Professional Documents
Culture Documents
The decentralization of basic social services in 1992 prompted local chief executives to
assume the responsibility of providing these services, including health, to their constituents.
It aims to improve the delivery of services by empowering local leaders and giving them
the mandate to undertake decision-making to immediately respond to local needs.
The decentralization was envisioned to bring governance closer to the people.
The Local Government Code (LGC) of 1991 set up various mechanisms to ensure
support for the decentralization and responsiveness of the local health system. This included
institutionalization of local health boards (LHB) at every level of the local government unit
(LGU). The LHB is regarded as an avenue for wider community participation at the local
level. Community-based organizations can become members of the LHB and take part in
the decision-making process. The LHB
also assists the LGU, particularly the
Sangguniang Bayan, in crafting health
ordinances and resolutions, as well as in
preparing health budgets.
However, after almost two decades
of implementation, not all LGUs have
been able to institutionalize their LHBs.
Evidence shows varying outcomes of
decentralization, with some LGUs faring
better and being more responsive than
others. Some had no organized LHBs, while
others had functional and effective LHBs.
Still, there were others that organized
Datu Paglas municipal health officer, Dr. Tina
their LHBs, but only on paper. The study1
Almirante (in white shirt) leads the LHB members
during the municipal health summit.
on the status of LHBs supported positive
correlation between the functionality
of local health boards and some indicators of LGU responsiveness such as community
consultations, health initiatives, and the allotment of budget for health, among others.
This study is part of the situational analysis for an intervention that intends to ensure the
presence of a supportive policy environment in the local health system. The analysis examines
the functionality of LHBs in the Zuellig Family Foundations (ZFF) Cohorts 1 and 2 partnermunicipalities at the onset of the partnership. The Foundation envisions the LHBs as a critical
institution to support the reforms that can be instituted in the municipalities and as a catalyst
of a more responsive policy environment. The analysis also explores the difference in the
possible outcomes between municipalities with functional and non-functional LHBs in terms
of percentage of budget allocated for health, adequacy of health workers, and the provision
and amount of barangay health worker honorarium.
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Ramiro, Laurie S., Fatima A. Castillo, Tessa Tan-Torres, Cristina E. Torres, Josefina G. Tayag,
Rolando G. Talampas, and Laura Hawken (2001). Community participation in local health boards in a
decentralized setting: Cases from the Philippines. Oxford University Press.
Decentralization
The decentralization of basic social services in 1992 intends to empower both the LGUs
and the community. It gives local leaders the mandate to undertake local decision-making
and respond according to local health needs. Devolved functions of LGUs, including provision
and financing of basic health services, are intended to ensure a responsive local health
delivery system as well as community participation and accountability. For the community,
various mechanisms are enshrined in the LGC to ensure greater participation, including the
institutionalization of the LHB. The table below enumerates the basic functions devolved to
various institutions of the LGU.
Provision
Financing
1. Funds for basic services and facilities shall come from the share
of LGUs in the proceeds of national taxes (IRA and national
wealth), other local revenues, and transfers from the national
government, national government agencies (NGAs) and
government owned & controlled corporations (GOCC).
2. NGAs affected by devolution or the next higher LGU may
augment basic services and facilities assigned to a lower LGU
Participation
and
Accountability
Bautista, A. B. (1993). Rules and regulations implementing the Local Government Code of 1991 with
related laws and concept of decentralization. Mandaluyong City: National Bookstore.
With the authority given to local government units comes greater accountability, as
embodied in the concept of closer governance. Local governments now have the responsibility
of providing health services to their respective communities. Through decentralization, the
Rural Health Unit (RHU) is administratively and financially under the Municipal Mayor while
government provincial and district hospitals are under the Provincial Governor. The Department
of Health (DOH), however, maintains specialty hospitals, regional hospitals and medical centers.
