|SYMPOSIUM – IOMC 2011
|Year : 2011 | Volume
| Issue : 4 | Page : 470-478
The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems
Menizibeya Osain Welcome
Department of Normal Physiology, Belarusian State Medical University, Minsk, Belarus, Pr., Dzerjinsky 83, Minsk, Belarus
|Date of Submission||18-May-2011|
|Date of Decision||18-May-2011|
|Date of Acceptance||18-May-2011|
|Date of Web Publication||23-Nov-2011|
Menizibeya Osain Welcome
Department of Normal Physiology, Belarusian State Medical University, Minsk, Belarus, Pr., Dzerjinsky 83, Minsk
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe) health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles.
Keywords: Health care, medical intelligence, medical surveillance systems, Nigeria, Nigerian health care system, public health
|How to cite this article:|
Welcome MO. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. J Pharm Bioall Sci 2011;3:470-8
|How to cite this URL:|
Welcome MO. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems. J Pharm Bioall Sci [serial online] 2011 [cited 2020 Feb 24];3:470-8. Available from: http://www.jpbsonline.org/text.asp?2011/3/4/470/90100
The Nigerian health care has suffered several down-falls. ,,,,,, Despite Nigerian's strategic position in Africa, the country is greatly underserved in the health care sphere. Health facilities (health centers, personnel, and medical equipments) are inadequate in this country, especially in rural areas. ,, While various reforms have been put forward by the Nigerian government to address the wide ranging issues in the health care system, they are yet to be implemented at the state and local government area levels. , According to the 2009 communiquι of the Nigerian national health conference, health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care. The communiquι further outlined the lack of clarity of roles and responsibilities among the different levels of government to have compounded the situation. 
Unarguably, problems in the health care system of any country abound to a certain extent. ,,, Although health has the potential to attract considerable political attention, the amount of attention it actually receives varies from place to place. In their commentary of the 3T's road map to transform US health care, Denise Dougherty and Patrick H. Conway rightly stated a step by step transformation of the US health care system from 1T →2T →3T which is required to create and sustain an information-rich and patient-focused health care system that reliably delivers high-quality care. 
Provision of timely information aimed at combating possible health menace among many other things is an important function of public health. Hence, inadequate tracking techniques in the public health sector can lead to huge health insecurity, and hence endanger national security, etc. ,,,,,
For decades ago, communicable diseases outbreak was a threat not only to lives of individuals but also national security. Today it is possible to track outbreaks of diseases and step up medical treatment and preventive measures even before it spreads over a large populace. ,,, Medical and epidemiological surveillance, besides adequate health care delivery, are essential functions of public health agencies whose mandate is to protect the public from major health threats, including communicable diseases outbreak, disaster outbreak, and bioterrorism. ,,, To avoid the various threats and communication lapses to strengthen the health work force planning, management, and training which can have a positive effect on the health sector performance, one requires timely and accurate medical information from a wide range of sources. 
The Nigerian health care had suffered several infectious disease outbreaks and mass chemical poisoning for several years. Hence, there is immense need to tackle the problem. ,,,,,,,,,
This study aims to review the state of the Nigerian health care system and to provide possible recommendations/solutions to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, the dynamics of health care in the United States and Europe with regards to methods of medical intelligence and surveillance (MIS) are also reviewed. In this article, MIS systems are suggested to be integrated into Nigerian health care system to serve the needs the health care system of the modern era.
| Materials and Methods|| |
Search for literatures for this review was conducted throughout the period of the study to track new developments and published reports and articles. The search period was from June 2010 to January 2011. This study adopted a qualitative approach, so as to adequately describe the study aims and objectives. The study was based on both primary and secondary data. The primary data for this study were collected through scientific database sources and web engine searches. Secondary data were based on direct observation and relevant documents from the Nigerian Ministry of Health.
Sources of literatures
- Scientific databases: the following databases were included in the search process-PubMed and African Journals Online.
- Internet searches were based on Google and Search Nigeria (http://www.searchnigeria.net).
Searches in peer-reviewed databases, Google, and Search Nigeria were conducted in the following phases [Table 1]. Once a preliminary list of articles was determined, the databases and Google were researched for additional articles/reports once a month to constantly track new reports and articles. Using an analytical and ancestry approach, the articles chosen were scanned for further relevant articles. The following techniques  were applied to further retrieve relevant articles for the review process.
Backward references search: The references of high-quality articles were searched to retrieve important information about the state of the Nigerian health care system.
Forward references search: Reviewing additional articles that have cited the article/report to locate follow-up studies or newer developments related to the state of the Nigerian health care system.
The backward and forward searches were terminated when no new idea was found. The reference list represents part of the literatures retrieved during the data collection process.
Keyword search parameters
This study was limited to keyword searches that resulted in the most relevant results. A keyword combination search was used since in this way the study aims and objectives are better attained. The following keyword combinations were used in all cases of the literature searches. The keyword searches were performed in three phases:
First phase keyword search
health care, Nigerian health care system, and Nigerian primary health care system.
Second phase keyword search
keywords used in the search were United States (OR Europe) health care dynamics. This additional search was performed to ensure an up-to-date review and recommendations for the Nigerian health care system and was not meant to review health care in the United States, Britain, or Europe with regards to methods of medical intelligence/surveillance. Some of the literatures retrieved in this search phase are listed in the reference list. ,,,,,,,,,,,,,,,
Third phase keyword search
third phase literature search was necessarily based on the retrieved results of the second phase backward reference searches. The third phase keywords combination included the following: Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system.
Backward and forward reference searches were carried out in all phases of the keyword search.
