INFORMATION SEEKING BEHAVIOUR AND UTILIZATION OF INFORMATION COMMUNICATION TECHNOLOGY AMONG REPRODUCTIVE HEALTH PROFESSIONALS IN GENERAL HOSPITAL

CHAPTER TWO

LITERATURE REVIEW

INTRODUCTION

Our focus in this chapter is to critically examine relevant literature that would assist in explaining the research problem and furthermore recognize the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps.

Precisely, the chapter will be considered in two sub-headings:

• Conceptual Framework
• Empirical Review

2.1 CONCEPTUAL FRAMEWORK

Information And Communication Technology

Information systems and technology in the organization have developed from one level to another through different ages and times.

In the dark ages, business transactions were executed through personal contracts. There was no system of writing and keeping records. Business deals were settled and information exchanged at coffee house, bar etc.

Pitman (1997) as found in Ahukannah (2009). Posit that Business grew bigger and faster during the industrial revolution and so there was the need to communicate and record business transactions settling business deals with mere words, was no longer sufficient. Invoices are essential part of business transactions. The documents were however handwritten by clerks using the “quill pen”. The production of documents in printing started in the year 1437. These early attempts marked the. However, information and communication technology which have from the core of modern business organization is an indispensable resources in our day-t0-day organizational works performed by workers in both private and public sectors.

In a Nutshell, this concept information and communication technology may mean different things to different people based on their perception. However, it will be much pertinent to draw/disclose the meaning of information and communication technology.

According to Aronu (1999) information and communication technology involves the combination of two technologies, computing and telecommunication (the corner stone of information technology and the main purpose of which is to transmit representation of information (signals) between remote locations). In the same vein, Ogwe (2016) sees information and communication technology as an umbrella term that includes all technologies for the manipulation and communication of information. Furthermore, Kabari (2015), said, “that information and communication technology is the use of technology in managing and processing information especially in a large organization. He further stated that over the past 20 years, the prevalence of information technology has dramatically increased so that it is now a part of nearly every aspect our dear life.

In a Nutshell, it will be pertinent to note from the definitions and meanings given by these authors above, that today the term information and communication technology has enveloped to encompass many aspects of computing and technology, and the term is more recognizable than ever before. The information technology umbrella can be quite large, covering many fields and scopes of modern business organization. According to Kabari (2015), the following are the perceivable importance of information and communication technology

1.Speed: Information and communication technology gadgets help a worker to calculate a whole lot faster than human beings. Therefore, more work can be accomplished within the same number of working hours (Kabari 2015).

2.Cost effectiveness: Information technology has helped to computerize the business process thus streamlining businesses to make them extremely cost effective money making machines (Kabari 2015).

3. Trade convenience: Internet is a great place to post an advertisement for selling any product: as it accessed across the globe, it is possible to receive quotations from other parts of the world (Kabari 2015).

Creation of new jobs: It is true that information and communication technology has made mechanical jobs like that of a typist, redundant. But it is also true that new lines like software engineer, hardware engineer, networking data analyst, etc have emerged because of information and communication technology. These jobs are more intellectually propelling. Therefore, the staff is likely to experience greater job satisfaction. However, nobody or modern business organization can deny that its sectors has improved for better since the last decade or two, primarily because of information and communication technology (Kabari 2015).

Function Of Information And Communication Technology

Weill (1998) stated that the relevance/functions of information and communication technology is enormous to the modern business organization and its workers performance cannot be over emphasized. The basic function includes:

a. Increased productivity: When a worker gets himself abreast with the latest happenings and innovation in the business organization, his efficiency and effectiveness is improved, resulting to increased productivity (Weill 1998).

b. Prestigious status: When an office worker gives himself over to hearing new things he simply makes himself have our edge over others.

c.Conducive/pleasant working environment: The use of modern machines like computers. Telephones, tax machines, etc has drastically reduced the quantity of files, papers, cabinets in some organizations, making them neat and pleasant (Weill 1998).

d. Ease of communication: When a worker is conversant with the modern communication gadgets e.g telephone types to perform different functions, have good knowledge of e-mails, internet, etc. Communicating with other workers and organization becomes very easy.

e. Relevance and promotion in the place of work: A worker who has taken time to develop himself becomes very relevant and inevitable to his organizations. No organization would want to lose such a worker and as a result, there is job security and of course the chances of getting promoted are facilitated.

