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Perspective
4 (
2
); 34-41
doi:
10.25259/GJMS_1_2025

Barriers to the Adoption of Electronic Health Records in Nigerian Healthcare Systems: Analysing Infrastructure, Training and Policy Challenges

,
1College of Medicine, University of Ibadan, Ibadan, Nigeria, USA
2Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.

*Corresponding author: Taofeeq Oluwatosin Togunwa, Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA. togunwa@umich.edu

Received: , Accepted: ,
© 2024 Published by Scientific Scholar on behalf of Global Journal of Medical Students
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Bolatito BA, Togunwa TO. Barriers to the Adoption of Electronic Health Records in Nigerian Healthcare Systems: Analysing Infrastructure, Training and Policy Challenges. Glob J Med Stud. 2024;4:34-41. doi: 10.25259/GJMS_1_2025

Abstract

Electronic Health Records (EHRs) have transformed healthcare by digitising patient data, improving efficiency, and reducing costs. While 90% of U.S. physicians use EHRs, adoption in Nigeria remains as low as 18%, despite evidence that EHRs reduce medical errors and enhance care coordination. Nigeria’s doctor-to-patient ratio of roughly 1:9,000, combined with a high disease burden, makes limited EHR adoption especially likely to worsen healthcare disparities. This perspective article examines key barriers to EHR adoption in Nigeria, focusing on infrastructure limitations, workforce training deficits, and policy gaps. Infrastructure challenges include unreliable electricity (60.5% access) and limited internet penetration (40%), making digital systems difficult to sustain. In addition, digital literacy among healthcare professionals is uneven, with some regions reporting only 26.7% of workers possessing basic computer proficiency. The lack of structured EHR training contributes to resistance, as providers struggle with workflow disruptions when transitioning from paper-based systems. Policy and regulatory weaknesses further hinder adoption. Fragmented guidelines, weak data privacy laws, and limited political commitment undermine trust and scalability. Financial constraints are another major barrier, as annual EHR costs exceed $10,000 per practice, making implementation unaffordable for many facilities. To overcome these challenges, Nigeria must invest in alternative energy sources, offline-capable EHR systems, and sustainable funding models through public-private partnerships. Integrating EHR training into medical curricula and professional development programmes can help ease resistance. In addition, standardised policies, financial incentives, and robust data protection laws are crucial for long-term adoption. Countries such as Rwanda and Kenya offer scalable models – Rwanda successfully integrated EHRs into its human immunodeficiency virus and cancer programmes, while Kenya upgraded hospital IT systems through collaborative initiatives. By following these examples and prioritising strong government leadership, Nigeria can enhance EHR adoption and improve healthcare efficiency.

Keywords

Electronic health records
Healthcare policy
EHR
Infrastructure
Nigeria

INTRODUCTION

Electronic Health Records (EHRs) digitise patient information, enhancing healthcare delivery by improving safety, effectiveness, and efficiency. EHRs play a vital role for both clinicians and patients, encompassing tasks such as documenting and accessing patient records, prescribing medications, coordinating complex care plans across providers, and handling electronic billing.1 Introduced in the USA in the 1960s, EHR systems are now used by nearly 9 in 10 office-based physicians in the United States, reflecting their significant impact.2,3 Precisely, the adoption of basic EHR systems grew from 6.6% to 81.2%, while that of comprehensive systems rose from 3.6% to 63.2% between 2009 and 2019.3,4 This contrasts sharply with low-resource settings like Nigeria, where adoption rates are estimated to be as low as 18%.5

Nigeria’s digital health policy landscape provides context for the current EHR adoption challenges. The National Health Information and Communication Technology (ICT) Strategic Framework (2015–2020)6 and its counterpart, the Nigeria Digital in Health Strategy (2024),7 provide a framework for interoperability, data governance, and established policy direction for health technology implementation. Pilot initiatives such as the Surveillance Outbreak Response Management and Analysis System during the COVID-19 response demonstrated the value of real-time data for surveillance and decision-making.8 However, these frameworks have faced implementation challenges due to limited funding, weak institutional capacity, and inadequate coordination between federal and state levels, contributing to the persistent low adoption rates observed today.

