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IS DAVAO CITY, PHILIPPINES READY FOR E-HEALTH?

Dennis John F. Sumaylo

UP Mindanao
dfsumaylo@up.edu.ph

Christian Joy C. Salas

PMDT Team Mindanao
Philippine Business for Social Progress
christianjoysalas@gmail.com

ABSTRACT

In the Philippines wherein most concepts are taken from a western perspective, the
transmission of information from the source to the receiver rely solely on what is
affordable and logistically doable resulting to areas in Geographically Isolated and
Disadvantaged Area (GIDA) sites to receive less or no health care information from the
government.

To answer this, the Department of Health (DOH) Regional Office XI and Davao City
Health Office make their presence available to the netizens of Davao through its
website. However, technical problems seem to always hinder a smooth transfer of
information. For instance, the link provided for the City Health of Davao in the website
of DOH Regional Office XI is not active. Furthermore, the website of Davao City
Health Office is available intermittently. The presence of the City Health Office in
Social Networking Sites (SNS) is not available as well despite the fact that the several
government agencies and local government units are already doing online as well as
offline transactions such as the local government of Davao City’s presence in twitter
(@DavaoCityGov) as well as the presence of the Department of Education Regional
Office XI in twitter (@DepEdDavao), including the active Facebook and Twitter
accounts of the Mayor and Vice-Mayor of the city are evidences that the government
wants to create an identity online.

Despite its absence in digital media channels, Davao City Health Office is a recipient of
the Outstanding Lifestyle Advocacy Award given by the DOH Regional Office XI.
With this, it is assumed that once Davao City Health Office takes an active role in the
communication process by designing new messages and introducing new channels to
the growing demand of its clients; the city health office will be able to reach a lot of its
clients.

With this, a descriptive auditing of the current communication tools and the readiness of
Davao City to shift from traditional communication tools to eHealth is documented in
this paper. This working paper is part of a descriptive ongoing study on the health
communication cycle in Davao City.
 2

INTRODUCTION

One of the common curiosities in the context of health communication is that it is one
of the best examples of science communication. It is translated into a language
understandable by its stakeholders yet its stakeholders are one of the most complex and
demanding. It is also the field of communication that transcended from science
communication to medical sociology, medical anthropology, and intercultural and
transcultural communication in health care.

Several studies have been made in terms of documenting health care systems around the
world. In People’s Republic of China during Mao Zedong’s time, its health care system
emphasized preventive public health yet after the market reform, it emphasized in
curative medicine. (Chen, 2005) Japan also identified its 10 Components of a Nations
Health Care, which are determined by its history, economy, technology, culture, and
traditions. (Anesaki and Munakata, 2005)

In the Philippines wherein most concepts are taken from a western perspective, the
transmission of information from the source to the receiver rely solely on what is
affordable and logistically doable resulting to areas in the boondocks to receive less or
no health care service from the government. This is also a result of political issues and
bureaucracy per area affecting the delivery of government health care.

According to Mary Divene C. Hilario (2012) of the Health Advocacy and Promotion
Unit of the Department of Health (DOH) Regional Office XI, the process in developing
health care intervention programs, which includes development of communication
collaterals, starts with the National Center for Health Promotion of the Department of
Health Central Office calling for a collaborative national workshop. This workshop
involves representatives from the Department of Health Regional Offices and
consultants. (M.D. Hilario, Personal Interview, January 2012)

Hilario also opined that the city and the barangay can create their own tools and
methodologies in implementing the government’s health care programs as long as it
follows the prescribe content. However, with the Interpersonal Communication and
Counseling Manual, message designing is not part of the training of grassroots
implementers. Moreover, the said manual only emphasizes the use of traditional
communication tools like posters and putting face-to-face communication. Hilario also
mentioned that aside from the tools, the other problem they encountered is sending the
tools (messages) to difficult areas or known as the geographically isolated and
disadvantaged areas (GIDA). Most of the communication collaterals are delivered late
or sometimes, these are not delivered at all.

