TeleMedicine



Telemedicine is a growing industry and practice in the worldwide. This is a new means in the Philippines where the remote areas and low resource institutions can avail of the assistance from established institutions who have consultants who may give advice even from a distance. Below is a project we conducted for the Aeta resettlement in Zambales using the Telemedicine.

A. The Health Knowledge and Skills Development Project

1. The impact of the Indigenous Peoples - Community Health Workers Telemedicine Project (IP-CHWTP) will be the development of more knowledgeable and skilled health workers from the ethnic minority groups of the Philippines. The project is consistent with the mandate of the Department of Health (DOH) and the National Commission on the Indigenous Peoples (NCIP) on health for all regardless of geographic location or cultural background. The project envision a strengthened capacity of the health education and training system pioneered by the Foundation of Our Lady of Peace Mission, Inc.(FOLPMI) together with the multisectoral partners.
2. The project will have five outputs:
(i)a national ICT consultation and training of the one hundred eighty-eight (188) IP-CHW graduates of FOLPMI together with their updates and monitoring
(ii) an IP-CHW training center equipped with information and communication technology (ICT) responsive to the remote location of the IPs
(iii)strengthened commitment of the multi sectoral partners in utilizing ICT in assisting the IPs, namely with the government agencies (DOH, NCIP), civic organizations (Tuklas Katutubo-youth tribal leaders, Community Medicine Foundation, Philippine National Red Cross), religious organization (Catholic Bishops Conference of the Philippines - Episcopal Commission on Indigenous Peoples) and academic institution (University of the Philippines-Philippines General Hospital, Learn.ph Foundation) who had previously assisted the trainings of the 6 batches of IP-CHWs
(iv) establish ten pilot sites equipped with ICT
(v) a website for the advocacy and baseline knowledge collection tool of the IP-CHW Telemedicine Project

B. Background


3.The Philippines' Indigenous Peoples Rights Act (IPRA) defines Indigenous Peoples or IPs as "a group of people or homogeneous societies identified by self-ascription and ascription by others, who have continuously lived as organized community on communally bounded and defined territory, and who have, under claims of ownership since time immemorial, occupied, possessed and utilized such territories, sharing common bonds of language, customs, traditions and other distinctive cultural traits, or who have, through resistance to political, social and cultural inroads of colonization, non indigenous religions and cultures, became historically differentiated from the majority of Filipinos." (Section 3, Article II, R8371).
4. The NCIP tries to address the lack of access to health care through outreach programs to the IPs. The NCIP Central Office has a clinic that provides free consultation and medicines. Medical and dental missions to remote IP communities have also been carried out (NCIP Accomplishment Report 2002). However, an outreach program alone will not provide a sustainable health development program for the IP communities. On the other hand, the DOH coordinate with the Barangay Health Workers (BHW), however their coverage is limited with the remote location and cultural differences of the IPs. Thus, there is a need to establish a solid base within the community, in the form of trained Community Health Workers, who will serve as health care providers and spearhead health programs in their respective communities without compromising their indigenous beliefs and traditions.
5. The FOLPMI has developed 188 community health workers from the 77 tribes of the Philippines (see annexes A & B). At present, some graduates are working as barangay health workers, nutrition scholars, NGO employees and local government consultants. Their continuing education and monitoring is important to supplement the knowledge and skills they have obtained from the 3-week intensive training. To do so, most of the monitoring were done through on-site visits, posts and phone calls which required considerable financing and time. Thus, an ICT program paralleled to this health program would cut short the time and money spent for their consults and vice versa.
6. ICT is no longer new in offering alternative assistance to the remote areas in the Asia Pacific. It has been used to leapfrog the economies of the Peoples Republic of China and South Korea through Knowledge-based economy. In the remote areas of the Solomon Islands, solar powered internet and low frequency radio were used as a means of communication.
7. The FOLPMI receive regular consults from the IP-CHW through text messages from the mobile phones. Resource speakers such as those from the National Poison Management and Control Center expressed interest in answering consults through their hot line and mobile numbers. ICT can offer a bridge to this gap between health professionals and IP-CHW.
8. Considering health as not merely a state of having no illness but a state of total well being, social and political issues are confronted as well. The foundation has been lobbying for the ancestral domains of the IP-CHWs starting from the slow process of receiving bulky document by post and sorting it through a myriad of government agencies. An ICT network of legal and government agencies can challenge this process of transacting. The use of ICT can also allow recording and documentation of the consults and traditional health practices of the IPs which can be a baseline knowledge and reference with the permission of the Indigenous Peoples..

C. Legal Framework


9. The contents of this Policy Framework are based on laws and policies of the Government of the Philippines and policies of the World Bank as follows:
a. Republic Act 8371, otherwise known as the Indigenous Peoples Rights Act or IPRA, provides that the IPs have the right to an informed and intelligent participation in the formation and implementation of any project, government or private, that will impact on their ancestral domain, and that the IPs have the right to participate in decision-making, in all matters which may affect their rights, lives and destinies.
b. IPRA Section 34 states that IPs are entitled to the recognition of the full ownership and control and protection of their cultural and intellectual rights. They shall have the right to special measures to control, develop and protect their sciences, technologies and cultural manifestations, including human and other genetic resources, seeds, including derivatives of these resources, traditional medicines and health practices, vital medical plants, animals and mineral, indigenous knowledge systems and practices, knowledge of the properties of fauna and flora, oral traditions, literature, designs, and visual and performing arts.
c. IPRA Section 46 states further that the NCIP is mandated to identify IPs with potential training in health profession and encourage and assist them to enroll in schools of medicine, nursing, physical therapy and other allied courses pertaining to the health profession.
b. World Bank Operational Directives on Indigenous Peoples (OD 4.20) requires Bank-assisted projects to ensure that interventions avoid or minimize detrimental impacts on indigenous peoples/ cultural minorities and that measures are made to maximize project benefits on IPs. It likewise requires Bank-assisted projects in areas with IPs to guarantee the informed and meaningful participation of IPs in various stages of project development and implementation. Moreover, this directive expects that IPs receive social and economic benefits that are compatible with their cultural practices and tradition.