Literature selection process
communications, review articles, reports, and web page documents that report on the aim of this study were included for the review process. The articles were selected based on their relevance to the topic of this study. The results of searches were filtered according to their relevance to the aim of this search. The tittles that were logged in the various databases searched were analyzed against the keyword terms. Reports not wholly focused on the topic of this study were not included for review. All the retrieved publications were reviewed with emphasis on the state/dynamics of the Nigerian health care system, role of medical intelligence/surveillance systems in the health care system.
- This study included literatures that meant the following criteria:
- Literatures that meant the parameters of the keyword search.
Studies that discuss the history and state/dynamics of the Nigerian health care system; flaws of the Nigerian health care; managerial/information technological aspect of the Nigerian health care system; and medical intelligence/surveillance system in the Nigerian as well as other countries' health care system.
Data analysis and synthesis
Data were extracted and recorded in Excel and Word 2007. The statistical value for significance was set at P < 0.05. Studies were analyzed based on its relevance to the Nigeria health care system.
| Results and Discussion|| |
The provision of health care in Nigeria remains the functions of the three tiers of government: the federal, state, and local government. ,, The primary health care system is managed by the 774 local government areas (LGAs), with support from their respective state ministries of health as well as private medical practitioners.  The primary health care has its sublevel at the village, district, and LGA. The secondary health care system is managed by the ministry of health at the state level. Patients at this level are often referred from the primary health care. This is the first level of specialty services and is available at different divisions of the state. The state primary health care comprises laboratory and diagnostic services, rehabilitation, etc. The tertiary primary health care is provided by teaching hospitals and specialist hospitals. At this level, the federal government also works with voluntary and nongovernmental organizations, as well as private practitioners. ,,,
Health care reforms launched in Nigeria
Ten-year developmental plan
independence in 1960, a 10-year developmental plan (1946-1956) was introduced to enhance health care delivery. Several health schools and institutions (Ministry of Health, several clinics and health centers) were developed according to this plan. By the 1980s, there had been great development in health care-general hospitals and several other health centers (over 10,000) had been introduced. ,
The primary health care plan
August 1987, the federal government launched its primary health care plan with the following major objectives: ,,
- Improve collection and monitoring of health data
- Improve personnel development in the health care
- Ensure the provision essential drug availability
- Improve on immunization programs
- Promote treatment of epidemic diseases
- Improve food supply and nutrition
- Improve material and child care, and family planning
- Educate people on prevailing health problems and the methods of preventing and controlling them.
This health care plan made little impact on the health sector, as it continued to suffer major infrastructural, and personnel deficit, in addition to poor public health management.
Nigerian health insurance scheme
As an effort by the federal government to revitalize the worsening state of health, the Nigerian health insurance scheme (NHIS) that was established in 2005 by Decree 35 of 1999 provided for the establishment of a governing council with the responsibility of managing the scheme.  However, Ladi Awosika noted that the scheme was first proposed in 1962 under a bill to parliament by the then Minister for Health. 
The objectives of the scheme were to ,
- Ensure that every Nigerian has access to good health care services
- Protect Nigerians from the financial burden of medical bills
- Limit the rise in the cost of health care services
- Ensure efficiency in health care services
- Ensure equitable distribution of health care costs among different income groups; equitable patronage of all levels of health care
- Maintain high standard of health care delivery services within the scheme
- Improve and harness private sector participation in the provision of health care services
- Ensure adequate distribution of health facilities within the Federation
- Ensure the availability of funds to the health sector for improved services.
The objectives and functions of the NHIS , according to this present review have hardly attained any height as health care delivery continues to be limited; not equitable and does not meet the needs of the majority of the Nigerian people. This is indicative of the high infant mortality rate/poor maternal care, very low life expectancy as at 2010, and periodical outbreak of the same disease, as well as the long period of time spent for control of the various outbreaks [Table 2] and [Table 3].
|Table 3: Disease outbreak and chemical disaster in Nigeria between 2006 and 2010|
Click here to view
The appendage program of the NHIS launched in October 2008-Millennium Development Goals-also reported little positive effect a year later. The Nigerian National Health Conference in 2006 which was attended by more than 400 participants, including high cadre dignitaries ranging from the presidency to local governments and their agencies were aimed at ensuring effective, qualitative, affordable, and accessible health care for all Nigerians beyond 2007. ,,, According to the 2005 January issue of CARE-NET limited health insurance report concerning the NHIS, the Nigerian national health policy objective was the attainment of a level of health that will enable all Nigerians to achieve socially and economically productive lives.  Since its lunching primary health care has not gained its right place in the priority of things. ,,,, As part of the struggle to advance health care, the Nigerian senate in 2008 launched a bill for an act to provide a framework for the regulation, development, and management of a national health system and set standards for rendering health services in the federation and other matters connected with it. 
In spite of the several failures of the Nigerian health care system, recent study had suggested that if managed well, the NHIS could be a useful ground for good health care delivery.  At its present state, it is true that the scheme does not adequately account for the needs of the Nigerian people.
Indicators of health care in Nigeria
In spite of the huge development in the health care in relation to the last decades, ,,, much is still needed to be done in the health care system. , This is evident in the various health indicators outlined in [Table 2] and mortality from several outbreaks of diseases in [Table 3]. 
Although the total expenditure in health amounts to 4.6% GDP,  financial managerial competency, besides inadequate funding, remains a major problem. Current statistics show that health institutions rendering health care in Nigeria are 33,303 general hospitals, 20,278 primary health centers and posts, and 59 teaching hospital and federal medical centers.  This represents a huge improvement in regards to the last decades; nonetheless, health care institution continues to suffer shortage.
