Introducing electronic clinical social case management in Nigeria

This blog post by Oyinlola Oluwagbemiga (husITa board member, and Senior Medical Social Worker, University College Hospital, Ibadan, Nigeria) describes Oyinlola’s involvement in the introduction of electronic clinical social case management into the Nigerian Health Information Management System (HIMS).

Background

Nigeria is an African state that is home to over 180 million people: it has largest population of all African countries, and is the seventh most populous region in the world. Nigeria achieved independence from British colonial rule in 1960 and settled into a stable, civilian democracy in 1999. The Nigerian economy is currently the largest in Africa, and the 20th largest in the world.

From a historical point of view, community based social support in Nigeria was founded on the informal networks provided by the extended family system, kin group, the clan and social clubs (Iwariemie-Jaja, 2002). The development of contemporary human or social services was the result of colonization; although, social work in modern Nigeria has travelled a long way from its roots in religious and voluntary organizations to its current status as a professional discipline.

Like social work in other countries, Nigerian social work is characterized by diversity and practitioners engage in a wide range of activities, within many settings and with many different people. Nigerian social workers’ work includes clinical social services with patients in hospitals, and agency-based practice where social workers serve as administrators, supervisors, community developers, case managers and so on. Some social workers specialize in work with children, women, youth, health care, older adults and people with special needs. Sometimes social workers play the role of counselors and psychotherapists.

Social workers in Nigeria also engage in teaching social work programs: although, few Nigerian universities offer social work programs at both undergraduate and postgraduate levels.

Clinical social services and the use of human service technology in Nigeria

The introduction of technology in the form of the Health Information Management System (HIMS) has had a significant impact on the delivery of health care services in Nigeria.  The HIMS developed from a need to capture the health information of patients presented from the primary health care system up to the tertiary health care system. It aimed to provide easy access to patient records for health care professionals whilst ensuring strict data security. It had the secondary aim of replacing paper based systems for arranging laboratory and radiological investigations as well as procuring drugs from the pharmaceutical stores. Through the online health information management system, patients could also schedule appointments with doctors, and other health care professionals, without the stress of waiting long hours at outpatient clinics. This initiative has helped in providing quality health services, but there are some problems with patient consistency in attending follow-clinics, home-visits, booking psychotherapy sessions, documenting financial assistance for patients and other core clinical social services.

All federal government funded teaching hospitals in Nigeria include Medical Social Services Departments headed by trained and registered social workers. The Medical Social Services Department is one of the clinical services of each teaching hospital and provides psychosocial services to patients. In 2014, the Association of Medical Social Workers of Nigeria (AMSOWN) approved a concept paper, drafted by me and my team, to add electronic clinical social case management to the Health Information Management System. Following  approval by the Chief Medical Director the project commenced at the University College Hospital, Ibadan. The University College Hospital (UCH) is a tertiary health institution founded in 1957, and has 1000 beds. It has various specialty units and paramedical services with inpatient and outpatient services. UCH has patients referred from all parts of Nigeria and the West African sub-region. The project for e-social case management was rolled out in three phases (described below) and was conducted in partnership with the hospital’s department of information technology. The project was subsequently adopted by two other teaching hospitals in Nigeria: Ondo State Trauma Centre and the Federal Medical Centre in Bauchi state.

 

First phase

The first phase of the project involved meeting with head of the information technology department to develop an application that core professional social workers, and their assistants, would find easy to use. The application was installed on the hospital’s Health Information Management System (HIMS) to serve as a means of referral to medical social workers and to give them access to: the medical history of patients, their diagnoses, family and social history, general health condition and other important information that would assist the social worker to work effectively with the patient.

 Second Phase

This phase focussed on the integration into the system of historical medical social services records from 1957 to 2014. This was a difficult but important task since it enabled social workers to have seamless, electronic access to records from the first patient ever seen by the department.  Patient records were digitally archived on the electronic clinical social case system of the hospital’s Health Information Management System (HIMS) in just over six months. The total number of patients seen in the department between 1957-2014 was about 831,600. The e-clinical social case system classified each patient based on clinical diagnoses, medical history, family and social history, social diagnosis, review (presenting social problem), plan of action and social work intervention.

The electronic clinical social case system includes functions that:

• schedule appointments with patients
• alert medical social workers to follow-up visits
• generate GPRS of patients location for easy home visits
• support communication with other health professionals using the intranet chat platform
• generate descriptive percentage scores of the number of patients presented with psychosocial problems within the department (disaggregated by gender).

In addition, case managers (supervisors) have the opportunity of supervising case workers electronically and sending their comments via email. At the end of every month medical social workers meet during the ground-round to discuss topical clinical social work issues in the management of patients in the hospital.

Third Phase 

This phase occurred on completion of the project and included the official presentation of the project to hospital management. The project was also presented during the socio-scientific conference of the Association of Medical Social Workers of Nigeria (AMSWON) where a member of the board of the association recommended the project should be replicated by all medical social services departments in Nigeria.

Challenges of electronic social case management system in Nigeria

Managing the changes associated with technological innovation can be challenging and stressful. The following are some of the challenges faced during the implementation of electronic social case management system in Nigeria:

1. At the start of the project there was a low level of computer literacy among medical social workers in the teaching hospitals. The few social workers who had good computer literacy acted as mentors to others, and some social workers were given clerical assistance to assist with data entry.
2. There was a problem using the system at the emergency department of the hospital: especially when social workers were required to provide crisis intervention services to victims of accidents brought to the hospital by road safety officers, police officers, good Samaritans or the ambulance service. As a result of this, social workers now provide the immediate crisis intervention services before going to the administrative office to input patient data on the electronic social case management system.
3. There was inadequate funding from hospital management and no financial support from the professional association of medical social workers in Nigeria. However, in kind support was received through a multi-sectoral approach involving some key departments in the hospital (information technology department, health information department, medical social services department and the hospital services department).
4. There was a problem with the integration of other social service sectors into the electronic social case management system. Efforts are now underway to develop a Comprehensive Electronic Social Services System (CESSS) for the Federal Ministry of Women Affairs and Social Welfare in Abuja. This will be achieved through the support of the Nigerian Association of Social Workers (NASoW) and the newly established Nigerian Social Work Council (NSWC).
5. Training social workers to use the electronic social case system in all of the 36 States in Nigeria was a major challenge. However, the Association of Medical Social Workers of Nigeria (AMSWON), during its annual socio-scientific conference in 2017, plan to organize a workshop session for all Heads of Department of Medical Social Services Department in Nigerian Hospitals (both States and Federal).

Finally, the level of participation of social workers in this project was encouraging, and stakeholder participation is crucial at this critical time when the whole world is going digital. One of the direct results of the project, was the formation of partnerships between core departments in the hospital, and the professional association of social workers. The partnerships formed are working towards providing an ethical and effective environment for professional data management and sharing. Moving forward, there will be a continuing need for stakeholder engagement and increased participation and commitment from governmental agencies in order to provide the technical expertise necessary for a unified and Comprehensive Electronic Social Services System (CESSS) for the Nigerian social service workforce.

Image credit: Christopher Congdon

 

References

Iwarimie-Jaja, D. (2002). Understanding social work. Owerri: Springfield Publishers Ltd.