APPENDIX 3: Recommended Nigeria Health ICT Architecture . . . . . . . . 39 ..... recognition for the opportunities that
National Health ICT Strategic Framework 2015 - 2020
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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
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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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Foreword (Forthcoming)
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Acknowledgements This Health ICT Strategic Framework document has been developed and produced through the visionary leadership provided by the Honorable Minister of Health and Honorable Minister of Communication Technology. Their leadership and recognition of the synergies between health and technology has been priceless. Several organizations have been involved in developing the strategy. It is impossible to name all that contributed to this piece of work, but we would like to acknowledge as many as we can. They include but are not limited to: departments of Federal Ministry of Health the Federal Ministry of Communication Technology, the Saving One Million Lives (SOML) Programme Delivery Unit; the Nigerian Information Technology Development Agency; the National Health Insurance Scheme; the National Identity Management Commission; the Federal Capital Territory Administration Health and Human Services Secretariat Health Planning Research and Statistic; the State Ministries of Health; and the State Ministries of Communications or Science and Technology. Others are the Nigerian Communications Commission; the Digital Bridge Institute; the Universal Service Provision Fund; the Nigerian Communications Satellite Ltd.; the Centre for Management Development; and Galaxy Backbone Ltd.; the National Primary Health Care Development Agency; the National Agency for the Control of AIDS; the SURE-P MCH PIU; National Agency for Food and Drugs Administration and Control; the National Universities Commission; the Standards Organization of Nigeria; the Medical and Dental Council of Nigeria; Computer Professionals Registration Council of Nigeria.
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We cannot thank enough and acknowledge the immense contribution from partners in non-governmental organizations and the private sector, such as the World Health Organization; John Snow Incorporated; Clinton Health Access Initiative; Health Information System Program (HISP); InStrat Global Health Solutions; Technology Advisers; AAJIMATICS; Pathfinder International; the Health Reform Foundation of Nigeria; the Praekelt Foundation; Maternal Action for Mobile Alliance; Groupe Speciale Mobile Association; and the Private Sector Health Alliance of Nigeria.
Lastly, this collaborative multi-stakeholder and multi-sectoral development process would not have been possible without the funding support from the Norwegian Agency for Development and Cooperation through the United Nations Foundation. Gratitude is also due to the ICT4SOML In-Country Team for facilitating and coordinating this collaborative drafting process. We would also like to acknowledge the Regenstrief Institute for the wonderful support on the architecture and health information exchange (HIE) piece and several others who worked tirelessly in the background: PATH; VitalWave; and Asia eHealth Information Network, to name a few. We sincerely express our heartfelt gratitude to all who have contributed — in one way or another — to the development of this Nigerian Health ICT Strategic Framework 2015 – 2020. Dr. NRC Azodoh, Director of Planning Research and Statistics, Federal Ministry of Health, Nigeria
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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
DRAFT 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
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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 MDG
DRAFT Ministries, Departments and Agencies 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
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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
DRAFT
SURE-P
Subsidy Reinvestment and Empowerment Program
TS
Terminology Service
TWG UHC UN
Technical Working Group
Universal Health Coverage United Nations
USAID
United States Agency for International Development
USD
United States Dollar
USPF WHO
Universal Service Provision Fund World Health Organization
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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.
DRAFT
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.
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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
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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
DRAFT
TABLE 1. Components of the Health ICT Enabling Environment
TABLE 2. Summary of Recommendations to Improve Health ICT
Enabling Environment
TABLE 3. N igeria National Health ICT Vision Integrated Action
Plan 2015 - 2020
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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.
DRAFT
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;
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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)
DRAFT
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.
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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
DRAFT 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
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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
DRAFT 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
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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.
DRAFT “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
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• 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
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.
DRAFT
UHC OUTCOMES
HEALTH ICT OUTCOMES
LONG-TERM ICT OUTPUTS
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.
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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
M&E-DPRS
NHIS + NIMC
M&E-DPRS
NACA + NPHCDA
NAFDAC
HRH-DPRS
DRAFT
Existing Shared Health Information Services
Registry of Health Facilities
Registry of Clients
National Health Management Information System (NHMIS)
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
Clinical Record Systems
Hospital Information Systems
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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
DRAFT
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
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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.
DRAFT
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.
