Philippine Health Information System: Review and Assessment. February - July 2007

(1)

Health Metrics Network

Philippine Health Information System:

Review and Assessment

February - July 2007

by

The Philippine Health Information Network

The Philippine Health Information Network c/o Ms. Charity Tan

Information Technology Officer Information Management Service Department of Health

(2)

List of Acronyms

AIDS Acquired Immune Deficiency

Syndrome

LGU Local Government Unit

AO Administrative Order MCH Maternal and Child Health

Survey

API Annual Parasitic Incidence MCR Municipal Civil Registrar

APSED Asia Pacific Strategy for Emerging Diseases

MDG Millennium Development

Goal

ARMM Autonomous Region of Muslim

Mindanao

MFHSIS Modified Field Health Service Information System

BAS Bureau of Agricultural Statistics MHO Municipal Health Officer

BFAD Bureau of Food and Drugs MIMAROPA Mindoro, Marinduque,

Romblon, Palawan

BHS Barangay Health Station MMR Maternal Mortality Rate

BIIS Bureau of Food and Drugs Integrated Information System

MPDO Municipal Planning

Development Officer BLES Bureau of Labor and Employment

Statistics

MTPDP Medium-Term Philippine

Development Plan

BNB Botika ng Bayan MTPPAN Medium-Term Philippine

Plan of Action for Nutrition CALABARZON Cavite,Laguna,Batangas,Rizal,Quezon NCR National Capital Region

CAR Cordillera Administrative Region NDHS National Demographic and

Health Survey

CBMIS Community Based Management

Information System

NEC National Epidemiology

Center

CCR City Civil Registrar NEDA National Economic and

Development Authority CED Chronic Energy Deficiency NESSS National Epidemic Sentinel

Surveillance System

CHD Center for Health Development NGA National Government

Agency

CHO City Health Officer NGO Non-Governmental

Organization

CPDO CityPlanning Development Officer NHII National Health Information

Infrastructure

CRS Civil Registration System NHIP National Health Insurance

Program DDMS Infectious Disease Data Management

System

NNC National Nutrition Council

DFHSIS Decentralized FHSIS NNS National Nutrition Survey

DHS District Health System NOH National Objectives for

Health

DOH Department of Health NSCB National Statistical

Coordination Board DOHLIS DOH Licensing Information System NSO National Statistics Office

(5)

DOTS Directly Observed Treatment Short course

OPT Operation Timbang

DTIS Document Tracking Information System

PCHRD Philippine Council for Health Research and Development DTOMIS Drug Test Operation and

Management Information System

PhilHealth Philippine Health Insurance Corporation

e-NGAS electronic-New Government Accounting System

PHIN Philippine Health Information Network

ENHR Essential National Health Research PHN Public Health Nurse

EO Executive Order PHNIS

F1 Fourmula One for Health

Philippine Health and Nutrition Information System

FBS Food Balance Sheet PHO Provincial Health Officer

FGD Focus Group Discussion PHS Philippine Health Statistics

FHSIS Field Health Service Information

System

PIS Personnel Information System FIVIMS Food Insecurity and Vulnerability

Information and Mapping Systems

PLHIS Philippine Local Health

Information System

FNRI Food and Nutrition Research

Institute

PMIS Philippine Malaria Information System

FPS Family Planning Survey PNHA Philippine National Health

Accounts

FS Field Surveillance PNHRS Philippine National Health

Research System

GDP Gross Domestic Product POPCOM Commission on Population

GIDA Geographically Isolated and Disadvantaged Area

PPDO Provincial Planning

Development Officer

GNP Gross National Product PPMP-DP Philippine Population

Management Program Directional Plan

HAMIS Health and Management

Iinformation System

PSDP Philippine Statistical

Development Program HDL-c High Density Lipoproteins –

cholesterol

PSO Provincial Statistics Officer

HIS Health Information System PSS Philippine Statistical System

HIV Human Immunodeficiency Virus PSY Philippine Statistical Yearbook

HMIS Health Management Information

System

PWD Persons with Disabilities

HMN Health Metrics Network RA Republic Act

HOMIS Hospital Operation and

Management Information System

RHM Rural Health Midwife

HPDPB Health Policy Development and Planning Bureau

RHU Rural Health Unit

HSRA Health Sector Reform Agenda RHUMIS Rural Health Unit Information

(6)

IAC-HNS Inter-Agency Committee on Health and Nutrition Statistics

SEAMIC Southeast Asian Medical Information Center IBBIS Integrated Blood Bank Information

System

SPR Slide Positivity Rate

ICD-10 International Classification of

Diseases version 10

SRTC Statistical Research and

Training Center

ICT Information and Communications

Technology

SS Sentrong Sigla

ILHZ Inter-Local Health Zones SSM Sentrong Sigla Movement

IMR Infant Mortality Rate TB Tubercolosis

IMS Information Management Service U5MR under 5 mortality rate

IMST Internal Management Support Team UHMIS Unified Health Management

Information System

KM Knowledge Management UPPI University of the Philippines

Population Institute

LCR Local Civil Registrar WFPDS Work and Financial Plan

Database System LDL-c Low Density Lipoproteins - cholesterol

LGC Local Government Code

WNDRS Weekly Notifiable Disease

(7)

List of Tables and Figures

Table page

Table 1. Strategies for Health Information Systems under Fourmula One 15

Table 2. Statistical Framework on Health and Nutrition 19

Table 3. Implications of the Devolution and Health Sector Reform Agenda on the Local health System

32 Table 4. Strengths and Weaknesses of the Surveillance Systems of the

National Epidemiology Center

35 Table 5. Targets in Knowledge Management in the Philippine Health Sector 38 Table 6. Matrix on Statistical Development Programs for Health and

Nutrition Information Systems

42 Table 7. Participants in the Philippine Assessment using the HMN Procedure 56 Table 8. Data Producers of Field Health Service Information System and

Civil Registration System that participated in the Assessment in the Subnational Level

58

Table 9. Data Users of Field Health Service Information System and Civil Registration System that participated in the Assessment in the Subnational Level

58

Table 10. Summary of Results of the Assessment of Health Information System Resources

59 Table 11. Problems on HIS Resources Identified by Regional FHSIS Regional

Coordinators With the Existing FHSIS at Different Administrative Levels 63 Table 12. Summary of the Result of the Assessment of Indicators 63 Table 13. Summary of Results of the Assessment of Data Sources 64 Table 14. Summary of the Result of the Assessment of Data Management 67 Table 15. Summary of Results of the Assessment of Information Products 68 Table 16. Problems on Information Products Identified by Regional FHSIS Regional Coordinators With the Existing FHSIS at Different Administrative Levels

70 Table 17. Summary of Results of the Assessment of Dissemination and Use 71 Table 18. Problems on Dissemination and Use Identified by Regional FHSIS

Regional Coordinators With the Existing FHSIS at Different Administrative Levels

73

Figure page

Figure 1. Health and Nutrition Strategies and Expected Outcome 13 Figure 2. Framework for the Development of the Philippine Health

