Themes

Citizen-Centered Service: The initiative emphasizes stakeholder collaboration, ensuring that health services are responsive to the needs and expectations of communities and empowering citizens through co-creation and engagement.

Innovation Leadership: SIHI leads the way in fostering social innovations in health, creating effective and inclusive solutions that improve public health outcomes.

Overview

The UP Manila National Institutes of Health (NIH) Program on Social Innovation and Entrepreneurship in Health (PSIEH) focuses on addressing systemic health challenges in the Philippines through creative, community-driven solutions. One notable example of a social innovation in health is the One Boat Project. This innovative project addressed a significant challenge in healthcare accessibility in remote areas through an inter-island referral system connecting remote health centers to main birthing facilities. The PSIEH’s main strategies to advance social innovations in health include facilitating multi-stakeholder collaboration, capacity strengthening, and research to mainstream innovations in the broader health systems through initiatives like the Gelia Castillo Award on Research in Social Innovation in Health (GCARSIH), the PSIEH partners with social innovators to empower local solutions to improve health outcomes nationwide.

Challenge

The challenge lies in inefficient healthcare service delivery and difficulties in accessing healthcare services, particularly for marginalized populations in geographically isolated and disadvantaged areas. These inefficiencies contribute to inequitable access to essential healthcare, insufficient service quality, and overuse of already scarce public resources. Systemic issues such as poorly managed programs, fragmented health systems, corruption, and the failure to actively involve communities as partners in healthcare decision-making further exacerbate the problem and limit the potential for sustainable improvements. Services often do not align with the actual needs of these communities, which leads to inappropriate or ineffective care. The result is ineffective use of public funds, stagnant service delivery, and non-prioritization of the needs of underserved populations.

Solution/s

With these prevailing health challenges in the country, the Social Innovation in Health Initiative (SIHI) Philippines Hub was established in 2017 under the leadership of the late Dr. Noel Juban, with the aim of becoming a leading institutional partner for strengthening the country’s health system through social innovation. Seven years later, the Hub has been institutionalized as PSIEH and is hosted at the Institute of Clinical Epidemiology of the UP Manila National Institutes of Health (NIH) with Dr. Meredith del Pilar-Labarda as the lead. The program serves as the home of SIHI Philippines and the SIHI Secretariat. The SIHI Philippines Hub is part of a broader SIHI Global Network which consists of thirteen hubs across Africa, Asia, Latin America and the Caribbean (LAC), and Europe. This network fosters international collaboration and knowledge sharing, creating a collective movement that empowers local actors to develop innovative health solutions tailored to their contexts.

PSIEH focuses on social innovations as a catalyst to transform health systems by 2030. This program seeks to support community-engaged research and entrepreneurial initiatives through various activities, including capacity strengthening, knowledge brokering, and ecosystem development. By promoting social entrepreneurship in health, it aims to enhance the overall health landscape, improve health equity, and ensure that health solutions are accessible to all. It comes from the concept of social innovation in health, which refers to the development and implementation of creative and inclusive solutions that address systemic health challenges through multi-stakeholder collaboration. As defined by van Niekerk et al. (2017), it encompasses a variety of processes, products, and practices that profoundly challenge existing health systems, making healthcare more inclusive, effective, and affordable. Key characteristics of social innovation in health include:

  • Stimulus: Addressing social problems faced by individuals and communities.
  • Actors: Involvement of diverse social actors, organizations, and institutions.
  • Sectors: Interplay across technical, social, economic, and political dimensions.
  • Process: Emphasis on inclusive participation, collaboration, and coordination in decision-making.
  • Qualities: Solutions that are more effective, efficient, sustainable, and just compared to existing approaches.
  • Outputs: Introduction of new initiatives, services, and programs that enhance health delivery.
  • Outcomes: Promotion of institutional or systemic changes and empowerment of communities.
  • Impact: Improvement of quality of life and overall societal well-being.

SIHI emphasizes the importance of stakeholder collaboration across its four main focus areas:

Identification and Research: The initiative conducts rigorous research to identify and analyze local social innovations in health. Programs like GCARSIH recognize and support initiatives that address persistent health challenges in the Philippines. Guided by the principles of the late Dr. Gelia Castillo, a revered Filipino national scientist, the award emphasizes that “science must serve a human purpose” by extending research benefits equitably to all Filipinos.

Capacity Strengthening: SIHI offers capacity strengthening activities and educational tools for stakeholders in the health sector. Utilizing human-centered design (HCD) approaches, it develops innovative models for delivering essential health services, training community health workers, and implementing telemedicine systems.

Connecting and Convening: SIHI actively connects innovators, partners, and resources through initiatives such as the SIH Exchange (InnovEx) Platform and regular community engagement events. This fosters collaboration, knowledge sharing, and mutual support within the health innovation ecosystem. InnovEx serves as a hub for exchanging best practices, tools, and strategies for developing and scaling social innovations in health. It encourages participatory engagement by offering resources such as case studies, training modules, research articles, and opportunities for networking among like-minded individuals and organizations. The platform’s main goal is to break down silos, enabling the cross-pollination of ideas and fostering partnerships that can lead to impactful health innovations.

Knowledge Translation and Uptake: To facilitate the uptake of social innovations, SIHI employs advocacy strategies and support for innovators and other stakeholders in upscaling and institutionalization of the innovation into the health system. One of their examples is assisting the LGU of Del Carmen, Siargao in translating the Community Engagement Self-Monitoring (CE-SM) Strategy for social innovations in health into a municipal ordinance. CE-SM is a strategy for monitoring and evaluation that aims to empower communities by actively involving them in monitoring the progress and effectiveness of interventions. This innovative approach recognizes the importance of community participation as a cornerstone of successful health solutions, particularly in addressing systemic challenges and improving health outcomes at the local level.  In the Philippine pilot of CE-SM, the strategy was tested and refined by drawing from the deep involvement of local communities in the identification, development, and assessment of social innovations before institutionalization as a municipal ordinance in Del Carmen, Siargao.

By mainstreaming stakeholder collaboration, the Social Innovation in Health Initiative aims to build a robust ecosystem that empowers communities and enhances health service delivery across the Philippines.

Productivity Gains, Outcomes, and Impact

Since its inception in 2020, GCARSIH has recognized six winners and fourteen finalists over two cycles of the award. Each winner and finalist put forth innovative solutions that improve health outcomes and address systemic health challenges in their communities and has been support through the award. GCARSIH was established in collaboration with the Department of Science and Technology-Philippine Council for Health Research and Development (DOST-PCHRD). For instance, initiatives like the Holistic Water Systems for Pumping Water Uphill, Telepsychiatry, and the COVID-19 Risk Assessment, Monitoring, and Management Systems exemplify the diversity and effectiveness of social innovations nurtured by SIHI.

By fostering collaboration among government, academia, NGOs, and the private sector, these initiatives help fulfill UP Manila NIH’s mandate of creating scalable models that can be integrated into existing health systems. The support for these innovative projects not only elevates the profile of social innovations in health but also ensures that effective solutions are disseminated widely, ultimately improving health service delivery and equity for underserved communities. The impact of SIHI enhances productivity in health research and translates those gains into tangible benefits for Filipino communities, ensuring that innovative health solutions are accessible and sustainable.

Lessons Learned/Challenges in Implementing the Intervention

A key challenge was maintaining effective stakeholder collaboration, given the diversity of actors involved across sectors, with their own priorities. Establishing consistent communication and coordination mechanisms among these stakeholders can be difficult, as has ensuring inclusive participation, particularly from marginalized communities. Moreover, the sustainability of the initiatives has posed a challenge, as some projects have struggled to maintain momentum and funding once initial support waned.

Lessons learned from these challenges highlight the importance of embedding strong governance structures and accountability mechanisms early in the design phase to ensure project continuity. Additionally, there is a need for more robust monitoring and evaluation frameworks to measure the long-term impact of social innovations. Strengthening capacity-building efforts, particularly in research and implementation skills, will also be crucial for future success. Moving forward, PSIEH could benefit from focusing on improving resource mobilization and social entrepreneurship strategies, fostering deeper community engagement, and enhancing knowledge dissemination to ensure a broader uptake of successful innovations in the health sector.

Themes

e-Government: The platform exemplifies the effective use of information and communication technologies to enhance public sector operations and improve overall productivity. Join.gov.tw leverages digital tools to streamline citizen engagement and governance processes by enabling online submissions, discussions, and responses.

Citizen-Centered Service: Join.gov.tw focuses on understanding and addressing citizens’ expectations by providing a platform for public input on policy proposals. It emphasizes transparency, accountability, and direct interaction with government processes, aligning with the goals of improving service performance and public sector capacity.

Overview

Join.gov.tw, developed by Taiwan’s National Development Council, marks a significant advancement in participatory governance. The platform enables citizens to propose, discuss, and vote on public policies, fostering direct engagement in governance. Established in response to public dissatisfaction with previous governance failures further exacerbated by the 2014 Sunflower Student Movement, Join.gov.tw addresses the need for more transparent and inclusive decision-making processes. It has successfully engaged nearly five million users, enhancing government responsiveness and accountability. By bridging the gap between citizens and government, Join.gov.tw underscores the value of integrating public input into policy-making and improving overall governance practices.

