Health Informatics Deployment in Nigeria

Full text

Vol.2 • No.1 • Jan 08
www.jhidc.org
Information and Communication Technology (ICT) has become a major tool in delivery of health services
and has had a revolutionary impact on how we live and perceive the world. ICT has given birth to the
contemporary “Es” such as e-learning, e-commerce, e-governance, e-banking, e-shopping and e-health,
the primary focus of this paper. In this paper, we discuss ICT in Nigeria with focus on three common ICT
indicators: Internet, computing and telephony. We review the past and present state of health informatics in
Nigeria, in comparison to the United Kingdom as examples of less developed and developed nations. We
also analyse the problems facing successful implementation of health informatics in Nigeria and suggest
possible solutions.
Health informatics deployment in Nigeria
Abstract
Peter Idowua Dan Cornfordb and Lucy Bastinc
Introduction
ICT in Nigeria and the United
Kingdom
Keywords: Information and Communication Technology, ICT Indicators, health Informatics.
Referencing this article
Idowu, P., Cornford, D., &
Bastin, L. (2008). Health
informatics deployment in
Nigeria [Electronic Version].
Journal of Health Informatics
in Developing Countries, 2,
15-23 from http://www.jhidc.
org/index.php/jhidc/issue/
view/4.
Department of Computer Science
Aston University
Birmingham
B4 7ET
UK
apaidowu1@yahoo.com
idowupa@aston.ac.uk
bd.conford@aston.ac.uk
cl.bastin@aston.ac.uk
ICT enables people to interact and communicates
no matter the distance, also makes it easy for us to
obtain goods and services in convenient ways. The
world in which we live in today has been changed
by ICT. ICT has the potential to transform radically
the delivery of health care and to assist in dening
strategies to address future health problems. ICT
has assisted in driving down healthcare costs
(Remlex, 2007); and improved the delivery and
effectiveness of healthcare services through help in
disease management, improved patient safety and
decision support for practitioners (O’Carroll, et al,
2003). Various systems have been developed to
aid health care delivery such as local area network
based patient information systems (Modai et al,
2002), and online health information for patients
and medical personnel (DG INFSO, 2006). Despite
Nigeria’s claims to have reorganised its health care
delivery system since Bamako’s 1987 initiative,
which focused on how to increase access of good
health care systems, the government is yet to
implement any ICT policy in the health sector. In
this paper, we discuss the problems facing the
use and implementation of ICT in Nigeria health
informatics.
Today, we live in a world in which aspects of
human life such as services, business, research,
security, culture, religion, education, commerce,
entertainment and health are all inuenced by ICT.
In the context of this paper we will discuss ICT as
the driving force of health informatics. According to
the World Bank (2002) ICT was dened as ‘the set
of activities that facilitate the capturing, storage,
processing, transmission and display of information
by electronic means’. Frenzel (1996) dened ICT as
‘a tool that is radically altering the balance of power
between institutions, governments and people by
broadly disseminating important information’. ICT in
the health context is unlikely to alter the balance of
power between institutions, but it is assuredly a tool
that can aid dissemination of information through
electronic media. In this paper, we will dene ICT
as a tool or technology for gathering, storing,
retrieving, processing, analyzing and disseminating
information electronically. There are many factors
that determine the implementation and use of ICT
such as ICT expert knowledge, user’s attitudes, etc.
ICT is a fusion of telecommunication and computing
with the aim of disseminating and processing
information.
The advent of ICT in many developing countries
can be linked to international organisations (such
as World Health Organisation, World Bank, United
Nations Development Program, etc), research
institutes and educational institutions. For example,
in 1993 Mongolia was provided with personal
computers funded by the World Health Organisation
to support health care services in the country (Braa,
et al., 1995).
In Nigeria, the history of ICT initiatives can be
traced to the1950s when electronic and print media
were formed but there was little progress until
National Broadcasting Commission (NBC) and the
Nigerian Communication Commission (NCC) was
formed in the early 90s. In the late 1990s, NCC
licensed some wireless telephone operators and

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 16
Telephony System in Nigeria
Figure 1
Number of Mobile Phone
subscribers
Data source: The World
Fact book
the commission was reconstituted in 2000 so as
to function well. (Emadoye, 2002). A year later
after proper commissioning of NCC, the Obansajo
administration established the National Information
Technology Development Agency (NITDA) to see to
implementation of ICT policy in Nigeria, although
this has little signicant effect on the Nigerian
economy (Idowu et al, 2003a). Three specic
components of a successful ICT system (telephony,
Internet and computing) are further discussed
below in the Nigerian context and briey compared
with that of UK, an example of a developed nation.
In 1960, after independence, Nigeria had a
population of about 45 million people with 18,724
functioning telephone lines - a teledensity ratio
of 0.04 telephones per 100 people. During the
subsequent period of military rule, which lasted
almost 30 years, there was little or no development
in the telecommunication industry. A breakthrough
in this sector emerged in 2001 when the Obasanjo
administration introduced a Global System for Mobile
(GSM) Communication system and established the
National Communication Commission (NCC) to
license GSM operators in Nigeria. NCC currently
licences four communication companies; MTN
(Mobile Telephone Network), CelTel (which was then
ECONET Wireless Nigeria Limited), NITEL (Nigerian
Telecommunication Limited) and GlobalCom (Global
Communication).
