The National Telehealth Service Program (NTSP), one among the Philippine’s efforts to achieve Universal Health Care through information and Communication Technologies (ICTs), was one among the five mHealth innovations featured in the Harvard School of Public Health Southeast Asia Student Association Newsletter.  Highlight of the article is the development of mobile health solutions  towards managing non communicable diseases in the country which is being developed by the Department of Health and the National Telehelealth Center-University of the Philippines Manila.

NCDs, one among the growing concerns in health today, was accounted for  half of the causes of deaths in the country. According to the article, initiatives under the NTSP,  are becoming relevant in addressing non communicable diseases. With mobile phones, a general practicing doctor in a remote rural area can now be assisted in handling a difficult case by a clinical specialist in Manila. A patient’s health can be monitored longitudinally using an electronic medical record deployed in government health facilities. With these innovations, the Philippines posit the beginnings for mHealth solutions in the country.

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On February 22, Department of Health (DOH) Secretary Enrique Ona will meet researchers and academicians to listen to a set of policy recommendations based from health researchers led by the National Institutes of Health (NIH)-University of the Philippines Manila. This event is the highlight of NIH’s 15th anniversary celebration at Century Park Hotel.

An endorser of the Reproductive Health and Sin Tax Bills, the NIH will lead policy recommendations that are critical to address issues in Kalusugan Pangkalahatan (KP), most specifically in KP’s third strategic thrust: the attainment of the Millennium Development Goals (MDGs).

Since KPs’ launch, NIH has supported DOH direction to universal health care by aligning its research agenda to help meet the challenges of the MDGs. According to Dr. Manuel B Agulto, Chancellor of UP Manila, this underscores NIH’s “unique position” as provider of technical expertise in health research and development to DOH and other sectors.

“Relevant research is the backbone of any policy; we as NIH would help put forth policies relevant to the country’s needs,” says Dr. Shelley Dela Vega, Director, Institute of Health Policy and Development Studies (IHPDS). IHPDS, one of the eleven institutes under NIH, will lead this year’s anniversary.

As 2015 approaches, the Aquino administration is pressured to meet Millennium Development Goals 4, 5, and 6. Health policies based from evidence in research would strategize funding for better infrastructure, facilities, and human resources to serve the best doctors and health researchers of the country. With the recent approval of the 1 billion NIH building in the 2013 UP budget, support for research and development in the health sector is expected to escalate.
NIH was instrumental in the passage of 2 laws – Republic Act 9288 or “The Newborn Screening Act of 2004” and Republic Act 9709 or “The Newborn Hearing Screening Act of 2009”. Both were signed into law by Pres. Gloria Macapagal-Arroyo to protect the “future generation of our country.”

Along with the DOH Secretary, gracing the event are: UP System President Alfredo Pascual, and Dr. Manuel B. Agulto, UP Manila Chancellor.

The anniversary is in conjunction with the 11th Metro Manila Health Research Development Consortium and the 4th Science and Technology Week of UP Manila.

Emmanuel Pajarillaga, NTHC eHealth Nurse, teaches a doctor on how tap use a smartphone’s screen for activating controls on the phone.

Baguio City, Philippines – 78 health workers from six provinces  of Cordillera Administrative Region (CAR) are trained on using mobile phones and email for delivering quality care through Department of Health’ (DOH) Telemedicine Project.

The project, formally launched as the National Telehealth Service Prorgam (NTSP), is a program of the DOH in partnership with the National Telehealth Center (NTHC), University of the Philippines Manila. It is one of the many efforts of DOH in “using ICTs (information and communications technology) for Kalusugan Pangkalahatan (Universal Health Care)”. Representatives fromDOH - National Center for Pharmaceutical Access & Management, Philippine Health Insurance Corporation, who are members of the NTSP’s Project Management Committee, and DOH-Center for Health Development-CAR, are present to observe and support the health workers as they participate in the Certificate Course on eHealth. The said course on eHealth is part of the capacity building trainings of NTSP.