Information System

17

Figure 3. The Philippine Statistical System 22

Figure 4. HMN Framework 53

Figure 5. Selected Indicators and Results 64

(8)

1 Background

The monitoring and assessment of the status of the health and nutrition of the Philippine citizenry is a concern not just of the government but also of international donor agencies and other non-governmental organizations. Such monitoring and assessment require data that shall be used to generate measures/indicators on the health and nutrition status of the population over a period of time. In recognition of the importance of data that feed into the monitoring and assessment of its health system, the Philippines through the Philippine Health Information Network (PHIN) with the support of the World Health Organization and the Health Metrics Network conducted an assessment of the health information systems that generate health and nutrition data. The assessment started in November 2006 with the conduct of a Training of Trainers on the Health Metrics Network (HMN) framework and tools for assessing health information systems. The activities that followed included workshops to evaluate and customize the HMN assessment tool for the Philippines; pretesting and finalizing the customized tool; the actual assessment; workshop to discuss the result of the actual assessment; additional assessment in the subnational level of two specific systems that generate health information – Field Health Service Information System of the Department of Health and civil registration system of the National Statistics Office; and, meetings to finalize the report on the assessment. This report presents the results of the assessment.

2 The Philippines

To properly appreciate the discussions of health information systems in the Philippines, an understanding of the country’s characteristics and health system is needed. This chapter presents the Philippines geography, administrative divisions, government, climate, demographic characteristics, economic characteristics, organization of its health care system, health facilities, and health human resources.

Geography, Administrative Divisions and Government

The Philippines is an archipelago of about 7,100 islands located in the western part of the Pacific Ocean off the coast of Southeast Asia. The country has a total land area of 300,000 square kilometers and is one of the largest islands groups in the world. The three island groupings are Luzon in the north, Visayas in the central area, and Mindanao in the south. Metropolitan Manila, also known as the National Capital Region (NCR), is located in the central part of Luzon. It is the biggest urban center in the country. It is made up of 14 highly urbanized cities and three municipalities. The country is divided into 17 administrative regions: Regions 1 to 5, NCR, Cordillera Administrative Region (CAR) , CALABARZON (Cavite,Laguna,Batangas,Rizal,Quezon), and MIMAROPA (Mindoro, Marinduque, Romblon, Palawan) which are in Luzon; Regions 6 to 8 which are in the Visayas; and, Regions 9 to 12, Autonomous Region of Muslim Mindanao (ARMM), and Caraga which are in Mindanao. Regions are composed of 79 provinces headed by governors while provinces are divided into 117 cities and 1500 municipalities, collectively called local government units. The local government units, headed by mayors, make up the political subdivisions of the Philippines. They are divided into villages or barangays totaling 41,975. These are headed by barangay chairpersons (NSCB, 2004). It must be noted that regions are administrative units only and the political units aside from the national level are the provinces, cities and municipalities, and barangays.

(9)

The Philippines is a republican state with three branches of government- executive. legislative and judicial. The executive power is vested in the President, who is the head of state and the commander-in-chief of the Armed Forces. The President appoints the Cabinet members of who assist the President in executing laws, policies and programs of the government. The lawmaking power is vested in a bicameral Congress composed of the Senate and the House of Representatives. The Senate has 24 senators directly elected nationwide by the people. The House of Representatives has 250 members elected by congressional districts and by party list system. Judicial power is vested in the Supreme Court and a system of several lower courts. The Supreme Court is composed of the Chief Justice and 14 associate justices (NOH, 2005-2010).

The Climate

The country’s climate is generally hot and humid and favors the existence of disease vectors and parasites. On the average, the temperature is 32o with March to June as the hottest months when temperatures may reach 38oC. On the other hand, November to February provide cooler weather with temperatures around 23oC. The Philippines is prone to natural disasters brought about by volcanic eruptions, earthquakes, floods and typhoons. Rains and typhoons prevail from July to October (NOH, 2005-2010).

Demographic Characteristics

The population of the Philippines in the 2000 census was 76,504,077, a 58 percent increase from the 1980 census. The population grew at the rate of 2.4 percent annually between 1995 and 2000 while it grew at 2.1 percent between 2000 and 2005. The population is projected to increase to 91,868,309 in 2010. The NCR has an estimated 13.3 percent of the total population of the Philippines. It has the greatest population concentration with 16,091 people per square kilometer, a ratio that is 63 times the national average. The least population areas are the CAR and Region 2 with a population density of 70 and 90 people per square kilometer, respectively. Five out of the 17 administrative regions have growth rates higher than the national average: Region 3, MIMAROPA and CALABARZON, Region 7, Region 11 and ARMM. NCR has the lowest population growth rate of 1.06 percent and ARMM has the highest at 3.86 percent. In comparison with other countries, the Philippine ranked twelfth among the countries of the world in terms of total population. The Philippines is ranked fifth among Southeast Asian countries in annual population growth rate (PSY, 2004 and NOH, 2005-2010).

Approximately 52 percent of the Philippine population live in rural areas. However, urbanized areas now attract migrants from rural communities due to more economic, educational, recreational opportunities. Rural-to-urban migration causes much pressure on government to provide basic social services like health care, shelter, water, sanitation and education. The congestion and pollution in urban areas are harmful to health. In frontier areas where more migration is also noted, the people’s health is affected by difficult access to health services and the presence of locally endemic diseases like malaria, filariasis and schistosomiasis (PSY, 2004 and NOH, 2005-2010).

The median age of the Philippine population is 21 years old. This makes the Philippines a country of young people with, half of its population below 21 years old. Males outnumber females with a sex ratio of 101.43 males for every 100 females. There are more males than females in the age groups 0-19 and 25-54 years.The age structure of the Philippine

(10)

population is typical broad base at the bottom consisting of large numbers of children and a narrow top made up fairly small numbers of older persons. The dependency ratio is 69, which means that every 100 persons in the working age group (15-64 years old) have to support about 63 young dependents and about six old dependents. Young dependents (65 years old and over) account for 3.8 percent, while 59.2 percent comprise the economically active population (15-64 years old). Women of reproductive age comprise around 51 percent of the total number of females in country (PSY, 2004 and NOH, 2005-2010).

Economic Characteristics

The Philippines is a developing country. Per capita Gross National Product(GNP) was P56,109 and per capita Gross Domestic Product (GDP) was P52,241 in 2003. The 2002-2003 GNP growth rate was 5.6 percent and GDP was 4.7 percent. In 2000, the annual per capital poverty threshold was estimated at P11,605, an 18 percent increase over the 1997 threshold of P9,843. With this threshold, a family of five members should have a monthly income of P4,835 to meet its food and non-food basic needs. Average annual family income reached P148,757 in 2003, increasing by 2.5 percent over the P145,121 average in 2000. As earnings rose across all income levels, from the 27.5 percent revised estimate from 2000 down to 24.7 percent in 2003 (NSCB, 2005).