0
10
20
30
40
50
60
70
80
90
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Ye a r
Percentage of Mobile Users
NIGE RIA(% ) UK (% )
At the launch of Nigerian mobile telephony in 2001,
there were only a few thousand lines available from
the operators and services were too expensive for
the average Nigerian to purchase. The following
year, the number of mobile subscribers stood at 1.5
million (Nigerian Tribune, 2003) and prices continued
to fall. Towards the end of 2003, MTN alone had
about 1,650,000 active subscribers on its network,
while CelTEl (then Econet) had over one million
subscribers and MTel and Global Com had close to a
million subscribers (The Guardian, 2004). By the end
of 2004, the GSM operators had recorded well over
seven million subscribers, which is a real explosion
when compared with about half a million working
lines from NITEL in 2001 (Okoruwa, 2004) . This
shows that Nigerian telecommunication industries
Internet in Nigeria
The Internet is playing a useful role in almost all
aspects of modern life. In the health sector, the
Internet can be a useful tool for accessing up to
date information about health (Ajuwon, 2003). The
use of Internet for health care systems such as
teleradiology, remote neonatal monitoring system,
electronic patient record system, Internet based
patient information system (DG INFSO, 2006) is
well documented, though uptake of such systems
is variable; unfortunately, access to the Internet in
Nigerian hospitals is rarely available.
The Internet initiative in Nigeria started in 1994
with the efforts of the Nigerian Internet Group.
At this time the only access to the Internet was
provided by NITEL and it was extremely expensive.
NITEL was pressurised to build an infrastructure
backbone to make Internet service more accessible
and cheaper; by the end of 1997 NITEL provided
a backbone of 2 Mbps bandwidth and ve
strategically-located points within the ve major
cities in Nigeria (Olayinka, 2000). Since that time
various Internet service providers have emerged
and terms like “browsing and surng the net” are
common slang among average Nigerian yet Internet
penetration remains very low in Nigeria. In 2004,
Nigeria, with a population of almost 130 million
people, had 750,000 Internet connection points
compared with South Africa with population of 45
million and Internet connectivity of 3.1 million (World
Fact Book, 2005). In 2006, the number of Internet
hosts was 1,549 with 5,000,000 Internet users
645,179 Internet hosts and over ve million Internet
users in Nigeria and South Africa respectively
(World Fact Book, 2007). Figure 2 shows the
relative numbers of Internet users in Nigeria and the
experienced rapid growth in terms of usage and
subscription.
The pervasive growth of GSM in Nigeria has deeply
affected the Nigerian economy. In comparison,
other ICT indicators like Internet and computing still
have a very low diffusion rate. Use of and access
to mobile phones in Nigeria has increased (Adomi,
2005) and the average Nigerian can access a mobile
phone either through a personal subscription or via
commercial phone centres which cost about 8p
($0.15) to 12p ($0.23) per minute. It is not unusual to
subscribe to two, three or four providers at the same
time but rarely can one nd a Personal Computer
(PC) in the home of an average Nigerian. At 2007
in Nigeria, there are 34 million telephone lines with
1,670,767 xed lines and 32,265,827 mobile phones
(ThisDay, 2007).
The use of mobile phones started in 1997 and 2003
in UK and Nigeria respectively. As at 2006 about
32 million Nigerians (23% of the population) and
about 48 million people in the UK (almost 80% of
the population) use mobile phones. Figure 2 shows
there is a wide gap between the percentage of user
in Nigeria and UK. From gure 1, it might be argued
that UK market is becoming saturated while that of
Nigeria is still far behind. It may be difcult to predict
when the Nigerian market will be saturated due to
factors affecting the use of mobile phones such as
poverty and network coverage problems.

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 17
Computers in Nigeria
Figure 3
Number of Personal
Computers in Nigeria
Data Source: The World
Fact book
UK between 1994 and 2006 with that of UK. There
is still a wide gap between the 2 countries, despite
the fact that Internet use began in Nigeria in 2000;
at present, less than 4% of the Nigerian population
have access to Internet, while in the UK, over 50%
of the population have access to Internet. If Internet
access is to be increased in Nigerian hospitals and
Nigeria as a whole, Nigerian government may need
to address the obstacles to the use of ICT, which
might affect the use of ICT in Nigerian hospitals.
The rst computer emerged in Nigeria in 1948
when the Nigerian Ports Authority bought a ‘Visible
Record Computer’ from International Computer
Limited (ICL). In 1963, IBM (International Business
Machines) established the IBM African Education
Centre at the University of Ibadan in Western
Nigeria, enrolling fty–two students from Nigeria
and other English speaking African countries
(Anyanwu, 1978). In the same year, a computer was
used to process the Nigerian national census data.