*E MR = 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)
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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
DRAFT
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
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TABLE 2. Summary of Recommendations to Improve Health ICT Enabling Environment COMPONENT
RECOMMENDATIONS
Leadership and Governance
•E stablish a National Health ICT Steering Committee and supporting structure to oversee Health ICT planning, implementation, coordination, governance and evaluation •E ngage 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 •S ecure 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 •S et 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
•C onduct 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 •E stablish 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)
DRAFT
Architecture, Standards and Interoperability
•D efine 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
•E stablish 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
•E stablish a system for Health ICT workforce monitoring and evaluation, readiness, adoption and practices •D evelop 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 •E stablish methodology for accreditation and revision of Health ICT training Curriculum
•E stablish special Health ICT education, training and career path development programs •D evelop 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
•R einforce 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 •D efine minimum infrastructure and computing requirements for each type of health facility and health administrative office and link to accreditation and assessment •D evelop 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 •S trengthen 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
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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:
DRAFT
• 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
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• 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.
DRAFT 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
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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.
DRAFT
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
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requirements for electronic reporting of health data and indicators
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.
DRAFT
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 • E stablish 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
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Community Resource Centers, may be leveraged. Specific infrastructure recommendations include the following: • 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 • S trengthen 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
DRAFT
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.
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well as State and LGA level health administrative offices • D evelop incentive mechanism for further Health ICT infrastructure improvements
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
DRAFT
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
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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
DRAFT
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)
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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
DRAFT
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.
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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.
DRAFT
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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
DRAFT
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
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
Develop strategy for continued Health ICT skills and competency acquisition
Q2
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)
Implement new accreditation requirements
Q1
TABLE 3. Nigeria National Health ICT Vision Integrated Action Plan 2015 - 2020 continued
DRAFT
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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
TABLE 3. Nigeria National Health ICT Vision Integrated Action Plan 2015 - 2020 continued
Q2
Q3
Q4
Q1
Q2
YEAR 3
Q3
Q4
Q1
Q2
YEAR 4 Q3
Q4
Q1
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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)
DRAFT
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.
DRAFT
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Appendices APPENDIX 1:
LIST OF CONTRIBUTORS (Placeholder)
DRAFT
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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.
DRAFT
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.
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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.
*E MR = 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)
DRAFT
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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
DRAFT
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
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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.
DRAFT
• 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.
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• 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. • P oint 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.
DRAFT
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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
DRAFT • 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
•T he Chair member will be appropriate government ministry, department or agency.
•O ther members can be drawn from a wide range of stakeholders ranging from the private sectors, to development partners to health ICT subject experts
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
•T here may be several subject matter specific working groups
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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. 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.
GENERAL FUNCTIONS AND RESPONSIBILITIES 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.
DRAFT
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Output Title
Output (Recommendation)
National Health ICT governance structure established National Health ICT governance structure established
1.1 Governance Structure
1.1 Governance Structure
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
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
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
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
State Government engaged
1.2 State Government Engagement
Broad stakeholder engagement achieved
State Government engaged
1.2 State Government Engagement
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
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
Formalize governance interactions between Federal and States as well as between States and LGAs
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
DRAFT
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
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
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3.0 Standards and Interoperability
3.0 Standards and Interoperability
3.0 Standards and Interoperability
Component
Component
Component
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
Output (Recommendation)
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
Output Description
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
Investment management to enable proper allocation of Health ICT infrastructure development, investment funding o priority entrepreneurs and dtevelopers projects infrastructure development, entrepreneurs and developers
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 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
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
3.2 Standards capacity building
3.1 Established Standards 3.2 Standards capacity building
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
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
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.