Objectives Of Information And Communication Technology

As aforementioned, information and communication technology is an indispensable resources to the modern business organization and the world at large. Because without of dynamism on business organizations cannot be accomplished. Therefore, the objectives/aims of information and communication technology according to Kabari (2015).

a.Support information processing task in an organization: Tasks such a computing and printing payroll slips, creating presentations, setting up was sites from which customers can order products etc.

b. Enable innovation: A company/business can adopt information technology to enhance its operations and satisfy its customers better them other companies that do not adopt such innovations (Kabari 2015).

c. As a Collapse of time: This means information technology speed. E.g, a typical home computer today can execute about 130 million instructions per-second.

The emergence of information and communication technologies (ICTs) and their role in stimulating rapid development in all sectors of the economy, and in the inseparable sociocultural and political spheres of life, is widely acknowledged (Ajayi 2003; Akanbi 2005; Idowu, Ogunbodede, & Idowu, 2003). According to Ajayi (2003), ICTs are redefining the way almost everything is done and are a ready tool for all strata of society. Previous studies, like those of Idowu et al. (2003) and Akanbi (2005), have highlighted the strategic disadvantages that nations, institutions, and industrial sectors would face if they did not position themselves to harness and implement ICTs as tools for leveraging their activities in the emerging global economy. In the health sector, for instance, ICTs are being applied to facilitate the delivery of appropriate health services to the populace (Mechael, 2005). ICTs also contribute to health education, knowledge sharing, health monitoring, statistics gathering and analysis, the delivery of care, and in meeting internationally agreed upon health targets with respect to a number of diseases (United Nations Development Programme [UNDP], 2003). ICTs’ impact on health care have been particularly significant in developing countries and in rural settings, where long distances and the quality of the infrastructure hinder the movement of physicians and patients (Geissuhler, Ly, Lovis, & L’Haire, 2003), reducing the quality of the health services delivered.

Concept of Reproductive Health Workers

Health workers play important roles in a nation’s socioeconomic and political growth. ICTs are vital tools that help them to access and use relevant information in their jobs. ICT usage can be highly effective if health workers harness the opportunities it offers to meet their needs. Ibegwam (2004) observed that the Internet has become an important component of the electronic services in academic institutions and has permeated all aspects of life, breaking down barriers to communication and information access worldwide. The Internet is a particularly valuable resource for information relating to health care. However, in spite of the potential contributions of ICTs to the activities of health workers, some constraints exist that prevent their widespread utilization. Some of the more obvious constraints common to developing countries include the limits of physical access to ICTs, the high cost of providing access for nations trying to balance multiple financial priorities, and the exclusion from access of large segments of the population due to inadequate infrastructure (Chandrasekhar & Ghosh, 2001).

One specific area of health is reproductive health, which represents a crucial part of general health and a central feature of human development. Globally, both epidemiological data and the expressed wishes of diverse constituencies indicate that reproductive health interventions are most likely to include attention to the issues of family planning, sexually transmitted disease (STD) prevention and management, and prevention of maternal and perinatal mortality and morbidity. Reproductive health should also address issues such as harmful practices, unwanted pregnancy, unsafe abortion, reproductive tract infections that include STDs and HIV/AIDS, gender-based violence, infertility, malnutrition and anemia, and reproductive tract cancers (United Nations Population Information Network, 1995). Reproductive health workers (RHWs) need timely information to discharge their duties effectively, to collaborate with colleagues and apply ICTs on their job. However, they are also constrained by the same factors that limit the general body of health workers from exploiting ICTs. Of major concern is the fact that many RHWs who live in rural areas, particularly in developing countries or emerging economies, do not have information on current developments in medicine because of their inadequate access to ICTs, nor are they able to collaborate with geographically distant colleagues, as their counterparts in other parts of the world can. For instance, in developed countries, health workers conduct on-line consultation with colleagues that is only possible through the use of ICTs. Thus, health workers with inadequate access to ICTs, such as those at the University College Hospital (UCH), Ibadan, Nigeria, are less likely to be able to collaborate with peers, to gather current or timely information, or to be skilled in the use of various ICTs.