After the completion of the programme in 1965,
IBM donated its training centre to the University
of Ibadan. In 1973, computer education started
in three universities; namely, University of Ife (now
known as Obafemi Awolowo University), University
Figure 2
Number of Internet Users
in Nigeria
Data Source: The World
Fact book
0
10
20
30
40
50
60
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Ye a r
Percentage of Internet Users
NIGE RIA UK
of Lagos and University of Ibadan. There were
20-25 computers in the whole of Nigeria before
1973 with six of these computers being associated
with multinational companies (Nwachuku, 1994).
A few years after computer science education
commenced in Nigeria, the government
establishments and parastatals (such as West
African Examination Council, National Electric
Power Authority, Joint Admission and Matriculation
Board) and commercial banks showed interested in
computing and this made the number of computers
in the country increase to about 70. At 1977 only
three computer companies namely; IBM, NCR and
JCL which are subsidiaries of foreign computer
companies had a presence in the country and the
decree promulgated by the government in favour of
indigenous vendors in 1977 forced IBM out of the
country and led to inux of indigenous computer
vendors which remain at 2007 in the business of
marketing computers and accessories (Nwachuku,
1994).
In 1978 the Nigerian computing profession
experienced some development; four computer
companies namely: Debis Computers, Data
Science, Datamatics, and Joint Komputer Kompany
(JKK) were established and Computer Association
of Nigeria (COAN) was inaugurated (now Nigeria
Computer Society) which later gave birth to
Computer Professional of Nigeria. Between 1982
and 1983 149 new computers were installed
because by that time banks were moving from
manual way of operations to full automation. 1983
was the same year that the rst micro computer
exhibition took place in Lagos. In 1984, state
government began to use computers in various
ministries especially the nance ministry and by
the end of 1986 there were another 99 computer
installations. It was around that time that Nigerian
universities computer centres emerged. By 1987,
Nigerian National Petroleum Corporation (NNPC)
began to lay bre optical cable for a computer
communication network.
Despite the 60-year history of computer use in
Nigeria, the diffusion and usage of computers in
Nigeria is still very low due to the cost of Personal
Computer (PC) which is very high for an average
Nigerian. The majority of desktop computer
systems found in Nigeria are cloned, because 2
PCs can be cloned for the price of a new branded
system of the same specications. In general, it
is only the multinational companies (especially oil
companies) and banks that can afford to purchase
branded computer systems (Osuji, 1984). Figure
3 compares the estimated percentage of the
number of personal computers in Nigeria with that
of UK. There is a wide gap between the UK and
Nigeria, the percentage of computers in Nigeria is
less than 5% of the population while in the UK it
is almost 70% as at 2006. The research institutes,
banks, and oil companies are the major users of
computers in Nigeria and very few individuals. It
may take more than 20 years before Nigeria can be
at the same level with UK in the use of computers
due to low income of most Nigerians.
In 2007, the Nigerian government established an
initiative called Computer for All Nigerians Initiative
(CANi); a Government Assisted PC Programme
0
10
20
30
40
50
60
70
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Ye a r
Percentage of Computer Users
NIGE RIA UK

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 18
Nigerian Health Informatics: Past
and Present
(GAPP), which aims to expand the usage of
computers within the country by making computers
(laptop and desktop) available for all Nigerians at
affordable prices (Copine, 2007) through a public-
private partnership between NITDA, Microsoft
Corporation and Intel Corporation. One potential
problem is that there is a need for a computer
literacy programme in the country to support the
aims of CANi. If NITDA is not careful, the people
that will benet from the initiative are the people
that already have one or more computer system at
home.
Out of the three selected ICT indicators, mobile
telephony has the highest number of users, for
both the UK and Nigeria. The reason for high rate
of mobile phone usage/ ownership is that they are
cheaper to acquire and some of the obstacles to
the use of ICT in Nigeria do not affect mobile phone
users. In UK, between 1998/1999 the number of
computer users intersected that of mobile phone
and in the next 2 years the number of Internet and
computer users may intersect again. In Nigeria,
it is only the use of mobile phone that is growing
fast; other ICT indicators are still growing slowly. It
may be difcult to predict when the percentage of
Internet and computer users will equal with that of
mobile phone users because it is cheaper to buy
mobile phones than PCs and prediction is difcult.
Nigeria has one of the highest mortality rates
in sub-Saharan Africa; (WOCON, 2004) with a
population of 140,003,542 (Nigeria Census, 2006)
which is the highest in Africa but with inadequate
health care delivery system. According to Hyman
& Silver (2004), inadequate health care delivery
might gives birth to health risk which means that
Nigerian may be liable to health risk. The problem
of inadequate health care delivery are arguably
minimised in countries like United Kingdom (UK)
whose health services make more extensive use of
ICT. The Nigerian health sector would have been
improved, if government had exploited the potential
of ICT like other developed nations of the world
(NHS, 1998).
Health informatics which was formerly known as
medical informatics was dened by Warner et al
(1997) as the science that deals with the use of
computers and communication technology to
acquire, store, analyze, communicate, and display
medical/health information and knowledge to
facilitate understanding and improve the accuracy,
timeliness, and reliability of decision making.