Unemployment and underemployment rates have increased in the past three years. Unemployment rates stood at 10.2 percent in October 2002, it has gone up to 10.9 percent as of October 2004. Underemployment has also gone up from 15.3 percent in October 2002 to 16.9 percent in October 2004. Average inflation rate has also gone up from 3.5 percent in 2003 to six percent in 2004 (PSY, 2004)

Organization of the Health Care System

The Philippines recognizes health as a basic human right. It protects and promotes the right to health of the people and instills health consciousness among them. Although this provision is guaranteed by the 1987 Constitution (Article II, Section 15) and the health care system in the Philippines is generally extensive, access to health services, especially by the poor, is still hampered by high cost, physical and social-cultural barriers (NOH, 2005-2010). To address these concerns, reforms in the country’s health care system have been instituted in the past 30 years: the adoption of Primary Health Care in 1979; the integration of public health and hospital services in 1983 (EO 851); the enactment of the Generics Act of 1988 (RA 6675); the devolution of health services to LGUs as mandated by the Local Government Code of 1991 (RA 7160); and the enactment of the National Health Insurance Act of 1995 (RA 7875). In 1999, the DOH launched the Health Sector Reform Agenda (HSRA) as a major policy framework and strategy to improve the way health care is delivered, regulated and financed(NOH, 2005-2010).

The Philippines has a dual health system consisting of : the public sector, which is largely financed through a tax-based budgeting system national and local level and where health care is generally given free at the point of services (although socialized user charges have been introduced in recent years for certain types of services), and the private sector (consisting of for-profit and non-profit providers), which largely market-oriented and where health care is paid through user fees at the point of service. The expansion of social health insurance in recent years and its emergence as a potential major source of health financing

(11)

will have a positive and private sectors and in terms of the people’s health-seeking behavior (NOH, 2005-2010).

Under this health system, the public sector consists of the DOH, LGUs and other national government agencies providing health services. The DOH is the lead agency in health. Its major mandate is to provide national policy direction and develop national plans, technical standards and guidelines on health. It has a regional field office in every region and maintains specialty hospitals, regional hospitals and medical centers. It also maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control (NOH, 2005-2010).

With the devolution of health services under the 1991 Local Government Code, provision of direct health services, particularly at the primary and secondary levels of health care, is the mandate of LGUs. Under this set-up, provincial and district hospitals are under the provincial government while the municipal government manages the rural health units (RHUs) and barangay health stations (BHSs). In every province, city or municipality, there is a local advisory body to the local executive and the sanggunian or local legislative council on health-related matters (NOH, 2005-2010).

The passage of the 1995 National Health Insurance Act expanded the coverage of the national health insurance program to include not only the formal sector but also the informal and indigentsectors of the population. The program founded under the principle of social solidarity where the healthy subsidizes the sick and those who can afford to pay subsidize those who cannot. PhilHealth, a government-owned and controlled corporation attached to the DOH, is the agency mandated to administer the national health insurance program and ensure that Filipinos will have financial access to health services (NOH, 2005-2010).

The private sector includes for-profit and non-profit health providers whose involvement in maintaining the people’s health is enormous. Their involvement include providing health services in clinics and hospitals, health insurance, manufacture and distribution of medicines, vaccines, medical supplies, equipment, other health and nutrition products, research and development, human resource development other and other health-related services (NOH, 2005-2010).

Health Care Facilities

Various health facilities serve the health needs of the Filipinos. The total number of hospital, both government and private, increase from 1,607 in 1980 to 1,738 in 2002. Though the number of hospitals increased nationwide, the number of beds per 10,000 population decreased from 18.2 in 1980 to 10.7 in 2002 (PSY 2004). The number of government hospitals nationwide increased from 623 in 2000 to 661 in 2002, while private hospitals slightly decreased from 1,089 in 2000 to 1,077 in 2002. Although only 661 or 38 percent of hospitals are government hospitals, these contribute 45,395 beds or 53.3 percent of bed capacity nationwide (PSY, 2004 and NOH, 2005-2010).

ARMM has the least number of hospitals, consisting of three private hospitals and 11 government hospitals in 2002. CALABARZON and MIMAROPA have the most number of hospitals with 176 private hospitals and 95 government hospitals (PSY, 2004 and NOH, 2005-2010).

(12)

In terms of government hospital beds, NCR has the most number of 9,965 beds followed by CALABARZON and MIMAROPA at 6,295 beds and Region 3 at 3,385 beds. The regions with the least number of government hospital beds are ARMM at 870 beds, Region 10 at 1,150 beds and Region 12 at 1,195 beds. The government hospital bed to population ratio is worst in Region 11 in Mindanao with one bed for every 3,575 people while it is best in NCR with one bed for every 807 people (PSY, 2004 and NOH, 2005-2010).

There is increasing trend in the number of BHSs from 9,184 in 1988 to 15,343 in 2002 while there is a decreasing trend in the number of RHUs in the country from 1,962 in 1986 to 1,879 in 2001. NCR has the most number of RHUs while the Central Mindanao has the least number of RHUs. On the other hand, CALABARZON and MIMAROPA have the most number of BHSs while NCR has the least (PSY 2004). On the average, each RHU serves around 41,000 people while each BHS serves around 5,100 people (PSY, 2004 and NOH, 2005-2010).

Health Human Resources

Human resources for health are central to managing and delivering health services. They are crucial in improving health systems and health services and in meeting the desired health outcome targets. Human resources for health are enormous but unevenly distributed in the country. Most health practitioners are in Metro Manila and other urban centers. Compared to most Asian countries, the Philippines is producing more and better human resources for health (NOH, 2005-2010).

The number of physicians per 100,000 populations slightly increased from 123.8 in 1998 to 124.5 in 2000, which translates into one physician for every 803 people in 2000. The number of dentist per 100,000 population almost remained unchanged at 54.2 in 1998 and 54.4 in 2000 or one dentist per 1,840 people in 2000. The number of pharmacists per 100,000 populations improved slightly from 55.8 in 1998 to 58.1 in 2000. This means one pharmacist for very 1,722 people in 2000. The number of nurses per 100,000 populations almost remained constant from 442.7 in 1998 to 442.8 in 2000, a ratio of one nurse per 226 people for both 1998 and 2000 (SEAMIC, 2003 and NOH, 2005-2010).

In 2002, there are 3,021 doctors, 1,871 dentist, 4720 nurses and 16,534 midwives employed by LGUs. Other health personnel employed by LGUs consist of 3,271 engineers/sanitary inspectors, 303 nutritionist, 1,505 medical technologist, 977 dental aides and 2,808 non-technical staff. Assisting these health personnel at the grassroots are 195,928 volunteer barangay health workers and 54,557 birth attendants (FHSIS, 2002 and NOH, 2005-2010). The Philippines has traditionally been a major source of health professionals to many countries because of their fluent English, skills and training, compassions, humaneness and patience in caring. The country is purportedly the leading exporter of nurses to the world (Aiken, 2004) and the second major exporter of physicians (Bach, 2003). Although the country is producing a surplus of health workers for overseas market since the 1960s, the large exodus of nurses in the last four years has been unparalleled in the migration history of the country. While Filipino physicians have been migrating to the United States since the 1960s and to the Middle East countries in the 1970s in steady outflows, the recent outflows are disturbing because they are no longer migrating as medical doctors but as nurses (NOH, 2005-2010).

