Health Metrics Network

Philippine Health Information System:

Review and Assessment

February - July 2007

by
The Philippine Health Information Network

The Philippine Health Information Network

c/o Ms. Charity Tan
Information Technology Officer
Information Management Service
Department of Health
 Table of contents
List of Acronyms 4
List of Tables and Figures 7
1 Background 8
2 The Philippines 8
Geography, Administrative Divisions and Government 8
The Climate 9
Demographic Characteristics 9
Economic Characteristics 10
Organization of the Health Care System 10
Health Care Facilities 11
Health Human Resources 12
3 Frameworks for Generating Health and Nutrition Statistics 13
The Framework Based on the National Objectives for Health 2005-2010 15
The Philippine Statistical Development Plan 2005-2010 18
The Philippine Statistical System 21
4 Government Agencies Generating Health and Nutrition Statistics 22
The Department of Health 23
The Food and Nutrition Research Institute 25
The National Nutrition Council 25
The Philippine Health Insurance Corporation 26
The National Statistics Office 26
The National Statistical Coordination Board 27
5 Previous Studies on the Assessment of Health Information in the 27
Philippines
Past Reviews/ Assessment of Health Statistics and Information System 27
in the Philippines
Interagency on Health and Nutrition and PSDP 2005-2010 Assessment 29
Issues on Health Information Presented in the National Objectives 30
for Health 2005-2010
The Philippine Integrated Disease Surveillance and Response 34
6 Assessment of Health Information System of the Philippines 52
Health Metrics Network Approach 52
Assessment of the Field Health Surveillance Information System and 56
the Civil Registration System in the Subnational Levels
7 Results of the Health Metrics Network Assessment 58
8 Recommendations 75
References 78
Annex 1. Matrix of Available Health and Nutrition Statistics in 80
Agencies of the Department of Health
Annex 2. Matrix of Available Health and Nutrition Statistics 91
in the Philippine Statistical System
Annex 3. CD copy of the Instruments Used in the Assessment of the 97
Field Health Service Information System and the

2
 Civil Registration System
Annex 4. CD copy of the results of the HMN Assessment 98
Annex 5. List of Philippine Laws and Administrative Orders on 99
Vital Statistics and Generation of Health Statistics
Annex 6. The Philippines’ MDGs Indicators 102

3
 List of Acronyms

AIDS Acquired Immune Deficiency LGU Local Government Unit

Syndrome
AO Administrative Order MCH Maternal and Child Health
Survey
API Annual Parasitic Incidence MCR Municipal Civil Registrar
APSED Asia Pacific Strategy for Emerging MDG Millennium Development
Diseases Goal
ARMM Autonomous Region of Muslim MFHSIS Modified Field Health Service
Mindanao Information System
BAS Bureau of Agricultural Statistics
MHO Municipal Health Officer
BFAD Bureau of Food and Drugs MIMAROPA Mindoro, Marinduque,
Romblon, Palawan
BHS Barangay Health Station MMR Maternal Mortality Rate
BIIS Bureau of Food and Drugs Integrated MPDO Municipal Planning
Information System Development Officer
BLES Bureau of Labor and Employment MTPDP Medium-Term Philippine
Statistics Development Plan
BNB Botika ng Bayan MTPPAN Medium-Term Philippine
Plan of Action for Nutrition
CALABARZON Cavite,Laguna,Batangas,Rizal,Quezon NCR National Capital Region
CAR Cordillera Administrative Region NDHS National Demographic and
Health Survey
CBMIS Community Based Management NEC National Epidemiology
Information System Center
CCR City Civil Registrar NEDA National Economic and
Development Authority
CED Chronic Energy Deficiency NESSS National Epidemic Sentinel
Surveillance System
CHD Center for Health Development NGA National Government
Agency
CHO City Health Officer NGO Non-Governmental
Organization
CPDO CityPlanning Development Officer NHII National Health Information
Infrastructure
CRS Civil Registration System NHIP National Health Insurance
Program
DDMS Infectious Disease Data Management NNC National Nutrition Council
System
DFHSIS Decentralized FHSIS NNS National Nutrition Survey
DHS District Health System NOH National Objectives for
Health

DOH Department of Health NSCB National Statistical

Coordination Board
DOHLIS DOH Licensing Information System NSO National Statistics Office

4
DOTS Directly Observed Treatment Short OPT Operation Timbang
course
DTIS Document Tracking Information PCHRD Philippine Council for Health
System Research and Development
DTOMIS Drug Test Operation and PhilHealth Philippine Health Insurance
Management Information System Corporation
e-NGAS electronic-New Government PHIN Philippine Health Information
Accounting System Network
ENHR Essential National Health Research PHN Public Health Nurse
EO Executive Order PHNIS Philippine Health and Nutrition
F1 Fourmula One for Health Information System
FBS Food Balance Sheet PHO Provincial Health Officer
FGD Focus Group Discussion PHS Philippine Health Statistics
FHSIS Field Health Service Information PIS Personnel Information System
System
FIVIMS Food Insecurity and Vulnerability PLHIS Philippine Local Health
Information and Mapping Systems Information System
FNRI Food and Nutrition Research PMIS Philippine Malaria Information
Institute System
FPS Family Planning Survey PNHA Philippine National Health
Accounts
FS Field Surveillance PNHRS Philippine National Health
Research System
GDP Gross Domestic Product POPCOM Commission on Population
GIDA Geographically Isolated and PPDO Provincial Planning
Disadvantaged Area Development Officer
GNP Gross National Product PPMP-DP Philippine Population
Management Program
Directional Plan
HAMIS Health and Management PSDP Philippine Statistical
Iinformation System Development Program
HDL-c High Density Lipoproteins – PSO Provincial Statistics Officer
cholesterol
HIS Health Information System PSS Philippine Statistical System
HIV Human Immunodeficiency Virus PSY Philippine Statistical Yearbook
HMIS Health Management Information PWD Persons with Disabilities
System
HMN Health Metrics Network RA Republic Act
HOMIS Hospital Operation and RHM Rural Health Midwife
Management Information System
HPDPB Health Policy Development and RHU Rural Health Unit
Planning Bureau
HSRA Health Sector Reform Agenda RHUMIS Rural Health Unit Information
System

5
IAC-HNS Inter-Agency Committee on Health SEAMIC Southeast Asian Medical
and Nutrition Statistics Information Center

IBBIS Integrated Blood Bank Information SPR Slide Positivity Rate

System
ICD-10 International Classification of SRTC Statistical Research and
Diseases version 10 Training Center
ICT Information and Communications SS Sentrong Sigla
Technology
ILHZ Inter-Local Health Zones SSM Sentrong Sigla Movement
IMR Infant Mortality Rate TB Tubercolosis
IMS Information Management Service U5MR under 5 mortality rate
IMST Internal Management Support Team UHMIS Unified Health Management
Information System
KM Knowledge Management UPPI University of the Philippines
Population Institute
LCR Local Civil Registrar WFPDS Work and Financial Plan
Database System
LDL-c Low Density Lipoproteins - cholesterol WNDRS Weekly Notifiable Disease
LGC Local Government Code Reporting System

6
 List of Tables and Figures
Table page
Table 1. Strategies for Health Information Systems under Fourmula One 15
Table 2. Statistical Framework on Health and Nutrition 19
Table 3. Implications of the Devolution and Health Sector Reform Agenda 32
on the Local health System
Table 4. Strengths and Weaknesses of the Surveillance Systems of the 35
National Epidemiology Center
Table 5. Targets in Knowledge Management in the Philippine Health Sector 38
Table 6. Matrix on Statistical Development Programs for Health and 42
Nutrition Information Systems
Table 7. Participants in the Philippine Assessment using the HMN Procedure 56
Table 8. Data Producers of Field Health Service Information System and 58
Civil Registration System that participated in the Assessment
in the Subnational Level
Table 9. Data Users of Field Health Service Information System and 58
Civil Registration System that participated in the Assessment
in the Subnational Level
Table 10. Summary of Results of the Assessment of Health Information 59
System Resources
Table 11. Problems on HIS Resources Identified by Regional FHSIS Regional 63
Coordinators With the Existing FHSIS at Different Administrative Levels
Table 12. Summary of the Result of the Assessment of Indicators 63
Table 13. Summary of Results of the Assessment of Data Sources 64
Table 14. Summary of the Result of the Assessment of Data Management 67
Table 15. Summary of Results of the Assessment of Information Products 68
Table 16. Problems on Information Products Identified by Regional FHSIS Regional 70
Coordinators With the Existing FHSIS at Different Administrative Levels
Table 17. Summary of Results of the Assessment of Dissemination and Use 71
Table 18. Problems on Dissemination and Use Identified by Regional FHSIS 73
Regional Coordinators With the Existing FHSIS at Different
Administrative Levels

Figure page
Figure 1. Health and Nutrition Strategies and Expected Outcome 13
Figure 2. Framework for the Development of the Philippine Health 17
Information System
Figure 3. The Philippine Statistical System 22
Figure 4. HMN Framework 53
Figure 5. Selected Indicators and Results 64
Figure 6. Assessment of Information Products 69

7
1 Background

The monitoring and assessment of the status of the health and nutrition of the Philippine
citizenry is a concern not just of the government but also of international donor agencies
and other non-governmental organizations. Such monitoring and assessment require data
that shall be used to generate measures/indicators on the health and nutrition status of the
population over a period of time. In recognition of the importance of data that feed into the
monitoring and assessment of its health system, the Philippines through the Philippine
Health Information Network (PHIN) with the support of the World Health Organization
and the Health Metrics Network conducted an assessment of the health information systems
that generate health and nutrition data. The assessment started in November 2006 with the
conduct of a Training of Trainers on the Health Metrics Network (HMN) framework and
tools for assessing health information systems. The activities that followed included
workshops to evaluate and customize the HMN assessment tool for the Philippines;
pretesting and finalizing the customized tool; the actual assessment; workshop to discuss
the result of the actual assessment; additional assessment in the subnational level of two
specific systems that generate health information – Field Health Service Information
System of the Department of Health and civil registration system of the National Statistics
Office; and, meetings to finalize the report on the assessment. This report presents the
results of the assessment.

2 The Philippines

To properly appreciate the discussions of health information systems in the Philippines, an

understanding of the country’s characteristics and health system is needed. This chapter
presents the Philippines geography, administrative divisions, government, climate,
demographic characteristics, economic characteristics, organization of its health care
system, health facilities, and health human resources.

Geography, Administrative Divisions and Government

The Philippines is an archipelago of about 7,100 islands located in the western part of the
Pacific Ocean off the coast of Southeast Asia. The country has a total land area of 300,000
square kilometers and is one of the largest islands groups in the world. The three island
groupings are Luzon in the north, Visayas in the central area, and Mindanao in the south.
Metropolitan Manila, also known as the National Capital Region (NCR), is located in the
central part of Luzon. It is the biggest urban center in the country. It is made up of 14
highly urbanized cities and three municipalities. The country is divided into 17
administrative regions: Regions 1 to 5, NCR, Cordillera Administrative Region (CAR) ,
CALABARZON (Cavite,Laguna,Batangas,Rizal,Quezon), and MIMAROPA (Mindoro,
Marinduque, Romblon, Palawan) which are in Luzon; Regions 6 to 8 which are in the
Visayas; and, Regions 9 to 12, Autonomous Region of Muslim Mindanao (ARMM), and
Caraga which are in Mindanao. Regions are composed of 79 provinces headed by
governors while provinces are divided into 117 cities and 1500 municipalities, collectively
called local government units. The local government units, headed by mayors, make up the
political subdivisions of the Philippines. They are divided into villages or barangays
totaling 41,975. These are headed by barangay chairpersons (NSCB, 2004). It must be
noted that regions are administrative units only and the political units aside from the
national level are the provinces, cities and municipalities, and barangays.

8
The Philippines is a republican state with three branches of government- executive.
legislative and judicial. The executive power is vested in the President, who is the head of
state and the commander-in-chief of the Armed Forces. The President appoints the Cabinet
members of who assist the President in executing laws, policies and programs of the
government. The lawmaking power is vested in a bicameral Congress composed of the
Senate and the House of Representatives. The Senate has 24 senators directly elected
nationwide by the people. The House of Representatives has 250 members elected by
congressional districts and by party list system. Judicial power is vested in the Supreme
Court and a system of several lower courts. The Supreme Court is composed of the Chief
Justice and 14 associate justices (NOH, 2005-2010).

The Climate

The country’s climate is generally hot and humid and favors the existence of disease
vectors and parasites. On the average, the temperature is 32o with March to June as the
hottest months when temperatures may reach 38oC. On the other hand, November to
February provide cooler weather with temperatures around 23oC. The Philippines is prone
to natural disasters brought about by volcanic eruptions, earthquakes, floods and typhoons.
Rains and typhoons prevail from July to October (NOH, 2005-2010).

Demographic Characteristics

The population of the Philippines in the 2000 census was 76,504,077, a 58 percent increase
from the 1980 census. The population grew at the rate of 2.4 percent annually between
1995 and 2000 while it grew at 2.1 percent between 2000 and 2005. The population is
projected to increase to 91,868,309 in 2010. The NCR has an estimated 13.3 percent of the
total population of the Philippines. It has the greatest population concentration with 16,091
people per square kilometer, a ratio that is 63 times the national average. The least
population areas are the CAR and Region 2 with a population density of 70 and 90 people
per square kilometer, respectively. Five out of the 17 administrative regions have growth
rates higher than the national average: Region 3, MIMAROPA and CALABARZON,
Region 7, Region 11 and ARMM. NCR has the lowest population growth rate of 1.06
percent and ARMM has the highest at 3.86 percent. In comparison with other countries, the
Philippine ranked twelfth among the countries of the world in terms of total population.
The Philippines is ranked fifth among Southeast Asian countries in annual population
growth rate (PSY, 2004 and NOH, 2005-2010).

Approximately 52 percent of the Philippine population live in rural areas. However,

urbanized areas now attract migrants from rural communities due to more economic,
educational, recreational opportunities. Rural-to-urban migration causes much pressure on
government to provide basic social services like health care, shelter, water, sanitation and
education. The congestion and pollution in urban areas are harmful to health. In frontier
areas where more migration is also noted, the people’s health is affected by difficult access
to health services and the presence of locally endemic diseases like malaria, filariasis and
schistosomiasis (PSY, 2004 and NOH, 2005-2010).

The median age of the Philippine population is 21 years old. This makes the Philippines a
country of young people with, half of its population below 21 years old. Males outnumber
females with a sex ratio of 101.43 males for every 100 females. There are more males than
females in the age groups 0-19 and 25-54 years.The age structure of the Philippine

9
population is typical broad base at the bottom consisting of large numbers of children and a
narrow top made up fairly small numbers of older persons. The dependency ratio is 69,
which means that every 100 persons in the working age group (15-64 years old) have to
support about 63 young dependents and about six old dependents. Young dependents (65
years old and over) account for 3.8 percent, while 59.2 percent comprise the economically
active population (15-64 years old). Women of reproductive age comprise around 51
percent of the total number of females in country (PSY, 2004 and NOH, 2005-2010).

Economic Characteristics

The Philippines is a developing country. Per capita Gross National Product(GNP) was
P56,109 and per capita Gross Domestic Product (GDP) was P52,241 in 2003. The 2002-
2003 GNP growth rate was 5.6 percent and GDP was 4.7 percent. In 2000, the annual per
capital poverty threshold was estimated at P11,605, an 18 percent increase over the 1997
threshold of P9,843. With this threshold, a family of five members should have a monthly
income of P4,835 to meet its food and non-food basic needs. Average annual family
income reached P148,757 in 2003, increasing by 2.5 percent over the P145,121 average in
2000. As earnings rose across all income levels, from the 27.5 percent revised estimate
from 2000 down to 24.7 percent in 2003 (NSCB, 2005).

Unemployment and underemployment rates have increased in the past three years.
Unemployment rates stood at 10.2 percent in October 2002, it has gone up to 10.9 percent
as of October 2004. Underemployment has also gone up from 15.3 percent in October
2002 to 16.9 percent in October 2004. Average inflation rate has also gone up from 3.5
percent in 2003 to six percent in 2004 (PSY, 2004)

Organization of the Health Care System

The Philippines recognizes health as a basic human right. It protects and promotes the right
to health of the people and instills health consciousness among them. Although this
provision is guaranteed by the 1987 Constitution (Article II, Section 15) and the health care
system in the Philippines is generally extensive, access to health services, especially by the
poor, is still hampered by high cost, physical and social-cultural barriers (NOH, 2005-2010).

To address these concerns, reforms in the country’s health care system have been instituted
in the past 30 years: the adoption of Primary Health Care in 1979; the integration of public
health and hospital services in 1983 (EO 851); the enactment of the Generics Act of 1988
(RA 6675); the devolution of health services to LGUs as mandated by the Local
Government Code of 1991 (RA 7160); and the enactment of the National Health Insurance
Act of 1995 (RA 7875). In 1999, the DOH launched the Health Sector Reform Agenda
(HSRA) as a major policy framework and strategy to improve the way health care is
delivered, regulated and financed(NOH, 2005-2010).

The Philippines has a dual health system consisting of : the public sector, which is largely
financed through a tax-based budgeting system national and local level and where health
care is generally given free at the point of services (although socialized user charges have
been introduced in recent years for certain types of services), and the private sector
(consisting of for-profit and non-profit providers), which largely market-oriented and where
health care is paid through user fees at the point of service. The expansion of social health
insurance in recent years and its emergence as a potential major source of health financing

10
will have a positive and private sectors and in terms of the people’s health-seeking behavior
(NOH, 2005-2010).

Under this health system, the public sector consists of the DOH, LGUs and other national
government agencies providing health services. The DOH is the lead agency in health. Its
major mandate is to provide national policy direction and develop national plans, technical
standards and guidelines on health. It has a regional field office in every region and
maintains specialty hospitals, regional hospitals and medical centers. It also maintains
provincial health teams made up of DOH representatives to the local health boards and
personnel involved in communicable disease control (NOH, 2005-2010).

