National Health Management Information System

FEDERAL MINISTRY OF HEALTH
DEPARTMENT OF HEALTH PLANNING AND RESEARCH
NATIONAL HEALTH MANAGEMENT INFORMATION SYSTEM

(NHMIS) UNIT
REVISED POLICY-PROGRAMME AND STRATEGIC PLAN OF ACTION
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NHMIS POLICY DOCUMENT
INTRODUCTION
The new National Health Policy has been formulated  health and access to quality and affordable health
within the context of: care is a human right;
 the Health Strategy of the New Partnership for  equity in health care and in health for all Nigerians is
Africa’s Development (NEPAD), a pledge by African an ideal goal to be pursued;
leaders based on a common vision and a firm
conviction that they have a pressing duty to  primary health care (HC) shall remain the basic
eradicate poverty and place their countries philosophy and strategy for national health
individually and collectively on a path of sustainable development;
growth and development;
 good quality health care shall be assured through
 the Millennium Development Goals (MDGs) to which cost-effective interventions that are targeted at
Nigeria, like other countries, has committed to priority health problems;
achieve;
 a high level of efficiency and accountability shall be
 the National Economic Empowerment and maintained in the development and management of
Development Strategy (NEEDS) which is aimed at the national health system;
re-orienting the values of Nigerians, reforming
government and institutions, growing the role of the  effective partnership and collaboration between
private sector, and enshrining a social charter on various health actors shall be pursued while
human development with the people of Nigeria; and safeguarding the identity of each;
 the development of a comprehensive health sector  since health is an integral part of overall
reform programme as an integral part of the NEEDS. development, inter-sectoral cooperation and
collaboration between the different health-related
1.1 Underlying Principles and Values Ministries, development agencies and other relevant
institutions shall be strengthened; and a gender
 the principles of social justice and equity and the sensitive and responsive national health system shall
ideals of freedom and opportunity that have been be achieved by mainstreaming gender
affirmed in the 1999 Constitution of the Federal considerations and implementation of all health
Republic of Nigeria; programmes.
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health that will permit them to lead socially and

1.2 Overall Policy Objective economically productive lives at the highest
possible level.
To strengthen the national health system such that it
will be able to provide effective, efficient quality, ii. All Governments of the Federation are convinced
accessible and affordable health services that will that the health of the people not only contributes
improve the health status of Nigerians through the to better quality of lives but is also essential for
achievement of the health-related Millennium the sustained economic and social development of
Development Goals (MDGs). the country as a whole.
1.3 Targets iii. The people of this nation have the right to
participate individually and collectively in the
The main health policy targets are the same as the health planning and implementation of their health care.
targets of the Millennium Development Goals, namely: However, this is not only their right, but also their
solemn duty.
 reduce by two-thirds, between 1990 and 2015, the
under-5 mortality rate; iv. Primary health care is the key to attaining the goal
of health for all people of this country. Primary
 reduce by three-quarters, between 1990 and 2015, health care is essential health care based on
the maternal mortality rate; practical, scientifically sound and socially
acceptable methods and technology made
 to have halted by 2015 and begun to reverse the universally accessible to individuals and families in
spread of, HIV/AIDS; the community through their full involvement and
at a cost that the community and state can afford
 to have halted by 2015 and begun to reverse the to maintain at every stage of their development in
incidence of malaria and other major diseases. the spirit of self-reliance. It shall form an integral
part both of the national health system, of which
1.4 Health Policy Declaration and Commitments its central function and main focus is the overall
social and economic development of the
i. The federal, state, local governments and private community.
health sector of Nigeria hereby commit themselves
and all the people to intensive action to attain the v. All Governments and the people are determined to
goal of health for all citizens, that is, a level of formulate strategies and plans of action,
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particularly action to be taken by governments, to viii. All Governments accept to exercise political will to
re-launch and sustain primary health care in mobilize and use all available health resources rationally.
accordance with this national health policy. 1.5 Major Thrusts of Health Policy
vi. All Governments agree to co-operate among The major thrusts of the National Health Policy relate to:
themselves in a spirit of partnership and service to
ensure primary health care for all citizens, since  National Health System and Management
the attainment of health by people in any area
directly concerns and benefits others in the  National Health Care Resources
Federation.
 National Health Interventions
vii. The Federal Government undertakes:-
 National Health Information System
 to provide policy guidance and strategic
support to States, local governments and the  Partnerships for Health Development
private sector in their efforts at establishing
health systems that are primary health care  Health Research
oriented and are accessible to all their people;
 National Health Care Laws
 to coordinate efforts in order to ensure a
coherent, nationwide health system;
 to provide incentives in selected health fields
to the best of its economic ability to promote
this endeavour; and
 in collaboration with the State and Local

Governments and the organized private sector
as well as Non Governmental Organizations
(NGOs), to undertake the overall responsibility
for monitoring and evaluation of the
implementation of the health strategy.
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NATIONAL HEALTH SYSTEMS AND MANAGEMENT  maternal and child health care, including family
planning. In this context, family planning refers to
2.1 A Comprehensive National Health System services offered to couples to educate them about
family life and to encourage them to achieve their
(a) The goal of the national health policy shall be to wishes with regard to: preventing unwanted
establish a comprehensive health care system, pregnancies; securing desired pregnancies;
based on primary health care that is promotive, spacing of pregnancies; and limiting the size of the
protective, preventive, restorative and family in the interest of the family health and
rehabilitative to every citizen of the country within socio-economic status. The methods prescribed
the available resources so that individuals and shall be compatible with their culture and religious
communities are assured of productivity, social beliefs.
well being and enjoyment of living.  immunization against the major infectious
diseases;
(b) Guaranteed minimum health care package for all  prevention and control of locally endemic and
Nigerians shall be the mobilizing target. As a long- epidemic diseases;
term policy and within available resources, the  appropriate treatment of common diseases and
governments of the Federation shall provide a injuries;
level of health care for all citizens to enable them  provision of essential drugs and supplies;
to achieve socially and economically productive  promotion of a programme on mental health; and
lives.  promotion of a programme on oral health.
2.2 Health System Based on Primary Healthcare The health system shall:-
The health system, based on primary health care, shall  reflect the economic conditions, socio-cultural and
include as a minimum:- political characteristics of the communities as well
as the application of the relevant results of social,
 an articulated programme on information, biomedical, health system research and public
education and communication (IEC), which should health experience;
also include specific programmes on school health  address the main problems in the communities,
services; providing promotive, preventive, curative and
 promotion of food supply and proper nutrition; rehabilitative services accordingly;
 an adequate supply of safe water and basic  involve, in addition to the health sector, all related
sanitation; sectors and aspects of state and community
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development, in particular agriculture, animal specific responsibilities to the State and Local
husbandry, food industry, education, housing, Governments.
transportation, public works, communications,
water supply and sanitation and other sectors, and  The Nigerian Constitution of 1999, which is the
demand the coordinated efforts of all those operative document, is almost silent on health
sectors; care delivery except the vague reference made on
 promote maximum community and individual self- Local Governments’ responsibility for Health. In
reliance and participation in the planning, section 45 the constitution also made provision for
organization, operation and control of primary the over riding of individual rights, if it is in the
health care, making full use of Local, State, interest of, among other things, public health. It is
Federal Government and other available therefore imperative that a National Health Act be
resources; and enacted to state the roles and responsibilities of
 to this end, develop, through appropriate each tier of government.
education and information, the ability of
communities to participate.  The national health care system is built on the
basis of the three-tier responsibilities of the
2.3 An Integrated and Co-ordinated National Health Federal, State and Local Governments. Schedules
Care System of responsibilities to be assigned to the Federal,
State and Local Governments respectively, shall in
 Federal, State and Local Governments shall consultation with all tiers of government, be
support, in a coordinated manner, a three-tier prepared for approval by the Federal Ministry of
system of health care. Essential features of the Health.
system shall be its comprehensiveness,
multisectoral inputs, community involvement and  In order to ensure that the primary health care
collaboration with non-governmental providers of services are appropriately supported by an
health care. efficient referral system, Ministries of Health shall
review the resources allocated to, and the facilities
 In the Nigerian Constitution of 1963, health is on available at, the secondary and tertiary levels.
the concurrent list of responsibilities with the Whilst high priority shall be accorded to primary
exception of international health, quarantine and health care, within available resources, the
the control of drugs and poisons which is secondary and tertiary levels shall be
exclusively the responsibility of the Federal strengthened. The long-term goal is that
Government. The Constitution also assigned eventually all Nigerians shall have easy access not
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only to primary health care facilities but also to 2.4 Voluntary Agencies and the Private Sector
secondary and tertiary levels as required.
Particular attention shall be placed on the needs of The non-governmental health sector shall comprise:
remote and isolated communities, which have
special logistic problems in providing access to the  A variety of non-governmental agencies, especially
referral system. religious bodies that provide health care including
both curative and preventive services.
 In discharging the responsibilities assigned under
the Constitution and/or National Health Act, the  Private practitioners that also provide care.
Federal, State and Local Governments shall
coordinate their efforts in order to provide the 2.5 Community Involvement
citizens with effective and efficient health services
at all levels. (a) Governments of the Federation shall devise
appropriate mechanisms for involving the
 Governments of the Federation shall work closely communities in the planning and implementation
with voluntary agencies and the private sector to of services on matters affecting their health.
ensure that the services provided by these other
agencies are in consonance with the overall (b) Such mechanisms shall provide for appropriate
national health policy. The establishment of consultations at the community level with regard
National Hospital Services Agency would further to local health services on the basis of increasing
enhance the coordination. self-reliance. The traditional system and
community organizations (cultural and religious
 Mechanisms shall be established to ensure that all associations) shall be fully utilized in reaching the
sectors related to health and all aspects of national people.
and community development, in particular,
agriculture, animal husbandry, rural development, (c) The Federal and State Ministries of Health shall
food, industry, education, social development, consult accredited groups and associations, which
housing, transportation, water supply, sanitation represent the various interests within the society,
and communications are involved and their health including the various professional associations.
related activities are coordinated.
(d) The Armed Forces and Police Barracks are usually
not taken care of by the Local Government Areas
where they are situated. The Ministry of Defence
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and Police shall therefore be responsible for the immunizations. Traditional health
health care of the citizens living in such practitioners shall be trained to improve
communities. their skills and to ensure their cooperation
in making use of the referral system in
2.6 Levels of Care dealing with high risk patients.
Governments of the Federation shall seek
National Health Care System shall be developed at to gain a better understanding of traditional
three levels viz: health practices, and support research
activities to evaluate them. Practices and
(a) Primary Health Care technologies of proven value shall be
i. Primary Health Care shall provide general adapted into the health care system and
health services of preventive, curative, those that are harmful shall be
promotive and rehabilitative nature to the discouraged.
population as the entry point of the health
care system. The provision of care at this (b) Secondary Health Care
level is largely the responsibility of Local The Secondary health care level shall provide
Governments with the support of State specialized services to patients referred from the
Ministries of Health and within the overall primary health care level through out-patient and
national health policy. Private sector in-patient services of hospitals for general medical,
practitioners shall also provide health care surgical, paediatrics, obstetrics and gynaecology
at this level. patients and community health services. It shall
also serve as administrative headquarters
ii. Noting that traditional medicine is widely supervising health care activities of the peripheral
used, that there is no uniform system of units. Secondary health care shall be available at
traditional medicine in the country but that the district, division and zonal levels as defined by
there are wide variations with each variant the authorities of the State. Adequate specialized
being strongly bound to the local culture supportive services such as laboratory, diagnostic,
and beliefs, the local health authorities blood bank, rehabilitation, and physiotherapy shall
shall, where applicable, seek the be provided.
collaboration of the traditional practitioners
in promoting their health programmes such
as nutrition, environmental sanitation,
personal hygiene, family planning and
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(c) Tertiary Health Care 2.8 The National Health Managerial Process
Tertiary health care, which consists of highly
specialized services, shall be provided by teaching A national managerial process shall be established to
hospitals and other special hospitals which provide include the following elements.
care for specific disease conditions or specific
group of patients. Care should be taken to ensure (a) The national health policy - comprising the
that these are evenly distributed geographically. goals, priorities, main directions towards priority
Appropriate supporting services shall be goals, that are suited to the social needs and
incorporated into the development of these economic conditions in the different States and
tertiary facilities to provide effective referral form part of national, social and economic
services. Selected centres shall be encouraged to development policies;
develop special expertise in the advanced modern
technology thereby serving as a resource for (b) Programming - the translation of these policies
evaluating and adapting these new developments through various stages of planning at the local,
in the context of local needs and opportunities. state and national levels into strategies to achieve
clearly stated objectives.
2.7 National Health System Management
(c) Programmed budgeting - the allocation of
It is generally recognized that a more effective and health resources by Governments of the
efficient delivery of health care can be achieved in this Federation for the implementation of these
country by a more efficient management of the health strategies;
resources. Experience has shown repeatedly that many
well-conceived health schemes fail to meet expectations (d) Plan of Action - describing strategies to be
because of failures in implementation. It is essential to followed and the main lines of action to be taken
establish permanent, and systematic managerial in the health and other sectors to implement these
processes for health development at all levels of care. strategies;
These shall include appropriate control to ensure the
continuity of the managerial process from design to (e) Detailed programming - the conversion of
application. strategies and plans of action into detailed
programmes that specify objectives and targets
and the technology, manpower, infrastructure,
financial resources, and time required for their
implementation through the health system;
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(f) Implementation - the translation of detailed (b) National health planning shall relate to the
programmes into action so that they come into determination of broad policy and priorities, and
operation as integral parts of the health system; their translation into forward plans for the
the day-to-day management of programmes and utilization of resources. It shall not be concerned
the services and institutions for delivering them, with detailed implementation of individual projects
and the continuing follow-up of activities to ensure or developments, but only with determining their
that they are proceeding as planned and priority and timing and the resources to be
scheduled; allocated to them.
(g) Evaluation - of health development strategies (c) The functions inherent in health planning shall be
and operational programmes in order to broken down between:-
progressively improve the effectiveness and
efficiency of their implementation; i. the research, analytical and considerative
processes which result in strategic policy
(h) Reprogramming - with a view to improving the choices and long-term objectives shall be a
master plan of action or some of its components, continuous process which cannot
or preparing new ones as part of a continuous appropriately be fit into an annual cycle,
managerial process for national health though an annual summary of long term
development; aims and objectives shall be produced as
background to programming decisions;
(i) Relevant health information - to support all
these components at all stages to ensure regular ii. the programming and budgeting process
and wide dissemination of needed information. will result in decisions to put into effect
specific courses of action within a definite
2.9 National Health Planning time scale as a means of achieving the
long-term aims, and to allocate resources
(a) National health planning shall form an integral part to them. This process, which gives rise to
of the national health policy and any ensuing the preparation of financial estimates,
legislation. It will be an important administrative budgets and operating targets, shall be
framework for assigning duties and responsibilities subject to annual revision and updating in a
as well as determining the working relationships formal planning cycle.
between different levels of health management;
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2.10. Planning by the Federal Ministry of Health iii. the performance of state health planning
and development functions; and
(a) The Federal Ministry of Health shall prepare and
submit for annual review medium and long-term iii. the planning performance of Local
national health plans that detail the health Government health authorities.
problems and needs of the country. Each plan
shall also detail the goals and objectives, priorities, 2.11 Planning and Development Guidelines
implementation and evaluation procedures of
solving the health problems and meeting the (a) The Federal Ministry of Health shall, by
health needs of the country. regulations, issue guidelines concerning national
health policies, plans and programmes, and shall,
(b) Each National Health Plan shall be made up of the as it deems appropriate, by regulation, revise such
State health plans submitted by every State guidelines.
Ministry of Health suitably revised to achieve the
appropriate coordination or to deal more (b) The Federal Ministry of Health shall include in the
effectively with the national health needs. guidelines issued:
(c) The Federal Ministry of Health shall also provide i. standards respecting the appropriate
guidelines on planning approaches, supply, distribution, and organization of
methodologies, policies, standards, and health resources;
development of health resources.
ii. statement of national health planning goals,
(d) The Federal Ministry of Health shall also provide objectives and targets developed after
guidelines for the organization and operation of consideration of the priorities stated above.
state health planning and development units The goals, objectives and targets shall be
including:- expressed in quantitative terms to the
maximum extent practicable.
i. the structure of a state health planning and
development unit; (c) In issuing guidelines, the Federal Ministry of
Health shall consult with, and solicit for
ii. the conduct of the planning and recommendations and comments, the State
development processes; Ministries of Health, the State Ministries of
Education and Local Government, professional
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associations and special societies representing i. the development of standardised national