The Concept Of ICT In Health Sector

According to UNDP (2001), ICT in health sector can be used interchangeably with the term e- health or health information technology which comprises of telemedicine and Medical informatics. The concept of changing from a paper based for record keeping and reference purposes in our health sector to a computer based approach will be a fantastic idea because it will go a long way in securing patient information and keeping it safer in case of fire or any emergency (UNDP 2001). In well developed countries, daily lifestyle is now ICT-driven and in the next few years, it appears daily existence and experiences will be further defined and refined by the role of ICTs in the society. With e-health method, healthcare givers can easily accessed medical records and prescriptions in a timely manner without going through lots of files placed on shelves. With the use of ICT in health sector, many problems such as the time spent by the patients waiting for their turn, missing cards and files of patients, lack of information and so on will be solved and there will be better service for the patient. The chance of survival will also be high and adequate care will be given to people because there is more information about them that will hasten the doctor’s work in order to satisfy the patients (M.S. 2001).

Laudon, D.P. & Laudon, J.P. (2010) observed that recently, ICT is a tool of expression for healthcare workers such as medical doctors, nurses, medical laboratory scientist and radiologist in modern healthcare. ICT has become well assimilated into healthcare delivery system especially in developed countries that few doctors can imagine a day without using computers or network for the purpose of prevention of disease and injury, promotion and maintenance of health, relief of pain and suffering, care and cure of those with malady, avoidance of premature death, and pursuit of a peaceful death (Kinuthia, 2012).

Kim & Galliers, (2004) noted that through the internet, it is possible to set up facilities for intensive patient monitoring service which can enable doctors to watch their patients at a remote site, monitor their vital signs in real time as well as give advice for treatments. ICTs can also be used for exchange of information between different health professionals. Surgery can be made easier and more effective by giving surgeons the ability to visualize the area of the body that will be the subject of the operation by using endoscope, scanned images of tumours or other technological devices to aid surgical interventions with minimal complications. However, it is important to point out that inadequacy of ICT in health systems will not only hamper individual’s social and economic development, but also they may cause detrimental effects on national economic prospects especially in developing countries like Nigeria. The recent Covid 19 outbreak in the world has caused economic downturn and almost brought to halt economic activities worldwide (Kim & Galliers, 2004).

Although, the Nigerian government has proposed a generic and unifying Health ICT strategy that can be used to generate demand for an increase to improve the quality of health services and implementation of appropriate IT solutions in health. Part of the ways to achieve this purpose is the establishment of the National Health Promotion Policy in 2016, which created an ICT department to support the health sector electronically through digitizing and automating the various healthcare processes.The Policy also provides solid infrastructure and technical support for solutions with the help of theFederal Ministry of Communication, Federal Ministry of Science and Technology, Office of the Head of Service of the Federation and National Information Technology Development Agency (Khalil, 2000).

Importance Of ICT In Health Sector

A country like Nigeria with daily rising in population of over 190 million people with most of its citizen attending a public hospital (Government owned) should have a more advanced way of attending to people and giving them proper care. Every organization especially the health sector in Nigeria needs ICT in their endeavors in order to flourish and achieve its potentials in the management and planning of their programmes. Thus, the importance of ICT in Nigerian health sector cannot be over emphasized. According to Kevin, (2006), below are some of the advantages ICT can bring into the Nigerian health sector.