Moreover, despite such emphasis on traditional communication tools in the

Interpersonal Communication and Counseling Manual, the Department of Health
Regional Office in Davao also makes its presence available to the netizens of Davao
City. However, the link provided for the City Health Office of Davao in the website of
the Department of Health Regional Office XI is not active. Furthermore, the website of
the City Health Office of Davao is available intermittently. The presence of the City
Health Office in Social Networking Sites (SNS) is not available as well despite the fact
 3

that the local government of Davao City (@DavaoCityGov in twitter), the Department
of Education Regional Office XI (@DepEdDavao in twitter), including the Mayor and
Vice-Mayor, maintains an active Facebook and Twitter accounts. This somehow
contradicts several formative studies conducted specially on the increasing cases of
HIV/AIDS in the city. As reported, the increasing cases of HIV/AIDS cases in Davao
City covers an age bracket who are almost always active online.

Yet, despite its absence in new media channels, Davao City’s health office is DOH’s
recipient of the Outstanding Lifestyle Advocacy Award. (Mindanews, 2012) Therefore,
it is easy to assume that once Davao City’s health office takes an active role in the
communication process by designing new messages and introducing new channels to
the growing demand of its clients, the city health office will be able to reach a lot of its
clients. This new media channel is referred to as eHealth and is used as a catchall phrase
for this type of information dissemination strategy in this paper. The World Health
Organization (2005) defines eHealth as “the cost-effective and secure use of
information and communication technologies in support of health and health-related
fields, including health-care services, health surveillance, health literature, and health
education.” It simply means that health care services will be received not only by
visiting the health centers, clinics or hospitals but also by getting health care
information through available mobile applications, online interface with a health care
specialist or subscribing to short message service (SMS) for medical consultation.

With the current move of the Department of Health Head Office, to study and
implement eHealth in the country, it is notable to look at the capacity of Davao City,
Philippines to get into the bandwagon. The general objective of this paper then is to
know whether Davao City is indeed ready for eHealth.

METHODOLOGY

With this objective, a series of Key Informant Interviews were conducted at the level of
the top management implementers of the Davao City Health Office, which is also the
delimitation of this study. It was appropriate to look at the research question from the
perspective of top management before we go into the frontline implementers at the
grassroots level since they are the direct connection of the city to the Department of
Health Regional Office. Moreover, program planning,policy making and self-evaluation
by implementers were done at this level.

An interview schedule was prepared and the questions were divided into 3 parts –
Program Planning, Policy Making, and (Self) Evaluation. Program planning questions
focused on the capacity of the City Health Office to design, and disseminate
information and knowledge to its target audience.Whereas, policy making is centered on
the relationship of the City Health Office to the Local Government Unit and the
Department of Health Regional Office wherein it highlights the implementation of DOH
orders, transition to eHealth, and budget. Evaluation, on the other hand, is an anecdotal
and personal evaluation of the capacity of the City Health Office to go into eHealth.
 4

eHealth in the context of this paper includes, but not limited to, text messages (SMS),
phone calls, online, radio, and social networking sites. It is to operate as something
beyond face-to-face interpersonal communication and traditionally mediated
communication – television, radio transistors, and newspapers.

Another method used in gathering data was document review looking at the past and
current Health Communication collaterals of the City Health Office. Also included in
the document review are records of mortality rates and causes of mortality to verify the
increasing and decreasing statistics and if communication plays an important role.
Lastly, the list of health districts, the number of health centers and sub-centers were
identified. In the process, no particular document was found related to policy.

However, included in the document review is an investigation of how the Philippines is

transitioning from traditional information transfer system to eHealth. Therefore, part of
the result of this investigation is a data on the various methodologies on how the
country adapts to eHealth and looking into specific media as well.