health organizations. guidelines for the hospitals;
ii. the administration of hospitals; and
2.12 National Council on Health iii. technical matters regarding the
organization and distribution of hospital
(a) The National Council on Health shall advise the services at tertiary and secondary levels as
Government of the Federation through the part of the health systems.
Minister on
(b) The Agency shall monitor and provide guidelines
i. the development of national guidelines for on health services at tertiary and secondary
Health; levels in both public and private sectors.
ii. the development, implementation and
administration of the National Health Policy; (c) The Agency shall consider applications and make
iii. technical matters regarding the recommendations to the Minister for the issuance
organization, delivery, and distribution of of Certificates of Need and Standard for and as
health services.; and appropriate for the establishment of tertiary
iv. any other matter assigned by the Minister; health institutions.
(b) The National Council shall determine the time (d) The Agency shall establish an Office of Standards
frames, guidelines and the format for the Compliance, which shall include a person who
preparation of National and State Health Plans. acts as ombudsman in respect of complaints as
regards the activities of the Agency.
(c) The National Council shall be advised by the
Technical Committee. (e) The Minister may make regulations to facilitate
the activities of the Agency.
(d) The National Council on Health shall normally
meet at least once a year. (f) The composition of the Board of the Agency shall
adequately represent all stakeholders in the health sector.
2.13 National Hospital Services Agency
2.14 Managerial Process at State Level
(a) There shall be established a National Hospital
Services Agency to advise the Minister on (a) To permit them to develop and implement their
strategies, State Ministries of Health shall
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 establish a permanent, systematic, managerial (b) State Ministries of Health shall establish
process for health development which shall permanent mechanisms to develop and apply their
lead to the definition of clearly stated managerial processes and to provide adequate
objectives as part of the State strategy and, training to all those who need it. These shall
wherever possible, specific targets. include mechanisms in ministries themselves, as
 facilitate the preferential allocation of health well as all networks of individuals and institutions,
resources for the implementation of the State to participate in the managerial research,
strategy, and shall indicate the main lines of development and training efforts required for
action to be taken in the health and other health development.
sectors to implement it.
 specify the detailed measures required to build (c) State Ministries of Health shall establish machinery
up or strengthen the health system based on for implementation.
primary health care for the delivery of state
programmes. (d) State Ministries of Health shall coordinate Disease
Control Programmes
The managerial process shall also specify the
action to be taken so that detailed programmes 2.15 State Hospital Management Board
become operational as integral parts of the health
system, as well as the day-to-day management of  A Board known as the State Hospital
programmes and the services and institutions Management Board shall be established for each
delivering them. Finally, it shall specify the process State and shall be responsible for the
of evaluation to be applied with a view to administration, management of the hospitals that
improving effectiveness and increasing efficiency, come under their jurisdiction and ensure that the
leading to modification or updating of the State standard national guidelines for hospitals are
strategy as necessary. Health manpower planning adhered to.
and management shall be an inseparable feature  A State Hospital Management Board shall consist
of the process. of nominees to represent all the stakeholders in
the health sector (doctors, pharmacists, nurses,
For all the above, the support of relevant and medical laboratory scientists, patients etc.) to be
sensitive information will be organized as an appointed by the Governor.
integral part of the health system.  The Commissioner shall recommend the process
of selection, appointment and termination of
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office of the members of the Board to the and objectives, implementation and evaluation
Governor. procedures for the State. It shall also submit medium
 A State Hospital Management Board shall and long-term plans to the Federal Ministry of Health
function under the general supervision of a after the approval of the State Executive Council.
Commissioner.
 Each State Ministry of Health shall perform within the
2.16 Federal Capital Territory Hospital Management State the following functions:-
Board
i. conduct health planning activities and help
 A Board known as the Federal Capital Territory in implementing and co-ordinating the
Hospital Management Board shall be for the various components of the State Health
Federal Capital Territory. Plan;
 The Federal Capital Territory Hospital
Management Board shall be appointed by the ii. prepare, review and revise as necessary
Minister of the Federal Capital Territory. (but at least annually) a preliminary State
 The Executive Secretary of Health and Human Health Plan which shall include the Local
Services shall recommend the process of Government Health Authority plans;
selection, appointment and termination of office
of the members of the Board to the Minister of iii. assist the State Hospital Management
the Federal Capital Territory. Board in the review of the State health
 The Federal Capital Territory Hospital facilities plan and in the performance of its
Management Board shall function under the functions generally;
general supervision of the Director of Health iv. review on a periodic basis (but not less
Services. often than every three years) all
institutional health services being offered
2.17 State Health Planning by the state.
 Each Ministry of Health shall establish an appropriate 2.18 Technical Assistance for State Health Services
mechanism for the planning and implementation of its
development functions; The Federal Ministry of Health and where
applicable, the National Planning Commission,
 The State Ministry of Health shall submit an annual health shall provide the following technical assistance to
plan that shall outline the health problems, needs, goals the State Ministry of Health:-
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i. assistance in developing their health plans delivery of Primary Health Care and enforce compliance
and approaches to the planning of various with guidelines.
types of health services; The National Primary Health Care Development Agency
shall include:-
ii. technical materials, including (a) a part time Chairman;
methodologies, policies and standards
appropriate for use in health planning; (b) a representative of Federal Ministry of Health;
iii. other technical assistance as may be (c) six members representing the State Ministries of
necessary in order that such institutions Health and the Federal Capital Territory Ministry
may properly perform their functions. of Health, one per zone on rotation;
2.19 Local Government Health Services (d) six members representing the Local Government
Health departments, one per zone on rotation;
In order to involve every Local Government in the
development and provision of health services, there (e) one representative of Federal Ministry of
shall be established: Finance;
(a) a body to be known as the National Primary (f) one representative of National Planning
Health Care Development Agency; Commission;
(b) State Primary Health Care Development Boards
in every State and the Federal Capital Territory; (g) one representative of the registered Health
and Professional Associations and
(c) Local Government Health Authorities in every (h) The Executive Director as an ex-officio member
Local Government Area and Federal of the Board.
Capital Territory Area Council.
2.21 State Primary Health Care Management Boards
2.20 National Primary Health Care Development (SPHCMB)
Agency
(a) There shall be established for each State a State
There shall be established for the federation the Primary Health Care Board and for the Federal
National Primary Health Care Development Agency to Capital Territory, a Federal Capital Territory
provide strategic support for the development and Primary Health Care Board. The NPHCDA will
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provide technical support and supervision 2.22 Local Government Health Authorities
through the SPHCMB in the delivery of Primary
Health Care services. The Board shall be (a) There shall be established for each Local
responsible for the coordination of planning, Government Area of a State and Area Councils of
budgeting, provision and monitoring of all the Federal Capital Territory a Local Government
primary healthcare services that affect residents Health Authority that shall be subject to the
of the state and other matters incidental thereto. supervision of the State Primary Health Care
Board.
(b) The State Primary Health Care Board shall (b) The membership of the authority shall be as
include- determined by the Chairman of the Local
Government on the recommendation of the
(i) a full time chairman with experience in health Supervisory Councillor for Health in accordance
management who shall be the Chief Executive Officer with National Guidelines.
and Accounting Officer of the Board; (c) There is hereby established the Area Council
(ii) three other full time members who shall have Health Authority. The Area Council Health
qualification and experience in human resources, Authority shall include:-
financial management and administration;
(iii) one ex-officio member to represent the Ministry (i) A part time Chairman who shall be a qualified
of Health in the State/Federal capital Territory and experienced public health manager;
Department of Health; (ii) one representative of the private healthcare
(iv) three ex-officio members to represent the Local providers in the Area Council;
Governments/Area Council on biennial rotational (iii) one representative of women in the Area
basis; Council;
(v) one representative each of- (iv) one female representative of the Area Council
- private health care provider in the state; Social Welfare Department;
- state hospital management board. (v) one representative of the Traditional Rulers’
Council;
(c) The State Primary Health Care Board members (vi) two representatives of Religious Organizations;
shall be appointed by the Governor/Minister of and
FCT on the recommendation of the (vii) the Head of the Department of Health of the
Commissioner of Health/Executive Secretary of Area Council who shall be the Secretary of the
Health and Human Services’ Authority.
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(d) The members of the Area Council Health 2.24 Establishment of Village Development
Authority shall be appointed by the Chairman of Committees
the Area Council on the recommendation of the
Head of the Department of Health of the Area (a) There shall be established, in every village, a
Council. Village Development Committee whose
composition and responsibilities are as
2.23 Preparation of Local Government Primary Health determined by the PHC guidelines.
Care plans
(d) The NPHCDA shall issue operational guidelines
(a) The Federal Ministry of Health, in collaboration for the Village (Community) Development
with NPHCDA, shall within the national budget Committee.
cycle work with the State Primary Health Care
Boards and Local Government Health Authorities 2.25 Establishment of Ward Development
to develop and implement a health plan in Committees
accordance with National Health Guidelines
issued by it. (a) There shall be established for each ward in every
(b) A Local Government Health Authority shall, Local Government or Area Council, a Ward
within the national budget cycle, develop and Development Committee which shall be
present to the State Primary Health Care Board, responsible for the coordination of planning,
a Local Government health plan, drawn up in budgeting, provision and monitoring of all
accordance with national guidelines issued by the primary healthcare services that affect residents
Federal Ministry of Health, with due regard to of the ward and other matters incidental hereto.
national and State health policies. t
(c) The State Primary Health Care Board in (b) The membership of the Committee shall be
collaboration with NPHCDA shall ensure that determined by members of the ward according
each Local Government Health Authority to PHC guidelines on formation of Ward
develops and implements a health human Development Committee.
resource plan in accordance with national
guidelines issued by the Federal Ministry of
Health.
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3. NATIONAL HEALTH INFORMATION SYSTEM POLICY individuals for choices in matters relating to their
health.
a) PHILOSOPHY: The availability of accurate,
timely, reliable and relevant health information is the b) Background:
most fundamental step toward informed public health Planning, monitoring and evaluation of health services are
action. Therefore, for effective management of health hampered by the dearth of reliable data. The basic
and health resources, governments at all levels have demographic data about the size, structure and distribution of
overriding interest in supporting and ensuring the the population are unreliable on a national scale. The system
availability of health data and information as a public for the registration of births and deaths nationally is defective
good for public, private and NGOs’ utilization. The role and hence it is not possible to calculate the simplest indicators
of government must extend to ensuring like the crude birth rate, crude death rate and infant mortality
standardization and financing of health data rate. The state of health of the population is assessed on the
infrastructure, especially with respect to establishing basis of scanty information, which has been collected in a few
and strengthening relevant organizational structures limited surveys and research studies. The health services at
for Health Management Information System (HMIS) the national, state and local government levels cannot be
activities. It should also extend to procurement and managed efficiently on the basis of the available data.
installation of appropriate information technology,
staff training and collection, storage, analysis, c) GOAL: The establishment of an effective National
dissemination and use of health information, as well as Health Management Information System (NHMIS) by
in financing essential systems and biological research. all the governments of the Federation to be used as a
management tool for informed decision-making at all
The interface between the government, the private levels.
sector and communities is desirable for a more
comprehensive health profile of population. However, d) Objectives:
as a public good, the onus is largely on the government
to collect, analyze and make available, information on The NHMIS consists of the provision of appropriate
health status, health behavioural risk practices, infrastructure, the establishment of mechanisms and
prevention and containment of epidemic outbreaks and procedures for collecting and analyzing health data to
support for essential national health research, provide needed information:-
especially at the local level. Government should
facilitate standardization, ensure cooperation and  to assess the state of the health of the population;
coordination among agencies (public and private) and  to identify major health problems;
make information available to the communities and  to set priorities at the local, state and national levels;
18
 to monitor the -progress towards stated goals and  At the federal level, in collaboration with the Federal
targets of the health services; Office of Statistics, the Department of Health Planning
 to provide indicators for evaluating the performance of & Research (DHPR) of the Ministry of Health shall be
the health services and their impacts on the health responsible for obtaining, collating, analyzing and
status of the population; interpreting health and related data on a national basis.
 to provide information to those who need to take The DHPR shall support the state health authorities in
action, those who supplied the data and the general the development of their information systems.
public.
f) National Health Indicators
e) NHMIS Development
For comprehensive monitoring and evaluation of health care,
Development of the information system shall proceed as minimum categories of indicators shall be as follows:
follows:
 Health Policy Indicators;
 The information system shall be developed in a phased  Health Status and Performance Indicators (Ill-health
manner starting with the simplest data which can be prevention indicators, health restoration and
collected at the peripheral institutions. Efforts shall be rehabilitation indicators, and health protection
made to implement based systems for the collection of indicators);
vital health statistics: births and deaths. Such data shall  Socio-economic indicators related to health and living
be used for planning and monitoring of health services standard;
at the local level;  Indicators on Provision and utilization of health care
services.
 The state ministry of health shall promote and support
the collection of data by the local government health The indicators to be selected shall be based on the available
authorities to improve the quality and quantity of the resources, relevance to the health policy and availability of the
information. The methods of collection and recording data requirement.
shall be standardized as far as possible to facilitate their
collation and comparison; The four main indicators shall be as defined below:-
 As and when feasible, LGA and state health authorities i) Health Policy Indicators: - shall include:
shall use simple electronic data processing equipment
for storage, retrieval and analysis of the data;
19
 political commitment to "Health for All" especially  life expectancy at birth and at 5 years of age and
enactment of any necessary legislation to effect the  fertility rate.
commitment;
 financial resources allocation in terms of the Social and Economic Indicators shall include:-
proportion of the Gross National Product spent on
health, the proportion of the total governments'  rate of population increase;
expenditure going to health and specifically to  gross national or domestic product;
primary health care and per capita government  income distribution;
expenditure on health described by states and local  work conditions;
government areas;  adult literacy rate by sex;
 food availability; housing;
• the distribution of health resources, financial,  basic sanitation and school enrollment by sex.
manpower and physical facilities to reflect the
degree of equity by geography and by the iv) Provision and Utilization of Health Care Indicators shall
urban/rural ratios; include coverage by primary health care referral support: -
• the degree of community (village) involvement as  information and education concerning proportion of
indicated by the establishment of Community population with access to mass media outlets and
(village) development committees, community measurement of adult literacy activities to the
participation in health and health-related community;
programmes and contribution towards health care  food and nutrition;
and organizational framework and managerial  water supply and sanitation as above;
process.  family health indicators including proportion of
children receiving child health services; proportion of
ii) Health Status and Performance Indicators:- shall include at pregnant women receiving antenatal, essential
the minimum: obstetrics and post- natal care and proportion of
 nutritional status as indicated by the birth weight of eligible women receiving family planning advice;
babies, weight and height measurement of infants and  immunization indicators shall include the percentage
children in relation to age; of children at risk who are fully immunized against
 infant mortality rate; child (I - 4 years) mortality rate; the major childhood diseases; the incidence of the
 maternal mortality rate; six diseases in children under 5 years of age and
 crude death rate; mortality rate due to the six diseases in children
 crude birth rate; under 5 years of age;
20
 prevention and control of epidemic and endemic Principal Sources of Health Data and Information shall include
diseases. Indicators shall specify disease specific the following:
incidence and prevalence rate; mortality for selected
number of diseases; proportion of mortality rates  Population and household censuses as prepared and
from communicable diseases; proportion of leprosy projected by the National Population Commission and
and tuberculosis detected as well as under regular Federal Office of Statistics; household censuses will
treatment and lastly vector indices; produce data on health-related services such as
housing, water supply, toilet facilities and overcrowding;
 treatment of common diseases and injuries  Vital Events Register - legal registration, statistical
indicators shall include proportion of cases of recording and reporting of vital events such as births,
diarrhea in children under 5 years, proportion of deaths, marriages and divorces. These registrations of
fevers treated with chloroquine, proportion of vital events are available at appropriate state
respiratory infections treated with common authorities;
antibiotics, proportion of malnutrition treated with  Routine health services data dealing with morbidity and
supplementary feeds and proportion of injuries or mortality data; immunization, disease treatment, out-
accidents treated by first-aid or simple treatment; patient attendance, admissions, etc. These records
 provision of essential drugs indicators shall specify should be obtained from the records of health services
provision of essential. drugs, vaccines and supplies, in health institutions;
standard drug list and availability of such items;  Epidemiological surveillance data to cover immunization
 coverage by referral system indicators shall state the records, notifiable diseases, and indication of disease
proportion of the population in a given area with incidence and prevalence;
access to the services within five kilometers or one  Disease registers for specific morbidity and mortality
hour travel time, the proportion of referred cases shall be kept such as for cancer, sickle cell disease,
who made use of the services and the availability of handicapped persons, etc.;
referral services, e.g., pediatric, obstetric, surgical,  Budgetary allocation data to be obtained from the
medical, etc. federal and state ministries of finance and planning; as
 promotion of mental health indicators; well as the local government authorities;
 promotion of oral health indicators;  Community surveys shall be undertaken in collaboration
 promotion of school health services. with the NPHCDA, National Population Commission,
Federal Office of Statistics, university departments and
non-governmental organizations and
 Other health data sources including libraries, archives,
registers of health institutions and health personnel.
21
h) Responsibilities At Each Level  ensuring timely forwarding/sharing of data to relevant

