National Health ICT Strategic Framework 2015 - 2020

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National Health ICT Strategic Framework 2015 - 2020

DRAFT // OCTOBER 2015 DRAFT FOR REVIEW

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Table of Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Acronyms and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Important Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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List of Figures and Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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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

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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.

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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

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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.

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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)

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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

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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.

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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

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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

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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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