Devolution In The Philippines

I. Devolution (300) In the Philippines, devolution was introduced through the Local Government Code of 1991. This passed on majority of control of major administrative government functions from national government to the local government, including management of the health system. The intentions of devolution were good – local governments should have had a more detailed grasp of the needs of their people, and thus adjusted their health system to be more relevant and appropriate to their population and geography. In reality, however, the promises of devolution have yet to be fulfilled.

Chronic underfunding mars the health systems in poorer localities due to the low allocation they receive to spend for public services. There is also chronic

From patient consults, to procurement of medical equipment, and even hospitalization. This explains why health promotion programs are virtually non-existent: because of their intangible and upstream nature, local executives tend to gravitate to more politically favorable health projects (e.g. building health facilities, medical missions), which can be seen by the people.

The concept of devolution of health is further complicated by the fact that there are still national programs created at the national level that are implemented locally: These include vertical programs for TB, vaccination, Dengue, among others. While national government ensures oversight and funding of these programs to a certain extent, it is the local health workers who carry the burden of implementation.

These factors, compounded with an understaffed and underfunded local health system, points to a structurally flawed system of governance and program implementation that explains the effect of devolution on the Philippine health

It is a framework of health that purports that health is a function of many social determinants, outside the health system. This brings the concept of improving health beyond providing vaccinations or appropriate medical care – it tackles the improvement of daily living and working conditions, addressing economic and power inequalities in a country. This is grounded in the concept that health is not created in hospitals, nor in health care facilities; it is created places where people spend most of their time – in their homes and in work.

In the Philippines, the social health determinants framework may aid in tackling the country’s health problems: chronic malnutrition has been high in the past ten years, maternal mortality remains unchanged, and infant mortality has marginally decreased. This is despite the government’s efforts to fund the health system through the National Health Insurance Program (Philhealth), and improve government