According to O’Carroll, et al, (2003), health
informatics was dened as a demonstration of how
organisations can use IT to bring their strategic
goals from theory into practice. The term medical
informatics was changed to health informatics or
healthcare informatics when some health ofcers
felt that the term medical informatics had to do
with physicians alone (Shortliffe & Blois, 2001)
although today some people still use the two
terms interchangeably. In this paper we will dene
health informatics as the application of information
systems that allow collection, updating, storing,
analysis and management of health related data in
order to assist health care delivery.
Health informatics has a number of branches and
sub domains, Shortliffe & Blois (2001) grouped
health informatics into seven domain namely,
clinical Informatics, Nursing Informatics, Veterinary
Informatics, Dental Informatics, Bioinformatics,
Imaging Informatics and public health informatics
which is the focus of this paper. Figure 4 shows the
hierarchical relationship between health informatics
and its branches. Public health informatics is “the
systematic application of ICT to public health
practice, research and learning” (ASTHO, 2004 &
O’Carroll, et al, 2003). It uses ICT to analyse risk
factors to prevent and record health problems, and
to promote health. Epidemiology, which deals with
health in relation to communities, is our focus in this
paper.
The history of health informatics in Nigeria started in
the late 80s when a collaborative research project
between the Computing Centre of the University of
Kuopio, Finland and Obafemi Awolowo University,
and Obafemi Awolowo University teaching Hospital
(OAUTHC), Nigeria (Idowu, et al, 2003a) was
initiated and this initiative was part of INDEHELA
(a long term research project on Informatics
Development for Health in Africa) details of which
can be found at http://www.uku./indehela/.
The joint project produced a very rudimentary
hospital information system based on the Veterans
Health
Informatics
Veterinary Dental Bioinformatics ImagingNursingClinical
Public
Health
Public
Education
Health &
Social Policy
Disease
Monitoring
Disease
Surveillance
Disease
Mapping
Disease
Analysis &
Modelling
Epidemiology Health
Research
Environmental
Health
Figure 4
Sub domain of Health
Informatics

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 19
Figure 5
Nigeria Health Informatics
Model
Administration’s (VA) Admission Discharge Transfer,
running on a stand-alone PC, which was in use at
OAUTHC in 1991(Daini et al, 1992). According to
Daini et al (1992), the group then organised the
rst International Working conference on Health
Informatics in Africa which was held April 19-23,
1993 at Ile-Ife, Nigeria (HELINA, 1993).
In the late 1990s, the Finnish / Nigerian research
team decided to expand their rudimentary hospital
information system with the aim of developing
a comprehensive system suitable for use in all
Nigerian teaching hospitals and medical centres.
The plan then was that by 2001 all the teaching
hospitals in Nigeria would have Health Informatics
units which could make use of standardised
software. In reality, though some hospitals have
computer or IT units, these serve primarily to
support word processing for typing pools and
ofces. Development of the commercial software
‘Made in Nigeria Primary Healthcare and Hospital
Information System’ (MINPHIS) ran alongside the
doctoral programme of one of the staff of the
Department of Computer Science & Engineering,
Obafemi Awolowo University, and was completed
in 2004. Unfortunately, the system was not tested
at OAUTHC and only ve teaching hospitals and
medical centres use the system as of 2007. The
primary reason for this limited use is the cost of
purchasing the commercial software. As Finnish/
Nigerian research team were working on primary
healthcare and hospital information system, a
Norwegian and South African team focused on a
district-level information management system (Anja,
2002).
There are other software packages developed
for hospitals in Nigeria, though they are non-
commercial. In 2003, the State Hospital Network
known as SHONET was developed for sharing of
hospital resources over the computer network in
Nigeria. The philosophy behind the development of
SHONET was to minimize the cost of running state
hospitals; hospital resources such as personnel,
laboratory and equipment will be distributed to
various zones in the state. The allocation of the
resources depend on the diseases that is peculiar
to the zone and whenever there is need for any of
those resources in another zone within the system,
the hospital equipment can then be allocated over
the network (Idowu, et al, 2003b).
In 2004, another system was developed at the
Department of Computer Science & Engineering,
Obafemi Awolowo University, Nigeria. The system
was developed for referral of patients from one
hospital to another such that patient’s case le,
referral note and medical examination result that
were transferred manually from one hospital to
another could be transferred over a computer
network (Idowu, et al, 2004).
Presently most Nigerian teaching hospitals have to
generate money by billing patients for the services
rendered to them, so as to augment the money
received from the government to run the hospital
and pay staff salaries. Meanwhile, it is believed that
if the use of ICT is adopted the cost of running the
hospital on the long run will be reduced and the
health care delivery system may be as efcient and
effective as it is in the developed world(NHS, 1998).
Figure 5 below depicts the state of Health
Informatics in Nigeria. The hospitals in Nigeria
are battling with opposing forces which serve as
barriers to the adoption and infusion of ICT in health
sector. The details of these barriers are discussed in
the later part of this paper with possible solutions.
Health Informatics: Comparing
the United Kingdom & Nigerian
Experiences
In the context of developing nations the use of
ICT can potentially improve delivery of health care,
patient care and reduce cost of running hospital
(Mbananga, et al, 2002). In 1996, the UK began
to use electronic records and ICT in the NHS and
this had reformed the health sector (Hackney et al,
1996).
