ACCESS Health International, Inc.
The eAKaP Project is an integrated maternal and child healthcare delivery and training for Community Health Teams (CHT) in the Philippines. The project uses innovative mobile technology tools to expand the capacity of CHTs as the government’s frontline health workers to deliver high quality maternal and child healthcare, and other health-related plans to the poorest Filipino families.
eAKaP is an acronym for electronic Aksyon Para Sa Kalusugang Pangkalahatan, or Action for Universal Healthcare Coverage in English. The project provides mobile tablets and trains Community Health Teams to use a Filipino web and mobile application called iCHT (automated Community Health Team). Use of the application addresses many of the challenges that Community Health Teams face in their day-to-day work, including the lack of availability of needed forms and the considerable time expended consolidating and processing data.
The web and mobile application expedites the development of individual household profiles, formulates individualized health-use plans for household members, delivers standardized multimedia health messages, helps workers manage follow-up and tracking of household members’ progress with health-use plans, and facilitates electronic reporting on the health status of target households to the City Health Office, healthcare facilities, and national government agencies, including the Department of Health and Department of Social Welfare and Development (DSWD). The iCHT system further helps in the storage and management of health information.
Despite focused efforts to improve maternal and child health in the Philippines, reducing the maternal and child mortality rate to reach targets established in the Millennium Development Goals is proving particularly difficult. Some accounts suggest that the rate is actually rising.
The Department of Health uses Community Health Teams as a key strategy to help achieve universal health coverage. The government has deployed 100,000 team members to provide important information to families about healthcare, prevention and health promotion, and the benefits of PhilHealth, the national health insurance program. The Community Health Team composed mainly of Midwife, Community Nurse and volunteer health workers called CHT Partners. The CHT Partners are the ones who visit families to do household health profiling, help each member of the family develop their Health Use Plan, deliver healthcare messages to encourage family members to comply to their health use plan, monitor adherence, and submit these reports to the local health center on a monthly basis. These reports will be consolidated by the community Nurse and midwife and submit to the City Health Office to be forwarded to various government agencies. The CHT Partners as the frontline health navigators, have also key to reaching poor households identified by the National Household Targeting System for Poverty Reduction (NHTS-PR) in providing them information on their benefits and responsibilities as PhilHealth members.
However, the implementation of CHTs nationwide has experienced bottlenecks and inefficiencies due to: (1) high cost of printing various paper forms and materials, (2) high transaction cost for the validation of profiles of household members, (3) time consumed in the consolidation of data (barangay to regional level), in updating the central database of the National Household Targeting System (NHTS) and PhilHealth membership list, and in relaying information to health facilities to help them estimate resources for health needs of clients, and (4) error prone manual reporting system. This means lack of access to appropriate technologies that would facilitate the work of CHT in an efficient manner. Aside from that, considering that CHT Partners are the backbone of the health system yet they are less empowered. They are trained volunteers from the community and received just a minimal allowance to do various tasks mentioned above. Many of them dropped out and looked for a stable source of income.
ACCESS Health Philippines recognized these challenges and grabbed the opportunity to enhance the capacity of the government’s frontline health workers to deliver high quality maternal and child healthcare. By training and equipping the CHTs with a mobile technology tool to address bottlenecks in the CHT mobilization, it improves their efficiencies of combating maternal and child mortality.
eAKaP demonstrated significant benefits both at the community level and at the local government management level.
1. The project empowered the CHT Partners who are frontline health navigators of Filipino poorest families, to do their job as they have the system that made their tasks easier and faster.
2. With the use of iCHT system, CHTs are able to deliver standardized healthcare messages right at the doorstep of the family in video format that excites household members, get them interested to learn the messages and eventually encourage them to adhere to their Health Use Plans. In the process, healthcare risks are prevented and mitigated.
3. eAKaP uses a localized system that made the CHT Partner who are volunteers with less literacy, easy to follow and easy to learn.
4. The use of iCHT system is more economically viable compare to the use of paper forms, lesser cost to implement the project, making it more feasible to scale up.
5. eAKaP is a better mechanism to gather community-level health data and information that are necessary in crafting or developing health policies and programs to improve the healthcare system, and a faster way to share data to various agencies. Faster access to information is very important to policy-makers and program managers for prompt decision-making and finding solution to healthcare.
6. eAKaP has a long-term benefit in terms of improved monitoring of health status in a particular location which is very useful in strategizing for better allocation of funds and human resources at the local level.
In general, eAKaP enables CHT works effectively and efficiently by providing a system that tracks and monitors mothers and infants health situation, giving them the healthcare services that they need in a timely manner, thereby mitigating risks of patients and contributing to the reduction of maternal and child mortality.
