The CHITS (Community Health Information and Tracking System), the first electronic medical record system in the Philippines that is used widely, has persevered through time and slowly extended its geographic footprint, even without a national policy. This study describes the process of CHITS development, its enabling factors and challenges affecting its adoption, and its continuing use and expansion through eight years of implementation (2004 to 2012) using the HOT-fit model. This paper used a case study approach. CHITS was developed through a collaborative and participative user-centric strategies. Increased efficiency, improved data quality, streamlined records management and improved morale among government health workers are benefits attributed to CHITS. Its longevity and expansion through peer and local policy adoption speaks of an eHealth technology built for and by the people. While computerization has been adapted by an increasing number of local governments, needs of end-users, program managers and policy-makers continue to evolve. Challenges in keeping CHITS technically robust, up-to-date and scalable are already encountered. Lack of standards hampers meaningful data exchange and use across different information systems. Infrastructure for electricity and connectivity especially in the countryside must be established more urgently to meet over-all development goals specially. Policy and operational gaps identified in this study have to be addressed using peoplecentric perspective and participatory strategies with the urgency to achieve universal health care. Further rigorous research studies need be done to evaluate CHITS' effects on public health program management, and on clinical outcomes.
Background. The Philippine government aims for a modern information system to enhance data quality and provide more rational evidence to support timely and efficient delivery of health care, management of health systems, programs and policy. Hence, the Real-time Regular Routine Reporting for Health (R4Health) mHealth application was developed and field tested in 246 isolated and disadvantaged municipalities to support the campaign for Universal Health Care and the achievement of the Millennium Development Goals. The R4Health collected point-of-care-specific data on services routinely provided at the rural health facilities, aggregated them and presented in a dashboard for use by program managers and policy makers. Objective. This paper describes the use of R4Health, a mobile technology-based health reporting system. It will discuss the context of the R4Health implementation, its development and deployment to 246 municipalities in the Philippines. Furthermore, the paper sought to determine enablers and challenges to the adoption of R4Health in routine health care. Methods. Data was collected through surveys, focus group discussions, participant-observation and review of project reports. Quantitative data was summarized using descriptive statistical methods; qualitative data underwent content analysis. Results and Conclusion. A total of 515,855 R4Health reports equivalent to 48,856 patient transactions were received from 246 municipalities within a nine-month observation period, supporting the viability of the R4Health as an alternative option to the existing manual and paper based health information management to improve the quality of data. R4Health utilizes a tool that everyone is familiar with, can easily be incorporated in their workflow, can be brought and used anywhere and has an application that is clear, understandable, and easy to learn and use. R4Health data elements, however, have overlaps with other government health reporting systems and is already misconstrued to further duplicate work. More discussions are warranted to coordinate and integrate systems. Given the general positive perspectives, integration of this alternative system to the RHU workflow, an improved R4Health, has a high potential of being accepted and adopted by the first-line health workers across the country.
Objective. This paper describes the process utilized in developing a training program on data use for decision making tailored for real-time monitoring of maternal and child health indicators through Community Health Information Tracking System (rCHITS) end-users in selected areas in the Philippines. Methods. Guided by the ADDIE (Analysis, Design, Development, Implementation and Evaluation) model and the training cycle, existing records and reports lodged with the National Telehealth Center (NTHC) pertaining to rCHITS were reviewed, supplemented by interviews with the technical staff of the NTHC and discussion with healthcare workers. Training design was developed, training modules and materials were prepared, critiqued, revised and finalized. The training was implemented and evaluated using an evaluation tool designed for this specific capability-building endeavor. Results. A tailored training program on data use for decision-making was designed for rCHITS end-users in select areas in the Philippines. The process of developing the training program was guided by the ADDIE Model and the Training Cycle. Training was delivered to a total of 128 public health workers. Majority of the participants gave high evaluation on the clarity and relevance of objectives, discussion of topics, methods of delivery, and time devoted in addressing issues (range 3.5-3.8 out of highest possible score of 4). Conclusion. This paper demonstrates the utility of the ADDIE Model and the Training Cycle in developing a training program aimed at enhancing the capability of the field personnel in utilizing the data generated from rCHITS in decision-making. Training participants must also be monitored and evaluated in their workplace setting in order to determine if the concepts and principles covered during the training program are put into practice.
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