With the devolution of health services under the 1991 Local Government Code, provision
of direct health services, particularly at the primary and secondary levels of health care, is
the mandate of LGUs. Under this set-up, provincial and district hospitals are under the
provincial government while the municipal government manages the rural health units
(RHUs) and barangay health stations (BHSs). In every province, city or municipality, there
is a local advisory body to the local executive and the sanggunian or local legislative
council on health-related matters (NOH, 2005-2010).

The passage of the 1995 National Health Insurance Act expanded the coverage of the
national health insurance program to include not only the formal sector but also the
informal and indigentsectors of the population. The program founded under the principle
of social solidarity where the healthy subsidizes the sick and those who can afford to pay
subsidize those who cannot. PhilHealth, a government-owned and controlled corporation
attached to the DOH, is the agency mandated to administer the national health insurance
program and ensure that Filipinos will have financial access to health services (NOH, 2005-
2010).

The private sector includes for-profit and non-profit health providers whose involvement in
maintaining the people’s health is enormous. Their involvement include providing health
services in clinics and hospitals, health insurance, manufacture and distribution of
medicines, vaccines, medical supplies, equipment, other health and nutrition products,
research and development, human resource development other and other health-related
services (NOH, 2005-2010).

Health Care Facilities

Various health facilities serve the health needs of the Filipinos. The total number of
hospital, both government and private, increase from 1,607 in 1980 to 1,738 in 2002.
Though the number of hospitals increased nationwide, the number of beds per 10,000
population decreased from 18.2 in 1980 to 10.7 in 2002 (PSY 2004). The number of
government hospitals nationwide increased from 623 in 2000 to 661 in 2002, while private
hospitals slightly decreased from 1,089 in 2000 to 1,077 in 2002. Although only 661 or 38
percent of hospitals are government hospitals, these contribute 45,395 beds or 53.3 percent
of bed capacity nationwide (PSY, 2004 and NOH, 2005-2010).

ARMM has the least number of hospitals, consisting of three private hospitals and 11
government hospitals in 2002. CALABARZON and MIMAROPA have the most number
of hospitals with 176 private hospitals and 95 government hospitals (PSY, 2004 and NOH,
2005-2010).

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In terms of government hospital beds, NCR has the most number of 9,965 beds followed by
CALABARZON and MIMAROPA at 6,295 beds and Region 3 at 3,385 beds. The regions
with the least number of government hospital beds are ARMM at 870 beds, Region 10 at
1,150 beds and Region 12 at 1,195 beds. The government hospital bed to population ratio
is worst in Region 11 in Mindanao with one bed for every 3,575 people while it is best in
NCR with one bed for every 807 people (PSY, 2004 and NOH, 2005-2010).

There is increasing trend in the number of BHSs from 9,184 in 1988 to 15,343 in 2002
while there is a decreasing trend in the number of RHUs in the country from 1,962 in 1986
to 1,879 in 2001. NCR has the most number of RHUs while the Central Mindanao has the
least number of RHUs. On the other hand, CALABARZON and MIMAROPA have the
most number of BHSs while NCR has the least (PSY 2004). On the average, each RHU
serves around 41,000 people while each BHS serves around 5,100 people (PSY, 2004 and
NOH, 2005-2010).

Health Human Resources

Human resources for health are central to managing and delivering health services. They
are crucial in improving health systems and health services and in meeting the desired
health outcome targets. Human resources for health are enormous but unevenly distributed
in the country. Most health practitioners are in Metro Manila and other urban centers.
Compared to most Asian countries, the Philippines is producing more and better human
resources for health (NOH, 2005-2010).

The number of physicians per 100,000 populations slightly increased from 123.8 in 1998 to
124.5 in 2000, which translates into one physician for every 803 people in 2000. The
number of dentist per 100,000 population almost remained unchanged at 54.2 in 1998 and
54.4 in 2000 or one dentist per 1,840 people in 2000. The number of pharmacists per
100,000 populations improved slightly from 55.8 in 1998 to 58.1 in 2000. This means one
pharmacist for very 1,722 people in 2000. The number of nurses per 100,000 populations
almost remained constant from 442.7 in 1998 to 442.8 in 2000, a ratio of one nurse per 226
people for both 1998 and 2000 (SEAMIC, 2003 and NOH, 2005-2010).

In 2002, there are 3,021 doctors, 1,871 dentist, 4720 nurses and 16,534 midwives employed
by LGUs. Other health personnel employed by LGUs consist of 3,271 engineers/sanitary
inspectors, 303 nutritionist, 1,505 medical technologist, 977 dental aides and 2,808 non-
technical staff. Assisting these health personnel at the grassroots are 195,928 volunteer
barangay health workers and 54,557 birth attendants (FHSIS, 2002 and NOH, 2005-2010).

The Philippines has traditionally been a major source of health professionals to many
countries because of their fluent English, skills and training, compassions, humaneness and
patience in caring. The country is purportedly the leading exporter of nurses to the world
(Aiken, 2004) and the second major exporter of physicians (Bach, 2003). Although the
country is producing a surplus of health workers for overseas market since the 1960s, the
large exodus of nurses in the last four years has been unparalleled in the migration history
of the country. While Filipino physicians have been migrating to the United States since
the 1960s and to the Middle East countries in the 1970s in steady outflows, the recent
outflows are disturbing because they are no longer migrating as medical doctors but as
nurses (NOH, 2005-2010).

12
Based on the baseline survey of nursing-medics in the Philippines, more than 3,500 Filipino
doctors have left as nurses since the year 2000 (Galves-Tan, Sanchez, Balanon,2004). A
little more than 1,500 doctors have passed the national nurse licensure examination in 2003
and 2004 (PRC, 2002). An estimated 4,000 doctors are enrolled in nursing schools all over
the country (Galves-Tan, Sanchez, Balanon, 2004). The Philippine socioeconomic and
political situations have not helped munch in retaining licensed and skilled nurses and other
health professionals in the country. (NOH, 2005-2010).

3 Frameworks for Generating Health and Nutrition Statistics

The Millennium Development Goals (MDGs), the Philippine Statistical Development

Program (PSDP) 2005-2010, the Medium-Term Philippine Development Plan (MTPDP)
for Health and other health and nutrition sectoral plans such as the National Objectives of
Health (NOH) 2005-2010, the Medium-Term Philippine Plan of Action for Nutrition
(MTPPAN), and the Philippine Population Management Program Directional Plan (PPMP-
DP) provide very clear strategies and expected outcomes of international and national
development goals and targets which require statistics and indicators. These frameworks
serve as basis for identifying priority indicators/statistics for monitoring and evaluating the
progress of the country’s health and nutritional plans, programs and policies. Figure 1
summarizes the major strategies and expected outcomes for health and nutrition as drawn
from the different plans and programs.

Figure 1. Health and Nutrition Strategies and Expected Outcome1

MILLENIUM DEVELOPMENT GOALS

STRATEGIES EXPECTED OUTCOMES

(1) Eradicate extreme poverty and (1) Halve, between 1990 and 2015, the
hunger proportion of people who suffer from
hunger
(2) Reduce by two-thirds, between 1990
(2) Reduce child mortality
and 2015, the under five mortality
rate
(3) Improve maternal health (3) Reduce by three-quarters, between
1990 and 2015, the maternal
(4) Combat HIV and AIDS, Malaria mortality ratio
and other diseases (4) Have halted by 2015 and begun to
reverse the spread of HIV/AIDS
(5) Ensure environmental (5) Have halted by 2015 and begun to
reverse the incidence of malaria and
sustainability
other major diseases
(6) Halve, by 2015, the proportion of
(6) Develop a global partnership for people without sustainable access to
development safe drinking water
(7) In cooperation with pharmaceutical
companies, provide access to
affordable, essential drugs in
developing countries

1
from the Philippine Statistical Development Plan 2005-2010

13
Continuation of Figure 1
HEALTH
STRATEGIES
(1) Reduce the cost of essential medicines
(2) Expand health insurance particularly for
indigents
(3) Strengthen national and local health
systems through the implementation of
the Health Sector Reform Agenda for
health regulation reforms
(4) Improve Health Care Management
System;
(5) Improve health and productivity through
Research and Development; and
(6) Establish drug treatment and rehab
centers and expand existing ones.
NUTRITION
STRATEGIES
(1) Focus on adolescent females,
pregnant and lactating women and
children 1-3 years old
(2) Complementation of nutrition
interventions with other development
programs
(3) Geographical focus to needier areas
(4) Food-based interventions for
sustained improvement in nutritional
status
(5) Increased investments in nutrition
. deficiency disorders among lactating
14
EXPECTED OUTCOMES
(1) Fifty percent reduction in prices of 22
therapeutic classes essential
medicines from 2004 prices by 2010;
(2) Covered 5 million indigent families
enrolled and sustained in National
Health Insurance Program (NHIP);
(3) One hundred percent of hospitals
licensed by Department of Health;
(4) Standardized training courses,
registration, regulation and
accreditation developed and
institutionalized;
(5) Seventy percent increase in utilization
of health, nutrition and population
related Research and Development
results
(6) Treatment and rehabilitation care
EXPECTED OUTCOMES
(1) Reduced proportion of Filipino
households with intake below 100%
dietary energy requirement
(2) Reduced prevalence of underweight
children 0-5 and 6-10 years old
(3) Reduced prevalence of stunting
among children 0-5 years old
(4) Reduced prevalence of chronic
energy deficiency among pregnant
women
(5) Reduced prevalence of vitamin A
deficiency disorders among children 6
mos.-5 years old, pregnant and
lactating women
(6) Reduced prevalence of iodine
women
(7) Reduced prevalence of low birth
weight
The Framework Based on the National Objectives for Health 2005-2010

The DOH in its quest to strengthen the Philippine health system and make it a vehicle for
social change, engineered the Fourmula One for Health (F1) in 2005 as the new
implementation framework for vital health sector reforms as stated in its HSRA in 1999. F1
became the DOH’s guiding philosophy and strategic approach to implement health reforms.
On the other hand, the NOH 2005-2010 provides the “road map” of key ideas, targets,
indicators and strategies to bring the health sector to its desired outcomes. (NOH 2005-
2010) .

With the F1 in mind, the following was developed by the Information Management Service
(IMS) of DOH as its major strategies for developing rationalized and more efficient
national and local health information systems through strengthening networking
mechanisms and referral systems, sharing of resources, organizational transformation and
restructuring, capacity building.

Table 1. Strategies for Health Information Systems under Fourmula One

Key Result Deliverables Unit
Areas Responsible

Easy access to • PHIN established and operational IMS, health Formatted: Indent: Before:
-5.4 pt, Bulleted + Level: 1 +
health programs, Aligned at: 18 pt + Tab after:
information. • Health Information standards developed and services, 36 pt + Indent at: 36 pt,
bureaus, other Tabs: Not at 36 pt
implemented
Health Formatted: Indent: Before:
-5.4 pt, Bulleted + Level: 1 +
• Various information systems developed Information Aligned at: 18 pt + Tab after:
(Hospital Operations and Management Generators 36 pt + Indent at: 36 pt,
Tabs: Not at 36 pt
Information System(HOMIS), FHSIS, (NSO,
Philippine Formatted: Indent: Before:
Integrated Blood Bank Information -5.4 pt, Bulleted + Level: 1 +
System(IBBIS), Bureau of Food and Drugs Council for Aligned at: 18 pt + Tab after:
Integrated Information System(BIIS), Drug Health Research 36 pt + Indent at: 36 pt,
Tabs: Not at 36 pt
Test Operation and Management Information and
System (DTOMIS), DOH Licensing Development(P
Information System(DOHLIS), etc.) CHRD), NSCB,
medical
• Data warehouse with the following health societies, etc) Formatted: Indent: Before:
-5.4 pt, Bulleted + Level: 1 +
information: Aligned at: 18 pt + Tab after:
o Health service statistics and disease 36 pt + Indent at: 36 pt,
surveillance Tabs: Not at 36 pt

o Health regulation
o Health statistics such as vital statistics,
health accounts, health surveys,
censuses
o Health researches, best practices,
lessons learned

15
 Key Result Deliverables
Areas
DOH • Health portal which is the repository of
transformed to a the health intellectual capital is
knowledge established, operational and used
organization
• Resource learning center operational with
virtual health library and knowledge bases
established and utilized
• Knowledge management(KM)
infrastructures established
• Knowledge is shared to stakeholders
through knowledge networks
• Health workers imbibed KM qualities
such that seeking, sharing and utilization
of knowledge has become a habit.
Health data and • Information and Communications
infrastructure Technology(ICT) standards developed and
are used by stakeholders
interoperable • Interconnection of central office, Centers for
Health Development(CHDs) and DOH
retained hospitals
• DOH, Philippine Health Insurance
Corporation(PHIC or PhilHealth) and private
sector databases are interoperable
Efficient, • Monitoring and evaluation of Fund
rational and resources
appropriate use • electronic-New Government Accounting
of funds
System( e-NGAS) reports/Work and
Financial Plan Database System(WFPDB)
• Develop feedback mechanisms for fund
utilization at regional level
• Installation of e-NGAS in all regions
Source: IMS, DOH
16
Unit
Responsible
IMS , programs, Formatted: Bulleted + Level:
1 + Aligned at: 18 pt + Tab
sectoral support after: 36 pt + Indent at: 36
cluster, Internal pt, Tabs: 18 pt, List tab + Not
Management at 72 pt
Suppot Formatted: Bulleted + Level:
Team(IMST) 1 + Aligned at: 18 pt + Tab
after: 36 pt + Indent at: 36
pt, Tabs: 18 pt, List tab + Not
at 72 pt
Formatted: Bulleted + Level:
1 + Aligned at: 18 pt + Tab
after: 36 pt + Indent at: 36
pt, Tabs: 18 pt, List tab + Not
at 72 pt
Formatted: Bulleted + Level:
1 + Aligned at: 18 pt + Tab
after: 36 pt + Indent at: 36
pt, Tabs: 18 pt, List tab + Not
at 72 pt
Formatted: Bulleted + Level:
1 + Aligned at: 18 pt + Tab
after: 36 pt + Indent at: 36
pt, Tabs: 18 pt, List tab + Not
IMS with other at 72 pt
units
Formatted: Indent: Before:
-5.4 pt, Bulleted + Level: 1 +
Aligned at: 18 pt + Tab after:
36 pt + Indent at: 36 pt,
Tabs: Not at 36 pt
Field Formatted: Bulleted + Level:
1 + Aligned at: 18 pt + Tab
Surveillance(FS after: 36 pt + Indent at: 36
)/ Planning pt, Tabs: 18 pt, List tab + Not
Division at 72 pt
The following framework is then suggested for an integrated Philippine Health Information
System:

Figure 2
FRAMEWORK FOR THE DEVELOPMENT OF THE
PHILIPPINE HEALTH INFORMATION SYSTEM

PERFORMANCE METRICS

HEALTH AND VITAL HEALTH SERVICE

STATISTICS DELIVERY

Vital Statistics Public Health

National Health Executive Support System

Disease Surveillance
Account
Hospital Operations
Demographic and
and Management
Health Surveys
Health Emergencies
Response

HEALTH DATA
WAREHOUSE
HEALTH SYSTEMS HEALTH SYSTEM
MANAGEMENT INFORMATION

Local Health Systems Human Resources

Development Management

Health Care Financing Information Resources

Management
International Health
Cooperation Logistics
Decision Support System
Management

Health Facilities
Health Regulation

KNOWLEDGE SHARING
HEALTH RESEARCH
BEST PRACTICES / LESSONS LEARNED
PORTALS (EXTRANET/INTRANET)

17
It is noted that in a DOH Health Information System (HIS) Integration Workshop on
January 16 -17 2007, the following guidelines in constructing a Philippine Integrated
Health Information System(PIHIS) was suggested:

ƒ Build on existing health information systems to integrate content and information

functions,
ƒ Develop/Strengthen policy and regulation for data submission and/or information
gathering,
ƒ Compliance to government policy on ICT, and
ƒ Compliance to DOH Department Order 2005-0032 – Standard Operating Procedure
and Guidelines on ICT Works in the DOH.

These guidelines are based on the conceptual framework of bringing together data from
different information systems, to share and disseminate them, and to ensure that health
information is used rationally, effectively and efficiently to improve health action or
decision-making process. Additional guidelines are:

ƒ Compliance to the General Standards on Statistical Information Dissemination

(GSSID) per NSCB Board Resolution No. 8, s. 1999, and,
ƒ Compliance to the IMF Data Assessment Quality Framework (DQAF).

Furthermore, the following strategies were enumerated:

ƒ Standardization – common data indicators, definitions, data formats, data

transmission protocols
ƒ Data Warehousing – central data repository
ƒ Process Integration – eliminate redundancies and/or duplications.
ƒ Integrated Data Management
ƒ Integrated Human Resource
ƒ Integrated Financial Resources.

It must be emphasized, though, that the integration workshop focused only on the
information systems of DOH which are mainly administrative records and did not include
the other health and nutrition data being generated by other government agencies auch as
the NSO and the NSCB.

The Philippine Statistical Development Plan 2005-2010

The Philippine Statistical Development Program (PSDP) 2005-2010 serves as the blueprint
of all statistical activities that will generate the data requirements for all international and
national development plans and programs. The PSDP chapter on Health and Nutrition is
guided by the above development priorities for the health and nutrition sector.

Table 2 depicts the statistical framework for the health and nutrition sector in the PSDP
2005-2010. The framework has 6 components. These are: health status, health resources,
health services, nutritional status, nutrition resources, and nutrition services. These
components correspond to the major areas of concern and areas where the indicators to be
used in monitoring will be identified. Thus, the framework shall serve as a basis for data
production and dissemination as well as for coordination among the agencies producing the
data.

