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Appl Clin Inform 2025; 16(04): 1077-1085
DOI: 10.1055/a-2595-2824
Research Article

Challenges and Opportunities for Health Information Systems in Primary Care Clinics: A Mixed-Method Study among Health Workers in Manila, Philippines

Authors

  • Ma Sergia Fatima Sucaldito

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Rahul Malhotra

    2   Program in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore

  • Lia Palileo-Villanueva

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • John Jefferson Besa

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Precious Angelica Echague

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Mary John Saquilayan

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Jessa Mae Banzuela

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Kian Mendoza

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Anton Elepaño

    1   Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines

  • Lijing L. Yan

    3   Non-communicable Disease Research Division, Global Heath Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, People's Republic of China

  • Truls Østbye

    2   Program in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
    4   Family Medicine and Community Health Division, Duke University School of Medicine, Durham, North Carolina, United States

Funding This work was supported by the SingHealth Duke-NUS Global Health Institute (SDGHI) Pilot Grant (grant no.: SDGHI_PGA_FY2023_0015-05).
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Abstract

Purpose

Globally, health information system (HIS) development projects face challenges regarding technology infrastructure, financing, user resistance, and interoperability. While these challenges are well-described in literature, most studies on HIS digitalization focus on the development of national and hospital HISs, with little focus on HISs in primary care. We described the HISs of two primary care clinics in Manila, Philippines in terms of data management procedures, governance, training and equipment, information culture, and health worker data skills, and investigated health workers' experiences during digitalization.

Methods

This convergent mixed-methods descriptive study included two clinics: a nongovernmental organization (NGO)-operated clinic and a government-operated public health center (PHC). We surveyed eight health workers in the NGO clinic and six in PHC using the Performance of Routine Information System Management (PRISM) Community HIS evaluation tools from the World Health Organization and MEASURE Evaluation and conducted in-depth interviews among the same participants to explore their HIS experiences.

Results

Respondents in both clinics provided low scores on governance, indicating deficiencies in HIS strategy and documentation. PHC scored higher on data management, training, and equipment compared with the NGO clinic, whereas information culture scores were similar. Survey results reflected differences in IT infrastructure and services, stemming from PHC's larger size and funding. Interviews corroborated the survey results, highlighting barriers such as inadequate training and resources and the critical roles of internal communication and joint data stewardship, as described by the Filipino term “damayan,” which means working together in times of adversity. Additionally, interviews revealed expected benefits from digitalization, negative impact on workflow, and limited communication with external organizations.

Conclusion

The findings highlight critical areas for enhancing HIS implementation and digitalization in primary care clinics in the Philippines. Addressing governance gaps, resource deficiencies, and communication barriers can improve HIS performance and help build digital resilience.

Keywords

health information systems - primary care - digitalization - health workers - Philippines

Human Subject Research Approval

As the study involved human participants, it was submitted for formal review to the University of the Philippines Manila research ethics board and received approval (UPMREB 2023-0637-01). There was minimal risk sustained by the participants during the survey and interviews. Participant information was collected, anonymized, and managed securely as stipulated by national data privacy regulations. Participant records will be destroyed 10 years after study conclusion.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. Januar 2025

Angenommen: 25. April 2025

Artikel online veröffentlicht:
12. September 2025

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