I understand that Professor Montefiore passed on only about a month ago. I join you all in commiserating with his family, friends, colleagues and students on this fresh loss and hope that the honour we give to him as well as to his late, learned colleagues will give them strength.
These dedicated professionals, as well as the late Professor Oladele Ajose, the late Chief Adeola Odutola and the late Chief Nathaniel Olabiyi Idowu who are also to be honoured today, showed consistently bold, innovative thinking as well as extremely keen intellects and above all, a desire and an ability to uplift the society in which they found themselves.
The honour that this august body chose to give to them all should be a source of great pride to their families, former colleagues and students as well as the establishments they left behind.
Introduction
Prof Olaopa, the Executive Secretary of AIM gave me some latitude to select a topic of my choosing as long as it could sensibly link information and commmunication technologies to health systems and health care delivery. So looking at the state of our health systems today, Nigeria's position on the human development index and the far reaching impact of ICTs on a nation's socio economic development the topic that I have chosen and which I will speak to for the next 30 minutes or so will be simply "The role of information and communication technologies in health system delivery."
Context: The Nigerian Health Care System
Let me set the context for this lecture by briefly describing the state of health systems in sub-saharan Africa and Nigeria in particular - a context that many of you in this room are already familiar with.
Sub-Saharan Africa carries a disproportionate share of global diseases. According to World Health Organization (WHO) estimates, the region has 11 per cent of the world's population but carries approximately 24 per cent of global diseases. This situation is reflected in high maternal and infant mortality as well as low life expectancy indices. Nigeria's Human Development Index rating of 0.471 currently ranks us 153rd in the world . To put this in context, Ghana's rating of 0.558 ranks them 135th in the world, South Africa's rating is 0.629 putting them at 121 and Mauritius' is 0.737 putting then at 80th.
The ability of many sub-saharan African countries to improve their rating and ranking on the Human Development Index, especially those that relate to health are constrained by several socio-economic and infrastructural factors.
For example, Nigeria's per capita spending on health is currently $161, comparing unfavorably with the $948 calculated by the WHO as the recommended total global spending on health per person per year. Inherent in this low per capita spend on health is an acute shortage of healthcare workers.
This human resource constraint significantly intensifies the pressure on our health systems in the face of a complex mix of the health needs of our population.
The epidemiological transition theory describes the gradual transition of the health needs of a population. The health professionals in this room are already aware that there are typically three major stages of the epidemiological transition. For those of us that are not health professionals let me quickly describe them:
- The age of Pestilence and Famine: At this stage, the main causes of mortality were wars, epidemics and famines. Approximately 75 per cent of all deaths will be attributed to malnutrition, maternity complications and infectious diseases. In this age, cardiovascular diseases and cancer accounted for less than six percent of the total morbidity.
- The age of Receding Pandemics: At this stage, mortality declines, as there are fewer epidemics. The main causes of death shift from infectious diseases to non-communicable diseases.
- The age of Degenerative and Men-Made Diseases: At this stage, mortality continues to decline. Average life expectancy exceeds 50 years and fertility becomes the crucial factor in population growth. The main causes of mortality would include primarily NCDs such as diabetes mellitus, cancer, cardiovascular disease (CVD) and chronic respiratory disease. NCDs often originate from a mixture of behavioral risk factors, including tobacco use, unhealthy nutrition, physical inactivity, and alcohol usage. Occupational stress can also contribute to the development of physiological, as well as psychological diseases
NCDs are often seen as 'western' diseases, as they are often a result of growing economic prosperity. Currently, more developing countries are confronted with these diseases today, unfortunately in addition to infectious diseases.
Nigeria is currently adjudged to be in transition from "low income" status to being a "medium income" country and has a growing middle class with increasing household demand. However with 31.1 per cent of Nigerians living below the poverty line and a GINI coefficient (a measure of income distribution of a nation's residents) of 48.8 significant income inequality exists amongst its citizens.
