As an archipelago of more than 7000 islands, and a high level of social media engagement and an internet-literate population, the Philippines is looking to e-health to help it meet its goal of achieving universal health coverage. For the government, technology is a way to streamline the management of devolved health systems and improve health care delivery in rural areas by providing remote clinics, which often lack the necessary equipment and specialist expertise, with new ways to assess and test patients. E-health also gives patients themselves the opportunity to consult medical professionals through their smartphones and the internet, which means they no longer need to rely solely on health care providers for information.
Despite a concerted national effort, the country has yet to make serious progress in developing and expanding e-health services to its citizens. “It is a kind of dark ages,” Hugh McClung, CEO of telemedicine firm MyDocNow, told OBG. MyDocNow has found uptake for its diagnostic call-services far slower than anticipated, largely due to the fact that patients, doctors and clinics have been reluctant to adopt the technology, McClung said.
Part of the problem is the speed of internet services in the country. Internet connectivity in the Philippines is among the slowest in the world, and expensive, too. The average connection speed in the country was 4527 Kbps, with only 30.8% coverage of 4-Mbps broadband and 7.5% for 10 Mbps at the end of 2016, according to US-based content delivery services firm Akamai’s State of the Internet index. Although this is an improvement over the first quarter of 2008, when internet speeds averaged 975.9 Kbps, it is still not up to par. According to data from the Philippines’ Globe Telecom, while there are 119m mobile phone subscriptions, leading to a penetration rate of 117% for a population of 101m people, the majority of subscribers are on pre-paid plans.
Moreover, many clinics simply do not have the necessary infrastructure to support e-health services. “Most urban and local health stations lack not only internet, but even basic hardware,” wrote Vera Siesjö, Philippines’ country manager for New York-based non-profit think tank ACCESS Health International, which is working on a number of e-health-related projects in the Philippines, in a 2015 update for the group. “It is not unusual to find health care 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.”
In 2010 then-President Benigno Aquino III declared technology to be one of six strategic instruments necessary to achieve universal health care, and he followed up with the Philippine eHealth Strategic Framework and Plan (PeHSFP) in 2014, which set out a roadmap for the country’s digital health policy up to 2020. The PeHSFP aims to create a unified health management information system for the Philippines and leverage existing technology to provide more effective medical care and better access to health services for patients across the archipelago nation. The initiative is guided by the Philippine eGovernment Master Plan, which is designed to link government databases and public sector IT systems, and is supported by new legislation designed to reassure patients and medical professionals concerned about privacy and security. The Cyber Crime Prevention Act of 2012, signed into law in 2015, was the first comprehensive law to address crime committed online, and the Data Privacy Act of 2012 addresses protection of consumer data, among other things.
Under its eHealth Vision the government expects that “by 2020, e-health will enable widespread access to health care services, [and] health information, and securely share and exchange client’s information in support of safer, quality health care, [and a] more equitable and responsive health system for all the Filipino people by transforming the way information is used to plan, manage, deliver and monitor health services.”
The five-year National Teleservice Health Programme, a joint Department of Health (DoH) and National Telehealth Centre initiative, was set up to allow primary care professionals in some of the Philippines more remote areas to work with specialists at the Philippine General Hospital. Some 350 municipal officers and participants in the DoH’s Doctors in the Barrios programme are now using telemedicine services.
Another DoH programme, the R4 Health initiative, enables the collection and monitoring of a range of health data, including maternal and child health, giving the government the means to better allocate funds and resources to meet challenges. The new administration of President Rodrigo Duterte continues to see technology as a way to address persistent problems with record keeping and data collection. The more regular collation of data enables health planners to improve health systems management and better prepare for emerging threats. Benjamin K Liboro, president of the Asian Eye Institute, told OBG, “Technology adoption is crucial in health care meeting the rising demand for quality care and increasing efficiency. Likewise, technology allows for treatments to be delivered at a lower cost, which is crucial for accessibility.”
Among other initiatives, at the Health Summit in Pasay City in September 2016, Paulyn Jean B Rosell-Ubial, secretary of health, detailed plans for regular online data submission to be made a requirement for licensing, and contracting health facilities and drug outlets. The use of electronic medical records will also be mandated in all health facilities, and all major business processes will need to be automated. The authorities will also invest in nationwide surveys, administrative data and disease registries, and allow open access to anonymised data for researchers.
