Real-time regular routine reporting for health (R4Health): Lessons from the implementation of a large scale mobile health system for routine health services in the Philippines

BACKGROUND: The Philippine government aims for a modern information system to enhance data quality and provide more rational evidence to support timely and efficient delivery of health care, management of health systems, programs and policy. Hence, the Real-time Regular Routine Reporting for Health (R4Health) mHealth application was developed and field tested in 246 isolated and disadvantaged municipalities to support the campaign for Universal Health Care and the achievement of the Millennium Development Goals. The R4Health collected point-of-care-specific data on services routinely provided at the rural health facilities, aggregated them and presented in a dashboard for use by program managers and policy makers. OBJECTIVE: This paper describes the use of R4Health, a mobile technology-based health reporting system. It will discuss the context of the R4Health implementation, its development and deployment to 246 municipalities in the Philippines. Furthermore, the paper sought to determine enablers and challenges to the adoption of R4Health in routine health care. METHODS: Data was collected through surveys, focus group discussions, participant-observation and review of project reports. Quantitative data was summarized using descriptive statistical methods; qualitative data underwent content analysis.    RESULTS AND CONCLUSION: A total of 515,855 R4Health reports equivalent to 48,856 patient transactions were received from 246 municipalities within a nine-month observation period, supporting the viability of the R4Health as an alternative option to the existing manual and paper based health information management to improve the quality of data. R4Health utilizes a tool that everyone is familiar with, can easily be incorporated in their workflow, can be brought and used anywhere and has an application that is clear, understandable, and easy to learn and use. R4Health data elements, however, have overlaps with other government health reporting systems and is already misconstrued to further duplicate work. More discussions are warranted to coordinate and integrate systems. Given the general positive perspectives, integration of this alternative system to the RHU workflow, an improved R4Health, has a high potential of being accepted and adopted by the first-line health workers across the country. 

Formulating the national policy on telehealth for the Philippines through stakeholders' involvement and partnership

The Philippine Department of Health (DOH) recognized the potentials of information and communication technology (ICT) as a valuable aid to achieve Kalusugan Pangkalahatan (KP) or Universal Health Care for all Filipinos. In 2011, the Development of the National Telehealth Service Program (NTSP) in the DOH Project was proposed and implemented as a collaborative and developmental project of the DOH, with the University of the Philippines-Manila through the National Telehealth Center. The Project defined operational and policy issues critical in incorporating telehealth as a standard program, service delivery and information management mode in the DOH. To sustain this beyond the current Project financing and political leadership, as well as to provide a policy framework to guide the implementation of telehealth in the country, a DOH administrative order (AO) was proposed. Stakeholder feedback was sought to surface views and concerns to ensure better relevance and effective policy implementation. Four public fora were held from 2012 to 2014 participated in by 241 individuals from the national agencies and local governments, project implementers, academe, and the private sector. General comments centered on governance and ensuring representation by patient advocate groups and the local governments. Capacity building and financing of telehealth, and regulation especially with regards to ethical use and protection of patients' privacy were prominent concerns. Participants affirm the preference for the poor and marginalized, although envision that telehealth and digital health information systems should be standard components of health care in the country. Other comments were specific to telemedicine and using mobile phones to report on health services from the frontline clinics. Recommendations are presented.