In reality, however, there is evidence to suggest that decision-making often can be constrained in the devolved context by political priority setting of local authorities, which can sometimes be perceived by health managers to be in conflict with priority setting based on health needs. The process of devolution is now in its third year. This site needs JavaScript to work properly. Health services delivery reforms for local health systems, government hospitals and public health programs. Devolution is one administrative category of decentralization and typically involves legal transfer of administrative powers to political units. Keywords: decentralisation,devolution,reproductive health services, healthsectorreforms, Philippines D ECENTRALISATION is one of the most common health sector reform interven-tions introduced in many developing countries during the 1980s and 1990s. There are high functional literacy rates, and life expectancy at birth is 68 years. The facility response rate was greater than 90%. Design, content and financing of an essential national package of health services. 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. Conclusion: Phommasack B, Oula L, Khounthalivong O, Keobounphanh I, Misavadh T, Loun, Oudomphone P, Vongsamphanh C, Blas E. Southeast Asian J Trop Med Public Health. 2017 Nov 1;32(9):1327-1336. doi: 10.1093/heapol/czx082. In Papua New Guinea in the mid-1990s, responsibility for public health was devolved from provincial to district health offices. In many cases, primary and secondary hospitals were sited next to rural health units, but were largely performing the same basic outpatient health center functions. 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. 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. Report No. This is particularly relevant to the funding of the district hospital sector. The appraisal was conducted using a range of methods. Rapid appraisals of health management systems were conducted in both provinces. Health referral system impacts Tuberculosis is a persistent problem however, and remains the fifth leading cause of reported morbidity and mortality in the Philippines. Rapid appraisals of health services in two Mindanao ICHSP project provinces confirmed the findings of the earlier Asia Development Bank consultants. 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'. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Grundy J, Healy V, Gorgolon L, Sandig E. Source Centre for Remote Health, Alice springs, Northern Territory, Australia. The dysfunctions of this centralised system motivated development administration specialists to call for decentralisation in the 1970s. Health care providers are abundant, but unevenly distributed as most are in the urban centres. Thus, the health sector has remained chronically under funded. Rapid appraisals of health management systems were conducted in both provinces. The Philippines has a health profile that is generally typical of a middle developing country. Health care reform in Portugal: an evaluation of the NHS experience. In China, responsibility for provision of health services has been devolved to provincial and county governments, and has been associated with greater inequity of access to services and less efficient use of resources6. The country is made up of political Local Government Units (LGUs) of provinces, cities, municipalities and barangays or townships. The population is approximately 78 million, of which over 52% is urbanized. NIH Acknowledgement Get the latest research from NIH: https://www.nih.gov/coronavirus. 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. There is difficulty in managing referral systems that have catchment areas that cut across these political/administrative units. Decentralization and recentralization: effects on the health systems in Lao PDR. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. This lack of investment in public infrastructure and operational costs is further evidenced by under utilization of services (Figure 2) and the high out-of-pocket expenses borne by those who access services (eg to buy their own drugs, medicines and supplies). In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. Government hospitals had control of expenditure at the local level. In 1992, the Philippines Government devolved … The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Rapid appraisals of health management systems were conducted in both provinces. Reintegration of systems through re-nationalization. The two largest islands are Luzon in the north and Mindanao in the south. Management and delivery of primary health services took a vertical program approach. Rapid appraisal information and subsequent field reporting and consultative workshop feedback filled gaps in routine information system data. Table 1: Indicators of Provincial expenditure on health, Surigao del Norte and South Cotabato, the Philippines, 1998? Figure 1 shows in detail the devolved personnel, budget, and facilities from the DOH. Philippines—Devolution and Health Services: Managing Risks and. Mills A, Vaughan P, Smith D, Tabibzaquedeh I. Bossert T, Beauvais J. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. An example of provincial health expenditure shows a very high proportion of budgets allocated to personnel costs, in contrast to expenditures on operating costs (Table 1); there was almost no finance budgeted for capital outlay (which includes maintenance and repairs). Commenting about “The Covid-19 pandemic: ‘An ounce of prevention is better than a pound of … A third aim of decentralization is to enhance the efficiency and effectiveness of health services management through prompt and appropriate middle level management decision-making. Hassall and Assoc. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Sources of information and methods of data collection Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. Epub 2019 Jun 14. Results health facilities and providers in contiguous areas, despite these facilities being under different LGUs, to offer a package of health services in an integrated and coordinated manner. School of Economics I. Opportunities. 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. doi: 10.1371/journal.pone.0206809. Additionally, the demonstrated lack of a sufficient revenue base for operational costs of the DHS limits the capacity of middle-level managers to exercise decision-making powers in support of the provision of basic health services. What conditions enable decentralization to improve the health system? eCollection 2018. Additional data were accessed from the rural health information system and previous consultant reports. In 1998 many rural health staff and DOH officials began to actively lobby for a 're-nationalization' of health services. A mixed methods study of preferences for decision-making in the decentralized Philippine health system. 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. Who should decide for local health services? 2005. Health Policy Plan. Final report of the Asian Development Bank, ADB TA no. Integrated Community health Services Project, The Phillipines, 3 Additionally, there was no prior development of health staff (including those retained by the DOH) or local government executives and officials for their new roles in a devolved environment. Acceptability and feasibility of delegating HIV counseling and testing for TB patients to community health workers in the Philippines: a mixed methods study. International literature was reviewed on the subjects of decentralization. Health Res Policy Syst. 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). 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. The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) describe the impact of devolution on the structure and functioning of the health system in defined locations. BMJ 1999; 354: 1291-1294. (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.) Bobadilla, Cowley, Musgrove. In the peer-reviewed literature, studies reported how devolution in the Philippines failed to 2018 Nov 5;13(11):e0206809. 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. The Politics of Health Devolution in the Philippines: Experiences of Municipalities in a Devolved Set-up ”, and subsequent to the aforementioned State policy, the Local Government Code of 1991 was enacted to introduce, among others, the devolution of the country's health care system from the national government to local gov-ernment units (LGUs). This reallocation of resources and decision-making is usually implemented within the framework of the District Health System (DHS). If a patient is referred from one level to the next, who funds the transport costs - the referring municipal authority or the Provincial Government that funds the district hospital? 1981-PHI. Health system reform has been a priority issue for governments and communities in the Asia-Pacific region. Health Policy Plan. This provided for the devolution of powers, resources and service functions from central government to local government. Decentralization involves delegation of powers from central towards provincial or district departments of health. Indicators were tabulated and where possible presented in graphic format for ease of presentation to health managers and political leaders. Additionally, there are 18 administrative regions, which typically comprise 3 to 4 provinces. Although there are persistent high fertility levels, there is evidence of declining mortality. • With the devolution of health services to LGUs, the provincial government oversees provincial and district hospitals, while the municipal government manages Rural Health Units (RHUs) and Baran- gay Health Stations (BHSs). National government staff, equipment and facilities associated with the devolved functions were all transferred to the LGUs. 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). HEALTH FINANCING The health financing system in the country is complex as it involves different layers of financial sources, regulatory bodies and health service providers. A perceived political recruitment and retention of health staff at the LGU level exacerbated this sense of lack of regulatory control. This provided information on morbidity rates and heath service utilization data. PLoS One. Introduction: Therefore province wide health-referral systems were unable to take account of the administrative reality of five political units managing two technical levels of the health system (primary and secondary levels). The national Department of Health managed pre-devolution health services. BMC Health Serv Res. While the DOH created the Local Government Assistance and Monitoring Service (LGAMS) to assist and support DOH representatives located at provincial level this was an ad hoc body with limited resources and adequately prepared staff. 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. 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. 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). Method: International literature was reviewed on the subjects of decentralization. Devolution. 2005 Mar;36(2):523-8. 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. Justice and Health: The Ambivalence of Democracy and Justice in the Devolution of Health Services in the Philippines Jeffrey Bartilet. Michael Ralph M. Abrigo . Describe the impact of devolution on the health system, services and selected health status in two selected Provinces in the Philippines (Surigao del Norte, South Cotabato; Figure 1). 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