MODULE 5

Community
Development
and
e-Health
 Working with Groups toward Community Development

Community, Health, Development

WHO defined COMMUNITY as

 “A social group determined by geographical boundaries and/ or common values
and interests.”
WHO defined HEALTH as
 “A complete state of physical, mental, and social well-being and not merely the
absence of disease or infirmity.”

Development defined as:

 A change, a process of unfolding from a un- manifested condition to more
advanced or effective condition.
 In these processes the qualities reveals possibilities, capabilities emerge and
potentials are realized.
 A multi-dimensional process involving major changes in social structures,
population, attitudes and national institutions, as well as the acceleration of
economic growth, reduction of inequality and eradication of absolute poverty.
 The goal of development is to have a better life. (Teodoro, 1978)
 According to NEDA: Development includes consumption of basic goods and
services such as health and education and the generation of more productive
employment and reduction of inequalities in income and access.

Community Development

 Is a process designed to create a condition of economic and social progress for

the whole community with its active participation and fullest possible reliance on
the community initiatives
 This is achieved through:
 Democratic procedures
 Voluntary cooperation
 Self-help
 Development of indigenous leadership
 Education
 How can we say that the community is developed?
 the people are working together
 have the vision
 know how
 capabilities and experience to confront and solve problems of under
development
 Community development principle is committed to the services of the people to
become self-reliant.
  Therefore, the health of the community depends on its ability to work toward
common health goals and upon adequate distribution of health resources to all
members.
 Furthermore, organized community effort to prevent disease and promote health
is valuable and effective.
 A group of people in a community reaching a decision to initiate a social action
process (planned intervention) to change their economic, social, cultural, or
environmental situation.
 Advocates “self-help”, voluntary participation and cooperation of the people.

Approaches to community development

1. Welfare Approach

 This is an immediate and/ or spontaneous response to ameliorate the

manifestation of poverty, especially on the personal level.
 Assumes that poverty is caused by bad luck, natural disasters and certain
circumstances, which are beyond the control of the people.

2. Modernization Approach

 This is also referred to as the project development approach.

 Introduces whatever resources are lacking in a given community.
 Also considered a national strategy, which adopts the western mode of
technological development.
 Assumes that development consists of abandoning the traditional methods of
doing things and must adopt the technology of industrial countries.
 Believes that poverty is due to lack of education, lack of resources such as
capital and technology.

3. Transformatory/ Participatory Approach

 This is the process of empowering/ transforming the poor and the oppressed
sectors of society so that they can pursue a more just and humane society.
 Believes that poverty is caused by prevalence of exploitation, oppression,
domination and other unjust structure.
Community Health Organizing Utilizing COPAR

HRDP

 was developed and sponsored by the Philippine Center for Population and
Development (PCPD)
 PCPD is a non-stock, non-profit institution, which serves as a resource center
assisting institutions and agencies through programs and projects geared toward
the social human development of rural and urban communities
 formerly known as The Population Center Foundation
 to make health services available and accessible to depressed and underserved
communities in the Philippines

History of HRDP

 Community organizing as the main strategy to be employed in preparing the

communities to develop their community health care systems and the
establishment of community health organization to manage the community health
programs.
 Organizing work in the communities was done in 3 phases.
 PAR as fascinating strategy for maximum community involvement through
collective identification and analysis of community health problems and collective
health action.
 Available funds to finance community initiated projects.

HRDP I
 Trained the faculty, medical/ nursing students to provide health care services to
the far flung barrios because of lack of man power for health services at the
same time that similar activities fulfilled the curricular requirements of the
students for public health.
 The PCPD provides seed money for the income generating projects.
 Short-term service.
HRDP II
 The 2nd cycle uses the same strategy but the program could not be sustained by
the schools or hospitals and the income- generating projects eventually become
the hindrance to the goal of achieving the health program because the people
tend to be more interested in the income generated by the projects.
 Both HRDP I and HRDP II have brought about some changes in the community
life of the people
 Established basic health infrastructure; basic health services were increased;
there were trained workers and organized health groups to take care of the
needs of the community

HRDP III
 PCPD refined the program and resulted to what is now called HRDP III, which
has these unique features:
 Comprehensive training of the staff and faculty of the participating agency in
which the community work was initiated
 Periodic training program and regular assistance to the participating agency were
provided to strengthen the health outreach program to become community
oriented
 PHC as the approach with which all nursing/ medical students, their CI’s and
indigenous health workers are trained for community health work and around
which all other project inputs will revolve

Community Organizing Participatory Action Research (COPAR)