Challenge

In 2012, failures in Taiwan’s e-governance, such as a poorly designed housing price website and an ineffective economic recovery TV campaign, spurred the creation of g0v, an open-source civic movement advocating for accessible, participatory, and transparent governance. Known as the “provisional government” (linshi zhengfu), g0v arose from widespread dissatisfaction with traditional authorities. This discontent deepened during the 2014 Sunflower Student Movement, which protested the Cross-Strait Service Trade Agreement, exposing issues like limited public involvement and poor inter-agency collaboration. Rigid institutional structures further hindered innovation and reduced government responsiveness, eroding public trust and fueling demands for more open, accountable, and efficient governance.


Image 1: Protesters from the Sunflower Student Movement in 2014 (CC BY-SA 3.0, Wikipedia)

Solution/s

In response, the Taiwan National Development Council (NDC) established a public policy participation platform to enhance open government practices. Launched in 2015, this platform enables citizens to engage directly with public affairs throughout the policy development and implementation stages. Though petitions on Join are not legally binding, government agencies must provide detailed responses to petitions that receive over 5,000 signatures. Here’s a breakdown of the platform:

Want to Propose: This section invites individuals with Taiwanese nationality or residence permits to submit creative policy suggestions and insights. It aims to foster collaboration and build consensus to enhance governance capacity by pooling public wisdom.


Image 2: Screenshot of the “Want to Propose” page of the Join platform

To Second the Motion: In this section, users can support proposals made by others. This process helps form a consensus and expand governance capacity by encouraging collective input from the public.


Image 3: Screenshot of the “To Second the Motion” page of the Join platform

Public Lecture: This section provides information about upcoming policies from various government ministries and actively seeks public opinion. It invites both support and criticism to gather diverse perspectives on policy plans.


Image 4: Screenshot of the “Public Lecture” page of the Join platform

To Supervise: Here, users can access general information on government plan implementations since 2017 and participate in overseeing governance. It encourages public involvement in promoting improved government performance.


mage 5: Screenshot of the “To Supervise” page of the Join platform

Participatory Budgeting: This unit focuses on integrating public proposals into the budgeting process. It allows the public to vote on and participate in budgeting decisions, promoting transparency and citizen involvement in municipal development.


Image 6: Screenshot of the “Participatory Budgeting” page of the Join platform

Collaboration Meeting: This section facilitates meetings where government agencies and public participants can collaborate on various initiatives. It aims to improve communication and cooperation between the public and government.


Image 7: Screenshot of the “Collaboration Meeting” page of the Join platform

Participate in Audit: This section allows citizens to engage in auditing activities, including reviewing budgets, financial management, and policy implementation. It aims to enhance government accountability and public governance efficiency through active citizen participation.


Image 8: Screenshot of the “Participate in Audit” page of the Join platform

Each section is designed to encourage public engagement in different aspects of governance, aiming to improve transparency, accountability, and overall government performance.

The platform operates under regulations that include:

  • Directions for Implementing Online Participation in Public Policy.
  • Directions for Implementing Open Government Liaison Officers in the Executive Yuan and its subordinate agencies.

Productivity Gains, Outcomes, and Impact

As of June 3, 2022, the platform has garnered 13,853 proposals, with 289 receiving official government responses. The platform has engaged nearly five million of Taiwan’s 23 million residents, markedly enhancing government responsiveness and transparency. Its impact is particularly visible in fostering civic engagement and collaboration between civic tech activists and government agencies. A key example is the creation of a visualization website for Taipei City’s municipal budget, a collaborative effort between activists and the Taipei City Government. This initiative has made budget information more accessible and understandable to the public, thereby improving fiscal transparency.


Image 9: A scene during a participatory budgeting class

This exemplifies Taiwan’s shift from top-down e-governance to a more participatory, bottom-up approach. This transition has led to successful projects like the digital visualization of the national budget and the campaign finance transparency initiative, which have empowered citizens to engage more actively in governance and influenced policy-making by increasing public input and oversight. The platform demonstrates how digital tools can effectively bridge the gap between citizens and government, resulting in more responsive and transparent governance. Its capacity to facilitate public participation and integrate civic tech innovations has delivered measurable productivity gains and strengthened democratic engagement in Taiwan.

Lessons Learned/Challenges in Implementing the Intervention

Join.gov.tw has provided valuable insights into participatory governance and civic engagement, including the relevance of leveraging digital platforms to enhance government transparency and responsiveness. The platform has successfully engaged a large segment of the population, fostering collaboration between citizens and government agencies on various issues. However, several challenges have emerged. One key challenge is the resistance from government bureaucracy, where senior public servants sometimes struggle to view online feedback as constructive rather than confrontational. This resistance underscores the need for continued training and support to bridge this perception gap. Additionally, Join.gov.tw’s focus on a broad range of issues, including those beyond digital economy topics, has attracted a diverse user base but also led to increased complexity in managing and addressing varied proposals. This diversity, while beneficial, can strain resources and slow down response times. Future improvements could involve streamlining the proposal review process and enhancing user support to manage the broader range of topics effectively. Additionally, increasing efforts to integrate and respond to feedback from both citizens and government participants could further enhance the platform’s impact and efficacy.

References

2023 Taipei City Voluntary Local Review. Institute for Global Environment Strategies. (2023). https://www.iges.or.jp/en/vlr/taipei

Ho, M. (2022, June 17). Exploring Worldwide Democratic Innovations – A Case Study of Taiwan: European Partnership for Democracy 3445 Exploring Worldwide Democratic Innovations – a case study of Taiwan. European Partnership for Democracy. https://epd.eu/news-publications/exploring-worldwide-democratic-innovations-a-case-study-of-taiwan/

Taipei Yearbook 2015. 臺北市資料大平臺. (2016, June). https://data.taipei/dataset/detail?id=4edf771b-bcc5-42c0-bea2-c003e3435d0e

Themes

e-Government: The PhilHealth Virtual Front Desk (PVFD) effectively uses information and communication technologies to improve the productivity and accessibility of public-sector services. By providing an alternative to traditional, paper-based registration processes, the PVFD enhances service quality through continuous improvements and ensures that services are more efficient and effective.

Innovation Leadership: Introduces a digital solution that influences and improves the accomplishment of public tasks, making essential healthcare services more accessible.

Overview

The PVFD centers on creating an alternative touchpoint for membership registration and service access, which was crucial especially during the pandemic. The main challenge was ensuring continuous and efficient service delivery without requiring physical visits to Local Health Insurance Offices (LHIO). The solution was the deployment of PVFD, leveraging ICT to provide a convenient, accessible platform for users to conduct transactions online. This addressed the immediate need for safety and convenience, supporting universal health care goals and enhancing PhilHealth’s responsiveness to evolving public service requirements.

Challenge

The PVFD addresses the challenge of low membership registration rates, exacerbated by limited registration mechanisms during the pandemic. Based on a report from PhilHealth’s Member Management Group as of 31 May 2021, the membership registration rate nationwide is 84%, while Region X is only 82%. Cagayan de Oro City’s registration rate is slightly higher at 85.8%. For CY 2021, PhilHealth’s management has set the membership registration target to 90% of the population across all regions, as provided in its Office Performance Scorecard (OPS). This indicates that for Cagayan de Oro City, PRO X still needs to register an additional 31,563 individuals from June to December 2021 to achieve the annual target.[1] [2]  Despite the government’s commitment to universal health coverage, a significant portion of the population remains unregistered, which hampers their ability to promptly avail of PhilHealth benefits. The traditional registration process is primarily paper-based and requires physical visits to PhilHealth offices. The turnaround time (TAT) ranges from 3 to 5 minutes from the moment clients are attended by frontline staff (excluding queueing time at LHIOs). This requirement poses challenges for some PhilHealth members, particularly those who are handicapped or ill, ultimately resulting in reduced access to essential healthcare services as they struggle to register or update their membership.[3] [4]  The challenge is further compounded by the need to align PhilHealth’s service delivery with the new normal, where digital and remote transactions have become more critical. NCR North BranchManager Mae R. Dizon shares her perspectives on the difficulties encountered during lockdowns, especially in maintaining frontline services for PhilHealth members.Based on a report from PhilHealth’s Member Management Group as of May 31, 2021, the membership registration rate nationwide is 84% while Region X is only 82%. For Cagayan de Oro City, the registration rate is slightly higher at 85.8%. For CY 2021, PhilHealth’s management has set the membership registration target to 90% of the population across all regions as provided in its Office Performance11Scorecard (OPS). This indicates that for Cagayan de Oro City, PRO X still needs to register an additional 31,563 individuals for the period June to December 2021 to achieve the annual target.

The traditional registration process is primarily paper-based and requires physical visits to PhilHealth offices, with a Turnaround Time (TAT) ranging from 3 to 5 minutes from the moment clients are attended by frontline staff (excluding queueing time at LHIOs). This requirement poses challenges for some PhilHealth members, particularly those who are handicapped or ill, ultimately resulting in reduced access to essential healthcare services as they struggle to register or update their membership.

