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www.jghcs.info
[ISSN 2159-6743 (Online)]
Barriers to Implementation of E-Health in Africa The Bulletin of the World Health Organization (2008) stated that Nigeria has been searching for the right policy formulation in health care more than 30 years since the Alma Ata declaration of health for all in 1978. Successive Nigerian governments have not enacted any policy on the implementation of hospital information systems in the health care delivery apparatus of the nation. This lack of policy partly explains the continued poor national health outcomes as revealed by the Nigerian Ministry of Health survey in 2003. The report put infant mortality at 110 per 1000 births and maternal mortality of 1100 per 100,000 live births. The United Nations report ranked Nigeria as the second highest in maternal mortality in the world (Akinyemi, 2008). In Africa, the loss of health triggers the near-poor into poverty with consequent dehumanizing effects of extreme poverty (Pick, Rispel, & Doo, 2008). The Millennium Declaration pledged freedom for men, women, and children from adverse consequences of poverty, but in Sub-Saharan Africa, concerns abound on the projected outcome of the current millennium development initiatives that do not include any elements of electronic health system implementation (Pick et al., 2008). Ouma and Herselman (2008) indicated that whereas the developed Western nations are at the forefront of implementation of electronic health, African countries are still at the rudimentary stages of adoption processes. Some of the reasons attributed to this disparity include poverty, poor economic diversification, and lack of supportive infrastructure and inadequate use of natural resources. Stressing that lack of leadership responsibility in setting the right health care priorities may well have been the bane on accelerated development of the Nigerian health care. The peculiar Nigerian situation. The Nigerian health care system has continued to suffer from years of neglect by successive governments, hence the poor infrastructural base of both public and private health establishments (Okogbule, 2007). The trend is the same in almost every subset of the national life. At the 2009 UNESCO conference organized to review and evaluate development efforts by member states after a decade, the Nigerian score card showed failure in all ramifications. Other West African countries like Senegal and Ghana were proud of their achievements within the last 10 years (Ogunlana, 2009). According to Gyoh (2008), the revised health policy document indicated that government expenditure on health was below $8 per capita, against the $34 recommended internationally. Compounding poor government funding of health care in Nigeria is the high rate of corruption in the national polity (Christoff, 2005). Overvalued contracts and failed projects abound in an economic system leading to nonactualization of technological breakthroughs and infrastructural decay. Poverty seems to be a common excuse for poor investment in infrastructure in Nigeria. Sofowora (in press) opined that despite the abundant natural resources in Nigeria, the country ranks ninth poorest in the world because of its failure to harness its natural wealth. World Bank (2007) statistics indicated that the poverty rate rose from 27% in 1980 to 70% in 1990, and even at present does not show any economic index of improvement. The consequence is the dearth of basic social infrastructure (Sofowora, in press). Electric power supply is at its lowest ebb with less than 50% of the country connected with electricity. In places with electric power connectivity, the supply is fewer than 12 hours daily. Lack of consistent power has caused poor industrialization of the country at large. In a related subject examining the poor adoption of innovative information technology in the Nigerian banking industry, Ayo, Ayodele, Tolulope, and Ekong (2008) reported that poor electric power supply is a major hindrance. The erratic power supply is a challenge to infrastructural development in every facet of the Nigerian economy. Inadequate Internet bandwidth is also a notable challenge in Africa. Internet connectivity problems abound in Nigeria with the few Internet service providers in the market offering very poor services because of bandwidth constraints (Ayo et al., 2008). Other barriers hindering adoption of hospital information technology in Nigeria, and some African countries include the high cost of implementation, poor infrastructural development, and inadequate trained manpower. Ouma and Herselman (2008) conducted multiple case studies of technological assessments in the province of Nyanza in Kenya to ascertain how rural hospitals are adapting to technology shift in health care. The issues examined were
www.jghcs.info
[ISSN 2159-6743 (Online)]
JOURNAL
OF
GLOBAL
HEALTH
CARE
SYSTEMS/VOLUME
1,
NUMBER
3,
2011