Community Organizing on the Net: The Case of the Philippine e-Health Initiative

Merlita M. OPEÑA <mmo@health.pchrd.dost.gov.ph>
Philippine Council for Health Research and Development
Philippines

Abstract

The paper describes how the Philippine Council for Health Research and Development (PCHRD), a database producer and information service provider, is moving towards a value-added information service on the Internet, the e-Health Initiative.

E-Health, or the Philippine Electronic Health Information Village, sets the stage for the construction of an electronic community, designed within the Filipino context, for the Filipinos and the rest of the world to access.

The community aims to build a one-stop-shop information resource on the Net which generalists and specialists in the health community can have access to, in the form of specialty databases, journal articles, health policies and advisories, and directory type of information, among other things. At the same time, e-Health is designed to be a place where people interact with each other as peers, as a health professional and a patient, as a researcher and an information provider, or as a student and a mentor.

The first part of the paper discusses the experience of PCHRD, through its Health Research and Development Information Network (HERDIN), in developing its information products and services; its pioneering role as an online service provider in the country; and how it sustains its programs by being constantly in touch with users.

The second part deals with the processes undertaken by the Council to build the electronic community with its multifaceted roles as community organizer, designer, content editor, and trainer.

PCHRD acts as a community organizer by selling the e-Health idea to organizations, professional societies, and research groups in the health research network and getting these groups organized as content providers on a sustained basis. As a virtual integrator, PCHRD designs the electronic community and builds the links to these Philippine information providers based on editorial criteria.

The Council envisions that the creation of the community's information resource will serve as a jumping board for other initiatives like distance education and tele-medicine.

Contents

• Introduction
• Content is the heart of database production
• Gauging demand from user responses
• At the heart of the Internet, content
• Creating a sense of community through e-Health
• References

Introduction

The Philippines' first online information service provider came from the health community long before the Internet was introduced in 1994. This service was established in 1991 by the Philippine Council for Health Research and Development (PCHRD), a sectoral planning council under the Department of Science and Technology.

The PCHRD functions as a coordinating body for all health R&D activities in the country. It facilitates the formulation of the National Health R&D Agenda, and based on this agenda, provides assistance in building capability in health research. For this kind of work, networking becomes a way of life for the Council. And for networking to work to their advantage, the Council and its partners need a good information system in place. The latter's situation is not yet in a satisfactory state but is slowly being addressed.

The decision to go online in 1991 was a logical step after the computerized local health databases were created by the Council through its program, the Health Research and Development Information Network, or HERDIN, in 1987.

People refer interchangeably to HERDIN as the information network, the databases, the information services, or the information program or project at PCHRD. However they use HERDIN, our main concern is that people know that there is an information resource that they can use when they need it.

HERDIN, a partnership of PCHRD with the Department of Health and the University of the Philippines Manila, was conceived, initially, to link and share the resources of health libraries in support of health research. The partners which represented the research, academic, and health care delivery sectors were assigned to develop their respective information (library) resources along their natural area of strengths, that is, they'll do this job without exerting any extra effort since it's part of their routine.

HERDIN's tasks, as the creators conceived, will be more productive if the librarians themselves were organized as a professional group. Hence, in 1988, the HERDIN partners helped established the Medical and Health Librarians Association of the Philippines. With this organized group, tools like Union List of Serials (in computer and print forms) were produced and are continuously updated. The concern for human resource development for librarians by way of training was then taken over by the association, a partnership which gave us more time to respond to other developments that are happening in the information field.

The development in the library field was a slow process, especially in a situation where it is common to see one-person libraries, with inadequate collections. Only in the 90s do we see some of the bigger, mostly university-based, libraries use new technology and processes to create more responsive information services to ease access to local and network collections. In particular, through a World Bank-funded Engineering and Science Education Project of the Department of Science and Technology, eight university libraries were linked.

Content is the heart of database production

As I discuss our work as a database producer, I'd like to stress that content is the heart of this work.

Although HERDIN tackled first the area of library networking, its long-term concern was to develop information systems and resources to serve a broader base of users in the health community. So, while PCHRD was persuading the partner institutions to upgrade their libraries, it began developing electronic information resources and delivering these resources in the same electronic media.

With support from the International Development Research Center of Canada, and using free software (CDS/ISIS) from UNESCO, the HERDIN databases as they are known -- including published materials, research projects, research institutions, and researchers -- were developed.

The BIB database which contains information from the 65 local journals (70% of the content) as well as from theses, conference proceedings, reports, and monographs proved to be very useful not only to researchers but to students and health professionals alike. The enthusiastic response to the initial offering made by PCHRD in 1989 encouraged the Council to step up its data-gathering activities, for we believe that more quality information meant a higher level of user satisfaction.