With Nigeria already burdened by high disease prevalence and critical doctor-to-patient ratios,8 EHR adoption holds significant potential. Studies highlight that EHRs provide timely access to clinical data such as laboratory and radiology results, improving care planning and reducing medical errors.9,10 These tools also minimise redundancy and help lower costs.11 However, Nigeria’s low adoption rates, despite these benefits, threaten to further widen existing global health inequities. This perspective article explores barriers to EHR adoption in Nigeria’s healthcare system, focusing on challenges related to infrastructure, training, and policy, while proposing an inclusive framework of recommendations.

METHODOLOGY

This article synthesises existing literature and publicly available data to explore barriers to EHR adoption in Nigeria. Our approach involved a targeted literature search across academic databases (e.g., PubMed and Google Scholar) using keywords such as ‘EHR adoption Nigeria’, ‘electronic health records challenges Africa’, ‘digital health strategies Nigeria’, and ‘healthcare IT infrastructure Nigeria’. Sources were selected based on relevance to the Nigerian healthcare context, methodological quality, and data recency (primarily 2014–2024). We included peer-reviewed articles, government reports, World Health Organization/United Nations Development Programme (UNDP) publications, and policy documents. Cited studies and country comparisons were included based on their relevance to the identified challenges and proposed strategies, aiming to provide a comprehensive overview of the current landscape and potential solutions.

Conceptual framework

To provide structure and analytical depth, this paper adopts the Technology-Organisation-Environment (TOE) framework, which is widely used to examine technology adoption in organisational settings.12,13 The TOE model categorises the key determinants of technology implementation into three domains: (1) Technological context, which includes the availability, compatibility and perceived benefits of the technology; (2) organisational context, which refers to internal factors such as staff capacity, training and leadership support and (3) environmental context, encompassing external influences such as government policy, regulatory support and socio-economic factors.

In the context of EHR adoption in Nigeria, this framework is particularly relevant. The technological domain captures issues related to electricity, internet access, and EHR system functionality. The organisational domain includes healthcare worker training, digital literacy, and resistance to change. The environmental domain reflects the broader policy environment, including data protection laws, political will, and financial incentives.

Challenges to EHRs adoption in Nigeria

Infrastructure challenges

In Nigeria, inadequate technological infrastructure, including unreliable electricity and internet access, poses significant challenges to EHR adoption. Only 62% of the population has access to electricity,14 with rural areas experiencing about a 41.1% grid access rate.15 Internet penetration stands at approximately 40%,16 further complicating EHR implementation. In addition, the high costs of EHR systems, including initial setup and ongoing maintenance, represent a substantial financial burden for healthcare facilities, with typical practices spending upwards of $10,000 annually.17 Notably, rural areas face even greater barriers due to significant disparities in access to technology compared to urban centres.

Training and capacity-building challenges

Limited training opportunities hinder EHR adoption in Nigeria, with considerable variation in computational skill levels among healthcare workers. A recent study by Akwaowo, Sabi18 revealed that only 26.7% of healthcare workers in the Niger Delta region possess sufficient proficiency with computer tools to perform advanced tasks. This directly impacts their willingness to adopt and effectively utilise EMR systems. In contrast, Alobo, Soyannwo19 found that over 90% of healthcare workers in Kogi State rated their EHR competence as fair or good. The absence of structured EHR training in medical and nursing curricula further exacerbates this digital literacy gap. This contrast reveals how healthcare infrastructure capacity is highly uneven across Nigeria. Urban tertiary hospitals may have intermittent internet access and some on-site IT staff, while rural primary health centres often lack basic electricity or computer equipment, making even minimal EHR functionality unattainable. In addition, resistance to change is significant, with many providers hesitant to transition from paper-based systems due to unfamiliarity and perceived workflow disruptions.