18
 Table 2. Statistical Framework on Health and Nutrition
Sector/Components/
Key Indicators
Sub-Components
HEALTH
Health Status
Mortality Life expectancy
Proportion surviving from birth by sex
Proportion population 65 and over
Crude Death Rate
Infant Mortality Rate 2/
Child Mortality Rate
Under-Five Mortality Rate 2/
Maternal Mortality Ratio 2/
Causes of Mortality
Death rates for selected causes of deaths
Morbidity Incidence of Specific Notifiable Diseases
No. of bird or avian flu cases
Causes of Morbidity
Fully Immunized Children
Proportion of 1 year-old children immunized against measles 2/
HIV prevalence among 15-24 year old pregnant women 2/
Number of children orphaned by HIV/AIDS 2/
Prevalence and death rates associated with malaria 2/
Proportion of population in malaria risk areas using effective
malaria prevention & treatment measures 2/
Prevalence & death rates associated with tuberculosis 2/
Proportion of tuberculosis cases detected & cured under directly
observed treatment short course (DOTS) 2/
Condom use rate of the contraceptive prevalence rate 2/
Prevalence of Specific Drug and Substance Abuse
Proportion of population with access to affordable essential
drugs on sustainable basis 2/
Reported Cases of Drug Dependency
DOH-retained and Local Government Unit- hospitals selling
low-priced drugs 1/
Rate of increase / decrease in the number of mental health
facilities upgraded 1/
Environmental Proportion of households with Sanitary Toilet Facilities
Sustainability Proportion of population with sustainable access to improved
water source 2/
Proportion of urban population with access to improved
sanitation 2/
Disability Prevalence of Disability
Causes of Disability
Health Resources
Facilities No. of government hospitals provided with training to improve
their service capabilities 1/
No. of licensed hospitals 1/
Ratio to Population of Health Facilities
Manpower Proportion of births attended by skilled health personnel 2/
No. of government doctors, nurses, dentists & midwives
Physicians per 1,000 population

19
Sector/Components/
Key Indicators
Sub-Components
Ratio to Population of Health Manpower
Financing Total Health Expenditure
Share of Health Expenditure to GNP and GDP
Health Expenditure by Source of Funds
Health Expenditure by Use of Funds
Gross Value Added on Health
Per Capita Health Expenditure
Health Services (Provision and Utilization)
Health R & D No. of health & population related reaseach and development
utilized 1/
Promotive Percentage of Population Availing of Health Services by Type
Preventive Percentage of the Population Covered by Health Insurance 1/
Curative Percentage of population availing of health services by type of
service
Rehabilitative Percentage of population using health facilities
Overall satisfaction with health facilities and services
NUTRITION
Nutrition Status
Prevalence of Prevalence of underweight children under 5 years of age 2/
Malnutrition Prevalence of underweight adolescents
Prevalence of underweight other age group
Prevalence of underweight-for-age, underheight-for-age,
underweight-for-height; overweight and obesity
Prevalence of low birthweight infants
Proportion of population below minimum level of dietary
energy consumption 2/
Prevalence of low birthweight infants
Prevalence of CED, overweight and obesity
Prevalence of Prevalence of Vitamin A deficiency
Micronutrient Deficiency Prevalence of anemia
Prevalence of Iodine deficiency
Food and Nutrient Intake Per Capita Energy/Nutrient Intake
Percent nutrient adequacy
Per capita food intake (total, by food groups, food source)
Per capita consumption per day
Per Capita Food Supply (per year, per day, per day energy, per
day protein, per day fats)
Total Domestic Supply by Major food Group
Prevalence of nutrition- Prevalence of hypertension
related risk factors to Prevalence of high total serum cholesterol
chronic degenerative Prevalence of high triglyceride
disease
Prevalence of low HDL-c
Prevalence of high LDL –c
Prevalence of high fasting blood sugar among adults
Prevalence of females with high waist-hip ratio
Prevalence of Prevalence of exclusive breastfeeding (BF) among 0-6 monts
Breastfeeding (BF) and old children
Complementary Feeding
Proportion of children not breastfed among 0-24 months
Proportion of children receiving breast milk + water only among
0-6 and 6-9 months old children

20
 Sector/Components/
Key Indicators
Sub-Components
Proportion of children receiving breast milk + water-based
liquids/juice among 0-6 and 6-9 months old children
Proportion of children receiving breast milk + other milk among
0-6 and 6-9 months old children
Proportion of children receiving breast milk + complementary
food among 0-6 and 6-9 months old children
Nutrition Resources
Financing NGA, NGO and LGU funding for nutrition programs/activities
Proportion of Government Expenditures for Nutrition
Programs
Facilities No. of hospitals
No. of RHUs and BHS
No. of weighing stations
No. of weighing scales
Ratio to Population of Manpower and Facilities
Manpower No. of medical personnel
No. of dietitians, nutrition officers, nutrition action officers,
barangay nutrition scholars, barangay health workers
Ratio to population of manpower and facilities (nutrition
related activities/program by government and private sector)
Nutrition Services (Provision & Utilization)
Nutrition R & D No. of health & population related research and development
utilized 1/
Promotive Proportion of Population Availing Various Nutrition
Preventive Programs/Services by Type
Curative Percent of 0 - 5 year old children given vitamin A supplements
Rehabilitative
Percent of households using iodized salt
Source: Philippine Statistical Development Plan 2005-2010
Notes: 1/ Indicators to monitor MTPDP Goals/Priorities 2/ Indicators to monitor

* - not available (what is available is percent of households with per capita energy less
than 100% adequacy based on the 1993 National Nutrition Survey)

The Philippine Statistical System

Government and official statistics in the Philippines are generated by a decentralized

statistical system called the Philippine Statistical System(PSS). This system is a
government-wide decentralized system of government agencies that provide statistical
information and services to the public. Statistical services include the gathering, compiling,
processing, aggregation, analysis and dissemination of data. The set up is decentralized
with the following main government agencies:
• the National Statistical Coordination Board (NSCB) which is the policy-making
and coordinating body for the statistical system;
• the National Statistics Office (NSO) which is the single general purpose
statistical agency conducting the censuses such as the Census of Population and
Housing, the surveys such as the Labor Force Survey, and the civil registration
of the country;

21
 • the Statistical Research and Training Center (SRTC) which is the statistical
research and training arm of the system;
• Other major statistical agencies such as the Bureau of Agricultural Statistics
(BAS) and the Bureau of Labor and Employment Statistics(BLES) ;and,
• all the departments, bureaus, offices, agencies and instrumentalities of the
National Government and Local Government and Government Owned and
Control Corporations and their subsidiaries that are engaged in statistical
activities either as their primary functions or part of their administrative or
regulatory functions.

The following is the structure of the system:

Figure 3

The official statistical unit of the DOH, the National Epidemiology Center (NEC), is
DOH’s focal point for the PSS under other departments’ statistical units. Being DOH’s
focal point, it should represent the statistical concerns of the DOH as a whole. There are at
present, however, other units at the DOH that generate health statistics, e.g., Bureau of
Health Facilities and Services, that may be considered as part of this system but are not
actively involved in the PSS. The creation of an integrated Philippine Health Information
System (PHIS) aims to correct this situation. This PHIS framework as presented in Figure 2
is envisioned to be part of the PSS in Figure 3.

4 Government Agencies Generating Health and Nutrition Statistics

As presented in the different frameworks in the previous chapters, many government

agencies are involved in generating health and nutrition statistics. This chapter presnts the
different government agencies and the important data systems they maintain.

22
The Department of Health

The DOH remains as the major source of data for the health sector. Its statistics are mostly
derived from administrative reporting forms regularly furnished by public hospitals, rural
health units and other health units in the lower administrative units of government. The
Philippine Health Statistics (PHS) is a report of the NEC of DOH. It provides a summary of
statistical data on births, deaths and notifiable diseases registered and reported through the
Notifiable Diseases Registry of the FHSIS submitted by the RHUs and BHSs. Diseases,
injuries and health conditions are coded using the International Classification of Diseases
version 10 (ICD-10).The different data systems being generated by different offices in
DOH may be classified as:

1. Health Service Delivery Systems

ƒ The FHSIS serves as the major source of data for the DOH. The system
provides information on the different public health programs such as:
Maternal and Child Health; Nutrition; Family Planning; Expanded Program
on Immunization; Dental Health; Communicable Disease Prevention and
Control(TB, Malaria, Schistosomiasis, Leprosy); Environmental Health; Vital
Statistics (Natality, Mortality, Population); and, Notifiable Disease Reporting
System. Data are provided by the local field health personnel through the
regional and provincial health offices, and consolidated at the Central Office.
These are presented by province, city and region in a publication of the same
title.

ƒ The Health Management Information System (HMIS) consists of several sub-

systems, two of which are the HOMIS and the Rural Health Unit Information
System (RHUMIS).The HOMIS generates information on hospitals to support
the delivery of hospital services and the management of the hospital.The
RHUMIS is a public health information system designed for the rural health
units to efficiently and effectively monitor patient cases. A plan is to create a
Unified Health Management Information System (UHMIS) which shall report
statistical data of diseases/diagnosis from HOMIS and non-HOMIS users on a
daily basis for the Alert System and sending of data to the DOH central
storage or database.

ƒ Surveillance systems which include the two major disease surveillance

systems that provide information on notifiable diseases are the Weekly
Notifiable Disease Reporting System (WNDRS) which comes from the FHSIS
and the National Epidemic Sentinel Surveillance System (NESSS).

• The WNDRS provides information on 17 diseases(Anthrax, Cholera,

Diphtheria, Viral Encephalitis, Viral Hepatitis,
Leprosy,Leptospirosis,Malaria, Measles, Viral Meningitis, Neonatal
Tetanus, Non-neonatal Tetanus, Meningococcal Infections, Paralytic
Shellfish Poisoning, Rabies, Typhoid and Paratyphoid fever,
Whooping cough or Pertussis) and 7 syndromes(Acute Flaccid
Paralysis, Acute Hemorrhagic Fever Syndrome, Acute Lower
Respiratory Tract Infection and Pneumonia, Acute Watery

23
 Diarrhea, Acute Bloody Diarrhea, Food Poisoning, Chemical
Poisoning).

• The NESSS is a hospital-based system that yields information on

admitted cases in sentinel to monitor the occurrence of 14 infectious
diseases with outbreak potential. These included laboratory-diagnosed
diseases (Cholera, Hepatitis A, Hepatitis B, Malaria, Typhoid Fever)
and clinically-diagnosed diseases (Dengue Hemorrhagic Fever,
Diphtheria, Measles, Meningococcal Disease, Neonatal Tetanus, Non-
neonatal Tetanus, Pertussis, Rabies, Leptospirosis).

ƒ Registries (HIV and AIDS, Diabetes, Injuries, Cancer, Persons with

Disabilities (PWD), Tubercolosis (TB), Renal Diseases) which are also
maintained by various professional societies and non-government
organizations.

ƒ Philippine Malaria Information System (PMIS) is a relatively new system

which was piloted in 27 project sites, could also be used by other provinces in
2005 and is yet to be deployed in other provinces. It uses a license-free
software and runs in any Windows operating system. Its indicators include
SPR, API, age-gender-species, % coverage of mosquito net, % coverage of
households sprayed. Malaria data for FHSIS can be extracted from PMIS and,
thus, it can be integrated into FHSIS. Future enhancements to PMIS are web-
based reporting, and use of mapping facilities such as HealthMapper.

2. Health Regulation Systems

ƒ BIIS consisting of Health Product Regulation and Health Product

Establishment Regulation

ƒ DTOMIS which includes DOHLIS and Health Facilities and Service

Regulation

ƒ Health Devices Regulation

3. Health Governance Systems

ƒ WFPDS which collect data on plans and programs of the DOH Central Formatted: Indent: Before:
36 pt, Hanging: 27 pt,
Office , the Centers for Health Development(CHDs), DOH hospitals, and Bulleted + Level: 3 + Aligned
Attached agencies. Some of the data include: number of health at: 162 pt + Tab after: 180
products/establishments/ facilities/devices registered/licensed/ accredited, pt + Indent at: 180 pt, Tabs:
36 pt, List tab + Not at 117 pt
number of policies/standards/guidelines formulated, number of trainings + 180 pt
conducted/attended in persondays (men/women), number of technical
assistance provided in person-days, number of LGUs provided with
logistics/technical assistance, number of Botika ng Barangay(BNBs)
established, number of low cost drugs made available in F1 sites, number of
Inter-Local Health Zones (ILHZs) developed as well as hospital data such as
number of admissions, number of discharges, number of patient days, number
of outpatients served, number of major/minor operations, number of

24
 laboratory examinations done, number of radiological procedures done,
number of prescriptions filled.

ƒ National Health Atlas is a facility-mapping software of all rural health units Formatted: Indent: Before:
36 pt, Hanging: 27 pt,
and government hospitals in the country. Health human resource complement, Bulleted + Level: 3 + Aligned
health care services available and equipment are included in the database. at: 162 pt + Tab after: 180
pt + Indent at: 180 pt, Tabs:
36 pt, List tab + Not at 117 pt
ƒ Philippine Local Health Information System (PLHIS) which provides + 180 pt
information from LGUs Formatted: Indent: Before:
36 pt, Hanging: 27 pt,
Bulleted + Level: 3 + Aligned
ƒ Others (eNGAS, LMIS, PIS, eProcurement, Document Tracking Information at: 162 pt + Tab after: 180
System (DTIS), Contract Distribution System of Core Essential Drugs which pt + Indent at: 180 pt, Tabs:
is being implemented in phases) 36 pt, List tab + Not at 117 pt
+ 180 pt
Formatted: Indent: Before:
4. Other systems 36 pt, Hanging: 27 pt,
Bulleted + Level: 3 + Aligned
ƒ Community Based Management Information System (CBMIS) at: 162 pt + Tab after: 180
pt + Indent at: 180 pt, Tabs:
ƒ PhilHealth systems 36 pt, List tab + Not at 117 pt
+ 180 pt
The DOH also conducts surveys. These include Prevalence Surveys (TB, Leprosy, Formatted: Indent: Before:
36 pt, Hanging: 27 pt,
Schistosomiasis) and the National Health Surveys in 1978, 1981 and 1987 which were Bulleted + Level: 3 + Aligned
eventually stopped when the NSO conducted the National Demographic and Health at: 234 pt + Tab after: 252
Surveys (NDHS) starting 1993. pt + Indent at: 252 pt, Tabs:
Not at 252 pt

The Food and Nutrition Research Institute

The Food and Nutrition Research Institute (FNRI) remains the major source of data on
nutrition. It conducts the National Nutrition Survey every five years. Data generated
through this survey include the nutritional food situation of the country, per capita food
intake in grams and in nutrient equivalent, anthropometric data, extent of some nutritional
deficiencies among various age groups of the population, and food menus fro the poverty
statistics being generated by NSCB.

The National Nutrition Council

The National Nutrition Council (NNC), the highest policy making and coordinating body
on nutrition, is under the DOH and is mandated to formulate national nutrition policies and
coordinate the policy formulation, planning, monitoring and evaluation, resource generation
and mobilization for nutrition improvement. Its additional mandates are: to address food
insecurity by being the focal agency for Food Insecurity and Vulnerability Information and
Mapping Systems (FIVIMS), to address hunger as the lead agency to ensure achievement
of MDG goals and targets on hunger and malnutritionto, and to ensure that hunger-
mitigation measures are in place. Data being generated by NNC include indicators of
nutrition resources (financing, manpower, facilities) and nutrition services (promotive,
curative, preventive). Specific indicators are: ratio to population of nutrition manpower and
facilities, proportion of government expenditure to nutrition program, consolidated data
from Operation timbang received from local nutrition committees. The latter is used for the
ranking of mutritionally depressed communities.

25
The Philippine Health Insurance Corporation

PhilHealth is the agency under the DOH that provides and maintains database systems on
health insurance and financing and accreditations of health providers and health facilities.

The National Statistics Office

The NSO, as mandated by the Civil Registry Law, generates vital health statistics such as
marriages, births, deaths, infant deaths, foetal deaths, maternal deaths, and mortality by
leading causes.

o The NDHS which is undertaken by the NSO in collaboration with the University of Formatted: Indent: Before:
18 pt, Bulleted + Level: 2 +
the Philippines Population Institute (UPPI), DOH, Commission on Population Aligned at: 54 pt + Tab after:
(POPCOM), National Economic and Development Authority (NEDA), and the 72 pt + Indent at: 72 pt,
NSCB, provides national and regional estimates of levels and trends of fertility as Tabs: Not at 72 pt

well as examines the differentials and determinants of fertility. It also yields

information on family planning, childhood and adult mortality, maternal and child
health, and knowledge and attitudes related to HIV/AIDS and other sexually
transmitted infections. The National Health Survey of DOH was incorporated in the
NDHS starting 1993.
o The annual Maternal and Child Health Survey (MCHS) provides information on the
coverage and effectiveness of the maternal and child health programs of the DOH at
the regional level.
o The Family Planning Survey (FPS) provides data on prenatal and postpartum care,
protection at birth against neonatal tetanus, breastfeeding, and immunization.

The National Statistical Coordination Board

The NSCB produces the Philippine National Health Accounts (PNHA) with the following
indicators: total health expenditure at current and at constant prices, health expenditure per
capita at current and at constant prices, share of health expenditure to GNP and GDP,
health expenditure by source of funds, health expenditure by use of funds, and selected
national health accounts indicators compared with Asian countries.

Annex 1 provides a matrix of available health statistics available in the DOH while Annex
2 provides a matrix of Matrix of Available Health and Nutrition Statistics in the Philippine
Statistical System.

It is noted that health and nutrition statistics come from various sources which operate on
systems which are independent of one another. Thus, there is a need to improve, harmonize,
and utilize existing data generation systems that may provide the relevant key health and
nutrition statistics and indicators that will help monitor and assess the attainment of
expected outcomes.

26
5 Previous Studies on the Assessment of Health Information in the
Philippines

The assessment being presented in this report is not the first one done for the Philippines.
Many studies have already been done. This chapter shall presentg the results of these
previous assessments.

Past Reviews/ Assessment of Health Statistics and Information System in the

Philippines

Studies assessing health information systems were done in the past. Aguilar (1976)
conducted a study to develop a Health Information System in the Philippines in the 70s.
The proposed HIS shall have the following features specific subsystems to answer
information requirements of activities and programs of the DOH which when viewed in its
entirety, shall be so integrated to promote and enhance DOH objectives. It shall provide a
mechanism that will effectively connect the data gathering with the information needs of
the different management levels through the installation of a database that contains data
gathered from the field, data do not necessarily have to be centrally stored; they could be
situated in different units in the department; equipped with the capabilities to transform
these data into information as required by management and to transmit these to whoever
needs them. The database shall employ computers for data processing and storage, and
communication facilities as the situation may warrant. The study recognized that problems
in HIS development concern the highly dynamic environment within which the HIS must
operate, the peculiar problems the Department of Health has as the agency primarily
involved in HIS development and the difficulty of applying the MIS concept to situations
involving health program and evaluation.

