Duke T. Decline in child health in rural Papua New Guinea. These include reclassification of agricultural lands, enforcement of environmental laws, inspection of food products and quarantine, enforcement of National Building … Reintegration of systems through 'making devolution work'. Health regulatory reform to fill gaps post-devolution and since the advent of the. Equally persistent are the problems of infant and maternal mortality, with particularly high levels in rural and remote regions. 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). International literature was reviewed on the subjects of decentralization. Table 1: Indicators of Provincial expenditure on health, Surigao del Norte and South Cotabato, the Philippines, 1998? 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. Key words: decentralization, District Health System, health sector reform, Philippines. 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. Bossert T, Beauvais J. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. The code transfers certain regulatory and licensing powers to local governments. However, the example of the Philippines indicates that the health referral system lost cohesion post-devolution. The Department of Health (DOH) is the country's main authority on health in the Philippines. Reintegration of systems through re-nationalization. Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. 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. 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. Michael Ralph M. Abrigo . Introduction Figure 1 shows in detail the devolved personnel, budget, and facilities from the DOH. Integrated Community health Services Project, The Phillipines, 3 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. The paper looks into how the present level of health devolution came about, the reform's impact on the public health To obtain health care services, you can visit the … Principles of health sector planning in less developed countries. In the remote province of Surigao del Norte there were 12 municipal and 'district' hospitals in operation in 1998 but none could conduct emergency Caesarian section. Background to devolution: Local Government Code of 1991 International Journal of Health Policy and Planning 1995; 10: 113-128. 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. It was against this background that the Philippines commenced a program of health sector reform in 1991. Bobadilla, Cowley, Musgrove. International background 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. Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries. 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). 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. School of Economics I. Local health care system is close to the average, which is rather fair compared to many Asian countries. The experience of this second wave of reform from 1998 will be the subject of a second paper, which will analyze the process of reform, and seek to draw more detailed lessons learned from implementation of the policy of devolution in the Philippines. 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. A second aim is expand the 'decision making space' of middle and lower level managers, in order to increase the responsiveness of sub national authorities to local health needs and situations. 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'. Although there are persistent high fertility levels, there is evidence of declining mortality. The appraisal was conducted using a range of methods. In 1991 the Philippines Government introduced a major devolution of national government services through the introduction of the Local Government Code of 1991. 1981-PHI. 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. BMC Health Serv Res. 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. Health Policy Plan. A local chief executive leads each LGU. One of the most affected sectors was the health sector. eCollection 2018. There are six 'facility levels' in the immediate post-devolution health system managed by different political/administrative units. If a maternal death is recorded, who is the report made to - the local political authority or the district hospital? NIH References These included field observation, interviews, group discussions, review of health information data and socio-economic profile and the conducting of survey questionnaires. Health Res Policy Syst. These issues associated with devolution were recognized at both a health management and political level in The Philippines, by the decision of the DOH and the League of Governors in 1999, when they entered into a Health Covenant to achieve a unified integrated health care delivery system based on local government co-operation. In 1998 many rural health staff and DOH officials began to actively lobby for a 're-nationalization' of health services. This Covenant essentially expressed a political commitment to 'making devolution work.' Provincial health boards administer the 'district' hospital sector, but municipal health boards administer the catchment areas of the hospitals. COVID-19 is an emerging, rapidly evolving situation. 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. These are the: Local Health Boards have jurisdiction over single political/administrative levels, rather than having jurisdiction between the levels of service. A team of Provincial Health Managers and project advisers undertook follow up field supervision to collect the questionnaires and undertake direct observation of facilities and services. How will the family planning program be affected when local governments get greater autonomy? 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. 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? Initial attempts at decentralisation were mainly functionally and structurally-oriented, that is, the health care bureaucracy … 2. ) A similar situation existed in South Cotabato for the 3 municipal and 'district' hospitals. Foreign loans. 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. This site needs JavaScript to work properly. Introduction: Philippines—Devolution and Health Services: Managing Risks and. However, political unit management of health facility levels effects system integration by altering the relationships of authority between health system levels. Government hospitals had control of expenditure at the local level. Management and delivery of primary health services took a vertical program approach. Integrated Community Health Services Project, Local Government Assistance and Monitoring Services. Title: DECENTRALIZATION AND HEALTH IN THE PHILIPPINES AND INDONES… Author: WB81131 Created Date: 4/25/2002 2:20:05 PM Financing and utilization of health services impacts DHS are divided into primary, secondary and tertiary sectors. Rural and Remote Health 2003; 3: 220. 