1. It can link the patients and health care providers through information support networks: Instead of coming to the clinic for information about a particular illness patients can find information on the health center website through telehealth and the e-health schemes and can apply it. This will reduce long queue in the health center and it will give the doctors more time to attend to other patients for their needs. ICT will also facilitate networking and collaboration between healthcare service delivery practitioners, this will enhance knowledge sharing and better health delivery results. With ICT, new drugs can easily be modelled to test its effects on the ultimate consumers, facilitate clinical trials online as well as facilitate collaboration, information and knowledge sharing between international teams of medical researchers' within real time (Kevin, 2006).
2. It can be used to monitor patient’s health conditions: ICT can provide collection and analysis of a large quantity of data related to the patients’ medical historyto other clinical studies. With the use of ICT a medical practitioner can monitor, report on outbreaks of diseases, disseminate guidelines for controlling, treating such diseases and administer drugs to the patients by checking their chart. In addition, scientific knowledge and research findings among professionals in the health community can also be shared through the use of ICT in health sector (Kevin, 2006).
3. Itprovidesadequatestorageofpatient’srecord:WiththehelpofICTs,patients'recordscanbestoredincomputer-aideddatabase,andattheclickofabutton,patients'medicalhistorysuchas prescribed drugs and what illness the patient has suffered in the past can be trackedeasily. Recently, equipment such as the body scanner is now ICT-aided and can be used toprocessdataintoreadableformats.Also,microprocessorscannowbeusedtocontrolavarietyof medical devices such as blood pressure. In addition, electrocardiogram can be used tomeasures electrical activity generated by the heart and blood oxygen can be used to monitorsthe amount of oxygen in a patient's blood.Pacemakers and computer guided lasers can also beused in very delicate operations such as removal of brain tumors through the use of ICT. Inmost advanced countries prescription given out by a doctor is no longer on paper, but is eitherwritten on the patient card, or stored over a network (or in the cloud), and the patient card willbeused asthesecurekeytogainaccesstoitwhenthepharmacistdeliversthe medicines (Kevin, 2006).
4. It saves a lot of time, resources and aid referral system: Computer-aided equipment saves a lot of time, increases performance and reduces patients' waiting time. Interestingly, surgeons can now perform operations remotely through tele-conferencing and prescribe drugs through tele-medicine. ICT in health sector helps to facilitate a robust referral system. The lengthy time it takes to refer and transfer patient from one health facility to another with the required technical capacity makes emergency interventions come late. But in a situation in which hospitals are ICT connected, patients' diagnostic results and tests can be sent electronically to another hospital where the consultant that will handle the patient's case will be able to examine the tests and results in order to propose right treatment without any loss of documents (Kevin, 2006).
5. It can be used to safe lives through reduction in medication error rates: Another vital benefit of ICT in health sector is that it can be used to perform life-saving operation via robots. For example if someone who has a bad heart condition is in need of a vital operation and the health professional was unable to perform it then a robot can perform the operation by the commands of another surgeon elsewhere. The use of online integrated intelligent healthcare delivery portals often reduce errors in medical diagnosis and treatment by providing large base knowledge across various areas of specialization (Kevin, 2006).
6. It aids even distribution of healthcare to people: The usage of ICT in Nigerian health sector will increased equity in access and quality of health services, information, and financing for better coverage of health services especially among the people living in rural areas which form more than 60 percent of the Nigerian population through the effective use of civil registration and vital statistics. The usage of ICT in health sector will alsohelp to promote transparency among the health care providers especially those in National Health Insurance Scheme (Kevin, 2006).
7. It helps to promote healthcare insurance: Patients in other countries with an E-Health system are generally happier to have their medical expenses paid directly by public and private insurances rather than to pay for medical expenses upfront and later be reimbursed. Such a system is therefore recommended for patients in Nigeria even though other systems of payment could still be used such as mobile money or online payments. A country like Nigeria where many people live in abject poverty will depend much on the assistance the government can render for them for their survival and one of the best way to go about this is have a health insurance for Nigerian citizens through ICT devices for proper connection and documentation (Kevin, 2006).