Solution/s

This online platform provides PhilHealth members safe access to its services, enhancing client touchpoints and ensuring efficient transactions anytime, anywhere. Innovative features include a user-friendly interface, digital document submission, and real-time assistance, which streamline the registration process and reduce the need for physical visits. By leveraging ICT, the Virtual Public Assistance Desk ensures compliance with health protocols and addresses the digital divide with support for free public Wi-Fi, significantly improving accessibility. Members of the PhilHealth Head Office ITMD Team and PVFD support providers, Nelson de Vera and Jocelyn Pablo provided their insights into the strong security mechanisms built into their system to provide a secure user experience.

Member-Initiated and Assisted Registration Process: Enables individuals to initiate their PhilHealth membership registration online with assistance from virtual assistants. This is in contrast to the traditional unassisted online systems. Unlike purely automated systems, the VPAD provides real-time help from trained assistants, improving the registration experience and reducing errors.

Figure 1. PVFD Client Membership Registration Screenshot

Centralized Online Platform: Serves as a single gateway for all PhilHealth registration-related activities, consolidating various processes and documents in one place. This reduces the need for multiple physical visits or interactions with different PhilHealth offices. Users can access the platform from anywhere with an internet connection, significantly improving accessibility, especially in rural areas.

Figure 2. PVFD Main Page Screenshot

Real-Time Document Upload and Verification: Allows users to upload required documents in real-time, which can then be immediately verified by the virtual assistants. Users receive immediate confirmation and guidance if documents need corrections or additional submissions, speeding up the registration process. This eliminates delays associated with mailing or physically submitting documents.

Figure 3. PVFD File Upload and Verification Screenshot

Data Security and Privacy Measures: Enhanced data security protocols are implemented to protect users’ personal information during the registration process. This utilizes encryption and secure data storage practices, addressing concerns over data breaches and unauthorized access that were prevalent with previous email-based systems, which ensure adherence to national and international data protection laws, building trust among users.

Integration with Existing PhilHealth IT Systems: Integrates seamlessly with existing PhilHealth IT systems like the PhilHealth Website and Member Portal. This ensures that data flows smoothly between different PhilHealth services, reducing redundancy and improving efficiency. Iann Acutina, Head of ARTA Compliance Team and PVFD BPO, conveyed how PVFD is aligned with ARTA’s objectives and improves PhilHealth’s internal operations and ease of doing business by utilizing its framework.

User Feedback and Continuous Improvement Mechanism:Incorporates a feedback mechanism that allows users to rate their experience and suggest improvements. This regular feedback helps identify issues and areas for improvement, allowing for continuous enhancements to the platform.

Figure 4. Client Feedback Frontline Transaction Survey Result for the Period April to June 2021

Information, Education and Communication Activities: Strategic marketing ensures that a broader audience is aware of the new service, promoting higher registration rates. These informative campaigns help educate the public on how to use the platform effectively, reducing barriers to adoption.

Figure 5: PVFD Instructional Art Card

Productivity Gains, Outcomes, and Impact

Following its initial deployment in November 2021 in PhilHealth Regional Office (PRO) X, the system expanded to all PROs in Mindanao by January 2022. Within the first fourteen months, the PVFD successfully processed 27,246 tickets, with 99.02% related to membership transactions. This figure rose to 29,929 tickets by March 2023. Membership transactions, particularly new member registrations, accounted for 85% of all PVFD tickets, indicating the system’s substantial impact on streamlining these services. Additionally, the PVFD attracted 18,573 users nationwide by April 2023, a 682% increase from April 2022. This surge in user adoption is attributed to extensive marketing and information dissemination campaigns by the Mindanao PROs.

The system’s usability and effectiveness were underscored by user feedback: 80.8% rated the PVFD as “Excellent” for ease of use, and 77.9% rated the Virtual Assistant services as “Excellent.” Despite some areas needing improvement, overall client satisfaction remained high, with 92.3% of respondents expressing satisfaction with their PVFD experience. The platform’s capacity to handle increased traffic during peak periods, such as April and May 2022, due to the Department of Health’s requirements for student medical insurance, demonstrated its robustness and efficiency.

The collaborative efforts among various PhilHealth offices and the consistent monitoring and adjustment of tasks via weekly meetings and a Trello Board contributed to the project’s success. This coordination ensured that the team members stayed focused on their deliverables while managing their primary responsibilities, leading to timely system enhancements and nationwide deployment readiness. The measurable productivity gains from the PVFD project illustrate its efficacy in improving service delivery, enhancing user experience, and supporting PhilHealth’s commitment to innovation and responsive public service. Walter Bacareza, the Area VP for Luzon and NCR and a PVFD Champion believes in cultivating an innovative environment and creating a safe space for creativity among its staff to enable PhilHealth to pave the way for innovative solutions that will benefit its members and contribute to the advancement of healthcare in the country.

Lessons Learned/Challenges in Implementing the Intervention

One major lesson learned for the implementation of PVFD is the importance of citizen participation and collaboration with key stakeholders in developing sustainable innovations. This ensured that the PVFD was relevant and responsive to user needs. However, challenges arose in areas such as IT infrastructure, policy updates, and human resource competitiveness. These challenges underscored the necessity for PhilHealth to continuously review and enhance its systems and policies to keep pace with changing demands. The PVFD’s deployment demonstrated the value of leveraging information and communications technology to provide a safe and convenient alternative for accessing PhilHealth services, especially amid pandemic restrictions. Nonetheless, the need for better integration and interoperability of database systems became evident to avoid redundancy and minimize turnaround times. Additionally, ensuring data privacy and managing potential fraudulent transactions were identified as critical areas requiring robust policies and ongoing vigilance. For sustainability, creating a dedicated Virtual Frontline Unit, investing in more effective web application development software, and continuous training for Virtual Assistants were recommended. By addressing these areas, PhilHealth can enhance the effectiveness and sustainability of the PVFD, ultimately supporting the broader goals of universal health care and streamlined government services. Gregorio C. Rulloda, the Area VP for Mindanao and a PVFD champion, shares the significance of securing management support from the outset to avoid challenges later on and ensure the smooth implementation of initiatives.

Themes

Regulatory Reform: The program aims to improve regulatory quality by detecting and preventing fraud, which can obstruct competition, innovation, and growth in healthcare institutions. Integrity management implemented with data analytics addresses regulatory shortcomings and ensures that regulations efficiently serve important social objectives.

Service Quality: While the primary focus is on regulatory reform, the program indirectly contributes to service quality by enhancing the integrity and reliability of healthcare services. By preventing fraud, it promotes service excellence and continuous incremental improvements in the quality of healthcare services offered by public-sector organizations.

Overview

This case study focuses on combating fraud in healthcare institutions (HCIs) through a localized Integrity Management Program (IMP) using data analytics. The main challenge lies in the increasing fraud cases within HCIs, with the Bicol region receiving a total of 2,305 cases from 2018 to 2022. Although the volume of cases decreased starting in 2020, the percentage of fraud cases per year revealed an upward trend from 21% in 2020 to 68% in 2022. Nationally, the number of fraud cases under investigation rose significantly—by 36% from 2020 to 2021, and 53% from 2021 to 2022. The solution involves implementing a bottom-up IMP, comprising data analytics training and orientation seminars, to empower employees and detect potential fraud activities. Through data analytics, the program transforms evidence into actionable measures, effectively addressing fraud concerns. This initiative not only enhances integrity awareness but also fosters good governance and restores public trust in healthcare financing systems.

Figure 1. Fraud Cases Per PhilHealth Regional Office (PRO), 2020-2022

Challenge

Fraud within HCIs drains resources, undermines healthcare quality and accessibility, and erodes public trust in the system. The traditional approach to fraud detection relies on random hospital visits and data provided by the head office, which often proves to be inefficient and inadequate. This manual method is not only time-consuming but also reactive, making it difficult to effectively identify and address fraudulent activities. Detecting and preventing fraud is crucial for optimizing resource allocation and ensuring that members’ premium contributions are used efficiently to provide quality healthcare. Legal Researcher Philia Joy N. Gaitana shares the limitations and challenges of this traditional approach to fraud investigation, highlighting the need for improved methods.

Solution

The Localization of IMP Using Data Analytics to Detect and Prevent Fraud in Health Care Institutions addresses the challenge of fraud in HCIs by implementing a multifaceted approach. It recognizes the need for targeted intervention at the regional level, acknowledging that fraud issues can vary between different areas. By focusing on PhilHealth Regional Office V, the program tailors its strategies to address specific challenges within the region, ensuring relevance and effectiveness. Since the project proponent hails from the same area, she can pilot this initiative within her jurisdiction. Second, the program integrates data analytics as a central tool for fraud detection and prevention. Leveraging quantitative and qualitative data it enables proactive identification of potential fraudulent activities, enhancing the efficiency and accuracy of fraud detection processes. Furthermore, the Localization of IMP follows a phased implementation approach, starting with localized IMP and extending to Corruption Risk Management and Internal Audit. This structured progression ensures a comprehensive anti-fraud framework, covering various aspects of fraud prevention within HCIs. Special Investigator and Capstone Project Proponent Ma. Theresa B. Eva shares the relevance of the use of data analytics in fraud detection.