(13)

STRATEGIES (1) Eradicate extreme poverty and

hunger

(2) Reduce child mortality (3) Improve maternal health (4) Combat HIV and AIDS, Malaria

and other diseases (5) Ensure environmental

sustainability

(6) Develop a global partnership for development

EXPECTED OUTCOMES

(1) Halve, between 1990 and 2015, the proportion of people who suffer from hunger

(2) Reduce by two-thirds, between 1990 and 2015, the under five mortality rate

(3) Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

(4) Have halted by 2015 and begun to reverse the spread of HIV/AIDS (5) Have halted by 2015 and begun to

reverse the incidence of malaria and other major diseases

(6) Halve, by 2015, the proportion of people without sustainable access to safe drinking water

(7) In cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries

Based on the baseline survey of nursing-medics in the Philippines, more than 3,500 Filipino doctors have left as nurses since the year 2000 (Galves-Tan, Sanchez, Balanon,2004). A little more than 1,500 doctors have passed the national nurse licensure examination in 2003 and 2004 (PRC, 2002). An estimated 4,000 doctors are enrolled in nursing schools all over the country (Galves-Tan, Sanchez, Balanon, 2004). The Philippine socioeconomic and political situations have not helped munch in retaining licensed and skilled nurses and other health professionals in the country. (NOH, 2005-2010).

3 Frameworks for Generating Health and Nutrition Statistics

The Millennium Development Goals (MDGs), the Philippine Statistical Development Program (PSDP) 2005-2010, the Medium-Term Philippine Development Plan (MTPDP) for Health and other health and nutrition sectoral plans such as the National Objectives of Health (NOH) 2005-2010, the Medium-Term Philippine Plan of Action for Nutrition (MTPPAN), and the Philippine Population Management Program Directional Plan (PPMP-DP) provide very clear strategies and expected outcomes of international and national development goals and targets which require statistics and indicators. These frameworks serve as basis for identifying priority indicators/statistics for monitoring and evaluating the progress of the country’s health and nutritional plans, programs and policies. Figure 1 summarizes the major strategies and expected outcomes for health and nutrition as drawn from the different plans and programs.

Figure 1. Health and Nutrition Strategies and Expected Outcome1

MILLENIUM DEVELOPMENT GOALS

1

(14)

Continuation of Figure 1

HEALTH

NUTRITION

STRATEGIES

(1) Focus on adolescent females, pregnant and lactating women and children 1-3 years old

(2) Complementation of nutrition interventions with other development programs

(3) Geographical focus to needier areas

(4) Food-based interventions for sustained improvement in nutritional status

(5) Increased investments in nutrition

.

(1) Reduced proportion of Filipino households with intake below 100% dietary energy requirement

(2) Reduced prevalence of underweight children 0-5 and 6-10 years old

(3) Reduced prevalence of stunting among children 0-5 years old

(4) Reduced prevalence of chronic energy deficiency among pregnant women

(5) Reduced prevalence of vitamin A deficiency disorders among children 6 mos.-5 years old, pregnant and lactating women

(6) Reduced prevalence of iodine deficiency disorders among lactating women

(7) Reduced prevalence of low birth weight

STRATEGIES

(1) Reduce the cost of essential medicines (2) Expand health insurance particularly for

indigents

(3) Strengthen national and local health systems through the implementation of the Health Sector Reform Agenda for health regulation reforms

(4) Improve Health Care Management System;

(5) Improve health and productivity through Research and Development; and

(6) Establish drug treatment and rehab centers and expand existing ones.

(1) Fifty percent reduction in prices of 22 therapeutic classes essential medicines from 2004 prices by 2010;

(2) Covered 5 million indigent families enrolled and sustained in National Health Insurance Program (NHIP);

(3) One hundred percent of hospitals licensed by Department of Health;

(4) Standardized training courses, registration, regulation and accreditation developed and institutionalized;

(5) Seventy percent increase in utilization of health, nutrition and population related Research and Development results

(15)

The Framework Based on the National Objectives for Health 2005-2010

The DOH in its quest to strengthen the Philippine health system and make it a vehicle for social change, engineered the Fourmula One for Health (F1) in 2005 as the new implementation framework for vital health sector reforms as stated in its HSRA in 1999. F1 became the DOH’s guiding philosophy and strategic approach to implement health reforms. On the other hand, the NOH 2005-2010 provides the “road map” of key ideas, targets, indicators and strategies to bring the health sector to its desired outcomes. (NOH 2005-2010) .

With the F1 in mind, the following was developed by the Information Management Service (IMS) of DOH as its major strategies for developing rationalized and more efficient national and local health information systems through strengthening networking mechanisms and referral systems, sharing of resources, organizational transformation and restructuring, capacity building.

Table 1. Strategies for Health Information Systems under Fourmula One Key Result Areas Deliverables Unit Responsible Easy access to health information.

• PHIN established and operational

• Health Information standards developed and implemented

• Various information systems developed (Hospital Operations and Management Information System(HOMIS), FHSIS, Integrated Blood Bank Information System(IBBIS), Bureau of Food and Drugs Integrated Information System(BIIS), Drug Test Operation and Management Information System (DTOMIS), DOH Licensing

Information System(DOHLIS), etc.) • Data warehouse with the following health

information:

o Health service statistics and disease surveillance

o Health regulation

o Health statistics such as vital statistics, health accounts, health surveys, censuses

o Health researches, best practices, lessons learned IMS, health programs, services, bureaus, other Health Information Generators (NSO, Philippine Council for Health Research and Development(P CHRD), NSCB, medical societies, etc)

Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt

Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt

(16)

Key Result Areas Deliverables Unit Responsible DOH transformed to a knowledge organization

• Health portal which is the repository of the health intellectual capital is established, operational and used

• Resource learning center operational with virtual health library and knowledge bases established and utilized

• Knowledge management(KM) infrastructures established

• Knowledge is shared to stakeholders through knowledge networks • Health workers imbibed KM qualities

such that seeking, sharing and utilization of knowledge has become a habit.