Nigeria is a country that is also in another kind of transition - an epediomological transition. Our fragile and strained healthcare systems are struggling to cope with the burden of containing the spread of communicable diseases associated with extreme poverty, as well as the growing incidence of chronic NCDs associated with increasing wealth, social, economical and cultural changes that lead to the increase of health risk factors.
In the light of this fairly grim picture of our health systems what role can ICTS play in the improvement of health care delivery systems?.
Bialobrezeska & Cohen (2003) regarded ICTs as technologies that generally support an individual's ability to manage and communicate information electronically. This definition includes the use of hardware such as computers, printers, scanners, video recorders, television, radio, and digital cameras;. Implicit is the software and applications needed to enable seamless communication, such as the Internet and e-mail.
Around the world, numerous studies have been carried out with regard to the relationship between the efficient deployment of ICTs and socio-economic development and there is broad agreement that a strong correlation exists.
Multiple research efforts specific to Nigeria have also shown that ICT investments can positively impact jobs, productivity, GDP growth, and innovation.
The demonstrated impacts of ICTs include:
- Improvement of national and global commerce through easier and faster creation, distribution, and consumption of information
- Development of ICT workforce with knowledge and skills to export technology to trade partners
- Creation of high skilled, high paying jobs
- Improved international competitiveness
- Stronger, more competitive small and medium businesses
- A "spillover effect", creating opportunities in other industries and last but not least..
- Better quality of life through enhanced education, business practices and health care
A brief synopsis of the evolution of ICTs will shed some light into how ICTs have and will continue to be an important facilitator and even driver of improvements in health care systems especially in developing / emerging economies such as ours.
The evolution of ICTs can be broadly divided into four (4) phases:
-The Mainframe Phase: Mid-1960s to late 1970s
During this phase, a number of computer-aided applications and services were developed which demonstrated the potential of ICTs.
The first IBM 1401 Data Processing system in Middle East & Africa was installed in Nigeria in 1963 at the Nigerian Railway Corporation to process freight, passenger and locomotive data.
But the IBM 1401, iconic as it was, weighed about five tons and had only about 16 kilobytes of memory. [In comparison, a low-end personal computer today has typically 500 Gb of storage and up to two Gb of Random Access Memory (RAM)].
The extremely high costs of direct interaction with the IBM 1401 and other mainframe computers of this era meant that the only practicable applications were based on batch processing. This was definitely a highly skilled task with no direct interaction with the computers; rather jobs were prepared for the computers using off-line equipment like cardpunches. It could take days between job (or batch) preparation and computer output.
The static nature of this process and the associated feedback delays were a key limit to the widespread implementation of such systems leading to the now famous or infamous prediction of Thomas Watson Sr., then Chairman of the IBM Corporation who said "'I think there is a world market for about five computers."
This is a far cry from what we are used to today. Computers, notebooks, tablets, smartphones are quite prevalent, they each have their own operating system and the needed skills to program or 'code' new applications are easily obtained by anyone with a laptop, an internet connection and a willingness to learn.
The Microcomputer phase: Early 1980s to mid-1990s
During this phase, interactive usage was made much more economical. It was also much easier to develop and market limited software packages and as more powerful versions of the personal computer were developed, the result was a substantial growth in the number of computer-aided applications and services, and in the extent of their usage.
By the 1990s it was difficult to find a socially driven application in any developed country, which did not make use of systems based on the then-new microcomputers.
At about this time in 1991 to be precise, the first Nigerian health informatics project was launched as a collaborative research project between the Computing Centre of the University of Kuopio, Finland and Obafemi Awolowo University (OAU) /Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria .
The joint research project produced a very rudimentary hospital information system running on a stand-alone PC. .
The plan then was that by 2001 all the teaching hospitals in Nigeria would have Health Informatics units, which could make use of standardized software. However, cost and rollout issues hindered this plan and various other manifestations of this plan have had limited success to date.
-The World Wide Web Phase: Late 1990s
The precursor to the Internet was laid down in the early days of computing history, in 1969 with the U.S. Defense Department's Advanced Research Projects Agency Network (ARPANET). ARPA-funded researchers were the first to implement the now-ubiquitous Transmission Control Protocol / Internet Protocol (TCP/IP) and created one of the world's first operational packet switching networks.