The Localization of IMP offers innovative solutions to combat fraud in healthcare institutions (HCIs) by incorporating several key features


Tailored Approach: The program adopts a bottom-up strategy, focusing on PRO V to address specific regional challenges rather than a one-size-fits-all approach. This customization ensures interventions are relevant and effective, enhancing the program’s impact.

Figure 2.  Conceptual Framework

Data Analytics Integration: By leveraging data analytics, the program can proactively detect and prevent fraudulent activities in HCIs. This innovative use of technology allows for the analysis of both quantitative and qualitative data, providing deeper insights into potential fraud risks.

Figure 3.  Sample Screenshot in the Use of Data Analytics in Detecting Fraud

Phased Implementation: The program follows a phased approach, starting with the Localization of IMP and extending to Corruption Risk Management and Internal Audit. This structured progression ensures a comprehensive anti-fraud framework, laying the foundation for sustainable fraud prevention measures.

 
         Figure 4.  Phases of the Proposed Integrity Management Program in PhilHealth

Sustainability Measures: To ensure long-term effectiveness, the program incorporates sustainability measures such as Corporate Personnel Orders and ongoing updates to adapt to evolving fraud behaviors. These mechanisms enable continuous improvement and adaptation to changing circumstances.

Figure 4:  Corporate Personnel Order for PAFT V2.0 Project Team

Stakeholder Engagement: The program emphasizes collaboration with stakeholders, including healthcare institutions and external partners, fostering a collective effort to combat fraud. This inclusive approach promotes transparency, accountability, and trust, essential elements in effective fraud prevention strategies.

Figure 5: PRO V Localized Integrity Management Program Orientation Seminar, August 4, 2023

The program’s solutions combine targeted regional interventions, data analytics integration, and phased implementation to effectively address the challenge of fraud in healthcare institutions. By utilizing innovative strategies and technologies, it aims to enhance transparency, accountability, and integrity within the public sector, ultimately fostering good governance and restoring public trust.

Productivity Gains, Outcomes, and Impact

The Localization of IMP Using Data Analytics to Detect and Prevent Fraud in Health Care Institutions demonstrated significant productivity gains and outcomes, with the Implementation Team identifying 24 HCIs with irregularities in utilization, achieving a 21% fraud detection rate from zero prior to the data analytics training. A focused group discussion highlighted the importance and potential of Power BI in aiding investigation activities despite initial challenges. The Localized IMP Orientation Seminar significantly improved awareness and knowledge of integrity management among participants, with pre-test and post-test scores increasing from 7 to 9 on average. Regional Vice President Alberto C. Mandurriao shares the improvements in fraud detection using data analytics.

One key outcome of the intervention is the significant improvement in the detection of potential fraud behaviors in HCIs. Before the implementation of the program, the PhilHealth Region V office lacked the capacity to detect irregularities in healthcare claims effectively. However, after the Data Analytics Training and implementation of the IMP, the team was able to identify 24 HCIs with irregularities in utilization through data analytics and assessment processes. This improvement indicates a more efficient use of resources in detecting and preventing fraudulent activities, enhancing the productivity performance of the Philippine Health Insurance Corporation (PhilHealth)

Moreover, the intervention positively impacted the knowledge and awareness levels of PRO V employees regarding integrity management. The Localized IMP Orientation Seminar led to significant differences in test scores among participants, indicating an increase in awareness and understanding of the IMP. This improved knowledge can lead to better decision-making processes, increased integrity, and enhanced productivity among employees.

The use of data analytics as a major tool for fraud detection and prevention is an innovative feature of the program. By leveraging quantitative and qualitative data, PhilHealth Region V was able to proactively identify potential fraud behaviors and allocate resources more effectively. Additionally, the localization of the IMP tailored the intervention to the specific needs and challenges of the Bicol region, demonstrating a strategic and targeted approach to addressing fraud in healthcare institutions.

The Localization of IMP Using Data Analytics to Detect and Prevent Fraud in Health Care Institutions achieved measurable productivity gains by improving fraud detection rates, enhancing employee knowledge and awareness, and leveraging innovative tools and strategies. These outcomes positively impact the productivity performance of PhilHealth Region V and contribute to the overall integrity and efficiency of healthcare services in the Bicol region, benefiting both the organization and its stakeholders.

Lessons Learned/Challenges in Implementing the Intervention

The implementation of the localized Integrity Management Program (IMP) using data analytics presented several challenges and areas for improvement. Despite these challenges, the project was deemed a success. However, there are potential areas for enhancement, with the data analytics process being more efficient by exploring additional tools that can streamline data transformation into visual representations and reporting tools. This could have potentially reduced the complexity and time required for generating reports.

Furthermore, budgetary constraints posed significant challenges throughout the project. Securing sufficient funding from the onset would have alleviated many of the challenges encountered during the implementation phase. Adequate funding is crucial for the smooth execution of projects and ensuring the availability of resources necessary for success.

In summary, while the localized IMP using data analytics achieved its objectives, there are valuable lessons learned and opportunities for improvement. Streamlining processes, simplifying documentation, extending training durations, and securing adequate funding are essential considerations for enhancing the effectiveness and sustainability of similar projects in the future.

Overview

The Philippine Institute of Volcanology and Seismology (PHIVOLCS) developed a software and decision-support tool that saves not just lives but also government resources, helping boost public-sector productivity. Dubbed the Rapid Earthquake Assessment System (REDAS), the tool provides real-time hazard monitoring, database development, and multi-hazard impact assessment coupled with capacity-building sessions for the target users.

Challenge

Before implementing REDAS, government agencies and local government units faced challenges in accessing real-time, accurate data, which hindered prompt decision-making and effective resource allocation in emergencies.

REDAS was conceptualized after the 7.8 earthquake on July 16, 1990, which claimed more than 1,000 lives and destroyed infrastructure. Getting information about potentially damaged areas was quite difficult, affecting relief and rescue operations. PHIVOLCS Associate Scientist and REDAS Program Coordinator Dr. Maria Leonila P. Bautista recalled that it was challenging to provide information during the early 1990s as the Internet was not accessible yet. Communication facilities failed. There was also a power outage and roads were blocked by landslides, and many places were inaccessible.

“It was difficult to tell (the public) what really happened. If we had a tool that can tell us right away what really happened or the impacts, then we can easily answer questions from the public,” she said.

Dr. Bautista used to be the spokesperson of PHIVOLCS and experienced first-hand how challenging it was to provide real-time information to relevant government agencies and LGUs, especially after a disaster.

Solution

REDAS served as an attempt to make scientific information more accessible to the public to guide relevant agencies and LGUs on preparing even before a disaster strikes. The REDAS software tool was an answer to the need of the government to determine the resources needed to be deployed, avoiding duplication of efforts and helping ensure that lives are saved in any disaster-prone or disaster-hit area.

Screenshot of the REDAS Intro Page

REDAS was initially designed for earthquake simulation only. However, due to the changing needs and demands of its target users and the exposure of the Philippines to natural hazards, REDAS has evolved over the years. From an earthquake simulation tool, REDAS has become a multi-hazard impact calculation tool that can also cover tsunami, lahar, flood, severe wind, rainfall, and agricultural damages. REDAS also has earthquake and rainfall monitoring capabilities. Aside from the actual tool, PHIVOLCS also conducts training sessions to ensure that the intended users can optimize what the tools can offer.

Screenshot of the REDAS Satellite Rainfall Monitor (SRM) Module

PHIVOLCS ensures that each training session is based on the specific needs of the audience to make the training curriculum more attuned to the needs and requirements of the requesting partner.

REDAS Science Research Assistant Jordana Marie Argamosa shared that the REDAS team tailor-fits each session based on the challenges and needs of their participants. She added that they ensure continuous communication and feedback from stakeholders to ensure that their needs and requests for additional functionalities are added to the REDAS system.

REDAS has the following features that can be replicated by other public sector organizations dealing with managing disaster risks:

  • Ability to develop and plot elements-at-risk data. Indeed, government agencies and LGUs cannot manage what they do not know. REDAS can be a tool for them to develop their own elements-at-risk that they need: making their communities safe from and resilient to natural hazards. REDAS can also generate deterministic ground shaking hazard maps for the target communities. This means LGUs can be guided in determining which areas are highly exposed to potential disasters. The elements-at-risk data can feed into their preparation, mitigation, and response plans.
Screenshot of the REDAS Earthquake Impact Assessment Module
  • Accessibility since it is a freeware. Since REDAS is a freeware, government agencies can use the tool without paying extra for them to be able to use it. The training sessions, post-training support, and future upgrades are offered at no cost as well. The tool does not require users to master a Geographic Information System (GIS), making it relatively user-friendly.
Screenshot of the Opening Window of REDAS ETAM and SRM Modules, both free to use
  • Two-way feedback mechanism. Each training session is also an opportunity to gather feedback from the users. From a simple, straightforward earthquake assessment and impact calculation tool, REDAS has morphed into a highly-improved version after considering the needs of its users.
REDAS Capability Development Session for Moro Gulf Stakeholders

Productivity Gains, Outcomes, and Impact

Dr. Bautista shared that different government agencies are using REDAS to ensure that the disruptions in their services are minimized. REDAS, for example, has been helping the Department of Energy (DOE) determine how REDAS simulation and tools help our country’s energy sector through the DOE respond to earthquake emergencies using a simulation tool such as REDAS. REDAS has also been helpful for LGUs as it provides science-backed information on when they need to evacuate their constituents. To date, a total of 55 provinces, 690 municipalities/cities, 19 NGAs, 39 SUCs, 79 private companies, and 10 NGOs have been trained in the use of the software.