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. Decentralization and recentralization: effects on the health systems in Lao PDR. Clipboard, Search History, and several other advanced features are temporarily unavailable. Phommasack B, Oula L, Khounthalivong O, Keobounphanh I, Misavadh T, Loun, Oudomphone P, Vongsamphanh C, Blas E. Southeast Asian J Trop Med Public Health. Sources of information and methods of data collection The questionnaires were circulated to all district hospitals and rural health units in both Provinces. Grundy J, Healy V, Gorgolon L, Sandig E. Source Centre for Remote Health, Alice springs, Northern Territory, Australia. Integrated Community Health Services Project. Health services delivery reforms for local health systems, government hospitals and public health programs. 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. Health Policy and Planning 2002; 17: 14-31. The 'district' hospital sector illustrates this the most clearly. Results: Subsequent to the introduction of devolution, quality and coverage of health services declined in some locations, particularly in rural and remote areas. 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). Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. Many countries have embarked on a process to decentralize their health systems as a means to improve their responsiveness and performance. Various functions can be decentralized to varying degrees, and can be categorized broadly in terms of legislation, policy making, revenue raising, regulation, planning and resource allocation, management, training and interagency coordination2. HHS (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.) WHO Bulletin 1994; 4: 853-862. Referral systems lacked clear definition. ... 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. NLM 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. If the most obvious feature of early implementation of the policy of devolution in the Philippines was 'disintegration' of systems, two options remained: A primary aim of decentralization is to increase the resource base for primary care, by shifting as many resources as possible from central to peripheral locations. The following sections describe the impact of devolution on middle level managers, health administration systems, the financing and utilization of health services and the health referral system. With different reasons such as low budget, low number of man power, or general neglect for the poor, the Philippines has always been unable to keep up with the high standards of healthcare abroad. 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. Method: Hassall and Assoc. 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. PLoS One. The Code devolved basic services, giving responsibility for agriculture extension, forest management, health services, barangay roads and social welfare to LGUs. Resuscitation of preterm infants in the Philippines: a national survey of resources and practice. There are high functional literacy rates, and life expectancy at birth is 68 years. Data were analyzed according to health management system themes of health financing, human resource development, health referral systems, and health planning and community participation. 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. The dysfunctions of this centralised system motivated development administration specialists to call for decentralisation in the 1970s. Health care reform in Portugal: an evaluation of the NHS experience. Despite the long tradition of decentralization in health care worldwide, there remains limited evidence on its impact on health outcomes. Operations of the referral system are therefore hindered by limits of jurisdiction, which acts to restrain cooperative health activities such as technical supervision, health referral communications, sharing health information, joint health planning and cost sharing. 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. Responding to effects of reform 1998 by making devolution work DOH VISION-MISSION OF DOH • Vision – To be the leader of health for all in the Philippines • Mission - Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. 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. Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines. rrh.org.auJames Cook University ISSN 1445-6354, 1 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. Provide a background to the introduction of devolution to the health system in the Philippines. 2005. Decentralization involves delegation of powers from central towards provincial or district departments of health. 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). Centre for Remote Health, Alice springs, Northern Territory, Australia, 2 2018 Nov 5;13(11):e0206809. Additionally, there are 18 administrative regions, which typically comprise 3 to 4 provinces. 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). This paper investigates how the expansion of local government incomes in the Philippines influences household demand for healthcare under a decentralized setting. Health care providers are abundant, but unevenly distributed as most are in the urban centres. 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. 1992 saw radical reform to local government in the Philippines through enactment of a new Local Government Code. 2019 Jan 10;17(1):4. doi: 10.1186/s12961-018-0402-1. Consequently, access to essential obstetric care was dictated less by need and more by the ability to pay for care in more distant towns and cities. National government staff, equipment and facilities associated with the devolved functions were all transferred to the LGUs. 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). LGAMS also had a role in representing the DOH in legislative activities and inter-agency concerns related to devolution, including drafting of proposed amendments to the Local Government Code (LGC) in response to concerns over the model of devolution of health services. 