The Domain Name System was developed in 1983, Cisco shipped their first routers in 1987, the same year that Internet Hosts exceeded 20,000 and Hyper Text Markup Language / HTML was developed in 1990 at the European Organization for Nuclear Research. (CERN).
CERN introduced the World Wide Web to the public in 1991.
The advent of the World Wide Web meant that instead of freestanding systems located in dedicated service centres, websites could be developed which individuals could access instantly from a wide variety of sites, including their homes.
The ease of developing such websites produced a massive increase in their number; the ease of interconnecting them meant that they no longer needed to be viewed as discrete entities. Rather than perceiving ICT solely as a service from external suppliers, governments, NGOs and service providers began to develop their own websites.
-The Digital Phase: 2000 an beyond
Nothing short of a revolution has been taking place in the mobile communications sub-sector of the ICT industry. There are almost 7 billion mobile phone subscriptions globally and 629 Million in Africa. Nigeria has just under 130 Million mobile and fixed wired / wireless active lines, achieving a teledensity of 92.42 per cent in just over 12 years.
Individuals are now able to access the Internet not only through their personal computers but also through their mobile phones. Greatly enhanced bandwidth has enhanced the speed and capacity of the Internet for transmitting video and audio as well as text.
This means that much more can be done over our phones, truly the "democratisation" of Internet access through mobile broadband. Coupled with this, the fall in costs of handsets and devices has driven the growth of a vibrant software applications (apps) development market. There are almost as many health service related apps available today as there are services in conventional Hospitals.
In Nigeria in particular, the astounding pace of growth of mobile phones makes them an invaluable tool for improving health outcomes.
The Role of ICTs in Health Systems Improvements
Across these four phases of the evolution of ICTs, key trends can be observed and used to discern the role of ICTS in improving health care systems.
The first trend is the role of ICTs in improving the accessibility and affordability of health care. A notable case in Nigeria is the Ondo State Abiye Programme - an initiative that gives a practical, inexpensive interface between (i) pregnant mothers and infants up to age five with (ii) health centres or clinics near them and (iii) the Mother and Child Hospital (MCH) in Akure, the State capital.
Key to this solution are Health Rangers (who are specially trained community health extension workers, equipped to take care of pregnant mothers and infants up to age five); ICTs, and various types of transportation that both mothers and health rangers have access to (motorbikes, tricycles and ambulances) that allow for 24 hour health services.
When a pregnant woman registers at a clinic in Ondo State, she is immediately attached to a team of medical personnel and from this point onwards, is closely monitored. She is given a mobile phone pre-loaded with credit (funded by the State Government), which allows her to seek and receive accurate and regular medical attention/advice irrespective of where she lives. Health Rangers are also provided with mobile phones, again loaded with credit by the State government.
In parallel to this basic first step, primary health centres, staffed by trained medical professionals, are also provided and equipped in villages and remote towns. These centres receive regular supplies of consumables and drugs needed by the targeted demographic, expectant mothers and mothers of children under five years of age.
Comprehensive health centres were also established in major towns to handle serious cases; whilst the Mother and Child Hospital (MCH) is equipped to deal with complicated cases. Services at the MCH, including surgeries, are provided free of charge to pregnant women, mothers, and children up to the age of five.
The Abiye programme is regarded as a huge success; by mid-2011, 15 months into the programme, over 26,000 patients had been treated and 6,000 babies had been safely delivered, 905 by caesarean sections.
These performance figures are noteworthy for a State that was ranked by the World Bank in 2008 as having the highest maternal mortality rate in South West Nigeria.
Yet another application of ICTs that is having far reaching impact on access to and affordability of medical expertise is in the field of Telemedicine. Telemedicine tools enable the communication and sharing of medical information in electronic form, and thus facilitate access to remote expertise. A physician located far from a reference center can consult his colleagues remotely in order to solve a difficult case. These same tools can also be used to facilitate exchanges between centers of medical expertise, at a national or international level.