Pons and Schwefel (1993) used the Goal Oriented Project Planning (GOPP) methodology
determine essential elements in strengthening the Health and Management Information
System (HAMIS) in the Philippines. Highlights of this planning strategy are:

• planning by Filipino nationals mainly

• participation by various professional groups with different levels of responsibility
• use of visualization techniques
• smooth consensus finding and democratic decision rules.

The study identified the core problem in health care management as an inefficient and
ineffective health and management information system. Six major causes were identified:

• information gaps Formatted: Indent: Hanging:

36 pt, Bulleted + Level: 1 +
• underutilization of data Aligned at: 36 pt + Tab after:
• excessive generation of data 54 pt + Indent at: 54 pt,
Tabs: 36 pt, List tab + Not at
• poor reliability and validity of data 54 pt
• lack of skills in information management
• lack of cost-effectiveness of health management.

Jayasuriya (1994 ) in studying HIS in the Philippines, reported the following:

27
 1. The Health Services in the Philippines underwent a major change in their
organization and structure following the devolution of the delivery of services to
LGUs.

2. Information systems development were to a great extent determined by the

management systems in place and the most extensive use of information is in,
planning and controlling.

3. Routine information systems were expensive to establish and maintain and if the
validity of some information is questionable it is nonsensical to submit it to levels
where action cannot take place.

4. The assessments of the existing systems identified deficiencies that were found in
most HIS. These were the existence of major gaps in information, the
inappropriateness of the available information for the needs and most evidently that
information is not utilized for management at most levels.

Marcelo et. al.( 2004) did an evaluation study in three of six pilot sites, i.e. Samar province,
Baguio City and Cotabato City of the Decentralized FHSIS (DFHSIS). This study
discovered that the DFHSIS reduced the number of required national indicators collected
by local health personnel and simplified the data flow as intended. For these reasons, the
DFHSIS was preferred over the Modified FHSIS (MFHSIS). Despite this however, the new
system did not generate enough information needed by the national program managers.
Furthermore, it did not result into better data accuracy, timeliness, and completeness, nor
did it encourage the implementors, i.e., local health personnel, to customize the system for
their local health needs. The software component of the DFHSIS was considered
incomplete by end-users and therefore not useful. Reasons noted for these problems include
lack of policy or implementing rules and regulation, poor support systems and structures,
lack of financing, and lack of capacities at the community level for health data utilization
for program improvement.The same problems of inaccuracy, incompleteness, and delay
that hounded the original FHSIS and MFHSIS also plagued the pilot implementation of the
DFHSIS. Thus, it was recommended that the DFHSIS, as planned and implemented in the
three pilot sites, not be adopted in other areas of the country unless fundamental
management systems and structures at all health system are put in place.

Decentralization, participatory governance and the principles of the declaration of Primary

Health Care are key concepts that should anchor a sound national health information
system. The authors further recommend [1] an enhancement of capability building
packages for local health personnel on health information systems management; [2] a
review of the data model of the DFHSIS/FHSIS; [3] innovations in collection such as
acceptance of barangay level data as soon as these are available; [4] automation of
transaction systems to facilitate transmission to higher levels of the DOH; and [5] use of
computerized tools to assist health units in understanding their own data through data clubs
and integrating their analysis of health information into their barangay health plans. Such
an approach will help make the DFHSIS a valuable asset not just for the DOH but also for
the community, which it intends to serve. The role of the National Epidemiology Center
must be sharpened as it takes the lead in managing the DFHSIS and ultimately, in setting
directions in knowledge-based decision-making at all levels of health care.

28
While administrative reports and surveillance systems are in place, these are limited only to
government-owned health facilities. Thus, only the surveys are able to capture the
contribution of privately-owned health facilities. However, the estimates that result from
these surveys are at best available up to the provincial level. Sub-provincial disaggregations
are not available. Current initiatives to address the unavailability of local-level data include
measuring LGUs health systems performance through the Organizational Performance
Indicator Framework (OPIF) or through small area estimation. The latter has been applied
but on vety limited health/information statistics.

Initiatives to address data quality assurance have led to the upgrading of health facilities to
conform to effective management standards. Facilities with such standards are referred to
as Sentrong Sigla. The upgrades include, among others, facilities for information systems.
Another concept being promoted is the ILHZs which aims for better data collection and
transfer from health facilities at municipal and provincial level.

Interagency on Health and Nutrition and PSDP 2005-2010 Assessment

The Inter-Agency Committee on Health and Nutrition Statistics (IAC-HNS) was created by
the NSCB to tackle issues on health and nutrition statistics. The IAC, co-chaired by the
DOH provided inputs to the PSDP through an assessment of the the different data sources,
and recognized the need to improve and synchronize/harmonize the various health
information systems. The PSDP specifically cites the problems of the FHSIS, PHS, and the
NESSS of the DOH. Issues on completeness, timeliness, quality/accuracy, and relevance of
health and nutrition statistics, especially those monitored in the MTPDP and in global
concerns like the MDGs, need to be resolved. The NSO also recognizes problems in its
Comment [FVNDL1]:
vital statistics in some areas in the country, which need to be improved.. Mention of NSO (only) should not
be under IAC..

The PSDP, following one of its key result area, shall maximize use of information
technology in data collection, processing, analysis, dissemination and archiving to enable
faster and wider utilization of data and promote transparency, information sharing and user
confidence on official statistics. This particular key result area aims to capitalize on
existing developments in information technology, specifically in enjoining government
agencies to establish websites and develop statistical information systems that would enable
them to upload/share statistical information available in the agency. The development of
interactive national statistical databases shall be promoted for different sectors and to
develop innovative statistical software that could be used within the PSS. An improvement
on the information systems of different agencies is likely to be expected.

The PSDP programs designed to address issues and challenges towards improving the
generation, dissemination and utilization of quality statistical information for health and
nutrition, are as follows:

ƒ Generation and improvement of the timeliness, accuracy and reliability of statistics,

especially those that address the requirements of the MTPDP, MDG especially on
the estimation of Maternal Mortality Rate (MMR) and improvement of Infant
Mortality Rate (IMR), Under Five Mortality Rate (U5MR), life expectancy,
dissemination of a single figure for IMR;

29
 ƒ Providing implementers and policymakers with reliable and timely information,
through the conduct and improvement to the following health and related surveys
the same period: a) 2008 NDHS; b) 2005-2007, 2009-2010 Maternal and Child
Health Care (MCHS); c) 2008 NNS; d) 2005, 2007, 2009 Regional Updating of the
Nutritional Status of Filipino Children;

ƒ Development and improvement of administrative reporting forms to generate

official statistics more frequently and for lower levels of disaggregation;

ƒ Generation of the following new indicators to address the problem in data gaps:
• Proportion of population with access to affordable essential drugs on Formatted: Indent: Before:
45 pt, Bulleted + Level: 1 +
sustainable basis. Aligned at: 27 pt + Tab after:
• DOH-retained and LGU hospitals selling low-priced drugs 45 pt + Indent at: 45 pt,
• HIV prevalence among 15-24 year old pregnant women Tabs: Not at 45 pt

• Number of children orphaned by HIV/ AIDS

• Proportion of population in malaria risk areas using effective malaria
prevention and treatment measures
• Proportion of tuberculosis cases detected and cured under directly observed
treatment short course (DOTS)
• Number of doctor/physician deployed to doctor-less 5th and 6th class
municipalities
• Number of health and nutrition and population related R and utilized
• Rate of increase/decrease in the number of mental health facilities upgraded
• Number of bird/avian flu cases;

ƒ The development and implementation of a coordinated and comprehensive

Philippine Health and Nutrition Information System (PHNIS) covering the different
information systems within the DOH and other health-related agencies, foremost of
which is the FHSIS, the surveys on health and nutrition, and the civil registration
system; and,

ƒ The improvement of statistical methodologies and framework of the Philippine

National Health Accounts (PNHA).

Issues on Health Information Presented in the National Objectives for Health 2005-
2010

The NOH 2005-2010 also documented the impacts of the a devolved health system
mandated by the Local Government Code (LGC) of 1991 and emphasizes importance of
the leadership and political authority of LGUs in terms of their greater role in the delivery
of health services. It further highlights the role of a good health information system as
written in the following statements:

Good governance also necessitates a clear knowledge of what is happening in the health system in
order to develop policies, programs and strategies that support the overall health goals and
objectives. The health sector, in general, gathers large amount of information from those collected
and compiled by thousands of health personnel most of which are never used. A good health
intelligence and knowledge management system needs to be selective in the information it generates
to avoid inefficiencies and wa stage of limited resources. It is critical that knowledge is
disseminated to provide support for policy and decision-making, to build constituency of public

30
support for health policy, to form part of capacity-building program, and to inform and influence
behavior and events within the health system (NOH, 2005-2010 and WHO 2000).

In documenting the impacts of devolution of health services to the local government units,
NOH 2005-2010 identified the following three phases:

• Pre-devolution phase

The pre-devolution period covers the period prior to the enactment of the LGC.
During this period, the Philippine health care system was administered by a
central agency and a unified health service delivery network was in place through
the establishment of District Health Systems (DHS). The DHS is a well defined
administrative and geographic area, either rural or urban, and all institutions and
sectors whose activities contribute to improve health.

• Devolution phase

The devolution phase is the period of the implementation of the LGC to establish
local autonomy. During this phase, the devolution of most of the national
government social services including health to the various levels of local
government (i.e., province, city, and municipality) was implemented. The
devolution of health services weakened the DHS, resulting in a fragmented health
service delivery system. This situation and the inadequate regulatory mechanisms
and poor health care financing compromised access to health services and
hampered the improvement of the country's health status.

• Health sector reform implementation phase

The government developed and implemented the HSRA in 1999 to address the
problems encountered due to devolution. It is noted that one of the reform areas
under the HSRA is the development and strengthening of local health systems
capacities. Implementation of reforms, however, was a challenge. Thus, an
implementation strategy, called “Fourmula One for Health” of F1, consisting of
four components, namely: health financing, health service delivery, health
regulation and governance, with all the major flagship programs and projects to
carry out reforms under each component was developed in July 2005.

The following table documents the impacts of the devolution and the HSRA:

31
Table 3. Implications of the Devolution and Health Sector Reform Agenda on the Local health System2
Comment [JB2]: Restate!!!!

2
Source: National Objectives for Health 2005-2010

32
Table 3(continuation)

Under the HSRA, the Local Health System is expected to serve as the venue for the
integration of all the reform efforts. Inter-Local Health Zones (ILHZ), similar to the the
DHS before devolution, were identified to serve as a focal points of convergence of the
reforms. The ILHZ is a well-defined geographic area where individuals, communities and
all other health care providers participate in providing quality, equitable and accessible
health care with inter-LGU partnership as the basic framework. It is envisioned that with
the ILHZ, reforms are achieved through the integrated governance, management, financing,
resource sharing and provision of health services among the local government units and
partner agencies. To date, 39 LGUs have already signed the Pledge of Commitment to
implement health reforms in their areas. Activities have already been initiated in 30 out of
the 65 targeted convergence sites and 73 ILHZs have been established in both convergence
and non convergence sites. Solon, Panelo and Gumafelix (2003) emphasized the key role of
local government officials in all levels of administration in achieving the reforms in the

33
ILHZs. They specified the following key elements needed for the reforms to take place: a
dynamic and reform oriented local chief executives; creative and innovative provincial, city
and municipal health officers; collaborative effort between DOH, PhilHealth and LGU
staff; and, the presence of technical assistance and capability building efforts (NOH 2005-
2010).

Another reform effort of the DOH is the implementation of the Philippine Local Health
Information System (PLHIS) in 6 provinces (i.e., Bulacan, Iloilo,Agusan del Sur, Ilocos
Norte, Camiguin and Negros Oriental) has also contributed timely and accurate data for
local health system planning to both DOH and LGUs. The PLHIS is a web-based, data
collection system which is directly accessible from local government units or convergence
sites. To ensure equitable access to health care, the concept of a health system model for
geographically isolated and disadvantaged areas (GIDAs) is being developed as an
approach to support the implementation of local health systems development. The GIDA is
being linked or integrated to a nearby functioning ILHZ in order to address the health care
needs of the isolated and disadvantaged communities and vulnerable groups separated from
the mainstream of socio-economic activities. So far, local health system development was
initiated in four GIDAs. One of the GIDA sites, San Juan/San Pedro in Southern Leyte,
won the WHO Sasakawa Award on Primary Health Care (NOH, 2005-2010).

It must also be noted that to ensure quality health care, services and facilities, the Quality
Assurance Program (QAP) developed in 1998 and renamed as the Sentrong Sigla
Movement (SSM). The objectives of this movement are to institutionalize quality assurance
through capability building, developing a cadre of quality experts, advocates and
practitioners; to establish mechanisms to coordinate, support and monitor efforts, develop
and implement an effective information and advocacy campaign, and make clients active
partners in health. The program's two main strategies were the certification or recognition
of health facilities - rural health units, health centers and barangay health stations- that have
met established criteria under QAP; and capability building to internalize continuous
quality improvement of health services in these facilities. As of 2005, 58 percent of Rural
Health Units and Health centers have been certified with Sentrong Sigla (SS) seals (NOH,
2005-2010).

The Philippine Integrated Disease Surveillance and Response

A National Strategy for Emerging Diseases 2008-2010 named the Philippine Integrated
Disease Surveillance and Response (PIDSR) was developed by the NEC in response to the
gaps and weaknesses of the epidemiologic surveillance and response systems that resulted
in an assessment in 2006. The assessment reported that:
• There is a lack of capacity especially in the local level to perform the required
epidemiologic surveillance and response functions. Thus, the quality of information
being generated is put into question.
• Surveillance staff at the local level do not have training in performing their
functions and are not supervised in performing critical functions
• Support for equipment, travel, logistics and other supplies essential for the optimal
operations is inadequate.
The assessment reported inefficiencies, redundancises, and duplication of efforts that result
in extra costs and training requirements as well as an overloaded and unmotivated
workforce.

34
The following table provides the strengths and weaknesses of the two major disease
surveillance systems of the NEC:
Table 4. Strengths and Weaknesses of the Surveillance Systems
of the National Epidemiology Center
Disease Strength
Surveillance
System
Weekly 1. It can provide better estimates of
Notifiable morbidity rates and trends of
Disease certain diseases at the community
Reporting level.
System(WNDRS) 2. Community epidemics could
easily be detected since the lowest
data collection units are the
barangay health stations.
3. It complements community-based
disease surveillance systems.
4. The data are readily accessible to
the rural health unit for purposes
of prioritizing planning and
evaluating public health
programs.
5. It provides estimates for the
national morbidity rates and
trends.
National 1.It can provide weekly trend of
Epidenic Sentinel notifiable diseases.
Surveillance 2.It can detect disease outbreaks if
System(NESSS) cases are admitted to sentinel
hospitals.
3.Its case-based data provide better
epidimeologic profile of diseases
under surveillance.
4.It provides accurate diagnosis of
some reported cases since these
laboratory-confirmed.
35
Weakness
1. Standard case definitions are often Formatted: Indent: Before:
0 pt, Hanging: 11.05 pt,
not used for purposes of case Numbered + Level: 1 +
detection and reporting. Numbering Style: 1, 2, 3, … +
2. Analysis of data by time,place and Start at: 1 + Alignment: Left +
Aligned at: 18 pt + Tab after:
person is not possible due to limited 36 pt + Indent at: 36 pt,
information obtained from reported Tabs: 11.05 pt, List tab + Not
at 36 pt
cases.
3. Cases admitted to hospitals are often
not captured or included in the rural
health unit notifiable disease report.
This affects the accuracy of
calculated morbidity rates and trends.
4. Notifiable disease reports are often
not transmitted regularly or are
submitted very late to the next higher
levels (e.g., Provincial Health Office ,
CHD, NEC). This limits the
usefulness of this information at the
higher levels in terms of providing
prompt and appropriate assistance,
establishing trends at the provincial
or regional levels, guide
prioritization,allocation of resources,
planning , evaluating programs and
policy-making.
5. Laboratory confirmation for the
diagnosis of some notifiable diseases
(e.g., cholera, hepatitis, typhoid fever)
is often not performed. Therefore,
reported morbidity rates for these
diseases may not be that accurate.
1. The system cannot provide morbidity Formatted: Indent: Before:
1.5 pt, Hanging: 9 pt, Outline
or incidence rates of notifiable numbered + Level: 1 +
diseases since the source of reported Numbering Style: 1, 2, 3, … +
cases come from selected hospitals orStart at: 1 + Alignment: Left +
Aligned at: 18 pt + Tab after:
sentinel sites only. 36 pt + Indent at: 36 pt,
2. Most community disease outbreaks Tabs: 10.5 pt, List tab + Not
could not be detected by the system at 36 pt
because oftentimes, the cases are not
admitted to any of the sentinel sites or
hospitals.
3. The morbidity trends of diseases
Disease Strength
Surveillance
System
5.Data analysis (by time, place,
person) and dissemination of
reports are done regularly by
trained surveillance staff at the
epidemiology and surveillance
unit(ESU) and national levels.
6.Reporting to the nest higher level
is efficient.
Both 1.Both systems are supported by
systems(WNDRS mandates for their operations.
and NESSS) 2.Both systems are currently
existing
Source: Philippine Integrated Disease Surveillance and Response(PIDSR): A National Strategy for Emerging
Diseases 2008-2010
Weakness
provided by the system in a particular
areas could be misleading because it
does not include cases coming from
the community or sentinel hospitals.
1.Both systems operate independently
and are not adequate to fully comply
with the International Health
Regulations(IHR) and APSED
requirements.
Formatted: Indent: Before:
1.5 pt, Hanging: 9 pt,
Numbered + Level: 1 +
Numbering Style: 1, 2, 3, … +
Start at: 1 + Alignment: Left +
Aligned at: 18 pt + Tab after:
36 pt + Indent at: 36 pt,
Tabs: 10.5 pt, List tab + Not
at 36 pt

The following is the NOH 2005-2010 summary of the problems which need to be
addressed in order to create an environment where planning and policy decisions are
knowledge based:

(a) Weak health research and information systems. The

Philippines has an active health research environment where
government agencies, non-government organizations, public
and private hospitals, academic institutions and private
agencies have some form of research activities. A closer look,
however, would reveal that these researches are uncoordinated,
fragmented and duplicated which precludes the optimal use of
time, effort and resources (Acuin, 2001).

