Expanding primary health care

Ike Señeres . 

HEALTH and justice may be two separate social concerns, but there is an observable similarity between the two. It has been said by some experts that if only the barangay justice system is working, the number of actual legal cases will not clogged up all the way to the level of the Supreme Court. With that as a frame of reference, it could also be said that if only the barangay health system is working, the number of actual medical cases will not get clogged up all the way to the tertiary care hospitals. The logic may be simple, and yet it is imminently valid. Looking at the actual reality however, we seem to be too far from the realization of the barangay justice system in its fullest sense. Part of the reason perhaps is the predominance of the politics of patronage, wherein many incompetent local politicians get elected to lead the barangay government, thus stalling barangay justice itself.

In theory, it could be said that if only the politics of performance would predominate at the barangay level, the realization of the barangay health system would be realized in its fullest sense. More often than not, it could be said that it is not realized because of the lack of money, but I do not believe that because the barangay government has a share of the Internal Revenue Allocation (IRA), and so does the municipal government. It would therefore be more correct to say that instead of the lack of money, there is a lack of transparency at the barangay level, because the money for health services is either corrupted or misappropriated. To some extent, it could be said that there may be a lack of vision or a lack of purpose, because some barangay leaders may not really know what to do or how to do it, even if they have the money.

It seems that in most cases, barangay health centers are seldom open all the time, and are seldom fully equipped. As it is supposed to be, barangay health centers are supposed to be the alternative destinations for the poor people who could not afford the very expensive private clinics. The irony however is that the private clinics are almost always open all the time, and are almost always fully equipped. What have the barangay leaders missed in this regard? Which part of the public service mandate don’t they understand? As it almost always happens, most barangay health centers do not have doctors and if they do, they do not have medical equipment and if they do, they do not have medicines. Although this might seem as simple as mixing coffee, cream and sugar into a hot drink, it really is not, because doctors, equipment and medicines rarely do ever converge at the barangay level.

Thanks to Information and Communications Technology (ICT), it is now possible to virtually talk to a doctor remotely, and that means from anywhere there is a telephone or internet connection as the case may be. Using this technology, there is now a solution to the problem of not having enough doctors to man all of the 42,000 or so barangays nationwide. One approach is to have a doctor based in a central barangay but have him service nearby barangays remotely. The other approach is to have a central facility at the municipal level that would service all barangays that could be reached by a signal. It should be made clear however that telemedicine should only be an alternative or a supplement whenever there is no doctor that could be assigned, or if there is no doctor that could maintain a regular daily schedule.

Given the present state of mobile technology, anyone who has a smartphone can take pictures or videos of any medical patient and send these to a doctor somewhere, anywhere for that matter. This technology has become so ordinary because anyone could now use Skype, Viber, WhatsApp, Facebook Messenger and many other options to do this. Basically, telemedicine could happen if two or more medical workers could communicate with each other at the very least using a telephone or radio, but at best using a video call. Of course any patient could also talk directly to a doctor, but for good measure, it is always better for a medical worker to assist the patient. A call between two doctors would be best, but at least, it could be a nurse or a nursing assistant, even a midwife or a medic.

Historically, it has been proven that there has always been a lag time in the implementation or adoption of foreign technologies in the Philippines. While it is widely known that individual Filipino users have already gotten used to video messaging on a day to day basis, telemedicine via video messaging has not been adopted for public health. As it is now, there is no more excuse not to do it, except for the usual lack of people and the absence of connectivity. In the interest of public health, let us just set aside those excuses and start with what we have. I have heard before that some doctors are not keen on telemedicine because they do not know how to make money from it. May God bless their spirits and make them realize that one way or the other, there will be financial rewards for them but in the meantime, they should just be truthful to the oath that they swore.

E-mail: iseneres@yahoo.com