IMS , programs, sectoral support cluster, Internal Management Suppot Team(IMST)

Health data and infrastructure are

interoperable

• Information and Communications

Technology(ICT) standards developed and used by stakeholders

• Interconnection of central office, Centers for Health Development(CHDs) and DOH retained hospitals

• DOH, Philippine Health Insurance

Corporation(PHIC or PhilHealth) and private sector databases are interoperable

IMS with other units

Efficient, rational and appropriate use of funds

• Monitoring and evaluation of Fund resources

• electronic-New Government Accounting System( e-NGAS) reports/Work and Financial Plan Database System(WFPDB) • Develop feedback mechanisms for fund

utilization at regional level

• Installation of e-NGAS in all regions

Field

Surveillance(FS )/ Planning Division

Source: IMS, DOH

Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt

Formatted: Indent: Before: -5.4 pt, Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: Not at 36 pt

Formatted: Bulleted + Level: 1 + Aligned at: 18 pt + Tab after: 36 pt + Indent at: 36 pt, Tabs: 18 pt, List tab + Not at 72 pt

(17)

The following framework is then suggested for an integrated Philippine Health Information System:

Figure 2

HEALTH AND VITAL STATISTICS Vital Statistics National Health Account HEALTH DATA WAREHOUSE HEALTH SYSTEMS MANAGEMENT

Local Health Systems Development

Health Care Financing

International Health Cooperation Management HEALTH SERVICE DELIVERY Public Health Disease Surveillance Hospital Operations and Management HEALTH SYSTEM INFORMATION Human Resources Management Information Resources Management Logistics Health Facilities Executive Support System

Decision Support System Demographic and

Health Surveys

KNOWLEDGE SHARING BEST PRACTICES / LESSONS LEARNED

PERFORMANCE METRICS

FRAMEWORK FOR THE DEVELOPMENT OF THE

PHILIPPINE HEALTH INFORMATION SYSTEM

Health Emergencies Response

PORTALS (EXTRANET/INTRANET) HEALTH RESEARCH Health Regulation

(18)

It is noted that in a DOH Health Information System (HIS) Integration Workshop on January 16 -17 2007, the following guidelines in constructing a Philippine Integrated Health Information System(PIHIS) was suggested:

Build on existing health information systems to integrate content and information functions,

Develop/Strengthen policy and regulation for data submission and/or information gathering,

Compliance to government policy on ICT, and

Compliance to DOH Department Order 2005-0032 – Standard Operating Procedure and Guidelines on ICT Works in the DOH.

These guidelines are based on the conceptual framework of bringing together data from different information systems, to share and disseminate them, and to ensure that health information is used rationally, effectively and efficiently to improve health action or decision-making process. Additional guidelines are:

Compliance to the General Standards on Statistical Information Dissemination (GSSID) per NSCB Board Resolution No. 8, s. 1999, and,

Compliance to the IMF Data Assessment Quality Framework (DQAF). Furthermore, the following strategies were enumerated:

Standardization – common data indicators, definitions, data formats, data transmission protocols

Data Warehousing – central data repository

Process Integration – eliminate redundancies and/or duplications.

Integrated Data Management

Integrated Human Resource

Integrated Financial Resources.

It must be emphasized, though, that the integration workshop focused only on the information systems of DOH which are mainly administrative records and did not include the other health and nutrition data being generated by other government agencies auch as the NSO and the NSCB.

The Philippine Statistical Development Plan 2005-2010

The Philippine Statistical Development Program (PSDP) 2005-2010 serves as the blueprint of all statistical activities that will generate the data requirements for all international and national development plans and programs. The PSDP chapter on Health and Nutrition is guided by the above development priorities for the health and nutrition sector.

Table 2 depicts the statistical framework for the health and nutrition sector in the PSDP 2005-2010. The framework has 6 components. These are: health status, health resources, health services, nutritional status, nutrition resources, and nutrition services. These components correspond to the major areas of concern and areas where the indicators to be used in monitoring will be identified. Thus, the framework shall serve as a basis for data production and dissemination as well as for coordination among the agencies producing the data.

(19)

Table 2. Statistical Framework on Health and Nutrition Sector/Components/

Sub-Components Key Indicators

HEALTH Health Status

Mortality Life expectancy

Proportion surviving from birth by sex

Proportion population 65 and over

Crude Death Rate

Infant Mortality Rate 2/

Child Mortality Rate

Under-Five Mortality Rate 2/

Maternal Mortality Ratio 2/

Causes of Mortality

Death rates for selected causes of deaths Morbidity Incidence of Specific Notifiable Diseases

No. of bird or avian flu cases

Causes of Morbidity

Fully Immunized Children

Proportion of 1 year-old children immunized against measles 2/ HIV prevalence among 15-24 year old pregnant women 2/

Number of children orphaned by HIV/AIDS 2/

Prevalence and death rates associated with malaria 2/ Proportion of population in malaria risk areas using effective

malaria prevention & treatment measures 2/

Prevalence & death rates associated with tuberculosis 2/ Proportion of tuberculosis cases detected & cured under directly

observed treatment short course (DOTS) 2/

Condom use rate of the contraceptive prevalence rate 2/ Prevalence of Specific Drug and Substance Abuse Proportion of population with access to affordable essential

drugs on sustainable basis 2/

Reported Cases of Drug Dependency

DOH-retained and Local Government Unit- hospitals selling low-priced drugs 1/

Rate of increase / decrease in the number of mental health facilities upgraded 1/

Proportion of households with Sanitary Toilet Facilities Environmental

Sustainability Proportion of population with sustainable access to improved water source 2/

Proportion of urban population with access to improved sanitation 2/

Disability Prevalence of Disability

Causes of Disability

Health Resources

Facilities No. of government hospitals provided with training to improve their service capabilities 1/

No. of licensed hospitals 1/

Ratio to Population of Health Facilities

Manpower Proportion of births attended by skilled health personnel 2/ No. of government doctors, nurses, dentists & midwives

(20)

Sector/Components/

Ratio to Population of Health Manpower

Financing Total Health Expenditure

Share of Health Expenditure to GNP and GDP

Health Expenditure by Source of Funds

Health Expenditure by Use of Funds

Gross Value Added on Health

Per Capita Health Expenditure

Health Services (Provision and Utilization)

Health R & D No. of health & population related reaseach and development utilized 1/

Promotive Percentage of Population Availing of Health Services by Type Preventive Percentage of the Population Covered by Health Insurance 1/ Curative Percentage of population availing of health services by type of

service

Rehabilitative Percentage of population using health facilities Overall satisfaction with health facilities and services

NUTRITION Nutrition Status

Prevalence of Prevalence of underweight children under 5 years of age 2/ Malnutrition Prevalence of underweight adolescents

Prevalence of underweight other age group

Prevalence of underweight-for-age, underheight-for-age, underweight-for-height; overweight and obesity Prevalence of low birthweight infants

Proportion of population below minimum level of dietary energy consumption 2/

Prevalence of low birthweight infants Prevalence of CED, overweight and obesity

Prevalence of Vitamin A deficiency Prevalence of

Micronutrient Deficiency Prevalence of anemia

Prevalence of Iodine deficiency

Food and Nutrient Intake Per Capita Energy/Nutrient Intake

Percent nutrient adequacy

Per capita food intake (total, by food groups, food source)

Per capita consumption per day

Per Capita Food Supply (per year, per day, per day energy, per day protein, per day fats)

Total Domestic Supply by Major food Group

Prevalence of hypertension

Prevalence of high total serum cholesterol Prevalence of

nutrition-related risk factors to chronic degenerative

disease Prevalence of high triglyceride

Prevalence of low HDL-c

Prevalence of high LDL –c

Prevalence of high fasting blood sugar among adults Prevalence of females with high waist-hip ratio Prevalence of