The United Kingdom (UK), made up of England,
Scotland, Wales and Northern Ireland, has a
population of about 60 million - less than half the
population of Nigeria. In the 1980s, the hospitals in
UK were at a level where paper les, paper cards,
!
! Remote Consultation
! Patient Information System
! Electronic Referral System
! Disease Mapping
! Online Record Keeping
! E-Registration of patient
! Paper File
! Paper Card
! Manual referral of patient
! Cabinet
! Manual medical record
! Paper Registration
! Manual Word Processor
Obstacles
Hospital in the 21st century
Hospital in the 1980s
! Power Supply
! Government Attitude
! Cost of ICT
! Inadequate Telecom
! Resistance to Technology
! Bad Maintenance Culture

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 20
manual referral systems and manual typewriters for
word processing were used as shown in Figure 5.
In UK hospitals, patients’ records are now in
digital format and this makes storage, retrieval and
transfer of patients’ data economical, faster and
easier. Nigeria is still behind because of obstacles
(e.g., high cost of ICT equipment, power failure,
and inadequate telecommunication facilities) to the
adoption and infusion of ICT. UK hospitals found it
relatively easy to move away from the traditional,
manual ways of delivering health care because
other sectors such as banking and educational
institutions had adopted ICT.
Until the mid-20th century, the UK government
was not involved in delivery of health care; it was
philanthropists and social reformers that offered free
health facilities to the poor. Later, the government
saw the need to provide a free quality health care
system and in July 5th 1948 the NHS (National
Health Service) was established (NHS, 2007). In
2005, the Nigerian government embarked on a
system similar to the UK NHS which is called the
National Health Insurance Scheme (NHIS). Arguably
establishment of the scheme ought to begin with
the introduction of ICT in hospitals because ICT
will reduce the cost of running the hospital and
improve the delivery of healthcare system if fully
implemented (O’Carroll et al, 2003).
In UK hospitals, all patients’ data are stored on a
computer system which is updated each time the
patients visit the hospital. In Nigeria, to nd the
number of patients that visited a particular hospital
could take weeks, because numerous les must be
checked. Hospitals which are not research-based
may not even have records.
In UK, the patient records can be accessed in any
hospital provided the person in need of such a
record is authorized to do so. There is no need to
carry patients’ les from one hospital to another
as the case is in Nigeria. In Nigeria, there are no
electronic patient records; les are kept at the
medical records section of the hospital. Sometimes,
some of the les go missing within the hospital,
making it difcult for physicians to trace the medical
history of patients. Although few researchers (Idowu
et al, 2004) have developed systems to solve
referral system in the hospitals but the system
were yet to be implemented because the Nigerian
government has yet to show interest in any ICT
investment in any hospital.
A GP in the UK can make use of the electronic
booking service to contact consultants and
share the patient’s record with the consultant
electronically. GPs are also connected via the
NHS national network which is an Intranet (NHS
Bulletin, 2007). In Nigeria, the physicians in the
same hospital cannot share a patient’s le within
the hospital and an electronic booking service is not
available in any hospital in Nigeria.
There are medical national libraries in UK which
are online, where authorized medical personnel
(doctors, nurses and other clinical professionals)
can access information about the latest health
research and best practice, anytime the need
arises. This type of facility is not available in Nigeria.
Most UK doctors’ surgeries and hospital clinics
In Nigeria, seven specic obstacles to the use of
ICT and the successful implementation of health
informatics are identied; these problems stem from
three factors, namely people, government and ICT
infrastructure. The obstacles were discovered as a
result of personal experience and observation from
Nigeria and details are discussed as follows.
i.‘Epileptic’ Electric Power Supply
Any country that nds it difcult to provide
uninterrupted Power Supply (UPS) to its citizens
will denitely have problems with deployment of
good ICT services. Nigeria is synonymous with this
problem. People brought up in developed nations
of the world will nd it difcult to adapt to the
‘epileptic’ electric power supply in Nigeria, which
has caused a lot of damage to research institutes
computer laboratory equipments, as computer
components such as hard disks and motherboards
can be destroyed by interrupted and unreliable
power supply. ICT equipment was made to function
with other infrastructure such as electricity under
“controlled conditions” that is when electricity
supply is stable and constant. Most internet
facilities in Nigeria suffer frequent downtime due to
power interruptions and equipment damage.
A few years ago, Ghana celebrated one year
without power failure; in contrast, Nigeria, despite
its claims to be ‘the giant of Africa’ rarely has stable
and reliable electricity for ten consecutive hours. In
developed nations, many companies supply and
guarantee electricity and there is no problem of
Obstacles to Health Informatics
in Nigeria
have computer-based appointments systems; if you
are in the waiting room the system will display your
name and “waiting”, and after the consultation, it
will show that you have been attended to. At any
time, a doctor can view the number of patients
waiting outside in the waiting room, making the
running of clinics more efcient and effective. In
Nigeria, no such system exists.