The backward and forward reference searches on second phase keywords search revealed increasing role of health information, communication as integral to leadership, ,,,,,,,,,,,,,,,,,,, as well as increasing role of medical intelligence/surveillance in the health care system in the United States and Europe. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Health care dynamics in the United States and Europe with regards to methods of medical intelligence/surveillance
Literature data report on the huge developments of MIS systems in Europe and most especially in the United States in the last few decades. For instance, the MedISys is adapted and used by 11 national public health of Europe and 4 supranatural organizations, including World Health Organization and Euro-Surveillance. MedISys provides opportunity to monitor issues of health concerns to registered countries and organizations. ,,, MIS has often been used in both military health care departments  and public health sector.  MIS systems have been used to combat and effectively monitor the outbreak of communicable diseases, bioattack. etc. , Indeed, MIS systems were crucial to controlling SARS in 2003 and eradication of small pox in the 1970s.  Some MIS systems used today are listed in [Table 3]. Other monitoring systems in the health care setting are the Global Monitor and HealthMap. ,,
Based on the analysis ,,,,,,,,,,,,,,,,,, ,,,,,,,,,,7,,,,,,,,,,,,, of this study, MIS systems could be divided into three broad categories:
- Manual-based medical MIS systems. A huge disadvantage of method of MIS: difficult to manage, poor access, data are not easily presentable, data processing is time-consuming, and large space storage space needed.
- Automated-based medical MIS systems. Although this method of data processing has its peculiar shortcomings, the advantages exceed its disadvantages: data collection, aggregation, storing and analysis, sharing, and transmission is by hundreds of times faster and easier.
- Integrated manual-web based MIS systems (use both manual data search and web-mining).
MIS match searched results against taxonomy of named entities, e.g., names of infectious diseases, countries, or cities. Using specialized principle (e.g., ontology principle), terms/words are organized into synonyms, symptoms, associated syndromes and hosts, etc. ,,,,,,,, A combination of at least two MIS systems has always provided for a higher tracking precision. For example, analysis of documents by PULS, previously identified by MedISys, improves precision by almost 100%, although economically expensive.  However, a major disadvantage of the MedISys and PULS is their inability to perform deeper analysis of critical issues of public health concerns which is a major disadvantage.  Hence, integrated manual web-based medical intelligence/surveillance with professional analysis in the field provides a greater advantage over other methods of MIS (an example of such a model in shown in [Figure 1]).
One of the most advanced MIS systems used today is the BioWatch which is presently installed in 30 US cities to constantly monitor biothreats.  The biowatch system consists of airfilter that collects air sample for genetic analysis of any bioweapon of specific interest. Targeted nucleic acid sequence associated with a pathogenetic agent is screened for in specialized laboratory. A positive result meant that the pathogenetic agent of specific interest is present in the air. ,,,,,, It is, however, pertinent to note that the present second-generation biowatch system carry a huge disadvantage as air filtered are not automatically analyzed by the system. Manual collection of filtered air sample for laboratory test has to be carried out before obtaining results. The next-generation BioWatch is presently been developed to solve this problem.  Several other MIS systems  work by syndromic approach and by analyzing signs and symptoms of diseases based on respiratory, gastrointestinal, hemorrhagic illness, etc. [Table 4].
|Table 4: Medical intelligence/surveillance systems and their country of usage|
Click here to view
A major disadvantage that could be noted in all MIS systems is the detection of already present disaster (although the early detection allows for a faster action/control of the disaster). At this point, there could have been several fatal cases. ,,,, To avoid this, the present-day MIS systems integrate their functions with the evaluation of risk. That means public health disaster can be tracked even before it affects a wide population of people. One example of MIS risk system is the Brief Spousal Assault Form for the Evaluation of Risk. 
Major flaws in the Nigerian health care system
In spite of the various reforms to increase the provision of health to the Nigerian people, health access is only 43.3%.  The inadequacy of the health care delivery system in Nigeria could be attributed to the peculiar demographics of the Nigerian populace. About 55% of the population lives in the rural areas and only ~45% live in the urban areas. , About 70% of the health care is provided by private vendors and only 30% by the government. ,,,,,, Over 70% of drugs dispensed are substandard. Hence, the ineffectiveness of the NIHS had recently been attributed to the fact that the scheme represents only 40% of the entire population, and 52-60% are employed in the informal sector.
Over half of the population live below the poverty line, on less than $1 a day and so cannot afford the high cost of health care. 
Also, a recent study by Akande had reported a poor referral system between the various tiers of health care which probably tells on the poor managerial functions of the health care delivery system. 
At the primary health care level, some have sort solutions to the aforementioned flaws. For example, several community health financing schemes [Community Based Health Insurance (CBHI)] from individuals' (taxi drivers, market women, etc.) effort to provide the health needs for their communities are documented. , Some urban subpopulations have also initiated the scheme. The number of CBHI probably exceeds 585 according to a recent report by Obinna Onwujekwe and colleagues (2010).  In that study, the authors reported high preferences for health care benefits both at the urban and rural areas [Table 5]. Problems encountered in the CBHI are its very small and inadequate funding capabilities. That notwithstanding, some CBHI have increased their scope to be registered as health maintenance organizations.  Also, quality of health care provided is not accessed, although this remains a problem for the NHIS too.
|Table 5: Preferences for health care packages as reported by majority of people|
Click here to view
While several studies have reported many aspects of the Nigerian health care system, no work has been done in the aspect of disease tracking, and MIS techniques to meet the need of the Nigerian populace in the modern era; practically, no attention is given to surveillance systems. Hence, a major shortcoming of the Nigerian health care system is the absence of adequate MIS systems to track disease outbreaks, mass chemical poisoning, etc.