 A social development approach that aims to transform the apathetic,

individualistic, and voiceless poor into a dynamic, participatory and politically
responsive community.
 A collective, participatory, transformative, liberated, sustained and
systematic process of building people organizations by mobilizing and
enhancing the capabilities and resources of the people for the resolution of their
issues and concerns towards affecting change in their existing oppressive and
exploitative conditions.
 A process by which community identifies its need and objective. Develops
confidence to take action in respect to them and in doing so extends and
develops cooperative attitudes and practices in the community. - Rose, 1967
 A continuous and sustained process of educating the people to understand and
develop their critical awareness of their existing condition, working with the
people, collectively and efficiently on their immediate and long term problems,
and mobilizing to pursue to develop their capability and readiness to respond and
take action on their immediate needs toward solving their long term problems.
- A Manual of Experience, PCPD
 a collective, participatory, transformative, liberative, sustained, and systematic
process of building people’s organizations by mobilizing and enhancing the
capabilities and resources of the people for the resolution of their exploitative
conditions - National Rural CO Conference, 1994
Community Organizing

 a continuous process of awareness building, organizing and mobilizing

community members towards community development

Importance of COPAR

 It’s an important tool for community development and people empowerment, as

this helps the community workers to generate community participation and
development activities.
 Prepares people/clients to eventually take over the management of development
programs in the future.
 Maximizes community participation and involvement; community resources are
mobilized for health development services.

Principles of COPAR

 People especially the most oppressed, exploited and deprived sectors are open
to change, have the capacity to change, and able to bring about change.
 COPAR should be based on the interest of the poorest sectors of the society.
 COPAR should lead to self-reliant community and society.

Process and Methods Used in COPAR

1. a progressive cycle of Action-Reflection- Action

- This begins with small, local, and concrete issues identified by the people
and the evaluation and reflection of actions taken by them.

2. Consciousness Raising
- through experiential learning
- Is central to the COPAR process because it places emphasis on learning
that emerges from concrete action and which enriches succeeding action.

3. Participatory & Mass- based

- it is primarily DIRECTED TOWARDS AND BASED IN FAVOR OF THE
POOR, the powerless and the oppressed

4. Group centered & not leader oriented

- leaders are identified, emerge and are tested through action rather than
appointed or selected by some external force or entity
Phases of COPAR Process

1. Pre-entry Phase - called the Social Preparation Phase

 The initial phase of the organizing process where the community organizer looks
for communities to serve or help.
 It is considered the simplest phase in terms of actual outputs, activities and
strategies and time spent for it.

2. Entry Phase - The IMMERSION Phase

 This includes the synthesis of the people on the critical events in their life,
motivating them to share their dreams and ideas on how to manage their
concerns and eventually mobilizing them to make collective action on these.
 This phase signals the actual entry of the community worker/ organizer into the
community.
 She must be guided by the following:
- Integration with the community
- Conduct of courtesy calls
- Conduct of information campaigns about the community health
development programs
- Conduct of the community study and social investigation
- Provision of health and health related services
- Identification of potential leaders
 ENTRY IN THE COMMUNITY AND INTEGRATION WITH THE PEOPLE
- before actual entry into the community, basic information about the area in
relation to the cultural practices and lifestyles of the people must be known
- establishing rapport and integrating with them will be much easier if one is
able to understand, accept or imbibe their community life
- living with the people, undergoing their hardships and problems and
sharing their hopes and aspirations help build mutual trust and
cooperation
- Recognize the role of local authorities by paying them visits to inform them
of their presence and activities.
- Health worker appearance, speech, behavior and lifestyle should be kept
in low profile and health workers should always serve as a role model.
- Avoid raising the consciousness of the community residents
- Work always with community member to identify potential leaders
 GUIDELINES IN CONDUCTING INTEGRATION WORK
- recognize the role and position of local authorities
- adapt a lifestyle in keeping with that of the community
- choose a modest dwelling which the people , especially the economically
disadvantaged will not hesitate to enter
- avoid raising expectations of the people; be clear with your objectives and
limitations
- participate directly in production process
 - make house calls and seek out people where they usually gather
- participate in some social activities

3. Core Group Formation Phase

 Once the community health nurse identifies the potential leaders, they are
formed into a core group.
 The core group will be given the role of community organizer.
- Integration with the core group members
- Deepening social investigation
- Training and education
- Mobilizing the core group

4. Organization-building Phase

 Entails the formation of more formal structures and the inclusion of more formal
procedures of planning, implementing, and evaluating community- wide activities.
 It is at this phase where the organized leaders or groups are being given
trainings to develop their KSA (knowledge, skills and attitude,) in managing their
own concerns/ programs.
 Other community members are encourage to join and form a community
organization
- Pre-organization building activities
- Organizing the barrio health committee
- Setting up community organization
 Training and education for the organization

5. Sustenance and Strengthening Phase

 Occur when the community organization has already been established and the
community-wide undertakings.
 At this point, the different committees set-up in the organization-building phase
are already expected to be functioning by way of planning, implementing and
evaluating their own programs, with the overall guidance from the community-
wide- organization.
 Strategies used:
- Education and training
- Networking and linking
- Conduct of mobilization on health and development concerns
- Implementation of livelihood projects
- Developing secondary leaders.

