Nothing is Important (or The Importance of Nothing)

"Nothing" is a very complex concept that can be simply explained as "nothing". A concatenation of "not a thing", nothing is probably the most abused word of all (if abuse can be measured as the range of all possible assignments of meaning to a word). For some, "nothing" might mean there is something. To others, "nothing" might mean everything. One could say that the spectrum of "not a thing" to "every thing" would cover all possible concepts of anything.

So rather than explaining what is nothing, this blog will explain instead the importance of "nothing" in the context of health.

In traditional health information systems (where reporting was still on paper), there was a concept of "all-or-none" reporting which compromised the quality of the whole national health information system. This was how it worked (or did not work):

If there were ten barangays in a municipality, and ten municipalities in a province, then the all-or-none data reporting required that all barangays must submit complete, accurate data on time to their municipalities. In turn, each of these ten municipalities, after reviewing the barangay data, must submit to their province. Only then can the provinces, after reviewing the reports, submit to their regions. But the reality in the 1990s is that at least one barangay was not able to submit on time which means the municipality, province, and region won't be able to submit on time as well. 

In summary, all we needed was for one barangay to submit nothing and this will affect the quality of the whole country's health information system.

This was the case in the early 2000s when the Field Health Surveillance Information System or FHSIS suffered from late consolidation.

Fast forward 2022, the Internet is on everyone's phone and instant messaging is the norm. There is in fact an easy and cost-effective way for barangays to submit data straight to national, down to the granularity of patient visit. How can we harness this power?

Governance. First there should be a clear structure and decision-making process on how the power is  wielded. Why? Because there are so many ways to skin the cat and there are serious privacy issues.  The governance body will take accountability for the strategy, for the investment, and for taking risks on behalf of the rest of the stakeholders.   

Architecture. Once the governance is formalized, the first thing the decision-makers commission is a blueprint of what health information system will be built. This blueprint serves as a guide to all stakeholders on what the country needs in terms of data management.

But despite this hyperconnected world, there will still be barangays who will submit nothing. What do we do with them? We view them as our underserved stakeholders using the lens of equity. In these barangays, nothing means something - that they lack the minimum capacity to even just send an instant message to the nearby health system and ask for help. As mentioned earlier on, "nothing" is not always nothing -- In data reporting, when nothing is submitted, that could mean that health services are not available in that area, which in itself, requires attention from the authorities. What may be more alarming is when the regional and national health offices receive messages from patients in a barangay and there are no responses coming from any health worker assigned to that barangay. The first thing to do for access is to ensure there are competent and knowledgeable health workers for each Filipino.

So let us not belittle "nothing" because it actually means a lot. Especially if after knowing there is no report emanating from certain barangays, government still does nothing.