MANILA, Philippines – Renationalizing the Philippine healthcare system could help address gaps in the country’s delivery of health services, according to Health Secretary Francisco Duque III.
Duque told reporters this much as he answered a question about access to vaccines in remote areas in the country. He said on Wednesday, October 9, that a review of the Local Government Code of 1991, specifically its provisions on health, is needed to assess if the law really resulted in good health outcomes.
Healthcare in the Philippines is currently devolved, meaning the management and delivery of health services are in the hands of locally elected provincial, city, and municipal governments. Along with health services, social welfare was also devolved through the 1991 law. (READ: Stop blaming devolution for health sector failures)
With the current system, for instance, the Department of Health (DOH) makes sure that vaccines are delivered to local government units (LGUs) and their respective health officials. Whether the vaccines are delivered or not to constituents is up to LGUs, Duque said.
“Sometimes, in local government units (LGUs) – and I don’t want to generalize – if health is not a priority and there are other priorities like infrastructure, health programs can be compromised. If they don’t put enough money for health workers to deliver the services, for example, then you have these problems on the ground,” Duque said in a mix of English and Filipino.
He said it was important that all LGUs were on the same page regarding healthcare. “Health is very technical. We’re talking about continuum of care: health promotion, disease prevention, cure, rehabilitation, treatment, outbreaks.”
The health chief discussed this potential review of the local government code with Quezon 4th District Representative Angelina Tan, who heads the House committee on health.
“[She] might be good to champion, initially for the review of the health provisions of the local government code, and then if the indication is there to renationalize, then let’s renationalize so that we have one unified command [in health services delivery],” Duque said.
Duque said he would also seek dialogue with Senate health and demography chairperson Senator Bong Go for a similar discussion in the upper chamber.
The health chief added the Universal Health Care Law could be a solution to the country’s health woes. The DOH will sign the law’s implementing rules and regulations on Thursday, October 10, about 8 months since the passing of the landmark law. (READ: EXPLAINER: What Filipinos can expect from the Universal Health Care Law)
Due to budgetary constraints, the law will be implemented in only 33 areas for 2020. The DOH identified the said provinces and cities as “UHC implementation sites” when it defended its proposed P160.15-billion budget before House lawmakers in August.
Healthcare in the Philippines has been devolved since 1991.
By 1995, 490 of the country’s 534 public hospitals, 12,580 rural health units, municipal health centers, and barangay health stations, were transferred from the national DOH to LGUs.
With devolved powers and responsibilities also came problems for LGUs. Health policy scholar Maria Ela Atienza of the University of the Philippines (UP) Political Science Department pointed out in a 2015 paper that “skewed distribution, health personnel issues, lack of local prioritization for health, local competence on health” were among the challenges in the devolved system. Urban and rural areas still experience inequalities in terms of health status and healthcare provision, for instance.
“Political and other vested interests of legislators such as preoccupation with reelection and rivalry with local politicians resulted in hasty deliberations on the merits of devolving health services,” Atienza added.
Medicine procurement has also become politiczed due to devolution, according to Atienza, as local politicians may use health resources to curry favor with constituents. Devolution also puts local politicians in charge of improving health facilities and providing sufficient compensation for health workers.
Atienza did point out, though, that since 1991, “the health situation in the country improved in the areas of life expectancy and mortality rates.” (READ: PH health care, infra, institutions among worst in the world – WEF)
Much still needs to be done, however, as the country still lags behind Asian neighbors in terms of healthcare. – Rappler.com