6. Phase-out

 the phase when the health care workers leave the community to stand alone
  this phase should be stated during the entry phase so that the people will be
ready for this phase
 the organizations built should be ready to sustain the test of the community itself
because the real evaluation will be done by the residents of the community itself

Activities of COPAR Process

A. PRE-ENTRY PHASE

 Preparation of the staff:

- Statement of objectives and realization of COPAR guidelines
- Development of criteria for site selection
- Site selection
- Setting of issues/ considerations related to site selection
- Preliminary Social Investigation (PSI)
- Community consultations/ dialogues
- Networking with LGU’s, NGO’s and other departments
 CRITERIA FOR SITE SELECTION:
- Is the community in need of assistance?
- Do the community members feel need to work together to overcome a
specific health problem?
- Are there concerned groups and organizations that the nurse can possibly
work with?
- What will be the counterpart of the community in terms of community
support, commitment and human resources?

B. Entry Phase

 Courtesy call to mayor, or the local government leader of the selected site.
 Courtesy call to the barangay level.
 Meeting with the “will be” foster parents of health care students.
 Appreciating the environment.
 Coordination/ dialogue/ consultation with other community organizations
 Self-awareness and Leadership training (SALT), action, planning
 General assembly.
 Preparation of survey forms.
 Actual survey.
 Analysis of the data gathered.

C. Core Group Formation Phase

D. Organization- building Phase

 Identifying problems.
  Spreading awareness and soliciting solution or suggestion.
 Analysis of the presented solution.
 Planning of the activities.
 Organizing the people to build their own organization.
 Registration of the organization.
 Implementing of the said activities.
 Evaluation.

E. Sustenance and Strengthening Phase

 Meeting with the organizational leaders.

 Evaluation of the programs.
 Re-implementing of the programs. (For unmet goals)
 Education and training.
 Networking and linking.
 Implementation of livelihood projects.
 Developing secondary leaders

F. Phase out

 Leaving the immersion site

 Documentation

Summary of Phases and Activities:

I. Pre-entry - preparation of the staff

- site selection

II. Entry - integration with the community

- courtesy call; information
- campaigns; identification of potential leaders

III. Core-group formation & - integration with core group

mobilization

IV. Organization-building - organizing barrio health committee

- setting up the community organization

V. Consolidation & expansion - networking & establishing linkages

phase - implementation of livelihood projects
- developing secondary leaders
Critical Steps in Building People Organization

1. Integration
 a community organizer becoming one with the people in order to:
- immerse himself in the poor community
- Understand deeply the culture, economy, leaders, history, rhythms and
lifestyle of the community.
 Methods of Integration includes:
- Participation in direct production activities of the people
- Conduct of house visits
- Participation in activities like birthdays, fiestas, wakes, etc.
- Conversing with people where they usually gather such as stores, water,
walls, washing streams, or churchyards
- Helping out in the household chores like cooking, washing the dishes, etc.

2. Social Investigation
 A systematic process of collecting, collating, analyzing data to draw a clear
picture of the community.
 Also known as community study.
 Pointers for the conduct of SOCIAL INVESTIGATION:
- Use of survey or questionnaires is discouraged
- Community leaders can be trained to initially assist the community
worker/organizer in SI
- Data can be more effectively and efficiently collected through informal
methods-house visits, participating in conversations in jeepneys and
others
- Secondary data should be thoroughly examined because much of the
information might already be available
- SI is facilitated if the CO/ community worker is properly integrated and has
acquired the trust of the people
- Confirmation and validation of community data should be done regularly
- SI is facilitated if the CO/ community worker is properly integrated and has
acquired the trust of the people
- Confirmation and validation of community data should be done regularly
- A systematic process of collecting, collating, analyzing data to draw a
clear picture of the community
- Also known as the COMMUNITY STUDY

3. Tentative Program Planning

 Community organizer to choose one issue to work on in order to begin organizing
the people.

4. Groundwork
 Going around and motivating the people on something or an issue.
 A time to spot and develop potential leader.
 The entry phase or sometimes called the social preparation phase.
 5. Meeting
 Core group formation.
 People collectively ratifying what they have already decided individually.
 The meeting gives the people the collective power and confidence.
 Problems and issues are discussed.

6. Role Playing
 To act out the meeting that will take place between the leaders of the people and
the government representatives.
 It is a way of training the people to participate what will happen and prepare
themselves for such eventually

7. Mobilization of Actions
 Actual experience of the people in confronting the powerful and the actual
exercise power.

8. Evaluation
 determines whether the goal is met or not
 The people reviewing the steps 1-7, so to determine whether they were
successful or not in their objectives.

9. Reflection
 dealing with deeper, on-going concerns to look at the positive values CO is trying
to build in the organization
 It gives the people time to reflect on the stark reality of life compared to the ideal.

10. Organization
 the result of many successive and similar actions of the people.
 Occurs when the community organization has already been established and the
community members are already participating in a community wide undertaking.

The Community Health Care Delivery

The Community Health Worker as a Documenter/Reporter

 the community health worker keeps a written account of services rendered,

observations, condition, needs, problems and attitude of the client in community
activities, accomplishments made etc.
 community workers takes responsibility to disseminate pertinent information to
appropriate authorities, agencies, and most especially to the client
 at the same time, the community worker develops the people’s capabilities to
keep/ maintain their recording and reporting system
Conflict Management

Conflict
 A state of disharmony between incompatible or antithetical persons, ideas, or
interests; a clash.
 Opposition between characters or forces in a work of drama or fiction, especially
opposition that motivates or shapes the action of the plot.
 A psychic struggle between opposing or incompatible impulses, desires, or
tendencies.

