Decentralization (n) political reform designed to promote local autonomy, decentralization entails changes in authority and financial responsibility for health services. Hence, decentralization can have a large impact on health service performance.
In 1991, Decentralization (RA 7160) was first introduced in the Philippine health sector. Local Government Units (Rural Health Units) were granted autonomy and responsibility for their own health services, and provincial governments were given responsibility for secondary hospital care.
“Section 16. General Welfare. – Every local government unit shall exercise the powers expressly granted, those necessarily implied therefrom, as well as powers necessary, appropriate, or incidental for its efficient and effective governance, and those which are essential to the promotion of the general welfare. Within their respective territorial jurisdictions, local government units shall ensure and support, among other things, the preservation and enrichment of culture, promote health and safety, enhance the right of the people to a balanced ecology, encourage and support the development of appropriate and self-reliant scientific and technological capabilities, improve public morals, enhance economic prosperity and social justice, promote full employment among their residents, maintain peace and order, and preserve the comfort and convenience of their inhabitants.“
RA 7160 is an example of devolution, a type of decentralization that transfers authority and responsibility from the central level of the Government to lower-level autonomous units of government. This move by the government, in my opinion, imposed great challenges that affected or could affect the Routine Health Information System (RHIS) in the Philippines. Highlighted in this blog are the three areas that affected RHIS because of a decentralized governance.
1. Provision of resources both human and infrastructure
Discussed during our first meeting in MI 239 class, Municipal Health Offices (MHO) are under the local government units (LGU) and that policies and projects in a way depended on the support of the LGU. Many of the sites I’ve visited as part of my job in the National Telehealth Center had difficulty maintaining or implementing their health information system because of the lack of support from their local LGU. The hiring of regular-positioned nurses and staff for HIS, and the procurement of needed infrastructures and computer units to ensure the implementation of HIS is often disapproved by the mayors of the respective LGUs. With the lack of human resource to ensure the operation of an RHU hampers also the quality of data collected by the MHO.
With governance reverted back to the Department of Health (DOH), the MHO can (in an ideal setting) request budget from the DOH for the required man-power and infrastructure needs of it’s RHU, conversely, the DOH can allocate a standard minimum manpower and infrastructure needs for the RHU without having to undergo approval from the LGUs. In this way, the quality of data collection across all MHOs in the Philippines can be ensured.
2. Implementation of RHIS i.e. Electronic Medical Record
A far-fetch effect of 1991 Decentralization, but an example of a decentralized governance structure in health care is the current implementation and roll-out of Electronic Medical Record (EMR). There is an existing and persisting confusion in the ground on what EMR to use (CHITS, iClinicSys, WAH) by the MHOs. Feedback from the MHOs on the ground said that they are being obliged by their regional DOH and PhilHealth to use iClinicSys, a directive being denied by the Knowledge Management and Information Technology Service (KMITS) head Ms. Crispinita Valdez. Regardless if true or not, there should be a centralized directive from the DOH, as the highest governing body for health, clarifying what EMRs should be used by the MHOs.
3. Flow of Data
When we discussed the flow of data during in the current set-up of the Philippine health system, I find it problematic that there is no centralized body (preferably the DOH) that manages or controls the flow of data. And the status quo that in the MHO there are other entities (private and project based entities) that require additional data collection method (or sometimes almost the same but has to be done their way) that burdens the MHO. What I think would be ideal is for DOH to have a control on what data to gather by the MHO to anticipate workload, and decide whether to allow or disallow external entities to gather other data that are not prescribed. I envision that there will be a centralized body (preferably the DOH) that will monitor the flow of data to avoid waste of effort and possible redundancy of data collection.
In order to address this challenge, as researchers and future MS Health Informatics graduate, and with limited resource and influence, research should be conducted to establish problem of the present status quo. As discussed during one of our meetings, an assessment of the data flow of health data in the Philippines to provide a context of the problem would be a good start to push for policy recommendations that are backed up with concrete data and research. With its 16 years of implementation, a vast amount of data is available for research in order to come up with a policy recommendation to improve the governance and shift back to a centralized (DOH) health governance.
Second is to empower the KMITS and give a specific directive to address the problematic data flow and the confusion in the choice of EMR.
The third is to invest in Information Communication Technology infrastructure to help improve the quality of data being conducted at the grassroots level: timely, accurate, legible, complete and secured.
Re-opening the discourse on the topic of de-centralization should come very timely considering the thrust of the current administration for a federal government. Aside from legislation consistent monitoring of outputs and health outcomes– research will make this initiative sustainable. A good study design of pre- post or case control is strong enough to prove or improve the effectivity of this initiative in terms of quality of data gathered in an RHIS.
The value of having a quality data for public health is out of the question. I believe that these are far-fetched ideas and might be difficult to achieve anytime soon, but I believe that these are doable and applicable given the circumstance.
I would do my best, after I graduate from this degree, to contribute to this change I am firmly proposing.