In the UK, there is easy and fast access to
information, health advice and care through online
information systems aimed at the public. In early
1998, NHS Direct was launched to provide 24 hour
health advice via browser or phone. This service
handles over 500 thousand telephone calls and
one million online transactions each month (Clark,
2006). Also, the National Health Service (NHS)
developed “NHSDirect online” which provides
access to information about healthcare and heath
through the Internet for citizens and medical
personnel (DG INFSO, 2006). Until 2001, when
GSM was introduced, the telephone system in
Nigeria was severely limited, and in the teaching
hospitals, usually restricted to the ofce of the Chief
Medical Director. Even today, no nurses or medical
doctors have access to fax, landline telephone and
e-mail facility expect intercom in the ward. This
illustrates the level of technological development
in Nigerian hospitals. Nowadays, hospitals could
potentially use mobile phone technology to offer
such a service, but maintenance of the service
requires funding.

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 21
electric power supply. Nigerian government should
critically look at this area of power problem and
urgently address it.
ii. Government’s Attitude
The Nigerian government has yet to appreciate
the use of ICT in health care delivery. Government
has not seen ICT as a vehicle that can drive
health and provide good health care facilities
for the citizenry. Presently, apart from University
College Hospital Ibadan Abuja National Hospital,
no teaching hospitals or medical centres have
websites. The Nigerian government could perhaps
support the use of ICT in health care delivery
systems by establishing an agency that will see to
the deployment of ICT in Nigerian hospitals, with a
separate remit and budget from the health ministry.
This should aim to ease delivery of health care by
allowing staff and patient records to be kept in a
database and accessed online.
iii. Cost of ICT Peripherals
The price of computer hardware and software
in Nigeria is very high compared with the
income of an average Nigerian making them
prohibitive for most people, and even government
establishments, to buy. Government should
encourage indigenous computer companies to
produce major components in house by giving
interest free loans to them. Research institutes can
be used in production of the components because
in developed nations like UK research institutes are
the ones spearheading technological innovations
and development. Nigeria government should
encourage research institutes to become actively
involved in software development and identication
of best practice from other countries; particularly
extensive, open source applications.
iv. Telecommunication Facilities
The ICT development problem in Nigeria is due to
inadequate telecommunication facilities. Though
the International Telecommunication Union (ITU)
has rated Nigerian’s telecommunication sector
as the fastest growing in Africa, this applies
chiey to mobile technology, and the majority of
Nigerians have no access to landlines. The Nigerian
government should nd means of restoring an
effective and efcient telephone system that is
landline, which is more economical to maintain.
Also there is a need for Intranet within the hospitals
which will aid communication.
v. Internet connectivity
The Internet help in controlling cost and more
importantly it transform the ow of information in
health sector. Healthcare organisations use Internet
for business processes due to cost reduction
which was estimated at 10:1 to 100:1 in routine
transactions (O’Carroll, et al, 2003). Communication
satellite is not common in Nigeria due to the costs
of equipment. As at 2003 no communication
satellite has been issued by NCC (Esselaar, et
al, 2004). Private or government-run hospitals
can not host websites (Oak, 2007) because of
subscription and maintenance costs. In May 14,
2007, China built a communication satellite called
NIGCOMSAT-1 for Nigeria, which may promote an
expansion in the communication sector, though
government should also consider the use of bre
optics for hospitals.
vi. Resistance to New Technology
The introduction of new technology is related to
the user of the technology which may be positive
and negative. Many Nigerians, like any other
citizens of the world, will resist new technological
developments which will have negative impact on
their job. The ideal is for new technology to be
associated with new knowledge and skills, through
training on how to use the technology. Workers
expect training on how to use new technology
and a corresponding increase in their income,
while the organisation introducing new technology
expectation may be to reduce staff strength and
cost of operation. Often in Nigeria, downsizing is
the issue to be raised before the introduction of
new technology and this always leads to resistance
by the workers, because of the fear of losing their
job. In order to use ICT in Nigerian hospitals,
government should training hospital staff on how to
use it and not lay them off and employ those with
ICT skills.
vii. Lack of Maintenance Culture
Lack of maintenance culture is another problem;
even government agencies nd it difcult to
maintain ICT equipment in Nigeria. Both preventive
and corrective maintenance is very important
for any ICT equipment. The nancial plans for
purchases of any equipment should encompass the
maintenance of such equipment, and allowances
for depreciation in value which is not the case
in many organisations in Nigeria This could be
enforced by an ICT policy banning any organisation
from importing, supplying and installing any ICT
equipment for another organisation or herself
without maintenance agreement.
ICT has beneted the health sector both in
developed nations and developing nations,
the benets affect the hospital’s stakeholders:
management of the hospital, health personnel and
patients.
The use of ICT in health sector reduces the cost
of running hospitals (Remlex, 2007). For example,
The NHS in UK has its own network known as
NHSnet which has beneted all parts of NHS.
Apart from data networking and Internet, the NHS
spends millions of pounds each year on telephone
services across England to aid patient transport
services and emergency ambulance because the
two areas help the NHS to deliver a good health
care facilities(NHS, 1998). ICT introduces potential
of sharing of patients les easy without any threat to
patient privacy. It is used for hospital management
such as admission and appointment management.
