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REPORT

The National Health ICT Strategic Framework (2015-2020) states

review meeting

Evaristus Hall, Sandralia Hotels, Utako,

29 September 2015

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Table of Contents Executive Summary...........................................................................................................................3

CHAPTER ONE – Introduction, Opening Remarks and Presentations................................4

Introduction...........................................................................................................................................4

Opening Remarks - Mr Tope Fashedemi and Dr Aderemi Azeez.......................................4

What is Health ICT? - Dr Iniobong Obong..................................................................................5

Strategic Context for Health for ICT - Ms. Damola Sogunro..................................................5

Vision for Health ICT - Mr Adeleke Balogun...............................................................................6

Action Plan - Olasupo Oyedepo....................................................................................................6

Health ICT M&E Plan - Dr. Maryam Al-Mansur........................................................................7

CHAPTER TWO – Health ICT Framework Review.....................................................................9

Group discussion session................................................................................................................9

Group report back session..............................................................................................................9

Advocacy..........................................................................................................................................9

Community Action........................................................................................................................10

Typographical Errors...................................................................................................................10

Citations and References...........................................................................................................10

CHAPTER THREE – SDGs and National Health Policy..........................................................11

Recap – Emeka Chukwu..........................................................................................................11

SDGs - Dr Chima Elenwune.....................................................................................................11

Review of National Health Policy – Bison John......................................................................12

CHAPTER FOUR - Conclusion.......................................................................................................13

How the Health ICT Framework Action Plan was developed - Olasupo Oyedepo...13

State Health ICT Action plan – Regional Group discussion session................................13

Closing Remarks - Mrs. Vasti Said.............................................................................................13

Appendix 1 - Recommended changes to the DRAFT Health ICT Framework...............14

Appendix 2 – Cross section of participants..............................................................................20

Appendix 3 – Meeting Agenda....................................................................................................21

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Executive Summary With support from the United Nations Foundation, the meeting reported in this document was co-convened by the Federal Ministries of Health and Communications Technologies (FMoH & FMCT). The aim was to present the draft National Health ICT Strategic Framework 2015-2020 to state technical teams. Facilitated by Mr Adeleke Balogun, Assistant Director & Head of ICT FMoH, the objectives were to gather feedback on presented draft and catalyze interest around development of state Health ICT action plans with technical assistance from ICT4SOML.

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CHAPTER ONE – Introduction, Opening Remarks and Presentations Introduction Registration of participants started at 8:30am, and by 9:00am the tea break was served. This went on till 9:45am. The meeting started immediately with the Facilitator, Balogun Adeleke anchoring the introduction of participants. Introduction lasted till 10am. Volunteers among the participants offered Christian and Muslim prayers. Opening Remarks - Mr Tope Fashedemi and Dr Aderemi Azeez Mr Tope Fashedemi, Director of eGovt. FMCT welcomed delegates from all the thirty six states, including the FCT. He gave a brief explanation of the relevance of ICT in the life of modern man. The following captures the main point of Mr. Fashedemi’s opening remark: § Health and Health Sector is important § ICT affects every area of our lives § ICT can help achieve health MDG goals § ICT for Saving One Million Lives (ICT4SOML) & the two ministries

collaborating to address ICTs in public health. § UN Foundation involved to provide technical assistance to the multi-

stakeholder approach § Need to have an all-inclusive framework.

Representing the Director, Health Planning Research Statistics-FMoH, Dr. Aderemi Azeez, Deputy Director, Monitoring & Evaluation-FMoH, followed. He said the collaboration between his Ministry, UN Foundation and FMCT had come a long way. Though it took three years to come up with a working plan, he however noted that there were still lapses and therefore the need to address them. One of such was the absence of clear policy on telemedicine. With developments like the NHMIS and support from development partners, the director pointed out the benefits of having the final draft ready before the next National Council on health. Looking at National Health ICT Strategic Framework 2015-2020, he praised the contribution made by FMCT and encouraged collaboration with the National Identity Management Commission (NIMC). The framework, he said, was created to benefit the people and all should approach

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the review with an open mind. In summary he thanked the participants for representing their parent bodies & states and reiterated the urgency to review and come out with an improved & updated draft by the end of the meeting. What is Health ICT? - Dr Iniobong Obong Dr. Iniobong Ebong, eHealth Desk Officer at FCT Health & Human Services Secretariat, defined Health ICT and the purpose of the state technical review meeting. According to him, Health ICT or eHealth refers to the use of ICT in support of health and health-related fields, including health care service delivery; health surveillance; health literature; human resources for health, health accounting & financing, health sector partnership and collaboration, health education, research, and health management information system. He highlighted that the Health ICT strategic framework is a document that articulates the five-year Health ICT vision and activities to help achieve Universal Health Care (UHC) in Nigeria. The framework he explained is broken into three parts as follows and was drafted based on recommendations from WHO-ITU eHealth Strategy toolkit:

§ Part I: Health ICT Context and Vision § Part II: Health ICT Action Plan § Part III: Health ICT M&E Plan

In conclusion, Dr. Ekong called on all stakeholder’s feedback & recommendations and pointed all to access information from baseline assessment conducted at the start of this initiative1. Strategic Context for Health for ICT - Ms. Damola Sogunro Ms. Sogunro, Principal Computer Analyst, eGovt. FMCT explained that current statistics reveal that though the ICT enabling environment is growing at an amazing pace, the eHealth enabling environment is not growing at the same pace. Within this framework document, there are considerable opportunities for Health ICT to bridge this gap by addressing health challenges and towards Nigeria’s goal of universal health coverage. In summary, she hoped that with the adoption of the integrated action plan, we can leverage ICTs to achieve better results within the nation’s health sector.

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Vision for Health ICT - Mr Adeleke Balogun In presenting the Vision for Health ICT for Nigeria, which is “By 2020, Health ICT will help enable and deliver universal coverage”, Mr. Balogun strongly emphasized identified priorities and recommendations to help create a Health ICT enabling environment. Seven major areas were considered as follows:

1. Leadership and Governance 2. Strategy and Investment 3. Legislation, Policy and Compliance 4. Standards and Interoperability 5. Capacity Building 6. Infrastructure 7. Services and Applications

Without good leadership and governance, most projects, policies and frameworks fail to achieve their vision he explained. To forestall this, the framework recommends the establishment of health ICT governance structure at the Federal and State levels. Speaking on strategy and investment, he also stated the need to sustain funding and leverage on existing resources. The formulation and review of policies that will address regulatory gaps must be addressed when making legislations. The minimum infrastructure and computing requirements for each type of health facility and health administrative office must be defined and linked to accreditation and assessment. In conclusion, Balogun made it clear that solutions must be harmonized to avoid duplication of applications. He said infrastructure must be made a priority and bemoaned the poor state of power infrastructure in the country. One of the greatest challenges faced by the ICTs in health is the shortage of knowledgeable personnel. Knowledge impartation and training of personnel must be thorough and a key priority of stakeholders. Action Plan - Olasupo Oyedepo Olasupo Oyedepo, Country Director, ICT4SOML, presented the action plan to delegates and explained that it was developed using Theory of Change (which presents the pathway of change from the Health ICT enablers, to the short- and long-term related outputs and Health ICT outcomes as they align with UHC), along with the stakeholder-generated recommendations. The Action Plan is phased and spread over a period of 5yrs. In conclusion he highlighted that

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basically, the action plan outlines the elements required to achieve the vision of Health ICT in the delivery of UHC in a visual manner. Figure 1 summarizes the framework’s action plan.

Fig. 1 Overview of the National Health ICT Action Plan

Health ICT M&E Plan - Dr. Maryam Al-Mansur Against the backdrop of the action plan, Dr. Maryam Al-Mansur, presented the Monitoring and Evaluation (M&E Plan). In her words, the main focus of the plan is to track the impact of using ICT in health. It provides a link between the vision, action plan and desired results. M&E Framework is categorized by Health ICT outcomes and health impact and is structured into: Indicators, Target Measures and Governance (as shown in Fig. 2 below). With this plan activities are measurable and progress can be tracked and evaluated. However, she brought to the attention of the participants that it was going to need a lot of operational research since this is new.

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Fig. 2 M&E Plan

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CHAPTER TWO – Health ICT Framework Review

Group discussion session The breakout session provided an opportunity for participants to review and make contributions to the draft National Health ICT Framework 2015-2020. A template (shown below in Fig. 3) for capturing comments and focusing the report back to the plenary session was used. Group report back session The various groups reported back using the template after the break-out session. Group representatives presented group outcomes at plenary.

Section Comments i. The strategic Context for Health ICT and

the Vision

ii. The Health ICT Vision and Recommendations

iii. The Health ICT Integrated Action Plan iv. The Health ICT M&E Plan v. Other

Fig. 3 Facilitated Discussion Report-Back Template The details of the group output can be accessed from appendix 1. During the report back session, comments and issues identified by all groups fall primarily within the following broad areas: § Advocacy § Community Action § Typographical Errors § Citations/References Advocacy There was the unanimous consensus that there was a need for more aggressive advocacy & information campaign on health ICT. To realize the vision of Health ICT framework 2015-2020, it was suggested that advocacy should occupy the first rung of the action plan ladder. Without the proper level of awareness most people tend to shy away from change, new policies and technologies.