Causes of Conflict
1. Security
2. Inability to control self and others
3. Respect between parties
4. Limited Resources
5. Frustrations

Types of Conflict

1. Intra-sender
- conflict originates in the sender who gives conflicting instructions

2. Inter-sender
- arises when a person receives conflicting messages from one or more
sources

3. Inter-role
- occurs when a person belongs to more than one group

4. Person-role
- result of a discrepancies between internal and external role

5. Inter-person
- between people whose positions require interaction with other persons
who fill various roles in the same organization or other organizations

6. Intragroup
- occurs when a group faces new problem, when new values are imposed
on the group from outside, or when one’s extra group role conflicts with
one’s intragroup role

7. Intergroup
- common when two groups have different goals and can only achieve their
goals at the other’s expense
 8. Role-ambiguity
- condition where an individual do not know what is expected of them

9. Role-oriented
- individuals cannot meet the expectations placed on them

Stages of Conflict

1. Latent Conflict
- phase of anticipation
- It exists whenever individual, groups, organization or nations have
differences that bother one or the other but those differences are not great
enough to cause one side to act to alter the situation.
- There is not yet an outright conflict present but a number of factors exist
that create the conditions that could result in a conflict.

2. Perceived Conflict
- indicates cognitive awareness of stressful situation
- It exists when there is a cognitive awareness on the part of at least one
party that events have occurred or that conditions exist favourable to
creating overt conflict.
- Groups recognize that a conflict is emerging and starts to look for possible
explanation.

3. Felt Conflict
- presence of affective states such as stress, tensions, anxiety, anger,
hostility
- Organization, groups or individual become more internally cohesive.
- Other group in the organization are viewed with suspicion as outsider.
- Us versus them mentality begins to really take hold.

4. Manifest Conflict
- overt behavior resulting from the above three stages
- At this stage the conflicting parties are actively engaging in conflict
behavior which is usually very apparent to non-involved parties.
- Feelings of conflict are now translated into actions and words which could
either be constructive obstructive to problem solving process.

Reactions to Conflict

1. Sublimation
- a defense mechanism by which the individual satisfies a socially
prohibited instinctive drive through the substitution of socially acceptable
behavior.
2. Vigorous physical exercise

3. Increase efforts

4. Identification
- a person’s association with or assumption of the qualities, characteristics
or views of another person or group
- attribution to yourself (consciously or unconsciously) of the characteristic
of another person

5. Re-interpret goals

6. Substitute goals
- setting another goal

7. Rationalization
- a defense mechanism by which your true motivation is concealed by
explaining your actions and feelings in a way that is not threatening

8. Attention getting

9. Reaction formation
- a defense mechanism by which an objectionable impulse is expressed in
an opposite or contrasting behavior

10. Flight into fantasy

11. Projection
- the attribution of one’s own attitudes, feelings or desires to someone or
something as a naïve or unconscious defense against anxiety or guilt

12. Displacement
- unconscious defense mechanism whereby the mind redirects emotion
from a dangerous object to a safe object

13. Fixation
- a strong attachment to a person or thing especially such an attachment
formed in childhood or infancy and manifested in the immature or neurotic
behavior that persists throughout life

14. Withdrawal
- detachment as from social or emotional involvement

15. Repression
- the classical defense mechanism that protects you from impulses or ideas
that would causes anxiety by preventing them from becoming conscious
 16. Conversion
- repressed ideas conflicts or impulses are manifested by various bodily
symptoms, such as paralysis or sensory deficits that have no physical
cause
- a change in which one adopts a new religion, faith or beliefs

Approaches to Conflict Resolution

1. Accommodating
- the person neglects personal concerns to satisfy the concerns of others
- It is cooperative but unassertive.

2. Compromising
- the individual attempts to find mutually acceptable solutions that partially
satisfy both parties in reflects assertiveness and cooperation

3. Collaborating
- the individual attempts to work with others toward solutions that satisfy the
work of both parties it is both assertive and cooperative

4. Competing
- the person pursues personal concerns at another’s expense
- It is a power oriented mode that is assertive but uncooperative.
- The competition is aggressive and pursues one’s own goals at another’s
expense.

Conflict Management:

 Negotiation - is a strategic process used to move conflicting parties toward an

outcome.

Process/ Phases of Negotiation:

 PHASE 1- Establishing the issue and agenda
 PHASE 2- Advancing demands and uncovering interests
 PHASE 3- Bargaining and discovering new options – inflict resolution to both
parties; options to resolve
 PHASE 4- Working out an agreement
 PHASE 5- Aftermath – is the period following an agreement where parties are
expending the consequences of their decisions.
 Collaboration - is achieved through a developmental process. It is sequential yet
reciprocal and characterized by seven strategies and activities.

