -­‐ National and State Technical Working Groups (TWGs) ICT policy changes Health of healthcare consultations adopted and enacted made through telemedicine es/No ( /N) Health ICT solution developed/available No. of national policy documents target population released/reviewed in the preceding year 3 States of Nigeria Identified stakeholder Total ngroups o innovative deployed No. of national policy no wdocuments ith appropriate released/reviewed Health ICT solution in the preceding year amongst target with population subsections for N/A No. of stakeholder groups epresented No of irnnovative at m
eetings Health ICT solution No. of states with state strategies, plans and budgets N/A No of health No of health providers with providers reach with access to electronic electronic health health information information interventions No of healthcare N/A No of health consultations made providers reach with through telemedicine telemedicine interventions No of communities/ total no. of health facilities N/A communities/ health supplied with facilities targeted to connectivity N/A be supplied with hardware connectivity infrastructure N/A hardware infrastructure No of total no. of communities/health communities/health No. of meetings held No. of planned facilities connected facilities to within the reporting meeting targeted for within to a ISP be reporting connected to a ISP period period no of health facilities no of health facilities with needs N/A targeted for assessment assessment No. completed of states with 3 States of Nigeria functional TWGs N/A Denominator N/A umerator Indicator De inition Indicator N/A No of Health ICT education programs established Plan for Health ICT awareness and stakeholder engagement established( /N) Policy document TBD review TBD TBD TBD TBD TBD TBD early TBD TBD uarterly uarterly TBD uarterly TBD TBD Policy documents TBD released/re
viewed National/St
ate PMO TBD TBD TBD TBD FMCT/F
MOH PMO FMCT/F
MOH FMCT/F
MOH State PMO, SMOH, FMOH PMO FMCT State PMO, SMOH, FMOH FMCT FMCT FMCT Annual PMO Surveys/TB
D FMCT Annual Surveys/TB
D PMO State FMCT Annual Surveys/TB
D PMO State Nation
al /state /state Nation
al Nation
al /state Nation
al/Stat
Nation
e al TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD State Nation
al State TBD TBD Nation
al Nation
al TBD TBD TBD PMO TBD TBD 2020 Targ
TBD et TBD TBD Nation
Nation
al al Nation
al, al State TBD 2015 ase
TBD line TBD TBD TBD TWGs FMCT -­‐ National and State, FMOH FMCT FMOH, PMO Nation
al Nation
al Scope Nation
al TBD TBD TBD Bi-­‐Annual TBD FMCT Responsi
ility PMO PMO TBD TBD Reports TBD of meetings TBD re uency o Data uarterly Bi-­‐Annual PMO FMCT Annual Surveys/TB
D FMCT PMO Annual Surveys/TB
D PMO TBD Data Collection Periodic ethod Review Periodic Review FMCT Annual Surveys/TB
D Data Sources Workforce TWG Workforce TWG NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!57
i
health workers by cadre registered in HRIS of health facilities reporting into NHMIS (public and private) 2.