The Philippine National Health Research System (PNHRS) is a

collaborative effort from Department of Science and
Technology Philippine Council for Health Research and
Development (PCHRD) and DOH to improve the current status
of Philippine health research system. The main focus is on
integration and creating synergy to address the perennial
concerns such as lack of resources for research,
unsynchronized research agenda, maldistributed and
undercapacitated researcher pool, and underutilized research
information.

(b) Gaps in the management of health information. There are

several sources of health information in the country. These
information are collected by various agencies both government
and private through routine information systems, population
surveys and special studies. There are, however, weaknesses in
the management of such information. For instance, timeliness
and completeness are two major limitations in generating

36
 health information. Disseminated and published reported are
critical ingredients I knowledge sharing and utilization. Most
of the bigger surveys are published every 3 to 5 years. Official
published reports are often times delayed by more than 2 years
in the case of the Field Health Service Information System
(FHSIS) and the Philippine Health Statistics (PHS). This is
brought about by non-compliance and incomplete submissions
of report by some LGUs and private health facilities, and the
delay in the submission of civil registry records to NSO or
DOH by the LGUs. In some case, important indicators are not
reported. The 2003 National Demographic and Health Survey
(NDHS) failed to include the maternal mortality ratio (MMR)
due to sampling limitations.

There are also information systems that lack complete

information for knowledge-based decisions. In the case of the
National Epidemiology Sentinel Surveillance System (NESSS),
private facility data sources are not included. Furthermore,
while several systems have been developed to generate vital
information, these information system have yet to be integrated.
For instance, hospital system such as Hospital Epidemiology
Program (HOMIS) have been initiated by DOH to better
manage a wide range of activities ranging from planning to
procurement and staffing. However, the systems are run
independently by DOH hospitals and have yet to be linked to
the central office.

Given the gaps in the management of health information, there

is a need to standardize health indicators and health
information requirements in order to eliminate inefficiencies
and reduce cost in data collection. A compendium of health
indicators should be made in order to have a unified definition
of health indicators and terminologies. Likewise, there is a
need to standardize health information requirements and
ensure the appropriate systems (whether automated or manual)
are properly linked from the local to national
levels .(NOH,2005-2010)

The following matrix provides targets that aim to address problems identified above:

37
 Table 5. Targets in Knowledge Management in the Philippine Health Sector
Objective Indicator Target Baseline Data and
Source
Quality, timely and Standardized and Standardized definitions Begun later part if
relevant health harmonized health data of health indicators 2004 and finalization
information at all requirements and nationwide 2005
levels is ensured indicators
Standardized health data NEC, 2004
requirements for every
level of health facilities

Harmonized system of
health data generation
among different
government agencies
Compliance to a 80% of LGU and private All health facilities
standard health sector facilities with ran by LGU and/or
information reporting accurate and complete government agencies
system of all public and FHSIS reports are at 100%
private health facilities submitting complete
80% of LGU and private reports except
sector facilities with ARMM
timely reports
For timeliness, only
50% were submitting
forms on scheduled
date

NEC, 2004
Number of health At least 1 health At present, all health
personnel trained on personnel per LGU facilities have trained
health information trained on data personnel in charge
systems generation, basic health of FHSIS
information system or
database administration NEC, 2004
Number of staff in At least 1 staff per health To be determined
health facilities (up to facility who is computer
the level of the RHU) literate
who are computer
literate

38
 Objective Indicator Target Baseline Data and
Source
Access to and Interoperability Framework for National To be determined
sharing/exchange standards developed and Health Information
of health adapted by health Infrastructure (NHII)
knowledge and sectors stakeholders developed;
information is (e.g. private hospitals, Repositories for essential
increased PhilHealth, and codified health
pharmaceutical and information established;
other health-related
industries etc.)
Health sector portal Health portal established To be determined
established that will integrate and
harmonize health
information from
different sources (e.g.
routine reports, vital
registries, survey
researches)
Establish At least one functional Structural
networks/communities network and organization of
to facilitate knowledge communities established PHNRS already in
sharing and exchange per domain place
Physical infrastructure At least one functional To be determined
for health information computer for health
system established information management
is available in every
municipality

Health facility routine

health related reports
encoded in electronic
format in all
municipalities
Health policy Essential health 2-3 health data and Health information
development and researches, data and information publications (Phil.
decision-making, information, best published/dissemination Health Statistics;
including clinical practices are FHSIS)
management published/disseminated Completed Essential
decisions, are Essential health 5-10 health researches National health
evidenced-based researches, data and and information used for research (ENHR)
information are used for policy and program studies
policy and program development per year Research/policy
development advocacy fora
Health systems Data generated from NEC/Health Policy
performance measures standard health Development
among LGUs are indicators utilized for Planning Bureau
institutionalized measuring LGU (HPDPB-DOH)
performance
Source: National Objectives for Health 2005-2010

39
The Philippine Statistical System through the Inter-Agency Committee on Health and
Nutrition Statistics (IAC-HNS) as well as the DOH itself have made assessments of the
status of these different data sources and have recognized the need to improve and
synchronize / harmonize the various health information systems. The PSDP 2005-2010
specifically cites the FHSIS, PHS, and the NESSS of the DOH. Specifically, issues on
completeness, timeliness, quality/accuracy, and relevance of health and nutrition statistics,
especially those monitored in the MTPDP and in global concerns like the MDGs, need to
be resolved. The NSO also monitors and assesses the completeness, coverage and
timeliness of its vital statistics and recognize that some areas in the country need
improvements on these.

One of the key result area of the PSDP 2005-2010 is to maximize use of information
technology in data collection, processing, analysis, dissemination and archiving to enable
faster and wider utilization of data and promote transparency, information sharing and user
confidence on official statistics. This particular key result area aims to capitalize on
existing developments in information technology, specifically in enjoining government
agencies to establish websites and develop statistical information systems that would enable
them to upload/share statistical information available in the agency. The development of
interactive national statistical databases shall be promoted for different sectors and to
develop innovative statistical software that could be used within the Philippine Statistical
System. An improvement on the information systems of different agencies is likely to be
expected.

The statistical development programs pertaining to health and nutrition are designed to
address issues and challenges towards improving the generation, dissemination and
utilization of quality statistical information. One of the programs is the generation and
improvement of the timeliness, accuracy and reliability of statistics, especially those that
address the requirement for MTPDP, MDG monitoring especially on the estimation of
MMR and improvement of IMR, U5MR, life expectancy, dissemination of a single figure
for IMR. Statistics on maternal mortality will be produced from the census of the
population while improved methodologies to estimate mortality statistics will be developed.
To provide implementers and policymakers with reliable and timely information, the
following health and related surveys will be improved and conducted within the same
period: a) 2008 NDHS; b) 2005-2007, 2009-2010 MCHS; c) 2008 NNS; d) 2005, 2007,
2009 Regional Updating of the Nutritional Status of Filipino Children. To have a cost-
effective approach that will reduce reliance on statistical surveys for more frequent and
finer levels of disaggregation, the development and improvement of administrative
reporting forms to generate official statistics will be likewise undertaken. Another program
is to generate data to complete and fill in data gaps to monitor the MTPDP, MDGs and
other sectoral plans. A total of 10 new indicators will be generated to address the problem
in data gaps and are given below:
• Proportion of population with access to affordable essential drugs on sustainable
basis.
• DOH-retained and LGU hospitals selling low-priced drugs
• HIV prevalence among 15-24 year old pregnant women
• Number of children orphaned by HIV and AIDS
• Proportion of population in malaria risk areas using effective malaria prevention
and treatment measures

40
 • Proportion of tuberculosis cases detected and cured under directly observed
treatment short course (DOTS)
• Number of doctor/physician deployed to doctor-less 5th and 6th class municipalities
• Number of health and nutrition and population related R and utilized
• Rate of increase/decrease in the number of mental health facilities upgraded
• Number of bird/avian flu cases

Another important program in the PSDP is the development and implementation of a

coordinated and comprehensive PHNIS. In response to the need to coordinate the
generation of and to improve the quality of statistics from the various health information
systems, the DOH will lead the design and development of the PHNIS in collaboration with
the NSCB, the NSO, the PCHRD and other health-related agencies. This will cover the
different information systems within the DOH and other health-related agencies, foremost
of which is the FHSIS, the surveys on health and nutrition, and the civil registration system.
And the last program is the improvement of statistical methodologies and framework
enhancement of the PNHA.

In the following table, Table 6, the PSDP 2005-2010 enumerates the statistical development
programs to address the problems with health information.

41
 Table 6. Matrix on Statistical Development Programs for Health and Nutrition Information Systems3
Target Date of
Statistical Program/ Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Project/Activity Statistical Program/Activity/Project Agencies
(Specific Year/s)
1. Regular Statistical Activities
1.1 Conduct of Censuses and Surveys
Inclusion of question of (Refer to PSDP Chapter on Population and 2005-2010 NSO
maternal mortality in the Housing)
census of population
Improvement of health and
nutrition related surveys and
studies:

Conduct of the 2005-2007,
2009-2010 Maternal and
Child Health Care Survey
(MCHS)
The MCHS presents up-to-date data on Offers facts that are useful 2005-2007, NSO
prenatal and postpartum care, protection at in influencing policy makers 2009-2010
birth against neonatal tetanus, breastfeeding and program manages on
and immunization. The MCHS aims to the support needed to
provide the DOH info on the coverage and effectively implement the
effectiveness of its maternal and child health health programs of the
programs at the regional level. government.

Conduct of the 2008 National
Demographic and Health
Survey
The NDHS is a nationwide sample survey This provides an up-to-date 2008 NSO, DOH, UPPI
designed to collect information on fertility, set of relevant data useful to
family planning and health in the evaluate population, health
Philippines. and family planning
programs.

3
Source: Philippine Statistical Development Plan 2005-2010
42

Statistical Program/
Project/Activity
Conduct of the 2008 National
Nutrition Surveys
Conduct of 2005, 2007, 2009
Regional Updating
Nutritional Status of Filipino
Children
Improved statistics on PWDs
from the Census of
Population (Improved
questions in the census)
1.2 Administrative-Based Data Systems
Provision of more timely,
accurate, reliable, valid and
consistent statistics from the
existing administrative-based
reporting systems
- Field Health Service
Information System
(FHSIS)
- Vital statistics from the
Civil Registration System
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
To assess and update the food consumption Provide basis in planning, 2008 FNRI-DOST
and nutritional status of Filipino households monitoring, & evaluation of
and selected population groups. nutrition and health
programs for the prevention
and control of nutrition-
related and lifestyle
diseases.
To update the state of nutrition of Filipino Provides an update on the 2005, 2007, 2009 FNRI-DOST
children in various regions of the country. nutritional status of children
Anthropometric measurements such as 0-10 years old in between
weight, height and recumbent length, which national surveys that This
were collected using standard techniques, also serves as a basis in
served as database. planning, monitoring and
evaluation of nutrition
programs.
Updating of the population count and other Provide government 2006, 2010 NSO
information on the demographic, social planners, policy makers and
economic, and cultural characteristics of the administrators with data on
population, including PWDs which to base their social
and economic development
plans and programs on
PWDs
The FHSIS is a nationwide compilation of
health indicators from health facilities
collected through the provincial and regional
health offices.
43

Statistical Program/
Project/Activity
Full implementation of the
automated civil registration
system such as the CRIS in
the Local Civil Registry
Offices (LCROs)
Institutionalization of the
Registry of Persons with
Disabilty
1.3 Statistical Frameworks and Indicators System
Development of new health
and nutrition statistics and
indicators systems
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
This includes information dissemination to To help encourage the use 2005-2010 NSO
non-CRIS users and eventual training of of information technology
LCROs on CRIS usage. in building-up databases and
enhance the capability of
LCROs in establishing vital
statistics in their areas of
concern.
Includes the maintenance and updating of the Results from the registration 2005-2010 DOH
Philippine Registry for PWDs (PRPWD) are stored in the DOH Field
which has the main objective of monitoring Health Information System
health services rendered to PWDs.
The development of new health and nutrition 2006-2010 IAC on Health and
statistics and indicator systems will generate Nutrition Statistics
data to complete and fill-in data gaps needed with implementing
to monitor development goals agencies
Proportion of population with access
to affordable essential drugs on sustainable
basis
DOH-retained and LGU hospitals
selling low-priced drugs
HIV prevalence among 15-24 year
old pregnant women
Number of children orphaned by
HIV/AIDS
44
 Target Date of
Statistical Program/ Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Project/Activity Statistical Program/Activity/Project Agencies
(Specific Year/s)
Proportion of population in malaria
risk areas using effective malaria prevention
and treatment measures

Proportion of tuberculosis cases

detected and cured under directly observed
treatment short course (DOTS)

No. of licensed hospitals

Number of doctor/physician
deployed to doctor-less 5th and 6th class
municipalities
No. of health and nutrition and
population related R & D utilized
Rate of increase / decrease in the
number of mental health facilities upgraded

No. of bird or avian flu cases

Development and adoption of The rights-based approach will be used to 2005-2010 CHR
a set of indicators on the substrantiate indicators on the rights to food,
rights to food, water and water and health
health.

45

Statistical Program/
Project/Activity
Generation of annual
Operation Timbang (OPT)
statistics
Improvement of the
Philippine Food Balance
Sheet(FBS), and publication
of the 2007-2009 estimates
Improvement of Food
Insecurity and Vulnerability
Information Mapping
Systems (FIVIMS)
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
The OPT results from municipalities will be 2005-2010 NNC
used to rank municipalities based on
prevalence of underweight 0-5 years old
children and identify nutritionally depressed
municipalities for reference in identifying
geographic focus for programs.
The FBS of the Philippines presents a A useful tool in the 2005-2010 NSCB
country's pattern of food supply and formulation of national food
utilization during a specified reference production aimed at
period. It gives an indication of the adequacy satisfying the dietary and
of food supply relative to the nutritional nutritional needs of the
requirements of the population. Filipinos.
The Philippine FIVIMS is a system that Provide basis in planning 2005-2010 NNC
assembles, analyses, identifies, and and monitoring of food
disseminates information to policy makers security issues such that
on food insecure and vulnerable or at risk areas identified as food
provinces. Its main goal is to contribute to insecure and vulnerable will
the reduction of food insecurity and receive higher priority in
vulnerability in the country. policy and strategy
formulation, program
development and
assessment, amd resource
allocation.
46

Statistical Program/
Project/Activity
Upgrading of statistical
methodologies and
framework enhancement of
the Philippine National
Health Accounts (PNHA):
Improvement of the PNHA
based on the WHO / OECD
Producer’s Guide (PG)
Development of a projection
model for the PNHA
Improvement of data
generation to support the
PNHA
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
The PNHA is a framework for the It provides insights on the 2005-2010 NSCB
compilation of information on the country’s efficiency and effectiveness
health expenditures. It consists of a set of of health care financing and
statistics that systematically presents national helps determine appropriate
health spending for a given year. interventions to improve the
delivery of health care.
This aims to expand the usefulness of PNHA Analysis of the allocation of 2005-2006 NSCB, DOH, PIDS
through the development of new matrices; expenditures by certain
also designed to enhance capacity for categorization - geographic,
estimation and use among stakeholders. population groups, priority
programsComparison of
PNHA with other countries.
This aims to expand the usefulness of PNHA Examining future financial 2005-2006 DOH, PIDS
through the development of a projection requirements and prospects
model; also designed to enhance capacity for for increasing funds for
estimation and use among stakeholders. health.
To put in place a more systematic generation Updated parameters and 2006-2010 NSCB
of data inputs to the NHA. This can build on easier/faster collection of
the current data collection/ generating more accurate data inputs
system of involved agencies (eg DOH, COA,
DSWD etc.). Household and establishment
surveys will be conducted to provide
benchmark estimates for specific sources and
uses of health expenditures
47
 Target Date of
Statistical Program/ Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Project/Activity Statistical Program/Activity/Project Agencies
(Specific Year/s)
Improvement of the existing (Refer to PSDP Chapter on Population and 2005-2010 Tech Committee on
methodology in generating Housing) Population and
mortality statistics Housing Statistics
(TCPHS)
1.4 Statistical Policy and Coordination
Improve the timeliness, 2005-2010 DOH/
accuracy, and reliability of NSO, NSCB,
statistics, especially those that PCHRD/other
address the requirements for producers of health
MTPDP, MDG monitoring information
especially on the
improvement of IMR,
U5MR, MMR and life
expectancy estimates
Formulation of policy on the (Refer to PSDP Chapter on Population and 2006 TCPHS
dissemination of a single Housing)
figure for IMR

Enhanced information
disssemination and awareness
campaign on civil registration
Adoption of standard
classification systems for
international comparability
Educating and motivating the public to This activity will increase 2005-2010 NSO
register vital events such as births, deaths the circulation base of vital
and marriages accurately within the statistics information to
prescribed period include new users and non-
users as well.

Improvement of morbidity, To promote the use of ICD-10 in the Comparability of 2005-2007 DOH
mortality statistics based on tabulation of morbidity, mortality data in all morbidity/mortality
ICD-10 health facilities. And to train statisticians on statistics
ICD-10 at all levels.