Private organisations are assisting in efforts to meet that goal. ACCESS Health International has been working with the Philippine government to improve the collection of reliable data for community health workers through the e-AKaP project – e-AKaP is the Tagalog acronym for e-Action for Universal Health Coverage. The app automatically stores and forwards information, only requiring an internet connection when the data is synchronised to a cloud-based server. Via the e-AKaP project, ACCESS Health International will equip and trains frontline community health workers with tablets loaded with mobile apps to help monitor and communicate information to expectant mothers and their families. The technology allows a health worker to develop a profile for each household and create individual health plans for each person, making it easier for health workers to track their progress and follow up on their patients’ needs. Other features include multimedia health messages and a task manager for each individual patient. The project also facilitates electronic reporting on the health status of households to the local City Health Office, health care facilities and national government offices by automatically generating reports that decision makers can use.
RxBox is a telehealth system, often referred to as “life saving diagnostics in a box”, developed by the National Telehealth Centre at the University of the Philippines and funded by the Department of Science and Technology, which is helping improve health care in disadvantaged and geographically isolated communities. Initiated in 2012, it is linked to the Community Health Information Tracking System (CHITS), the country’s oldest and most comprehensive electronic medical record database. The system can be used to store patient records and for referral purposes. The CHITS uses standard medical terminology and adheres to the World Health Organisation’s standards for health informatics. The locally developed kit includes a blood pressure monitor, a pulse oximeter to measure oxygen levels in the blood and detect potential respiratory or cardiovascular issues, an electrocardiogram, a foetal heart monitor, a maternal tocometer for use during labour and delivery and a temperature sensor. About 1000 RxBoxes have been delivered to rural health centres in the south of the country.
Beyond the Philippines’ remote communities, technology is also transforming the drug and pharmaceuticals retail market, with the growth of online pharmacies attracting the attention of some of the country’s biggest conglomerates. The Ayala Corporation, which holds a 50% stake in generic drugs pharmacy Generika, recently took a minority stake in Wellbridge Health, a domestic start-up company that operates an online pharmacy known as MedGrocer, which sells medicines approved by the Philippines’ Food and Drug Administration. Through its Globe Telecom unit, Ayala also runs a medical hotline service in a joint venture with Mexico’s Salud Interactiva. In February 2017 Paolo Borromeo, chief executive of Ayala’s health unit AC Health, told local media that the firm was “looking to build a portfolio of innovative technology solutions across the continuum of care.”
International investors are also seeking opportunities within e-health. MyDocNow is a telemedicine initiative that aims to give the country’s poorest an opportunity to consult a doctor using a medical platform that has proven successful in the US in areas with poor internet access or even no access at all. MyDocNow leverages the country’s successful call centre business, and uses the same model to connect patients with trained nurses. The firm has been able to overcome technological hurdles by use of text messages, with the initial message being forwarded to a nurse, and audio calls in which patients can be connected with a doctor. Recognising the difficulty poorer people find in paying cash for medical services, MyDocNow also includes a health plan under which members can put aside a small amount each month, as well as a programme that will provide loans for emergency procedures. Despite the slow start, McClung remains confident that there is plenty of potential for telemedicine in a country where about 70% of people die without ever having seen a doctor.
Health maintenance organisations (HMOs), which are regulated by the Insurance Commission and provide access to a wide range of health care services to members, depending on the fees paid and the package bought, are also providing solutions. Medicard, an HMO, has more than 448,000 members and accreditations with some 8000 doctors, specialists and dentists. The firm has also experimented with technology, setting up a teledoctor service in conjunction with an IT company. Even though the HMO had 100,000 subscribers, the service received just 100 calls in the last four months of 2016. In the long run, the success of e-health initiatives, along with efforts by the private sector, will depend largely on whether the government can improve internet infrastructure to provide service that is fast and reliable. Duterte’s administration has promised to ramp up connection speeds and reduce red tape for telecoms firms that want to set up cell sites to fuel the expansion of mobile networks. The government also plans to establish a nationwide wireless network, focused on poor and remote areas, and plans to have at least 100,000 sites by 2026 (see Telecoms & IT chapter).