Repositioning health information management practice in Nigeria: Suggestions for Africa

Shortage of health information management professionals

The Master Health Facility list developed by Nigeria’s Federal Ministry of Health and reported by Makinde et al. (2014) uniquely identified 30,345 primary health facilities, 3993 secondary health facilities and 85 tertiary health facilities distributed across the country. However, as at 2012, there were just 14,800 health information management professionals in Nigeria (Adeleke et al., 2014). These professionals were individuals who had completed either a 2-year certificate programme or a 3-year technician programme or a 4-year higher national diploma programme. This situation highlights the gross inadequacy of the workforce of health information management professionals in Nigeria. While information on the situation of the health information management workforce in other African countries is scarce, reports from developed countries such as the United States, Canada and Australia indicate a shortage in the health information management workforce globally (Dyson et al., 2004; Gibson et al., 2015; HIMAA, 2015). This workforce shortage could undermine the quality of information available for making meaningful health decisions.

Quality of professionals and training

Information on training programmes for health information management professionals at an undergraduate and postgraduate level in Africa is scarce. In Nigeria, Makinde et al. (2016) reported on 79 training institutions that offered health information management diplomas in Nigeria. These training institutions, referred to as Departments of Health Information Management and Schools of Health Information Management, were located in colleges of health technology and teaching hospitals, respectively. The colleges of health technology offered technician certificates and professional diplomas in health information management, while the schools of health information management offered an Ordinary National Diploma and a Higher National Diploma in health information management. However, this form of training does not cover all of the required skills needed by health information management professionals. These skills gaps have been well documented in previous studies (Adeleke et al., 2014; Makinde et al., 2016), and a subsequent curriculum assessment (Makinde et al., 2016) led to the development of an improved curriculum, which is now being used in all schools of health information management in Nigeria. This new curriculum saw the introduction of courses such as health informatics, electronic medical records, database management systems and monitoring and evaluation. However, studies evaluating the impact of the new curriculum on the quality of health information management graduates have not been reported in the literature.

Furthering the discourse on shortcomings in the training of health information management professionals in Africa, a Vital Wave Consulting Report (2009) cited lack of qualified health information management practitioners in district hospitals in Ghana and Sierra Leone and also mentioned that this state of affairs was particularly unsatisfactory in Uganda, as there were no formalised training programmes in general for health information management practitioners, regardless of their level in the health system. Lack of technologically skilled health information management personnel was also cited in a study of hospital facilities in South Africa (Bimerew et al., 2015), where human resources development planning is limited, there are no established health information management career paths, and accredited health information management training programmes do not exist (English et al., 2011).

Involvement in e-health information management implementation

Information and communication technology (ICT) tools drive information management across all sectors of the economy. The WHO (2006) used the term e-health to refer to the application of ICT in the health sector, and ICT has also been adopted for the purpose of health information management. While a number of e-health implementations, particularly electronic health records (EHR) have occurred in Africa, reports are often silent on the involvement of health information management professionals (Akanbi et al., 2012; Ohuabunwa et al., 2015; Tierney et al., 2010). This state of affairs could hamper successful implementation of EHR projects when health information management professionals, who play a leading role in healthcare information systems and have an understanding of the information processes in healthcare, are not involved. As results of studies in more advanced countries have highlighted, the success of EHR projects can be attributed to the involvement of health information management professionals (Fenton et al., 2006; Masuku et al., 2013).

Visionary leadership

The significance of leadership in any given endeavour cannot be overstated. This section discusses visionary leadership first because most of the challenges previously highlighted could be tied to leadership challenges. It is proposed that for the health information management profession to progress in Nigeria and the rest of Africa, there is a need for leaders who can, through advocacy, public–private partnerships and international collaboration, situate the profession in its appropriate position within the overall health sector. Leaders who can effect change in the mindsets of health information management practitioners, who may otherwise see themselves as inferior, are needed. For instance, the important role of leadership in transforming health information management practice in the American health information landscape has been well documented (Sheridan and Smith, 2009; Sheridan et al., 2016). There is also the need for strong and united national health information management associations. Their roles should be clearly spelled out in constitutions and upheld in the spirit of fairness and altruism.