The eAKaP mHealth project aims to contribute to the attainment of universal healthcare coverage and the reduction of maternal and child mortality in the Philippines. The program achieves these dual aims through the use of a mobile technology application. The mobile app builds the capacity of frontline health workers to deliver vital healthcare services to the poorest Filipino families and to improve household knowledge about health risks and available healthcare services in the locality.
eAKaP uses iCHT, a web and mobile application, which is an automated version of the CHT tools specifically designed for the profiling of families, provision of critical health information, and development of Health Use Plans (HUP). It uses a store and forward feature to address the issues related to inconsistent internet connectivity. A health worker can visit a household and use the tablet with iCHT installed without the need for internet connection. The household information is stored in the device. An internet connection is needed to synchronize the data to a cloud based server that automatically generates reports.
We used 7-inch tablet PC and mobile wifi for internet connection. These were donated by Globe BridgeCom, the Corporate Social Responsibility arm of Globe TeleComm. The admin panel is cloud-based which means it can be accessed anytime anywhere with internet connection. Reports are generated automatically in a format uniformed to what CHT used in paper and thus can be printed on the same format when necessary. CHTs do not have to print several reports forms since it can be accessed directly through the admin panel by the City Health Office or CHT Coordinator and can easily be shared to other government agencies when needed.
The most relevant activities conducted were the following:
1. Reengineering and improvement of the iCHT application – ACCESS Health adopted, reengineered and improved the iCHT system for e-AkAP. iCHT is a system that was initially piloted and tested by the UP Econ Foundation in terms of its economic viability, which demonstrated positive results in terms of its economic valuation.
2. Data entry – we encoded into the iCHT system the profiles of the Community Health Team partners (the health volunteer workers), information about their assigned households, and the list of local healthcare facilities and their contact details prior to the training.
3. Installation of the iCHT app to the PC tablet – we installed the iCHT app in each PC tablet, together with the video messages and the training materials in html format
4. Training of Community Health Teams on the use of iCHT – we conducted training and workshop for the CHTs on the use of iCHT on the tablet. The training involved coaching and mentoring on the proper use of the tablet, control of fingers in tapping and typing, editing, deleting, and other features of the system.
5. Continuous coaching and feedback on the use of iCHT – After the training, CHT Partners used the iCHT to manage household visits and develop health use plans. Every week, we provide coaching and feedback essions to talk about their experiences and resolve technical issues. e.g., technical problem on the device, how to edit/delete. We also discuss whether there are questions missing in the app that are necessary for the development of health use plans.
6. Building Team Leaders - with the continuous coaching and mentoring, we build team leaders that supervise and provide coaching to the rest of the CHT partners per group. This way, it made the learning process faster and we able to build Trainers from among the CHTs that could help the scaling-up of this initiative.
7. Updating and improvement of the system – based on the feedback from Community Health Teams, we update the system and install new updates in each device.
The eAKaP Project has so far trained 100 health workers to use iCHT at this pilot stage. Each CHT Partner covers at least 50 families, or approximately a total of 5000 families. CHTs, during the focus group discussion expressed that iCHT made it easier for them to do their tasks particularly in updating household profile and in health use planning. From their household visits using iCHT, family members get excited to be interviewed and watch the video health messages, which encourage them more to go to the health center based on the Health Use Plan, compare when the CHT delivers the messages to them verbally. A CHT Partner once said that she felt her job and efforts being appreciated by the family now that she is using the PC tablet with iCHT app. Thus made her feel empowered to do her job.
“As frontliners in the delivery of health services, we go around bringing a lot of forms, health plans and guides. With eAKaP, we were taught how to use a tablet. It contains all the health messages that we read and show to the households. There’s also a reminder on who should go to the health center on a specific date. Our work becomes easier now, so we are able to teach more people, especially the children and pregnant mothers, to be aware of the risk factors,” said Sonata Sadsad, a CHT Partner.
The Economic Evaluation of Using iCHT Versus Paper-based Forms conducted by University of the Philippines Econ Foundation showed that, relative to using paper based forms, using the iCHT application resulted in decreased spending for materials and further lowered costs by reducing time spent performing CHT related tasks.
In addition, the eAKaP project was able to advance public-private partnership between telecommunications company (Globe) that provide the mobile devices and internet connectivity, local government unit for the participation of the CHTs and Gawad Kalinga, a non-profit organization that mobilized the community and volunteer health workers.
Dr. Laila Celino, Community Physician, expressed gratitude that eAKaP was first introduced in Caloocan City. “If we can conduct a fast assessment of the health situation in the community, we can also address the problem promptly. In Bagong Silang alone, there are only six doctors for a population of 300,000. It is impossible to reach everyone. But now, with the help of the CHT partners and electronic monitoring, bringing health services right to the people’s doorstep is much quicker,” she said.
eAKaP was presented during the First Philippine mHealth Forum on April 10, 2014, atttended by no less than the Department of Health Secretary Ona and the UNICEF Country Representative.
Mary Rose Rontal