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. Protecting resources for primary health care under fiscal federalism: options for resource allocation. Figure 2: District hospital occupancy rate Surigao Del Norte 1993-1998 What conditions enable decentralization to improve the health system? Get the latest public health information from CDC: https://www.coronavirus.gov. 2007 Nov;22(6):415-26. doi: 10.1093/heapol/czm032. 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. 4. In Papua New Guinea in the mid-1990s, responsibility for public health was devolved from provincial to district health offices. 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. Additional data were accessed from the field health information system and previous consultant reports. Opportunities. 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 This was despite some national government effort to augment LGU budgets to address inadequate financial capacity of LGUs in terms of absorbing staff and operations following devolution. BMJ 1999; 354: 1291-1294. 2019 Feb 13;19(1):185. doi: 10.1186/s12889-019-6497-7. The study is based mainly on survey techniques. 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. Epub 2019 Jun 14. Health profiles now demonstrate rising mortality due to cardiovascular disease and cancer1. Additional data were accessed from the rural health information system and previous consultant reports. Due to understaffing (despite high expenditure on personnel), a critical lack of operating expenses and decaying infrastructure, the distinction between levels of service was being lost. In the peer-reviewed literature, studies reported how devolution in the Philippines failed to Acknowledgement This is particularly relevant to the funding of the district hospital sector. International Journal of Health Services 1994; 24: 459-475. Rapid appraisals of health management systems were conducted in both provinces. This was based on the postulate that Results Justice and Health: The Ambivalence of Democracy and Justice in the Devolution of Health Services in the Philippines Jeffrey Bartilet. 2005 Mar;36(2):523-8. education services in the Philippines By Joseph J. Capuno U.P.  |  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 facility response rate was greater than 90%. In this situation, health providers then come under the management of non-health managers. - The Philippine health devolution experience can be considered as “the most ambitious health decentralization initiatives ever undertaken in Asia (World Bank 1994, p.i).” NB.1. Health referral system impacts (According to the DHS model of WHO, facility levels 1-3 correspond to the primary level of care, facility level 4 to the secondary level of care, and facility levels 5-6 to the tertiary level of care.) Health financing reforms for the National Health Insurance Program and creation of mechanisms for complementation with community health insurance schemes. The experience in the Philippines is that LGUs often lacked sufficient financial commitment or capability to fund a DHS post-introduction of devolution. This provided for the devolution of powers, resources and service functions from central government to local government. THE PHILIPPINE HEALTH SYSTEM AT A GLANCE 1.1. Provincial Health Department Surigao Del Norte, The Phillipines, 4 5. 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'. Indicators were tabulated and where possible presented in graphic format for ease of presentation to health managers and political leaders.  |  The process of devolution is now in its third year. In 1992, the Philippines Government devolved … It can be defined in general terms as the transfer of power in planning, management and decision-making from the national level to sub-national levels of government. Geneva: WHO, 1990. 12343-PH, Country Department I, Population and Human. Each sector level characteristically has a defined specialized role that is distinctive but complementary to the other levels. Methods The Code has now been implemented, and local and central health officials are adapting to the new system. Southeast Asian J Trop Med Public Health. This paper analyzes the dynamics of health devolution in the Philippines within the context of the 1991 Local Government Code. Logistics, transport, patient referral protocol, distinctions (complementarities) between levels of service were all affected adversely by lack of clarity regarding local government co-operation and under-financing of the operational costs of the DHS. In addition to the rapid appraisal, public health data were analyzed through the Field Health Information System. In this sense, the referral system is 'integrated' within one comprehensive operating system. Health Policy Plan. 8. 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. Method: International literature was reviewed on the subjects of decentralization. doi: 10.1002/hec.1037. Health system reform has been a priority issue for governments and communities in the Asia-Pacific region. Commenting about “The Covid-19 pandemic: ‘An ounce of prevention is better than a pound of … Health System Decentralisation. The authors wish to thank the following for their comments and suggestions on draft documents: Mario Villaverde, Director IV, Health Policy Development and Planning Bureau; and Juanito Taleon, Officer-in-charge, Bureau of Local Health Development: Department of Health, the Philippines A perceived political recruitment and retention of health staff at the LGU level exacerbated this sense of lack of regulatory control. Devolution is one administrative category of decentralization and typically involves legal transfer of administrative powers to political units. assessment of the factors that influenced implementation of devolution in the health services, its impacts and its effectiveness. The two largest islands are Luzon in the north and Mindanao in the south. 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. The national Department of Health managed pre-devolution health services. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. Overview of devolution of health services in the Philippines. This PDF has been produced for your convenience. 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. 2017 Nov 1;32(9):1327-1336. doi: 10.1093/heapol/czx082. Get the latest research from NIH: https://www.nih.gov/coronavirus. Who should decide for local health services? PDF | The 1991 Local Government Code devolved the health service delivery system to the lower tiers of government.
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