Are LGUs hampering access to medicine?

MANILA, Philippines – Citizens have benefited from the devolved functions of local government units (LGUs), delivering more nuanced services based on hyperlocal needs. But do these benefits include better health outcomes and greater access to medicine?

Various stakeholders mostly from the public health sector concluded in a policy dialogue that ended Friday, July 26, that much more can be done by LGUs in pushing for universal health care (UHC) and access to medicine.

“Unlike the Department of Health (DOH) set-up prior to the devolution, the provincial health officer (PHO) has the responsibility plus the authority because you manage fully all the resources – from manpower to logistics,” said Tarlac PHO Dr Ricardo Ramos.

There was less politicking, he explained, when the health professionals had the upper hand in managing health resources instead of the local executives.

Dr Melissa Guerrero of the DOH-National Center for Pharmaceutical Access and Management (NCPAM) echoed Ramos’ sentiments, adding that constitutional term limits also add to the problem.

“It became more difficult for DOH to implement the policies at the local level. We have national standards that they’re not enforcing…The constant changes in leadership also create problems in implementation,” explained Guerrero.

Procurement of medicines

The independent procurement of medicines per local government has raised issues of money wastage and the inefficient selection of purchased drugs.

The inability of small municipalities to buy in bulk – as they could only buy based on the needs of their population – also prevents them from taking advantage of discounted prices on the basis of the quantity of purchase.

DOH Undersecretary Madeleine de Rosas-Valera said drugs become costlier without a bulk procurement of medicines.

“It’s better to have a more tailored bulk procurement system rather than the mayor could only procure this much (sic)… Perhaps set up a system where the national government could procure for the local government,” she said.

One hindrance, however, to the national procurement model is that the funds have already been devolved to the LGUs through their Internal Revenue Allotment (IRA).

To enforce the central procurement of medicines, a scheme that requires LGUs to take out money from their IRA and contribute to a collective fund that distributes medicines based on needs per area, will be needed.

Selection of medicines

Health professionals are also wary about LGUs that buy medicines not included in the Philippine National Drug Formulary (PNDF), the country’s list of essential medicines.

Drugs listed in the PNDF are selected based on cost-effectiveness, said Guerrero of DOH-NCPAM. This is why LGUs that do not abide by the drug formulary may be wasting government money.

“We did a series of consultations a month ago and found out that many of them (LGUs) are not [compliant]… The essential medicines list is supposed to represent the medicines that are good value for money – what they need – so (non-compliance) may lead to smaller returns. They may be buying medicines that are priced too high, but the benefit is too small,” she explained.

Guerrero added that constant monitoring, information dissemination about the list, and proper enforcement with the help of the Commission on Audit are needed to make sure taxpayers get the best value for their money.

Fragmentation in referral system

DOH Undersecretary de Rosas-Valera said health services have become fragmented after devolution.

“Patients are no longer referred properly from the municipal primary care level to the hospital curative level. Likewise, kapag lumalabas sa hospital, hindi na rin nari-refer (after being discharged from the hospital, they are not referred) properly down to the municipal level for monitoring and evaluating,” explained de Rosas-Valera.

She added it is easier to supervise health interventions for the local populace if there is a well-connected health delivery system.

“[The challenge is] how we could streamline and bring back the referral gatekeeping system, bring back the technical support of the DOH down to the provincial and municipal level,” explained the DOH official.

Empowering dialogue

Reiner Gloor of the Pharmaceutical and Healthcare Association of the Philippines described the two-day dialogue as a “step forward towards universal health care (UHC),” with the delegates being able to talk openly about the barriers to UHC.

Other issues discussed during the forum included the referencing of drug prices to stop overpriced medicines from being procured, the proper storage of drugs at the local level, and the inclusiveness of the national health insurance system.

The event was jointly organized by the DOH with its attached agencies such as the Food and Drug Administration (FDA), the Philippine Health Insurance Corporation (PhilHealth), and its academic partner, the Asian Institute of Management (AIM) Dr Stephen Zuellig Center for Asian Business Transformation. – Rappler.com

Pills and stethoscope image from Shutterstock