Rapid appraisals of health management systems were conducted in both provinces. Decreased hospital occupancy and health center utilization rates, Untimely or decreased procurement of drugs, medicines and supplies by LGU officials, Decreased maintenance and operating expenses for health facilities, Loss of managerial and fiscal control of hospitals by hospital administration, Barangay health unit (managed by barangay and municipal governments), Rural health unit (managed by municipal government), City health offices (managed by city governments), Municipal or 'district' hospitals (managed by the Provincial government), Provincial hospitals (managed by Provincial government), Regional hospital and medical center levels (managed by the DOH). Within a national health system, the lines of authority and reporting are clear from central to peripheral level. The Philippines Department of Health (DOH) was concerned that the rapid and far-reaching decentralization mandate by the Code would impose a wide array of problems on the health system and result in sharply diminished performance. In this situation, health providers then come under the management of non-health managers. Integrated Community Health Services Project, Local Government Assistance and Monitoring Services. The 'district' hospital sector illustrates this the most clearly. The study is based mainly on survey techniques. A recent study of decentralization in four countries indicated that, based on a set of decision-making criteria, the Philippines demonstrated one of the most extensive levels of decision-making in an administrative sense2. Method: International literature was reviewed on the subjects of decentralization. Health system reform has been a priority issue for governments and communities in the Asia-Pacific region. Financing and utilization of health services impacts In the Philippines, the enactment of the 1991 Local Government Code (the 1991 Code) led to further fiscal decentralization; in addition, it brought about significant devolution of the provision of public services. 2019 Feb 13;19(1):185. doi: 10.1186/s12889-019-6497-7. A perceived political recruitment and retention of health staff at the LGU level exacerbated this sense of lack of regulatory control. Conclusions: The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. These were to provide: (i) baseline data for project monitoring and evaluation; and (ii) an analysis of the health situation for the Provincial Health Office. However, the example of the Philippines indicates that the health referral system lost cohesion post-devolution. Figure 1 shows the financing flows for health as to sources and uses. The Technical Assistant team of consultants who helped define ICHSP found that in the first year post-devolution there was8: There was a perceived loss of regulatory control by the DOH. 2005 Mar;36(2):523-8. National government staff, equipment and facilities associated with the devolved functions were all transferred to the LGUs. Most policies focus on reforms in the area of health services decentralization. International Journal of Health Services 1994; 24: 459-475. Introduction This report is one of the background papers for the Philippine Human Development Report 2008, which has for its theme Institutions, Politics and Human Development in the Philippines. If a maternal death is recorded, who is the report made to - the local political authority or the district hospital? NIH COVID-19 is an emerging, rapidly evolving situation. There was little coordination with or involvement of local governments in health services. In addition to the rapid appraisal, public health data were analyzed through the Field Health Information System. Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. In this sense, the referral system is 'integrated' within one comprehensive operating system. The roles are complementary in so far as cases or services that cannot be managed at a particular level are appropriately identified and referred to a higher level for management. Of the total population 37.5% is below a government-defined cut off point for living in poverty. All concerned and affected by devolution in respect of health services were insufficiently prepared to cope with the wide sweeping changes it brought. Provincial health boards administer the 'district' hospital sector, but municipal health boards administer the catchment areas of the hospitals. The Philippines has a health profile that is generally typical of a middle developing country. Implementation of devolution: effects 1992-1997 Always refer to the live site https://www.rrh.org.au/journal/article/220 for the Version of Record. Data were analyzed according to health management system themes of health financing, human resource development, health referral systems, and health planning and community participation. Initial attempts at decentralisation were mainly functionally and structurally-oriented, that is, the health care bureaucracy … Within an integrated DHS, systems of information, transport, logistics and patient referral are defined by regulations that link facilities from primary to secondary to tertiary level. WHO Bulletin 1994; 4: 853-862. This paper investigates how the expansion of local government incomes in the Philippines influences household demand for healthcare under a decentralized setting. Introduction: Provincial health expenditure statistics indicate very high expenditure on personnel, but contrastingly very low expenditures on resources to deliver services and virtually no funding for capital investment. The devolution reforms were wide sweeping and fundamental in changing relationships among health providers and their managers and funders. Mills A, Vaughan P, Smith D, Tabibzaquedeh I. Consequently, access to essential surgical and obstetric services in the primary/secondary hospitals was reduced. The devolution of health services involved the transfer to LGUs7of the records, equipment, and other assets and personnel of the DOH, corresponding to the devolved powers, functions, and responsibilities (Section 17.i). The aim of decentralization is to widen decision-making space of middle level managers, enhance resource allocations from central to peripheral areas and to improve the efficiency and effectiveness of health services management. Collins C, Green A. Decentralization and primary health care: some negative implications in developing countries. LOCAL HEALTH SYSTEMS The implementation of the Local Government Code of 1991 resulted in the devolution of health services to local government units (LGUs) which included among others the provision, management and maintenance of health services at different levels of LGUs. Very high death rates from TB also highlighted the disintegration of systems of logistics, technical supervision, health information and drug supply between levels of service. 