departments, agencies and programmes operating at
Each level of government shall have assigned roles and the state level;
responsibilities as described below:-  training and supervision of state health facilities and
LGA officials;
i) Local Level:- The local government health authorities shall  ensuring the preparation of state health bulletin for
be responsible for decision making, dissemination and feedback and in the
 the collection, analysis, utilization and dissemination of iii) National Level:- The National Health Management
all data in its area of jurisdiction Information System (NHMIS) Unit of the Federal
Ministry of Health shall be responsible for:-
 ensuring timely forwarding/sharing of data to relevant
departments, agencies and programmes operating at  the establishment and sustenance of an effective
the LGA level national health management information system;
 ensuring forwarding of aggregated data, prescribed  the central coordination of the health information sub-
forms, to the state level; systems;
 training and supervision of health facilities and  collecting, processing and dissemination of relevant and
necessary information required both for national health
 ensuring that the LGA-GIS serves as the management planning and for monitoring the utilization of resources
unit for HMIS at the LGA level; in accordance with national priorities, objectives and
health indicators,
 A regular feedback mechanism should be in place to
facilities/States.  ensuring timely forwarding/sharing of data to relevant
agencies, departments and programmes operating at
ii). State Level: - State ministries of health shall be the Federal level;
responsible for  providing technical and managerial support to facilitate
health management information systems at all levels;
 collecting and aggregating relevant information from
local government areas;  A regular feedback mechanism should be in place to
facilities/States.
22
HISTORICAL DEVELOPMENT OF NHMIS established the new Disease Surveillance and Notification
(DSN) system.
All policy and strategy documents which attempt to define the
health problems, health priorities and the distribution and Since 1980, the Federal Ministry of Health in partnership with
coverage of health resources in Nigeria, emphatically highlight international organizations established various disease control
the lack of meaningful, accurate and timely data. programmes; some in the context of PHC such as NPI (former
Denominators (the demographic base around which services EPI), CDD/ARI, Malaria and Vector Control Programme, Guinea
are planned and indicators are calculated), are difficult to Worm Eradication Programme, Onchocerciasis Control
ascertain at the operational level. Disease surveillance systems Programme, Leprosy and Tuberculosis Control Programme
are not well defined and are not recognized by health workers STD/HIV/AIDS control etc. Administratively, these
at all levels from the policy maker and health manager to the developments have compounded the problem of coordination
health worker providing individual care or population care. within the existing systems.
Whatever information there is, is from a few isolated surveys
or research studies. Thus, it has been recognized that those In 1988, Government formulated a national policy on
who are responsible for the health of Nigerians at any level of population for development, unity, progress and self-reliance.
government have to sooner or later attempt to develop the Some of the strategies were population data collection,
intelligence base for monitoring the health status of the training and research. Emphasis was given to vital registration
population they serve. of births and deaths, conducting a census and demographic
surveys, data on family planning activities and coverage.
Since 1986, primary health care has been adopted by the These efforts were strongly supported by UNFPA and USAID
government of Nigeria as the strategy for achieving health for (the latter through the Family Health Services -- FHS project).
all Nigerians by the year 2000. Since the inception of PHC, the
Federal Ministry of Health has been committed to a simple and The Federal Ministry of Health has had a medical statistics
objective monitoring and evaluation of the programme. This system in place since the 1960s. Health manpower, hospital
has resulted in various committees being set up to design activities, morbidity and mortality data, records of births and
methods and formats for monitoring and evaluation -as well as deaths in hospitals used to be published on a quarterly or
to develop the training manuals and instruction booklets. annual basis.
The epidemic outbreak of yellow fever and cerebro-spinal The reorganization of the civil service in 1988 by the Federal
meningitis between 1986-1987 revealed that the disease government to make all ministries efficient, productive and
surveillance and notification system was poor and undermined effective created three mandatory departments in each
the national capacity to detect and control epidemics. This ministry, one of which is the Department of Planning,
resulted in the setting up of a national task force on epidemic Research and Statistics. Also in 1988, the government adopted
control, which reviewed the existing surveillance systems and its first comprehensive National Health Policy, which calls for,
23
among other things, the establishment of a national health meeting in July 2004 where the findings and recommendations
information system by all the governments of the Federation of the team were considered among other things. At the
to be used as a management tool for the health sector. Thus, meeting, a consensus was reached on the need to commence
the medical statistics and health information system activities the restructuring of the NHMIS so that it might provide an
have evolved as part of the Department of Planning, Research efficient and effective basis for planning, management and
and Statistics in the Federal Ministry of Health. In this evidence-based decision-making.
department, operational research and planning have had
prominence, but support for medical statistics and information Between October and December 2004, several technical
systems has been limited. committee meetings were held to review and put modalities in
place for the implementation of consensus reached at the
As a result of neglect and under funding over the years, the HDCC meeting. Highlights of the process include the
National Health Management Information System suffered a following.
lot of setbacks and could not meet the objectives for which it
was set up. This necessitated the need for a complete  Review of the existing policy documents on NHMIS
overhaul of the system in order for it to make it responsive to
the initiatives for the current Health Sector Reform and in  Agree on roles and functions of the newly established
compliance with the resolution of the National Council on Technical Working Group (TWG), which is a consortium
Health to commence a review process that would lead to a of qualified professionals that would provide technical
strengthened National Health Management Information assistance and imputs to the NHMIS process on a
System. continuous basis.
With support from the UK Department for International  Assessment and review of Health Indicators and health
Development (DFID) through the Partnership for Transforming data systems
Health Systems (PATHS) programme, a multidisciplinary pre-
consultation team was set up in concert with the Department  Revision of routine NHMIS forms, registers and
of Health Planning and Research of the Federal Ministry of manuals.
Health to conduct widespread consultations with all
stakeholders in healthcare delivery in the country in order to  Printing of pilot forms and manuals and the adoption of
come up with a functional and more responsive NHMIS for the final copy for production and usage.
nation.
 Donor/Partners resource mobilization.
The pre-consultation process culminated in the convening of  Advocacy and sensitization on HMIS at all levels of
an Extended Health Data Consultative Committee (HDCC) health care delivery.
24
 Distribution of NHMIS materials to all health data  to develop a mechanism and procedures to make the
generators across the nation, states, LGAs, private and information system dynamic and responsive to changing
public health facilities. needs;
 to establish a set of criteria and standards for
 Cascaded trainings of all stakeholders on NHMIS. information system in order to enhance quality and the
effectiveness of PHC monitoring and evaluation
 Budgetary line and release of funds by all tiers of activities;
government and other stakeholders for NHMIS.
The emphasis on development of the information system is to
a) A case of Parallel Systems: mobilize and empower local health authority and the
community to undertake health care needs assessment,
i) PHC Information System priority setting and implement action programmes.
The overall objective of the PHC information system (which is The PHC information system process consists of: baseline
a sub-system of the NHMIS) was to develop a dynamic and surveys, household surveys, situation analysis and health
responsive system that would provide information for strategic profiles: health maps; house numbering; home base records
planning, management and operational functions of PHC (child health card, personal treatment card, clinic master
activities at all levels. card); the wall chart; Health Facility/District referral forms
(VHW Forms Book 1-HF, Tracer Disease Cases I HF- I and HF-
The specific objectives are: 2, Birth and Deaths I HF-3 and I HF- 4, Community Health
Activities I HF-5 and I HF-6, Antenatal and Family Planning I
 to develop an effective and efficient PHC information HF-7 and I HF-8, and General Health Facility Booklet). These
system that would generate, transmit, store, retrieve forms are no more in use.
and process PHC data, and provide the right
information services to the appropriate levels of PHC The PHC system data flow and returns rate has been low. It
management in the desired form and at the right time; was 22% in 1994 and 18% in 1995. A return rate below 2%
has been recorded for some states. In addition there is a lot of
 to identify and adopt appropriate technological data duplication in the system. For example, PHC Form I HF-3 and I
processing support / hardware and software HF-4 collect the same information, which the parallel vital
consideration that would be needed for the PHC registration system is collecting at the same level. Similarly,
information system to function satisfactorily; most of the information collected via the Tracer Disease Form
 to integrate different PHC-related information to provide I HF- I and I HF-2 are also collected in the DSN system. More
multivariable and multidimensional information services; importantly, the reporting requirements at this level are
25
overloaded and not adequately matched with resource inputs: Malaria and diarrhoea were the most noticeable tracer
human, technical, material and financial. diseases in all the health centers. The monthly record of
tracer disease and outpatient attendance are to monitor
Federal Government, through NPHCDA constructed 200 new diarrhoea, measles, pneumonia, malaria, tetanus, malnutrition
model Health Centres that are evenly distributed throughout accidents and other unspecified health problems.
the six geographical zones and 36 states of the federation.
The health staffs of the centers had been trained on PHCMIS It is instructive to note that the above data came from 18 out
and were given PHCMIS forms required for data collection. of 8,797 (0.21%) health centres in the country. Yet this
information is necessary for planning and monitoring of health
The 2003 annual report and statistics provided by 4 zones, 12 services in PHC Centres.
states and 21 health facilities indicated underutilization of PHC
centers, with North Central (8), North West (5), South East (7) Throughout the year 2004, the six zonal offices regularly sent
and South South (1). Utilization of facilities was highest in health service data to the Department of PRS of the NPHCDA.
the North West zone with 99 cases per month per health In all, data was received from 110 (55%) out of 200 newly
center, followed by North Central zone (23) and South East completed Model PHC Centres, in 31 States. The pattern of
(20). distribution is as follows: NC Zone, 12 health centers sent in
health service data out of 33 health (36.4%); NE 19 out of 32
Newly Registered Pregnant Women was high in 16 reporting (59.4%); NW 27 out of 38 (71.1%); SE 18 out of 31 (58.1%);
centers. Deliveries were low with an average of 4 per month SS 18 out of 33 (54.5%) and SW 16 out of 33 (48.5%). Thirty
per zone, showing that pregnant women were delivered one (31) State sent reports.
outside the health centres, which provided them antenatal
care. There were no reported case of maternal or neonatal Tracer Diseases
deaths. Post natal visit were poor. Data on birth weight 121,584 cases of tracer diseases were reported in 2004.
shows that 78.6% of babies born had weight of 2.5kg and These diseases were namely, Malaria, Diarrhoea, Pneumonia,
above. Malnutrition, Measles, Accidents and diseases classified as
“Others”.
Family Planning Services were underutilized, making Oral Pill
and injectable more popular choices. Statistics further show Malaria accounted for the largest proportion of tracer diseases
that only 29.7% of children completed routine immunization (37.2%) followed by diarrhoea (16.9%), Pneumonia (7.3%)
against the six childhood preventable diseases with the highest Measles (3%) and Malnutrition (2.8%). Malaria remains the
number recorded in the North Central and the lowest in North most common cause of out patient clinic attendance for infants
West zone. (37.8%), under 5s (41.65%) and 5-14 years (37.2%).
26
Ante-Natal Care and Pregnancy Outcome iii) Immediate Notification (DSN-001):
NE recorded highest number of ANC clients, while SS had the This system, which is one of the two methods of disease
lowest. Deliveries in the health center were lower in notification, involves immediate reporting of any suspected
comparison with registered ANC cases. This means that not cases of 9 notifiable diseases selected because of their high
all those who registered in the health centers for ANC case fatality and their potential for breaking out as epidemics.
delivered in the health facilities. A larger percentage of An epidemic is defined as the occurrence of a number of cases
deliveries must have taken place at home, with TBAs, and of a disease or condition that is unusually large or unexpected
private clinics. for the given place and/or time. The form DSN-001 is sent by
the fastest means available to the epidemic control unit of the
ii) Disease Surveillance and Notification System (DSN) Ministry. Weekly follow-up reports on the progress of the
epidemic are undertaken until there has been three
During the 1986/87 outbreak of yellow fever which affected consecutive weeks with "nil " cases reported.
ten states of the Federation, it was identified that poor disease
surveillance and notification was a major national problem iv) Routine (monthly) notification (DSN-002) of 40
which is still an important constraint to effective disease diseases:
control in Nigeria. In response, a national task force on
epidemic disease control was set up. One of the issues it This system reports on 40 diseases, including the 9 diseases of
addressed was the weaknesses in the national diseases the Immediate Notification system. The rationale for the
surveillance and notification system. The task force conducted choice of these diseases for routine notification is because
a full review of the system and recommended the they can cause an immediate threat to the health of the
development of a new disease surveillance and notification population or because they are being addressed by national
system. control programmes and their incidence needs to be monitored
to evaluate the impact of the control programme. The form
The new uniform system of disease notification, throughout DSN-002 should leave each health institution by the end of the
the country comprising of only two methods of notifications, first week of the month after the month being reported on.
has since been put in place under the Epidemiology Division of The LGAs are responsible for collecting the completed form
the Department of Primary Health Care and Disease Control each month and are supposed to collate them for their area by
(now Department of Public Health). However, to a the end of 4th week of the next month. Epidemiological units
considerable extent, the same information collected through in the states prepare a consolidated report from all their LGAs.
the DSN is also collected through other systems, such as the One copy is retained in the files and one copy is sent to the
PHC Tracer Diseases forms and the data systems of the Federal Epidemiology Division.
various vertical health programmes.
27
v) Sentinel Surveillance System: initially quarterly returns but in reality they have become
annual returns, if at all.
In 1984, FMOH with WHO and LJNICEF developed a sentinel
surveillance system for EPI at 43 sites. However, by the end of vii) Returns From Hospitals:
1989 only 19 LGA capitals out of the 49 proposed sites were
functioning. Efforts to strengthen the system were again All public sector hospitals were required to collect and submit
started in 1989 with the intention to operate in ISO sites. The monthly returns on hospital medical statistics using FMOH
sentinel system was envisaged as complementary to the CMF-12 Form which is based on the ICD coding.
routine disease (DSN) reporting system, which provided
information on forty diseases of public health importance. The In 1990, under the USAID-CCCD project, certain hospitals
DSN was observed to have problems with under-reporting and were identified to pilot the development of in-patient
incorrect diagnoses. Therefore, the sentinel surveillance was information system. These were: Jos University Teaching
proposed to monitor notifiable diseases by involving and using Hospital; Plateau State Hospitals; Ahmadu Bello University
selected facilities whose reports were more complete, more Teaching Hospitals; Kaduna State Hospitals; Usman Dan Fodio
accurate and more timely than those of routine diseases Teaching Hospital, Sokoto; University College Hospital, lbadan;
reporting system. Apart from the obvious fact that the system University of Nigeria Teaching Hospital, Enugu; Ogun State
was duplicative of the DSN system (because it collects the Teaching Hospital; Massey Children's Hospital Lagos and
same data as DSN), it did not take-off as planned because of Mainland Hospital, Lagos. There was an initial seminar
its multiple flow-paths and inadequate management and organized for these hospitals and an admission form was
responsibility arrangement. designed to include all basic information on the patient which
is immediately supplied to the medical records office. This
vi) Vital Statistics: allowed for preliminary timely analysis of the information on
the patient and allowed follow up to ensure completeness of
The registration of births and deaths nationwide was made the report on discharge.
compulsory by the promulgation of Decree 39 of 1979. In
order to establish a unified system of registration for the The medical records departments were provided with a
country, the National Population Commission (NPC), with computer and data entry and analysis software MEDPRO. The
assistance from UNFPA and other bilateral cooperation, system is functioning only in very few institutions and suffered
embarked upon a phased implementation of the Vital setbacks as a result of the scale-down of USAID activities in
Registration Project. However, a parallel vital registration Nigeria.
system is operated by the ministries of health, through the
PHC information system. The returns from the system were
28
viii) National Programme on Immunization (NPI):  to establish database on personnel, facilities and
equipment;
The NPI (formerly EPI) system, was one of the earliest  to aid decision making, forecasting of commodities'
information systems based on standard EPI monthly activity need and constraints in services delivery and methods
reporting forms. These forms have been introduced in the for improvement.
PHC-information system with minor modifications. Typically,
staff at the health facilities where vaccinations services are The Family Planning (FP) system is a classic example of the
provided complete two monthly reports, using two slightly pitfalls of a donor-driven system. While the system was
different forms that contain the same data. One of the forms functioning, the data followed two pathways: one followed the
follows the PHC(M&E) pathway, while the other follows the EPI USAID-FHS information system, while a sub-set followed the
reporting flow-path. The data are separately entered and PHC (M&E) reporting system. With the collapse of the USAID-
analyzed in each of the reporting system. FHS system, the entire public sector was jeopardized. The
The EPI reporting system was the first area where computers department of Community Development and Population
and appropriate software were introduced into the information Activities, the MCH Unit of PHC&DC in concert with UNFPA
system. With the assistance of UNICEF, as early as 1988, the have started to revive the FP MIS.
hardware and WHO, EPI software were introduced into the EPI
system within UNICEF, federal and zonal offices of the FMOH. In addition to the USAID-FHS and the PHC (M&E) FP data
Annual graphic analysis and reports were produced by zonal, flow, there is also the parallel and extensive (private sector) FP
state and LGA level. Unfortunately, this development was not record system organized and managed by the Planned
actively followed up to introduce the hardware and software at Parenthood Federation of Nigeria (PPFN). There is no where in
the state level. the system where the two systems converge to give a profile
of the Family Planning situation in Nigeria. UNFPA is assisting
ix) National Contraceptive Logistic Management with strengthening the MCH/FP MIS but this is being done
System (CLMS): outside the mainstream of an integrated and comprehensive
NHMIS process.
The objectives of this system are:
In 1995 the Government of the Federal Republic of Nigeria
 to show how well the clinics are recruiting new family adopted the National Contraceptive Logistic Management
planning users; System (CLMS). The System was designed to improve access
 to indicate the number of different methods provided of Nigerians to quality contraceptive commodities. The CLMS
and the method mix for new acceptors; system was also meant to overcome problems of irregular
 to source for referral for new acceptors which is distribution of contraceptives to Service Delivery Points (SDPs),
important for evaluating IEC activities; multiplication of Logistic Management Information System
29
(LMIS) and lack of collaboration among stakeholders. The NIGERIA CONTRACEPTIVE LOGISTICS MANAGEMENT
CLMS was revised and overhauled in 2003 to make the system INFORMATION SYSTEM
work and serve the people better. The revised CLMS is
expected to enhance the realization of Reproductive Health
CENTRAL
Commodity Security (RHCS) in Nigeria. Data/Information from Tally Card, Cost
Recovery
the revised CLMS would be shared with the NHMIS. Monitoring Form  Distribution and
ZONAL Stores Activity
Report
Under the new system, data would flow as shown:  RIF
 Supervision
Report
STATE
FEEDBACK  Teaching hospitals
Tally Card,
REPORTS RIF  Federal Medical
Cost recovery and
Monitoring Form Centres
 State General
Hospitals
 Specialist
 Distribution and Stores
Hospitals
 Activity Report
 RIF
 Supervision Report LGA
Tally Cards, Cost Recovery and
monitoring form
RIF SDP
Daily Consumption Record, CBD Voucher, Cost
Recovery Form and Monitoring Form
CBD
CLIENTS
CLIENTS
Source: FGN, National Guideline on contraceptive logistic
30
x) HIV and AIDS Surveillance: xii) National Onchocerciasis Control Programme
The system consists of HIV/AIDS Surveillance (passive), HIV The onchocerciasis control programme is developing the use of
Infection Surveillance (active), HIV screening (passive), HIV a rapid assessment method for community diagnosis of
Sentinel Surveillance (active). The forms in use are:- onchocerciasis in order to identify prevalence areas of leopard
skin or nodules. This is to be followed up with mectizan
NACP/001 Form: HIV testing request treatment. The programme is also considering setting up its
NACP/002 Form: HIV infection report own parallel information system, with support from the
NACP/003 Form: AIDS cases report International Eye Foundation, even though routine data
NACP/004 Form: Monthly screening report requirements can be obtained from the DSN.
AIDS was originally one of the diseases classified for xiii) Essential Drug Programme (EDP):
immediate notification, but since September 1992 it has been
put under the monthly routine notification system on DSN-002. The MIS system for the EDP is not functioning at the moment.
Thus, the existing AIDS programme data system overlaps with The Federal Ministry of Health, with assistance from the World
the AIDS reporting within the DSN. Bank, engaged a consulting firm, Management Sciences for
Health (MSH), Boston, USA, to develop the MIS for the
However HIV & AIDS Surveillance has been strengthened National Essential Drug Programme. A draft report prepared in
through a National Policy adopted in 1997, which was 1993 indicates that the system developed by MSH consisted of
reviewed in 2003. a set of manual procedures to collect data on selected
indicators and to improve the flow of management information
xi) Nigeria Guinea Worm Eradication Programme through the EDP. Computerization of the system was not
covered under the submitted draft. The entire EDP MIS
Guinea worm surveillance is conducted by an active national initiative has not progressed much since the draft report was
case search based on standardized questionnaires. The data is submitted in 1993.
collected annually. Four case searches have been conducted
since the inception of the programme in 1987. Because the Parallel to the fledgling EDP MIS is a Drug Revolving Fund
information on guinea worm is already reported through the system of the Bamako Initiative (BI) which operates primarily
DSN, the existence of a separate system for guinea worm at the PHC level. There is scope to streamline and integrate
reporting is a duplication. the DRF Under BI with EDP and HSF-EDP components.
31
xiv Integrated Disease Surveillance and Response demographic data. The most notable ones are: National EPI
(IDSR) Coverage Surveys; District Household Surveys for monitoring
HFA 2000; NBS National Integrated Household Surveys;
The IDSR strategy was adopted in September 1998 at the 48th Demographic and Household Surveys; Community Household
World Health Organization (WHO) African Regional Committee Surveys for Knowledge, Attitudes, Beliefs and Practices,
meting in Harare, Zimbabwe to strengthen disease surveillance National HIV Sero-prevalence Sentinel Surveillance; Health
system in all member states. The adoption of this strategy Facility Assessment Surveys; WHO-Nigeria Composite
commenced in Nigeria in January 2001 with the inauguration Indicators Surveys (A Primary Health Care Decision Support
of a coordinating committee to steer the introductory phase. System). These surveys have been promoted largely to meet
Other activities that were carried out toward the the programmatic data requirements of international health
implementation of IDSR include assessment of the old Disease organizations and not necessarily to strengthen and support a
Surveillance and Notification (DSN) system to identify its specific aspect of the national health information system. The
strengths and weaknesses, and sensitization of National numbers are far too many and lack coordination.
Programme Managers on IDSR in June 2001. The national
policy on IDSR was approved in 2006 for use at all levels of Number of surveys has been used to capture various health
health service delivery in the country. and demographic data. The most notable ones are:
IDSR focuses on 22 priority diseases, sub-divided into three - the NBS NISH (National Integrated Survey of
categories: epidemic-prone diseases, diseases targeted for Households)
elimination and eradication and other diseases of public health - WHO – Nigeria Composite Indicator Survey;
importance. The forms in use under this strategy are: - The NDHS 1995
- The NDHS 2003
 Immediate Notification Form (IDSR 001A, 001B, 001C) - The national Survey on RH facilities and services
for epidemic-prone diseases 2003 CDPA/FMOH
 Weekly Reporting Form (IDSR 002) for epidemic-prone
diseases c) Programme Reviews and Operations/ Health System
 Routine Monthly Notification Form (IDSR 003) for the Research:
22 priority diseases.
Programme reviews and operations research are essential for
b) Survey Systems: generating data for decision making especially for health
intervention programmes. Early in 1992, an essential national
A plethora of survey schemes and instruments has been used health research framework was prepared and adopted. The
and continues to be used to gather various health and framework did not lead to any systematic programme of
32
health intervention programme reviews nor a sustainable report, NACP/003 Form for AIDS cases report and
health system research. NACP/004 Form for monthly screening report);
d) Health Care Level-Specific Forms:  The Onchocerciasis Control Programme implement a