RESULTS AND DISCUSSION

Discussed in the Philippines eHealth Strategic Framework and Plan 2013-2017 (2014),
the Philippines’ health goals are guided by its National Objectives for Health. This
helps the government to decide and prioritize their activities to improve health programs
in the country. In the years 2005-2010 and 2011-2016, the National Objectives for
Health is geared towards harnessing the use of information and communication
technologies (ICTs) in various health concerns as to reform areas, critical health
programs, as well as, specific points in health administration.

Moreover, the Philippines signed in support to the resolution drafted during the 58th and
66th World Health Assembly. Cited also in the Philippine eHealth Strategic Framework
Plan 2013-2017 (2014), the 58th World Health Assembly in 2005 focuses on the
following: (1) to draft a long-term plan as guide for the implementation of eHealth
services including infrastructure and lawful structure (for manpower and activities)
encouraging also public-private partnerships; (2) the ICT infrastructure for health
should be reasonable, affordable and accessible; (3) partnerships with private and non-
profit institutions should be built; (4) vulnerable populations should be included and
suitable eHealth services be delivered accordingly; (5) creating ties with various sectors
to determine evidence-based eHealth practices to impart, with inexpensive model and
safeguarding quality and ethical standards – confidentiality and impartiality; (6)
creating a national body governing practices of eHealth services; and (7) start an
efficient public-health information system to respond to the needs of the community or
country. While the 66th World Health Assembly in 2013 focuses on the following and
serves as an update to the previous eHealth Resolution, to wit: (1) study on possibilities
to work with participating individuals taking consideration people in authority –
national leaders, health care workers and relevant academes – in drafting and
implementing eHealth at the levels of national and subnational; (2) toensure
confidentiality at all times, legal measures – drafting of policies or passage of legislative
resolutions – regarding implementation of eHealth should be complied; and (3) ensure a
 5

representative on the ICANN Governmental Advisory Committee with open

communication to the national authorities concerning health to relay national stand in
implementing eHealth.

The World Health Organization (WHO) eHealth Resolution (2005) signed during the
58th World Health Assembly also endorsed and adopted a health academy, which aims
to promote good health and healthy lifestyle, and increase health awareness among its
clients. This health academy will achieve these two goals through eLearning as an
alternative way to attain knowledge through various types of devices. This effort is
made to address the advocacies stipulated during the 58th World Health Assembly.

Moreover, during the 66th World Health Assembly, eHealth and health internet domain
names (2013) were reported by the Secretariat. It updated discussions on the eLearning
that discussed matters on strengthening the idea of eLearning and building partnerships.
According to this report, the use of eLearning technologies is to make available a
number of educational and training materials on health. Using the health academy,
many young people are given the opportunity to access health information that
promotes health and disease prevention and promotes better health activities. Added
also in this report were WHO-validated health information that can be adapted for
translation to local language and culture. With this, more population will be reached.

The Philippines Strategic Framework and Plan 2013-2017 was laid down as a way of
showing the active participation of the Philippines towards the implementation of
eHealth. It posits that “by 2020 eHealth will enable widespread access to health care
services, health information, and securely share and exchange patient’s information in
support to a safer, quality health care, more equitable and responsive health system for
all the Filipino people by transforming the way information is used to plan, manage,
deliver and monitor health services.”The ultimate goal is to attain health system goals of
“financial risk protection, better health outcomes and responsive health system for the
Filipino people.” The use of eHealth in the country will also give appropriate health
information to health consumers as reference and health care workers will have ready
standard operating procedure for referrals.

The Philippine eHealth Strategic Framework and Plan also has set nine (9) strategic
guidelines for eHealth implementation, to wit: “(1) eHealth must serve the needs of the
client or person, (2) collaboration and partnerships with key health care stakeholders are
critical in realizing the country’s eHealth vision, (3) Users must be involved at all
phases of development and implementation to gain commitment for implementation, (4)
a strategic approach in terms of phases enables more focus, and judiciously and
efficiently make use of resources to achieve eHealth vision, (5) eHealth activities must
be aligned or harmonized, without controlling health care providers to implement local
eHealth solutions, (6) the presence of entities that have already started eHealth must be
recognized so as not to constraint their continuing advancement and gain their support,
(7) human resource can be made available by building capacity to implement eHealth
agenda in the country and promote transparency and public accountability, (8)
implementation of eHealth must comply to relevant laws and regulation, and (9)
investments must be made on areas that deliver the greatest benefits to health consumers,
 6

health care providers, and health care managers; and ensure no duplication in terms of
time, effort and resources.”