Challenges affecting adequate usage of ICT in health sector

It is not a gain saying that health facilities are inadequate in Nigeria, especially in rural areas. Beside the scantiness of facilities, the country is also faced with deficiency of human resources, poor quality of care, lack of drugs and equipment, ineffective referral systems and so on especially in the remote areas which slow the development of good health care delivery in Nigeria. Besides these general challenges in health sector, the introduction and usage of ICT in Nigerian health sector has also been hampered due to certain factors. Thus according to Ikechukwu, (2000), ICT application in the Nigerian health sector is amputated by some of the following challenges:

Epileptic power supply: Power is needed in every sector especially health sector because they deal directly with lives. It is so unfortunate that one of the less productive sectors in Nigeria is the power sector. Nigeria has been characterized as a country with epileptic power supply withhigh importers of generatorsets for power supply and virtually, 3 out of 5 household of people living in urban centers in Nigeria will have generator sets in their respective houses. Most ICT facilities rely on electric power to function otherwise, they will be useless. Most of the government owned hospitals which is the hope of a common man are experiencing power failure. Failure of reliable power supply can lead to interruption of electricity while surgical operation is going on which will be detrimental to patients undergoing such operations. Before ICT can be maximally utilized in Nigerian health sector, it is very essential and germane for our power sector to be refined for adequate output (Ikechukwu, 2000).

Illiteracy: To access information and make meaningful decision out of information received, the parties involved must be educated with some level of proficiency in computer or digital education. Most rural dwellers are illiterate and have never come in contact with computer or ICT tools. Some of the urban dwellers are more concerned with basic necessities of life and a large number are not versatile with the benefit of ICT in health system. Literacy goes beyond mere skill of reading and writing. It is a process of transformation that empowers an individual and broadens critical thinking. There are also problem of low level of education and illiteracy among health officials which has created scarcity in skills and expertise. Nigeria is quite a world of its own considering its heterogeneity evidenced by the presence of over 250 ethnic nationalities with diverse beliefs, customs, ideologies, organization, practices, behaviors and languages. These factors cannot be overlooked as they are vital to the implementation of ICT usage in delivering health care in Nigeria (Ikechukwu, 2000).

High cost of ICTs equipment: Among the number of factors affecting access to the usage of ICT and Internet in Nigerian health sector is high cost of ICT health sector related equipment. In addition, most Nigerian General hospitals do not have connection with the Internet Service Providers (ISPs) because of the huge amount of money it costs. The government are not ready to spend enough on health sector, since many of them receive treatment abroad and they do not see any good reason why they should invest more on health sector. Besides, some of the private owned hospital are handicapped in terms of financial capability. Mostprivate owned hospitals cannot afford adequate modern technological equipment because they are very expensive (Ikechukwu, 2000).

Lack of clear-cut policy: Implementation of e-health as an integral part of the whole healthcare delivery system requires vibrant and dynamic legal frameworks owing to the rapid changes that are associated with advancement in technology. Dynamism here is stressed because it would be difficult for any health personnel to go extra mile in providing care without the necessary assurance that he/she is protected by the law. The laws in this regard must be dynamic and enforceable to the effect that its provisions must take cognizance of the rapid rate of technology advancement so as to include appropriate clauses that would cover such developments. Definitely, one of the most important factors related to allocation and development of E-health is provision of laws and policies to regulate its practices. Some of the legal challenges of electronic health system in most countries especially developing countries like Nigeria are; lack of following government's ratified laws, poor support of national and universal standards, inadequacyof existing suitable laws regarding personal rights and keeping patients' private surroundings. The need to develop a legal framework for managing health care delivery in Nigeria is very essential. Many health policies are implemented wrongly while some shabbily made by the authorities responsible for it. More efforts are needed to turn things around especially in the area of ICT in health (Ikechukwu, 2000).