ICT improves the efciency of medical personnel
by reducing waiting times and minimise paperwork.
ICT makes information available for the use of
hospital personnel in an easily readable form.
The result of patients’ test can be added to the
patients’ case le as soon as they are ready. To
the patients, ICT assists the patients to locate the
heath facility and personnel, gives 24-hour access
to health information and through encryption and
password protection can help to keep patients’
data condential.
Benefit of ICT in Health Sector

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 22
The state of ICT in Nigeria is incomparable with
developed nations like UK. Out of all the three ICT
Indicators, mobile phone has the highest number of
users in UK and Nigeria. The number of computer
users equals to that of mobile phones in UK and
with time the number of Internet and computer
users in Nigeria may equal to that of UK. In Nigeria,
mobile phone has the highest number of users,
follow by Internet and computer. In this paper,
we have discussed the problems facing the use
and implementation of ICT in Nigeria which also
have direct effect on health informatics in Nigeria.
Since “health is wealth”, there is a need for Nigeria
government to make use of ICT to improve the
delivery of healthcare so as to get out of poverty. In
order to coordinate this initiative and tackle some of
the problems highlighted, the Nigerian government
could to establish an agency, separately from the
ministry of health and to empower this agency
nancially to administer and fund ICT equipment
and personnel in government hospitals, while also
overseeing the deployment of ICT at a variety of
levels, from state hospitals to rural clinics.
Conclusion
Adomi, E.(2005). Mobile Telephoning in Nigeria, Library Hi
Tech News, emerald Group Publishing Limited, Volume
22(4) pp.2-3
Ajuwon G. A. (2003). Computer and Internet use by First year
Clinical & Nursing Students in a Nigerian Teaching Hospital,
Journal of Medical informatics & Decision Making, Volume
3(1) pp.10-15
Anja M.(2002). Information System Development in
Developing Countries, Risk management and Sustainability
Analysis in Nigeria Software Companies. In Seppo
Puuronen(eds.), Department of Computer Science and
Information Systems, University of Jyvaskyla, Marja-Leena
Tynkkynen and pekka Olsbo pp.27-54.
Anyanwu, J. A. (1978): ACM SIGCSE Bulletin, The papers
of the SIGCSE/CSA technical symposium on computer
science education Volume 10(1)
Association of State and Territorial health Ofcials (2004).
Public Health Informatics Policy, Available from: http://
www.astho.org/policy_statements [Accessed 12 Aug 2007]
Braa, J. B & Nermunkh C. (2000). Health Information System
in Mongolia; a difficult process of change Inc C. Avgeuru
& G. Walsham (Eds.) Information Technology in Context,
perspective from developing countries, UK, Ashgate.
Borzekowski, R. (2002): Measuring the Cost Impact of
Hospital Information Systems, The Federal Reserve Board,
Finance and Economics Discussion series, September, NW
Washington, DC 20551
Clark J. (2006). The Impact of ICT on Health, Healthcare and
Nursing in the next 20 years [online]. Available from http://
etdevents.connectingforhealth.nhs.uk/eventmanager/
uploads [Accessed 15 Aug 2007]
References
We hereby acknowledge the referees, Titilope,
Iyinoluwa, Commonwealth Scholarship Commission
and Iyanuoluwa.
Acknowledgement
Copine (2007). What is CANi, [online]. Available from http://
www.oauife.edu.ng/research/copine [Accessed 17 June
2007]
Daini O. A., Korpela M. Ojo J. O. & Soriyan H. A. (1992).
The Computer in a Nigeria Teaching Hospital: First Year
Experience. In Lun KC, Degoulet P. Piemme TE, Rienhoff O,
eds., MEDINFO 92, Proceedings, Amsterdam Elsevier.
eHealth Initiative(2006). Improving The Quality of Healthcare
Through Health Information Exchange, E Health Initiative’s,
Third Annual Survey of Health Information Exchange
Activities at the State, Regional and Local levels,
September, 2006.
Emadoye J. O. (2002). Information Communication &
Technologies Impact on Governance, Social and Economic
Development, workshop and exhibition on windows of
Investment Opportunities in the Petroleum, Power &
Telecommunications Sectors of Delta State, held at Nelrose
Hotel, Asaba, Delta State.
Eysenbach G. (2000). Recent Advances: Consumer Health
informatics, British Medical Journal, Volume 320(17),
p.13-16
Esselarr S. Stavrou A. and Riordan J.(2004).VSAT Case
Studies(Nigeria, Algeria and Tanzania, Research Report
prepared on behalf of the LINK Cnetre for the IDRC, CATIA
and GVF [online]. Available from http://link.wits.ac.za/
papers/vsatngltz.pdf. [Accessed 17 July 2007]
Frenzel, C.W.(1999). Management of Information Technology.
3rd Edition, Course Technology Canada.
