Make Health A Priority

RHIS in the country still has a long way to go. As defined by Hotchkiss DR [2], Routine Health Information System are systems that provide information at regular intervals of a year or less to meet predictable health information needs. Common misconception with the term “information system” is that it always deals with computers or advance technology, but this may also include paper-based health records, aside from electronic health records, facility, and district management level of information systems.

Before dwelling on the issue of RHIS in the country, defining what HIS of Health Information System is also essential. As defined by World Health Organization, HIS provides support for sound decision-making, and it has four key functions which are 1) data generation, 2) compilation, 3) analysis and synthesis, and 4) communication and use. Health Information Systems aid in the collection of data across health sectors, analyses the data, and ensures the overall quality, relevance, and timeliness, and convert these data into information for health-related decision making. [1]

Studying the RHIS in developing countries like the Philippines is very interesting. Not because of the many loopholes you can find, but you get to appreciate more the elements of a Health Information System, and how it will not be successful if one will not be functioning, and how a strong HIS makes it easier to support progress of the other 5 elements of health system. As discussed in the RHIS Curriculum [3], WHO endorses the strengthening of the six building blocks of health systems which are 1) governance and policy, 2) service delivery, 3) human resource, 4) health commodities, 5) health financing, and 6) health information system.

In a developing country like the Philippines, the problem is not just a one sided issue. However, mostly coming from its’ roots which is the structure of the leadership and governance, and the devolution of health services, its’ fruits and the people working and collecting data also are dealing with their own issues as well.

Department of Health or DOH mandates to provide the national policy direction and develop national plans, technical standards, and guidelines of health in the Philippines. [4] Aside from that, they are the governing body who provide technical assistance, capacity building, and advisory services for disease prevention and control, and the governing body who supplies medicine and vaccine to Filipinos.

Under the Local Government Code (1991), devolution of health services happened and local government units were granted autonomy and responsibility for their own health services delivery. Although National Health Programs are still coordinated by the DOH, the delivery would still depend on the local government unit [7]. The problem with coordination between the governing body which is DOH and local government unit lead to poor implementation of national health programs and policies, and poor functioning of the local government unit. And since that autonomy was given to local government unit, which is regulated by the mayor, health is never the priority of most local government units.

Image 1. Organizational Structure of the Philippine Health Sector After Devolution
Source: Alliance for Improving Health Outcomes Inc. (AIHO)

As responsibility is with the local government unit, the initiative to source pool of skilled health workers, or the lack thereof that are willing in a primary level is also scarce. Not only the human resource, but the skills or trainings that are available is limited. This leads to where the other side of the issue is, which is in the very cellular level of the structure, in which the people collecting data are not as skillful as they are expected to be, thus affecting integrity of data collected, that are essential in health decision making.

Devolution of health service delivery may work in other countries, but studies suggest that it works well in countries that see health as a priority. In many developing countries, traditional health service is highly centralized. It was a top down center design program as well in the Philippines before, but decentralization was decided upon the idea of systematic citizen involvement in setting goals, execution, functioning, financing, monitoring and other functions, thus the increase of local control and accountability [6]. However, one evident factor was overseen in this process. In the past years, studies and surveys suggest that health is not a top priority of Filipinos. It is only in some very recent surveys for the past couple of years that health became one of the top priorities of Filipinos [5], thus involvement in setting up these goals was very low. There should have been participation and consultation from local population and other stakeholders, especially in the governing body of local government unit, as capacity to handle new responsibilities is lacking, and health was never really their priority.

Solving minute issues, perhaps in the local government unit like strict implementation of data gathering to strengthen integrity of data could help, but in the long run may not be very sustainable. If the roots of the problem will not be given its’ treatment, the problem will continue to bear fruits.

As a student of Health Informatics, and a catalyst of change, raising awareness to my reach is very essential. However, this will never be enough to instill change in the mind of Filipinos. In the future, I aspire to be one of the leads to pioneer the drive to make health as a priority, and to bring the centralization back in the delivery of health services. The delivery of health services should be brought back in the hands of health professionals, as health professionals are the ones who are more knowledgeable with health care needs, and are more skilled and making sound decisions in dealing with health care data.

After all, introduction of new processes especially by the governing body should not always be forced. The population would take time to adjust from it, and should be steered slowly while still aiming quality improvements.


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