The way forward for the Nigerian health care system/recommendations
Several flaws in the health care system could have been averted through adequate MIS, which is supposed to be the first line of approach to developing the Nigerian health care system. Of course, there is a long list of barriers which lie on the pattern of leadership, infrastructures, man power challenges, clinical training, standardized diagnostic instruments, etc. ,,,,,,,,,,,,,,,,,
The reforms and changes made to retain health security seem not to have made positive effect on the health care system. ,,,
Considering the threats of health insecurity,  there is therefore immense need to revitalize the Nigerian health care system and provide specific project design to enhance cooperation and efficiency. To account for the modern day needs of Nigerians, the health care delivery system must adequately meet the following functions:
- Effectively assess patients' dilapidating state of health
- Refer patients to specialists for appropriate treatments and supportive services
- Recognize, treat, or refer comorbid medical and psychiatric conditions for specialists' treatment
- Perform age, gender, and culturally appropriate disease screening
- Provide brief interventions to patients with dilapidating state of health
- Chronic diseases management and prevention
- Family planning to be cooperated effectively into the health care delivery system
- Systematically and routinely measure the quality of services provided by the health system
- Mortality data of specific project enrollees to measure the effectiveness of health care provided
- Carry out health campaigns and awareness
- Develop effective counseling methods
- Comparative analysis with other countries' experiences in addressing health changes
- Calculate the economic gain or loss of health care provided
- Economic distribution of services with adequate capitation rate
- Verify delivery of health services
- Provide performance based incentives on a regular basis
- Strong knowledge base/research culture
The huge problems encountered by the Nigerian health care system ,,,,,,,,,,,,,,,,,,, could partly be due to the absence of MIS system which holds the key to successful medical leadership, as well as health care delivery. Hence, there is necessity to setup a model of MIS systems for action to suit the interest of the Nigerian people. It is supposed that if adequately managed, MIS system model for the Nigerian health care will turn out to be the Cinderella of Nigerian health care system. A view of the model is shown in [Figure 1].
The model not only specifically addresses the present problem but also put into consideration modern MIS techniques; it solves the problems encountered in several other models by adding a deeper professional analysis. Besides, it is multifunctional.
The model will perform the same functions as other MIS systems , do text mining from a variety of sources and track bioterrorism (such as airport biothreat, etc.), diseases (contagious, sexually transmitted diseases. etc.), events etc. The central system will analyze current result of reports and internet data received against keyword entities and to undergo selective processing of results. By selective processing, the system sends information, where appropriate to local points, government organizations, and intelligence; perform professionalized and deeper analysis of critical information or search results of critical importance will be sent for a deeper professional analysis. The model for MIS will match searched/received results against taxonomy of named entities, names of infectious diseases, states, local governments or cities/towns, villages, health agencies, etc. Besides its basic functions, it will file-out reports, send requests, issue alerts, perform several system commands, and have several databases access. Also, it will track progression and capture ongoing events, and brief situation and dynamics of events to others by selective processing. The proposed model for MIS will be suited for the Nigerian interest. To optimized information, the system will be linked to other international monitoring systems to effectively manage and control outbreaks of communicable diseases and bioterrorism threats.
| Conclusion|| |
The Nigerian health care system is poorly developed and has suffered several backdrops, especially at the Local Government Levels. No adequate and functional surveillance systems are developed and hence no tracking system to monitor the outbreak of communicable diseases, bioterrorism, chemical poisoning, etc. To achieve success in health care in this modern era, a system well grounded in routine surveillance and medical intelligence as the backbone of the health sector is necessary, besides adequate management couple with strong leadership principles. The recommendations given in this study may as well be applicable to other countries (especially African countries, such as Niger) that suffer the same problem.
| References|| |
|1.||Health Reform Foundation of Nigeria (HERFON). Available from: http://www.herfon.org/. [Last accessed on 2010 Nov 23]. |
|2.||Maternal Mortality in Nigeria. Available from: http://reproductiverights.org/en/feature/maternal-mortality-in-nigeria. [Last accessed on 2010 Dec 16]. |
|3.||Nigeria National Health Conference 2009 Communique. Abuja, Nigeria. Available from: http://www.ngnhc.org. [Last accessed on 2010 Nov 5]. |
