Can technology-based measurement transform the Nigerian Health Sector?


The Nigerian Banking Sector is almost unrecognizable compared to where it was just a few years ago. As a consumer, you can get cash from almost any ATM in Nigeria, transact business in any bank, pay for goods by mobile phone, and confirm transactions in seconds. You have access to statements 24/7, at least as long as there is connectivity. In addition to increasing the ease of transactions, the other major impact of these changes has been increased accountability and transparency, not just for the banks but for every individual or firm using bank services.

In contrast, our public sector hospitals these days seem to be constantly shut as one of several groups of health professionals is almost always on strike. While we may guess, we really do not know the impact this has on the Nigerian Health Sector. It is almost impossible to get data on how many surgeries surgeons actually carry out in our teaching hospitals or how many deliveries the midwives have performed in a month. What if we knew how many contact-hours medical students had with patients before being released to the world with that god-like title of “Doctor”? Would it make a difference to the perception we have of our apparently great healthcare institutions if we actually knew what they were “producing” per naira of funds allocated? As budgets tighten for our governments, these questions will get even louder because healthcare is an expensive business. The biggest irony of all salary negotiations with health sector professionals in Nigeria is that they take place in the absence of any data on productivity.

I have been reading about one of the greatest technology personalities of our time, more so since his interest in the health sector has grown; Bill Gates. One philosophy of his that has stuck with me is his reputed obsession for measurement. In his annual letter in 2013, Gates makes the case for how measurement has driven some of the biggest recent public health successes of this era. There is no doubt that improved data collection and sharing in Nigeria has been critical to the recent progress on polio in Nigeria.

Increasing accountability, efficiency and profitability in the health sector is not possible without the tools for measurement. Technology, especially mobile, has the power to transform the delivery of healthcare services and improve compliance, accountability and care. Driven by some of the fastest mobile subscriber growth in the world, cheaper mobile devices, and continued innovation, emerging mobile health solutions are already saving lives – an estimated 1 million of them by 2017, according to a recent report by PricewaterhouseCoopers.

Despite the growing interest in Mobile Health (mHealth) initiatives globally, adoption rates of mobile solutions has been slow in Nigeria. An emerging opportunity exists for healthcare providers to adopt mobile technology to not only to improve the effectiveness of healthcare delivery but to also measure and demonstrate results.

While the sector is eager for mHealth solutions, most care providers in Nigeria still lack the required infrastructure to support widespread deployment of apps that might integrate personal medical information. Healthcare organisations will need to start from the basics, e.g. the deployment of Electronic Medical Records (EMR) systems, from which relevant data can be extracted and integrated into mobile health apps. When you consider that one of the major hospital groups in Nigeria, Lagoon hospitals only announced a full adoption of electronic medical records in 2013, it demonstrates how far the distance still is. Most medical records of patients in Nigeria are stored in folders as shown below.

Paper Records at a Nigerian Hospital
Paper Records at a Nigerian Hospital

One firm that is making progress in this space is Sabaoth Technologies Ltd, an all-purpose medical information systems firm, which is currently providing hospital information management systems to the Delta State University Teaching Hospital, Oghara and University College Hospital Ibadan in the public sector as well as several private hospitals.

There are other firms now making inroads into the health space. If you have not heard about the IT and logistics platform Integrahealth, note the name. Their flagship product ‘DrugStock’ enables the purchase of good quality drugs, managing the supply chain, payments, and capacity building for medium size hospitals mostly in Lagos, Nigeria. The co-founder Chibuzor Opara was at the World Economic Forum this year speaking about their dream of increasing efficiency of hospitals in Nigeria and beyond.

Early in 2015, the Private Sector Health Alliance hosted “The Health Innovation Challenge;” a multi-stage competition to recognise, reward and celebrate innovations that show potential to improve health in Nigeria. Several innovative firms and ideas competed for the challenge and some of these ideas will grow to dominate the sector in their niches in a few years.

There are also several examples from outside our shores. In Zambia, the government partnered with IBM to deploy a mobile program aimed at better managing the inventory and delivery of 200 life-saving prescription drugs. Staff members from three local health facilities are now using mobile devices with barcode scanners to record stock and generate real-time views of supplies. The solution also allows workers to transfer supplies and identify trends, thereby preventing gaps in the medical supply chain and ensuring that citizens have access to the medications they need.

Whether it is in the public or private sectors, demands for data and information for multiple purposes, including performance improvement, accountability, and stakeholder decision making, are likely to increase in the future.  At the same time, there is a growing tech community with technology startups, developers and a fast-moving technology ecosystem which has been dubbed Silicon Lagoon.

The reason we are not measuring enough in the public sector is not because we lack the tools or the technology. It is also not for a lack of need or demand, but mostly it is because it’s convenient for many not to measure, so that we do not know. Ignorance, for them, is bliss…

If we want to transform our health sector, we must begin to measure performance. We may be shocked by what we find.


P/s: If you know of  projects, initiatives, ideas using technology innovatively in our health sector please share with us on twitter @nighealthwatch

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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