Quality of training

Some significant steps have been taken to improve the quality of training, which has led to an increasing number of more highly qualified health information management professionals in Nigeria. For instance, Makinde et al. (2016) reported a review of the diploma training curriculum in Nigeria done in light of advances in ICT and its application in health information management. While this is an important step in improving the quality of training, it has been limited to the training offered at the diploma level. Diploma level training is also the most widely available training in countries such as Ethiopia and Kenya. Unfortunately, this level of training is minimal and has long stifled the growth of health information management practice in the region. As a result, there has been a long-standing call for a health information management bachelor’s degree programme in Nigeria, as well as in some other parts of Africa, such as Ethiopia (Adeleke et al., 2014; Tilahun et al., 2014), although it should be noted that some African countries do already have a bachelor’s degree programme in place (e.g. Houdegbe North American University in the Republic of Benin; Kenyatta University in Kenya; and Botho University, Botswana). Tilahun et al. (2014) also reported the development of a bachelor’s degree programme in health informatics at the Gondar University in Ethiopia. However, there is a need for various national associations to collaborate with Universities in their respective countries to push for more bachelor’s degree programmes. Another notable step in this direction is the development of a Global Academic Curricula Competencies for Health Information Professionals by the American Health Information Management Association, with inputs from representatives of the International Federation of Health Information Management Association (IFHIMA). Therefore, it is important that this developed curriculum be integrated into existing degree programmes in countries where such programmes exist and should form the basis of the curricula in institutions intending to commence the health information management bachelor’s degree programme across the continent. In addition, there is a need to begin to train health information management professionals early on software development, so that they can become leaders in software development for the health sector.

There are a number of health information management postgraduate degree programmes spread across Africa – Masters of Health Information Management offered at the University of Ibadan, Nigeria (University of Ibadan, n.d.); Joint Master’s degree programme offered by Muhimbili University of Health and Allied Sciences, Tanzania; University of the Western Cape (UWC), South Africa and Neu-Ulm University of Applied Sciences, Germany (UWC, n.d.); and Masters of Information Resources Management (health information management specialisation) offered at Babcock University, Nigeria (Babcock University, n.d.). Others postgraduate degrees that are more focused on health informatics are Masters of Science in Health Informatics offered at the University of Ghana, Ghana (University of Ghana, n.d.) and Moi University, Kenya (Moi University, 2016); Masters of Public Health in Health Informatics at the University of Gondar, Ethiopia (University of Gondar, n.d.); and Masters of Medical Science in Medical Informatics at the University of KwaZulu-Natal, South Africa (University of KwaZulu-Natal, n.d.). It is worth noting that Babcock University in Nigeria is perhaps the only University in Africa to offer a Doctor of Philosophy (PhD) programme in Information Resources Management that allows for a specialisation in health information management (Babcock University, n.d). The need for PhD programmes in health information management cannot be overstressed, considering its importance in providing the much-needed academic manpower to lead quality programmes. Furthermore, health information management regulatory bodies should champion collaboration efforts with other stakeholders, such as the African region of IFHIMA and national associations and institutions of higher learning for the purpose of improving the quality of existing academic programmes and developing new ones.

Health information management professionals’ involvement in electronic environment

There is a need for a redefinition of roles for health information management professionals in the electronic environment. Health information management national associations need to develop policies or position papers to clearly outline the roles and responsibilities of health information management practice in EHR implementation and use. Studies showing the involvement of health information management practitioners in the wave of e-health implementations sweeping across the region have been relatively scarce (Masuku et al., 2013). Health information management professionals, through the leadership of national associations, must strategically position themselves and take a stand on matters relating to EHR. However, it is also important to note that e-health information management development and implementation is not the sole responsibility of health information management professionals. It requires a mix of input from others such as system developers and other potential users in the case of an integrated system. As such, collaboration with existing e-health providers for the greater good of the health sector is important.

Policies and standards

In the African health information management practice environment, there is a lack of explicit policy to guide practice. South Africa, with its Health Professions Council, is the only African country with an explicitly laid out procedure for medical records practice, but it does not mention the practitioners (Anthony, 2012; HPCSA, 2002). Also, the era of EHR calls for a number of policies, especially in areas of implementation, standardisation and interoperability. Thus, there is a need for the leadership of health information management national associations and regulatory bodies to make a case to relevant government agencies via position papers, round table meetings and symposiums in a bid to come up with policies guiding health information management practice in general. Furthermore, health information management leadership should champion efforts aimed at implementing existing e-health strategies and policies in the various countries.

Research

One way to improve the professional practice of a profession is through the research and scholarly activities carried out by its members. Results of such research should be reported and published, thereby contributing to the knowledge base in that area of practice. There is a need for a greater number of health information management professionals to become involved in research activities. International summits with a focus on African health information management, championed by the executives of the African region of IFHIMA need to be organised, not just for the purpose of interaction but also for charting actionable courses. In addition, the need for a high-standard academic African health information management journal has never been more urgent than now.