REDAS has been helpful in promoting public-sector productivity by enhancing preparedness, response, and recovery efforts. Through REDAS, government agencies and local government units can handle crises effectively by helping ensure the following:

  • Faster decision-making before, during, and after a disaster. Training equips public sector employees with the knowledge and skills to make informed decisions during a disaster. This leads to quicker, more effective decision-making, reducing confusion and ensuring resources are allocated efficiently. When different agencies and departments can work together seamlessly, it minimizes duplication of efforts and streamlines the response to a disaster.
  • Better resource management and reduced economic losses. Training helps public sector workers understand how to allocate resources efficiently during a crisis. This ensures that resources such as personnel, equipment, and funds are used where needed most, preventing waste and inefficiency. By effectively managing disasters and their aftermath, public sector productivity can help reduce economic losses for the community, helping free up resources for other critical public services and projects.
  • Reduced risks in communities. Since REDAS can provide scientific information on impact calculation, government agencies, and LGUs. By proactively mitigating risks, government agencies can help reduce the frequency and severity of disasters, ultimately leading to fewer disruptions and less strain on resources.
  • Efficient recovery planning. The faster a community can recover from a disaster, the less productivity is lost. Public sector employees training in this area can help communities get back on their feet more quickly.

PHIVOLCS has also been working closely with international partners. REDAS is one of the tools proposed by the Japan International Cooperation Agency (JICA) to provide impact calculations in some of their project sites. Dr. Bautista shared that the JICA team think of ways to reduce the impacts as calculated by REDAS.

REDAS has also been tapped by the Asian Disaster Preparedness Center (ADPC) to develop a gender and human rights-based questionnaire tool from a disaster risk reduction perspective.

Aside from providing crucial information before or after a disaster, REDAS also gives information that can guide policymakers, land use planners, and local chief executives in considering the hazards present in their communities in preparing their development initiatives. Doing so would help ensure that resources are not spent in building infrastructure or facilities within hazard-prone areas.

Lessons Learned and Challenges in Implementing the Intervention

One of the greatest lessons in rolling out REDAS is the need for more continuity in some agencies or communities. Some of the participants, according to Dr. Bautista, are non-plantilla personnel. In the succeeding years, PHIVOLCS needs to train a different set of users from the same agency or LGU. Trainings have to be continuously done as new REDAS modules are developed and there is a turnover of LGU personnel.

The REDAS team is aware of the necessary improvements to work on. For example, REDAS currently provides impact calculations at the barangay level. Further improvement can be done by offering a household-level impact calculation to help residents prepare.

There is also a need to provide off-the-shelf learning materials to help promote better knowledge-sharing and knowledge transfer to the intended users of the software. The COVID-19 pandemic was also a wake-up call for PHIVOLCS as the team needed to prepare to deliver sessions online. The program team then offered online sessions during the pandemic to ensure that the target agencies could still use the tool despite the physical restrictions.

In summary, REDAS has helped promote public-sector productivity by equipping employees with the necessary skills and knowledge to help mitigate, respond to, and recover from disasters effectively. This, in turn, leads to improved public productivity as resources are used more efficiently while public service delivery disruptions are minimized.

Sources

Bautista, M. L. P. (2009, July 29). Philippines: PHIVOLCS-DOST conducts redas trainings for Surigao del Sur, Dinagat and Bohol provinces – Philippines. ReliefWeb. https://reliefweb.int/report/philippines/philippines-phivolcs-dost-conducts-redas-trainings-surigao-del-sur-dinagat-and

De Vera, A. V., Pedrosa, M., Largo, F. F., Chua, F. S., & Botona, R. (1970). Earthquake impact assessment using redas software in selected barangays in region XI. International Journal of Education Research for Higher Learning. https://ejournals.ph/article.php?id=13292

MCR collaborates with DOST-PHIVOLCS and ICDRRMO for redas modules 1-3 training for Iligan City. Mindanao State University – Iligan Institute of Technology. (2023, October 17). https://www.msuiit.edu.ph/news/news-detail.php?id=1690

REDAS Activities. Philippine Institute of Volcanology and Seismology. (n.d.). https://www.phivolcs.dost.gov.ph/index.php/redas

Overview

iRISE UP (Intelligent, Resilient, and Integrated Systems for the Urban Population) is an intelligent and integrated early warning system that empowers the Local Government of Quezon City to address various hazards proactively, such as flooding and extreme weather events. By utilizing both the latest and traditional technologies, community engagement, and data-driven governance, iRISE UP has successfully enhanced the city’s disaster preparedness and response capabilities. Its impact includes improved risk assessment, streamlined communication channels, and establishing a resilient framework that prioritizes public safety and sustainable development.

Challenge

Before implementing the iRISE UP program, the Local Government of Quezon City was lacking on reliable, localized, and real-time data system that provided residents with timely and comprehensive hazard and disaster information. As a result, response time during disasters was delayed, the allocation of city resources was wasted, and the lives of its citizens were put on the line. With the city’s history of devastating disasters, including the traumatic impacts of the 2009 Tropical Storm Ondoy and the recurring threat of flooding, there is a critical need to enhance disaster preparedness and response mechanisms.

QCDRRMO Officer-in-Charge Ricardo Belmonte emphasized the need for a more precise method of gathering weather and flooding information, considering the extensive constituency comprising 142 barangays, covering approximately 35% of Metro Manila.

Solution

The iRISE UP program is established as a multi-hazard early warning system within the city’s Disaster Risk Reduction and Management Operations Center, enhancing the city’s capabilities to tackle the changing disaster risks and provide accurate information for informed decision-making and disaster preparedness. It employs a system-driven approach, converging multiple data and systems of the city government into a unified platform, thereby serving as a foundation for tailored interventions that build safer, more adaptive, and resilient communities. QCDRRMO Geographic Information System (GIS) Team Leader Jose Leo Martillano says that through iRISE UP’s GIS feature, they were able to allot essential resources such as rescue boats more effectively and efficiently.

Innovative features of the iRISE UP Program include:

  1. Backend System: The program incorporates an extensive sensor network and Geographic Information System (GIS) database, enabling dynamic analysis and data visualization. This allows for the continuous evolution of the program in response to changing disaster risks, facilitating informed decision-making and effective disaster preparedness.
Screenshot of the Local Government of Quezon City’s iRISE UP Dashboard
  1. Real-Time Monitoring: Utilizing remote sensors, field equipment, and data loggers, iRISE UP enables efficient data transmission, ensuring timely and accurate monitoring of various hazards. This real-time monitoring capability enhances the city’s ability to respond promptly to emerging risks and threats.
iRISE UP enables real-time monitoring in the Barangay Batasan Hills’ Operations Center
  1. Downloadable Historical and Live Data: iRISE UP provides accessible historical and live data, empowering stakeholders to make informed decisions and implement targeted interventions based on past events and trends. This feature enhances overall disaster response capabilities and supports proactive risk management.
  2. Localized Hazard and Risk Maps: The program offers localized hazard and risk maps, providing accessible information for effective mitigation and response planning. This feature aids in identifying high-risk areas and supports the development of comprehensive strategies to address potential disasters.
Screenshot of the iRISE UP Barangay Risk Assessment for Rain
  1. Impact-Based Weather Forecasting: By focusing on impact-based weather forecasting, iRISE UP delivers actionable information for disaster preparedness, emphasizing the potential impacts of weather events rather than just the meteorological data. This approach informs anticipatory action helping communities and decision-makers make well-informed choices in their disaster response strategies.
QCDRRMO personnel monitoring weather data at the QCDRRMO Operations Center
  1. End-to-End Approach: iRISE UP fosters community engagement and empowerment by promoting a comprehensive approach to risk assessment and management activities. An end-to-end approach, which is crucial in risk communication, ensures that the important messages reach the intended audience. This inclusive strategy also encourages community members to actively ensure their safety and well-being, thereby building more resilient communities.
Barangay DRRMC Member checking the rain gauge at Barangay Batasan Hills
  1. Utilization of Digital and Traditional Instruments: The program integrates digital and traditional instruments, emphasizing the synergy between modern technology and community capabilities. This approach ensures that the benefits of technological advancements are combined with the practical knowledge and resources available within the community.
QCDRRMO staff checking the rain gauge at Barangay Batasan Hills
  1. System-Driven Whole-of-Government Approach: iRISE UP adopts a whole-of-government approach that converges data from various departments and offices within the city government. This unified approach facilitates effective disaster risk reduction and management, enabling a coordinated and comprehensive action plan for building resilient communities. This also helps in avoiding task duplication and reducing costs, promoting productivity.
The iRISE UP Operational Matrix adopts a whole-of-government approach to disaster management.

Productivity Gains, Outcomes, and Impact

The integration of the iRISE UP program into the disaster risk management and response framework of Quezon City has yielded substantial and measurable productivity gains and outcomes, significantly enhancing the performance of the Local Government of Quezon City and the Quezon City Disaster Risk Reduction and Management Office (QCDRRMO).