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Community Action The importance of involving the local governments was strongly reiterated as it was not clearly indicated in the draft document. It was recommended that having contact persons at the local go vernments and engaging them in meetings at state and federal levels was crucial to the realization of Universal Health Coverage (UHC) by 2020. Based on this suggestion, it was also advised that offices be created and delegated with clear tasks to prevent politicians from hijacking funds meant for the implementation process. Typographical Errors Presence of typographical errors within sentences proved the document was in need of thorough proof-reading. There were problems with the formulation of some acronyms and their initializations. Finally, some paragraphs might need rephrasing for more clarity. Citations and References It was highly recommended that citations be reviewed and made from more recent sources. In the same vein, there wasn’t enough citation for a handful of quoted statistics in the document. One or two appendices referred to were either missing or wrongly numbered.

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CHAPTER THREE – SDGs and National Health Policy

Recap – Emeka Chukwu

After the lunch break, Mr Emeka Chukwu, Project Manager, ICT4SOML provided a recap of the meeting proceedings so far. SDGs - Dr Chima Elenwune Dr. Chima Elenwune, Head, MDGs Coordination, FMoH was then invited to make a presentation on Sustainable Development Goals (SDGs). The Sustainable Development Goals (SDGs), also known as Global Goals or Agenda 2030, are an globally agreed set of targets relating to international development. Chima said up to 2015 the global development agenda was based on the MDGs. Why SDGs?

Since the MDGs will expire at the end of 2015, there was a clear need for a follow-up set of goals. The SDGs were first formally discussed at the United Nations Conference on Sustainable Development held in Rio de Janeiro in June 2012 (Rio+20). In 2014, the UN General Assembly's Open Working Group on Sustainable Development Goals (OWG) forwarded a proposal for the SDGs to the Assembly. The proposal contained 17 goals with 169 targets covering a broad range of sustainable development issues. These included ending poverty and hunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests. Implication for the Nigerian Health Sector

Dr. Chima specially pointed out that globally, the world was able to meet MDGs’ targets on poverty and water. Nigeria did particularly well in reducing infant mortality and improving maternal health (MDG No. 4 & 5) respectively. The successful early containment of Ebola and certification as guinea worm disease-free country by WHO in December 2013; were among other successes achieved by the Nigerian Healthcare system. However, he noted the need for Nigeria to focus on the unfinished projects of MDGs. Some of the implications the SDGs will have on the Nigerian health sector include: § Making more effort to cultivate successful public-private partnerships § Improve, monitoring, evaluation, accountability, and the NHIMS and allow

same to influence future policy § Must invest in increasing community participation § Make the shift to a performance based payment/funding model of operation

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Challenges

§ Systems: Suboptimal and still inadequate healthcare infrastructure within the country.

§ Resources: No debt-relief intervention this time and since the SDGs are broader , it will require a lot of financial investments

§ Direction: No clearly defined implementation arrangements in place yet. The SDGs global indicators will be agreed by March, 2016.

Conclusion and Reactions from Delegates

In conclusion, Chima noted that since 2006, there have been a lot of changes which required change of focus and direction. Despite the obvious challenges, he said the shift to Universal Health Coverage (UHC) and the ongoing review of the national health policy were among the handful of opportunities to be tapped. Following the presentation by Chima, participants reacted with observations and recommendations. First and foremost, one of the delegates from Kano state pointed that financing the SDGs was going to be a problem since the MDGs also suffered lack of finance for major developmental projects. Secondly, another delegate from Benue state said that the absence of an MDG office in her state with the early stages made implementation of the MDGs difficult. She prayed and hoped the SDG does not suffer the same fate. Review of National Health Policy – Bison John Against that backdrop, Mr Bisong John said there was every need for the review of the National Health Policy. Among the reasons he gave were population growth, need to align the policy with the FG policies and health sector challenges. He also highlighted that the old national health policy lacked clearly articulated mission and vision statements.

