A New Work Scope for Healthcare Systems Development in Nigeria

Federal and State regulatory relaxations coupled with increasing social distancing guidelines due to the COVID-19 pandemic is promising to accelerate eHealth adoption and healthcare innovation in Nigeria. Rapid technology adoption globally is fostering more innovation in recent weeks than in the recent and somewhat distant past. Discussions regarding the expectation of a necessary advancement in current healthcare systems and the role IT strategy will play in positioning administrative processes and clinical operations to respond to the new challenges posed by the coronavirus epidemic, is likely to hold on the background of a potential breakdown of the country’s health system due to increasing spread rate.

The three top priorities in dealing with the situation during the pandemic on the side of government was first to safeguard the safety of first-line responders, healthcare workers, patients and household. Next was a renewed focus on practice collaboration and cooperation, not competition. The third was the exploitation of technology, at least on a fundamental scale to track the pandemic early enough and to support first line responders in curtailing an escalation in the spread of the pandemic. Afterwards and hopefully too, the pandemic is expected to influence a nationwide adoption of IT and innovation strategy in health systems management, and then streamline the focus of government and other stakeholders to the need for an overarching strategy for the implementation of eHealth systems nationwide over the coming months.

Our national response strategy to pandemic is bound to define the new normal. Technology adoption vis-à-vis tele/virtual health and regulatory adjustment will by no means foster more and more innovation in the coming months, than in the recent and somewhat distant past. It will be hard to imagine going back to an 'over-encumbered’ health system model after we have experienced the benefit of greater collaboration and existential innovation. We will not be transitioning from crisis to normal. Rather, we will be moving from crisis, through multiple periods of aftershocks, through to eventual stability. We will certainly be treating this in waves of severity – preparation for surge, managing the apex and navigating through recovery.

However the progress trajectory will lead, we expect a seismic shift in business and clinical workflow models. As a driver and supporter of change, IT will need to stay closely partnered with the administrative and clinical operations as stakeholders take time to figure out the new normal. Digital technologies will continue to be the answer to consumer demand outpacing provider supply of services. This will include:

·        Launch in consumer healthcare – Provision of digital products and services, consumer generated data, digital health/digital front doors.

·        Update training – Clinicians will be working in roles/parts of the organization to which they are unaccustomed. They will need to be prepared to support the end user community in their new roles

·        Signage, direction and way finding – Health facilities will work on the communication to ensure messages are clear, current and easily understood as clinicians, patients and families navigate their facilities physically and across new digital tools.

·        Emergency Messaging Services (EMS) to emergency responders – There will be more robust coordination across all layered service points with multi access channels fully functional to ensure accurate communication with the country’s health system.

·        Clinic to patient communications – Cellular, text, web, mobile app and automated call apps will become an integral part of care process in the country.

·        EHR configuration – All EHR technologies in the country will be regulated to provide fundamental new services such as bed tracking for converted beds, patient tracking, patient room EVS status, biomed equipment cleaning, user accounts and permissions, under a certification program to address dynamic workflow models required to address patient surge and peak demand.

·        System capacity – Be prepared to support new and increased levels of remote workers through Skype, Zoom, Citrix, virtual desktops and other cloud-based productivity solutions

·        eHealth capability – Be prepared to support a new and increased demand for digital technologies, and be mindful of security related requirements..

·        Information security – Be aware and have heightened preparedness as bad actor activities have been on a steady rise. We are in unprecedented times creating unprecedented vulnerabilities.  

At the moment, Durandel, like all stakeholders in the sector, is focusing all of our efforts on "raising the line" beyond the first-line focus of "flattening the curve". Flattening the curve is in reference to efforts to avoid spread of the disease, through common sense measures like hand hygiene, but also through major societal and workplace measures such as social distancing, cancellation of large gatherings and virtualization of as much work activity as possible.

“Raising the line” in our narrative refers to increasing the capacity of our health systems to deal with the expected large number of cases — both "real" cases and worried well. To accomplish this, we have accelerated work towards the commencement of our Small Scale Pilot (SSP) of the National Healthcare DataShare System (nHDS) which is an electronic Health Information Exchange (HIE) for Nigeria’s health system. We have further expanded the reach of the SSP to accommodate a significant number of participating entities in order to accelerate the adoption and reach.

The outbreak is nothing to be happy about, but it has forced a lot of conversations that would have taken years to happen otherwise. There is need to figure out how to dynamically address specific situations and to keep all Nigerians safe and well. Likewise, realizing that the situation is changing by the hour, we anticipate that the conversation on how to go beyond staying on top of the situation would begin, in order to commence the development of a national system based technology tools to facilitate innovation in healthcare treatment approaches, diagnostics, monitoring and surveillance, and response capacitation.

To support the process, Durandel in its healthcare systems market development strategy delineated the eHealth sub-sector into three (3) stream segments with each providing strategic support for the capacitation of the country’s healthcare workforce. The downstream segment deals with the provision of productivity-related technology tools to improve positive health outcomes and deliverable among the country’s healthcare workforce. The midstream segment provides for an information exchange that supports safe, complete and standardized sharing of healthcare data. The downstream segment provides for the access of information and services by the demand side of the market through mobile apps.

For government and stakeholders to expect any significant returns in investments in the eHealth sub-sector, the midstream infrastructure which is the HIE needs be in place. The development across the other two streams will be referenced from our HIE infrastructure. And early adopting participating entities and Point-of-Care facilities will become indexes in the escalation of the solution nationwide and possibly cross-border covering Africa’s sub-Saharan region. Nigeria’s healthcare stakeholders have invested a lot in hard infrastructure, it is time now to optimize existing assets, innovate on systems and processes and begin to leverage private capital to be able to orchestrate sub-Saharan Africa’s healthcare market.

Looking ahead, we see the biggest opportunity to disrupting the healthcare market as contained within the capability to provide clinicians with the scale and size of data to make the best decisions for their patients at the lowest cost. This we have over the last couple of months aimed to accomplish with the development of the nHDS, and that remains top of mind for us at this trying moment for our world. Hopefully, the Federal government and regulators will support a lot more organizations, whether they be large companies or small startups, to channel their innovation work to the eHealth space. There is a whole lot of work to be done within that space but it has to be done with a focus on the industry's key value drivers, path of least resistance and delivery path. We are providing the fulcrum to unleash real innovation in the industry and to getting this done in a way that fits our context.

Durandel has been working on influencing a resilient market system for Nigeria’s healthcare and will be seeing that through in the coming months. Irrespective of the sector we continue to work in, our goal remains to make deploy technologies that support market systems model that serves Africa. Our goal is to be a resource that the sectors and markets we play in need, and then to deliver innovations that can be distributed across Africa. The enormity of Africa’s development task is constantly in our face. It is a difficult time for us all, but innovation is not OPTIONAL, it is the BASIC REQUIREMENT going forward.