Breastfeeding (BF) and Complementary Feeding

Prevalence of exclusive breastfeeding (BF) among 0-6 monts old children

Proportion of children not breastfed among 0-24 months Proportion of children receiving breast milk + water only among

(21)

Sector/Components/

Proportion of children receiving breast milk + water-based liquids/juice among 0-6 and 6-9 months old children

Proportion of children receiving breast milk + other milk among 0-6 and 6-9 months old children

Proportion of children receiving breast milk + complementary food among 0-6 and 6-9 months old children

Nutrition Resources

Financing NGA, NGO and LGU funding for nutrition programs/activities Proportion of Government Expenditures for Nutrition

Programs Facilities No. of hospitals

No. of RHUs and BHS

No. of weighing stations

No. of weighing scales

Ratio to Population of Manpower and Facilities Manpower No. of medical personnel

No. of dietitians, nutrition officers, nutrition action officers, barangay nutrition scholars, barangay health workers Ratio to population of manpower and facilities (nutrition

related activities/program by government and private sector)

Nutrition Services (Provision & Utilization)

Nutrition R & D No. of health & population related research and development utilized 1/

Promotive Preventive

Proportion of Population Availing Various Nutrition Programs/Services by Type

Curative Rehabilitative

Percent of 0 - 5 year old children given vitamin A supplements Percent of households using iodized salt

Source: Philippine Statistical Development Plan 2005-2010

Notes: 1/ Indicators to monitor MTPDP Goals/Priorities 2/ Indicators to monitor * - not available (what is available is percent of households with per capita energy less than 100% adequacy based on the 1993 National Nutrition Survey)

The Philippine Statistical System

Government and official statistics in the Philippines are generated by a decentralized statistical system called the Philippine Statistical System(PSS). This system is a government-wide decentralized system of government agencies that provide statistical information and services to the public. Statistical services include the gathering, compiling, processing, aggregation, analysis and dissemination of data. The set up is decentralized with the following main government agencies:

• the National Statistical Coordination Board (NSCB) which is the policy-making and coordinating body for the statistical system;

• the National Statistics Office (NSO) which is the single general purpose statistical agency conducting the censuses such as the Census of Population and Housing, the surveys such as the Labor Force Survey, and the civil registration of the country;

(22)

• the Statistical Research and Training Center (SRTC) which is the statistical research and training arm of the system;

• Other major statistical agencies such as the Bureau of Agricultural Statistics (BAS) and the Bureau of Labor and Employment Statistics(BLES) ;and,

• all the departments, bureaus, offices, agencies and instrumentalities of the National Government and Local Government and Government Owned and Control Corporations and their subsidiaries that are engaged in statistical activities either as their primary functions or part of their administrative or regulatory functions.

The following is the structure of the system: Figure 3

The official statistical unit of the DOH, the National Epidemiology Center (NEC), is DOH’s focal point for the PSS under other departments’ statistical units. Being DOH’s focal point, it should represent the statistical concerns of the DOH as a whole. There are at present, however, other units at the DOH that generate health statistics, e.g., Bureau of Health Facilities and Services, that may be considered as part of this system but are not actively involved in the PSS. The creation of an integrated Philippine Health Information System (PHIS) aims to correct this situation. This PHIS framework as presented in Figure 2 is envisioned to be part of the PSS in Figure 3.

4 Government Agencies Generating Health and Nutrition Statistics

As presented in the different frameworks in the previous chapters, many government agencies are involved in generating health and nutrition statistics. This chapter presnts the different government agencies and the important data systems they maintain.

(23)

The Department of Health

The DOH remains as the major source of data for the health sector. Its statistics are mostly derived from administrative reporting forms regularly furnished by public hospitals, rural health units and other health units in the lower administrative units of government. The Philippine Health Statistics (PHS) is a report of the NEC of DOH. It provides a summary of statistical data on births, deaths and notifiable diseases registered and reported through the Notifiable Diseases Registry of the FHSIS submitted by the RHUs and BHSs. Diseases, injuries and health conditions are coded using the International Classification of Diseases version 10 (ICD-10).The different data systems being generated by different offices in DOH may be classified as:

1. Health Service Delivery Systems

The FHSIS serves as the major source of data for the DOH. The system provides information on the different public health programs such as: Maternal and Child Health; Nutrition; Family Planning; Expanded Program on Immunization; Dental Health; Communicable Disease Prevention and Control(TB, Malaria, Schistosomiasis, Leprosy); Environmental Health; Vital Statistics (Natality, Mortality, Population); and, Notifiable Disease Reporting System. Data are provided by the local field health personnel through the regional and provincial health offices, and consolidated at the Central Office. These are presented by province, city and region in a publication of the same title.

The Health Management Information System (HMIS) consists of several sub-systems, two of which are the HOMIS and the Rural Health Unit Information System (RHUMIS).The HOMIS generates information on hospitals to support the delivery of hospital services and the management of the hospital.The RHUMIS is a public health information system designed for the rural health units to efficiently and effectively monitor patient cases. A plan is to create a Unified Health Management Information System (UHMIS) which shall report statistical data of diseases/diagnosis from HOMIS and non-HOMIS users on a daily basis for the Alert System and sending of data to the DOH central storage or database.

Surveillance systems which include the two major disease surveillance systems that provide information on notifiable diseases are the Weekly Notifiable Disease Reporting System (WNDRS) which comes from the FHSIS and the National Epidemic Sentinel Surveillance System (NESSS).

• The WNDRS provides information on 17 diseases(Anthrax, Cholera, Diphtheria, Viral Encephalitis, Viral Hepatitis, Leprosy,Leptospirosis,Malaria, Measles, Viral Meningitis, Neonatal Tetanus, Non-neonatal Tetanus, Meningococcal Infections, Paralytic Shellfish Poisoning, Rabies, Typhoid and Paratyphoid fever, Whooping cough or Pertussis) and 7 syndromes(Acute Flaccid Paralysis, Acute Hemorrhagic Fever Syndrome, Acute Lower Respiratory Tract Infection and Pneumonia, Acute Watery

(24)

Diarrhea, Acute Bloody Diarrhea, Food Poisoning, Chemical Poisoning).

• The NESSS is a hospital-based system that yields information on admitted cases in sentinel to monitor the occurrence of 14 infectious diseases with outbreak potential. These included laboratory-diagnosed diseases (Cholera, Hepatitis A, Hepatitis B, Malaria, Typhoid Fever) and clinically-diagnosed diseases (Dengue Hemorrhagic Fever, Diphtheria, Measles, Meningococcal Disease, Neonatal Tetanus, Non-neonatal Tetanus, Pertussis, Rabies, Leptospirosis).

Registries (HIV and AIDS, Diabetes, Injuries, Cancer, Persons with Disabilities (PWD), Tubercolosis (TB), Renal Diseases) which are also maintained by various professional societies and non-government organizations.