1. Awareness – makes a conscious entry into a group process, focus on goals of

convening together, generate definition of collaborative process and what it
means to team members
2. Tentative exploration and mutual acknowledgement
a. Exploration - disclose professional skills for the desire process; disclose
areas where contribution cannot be mace disclose values reflecting priorities;
identify roles and disclose personal values, including time, energy, interest and
resources.
b. Mutual acknowledgements - clarify each member’s potential contributions;
clarify member’s work style, organizational supports and barriers to collaborative
efforts.
3. Trust building – determines the degree to which reliance on others can achieve;
examines congruence between words and behaviors; set interdependent goals;
develop tolerance for ambiguity
4. Collegiality – defines the relations of the members with each other; define the
responsibilities and tasks of each; defines entrance and exit conditions
5. Consensus – determine the issues for which consensus; determine the process
for re-evaluating consensus outcomes
6. Commitment – realize the physical; emotional and material actions directed
toward the goal; clarify the procedures for re-evaluating commitment in light of
goal depends and group for deviance
7. Collaboration – initiate process of joint decision making reflecting the synergy
that results from combining knowledge and skills

Strategies of Conflict Resolution

1. Win – Lose
a. Position Power
b. Mental/ Physical Power
c. Failure to respond
d. Majority rule
e. Railroading
2. Lose – Lose
a. Compromise
b. Bribes
c. Arbitration
d. General Rules
3. Win – Lose
a. Consensus
b. Problem-solving

https://www.slideshare.net/mamirich12/community-health-care-development-process
Information Technology and Community Health

What is eHealth?

 E-health is an evolving field in the juncture of medical informatics, public health, and
business, stating to the health services and information distributed or heightened
through the Internet and associated technologies.
 In a broader sense, the term exemplifies technical progress along with state-of-
mind, an approach of thinking and an attitude for networked, global thinking, to
expand health care locally, countywide, and universal by using information and
communication technology.
 E-health encompasses all sorts of electronic health data exchange such as
Telemedicine, Tele-health etc.
 It also characterizes technological commitment towards global health care action.
 Simply understanding, E-health is the transfer of health resources and health care
by electronic means. It is the healthcare supported by electronics, informatics and
tele-communications.

According to World Health Organization (World Health Organization, n.d.) three

main core areas of E-health are:

1. Delivery of health information, for health professionals and health consumers,

through the Internet and telecommunications.
2. Using the power of IT and e-commerce to improve public health services, e.g.
through the education and training of health workers.
3. The use of e-commerce and e-business practices in health systems management.

What are the different E-health activities around the world?

 Endorsing and firming up the use of ICT (Information and Communication

technologies) in health development.
  Developing strategies and assessment agendas to help the member states select,
embrace, cope and estimate e-Health clarifications to support worthy governance
and investment verdicts.
 Providing supervision and technical provision to the Member States to incorporate
e-health solutions into their national e-health policies through a synchronized
multi-stakeholder and multi-sectoral approach.
 Monitoring and broadcasting on developments and inclinations in digital
improvement for public health to notify policy and practice in nations, and to report
frequently on the use of e-Health in the Region
 Supporting multi-sectoral partnership and management between diverse
organizations with a view to refining coordinated approaches for executing and
scaling up cost‐effective e-Health resolutions.

Characteristics of E-health:

The characteristics of e-health or what e-health should comprise of can be illustrated in

following 10 e’s. The 10 e’s of “e-health” (adopted from Eysenbach, 2001) are:

1. Efficiency

 One of the assurances of e-health is to upturn efficiency in health care, thus

reducing costs.
  One potential way of decreasing costs would be by dodging duplicative or
avoidable diagnostic or therapeutic intermediations, through improved
communication potentials between health care institutions, and patient
participation.

2. Improving the quality of care

 Increasing efficiency implicates not only decreasing costs but at the identical time
improving quality of services.
 E-health may improve the quality of health care by allowing comparisons between
diverse providers. It will also focus on quality assurance, aiming patient streams to
the finest quality suppliers.

3. Evidence-based

 E-health interventions must be evidence-based in the sense that their value and
competence should not be presumed but proven by laborious scientific
assessment. Yet, plentiful work still has to be done in this field.

4. Empowerment of consumers and patients

 By making the knowledge base of medicine and personal electronic records easily
available to users over the internet, e-health unseals new opportunities for patient-
centered medicine and facilitates evidence-based patient choice.

5. Encouragement

 E-health provides encouragement for a new link between the patient and health
expert, towards a true corporation, where choices are made mutually.

6. Education of physicians through online sources (ongoing medical education) and

consumers (health education, personalized preventive information for consumers)

7. Enabling information discussion and communication in a consistent way between

health care institutions.

8. Extending

 E-health extends opportunity of health care further than its conservative

boundaries.
 This is meant in both a topographical sense along within a conceptual sense.
 E-health also facilitates consumers to effortlessly achieve health services online
from international providers. These facilities can range from simple
advice/suggestions to more compound intermediations or medications.
9. Ethics

 E-health includes new forms of patient-physician communication, poses new

challenges, and pressures to ethical issues
 For example: online professional practice, informed consent, privacy and equity
issues.