Hackney R, Dhillon G., and McBride N. (1996). Primary Care
Information Technology within the NHS. The concept
of markets and hierarchies on system exploitations,
International of Journal of Public Sector Management,
Volume 10(5), p. 61-89
HELINA (1993): First International Working conference on
Health Informatics in Africa [online]. Available from http://
www.africa.upenn.edu/Listserv/Health_informatics_15163.
html [Accessed 17 July 2007].
Hyman D. & Silver C. (2004). The Poor State of Health
Care Quality in the US: IS Malpractice Liability Part of the
Problem or Part of the Solution. Research Paper Series
[online]. Available from http://papers.ssrn.com/sol3/
[Accessed 27 October 2007]
Warner Homer R., Sorenson Dean K. & Bouhaddou
Omar(1997). The Expert System Model” in Computers and
Medicine :Knowledge Engineering in Health Informatics,
New York :Springer-Verlag.
Idowu Bayo, Ogunbodede Eyitope and Idowu Bimbo (2003a).
Information and Communication Technology in Nigeria:
The Health Sector Experience, Journal of Information
Technology Impact, Volume 3(2), pp 69-79.
Idowu, P.A., Adagunodo, E.R. and Ogunbodede, E. O.
(2003b). Distributed Resource Sharing System for Hospitals
in Nigeria. Journal of Biomedical Soft Computing and
Human Sciences, Volume 9 (2), p.1-7
Idowu, P.A., Adagunodo, E.R. Aderounmu G. A. and
Ogunbodede E. O. (2004). Electronic Referral System for
State Hospitals in Nigeria. Ife Journal of Science, Volume 6
(2), p.161-166.
Modai I., Ritsner M., Silver H., & Kurs R.(2000). A
Computerized Patient Information System, Psychiatric
Service, American Psychiatric Association, Volume 53, p.
476-478
Mbananga, N., Madale, R. & Becker P. (2002). Evaluation of
Hospital Information System in the Northern Province in
South Africa Using Outcome Measure, Report prepared for
the Health Systems Trust, The Medical Research Council of

Journal of Health Informatics in Developing Countries
www.jhidc.org
Vol.2 • No.1 • Jan 08 Page 23
South Africa, Pretoria.
Nigerian Census (2006). Nigerian Population State by
State Analysis, 2006 [online]. Available from http://www.
nigeriannews.com/census/census2006.htm [Accessed
17 July 2007].
NHS (1998). Information for Health: An Information
Strategy for the Modern NHS. 1998-2005 Leeds.
NHS (2007). NHS in England [online]. Available from http://
www.nhs.uk/England/AboutTheNhs/Hsitory/Before1948.
cmsx [Accessed 27 July 2007].
NHS Bulletin (2007). New Guide and Tools to assist
Implementation, NHS Bulletin, [online]. Available from
www.chooseandbook.nhs.uk/news/choose-and-book-
bulletin-9 [Accessed 11 July 2007].
Nigerian Tribune (2003). The Pervasive Growth of GSM in
Nigeria, Nigerian Tribune Newspaper, October, 21, 2003.
Nigerian Tribune (2007). Internet Connectivity for Nigerian
Schools will take 1000 years. Nigerian Tribune
Newspaper, February, 23, 2007.
Nwachuku, M.A.(1994). Development of Information
Technology in Nigeria. In Drew, E.P & Foster, F. G. (eds)
Information Technology in Selected Countries.
Oak, M. R.(2007). A Review on Barriers to Implementing
Health Informatics in Developing Countries, Journal of
Health Informatics in Developing Countries, Volume 1(1),
2007.
O’Carroll, P. W.; Yasnoff, W. A., Ward M. E.; Ripp, L.
H.; Martin, E. L.(eds.). Public Health Informatics and
Information Systems, Springer.
Okoruwa, C. (2004). Three Years of GSM, The Guardian,
August 4, P5.
Olayinka, T. O. (2000). Internet Development, Applications
and Public Access in Nigeria, The African Internet and
Telecom Submit, Banjul, The Gambia June 5-9, 2000
Remlex D. (2007). Information and Communication
Technology in Chronic Disease care. Medical Care
Research and Review. 64(2). P.123-147
Shortliffe, Edward H. & Blois, Marsden S.(2001). The
Computer Meets Medicine and Biology: Emergence of a
Discipline, Medical Informatics: Computer Applications
in Health Care and Biomedicine, (formerly Computer in
Health Care) Second Edition,Edited by Shortliffe, Edward
H. , and Leslie E. Perreault(eds.), New York:Springer-
Verlag. P. 3-40.
Thisday (2007): Nigerian Telephone Lines Hit 34m, Thisday
Nigeria Newspaper, Jan 31, 2007[online] Avaialble from
http:// www.africannews.com/site/list_messages/3161
[Accessed 21January 2008]
WOCON (2004): Nigeria go Report of the decade of Review
of the Implementation of Beijing Platform for Action
[online]. Available from http://www.wildaf-ao.org/eng/
IMG/doc/Nigeria_ENG-2.doc [Accessed 27 July 2007].
World Bank (2002): Information and Communication
Technologies: A World Bank Group Strategy [online].
Available from http:info.worldbank.org/ict/assets/docs/
ExecSum.pdf [Accessed 15 August 2007].