Philippine Malaria Information System (PMIS) is a relatively new system which was piloted in 27 project sites, could also be used by other provinces in 2005 and is yet to be deployed in other provinces. It uses a license-free software and runs in any Windows operating system. Its indicators include SPR, API, age-gender-species, % coverage of mosquito net, % coverage of households sprayed. Malaria data for FHSIS can be extracted from PMIS and, thus, it can be integrated into FHSIS. Future enhancements to PMIS are web-based reporting, and use of mapping facilities such as HealthMapper.

2. Health Regulation Systems

BIIS consisting of Health Product Regulation and Health Product Establishment Regulation

DTOMIS which includes DOHLIS and Health Facilities and Service Regulation

Health Devices Regulation

3. Health Governance Systems

WFPDS which collect data on plans and programs of the DOH Central Office , the Centers for Health Development(CHDs), DOH hospitals, and Attached agencies. Some of the data include: number of health products/establishments/ facilities/devices registered/licensed/ accredited, number of policies/standards/guidelines formulated, number of trainings conducted/attended in persondays (men/women), number of technical assistance provided in person-days, number of LGUs provided with logistics/technical assistance, number of Botika ng Barangay(BNBs) established, number of low cost drugs made available in F1 sites, number of Inter-Local Health Zones (ILHZs) developed as well as hospital data such as number of admissions, number of discharges, number of patient days, number of outpatients served, number of major/minor operations, number of

Formatted: Indent: Before: 36 pt, Hanging: 27 pt, Bulleted + Level: 3 + Aligned at: 162 pt + Tab after: 180 pt + Indent at: 180 pt, Tabs: 36 pt, List tab + Not at 117 pt + 180 pt

(25)

laboratory examinations done, number of radiological procedures done, number of prescriptions filled.

National Health Atlas is a facility-mapping software of all rural health units and government hospitals in the country. Health human resource complement, health care services available and equipment are included in the database.

Philippine Local Health Information System (PLHIS) which provides information from LGUs

Others (eNGAS, LMIS, PIS, eProcurement, Document Tracking Information System (DTIS), Contract Distribution System of Core Essential Drugs which is being implemented in phases)

4. Other systems

Community Based Management Information System (CBMIS)

PhilHealth systems

The DOH also conducts surveys. These include Prevalence Surveys (TB, Leprosy, Schistosomiasis) and the National Health Surveys in 1978, 1981 and 1987 which were eventually stopped when the NSO conducted the National Demographic and Health Surveys (NDHS) starting 1993.

The Food and Nutrition Research Institute

The Food and Nutrition Research Institute (FNRI) remains the major source of data on nutrition. It conducts the National Nutrition Survey every five years. Data generated through this survey include the nutritional food situation of the country, per capita food intake in grams and in nutrient equivalent, anthropometric data, extent of some nutritional deficiencies among various age groups of the population, and food menus fro the poverty statistics being generated by NSCB.

The National Nutrition Council

The National Nutrition Council (NNC), the highest policy making and coordinating body on nutrition, is under the DOH and is mandated to formulate national nutrition policies and coordinate the policy formulation, planning, monitoring and evaluation, resource generation and mobilization for nutrition improvement. Its additional mandates are: to address food insecurity by being the focal agency for Food Insecurity and Vulnerability Information and Mapping Systems (FIVIMS), to address hunger as the lead agency to ensure achievement of MDG goals and targets on hunger and malnutritionto, and to ensure that hunger-mitigation measures are in place. Data being generated by NNC include indicators of nutrition resources (financing, manpower, facilities) and nutrition services (promotive, curative, preventive). Specific indicators are: ratio to population of nutrition manpower and facilities, proportion of government expenditure to nutrition program, consolidated data from Operation timbang received from local nutrition committees. The latter is used for the ranking of mutritionally depressed communities.

Formatted: Indent: Before: 36 pt, Hanging: 27 pt, Bulleted + Level: 3 + Aligned at: 162 pt + Tab after: 180 pt + Indent at: 180 pt, Tabs: 36 pt, List tab + Not at 117 pt + 180 pt

Formatted: Indent: Before: 36 pt, Hanging: 27 pt, Bulleted + Level: 3 + Aligned at: 234 pt + Tab after: 252 pt + Indent at: 252 pt, Tabs: Not at 252 pt

(26)

The Philippine Health Insurance Corporation

PhilHealth is the agency under the DOH that provides and maintains database systems on health insurance and financing and accreditations of health providers and health facilities.

The National Statistics Office

The NSO, as mandated by the Civil Registry Law, generates vital health statistics such as marriages, births, deaths, infant deaths, foetal deaths, maternal deaths, and mortality by leading causes.

o The NDHS which is undertaken by the NSO in collaboration with the University of the Philippines Population Institute (UPPI), DOH, Commission on Population (POPCOM), National Economic and Development Authority (NEDA), and the NSCB, provides national and regional estimates of levels and trends of fertility as well as examines the differentials and determinants of fertility. It also yields information on family planning, childhood and adult mortality, maternal and child health, and knowledge and attitudes related to HIV/AIDS and other sexually transmitted infections. The National Health Survey of DOH was incorporated in the NDHS starting 1993.

o The annual Maternal and Child Health Survey (MCHS) provides information on the coverage and effectiveness of the maternal and child health programs of the DOH at the regional level.

o The Family Planning Survey (FPS) provides data on prenatal and postpartum care, protection at birth against neonatal tetanus, breastfeeding, and immunization.

The National Statistical Coordination Board

The NSCB produces the Philippine National Health Accounts (PNHA) with the following indicators: total health expenditure at current and at constant prices, health expenditure per capita at current and at constant prices, share of health expenditure to GNP and GDP, health expenditure by source of funds, health expenditure by use of funds, and selected national health accounts indicators compared with Asian countries.

Annex 1 provides a matrix of available health statistics available in the DOH while Annex 2 provides a matrix of Matrix of Available Health and Nutrition Statistics in the Philippine Statistical System.

It is noted that health and nutrition statistics come from various sources which operate on systems which are independent of one another. Thus, there is a need to improve, harmonize, and utilize existing data generation systems that may provide the relevant key health and nutrition statistics and indicators that will help monitor and assess the attainment of expected outcomes.

Formatted: Indent: Before: 18 pt, Bulleted + Level: 2 + Aligned at: 54 pt + Tab after: 72 pt + Indent at: 72 pt, Tabs: Not at 72 pt

(27)

5 Previous Studies on the Assessment of Health Information in the

Philippines

The assessment being presented in this report is not the first one done for the Philippines. Many studies have already been done. This chapter shall presentg the results of these previous assessments.

Past Reviews/ Assessment of Health Statistics and Information System in the Philippines

Studies assessing health information systems were done in the past. Aguilar (1976) conducted a study to develop a Health Information System in the Philippines in the 70s. The proposed HIS shall have the following features specific subsystems to answer information requirements of activities and programs of the DOH which when viewed in its entirety, shall be so integrated to promote and enhance DOH objectives. It shall provide a mechanism that will effectively connect the data gathering with the information needs of the different management levels through the installation of a database that contains data gathered from the field, data do not necessarily have to be centrally stored; they could be situated in different units in the department; equipped with the capabilities to transform these data into information as required by management and to transmit these to whoever needs them. The database shall employ computers for data processing and storage, and communication facilities as the situation may warrant. The study recognized that problems in HIS development concern the highly dynamic environment within which the HIS must operate, the peculiar problems the Department of Health has as the agency primarily involved in HIS development and the difficulty of applying the MIS concept to situations involving health program and evaluation.