ective use o human resource in ormation system (HRIS) or distri ution o health orkers ective use o H IS or health system planning National ervice eliver ndicators of pregnant women and of facilities with eLMIS reporting no stock outs No. of health facilities reporting into NHMIS (public and private) No. of facilities with eLMIS reporting no stock outs pregnant women registered in pregnancy registry 2.2 ective use o pregnancy registry or maternal health ective use o L IS or tracking supply and demand or commodities .0 Increased uptake o health services .1 ective use o No. of health workers registered in HRIS children born registered in birth registry system 2.1 ective use o CR S or child health No. of pregnant No. of pregnant women registered in pregnancy registry No. of children registered in birth registry National indicator for covera e of health services supervised using ICT tools ICT or health orker supervision and support 2.0 Improved coverage o health services workers supervised using ICT tools by cadre No. of health encounters resolved or supported through telemedicine No. of health workers trained using ICT of health encounters resolved or supported through telemedicine of health workers trained using ICT No. of health facilities delivering telemedicine services of health facilities providing telemedicine services umerator Estimated no. of No. of facilities with eLMIS No. of health facilities (public and private) No. of health workers by cadre (as estimated by key sources) No. of pregnant women (estimated through DHS or Census) No. of children born (estimated through DHS or Census) by cadre No. of health workers by cadre No. or health facilities identified as potential telemedicine centers No. of health encounters Denominator Indicator de inition 1.1 ective use o telemedicine Indicator National indicator for access to health services 1.2 ective use o ICT or health orker training No. of health workers trained using ICT No. of health workers by cadre HRIS Telemedici
ne platforms/ NHMIS HRIS NHMIS-­‐ facility registry Data sources Existing/ new electronic systems Data collection method uarterly uarterly re uency o Data MAMA/ eLMIS DHIS2 Birth registry/ other sources TBD Pregnancy registry/ other sources TBD Health workers by cadre baseline Existing/ new Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems uarterly uarterly uarterly uarterly uarterly uarterly National/ FMOH/ SMOH FMOH/S
MOH FMOH HRH/ SMOH National Populatio
n Commissi
on FMOH/ SMOH National/ State PMO National/ State PMO National/ State PMO Responsi
ility Nation
Nation
al/ State Nation
al/ State Nation
al/ State Nation
al/ State Nation
al/ State Nation
al/ State Nation
al/ State Nation
al/ State Scope TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2015
ase
line TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
et Where possible and appropriate impact evaluations to assess the effectiveness, efficacy, and cost-­‐utility of Health ICT implementations will be conducted. of health workers trained using ICT 1.0 Improved access to health services Proximal Outcome Output i
1.2 ective use o ICT or health orker 1.
ective use o otf o haealth workers being No. of health No. oof f hH
ealth workers HRIS Where possible and appropriate impact evaluations ssess the effectiveness, efficacy, and cost-­‐utility ealth ICT implementations will be conducted. uarterly By 2 2 , Health ICT will help enable and deliver universal health coverage Health Impact Health ICT Outcomesi disseminated. uarterly Na
S
58!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome Health ICT na
.0 Increased e uity in access to and uality o health services in ormation and inancing ICT or non
Insurance related inancial transactions National health e
indicators it of mobile money or electronic payments for health workers, etc. o f onf ational olicy claims apnd documents reimbursements processed released/reviewed in the through NHIS platform preceding year with subsections or Health TBD-­‐ this may ifnclude the ICT use of identified key of citizens egnrolled n NHIS stakeholder roups eingaged system 1. road 5.1 stakeholder ective use o ICT or HIS engagement achieved 1. ational Health ICT rame ork integrated and linked ith ational Act uase nd o 5.2 Health ective 5.0 Increased inancial coverage or health care 1.2 State Government ective use o ICT engaged ithin the continuum o care (incl. re errals) ective use o ICT or decision support .0 Improved uality o care of citizens accessing health services through mobile National Health ICT Steering conditional cash transfer Committee ( /N) programs National Health ICT TWG/committee ( /N) National alitICT of pcroject are National Health management office (PMO) indicators ( /N) of health workers using Percentage ( ) of meetings decision support tools to held by the National TWG in improve quality of care a year (with outputs and resolutions) State Health ICT TWGs established ( /N) of facilities implementing o