For example, a successful pilot was carried out in Senegal, Dakar in 2011 linking the University Hospital of Dakar-Fann with the Regional Hospital in Dioubel, Senegal. The transmission of medical images as well as patient data records and other medical information was made possible by a customized network using a "store and forward" method.
Once digitized, images from radiographs, extracts of patient records and voice messages are compressed, encrypted and stored in one file that is sent through a high speed network. Tele-radiology, tele-dermatology and tele-consultation were the main applications used during the pilot.
This and several other telemedicine-based pilots have determined that the main draw back to be addressed before this valuable tool can be deployed in a cost effective manner would be for improved national broadband networks to be rolled out, particularly in the rural areas where the remote consultations, diagnoses and education are most sorely needed.
Secondly, ICTs can improve on the quality of health care through the provision of relevant information to support diagnosis and treatment. Several start up companies are achieving notable success in bringing remote diagnosis and case management to remote areas of Nigeria by using data gathered through mobile phones and "data collection centres" manned with little more than a tablet PC and a SIM card.
Royal Philip, the Dutch based equipment manufacturer recently introduced VISIQ in Nigeria. VISIQ is a tablet based ultra mobile ultra sound system that provides high quality images for expectant mothers wherever care is taking place. Critical conditions in expectant mothers can be detected early ensuring that preventable complications during childbirth are avoided with positive outcomes on child and maternal mortality. The portability and ease of use of this device means that it is available for expectant mothers in remote areas who wouldn't otherwise have access to this kind of innovative technology. Interestingly the headline of this article in the Vanguard newspaper read - "Solution to Africa's mortality lies in modern day technology." I couldn't agree more.
Another good example of how modern day technology can save lives in Africa is seem in Rwanda. In response to a cholera outbreak between 2006 and 2008, an unusual source was tapped by an ongoing Harvard School of Public Health (HSPH) project to develop a simple model for predicting cholera outbreaks: cellphone data. The model was predicated on the hypothesis that a telltale sign of an outbreak could be found by tracking people's locations through their mobile phones. For instance, if the movements of 100 people within a 10-mile radius suddenly slow, the cause might be illness; and a looming epidemic.
The Save One Million Lives Initiative (SOML) launched by President Goodluck Jonathan in October 2012 is another example of how ICTs can improve both access to and the quality of health services. SOML has the objective of scaling up access to essential primary health services and commodities for Nigerian women and children. ICTs are a key part of Saving One Million Lives; from the development and implementation of information systems amongst healthcare providers and administrators, to the use of mobile phones in providing information and health services that improve the quality of life of Nigerians.
Thirdly, ICTs can inform and aid citizens to have healthy lifestyles and reduce the incidences of NCDs. Software apps on mobile phones, linked to bracelets that monitor vital signs can now be programmed to send alerts once measurements exceed pre-set figures.
Simpler solutions based on text message sent by patient to a local number also after self monitoring sugar levels, blood pressure or other easily measured vital signs exist and are just as effective
Fourthly, ICTs can support capacity building of healthcare workers/professionals and deliver important improvements in their productivity. Healthcare pofessionals can follow a continuing education course over the Internet or access medical information from digital libraries. Medical students and health workers can watch and learn from complex surgeries streamed live or stored in Cloud-based services for further review by health workers in rural areas. A lecturer/expert or specialist resident in one college of medicine can teach several classes of students through teleconferencing or live streaming.
It is extremely gratifying to note the emphasis on the use of ICTs in the National Strategic Health Development Plan (NSHDP 2010-2015) launched in December 2010 by Mr President. This document essentially acts as the roadmap for Mr. President's Transformation Agenda in the Health Sector and has one of its priority areas involving the planning, development and rollout of a National Health Management Information System (NHMIS).
The NHMIS has undergone considerable overhaul since it's early establishment in the 1990s. It was re-positioned in 2004 to keep track of the Millennium Development Goals (MDGs) and was recently upgraded to a web-based platform that allows real time data entry and much more flexible access.
