University of the Philippines Manila National Telehealth Center mHealth in the Philippines Alvin B. Marcelo, MD

Goals for this Presentation Provide examples of how we use mobile phones for health in the Philippines Present results of our research on using mHealth for delivering care to remote underserved areas

State of (ill-) health: Why? Philippines 90 million people Growing at 2 million per year 7,107 islands Maldistribution of doctors and nurses to urban areas and few/none in rural areas

Opportunity for mHealth Philippines Three wireless providers 75% penetration rate (with several having more than one line) “the texting capital of the world with 2 BILLION text messages exchanged everyday”

OneHEALTH Program eMedicine (Telemedicine) eLearning for Health eRecords (CHITS)

Telemedicine in the Philippines 6 years of experience and collaborations with DOH-DTTBs with research support from DOST RESEARCH SERVICE DOST, 2008 CICT 2004 Our experience with IT started in 2004 when UP Manila and DOH received a grant from CICT to design and implement telemedicine services through the BuddyWorks Project. Over the next 6 years, with additional support from various funders such as DOST, IDRC, USAID, and UNDP, we are now ready to translate our research into service and to align information technology within the Aquino Health Agenda. DTTBs 2008-2011

How do we do Telemedicine? We train health workers how to use the cellphone to effectively collaborate with doctors, specialists, and other health workers in their region.

TELEMEDICINE How it Works Internal Medicine Doctor-to- the-Barrio Pediatrics Radiology NTSP Central 4th, 5th, 6th class LGUs Dermatology Doctor-less site The transaction starts when a health worker encounters a case beyond his or her capacity to manage. Using text or email, the health worker describes the situation and sends it to NTSP Central where a triage nurse relays it to the appropriate domain expert. The domain expert may opt to respond by text, email or voice call as is necessary. This exchange can occur once or as frequent as is needed until a case is deemed resolved. And all transactions are recorded at NTSP Central for documentation purposes. Ophtha *** Ethical, legal, and social framework for the practice of telemedicine Others PGH and DOH regional hospitals

TELEMEDICINE How it Works We built a network of doctors. We defined guidelines and protocols. We trained the network. We use SMS, MMS, voice and email. The transaction starts when a health worker encounters a case beyond his or her capacity to manage. Using text or email, the health worker describes the situation and sends it to NTSP Central where a triage nurse relays it to the appropriate domain expert. The domain expert may opt to respond by text, email or voice call as is necessary. This exchange can occur once or as frequent as is needed until a case is deemed resolved. And all transactions are recorded at NTSP Central for documentation purposes. PGH and DOH regional hospitals

Stories of Telemedicine

Skin Diseases among Tribesmen A young doctor with a cellphone saw a unique skin problem among the tribesmen Using his cellphone camera (with patient consent), he referred the case to Manila Dermatologist recognizes the problem as a rare skin disease and asks for more examinations Young doctor complies and sends confirmatory images Patients got treated appropriately and in a timely manner

Results Telemedicine is possible in geographically isolated and disadvantaged areas (GIDA) Telemedicine is fraught with ethical, social, and legal challenges (read: should only be done by trained health professionals and certified personnel). Protocols are important. Telemedicine is expensive for few sites, but costs go down with more sites

NTSP National Telehealth Service Program We are now in the process of finalizing a grant from the Government to offer the services on a national scale.

Thank you for listening alvin.marcelo@telehealth.ph