DRAFT
3.1 Established Standards
Output Title
3.1 Established Standards information exchange defined and established
Investment management plan established
2.3 Investment
Output (Recommendation) Standards for Health ICT and health
Investment management plan established
2.3 Investment
Output Title
Output (Recommendation)
Investment management plan established
Output Title
2.3 Investment
A. Investment management structure
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 // OCTOBER 2015 DRAFT FOR REVIEW
3.1 Established Standards
Component
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)
Output Title
Component
5.0 Change and Adoption (Capacity Building)
5.1 System for Health ICT Adoption
5.1 System for Health ICT Adoption
5.1 System for Health ICT Adoption
Output Title
Component
5.1. 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)
3.3 Data Collection and Registries
Output Title
Standardized registries, instruments (data collection forms, reports etc.) and indicators
4.1 Regulatory Framework Established
4.0 Legislation, Policy and Compliance
Component
Empower National Health ICT PMO to support legislation, policy and compliance
4.1 Regulatory Framework Established
4.0 3.0 Legislation, Policy and Compliance Standards and Interoperability
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
4.1 Regulatory Framework Established
3.2 Standards capacity building
4.0 Legislation, Policy and Compliance
5.0 Change and Adoption (Capacity Building) 5.0 Change and Adoption (Capacity Building)
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
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
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
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
DRAFT
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
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
TWG, FMOH, FMCT, implementing partners, SMOH
TWG, FMOH, FMCT, implementing partners, SMOH
TWG, FMOH, FMCT, implementing TWG, FMOH partners, SMOH
TWG, FMOH
TWG, FMOH
Stakeholders
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 // OCTOBER 2015 DRAFT FOR REVIEW | 47
3.0 Standards and Interoperability
Component
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
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
5.2. Develop and adopt Incentive mechanisms to encourage uptake of Health ICT skills and competencies
Standardized registries, instruments (data collection forms, reports etc.) and indicators
5.3. Establish methodology for accreditation and revision of Health ICT Curriculum
5.2 Incentivize skills uptake
3.3 Data Collection and Registries
5.3 Skills accreditation and curriculum review
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.
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.
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
DRAFT
Capacity built for ensuring standards and interoperability
Standards for Health ICT and health information exchange defined and established
3.1 Established Standards
3.2 Standards capacity building
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
Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives
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
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 // OCTOBER 2015 DRAFT FOR REVIEW
3.0 Standards and Interoperability
Component
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
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
Capacity built for ensuring standards and interoperability
3.1 Established Standards
3.2 Standards capacity building 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
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
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,
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
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,
Standardized registries, instruments (data collection forms, reports etc.) and indicators
3.3 Data Collection and Registries
Building on existing standards and requirements for some foundational Health ICT services
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.
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
DRAFT
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
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, FMCT 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 // OCTOBER 2015 DRAFT FOR REVIEW | 49 Capacity of stakeholders built as Output Description appropriate, to understand, define, review, apply and manage standards in Health DICT initiatives Output escription
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 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 of Health ICT skills skills and and sipread 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
6.1 Expanded Coverage
6.1 Expanded Coverage
6.0 Infrastructure
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)
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
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
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 purpose’ priority health-‐care nd the 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
DRAFT 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
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
6.0 Infrastructure
3.0 Standards and Interoperability
Component
Component
Component
2.3 Investment
Investment management to enable proper allocation of Health ICT investment funding to priority projects
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, NBTE, 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 // OCTOBER 2015 DRAFT FOR REVIEW 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
Standards for Health ICT and health information exchange defined and established
3.1 Established Standards
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
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
7.1 Prioritize Services and Applications
7.0 Solutions (Services and Applications)
Minimum infrastructural requirements for e-‐health implementation defined
6.3 Define Minimum Infrastructural Requirements
Core set of appropriate Health ICT services and Applications prioritized and deployed
Output (Recommendation)
Standardized registries, instruments (data collection forms, reports etc.) and indicators
3.3 Data Collection and Registries
Output Title
Existing Infrastructure for Health ICT identified and assessed
Capacity built for ensuring standards and interoperability
6.2 Identify and assess existing infrastructure
3.2 Standards capacity building
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 infrastructure Health ICT services Others are Power, Connectivity and Equipment
Capacity of stakeholders built as appropriate, to understand, define, review, apply and manage standards in Health ICT initiatives
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
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
DRAFT
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
3.0 Standards and Interoperability
Component
2.3 Investment
A. Investment management structure
and revenues from Health ICT 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 // OCTOBER 2015 DRAFT FOR REVIEW | 51
7.1 Prioritize Services and Applications
7.0 Solutions (Services and Applications)
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
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
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
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
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
DRAFT
7.2 Share Best Practices
Output Title
Component
This will give the general public some comfort that the healthcare facilities they attend has met certain Health ICT standards/ conditions/ requirements.