10. Equity

 To make health care further justifiable is one of the assurances of e-health, but at
the same time there is a substantial risk that e-health might expand the gap
between the “haves” and “have-nots”.
 E-health is and should be equitably accessible to all the people, irrespective of
their age, race, gender, ethnicity etc.
 People, whose economic conditions are poor, people who lack skills, and access
to computers and networks, cannot use computers efficiently. As a result, these
patient populations (which would truly value the utmost from health information)
are those who are the least expected to benefit from developments in information
technology, except political trials ensure equitable access wholly. The digital gap
presently runs between rural vs. urban inhabitants, rich vs. poor, young vs. old,
male vs. female people, and among the neglected/rare vs. common illnesses.
Benefits of E-health:

 E-Health is the cost‐effective and protected use of facts and communication

technologies (ICT) in favor of health and health‐related fields.
 It covers more than a few interventions, together with tele-health, telemedicine,
mobile health (mHealth), electronic medical or health records (eMR/eHR), big
data, wearable’s, and even artificial intelligence.
 The role of e-health has been acknowledged as crucial in accomplishing supreme
health priorities such as universal health coverage (UHC) and the Sustainable
Development Goals (SDGs).
 eHealth conveys the promises and excitement of bringing e-commerce to health
care.
 It provides quick access to patient records and information for efficient health care.
 Reduced paper work, reduced duplication of costs etc. thus reducing the cost of
health care.
 Reduced medical errors and better clinical decision making.
 Better health care by improving all aspects of patient care, including safety,
effectiveness, patient-centeredness, communication, education, timeliness,
efficiency, and equity.
 Better health by encouraging healthier lifestyles in the entire population, including
increased physical activity, better nutrition, avoidance of behavioral risks, and
wider use of preventative care.

Limitations/challenges of E-health:

 The financial barrier in procurement

 Cost challenges in common
 Shortage of IT and clinical resources
 Trouble in learning and using the software
 Personnel costs
 Systematizing of all health information systems, from the time when the content
and arrangement of all health information systems should be standardized
 It might be time-consuming to bring up-to-date the EHR comprehensively
 The unavailability or lack of the basic infrastructure, such as internet connection
 The lack of applicable software
 Even though it saves time, the decline list of options in health information systems
may perhaps lack comprehensive information.

https://www.publichealthnotes.com/what-is-e-health-its-characteristics-benefits-and-
challenges/
Power of Data in Information

A data-centric approach to health care promises to deliver interventions more

proactively, leading to better outcomes and a shift to prevention.

Data is the driving force underpinning the Fourth Industrial Revolution; in health care,
the goal is to use data to achieve better, more personalized health outcomes and
ultimately, a shift towards prevention rather than treatment.

Trends are leading the rise of a new, data-centric approach to health care. An
organization’s ability to generate value depends on how effectively it can unlock the
power of data and generate insights by connecting, combining and securely sharing
data at greater scale than ever before.

1. Data will be better connected, combined and shared across the health
ecosystem

Data are being democratized and that means every health company is now a
data company. The goal must be to use these data to drive actions that lead to
improved health outcomes – better clinical outcomes, more efficient care delivery
or lower health care costs.

Today, health data are split between too many organizations to achieve usable
insights. No single company has access to the totality of relevant data that could
improve health outcomes. Companies equate data with intellectual property; they
treat them as a proprietary asset and resist wider disclosure. Limitations imposed
by regulatory frameworks also discourage data sharing. Ultimately stakeholders
can work around these barriers, but only if they can minimize risk and realize
mutual benefits from their data collaborations.

2. Nano medicine, sensors and artificial intelligence will be recognized as the

nervous system driving innovation

Technologies such as nano medicine, sensors and artificial intelligence (AI)

make it possible to decouple data collection from the traditional health care visit
and process massive amounts of health data in real time. As such, they
represent a new “nervous system” for receiving and transmitting health data that
makes it possible to deliver convenient care anytime, anywhere.
 It’s not just about which organization develops the best-in-class nano devices,
connected devices or algorithms. The organizations that succeed will be the ones
that best adapt their business models to these technologies, with an emphasis on
interoperability and turning data into actions and economic results.

https://www.ey.com/en_gl/life-sciences/five-ways-the-power-of-data-will-improve-health-
outcomes

Philippines: Developing an eHealth infrastructure

In 2019 alone, four house bills on eHealth were filed with the House of Representatives
of the Republic of the Philippines ('the House'). The most prominent of these measures
is House Bill No. 8 ('HB 8'), which seeks to establish the national health passport system.
Mary Thel Mundin, Partner at Gatmaytan Yap Patacsil Gutierrez & Protacio (C&G Law),
discusses the benefits and concerns surrounding the development of an eHealth
infrastructure, and considers why this infrastructure may be deemed necessary.

The current state of Philippine healthcare and the development of eHealth in the
Philippines

When it comes to the availability of healthcare services, Filipinos often experience a crisis
in confidence brought about by various factors, such as high cost, poor accessibility, and
lack of patient data or information.

High cost
A recent study shows that 40% of Filipinos are unsure whether they can pay for their
medical bills, while 35% do not know whether they can afford regular check-ups. In a
country where more than half of health spending comes from out of pocket payments, this
uncertainty greatly deters citizens from getting necessary healthcare.

