Pharmacist Fati Murtala-Ibrahim is the Director of Strategic Information at the Institute of Human Virology Nigeria (IHVN). In this interview, Murtala-Ibrahim, whose experience spans public health and community pharmacy speaks on the importance of electronic medical records (EMR) systems and ways strategic information helps in monitoring trends in diseases and other related health events, as well as how to tackle challenges of relevant health data collection, among others.
Can you tell us the importance of strategic information to healthcare?
Strategic information is high-quality, reliable evidence and data that have been effectively collected and used to improve all levels of health programmes and ultimately patient care.
And without strategic information, it will be impossible to make policy decisions that can help transform the health system.
So, we use strategic information to help us monitor trends in diseases and other related health events so that deviations from the normal course can be promptly identified and addressed.
It is also helpful to measure the impact of health programme strategies, and investments inother to make the required adjustments when needed.
Resources are very limited, so we need to be able to use strategic information to know how to guide where our resources are used.
Everyone has a role to play in strategic information, the government and policymakers need to make adequate resources available for strategic information.
Data collectors and health information managers need to ensure quality assurance and integrity in the process of data collection, transmission, analysis, and use. It is very important that citizens provide the right information so that we can synthesise strategic information.
What is your assessment of the collection of relevant health data currently in the country?
Well, as a nation we have come a long way from where we are coming from, but we are still evolving. You know we are not where we had hoped to be, but I think there is room for improvements and we are progressing along very well.
Over the past few years, donor agencies have partnered with organisations and governments to improve the collection of both routine service data and disease-specific data both at the facility and the community.
We also have a few national and sub-national health-related surveys which are done at different levels, and this is also to help decision-making and national development.
What are the challenges to collecting relevant health data in the country?
The major problem is the lack of a unique and unified patient identification management system.
We run different programmes, a lot of programmes that are vertical. So, you have the TB programme, you have the HIV programme, you have other non-communicable diseases. But what we lack is one unique identifier so that you can link a patient’s different disease situation together and it will give you a better outlook of how to manage that patient.
But because we lack that, it’s difficult to do that. So, you see that you are attending to patients as individuals.
For instance, if the patient is HIV positive, you attend to that patient in the HIV clinic just as an HIV patient. If the patient has, let’s say diabetes or hypertension, he goes to the general clinic and is treated as an independent person.
But if we have an integrated system with a unique patient identification, you can manage the patient across all the different disease areas.
Currently, in the HIV programme, efforts are being made to address this challenge through biometric capture on the EMR and subsequent duplication on the NDR. However, this system is still evolving, and a patient identity management system (PIMS) is being developed to link and monitor HIV patients’ care across multiple facilities.
We also have the problem of poor documentation of service delivery data which we continue to resolve through various data quality assurance methods including training of service providers as well as provision of job aids and standard operating procedures to relevant staff.
There is also the lack of adequately trained human resources for health due to frequent staff attrition as a result of the current wave of brain drain in the country.
What is your advice on ensuring an efficient health data collection system in the country?
It is important for us to manage our health information in one system, starting by agreeing to have that one unique identifier. You know, like in developed countries, once you have a Social Security number that serves as your identification. And we’re hoping that we’ll get to the point in this country where we can use our National Identity Number (NIN) as a unique identifier.
If government can invest more in data collection processes and data management processes in general, we will do well as a country.
What standardised data management systems do you think should be deployed to ensure efficient healthcare delivery?
Adoption of a robust EMR system that incorporates all disease areas, and is interoperable with other health information management systems will go a long way in ensuring efficiency in the healthcare data management system in Nigeria.
It will enable providers to have quick access to accurate, up-to-date, and complete information about their patient’s medical history at the point of care, and to diagnose patients, reduce medical errors, and provide safer care more effectively.
Some private health facilities and pockets of secondary and tertiary health facilities that are already moving away from the traditional paper-based medical record system can attest to these benefits. In the HIV programme for example, all our supported health facilities have EMR.
However, we have realised that there must be integration of other disease areas to derive maximum benefits for our patients.
This is not to appreciate how far we have come as a country; some disease areas have electronic medical records systems but the need for an integrated system cannot be overemphasised.
How has IHVN been supporting facilities towards utilising tools for data?
Tools are essential for monitoring and evaluation in any programme. IHVN has an efficient system of budgeting, procuring, and distributing data collection tools to all our supported sites irrespective of the disease area that we are supporting.
As health programmes continue to evolve, periodic reviews of these Data Collection Tools (DCTs) become necessary, and IHVN as an organisation partners with the government of Nigeria and other relevant stakeholders. It also contributes to the review process at the national level.
We also support the replacement of old versions of DCTs with newer versions at our sites whenever they are rolled out by the Federal Ministry of Health, and also support capacity building on the use of the tools at all levels.
You know, it is one thing for you to develop the tools and it’s another thing for people to be able to use the tools.
One of our major successes is that we have been able to deploy EMR systems to facilities that we support.
We have been able to deploy EMRs to all the facilities that we support in the ASPIRE Project, which is our HIV project.
We are trying to move away from the traditional paper-based system but we all realise that EMRs come with their costs so we have also adopted the use of other mobile devices to see how we can support the monitoring and evaluation of diseases.
In our HIV project, we support 386 facilities across four states: FCT, Katsina, Nasarawa, and Rivers.
I think that government buy-in is what is key because we have been dependent over a number of years on support from international funders.
If Nigerians can push forward the agenda of an EMR system irrespective of the level of facility, Nigeria will be better for it. Government has to find a way of supporting facilities by providing alternative sources of power. Not necessarily generators but solar-powered infrastructure. EMR doesn’t come cheap even in the management and the support that you provide for it.
As a country, we just need to own it and plan for it. Planning can help but relying 100% on funders is not the way to go. We need to start looking inward to see how we can support our health facilities even if we start with just providing a facility with one computer system.