In adequate of expertise: In the year 2014, the estimated figure for registered hospitals nationwide stands at around 4,000, excluding the 700 health care centers, 1,670 maternity centers and the 12 University Teaching Hospitals which handles tertiary care; it is believed that it would have increased greatly by now.46 However,the challenge here is the qualifications and experiences of the health practitioners coordinating or managing these health delivery centres. It is axiomatic that one cannot give what he or she does not have. Thus, the level of the experience and exposure of medical experts in Nigeria will determine how far they can go with the usage of ICT to improve their health care delivery to the masses. Ability to purchase technological equipment is different from the knowledge of its usage which is more important. Thus, for there to be an improvement on the connection between ICT and Nigerian health sector, there is a need to increase the number of our medical experts who must be versatile with the usage and application of ICT to develop our health sector. The state of educational system in which the doctors are being trained in Nigeria is not in the best position and that is another challenge contributing to inadequacy of experts in health sector this is because a few universities have enough facilities for training. Many government owned institutions in Nigeria where medicine are studies are not well equipped and as a result, the output of such institutions might find it difficult to compete with other contemporaries globally. Thus, adhering to best practice is important as well as providing adequate measure to achieve the expected results (Ikechukwu, 2000).

Corruption: This is regarded as a social problem which connotes an act or a form of behavior that constitutes concern to a significant proportion of the society which warrants a common solution by that society. Social problems are serious behavioural deviations hindering the functioning of society and inhibiting the needs and goals of society. Corruption is responsible for perpetual collapse of infrastructure and institutions and it can be said to be the cause of the endemic poverty in Africa. Corruption is behind the underdevelopment and cyclical failure of democracy because corrupt government officials can shift government expenditures to areas they can collect bribes easily. Corruption is one of the biggest factors affecting the development of the health sector in Nigeria and it has eaten it up to the highest level. Nigerian government pays little attention to the health sector especially before the breakdown of the current Covid 19 pandemic because they can afford to go abroad for better healthcare. Thus, the usage of ICT in health care system is not only hampered but crippled by corruption. In addition, poor state of social and physical infrastructure such as power supply, roads, and ambulance service have been immensely affected due to corruption (Ikechukwu, 2000).

Lack of political will is another grave challenge to consider. Quite often, lack of good quality leadership within the public service has been more closely linked to poor performance of the public sectors than to lack of national resources. Many developed countries that have successfully improved healthcare delivery have had strong political commitment, creating policies and devoting resources to ensure improvement. In Nigeria,different government wants a different approach or policy to implement its agenda which does not correspond with the existing one and there is no plan for continuity. In addition, political leaders are not determined to do anything about it because they are not affected by it and they seem to overlook many things through negligence. Recent records of Covid 19 has shown that the poor political will of our leaders and their negligence which has never benefited the general masses (Ikechukwu, 2000).

Inadequate and inequality access to infrastructural facilities: Inequality access to ICT facilities in Nigerians health sector is a serious problem as computers, telephone lines, satellite dishes and so on which are necessary for internet connectivity are not evenly distributed in Nigeria especially in the rural rears. Also lack of provision of ICT devices in Nigerian General Hospitals and installation of internet are serious challenges. Many healthcare workers in General Hospitals do not have computers individually, even projectors and other digital electronics and most of these electronic health machines such as computerized tomography (CT), Magnetic Resonance Imaging (MRI), are expensive to set up. In addition, the state of some of the health centres are nothing to write home about, they are in their worst state and the government is not ready to do much. Presently, most of the isolation or treatment centres during this pandemic period are not well facilitated neither are they conducive for patients’ proper treatment. Whereas, at this period ICT is needed more in health sector for proper testing and treatment but on the contrary, those in charge of procuring the technological facilities prefer to pay less attention to such procurement or better still, purchase inferior facilities because of their financial gains (Ikechukwu, 2000).