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 // OCTOBER 2015 DRAFT FOR REVIEW
Enabling and sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
Intermediate Outcome Numerator
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
1.3-‐Broad stakeholder engagement achieved 1.4-‐ National Health ICT Framework integrated and linked with National Health Act and
PMO
N/A
36 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
36 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
National Health ICT Steering Committee (Y/N) National Health ICT TWG/committee (Y/N) National Health ICT project management office (PMO) (Y/N) Percentage (%) of meetings held by the National TWG in a year (with outputs and resolutions) State Health ICT TWGs established (Y/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
1.2-‐ State Government engaged
TWGs -‐ National and State, FMOH FMOH, PMO
Responsi bility
Nation al, State
Scope
2015 Base line
Policy document review
Yearly
Quarterly
Quarterly
Quarterly
PMO
State PMO, SMOH, FMOH PMO
State PMO, SMOH, FMOH
Nation al
Nation al/Stat e
State
State
Nation al
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
Bi-‐Annual
Frequency of Data
N/A
Reports of meetings
Data Collection Method
TBD
PMO
Data Sources
N/A
No. of planned meeting for within reporting period
Denominator
Indicator Definition
DRAFT
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 Yes/No (Y/N)
Indicator
1.1-‐ National Health ICT governance structure established
1.0-‐ Established sustainable governance structure
Proximal Outcome/Output
Health ICT Enablers
HEALTH ICT M&E FRAMEWORK
APPENDIX Appendix 66: : Health ICT M&E Framework
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
2020 Targ et
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW | 53
Enabling and sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
Intermediate Outcome
2.1-‐ Funding for Health ICT operations secured
3.1-‐ Standards for
3.0-‐ Standards and Interoperability
2.2-‐ Incentives 1.3-‐Broad mechanism stakeholder established engagement achieved 1.4-‐ National Health ICT Framework integrated and 2.3-‐Investment linked with National management plan Health Act and established
1.2-‐ State Government engaged
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 (Y/N) adopted eandorsed nd enacted Yes/No (Y/N) National Health ICT framework reviewed after 5 (Y/N) National years Health ICT Steering Resources committed Committee (Y/N) to Health ICT implementation National Health ICT and scale-‐up from partners, TWG/committee (Y/N) donors aHnd other National ealth ICT sptake-‐ roject holders (financial and (iPMO) n-‐kind management office contributions) (Y/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 (Y/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 % % of osf tatutory budget state strategy, plan aICT nd released for Health budget
Indicator
Health ICT
Numerator
PMO PMO
N/A
FMOH’s PMO annual report PMO
Data Sources
N/A
N/A
N/A N/A
N/A
Denominator
Indicator Definition
Report of review
Report oof f Reports review meetings
Data Collection Method
TBD
5 yearly
One-‐off Bi-‐Annual
Frequency of Data
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 (Y/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 (Y/N)
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
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 36 States of Nigeria ICT functional hTealth WGs Statutory Statutory health budget allocated for budget Health ICT No. of states with 36 States of hN igeria Statutory health Statutory 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
N/A
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
Audit report State PMO Fund raised
Budget PMO document
PMO
TBD
TBD
TBD
PMO
FMOH
FMOH
FMOH
TBD
TBD
PMO
FMOH
State FMOH PMO, SMOH, FMOH FMOH PMO
State FMOH PMO, SMOH, FMOH FMOH
FMOH
FMOH
FMOH -‐ TWGs DPRS National and FMOH State, FMOH FMOH, PMO
Responsi bility
Yearly
TBD
TBD Quarterly
Quarterly TBD
TBD
Quarterly TBD
TBD
DRAFT
1.1-‐ National Health 2.0-‐ Increased Funding for ICT governance Health IeCT structure stablished
1.5-‐National Health ICT Framework developed, endorsed and periodically reviewed
1.0-‐ Established NSHDP and others sustainable governance structure
Proximal Outcome/Output
Health ICT Enablers
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 Base line
54 | NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW
Enabling and sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
Intermediate Outcome
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 (Y/N) adopted and enacted Standards for Health Yes/No (Y/N) ICT and health information exchange disseminated (Y/N) % of defined Health and National Health ICT SICT teering Committee (Y/N) HIE disseminated National Health ICT (Y/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 (Y/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 (Y/N) interoperability other key % of states in Nto igeria with stakeholders functional state level TWGs (functional -‐defined a meeting per quarter) % % oof 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 (Y/N) National fund coordinating Indicator mechanism established (Y/N)
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 36 States of Nigeria and interoperability functional TWGs to other key stakeholders No. oof f srtates egistries, Total o. of orf egistries, No. with 36 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
N/A
N/A
TWG/PMO PMO reports PMO TWG/PMO reports PMO
TWG/PMO reports TBD
Reports of meetings TBD
TBD
TBD
Bi-‐Annual
TBD
TBD
N/A
TBD Frequency of TBD Data
TBD
TBD
TWG/PMO reports PMO
reports
TWG/PMO Data reports Collection TWG/PMO Method reports
TWG/PMO reports
N/A
Denominator
Total no. of states in Nigeria
TWG/PMO Data reports Sources TWG/PMO
N/A Indicator Definition No. of states with established state fund coordinating Numerator mechanisms
TWG/PMO reports
N/A
Health Act and 4.1-‐ Legislation, policy and compliance supported by National Health ICT PMO 5.0-‐ Change and Adoption (Capacity Building)
1. No. of consumers, care providers and health-‐care managers reached with Health
1. No. of consumers, care providers and health-‐care managers using
1. % of consumers, care providers and health-‐care managers using Health ICT solutions/innovations
compliance supported by National Health ICT PMO (Y/N)
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
documents Health ICT policy changes released/reviewed in the adopted and eynacted (Y/N) preceding ear with subsections f or H ealth ICT Legislation, policy and
Health ICT Standards advocated for p(Y/N) % of national olicy
% of identified key stakeholder groups engaged
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
TWG/PMO reports
PMO
Periodic Review
document review
Monthly Reports Policy
Registries of instruments and standardized instruments
Training registers + Registered targets
Training registers + Registered targets
Bi-‐Annual
Yearly
Monthly
Quarterly
Bi-‐Annual Quarterly
Quarterly Quarterly
Quarterly
DRAFT
engagement 3.4-‐ achieved Health ICT Standards 1.4-‐ National Health advocated for ICT Framework 4.0-‐ Legislation, Policy and integrated and Compliance linked with National
3.3-‐Registries, instruments (data collection forms, reports etc.) and indicators, 1.3-‐Broad standardized stakeholder
1.2-‐ State Government engaged
1.1-‐ National Health ICT governance structure established 3.2-‐ Capacity built for ensuring standards and interoperability
1.0-‐ Established 3.0-‐ Standards and sustainable governance Interoperability structure 3.1-‐ Standards for Health ICT and health information exchange defined and established
Proximal Outcome/Output
2.3-‐Investment Health ICT Enablers management plan established
PMO
PMO
FMOH
SMOH, FMOH PMO
FMOH/P State MO PMO,
PMO State PMO, SMOH, FMOH
PMO
TWGs -‐ National PMO and State, FMOH PMO FMOH, PMO
PMO
FMOH Responsi bility FMOH
FMOH
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
TBD
TBD
TBD 2020 Targ TBD et
TBD
TBD
TBD
TBD
TBD
TBD
TBD 2015 Base TBD line
TBD
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW | 55
Enabling and sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
Intermediate Outcome
National Health ICT Steering Committee (Y/N) National Health ICT TWG/committee (Y/N) National Health ICT project management office (PMO) (Y/N) 1. Health (I%) CT oreadiness Percentage f meetings assessment completed (Y/N) held by the N ational TWG in Health ICT readiness a 2. year (with outputs and system resolutions) established (Y/N) State Health ICT TWGs 1. No of incentive established (Y/N) eveloped % mechanisms 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 (Y/N) stakeholder groups engaged
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 Yes/No (Y/N) solutions/innovations