Having now appreciated the role of ICTs in health systems improvement and In the light of the inadequacy of our health care systems to deliver health services to a large very diverse it should be easy to understand the priorities of the Ministry of Communication Technology described in terms of current efforts to: Connect Nigeria; Achieving ubiquitous, efficient, cost-effective broadband Internet access services; Connect Nigerians; Ensuring cost-effective access to infrastructure and bringing down barriers to device ownership; Develop Local Content; Ensuring Local Value-Added to the growing ICT industry in Software, Hardware and Telecoms sub sectors; Develop efficient E-Government systems; Ensuring Transparency, Efficiency, Productivity in Governance & Citizen Engagement through the efficient deployment of ICTs.
In spite of the success of the Telecoms revolution in Nigeria, (there are now about 130 Million active SIM cards in Nigeria), and with over 40 million Nigerian accessing the internet on a regular basis only about 50 per cent of rural areas have sufficient mobile coverage to enable any sort of connectivity.
Our National Broadband Strategy and Roadmap articulates how we intend to increase broadband penetration from six per cent to 30 per cent by 2018. Judicious implementation of this plan should result in wireless broadband coverage to 80 per cent of the population, fixed broadband to 10 per cent of the population - broadband being defined as download speeds of a minimum of 1.5Mbs per second by 2018. Our collaborative efforts to bring the needed finance, technology and skills to rollout a truly nationwide broadband infrastructure will facilitate the delivery of social as well as commercial services to all Nigerians.
The Universal Service Provision Fund, on behalf of the Ministry of Communication Technology been providing incentives to the mobile telephone company operators to improve coverage in areas that are currently un-served and underserved.
This has been done by identifying clusters of potential users of ICTs in the rural areas (farmers have been the drivers so far with the Federal Ministry of Agriculture's e-wallet programme) and using these clusters as proxies for the demand for health care, education and e-government services that will be latent with any such group.
Johnson is the Minister of Communications Technology. She delivered this paper at the 12th Archives of Ibadan Medicine Inc. Public Honours Lecture.
This has been successful so far in confirming the demand side dynamics for key members of the supply chain, the mobile telephone company operators. Geographic Information System (GIS) maps will shortly be published so mapping information for these clusters can be easily displayed, thus making it easy for Health, Education, E-Government service providers to scale and roll out their respective ICT service delivery projects.
The Nigerian Research & Education Network (NgREN), hosted in the National Universities Commission, with significant financial support from the USPF and commissioned earlier this month by Mr. President provides high speed data connectivity between all Federal Universities and Medical Schools in Nigeria (the University of Ibadan and the College of Medicine included) and research establishments worldwide. This ensures that the kind of connectivity that supports teaching and research is available to Nigeria's tertiary institutes and also provides the basis for telemedicine initiatives.
The Ministry has also embarked on a campaign to increase digital awareness and literacy amongst the population. The campaign is aimed at increasing familiarity with ICTs and helping foster confidence in ICTs as a primary mode of access for basic government to citizen engagement. This is key in ensuring citizen's confidence in storing and accessing sensitive personal information online and routinely having health care professionals access and handle this data online on their behalf.
An executive Cyber Crime bill is currently being considered by the National Assembly and once passed, will help to improve confidence that appropriate sanctions will be carried out against any who use ICTs to commit any crimes whether financial or identity related crimes using the confidential data of Nigerian citizens.
Meeting the connectivity challenge and ensuring that citizens are attracted to the internet and have confidence in living a 'digital life" is one thing but we must ensure that there is useful content on the internet ie products and services delivered over the communications infrastructure are accessible, relevant and affordable. This is where the ideation and innovation ecosystem come in.
We have found that often when people have good ideas for a technology product or service they do not have the resources to build prototypes, nor the business acumen to sell their innovations.