2020 Apr 15;20(1):305. doi: 10.1186/s12913-020-05174-w. Hayden D, Villanueva-Uy ME, Mendoza MK, Wilkinson D. Arch Dis Child Fetal Neonatal Ed. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Commenting about “The Covid-19 pandemic: ‘An ounce of prevention is better than a pound of … Health Res Policy Syst. Introduction: In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. (At the time of writing, attempts by the DOH to obtain Congressional approval to amend the LGC in relation to health services had proved unsuccessful.) It shows how prescriptions during the 1950s and 1960s led to the creation of a centrally planned Philippine health care system. Rapid appraisals of health services in two Mindanao ICHSP project provinces confirmed the findings of the earlier Asia Development Bank consultants. Administrative autonomy was also granted, which enabled the LGUs to raise local revenues, to borrow and to determine types of local expenditure - including expenditures on health care. Health referral system impacts PDF | The 1991 Local Government Code devolved the health service delivery system to the lower tiers of government. The process of devolution is now in its third year. The implementation of Primary health Care in 1979 resulted in some progress in basic delivery of healthcare services for the poor Access to health care services in the Philippines is limited by financial and social barrier. One of the most affected sectors was the health sector. Opportunities. Health care reform in Portugal: an evaluation of the NHS experience. One such commentary that drives to the point the consequences of health devolution as our country confronts Covid-19 comes from a seasoned multiawarded hospital administrator, Chief of Hospital 3 of the J.R. Borja General Hospital in Cagayan de Oro City, Dr. Ramon M. Nery, MD, FPSP, MHA, CEO 6. Results Report No. Conclusion: The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Despite the long tradition of decentralization in health care worldwide, there remains limited evidence on its impact on health outcomes. Overview of devolution of health services in the Philippines. The intent of decentralization and devolution is to improve the efficiency and effectiveness of health-service provision through reallocation of decision-making and resources to peripheral areas. International literature was reviewed on the subjects of decentralization. Human resources impacts 7. The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines in undertaking a second wave of reform in order to 'make devolution work'. PLoS One. Figure 1 shows in detail the devolved personnel, budget, and facilities from the DOH. Under-financing and under-resourcing had resulted in the primary and secondary hospitals no longer having the capability of providing referral services to the health centers in the catchment areas. Downloadable! BMC Health Serv Res. development efforts in the Philippines have aimed to address the problem of inequity for almost four decades. THE DEVOLUTION OF THE. This is particularly relevant to the funding of the district hospital sector. The devolution of health services to local government units, in line with the Local Government Code, even worsened the state of the government’s health services. Method: Justice and Health: The Ambivalence of Democracy and Justice in the Devolution of Health Services in the Philippines Jeffrey Bartilet. Provincial health Department Sth Cotabato Province, The Phillipines, Grundy J, Healy V, Gorgolon L, Sandig E.  Overview of devolution of health services in the Philippines. Health profiles now demonstrate rising mortality due to cardiovascular disease and cancer1. A local chief executive leads each LGU. Sources of information and methods of data collection Face-to-face interviews were undertaken with policy makers to establish motivations underlying devolution, what they believe has been achieved, and what they think promote or impede implementation. 2. ) There are six 'facility levels' in the immediate post-devolution health system managed by different political/administrative units. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Many countries have embarked on a process to decentralize their health systems as a means to improve their responsiveness and performance. 6. Rapid appraisal information and subsequent field reporting and consultative workshop feedback filled gaps in routine information system data. ... Hinting on the spirit of the law the architects of the 1987 Constitution has indeed stressed that Philippine society should be participatory, democratic and oriented towards a government that would be pro-people. Responding to effects of reform 1998 by making devolution work Principles of health sector planning in less developed countries. Devolution of Health Services, Fiscal Decentralization, and Antenatal Care in the Philippines . Although there are persistent high fertility levels, there is evidence of declining mortality. Philippines—Devolution and Health Services: Managing Risks and. Equally persistent are the problems of infant and maternal mortality, with particularly high levels in rural and remote regions. It was against this background that the Philippines commenced a program of health sector reform in 1991. Health systems decentralization involves moving decision making away from centralised control and closer to the users of health services. Figure 2: District hospital occupancy rate Surigao Del Norte 1993-1998 Final report of the Asian Development Bank, ADB TA no. In a devolved system, relationships of power and authority between health managers at different levels are more complex given the fact that their primary accountability is to political authority rather than a Department of Health Management system. There was a general perception by rural health staff in many areas of the country that devolution was not working, particularly for the poor and rural and remote populations. This review of devolution in the Philippines was written based on the authors' involvement in a health sector reform project jointly undertaken by the Department of Health (DOH; the Philippines), Provincial Governments of South Cotabato and Surigao Del Norte, Asia Development Bank and Australian Aid (Integrated Community Health Services Project - ICHSP; Figure 1). The code transfers certain regulatory and licensing powers to local governments. Acceptability and feasibility of delegating HIV counseling and testing for TB patients to community health workers in the Philippines: a mixed methods study. Unger JP, Criel B. Other analysts have categorized decentralization in terms of a widening of 'decision-making space' across such technical domains as human resource management, financing and planning3. 