Likely issues that may arise in the usage of ICT in health care sector

According to Evans, & Wurster, (2007), some of the issues that may arise in the usage of ICT are:

Whether ICT in health will not breach patient’srights on privacy and confidentiality: Privacy and confidentiality are part of the rights every patient should enjoy in the medical parlance. However, with the usage of ICT to store patients’ data and confidential medical information via ICT specifically telemedicine and cyber medicine can result in ambiguous doctor -patient relationships. This is because such an information can be leaked to other health professionals who have access to the same server where the information is stored.The communication between physician and patients via e-mails lacks human touch and is fragile in terms of privacy and confidentiality. Before a patient can enjoy the right of privacy and confidentiality in healthcare delivery through the usage of ICT, proper measure should be put in place and the medical practitioner should protect patients’ information about their health condition as much as possible, otherwise, some patience will feel uncomfortable using applicable ICT devices in health sector (Evans, & Wurster, 2007).

Whether a health care personnel can be held liable for failure of ICT facilities:

The failure of health personnel through ICT could come in diverse ways, it could be through wrong assessment of patients’ data due to the malfunction of the ICT facilities or where upon the directive of health personnel, a patient over reliance on electronic health devices and equipment which latter lead to death or incapacitation of such a patient. A close example is what happened in America where a radiation therapy machine accidentally gave patients overdoses of radiation, leading to 3 patients death. It is important to start here that the machine cannot operate on its own and at the same time the operator must pay a kin attention to how the machine or any ICT related device in health sector works before a reliance is placed on such a machine for usage. It will be wrong for a health practitioner not to pay a close supervision to the usage of machines or robot while treating a patient (Evans, & Wurster, 2007). Thus, where an ICT facility malfunctions and lead to the death of a patient, the writer is of the opinion that many things should be put into consideration before a health personnel can be held responsible. Where a health personnel can adequately prove that the ICT facility is functional as at the time of usage without any sign of malfunctioning and it was used for the purpose for which it was made with adequate supervision and close monitoring, the health personnel should not be held liable because it is difficult to expect even the most sophisticated of computing system to discharge all its duties to provide a safe and reliable answer at hundred percent (Evans, & Wurster, 2007).

Solutions to the Challenges faced by Health Care workers in the Use of ICT

ICT in health sector will be impressive if it can be predicated upon four major pillars which are; Information surveillance, research management of health services, human resources and financing. In developed countries where literacy level is high, little effort is needed for application of ICT in any sector and at any level. For Nigeria to benefit fully from ICT, it requires people-centred development programmes, which must be supported by an appropriate mix of adequate resources, good and strong political will for policies implementation.

Thus according to Evans, & Wurster, (2007), these are some of the approaches to resolve the challenges combating ICT in health sector;

i.Developing Internet information portals;

ii.Using mass media to broadcast widely;

iii.Developing interactive programming on broadcast media;

iv.Making more effective use of existing communication systems; and

Developing community access points (CAPs).

2.2 Empirical Review of Related Literature

Several studies have reported on ICT use among RHWs. Idowu et al. (2003) reported that while ICT capabilities (personal computers, mobile phones, Internet) were available in Nigerian teaching hospitals, mobile phones were spreading fastest. Their findings also revealed that computers and mobile phones were in use in all the teaching hospitals but not much Internet connectivity was available, meaning that most of the medical experts used external (nonhospital) Internet services, such as cybercafés, for even rudimentary Internet access, such as e-mail. They further explained that while just 1.4% of the medical staff did not use the Internet in any fashion, the vast majority (70.7%) of those using the Internet did so only for e-mail. In addition, Adeyemi and Ayegboyin (2004), in a survey involving four general hospitals, 10 primary health-care centers, and six private hospitals in Nigeria reported that none of the institutions had e-mail access or a Web site, only 5% of the workers possessed personal computers, only 7% of the health-care workers were computer literate, only 2% had any measurable computer skills, and just 65% had access to a mobile phone, but not necessarily their own. This was in spite of the fact that the state of Lagos has the largest concentration of Internet service providers, telecom operators, and cybercafés, intended to create a reasonable platform for ICT use.