Better health reform

“Let’s try it again” says Dr Portia Marcelo-Fernandez, NTHC Director as she explains factors that impede delivery of quality health care in the country. In her lecture, she said that problems in the health care system, like the lack of health care professionals in rural remote communities, impede better coverage and quality of health services in the country.

“If the DOH wanted to achieve universal health care at all, we should also aim for better, more systematic health reform” added Marcelo, “and using ICTs is part of it”.

ICT is an umbrella term for the convergence of communication platforms and technologies to access, deliver, and store information. It has various applications in the field of health, governance, and education. Since 2004, NTHC has been implementing projects in telemedicine, with various government offices including DOH, to improve access to medical specialists, especially those in remote rural communities.

The training catered to needs of health workers from all 75 municipalities in CAR. First of the two-day training is devoted to explaining the role of health workers as frontliners in the collection of health data while the second day is on equipping doctors on creating teleconsults and on teaching nurses and midwives on using smart phones for health data reporting. A continuing medical education is also held in the morning of the training’s second day.

Dr Portia Fernandez-Marcelo, NTHC Director, acts as patient in one of telemedicine’s return demo for teledermatology. DOH Telemedicine project receives image-based consults of dermatology cases.

With technology comes responsibility

“In a time when the ratio of using mobile phones exceed the population, we should definitely use these available tools to improve the health situation, ” said Dr. Patrick Sylim, NTHC Research Associate during his talk on how telemedicine in the NTSP works.

“But using technology requires a high degree of responsibility. In telemedicine, we should adhere to the same ethical principles when we were sworn in as medical personnel, ” said Dr. Ryan Bañez, NTHC eHealth Analyst in his talk on the ethical and legal consideration in the practice of telemedicine .

“A doctor may readily call a colleague and ask for an expert opinion but there are certain guidelines that have to be observed in this practice,” he said.

During the open forum, doctors asked about possible legal liabilities in telemedicine. Bañez underscored that the responsibility for patient care remains that of the doctor sending the teleconsult. Currently, there are no  laws regulating the practice of telemedicine and telehealth, “but in the meantime, existing laws such as the Medical Act of 1959, apply, which defines the doctor-patient relationship, including liabilities” Bañez said.

“The use of cellphones and internet for health care is not always without harm and certainly has limits.  Health workers are expected to demonstrate the same or even higher degree of professionalism and responsibility for information exchanged through these tools”, added Marcelo.

Health information for better health

Health workers discussed the limitations of manual and paper-based recording and problems quality of health. “Submitting reports to various DOH offices took time, by the moment they receive the data from our health centers / rural health unit, it is already stale and irrelevant,” Marcelo said, “authorities may not be able to respond to a disease outbreak immediately”

In a stacking game, health workers learned the importance of their role as health data collectors submitting reports to various DOH offices. “If we don’t report the right data to DOH, much resources will be wasted,” said Dr. Marcelo.

“Coordination, team work, and communication are important in forming the base of the stacks,” explained Dr. Arlene Ottao, Municipal Health Officer of Barlig, Mt. Province. Trainers correlate the base of the stacks which forms the health data structure in the country’s health care system.

“We are disheartened by the fact that there are a lot of projects initiated but very few have flourished. We hope you understand that we have a lot of work as health workers, but then, we hope that we will be able to maximize this telemedicine initiative,” said Dr Rhodora Montesa, municipal health officer of Asipulo, Ifugao. All health workers agreed that that the results of the telehealth project is something to look forward to.

Since November 2011, NTHC has been working closely with DOH in implementing NTSP nationwide. Aside from CAR, NTHC has started training health workers of Eastern Visayas (Region 8), Masbate and Tawi Tawi as part of its priority sites. Aside from specialists in Philippine General Hospital, the Eastern Visayas Regional Medical Center has come on board, and specialists began addressing teleconsults from municipalities from Region 8.