|4.||Nnamuchi O. The right to health in Nigeria. 'Right to health in the Middle East' project, Law School, University of Aberdeen. Draft Report December 2007. Available from: http://www.abdn.ac.uk/law/hhr.shtml. [Last accessed on 2010 June 21]. |
|5.||Onwujekwe O, Onoka C, Uguru N, Nnenna T, Uzochukwu B, Eze S, et al. Preferences for benefit packages for community-based health insurance: An exploratory study in Nigeria. BMC Health Services Research 2010;10:162. Availabe from: http://www.biomedcentral.com/1472-6963/10/162. [Last accessed on 2010 June 21]. |
|6.||Nigeria Primary Health Care Policies. Available from: http://www.photius.com/countries/nigeria/society/nigeria_society_primary_health_care_~10006.html. [Last accessed on 2010 June 21]. |
|7.||Asangansi I, Shaguy J. Complex dynamics in the socio-technical infrastructure: The case with the Nigerian health management information system. Proceedings of the 10 th International Conference on Social Implications of Computers in Developing Countries. Dubai, May 2009. Available from: http://www.ifip.dsg.ae/Docs/dc17_Asangansi_finalv3.pdf. [Last accessed on 2011 Jan 2]. |
|8.||Dougherty D, Conway PH. The "3T's" road map to transform US health care. The "how" of high-quality care. JAMA 2008;299:2319-21. |
|9.||Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med 2005;20:953-7. |
|10.||Green-Pedersen C, Wilkerson J. How agenda-setting attributes shape politics: Basic dilemmas, problem attention and health politics developments in Denmark and the US. J Eur Publ Pol 2006;13:1039-52. |
|11.||Moe JL, Pappas G, Murray A. Transformational leadership, transnational culture and political competence in globalizing health care services: A case study of Jordan's King Hussein Cancer Center. Globalization and Health 2007;3:11. Available from: http://www.globalizationandhealth.com/content/3/1/11.[Last accessed on 2010 Oct12]. |
|12.||The Library of Congress Country Studies. CIA World Factbook. Available from: http://www.cia.gov. [Last accessed on 2010 June 21]. |
|13.||Stoller JK. Developing physician-leaders: a call to action. J Gen Intern Med 2009;24:876-8. |
|14.||Taylor CA, Taylor JC, Stoller JK. Exploring leadership competencies in established and aspiring physician leaders: An interview-based study. J Gen Intern Med 2008;23:748-54. |
|15.||Hjortdahl M, Ringen AH, Naess AC, Wisborg T. Leadership is the essential non-technical skill in the trauma team- results of a qualitative study. Scand J Trauma Resusc Emerg Med 2009;17:48. |
|16.||Jones DS, Tshimanga M, Woelk G, Nsubuga P, Sunderland NL, Hader SL, et al. Increasing leadership capacity for HIV/AIDS programmes by strengthening public health epidemiology and management training in Zimbabwe. Human Resources for Health 2009;7:69. Available from: http://www.human-resources-health.com/content/7/1/69. [Last accessed on 2010 Nov 10]. |
|17.||Schiffbauer J, O'Brien JB, Timmons BK, Kiarie WN. The role of leadership in HRH development in challenging public health settings. Human Resour Health 2008;4:23. Available from: http:// www.human-resources-health.com/content/6/1/23. [Last accessed on 2010 Nov 23]. |
|18.||Yangarber R, Jokipii L, Rauramo A, Huttunen S. Extracting information about outbreaks of infectious epidemics. Vancouver, Canada: Proc HLT-EMNLP; 2005. |
|19.||Grishman R, Huttunen S, Yangarber R. Information extraction for enhanced access to disease outbreak reports. J Biomed Inform 2002;35:236-46. |
|20.||Soteriades ES, Falagas ME. Occupational and environmental medicine, epidemiology, and public health. BMC Public Health 2006;6:301. Available from: http://www.biomedcentral.com/1471-2458/6/301. [Last accessed on 2010 Aug 4]. |
|21.||United Nations Population Fund (UNFPA). Maternal Morbidity. Available from: http://www.unfpa.org/mothers/morbidity.htm. [Last accessed on 2010 Aug 13]. |
|22.||WHO, UNICEF, UNFPA and The World Bank. Maternal Mortality in 2005. Availlable from: http://www.who.int/whosis/mme_2005.pdf. [Last accessed on 2010 Nov10]. |
|23.||Brian B, McGreevey W. The costs and benefits of a maternal and child health project in Nigeria. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1, 2010. Available from: http://ghiqc.usaid.gov, http://www.healthpolicyinitiative.com. [Last accessed on 2010 Nov 28]. |
|24.||Federal Ministry of Health, Department of Planning and Statistics. Draft: National Child Health Policy. Available from: http://www.fmh.gov.ng/. [Last accessed on 2010 Nov 10]. |
|25.||Welcome MO, Razvodovsky YE, Pereverzeva EV, Pereverzev VA. The error monitoring and processing system in alcohol use. IJCRIMPH 2010;2:318-36. |
|26.||de Stampa M, Vedel I, Mauriat C, Bagaragaza E, Routelous C, Bergman H, et al. Diagnostic study, design and implementation of an integrated model of care in France: A bottom-up process with continuous leadership. Int J Integr Care 2010;10:e034. Available from: http://www.ijic.org/. [Last accessed 2010 Dec 29]. |
|27.||Hobgood C, Anantharaman V, Bandiera G, Cameron P, Halpern P, Holliman CJ, et al. International federation for emergency medicine model curriculum for medical student education in emergency medicine. Int J Emerg Med 2010;3:1-7. |
|28.||Lord J. Future of primary healthcare education: Current problems and potential solutions. Postgrad Med J 2003;79:553-60. |
|29.||McManus IC, Smithers E, Partridge P, Keeling A, Fleming PR. A levels and intelligence as predictors of medical careers in UK doctors: 20 year prospective study.BMJ 2003;327:139-42. |