Poor accessibility
According to the Philippine Department of Health ('the DOH'), only 13% of all healthcare
providers and 40% of all tertiary hospitals are located in rural areas. As a result, 70% of
the population in these places have little to no access to healthcare services. However,
even where health care is available, access is not so easily obtained. On average, it takes
a Filipino 39 minutes to travel to the nearest health facility- minutes that can mean life or
death in the worst instances.

Lack of patient data or information

Moreover, even assuming healthcare is affordable and accessible, a problem still stems
from the fact that patient data or information, which are necessary in order to provide
adequate healthcare, is often incomplete, inaccurate, misplaced, or at times, simply
unknown. Different healthcare providers all too often fail to harmonise their different data
formats, therefore compromising the quality of information. Additionally, bureaucracy
exacerbates the poor processing of data, with some estimates pegging data validation at
more than a year to reach various levels.

Proposed solution
One key solution to the healthcare problems that has recently been gaining traction, is
the development of a framework for eHealth in the Philippines. The DOH has taken the
lead on this front, spearheading initiatives such as the Philippine eHealth Strategic
Framework and Plan 2014-2020 and National eHealth Programme, which aim to
capitalise on IT to provide better healthcare services. On the back of these efforts, the
DOH has also issued administrative issuances, which set mandatory health data
standards to ensure interoperability and to identify the respective roles and
responsibilities of the relevant government agencies.

On the legislative side, lawmakers have introduced several bills to develop the country's
eHealth system and services. Under HB 8, all Filipino citizens will be entitled to a health
passport that shall contain their medical history, health-related benefits, and patient rights
and privileges. Additionally, the health passport can be used for free medical and dental
diagnostic tests in government hospitals. HB 8 also provides for other health infrastructure
programmes, such as the digitisation of health centre records and monitoring of rural
health units.

Apart from HB 8, several bills also seek to create the legislative framework for the
Philippine eHealth system. These measures are House Bills No. 61 ('HB 61'), House Bill
No. 171 ('HB 171'), and House Bill No. 665 ('HB 665'), all of which propose to
institutionalise the policy framework for eHealth infrastructure in the Philippines. At the
time of publication, these bills, along with HB 8, are pending consolidation before the
House Committee on Health.

Benefits of the eHealth System

Considering the current status of healthcare in the country, developing a framework for
eHealth infrastructure can lead to a host of benefits, namely:
 improving communication and responsiveness within the health care system;
 addressing obstacles to equitable access of health care; and
 Supporting other health initiatives, such as universal health care.

Firstly, developing eHealth infrastructure improves the flow of health information. The
common thread of the above-mentioned measures and bills is the push towards
standardising and consolidating information for easier access by healthcare providers.
HB 8, for instance, aims to create a shareable database to consolidate medical records
and evaluation results in rural areas. Meanwhile, HB 61, HB 171, and HB 665 provide for
programmes to ensure common standards and interoperability, including the creation of
the appropriate infrastructure for health sector enterprises. These measures will
institutionalise the sharing of health information among stakeholders, ideally leading to
more responsive and coordinated services.
Secondly, eHealth infrastructure leads to equitable health care access. As earlier
mentioned, HB 8 intends to use the health passport in connection with free services from
public hospitals. In addition, investing in eHealth can lead to a better IT infrastructure for
health information. Initiatives that diagnose and treat patients using telecommunications
are thus more likely to succeed, improving the delivery and the speed of services,
especially in geographically isolated and disadvantaged areas. A robust eHealth
framework can also avoid duplication of services and efforts among government agencies
with the private sector. Efforts, such as the interoperability of systems and a health sector
enterprise architecture, prevent duplication by granting agencies and healthcare facilities
access to the same health information. For patients, this avoids unnecessary costs
brought about by different facilities repeating the same service. For the general public,
this means more unified and data-driven public health initiatives from government
agencies.

Lastly, eHealth infrastructure supports other health legislation, such as the Universal
Health Care Act, which implements a host of health-related measures including
expanding immediate eligibility and access to health services to all Filipinos. Critical
provisions of the Universal Health Care Act require the integration of local health systems
into province-wide and city-wide systems, and facilitating a health information system that
respects patient privacy and confidentiality in accordance with the Data Privacy Act of
2012 (Republic Act No. 10173) ('the Act'). These measures all require the integration of
new existing systems with IT capabilities, hence, the necessity for a framework for
eHealth infrastructure.

Quite clearly, a stronger policy framework for eHealth infrastructure will improve access
to healthcare, in turn creating better health outcomes and restoring confidence in the
Philippine health care system. That said, there are a number of concerns in implementing
this initiative, not the least of which are its privacy and security implications, especially in
light of the Philippines' still-developing IT infrastructure. Some of these concerns are
further discussed below.

Concerns for the introduction of an eHealth system

Despite the benefits promised by eHealth advocates, concerns have been raised
regarding the introduction and implementation of such a system in the Philippines. The
country's emerging data privacy and cyber security regulatory framework, coupled with
the limited IT capabilities and geographic landscape, makes rolling out an eHealth system
difficult. To overcome these, the Philippine government must think of a way to
systemically implement the changes while maintain the integrity of the system.