f tates in Nigeria with ICT to ssupport the continuum functional of state care level TWGs (functional -­‐defined a meeting per quarter) of states in Nigeria with state strategy, and e National financial pclan overa
budget for health care indicators TBD Identified stakeholder No. groups of citizens targeted for enrollment in NHIS No. of onf ational No. claims paolicy nd documents reimbursements released/reviewed submitted for in the pprocessing receding year 3 States of Nigeria No. of states with state strategies, plans and budgets No. of stakeholder No. orepresented f citizens groups enrolled in NHIS at meetings system No. of onf ational No. claims paolicy nd documents reimbursements released/reviewed processed in the preceding year with subsections for TBD TBD State PMO No. of facilities 3 States of Nigeria No. of facilities No. of states w
ith to implementing ICT functional support TtWGs he continuum of care TBD Policy NHIS/ TBD documents released/re
viewed National/St
NHIS/ TBD ate PMO State PMO Decision PMO support tool dashboards
/ TBD PMO mCCT/ Other PMO sources TBD PMO MAMA/ Other sources PMO TBD Data Sources eLMIS DHIS2 No. of health workers Estimated no. of No. of meetings held No. of planned using decision health workers within the reporting meeting for within support tools to targeted for decision period reporting period improve quality of support tools care N/A No. of pregnant Estimated no. of women and new pregnant women and mothers receiving new mothers mobile messages N/A targeted for mobile accessing health messaging services No. of citizens Estimated no. of accessing health citizens to be services through N/A covered/ supported mobile conditional through mobile N/A conditional cash cash transfer transfer programs programs N/A N/A Number of Health National (No.) ervice eliverICT initiatives led by key ndicators stakeholders in w
government of pregnant omen and -­‐ National and receiving State Technical new mothers mobile Working aGccessing roups (TWGs) messages health Health ICT policy changes services adopted and enacted es/No ( /N) of facilities with eLMIS reporting no stock outs No. of health No. of health facilities facilities reporting (public and private) into NHMIS (public Indicator De inition and private) No. of facilities with No. of facilities with eLMIS reporting no eLMIS stock outs umerator Denominator of health facilities reporting into NHMIS (public and private) Indicator .2 ective use o mo ile conditional 1.1
tational cash rans er Health or ICT governance demand creation structure esta lished Proximal ective use o L IS Outcome Output or tracking supply and demand or commodities 1.0 sta ulished .0 Increased ptake o sustaina
governance health le services .1 structure ective use o mo ile messaging or demand creation or R
CH distri ution o health orkers lers ective use o H IS or health system planning Existing/ new electronic systems Policy new Existing/ document electronic review systems Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems Existing/ new electronic systems Reports of meetings Existing/ new electronic systems Data Collection Existing/ new ethod electronic systems uarterly early uarterly uarterly uarterly uarterly uarterly uarterly uarterly uarterly Bi-­‐Annual uarterly re uency o Data uarterly uarterly PMO/ TBD PMO NHIS National/ State PMOs and impleme
State nters PMO, National/ SMOH, State FMOH PMOs and impleme
State nters PMO, SMOH, FMOH PMO NHIS National/ State PMO -­‐ & TWGs MAMA National and State, FMOH FMOH, PMO Responsi
ility FMOH/ SMOH FMOH/S
MOH Nation
al/ State Nation
Nation
al al/ State Nation
Nation
al/Stat
al/ e State State Nation
State al , State Nation
al , State Nation
al, Nation
State al Nation
al/ State Nation
al, State Nation
al/ State Nation
al/ State Scope TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 Targ
TBD et TBD TBD TBD TBD TBD 2015 ase
TBD line TBD NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020!|!59
Enabling and sustainable environment for implementation and scale-­‐up of Health ICT in Nigeria Intermediate Outcome 1. road stakeholder engagement achieved 1. ational Health ICT rame ork integrated and linked ith ational Health Act and 1.2 State Government engaged .2 ective use o ICT or delivering appropriate health services or those ho need them most ased on inancial need enrollment in NHIS umerator Denominator No. of claims and reimbursements submitted for processing TBD Indicator De inition TBD system No. of claims and reimbursements processed No. of national policy documents released/reviewed in the preceding year with subsections for of national policy documents released/reviewed in the preceding year with subsections for Health ICT No. of national policy documents released/reviewed in the preceding year Identified stakeholder groups 3 States of Nigeria No. of states with state strategies, plans