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

Merlita M. OPEÑA <>
Philippine Council for Health Research and Development


The paper describes how the Philippine Council for Health Researchand Development (PCHRD), a database producer and information serviceprovider, is moving towards a value-added information serviceon 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 therest of the world to access.

The community aims to build a one-stop-shop information resourceon the Net which generalists and specialists in the health communitycan have access to, in the form of specialty databases, journalarticles, health policies and advisories, and directory type ofinformation, among other things. At the same time, e-Health isdesigned to be a place where people interact with each other aspeers, as a health professional and a patient, as a researcherand 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 touchwith users.

The second part deals with the processes undertaken by the Councilto build the electronic community with its multifaceted rolesas community organizer, designer, content editor, and trainer.

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

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



The Philippines' first online information service provider camefrom the health community long before the Internet was introducedin 1994. This service was established in 1991 by the PhilippineCouncil for Health Research and Development (PCHRD), a sectoralplanning council under the Department of Science and Technology.

The PCHRD functions as a coordinating body for all health R&Dactivities in the country. It facilitates the formulation of theNational Health R&D Agenda, and based on this agenda, providesassistance in building capability in health research. For thiskind of work, networking becomes a way of life for the Council.And for networking to work to their advantage, the Council andits partners need a good information system in place. The latter'ssituation is not yet in a satisfactory state but is slowly beingaddressed.

The decision to go online in 1991 was a logical step after thecomputerized local health databases were created by the Councilthrough its program, the Health Research and Development InformationNetwork, or HERDIN, in 1987.

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

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

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

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

Content is the heart of database production

As I discuss our work as a database producer, I'd like to stressthat 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 resourcesto serve a broader base of users in the health community. So,while PCHRD was persuading the partner institutions to upgradetheir libraries, it began developing electronic information resourcesand delivering these resources in the same electronic media.

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

The BIB database which contains information from the 65 localjournals (70% of the content) as well as from theses, conferenceproceedings, reports, and monographs proved to be very usefulnot only to researchers but to students and health professionalsalike. The enthusiastic response to the initial offering madeby PCHRD in 1989 encouraged the Council to step up its data-gatheringactivities, for we believe that more quality information meanta higher level of user satisfaction.

Content development also means sustaining the supply of informationon a long-term basis. To do this, PCHRD tapped its network ofpeople and organizations in the health research network. The problemof data gathering was, however, contingent on how organized theinformation was at the institutional level. Unfortunately, thein-house information was not organized, a state which continuestoday 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 editorsof Philippine health journals in 1990. This link proved to bevery helpful especially as the journals slowly adopted the placementof author-supplied abstracts and keywords in the formats suggestedby PCHRD. In addition, through the specialty societies, retrievalof missing issues was undertaken.

The experts in the specialty societies also serve as advisorsin selecting the materials which should be gathered first. Withthis relationship, issues on publishers' permission do not poseproblems.

On the other hand, the information which is organized in electronicformat by PCHRD makes access by the members of the contributingsocieties to their and other journals' information easy, asidefrom the fact that their research is being made known to a biggeraudience.

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

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

Gauging demand from user responses

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

  • Although there's a certain level of user loyalty, there wasa need to maintain customer relations to retain the old usersand to tap potential users to expand the user base;
  • The profile of the users tended to be young, i.e., 60% ofrespondents were 35 years old and below, indicating the primarymarket segment;
  • The service's reach is still within the urban capital of MetroManila; 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, manyimprovements were still necessary: e.g., shorter service turnaroundtime, 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 pursueto offer new products and services. For instance, we need to encouragemore online users, not only to speed up turnaround time, but toaddress the staffing constraints.

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

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

In like manner, we need work on strategies to aggressively marketHERDIN 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 privatizationare not clear.

At the heart of the Internet, content

As we undertook a transformation from an online database producerand provider to one with an Internet presence, we still maintainthat 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 redefiningthe way we work and do business, more so with the user-orientedWorld Wide Web.

A critical mass of users was easily built and the previously nonexistentinformation industry, specifically those which are Web-based,mushroomed. It seemed that the ideas which PCHRD wanted to conveyto 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 theacademe, as well as the connection to the Internet, was supportedthrough a project grant from the Department of Science and Technologyto the Industrial Research Foundation which put up the PHNet backbone.

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

As we move into the Web environment, creating our organization'shome 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 subjectmatter experts and the creative people. It's possible that anindividual can create his or her own Web site by himself, yethe or she can still benefit from the input of other people withanother background.

Coming up with a Web site is not the end. It's the beginning ofa continuing process of updating and innovating the Web site consideringthat your space is just one among the plethora of home pages createdeveryday. In the long-term, however, we'll have to train the subjectspecialists (the information generators) themselves in Web sitemechanics so that, as the source of information, they can directlyinput their updates.

In terms of information delivery, the country is divided intothose who have access to telecommunication infrastructure andthose who have not. Thus, we adopted two ways to distribute HERDINinformation. One, through the Internet, and, two, through theCD-ROM technology as we've produced our first in-house CD versionof the HERDIN (BIB) database with some of the citations linkedto full-text articles. Still, we see that there'll be a placefor 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 assessmentof Dr. William G. Padolina, Secretary of Science, on the country'snational information infrastructure:

First, these information infrastructures have been concentratedin the urban areas and academic institutions. It may be justifiedon the basis of the existence of a communication network and thepresence of trained users but this trend must be corrected creativelyso that eventually those whose lives need to be touched by theliberative nature of the information revolution will be reached.
Secondly, the role of an efficient and reliable telecommunicationsnetwork is vital to the information systems. Fortunately, thereare now emerging cost-effective solutions to be able to surmountgeographic, political and social difficulties that continue tohinder the expansion of the reach of these telecommunicationssystems. We look forward to the day when villages have greateraccess to telephones, as an example.
Thirdly, database creation and content services are still wantingespecially in developing countries. Interconnecting is uselessif poor quality, outdated, and inaccurate information is transmittedthrough the lines. Thus, database creation activities, includingdigitization of vital information, should be given high priority."

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

By building the content in e-Health (the electronic Health InformationVillage), we will give people good reasons to go to our site.With the empowering nature of information and the Internet, webelieve that the building process can be fast-tracked if we helporganizations or groups build the information they need on theNet. We're moving away from a centralized mode to a decentralizedone. Instead of thinking of a central processing point and a repositoryas we've done with our database production, we're shifting ourparadigm. We want the information generators themselves to buildwhat they produce so they have a bigger stake in the development.

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

In the development process, the question we faced was which groupto organize first. In response, we tied this concern with theresult of our user survey which pointed to the value of specialtydatabases. So, the question was now translated to which specialtydatabase to develop first -- a more user-oriented approach.

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

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

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

Organizing the content development of e-Health in a distributedmanner is also our strategy to heed the fast turnover of peopleworking in the information technology field. We have to empoweras many people who form the health community by making them awareof what we're doing, what's the place of technology in the schemeof things, and, most importantly, training them to use the technologyextensively. We need partners, though, to fast-track the empowermentprocess because most organizations are not that ready -- people-wiseand infrastructure-wise.

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

Thank you.


  1. e-Health conceptual page,
  2. Engineering Information, Inc. (Engineering Information Village),
  3. 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.

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