rapid assessment method for community diagnosis
The existing forms according to the level of use can be record form;
grouped as follows:-
 Nigerian Guinea Worm Eradication Programme Form 1,
i) At the Federal/Tertiary level: for village household survey and Form 2 for LGA survey;
 Health Establishment Returns (FMH/STATS/HE and  NPI (EPI) forms (FMH/STATS – monthly immunization
FMH/STATS/LGA/T) for listing registered establishments activity, EPI disease sentinel surveillance summary
in the country); reporting form and state monthly immunization
 Health Manpower Returns (FMH/STATS/HM/A) for summary);
health manpower situation);
 Health Manpower Development Returns-  Family Planning Statistics (Form I for individual records
(FMH/STATS/HMD for annual enrollment by category, system, that is, Family Planning Client Record, Form 2
FMH/STATS/HMD-2 for health manpower development, for daily activity register, Form 3A for summary family
FMH/STATS/HMD-3 for establishment for training planning activities, CF003a for Planned Parenthood
medical and paramedical personnel); Federation of Nigeria daily collation of clients served
 Hospital Statistics (FMH/STATS/FMOH for monthly and contraceptives issued and distributed, CF003b for
summary of in-patient movement, CMF-12 for combined Planned Parenthood Federation of Nigeria weekly
medical forms-hospital morbidity and mortality); collation of clients served and contraceptives issued and
 Vital Statistics (MH/STATS/V2/3, quarterly vital statistics distributed;
returns);
 Disease Surveillance and Notification System (DSN-001  Control of Diarrhoeal Diseases CDD Monthly report;
for Immediate Notification and DSN-002 for routine
(monthly) disease notification, IDSR form;  Essential Drug Action Programme (BI/NG/02/00 District
 Leprosy and Tuberculosis Statistics (consisting of collation form, BI/NG/04/00 Bamako Initiative
quarterly statistics returns, leprosy record card, leprosy monitoring system, data collation form for district level,
treatment register); BI/NG/05/00 Bamako Initiative monitoring system, data
 HIV/AIDS forms (consist of NACP/001 Form for HIV collation form for LGA level, BI/NG/01/00 Bamako
testing request, NACP/002 Form for HIV infection Initiative programme supervisory checklist;
33
The PHC M&E system operates at three levels: home; health Other PHC M&E forms consists of:
facility (ward); and local government level.
*BOOK 2HF
Home Level:  Tracer Diseases and OPD Attendance 2HF- I
 Child Home-based Record  Monthly Record 2HF-2
 Adult Home-based Personal Record  Annual Record 2HF-2
 Ante-natal Record  Antenatal Care and Pregnancy Outcome
This has been modified since 2001 to include:
1. The PHC child health card *BOOK 3HF
2. The personal health card  Tally Sheet 3 HF- I
 Daily and Monthly Record 3HF-2
Village Level  Annual Record 3HF-3
 VHW/TBA Pictorial Record of Work
 Community Maternity Profile (Wall Chart) *Family Planning BOOK 4HF
 Community Family Planning Profile (Wall Chart)  Daily Record 4HF-I Side A (New Acceptors) and B
 Community Demographic Profile (Wall Chart) (Revisits)
 Monthly Record 4HF-2 Side A and B
Health Facility Level:  Annual Record 4HF-3 Side A and B
 Clinic Master Card
*Immunization BOOK 5HF
*Monthly:  Tally Sheet 5HF- I
 Tracer Disease Cases I HF- I  Monthly Record 5HF-2
 Births and Deaths I HF-3  Annual Record 5HF-3
 Community Health Activities I HF-5
 Ante-natal and Family Planning I HF-7 *In-Patient Care BOOK 6HF
 Daily/Monthly Record 6H:F-1
*Annual:  Annual Record 6HF-2
 Tracer Disease Cases I HF-2
 Births and Deaths I HFA-4 *Environmental Health Activities BOOK 7HF
 Community Health Activities I HF-6  Diary of Environmental Health Activities 7HF- I
 Ante-natal and Family Planning I HF-8  Monthly Record 7HF-2
 Tracer Diseases and Out-patient Attendance 2HF-1  Annual Record 7HF-3
34
*Growth Monitoring and Promotion 8HF trained for data collection and therefore may not be fully
 Tally Sheet 8HF-I aware of the importance of such data particularly as no
 Monthly Record 8HF-2 returns are ever received to reward faithful filling of such
 Annual Record 8HF-3 forms.
* All these forms were modified in 2001 as follows: iii) Shortage of materials:- Basic facilities for health information
1. Facility based family master card collection, compilation and management are not always
2. Attendance registers available. The health establishments are often without the
3. Monthly records necessary forms for collecting health data.
4. Annual records of PHC services iv) Transportation Difficulties: - When forms are dutifully filled,
5. Other facility based forms transportation difficulties often prevent immediate forwarding
of the returns for processing.
e) Additional Constraints
v) Inadequate coordination of health data flow:- There are
Field visits to a representative number of state ministries of multiple channels of information flow with little interaction,
health and local government health departments revealed the collaboration or co-ordination. This often results in differing
following additional constraints:- figures for health statistics depending upon the organizations
involved in collection and analysis. Many international
i) Finance:- A major problem of health management organizations do not even reconcile their figures with those
information systems (HMIS) is inadequacy of funds. This emanating from the FMOH/SMOH nor exchange figures with
problem persists across all levels of health care data collection them.
system. The principal reason for the poor funding of HMIS vi) Inadequate appreciation of the importance of HMIS:-
activities is the absence of a HMIS-specific budgetary line Inadequate appreciation of the role of health information to
(vote of charge, VOC) at the federal, states and LGAs, planning and programme implementation, resulting in
including health institutions/facilities. complete absence of a budgetary line for health data collection
has become the norm at all levels of government.
ii) Shortage of staff:- Collection of health information is
hampered by shortage of qualified staff at all levels of the vii) Complexity of data collection instruments:- Too many
health care delivery system. At the LGA health facility level, forms are filled at all levels of governments and with a great
health information collection is a secondary function of health deal of overlap. Many of these forms are far too complex for a
personnel who have to carry out some more demanding tasks health worker with other primary job-functions.
such as taking deliveries of babies, attending to patient care
and dispensing drugs. Often, these members of staff are not
35
viii) Lack of feedback in the data collection system:- Health and the absence of a strong central co-ordinating
data are generated and collected from the health facilities and institutional framework.
are passed on to the LGA and the FMOH and NPHCDA through
the state ministry of health. Even where there are other flow Following current events the FMOH, SMOH and LGA health
channels, the forward flow of information is emphasized and at authorities are beginning to realize importance of the health
times enforced but feedback is almost non-existent anywhere information system in patient care, disease surveillance and
along the line. control, health services plan and monitoring and evaluation.
The preceding situation analysis highlighted the constraints,
ix). At the LGA, state and federal levels, there is a huge challenges and opportunities for refocusing the NHMIS,
back-log of unprocessed data. Consequently, publications on especially in co-coordinating and integrating existing
health situation analysis are usually many years behind. The information systems to enhance its effectiveness
few publications that are available are not distributed nor f) International Collaboration in Health Information System:
produced in simple non-technical language and graphic forms
for the operators of HMIS at the lowest levels to understand. Over the years, UN agencies and other bilateral and non-
Unless well motivated, records officers do not see the effect governmental agencies have been involved in strengthening
of incessant form filling on their day-to-day operations. Some some aspects of health information system in Nigeria,
feedback no matter how little will not only encourage the especially in providing computers, software and training.
collectors and compilers of these data but reassure them that Unfortunately, in the most part, these activities have
they are used somewhere for health management purposes. contributed to the development of the parallel health
information sub-systems and features described in the
The existing health information system in Nigeria is preceding section. For many years the USAID-sponsored CCCD
characterized by extensive duplication of data and FHS projects were responsible for strengthening the PHC
collection, entry and analysis (no fewer than 50 data (M&E) system and the DSN. They were equally responsible for
forms are in use at the federal level alone); multiple promoting and sustaining the parallel family planning system
data pathways; lack of standard case definitions; lack and a majority of the ad hoc survey systems.
of clarity with regards to data submission and
responsibilities; inadequate quality control measures; International and donor agencies' support for the development
inadequate and ineffective staff training in data of health information system is desirable. This must be
analysis, interpretation and use at all levels; mis- channeled and coordinated to support a well articulated HIS
reporting of conditions, poor understanding, low programme framework. The loss of USAID support for HIS
confidence and acceptability; weak monitoring, development resulted in the collapse of significant components
evaluation and managerial capacity at the periphery of the national HIS, thus demonstrating the vulnerability of
36
over-dependence on external assistance for the development articulate the content, structure and an action agenda to
and sustainability of the national HIS system. implement the NHMS programme.
5. THE NATIONAL HEALTH MANAGEMENT The NHMIS programme is aimed at putting in place and
INFORMATION SYSTEM PROGRAMME sustaining, as an on-going effort, an institutional structure
interfacing at various hierarchical levels. It involves the
The total of all health information sources make up the provision of appropriate infrastructure for collecting and
National Health Management Information System analyzing data. The principal objectives of the NHMIS
(NHMIS). The NHMIS programme involves the programme are:-
articulation, establishment and development of the
system’s constituent parts, including the provision of  to establish, develop and strengthen HMIS units
appropriate infrastructure to make the system function appropriate to each level of service delivery and
optimally at all levels. The Federal NHMIS Unit is at decision making;
the apex of the national health information system and  to provide information, to manage the health care
provides a focal point for co-ordinating health system;
information activities nation-wide.  to provide information for assessing the state of health
of the population;
The widely recognized deficiencies existing in the present  to provide information to identify major health problems
national health data systems generated some responses from and to set priorities at the local, state and national
the Federal Ministry of Health and international agencies which levels;
were aimed at capacity building. Hitherto, the responses have  to provide information to monitor the progress towards
been largely piecemeal, partial in scope, under-funded, unco- stated goals and targets of the health services;
ordinated and have adopted a project approach (as opposed  to provide indicators for evaluating the performance of
to a programme approach) and could not be sustained beyond health services and their impact on the health status of
the duration of (donor-driven) technical assistance. It thus the population;
became imperative that the development of HMIS must be  to produce and validate standardized data collection
premised on a programme approach, reflecting the need for forms; to provide technical support and review of data
integration and comprehensives. validation and quality assurance processes;
 to serve as a focal point in FMOH and other appropriate
Within the context of implementing government mandate to levels for discussion/review for proposed health data
establish NHMIS and to strengthen planning, monitoring and and surveys by international agencies and by other
evaluation, as an integral part of national health system governmental and nongovernmental bodies;
development, a national conference was organized in 1992 to
37
 to prepare and disseminate protocols for collecting