Partner institutions in this endeavor include a privatetelecommunications company. In

one of the messages sent by Globe Telecom to its prepaid and postpaid subscribers, they
informed the public that they are supporting the country’s telehealth service.This phone
call service is a 24/7 medical advice hotline provided by licensed and skilled Filipino
doctors. (Balea, 2015)It is named as KonsultaMD, which in English is Consult MD.
Balea (2015) added that the development of this service in the Philippines was made
possible with the help of a Mexican telecommunications company, SaludInteractiva,
already delivering the same health services in Mexico. Basically, the services included
consultation via phone call, which the client needs to subscribe to Globe Telecom. The
clients can opt to subscribe for a month or a week that costs PhP 15.00 to PhP 150.00
($ 0.33 to $ 3.33). However, Balea added that non-Globe Telecom subscribers can still
avail of the services but regular rates will be charged accordingly.This new telehealth
service is said to be gaining grounds of immediate medical attention just by calling the
physicians on duty without problems of long queue at medical clinics or hospital clinics.
Currently, KonsultaMD has 10 doctors receiving calls and their number is expected to
grow in the coming months as the demand grows.

Image 1: SMS of Globe Telecommunication Company on KonsultaMD!

Updates on the development of eHealth in the Philippines were also presented during
the 2nd eHealth Summit in July of 2015 in Manila, Philippines. Part of the presentation
includes plans and other advances in telehealth, teleconsultation, and telemedicine.

The Executive Director of the Department of Science and Technology – Philippine

Council for Health Research and Development, Dr. Jaime C. Montoya (2015) said in his
opening remarks during the 2nd eHealth summit that he is “convinced that ICT-based
innovations in health or eHealth, can address our challenges in accessing health care
services and accessing real time information for decision making.” These words from
Dr. Montoya show that the Philippines is gearing toward a connection of a health
facility and local government unit (LGU) to exchange information on health for future
establishment of appropriate measures in addressing health concerns in the community.
This brought the idea of e-Hatid LGU project popularly known as the eHealth Tablet for
 7

Informed Decision-making of Local Government Units. The Ateneo de Manila

University, together with the Department of Science and Technology (DOST),
partnered for the development of this project. (eHATID LGU Beta, 2015) According to
the proponents this program “is a health information system support for Local
Government Units through an Android-based Electronic Medical Record application.”
This project also abides with the information technology needs of the Philippine Health
Insurance Corporation (PHIC) outpatient benefit package for better and transparent
monitoring of services to the stakeholders, especially those recipients of the social
service support from the government.

Another eHealth project that is being piloted in 115 sites in the country is the RxBox
(2012). This is another eHealth project wherein another academic institution,
particularly the University of the Philippines Manila, in partnership also with theDOST,
innovated a device that can provide blood pressure monitoring, pulse oximeter reading,
electrocardiogram (ECG) function, fetal heart monitoring, maternal tocometer
monitoring, and temperature reading. Not only that, the device can also give health
workers more than those services enumerated since the RxBox also serves as
telemedicine device, recording of patient information, and teleconsultations. This is a
milestone in the Philippine eHealth program. However, these projects need to be scaled
further. In the Davao Region, only two (2) RxBox devices are deployed in the
municipalities of Governor Generosoand Lupon, Davao Oriental – a lot more
municipalities need the same device to serve the community better and be more efficient.
Telemedicine, as cited by the World Health Organization in the Telemedicine:
Opportunities and Developments in Member States (2010), defines as “healing at a
distance”. Telemedicine services include teleconsultation which is creating an
environment of interaction of a medical provider to a client without doing it face to face,
yet still able to provide the adequate care.