Legislation, policy and Indicator compliance supported by National Health ICT PMO (Y/N) Denominator
Periodic Data Review Collection Method
Reports
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
Numerator
N/A Indicator Definition
TWG/PMO Data reports Sources
TWG/PMO reports
Health ICT policy changes adopted and enacted (Y/N)
N/A
reports
advocated for (Y/N)
Annually
Bi-‐Annual
Bi-‐Annual Frequency of Data
5.1-‐ System for Health ICT readiness, M&E and adoption of best practices established 1.2-‐ State 5.2-‐ Incentive Government mechanisms engaged to encourage uptake of Health ICT skills and competencies established 5.3-‐ Methodology for accreditation and revision of Health ICT training 1.3-‐Broad curriculum stakeholder established engagement 5.4-‐ Pachieved lan for Health ICT N awareness and 1.4-‐ ational Health stakeholder ICT Framework engagement integrated and established linked with National 5.5-‐ Health CT Health Act aInd education and training programs established 6.0-‐ Infrastructure 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
Plan for Health ICT awareness and s% takeholder engagement of national policy established(Y/N) documents released/reviewed in the preceding year with No of Health fIor CT Heealth ducation subsections ICT programs established
FMCT
FMCT Annual Surveys/TB D
documents released/re viewed Workforce TWG
National/St ate PMO
No. of stakeholder groups represented at meetings
Workforce TWG Policy
State PMO Workforce TWG
No. of states with 36 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 36 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
TBD
Quarterly
Periodic Review
TBD
Bi-‐Annual Yearly
Quarterly
Quarterly Annually
Quarterly Bi-‐Annual
Periodic Review Policy document review
Periodic Review
Periodic Review
Periodic Review
DRAFT
1.1-‐ National Health ICT governance structure established
4.1-‐ Legislation, policy and Proximal compliance Outcome/Output supported by National Health ICT PMO Established 5.0-‐ C1.0-‐ hange and Adoption sustainable (Capacity gBovernance uilding) structure
Standards advocated for 4.0-‐ Legislation, Policy and Health ICT Enablers Compliance
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 bility
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 Base line
TBD
56 | NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW
6.2-‐ Existing Infrastructure 1.2-‐ State for Health ICT identified Government and assessed engaged 6.3-‐ Minimum infrastructural requirements for Health ICT infrastructure defined 7.0-‐Solutions (Services and Applications) 1.3-‐Broad stakeholder 7.1-‐ Core set of engagement appropriate Health ICT sachieved ervices and 1.4-‐ Applications National Health ICT Framework prioritized and integrated and deployed linked with National Health Act and 7.2-‐ Best practices in development and use of Health ICT documented and disseminated.
Health ICT Outcomesi
1. % of communities/ health National Health ICT Sw teering facilities supplied ith Committee (Y/N) connectivity hardware infrastructure National Health ICT TWG/committee (Y/N) National Health ICT project management office (PMO) % of communities/health (Y/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 (Y/N) % of states in Nigeria with Minimum sitate nfrastructural functional level TWGs requirements Health aI CT (functional f-‐or defined infrastructure defined (Y/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 Yes/No (Y/N)
N/A
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 36 States of Nigeria functional TWGs N/A
Denominator
Indicator Definition
Indicator
No of Health ICT education programs established Numerator
N/A
Plan for Health ICT awareness and stakeholder engagement established(Y/N)
Reports TBD of meetings
PMO FMCT Annual Surveys/TB D FMCT PMO Annual Surveys/TB D PMO
TBD
TBD
Data Collection Periodic Method Review
Periodic Review
FMCT Annual Surveys/TB D
Data Sources Workforce TWG
Workforce TWG
TBD
Bi-‐Annual TBD
TBD
Frequency of Data Quarterly
Bi-‐Annual
% 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. (Y/N)
solution deployed
% of identified key stakeholder groups engaged % of innovative Health ICT
Health ICT solution developed/available No. of national policy documents target population released/reviewed in the preceding year
36 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
Policy document TBD review
TBD
TBD
TBD
TBD
TBD
TBD
Yearly TBD
TBD
Quarterly
Quarterly