comparable data on national health objectives and
indicators; MANAGEMENT STRUCTURE OF THE NATIONAL
 to prepare appropriate HMIS manuals for the operation HEALTH MANAGEMENT INFORMATION SYSTEM
of the system; PROGRAMME
 to provide information to those who need to take FMOH
action, those who supplied the data and the general DHPR
public. (NHMIS UNIT)
a) Element of the NHMS Programme Structure:

HDCC
i) Structure
The structure of the National Health Management Information NHMIS TWG

System is illustrated in Figure 1. It shows the institutional
framework of hierarchical levels from which health data and
information are to be obtained. At the apex of the structure is SMOH
the NHMIS Unit. The Unit relates horizontally with the Federal PRS
Office of Statistics, the National Population Commission, the (HMIS UNIT)
National Bureau of Statistics(NBS), other ministries,
international health organizations and other key health data
generating agencies in the public health sector, such as the LGA – HMIS/M&E
National Primary Health Care Development Agency (NPHCDA), UNIT
National Agency for Food, Drug Administration and Control
(NAFDAC), the National Health Insurance Scheme (NHIS), etc.
The relationships with these bodies are illustrated in the
expanded operational diagram of the NHMIS in Appendix 3. HEALTH FACILITY
Vertically, the NHMIS Unit relates and co-ordinates health
information related-activities of FMOH departments,
parastatals, agencies and professional bodies and interfaces
through established protocols with health information related
activities of SMOHs and LGAs and other health facilities (public COMMUNITIES
and private).
38
ii) Roles & Responsibilities performance of the National Health Plan and the overall goal
of the National Health Policy.
The principal roles and functions of each HMIS units at local,
state and federal levels are discussed under Responsibilities At The major types of data required for assessing the state of
Each Level in the NHMIS policy section of this document. In health of the population and the health system would come
addition, the NHMIS operational manual, which is available at from:-
all levels, addresses, in greater details, specific responsibility,
operational modalities and interactive roles with regards to  disease and related reporting mechanisms; e.g., the
horizontal flow and sharing of data and feedback processes revised HMIS forms;
between key agencies, departments and units, including  vital statistics, e.g. from the National Population
international agencies and NG0s that operate at the same level Commission.
with the HMIS units. (See Appendix 3: NHMIS: Expanded and  Sentinel Surveillance, focusing on the monitoring of key
Operational Organogram). health indicators in the general population or in special
populations. A sentinel surveillance system is to be
iii) Contents: maintained for the STD/HIV/AIDS programme, Acute
Flaccid paralysis (AFP) surveillance a global strategy is
The contents of the NHMIS programme are determined by the to be maintained for poliomyelitis eradication program;
range of information needed for decision making and as  registries, to monitor the public health impacts of non-
articulated in the National Health Indicators compendium acute diseases. Exposure and work-related based
(Appendix 1). From the indicators are derived the minimum registries may be particularly useful in tracking the
national core data to be collected via appropriate data health protection objectives of the environmental and
collection instruments (forms, registers, etc.) occupational health activities of the Ministry;
 surveys, health and demographic surveys, such as are
The data sources for the NHMIS programme would come undertaken by NBS, National Population Commission
primarily, from 4 major categories of data: (a) Inputs; (b) are particularly useful in tracking national level
Processes; (c) Outcomes; and (d) Impacts of the health care indicators of the prevalence of health conditions and
delivery systems. Inputs and Processes are mostly concerned estimates of other socioeconomic parameters. Examples
with policies, manpower, facilities, funding, appropriate of these are health- interview surveys, service
regulations, manuals, logistics, equipment, forms, registers provider surveys, health manpower/facilities surveys,
and information technology. With respect to Outcomes and non-communicable diseases surveys and other ad hoc
Impacts, data is collected to estimate national health special programme requirements. Statutorily, these are
indicators and targets for monitoring and evaluation of the to be coordinated by the Ministry, through the
Department of Health Planning and Research (DHPR);
39
 administrative and routine service data collection health status measures or indicators. An example is the level
systems, e.g., MIS data from support services, etc. of morbidity and mortality for a given condition and for specific
target population: IMR, U-5MR, MMR, prevalence of HIV/AIDS,
iv) Data Bases: etc. However, it is noteworthy that Outputs are direct
measures of programme efforts, while Outcomes/lmpacts are
Four major categories of data are to be maintained at all levels indirect results of programme efforts as they are more likely to
of the health care system, with appropriate data-structure be influenced by other socioeconomic development.
format provided by the central NHMIS Unit. The four
categories of data are: (1) Inputs Database; (2) Process b) NHMIS Programme Key Results Areas:
Database; (3) Outputs Database; and (4) Outcomes or
Impacts Database. In order to refocus and strengthen the health information
system processes, the following have been identified as key
lnputs refer to resources and requirements to create and results areas:-
enable the success of health programmes. They are the
precedent actions that must be taken (invested) for the health  Nation-wide health information system assessment and
system. They are not limited to physical inputs, but may also state HMIS Programme institutionalized;
include provision of appropriate institutional arrangements,  Develop national health measurable objectives and
policy instruments and legislation. indicators with minimum national health data set
established;
Process refers to a set of activities that must be undertaken or  Strengthen epidemic surveillance;
actions and rules and regulation that are required to take  Establish electronic voice/data transfer wide-area
place. This may include for instance, protocols for network system to support epidemic surveillance and
immunization, for collecting, storing, processing and making emergency response mechanism;
available health data, etc.  Strengthen vital registration system;
 Develop and continuously review appropriate formats
Outputs database will concern itself to keeping time-series and protocols for health data collection and for
data on activities completed in relation to set targets. An monitoring and evaluation of all activities of the Federal
example is interval data on immunization status of children Ministry of Health;
under-5 years old.  Maintain appropriate databases for health programmes,
health facilities, health manpower and health system
Another example is the efficacy of health intervention support activities and functions;
programmes, e.g., the eradication of guinea worn and -control  Establish a computerized medical information system
of tuberculosis. Outcomes/Impacts data is concerned with for all federal health institutions (e.g., teaching
40
hospitals, federal medical centres, specialist hospitals, where needed for informed decision making, especially in
specialized programmes); profiling the state of health of the population and the health
 Strengthen institutional capacity of SMOH (DPRS) for system.
data processing and technical report writing and
publishing;
 Enhance capacity for health data programme co- 6. THE REVISED HEALTH MANAGEMENT INFORMATION
ordination among all health data producers and users at SYSTEM
all levels;
 Training of personnel on the use of NHMIS manuals and The guiding principle for the revised HMIS is to keep things
forms for data collection; Advocacy and empowerment simple, practicable and sustainable.
of users of health data and information;
 Strengthen institutional capacity of SMOH (DPRS), HMB, The revised HMIS consists of a fewer number of forms, Tally
and LGAs (GIS) for data storage, processing, retrieval, Sheets (Register) with associated summary forms, MIS Matrix
information generation and dissemination; Install Form, Sentinel Surveillance Form Registers for
standardized database management system at the occupational/environmental and non-communicable - diseases,
SMOH (DPRS). Baseline Surveys and Health & Demographic Surveys. The
 Ensure adequate enabling legislation for NHMIS recommended Tally Sheets would be available in all facilities in
activities and compliance with the reporting system; the form of durable color-coded registers, which are based in
 Establish sustainable mechanism for adequate funding the facility. But, because all facilities at the same and different
of the NHMIS Programme at all levels of service levels of services do not provide the same services, some data
delivery. items on the facility summary forms will 'be left un-filled.
c) Legal Framework: a) The Revised HMIS Forms

The National Health Policy and the National Health Plan
establish the framework for advancing the health agenda of The NHMIS forms consists of.-
the nation. i) Routine Data Collection Summary Forms
The National Health Act will give support to the National NHMIS Forms 000: Community based Summary form:
Health Plan. This is particularly relevant for the NHMIS
programme in order to institutionalize required practices, This form is used by the community Village Health Worker to
procedures and expectations with respect to health data summarise activities at monthly intervals and sent to the
production and dissemination; to promote standardization; and Health Facility through the Community Health Extension
to ensure that health information will be available when and Workers (CHEWS)
41
NHMIS Summary Form 001A & B – Health Facility  Pharmaceutical Services

Community Outreach Forms:  Drug Inventory/ Utilization
This form is used by the health facility to summarize  Laboratory Services
community outreach activities at monthly intervals of time.  Occupational Health Services
The aggregated summary is transferred into health facility
form 001. ii) HMIS Matrix Form: for Administrative and Support Services
A simple generic MIS form called the HMIS Matrix Form, is to
NHMIS Summary Form 001 – Health Facility Based Forms: be administered at all levels. This form will be used to collect
This form is used by the health facility to summarize activities information on support services for technical programmes
at monthly intervals of time the summary is sent to the LGA. A (functions). The support service MIS should, at the minimum,
daily register has been developed for Health facility, from collect information on the following: finance, personnel,
which data is summarized monthly. training, statistics, supplies, transport, maintenance and
others. This will be implemented, first, by level of service
NHMIS Summary Form 002 delivery (that is, FMOH, SMOH and LGA), and then
This form is used by the LGAs to summarize returns from all progressively expanded to technical functional areas
health facilities in their area at quarterly intervals for onward (departments, units, programmes etc.) such as NPI,
transfer to SMOH, DPRS (HMIS Unit). AIDS/STD, CDD/ARI, Hospital Services, MCH/FP, other disease
control programmes, etc. in order to achieve a full accounting
NHMIS Summary Form 003 system. The summary form for this purpose shall be presented
This form is used by the SMOH, DPRS, to summarize returns in the form of a matrix, with the support services on the left-
from al LGAs in the state for onward transfer to the Federal hand side and the level of service/technical functions across
NHMIS Unit every six months the top of the matrix. These data and information are to be
collected on an annual basis.
Each of these forms addresses:
 Antenatal Care and Pregnancy Outcome iii) Sentinel Surveillance System (SSS) and Registers:
 National Programme on Immunization These consist of STD,'HIV/AIDS Sentinel Surveillance Form
 Family Planning Services and registers for occupational and environmental health and
 Family Planning Commodity Utilization non- communicable diseases. The sentinel surveillance of
 Growth Monitoring and Promotion special groups would be undertaken yearly, using a special
 In-patient Cases form. Registers for environmental and occupational health and
 In-patient Deaths specific non- communicable diseases are to be placed with
 Out-patient Cases appropriate governmental and nongovernmental institutions
 Disease Surveillance and Notification and societies, major industries and associations.
42
iv) Baseline Surveys (for Specialized Health Programmes):