Projects like those above mentioned should be scaled or institutionalized and realized to
be very significant in the society. Wilson et al (2014) wrote about The Journey to Scale:
Moving together past digital health pilots. They pointed out in this paper that to
institutionalize a project, may it be a service or a product, it needs to have the right
leader, right solution, right approach and right capacity. To start the sequence to scale,
there has to be a trigger or a call of action on an emerging problem. This is true to
incidences like the need of developing a vaccine for Ebola virus – it triggers the
government officials to act on the problem, for a specific need and right capacity for the
development. This goes same with the projects of institutionalizing the use of barcodes
for inventory purposes, standardization of shipping container dimensions so that it will
be easy to transfer whenever the container goes around the globe, and among others. An
example of mobile health project that can address maternal and child health is the
mobile alliance for maternal action (MAMA). This project started in Bangladesh on
2012, then in South Africa on 2013, and in India on 2014. The MAMA project helps
increase the knowledge of mothers in taking care of themselves and their child towards
better health.

In the coming months or years, more and more eHealth initiative will be available and it
needs to be scaled accordingly to realize the effects of these projects in the society.
There are projects that may be small or large at scale but the ultimate goal is to serve the
 8

community and give necessary information to be disseminated to the stakeholders and

the government leaders.

THE CASE OF DAVAO CITY

It is good to note that the objective of this paper is to describe, based on qualitative
methodologies, the capacity of Davao City to go into eHealth. Moreover, it is also best
to take into consideration the delimitation of this paper, which is focused on the
perspective of the implementers of health promotion programs. The fact that this study
is ongoing mean that it could not provide any form of conclusion nor present a series of
recommendations because the communication cycle is not yet complete. For now this
paper only provides a descriptive overview of the planning, implementation, and self-
evaluation of the delivery of health promotion programs of this city. It also provides
anecdotals coming from the implementers of health promotion programs as to the
readiness of the city to go into eHealth.

Background on Davao City and its Health Care System

Posted on the National Economic Development Authority (NEDA) Davao Region

website, Davao City is among the largest cities in the world in terms of land area that
expands 244,000 hectares. It is located at the southeastern part of Mindanao, the second
largest island in the country. The boundaries of Davao City are the provinces of Davao
del Norte at the north, Davao Oriental and Davao Gulf at the east, Davao del Sur at the
south, and North Cotabato at the west side. The city is the economic center of the
southern part of the country, which caters domestic and international trade. The city is
also the Philippines’ gateway to the neighboring countries of Brunei, Indonesia,
Malaysia, and Australia and among others.

In 2013, the Philippine Statistics Authority indicates that Davao City’s population has
reached 1.4 million during the 2010 census of population and housing. Adding to this
report, the agency said that the city has a 2.36% annual population rate increase.
Previously, reported during the 2000 census of this highly urbanized city, 300,000
persons are added from its 1.1 million population.

Moreover, Davao City is divided into three congressional districts. The 1st
Congressional District includes the city proper divided into 4 districts: A, B, C, D, and
then Talomo District. The 2nd Congressional District includes the districts of Buhangin,
Bunawan, Agdao and Paquibato. Then, the 3rd Congressional District includes the
districts of Baguio, Calinan, Marilog, Toril and Tugbok. Among these districts, there
are two districts that belong to GIDA sites, to wit: Marilog (66, 242 hectares) and
Paquibato (63, 800 hectares), which are also the biggest districts of the city.

However, the City Health Office made its own way of dividing the entire city into 16
Health Districts. The number of Health Centers and Substations also reflect the
coverage of a certain health district.
 9

Program Planning and Implementation

NO. NAME OF HEALTH DISTRICT NUMBER OF HEALTH

CENTERS/SUB-
STATIONS
1 District A 7
2 District B 10
3 District C 11
4 District D 6
5 Talomo North District 10
6 Agdao District 12
7 Tugbok District 18
8 Talomo South District 11
9 Bunawan District 11
10 Sasa District 8
11 Buhangin District 10
12 Toril District 27
13 Baguio District 7
14 Calinan District 20
15 Paquibato District 16
16 Marilog District 13
Table 1. List of Health Districts as of May 2015.