TBD Quarterly
TBD
TBD
TBD
Policy documents TBD released/re viewed
National/St ate PMO TBD
FMCT Annual PMO Surveys/TB D FMCT Annual Surveys/TB D PMO State FMCT Annual Surveys/TB D PMO State
PMO
PMO
FMCT/F MOH
PMO FMCT/F MOH
FMCT/F MOH
State PMO, SMOH, FMOH PMO
FMCT State PMO, SMOH, FMOH FMCT
FMCT
TWGs FMCT -‐ National and State, FMOH FMCT FMOH, PMO
FMCT
Responsi bility PMO
DRAFT
6.1-‐Connectivity 1.1-‐ National Health coverage expanded ICT and geovernance nhanced structure established
established 5.4-‐ Plan for Health Health ICT Enablers ICT awareness and stakeholder engagement Intermediate established Outcome Proximal 5.5-‐ Health ICT Outcome/Output education and training programs established 1.0-‐ Established 6.0-‐ Infrastructure sustainable governance Enabling and structure sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
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
TBD TBD
TBD
TBD
TBD TBD
TBD TBD
TBD
TBD
2020 Targ TBD et
TBD
TBD TBD
TBD
TBD
2015 Base TBD line
TBD
Nation al
Nation al
Nation Nation al al
Nation al, al State
Nation al
Nation al
Scope
Nation al
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW | 57
i
No. of health encounters resolved or supported through telemedicine No. of health workers trained using ICT
% of health facilities providing telemedicine services
% of health encounters resolved or supported through telemedicine
1.1-‐ Effective use of telemedicine
No. of health workers by cadre
No. of health workers by cadre
No. or health facilities identified as potential telemedicine centers No. of health encounters
Denominator
Telemedici ne platforms/ NHMIS HRIS
NHMIS-‐ facility registry
Data sources
Existing/ new electronic systems
Data collection method
Quarterly
Quarterly
Frequency of Data
% health workers by cadre registered in HRIS
% of health facilities reporting into NHMIS (public and private)
2.3-‐Effective use of human resource information system (HRIS) for distribution of health workers Effective use of NHMIS for health system planning
National Service Delivery Indicators % 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-‐ Effective use of pregnancy registry for maternal health
Effective use of LMIS for tracking supply and demand for commodities 3.0-‐ Increased uptake of health services 3.1-‐ Effective use of
No. of health workers registered in HRIS
% children born registered in birth registry system
2.1-‐ Effective use of CRVS for child health
No. of pregnant
No. of pregnant women registered in pregnancy registry
No. of children registered in birth registry
National indicator for coverage of health services
workers supervised using ICT tools by cadre
ICT for health worker supervision and support 2.0-‐ Improved coverage of health services
supervised using ICT tools
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
DRAFT
% of health workers trained using ICT
No. of health facilities delivering telemedicine services
National indicator for access to health services
1.0-‐ Improved access to health services
Numerator
Indicator definition
Indicator
1.2-‐ Effective use of ICT for health worker training
No. of health workers trained using ICT
HRIS
Quarterly
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
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
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 bility
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 Base 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
Proximal Outcome/Output
i
1.2-‐ Effective use of ICT for health worker
1.3-‐Effective use of % otf o haealth workers being No. of health No. oof f hH ealth workers HRIS Quarterly Where possible and appropriate impact evaluations ssess the effectiveness, efficacy, and cost-‐utility ealth ICT implementations will be conducted.
By 2020, Health ICT will help enable and deliver universal health coverage
Health Impact
Health ICT Outcomesi
disseminated. Na S
58 | NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW
% of identified key % of citizens egnrolled n NHIS stakeholder roups eingaged system
6.0-‐ Increased equity in access to and quality of health services, information, and financing
ICT for non-‐ Insurance-‐related financial transactions
mCCT/ Other PMO sources TBD PMO
Existing/ new electronic systems
Quarterly
Bi-‐Annual
Quarterly
National health equity indicators
of mobile money or electronic payments for health workers, etc.