and budgets No. of stakeholder groups represented at meetings 3 States of Nigeria No. of states with functional TWGs N/A of identified key stakeholder groups engaged resolutions) State Health ICT TWGs established ( /N) of states in Nigeria with functional state level TWGs (functional -­‐defined a meeting per quarter) of states in Nigeria with state strategy, plan and budget Number (No.) of Health N/A National health e itICT initiatives led by key indicators stakeholders in government -­‐ National and State Technical Working Groups (TWGs) Health ICT policy ocf hanges of distribution services No. of distribution of N/A No. of distribution of and adopted human resource plans and services and human services and human and enacted fund allocations ade through resource plans and resource plans and es/No (m/N) the use of epidemiological fund allocations fund allocations made data accessed through ICT made through the services use of National Health ICT Steering N/A epidemiological data Committee ( /N) accessed through ICT National Health ICT N/A services TWG/committee ( /N) of plans H
and fund No. of plans and N/A No. of plans and fund National ealth ICT allocations project made that target NHIS (PMO) services fund allocations allocations made to management office to the poor and most in made that target deliver NHIS services ( /N) financial NHIS services the Percentage ( ) onf eed meetings No. of m
eetings to held No. of planned poor the and most in held by the National TWG in within reporting meeting for within financial a year (with outputs and period need reporting period Indicator TBD-­‐ this m
ay include the use of mobile money or electronic payments for health workers, etc. of claims and reimbursements processed through NHIS platform rame ork sta lished .0 1.0
Increased e uity in sustaina
governance access to ale nd uality o structure health services in ormation and inancing .1 ective use o ICT or delivering appropriate health services or those ho need them ased n 1.1most ational Hoealth epidemiology ICT governance structure esta lished 5.2 ective use o Proximal ICT or non
Outcome
Output Insurance
related inancial transactions Health ICT na lers Appendix : Health ICT Policy documents released/re
viewed National/St
ate PMO State PMO State PMO NHIS/ PMO Other sources TBD PMO PMO PMO PMO NHMIS/ Other sources TBD Data TBD Sources NHIS/ TBD systems Policy document review Existing/ new electronic systems Reports onf ew Existing/ electronic meetings systems Data new Existing/ Collection electronic ethod systems Existing/ new electronic systems early uarterly uarterly uarterly uarterly Bi-­‐Annual uarterly reuarterly uency o Data uarterly PMO State PMO, SMOH, FMOH PMO State PMO, SMOH, FMOH PMO/ TBD TWGs -­‐ PMO/TB
D National and State, FMOH FMOH, PMO Responsi
PMO/ ility TBD NHIS State Nation
al Nation
al/Stat
e State State Nation
al / State Nation
al Nation
Nation
al/ al, State State Scope Nation
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al/ State TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD TBD 2020 TBD Targ
et TBD TBD TBD TBD TBD TBD TBD TBD 2015 TBD ase
line TBD Endnotes
1.#UN Foundation in support of ICT4SOML. “Assessing the Enabling
Environment for ICTs for Health in Nigeria: A Review of Policies.” Abuja,
Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeria-HealthICT-policy-report.pdf
2.#The World Bank. “Nigeria Country Data.” 2015. Available at: http://data.
worldbank.org/country/nigeria. Accessed May 27, 2015.
3.#The World Bank. “World Bank Data.” 2015. Available at: http://databank.
worldbank.org/Data/Views/VariableSelection/SelectVariables.
aspx?source=Health Nutrition and Population Statistics: Population
estimates and projections. Accessed May 28, 2015.
4.#National Populations Commission. “Nigeria Demographic and Health
Survey 2013.” 1st ed. (USAID, UKAID, UNFPA, eds.). Abuja; 2014. Available
at: http://www.population.gov.ng/images/ndhs_data/ndhs_2013/2013_
ndhs_final_report.pdf.
5.#The World Bank. “World Bank Data.” 2015. Available at: http://databank.
worldbank.org/Data/Views/VariableSelection/SelectVariables.
aspx?source=Health Nutrition and Population Statistics: Population
estimates and projections. Accessed May 28, 2015.
6.#National Populations Commission. “Nigeria Demographic and Health
Survey 2013.” 1st ed. (USAID, UKAID, UNFPA, eds.). Abuja; 2014. Available
at: http://www.population.gov.ng/images/ndhs_data/ndhs_2013/2013_
ndhs_final_report.pdf.
7.#Center for Disease Control and Prevention. “Impact of Malaria.” 2014: CDC.
Available at: http://www.cdc.gov/malaria/malaria_worldwide/impact.html.
Accessed May 27, 2015.
8.#WHO. “Nigeria Country Profile.” 2014. Available at: http://www.who.int/
nmh/countries/nga_en.pdf.
9.#WHO. “State of Health Financing in the African Region.” 2013. Available
at: http://www.afro.who.int/pt/downloads/doc_download/8698-state-ofhealth-financing-in-the-african-region.html.