Cost-effective training models also show promise for addressing capacity-building challenges in resource-limited settings. Mobile-based microlearning platforms can deliver bite-sized learning modules that support offline functionality and provide multilingual content suitable for Nigeria’s diverse healthcare workforce.20 Continuing Professional Development (CPD) that is provided through mobile devices can support workplace-based practical training, reduce in-person instruction time, support social peer learning, and allow programmes to reach a greater number of providers, especially those practicing in remote locations.21 Virtual training is affordable and can be easily adapted as new information is discovered to update providers with the latest information and clinical developments.22-24 Furthermore, virtual CPD that is provided through mobile technology has demonstrated high feasibility and acceptability among healthcare providers in Low-and-Middle-Income-Countries (LMIC) settings.20

Policy and regulatory challenges

The absence of comprehensive national EHR policies or guidelines in Nigeria and many sub-Saharan African countries remains a significant barrier to EMR adoption. Limited financial incentives, fragmented implementation efforts, and inadequate political will have left even available EHR systems dependent on unsustainable foreign funding.25,26 Moreover, policy implementation also varies regionally,8 with some state governments initiating standalone EHR pilots in tertiary hospitals, while others lack any digital health strategy at all. These fragmented efforts create inconsistent user experiences and complicate interoperability. This lack of cohesive policy and funding framework greatly complicates the effective implementation and utilisation of EHR systems. In addition, data security and privacy concerns pose critical barriers. The absence of robust laws to protect patient information creates an environment of mistrust among patients and healthcare providers, deterring the adoption of EHR systems.19,27

Beyond their individual impact, these barriers are deeply interconnected and mutually reinforcing. For example, weak policy guidance and fragmented governance structures contribute to underinvestment in digital infrastructure, while the lack of reliable infrastructure disincentivises long-term policy planning and training investments. Institutional inertia, characterized by limited stakeholder coordination, inconsistent funding mechanisms, and weak accountability, further entrenches these challenges and prevents sustained progress over time. As highlighted by Babatope, Adewumi28, and Onyeabor, Onwuasoigwe,29 systemic fragmentation, lack of ownership by local institutions, and unclear roles between federal and state actors have severely limited progress. This emphasises the need for integrated strategies that recognise the complex interplay among technical, organisational, and environmental forces affecting EHR adoption.

Comprehensive strategies to overcome EHR adoption challenges in Nigeria

Addressing EHR adoption challenges in Nigeria requires multi-faceted strategies. Investments in alternative energy sources, such as solar power, and low-energy devices can reduce the impact of unreliable electricity,30 with the UNDP noting that health facilities using solar energy can recoup their investment in 2–5 years.31 The Nigerian government, in partnership with the private sector, should prioritise investments in solar power for healthcare facilities, with short-term implementation focused on urban areas and long-term expansion to rural regions.32 In addition, healthcare institutions and professional bodies should initiate peer mentoring programmes, starting with EHR champions in tertiary hospitals and gradually extending to primary health centres. To complement these efforts, offline-capable EHR systems with data synchronisation features, along with partnerships with multiple internet providers, can bridge connectivity gaps. Financial challenges can be alleviated through open-source EHR solutions, government subsidies, and public–private partnerships. Meanwhile, comprehensive training programmes ensure that healthcare workers have the technical expertise to use these systems effectively, and a unified national regulatory framework is essential to guarantee interoperability and scalability.33

Overcoming training and resistance challenges is equally critical for successful EHR adoption in Nigeria. Structured EHR training programmes integrated into medical and nursing curricula can build digital literacy among future healthcare professionals.34 For current staff, continuous professional development initiatives, such as workshops and certification programmes, should focus on practical, hands-on training tailored to varying proficiency levels. Peer mentoring programmes, drawing on the expertise of experienced users, can boost confidence among hesitant staff, while robust change management strategies (such as stakeholder engagement and demonstrating workflow benefits) help facilitate the transition from paper-based systems.35,36 Performance-based incentives further encourage adoption and reinforce sustained use of EHR systems.

Building a supportive policy framework is also vital to ensuring the success of EHR adoption efforts in Nigeria and Sub-Saharan Africa.18 Governments must prioritise developing cohesive, standardised policies and guidelines that align with global best practices, complementing on-the-ground training and infrastructure improvements. Financial incentives, such as subsidies or tax relief for healthcare facilities, can ease the economic burden of implementation. To ensure sustainability, fostering local investments and partnerships can reduce dependency on foreign funding.25 At the same time, robust privacy laws are essential to address data security concerns, instilling trust among patients and healthcare providers, and reinforcing the foundation for successful adoption.

