Advancing Health Informatics in the Philippines

In a funny coincidence, I was having problems accessing the internet the whole week doing this. I'm not sure if it was the rainy weather or just our service provider being consistently inconsistent - which is somewhat related to this topic.

How can we advance health informatics in the Philippines? This is the guiding question for this week. To understand what needs to be done, we have to know what has been done. Unfortunately, there isn’t much to go on. Sources are scarce, and many of them are outdated.

In 2014, the DOH drafted a strategic plan for the advancement of eHealth of the country, with its main goal being “Kalusugan Pangkalahatan” or universal health care. This means that health care of the best quality is available for all Philippine citizens regardless of economic and social standing or geographical location. I’ll only be covering certain key components that the plan focuses on and relate it to the problems that I was able to read on.

The eHealth Solutions are the innovations in the field. In this respect, a good number of projects have already begun. The National Telehealth Center, based in U.P. Manila is a vanguard in this regard, with pilot projects like the Community Health Information Tracking System (CHITS) that started in 2004 and the RxBox. Meanwhile, the DOH has begun the Nationwide Unified Health Management System, which is planned to include systems such as the National Health Directory, National Electronic Injury Surveillance, Electronic Essential Drug Price Monitoring, Health Facility Database, Hospital Reporting, Organ Donor and Recipient Registry, and many more. While many of these projects are already finished with testing and are on the implementation phase, there is still a limited number of participating health care facilities. As of May this year, only 95 facilities that report to DOH’s ICLINICSYS, when there are over 1000 hospitals in the country. While time is required for the innovation to spread, what other factors can help improve its chances of being adopted by all facilities around the country?

The starting point is by having plans and this requires political action. Our legislative and governing bodies in regards to information and computer technology (ICT) is unfortunately lagging behind the rate new technologies are becoming available to us. The country’s Network Readiness Index factors in effectiveness of law-making bodies and the laws relating to ICTs score 3.46 and 3.96 out of 7 respectively, which is average, ranking us 73 and 78 out of 166 countries studied respectively. Other political indicators like efficiency of the legal system in settling disputes and intellectual property protection do not fare any better.

For the plan to be implemented, money is needed. Back in 2010, the total health expenditure of the country was 4.1% of the country’s GDP which is lower than the recommended cost of health authorities of 5%. 40% of it was covered by the government, while 48% was still out-of-pocket. It becomes clear that these projects  are something the government can’t shoulder alone. Partnership with the private sector is important because majority of the health facilities and health professionals work for them. This isn’t anything new as the private sector has collaborated in the management of health facilities previously run by the government. 

What needs to be done is to improve relations between the health professionals, law-makers, governing bodies, and the private sector. We need to identify and communicate with important stakeholders that can be seen as opinion leaders. Opinion leaders are described as individuals that “promote new innovations by influencing the opinions of others.“ These people can be members of these sectors or even not, like celebrities.  A personal form of communication can be more effective to speak to these stakeholders. Now that we have the internet and social networking sites like Facebook, this is much easier. Conducting awareness activities like fora, summits, and even advertisements can also inform them of these projects. With the help of these opinion leaders, it will be easier to get the political and financial backing to implement these projects nationwide.

On the other hand internet availability leads to the next issue - infrastructure. In order for widespread implementation, we need good network infrastructure. Sadly, this far from the truth. Only 13% of total households have computer access and 37% can access the internet. The only positive side is that mobile phone subscriptions are over 105%, although only 15% of phone sales are smart phones. With the help of the private sector (such as telecommunication, cell phone, computer companies) and stronger political backing, this can be improved, but it will take some more time to build.

Lastly there is a severe lack of health workers to use these innovations. For every 10,000 Filipinos there is 0.05 nurses and 0.63 doctors. Also, 62% of health professionals practice in Luzon, majority of them in urban areas. This is unfavourable for citizens who need health care the most - people who live in far-flung areas. Training and education of these health workers are not enough. More individuals not necessarily experienced in health care can be trained to take some of the load off of them. Since many of these applications and equipment are designed to be easy to use, a simple training program can be designed to equip even laypeople to effectively utilise them. These people can be locals in remote areas, and through networking, they can contact health care specialists who are far away.

As I said before, reaching the goal of universal health care will take a while. DOH’s  estimated year to accomplish this is 2020, which I think is pretty ambitious (good for them for aiming high). Hopefully, with a lot of hard work and cooperation, we will get there sooner rather than later.

Sources:

1. Infographic: 10 Years of CHITS. (2014). Retrieved from National Telehealth website: https:// telehealth.ph/2014/09/17/10-years-of-chits-infographic.
2. Integrated Clinic Information System (ICLINICSYS) Number of Reporting Facilities per Region and Province for May 2015. (2015). Retrieved from Department of Health Unified Health Management Information System website: http://uhmis.doh.gov.ph/reports/list-of-reporting- health-facilities/370-iclinicsys-reporting-facilities-may-2015.html.
3. J.R. Albert and R.E. Gaspar. What do ICT stats say about the Philippines?. (2015). Retrieved from Rappler website: http://www.rappler.com/thought-leaders/90584-ict-statistics-philippines.
4. M.E.B. Herrera, F.L. Roman, M.C.I. Alarilla. Overview of Health Sector Reform in the Philippines and Possible Opportunities for Public-Private Relationships. Retrieved from Asian Institute of Management website: www.aim.edu/files/download/131.
5. N.S. Sabornido. Health Sector Budget: an Analysis. (2013). Legislative Budget Research and Monitoring Office Budget Facts & Figures Vol. 1. Retrieved from Senate of the Philippines website: http://www.senate.gov.ph/publications/LBRMO%202013-02%20Budget%20Facts.pdf
6. Philippines eHealth Strategic Framework and Plan 2013-2017. (2014). Retrieved from the Department of Health website: http://www.doh.gov.ph/sites/default/files/Philippines_eHealth StrategicFrameworkPlan_February02_2014_Release02.pdf.
7. RxBox Sites. Retrieved from RxBox website: https://rxbox.chits.ph/rxbox-sites.