Content development also means sustaining the supply of information on a long-term basis. To do this, PCHRD tapped its network of people and organizations in the health research network. The problem of data gathering was, however, contingent on how organized the information was at the institutional level. Unfortunately, the in-house information was not organized, a state which continues today in many organizations. This state makes data gathering difficult.

One of the ways adopted by PCHRD, in the case of its BIB databases, was forging a partnership with an organized group like the editors of Philippine health journals in 1990. This link proved to be very helpful especially as the journals slowly adopted the placement of author-supplied abstracts and keywords in the formats suggested by PCHRD. In addition, through the specialty societies, retrieval of missing issues was undertaken.

The experts in the specialty societies also serve as advisors in selecting the materials which should be gathered first. With this relationship, issues on publishers' permission do not pose problems.

On the other hand, the information which is organized in electronic format by PCHRD makes access by the members of the contributing societies to their and other journals' information easy, aside from the fact that their research is being made known to a bigger audience.

To date, the BIB database contains 25,000 records, 21% of which are materials from the 90s. From the PCHRD site alone, 26,000 requests havebeen served in the last six years.

One of the important lessons we learned is that an information provider's competitive advantage lies with the local content it has built. And rightly so because this is one thing which no one has a working knowledge of and a network to boot but the local organization.

Gauging demand from user responses

The success of PCHRD's information services program lies in the patronage of its users. The 1996 users' survey of HERDIN information services gave the following insights:

• Although there's a certain level of user loyalty, there was a need to maintain customer relations to retain the old users and to tap potential users to expand the user base;
• The profile of the users tended to be young, i.e., 60% of respondents were 35 years old and below, indicating the primary market segment;
• The service's reach is still within the urban capital of Metro Manila; there's a need to expand to the other parts of the country, especially the rural areas;
• Although a satisfactory level of service is delivered, many improvements were still necessary: e.g., shorter service turnaround time, easier access to databases, more library materials for research;
• There's usually resistance to proposed price increases; users' capability of paying and full product costing need to be balanced;
• There's a need to innovate in the delivery of services: e.g., more offsite stations, especially if space and staffing are limited; and
• There's value in going into specialty databases.

These insights provide directions as to what innovations to pursue to offer new products and services. For instance, we need to encourage more online users, not only to speed up turnaround time, but to address the staffing constraints.

The feedback also guides us as to what markets to develop. The pressure to innovate and segment the market becomes imperative as the Internet revolutionized information production and delivery as it empowers personal and organizational publishing.

On the other hand, while it is good to pursue niche marketing among the young professionals in the urban capital, we have also a social responsibility not to neglect the rural communities. Thus, we're now working on developing a concept for a multi-purpose community telecenter with telemedicine as an entry point. We're actually looking for models in developing countries to help us to work out this concept.

In like manner, we need work on strategies to aggressively market HERDIN information services in the local and international market. We're handicapped in this area because we're a government agency, not a money-making business. Also, the rules on privatization are not clear.

At the heart of the Internet, content

As we undertook a transformation from an online database producer and provider to one with an Internet presence, we still maintain that content is as important in the Internet environment as before.

The introduction of the Internet in 1994 intensified peoples' appreciation of what information technology can do in redefining the way we work and do business, more so with the user-oriented World Wide Web.

A critical mass of users was easily built and the previously nonexistent information industry, specifically those which are Web-based, mushroomed. It seemed that the ideas which PCHRD wanted to convey to the users in the six years prior to the advent of the Internet, through its briefings in various organizations in the country, became instantly clear, where before they seemed nebulous.

The first national communication backbone for research and the academe, as well as the connection to the Internet, was supported through a project grant from the Department of Science and Technology to the Industrial Research Foundation which put up the PHNet backbone.

Today, we see over 100 Internet service providers of varying service levels. The growth has spread to the other parts of the country although, in most cases, still in the urban capital cities. Notably, there's a heavy outgoing traffic, indicative of a small number of sites with good local content. This latter situation is better appreciated as the novelty of the Internet infrastructure, more on e-mail and less of content, wears out.

As we move into the Web environment, creating our organization's home pages, we realize that we are in a continuing learning process. The product of this creative process is a product of a team effort. People in the computing group cannot do it without the subject matter experts and the creative people. It's possible that an individual can create his or her own Web site by himself, yet he or she can still benefit from the input of other people with another background.