D. Guiding Principles


10. For the project and the ICT to be culturally acceptable, guidelines are established as follows:
a. The IP-CHWTP shall ensure that the IPs are engaged in the decision-making processes in identifying, planning and implementing project interventions in areas within ancestral domain claims or areas where IPs depend for their livelihood.
b. The project must ensure that the IPs does not suffer adverse effects during and after project implementation and that they receive social and economic benefits that are compatibles with their cultural practices and tradition.
c. The Project Management Teams and its Regional counterparts must ensure at all times that the implementation of the project fosters full respect for IP's dignity, human rights and cultural uniqueness.
d. Whenever necessary, consensus of all IP members who are affected by the project must be obtained in accordance with their respective laws and practices and customary practices of consensus-building, and shall conform to Section 14 (Mandatory Activities for FPIC) of NCIP Administrative Order No. 3, series of 2002.
e. The Project Regional Implementation Teams shall ensure that project implementation will not result in damage to non-replicable cultural property. In cases where infrastructures improvement shall affect sites considered as cultural properties of the IPs. Project Implementation Teams must exert best efforts to relocate or redesign the planned renovations so that these sites can be preserved and remain intact in site.
f. Infrastructure designs must at all times be consistent with the traditional and cultural practices of the IPs in the area.

E. The Procedures


11. The IPs in the national convention shall be encouraged and given the opportunity to participate in all stages of planning, implementation and project monitoring. The IPs shall be included in the discussions, workshops and survey interviews. Efforts shall be exerted to solicit their views and suggestions in the implementation of the project. Pilot sites will be prioritized based on the following: 1.) Groups who are favorable with the ICT 2.) highly coordinated as a people's organization 3.)has established health programs. For areas unequipped with Internet transmission or IPs who are unprepared for the project, the national convention shall also be a venue for them to undergo training on being an operator of a "Botika ng Barangay" (local pharmacy) or be assimilated to the Community-based Health Program of the Community Health Development. More importantly, a federation will be organized among IP-CHW which is envisaged to be self-governing and self-reliant.
12. Building on World banks formulation of a Knowledge-Based Development, three categories of intellectual capital are applied, namely human capital, structural capital and stakeholder capital. The IP-CHW Development Program of FOLPMI has developed 188 skilled workforce for the human capital. In addition, it has established a network with multisectoral agencies (stakeholder capital) which aided in the development and monitoring of the IP-CHWs. However, the FOLPMI lacked a structural capital to convene or coordinate these human and stakeholder capital. In this regard, a national coordinating center, a structural capital, has to be setup which will extensively cater the assistance and development of the IP-CHWs. This center shall be equipped with ICT equipments that are cost-effective.
13. A memorandum of agreement will be reached by the multi sectoral partners in committing to address the consults of the IP-CHWs. These partners will be trained on IP cultural sensitivity and ICT skills. Learn.ph Foundation whose core competency is online education will provide the literacy software while UP-PGH Telehealth will provide the software and technical support for health.
14. Pilot sites will be equipped with a low memory computer with wireless Internet connection and powered by solar panels. These computers will function as ports where text messages from the mobile phones are converted to Internet messages and documents. The project shall ensure that assistance is provided to enable the IPs to participate meaningfully in the process. This may mean deployment of competent and committed staff to work in IP communities and ensure that IPs are knowledgeable and skilled in the ICT operations.
a.) The design of facilities and service delivery protocols shall be sensitive to culture and beliefs.
b.) Efforts shall be made to train IPs to serve as trainers in their respective communities
c.) IP community involvement in implementation shall be actively sought
15. Consults received through the Internet will then be forwarded to specific health professional partners who specialize on the topic relating to the consult. The answers will be processed and sent immediately to the IP-CHW. All documents processed in the Internet will be collected and sorted in the launched website which can be viewed through the Internet with the initial approval of the IPs.

F. Monitoring


16. Monitoring of project impact on IPs shall be carried out through the following:
a.) Personnel and facility-based surveys will be carried out at various stages of the project to track implementation progress and effectiveness.
b.) Special studies to provide further insight into how health outcomes have been influenced by the project will be done.

G. Sustainability


17.) Paralleled with socioeconomic assistance, this project can be a channel for transacting sales of indigenous products. Furthermore, the IP ports can be used in research or data gathering. The knowledge can be used in national policies or surveys which will be critical in decision making.

H. Impact of the Project on Indigenous Peoples


18. The activities under the project are not foreseen to impact negatively on IPs, rather, their implementation will improve the quality and relevance of skills training for IP-CHW. This would contribute to immediate measures for emergency cases and consultative means for preventive medicine. Relaying of reports for updating and monitoring would be cost effective. This will increase the likelihood of the IP-CHWs knowledge and skills to be nurtured upon their return. In addition, understanding their culture and traditional health practices will improve our understanding of disease transmission and etiology, and alternative medicines. Socioeconomic concerns such as the issuance of their land titles and sale of indigenous products may also be improved in the process. Through ICT, the most marginalized sector of the society can be placed at the forefront of health care.
COPYRIGHT @ PHILIPPINE-HEALTHNET thru Dr. Jason Abello

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