Initial baseline surveys of geographic areas of focus are to be Ad hoc special-purpose health data requirements will be
conducted for specialized health intervention programmes. implemented as the need arises (e.g., health manpower and
This is to provide benchmark data against which to monitor facilities surveys, health nutrition and examinations survey,
such programmes. Thereafter, the data requirements for maternal mortality, etc.). Such exercise will be undertaken by
programme monitoring should be sourced from routine the NHMIS in active collaboration with the National Bureau of
reporting systems, except where otherwise stated. This is to Statistics (NBS) and other relevant partners and interested
conserve resources, strengthen the existing system and keep parties.
the NHMIS data systems simple and manageable as opposed
to establishing duplicative/parallel functions. b) Data Flow System:
v) Health and Demographic Surveys: No summary forms would be sent from one level
Health and demographic surveys, especially when conducted directly to multiple layers of levels higher than the
on a regular basis, provide the most reliable source of immediate (next) higher level. This is to ensure
information for assessing and monitoring nation-wide trends in ownership, NBSter immediate utilization and
the prevalence of health conditions for which national and strengthen capacity building in each level for the
international targets have been established. The NBS currently continuum of health information activities identified
fields a national integrated survey of households. Up to 1999 for each aggregative unit.
Federal Office of Statistics (NBS) conducted the National
Demographic and Health Survey. This activity is now the The various data flow pathways are illustrated in the data flow
responsibility of the National Population Commission. charts in Appendix 2.
It is desirable for FMOH, through DHPR, to establish All summary forms with the designation 000 in use in
sustainable modality, in concert with NBS and other agencies, communities are to be sent to the health facilities through the
for conducting on a regular basis a health and demographic Junior Community Health Extension Workers (JCHEWs). Daily
survey. Other special purpose surveys, such as baseline registers have been developed for the health facilities for
surveys, may be conducted on an ad hoc basis to meet standardized health data collection nationwide. Data on daily
immediate programmatic data requirements. It is important registers are summarized monthly into form 001. Summary
that all sample surveys are representative of the source forms with designation 001 are to be sent to the local
population in order to increase the validity and reliability of government area (LGA) – M&E unit to the attention of the PHC
findings extrapolated to the larger population. M&E Co- ordinator. Information from the health facilities will
summarized in the LGA summary 002, which is in turn sent to
vi) Special Purpose Health Data: state MOH, HMIS Unit. The state HMIS Unit shall forward a
43
copy of the HMIS Summary Form 003 to the relevant will take the reverse route, from the highest level to the lowest
department and units within the SMOH such as the PHC level.
department, the epidemiology unit, relevant health
programmes, NGOs, international health organizations etc with The following minimum number of publications are to be
state level offices. The state NHMS unit shall use the HMIS sustained:-
Summary Form 003 to send state level summary to the
Federal NHMS Unit. i) Federal Level:
 Health In Nigeria. (an annual profile of the health status
Within the Federal DHPR, NHMIS Unit are to be located and situation in the country, including the health
designated desk officers/data expediters who will be system)
responsible for facilitating the sharing and transfer of data to  Nigeria Bulletin of Epidemiology (a quarterly publication,
relevant FMOH level departments and agencies such as focusing on notifiable diseases)
NPHCDA, Epidemiology Division of Department of Public  National PHC Profile (an annual publication of the
Health, Hospital Services, Community Development and NPHCDA)
Population Activities, and other federal institutions such as the  Monthly Disease Trends
National Bureau of Statistics (NBS) and international agencies  PHC News (a bi-annual publication of the NPHCDA)
etc.  All major health programmes, e.g., TB and Leprosy,
STD/AIDS, guinea worm, schistosomiasis, etc., to
c) NHMIS Publications: publish annual reports with the collaboration of the
NHMIS Unit
Within the public health sector, the statutory power for the  Health Alert (an ad hoc publication of the NHMIS Unit
release and publication of health statistics is vested in the on health development and/or events of immediate
Office of the Honourable Minister of Health. Such health public health interest).
information must be passed through the Department of Health
Planning and Research, specifically the NHMIS Unit. The NIMS ii). State Level:
Unit is the apex health databank. Consequently, all official  State Health Bulletin (an annual publication).
publications will be deemed to have been released by the  State Health Plan
NHMIS Unit on behalf of the Ministry. Such publications would
carry the name NHMIS Unit and that of the department, iii). LGA level:
agency or unit directly in-charge of the subject matter.  Health Profile (a quarterly publication).
Appropriate summary of all health data, as collected through  LGA Health Plan
the NHMIS will end up at the NHMIS Unit. Feedback processes
44
d). National Health Status and Performance Indicators: development and in technical assistance within and between
the levels. Thus, as part of the overall strategy to improve the
A consensus set of National Health Indicators (NHI) has been quality and quantity of health data and information available
developed to operationalize the National Health Policy and the for decision-making, NHMIS units are to be provided with a
National Health Plan (2004 - 2007). The NHI points out the threshold of minimum package to enable them function
kinds of data and - information to be made available for effectively.
assessing the performance of the health sector. In selecting
the indicators, action- strategy areas in the national health f) HMIS Unit Minimum Package:
policy were identified as: policy, context; health status access
and utilization and socioeconomic variables. The action i) Federal NHMIS Unit
strategies have been translated into key priority areas within
which measurable objectives, targets, indicators and Requirements
responsible agencies have been identified. The development of  NHMIS Working Document (plan)
health indicators is a dynamic process and reflects the  NHMIS Operational Manual
changing nature of issues of public health interest to the  Adequate office space
country. The priority areas, objectives, indicators and targets  Office furniture
will change from time to time, reflecting the state of health of  Micro-computers for data processing and storage
the population. (10)
 High capacity printers, photocopiers
Each form specific to levels of data collection collects minimum  Full complements of desktop publication (DTP)
core data. The National Minimum Data Sets is, as the name equipment
suggests, the minimum data required at each level of health  Appropriate software
care for policy formulation, management decision, priority  Telematics: telephone lines (2) with fax, network
setting and allocation of resources and accountability. State system, internet, website, VSAT
and LGAs may have cause to collect additional information, but  Vehicles: 4-WDR (2), Utility bus(1)
the core minimum must be maintained and caution exercised  Binding machines
not to unduly overload the reporting system.  Digital camera and projectors
 Power backup and/or Generator
e) Managing HMIS Units:  GIS Software
 HMIS Staff. National Expert/Consultant (1), HMIS
The establishment and management of an effective NHMIS, specialist (3) Epidemiologist (2), Public Health
requires substantial investment by federal, state and LGA Specialist (1), Computer Programmer (2), System
health authorities in manpower and infrastructural Manager (1), User-services staff (1), Data Entry and
45
Processing Clerks (6), office assistance (3)  Binding machines

Statistician (2), System Administrator (1).  Digital camera and projectors
 Power backup and/or Generator
Activities  GIS Software
 HMIS Staff. HMI Specialist (2) epidemiologist (1),
 Data storage, analysis, publication and presentation public health specialist (1), Computer
 Documentation and publication services Programmer (1), System Manager (1), User-
 User services services staff (1), Data Entry and Processing
 Clearing house for health information Clerks (3), office assistance (3) Statistician (2),
 Survey operations System Administrator (1).
 On-line services Activities
 Technical assistance
 Database development  Data storage, analysis, publication and presentation
 Informatics services  Documentation and publication services
 HMIS Forms reproduction  User services
 Computerization  Clearing house for health information
 Training.  State Health Profile
 HMIS Forms reproduction
ii) State HMIS Unit  Training
Requirements iii LGA-M&E UNIT

 State HMIS Working Document (plan)
 NHMIS Operational Manual Requirements
 Adequate office space  LGA HMIS Working Document (plan)
 Office furniture  NHMIS Operational Manual
 Micro-computers for data processing and storage  Office space Office furniture
(6)  Micro-computer (1)
 High capacity printers, photocopiers Full  Dot Matrix printer (1), photocopier (1)
complements of DTP equipment  Telematics: telephone lines (1) with fax
 Appropriate software  Motorcycles (2)
 Telematics: telephone lines (2) with fax network  Binding machines
system, internet, website.  Power backup and/or Generator
 Vehicles: 4-WDR (2), Utility bus(1)  Geographical Position Machine (GPS)
46
 HMIS Staff. HMIS Specialist (1) PHC M&E Coordinator  Data usage
(2), Assistant M&E Coordinator (3), System Manager  Training
(1).
7. FUNDING AND SUSTAINABILITY
Activities
Regular and adequate budgeting for HMIS-related -activities
 Data storage, and functions is a requirement for the sustainability and
 Analysis, presentation maintenance of the NHMIS across all tiers of government. The
 Data forwarding National Council on Health has approved that between 0.5%
 User services LGA Health Profile and 1.0% of the health capital budget should be released
 HMIS Forms reproduction annually for funding NHMIS-related activities at all levels:
 Training federal, states and local government areas. A circular to
implement this decision has since come into effect (see
iv HEALTH FACILITY – HIS Appendix 6) . However to assure effective take-off of the
revised NHMIS, states with health system strengthening
Requirements projects funds, such as HSF- participating states, ADB-assisted
 Adequate office space for record keeping with shelves health system rehabilitation projects, and other states with
and cabinets etc. health system support from UN agencies and bilateral
 Office furniture organizations, are expected to commence immediate
 HMIS facility level summary forms with enough stock to implementation of the revised HMIS forms.
last six months
 Working materials: pencil, erasers, sharpeners Specialized health control programmes are expected to budget
 Solar powered calculators appropriately for mis-related activities, which they will
 Health Record Officers/Assistants (2) implement in collaboration with the NHMIS Unit. Specifically,
they are expected to contribute in strengthening the health
data processes in their respective states of operation.
Activities International and bilateral agencies would be expected to

 Data collection daily in registers and monthly in facility provide funding and technical assistance for strengthening the
summary forms HMIS processes. Such assistance should be coordinated with
 Data storage the NHMIS unit to strengthen any component of the system at
 Data forwarding any level (Federal, State and LGA).
 Data sharing
47
APPENDIX I: PLAN OF ACTION FOR STRENTHENING NHMIS
KEY RESULTS Strengthening the National Health Management Information System

AREAS
OBJECTIVES: To provide supporting infrastructure, NHMIS forms and encourage integrated management of health data.
STRATEGY: Meeting NHMIS minimum package, printing, distribution and training on forms. Database of Health facilities, Service Availability
Mapping, HDCC/ HDPU meetings.
S/N Activities Timing Responsibilities Resources cost Expected
Output
1 Meeting the NHMIS minimum package at 2007-2009 FMOH/Partners Equipment, N30m NHMIS
Federal Level Vehicles and minimum
working package met.
materials
2 Meeting the HMIS minimum package at 2007-2009 States/LGA and Equipment, N30m/State NHMIS
state and LGAs levels partners Vehicles and minimum
working package met.
materials
3 Printing of level specific NHMIS forms. 1st and 2nd States/LGA and Funds N10m/State Forms printed
Qtr 2007 partners for levels of
data
management
4 State, LGA and Health facility level 1st,2nd and States/LGA and Technical N1.5m/State State and LGA
training on NHMIS forms 3rd partners support training training NHMIS
Qtr.2007 materials funds held.
for meeting.
5 Federal technical support at state level 1st,2nd and State partners FMOH Resource N250,000/State Training
training 3rd persons cost of workshop
Qtr.2007 participation monitored to
ensure
standard
6 Quarterly HDCC meetings 2007 FMOH/ partners Funds for N1.5m/ HDCC meeting
meetings meeting held. Report of
meeting.
AREAS
Output
rd
7 Annual HDPU meeting 3 Qtr. FMOH, States and Funds for N3m/year= HDPU meeting
2007-2009 partners meeting, DSA, N9m held and
transportation Report of the
meeting.
8 State HDCC meetings Quarterly States/ partners Funds for N300,000 /
holding quarterly meeting
State HDCC
meetings
9 Listing of health facilities nationwide. 2007 FMOH/ Partners Procurement of N5.50m Database of
Development of Database. Consultant health facilities
services available.
10 Services Availability mapping in States 2007-2008 States/ Partners Procurement of N3.5m/State Maps of
PDAs, GPS, services
Training cost, availability as
Trainee DSA, baseline
Venue, information.
Transportation.
11 Request for Technical support to States 2007-2008 States/Partners Resource N1.5m/State Technical
on SAM persons DSA and support
transportation provided
12 Support to HMN activities 2007 FMOH/ Partners Funds for N2.0m HMN activities
meetings. supported
49
AREAS
Output
13 Nigeria Evidence Based Health System 2007-2009 FMOH, Establishment of N100m Functional
Initiative (NEHSI) project. IDRC/CIDA, DSS/ MSS Sites DSS/MSS sites
C/Rivers, Bauchi Funds for in support of
State. Meetings, NHMIS
Technical
Assistance.
14 National Demographic and Health 2008 National Planning N120m NDHS
Surveys (NDHS) Population meetings, field conducted
Commission, work, analysis
FMOH and report
writing
15 Sentinel Survey 2007 2007 National Planning N35m Sentinel survey
Population meetings, field conducted
Commission, work, analysis
FMOH and report
writing
16 Multiple Indicator Cluster Survey (MICS) 2007 NBS, UNICEF Planning N180m MICS
meetings, field conducted
work, analysis
and report
writing
17 COLLABORATIVE SURVEY ON SOCIO- 2007 NBS/CBN/NCC Planning N80m Survey on
ECONOMIC ACTIVITIES IN NIGERIA meetings, field socio-economic
work, analysis activities in
and report Nigeria
writing conducted
18. Training for Military and Paramilitary 3rd Qtr FMOH DSA, N750,000 Military and
personnel on NHMIS format 2007 Transportation paramilitary
cost, cost of personnel
venue for trained on use
trainees of revised form
50
KEY RESULTS ICT in development of NHMIS
AREAS
OBJECTIVES: To deploy ICT in the development and implementation of NHMIS activities
STRATEGY: Electronic data collection, Electronic data transfer, networking
S/N Activities Timing Responsibilities Resources cost Expected Output
1 Federal level Training on NHMIS 1st Qtr. FMOH, Partners Consultancy N900,000 Federal level
software 2007 services training
conducted
2 Zonal Training on NHMIS software 1st Qtr. FMOH, Partners Technical Support, N500,000/zone Zonal level
2007 consultancy training
services. conducted.
3 State and LGAs level training on NHMIS 2nd and 3rd State and DSA, materials, N2.0m/State State and LGA
software Qtr. 2007 Partners Transportation level training
cost, cost of venue conducted on
for trainees NHMIS
4 Procurement of PDAs/ accessories for 3rd Qtr. States, LGAs, and Funds for PDAs N750,000/State PDAs &
electronic data collection and training. 2008 partners and training assessories
procured for
electronic data
transfer
5 Electronic data transfer 3rd Qtr. FMOH/ States, Hardware, N2.5m Data transferred
2008 LGAs and software. electronically
partners Development of
WAN consultancy
6 Networking of SMOH – DPRS with 3rd Qtr. FMOH, FHIs Development of N7.5m SMOH-HPRS
FMOH-DHPR/NHMIS 2008 WAN consultancy networked with
services. FMOH-
DHPR/NHMIS
unit
7 Networking of FHIs with FMOH- DHS 3rd Qtr. FMOH, FHIs Development of N7.5m FHIs networked
and DHPR. 2008 WAN consultancy with DHS/DHPR
services.
51
KEY RESULTS
AREAS Supervision, Monitoring & Evaluation of the NHMIS programme implementation
OBJECTIVES: To assess the state of progress in programme implementation and its performance
STRATEGY Establishment of monitoring protocol for NHMIS programme implementation at all levels in line with stated
activities and expected outputs
Activities Timing Responsibility Resources Cost/Source Expected
Needed Output
1. Development of a field 2nd QTR. FMOH, NPHCDA, Funds for N1.50m Monitoring and
monitoring checklist instrument 2007 NPI, NBS, NPC, materials and Assessment
for NHMIS programme at all Partners and distribution of instrument
levels. selected States. protocols. developed.
2. Preparation of HMIS Quality 3rd Qtr. FMOH, SMOH, Funds for N4.5m QA Handbook
Assurance (QA) Manual 2007 NPHCDA and preparation, mass produced and
(Handbook) for use at each level Partners. production and distributed.
of health care delivery. distribution of QA
Handbook
3. Support to Operations Research 4th Qtr. FMOH NPHCDA Resources for N5.0m Operations
on NHMIS. 2008 SMOH, Partners operations research
LGAs research established on
programme
implementation
and impact.
52
KEY RESULTS Production and dissemination of annual bulletins
AREAS
OBJECTIVES: To produce annual bulletin on health data in Nigeria
STRATEGY: Collect, collate, analyse and publish
Zonal dissemination
Activities Timing Responsibility Resources Cost/Source Expected
Needed Output
1. Support in Publication of the 3rd FMOH Funds for N5.0m Health Data
Health Data Bulletin in Quarter of SMOH materials for (FMOH) Bulletin in
Nigeria. every year LGA publication of SMOH Nigeria
the Bulletin. LGA published.
2. Publication of State/LGAs 3rd SMOH Funds for N5.0m Health
Health bulletins Quarter of LGA materials for SMOH Bulletin in
every year publication of LGA Nigeria
the Bulletin. published.
3. Dissemination of Health in 4th FMOH Funds for N4.6m Health Data
Nigeria. Quarter of SMOH meeting, zonal (FMOH Bulletin
every year LGA dissemination SMOH launched and
seminar LGA) disseminated.
4. Dissemination of State/LGAs 4th Funds for N4.6m Health Data
Health Bulletin. Quarter of SMOH meeting, (SMOH Bulletin
every year LGA State/LGAs LGA) launched and
dissemination disseminated.
seminar
53
APPENDIX II
INFORMATION FLOWCHART
RESPONSIBLE OFFICER
FEDERAL
BY STATE HMIS UNIT OFFICER 6 Weeks After End of a Semi Annum
STATE Semi-Annual Summary
BY M&E OR HMIS OFFICER Submission latest 4 Weeks After End of Quarter

(DSN Reports collected by DSN officers
And submitted to the HMIS Officer monthly)
LGA Quarterly Summary
BY DESIGNATED HEALTH RECORDS 2 Weeks After End of Month

OFFICER/CLERK
HEALTH FACILITY Monthly Summary
BY JCHEWS Submission latest 3 Days After End of Month
COMMUNITY Monthly Summary
54
APPENDIX III: NHMIS: EXPANDED OPERATIONAL ORGANOGRAM
NBS, NGOs, FMOH DPRS FMOH

DONORS, NDB, NPC, (NHMIS UNIT) DEPARTMENTS
Other Ministries
& PARASTATALS
-NPHCDA, NAFDAC,
NHIS etc
-EPID UNIT
OTHER SMOH DPRS HMB, ZONAL