It also operates regional field offices known as Centers for Health Development (CHD) in every
region, which has a provincial health team made up of representatives to the local health
boards and retained personnel involved in managing selected priority health problems. 3
At the local level, citizens can more easily learn of the activities and programs that their
local leaders have promoted and supported, discern how much effort they have devoted to
improving public services, and confirm whether they have delivered on campaign promises. In
other words, the information that citizens need to make judgments is more readily accessible
under decentralization. 4
The responsibilities devolved to LGUs demand greater leadership and management
competencies. This poses imperatives for local chief executives to exercise good
governance to ensure efficiency and efficacy. They are expected to optimize the various
support mechanisms provided by the LGC to ensure smooth transition of authority and
responsibility from the national to the local governments. These support mechanisms
are intended to complement the skills and expertise of local chief executives in
carrying out devolved functions. A case in point is an LHB intended to guide and
provide technical support on health to the local chief executive and other local
decision-making authorities.
Mayor Datu Abdulkarim Langkuno addressing his constituents during Paglats community health summit.
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The LGC also set provisions for conducting regular meetings and quorums.
The provision requires at least one meeting a month, or as often as necessary.
The quorum is constituted by the majority of the members while the affirmative vote of the
majority of the members is necessary to approve proposals. Regular meetings ensure that
members are up-to-date and informed of the health situation, issues, and current status of
programs and projects.
The abovementioned functions of the LHB are critical in local health system
development. The LHB serves as an avenue where the LGU and local health officers can
sit together to discuss and address health concerns of their constituents. Local health officers and
community representatives are given the opportunity to air out health issues and consequently,
provide feedback to the community. The LHB also serves as an accountability mechanism that
ensures checks and balances on the local chief executives decision-making power.
In a comparative study conducted in 2001, there were more community participation,
fund-raising activities, health initiatives and higher per capita health expenditure in LGUs
with functioning LHBs than in LGUs with non-functional LHBs. (Ramiro et. al. 2001)
Moreover, in the case of ARMM, the LHB serves as the link between the DOH-ARMM and
its institutions on one hand and the local governments on the other (refer to Figure 1).
The LHB serves as a venue to get LGUs involved in discussing and addressing local health
needs of the community.
Assessment of Functionality
The study assessed the functionality of LHBs in the Zuellig Family Foundation Cohorts
1 and 2 partner-municipalities at the onset of the partnership. The research is part of the
situational analysis for an intervention to create a supportive policy environment in the local
health system where the LHB shall serve as the critical mass that will advocate and support
health reforms initiated by health leaders.
Performance Indicators
Composition is in accordance with Sec. 102 of RA No. 7160, or the Local
Government Code of ARMM, in the case of ARMM LGUs
the LHB has submitted an annual health plan and budget to the Sanggunian
the LHB has served as the advisory committee to the Sanggunian on health matters
the LHB has created committees that would advise local health offices or units on
personnel selection, promotion and discipline, grievance and complaints, bids and
awards, budget review and other related matters
the LHB holds meetings at least once a month
The analysis showed that 11 out of the 22 local health boards can be considered functional.
These include two from Cohort 1 and nine from Cohort 2. Functionality is measured based on
the averaged rating of the municipality on the performance indicators mentioned above. Of
the five criteria, most of the functional LHBs were able to get high ratings on composition and
regular meetings. Only three, however, were able to submit annual health plans and budgets
to their Sanggunian. Eight LHBs were able to serve as advisory committees to the Sanggunian
on health matters, while eight others were able to create functional committees. The findings
indicate that despite their functionality, areas for improvement remain, particularly in terms
of performing their functions.
LHBs in eleven of the municipalities were rated as non-functional. Ten had formal
documents stating their composition based on the LGC, yet were rated low based on
compliance to its mandate and functions. Their LHBs existed merely on paper.
