The ACCESS Health Philippines team was recently invited to speak at the Digital Strategies for Development Summit. The summit provided an opportunity to share and learn about information and communications technology (ICT) solutions that address emerging challenges in education, employment, gender equality, agriculture, social protection, and healthcare. At the summit, high level policymakers, regulators, members of the private sector, academia, and regional and international development partners engaged in dynamic discussions, sharing experiences and best practices in information and communications technology.
In this blog post, I discuss some of my observations from the summit, as well as a few main points from our own presentation.
Information and Communications Technology Is Key to Achieving Universal Health Coverage in the Philippines
Universal health coverage (UHC) ensures that good quality health services are available to all people in need, without the risk of financial hardship. Universal health coverage is a critical element to achieving inclusive growth, sustainable economic development, health security, and social protection. The World Health Organization (WHO) has declared universal health coverage to be the “single most powerful concept that public health has to offer.” The concept has been widely embraced by governments in Asia and the Pacific.
In the Philippines, individuals bear a high burden for the cost of healthcare. Millions of people are driven into poverty due to high out of pocket expenditure and their inability to pay for the care they need. According to a 2015 study by the World Bank, out of pocket expenditure in the Philippines increased by 150 percent from 2002 to 2012.
The Department of Health universal healthcare strategy for 2011-2016 puts a special focus on financial risk protection through the expansion of the national health insurance program, commonly known as PhilHealth. Benefit delivery, member enrollment, and improved access to high quality hospitals and healthcare facilities are the main pillars of the PhilHealth universal health coverage strategy. The Philippine government is committed to reducing the financial burden and improving the quality of healthcare services.
To achieve this goal, the government must make the health system more efficient and effective. In recent years, the Philippines has mobilized additional resources through sin taxes, taxes on alcohol and tobacco. PhilHealth is now looking at how to use those resources to ensure wider social protection. Information and communications technology, or eHealth solutions, can be used to maximize coverage, reduce waste, and provide better quality healthcare at a lower cost. The government has successfully established an eHealth program management office to coordinate several sectors: health, social protection, finance, and planning. The government has trained staff to meet internationally recognized standards in each of these sectors and to use enforceable key performance indicators. This effort has helped PhilHealth detect inappropriate hospital admissions with the use of the shared electronic health records. Information and communications technology can enhance health system performance in many other ways as well, such as through health information systems, drug logistics management information systems, corruption and fraud monitoring, patient monitoring, disease surveillance, and tracking population health indicators.
Information and Communications Technology for Everyone?
The information and communications technology revolution has created opportunities to strengthen the Filipino healthcare system. Paper based membership registrations with PhilHealth have now been digitized. Digitization allows access to data that was previously time consuming and expensive to compile. Without these new technologies, recent achievements for PhilHealth – increasing coverage to ninety percent and decreasing delays in claim reimbursements – would have been impossible.
I am fascinated by how technology has evolved and what it can do for us. In higher income countries, almost everyone has access to a broad range of these innovations. Information and communications technology in healthcare has become an important component of a well functioning healthcare system. This technology can improve the flow of information, through electronic means, to support the delivery of quality and equitable healthcare services and management of health systems. Today, information and communications technology manages everything from hospital admissions to drug procurement. This technology also allows a doctor in an urban area to attend to a patient in a rural area several hundred miles away. Devices can measure our blood sugar, strengthen compliance of treatment for tuberculosis patients, and manage enormous volumes of national health data. These new technologies can be transformative, but what happens to the majority of the world’s population that does not have access to this technology?
I am always impressed and inspired by the technologies presented at conferences like the Digital Strategies for Development Summit. Yet, in my own work, I have visited many healthcare facilities, in rural and urban areas, where I confront a far different reality. Most urban and local health stations lack not only internet, but even basic hardware. It is not unusual to find healthcare facilities in rural areas that don’t have electricity. The reality is that only those who can afford private health insurance can access the benefits of new information and communications technologies.
The Philippines has the slowest internet connectivity speed in Southeast Asia, and among the slowest in the world. Aside from the lack of needed infrastructure, the main reason for the relatively low uptake of information and communications technology in the Philippines can be attributed to the high cost. According to a report from 2014, only thirty six percent of the population in the Philippines can access the internet. Access and usage are unevenly distributed across different age groups. Almost fifty percent of people below the age of thirty use the internet, but for those in their forties, this figure is less than thirteen percent. Only four percent of Filipinos fifty and older use the internet.
Due to poor internet penetration, the use of information and communications technology to achieve universal health coverage in the Philippines has been limited to national level efforts. Even those with access do not derive maximum benefit from technology, because of poor data quality and lack of data use.
This reality – this moment of opportunities, but also challenges – leads to many questions: How can countries like the Philippines benefit from advances in information and communications technology without the most basic infrastructure? How do we ensure an equitable distribution of the innovations in healthcare? How do we promote a reasonable information and communications technology strategy for universal health coverage?