The Tucker and Chetty (2004) case study series on ICT-enabled development initiatives illustrated the possible benefits when health workers use ICTs successfully to overcome development obstacles, and thus narrowing the digital divide gap. In their study, a wireless local area network (LAN) was set up in 1999 to connect the hospital in Sulenkama in Cape Town, with a clinic, local school, community center, and police station in Tsilitwa, South Africa. The LAN used wireless fidelity (WiFi) signals, with a booster between Tsilitwa and Sulenkama since Sulenkama lies in a slight valley. The clinic and hospital used the system in a telehealth project pioneered by researchers at the University of Cape Town. The system worked in such a way that a nurse at Tsilitwa focused a web camera on a patient and the picture was displayed on a computer in Sulenkama. In Sulenkama, the doctor opened up his computer that had been configured to load a Web page associated with the IP address of the Web camera that was focused on a patient in Tsilitwa and thus access the image. Simultaneously, the nurse, doctor, and patient could speak to one another using a Voice over Internet Protocol (VoIP) program on the LAN. The doctor was then able to advise the nurse regarding a course of treatment or could refer the patient to a specialist elsewhere, thus improving care while saving time and money.

In addition, Braa, Macome, Mavimbe, and Jose (2001) conducted a study of actual and potential usage of ICTs at the district and provincial levels in Mozambique, with a focus on the health sector. They demonstrated that computers and Internet access were rapidly becoming available in all provinces and major districts in Mozambique, although most of the health workers were using the computers only as advanced typewriters, that is, for word processing. The National Health Information System of Mozambique was said to be among the very first computer applications in the provinces. The study also revealed that while it was still rare to use application software developed in order to address particular needs, the health sector was a forerunner with such an innovation.

Meanwhile, an Academy for Educational Development-Sattellife (2009) study determined the extent of use of HealthNet by health workers. The study revealed that HealthNet was used by 1,950 health-care workers in more than 150 countries worldwide, and that the development impact of HealthNet had been most prevalent in Africa, where the model has contributed to increased rural and urban connectivity, capability building, increased demand for IT services, and, in some cases, commercially viable IT service enterprises. The study further explained that surgeons from Mozambique, Tanzania, and Uganda used HealthNet to consult regarding patient treatments and to learn new reconstructive surgery techniques. In Zambia, health-care workers who once traveled 700 kilometers each week to collect data for clinical trials now used HealthNet to send this information via e-mail. Physicians in Ethiopia used HealthNet to schedule consultations, making it unnecessary for ill patients to travel long distances with no guarantee of seeing a physician. Health workers in the Democratic Republic of Congo used HealthNet to report progress on treating trypanosomiasis to public health organizations in the north of the country while, in Gambia, malaria researchers used HealthNet to submit data to European medical schools for clinical trials. The study concluded that many physicians in developing countries relied on HealthNet as their sole source of information on the treatment of AIDS and tropical diseases, essential drugs, pediatrics, and public health promotion (Academy for Educational Development-Sattellife, 2009).

Taylor and Lee’s (2005) study on occupational therapists’ use of ICTs in Western Australia revealed that e-mail and the personal computer were the most frequently used ICT- enabled services. Furthermore, regarding competency in the use of ICTs, 58% of therapists rated their competency level as good or better, although competence was rated lower for Web searching (48.5%) and searching for electronic articles (29.8%). Additionally, approximately one third of respondents were dissatisfied with the level of technical support available to them, and only 38.4% of the therapists had participated in basic computer training provided by their current employer. Rural therapists had less access to a computer in their work environments in comparison to their metropolitan peers but they proportionately used e-mail, teleconferencing, and videoconferencing more frequently than their metropolitan counterparts.