Digitalizing Health Care in Africa for UHC: Health Work Force Dr Obinna Oleribe Chief Executive Officer (CEO) Excellence & Friends Management Consult Ltd/Care

© Obinna Oleribe 2015 1

Digitalizing Health Care in Africa for UHC: Health

Work ForceDr Obinna Oleribe

Chief Executive Officer (CEO)Excellence & Friends Management Consult Ltd/Care Center (EFMC)

Dutse Abuja 26th October 2015


Appreciations

• I first and foremost want to applause the National Information Technology Development Agency (NITDA) for this very innovative meeting• It is long over due

• I congratulate you on a very timely topic – Digitalizing Health Care in Africa for UHC• I congratulate all those who are here to be part of this history making • I thank you, the organizing committee, for inviting me to be part of

this process


My beliefs

• I strongly belief in a highly digitalized health care system – in Nigeria • I belief that Universal Health Coverage (UHC) is possible in Nigeria and

that the National Health Insurance Scheme(NHIS) is vital towards the achievement of this process?• Human resources for health is critical to the achieve of better health

outcomes, and sustainable health development in Nigeria• Digitalization of Human Resources for Health is the way forward


Universal Health Care

• Is possible• Is achievable• Is what we need in Nigeria to get the right outcomes, health indices

and mortality/morbidity results • Prevents catastrophic health expenditures• Improve access to health care for all• Results in equitable and fair society• Lead to sustainable development


But UHC is not POSSIBLE without HRH• Thus the need to look at Human Resources for Health in Digitalizing

Health Care in Africa for UHC


Introduction

• Nigeria’s overall health system performance was ranked 187th position among 191 Member States by WHO in 2000 • Nigeria has the largest stocks of human resources for health (HRH) in Africa

comparable only to Egypt and South Africa. • Nigeria is still one of the 57 countries that are identified as ‘in crisis’. • Nigeria is the chief supplier of human resources to most European and

American countries • Nigerian health workers are building the health industries of other nations of

the world• There are only 2.3 doctors per 1,000 people in Africa• Do we have real figures, estimates or gestimates?


Physicians Density (Per 10,000 Population)



Questions we must answer• How many health workers – line and staff managers – do we need in

Nigeria?• How many do we produce annually from local health training

institutions?• How many of the graduates of our schools are in the health system• How many migrate out of Nigeria in search of better jobs• How many are currently doing what they were trained to do?• How many are in the urban vs. rural areas of Nigeria?• How many are in private, NGOs or other places• How many are jobless or in between jobs?


Questions we MUST answer

• What is the need we have in the health system as at today?• Of those in the health system, how many have the right skillsets?• Of those looking for job, who among them have the skillsets we need

in a particular health sector of Nigeria?• What are the regional or state gaps that are unique to the regions or

states?• What are the additional courses we need to activate to empower

people to meet the needs of the health system• What are we doing, or not doing that we should change?


These are the essence of

• Digitalize Health Care Work Force• We need a centralized database system that is validated and periodically

reviewed and updated• We need a database that we can use for planning, evidence based decisions

and international communication• We need a database that provides information for HRH development,

employment, retention, deployment, motivation, and even compensation• We need a digitalized data base that is responsive to the needs of the people

and the policy makers


We NEED Data to plan

• In CDC, I chaired the HRH desk and was part of the global HRH TWG• Recently, I did a HRH Effort Index for Nigeria – funded by

IntraHealth/Capacity Plus – first of its kind in the world• I also did HRH situation analysis for Imo State in 2013/14 and Akwa

Ibom State 2014/15 with development of HRH Strategic and Implementation Plans• The greatest challenges we faced in all these exercises were THE

ABSENCE OF REAL RELIABLE VALIDATED DATA ON HRH in Nigeria and the states


The TRUTH

• We need data – factual data – not estimates, not gestimates - to plan and manage the health system.• Every staff must have applied to be employed and thus has a staff file• Every staff has an account number into which his/her salary is paid

into every month• Every staff is in a system’s staff nominal roll• Every staff is documented somehow• ALL STAFF CAN ONLY BE FULLY DOCUMENTED IF WE HAVE A ICT