DEPARTMENTS, (STATE HMIS NPHCDA
PROGRAMMES UNIT) SSA
HEALTH LGA- OTHER

PROGRAMMES M&E/NHMIS DEPARTMENTS
UNIT
HEALTH FACILITY
COMMUNITIES
55
APPENDIX IV
NATIONAL HEALTH STATUS & PERFORMANCE INDICATORS
S/N INDICATORS MEASURE/ DETERMINATION SOURCES
COMMUNITY/VILLAGE LEVEL
1 No. of trained, kitted and functional VHWs No. of trained, kitted and functional VHWs in the community Routine NHMIS
in the community Data
2a No. of TBAs in the community No. of TBAs in the community Routine NHMIS
Data
2b No. of trained, kitted and functional TBAs in No. of trained, kitted & functional TBAs in the community
the community
3 No. of live births No. of live births Routine NHMIS
Data
4 No. of still births No. of still births Routine NHMIS
Data
5 No. of maternal deaths No. of maternal deaths Routine NHMIS
Data
6 No. of referral No. of referral Routine NHMIS
Data
7 No. of patients attended by VHWs No. of patients attended by VHWs Routine NHMIS
Data
8 No. of women attended by TBAs No. of women attended by TBAs Routine NHMIS
Data
9 No. of clients that received family planning No. of clients that received family planning services Routine NHMIS
services Data
10 No. of cases of diseases seen e.g. malaria No. of cases seen e.g. malaria (specify) Routine NHMIS
(specify) Data
11 No. of deaths (specify age and sex) No. of deaths (specify age and sex) Routine NHMIS
Data
56
FACILITY/WARD LEVEL
1 Maternal mortality rate, No. of deaths of WRA (15-49yrs) resulting from pregnancy Survey
related causes, child birth and post-natal in a year x 100,000
Total No. of live births in the same period
2 Infant Mortality Rate No. of U-1 year deaths in a year x 1000 Survey
Total No. of live births during the same period
3 Under-5 Mortality Rate No. of U-5 years deaths in a year X 1000 Survey
Total No. of U-5 children in the population in the same period
4 Crude Birth Rate No. of Births in a year X 1000 Survey
Mid year population
5 Crude Death Rate No. of deaths in a year X 1000 Survey
Mid year population
6 No. of WRA (15-49 yrs) using modern No. of WRA (15-49 yrs) using modern contraceptives in the Health facility Routine NHMIS
contraceptives Data
7 No. of deliveries by trained TBAs
No. of deliveries by trained TBAs Routine NHMIS
Data
8 No. of ANC clients that received 3 doses of
IPT. No. of ANC clients that received 3 doses of IPT Routine NHMIS
Data
9 % of newborn with low birth weight
No. of new born with weight lower than 2.5kg X 100 Routine NHMIS
Total No. of new born Data
10 DPT3 coverage
No. of infants that received DPT3 vaccinations Routine NHMIS
No of infants that received DPT 1 vaccination Data
11 Immunization coverage
No. of children less than 12 months fully Immunised X 100 Survey
Total No. of children less than 12 months
12 % of women that received ante-natal care No. of women that received at least 4 ante-natal care contacts in a year X 100 Survey
in a year Total No. of deliveries in the same period
13 No. of children 0-6 months – exclusively No. of children 0-6 months exclusively breast fed Routine NHMIS
breast-fed Data
57
14 No. of deliveries in the health facility No. of deliveries in the health facility Routine NHMIS
Data
15 % of children aged 0-59 months weighing No. of children aged 0-59 months weighing below the lower line X 100 Routine NHMIS
below the lower line (3rd percentile) on the Total No. children aged 0-59 months weighed Data
child’s health card
16 No. of children( 6-59 months) given Vitamin No. of children (6-59 months) that received Vitamin A in the health facility Routine NHMIS
A Data
17 Incidence of each of the notifiable No. of new cases of notifiable Communicable Survey
Communicable diseases (specify) diseases (specify) in a target group in a year x 1000
Total population of target group in the same period
18 Incidence of each of the notifiable Non No. of new cases of notifiable Non Communicable Survey
Communicable diseases (specify) diseases (specify) in a target group in a year x 1000
19 Prevalence of notifiable Communicable No. of new & old cases of notifiable Survey
diseases (specify) Communicable diseases in a target group in a year x 1000
Total population of target group in the same year
20 Prevalence of notifiable Non No. of new & old cases of notifiable Non Survey
Communicable diseases (specify) Communicable diseases in a target group in a year x 1000
21 % of HF in the ward providing condoms to No. of HF in the ward providing condoms to clients x 100 Routine NHMIS
clients Total No. of HF in the ward Data
22 % of health facilities in the ward providing No. of health facilities in the ward providing minimum Routine NHMIS
minimum health services package as health services package as defined in the HSR document x 100 Data
defined in HSR document Total No. of health Total No. of HF in the ward
23 Incidence of malaria in the U-5 children Survey
No. of new cases of malaria in Children 0-59 months in a year x 1000
Total population of children 0-59 months in the same period
24 Incidence of malaria in pregnant women No. of new cases of malaria in Pregnant women in a year x 1000 Survey
Total population of pregnant women in the same period
25 % of deaths due to notifiable Non No. of deaths due to notifiable Routine NHMIS
communicable diseases (specify) Non communicable diseases (specify) in a year x 100 Data
Total No. of deaths in the health facility in the same year
26 % of deaths due to notifiable communicable No. of deaths due to notifiable Routine NHMIS
diseases (specify) communicable diseases (specify) in a year x 100 Data
Total No. of deaths in the health facility in the same year
58
27 No. of deaths due to vaccine preventable No. of deaths due to vaccine preventable diseases at the facility (specify) Routine NHMIS
diseases (VPD) (specify) Data
28 No. of health facilities not experiencing No. of health facilities that did not experience stock-out of essential drugs in the Routine NHMIS
stock-out of essential drugs in the ward in last 3 months Data
the last 3 months
LGA LEVEL
1 Maternal mortality rate, No. of deaths of WRA resulting from pregnancy Survey
related causes, child birth and post-natal in a year x 100,000
2 Infant Mortality Rate No. of U- 1 year death in a year x 1000 Survey
3 Under-5 Mortality Rate No. of U-5 year deaths in a year x 1000 Survey
Total No. of U-5 children in the population in the same year
Mid year population
Mid year population
6 Contraceptive Prevalence Rate No. of WRA (15-49 yrs) using modern contraceptives in a year x 100 Survey
Total No. of WRA (15-49yrs) in the same year
7 % of new born with low birth weight No. of new born with birth weight below 2.5kg X 100 Survey
Total No. of new borns at the LGA
8 DPT3 Coverage No. of infants that received DPT3 Survey
No. of infants that received DPT 1
9 Immunization Coverage
No. of children less than 12 months fully Immunised X 100 Survey
Total No. of children less than 12 months
10 % of health facilities that provide minimum No. of health facilities providing minimum health package x 100 Routine NHMIS
health package Total No. of health facilities Data
11 No. of deliveries in the LGA No. of deliveries in the LGA Survey
12 % of deliveries by trained TBAs in the LGA No. of deliveries attended to by trained TBAs in the LGA x 100 Routine NHMIS
Total No. of deliveries in the LGA data
13 % of health facilities providing clients with No. of health facilities providing clients with condoms in the LGA X 100 Routine NHMIS
condoms in the LGA Total No. of health facilities in the LGA. data
59
14 % of health facilities providing services on No. of health facilities providing services on STIs, HIV/AIDS X 100 Routine NHMIS
STIs, HIV/AIDS Total No. of health facilities data
15 % of health facilities providing family No. of health facilities providing family planning services X 100 Routine NHMIS
planning services Total No. of health facilities data
16 % of health facilities with referral protocol No. of health facilities with referral protocol X 100 Routine NHMIS
Total No. of health facilities data
17 % of pregnant women that received ante- No. of women that received ante-natal care (ANC) in a year X 100 Survey
natal care (ANC) in a year Total No. of pregnant women in the same period
18 % of infants 0-6 months exclusively breast- No. of infants 0-6 months exclusively breast- fed X 100 Routine NHMIS
fed Total No. of infants 0-6 months data
19 Incidence of each of the notifiable Non No. of new cases of notifiable Non Routine NHMIS
communicable diseases (specify) communicable diseases (specify) in a target group in a year x 1000 data & Survey
20 Incidence of each of the notifiable No. of new cases of notifiable Routine NHMIS
communicable diseases (specify) communicable diseases (specify) in a target group in a year x 1000 data & Survey
21 Prevalence of notifiable Non communicable No. of new & old cases of notifiable Routine NHMIS
diseases (specify) Non communicable diseases in a target group in a year X 1000 data & Survey
Total population of target group
22 Prevalence of notifiable Communicable No. of new & old cases of notifiable Routine NHMIS
diseases (specify) Communicable diseases in a target group in a year X 1000 data & Survey
Total population of target group
23 % of establishments providing occupational No. of establishments with 10 or more employees providing occupational health services X 100 Routine NHMIS
health services Total No. of establishments with 10 or more employees data
24 % of private health providers participating in No. of private health providers participating in the NHMIS x 100 Routine NHMIS
the NHMIS Total No. of private health providers data
25 % of deaths due to notifiable No. of deaths due to notifiable Communicable diseases (specify) in a year x 100 Routine NHMIS
Communicable diseases (specify ) Total No. of deaths in the same period data
26 % of deaths due to notifiable Non No. of deaths due to notifiable Non communicable diseases (specify)in a year x100 Routine NHMIS
Communicable diseases (specify) Total No. of deaths in the same year data
27 % of deaths due to vaccine preventable No. of deaths due to vaccine preventable diseases in a year (specify) X 100 Routine NHMIS
diseases (VPD) (specify) Total No. of deaths in the same year data
60
28 % of health facilities not experiencing stock- No. of health facilities that did not experience Routine NHMIS
out of essential drugs in the last 3 months stock-out of essential drugs in the last three months x 100 data
Total No. of health facilities in the LGA
STATE LEVEL
1 Immunization coverage rate
No. of children less than 12 months fully Immunised in a year X 100 Survey
Total No. of children less than12 months in the same period
2 Infant Mortality Rate No. of U-1 year deaths in a year X 1000 Survey
3 Maternal mortality rate No. of deaths of WRA (15-49 yrs) resulting from pregnancy Survey
related causes, child birth and post-natal in a year X 100,000
4 Under-5 Mortality Rate No. of U-5 year deaths in a year X 1000 Survey
Total No. of U-5 in the population in the same year
Mid year population
Mid year population
8 % of new born with low birth weight No. of new borns with birth weight below 2.5kg X 100 Routine NHMIS
Total No. of new borns data
9 DPT3 coverage No. of infants that received DPT3 Routine NHMIS

No. of infants that received DPT 1 data
10 % of pregnant women that received ante- No. of women that received ante-natal care (ANC) in a year X 100 Survey
natal care (ANC) in a year Total No. of pregnant women in the same period
11 % of infants 0-6 months exclusively breast No. of infants 0-6 months exclusively breast fed X 100 Routine NHMIS
fed Total No. of infants 0-6 months data
12 % of deaths due to notifiable Non No. of deaths due to notifiable Non Communicable diseases (specify)in a year x100 Routine NHMIS
Communicable Diseases (specify) Total No. of deaths in the same year data
13 % of deaths due to notifiable No. of deaths due to notifiable Communicable diseases (specify) in a year X 100 Routine NHMIS
Communicable Diseases (specify) Total No. of deaths in the same period data
diseases (VPD) (specify) Total No. of deaths in the same period data
61
15 Incidence of each of the notifiable No. of new cases of notifiable communicable diseases in a year (specify) x 1000 Routine NHMIS
communicable diseases (specify) Total population of target group in the same period Data; Survey
16 Incidence of each of the notifiable Non No. of new cases of notifiable Non NHMIS Data;
communicable diseases (specify) communicable diseases in a year (specify) x 1000 Survey
17 Prevalence of notifiable communicable No. of new & old cases of notifiable communicable diseases in a year X 1000 Routine NHMIS
diseases Total population of target group in the same year Data; Survey
18 Prevalence of notifiable Non communicable No. of new & old cases of notifiable Routine NHMIS
diseases Non communicable diseases in a year X 1000 Data; Survey
19 % of establishments providing occupational No. of establishments with 10 or more employees providing occupational health services X 100 Routine NHMIS
health services Total No. of establishments with 10 or more employees data
20 % of private health providers participating in No. of private health providers participating in the NHMIS X 100 Routine NHMIS
the NHMIS Total No. of private health providers data
21 No. Secondary Health facilities (Public & No. of Secondary Health facilities (Public & Private) providing voluntary Routine NHMIS
Private) providing voluntary counselling and counselling and testing for HIV/AIDS Data
testing for HIV/AIDS
22 No. of Secondary Health facilities (Public & No. of Secondary Health facilities (Public & Private) providing Antiretroviral (ARV) Routine NHMIS
Private) providing Antiretroviral (ARV) therapy data
therapy
23 No. of Secondary Health facilities (Public & No. of Secondary Health facilities (Public & Private) providing blood screening Routine NHMIS
Private) providing blood screening service service data
24 No. of Secondary Health facilities (Public & No. of Secondary Health facilities (Public & Private) not experiencing stock-out of Routine NHMIS
Private) not experiencing stock-out of essential drugs in the last 3 months data
essential drugs in the last 3 months
FEDERAL LEVEL
1 Infant Mortality Rate No. of U-1 year deaths in a year X 1000 Survey
2 Maternal Mortality Rate, No. of deaths of WRA resulting from Survey
pregnancy related, child birth and post-natal causes in a year X 100,000
3 Under-5 Mortality Rate No. of U-5 year deaths in a year X 1000 Survey
Total No. of U-5 in the population in the same year
4 Crude Birth Rate No. of Births registered in a year X 1000 Survey
Mid year population
62
5 Crude Death Rate No. of deaths registered in a year X 1000 Survey

Mid year population
7 % of new born with low birth weight No. of new born with birth weight below 2.5kg X 100 Routine NHMIS
Total No. of new borns Data
8. DPT3 coverage No. of infants that received DPT3 Routine NHMIS
No. of infants that received DPT 1 data
9 Immunization coverage rate;
No. of children less than 12 months fully Immunised in a year X 100 Survey
Total No. of children less than12 months in the same period
10 % of pregnant women that received ante- No. of women that received ante-natal care (ANC) in a year X 100 Routine NHMIS
natal care (ANC) in a year Total No. of pregnant women in the same period Data
11 % of infant 0-6 months exclusively breast No. of infant 0-6 months exclusively breast fed X 100 Routine NHMIS
fed Total No. of infants 0-6 months Data
12 No. of deliveries in the States No. of deliveries in the state Routine NHMIS
Data
13 % of deliveries by trained TBAs No. of deliveries by trained TBAs in year x 100 Routine NHMIS
Total No. of deliveries in the same period Data
14 % of deaths due to notifiable Non No. of deaths due to notifiable Non Communicable Diseases in a year x 100 Routine NHMIS
Communicable Diseases Total No. of deaths in the same year Data; Survey
15 % of deaths due to notifiable No. of deaths due to notifiable Communicable Diseases in a year X 100 Routine NHMIS
Communicable Diseases Total No. of deaths in the same year Data; Survey
diseases(VPD)(specify) Total No. of deaths in the same year Data; Survey
17 Incidence of each of notifiable Non No. of new cases of notifiable Routine NHMIS
communicable diseases (specify) Non communicable diseases in a year (specify) x 1000 Data; Survey
Total population of target group in a year
18 Incidence of each of notifiable No. of new cases of notifiable Routine NHMIS
communicable diseases (specify) communicable diseases in a year (specify) x 1000 Data; Survey
Total population of target group in a year
20 Prevalence of notifiable communicable No. of new & old cases of notifiable Routine NHMIS
diseases communicable diseases (specify) in a year X 100 Data; Survey
63
21 % of establishments providing occupational No. of establishments with 10 or more Routine NHMIS