Coming up with a Web site is not the end. It's the beginning of a continuing process of updating and innovating the Web site considering that your space is just one among the plethora of home pages created everyday. In the long-term, however, we'll have to train the subject specialists (the information generators) themselves in Web site mechanics so that, as the source of information, they can directly input their updates.

In terms of information delivery, the country is divided into those who have access to telecommunication infrastructure and those who have not. Thus, we adopted two ways to distribute HERDIN information. One, through the Internet, and, two, through the CD-ROM technology as we've produced our first in-house CD version of the HERDIN (BIB) database with some of the citations linked to full-text articles. Still, we see that there'll be a place for delivering information in the traditional way -- by phone, by post, through personal contacts -- for some time.

Creating a sense of community through e-Health

Before I talk about our e-Health initiative, let me cite the assessment of Dr. William G. Padolina, Secretary of Science, on the country's national information infrastructure:

First, these information infrastructures have been concentrated in the urban areas and academic institutions. It may be justified on the basis of the existence of a communication network and the presence of trained users but this trend must be corrected creatively so that eventually those whose lives need to be touched by the liberative nature of the information revolution will be reached.
Secondly, the role of an efficient and reliable telecommunications network is vital to the information systems. Fortunately, there are now emerging cost-effective solutions to be able to surmount geographic, political and social difficulties that continue to hinder the expansion of the reach of these telecommunications systems. We look forward to the day when villages have greater access to telephones, as an example.
Thirdly, database creation and content services are still wanting especially in developing countries. Interconnecting is useless if poor quality, outdated, and inaccurate information is transmitted through the lines. Thus, database creation activities, including digitization of vital information, should be given high priority."

Given this assessment, we believe that we can make a dent if we address the content requirement while the private sector addresses the telecommunications infrastructure.

By building the content in e-Health (the electronic Health Information Village), we will give people good reasons to go to our site. With the empowering nature of information and the Internet, we believe that the building process can be fast-tracked if we help organizations or groups build the information they need on the Net. We're moving away from a centralized mode to a decentralized one. Instead of thinking of a central processing point and a repository as we've done with our database production, we're shifting our paradigm. We want the information generators themselves to build what they produce so they have a bigger stake in the development.

In this scenario, it'll be incumbent on PCHRD to help people help themselves since, in the long-term, it is to their interest that they are able to get their information when they need it. In this decentralized mode, we need, therefore, to transform ourselves into new roles -- that of community organizing; that of being an information resource integrator.

In the development process, the question we faced was which group to organize first. In response, we tied this concern with the result of our user survey which pointed to the value of specialty databases. So, the question was now translated to which specialty database to develop first -- a more user-oriented approach.

PCHRD, as the convener, started working with the Malaria, Tuberculosis and Biomedical Devices Study Groups; the Philippine College of Surgeons; and the Medical and Health Librarians Association; and now we've started talking with people working on population, nutrition and cardiovascular diseases. The choice of these groups stems from a combination of reasons -- the area is a priority program, there is good starting material, or we have champions who can carry on the work within each group.

Each of these groups will build the various e-Health components -- databases, directories of people and organizations, journal publishing, health advisories, discussion groups, Ask a Health Professional corner, and the libraries.

We're not starting from an original idea of a community here when we went into e-Health. The concept had been tried by other groups. In fact, we're building on the work of the Engineering Information Inc. in the development of their Ei Village.

Organizing the content development of e-Health in a distributed manner is also our strategy to heed the fast turnover of people working in the information technology field. We have to empower as many people who form the health community by making them aware of what we're doing, what's the place of technology in the scheme of things, and, most importantly, training them to use the technology extensively. We need partners, though, to fast-track the empowerment process because most organizations are not that ready -- people-wise and infrastructure-wise.

Community organizing -- convening people and groups; helping people and organizations help themselves; linking experts and resources; designing an electronic community; ensuring productive activities in each village site; selling the e-Health concept. These are some of the things we are doing at PCHRD, a role transformation brought about by the Internet -- roles that we need to act on today to ensure that we'll have a steady supply of health information on the Net for the Filipinos and for the rest of the world.

Thank you.

References

1. e-Health conceptual page, http://www.pchrd.dost.gov.ph/e-Health/
2. Engineering Information, Inc. (Engineering Information Village), http://www.ei.org
3. HERDIN, http://www.pchrd.dost.gov.ph/herdin/
4. PCHRD. Health Research and Development Information Network, A User Survey (unpublished). Manila. PCHRD. 1996
5. Opena, M.M. A Concept Paper on e-Health (unpublished). Manila. PCHRD. 1997.
6. Opena, M.M. Health S&T Publishing in the Philippines : Notes from HERDIN Experience (unpublished). Manila. PCHRD. 1997.