Case studies of EHR adoption in Africa

Despite growing interest in EHR implementation across subSaharan Africa, several efforts have encountered substantial setbacks. In Nigeria, many initiatives have faltered due to poor stakeholder alignment and a lack of sustained funding, leading to systems being abandoned shortly after pilot phases. As shown in Table 1, various short- and long-term strategies have been identified to overcome these barriers and guide more sustainable EHR adoption. For instance, partially implemented systems in public hospitals have remained underused due to unclear maintenance responsibilities and staff turnover. Similarly, in Ghana and Uganda, studies report that while donor-funded systems initially succeeded, long-term sustainability was undermined by a lack of local ownership and integration into national health strategies.25,37 These experiences highlight the importance of institutional commitment, long-term financing models, and adaptive implementation strategies tailored to evolving local needs.

Table 1: Prioritised Strategies for EHR Adoption in Nigeria.
S. No. Challenge Specific problem Proposed strategies Responsible stakeholder Implementation cost (USD) Monitoring indicator Timeframe
1. Infrastructure Unreliable electricity and internet access. Deploy offline-capable EHR systems with data synchronisation. Nigerian Government, EHR vendors, Healthcare facilities $10,000 - $50,000 per facility (for system setup) Number of facilities with offline EHR systems; system uptime Short-term
Connectivity gaps in rural areas. Partner with multiple internet providers to improve connectivity. Nigerian Government, Telecom providers, Healthcare facilities $5,000 - $10,000 for initial partnerships Increased internet connectivity in rural areas; internet speed performance Short-term
Frequent power outages and cost of electricity. Invest in solar power and low-energy devices for health facilities. Nigerian Government, Solar energy companies, Healthcare facilities $15,000 - $30,000 per facility Percentage of healthcare facilities with solar power; cost savings on electricity Long-term
High financial burden for EHR implementation. Promote public-private partnerships to reduce costs. Nigerian Government, Private Sector Partners, Healthcare facilities $100,000 - $500,000 (depending on facility scale) Number of partnerships formed; amount of funding secured Long-term
2. Training and Capacity Building Limited digital literacy among future healthcare professionals. Integrate EHR training into medical and nursing curricula. Ministry of Health, Academic institutions Varies (dependent on curriculum integration) Number of students trained in EHR; curriculum updates completed Long-term
Variable computational skill levels. Conduct workshops and certification programmes for current staff. Healthcare institutions, EHR vendors and training providers $500 - $2,000 per workshop Number of healthcare workers certified; participant feedback Short-term
Resistance to transitioning from paper systems. Develop peer mentoring programmes for hesitant staff. Healthcare institutions, Senior healthcare providers $1,000 - $5,000 per programme Number of peer mentors trained; adoption rate of EHR by mentored staff Short-term
Lack of motivation for EHR adoption. Provide performance- based incentives to encourage adoption. Healthcare institutions, the Nigerian Government Varies based on the incentive model Percentage increase in EHR adoption; staff participation in the incentive programme Short-term
3. Policy and Regulation Fragmented implementation and lack of political will. Establish cohesive, standardised national EHR policies and guidelines. Nigerian Government, Ministry of Health N/A Policy drafts reviewed; stakeholder engagement meetings Long-term
Economic burden of EHR systems. Offer financial incentives, such as subsidies or tax relief, to healthcare facilities. Nigerian Government, Taxation authorities Varies (subsidy/tax relief costs) Number of facilities receiving incentives; financial savings reported Short-term
Data security concerns and patient mistrust. Strengthen privacy and data protection laws to build trust. Nigerian Government, Data Protection Agencies N/A Data protection laws drafted; public awareness campaigns conducted Long-term
Unsustainable foreign funding for EHR systems. Foster local investments to reduce dependency on foreign funding. Nigerian Government, Local investors, Healthcare facilities Varies based on funding models Number of local investors engaged; amount of local funding secured Long-term

This summarises short-term and long-term strategies to address the challenges of EHR adoption in Nigeria, aligning each solution with its corresponding problem to offer a prioritised framework for action. EHR: Electronic health records, N/A: Not applicable