Under the Disaster Risk Reduction key result area, iRISE UP has facilitated the generation of over 1,000 maps, enabling a comprehensive understanding of hazard-prone areas and informing preemptive actions such as localized evacuations. The program has also empowered Barangay DRRM Committees to implement preemptive and forced local evacuations, leading to a successful partnership with numerous grassroots organizations in executing DRRM programs. These initiatives have substantially reduced the number of casualties, with zero recorded casualties since the implementation of iRISE UP in 2020.

Regarding Disaster Preparedness and Response, the program has contributed to training more than 17,000 individuals as disaster response force multipliers, ensuring a more efficient and coordinated response during calamities. The identification of evacuation sites and camp managers using iRISE UP data has improved evacuation procedures’ management, guaranteeing evacuees’ safety and well-being. Moreover, providing hot and healthy meals and child-friendly spaces in evacuation sites has significantly enhanced the overall well-being of affected individuals and families. QCDRRMO Research and Planning Section Chief, EnP Ma. Bianca D. Perez, MPA, elaborated on these achievements in a key informant interview.

The Bounce Forward Together initiative has resulted in the design of stormwater harvesting detention basins and the identification of hazard-prone areas, paving the way for developing and implementing critical infrastructure projects. The identification and planned relocation of informal settler families living in hazardous zones reflect the city’s commitment to ensuring the safety and security of its citizens.

Lessons Learned and Challenges in Implementing the Intervention

A key lesson learned is the importance of redundancy for disaster resilience. The program has recognized that digital communication methods may falter during crises. The deployment of radio communication serves as a robust backup method, ensuring efficient information exchange among response teams and the community. This redundancy enhances disaster resilience by facilitating coordinated responses to emergencies. Integrating solar power and Uninterruptible Power Supply (UPS) systems in key buildings also ensures the availability of electricity during power outages, which is crucial for maintaining essential services and communication during disasters.

To further enhance the sustainability and effectiveness of iRISE UP, the institutionalization of the program is an ongoing process. Building the capacity of personnel, collaboration with various stakeholders, and budget allocation are essential elements of this institutionalization, ensuring the long-term viability of disaster risk management efforts in Quezon City. The end-to-end approach emphasizes community understanding of the information generated by iRISE UP and its subsequent actions provides valuable lessons in empowering and engaging communities. House-to-house education campaigns, the use of physical flood markers, traditional signages, and manual hand-crank sirens all contribute to ensuring that communities are well-prepared and proactive in their response to disaster-related information.

In terms of potential areas of improvement, ongoing community engagement and education are crucial to sustaining the program’s effectiveness. Continuous efforts to reinforce community understanding and action should be a priority. Additionally, regular maintenance and upgrading of technology, infrastructure, and communication equipment are essential to ensure their reliability during emergencies. Lastly, a review of the allocation of resources and budget to support the program’s long-term sustainability may identify areas for improvement and optimization.

Resources

Caliwan, C. L. (2023, October 13). Galing Pook winners urged to share best practices with other LGUs. Philippine News Agency. https://www.pna.gov.ph/articles/1211732

Gozum, I. (2023, November 1). Quezon City’s early warning system keeps residents prepared for weather events. Rappler. https://www.rappler.com/nation/metro-manila/quezon-city-early-warning-system-keep-residents-prepared-weather-events/

Mateo, J. (2023, October 16). Quezon City among Galing Pook Awardees for 2023. Philstar.com. https://www.philstar.com/nation/2023/10/17/2304339/quezon-city-among-galing-pook-awardees-2023

Overview

The Bataan General Hospital and Medical Center (BGHMC) Healthcare Provider Network (HCPN) Online Referral System stands as an example of healthcare innovation and leadership. BGHMC, a tertiary hospital, encountered significant challenges related to inefficient patient referrals and resource allocation, leading to overcrowding and delayed care. To address these issues, BGHMC introduced an Online Referral System within a broader Service Delivery Network (SDN). This system improved patient referrals, optimized resource distribution, and mitigated patient bypassing, thereby enhancing healthcare productivity and service quality.

Challenges

BGHMC faced productivity challenges characterized by inefficient allocation of healthcare resources and patient congestion. As a tertiary hospital, it struggled with an influx of primary cases, compromising its capacity to provide specialized tertiary-level care. A disorganized referral process allowed patients to bypass primary care facilities, such as Rural Health Units (RHUs), and seek care directly at BGHMC, exacerbating congestion, resource wastage, delayed care, and patient dissatisfaction.

Solution

The BGHMC-HCPN Online Referral System addresses the challenges of inefficient resource allocation and congestion by introducing several innovative features:

Streamlined Referral Process: The HCPN Online Referral System streamlines the patient referral process through a two-way mechanism. This process empowers primary healthcare facilities to act as gatekeepers, ensuring that patients receive care appropriate to their needs. This prevents bypassing of primary care facilities and optimizes resource allocation.

The Streamlined Referral reflected in the SDN Process Flow

Data-Driven Decision-Making: The system incorporates data collection and analysis, providing valuable insights into patient demographics, case distribution, and referral patterns through the bed tracker and medicine inventory. This data-driven approach allows healthcare providers to make informed decisions about resource allocation and identify areas for improvement.

Features such as the Medicine Inventory and Bed Tracker provide Data-Driven Decision Making

Improved Connectivity: Addressing connectivity challenges, BGHMC donated desktop computers to RHUs, ensuring efficient system access in areas with limited connectivity.

Patient Empowerment: Patients are actively involved in the referral process by receiving access codes. This feature enhances patient understanding of their healthcare journey and ensures smooth transitions between healthcare levels.

Integration of Health Records: Electronic Medical Records (EMR) organize patient data, fostering better communication between healthcare providers, reducing paperwork, and eliminating data entry redundancy.

Since the EMR is web-based, patients’ records can be viewed by physicians using any mobile device as long as it is connected to the internet, ensuring data privacy.

Telemedicine and Teleconsultations: Telemedicine was leveraged, especially during the pandemic, enabling remote medical consultations, reducing physical visits, and decongesting hospital facilities.

Steps on how to use, register, and avail of the BGHMC Telemedicine

The BGHMC HCPN Online Referral System offers a comprehensive approach to addressing congestion and inefficient resource allocation in the healthcare sector. It leverages technology, data-driven decision-making, patient empowerment, and a commitment to good governance to optimize healthcare productivity and improve patient care quality.

Productivity Gains, Outcomes, and Impact

The BGHMC-HCPN Online Referral System has produced significant measurable productivity gains and outcomes, leading to enhanced hospital performance and superior patient care.

Before the HCPN system, BGHMC was congested with primary cases that could have been handled at lower-level facilities. As interviews with BGHMC Medical Center Chief Dr. Glory Baltazar and Mariveles District Hospital Chief Dr. Hector T. Santos revealed, the system’s gatekeeping mechanism has significantly reduced this congestion. The hospital now caters to 90% of tertiary cases, up from 13% before the implementation of the program, thereby improving resource utilization and patient care.

The system’s data-driven approach allows BGHMC to allocate resources more efficiently. Dr. Romeo Tuazon, Chairperson of the Office of Strategy Management, emphasized the importance of coordinating with offices and streamlining referral systems. This efficiency results in reduced patient waiting times and improved services. The HCPN Online Referral System has expanded access to healthcare services. Patients can now identify where to seek care as the system guides them to the appropriate level of healthcare. This was confirmed in interviews with Dr. Bhen Bautista and Violeta S. Sebastian, among others, from rural health units and health stations.

The introduction of telemedicine, highlighted by Mariveles District Hospital Chief Dr. Hector T. Santos, has played a crucial role during the pandemic. Patients can access consultations remotely, reducing the need for physical visits. This not only improves patient safety but also helps decongest hospital facilities.

In addition, the system’s data collection and analysis have empowered BGHMC to make data-driven decisions. This information is essential for resource planning and allocation. An interview with BGHMC Professional Education, Training and Research Office Secretariat Ria-ann Dizon emphasized the importance of data protection and research studies to improve the system continuously.

The system empowers patients to understand their healthcare journey by involving them in the referral process. Dr. Gerard B. Sebastian, Mariveles Municipal Health Officer, mentioned educating patients about their health-seeking behavior, which leads to better-informed choices. Adopting the PGS, as mentioned by Dr. Romeo Tuazon, ensures that the system aligns with organizational goals. It allows for continuous monitoring and evaluation, crucial for productivity gains.

Lessons Learned and Challenges in Implementing the Intervention

The implementation of the BGHMC HCPN Online Referral System met several challenges, including initial resistance to the new system and internet connectivity issues, emphasizing the importance of comprehensive training, change management, IT infrastructure improvement, and data privacy measures. Collaboration with local providers and government agencies can enhance internet services. Ongoing training and community education are vital for system success, as is integration with other healthcare systems, data analytics, and expansion to private hospitals.

In conclusion, the BGHMC-HCPN Online Referral System improved the way healthcare is delivered in the province of Bataan. While challenges were encountered, ongoing efforts and enhancements ensure the system’s long-term success and benefit to the community.

