Equity

equity

I always look forward to weekends. There is this thing they call “weekend warrior” in which people who are like this are the ones who make the most out of their weekends, and I’d like to consider myself one –  a weekend warrior. Timely as it was, my good friends from the creative side (Sino Pinas) invited me for a trip to Zambales – and it was probably one of the best weekend I had this year so far! (Blog about the trip and visual diary will be shared in a different post)

My favorite part of the trip with Sino Pinas was really the trek going back to where we parked our 4×4 cars. Not only because the weather got better that time, and most of my friends were all busy taking photographs, but I had the time to be alone, to discover some new wonders, and to get to know more about the place, and talk to our guide, Clement, who’s a local in the area. Afterall, the best part of every travel is not making everyone around you stay as a stranger.

Clement was born in the evacuation center on the year Pinatubo erupted, so he had no memory of how chaotic it was that time. But his memory of growing up near Pinatubo, and witnessing how this mess turned into a beautiful disaster was still perfectly painted in the interesting stories he shared.

Clement genuinely loves his place, which I admire a lot in our countrymen. He shared to me the challenges they have as locals living in the vicinity of Pinatubo. He shared how electricity can be difficult sometimes, especially at night, and how school is quite difficult as well to reach especially to those living in the mountains. Being a healthcare professional, I asked him questions about their access to healthcare, and I learned that the locals who reside in the mountains hardly get a visit from doctors or nurses since the nearest center is 7-8 kilometres of rocky and slippery trek away.

My heart ached as I listen to Clement, and witness first hand how it is still a long way to go foor healthcare in our country to be accessible especially in rural areas. This has always been an issue in the public health scene, and accessibility is always partnered with equity in this issue.

This is why it has always been in my greatest hopes to achieve accessibility, and equity in healthcare especially in far flung areas – although this would take a lot of effort, but committing to small actions and starting smart like learning inforamtion like this, and practicing knowledge management can be a good start.

Knowledge management as defined is a belief that increases an entity’s capacity in performing an effective action to solve an issue or problem. As this involves strategies or processes for carefully identifying and meticulously structuring organization or individual’s knowledge to create sources and solutions to a sustainable progress – relating well to achieving an equitable healthcare in rural areas.

Our knowledge for this public health issue has been very apparent for a very long time; however, management of this knowledge has not always been well utilized by our government and the people, thus solution to this issue, has always been in pending ever since. There may be researches about some rural areas in the Philippines, and it’s true that data has always been available, but there is a lack of initiative in translating these data to information, and using it as a knowledge to perform corrective actions. However, given the many contributing factor like resistance to accepting such data, lack of communicating data, lack of understanding with the recipient of information, and also external factors like our challenging archipelago being surrounded by a lot of beautiful mountains and bodies of waters, and transfer of  data or information is still limited.

Becerra – Fernandez, et all, 2014 has identified that in the use of knowledge, one has to identify its’ value for it to be utilized well by an organisation or by an individual – as such will also serve as a guide in the doing actions or solutions to these issues. In identifying such issue, a strong support from our government, with emphasis on the local government, must be committed when we speak of accessibility and equity. The collection of data and information must be started or well supported by the local government, , and data must be excellently managed by our local government.

Another issue we have about these available data that we have, is we never really talk about it – or we do, but never give much attention to it. As knowledge should be naturally transferred in every organization or individual, whether or not the process has been managed at all, but there are other underlying issues that causes the delay for this as well: 1) we choose not to care about it, or 2) our government keeps us blinded from this ugly reality.

The worst reality here is that we may have these data available, although scarce, but actions to this public health issues are very minimal too – or actions are not enough to solve the issue.

Mentioning about our archipelago as one of the contributing factors to why it is challenging to have knowledge management in our country, there are emerging technology already that can possibly resolve this – one of which is the utilization of Telehealth.

Telehealth, from its’ Greek word “tele” which means “from a distance, means managing a patient remotely with the use of technology mediated communications that will facilitate health interventions, and can also be used in the exchange of information in relation to the health delivery.

Our government is very supportive on this, as they have created House Bill 6336 or Telehealth Act of 2012 that later became House Bill 4199 or The Telehealth Act of 2014. However, it seems that there is still vagueness in it as it contradicts something in the Medical Act:

Section 10. Acts constituting practice of medicine. A person shall be considered as engaged in the practice of medicine (a) who shall, for compensation, fee, salary or reward in any form, paid to him directly or through another, or even without the same, physical examine any person, and diagnose, treat, operate or prescribe any remedy for any human disease, injury, deformity, physical, mental or physical condition or any ailment, real or imaginary, regardless of the nature of the remedy or treatment administered, prescribed or recommended. 

Also in Section 10 (1) on Who may practice Telehealth of House Bill 4199 or The Telehealth Act of 2014, it is only stated there that 1) a registered medical practitioner holding a valid Philippine license, 2) healthcare provider or licensed individual who provides health care within his scope of his professional license. In my opinion, the delivery of health care with the use of Telehealth will be very much effective if at least these health care professionals do have a background on Health Informatics – as for them to have a deeper grasp of using technology in transforming data to information and knowledge, and how to effectively handle them.

Another would be Section 17. Health Insurance Policy – If the health care services provided through telemedicine are included benefit in a health insurance policy or health plan coverage, such services must be paid in an amount equal to the amount that a health care provider would have been paid had such services been furnished without the use of advanced communications technology. A health insurance policy or health plan may limit coverage for health care services that are provided through telehealth. Which is actually a great idea, however, it limits itself to those who are only covered by Philhealth. Although in the year 2013, Philhealth claimed that 81% of Filipinos are covered (Tubeza, 2013). I think it would be best if we look into supporting more the Local Government Unit as we really have a lot of rural places that are still struggling with accesibble healthcare.

Telehealth is a very bold move in letting technology penetrate our healthcare system here in the Philippines, however, it seems that health care professionals are still doubtful about this, and still has to be educated how beneficial this will be four our countrymen like Clement. Participation and open mindedness of healthcare professional, and also those who are well knowledgable about Health Informatics should happen in the revision of the said bill, so we can achieve an equitable and accessible healthcare for all.


Photo take by Kir Ubungen

  1. Grimshaw JM et al. Knowledge translation of research. Implementation Science 2012,7:50.
  2. Straus et al. Knowledge translation is the use of knowledge in healthcare decision making. J Clinical Epidemiology 2011;64:6-10.
  3. https://business.inquirer.net/134533/philhealth-firm-on-claim-81-of-filipinos-covered
  4. http://www.congress.gov.ph/legisdocs/basic_16/HB04199.pdf

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