Rather successful regional case studies from Rwanda by Chizyuka, Crawford38 highlight the government’s critical role in integrating EHR systems into their cervical cancer screening national health strategies. By prioritising cervical cancer screening as a national health objective, the government ensured the programme’s alignment with broader health initiatives, enhancing its relevance and sustainability. The Ministry of Health actively engaged healthcare providers, programme managers, and other stakeholders in the design and rollout of the system, ensuring that it met local needs and was contextually appropriate. Similarly, Fraser and Mugisha39 describe how the Rwandan government incorporated an EHR system into its national human immunodeficiency virus care strategy, supporting its rollout across over 300 health facilities by leveraging public health infrastructure. This comprehensive approach addressed key challenges in implementation and scaling. In addition, a study from Kenya demonstrates the collaborative implementation of an EHR system by consultants in Kenya, developers in India, and project stakeholders.40 This effort involved upgrading hospital IT infrastructure, training users, and fostering administrative and clinical buy-in at several public hospitals in a rural county.

While the above examples provide valuable insights, Nigeria’s federal system notably presents different challenges and opportunities compared to Rwanda’s centralised approach.39 Nigeria could adapt successful elements through state-level pilot programmes that demonstrate feasibility before national scaling, federal coordination mechanisms that maintain standards while allowing state flexibility, gradual integration with existing health programmes rather than wholesale system replacement, and a recognition that Nigeria’s size and complexity require longer implementation timelines and more flexible approaches than smaller, more centralised countries.

Even now, by drawing insights from these examples, Nigeria can develop a tailored and effective framework for EHR adoption that addresses its unique challenges.

Ethical, privacy, and cultural considerations in EHR adoption in Nigeria

The adoption of EHRs in Nigeria and broader sub-Saharan Africa presents several ethical and privacy challenges. Central to these concerns is patient consent and data protection.41 Informed consent is essential, as patients must be made fully aware of how their personal health data will be used, stored, and shared. In Nigeria, however, the absence of a robust data protection framework creates significant barriers to ensuring that patient information remains confidential and secure.18 Without strong legal safeguards, patients may be reluctant to trust EHR systems, fearing misuse of their sensitive information. To address these issues, healthcare facilities must ensure that patients are not only informed but also empowered to make decisions about their health data. This includes integrating clear, understandable consent processes and enhancing data protection practices such as encryption and secure data storage.

Another critical factor is digital trust in health systems.42 In countries like Nigeria, where digital infrastructure is still developing, scepticism regarding the security and reliability of EHRs is widespread. Patients and healthcare providers may resist the transition from paper-based records due to concerns about data breaches, the lack of transparency in data management, and the unfamiliarity with new technologies. To foster digital trust, it is essential that healthcare providers actively engage patients, explaining the benefits of EHR systems and the measures in place to protect their data.

Moreover, Nigeria’s limited legal framework on data security poses significant challenges for EHR adoption. While global standards like the European Union’s General Data Protection Regulation provide a model for protecting health data,43 Nigeria’s healthcare data protection laws are still in their infancy. The lack of cohesive national regulations compromises data security and hinders the scalability and sustainability of EHR systems. There should be a short-term focus on developing a comprehensive legal framework that establishes clear data protection standards and promotes digital health initiatives that align with international best practices.

Limitations

This study has several limitations. First, the geographic scope was limited to selected regions, which may not comprehensively reflect Nigeria’s diverse population, especially considering differentiation across primary, secondary, and tertiary levels of care. Second, the data on private sector EHR adoption remain limited, potentially underestimating overall adoption rates. Finally, the rapid evolution of digital health technology means that some infrastructure discussed may change as technology advances and becomes more affordable.

CONCLUSION

The adoption of EHRs in Nigeria’s healthcare systems faces a range of challenges, including significant infrastructure, policy, and capacity building challenges. While these barriers are substantial, they are not insurmountable. A coordinated approach involving government investment in infrastructure, comprehensive healthcare workforce development, of robust regulatory frameworks is essential. Specifically, the Ministry of Health must lead in policy formulation and resource allocation, donors should prioritise sustainable funding models, and IT firms must develop contextually appropriate and affordable EHR solutions. Success in implementing EHRs could transform the delivery of healthcare in Nigeria, improve patient outcomes, and ultimately contribute to a more efficient healthcare system.

Ethical approval:

Institutional review board approval is not required.

Declaration of patient consent:

Patient’s consent is not required as there are no patients in this study.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship: Nil.

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