48

Statistical Program/
Project/Activity
Adoption of International
Classification of Functioning,
Disability and Health (ICF)
1.5 ICT and Related Activities
Development and
implementation of a
coordinated and
comprehensive Philippine
health and nutrition
information system (PHNIS)
Improvement of the Field
Health Service and
Information System (FHSIS)
Development of a National
Hospital Statistical Reporting
System.
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
To provide the health sector a common 2005-2006 DOH, NSO
system of defining and classifying disability
The project is a collaborative effort among Streamline the delivery of 2005-2010 DOH/
government agencies, donor organizations, timely, relevant and reliable NSO, NSCB,
academe, private sector as well as other health information to users PCHRD/other
stakeholders in health information to develop producers of health
and implement a coordinated and information
comprehensive PNHIS.
The FHSIS is a nationwide compilation of Can be utilized by national 2005-2010 DOH
health indicators from health facilities and local government
collected through the provincial and regional officials and managers for
health offices. policy-making, monitoring
and evaluating health
activities. Also for planning
appropriate public health
interventions, stimulating
medical researches and
highlighting topics of
relevance in health
education of the public.
To revise the Hospital Statistical reporting More wholistic picture of 2005-2007 DOH
system; conduct orientation on the revised health statistics with the
system; and generate a National Hospital inclusion/ maintstreaming
Statistical Report. of hospital data; better and
more sound-evidence for
policies and programs.
49

Statistical Program/
Project/Activity
Development and
Implementation of SPReAD
Establishment of linkages
among data producers and
data users of health and
nutrition statistics to enhance
data dissemination and
utilization
Improvement of the
Philippine Health Statistics
(PHS) publication
Establishment of the
Philippines' Knowledge
Center on Food and Nutrition
(e-Nutrition)
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
The SPREAD is a content management Provide accurate data and 2005-2006 PhilHealth
system of Corporate Planning in support of information that are
its mandate of data and information organized, readily available
management on the National Health and easily accessible. The
Insurance Program. It shall be an archive of system will be used for
in-house and external data. The range and planning and decision-
scope of information shall be both making of management and
quantitative (statistical) and qualitative other stakeholders.
(textual and descriptive).
PHS is a summary of statistical data on Supply vital information for 2005-2010 DOH
births and deaths registered and reported in a planning appropriate public
given years. It also contains reports on health interventions,
notifiable diseases which were taken from stimulating medical
the FHSIS. researches and highlighting
topics of relevance in health
education of the public.
E-Nutrition is an information system that This activity is essential for 2005-2010 FNRI-DOST
will allow the electronic dissemination and policy making and
maximum utilization of nutrition survey community empowerment,
results to pave the way for collaborative will be made available and
projects of national significance with NGOs easily accessible through the
and other local and international government internet and a website.
agencies.
50

Statistical Program/
Project/Activity
1.6 Statistical Capacity Building
Capability building of
personnel involved in the
production of health and
nutrition statistics
Target Date of
Brief Description/Objective of the Lead/Implementing
Policy Use/Relevance Implementation
Statistical Program/Activity/Project Agencies
(Specific Year/s)
Training of processors of civil registry This activity is essential in 2005-2010 NSO
documents such as personnel of the Civil building the capability of
Registry Offices, of the National Statistics Local Civil Registry Offices
Office on all aspects of vital registration and and the NSO Provincial and
statistics. This will also include follow-up Central Office in the civil
training of personnel as a support mechanism registry and vital statistics
to maintain and sustain their operations. operations.
51
6 Assessment of Health Information System of the Philippines

After the assessments of Aguilar (1976), Pons and Schwefel (1993), Jayasuriya (1994),
Marcelo et. al. (2004), as well as recommendations from the IAC-HNS and self-
assessments of the DOH , there is still recognition of uncontrolled growth of data and
information that are not integrated and harmonized.

Health Metrics Network Approach

A global initiative of the HMN is for different countries to integrate their respective health
information systems. The goal of the HMN is to increase availability and use of timely,
reliable health information in countries and globally through shared agreement on goals and
coordinated investments in health information systems. Its objectives are:

• HMN framework and standards for health statistics

• Country HIS strengthening and transformation
• Better dissemination and wider use of health statistics

It identifies its partners as the producers (nurses, doctors, statisticians) and users (managers,
policy makers, patients) of health statistics: health and statistical constituencies and non-
health sectors: economic institutions, political parties, social organizations and citizens

The Philippine participation in the HMN was spearheaded by the PHIN with the DOH as
lead agency. The PHIN goal of integrating and harmonizing the Philippine HIS is along the
same goal as HMN’s. The PHIN was formally launched on 9 September 2005 with DOH,
NSO, NSCB, and PCHRD as the founding members. It aims to strengthen coordination
among stakeholders (government agencies, donor organizations, academe, private sector,
and other constituencies involved in health information); to expand the network to include
those in the private sector and the academe; and, to work at integrating and harmonizing the
Philippine HIS.

The assessment of the Philippine HIS using the HMN framework, tools and procedures was
done in February 2007 with 51 key informants. Prior activities included a training of
trainers by the HMN in November 2006 and a pretest and customization of the HMN
questionnaire on February 9 to 14, 2007. All these activities were conducted with the
financial and technical support of the HMN through Dr. Bruno Piotti.

The HMN Framework

The HMN Framework centers on six components for the assessment of HIS. It emphasizes
on the principles, processes, and tools for the achievement of an integrated and harmonized
HIS. Below is the framework:

52
 Figure 4.

HMN Framework

Health information system Roadmap

components & standards for implementation

HIS Resources Principles

Indicators
Process
Data Sources

Data Management Tools

Information Products
Dissemination and use
HMN Goal
Increase availability, accessibility, quality and
use of health information that is critical for decision
making at country & global levels.

The following provides the items under each component of the assessment:

a. HIS Resources
• Information policies
– Supportive legislative framework and regulatory environment
– Institutional policy (e.g. coordinating mechanisms; engagement of private
sector, non-health sectors)
– UN Fundamental Principles of Official Statistics
• Financial resources
– Relation with health status or GDP
– $0.50 to $3.00 per capita per year or between 5-10% of projects and
programme
– Requires international and domestic funding
• Human resources
– National level: epidemiologists, demographers, statisticians, public health
experts;
– Front lines: Training, sub-national cadres; multi-tasking burdens
– Level of remuneration in DOH, Non Profit Organizations, University
• Infrastructure and communications
– Well-defined paper based systems
– Computers, communications, internet connection, database policies,
compatible systems
• Coordination and leadership
– National stakeholders committee of key health and statistical constituencies
– Build upon existing mechanisms

53
 – Links to national statistical plans beyond the sector, Poverty Reduction
Support Programme, MDGs, etc.
b. Indicators
• Key principles
– Development of minimum set of core health indicators, with targets
– Indicators should be national priorities, but also harmonize with global
initiatives such as MDGs
– Comprehensive across the indicator domains of health determinants, health
systems, and health status outcomes
• Selection process
– Involves key stakeholders (national and international)
– Incorporates health statistics into national statistical plans, link with poverty
monitoring master plans, health sector support programme or similar
Government plans
– Links indicators with data collection strategies over 10 year time (Ten year
frame, Plan x 2015) that encompasses routine system (HMIS), episodic
surveys (MCH, Malaria) and periodic surveys (DHS or similar)

c. Data Sources
• Population-based census, population-based surveys, civil/vital registration
• Health services based- health administrative records , health service records, health
and disease records

d.Data Management

• Overall structure: All data collection and reporting tools need to be coordinated and
aligned. Data elements, data sets and data sources need to be coordinated, combined
and clearly defined (in a "data dictionary")
• User dimension: there are multiple users and purposes, from local management to
monitoring MDGs for policy and national resource allocation
• Standards dimension: core indicator set with measurement strategies, independence
of statistics, data flow and analysis protocols
• Tools dimension: enhancing access at all levels: e-doc for reports, district and
national data warehouse or repository, micro-data repository (Data Dissemination
Toolkit), standardized dissemination tools

e.Information Products

• Availability and quality of the products of health information systems are the health
statistics which can be evaluated using international standards for statistics (notably
Data Quality Assessment Framework)
– Timeliness: most recent data collection
– Periodicity (frequency): more data points provide better basis for health
statistics
– Consistency: if there are more points, consistency is a good sign; use for
calibration and validation
– Representativeness: for whole population, sub-populations
– Disaggregation: socio-economic, geographic regions, urban rural, sex
– Estimation methods and statistical techniques: transparent, international
standards

54
d.Dissemination and Use

– Who utilizes the information products and for what purpose.

The Procedure

The HMN Procedure for the assessment uses a Group Consensus through workshops. It is
not a survey but is more a variant of focus group discussions (FGDs) where participants’
individual responses are reviewed by the whole group to reach a group consensus. It uses
the HMN assessment tool which is an Excel-based questionnaire. The participants are
actually key informants composed of all major stakeholders (producers, users, financiers).
The assessment process is done by groups followed by a plenary to present the groups’
assessment results. These are further followed by consensus building in both group and
plenary sessions and, finally, feedback.

The Assessment Tools

An electronic questionnaire in Excel which carries a switchboard and automatic

computation of scores once filled up. Questions are perception-type questions but are
expected to be answered by key informants so the respondent’s “perception” is based on
proper information at his level. The questionnaire has a total of 244 items. Each item is
scored:
– Highly adequate 3
– Adequate 2
– Present but not adequate 1
– Not adequate at all 0

The total score for each category is compared to a maximum score to yield a percentage
rate. The scores are then given adjectival ratings based on quintiles of scores:
– Lowest quintile (<20th percentile) >>Not functional
– Second quintile >>> Not adequate at all
– Third quintile >>> Present but not adequate
– Forth quintile >>> Adequate
– Fifth quintiles >>> Highly adequate

HMN conducted a training of trainers on November 14 – 16, 2006 with participants coming
from the member agencies of the PHIN including the academe. The HMN questionnaire
was pretested on February 9, 2007 in Ba-y, Laguna and was customized to the Philippine
context. The changes that were made to Philippinize the questionnaire were mainly the use
of existing administrative levels in the Philippines (from national, regional, provincial,
municipal/city, down to barangay level) and to reflect devolution of health services in the
Philippines(i.e., the health facilities in the provincial, municipal/city and barangay levels
are under the respective local government units and not under the national office of the
DOH).

55
The group builder which identifies which groups are to answer what questions was utilized.
The following participated in the assessment:

Table 7. Participants in the Philippine Assessment using the HMN Procedure

Group Area of Interest
G1 Census, Demography, University/ Research entities
G2 Senior DOH Planners
G3 Project and Programme Managers
G4 Subnational (Regional, Provincial, City, Municipal)
G5 Aid donors
G6 Financial, Monitoring and Evaluation
G7 Administrative Statistics
G8 PHIN Steering Committee*
*done on February 15, 2007 at DOH

The group organisation followed the following guidelines:

• Persons competent to give answers to specific questions are grouped together, so
each group responds only to a part of the questionnaire.
• Tasks of the group facilitator:
– To respond to doubts and clarify meanings,
– To promote the discussion among the participants,
– To enter the scores of each participant,
– To write down the comments raised by participants
• Each participant should receive his/her own identification number in the filled up
assessment tool for an ordered scoring.
• Participants are encouraged to discuss every question, but they should score only
the matter that they really know and/or have direct experience. Facilitators should
supervise this aspect.
• At the end of each Question Sections the facilitator presents the results to the group
and allows supplementary comments and alterations of the score, if necessary.
• Keep an objective attitude all along the exercise: feel relaxed toward their own
situation and express freely what you feel about the HIS. No generosity neither
negativism during the appraisal.

Assessment of the Field Health Service Information System and the Civil Registration
System in the Subnational Levels

To augment the results from the HMN assessment, the PHIN did focus group discussions
with FHSIS regional coordinators and conducted a survey of selected regions, provinces
and municipalities nationwide to focus on the two important sources of administrative or
reporting statistics – the FHSIS of the DOH and Civil Registration System (CRS) of the
NSO. It must be reiterated that the generation of these statistics are devolved to the local
government units and are not under DOH and NSO. The national and regional agencies,
however, provide technical, capacity building, and other logistical support for the local
government units.

56
The FGDs with the regional FHSIS coordinators under the CHDs in the different regions
was conducted on May 18, 2007 at Ba-y, Laguna. Two FGDs were done simultaneously:

• FGD with FHSIS coordinators of NCR, Caraga, ARMM, and Regions 3, 8, 10, 11,
12; and,
• FGD with FHSIS coordinators of CAR, MIMAROPA, CALABARZON and
Regions 1, 5, 6, 7, and 9.

Only one region, Region 2, was not represented in the FGDs.

For additional assessment in the provincial and municipal/city levels, a survey of key
informants was conducted where areas covered by the assessment were selected to
represent regions and provinces exhibiting best, average, and poor performance in the
generation of FHSIS and Vital Statistics. The following were selected using this procedure:

• Region 1
– Ilocos Norte
– Ilocos Sur
• Region 8
– Western Samar
• Region 9
– Zamboanga del Norte (Zambo City)
– Zamboanga del Sur (Isabela)
• Region 11
– Davao Sur
– Compostela Valley
• Region 12
– South Cotabato(Cotabato City)
– S. Kudarat(Gen Santos City)
• MIMAROPA
– Marinduque
– Palawan
• NCR
– Manila , Marikina
• ARMM
– Maguindanao
– Lanao del Sur
• CAR
– Baguio City
– Ifugao

The assessment was supported by the HMN. The survey for Region 8 was done in
collaboration with GTZ.

The respondents of the survey were the following:

• Provincial Statistics Officers(PSOs)
• Provincial Health Officers(PHOs)
• Regional and provincial FHSIS coordinators
• City and Municipal Health Officers(CHOs, MHOs)
• City and Municipal Civil Registrars(CCRs, MCRs)

57
 • City and Municipal Planning Development Officers(CPDOs,MPDOs)
• Provincial Planning Development Officers (PPDOs)
• Public Health Nurses(PHNs)/Rural Health Midwives(RHMs).

Two survey instruments were constructed – one for the data producers and one for the data
users. Annex 3 provides the instruments used in the field operations. These instruments are
the revised versions after pretesting. It is noted that the questionnaires include items that
follow the components of the HMN framework.

A total of 559 respondents were interviewed for Questionnaire 1, the questionnaire for data
producers while a total of 86 respondents were interviewed for Questionnaire 2, the
questionnaire for data users. The questionnaire items were those under the different areas of
assessment of the HMN. Thus, the framework of the assessment followed that of the
HMN’s. The following tables show the number of respondents for the two kinds of
respondents:

Table 8. Data Producers of Field Health Service Information

System and Civil Registration System that participated in the
Assessment in the Subnational Level
Type of Respondent Total Percent
Provincial Health Officer 15 2.7
Provincial Statistics Officer 18 3.2
Municipal Health Officer /City Health
125 22.4
Officer
Local Civil Registrar 71 12.7
Public Health Nurse 131 23.4
Rural Health Midwife 142 25.4
Provincial FHSIS Coordinator 20 3.6
Provincial NSO Staff designated for Civil
17 3.0
Registration
Others 20 3.6
Total 559 100.0

Table 9. Data Users of Field Health Service Information System

and Civil Registration System that participated in the
Assessment in the Subnational Level
Type of Respondent Total Percent
City/Municipal Planning Development Officer 66 76.7
Provincial Planning Development Officer 20 23.3
Total 86 100.0

7 Results of the Health Metrics Network Assessment

The assessment was done with three members of the PHIN steering committee (Group 8 of
the working groups) on February 15, 2007 and on February 21- 23, 2007 with 48
participants from the national and subnational levels comprising the different working
groups: Census, Demography, University/ Research entities (G1), Senior DOH Planners

58
(G2), Project and Programme Managers (G3), Subnational -Regional, Provincial, City,
Municipal (G4), Aid donors (G5), Financial, Monitoring and Evaluation (G6),
Administrative Statistics (G7). Annex 4 is the HMN assessment tool with the results. The
following is a discussion of these results.

a. HIS Resources

HIS Resources was rated overall as present but not adequate with a score of 48%, which
rates as “present but not adequate”. For this component, Policy and Planning is considered
not adequate; HIS institutions, human resources and financing is present but not adequate;
and HIS Infrastructure is adequate.

Table 10. Summary of Results of the Assessment

of Health Information System Resources

Summary Result
35%
Policy and Planning
Not adequate
46%
HIS institutions, human resources and
financing
Present but not adequate
71%
HIS Infrastructure
Adequate
48%
Overall
Present but not adequate

The following issues came out of the discussions under HIS resources:

On information policies:

There are comprehensive laws and executive orders governing the generation of vital
statistics. Though not as comprehensive as those for vital statistics, laws and executive
orders on generation of health statistics have also been administered. Annex 5 provides
a listing of these laws. There is no law, however, focusing specifically on a health
information system. Instead, Executive Order No. 121 created a decentralized PSS
already presented in Chapter 3 of this report. The different agencies producing health
and nutrition statistics are part of the PSS. The NSCB is the highest policy and
coordination body on statistical matters in the country. It designates important statistics
as official and identifies the agency that produces the statistics. However, there are
statistics produced by other agencies that are beyond the designated statistics. These
statistics include those that are generated by the DOH usually from projects with
foreign funding. The problem is that these statistics are inconsistent with the ones being
officially released.

On the subnational assessment of the FHSIS and the CRS, majority of the data
producers said that they are aware of national laws, executive and administrative orders,
legislation on FHSIS/CRS with respondents for CRS posting higher percentages(90%+)

59
 than those for FHSIS (percentages less than 80%). The percentages are much lower
when data producers are asked about awareness of local laws and ordinances. The high
percentages are from those doing CRS. This indicates that most provincial and
municipal level ordinances are made more for CRS concerns and not for FHSIS or
health information. On the other hand, only fifty percent (33) of the 66 municipal and
city development officers are aware of national laws, executive and administrative
orders, legislation on FHSIS/CRS. The positive result is that the percentages are much
higher when these respondents are asked of local laws and ordinances: sixty three
percent (41 out of 66). Provincial development officers seem to be the least aware of
legal bases for HIS. Out of the twenty provincial development officers, only 40 percent
(8) are aware of national laws, executive/administrative orders, legislation on
FHSIS/CRS. Legislations cited are on blood letting vital registration, family code, and
HIV/Malaria. For awareness on local ordinances, the percentages are much lower:
only 21 percent (4) of the 20 provincial development officers interviewed gave a
positive answer.

