One of the greatest problems afflicting millions of poor families in the Philippines is inequity in health status and access to health care services. Although improvements in technology have brought the health care industry tools like electronic health records and SMS patient communications—technologies that deliver a tremendous improvement in care delivery and outcomes— developing countries have been slower to adopt these tools because of challenges that impact their sustainability and support.
Across the Philippines, more than 10 million families depend on Rural/City Health Units (RHUs) and village health stations for primary care. But many citizens do not seek care from these units because they perceive them as inefficient and as providing a lower level of care than private facilities.
Patients experience long wait times, health workers have difficulty tracking patients’ health histories, and health workers spend hours on manual data recording and reporting, a laborious task that often results in inaccurate information. These health facilities are responsible for primary care services, yet they often lack accurate, up-to-date information about services and community health.
Making Health Access Mobile and Electronic Health Records Sustainable
In 2009, RTI joined Qualcomm Wireless Reach and a team of local partners, to launch a pilot initiative in the rural province of Tarlac to address these longstanding problems and leverage the promise of health information technologies to improve access and care for poor Filipino communities across the province.
Known as Wireless Access for Health (WAH), this program delivered critical technical assistance to help RHUs in Tarlac improve their operations and quality of care. An innovative public-private partnership, the WAH initiative provided RHUs with low-cost, locally built and sustained electronic health records and mobile health (mHealth) tools, training, and support.
Developed by RTI, WAH’s platform features an electronic health records (EHR) system that is compatible with all major health programs, a mobile application known as EHR-Lite to track patient care outside of the main health clinic, and SMS patient alerts to improve follow-up and use of preventative services such as prenatal care and immunizations. The platform supports reporting of health claims to PhilHealth, the national health insurance program, and to the Department of Health’s Field Health Service Information System—reducing the burden on health workers and improving the timeliness and accuracy of health information.
As part of WAH platform deployment we prepare partner clinics to shift from manual recording of patient and health data to digital and electronic records. As of August 2016, our WAH team has conducted 251 trainings for 141 clinics in 100 municipalities and five cities in 26 provinces.
The WAH team was able to train over 175 doctors, 85 dentists, 107 medical technologists, 692 nurses, 951 midwives, and 737 other personnel—including laboratory aides, dental aides, volunteer neighborhood health workers, administrative aides and encoders. To date, our team has trained more than 2,740 clinicians.
Sustaining Progress through Partnership and Strong Local Ownership
Since its kick-off in 2009, WAH developed broad partnerships with private corporations, universities, local and national government agencies. These partnerships, as well as grassroots advocacy, have been instrumental in the transition of WAH to local sustainability and independence from international support.
In 2013, we joined our partner organizations to form a nongovernmental organization (NGO)— the Wireless Access for Health Initiative—as a means of making its service sustainable and scalable. As a nonprofit NGO, WAH appeals to local governments, which are responsible for managing health services, because the platform is open source, which makes adoption of EHRs more affordable. In particular, local governments need EHR solutions that can be used offline with a local server, as most rural health units do not have a dedicated Internet connection.
Continuous Improvement and Scale-Up
Since launch of the NGO, WAH has been continuously improving its platform and products based on suggestions from health workers and key stakeholders. It has provided ongoing supports for RHUs, as well as training and tools to help mayors and health workers use the information produced by the electronic health record.
Today, all 39 rural health units in Tarlac Province benefit from the service. More than 140 clinics and more than 100 cities and municipalities covering Metro Manila, Luzon, Visayas, and Mindanao have implemented the WAH platform, enabling medical services to be provided more promptly and giving medical providers accurate health information about their patients.
Although a number of rural areas continue to lack this resource, local funding to deploy and support WAH scale-up continues to increase, demonstrating that WAH has a tremendous value to local government.
Since the WAH project, we have leveraged this experience in implementing other health information systems projects around the world. We continue to support WAH scale up and sustainability through the LuzonHealth project and other initiatives.