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CHAPTER FOUR - Conclusion How the Health ICT Framework Action Plan was developed - Olasupo Oyedepo Olasupo Oyedepo, emphasized the linkages between the vision and the various action items in the integrated Action Plan. In his brief presentation, he highlighted how the vision informed the recommendations which evolved into activities which when over laid on a 5 year time line formed the Action plan. He explained that the break-out session would provide greater details on the process of developing the Action plan from the vision and recognized the need for subsequent state action plans & activities to be domesticated to the specific contexts of the states. Consequently, he explained that the groups for the break-out session would be constituted by geo-political zones. He explained that it was not an Action plan developing session but was focused ensuring that state delegates understood the process that created the integrated action plan and are able to apply same within the specific context of their states. State Health ICT Action plan – Regional Group discussion session For the break-out session, state representatives were divided according to regions to discuss the evolution of action items & activities over a 5 year period (i.e. the integrated Action Plan) from the vision. The discussions within the groups were quite animated with the core strategy team working to enlighten & educate the state delegates on their process while the state teams highlighted & discussed possible challenges & risks to appropriate action plans at the state level. It was noted that political leadership at the states (i.e. Governors, commissioners) need to be carried along to ensure success while the possible hijack of health ICT funding by competing priorities was highlighted as a major challenge and risk. Closing Remarks - Mrs. Vasti Said In conclusion, Mrs. Vasti Said gave the final vote of thanks and enjoined the delegates to keep working on the document & the action plan in their states. She also emphasized the need to keep in touch with the FMoH, FMCT & ICT4SOML team for technical assistance.

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Appendix 1 - Recommended changes to the DRAFT Health ICT Framework

Section Comments

The strategic

Context for

Health ICT

and the

Vision

Page 14, Part I. Section 1

· Population & Health status:

· Sources of information and references should be stated

· Pg.14, Par.2 Line 7. Typo: “Infections” should read

“infectious”

· Pg. 14. Section.1 Under the subheadings, we need to provide

references or sources for quoted statistics. Some were provided and

others left out.

· Page 14, Referencing not indicated in some area e.g. Population

estimates.

· More recent data sources should be used.

· Include reasons for high mortality rate.

· More enlightenment on Health Insurance.

Recommendation:

· In Page 15, Fig. 1 Remove the complex diagram and replace with

a simpler diagram – bar chart or 2-line graph

Page 18, Fig 3.

· Concern was showed that this might be interpreted that only

NIMC & NHIS can be involved in this. The facilitator explained that it does

not mean that other organizations cannot be involved in doing all these in

future. It just means that for this purpose, NHIS & NIMC are the key

players.

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Between pages 14& 16- strategic context for health ICT.

· PG 14: Population and health status; we need to identify the

source of information (check and site source).

Page 15, Fig 1- check and site source

· Share the report on assessing the enabling environment for

Health ICT in Nigeria with all.

Page 61: Bullet 16- End notes

· Main Point: Check and site sources for data

· Some states have more partner and donor support for health ICT

than others. The FMoH should encourage Partners/donors to go to

orphan states to make investments on ICT so that all states will be on the

same page for full operationalization.

The Health

ICT Vision

and

Recommend

ations

· Speedy formation of state level framework to achieve the set

vision

· Page 18: Integration of private sector

· Page 43: A desk officer should be appointed in MOH and

responsible to the DPRS (this should be concretely defined to avoid

political interference)

· Page 22: Line 5-7: States should be persuaded to invest more in

ICT

· Pg.16 Line 1 Typo: …Identifying the potential(s)

· Pg.16. Line.11 Par. 1,

· We suggested the inclusion of “affordable” to the statement

…”delivery of quality, affordable, and equitable…”

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· Pg. 16 Section 2. Localize statement in green box:

· “By 2020, Health ICT will help enable and deliver universal health

coverage” should read “By 2020, health ICT in Nigeria will help

enable and deliver universal health coverage

· Pg.17. line 12. Initial caps. : “health information exchange”

should be “Health Information Exchange”.

· P.17. Line. 13 : “infrastructure and equipment” should read

infrastructure & equipment.

· Pg.18 Lines 9, 10 and 11. Capitalize all first letters in group

of words leading to acronyms,

· Pg. 19. Bullet point 6: “material” should read “materials”

· Pg. 23. Line 3. “National Council for Health” should be

“National Council on Health”. This correction should be reflected in the

entire document as appropriate.

· “Commissioner on Health” should be replaced with

“Commissioner for Health”

· Page 16, a mission statement should be included.

· Local Governments should be included anywhere Federal and

States are mention.

· Awareness of Health ICT at LGA level

· Page 22, item legislation, Policy and Compliance, line 1, should

read existing laws and policies

· Page 23, the governance structure for states, LGA team

should be included in the steering committee.