% % of 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
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
36 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 36 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
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
PMO
Existing/ new electronic systems
Policy new Existing/ document electronic review systems
Existing/ new electronic systems
Existing/ new electronic systems
Existing/ new electronic systems
Quarterly
Yearly Quarterly
Quarterly Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
DRAFT
1.3-‐Broad 5.1-‐ Estakeholder ffective use of ICT for NHIS engagement achieved 1.4-‐ National Health ICT Framework integrated and linked with National Act uase nd 5.2-‐ Health Effective of
5.0-‐ Increased financial coverage for health care
1.2-‐ State Government Effective use of ICT engaged within the continuum of care (incl. referrals)
Effective use of ICT for decision support
4.0-‐ Improved quality of care
% of citizens accessing health services through mobile National Health ICT Steering conditional cash transfer Committee (Y/N) programs National Health ICT TWG/committee (Y/N) National uality of pcroject are National Hqealth ICT management office (PMO) indicators (Y/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 (Y/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 National financial pclan overage budget for health care indicators
Existing/ new electronic systems Reports of meetings
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
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
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
2015 Base TBD line
TBD
TBD
MAMA/ Other sources PMO TBD
Nation al/ State
Nation al/ State Scope
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
Responsi bility FMOH/ SMOH
FMOH/S MOH
TBD
Frequency of Data Quarterly
Quarterly
N/A
Data Sources eLMIS
Existing/ new electronic systems Data Collection Existing/ new Method electronic systems
Number of HDealth ICT National (No.) Service elivery initiatives led by key Indicators 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 Yes/No (Y/N)
% of facilities with eLMIS reporting no stock outs
DHIS2
No. of health No. of health facilities facilities reporting (public and private) into NHMIS (public Indicator Definition and private) No. of facilities with No. of facilities with eLMIS reporting no eLMIS stock outs Numerator Denominator
% of health facilities reporting into NHMIS (public and private) Indicator
3.2-‐ Effective use of mobile conditional 1.1-‐ Ntational cash ransfer Hfealth or ICT governance demand creation structure established
distribution of health workers Health ICT Enablers Effective use of NHMIS for health system planning Intermediate Outcome Proximal Effective use of LMIS Outcome/Output for tracking supply and demand for commodities 1.0-‐ Established 3.0-‐ Increased uptake of sustainable governance Enabling and health services sustainable 3.1-‐ structure Effective use of environment for mobile messaging implementation for demand creation and scale-‐up of for RMNCH Health ICT in Nigeria
NATIONAL HEALTH ICT STRATEGIC FRAMEWORK 2015–2020 // OCTOBER 2015 DRAFT FOR REVIEW | 59
Enabling and sustainable environment for implementation and scale-‐up of Health ICT in Nigeria
Intermediate Outcome
6.2-‐ Effective use of ICT for delivering appropriate health services for those who need them most based on financial need
1.3-‐Broad stakeholder engagement achieved 1.4-‐ National Health ICT Framework integrated and linked with National Health Act and
1.2-‐ State Government engaged
resolutions) State Health ICT TWGs established (Y/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
Numerator
Denominator
Number (No.) of Health ICT N/A National health equity 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 Yes/No (m Y/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 (Y/N) accessed through ICT National Health ICT N/A services TWG/committee (Y/N) % National of plans H and fund No. of plans and N/A No. of plans and fund 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 (Y/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.
enrollment in NHIS
No. of claims and reimbursements submitted for processing TBD Indicator Definition TBD
system No. of claims and reimbursements processed
PMO
PMO NHMIS/ Other sources TBD
Data TBD Sources
NHIS/ TBD
systems
Existing/ new electronic systems
Reports onf ew Existing/ electronic meetings systems
Data new Existing/ Collection electronic Method systems
Existing/ new electronic systems
Quarterly
Bi-‐Annual Quarterly
Frequency Quarterly of Data
Quarterly
No. of stakeholder groups represented at meetings 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
36 States of Nigeria
No. of states with state strategies, plans and budgets
% of identified key stakeholder groups engaged
36 States of Nigeria
No. of states with functional TWGs
N/A
Policy documents released/re viewed
National/St ate PMO
State PMO
State PMO
NHIS/ PMO Other sources TBD PMO
PMO
Policy document review
Yearly
Quarterly
Quarterly
Quarterly
DRAFT
Established 6.0-‐ 1.0-‐ Increased equity in sustainable governance access to and quality of structure health services, information, and financing 6.1-‐ Effective use of ICT for delivering appropriate health services for those who need them most based n 1.1-‐ National Hoealth epidemiology ICT governance structure established
5.2-‐ Effective use of Proximal ICT for non-‐ Outcome/Output Insurance-‐related financial transactions
Health ICT Enablers
% of claims and reimbursements processed through NHIS platform
Appendix 6: Health ICT M&E Framework
PMO
State PMO, SMOH, FMOH PMO
State PMO, SMOH, FMOH
PMO/ TBD
TWGs -‐ PMO/TB D National and State, FMOH FMOH, PMO
Responsi PMO/ bility TBD
NHIS
State
Nation al
Nation al/Stat e
State
State
Nation al / State
Nation al
Nation Nation al/ al, State State
Scope Nation al/ State
Nation 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 Base 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.
DRAFT
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 // OCTOBER 2015 DRAFT FOR REVIEW
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.
DRAFT
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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