On Coordination and Leadership

On 9 September 2005, the PHIN was formally launched to strengthen collaboration

among stakeholders, expand the network to include those in the private sector and the
academe, to work at integrating and harmonizing the Philippine HIS. Its founding
members are: DOH, NSO, NSCB, and PCHRD. This collaborative effort has been
continuously expanded to include other government agencies as well as donor
organizations, academe, private sector, and other constituencies involved in health
information. The steering committee of this network has not been meeting regularly,
though, but its secretariat has been working since 2006 on the assessment and
construction of a strategic plan for an integrated and harmonized PHIS. It must also be
noted that a committee to review the Philippine Statistical System was created in July
2007 to evaluate and make a strategic plan to address the concerns of the different
stakeholders of the system, both data producers and data users. The committee’s
evaluation and recommendations are due in January 2008. It has already conducted
consultations with DOH and its concerns regarding data generation and data use within
the statistical system as a whole and DOH in particular.

On the subnational level, local health boards in the provincial and municipal//city levels
are supposed to serve as recommending bodies for their respective local chief
executives on health concerns including health inforation systems. They also serve as
the recommending body for the creation of ILHZ. However, less than half of the
provinces have functional local health boards and more than half for the cities and
municipalities. Given their critical contribution to the decision making process, there is
a need for the local health boards to be more responsive towards the development of
the local health systems through the ILHZs.While a Local Health Assistance Division
(LHAD) has been created at the CHD, the unit is currently ad hoc in nature. They are
yet to be integrated as part of the organic structure of the regional health office. This
would synchronize functions and staff complement between the DOH and its regional
offices, and ensure appropriate resource allocation with the end in view of enhancing
the CHD's capacity to provide technical assistance to LGUs. It must be noted that use of
information technology in decision making has yet to be optimized at the local level.
While the PLHIS has contributed to the performance of some LGUs within the

60
 convergence sites, the utilization of the system remains to be weak in most local health
zones as well as local government units. Also, (NOH, 2005-2010).

Results of the assessment of FHSIS and CRS, on the other hand, reveal that majority of
all data producers said that there a committee/group/venue that addresses FHSIS/ CRS
at the subnational ( provincial/city/municipal/barangay) level. These are local health
boards as well as meetings where FHSIS/CRS generation and submissions are
discussed. On the other hand, there seems to be no such activities for PHIS concerns, in
general. This is more evident from those doing CRS than from those generating data
for FHSIS. Majority of the planning officers also said that there is a
committee/group/venue that meets regularly and addresses FHSIS/CRS in the
subnational (provincial/municipal/barangay) level.The commonly cited committees are
local/provincial health boards, committee on health, nutrition council, and
local/provincial development council. In addition, most of the His concerns are
discussed by the committees.

On Financial Resources

There is no written HIS strategic plan specifically on an integrated HIS. Thus, there is
no allocation of resources specifically for such a system. Furthermore, although each
data-generating agency under the DOH and the PSS does its own monitoring and
evaluation of its processes in generating, processing and disseminating data, there is no
regular system in place for monitoring the performance of the PHIS as a whole. It must
be noted, though, that the NSO has demonstrated best practices in its generation of vital
statistics. This may be because laws mandating it have been properly established.
Furthermore, it must also be pointed out that the PSS in the PSDP and the DOH as
stated in the NOH have recognized the need to have an integrated HIS. This was
already pointed out in the previous sections of this report.

Local planning officers indicated that there is some budget allocated for FHSIS
although, this is usually integrated in the line functions of the LGUs. It is noted that
there is more budget allocation for FHSIS in the provincial level than the municipality
level. On the other hand, there is a bigger percentage of the budget allocated for CRS
compared to FHSIS in the municipality than the provincial level.

On Human Resources

There is national capacity in core health information sciences to meet health

information needs (epidemiology, demography, statistics, health planning). For vital
registration, personnel , capacity building for them, equipments and supplies for their
use are suffiecient. However, this is not so for the generation of health and nutrition
statistics, especially at the subnational levels. The participants of the HMN workshops
noted that less than 50% of health offices in regions and provinces have a designated
full-time health information officer position. HIS capacity building activities have
occurred over the past year for HIS staff but these are largely dependent on external (e.g.
donor) support and input. HIS capacity building activities have occurred over the past
years for health facility staff but these are also very limited. Fast turnover of staff
involved in generation, processing and turnover of data is also a concern and any
capacity building cannot keep up with such turnovers. Availability of IT and database
support to health and HIS staff at the national level seem to be adequate but this is not

61
 so for the subnationals levels. They are limited and do not meet the needs of staff. In
fact in the municipalities and the barangays telephone access is still a problem and
internet connection is non-existent. As regards guidelines for the processes of HIS data
collection, management and analysis, these exist and are used but no proper orientation
seem to be done for new staff.

Majority of data producers interviewed in the subnational assessment of the FHSIS and
the CRS said that they have an operations manual with those doing CRS posting very
high percentages (93% and up) compared with those in FHSIS (80% and up). When
asked about formal trainings, orientation, and updates for them, higher percentages of
respondents for CRS answered positively at all levels (provincial and municipal). For
respondents for FHSIS, high percentages of nurses (82%), midwives(90%), and
provincial FHSIS coordinators (79%) answered positively while lower percentages of
provincial health officers (47%) and municipal or city health officers (48%) did so.

It is noted that majority of those in FHSIS who did not undergo formal training or
orientation said that they learned their skills either through self-study or while doing
their job.

On Infrastructure and Communications

One of the problems often cited by data producers for FHSIS is the lack of supply of
forms. Such a problem is cited by 57% of nurses and 58% of midwives.

Different problems occur at different levels. First level data generators- nurses and
midwives-have problems with supply of forms and duplications of entries for different
forms. On the other hand, the next levels ( provincial and regional) see the problems of
timeliness, completeness and quality of data.

Computers, printers, calculators, mimeographing machines are available at all levels.

More telephones and fax machines seem to be needed at the municipal level. Internet
access is generally available at provincial level only. Majority of provincial health
officers only have LCD projectors.

Software for data entry is available at all levels for both FHSIS and CRS. However,
only CRS has software for data processing, tabulation and reporting. Manual filling up
of forms is still generally done for FHSIS. Any use of electronic processing is
dependent on advocacies of the CHDs and local chief executives. It is noted that data
entry software for FHSIS is usually Excel. Data generators for FHSIS seldom do more
in-depth analysis of the data and are not usually aware of simple tools for summarizing
data in Excel such as graphs and desciptive statistics. All said yes to provision of a
software.

Majority of the development planning officers said that there were capacity-building
activities provided to personnel for HIS in 2006. The activities cited are scholarships
for formal education, study tours, and trainings and seminars. In cases when capacity-
building activities were not provided, the reasons usually cited are;
a. No funding/budget
b. Not a priority
c. This is the concern of the RHU and not the LGU.

62
 Table 11. Problems on HIS Resources Identified by Regional FHSIS Regional Coordinators With the
Existing FHSIS at Different Administrative Levels

Barangay Municipal/City Province Regional

Number of Number of Number of Number of
FHSIS FHSIS FHSIS FHSIS
Coordinators Coordinators Coordinators Coordinators
Who Who Who Who
Identified Identified Identified Identified
Type of Problems Encountered the Problem Percentage the Problem Percentage the Problem Percentage the Problem Percentage
Inadequate training of
health workers on how
to fill out forms 12 100.0 11 91.7 5 41.7 0 0.0
Lack of technical
expertise of staff to
properly analyze the
data collected 8 66.7 9 75.0 9 75.0 4 33.3

b. Indicators

Of the six components of HIS for assessment, Indicators got highest score – 82% . The
participants agreed with this since the assessment items were on the existence of core
indicators which were identified by consulting different stakeholders and using clear
explicit criteria including usefulness, scientific soundness, reliability, representativeness,
feasibility, accessibility. The list of indicators is presented in Annexes 1 and 2.
Furthermore, the Philippines has a clear and explicit official strategy for measuring each of
the country relevant health-related MDG-indicators. Annex 6 lists the Philippines’ MDGs
with metadata information.

Table 12. Summary of the Result of the Assessment of Indicators

Summary Result
82%
Indicators
Highly adequate

63
 Figure 5

c. Data Sources

Data Sources was rated as present but not adequate with a score of 58%.For this component,
data from the NSO(census, population-based surveys, vital statistics which are from the
NDHS) received high scores, a result the participants validated since there is the Philippine
Statistical System coordinated by the NSCB follows international standards for
methodologies used. Facilities-based information, however, have a number of non-
functional and inadequate ratings. These are shown by the table and graph below:

Table 13. Summary of Results of the Assessment of Data Sources

Capacity & Integration
Data Source Contents Dissemination Total
Practices and use
Present but
Present but not Highly
Census not Adequate Adequate
adequate adequate
adequate
Vital statistics Adequate Adequate Adequate Adequate Adequate
Population-based Highly Highly Highly
Highly adequate Adequate
surveys adequate adequate adequate
Health and disease
Present but
records (incl. Present but Not
Adequate not Not functional
disease not adequate adequate
adequate
surveillance sys.)
Present but Present but Present but
Health service Present but
not not Adequate not
records not adequate
adequate adequate adequate

64
 Capacity & Integration
Data Source Contents Dissemination Total
Practices and use
Present but
Administrative Not Not
not Not adequate Not adequate
records adequate adequate
adequate

On the census, the Philippines has adequate capacity to (1) implement data collection, (2)
process the data and (3) analyze the data. A census was carried out in 2000 and in 2006 and
results have been published or are likely to be published in the next five years. Questions
on recent household death or questions for indirect estimating either child mortality or adult
mortality are present but not adequate. Census sample re-interview undertaken for the 2000
census but no report was made available for public use. On dissemination, all provinces
have immediate access to 2000 census results including descriptive statistics (age, sex,
residence by smallest administrative level). These are available and widely distributed
online and with paper copy. Lag between the time that descriptive statistics (age, sex,
residence by enumeration area) were last published and the time that the data were
collected is from 2 to 3 years. Accurate population projections by age and sex are available
for provinces/regions but not for lower levels (municipal and barangay). Microdata are
available on request and with restrictions. Census projections are used for determining of
coverage and for planning of health services but only for provinces/regions and not for
lower levels.

On vital statistics, the civil registration system has completeness of 50% to 89%. The
coverage of vital registration of deaths is from 70% to 89%. Cause of death information is
always recorded on the death registration form as required by law. The country has
adequate capacity to (1) implement data collection, (2) process the data and (3) analyze the
data from vital registration since the NSO has a nationwide network of civil registrars that
it constantly meets for trainings, updates, and consultations. Frequency of the assessment of
completeness of vital registration is evetry five years. International Statistical Classification
of Diseases and Related Health Problems (ICD) that is currently in use is the ICD10.
Proportion of all deaths coded to ill defined causes (garbage codes) is 5-10%. Published
statistics from vital statistics (VR) are disaggregated by (1) sex, (2) age, and (3) geographic
region (or urban / rural). To aid in effective decision policies, an overall burden of disease
study was undertaken.

Population-based surveys rated vey high in terms of capacity and practices, dissemination,
an integration and use. This is a reflection of a well-developed statistical system in the
Philippines in the national and regional levels. It must be noted, though, that subnational
levels still need to be developed under the different local units.

On health disease records including surveillance systems which were rated as not adequate,
for all key epidemic prone diseases and diseases targeted for eradication / elimination (see
text) appropriate case definitions have been established and cases can be reported on the
current reporting format. Also, for major infectious and some non-communicable
conditions of public health importance a measurement/assessment strategy exists and is
reflected in appropriate plans, tools, supporting structures, and assignments of
responsibility. Mapping, however, is available only for a few public health risks or
resources. Adequate capacity is present only for diagnosis and recording cases of notifiable
diseases but reporting and transmiting timely and complete data on these diseases are not
yet achieved fully. Low percentages are recorded for the following indicators of capacity

65
and practices- percentage of health workers making primary diagnoses who can correctly
cite the case definitions of the majority of notifiable diseases, percentage of health facilities
submitting weekly or monthly surveillance reports on time in the subnational levels, and 4
percentage of municipalities, cities, provinces submitting weekly or monthly surveillance
reports on time to the next higher level. It is noted tjoigh that 90 % of investigated
outbreaks are with laboratory results. Essential patient information is often not recorded
and/or records cannot be retrieved for most patients. Although there are a number of
reporting forms, there is good coordination and efforts to integrate the reporting
requirements of public health programs. Surveillance data are produced regularly and
available at the national level .At least 75% of epidemics noted at regional or national
levels are first detected at the provincial level.

On health service records, there is a health services based information system that brings
together data only from public health facilities . There is information on quality of services
but only from a convenience sample of health facilities. The health information system has
a cadre of trained health information specialists who have at least two years of training only
in about 1% to 9% of provinces. Most health workers received training in the last 5 years
in health information, which is either integrated into continuing education or through
special workshops. Mechanisms are in place at national and regional levels for supervision
and feedback on information practices as well as verification of completeness and
consistency of data from facilities. However, these are not yet adequate. Population
projections based upon census statistics are used to calculate coverage rates (e.g. for
immunization) at the provincial level in at least 90% of provinces. Dissemination is rated as
present but not adequate because of the following: the last time that an annual summary of
health service statistics was published with statistics disaggregated by major administrative
region\ was from 4 to 5 years ago; compilation of monthly and annual summary reports by
health facility is available but not adequate since these are only for public health facilities ;
managers and analysts at national and regional levels use findings from surveys, vital
registration to assess the validity of clinic-based data but these are not adequate; data
derived from health service records are only occasionally used to estimate coverage with
key health services. It must be noted, though, that vertical reporting systems such as those
for tuberculosis and vaccination communicate well with the general health service reporting
system.

Administrative records on health facilities, human resources for health, financing of health
sertvices, database on equipments, supplies and commodities are not considered adequate
at all:
• These include the roster of health facilities which does not include adequate list of
private health facilities and which does not have a unique identifier code for each
health facility that permits data on facilities to be merged. The maps of provinces
showing the location of health infrastructure, health staff and key health services
are not adequate. Managers and analysts at national and provincial levels are not
always able to evaluate physical access to services by linking information about the
location of health facilities and health services to the distribution of the population.
• The national HR database tracks numbers by professional category but only those
working in the public sector. Numbers graduating from certain health training
institutions (e.g. nursing; private institutions) are not tracked. There are human
resources for maintaining and updating the national HR database but they are not
adequate. The national HR database statistics on the number of public sector health
professionals was last updated six years ago or more.

66
 • Financial records are available on general government expenditures on health,
private expenditures on health (and their components) and external expenditure on
health. Estimates of routine NHA are computed every year with at most 2 year lag.
NHA routinely provides information on the following 4 classifications - sources,
agents, providers, functions. However, government budget/expenditure plus at least
one more source such as donors are available but only at national level. Adequate
numbers of qualified, long-term staff are regularly devoted to work on NHA but are
in need of external technical support. Estimates are available of expenditure on
some areas of policy concern but they exclude some important sources of finance
(e.g. out-of-pocket) NHA findings are available within the agency but have not
been widely disseminated. Policy makers and other stakeholders are aware of the
NHA findings but there is no evidence that these findings have shaped policy and
planning.
• Each facility is required to report at least annually on any one of the following:
inventory/ status of equipment/physical infrastructure. Each facility is required to
report at least once a year on its stock of health commodities (drugs, vaccines,
contraceptives, other supplies). There are sufficient numbers of adequately skilled
human resources for managing the logistics of equipment, supplies and
commodities. However, reports are incomplete and reporting systems for different
commodities are not integrated. Managers at national and regional levels rarely
attempt to reconcile data on consumption of commodities with data on cases of
disease reported.

d.Data Management

Of the six components of HIS for assessment, Data Management got lowest score – 17% -
considered not functional. The participants agree with this since there is still no integrated
data warehouse with written procedures for data management and metadata data dictionary.
Furthermore, there are no identifier codes for health facilities. Available data are for public
health facilities. There is no comprehensive database for private health facilities. It must be
noted that the Philippine Health System is one wherein the DOH is the agency tasked for
health on the national level and local governments on their respective levels.It must be
noted that policy planning is from national to local level while data generation is from local
level to national.

Table 14. Summary of the Result of the Assessment of Data Management

Summary Result
17%
Data management
Not functional

There is no written set of procedures for data management including data collection,
storage, cleaning, quality control, analysis, and presentation for target audiences, and these
are implemented throughout the country. Actually, there is no integrated “data warehouse”
containing data from all data sources (both population-based and facility-based sources
including all key health programmes) yet. This is true for both national and subnational
levels . "Metadata dictionaries'' for health and nutrition statistics exist in the government
agencies that generate them but usually incomplete sets of definitions and specifications. It
must be noted, though, that for the MDGs indicators, complete metadata whish are

67
disseminated well are maintained by the NSCB. Identifier codes are not available for health
facilities and administrative geographic units (e.g. province, district, municipality, etc.) to
facilitate merging of multiple databases from different sources

e. Information Products

The component Information Products was rated as adequate with a score of

69%.Participants validated this result since the NDHS is the official source of mortality and
morbidity. The DOH also estimates such indicators from its FSHIS, but the participants
from DOH said that these estimates are designed for internal use only recognizing the
limitations and weaknesses of FHSIS. Risk factors indicators asked in the assessment are
generated by the DOH. In addition to NDHS, the assessment items asked about other
surveys, e.g., on malaria. These are done by DOH; thus, the adequate assessment. It must
be noted, though, that administrative records are the sources of inadequacy. This result
seems to be inconsistent with the assessments already done wherein timeliness,
completeness, and consistency were recognized as still not achieved. The source of this
result was traced by the participants to the questions in the HMN questionnaire. They are
noted not to be sensitive to situations in the Philippines.

Table 15. Summary of Results of the Assessment of Information Products

Marking Indicators Health status Overall
Health Risk
health
system factors
Elements for indicators
indicators indicators
assessing selected Mortality Morbidity Overall quality
indicators
present
Data collection
but not adequate adequate adequate adequate adequate
method
adequate
present present but
Timeliness but not adequate adequate not adequate adequate
adequate adequate
present but
Periodicity adequate adequate adequate adequate not adequate
adequate
present but
Consistency /
adequate adequate adequate not adequate adequate
completeness
adequate
Representativeness / highly
adequate adequate adequate adequate adequate
appropriateness adequate
highly highly highly
Disaggregation adequate adequate adequate
adequate adequate adequate
Estimation method / highly highly
adequate adequate
transparency adequate adequate
Overall assessment
adequate adequate adequate adequate adequate adequate
of results

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 Figure 6
Assessment of Information Products

Majority of the data producers said that they had experienced delays in submissions to the
next level. The following are the percentages who said so:

a. 80% of provincial health officers

b. 65% of provincial statistical officers

c. 58% of municipal and city health officers

d. 62% of nurses

e. 94% of provincial FHSIS coordinators

f. 77% of provincial NSO staff designated of CRS

Only 37% of city/municipal civil registrars and 40% of rural health midwives said they had
delays.