The results reveal that generally, the average percentage of health budget of LGUs with
functional LHBs are higher than those with non-functional LHBs. The average percentage of
budget allocated for health of LGUs with functional LHBs was 10.27% of the total budget
compared to 8.73% in LGUs with non-functional LHBs. Municipal health officers said that
LHB meetings and budget deliberations in the LHBs enable the mayors and SB on health
chairmen to recognize the importance and implications of addressing health concerns. It also
builds their awareness on the need for health programs that will be implemented in the
municipalities; thus, they provide relatively higher financial support for health. Moreover, LHB
meetings discussing budget allocations for health enable MHOs to lobby for the support of
other LHB members.
Average healthcare provider index calculates the adequacy of selected rural health workers (doctors, nurses,
midwives and BHWs) computed based on the provider to population/household ratio. Index closer to one
indicates more adequate number of selected rural health workers compared to index closer to zero.
Figure 2.
Figure 3.
Indicators
Adequacy of selected
rural health workers
Significance
Midwife to population
BHW to household
Average provider
to population/
household index
0.7396
0.8582
0.7203
0.5279
0.6069
0.5650
0.015
0.043
0.013
The study also indicated a positive correlation between the frequency of regular meetings
of the LHB and the average amount of BHW monthly honorarium. Statistical analysis revealed
that on the average, the BHW monthly honorarium is relatively higher in municipalities with
more frequent LHB meetings 9 (See Figure 4). This particular test excludes four municipalities
from ARMM since incentives and compensation of health personnel come from the
DOH-ARMM. Municipal health officers acknowledge the value of regular meetings as a venue
to raise and address contentious issues that would have been neglected. Commonly neglected
issues include rural health worker benefits and incentives. In this case, frequent meetings
enable the BHWs to voice out their needs and sentiments to the local chief executives and
other authorities.
Figure 4. 10
10
LHBs are rated 1, 3, 5 according to frequency of regular meeting. (1-less than quarterly; 3-Semi-monthly/
Quarterly; 5- Monthly)
10
Former Sta. Fe Mayor Florante Gerdan (left) discussing health plans with his MHO Dr. Ernesto Robancho, Jr.
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SOURces:
Bautista, A. B. (1993). Rules and regulations implementing the Local Government
Code of 1991 with related laws and concept of decentralization. Mandaluyong City:
National Bookstore.
Campos, J. E. and J. S. Hellman (2005). Governance gone local: Does decentralization
improve accountability?, in R.White and P. Smoke (eds.) East Asia Decentralizes: Making
Local Government Work. Washington, DC: The World Bank. pp. 237-252.
Department of Health; Autonomous Region of Muslim Mindanao and Department of HealthARMM (2008). ARMM-Wide Investment Plan for Health (AIPH).
Ramiro, Laurie S., Fatima A. Castillo, Tessa Tan-Torres, Cristina E. Torres, Josefina G. Tayag,
Rolando G. Talampas, and Laura Hawken (2001). Community participation in local health
boards in a decentralized setting: cases from the Philippines. Oxford University Press.
Ronquillo, Kenneth, Fely Marilyn Elegado-Lorenzo, Rodel Nodora. (2005) Human Resources
for Health Migration in the Philippines: A Case Study and Policy Directions. Paper for ASEAN
Learning Networks for Human Resources for Health (August 2-5, 2005) Bangkok, Thailand.
Department of Interior and Local Government. Local Government Code 1991. 1992.
Local Government Code of the Autonomous Region in Muslim Mindanao: Muslim Mindanao
Autonomy Act No. 25. An Act Providing for a Local Government Code of the Autonomous
Region in Muslim Mindanao. Autonomous Region in Muslim Mindanao, Regional Legislative
Assembly 1995].
Local Governance Performance Management System(2005). Department of Interior and
Local Government. Bureau of Local Government Supervision, Department of the Interior and
Local Government. Quezon City.
Ana Katrina A. Go
Author
Juan A. Villamor
Director
Zuellig Family Foundation Institute
Editor
Ernesto D. Garilao
President
Zuellig Family Foundation
Executive Editor-in-chief
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