The Philippines offers a wealth of health market innovations that are working to improve quality, access, and affordability for the lower income communities. I traveled to visit two different programs operating just outside of Manila with our partners at the Philippine Institute for Development Studies (PIDS). Each program took a very different approach to healthcare delivery – one using technology to improve electronic recordkeeping, and the other offering a low-cost public-private partnership birthing center model – but both offered a glimpse into the types of innovative approaches proliferating throughout the country.
Electronic data collection through Wireless Access for Health
Wireless Access for Health (WAH), an electronic health system, was launched in 2010 in the Tarlac province of the Philippines. The program helps local government units (LGUs) move away from paper-based monitoring and documentation to electronic data collection processes – it has since expanded into 89 health centers in rural areas. This is a particularly impressive feat considering that many urban facilities are still using paper-based recordkeeping processes.
We visited the Gerona Health Center within the province of Tarlac, which served as a pilot site for WAH. The facility was selected for its internet connectivity, and the level of interest from its staff and management to embrace the new technology.
During the piloting process, implementation staff worked very closely with midwives – who were initially resistant – to talk through the potential benefits of using the new platform. This included a decrease in paperwork, more accurate reports, and as a result, fewer work hours. They were given a one week training to introduce them to computers, tablets, and other related devices they would be using. This was followed by an intensive one-month onboarding period, with midwives and other staff working with trainers on a daily basis to field test the devices and data collection practices.
Since the pilot, other sites have been able to build on the initial experience – the training now takes place over one day, with an additional 2 days for field testing and onboarding. The program has also developed monitoring forms so that new sites can report problems experienced on a weekly basis. Dedicated technical teams and system administrators work with new sites to provide ongoing support.
In addition to expansion of WAH locations, the program has also added a new SMS feature to remind patients of upcoming appointments and send follow-up reminders on care protocols. The program uses Frontline SMS technology, with each facility staffing a dedicated team member to the SMS process management. The text is sent to both the patient and the midwife five days before the appointment, the day of the appointment, and the day after.
Dr. Juliet Ofriara, pediatrician for the clinic, shared that since the implementation of WAH, the patient experience has significantly improved. “Before, our patients used to be angry! But now, they say to us, ‘Woah, this is high tech.’”
I watched as a patient’s record was pulled up in less than a minute, an initial consult was conducted in three, and the patient was seen by the doctor with real time updates to the electronic file in another five minutes – all in the all, the entire process took less than 15 minutes.
When we arrived at Mother Bles Birthing Clinics in Angeles, the midwife was occupied as one of her patients was in the middle of labor. At the same time, the clinic was occupied by three other new mothers, all who had just given birth in the last 24 hours. And in the course of an hour, the clinic was visited by two other pregnant women for their prenatal checkups. It was quickly evident that the clinic was busy and a clear choice for women in the Angeles community.
The birthing clinics are PhilHealth accredited and managed by the KaKaK Foundation, with a focus on increasing access for poor families to affordable, quality and safe maternal and infant health services.
The Angeles location offers one delivery room and a labor recovery room that can hold 3 additional mothers. There is also a space for prenatal checkups and other basic health services. The facility is open 24 hours, with Annaliza Dungca running the facility as the head midwife, and one nurse on staff.
Mother Bles offers free prenatal services to pregnant women in the community, using it as a way to build trust in the community for the services offered. Over 3 years, the clinic has had over 760 births, with an average of over 20 deliveries a month.
The facilities are visited annually by PhilHealth staff to renew the accreditation – which includes a review of recordkeeping, a physical inspection of the facility, and a closer look at the staff’s continued training and certification.
When discussing what about Mother Bles Clinics makes it stand out from other birthing centers, the notion of a warm, welcoming and friendly place stood out. The walls are painted in bright colors, Sister Eloisa who founded the clinics is a frequent visitor, and the nurse and midwife are dynamic figures within the community. Many women have chosen to return to Mother Bles, a strong signal of its success in supporting maternal care in the Angeles area.