A previous attempt at a national computerised identification system was declared

unconstitutional by the Supreme Court of the Philippines ('the Supreme Court') in 199825.
While the Supreme Court recognised that information systems which make use of
computers facilitate important social objectives, such as better law enforcement, faster
delivery of public services, more efficient management of credit and insurance
programmes, improvement of telecommunications, and streamlining of financial activities,
it held that the broadness, vagueness, and over-breadth of the measure put the Filipino
peoples' right to privacy in clear and present danger, which under Philippine law, are
sufficient grounds to invalidate legislation. The Supreme Court further cautioned that any
intrusion into the right to privacy must be accompanied by proper safeguards and well-
defined standards to prevent unconstitutional invasions.

Notably, however, data privacy frameworks and regulations have come a long way
since then, especially with the introduction of the Act, the Implementing Rules and
Regulations of Republic Act No. 10173, and other issuances of the National Privacy
Commission ('NPC') (collectively, 'the DPA Laws'). The DPA Laws provide 'safeguards
and well-defined standards' that were lacking in previous proposed measures. Moreover,
the NPC, which has issued advisories and opinions specific to the Government and the
healthcare industry, has frequently been cited as a coordinating agency in the
implementation of various pieces of legislation, including the eHealth bills pending before
the House. In fact, the recently passed Republic Act No. 11055, or the Philippine
Identification System Act, lists the Chairman of the NPC as one of the members of the
council responsible for ensuring implementation of the system. The statute also contains
provisions meant to safeguard the national identification system, including the information
gathered.

Still, given the lofty goals of the eHealth initiative, the NPC should work on the
development of procedures and policies to address the requirements and repercussions
of implementing an eHealth system. Under Philippine law, information about an
individual's health is classified as sensitive personal information, which is granted greater
protection and requires stricter compliance with the DPA Laws. In fact, the processing of
sensitive personal information is generally prohibited, except in cases indicated under the
DPA Laws including, but not limited to, if necessary to protect the life and health of the
individual, if existing laws and regulations provide for it, or if the individual data subject
provides consent.

Furthermore, even when the processing of this information is permitted by law, the
persons or entities involved in the processing may not have the necessary policies,
procedures, or systems in place to ensure that the information being processed is
protected with adequate safeguards as required by law. For example, an eHealth
measure that grants a private healthcare institution access to sensitive personal
information collected by a different institution may not have an efficient regulatory
framework within which to operate. As such, while the data sharing between the
institutions may be expressly authorised under the eHealth programme, the DPA Laws,
which require that adequate safeguards for data privacy and security are in place and
that any processing adheres to the principles of transparency, legitimate purpose, and
proportionality, may not actually be complied with. In this regard, requiring far-flung
hospitals to comply with DPA Laws when processing information may be difficult given,
for example, their personnel's possible limited experience with data privacy regulations.
To address this, the NPC and the eHealth regulators may need to supplement the eHealth
programme with implementing guidelines that would balance and operationalize the
fulfilment of data privacy regulations, while providing adequate and timely healthcare
services.

The dependence on IT also makes the eHealth system vulnerable, and poses questions
on the integrity of the system. Despite cyber security and cybercrime measures already
introduced through Philippine laws, the Government cannot guarantee that each entity
that is permitted access to the personal data will be able to secure the database against
attacks. The Government also cannot guarantee that the healthcare institutions that are
supposed to participate in the eHealth system have adequate access to the technology
required to host these services. Moreover, given that a database capable of hosting the
health-related information needs to be constantly updated and synced across various
devices, the database will likely need to be built and accessed online. The difficulty of
complying with the eHealth initiative, in the context of other laws and regulations that
protect the rights of the individuals and entities engaged in the initiative, may discourage
involvement from both individuals and health care institutions.

Finally, another significant issue to consider with the eHealth system is that adoption is
not likely to be widespread in the Philippines. How many health care institutions and
facilities will willingly change their existing IT infrastructure to make it compatible with a
national eHealth system? How many individuals will actually voluntarily sign-up for a
service that asks for their personal data, including their medical history? An attempt to
answer this question was introduced in HB 8, which proposed that parents or legal
guardians of children born after the effectivity of the law should be required to enroll their
children in the health passport programme. However, there is no coercive force in the
proposed legislation, or in any of the other bills on this matter, that requires such
registration. Effectively, there appears to be no mandatory registration imposed on
individuals and institutions. Poor opt-in turnout may turn the eHealth initiative into a costly
experiment for the Government and the Filipino people.

The Philippine eHealth system moving forward

A quick glance at the issues above may give the impression that the Philippines has
inadequate mechanisms, both legal and infrastructural, to support eHealth initiatives.
Nonetheless, the different eHealth initiatives show promise in curing longstanding ills of
the Philippine healthcare system, and are well worth exploring. Implementing the eHealth
initiatives in a way that benefits the Filipino people requires a concerted effort, not only
among lawmakers and regulators, but also healthcare providers and ultimately the
general public itself.

https://www.dataguidance.com/opinion/philippines-developing-ehealth-infrastructure