health services employees who provide occupational health services X 100 Data
Total No. of establishments with 10 or more employees
22 % of private health providers participating in No. of private health providers in the country participating in the NHMIS X 100 Routine NHMIS
the NHMIS Total No. of private health providers in the country Data
23 % of Secondary Health facilities (Public & No. of Secondary Health facilities Routine NHMIS
Private) providing voluntary counseling & (Public & Private) providing voluntary counseling & therapy (VCT) x 100 Data
therapy (VCT) Total No. of secondary health facilities in the country
24 % of Secondary Health facilities (Public & No. of Secondary Health facilities Routine NHMIS
Private) providing Antiretroviral (ARV) (Public & Private) providing Antiretroviral (ARV) therapy x 100 Data
therapy Total No. of secondary health facilities in the country
25 No. of Secondary Health facilities (Public & No. of Secondary Health facilities Routine NHMIS
Private) providing blood screening service (Public & Private) providing blood screening service x 100 Data
Total No. of secondary health facilities in the country
26 No. of Secondary Health facilities (Public & No. of Secondary Health facilities (Public & Private) Routine NHMIS
Private) not experiencing stock-out of not experiencing stock-out of essential drugs in the last 3 months x 100 Data
essential drugs in the last 3 months Total No. of secondary health facilities in the country
64
APPENDIX 5: NATIONAL HEALTH OBJECTIVES AND INDICATORS
A number of national health objectives and indicators have been put together for comprehensive monitoring and evaluation of the national health care system. The objectives and indicators
were selected based on available resources, relevance to national health policy and ease of data collection.
S/N PRIORITY AREA PRIORITY AREA MEASURABLE NATIONAL INDICATORS CALCULATION OF SOURCE OF DATA
IMPLEMENTING OBJECTIVES/TARGETS INDICATORS (DATA SYSTEM)
AGENCY
1. Political Commitment to Health Federal, State & LGAs 1.1 Increase in budgetary Proportion of annual budget Allocation for health x Federal Ministry of
Policy at all levels (assessed in allocation to health (by at least allocation to health 100 Finance, FMOH,
terms of resource allocation, 10% by the year 2000). Total annual budget SMOH, LGA
equity, organization framework
and involvement of FMF, FMOH, SMOH,
community). 1.2. Increase in annual per Per capital expenditure on LGA
capita (national) expenditures on health at national level. Actual national expenditure
health. on health x 100
Total population FMOH
1.3. Increase in health budget Proportion of health budget
allocation to PHC. allocation to PHC. PHC Budget x
100
Total health budget FMF, FMOH, SMOH,
1.4. Increase in actual Percent of budgetary allocation LGA
expenditures of annual budget on to health expended
health. Actual FMOH expenditures
on health x 100
Proportion of LGAs with health Actual annual FMOH budget FMOH, NPHCDA,
1.5. Increase in the number of committees. on health Survey
LGAs with health committees.
Number of LGAs with health
committees x 100
Total No. of LGAs in the
country
2 SMOH 2.1 Increase the annual a. Percent of annual State a. State allocation SMOH
State budget on health to at budget allocated to health on health x 100
least 10% by the year 2000 Annual State budget
b. Percent of health budget b. Actual State health SMOH

expended expenditures X 100
Annual State health budget
c. State budget on
c. Per capita allocation on health X 100 SMOH
health at the state level Total State health budget
d. Proportion of State d. State budget

health budget allocated to on PHC X 100
PHC Total State health budget SMOH
65
AGENCY
Percent of LGAs with health Total no. of LGAs in the

committees state with health
2.2. Increase in the number of committees x 100 SMOH,
LGAs in the State with health Total No. of LGAs in the NPHCDA
committees. state
3 LGA 3.1. Increase the annual LGA a. Percent of LGA budget a. LGA allocation to LGA, NPHCDA, Survey
budget on health to at least 30% allocated to health health x 100
by the year 2010. Annual LGA budget
b. Actual expenditures of LGA b. Actual LGA budget on LGA, NPHCDA,

budget on health health x 100 Survey
Annual LGA budget
3.2. Increase in the per capita Per capita health expenditure Actual LGA expenditure on
income on health at the LGA health x 100 LGA, NPHCDA,
Total LGA proportion NPC,Survey
3.3. Increase in the number of Proportion of houses with PHC Number of PHC numbered
PHC numbered houses in the number in the LGA houses in the LGA x 100 LG Health Dept, LG
LGA Total No. of houses in the Works Dept, Survey
LGA
HEALTH ACCESS/UTILISATION INDICATORS
1. Physical Accessibility to Health MOH 1.1. To increase the number of Proportion of population living Number of population living Health Survey, NPC
Service (PHC/Referral System) facilities to improve the proportion within 5km distance of a health within 5km distance x 100
of population having access to facility Total population
health facilities.
Number of population seen by
1.2. To increase the number of Proportion of population seen trained health workers x 100 PHC M&E, LGA(PRS),
health workers in the country. by trained health workers Total Population. Health facility
1.3. To increase the level of two- Proportion of referrals recorded To No. of attendances x 100 Health facility
way referral system in support of within the health system Total No. of cases needing
PHC. referrals
2. Provision of out-patient care for FMOH 2.1. To achieve a minimum of Attendance per year per 1000 Health facility
Number of attendances x 1000
common and specific three attendances for each population
conditions at all levels of health person per year, including out- Total population
care delivery system. patient and hospital visits.
3. Provision of accessible in- FMOH 3.1. To increase the number of Ration of hospital beds per Total No. of beds available Hospitals
patient and referral services to in-patient beds from the present 2 1000 population per year. for in-patient care x 1000
all those who require them. per 1000 to at least 4 per 1000 Total population
66
AGENCY
(by the year 2010)
3.2. To increase the number of a. Ration of doctors per 10,000 a. Number of doctors x 1000 Hospitals
doctors from the present 2.5 per population. Total population
10,000 population to 4 doctors
per 10,000 population by the year b. Percentage of LGAs having b. Number of LGAs with two or Hospitals
2010 (with at least 2 doctors per more than 2 doctors practicing more practicing physicians x 100
LGA in the country). within the LGA Total No. of LGAs
4. Health Insurance coverage of FMOH (Health 4.1. To provide health insurance Percentage of employees Number of employees covered Health Insurance
employees in the formal sector Insurance Scheme). cover to all employees covered in the formal sector by in the formal sector x 100 Scheme
Health Insurance Scheme Total No. of employees
5. Dental and Oral Health FMOH 5.1. To increase the number of Percentage of health facilities Number of health facilities in Survey, PHC M&E
health facilities in the LGA in the LGA equipped to offer LGA equipped to provide
offering dental/oral health dental/oral health services dental/oral health services x 100
services Total no of health facilities in
LGA
6. Mental Health FMOH 6.1. To increase the number of Percentage of health facilities Number of health facilities in Survey, PHC M&E
health facilities in the LGA in the LGA equipped to offer LGA equipped to provide
offering Mental health services Mental health services Mental health services x 100
Total no of health facilities in
LGA
7. School Health Services FMOH, FME 7.1. To increase the number of Percentage of schools in LGAs Number of facilities that provide Survey, PHC M&E
schools with health services with health services. laboratory services x 100
Total No. of facilities
8. Laboratory Services FMOH, SMOH, NGOs, 8.1. To increase the number of Percentage of health facilities Number of facilities that provide Survey
Private Sector health facilities that provide by states/LGAs the provide laboratory services x 100
essential laboratory services. essential laboratory services. Total No. of facilities NHMIS Forms
8.2. To increase the number of Percentage of trained Number of trained laboratory

trained laboratory personnel. laboratory workers workers x 100
Total No. of laboratory staff
8.3. To ensure the utilization of Proportion of patients sent for Number of laboratory
laboratory services. laboratory investigation requests x 100
Total no. of hospital/clinic
consultants
8.4. To ensure that all Proportion of laboratories Number of laboratories

laboratories confirms to a national participating in National Quality in scheme x 100
Quality Assurance Scheme. Assurance Scheme. Total No. of registered
laboratories
67
AGENCY
8.5. to increase the number of Proportion of health facilities Number of health facilities
health facilities with major with major laboratory with major laboratory
laboratory equipment and equipment and reagents equipment
reagents. and reagents x 100
Total No. of health facilities
9. Radiology Services FMOHs, SMOHs, To increase the numbers of Percentage of health facilities Number of facilities that provide Survey
LGAs, NGOs health facilities that provide by state/LGAs that provide radiological equipment and
radiological services. radiological services reagents x 100 NHMIS Forms
Total No. of facilities
9.2. To increase the number of Percentage of trained radiology Number of trained

trained radiology personnel personnel radiology personnel x 100
Total No. of Laboratory staff
9.3. To ensure the utilization of Proportion of patients sent for Number of laboratory
radiology services radiological services request x 100
Total No. of hospital/clinic
consultants.
9.4. To ensure that the Proportion of laboratories Number of laboratories in

laboratories conform to a National participating in National Quality scheme x 100
Quality Assurance Scheme Assurance Scheme Total No. of registered
laboratories
10. Pharmacy Services FMOH, SMOH, NGOs, To increase the number of Percentage of health facilities Number of health facilities Survey
Private Sector facilities that participate in that participated in essential per state/LGA that
essential drug programme drug programme. participate in EDP X 100 NHMIS forms
Total number of
facilities
11. District Minimum Health FMOH, SMOH, NGOs To increase the proportion of Percentage of PHC facilities in Number of PHC facilities in Survey
Services Package Primary health care facilities states/LGA providing minimum State/LGAs providing minimum
meeting the minimum health health services package. health services package x 100 NHMIS forms
services Total No. of facilities in
States/LGAs
12. Public Private Sector Health FMOH, SMOH, NGOs, To set up an efficient and Percentage of health care Number of private sector Survey
Care Services Private Sector dynamic public/private sector mix services provided by private health facilities x 100
sector. Total no. of facilities NHMIS forms
13. Traditional and Medical FMOH, SMOH To establish appropriate Percentage of states and LGAs Number of LGAs/State with Survey
Practices legislation and mechanism for with edicts regulating traditional traditional
standardization and control of medical practices. medicine boards X 100 NHMIS forms
traditional medical practices Total No. of LGAs/state
14. Health manpower Management FMOH, SMOH To institutionalize re-certificate Percentage of health Number of professional Survey
and continuing education professional recertified yearly recertified x 100
programmes by the relevant professional Total No. of registered NHMIS forms
bodies professionals
68
AGENCY
MONITORING AND EVALUATION OF INFORMATION SYSTEMS
1. National Health Indicators DPRS, (FMOH) 1.1. To increase regular use of Proportion of LGAs and states Number of LGAs/States NHMIS
national health indicators at all developing health plans based with health plans x 100
levels of service delivery on HMIS Total No. of LGAs/States
2. Immediate Notifiable Disease FMOH (DPRS, 2.1. To enhance immediate Proportion of suspected Number of disease out-breaks NHMIS
PHC&DC) notification of suspected epidemic disease outbreaks promptly promptly notified x 100
outbreak. Total No. of disease
outbreaks notified for a
given year
2.2 To install an electronic Proportion of states with Number of states with

voice/data communication electronic/voice/data EVDCN x100
network in all states of facilitate communication network
emergency preparedness and (EVDCN) system Total No. of states
response mechanism
3. Co-ordination and Integration FMOH (DPRS) 3.1. To facilitate the development Percentage of states with Number of states Survey
of HMIS NPHCDA of HMIS units at State and LGAs HMIS/ M&E plan. with HMIS plan x 100
STATES levels and to strengthen the co- Total No. of states
LGAS ordination of M&E systems by
NHMIS strategic plan of action. Percentage of LGA with HMIS/ Number of LGAs
M&E plan. with HMIS plan x 100 Survey
Total No. of LGAs
3.2. to improve the capacity Percentage of required Number of required Survey

building activities and systematic personnel trained in the NHMIS personnel trained x 100
training of M&E personnel and processes Total No. of required
health managers disease personnel.
surveillance and M&E systems
3.3. To improve supervision of Percentage of States and Number of States/LGAs Survey

HMIS at state, LGA and health LGAs implementing HMIS implementing QA x 100
facility level. quality assurance (QA) Total No. of states/LGAs
supervision.
3.4. To increase the participation Percentage of private health Number of private providers NHMIS
of private health providers in the providers participating in the participating in NHMIS x 100
NHMIS. NHMIS Total No. of private providers.
3.5. To develop appropriate Percentage of state and LGAs Number of states/LGA

with NHMIS
operational manual for the NHMIS with NHMIS operational Survey
operational manuals x 100
at all levels. manuals. Total No. of states/LGAs
69
AGENCY
SOCIO – ECONOMIC OBJECTIVES AND INDICATORS
Education
Adult Literacy NPC, FME, MLP, MWH, 1.1. To increase the proportion of Percentage of population Population aged 15 years + NPC, Federal
MANR the population that is literate to at literate by gender who can Ministry of
least 70% by the year 2010. read and write x 100 Education, Survey.
Total population 15 years +
Female Education FME, FMW 1.2. To increase the proportion of Female-male enrolment ratio Number of females enrolled FME Statistics
females enrolled in schools. in formal schools x 100
Total No. of school
enrolments
Population Growth NDC, FME, FMW, 1.3. To reduce the population Annual population growth rate Total population in a given NPC, NBS
FMOH growth rate. year x 100
Total population in preceding
year
Employment FMLP, FMOH 1.4. To increase the level of Unemployment Rate Total No. of NPC, Ministry of Labour
employment employed x 100 and Productivity, NBS
Total No. of people within
the productive age group.
Housing FMHousing 1.5. To increase the proportion of Percentage of population with Number of households with NBS
Nigerian households with access access to adequate housing. adequate housing x 100
to adequate housing according to Total No. of households
public health standards.
Safe Drinking Water FMEnv, FMOH 1.6. To increase the proportion of Proportion of households with Number of households FMOH, FMWR, Survey
Supply households with regular supply of regular supply of safe drinking with regular
safe drinking water (to at lease water supply of safe water x 100
80% by the year 2010) Total No. of households
Food Availability FM AgRIc 1.7. To increase household food Proportion of households with Number of households that Survey, NBS.
security and nutrition food security have food security x 100
Total No. of households
70
71
72
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FEDERAL MINISTRY OF HEALTH

DEPARTMENT OF HEALTH PLANNING AND RESEARCH

NATIONAL HEALTH MANAGEMENT INFORMATION SYSTEM

REVISED POLICY-PROGRAMME AND STRATEGIC PLAN OF ACTION

health that will permit them to lead socially and

 in collaboration with the State and Local

associations and special societies representing i. the development of standardised national

h) Responsibilities At Each Level  ensuring timely forwarding/sharing of data to relevant

Ante-Natal Care and Pregnancy Outcome iii) Immediate Notification (DSN-001):

Source: FGN, National Guideline on contraceptive logistic

x) HIV and AIDS Surveillance: xii) National Onchocerciasis Control Programme

d) Health Care Level-Specific Forms:  The Onchocerciasis Control Programme implement a

 to prepare and disseminate protocols for collecting

a) Element of the NHMS Programme Structure:

The structure of the National Health Management Information NHMIS TWG

c) Legal Framework: a) The Revised HMIS Forms

NHMIS Summary Form 001A & B – Health Facility  Pharmaceutical Services

iv) Baseline Surveys (for Specialized Health Programmes):

Processing Clerks (6), office assistance (3)  Binding machines

Requirements iii LGA-M&E UNIT

Activities International and bilateral agencies would be expected to

KEY RESULTS Strengthening the National Health Management Information System

STRATEGY: Electronic data collection, Electronic data transfer, networking

S/N Activities Timing Responsibilities Resources cost Expected Output

STATE Semi-Annual Summary

BY M&E OR HMIS OFFICER Submission latest 4 Weeks After End of Quarter

LGA Quarterly Summary

BY DESIGNATED HEALTH RECORDS 2 Weeks After End of Month

HEALTH FACILITY Monthly Summary

BY JCHEWS Submission latest 3 Days After End of Month

COMMUNITY Monthly Summary

NBS, NGOs, FMOH DPRS FMOH

OTHER SMOH DPRS HMB, ZONAL

HEALTH LGA- OTHER

NATIONAL HEALTH STATUS & PERFORMANCE INDICATORS

S/N INDICATORS MEASURE/ DETERMINATION SOURCES

9 DPT3 coverage No. of infants that received DPT3 Routine NHMIS

5 Crude Death Rate No. of deaths registered in a year X 1000 Survey

21 % of establishments providing occupational No. of establishments with 10 or more Routine NHMIS

b. Percent of health budget b. Actual State health SMOH

d. Proportion of State d. State budget

Percent of LGAs with health Total no. of LGAs in the

b. Actual expenditures of LGA b. Actual LGA budget on LGA, NPHCDA,

8.2. To increase the number of Percentage of trained Number of trained laboratory

8.4. To ensure that all Proportion of laboratories Number of laboratories

9.2. To increase the number of Percentage of trained radiology Number of trained

9.4. To ensure that the Proportion of laboratories Number of laboratories in

2.2 To install an electronic Proportion of states with Number of states with

3.2. to improve the capacity Percentage of required Number of required Survey

3.3. To improve supervision of Percentage of States and Number of States/LGAs Survey

3.5. To develop appropriate Percentage of state and LGAs Number of states/LGA

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