Resources

Esconde, E. (2021, March 19). Bataan hospitals can still accommodate patients – Philippine News Agency. Philippine Information Agency. https://www.pna.gov.ph/articles/1134236

Philstar.com. (2020, August 26). Rural Health Units urged to step up services under “New normal.” Philstar.com. https://www.philstar.com/headlines/2020/08/26/2037988/rural-health-units-urged-step-services-under-new-normal

Overview

The Laguna Medical Center Queuing Management System (QMS) is a technology-driven solution designed to optimize patient services efficiently. The primary challenge it addresses is the inefficient utilization of resources and time in managing patient queues. The QMS optimizes the patient journey, eliminating long wait times, streamlining operations, and enhancing resource allocation. Key features include automated routing, priority handling for special cases, open-source adaptability, and educational health videos. By ensuring patients receive prompt services with minimal hassle, the QMS enhances productivity, resource management, and overall patient satisfaction.

Challenge

The Laguna Medical Center faced lengthy patient wait times and chaotic queues. The manual queuing system often resulted in disruptions and mismanagement of patient flow, necessitating additional administrative personnel to handle the queues.

Moreover, the lack of a structured approach adversely affected the quality of patient care, with some individuals needing timely attention due to queue disruptions or record misplacement. This undermined the medical center’s ability to efficiently serve its patients, manage resources, and maintain high healthcare standards.

Solution

The introduction of the QMS aimed to tackle the challenges by automating and streamlining the queuing process, ensuring prompt services for patients, and optimizing resource allocation, ultimately enhancing productivity and healthcare service quality.

Its key features and innovations include:

Automated Routing: Unlike traditional queuing systems that require patients to obtain a new ticket for each service, the QMS utilizes advanced routing. Once patients receive their initial ticket, they are automatically directed to subsequent services based on their previous ticket number, eliminating the need for constant returns to the ticket booth, reducing wait times, and streamlining the process.

Screenshot of the Central Screen View, which automatically routes patients to the next step.

Priority Flagging: The QMS enables operators to prioritize patients based on their specific needs, such as individuals with disabilities. This ensures that vulnerable patients receive more convenient and efficient service, demonstrating a commitment to inclusivity and improved patient care.

Screenshot of the User Dashboard, which displays waiting, priority, and pending clients.

Open Source Software: One remarkable aspect of this system is its use of open-source software. This allows for easy replication and modification by other developers and institutions, making it adaptable for similar queuing management needs across various organizations.

Screenshot of the Ticketing Dashboard which was built using Open-Source Software

Smaller File Size: The QMS boasts smaller files compared to similar systems, facilitating replication in other offices and institutions while reducing hardware and software resource requirements.

Screenshot of the Queuing Management System which utilizes a small file size.

Educational Health Videos: The QMS goes beyond mere queue management by incorporating the innovative feature of playing educational health videos while patients wait, providing patients with essential health knowledge and encouraging healthier lifestyles.

Screenshot of the Main Building Screen View, which plays informative health videos on the upper right.

Productivity Gains, Outcomes, and Impact

According to Randolf Abadier Jr., Assistant Systems Administrator, the QMS streamlined patient flow by automating routing, reducing the time patients spend in queues from more than an hour to 15 minutes, and enhancing service efficiency. The system seamlessly assigns patient ticket numbers and routes them to the appropriate departments, preventing long waits and disruptions.

Crystal Jade Gache, a Social Worker, highlighted that the QMS effectively controls the number of people entering the office, ensuring manageable client interviews for better time management. Patients no longer endure long, chaotic lines but can sit comfortably, knowing the system will notify them when it’s their turn.

Dr. Judy Rondilla, Chief of Hospital, emphasized that although patients initially experienced confusion, they quickly adapted, improving overall satisfaction. Furthermore, the priority flagging feature assists vulnerable patients, offering a more convenient and respectful service.

The QMS also provides real-time data insights into patient volumes and queue lengths, which is invaluable for resource allocation and staff management. It allows the hospital to optimize operations according to demand, significantly improving productivity.

Jonel Osio, Supervising Administrative Officer, noted that the QMS has made processing faster and more convenient, ensuring efficient staff resource utilization and reducing administrative bottlenecks, leading to a more productive work environment.

Dr. Rondilla shared that the success of the QMS has inspired plans for expansion to other departments and even other hospitals, fostering a culture of continuous improvement and knowledge sharing.

While exact statistics are not provided, the qualitative feedback from key informants strongly suggests that the QMS has led to productivity gains, including time savings, improved resource utilization, and enhanced patient satisfaction. These outcomes collectively demonstrate how the intervention has positively impacted the Laguna Medical Center’s operations and patients, aligning with the core goals of public-sector productivity.

Lessons Learned and Challenges in Implementing the Intervention

Key lessons learned from the implementation of the Laguna Medical Center’s QMS include the importance of comprehensive user training to ensure a smooth transition and efficient utilization of the system. Users’ feedback, such as the request for an “undo” feature, highlights the need for continuous improvement in the user experience, making the system more user-friendly and reducing errors.

Improvements in the display functionality have been suggested, such as seeing all tickets on the dashboard, enhancing visibility, and assisting staff in resource allocation and patient prioritization.

Due to the sensitive nature of patient data, ensuring robust data security measures is crucial. Continuous assessment and enhancement of data security protocols are necessary to safeguard patient information.

As the QMS expands to other departments and facilities, scalability and adaptability to different contexts and needs are vital, as each department or facility may have unique requirements that must be addressed during implementation.

Patient feedback and the initial confusion during the transition period highlight the importance of patient education, emphasizing the need for clear and accessible information for patients on how to use the QMS to improve their experience and reduce misunderstandings. Implementing a structured feedback mechanism can help gather insights from users and patients, enabling continuous improvement in the system’s functionality and overall effectiveness.

In conclusion, the lessons learned and potential areas of improvement for the Laguna Medical Center QMS revolve around user training, user-friendly features, display functionality, data security, scalability, patient education, and feedback mechanisms. Addressing these aspects can contribute to the system’s ongoing success and positively impact operational efficiency and patient satisfaction.

Resources

6 winning lgus in Digital Governance Awards 2019 get China trip. Philippine Information Agency. (2019, November 29). https://www.pna.gov.ph/articles/1087200

Overview

Faced with manual operations, time-consuming processes, and limited data accessibility, the Laguna Medical Center sought a solution. The Integrated Hospital Operations and Management Information System (iHOMIS) is a computer-based system developed by the Philippine Department of Health to streamline patient management, enhance service delivery and reduce processing time, which complies with healthcare standards. This innovation enables the Provincial Government of Laguna to optimize the use of public resources and improve healthcare services for its constituents. Transitioning from manual to digital operations was achieved through comprehensive training, addressing employee resistance, effective communication, and hardware upgrades.

Challenge

The main challenge the iHOMIS addresses is the inefficiency and complexity of manual healthcare management processes in the public healthcare system. Before iHOMIS, hospitals, including the Laguna Medical Center, faced hurdles like slow patient data retrieval, cumbersome record keeping, and lengthy transaction processing times. These challenges resulted in prolonged patient waiting times, increased staff workload, and potential data management errors. iHOMIS aimed to transform these operations by digitizing and automating various functions, including patient admission, billing, claims processing, and report generation. By streamlining these processes and providing quick access to patient data, iHOMIS aims to enhance the efficiency of healthcare services, reduce administrative burdens, and optimize the allocation of public resources while ultimately delivering higher-quality patient care.

Solution

The iHOMIS provides a comprehensive and integrated digital platform for hospital management. This innovation offers a range of solutions to improve hospital management. Firstly, iHOMIS enables faster retrieval and quick access to patient data, reducing patient waiting times and streamlining processes for hospital staff. This is achieved by digitizing patient records and allowing easy access to their medical history. The system’s innovative features include:

Comprehensive Patient Management: iHOMIS integrates various modules, including admission, billing, patient records, and claims processing. This integration minimizes duplicated efforts among departments, ensuring accurate and up-to-date patient information is available across the hospital.

Screenshot of the Admission/Discharge Form

Real-time Reporting: iHOMIS generates various reports on collections, revenues, expenses, and statistics in real-time. This eliminates the previous two to three days delay for generating reports, enabling quicker decision-making by hospital administrators. Dr. Rene P. Bagamasbad, Provincial Health Officer II, emphasized the transparent operations and financial accountability that iHOMIS introduced, providing accurate insights into expenses, dispensing of medications, and other hospital processes.

Screenshot of Generated Revenue Reports

PhilHealth Integration: iHOMIS seamlessly integrates with PhilHealth, enabling online verification of patient eligibility and claims processing. This eliminates the need for manual submission of documents and reduces processing time and costs. Menandro C. Pailan, Section Head for Claims and Benefits Section, stated that the system has significantly expedited claims processing, reducing reimbursement time from months to a month. This improved patient satisfaction and accelerated revenue cycles for the hospital.

Screenshot of the PhilHealth Benefit Eligibility Form

Process Automation: The system automates claims monitoring, reducing administrative workload and minimizing errors in claims processing.

Screenshot of the Electronic Claims Transmittal Barcode

What makes these features innovative is the holistic approach that combines patient care, administrative efficiency, and regulatory compliance in a single system. The real-time reporting and integration with external agencies like PhilHealth enhance transparency and accountability.