Pons and Schwefel (1993) used the Goal Oriented Project Planning (GOPP) methodology determine essential elements in strengthening the Health and Management Information System (HAMIS) in the Philippines. Highlights of this planning strategy are:

• planning by Filipino nationals mainly

• participation by various professional groups with different levels of responsibility

• use of visualization techniques

• smooth consensus finding and democratic decision rules.

The study identified the core problem in health care management as an inefficient and ineffective health and management information system. Six major causes were identified:

• information gaps • underutilization of data • excessive generation of data • poor reliability and validity of data • lack of skills in information management • lack of cost-effectiveness of health management.

Jayasuriya (1994 ) in studying HIS in the Philippines, reported the following:

Formatted: Indent: Hanging: 36 pt, Bulleted + Level: 1 + Aligned at: 36 pt + Tab after: 54 pt + Indent at: 54 pt, Tabs: 36 pt, List tab + Not at 54 pt

(28)

1. The Health Services in the Philippines underwent a major change in their organization and structure following the devolution of the delivery of services to LGUs.

2. Information systems development were to a great extent determined by the management systems in place and the most extensive use of information is in, planning and controlling.

3. Routine information systems were expensive to establish and maintain and if the validity of some information is questionable it is nonsensical to submit it to levels where action cannot take place.

4. The assessments of the existing systems identified deficiencies that were found in most HIS. These were the existence of major gaps in information, the inappropriateness of the available information for the needs and most evidently that information is not utilized for management at most levels.

Marcelo et. al.( 2004) did an evaluation study in three of six pilot sites, i.e. Samar province, Baguio City and Cotabato City of the Decentralized FHSIS (DFHSIS). This study discovered that the DFHSIS reduced the number of required national indicators collected by local health personnel and simplified the data flow as intended. For these reasons, the DFHSIS was preferred over the Modified FHSIS (MFHSIS). Despite this however, the new system did not generate enough information needed by the national program managers. Furthermore, it did not result into better data accuracy, timeliness, and completeness, nor did it encourage the implementors, i.e., local health personnel, to customize the system for their local health needs. The software component of the DFHSIS was considered incomplete by end-users and therefore not useful. Reasons noted for these problems include lack of policy or implementing rules and regulation, poor support systems and structures, lack of financing, and lack of capacities at the community level for health data utilization for program improvement.The same problems of inaccuracy, incompleteness, and delay that hounded the original FHSIS and MFHSIS also plagued the pilot implementation of the DFHSIS. Thus, it was recommended that the DFHSIS, as planned and implemented in the three pilot sites, not be adopted in other areas of the country unless fundamental management systems and structures at all health system are put in place.

Decentralization, participatory governance and the principles of the declaration of Primary Health Care are key concepts that should anchor a sound national health information system. The authors further recommend [1] an enhancement of capability building packages for local health personnel on health information systems management; [2] a review of the data model of the DFHSIS/FHSIS; [3] innovations in collection such as acceptance of barangay level data as soon as these are available; [4] automation of transaction systems to facilitate transmission to higher levels of the DOH; and [5] use of computerized tools to assist health units in understanding their own data through data clubs and integrating their analysis of health information into their barangay health plans. Such an approach will help make the DFHSIS a valuable asset not just for the DOH but also for the community, which it intends to serve. The role of the National Epidemiology Center must be sharpened as it takes the lead in managing the DFHSIS and ultimately, in setting directions in knowledge-based decision-making at all levels of health care.

(29)

While administrative reports and surveillance systems are in place, these are limited only to government-owned health facilities. Thus, only the surveys are able to capture the contribution of privately-owned health facilities. However, the estimates that result from these surveys are at best available up to the provincial level. Sub-provincial disaggregations are not available. Current initiatives to address the unavailability of local-level data include measuring LGUs health systems performance through the Organizational Performance Indicator Framework (OPIF) or through small area estimation. The latter has been applied but on vety limited health/information statistics.

Initiatives to address data quality assurance have led to the upgrading of health facilities to conform to effective management standards. Facilities with such standards are referred to as Sentrong Sigla. The upgrades include, among others, facilities for information systems. Another concept being promoted is the ILHZs which aims for better data collection and transfer from health facilities at municipal and provincial level.

Interagency on Health and Nutrition and PSDP 2005-2010 Assessment

The Inter-Agency Committee on Health and Nutrition Statistics (IAC-HNS) was created by the NSCB to tackle issues on health and nutrition statistics. The IAC, co-chaired by the DOH provided inputs to the PSDP through an assessment of the the different data sources, and recognized the need to improve and synchronize/harmonize the various health information systems. The PSDP specifically cites the problems of the FHSIS, PHS, and the NESSS of the DOH. Issues on completeness, timeliness, quality/accuracy, and relevance of health and nutrition statistics, especially those monitored in the MTPDP and in global concerns like the MDGs, need to be resolved. The NSO also recognizes problems in its vital statistics in some areas in the country, which need to be improved..

The PSDP, following one of its key result area, shall maximize use of information technology in data collection, processing, analysis, dissemination and archiving to enable faster and wider utilization of data and promote transparency, information sharing and user confidence on official statistics. This particular key result area aims to capitalize on existing developments in information technology, specifically in enjoining government agencies to establish websites and develop statistical information systems that would enable them to upload/share statistical information available in the agency. The development of interactive national statistical databases shall be promoted for different sectors and to develop innovative statistical software that could be used within the PSS. An improvement on the information systems of different agencies is likely to be expected.

The PSDP programs designed to address issues and challenges towards improving the generation, dissemination and utilization of quality statistical information for health and nutrition, are as follows:

Generation and improvement of the timeliness, accuracy and reliability of statistics, especially those that address the requirements of the MTPDP, MDG especially on the estimation of Maternal Mortality Rate (MMR) and improvement of Infant Mortality Rate (IMR), Under Five Mortality Rate (U5MR), life expectancy, dissemination of a single figure for IMR;

Comment [FVNDL1]:

Mention of NSO (only) should not be under IAC..

Philippine Health Information System: Review and Assessment. February - July 2007

Health Metrics Network

Philippine Health Information System:

Review and Assessment

February - July 2007

Table of contents

List of Acronyms

List of Tables and Figures

1

Background

2

The Philippines

3

Frameworks for Generating Health and Nutrition Statistics

FRAMEWORK FOR THE DEVELOPMENT OF THE

PHILIPPINE HEALTH INFORMATION SYSTEM

4

Government Agencies Generating Health and Nutrition Statistics

5

Previous Studies on the Assessment of Health Information in the

Philippines