|30.||Mohammed MA, Worthington P, Woodall WH. Plotting basic control charts: Tutorial notes for healthcare practitioners. Qual Saf Health Care 2008;17:137-45. |
|31.||Nelson BD, Dierberg K, Sæepanoviæ M, Mitroviæ M, Vuksanoviæ M, Miliæ L, et al . Integrating quantitative and qualitative methodologies for the assessment of health care systems: Emergency medicine in post-conflict Serbia. BMC Health Serv Res 2005;5:14. Available from: http://www.biomedcentral.com/1472-6963/5/14. [Last accessed on 2010 Nov 23]. |
|32.||Ogle KD, Boulé R, Boyd RJ, Brown G, Cervin C, Dawes M, et al. Family medicine in 2018. Can Fam Physician 2010;56:313-5. |
|33.||Sabol B, Treadwell HM. On inspiration and leadership: A conversation with Barbara Sabol, MA, RN, and Henrie M. Treadwell, PhD. Interview by Kathleen M. Nelson. Am J Public Health 2008;98:1553-5. |
|34.||Oregon Health Policy and Research. HRSA State Planning Grant. State of Washington. Health Care Authority. A Study of Washington State Basic Health Program. Available from: http://www.oregon.gov/OHPPR/RSCH/docs/HRSAOR.WashingtonPlan.rpt.pdf?ga=t. [Last accessed on 2010 Aug 10]. |
|35.||Quirke V, Gaudillie`re JP. The era of biomedicine: Science, medicine, and public health in Britain and France after the second world war. Med Hist 2008;52:441-52. |
|36.||Bache J. Emergency medicine: Past, present, and future. J R Soc Med 2005;98:255-8. |
|37.||Battani J, Zywiak W. US health care in the year 2015. Available from: http://www.csc.com. [Last accessed 2010 Nov 4]. |
|38.||Bey TA, Hahn SA, Moecke H. The current state of hospital-based emergency medicine in Germany. Int J Emerg Med 2008;1:273-7. |
|39.||Adeyemo DO. Local government and health care delivery in Nigeria: A Case Study. J Hum Ecol 2005;18:149-60. |
|40.||Omoruan AI, Bamidele AP, Phillips OF. Social health insurance and sustainable healthcare reform in Nigeria. Ethno Med 2009;3:105-10. |
|41.||National Health Insurance Scheme Decree No 35 of 1999. Laws of the Federation of Nigeria. Available from: http://www.nigeria-law.org/National%20Health%20Insurance%20Scheme%20Decree.htm. [Last accessed on 2010 Nov 6]. |
|42.||Healthcare. Available from: http://www.motherlandnigeria.com/health.html. [Last accessed June 10]. |
|43.||Awosika L. Health insurance and managed care in Nigeria. Ann Ibadan Postgrad Med 2005;3:40-6. |
|44.||Akande TM. Referal system in Nigeria: Study of a tertiary health facility. Ann Afr Med 2004;3:130-3. |
|45.||Senate, Federal Republic of Nigeria. National health bill 2008 (SB.50). Available from: http://www.unicef.org/nigeria/ng_publications_national_health_bill_2008.pdf. [Last accessed on 2010 Sep19]. |
|46.||A CARE-NET Limited Publication. Repositioning the National Health Insurance Scheme (NHIS) for effective take-off: From policy to Action Health Insurance. January 2005, Issue 7. Available from: http://www.carenet.info/files/Health_Insurance_7.pdf. [Last accessed on 2010 December 10]. |
|47.||Okaro AO, Ohagwu CC, Njoku J. Awareness and perception of national health insurance scheme (NHIS) among radiographers in south east Nigeria. Am J Sci Res 2010;8:18-25. |
|48.||Global Alert and Response (GAR): Nigeria. Available from: http://www.who.int/csr/don/archive/country/nga/en/. [Last accessed on 2011 Jan 3]. |
|49.||Steinberger R, Fuart F, van der Goot E, Best C, von Etter P, Yangarber R. Text mining from the web for medical intelligence. In: Mining Massive Data Sets for Security, D Perrotta, J Piskorski, F Soulie-Fogelman, R Steinberger, editors. Amsterdam, the Netherlands: OIS Press; 2008. |
|50.||Costagliola D, Flahault A, Galinec D, Garnerin P, Menares J, Valleron AJ. A routine tool for detection and assessment of epidemics of influenza-like syndromes in France. Am J Public Health 1991;81:97-9. |
|51.||Vergu E, Grais RF, Sarter H, Fagot JP, Lambert B, Valleron AJ, et al. Medication sales and syndromic surveillance, France. Emerg Infect Dis 2006;12:416-21. |
|52.||Lewis MD, Pavlin JA, Mansfield JL, O'Brien S, Boomsma LG, Elbert Y, et al. Disease outbreak detection system using syndromic data in the greater Washington DC area. Am J Prev Med 2002;23:180-6. |
|53.||Reis BY, Pagano M, Mandl KD. Using temporal context to improve biosurveillance. Proc Natl Acad Sci U S A 2003;100:1961-5. |
|54.||Reis BY, Mandl KD. Time series modeling for syndromic surveillance. BMC Med Inform Decis Mak 2003;3:2. |
|55.||Suzuki S, Ohyama T, Taniguchi K, Kimura M, Kobayashi J, Okabe N, et al. Web-based Japanese syndromic surveillance for FIFA World Cup 2002. J Urban Health 2003; 80:i123. |
|56.||Reis B, Mandl K. Syndromic surveillance: The effects of syndrome grouping on model accuracy and outbreak detection. Ann Emerg Med 2004;44:235-41. |
|57.||Pavlin JA. Investigation of disease outbreaks detected by "syndromic" surveillance systems. J Urban Health 2003;80(2 Suppl 1):i107-14. |
|58.||Pinner RW, Rebmann CA, Schuchat A, Hughes JM. Disease surveillance and the academic, clinical, and public health communities. Emerg Infect Dis 2003;9:781-7. |
|59.||Centers for Disease Control and Prevention. Surveillance for Certain Health Behaviors Among States and Selected Local Areas - United States, 2008. Dec 10, 2010 / Vol. 59 / No. SS-10 / Pg. 1 - 224. Available from: http://www.cdc.gov/mmwr/mmwr_ss/ss_cvol.html.[Last accessed on 2011 Jan 4]. |