Productivity Gains, Outcomes, and Impact

Implementing the iHOMIS has resulted in substantial, measurable productivity gains and positive results for the hospital and its patients. One of the key improvements is the faster retrieval and quick access to patient data. Previously, retrieving patient records manually took several minutes and sometimes even longer if records were misplaced. With iHOMIS, the process has been reduced to mere seconds, enhancing the efficiency of patient care. This improved speed not only saves time but also accommodates a higher volume of patients seeking medical records, doubling the capacity of the hospital to provide this service.

Another significant achievement is reducing processing time for various hospital transactions, such as patient admission, billing, and Philhealth claims. In the past, these processes could take up to 15 minutes for billing alone, but now, with the system’s automation and integration, it takes only 3-5 minutes to complete the entire process, including interviews with patients or their relatives. This has streamlined operations and minimized inconvenience for patients and their families.

Moreover, the system’s ability to generate hospital reports promptly, such as collections, revenues, expenses, and statistical data, showcases the depth of its gains. Reports that used to take days to compile are now generated automatically, improving decision-making and financial management within the hospital. Elenor O. Perejas, System Administrator, highlighted iHOMIS’s contribution on automation and efficiency.

The system’s ability to quickly retrieve patient records, expedite hospital transactions, generate reports, and facilitate Philhealth claims has elevated the hospital’s efficiency, reduced waiting times, and enhanced overall patient satisfaction.

Lessons Learned/Challenges in Implementing the Intervention

The introduction of iHOMIS has imparted valuable insights to the hospital administration and stakeholders. A noteworthy lesson is the necessity of effective communication and collaboration among staff and departments while adopting new technology. The initial resistance from employees unfamiliar with tech-based systems highlights the importance of thorough training and gradual integration to ensure a smooth transition. Moreover, building strong relationships between IT personnel and staff played a pivotal role in overcoming challenges and fostering adaptability.

The system’s successful deployment at LMC also serves as a model for other healthcare institutions looking to modernize their operations. However, the expansion of iHOMIS presents some areas for improvement. The need for increased hardware and better internet connectivity was highlighted, essential for handling cloud-based services and ensuring seamless data access. Extending iHOMIS’s features could enhance operational efficiency and patient experience. The lessons from LMC’s experience underscore the significance of stakeholder engagement, gradual implementation, and addressing infrastructure limitations for a successful digital transformation in the healthcare sector.

Resources

Aquino, R. (2022, March 4). Janairo receives award from Laguna Medical Center. The Manila Times. https://www.manilatimes.net/2022/03/05/news/regions/janairo-receives-award-from-laguna-medical-center/1835179

Ismael, J. J. (2021, May 22). 113th malasakit center opens in San Pablo City. The Manila Times. https://www.manilatimes.net/2021/05/23/news/regions/113th-malasakit-center-opens-in-san-pablo-city/1800287

Overview

The Laguna Iskolar Information System (IIS) is an innovative platform that efficiently manages the scholarship program in the province. By automating the application and verification processes, IIS significantly reduces time, resources, and paperwork, allowing the government to provide scholarships to deserving students promptly. Historically, the main challenge was the restriction on physical interaction during the pandemic and budget allocation. The IIS addresses this by offering real-time verification, digital document storage, and a secure data privacy framework. With its successful implementation, the Provincial Government of Laguna was recognized first place in the 2020 DICT Digital Governance Awards-Provincial Level Category as the Best in e-Governance Customer Empowerment (G2C).

Challenge

The main productivity challenge addressed by the Laguna Iskolar Information System (IIS) is the inefficient and resource-intensive nature of the traditional manual processes for managing the scholarship program. Before the implementation of IIS, the submission and verification of requirements were conducted through physical interactions, leading to delays and increased administrative burden. This manual approach hindered the government’s ability to efficiently utilize public resources, such as time, manpower, and budget allocation. With the introduction of IIS, the entire scholarship process became automated, enabling real-time verification, streamlined application procedures, and digital document storage. As mentioned by Laguna MISO Systems Analyst Derel M. Tuazon, IIS addresses the challenge of restricted physical interactions during the pandemic, saving resources that were previously spent on travel, food, and team logistics.

The long lines for scholarship applications before the implementation of the IIS.

Solution

The IIS effectively addresses the challenge of inefficiency and resource-intensive manual processes in managing the scholarship program. Its innovative features simplify the scholarship process, optimizing public sector productivity and enhancing service delivery.

Online Application Platform: The IIS allows scholars to register and submit their requirements digitally, eliminating the need for physical interactions. This feature saves time, reduces paperwork, and provides a convenient and accessible application process.

Laguna Iskolar Information System (IIS) Main Page

Real-Time Verification: IIS offers real-time verification of documents, providing immediate feedback to applicants through email or text messages. This swift verification process expedites the evaluation of scholar applications, reducing waiting times for applicants and improving efficiency.

The IIS List of Scholars displays the real-time status of verified requirements.

Secure Data Privacy Framework: IIS ensures the confidentiality and security of scholars’ personal information and documents. The use of a robust data privacy framework instills trust among applicants and complies with data protection regulations.

Paperless Transactions: IIS minimizes the need for physical document storage, reducing the use of paper and physical storage space.

Laguna IIS Dashboard

Dashboard: IIS includes a dashboard that displays relevant information about scholars, their backgrounds, and courses. This centralized repository enhances decision-making and program management for administrators, providing quick access to vital data. As noted by Laguna Provincial Government Assistant Department Head Carina F. Macalos, IIS provides a comprehensive view of the scholar’s details. The system allows the government to make informed choices and allocate resources effectively.

Open-Source Libraries: The use of open-source libraries in IIS makes the system cost-effective and adaptable to future advancements. It promotes collaborative development and ensures sustainability in the long run.

Laguna IIS Online Claims Page

The Laguna Iskolar Information System’s innovative features provide efficient and secure digital solutions to the public sector’s productivity challenge. By automating processes, offering real-time verification, and ensuring data privacy, IIS optimizes the use of public resources, reduces administrative burden, and fosters good governance in delivering a quality scholarship program to the youth of Laguna.

Productivity Gains, Outcomes, and Impact

Through the implementation of the Laguna Iskolar Information System (IIS), the Provincial Government of Laguna has achieved remarkable gains in organizational productivity. Below are the notable measurable productivity gains and positive outcomes realized by IIS.

Faster Application Process: IIS’s online application platform and real-time document verification have significantly expedited the application process. IIS reduced the application and verification time from 7-14 days to real-time, allowing swift processing of scholar applications.

Increased Accessibility: With the streamlined and efficient online application process, IIS has become more accessible to the youth population in Laguna. To date, a total of 2,169 out of 2,338, or 92.90% new scholars have been registered in the system since its implementation.

Improved User Experience: Former Scholar Jannie Rosella J. Pereira reported a positive experience with IIS, emphasizing clear instructions from the office, quick responses to concerns, and the user-friendly nature of the system. This improved user experience enhances satisfaction and trust among scholars in the scholarship program.

Resource Optimization: The automation of processes through IIS has significantly reduced the need for physical interactions, manpower, and budget allocation.

Lessons Learned and Challenges in Implementing the Intervention

The implementation of the IIS has provided valuable insights and lessons for the Provincial Government of Laguna. One major lesson learned is the importance of building strong relationships with users to foster better system adoption. The success of IIS largely depended on the willingness of users to embrace change and adapt to the new system. To overcome this challenge, IIS deployed personnel to assist users during the transition period, allowing them to appreciate the system’s benefits gradually.

Another lesson learned from the IIS implementation is the need for active user involvement during the development process. Gathering requirements and involving users from different offices early on can lead to a more customized and user-friendly system. This approach can ensure that the system is tailored to the specific needs and preferences of the users, thus promoting better acceptance and usage.

The potential areas of improvement for IIS include continuous enhancements based on user feedback. IIS has established feedback mechanisms, such as request forms and verbal communication, to collect insights for further improvements. Addressing feedback promptly can lead to a more efficient and effective system that aligns better with user requirements.

Moreover, IIS can explore the use of emerging technologies to enhance its features and functionalities. Leveraging AI and machine learning can help in automating certain processes, such as profiling applicants for suitable employment opportunities, as suggested in the interview notes.

Overall, IIS has demonstrated its potential to optimize public sector productivity in Laguna. Through its innovative features, IIS has improved the scholarship application process, making it faster, more accessible, and environmentally friendly. The positive impact on scholars’ experience and the efficient utilization of public resources demonstrate IIS’s effectiveness in achieving the government’s productivity goals while providing more opportunities to the youth of Laguna.

Resources

Ebron, J. (2023, July 20). UPOU, PESO Laguna and Concentrix Philippines explore Barangay Transformation and digitalization of employment servicing. University of the Philippines Open University. https://www.upou.edu.ph/news/upou-peso-laguna-and-concentrix-philippines-explore-barangay-transformation-and-digitalization-of-employment-servicing/

Makinano, R. D. (2018, September 18). An assessment on the functionality of the Iskolar ng Laguna Program Committee: Towards an enhanced client-oriented service performance package. Ascendens Asia Journal of Multidisciplinary Research Conference Proceedings. https://ojs.aaresearchindex.com/index.php/aajmrcp/article/view/598