2007 Nov;22(6):415-26. doi: 10.1093/heapol/czm032.  |  References Phommasack B, Oula L, Khounthalivong O, Keobounphanh I, Misavadh T, Loun, Oudomphone P, Vongsamphanh C, Blas E. Southeast Asian J Trop Med Public Health. The experience in the Philippines is that LGUs often lacked sufficient financial commitment or capability to fund a DHS post-introduction of devolution. According to Pimentel (1991), access to “secondary health services” means access to doctors for the treatment of diseases and provision of medicine for With devolution, the role of the Department of Health (DOH) changed from sole provider of health services to provider of specific health services and technical assistance for health to LGUs. Decentralization involves delegation of powers from central towards provincial or district departments of health. Devolution. International Journal of Health Policy and Planning 1995; 10: 113-128. This more local transfer of control is viewed as a way of implementing the primary health-care strategy of increased responsiveness of health systems to local needs. Available: www.rrh.org.au/journal/article/220, © John Grundy, V Healy, LP Gorgolon, E Sandig 2003 A licence to publish this material has been given to Deakin University, deakin.edu.au. Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines. Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. Integrated Community health Services Project, The Phillipines, 3 addressing health devolution gaps and mainstreaming the philippine health agenda to local governments The Department of the Interior and Local Government (DILG), Union of Local Authorities of the Philippines (ULAP), and the United Nations Philippines RePubLiKo campaign initiated a series of Roundtable Discussion (RTD) as part of the #ParaSaBayan partnership forged early this year. Methods Devolution is one administrative category of decentralization and typically involves legal transfer of administrative powers to political units. The country therefore displays the so-called 'double burden' picture of epidemiological transition (high prevalence of both communicable and non-communicable diseases and remaining high fertility). The Philippines is a country of 7100 islands. Aim: Health regulatory reform to fill gaps post-devolution and since the advent of the. 8. Health Policy Plan. Participants in interviews and group discussions included health managers and staff, local chief executives (municipal mayors and their staff) and community members. In 1998 many rural health staff and DOH officials began to actively lobby for a 're-nationalization' of health services. 2020 Mar;105(2):209-214. doi: 10.1136/archdischild-2019-316951. Introduction These reported negative effects include an under-prepared middle level management, increased local political influence and control over technical management, and declines in quality of infrastructure and service delivery, particularly in rural areas. Decentralization and recentralization: effects on the health systems in Lao PDR. Table 1: Indicators of Provincial expenditure on health, Surigao del Norte and South Cotabato, the Philippines, 1998? It was found that in 1992-1997, system effects included a breakdown in management systems between levels of government, declining utilization particularly in the hospital sector, poor staff morale, a decline in maintenance of infrastructure and under financing of operational costs of services. eCollection 2018. In 1991 the Philippines Government introduced a major devolution of national government services through the introduction of the Local Government Code of 1991. This system is rationalized according to specific criteria such as geographical accessibility of services, clearly defined catchment areas and specificity of roles at each service level1,4. This paper analyzes the dynamics of health devolution in the Philippines within the context of the 1991 Local Government Code. Managers, consumers and providers expressed concern that there was an association between the introduction of devolution and declining quality and coverage of care. There are only limited direct references to health services and its organization in the Code and such treatment for the “largest and most complex” basic government Each sector level characteristically has a defined specialized role that is distinctive but complementary to the other levels. Health System Decentralisation. This PDF has been produced for your convenience. BMC Public Health. To obtain health care services, you can visit the … The findings of the historical review of devolution in the Philippines reveals some consistencies with the international literature, which describe some negative effects of decentralization, and provide a rationale for the Philippines in undertaking a second wave of reform in order to 'make devolution work'. This review was written based on the authors' involvement in a project jointly undertaken by The Department of Health (the Philippines), Provincial Governments of South Cotabato and Surigao Del Norte, and Australian Aid. USA.gov. There are high functional literacy rates, and life expectancy at birth is 68 years. Hesketh T, Zhu W. Health in China: The Health Care Market. Foreign loans. Bobadilla, Cowley, Musgrove. HISTORY OF THE DOH • In 1947, under Executive Order No. Hassall and Assoc. 2. The vacuum of regulations, management systems and administrative culture that resulted from the loss of a national bureaucracy was rapidly filled by local government political power. Health care in the Philippines has been defined by the WHO as "fragmented", meaning there's a large gap between the quality and quantity of health services for the poor and the rich. Please enable it to take advantage of the complete set of features! Geneva: WHO, 1990. 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