Challenges and Opportunities for Health Information Systems in Primary Care Clinics

A Mixed-Method Study among Health Workers in Manila, Philippines

Sucaldito, Ma Sergia Fatima
Malhotra, Rahul
Palileo-Villanueva, Lia
Besa, John Jefferson
Echague, Precious Angelica
Saquilayan, Mary John
Banzuela, Jessa Mae
Mendoza, Kian
Elepaño, Anton
Yan, Lijing L.
Østbye, Truls

Department of Medicine, University of the Philippines College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Metro Manila, Philippines
Program in Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
Non-communicable Disease Research Division, Global Heath Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, People's Republic of China
Family Medicine and Community Health Division, Duke University School of Medicine, Durham, North Carolina, United States

Address for correspondence

Ma. Sergia Fatima Sucaldito, MD University of the Philippines College of Medicine Pedro Gil Street, Ermita, Manila, 1000 Metro Manila Philippines [email protected]

Conflict of Interest

R.M. received funding for this study through the SingHealth Duke-NUS Global Health Institute (SDGHI) Pilot Grant (SDGHI_PGA_FY2023_0015–05). The rest of the authors have no conflict of interest related to this study.

Applied Clinical Informatics 16(04):p 1077-1085, August 2025. | DOI: 10.1055/a-2595-2824

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.