Table 1 indicates that the largest health district is Toril with 27 Health Centers and Sub
Stations, followed by Calinan and Tugbok and in terms of program planning and
implementation, these 16 health districts and each individual district’s profile is
considered. In an interviewwith Dr. Marjorie Dureza-Culas, the Assistant City Health
Officer for Operations, she mentioned that the City Health Office of Davao is composed
of several programs with one program head assigned to each. The program head is also
in-charge in the dissemination of health information to its clients. In general, Dureza-
Culas said that 95% of the projects that they implement are Department of Health orders.
Only 5% of the projects of the City Health Office are initiated locally. The 5% is the
health caravan of the CHO conducted in Barangays during the Araw ng Barangay
celebration. However, the caravan is only conducted upon the request of the Barangay
Officials. During the caravan, free medical consultation and tooth extraction is provided.
According to Dureza-Culas, the City Health Office has difficulty coming up with its
own programs due to lack of budget. (M.D. Culas, Personal Interview, July 7, 2015)

In terms of information dissemination, Dureza-Culas believed that there is no need for a

campaign for their programs since these programs are routinary and clients are already
familiar with the schedule. However, the city still uses posters, fliers, and barangay
meetings as ways to disseminate information. Barangay Health Workers (BHWs) are
considered to be the last medium of information dissemination in the whole flow but
Dureza-Culas talked about the fast turnover of BHWs from late 1990 to early 2000.
Lastly, she mentioned that the City Health Office maintains a website and considers this
as the city’s first step in going into eHealth. She also added that in terms of eHealth in
program implementation, the program on HIV-AIDS is among the first to utilize
 10

eHealth by providing eConsultation to its clients.(M.D. Culas, Personal Interview, July

7, 2015)

Image 2: Screenshot of Davao City Health Office Website.

With this background, an investigation on two big programs was conducted. An

interview with Elma Albay of the Maternal and Newborn Child Health Program and
Armi Capili of the Nurse Child Program yielded the same stories on lack of budget
intended for program development and information dissemination. In the late 1980s to
early 1990s, a lot of budget coming from the national government and international
funding agencies were available. During this time, programs on family planning and
efforts to disseminate information on family planning were evident in print, radio, and
television bringing the slogan “Kung Sila’y Mahal Niyo, Magplano” (Translation: If
you love them (kids), plan ahead). A series of poster making and mural painting
competitions nationwide were conducted. There were abundant supplies of posters and
fliers. The City Health Office can afford radio programs and cassette players and tapes
of recorded lectures on family planning were provided for each barangay health center
for their house visits. All of these disappeared during the late 1990s when the budget
was cut. Now, the DOH, the City Health Office, and the Local Government Unit work
together to produce posters, leaflets, and flipcharts. If funding is available from the
LGU, these materials will be translated by the Philippine Information Agency to be
used in school visits.(E. Albay and A. Capili, Personal Interview, July 9-10, 2015)

Policy-Making

How meager is meager? In December of 2014, only 15 tarpaulins were produced to be

used in 16 Health Districts covering 165 barangays. The budget for IEC is only PhP
20,000.00 ($430.10*) per year and this budget is not provided on a regular basis. The
eHealth aspect is in the context of eReporting and the City Health Office website which,
according to Dureza-Culas, Albay, and Capili are not regularly updated and is run by an
IT personnel than a (health) communication specialist. They attributed this situation to
 11

the lack of interest of the leadership of the City Health Office in information, education
and communication (IEC) materials and information and knowledge transfer.