|60.||Centers for Disease Control and Prevention. Cryptosporidiosis Surveillance - United States, 2006--2008; Giardiasis Surveillance - United States, 2006--2008. Jun 11, 2010 / Vol. 59 / No. SS-6 / Pg. 1-26. Available from: http://www.cdc.gov/mmwr/mmwr_ss/ss_cvol.html. [Last accessed on 2010 Dec 21]. |
|61.||Knobler S, Mahmoud A, Lemon S, Mack A, Sivitz L, Oberholtzer K, editors. Learning from SARS. Preparing for the next disease outbreak. Available from: http://depts. washington.edu/einet/doclib/final_version_reporting_surveillance_and_information_exchange.pdf. [Last accessed on 2010 Dec 5]. |
|62.||Yan P, Chen H, Zeng D. Syndromic surveillance systems. Ann Rev Inform Sci Tech 2008;42:425-95. |
|63.||Fricker RD. Syndromic surveillance. An article for the encyclopedia for quantitative risk assessment. Available from: http://faculty.nps.edu/rdfricke/docs/SyndromicSurveillance.pdf. [Last accessed on 2010 Dec 5]. |
|64.||Reingold A. If syndromic surveillance is the answer, what is the question? Biosec Bioterr Biodef Strat Pract Sci 2003;1:1-5. Accessed online at Available from: http://www.medscape.com/viewarticle/458654.[ Last accessed on 2010 Sept 20]. |
|65.||Lenhart MK, Lounsbury DE, Martin JW, editors. Medical aspects of biological warfare. Available from: http://prepbug.com/files/Biological/Medical%20Aspects%20of%20Biological%20Warfare.pdf. [Last accessed on 2010 Dec 5]. |
|66.||Best C, van der Goot E, Blackler K, Garcia T, Horby D. Europe Media Monitor-system description. EUR Tech Rep. 22173 EN. Belgium: Joint Research Centre, European Commission; 2005. |
|67.||Goldstein BD. Biowatch and public health surveillance: Evaluating systems for the detection of biological threats. Available from: http://www7.nationalacademies.org/ocga/testimony/BioWatch_and_Public_Health_Surveillance.asp. [Last accessed on 2010 June 21]. |
|68.||Defense Advanced Research Projects Agency. Information extraction task: scenario on management succession. Proceedings of the 6th Message Understanding Conference (MUC-6). Columbia, MD: Morgan Kaufmann; 1995. |
|69.||Doan S, Hung-Ngo Q, Kawazoe A, Collier N. Global health monitor-a web-based system for detecting and mapping infectious diseases. Proceedings of the International Joint Conference on Natural Language Processing (IJCNLP), Companion Volume, 2008. p. 951-6. |
|70.||Jarcho S. Historical perspectives of medical intelligence. Bull NY Acad Med 1991;67:501-6. |
|71.||Department of the Navy. Armed forces medical intelligence centre. Available from: http://www.fas.org/irp/doddir/navy/secnavinst/3800_9a.pdf. [Last accessed on 2010 Dec12]. |
|72.||Steinberger R, Fuart F, van der Goot E, Best C, von Etter P, Yangarber R. Text mining from the web for medical intelligence. IOS Press. 2008. Available from: http://langtech.jrc.it/Documents/2008_MMDSS_Medical-Intelligence.pdf. [Last Accessed on 2010 Nov 23]. |
|73.||Yan P, Chen H, Zeng D. Syndromic surveillance systems: Public health and biodefense. ARIST 2008;42:340-425. |
|74.||Swan M. Emerging patient-driven health care models: An examination of health social networks, consumer personalized medicine and quantified self-tracking. Int J Environ Res Public Health 2009;6:492-525. |
|75.||MedISys. Available from: http://medusa.jrc.it. [Last accessed on 2011 Jan 2]. |
|76.||Gaizauska s R, Robertson A. Coupling information retrieval and information extraction: A new text technology for gathering information from the web. In: Proceedings of the 5th RIAO Computer-Assisted Information Searching on Internet. Montreal, Canada, 1997: 356-370. Available from: http://reference.kfupm.edu.sa/content/c/o/coupling_information_retrieval_and_infor_27675.pdf. [ Last accessed on 2010 Nov 23]. |
|77.||Hovy E, Ide N, Frederking R, Mariani J, Zampolli A, editors. Multilingual information management: Current levels and future abilities. Available from: http://www.cs.cmu.edu/~ref/mlim/index.html. [Last accessed on 2011 Jan 4] |
|78.||Pouliquen B, Kimler M, Steinberger R, Ignat C, Oellinger T, Blackler K, et al. Geocoding multilingual texts: Recognition, disambiguation and visualization. Genova, Italy: Proceedings of LREC-2006; 2006. |
|79.||Reason JT, Carthey J, de Leval MR. Diagnosing "vulnerable system syndrome": An essential prerequisite to effective risk management. Qual Health Care 2001;10 Suppl 2:ii21-5. |
|80.||Regli SH, Tremoulet P, Samoylov A, Sharma K, Stibler K, Anthony L. Medical intelligence informatics. WISH; 2010 Apr 11. Atlanta, Georgia, USA: Springfield, IL; 2010. |
|81.||Robertson A, Gaizauskas R. On the marriage of information retrieval and information extraction. In: Information retrieval research 1997: Proceedings of the 1997 annual BCS-IRSG colloquium on IR research. J Furner, D Harper, editors. Aberdeen, Scotland, London: Springer-Verlag; 1997. |
|82.||Steinberger R, Pouliquen B, Ignat C. Navigating multilingual news collections using automatically extracted information. J Comp Inform Tech (J CIT) 2005;13:257-64. |
|83.||Freifeld CC, Mandl KD, Reis BY, Brownstein JS. HealthMap: Global infectious disease monitoring through automated classification and visualization of Internet media reports. J Am Med Inform Assoc 2008;15:150-7. |
|84.||Akande TM, Monehin JO. Health management information system in private clinics in iIorin, Nigeria. Nig Med Pract 2004;46:102-7. |
|85.||Health Partners International. Health systems case study: Health management information systems (HMIS) in Nigeria and Zambia. Available from: http://www.healthpartners-int.co.uk/case_studies/cs-06.pdf. [Last accessed on 2011 Jan 3]. 2011. |