COMPLIANT SYSTEM


Health System Building Blocks

• Health workforce is one of the six WHO 2006 Health System Building Block• Others are - • Leadership and governance• Health financing system • Essential medical products , vaccines and technologies• Health information system and Research• Health services

• Surprisingly, until we have a reliable health workforce, the rest of the building blocks are ineffective


We need to digitalize

• Health Workforce Planning• Health Workforce Production• Health Workforce Management • Human Resources Information Systems• Health workforce Coordination• Health workforce Monitoring and Evaluation• We need to digitalize all aspects of health workforce spectrum



Development: Education and Training• eLearning and Virtual Trainings• Health informatics, • Medical informatics, • Telemedicine, • Public health informatics and • Bioinformatics

• Virtual surgeries • Online courses – Nigerian Open University, Cousera, Philanthropy

University, Walden University, etc.


Distribution, Deployment, Recruitment and Retention• Health informatics• Data Collection• Information management• Access to research and • Management


Human Resources Management


Monitoring, Evaluation, and Information Systems


Health Workforce Recruitment process


Health Workforce Retention process


Health Workforce Compensation


Health Workforce Occupational Safety and Health (OSH)


Implementation, Monitoring and Evaluation


Challenges – but easily overcome able • High adult illiteracy rates• Low enrolment rates in primary and secondary schools and in tertiary

institutions • Lack of ICT technical expertise • Low per capita incomes • Lack of ICT infrastructure and limited Internet connectivity


Health care funding in Africa


We need funding to digitalize

• One day oil revenue earmarked for health is enough to turn the health system around for ever• One politician who have all our resources in a foreign account can

bank role this process without noticing any changes in his bottom-line• Aliko Dangote, Mike Adenuga, Tony Elumelu, or even TY Danjuma can

fund this process from their personal left pockets• The NHIS can fund this as part of their quality improvement process

and facilitate buy-in from people across the world


Funding can thus be from

• Public-private partnerships (PPP) • Private finance initiatives (PFI) • Public grants and loans • Research projects• Charitable donations • Citizens’ out-of-pocket payments• Private and commercial financing, including loans and leases, as well as venture and

equity capital • Public procurement, including pre-commercial procurement • Health services reimbursement mechanisms facilitating eHealth-enabled activities


Policies and Guidelines

• A digitalization policy that mandate digitalization should be enacted and enforced• A policy of data confidentiality should be enacted and enforced as is

seen in several parts of the world like the HIPAA (Health Insurance Portability and Accountability Act) of USA• A digitalization guideline – step by step for all health facilities should be

developed and implemented• A national database should be established and managed by qualified

data managers • Data should inform all policy decisions in and around the health

workforce and this should be validated periodically


The technology and infrastructures are already in place:


Advantages of proper digitalization of HRH• Reliable and validated national, regional and local data• Clearly identified and documented gaps and needs• Improved cost-effectiveness with better return on investment (ROI)• Appropriate and timely provision of information• Improved management of medical and natural disasters • Facilitated tracking of health workers and trend analysis


7-Steps to proper digitalization of HRH1. Assembly a functional TWG with all relevant stakeholders included2. Develop, approve and operationalize the digitalized HRH policy3. Develop, approve and operationalize a digital HRH national

guidelines and SOP4. Establish a health information data base with a HRH component5. Train and cascade training from tertiary to primary facilities6. Legalize and enforce Electronic Medical and Electronic Health

Record systems7. Outlaw and enforce paper based systems


Is it not amazing that…

• Long after bar codes and online ordering had become common elsewhere, medical professionals still shuffled paper records• Whatever else the emerging medical system accomplishes, it must

bring teamwork and modern information technology to the practice of medicine.• Inadequate management structure and IT means that administrative

costs are higher, and the ability to track results lower• Nigeria and the rest of Africa cannot be left behind…we must change

our habits, practices and systems to align with current realities in the world.


When will this STOP?


We can electrify Africa through digitalizing the Health work force

It is not the legislation that creates change but the change in organizations and institutions

that creates a new “path.”Getzen, 2013


Thank you for listening.

• Questions, Comments, and Discussions

Documents

Digitalizing Health Care in Africa for UHC: Health Work Force Dr Obinna Oleribe Chief Executive Officer (CEO) Excellence & Friends Management Consult Ltd/Care