· Between Page 16-20

· Page 16: Does this mean that only ICT can deliver this to the

health sector?

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· It was made quite clear that we need to understand that ICT is to

help deliver to universal health coverage. This is just giving a vision to

Health ICT.

· PG 19- Table 1: Component of health ICT Enabling environment.

· Making reference to Page 61: Bullet 15

· Page 19, line 3: Vignette should be replaced by scenario, for the

reason of consistency in terms.

· Page 20: This scenario is possible now just needs to be tied

together to make it a reality. First line, “Herself” not “her”. *Fatima

was expecting.

· Re-color the subject and make it bolder. Move this immediately

before figure two on page 17.

· Suggestions: Anyone who can come up with a better story should

please do and send it in an email.

· Page 19: Foundations for Change

· 3.1: Leadership & Government- Not much is mentioned on what

is needed by government at state level. Page 43: talks about the state.

We should add a reference from state as done on.

· Page 27, figure 5: Check and site your source.

The Health

ICT

Integrated

Action Plan

· Part II, Section 2, Paragraph 2

· Appendix 5 not 6

· Pg.24. Par.1 “Rephrase the Paragraph.”

· Pg. 26. Section 3.6. Line 5. Change “marginalized to

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“underserved”.

· Page 29, figure 6, under UHC outcomes, column 2 should be

Increased/Improved coverage

· The biggest solution health ICT to health insurance and the

biggest challenges are identification and verification done through ICT.

This is the concept of using technology without being exposed to financial

risk.

· Action plan is adequate for robust ICT implementation

The Health

ICTM&E Plan

· Pg. 30: Part II Sec. 2. Par. 2 Line.3 “Change “appendix 6” to “

Appendix 5”

· Pg. 30. Part II Sec. 2. Par. 2 Line.8. “There is no figure 7 in the

document

· Page 35, para 1, line 1: should read vision, mission, action plan

and desired results.

· Page 57, the head note: Where possible should be expunged

from that statement.

· Page 35, Paragraph 2,

· In public health technology an impact is most important, what the

output is doesn’t matter.

· Need for baseline assessment of ICT infrastructure in each state

Other Page 7,

· LGA – Area not Authority

· NIGCOMSAT – Nigeria Communications Satellite Ltd

· NITDA – National Information Technology Development Agency

Governance

· Advocacy for incorporation of LGAs into the stakeholders forum

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· States to evolve homegrown models based on their peculiarities,

taking a cue from the draft document

· Synergy with Local Government Service Commission on

deployment of trained manpower to avoid inadequacy of manpower at

different facilities

· Manpower training and re-training be high on priority

· Strengthening of collaborations between all stakeholders in the

States like HSMB and MoH, etc

· Buy-in of Governors, Commissioners of Health, ICT, Economic

planning and other relevant stakeholders will be very important to ensure

success

· Continuity of implementation is the responsibility of respective

States and should be reflected in the plan

Legislation, Policy & Compliance

· Statutory & Legislative backing should be provided for the

document in states as administrative approvals may not be sufficient

· Review and update of policy be reviewed occasionally especially

as the National Health Act may not capture specifics

Role of States

· Creation of demand should be incorporated into the document.

· States are at liberty to create their own governance structure

based on their own peculiarities

· This document needs to be domesticated in the state as a key

requirement to make it actionable.

· States need to be part of the process of framework development

(bottom-up approach)

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Appendix 2 – Cross section of participants

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Appendix 3 – Meeting Agenda Meeting Objectives: • Present the draft Health ICT Vision, Plan and Theory of Change to state

teams and gather feedback • Catalyze interest around development of state Health ICT action plans with

Technical Assistance from FMoH, FMCT & ICT4SOML 29th September 2015 Agenda

Activity Time

Tea and coffee 8:30am – 9:30am

Welcome Remarks - (Directors of eGovt. FMCT. & HPRS-FMOH)

9:30am – 9:50am

Introduction 9:50am – 10:30am

Presentation: ● Why are we here? & What is eHealth? ● Strategic Context for Health ICT ● Health ICT vision and Recommendations ● Health ICT Action Plan ● Health ICT M&E Plan

10:30am – 11:30am

Health ICT Framework review 11:30am – 12:30pm

Report back 12:30pm – 1:30pm

Lunch 1:30pm – 2:30pm

Recap 2:30pm – 2:40pm

Review of additions to the National Health Policy 2:40pm – 3:30pm

Presentation on Action plan process Discussion

3:30pm – 4:30pm

Next steps & Wrap-up 4:30pm – 5:00pm

Tea break 5:00pm – 5:30pm