Atipan+: Telehealth for geographically isolated and disadvantaged areas in the Philippines

Atipan+ addresses multiple problems of healthcare in the Philippines:

1. Lack of healthcare access in remote areas: Atipan+ makes telehealth services available to remote communities
2. Lack of prioritization of our Indigenous and rural communities in terms of healthcare: Atipan+ prioritizes Indigenous and rural communities
3. Data poverty of communities (which results in their invisibility to healthcare authorities/policymakers and lack of prioritization #2): Atipan+ generates telehealth data for health policies development.
4. Limited use of digital health technologies in poor, underserved and under-resourced area: Atipan+ facilitates the use of digital health in communities not expected to easily adopt them

The Atipan Project is an award-winning telehealth program run by the Center for Informatics (CFI) that provides free healthcare services to remote, underserved, under-resourced, marginalized and highly vulnerable Indigenous (Ati) and rural low-income communities in Western Visayas (Region 6, Philippines). Atipan means “to take care of” in the local language and originally served 7 Indigenous and 3 rural low-income communities in Panay and Guimaras Islands.

It is a community-led, gender-sensitive, digital health-enabled and data-focused social protection program meant as a response to the myriad issues brought about by the pandemic to highly vulnerable populations, and after 2 years of implementation the fact is that it also

1. brought about health transformation by promoting health-seeking behaviors among community members
2. led to empowerment with community innovations on local internet access, medicines acquisition and patient registration/finding
3. promote health consciousness and community healthcare advocacy because the telehealth data generated revealed a view and the status of community health.

In the Philippines underserved and vulnerable communities are associated with geographically isolated and disadvantaged areas (GIDAs). These are the remotest parts of the country still mostly unreached by government services including healthcare. Between 15-20% of the entire Philippines are considered GIDAs. In Western Visayas, in the 6 provinces (Aklan, Antique, Capiz, Guimaras, Iloilo and Negros Occidental) there are a total of 607 barangays (smallest government administrative units) that are GIDAs. Indigenous peoples, among the most vulnerable segments of the Philippine populace, reside mostly in GIDAs. In the original rollout of Atipan, 7 out of 10 of our partner communities, 6 Indigenous and 1 rural, are located in GIDAs.

Atipan has telehealth sites located in our partner communities, but also has recently piloted a telehealth caravan that can reach even more remote communities periodically. The communities served by the telehealth caravan are those still lacking internet (for which the Starlink satellite internet is used) and electricity sometimes. For non-ambulatory patients, the elderly and persons with disabilities, our community healthcare coordinators (HCs) have organized patient finding missions within their communities.

Atipan is proof of concept that technology can extend healthcare services more equitably to the most remotely located and vulnerable members of our society. However, technology alone may not always be adequate or acceptable. Atipan’s approach has been of thorough social preparation which includes information dissemination ahead of implementation, myriad community consultations, and continuous training of HCs who are the navigators facilitating telehealth consultations, often for patients who have never seen a doctor before, and their many innovations focused on the specific needs of their respective communities.

There is no other example of the facile embrace of digital health technology by poor, underserved, under-resourced and marginalized highly vulnerable Indigenous and rural low income communities in the Philippines. Atipan has created  a rich circumstance in the most challenging segments of our population with which healthcare transformation via digital technology can be achieved. Atipan is a model for digital health implementation for the rest of the country towards the goal of addressing health disparities and Universal Health Care/Coverage.