We need a coordinated effort from the government to address these constraints. Limitations in access and data quality threaten to increase the technology gap between the national and regional levels, and private and public healthcare services. The Philippines needs to revise existing policies and develop appropriate strategies to improve the use of information and communications technology. The privacy acts in the Philippines are a major road block. Legislation needs to be revised to allow the government to collect important health data from its citizens and to use the data for knowledge based decision making. We also need a coordinated plan to build out the eHealth infrastructure in rural and remote areas. The government needs a national strategy to provide internet connectivity to all health centers, which would allow the centers to make use of existing electronic medical health records. Advances in technology will continue to marginalize health workers in lower income countries – especially those workers living in remote areas – if a coordinated government plan is not put in place.
A Summit to Share Challenges and Solutions
The summit aimed to cover many of key questions related to technology in the health sector and how technology policy can advance universal health coverage. Summit participants explored how technology can best be used to help bridge the information divide between health professionals and the communities they serve, and between the producers of health research and the practitioners who need it. Summit sessions looked at existing policies and infrastructure and tried to devise a common solution to their limitations. Discussion at the summit shed light on the need for partnerships. Summit participants examined how to improve the ability of consumers of health and social protection services to interact digitally.
We Identify, Document, and Evaluate Innovative Best Practices in Healthcare
The challenges and opportunities in information and communications technology touch our own work, particularly in the Philippines. As an organization, ACCESS Health identifies, documents, and evaluates best practices in healthcare. Many of the strategies we study use innovative information and communications technology approaches. We need better ways to capture data and perform robust analytics so that we can understand what works and how it works. Access to this information will help us replicate the best features of a healthcare program in new contexts. ACCESS Health has facilitated discussion between the private and public sector on ways to deploy the right kinds of technology – technology that is easy to use and efficient – in urban primary care settings. By documenting best practices, we make it possible to share technology innovations that can easily be adopted by medical staff and healthcare workers in different contexts.
The collection of data to inform decision makers has proven to be difficult and time consuming in the absence of a solid information and communications technology system. We saw that health workers in the Philippines had trouble accessing reliable data, so we created an eHealth initiative called the e-AKaP Project. The project facilitates the collection of health data for community health workers. e-AKaP is a Tagalog acronym that stands for “e-Action for Universal Health Coverage.”
The e-AKaP Project trains and equips frontline community health workers in the Philippines with mobile applications and tablets to help monitor and communicate information to expectant mothers and their families. The e-AKaP Project aims to address many of the daily challenges facing community health workers. The e-AKaP mobile application expedites the development of individual household profiles and creates individualized health use plans for each household member. The application delivers targeted multimedia health messages and helps workers manage follow up and tracking of household members’ progress. The e-AKaP Project also facilitates electronic reporting on the health status of households to the City Health Office, healthcare facilities, and national government offices. Because of poor internet connectivity in the Philippines, the e-AKaP Project uses a web and mobile application that automatically stores and forwards information without an internet connection. An internet connection is only needed when the data is synchronized to a cloud based server. The e-AKaP Project automatically generates reports that decision makers can readily use.
At the summit, we also discussed our work with the Joint Learning Network for Universal Health Coverage (JLN). The Joint Learning Network is a community of practitioners and policymakers from ministries of health and national health financing agencies from twenty two countries. The goal of the Network is to bridge the gap between theory and the “how to’s” of achieving universal health coverage. We identify common challenges to health system reforms and work jointly on solutions in five technical areas, including information technology. We help Network members build on their experience to experiment and produce useful new knowledge and tools. One such tool was the book produced by the Network on how to connect health information systems for better health. The book is a practical guide for how countries can use available resources to develop a national eHealth standard framework and create interoperability standards to link patients, provides, payers, and policymaker data. We believe that the national eHealth architecture and related policies must be driven by the interest of each country. Their citizens and the policymakers participating in the Network are in the best position to make those decisions. Our goal is to facilitate a dialogue and unpack some of the complexities in the development and implementation of an eHealth system. We provide a way for countries to use this information to start designing their own eHealth strategies, based on examples from countries that have already overcome some of the challenges of implementing a well functioning eHealth strategy.
We also presented our work with the Center for Health Market Innovations (CHMI). The Center is a website where people can learn about and connect with programs that strive to improve the health of the poor. On the website, we have listed more than 1,400 innovative health enterprises, nonprofits, public private partnerships, and policies. Many of these programs focus on strengthening eHealth. The Center identifies good practices that can be scaled up or adapted in other countries. The Center connects people implementing promising programs to funding.
The experiences of ACCESS Health have taught us that information and communications technology can be used to advance progress toward universal health coverage. An evaluation of our eAKaP Project demonstrated not only that using eHealth solutions will reduce the cost of health data collection but eHealth also increases transparency and accuracy and saves valuable time for community health workers. The Joint Learning Network and the Center for Health Market Innovations are providing tools for those within government and the private sector to advance eHealth. These efforts are driving progress, but without a coordinated investment from the government, it will take many years before eHealth solutions are widely accessible to the majority of the population in lower income countries.