In the past year, we have launched two incubation centres where people can develop and test their ideas and get the support that they need to turn these ideas into a commercial success. The two centres - known as "Information Technology Developers Entrepreneurship Accelerator" (iDEA) - are located in Lagos (Yaba) and Cross River (Tinapa) States.
Innovators that have a marketable product or service also need funding to kick-start their venture. We found that young people and their businesses struggle to raise the capital they need particularly from traditional, conventional sources of funds. Interest rates are prohibitively high and those looking for capital often do not have the collateral that financial providers demand for.
Learning from the successes of countries such as the US, Israel, India, Ireland that have built globally recognised ICT sectors, Nigeria has created the first Venture Capital (VC) Fund, in which the Federal Government is a seed funder, that focuses specifically on the ICT sector - and in particular software development.
The Ministry of Communication Technology has also provided a platform through which competent software developers get to meet and develop products for major Nigerian and International companies. Known as Tech Launch Pad this initiative matches key players in pre-defined industry sectors (and the specific problems they are trying to solve) with local software companies. The first edition of the initiative focused on the Oil and Gas and Financial Services industry and resulted in the selection of 10 finalists who are have spent time in the Lagos iDEA Hub, fine-tuning their software products with mentorship and advice from the iDEA Hub and their future customers.
In a major affirmation that we are doing something right, one of these companies received $10 Million in VC funding from a major local VC fund, Synergy Capital at graduation in March this year.
Importantly our second edition is focussed on the Health Sector. The Open Data Day Health Hackathon organized in February in conjunction with World Bank, the Private Sector Health
Alliance of Nigeria and other partners witnessed the participation of local software developers, tech startups working on health datasets from the National Primary Health Care Development Agency to develop innovative solutions.
The winner of the hackathon was a startup, iQube Labs, who demonstrated a mobile health solution to address supply chain challenges for emergent and critical health commodities like blood and vital organs. The solution incorporated with Global Information Systems (GIS), mobile long code and crowd sourcing layers to provide real-time information on nearest organ or blood bank location and time to delivery.
The first runner-up, Health Central showcased an integrated predictive health service delivery software on multi-channel solution (i.e. mobile and web). The solution allows people to make an informed decision about which health care centre to use for health services. The second runner-up, Health IT, provided a location and information-based solution on health infrastructure and human resources for health mapping to empower patients to locate health services in time of need.
We are taking a bet on these three companies and the young Nigerians that own them by accomodating them in the IDEA incubation centre in Yaba to fully develop these health applications. They have received some form of grant funding to assist them complete the product development and take their products to market.
Conclusion
I would like to conclude this lecture by describing yet another opportunity for collaboration between the private sector, public sector and academia that could offer even greater impact to the Health sector. IBM) has recently approached the Ministry of Communication Technology with a request to carry out a "Personalized Healthcare" research project.
IBM would deploy their cognitive computing research computer, (named "Watson" after IBM's founder) to collect encyclopaedic knowledge about traditional and non-traditional diseases in Nigeria to help bridge our well-documented Health services gap.
Watson provides access to cognitive technology that processes information more like a human than a computer; by understanding natural language, generating hypotheses based on evidence and learning as it goes. This project, which would be the first of its kind in Africa, is at initiation phase and we are currently fine-tuning its scope with the Ministry of Health.
I have proposed that the University of Ibadan College of Medicine be selected as the project research partner and this has been accepted both by IBM and the University (through Professor Olaopa) and we are very hopeful that we can make this project a reality and help bring cutting edge research capabilities and inferences to the Nigerian Health care system.
I hope that from this lecture I have been able to show that ICTs have a significant, strategic and important role to play in the improvement of our healthcare delivery systems and health outcomes. What should also be evident is that Nigeria is yet to fully tap into the potential of ICT for health systems improvement. We in the Federal Ministry of Communication Technology stand ready to support the healthcare industry to fully realise this potential to ensure that Nigerians can be guaranteed access to quality healthcare regardless of their economic, social or demographic status.
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Autor(en)/Author(s): Omobola Johnson
Quelle/Source: AllAfrica, 06.08.2014
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