ICT and universal healthcare in the Philippines

As chairman of the Zuellig Family Foundation I hosted the annual Health Outlook Forum last month. One of the facilitators of the break out session on “ICT in Health” was Dr. Emmanuel C. Lallana, CEO of ideacorp. Secretary Ona considered this topic one of the most significant items he would focus on during his incumbency. With that in mind, I invited Dr. Lallana to write this guest column.

In the Second Philippine Health Outlook Forum 2010, Health Secretary Dr. Enrique Ona underscored the important role that Information and Communications Technology (ICT) would play in achieving universal health care in the country. This is a welcomed development as, globally, ICT is increasingly seen as critical in addressing global health needs. As noted by the WHO in Essential Health Technologies Strategy 2004-2007, “Health technologies are the backbone of all health systems. They are essential tools in solving health problems”.

ICT for health

While ICT is not a miracle cure, its potential to transform almost every aspect of the health sector makes it an attractive tool for those interested in reforming the sector. In Improving Health, Connecting People, a study by Healthlink Worldwide, AfriAfya and the Institute for Sustainable Health Education and Development, the following are identified as benefits of using ICT:

• improved dissemination of public health information and facilitated public discourse and dialogue around major public health threats;

• remote consultation, diagnosis and treatment through telemedicine;

• collaboration and cooperation among health workers, including sharing of learning and training approaches;

• more effective health research and the dissemination and access to research findings;

• enhanced ability to monitor the incidence of public health threats and respond in a more timely and effective manner; and

• improved efficiency of administrative systems in health care facilities.

ICT is particularly useful in our public health sector, where improved information management and communication processes could dramatically improve healthcare. For example, the Department of Health (DOH) would be better able to allocate its limited resources more effectively and efficiently if it uses ICT-based Health Information Systems and Decision Support Systems.

ICT can also help deliver health and other related services faster. Take for instance, the servicing of health insurance claims/reimbursements. PhilHealth’s ability to quickly reimburse claims will be enhanced by an ICT application that links accredited hospitals to PhilHealth.

Using ICT as a channel to ‘remotely’ deliver health information and service would improve the penetration of basic health services across the country. Telemedicine — the use of ICT to deliver a clinical “presence” in remote health services — and mHealth – the use of mobile technology, such as mobile phones and SMS, for health services and information – are not just ideas but realities.

A good example of mHealth is the Red Cross’ use of SMS in fighting cholera outbreak in Haiti.   Twice a day, residents at the epicenter of that country’s cholera outbreak receive this message (in creole): Drink ORS (oral rehydration solution) to treat diarrhea. One liter of treated water, eight teaspoons of sugar, 1⁄2 teaspoon of salt.” 

The UP Manila National Telehealth Center’s (NThC) telemedicine system allows specialists based at the Philippine General Hospital in Manila to help rural doctors or health workers deliver quality health care. This Internet-based system has been accepting referrals through text messages. Its computer system receives the message and forwards them to the cell phone of the appropriate expert. The expert’s response is also usually sent back by SMS.

PPP for ICT4H

However, like any other ICT for Development project, all ICT4H undertaking in the Philippines would face constraints. These include:

• Infrastructure limitations. Not all Rural Health Units (RUHs) would have Internet access and those that do may not have a budget for an Internet subscription;

• Budget constraints.  Computers with internet connections are a rarity in RUHs. Lack of resources prevent DOH from fully implementing its National eHealth Strategic Framework; and

• Lack of ICT skills in the organization.

Clearly all these constraints need to be addressed individually. Interestingly, one approach seems to be in the “hitting several birds with one stone” category.           

The World Bank’s Health, Nutrition, and Population Family (HNP), in its Public-Private Partnerships and Collaboration in the Health Sector report, concluded that “turning to the private sector can, when appropriately structured and executed, help address specific cost and investment challenges, deliver improvements in efficiency (e.g., improved service provision and management at reduced costs), and enhance service quality (e.g., increased expertise, more rapid and substantial investments in infrastructure and new medical technologies, a potential to attract and retain better performing staff).”

As we all know, the Aquino administration champions Public Private Partnership (PPP). Secretary Ona has also expressed confidence in PPP. But it takes ‘two to tango’. Will the private sector be as enthusiastic in PPP in healthcare?

In the same forum where Secretary Ona declared the importance of ICT for health, an ICT4H group - composed of public and private sector representatives - was formed. This group was one of four 4 breakout groups organized in the forum to define priority issues and challenges to achieve universal healthcare in the country. It is a good sign for the future of PPP in healthcare that the ICT4H group members decided to extend the life of the group beyond the forum. If this group’s output is anywhere near their stated intentions, the future is bright for ICT4H PPP projects for the DOH. 

The road ahead

It is difficult to be enthusiastic about universal healthcare in the country. But, if PPP is the road to improved healthcare, and ICT is the tool to broaden the reach of health services, the Philippines may yet be on the right road with the right tool to achieve this magnificent goal.