In a research conducted by Lewis et al (2012), low- and middle-income countries

usually harness technologies for health like in a software for collection and to analyze
health data, voice to contact hotline numbers, internet to exchange electronic mails and
share health information in the world-wide-web (www), text messaging (SMS), and
videoconferencing. They also identified that the common devices used are camera,
computer, tablet computer, phones (just like the smart phones, cellular phones and
landline phones), radio, portable diagnostic tool, smart card, unique ID such as
biometric scanners, and others. Among these devices, this research shows that common
devices utilized for the services are phones (71% of users) and computers (39% of
users). The research also shows that the common applications are voice (34%), software
(32%) and text messages (31%).

The data of Lewis et al’s (2012) research are taken from the Center for Health Market
Innovations (CHMI), which has several partners in the world, including 16 countries in
both low- and middle-income status, and other active private sectors. Among the 16
countries, 4 countries come from the Southeast Asian Nations, namely: Cambodia,
Indonesia, the Philippines and Viet Nam. There are several eHealth strategies already
documented in the Philippines but no specific data yet is available for Davao City,
Philippines alone.

In the case of Davao City, the use of phones and computers are also common as it
speeds up reporting.However, no data is available if these are also used in health
information dissemination to the grassroots level taken into consideration that this paper
is delimited to the implementing agency only. If you look at eHealth from this context,
what is relevant for the implementers is fast reporting and data generation. This idea
does not necessarily coincide with what Kotler and Lee (2008) discussed on desired
positioning in social marketing. Kotler and Lee (2008) argued that in social marketing, a
clear positioning whether it is behavior-focused, barriers-focused, benefit-focused,
competition-focused, or repositioning-focused should be evident in the planning and
implementing stages especially when we talk of health promotion programs. The
maintenance of a website is evident but as to what purpose does the website serve is not
clear to the implementers interviewed even if they believe that it is essential in
information dissemination especially now that government transactions are almost
always done online.

Lewis et al (2012) also show the main purposes of health program’s ICT use, which was
taken from CHMI data. The following are the purposes: (1) extending geographic
access, (2) facilitating patient communications, (3) improving diagnosis and treatment,
(4) improving data management, (5) streamlining financial transactions, (6) mitigating
fraud and abuse, and (7) others – that include overcoming hindrances of health care
service delivery due to language challenges or attracting more patients or users with
technology’s appeal. For this paper, it will be concentrating much on the second
purpose. This is for the reason that health information should be communicated by the
health workers to the patients even outside the health facilities. This means that health
workers should be able to give general health education, encourage compliance of
 12

patients on health programs, empower the community for emergency care, and keeping
confidentiality.

Using the Seven (7) Purposes enumerated by Lewis et al, Davao City is still compliant
but partially observed to some items.

Purposes Davao City’s Status Discussion

(1) Extending geographic ✓ This is true for Davao City
access but only in the context of data
reporting to the City Health
Office passed on to DOH. In
the implementation of
programs in GIDA sites, the
Armed Forces of the
Philippines (AFP) are tapped
to go into contested and
highly critical areas of the
city. Currently, the City
Health Office partners with
UNICEF and UP Telecenter
in providing fast and efficient
reporting to address the issue
on geographic access.
(2) Facilitating patient ✓ This is true for Davao City
communications but only in the HIV-AIDS
Program. There is no effort
coming from the City Health
Office to build a bridge
between them and their
general public. The website
does not serve its purpose
since it is not updated, the
design is not aesthetically
pleasing, and the interface is
not user-friendly. The City
Health Office does not utilize
SNS and other FREE sites as
well that they can use for
information dissemination and
knowledge transfer. However,
some of the program
coordinators are already
looking at the possibility of
creating a presence online and
some are already present. The
only problem is the whole
City Health Office is not yet
considering eHealth which
 13