69
Table 16. Problems on Information Products Identified by Regional FHSIS Regional Coordinators With
the Existing FHSIS at Different Administrative Levels

Barangay Municipal/City Province Regional

Number of Number of Number of Number of
FHSIS FHSIS FHSIS FHSIS
Coordinators Coordinators Coordinators Coordinators
Who Who Who Who
Identified Identified Identified Identified
Type of Problems Encountered the Problem Percentage the Problem Percentage the Problem Percentage the Problem Percentage

Duplication of forms 4 33.3 4 33.3 3 25.0 3 25.0

Too many record
books/forms being
filled out at this level 10 83.3 5 41.7 2 16.7 1 8.3
Reports not submitted
on time 10 83.3 11 91.7 12 100.0 7 58.3
High degree of
inaccuracies in data
collected 8 66.7 7 58.3 4 33.3 0 0.0

Majority of the problems cited by data generators for FHSIS in the provincial and
municipal levels are concerned with data management:

a. There are difficulties in collecting data for this form from all geographic or
service areas covered (64% of provincial health officers)
b. Completed form not submitted on time(64% of provincial health officers
75% of FHSIS provincial coordinators)
c. Lack of constant supply of this form Entries in this form duplicate those of
other forms (50% of provincial health officers
d. High degree of inaccuracies in data collected (50% of FHSIS provincial
coordinators)
e. Not all items in the form are filled out or completed( 70% of FHSIS
provincial coordinators)

Majority of the development planning officers encountered difficulties/problems in the

different FHSIS programs. Usual problems are on:

a. Timeliness
b. Coverage
c. Data quality.

The most common difficulty/problem encountered among the different types of FHSIS
programs are insufficient funds, late/lacking reports, narrative reports are difficult to
understand, data has no analysis and interpretation, target population used by municipal
health is different from the municipality, health targets are overestimated, lack medicines,
lack support, and lack midwives.The most common problems/difficulties encountered with
vital statistics are lack of personnel, low registration on birth/death especially for far flung
areas, no data maintenance, some deaths are not registered, and delay in reporting.

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The following ratings were given by the FHSIS regional coordinators when asked to rate
the performance of FHSIS data.
Performance Frequency Mean
Indicator 1 2 3 4 5 rating
Timeliness 0 1 10 1 0 3.0
Completeness 0 0 5 4 3 3.8
Accuracy 0 1 7 4 0 3.3
Adequacy 0 2 5 4 1 3.3
Note:1 is the lowest rating and 5 is the highest rating

The FHSIS regional coordinators highlighted the following problems when asked to
evaluate the system:

• Accuracy of the data is a problem. Those who fill up the FHSIS forms, especially
the midwives, do not seem to have the proper understanding of how to fill up the
forms;
• Late submission of reports is a problem in all levels;
• Incomplete data being submitted are also noted ; and,
• Some reports are also not standard for all geographic areas; e.g., age brackets vary
from province to province.

It is observed that ratings that resulted in the survey for the assessment of FHSIS are higher
than one expected after hearing the comments on problems with FHSIS. This is consistent
with the results of the HMN assessment of the performance of indicators. The ratings seem
to be inconsistent with the comments that the key informants give in focus group
discussions and in the other responses when probed on their experience with the data
systems they generate and use. It is hypothesized that there is a tendency for key informants
to be more neutral and provide a more optimistic attitude when asked to make ratings.

f. Dissemination and Use

Dissemination and Use was rated as present but not adequate. The following table provides
the specific items:

Table 17. Summary of Results of the Assessment of Dissemination and Use

Summary Result
50%
Analysis and Use of Information
Present but not adequate
56%
Policy and Advocacy
Present but not adequate
72%
Planning and Priority Setting
Adequate
54%
Resource allocation
Present but not adequate
75%
Implementation/action
Adequate

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 Summary Result
59%
Overall
Present but not adequate

The data on health are used by policy makers and planners. However, there is a need to do
more analyses on existing data. Thus, “analysis and use of information” received a rating of
“present but not adequate”.

For planning and prority setting the data available are more general; and, thus, what are
available are usually adequate. On the other hand, for policy formulation, more specific
information and more in-depth analyses are needed.

As to uses, provincial health officers, provincial NSO staff designated for CRS, and
provincial statistical officers use the data more for planning and prioritizing. Health officers,
nurses, midwives, and local civil registrars state that aside from planning and prioritizing,
they use the data for reports and bases for compliance. Provincial FHSIS coordinators also
use the data for planning and prioritizing, for reports and bases for compliance, as well as
detection of epidemics and resource allocation.

A large percentage of them (89.2% of municipal and city officers and 94.7% of provincial
officers) used/requested the data and/or reports from FHSIS in the municipality/province.
Majority said that the data/reports from FHSIS are readily available. Also, a large
percentage of the municipal and city planning offficers (81.8%) requested data/reports from
CRS in their municipality. On the other hand, only 55.6% of the provincial planning
officers used/requested data/reports from CRS.

The most common uses of both FHSIS and CRS for local development officers are for
planning and prioritization of activities; for reports; as bases for accomplishments; for
resource allocation and budget estimation; for monitoring and evaluation; for
program/project development; and, for research. Other uses of CRS data/reports in 2006
were:
a. Profiling of the province
b. Monitoring growth and death rate
c. Population projection

Majority of them said that the data are sufficient for their purposes. However, those who
indicated otherwise gave the following reasons why they considered the FHSIS data/reports
are not sufficient :
a. No data analysis
b. Not all indicators relevant to the municipality are in the FHSIS (morbidity,
mortality, nutrition, poverty threshold, population)
c. Lacks data disaggregation by barangay, purok, sex
d. Inconsistent forms (e.g. age grouping do not coincide)

Those who did not request for FHSIS data/reports said that they were either unaware of the
FHSIS, that there is no funding for FHSIS data/reports, and that the local chief executive’s
priority is infrastructure and not health and nutrition.

72
 Those who requested data/reports from CRS stated that they are always available
(municipal and city planning offficers - 98.2%, provincial planning officers – 100.0%).

Majority, 90.7%, of the municipal and city development officers and 70.0% of the
provincial development officers, said that the CRS data/reports were sufficient for their
purposes. Those who did not request for CRS data said that this was because they did not
need the data or that they are not familiar with data from the CRS.

Table 18. Problems on Dissemination and Use Identified by Regional FHSIS Regional Coordinators
With the Existing FHSIS at Different Administrative Levels

Barangay Municipal/City Province Regional

Number of Number of Number of Number of
FHSIS FHSIS FHSIS FHSIS
Coordinators Coordinators Coordinators Coordinators
Who Who Who Who
Identified Identified Identified Identified
Type of Problems Encountered the Problem Percentage the Problem Percentage the Problem Percentage the Problem Percentage
Lack of utilization of
data being collected 8 66.7 7 58.3 7 58.3 4 33.3
Low level/no
dissemination of and
feedback about data
collected 4 33.3 9 75.0 8 66.7 4 33.3

FHSIS regional coordinators are optimistic about future use and dissemination of FHSIS
because of the “horizontal flow” of information dissemination. This means that reports
shall not only be submitted to the next administrative level (from barangay to municipality ,
from municipality to province, from province to region, from region to DOH central office)
but also to the stakeholders within the geographic area (e.g., barangay level data to be
disseminated in the barangay level, municipal level data to be disseminated to municipal
health boards and the local chief executive).

g. Summary

In summary, the assessment using HMN tools, indicated warning signals on data
management, inadequacy of HIS resources, data from health administrative records,
dissemination and use. Information products and indicators are rated adequate. The latter
needs closer inspection though since this result seems inconsistent with other previous
assessments.

Component with Highest Score

• Of the six components of HIS for assessment, Indicators got the highest score –
82% .
• The participants agree with this since the assessment items are on the existence of
core indicators which were identified by consulting different stakeholders and using
clear explicit criteria including usefulness, scientific soundness, reliability,
representativeness, feasibility, accessibility.
• Furthermore, the Philippines adopts a clear and explicit official strategy for
measuring each of the country relevant health-related MDG-indicators.

73
Component with Lowest Score

• Of the six components of HIS for assessment, Data Management got the lowest
score – 17% - considered not functional.
• The participants are in agreement with this since there is still no integrated data
warehouse with written procedures for data management and metadata data
dictionary. Furthermore, there are no identifier codes for health facilities. Available
data are for public health facilities. There is no comprehensive database for private
health facilities.
• The Philippine Health System has the DOH as the agency tasked for health at the
national level while the LGUs are the ones responsible for health at the local level.
• Policy planning follows the top-down approach while data generation is undertaken
from the local level to the national level.

Component Rated as Adequate

• Information Products – 69%

– Participants validated this result since the NDHS is the official source of
mortality and morbidity. The DOH also estimates such indicators from its
FSHIS, but based on feedback from the participants from DOH, these
estimates were designed for internal use only recognizing the limitations and
weaknesses of FSHIS
– Risk factors indicators asked in the assessment are generated by the DOH
– In addition to NDHS, the assessment items asked about other surveys, e.g.,
on malaria. These are done by DOH and got adequate scores. It must be
noted, though, that administrative records are the sources of inadequacy.

Components Rated as Present but Not Adequate

• Dissemination and Use – 59%

– For this component, planning and priority setting as well as
implementation/action got high scores but Analysis and Use of Information,
Policy and Advocacy, Resource allocation had low points and, thus, need to
be addressed.

• Data Source – 58%

– For this component, data from the NSO(census, population-based surveys)
received high scores, a result that the participants validated since they follow
international standards for concepts and methodologies.
– Facilities-based information, however, have a number of non-functional and
inadequate ratings.

• Resources – 48%

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 – Policy and Planning under this component is considered not adequate; HIS
institutions, human resources and financing are present but not adequate;
while HIS Infrastructure is adequate.

8 Recommendations

The results of the assessment based on the HMN framework serve to bring to a new light
the situation of health information in the Philippines. They also confirm what have been
perceived as the problems besetting the state of health information in the Philippines.
Solutions to the problems of health information have long been identified and planned for,
but lack of resources hampers its implementation. This chapter reiterates some of the
solutions but emphasizes on the construction of a framework that shall provide based for
the rationale of these solutions. The following are recommended: to develop a
comprehensive plan and coordinated health information system, to advocate the importance
and utilization of health information to health workers and local officials, to capacitate the
health workers on health information, to revisit and re-engineer the FHSIS, to involve the
local governments as partners in the FHSIS detailed assessment and planning activities, and
to network the health information agencies for more concerted and consolidated actions to
strengthen health information.

In all these recommendations, the Department of Health, the National Statistics Office, and
the National Statistical Coordination Board have direct influence albeit a bit less on
compelling local governments to submit health data. Addressing these identified concerns
should be the priority of the Philippine Health (and Nutrition) Information Network.

The following provide more detailed discussion of the recommendations.

1. Develop a comprehensive and coordinated health and nutrition information

system. There are a number of key players in the country’s health information
scene. Currently, each bureau, agency, and program within DOH develops and
implements its own plan with minimal coordination and no integration with other
statistics-producing units and organizations. They are working vertically which
results in overlapping and duplication that increases the burden on the field health
workers. Although there are existing statistical coordination mechanisms in place to
resolve issues on duplication of statistical activities such as the Inter-agency
Committee on Health and Nutrition Statistics, and the formulation of the PSDP
being coordinated by the NSCB and participated in by the DOH and other health
stakeholders , there are still vast areas for improvement.

A common framework would align and harmonize the efforts of all concerned
agencies within and outside the DOH and ensure that quality health information is
efficiently produced. The suggested conceptual framework is characterized by a
decentralized network of non-duplicating, synchronized, and harmonized health
information subsystems maintained and managed by different agencies following
the same set of quality standards.The framework identifies the data sources of
health information categorized as presented in Figure 2. The framework identifies
the data sources of health information categorized as: health and vital statistics,
health service information delivery, health system information.The system is
expected to provide all the indicators for the evaluation of the performance of the

75
health system. It is also noted that the framework should emphasize knowledge
sharing; health research; documentation and use of best practices and lessons
learned; and, provides for intranet and extranet portals. The framework is a
combination of Figures 2 and 3 where Figure 3 reperesnts the decentralized system
and Figure 2 provides the details of the different subsystems. Ultimately, the DOH,
the major stakeholder and in collaboration with other stakeholders, shall maintain a
central data warehouse that will sustain an executive support system and a decision
support system.

The next activity of the PHIN is to construct a comprehensive plan for the
envisioned health information system and to advocate for the provision of a budget
for actualizing such a plan. The plan shall be constructed so that it is aligned with
the NOH’s health sector strategic plan and the PSDP’s health and nutrition
component. The following specific items should be reflected in the said plan:

HIS Resources
Formatted: Indent: Before:
o Proposed NSCB Resolution designating clearly what health and nutrition 72 pt, Bulleted + Level: 2 +
Aligned at: 54 pt + Tab after:
data/indicators to produce, what agency will produce the data to ensure 72 pt + Indent at: 72 pt,
non-duplication, frequency and level of disaggregation, how Tabs: 90 pt, List tab + Not at
72 pt
harmonization should be achieved within a devolved health system

o Budget allocation at different levels of disaggregation

o Human resources(continuing capacity building, deal with turnovers)

o Other resources(communication facilities including internet connection,

hardware and software to automate)

Indicators
Formatted: Indent: Before:
o Core indicators are clearly identified and prioritized should have clear 72 pt, Bulleted + Level: 2 +
single data source Aligned at: 54 pt + Tab after:
72 pt + Indent at: 72 pt,
Tabs: 45 pt, List tab + Not at
o Compliance to standard concepts and definitions, classifications, and 72 pt
coding systems as well as to sound statistical methodology

Data Sources and Data Management

Formatted: Indent: Before:
o linked data from the different data sources ( health to be linked with 72 pt, Bulleted + Level: 2 +
socioeco databases) are easily linked (unique identifiers exist at different Aligned at: 54 pt + Tab after:
72 pt + Indent at: 72 pt,
levels of disaggregation, variable names and definitions are Tabs: 45 pt, List tab + Not at
standardised ) 72 pt

o existence of a central data warehouse of all data or a website linking

different databases maintained by a group or agency

Information Products and Dissemination and Use

Formatted: Indent: Before:
72 pt, Bulleted + Level: 2 +
o regular information products easily accessible to users at different levels Aligned at: 54 pt + Tab after:
of disaggregation 72 pt + Indent at: 72 pt,
Tabs: 45 pt, List tab + Not at
72 pt

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 After the plan is constructed and a budget for its actualization is determined, the next
concrete step is to develop and submit proposals for its actualization for external funding.

2. Strengthen the Philippine Health Information Network. The PHIN is an inter-

agency body composed of agencies that have critical stakes in health information.
The existing technical working groups and inter-agency committees should be
rationalized and re-structured as part of the PHIN. To ensure that LGU concerns
are addressed, participation of the Department of Interior and Local Government
shall be actively sought. A critical role of the PHIN would be to define policies on
health information, develop comprehensive health information strategic plan, and
identify data producer of particular indicators.

3. Advocate for the importance and utilization of Health Information specifically

FHSIS in health program management. The field health workers should realize
the value of health information. It must be emphasized that health information is
more than a service statistics reporting tool. It is the foundation of policy
development and health program management and is, thus, is a very critical
program management tool. The advocacy should be done specifically for the
FHSIS.

Advocacy programs should be done separately for the following different

stakeholders: national and regional health workers; provincial and municipal health
workers; local health boards and local officials; data producers for health, in
general; and, users of health data in the national and subnational levels.

4. Capacitate health care facilities, health workers and local officials on health
information. Capacity building involves human resource, infrastructure and
systems and processes for health workers that generate health information. A more
responsive roll-out program should be developed to ensure that health workers
acquire the statistical and IT skills. A user-friendly users’ manual for the generation
of health data should also be developed so that health workers would have reference
materials.

ICT infrastructure in the Philippines is not very mature. Very limited areas have
broadband connections. Municipalities with landlines may access the internet
through dial-up connection but most rural health units do not have computers. Such
an environment should be corrected by the provision of proper infrastructure.

5. Revisit and re-engineer the FHSIS and other legacy systems. The public health
information system of the country is 17 years old. Since the time it was
implemented, there have been two major organizational developments occurred: the
devolution of health services in 1993 (it was ratified 1991 but implemented 1993)
and the reengineering of DOH in 2000. The devolution transferred the service
delivery function from the DOH to the local governments. The DOH reengineering
on the other hand, integrated, consolidated and flattened the different public health
services. The latter limited the functions and roles of DOH staff to policy
development and technical assistance. Despite the major changes that have
transpired, no corresponding overhaul was done on FHSIS. As a result, there are
sections of FHSIS that are no longer relevant while new programs have to be added.

77
 Automation shall also address the issues identified under Information Products: late
and incomplete submission. Currently, the flow of reports is hierarchical. From the
lowest primary care level, reports would be submitted to the next higher level then
to the next until it reaches the central office in Manila. Because of the progressive
nature of the delay, by the time results reach Manila, delays would be in months.

We should make use of available technology to improve the health information

system. A suggested flow of reporting would be using the internet to submit directly
to central office, thereby submission of reports would be in real time. In the absence
of internet connection, an alternative would be submissions in diskette or CD. The
system would have the capability to be automatically appended.

6. Invest in health information. There is a need to invest in health information.

Significant capital investment should be made by the DOH as well as the LGUs.
Such investment shall be to develop systems, infrastructure such as ICT equipments
and internet connection, human resource development such as statistical and IT
trainings and research.

The human resource component would be a major investment since there is need to
train health workers (doctors, nurses and midwives) on the new system as well as
increase their appreciation and awareness of the value of health information in
health system management. Because most health workers are not computer literate,
they will need to be trained on basic computer operation.

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