10.#NHIS. “Low Enrolment Level Unacceptable – NHIS Boss.”
Available at: http://www.nhis.gov.ng/index.php?option=com_
content&view=article&id=221:low-enrolment-level-unacceptable--nhisboss&catid=46:newsletter. Accessed May 27, 2015.
11.#Jenna D, Eric T, Isaac L. “Ghana’s National Health Insurance Scheme: a
national level investigation of members’ perceptions of service provision.”
BMC Int Health Hum Rights. 2013;13(1):35. doi:10.1186/1472-698X-13-35.
12.#UN Foundation in support of ICT4SOML. “Assessing the Enabling
Environment for ICTs for Health in Nigeria: A Review of Policies.” Abuja,
Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeria-HealthICT-policy-report.pdf
13.#UN Foundation in support of ICT4SOML. “Assessing the Enabling
60!|!NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020
Environment for ICTs for Health in Nigeria: A Review of Policies.” Abuja,
Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeria-HealthICT-policy-report.pdf.
14.#UN Foundation in support of ICT4SOML. “Assessing the Enabling
Environment for ICTs for Health in Nigeria: A Review of Policies.” Abuja,
Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeria-HealthICT-policy-report.pdf.
15.#WHO, ITU. WHO-ITU. “National eHealth Strategy Toolkit.” 2012. Available
at: https://www.itu.int/pub/D-STR-E_HEALTH.05-2012.
16.#UN Foundation in support of ICT4SOML. “Assessing the Enabling
Environment for ICTs for Health in Nigeria: A Review of Policies.” Abuja,
Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeria-HealthICT-policy-report.pdf.
17.#Trust Law, mHealth Alliance, Baker&McKenzie, MSD Bewell. “Patient
Privacy in a Mobile World: A Framework to Address Privacy Law Issues
in Mobile Health.” 2013. Available at: http://www.trust.org/contentAsset/
raw-data/03172beb-0f11-438e-94be-e02978de3036/file.
18.#Federal Government of Nigeria. “National Health Act.” 2014.
19.#Trust Law, mHealth Alliance, Baker&McKenzie, MSD Bewell. “Patient
Privacy in a Mobile World: A Framework to Address Privacy Law Issues
in Mobile Health.” 2013. Available at: http://www.trust.org/contentAsset/
raw-data/03172beb-0f11-438e-94be-e02978de3036/file.
20.#Global Health Workforce. “Human Resources for Health Country Profile
Nigeria.” 2008. Available at: http://www.unfpa.org/sowmy/resources/
docs/library/R050_AHWO_2008_Nigeria_HRHProfile.pdf.
21.#WHO. “WHO Country Brief: Nigeria” Global Health Workforce Alliance.
Available at: http://www.who.int/workforcealliance/countries/nga/en/.
22.#UN Foundation in support of ICT4SOML. “Nigeria Health ICT Phase 2
Field Assessment.” Abuja, Nigeria; 2015. Available at: http://www.health.
gov.ng/doc/FieldAssessment.pdf.
23.#UN Foundation in support of ICT4SOML. “Nigeria Health ICT Phase 2
Field Assessment.” Abuja, Nigeria; 2015. Available at: http://www.health.
gov.ng/doc/FieldAssessment.pdf.
24.#UN Foundation in support of ICT4SOML. Assessing the Enabling
Environment for ICTs for Health in Nigeria: A Landscape and Inventory.
Abuja, Nigeria; 2014. Available at: http://www.health.gov.ng/doc/nigeriaHealth-ICT-landscape-report.pdf.
25.#Mehl G, Labrique A. “Prioritizing integrated mHealth strategies for
universal health coverage.” Science (80- ). 2014;345(no. 6202):1284-1287.
doi:10.1126/science.1258926.
26.#Mehl G, Labrique A. “Prioritizing integrated mHealth strategies for
universal health coverage.” Science (80- ). 2014;345(no. 6202):1284-1287.
doi:10.1126/science.1258926.
27.#UN Development Group. “Results-Based Management Handbook.” 2010.
Available at: http://www.un.cv/files/UNDG RBM Handbook.pdf.
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