creates a breakdown in
communicating an image of
strong and connected
organization.
(3) Improving diagnosis ✓ This is true for Davao City
and treatment Chest Center only which is a
special entity of the City
Health Office. This center
addresses the clients with
tuberculosis and currently
uses Gene XPERT in
diagnosing presumptive drug-
resistant TB clients. This
center is also a prime
referring facility practicing
public-private mix DOTS.
(4) Improving data ✓ This is the main focus of the
management City Health Office of Davao.
Not only that, data
management is also within the
context of providing fast and
efficient reporting to the
DOH.
(5) Streamlining financial ✓ This is the main focus of the
transactions City Health Office of Davao
and is directly connected to
program budget management
rather than information and
knowledge transfer.
(6) Mitigating fraud and ✓ This is true in Davao City but
abuse only in the context of program
planning and reporting and
not in information and
knowledge transfer.
(7) Others – ✓ City Health Office’s current
Geographically Isolated effort to reduce the problems
and Disadvantaged Areas indicated are within the
(GIDA), Security and context of eHealth,
Hostility, Language specifically, mobile and
online communication,
through the provision of
internet connections to all
health districts.
Table 2: Davao City’s Standing Based on Lewis et al Purposes.

The data in Table 2 only means that Davao City is starting to transform its information
and knowledge transfer efforts into eHealth by providing first the infrastructure.
However, looking at how it is currently implementing programs, one can say that there
 14

is a complete detach between the heads of office and the program coordinators. The
heads of office focus more on one client and that is the Department of Health, while the
program coordinators are focused on their individual target audiences. If the website
will be used as a representation of the City Health Office, you can immediately say that
everyone is detached from everything; doing efficiently their individual tasks but the
results of their individual tasks does not necessarily mean it can be part of the whole
picture. The City Health Office as an entity should act as gatekeeper of the programs
rather than a data collection unit as what is observed in the website.

Self-Evaluation

The problems mentioned during the interviews are budget, no support from local
government unit in terms of policy (regular budget allocation), minimal financial
support from DOH Regional Office, and the expectation of the DOH that the LGU will
always provide budget for health. However, these problems are superficial especially in
the context of eHealth. The following points may be of help only on the side of the
heads of office base on the problems provided by the interviewees and not yet
applicable to grassroots. These are not yet recommendations since the investigation is
not yet final.

First, the understanding of eHealth in Davao City, Philippines and perhaps the country
is more concentrated on data collection and reporting as what can be observed in the
Philippine eHealth Strategic Framework and Plan, and lack of emphasis on eLearning
tools. Second, the local idea of eHealth is more online than offline hence the
infrastructure problem on internet connection is at hand. Third, the idea that everything
revolves around money is half-truth. eHealth is more of an initiative problem than
budgetary. Printing posters and leaflets are expensive but through eHealth, you can
make these collaterals readily available online in JPEG or PDF format which majority
of the residents of Davao City can have access. On the other hand, the printed materials
can be sent to GIDA sites since these are only available in limited copies. Maintaining
Twitter, Facebook, and other SNS accounts aside from the website does not require a
big budget as well. An internet connection in the office as well as a trained (health)
communication staff can handle the presence of the City Health Office in digital media.
Should a post needs promotion, the City Health Office can pay a minimal amount of
PhP 500.00 ($10.75) to promote a post for a month to its targeted audience. Fourth,
offline promotion does not necessarily mean printed materials. Face-to-face interactions
and SMS can be used. A policy can be lobbied by the City Health Office to the
barangay captains on the provision of a monthly prepaid credit of PhP 200.00 ($4.30) to
its midwife. This amount is enough to disseminate information to all its clients
especially now that telecommunication companies offer unlimited calls and texts
promos. Sumaylo (2013) cited that the use of SNS for health information dissemination
has been done in Dawis, Digos City, a coastal barangay 56 kilometers away south of
Davao City. This practice now only needs support from the local government unit and
the Department of Health.

In general, the problem of Davao City is not in its capacity to implement neither
eHealth nor the presence of geographically isolated and disadvantaged areas. The
problem is in the blatant neglect of the importance of (health) communication in
 15

knowledge transfer and behavior change among its clients. The fact that a website is
present, internet connections are slowly being provided to the health centers, and
Barangay Health Workers are already utilizing SMS in information dissemination are
already proof that it can be ready to be eHealth compliant.

*$1 = PhP46.50
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