|86.||Health Insurance report. Repositioning the National Health Insurance Scheme (NHIS) for effective take-off: From policy to Action. Quart Health Insur J 2005;7:1-4. |
|87.||National Bureau of statistics. Available from: http://www.nigerianstat.gov.ng/. [Last accessed on 2011 Jan 5]. |
|88.||Nigeria Demographic and Health Survey 2008. Available from: http://pdf.usaid.gov/pdf_docs/PNADQ923.pdf. [Last accessed on 2010 Dec 12]. |
|89.||Nigeria Medical News. Available from: http://www.nigerjmed.com/.[Last accessed on 2010 Nov 6]. |
|90.||Nigerian National Population Commission. Available from: http://dec.usaid.gov/index.cfm?p=search.getSqlResultsandCFID=9534andCFTOKEN=82199862 andp_searchtype=detailedandq_InstNmx=Nigeria.%20National%20Population%20Commission. [Last accessed on 2010 Dec12]. |
|91.||Banjoko SO, Banjoko NJ, Omoleke IA. Knowledge and perception of telemedicine and E-health by some Nigerian health care practitioners. Available from: http://wikieducator.org/images/d/df/PID_536.pdf. [Last accessed on 2010 Dec 15]. |
|92.||The world health report 2000. Health Systems: Improving Performance. Available from: http://www.who.int/whr/2000/en/. [Last accessed on 2010 Nov15]. |
|93.||Omolase CO, Ihemedu CO, Ogunleye OT, Omolase BO. Use of internet for health information amongst medical practitioners in a Nigerian community. TAF Prev Med Bull 2010;9:93-8. |
|94.||Yusuf TO, Gbadamosi A, Hamadu D. Attitudes of Nigerians towards insurance services: An empirical study. Afr J Account Econ Finan Bank Res 2009;4:34-46. |
|95.||Agba MS. Perceived impact of the national health insurance schemes (NHIS) among registered staff in federal polytechnic, Idah, Kogi state Nigeria. Stud Sociol Sci 2010;1:44-9. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
|This article has been cited by|
||Determinants of catastrophic health expenditure in Nigeria
| ||Bolaji Samson Aregbeshola,Samina Mohsin Khan |
| ||The European Journal of Health Economics. 2017; |
|[Pubmed] | [DOI]|
||Using Small Tests of Change to Improve PMTCT Services in Northern Nigeria
| ||Bamidele Osibo,Frank Oronsaye,Oluwafemi D. Alo,Abimbola Phillips,Renaud Becquet,Nathan Shaffer,Francis Ogirima,Collins Imarhiagbe,Bernice Ameh,Obioma Ezebuka,Sodzi Sodzi-Tettey,Adaobi Obi,Olusegun T. Afolabi,Abutu Inedu,Chukwuma Anyaike,Bolanle Oyeledun |
| ||JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017; 75: S165 |
|[Pubmed] | [DOI]|
||Socio-economic inequalities in access to maternal and child healthcare in Nigeria: changes over time and decomposition analysis
| ||Oludamilola Adeyanju,Sandy Tubeuf,Tim Ensor |
| ||Health Policy and Planning. 2017; |
|[Pubmed] | [DOI]|
||The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria
| ||Bolanle Oyeledun,Abimbola Phillips,Frank Oronsaye,Oluwafemi David Alo,Nathan Shaffer,Bamidele Osibo,Collins Imarhiagbe,Francis Ogirima,Abiola Ajibola,Obioma Ezebuka,Bebia Ojong-Etta,Adaobi Obi,John Falade,Adunbi Kareem Uthman,Busuyi Famuyide,Deborah Odoh,Renaud Becquet |
| ||JAIDS Journal of Acquired Immune Deficiency Syndromes. 2017; 75: S156 |
|[Pubmed] | [DOI]|
||Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria
| ||R.N. Ogu,L.F.C. Ntoimo,F.E. Okonofua |
| ||Midwifery. 2017; 55: 1 |
|[Pubmed] | [DOI]|
||Strengthening the Primary Care Delivery System: A Catalytic Investment Toward Achieving Universal Health Coverage in Nigeria
| ||Ritgak Tilley-Gyado,Oyebanji Filani,Imran Morhason-Bello,Isaac F. Adewole |
| ||Health Systems & Reform. 2016; 2(4): 277 |
|[Pubmed] | [DOI]|
||The Use of Qualitative Methods in Developing Implementation Strategies in Prevention Research for Stroke Survivors in Nigeria
| ||Samantha Hurst,Oyedunni Arulogun,Mayowa O. Owolabi,Rufus O. Akinyemi,Ezinne Uvere,Stephanie Warth,Gregory Fakunle,Bruce Ovbiagele |
| ||The Journal of Clinical Hypertension. 2016; : n/a |
|[Pubmed] | [DOI]|
||An examination of the maternal social determinants influencing under-5 mortality in Nigeria: Evidence from the 2013 Nigeria Demographic Health Survey
| ||Sarah R. Blackstone,Ucheoma Nwaozuru,Juliet Iwelunmor |
| ||Global Public Health. 2016; : 1 |
|[Pubmed] | [DOI]|
||African solutions to African problems and the Ebola virus disease in Nigeria
| ||Nathaniel Umukoro |
| ||Development in Practice. 2016; 26(2): 149 |
|[Pubmed] | [DOI]|
||Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis
| ||O. K. Ezeh,K. E. Agho,M. J. Dibley,J. J. Hall,A. N. Page |
| ||BMJ Open. 2015; 5(3): e006779 |
|[Pubmed] | [DOI]|
||Nurse reported patient safety in low-resource settings: a cross-sectional study of MNCH nurses in Nigeria
| ||Yolanda Ogbolu,Mary E. Johantgen,Shijun Zhu,Jeffrey V. Johnson |
| ||Applied Nursing Research. 2015; 28(4): 341 |
|[Pubmed] | [DOI]|
||Harmony in health sector: a requirement for effective healthcare delivery in Nigeria
| ||Erhabor Osaro,Adias Teddy Charles |
| ||Asian Pacific Journal of Tropical Medicine. 2014; 7: S1 |
|[Pubmed] | [DOI]|
||Patterns and predictors of malaria care-seeking, diagnostic testing, and artemisinin-based combination therapy for children under five with fever in Northern Nigeria: a cross-sectional study
| ||Kathryn R Millar,Jennifer McCutcheon,Eugenie H Coakley,William Brieger,Mohammed A Ibrahim,Zainab Mohammed,Amos Bassi,William Sambisa |
| ||Malaria Journal. 2014; 13(1): 447 |
|[Pubmed] | [DOI]|